Association between concomitant psychiatric drug use, and patients' beliefs about and persistence with chronic cardiovascular medication.

OBJECTIVE: Psychiatric disorders are associated with an increased risk of cardiovascular diseases and may result in additional risk of non-adherence. No data on the influence of concomitant psychiatric drug use on patients' beliefs and persistence related to cardiovascular medication are available. The objective of this study was to assess to what extent the use of concomitant psychiatric drugs is associated with patients' beliefs about and persistence with chronic cardiovascular medication. METHODS: An observational study in patients using cardiovascular medication was conducted. A mailed questionnaire containing socio-demographical questions and a measure of beliefs about medication (Beliefs about Medicines Questionnaire - specific) was sent to patients selected from fifteen participating pharmacies. Persistence was evaluated based on pharmacy records. RESULTS: Of the 1547 included patients, 551 responded to key questions in the questionnaire and were included for beliefs about medication analysis. In concomitant users of psychiatric drugs significantly higher necessity (17.0 vs. 16.0) and higher concerns (14.3 vs. 13.3), as well as higher proportion of ambivalent (34.5% vs. 25.6%) and lower proportion of indifferent patients (24.1% vs. 33.0%) were found compared with non-users (p < 0.05). 65.2% (n = 1009) of patients were persistent on all their cardiovascular drugs. There was no significant association between concomitant use of psychiatric drugs and non-persistence (OR = 1.2; 95% CI 0.9-1.5). CONCLUSION: Concomitant use of psychiatric drugs was found to be associated with increased beliefs about the necessity of and concerns about cardiovascular medication. Clinicians caring for cardiovascular patients should give additional attention to identifying patients' beliefs about medication among those concomitantly using psychiatric drugs.

[Drug compliance - a pitfall of therapy of rheumatoid arthritis?]. / Léková compliance - úskalí terapie revmatoidní artritidy?

Drug compliance is one of the conditions for effective treatment of various chronic diseases, including rheumatoid arthritis as well. This disease is characterized by a variable course, remissions and relapses, and also by specific treatment. The character of this illness and used medications may represent a risk in terms of non-compliance. As in other chronic diseases, scientists engage in identifying of the compliance rate for many years and the aim of this work is to summarize the state of knowledge in the field of drug compliance in rheumatoid arthritis.

Important drug interactions in patients with rheumatic disorders: interactions of glucocorticoids, immunosuppressants and antimalarial drugs.

Despite the fact that biological treatments are very promising, classical immunosuppressants, antimalarial drugs and glucocorticosteroids are still very important and widely used in practice. Although drug interactions can have fatal consequences, few studies have reviewed drug interactions of these classical drugs used in rheumatology, and very few guidelines are available on this subject. Therefore, this report summarizes important interactions of immunosuppressants, antimalarial drugs and glucocorticosteroids with drugs commonly used in internal medicine. In the present study, more than 300 interactions were retrieved from the Micromedex ® database. The selection was reduced to the interactions rated as moderate, major or contraindicated. The selected interactions were further checked against PubMed ®, MEDLINE ®, InfoPharm Compendium of Drug Interactions and Summaries of Product Characteristics. For each interaction, its nature, mechanism, onset and clinical severity were indicated, documentation quality was rated and recommendations for clinical practice were formulated. Twenty significant interactions that we rated as moderate, severe and very severe were identified. Interacting drugs were warfarin, fluoroquinolones, azole antifungals, co-trimoxazole, proton pump inhibitors, amiodarone, cholestyramine, activated carbon, allopurinol, angiotensin-converting enzyme inhibitors, statins, digoxin, iron, aluminium and magnesium salts, and hepatotoxic and nephrotoxic agents.

[Effect of early surgery in essential infantile esotropia on the quality of binocular vision]. / Efekt casné operace esenciální infantilní ezotropie na kvalitu binokulárního videní.

In a retrospective study of 397 children operated in the course of 10 years (1985-1995) on account of essential infantile esotropia the authors evaluate the effect of early surgery implemented before the age of two years on the quality of binocular vision as compared with a later operation. The group of children was divided into three sub-groups. Group A comprised 75 children with the operation during the first six months of life (mean 3.8 months), sub-group B 194 children with the operation at the age of 6-24 months and in group C 128 children operated at the age of 2-6 years (mean 3.56 years). In group A binocular vision was recorded in 80% children (15% superposition, 60% fusion, 5% stereopsy). In groups B binocular vision was recorded in 76% children (18% superposition, 50% fusion, 8% stereopsy). In group C simple binocular vision in the form of superposition was present in 24% and fusion only in 21% children. The results of binocular vision after surgery of essential infantile esotropia are in favour of early surgery, preferably by the age of 6 months, not later than at the age of 2 years. An essential part of comprehensive treatment is active and positive pleoptic and orthoptic care incl. supplementary surgical correction of residual horizontal or vertical deviations. Early surgery of an adequate extent with a safeguarded parallel position of the eyes implies in the long run more frequent achievement of a higher quality of binocular vision incl. stereopsy.

[Strabismus surgery in adults]. / Príspevek k problematice chirurgie strabismu v dospelém veku.

The authors operated 24 adult patients with strabismus (20 with concomitant, 4 with paralytic) aged 18 to 66 years, mean age 30.5 years. They focused attention on the possibility to adjust the deviation, to achieve binocular vision and postoperative diplopia. Based on their own results and those of other authors they found that surgery of strabismus in adults is not only a cosmetic operation. The possibilities to adjust the deviation are very favourable, and this applies also to achievement of binocular vision. The latter was attained in 66.7% of the patients. Postoperative diplopia in patients, incl. those with abnormal retinal correspondence, is only a rare complication. The authors recommend that adult patients with strabismus demanding operation should not be refused.

[Vertical strabismus in plagiocephaly]. / Vertikální silhání u plagiocefalie.

Plagiocephaly is cranial synostosis caused by premature closure of one half of the coronal suture. It is manifested by asymmetry of the face of a varying degree with vertical strabismus on the affected side and tilting of the head to the sound side. The vertical deviation imitates ocular torticollis, there are, however, no signs of paresis nor a positive Bielschowski test. Treatment involves early opening of the coronal synostosis or later at least treatment of vertical strabismus. The authors operated successfully a 14-year-old girl with medium grade plagiocephaly. They describe the preoperative and postoperative state. The authors recommend, in case of asymmetry of the face and vertical strabismus, to consider the possible diagnosis of this anomaly.

[Aarskog's syndrome]. / Aarskoguv syndrom.

The authors described the rare Aarskog syndrome in a 6-year-old boy, associated with left-sided Brown's syndrome. Another 4-year-old boy came from an affected family where the brother suffered also from Aarskog's syndrome and in the mother some microsymptoms were detected. The authors recommend that patients who on examination of a refraction defect or strabism display uncommon features in the face or other parts of the body should be always subjected to a general examination incl. genetic examination.

[The effect of general anesthesia on the position of the eye]. / Vliv celkové anestézie na postavení bulbu.

In 100 children operated on account of strabismus the authors tried to assess whether changes in the position of the eyeballs during general anaesthesia with the stretch test can contribute towards the decision on the magnitude of the surgical operation. At the same time they compared changes in the position of the eyeballs during intubation anaesthesia by means of nitrous oxide and halothane with anaesthesia with ketamine, administered by the i.m. or i.v. route. They found that in 92% of the examined subjects the position of the eyeballs changed during general anaesthesia, most frequently the convergent deviation diminished. During ketamine anaesthesia the changes were more marked. The stretch test was in 73% of the patients normal, in 93% it was equal in both eyes. Based on the results, the authors conclude that neither the evaluation of changes of the eyeballs during general anaesthesia nor the stretch test can make the dosage of the surgical operation in concomitant strabismus more accurate.

The decreased in vitro chemotactic activity of polymorphonuclear leukocytes of newborns and infants.

Using Boyden's technique, a statistically significant decrease in the chemotactic activity of polymorphonuclear (PMN) leukocytes was found during the early postnatal period, i.e. in the cord blood and in blood of newborns within the first 10-15 d of life after stimulation of cells with both zymosan-activated adult serum (ZAS) and with an abacterial filtrate of Escherichia coli broth culture (ECF). After this period, the responsiveness of leukocytes to both chemotactic agents increased and remained at the same level during the whole observation period, i.e. up to the age of 6 months. Nevertheless even then it did not reach fully the responsiveness of the leukocytes of mothers and pregnant women. Zymosan-activated serum was shown to be a more potent chemotactic stimulus to leukocytes of infants as compared to the E. coli filtrate.

The bactericidal activity of sera of healthy neonates and of newborns with hyperbilirubinaemia to Escherichia coli.

Cord and newborn sera were found to possess a significantly decreased in vitro bactericidal activity to Escherichia coli as compared to sera of adult individuals. Hyperbilirubinaemia in neonates suffering from both Rh and ABO incompatibility results in a further significant impairment of the bactericidal activity of their sera in comparison with healthy newborn infants. Exchange transfusion improved considerably the serum bactericidal activity. The possible mechanism of toxic action of unconjugated bilirubin on cells of the immune system is discussed.

The bactericidal activity of sera of healthy neonates and newborns with hyperbilirubinaemia to E. coli.

Cord and newborn sera were found to possess a significantly decreased in vitro bactericidal activity to E. coli as compared to sera of adults. Hyperbilirubinaemia in neonataes suffering from both Rh and ABO incompatibility results in a further significant impairment of bactericidal activity of their sera in comparison to healthy newborn infants. Exchange transfusion considerably improved this serum antibacterial activity. The possible mechanism of toxic action of unconjugated bilirubin on the cells of the immune system is discussed.

Skin-window study on the migration of leukocytes of newborns and infants.

Migration of leukocytes of newborns and of infants up to the age of 6 months was studied using the in vivo skin-window technique according to Rebuck. Using the non-specific stimulation (abrasion of the skin only) a slight age-dependent physiological increase of migration of cells was observed within the observation period; after a strong local irritation with diphtheria-tetanus-pertussis vaccine (Alditepera) there was a vigorous migratory response of cells in the skin lesion. Both quantitatively and qualitatively, the migration pattern (i.e. shift from PMN leukocyte to mononuclear cells in the exudate within a 1 d period after abrasion) was not influenced by immunization of infants with Alditepera, suggesting thus the nonspecific nature of this cellular response. The "normal" values of the chemotactic response of leukocytes of newborns and infants are given as a basis for evaluation of defects of this functional activity of leukocytes.