Effects of xylazine and adrenaline combinations: Preliminary clinical application for non-surgical protocols of nephrosplenic entrapment in horses

Background and Aim: The medical treatment of horses with nephrosplenic entrapment (NSE) of the large colon through administrating phenylephrine and rolling during general anesthesia was effective and less expensive than surgical treatment. However, the selection of drugs for non-surgical treatment of NSE is not a usual method for clinical practice. This study aimed to identify the effects of combined drugs on the cardiac and splenic response in horses and provide information on the NSE of the large colon for clinical application. Materials and Methods: Six healthy Thai native crossbred horses were enrolled in this study. Horses received two protocols with a withdrawal period of 14 days: Group 1 received xylazine (0.5 mg/kg IV) and adrenaline (1 mcg/kg IV), and Group 2 received xylazine (0.5 mg/kg IV) and adrenaline (3 mcg/kg IV). Heart rate (HR), HR variability (HRV), heart dimensions, and the splenic response of six horses were measured before the sedation, 30 and 60 min later, and 65, 70, 75, 80, 90, and 100 min after adrenaline administration. Doppler was used to obtain systolic blood pressure. Results: The HRV low-frequency and high-frequency power ratios decreased after using xylazine. Hypertension was observed after adrenaline administration. In this study, there were only minimal differences in the HR and respiratory rate between groups. However, overall cardiac and splenic parameters were statistically higher in Group 2. Conclusion: This study suggested that xylazine and three micrograms of adrenaline preserved the cardiac autonomic activity balance and were safe to use non-surgical applicability in horses.

Cardiotoxicity with antihypertensive drugs (literature review). Part II. Angiotensin converting enzyme inhibitors and multi-drug intoxication

Overdose with angiotensin converting enzyme (ACE) inhibitors, especially in combination with other cardiovascular drugs, is limited by a small number of publications. A serious problem is an overdose with combined drugs with a fixed dose and poisoning with several drugs at the same time. ACE inhibitors poisoning has serious complications and can lead to a fatal outcome. Acute ACE inhibitors poisoning comes out in disorders of hemocirculation, where one of the predisposing mechanisms of decompensation of blood circulation is the failure of cardiomyocytes, the pathogenesis of which is not fully studied. Therefore, the currently used the methods of cardio- and hemodynamic disorders correction which are currently used do not always give a positive effect. The review highlights the difficulties of clinical and functional diagnosis and treatment of overdose with ACE inhibitors, combined drugs with a fixed dose, as well as poisoning with several drugs.

Captopril Combined with Furosemide or Hydrochlorothiazide Affects Macrophage Functions in Mouse Contact Hypersensitivity Response

Hypertension is a chronic disease associated with chronic inflammation involving activated macrophages. Antihypertensive drugs (for example, angiotensin-converting enzyme inhibitors—ACEIs) used in the treatment of hypertension have immunomodulatory properties. On the other hand, the immunological effect of diuretics and combined drugs (diuretics + ACEI) is unclear. Therefore, we examined the influence of diuretics and combination drugs (ACEI + diuretic) on cellular response (contact hypersensitivity), production of reactive oxygen intermediates (ROIs), and nitric oxide (NO), and the secretion of interleukin-12 (IL-12). CBA mice were administered i.p. captopril (5 mg/kg) with or without hydrochlorothiazide (10 mg/kg) or furosemide (5 mg/kg) for 8 days. On the third day, the mice were administered i.p. mineral oil, and macrophages were collected 5 days later. In the presented results, we show that diuretics administered alone or with captopril increase the generation of ROIs and reduce the formation of NO by macrophages. Moreover, tested drugs inhibit the secretion of IL-12. Diuretics and combined drugs reduce the activity of contact hypersensitivity (both activation and induction phases). Our research shows that the tested drugs modulate the cellular response by influencing the function of macrophages, which is important in assessing the safety of antihypertensive therapy.

Osteoarthritis as an interdisciplinary problem: treatment algorithm for physicians and general practitioners

Modern therapy of osteoarthritis (OA) consists of four sequential stages and includes non-pharmacological, pharmacological and surgical methods of treatment, and also assumes the possibility of collaborative management of the patient by doctors of different specialties, which allows to optimize the processes of diagnosis and treatment. The article presents simple and convenient algorithms, including diagnostic criteria, options for providing medical care, as well as situations (so-called red flags) that require referral of a patient to a specialist, primarily a rheumatologist. It has been demonstrated that the early use of the well-proven SYSADOA in any localization of OA, in particular the combined drugs of chondroitin sulfate and glucosamine, can increase the effectiveness of treatment, reduce possible functional disorders, and minimize the adverse effects of analgesic therapy.

Assessment of serum amylase, lipase and associated factors among patients with visceral leishmaniasis treated with sodium stibogluconate/paromomycin at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

Background Visceral leishmaniasis (VL) is a life-threatening parasitic disease next to malaria, which is responsible for the death of 50,000 patients annually. It has three major clinical stages, including visceral, cutaneous, and mucocutaneous leishmaniasis. Ethiopia is one of the east African countries commonly affected with leishmanisis disease. There are many drugs for leishmaniasis, including sodium stibogluconate and paromomycin combined therapy. However, the adverse effect of those combined drugs is not well-defined. Therefore, the purpose of this study was to assess serum amylase, lipase, and associated factors among patients with VL treatment with those combined drugs. Methods Hospital-based cross-sectional study was conducted at the University of Gondar Comprehensive Specialized Hospital Leishmaniasis Research and Treatment Center from February to September 2020 G.C. Simple random sampling technique was utilized to select study participants. The study participants who fulfill the inclusion criteria were included in the study with written informed consent. 5 ml of blood was withdrawn by an experienced health professional to analyze serum amylase and lipase level. Descriptive data was presented by tables, charts and graphs. Data was cleared, entered by Epi-data version 3.1 then transfer to STATA 14.1 SE version and for analysis paired t-test was used, for factors correlation and regression was used. Those factor variable who have p-value <0.25 was filtered and goes to multivariate regression and p-value <0.05 was considered as significant variables. Results The result of this study showed that there was a significant mean difference between serum pancreatic amylase and lipase before and after treatment. The mean ± SD level of serum amylase after treatment showed a statistically significant elevation (P<0.001) as compared to its level before treatment. Similarly, the mean ± SD level of serum lipase after treatment showed a statistically significant elevation (P<0.001) as compared to its level before treatment. There was also significant association between age and baseline serum amylase as compared to serum amylase after treatment. Similarly, there was also significant relation of age and serum lipase with serum lipase after treatment. Conclusion In this study, the level of serum amylase and lipase at treatment of cure was higher and there was an increase in mean serum amylase and lipase after a patient taking sodium stibogluconate and paromomycin combined drugs. Consequently, the elevated result of these biochemical profiles mainly associated with drug induced adverse effect and associated risk factors in VL patients.

Influence of the isoelectric point of gelatin on its adsorption on nanosilica surface

The joint efforts of chemists, physicians and technologists conducting researches to create new medical sorbents and combined drugs based on nanosilica, which have not only a detoxifying effect, but also antibacterial, wound healing, hemostatic and other important properties. One of the stages of such a research is developing regulatory documentation. To control the quality of the sorbent, the method of point measurements is most often used, according to it, the amount of adsorption of the marker substance at the single point of the adsorption curve is determined. The suitability of sorbents based on nanosilicа for using is determined by the value of the adsorption capacity concerning to medical gelatin. No other requirements for the process of test adsorption of gelatin by the sorbent are given. although it is known that the adsorption of proteins depends on the pH of the solution. Its maximum value is reached at a pH value corresponding to the isoelectric point (pI) of the protein. Each protein can be characterized by its own isoelectric point. Domestic and foreign standards give only the value of “pH of aqueous solutions” of gelatin and do not contain the indicator “isoelectric point”. The aim of the work is to study the influence of the isoelectric point of gelatin on its adsorption on nanosilica surface at different pH to appreciate the suitability of conditions for determining the adsorption activity of medical sorbents based on nanosilica. The adsorption of three samples of gelatin was examined in the work: A – edible gelatin (pI = 4.3–4.8); B – that from the catalog “Merck” (pI = 4.3–4.8) and C – that from the catalog “Fluka” (pI = 7.5–7.7) on nanosilica surface in the pH range from 3 to 8. It has been shown that for samples A and B the dependence has a maximum at pH ~ 4.5–5; and for sample C, the adsorption increases monotonically with increasing pH. It was noted that at pH ~ 5 the adsorption values for all gelatin samples were approximately equal. The adsorption activity of nanosilica concerning to proteins determined from the isotherms and the method of point measurements is compared. It has been found that the adsorption value of gelatin A onto the nanosilica at Cinitial = 700 mg/100 ml is equal to the Aave value determined by the Langmuir isotherms. This fact verifies the applicability of the method of point measurements for nanosilica/gelatin system to characterize the pharmacological activity of nanosilica based sorbents.

EVALUATION OF THE EFFECTIVENESS OF COMBINING ANALGESICS AND ANTISPASMODICS IN THE MANAGEMENT OF ABDOMINAL PAIN IN URGENT SURGERY

Acute abdominal pain, a set of symptoms developing in patients having pathology of the gastrointestinal tract, abdominal cavity and retroperitoneal space, is known as one of the leading causes for surgical hospitalization both in Ukraine and abroad. The aim of this study was to evaluate the effects of a combination drug "Neospastil", which belongs to the group of antispasmodics in combination with analgesics, on the severity of symptoms of abdominal spastic pain in order to improve the treatment of patients. This clinical study included 90 patients with a clinical picture of abdominal pain syndrome, who were hospitalized to the surgical departments. The patients were divided into 3 groups, 30 patients in each. We used various options for antispasmodic and analgesic therapy and compared their effectiveness in terms of the time of the onset of the analgesic effect, the time period of relieving abdominal spasm, and the duration of the periods between repeated spastic pain attacks. The results of our study demonstrated the use of the combined drug "Neospastil" in the management of acute abdominal pain syndrome even in the first day enabled to reduce the severity of the pain syndrome by 38% compared with the drotaverine therapy and by 19% compared with analogues of the combined drugs. The period of the occurrence of subsequent spastic pains was prolonged with the study drug by 2.2 ± 0.5 hours compared with drotaverine and by 1.1 ± 0.1 hours compared with spasmalgon. When using “Neospastil”, a decrease in the duration of an attack of abdominal spasm was noted by 29% compared with drotaverine and by 22% compared with spasmalgon. Summarizing the obtained data, we can recommend the use of “Neospastil” for the primary therapy of abdominal spastic pain in surgical patients that will lead to an improvement in the clinical treatment outcomes.

Pharmacoeconomical approaches for assessing the rational use of ophthalmic drugs in polyclinic settings

Purpose. To evaluate the results of the rational use of ophthalmic medicines with the use of pharmacoeconomical analysis. Material and methods. With the help of ABC-VEN analysis, a comparative study of the quality of pharmacotherapy and drug provision of patients who were monitored and treated by an ophthalmologist of the polyclinic in 2015 and 2019 was conducted. Results. As a result, it was found that the share of costs for vital drugs increased by 10.1% and amounted to 71.1% in 2019, which corresponds to the standardized criterion (70-80%). There was a reduction in the cost of purchasing secondary drugs by 7.6%, which indicates a rational drug supply of ophthalmic drugs. The most commonly used drugs for the treatment of glaucoma were 27.8% in 2015 and 35.1% in 2019. The share of their acquisition costs was 54.9% and 67.9%, respectively. There was a significant increase in the range and number of drugs for the treatment of patients with glaucoma: a 2.8-fold increase in the number of purchased eye drops for monotherapy and a 12% increase in the number of combined drugs. Conclusion. Pharmacoeconomical analysis showed an optimization of spending money on the purchase of drugs used in ophthalmology: an increase of 10.1% in the share of vital drugs and a decrease of 7.6% in the cost of purchasing secondary drugs. There was an increase in the range and quantity of drugs for the treatment of patients with glaucoma. Key words: ABC-VEN-analysis, drugs, ophthalmology, pharmacoeconomics.

Combined drugs in local therapy of infectious vulvovaginitis are a priority area of ​​today

One of the key and strategically important problems of modern gynecology both around the world and in Ukraine is infectious and inflammatory diseases (IVD) of the lower genital tract: according to various estimates, back in the 90s of the last century, this diagnosis was made in about 40 % of patients in gynecological hospitals. Over the first decade of the 21st century, the incidence rate of genital IVI increased 1.4 times in 18–24-year-old patients, and 1.8 times in 25–29-year-old patients. At the same time, the costs of diagnostics and treatment have increased, which reach 50-60% of all costs for the provision of gynecological care to the population.In the structure of gynecological morbidity, the indicator of the number of patients with infectious and inflammatory diseases of the genital area continues to occupy a leading position in terms of frequency in the population, amounting to 60.4-65.0%, however, information from different authors regarding their true prevalence is very contradictory. So, according to the materials of the 33rd European Congress of the International Union against for Sexually Transmitted Infections (IUSTI-Europe), bacterial vaginosis (BV) occurs in 12-80% of women, vulvovaginal candidiasis – VVC (at least one episode in life) - in 75%, aerobic vaginitis (AV) – in 15-25% [8]. According to other authors, the prevalence of BV is 24-30%, VVC – 9.7-11.7%, nonspecific (aerobic) vaginitis – 5.0-23.7%.Combined drugs Neo-Penotran® Forte and Gainomax have a high safety profile, which is due to the unique features of the pharmacokinetics and pharmacodynamics of their components. This determines the advantages in the speed of bactericidal action over other antibacterial and antimycotic agents. These drugs are highly effective in the local treatment of BV and vulvovaginal infections, reaching 98.5% in some nosologies.The effectiveness and safety of the use of Neo-Penotran® Forte and Gainomax in the treatment of infections of the female genital area served as the basis for their inclusion in standard treatment regimens according to indications, and their use is regulated by the normative documents of the Ministry of Health of Ukraine.