Pharmacokinetics of enalapril and metoprolol in hypertensive patients with hepatic pathology

AIM: To examine characteristics of pharmacokinetics and pharmacodynamics of enalapril and metoprolol in hypertensive patients with gastrointestinal diseases to make relevant corrections in the treatment. MATERIAL AND METHODS: The study included 36 hypertensive patients with steatosis, hepatic cirrhosis and ulcer. All the patients received metoprolol or enalapril. Concentrations of metoprolol and enalaprilate (active enalapril metabolite) were determined with high performace liquid chromatography. The findings gave grounds for calculation of mean drug retention time (MRT) and area under curve "concentration-time" (AUC). Efficacy of the drugs was estimated by the data of 24-h blood pressure monitoring. RESULTS: Hypertensive patients with hepatic diseases given enalapril exhibited lowering of maximal concentration (C(max)) of enalaprilate and prolongation of time of its reaching (T(max)) compared to ulcer patients. MRT and AUC were increased in hepatic cirrhosis patients treated with enalapril and metoprolol. Metoprolol C(max) in this group of patients was higher than in the controls. Blood pressure monitoring showed that enalapril therapy was more effective in ulcer patients vs patients with liver diseases. Metoprolol treatment of hypertensive patients with hepatic cirrhosis resulted in development of bradycardia. CONCLUSION: In hypertensive patients with liver diseases on enalapril therapy its metabolite production may appear insufficient for therapeutic effect and higher dose may be needed. Metoprolol in the treatment of hypertensive patients with hepatic cirrhosis should be used with caution because of disturbance of its metabolism and possible cumulative effects.     

Multipurpose psyllium monotherapy in patients with diverticular disease

The purpose of the research was the study of the prebiotic and hypolipidemic effects of 12-week treatment by psillium of patients with uncomplicated diverticular disease and hyperlipidemia. It has been established that the examined medicine has not any by-effects, normalizes intestinal motility and lowers a pain syndrome and flatulence. Prebiotic effect has proved by higher concentration of short-chain fatty acids in faeces and reduction of anaerobic index. Psillium certainly reduces levels of hyperlipidemia and could be recommended as hypolipidemic remedy for monotherapy as long as base datum of cholesterol is less than 6,4 mmol/l.     

Pre-and probiotics effectiveness in intestine microbiocenosis correction in patients after hemicolectomy

Normal microflora plays a key role in ensuring and maintaining the health of human body. Currently, much attention is paid not only to rational, but the so-called optimal, or health nutrition, which includes individual selection of food, the most satisfying human needs for energy, plastic and regulatory components. The aim of our study was to evaluate the effectiveness of pre-and probiotics in correction of the intestine microbiocenosis, effect on the rate of the hyperendotoxemia and related functional changes in the liver and lipid metabolism. In our study, we identified changesof the intestine microbiocenosis, which led to endotoxemia to develop, and the associated changes in liver enzymes and lipid blood composition in patients after various variants of the hemicolectomy. During treatment were selected 50 patients with dysbiosis 2 - 4-th degree who underwent hemicolectomy. In the 1st groupwere patients (25 pat.) with the prevailing complaints of constipation that were performed therapy with lactulose prebiotics (Dyufalak) at 20 - 30 ml per day for 3 months. In the 2nd group were patients (25 pat.) with complaints of diarrhea and was conducted therapy with bifiform probiotic in a daily dose to 2 capsules 2 times a day for 3 months. The results of studies performed after treatment showed that the admission of pro-and prebiotics in patients after hemicolectomy, has a high efficiency in micro biocenosis restoring and had a positive effect not only on bacterial composition of the microflora, but also on the functional state of the liver and lipid levels in patients serum.     

Hepatic lesion in patients with hepatocerebral dystrophy

AIM: To study hepatic affection in hepatocerebral dystrophy (HCD) regarding clinical course and duration of the disease. MATERIAL AND METHODS: The records on 63 HCD patients were studied retrospectively as to early clinical symptoms, onset dynamics, biochemical tests for hepatic function, morphological changes of the liver, immune and cytokine status, markers of hepatotropic viruses. RESULTS: Six variants of HCD course were identified: hepatic (24 patients), endocrine (17 patients), neurological (12 patients), psychoemotional (5 patients), hemolytic (3 patients), renal (1 patient). Early hepatitis and hepatic cirrhosis progress were characteristic for the hepatic variant. The other variants were characterized by hepatic fibrosis, lipofuscinosis, fat dystrophy of the liver. Markers of viral hepatitides B, C, G, TT were detected primarily in patients with a hepatic variant of HCD. A moderate rise of aminotransferases, immunoglobulins, cytokines level indicate weak inflammation in hepatic tissue. Disorders in proteins synthesis, hepatic detoxication function reflect changes in the microsomal system and endoplasmic network. CONCLUSION: Hepatic lesions in HCD are different. Clinical, biochemical, morphological activity and immune status affections were most severe in patients with hepatic and endocrine variants of HCD, being the least severe in neurological, psychoemotional and hemolytic variants. Hepatotropic viruses in some patients deteriorate hepatic lesion caused by copper imbalance.     

Preventive chemotherapy of duodenal ulcer

An attempt was made to solve the problem in preventive drug therapy for duodenal ulcer in terms of various types of the course of the disease, its heterogeneity, features of metabolic processes, a patient's age, individual selection of the optimal drug, its dosage, regimen, intake duration, which would provide a differential individual design of drug therapy and change multicomponent drug therapy by mono- or diet therapy. Pharmacokinetic features of currently available antiulcer agents of groups of pyrenezepine or H2-blockers of histamine are presented, which should be taken into account when these drugs are used. A relationship is shown between the pharmacokinetics of drugs to an immune response as production of specific anti-drug++ antibodies that occasionally cause inefficiency of the therapy performed and a relapse of the disease during continuous treatment. The outcomes of differential preventive therapy are given in various types of the course of duodenal ulcer.     

Characteristics of the intestinal dysbiosis and endotoxemia after hemicolectomy

The normal intestinal microflora important for maintaining the optimum level of metabolic processes in the human body, the immune system, as well as to create a high colonization resistance against the pathogenic microbes. With aging, changes microbiocaenosis intestine, resulting in an increase in the total number of microbes in the gut and profound changes in the functional properties of microorganisms. Under physiological conditions, the main reservoir of endotoxin in the human body is the intestine. Endotoxins, penetrating through the intestinal mucosa, arrive first at the local (intestinal), and then through the portal system in the liver, are able to initiate it various lesions, including fatty degeneration of the parenchyma. OBJECTIVE: Based on clinical and laboratory studies to determine changes in gut microbiota and the level of endotoxemia in elderly patients in the remote period after undergoing surgery--hemicolectomy. RESULTS OF THE STUDY: Metabolic activity of microflora in the colon according to the concentrations of short chain fatty acids in the feces of elderly patients in distant periods after hemicolectomy revealed in various degrees of violation of the microbiota of the colon. Violation of gut microbiota leads to endotoxaemia, which has a toxic effect on liver function, level of endotoxin and protein that binds to endotoxin was significantly higher in patients who underwent left-sided hemicolectomy.     

Effect of zinc deficiency on effectiveness of the treatment of liver encephalopathy in patients with liver cirrhoses]

Zinc plays an important role in human physiologic processes being cofactor of many enzymes, it participates in numerous enzyme reactions. We have investigated 15 patients with liver cirrhoses of different etiology. With the rising of class of liver impairment and developing liver encephalopathy, level of zinc in blood drops. Treatment with diuretic therapy results in increase of discharge of zinc with urine and prevents recovery of its level in blood.