Репозитарій

Keywords: childbirth; fibrinolysis system; thrombocytopathy; thromboelastography; tranexamic acid; idiopathic arterial hypotension.

Abstract
Introduction: The main task of palliative care is to improve the quality of life of a patient, and the therapy of chronic pain with opioids is a significant problem for palliative care patients in Ukraine. Therefore, this study aimed to assess the opioid availability for palliative care patients in Ukraine.
Methods: Analysis of the list and consumption of opioids according to the scientific publications and legal documents.
Results: It was found that in Ukraine as of June 2021, 12 international non-proprietary names of opioids were registered, most of which are represented by several dosage forms, which makes it possible for patients to receive adequate pain relief through non–invasive therapy with oral forms. It was shown that two thirds (63.2%) of trade names of opioids registered in Ukraine were of domestic origin. Based on a comparative analysis of the range of opioids, available in current regulatory documents, it was established that in the State Register of Medicines of Ukraine and the Unified clinical protocol there is an almost identical list of opioids (12 drugs). However, in the State Drug Formulary and the National List of Essential Medicines, this list is much smaller (8 and 5 drugs, respectively). Since 2013 changes in the regulatory documents on the medical use of opioids in Ukraine have occurred, and oral morphine was registered for the first time, allowing access to adequate pain relief. Analysis of the morphine consumption level by dosage forms has shown that before 2013, the pharmacies sold only morphine in injections, and since 2013, the consumption of oral morphine increased.
Conclusions. Changes in regulatory documents partially simplified the complicated process of obtaining opioids by patients. However, more than 80% of patients still do not receive adequate pain therapy due to the hesitancy of doctors to prescribe opioids and an extremely insufficient number of pharmacies (1.8%) that sell opioids for the population.

Introduction

Many clinical studies have proved the effectiveness of probiotics in metabolic disorders associated with insulin resistance. However, the impact of probiotic therapy on pancreatic β-cell function is ambiguous. The influence of probiotic supplementation vs. placebo on β-cell function in people with type 2 diabetes (T2D) was assessed in a double-blind, single-center, randomized, placebo-controlled trial (RCT).

Methods

Sixty-eight patients with T2D were selected for participation in the RCT. Patients were randomly allocated to consumption of live multistrain probiotics or a placebo for 8 weeks, administered as a sachet formulation in double-blind treatment. The primary main outcome was the assessment of β-cell function as change in C-peptide and HOMA-β (homeostasis model assessment-estimated β-cell function), which was calculated using the HOMA2 calculator (Diabetes Trials Unit, University of Oxford). Secondary outcomes were the changes in glycemic control-related parameters, anthropomorphic variables, and cytokines levels. Analysis of covariance was used to assess the difference between groups.

Results

Supplementation with live multiprobiotic was associated with slight significant improvement of β-cell function (HOMA-β increased from 32.48 ± 13.12 to 45.71 ± 25.18; p = 0.003) and reduction of fasting glucose level (13.03 ± 3.46 vs 10.66 ± 2.63 mmol/L and 234.63 ± 62.36 vs 192.07 ± 47.46 mg/dL; p < 0.001) and HbA1c (8.86 ± 1.28 vs 8.48 ± 1.22; p = 0.043) as compared to placebo. Probiotic therapy significantly affects chronic systemic inflammation in people with T2D by reducing pro-inflammatory cytokine levels.

Conclusions

Probiotic therapies modestly improved β-cell function in patients with T2D. Modulating the gut microbiota represents a new diabetes treatment and should be tested in more extensive studies.

Trial Registration

NCT05765292.