Studi Interaksi Obat Antihiperlipidemia Pada Pasien Rawat Jalan RSUD Dr. M.M. Dunda Limboto

Hyperlipidemia is an abnormal lipid condition of metabolism which is characterized by increasing the level of blood lipid. Hyperlipidemia is often followed by other diseases. Therefore, the treatment of hyperlipidemia is often combined with other drugs and potentially increases the occurrence of drugsinteractions. This study aimed to identify the severity of antihyperlipidemic drugsinteractions to the outpatients at Dr. M.M Dunda Limboto Regional PublicHospital on January to March 2018.This research was included in the observation (survey) research, the type of research was the analytic survey and the data was obtained retrospectively. The type of data analysis was univariate analysis and the data was managed theoretically using the guidelines of Stockley Drug Interactionand drugs.com application review. Of the 170 prescription sheets that met the inclusion criteria, 67.65 % were potentially triggered the drugs interactions and 32.35 % had no drugs interactions. One of Antihyperlipidemic drug was often prescribed and mostly generated the interactions was simvastatin (64.12 %). Of the 170 prescriptions, 209 cases of severity of drugs interactions were found, with minor severity of 27.27 %, moderate severity of 47.85 % and major severity of 24.88 %. Hiperlipidemia merupakan suatu keadaan ketidaknormalan metabolisme lipid yang ditandai dengan adanya peningkatan kadar lipid dalam darah. Hiperlipidemiasering diikuti dengan penyakit lain. Sehingga pengobatan hiperlipidemia seringdikombinasikan bersama obat lain dan berpotensi meningkatkan terjadinyainteraksi obat. Penelitian ini bertujuan untuk mengidentifikasi tingkat keparahaninteraksi obat antihiperlipidemia pada pasien rawat jalan RSUD Dr. M.M DundaLimboto periode Januari sampai Maret 2018. Penelitian ini termasuk penelitian observasi (survei), jenis penelitian survei analitik dan data diambil secara retrospektif. Jenis analisis data adalah analisis univariat dan data dikelola secara teoritik menggunakan Stockley Drug Interaction dan review aplikasi drugs.com. Dari 170 lembar resep yang memenuhi kriteria inklusi, diperoleh 67,65 % berpotensi mengalami interaksi obat dan 32,35 % tidak mengalami interaksi obat. Antihiperlipidemia yang sering diresepkan dan paling besar menimbulkan interaksi obat adalah simvastatin (64,12 %). Dari 170 lembar resep, ditemukan 209 kasus tingkat keparahan interaksi obat, dengan tingkat keparahan minor sebesar 27,27 %, tingkat keparahan moderat sebesar 47,85% dan tingkat keparahan mayor sebesar 24,88 %.

Acute Aortic Thrombus with Splenic Infarction in a Patient with COVID-19 Infection

Acute Aortic thrombus with splenic infarction is a rare complication of COVID-19. This manuscript highlights the importance of early identification of this complication with abdominal imaging and early initiation of anticoagulation despite moderate severity of the disease.

Microbiota and intestinal permeability as drivers of gastroenterological manifestations of new coronavirus infection (COVID-19)

An important area of effective control of the COVID-19 pandemic is the study of the pathogenetic features of SARSCoV-2 infection, including those based on the assessment of the state of the microbiota and intestinal permeability.Purpose: To study the clinical features of the new coronavirus infection (COVID-19) in patients of mild and moderate severity at the stage of hospitalization, to determine the role of intestinal permeability disorders, changes in the qualitative and quantitative composition of the microbiota in the formation of systemic inflammation in COVID-19 patients.Material and methods: The study was performed in 80 patients with COVID-19, whose average age was 45 years, 19 of them had mild and 61 had moderate severity of the disease. The scope of the examination included traditional clinical, clinical and laboratory, biochemical, instrumental and radiation studies, as well as original methods for studying microbiota and intestinal permeability.Results and conclusions: Clinical features of the course of COVID-19 were studied, clinical and biochemical features, manifestations of systemic inflammation, changes in the intestinal microbiome of patients with mild and moderate severity were identified, concentration levels of proinflammatory cytokines, insulin, fecal calprotectin and zonulin were determined, reflecting the features of intestinal permeability against the background of COVID-19. The role of intestinal permeability and microbiota as the main drivers of the development of gastroenterological manifestations of COVID-19, accompanied by a more severe course of the disease, is emphasized.

Complex non-drug correction of menopausal disorders in patients with metabolic syndrome

The monograph is devoted to the complex non-drug correction of menopausal disorders in patients with metabolic syndrome in the period of menopausal transition. Modern ideas about menopausal and metabolic syndromes are presented, a review of modern approaches to their treatment is carried out. A complex personalized system of non-drug correction of functional disorders in patients with metabolic syndrome and menopausal syndrome of mild and moderate severity in the period of menopausal transition is presented, including preformed therapeutic factors (vibrotherapy, chromotherapy, aeroionotherapy, musicotherapy (melotherapy), aromatherapy), physical therapy with pelvic floor muscle training, drinking balneotherapy, vitamins and minerals against the background of lifestyle modification. The algorithm of dynamic clinical and laboratory examination of women with menopausal disorders of mild and moderate severity and metabolic syndrome in the period of menopausal transition has been developed, including a general clinical examination, assessment of alimentary, thyroid, psycho-emotional, gynecological, urological statuses, the state of the intestinal microbiota, the function of the hypothalamic-pituitary complex, biochemical blood profile, hemostasis, levels of markers of inflammation, assessment of the state of the musculoskeletal system, sexual function, allowing to get an idea of the state of mental and physical health of patients, evaluate the effectiveness of the complex of measures, optimize therapeutic tactics. It is addressed to a wide range of readers interested in women's health. It can be useful for students, postgraduates, teachers of medical universities, obstetricians, gynecologists, endocrinologists, cardiologists, specialists of restorative medicine.

Psychophysiological Adaptation of a Patient with Acute Radiated Sickness of Average Degree and Acute Leukemia

Purpose: Clinical and psychophysiological assessment of the adaptation of a patient who suffered from acute radiation sickness of moderate severity after the Chernobyl accident and acute leukemia, which began 30 years after the transferred ARS. Material and methods: A clinical and psychophysiological examination of a patient who suffered from acute radiation sickness of moderate severity after the Chernobyl accident and acute leukemia that occurred 30 years after the Chernobyl accident was carried out. The object of the study was the patient D.R.I., born in 1950, deputy. Head of the Chernobyl NPP workshop, participant in the liquidation of the consequences of the 1986 Chernobyl accident. On April 26, 1986, during an emergency, he underwent relatively uniform beta-gamma radiation with the development of ARS II (moderate) severity. Within 3.5 hours after the accident was in the premises of the Chernobyl nuclear power plant. In the structure of ARS, bone marrow syndrome of the second degree and oropharyngeal syndrome of the first degree of severity were observed. The radiation dose, according to a cytogenetic study, was 3.4 Gy. A psychophysiological study was carried out using the MMPI methodology, the Cattell’s 16 Personality Factors Test, the Expert automated software and methodological complex, designed to study the personality characteristics of a person, the cognitive and intellectual characteristics of a person, the Raven’s Progressive Matrices, simple and complex sensorimotor reactions and reactions to a moving object, 15 (2001) and 30 years (2016) after the Chernobyl radiation accident. Results: The clinical and psychophysiological assessment of the personality and the actual mental state made it possible to determine the demonstrative-hypochondriacal type of disturbance in the psychophysiological adaptation with the tendency for the anxiety-depressive behavior of the patient to progress to a state of increasing depression, more pronounced in dynamics. Conclusion: The psychophysiological assessment of the personality and current mental state of the patient who had ARS, moderate and, 30 years after the Chernobyl accident, acute leukemia showed a demonstrative-hypochondria type of adaptation disorder, as a variant of a disharmonious combination of hypochondria, anxiety-depressive and demonstrative tendencies with a predominance of demonstrativeness (the first, second and third scale of the MMPI methodology) with a significant decrease on the ninth scale in the form of an increase in depression in dynamics. The prevalence of demonstrativeness over growing depression in a person with high intellect, good figurative and logical thinking, and a lack of sensorimotor inhibition is a manifestation of optimism and resistance to a serious illness.

USE OF "INTRAFEN" IN MILD TO MODERATE COVID-19

Повышение температуры тела человека-это своеобразная реакция на воздействие какого-либо агента и/или возбудителя, попавшего в организм человека. При каких-либо инфекционных заболеваниях в организме человека повышается температура тела человека. Также в настоящее время повышение температуры тела при распространенной коронавирусной инфекции является одним из симптомов заболевания. Цель: в нашей статье мы хотели бы рассмотреть клиническую ситуацию с больными COVID-19 и отметить, что был проведен ряд наблюдений и анализов для оценки эффективности и безопасности применения препарата «Интрафен» с целью снятия повышенной температуры, что дает положительный эффект лекарственного средства. Материалы и методы: рекомендовать пациентам с симптомами заболевания короновирусной инфекцией легкой и средней тяжести, С целью снижения повышенной температуры тела, противовоспалительного и улучшения общего состояния пациента, что мы достигнем положительного результата путем введения препарата интрафен в Вену. Результат: на основании анамнезных данных, полученных от больного, результатов клинических, лабораторных, инструментальных исследований выявлено эффективное действие препарата интрафен. Вывод: пациентам легкой и средней тяжести, перенесшим короновирусную инфекцию, можно увидеть, что введение препарата интрафен в Вену эффективно влияет на кратковременное снижение повышенной температуры тела, противовоспалительное действие, улучшение общего состояния больного. An increase in a person's body temperature is a self-contained response to the action of some agent and/or pathogen that has entered the body. With any infectious diseases in the human body, a person's body temperature increases. In addition, with the current coronavirus infection, an increase in body temperature is one of the symptoms of the disease. Purpose: in our article, we would like to consider the clinical situation of patients with COVID-19 and draw attention to the fact that a number of observations and analyses were carried out to assess the effectiveness and safety of using the drug "Intrafen" in order to relieve elevated fever. Materials and methods: in order to reduce elevated body temperature, anti-inflammatory and improve the general condition of the patient, to suggest that we will achieve a positive result by injecting the drug intrafen into the vein in patients with mild to moderate severity with symptoms of coronavirus infection disease. Result: based on Anamnesis data obtained from the patient, the results of Clinical, Laboratory, and instrumental studies, the effective effect of intrafen was determined. Conclusion: by injecting the drug intrafen into the vein in patients of mild and moderate severity who have had a Coronavirus infection, it can be seen that it has an effective effect on the short-term reduction of elevated body temperature, anti-inflammatory effect, improvement of the general condition of the patient.

CLINICAL CASE: STEROID-RESISTANT NEPHROTIC SYNDROME

Описан клинический случай пациент с нефротическим синдромом, стероид резистентный вариант, с артериальной гипертензией, осложненный полисерозитом (гидроторакс, асцит, плеврит). Пациент поступил в клинику в состоянии средней степени тяжести, с массивными отеками, полисерозитом, артериальной гипертензией и выраженным нефротическим синдромом. Диагноз: Гломерулярная болезнь. Нефротический синдром, стероид резистентный вариант. Функция почек снижена (СКФ- 84мл/мин по Шварцу). Двухсторонний экссудативный плеврит. Гидроторакс. Полисерозит (в рамках нефротического синдрома) был установлен на основании выраженного нефротического синдрома. Пациенту была проведена патогенетическая терапия. Отмечено улучшение состояния больного, в виде снижения отеков, нормализаций артериального давления, что в свою очередь поспособствовало сохранению и улучшению качества жизни пациента. A clinical case of a patient with nephrotic syndrome, steroidresistant variant, with arterial hypertension complicated by polyserositis (hydrothorax, ascites, pleurisy) is described. The patient was admitted to the clinic in a state of moderate severity, with massive edema, polyserositis, arterial hypertension, and severe nephrotic syndrome. Diagnosis: Glomerular disease. Nephrotic syndrome, steroidresistant variant. The kidney function is reduced (GFR - 84 ml/min according to Schwartz). Bilateral exudative pleurisy. Hydrothorax. Polyserositis (within the framework of nephrotic syndrome) was established based on the severe nephrotic syndrome. The patient underwent pathogenetic therapy. An improvement in the patient's condition was noted, in the form of a decrease in edema, normalization of blood pressure, which in turn contributed to the preservation and improvement of the patient's quality of life.

Oral antiviral clevudine compared with placebo in Korean COVID-19 patients with moderate severity

Background: Clevudine, an antiviral drug for chronic hepatitis B virus infection, is expected to inhibit the replication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Therefore, we conducted a prospective, single-blind, proof of concept clinical study to examine the antiviral efficacy and safety of clevudine compared to placebo in Korean corona virus disease 19 (COVID-19) patients with moderate severity. Methods: Adults with confirmed SARS-CoV-2 infection and symptom onset within 7 days were randomized 2:1 to 120 mg clevudine or placebo to receive one of treatments orally once-daily for 14 days. Antiviral efficacy outcomes were the proportion of patients with real-time reverse transcription polymerase chain reaction (RT-PCR) negative result for SARS-CoV-2 infection and cycle threshold (Ct) value changes from baseline. Clinical efficacy outcomes included proportion of patients who showed improvement in lung involvement by imaging tests, proportion of patients with normal body temperature, proportion of patients with normal oxygen saturation, and the changes in C-reactive protein (CRP) from baseline. Safety outcomes included changes in clinical laboratory tests, vital signs measurement, and physical examination from baseline, and incidence of adverse events. Results: The proportion of patients with real-time RT-PCR negative test and Ct value changes showed no significant difference between clevudine group and placebo group. The changes in Ct value from baseline were significantly greater in clevudine group compared to placebo group in patients with hypertension, and patients who underwent randomization during the first 5 and 7 days after the onset of symptoms. All clinical efficacy outcomes had no significant difference between clevudine group and placebo group. Clevudine was well tolerated and there was no significant difference in safety profile between two treatment groups. Conclusions: This is the first clinical study to compare the antiviral efficacy and safety of clevudine to placebo in Korean COVID-19 patients with moderate severity. The study has demonstrated a possible favorable outcome for the reduction of SARS-CoV-2 replication, with acceptable safety profile, when COVID-19 patients were treated with clevudine. Further large-scale clinical studies, preferably with various clinical endpoints and virus titer evaluation, are required to better understand the effectiveness of using clevudine in COVID-19 treatment. Considering recent trend in clinical development for antiviral drugs, we need to design a clinical study aiming for reducing clinical risk of COVID-19 in mild to moderate patients with at least one risk factor for serious illness.

Cardiomyopathy Associated with Anti-SARS-CoV-2 Vaccination: What Do We Know?

The SARS-CoV-2 pandemic has mobilized many efforts worldwide to curb its impact on morbidity and mortality. Vaccination of the general population has resulted in the administration of more than 6,700,000,000 doses by the end of October 2021, which is the most effective method to prevent hospitalization and death. Among the adverse effects described, myocarditis and pericarditis are low-frequency events (less than 10 per 100,000 people), mainly observed with messenger RNA vaccines. The mechanisms responsible for these effects have not been specified, considering an exacerbated and uncontrolled immune response and an autoimmune response against specific cardiomyocyte proteins. This greater immunogenicity and reactogenicity is clinically manifested in a differential manner in pediatric patients, adults, and the elderly, determining specific characteristics of its presentation for each age group. It generally develops as a condition of mild to moderate severity, whose symptoms and imaging findings are self-limited, resolving favorably in days to weeks and, exceptionally, reporting deaths associated with this complication. The short- and medium-term prognosis is favorable, highlighting the lack of data on long-term evolution, which should be determined in longer follow-ups.