Medication use in pregnancy: a cross-sectional, multinational web-based study

Objectives: Intercountry comparability between studies on medication use in pregnancy is difficult due to dissimilarities in study design and methodology. his study aimed to examine patterns and factors associated with medications use in pregnancy from a multinational perspective, with emphasis on type of medication utilised and indication for use. Design: Cross-sectional, web-based study performed within the period from 1 October 2011 to 29 February 2012. Uniform collection of drug utilisation data was performed via an anonymous online questionnaire. Setting: Multinational study in Europe (Western, Northern and Eastern), North and South America and Australia. Participants: Pregnant women and new mothers with children less than 1 year of age. Primary and secondary outcome measures: Prevalence of and factors associated with medication use for acute/short-term illnesses, chronic/long-term disorders and over-the-counter (OTC) medication use. Results: The study population included 9459 women, of which 81.2% reported use of at least one medication (prescribed or OTC) during pregnancy. Overall, OTC medication use occurred in 66.9% of the pregnancies, whereas 68.4% and 17% of women reported use of at least one medication for treatment of ute/short-term illnesses and chronic/long-term disorders, respectively. The extent of self-reported medicated illnesses and types of medication used by indication varied across regions, especially in relation to urinary tract infections, depression or OTC nasal sprays. Women with higher age or lower educational level, housewives or women with an unplanned pregnancy were those most often reporting use of medication for chronic/long-term disorders. Immigrant women in Western (adjusted OR (aOR): 0.55, 95% CI 0.34 to 0.87) and Northern Europe (aOR: 0.50, 95% CI 0.31 to 0.83) were less likely to report use of medication for chronic/long-term disorders during pregnancy than nonimmigrants. Conclusions: In this study, the majority of women in Europe, North America, South America and Australia used at least one medication during pregnancy. There was a substantial inter-region variability in the types of medication used

The effect of rs776746 polymorphism in the <i>CYP3A5</i> gene on heart rate when using bisoprolol in patients with acute coronary syndrome

Aim. The aim of this work was to study the occurrence of the rs776746 allelic variant of the CYP3A5 gene and its effect on heart rate (HR) when using bisoprolol in patients hospitalized with acute coronary syndrome (ACS).Materials and methods. The study included patients with ACS who were prescribed bisoprolol for clinical indications. All patients underwent molecular genetic testing. In order to evaluate the effectiveness of the therapy with bisoprolol, all patients underwent Holter electrocardiogram (ECG) monitoting on days 10, the following parameters were assessed: minimum, average, maximum heart rate and heart rate during an exercise test. The stress test was performed as a ladder test.Results. The study involved 97 patients (63,5±10,5 years), including 60 men and 37 women. The frequency of occurrence of the desired alleles of the CYP3A5 gene was: CYP3A5*3 - 93%, and CYP3A5*1 - 7%, which corresponds to its prevalence in the European population. 84 carriers of the CYP3A5*3*3 genotype (87%), 12 heterozygous carriers of the *1 allele (12%) and one patient with the *1*1 genotype (1%) were identified. In order to search for differences in the effects of bisoprolol depending on the genetically predetermined activity of CYP3A5, we divided the general group of patients into two subgroups: subgroup 1 (CYP3A5*3*3), represented by carriers of the genotype associated with the synthesis of the inactive form of CYP3A5, and subgroup 2 (CYP3A5*1*3 and CYP3A5*1*1), represented by carriers of at least one allele encoding the synthesis of a fully functional protein CYP3A5, coupled with an increased metabolic rate. Patients did not differ in clinical and demographic characteristics. By the time of daily ECG monitoring, both groups reached comparable heart rate values. In carriers of at least one CYP3A5*1 allele (n = 13), associated with an increased metabolic rate, the daily dose of bisoprolol on the 10th day of hospitalization was significantly higher (p &lt;0.05). The only carrier of the homozygous CYP3A5 *1*1 variant receives bisoprolol at a daily dose of 10 mg. Taking into account the close to significant differences in glomerular filtration rate (GFR) in patients in the groups with the studied genetic variants, and the known eliminating role of the kidneys for bisoprolol, a linear regression model was built with the inclusion of factors that could affect the dose of bisoprolol: GFR, functional class of chronic heart failure, gender, age, number of simultaneously assigned CYP3A5 substrates. Of the parameters listed, only the CYP3A5 genotype significantly predicted the dose of bisoprolol (F=8.5; p&lt;0.005; R2=0.096).Conclusion. In this study, it was demonstrated for the first time that patients with different genetic variants of CYP3A5, in particular with respect to the rs776746 polymorphism, may differ in individual requirements for the dose of bisoprolol

EVALUATION OF PATIENT’S LIFE QUALITY AFTER SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANTATION

Introduction: the use of standardized questionnaires for  assessment of patients’ life  quality after organ transplantation has not been widely used in our country.Purpose: The assessment of patients’ quality of life after the simultaneous pancreas &amp; kidney transplantation using the SF-36 questionnaire.Material and methods: 35 patients with type I diabetes mellitus (DM1) complicated by end-stage chronic renal failure were investigated. There were 16 women (45.7%) and 19 men  (54.3%). The median age was 36 [33; 45] years. The patients were divided into 2 groups depending on the transplantation type:  group I included the patients who underwent isolated kidney transplantation, group  II  included those  after combined kidney and  pancreas transplantation. Patients’ life quality was estimated using the SF-36 questionnaire.Results: Patients in group II had significantly better physical functions, general health  status, and vital activity.Conclusion: Simultaneous pancreas &amp; kidney transplantation considerably improves the life quality of patients with DM1

The Case of Langerhans Cell Histiocytosis (Abt-Letterer-Siwe Disease) in Twin Girls

Abt-Letterer-Siwe disease is a form of Langerhans cell histiocytosis and occurs in 2–10 cases per 1 million of the child population per year. The Russian and foreign literature provide descriptions of this disease in children of different ages. Family cases of this pathology are described in a small number. The chapter presents a rare clinical observation of the Abt-Letterer-Siwe disease in twin girls

Сравнительный клиникоэкономический анализ затрат на лекарственные препараты в многопрофильном стационаре за 2014-2018 гг.

Objectives. To study the structure of drug purchases by a general hospital considering the names and costs of the purchased drugs as well as their current consumption by various clinical departments.Materials and Methods. The drug consumption was analyzed using the ABC/VEN and ATC/DDD methods with a simultaneous analysis of case histories.Results. The analysis of drug purchases in 2014-2018 and the obtained results prompted a reassessment of the drug procurement policy and readjustment of the financial resources between various groups of drugs.Conclusion. The simultaneous use of the ABC/VEN and ATС/DDD analyzes and the reevaluation of the list of prescribed medications allowed us to propose the ways to optimize the structure of drug consumption in a typical hospital.Цель – провести оценку структуры расходования финансовых средств медицинского учреждения на закупку лекарственных препаратов по номенклатуре и стоимости закупаемых лекарственных препаратов, потреблению различными подразделениями в течение года и в разные годы.Материалы и методы. Анализ расхода лекарственных препаратов выполнен с помощью АВС/VEN- и АТС/DDD-анализов с одновременным анализом медицинских карт пациентов.Результаты. Произведен анализ расходования лекарственных препаратов в медицинской организации за 2014-2018 гг. По результатам оценки структуры потребления лекарственных препаратов была изменена политика закупки препаратов, произведено перераспределение финансовых средств на различные группы лекарственных препаратов.Заключение. Одновременное проведение АВС/VEN- и АТС/DDD-анализов и оценки назначений лекарственных препаратов по медицинским картам позволило оптимизировать закупку и расход лекарственных препаратов в медицинской организации

The causes of development and methods of correction of post-transplant diabetes mellitus

The Review deals with the problem of post-transplant diabetes mellitus as one of the complications after kidney transplantation. The authors have reviewed the clinical and experimental studies, described the mechanisms of immunosuppressive drug effects on carbohydrate metabolism and the risk factors for posttransplant diabetes mellitus and its complications, discussed the main drugs used for the carbohydrate metabolism correction and their mechanisms of action