Pattern and Factors Associated with Medicine Usage in Middle-aged Adults: a Population Based Cross-Sectional Study.

AIM: The present study analyzes the adherence phenomenon and possible correlations between active individuals and their educational status on the prevalence of medicine use in the population of a young and developing country such as Kosova. MATERIALS AND METHODS: This is an observational, cross-sectional, research study including a total number of 162 subjects aged 40-65 years residents of Kosova. Gender distribution was: 32.7% males and 67.3% females. Assessments of medication adherence and compliance, the level of physical activity (PA), and education were made by reliable and validated questionnaires. RESULTS: Analyzing medication compliance, of 162 interviewed subjects, 29.6% (32.1% males and 28.4% females) and 27.2% (22.6% males and 29.3% females) responded that they sometimes forget to take their medicines, or that they stop taking them for reasons other than forgetting. Meanwhile, 40.1% declared that they usually stopped the medicine only because they felt better, 38.9% claimed to have stopped the medicine because they believed they felt worse, whereas more than half of our study responders declared having problem with buying the medicine. Regarding PA, significantly better results (p<0.05) in medicine use were shown by subjects with higher PA level in our population. Additionally, higher levels of education correlated with lower amount of medication consumption. CONCLUSION: The results of this study suggest for certain lack of adherence, difficulties and information related to medicine use. Consequently this raises the need for public education on the medication adherence and life style factors such as PA for the success of the treatment.

Prevalence of Asymptomatic Arterial Hypertension and Its Correlation with Inflammatory Activity in Early Rheumatoid Arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease that worsens during the course of the disease and can cause disability. Early RA refers to the onset of symptoms within the past 3 months. In RA, increased levels of mediators of inflammation may cause arterial stiffness consequently leading to arterial hypertension. AIM: The aim of this cross-sectional study was to assess the prevalence of asymptomatic arterial hypertension in early RA patients as well as the correlation with parameters of inflammation. METHODS: One hundred and seventy-nine early RA patients diagnosed in agreement with ACR/EULAR (American College of Rheumatology/ European League against Rheumatism) 2010 criteria were consecutively included in the study. CRP (C-reactive protein) and anti CCP (Antibodies to cyclic citrullinated peptides) serum levels, WBC (white blood cells) count and ESR (Erythrocyte sedimentation rate), likewise DAS-28 (28-joint disease activity score) were determined in all included patients. Parametric tests were used to compare the characteristics of the groups and to test the correlation of the variables. RESULTS: Statistical data analysis revealed that a majority of the patients were females (n = 141; 78.7%); the mean age at RA onset was 49.13 ± 12.13 years. Overall prevalence of hypertension was 44.13 % (n = 79). In comparison with the normotensive patients, the hypertensive patients were older and had significantly higher values of CRP, ESR, anti-CCP and DAS-28. A highly significant positive correlation between all the study parameters and systolic and diastolic blood pressure was observed. CONCLUSION: Presence of significantly higher values of CRP, ESR, anti-CCP and DAS-28 in hypertensive patients indicate that inflammation is associated with an increased risk of hypertension. In this context, early screening for arterial hypertension and adequate therapeutic measures should be considered in early RA patients.

Treatment of rheumatoid arthritis with biologic DMARDS (Rituximab and Etanercept).

GOAL: To determine efficacy and safety of treatment with Rituximab and Etanercept plus Methotrexate in patients with active Rheumatoid Arthritis (RA), who had an inadequate response to nonbiologic DMARDS therapies and to explore the pharmacogenetics and pharmacodynamics of Rituximab and Etanercept in our populations. Study was done at Rheumatology Clinic of University Clinical Centre in Prishtina during 2009-2011 years. METHODS: We evaluated primary efficacy and safety at 24 weeks in patients enrolled in the study of long-term efficacy of Rituximab and Etanercept. Patients with active Rheumatoid Arthritis and an inadequate response to 1 or more non biologic DMARDS were randomized to receive intravenous Rituximab (1 course consisting of 2 infusions of 1.000 mg each -one group, and Etanercept 25 mg twice weekly -second group, but both groups with background MTX. The primary efficacy end point was a response on the ACR 20%, improvement criteria at 24 weeks, Secondary end points were responses on the ACR 50 and ACR 70, improvement criteria, the DAS 28, and EULAR response criteria at 24 weeks. RESULTS: During our investigations we treated 20 patients, 15 females and 5 males, in the treated group with RTX and 13 patients 8 females and 5 males in the treated group with ETN. Patients of group 1 and group 2 were of ages 37-69 years old and 19-69 years old (average 47-44) Most of the patients belong in 2nd and 3rd functional stage according to Steinbrocker. All ACR response parameters were significantly improved in RTX treated patients who also had clinically meaningful improvement in fatigue, disability and quality of life. Patients showed a trend less progression in radiographic end points. Most adverse events occurred with the first RTX infusion and were mild to moderate severity. CONCLUSION: At 24 weeks, a single course of RTX and ETN provided significant and clinically meaningful improvements in disease activity in patients with active, longstanding RA who had an inadequate response to 1 or more nonbiologic DMARDS.

Incidence, prevalence and clinical manifestations of systemic sclerosis in dukagjini plain.

INTRODUCTION: Progressive systemic sclerosis (PSS) is an inflammatory disease of connective tissue, with onset as edema that continues with fibrosis, induration, and skin atrophy, followed by attacks on the joints, internal organs, and secondary proliferation of connective tissue. PURPOSE: To research in which residence locations and among which group age is the most frequent incidence, prevalence and clinical manifestations of systemic sclerosis in Dukagjini Plain which is inhabited by 698450 resident citizens. MATERIAL AND METHODS: 51 patients with progressive systemic sclerosis were studied, out them 44 were females (86.3%) and 7 males (13.7%) respectively, during the period from 2005 to 2010. Their illness was active from 18 to 60 months in accordance with EUSTAR criteria. They are of different age, median age is 44.2 ±10.1. Their diagnose is determined based on revised ACR criteria. Prevalence of patients with PSS was 14.61/100.000, while the incidence was 2.8/100.000, whereas CI (Confidence interval) or limit of accuracy was 95%. RESULTS: Largest number of patients per 100.000 citizens has Istog municipality which has the largest number of patients with PSS. It is followed by Mamusha and Rahovec municipalities. The largest examined group age is 35-44 year old, 41.2% respectively. CONCLUSION: Additional studies are necessary to carry out in order to find the reasons of asymmetrical distribution of patients with systemic sclerosis in the municipalities of Dukagjini Plain.

Cardiac and pulmonary alterations in patients with rheumatoid arthritis.

INTRODUCTION: cardiac and pulmonary clinical manifestations frequently absent in patients with rheumatoid arthritis (RA). The aim of this study was to evaluate cardiac and pulmonary alterations in RA among patients without clinical manifestations. MATERIALS AND METHODS: The study was conducted in 169 patients (127 female and 42 male, with mean age 51.6, SD +/- 12.7 years, P > 0.05) with RA diagnosed on the basis of ACR criteria. All patients underwent a transthoracal echocardiography (TTE), a chest X ray, an electrocardiogram and laboratory tests. Patients with clinical manifestations of cardiac and pulmonary disease were excluded from the study. RESULTS: Pericarditis was evidenced in 16.6%, mitral regurgitation in 21.9%, aortal regurgitation in 26%, and pulmonary diffuse fibrosis in 16.6% of cases The authors found that 158 (93.5%) of patients were CRP positive. CONCLUSION: Our study demonstrated that cardiac and pulmonary alterations are frequently present and prevalence of elevated CRP levels and positive serologic tests was high in asymptomatic patients with RA among patients without clinical manifestations.

Acute myocardial infarction in a patient with severe unrecognized mitral stenosis.

BACKGROUND: Acute myocardial infarction is a rare complication of mitral stenosis. Acute myocardial infarction in the setting of severe unrecognized mitral stenosis has not been described. CASE REPORT: A 47-year-old-woman was admitted to our department for chest pain typical of myocardial infarction. Electrocardiogram showed ST segment elevation in leads II, III, and aVF and atrial fibrillation. Creatine kinase level was elevated to 268 U/L. The diagnosis of acute myocardial infarction of the inferior wall was established. The patient reported breathlessness after physical exertion over the last 2 years; however, she had not sought medical help and was unaware of her heart disease. Transthoracic echocardiography showed severe mitral stenosis (surface mitral valve area <1 cm2) and inferior wall akinesia. CONCLUSIONS: We present a case of acute myocardial infarction in a patient with unrecognized severe mitral stenosis and atrial fibrillation. Our suggestion is that acute myocardial infarction in this patient with no risk factors for coronary atherosclerosis was of thromboembolic origin, from left atrial thrombi.