Pharmacological Therapy In Patients Research Articles

Effects of Implementing a Heart Failure Order Set to Optimize Guideline-Directed Medical Therapy and Diuresis in Patients with Acute Heart Failure.

Background: Utilization of guideline-directed medical therapy in patients hospitalized for acute heart failure is suboptimal during the hospitalization and after discharge. An inpatient heart failure order set may be a convenient and useful intervention to improve heart failure therapy in the inpatient setting. Methods: This is a retrospective study that assessed the use of an inpatient heart failure order set on pharmacologic therapy in patients hospitalized for acute heart failure from May to August 2022. Patients with heart failure with an ejection fraction less than 50% were included in the analysis. The co-primary endpoints were maintenance or optimization of guideline-directed medical therapy during the hospitalization. Results: Maintenance of guideline-directed medical therapy was significantly greater when providers used the heart failure order set (OR 2.35, 95% CI 1.03-5.33, P = .041). Optimization of guideline-directed medical therapy was also statistically greater with use of the order set (OR 11.31, 95% CI 4.37-29.31, P < .001). Conclusions: An inpatient heart failure order set may be an effective strategy to improve heart failure pharmacotherapy in patients hospitalized with acute heart failure.

Blood pressure control in pregnant patients with chronic hypertension and diabetes: should

BackgroundThe Chronic Hypertension and Pregnancy Study (CHAP) demonstrated that a target blood pressure of <140/90 mm Hg during pregnancy is associated with improved perinatal outcomes. Outside of pregnancy, pharmacologic therapy for patients with diabetes and hypertension is adjusted to a target blood pressure of <130/80 mm Hg. During pregnancy, patients with both diabetes and chronic hypertension may also benefit from tighter control with a target blood pressure (BP) <130/80 mm Hg. ObjectiveWe compared perinatal outcomes in patients with hypertension and diabetes who achieved BP <130/80 versus 130-139/80-89 mm Hg. Study DesignThis was a secondary analysis of a multi-center randomized controlled trial. Participants were included in this secondary analysis if they had diabetes diagnosed prior to pregnancy or at <20 weeks’ gestation and at least two recorded BP measurements prior to delivery. Average systolic and diastolic BP were calculated using ambulatory antenatal BPs. The primary composite outcome was preeclampsia with severe features, indicated preterm birth <35 weeks, or placental abruption. Secondary outcomes were components of the primary outcome, cesarean delivery, fetal or neonatal death, neonatal intensive care unit (NICU) admission, and small for gestational age (SGA). Comparisons were made between those with an average systolic BP <130 mm Hg and average diastolic BP <80 mm Hg and those with an average systolic blood pressure 130-139 mm Hg or diastolic blood pressure 80-89 mm Hg using Student’s t-test and chi-squared tests. Multivariable log-binomial regression models were used to evaluate risk ratios between blood pressure groups for dichotomous outcomes while accounting for baseline covariates. ResultsOf 434 participants included, 150 (34.6%) had an average blood pressure less than 130/80 mm Hg. Participants with an average blood pressure less than 130/80 were more likely to be on antihypertensive medications at the start of pregnancy and more likely to have newly diagnosed DM prior to 20 weeks. Participants with an average blood pressure less than 130/80 mm Hg were less likely to have the primary adverse perinatal outcome (19.3% vs 46.5%, adjusted relative risk (aRR) 0.43, 95% CI 0.30-0.61, p<0.01), with decreased risks specifically of preeclampsia with severe features (aRR 0.35, 95% CI 0.23-0.54) and indicated preterm birth prior to 35 weeks (aRR 0.44, 95% CI 0.24-0.79). The risk of NICU admission was lower in the lower blood pressure group (aRR 0.74, 95% CI 0.59-0.94). No differences were noted in cesarean delivery (aRR 1.04, 95% CI 0.90-1.20), fetal or neonatal death (aRR 0.59, 95% CI 0.12-2.92). SGA less than the 10th percentile was lower in the lower blood pressure group (aRR 0.37, 95% CI 0.14-0.96). ConclusionIn those with chronic hypertension and diabetes prior to 20 weeks, achieving an average goal blood pressure of <130/80 mm Hg may be associated with improved perinatal outcomes.

Ketamine Usage Effectivity on Treatment-Resistant Depression Diagnosed Patients: a Scoping Review

Introductions: In Indonesia, a median of 6.1% of people diagnosed with depression disorder are people over 15 years old. Only 9% of that amount underwent medical treatment, while the rest, 91%, did not undergo treatment for their depressive conditions. Inadequate and inappropriate treatment of depression will lead to Treatment-Resistant Depression (TRD). Using ketamine as a pharmacotherapy opens up new possibilities for TRD treatments. Methods: This study uses a retrospective observational study design with a systematic review approach, in which all variable data were collected from previous studies aimed at measuring the effectiveness of ketamine pharmacological therapy in patients diagnosed with treatment-resistant depression (TRD) using placebo as a benchmark of the effectiveness of ketamine in reduced clinical symptoms of TRD using secondary data in the form of study results and analyzes from published studies of the effectiveness of ketamine therapy. Results: Administration of ketamine at doses of 0.4 mg/kg and 0.5 mg/kg is more effective as an antidepressant compared to placebo in adults and is effective in the elderly at doses above 0.2 mg/kg with a maximal effect at 24 hours post-administration and disappeared by about 7 days post-administration. Conclusions: The administration of ketamine therapy is more effective at reducing depressive symptoms in diagnosed patients (TRD) than the use of placebo and repeated administration of ketamine can increase the likelihood that TRD sufferers respond to therapy and experience remission.

Initiation and continuation of pharmacological therapies in patients hospitalized for heart failure in Japan.

Currently, the utilization patterns of medications for heart failure (HF) after worsening HF events remain unelucidated in Japan. Here, we conducted a retrospective cohort study evaluating the changes in HF drug utilization patterns in 6 months before and after hospitalizations for HF. The adherence to newly initiated HF medications was evaluated based on the proportion of days covered (PDC) and persistence as continuous treatment episodes among new users. The study included 9091 patients hospitalized for HF between January 2016 and September 2019, including 2735 (30.1%) patients who were newly prescribed at least one HF medication after hospitalization. Despite increases in the use of foundational HF therapy (beta-blockers, angiotensin-converting-enzyme inhibitors/angiotensin receptor blockers, or mineralocorticoid receptor antagonists), 35.6% and 7.6% of patients were treated with the HF foundational monotherapy or diuretics alone after hospitalization, respectively. The mean PDC of newly initiated HF medications ranged from 0.57 for thiazide diuretics to 0.77 for sodium-glucose cotransporter-2 inhibitors. Continuous use of HF medications during the first year after initiation was observed in 30-60% of patients. The mean PDC and one-year continuous HF medication use were consistently lower in patients aged ≥ 75years and in patients with a history of HF hospitalization for all HF medication classes except for tolvaptan and digoxin. Despite the guideline recommendations of HF pharmacotherapy, both treatment and adherence were suboptimal after HF hospitalization, especially in vulnerable populations such as older patients and those with prior HF hospitalizations.

Adherence to pharmacological therapy in patients with hypertension: protocol of a qualitative study by focus groups

IntroductionNon-adherence to antihypertensive medication significantly contributes to inadequate blood pressure control. Regarding non-pharmacological interventions to improve medication adherence, the question remains of which interventions yield the highest efficacy.Understanding the complementary...

Real-World Effectiveness of Preventive Pharmacological Therapy in Patients With Urolithiasis: A Retrospective Cohort Study

Data supporting the efficacy of preventive pharmacological therapy (PPT) to reduce urolithiasis recurrence are based on clinical trials with composite outcomes that incorporate imaging findings and have uncertain clinical significance. This study evaluated whether the use of PPT leads to fewer symptomatic stone events. Retrospective cohort study. Medicare enrollees with urolithiasis who completed 24-hour urine collections that revealed hypercalciuria, hypocitraturia, low urine pH, or hyperuricosuria. PPT (thiazide diuretics for hypercalciuria, alkali for hypocitraturia or low urine pH, or uric acid lowering drugs for hyperuricosuria) categorized as (1) adherent to guideline-concordant PPT, (2) nonadherent to guideline-concordant PPT, or (3) untreated. Symptomatic stone event occurrence (emergency department [ED] visit or hospitalization for urolithiasis or stone-directed surgery). Cox proportional hazards regression. Among 13,942 patients, 31.0% were prescribed PPT. Compared with no treatment, concordant/adherent PPT use was associated with a significantly lower hazard of symptomatic stone events for patients with hypercalciuria (HR, 0.736 [95% CI, 0.593-0.915]) and low urine pH (HR, 0.804 [95% CI, 0.650-0.996]) but not for patients with hypocitraturia or hyperuricosuria. These associations were largely driven by significantly lower rates of ED visits after initiating PPT among the concordant/adherent group versus untreated patients. Patients with hypercalciuria had adjusted 2-year predicted probabilities of a visit of 3.8% [95% CI, 2.5%-5.2%%] and 6.9% [95% CI, 6.0%-7.7%] for the concordant/adherent PPT and no-treatment groups, respectively. Among patients with low urine pH, these probabilities were 4.3% (95% CI, 2.9%-5.7%) and 7.3% (95% CI, 6.5%-8.0%) for the concordant/adherent PPT and no-treatment groups, respectively. Potential bias from the possibility that patients prescribed PPT had more severe disease than untreated patients. Patients with urolithiasis and hypercalciuria who were adherent to treatment with thiazide diuretics as well as those with low urine pH adherent to prescribed alkali therapy had fewer symptomatic stone events than untreated patients. Despite multiple clinical trials demonstrating the efficacy of thiazide diuretics and alkali for secondary prevention of kidney stones, they are infrequently prescribed due in part to a lack of data about their effectiveness in real-world settings. We analyzed medical claims from older adults with kidney stones for whom urine chemistry data were available. We found that patients who took prescribed thiazide diuretics for elevated urine calcium levels or alkali for low urinary pH were less likely to experience symptomatic stone recurrences than untreated patients. This benefit was expressed as lower rates of emergency department visits after initiating therapy. Our findings should inform the prescription of and adherence to treatment with thiazide diuretics and alkali for the prevention of recurrent kidney stones.

Early Pharmacologic Therapy in Patients With Blunt Cerebrovascular Injury and TBI: Is it Safe and Effective? An EAST Multicenter Study.

Blunt cerebrovascular injury (BCVI) with concurrent traumatic brain injury (TBI) presents increased risk of both ischemic stroke and bleeding. This study investigated the safety and survival benefit of BCVI treatment (antithrombotic and/or anticoagulant therapy) in this population. We hypothesized that treatment would be associated with fewer and later strokes in patients with BCVI and TBI without increasing bleeding complications. Patients with head AIS >0 were selected from a database of BCVI patients previously obtained for an observational trial. A Kaplan-Meier analysis compared stroke survival in patients who received BCVI treatment to those who did not. Logistic regression was used to evaluate for confounding variables. Of 488 patients, 347 (71.1%) received BCVI treatment and 141 (28.9%) did not. BCVI treatment was given at a median of 31h post-admission. BCVI treatment was associated with lower stroke rate (4.9% vs 24.1%, P < .001 and longer stroke-free survival (P < .001), but also less severe systemic injury. Logistic regression identified motor GCS and BCVI treatment as the only predictors of stroke. No patients experienced worsening TBI because of treatment. Patients with BCVI and TBI who did not receive BCVI treatment had an increased rate of stroke early in their hospital stay, though this effect may be confounded by worse motor deficits and systemic injuries. BCVI treatment within 2-3days of admission may be safe for patients with mean head AIS of 2.6. Future prospective trials are needed to confirm these findings and determine optimal timing of BCVI treatment in TBI patients with BCVI.

Non-Pharmacological Treatment of Autonomic Dysfunction in Parkinson's Disease and Other Synucleinopathies.

Symptoms of autonomic dysfunction are prevalent and can be very debilitating, reducing the quality of life in patients with Parkinson's disease (PD) and other synucleinopathies such as dementia with Lewy bodies and multiple system atrophy. Non-pharmacological therapies are key to effective management and are frequently used alone in patients with mild autonomic symptoms, or in combination with pharmacological therapies in patients with moderate and severe symptoms. This article focuses on non-pharmacological approaches. Our objective was to review the non-drug and non-surgical approaches to treating autonomic symptoms in patients with PD and other synucleinopathies, focusing on cardiovascular, gastrointestinal, and genitourinary autonomic dysfunction. Evidence supporting the effectiveness of non-pharmacological treatment for the management of neurogenic orthostatic hypotension, supine hypertension, constipation, and bladder and sexual dysfunction is available. High-quality prospective trials are scarce, yet some non-pharmacological interventions (e.g., physical counter maneuvers) can be evaluated relatively quickly on an individual basis and often seem effective. The emerging variety of clinical presentations advocates for a stepwise, individualized, and non-pharmacological approach for the management of autonomic symptoms. Often, the first step is to reduce or discontinue drugs that cause or aggravate autonomic symptoms followed by lifestyle measures. While non-pharmacological and non-surgical treatments are available and, in many cases, effective to improve symptoms of autonomic dysfunction in PD and other synucleinopathies, they are often overlooked. Large randomized trials testing and comparing non-pharmacological approaches are warranted.

Efficacy of ablation therapy on clinical outcomes in patients with atrial fibrillation: a systematic review and meta-analysis.

Optimal treatment regimen for patients with atrial fibrillation (AF) remains unclear. Therefore, the authors sought to compare the outcomes of ablation therapy versus pharmacological regimens in patients with AF. MEDLINE, Embase, and Cochrane Central databases were searched for randomized controlled trials and observational studies comparing clinical outcomes between of ablation and pharmacological therapy in patients with AF. Stroke, all-cause mortality, cardiovascular mortality, cardiovascular hospitalization, heart failure (HF), and bleeding were among outcomes of interest. Mantel-Haenszel weighted random-effects model was used to calculate relative risks (RRs) with 95 % CIs. The analysis included ~200000 patients from 4 randomized controlled trials and 7 observational studies. Meta-analysis showed statistically significant reduction in stroke among patients on ablation therapy [hazard ratio (HR) 0.51, 95% CI (0.43, 0.60), P<0.00001, I2=10%], all-cause mortality [HR 0.64, 95% CI (0.45, 0.93), P=0.02, I2=58%], cardiovascular mortality [HR 0.35, 95% CI (0.25, 0.50), P<0.0001, I2=0%], and HF [HR 0.40, 95% CI (0.31, 0.53), P<0.00001, I2=30%]. However, no significant difference was revealed in the risk of cardiovascular hospitalization [HR 1.04, 95% CI (0.88, 1.23), P=0.66, I2=89%] and bleeding [HR 1.11, 95% CI (0.97, 1.27), P=0.13, I2=0%]. Ablation significantly reduces the risk of stroke, cardiovascular mortality, all-cause mortality, and HF in AF patients, compared with medical therapy alone, supporting its use in clinical practice.

Overview of Antipsycotic Using on Schizophrenic Patients in Hospitals Indramayu City

Schizophrenia is a psychiatric disorder characterized by disturbances in thinking processes, perceptions, emotional responses, and social interactions. The therapy commonly used in the treatment of schizophrenia is antipsychotic or psychotropic drugs. The use of psychotropic drugs is the first step in overcoming and following up on mental disorders. The object of this research is several hospitals that treat patients with psychiatric disorders, namely schizophrenia. Where the subjects used in this study were men/women with schizophrenia aged 18 to 60 years in the city of Indramayu who are undergoing treatment at the hospital for the 2020-2022 period. This study aims to describe the use of antipsychotic classes that are used as one of the pharmacological therapies in patients. This research method uses a descriptive quantitative method, while the sample fee used in this study is the slovin calculation formula, with a total population of 875 and a sample of 274 is obtained. The results obtained are based on the proportion of sex, mostly male patients (62.4%), the highest proportion of the age range was found in early adulthood (70.8%), the highest diagnosis was YTT schizophrenia (46%). Then patients with a history of not going to school (63.5%) and a history of not working (88.3%). Most of the data obtained were patients who experienced mild recurrence of 62%. As for the large number of patient histories with mild or insignificant recurrence, this can influence the factors supporting the success of treatment, namely the use of insurance. This opinion was obtained from patient payment status data, in which the most widely used payment status was the use of insurance by 82.1%. In data on the use of the single antipsychotic that is most widely used in each type of schizophrenia is the antipsychotic haloperidol and the combination that is most widely used is haloperidol-chlorpromazine

Alpha-Lipoic Acid, Palmitoylethanolamide, Myrrh, and Oxygen-Ozone Therapy Improve Pharmacological Therapy in Acute Painful Lumbosacral Radiculopathy due to Herniated Disc

BACKGROUND: Neuropathic mechanisms largely contribute to radicular Low Back Pain (LBP) and an increase in oxidative stress is recognized as one of the possible causes of nerve damage, inducing axonal degeneration and myelin degradation of nerve fibers. OBJECTIVES: We investigated whether a combination of nutraceutical supplements and oxygen-ozone (O2-O3) therapy might reduce disability and improve clinical effects of pharmacological therapy in patients with acute radicular LBP. STUDY DESIGN: This is a prospective, open-label, comparative observational study approved by the Institutional Review Board of the Sapienza University of Rome (RS 6285/2021). SETTING: Physical Medicine and Rehabilitation Unit of Sant’Andrea Hospital. METHODS: Within the scope of this study, 62 patients with acute radicular LBP diagnosed with disc herniation were assigned into 4 groups. The first group was assigned pharmacological therapy (n = 16), the second group was assigned pharmacological therapy and nutraceutical supplements (n = 15), the third group was assigned pharmacological therapy and O2-O3 therapy (n = 15), and the fourth group was assigned pharmacological therapy, nutraceutical supplements, and O2-O3therapy (n = 16). All patients who participated in the study were evaluated at the beginning of the study, 2 weeks, and 4 weeks (T2) after the beginning of treatment using the Numeric Rating Scale (NRS-11), Oswestry Disability Index (ODI), and 12-item Short-Form Health Survey. Opioid analgesic intake was noted from baseline to end of treatment (T2). RESULTS: In each group was observed a statistically significant difference for all measures compared to the baseline. At the T2 evaluation time between groups for the Mann-Whitney U test, a statistically significant difference was found: in the ODI scale between groups B and A (P = 0.004), groups C and A (P &lt; 0.001), and groups D and A (P &lt; 0.001); in the NRS-11 between groups B and A (P = 0.017), groups C and A (P = 0.002), and groups D and A (P &lt; 0.001); in the 12-item Physical Component Summary score between groups B and A (P = 0.003), groups C and A (P = 0.002), and groups D and A (P &lt; 0.001), while no significant differences between groups were observed in the 12-item Mental Component Summary score. The average days of opioid usage were similar in the 4 groups (8.33 in group A, 8.33 in group B, 8.33 in group C, and 8.75 in group D). However, the percentage of patients requiring adjuvant opioid therapy differed remarkably: 60% in group A, 40% in group B, 20% in group C, and 25% in group D. LIMITATIONS: A small number of patients were recruited, and we did not perform long-term follow-up. CONCLUSIONS: This study supports a multimodal approach combining nutraceutical supplements and O2-O3 therapy with pharmacological therapy in the treatment of acute radicular LBP secondary to disc herniation. The combination of neurotrophic and antioxidant therapies represents an etiopathogenetic approach, not purely symptomatic, that reduces symptomatology and avoids progression of the nerve damage. KEY WORDS: Low back pain, lumbar radicular pain, neuropathic pain, herniated disc, alpha lipoic acid, palmitoylethanolamide, myrrh, oxygen-ozone therapy, ozone, nutraceuticals

The 2023 GOLD Report: Updated Guidelines for Inhaled Pharmacological Therapy in Patients with Stable COPD.

Over the past 22years, annual GOLD Reports have documented important changes in guidance and recommendations for uniformly treating patients with chronic obstructive pulmonary disease (COPD) with the goal of improving outcomes in patients suffering from this condition. The most recent GOLD Report, released in 2023, shows continued refinement in several areas, including more precise definitions of COPD and exacerbations of COPD, a new set of parameters to assess exacerbation severity, an updated COPD assessment tool, updated guidelines for initial and follow-up treatment, new information regarding the association between pharmacological triple therapy and reduction in mortality, and new discussions of inhaler device choice and adherence to COPD medications. Whereas we do not address all of the new or updated material in GOLD's 2023 Report, we summarize key changes in GOLD's recommendations regarding inhalation therapy for stable COPD and frame these changes in the context of previous GOLD recommendations.

An Update on Outcomes for COPD Pharmacological Trials: A COPD Investigators Report - Reassessment of the 2008 American Thoracic Society/European Respiratory Society Statement on Outcomes for COPD Pharmacological Trials.

Background: In 2008, a dedicated American Thoracic Society/European Respiratory Society task force published a paper on the possible use and limitations of clinical outcomes and biomarkers to evaluate the impact of pharmacological therapy in patients with chronic obstructive pulmonary disease. Since then, our scientific understanding of chronic obstructive pulmonary disease has increased considerably; there has been a progressive shift from a one-size-fits-all diagnostic and therapeutic approach to a personalized approach; and many new treatments currently in development will require new endpoints to evaluate their efficacy adequately. Objectives: The emergence of several new relevant outcome measures motivated the authors to review advances in the field and highlight the need to update the content of the original report. Methods: The authors separately created search strategies for the literature, primarily based on their opinions and assessments supported by carefully chosen references. No centralized examination of the literature or uniform criteria for including or excluding evidence were used. Measurements and Main Results: Endpoints, outcomes, and biomarkers have been revisited. The limitations of some of those reported in the American Thoracic Society/European Respiratory Society task force document have been highlighted. In addition, new tools that may be useful, especially in evaluating personalized therapy, have been described. Conclusions: Because the "label-free" treatable traits approach is becoming an important step toward precision medicine, future clinical trials should focus on highly prevalent treatable traits, and this will influence the choice of outcomes and markers to be considered. The use of the new tools, particularly combination endpoints, could help better identify the right patients to be treated with the new drugs.

Optimization of the pharmacological therapy in patients with poly-vascular disease: A multidisciplinary approach

The recent shift of the concept of cardiovascular disease as a chronic progressive condition, potentially involving multiple districts, has driven attention to the optimal management of patients with concomitant coronary and peripheral artery disease, representing a subset of patients with an increased risk of events and impaired survival. Recent pharmacological achievements in terms of antithrombotic therapy and lipid-lowering drugs allow multiple therapeutical combinations, thus requiring optimizing the treatment in a tailored fashion according to patients' risk profiles. Nevertheless, data dedicated to this specific subset of patients are still modest. We summarize currently available strategies and indications for the management of antithrombotic and lipid-lowering drugs in patients with the poly-vascular disease.

Acute Biomechanical Effects of Empagliflozin on Living Isolated Human Heart Failure Myocardium

PurposeMultiple randomized controlled trials have presented SGLT2 inhibitors (SGLT2i) as novel pharmacological therapy for patients with heart failure, resulting in reductions in hospitalization for heart failure and mortality. Given the absence of SGLT2 receptors in the heart, mechanisms of direct cardioprotective effects of SGLT2i are complex and remain to be investigated. In this study, we evaluated the direct biomechanical effects of SGLT2i empagliflozin on isolated myocardium from end-stage heart failure patients.MethodsVentricular tissue biopsies obtained from 7 patients undergoing heart transplantation or ventricular assist device implantation surgery were cut into 27 living myocardial slices (LMS) and mounted in custom-made cultivation chambers with mechanical preload and electrical stimulation, resulting in cardiac contractions. These 300 µm thick LMS were subjected to 10 µM empagliflozin and with continuous recording of biomechanical parameters.ResultsEmpagliflozin did not affect the maximum contraction force of the slices, however, increased total contraction duration by 13% (p = 0.002) which was determined by prolonged time to peak and time to relaxation (p = 0.009 and p = 0.003, respectively).ConclusionThe addition of empagliflozin to LMS from end-stage heart failure patients cultured in a biomimetic system improves contraction and relaxation kinetics by increasing total contraction duration without diminishing maximum force production. Therefore, we present convincing evidence that SGLT2i can directly act on the myocardium in absence of systemic influences from other organ systems.

COVID-19-associated phlebopathy as a current problem of modern phlebology

Введение. SARS-CoV-2 сопровождается развитием дисфункции венозного эндотелия, которая может привести к развитию персистирующей флебопатии нижних конечностей, снижаю щей качество жизни пациентов.Цель. Оценить эффективность фармакологической терапии пациентов с постковидной флебопатией.Introduction. SARS-CoV-2 is accompanied by the development of venous endothelial dysfunction, which can lead to the development of persistent phlebopathy of the lower limbs, reducing the quality of life of patients.Objective. To evaluate the efficacy of pharmacological therapy in patients with postcocclusive phlebopathy.Materials and methods. 178 patients (125 women), mean age 34.8 ± 3.2 years, who underwent SARS-CoV-2, for their first veno-specific complaints received micronized purified flavonoid fraction (MPFF) 1,000 mg per day for 90 days. Complaints were monitored using a 10-cm visual analog scale and the CIVIQ-20 questionnaire. All patients underwent ultrasound examination of the venous system of both lower extremities and photoplethysmography. Laboratory biochemical examination with determination of endothelial dysfunction marker levels was performed in 30 patients before and after treatment.Results. After 90 days of phlebotropic therapy, there was a significant reduction in the severity of all venous-specific complaints, except for intradermal vein dilation. The global quality of life index increased from 64.4 ± 11.2 to 86.6 ± 9.1% (p &lt; 0.001). There was an improvement in photoplethysmography (PPG) scores. Return blood-flow time and tibial venous muscle pump strength increased significantly (p &lt; 0.05) by 4.3 s and 3.5%, respectively. The 30 patients who underwent biochemical examination in the first blood samples obtained from the great saphenous vein showed a significant increase in IL-1 concentration (7.8 ± 0, 7 pg/ml), IL-6 (18.7 ± 1.8 pg/ml), VEGF (187.8 ± 11.6 pg/ml), TNF (7.8 ± 0.9 pg/ml), histamine (22.4 ± 11.4 nmol/L) and hsCRB (5.4 ± 0.3 mg/L), indicating that a proinflammatory phenotype of venous endothelium was formed. After 90 days of MOFF administration, these indices significantly decreased. The levels of IL-1 and IL-6 decreased by 3.2 and 10.4 pg/ml, respectively, the values of VEGF and TNF decreased by 114.6 pg/ml and 2.9 pg/ml. There was a gradual normalization of histamine and hsCRB to 6.1 ± 4.1 nmol/L and 1.1 ± 0.9 mg/L.Conclusions. The data obtained indicate that the appearance of veno-specific symptoms and syndromes in patients who have undergone SARS-CoV-2 may be due to the development of phlebopathy, the correction of which requires the use of pharmacological drugs with relevant mechanisms of action.

Aduhelm, a novel anti-amyloid monoclonal antibody, for the treatment of Alzheimer's Disease: A comprehensive review.

Alzheimer's disease (AD) is the most common form of dementia affecting millions of individuals, including family members who often take on the role of caregivers. This debilitating disease reportedly consumes 8% of the total United States healthcare expenditure, with medical and nursing outlays accounting for an estimated $290 billion. Cholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists have historically been the most widely used pharmacologic therapies for patients with AD; however, these drugs are not curative. The present investigation describes the epidemiology, pathophysiology, risk factors, presentation, and current treatment of AD followed by the role of the novel monoclonal antibody, Adulhelm, in the treatment of AD. Currently, Adulhelm is the only Food and Drug Administration (FDA) approved drug that acts to slow the progression of this disease. Adulhelm is an anti-amyloid drug that functions by selectively binding amyloid aggregates in both the oligomeric and fibrillar states. Studies show Adulhelm may help to restore neurological function in patients with AD by reducing beta-amyloid plaques and reestablishing neuronal calcium permeability. At present, there is concern the magnitude of this drug's benefit may only be statistically significant, although not clinically significant. Despite skepticism, Adulhelm has proven to significantly decrease amyloid in all cortical brain regions examined. With such high stakes and potential, further research into Adulhelm's clinical efficacy is warranted in the treatment of AD.

Obesity and COVID-19: insights from two pandemics

This review article discusses the pathophysiological mechanisms of the development of coronavirus infection in obese patients. It has been shown that obesity is considered as the most important risk factor for the development of many comorbid diseases, including severe forms and deaths as a result of a new coronavirus infection. The higher incidence and severity of a new coronavirus infection in obese patients is based on a complex of factors, the main of which are an increase in cardiovascular risk, including a tendency to thrombosis, a decrease in the efficiency of the respiratory system, impaired immune response, and the presence of chronic inflammatory state. The article discusses non-drug approaches and issues of pharmacological therapy in patients with obesity in the context of a pandemic of a new coronavirus infection. It is shown that the implementation of national quarantine measures has led to an increase in physical inactivity, the level of stress and a change in the eating behavior of the population, closing a vicious circle and contributing to an increase in body weight. For this reason, the efforts of physicians of therapeutic specialties should be directed primarily to increasing resistance to infection among obese patients and combating physical inactivity. The main groups of drugs that can be used to combat lipotoxicity are listed. It was noted that infectious disease doctors and endocrinologists can use those groups of drugs that affect the most vulnerable pathogenetic triggers for the development of obesity and comorbidities: hunger and satiety processes, decreased insulin sensitivity, development of lipotoxicity and chronic inflammation. It has been proven that the range of positive effects of new antihyperglycemic drugs from the groups of type 1 glucagon-like peptide agonists and type 2 sodium-glucose transporter inhibitors, combined with a well-studied efficacy and safety profile, represents a new opportunity for the treatment of obesity in the context of a coronavirus infection pandemic.

Clinical Outcomes When Utilizing Sacubitril-Valsartan Vs. ACEi/ARB In Patients With HF And Ejection Fractions Spanning From Reduced To Preserved - A Retrospective, Parallel, Multi-Group Study

<h3>Introduction</h3> Health outcomes- all-cause hospitalization (hosp), HF hosp, HF-related emergency dept. (ED) visits and a composite of all 3 outcomes provide important information about the benefits of using pharmacological therapy in patients with HF. It is important to assess real-world outcomes after Food and Drug Admin. indication expansion of sacubitril/valsartan (sac/val). <h3>Hypothesis</h3> Patients treated with sac/val vs. ACEi/ARB will have improved post-index date 6-month hosp and ED visit health outcomes. <h3>Methods</h3> Within 12 hospitals and over 100 outpatient practices (OPD) in OH and FL within a large healthcare system, adult patients prescribed sac/val between August 2015 through July 2018 were matched to patients prescribed ACEi/ARB (based on age, sex, EF, comorbidity status, index date, hospital vs. OPD index date and systolic BP) and health outcomes were assessed. Differences in outcomes of sac/val treated vs. matched ACEi/ARB controls were compared using linear, logistic, and Poisson models with generalized estimating equations. <h3>Results</h3> Of 3588 patients (1794 per group), 3413 (95.1%) had sac/val initiated in OPD. Baseline mean (SD) age was 64.2 (13.0) yrs, 70.3% were male, 20.7% were Black, mean systolic BP was 122.1 (16.1) mmHg, mean NTproBNP (n=2574) was 3732.4 (6453.0) pg/mL and estimated glomerular filtration rate (eGFR) was normal (>60 ml/min/1,73²) in 76.2% of patients and of those with kidney dysfunction, the mean was 47.3 (12.1) ml/min/1,73². By HF factors, 40.2% had dilated cardiomyopathy and 47.6% were NYHA-functional class II. Mean EF% was 29.0 (9.9) but spanned from under 10% (2.4%) to 60% with 90.3% as HFrEF and 349 (9.7%) as HFmidrangeEF. Of medications, 92.4% were on beta-blocker, 43% were on a mineralocorticoid receptor antagonist and 63.1% were on a loop diuretic. From baseline to 6 months, 50 patients died (16 sac/val vs. 34 ACEi/ARB; <i>p</i>=0.011). At 6-month assessment, sac/val use was associated with lower rates of all-cause and HF hosp, HF ED visits and the composite outcome (all <i>p</i> <0.001); see Figure of event rate (%) odds ratios. <h3>Conclusions</h3> Among a heterogenous sample of patients with HF (EFs spanned from 10-60%), utilization of sac/val was associated with fewer deaths at 6 months and improvement in 6-month all-cause and HF hosp, HF-related ED visits and the composite outcome. In future analyses, it will be important to determine patient and provider factors that facilitated sac/val use and improved clinical outcomes.

АНАЛИЗ ФАРМАКОЛОГИЧЕСКОЙ ТЕРАПИИ У ПАЦИЕНТОВ КАРДИОЛОГИЧЕСКОГО СТАЦИОНАРА С ЛЕКАРСТВЕННО-ИНДУЦИРОВАННЫМ СИНДРОМОМ УДЛИНЕННОГО ИНТЕРВАЛА QT

Background: The most common reason for drug-induced long QT syndrome is the intake of class III antiarrhythmic agents (according to the Vaughan-Williams classification). Their therapeutic effect is based on the ventricular repolarization deceleration and QT interval prolongation. Combined therapy with antiarrhythmic agents and other drugs increases the risk of QT interval prolongation. Objective: To assess the quantitative and qualitative structure of pharmacological therapy in patients who receive antiarrhythmic therapy during their inpatient treatment in a cardiology hospital. Material and methods: A retrospective analysis of the medical records of 120 patients, predominantly of those with ischemic heart disease, arterial hypertension and cardiac arrhythmias was carried out. All patients were divided into 2 groups based on the degree of QT interval prolongation in response to antiarrhythmic therapy. All drug therapies were recorded (name, dose, frequency and duration of drug intake, indicated in the prescription sheet). Only the drugs included in the international Crediblemeds Database were considered to have influence on the duration of the QT interval. Results: The patients of both groups had no statistically significant differences in terms of the total number of drugs taken (7.3±2.4 in the first group versus 6.92±1.6 in the second group, p=0.12). The percentage ratio of drugs that affect the duration of the QT interval to the total amount of the drugs used was 26±15% in the first group and 20.5±8% in the second group, p=0.71. When assessing the duration of the corrected QT interval depending on the structure of the combinations of drugs used, the highest incidence of torsades de pointes and the highest corrected QT interval values (503.45±23.9 ms) were recorded in the subgroup of patients taking 3 such drugs at the same time. Conclusions: A positive correlation was established between the number of drugs that prolong the QT interval and the value of the corrected QT interval. No statistically significant differences were found in the quantitative and qualitative structure of pharmacological therapy in patients with and without prolongation of the QT interval.