Intravenous Drug Administration Research Articles

Patient-reported preferences for subcutaneous or intravenous administration of parenteral drug treatments in adults with immune disorders: a systematic review and meta-analysis.

Aim: Several studies have found subcutaneous (SC) and intravenous (IV) administration of similar drugs for long-lasting immunological and autoimmune diseases to have similar clinical effectiveness, meaning that what patients report they prefer is, or should be, a major factor in treatment choices. Therefore, it is important to systematically compile evidence regarding patient preferences, treatment satisfaction and health-related quality of life (HRQL) using SC or IV administration of the same drug. Materials & methods: PubMed database searches were run on 15 October 2021. Studies involving patients with experience of both home-based SC and hospital-based IV administration of immunoglobulins or biological therapies for the treatment of any autoimmune disease or primary immunodeficiencies (PIDs) were included. The outcomes assessed were patient preferences, treatment satisfaction and HRQL. Preference data were meta-analyzed using a random-effects model. Results: In total, 3504 citations were screened, and 46 publications describing 37 studies were included in the review. There was a strong overall preference for SC over IV administration, with similar results seen for PIDs and autoimmune diseases: PID, 80% (95% confidence interval [CI], 64-94%) preferred SC; autoimmune diseases, 83% (95% CI: 73-92%); overall, 82% (95% CI: 75-89%). The meta-analysis also found that 84% (95% CI: 75-92%) of patients preferred administration at home to treatment in hospital. Analysis of treatment satisfaction using the life quality index found consistently better treatment interference and treatment setting scores with SC administration than with IV administration. Conclusion: Compared with IV infusions in hospital, patients tend to prefer, to be more satisfied with and to report better HRQL with SC administration of the same drug at home, primarily due to the greater convenience. This study contributes to evidence-based care of patients with autoimmune diseases or PIDs.

Utilizing a sutureless valve for prosthetic valve endocarditis after aortic root replacement

BackgroundReoperation following aortic root replacement is associated with significantly high operative mortality. Etiologies related to infection are known to increase the operative mortality rate more than other etiologies. In such a clinical setting, a sutureless valve could lower the operative mortality by shortening the cardiac arrest and the operative time.Case presentationA 61-year-old male underwent emergent aortic root and total arch replacement with an open stent graft for acute type-A aortic dissection. A bioprosthetic valve was employed for aortic root replacement using the double-sewing ring technique. A fungal infection by Candida parapsilosis was postoperatively detected and improved with intravenous antifungal drug administration. However, he developed congestive heart failure one year later, and the blood cultures turned positive repeatedly for Candida parapsilosis. The prosthetic valve infection was suspected upon identifying vegetation on the bioprosthetic valve through transthoracic echocardiography. The computed tomography scan and operative findings confirmed that the infection was localized on the prosthetic valve. Consequently, the infected valve was removed without a vascular conduit, and a sutureless valve was implanted. The postoperative course was uneventful, without any evidence of recurrent fungal infection, and the patient was discharged on postoperative day 28.ConclusionsDeploying a sutureless valve can facilitate a more straightforward and minimally invasive redo procedure. Preoperative computed tomography can predict the valve size, which is the key to implanting a sutureless valve successfully after the modified Bentall procedure.

Electrochemotherapy with intravenous, intratumoral, or combined administration of bleomycin in the treatment of colorectal hepatic metastases in a rat model

Electrochemotherapy (ECT) combines the reversible electroporation (rEP) with intravenous (i.v.) or intratumoral (i.t.) administration of chemotherapeutic drugs. We conducted this study to compare the efficacy of i.v., i.t., and i.v. + i.t. injection of bleomycin (BLM) in ECT treatment of colorectal hepatic metastases in a rat model. WAG/Rij rats were randomized into three groups and underwent ECT with i.v., i.t., or i.v. + i.t. injection of BLM. Tumor volumes and oxygenation were measured by means of ultrasound and photoacoustic imaging. Moreover, liver and tumor tissue were analyzed by histology and immunohistochemistry. The i.v. and i.v. + i.t. groups exhibited a 44.0% and 46.6% reduction in oxygen saturation of the tumor tissue when compared to pretreatment values, whereas the i.t. group only showed a reduction of 35.2%. The extent of tumor tissue necrosis did not statistically differ between the groups. However, the i.t. group showed a tendency towards a lower necrosis rate. Cell proliferation, apoptotic cell death, vascularization, and immune cell infiltration were comparable in the treated tumors of the three groups. ECT with i.v. administration of BLM should be preferred in clinical practice, as the combined i.v. + i.t. therapy did not show superior oncological outcomes in the present study.

Plasma and Tissue Amikacin Concentrations Following Regional Limb Perfusion of Chickens (Gallus gallus domesticus).

Intravenous regional limb perfusion (IVRLP) has been used in the treatment of pododermatitis and distal limb infections, which are significant causes of morbidity in avian species. This intravenous drug administration technique is designed to achieve high drug tissue concentrations while minimizing systemic toxic effects. Amikacin is commonly used for IVRLP in veterinary medicine, but dosing guidelines have not been established for its use in birds. The current study aimed to determine the tissue concentration of amikacin after a single IVRLP administration in healthy, euhydrated leghorn hen chickens (Gallus gallus domesticus). Chickens received a single IVRLP dose of 10 mg/kg amikacin and were euthanatized posttreatment at 1 hour (n = 6), 12 hours (n = 6), and 24 hours (n = 6) to assess tissue and synovial fluid concentrations of amikacin in the injected leg. Mean tissue concentrations were highest 1 hour post-IVRLP (synovial fluid = 153.0 µg/mL, metatarsal pad tissue = 26.05 µg/mL) before declining at the 12- and 24-hour time points. This indicates that administration of amikacin via IVRLP can reach minimum inhibitory concentrations of common bacterial isolates in tissues after a single treatment with 10 mg/kg amikacin. Regional limb perfusion every 24 hours is recommended, although the minimum days of treatment may be case dependent and vary based on response to therapy.

An Integrated Approach to the Prevention of Postpartum Bleeding in High-Risk Patients

Aim. To evaluate the effectiveness of an integrated approach to the prevention of postpartum hemorrhage (PPH) in high-risk patients using uterine balloon tamponade with a double-balloon system, double-sided compression suture on the lower uterine segment, and administration of a uterotonic drug.Materials and Methods. Here we performed an open-label, comparative, controlled clinical trial aimed at establishing superiority. 144 pregnant patients with a high risk of PPH were randomised into 2 groups of 72 patients each. When implementing the study protocol, 22 patients were excluded from the treatment group, and 1 patient was excluded from the control group. In the treatment group, in addition to routine prevention, we applied an original technique which included uterine balloon tamponade with a double-balloon system, double-sided compression suture in the lower uterine segment, and intravenous administration of carbetocin. Control group received routine prevention of PPH. Statistical data analysis was carried out using Python version 3.11.Results. The volume of blood loss ranged from 500 to 1900 mL in the treatment group and from 400 to 3900 mL in the control group (p = 0.375). In the treatment group, the incidence of PPH was significantly lower than in the control group (10.00% and 49.30%, respectively, p < 0.0001), as well as the frequency of blood loss > 1000 mL (20.00% and 39.44%, respectively, p = 0.002). Blood loss > 2000 mL was recorded exclusively in the control group (12.69% patients). Among the secondary outcomes, blood products were used significantly less frequently in patients of the treatment group compared to the control group (12.00% and 29.58%, respectively, p = 0.027); hysterectomy was performed only in 6 (8.45%) patients of the control group. The duration of hospitalisation after childbirth did not differ significantly between the groups.Conclusion. An integrated approach to the prevention of PPH, which employs a double-sided compression suture on the lower uterine segment, uterine balloon tamponade using a double-balloon Zhukovsky system, and intravenous administration of a uterotonic drug, is more effective in preventing PPH in high-risk patients as compared with routine practice. Further multicenter extended studies in this direction are needed.

Disseminated Granulomatous Lung Disease in Patients with Intravenous Drug Use: Clinical and Morphological Features

Pulmonary dissemination syndrome is a radiological syndrome characterised by the development of multiple focal opacities and/or an increase and reticular deformation of the lung pattern, often bilaterally. It can occur in the development of various pathological processes, with over 200 different lung diseases associated with its development.Key components of differential diagnosis include a thorough study of the patient’s history, evaluation of clinical symptoms, radiological imaging and the dynamics of the process during observation, laboratory indicators and spirometry data. If a diagnosis cannot be established, it is appropriate to perform transbronchial lung biopsy or video thoracoscopy with biopsy of the most affected lung areas.This paper presents current data on the development of a rare variant of disseminated granulomatous process in the lungs, which can occur in drug-dependent individuals who intravenously inject solutions or suspensions of drugs originally manufactured in tablet form and intended for oral use. Literary data and personal observations from practice are provided. Typically, such patients do not have specific complaints or clinical signs, and their laboratory indicators are also non-specific. Radiologically, a disseminated process in the lungs is diagnosed. The main diagnostic measure in such cases is surgical lung biopsy followed by morphological examination. Histological descriptions of peculiar changes in lung tissue and useful additional studies for differential diagnosis are presented. Two cases are detailed, one of which involved a combination of morphological signs of past tuberculosis with manifestations of another giant cell granulomatous process.It is crucial in the diagnosis of this pulmonary pathology to establish and clarify the history—repeated intravenous administration of drugs intended for oral use, as most patients tend to conceal this information.

Percepción del impacto del tratamiento biológico endovenoso sobre el ámbito laboral y personal en pacientes con enfermedad inflamatoria intestinal

IntroductionIn the treatment of inflammatory bowel disease (IBD), we have biologic therapies administered intravenously and subcutaneously. Recently, some drugs can be administered by either of these routes. The real impact that intravenous administration has on the perception of the disease and the personal and work life of the patient is unknown. MethodsAll IBD patients receiving intravenous infliximab treatment for at least 6 months were anonymously invited to participate. They were provided with a specific structured questionnaire with visual analogue scales (0-10) at two reference centers in the Barcelona area. ResultsA total of 90 patients with a median age of 45 years (36-56) and a median infliximab treatment duration of 48 months (24-84) were included. The visit and therapy with infliximab in the day hospital were globally well evaluated (9, IQR 7-10). 78% of patients combined day hospital stays with other activities (26% employment). The personal impact was generally low (4, IQR 0-5.8), but the patient's job was threatened in 43% of patients on intensified treatment. ConclusionsThe intravenous administration of biologic drugs on an outpatient basis is highly satisfactory among IBD patients. The impact on the work sphere appears to be more pronounced than on the personal sphere, an aspect that should be considered in shared decision-making with the patient.

Hyaluronic acid-oleylamine and chitosan-oleic acid conjugate-based hybrid nanoparticle delivery via. dissolving microneedles for enhanced treatment efficacy in localized breast cancer

Microneedle technology offers a minimally invasive treatment strategy to deliver chemotherapeutics to localized tumors. Amalgamating the surface functionalized nanoparticles with microneedle technology can potentially deliver drugs directly to tumors and subsequently target cancer cells via, overexpressed receptors on the cell surface, thereby enhancing the treatment efficacy while reducing side effects. Here, we report cetuximab anchored hyaluronic acid-oleylamine and chitosan-oleic acid-based hybrid nanoparticle (HA-OA/CS-OA NPT)-loaded dissolving microneedles (MN) for targeted delivery of cabazitaxel (CBT) in localized breast cancer tumor. The HA-OA/CS-OA NPT was characterized for their size, surface charge, morphology, physicochemical characteristics, drug release behavior, and in vitro anti-cancer efficacy. The HA-OA/CS-OA NPT were of ~125 nm size, showed enhanced cytotoxicity and cellular uptake, and elicited a superior apoptotic response against MDA-MB-231 cells. Subsequently, the morphology and physicochemical characteristics of HA-OA/CS-OA NPT-loaded MN were also evaluated. The fabricated microneedles were of ~550 μm height and showed loading of nanoparticles equivalent to ~250 μg of CBT. The ex vivo skin permeation study revealed fast dissolution of microneedles upon hydration, while the drug permeation across the skin exhibited ~4-fold improvement in comparison to free drug-loaded MN. In vivo studies performed on DMBA-induced breast cancer in female SD rats showed a marked reduction in tumor volume after administration of drug and nanoparticle-loaded microneedles in comparison to intravenous administration of free drug. However, the HA-OA/CS-OA NPT-MN showed the highest tumor reduction and survival rate, with the lowest body weight reduction in comparison to other treatment groups, indicating its superior efficacy and low systemic toxicity. Overall, the dissolving microneedle-mediated delivery of targeted nanoparticles loaded with chemotherapeutics offers a superior alternative to conventional intravenous chemotherapy.

Evolution of Intravenous Medication Errors and Preventive Systemic Defenses in Hospital Settings-A Narrative Review of Recent Evidence.

Intravenous drug administration has been associated with severe medication errors in hospitals. The present narrative review is based on a systematic literature search, and aimed to describe the recent evolution in research on systemic causes and defenses in intravenous medication errors in hospitals. This narrative review was based on Reason's theory of systems-based risk management. A systematic literature search covering the period from June 2016 to October 2021 was conducted on Medline (Ovid). We used the search strategy and selection criteria developed for our previous systematic reviews. The included articles were analyzed and compared to our previous reviews. The updated search found 435 articles. Of the 63 included articles, 16 focused on systemic causes of intravenous medication errors, and 47 on systemic defenses. A high proportion (n = 24, 38%) of the studies were conducted in the United States or Canada. Most of the studies focused on drug administration (n = 21/63, 33%) and preparation (n = 19/63, 30%). Compared to our previous review of error causes, more studies (n = 5/16, 31%) utilized research designs with a prospective risk management approach. Within articles related to systemic defenses, smart infusion pumps remained most widely studied (n = 10/47, 21%), while those related to preparation technologies (n = 7/47, 15%) had increased. This narrative review demonstrates a growing interest in systems-based risk management for intravenous drug therapy and in introducing new technology, particularly smart infusion pumps and preparation systems, as systemic defenses. When introducing new technologies, prospective assessment and continuous monitoring of emerging safety risks should be conducted.

Factors related to nurse compliance in monitoring infusion fluid in hospital

Infusion therapy involves the intravenous administration of drugs, fluids, and blood products to hospitalized clients. This study aimed to identify factors influencing nurse compliance in monitoring infusion fluids according to Standard Operating Procedures (SOPs). The research adopted a quantitative approach with a descriptive correlational design and a cross-sectional approach, focusing on a study population of 50 nurses. Data collection utilized observation techniques and questionnaires as research instruments, with the analysis employing Kendall's Tau B and Kendall's Tau C methods. The findings revealed significant correlations between age (p-value=0.000), education (p-value=0.006), career path level (p-value=0.013), and knowledge (p-value=0.011). However, there was no significant relationship between the length of work experience and nurse compliance in monitoring infusion fluids (p-value=0.257) according to SOPs in this private hospital. To enhance the quality of care, it is recommended that nurses receive additional training provided by the nursing education team at the hospital, focusing specifically on the monitoring of infusion fluids. This targeted training could contribute to reducing instances of complaints related to mismatched patient needs and ultimately improve compliance with established SOPs in infusion therapy.

Strategy to secure the neuraxial route in anaesthesia: Risk mapping and feedback from the application of the ISO 80369-6 standard NRFit® connectors

In anesthesia, a medication error would occur every 20 to 133anesthesia procedures, and 14% is related to a route administration error. To secure neuraxial route, ISO group published a norm in 2016 to develop specific connectors, the "NRFit® connector". The main objective of this work, is to develop a risk mapping related to neuraxial medication errors therefore prepare the NRFit® implementation in anesthesia units in a French Universitary Hospital. Failure modes, effects and criticality analysis (FMECA) methodology was used for our risk mapping which was divided in 3 anesthesia specialities. For each, the analysis was performed for accidental neuraxial administration of intravenous drugs, and its opposite error. Secondly, NRFit® devices were tested for 1month by 3 experimented anesthetists. The majority of reported errors concerns epidural and intrathecal anesthesia, and more frequently in the field of obstetrics. Opioids and tranexamic acid, administered in neuraxial route, are drugs with the highest criticality. The tests were rather conclusive and made it possible to highlight the additional needs in medical devices. Obstetrics is the riskiest area due to the frequency of epidural anesthesia, the administration of critical drugs in intravenous and neuraxial route. This work increased the awareness of our group, improved the measure of this risk and harmonized practices. This work is the first step of the project to prevent administration route error in anesthesia during patient's drug management. The next step will be the NRFit® implementation for epidural and combined spinal-epidural anesthesia in our hospital.

The significance of risk factors for acquiring hepatitis B and C virus infections in children with oncological and hematological diseases and immunodeficiencies

Patients with oncological and hematological diseases are at high risk of nosocomial bloodborne infections (hepatitis B, hepatitis C, and HIV) due to their immunosuppressed condition and highly invasive treatment. The aim of our study is to identify the key risk factors of acquiring bloodborne infections among patients with hematological and oncological diseases and to determine the causes of uneven prevalence of hepatitis B and C among main clinical groups of patients. The study was carried out from 2021 to 2023. The study cohort consisted of 500 patients, with 100 patients in each clinical group: primary immunodeficiencies PID), disorders of the blood and blood-forming organs (BD), hematological malignancies (HM), malignant solid tumors (MST), benign tumors (BT). The median burden of invasive procedures per patient in the patients with HM, MST, BD, BT, and PID amounted to 10.9, 6.2, 5.1, 4.1, and 2.2 invasive interventions a day, respectively. The median infusion/injection burden was 8.3, 4.0, 2.7, 2.7, and 0.6 drugs a day, respectively. The median blood sampling burden amounted to 2.0, 1.7, 1.7, 1.3, and 1.6 samples a day, respectively. The median transfusion burden was 0.14, 0.07, 0.25, 0, and 0 units of transfused blood components a day, respectively. The median surgery burden was 0, 0.15, 0, 0.17, 0 surgical procedures a day, respectively. The medians for other medical procedures in all clinical groups amounted to 0. The patients with PID representing a clinical group of patients with the highest prevalence of hepatitis B and C infections (2.5 % and 2.3 %, respectively) have the lowest level of invasive burden. It should be supposed that the major risk factor of acquiring HBV or HCV among patients with oncological and hematological diseases is the level of immunocompetence together with the impact of risk factors associated with invasive procedures such as blood transfusions, the use of venous catheters (for intravenous administration of drugs and blood sampling), and extensive surgeries.

Значение факторов риска заражения вирусными гепатитами в и с у детей с онкогематологическими заболеваниями и иммунодефицитными состояниями

Patients with oncological and hematological diseases are at high risk of nosocomial bloodborne infections (hepatitis B, hepatitis C, and HIV) due to their immunosuppressed condition and highly invasive treatment. The aim of our study is to identify the key risk factors of acquiring bloodborne infections among patients with hematological and oncological diseases and to determine the causes of uneven prevalence of hepatitis B and C among main clinical groups of patients. The study was carried out from 2021 to 2023. The study cohort consisted of 500 patients, with 100 patients in each clinical group: primary immunodeficiencies PID), disorders of the blood and blood-forming organs (BD), hematological malignancies (HM), malignant solid tumors (MST), benign tumors (BT). The median burden of invasive procedures per patient in the patients with HM, MST, BD, BT, and PID amounted to 10.9, 6.2, 5.1, 4.1, and 2.2 invasive interventions a day, respectively. The median infusion/injection burden was 8.3, 4.0, 2.7, 2.7, and 0.6 drugs a day, respectively. The median blood sampling burden amounted to 2.0, 1.7, 1.7, 1.3, and 1.6 samples a day, respectively. The median transfusion burden was 0.14, 0.07, 0.25, 0, and 0 units of transfused blood components a day, respectively. The median surgery burden was 0, 0.15, 0, 0.17, 0 surgical procedures a day, respectively. The medians for other medical procedures in all clinical groups amounted to 0. The patients with PID representing a clinical group of patients with the highest prevalence of hepatitis B and C infections (2.5 % and 2.3 %, respectively) have the lowest level of invasive burden. It should be supposed that the major risk factor of acquiring HBV or HCV among patients with oncological and hematological diseases is the level of immunocompetence together with the impact of risk factors associated with invasive procedures such as blood transfusions, the use of venous catheters (for intravenous administration of drugs and blood sampling), and extensive surgeries.

The effect of air-free administration of intravenous drugs on microemboli during cardiopulmonary bypass.

During cardiopulmonary bypass (CPB), gaseous microemboli (GME) that originate from the extracorporeal circuit are released into the arterial blood stream of the patient. Gaseous microemboli may contribute to adverse outcome after cardiac surgery with CPB. Possibly, air may be collected in the right atrium during induction of anesthesia and released during CPB start. The aim of this study was to assess if the GME load entering the venous line of the CPB circuit could be reduced by training of anesthesia personal in avoiding air introduction during administration of intravenous medication. In 94 patients undergoing coronary artery bypass grafting with CPB, GME number and volume were measured intraoperatively with a bubble counter (BCC300). The quantity and the relationship between GME number and volume in the venous and arterial line were determined in 2 periods before and after education of the anesthesiologists and nurses. In the venous line no significant differences were observed between numbers and volumes of GME between groups. Comparing patients with low versus high GME load, showed significantly more patients from the intervention group in the low GME-load group, namely 29 versus 18. Administration of medication by anesthesia was confirmed as a clear cause of GME/air-introduction into the venous circulation. Scavenging properties of the CPB circuit including the oxygenator showed a 99.9% reduction of GME. A wide spread of GME generation during perfusion was present with no difference in generation of GME between groups. Lower GME load observed in patients (intervention group) and examples of air introduction during drug administration suggest that air introduced by anesthesia contributes to the GME load during CPB. Scavenging properties of the CPB circuit contribute very much to patient safety regarding reduction of venous air. Awareness and education create the possibilities for further reduction of GME during cardiopulmonary bypass.

How should newer therapeutic agents be incorporated into the treatment of patients with myasthenia gravis?

Generalized myasthenia gravis (gMG) is a postsynaptic neuromuscular junction disorder that results in fatigable muscle weakness. The traditional treatment approach includes the use of acetylcholinesterase inhibitors, corticosteroids, and steroid-sparing immunosuppressant therapies (ISTs) for chronic management, whereas exacerbations and crises are managed with intravenous immunoglobulin (IVIg) and plasma exchange (PLEX). Over the past 6 years, four new therapeutic agents with novel immunological mechanisms of action-complement and neonatal Fc receptor (FcRn) inhibition-were approved as a result of clinically significant improvement in gMG symptoms of those treated with these newer agents in Phase 3 clinical trials. At present, it is unclear when and in whom to initiate these therapeutic agents and how to integrate them into the current treatment paradigm. When selecting a newer therapeutic agent, we use a simple equation: Value = Clinical Improvement/(Cost + Side Effects + Treatment Burden), which guides our decision-making. We consider using these novel therapeutic agents in two specific clinical situations. Firstly, the newer agents are fast-acting, suggesting they can be used in clinically unstable patients as "bridge therapy," and secondly, they provide additional options for those patients considered treatment-refractory. There are downsides, however, including treatment cost, unique side effect profiles, and intravenous and subcutaneous drug administration (though for some, this may be an advantage). As additional drugs enter the marketplace with unique mechanisms of action, routes of administration, and dosing schedules, the placement of the novel therapeutic agents in the gMG treatment algorithm will likely evolve.

Prevalence of errors in the preparation and administration of intravenous drugs in adults: Meta-analysis with meta-regression

Objective: To evaluate the average prevalence of errors in the preparation and administration of intravenous medications in a hospital by means of a meta-analysis. Method: Systematic review through meta-analysis with meta-regression, registered in PROSPERO (CRD42022324431), with a search in the seven databases, using the Rayyan QCRY®. The methodological quality of the selected studies was assessed using the Newcastle-Ottawa Scale. The meta-analysis was calculated using the random-effect model and adjusted by the inverse of the variance, and analyses were carried out to investigate heterogeneity. Results: 34 primary studies were included. The estimated prevalence of errors in the preparation and administration of intravenous drugs was 41,23% (IC95% 30,51–51,96; I2 = 100,00%). Conclusion: The results reflect the lack of health systems official data on the reporting of errors in institutions, the basis for the effective strategies that ensure for patient safety in the process medicated.

Pharmacokinetics, biodistribution, and in vivo toxicity of 7-nitroindazole loaded in pegylated and non-pegylated nanoemulsions in rats

Sepsis is a life-threatening condition caused by a dysregulated host response to infection. The development of sepsis is associated with excessive nitric oxide (NO) production, which plays an important role in controlling vascular homeostasis. 7-nitroindazole (7-NI) is a selective inhibitor of neuronal nitric oxide synthase (NOS-1) with potential application for treating NO imbalance conditions. However, 7-NI exhibits a low aqueous solubility and a short plasma half-life. To circumvent these biopharmaceutical limitations, pegylated (NEPEG7NI) and non-pegylated nanoemulsions (NENPEG7NI) containing 7-NI were developed. This study evaluates the pharmacokinetic profiles and toxicological properties of 7-NI loaded into the nanoemulsions. After a single intravenous administration of the free drug and the nanoemulsions at a dose of 10 mg.kg−1 in Wistar rats, 7-NI was widely distributed in the organs. The pharmacokinetic parameters of Cmax, t1/2, and AUC0-t were significantly increased after administration of the NEPEG7NI, compared to both free 7-NI and NENPEG7NI (p < 0.05). No observable adverse effects were observed after administering the free 7-NI, NEPEG7NI, or NENPEG7NI in the animals after a single dose of up to 3.0 mg.kg−1. The results indicated that 7-NI-loaded nanoemulsions are safe, constituting a promising approach to treating sepsis.

ЭФФЕКТИВНОСТЬ ЛЕЧЕНИЯ БОЛЬНЫХ ТУБЕРКУЛЕЗОМ ЛЕГКИХ С ПРЕ-ШЛУ И ШЛУ M. tuberculosis C ИСПОЛЬЗОВАНИЕМ РАЗЛИЧНЫХ СПОСОБОВ ВВЕДЕНИЯ ПРОТИВОТУБЕРКУЛЕЗНЫХ ПРЕПАРАТОВ

Aim: to evaluate effectiveness of treatment of patients with extensively drug resistant (XDR) or pre-extensively drug resistant (pre-XDR) pulmonary TB using parenteral administration of TB drugs. Materials and methods. We carried out a prospective open cohort study of 143 patients with pulmonary TB hospitalized in 2022. The patients were divided into two groups according to the route of drug administration. The main group consisted of 74 patients, who received parenteral TB drugs before sputum conversion followed by oral drug administration. Parenteral drug administration was indicated to patients with severe intoxication syndrome, advanced TB process, or concomitant gastrointestinal diseases. The control group consisted of 69 patients, who received all TB drugs orally. Oral drug administration was also indicated to patients with difficult venous access. Results. Sputum conversion was observed by the third month of treatment much faster in the main group than in the control group. Treatment effectiveness by cavity closure did not differ between the groups. Conclusion. Intravenous administration of TB drugs contributes to rapid sputum conversion, which allows earlier patient discharge from hospital or surgical treatment.

Stress echocardiography in valvular heart disease.

Valvular heart disease (VHD) has been a significant health problem, particularly in developed countries, in relation to the aging population. Recent developments in the management of VHD require a more accurate assessment of disease severity to determine the need for transcatheter interventions or open heart surgery. Stress echocardiography is a crucial imaging modality for identifying the underlying pathology of VHD. Optimal administration of exercise or intravenous drugs may reveal hemodynamic abnormalities under stress without posing an invasive risk. Therefore, the implementation of stress echocardiography is recommended for determining interventional indications and risk stratification in mitral regurgitation and aortic stenosis. In addition, recent evidence has accumulated regarding the usefulness of stress echocardiography in various conditions including mitral stenosis, aortic regurgitation, and post-interventional VHD. Here, we summarize the current evidence and future perspectives on stress echocardiography in VHD.

Experience in the lower extremities trophic ulcers treatment in patient with combined pathologies: varicose veins and rheumatoid arthritis

Varicose veins of the lower extremities is one of the most common diseases on Earth and its combination with other diseases is inevitable. The combination of diseases aggravates the course of each other. Rheumatoid arthritis worsens the course of varicose veins with trophic disorders – both independently – an increase in pro-inflammatory factors, a change in microcirculation, deformation of the limb axis with a violation of musculoskeletal function, and treatment of rheumatoid arthritis reduces the immune response of the body reducing the reparative capabilities of the body. Clinical case: a patient with a long course of rheumatoid arthritis and varicose veins. For a long time he used cytostatic drugs with a subsequent transition to hormonal drugs. For about 5 years, he noted the appearance of ulcers on both shins, which took a circular shape, which significantly reduced the quality of life and did not respond to conservative treatment. He repeatedly underwent inpatient treatment with intravenous administration of general restorative and vascular drugs. He was also constantly observed in the polyclinic at the place of residence with the implementation of local treatment of ulcerative surfaces. The patient was successively treated for varicose veins by endovenous laser coagulation of the trunks of large subcutaneous veins. The second stage was performed debridement of the wound surface and skin grafting with a free perforated flap. Between the stages, the appointment of drug therapy according to clinical recommendations. Rheumatoid arthritis and varicose veins aggravate each other, especially trophic manifestations. Treatment of such patients should be carried out by a team ofspecialists of various profiles together. Step-by-step treatment ofsuch patients with careful preparation for each of them shows excellent results. A special place is occupied by the patients’ commitment to treatment.