scholarly journals Pharmacokinetics and diuretic effect of furosemide after single intravenous, oral tablet, and newly developed oral disintegrating film administration in healthy beagle dogs

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Suk-Kyu Koh ◽  
Jong-Woo Jeong ◽  
Seo-In Choi ◽  
Rae Man Kim ◽  
Tae-Sung Koo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Companion Animals ◽  
Urine Specific Gravity ◽  
Diuretic Effect ◽  
Beagle Dogs ◽  
Oral Tablet ◽  
Significant Difference ◽  
Rapid Dissolution ◽  
Chloride Excretion

Abstract Background Furosemide, a diuretic that acts on the loop of Henle, is commonly used to treat congestive heart failure in veterinary medicine. Some owners have difficulty in administering oral tablet medication to animal patients, which leads to noncompliance, especially during long-term administration. Oral disintegrating film (ODF) has the advantages of easy administration via a non-invasive route, rapid dissolution, and low suffocating risk. The objective of this study was to research the pharmacokinetic (PK) profiles and diuretic effect of furosemide after intravenous (IV), orally uncoated tablet (OUT), and newly developed ODF administration in healthy beagle dogs. In this study, a furosemide-loaded ODF (FS-ODF) formulation was developed and five beagle dogs were administered a single dose (2 mg/kg) of furosemide via each route using a cross-over design. Results The most suitable film-forming agent was sodium alginate; thus, this was used to develop an ODF for easy drug administration. No significant differences were detected in the PK profiles between OUT and FS-ODF. In the blood profiles, the concentration of total protein was significantly increased compared to the baseline (0 h), whereas no significant difference was detected in the concentration of creatinine and hematocrit compared to the baseline. FS-ODF resulted in a similar hourly urinary output to OUT during the initial 2 h after administration. The urine specific gravity was significantly decreased compared to the baseline in each group. The peak times of urine electrolyte (sodium and chloride) excretion per hour were 1 h (IV), 2 h (OUT), and 2 h (FS-ODF). Conclusions These results suggest that the PK/PD of furosemide after administration of newly developed FS-ODF are similar to those of OUT in healthy dogs. Therefore, the ODF formulation has the benefits of ease and convenience, which would be helpful to owners of companion animals, such as small dogs (< 10 kg), for the management of congestive heart failure.

scholarly journals Pharmacokinetics and Diuretic Effect of Furosemide after Single Intravenous, Oral Tablet, and Newly Developed Oral Disintegrating Film Administration in Healthy Beagle Dogs

2021 ◽  
Author(s):  
Suk-kyu Koh ◽  
Jong-Woo Jeong ◽  
Seo-In Choi ◽  
Rae-Man Kim ◽  
Tae-Sung Koo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Companion Animals ◽  
Urine Specific Gravity ◽  
Maximum Plasma ◽  
Beagle Dogs ◽  
Oral Tablet ◽  
Significant Difference ◽  
Rapid Dissolution ◽  
Chloride Excretion

Abstract Background: Furosemide, a diuretic that acts on the loop of Henle, is commonly used to treat congestive heart failure in veterinary medicine. Some owners have difficulty in administering oral tablet medication to animal patients, which leads to noncompliance, especially during long-term administration. The oral disintegrating film (ODF) has the advantages of easy administration via a non-invasive route, rapid dissolution, and low suffocating risk. The objective of this study was to research the pharmacokinetic and pharmacodynamics (PK/PD) profiles of furosemide after intravenous (IV), orally uncoated tablet (OUT), and newly developed ODF administration in healthy beagle dogs. In this study, a furosemide-loaded ODF (FS-ODF) formulation was developed and five beagle dogs were administered a single dose (2 mg/kg) of furosemide via each route using a cross-over design.Results: The most suitable film-forming agent was sodium alginate; thus, this was used to develop an ODF for easy drug administration. No significant differences were detected in the PK profiles between OUT and FS-ODF. The maximum plasma concentration of furosemide was higher and the elimination half-life and time at maximum concentration were slightly lower after FS-ODF administration than after OUT administration. In the blood profiles, the concentration of total protein was significantly increased compared to the baseline (0 h), whereas no significant difference was detected in the concentration of creatinine and hematocrit compared to the baseline. FS-ODF resulted in a similar hourly urinary output to OUT during the initial 2 h after administration. The urine specific gravity was significantly decreased compared to the baseline in each group. The peak times of urine electrolyte (sodium and chloride) excretion per hour were 1 h (IV), 2 h (OUT), and 2 h (FS-ODF). Conclusions: These results suggest that the PK/PD of furosemide after administration of newly developed FS-ODF are similar to those of OUT in healthy dogs. Therefore, the ODF formulation has the benefits of ease and convenience, which would be helpful to owners of companion animals, such as small dogs (<10 kg) or cats, for the management of congestive heart failure.

scholarly journals An Echocardiographic Evaluation of Dilated Cardiomyopathy in a Tertiary Care Hospital

2019 ◽  
Vol 57 (215) ◽  
Author(s):  
Raj Kumar Thapa ◽  
Kanchan K.C ◽  
Rishi Khatri ◽  
Devendra Khatri ◽  
Rajeeb Kumar Deo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Dilated Cardiomyopathy ◽  
Tertiary Care ◽  
Left Ventricular ◽  
Care Hospital ◽  
Echocardiographic Evaluation ◽  
Significant Difference

Introduction: Cardiomyopathies are diseases of heart muscle that may originate from genetic defects, cardiac myocyte injury or infiltration of myocardial tissues. Dilated cardiomyopathy is the most common phenotype and is often a final common pathway of numerous cardiac insults. Mostly it remains unknown in the absence of echocardiography, histopathology and genetic evaluation. Though common it is underdiagnosed with not much of data available in our setup.Methods: This study was analytical cross-sectional study of hospital data on Echocardiographic findings in 65 patients of DCM visiting cardiology unit for Echocardiographic evaluation from 1st of February to 31st July 2018 for the period of six months in Shree Birendra Hospital, a tertiary care military hospital at Chhauni, Kathmandu. Pediatric age group patients and those who refused to give consent were excluded. Data obtained were entered in Microsoft Excel 2010 and analyzed by IBM SPSS 21.Results: Among 65 patients enrolled 40 (61%) were male and 25 (39%) female with male to female ratio of 1.6:1. Elderly people (61-75 years) with an average age of 65 were commonly involved and they presented mostly with congestive heart failure, 32 (49%). Echocardiographic evaluation showed 36 (55%) with mildly dilated Left Ventricle (5.6-6.0cm). Majority had reduced Left ventricular systolic function with an average Ejection fraction (EF) of 39.6%. No significant difference between male and female with the average EF% (P=0.990) and there was no significant relation between age and average EF% (P=0.091).Conclusions: Dilated Cardiomyopathy is the commonest cardiomyopathy phenotype mostly presenting with congestive heart failure. It is often underdiagnosed in our part of the world, however echocardiography will easily detect the condition. Keywords: dilated cardiomyopathy; echocardiography; ejection fraction; left ventricle.

scholarly journals Degenerative Pathology of the Ankle, Hindfoot, and Midfoot is as Limiting to Patient Mobility as Congestive Heart Failure

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0016
Author(s):  
Amalie Erwood ◽  
Gregory Kurkis ◽  
Samuel David Maidman ◽  
Robert Cole ◽  
Shay Ariel Tenenbaum ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Nyha Class ◽  
Class Ii ◽  
Study Patient ◽  
Foot And Ankle ◽  
Ankle Arthritis ◽  
Patient Mobility ◽  
Patient Demographics ◽  
Significant Difference

Category: Ankle, Ankle Arthritis, Hindfoot, Midfoot/Forefoot Introduction/Purpose: Degenerative conditions of the ankle, hindfoot, and midfoot can markedly limit mobility. The Life-Space Assessment (LSA) is a questionnaire quantifying how patients mobilize after a medical event as they return to their previous daily settings. Current outcome measures do not accurately assess mobility in the geriatric foot and ankle population. In contrast, the effect of congestive heart failure (CHF) on patient mobility is routinely assessed via the New York Heart Association (NYHA) functional classification. The NYHA classification is stratified by limitation of physical activity: I (no limitation), II (some limitation), III (marked limitation), and IV (unable to carry out without discomfort). We hypothesized that degenerative conditions of the foot and ankle would be as mobility limiting as CHF. Methods: Patients over the age of 50 were included in this study. LSA data was prospectively collected from patients with degenerative ankle, hindfoot, and midfoot diagnoses at their preoperative visit and NYHA-classified CHF patients at a cardiology clinic. The degenerative foot and ankle cohort included Achilles tendonitis, ankle joint cartilage defects, ankle arthritis, subtalar arthritis, and midfoot arthritis. Patient demographics and comorbidities were recorded from the electronic medical record. Mean LSA data was analyzed and compared using a Student’s t-test. Results: 28 degenerative foot and ankle patients and 44 CHF patients met inclusion criteria for the study. Patient demographics, including age, gender, and BMI, were not significantly different between the two groups. The foot and ankle cohort had a mean LSA score of 68. Mobility of the foot and ankle group was significantly less compared to NYHA class I patients, who had a LSA score of 103 (p=0.008). There was no significant difference in mobility compared to class II or III congestive heart failure patients, who recorded a mean LSA score of 62 (p=0.60). There was insufficient data available on NYHA class IV patients to make comparisons to this group. Conclusion: Degenerative ankle, hindfoot, and midfoot pathology is associated with similar mobility limitation to that of NYHA class II and III congestive heart failure.

Normal-sodium diet compared with low-sodium diet in compensated congestive heart failure: is sodium an old enemy or a new friend?

2008 ◽  
Vol 114 (3) ◽  
pp. 221-230 ◽  
Author(s):  
Salvatore Paterna ◽  
Parrinello Gaspare ◽  
Sergio Fasullo ◽  
Filippo M. Sarullo ◽  
Pietro Di Pasquale
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Heart Association ◽  
Plasma Renin ◽  
High Dose ◽  
Sodium Diet ◽  
Low Sodium Diet ◽  
Low Sodium ◽  
Significant Difference

The aim of the present study was to evaluate the effects of a normal-sodium (120 mmol sodium) diet compared with a low-sodium diet (80 mmol sodium) on readmissions for CHF (congestive heart failure) during 180 days of follow-up in compensated patients with CHF. A total of 232 compensated CHF patients (88 female and 144 male; New York Heart Association class II–IV; 55–83 years of age, ejection fraction <35% and serum creatinine <2 mg/dl) were randomized into two groups: group 1 contained 118 patients (45 females and 73 males) receiving a normal-sodium diet plus oral furosemide [250–500 mg, b.i.d. (twice a day)]; and group 2 contained 114 patients (43 females and 71 males) receiving a low-sodium diet plus oral furosemide (250–500 mg, b.i.d.). The treatment was given at 30 days after discharge and for 180 days, in association with a fluid intake of 1000 ml per day. Signs of CHF, body weight, blood pressure, heart rate, laboratory parameters, ECG, echocardiogram, levels of BNP (brain natriuretic peptide) and aldosterone levels, and PRA (plasma renin activity) were examined at baseline (30 days after discharge) and after 180 days. The normal-sodium group had a significant reduction (P<0.05) in readmissions. BNP values were lower in the normal-sodium group compared with the low sodium group (685±255 compared with 425±125 pg/ml respectively; P<0.0001). Significant (P<0.0001) increases in aldosterone and PRA were observed in the low-sodium group during follow-up, whereas the normal-sodium group had a small significant reduction (P=0.039) in aldosterone levels and no significant difference in PRA. After 180 days of follow-up, aldosterone levels and PRA were significantly (P<0.0001) higher in the low-sodium group. The normal-sodium group had a lower incidence of rehospitalization during follow-up and a significant decrease in plasma BNP and aldosterone levels, and PRA. The results of the present study show that a normal-sodium diet improves outcome, and sodium depletion has detrimental renal and neurohormonal effects with worse clinical outcome in compensated CHF patients. Further studies are required to determine if this is due to a high dose of diuretic or the low-sodium diet.

scholarly journals Advanced Practice Registered Nurse – Led Transition of Care for Congestive Heart Failure Patients

2018 ◽  
Vol 3 (2) ◽  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Registered Nurse ◽  
Self Care ◽  
Transition Of Care ◽  
Advanced Practice ◽  
Institute Of Medicine ◽  
Advanced Practice Registered Nurse ◽  
Significant Difference ◽  
Chi Square Analysis

Purpose: This scholarly project was to determine if an advanced practice registered nurse (APRN) – led transition of care (TOC) would positively influence the outcome of quality of life in congestive heart failure (CHF) patients. The purpose was to meet Medicare-mandated target goals in reducing readmission to 12%. The project investigates the gap between the time of discharge and transition of care. The improvement plan objectives are threefold: to increase retention of self-care activities utilizing the teach-back method while monitoring emergency room (ER) utilization and measuring benchmark assessment. This project aligns with one of the Institute of Medicine [IOM] six dimensions of patient-centered care. Findings: In the period of February 22 – March 22, 2018, ten subjects were enrolled in the project (N=10). Even though chi square analysis revealed no significant difference (x2 (1, N= 10) = 2.3746, p = .1233) in readmissions post intervention (See Appendix -T); APRN – led TOC demonstrated positive changes in teach back and reteach via leadership competences and clinical experience revealing overall improvement in trends. Discussion: There were ten participants in the pilot study (N=10). Out of these ten CHF patients one was readmitted in the 30-day period of the study. All subjects were carefully followed and monitored. Field assessment benchmark revealed that at one week 100% of all patients were retaining 90% or more of the self-care activities and maintaining appropriate priority tasks. There was no ER utilization and patients in the “yellow” zone knew what to do with a three-pound weight gain.

Robust correlation dimension estimator for heart rate variability

2020 ◽  
Vol 15 (16) ◽  
pp. 62-68
Author(s):  
A.V. Martynenko ◽  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Sinus Rhythm ◽  
Correlation Dimension ◽  
Normal Sinus Rhythm ◽  
Robust Estimator ◽  
Normal Sinus ◽  
Significant Difference ◽  
Limited Length

Introduction. Non-linear methods of analysis have found widespread use in the Heart Rate Variability (HRV) technology, when the long-term HRV records are available. Using one of the effective nonlinear methods of analysis of HRV correlation dimension D2 for the standard 5-min HRV records is suppressed by unsatisfactory accuracy of available methods in case of short records (usually, doctors have about 500 RRs during standard 5-min HRV record), as well as complexity and ambiguity of choosing additional parameters for known methods of calculating D2. The purpose of the work. Building a robust estimator for calculating correlation dimension D2 with high accuracy for limited se-ries of RR-intervals observed in a standard 5-minute HRV record, i. e. with N  500. As well as demonstrating the capabilities of the D2 formula on a well known attractors (Lorenz, Duffing, Hennon and etc.) and in applications for Normal Sinus Rhythm (NSR), Congestive Heart Failure (CHF) and Atrial Fibrillation (AF). Materials and Methods. We used MIT-BIH long-term HRV records for normal sinus rhythm, congestive heart failure and atrial fibrillation. In order to analyze the accuracy of new robust estimator for D2, we used the known theoretical values for some famous attractors (Lorenz, Duffing, Hennon and etc.) and the most popular Grassberger-Procaccia (G-P) algorithm for D2. The results of the study. We have shown the effectiveness of the developed D2 formula for time series of limited length (N = 500–1000) by some famous attractors (Lorenz, Duffing, Hennon and etc.) and with the most popular Grassberger-Procaccia (G-P) algorithm for D2. It was demonstrated statistically significant difference of D2 for normal sinus rhythm and congestive heart failure by standard 5 min HRV segments from MIT-BIH database. The promised technology for early prediction of atrial fibrillation episodes by current D2 algorithm was shown for standard 5 min HRV segments from MIT-BIH Atrial Fibrillation database. Conclusion. Robust correlation dimension D2 estimator suggested in the article allows for time series of limited length (N ≈ 500) to calculate D2 value that differs at mean from a precise one by 5 ± 4%, as demonstrated for various well known attractors (Lorenz, Duffing, Hennon and etc.). We have shown on the standard 5-min segments from MIT-BIH database of HRV records: - the statistically significant difference of D2 for cases of normal sinus rhythm and congestive heart failure; - D2 drop significantly for the about 30 min. before of AF and D2 growth drastically under AF there was shown for HRV records with Atrial Fibrillation (AF) episodes. The suggested robust correlation dimension D2 estimator is perfect suitable for real time HRV monitoring as accurate, fast and non-consuming for computing resources. Key words: Hearth rate variability; Correlation dimension; Congestive heart failure; Atrial fibrillation.

High-Dose Sequential Chemotherapy (HDSC) in Support of Autologous Stem Cell Transplantation (ASCT) in Patients with Relapsed/Refractory Hodgkin Lymphoma (HL) and Non-Hodgkin Lymphoma (NHL).

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5231-5231
Author(s):  
Basak Oyan ◽  
Yener Koc ◽  
Evren Ozdemir ◽  
Emin Kansu
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Mortality Rate ◽  
Hodgkin Lymphoma ◽  
Disease Free Survival ◽  
Large Cell ◽  
High Dose ◽  
High Survival ◽  
Term Survival ◽  
Significant Difference

Abstract Background and aim: High-dose chemotherapy followed by ASCT is currently the standard treatment in achieving long-term survival in patients with relapsed or refractory HL and NHL. The aim of the present study is to assess the role of HDSC and ASCT in attaining high survival rates in patients with relapsed or refractory lymphoma. Patients and Method: From 2000 to 2004, 42 patients with relapsed/refractory HL or NHL with a median age of 42 years (M:F=28:14) were treated with HDSC and ASCT. Only patients who were sensitive to salvage chemotherapy were eligible for the protocol, consisting of 3 phases. Phase I consisted of cyclophosphamide (4.5 g/m2) followed by G-CSF (10 mcg/kg/d) and PBSC collection. Phase II consisted of etoposide (2 g/m2) with G-CSF support of at 5 mcg/kg/d. The transplant phase consisted of mitoxantrone (60 mg/m2) and melphalan (180 mg/m2) followed by APBSC infusion. Results: NHL patients had diffuse large cell (n=16), anaplastic large cell (n=4), mantle cell (n=2), follicular (n=2), small lymphocytic (n=2) and peripheral T cell (n=2) histology. Patients with HL had mixed cellular (n=7) and nodular sclerosing (n=7) histology. The rationale for ASCT was first relapse in 17 (41%) patients, more than one relapse in 14 (33%) patients, primary refractory disease in 10 (24%) patients and high risk disease in 1 (2%) patient. Prior to HDSC, 69% and 31% of the patients were in CR and PR, respectively. Patients received a median of 5.3x106/kg CD34+ cells. Median times to achieve neutrophil and platelet engraftments were 14 and 24 days, respectively. Transplant related mortality rate was 7% (n=3). At a median follow-up of 26 months (range, 1–48), 10 patients relapsed and 12 patients died. Causes of mortality were; veno-occlusive disease (n=1), infection (n=3), progression/relapse (n=6), congestive heart failure (n=1) and secondary AML (n=1). Five patients developed congestive heart failure (severe in one patient), mainly due to high cumulative doses of anthracyclines during the previous therapies. The estimated 3-year disease-free survival (DFS) and overall survival (OS) were 66.7% and 69.2% in HL patients and 75% and 77.4% in NHL patients, respectively. Regarding DFS and OS, there was no statistically significant difference between HD and NHL. Currently, 30 (71%) of patients are alive, of which 28 (67%) patients are in complete remission. Conclusion: HDSC followed by APBSCT is an effective therapy in patients with relapsed/refractory NHL or HD, with an acceptable mortality rate.

Chronic administration of phosphodiesterase type 5 inhibitor suppresses renal production of endothelin-1 in dogs with congestive heart failure

2002 ◽  
Vol 103 (s2002) ◽  
pp. 258S-262S ◽  
Author(s):  
Takashi YAMAMOTO ◽  
Atsuyuki WADA ◽  
Masato OHNISHI ◽  
Takayoshi TSUTAMOTO ◽  
Masanori FUJII ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Sodium Excretion ◽  
Pde5 Inhibitor ◽  
Vehicle Group ◽  
Endothelin 1 ◽  
Phosphodiesterase Type 5 Inhibitor ◽  
Significant Difference ◽  
Phosphodiesterase Type ◽  
Renal Expression

Endothelin-1 (ET-1) and atrial natriuretic peptide (ANP) play important roles in the regulation of body fluid balance in congestive heart failure (CHF). Renal production of ET-1 increases in CHF and it is a significant independent predictor of sodium excretion. ANP inhibits the ET system through cGMP, a second messenger of ANP. However, in severe CHF, plasma cGMP levels reached a plateau despite the activation of ANP secretion. Thus, ANP does not seem to sufficiently oppose exaggerated ET-1 actions in severe CHF, partially due to the accelerated degradation of cGMP, through phosphodiesterase type 5 (PDE5). We examined the chronic effects of a PDE5 inhibitor, T-1032 (1mg/kg per day, n = 5), on renal function and renal production of ET-1 in dogs with CHF induced by rapid ventricular pacing (270beats/min). Vehicle dogs were given a placebo (n = 5) and normal dogs (n = 5) served as normal controls without pacing. In this experimentally produced CHF, plasma levels of ET-1, ANP and cGMP were elevated and renal production of cGMP was increased compared with the normal group, associated with increases in renal expression of preproET-1 mRNA and the number of ET-1-positive cells in glomeruli. In the T-1032 group, systemic and renal production of cGMP were further increased compared with the vehicle group despite no significant difference in plasma ANP levels between the two groups. Subsequently, the agent significantly improved urine flow rate, sodium excretion rate and glomerular filtration rate (GFR) associated with reductions in renal expression of preproET-1 mRNA and the number of ET-1-positive cells compared with the vehicle group. Moreover, there was a significant negative correlation between the number of ET-1-positive cells and GFR (r =-0.802 and P<0.001 respectively). Our results indicate that chronic PDE5 inhibition ameliorates the antagonistic relationship between renal ANP and ET-1 through the cGMP pathway, subsequently preventing renal dysfunction during the progression of CHF.

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