Effect of pharmaceutical excipients on the stability of angiotensin-converting enzyme inhibitors in their solid dosage formulations.

CONTEXT: The compatibility studies of moexipril hydrochloride (MOXL), imidapril hydrochloride (IMD), enalapril maleate, (ENA) and lisinopril (LIS) in solid state with magnesium stearate and glyceryl behenate were performed. OBJECTIVE: The aim of this study was to detect any possible drug-excipient interactions in order to optimize technological process conditions by the selection of the most adequate lubricant. MATERIALS AND METHODS: Reversed-phase high-performance liquid chromatography was employed for studying drug-excipient binary mixtures in 1:1 ratio and pure drugs under forced ageing test conditions: temperature 318K (45 °C) and relative humidity range of 50.9%-75.4%. The method had been revalidated prior to use. The degradation rate constants for the binary mixtures and pure substances were calculated. RESULTS: The experimental results evidenced that moexipril and enalapril degradation accorded with autocatalytic-second-order kinetics, imidapril degradation followed first-order reaction mechanism, and LIS followed reversible first-order reaction mechanism. A degradation pathway for each substance was proposed to account for the observed decomposition products. It was determined that moexipril stability decreased threefold in the presence of magnesium stearate indicating an incompatibility--(4.15 ± 0.12) 10(-3) compared to (1.43 ± 0.32) 10(-6) for moexipril in pure. No interaction between magnesium stearate and the remaining studied compounds was observed. The stability studies of MOXL-glyceryl behenate binary mixture revealed no interaction. CONCLUSION: Magnesium stearate and increased relative humidity induce MOXL instability, while glyceryl behenate is an optimal lubricant, and therefore, it is recommended for moexipril-containing solid formulations. However, for the formulations containing moexipril and magnesium stearate, it is suggested to minimize the humidity level during storage.

"A Comparative Analysis of the Number of Organ Retrievals in Relation to Potential Donation Qualifications in Populations of Patients From a Single Anesthesiology and Intensive Care Unit in 2017-2018".

The population of patients declared as brain dead and qualified for organ donation is relatively low in Poland. The main causes of brain death include cerebral vascular diseases and brain trauma (54 and 34%, respectively, according to Poltransplant registry data). The number of organ procurements in Poland is constantly recorded on average at 14 donations per 1 million citizens (14/mln) in 2017 and 12 donations per one million in 2018. It is difficult to precisely define the number of patients who meet the criteria for brain death certification. The authors have retrospectively analyzed the medical data of 229 patients from 2017 and 2018 records with the aim of identifying potential organ donors among patients of the Intensive Care Unit (ICU) in the University Hospital in Western Poland. Brain death was suspected in 53 patients (23.14%). Brain imaging to confirm no cerebral flow (which is consistent with brain death) was performed in 17 patients (7.45%) and this, as a result, led to organ donation in 9 cases (3.93%). The factors identified as having a positive influence on organ donation included: daily thorough physical examination, (Glasgow Coma Scale) GCS assessment, depth and duration of sedation, ICU length of stay and early performance of a CT-angiogram.

Systemic Inflammatory Predictors of In-Hospital Mortality in COVID-19 Patients: A Retrospective Study.

The purpose of this study was to investigate whether routine blood tests and clinical characteristics can predict in-hospital mortality in COVID-19. Clinical data of 285 patients aged 59.7 ± 10.3 yrs. (males n = 189, females n = 96) were retrospectively collected from December 2020 to June 2021. Routine blood tests were recorded within the 1st hour of admission to hospital. The inflammatory variables, such as C-reactive protein (CRP), procalcitonin (PCT), neutrophils−lymphocyte ratio (NLR) and the systemic inflammatory index (SII), exceeded the reference values in all patients and were significantly higher in deceased patients (n = 108) compared to survivors (n = 177). The log-rank test for comparing two survival curves showed that patients aged ≥60.5 years, with PCT ≥ 0.188 ng/mL or NLR ≥ 11.57 103/µL were at a greater risk of death. NLR demonstrated a high impact on the COVID-19 mortality (HR 1.317; 95%CI 1.004−1.728; p < 0.05), whereas CRP and SII showed no effect (HR 1.000; 95%CI 1.000−1.004; p = 0.085 and HR 1.078; 95%CI 0.865−1.344; p = 0.503, respectively). In the first Polish study including COVID-19 patients, we demonstrated that age in relation to simple parameters derived from complete blood cell count has prognostic implications in the course of COVID-19 and can identify the patients at a higher risk of in-hospital mortality.

Active surveillance in prostate cancer management: where do we stand now?

Prostate cancer (PCa) is the most common cancer in men, with a steadily rising incidence, affecting on average one in six men during their lifetime. The increase in morbidity is related to the increasing overall life expectancy, prostate-specific antigen testing, implementation of new molecular markers for cancer detection and the more frequent application of multiparametric magnetic resonance imaging. There is growing evidence demonstrating that active surveillance (AS) is an alternative to immediate intervention in patients with very low- and low-risk prostate cancer. Ongoing reports from multiple studies have consistently demonstrated a very low rate of metastases and prostate cancer specific mortality in selected cohorts of patients. As a matter of fact, AS has been adopted by many institutions as a safe and effective management strategy. The aim of our review is to summarize the contemporary data on AS in patients affected with PCa with the intention to present the most clinically useful and pertinent AS protocols.