SCREENING OF NUTRITIONAL STATUS AMONG ELDERLY PEOPLE AT FAMILY MEDICINE

Prevalencija malnutricije kod osoba starije životne dobi je visoka. Otkrivanje malnutricije ili rizika za nastanak malnutricije se može sprovesti korištenjem instrumenata za probir i procjenu nutritivnog statusa. Cilj ovog preglednog članka je istražiti instrumente kojima je bilo provedeno istraživanje validnosti, pouzdanosti, specifi čnosti i senzitivnosti za probir nutritivnog statusa osoba starijih od 65 godina u obiteljskojj medicini. Sistematski pregled literature učinjen je prema iskazu Preferencijalno izvještavanje o stavkama za sistematske preglede i meta-analiza (Preferred Reporting Items for Systematic Reviews and meta-analysis (PRISMA) statement). Studije su preuzete preko elektronskih baza MEDLINE, Pubmed i Cochrane Library, te manualnim pretraživanjem relevantnih studija citiranih u listi referenci ključnih članaka. Elektronske baze su pretraživane defi niranjem ključnih riječi (nutrition, nutritional status, malnutrition, screening, assessment, evaluation, tool, family medicine, general practice) adaptiranih za svaku bazu i korištenjem termina MESH (Medical Subject Headings). Manualno pretraživanje preglednih članaka i originalnih članaka učinjeno je preko Electronic Journals Library. Uključene studije su obuhvatile ispitivanje validacije instumenata probira nutritivnog statusa na samostalnim osobama starijim od 65 godina života. Analizom studija pronađeni su sljedeći instrumenti: Mini nutritivna procjena (engl. Mini Nutritional Assessment - MNA), Kratka Mini nutritivna procjena (engl. Mini Nutritional Assessment-Short Form - MNA-SF), Inicijativa za nutritivni probir (engl. Nutrition Screening Initiative - NSI), koja uključuje listu DETERMINE, Level I i II Screen, Stari u zajednici: Evaluacija rizika za jedenje i nutriciju (engl. Seniors in the Community: Risk Evaluation for Eating and Nutrition -SCREEN I and SCREEN II), Subjektivna globalna procjena (engl. Subjective Global Assessment - SGA), Indeks nutritivnog rizika (engl. Nutritional Risk Index - NRI), zatim južnoafrički i malezijski instrument bez specifi čnog naziva. MNA i MNA-SF imaju najveću pouzdanost i validnost za probir nutritivnog statusa (NS) u zajednici, a pouzdanost i validnost SCREEN II su zadovoljavajući. Premda je za probir NS kod samostalnih osoba starijih od 65 godina razvijeno nekoliko instrumenata, većina nije prošla sveobuhvatno ispitivanje validnosti. MNA i MNA-SF imaju najveću pouzdanost i validnost za skrining NS kod samostalnih osoba starijih od 65 godina, a pouzdanost i validnost SCREEN II su zadovoljavajuće. Ovi instrumenti također sadrže sva tri indikatora NS i praktični su za korištenje u obiteljskoj medicini. Ipak, zlatni standard za probir se ne može postaviti jer je dalje ispitivanje pouzdanosti i kontinuiranu validaciju studijama više razine dokaza potrebno kontinuirano sprovesti u obiteljskoj medicini.The prevalence of malnutrition in elderly is high. Malnutrition or risk of malnutrition can be detected by use of nutritional screening or assessment tools. This systematic review aimed to identify tools that would be reliable, valid, sensitive and specifi c for nutritional status screening in patients older than 65 at family medicine. The review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were retrieved using MEDLINE (via Ovid), PubMed and Cochrane Library electronic databases and by manual searching of relevant articles listed in reference list of key publications. The electronic databases were searched using defi ned key words adapted to each database and using MESH terms. Manual revision of reviews and original articles was performed using Electronic Journals Library. Included studies involved development and validation of screening tools in the community-dwelling elderly population. The tools, subjected to validity and reliability testing for use in the community-dwelling elderly population were Mini Nutritional Assessment (MNA), Mini Nutritional Assessment-Short Form (MNA-SF), Nutrition Screening Initiative (NSI), which includes DETERMINE list, Level I and II Screen, Seniors in the Community: Risk Evaluation for Eating, and Nutrition (SCREEN I and SCREEN II), Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), and Malaysian and South African tool. MNA and MNA-SF appear to have highest reliability and validity for screening of community-dwelling elderly, while the reliability and validity of SCREEN II are good. The authors conclude that whilst several tools have been developed, most have not undergone extensive testing to demonstrate their ability to identify nutritional risk. MNA and MNA-SF have the highest reliability and validity for screening of nutritional status in the community-dwelling elderly, and the reliability and validity of SCREEN II are satisfactory. These instruments also contain all three nutritional status indicators and are practical for use in family medicine. However, the gold standard for screening cannot be set because testing of reliability and continuous validation in the study with a higher level of evidence need to be conducted in family medicine

O granicama sadržaja radionuklida u hrani i hrani za životinje u normalnim uslovima

У раду је дат приказ домаћих и европских прописа којима се регулише садржај радионуклида у храни и храни за животиње. Будући да се релевантним међународним документима не прописују експлицитно границе садржаја радионуклида у храни и храни за животиње у нормалним околностима, у овом раду ће бити дат приступ за решавање недоумица у погледу наведене регулативе и прописивања квалитета хране са радиолошког становишта.Radionuclide content in food, feed and MCP/DCP as additives in feeding stuffs are discussed regarding national and EU current regulations and law. Since there is no relevant international legislation on radioactive contamination of food and feed under normal conditions, it has been proposed the way of overcoming concerns about guideline level.Зборник радова : XXIX симпозијум ДЗЗСЦГ : Сребрно језеро, 27-29. септембар 2017. годин

O granicama sadržaja radionuklida u hrani i hrani za životinje u normalnim uslovima

У раду је дат приказ домаћих и европских прописа којима се регулише садржај радионуклида у храни и храни за животиње. Будући да се релевантним међународним документима не прописују експлицитно границе садржаја радионуклида у храни и храни за животиње у нормалним околностима, у овом раду ће бити дат приступ за решавање недоумица у погледу наведене регулативе и прописивања квалитета хране са радиолошког становишта.Radionuclide content in food, feed and MCP/DCP as additives in feeding stuffs are discussed regarding national and EU current regulations and law. Since there is no relevant international legislation on radioactive contamination of food and feed under normal conditions, it has been proposed the way of overcoming concerns about guideline level.Зборник радова : XXIX симпозијум ДЗЗСЦГ : Сребрно језеро, 27-29. септембар 2017. годин

Predicting violence in veterans with posttraumatic stress disorder

Background/Aim. Frequent expression of negative affects, hostility and violent behavior in individuals suffering from posttraumatic stress disorder (PTSD) were recognized long ago, and have been retrospectively well documented in war veterans with PTSD who were shown to have an elevated risk for violent behavior when compared to both veterans without PTSD and other psychiatric patients. The aim of this study was to evaluate the accuracy of clinical prediction of violence in combat veterans suffering from PTSD. Methods. The subjects of this study, 104 male combat veterans with PTSD were assessed with the Historical, Clinical and Risk Management 20 (HCR-20), a 20-item clinicianrated instrument for assessing the risks for violence, and their acts of violence during one-year follow-up period were registered based on bimonthly check-up interviews. Results. Our findings showed that the HCR-20, as an actuarial measure, had good internal consistency reliability (α = 0.82), excellent interrater reliability (Interaclass Correlation ICC = 0.85), as well as excellent predictive validity for acts of any violence, non-physical violence or physical violence in the follow-up period (AUC = 0.82-0.86). The HCR-20 also had good interrater reliability (Cohen's kappa = 0.74), and acceptable predictive accuracy for each outcome criterion (AUC = 0.73-0.79). Conclusion. The results of this research confirm that the HCR-20 may also be applied in prediction of violent behavior in the population of patients suffering from PTSD with reliability and validity comparable with the results of previous studies where this instrument was administered to other populations of psychiatric patients

Razvoj i validacija metode tečne hromatografije spregnute sa masenom spektrometrijom za određivanje sadržaja rivaroksabana u uzorcima plazme

Rivaroxaban belongs to the group of direct oral anticoagulants (DOAC), drugs used to prevent and treat venous thrombosis and venous thromboembolism. Drugs from this group are considered safer than vitamin K antagonists. In case of overdose, their most significant side effect is bleeding. Given the great toxicological significance, it is very important to develop an analytical method for quantification of this drug in biological samples. The liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the determination of rivaroxaban content in plasma samples was optimized and validated. Plasma samples were prepared by protein precipitation with cold acetonitrile. Carbamazepine was used as an internal standard. The analysis was performed on an Infinity Lab Poroshell 120 EC-C18, 4.6 ×100 mm, 2.7 μm chromatographic column. The mobile phase consisted of acetonitrile and 0.1% formic acid (50:50, v/v), at a flow rate of 400 μL/min and a column temperature set at 30°C. The autosampler temperature was 4C. The injection volume was 10 μL. Detection of analytes and internal standard was performed in multireaction monitoring mode (MRM), at the following ion transitions: 437>145 (m/z) for rivaroxaban, and 237>194 (m/z) for the internal standard. The optimized method was validated and the obtained parameters indicate that the method is sensitive, specific, selective, precise and accurate. The samples were stable under the tested conditions. A validated method has been used to determine the concentration of rivaroxaban in plasma samples of patients with atrial fibrillation who were hospitalized under strict medical supervision. Obtained concentrations were in the expected range.Rivaroksaban pripada grupi direktnih oralnih antikoagulanasa (DOAK), lekova koji se koriste za prevenciju i lečenje venske tromboze i venske tromboembolije. Lekovi iz ove grupe se smatraju bezbednijim od antagonista vitamina K. U slučaju predoziranja, njihov najznačajniji neželjeni efekat je krvarenje. S obzirom na veliki toksikološki značaj, veoma je važno postojanje analitičke metode za određivanje sadržaja ovog leka u uzorcima biološkog materijala. Optimizovana je i validirana metoda tečne hromatografije spregnute sa masenom spektrometrijom (LC-MS/MS) za određivanje sadržaja rivaroksabana u uzorcima plazme. Uzorci plazme su pripremani metodom precipitacije proteina koja je vršena hladnim acetonitrilom. Kao interni standard korišćen je karbamazepin. Analiza je izvršena na Infinity Lab Poroshell 120 EC-C18, 4,6×100 mm, 2,7 μm hromatografskoj koloni. Mobilna faza se sastojala od acetonitrila i 0,1% mravlje kiseline (50:50, v/v), pri protoku od 400 μL/min i temperaturi kolone podešenoj na 30°C. Temperatura autosemplera je bila 4C. Injekciona zapremina je bila 10 μL. Detekcija analita i internog standarda je izvršena u multireakcionom monitoring modu (MRM), pri sledećim jonskim prelazima: 437>145 (m/z) za rivaroksaban, odnosno 237>194 (m/z) za interni standard. Optimizovana metoda je validirana i dobijeni parametri ukazuju da je metoda osetljiva, specifična, selektivna, precizna i tačna. Uzorci su stabilni pri ispitivanim uslovima. Validirana metoda je primenjena za određivanje koncentracije rivaroksabana u uzorcima plazme pacijenata sa atrijalnom fibrilacijom, koji su bili hospitalizovani, pod strogim medicinskim nadzorom. Određene koncentracije su bile u očekivanom opsegu.VIII Kongres farmaceuta Srbije sa međunarodnim učešćem, 12-15.10.2022. Beogra

Long-term stability of clopidogrel solid dispersions-Importance of in vitro dissolution test

Formulation of solid dispersions (SDs), in which the drug substance is dissolved or dispersed inside a polymer matrix, is one of the modern approaches to increase the solubility and dissolution rate of poorly soluble active pharmaceutical ingredients (APIs), such as clopidogrel. In the form of a free base, clopidogrel is unstable under increased both high moisture and temperature, so it is most often used as its salt form, clopidogrel hydrogen sulfate (CHS).The aim of this study was the formulation, characterization, and long-term stability investigation of CHS solid dispersions, prepared with four different hydrophilic polymers (poloxamer 407, macrogol 6000, povidone, copovidone) in five API/polymer ratios (1:1, 1:2, 1:3, 1:5, 1:9). SDs were prepared by the solvent evaporation method, employing ethanol (96% v/v) as a solvent. Initial results of the in vitro dissolution test showed an increase in the amount of dissolved CHS from all prepared SD samples compared to pure CHS, corresponding physical mixtures (PMs), and commercial tablets. SDs, prepared with poloxamer 407, macrogol 6000, and copovidone, at CHS/polymer ratios 1:5 and 1:9, notably increased the amount of dissolved CHS (> 80%, after 60 min), thus they were selected for further characterization. To assess the SDs long-term stability, in vitro dissolution studies, clopidogrel content determination, differential scanning calorimetry (DSC), and Fourier transform infrared spectroscopy (FT-IR) were performed initially and after 12 months of long-term stability studies under controlled conditions (25°C, 60% RH) meeting the ICH guideline Q1A (R2) requirements. The clopidogrel content in the selected samples was very similar at the beginning (96.13% to 99.93%) and at the end (95.98% to 99.86%) of the conducted test. DSC curves and FT-IR spectra of all SD samples after 12 months of stability study, showed the absence of CHS crystallization, which is an indication of good stability. However, the in vitro dissolution test showed a considerable reduction in CHS released from SDs with macrogol 6000. The amount of dissolved CHS from SDs with macrogol 6000 was initially 94.02% and 92.01%, and after 12 months of stability study, only 65.13% and 49.62%. In contrast, the amount of dissolved CHS from SDs prepared with poloxamer 407 and copovidone was very similar after 12 months of the stability study compared to the initial values. Results obtained indicated the great importance of the in vitro dissolution test in determining the long-term stability and quality of SDs