The Antioxidant Activity of Wild-Growing Plants Containing Phenolic Compounds in Latvia.

Ethnobotanical reports from Latvia show that Tanacetum vulgare, Calluna vulgaris, Quercus robur, Artemisa absinthium, and Artemisia vulgaris contain phenolic compounds that have antioxidant properties, which can be beneficial in the treatment and prophylaxis of many diseases. The aim of this study was to characterize the phenolic compounds and antioxidant properties of these plants. Plant extracts were prepared using ethanol or acetone and then freeze-dried. Their total phenolic content (TPC), total flavonoid content (TFC), and total tannin content (TTC) were determined and characterized by HPLC. Their antioxidant properties were determined using a DPPH (2,2-diphenyl-1-picrylhydrazyl) radical scavenging assay. C. vulgaris herb and T. vulgare leaf extracts contained the highest amounts of flavonoids, but the bark of Q. robur had mostly tannins and phenolic acids. A. absinthium and A. vulgaris had the lowest amounts of polyphenols. When compared using extraction solvents, all acetone extracts had more TPC, more TFC, and better antioxidant activity. All plants contained chlorogenic acid, which contributes to antioxidant properties. The analysed plant extracts could be used in future studies to develop medicinal products with antioxidant properties.

Safety Aspects of Extemporaneous Prescriptions Prescribed by Latvian Healthcare Specialists.

Until 1991, Latvia had been part of the Union of Soviet Socialist Republics, and medicines in Latvia were prepared in accordance with the Union of Soviet Socialist Republics Pharmacopoeia and standardized prescriptions. Latvia regained its independence 30 years ago, but Latvia still does not have its standardized prescriptions and official sources of information in the official language. So far, there have been no studies which would collect data about prescribed extemporaneous prescriptions and characterize the current situation in different Latvian regions. For this reason, we analyzed the extemporaneous prescriptions prepared in Latvian pharmacies in 2017. Previous studies identified specialties of those physicians who prescribed extemporaneous prescriptions most often, the most popular dosage forms, as well as identified the active substances, combinations of active substances, and excipients most commonly used in dermatology and rhinology. Having analyzed the compositions prescribed in dermatology and rhinology, our greatest concern was related to the fact that several substances were identified, the use of which in Germany was controversial or even unacceptable in certain dosage forms. The presence of such substances in Latvian prescriptions constitutes a risk to patient safety, and, since part of this article was to analyze all the collected extemporaneous prescriptions to identify unsafe substances. In order to gain insight into usage habits of these substances outside the European Union, information about them was searched in the U.S. As the history of the use of these substances in Latvia dates back to the Union of Soviet Socialist Republics, we wanted to learn whether they are mentioned in modern Russian professional literature. Having analyzed extemporaneous prescriptions of Latvian pharmacies, seven substances were identified: boric acid, borax, mercuric oxide, sodium bromide, potassium bromide, phenol, and formaldehyde. Boric acid, bromides, phenol, and formaldehyde were also found in modern U.S. and Russian professional literature. However, in this article, safety aspects in relation to the use of these substances in the preparation of medicines are emphasized. Preparations containing mercuric oxide are not found in the current U.S. or Russian professional literature.

Analysis of Extemporaneously Compounded Nasal Preparations Prescribed by Latvian Otorhinolaryngologists and General Practitioners and Comparison with German Formulations.

It has been reported that sinusitis and rhinitis are included in the list of most common diagnoses made by general practitioners. Even though treatment of diseases of the nasal cavity and paranasal sinuses requires many manufactured medicines, several European countries, as well as the U.S. and Australia, still prescribe extemporaneous prescriptions for nose conditions. Germany created standardized compounded preparation monographs. Monographs allow prescription and preparation of medicines containing such active ingredients and combinations of active ingredients, the use of which is evidence-based. Latvia does not have any standardized compounded preparation monographs. The purpose of this survey was to analyze the active ingredients, combinations of active ingredients, and excipients of the extemporaneous prescriptions intended for administration to the nasal cavities which were prescribed by Latvian otorhinolaryngologists and general practitioners and to find out how many active ingredients are most often compounded in the analyzed dosage forms. To understand whether the extemporaneous formulations prescribed in Latvia are evidence based, they were compared with German formulations. A database was created entering data on all the prescriptions prepared in the selected pharmacies in 2017 to summarize information on extemporaneous prescriptions. The prescriptions prescribed by Latvian otorhinolaryngologists and general practitioners were selected and compared with German formulations. Data from 17 Latvian pharmacies were collected, and 1094 prescriptions of nasal preparations were analyzed. In preparation of nasal drops, 15 bulk drug substances and 10 manufactured preparations were used; in preparation of semi-solid nasal preparations, 14 bulk drug substances and 15 manufactured preparations were used. The analyzed prescriptions contained active ingredients and excipients currently used in Germany, as well as active ingredients and excipients, the use of which, in Germany, is limited or impermissible in the preparation of nasal preparations. More than 70% of analyzed nasal preparations contained two or more active ingredients. Several nasal drops prescribed in Latvia need isotonization to avoid damage to nasal mucosa.

Analysis of Extemporaneous Prescriptions Prescribed by Dermatovenerologists in Latvia and Comparison with Standardized Compounded Preparation Monographs of Germany and USA.

BACKGROUND AND OBJECTIVES: Even though many industrially manufactured medicines are available, extemporaneous preparations still have their niche in dermatology. In several countries, dermatovenerologists are one of the specialists prescribing extemporaneous medicines the most. In order to increase the quality of compounded medications and minimize risks to patient safety, several countries, for example, Germany and the United States of America (USA), created standardized compounded preparation monographs. Latvia, unlike these countries, does not have any officially approved standardized compounded preparation monographs. The purpose of this survey is to analyze the extemporaneous prescriptions prescribed by Latvian dermatovenerologists to identify the active ingredients, combinations of active ingredients, and excipients prescribed by dermatovenerologists the most often, and to find out how many active ingredients are most often compounded in different dosage forms. To understand whether the extemporaneous formulations used in Latvia for dermatological indications are evidence-based, they were compared with German and USA formulations. MATERIALS AND METHODS: A database was created entering data on all the prescriptions prepared in the selected pharmacies in 2017 to summarize information on extemporaneous prescriptions. The prescriptions prescribed by Latvian dermatovenerologists were selected and compared with German and USA formulations. RESULTS: Data from 17 Latvian pharmacies were collected, and 2521 extemporaneous formulations were analyzed. In preparation of semi-solid dosage forms, 25 bulk drug substances and 37 industrially manufactured preparations were used; in preparation of suspensions, 25 bulk drug substances and 10 industrially manufactured preparations were used; in preparation of topical solutions, 23 bulk drug substances and two industrially manufactured preparations were used; in preparation of topical powders, nine bulk drug substances were used; in preparation of oral solutions, five bulk drug substances were used. CONCLUSIONS: The analyzed prescriptions contained active ingredients used in Germany and the USA, as well as active ingredients, the use of which is limited in Germany and the USA. In Latvia, topical dosage forms containing two or more active ingredients are widely prescribed.

Data on medicinal plants in the records of Latvian folk medicine from the 19th century.

The data presented in this article is in support of the research paper "Medicinal plants and their uses recorded in the Archives of Latvian Folklore from the 19th century" [1]. This article provides the list of plant species and disorders treated with medicinal plants mentioned in the records of Latvian folk medicine and used by indigenous people of Latvia in the 19th century. In total, the data include 211 genera belonging to 71 plant families. The accepted scientific names of plant species, plant parts used, dosage forms of herbal medicines, and routes of administration are reported in the table. Plant uses are grouped into one of the 17 categories based on the body systems and psychological and social problems. The frequency of citations is indicated for each use of medicinal plant.

Medicinal plants and their uses recorded in the Archives of Latvian Folklore from the 19th century.

ETHNOPHARMACOLOGICAL RELEVANCE: The records of folk medicine present historical evidence of medicinal plant usage in the territory of Latvia and describe native and imported plants and plant products that were used as medicine. AIM OF THE STUDY: To collect and analyse the ethnobotanical knowledge found in records of Latvian folk medicine available in the Archives of Latvian Folklore. MATERIALS AND METHODS: Following the International Classification of Primary Care, plant uses were grouped into one of the 17 categories based on the body systems and psychological and social problems. Each plant was identified by its scientific name according to The Plant List website. Additionally, the plant parts used, dosage forms of herbal medicines and routes of administration were analysed. RESULTS: In total, 211 genera belonging to 71 families were mentioned in the analysed materials. The most common health conditions were digestive system disorders, respiratory system disorders and skin disorders. The plant families with the largest number of taxa were Asteraceae, Rosaceae, Lamiaceae, and Apiaceae. The most frequently mentioned native plant taxa were Achillea millefolium L., Matricaria chamomilla L., Allium cepa L., Artemisia absinthium L., and Plantago sp. L. Leaves and flowers were the most commonly used parts, and herbal tea was the most common dosage form. Only 59 out of 211 taxa mentioned in this study are included in the official herbal monographs of the European Medicines Agency. CONCLUSIONS: One hundred and fifty-two plant taxa mentioned in the records of Latvian folk medicine are not included in the European Union herbal monographs providing scientific information on the safety and efficacy and deserve further exploration as traditional herbal medicines.

Knowledge about Disease, Medication Therapy, and Related Medication Adherence Levels among Patients with Hypertension.

Background and Objectives: A particular problem in cardiology is poor adherence to pharmacological treatment among patients with hypertension. It is known that approximately half of these patients do not use their medications as prescribed by their doctor. Patients may choose not to follow the doctor's recommendations and regularly do not control their blood pressure, owing to many factors. A convenient method for measuring the level of adherence is the Morisky Medication Adherence Scale, which also provides insight into possible remedies for low adherence. We investigated their therapy, knowledge about the disease and its control, and demographic differences to assess the adherence of patients with hypertension. Materials and Methods: This was a cross-sectional observational study. Data were collected through a survey of 12 pharmacies in Latvia. The study involved 187 participants with hypertension. Results: The prevalence of non-adherence was 46.20% in Latvia. The oldest patients were the most adherent (p = 0.001, ß = 0.27). The higher the self-rated extent from 0 to 10, to which the patient takes their antihypertensives exactly as instructed by their physician, the higher the level of adherence (p < 0.0001, ß = 0.38), where at "0", the patient does not follow physician instructions at all, and at "10", the patient completely follows the physician's instructions. Non-adherent patients tend to assess their medication-taking behavior more critically than adherent patients. The longer the patient is known to suffer from hypertension, the more adherent he or she is (p = 0.014, ß = 0.19). Conclusions: Medication non-adherence among patients with hypertension is high in Latvia. Further investigations are needed to better understand the reasons for this and to establish interventions for improving patient outcomes.

The Extent of Extemporaneous Preparation and Regulatory Framework of Extemporaneous Compounding in Latvia.

Background and objectives: Extemporaneous preparations are pharmaceutical preparations individually prepared for a specific patient or patient group, but also high-risk products accompanied by doubts regarding their safety and quality. Legislation regulating the compounding of extemporaneous preparations is not harmonized among European countries. This problem is partially resolved by Resolution CM/Res(2016)1 on quality and safety assurance requirements for medicinal products prepared in pharmacies for the special needs of patients. In order to understand the relevance of extemporaneous compounding in Latvia and the fulfillment of the abovementioned resolution's requirements, it is essential to get information about the volume and breakdown of sales of extemporaneous medicinal products in community pharmacies. The purpose of this survey is to identify the sales volume of extemporaneous preparations in community pharmacies in Latvia in 2017 by analyzing unpublished data of the State Agency of Medicines (SAM), as well as comparing Latvian laws with the requirements of the resolution. Materials and Methods: A separate Microsoft Excel spreadsheet was prepared for each statistical region in order to summarize the unpublished information of SAM on the turnover of extemporaneous preparations in 2017 in all Latvian statistical regions. In order to compare the regulatory framework in Latvia with the resolution, the Latvian Pharmaceutical Law and the Cabinet of Ministers Regulations regulating prescription, compounding and control of extemporaneous preparations in community pharmacies were analyzed. Results: Only 280 of 384 pharmacies submitted a report of sales of extemporaneous preparations for 2017 to the SAM. These pharmacies represented all Latvian statistical regions. Extemporaneous preparations were mostly sold in Riga (78.93%). The Latvian regulation does not include all paragraphs of the resolution. Most of the paragraphs of the resolution are described in Latvian regulatory enactments only partially. Conclusions: The total number of compounding pharmacies evidence that the service is needed. Latvian example highlights a necessity for European Union countries to compare their national legislation with the requirements of the resolution's last version and, if necessary, implement relevant amendments.

Trends of Extemporaneous Drug Prescription in Latvia in 2017.

Despite the numerous industrially manufactured medicines available in the market, extemporaneously prepared drugs still have their niche among the services offered by the pharmacies. The physicians prescribe extemporaneously prepared drugs for special patient groups that require custom approach. Therefore, physicians' knowledge about extemporaneously prepared drugs and experience in prescribing them is the main precondition for satisfying patients' needs. The purpose of this article is to analyze the prescribing practice for extemporaneous formulations prepared in pharmacies in Latvia in order to identify the healthcare specialists who prescribe extemporaneously prepared drugs most frequently and the most common dosage forms. A database was created that includes the following data on each prescription form: 1) the name of the pharmacy where the medicine was prepared; 2) the region or the city where the pharmacy is located; 3) the month when the prescribed medicine was prepared; 4) the speciality of the healthcare professional who prescribed the medicine; 5) the dosage form; 6) all the active ingredients; 7) the number of active ingredients in the dosage form; 8) all the excipients. Data on 2,647 extemporaneously prepared drug prescriptions from 15 pharmacies in Latvia were collected. The extemporaneously prepared drugs were prescribed by physicians of 24 specialities, as well as dentists and physician assistants. The majority of the extemporaneously prepared drug prescriptions (87.5%) were from these 4 specialities: 1) general practitioners, 2) dermatovenereologists, 3) otorhinolaryngologists, and 4) pediatricians. General practitioners most commonly prescribed nasal drops, solutions for cutaneous application, and semisolid dosage forms. Dermatovenereologists mostly prescribed semi-solid dosage forms, suspensions, and solutions for cutaneous application. Otorhinolaryngologists most commonly prescribed nasal drops and semi-solid dosage forms. Pediatricians, as well as general practitioners and otorhinolaryngologists, favored nasal drops. To find out the opinion of general practitioners, dermatovenereologists, otorhinolaryngologists, and pediatricians on extemporaneously prepared drugs and the factors that hinder or facilitate their prescription, an extension of the study is planned that will include partially structured, in-depth, qualitative interviews.

Pharmacy Practice and Education in Latvia.

The PHARMINE ("Pharmacy Education in Europe") project studied the organisation of pharmacy practice and education in the member states of the European Union (EU). The work was carried out using an electronic survey sent to chosen pharmacy representatives. The surveys of the individual member states are now being published as reference documents. This paper presents the results of the PHARMINE survey on pharmacy practice and education in Latvia. In the light of this, we examine the harmonisation of practice and education in Latvia with EU norms.

Factors related to poor asthma control in Latvian asthma patients between 2013 and 2015.

OBJECTIVES: To investigate whether beliefs about asthma medication, cognitive and emotional factors are related to poor asthma control in a sample of Latvian asthma patients in 2015. DESIGN: Cross-sectional, self-administered survey. SUBJECTS: Three hundred and fifty two asthma patients (mean age 57.5 years) attending outpatient pulmonologist consultations in Riga, Latvia during September 2013 to December 2015. The sample size was calculated to detect a prevalence of poor asthma control of 50% with a margin of error of 5% and a power of 95%. MAIN OUTCOME MEASURES: The validated Beliefs about Medication Questionnaire (BMQ) and the Brief Illness Perception Questionnaire (brief IPQ) were used. Good asthma control was assessed using the asthma control test (ACT), a validated five-item scale that reliably assesses asthma control over a recall period of four weeks. Logistic regression models were used to predict poor asthma control. RESULTS: Patients who had a good control of asthma medication (OR 0.70; 95% CI 0.61-0.79) or were confident that their asthma medication improves illness (OR 0.84; 95% CI 0.74-0.95) had a reduced risk of poor asthma control. The more symptoms (OR 1.63; 95% CI 1.44-1.84) the asthma patients perceived or the more their illness affects their life, the higher the probability of poor asthma control (OR 1.47; 95% CI 1.31-1.65). Some beliefs of necessity and concerns of asthma medication were also statistically significantly related to poor asthma control. CONCLUSIONS: Beliefs of necessity of asthma medication, cognitive and emotional illness perception factors correlate well with poor asthma control in Latvian patients.

Factors related to good asthma control using different medical adherence scales in Latvian asthma patients: an observational study.

One of the main challenges in asthma control is adherence to pharmaceutical treatment. The aim of this study was to test the association between adherence to asthma medication, control and medical beliefs, cognitive and emotional perceptions using three different validated questionnaires. Beliefs about asthma medicine, cognitive and emotional factors were determined in a cross-sectional survey of patients attending outpatient pulmonologist practices in Latvia (n = 352). The validated Beliefs about Medicines Questionnaire and the Brief Illness Perception Questionnaire were used. Adherence to asthma medication was assessed using the Morisky Medication Adherence Scale and two different versions of the Medication Adherence Reporting Scale. Several questions about necessity or concerns related to pharmaceutical treatment were able to predict poor adherence according to the Morisky scale. If the patient felt that without the asthma medication his life would be impossible, his risk to have poor treatment adherence was 46% reduced (odds ratio 0.54; 95% confidence interval 0.33-0.89). Furthermore, asthma patients who were convinced that their health depends on the asthma treatment were less likely to have poor treatment adherence (odds ratio 0.56: 95% confidence interval 0.32-0.97). In case the patient was concerned by the need to constantly use asthma medication or sometimes concerned by long-term effects of asthma medication the odds of poor treatment adherence were 1.96 (95% confidence interval 1.19-3.24) and 2.43 (95% confidence interval 1.45-4.08), respectively. In conclusion, medication beliefs, particularly concerns and necessity of asthma treatment were associated with poor treatment adherence when assessed with the Morisky or 5-item Medication Adherence Reporting Scale. ASTHMA TREATMENT: INVESTIGATING POOR ADHERENCE IN THE LATVIAN POPULATION: Concerns about treatment necessity and uses of asthma medication are key factors influencing poor treatment adherence in Latvia. There are multiple psychological and behavioral reasons why patients do not adhere to asthma treatment courses, including social and religious beliefs, and perceptions of chronic illness. Patient questionnaires and 'adherence scales' can help predict whether patients are likely to follow advice, but their efficacy differs for individual nations. Dins Smits at Riga Stradins University, Latvia, and co-workers analyzed responses to three questionnaires completed by 352 asthma patients to assess treatment perceptions and the best questionnaire option for the Latvian population. Concerns about the use of asthma medication and beliefs about treatment necessity were key factors in poor adherence. These were picked up by the Morisky and MARS 5-item scales, which the authors recommend for future use.

Perception of the Professional Knowledge of and Education on the Medical Technology Products among the Pharmacists in the Baltic and Nordic Countries-A Cross-Sectional Exploratory Study.

With increased development of medical technology (MT), new challenges emerge related to education and training of pharmacists and other healthcare specialists. Currently, only a few universities in the EU promote MT education and research. OBJECTIVES: The aim of this study was to evaluate the current status, views on, and need for the education on MT for the pharmacy students and practicing pharmacists in the Baltic and Nordic countries. METHODS: The representatives of higher education institutions and community/hospital pharmacists from six Baltic and Nordic countries participated in a qualitative cross-sectional exploratory internet-based study from May to October 2014. RESULTS: Approximately two-third of the respondents considered professional knowledge about MT products important for pharmacists, but half of them had never participated in any MT courses. More practicing pharmacists than representatives of academia underlined the need for increased MT education for pharmacy students in the future. CONCLUSIONS: The pharmacists in the Baltic and Nordic countries consider the professional knowledge about MT as pertinent in their education and work. The limited number and status of MT courses available today, however, is a major concern among both pharmacy students and practicing pharmacists in these countries. In the future, increasing education combining theory and practice about MT products would be one possible solution to overcome this challenge.

Flow cytometric analysis of glyoxalase-1 expression in human leukocytes.

Altered glyoxalase-1 (GLO-1) activity and expression is associated with the development of late diabetic complications, malignancy and oxidative stress- and aging-related diseases. In the present study, we developed a flow cytometry method for GLO-1 detection in human leukocytes isolated from peripheral blood samples to investigate GLO-1 expression in leukocyte subsets from type 1 and 2 diabetes mellitus patients (n = 11) and healthy subjects (n = 8). The flow cytometry analysis of GLO-1 in leukocytes showed that expression index of GLO-1-positive cells was slightly increased in mononuclear leukocytes from diabetic patients. This result correlated with the increase in GLO-1 activity in the whole blood samples of type 2 diabetes patients. In conclusion, the present study demonstrates that flow cytometry is suitable for the detection of the GLO-1 enzyme in human leukocytes and that this method could be used to investigate the fast adaptation of the glyoxalase system related to the pathogenesis of late complications of diabetes mellitus and other glycation stress-related disorders.

Master of Pharmacy Wilhelm Grining and his pharmaceutical laboratory.

Very little is known about the history of pharmaceutical industry in Latvia, especially about the history of small pharmaceutical enterprises in Riga at the turn of 19-20th centuries. The laboratory of Wilhelm Grining, Master of Pharmacy, (established in 1899) became well known because of its product Liquor Ferri albuminati Grining. The liquor was used for treatment of anemia and became very popular in the whole Russian empire. The owner of the laboratory Wilhelm Grining was a very erudite man and also a good businessman. He was a son of a pharmacist and has been acquainted with apothecary's practice and specificity of the work of the owner of a pharmacy since his childhood. Wilhelm Grining was particularly interested in proteins and started to carry out scientific research both in the fields of chemistry and pharmacy. He participated with his reports in the congresses of Russian Pharmacy Society and published his works in the journal of Russian Pharmacy. Besides all this W. Grining is believed to be the author of the concoction of curative herbs "Trejos devynerios". Biography of W. Grining, as well as the products produced by his pharmaceutical laboratory, was explored using materials from the archive of Latvian State history and 19th century's German literature of pharmaceutical history.