Determination of arsenic content in tea samples available on Republic of Srpska market by atomic absorption spectrophotometry

Introduction. Arsenic exists in various forms in nature and living organisms.Toxic elements, including arsenic, which are present in some plants,can severely damage haemopoietic, immune, nervous and reproductivesystems. For this reason, a content of heavy metals is one of the criteria forthe assessment of the safe use of plant material in the production of traditionalmedicines and herbal infusions. This instigates the need for constantand organized safety control of plants that are used as raw materialsin pharmaceutical industry.The aim of this study is to determine the arsenic content in selected teaswhich are available on the market of the Republic of Srpska.Methods. The 10 g samples of 13 herbal and 3 fruit teas were mineralizedby dry ashing and arsenic contents were determined by the atomicabsorption spectrophotometer Agilent Technologies Series 200 with anair-acetylene burner and D2 background correction.Results. Mean arsenic concentrations in the herbal tea samples rangedfrom 0.009 to 0.145 mg/kg. The lowest arsenic concentration in a singlesample of 0.007 mg/kg was found in Chamomile tea and Uva ursi collectedas a wild plant at elevation above 1200 m. The highest arsenic concentrationwas found in the sample of Sambucus nigra tea (0.145 mg/kg). Infruit teas, the arsenic concentration ranged from 0.014 mg/kg (Cranberry)to 0.027 mg/kg (Fruit mix).Conclusion. Arsenic content in all analyzed tea samples is below the valuestipulated by the national legislation

Initiatives to reduce non-prescription sales and dispensing of antibiotics in the Republic of Srpska : findings and implications

Objective: Irrational use of antimicrobials is a major driver of antimicrobial resistance, exacerbated by dispensing antibiotics without a prescription. Our previous study suggested this was a problem in the Republic of Srpska despite legislation. Since then, a number of activities have been initiated. Consequently, the study aimed to ascertain whether these multiple initiatives had reduced this. Methods: Patients visiting all community pharmacies in the Republic from October 2014 to July 2015 presenting with symptoms typical of an acute, viral and mostly uncomplicated upper respiratory tract infection, with results compared to the previous study. If an antibiotic was suggested, the maximum allowance was Euro 3/ pack. Findings: Self-medication with antibiotics significantly decreased from 58% to 18.5% of pharmacies. In both studies, most patients were offered over-the-counter medication. The most common reason for not dispensing an antibiotic was ‘antibiotics can be dispensed with a prescription only’. The penicillins were the most dispensed antibiotic. Fewer patients than the previous study were given instructions about antibiotic use and no discussion on their side-effects. Conclusion: Whilst encouraging that self-medication decreased significantly, 18.5% was disappointing given recent initiatives Fewer instructions about antibiotics if an antibiotic was dispensed was also disappointing. This suggests the need for even stronger enforcement of the laws as well as further training of pharmacy personnel to ensure future appropriate use of medicines

Eight-year study of antibiotic utilisation in the Republic of Srpska (2010-2017 years); findings and implications

Background: There have been multiple initiatives to improve antibiotic utilisation in the Republic of Srpska in recent years including educational activities with all key stakeholder groups, greater scrutiny over self-purchasing of antibiotics and reimbursement restrictions. This study aimed to analyse total antibiotic utilisation following these initiatives including the quality of use and assess whether additional measures are needed. Methods: Analysis of total outpatient antibiotic utilisation from 2010 to 2017 in DIDs based on data obtained from the Public Health Institute of the Republic of Srpska. Quality indicators based on ESAC, ECDC and WHO recommendations and compared with neighbouring countries in the WHO AMC network. Results: Antibiotic utilisation ranged from 15.6 DIDs to 23.1 DIDs, which is encouraging versus other similar neighbouring countries. Penicillins were the most used antibiotics, accounting for approximately 50-55% of total antibiotic utilisation, with amoxicillin the most used (29 – 41% of total utilisation) versus low use of co-amoxiclav (7 - 11% of total utilisation). This compares favourably with other countries. Cephalosporins were the second most used antibiotic class (13-14%) followed by macrolides (8-9 %) and quinolones (8-9 %). Low use of third and fourth generation cephalosporins (10-20% of total cephalosporins) versus first and second generation. However, rising utilisation of co-amoxiclav and azithromycin (5-10% per years), and higher rates of quinolone utilisation in recent years are noted and are now being addressed through additional interventions. Conclusion: Multiple interventions in the Republic of Srpska have helped enhance the appropriate use of antibiotics. Identified concerns are being addressed

Recent initiatives in the Republic of Srpska to enhance appropriate use of antibiotics in ambulatory care : their influence and implications

Introduction:There are increasing concerns world-wide with growing rates of antibiotic resistance necessitating urgent action. There have been a number of initiatives in the Republic of Srpska in recent years to address this and improve rational antibiotic prescribing and dispensing despite limited resources to fund multiple initiatives. Objective: Analyse antibiotic utilization patterns in the Republic of Srpska following these multiple initiatives as a basis for developing future programmes in the Republic if needed. Methods: Observational retrospective study of total outpatient antibiotic utilization from 2010 to 2015, based on data obtained from the Public Health Institute, alongside documentation of ongoing initiatives to influence utilization. The quality of antibiotic utilisation principally assessed according to ESAC, ECDC and WHO quality indicators and DU 90% (the drug utilization 90%) profile as well as versus neighbouring countries. Results: Following multiple initiatives, antibiotic utilization remained relatively stable in the Republic at 15.6 DIDs to 18.4 DIDs, with a decreasing trend in recent years, with rates comparable or lower than neighbouring countries. Amoxicillin and the penicillins accounted for 29%-40% and 50% of total utilization, respectively. Overall, limited utilization of co-amoxiclav (7% - 11%), cephalosporins, macrolides and quinolones, as well as low use of third and fourth generation cephalosporins versus first and second cephalosporins. However, increasing utilization of co-amoxiclav and azithromycin, as well as higher rates of quinolone utilization compared to some countries, was seen. Conclusions: Multiple interventions in the Republic of Srpska in recent years have resulted in one of the lowest utilisation of antibiotics when compared with similar countries, acting as an exemplar to others. However, there are some concerns with current utilisation of co-amoxiclav and azithromycin which are being addressed. This will be the subject of future research activities

Recent initiatives in the Republic of Srpska to enhance appropriate use of antibiotics in ambulatory care : their influence and implications

Introduction:There are increasing concerns world-wide with growing rates of antibiotic resistance necessitating urgent action. There have been a number of initiatives in the Republic of Srpska in recent years to address this and improve rational antibiotic prescribing and dispensing despite limited resources to fund multiple initiatives. Objective: Analyse antibiotic utilization patterns in the Republic of Srpska following these multiple initiatives as a basis for developing future programmes in the Republic if needed. Methods: Observational retrospective study of total outpatient antibiotic utilization from 2010 to 2015, based on data obtained from the Public Health Institute, alongside documentation of ongoing initiatives to influence utilization. The quality of antibiotic utilisation principally assessed according to ESAC, ECDC and WHO quality indicators and DU 90% (the drug utilization 90%) profile as well as versus neighbouring countries. Results: Following multiple initiatives, antibiotic utilization remained relatively stable in the Republic at 15.6 DIDs to 18.4 DIDs, with a decreasing trend in recent years, with rates comparable or lower than neighbouring countries. Amoxicillin and the penicillins accounted for 29%-40% and 50% of total utilization, respectively. Overall, limited utilization of co-amoxiclav (7% - 11%), cephalosporins, macrolides and quinolones, as well as low use of third and fourth generation cephalosporins versus first and second cephalosporins. However, increasing utilization of co-amoxiclav and azithromycin, as well as higher rates of quinolone utilization compared to some countries, was seen. Conclusions: Multiple interventions in the Republic of Srpska in recent years have resulted in one of the lowest utilisation of antibiotics when compared with similar countries, acting as an exemplar to others. However, there are some concerns with current utilisation of co-amoxiclav and azithromycin which are being addressed. This will be the subject of future research activities

TREATMENT OF LANGERHANS CELL HISTIOCYTOSIS IN CHILDREN

Histiocitoza Langerhansovih stanica (HLS) jest bolest karakterizirana patološkim nakupljanjem i umnožavanjem stanica monocitno-makrofagnog sustava u tkivima. Bolest može zahvatiti bilo koji organski sustav. U ovoj retrospektivnoj studiji analizirani su podatci pacijenata liječenih u Zavodu za dječju hematologiju i onkologiju Klinike za pedijatriju Medicinskog fakulteta u Zagrebu kojima je potvrđena dijagnoza HLS-a u petnaestogodišnjem razdoblju od 1. 1. 1996 do 31. 12. 2010. g. Liječeno je 22-je djece oboljele od HLS-a kod koje je bilo potrebno sustavno liječenje. Izliječeno je 19-ero (86%), a umrlo je troje (14%) djece, sve troje mlađe od 2 godine s multisustavnom bolešću. Kod postavljanja dijagnoze 12-ero djece imalo je bolest samo jednog organskog sustava (55%), i to u najvećoj mjeri zahvaćen je bio koštani sustav, kod 8 bolesnika (36%). Sva su djeca liječena prema protokolima LCH-I i LCH-III. Blaže posljedice bolesti i liječenja imalo je osmero djece. Kod četvero djece zaostao je dijabetes insipidus.Langerhans’ cell histiocytosis (LCH) is a disease characterised by pathologic accumulation and proliferation of histiocytes, cells from the monocyte-macrophage system, in various tissues and organs. In this retrospective study we analyzed patients charts treated in the Department of pediatric hematology and oncology at the University Hospital Zagreb with the diagnosis of LCH. Twenty-two children were diagnosed between January 1st 1996 and December 31st 2010, and all were treated with chemotherapy. 19 patients survived (86%) and the remaining 3 (14%), all under the age of 2 with multisystem disease, died. At the time of diagnosis 12 children (55%) presented with single-system disease, the most common were bone lesions in 8 children (36%). All children were treated according to protocols LCH-I and LCH –III. Eight children had mild complications of treatment and the disease itself. Diabetes insipidus remains in 4 children

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

Introduction: Antibiotics are indispensable to maintaining human health; however, their overuse has resulted in resistant organisms, increasing morbidity, mortality and costs. Increasing antimicrobial resistance (AMR) is a major public health threat, resulting in multiple campaigns across countries to improve appropriate antimicrobial use. This includes addressing the overuse of antimicrobials for self-limiting infections, such as upper respiratory tract infections (URTIs), particularly in lower- and middle-income countries (LMICs) where there is the greatest inappropriate use and where antibiotic utilization has increased the most in recent years. Consequently, there is a need to document current practices and successful initiatives in LMICs to improve future antimicrobial use. Methodology: Documentation of current epidemiology and management of URTIs, particularly in LMICs, as well as campaigns to improve future antimicrobial use and their influence where known. Results: Much concern remains regarding the prescribing and dispensing of antibiotics for URTIs among LMICs. This includes considerable self-purchasing, up to 100% of pharmacies in some LMICs. However, multiple activities are now ongoing to improve future use. These incorporate educational initiatives among all key stakeholder groups, as well as legislation and other activities to reduce self-purchasing as part of National Action Plans (NAPs). Further activities are still needed however. These include increased physician and pharmacist education, starting in medical and pharmacy schools; greater monitoring of prescribing and dispensing practices, including the development of pertinent quality indicators; and targeted patient information and health education campaigns. It is recognized that such activities are more challenging in LMICs given more limited resources and a lack of healthcare professionals. Conclusion: Initiatives will grow across LMICs to reduce inappropriate prescribing and dispensing of antimicrobials for URTIs as part of NAPs and other activities, and these will be monitored

Analysis of Contents of Calcium, Magnesium and Total Hardness in Water for Pharmaceutical Use

Water is one of the most frequently used raw materials in pharmaceutical industry. Water for pharmaceutical purposes includes the two primary water types: purified water and water for injection. Drinking water used for obtaining purified water is not official in pharmacopoeia. Depending on quality prescribed for a certain product preparation, various water types and procedures have been used to prepare pharmaceutical industry water. Possible ways to obtain water for pharmaceutical purposes are: reverse osmosis, demineralization, electrodeionization, ultrafiltration, distillation. Reasons for the widespread use of water lie in the facts that it is capable of dissolving a great number of therapeutic substances, compatible with a large number of substances, appropriate to be used from a physiological aspect given that it is an integral part of the cell and the major component of body fluids and whenever the drug is administered in the form of an aqueous solution, reabsorption is rapid and complete, it also has suitable physical-chemical properties. In this study, analysis results of 15 samples of water were obtained using pharmacopoeial methods for pharmaceutical purposes. Results showed that 86.6% of water samples were accurate and 13.3% did not have appropriate calcium content, magnesium content and total hardness values

Recent Initiatives in the Republic of Srpska to Enhance Appropriate Use of Antibiotics in Ambulatory Care; Their Influence and Implications

Introduction: There are increasing concerns world-wide with growing rates of antibiotic resistance necessitating urgent action. There have been a number of initiatives in the Republic of Srpska in recent years to address this and improve rational antibiotic prescribing and dispensing despite limited resources to fund multiple initiatives.Objective: Analyse antibiotic utilization patterns in the Republic of Srpska following these multiple initiatives as a basis for developing future programmes in the Republic if needed.Methods: Observational retrospective study of total outpatient antibiotic utilization from 2010 to 2015, based on data obtained from the Public Health Institute, alongside documentation of ongoing initiatives to influence utilization. The quality of antibiotic utilization principally assessed according to ESAC, ECDC, and WHO quality indicators and DU 90% (the drug utilization 90%) profile as well as vs. neighboring countries.Results: Following multiple initiatives, antibiotic utilization remained relatively stable in the Republic at 15.6 to 18.4 DIDs, with a decreasing trend in recent years, with rates comparable or lower than neighboring countries. Amoxicillin and the penicillins accounted for 29–40 and 50% of total utilization, respectively. Overall, limited utilization of co-amoxiclav (7–11%), cephalosporins, macrolides, and quinolones, as well as low use of third and fourth generation cephalosporins vs. first and second cephalosporins. However, increasing utilization of co-amoxiclav and azithromycin, as well as higher rates of quinolone utilization compared to some countries, was seen.Conclusions: Multiple interventions in the Republic of Srpska in recent years have resulted in one of the lowest utilization of antibiotics when compared with similar countries, acting as an exemplar to others. However, there are some concerns with current utilization of co-amoxiclav and azithromycin which are being addressed. This will be the subject of future research activities

Optical parameters measurements and modelling in biology and some laser applications in life

Laser applications in plant selection and their influence on living cells and organisms have been the topic for a long time. Some modern treatments compare the laser influence with nuclear, X-ray and chemical agents for those purposes. A large number of reviewed data are related only to the numbers linked to power or energy density without including the coefficients of reflection or other optical characteristics of living cells or organisms. Due to the fact we measured some of the reflection coefficients for plants of interest as medicaments (in pharmaceutical purposes) in the whole visible range as well as in IR and UV ranges. Knowing those constants and other from references, the discussion will be performed considering the possible comparisons between some experimental data and the results with wheat, corn, tomato. Simultaneously, some laser irradiation would be organized for some plants whose vegetation period could be given some first results. The highest differences could be an irradiation of dry and wet seeds. Nowadays very interesting conclusions are those claiming that laser irradiation changes are more long living than nuclear beams provoked mutations. Some models will be discussed