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B. Luka, M. Stojiljkovic, Z. Vujković, N. Ponorac, E. Board, M. Dilić, Darko Golić, J. Komić et al.

Background: Tablet splitting is commonly used in clinical practice as a way to attain a desired drug dose and/or reduce its side effects, particularly among paediatricians and psychiatrists. However, uneven tablet scoring can lead to significant fluctuations of the administered doses, where subpotency or superpotency of drugs might harm the patients. The aim of this study was to evaluate the influence of tablet splitting on dose uniformity of diazepam by the utilisation of Ph. Eur. 9.0 and FDA recommendations. Methods: Mass variation of whole and half-tablets in parallel with the determination of their content uniformity were performed according to the pharmacopoeial methods. The weight loss after tablet splitting was assessed by employing FDA guidelines. It was also investigated if tablet splitting influenced the in vitro dissolution properties of diazepam tablets. Results: Diazepam whole tablets fulfilled the pharmacopoeial requirements in regard to all the investigated properties. The weight uniformity of scored diazepam tablets ranged from 63.80% to 122.55% label claim. The losses of mass after splitting diazepam tablets were 5.71%. Despite the average content of diazepam in half-tablets was found to be 104.24% label claim, the requirements of Ph. Eur. were not fulfilled. Diazepam content in half-tablets ranged from 0.76 mg to 1.21 mg, thus, patients might receive doses that vary by as much as 45%. However, after weight adjustment, diazepam content in each of the tested half-tablets was in the range of 85-115% of the average drug content meeting the Ph. Eur. criteria. Dissolution profiles of whole and half-tablets were found to be similar, following the Hixson-Crowell kinetic model. Conclusion: According to the results, splitting of diazepam tablets greatly influenced the drug content in the obtained parts, ie the dose accuracy was fully dependent of the ability to score the tablet into exactly equal halves.

D. De Bacquer, D. De Smedt, K. Kotseva, C. Jennings, D. Wood, L. Rydén, V. Gyberg, B. Shahim et al.

M. S. Pola, K. Turk-Adawi, Ella Pesah, F. Lopez‐Jimenez, Ding Rongjing, R. Britto, W. Derman, B. Bjarnason-Wehrens et al.

J. Ostrowska, M. Jakubczyk, M. Niewada, I. Lipka, G. Petrova, D. Tcharaktchiev, Z. Mitkova, S. Tsonev et al.

D. Vulic, S. Lončar, M. Ostojić, J. Marinković, B. Vulic, N. Wong

Introduction Risk factor differences among offspring of patients with premature coronary heart disease (CHD) have not been widely studiem. Material and methods We examined 161 persons from the region of Banja Luka, including 81 children (mean age: 25.9 years, 45.7% female) with a history of CHD and a control group of 80 persons (mean age: 24.1, 50% female). Medical history interviews and risk factor measurements were performed. Results There were differences in mean body amss index (BMI) (26.1 kg/m2 vs. 23.1 kg/m2, p < 0.0001), waist circumference (87.7 cm vs. 83.9 cm, p = 0.002), hip circumference (99.3 cm vs. 95.84 cm, p < 0.002), systolic blood pressure (BP) (128.09 mm Hg vs. 122.7 mm Hg, p = 0.007), and diastolic BP (99.3 mm Hg vs. 95.8 mm Hg, p = 0.07). Moreover, HDL-cholesterol was significantly lower (1.1 mmol/l vs. 1.4 mmol/l, p = 0.0001), triglycerides significantly higher (2.2 mmol/l vs. 1.6 mmol/l, p = 0.001), and TC/HDL-ratio was significantly higher (5.1 vs. 4.0, p < 0.001) comparing cases and controls, respectively, adjusted for age, gender, and standard CHD risk factors total cholesterol, LDL and HDL cholesterol, smoking, systolic and diastolic BP, and BMI, those with HDL-C > 1.0 mmol/l in men and 1.2 mmol/l in women had a reduced odds (OR = 0.08, 95% CI: 0.02–0.34 of CHD as well as those with change of fat type (OR = 0.26, 95% CI: 0.11–0.60). Conclusions Children of parents with premature CHD have a significantly greater burden of CHD risk factors, with low HDL-C, in particular, being associated with an increased likelihood of being a child of a parent with premature CHD.

OBJECTIVE The aim of this study was to investigate the differences in pre-hospital care of patients with acute myocardial infarction between emergency medical services and family medicine. PATIENTS AND METHODS This retrospective descriptive study included patients treated for acute myocardial infarction at the University Clinical Centre of Banja Luka, in the period from 1st January to 31st December 2011. The patients were divided into two groups: patients who received a hospital referral from the family medicine service and those who received one from the emergency medical service. RESULTS The majority of patients (54.8%) received pre-hospital care from emergency medical services, while in 24.8% of cases the care was provided by family medicine physicians. The analysis showed that the time that passed from the onset of symptoms to the visit to the health institution of first medical contact was shorter in the emergency medical service (p<0.001). The average time from the onset of symptoms to arrival at the family practice was 24 hours, and to the emergency service 2 hours. The patients who established their first medical contact with the emergency service reported more severe symptoms than the ones who visited a family practice over the same period of time. CONCLUSION The severity of symptoms affected the patients' decisions to seek help in a timely manner and to choose the facility of first medical contact. Interventions to decrease delay must focus on improving public awareness of acute myocardial infarction symptoms and increasing their knowledge of the benefits of early medical contact and treatment. Continuing education of family practitioners in this field is required.

K. Kotseva, D. Wood, D. De Bacquer, G. De Backer, L. Rydén, C. Jennings, V. Gyberg, P. Amouyel et al.

Aims To determine whether the Joint European Societies guidelines on cardiovascular prevention are being followed in everyday clinical practice of secondary prevention and to describe the lifestyle, risk factor and therapeutic management of coronary patients across Europe. Methods and results EUROASPIRE IV was a cross-sectional study undertaken at 78 centres from 24 European countries. Patients <80 years with coronary disease who had coronary artery bypass graft, percutaneous coronary intervention or an acute coronary syndrome were identified from hospital records and interviewed and examined ≥ 6 months later. A total of 16,426 medical records were reviewed and 7998 patients (24.4% females) interviewed. At interview, 16.0% of patients smoked cigarettes, and 48.6% of those smoking at the time of the event were persistent smokers. Little or no physical activity was reported by 59.9%; 37.6% were obese (BMI ≥ 30 kg/m2) and 58.2% centrally obese (waist circumference ≥ 102 cm in men or ≥88 cm in women); 42.7% had blood pressure ≥ 140/90 mmHg (≥140/80 in people with diabetes); 80.5% had low-density lipoprotein cholesterol ≥ 1.8 mmol/l and 26.8% reported having diabetes. Cardioprotective medication was: anti-platelets 93.8%; beta-blockers 82.6%; angiotensin-converting enzyme inhibitors/angiotensin receptor blockers 75.1%; and statins 85.7%. Of the patients 50.7% were advised to participate in a cardiac rehabilitation programme and 81.3% of those advised attended at least one-half of the sessions. Conclusion A large majority of coronary patients do not achieve the guideline standards for secondary prevention with high prevalences of persistent smoking, unhealthy diets, physical inactivity and consequently most patients are overweight or obese with a high prevalence of diabetes. Risk factor control is inadequate despite high reported use of medications and there are large variations in secondary prevention practice between centres. Less than one-half of the coronary patients access cardiac prevention and rehabilitation programmes. All coronary and vascular patients require a modern preventive cardiology programme, appropriately adapted to medical and cultural settings in each country, to achieve healthier lifestyles, better risk factor control and adherence with cardioprotective medications.

I. Tasic, G. Lazarević, S. Kostić, D. Djordjević, D. Simonović, M. Rihter, D. Vulic, V. Stefanović

BackgroundThe aim of this study was to assess the impact of the depression on sexual dysfunction and the health-related quality of life (HRQoL) in coronary artery disease (CAD) patients admitted for cardiovascular rehabilitation within 3 months after an acute myocardial infarction (AMI). Methods. In all, 745 consecutive CAD patients (502 men and 243 women, aged 60.9 ± 9.3 years) admitted for cardiovascular rehabilitation within 3 months after an AMI, were enrolled in the study and divided into 4 groups according to Beck depression inventory (BDI) score range. HRQoL was estimated using the SF-36 questionnaire for total QoL and dimensions for physical and mental health [physical and mental component summary scores (PCS, MCS)]. Sexual dysfunction was assessed using the ASEX scale.ResultsThe HRQoL decreased following the range of depression, as demonstrated for significantly higher PCS in minimal compared to mild, moderate and severe depression groups (P<0.001). The MCS was significantly higher in minimal compared to mild, moderate and severe depression groups (P<0.001). The ASEX score was significantly higher in minimal, compared to mild, moderate and severe depression groups, as well as in mild and moderate compared to severe depression group. A significant association was found between depression score range and age, self-reported regular exercise, type 2 diabetes mellitus, and cigarette smoking.ConclusionsDepression significantly affected HRQoL and sexual dysfunction in CAD patients, as demonstrated by the significant decrease of PCS, MCS, and significant increase of ASEX score following the range of the depression according to BDI.

D. Vulic, D. Secerov-Zecevic, M. Burgic-Radmanovic, Z. Vujković, J. Marinković, A. Lazarević, N. Wong, S. Ristić

I. Tasic, G. Lazarević, M. Stojanovic, S. Kostić, M. Rihter, D. Djordjević, D. Simonović, D. Vulic et al.

The aim of this study was to investigate the quality of life (HRQoL) in coronary artery disease(CAD) patients, admitted for rehabilitation within 3 months after an acute coronary event, in relation to treatment strategy [conservative treatment without revascularization (WR), percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG)]. Methods: Overall 719 consecutive CAD patients were involved in the study: WR (n=170), PTCA (n=226), CABG (n=323). HRQoL was estimated using the SF-36 questionnaire for total QoL and its two dimensions for physical and mental health [physical and mental component scores (PCS, MCS)]. Sexual dysfunction was assessed using the ASEX scale. Results: Significantly higher PCS, MCS and total SF-36, but lower ASEX score, were found in men compared with women. The ASEX score was significantly affected by age. Significantly higher PCS was found in PTCA group compared with that of CABG group. In multivariate analysis a significant positive association was obtained between PCS/MCS and male sex, between regular exercise, hyperlipoproteinemia, and permanent stress. ASEX was significantly positively associated with the age, CHF and non smoking. Conclusion: The results of this study have demonstrated significantly better HRQoL in men, younger CAD patients, patients who underwent PTCA and in patients without self-reported exposition to stress.

D. Vulic, D. Secerov-Zecevic, I. Tasic, M. Burgic-Radmanovic

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