Possible adverse effects of antiepileptic therapy in pregnancy

Epilepsija je jedna od najučestalijih neuroloških bolesti današnjice. Također se smatra drugom najčešćom neurološkom bolesti u trudnoći. Povijesno se primjena antiepileptika tijekom trudnoće povezala s nizom neželjenih učinaka, što je dovelo do razmatranja potrebe nastavka terapije u trudnoći. Međutim, većini žena koje boluju od epilepsije preporuča se nastavak terapije tijekom trudnoće, kako bi se održala kontrola napadaja, a time i spriječio nastup neželjenih učinaka koji mogu ugroziti kako majku, tako i plod. Primjena antiepileptika u trudnoći dodatno je otežana fiziološkim promjenama do kojih dolazi tijekom trudnoće, a koje mogu utjecati na promjenu farmakokinetike lijekova. Stoga najveći izazov u terapiji epilepsije tijekom trudnoće predstavlja postizanje ravnoteže između koristi primjene antiepileptika i rizika javljanja nuspojava. Jedan od najtežih oblika nuspojava predstavljaju kongenitalne malformacije ploda. Dokazivanje teratogenog potencijala pojedinog antiepileptika iznimno je teško. Naime, podatci o povezanosti primjene određenog antiepileptika tijekom trudnoće i pojave kongenitalnih malformacija najčešće se dobivaju iz trudničkih registara. Većina starijih antiepileptika ima već poznat teratogeni potencijal, a utvrđivanje teratogenog potencijala prilikom primjene novijih antieplieptika predstavlja problem zbog male veličine uzorka, kao i problema činjenice da je terapija antiepilepsije u trudnoći većinom polifarmakološka. Nažalost, većina dosadašnjih studija teratogenih učinaka antiepileptika nije imala dovoljnu jačinu dokaza da bi dovela do značajnijih zaključaka o odnosu dobrobiti i riziku primjene ovih lijekova u trudnoći. No, bez obzira na neželjene učinke koji se mogu javiti prilikom primjene antiepileptika u trudnoći, većina žena koje boluju od epilepsije imat će urednu trudnoću, koja će rezultirati rođenjem zdravoga djeteta.Epilepsy is one of the most common neurological diseases of today. It is also considered the second most common neurological disease in pregnancy. Historically, the use of antiepileptic drugs during pregnancy is connected with a number of adverse effects, which has led to considering the need of continuing therapy during pregnancy. However, it is recommended for women with epilepsy to continue antiepileptic therapy during pregnancy in order to maintain seizure control and prevent the appearance of adverse effects that can endanger both mother and fetus. The use of AEDs in pregnancy is exacerbated by the physiological changes that occur during pregnancy, which may affect the pharmacokinetics of drugs. Therefore, the greatest challenge in the treatment of epilepsy during pregnancy is maintaining a balance between the benefits of AEDs and the risk of side effects. One of the most serious side effects are congenital malformations of the fetus. Proving teratogenic potential of individual antiepileptic drugs is extremely difficult. Data on the application of certain antiepileptic drugs during pregnancy and the occurrence of congenital malformations are most often obtained from maternity registers. Older AEDs already have known teratogenic potential but determining teratogenic potential of newer AEDs remains a problem because of the small sample size and the use of these AEDs as a part of a polytherapy. Unfortunately, previous studies of teratogenic effects of AEDs did not have sufficient strength of evidence that would lead to significant conclusions about the relative benefits and risks of application of these drugs in pregnancy. But regardless of the adverse effects that may occur during the use of AEDs during pregnancy, most women with epilepsy will have a normal pregnancy, which will result with the birth of a healthy child

Possible adverse effects of antiepileptic therapy in pregnancy

Epilepsija je jedna od najučestalijih neuroloških bolesti današnjice. Također se smatra drugom najčešćom neurološkom bolesti u trudnoći. Povijesno se primjena antiepileptika tijekom trudnoće povezala s nizom neželjenih učinaka, što je dovelo do razmatranja potrebe nastavka terapije u trudnoći. Međutim, većini žena koje boluju od epilepsije preporuča se nastavak terapije tijekom trudnoće, kako bi se održala kontrola napadaja, a time i spriječio nastup neželjenih učinaka koji mogu ugroziti kako majku, tako i plod. Primjena antiepileptika u trudnoći dodatno je otežana fiziološkim promjenama do kojih dolazi tijekom trudnoće, a koje mogu utjecati na promjenu farmakokinetike lijekova. Stoga najveći izazov u terapiji epilepsije tijekom trudnoće predstavlja postizanje ravnoteže između koristi primjene antiepileptika i rizika javljanja nuspojava. Jedan od najtežih oblika nuspojava predstavljaju kongenitalne malformacije ploda. Dokazivanje teratogenog potencijala pojedinog antiepileptika iznimno je teško. Naime, podatci o povezanosti primjene određenog antiepileptika tijekom trudnoće i pojave kongenitalnih malformacija najčešće se dobivaju iz trudničkih registara. Većina starijih antiepileptika ima već poznat teratogeni potencijal, a utvrđivanje teratogenog potencijala prilikom primjene novijih antieplieptika predstavlja problem zbog male veličine uzorka, kao i problema činjenice da je terapija antiepilepsije u trudnoći većinom polifarmakološka. Nažalost, većina dosadašnjih studija teratogenih učinaka antiepileptika nije imala dovoljnu jačinu dokaza da bi dovela do značajnijih zaključaka o odnosu dobrobiti i riziku primjene ovih lijekova u trudnoći. No, bez obzira na neželjene učinke koji se mogu javiti prilikom primjene antiepileptika u trudnoći, većina žena koje boluju od epilepsije imat će urednu trudnoću, koja će rezultirati rođenjem zdravoga djeteta.Epilepsy is one of the most common neurological diseases of today. It is also considered the second most common neurological disease in pregnancy. Historically, the use of antiepileptic drugs during pregnancy is connected with a number of adverse effects, which has led to considering the need of continuing therapy during pregnancy. However, it is recommended for women with epilepsy to continue antiepileptic therapy during pregnancy in order to maintain seizure control and prevent the appearance of adverse effects that can endanger both mother and fetus. The use of AEDs in pregnancy is exacerbated by the physiological changes that occur during pregnancy, which may affect the pharmacokinetics of drugs. Therefore, the greatest challenge in the treatment of epilepsy during pregnancy is maintaining a balance between the benefits of AEDs and the risk of side effects. One of the most serious side effects are congenital malformations of the fetus. Proving teratogenic potential of individual antiepileptic drugs is extremely difficult. Data on the application of certain antiepileptic drugs during pregnancy and the occurrence of congenital malformations are most often obtained from maternity registers. Older AEDs already have known teratogenic potential but determining teratogenic potential of newer AEDs remains a problem because of the small sample size and the use of these AEDs as a part of a polytherapy. Unfortunately, previous studies of teratogenic effects of AEDs did not have sufficient strength of evidence that would lead to significant conclusions about the relative benefits and risks of application of these drugs in pregnancy. But regardless of the adverse effects that may occur during the use of AEDs during pregnancy, most women with epilepsy will have a normal pregnancy, which will result with the birth of a healthy child

ENCEPHALOPATHY CAUSED BY THE APPLICATION OF METRONIDAZOLE

Metronidazol je antibiotik koji se koristi u liječenju anaerobnih bakterijskih i parazitarnih infekcija. Kao rijetka nuspojava primjene ovog lijeka može se javiti encefalopatija. Najčešće primijećeni klinički simptomi uključuju dizartriju, nestabilnost u hodu i/ili ataksiju. Encefalopatiju uzrokovanu primjenom metronidazola potrebno je diferencijalno dijagnostički razlikovati od drugih mogućih uzroka encefalopatije. Uz kliničku sliku i podatak o primjeni metronidazola od pomoći su magnetska rezonancija mozga (MRI) - T2 i prikaz FLAIR te neurološka dijagnostika koja uključuje elektroencefalografi ju (EEG), laboratorijsku obradu i lumbalnu punkciju. Tipični nalazi MRI mozga u T2 i FLAIR tehnici pokazuju hiperintenzitet koji u većini slučajeva zahvaća nucleus dentatus malog mozga, dijelove moždanog debla te splenium corpus callosuma. Ponekad je potrebno učiniti i gensko testiranje kako bi se isključili i vrlo rijetki uzroci encefalopatije. Neurološke promjeneuzrokovane primjenom metronidazola najčešće su reverzibilne i povlače se nakon ukidanja metronidazola iz terapije. U liječenju ove vrste encefalopatije može se primijeniti metilprednizolon.Metronidazole is an antibiotic used for treating anaerobic bacterial and parasitic infections. A rare side effect of using this drug is encephalopathy. The most commonly observed symptoms include dysarthria, gait instability, and/or ataxia. Metronidazole induced encephalopathy should be differentiated from other possible causes of encephalopathy. Clinical picture with data on metronidazole application, as well as magnetic resonance imaging (MRI) of the brain, T2 and FLAIR sequences, neurological diagnostic procedures such as electroencephalography (EEG), laboratory tests and lumbar puncture should be performed. Typical brain MRI fi ndings in T2 and FLAIR technique show hyperintensity, which in most cases affects dentate nucleus of the cerebellum, parts of brainstem, and splenium corporis callosi. Genetic testing is sometimes required to distinguish some rare causes of encephalopathy. Neurological changes due to metronidazole application are most often reversible and vanish after metronidazole withdrawal. Use of methylprednisolone in treating this type of encephalopathy is sometimes helpful

ENCEPHALOPATHY CAUSED BY THE APPLICATION OF METRONIDAZOLE

Metronidazol je antibiotik koji se koristi u liječenju anaerobnih bakterijskih i parazitarnih infekcija. Kao rijetka nuspojava primjene ovog lijeka može se javiti encefalopatija. Najčešće primijećeni klinički simptomi uključuju dizartriju, nestabilnost u hodu i/ili ataksiju. Encefalopatiju uzrokovanu primjenom metronidazola potrebno je diferencijalno dijagnostički razlikovati od drugih mogućih uzroka encefalopatije. Uz kliničku sliku i podatak o primjeni metronidazola od pomoći su magnetska rezonancija mozga (MRI) - T2 i prikaz FLAIR te neurološka dijagnostika koja uključuje elektroencefalografi ju (EEG), laboratorijsku obradu i lumbalnu punkciju. Tipični nalazi MRI mozga u T2 i FLAIR tehnici pokazuju hiperintenzitet koji u većini slučajeva zahvaća nucleus dentatus malog mozga, dijelove moždanog debla te splenium corpus callosuma. Ponekad je potrebno učiniti i gensko testiranje kako bi se isključili i vrlo rijetki uzroci encefalopatije. Neurološke promjeneuzrokovane primjenom metronidazola najčešće su reverzibilne i povlače se nakon ukidanja metronidazola iz terapije. U liječenju ove vrste encefalopatije može se primijeniti metilprednizolon.Metronidazole is an antibiotic used for treating anaerobic bacterial and parasitic infections. A rare side effect of using this drug is encephalopathy. The most commonly observed symptoms include dysarthria, gait instability, and/or ataxia. Metronidazole induced encephalopathy should be differentiated from other possible causes of encephalopathy. Clinical picture with data on metronidazole application, as well as magnetic resonance imaging (MRI) of the brain, T2 and FLAIR sequences, neurological diagnostic procedures such as electroencephalography (EEG), laboratory tests and lumbar puncture should be performed. Typical brain MRI fi ndings in T2 and FLAIR technique show hyperintensity, which in most cases affects dentate nucleus of the cerebellum, parts of brainstem, and splenium corporis callosi. Genetic testing is sometimes required to distinguish some rare causes of encephalopathy. Neurological changes due to metronidazole application are most often reversible and vanish after metronidazole withdrawal. Use of methylprednisolone in treating this type of encephalopathy is sometimes helpful

Risk Factors for Cardiovascular Disease in Rural Area of Croatia

Rural areas, where 47.6% of the Croatian population lives are not generally the focus of research; yet there are challenges which affect the rural population that often go unreported. These communities often exhibit disadvantages in many areas of health. The aim of this study is to examine the specific health needs and related determinants of rural populations influenced by transition that were affected by the consequences of war. The focus of the research is rural lifestyle, behaviour and cardiovascular risk factors in three villages of Sisa~ko-moslava~ka County. Results show that participants generally understand that their own lifestyles influence their health, but they often neglect to change their behaviour to improve their health. This can be explained through complex socio-economic conditions and traditional values of their heritage. These results suggest a need for further research on health status, attitude, and behaviour of Croatia’s rural population. Specific public health intervention and services for rural populations must be promoted

Advantages and Disadvantages of Inclisiran: A Small Interfering Ribonucleic Acid Molecule Targeting PCSK9—A Narrative Review

As dyslipidemias remain one of the main risk factors for developing cardiovascular disease, the question of maintaining optimal lipid levels with pharmacotherapy remains a subject of interest worldwide. In contrast to conventional pharmacotherapy, human monoclonal antibodies directed against proprotein convertase subtilisin/kexin type 9 (PSCK9) and small interfering RNA- (siRNA-) based drug targeting PCSK9 represent a new strategy for managing lipid disorders and reducing cardiovascular risk. Inclisiran is a long-acting, synthetic siRNA that targets hepatic production of PCSK9 and consequently causes a reduction in LDL-C concentrations by approximately 50% compared to placebo. The structural modification of inclisiran has led to better stability and prolonged biological activity of the drug. The main advantage over conventional pharmacotherapy and anti-PCSK9 monoclonal antibodies is its favorable administration regimen (0–90–180 days), which should lead to much better compliance. Clinical trials conducted so far have confirmed the tolerability and efficacy of inclisiran in long-term PCSK9 and LDL-C level reductions. Moreover, a short-term follow-up on the safety of inclisiran showed a relatively good safety profile of the drug. However, it is still of great importance for ongoing and forthcoming clinical trials to be continued on a larger group of patients in order to assess long-term tolerability, efficacy, and safety of inclisiran

Risk factors for cardiovascular disease in rural area of Croatia [Rizični čimbenici za nastanak kardiovaskularnih bolesti u ruralnim područjima u Hrvatskoj]

Rural areas, where 47.6% of the Croatian population lives are not generally the focus of research; yet there are challenges which affect the rural population that often go unreported. These communities often exhibit disadvantages in many areas of health. The aim of this study is to examine the specific health needs and related determinants of rural populations influenced by transition that were affected by the consequences of war. The focus of the research is rural lifestyle, behaviour and cardiovascular risk factors in three villages of Sisacko-moslavacka County. Results show that participants generally understand that their own lifestyles influence their health, but they often neglect to change their behaviour to improve their health. This can be explained through complex socio-economic conditions and traditional values of their heritage. These results suggest a need for further research on health status, attitude, and behaviour of Croatia's rural population. Specific public health intervention and services for rural populations must be promoted