Drug Of Choice Research Articles

Modern approaches in the diagnosis, treatment and prevention from obesity

Today, from 1.0 to 1.9 billion adults are overweight, including 312-650 million of them, and 124 million children and adolescents are obese. In Russia and Europe, about 60% of residents are obese and overweight. According to WHO forecasts, by 2025 the number of obese patients will double and will account for 30-50% of the population of economically developed countries. Morbid obesity is usually a multifactorial disease that is acquired and progresses under the influence of many factors (geography, level of economic development, cultural values, lifestyle, and others) as well as hereditary predisposition. Among people suffering from comorbid obesity, there is an atypical course of concomitant comorbid diseases. Against the background of morbid obesity, the likelihood of acquiring other diseases of organs and systems increases: the cardiovascular system, hormonal system, digestive tract, erosive esophagitis, fatty liver dystrophy, cirrhosis of the liver, obstructive sleep apnea, osteoarthritis, etc. To confirm the presence of morbid obesity in humans, the following indicators are evaluated: the number of kilograms per square meter of human body area (BMI calculation), waist circumference, triglyceride index, as well as the use of instrumental diagnostics: radiation and ultrasound methods to study the level of obesity of internal organs. To date, orlistat, sibutramine and liraglutide have been registered in Russia for the conservative therapy of morbid obesity, i.e. the choice of drugs is very limited. Surgical methods and electrical stimulation of the stomach are also used. Obesity ranked 5th in the world ranking of risk factors for premature death. A targeted policy and an integrated approach aimed at improving the system of medical care for overweight and obese patients should become key factors in achieving the national goal of improving people's health and well-being. The expansion of preventive measures at the local, regional and federal levels will help significantly reduce the spread of this pathology and prevent the development of an "obesity pandemic".

HIV postnatal prophylaxis and infant feeding policies vary across Europe: results of a Penta survey.

This survey was conducted to describe current European postnatal prophylaxis (PNP) and infant feeding policies with the aim of informing future harmonized guidelines. A total of 32 senior clinicians with relevant expertise, working in 20 countries within the European Region, were invited to complete a REDCap questionnaire between July and September 2023. Twenty-three of the 32 invited paediatricians responded, representing 16/20 countries. There were multiple respondents from the same country for Italy (n = 5), the UK (n = 2), Germany (n = 2) and France (n = 2). All countries use risk stratification to guide PNP regimen selection. Nine out of 16 countries reported three risk categories, six out of 16 reported two, and one country reported differences in categorization. Criteria used to stratify risk varied between and within countries. For the lowest risk category, the PNP regimen reported ranged from no PNP to up to four weeks of one drug; the drug of choice reported was zidovudine, apart from one country which reported nevirapine. For the highest risk category, the most common regimen was zidovudine/lamivudine/nevirapine (20/23 respondents); regimen duration varied from twoto six weeks with variation in recommended dosing. Guidelines support breastfeeding for infants born to people living with HIV in eight out of 16 countries; in the other eight, guidelines do not support/specify. Guidelines and practice for PNP and infant feeding vary substantially across Europe and within some countries, reflecting the lack of robust evidence. Effort is needed to align policies and practice to reflect up-to-date knowledge to ensure the vertical transmission risk is minimized and unnecessary infant HIV testing and PNP avoided, while simultaneously supporting families to make informed decisions on infant feeding choice.

GC–MS analysis, molecular docking, and pharmacokinetic studies on Dalbergia sissoo barks extracts for compounds with anti-diabetic potential

Diabetes is a metabolic condition defined by abnormal blood sugar levels. Targeting starch-hydrolyzing enzymes and Dipeptidyl Peptidase 4 (DPP-4) expressed on the surface of numerous cells is one of the key strategies to lower the risk of Type-2 diabetes mellitus (T2DM). Dalbergia sissoo Roxb. bark (DSB) extracts have been reported to have anti-diabetic properties. This study intended to scientifically validate use of alcoholic and hydro-alcoholic extracts of DSB for T2DM by conducting preliminary phytochemical investigations, characterising potential phytochemicals using Fourier transform infrared (FT-IR) spectroscopy and Gas chromatography-mass spectrometry (GC–MS) analysis followed by comprehensive in-silico analysis. A qualitative phytochemical evaluation indicated the presence of alkaloids, phenolics, glycosides, conjugated acids and flavonoids. Ethanolic extracts showed highest total phenolic content (TPC) (127.072 ± 14.08031 μg GAE/g dry extract) and total flavonoid content (106.911 ± 5.84516 μg QE /g dry extract). Further FT-IR spectroscopy also revealed typical band values associated with phenol, alcohol, alkene, alkane and conjugated acid functional groups. The GC–MS analysis identified 139 compounds, 18 of which had anti-diabetic potential. In-silico ADMET analysis of potential compounds revealed 15 compounds that followed Lipinski’s rule and demonstrated drug-like properties, as well as good oral bioavailability. Molecular docking was utilised to analyse their potential to interact with three targets: α-amylase, α-glucosidase, and DPP-4, which are crucial in managing diabetes-related problems. Molecular Docking analysis and membrane permeability test utilising the PerMM platform revealed that compounds in the extracts, such as Soyasapogenol B and Corydine, had better interactions and permeability across the plasma membrane than standard drugs in use. Molecular dynamics simulations also showed that selected compounds remained stable upon interaction with α-amylase. Overall, using the in-silico approaches it was predicted that DSB extracts contain potential phytochemicals with diverse anti-diabetic properties. It further needs to be investigated for possible development as formulation or drug of choice for treating T2DM.

Investigating predictors in parenteral to oral switch of Analgesia in postoperative patients: An observational study

Introduction: A thorough understanding of various routes of analgesic administration and their limitations enables pain therapists to effectively manage postoperative pain, reduce the risk of chronic pain development, and enhance patient satisfaction. Considerations such as pain type, patient preferences and medical conditions guide the selection of the most appropriate administration method and dosage form for optimal outcomes. This observational study aimed to investigate the factors associated with the switch of analgesic medication from parenteral to oral in postoperative patients. Methods: This study was conducted for six months among 305 patients at a tertiary care teaching hospital, Davangere, India. The data about patient was collected through case sheets and was analyzed with IBM SPSS Version 25 for windows. Results: The study conducted on 305 patients found that the switch was mostly done within the time interval of 2-4 days. The combination of paracetamol and tramadol (22.6%) was the main drug of choice for switch. The switch from parenteral to oral analgesia was not found to be significantly associated with age, severity of pain, or length of hospital stay. Conclusion: Although switching between parenteral and oral routes of analgesic administration appears to be effective in managing surgical patients, but the decision to switch does not seem to be influenced by the hypothesized factors.

Modern etiotropic therapy of chronic viral hepatitis B

Chronic viral hepatitis B (CHB) is a significant global health problem. The biological characteristics of the hepatitis B virus, which causes this disease, significantly impede the achievement of complete virus elimination in most patients. In this regard, the rational choice of drugs and antiviral therapy regimens is crucial for increasing life expectancy and improving the quality of life in patients with CHB. The purpose of this literature review is to identify current approaches and trends in etiotropic therapy for CHB.Materials and methods. The review uses data published in domestic and foreign scientific journals, clinical guidelines, regulatory documents, and Internet resources.Results. Currently, the most effective means of etiotropic therapy for CHB are interferons (standard interferon alpha, pegylated interferons alpha-2a and alpha-2b), as well as first-line nucleoside/nucleotide analogs (entecavir, tenofovir) and second-line analogs (lamivudine, telbivudine, adefovir). The choice of a specific drug is determined by the patient's clinical condition, preferences, availability, and cost of treatment. Despite certain limitations of current etiotropic therapies for CHB, their use can significantly increase patients' life expectancy and improve their quality of life.

Treatment of mildandmoderateforms of ulcerativecolitis: the possibilities of mesalazine

The article indicates the specific niche and principles for choosing mesalazine formulations, and the selection of a dose for the treatment of mild to moderate extensive (left-sided and total) ulcerative colitis (UC). It doesn’t consider any approaches to the treatment of more severe UC or distal UC (proctitis). The current concepts on the use of 5-aminosalicylic acid (5-ASA) formulations to induce and maintain remission in mild to moderate active UC are discussed. The principles for drug administration and a comparative analysis of domestic and international mesalazine dosing recommendations are provided. The guidelines place special emphasis on the importance of high-dose mesalazine therapy (≥4 g/day), which allows to achieve the targets set by the Treat-to-target (T2T) strategy and to reach the clinical and endoscopic remission. The evidence from meta-analyses and comparative studies demonstrating the same efficacy of different forms of mesalazine in the treatment of UC are presented. Attention is drawn to the choice of the optimal drug with enteric coating that consists of two types of Eudragit (Eudragit L and Eudragit S) in contrast to mesalazine formulations with one and the same type of coating (only L or only S). The double Eudragit (L + S) pH-dependent coating of mesalazine tablets dissolves in the terminal ileum, cecum and partially in the right half of the colon at pH 6–7.5, while formulations coated with only L or S dissolve at a narrower pH range. The clinical efficacy of mesalazine directly depends on its intraluminal concentration that is determined by the amount of the released drug according to the pH level in the intestinal lumen. The double Eudragit coating allows to cover the entire pH range in the ileum and colon. The paper presents evidence from the domestic clinical practice that confirms the Cochrane meta-analysis statements on the comparable efficacy of different mesalazine formulations concerning the targets to reach remission and reduce the level of fecal calprotectin. In addition, a high incidence of clinical remissions (more than 80% at 48 weeks of treatment) on double coated (L + S) mesalazine is demonstrated.

Overexpression of l,d-Transpeptidase A Induces Dispensability of Rod Complex in Escherichia coli.

Antimicrobial resistance (AMR) is a significant global threat, and the presence of resistance-determinant genes is one of the major driving forces behind it. The bacterial rod complex is an essential set of proteins that is crucial for cell survival due to its role in cell wall biogenesis and shape maintenance. Therefore, these proteins offer excellent potential as drug targets; however, compensatory mutations in nontarget genes render this complex nonessential. The MreB protein of this complex is an actin homologue that rotates along the longitudinal axis of the cell to provide rod shape to the bacteria. In this study, using chemical-chemical interaction profiling and FtsZ suppression assay, we identified the MreB targeting activity of IITR07865, a previously discovered small molecule in our lab. Escherichia coli suppressors against IITR07865 revealed mutations in two cell division-associated genes, min C and pal, that have not been previously implicated in rod complex essentiality. IITR07865 resistant mutants were found to inactivate and render the rod complex nonessential, making the rod complex inhibitors ineffective. Further, through transcriptome analysis, we reveal the primary cause of resistance in suppressor strains to be the overexpression of an l, d-transpeptidase A enzyme, which is involved in peptidoglycan and Braun's lipoprotein cross-linking. Our results demonstrate a novel mechanism of resistance development in rod-shaped Gram-negative bacterial pathogen E. coli involved in UTIs where mecillinam, a clinically used antibiotic that targets rod complex, is a drug of choice.

Lyotropic liquid crystal and self-emulsifying drug delivery systems nanoparticles as artesunic acid and praziquantel carriers: An innovative approach for formulation of anti-malaria and schistosomicidal drugs

Praziquantel (PZQ) is the drug of choice for treating cestode and trematode infections, and it is currently the only option against schistosomiasis. Artesunic acid (AcART) is effective against several parasites and has emerged as an alternative for schistosomiasis treatment. However, AcART and PZQ have limited bioavailability due to poor water solubility, low permeability, and rapid cell clearance. To address these challenges, this study aimed to develop self-emulsifying drug delivery systems to develop SEDDS and NPs-LLC to overcome the low water solubility affecting AcART and PZQ bioavailability. The study involved validating the HPLC analytical methodology for AcART, SEDDS, and NPs-LLC formulations, and conducting physicochemical characterization and ex-vivo intestinal permeation assays. The composition of formulations was determined by the solubility balance of AcART and PZQ. The drug content ranged between 83 and 90 %. The anionic zeta potential was attributed to Myverol®, and the particle diameter increased slightly after the drug incorporation, while the polydispersity index indicated the relatively narrow particle size distribution. Additionally, the DSC thermogram confirmed that PZQ and AcART are in solution within SEDDS and NPs-LLC. The FTIR analysis suggests that components of SEDDS and NPs-LLC and drugs do not react to form new chemical species. The selection of specific compound formulations was based on achieving the best solubility balance. The nanostructures were stable and exhibited a surface charge favorable to mucosal permeation, with slightly superior performance for SEDDS. The innovative formulations, SEDDS and NPs-LLC, are suitable and effective carriers for AcART and PZQ.

Comparison of Butorphanol-Azaperone-Medetomidine and Nalbuphine-Medetomidine-Azaperone in Free-Ranging Elk (Cervus canadensis) in Pennsylvania, USA.

Chemical immobilization is commonly used to capture and handle free-ranging elk (Cervus canadensis). Butorphanol-azaperone-medetomidine (BAM) and nalbuphine-medetomidine-azaperone (NalMed-A) are compounded drug combinations that are lower-scheduled in the US than drugs historically used for elk immobilizations. We compared BAM and NalMed-A for immobilization of free-ranging elk using free-darting and Clover trapping. From January 2020 to April 2022, 196 female elk were immobilized in Pennsylvania, USA. We report vital rates, induction and recovery times, and the need for supplemental drugs. We built mixed-effects logistic regression models to describe differences between drug choice based on induction and recovery times, capture method, and individual variation. Several models were competing, including our null model, which suggests that BAM and NalMed-A are comparable based on the parameters we evaluated. Supplemental drug administration was more frequently needed in NalMed-A immobilizations (21.2%) than in BAM immobilizations (9.0%). Overall, we found minor differences between BAM and NalMed-A, both of which appear to be effective for immobilizing elk in both free-darting and Clover trapping scenarios when performing moderately invasive, minimally painful procedures on free-ranging elk.

Rise in Campylobacter species antimicrobial resistance in Split-Dalmatia County in a ten-year period

Aim: The aim of this study was to determine whether there are changes in Campylobacter species antimicrobial resis-tance, and epidemiological characteristics of campylobacte-riosis in Split-Dalmatia County (SDC), Croatia, in 2021 com-pared to the period 2010-2012. Methods: The data for this study were obtained from the database of the Teaching Public Health Institute of Split and Dalmatia County (TPHI SDC) Split, and they included all outpatients who have been diagnosed with Campylobacterspp. in their stool samples from January to December 2021. The study analyzed the frequency of infections caused by Campylobacter spp., their distribution according to age, gen-der, place of residence, and month of the year, as well as the antimicrobial resistance of Campylobacter spp. isolates. Results: The total number of Campylobacter spp. stool isolates was 395, with the most common isolate being Campylobacter jejuni (365, 92.4%). Campylobacter jejuni isolates had high resistance to ciprofloxacin (74.8%), moderate resistance to tetracycline (21.2%) and co-resistance to tetracycline-ci-profloxacin (19.3%). The resistance rate to azithromycin was low (1.1%). Although Campylobacter jejuni isolates also showed low resistance to amoxicillin-clavulanate (5.3%), all Campylobacter jejuni strains resistant to amoxicillin-clavula-nate were also multidrug-resistant to two or more tested an-tibiotics: ciprofloxacin and ceftriaxone (100%), tetracycline (15.8%), and azithromycin (5.3%). Epidemiological charac-teristics of campylobacteriosis in SDC in 2021 were similar to those from previous research in the same area.Conclusions: The study revealed an increase in ciprofloxa-cin-resistant Campylobacter jejuni isolates in 2021, compared with findings from 2010 and 2012. However, the percent-age of tetracycline-resistant and tetracycline-ciprofloxacin co-resistant isolates remained stable. Based on these results, azithromycin remains the drug of choice, but it is also pos-sible to treat this infection with amoxicillin-clavulanate be-cause of its low resistance rate

Effectiveness of Adjunctive Drug Therapy to Endoscopic Stenting in Liver Cirrhosis Complicated by Refractory Variceal Bleeding

AIM OF THE STUDY. Comparative clinical analysis of the efficacy of terlipressin and octreotide as additional drug therapy to mechanical hemostasis with nitinol stent in patients with liver cirrhosis complicated by bleeding from esophageal varices refractory to endoscopic treatment.MATERIAL AND METHODS. Thirty-one patients with liver cirrhosis complicated by esophageal variceal bleeding refractory to endoscopic treatment , in whose complex treatment program, as a first-line life­saving measure, hemostasis with a self-expanding hemostasis was performed nitinol stent were randomly assigned to two groups. In group A, 20 patients were treated with terlipressin as an adjuvant to mechanical hemostasis, and in group B, 11 patients were treated with octreotide. Unpaired Student’s t-test was used for statistical analysis of the results. Graphs for assessing the survival function of patients for 8 weeks after the end of treatment were constructed using the Kaplan-Meier method.RESULTS. In the acute observation period terlipressin and octreotide were equally effective in treating refractory variceal bleeding. In the subacute observation period, the administration of octreotide was generally accompanied by a greater number of side effects (54.5%) than terlipressin (30.0%) (p=0.453). In the remote observation period, 8-week survival in the group of patients receiving terlipressin was higher than in the group of patients receiving octreotide.CONCLUSION. Terlipressin is as effective as octreotide as an adjunct to endoscopic stenting in drug therapy for liver cirrhosis complicated by esophageal variceal bleeding refractory to endoscopic treatment. At the same time, terlipressin has a greater effect than octreotide on reducing 8-week mortality, which approaches statistical significance. In this regard, terlipressin may be the vasoactive drug of choice in acute refractory variceal bleeding.

Epidemiology And Biological Mechanisms Of Cardiovascular Disease And Diabetes

The risk of CVDs in T2DM patients in LMICs is higher than in developed nations. It is essential to make an evaluation of the current situation of CVDs among people with T2DM. These CVDs are easily preventable through intervention especially in T2DM patients and this should be done in a comprehensive manner. The following targets and principles should be considered: individual targets of HbA1c for patients, a rigorous control of cardiovascular risk factors such as blood pressure and lipids, and incorporation of newer anti-diabetic, lipid-lowering and anti-hypertensive agents. It is, therefore, crucial to design a stepped-wedge approach that bundles a patient-level intervention, lifestyle, and pharmacological interventions to reduce the risk of CVD in LMIC T2DM populations. When selecting medications for T2DM patients with cardiovascular conditions, several key considerations must be made: When selecting medications for T2DM patients with cardiovascular conditions, several key considerations must be made: It should be noted that the choice of anti-diabetic drugs should take into consideration cardiovascular safety. SGLT2 inhibitors and GLP-1 agonists are newer agents for managing diabetes and have been found to have cardiorenal benefits. The choice of lipid-lowering should be targeted to lower LDL cholesterol and triglycerides as effectively as possible. If the intensity of statin is high; it is considered first-line therapy, and other optional medication includes ezetimibe and PCSK9 inhibitors. To maintain the best pressure level that is suitable for an individual, and as a result control hypertension, the use of antihypertensive drugs is necessary. This makes ACE inhibitors or ARBs the preferred first-line antihypertensive agents because of their cardiovascular benefits. For the purpose of secondary prevention in individuals who have experienced a cardiovascular event, the antiplatelet drug aspirin in a dosage of between 75 to 150 milligrams per day should be administered. This is to minimize the probability of such difficulties re-emerging by influencing platelet activity. In general, adequate blood pressure management and antiplatelet aggregation therapy are key interventions with specific antiplatelet medication needs in this setting.

The Impact of QT-Prolonging Medications and Drug-Drug Interactions on QTc Interval Prolongation in Hospitalized Patients: A Case-Crossover Study.

Researchers have studied potential corrected QT interval (QTc) prolongation from drug-drug interactions (DDIs), raising unresolved questions about their real-world impact. This retrospective case-crossover study investigated the effects of QT-prolonging drugs and DDIs on QTc prolongation in hospitalized patients aged 45 years and above. The cohort comprised patients who had multiple hospitalizations and developed QTc prolongation (QTc > 500 ms or an increase of >60 ms from baseline) at least 24 hours after admission between 2011 and 2019. Conditional logistic regression compared drug exposure between hospitalizations with QTc prolongation (case window) and those without (reference window). Among 2,276 patients (mean age 71; 43.8% female), the use of QT-prolonging drugs significantly increased the risk of QTc prolongation (odds ratio: 2.42 (95% confidence interval: 1.95-3.02)). The risk was higher with drugs of "known risks" (OR: 3.78 (2.91-4.90)) and "conditional risk" (OR: 2.08 (1.65-2.62)). DDIs, particularly involving multiple "known risk" drugs (OR: 7.86 (4.96-12.45)), strong cytochrome P450 enzyme inhibitors (OR: 5.57 (2.75-11.30)), or the concurrent use of ≥4 QT-prolonging drugs with any risk (OR: 5.28 (3.96-7.03)) substantially increased the risk. Cautious prescribing for patients with multiple risk factors is important to minimize the likelihood of QTc prolongation. However, when considering enhanced monitoring or drug choices, it is crucial to carefully evaluate the overall risk of QT prolongation against the benefits of treatment to ensure optimal patient care.

Anti-oxidant and antibacterial activities of novel N-sulfonylphtalimide in an ovalbumin-induced inflammation in Wistar rats.

Phthalimide and N-substituted phthalimide have a special structure that helps them to be pharmaceutically useful and biologically active. In this study, we investigated the antioxidant, anti-inflammatory and antibacterial effects of a synthetic phthalimide-containing derivative in an experimental asthma model. In vitro determination of antioxidant and chelating activity was carried out by spectrophotometric methods. The in vivo antioxidant activity was carried out in Wistar rats sensitized to ovalbumin in the experimental model of asthma. Our results reveal that that the synthesized N-sulfonylphthalimide molecule has a scavenging capacity against the free radical 2,2-diphenyl-1-picryl-hydrazyl (DPPH•) and a chelating activity on ferrous ions and revealed its protective capacity against altered markers of oxidative stress in the experimental asthma model. All the previous results were confirmed by the result of the histopathological study of the liver. Moreover, neo-synthesized N-sulfonylphthalimide 2 showed antibacterial activity against Gram-positive and Gram-negative bacteria with interesting MIC values. Finally, our study highlights the anti-inflammatory, anti-asthmatic and antibacterial effects of the N-sulfonylphthalimide molecule, which could potentially be a drug of choice in asthmatic pathology, especially during bacterial superinfections in the respiratory tract.

Management of Pulmonary Mucormycosis: A Systematic Review

Background Mucormycosis is a life-threatening fungal infection. Rhino-orbito-cerebral mucormycosis (ROCM) and pulmonary mucormycosis (PM) are the most common presentations. This systematic review focuses on the management of PM. Although the mortality from PM has improved over the last few decades, it is still high, at 49.8% (Muthu, Agarwal, et al., 2021). Objective The objective is to identify and map the management of PM. Design This review is designed for knowledge synthesis, with a systematic approach to identifying, synthesizing, and mapping treatment protocols for the management of PM. Methods This systematic review provides a clear, reproducible methodology. It is reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Inclusion criteria were defined: peer-reviewed journal articles published in English from 2018 to 2023 relating to treatment protocols for PM, where the full text of the article was available. Exclusion criteria were also defined - articles that focus on limited treatment regimens, such as the use of amphotericin B only, or topics not relevant to the research question, such as fungal infections and pulmonary diseases unrelated to mucormycosis. Results The results span six years, from 2018 to 2023, with 355 articles identified. After removing duplicates, 227 papers remained. Inclusion and exclusion criteria were applied, with 202 articles excluded as a result. The remaining 19 articles were deemed relevant. In addition, seven relevant articles were identified via citation tracking and two articles identified by hand search. Thus, a total of 28 articles thus reviewed. The management of PM was mapped in tabular and diagrammatic form. Conclusion The results indicate that early diagnosis, early and aggressive surgery, and effective antifungals may improve survival. There is a shift away from using Am-B and a clear preference for L-AmB as a first-line antifungal. Posaconazole and Isavuconazole are the drugs of choice for stepdown, maintenance, and salvage therapy, and as alternative therapies. The control of co-morbidities is a crucial aspect of treatment. Cytokines and hyperbaric oxygen may be beneficial. The therapeutic value of iron chelators, zinc, and nebulized amphotericin B (NAB) merit further study.

Pityriasis rubra pilaris: A review

Pityriasis rubra pilaris (PRP, syn.: Devergie's disease) is a rare idiopathic papulo-squamous inflammatory skin disease characterized by follicular papules, palmar-plantar keratoderma, scaling plaques of orange-red color with characteristic foci of unaffected skin. Histologically, the alternating pattern of orthokeratosis and parakeratosis is considered a distinctive feature of PRP (staggered hyperkeratosis). A violation of the regulation of innate immunity is a component of the pathogenesis of PRP. Congenital mutations of CARD 14 or concomitant antigens, which can take the form of iatrogenic lesions, infections or malignant neoplasms, can be the initial triggers of the disease, although the etiology is often idiopathic. There are classically five subtypes of the disease, depending on the age of onset and clinical picture. Type VI PRP is associated with infection caused by the human immunodeficiency virus. CARD 14-associated papulosquamous rash and discoid dermatitis of the face represent new clinical phenotypes of PRP. Devergie's disease has a pronounced negative impact on the quality of life, and those who become ill are at increased risk of depression and suicide. Ixekizumab, methotrexate and secukinumab can be considered as systemic drugs of the first choice. If there is a contraindication to immunosuppressive therapy, high doses of isotretinoin are recommended. Topical agents, including calcipotriene, calcineurin inhibitors, emollients and topical corticosteroids, are used as additional therapy.

Use of Dispersible Fixed-Dose Combinations in Chemotherapy of Drug Susceptible Tuberculosis: Results of the Observational Study

The objective: to assess effectiveness, safety and pharmacoeconomic feasibility of using a dispersible fixed-dose combination (isoniazid 150 mg, rifampicin 150 mg, pyrazinamide 375 mg) in patients with respiratory tuberculosis and preserved susceptibility of Mycobacterium tuberculosis (MTB) to anti-tuberculosis drugs.Subjects and Methods. A post-registration observational study was conducted to assess treatment effectiveness of pulmonary tuberculosis in 60 adult patients with drug susceptible tuberculosis. In Main Group, patients received the fixed-dose combination (isoniazid 150 mg, rifampicin 150 mg, pyrazinamide 375 mg), while in Control Group, patients were treated with the regimen consisting of single anti-tuberculosis drugs.Results. Sputum conversion rate made 76.7% by the end of the intensive phase (60 doses) when replacing isoniazid, rifampicin and pyrazinamide with the dispersible fixed-dose combination, while with the standard choice of drugs, it was 66.7%. The incidence of adverse reactions was 7-fold lower when using the investigational drug which contributed to a high level of adherence and high effectiveness of therapy. Pharmacoeconomic analysis convincingly demonstrated advantages and economic benefits of the dispersible fixed-dose combination (isoniazid 150 mg, rifampicin 150 mg, pyrazinamide 375 mg), which was more costly than the combination of single drugs.

In vivo anti-schistosomal activity of the methanol extracts from Searsia longipes and Lannea schimperi

Schistosomiasis is a disease caused by the flat worms under the genus Schistosoma. The disease is prominent in tropical and sub tropical countries and it is manifested in two forms; the acute and the chronic form. Treatment and control of the schistosomiasis is constrained with various factors including immerging worm resistance and selective efficacy of the current recommended drug of choice. This therefore calls for the search of new approaches to offset the problems. The aim of this study was to investigate the efficacy of the methanolic extract from Searsia longipes and Lannea schimperi against Schistosoma mansoni by using animal model. Swiss albino mice were used for the efficacy testing, whereby, for each extract, 5 groups of mice were used, and each contained 5 mice. Three different doses were administered to three groups, whereas the remaining two groups were used as negative and positive control arms. Efficacies were assessed based on the reduction of the worm eggs in the faeces and organs, body weight gain, loss of liver weight, as well as reduction of worm burden. Both extracts demonstrated significant egg and worm reduction, which was directly proportional to the dose increment. At the highest dose used, Searsia longipes expressed the higher percentage egg reduction (73.33 %), whereas Lannea schimperi demonstrated the higher worm burden reduction (68.53 %). The present study provides strong evidence of the anti-schistosomal activity of the extracts from both S. longipes and L. schimperi. These findings are a significant step forward, suggesting that these plants could be a promising alternative medicine for the treatment of schistosomiasis. However, further investigations are warranted to isolate the compound responsible for this activity and to assess the sub-acute toxicity of the plant extracts. This next phase of research is crucial for advancing our understanding and potential use of these plant extracts.

8801 Towards Safe and Efficacious Medical Therapy for Patients with Clinically Non-Functioning Pituitary Tumors

Abstract Disclosure: D. Zhang: None. M. Bergsneider: None. W. Kim: None. M.B. Wang: None. H. Vinters: None. A.P. Heaney: None. Clinically non-functioning pituitary tumors (CNFTs) account for one-third of all pituitary adenomas. They do not cause clinical and/or biochemical evidence of tumor-related hormone hypersecretion, grow insidiously and typically present with mass effect symptoms such as headache and visual field deficits. Surgical resection is the current standard of care for CNFTs but complete resection is infrequently achieved due to their size and invariable invasion of locally adjacent structures. CNFT remnant tumor regrowth rates approach 50% and these patients may need repeat surgery and/or radiotherapy (RT). The latter is quite effective in achieving tumor control, but carries a risk of hypopituitarism of ∼ 40% at 10 years. Although dopamine agonists and somatostatin receptor ligands have been explored as medical therapy, there are currently no consistently effective medical treatments for CNFTs. There is a clear unmet need for novel safe and effective medical therapies for these comparatively common tumors. In a highly innovative approach we have used patient-derived ex vivo 3D tumoroid human CNFTs in an automated high throughput compound screen (HTS) to identify novel tumoricidal and growth inhibitory compounds for CNFTs. To date, we have screened ∼4,000 compounds and have identified 13 potential hits that inhibited tumor cell proliferation (a reduction of 76±15%) and induced apoptosis (induction rate of 8.2 ± 6.6) in the CNFT tumoroids respectively. The hit compounds to date fall into 3 categories based on their targets, namely Na+/K+-ATPase inhibitors (n=6), reactive oxygen species (ROS) regulators (n=4), and cell cycle inhibitors (n=3). Representative “hit” compounds from each group identified in our primary screen were rescreened in triplicate in 20 concentrations from 25µM to 50pM at 2-fold dilutions. Dose-response curves characterized compound doses that inhibited cell viability by 50% (IC50) and ranged from 13nM to 103nM. Two of these 3 compounds also induced 2-3-fold apoptosis at 0.1uM with the final compound displaying a potent 5-10-fold pro-apoptotic effect at 0.15uM concentration. In parallel, we used single cell RNA sequencing to validate targets that emerged from our HTS and to characterize the mechanism of action (MOA) of these hit compounds. As proof of concept, several of the known drug targets were noted to be amongst the highest differentially expressed genes in the CNFT tumor cell population. This approach validating a candidate target in conjunction with demonstrable activity of a drug for that same target in CNFTs may simultaneously provide us with a back-bone molecule to further develop with structural activity relationship analysis and/or allow us to individualize drug choice in patients based on immunocytochemical tumor target expression. Presentation: 6/1/2024

Use of sirolimus-coated balloon in de novo coronary lesions; long-term clinical outcomes from a multi-center real-world population.

Sirolimus-coated balloon (SCB), a relatively novel technology appears attractive due to the drug properties (safety and efficacy) and sirolimus remains the drug of choice in stents. However, there is limited data long-term data on SCB. In this study, we have explored the clinical outcomes following the use of SCB in de-novo lesions from a real-world practice. To report long-term clinical outcomes following the use of Siroliumus coated balloon in de novo lesions. We analyzed all patients treated with an SCB in de novo lesions between 2016 and 2023 at four high-volume centers in UK and Italy. The outcomes measured included cardiac death, target vessel myocardial infarction (TVMI), target lesion revascularization (TLR) and major adverse cardiac events (MACE). During the study period, 771 patients had SCB in de novo lesions. Diabetes mellitus was noted in 36% of patients (n = 280), of which 14% (n = 108) were insulin dependent. Fifteen percent (n = 117) had chronic kidney disease, Fifty-two percent (n = 398) of cases were in the setting acute coronary syndrome (ACS) and of which 51 cases (7%) were ST-segment elevation myocardial infarction. Small vessels (<3.0 mm) accounted for 78% (n = 601) of cases and 76% (n = 584) were long lesions ( 20 mm). The mean diameter of SCB was 2.6 ± 0.4 mm and the mean length was 25 ± 10.39 mm. Bailout stenting following SCB was required in 9% lesions (n = 67). During the median follow-up 640 days, total death occurred in 39 (5%) patients and of which, cardiac death occurred in 10 patients (1.3%). TVMI occurred in 20 patients (2.6%). TLR and TVR were 5.6% and 5.8% respectively. The overall MACE rate was 8%. We had no documented case of acute vessel closure. The results from this long-term follow-up in a real-world population are encouraging with low rates of hard endpoints and acceptable rates of TLR and MACE despite a complex group of patients. Our data suggest that SCBs are safe in coronary intervention with good clinical outcomes in the long term.