RESUMO
Diabetic neuropathy is the third most common complication of diabetes mellitus. When this neuropathy is accompanied by pain, it requires a specific treatment. In the elderly patient, the pain has an enormous impact on quality of life, as it is associated with anxiety, depression and sleep disorders, leading to a direct impact on the functionality of the patient. Likewise, there are a number of changes at the central and peripheral nervous system, which contribute to the chronicity of painful processes, and eventually also affect and impact on the quality of life of elderly patients. It is fundamental before initiating treatment, to know of all aspects related to drug pharmacokinetics and pharmacodynamics, especially those related to aging, because this will allow you to select the best drug for each patient. This article aims to review the pathophysiological concepts related to diabetic neuropathy in the elderly and the best treatment options.
Assuntos
Analgésicos/uso terapêutico , Nefropatias Diabéticas/tratamento farmacológico , Fármacos do Sistema Nervoso Periférico/uso terapêutico , Psicotrópicos/uso terapêutico , Idoso , Envelhecimento/fisiologia , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Analgésicos/farmacocinética , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/psicologia , Interações Medicamentosas , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/uso terapêutico , Neuralgia/tratamento farmacológico , Neuralgia/etiologia , Neuralgia/psicologia , Neurotransmissores/administração & dosagem , Neurotransmissores/efeitos adversos , Neurotransmissores/farmacocinética , Neurotransmissores/uso terapêutico , Fármacos do Sistema Nervoso Periférico/administração & dosagem , Fármacos do Sistema Nervoso Periférico/efeitos adversos , Fármacos do Sistema Nervoso Periférico/farmacocinética , Polimedicação , Psicotrópicos/administração & dosagem , Psicotrópicos/efeitos adversos , Psicotrópicos/farmacocinética , Qualidade de VidaRESUMO
BACKGROUND: The pathophysiology of sensitive skin consists of an inflammatory reaction resulting from the abnormal penetration in the skin of potentially irritating substances, which occurs due to skin barrier dysfunction and changes in the production of local neuromediators. AIMS: The therapeutic potential of L-carnosine and Rhodiola rosea, as antioxidant and neuromodulatory, respectively, leads us to investigate the effects of the R. rosea extract/L-carnosine-associated compound (RCAC) on sensitive skin alterations. METHODS: A double-blind comparative study was conducted on 124 volunteers with sensitive skin, who were selected by their reactivity to stinging test. Two randomized groups of 62 each received either a formulation containing 1% of RCAC or placebo, which was applied twice a day for 28 consecutive days. One perceptibility questionnaire was applied at the onset and at the end of the treatment to evaluate the subjective response to test product. Additionally, in vitro studies were performed to investigate RCAC neuroimmunomodulatory mechanisms. RESULTS: RCAC treatment produced in vivo protective effects in skin barrier function and a positive subjective response of sensitive skin volunteers. In vitro treatment promoted the release of proopiomelanocortin peptides and restored to normal the increased levels of neuropeptides and cytokines produced by keratinocytes exposed to ultraviolet radiation. Clinical effectiveness was measured by reduction of transepidermal water loss, positive perceptions of improvements in skin dryness and skin comfort sensation, and reduction of discomfort sensation after stinging test. CONCLUSIONS: The protective effect of RCAC in skin barrier function and the positive response produced in human subjects with sensitive skin could be partially explained by our in vitro results showing a significant increase in opioid peptides release, an inhibitory effect on neuropeptides production, and modulation of cytokines production by keratinocytes under ultraviolet stress.
Assuntos
Antioxidantes/farmacologia , Carnosina/farmacologia , Queratinócitos/efeitos dos fármacos , Fármacos do Sistema Nervoso Periférico/farmacologia , Extratos Vegetais/farmacologia , Rhodiola , Pele/efeitos dos fármacos , Administração Cutânea , Análise de Variância , Peptídeo Relacionado com Gene de Calcitonina/metabolismo , Células Cultivadas , Citocinas/metabolismo , Método Duplo-Cego , Encefalinas/metabolismo , Humanos , Técnicas Imunoenzimáticas , Queratinócitos/metabolismo , Queratinócitos/efeitos da radiação , Pessoa de Meia-Idade , Pele/metabolismo , Substância P/metabolismo , Inquéritos e Questionários , Raios Ultravioleta , Perda Insensível de Água/efeitos dos fármacos , beta-Endorfina/metabolismoRESUMO
En este trabajo se evalúan diferentes técnicas para obten-ción y cultivo de células de Schwann provenientes del nervio periférico de rata adulta, de las cuales la que evi-dencia mejor respuesta es la que combina una degenera-ción walleriana durante 14 días in vitro, seguida de una disociación enzimática.La adición de mitógenos como la forskolina y extracto de pituitaria no muestra un efecto sobre estas células. Los niveles de enriquecimiento en células de Schwann, defi-nidos de acuerdo con patrones morfológicos y de expre-sión de marcadores tales como la proteína S-100 o la pro-teína acida fíbrilar glial (GFAP), son buenos (del orden de 80-88por cien) hasta los ocho días de cultivo. La detección de bromodeoxiouridina (BrdU) incorporada por células en fase S del ciclo celular, demuestra que en términos ge-nerales la tasa de incorporación de BrdU de las células guales del sistema nervioso periférico no cambia.