A War in a Pandemic: Implications of the Ukraine crisis and COVID-19 on global governance of migration and remittance flows

This Migration and Development Brief (number 36 in the series) discusses the anticipated effects of the Russian invasion of Ukraine on migration and remittance flows. And ahead of the International Migration Review Forum to be held in May 2022, the brief indicates how the global governance of migration can be strengthened and cross-border remittance flows facilitated. Developments concerning migration-related Sustainable Development Goal (SDG) indicators for which the World Bank is a custodian--increasing the volume of remittances as a percentage of gross domestic product (SDG indicator 17.3.2) and reducing remittance costs (SDG indicator 10.c.1)--are also discussed

Analiza kliničkih ispitivanja za procenu efikasnosti i bezbednosti kvetiapina u terapiji velike depresije

In this review is shown the analysis of clinical studies of the efficacy and safety of atypical antipsychotic extended release quetiapine, in the treatment of adult patients with major depressive disorder (MDD), as short-term monotherapy, short-term adjunctive treatment to on-going antidepressant and maintenance treatment or relapse prevention in major depressive episodes. Recommended dosing regimen was 50 to 300 mg daily. Six of seven studies were positive on the primary efficacy variable (MADRS, Montgomery Asberg Depression Rating Scale score) on at least one dose under investigation, whilst one study was not significant. None of the studies was positive on the secondary endpoint: improvement in the quality of life, by assessing the change in Q-LES-Q total score (Quality of Life Enjoyment and Satisfaction Questionnaire). Overall, the safety findings from the extended release quetiapine MDD clinical studies are consistent with known adverse event profile for quetiapine in other known indications: schizophrenia and bipolar disorder. However, during the short-term exposure in the extended release quetiapine MDD clinical studies, the long-term serious adverse events, in particular risk related to metabolic changes, and possibility of tardive dyskinesia and increased risk of sudden cardiac death, has not been adequately studied, therefore the risk benefit ratio, for now, can not be assessed as favorable, with high reliability. Despite that, the regulatory authorities in the U.S. (FDA - Food and Drug Administration) and EU (EMA - European Medicines Agency) have approved, however, reduced indication for extended release quetiapine in the treatment of major depressive disorder: add-on treatment of major depressive episodes in patients with MDD who had suboptimal response to antidepressant monotherapy, noting that, prior to initiating treatment, clinicians should consider the safety profile of extended release quetiapine.U radu je prikazana analiza kliničkih studija za procenu efikasnosti i bezbednosti atipičnog antipsihotika kvetiapina, u obliku tableta sa produženom brzinom oslobađanja kod odraslih pacijenata sa velikom depresijom, primenjenog kao: kratkotrajna monoterapija, kratkotrajna dodatna terapija na primenjivani antidepresiv i monoterapija održavanja u prevenciji relapsa epizode velike depresije. Preporučen opseg doza kvetiapina u ovim studijama bio je 50 do 300 mg/dan. Rezultati šest od sedam sprovedenih kliničkih studija pokazali su da je kvetiapin u obliku tableta sa produženom brzinom oslobađanja statistički značajno efikasniji u odnosu na placebo, s obzirom na primarni parametar efikasnosti, promenu ukupnog MADRS skora (Montgomery Asberg Depression Rating Scale Score) za bar jednu od doza koje su ispitivane u studijama, dok u jednoj od studija nije pokazana statistički značajna razlika između kvetiapina i placeba, u odnosu na ovaj parametar efikasnosti. Niti u jednoj od studija kvetiapin u obliku tableta sa produženim oslobađanjem nije bio statistički značajno efikasniji od placeba u odnosu na sekundarni parametar efikasnosti: poboljšanje kvaliteta života procenjeno na osnovu promene ukupnog skora Q-LES-Q upitnika (Quality of Life Enjoyment and Satisfaction Questionnaire total score). Profil neželjenih efekata kvetiapina u obliku tableta sa produženim oslobađanjem u sprovedenim kliničkim studijama na pacijentima sa velikom depresijom nije se razlikovao od poznatog bezbednosnog profila kvetiapina ustanovljenog u ranije odobrenim indikacijama za ovaj lek (shizofrenija i bipolarni poremećaj). Međutim, kratkotrajna izloženost pacijenata sa velikom depresijom kvetiapinu u sprovedenim kliničkim studijama, nije dovoljna za procenu rizika od njegovih dugoročnih ozbiljnih neželjenih efekata kao što su: metabolički poremećaji, potencijalni rizik za razvoj tardivne diskinezije i mogućnost povećanja rizika od iznenadne srčane smrti, tako da se odnos korist/rizik primene ovog leka kod pacijenata sa velikom depresijom, još uvek ne može, sa velikom pouzdanošću, proceniti kao povoljan. Uprkos tome, regulatorna tela u SAD (FDA - Food and Drug Administration) i EU (EMA - European Medicines Agency) odobrila su, doduše, suženu indikaciju za kvetiapin u obliku tableta sa produženim oslobađanjem u terapiji velike depresije: dodatna terapija (add-on) kod pacijenata sa velikom depresijom, koji su imali suboptimalan odgovor na monoterapiju antidepresivom, uz napomenu da, pre započinjanja terapije, lekari treba da razmotre profil bezbednosti ovog leka

Faktori koji utiču na cenu antibiotske terapije i ishod kod kritično obolelih pacijenata - 'real-life' studija

Background/Aim. Critically ill patients are at very high risk of developing severe infections in intensive care units (ICUs). Procalcitonin (PCT) levels are eleveted in the circulation in patients with bacterial sepsis and PCT might be useful in guiding antibiotic treatment. The aim of this study was to estimate factors influencing patients survival and treatment cost in ICU with special emphasis on the impact of PCT serum levels use in guiding antimicrobial therapy. Methods. The study was conducted from August 2010 to May 2012 in the Intensive Therapy Unit, Clinic of Anesthesiology and Intensive Therapy, Military Medical Academy (MMA), Belgrade, Serbia. All adult critically ill patients with sepsis and/or trauma admitted in the ICU were included in the study. This study included only the cost of antimicrobial therapy in the ICU and the cost for PCT analysis. We used prices valid in the MMA for the year 2012. PCT in serum was measured by homogeneous immunoassay on a Brahms Kryptor analyzer. Results. A total of 102 patients were enrolled. The mean patients age was 55 ± 19 years and 61.8% of patients were male. The mean length of stay (LOS) in the ICU was 12 ± 21 days. There was a statistically significant difference (p lt 0.001) between the sepsis and trauma group regarding outcome (higher mortality rate was in the sepsis group, particularly in the patients with peritonitis who were mostly women). The patients younger than 70 years had better chance of survival. LOS, the use of carbapenems and PCT-measurement influenced the cost of therapy in the ICU. Conclusions. The obtained results show that age, the diagnosis and gender were the main predictors of survival of critically ill patients in the ICU. The cost of ICU stay was dependent on LOS, use of carbapenems and PCT measurement although the influence of these three factors on the outcome in the patients did not reach a statistical significance.Uvod/Cilj. Kritično oboleli pacijenti imaju veliki rizik od razvoja teških infekcija u jedinicama intenzivne terapije (JIT). Nivo prokalcitonina (PCT) u cirkulaciji je povišen kod bolesnika sa bakterijskom sepsom, tako da PCT može biti koristan u praćenju antibiotske terapije. Cilj ove studije bio je da se ustanove faktori koji utiču na ishod i troškove lečenja u JIT u našoj ustanovi sa posebnim naglaskom na uticaj korišćenja serumskog nivoa PCT u vođenju antimikrobne terapije. Metode. Studija je sprovedena od avgusta 2010. godine do maja 2012. godine u Jedinici intenzivne terapije Klinike za anesteziologiju i intenzivnu terapiju Vojnomedicinske akademije (VMA) u Beogradu, Srbija. Svi kritično oboleli sa sepsom i/ili traumom koji su primljeni u JIT bili su uključeni u studiju. Studijom su obuhvaćeni samo troškovi antimikrobne terapije u JIT i troškovi PCT analize. Koristili smo cenovnik VMA za 2012. godinu. PCT u serumu je meren tehnikom homogenog imunoeseja na Brams Kriptor analizatoru. Rezultati. Studijom su bila obuhvaćena 102 bolesnika. Prosečna starost bolesnika iznosila je 55 ± 19 godina, a 61,8% bolesnika bili su muškarci. Prosečna dužina boravka u JIT (lenght of stay LOS) iznosila je 12 ± 21 dana. Postojala je statistički značajna razlika (p lt 0.001) između ishoda lečenja u grupi sa sepsom u odnosu na grupu sa traumom. Bolesnici mlađi od 70 godina imali su bolju šansu da prežive. Dužina boravka, upotreba karbapenema i merenje PCT uticali su na cenu terapije u JIT. Zaključak. Dobijeni rezultati pokazuju da su godine života, dijagnoza i pol bili glavni prediktori preživljavanja kritično obolelih u JIT. Cena terapije zavisila je od dužine boravka u JIT, upotrebe karbapenema i merenja PCT, ali uticaj ovih faktora na ishod lečenja nije dostigao statističku značajnost

Upotreba beta-laktamskih antibiotika u jedinicama intenzivne terapije - patofiziološki, farmakokinetički, farmakodinamički i farmakoekonomski pristup

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Factors influencing antibiotic treatment cost and outcome in critically ill patients: A “real-life” study

Background/Aim. Critically ill patients are at very high risk of developing severe infections in intensive care units (ICUs). Procalcitonin (PCT) levels are eleveted in the circulation in patients with bacterial sepsis and PCT might be useful in guiding antibiotic treatment. The aim of this study was to estimate factors influencing patients survival and treatment cost in ICU with special emphasis on the impact of PCT serum levels use in guiding antimicrobial therapy. Methods. The study was conducted from August 2010 to May 2012 in the Intensive Therapy Unit, Clinic of Anesthesiology and Intensive Therapy, Military Medical Academy (MMA), Belgrade, Serbia. All adult critically ill patients with sepsis and/or trauma admitted in the ICU were included in the study. This study included only the cost of antimicrobial therapy in the ICU and the cost for PCT analysis. We used prices valid in the MMA for the year 2012. PCT in serum was measured by homogeneous immunoassay on a Brahms Kryptor analyzer. Results. A total of 102 patients were enrolled. The mean patients age was 55 ± 19 years and 61.8% of patients were male. The mean length of stay (LOS) in the ICU was 12 ± 21 days. There was a statistically significant difference (p < 0.001) between the sepsis and trauma group regarding outcome (higher mortality rate was in the sepsis group, particularly in the patients with peritonitis who were mostly women). The patients younger than 70 years had better chance of survival. LOS, the use of carbapenems and PCT-measurement influenced the cost of therapy in the ICU. Conclusions. The obtained results show that age, the diagnosis and gender were the main predictors of survival of critically ill patients in the ICU. The cost of ICU stay was dependent on LOS, use of carbapenems and PCT measurement although the influence of these three factors on the outcome in the patients did not reach a statistical significance

Beta-lactam antibiotics use in intensive care units - the pathophysiological, pharmacokinetic, pharmacodynamic and pharmacoeconomic approach

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Determinants of quality of life among individuals seeking mental health care after termination of state of emergency due to the coronavirus disease 2019 pandemic

Prompted by the need to measure the impact of the coronavirus disease 2019 on main areas of quality of life related to mental health (MH), the COV-19-impact on quality of life (COV19-QoL) scale has been developed recently. We measured how patients seeking face-to-face MH care perceived the coronavirus disease 2019 impact on QoL and how socio-demographic factors, stress, and personality contributed to QoL in this diagnostically diverse population. Patients aged 18 to 65 years (n = 251) who came for the first time to the outpatient units during the 6-week index-period (May 21-July 1, 2020) were included. The cross-sectional assessment involved sociodemographic variables, working diagnosis, personality traits (7-dimension model, including HEXACO and DELTA), stress (list of threatening experiences and proximity to virus), and COV19-QoL. The perceived impact of the pandemic on QoL was above the theoretical mean of a 5-point scale (COV19-Qol = 3.1 +/- 1.2). No association between total COV19-QoL score, sociodemographic parameters, and working diagnoses was found in the present sample. After testing whether positional (threatening experiences), or dispositional (personality) factors were predominant in the perceived impact of COV-19 on QoL, significant predictors of the outcome were personality traits Disintegration (B = 0.52; P lt .01) and Emotionality (B = 0.18; P lt .05). It seems that pervasiveness and uncertainty of the pandemic threat triggers-especially in those high on Disintegration trait-a chain of mental events with the decrease of QoL as a final result. Present findings could be used to establish a profile of MH help seeking population in relation to this biological disaster, and to further explore QoL and personality in different contexts