Effectiveness of Vitamin K antagonist for secondary prophylaxis of brain stroke in patients with atrial fibrillation in routine public care settings

Vitamin K antagonists are the mainstay for prevention of strokes in patients with atrial fibrillation (AF) world-wide. Yet estimates on its effectiveness are heterogeneous and reveal stark differences between different health-care systems. The aim of the present study was to assess the laboratory parameters for achieving the goal of the therapy (Time in therapeutic range – TTR) and to describe the effectiveness of the therapy in real-time setting. Methods : Patients treated in our clinic, with confirmed AF were considered in the study. The study was prospective observational study by design, where the participants were assessed at baseline for known risk factors for stroke, diagnosis for atrial fibrillation, use of anticoagulant medication and presence of identifiable ischemic lesions in the brain with non-contrast computed tomography (NCCT). The drug of choice was acenocoumarol, with planned monthly measurements of INR with the duration of 6 months, and the study was concluded with additional NCCT at the end, in order to assess for differences. Results : 96 patients finished the observation. The mean age of the patients was 64.5 years (SD = 6.36), and 50 (52%) were male. Regarding the INR measurement, we collected data from 88.2% of the planed measurements; 69.7% of the patients achieved TTR above 60%. Cross-comparison between groups (TTR 60%) revealed that the first group had statistically significant higher proportion of patients with newly registered lesions on NCCT (p-value < 0.05). Conclusion: Acenocoumarol is the only therapeutic VKA option in our country, despite the availability of other VKA antagonists that show better indices for effectiveness. Our sample confirmed that the proper use of VKA significantly reduces the incidence of new NCCT ischemic lesions in conditions of routine public health care

Effectiveness Study On longitudinal Laboratory monitoring Of the INR in Patients Receiving Vitamin-K Antagonist For Atrial Fibrilation in R.Macedonia

Atrial fibrillation is preventable cause for ischemic stroke and various other thrombo-embolic events. One of the main agents used in the prevention of the consequences are the vitamin-K antagonists. Although efficacy is proven, studies have questioned their efficiency in this setting. Various factors contribute to variations of their efficiency, which is still underinvestigated in many health systems. Few studies have shown varied estimates and cited different reasons for its effectiveness, ranging from subtle differences in diet, concurrent medications use, variable level of enzyme activity to age and compliance of users, which can vary unexpectedly. The aim of the present study of effectiveness is to describe how often patients that use VKA achieve the targeted values for INR. The population consists of the hospital reach area of Clinical Hospital Tetovo, observed for 6 months with routine laboratory investigation for the values of INR. Our study reveals that 57.4% of all measurements of INR where within the target values between 2-3, while 9.7% of all measurements revealed extreme values that can put patients at risk for further thrombo-embolic events or catastrophic hemorrhagic events

Added Value of Modified Anderson–Wilkins Acuteness Score in Prognostication of Patients with Acute Myocardial Infarction

BACKGROUND: Electrocardiogram (ECG) signs on admission can serve as a prognostic marker in patients treated for myocardial infarction (MI). AIM: The aim of the study was to determine the predictive role of modified Anderson–Wilkins (MAW) ECG score of acuteness on the extent of myocardial injury, left ventricular (LV) remodeling, and clinical outcome in patients with acute MI. METHODS: Prospective, observational cohort study on patients treated for MI at the University Clinic for Cardiology. Subjects were analyzed for their demographic, clinical, ECG, LV functional, angiographic variables, course of treatment, and in-hospital outcome. MAW score was calculated for each patient. Patients were comparatively analyzed divided in two groups (score &lt;3 and ≥3). RESULTS: One hundred fifty patients (70% males and 30% females), aged 60.9 years were included in the study. Sixty-eight patients had MAW score &lt;3 (mean 1.7), and 82 had score ≥3 (mean 3.5), p&gt;0.001. Patients with ST-segment elevation MI had OR 2.1 (p&gt;0.000), and patients with multiple locations (excluding anterior) had OR 2.1 (p &gt; 0.000) of having MAW score ≥3. They received mechanical reperfusion 1.9 (p = 0.032) times more often. High MAW score was associated with stress hyperglycemia (OR 2.1; p = 0.032); low potassium (OR 2.8; p = 0.032), lower creatinine (p = 0.050), and higher NT-proBNP (OR 2.5; p = 0.050). High MAW score was associated with decreased LV function and increased LV dimensions on the follow-up echocardiography (p = 0.050 and 0.012, respectively). CONCLUSION: ECG is an important prognostic tool in MI patients. ECG-derived MAW score demonstrates a strong correlation with stress hyperglycemia, potassium, creatinine, and natriuretic peptides level and can serve as an early marker of LV remodeling after MI

Added Value of Modified Anderson–Wilkins Acuteness Score in Prognostication of Patients with Acute Myocardial Infarction

BACKGROUND: Electrocardiogram (ECG) signs on admission can serve as a prognostic marker in patients treated for myocardial infarction (MI). AIM: The aim of the study was to determine the predictive role of modified Anderson–Wilkins (MAW) ECG score of acuteness on the extent of myocardial injury, left ventricular (LV) remodeling, and clinical outcome in patients with acute MI. METHODS: Prospective, observational cohort study on patients treated for MI at the University Clinic for Cardiology. Subjects were analyzed for their demographic, clinical, ECG, LV functional, angiographic variables, course of treatment, and in-hospital outcome. MAW score was calculated for each patient. Patients were comparatively analyzed divided in two groups (score <3 and ≥3). RESULTS: One hundred fifty patients (70% males and 30% females), aged 60.9 years were included in the study. Sixty-eight patients had MAW score 0.001. Patients with ST-segment elevation MI had OR 2.1 (p>0.000), and patients with multiple locations (excluding anterior) had OR 2.1 (p > 0.000) of having MAW score ≥3. They received mechanical reperfusion 1.9 (p = 0.032) times more often. High MAW score was associated with stress hyperglycemia (OR 2.1; p = 0.032); low potassium (OR 2.8; p = 0.032), lower creatinine (p = 0.050), and higher NT-proBNP (OR 2.5; p = 0.050). High MAW score was associated with decreased LV function and increased LV dimensions on the follow-up echocardiography (p = 0.050 and 0.012, respectively). CONCLUSION: ECG is an important prognostic tool in MI patients. ECG-derived MAW score demonstrates a strong correlation with stress hyperglycemia, potassium, creatinine, and natriuretic peptides level and can serve as an early marker of LV remodeling after M

Evaluation a renal function of patients with Medication-overuse headache (MOH)

Excessive drug use causes Medication-overuse headache (MOH) which can be manifested of chronic daily headaches, occurring monthly 15 or more days, when the medicament is used redundantly for more than three months. Recent studies concerning the epidemiology of drug-induced disorders suggest that increased risk of nephrotoxicity appears in a group of patients who abuse NSAIDs. The aim is to confirm the early phase of nephrotoxicity in patients with (MOH),were treated with NSAIDs in combination with other drugs (analgesics, triptans and antidepressants) and compared patients treated only with Diclofenac, Piroxicam, Ketoprofen, Paracetamol, Ibuprofen and Celecoxib, Besides conventional markers of renal functioning (serum/urine creatinine determined by Jaffe methods, enzymatic assay for urea serum). Imunoturbodimetric assay for determination of urinary albumin, microalbuminuria and β2-microglobulin will be used. Significant glomerular and tubular damage has been reported, and patients on combination therapy with NSAIDs and other drugs (analgesics, triptans, and antidepressants) have seen more glomerular changes than patients treated with NSAID monotherapy. Keywords: Medication-overuse headache, Nephrotoxicity, Nonsteroidalantiinflammatory drugs

Migraine and the effects of NSAIDS on renal function

Trigeminovascular system (TGV) activation is a basic mechanism for generating pain during a migraine attack. Many experimental results highlight the importance of the cyclooxygenase system in the peripheral arm of TGV and suggest that NSAIDs may be effective in migraine therapy through the action of these peripheral nociceptors. Inhibition of NSAID-mediated prostaglandin synthesis prevents neurogenically mediated inflammation of the trigeminal system and reduces pain, but at the same time inhibition of prostaglandin in the kidney may reduce renal blood flow,speed glomerular filtration retention. and water. The purpose of the study is to follow the renal function, in patients with cefaleamigraine that has been treated for a long period, treated with Diclofenac and Paracetamol.We used Jaffe’s method for the determination of serum/urine creatinine and еnzymatic assays for urea and uric acid in serum and ᵧ glutamyl transferase (ᵧ-GT) in serum and jon selective electrode (ISE) are used for determination of electrolite in serum. We used nephelometry by β2 microglobulin (β2M) and photoelectric colorimetry for microalbuminuria in urine, to monitor glomerular and tubular functioning. Any history of kidney diseases was exclusion criteria to enter the study. In chronic treatment of patients with headache with Diclofenac and Paracetamol in symptomatic headaches, they have been confirmed as renoprotective in their use. Keywords: non-steroidal anti-inflammatory drugs, migraine, renal function, trigeminovascular syste

Asiakastyytyväisyys yksityisasiakkaiden kotiinkuljetuksien sujuvuudesta : case: yritys X

Tämän opinnäytetyön tavoitteena oli tehdä Yritys X:lle asiakastyytyväisyyskysely, joka liittyy ainoastaan Yritys X:n yhteen palvelumuotoon eli kotiinkuljetuspalveluun. Kyselyssä hyödynnettiin kerättyä tietoperustaa asiakastyytyväisyydestä sekä kotiinkuljetuspalveluun huomioon otettavia asioita. Tarkoituksena oli selvittää yksityisasiakkaiden tyytyväisyys Yritys X:n kotiinkuljetuksen asiakaskokemukseen, palvelun laatuun ja toimintaan. Työn teoriaosuudessa käsitellään asiakaskokemusta, palvelun laatua, asiakastyytyväisyyttä ja sen mittaamista. Asiakastyytyväisyyden selvittämiseen oli tavoitteena käyttää kyselytutkimusta eli kvantitatiivista tutkimusta, mutta kyselyn jakaminen vastaajille jäi suorittamatta, johtuen Yritys X:n resurssien ja ajan puutteesta. Kyselylomakkeen tekemiseen käytettiin Webropol-kyselylomakeohjelmaa ja kyselylomake jää toimeksiantajan käyttöä varten. Tämän työn ansiosta Yritys X:llä on valmis kyselylomake, minkä voi myöhemmin hyödyntää asiakastyytyväisyyden tutkimiseen kotiinkuljetuksessa. Kotiinkuljetus on kasvava palvelumuoto ja sen takia ajankohtainen tutkimusalue. Onnistunut kotiinkuljetus vaatii myös monta onnistuneita kuljetusvaiheita ja yhdenkin kuljetusvaiheen epäonnistuminen voi vaikuttaa koko kotiinkuljetuksen asiakastyytyväisyyteen. Kyselylomakkeen avulla Yritys X voi selvittää kotiinkuljetuksen kehityskohteita

Comparison of the adverse renal effects of Ketoprofen and Piroxicam in patients with headaches

Migraine is a common headache disorder that causes significant disability. Ketoprofen is one of the world's most widely-prescribed NSAIDs for treatment of headaches. Piroxicam is another NSAID that was approved in the last several years, with different mechanisms of action on cyclooxygenase inhibition. Theoretically, this approach can lead to various adverse effects on the kidneys. Relatively, little is known about comparative nephrotoxicity of NSAIDs. Therefore, the present study was designed to compare the adverse renal effects, of Ketoprofen and Piroxicam in patients with headaches. We used venous urine and blood from cephalic-migraine in 10 patients treated with Ketoprofen with a total dose of up to 100 mg per day, and 10 with Piroxicam 20 mg after 12 months of therapy, patients in comparison with the control group of examinees. Besides conventional markers of renal function (serum/urine creatinin determined by Jaffe methods enzymatic assay for urea in serum), we used nephelometry by β2 Microgloglobulin (β2 M) and photoelectric colorimetry for microalbuminuria in urine, to monitor glomerular and tubular functioning. Any history of kidney disease was exclusion criteria to enter the study. The standard metrics to follow the progression of AKI, like serum creatinine and blood urea levels, are inconvenient and depend on kidney injury. That’s why we must use specific markers for early detection. Following the levels of specific biomarkers in urine we can use them as signals for early detection of nephrotoxicity, we can recommend constant monitoring of renal functions during use of different groups of NSAIDs and be careful while using analgesic -anti-inflammatory drugs. Keywords: adverse renal effects, non-steroidal anti-inflammatory drugs, migrain

Comparison of the adverse renal effects of different types of NSAID based on COX inhibition in patients with headaches

Migraine is a common headache disorder that causes significant disabilities. Non-selective COX inhibitors (Piroxicam, Ketoprofen and Ibuprofen) are most widely-prescribed NSAIDs treatment of headaches. Celecoxib is another NSAID therapy that has been approved in the last several years, with different mechanisms of action. The purpose of the study is to follow the renal function and comparisons of nephrotoxicity of different types of NSAID based on COX inhibition, in patients with cefalea-migraine that has been treated for a long period. Besides conventional markers of renal function (serum/urine creatinin determined by Jaffe's methods of enzymatic assay for urea in serum), we used nephelometry by β2 Microglobulin (β2 M) and photoelectric colorimetry for microalbuminuria in urine, to monitor glomerular and tubular functioning. Any history of kidney diseases was an exclusion criteria to enter the study. The results show that the greatest deviations are observed in β2 microglobulin in terms of its increase in all patients treated with Piroxicam and Ketoprofen, in 91.7% patients treated with Ibuprofen, and in 50% of patients treated with Celecoxib. The most frequent decrease was shown in creatinine values in urine, in 50% of patients of Piroxicam-treated group, 66.7% of the group treated with Ketoprofen and Ibuprofen, and 75% of the patients treated with Celecoxib. Following the levels of specific biomarkers in urine we can recommend constant monitoring of renal functions during usage of different groups of NSAIDs and be careful while using analgesic -anti-inflammatory drugs