Self-treatment and drugs included in the over the counter list

Department of Pharmacology and Clinical Pharmacology, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: Self-treatment doesn’t affect the cause of the disease, but only some clinical manifestations and symptoms which, in many pathological states, are often the same. As a rule, the drug is administered without taking into consideration its contraindications, interactions with other drugs and patient’s individual characteristics. Some of these drugs, have contraindications for administration, may cause adverse effects and, in case of uncontrolled usage, may lead to complications. Material and methods: 3 types of questionnaires have been elaborated for: a) doctors, b) pharmacists, c) population. 240 questionnaires have been completed, 80 for each of the groups mentioned above. Results: The analysis of the results revealed that the respondents have different attitude towards self-treatment. Positive attitude manifest 55% of respondents from population; the majority of doctors respondents (87%) and pharmacists respondents (75%) – have negative attitude towards selftreatment. Doctors mentioned in the questionnaire that self-treatment may be ineffective, inappropriate, may not comply with the disease, leads often to complications and drug’s overdosage and can delay the start of the proper treatment. The majority of doctors respondents (80%) have negative attitude towards the possibility of buying a drug without prescription; 40% of doctors respondents consider that pharmacists sell without prescription drugs not included in the over the counter list. Conclusion: The positive attitude of majority of respondents from population group demands the necessity of providing a detailed explanation about a healthy lifestyle and the risks induced by self-treatment. Only the doctor can prescribe the appropriate treatment: involving maximum benefit and minimum risks

Strategies of the treatment of cardiac prosthetic valve thrombosis

Department of Cardiac Surgery, Republican Hospital, Chisinau, the Republic of MoldovaBackground: The article deals with the analysis of principal causes of valve prosthesis thrombosis and “pannus” thrombosis. The diagnosis and contemporary treatment strategy of prosthesis dysfunction have been considered. Material and methods: In our department 1670 patients with extracorporeal circulation were operated on, among them 1260 had valve pathology that made up 74.2%. 1164 heart valves were replaced, 145 of them were biological prostheses and 1019 were mechanical ones of different types. Prosthesis thrombosis took place in 28 patients that represented 60% of the number of patients with prothesis disfunction and 2.2% of the total number of operated patients from which 21 patients, their age ranged from 35 to 63 years old. The surgical treatment was performed to 9 patients, thrombolysis – to 19 patients. Results: During last 6-7 years the thrombolysis treatment with ateplasum and reteplasse has been successfully implemented in the therapy of thrombosis valve prothesis. Thrombolysis was performed to 19 patients. The results are the following: in 17 cases good outcomes (a complete recovery of the prosthesis function with transprosthetic gradient and the normalization of systolic pressure in right ventricle) have been registered, one case has been complicated with transitory ischemic ictus. Out of 19 patients who underwent the thrombolysis treatment, there were 2 lethal cases. Conclusions: The patients that are in a critical state with prosthesis thrombosis (acute pulmonary edema, hypotension, heart insufficiency NYHA IV) should immediately receive EchoCG confirmation of the need of intravenous thrombolitic therapy. The thrombolysis efficacy in prosthesis thrombosis is high; the rate of embolic complications is low, which can be used as the first line treatment for all patients with prothesis thrombosis (in the absence of contraindications). In the case of partial response to the thrombolysis treatment, the patient can be operated on in good hemodynamic conditions and with low surgical risk

Cardiac valves prostheses thrombosis: management of treatment

Departamentul Chirurgie Cardiovasculară și Toracică, IMSP Spitalul Clinic Republican „Timofei Moșneaga”, Chisinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Fenomenul de trombozăși "pannus" tromboză a protezei valvulare cardiace rămâne printre complicațiile ce necesită intervenție promptă prin metode cardiochirurgicale sau prin tromboliză. Material și metode: În lotul de studiu (2007-2018) au fost incluși 1827 pacienți cu patologii valvulare, operați în secția Chirurgia VCD, IMSP SCR ”Timofei Moșneaga”, la care s-au implantat 1762 valve cardiace, dintre care 198 - proteze biologice și 1564 - proteze mecanice. Disfuncția de proteză prin tromboză s-a depistat la 40 pacienți (2.2 % din numărul total al pacienților), cu vârstă cuprinsă între 35 și 65 de ani. Tratamentului chirurgical au fost supuși 13 pacienți. Tromboliza a fost efectuată la 27 pacienți. Rezultate: Din 27 cazuri supuse trombolizei cu alteplază și reteplază s-a reușit restabilirea completă a funcției protezei valvulare la 23 pacienți, două cazuri letale (1 – hemoragie, 1 – șoc anafilactic). În 2 cazuri de tromboliză s-a obținut restabilirea incompletă a funcției protezei, dar cu ameliorarea hemodinamică. Pacienții au fost operați cu succes peste două săptămâni. Concluzii: Pacienții cu tromboza protezelor valvulare în stare critică pot fi rezolvaţi efectiv prin aplicarea trombolizei medicamentoase care poate vindeca pacientul complet sau poate servi drept un procedeu de salvare până la aplicarea tratamentului chirurgical de schimbare a protezei valvulare. Având rata complicațiilor embolice joasă, tromboliza poate fi implementată ca tratament de prima linie. La răspunsul parţial tratamentului de tromboliză, pacientul poate fi operat în condiții hemodinamice satisfacatoare, cu un risc scăzut.Background: The thrombosis phenomenon and „pannus” thrombosis of cardiac valves prostheses remains among the complications that require prompt intervention by cardiac surgery or thrombolysis. Methods and materials: In the study group were included 1827 patients with valvular pathologies, operated (2007-2018) in Cardiovascularand Thoracic Surgery Department, Republican Clinical Hospital "Timofei Mosneaga", whom 1762 cardiac valves were implanted, of which 198 were biological prostheses and 1564 - mechanical prostheses. Prosthesis dysfunction due to thrombosis was found in 40 patients (2.2% of total patients) aged between 35 and 65 years. Surgical treatment underwent 13 patients. Thrombolysis was performed in 27 patients. Results: Of 27 cases undergoing thrombolysis with Alteplase and Reteplase, complete restoration of valvular prosthesis function was achieved in 23 patients; two lethal cases occurred (1 - hemorrhage, 1 - anaphylactic shock). In 2 cases of thrombolysis incomplete restoration of prosthesis function was obtained, but with hemodynamic improvement.These patients were successfully operated in two weeks. Conclusions: Critical patients with valve prostheses thrombosis can be effectively resolved by applying thrombolysis drugs that can cure the patient completely or serve as a rescue procedure until surgical treatment for prosthesis replacement. Having low rate of embolic complications, thrombolysis can be implemented as a first-line treatment. In case of partial response to thrombolysis treatment the patient can be operated in satisfactory, low-risk hemodynamic conditions

Implementing the minimally invasive cardiac surgery in the Republican Clinical Hospital ”Timofei Mosneaga”

Scopul lucrării. Evaluarea perioadei de implementare a intervențiilor cardiace minim invazive, evidențierea primelor diferențe a rezultatelor clinice obținute de către pacient comparativ cu intervenția cardiochirurgicală clasică. Materiale și metode. Conform programului implementării, la etapa obținerii de formare echipei și a tehnicii operatorii, în perioada de debut (noiembrie 2021-iunie 2023) au fost operați prin tehnica minim-invazivă 40 de pacienți. Leziunile cardiace au fost atât din malformațiile cardiace dobândite, cât și cele congenitale, astfel s-au format 5 grupuri de pacienți: 1. Pacienți cu patologie Mitrală izolată – 15 (plastie valvulară/ înlocuire); 2. Pacienți cu patologie Aortică – 12 (înlocuire valvulară); 3. Pacienți cu patologie Mitro- Tricuspidă 8 (plastie valvulară/ înlocuire); 3. Pacienți cu tumoare cardiacă – 3 (mixoame cardiace); 4. Pacienți cu patologie congenitală – 2 (defect de sept atrial, bicuspidie de Aortă). Toți pacienții au fost operați cu circulație extracorporeală cu canulare periferică doar femurală, cu ecocardiografie transesofagiană perioperatorie. Rezultate. Tehnica minim-invazivă în perioada de debut a reușit de aplicat în 18% din volumul total al operațiilor cardiochirurgicale clasice de corecție valvulară, astfel devine accesibilă pentru patologii cardiace complexe. Timpul aflării pacientului în Terapie Intensivă este redus cu 1 zi. Recuperarea postoperatorie variază între 7-10 zile comparativ cu evoluția clasică (12-18 zile). Volumul hemotransfuziei la pacientul cu intervenție cardiacă minim-invazivă este redus cu 40 %. Reintervenție pentru hemostază nu a necesitat nici un pacient. Mortalitatea constituie 0 %. Conversie de la minim invaziv la sternotomie s-a înregistrat la 1 pacient, care constituie 2,5 %. Concluzii. Reducerea traumei operatorii (deoarece nu se efectuează sternotomia), reducerea infecției și sângerării, reducerea hemotransfuziei, reducerea timpului aflării pacientului în staționar devin factorii care fac diferența considerabilă a rezultatului operației cardiace minim-invazive. După obținerea experienței tehnica respectivă devine acceptabilă pentru intervențiile cardiace complexe (multivalulare, DSA+corecție valvulară, tumori+corecție valvulară).Aim of study. Evaluation of the start period of setting up the minimally-invasive cardiac surgery (MICS) program in a multiprofile hospital and emphasising the most important challenges we faced, to be taken into account. Materials and methods. Minimally invasive cardiac interventions started due to implementation of a dedicated project financed by the National Agency for Research and Development. According to the program several steps were planned: team building, gaining knowledge and skills, equipment and disposal acquisition, and patient selection. After rigorous selection, 40 patients with acquired, congenital heart diseases and tumors, operated during the debut period, could be divided in five categories : I : Patients with isolated Mitral pathology -15 cases (plasty/valve replacement); II: Aortic patients -12 cases of valve replacement; III: Patients with Mitral- Tricuspid pathology - 8 cases (plasty/valve replacement); IV: Patients with cardiac myxoma (3 cases); V: Congenital heart disease – 2 patients (bicuspid aorta, atrial septal defect concomitant tricuspid valve regurgitation). All operations were performed with peripheral femoral cannulation under TEE visualization. Short-term and long-term outcomes were studied. Results. Of the total cases of valvular correction in this debut period, minimally invasive operations (MICS) represented 18%. Conversion from MICS to Sternotomy was required for 1 patient (2,5%) without further complications. Mortality was 0%. Mean patients’ stay in ICU was 15h, mean overall stay in hospital was 7-10 days. Conclusions. The established implementing program of MICS proved to be sustainable even for poor settings. The minimallyinvasive technique is applicable in a range of heart valvular pathologies, tumours, congenital defects. Clinical results of the debut period showed increased benefits (reduction of operative trauma, minimal pain, rapid recovery, reduced infectious risk) in all patients. It is of high interest for the implementation of the technique in congenital heart diseases (VSD), but also in ischemic heart disease for minimally invasive myocardial revascularization (MIDCAB)

COMPARATIVE PHARMACOEPIDEMIOLOGICAL ASSESSMENT OF ANTIHYPERTENSIVE DRUGS PRESCRIPTION IN OUTPATIENT PRACTICE IN KURSK AND CHISINAU

Aim. To study the structure of medical prescriptions of antihypertensive agents for patients with arterial hypertension (HT) in the outpatient practice of Kursk (Russia) and Chisinau (Republic of Moldova).Material and methods. The questioning of doctors of medical organizations in Kursk and Chisinau was carried out as a one-stage descriptive study from October 2015 to February 2016. The questionnaires included questions on the pharmacoepidemiological aspects of prescribing antihypertensive drugs. Total number of respondents was 218, of them – 106 (26 cardiologists and 80 therapists) in Kursk and 112 (28 cardiologists and 84 therapists) in Chisinau.Results. In the real practice for HT treatment doctors in Kursk used more often beta-adrenoblockers (BAB), somewhat less often – angiotensinconverting enzyme (ACE) inhibitors, then diuretics. The shares of calcium channels blockers (CCB) and angiotensin II receptors blockers (ARB) were small – 8.8 and 5.2%, respectively. In Chisinau doctors gave preference to ACE inhibitors, then diuretics and BAB. Frequency of CCB prescriptions was almost identical to that of ARA – 13.7 and 13.6%, respectively. The additional antihypertensives, including central action drugs and alpha-adrenoblockers, were used rarely in both Chisinau and Kursk (1.3 and 1.6%, respectively). Doctors of Chisinau, when carrying out combined pharmacotherapy, gave priority to free combinations of antihypertensive drugs (64.4%), fixed combinations were used in 26.7% of cases. In Kursk, the ratio of these specified tactics of combined therapy was 53.5 and 34.1%, respectively. Among the pharmaceutical companies whose medicines were preferred by doctors in Kursk and in Chisinau, the leading positions were taken by KRKA (38.0 and 25.4%, respectively), Gideon Richter (13.5 and 28.7%, respectively) and Berlin-Chemie (26.7 and 15.6%, respectively).Conclusion. ACE inhibitors, diuretics, BAB were priority classes in the prescribing antihypertensive drugs according to survey of doctors in Kursk and Chisinau. In the conditions of the existing pharmaceutical market of Chisinau doctors used ARB and CCB more often than doctors from Kursk. The main share of doctor’s prescriptions in Kursk and Chisinau, considered both for group of antihypertensive drugs, and for certain representatives of each group of drugs, corresponds to the current recommendations on the pharmacotherapy of patients with HT

Antiviral Activity, Safety, and Tolerability of Multiple Ascending Doses of Elbasvir or Grazoprevir in Participants Infected With Hepatitis C Virus Genotype-1 or -3

Purpose: Elbasvir (MK-8742) and grazoprevir (MK-5172; Merck & Co, Inc, Kenilworth, New Jersey) are hepatitis C virus (HCV)-specific inhibitors of the nonstructural protein 5A phosphoprotein and the nonstructural protein 3/4A protease, respectively. The aims of these studies were to evaluate the antiviral activity and safety of different doses of elbasvir or grazoprevir each administered as monotherapy to participants infected with either HCV genotype (GT) 1 or GT3. Methods: These 2 double-blind, randomized, placebo-controlled, sequential-panel, multiple ascending dose studies were conducted to assess the safety and pharmacodynamics of 5 days of once-daily elbasvir or 7 days of once-daily grazoprevir in adult male participants chronically infected with either HCV GT1 or GT3. Findings: Oral administration of elbasvir or grazoprevir once daily exhibited potent antiviral activity in participants with chronic GT1 or GT3 HCV infections. HCV RNA levels declined rapidly (within 1 day for elbasvir and 2 days for grazoprevir). At 50 mg of elbasvir once daily, the mean maximum reductions in HCV RNA from baseline were 5.21, 4.17, and 3.12 log10 IU/mL for GT1b-, GT1a-, and GT3-infected participants, respectively. At 100 mg of grazoprevir once daily, the mean maximum reductions in HCV RNA from baseline were 4.74 and 2.64 log10 IU/mL for GT1- and GT3-infected participants. Implications: The results in the elbasvir monotherapy study showed that 10 to 50 mg of elbasvir was associated with a rapid decline in HCV viral load; the results in the grazoprevir monotherapy study suggest that doses of 50 mg of grazoprevir and higher are on the maximum response plateau of the dose–response curve for GT1-infected participants. The results of these proof-of-concept studies provided preliminary data for the selection of the dosages of elbasvir and grazoprevir to test in Phase II and III clinical studies. ClinicalTrials.gov identifiers: NCT00998985 (Protocol 5172-004) and NCT01532973 (Protocol 8742-002). © 2018 Elsevier HS Journals, Inc

Antiviral Activity, Safety, and Tolerability of Multiple Ascending Doses of Elbasvir or Grazoprevir in Participants Infected With Hepatitis C Virus Genotype-1 or -3

Purpose: Elbasvir (MK-8742) and grazoprevir (MK-5172; Merck & Co, Inc, Kenilworth, New Jersey) are hepatitis C virus (HCV)-specific inhibitors of the nonstructural protein 5A phosphoprotein and the nonstructural protein 3/4A protease, respectively. The aims of these studies were to evaluate the antiviral activity and safety of different doses of elbasvir or grazoprevir each administered as monotherapy to participants infected with either HCV genotype (GT) 1 or GT3. Methods: These 2 double-blind, randomized, placebo-controlled, sequential-panel, multiple ascending dose studies were conducted to assess the safety and pharmacodynamics of 5 days of once-daily elbasvir or 7 days of once-daily grazoprevir in adult male participants chronically infected with either HCV GT1 or GT3. Findings: Oral administration of elbasvir or grazoprevir once daily exhibited potent antiviral activity in participants with chronic GT1 or GT3 HCV infections. HCV RNA levels declined rapidly (within 1 day for elbasvir and 2 days for grazoprevir). At 50 mg of elbasvir once daily, the mean maximum reductions in HCV RNA from baseline were 5.21, 4.17, and 3.12 log10 IU/mL for GT1b-, GT1a-, and GT3-infected participants, respectively. At 100 mg of grazoprevir once daily, the mean maximum reductions in HCV RNA from baseline were 4.74 and 2.64 log10 IU/mL for GT1- and GT3-infected participants. Implications: The results in the elbasvir monotherapy study showed that 10 to 50 mg of elbasvir was associated with a rapid decline in HCV viral load; the results in the grazoprevir monotherapy study suggest that doses of 50 mg of grazoprevir and higher are on the maximum response plateau of the dose–response curve for GT1-infected participants. The results of these proof-of-concept studies provided preliminary data for the selection of the dosages of elbasvir and grazoprevir to test in Phase II and III clinical studies. ClinicalTrials.gov identifiers: NCT00998985 (Protocol 5172-004) and NCT01532973 (Protocol 8742-002). © 2018 Elsevier HS Journals, Inc