Medicina Internacia Revuo - International Medicine Review

Role of TCD emboli-monitoring in evaluation of efficacy of anticoagulant therapy in patients with nonvalvular atrial fibrillation

2019-01-03T00:45:15+01:00

Background: Atrial fibrillation (AF) is a risk factor for stroke but, despite anticoagulation therapy, the risk of stroke is not completely eliminated. We evaluated the presence of microembolic signals (MES) by TCD emboli-monitoring in AF patients receiving various anticoagulation therapies.

Methods: In total, 103 patients were divided into four therapeutic groups (receiving warfarin, dabigatran, rivaroxaban, or apixaban; 22 patients in each group) and a control group (15 patients). Common stroke risk factors were evaluated, such arterial hypertension, ischemic heart disease, history of TIA/stroke, diabetes mellitus, and hyperlipidemia. TCD emboli-monitoring was performed on bilateral middle cerebral arteries for 45-60 minutes.

Results: No statistically significant differences were determined regarding the presence of risk factors between all groups. We found 2 MES in the warfarin group, 1 in the rivaroxaban group, 4 in the dabigatran group, and 0 in the apixaban group. One patient had positive MES in the control group. No statistical differences were seen when the groups were compared with the control group or with each other.

Conclusions: TCD emboli-monitoring can be used for MES detection in patients with AF receiving anticoagulation therapy and thus for the identification of patients at high risk of stroke occurrence/reoccurence.

Big Data Algorithms in Medicine

2019-01-03T16:37:29+01:00

Every week we read about new clinical pictures, that can be diagnosed faster and now with greater certainty than humans, using an algorithm. While doctors have to inform themselves about current studies and guidelines in addition to their clinical work and bureaucracy is accounting for an increasing share of working time, an algorithm can fall back on enormous computing capacities. In some areas of expertise, such as oncology or radiology, algorithms are already a step ahead of doctors. They will probably be of great help in medicine in the future. However, we must not forget that so-called neural networks only detect correlations, but never prove causalities. Furthermore, we must pay attention to which companies process our data so that monopolies are not promoted. With this commentary article we would like to point out the possibilities and possible risks of artificial intelligence in medicine and ask further questions regarding the future training of medical doctors the influence of politics and what role physicians will play in the future.

Differential Scanning Calorimetry (DSC) in the Study of Potential Incompatibilitis Between Fluconazole and Selected Pharmaceutical Excipients

2019-01-03T00:45:28+01:00

Studies of interactions between active pharmaceutical ingredients (APIs) and pharmaceutical excipients are one of the key aspects of quality control in the drug manufacturing. Potential physical and/or chemical incompatibilities may affect its stability, bioavailability, and consequently, the pharmacotherapeutic efficacy and safety. The aim of this work was to show the application of the differential scanning calorimetry (DSC) method in the assessment of the possible influence of selected pharmaceutical excipients on the physical properties of fluconazole. Therefore, a set of mixtures of fluconazole with microcrystalline cellulose Vivapur 12 and 112, Vitacel M80 cellulose, Maltodextrin N, corn starch - Starch 1500, agglomerated α-lactose Tabletoza, β-cyclodextrin and xylitol were examined. The measurements were carried out using both raw materials and physical mixtures in mass ratios of 1:9, 3:7, 1:1, 7:3, 9:1. In order to show the possible influence of manufacturing processes (such as milling, wet milling, granulation, compression etc.), micronized (kneaded) and co-precipitated (from water/alcohol solutions) mixtures were prepared and examined in a 1:1 weight ratio. The analysis of the DSC curves consisted in comparing the values of the maximum temperature Tmax, as well as the shape, height and area under the endothermic peaks of the melting process.

The main reason for writing this publication was the lack of easily available scripts or books in polish, concerning the subject of thermal analysis - especially differential scanning calorimetry DSC. By submitting this scientific and didactic article, we hope it would be a useful tool and teaching aids for students of pharmacy faculties and medicinal colleges.

Changes in pharmacokinetic properties of drugs in critically ill patients – Part I

2019-01-03T16:38:18+01:00

The essential and the most difficult goal for the implementation of pharmacotherapy in critically ill patients is to achieve the desired pharmacological effect, while minimizing side effects of drugs. The desired pharmacodynamic effect is dependent on the concentration of a drug obtained in a target tissue. Drug concentration, in turn, depends on pharmacokinetic processes which, in this group of patients, undergo significant, often difficult to predict, changes. These changes in pharmacokinetic properties of drugs may be caused by specific organ dysfunction, mainly liver or kidneys, and may be a consequence of an acute phase of inflammation, drug-drug interaction, or therapeutic intervention. Optimal use of drugs in patients of intensive care units requires a thorough understanding by physicians of the potential impact that a critical condition has on drug’s absorption, distribution, metabolism and excretion.

Biological activity of polypore Mushrooms: Laetiporus sulphureus, Piptoporus betulinus, and Trametes versicolor

2019-01-03T00:52:55+01:00

Polypore mushrooms from the Basidomycota taxon, are used in medicine. Laetiporus sulphureus, Piptoporus betulinus, Trametes versicolor, are species with proven antioxidant, anti-inflammatory, antimicrobial and anticancer effects. Well-known secondary metabolites produced by woodworm mushrooms are polysaccharides, phenolic compounds, indole compounds, terpenes, vitamins, bioelements. Isolated compounds and extracts of fruiting bodies and mycelial cultures have found application in the treatment of cancer and prevention of diseases of the cardiovascular system, diabetes, and microbial infections.

The aim of the work was to demonstrate a broad spectrum of biological activity of selected three species of polypore mushroom: Laetiporus sulphureus, Piptoporus betulinus, and Trametes versicolor.

Lucius Quintus Cincinnatus Lamar and his apoplexy

2019-01-03T00:46:05+01:00

Judge Lucius Quintus Cincinnatus Lamar (1825-1893) became one of JF Kennedy’s favourite political heroes. Lamar suffered from his first stroke in the age of 36. Searching his writings and historical material reveal that Lamar suffered also from depression, rheumatic heart disease and renal problems. Differential diagnosis of his disabilities is given together with descriptions of his ailments.

”Leave not a rack behind. We are such stuff As dreams are made on, and our little life Is rounded with a sleep. Sir, I am vexed. Bear with my weakness; my old brain is troubled. Be not disturbed with my infirmity. If you be pleased, retire into my cell And there repose. A turn or two I'll walk To still my beating mind..."

[W. Shakespeare, The Tempest , Act 4, Scene 1]