354 research outputs found

    Prohypertensive Effects of Non-Steroidal Anti-Inflammatory Drugs are Mostly Due to Vasoconstriction

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    Non-steroidal anti-inflammatory drugs (NSAIDs) have prohypertensive effects and blunt the effects of many antihypertensives. The mechanism of this interaction is still not understood enough. The objective of this investigation was to determine the level of prohypertensive effects of two NSAIDs (ibuprofen, piroxicam) and paracetamol, co-prescribed with two antihypertensive drugs (lisinopril + hydrochlorothiazide, amlodipine), and to improve the understanding of this interaction. A prospective clinical trial, conducted in a Croatian family practice, included 110 already treated hypertensive patients, aged 56ā€“85 years; 50 control patients and 60 patients who were also taking NSAIDs for osteoarthritis treatment. The antihypertensive regimens remained the same during this study, while NSAIDs and paracetamol were crossed-over in three monthly periods. Blood pressure, body weight, serum creatinine, potassium, sodium, diuresis and 24 h urinary sodium excretion were followed-up. In the lisinopril/hydrochlorothiazide subgroup, both ibuprofen and piroxicam elevated mean arterial pressure by 8.9ā€“9.5% (p<0.001). Body weight increased significantly in the lisinopril/ hydrochlorothiazide + piroxicam subgroup only, while creatinine, urinary output and electrolyte values did not change appreciably in any of the subgroups. NSAIDā€™s prohypertensive effects seem to be mostly due to vasoconstriction and, to a minor degree, to volume expansion, since no marked changes in body weight, urinary output, serum creatinine or serum/ urinary electrolyte profile were observed

    EFFICIENCY OF PREVENTIVE TREATMENT

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    Preventivna medicina usmjerena je na suzbijanje bolesti prije njihovog kliničkog prokazivanja, u prvom redu na kontrolu čimbenika rizika. U tom su smislu opće mjere glede promjene životnog stila daleko važnije, učinkovitije i jeftinije od farmakoterapije. Propisivanje lijekova na ovom području treba biti osobito dobro promiÅ”ljeno i utemeljeno, kako se brzopletom intervencijom ne bi učinilo viÅ”e Å”tete nego koristi.Preventive medicine is aimed at disease fighting before clinical manifestations take place, mainly at control of the respective risk factors. General measures in terms of life-style modification are much more important, proficient and cost-effective than drugs. Therefore the use of medicines in this field must be particularly well funded and considerate since hasty drug prescription may do more harm than good

    Ethical issues in family medicine

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    U ovom su prikazu razmotrene određene moralne dvojbe, poput odnosa liječnik-pacijent, liječničke tajne, priziva savjesti, sukoba interesa, suradnje među liječnicima ili nastupanja u medijima, koje se čeŔće susreću u ordinacijama obiteljske medicine.This essay deals with some moral uncertainties concerning doctor-patient relationship, confidentiality, conscientious objection, conflict of interest, cooperation with consultants and appearance in the media, which are often encountered in a family physician\u27s office

    Socioeconomic Stress and Drug Consumption: Unemployment as an Adverse Health Factor in Croatia

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    Aim: To explore to what degree unemployment was related to health problems expressed in terms of consumption of prescription drugs in Croatian citizens. Methods: Based on the Croatian Institute for Health Insurance data for 2003, the number of prescriptions per insured individual (NPI) was calculated for employed and unemployed persons, as well as for different subsets according to the region (Zagreb, Split, Rijeka, Osijek), age, gender, and prescribed drug category. Results: During 2003, a total of 1 003 547 drugs were prescribed to 949 746 health-insured persons aged 18-69 years. NPI was 32% higher for unemployed than for employed citizens; it averaged 0.995 among the employed, and 1.317 among the unemployed. Differences in NPI (āˆ†NPI) between the employed and the unemployed varied within the subsets; the largest difference was observed in the Zagreb region (Ī”NPIā€‰=ā€‰0.522), in the 30-39 age group (Ī”NPIā€‰=ā€‰0.563), in men (Ī”NPIā€‰=ā€‰0.565), and for anxiolytic/antidepressant drugs (Ī”NPIā€‰=ā€‰0.184). Conclusion: Our findings indicate that unemployed Croatian citizens used more drugs, which calls for the implementation of health care measures to reduce or prevent their medical problems, particularly those affecting mental health. Medical problems associated with unemployment present a specific burden for family medicine and the health care system

    Socioeconomic Stress and Drug Consumption: Unemployment as an Adverse Health Factor in Croatia

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    Aim: To explore to what degree unemployment was related to health problems expressed in terms of consumption of prescription drugs in Croatian citizens. Methods: Based on the Croatian Institute for Health Insurance data for 2003, the number of prescriptions per insured individual (NPI) was calculated for employed and unemployed persons, as well as for different subsets according to the region (Zagreb, Split, Rijeka, Osijek), age, gender, and prescribed drug category. Results: During 2003, a total of 1 003 547 drugs were prescribed to 949 746 health-insured persons aged 18-69 years. NPI was 32% higher for unemployed than for employed citizens; it averaged 0.995 among the employed, and 1.317 among the unemployed. Differences in NPI (āˆ†NPI) between the employed and the unemployed varied within the subsets; the largest difference was observed in the Zagreb region (Ī”NPIā€‰=ā€‰0.522), in the 30-39 age group (Ī”NPIā€‰=ā€‰0.563), in men (Ī”NPIā€‰=ā€‰0.565), and for anxiolytic/antidepressant drugs (Ī”NPIā€‰=ā€‰0.184). Conclusion: Our findings indicate that unemployed Croatian citizens used more drugs, which calls for the implementation of health care measures to reduce or prevent their medical problems, particularly those affecting mental health. Medical problems associated with unemployment present a specific burden for family medicine and the health care system

    Alkaptonurija ā€“ prilika za etička razmatranja anonimnosti na slikama

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    Alkaptonuria ā€“ a case for ethical assessment of pictorial anonymit

    Predictive Impact of Coronary Risk Factors in Southern Croatia: A Case Control Study

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    The aim of study was to compare the impact of coronary risk factors on the incidence of acute myocardial infarction (MI) between Croatia, Central and Eastern Europe, and the rest of the world. As a part of the large international INTERHEART case-control study of acute MI in 52 countries (15,152 cases and 14,820 controls) we have investigated the relationship between several known risk factors (smoking, history of hypertension or diabetes, waist/hip ratio, dietary patterns, physical activity, consumption of alcohol, blood apolipoproteins, and psychosocial factors) and MI among patients without previously known coronary heart disease in Southern Croatia. The main identified MI risk factors in Southern Croatia were heavy smoking (>20 cig/day; OR 3.86; 95% CI 2.31ā€“6.46), diabetes mellitus (OR 2.83; 95% CI 1.58ā€“5.23), abnormal ratio of B-100 and A-1 apolipoproteins (OR 2.23; 95% CI 1.28ā€“3.89), elevated waist to hip ratio (OR 1.96; 95% CI 1.21ā€“3.18), and arterial hypertension (OR 1.68; 95% CI 1.15ā€“2.45). Protective was moderate alcohol consumption (OR 0.63; 95% CI 0.40ā€“0.99). The prevalence of major MI risk factors in Croatia is similar to that in the surrounding countries and in the world, accounting for over 90% of the population attributable risk. However, physical activity, dietary and psychosocial factors are seemingly less important in this country, while moderate alcohol consumption is more protective than regionally or globally

    MERITS OF PARACETAMOL IN OSTEOARTHRITIC HYPERTENSIVE PATIENTS

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    Cilj ispitivanja bio je odrediti mjesto paracetamola u liječenju hipertoničara s artrozom, i utvrditi najpovoljniju kombinaciju antihipertenziva i antireumatika za te pacijente. U prospektivno ispitivanje provedeno u ordinaciji obiteljske medicine uključeno je 110 liječenih hipertoničara starijih od 55 godina; 50 u kontrolnu i 60 u interventnu skupinu (uzimali su i nesteroidne antireumatike zbog osteoartritisa). U tromjesečnom su razdoblju uspoređivana dva antihipertenziva, lizinopril/hidroklorotiazid i amlodipin s dva nesteroidna anrireumatika (NSAR): ibuprofenom i piroksikamom, te s paracetamolom. Nakon svakog jednomjesečnog razdoblja mjeren je arterijski tlak, učinak ispitivanih lijekova na intenzitet boli i kvalitetu života ispitanika. Ibuprofen i piroksikam pokazali su značajno prohipertenzivno djelovanje, a u razdoblju uzimanja paracetamola ono je bilo neznatno i klinički zanemarivo. U podskupini amlodipin Ā± ibuprofen, prosječni rezultat na ljestvici boli statistički se značajno smanjivao tijekom pokusa. U podskupini lizinopril/hidroklorotiazid Ā± piroksikam prosječna procijenjena kvaliteta života značajno se mijenjala. Paracetamol je pokazao podjednaku analgetsku učinkovitost kao ibuprofen, a tek neÅ”to slabiju od piroksikama. Kvaliteta života je u NSAR fazama bila loÅ”ija nego tijekom uzimanja paracetamola. Samo paracetamol nije utjecao na antihipertenzivno djelovanje lizinopril/ hidroklorotiazid kombinacije. U hipertoničara s artrozom paracetamol je analgetik prvog izbora, dok je antihipertenziv izbora jedan antagonist kalcija, navlastito amlodipin.Background: Nonsteroidal anti-inflammatory drug (NSAID) side effects can impair quality of life in patients with osteoarthritis. Due to its particular mechanism of action, paracetamol might bypass these negative effects. Objectives: To determine both the role of paracetamol in the treatment of osteoarthritis patients and optimal combination of antihypertensives and antirheumatics for these patients. Methods: A prospective clinical trial in a family practice included 110 treated hypertensives aged over 55 years: 50 controls and 60 also taking NSAIDs for osteoarthritis. This 3-month study compared two antihypertensives, lisinopril/hydrochlorothiazide fixed combination and amlodipine, with two NSAIDs, ibuprofen and piroxicam, and with paracetamol. Following clinical work-up and NSAID discontinuation for at least 3 days (run-in period of only 3-7 days), osteoarthritis subjects were randomized to 1-month periods of ibuprofen (400-600 mg t.i.d.) or piroxicam (10-20 mg o.d.) with one month of paracetamol (1000 mg t.i.d.) in the middle as a ā€œwash-outā€ interval, continuing the prescribed amlodipine (5-10 mg o.d.) or lisinopril/hydrochlorothiazide fixed drug combination (10/6.25-20/12.5 mg o.d.), while control subjects (hypertensives with no osteoarthritis) were just keeping their antihypertensive therapy. Blood pressure was measured with standard mercury sphygmomanometer and with an automatic device, in standing, sitting and supine position. The intensity of arthritic pain (on a visual analogue scale from 1 to 10, where 0 means ā€œno painā€ and 10 ā€œthe worst pain you may imagineā€) and the patientā€™s quality of life estimate (on a visual analogue scale from 1 to 10, where 0 means ā€œgeneral condition excellentā€ and 10 ā€œthe worst possibleā€) were recorded. Results: Blood pressure control was unchanged in the amlodipine group across the study periods and impaired in the lisinopril/ hydrochlorothiazide group during either ibuprofen or piroxicam, but not during paracetamol. In the amlodipine Ā± ibuprofen subgroup, the reduction of the average pain intensity score throughout the study was significant (2=8.250; df 3; P=0.037). In the lisinopril/hydrochlorothiazide Ā± piroxicam subgroup, the assessed quality of life differed significantly (2=9.716; df 3; P=0.018), while in the amlodipine Ā± ibuprofen and amlodipine Ā± piroxicam subgroups the changes were marginal (2=6.936; df 3; P=0.072 and 2=7.146; df 3; P=0.065, respectively). Discussion: In our trial, paracetamol had analgesic efficacy similar to ibuprofen and only marginally inferior to piroxicam. The analgesic effect of ibuprofen, piroxicam and paracetamol was more pronounced in amlodipine than in the lisinopril/hydrochlorothiazide subgroups. The quality of life was reported to be worse with NSAIDs than with paracetamol, presumably due to dyspeptic problems. Although during the paracetamol phases, the quality of life was slightly improved, the difference was statistically nonsignificant because of the small samples and insufficiently sensitive scale. Conclusion: Analgesic efficiency of paracetamol is comparable to that of ibuprofen and is marginally inferior to piroxicam. Only paracetamol did not interfere with the antihypertensive effects of lisinopril/ hydrochlorothiazide combination. Piroxicam and ibuprofen markedly blunt the effects of antihypertensive drugs while paracetamol is almost inert in this sense. Lisinopril/hydrochlorothiazide combination is much more affected by this interaction than amlodipine. Because of less side effects and better tolerability, paracetamol is the analgesic of choice for hypertensive patients with osteoarthritis, needed prolonged pain relief. The second choice drugs are narcotic analgesics (e.g., tramadol). Small doses of NSAIDs can eventually be added with concomitant prescription of gastroprotective agents

    ON PLAGIARISM IN SCIENCE

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    U ovom kratkom osvrtu autor razmatra pitanje intelektualnog poÅ”tenja u svjetlu tekućih rasprava o plagiranju u naÅ”oj znanstvenoj produkciji.In this brief commentary the author analyzes the issue of intelectual integrity in the light of current discussions about plagiarism in the Croatian scientifi c community
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