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Context: Ensuring the quality of a generic drug is essential for its commercialization. Propranolol hydrochloride is a drug in great demand on the market as it is widely used as an antihypertensive, antianginal, antiarrhythmic, and for the treatment of migraine, requiring a complete evaluation to determine equivalence. Aims: To evaluate the dissolution biopharmaceutical characteristic in multisource products marketed in the Peruvian market, taking Inderal® as a reference product. Methods: In vitro conditions are simulated using the USP apparatus II at 50 rpm and 900 mL of the dissolution media pH 1.2, 4.5, and 6.8 at 37°C. The dependent mathematical models were characterized by the Akaike information criterion, and the similarity was evaluated using the independent parameters (MDT, DE, and the similarity factor f2). Results: The average dissolution percentages demonstrate a difference between the multisource and the innovator in the three-dissolution media. The model that best characterizes the dissolution kinetics in all products is that of Hixson–Crowell. A significant difference was obtained in the MDT and DE between the innovative and multisource products and in the three-dissolution media. The similarity factor was not within the acceptable range for multisource products in the three-dissolution media. Conclusions: The 40 mg propranolol hydrochloride tablets included in the study are not equivalent in vitro to the innovative product and, therefore, are not interchangeable.

Introduction and purpose: The Coronavirus Disease 2019 (COVID-19) and its effects on patients remain the main focus of many researchers across the world. One of the challenges faced by medical professionals is the impact of the infection on the course of chronic diseases. Manifestations of the infection are observed mainly in the respiratory system, but other organs, particularly the cardiovascular system, are also frequently affected. Recent data indicates that arterial hypertension and cardiovascular diseases (CVD) are the most prevalent comorbidities in patients suffering from SARS-CoV-2 infection. Material and methods: This study aimed to investigate the impact of SARS-CoV-2 infection on the cardiovascular system. Apart from the literature review we conducted a retrospective study to check the necessity for modification of chronic treatment in patients with CVD after recovery from COVID-19, particularly regarding the use of beta blockers. Results: Using the Mann-Whitney U test a positive correlation (p = 0.04) was found between the presence of coronary artery disease before COVID-19 and a need for an increase in the beta-blockers dose. Conclusions: Patients with preexisting CVD should be closely monitored during and after recovery from SARS-CoV-2 infection due to the higher risk of complications and the potential need for modifications in the treatment of chronic diseases. Patients with coronary artery diseases may need an increase in beta-blocker doses after recovery. This is an important issue for future research, especially in the context of long COVID-19.

Introduction and purpose: Cardiological drugs are widely used in the management of various cardiovascular diseases, such as hypertension, angina, heart failure, and arrhythmias. However, when these drugs are taken in excessive amounts or are not used as prescribed, they can become toxic and cause significant harm to the heart and other organs. Our study aims to illustrate the most frequent causes of poisoning with cardiological drugs in patients hospitalized in the toxicological and cardiological department from April 2013 to December 2021. Brief description of the state of knowledge: Poisoning with cardiological drugs is a growing concern for healthcare professionals. In 2019, cardiovascular toxins were one of the top 10 categories of poisons evaluated by medical toxicologists. Data collected from the analyzed toxicology and cardiology department include a group of 387 hospitalized patients. The largest proportion were cases intoxicated by beta-adrenoreceptor antagonists. The second most common group was poisonings by angiotensin-converting-enzyme inhibitors. A slightly lower proportion implicated poisonings caused by other, unidentified substances affecting the cardiovascular system - calcium channel blockers and other antihypertensive drugs. Conclusions: All of the data demonstrated in our study shows the importance of understanding the pharmacology, pathophysiology, and treatment strategies of poisonings caused by cardiological drugs which are one the most widely used medications worldwide.

Introduction and purpose: Drug poisoning is one of the more common reasons for patients being hospitalized in toxicology wards. The wide availability and ease of obtaining a wide variety of drugs and supplements are the cause of adverse reactions associated with their use. Increasing life expectancy and emerging chronic diseases also require the use of sometimes many drugs to control people's health. This can lead to poly-pragmasy, which is an undesirable condition and leads to poisoning. The purpose of our work is to demonstrate the most common causes of drug poisoning considering the criterion of division according to ICD-10. Brief description of the state of knowledge: Any preparation, drug, supplement can cause negative effects on the organism. This depends on the dose, improper use, or cross-reactions of the relevant substances. The study compiled statistics on the cause of hospitalization of drug-poisoned patients based on ICD-10. 5433 patients were included in the study. Conclusions: Our work shows that the most common causes of hospitalization due to drug poisoning are those caused by antiepileptic drugs, sedative-hypnotics and antiparkinsonism medications. The data compiled in this article agree with scientific reports from different countries compiling the most common reason for hospitalization related to drug poisoning.

Objetivo: la hemorragia digestiva es una complicación frecuente en pacientes con cirrosis hepática. La tasa de recidiva tras un primer episodio oscila en torno al 60%, motivo por el cual la profilaxis está recomendada. Esta puede realizarse mediante fármacos (betabloqueantes y nitratos) combinados o no con ligadura endoscópica con bandas. El objetivo de este estudio es valorar el coste-efectividad de la medición del gradiente de presión venosa hepática (GPVH) previo a la elección de la profilaxis secundaria. Métodos: creamos un árbol de decisión para calcular el coste-efectividad de dos estrategias: grupo 1: pacientes a los que se les determinó el GPVH; cuando tras la administración de propranolol hubo una disminución del gradiente ≥ al 20% respecto al inicial o disminuyó por debajo de 12 mmHg, los pacientes fueron tratados con propranolol. Si no hubo tal variación del GPVH, se realizó ligadura endoscópica de las varices. Grupo 2: en este grupo no se monitorizó el GPVH. Los pacientes con varices grado I recibieron tratamiento con betabloqueantes más nitratos y los que presentaban varices grandes (II, III, IV) fueron tratados con betabloqueantes y LEB. Resultados: en el grupo del estudio hemodinámico respondió un 36%, estos recibieron tratamiento betabloqueante, la tasa de resangrado fue del 0%. En los no respondedores la tasa de resangrado fue de un 17%. En el grupo sin estudio se trató con propranolol más nitratos al 28,42% y resangraron un 25%; la tasa de resangrado en el grupo que recibió tratamiento con betabloqueantes más ligadura endoscópica fue de un 13%. El coste total en el grupo al que se realizó el estudio hemodinámico fue de 14.100,49 euros y de 14.677,16 euros para el grupo sin estudio hemodinámico. Conclusiones: la realización del estudio hemodinámico es una herramienta coste-efectiva en la profilaxis de la hemorragia digestiva varicosa en pacientes cirróticos y mantiene una relación coste efectiva favorable comparado con la no realización del mismo.Objective: variceal rebleeding is common following a first episode of hemorrhage in cirrhotic patients. The objective of this study was to determine the cost-effectiveness of monitoring hepatic venous pressure gradient (HVPG) to guide secondary prophylaxis. Methods: we created a Markov decision model to calculate cost-effectiveness for two strategies: Group 1: HVPG monitoring to decide treatment -when portal pressure was reduced by at least 20 percent or HVPG was less than 12 mmHg after beta-blocker administration, patients received beta-blockers; when portal pressure did not meet these criteria therapy was endoscopic band ligation. Group 2: in this group there was no monitoring of HVPG. Patients with large varices received treatment with beta-blockers combined with EBL; patients with small varices received beta-blockers plus isosorbide mononitrate. Results: there was no recurrent variceal bleeding in group 1 for good responders, and for 17% of poor responders. In group 2 a 25% rebleeding rate was detected in patients with small varices and 13% for those with big varices. Overall cost in group 1 was 14,100.49 euros, and 14,677.16 in group 2. Conclusions: HVPG measurement is cost-effective for the secondary prophylaxis of variceal bleeding.

El desarrollo de la cápsula endoscópica y la enteroscopia de doble balón ha aumentado las tasas de diagnóstico y tratamiento en la hemorragia digestiva de origen oscuro, en la que las angiodisplasias del intestino delgado son la causa más frecuente. Sin embargo, el 25-40% de los pacientes, no subsidiarios o no respondedores a la terapéutica endoscópica, angiográfica o quirúrgica, pueden tener alto riesgo de resangrado y carecen de tratamiento médico claramente eficaz. La utilidad de la terapia hormonal está cuestionada actualmente, sin olvidar los frecuentes y limitantes efectos secundarios. El octreótido suele ser eficaz en el control de la hemorragia pero no parece la terapia de mantenimiento más óptima. Los beta-bloqueantes no selectivos, de igual manera que en la profilaxis de la hemorragia por hipertensión portal, pueden ser útiles en combinación con otros fármacos. Recientemente, el octreotido LAR, una formulación de liberación retardada que se administra una vez al mes por vía intramuscular, y la talidomida oral, un potente inhibidor de la angiogénesis, han demostrado su eficacia y seguridad a largo plazo en casos graves aislados.The development of capsule endoscopy and double-balloon enteroscopy has increased diagnostic and therapeutic rates in obscure gastrointestinal hemorrhage, where angiodysplasia of the small bowel is the most frequent cause. Nevertheless, almost 25-40% of patients who are not candidates or do not respond to endoscopic, angiographic, or surgical management may be at high risk of rebleeding, and therefore lack a clearly effective medical therapy. The utility of hormonal therapy remains unclear and is burdened by adverse effects. Subcutaneous octreotide usually controls bleeding but does not seem adequate for mainteinance therapy. Non-selective beta-blockers alone or in combination with other treatments, as in the prophylaxis of portal hypertension variceal bleeding, may be helpful. Recently, octreotide LAR, a depot formulation administered once a month intramuscularly, and oral thalidomide, a powerful inhibitor of angiogenesis, have demonstrated their effectiveness and safety for long-term therapy in anecdotal case reports and deserve further investigation.

Ascites is the fluid accumulation in the peritoneal cavity, and it is the consequence of a wide variety of entities, being liver cirrhosis the most common one. In this kind of patients, the development of ascites results from splanchnic vasodilation; decreased effective circulating volume; the activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system; and a systemic inflammatory process. Its management is diverse and depends on the severity of the hemodynamic disturbance and other clinical manifestations. In recent years, therapeutic strategies have been developed, but they tend to result unconventional, so new evidence demonstrates the advantages of non-selective beta-blockers for the survival rate of patients with end-stage cirrhosis and ascites., (Copyright © 2022 Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Coronary heart disease is the leading cause of heart failure (HF). The aim of this study was to assess the risk of readmission for HF in patients with acute coronary syndrome without previous HF or left ventricular dysfunction., Methods: Prospective study of consecutive patients admitted for acute coronary syndrome in 2 institutions. Risk factors for HF were analyzed by competing risk regression, taking all-cause mortality as a competing event., Results: We included 5962 patients and 567 (9.5%) experienced at least 1 hospital readmission for acute HF. Median follow-up was 63 months and median time to HF readmission was 27.1 months. The cumulative incidence of HF was higher than mortality in the first 7 years after hospital discharge. A higher risk of HF readmission was associated with age, diabetes, previous coronary heart disease, GRACE score> 140, peripheral arterial disease, renal dysfunction, hypertension and atrial fibrillation; a lower risk was associated with optimal medical treatment. The incidence of HF in the first year of follow-up was 2.73% and no protective variables were found. A simple HF risk score predicted HF readmissions risk., Conclusions: One out of 10 patients discharged after an acute coronary syndrome without previous HF or left ventricular dysfunction had new-onset HF and the risk was higher than the risk of mortality. A simple clinical score can estimate individual risk of HF readmission even in patients without previous HF or left ventricular dysfunction., (Copyright © 2020 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Propranolol, a non-selective beta-blocker, remains the first line of treatment for problematic infantile hemangioma. However, although rarely, a subset of patients experience undesirable side effects, raising interest in other selective beta-blockers. We present a large case series of 46 infants treated successfully with oral atenolol, a selective beta-1 blocker., (Copyright © 2020. Publicado por Elsevier España, S.L.U.)

Beta-blockers are widely used molecules that are able to antagonize β-adrenergic receptors (ARs), which belong to the G protein-coupled receptor family and receive their stimulus from endogenous catecholamines. Upon β-AR stimulation, numerous intracellular cascades are activated, ultimately leading to cardiac contraction or vascular dilation, depending on the relevant subtype and their location. Three subtypes have been described that are differentially expressed in the body (β 1 -, β 2 - and β 3 -ARs), β 1 being the most abundant subtype in the heart. Since their discovery, β-ARs have become an important target to fight cardiovascular disease. In fact, since their discovery by James Black in the late 1950s, β-blockers have revolutionized the field of cardiovascular therapies. To date, 3 generations of drugs have been released: nonselective β-blockers, cardioselective β-blockers (selective β 1 -antagonists), and a third generation of these drugs able to block β 1 together with extra vasodilation activity (also called vasodilating β-blockers) either by blocking α 1 - or by activating β 3 -AR. More than 50 years after propranolol was introduced to the market due to its ability to reduce heart rate and consequently myocardial oxygen demand in the event of an angina attack, β-blockers are still widely used in clinics., (Copyright © 2019 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Beta-blockers are the cornerstone of treatment for various cardiovascular conditions. Although their effects have classically been considered to be driven by their antagonistic and competitive action on beta-adrenergic receptors, nowadays it is known that their effect goes beyond that of mere competition with catecholamines on these receptors. Beta-blockers were discovered as antianginal drugs in the 1960s and are currently widely used in heart failure, arrhythmias, and ischemic heart disease. In this article, we review the evidence for the beneficial effects of beta-blockers in these conditions, as well as the current recommendations in clinical practice guidelines for their use. Surprisingly, despite having been prescribed for more than 4 decades, new, previously unnoticed mechanisms of action on cellular compartments are still being discovered, which continues to open up new horizons for their use. All in all, beta-blockers are one of the most fascinating drug groups in our therapeutic armamentarium., (Copyright © 2019 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

In septic shock, high adrenergic stress is associated with cardiovascular and systemic adverse effects, which can negatively affect the results. Beta-adrenergic receptor block has been shown to be effective in controlling the disproportionate increase in heart rate, maintaining a favorable hemodynamic profile and apparently improving the efficiency of the cardiovascular system in order to maintain tissue perfusion. They have also been shown to modulate favorably catecholamine-induced immunosuppression and to decrease insulin resistance, protein catabolism, and proinflammatory cytokine expression associated with cardiovascular dysfunction. Selective beta-1 blockers appear to provide better results than non-selective blockers, even suggesting a positive impact on mortality. Future clinical trials are still needed to confirm these findings and define the scope of their benefits., (Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)