Modern Anticoagulant Therapy for Atrial Fibrillation: Patient Adherence in Clinical Practice

Aim. To assess the adherence of doctors and patients to anticoagulant therapy for atrial fibrillation (AF).Materials and methods. An observational prospective study included 99 patients with AF at high risk of thromboembolic complications in Ryazan and Omsk. To study adherence, a questionnaire for quantitative assessment of treatment adherence ("QAA-25") was used. The questionnaire allows you to assess adherence by three main parameters separately: adherence to drug therapy, lifestyle modification and medical support. For the purposes of the study, adherence rates of less than 75% were regarded as insufficient, 75%. % or more as sufficient. To assess food preferences and determine the risk of changes in the activity of warfarin, a questionnaire of food preferences was used. The questionnaire allows you to assess the risk of alimentary increase (≥30 points) and decrease (≥60 points) of warfarin activity, as well as the overall risk of alimentary change (≥90 points) of warfarin activity in each patient, taking into account the volume and frequency of consumption of products that affect the activity of warfarin.Results. After the first visit, 99% of respondents received anticoagulant treatment. Rivaroxaban was the leader in prescribability among anticoagulants (36.7%). About a third of respondents were prescribed apixaban by a doctor (30.6%) and dabigatran  (17.3%)  and  warfarin  (19.4%)  were prescribed almost twice as rarely as rivaroxaban. Respondents with the highest rates of adherence to drug therapy, lifestyle modification and medical support are AF patients taking apixaban. The respondents who were prescribed rivaroxaban had the lowest level of adherence to drug therapy and lifestyle modification. And the lowest level of commitment to medical support is among respondents who have been prescribed warfarin. The number of people with a sufficient level of commitment did not reach half. Only 43.9% were ready to take prescribed medications and slightly more than a third (34.7%) agreed to come to appointments for a long time. But, despite the importance of lifestyle modification in patients with AF, only 16.3% of respondents said they were ready to give up bad habits, lose weight and lead a more active lifestyle. The proportion of people with sufficient adherence to drug therapy was the smallest in the group taking rivaroxaban (25.7%). The least number of respondents with sufficient commitment to medical support in the group taking dabigatran (25%). Only one in ten patients (11.1%) taking warfarin had a sufficient level of commitment to lifestyle modification. 15% of the study participants had an increased risk of alimentary changes in the activity of warfarin.Conclusion. Assessment of adherence to anticoagulant therapy by doctors in two regional centers (Omsk and Ryazan) showed high prescribability of preventive antithrombotic therapy, which corresponds to modern therapeutic approaches. At the same time, patients demonstrated rather low levels of adherence to drug therapy, lifestyle modification, and medical support

Polymer Membranes in Medicine and Pharmaceutics

This review covers the main problems and basic principles of the use of various membranes in medicine and pharmacy. Developments in the field of sterilizing, bacteriostatic and bactericidal membranes and membranes for pyrogen-free water preparing are considered. An analysis of the scientific literature in this research area are identified. The main ways of development of this area, as well as an analysis of properties of membranes from different manufacturers for use in the medical and pharmaceutical industries are given. Their advantages and disadvantages are considered. It is shown that the main criterion for sterilizing membranes is the pore size, which should be no less than 0.1 microns. The most commonly used materials for sterilizing membranes are PTFE, polyamide and polysulfone. Review of methods for bacteriostatic and bactericidal membranes showed that there are different prospective modification methods of widely used membranes. Examples of some membranes modifications with inorganic and organic substances are considered. It is shown that the most effective modifying agents are chitosan and silver compounds. The mechanism of action of the ions and silver nanoparticles on bacterial cells is shown. A comparison of the effectiveness of distillation and membrane filtration processes for the preparation of water for injection is given. The ultra- and nanofiltration membranes used for pyrogen-free water preparing are described. New data about the properties of charged membranes are given. It is shown that the use of positively charged membranes for pyrogen-free water preparing is perspective, because it works by sieve and adsorption mechanism

Rapid analysis of urine using mass spectrometry with atmospheric pressure laser plasma ionization

Метод ионизации, индуцированной лазерной плазмой при атмосферном давлении (метод APLPI), исследован для решения проблемы быстрого определения физиологически активных веществ в моче. Задачи исследования включали: изучение методом APLPI образцов мочи, полученных от проходящих лечение пациентов; определение аналитических характеристик метода; сравнительные исследования методов APLPI и ВЭЖХ-МС/МС по отношениям сигнал/шум и оценка возможности скрининга образцов мочи без пробоподготовки методом APLPI. Приборная реализация метода основана на использовании масс-анализатора высокого разрешения “Orbitrap”, в котором штатный ионный источник заменен на разработанный нами источник APLPI, в сочетании с термодесорбционным вводом пробы. Исследовали образцы мочи, в которых предварительно методом ВЭЖХ-МС/МС обнаружены физиологически активные вещества, в частности, барбитураты, карбамазепин, тиаприд, сульпирид, псилоцин, амфетамин, трамадол, димедрол и другие. Установлено, что метод APLPI обеспечивает возможность детектирования всех этих аналитов. Длительность анализа одной пробы не превышает одну минуту. С использованием способа «разбавление в матрице» построили градуировочные зависимости для ряда соединений и определили аналитические характеристики метода. Градуировочные зависимости линейны в диапазоне трех порядков величины. Среднее значение относительного стандартного отклонения ионного сигнала в этом диапазоне составило 24 %. Пределы обнаружения, найденные на примере определения димедрола, лидокаина и фенобарбитала в экстрактах мочи составили 0.7 нг/мл, 0.5 нг/мл и 10 нг/мл, соответственно. Сравнительные исследования показали, что методы APLPI и ВЭЖХ-МС/МС характеризуются близкими значениями отношений сигнал/шум. Преимущества метода APLPI заключаются в экспрессности, ретроспективности анализа, в малом объеме проб. Ограничением метода является необходимость десорбции определяемых соединений в газовую фазу. Продемонстрирована возможность применения метода APLPI для скрининга физиологически активных веществ в моче без предварительной пробоподготовки.Atmospheric pressure laser plasma ionization (APLPI) technique was studied in application to the problem of rapid determination of physiologically active substances in urine. The objectives of this study included investigation by APLPI method of urine samples obtained from treated patients; determination of analytical characteristics of the method; comparative studies of APLPI and HPLC-MS/MS methods in terms of signal-to-noise ratio and evaluation of the possibility of screening urine samples without sample preparation by APLPI method. The instrumental implementation of the method is based on the use of a high-resolution mass analyzer “Orbitrap”, in which the standard ion source was replaced by the in-lab developed APLPI source, combined with thermal desorption sample introduction. Urine samples, in which physiologically active substances, in particular barbiturates, carbаmazepine, thiapride, sulpiride, psilocin, amphetamine, tramadol, diphenhydramine, and others were preliminarily detected by HPLC-MS/MS, were investigated. The APLPI method was found to be capable of detecting all these analytes. The duration of the analysis of one sample does not exceed one minute. Using the “dilution in matrix” method calibration curves for a number of compounds were constructed and the analytical characteristics of the method determined. The calibration curves are linear in the range of three orders of magnitude. The mean value of the relative standard deviation of the ion signal in this range was 24 %. The limits of detection found for the determination of diphenhydramine, lidocaine and phenobarbital in urine extracts were 0.7 ng/ml, 0.5 ng/ml and 10 ng/ml, respectively. Comparative studies showed that APLPI and HPLC-MS/MS methods were characterized by close values of signal-to-noise ratios. The advantages of the APLPI method are in the rapidity, retrospective analysis, and small sample volume. The limitation of the method is the necessity of desorption of the determined compounds into the gas phase. The possibility of using the APLPI method for screening physiologically active substances in urine without sample preparation has been demonstrated