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Background/Aim A number of patients continue to suffer from chronic abdominal pain of unknown origin, which may also lead to a prolonged use of opioid analgesics. Symptoms of abdominal pain, nausea and vomiting in this patient group resemble the characteristics of the Roux stasis Syndrome. The aim was to elucidate relationships between chronic abdominal pain, Roux limb motor activity and opioid analgesics. Methods Roux limb high-resolution manometry and ratings of abdominal pain and quality of life were analysed in 15 gastric bypass patients reporting abdominal pain of unknown origin. Effect of acute opiate administration (morphine i.v.) on fasting Roux limb motor activity was assessed in asymptomatic and morphine-naive gastric bypass patients (n = 9) and compared with an untreated control group (n = 11). Results In the symptomatic patient group, we found disturbed Roux limb motor patterns in 10 out of 15 examinations, but no signs of Roux stasis syndrome. A high prevalence of prescribed opioid analgesics as well as a high number of reoperations in this group. The worst quality of life and the highest number of pain-killing medications were observed among the patients with distal pacemaker activity in Roux limb. In the morphine-naive and asymptomatic patients, morphine increased the muscular tone in the Roux limb during phase III-like motor activity. Summary and Conclusions A majority of the RYGBP patients with chronic abdominal pain had a disturbed Roux limb fasting motility, and there was a high prevalence of prescribed opioid analgesics. In opiate-naive RYGBP patients, acute morphine intravenously increased the muscular tone of the Roux limb.

Guidelines recommend adults with pituitary disease in whom GH therapy is contemplated, to be tested for GH deficiency (AGHD); however, clinical practice is not uniform. Aims (1) To record current practice of AGHD management throughout Europe and benchmark it against guidelines; (2) To evaluate educational status of healthcare professionals about AGHD. Design Online survey in endocrine centres throughout Europe. Patients and methods Endocrinologists voluntarily completed an electronic questionnaire regarding AGHD patients diagnosed or treated in 2017–2018. Results Twenty-eight centres from 17 European countries participated, including 2139 AGHD patients, 28% of childhood-onset GHD. Aetiology was most frequently non-functioning pituitary adenoma (26%), craniopharyngioma (13%) and genetic/congenital midline malformations (13%). Diagnosis of GHD was confirmed by a stimulation test in 52% (GHRH+arginine: 45%; insulin-tolerance: 42%, glucagon: 6%; GHRH alone and clonidine tests: 7%); in the remaining, ≥3 pituitary deficiencies and low serum IGF-I were diagnostic. Initial GH dose was lower in older patients, but only women Conclusion Despite guideline recommendations, GH replacement in AGHD is still not available or reimbursed in all European countries. Knowledge among professionals and health administrators needs improvement to optimise the care of adults with GHD.

Background and objectives: The combination of non-steroidal anti-inflammatory drugs and paracetamol is widely used for pediatric postoperative pain management, although the evidence of superiority of a combination over either drug alone is insufficient. We aimed to find out if intravenous (i.v.) paracetamol in a dose of 60 mg kg&minus, 1 24 h&minus, 1, given in addition to i.v. ketoprofen (4.5 mg kg&minus, 1), improves analgesia, physical recovery, and satisfaction with postoperative well-being in children and adolescents following moderate and major general surgery. Materials and Methods: Fifty-four patients were randomized to receive either i.v. paracetamol or normal saline as a placebo in adjunct to i.v. ketoprofen. For rescue analgesia in patients after moderate surgery, i.v. tramadol (2 mg kg&minus, 1 up two doses in 24 h), and for children after major surgery, i.v. morphine-patient-controlled analgesia (PCA) were available. The main outcome measure was the amount of opioid consumed during the first 24 h after surgery. Pain level at 1 and over 24 h, time until the resumption of normal oral fluid intake, spontaneous urination after surgery, and satisfaction with postoperative well-being were also assessed. Results: Fifty-one patients (26 in the placebo group and 25 in the paracetamol group) were studied. There was no difference in required rescue tramadol doses (n = 11 in each group) or 24-h morphine consumption (mean difference (95% CI): 0.06 (&ndash, 0.17, 0.29) or pain scores between placebo and paracetamol groups. In patients given morphine-PCA, time to normal fluid intake was faster in the paracetamol than the placebo subgroup: median difference (95% CI): 7.5 (1.3, 13.7) h, p = 0.02. Parental satisfaction score was higher in the paracetamol than the placebo group (mean difference: &ndash, 1.3 (&ndash, 2.5, &ndash, 0.06), p = 0.04). Conclusions: There were no obvious benefits to opioid requirement or analgesia of adding regular intravenous paracetamol to intravenous ketoprofen in used doses. However, intravenous paracetamol may contribute to faster recovery of normal functions and higher satisfaction with postoperative well-being.

Background and objectives: Long-term therapy with oral anticoagulants is recommended for stroke prevention in patients with atrial fibrillation (AF). This study evaluated the quality of anticoagulation therapy among warfarin-treated AF patients in selected primary health care centres in Lithuania. Materials and Methods: This was a retrospective study conducted in nine primary health care centres in Lithuania. Existing medical records of randomly selected adult patients with AF who were treated with warfarin for at least 12 months were reviewed and analysed. Physicians&rsquo, decisions to adjust warfarin dose were considered as consistent with the approved warfarin posology if warfarin dose was increased in case of international normalized ratio (INR) &lt, 2.0, decreased in case of INR &gt, 3.0 or unchanged in case of INR within 2.0 to 3.0. Results: The study population included 406 patients. The mean duration of treatment with warfarin was 5.4 years. The median number of INR measurements per patient per year was 8.0. More than half (57.3%) of available INR values were outside the target range, with 13.6% INR values being above 3.0 and 43.7% INR values&mdash, below 2.0. The median time in therapeutic range (TTR) was 40.0%, only 20% of patients had TTR of &ge, 65%. In about 40% of the cases with INR values outside the target range, no dose corrections were implemented. About 27% of decisions on warfarin dose adjustment were not consistent with the recommended warfarin posology. The median number of INR measurements was lower among patients living in urban areas, while the median TTR was significantly higher in urban patients than in rural patients. In the multivariate regression model, gender, HAS-BLED score and warfarin treatment duration were associated with a TTR of &ge, 65%. Conclusions: Anticoagulation control is suboptimal in routine clinical practice with a median TTR of 40%. Our findings suggest that there might be a room for improvement of anticoagulation control in primary care.

[...]. The aim of the study. To establish influence of different anesthesia protocols and psychogenic stress on oxidative agents and antioxidants, cardiovascular and respiratory changes during OHE and OE and to measure how these parameters impact oxidative stress occurrence. Objectives of the study. 1. To determine long-term psychogenic stress impact on cortisol concentration changes and oxidative stress occurence. 2. To determine which combination of doses of medetomidine hydrochloride (MED) and butorphanol tartrate (BUT) had the lowest influence on cardiovascular and respiratory systems. 3. To evaluate dynamics of OS (total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI)) parameters in dogs when using different anesthesia protocols: medetomidine hydrochloride and butorphanol tartrate (MEDBUT) or medetomidine hydrochloride and buprenorphine hydrochloride (MEDBUT) for sedation, propofol for induction, and sevoflurane for anesthesia maintenance. 4. To determine psychogenic stress influence on oxidative stress index changes during sedation and general anesthesia when using MEDBUP for sedation. 5. To evaluate impact of surgery duration on oxidative stress parameters changes in the body. 6. To determine MEDBUT and MEDBUP impact on dynamics of cardiovascular (heart rate (HR), non-invasive systolic arterial pressure (SAP), [...].

Background Immune cells are involved in all stages of acute ischaemic stroke (AIS) and possess both neuroprotective and neurodamaging properties. It has been suggested that immune system activation after stroke may be associated with the development of haemorrhagic transformation (HT), which is the main complication limiting the clinical use of intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) for AIS. The purpose of our study was to analyse the association between absolute eosinophil count (AEC) at admission and the occurrence of HT after intravenous rtPA therapy for AIS. Methods In this retrospective study we enrolled AIS patients who were treated with rtPA within 4.5 h of symptom onset. Baseline stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS). Patients underwent head computed tomography scans at admission which were repeated 24 h after treatment with rtPA or promptly in case of clinical deterioration. HT was defined as blood at any site in the brain on follow-up head computed tomography scans. Spearman’s rank correlation test was used to analyse the correlation between AEC and NIHSS scores. The optimal AEC cut-off value for predicting HT was calculated using the area under the receiver operating characteristic curve. Multiple logistic regression was used to determine the association between AEC included as a binary variable and the incidence of HT. Results The data of 201 patients was analysed (59.7% females; median age 77 years); 23 (11.4%) of them developed HT. The median of AEC was 62.5% greater in the non-HT group compared to the HT group (0.13 × 109/l and 0.08 × 109/l, respectively, p = 0.026). No correlation was found between AEC and baseline NIHSS scores (r = 0.061, p = 0.393). AEC ≥ 0.11 × 109/l predicted the occurrence of HT with 69.6% sensitivity and 60.7% specificity. AEC ≥ 0.11 × 109/l was independently associated with a 78% reduction in the odds of developing HT (adjusted odds ratio = 0.223, 95% confidence interval = 0.069–0.723, p = 0.012). Conclusion Higher values of AEC were associated with lower odds of developing HT, thus, AEC at admission could be considered an independent predictive marker of HT after treatment with rtPA for AIS.

[...]. The aim of the study. To formulate optimal and stable microemulsions, to apply them as carriers for resveratrol delivery into the skin and to evaluate their quality using physicochemical, biopharmaceutical and biological studies. The objectives of the study. 1. To model microemulsions using an experimental planning and to perform optimization of obtained formulations according to the selected critical parameters of the quality. 2. To evaluate the quality of optimal composition of microemulsions and to investigate their stability. 3. To apply selected stable microemulsions for incorporationn of aan active substance and to evaluate the quality and stability of formulated systems. 4. To investigate kinetics of resveratrol release from microemulsions and to evaluate its penetration into the skin ex vivo. 5. To evaluate the irritating effect of microemulsions containing resveratrol on the experimental animals skin in vivo. [...].

Aims The objective of this study was to evaluate the impact of platinum dose reduction and delays on progression free survival (PFS) and overall survival (OS) in patients with stage I-IV ovarian cancer. Method Medical records of patients with FIGO stage I-IV ovarian cancer were reviewed. PFS was calculated as the time from surgery until the date of progression or death, OS from surgery until the date of death. Last follow up was on 2016-05-30. Results Patients were divided into four platinum response status groups: 1) platinum refractory (N=19 ), OS 17 months (95% Cl: 2,4-31,5 ) ; 2) platinum resistant (N=26) OS 20 months (95% Cl: 15,1-24,8) ; 3) partially platinum sensitive (N=16 patients), OS 33 months (95% Cl: 19,8-46,1 ); 4) platinum sensitive (N=39), OS not reached (Figure 1), P 0,05 (Figure 2). The main reason of chemotherapy modification was neutropenia (52 %) (Figure 3). Conclusion There were no statistically significant OS differences the the four groups of chemotherapy modifications. Neutropenia is the mos common side efect affecting dose modifications.

(1) Background: In this work, we investigated the application of a natural superdisintegrant, psyllium (Plantago ovata Forsk) husk powder, for the manufacture of orodispersible meloxicam tablets. Meloxicam was chosen as a model compound for the study. (2) Methods: The tablets were prepared using different concentrations of psyllium husk by direct compression. Bulk density, tapped density, hardness, friability, in vitro disintegration, and dissolution time tests were used to assess the quality of the formulations. (3) Results: Psyllium husk powder significantly increased the dissolution rate of meloxicam. The formulation containing 16 mg of psyllium husk powder showed the lowest wetting time, the highest water absorption ratio, and the lowest disintegration time compared to the control and to the other formulations. These effects may be attributed to the rapid uptake of water due to the vigorous swelling ability of psyllium husk powder. (4) Conclusions: The powder could be recommended as an effective natural superdisintegrant for orodispersible formulations.

Background and objective: The aim of this randomized, single dose, two-period crossover study with two weeks wash-out period was the demonstration of bioequivalence of two recombinant human granulocyte colony-stimulating factor (rG-CSF) formulations after subcutaneous administration of 300 μg comparing their pharmacokinetic (primary endpoints AUC0–24, AUC0–∞ and Cmax) and pharmacodynamic (primary endpoints ANC AUC0–72, ANC AUC0–∞ and ANCmax) profiles in healthy male subjects. Materials and methods: A total of 36 (23.0 ± 6.0 years, 76.6 ± 7.2 kg) healthy subjects were recruited. Using a 1:1 randomization ratio, subjects were randomly assigned to one of two possible treatment-sequence groups to receive the single dose of test formulation (Gp-02) and reference product (NeupogenTM) concentrations were measured by enzyme-linked immunosorbent assay (ELISA) up to 24 h and the Absolute Neutrophil Count (ANC) was determined using hematology analyzer Coulter STKSTM (Beckman Coulter) up to 72 h after injection. The geometric mean of primary pharmacokinetic and pharmacodynamic variables were considered bioequivalent if the 90% confidence intervals (CI) would fall in the bioequivalence range of 80%–125%. Results: AUC0–24 (ratio of means 103.4, 90% CI: 95.6–111.9), AUC0–∞ (103.4, 90% CI: 95.7–111.7), Cmax (99.6, 90% CI: 89.0–111.4), ANC AUC0–72 (100.0, 90% CI: 96.6–103.5), ANC AUC0–∞ (100.8, 90% CI: 96.5–105.3), and ANCmax (100.2, 90% CI: 95.4–105.1) were determined. Single doses of test and reference formulations were well tolerated. The incidence of AEs was equally distributed across treatment groups with the most frequent AEs being headache, fever, and back pain. Conclusions: The study results demonstrated the bioequivalence of Gp-02, a new formulation of filgrastim, and the reference product NeupogenTM.

Gentamicin is still widely used in the treatment of patients in an intensive care unit (ICU). The efficacy of aminoglycosides correlates with the peak serum concentration (Cmax), and the toxicity with the minimum serum concentration (Cmin). The aim of this study was to determine Cmax and Cmin in serum of cerebral coma ICU patients when a dosage of gentamicin of 5 mg/kg body weight was administered once daily; to evaluate the rationality of mentioned dose; and to identify factors associated with these concentrations. Material and Methods. A total of 24 ICU patients suffering from cerebral coma were included into this analysis. A dosage of gentamicin of 5 mg/kg body weight was administered once a day. Gentamicin concentrations were tested twice after the first dose infusion (immediately and 5 hours after 1-hour infusion). Cmax, Cmin, volume of distribution (Vd), and elimination half-life (T1/2) were obtained. Results. The mean Cmax was 17.96 (SD, 4.31) μg/mL (range, 10.30–27.87 μg/mL). The desirable Cmax (≥20 μg/mL) was reached only in 6 patients (25%). Cmin was calculated using a special pharmacokinetic program “Kinetica.” Cmin of 0.5 μg/mL was not exceeded in any patient. A correlative analysis indicated a significant inverse direct correlation between Cmax and Vd and between Cmax and treatment duration in the ICU. An inverse correlation was observed between Cmin and T1/2, evaluation of coma according to the Glasgow coma scale, and creatinine clearance. Conclusions. A dosage of 5 mg/kg body weight once a day was not sufficient in cerebral coma ICU patients. This dose was not associated with the nephrotoxic effect of gentamicin (additional risk factors were absent). It is recommended to obtain gentamicin concentration at two time points following administration of the first dose (e.g., immediately after 1-hour infusion and 5 hours later), and using a special pharmacokinetic software, to calculate a necessary dose and interval of administration.

Introduction. The question of the targets of dialysis dosing remains controversial since the beginning of the long-term dialysis treatment era. It is still uncertain if higher dialysis dose is better. The aim of our study was to investigate issues of dialysis dose in Lithuania during the period of 1998–2005 and to determine associations between hemodialysis dose and survival of patients on chronic hemodialysis. Material and methods. We analyzed data of all patients who started hemodialysis due to endstage renal disease in Lithuania between January 1, 1998, and December 31, 2005. The information about hemodialysis frequency, duration, and adequacy (according to Kt/V) was obtained from medical documentation. The overall survival rate was estimated using the Kaplan- Meier method. Survival comparisons were made using the log-rank or Breslow tests. Univariate Cox proportional hazards analysis was used to select variables significantly associated with the risk of death, then these variables were included in multivariate Cox proportional hazards models. Results. During the study period, from 2428 patients who started chronic hemodialysis, 58.5% of patients started hemodialysis three times a week. More than one-third (36.2%) of patients were dialyzed twice weekly, and 5.3% of patients started hemodialysis once weekly. Survival analysis revealed that patients dialyzed less than three times per week survived shorter than patients receiving a higher dialysis dose. Duration of HD session of ≤8 hours per week was an independent risk factor for mortality. A higher mean Kt/V was associated with better survival of patients on chronic hemodialysis. Conclusions. Dialysis frequency and weekly duration of HD sessions were dependent on HD accessibility in Lithuania during the period of 1998–2005. Better survival of patients on chronic hemodialysis was associated with a higher hemodialysis dose.

Objectives. To assess self-reported adherence among pharmacy clients and to detect if there are any differences in medication use or storage between genders. Material and methods. The data were collected by means of questionnaires. A standard 45-item questionnaire was developed and used to assess adherence and nonadherence to medications. It was distributed to all pharmacy customers who entered pharmacies chosen by us. Results. Of the 162 (45 men and 117 women) pharmacy clients participating in the study, 36.42% were considered nonadherent. No significant difference in adherence rates between genders was observed (P&gt, 0.05). Women more often named themselves as being responsible for a medicine cabinet at home (P&lt, 0.001) and used more sources of information on medications (P&lt, 0.05). Women also more frequently checked the expiry date of medications in a medicine cabinet home than men (P&lt, 0.05). Conclusions. The problem of nonadherence to medications exists among pharmacy clients. There is no significant difference in the rate of self-reported adherence between male and female pharmacy clients. Women are the ones named as responsible for a medicine cabinet at home. They also are important health decision makers. Women are more interested in information on medicines and their use, therefore, this demand should be satisfied.

Methadone is a long-acting synthetic opioid with high affinity for various opioid receptors, especially for μ-opioid receptors. Methadone has been used as a successful pharmacologic intervention for the treatment of heroin dependence and acute and chronic pain. This treatment is effective for opiate addiction, reducing morbidity and mortality associated with heroin use. However, overdosing with methadone has become a growing phenomenon because of the increased availability of this drug. Patients enrolled in a methadone maintenance treatment program may become physically dependent and may experience methadone withdrawal symptoms. In this review article, there are discussed about pharmacokinetic and pharmacodynamic properties of methadone, clinical symptoms of its overdose, dosage problems, detection of methadone in biological samples, treatment, and causes of methadone overdose-related deaths.

Objectives. To collect the data about the consumption of digoxin, evaluate the tendencies towards usage of this drug during 2004–2007, and to find departments, which cover the main part of digoxin consumption in a tertiary hospital. To evaluate the intensity of serum digoxin concentration measurements during 2005–2007. Material and methods. Our study was carried out in a tertiary hospital with 2600 beds and 63 departments. Consumption of digoxin is expressed in defined daily doses per 100 occupied beds daily during 2004–2007. All serum concentration measurements in 2005–2007 were evaluated. Results. The main consumers of digoxin in 2007 were the Units of Endocrinology, Pulmonology and Immunology, Cardiology II, Neurosurgical Reanimation and Intensive Care, Neurology, Eye Disorders I, Intensive Care Unit of Cardiology; they consumed 51.05% of total digoxin. In total, 58 digoxin measurements were performed in 2005, 89 in 2006, and 64 in 2007. The intensity of serum concentration measurements for digoxin is 1/147 (one measurement for 147 defined daily doses) in 2005, 1/89 in 2006, and 1/107 in 2007. These results show that intensity of serum digoxin concentration measurements is low. Conclusions. Twenty-two out of the 63 departments cover 90% of digoxin consumption per year. The changes in digoxin consumption were not statistically significantly different in 2004– 2007. There was a tendency towards an increase in serum digoxin concentration measurements during the 3-year period. Digoxin concentration outside therapeutic ranges was established in about half of all cases in 2005–2006, but there was an increase in normal serum concentration in 2007.

Depression is one of the leading causes of disability worldwide, affecting 121 million people in whole world. In many developed countries, the number of prescriptions for antidepressants increased steeply during the 1990s. The objective of the present study was to evaluate the antidepressant prescribing patterns in all regions of Lithuania during 2003–2004, to analyze the use within different antidepressant groups, and to examine trends in age- and gender-specific antidepressant use. Antidepressants were classified into three groups according to Anatomic Therapeutic Chemical (ATC) Classification specifying the defined daily doses. The results of our study show an increase in the use of reimbursed antidepressants except tricyclic in 2004 when compared to 2003. Increase in the use of selective serotonin reuptake inhibitors and other nontricyclic antidepressants is probably related to their better tolerability, improved risk-benefit ratio, and less toxicity in overdose. There was no increase in the percentage of consumed selective serotonin reuptake inhibitors in elderly patients when compared with younger ones, despite elderly patients are most likely to benefit from reduced sedation, less antimuscarinic and less cardiac toxicity of selective serotonin reuptake inhibitors. The prevalence of the antidepressant use is the highest among middle-aged people (40–59 years), while the young (under 20) and elderly (older than 70) patients receive mostly selective serotonin reuptake inhibitors. Additional studies should be carried out in order to assess drug-prescribing patterns in accordance with the guidelines of depression treatment in Lithuania considering diagnosis, dosage, and duration of treatment.

b-adrenergic receptor blocking drugs are used in the treatment of hypertension, angina, myocardial infarction, cardiac dysrhythmia, cardiomyopathy, migraine headache, thyrotoxicosis, and glaucoma. b-adrenergic receptor blocking agents are competitive antagonist at b1, b2, or both types of adrenergic receptors. Overdoses of b-adrenergic receptor blockers are uncommon, but are associated with significant morbidity and mortality. This review article discusses the properties of b-adrenergic receptor blockers, presents the doses of these drugs causing toxicity and doses, after ingestion of which, referral to an emergency department is recommended. Clinical presentation of overdose (the cardiovascular, neurologic manifestations, pulmonary and other complications), diagnosis, and treatment (gastrointestinal decontamination; the usage of atropine, phosphodiesterase inhibitors, glucagon, insulin; indications for cardiac pacing, extracorporeal procedures of drug removal, etc.) are analyzed. In addition, this article focuses on clinical course and prognosis of beta-blocker overdose.

Theophylline is a methylxanthine derivative medication used in the treatment of astma, chronic obstructive pulmonary disease, and apnea and bradycardia of prematurity. Theophylline can cause either acute or chronic intoxication. Severe intoxication may result in life – threatening arrhythmias and seizures and has a mortality of at least 10 proc.. In this review article there are discussed about pharmacology and pharmacokinetics of theophylline, pathophysiology of therapeutic and toxic effects, clinical presentation and life – threatening complications, type of intoxication, diagnostic considerations and treatment (supportive care, gastrointestinal decontamination, pharmacologic management of emesis, seizures, hypotension and cardiac arrhythmias). There are reported also about enhancement of elimination of theophylline (multiple – dose activated charcoal, hemoperfusion, hemodialysis) and outcomes after theophylline poisoning.

Tyrimo tikslas. Išanalizuoti gydymo gentamicinu stacionare skyrimo indikacijas ir dozavimo principus, įvertinti gentamicinu gydomų ligonių stebėseną dėl galimo nefrotoksinio poveikio. Tyrimo medžiaga ir metodai. Iš archyvo paimta Kauno medicinos universiteto klinikose gentamicinu gydytų 105 ligonių ligos istorijos: 59 chirurgijos ir 46 vidaus ligų profilio. Surinkti duomenys apie gentamicino skyrimo indikacijas, dozavimą, gydymo trukmę, pacientų inkstų funkciją ir jos kitimus gydymo eigoje. Rezultatai. Daugiau kaip trečdalis gydytų ligonių buvo vyresni nei 65 metų. Gentamicino skirta: a) profilaktiškai po operacijos 14 (23,73 proc.) chirurgijos ligonių; b) infekcijai gydyti 45 (76,27 proc.) chirurgijos ir 46 (100 proc.) vidaus ligų profilio ligoniams. Empiriškai gentamicinu gydyti 29 (49,15 proc.) chirurgijos ir 29 (63,04 proc.) vidaus ligų skyrių ligoniai. 87,62 proc. ligonių gentamicino skirta po 240 mg, visiems 105 ligoniams – vieną kartą per parą. Prieš pradedant gydymą gentamicinu inkstų funkcija neištirta 11,86 proc. chirurgijos ir 19,56 proc. vidaus ligų stacionaro ligoniams, o gydymo eigoje inkstų funkcijos rodikliai tirti tik trečdaliui ligonių. Inkstų funkcija 87,62 proc. ligonių vertinta pagal šlapalo koncentraciją kraujyje. Kreatinino koncentracija kraujyje ištirta tik 12,38 proc. pacientų. Chirurgijos skyrių ligonių gydymo gentamicinu trukmės vidurkis – 5,932±2,392 dienos (2–13 d.), vidaus ligų – 8,283±3,344 dienos (3–19 d.). Išvados. Daugiau kaip pusei... [toliau žr. visą tekstą] The aim of the study was to analyze the treatment with gentamicin and possible nephrotoxicity of this antibiotic in patients treated in surgical and internal medicine departments of Kaunas University of Medicine Hospital. Materials and methods. A total of 105 case histories obtained from archive of our hospital were analyzed: 59 case records from surgical and 46 from internal medicine departments. Data were collected regarding indications for the administration of gentamicin, its dosage, duration of treatment, and patients’ renal function at the beginning and during the treatment. Results. There were more than 30% of patients older than 65 years. Gentamicin was administered in 14 (23.73%) surgical inpatients to prevent postoperative infection; 45 (76.27%) surgical and 46 (100%) internal medicine inpatients received gentamicin because of symptoms of infection. Half of the patients were treated empirically. In 87.62% of cases, gentamicin was administered at a dose of 240 mg; all 105 patients received it once per day. Before treatment, renal function was not evaluated in 11.86% of surgical and in 19.56% of internal medicine inpatients, and during treatment, it was examined only in one-third of patients. The duration of the treatment was 5.932±2.392 days (range 2–13 days) in surgical and 8.283±3.344 days (range 3–19 days) in internal medicine inpatients. Conclusions. More than half of patients received empirical treatment with gentamicin. Not enough attention has been paid to... [to full text]

Neracionalus antimikrobinių vaistų vartojimas didina mikroorganizmų atsparumą šiems preparatams. Didėjantis atsparumas antimikrobiniams vaistams yra didelė visuomenės sveikatos problema visame pasaulyje. Tyrimų, vertinusių šeimos gydytojo, dirbančio universitetinėje gydymo įstaigoje Lietuvoje, žinias apie tinkamą antibiotikų vartojimą, iki šiol nebuvo atlikta. Tyrimo tikslas – įvertinti antibiotikų vartojimą bei palyginti jų skyrimo indikacijas, dozavimą bei gydymo trukmę su racionalaus antibiotikų vartojimo rekomendacijomis. Kauno medicinos universiteto Šeimos medicinos klinikoje atliktas retrospektyvusis apžvalginis tyrimas: išanalizuotos visos dviejų apylinkių asmens sveikatos (ambulatorinės) kortelės (F25/a) ir atrinktos kortelės tų pacientų, kuriems per paskutinius vienerius metus (nuo 2005 m. sausio 1 d. iki gruodžio 31 d.) skirta antibiotikų. Antibiotikų vartojimas yra racionalus, jei jų skyrimas atitiko racionalaus antibiotikų vartojimo rekomendacijas. Tyrimo duomenų statistinė analizė atlikta naudojant statistikos paketą „SPSS 13“. Abiejose apylinkėse antibiotikų skirta 210 atvejų (I – 71 (33,8 proc.), II – 139 (66,2 proc.)). Iš viso abiejose apylinkėse antibiotikų skirta 184 pacientams (6,3 proc.). Atlikus tyrimo duomenų statistinę analizę, nustatyta, kad abiejų apylinkių šeimos gydytojai antibiotikus infekcinėms ligoms gydyti gali skirti racionaliau. Tik 9,5 proc. visų atvejų anti¬mikrobinių vaistų buvo skirta laikantis racionalaus antibiotikų vartojimo... [toliau žr. visą tekstą] Irrational and excessive use of antibiotics increases resistance to these preparations. Antimicrobial resistance is a serious public health problem worldwide. The main goal of our study was to evaluate the use of antibiotics (indications, dosage, and treatment duration) in daily family doctors’ practice and nonadherence to guidelines on rational antibiotic therapy. A retrospective study of records regarding the prescription of antibiotics for patients in two outpatient settings during the period of January 1, 2005, to December 31, 2005 was performed in Clinic of Family Medicine at Kaunas University of Medicine. Rationality of antibiotic therapy was evaluated according for adherence to published guidelines. A descriptive and comparative statistical analysis of data was processed with SPSS 13.0 program. There were 2935 patients in both outpatient settings (1285 and 1650, respectively). During the period of January 1, 2005, to December 31, 2005, antibiotics were prescribed in 210 cases for various reasons (71 (33.8%) and 139 (66.2%), respectively). A total of 184 (6.3%) patients received antibiotic therapy. It was determined that only in 9.5% of all cases, antibiotics were administered in keeping with the recommendations for rational antibiotic therapy. Only two treatment cases (1%) were based on bacteriological analysis. According to indications, appropriate antibiotics were prescribed in 42.9% of cases. The dosage of antibiotics was adjusted properly in 56.2% of cases, and... [to full text]

Epinephrine is an adrenergic agonist used to treat bronchospasm, anaphylactic reactions, bradycardia, cardiac arrest, and hypotension. Its toxicity is usually caused by iatrogenic errors. In overdose there is a typical rapid onset of agitation, hypertension, tachycardia, and dysrhythmias. This review article focuses on the causes of overdose, signs and symptoms, treatment and expected course, and prognosis of this iatrogenic pathology.

Tyrimo tikslas. Nustatyti minimalią veiksmingą hiperbarinio bupivakaino dozę spinalinei anestezijai darant anorektalines operacijas. Tyrimo metodai. Ištirti 93 pacientai, operuoti dėl gerybinių anorektalinių ligų. Sėdinčiam ligoniui 25–26G Tamanho (BBraun, Vokietija) spinaline adata buvo punktuojamas subarachnoidinis tarpas ir per dvi minutes sušvirkščiama: 1 grupės ligoniams (n=17) – 1,5 ml, 2 (n=38) – 1 ml, 3 (n=38) – 0,8 ml hiperbarinio bupivakaino 0,5 proc. tirpalo. Po 10 minučių ligoniai guldomi ant operacinio stalo ir daroma operacija. Atliekant šį tyrimą, vertinta: anestezijos efektyvumas, sensorinės ir motorinės blokados apimtis bei trukmė, laikas, kada ligonis pirmą kartą pasišlapino ir pradėjo vaikščioti, komplikacijos, analgetikų suvartojimas po operacijos, anestezijos kokybė ligonio ir gydančio personalo vertinimu. Rezultatai. Tiriamųjų grupės nesiskyrė demografiniais rodikliais. Neužfiksuota nė vieno nesėkmingo anestezijos atvejo, tačiau keturi ligoniai (10,5 proc.) iš trečios grupės operacijos metu juto tempimą pilve, jiems papildomai sušvirkšta fentanilo į veną. Sensorinės blokados lygis segmentais buvo: 1 grupės – 10,4±1,7; 2 grupės – 7,013±2,2; 3 grupės – 6,7±1,9 (p=0,0001 ANOVA; p

There was a purpose to create a composite ointment of proteolytic and antimicrobial activity, the formulation of which would contain the proteolytic enzyme procelan and the antimicrobial preparation with wide spectrum of action dioxidin. During the development of prodioxin ointment by means of biological experiments the optimal concentration of dioxidin was evaluated; it was 1 percent. The optimal dispersity value of dioxidin particles was estimated by dialysis through a semipermeable membrane. The best release of dioxidine from prodioxin ointment occured, when it was pulverized to particles with diameter 5–10 μm. The method of assay of dioxidin was modified for the ointment. The physicomechanical properties of the prodioxin ointment: flowability, colloidal stability, thermostability and rheological properties were examined. The investigated ointment is non-newtonian in character, e.g. an elastic and plastic system and may be intended for use in dermatological practice. Medicinal enzymic and antimicrobial effects of the prodioxin ointment were compared with the healing effect of Iruksol® ointment. The medicinal effect of the prodioxin ointment exceeded that of Iruksol® ointment by one day. Judging by the results of the physicochemical analysis a conclusion can be made that the prodioxin ointment is stable for two years at room temperature.

In December of 1999 and 2000 we visited all hemodialysis centers of Lithuania and collected data about all hemodialysis patients, using special questionnaires. The aim of the study was to evaluate the relationship between lethality of hemodialysis patients, erythropoietin dosage for renal anemia treatment and hemodialysis quality. The patients with higher Kt/V, higher levels of iron and albumin, normal levels of phosphorus and parathyroid hormone (PTH) requested lower doses of erythropoietin (analysis of the patients who were on hemodialysis in 2000 more than 6 months). So, we can conclude that adequate hemodialysis procedure and good management of hemodialysis patient are leading to the decrease request of erythropoietin doses for anemia treatment. We compared two groups of patients in order to examine relationship between hemodialysis quality and lethality of hemodialysis patients. We selected incident patients registered in December of 1999 and we divided these patients in December of 2000 in two groups: a) 175 patients, who continued hemodialysis treatment and b) 41 patients, who died in 2000. The results revealed, that dead patients were elder, their duration of weekly hemodialysis was shorter, Hb concentration lower, they had worse nutritional status (blood albumin level was lower). Lethality was associated with underlying diseases such as diabetes, hypertensive nephropathy and renal amyloidosis.

Experiments with piglets showed good assimilation and metabolism of iron (II) in antianemic powder Ferosol–1. In order to improve this drug, manganese, calcium (Ferosol–2, 1 composition) and ascorbic acid (Ferosol–2, 2 composition) were added. Manganese and ascorbic acid stimulate erythropoesis and being strong reductants stabilize iron (II) on storage and in gastrointestinal tract. Components of Ferosol–2 were identified using colour, precipitation- and extraction tests, as well as paper chromatography and absorption spectroscopy. Quantitative analysis of microelements and ascorbic acid was performed using absorption spectroscopy, extraction photometry and iodometric titration methods. Ferosol–2 proved to be more stable than Ferosol–1. Lichfield and Wilkinson method modificated by Roth was used for detection of acute toxicity of Ferosol– 2. A local action was estimated on quine pigs. Iron resorption was on 20 days old piglets. Antianemic effectiveness of Ferosol–2 was evaluated on newborn piglets watching their weight. Experiments with white mice showed low toxicity of Ferosol–2 (LD50=4.3 g/kg, for 1 composition and 4.6 g/kg for 2 composition). It does not irritate mucosa of duodenum and ventriculus. Iron in Ferosol–2 was found to be well assimilated in gastrointestinal tract of piglets, easily gets into blood and joins albumen of plasma. After administration of Ferosol–2 to piglets increased iron concentration in blood serum was observed for 3 hours (1 composition) and 6 hours (2 composition). Experimental data showed increased resorbtion of iron in Ferosol–2, 2 composition due to ascorbic acid. Components of Ferosol–2 are well assimilated and join erythropoetic processes. Ferosol–2 leads to quicker weight gain as well as significantly higher amount of hemoglobin and red blood cells in piglets.

Investigation of new stable iron (II) compounds is still an actual problem of today. Therefore we synthesized ferrous oxalate and prepared a stable antianemic powder Ferosol–1 including copper, zinc and cobalt. We used colour tests, precipitation reactions and paper chromatography for identification of components of this powder. Quantitative analysis of iron and other elements was performed using atomic absorption spectroscopy. We used Lichfield and Wilkinson method modificated by Roth to detect acute Ferosol–1 toxicity. To estimate a local action of this powder we used guinea pigs which were grouped into control and trial ones. We determined bioavailability of Ferosol–1 by giving it to rabbits with experimental posthemorrhagic anemia. Iron resorption was tested on 20–25 days old piglets. We also tried this drug on newborn piglets while atching their weight gain and calculation daily weight gain. This data was used to estimate indirect impact of Ferosol– 1 on metabolism of piglets. According to our data Ferosol–1 is of low toxicity (LD50=2.25 g/kg), it does not irritate mucosa of duodenum and ventriculus and could be used orally. Iron from Ferosol–1 was found to be well assimilated and to take place in hemopoetic processes of rabbit. After administration of Ferosol–1 to piglets iron concentration in their serum increased from 35.03±0.66 to 54.88±6.63 μmol/l, hemoglobin concentration increased to 96.4±2.5 g/l, erythrocyte number increased to 4.4±0.14·1012/l. The same data of control piglets were respectively 83.7±3.1 g/l and 3.52±0.3·1012/l. According to our results Ferosol–1 is an effective drug for prevention of iron-deficiency anemia and causes slight weight gain of piglets.

In recent years synthetic vasopressin analogues (particularly desmopressin) emerged as safe and effective representatives of this class of drugs for same clinical indications as natural hormone. It was imperative to create intranasal drug form using synthetic desmopressin compound. The purpose of this work was to develop formulations of intranasal desmopressin drug using synthetic active compound with optimal composition. Aquatic desmopressin intranasal solution was prepared in 0.05mg/ml concentration using phosphate buffer (pH 4.5–5.5) and following preservatives: nipagin-nipazol 7:3 – 0.1% or benzalkonium chloride 0.01% . Sterility is the main condition for intranasal drops and hormones as a raw material are thermolabile so it is not possible to apply a thermic sterilisation. Polymeric membrane filters of 0.22µm pore size were employed as sterilizing filters. In order to control the quality, to determine the stability of desmopressin intranasal drops at long-lasting storage (24 months) and to evaluate the influence of the technological factors we have developed the analytical methods of quality control. According to our quality control data, desmopressin intranasal drops are stable for two years and remain sterile during storage and administration of the drug.

A clinical effect of warfarin depends on highly polymorphic drug-metabolizing (CYP2C9) and drug-target (VKORC1) enzymes. The objective of this study was to investigate the impact of CYP2C9*2, CYP2C9*3, and VKORC1 (G-1639A) polymorphisms on the variability of warfarin dosage requirements in Lithuanian patients after heart valve replacement. Materials and Methods. The study included 83 patients with a mean age of 65.2 years (SD, 13.31) after heart valve replacement with an achieved stable international normalized ratio of 2–3.5. The restriction fragment length polymorphism method was used to identify polymorphisms of VKORC1 and CYP2C9. Results. Daily warfarin dosage significantly correlated with weight (r=0.4087) and height (r=0.3883) of the patients. Patients younger than 60 years required significantly higher daily warfarin dosages than older patients. Two-thirds (66.3%) of the patients had the wild-type (WT) CYP2C9* 1/*1 genotype; 38.6% and 54.2% of the patients had WT VKORC1 (G/G) and VKORC1 (G/A) genotypes, respectively. WT CYP2C9*1/*1 genotype was associated with a higher daily warfarin dosage (5.84 mg [SD, 2.84]) as compared to other CYP2C9 genotypes. Carriers of WT VKORC1 (G/G) required a higher warfarin dose as compared to (A/A) carriers (6.20±2.78 mg and 3.75±1.40 mg, respectively; P=0.04). Patients having CYP2C9*1/*1 or 1/*2 in combination with VKORC1 (G/G) or (G/A) genotypes required the highest daily warfarin dosage in comparison to other combinations of genotypes. Conclusions. The Lithuanian study sample is characterized by high a frequency (92.8%) of VKORC1 G/G and G/A genotypes that determines a higher warfarin-loading dose. Analysis of combined CYP2C9 and VKORC1 gene variants allows the prediction of warfarin dosage. These results can be used to individualize treatment with warfarin in the field of heart surgery in Lithuania.