Abstract WHO defined in 1976 psychopharmaca as drugs affecting psychological functions, behaviour and self-perception. Psychopharmacology is the study of pharmacological agents that affect mental and ...emotional functions. Creative approach to psychopharmacotherapy reflects a transdisciplinary, integrative and person-centered psychiatry. Psychiatric disorders often occur in cardiac patients and can affect the clinical presentation and morbidity. Cardiovascular (CV) side effects (SE) caused by psychopharmaceutic agents require comprehensive attention. Therapeutic approach can increase placebo and decrease nocebo reactions. The main purpose of this review is to comprehend CV SE of psychotropic drugs (PD). Critical overview of CV SE of PD will be presented in this review. Search was directed but not limited to CV effects of psychopharmacological substances, namely antipsychotics, anxiolytics, hypnotics, sedatives, antidepressants and stimulants. Literature review was performed and data identified by searches of Medline and PubMed for period from 2004 to 2015. Only full articles and abstracts published in English were included. SE of PD are organized according to the following types of CV effects: cardiac and circulatory effects, abnormalities of cardiac repolarisation and arrhythmias and heart muscle disease. There is wide spectrum and various CV effects of PD. Results of this review are based on literature research. The reviewed data came largely from prevalence studies, case reports, and cross-sectional studies. Psychopharmacotherapy of psychiatric disorders is complex and when concomitantly present with CV disease, presentation of drug SEs can significantly contribute to illness course. Further development of creative psychopharmacotherapy is required to deal with CV effects of PD.
Multiple sclerosis (MS) as chronic neurodegenerative disease significantly impact patients' quality of life (QoL). QoL instruments can be generic (EQ-5D, SF-36) and disease-specific like MSQoL-54. ...Use of disease-specific instruments is preferred since it captures broader symptoms related to MS than generic instruments. Mental health is impacted by MS and different psychiatric conditions significantly impact QoL. We have conducted prospective non-interventional study among MS patients. Aim was to measure and compare MS patients QoL by generic and disease-specific instrument at baseline and after one year and to identify potential correlation between these two types of measurements and to assess mental health scores among MS patients in Bosnia and Herzegovina (B&H) and other countries.
Study included 62 patients diagnosed with MS and treated at Neurology clinic in Sarajevo from April 2016 to May 2017. Study was approved by Ethical Committee. QoL has been measured by EQ-5D and MSQoL-54. Measurement has been performed at baseline and after 12 months.
Average utility score measured by EQ-5D at the baseline and end of the study were 0.688 and 0.639 respectively with no significant difference (p=0.850). EQ-5D utility and MSQoL-54 score showed high correlation at baseline; rho=0.873 p=0.0001 for physical health and rho=0.711 p=0.0001 for mental health. At the end of the study no significant correlations have been found (p>0.05). High negative correlation found between EDSS and scores measured by EQ-5D and MSQoL-54; at baseline (rho=-0.744 p=0.0001) and at the end of the study (rho=-0.832 p=0.0001). Similar MS impact and loss of QoL found in B&H and other countries.
Both instruments can be used in measuring QoL but disease-specific are preferred since they capture broader symptoms impacting MS patient QoL. Using QoL instruments could drive clinician decision and patient-centric care as well as reimbursement and policy decision by recording treatment outcomes.
Aim:
The aim of this study is to compare the differences in breast cancer therapy, health-care service practices, and their availability in ten European countries—Albania, Bosnia and Herzegovina, ...Bulgaria, Kosovo, Montenegro, Republic of North Macedonia, Croatia, Romania, Slovenia, and Republic of Serbia.
Methods:
An inquire survey was conducted among oncologists in the participating countries. The questionnaire was of qualitative character and focused on several key areas as screening practices, diagnosing, treatment, and health-care procedures utilization. The results were processed through comparative and percentage analysis.
Results:
All of the observed countries have national registries for breast cancer, but only in five, a mechanism of controlled action of early detection is implemented. Ninety percent of the countries have implemented in the national guidelines the European Society of Medical Oncology recommendations, while National Comprehensive Cancer Network is considered in only 50%. In all countries, digital mammography is a universal diagnostic method. Pathohistological analysis, including HER2 receptor expression and determination of the level of progesterone and estrogen receptors, is routinely performed in all countries prior to therapy. Some differences are observed in terms of FISH/CISH methods, determination of Ki-67 volume, and prognostic molecular assays. Trastuzumab is used as neo-adjuvant therapy in HER2-positive disease in all countries, while in Bosnia and Herzegovina and Croatia, only pertuzumab is used. Psychological support is integrated into the professional guidelines for treatment and monitoring in Bosnia and Herzegovina, Bulgaria, and Serbia.
Conclusions:
The international guidelines should be followed strictly, and some improvements in the health policies should be made in order to decrease the differences and inequalities in the availability of the breast cancer (BC) health services in the Central and Eastern European countries.
Aim To investigate the outpatient utilisation of cardiovasculardrugs in Zagreb, during the 2001-2004 period, and to identify thepossible association between the increase in the utilisation of ...particulardrug groups and decrease in the number of hospital admissions.Methods The number of DDD per thousand inhabitants per day(DDDs/TID) was calculated from data on the number and size ofdispensed drug packages, obtained from the Zagreb Pharmacies.Drug Utilisation 90% (DU90%) method was used on assessmentof drug prescribing quality.Results Total utilisation of the cardiovascular drugs was high inZagreb during the 2001-2004 period (between 402.9 DDDs/TIDand 406.9 DDDs/TID). Agents acting on the renin-angiotensinsystem (C09) (121.3 DDDs/TID) and calcium channel blockers(C08) (87.5 DDDs/TID) accounted for more than 50% of drugsused for the treatment of hypertension in 2004. The greatest utilisationincrease was observed for statins (78.3%). Comparison ofDU90% segment between 2001 and 2004 revealed pentoxifyllineand amiodarone to be absent, whereas cilazapril and ramipril intheir combination with HCTZ, bisoprolol, valsartan and losartanalone or in their combination with HCTZ were added in 2004,DU90% segment still contain doxazosin and propafenone, whichhad no grounds in therapeutic guidelines.Conclusion The outpatient utilisation of cardiovascular drugs washigh during the 2001-2004 period. The utilization pattern was improved.The result was a decrease in the number of hospital admissionsfor main cardiovascular events.
This study addressed the issue of medication compliance in general, compliance with antihypertensive therapy, and the relationship between these two groups. In addition to determining the reasons for ...noncompliance with therapy prescription, the aim of this study was to also establish whether it was considered feasible by the patients to comply with their physician’s instructions and whether the patients believed that the prescribed therapy was beneficial to their health. Hypertensive patients were compared to the total study population according to age groups. The study was designed as a cross-sectional survey with the use of a 33-item selfadministered questionnaire. The study included 635 individuals who were collecting or buying drugs for the treatment of chronic diseases, with special reference to subjects taking antihypertensive agents (n = 361). More than half (n = 361; 56.9%) of the 635 study subjects were on therapy for arterial hypertension and possibly for some other diseases. The great majority of study subjects reported forgetfulness as the main reason for skipping drug doses. Comparison between the total study population and the subjects treated for arterial hypertension according to age groups (compliant, noncompliant and all together) yielded no statistically significant difference. We concluded that there was no difference in medication compliance between the general patient population and patients receiving antihypertensive therapy and there was no correlation between medication compliance and age.
To compare the efficiency of isotonic and hypertonic seawater solutions used for nasal lavage and quality of life of the patients with chronic rhinosinusitis.
A random and controlled clinical study ...was performed. The study included 60 patients with history of chronic rhinosinusitis. At the beginning of the study, each subject was given a Patient Logbook, which needed to be filled out daily during the 15-day study period. There were three visits per each patient during the study.
Results Patient Logbook notes showed significant statistical differences in all symptoms in the group of patients using hypertonic seawater solution. However, while the notes showed significant statistical differences in congestion and rhinorrhea, in the group of patients using isotonic seawater solution, other symptoms showed no major changes during the study period.
Hypertonic seawater solution has been proven to be better than isotonic seawater solution in eliminating the symptoms of nasal congestion, rhinorrhea, cough, headache and waking up during the night.
The aim of the study was to analyse the relationship between meteorological conditions and Alternaria and Cladosporium spore concentrations in the air of Zagreb in August 2002 and August 2003. These ...months were chosen because they represented climatic extremes. A 7-day VPPS 2000 Hirst volumetric pollen and spore trap was used for spore sampling. Spores marked as 'others' (ascospores, basidiospores, Epicoccum, Ustilago, Pithomyces, Helminthosporium, Stemphylium, Torula, Botrytis, Didymella) were found to have predominated in the month of August in both 2002 and 2003 with 91.1% and 70.5%, respectively. Because of favourable weather conditions (higher air temperature and minimal precipitation) in August 2003, the concentrations of Alternaria and Cladosporium spores were 3.4-fold those recorded in the same month in 2002. Also, the peak daily concentrations of these spores were measured on days without precipitation and with higher air temperature. Intradiuranal variation in the Alternaria and Cladosporium spore concentrations was identical in 2002 and 2003 (lowest in 2-hour interval between 06:00-08:00, and highest between 10:00-12:00). In spite of the three-fold increase in the Cladosporium spore concentration in August 2003, the borderline concentration of 3,000 spores/m3 air that is associated with the occurrence of allergic reactions was only exceeded on a single day. Air concentration of Alternaria spores exceeded borderline value of 100 spores/m3 air on as many as 17 days, suggesting that at that time of the year the risk of allergic reaction was only present in individuals allergic to this spore type.
A comprehensive insight into drug utilization as an economic and primarily a public health issue can only be acquired in the context of overall health state of the respective population. The ...objectives of the study were: 1) to determine the real outpatient utilization of psychopharmaceuticals in Zagreb, 2) to determine the psychopharmaceutical prescribing quality during the study period; and 3) to propose appropriate interventions in Zagreb on the basis of the results obtained.
Data on drug utilization were obtained from all Zagreb pharmacies. The number of defined daily doses (DDD) and number of DDD per 1000 inhabitants per day (DDD/1000/day) were calculated from the number of particular drug packages. The Drug Utilization 90% (DU90%) method was used as a criterion of prescribing quality.
Outpatient utilization of psychopharmaceuticals showed a declining pattern from 115.40 DDD/1000/day in 2001 to 93.15 DDD/1000/day in 2006. Anxiolytics accounted for the majority of this drug group utilization in the City of Zagreb, although the anxiolytic/antidepressant ratio decreased from 7.19 in 2001 to 3.86 in 2006. The utilization of selective serotonin reuptake inhibitors showed a 2.5-fold increase and accounted for 90% of overall antidepressant utilization. A 2.5-fold decrease was recorded in the utilization of antipsychotics, while the atypical/typical antipsychotic ratio changed from 1:2 in 2001 to 1.1:1 in 2006.
Despite some improvement observed in the prescribing quality, the predominance of benzodiazepines in the utilization of psychopharmaceuticals points to the need of additional rationalization in the field.
Pollen allergy is characterized by seasonal allergic manifestations affecting patients during the plant pollen season. The aim of this study was to analyze the Betulaceae pollen pattern in Zagreb ...(2002-2005) and to determine the incidence of sensitization to these pollen types in patients with seasonal respiratory allergy. Twenty-four-hour pollen counts were carried out using volumetric procedure. Skin prick test were performed on a total of 864 patients aged 18-80< in Zagreb between 2 January-31 December 2004. Pollen of the representatives of the family Betulaceae accounted for a significant proportion of total pollen (34% on an average), predominated by Betula pollen and considerably lower proportion of Alnus sp. and Corylus sp. pollen. Alder and hazel pollen first occurred in the air in February throughout the study period. The highest airborne pollen concentration of these taxa was recorded in February and March. The birch pollen season generally peaked in April. Only 2.67% of patients showed birch pollen monosensitization. The proportion of patients with polysensitization to Betulaceae pollen was considerably greater (12.88%), whereas polysensitization to Betulaceae, Poaceae and Ambrosia pollen was recorded in the highest proportion of patients (26.23%). According to age, the highest and lowest rate of allergy was recorded in the 31-50 and >51 age groups, respectively (46.22% vs 23.12%). Female predominance was observed across all age groups. The patients with monosensitization to birch pollen had the most severe symptoms in April. In the patients with poylsensitization to alder, hazel and birch pollen who developed cross-reaction, initial symptoms occurred as early as February, with abrupt exacerbation in March and April. The most severe condition was observed in the patients allergic to birch, hazel, alder, grass and ragweed pollen, with symptoms present throughout the year and exacerbation in spring and late summer months.
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