Development and validation of stability-indicating HPLC methods for the estimation of lomefloxacin and balofloxacin oxidation process under ACVA, H2O2H_{2}O_{2} or KMnO4KMnO_{4} treatment. Kinetic evaluation and identification of degradation products by mass spectrometry

The oxidation of lomefloxacin (LOM) and balofloxacin (BAL) under the influence of azo initiator of radical reactions of 4,4′-azobis(4-cyanopentanoic acid) (ACVA) and H2O2 was examined. Oxidation using H2O2 was performed at room temperature while using ACVA at temperatures: 40, 50, 60 °C. Additionally, the oxidation process of BAL under the influence of KMnO4 in an acidic medium was investigated. New stability-indicating HPLC methods were developed in order to evaluate the oxidation process. Chromatographic analysis was carried out using the Kinetex 5u XB—C18 100A column, Phenomenex (Torrance, CA, USA) (250 × 4.6 mm, 5 μm particle size, core shell type). The chromatographic separation was achieved while using isocratic elution and a mobile phase with the composition of 0.05 M phosphate buffer (pH = 3.20 adjusted with o-phosphoric acid) and acetonitrile (87:13 v/v for LOM; 80:20 v/v for BAL). The column was maintained at 30 °C. The methods were validated according to the ICH guidelines, and it was found that they met the acceptance criteria. An oxidation process followed kinetics of the second order reaction. The most probable structures of LOM and BAL degradation products formed were assigned by the UHPLC/MS/MS method

Selenium deficiency and the dynamics of changes of thyroid profile in patients with acute myocardial infarction and chronic heart failure

Background: Selenium (Se) is incorporated in 25 enzymes, for example, glutathione peroxidase (activatedb by oxidative stress) and deiodinases (converting thyroid hormones). Oxidative stress present in heart failure (HF) and myocardial infarction (MI) might cause Se deficiency and decreased thyroxine to triiodothyronine conversion. Aims:  We sought to evaluate Se levels in Polish patients with MI, HF, and healthy volunteers in relation to thyroid hormone levels. Methods: The study group consisted of 143 participants: 54 patients with MI, 59 patients with decompensated HF, and 30 healthy matched volunteers. The patients underwent echocardiography and laboratory tests on admission and 5 months later. Results: Se levels were lower in patients with MI and HF than in controls (median [interquartile range, IQR], 65.9 [55.2–76.1] μg/l and 59.7 [47.7–70.7] μg/l vs 93.2 [84.2–99.1] μg/l, respectively; P < 0.001). The Se deficiency was very common in patients with MI and HF, while it was rare in controls (70.37% and 74.58% vs 10%, respectively; P < 0.001). Patients with MI and HF presented lower free triiodothyronine (FT3) levels and lower FT3 to free thyroxine (FT4) ratio in comparison with controls (median [IQR], 3.90 [3.60–4.38] pmol/l and 4.25 [3.57–4.60] pmol/l vs 4.92 [4.50–5.27] pmol/l; P < 0.001; and 0.25 [0.23–0.29] and 0.25 [0.21–0.28] vs 0.32 [0.29–0.37]; P < 0.001, respectively). There was a weak to moderate correlation between Se level, FT3 level, and the FT3/FT4 ratio. At follow‑up, the FT3/FT4 ratio tended to normalize in patients with MI and remained decreased in patients with HF (mean [SD], 0.31 [0.06] vs 0.27 ([0.05]; P < 0.001. Conclusions: Se deficiency is very common in Polish patients with MI and HF. Thyroid hormones disturbances were more transient in patients with MI, but more chronic in those with HF

"Złe dobrego początki" : ciężki przebieg okołooperacyjnego zespołu takotsubo powiązany z dobrymi wynikami odległymi

W niniejszym artykule przedstawiono opis okołooperacyjnego zespołu takotsubo u 59-letniej kobiety z nadciśnieniem tętniczym, napadowym migotaniem przedsionków i nadczynnym wolem guzkowym tarczycy. W trakcie indukcji znieczulenia ogólnego przed planowym zabiegiem tyroidektomii doszło do nagłego zatrzymania krążenia w mechanizmie asystolii. W wyniku podjętej resuscytacji przywrócono pracę serca. Stwierdzono wstrząs kardiogenny wymagający podaży amin presyjnych. W wykonanej w trybie pilnym koronarografii zaobserwowano cechy zwolnionego przepływu środka kontrastowego w tętnicach wieńcowych przy braku istotnych hemodynamicznie zwężeń. W przyłóżkowym badaniu echokardiograficznym uwidoczniono obniżoną do 20% frakcję wyrzutową lewej komory (LVEF) oraz akinezę segmentów koniuszkowych. Rozpoznano zespół takotsubo. W badaniach kontrolnych wykonanych w trakcie hospitalizacji stwierdzono szybką poprawę kliniczną ze wzrostem LVEF do 40% już 2. dnia hospitalizacji. W związku z dobrym stanem ogólnym chorą wypisano do domu 10. dnia hospitalizacji. Pacjentka pozostają pod regularną kontrolą kardiologiczną, bez cech nawrotu zespołu takotsubo. Po 3,5-letnim okresie obserwacji odnotowano LVEF wynoszącą 60% bez istotnych zaburzeń kurczliwości regionalnej.In the current article, the case report of perioperative takotsubo syndrome in a 59-year-old woman with hypertension, paroxysmal atrial fibrillation and toxic nodular goitre was presented. During the induction of general anaesthesia before scheduled thyroidectomy, the cardiac arrest in the mechanism of asystole was diagnosed. As a result of cardiopulmonary resuscitation, the spontaneous circulation returned. The cardiogenic shock requiring catecholamines administration was noted. In the urgent coronarography, the marked slow flow phenomenon was observed in coronary arteries. The bedside echocardiogram revealed left ventricular ejection fraction (LVEF) deterioration to 20% with the akinesia of apical segments. The diagnosis of takotsubo syndrome was made. In the control examinations, the rapid clinical improvement with the increase of LVEF to 40% on the second day of hospitalization was observed. Due to the good general condition, the patient was discharged on the tenth day of hospitalization. Currently, the patient remains in cardiological out-patient care without any signs of takotsubo syndrome relapse. After 3.5 years of observation, the LVEF equalled 60% without significant disturbances in regional contractility

Right ventricle to pulmonary artery coupling as a predictor of perioperative outcome in patients with secondary mitral valve insufficiency

Background: The aim of the study was to assess some parameters of right ventricle (RV) function aspredictors of short-term mortality in patients with severe secondary mitral regurgitation (SMR) aftermitral valve surgery.Methods: We conducted a retrospective analysis of 112 consecutive patients with severe SMR whohad undergone mitral valve repair or replacement with or without concomitant coronary artery bypasssurgery. We assessed RV to pulmonary artery coupling by calculating the ratio of tricuspid annularplane systolic excursion (TAPSE) to non-invasively estimated RV systolic pressure (RVSP). The studyendpoint was 30 days post-procedural mortality.Results: Overall, the 30-day mortality was 6%. TAPSE/RVSP ratio < 0.42 mm/mmHg was a significantpredictor of mortality and remained so after adjusting for age and sex. The Kaplan-Meier survivalanalysis showed that patients with RVSP > 55 mmHg and those with TAPSE/RVSP ratio < 0.42 mm/mmHg had a lower survival probability.Conclusions: TAPSE/RVSP < 0.42 mm/mmHg is a strong predictor of short-term mortality in patientswith SMR when considered for valve surgery

Percutaneous aspiration of a right atrial thrombus with the AngioVac system

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Simple, Accurate and Multianalyte Determination of Thirteen Active Pharmaceutical Ingredients in Polypills by HPLC-DAD

A new universal HPLC-DAD method has been developed for the separation and simultaneous determination of thirteen active pharmaceutical ingredients (APIs): ramipril, lisinopril, enalapril; atenolol, metoprolol; losartan, candesartan; rosuvastatin, atorvastatin, simvastatin; amlodipine; hydrochlorothiazide, acetylsalicylic acid in polypills used in the treatment of hypertension. The chromatographic analysis of the APIs was performed on an ACE-5 C18-PFP column (250 mm × 4.6 mm, 5 μm) with 0.01 M phosphate buffer (pH = 2.50) and acetonitrile in gradient elution as the mobile phase at a flow rate 1.0 mL min−1. UV detection was performed at 230 nm. The analysis time was 35 min. The elaborated method meets the acceptance criteria for specificity, linearity, sensitivity, accuracy, and precision for all examined substances. The linearity range was observed in a wide concentration range, whereas the determination coefficients (R2) for the linear model were greater than 0.990. The sensitivity of the method was good with the LOD and LOQ values ranged from 0.0009 to 0.0923 mg mL−1 and from 0.0027 to 0.2794 mg mL−1, respectively. The proposed method showed good precision with RSD less than 1.91% and the accuracy expressed as percent recovery was from 95.20% to 104.62%. The proposed HPLC-DAD method was successfully applied to determine APIs in prepared model mixtures corresponding to the commercially available polypill tablets. The obtained results of the measured contents were with good accuracy (95.84–103.92%) and high precision (RSD < 0.95%) indicating the applicability of the proposed method for the simultaneous determination of the polypill components. Therefore, the method can be an effective tool in the quality control of polypills

„Złe dobrego początki” — ciężki przebieg okołooperacyjnego zespołu takotsubo powiązany z dobrymi wynikami odległymi

In the current article, the case report of perioperative takotsubo syndrome in a 59-year-old woman with hypertension, paroxysmal atrial fibrillation and toxic nodular goitre was presented. During the induction of general anaesthesia before scheduled thyroidectomy, the cardiac arrest in the mechanism of asystole was diagnosed. As a result of cardiopulmonary resuscitation, the spontaneous circulation returned. The cardiogenic shock requiring catecholamines administration was noted. In the urgent coronarography, the marked slow flow phenomenon was observed in coronary arteries. The bedside echocardiogram revealed left ventricular ejection fraction (LVEF) deterioration to 20% with the akinesia of apical segments. The diagnosis of takotsubo syndrome was made. In the control examinations, the rapid clinical improvement with the increase of LVEF to 40% on the second day of hospitalization was observed. Due to the good general condition, the patient was discharged on the tenth day of hospitalization. Currently, the patient remains in cardiological out-patient care without any signs of takotsubo syndrome relapse. After 3.5 years of observation, the LVEF equalled 60% without significant disturbances in regional contractility.W niniejszym artykule przedstawiono opis okołooperacyjnego zespołu takotsubo u 59-letniej kobiety z nadciśnieniem tętniczym, napadowym migotaniem przedsionków i nadczynnym wolem guzkowym tarczycy. W trakcie indukcji znieczulenia ogólnego przed planowym zabiegiem tyroidektomii doszło do nagłego zatrzymania krążenia w mechanizmie asystolii. W wyniku podjętej resuscytacji przywrócono pracę serca. Stwierdzono wstrząs kardiogenny wymagający podaży amin presyjnych. W wykonanej w trybie pilnym koronarografii zaobserwowano cechy zwolnionego przepływu środka kontrastowego w tętnicach wieńcowych przy braku istotnych hemodynamicznie zwężeń. W przyłóżkowym badaniu echokardiograficznym uwidoczniono obniżoną do 20% frakcję wyrzutową lewej komory (LVEF) oraz akinezę segmentów koniuszkowych. Rozpoznano zespół takotsubo. W badaniach kontrolnych wykonanych w trakcie hospitalizacji stwierdzono szybką poprawę kliniczną ze wzrostem LVEF do 40% już 2. dnia hospitalizacji. W związku z dobrym stanem ogólnym chorą wypisano do domu 10. dnia hospitalizacji. Pacjentka pozostają pod regularną kontrolą kardiologiczną, bez cech nawrotu zespołu takotsubo. Po 3,5-letnim okresie obserwacji odnotowano LVEF wynoszącą 60% bez istotnych zaburzeń kurczliwości regionalnej