Assessment of Medication Use Among Adolescents in Sarajevo Canton.

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.

Evaluation of the Effectiveness of Coronavirus Disease (COVID-19) Therapeutic Protocols Using Inflammatory Markers.

Background: The pathophysiology and therapy of coronavirus disease-19 (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. Objective: 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. Methods: 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. Results: 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. Conclusion: 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.

The Use of Coagulation Markers to Evaluate the Effectiveness of Coronavirus Disease (COVID-19) Therapeutic Protocols.

Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusion: 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.

In vitro pH dependent passive transport of ketoprofen and metformin.

The kinetics of passive transport of ketoprofen and metformin, as model substances for high and low permeability, respectively, across the artificial membrane under the influence of the pH of donor solution was investigated. There was an upward trend in the apparent permeation coefficient (P app) of ketoprofen with the decrease in pH to a value close to pKa. At the pH value below pKa the permeation coefficient had lower value, due to the higher retention of ketoprofen in the artificial membrane. Metformin is a low permeable compound, and the highest permeation values were recorded at pH 7.4. Two dissociation constants determine that metformin at physiological pH exists as a hydrophilic cationic molecule, i.e. predominantly in ionized form. At pH values below 2.8, metformin mainly exists in diprotonated form, and it was, thus, very poorly permeable. The highest retention, i.e. affinity of both ketoprofen and metformin to the membrane, was at the lowest pH values, which is explained by different mechanisms. At higher pH values of donor compartment the substances showed significantly less affinity to the membrane. The obtained values of apparent permeation coefficients at studied pH values showed good correlation with the obtained experimental values by other in vitro methods.

Comparison of the Effects of Allopurinol and Febuxostat on the Values of Triglycerides in Hyperuricemic Patients.

INTRODUCTION: Hyperuricemia is an independent risk factor for the development of many diseases. AIM: 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. METHODS: 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. RESULTS: 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). CONCLUSION: The results of this research confirmed the previous findings and pointed out the positive pharmacological effects of allopurinol and febuxostat.

Bosnian Franciscans and the Monasteries in Kresevo and Fojnica as Source of Scientific Bibliography.

All of these centuries-old records contain enormous treasures, and the modern medicine is increasingly searching for the sources of natural remedies. The Franciscans should be credited for carefully collecting the methods folk treatment and passed them on to future generations. In the words of Br. Marko Karamatic: "The fact that the Friars were engaged in healthcare, that they became the first graduate doctors in Bosnia and Herzegovina, that they wrote" herbal manuals " and other medical records, is the result of historical opportunities in these areas, and this activity became one of the most important tasks for the Franciscans. They performed their duties regardless of the circumstances.

Importance of inflammatory markers and IL-6 for diagnosis and follow up of patients with type 2 diabetes mellitus.

Aim To analyse the long-term impact of altered metabolism on the level of mediators of inflammatory response in female patients with type 2 diabetes. Methods This study included 97 female patients with type 2 diabetes and 107 female, nondiabetic control subjects, who were recruited at the Clinical Centre University of Sarajevo and the General Hospital Tesanj. The effects of glycaemic control on markers of inflammatory response represented by C-reactive protein (CRP), fibrinogen, leukocytes, sedimentation rate, and cytokine IL-6 were tested. All subjects were free of evidence of infections, surgery, thyroid disease, polycystic ovarian syndrome, active liver and kidney damage. All biochemical analyses were performed according to standard International Federation of Clinical Chemistry (IFCC) protocols. Results A significant increase of fibrinogen (p<0.001), CRP (p=0.001), interleukin-6 (p=0.013), leukocytes (p<0.001) and sedimentation rate (p=0.008) in diabetic female population compared to control subjects was found. A significant correlation between CRP and haemoglobin A1c (p=0.035), interleukin-6 and glucose (p=0.032), IL-6 and body mass index (p=0.007) was found. Conclusion Our data suggest that inflammation plays an important role in the pathogenesis of diabetes in female diabetic population. A more detailed study on a far larger number of subjects is needed if they were to be used effectively as biomarkers in the primary prevention of type 2 diabetes in this population.

Effect of Cigarette Smoking on Haematological Parameters in Healthy Population.

OBJECTIVE: Tobacco cigarette smoking is one of the major leading causes of death throughout the world. Smoking has both acute and chronic effect on haematological parameters. The aim of the present study was to assess the extent of adverse effects of cigarette smoking on biochemical characteristics in healthy smokers. SUBJECTS AND METHOD: One hundred and fifty six subjects participated in this study, 56 smokers and 100 non-smokers. The smokers were regularly consuming 10-20 cigarettes per day for at least 3 years. Complete blood cell count was analyzed by CELL-DYN 3700 fully automatic haematological analyzer. RESULTS: The smokers had significantly higher levels of white blood cell (p<0,001), hemoglobin (p=0,042), mean corpuscular volume (p=0,001) and mean corpuscular hemoglobin concentration (p<0,001). All other measured parameters did not differ significantly. Cigarette smoking caused a significant increase (p<0,001) in red blood cells, white blood cells (p=0,040), hemoglobin (p<0,001), hematocrit (p=0,047) and mean corpuscular hemoglobin (p<0,001) in males in comparison to female smokers. CONCLUSION: In conclusion, our study showed that continuous cigarette smoking has severe adverse effects on haematological parameters (e.g., hemoglobin, white blood cells count, mean corpuscular volume, mean corpuscular hemoglobin concentration, red blood cells count, hematocrit) and these alterations might be associated with a greater risk for developing atherosclerosis, polycythemia vera, chronic obstructive pulmonary disease and/or cardiovascular diseases.

Pharmacoeconomic education for pharmacy students in bosnia and herzegovina.

Pharmacoeconomic (PE) is becoming more important in pharmaceutical reimbursement decision and drug evaluation. To ensure its appropriate application, conduction and assessment of studies it is important to have well trained and educated professionals. Pharmaceutical faculties all over the world have established PE in under- and post-graduate curricula's. In this pilot research we examine situation in B&H. In Bosnia-Herzegovina, education in this field is poor and only one faculty for pharmacy has introduced PE as subject in its program. Objective of this study is to explore understanding of PE and its concept and analysis and to evaluated adopted knowledge among graduate (fifth year/tenth semester) pharmacy students who have listened subject "pharmacoeconomics" in previous semester. A self-administered questionnaire was developed consisted of 12 questions and survey was conducted among students. Results are analyzed in MS Excel and we used descriptive statistics. Even graduate students have lessons from PE they understand its scope and definition, but do not feel capable for conducting PE studies, but show interest in additional education and getting competencies in this field finding it applicable in their future professional engagements.

In vitro modeling of the influence of FVIII activity and heparin induced prolongation of APTT.

Anticoagulant therapy is most commonly assessed by measuring the effect of the drug on global clotting assay, such as APTT. It is known that response of the APTT to heparin may be decreased in patients with high levels of factor VIII. In this work, we have attempted to determine in vitro conditions of experiment for obtaining relationship between different concentrations of heparin and values of APTT, and to investigate influence of factor VIII on correlation between concentrations of heparin and APTT. Measurement of the effect of heparin, added in vitro in normal coagulation control plasma (NCCP) showed that heparin in concentrations from 0.1 to 1.0 IU/mL prolonged APTT from 0.73 s to 99.26 s. Linearity of the relation of natural logarithm of APTT and concentration of added heparin in plasma for concentrations from 0.5 to 1.0 IU/mL (r = 0.995), and other characteristics of the validated method (RSD = 1.17%), made possible investigation of the influence of factor VIII addition in the solution. The addition of the Factor VIII concentrate, markedly influenced these APTT results. Increased factor VIII activity shortened the APTT, having more pronounced effect in the presence of the large amounts of heparin. Increased factor VIII was associated with downward shift in the concentration -- logAPTT response curve (y = 24644 x + 30.17 vs. y = 10.864 x + 27.256). This finding suggests the possibility for modeling of ex vivo establishment of correlation between plasma activity of FVIII and needed doses of heparin for appropriate management of heparin therapy.

[Pharmaco-economic analysis of NSAID usage in Gastroenterology Department of Tuzla Clinic]. / Farmakoekonomska analiza primjene nesteroidnih antireumatika na odjelu za gastroenterologiju Klinickog centra u Tuzli.

Pharmacoeconomics is young rapidly developing science that uses economic, clinical and epidemiologic methods. It studies adequate use of therapeutics giving guidelines towards rational utilization of the resources in health care. Pharmacoeconomics indentifies estimates and compares costs and clinical outcomes of different strategies giving the best solution: optimal cost/benefit ratio. These studies can be used to estimate existing programs and plan the new ones. The aim of this paper was to carry out pharmacoeconomic study on the non-steroid anti-inflamatory drugs (NSAID) use in canton Tuzla, to compare costs of medication with highly selective cyclooxygenase 2 (COX-2) inhibitors and nonselective NSAIDs and to calculate medication costs of the bleeding from upper parts of gastrointestinal tract. Study covers period from January to April 2004. Meta-analysis of selected clinical studies on safe and efficiency of NSAIDs was simultaneously conducted. Our results show that hospital treatment costs of the high-risk patients group significantly exceeds their potential medication costs with highly selective COX-2 inhibitors. Simultaneous use of non-selective NSAIDs with antacids has justification only in the low-risk group with mild gastrointestinal disturbances.

[Classification of drugs using the ATC system (Anatomic, Therapeutic, Chemical Classification) and the latest changes]. / Klasificiranje lijekova po ATC sistemu i najnovije izmjene.

World Health Organization (WHO) established ATC system of drug classification. All drugs are grouped in five levels (anatomical main group, therapeutic subgroup, pharmacological subgroup, chemical subgroup and chemical substance). Alterations in ATC classification are made only by experts in WHO centre in Oslo, Norway. Changes are made in assigned new international generic names (INN), in ATC levels likes in changes of Defined Daily Doses (DDD) once a year. Changes are made following current scientific articles and international pharmacopeas, as well as the guideline.