MONITORING OF ANTICOAGULANT THERAPY IN PATIENTS WITH DEEP VEIN THROMBOSIS

Aim. To evaluate the prevalence of accomplished goal in laboratory clotting parameters for the anticoagulant therapy in deep vein thrombosis (DVT).Material and methods. The study is performed as one-stage, descriptive, analytic, pharmacoepidemiologic investigation. The material for the study were 200 case histories of DVT from Volgograd hospitals. The analyzed were: structure of anticoagulant prescription, coagulogrammes with APTT, prothrombin complex and INR.Results. Direct acting anticoagulants were prescribed in 91% cases. High-molecular heparin was used in 84,5% prescriptions, low-molecular heparins — in 6,5%. Monitoring of APTT was done only in 36% patients. The target values of APTT (1,5–2,5 times higher than upper limit) was reached only in 6% cases. Of the indirect anticoagulants warfarin was used in 75,5%. Although laboratory control of warfarin was done in 97% cases, only in 28% of patients INR at discharge was in the range 2,0–3,0.Conclusion. The data witnesses a variety of drawbacks in anticoagulant therapy of DVT patients. High dosages of HMW heparin and warfarin, not enough rigourous control and dosage titration led to the absence of the desired therapeutic diapasone of hypocoagulation.

Tamsulosin for the Treatment of Benign Prostatic Hypertrophy

OBJECTIVE: To review the information necessary to assess the efficacy and safety of tamsulosin compared with other adrenergic antagonists for treatment of symptomatic benign prostatic hyperplasia. DATA SOURCES: A search was conducted of Cumulated Index Medicus, January 1993–August 1999, which was restricted to human trials and English-language journals. STUDYSELECTION AND DATAEXTRACTION: Efficacy studies were included if the design was randomized and included a control group. Drug safety was assessed using data from any patient series or controlled study. DATA SYNTHESIS: Tamsulosin, a uroselective α1A-adrenergic receptor antagonist, relaxes smooth muscle in the prostate and bladder neck, thereby enhancing bladder emptying. In randomized, controlled clinical trials using standardized instruments, tamsulosin improves obstructive voiding symptoms by at least 25% in 65–80% of patients with symptomatic benign prostatic hyperplasia. Tamsulosin also improves peak urinary flow rate by 1.4–3.6 mL/sec in various studies and reduces post-void residual urine volume. The usual dosage of tamsulosin was 0.4 or 0.8 mg orally once a day in the studies performed in the US and Europe; daily doses of 0.1–0.4 mg were used in studies performed in Japan. The beneficial effects of tamsulosin on voiding symptoms, peak urinary flow rate, and bladder emptying appear to be dose-related, up to a ceiling dose of 0.4 mg. The most common adverse effects are headache, asthenia, dizziness, and rhinitis-like complaints. Retrograde or delayed ejaculation occurs in 4.5–14.0% of patients and has required discontinuation of treatment in a minority of these patients. At the usual dose of 0.4–0.8 mg/d, tamsulosin does not appear to significantly reduce blood pressure, increase heart rate, or cause first-dose syncope; therefore, dosage titration is not necessary when initiating treatment. Use of nifedipine, enalapril, atenolol, furosemide, or digoxin does not require dosage modification when tamsulosin is initiated concomitantly; hypotension has not been reported with combined use of tamsulosin and these commonly used agents. CONCLUSIONS: Tamsulosin is an improvement over other a-adrenergic antagonists for the management of symptoms of benign prostatic hyperplasia. It is a more convenient alternative that does not require initial dosage titration, has a fast onset of action, and has a low potential to cause hypotension when used alone or in combination with commonly used antihypertensive agents. It is more costly than some of the other second-generation α-adrenergic antagonists.

Dosage Titration of a Characterized Competitive Exclusion Culture To Inhibit Salmonella Colonization in Broiler Chickens during Growout†

Broiler chicks were spray treated on the day of hatch with titrated dosages (106, 107, or 108 anaerobic CFU) of a characterized competitive exclusion culture (CF3) and challenged orally on day 3 with 104 CFU of Salmonella typhimurium. On day 10, cecal contents from control and CF3-treated chicks were cultured for S. typhimurium to determine the minimal efficacious dosage of the CF3 culture. The experiment was repeated in three replicated trials. Resistance to Salmonella cecal colonization was dosage related and progressively enhanced at the 107- and 108-CFU dosages compared with the 106-CFU dosage. The 107-CFU dosage was selected as the minimal effective dosage and evaluated for efficacy during a 43-day broiler growout study. Six hundred broilers were spray treated on the day of hatch and compared with 600 Controls. One-half of the control and CF3-treated birds were challenged orally on day 3 with 104 CFU of S. typhimurium and designated “seeders.” The remaining unchallenged birds were designated “contacts.” Compared with the Controls, the recovery of Salmonella cells from the ceca of the CF3-treated broilers was significantly decreased (P < 0.01) in the challenged seeders on days 21 and 43 of growout. Salmonella contamination of floor pen litter was significantly reduced (P < 0.05) in pens of CF3-treated birds compared with Controls. The transmission of Salmonella cells from seeder to contact birds in the same pens was decreased significantly (P < 0.01). The results indicated that treatment of broiler chicks on the day of hatch with the 107-CFU dosage of CF3 culture effectively increased resistance to S. typhimurium challenge during growout to market age.

Pharmacokinetics of Computer-controlled Alfentanil Administration in Children Undergoing Cardiac Surgery

Background Cardiopulmonary bypass (CPB) induces changes in the pharmacokinetics of drugs. The purpose of this study was to model the pharmacokinetics of alfentanil in children undergoing cardiac surgery to provide accurate dosage titration intraoperatively as well as in the postoperative period.

Adjusting Insulins

The teaching of effective insulin adjustment is a formal process that benefits from being carried out in a standardized way. The unique methods outlined in this report have been taught to people with diabetes for over 8 years. Iterative in nature, the methods are safe and work to achieve specified blood glucose or HbA 1c targets. They are designed to accommodate each individual's habits, recognizing that acceptance depends on adapting the medication to the life-style rather than vice versa. New technology was used to mediate insulin adjustments at home. Insulin adjustment of itself, however, is but one of five interdependent factors involved in successful self-management. These include (1) choosing sites of insulin injection; (2) choosing species of origin of insulins to be used; (3) reviewing life-style habits, including diet and exercise; (4) implementing dosage titration; and (5) follow-up. Lack of formalized insulin adjustment methods may be a major reason why many diabetes control programs fail to demonstrate significantly better metabolic control in their patients.