Is bioavailability altered in generic versus brand anticonvulsants?

© 2014 Informa UK, Ltd. Therapeutic window of anticonvulsants is not a wide one, with phenytoin being one extreme, which can be classified as a narrow therapeutic index drug, since its ratio between the least toxic and the least effective concentration is less than twofold. In order to obtain marketing authorization, a generic anticonvulsant should demonstrate relative bioequivalence with its brand-name counterpart. However, although bioequivalent, generic anticonvulsants still do not have the same bioavailability as brand-name drugs, which may lead to larger fluctuations of steady-state plasma concentrations, and sometimes to loss of seizure control if a patient is switched from brand-name to generic or from generic to generic anticonvulsant. Generic anticonvulsants are effective, safe and affordable drugs for treatment of epilepsy, and patients could be successfully treated with them from the very beginning. It is switching from brand-name to generic anticonvulsant or from one generic anticonvulsant to another that should be avoided in clinical practice, since subtle differences in bioavailability may disturb optimal degree of seizure control to which the patient was previously successfully titrated

Evaluation of the Beck Depression Inventory in a Nonclinical Student Sample

Depression is one of the most common psychological disorders in individuals seeking psychiatric treatment, and a frequent psychological disorder among patients who seek primary healthcare. There-fore, it is vitally important to employ reliable and valid diagnostic instruments and norms, both in clinical and research work to investigate this problem. This article is part of a larger study which has been conducted for ten years now with the aim to create a clearer picture about the level of depression which may be expected in the nonclinical population in Serbia, and in that way provide a basis for comparisons when diagnosing the clinical population. The subsidiary aims were to monitor potential changes in level of depressive reactions within the set time and to examine the psychometric properties and factor structure of the Beck Depression Inventory (BDI) scale. The sample consisted of 782 students (40% male, 60% female), mean age = 23.10 years, SD = 1.782. Mean score on the BDI-IA scale was 6.69; SD = 6.412. The study showed no significant relationships between the BDI scores and sociodemographic variables such as age, economic status, and educational profile, but showed significant differences within gender (t (780) = 3.222, p = 0.001). There was also a relatively stable level of depressive reactions in this population over the previous ten years. The Cronbach’s coefficient of the BDI scale was α = 0.860, with the majority of item-total correlations above 0.37. The three-factor structure represents cognitive aspect, affective component of depression, and somatic problems attached to depression. The cognitive factor prevails in the entire sample, which is in accordance with the Beck theory about dysfunctional attitudes, ie cognitive vulnerability is a psychological predisposition to depression. Keywords: Beck Depression Inventory, nonclinical student population, psychometric properties "Evaluación del Inventario de la Depresión Beck en una Muestra No Clínica de Estudiantes" RESUMEN La depresión es uno de los desórdenes psicológicos más comunes en los individuos que buscan tratamiento psiquiátrico, y un trastorno psicológico frecuente entre los pacientes que buscan atención primaria de la salud. Por consiguiente, es sumamente importante emplear normas e instrumentos de diagnóstico confiables y válidos en el trabajo investigativo o en el clínico, para investigar este problema. Este artículo es parte de un estudio mayor, llevado a cabo por espacio de diez años, con el objetivo de crear un cuadro más claro del nivel de depresión que puede esperarse en la población no clínica de Serbia, y de esa manera proveer una base para las comparaciones a la hora de diagnosticar la población clínica. Los objetivos secundarios fueron monitorear los cambios potenciales a nivel de las reacciones depresivas dentro del tiempo establecido y examinar las propiedades psicométricas y la estructura factorial del Inventario de Depresión de Beck (escala de BDI). La muestra estuvo formada por 782 estudiantes (40% varones, 60% hembra), edad M = 23.10, SD = 1.782. La puntuación media en la escala de BDI-IA fue 6.69; SD = 6.412. El estudio no mostró una relación significativa entre las puntuaciones de BDI y las variables sociodemográficas tales como la edad, la condición económica, y el perfil educacional, pero mostró diferencias significativas dentro del género (t (780) = 3.222, p = 0.001).  Hubo también un nivel relativamente estable de reacciones depresivas en esta población en los últimos diez años. El coeficiente de Cronbach en la escala de BDI fue = 0.860, hallándose la correlación ítem-total por encima de 0.37. La estructura trifactorial representa el aspecto cognitivo, el componente afectivo de la depresión, y los problemas somáticos vinculados con la depresión. El factor cognitivo prevalece en toda la muestra, lo cual concuerda con la teoría de Beck sobre las actitudes disfuncionales, es decir, la vulnerabilidad cognitiva es una predisposición psicológica a la depresión. Palabras claves: Inventario de Depresión de Beck, población estudiantil no clínica, propiedades psicométrica

Evaluation of the beck depression inventory in a nonclinical student sample

Depression is one of the most common psychological disorders in individuals seeking psychiatric treatment, and a frequent psychological disorder among patients who seek primary healthcare. Therefore, it is vitally important to employ reliable and valid diagnostic instruments and norms, both in clinical and research work to investigate this problem. This article is part of a larger study which has been conducted for ten years now with the aim to create a clearer picture about the level of depression which may be expected in the nonclinical population in Serbia, and in that way provide a basis for comparisons when diagnosing the clinical population. The subsidiary aims were to monitor potential changes in level of depressive reactions within the set time and to examine the psychometric properties and factor structure of the Beck Depression Inventory (BDI) scale. The sample consisted of 782 students (40% male, 60% female), mean age = 23.10 years, SD = 1.782. Mean score on the BDI-IA scale was 6.69; SD = 6.412. The study showed no significant relationships between the BDI scores and sociodemographic variables such as age, economic status, and educational profile, but showed significant differences within gender (t (780) = 3.222, p = 0.001). There was also a relatively stable level of depressive reactions in this population over the previous ten years. The Cronbach's coefficient of the BDI scale was a = 0.860, with the majority of item-total correlations above 0.37. The three-factor structure represents cognitive aspect, affective component of depression, and somatic problems attached to depression. The cognitive factor prevails in the entire sample, which is in accordance with the Beck theory about dysfunctional attitudes, ie cognitive vulnerability is a psychological predisposition to depression

The impact of gender differences on mortality in elderly patients after hip fracture

© 2018, Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved. Background/Aim. Hip fracture is one of the leading causes of death in elderly population. We evaluated the impact of gender differences on mortality rate in elderly patients with hip fracture. Methods. The study included all hospitalized elderly patients (aged over 65 years) with hip fracture during 2013. The patients were classified into four risk groups in accordance with institutional Şişli Etfal risk factor assessment scale ISERFAS to estimate postoperative mortality. Clinical, laboratory and risk score results were gender matched between survived and deceased patients. Hospital mortality was monitored as well as mortality at intervals of three and six months. The prediction effect of gender and overall risk variables on mortality rate were determined by univariate and multivariate logistic regression analyses. Results. The complete sample included 434 female and 163 male patients. Average age of men was 77.95 years and 79.18 years for women. Femoral neck fracture was more often seen in women (44.5%), but with no statistically significant difference (p = 0.57). Significant difference between the genders in relation to the risk score values was determined (p = 0.024). It was observed that the values of risk score was lower in the female patients and higher in the male patients. Cumulative mortality was 6% during hospital stay, 17.8% after three months and 25% after six months, respectively. In-hospital and six months after the hip fracture, the mortality rates were similar in both genders. The mortality rate was significantly higher in male patients (p = 0.035) three months after the hip fracture. The overall risk observed at all mortality intervals was a significant predictor by itself (p = 0.000). Independent gender prediction effect disappeared in joint effects of patients’ overall risk. Conclusion. Gender can be defined as a significant mortality predictor in patients with hip fracture. A risk assessment system to estimate postoperative mortality for hip fractures would be helpful in planning treatment for each patient

The impact of gender differences on mortality in elderly patients after hip fracture

Background/Aim. Hip fracture is one of the leading causes of death in elderly population. We evaluated the impact of gender differences on mortality rate in elderly patients with hip fracture. Methods. The study included all hospitalized elderly patients (aged over 65 years) with hip fracture during 2013. The patients were classified into four risk groups in accordance with institutional Şişli Etfal risk factor assessment scale ISERFAS to estimate postoperative mortality. Clinical, laboratory and risk score results were gender matched between survived and deceased patients. Hospital mortality was monitored as well as mortality at intervals of three and six months. The prediction effect of gender and overall risk variables on mortality rate were determined by univariate and multivariate logistic regression analyses. Results. The complete sample included 434 female and 163 male patients. Average age of men was 77.95 years and 79.18 years for women. Femoral neck fracture was more often seen in women (44.5%), but with no statistically significant difference (p = 0.57). Significant difference between the genders in relation to the risk score values was determined (p = 0.024). It was observed that the values of risk score was lower in the female patients and higher in the male patients. Cumulative mortality was 6% during hospital stay, 17.8% after three months and 25% after six months, respectively. In-hospital and six months after the hip fracture, the mortality rates were similar in both genders. The mortality rate was significantly higher in male patients (p = 0.035) three months after the hip fracture. The overall risk observed at all mortality intervals was a significant predictor by itself (p = 0.000). Independent gender prediction effect disappeared in joint effects of patients’ overall risk. Conclusion. Gender can be defined as a significant mortality predictor in patients with hip fracture. A risk assessment system to estimate postoperative mortality for hip fractures would be helpful in planning treatment for each patient. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175007

Risk factors for lethal outcome in patients with delirium tremens - psychiatrist's perspective: A nested case-control study

Background: The aim was to identify potential risk factors for lethal outcome in patients with delirium tremens (DT) treated in the psychiatric setting. Methods: In a nested case-control study, a total of 190 medical records of patients with DT hospitalized at the Psychiatric Clinic in Serbia between 2002 and 2011 were reviewed and analyzed. The characteristics of patients who died (cases) were compared with those who survived (controls). For each case, two controls (matched for age, gender, and year of hospitalization) were randomly chosen. Results: Significant differences between cases and controls were found for serum potassium levels (p 1,000.00; p = 0.004).Conclusions: Even though the number and duration of psychiatric hospitalizations were identified as factors determining survival after admission for DT, only serum potassium levels were found to be significant. Patients with an increase in potassium (or absence of hypokalemia) may require more intensive treatment. Monitoring of serum levels of potassium is important not only as an indicator for replacement but also as an indicator of maladaptation. © 2013 Ignjatovic-Ristic et al.; licensee BioMed Central Ltd

Depressive symptoms in medical students

Mental disorders represent a growing problem in the student population. Th ere has been a recent increase in the prevalence of depressive symptoms among medical students. Th e objective of this study was to determine the frequency of depressive symptoms in medical students to provide insight into this problem in our country. In total, 131 fourth-year medical students were included in the study. To determine rates of depressive symptoms in the student population, we used the BDI IA. Symptoms of depression were found in 26.7% of students. Th e most common levels of depression were mild and moderate. Th e mean value of the BDI scores was 7.51±7.62. Th e high level of depressive symptoms found in medical students highlights the need for more comprehensive insight and follow up of this problem in the student population

Structure of the attitudes towards cosmetic procedures’ acceptance

© 2019, Serbia Medical Society. All rights reserved. Introduction/Objectives The objective of our study was to investigate the structure of the cosmetic procedures’ acceptance attitudes and differences in acceptance between persons who had undergone minimally invasive cosmetic procedures and those who had not. Methods The study included 245 subjects (treatment group), 21–73 years old (42.02 ± 12.12). The control group included 250 subjects who had not previously undergone cosmetic procedures, also 21–73 years old (40.19 ± 11.71). The control group was balanced with the treatment group according to category distribution of demographic variables. The Acceptance of Cosmetic Surgery Scale, adjusted for cosmetic procedures in general, was used for the evaluation of participants’ attitudes towards these procedures. Results Internal consistency of the scale was α = 0.963, the split-half coefficient of validity was 0.861/0.810, and test–retest correlation coefficient was 0.892. The treatment group has shown overall higher acceptance (t(478) = 27.024, p < 0.001, η2 = 0.6), and higher scores in all three dimensions. No demographic variable has shown significant differences in total or individual factor scores in either group. Conclusion Subjects from both groups had scored higher on items dealing with the advantages of cosmetic procedures on a personal level (Intrapersonal Factor)