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Volume XVII, Number 4, 2013 - Therapeutics Pharmacology and Clinical Toxicology

Review

Original Papers


Selenium removal study in patients with chronic renal disease

Ana Maria Davitoiu, Barcanescu S., Negulescu V. Al., Avram Oana, Voicu V.A., Macovei R., Tudosie M., Caragea Genica, Forje Margarita, Mladin C., Fragkos A., Ardelean Luminita, Bumbea Viorica
Abstract: Selenium is an essential element of life. In humans, selenium is a cofactor of antioxidant enzymes, such as glutathione peroxidase and certain forms of tioredoxin - reductase. Selenium may inhibit Hashimoto`s disease (in which thyroid cells are attacked by autoantibody). Patients with chronic renal failure are usually subjected to three weekly dialysis procedures. Since selenium removal is done only during the dialysis procedure, it is important to study it to determine the risk of high level of selenium in blood. For determination of selenium concentrations, authors used a Varian atomic absorption spectrometer with graphite tube atomizer, GF-AAS. We have performed a comparative study concerning selenium concentrations in blood determined on subjects in a control group versus blood selenium concentrations in subjects belonging to a group of patients undergoing dialysis procedure. In order to highlight the selenium removal dynamics in dialysate fluid, samples were collected during dialysis procedure at predetermined intervals. Statistical analysis concerning the differences between the averages selenemia in the patients group versus control group, and the Lagrange polynomial interpolation ruling the variation of selenium level in the dialysate fluid, in order to establish eliminations equation of selenium in chronic renal disease patients during the dialysis procedure, are presented in this paper.

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Influence on acute nociceptive pain

Rus Natalia Niculina, Bocsan Ioana Corina, Buzoianu Anca Dana
Abstract: The aim of this study is to assess the pregabalin effects in different doses, single administration, on animal model of acute nociceptive pain. Material and method. We used 50 males Wistar Bratislava rats randomized in 5 groups: a control group treated with saline solution, the 2nd and 3rd groups injected with metamizole 50 mg/kg, respectively tramadol 10 mg/kg and 2 experimental groups treated with different doses of pregabalin 15 mg/kg and 30 mg/kg. The evaluation of pain perception was performed before injection (baseline) and after drug administration (ip 0.5 ml/100g) using 3 methods: paw pressure test, hot plate test and tail flick test. The obtained data were statistically analyzed, considering significance at p<0.05. Results. PGB (30mg/kg) increases the pain threshold after 1 hour (tail flick test), is maximal at 2 and 4 hours (tail flick and hot plate tests) and is maintained up to 24 hours (paw pressure test). PGB (15mg/kg) increases also the pain level after 1 hour (tail flick test), but is inconstant at 2 hours, increases again at 4 hours (hot plate test) and is maintained at 24 hours after administration (tail flick test). Conclusions. PGB(30 mg/kg) in single administration, has an analgesic effect in nociceptive pain in all 3 used tests, compared both with control and metamizole or tramadol. PGB 15 mg/kg has an inconstant and less intense analgesic effect. PGBs analgesic effect in acute pain is dose dependent.

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Multiple respiratory viral co-infections in patients with acute respiratory infection

Florea D., Visan Angelica, Draganescu Anca, Jugulete G., Luminos Monica, Otelea D.
Abstract: To investigate the prevalence of respiratory viruses and the rate of viral co-infection in patients with acute respiratory disease hospitalized in the National Institute for Infectious Diseases `Prof Dr Matei Bals` in the winter season 2012/2013. Methods: Nasopharyngeal swabs were collected from patients with acute respiratory illness admitted from December 2012 to March 2013. The samples were tested with xTAG Respiratory Virus Panel Fast (Luminex). Results: A total of 227 samples were prelevated, most of them (77.3%) from paediatric (0-14 years old) patients. More than half (56.3%) of the samples were positive for at least one virus; the predominant viruses were influenza A and influenza B. Adenovirus, RSV and Rhinovirus/Enterovirus (RV/EV) were detected most frequently in children less than 5 years old. Eleven samples (8.5%) were positive for two viruses and one sample was positive for three viruses. Co-infection was significantly associated (p=0.01) with age under 5 years. Adenovirus and RV/EV were more frequently detected with other viruses, and all the viruses of the panel (influenza, parainfluenza, RSV, adenovirus, RV/EV, Coronavirus, Metapneumovirus, Bocavirus) were identified in co-infections. Conclusion: Co-detection of two or more respiratory viruses is not uncommon in paediatric patients with acute respiratory illness.

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Optimal treatment of hypovolemic hypertensive crises in ckd nondialyzed patients

Lepar Zoe, Radulescu Daniela, Perida Ileana, Niculae A., Checherita I. Al., Ciocalteu Al.
Abstract: Hypovolemia and hypertension are important factors for worsening a previous CKD. The present article highlights the importance of concomitant treatment of both factors in nondialyzed CKD patients with hypertensive crises. Material and methods. The study included 454 patients with chronic kidney disease stage 3 or 4, who were admitted for hypertensive crises and who received treatment in accordance with volemic status and plasma sodium. Results. 96 patients had hypovolemia (21%). Reducing systolic blood pressure = 160mmHg was achieved faster in patients whom hypovolemia was corrected by parenteral route. Patients with hyponatremia received saline solutions via parenteral administration with better clinical benefits than glucose isotonic solutions. Conclusions. Optimal treatment of hypovolemic hypertensive crises requires promptly restoring of plasma volume. In some cases with hyponatremia, infusion of sodium chloride solution will correct, paradoxically, the raise in blood pressure.

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Safety concerns regarding the use of modern liver contrast medium

Motoi S.B., Birsasteanu F., Mogoseanu Maria, Costachescu D., Cerbu Simona, Gafencu M.
Abstract: The MRI is `the gold standard` to evaluate the nodular liver. A study made over a period of 22 months between 2009 and 2011 assessed the side effects of 2 types of contrast agents (SPIO and gadobutrol) administered to patients that underwent MRI investigations aimed to diagnose hepatic nodular lesions. 134 patients were examined and monitored. Gadolinium MRI contrast agents are much safer than the contrast used on CT, anaphylactic reactions being rare. None of the patients developed any clinical or biological side effects, contrast agents for magnetic resonance imaging being much safer than contrast used in computer tomography. Sex, age or associated pathology of the patients dont represent risk factors for the development of adverse reactions.

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Preparation, Optimization and Characterization Of Gastroretentive Ranitidine Hydrochloride Alginate Beads

Anmar A. Issa, Valentina Anuta, Alice Piperea, Nagwa Ibrahim
Abstract: Gastroretentive drug delivery system of RHCl using floating alginate beads as an approach for prolonged release was prepared and the results of factorial design indicated that the dissolution profile is significantly depended on the alginate: drug ratio and hydroxy proprylmethylcellulose(HPMC): alginate ratio. The determined drug loading % of optimized formula was 33% which means that the weight of floating beads equivalent to 336 mg of RHCl is 1018.18 mg.

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Therapeutical Practice


Therapeutic strategies in infective endocarditis: who and when necessitate surgery

Baluta Mariana Monica, Vintila M.M.
Abstract: Infective endocarditis (IE) remains even in our days a serious condition associated with high mortality. The need of a multidisciplinary team approach is now well known. Conservative therapy consists in high doses of antibiotics administered intravenously during 4, or 6 weeks. Dual therapy, medical and surgical may be the future attitude in endocarditis. The importance of early surgery was emphasized in contemporary literature even if some discrepancies appear in evidence-based data due to a not uniform data collection and to statistical methods. There are evidences today that the patient outcome may be improved by early surgery in few selected condition. Those are heart failure, uncontrolled infection and high risk for embolic events. IE patients with those complications are candidate to dual therapy, medical and surgical. There is no reason to delay surgical removal of infection except very large hemorrhagic and sometimes ischemic stroke. Cerebral complications delays only the intervention and do not contraindicate it. Patient appreciated as suitable for medical therapy only need regularly monitoring of clinical, biological and echocardiography parameters. Controlled randomized trials are needed to establish clearly the selection criteria for early surgery and the proper timing for that. The purpose of this paper is to emphasis the importance of optimal therapeutic strategy for patients with infective endocarditis.

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Triple therapy in HCV chronic hepatitis

Iliescu Laura, Toma Letitia, Minzala Georgiana
Abstract: As chronic HVC infection is one of the most common infections worldwide, with significant impact on morbidity and mortality, it is important to study the possible curative treatments and their prognostic factors. Triple therapy with interferon, ribavirin and a protease inhibitor (boceprevir) is an important step in the management of HVC positive patients who do not respond to double therapy. We present response rates and predictive factors of the triple therapy with Peginterferon + Ribavirin + Boceprevir. Methods. We included 27 patients with treatment failure to the initial therapy. We initially determined their IL28B genotype, viremia, degree of fibrosis and the response type to the initial therapy. On follow-up we tested their viremia at 4, 8, 12, 24, 48 and 72 weeks after the start of triple therapy. Results. Sustained Virologic Response (SVR) was achieved in four patients from the seven patients who have reached the 6 month period from the end of the treatment. The remainder of three patients had relapse after receiving the triple therapy. Seventeen patients (77.27%) had undetectable plasma levels of HCV RNA at week 48. An undetectable HCV RNA level was not achieved by treatment week 24 in three patients (13,63%) and all their therapy was discontinued. Also, all treatment was discontinued in two patients before week 24 due to severe adverse events. Conclusion. IL28B genotype, degree of fibrosis and type of response to previous therapy can be associated in order to predict the virologic response to triple therapy in HCV infection.

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