BETA-ADRENOBLOCKERS IN XXI CENTURY: EPOCH END OR IMMORTALITY BEGINNING? A VIEW OF ORDINARY CARDIOLOGIST

Usage of β-blockers (BB) for treatment of patients with cardiovascular diseases is discussed. Results of the basic clinical trials with BB (LIFE, ASCOT, etc.) are analyzed. The role of sympathetic system in different stages of cardiovascular continuum as well as forecast of BB clinical efficacy is surveyed. Author presents a review of data about selective β1-blocker, metoprolol succinate (Betalok ZОК), in patients with cardiovascular diseases

The Impact of Corruption on Migration: Evidence from the Western Balkans

The fight against corruption remains one of the most fundamental problems for Western Balkans societies and governments. Hiring in the public sector is often determined by networks and clientelism. The exchange of favours and loyalty to a patron are the “normal” ways to access economic opportunities. As a result, a considerable portion of the population considers emigration as the only path to succeed. The main objective of this study is to analyse the impact of corruption on Western Balkan migrant stocks over the years from 2012 to 2020. The selected time period depends mainly on data availability and frequency. A gravity-based equation is developed to explain changes in the number of immigrants living in 31 European destinations. The proposed econometric model confirms the statistical significance of corruption variables in migrant stocks of receiving countries. Individuals tend to move from countries with high levels of corruption and poor governance toward richer and less corrupt destinations

Pharmacoeconomic Evaluation of Costs of Myelomeningocele and Meningocele Treatment and Screening

Malvina Hoxha,1 Visar Malaj,2,3 Bruno Zappacosta,1 Najada Firza4,5 1Department of Chemical-Toxicological and Pharmacological Evaluation of Drugs, Catholic University Our Lady of Good Counsel, Tirana, Albania; 2Department of Economics, University of Tirana, Tirana, Albania; 3CERGE-EI, Center for Economic Research and Graduate Education-Economics Institute, Prague, Czech Republic; 4Department of Economics and Finance, University of Bari ”Aldo Moro”, Bari, Italy; 5Department of Economics and Business, Catholic University Our Lady of Good Counsel, Tirana, AlbaniaCorrespondence: Malvina Hoxha, Tel +355-42-273-290, Email [email protected]: The prevention of myelomeningocele (MMC) and meningocele (MC) is a public health concern. A systematic review on economic factors associated with MMC and MC can help the policy makers to evaluate the cost-effectiveness of screening and treatment. To our knowledge, this is the first systematic review to provide up-to date pharmacoeconomic evidence of all economic studies present in literature on different aspects of MMC and MC.Methods: We searched in the National Health Service Economic Evaluation Database (NHSEED), PubMed, Cost-effectiveness Analysis Registry (CEA Registry), Centre for Reviews and Dissemination (CRD), Health Technology Assessment Database (HTAD), Cochrane Library, and Econlit. The PRISMA guidelines were followed in the search and evaluation of literature. Only articles in English not limited by the year of publication that fulfilled the eligibility criteria were included in this systematic review.Results: Nineteen papers were included in the study. The studies were very heterogeneous and reported a comparison of the costs between prenatal versus postnatal repair, the cost of fetoscopic approach versus open surgery, the cost of ventriculoperitoneal shunting (VPS) versus endoscopic third ventriculostomy (ETV), and ETV with choroid plexus cauterization (ETV/CPC), the cost of hospitalization, and the cost of diagnosis for MMC.Conclusion: The results of this study can help in implementing new policies in different countries to assist MC and MMC patients with the cost of treatment and screening.Keywords: cost, myelomeningocele, meningocele, neural tube defects, pharmacoeconomi

Case report of an endovascular repair of a residual type A dissection using a not CE not FDA-approved Najuta thoracic stent graft system

This report describes an endovascular repair of a residual type A dissection using a medical device that is not marked by european conformity (CE) or Food and Drug Administration (FDA).The patient underwent ascending aortic surgery for acute type A dissection. The 2-year angio-computed tomography demonstrated patency of the residual false lumen with evolution into a 6 cm aneurysm, the extension of the dissection from the aortic arch to the aortic bifurcation with thrombosis of the right common iliac artery. There was no CE- or FDA-marked medical device indicated for this case or any other acceptable therapeutic alternative. We used the Najuta thoracic stent graft and successfully handled the pathology in a multiple-phase treatment.Technology is evolving with specific grafts for the ascending and fenestrated grafts for the aortic arch. In this single case the Najuta endograft, in spite of the periprocedural problems, was a valid therapeutic option

Value and limitations of chimney grafts to treat arch lesions

AIM: The endovascular debranching with chimney stents provides a minimally invasive alternative to open surgery with readily available devices and has extended the option of endoluminal therapy into the realm of the aortic arch. But a critical observation at the use of this technique at the aortic arch is important and necessary because of the lack of long-term results and long term patency of the stents. Our study aims to review the results of chimney grafts to treat arch lesions. METHODS: A systematic health database search was performed in December 2014 according to the Prisma Guidelines. Papers were sought through a meticulous search of the MEDLINE database (National Library of Medicine, Bethesda, MA) using the Pubmed search engine. RESULTS: Twenty-two articles were eligible for detailed analysis and data extraction. A total of 182 patients underwent chimney techniques during TEVAR (Thoracic Endovascular Aneurysm Repair). A total of 217 chimney grafts were implanted: 36 to the IA, 1 to the RCCA, 91 to the LCCA and 89 to the LSA. The type of stent-graft used for TEVAR was described in 132 patients. The type and name of chimney graft was described in 126 patients. In 53 patients information was limited to the type. Primary technical success, defined as a complete chimney procedure was achieved in 171 patients (98%). In 8 patients it was not clearly reported. The overall stroke rate was 5.3%. The overall endoleak rate, in those papers were it was clearly reported, was 18.4% (31 patients); 23(13,6%) patients developed a type IA endoleak, 1 patient (0.6%) developed type IB endoleak and 7 patients (4.1%) developed a type II endoleak CONCLUSION: The total endovascular aortic arch debranching technique represent a good option to treat high-risk patients, because it dramatically reduces the aggressiveness of the procedure in the arch. Many concerns are still present, mainly related to durability and material interaction during time. Long-term follow-up is exceptionally important in light of the interactions of the stents, the thoracic endograft, the aortic arch, and every variation in systolic and diastolic pressure. Actually this technique has acceptable short and mid-term results. Long term data are available just from a very small number of patients and more data from a wider number are needed in order to embrace this method as a safe one

Effect of particle size reduction and crystalline form on dissolution behaviour of nimesulide

The objective of this study was to develop and examine innovative and very simple and easily scalable techniques able to improve solubility and/or dissolution rate and thus oral bioavailability of nimesulide. Three different nimesulide batches were obtained by three different laboratory-scale methods: Method A (Batch A) used crystallization by solvent evaporation in a nanospray dryer, Method B (Batches G and GLN) involved cryo-milling, and Method C (Batch Neu) dispersed nimesulide in Neusilin(A (R)) UFL2. All the nimesulide batches were fully characterized for chemical stability, thermal behaviour, physicochemical and micromeritics properties, and intrinsic dissolution and particle dissolution rates. Batch A not only showed a good reduction in particle size but also exhibited a reduced degree of crystallinity by both differential scanning calorimetry and X-ray powder diffractometry, which could explain the increase in intrinsic dissolution rate (IDR) and particle dissolution. Batch GLN showed an acceptable increase in IDR, probably caused by a slight decrease in the degree of crystallinity, and good improvement in dissolution rate due to a certain decrease in particle size. Batches G and native crystals exhibited very close IDRs, while G showed somewhat higher particle dissolution, probably attributed to the particle size reduction. The dispersion of nimesulide in Neusilin UFL2 in a 1:6 drug-polymer ratio made it possible to recover anamorphous powder, as proven by thermal analysis and X-ray powder diffractometry, characterized by pronounced particle size reduction to nanometric dimensions. Both amorphous character and nanometric dimensions could account for the fastest particle dissolution during the first 10 min of the experiment. The stability study conducted according to the International Conference on Harmonization (ICH) confirmed the good chemical and physicochemical stability of all the batches

Characterization and outcome of invasive infections due to Paecilomyces variotii: Analysis of patients from the FungiScope®registry and literature reports

Objectives: To provide a basis for clinical management decisions in Paecilomyces variotii infection. Methods: Unpublished cases of invasive P. variotii infection from the FungiScope® registry and all cases reported in the literature were analysed. Results: We identified 59 cases with P. variotii infection. Main baseline factors were presence of indwelling devices in 29 cases (49.2%), particularly peritoneal catheters (33.9%) and prosthetic heart valves (10.2%), haematological or oncological diseases in 19 (32.2%), major surgery in 11 (18.6%), and diabetes mellitus in 10 cases (16.9%). The most prevalent infection sites were peritoneum (n = 20, 33.3%) and lungs (n = 16, 27.1%). Pain and fever were frequent (n = 35, 59.3% and n = 33, 55.9%, respectively). Diagnosis was established by culture in 58 cases (98.3%). P. variotii caused breakthrough infection in 8 patients. Systemic antifungals were given in 52 patients (88.1%). Amphotericin B was administered in 39, itraconazole in 15, and posaconazole in 8 patients. Clinical isolates were frequently resistant to voriconazole, whereas the above-mentioned antifungals showed good in vitro activity. Infections of the blood and CNS caused high mortality. Overall mortality was 28.8% and death was attributed to P. variotii in 10 cases. Conclusions: P. variotii causes life-threatening infections, especially in immunocompromised and critically ill patients with indwelling devices. Patients undergoing peritoneal dialysis are at particular risk. Multidisciplinary management is paramount, including molecular techniques for diagnosis and treatment with efficacious systemic antifungals. Amphotericin B, itraconazole and posaconazole are regarded as treatments of choice. Combination with flucytosine may be considered. Surgical debridement and removal of indwelling devices facilitate favourable outcome. © 2021 The Author(s). Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy