Pharmacological Medical Treatment of Epilepsy in Patients with Dementia: A Systematic Review

Background: Patients with dementia have an increased risk of developing epilepsy, es- pecially in patients with vascular dementia and Alzheimer’s disease. In selecting the optimal an- ti-epileptic drug (AED), the possible side effects such as drowsiness and worsening of cognitive function should be taken into consideration, together with co-morbidities and type of epilepsy. Objective: The current systematic review investigates the efficacy, tolerability, and changes in cog- nitive function after administration of AED in patients with dementia and epilepsy. Methods: We searched six databases, including MEDLINE and CENTRAL, checked reference lists, contacted experts, and searched Google Scholar to identify studies reporting randomized trials. Studies identified were independently screened, data extracted, and quality appraised by two researchers. A narrative synthesis was used to report findings. Results: We included one study with 95 patients with Alzheimer’s disease randomized to either lev- etiracetam, lamotrigine, or phenobarbital. No significant differences were found for efficacy, but patients receiving levetiracetam showed an improvement in mini-mental state examination scores and had fewer adverse events. Conclusion: High-quality evidence in the form of randomized controlled trials to guide clinicians in choosing an AED in patients with dementia and concomitant epilepsy remains scarce. However, levetiracetam has previously been shown to possibly improve cognition in patients with both mild cognitive impairment and Alzheimer’s disease, is better tolerated in the elderly population, and has no clinically relevant interaction with either cholinesterase inhibitors or NMDA receptor antagon- ists.

Acculturation and Sexual Attitudes: a Systematic Review

Introduction The culture plays an important role in sexuality. Although each ethnocultural group has its own sexual attitudes, in multicultural contexts, the acculturation process could modify the sexual attitudes of these groups. The aim of the study was to perform a systematic literature review of the studies that have examined the relationship between acculturation and sexual attitudes. Method The review was carried out in the ProQuest and Scopus databases. There was no time restriction in literature search. Results A total of 25 studies met the inclusion criteria. The year of publication of the studies ranged from 1982 to 2020. The studies were conducted in the USA and/or in Canada and included mainly Asians and Latinos/Hispanics. Proxy indicators, unidimensional, and bidimensional measures were used to measure acculturation. In general, results show that mainstream acculturation is positively related to liberal or positive sexual attitudes. Relevant interaction and mediation effects were also found: (1) mainstream dimension moderates the relationship between heritage dimension and sexual attitudes, (2) heritage dimension moderates the relationship between mainstream dimension and sexual attitudes, (3) acculturation moderates the relation between gender and sexual attitudes, (4) gender moderates the relation between acculturation and sexual attitudes, (5) the ethnocultural origin moderates the relationship between acculturation and sexual attitudes, and (6) sex guilt mediated the relationship between mainstream acculturation and sexual desire. Conclusion The acculturation process is related to sexual attitudes. Policy Implications Knowing the acculturation process could be important to achieve greater equity in sexual health among different groups.

Computational approach towards the design of artemisinin–thymoquinone hybrids against main protease of SARS-COV-2

Background The sanitary emergency installed in the world, generated by the pandemic of COVID-19, instigates the search for scientific strategies to mitigate the damage caused by the disease to different sectors of society. The disease caused by the coronavirus, SARS-CoV-2, reached 216 countries/territories, where about 199 million people were reported with the infection. Of these, more than 4 million died. In this sense, strategies involving the development of new antiviral molecules are extremely important. The main protease (Mpro) from SARS-CoV-2 is an important target, which has been widely studied for antiviral treatment. This work aims to perform a screening of pharmacodynamics and pharmacokinetics of synthetic hybrids from thymoquinone and artemisin (THY-ART) against COVID-19. Results Molecular docking studies indicated that hybrids of artemisinin and thymoquinone showed a relevant interaction with the active fraction of the enzyme Mpro, when compared to the reference drugs. Furthermore, hybrids show an improvement in the interaction of substances with the enzyme, mainly due to the higher frequency of interactions with the Thr199 residue. ADMET studies indicated that hybrids tend to permeate biological membranes, allowing good human intestinal absorption, with low partition to the central nervous system, potentiation for CYP-450 enzyme inhibitors, low risk of toxicity compared to commercially available drugs, considering mainly mutagenicity and cardiotoxicity, low capacity of hybrids to permeate the blood–brain barrier, high absorption and moderate permeability in Caco-2 cells. In addition, T1–T7 tend to have a better distribution of their available fractions to carry out diffusion and transport across cell membranes, as well as increase the energy of interaction with the SARS-CoV-2 target. Conclusions Hybrid products of artemisinin and thymoquinone have the potential to inhibit Mpro, with desirable pharmacokinetic and toxicity characteristics compared to commercially available drugs, being indicated for preclinical and subsequent clinical studies against SARS-CoV-2. Emphasizing the possibility of synergistic use with currently used drugs in order to increase half-life and generate a possible synergistic effect. This work represents an important step for the development of specific drugs against COVID-19.

Iatrogenic Cushing syndrome and multifocal osteonecrosis caused by the interaction between inhaled fluticasone and ritonavir

Inhaled corticosteroids are generally considered safe and do not usually lead to systemic adverse events since their plasma concentrations are low due to hepatic metabolism by the cytochrome P450 3A4. However, when associated with inhibitors of this cytochrome, such as ritonavir, they may lead to iatrogenic Cushing syndrome by the systemic accumulation of corticosteroids and consequent suppression of the hypothalamic-pituitary-adrenal axis. We present a case of iatrogenic Cushing syndrome complicated by multifocal osteonecrosis in a patient with HIV infection on antiretroviral therapy with protease inhibitors boosted with ritonavir, after the association of inhaled fluticasone. This clinical case highlights a relevant interaction between corticosteroids and inhibitors of the cytochrome P450 and the severe consequences that may occur.

COST MANAGEMENT

The National Meeting of Production Engineering (ENEGEP) is an event organized by the Brazilian Association of Production Engineering (ABEPRO) in which brings together the academic community of researchers working in the sector of Production Engineering and constitutes one of the leading promoters of technical and scientific production in the area. Among the various topics transiting the meeting, cost management is one of those who has relevant interaction. This article aims to analyze the academic contributions published in the Annals ENEGEP from 2008 to 2018 and trends in the area of ​​Economic Management, Cost Management subarea. Methodologically it made the use of bibliometric analysis techniques, analyzing, quantitatively and qualitatively, 219 articles, considering the following variables: quantitative evolution of publications; authoring features per article; authors; educational institutions; keywords; and themes. The main results identified an average of twenty papers per year with the cost management issue, the vast majority of publications were carried out with two or more authors, in relation to the authorship, 71% of authors had only one article, the southern region is the one most representative authors of publications, and as to the keywords which is evident most frequently are "Cost Management" and "costs".

Drivers and inhibitors of the compromise effect – a conceptual overview

Purpose This paper aims to review numerous known drivers and antecedents of compromise behavior, proposing a basic categorization of the various contributions. This is done with the goal to integrate drivers and antecedents, previously largely discussed in isolation of one another, into a single conceptual model. This sheds light on the issue of previously overstated or understated relevance of individual drivers. The picture is completed by the proposition of new potential drivers of the compromise effect like lay rationalism and approval motivation. Design/methodology/approach The paper takes a conceptual approach in reflecting on prior findings from the field of compromise effect research and adjacent fields to develop a number of propositions aggregated in a conceptual model. Findings A number of previously overlooked, but potentially highly relevant interaction effects among known drivers of the compromise effect are proposed along with the proposition of several new drivers. Originality/value This conceptual paper offers a novel, broadly applicable categorization of compromise effect research. Further, it seems to be the first paper dedicated to an extensive review of established drivers of the compromise effect to examine the interdependence and possible interaction effects and of those drivers. Additionally, completely new potentially relevant drivers are discussed in detail and integrated into a conceptual model.