La hipertensión arterial no controlada y sus factores asociados en un programa de hipertensión / Uncontrolled hypertension and its associated factors in a hypertension program

Resumen Objetivo Identificar la proporción de hipertensos no controlados y sus factores asociados, en pacientes del programa de hipertensión arterial de Pueblorrico, Antioquia, 2018. Método: Estudio transversal de asociación, en el que se obtuvieron datos sociodemográficos, clínicos y antropométricos. Se aplicaron encuestas y la revisión de historias clínicas en una muestra de 272 pacientes. Se realizó la caracterización de los pacientes. Por regresión logística multivariada se obtuvieron las razones de disparidad y los intervalos de confianza del 95% (IC95%). Resultados El no control de la presión arterial se evidenció en el 35.3% (IC 95%: 29.41-41.20). Las variables obesidad (odds ratio [OR]: 2.1; IC95%: 1.05-4.31), utilizar más de tres medicamentos al día (OR: 2.0; IC95%: 1.19-3.44) y asistir a menos de cuatro controles de seguimiento al año (OR: 2.2; IC95%: 1.03-4.74) se asociaron de manera significativa como factores de riesgo para el no control de la presión arterial. Tener excelente percepción de la calidad del programa fue un factor protector (OR: 0.5; IC95%: 0.28-0.87). Conclusiones La proporción de pacientes hipertensos que no logran la meta terapéutica (presión arterial ≤ 140/90 mm Hg) continúa siendo un desafío para la práctica clínica y la salud pública. La adherencia a los controles y el control de factores de riesgo, como la obesidad, son intervenciones importantes en este contexto.

Abstract Objective To identify the proportion of uncontrolled hypertensive patients and their associated factors in a population attending an HBP program. Method Cross-sectional association study. Sociodemographic, clinical and anthropometric data were obtained. Surveys and review of medical records were applied in a sample of 272 participants. The characterization of the patients was performed. By multivariate logistic regression the odds ratios (OR) and confidence intervals (95% CI) were obtained. Results The non-control of blood pressure was evidenced in 35.3% (95% CI: 29.41-41.20). The variables obesity (OR: 2.1; 95% CI: 1.05-4.31), use more than three medications per day (OR: 2.0; 95% CI: 1.19-3.44), and attending less than four follow-up controls per year (OR: 2.2; 95% CI: 1.03-4.74), were significantly associated as a risk factor for non-BP control. Having an excellent perception of the quality program was a protective factor (OR: 0.5; 95% CI: 0.28-0.87). Conclusions The proportion of hypertensive patients who do not achieve the therapeutic goal (PA ≤ 140/90 mm Hg), remains a challenge for clinical practice and public health. The adherence and control of risk factors such as obesity are important interventions in this context.

Pharmacognostic Studies Of Organically Cultivated Panacea Herb Cynodon Dactylon (l.) Pers.

This research paper knuckles down the organic agripractices of the Cynodon dactylon (L.) Pers.. It is a powerhouse house of multiple macro and micro nutrients including protein, carbohydrates, carotenoids, flavonoids, phenolic compounds and vitamins. Organic cultivation practices enhances these secondary metabolites biosynthesis resulting in therapeutic potential of the crude drug. The field experimental work was conducted from Nov, 2018 up to Mar, 2019 in Department of Medicinal Plants Sciences at Dev Sanskriti Vishwavidyalaya, Haridwar (U.K), India. Cynodon herb belonging to Poaceae family was organically cultivated in our herbal field laboratory (no. 4) by planting slips line to line in experimental blocks. Physical parameters were studied including total Ash (9.9 % w/w), Acid-insoluble Ash (5.8 % w/w), Water-soluble Ash (2.4 % w/w), Alcohol soluble extractive (39.2 % w/w) and Water soluble extractive (39.8 % w/w). Based upon results, it is concluded that secondary metabolites are highly biosynthesized during organic agri practices. Cynodon is credited as panacea herb due to its vital therapeutic benefits in curing multiple acute and chronic diseases or disorders including erysipelas, depigmentation, hysteroepilepsy, Irritable bowel syndrome (IBS) and menstrual irregularities.

Investigation of FDA Issued List and Guidance for Bioequivalence Recommendations for Specific Products Related with Narrow Therapeutic Index Drugs / 中国药学杂志

OBJECTIVE: To investigate FDA issued lists and guidance on Bioequivalence Recommendations for Specific Products related with Narrow Therapeutic Index Drugs.METHODS: FDA issued lists and Bioequivalence Recommendations for Specific Products related with Narrow Therapeutic Index Drugs was investigated in multiple aspects, including detailed drugs lists, bioequivalence study designs, selection of bioequivalence subjects,analytes to measure,bioequivalence waiver, selection of reference products.RESULTS: Keeping updated lists and Bioequivalence Recommendations for Specific Products relative with Narrow Therapeutic Index Issued by FDA are to further facilitate generic drug product availability and to assist generic pharmaceutical industry with identifying the most appropriate methodology for developing drugs and generating evidence needed to support ANDA approval or reassessment.CONCLUSION: Narrow therapeutic index list and Bioequivalence Recommendations for Specific Products issued by FDA would provide instructive and practical assists to the equivalence assessment of quality and curative effect for generic products in China, since CFDA have not released similar list and guidance on specific narrow therapeutic index.

Antiplasmodial, cytotoxic activities and characterization of a new naturally occurring quinone methide pentacyclic triterpenoid derivative isolated from Salacia leptoclada Tul. (Celastraceae) originated from Madagascar

Objective:To validate scientifically the traditional use of Salacia leptoclada Tul. (Celastraceae) (S. leptoclada) and to isolate and elucidate the structure of the biologically active compound. Methods:Bioassay-guided fractionation of the acetonic extract of the stem barks of S. leptoclada was carried out by a combination of chromatography technique and biological experiments in viro using Plasmodium falciparum and P388 leukemia cell lines as models. The structure of the biologically active pure compound was elucidated by 1D and 2D NMR spectroscopy and mass spectrometry. Results:Biological screening of S. leptoclada extracts resulted in the isolation of a pentacyclic triterpenic quinone methide. The pure compound exhibited both in vitro a cytotoxic effect on murine P388 leukemia cells with IC50 value of (0.041±0.020) μg/mL and an antiplasmodial activity against the chloroquine-resistant strain FC29 of Plasmodium falciparum with an IC50 value of (0.052±0.030) μg/mL. Despite this interesting anti-malarial property of the lead compound, the therapeutic index was weak (0.788). In the best of our knowledge, the quinone methide pentacyclic triterpenoid derivative compound is reported for the first time in S. leptoclada. Conclusions:The results suggest that furthers studies involving antineoplastic activity is needed for the development of this lead compound as anticancer drug.

Levotiroxina e o problema da permutabilidade de drogas de estreito intervalo terapêutico / Levothyroxine and the problem of interchangeability of drugs with narrow therapeutic index

Tem se tornado prática comum em nosso país a troca de medicamentos prescritos por outros similares, por produtos genéricos e até mesmo por produtos manipulados, muitas vezes ignorando-se preceitos básicos de bioequivalência, permutabilidade, estabilidade e características específicas do composto farmacêutico. No caso de drogas de índice terapêutico estreito, como a levotiroxina, esses problemas se agravam colocando em sério risco a eficácia do tratamento e a saúde do paciente. Revemos a legislação pertinente ressaltando as características da levotiroxina e os efeitos adversos que limitam a permutabilidade do composto.

The exchange of a prescribed drug by other similar, by generic products and even by custom products has become common practice in our country, often ignoring basic tenets of bioequivalence, interchangeability, stability and characteristics of the pharmaceutical compounds. In the case of drugs of narrow therapeutic index, such as levothyroxine, these problems are intensified, putting the effectiveness of treatment and patient health at serious risk. We review the pertinent legislation, emphasizing the characteristics of levothyroxine and adverse effects that limit the interchangeability of the compound.

The effects of promethazine on the analgesia,hypnosis,amnesia and therapeutic index of isoflurane treated mice / 中国药理学通报

Aim To observe the effects of promethazine on the analgesia,hypnosis,amnesia and therapeutic index of isoflurane.Methods The experiments were designed to study promethazine on the analgesic effect of isoflurane by hot-plate test and writhing test,and to study the effect of promethazine on the sleeping time of isoflurane by the method of righting reflex,and the amnesia of isoflurane by Morris water maze,and the ED_(50),LD_(50) by sequential method in mice.Results The result of hot-plate test and writhing test indicated that promethazine could enhance the analgesic effect of isoflurane(P＜0.05 or P＜0.01);through the experiment of righting reflex, sleeping time of isoflurane in mice was extended by promethazine(P＜0.01);in Morris water maze experiment, the average latency in the combination of promethazine and isoflurane was longer than that of the promethazine group or isoflurane group(P＜0.05 or P＜0.01), while aiming to the residence time, the combination of the two was shorter than that in the third quadrant(P＜0.01 or P＜0.05),the TCPP of the group of isoflurance was more than that of the combination group;promethazine could decrease the ED_(50) of isoflurance(P＜0.01),but it did not obviously affect its LD_(50)(P＞0.05).Conclusion Promethazine can not only reinforce the effect of isoflurance on analgesia,hypnosis and amnesia, but also boost the therapeutic index of isoflurance.

The prognostic value of lateral lymphadenectomy for advanced lower rectal cancer / 中华普通外科杂志

Objective To evaluate the prognostic value of lateral lymphadenectomy for advanced lower rectal cancer. Methods A total of 96 consecutive patients who underwent total mesorectal excision and lateral lymphadenectomy for advanced lower rectal cancer were retrospectively evaluated by using therapeutic index. A product of the frequency of lymph node metastasis and the cancer-related 5-year survival rate. Results The incidences of lymph node metastasis in mesorectal area, superior rectal artery area, inferior mesenteric artery area and lateral area was 21%,13%.10%and 15%respectively.The 5-year survival rate of patients with metastasis to the mesorectal area, superior rectal artery area, inferior mesenteric artery area and lateral area was 35%,25%,20%and 36%respectively.The therapeutic indexes for total mesorectal excision and lateral lymphadenectomy were 7.4 and 5.4,which were much higher than that of lymphadenectomy of the superior rectal artery area(3.3)and inferior mesenteric artery area(2.0).Local recurrence occurred in 19%(18 out of 96 cases)patients with advanced lower rectal cancer. Local recurrence rate of patients with positive lateral lymph node metastasis was 64%(9 of 14 cases),whereas it was 11%(9 of 82 cases)in those without lateral lymph node metastasis. The difference between these two groups was statistically significant(x2=22.308,P=0.000).Kaplan-Meier survival analysis showed significant improvements in median survival(80.9±2.1)m,95%CI:76.7～85.1 m vs(38±6.7)m,(95%CI:24.8～51.2 m)for patients with negative lateral lymph node metastasis over patients with lateral lymph node metastasis(log-rank,P=0.000). Conclusion The current results indicate that lateral pelvic lymphadenectomy could significantly reduce loeal recurrence and effectively improve the survival of patients with advanced lower rectal cancer. Except for total mesorectal excision, lateral pelvic lymphadenectomy should be followed in the surgery of pailents with advanced low rectal cancer.