Clinical Practice and Knowledge of Primary Health Care Physicians Toward Adverse Drug Reactions: Can We Recognize Adverse Drug Reactions and What Should We do to Maximize Patient Safety and to Improve Self-confidence of Doctors When Prescribing Medicines.

Aim: A suspicion about adverse drug reactions is sufficient for adverse drug reactions reporting. However, assessing the causal drug-disturbance(s) relation is the primary issue in physicians’ clinical practice, due to their principal responsibility among health care workers for patients' health, including patients' safety, while the far more studied adverse drug reactions reporting is the secondary one. Thus, adverse drug reactions, and the need for introducing activities for physicians toward adverse drug reactions. Study Design: It was a prospective, multicentric, questionnaire based, self-administered, and anonymous study, conducted during two months among physicians employed in five public (state) primary health care centers in the Republic of Serbia settled in Sombor, Mladenovac, Pozarevac, Cacak and Pirot. Results: It was questionnaired 238 out of 461 employed physicians. Doctors declared to diagnose adverse drug reactions (n = 213) but rarely report them (n = 49). They usually withdrew the drug suspected for adverse drug reactions (n = 212) and seldom introduce it to the same patient in the future (n = 5). They claimed to have difficulties in both the adverse drug reactions diagnosing (n = 146) and treating (n = 113). Almost all considered the improvement of the knowledge about adverse drug reactions beneficial for their clinical practice, adverse drug reactions diagnosing and treating (P < .001 for all the statements). With a very few exceptions, answers were not influenced by physicians’ ages and medical education. Conclusion: Physicians recognized the dimension of their problems in the field of adverse drug reactions, especially diagnosing, which is crucial for patient health. Better education and training are the most important strategies for improving existing weaknesses, which have to be translated into routine clinical practice.

Protective effects of glucose-6-phosphate dehydrogenase on neurotoxicity of aluminium applied into the CA1 sector of rat hippocampus.

Background & objectives: Aluminum (Al) toxicity is closely linked to the pathogenesis of Alzheimer’s disease (AD). This experimental study was aimed to investigate the active avoidance behaviour of rats after intrahippocampal injection of Al, and biochemical and immunohistochemical changes in three bilateral brain structures namely, forebrain cortex (FBCx), hippocampus and basal forebrain (BF). Methods: Seven days after intra-hippocampal (CA1 sector) injection of AlCl3 into adult male Wistar rats they were subjected to two-way active avoidance (AA) tests over five consecutive days. Control rats were treated with 0.9% w/v saline. The animals were decapitated on the day 12 post-injection. The activities of acetylcholinesterase (AChE) and glucose-6-phosphate dehydrogenase (G6PDH) were measured in the FBCx, hippocampus and BF. Immunohistochemical staining was performed for transferrin receptors, amyloid β and tau protein. Results: The activities of both AChE and G6PDH were found to be decreased bilaterally in the FBCx, hippocampus and basal forebrain compared to those of control rats. The number of correct AA responses was reduced by AlCl3 treatment. G6PDH administered prior to AlCl3 resulted in a reversal of the effects of AlCl3 on both biochemical and behavioural parameters. Strong immunohistochemical staining of transferrin receptors was found bilaterally in the FBCx and the hippocampus in all three study groups. In addition, very strong amyloid β staining was detected bilaterally in all structures in AlCl3-treated rats but was moderate in G6PDH/AlCl3-treated rats. Strong tau staining was noted bilaterally in AlCl3-treated rats. In contrast, tau staining was only moderate in G6PDH/AlCl3-treated rats. Interpretation & conclusions: Our findings indicated that the G6PDH alleviated the signs of behavioural and biochemical effects of AlCl3-treatment suggesting its involvement in the pathogenesis of Al neurotoxicity and its potential therapeutic benefit. The present model could serve as a useful tool in AD investigations.

Availability of the Drugs for Malignant Diseases Treatment: Comparison between Developing and Developed Countries.

Aim: The financial burden of malignant diseases treatment has increased remarkably over the years. This is due to, among many reasons, the costs of drugs, especially those of the new classes. Thus, it is of interest to assess the availability and differential cost of anti-cancer drugs in developing countries compared to developed countries. Study Design: The study was designed to determine the anti-cancer drugs availability in the world, in the United States of America (USA), the United Kingdom (UK) and the Republic of Serbia (RS), with the aim to get insights into the similarities and differences between developed and developing countries toward anti-cancer drugs availability, as well as the prices of these drugs. This analysis was based on three drug data bases for anti-cancer drugs that were available during 2011 and 2012 year in the world, USA, UK, and RS. Results: About 37% of anti-cancer drugs that were present in the world market in 2011 year were also present in the RS (the drugs that were reimbursed by the state health insurance), compared to 74.8 and 67.4% that were available in the USA and the UK, respectively. Furthermore, out of all drugs registered in 2012 in the UK, 62.8% were present in the RS and almost all pharmacological groups were represented with some drugs, including very expensive ones like the biological agents. Most of the drugs in the RS were cheaper, regardless of whether they belonged to nonproprietary or brand-name drugs. These findings could be the result of the very low national gross domestic product in the RS and thus, the small funds earmarked for the health care. Conclusion: The Republic of Serbia, which belongs to developing countries, face some difficulties in taking care of patients with malignant diseases where the prominent place have drugs for malignant diseases treatment, especially the newer classes, which are usually more expensive and generally do not provide the first-line treatment.