ВЛИЯНИЕ ПРЕДОПЕРАЦИОННОГО НАЗНАЧЕНИЯ ЭНАЛАПРИЛА НА ТЕЧЕНИЕ АНЕСТЕЗИИ ПРИ ОБШИРНЫХ АБДОМИНАЛЬНЫХ ОПЕРАЦИЯХ У ПОЖИЛЫХ ПАЦИЕНТОВ

Objective: to evaluate the impact of preoperative use of angiotensin-converting enzyme inhibitors on hemodynamics in elderly patients. The use of enalapril on the day of surgery in patients lowly tolerant to transient hypoxia and hypercapnia was accompanied by hemodynamic instability during anesthesia and by the higher frequency of vasopressor usage. The hemodynamics of patients moderately tolerant to transient hypoxia and hypercapnia did not depend on the intake of enalapril. Цель работы - оценка влияния предоперационного применения ингибиторов ангиотензинпревращающего фермента на гемодинамику у пожилых пациентов. Приём эналаприла в день операции у пациентов с низкой толерантностью к транзиторной гипоксии и гиперкапнии сопровождался нестабильностью гемодинамики в течение анестезии и увеличением частоты применения вазопрессоров. Гемодинамика пациентов со средней толерантностью к транзиторной гипоксии и гиперкапнии не зависела от приёма эналаприла

Polimerne mješavine obložene Eudragitom: Potencijalni sustav za kontroliranu peroralnu isporuku teofilina

Sustained release (SR) dosage forms enable prolonged and continuous deposition of the drug in the gastrointestinal (GI) tract and improve the bioavailability of medications characterized by a narrow absorption window. In this study, a new strategy is proposed for the development of SR dosage forms for theophylline (TPH). Design of the delivery system was based on a sustained release formulation, with a modified coating technique and swelling features aimed to extend the release time of the drug. Different polymers, such as Carbopol 71G (CP), sodium carboxymethylcellulose (SCMC), ethylcellulose (EC) and their combinations were tried. Prepared matrix tablets were coated with a 5 % (m/m) dispersion of Eudragit (EUD) in order to get the desired sustained release profile over a period of 24 h. Various formulations were evaluated for drug concentration and in vitro drug release. It was found that the in vitro drug release rate decreased with increasing the amount of polymer. Coating with EUD resulted in a significant lag phase in the first two hours of dissolution in the acidic pH of simulated gastric fluid (SGF) due to decreased water uptake, and hence decreased driving force for drug release. Release became faster in the alkaline pH of simulated intestinal fluid (SIF) owing to increased solubility of both the coating and matrixing agents. The optimized formulation was subjected to in vivo studies in rabbits and the pharmacokinetic parameters of developed formulations were compared with the commercial (Asmanyl®) formulation. Asmanyl® tablets showed faster absorption (tmax 4.0 h) compared to the TPH formulation, showing a tmax value of 8.0 h. The cmax and AUC values of TPH formulation were significantly (p < 0.05) higher than those for Asmanyl®, revealing relative bioavailability of about 136.93 %. Our study demonstrated the potential usefulness of eudraginated polymers for the oral delivery of the sparingly soluble drug theophylline.Pripravci za produljeno oslobađanje (SR) omogućavaju produljeno i kontinuirano oslobađanje lijeka u gastrointestinalnom (GI) traktu i poboljšavaju bioraspoloživost lijekova s uskim apsorpcijskim prozorom. U radu se predlaže nova strategija za razvoj formulacija s produljenim oslobađanjem teofilina (TPH), koja se temelji na sustavu za produljeno oslobađanje, kojem je u svrhu produljenja vremena oslobađanja modificiran način oblaganja i bubrenja. Korišteni su različiti polimeri, kao što su Carbopol 71G (CP), natrijeva karboksimetilceluloza (SCMC), etilceluloza (EC) i njihove kombinacije. Pripravljene matriks tablete obložene su 5-postotnom (m/m) disperzijom Eudragita (EUD) kako bi se postiglo produljeno oslobađanje tijekom 24 h. U pripravljenim formulacijama određena je koncentracija lijeka i in vitro oslobađanje. Rezultati pokazuju da se povećanjem udjela polimera smanjuje brzina oslobađanja in vitro. Oblaganje s EUD značajno je produljilo lag fazu tijekom prva 2 sata otapanja u kiselom pH simuliranog želučanog soka (SGF). Naime, oblaganje usporava ulazak vode i tako smanjuje pogonsku silu za oslobađanje lijeka. Zbog povećane topljivosti obložnog sloja i matriksa u lužnatom mediju, oslobađanje u simuliranoj intestinalnoj tekućini (SIF) je brže. Optimizirana formulacija ispitana je in vivo na zečevima. Farmakokinetički parametri novih formulacija uspoređivani su s komercijalnim pripravkom Asmanyl®. Asmanyl® tablete pokazuju bržu apsorpciju (tmax 4,0 h) u odnosu na TPH formulaciju (tmax 8,0 h). cmax i AUC vrijednosti TPH formulacije bile su značajno (p < 0,05) više od onih za Asmanyl®, što ukazuje na relativnu bioraspoloživost od oko 136,93 %. Stoga smatramo da su polimeri obloženi eudragitom potencijalno korisni za oralnu upotrebu teško topljivog lijeka teofilina

Течение и исходы острого коронарного синдрома в условиях новой коронавирусной инфекции COVID-19

Abstract We analyzed the clinical condition of patients with COVID-19 of varying severity, changes in instrumental and laboratory parameters, and assessed the impact of the severity of the course of a new coronavirus infection on the outcomes of acute coronary syndrome.AIM OF STUDY To study the mutual influence of acute coronary syndrome and the new coronavirus infection COVID-19 on the nature of the course and outcomes of the disease.Materia l and methods In March 21, 2020 – May 31, 2021, 3 625 patients were treated for COVID-19, including 131 patients with acute coronary syndrome due to COVID-19 disease. All patients underwent a number of studies: computed tomography of the chest, electrocardiography, echocardiography, monitoring of biomarkers of myocardial damage, diagnostic coronary angiography and, if necessary, intracoronary therapeutic intervention.Results Data on the distribution of patients with COVID-19 according to the presence or absence of ST segment elevation on the electrocardiogram and the degree of lung tissue damage, as well as information on mortality in these groups, are presented. The role of troponin I in the assessment of myocardial ischemia was analyzed. The direct dependence of its level on the volume of lung damage was found. The inverse relationship was shown between the degree of damage to the lung tissue and the indices of oxygen saturation in the blood. A poor prognostic value of low left ventricular ejection fraction in patients with COVID-19 disease has been described.Conclusions The development of acute coronary syndrome in the course of COVID-19 significantly worsens the prognosis of the disease, which requires the development of algorithms for providing medical care to patients in this category, as well as maximum vigilance in their treatment.ЦЕЛЬ ИССЛЕДОВАНИЯ Изучить взаимное влияние ОКС и НКИ COVID-19 на характер течения и исходы заболевания.МАТЕРИАЛ И МЕТОДЫ В ГБУЗ «НИИ СП им. Н.В. Склифосовского ДЗМ» с 21 марта 2020 по 31 мая 2021 года по поводу COVID-19 находились на лечении 3625 пациентов. В том числе по поводу ОКС на фоне заболевания COVID-19 госпитализирован 131 пациент. Всем больным был проведен ряд исследований: компьютерная томография органов грудной клетки, электрокардиография, эхокардиография, контроль биомаркеров повреждения миокарда, диагностическая коронароангиография и, при необходимости, интракоронарное лечебное вмешательство.РЕЗУЛЬТАТЫ Представлены данные о распределении больных COVID-19 по признаку наличия или отсутствия элевации сегмента ST на электрокардиограмме и степени поражения легочной ткани, а также сведения о летальности в данных группах. Проанализирована роль биомаркера тропонин I в оценке ишемии миокарда. Обнаружена прямая зависимость его уровня от объема повреждения легких. Показана обратная зависимость между степенью поражения легочной ткани и показателями сатурации кислорода в крови. Описано неблагоприятное прогностическое значение низкой фракции выброса левого желудочка у пациентов с заболеванием COVID-19.ЗАКЛЮЧЕНИЕ Развитие острого коронарного синдрома на фоне COVID-19 значительно ухудшает прогноз заболевания, что требует разработки алгоритмов оказания медицинской помощи больным этой категории, а также максимальной настороженности при их лечении

IMPACT OF PREOPERATIVE ENALAPRIL USE ON THE COURSE OF ANESTHESIA DURING EXTENSIVE ABDOMINAL SURGERY IN ELDERLY PATIENTS

Objective: to evaluate the impact of preoperative use of angiotensin-converting enzyme inhibitors on hemodynamics in elderly patients. The use of enalapril on the day of surgery in patients lowly tolerant to transient hypoxia and hypercapnia was accompanied by hemodynamic instability during anesthesia and by the higher frequency of vasopressor usage. The hemodynamics of patients moderately tolerant to transient hypoxia and hypercapnia did not depend on the intake of enalapril