SUGAMMADEX, A NEW DRUG FOR REVERSION OF MUSCLE RELAXANTS

Sugamadeks je novi lijek za reverziju neuromuskularnog bloka. Po kemijskoj građi on je alfa-ciklodekstrin s lipofilnom unutrašnjom stranom molekule koja omogućuje stvaranje stabilnih kompleksa, tzv. enkapsulaciju molekula mišićnih relaksatora, napose rokuronija. Fizička enkapsulacija novi je mehanizam eliminacije relaksatora s mjesta njegova učinka. Ona omogućuje brzu i potpunu reverziju dubokog i plitkog neuromuskularnog bloka ovisnu o primijenjenoj dozi. Sugamadeks nema neželjenih kolinergičkih muskarinskih nuspojava koje se opažaju nakon primjene inhibitora kolinesteraze neostigmina i edrofonija kao što su bradikardija, hipersalivacija i abdominalne boli. Nakon primjene prilagođene doze sugamadeksa učinak rokuronija može biti kratak kao i učinak sukcinilkolina. Ovo je osobito važno u situacijama kada se bolesnik ne može intubirati niti ventilirati ili kada je kirurški zahvat nepredviđeno brzo završen. Kliničke studije na većem broju bolesnika pokazat će omjer koristi i rizika njegove primjene u skupinama osjetljivih bolesnika, osobito može li sugamadeks smanjiti učestalost poslijeoperacijskih respiracijskih komplikacija.Sugammadex is a new pharmacological agent for neuromuscular block reversion. It is a cyclic oligosaccharide, a gamma cyclodextrin with lipophylic inner coat that enables forming of stable complexes with steroidal neuromuscular blocking drugs, especially with rocuronium. A physical encapsulation of the relaxants is a novel elimination pathway and it produces fast and complete reversion of both deep and shallow neuromuscular block. Consequently, sugammadex has no unwanted cholinergic muscarinic effects observed with cholinesterase inhibitors such as bradycardia, hypersalivation, and increased gastrointestinal motility. Since the effects of sugammadex are dose dependent it can very rapidly reverse the effects of rocuronium. After the adjusted dose of sugammadex was given, the duration of action of rocuronium can be made as short as that of succinylcholine. This characteristic is especially important in the ’can’t intubate, can’t ventilate’ situation and after surgical procedure was unexpectedly finished. Clinical studies involving more patients are needed to show the real risk-benefit profile and safety in the special patients’ population

PLACEBO IN THE PAIN TREATMENT

Uporaba farmakološki neaktivnih tvari ili postupaka poznatih kao ’placebo’ uvriježena je u medicinskim krugovima pri ispitivanju lijekova. Njihova primjena ima veliku važnost u kontroliranim kliničkim studijama liječenja boli i u istraživanjima mehanizama prijenosa bolnih podražaja. Novije studije pokazale su da je učinak placeba mjerljiv, praćen promjenama moždane aktivnosti i odgovarajućega subjektivnog doživljaja intenziteta boli. U ovom članku opisane su promjene koje se događaju kod placebne analgezije, intenzitet smanjenja boli u usporedbi s aktivnim lijekovima te osnovni problemi pri primjeni placeba u kliničkoj praksi i istraživanjima.Use of medical preparations having no specific pharmacological activity or dummy procedures administered to patients is known as placebo. Such maneuvers are important in the pain treatment and clinical studies investigating pain mechanisms. Several recent studies have shown that placebo treatment produces measurable psychophysiological effects, characterized by changes in specific brain functions and decreased subjective pain perception. This article reviews changes observed in placebo analgesia, its intensity as compared to active compounds, and principal problems observed during the placebo treatment and in clinical trials

PREDICTION OF USED LUBRICATING OILS PROPERTIES BY INFRARED SPECTROSCOPY USING MULTIVARIATE ANALYSIS

Infracrvena spektroskopija u kombinaciji s metodom parcijalnih najmanjih kvadrata (PLS) primijenjena je za razvitak kalibracijskih modela s ciljem brzog i točnog istovremenog određivanja svojstava rabljenih mazivih ulja: gustoće, viskoznosti i stiništa. U skupu za treniranje korišteno je stotinu uzoraka rabljenog mazivog ulja. PLS kalibracijski modeli za svako određivano svojstvo su razvijeni upotrebom infracrvenog transmisijskog spektra bez prethodne spektralne obrade. Za validaciju modela primijenjena je tehnika križne validacije. Razvijeni PLS modeli pokazuju vrlo dobro slaganje sa normirnim ispitnim metodama. Dobiveni rezultati pokazuju da su PLS modeli temeljeni na infracrvenim spektrima primjenjivi kao praktične i pouzdane analitičke metode za praćenje svojstava rabljenih mazivih ulja.Infrared spectroscopy (IR) in combination with partial least squares regression (PLS) algorithm was applied to develop calibration models for rapid and accurate simultaneous determination of the properties of used lubricating oils: density, viscosity, and pour point. Training sets were composed of hundred used lubricating oil samples. PLS calibration models for each property have been developed by using IR transmission spectra without spectral pretreatment. Cross validation technique was applied for validating models. The PLS models showed very good correlation with corresponding reference methods. Results indicated PLS models based on infrared spectra as practical and reliable analytical methods for routine monitoring of used lubricating oil

Ružička days : International conference 16th Ružička Days “Today Science – Tomorrow Industry” : Proceedings

Proceedings contains articles presented at Conference divided into sections: open lecture (1), chemical analysis and synthesis (3), chemical and biochemical engineering (8), food technology and biotechnology (8), medical chemistry and pharmacy (3), environmental protection (11) and meeting of young chemists (2)

Sugammadex, a new drug for Reversion of Muscle Relaxants

Sugamadeks je novi lijek za reverziju neuromuskularnog bloka. Po kemijskoj građi on je alfa-ciklodekstrin s lipofilnom unutrašnjom stranom molekule koja omogućuje stvaranje stabilnih kompleksa, tzv. enkapsulaciju molekula mišićnih relaksatora, napose rokuronija. Fizička enkapsulacija novi je mehanizam eliminacije relaksatora s mjesta njegova učinka. Ona omogućuje brzu i potpunu reverziju dubokog i plitkog neuromuskularnog bloka ovisnu o primijenjenoj dozi. Sugamadeks nema neželjenih kolinergičkih muskarinskih nuspojava koje se opažaju nakon primjene inhibitora kolinesteraze neostigmina i edrofonija kao što su bradikardija, hipersalivacija i abdominalne boli. Nakon primjene prilagođene doze sugamadeksa učinak rokuronija može biti kratak kao i učinak sukcinilkolina. Ovo je osobito važno u situacijama kada se bolesnik ne može intubirati niti ventilirati ili kada je kirurški zahvat nepredviđeno brzo završen. Kliničke studije na većem broju bolesnika pokazat će omjer koristi i rizika njegove primjene u skupinama osjetljivih bolesnika, osobito može li sugamadeks smanjiti učestalost poslijeoperacijskih respiracijskih komplikacija.Sugammadex is a new pharmacological agent for neuromuscular block reversion. It is a cyclic oligosaccharide, a gamma cyclodextrin with lipophylic inner coat that enables forming of stable complexes with steroidal neuromuscular blocking drugs, especially with rocuronium. A physical encapsulation of the relaxants is a novel elimination pathway and it produces fast and complete reversion of both deep and shallow neuromuscular block. Consequently, sugammadex has no unwanted cholinergic muscarinic effects observed with cholinesterase inhibitors such as bradycardia, hypersalivation, and increased gastrointestinal motility. Since the effects of sugammadex are dose dependent it can very rapidly reverse the effects of rocuronium. After the adjusted dose of sugammadex was given, the duration of action of rocuronium can be made as short as that of succinylcholine. This characteristic is especially important in the ’can’t intubate, can’t ventilate’ situation and after surgical procedure was unexpectedly finished. Clinical studies involving more patients are needed to show the real risk-benefit profile and safety in the special patients’ population

Physicians Overestimate Patient's Knowledge of the Process of Informed Consent: a Cross-sectional Study

AIM To evaluate the differences in the knowledge and attitudes of physicians and patients regarding the informed consent process. METHODS After institutional approval was obtained cohorts of 269 physicians and 265 patients completed a voluntary multiple-choice questionnaire on the informed consent process. RESULTS Most of the responses between physicians and patients were significantly different. A total of 77 physicians (30.7%) reported that they personally informed patients about their medical condition and forthcoming clinical procedures in detail and 138 (55%) informed patients as much as necessary. Only 29 patients (11%) reported being informed in detail, and 186 (70.2%) reported that they received only basic information (P < 0.001). Although 132 physicians (52.6%) reported that their patients received sufficient information to be able to decide on their treatment, only 31 patient (11.7%) reported the same (P < 0.001). Half of the doctors (126, 50.2%) reported that they informed their patients in detail on the possible consequences of treatment refusal whereas 23 patients (8.7%) were given such information. CONCLUSION There is a great discrepancy between physicians and patients concerning both understanding and knowledge of the informed consent process. The physicians have evaluated their practice of giving information and obtaining informed consent to be more detailed than their patients. The results of this study reflect the need for better communication between doctors and patients as well as physician and patient education programs on the process of informed consen

Knowledge and Practices of Obtaining Informed Consent for Medical Procedures among Specialist Physicians: Questionnaire Study in 6 Croatian Hospitals

Aim To assess physicians’ knowledge and practices for obtaining patients’ informed consent to medical procedures. Methods An anonymous and voluntary survey of knowledge and practices for obtaining informed consent was conducted among 470 physicians (63% response rate) working in 6 hospitals: 93 specialists in anesthesiology, 166 in internal medicine, and 211 in surgery. Results Only 54% physicians were acquainted with the fact that the procedure for obtaining consent was regulated by the law. Internists and surgeons were better informed than anesthesiologists (P = 0.024). More than a half of respondents (66%) were familiar with the fact that a law on patient rights was passed in Croatia; there were no differences among different specialties (P = 0.638). Only 38% of the physicians were fully informed about the procedure of obtaining consent. Internists and surgeons provided detailed information to the patient in 33% of the cases and anesthesiologists in 16% of the cases (P < 0.050). Internists reported spending more time on informing the patient than anesthesiologists and surgeons (P < 0.001). There were no differences in knowledge and practices for obtaining informed consent between physicians working in university and those working in community hospitals (P ≥ 0.05 for all questions). Conclusion Physicians in Croatia have no formal education on informed consent and implement the informed consent process in a rather formal manner, regardless of the type of hospital or medical specialty. Systemic approach at education and training at the national level is needed to improve the informed consent process

Microcirculation impairment and blood pressure in sepsis

Blood pressure is crucial for the tissue perfusion, oxygenation andelimination of metabolites in normal tissue. In septic patients itmay be altered by several mechanisms. Endothelial lesions andimpaired vasoregulation resulting from bacteriemia may producevasodilatation, hypotension, tissue hypoxia and decrease in theblood velocity. These events may favour disseminated intravascularcoagulation in septic patients, and thus pronounce perfusionmisdistribution. Since hypotension is commonly treated byvasoactive drugs to increase vascular tone toward normal values,more pronounced peripheral tissue ischemia may result. Duringthe process of blood pressure regulation in septic patients a diversityof physiological parameters should be encountered, i.e. age,body weight, core temperature, overall patients’ cardiovascularperformance, anemia, and protein status. In a healthy, adult person,in the absence of other causes of hypotension systolic bloodpressure of > 90 mmHg or mean arterial pressure ≥ 70 mmHgshould maintain adequate tissue perfusion. Together with specificantibiotics, therapeutic procedures like haemodilution, use of vasoconstrictors,vasopressin and its analogue terlipressin, corticosteroidsare currently used to improve outcome of hypotensive septicpatients. Numerous studies were undertaken to point the valuesof the biochemical tests suggesting a need for prompt intervention.The arterial lactate, cortisol response, TNF, interleukin (IL)6, IL-12p70 and IL-12p40 production, together with submucosal(gastric intramucosal or sublingual) CO2 values were proven as indicative.These may suggest whether microcirculatory impairmentis reversible or not, and which therapeutic maneuver should beappropriate

Smjernice Hrvatskog društva za transfuzijsku medicinu za određivanje Rh(D) krvne grupe i primjenu RhD genotipizacije

SAŽETAK Radna skupina Hrvatskog društva za transfuzijsku medicinu pripremila je smjernice za određivanje Rh(D) krvne grupe i primjenu RhD genotipizacije. U smjernicama je opisan klinički značaj antigena D, povijest i ograničenja serološkog testiranja antigena D te mogućnosti RhD genotipizacije. Cilj smjernica bio je objava novih postupnika serološkog određivanja Rh(D) krvne grupe bolesnicima, trudnicama i novorođenčadi s uputama za specijaliste transfuzijske medicine u hitnom i redovnom radu te tumačenjima nalaza namijenjenim ginekolozima, pedijatrima, neonatolozima, anesteziolozima, internistima, liječnicima obiteljske medicine te svim liječnicima koji se u svom radu susreću s bolesnicima koji primaju krvne pripravke i donose odluku o primjeni RhIG imunoprofilakse. Kao rezultat provođenja smjernica predviđeno je praćenje i periodično izvještavanje u slučaju sumnje na RhD imunizaciju kod osoba nositelja D-varijante. Tijekom trudnoće postoji i mogućnost neinvazivnog određivanja prijenatalnog fetalnog RhD genotipa iz majčine plazme iza 16. tjedna gestacije, kao važnog alata u procjeni rizika razvoja hemolitičke bolesti fetusa i novorođenčeta. Radi lakšeg snalaženja navedene su vrste spremnika za uzorkovanje krvi i potrebna količina uzoraka. Navedena pretraga dostupna je u Hrvatskom zavodu za transfuzijsku medicinu na zahtjev ginekologa, a preporučuje se prvenstveno RhD imuniziranim trudnicama te u slučaju donošenja odluke o ranoj prijenatalnoj anti-D imunoprofilaksi i svim Rh(D) negativnim neimuniziranim trudnicama

Ružička days : International conference 17th Ružička Days “Today Science – Tomorrow Industry” : Proceedings

In front of you are the Proceedings of the International Conference 17th Ružička days: „Today Science – Tomorrow Industry“ that was held in Vukovar, Croatia at September 19-21, 2018. The main goal of this interdisciplinary conference is to promote excellence in science and engineering as well as application of up-to-date research results and technological achievements in industry. In its fifth issue (2011, 2013, 2015, 2017, 2019) the Proceedings continues with publishing of quality scientific and professional full papers in sections Chemical Analysis and Synthesis (2), Chemical and Biochemical Engineering (3), Food Technology and Biotechnology (4), Medical Chemistry and Pharmacy (2), Environmental Protection (9) and Meeting of Young Chemists (4). All the papers were thoroughly reviewed from respectable evaluators, to whom we express our gratitude. We are also thankful to all the authors and participants of the Ružička days, and to all that support and contribute in its organization; especially our international coorganizers EuCheMS, EFFoST and EHEDG, the members of organizing and scientific committee, plenary and invited lecturers, sponsors, and of course our highly skilled and committed associates, which put a lot of effort in preparation of this book