ADAPTATION OF “DRIED BLOOD DROP” METHOD FOR THERAPEUTIC DRUG MONITORING

To control the concentration of drugs with a narrow therapeutic range, and to conduct effective and safe treatments, Therapeutic Drug Monitoring (TDM) is carried out. However, to date, the implementation of TDM is associated with various difficulties, for the solution of which more convenient and less invasive methods for collecting biological material are being developed.

The aim of the study was to develop protocols for the collection and storage of “dried blood spot” (DBS) samples, as well as protocols for the validation methods for the quantitative determination of drugs in whole blood, using this technology for subsequent therapeutic drug monitoring.

Materials and methods. To analyze a “dried blood spot” method in detail and to identify the characteristic features of taking and storing biosamples, a collection and analysis of scientific literature over the past 10 years has been conducted. The search for literature materials has been carried out from open and accessible sources located in the scientific libraries of institutions, in electronic databases and search engines: Elibrary, PubMed, Scopus, Cyberleninka, Medline, ScienceDirect, Web of Science, Google Scholar. Primary protocols for taking, storing and analyzing samples of the “dried blood drop” have been prepared. To obtain the adequate quality samples, the developed protocols have been tested and optimized at the stages of selection and storage. By high-performance liquid chromatography with mass spectrometric detection (HPLC-MS/MS), using a “dried blood drop” as a sample preparation, drug validation protocols have been optimized to ensure that acceptable validation characteristics were achieved, and subsequent Therapeutic Drug Monitoring was performed.

Results. The features of the collection, storage and analysis of the “dried blood spot” samples have been revealed. Such characteristics as a spot volume effect, a hematocrit effect, a droplet uniformity, which can affect the results of a quantitative HPLC-MS/MS analysis, have been determined. For a successful use of the new methods, appropriate protocols for taking samples of “dried blood spot” from the finger of adult patients and from the heel of newborns, as well as protocols for validating methods for the quantitative determination of drugs from these samples, have been developed.

Conclusion. The application of the “dried blood spot” method using newly developed protocols for taking, storing and analyzing biological samples, relieves the existing constraints in conducting TDM, and can later become a promising method for conducting preclinical and clinical studies.

Changes in Prescribing Antithrombotic Therapy in Patients with Atrial Fibrillation in the Multidisciplinary Hospital in Volgograd from 2012 to 2020

Aim. To study the frequency of prescribing antithrombotic agents in patients with non-valvular atrial fibrillation (AF) in real clinical practice, to evaluate changes of prescriptions from 2012 till 2020.

Material and methods. The medical records of inpatients (Form 003/y) with the diagnosis AF, hospitalized in the cardiological department were analyzed. According to the inclusion criteria, the patients were over 18 years of age, established diagnosis of non-valvular AF. There were two exclusion criteria: congenital and acquired valvular heart disease and prosthetic heart valves. In retrospective analysis we have included 263 case histories in 2012, 502 ones in 2016 and 524 in 2020. CHA2DS2-VASc score was used for individual stroke risk assessment in AF. The rational use of the antithrombotic therapy was evaluated according with current clinical practice guidelines at analyzing moment.

Results. During period of observation the frequency of antiplatelet therapy significantly decreased from 25,5% to 5,5% (р<0.001), decreased the frequency of administration of warfarin from 71,9% to 18,3% (р<0.001). The frequency of use of direct oral anticoagulants increased in 2020 compared to 2016 (р<0.001). For patients with a high risk of stroke anticoagulant therapy was administered in 71.8% of cases in 2012, 88.5% in 2016 and 92.5% in 2020. Before discharge from hospital majority of patients (72%) achieved a desired minimum international normalized ratio (INR) from 2.0 to 3.0 in 2012. In 2016 and 2020 an only 33% and 40.6% of patients achieved INR (2.0-3.0).

Conclusion. Doctors have become more committed to following clinical guidelines during the period of the investigation. In 2020 antithrombotic therapy for atrial fibrillation was suitable according to current clinical guidelines.

Effect of Direct Oral Anticoagulants for Ulcer Epithelization and Laser Doppler Flowmetry Parameters In Patients with Diabetic Foot Syndrome and Atrial Fibrillation

Aim. To study changes in epithelialization of diabetic foot ulcers and parameters of laser Doppler flowmetry (LDF) in patients with diabetic foot syndrome (DFS) and atrial fibrillation (AF) during complex therapy with the addition of direct oral anticoagulants (DOAC).

Material and methods. An open-label comparative randomized study in parallel groups was performed. Patients with neuroischemic DFS and persistent FA without previous anticoagulant therapy were randomized into two groups: combination therapy for DFS and rivaroxaban (group 1; n=24) or combination therapy for DFS and dabigatran (group 2; n=22). Changes in local status in diabetic foot ulcers, coagulogram parameters and LDF were studied at 4 and 12 weeks.

Results. Complete epithelialization of diabetic foot ulcers after 12 weeks was found in 14 (58.3%) patients in group 1, and in 10 (45.4%) patients in group 2. Statistically significant improvements in LDF parameters were found in both groups in both groups: an increase in the microcirculation index by 53.5% (p=0.02), pulse wave by 124.0% (p=0.003), respiratory wave by 59.4% (p=0.007) was found in group 1. An increase in the microcirculation index by 48.5% (p=0.02), pulse wave by 73.1% (p=0.003), respiratory wave by 47.1% (p=0.03) were found in group 2.

Conclusion. Positive statistically significant changes in epithelialization of diabetic foot ulcers and LDF parameters were found in patients with DFS and AF during 12 weeks of complex therapy with the addition of DOACs (rivaroxaban and dabigatran). Further research for DOACs in DFS patients is needed.

[Antioxidant effect of cortexin, cerebrolysin and actovegin in rats with chronic cerebrovascular insufficiency]

OBJECTIVE

To compare the antioxidant effects of cortexin, cerebrolysin and actovegin in rats with chronic brain ischemia.

MATERIAL AND METHODS

Chronic brain ischemia was modeled in male rats by 50% stenosis of the common carotid arteries. Forty days after surgery, the animals received 2 ten-day courses of therapy, separated by a break of 10 days. Placebo, cortexin (0.3, 1 and 3 mg/kg), cerebrolysin (0.8, 2.5 and 7.5 ml/kg) and actovegin (5 ml/kg) were administered to animals as treatment. The concentration of malondialdehyde (MDA) in the homogenates was determined by the reaction with thiobarbituric acid, the concentration of reduced glutathione was determined by the reduction reaction of 5.5-dithiobis- (2-nitrobenzoic acid); determination of catalase activity, as well as the content of lactate and pyruvate, by commercially available reagent kits. The activity of superoxide dismutase (SOD) was determined by the photometric method based on an assessment of the degree of inhibition of the epinephrine oxidation reaction. All reactions were carried out in triplicates.

RESULTS

Modeling of chronic brain ischemia led to the statistically significant decrease in the content of lactate and pyruvate (p<0.001, when compared with the control group), which was not accompanied by a significant decrease in their ratio (p>0.05), as well as to the decrease in SOD, catalase activity, restored glutathione and increase in MDA concentrations. Compared with the control group, in the groups that received cortexin at a dose of 3 mg/kg/day, cerebrolysin at a dose of 7.5 ml/kg/day and actovegin at a dose of 5 ml/kg/day, there were an increase in the content of lactate and pyruvate (without a significant change in their ratio), restoration of glutathione levels and the activity of SOD and, to a lesser extent, catalase, combined with a decrease in the concentration of MDA.

CONCLUSION

Course administration of cortexin (3 mg/kg), cerebrolysin (7.5 ml/kg) and, to a lesser extent, actovegin (5 ml/kg) has a positive effect on the state of the antioxidant system of the brain in rats with chronic brain ischemia.

Anticoagulation therapy in atrial fibrillation after intracranial hemorrhage

Intracerebral hemorrhage (ICH) is severe and fatal complication of anticoagulant therapy with an incidence 0.3-0.7% per year. For patients with atrial fibrillation (AF) anticoagulants are administered for decreasing risk of stroke and systemic embolism. In this case the occurrence of intracranial bleeding is hard task for doctor. From the one side it is necessary to reverse the action of the drug for preventing the growth of hematoma. At the same time the discontinuation of therapy increases the risk of systemic embolism for patients with AF significantly. Clinical guidelines and studies have been reviewed about ICH during anticoagulant therapy. Nowadays there is no quality evidence about reversal of anticoagulant effects after ICH and optimal time of resumption of anticoagulant therapy. Firstly, we do not have large randomized controlled trials on this issue. The majority of clinical guidelines were based on retrospective studies and opinions of experts. Soon several randomized controlled trials will be finished and new data will be presented.

Effects of a New Benzimidazole Derivative with Actoprotective Properties on Spermatogenic Epithelium of the Testes and Fertility of Male White Rats

The effects of a new derivative of benzimidazole (K-134) in doses of 5 and 50 mg/kg on the spermatogenesis and fertilizing ability of spermatozoa were studied on male rats. It was found that 2-month course treatment with the studied substance enhances the producing ability of the spermatogenic epithelium and improves fertilizing ability of spermatozoa.

Safety of Using Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Chronic Kidney Disease

The purpose of this review is to examine the possibilities and prospects for the use of direct oral anticoagulants for the prevention of thromboembolic complications in patients with atrial fibrillation and chronic kidney disease. Chronic kidney disease is an independent risk factor for cardiovascular complications. Atrial fibrillation is associated with a higher risk of developing chronic kidney disease and more rapid progression of existing renal pathology. The presence of chronic kidney disease in atrial fibrillation on the one hand leads to an increased risk of thromboembolism, and on the other to an increased risk of bleeding when using anticoagulants. The standard for the prevention of thromboembolic complications in atrial fibrillation, including those with concomitant renal pathology, was considered warfarin for many years. However, modern studies have shown that the use of warfarin may enhance vascular calcification in patients with chronic kidney disease, which in turn may lead to an increased risk of ischemic strokes.

Analyzing clinical recommendations, randomized studies, meta-analyzes and a systematic review on the use of anticoagulants in patients with atrial fibrillation and renal pathology, revealed the advantage of using direct oral anticoagulants over warfarin at stage 1-3 of chronic kidney disease. Data on the use of direct oral anticoagulants with a more pronounced renal dysfunction and in patients on dialysis is limited due to the lack of a sufficient number of large randomized studies. Due to the presence of renal clearance in all oral anticoagulants, their pharmacokinetics changes to some extent with a decrease in the glomerular filtration rate, which requires dose adjustment of drugs depending on creatinine clearance. Therefore, the use of anticoagulants for the prevention of thromboembolic complications during atrial fibrillation requires special attention in patients with chronic kidney disease.

Comparative Analysis of Antithrombotic Therapy in In-Patients with Atrial Fibrillation

Aim. To study the frequency of prescribing antithrombotic agents in patients with non-valvular atrial fibrillation (AF) who were hospitalized in the cardiology department of a multidisciplinary hospital.

Material and methods. A retrospective one-time study of medical records of 765 patients with non-valvular AF treated in the cardiology department of a multidisciplinary hospital in 2012 and 2016 was performed.

Results. All patients were stratified in three groups depending on the CHA2DS2-VASc score. The frequency of prescribing antithrombotic agents was evaluated in each group. A low risk of thromboembolic complications was found in 1% (n=3) of patients in 2012 and 0.6% (n=3) in 2016. All these patients received antithrombotic agents. CHA2DS2-VASc=1 was found in 6% (n=15) of patients with AF in 2012 and in 3.4% (n=17) in 2016. A significant number of patients in this group received anticoagulant therapy with vitamin K antagonists (warfarin) or with direct oral anticoagulants. A high risk of thromboembolic complications (CHA2DS2-VASc≥2) was found in 93% of patient (n=245) in 2012 and in 96% (n=482) in 2016. Anticoagulant therapy was prescribed in 70.2% (n=172) patients with high risk in 2012 and 80% (n=387) in 2016. However, some patients with high risk of thromboembolic complications did not have the necessary therapy.

Conclusion. Positive changes in the structure and frequency of prescribing anticoagulant drugs in patients with AF and a high risk of thromboembolic complications were found during the years studied. 

[Behavioral phenotyping in rats during the experimental modeling of chronic cerebral circulation disorder]

AIM

To describe motor, adaptive and cognitive disorders in rats with chronic cerebral circulatory deficiency caused by partial stenosis of the common carotid arteries (CCA).

MATERIAL AND METHODS

A study was performed on 20 white outbred male rats. This manipulation led to 40-45% and 50-60% reduction of blood flow in CCA and in the brain, respectively. Twenty days after operation, animal's condition was assessed in the following tests: open field test, rotarod performance test, marble burying test and novel object recognition.

RESULTS AND CONCLUSION

After 20 days of experimental CCA stenosis, animals demonstrated several signs of neuropsychiatric deficiency including coordination disorders, a decrease in locomotor activity as well as in explorative and protective behavior. The model of CCA partial stenosis could be used during further studies of the pathophysiology and pharmacology of chronic cerebral circulatory deficiency.

[Changes in the structure of pathogens of calculous pyelonephritis complicated with diabetes mellitus type ii, in the hospital urology of the city of Volgograd]

Among the diseases complicating the course of calculous pyelonephritis, are among the leaders of diabetes mellitus, which is associated with reduced immune response, deterioration of renal hemodynamics, the reduced sensitivity to antibacterial drugs. The purpose of the study is to improve the results of treatment of patients with calculous pyelonephritis and diabetes mellitus type 2. The materials and methods of research. We studied 179 people. This was a retrospective pharmaco-epidemiological analysis of medical records of patients who were treated in 2009 and 2013, in hospital of Volgograd. Women in the study was greater than 99(by 55.4%), males - 80 (44,6%). All patients underwent standard clinical examination, with mandatory bacteriological urine analysis, ultrasound study of kidneys.

RESULTS

During the observation period of 2009 and 2013 in patients with calculous pyelonephritis and type 2 diabetes, the major pathogens were representatives of the family Enterobacteriaceae. E.coli strains are constituted - 12 (54,5%), K. pneumoniae - 4 (18.1%) strains. In other etiologically significant microorganisms were Enterococcus spp. - 3 (13.6%) strain, P. aeruginosa - strain 2 (9%). The group of other (4.5%), we have carried pathogens isolated in the singular: Erobacter spp, S. aureus, and Klebsiella oxytoca. In patients with infection of the upper urinary tract and diabetes, there is a pronounced trend to decrease sensitivity to all groups of antibiotics. Sensitivity to unprotected penicillins and fluoroquinolones has decreased almost twice. Resistance to aminoglycosides of patients in this group increased by 23%. In patients with chronic calculous pyelonephritis and diabetes mellitus type 2 is high sensitivity of the main causative agents of infection to cephalosporins of the third and fourth generation (92%), protected beta-lactam penicillins (amoxicillin/clavulanate) - 86,4%, to carbapenemam is 89.4%.

CONCLUSIONS

For the empiric treatment of infections of the upper urinary tract in patients with diabetes mellitus, can be recommended drugs: protected beta-lactam penicillins, cephalosporins of the third and fourth generation, carbapenem.

Development of Clinical Pharmacology in the Russian Federation

PURPOSE

The article aims to provide the history, organization, and approaches to clinical pharmacology in the Russian Federation.

METHODS

This article is based on major international and Russian documents, along with groundbreaking historical facts and scientific articles related to the development of modern clinical pharmacology the Russian Federation.

FINDINGS

Improving the quality of drug therapy is the main goal of clinical pharmacology in the Russian Federation. Decisions of the World Health Organization, scientific achievements, and the work of well-known scientists among the world community and in the Russian Federation have strongly influenced the development of clinical pharmacology the Russian Federation. Clinical pharmacology in the Russian Federation addresses a wide range of problems; it actively engages in modern scientific research, education; and clinical practice. Clinical pharmacologists participate in studies of new drugs and often have a specific area of expertise.

IMPLICATIONS

The future development of clinical pharmacology in the Russian Federation will be related to improvements in training, refinement of the framework that regulates clinical pharmacologists, and the creation of clinical pharmacology laboratories with modern equipment.

MONITORING OF ANTICOAGULANT THERAPY IN PATIENTS WITH DEEP VEIN THROMBOSIS

Aim. To evaluate the prevalence of accomplished goal in laboratory clotting parameters for the anticoagulant therapy in deep vein thrombosis (DVT).

Material and methods. The study is performed as one-stage, descriptive, analytic, pharmacoepidemiologic investigation. The material for the study were 200 case histories of DVT from Volgograd hospitals. The analyzed were: structure of anticoagulant prescription, coagulogrammes with APTT, prothrombin complex and INR.

Results. Direct acting anticoagulants were prescribed in 91% cases. High-molecular heparin was used in 84,5% prescriptions, low-molecular heparins — in 6,5%. Monitoring of APTT was done only in 36% patients. The target values of APTT (1,5–2,5 times higher than upper limit) was reached only in 6% cases. Of the indirect anticoagulants warfarin was used in 75,5%. Although laboratory control of warfarin was done in 97% cases, only in 28% of patients INR at discharge was in the range 2,0–3,0.

Conclusion. The data witnesses a variety of drawbacks in anticoagulant therapy of DVT patients. High dosages of HMW heparin and warfarin, not enough rigourous control and dosage titration led to the absence of the desired therapeutic diapasone of hypocoagulation. 

[The place of novel oral anticoagulants in prevention and treatment of venous thromboembolism]

The notion "venous thromboembolism" combines two processes: thrombosis of deep veins and pulmonary artery thromboembolism. The necessity in long-term adequate anticoagulant therapy as the basic treatment of patients with deep vain thrombosis does not give rise to doubts, it should be started prior to instrumental verification of the diagnosis. The past decade was marked by the appearance on the pharmaceutical market of a new oral anticoagulant: selective blocker of the Xa factor of blood coagulation system - rivaroxaban. According to the data of large-scale randomized clinical trials, the efficacy and safety of rivaroxaban are comparable to those of traditional conventional anticoagulant therapy (non-fractionated/low-molecular-weight heparin NFH/LMW + warfarin). Indisputable advantages of new agents are as follows: the lack of the necessity in laboratory monitoring, no interaction with foodstuff, minimal interaction with other drugs, minimal risk for the development of haemorrhage, and simplicity of dosing.

[Influence of magnesium deficiency correction on the effectiveness of bronchial asthma pharmacotherapy in children]

We have performed 24-week open-labeled comparative randomized parallel-group study of the basic therapy efficacy of uncontrolled and partly controlled atopic asthma children with magnesium deficiency. The additional correction of magnesium deficiency increases the efficacy of atopic asthma basic therapy. It leads to more pronounced inhibition of local allergic inflammation in respiratory system, decreases the exacerbation frequency (9.5%, p = 0.02), and increases the number of asymptomatic days and the 12-week constant asthma control frequency (71.4%, p = 0.145) as compared to the group without magnesium deficiency correction.

[Fundamental bases of search of medicines for therapy of a diabetes mellitus type 2]

In the presented review the data on searching for new drugs for diabetes mellitus treantment are analyzed. These drugs are used for metabolic disorder correction leading to hyperglycemia: beta-cells dysfunction, peripheral insulin resistance, increased hepatic glucose output.

Experimental study of the effects of Dietressa, a new weight-reducing drug

The capacity of a new drug containing ultra-low doses of antibodies to cannabinoid receptor type 1 (Dietressa) to reduce body weight gain in mice on a high-calorie diet was evaluated, possible mechanisms of drug action were analyzed, and its safety (abuse potential in the reaction of self-stimulation) was evaluated. Dietressa was not inferior to sibutramine in reducing body weight gain in mice and exhibited no abuse potential.

[Drug therapy of bronchial asthma and chronic obstructive pulmonary disease: data of evidence-based medicine and real clinical practice]

The study was designed to estimate quantitative and qualitative characteristics of drug consumption for therapy of bronchial asthma and chronic obstructive pulmonary disease in outpatient and inpatient facilities. The frequency and intensity of the use of selected drugs are considered in terms of their conformity to principles of evidence-based medicine. Analysis of prescriptions revealed different degree of awareness of district physicians and other specialists about rational drug therapy. The drawbacks of the treatment of bronchial asthma and chronic obstructive pulmonary disease are first and foremost attributable to poor compliance with the existing standards and inefficient use of medications. It was shown that each outpatient and inpatient facility has its own policy of fund allocation for pharmacotherapy. The results of the study can be useful for rational organization of the treatment of patients with bronchial asthma and chronic obstructive pulmonary disease and for optimization of medical aid provision with a view to saving healthcare resources.

[Effect of kardostin on the generative function of female rats]

The effects of kardostin on the ovulatory cycle, conception, and sexual behavior of female rats have been experimentally studied. It is established that a two-week therapy with kardostin at a dose of 5 and 15 mg/kg changed phases of the estrous cycle (with the estrus phase being most prevalent) and led to ambiguous changes in the sexual behavior of female rats (a dose of 5 mg/kg increased sexual behavior, while a dose of 15 mg/kg inhibited it), activated fertility, and improved the quality of conception.

[The choice of pharmaceuticals for the treatment of bronchial asthma and chronic obstructive respiratory disease]

This pharmacoepidemiological study at the regional level permitted to reveal the real strategy of medical prescriptions and the choice of medications for the treatment of bronchial asthma and chronic obstructive respiratory disease. Regional variations in the combination of preparations actually used by patients with these diseases are investigated for the first time. The main causes of non-compliance with medical prescriptions are analysed.

Some aspects of toxicological activity of kardosten after chronic 6-month administration to rats

Chronic treatment of rats with kardosten for 6 months had a positive effect on some ECG values and behavior without disordering the hepatorenal functions. All effects of the drug observed during a course of treatment were leveled and the parameters reached the basal values within 2 weeks after drug discontinuation, this confirming its safety.

[Pharmacological neuroprotection against brain damage in ischemiai/reperfusion experiment]

Experiment carried out on laboratory animals (rats) were aimed at comparative evaluation of the effect of several neuroprotective drugs under the conditions of model brain ischemia-reperfusion. The experimental methods included staining of brain tissue sections by hematoxiline-eosine, Nissl staining, and expression of NOS1, NOS3, TRAIL by imunnohistological means. The intensity of damage in various parts of brain and the nature of apoptosis without neuroprotection and with popular neuroprotectors (cytoflavin, actovegin, mexidol) and a test drug at the stage ofpreclinical trial (AKF-90-7) were evaluated. Characteristic cytotoxic (coagulative pycnomorphic and colliquative necrosis of neurons) and vascular (hemostasia, erythropedesis) changes were revealed. The neuroprotective effectof drugs decreases in the following order: AKF-90-7 > cytoflavin > actovegin > mexidol.

The use of ultralow doses of antibodies to C-terminal fragment of angiotensin II AT1 receptor (kardos) in the therapy of arterial hypertension

Kardos monotherapy allows attaining the target levels of systolic and diastolic blood pressure in patients with high-risk and very-high-risk hypertension. We demonstrated excellent tolerability of the preparation in combination with reliable blood pressure decrease over 24 h, during day and night hours.

[Comparative study of magnesium salts bioavailability in rats fed a magnesium-deficient diet]

The purpose of this study was to compare efficiency of compensation of alimentary Mg deficiency after administration of 12 organic and 8 inorganic magnesium salts and to evaluate the ability of vitamin B6 to accelerate their effect. Two hundred eighty rats were placed on a Mg-deficient diet (Mg content (15 mg/kg) and demineralized water for 7 weeks. Twelve control rats were fed a basal diet (Mg content 500 mg/kg). Starting from day 49 of the Mg-deficient diet, the rats were given magnesium salts (50 mg magnesium and 5 mg pyridoxine per kg): Mg chloride, Mg sulphate, Mg oxide, M nitrate, Mg thiosulphate, Mg hydrophosphate, Mg carbonate, Mg trisilicate, Mg (L-, D- and DL-) aspartate, Mg (L- and DL-) pyroglutamate, Mg succinate, Mg glycinate, Mg orotate, Mg taurate, Mg lactate or their combination with vitamin B6 (5 mg/kg b.w.). Erythrocyte and plasma Mg levels were measured by spectrophotometry following the colour reaction between Mg and titanium yellow. Mg L-aspartate compensated for magnesium deficit more effectively and faster than all other salts. Mg chloride showed the highest efficiency among inorganic magnesium salts. Both Mg chloride and Mg L-aspartate in combination with vitamin B6 caused statistically significant compensation of magnesium deficit.

A randomized, open-label, comparative, 6-month trial of oral ultra-low doses of antibodies to tumor necrosis factor-alpha and diclofenac in rheumatoid arthritis

Artrofoon (oral ultra-low doses of antibodies to TNF-alpha is a novel drug approved by the Russian Ministry of Health for the treatment of rheumatoid arthritis (RA). The aim of this study was to assess clinical efficacy and safety of artrofoon in RA compared with diclofenac. In a 6-month, randomized, open-label, comparative trial, 60 patients with active RA (eight men and 52 women aged 23 to 62, mean disease duration 10 years) received artrofoon (8 tablets daily, n = 30) or diclofenac (100 mg daily, n = 30). RA signs and symptoms as well as serum levels of inflammatory markers were evaluated before treatment and at months 1, 3 and 6. Most patients in the artrofoon group showed a 20% improvement in major RA symptoms by the end of the study. The clinical effect rose gradually reaching maximum at month 6. In the artrofoon group, 57% of the patients achieved an American College of Rheumatology (ACR) 20% criteria (ACR20) by month 6 versus 20% of those receiving diclofenac. In some patients in the artrofoon arm, serum proinflammatory cytokine levels significantly decreased (> or = 25% reduction). Diclofenac produced a less pronounced clinical effect, and no changes in cytokine profile. Unlike conventional nonsteroidal anti-inflammatory drugs, artrofoon produced no adverse effects and the overall tolerability and safety were excellent. A half-dose treatment with artrofoon (4 tablets daily) was able to sustain clinical improvements over a 6-month follow-up period. To conclude, artrofoon is a safe and effective treatment for rheumatoid arthritis that acts by influencing the inflammatory process.

[Lactation mastitis: problems and perspectives]

Results of treatment of 664 patients with lactation mastitis were analyzed. It was demonstrated that Staph. aureus was the main infectious agent of the disease. Antibacterial therapy must be started with cephalosporins and aminoglycosides and corrected after tests for antibiotics sensitivity. In purulent mastitis breast feeding must be stopped, and drugs suppressing lactation should be added. In severe forms of intramammary purulent mastitis semi-oval incision by Rovinsky is recommended. In infiltrative-purulent mastitis it is better to resect the affected part of the mammary gland and apply delayed sutures in 5-7 days. Surgery must be performed by an experienced surgeon and assistant under general anesthesia.

[Study of pharmacological activity of complex magnesium-containing preparation based on mineral bishofit and pyridoxine hydrochloride in a rat model of chronic alcoholic intoxication]

Nervous disturbances accompanying alcoholic illness were studied in relation to the depletion of magnesium ion content in the organism. The possibility of correcting the development of psychic (behavioral) pathologies by treatment with a complex magnesium-containing preparation based on mineral bishofit and pyridoxine hydrochloride (below, Mg-containing preparation) was studied in rats upon three-month voluntary alcoholization. A decrease in the locomotor (number of crossed squares) and vertical (number of standings) activity as evaluated in the open-field test and an increase in the immobilization time in the forced swim test showed evidence of depressive state in animals after long-term ethanol administration. After treatment with the Mg-containing preparation (50 mg Mg/kg in 2.5 ml volume, p.o.), the immobilization time of alcohol-preferring rats decreased in comparison to that before treatment and showed no statistically significant differences from the value in the intact control group. A decrease in the immobilization time (the main sign of antidepressant action) allows the Mg-containing preparation to be considered as antidepressant. The level of magnesium in rat blood erythrocytes decreased upon three-month voluntary alcoholization by 40.95 +/- 2.41% relative to control (p < 0.05). After a 5-week treatment with Mg-containing preparation under conditions of free access to alcohol, the content of magnesium in the erythrocytes of alcohol-preferring rats restored on a normal level. Chronic alcoholism reduces the content of microelements and vitamins (in particular, B6), these changes being mutually related.

[Development and pharmacology of nootropic and antidepressive preparations based on EAA receptor ligands]

The paper assesses the role of the system of exciting amino acids (EAA) in the interneuronal interactions in CNS. The results of basic investigations of the EAAergic system are summarized and the prospects for development of the related drugs possessing antidepressant activity are considered. Participation of the EAA system in pathogenesis of some neurologic and psychic diseases and in the pathologic alcohol addiction is analyzed. Taking into account that the psychic processes are realized by multitransmitter systems involving various brain structures, the possibility of using EAAergic drugs for controlling the balance between activating and inhibiting systems of brain is discussed. In this respect, special attention is given to EAAergic modulation of the monoaminergic and dopaminergic cerebral transmission systems.

Efficiency of potentiated antibodies to tumor necrosis factor-alpha (Artrofoon) in the therapy of patients with rheumatoid arthritis

Antiinflammatory activity of a new preparation Artrofoon (antibodies against tumor necrosis factor-alpha in ultralow doses) and nonsteroid antiinflammatory drug diclofenac in patients with rheumatoid arthritis was compared in an open randomized trial. The course of treatment with Artrofoon more significantly improved clinical and laboratory signs in patients with the articular form of rheumatoid arthritis than diclofenac.

Impaza and sildenafil: comparison of clinical effectiveness in patients with erectile dysfunction

A blind, placebo-controlled, randomized trial showed clinical effectiveness of the preparation Impaza containing antibodies to endothelial NO synthase in ultralow doses. Impaza surpassed placebo, but was less potent than sildenafil in the ability to improve erectile function and other parameters characterizing sexual activity of men. Safety of Impaza was greater than that of other test preparations.

[Modern aspects of investigation and clinical application of glutamatergic agents]

The paper considers the main trends in development and summarizes the results of experimental and clinical investigations of glutamatergic drugs, including the glutamate synthesis and release inhibitors, NMDA receptor antagonists, AMPA receptor antagonists and positive modulants, and metabotropic glutamate receptors ligands.

[Pharmacokinetic properties of rithmidazole upon single intravenous introduction]

The kinetics of rithmidazole (an imidazobenzimiodazole derivative possessing the properties of I, III, and IV class antiarrhythmics) was studied upon a single intravenous introduction in rats (in a dose of 10 mg/kg) and in healthy male volunteers (300 mg/kg). The drug pharmacokinetics in rat blood plasma was characterized by rapid elimination from the systemic blood flow (drug detected by HPLC only within 6 h); the total plasma clearance was 1.43 liter/(h kg), the terminal half-elimination time was 1.76 h, and the equilibrium distribution volume (2.42 liter/kg) exceeded the total volume of water in the animal organism, which is indicative of a high level of absorption in tissues. The drug is characterized by a low level of binding to blood proteins and erythrocytes. Investigation of the drug distribution between tissues showed evidence of extensive, blood-flow-dependent penetration, with the drug concentration in most tissues exceeding that in the blood plasma. The maximum amounts of rithmidazole were found in the lungs, spleen, liver, and kidneys. The major excretion route for the unchanged drug is via urine and bile, amounting to 10% and approximately 1% of the dose introduced, respectively, determined within 72 h. The results are indicative of a low probability of the hepatoduodenal circulation of the unchanged substance: about 90% of the drug undergo metabolic transformation. The pharmacokinetics of rithmidazole in volunteers was also characterized by rapid elimination from the systemic blood flow; the total plasma clearance was 0.89 liter/(h kg), the terminal half-elimination time was 2.12 h, and the equilibrium distribution volume was 1.66 liter/kg. The obtained results show that the pharmacokinetic profiles of rithmidazole in rats and humans exhibit a similar character, with a high intensity of distribution and elimination processes.