Patient with constipation syndrome at the ambulatory-polyclinic reception: actual aspects of differential diagnosis and treatment

Constipation is a serious medical and social problem due to the widespread prevalence of this condition, a decrease in the quality of life and social activity of patients. For the successful treatment of constipation, it is necessary to establish the causes leading to the violation of the stool in the patient. And this task is a priority for the doctor at the outpatient stage.The clinical features of constipation largely depend on their cause, duration, severity and characteristics of intestinal damage. Constipation is often accompanied by general somatic and other gastroenterological symptoms.Within the framework of the review article, the main conditions and diseases are considered, in the clinical picture of which there is constipation syndrome, which must be considered by the doctor at the outpatient stage when conducting differential diagnosis and prescribing appropriate treatment, which also presupposes impact on causal factors. Currently, drugs based on high molecular weight polyethylene glycol 4000 are widely used to treat chronic constipation in adults and children in most countries of the world. Preparations based on polyethylene glycol 4000 are affordable and easy to use, they can be used both on an outpatient basis and in a hospital. Polyethylene glycol 4000 preparations act quickly, are highly effective and well tolerated, have a high safety profile (practically does not affect homeostasis) both for adult patients and in pediatric practice. International clinical trials have shown the possibility of long-term use of polyethylene glycol 4000 preparations.Current international clinical guidelines and domestic clinical guidelines for the treatment of constipation recommend the use of polyethylene glycol 4000 preparations instead of lactulose and volume-forming laxatives in the symptomatic treatment of constipation in children and adults. In the second part of the review, the possibilities of polyethylene glycol 4000 and the first domestic drug polyethylene glycol 4000 in the treatment of chronic constipation are considered.

Artemisinin is highly soluble in polyethylene Glycol 4000 and such solution has multiple biological effects

Artemisinin has a significant role in treatment of malaria, as well as effective anti-inflammatory and anti-cancer activities. However, such problems as poor water solubility and easy recrystallization limit its application. In this study, polyethylene glycol, a solvent which is widely used in pharmaceutics, was introduced to prepare an artemisinin dissolution. Under the action of hydrogen bonding in 12% polyethylene glycol 4000 solvent, the maximum solubility of artemisinin could reach up to 1 mg/mL. Meanwhile, biological functions of such artemisinin solution were evaluated. The obtained artemisinin solution had a significant inhibitory effect on Gram-positive bacteria, Gram-negative bacteria and fungi. As for the anti-inflammatory property, 0.031 mg/mL artemisinin solution had an obvious inhibitory effect on nitric oxide release in inflammatory cells, and the survival rate of cells was greater than 50%. Low concentration of the obtained artemisinin solution (0.031 mg/mL) had no significant cytotoxicity, while it displayed selective inhibition in cancer cells. IC50 for human hepatoma cells BEL-7404, SMMC7721 and Hep G2 is 0.0016 mg/mL, 0.0084 mg/mL and 0.0541 mg/mL, respectively. In conclusion, the 12% PEG4000-assisted artemisinin solution has a good biological effect and it can be further applied in pharmaceutics, biomaterials and medicine.

Povidone iodine loaded film-forming topical gel and evaluation of its chemical stability

The main aim of this study was to develop Povidone Iodine loaded film-forming gel for excellent wound healing property with various formulations, and corresponding application stratification was prepared with Povidone Iodine, polyethylene glycol-400, polyethylene glycol-4000, aloe vera, and honey. Povidone Iodine is a broad spectrum antiseptic for topical application in the treatment and prevention of infection in wounds. Among the antiseptic and antimicrobial substances, Povidone-Iodine still occupies its position of lasting importance in everyday human and veterinary medicine. Povidone-iodine products display the broadest spectrum of antimicrobial effect with high clinical efficacy together with extremely low toxicity in clinical practice. The purpose served by dressing includes protecting wounds, promoting healing, and providing, retaining, or removing moisture. Wound repairing is a complex process involving an integrated response by many different cell types and growth factors to achieve rapid restoration of skin integrity and protective function after injury. In recent years, there have been tremendous advances in the design and composition of bandages and dressings, and there are numerous wound care materials. Some wound dressing types are biosynthetic dressings, composite dressings, gauze, hydrocolloid dressings, hydrogels, transparent films, etc. Povidone Iodine is completely soluble in cold and mild-warm water, ethyl alcohol, Iso propyl alcohol, Polyethylene glycol, and glycerol. The developed Povidone Iodine loaded film-forming gel was evaluated for their physical and chemical stability. The film-forming optimized gel formulation composed of povidone-iodine, polyethylene glycol-400, polyethylene glycol-4000, aloe vera, and honey and this composition provides suitable consistency, spreadability, and adhesiveness. The prepared trials were coded PGAH-01, PGAH-02, PGAH-03, PGAH-04, and PGAH-05, respectively. Among these all formulations, the PGAH-04 formulation parameters was found within the limit.

DIAGNOSTICS AND COMPLEX TREATMENT OF ADGHESIVE INTESTINAL OBSTRUCTION

Summary: Develop a comprehensive program for the diagnosis, treatment and prevention of intestinal adhesive obstruction. Analyzed the results of diagnosis and treatment of 60 patients with acute adhesive intestinal obstruction. The diagnostic program included clinical, laboratory, X-ray and ultrasound diagnostics. Local barrier prevention of peritoneal adhesive disease was performed with a solution of polyethylene glycol 4000 according to the method developed by us. Conservative therapy was effective in 19 (31.7%) cases. 41 (68.3%) patients with a progression of adhesive ileus were operated. Laparoscopic adheolysis was performed in 4 (9.8%) patients. In 37 (90.2%) cases, surgical treatment was performed in the traditional method. The proposed diagnostic and treatment program with priority use of ultrasound diagnostics allows in a short time to establish a detailed diagnosis of adhesive intestinal obstruction and to determine the indications for surgical treatment. Intraoperative use of hypotonic solution polyethylene glycol 4000 allows to reliably prevent the development of peritoneal adhesive disease and adhesive obstruction.

Thermal cycling stage in the optimization of the freezing processes in the technology of drug lyophilized

Introduction . In the lyophilization technology, the freezing stage plays a key role in determining the time of primary sublimation, secondary desorption, and often the appearance of the lyophilisate. The duration of lyophilization is related to the composition and freezing conditions through the parameter resistance to mass transfer, which depends on the size of ice crystals.Objective: to select temperature regimes of thermal cycling (“annealing”) to obtain the most vapor-permeable sublimation layer, calculate the value of resistance to mass transfer of water and select the most optimal lyophilization mode for preparing lyophilisate GK-2 for preparing solutions for injections.Materials and methods . Substance: GK-2 (hexamethyleneamide bis-(N-monosuccinyl-L-glutamyl-L-lysine)) (V.V. Zakusov Research Institute of Pharmacology, Russia); excipients intended for parenteral use: lyoprotector – sucrose (CompriSugar®) (CristalUnion, France), cryoprotector – polyethylene glycol 4000 (PEG, macrogol) (Polyglykol® 4000, Panreac, Spain). Edwards EF-6 Lyophilic Dryer (Italy); microscope Nikon Eclipse E200; digital camera Nikon DS-Ri2; confocal microscope LEXT OLS 4100. Various freezing, lyophilization, direct optical microscopy in a cold chamber, laser microscopy and mathematical formulas were used to determine the values of resistance to mass transfer of water vapor from model lyophilisates.Results . This article discusses the possibilities of optimizing the freezing stage and, accordingly, the entire lyophilization cycle by introducing an intermediate thermal cycling stage, provides calculations of the mass transfer coefficient of the composition under different freezing conditions and ice crystal sizes.Conclusion . A simplified equation for calculating the coefficient of resistance to mass transfer for model solutions of GK-2 based on the correlation dependence was determined. The selection of freezing and “annealing” modes was carried out on the basis of the most important indicators, such as productivity and time of lyophilization.