Cardiovascular diseases are known to be treated with anticoagulants lifelong. Warfarin is one of the most commonly used medications for anticoagulation despite causing serious side effects in some ...patients. Different single nucleotide polymorphisms (SNPs) that have a role in the cytochrome P450 system can also affect the metabolism, as well as dosing, of warfarin. The purpose of this review is to look into the prevalence of this SNP in the past research and screen for possible correlations with age, place of origin, family history of cardiovascular and cerebrovascular diseases, or other medical conditions possibly present in various populations. In total, 20 scientific articles falling under the inclusion criteria were reviewed and found usable, and the rest of the cases will be highly beneficial in the upcoming years to determine the role of the recently discovered CYP4F2 rs2108622 variant, as well as the previously known CYP2C9 and VKORC1 SNPs, in the variance of warfarin dose requirement. These findings may also point researchers in the right direction for qualifying and validating these genetic variants for use as GBs (genomic biomarkers) in the clinical and medical practice of treatment with warfarin.
Background: Congenital fibrosis of extraocular muscles ( CFEOM) is a group of genetically defined eye-moving disorders. The syndrome is clinically characterized by congenital non-progressive ...ophthalmoplegia caused by dysinervation of the cranial nerves with or without ptosis. As a main sign of a CFEOM, extraocular muscles get shrunken and fibrotic, which makes surgery more technically demanding and the result more unpredictable, which makes the treatment challenging and highly customized. Our paper presents variations of the clinical picture and treatment cases of CFEOM1. Objective: To outline the importance of the clinical examination with the exact measurement of deviations for the patients with ocular fibrosis and passive duction test under general anesthesia, establishing them as the main criteria for treatment. Methods: We treated seven patients (14 eyes) with CFEOM1. The decision of the treatment was based on the measurement of the eye position in the primary position (PP), the severity of compensatory head position (CHP), restriction of motility, and passive motility test performed before surgery in general anesthesia. In 3 cases, patients were treated conservatively with the treatment of refractive error and amblyopia. However, in 4 patients, CHP and position of the eyes in PP were not acceptable, motility was severely impaired, and patients underwent surgery. The first surgery was performed on eye muscles: recession of inferior rectus muscle (IRM), anteposition, and resection of superior rectus muscle (SRM). As a second step procedure, ptosis surgery was performed. When the muscle was too tight, and it wasn’t possible to have a satisfying result with conventional surgery, we used a tissue expander to improve the position and motility of the affected eyes. Results: In all operated cases, CHP has significantly improved and the position of the eyes in PP. Conclusion: Exact eye and head position measurements and a passive motility test during general anesthesia should guide the surgery. In the case when conventional surgery is not possible, implantation of a bovine pericard is a safe and effective method.
The pathophysiology and therapy of
COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), are a dilemma for scientists and health professionals, and the fact that patients ...show different symptoms and severity of the clinical picture also contributes to that.
This paper aims to evaluate the effectiveness of therapeutic protocols (the use of immunomodulators) in the treatment of COVID-19 patients of various severity of the clinical picture by monitoring inflammatory markers (ESR and CRP), as well as the impact of the type and number of comorbidities patients had on these markers.
A total of 200 patients with a mild (n=76), moderate (n=70) or severe (n=54) clinical picture was included. Inflammatory markers ESR (erythrocyte sedimentation rate), CRP (C-reactive protein) were examined on three occasions: twice during hospitalization and once after hospital discharge. Immunomodulators used intrahospital were corticosteroids (methylprednisolone, dexamethasone, methylprednisolone + dexamethasone), tocilizumab or metenkefalin/tridecactide. Posthospital, patients were taking either methylprednisolone or did not use any immunomodulators. For statistical analysis, SPSS 26.0 and Microsoft Excel 2019 were used, with a level of significance of α=0.05. Nonparametric tests (Kruskal-Wallis and Wilcoxon Signed-Rank) were applied and effect size (ES) was calculated.
Three corticosteroid therapies used intrahospital caused a significant decrease in both inflammatory markers, especially in patients with a severe clinical picture, but the ES was the biggest with methylprednisolone + dexamethasone, then dexamethasone, and lastly methylprednisolone. Posthospital, methylprednisolone caused a significant decrease in both inflammatory markers, especially in patients with a severe clinical picture. The most common comorbidity in all patients, as well as in patients with a severe clinical picture, was hypertension. There was no statistically significant impact of the number of comorbidities patients had on ESR and CRP, but the highest number of comorbidities was in patients with a severe clinical picture.
The use of immunomodulators, especially methylprednisolone + dexamethasone intrahospital and methylprednisolone posthospital, is justified in most COVID-19 cases as there is a significant correlation between this disease's pathophysiology and the immune response. There is also a positive correlation between the number of comorbidities patients have and the severity of the clinical picture.
Background: Adolescents are a susceptible population in terms of medication use. They are not only inclined to abuse illegal substances but are also prone to nonmedical medication use, which exposes ...them to a significant risk of various adverse drug reactions (ADR). Objective: This research aims to assess medication use among adolescents in Sarajevo Canton. Methods: This paper features information about the most frequently used medications, reasons for their use, sources of their procurement, ADR and concurrent use with other medications and/or alcohol. To obtain this data, a questionnaire with open- and close-ended questions was created. The survey was conducted online and 444 participants were included. Results: Medications were used by 90.1% of adolescents. The most commonly used medications were non-opioid analgesics, antibiotics, dietary supplements, antihistamines and benzodiazepines. Mild to moderate pain was the most frequent reason for medication use. Participants were at risk of ADR, drug-drug interactions (DDI), and drug-alcohol interactions. Conclusion: It is up to healthcare workers, especially pharmacists, to educate and guide adolescent patients on rational medication use and inform them about potential dangers following the use of these medications.
Patients infected by coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), display various symptoms and severity of the clinical picture. Thus, the ...therapy and pathophysiology of this disease are a dilemma for health professionals and scientists.
This paper aims to evaluate the effectiveness of therapeutic protocols (the use of anticoagulants) in the treatment of COVID-19 patients of various severity of the clinical picture by monitoring coagulation markers (PT, INR, aPTT and D-dimer), as well as the impact of the type and number of comorbidities patients had on these markers.
A total of 200 patients with a mild (n=76), moderate (n=70) or severe (n=54) clinical picture was included. Coagulation markers PT (prothrombin time), INR (international normalized ratio), aPTT (activated partial thromboplastin time), D-dimer were examined on three occasions: twice during hospitalization and once after hospital discharge. Anticoagulants used intrahospital were fraxiparine, rivaroxaban or unfractionated heparin. Posthospital, patients were taking either rivaroxaban or did not use any anticoagulants. For statistical analysis, SPSS 26.0 and Microsoft Excel 2019 were used, with a level of significance of α=0.05. Nonparametric tests (Kruskal-Wallis, Wilcoxon Signed-Rank and Bonferroni) were applied and effect size (ES) was calculated.
Three anticoagulants used intrahospital caused a significant decrease in PT, INR and D-dimer and a significant increase in aPTT, especially in patients with a severe clinical picture, but the ES was the biggest with fraxiparine, then rivaroxaban, and lastly unfractionated heparin. Posthospital, rivaroxaban caused a significant decrease in PT, INR and D-dimer and a significant increase in aPTT, especially in patients with a severe clinical picture. Hypertension was the most common comorbidity in all patients, as well as in patients with a severe clinical picture. There was a statistically significant impact of the number of comorbidities patients had on D-dimer, and none on PT, INR and aPTT, but the highest number of comorbidities was in patients with a severe clinical picture.
The use of anticoagulants, especially fraxiparine intrahospital and rivaroxaban posthospital, is justified in most COVID-19 cases as there is a significant correlation between this disease's pathophysiology and the coagulation process. There is also a positive correlation between the severity of the clinical picture and the number of comorbidities patients have.
Hyperuricemia is an independent risk factor for the development of many diseases.
The aim of this paper is to compare the effects of allopurinol and febuxostat on the values of triglycerides and uric ...acid in hyperuricemic patients.
This was a pharmacological-clinical retrospective-prospective study. The research sample comprised 50 examinees of both genders and different ages who were undergoing allopurinol (100 mg/day) or febuxostat (80 mg/day) therapy. Statistical Product and Service Solutions (SPSS) Software and Microsoft Excel were used for statistical analysis.
Examinees who were treated with allopurinol had a statistically significant decrease in uric acid concentrations (by 126.28 ± 20.36 μmol/l) at the end of the observation compared to the initial values (p = 0.006). Examinees who were treated with febuxostat had a statistically significant decrease in uric acid concentrations (by 252.80 ± 94.17 μmol/l) at the end of the observation compared to the initial values (p = 0.001). The initial value of triglycerides was 1.58 ± 0.64 mmol/l in allopurinol-treated examinees, and 1.60 ± 0.52 mmol/l in febuxostat-treated examinees. After three and six months of allopurinol use, there was a statistically significant increase in triglyceride values (p = 0.046 and p = 0.042, respectively). A statistically significant decrease in triglyceride values (by 0.16 ± 0.10 mmol/l) was noted after three months of febuxostat use (p = 0.012).
The results of this research confirmed the previous findings and pointed out the positive pharmacological effects of allopurinol and febuxostat.
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