Sumnje na nuspojave lijekova anatomsko-terapijsko-kemijske skupine A

Cilj istraživanja: Cilj istraživanja bio je analizirati zaprimljene prijave sumnji na nuspojave lijekova koji pripadaju anatomsko-terapijsko-kemijskoj skupini A – lijekovi s djelovanjem na probavni sustav i mijenu tvari u RH, u razdoblju od 1. siječnja 2014. godine do 31. prosinca 2018. godine. Materijali i metode: Podaci o prijavljenim nuspojavama zatraženi su od HALMED-a. Zaprimljene prijave sumnji na nuspojave lijekova analizirane su s obzirom na sljedeće: dob i spol bolesnika, ozbiljnost nuspojave, prijavitelj nuspojave, najčešće nuspojave, te klasifikacija nuspojava prema organskim sustavima Medicinskog rječnika za regulatorne poslove, MedDRA. Rezultati: U promatranom petogodišnjem razdoblju zaprimljeno je ukupno 1527 prijava sumnji na nuspojavu lijeka, od čega najviše u 2017. godini (386). Nuspojave su najčešće prijavili farmaceuti (41%) i liječnici (40%). Osobe kod kojih su zabilježene prijavljene sumnje na nuspojavu lijeka su u 58% slučajeva bile ženskoga spola, a u najvećem broju slučajeva pripadale su dobnoj skupini od 45 do 64 godine (30%). Od ukupno 1527 zaprimljenih prijava sumnji na nuspojavu, 18% prijava ocjenjeno je ozbiljnim. Najviše prijavljenih nuspojava klasificirano je prema MedDRA-i kao poremećaji probavnoga sustava (40%). Sumnje na nuspojave najčešće su prijavljivane za pantoprazol (13,9%) i metformin (13,5%). Zaključak: Prijavitelji sumnji na nuspojavu lijeka u najvećem su broju slučajeva bili farmaceuti, a sumnje na nuspojave lijekova su u većini slučajeva prijavljene za osobe ženskoga spola. Najčešće prijavljene nuspojave za lijekove ATK skupine A bile su očekivane i nisu zadovoljile uvjete za klasifikaciju kao ozbiljne, te su u najvećem broju slučajeva klasificirane kao poremećaji probavnoga sustava. Najviše prijava sumnji na nuspojavu lijeka u promatranom razdoblju u RH zaprimljeno je za pantoprazol, što je vjerojatno posljedica načina propisivanja i izdavanja pantoprazola koji rezultiraju njegovom širokom i češćom primjenom u odnosu na druge lijekove iz iste skupine

Review of incentives for pediatric drug development and of the number of phase III clinical trials in selected countries

Procjenjuje se da više od 50 % lijekova korištenih u EU-u u pedijatrijske svrhe nikada nije bilo ispitano u toj populaciji. Cilj ovog članka bio je pregledati zakone i poticaje na klinička ispitivanja u pedijatrijskoj populaciji i usporediti ih s brojem kliničkih ispitivanja u pedijatrijskoj populaciji faze III koje financiraju industrije, kao i udjelom pedijatrijskih u ukupnom broju kliničkih ispitivanja faze III posljednjih deset godina. Napravljen je pregled poticaja za klinička ispitivanja u pedijatrijskoj populaciji i zakonskih okvira koji ih reguliraju za osamnaest država različite razvijenosti i EU. Za države uključene u istraživanje napravljen je pregledan broj pedijatrijskih kliničkih ispitivanja faze III koje je financirala industrija i njihova udjela u ukupnom broju kliničkih ispitivanja faze III koje je financirala industrija, registriranih u bazi clinicaltrials.gov u razdoblju od 2008. do 2017. godine. Najčešće usvojeni poticaji za razvoj pedijatrijskih lijekova bili su SPC ili višegodišnja patentna zaštita. Razvijeno zakonodavstvo sa sustavom obveza za njihovo provođenje imaju EU, SAD i Švicarska. Razvijene države imaju strogo regulirano zakonodavstvo i formirane poticaje za pedijatrijska klinička ispitivanja, ali se ispitivanja često provode u nerazvijenim državama zbog jednostavnosti i cijene. U EU-u, Japanu i Švicarskoj uočeni su trendovi porasta broja pedijatrijskih kliničkih ispitivanja nakon uvođenja inicijativa i poticaja za njihovo provođenje. Utvrđene su nejednakosti u stupnju reguliranosti obveze provođenja kliničkih ispitivanja u pedijatrijskoj populaciji među državama. Nije utvrđena povezanost broja ili udjela pedijatrijskih u ukupnom broju kliničkih ispitivanja faze III i stupnja regulacije obveza i poticaja za provođenje pedijatrijskih kliničkih ispitivanja u pojedinoj državi.It is estimated that more than 50% of medicines used in pediatric in the EU have never been tested in that population. The aim of this article was to review the laws and incentives for clinical trials in the pediatric population and compare them to the number of phase III clinical trials in the pediatric population funded by the industry as well as their proportion in the total number of clinical trials of phase III over the last ten years. A review of clinical trials in a pediatric population and legal frameworks that regulates the same for eighteen states of different development and the EU has been made. For the countries included in the study, the number of pediatric clinical trials of phase III funded by the industry and their proportion in the total number of clinical trials of phase III funded by the industry registered in the clinicaltrials.gov database during the period from 2008 to 2017 was reviewed. The most commonly used incentives for the development of pediatric drugs were SPCs or years of patent protection. EU, the US and Switzerland have developed legislation with a system of obligations to implement them. Developed states have strictly regulated legislation and formed incentives for pediatric clinical trials, but research is often conducted in underdeveloped states for simplicity and price. In the EU, Japan and Switzerland, an increasing trend in the number of pediatric clinical trials have been observed after introducing initiatives and incentives to encourage them. Inequalities in the degree of regulation of the obligation to carry out clinical trials in pediatric population among states have been established. There was no link between the number or the proportion of pediatric patients in the total number of phase III clinical trials and the degree of regulation of the obligations and incentives for pediatric clinical trials in a particular country

Over-the-counter medicinal products in drug outlets and general sales with reference to acetylsalicylic acid : master thesis

Cilj istraživanja: Cilj ovog istraživanja je ispitati opravdanost reklasifikacije bezreceptnih lijekova koji sadrže djelatnu tvar acetilsalicilatnu kiselinu registriranih u RH u lijekove s odobrenjem za izdavanje u ljekarni i specijaliziranim prodavaonicama. Materijal i metode: Sastavljen je usporedni pregled regulacijskog statusa OTC lijekova koji sadrže djelatnu tvar ASK registriranih u izabranim zemljama članicama EU. Pregledana je legislativa koja regulira promet i distribuciju OTC lijekova u RH te je napravljena usporedba prijavljenih sumnji na nuspojave lijekova koji sadrže djelatnu tvar ASK i lijekova koji sadrže djelatnu tvar paracetamol ili ibuprofen zaprimljenih u RH u 2015. godini. Rezultati: Lijekovi s odobrenjem za izdavanje u specijaliziranim prodavaonicama imaju dopuštenje za oglašavanje prema stanovništvu, OTC lijekovi koji sadrže djelatnu tvar ASK također imaju dopuštenje za oglašavanje prema stanovništvu. Usporedbom prijava sumnji na nuspojave lijekova koji sadrže djelatnu tvar ASK, ibuprofen ili paracetamol utvrđeno je da nije bilo značajne razlike u ozbiljnosti prijava sumnji na nuspojave lijekova. Također nije pronađena statistički značajna razlika u ishodu nuspojava za spomenute lijekove. Zaključci: Nisu pronađene razlike u prijavljenim sumnjama na nuspojave lijekova koji sadrže djelatnu tvar ASK i lijekova koji sadrže djelatnu tvar ibuprofen ili paracetamol, stoga nema ograničenja za promjenu mjesta izdavanja bezreceptnih lijekova u RH koji sadrže djelatnu tvar ASK. Potrebno je definirati zakonski okvir za spomenutu reklasifikaciju bezreceptnih lijekova.Objectives: The aim of this study was to examine the justification for the deregulation of Over-the- Counter (OTC) medicinal products containing active substance acetylsalicylic acid (ASA), registered in the Republic of Croatia, from Pharmacy Only to Pharmacy and Drug Outlet Medicinal Products. Material and Methods: A comparative review was made of the regulatory status of OTC medicinal products containing active substance ASA in a selected number of EU member states. We analysed the legislation on distribution of OTC medicinal products in the Republic of Croatia and compared reported adverse reactions of medicinal products with active substances ASA, ibuprofen or paracetamol reported in the Republic of Croatia in the year 2015. Results: Medicinal products classified as Pharmacy and Drug Outlet Medicinal Products have permission to advertise to the general public. OTC medicinal products containing the active substance ASA also have permission to advertise to the general public. Analysis of adverse events reported with medicinal products containing active substances ASA, ibuprofen or paracetamol found that there were no significant differences in the number of reported adverse reactions classified as serious. There was no statistically significant difference in the outcome of the adverse reactions among these medicinal products. Conclusions: There was no difference in reported adverse reactions among medicinal products containing active substance ASA, ibuprofen or paracetamol, therefore there is no obstacle for the deregulation of OTC medicinal products containing active substance ASA, registered in the Republic of Croatia, from Pharmacy Only to Pharmacy and Drug Outlet Medicinal Products. A reagulatory framework should be developed to address this deregulation

Assessment of knowledge and attitudes about antimicrobial therapy and resistance among medical and pharmacy students, and doctors and pharmacists

Cilj istraživanja: Jedan od izazova današnjeg globalnog zdravlja je predstavljen u sve većem broju multi-rezistentnih patogena. Predložene su brojne intervencije za suzbijanje antimikrobne rezistencije, uključujući nacionalne programe za kontrolu rezistencije bakterija na antibiotike, razvoj nacionalnih smjernica i edukaciju propisivača. Cilj ovog istraživanja bio je ispitati stavove i znanja o antimikrobnoj terapiji i rezistenciji budućih zdravstvenih radnika, studenata medicine i farmacije i liječnika i ljekarnika. Nadalje, ovim istraživanjem je ispitana i usklađenost registriranih pakiranja lijekova u Hrvatskoj s nacionalnim i međunarodnim smjernicama za njihovu primjenu. Ispitanici i postupci: Istraživanje stavova i znanja studenata i liječnika i ljekarnika je ustrojeno kao presječno anketno istraživanje, a istraživanje podudarnosti registriranih antimikrobnih lijekova sa smjernicama za njihovu primjenu je pregledno. Anketno istraživanje je bilo anonimno, a sudjelovanje u istraživanju dragovoljno. Pakiranja lijekova registrirana u Hrvatskoj su uspoređena sa smjernicama Interdisciplinarne sekcija za kontrolu rezistencije na antibiotike (ISKRA) Nacionalnog instituta za zdravlje i kliničku izvrsnost (NICE) i Američkog infektološkog društva (IDSA). Rezultati: U istraživanju je sudjelovalo 99 studenata studija Farmacija, 141 student studija Medicina i 72 studenta studija Medicina na engleskom jeziku (MSE), 175 ljekarnika i 162 liječnika. Studenti čiji članovi obitelji rade u zdravstvenom sektoru su skloniji čuvati preostale antibiotike kod kuće (54,5% naprema 24,2%, P<0,001). Da formalno obrazovanje studenata zdravstvenog usmjerenja o pravilnoj uporabi antimikrobnih lijekova može smanjiti fenomen antimikrobne rezistencije značajno češće su smatrali ljekarnici i liječnici u usporedbi sa studentima. Ljekarnici i liječnici su kao najveće doprinositelje antimikrobnoj rezistenciji naveli liječnike obiteljske medicine (62,9%; 59,9%) Čak 161 ljekarnik (92,0%) se slaže ili u potpunosti slaže s tvrdnjom da bi izdavanje antibiotika trebalo više nadzirati. Dobro ili odlično spremnima na korigiranje doze antibiotika se smatralo 137 (78,3%) ljekarnika. Od razmatranih 5 režima koje predlaže ISKRA za liječenje grlobolje uzrokovane beta-hemolitičkim streptokokom grupe A, apsolutna podudarnost je pronađena za njih 3. Od razmatranih 17 režima koje predlaže ISKRA za liječenje različitih urinarnih infekcija, apsolutna usklađenost s registriranim pakiranjima lijekova je mogla biti utvrđena u 9 slučajeva. Zaključci: Istraživanje je pokazalo da se studenti medicine i farmacije značajno ne razlikuju u znanju i stavovima o antimikrobnoj terapiji i rezistenciji. Nadalje, utvrđeno je i da liječnici posjeduju veća znanja o antimikrobnoj terapiji i rezistenciji nego ljekarnici te da kao izvore informacija o antimikrobnoj terapiji i rezistenciji liječnici najčešće koristile službene smjernice, dok se ljekarnici najčešće služe Sažetkom opisa svojstava lijeka ili Uputom o lijeku. Analizom registriranih pakiranja lijekova utvrđen je nesrazmjer u veličinama registriranih pakiranja lijekova i smjernicama za njihovu primjenu i općenito veća podudarnost s nacionalnim nego međunarodnim smjernicama za njihovu primjenu.Objectives: One of the challenges of today's global health is represented in the rising number of multidrug-resistant pathogens. Several interventions have been suggested to combat antimicrobial resistance, including antimicrobial stewardship programmes, development of national guidelines and prescriber education. The aim of this research was to examine the attitudes and knowledge of antimicrobial therapy and resistance of future healthcare professionals, medical and pharmacy students, and physicians and pharmacists. Furthermore, this research explored accordance of registered drug packs in Croatia with national and international treatment guidelines. Subjects and Methods: A survey of the attitudes and knowledge of students and physicians and pharmacists was organized as a cross-sectional survey, and the research of accordance of registered antimicrobials with treatment guidelines was observational. The survey was anonymous, and participation in the survey was voluntary. Packs of drugs registered in Croatia have been compared to the guidelines of the Interdisciplinary Section for Antibiotic Resistance Control (ISKRA) of the National Institutes of Health and Clinical Excellence (NICE) and the American Infectious Society (IDSA). Results: Overall, 99 Pharmacy students, 141 Medical students and 72 Medical students of Medical Studies in English (MSE), 175 pharmacists and 162 physicians participated in the study. Students who have family members in healthcare more often kept residual antibiotics at home (54.5% vs. 24.2%, P <0.001). Pharmacists and physicians felt that the formal education of health care students on the proper use of antimicrobials may reduce the phenomenon of antimicrobial resistance more often than college students. Pharmacists and physicians identified family medicine physicians as the major contributors to antimicrobial resistance (62.9%; 59.9%). As many as 161 pharmacists (92.0%) agree or fully agree with the claim that antibiotic dispensing should be more closely monitored. Overall, 137 (78.3%) pharmacists felt well or excellent a prepared to correct the dosage of antibiotic drugs. Of the 5 regimens that suggest ISKRA for the treatment of sore throat-growing beta-hemolytic streptococcus group A, an absolute match was found for them. 9 cases. Conclusions: Research has shown that medical and pharmacy students don't differ significantly in knowledge and attitudes regarding antimicrobial therapy and resistance. In addition, research showed that physicians had greater knowledge of antimicrobial therapy and resistance than pharmacists and that physicians most frequently used official guidelines, while pharmacists use the The Summary of Product Characteristics or Patient information leaflet as source of information on these topics. The analysis of registered drug packs has identified a disproportion in the size of registered drug packs and treatment guidelines. Generally, drug packs were more in accordance with national than international treatment guidelines

Assessment of knowledge and attitudes about antimicrobial therapy and resistance among medical and pharmacy students, and doctors and pharmacists

Cilj istraživanja: Jedan od izazova današnjeg globalnog zdravlja je predstavljen u sve većem broju multi-rezistentnih patogena. Predložene su brojne intervencije za suzbijanje antimikrobne rezistencije, uključujući nacionalne programe za kontrolu rezistencije bakterija na antibiotike, razvoj nacionalnih smjernica i edukaciju propisivača. Cilj ovog istraživanja bio je ispitati stavove i znanja o antimikrobnoj terapiji i rezistenciji budućih zdravstvenih radnika, studenata medicine i farmacije i liječnika i ljekarnika. Nadalje, ovim istraživanjem je ispitana i usklađenost registriranih pakiranja lijekova u Hrvatskoj s nacionalnim i međunarodnim smjernicama za njihovu primjenu. Ispitanici i postupci: Istraživanje stavova i znanja studenata i liječnika i ljekarnika je ustrojeno kao presječno anketno istraživanje, a istraživanje podudarnosti registriranih antimikrobnih lijekova sa smjernicama za njihovu primjenu je pregledno. Anketno istraživanje je bilo anonimno, a sudjelovanje u istraživanju dragovoljno. Pakiranja lijekova registrirana u Hrvatskoj su uspoređena sa smjernicama Interdisciplinarne sekcija za kontrolu rezistencije na antibiotike (ISKRA) Nacionalnog instituta za zdravlje i kliničku izvrsnost (NICE) i Američkog infektološkog društva (IDSA). Rezultati: U istraživanju je sudjelovalo 99 studenata studija Farmacija, 141 student studija Medicina i 72 studenta studija Medicina na engleskom jeziku (MSE), 175 ljekarnika i 162 liječnika. Studenti čiji članovi obitelji rade u zdravstvenom sektoru su skloniji čuvati preostale antibiotike kod kuće (54,5% naprema 24,2%, P<0,001). Da formalno obrazovanje studenata zdravstvenog usmjerenja o pravilnoj uporabi antimikrobnih lijekova može smanjiti fenomen antimikrobne rezistencije značajno češće su smatrali ljekarnici i liječnici u usporedbi sa studentima. Ljekarnici i liječnici su kao najveće doprinositelje antimikrobnoj rezistenciji naveli liječnike obiteljske medicine (62,9%; 59,9%) Čak 161 ljekarnik (92,0%) se slaže ili u potpunosti slaže s tvrdnjom da bi izdavanje antibiotika trebalo više nadzirati. Dobro ili odlično spremnima na korigiranje doze antibiotika se smatralo 137 (78,3%) ljekarnika. Od razmatranih 5 režima koje predlaže ISKRA za liječenje grlobolje uzrokovane beta-hemolitičkim streptokokom grupe A, apsolutna podudarnost je pronađena za njih 3. Od razmatranih 17 režima koje predlaže ISKRA za liječenje različitih urinarnih infekcija, apsolutna usklađenost s registriranim pakiranjima lijekova je mogla biti utvrđena u 9 slučajeva. Zaključci: Istraživanje je pokazalo da se studenti medicine i farmacije značajno ne razlikuju u znanju i stavovima o antimikrobnoj terapiji i rezistenciji. Nadalje, utvrđeno je i da liječnici posjeduju veća znanja o antimikrobnoj terapiji i rezistenciji nego ljekarnici te da kao izvore informacija o antimikrobnoj terapiji i rezistenciji liječnici najčešće koristile službene smjernice, dok se ljekarnici najčešće služe Sažetkom opisa svojstava lijeka ili Uputom o lijeku. Analizom registriranih pakiranja lijekova utvrđen je nesrazmjer u veličinama registriranih pakiranja lijekova i smjernicama za njihovu primjenu i općenito veća podudarnost s nacionalnim nego međunarodnim smjernicama za njihovu primjenu.Objectives: One of the challenges of today's global health is represented in the rising number of multidrug-resistant pathogens. Several interventions have been suggested to combat antimicrobial resistance, including antimicrobial stewardship programmes, development of national guidelines and prescriber education. The aim of this research was to examine the attitudes and knowledge of antimicrobial therapy and resistance of future healthcare professionals, medical and pharmacy students, and physicians and pharmacists. Furthermore, this research explored accordance of registered drug packs in Croatia with national and international treatment guidelines. Subjects and Methods: A survey of the attitudes and knowledge of students and physicians and pharmacists was organized as a cross-sectional survey, and the research of accordance of registered antimicrobials with treatment guidelines was observational. The survey was anonymous, and participation in the survey was voluntary. Packs of drugs registered in Croatia have been compared to the guidelines of the Interdisciplinary Section for Antibiotic Resistance Control (ISKRA) of the National Institutes of Health and Clinical Excellence (NICE) and the American Infectious Society (IDSA). Results: Overall, 99 Pharmacy students, 141 Medical students and 72 Medical students of Medical Studies in English (MSE), 175 pharmacists and 162 physicians participated in the study. Students who have family members in healthcare more often kept residual antibiotics at home (54.5% vs. 24.2%, P <0.001). Pharmacists and physicians felt that the formal education of health care students on the proper use of antimicrobials may reduce the phenomenon of antimicrobial resistance more often than college students. Pharmacists and physicians identified family medicine physicians as the major contributors to antimicrobial resistance (62.9%; 59.9%). As many as 161 pharmacists (92.0%) agree or fully agree with the claim that antibiotic dispensing should be more closely monitored. Overall, 137 (78.3%) pharmacists felt well or excellent a prepared to correct the dosage of antibiotic drugs. Of the 5 regimens that suggest ISKRA for the treatment of sore throat-growing beta-hemolytic streptococcus group A, an absolute match was found for them. 9 cases. Conclusions: Research has shown that medical and pharmacy students don't differ significantly in knowledge and attitudes regarding antimicrobial therapy and resistance. In addition, research showed that physicians had greater knowledge of antimicrobial therapy and resistance than pharmacists and that physicians most frequently used official guidelines, while pharmacists use the The Summary of Product Characteristics or Patient information leaflet as source of information on these topics. The analysis of registered drug packs has identified a disproportion in the size of registered drug packs and treatment guidelines. Generally, drug packs were more in accordance with national than international treatment guidelines

Assessment of knowledge and attitudes about antimicrobial therapy and resistance among medical and pharmacy students, and doctors and pharmacists

Cilj istraživanja: Jedan od izazova današnjeg globalnog zdravlja je predstavljen u sve većem broju multi-rezistentnih patogena. Predložene su brojne intervencije za suzbijanje antimikrobne rezistencije, uključujući nacionalne programe za kontrolu rezistencije bakterija na antibiotike, razvoj nacionalnih smjernica i edukaciju propisivača. Cilj ovog istraživanja bio je ispitati stavove i znanja o antimikrobnoj terapiji i rezistenciji budućih zdravstvenih radnika, studenata medicine i farmacije i liječnika i ljekarnika. Nadalje, ovim istraživanjem je ispitana i usklađenost registriranih pakiranja lijekova u Hrvatskoj s nacionalnim i međunarodnim smjernicama za njihovu primjenu. Ispitanici i postupci: Istraživanje stavova i znanja studenata i liječnika i ljekarnika je ustrojeno kao presječno anketno istraživanje, a istraživanje podudarnosti registriranih antimikrobnih lijekova sa smjernicama za njihovu primjenu je pregledno. Anketno istraživanje je bilo anonimno, a sudjelovanje u istraživanju dragovoljno. Pakiranja lijekova registrirana u Hrvatskoj su uspoređena sa smjernicama Interdisciplinarne sekcija za kontrolu rezistencije na antibiotike (ISKRA) Nacionalnog instituta za zdravlje i kliničku izvrsnost (NICE) i Američkog infektološkog društva (IDSA). Rezultati: U istraživanju je sudjelovalo 99 studenata studija Farmacija, 141 student studija Medicina i 72 studenta studija Medicina na engleskom jeziku (MSE), 175 ljekarnika i 162 liječnika. Studenti čiji članovi obitelji rade u zdravstvenom sektoru su skloniji čuvati preostale antibiotike kod kuće (54,5% naprema 24,2%, P<0,001). Da formalno obrazovanje studenata zdravstvenog usmjerenja o pravilnoj uporabi antimikrobnih lijekova može smanjiti fenomen antimikrobne rezistencije značajno češće su smatrali ljekarnici i liječnici u usporedbi sa studentima. Ljekarnici i liječnici su kao najveće doprinositelje antimikrobnoj rezistenciji naveli liječnike obiteljske medicine (62,9%; 59,9%) Čak 161 ljekarnik (92,0%) se slaže ili u potpunosti slaže s tvrdnjom da bi izdavanje antibiotika trebalo više nadzirati. Dobro ili odlično spremnima na korigiranje doze antibiotika se smatralo 137 (78,3%) ljekarnika. Od razmatranih 5 režima koje predlaže ISKRA za liječenje grlobolje uzrokovane beta-hemolitičkim streptokokom grupe A, apsolutna podudarnost je pronađena za njih 3. Od razmatranih 17 režima koje predlaže ISKRA za liječenje različitih urinarnih infekcija, apsolutna usklađenost s registriranim pakiranjima lijekova je mogla biti utvrđena u 9 slučajeva. Zaključci: Istraživanje je pokazalo da se studenti medicine i farmacije značajno ne razlikuju u znanju i stavovima o antimikrobnoj terapiji i rezistenciji. Nadalje, utvrđeno je i da liječnici posjeduju veća znanja o antimikrobnoj terapiji i rezistenciji nego ljekarnici te da kao izvore informacija o antimikrobnoj terapiji i rezistenciji liječnici najčešće koristile službene smjernice, dok se ljekarnici najčešće služe Sažetkom opisa svojstava lijeka ili Uputom o lijeku. Analizom registriranih pakiranja lijekova utvrđen je nesrazmjer u veličinama registriranih pakiranja lijekova i smjernicama za njihovu primjenu i općenito veća podudarnost s nacionalnim nego međunarodnim smjernicama za njihovu primjenu.Objectives: One of the challenges of today's global health is represented in the rising number of multidrug-resistant pathogens. Several interventions have been suggested to combat antimicrobial resistance, including antimicrobial stewardship programmes, development of national guidelines and prescriber education. The aim of this research was to examine the attitudes and knowledge of antimicrobial therapy and resistance of future healthcare professionals, medical and pharmacy students, and physicians and pharmacists. Furthermore, this research explored accordance of registered drug packs in Croatia with national and international treatment guidelines. Subjects and Methods: A survey of the attitudes and knowledge of students and physicians and pharmacists was organized as a cross-sectional survey, and the research of accordance of registered antimicrobials with treatment guidelines was observational. The survey was anonymous, and participation in the survey was voluntary. Packs of drugs registered in Croatia have been compared to the guidelines of the Interdisciplinary Section for Antibiotic Resistance Control (ISKRA) of the National Institutes of Health and Clinical Excellence (NICE) and the American Infectious Society (IDSA). Results: Overall, 99 Pharmacy students, 141 Medical students and 72 Medical students of Medical Studies in English (MSE), 175 pharmacists and 162 physicians participated in the study. Students who have family members in healthcare more often kept residual antibiotics at home (54.5% vs. 24.2%, P <0.001). Pharmacists and physicians felt that the formal education of health care students on the proper use of antimicrobials may reduce the phenomenon of antimicrobial resistance more often than college students. Pharmacists and physicians identified family medicine physicians as the major contributors to antimicrobial resistance (62.9%; 59.9%). As many as 161 pharmacists (92.0%) agree or fully agree with the claim that antibiotic dispensing should be more closely monitored. Overall, 137 (78.3%) pharmacists felt well or excellent a prepared to correct the dosage of antibiotic drugs. Of the 5 regimens that suggest ISKRA for the treatment of sore throat-growing beta-hemolytic streptococcus group A, an absolute match was found for them. 9 cases. Conclusions: Research has shown that medical and pharmacy students don't differ significantly in knowledge and attitudes regarding antimicrobial therapy and resistance. In addition, research showed that physicians had greater knowledge of antimicrobial therapy and resistance than pharmacists and that physicians most frequently used official guidelines, while pharmacists use the The Summary of Product Characteristics or Patient information leaflet as source of information on these topics. The analysis of registered drug packs has identified a disproportion in the size of registered drug packs and treatment guidelines. Generally, drug packs were more in accordance with national than international treatment guidelines

Expression of CD44 in Leukocyte Subpopulations in Patients with Inflammatory Bowel Diseases

CD44 expressed in monocytes and lymphocytes seems to play a crucial role in gastrointestinal inflammation, such as the one occurring in the context of inflammatory bowel diseases. Differentially methylated genes are distinctly expressed across monocyte subpopulations related to the state of Crohn&rsquo;s disease. Hence, the aim of this study was to detect CD44 expression in leukocyte subpopulations in relation to the type of IBD, therapy, and disease duration. Monocyte subpopulations CD14++CD16&minus;, CD14++CD16++, and CD14+CD16+ as well as other leukocytes were analyzed for their CD44 expression using flow cytometry in 46 patients with IBD and 48 healthy controls. Patients with Crohn&rsquo;s disease treated with non-biological therapy (NBT) exhibited a lower percentage of anti-inflammatory CD14+CD16++ monocytes, whereas NBT-treated patients with ulcerative colitis had lower expression of CD44 on CD14+CD44+ lymphocytes in comparison to controls, respectively. Conversely, patients with Crohn&rsquo;s disease treated with biological therapy had a higher percentage of CD44+ granulocytes but lower expression of CD44 on anti-inflammatory monocytes compared to controls. Median fluorescence intensity (MFI) of CD44 on CD44+CD14+ lymphocytes was higher in ulcerative colitis patients treated with biological therapy compared to NBT. The percentage of classical CD14++CD16&minus; monocytes was lower in the &lt;9 years of IBD duration subgroup compared with the longer disease duration subgroup. The present study addresses the putative role of differentiation and regulation of leukocytes in tailoring IBD therapeutic regimes

Knowledge and Attitudes towards Epilepsy of Croatian General Student Population and Biomedical Students: A Cross-Sectional Study

Epilepsy causes a significant burden to patients as it is linked with various somatic and psychiatric comorbidities, social issues, impaired quality of life, and increased mortality. Improving the population’s knowledge and attitudes about epilepsy patients could be beneficial as it could raise social awareness and lead to more social support for patients. For those reasons, a survey-based cross-sectional study was conducted to determine Croatian students’ knowledge and attitudes toward epilepsy. A previously developed survey questionnaire was adapted for the Croatian setting and distributed online to the students (n = 544). Croatian students generally had positive attitudes towards people with epilepsy (median score 28.0, interquartile range 29.0–26.0, with the minimum possible score being 0.0 and the maximum 30.0), with the female gender (B (male) = 0.664 (95% CI −1.158, −0.170), p = 0.009), biomedical education (B (other) = −0.442, (95% CI −0.823, −0.061), p = 0.023), and personal experience in the form of witnessing the seizure (B = 0.519 (95% CI 0,098, 0.940), p = 0.016) as predictors of more favorable attitudes. Overall knowledge was satisfactory concerning most items, with the exception of first aid measures and risk factors. Educational intervention targeting bio-medical students and other students who might, in their future professional lives, be responsible for people suffering from epilepsy is needed to improve the gaps in their knowledge

Helicobacter pylori Infection in Croatian Population: Knowledge, Attitudes and Factors Influencing Incidence and Recovery

Basic and clinical knowledge about Helicobacter pylori infections has been improved in the past. However, the translation of this knowledge into public health intervention has remained poor. A survey based cross-sectional study was performed to assess the factors regarding the H. pylori infection in the general population. The survey was conducted using a previously developed questionnaire, adapted for the population in Croatia. Respondents (N = 1131) had a good knowledge score with a median of 4 out of 5 correct answers (interquartile range: 2&ndash;4). Senior participants had a lower frequency of high knowledge answers about H. pylori (43.1%) compared to younger (56.1%) and middle-aged participants (51.5%, p = 0.014). Rural participants had a higher frequency of low knowledge answers compared to urban and suburban ones (21.7% vs. 9.5% and 9.4%, p = 0.011). Only 315 participants (27.9%) were screened for the H. pylori infection, despite high support for the screening programs among the untested (74.7%) and tested (85.7%). Habits of smoking (p = 0.036) and coffee drinking (p = 0.008) were associated with more symptoms after eradication therapy. Further education is needed for the groups at risk for H. pylori infection, especially to raise the awareness of the importance of screening programs. More research is warranted to assess the effects of dietary changes on therapy outcomes

Attitudes and Knowledge Regarding Antimicrobial Use and Resistance Among Pharmacy and Medical Students at the University of Split, Croatia

Purpose: Future physicians and pharmacists have to be educated and prepared to rationally manage the use of antimicrobials. The aim of this study was to evaluate attitudes and knowledge regarding the use of antimicrobials and antimicrobial resistance of medical and pharmacy students. Methods: We conducted a survey-based cross-sectional study at the University of Split School of Medicine (USSM). The survey consisted of 50 items. A total of 161 students participated in the study across 3 study programs as follows: Medicine (N = 78), Medical Studies in English (MSE; N = 37), and Pharmacy (N = 46). Results: Majority of students believe that antimicrobials are overused (90.7%). Keeping a stock of antibiotics at home is a practice more commonly seen among students who have a family member working in a health related field (58.5% vs. 25.0%, p < 0.001). There was no difference in average knowledge score among medical, MSE, or pharmacy students (p = 0.416). Students who achieved higher knowledge score were more likely to rate their education about antimicrobial use and resistance as very useful (p < 0.001). Conclusion: This study reveals that medical and pharmacy students at the USSM have a relatively good understanding of antibiotic resistance. However, more education on the appropriate use of antimicrobials is needed