Effect of antiepileptic drug comedication on lamotrigine concentrations

Aim To estimate the effect size of concomitant antiepileptic therapy on the concentrations of lamotrigine, a drug often prescribed in combination with other antiepileptic drugs (AED), which can act as enzyme inducers or inhibitors. Methods A total of 304 patients with epilepsy, aged 18- 70 years, were divided into a lamotrigine monotherapy group and groups receiving lamotrigine with AEDs that act as enzyme inducers, enzyme inhibitors, or both. We compared lamotrigine monotherapy serum concentrations with those where lamotrigine was administered with a metabolic inhibitor valproate, metabolic inducers carbamazepine, oxcarbazepine, phenobarbital, phenytoin, or topiramate, and both an inducer and an inhibitor. Results Comparison of trough lamotrigine monotherapy concentrations and lamotrigine polytherapy concentrations showed an almost similar median concentration in case of drug-inducers, and higher lamotrigine concentration in case of comedication with valproate as an inhibitor. A significant difference was confirmed after dose correction (P < 0.001). Significant positive correlations of lamotrigine trough serum concentrations with valproate were observed before and after the dose correction (r = 0.480, P < 0.001 and r = 0.561, P < 0.001, respectively). Positive correlations between the dose-corrected lamotrigine trough concentration and carbamazepine (r = 0.439; P < 0.001) or monohydroxy metabolite of oxcarbazepine (MHD) (r = 0.675; P < 0.001) were also significant. Conclusion Higher valproate levels resulted in higher inhibition potency and higher lamotrigine levels. Increased dose-corrected concentrations of inducers carbamazepine and MHD, after the process of induction was finished, did not lower lamotrigine concentrations. These findings can be of clinical significance for optimal AED dosing

The Chronology of Third Molar Eruption in the Croatian Population

Dental age estimation is common in orthodontics, paedodontics, paleodontology and forensic dentistry. The aim of this study was to assess chronological course of eruptive developmental phases of third molar and to establish parameters for the Croatian population. Sample of this study consisted of 1249 orthopantomograms of 530 (42.4%) male and 719 (57.6%) female subjects, aged 10 to 25 years. Eruptive phases were classified in 4 stages. No significant sex difference was found. Established chronology of the third molar eruption can be used as a standard for the assessment of dental age in clinical and forensic research on samples of Croatian population

Implantoprosthetic Therapy of a Missing Front Tooth

Posljednjih nekoliko desetljeća implantantno-protetička terapija sve se češće predlaže kod djelomice ozubljene čeljusti. Ugradnja implantata u prednjem dijelu usta vrlo je zahtjevna i tehnički osjetljiva. Pacijenti danas zahtijevaju da protetički radovi izgledaju potpuno prirodno, a to od kliničara traži edukaciju, znanje i sposobnost. Svrha ovoga rada jest predstaviti rezultate implatatno-protetičke terapije manjka prednjeg zuba kod pacijenata Katedre za fiksnu protetiku Stomatološkog fakulteta u Zagrebu. Posljednjih desetak godina ukupno su sanirana 23 pacijenta. Razlozi za manjak zuba bili su sljedeći: karijes nakon endodontskog liječenja ili pucanje devitaliziranog zuba, trauma, anodoncija te parodontni proces. Najčešće su bili nadomješteni gornji srednji sjekutići, zatim bočni sjekutići, očnjaci i jedan donji srednji sjekutić. Implantati su prosječno u funkciji oko 5 godina. Nije zabilježen njihov gubitak. Funkcijska i estetska trajnost implantantno-protetičke terapije ovise o biomehaničkim čimbenicima, no ne smije buknuti ni infekcija. Iako su pacijenti neredovito dolazili na kontrole, implantantno-protetičkom terapijom postigli smo zadovoljavajući uspjeh.In the recent decade, implant-prosthetic therapy in partially edentulous patients is more and more suggested therapy. Implant placement in front region is very demanding and technically sensitive. Growing patients’ demands for natural look of prosthetic appliances in visible region of oral cavity forces clinicians for education, knowledge and capabilities. The aim of the study is clinical evaluation of prosthetic-implant therapy in patients with missing front tooth at the Department of Prosthodontics, School of Dental Medicine Zagreb. Total of 23 patients had implant therapy during the last decade. The reasons for tooth loss were: caries and fracture of endodontic treated tooth, trauma, anodontia and periodontal disease. Upper medial incisor was replaced in most cases, than upper lateral incisor, upper canine and lower medial incisor. The implants are approximately 5 years in function. No implant failure was reported. Functional durability and esthetic of prosthetic/implant therapy depends on biomechanical factors and lack of infection. Cooperation of patients in this study for regular check-ups was minimal but nevertheless success of therapy was satisfactory

Occupational Injuries among Dentists in Croatia

Za stomatološku profesiju karakterističan je, nažalost, veliki rizik od ozljeda na radu. Uzrok su specifični radni uvjeti – radno polje je malo i nalazi se u ustima pacijenta, rukuje se mnogobrojnim oštrim instrumentima i svrdlima koja se okreću velikom brzinom, što uz vodeno hlađenje stvara aerosol kontaminiranu mnoštvom čestica sline i krvi. Na taj se način na stomatologa mogu prenijeti infekcije s pacijenta zaraženog, na primjer, hepatitisom B i/ili C, ili HIV-om ako se slučajno ubode iglom ili poreže, što su najčešće ozljede stomatologa na radu, a slijede ih prema učestalosti ozljede oka. Svrha rada: Svrha ovog rada bila je istražiti učestalost ozljeda stomatologa na radu u Hrvatskoj, koje su ozljede najčešće te ustanoviti rizične čimbenike za njihov nastanak (spol, dob, specijalizacija, godine staža). Jedan od ciljeva istraživanja bio je i doznati mišljenje stomatologa o uzročnicima odgovornima za nastanak profesionalnih bolesti i ozljede na radu. Materijal i metode: Istraživanje je provedeno na uzorku od 406 stomatologa u Hrvatskoj koji su odgovorili na pitanja postavljena u elektroničkoj anketi. Rezultati: Ozljedu koja je nastala tijekom obavljanja stomatološke djelatnosti imalo je 63,05 % ispitanika, a 16,5 % zbog je toga potražilo pomoć liječnika. Među ozljedama su najzastupljeniji bili ubodni incidenti iglom (57,75 %) te porezotine (20,86 %), slijede ozljede oka (13,37 %), ugriz pacijenta (4,81 %) pa udarac (1,60 %). Kao najvažniji uzročnik profesionalnih bolesti i ozljeda najviše ispitanika navelo je nepravilan položaj tijela pri radu, a slijede stres, infekcija i buka. Zaključak: Poznavanje rizičnih čimbenika najvažnije je u prevenciji ozljeda, stoga možemo zaključiti da su naši ispitanici velikim dijelom bili svjesni opasnosti koje ih okružuju. Unatoč tomu učestalost ozljeda bila je velika pa su i dalje potrebne preventivne mjere kao bi se ozljede svele na najmanju moguću razinu.Objectives: Dental profession is characterized by a high risk of injuries at work due to exposure to specific working conditions. The operating area in a patient’s mouth is small, and it is handled by a large number of sharp instruments and drills that rotate at high speed, which creates an aerosol contaminated with particles of saliva and blood. This poses a risk of transmitting infections from patients to the dentist through stabbing incidents and cuts, which are some of the most common occupational injuries that are reported in the scientific literature. Objective: The aim of this study was to examine the frequency of occupational injuries among dentists in Croatia, to establish most common injuries, and to determine the main risk factors. The aim of this research was also to determine the dentists’ opinion on causes that are responsible for the occupational diseases and injuries. Material and methods: The survey was conducted based on a sample of 406 dentists from Croatia as respondents to an electronic survey. Results: 63.05% of the respondents suffered injuries caused by dental practitioners. The most common injuries were needle puncture incidents (57.75%) and cuts (20.86%), followed by eye injuries (13.37%), patient bite (4.81%) and punches (1.60%). The largest number of respondents stated the improper posture as the most important cause of occupational diseases and injuries, followed by stress, infection and noise. Conclusion: knowledge of risk factors is the first step of injury prevention. Our respondents were largely aware of the dangers surrounding them. Nevertheless, the frequency of injuries was high and there is still a need for preventive measures to minimize the frequency of injuries in dentistry

In vitro dissolution/release methods for mucosal delivery systems

In vitro dissolution/release tests are an indispensable tool in the drug product development, its quality control and the regulatory approval process. Mucosal drug delivery systems are designed to provide both local and systemic drug action following ocular, nasal, oromucosal, vaginal or rectal administration. They exhibit significant differences in formulation design, physicochemical characteristics and drug release properties. Therefore it is not possible to devise a single method which would be suitable for release testing of such versatile and complex dosage forms. Different apparatuses and techniques for in vitro release testing for mucosal delivery systems considering the specific conditions at the administration site are described. In general, compendial apparatuses and methods should be used as a first approach in method development when applicable. However, to assure adequate simulation of conditions in vivo, novel biorelevant in vitro dissolution/release methods should be developed. Equipment set up, the selection of dissolution media and volume, membrane type, agitation speed, temperature, and assay analysis technique need to be carefully defined based on mucosal drug delivery system characteristics. All those parameters depend on the delivery system and physiological conditions at the site of application and may vary in a wide range, which will be discussed in details

In vitro dissolution/release methods for mucosal delivery systems

In vitro dissolution/release tests are an indispensable tool in the drug product development, its quality control and the regulatory approval process. Mucosal drug delivery systems are designed to provide both local and systemic drug action following ocular, nasal, oromucosal, vaginal or rectal administration. They exhibit significant differences in formulation design, physicochemical characteristics and drug release properties. Therefore it is not possible to devise a single method which would be suitable for release testing of such versatile and complex dosage forms. Different apparatuses and techniques for in vitro release testing for mucosal delivery systems considering the specific conditions at the administration site are described. In general, compendial apparatuses and methods should be used as a first approach in method development when applicable. However, to assure adequate simulation of conditions in vivo, novel biorelevant in vitro dissolution/release methods should be developed. Equipment set up, the selection of dissolution media and volume, membrane type, agitation speed, temperature, and assay analysis technique need to be carefully defined based on mucosal drug delivery system characteristics. All those parameters depend on the delivery system and physiological conditions at the site of application and may vary in a wide range, which will be discussed in details

Nurses’ Knowledge of Palliative Care

Introduction. Palliative care has evolved to identify the specific needs of patients with severe and incurable diseases. An estimated 46,000 patients in the Republic of Croatia require some form of palliative care. The aim of this study is to examine nurses’ knowledge of palliative care. Methods. A cross-sectional study included 198 nurses. The survey was conducted during March and April of 2017. As a survey instrument, a 2-part questionnaire was used. The first part dealt with sociodemographic data and the second part consisted of a standardized palliative care quiz for nursing (PCQN) questionnaire. Results. Respondents gave the most correct answers in the area of pain and other symptoms control. It was found that there was no significant difference in gender, age, or seniority in knowledge of palliative care. Respondents who received informal education showed better knowledge. Conclusion. From the study conducted, we can conclude that nurses have insufficient knowledge of palliative care

Spolno-neovisna ekspresija izmjenjivača klora i mravlje kiseline Cfex (Slc26a6) u gušterači, tankom crijevu i jetri štakora i povišena ekspresija u bubrezima mužjaka

Chloride/formate exchanger (CFEX; SLC26A6) mediates oxalate transport in various mammalian organs. Studies in Cfex knockout mice indicated its possible role in development of male-dominant hyperoxaluria and oxalate urolithiasis. Rats provide an important model for studying this pathophysiological condition, but data on Cfex (rCfex) localisation and regulation in their organs are limited. Here we applied the RT-PCR and immunochemical methods to investigate rCfex mRNA and protein expression and regulation by sex hormones in the pancreas, small intestine, liver, and kidneys from intact prepubertal and adult as well as gonadectomised adult rats treated with sex hormones. rCfex cDNA-transfected HEK293 cells were used to confirm the specificity of the commercial anti-CFEX antibody. Various biochemical parameters were measured in 24-h urine collected in metabolic cages. rCfex mRNA and related protein expression varied in all tested organs. Sex-independent expression of the rCfex protein was detected in pancreatic intercalated ducts (apical domain), small intestinal enterocytes (brush-border membrane; duodenum > jejunum > ileum), and hepatocytes (canalicular membrane). In kidneys, the rCfex protein was immunolocalised to the proximal tubule brush-border with segment-specific pattern (S1=S2 jejunum > ileum) i kanalikularnoj membrani hepatocita. U bubrezima je a) prijenosnik rCfex imunolokaliziran u četkastoj membrani proksimalnih kanalića sa segment-specifičnim obrascem (S1=S2 ženke) zbog stimulacijskoga učinka androgena nakon puberteta. Međutim, izlučivanje oksalata urinom nije bilo sukladno ekspresiji bubrežnoga prijenosnika rCfex. Dakle, nejasan je učinak povišene ekspresije prijenosnika rCfex u proksimalnim kanalićima mužjaka na izlučivanje oksalata, a postojanje prijenosnika u kanalikularnoj membrani hepatocita mogući je put izlučivanja oksalata putem žuči

Adiponectin level and gene variability are obesity and metabolic syndrome markers in a young population

BACKGROUND AND AIMS: Human obesity is accepted as an important risk factor for development of MetS. Adiponectin is linked to central obesity and ADIPOQ variants are promising markers for understanding the genetic base of obesity-related disorders. We performed analyses of adiponectin concentrations and ADIPOQ variants and tested their associations with obesity and MetS in young subjects of Croatian origin. ----- METHODS: Biochemical and anthropometric parameters of MetS were obtained for 149 unrelated subjects. Adiponectin levels were measured by ELISA assay. ADIPOQ -11391G>A and -11377C>G were genotyped by real-time PCR. ----- RESULTS: BMI and WC, TG and GLUC showed inverse correlation, whereas HDL-C showed a positive correlation with adiponectin concentrations. For central obesity, we found association with -11377C>G and with -11391G>A polymorphisms. ADIPOQ -11377GG and -11391GA significantly increased the risk for the development of central obesity (OR 5.57 and OR 3.37, respectively). Significant association was found between -11391A, -11377G allele and haplotype and increased TG. -11377C>G and -11391G>A variant were significantly associated with the incidence of MetS. C>G mutation at position -11377 significantly increased the risk of MetS development (OR = 2.93). Compared with the -11391G homozygotes, carriers of the A allele had a significantly increased risk for the development of MetS (OR = 3.15). The test of overall association showed a statistically significant correlation of MetS with -11377C>G and -11391G>A haplotypes (p = 0.008). ----- CONCLUSIONS: Analysis of adiponectin concentration and ADIPOQ -11391G>A and -11377C>G gene variants may be clinically meaningful for estimation of MetS risk in a young population

Materijali za seminare i vježbe iz kemije za stomatologe

Materijali za seminare i vježbe iz kemije za stomatolog