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CONTRIBUTORS IN THE NETWORK OF TEACHERS IN PHARMACOTHERAPY (NOTIP) (ALPHABETIZED BY COUNTRY): Atanasova, Ivanka (Sofia University St. Kliment Ohridski, Sofia, Bulgaria); Ganeva, Maria (Trakia University, Stara Zagora, Bulgaria); Gatchev, Emil (Medical University of Sofia, Sofia, Bulgaria); Kostadinova, II (Medical University Plovdiv, Plovdiv, Bulgaria); Mimica Matanovic, S (University of Osijek, Osijek, Croatia); Vitezic, D (University of Rijeka Medical School, Rijeka, Croatia); Wozniak, Greta (University of Cyprus, Nicosia, Cyprus); Kmonickova, E (Charles University, Pilsen, Czech Republic); Urbanek, Karel (Palacky University, Olomouc, Czech Republic); Damkier, P (University of Southern Denmark, Odense, Denmark); Huupponen, RK (University of Turku, Turku, Finland); Auffret, Marine (Hospices civils de Lyon, Lyon, France); Bejan-Angoulvant, T (Université de Tours, Tours, France); Chouchana, Laurent (Hospital Cochin, Paris, France); Cracowski, Jean-Luc (University Grenoble Alpes, La Tronche, France); Drici, MD (University of Nice Côte d'Azur, Nice, France); Faillie, JL (CHU Montpellier, Montpellier, France); Geniaux, Hélène (CHU de Limoges, Limoges, France); Molimard, M (Université de Bordeaux, Bordeaux, France); Orlikowski, D (Versailles Saint-Quentin-en-Yvelines University, Versailles, France); Palin, Karine (University of Bordeaux, Bordeaux, France); Pers, Y-M (CHU Montpellier, Montpellier, France); Picard, Nicolas (CHU de Limoges, Limoges, France); Simon, N (Aix-Marseille University, Marseille, France); Toussirot, E (CHU de Besancon, Besancon, France); Boger, RH (University Medical Center Hamburg-Eppendorf, Hamburg, Germany); Cascorbi, I (University of Kiel, Kiel, Germany); Mueller, SC (University Medicine Rostock, Rostock, Germany); Regenthal, R (University of Leipzig, Leipzig, Germany); Schwab, M (Eberhard Karl University of Tübingen, Tübingen, Germany); Schwaninger, MS (University of Luebeck, Luebeck, Germany); Thuermann, PA (University Witten/Herdecke, Witten, Germany); Wojnowski, L (University Medical Center Mainz, Mainz, Germany); Kouvelas, D (Aristotle University of Thessaloniki, Thessaloniki, Greece); Riba, P (Semmelweis University, Budapest, Hungary); Kerins, David M (University College, Cork, Ireland); Williams, David J (Royal College of Surgeons in Ireland, Dublin, Ireland); Cosentino, M (University of Insubria, Varese, Italy); De Ponti, Fabrizio (University of Bologna, Bologna, Italy); Filippelli, Amelia (University of Salerno, Baronissi, Italy); Leone, R (University of Verona, Verona, Italy); Locatelli, Vittorio (University of Milano - Bicocca, Monza, Italy); Jansone, Baiba (University of Latvia, Riga, Latvia); Gulbinovic, Romaldas (Vilnius University, Vilnius, Lithuania); Mifsud, Janet (University of Malta, Msida, Malta); Braszko, Jan J (Medical University of Bialystok, Bialystok, Poland); kocic, I (Medical University of Gdansk, Gdansk, Poland); Breitenfeld, Luiza (Beira Interior University, Covilh~a, Portugal); Castelo-Branco, M (University of Beira Interior, Covilh~a, Portugal); Conea, Simona (“Vasile Goldis” Western University of Arad, Arad, Romania); Magyar, Ioan (University of Oradea, Oradea, Romania); Bevc, S (University of Maribor, Maribor, Slovenia); Krzan, Mojca (University of Ljubljana, Ljubljana, Slovenia); Bernal, ML (University of Zaragoza, Zaragoza, Spain); Capellà, D (University of Girona, Girona, Spain); Carcas, A (Universidad Autónoma de Madrid, University of Maribor, Spain); De Abajo, FJ (University of Alcalá, Alcalá de Henares, Spain); Lopez-Rico, M (University of Salamanca, Salamanca, Spain); Lucena, MI (University of Malaga, Malaga, Spain); Pontes, C (Universitat Autonoma de Barcelona, Sabadell, Spain); Sanz, EJ (Universidad de La Laguna, La Laguna, Spain); Böttiger, Y (Linköping University, Linköping, Sweden); Le Grevès, Madeleine (Uppsala University, Uppsala, Sweden); de Waard-Siebinga, I (University Medical Center Groningen, Groningen, The Netherlands); Janssen, Ben JA (Maastricht University, Maastricht, The Netherlands); Knol, Wilma (University Medical Center Utrecht, Utrecht, The Netherlands); Pandit, Rahul (University Medical Center Utrecht, Utrecht, The Netherlands); van Rosse, F (Erasmus Medical Center, Rotterdam, The Netherlands); Dent, G (Keele University, Keele, United Kingdom); Ferro, Albert (King's College London, London, United Kingdom); Hitchings, AW (St George's, University of London, London, United Kingdom); Kapil, V (Queen Mary University London, London, United Kingdom); Linton, KD (University of Sheffield, Sheffield, United Kingdom); Loke, YK (University of East Anglia, Norwich, United Kingdom); Okorie, Michael (Brighton and Sussex Medical School, Brighton, United Kingdom); Plumb, Richard David (Queen's University Belfast, Belfast, United Kingdom); Pontefract, Sarah (University of Birmingham, Birmingham, United Kingdom); Ranmuthu, S (Queen Mary University London, London, United Kingdom); Sampson, AP (University of Southampton, Southampton, United Kingdom); Thanacoody, HKR (Newcastle University, Newcastle upon Tyne, United Kingdom); Whitfield, Jonathan P (University of Aberdeen, Aberdeen, United Kingdom); Wilson, Kurt (University of Manchester, Manchester, United Kingdom) Improvement and harmonization of European clinical pharmacology and therapeutics (CPT) education is urgently required. Because digital educational resources can be easily shared, adapted to local situations and re‐used widely across a variety of educational systems, they may be ideally suited for this purpose Methods With a cross‐sectional survey among principal CPT teachers in 279 out of 304 European medical schools, an overview and classification of digital resources was compiled. Results Teachers from 95 (34%) medical schools in 26 of 28 EU countries responded, 66 (70%) of whom used digital educational resources in their CPT curriculum. A total of 89 of such resources were described in detail, including e‐learning (24%), simulators to teach pharmacokinetics and/or pharmacodynamics (10%), virtual patients (8%), and serious games (5%). Together, these resources covered 235 knowledge‐based learning objectives, 88 skills, and 13 attitudes. Only one third (27) of the resources were in‐part or totally free and only two were licensed open educational resources (free to use, distribute and adapt). A narrative overview of the largest, free and most novel resources is given. Conclusion Digital educational resources, ranging from e‐learning to virtual patients and games, are widely used for CPT education in EU medical schools. Learning objectives are based largely on knowledge rather than skills or attitudes. This may be improved by including more real‐life clinical case scenarios. Moreover, the majority of resources are neither free nor open. Therefore, with a view to harmonizing international CPT education, more needs to be learned about why CPT teachers are not currently sharing their educational materials.

Aim of study. Estimation of urinary tract infection (UTI) risk factors, antimicrobial treatment, length of UTI-treatment and stay in Cardiac intensive care unit (CICU), mortality and its risk factors in CICU patients. Methods. Retrospective analysis of data of 57 patients with bacteriuria, who were treated in Kaunas Clinics CICU. Results. Bacteriuria rate between males and females was found to be equal (47.4% and 52.5%). Mean age 73.01±12.3 y/o; bacteriuria was more often present among patients over 65 y/o compared to younger ones, p

Objectives. To collect the data about the consumption of digoxin, evaluate the tendencies towards usage of this drug during 2004–2007, and to find departments, which cover the main part of digoxin consumption in a tertiary hospital. To evaluate the intensity of serum digoxin concentration measurements during 2005–2007. Material and methods. Our study was carried out in a tertiary hospital with 2600 beds and 63 departments. Consumption of digoxin is expressed in defined daily doses per 100 occupied beds daily during 2004–2007. All serum concentration measurements in 2005–2007 were evaluated. Results. The main consumers of digoxin in 2007 were the Units of Endocrinology, Pulmonology and Immunology, Cardiology II, Neurosurgical Reanimation and Intensive Care, Neurology, Eye Disorders I, Intensive Care Unit of Cardiology; they consumed 51.05% of total digoxin. In total, 58 digoxin measurements were performed in 2005, 89 in 2006, and 64 in 2007. The intensity of serum concentration measurements for digoxin is 1/147 (one measurement for 147 defined daily doses) in 2005, 1/89 in 2006, and 1/107 in 2007. These results show that intensity of serum digoxin concentration measurements is low. Conclusions. Twenty-two out of the 63 departments cover 90% of digoxin consumption per year. The changes in digoxin consumption were not statistically significantly different in 2004– 2007. There was a tendency towards an increase in serum digoxin concentration measurements during the 3-year period. Digoxin concentration outside therapeutic ranges was established in about half of all cases in 2005–2006, but there was an increase in normal serum concentration in 2007.

Objective. The main goal of this study was to evaluate the variation of antibiotic consumption and relation between antibiotic consumption and microorganism resistance. Material and methods. This analysis was performed in one of Lithuanian tertiary hospitals. The defined daily dose (DDD) analysis was performed to express drug consumption per every 100 occupied bed days (OBDs) for single units in clinical departments. Average of DDD/100 OBDs was estimated for 2004–2007, and mean values were compared among all four years. The relation between the number of surgical operations and antibiotic consumption in surgery departments was analysed. E. coli and K. pneumoniae resistance for four years (2004–2007) was determined. Moreover, the relation between microorganism resistance and variation of antibiotic consumption was determined. Data were analysed by descriptive and comparative statistics (by Mann–Whitney test for nonparametric criteria and Spearman correlation). Results. Comparing the DDD/100 OBD data during 2004–2007 revealed a statistically significant increase in piperacillin and tazobactam (877.50%), metronidazole (114.00%), cefuroxime (77.31%), meropenem (47.55%), cefoperazone and sulbactam (173.11%) consumption. The increased usage of these antibiotics was determined in surgery department too. However, the increased number of surgical operations cannot be the only reason of the growing antibiotic consumption. Results revealed a statistically significant decrease in ofloxacin use from 2006 to 2007 (93.94%). E. coli resistance to ampicillin (from 49.80% to 56.60%), ampicillin and sulbactam (from 25.50% to 39.20%), cefuroxime (from 7.40% to 10.10%), ciprofloxacin (from 4.20% to 12.50%), gentamicin (from 11.40% to 13.20%) and K. pneumoniae resistance to ampicillin and sulbactam (from 45.40% to 56.40%), cefuroxime (from 34.00% to 39.10%), ciprofloxacin (from 5.50% to 10.50%), gentamicin (from 32.00% to 35.80%) increased[...].

Tyrimo tikslas. Išanalizuoti gydymo gentamicinu stacionare skyrimo indikacijas ir dozavimo principus, įvertinti gentamicinu gydomų ligonių stebėseną dėl galimo nefrotoksinio poveikio. Tyrimo medžiaga ir metodai. Iš archyvo paimta Kauno medicinos universiteto klinikose gentamicinu gydytų 105 ligonių ligos istorijos: 59 chirurgijos ir 46 vidaus ligų profilio. Surinkti duomenys apie gentamicino skyrimo indikacijas, dozavimą, gydymo trukmę, pacientų inkstų funkciją ir jos kitimus gydymo eigoje. Rezultatai. Daugiau kaip trečdalis gydytų ligonių buvo vyresni nei 65 metų. Gentamicino skirta: a) profilaktiškai po operacijos 14 (23,73 proc.) chirurgijos ligonių; b) infekcijai gydyti 45 (76,27 proc.) chirurgijos ir 46 (100 proc.) vidaus ligų profilio ligoniams. Empiriškai gentamicinu gydyti 29 (49,15 proc.) chirurgijos ir 29 (63,04 proc.) vidaus ligų skyrių ligoniai. 87,62 proc. ligonių gentamicino skirta po 240 mg, visiems 105 ligoniams – vieną kartą per parą. Prieš pradedant gydymą gentamicinu inkstų funkcija neištirta 11,86 proc. chirurgijos ir 19,56 proc. vidaus ligų stacionaro ligoniams, o gydymo eigoje inkstų funkcijos rodikliai tirti tik trečdaliui ligonių. Inkstų funkcija 87,62 proc. ligonių vertinta pagal šlapalo koncentraciją kraujyje. Kreatinino koncentracija kraujyje ištirta tik 12,38 proc. pacientų. Chirurgijos skyrių ligonių gydymo gentamicinu trukmės vidurkis – 5,932±2,392 dienos (2–13 d.), vidaus ligų – 8,283±3,344 dienos (3–19 d.). Išvados. Daugiau kaip pusei... [toliau žr. visą tekstą] The aim of the study was to analyze the treatment with gentamicin and possible nephrotoxicity of this antibiotic in patients treated in surgical and internal medicine departments of Kaunas University of Medicine Hospital. Materials and methods. A total of 105 case histories obtained from archive of our hospital were analyzed: 59 case records from surgical and 46 from internal medicine departments. Data were collected regarding indications for the administration of gentamicin, its dosage, duration of treatment, and patients’ renal function at the beginning and during the treatment. Results. There were more than 30% of patients older than 65 years. Gentamicin was administered in 14 (23.73%) surgical inpatients to prevent postoperative infection; 45 (76.27%) surgical and 46 (100%) internal medicine inpatients received gentamicin because of symptoms of infection. Half of the patients were treated empirically. In 87.62% of cases, gentamicin was administered at a dose of 240 mg; all 105 patients received it once per day. Before treatment, renal function was not evaluated in 11.86% of surgical and in 19.56% of internal medicine inpatients, and during treatment, it was examined only in one-third of patients. The duration of the treatment was 5.932±2.392 days (range 2–13 days) in surgical and 8.283±3.344 days (range 3–19 days) in internal medicine inpatients. Conclusions. More than half of patients received empirical treatment with gentamicin. Not enough attention has been paid to... [to full text]

Neracionalus antimikrobinių vaistų vartojimas didina mikroorganizmų atsparumą šiems preparatams. Didėjantis atsparumas antimikrobiniams vaistams yra didelė visuomenės sveikatos problema visame pasaulyje. Tyrimų, vertinusių šeimos gydytojo, dirbančio universitetinėje gydymo įstaigoje Lietuvoje, žinias apie tinkamą antibiotikų vartojimą, iki šiol nebuvo atlikta. Tyrimo tikslas – įvertinti antibiotikų vartojimą bei palyginti jų skyrimo indikacijas, dozavimą bei gydymo trukmę su racionalaus antibiotikų vartojimo rekomendacijomis. Kauno medicinos universiteto Šeimos medicinos klinikoje atliktas retrospektyvusis apžvalginis tyrimas: išanalizuotos visos dviejų apylinkių asmens sveikatos (ambulatorinės) kortelės (F25/a) ir atrinktos kortelės tų pacientų, kuriems per paskutinius vienerius metus (nuo 2005 m. sausio 1 d. iki gruodžio 31 d.) skirta antibiotikų. Antibiotikų vartojimas yra racionalus, jei jų skyrimas atitiko racionalaus antibiotikų vartojimo rekomendacijas. Tyrimo duomenų statistinė analizė atlikta naudojant statistikos paketą „SPSS 13“. Abiejose apylinkėse antibiotikų skirta 210 atvejų (I – 71 (33,8 proc.), II – 139 (66,2 proc.)). Iš viso abiejose apylinkėse antibiotikų skirta 184 pacientams (6,3 proc.). Atlikus tyrimo duomenų statistinę analizę, nustatyta, kad abiejų apylinkių šeimos gydytojai antibiotikus infekcinėms ligoms gydyti gali skirti racionaliau. Tik 9,5 proc. visų atvejų anti¬mikrobinių vaistų buvo skirta laikantis racionalaus antibiotikų vartojimo... [toliau žr. visą tekstą] Irrational and excessive use of antibiotics increases resistance to these preparations. Antimicrobial resistance is a serious public health problem worldwide. The main goal of our study was to evaluate the use of antibiotics (indications, dosage, and treatment duration) in daily family doctors’ practice and nonadherence to guidelines on rational antibiotic therapy. A retrospective study of records regarding the prescription of antibiotics for patients in two outpatient settings during the period of January 1, 2005, to December 31, 2005 was performed in Clinic of Family Medicine at Kaunas University of Medicine. Rationality of antibiotic therapy was evaluated according for adherence to published guidelines. A descriptive and comparative statistical analysis of data was processed with SPSS 13.0 program. There were 2935 patients in both outpatient settings (1285 and 1650, respectively). During the period of January 1, 2005, to December 31, 2005, antibiotics were prescribed in 210 cases for various reasons (71 (33.8%) and 139 (66.2%), respectively). A total of 184 (6.3%) patients received antibiotic therapy. It was determined that only in 9.5% of all cases, antibiotics were administered in keeping with the recommendations for rational antibiotic therapy. Only two treatment cases (1%) were based on bacteriological analysis. According to indications, appropriate antibiotics were prescribed in 42.9% of cases. The dosage of antibiotics was adjusted properly in 56.2% of cases, and... [to full text]

Breastfeeding is the most healthful method of feeding neonates and infants. In 2001 about 98% of new mothers in Lithuania started breastfeeding their neonates. One-third of nursing women (34%) discontinued breastfeeding at the time when infant reached the age of 3 months. About 56% of women breastfed their infants longer than 4 months. Only 3–6% of nursing women discontinued breastfeeding after the fourth month. Discontinuation of breastfeeding in 21–23% of all cases was directly or indirectly associated with use of medications. Such data suggest that there is a lack of information often leading physicians to advise mothers to discontinue breastfeeding because of medication use. The aim of this article was to survey the situation about classification of drugs used during breastfeeding and factors influencing drug transfer into milk in order to give more information for physician concerning the use of medication during breastfeeding. In this review, a short description of main pharmacokinetic characteristics, influencing drug transfer into milk; information on the classification of drugs used during breastfeeding; some considerations on drug safety and possible adverse effects of medications on breastfed infant; the list of drugs preferred for nursing women are presented.

Gydytojo nurodymų nesilaiko iki 60 proc. pacientų. Vaistą išrašančio gydytojo nuomonė apie vaisto saugumą ir toleravimą yra vienas svarbesnių veiksnių, turinčių įtakos tam, kaip pacientas laikosi gydytojo nurodymų. Tačiau abiejų dalyvaujančių šalių, t. y. ir gydytojo, ir paciento, pastangų sutelkimas yra ne mažiau svarbus. Todėl atsižvelgti į paciento pageidavimus, parenkant vaisto formą (pvz., disperguojamąją burnoje tabletę galima nuryti neužgeriant vandeniu), yra teisingas kelias, užtikrinantis geresnį gydytojo nurodymų vykdymą. Šio darbo tikslas – klausimyno pagalba išsiaiškinti depresija sergančių pacientų nuomonę apie antidepresanto mirtazapino naują vaisto formą – burnoje disperguojamąją tabletę (Remeron SolTab). Leidimą tyrimui 2005 metais išdavė Valstybinės vaistų kontrolės tarnybos prie Lietuvos Respublikos sveikatos apsaugos ministerijos Ikiklinikinių ir klinikinių tyrimų komisija pritarus Etikos komitetui. Lietuvoje buvo apklausti 453 depresija sergantys pacientai. Dauguma pacientų vartojo vidutinę, t. y. 30 mg Remeron SolTab dozę (344 (75,88 proc.) pacientai). Didelė dalis apklaustųjų (189 pacientai arba 41,81 proc.) Remeron SolTab disperguojamosios tabletės skonį apibūdino kaip „labai malonų“. Tyrimo duomenimis, 281 (61,95 proc.) pacientų Remeron SolTab vartojo reguliariai. Tačiau 129 (28,54 proc.) pacientams nauja vaisto forma neturėjo įtakos vartojimo reguliarumui. Statistiškai reikšmingai daugiau (81,86 proc.) apklaustųjų nurodė, jog rinktųsi Remeron SolTab... [toliau žr. visą tekstą] As many as 60% of the patients do not follow the therapy recommended by their physicians. An important factor that can influence patient’s compliance is the physician’s opinion about the tolerability and safety of prescribed medication. However, the efforts of both parties, not only physician but also patient, have benefits on the outcome of treatment. Patient’s opinion on choosing the form of medication is appropriate way ensuring better compliance. The aim of the survey was to ascertain the opinion of depressed patients towards a new formulation of antidepressant drug, mirtazapine – orally disintegrating tablet Remeron SolTab. The study was approved by Lithuanian State Medicines Control Agency and local Ethics Committee. A total of 453 depressed patients were included in the survey. Most of the patients used a 30-mg dose of Remeron SolTab (n=344, 75.88%). Most of the patients (n=189, 41.81%) had a positive opinion about the taste of medication (“very pleasant”). According to the results of the survey, 281 (61.95%) used Remeron SolTab regularly. However, 129 (28.54%) patients noted that the new drug formulation had no influence on the regularity of use. Statistically significantly more patients (81.86%) noted that they would choose Remeron SolTab compared to the patients who would prefer conventional form of the medication (2.21%). In 184 (40.71%) patients, a significant mood improvement was noted. Most of the patients (n=246, 54.20%) indicated that mood improved. Based on... [to full text]

Žindymas yra sveikiausias naujagimių ir kūdikių maitinimo būdas. 2001 metais Lietuvoje atlikto tyrimo duomenimis, gimus naujagimiui žindyti pradeda 98 proc. moterų. Per pirmuosius tris mėnesius po gimdymo žindyti nustoja 34 proc. moterų. Keturis ir daugiau mėnesių žindė 56,5 proc. moterų. Po ketvirtojo mėnesio žindyti nustojo gerokai mažiau moterų – vos 3–6 proc. 21–23 proc. atvejų žindymo nutraukimas buvo tiesiogiai ar netiesiogiai susijęs su medikamentų vartojimu. Tokie duomenys rodo, kad informacijos stoka skatina gydytojus rekomenduoti žindyvėms nutraukti žindymą, jei reikia vartoti medikamentus. Šio straipsnio tikslas – supažindinti su vaistinių preparatų klasifikacija atsižvelgiant į žindymo riziką, pateikti informaciją apie vaistinių preparatų patekimą į motinos pieną lemiančius veiksnius, nepageidaujamo poveikio riziką, supažindinti su vaistiniais preparatais, kuriuos galima vartoti žindymo laikotarpiu. Pateikti duomenys bus naudingi įvairių specialybių gydytojams sprendžiant, ar visada būtina nutraukti žindymą, kai žindyvė vartoja medikamentus. Straipsnyje trumpai aptariami farmakokinetikos rodikliai, lemiantys vaistinio preparato patekimą į motinos pieną, pateikiama žindymo laikotarpiu vartojamų vaistų klasifikacija, apžvelgti vaisto saugumo aspektai, galimas nepageidaujamas vaistų poveikis, pateiktas trumpas sąrašas medikamentų, kuriuos saugu vartoti žindymo laikotarpiu. Breastfeeding is the most healthful method of feeding neonates and infants. In 2001 about 98% of new mothers in Lithuania started breastfeeding their neonates. One-third of nursing women (34%) discontinued breastfeeding at the time when infant reached the age of 3 months. About 56% of women breastfed their infants longer than 4 months. Only 3–6% of nursing women discontinued breastfeeding after the fourth month. Discontinuation of breastfeeding in 21–23% of all cases was directly or indirectly associated with use of medications. Such data suggest that there is a lack of information often leading physicians to advise mothers to discontinue breastfeeding because of medication use. The aim of this article was to survey the situation about classification of drugs used during breastfeeding and factors influencing drug transfer into milk in order to give more information for physician concerning the use of medication during breastfeeding. In this review, a short description of main pharmacokinetic characteristics, influencing drug transfer into milk; information on the classification of drugs used during breastfeeding; some considerations on drug safety and possible adverse effects of medications on breastfed infant; the list of drugs preferred for nursing women are presented.

Objective. To evaluate trends in the use of antidepressant drugs in Lithuania between 2002 and 2004 and to perform cost-minimization and reference price analysis enabling more rational use of financial resources of national health system. Material and methods. The data on sales of antidepressant drugs in Lithuanian over a 3-year period (2002–2004) were obtained from IMS Health Inc. database. Data were calculated by defined daily dose (DDD) methodology and expressed in DDDs per 1000 inhabitants per day. DU90% was used as the quality indicator of the drug prescribing. The pharmacoeconomic analysis of antidepressant drugs was performed by cost-minimization and reference price methodology. Results. The consumption of antidepressants in Lithuanian increased by 30.55% over a 3-year period (2002–2004) reaching the value of 10.00 DDDs/1000 inhabitants/day. Since 2002, the proportion of use of selective serotonin reuptake inhibitors has increased by 27.82%, and the use of tricyclic antidepressants has declined by 10.78%, while the use of other (newer) antidepressant drugs expanded almost three times. The expenditures of antidepressant drugs have reached 26 million Lt in 2004, of which 68.15% were costs for selective serotonin reuptake inhibitors. Choosing the second lowest price in different antidepressant drug class, it is estimated the possible savings of 4.34 million Lt lowering the total expenses by 16.5% (1 €=3.4528 Lt). Conclusions. The findings suggest that the use of total... [to full text] Tikslas. Įvertinti antidepresantų vartojimo tendencijas Lietuvoje 2002–2004 m. ir atlikti farmakoekonominę analizę kaštų mažinimo ir referentinės kainos metodu siekiant racionaliai panaudoti sveikatos apsaugos lėšas depresijai gydyti. Metodai. Duomenys apie antidepresantų pardavimą Lietuvoje 2002–2004 metais rinkti iš „IMS Health Inc.“ duomenų bazės. Vaistai buvo klasifikuojami pagal anatominę terapinę cheminę (ATC) klasifikaciją. Vaistų suvartojimas buvo vertinamas pagal apibrėžtos dienos dozės (DDD – angl. defined daily dose) metodiką, o duomenys pateikiami apibrėžta dienos doze tūkstančiui gyventojų. Pasirinktas vaistų išrašymo kokybės indikatorius DU95 proc. Antidepresantų farmakoekonominei analizei atlikti taikytas kaštų mažinimo bei referentinės kainos nustatymo metodas. Rezultatai. Per trejus metus (2002–2004) antidepresantų vartojimas padidėjo 30,55 proc. ir pasiekė 10,00 DDD/tūkstančiui gyventojų rodiklį. Selektyvaus poveikio serotonino reabsorbcijos inhibitorių (SSRI) klasės antidepresantų vartojimas padidėjo 27,82 proc., TCA sumažėjo 10,78 proc., o kitų antidepresantų vartojimas padidėjo beveik tris kartus. Išlaidos antidepresantams padidėjo iki 26 mln. litų 2004 metais, iš kurių net 68,15 proc. buvo skirta SSRI klasės vaistams. Taikant referentinės kainos metodiką, antrojo antidepresanto pagal pigumą kainą kiekvienoje vaistų klasėje būtų įmanoma sutaupyti 4,35 mln. litų išlaidas sumažinant 16,5 proc. (1€=3,4528 Lt). Išvados. Antidepresantų vartojimas Lietuvoje... [toliau žr. visą tekstą]

Tyrimo tikslas. Įvertinti cukrinio diabeto gydymo kompensuojamaisiais vaistais racionalumą Šiaulių teritorinės ligonių kasos veiklos zonoje 2005 metais. Metodai. Tyrimui naudoti Privalomojo sveikatos draudimo informacinės sistemos SVEIDRA duomenys, o dėl vaistų skyrimo neracionalumo patikrintos 906 asmens sveikatos istorijos. Rezultatai. Nustatyta 370 neracionalaus gydymo atvejų 184 (20,3 proc.) asmens sveikatos istorijose: 1) diagnostikos ir gydymo metodikos nesilaikymas sudarė 66,49 proc.; 2) indikacijų ir kontraindikacijų nesilaikymas – 13,24 proc.; 3) nepakankamai stebimas gydymas – 4,32 proc.; 4) receptų išrašymo reikalavimų nesilaikymas – 11,35 proc.; 5) nekokybiškas atliktų paslaugų dokumentavimas – 4,6 proc. Diagnostikos gydymo metodikos nesilaikymas nustatytas, kai: a) nevertintas ūgis, svoris ir kūno masės indeksas (30,1 proc.); b) nefiksuota glikemija (26,0 proc.); c) ligoniai per retai konsultuojami endokrinologo (17,5 proc.); d) taikyta monoterapija ilgo veikimo insulinu ar skirta kombinuota terapija geriamaisiais vaistais be monoterapijos (10,2 proc.); e) nesilaikoma endokrinologo rekomendacijų (8,5 proc.); f) nemotyvuotai keičiami vaistai (4,1 proc.). Tiazolinedionų dažnai skiriama esant kepenų nepakankamumui arba neištyrus jų funkcijos (60,4 proc.), arba esant širdies nepakankamumui (29,2 proc.). Išvados: 1) asmens sveikatos istorijose nustatyta 20,3 proc. neatitikimų racionalaus gydymo principams; 2) dažniausiai nesilaikoma diagnostikos ir gydymo metodikos... [toliau žr. visą tekstą] Objective. The evaluation of adherence to guidelines on rationality in prescribing reimbursed medicines for the treatment of diabetes mellitus. Material and methods. A retrospective evaluation of drug utilization in national public health insurance database and analysis of 906 case histories of diabetic patients in respect of nonadherence to guidelines. Results. A total of 184 (20.3%) case histories with 370 events were found to be nonadherent to: a) national guidelines on prescription of medicines (66.49%); b) authorized indications and contraindications (13.24%); c) insufficient monitoring (4.32%); d) nonadherence to the recommendations for prescription writing (11.35%); and e) nonadherence to the requirements for service provisions (4.6%). The analysis of nonadherence to national guidelines revealed: 1) failure to assess patient’s height, weight, and body mass index (30.1%); 2) poor glycemia control (26%); 3) failure in referring to an endocrinologist in case of noncontrolled glycemia (17.5%); 4) monotherapy with long-acting insulin or started combined oral therapy without monotherapy (10.2%); 5) noncompliance with the recommendations of endocrinologist (8.5%); 6) unsubstantiated changes in diabetes mellitus treatment (4.1%). Thiazolidinediones are often administered in case of liver failure or without investigation of its function (60.4%) or in case of heart failure (29.2%). Conclusions. 1) Nonadherence was observed in 20.3% of cases; 2) the most frequent cause was... [to full text]

Renal tubular acidosis (RTA) more frequently develops in case of chronic diseases of inflammatory-immunological origin. RTA is well known to be associated with chronic liver disease (CLD), with nephrolithiasis, common cases of RTA occur among cancer patients. Abnormalities in the expression or function of band 3 in cell membrane may play a role in the pathogenesis of RTA. Cl-/HCO3- anion exchanger (AE2) is an isoform of band 3 protein, which is expressed in cell membranes of organs such as liver cells and kidney endothelium. There are reports on downregulated AE2 immunoreactivity in the liver of patients with chronic liver diseases and in the kidney tubular tissue of patients with RTA. The proteolytic damage of cell membrane band 3 in tissues could be related to inflammatory-immunological processes. Another important factor able to disturb the band 3 function is medicinal products used in the treatment of certain pathologies. The active substance of a drug itself may have a direct effect on this protein or trigger a pathological process. In such cases ADR can take place and may be evaluated as such. Acid-base disturbances, notably metabolic acidosis, are a serious complication of drug treatment. Reduced AE2 expression or its changed activity (congenital or acquired) could be related with alterations of intracellular pH. This could lead to antigenic changes and autoimmunity. The derangement of band 3 function in organ cell membrane could act as a factor which creates an “acidotic environment” for organ cells. Such circumstances could be the reason for unsuccessful treatment or determine resistance of tumor treatment. The understanding of the mechanisms of RTA development, early diagnostics, and knowledge of the drugs that can cause RTA, are of particular practical significance.

Objectives: To assess patient’s knowledge and usage habits of food and medicinal products timing in community pharmacy and hospital. Methods: The study was conducted Lithuanian University of Health Sciences Kaunas Clinics Hospital Nephrology Clinic and community pharmacy „Sendvario vaistinė”, located in Klaipeda. Total study surveyed 213 respondents. Patients were divided into two groups: the VP Group – patients questioned in pharmacy, SP group – patients questioned in Nephrology Clinic. Data were collected using an anonymous questionnaire validated of 30 questions. Results. The study included 213 questionnaires (responsivenessincidence of 85.22 percent.). The study included respondents of various age, different education level, from rural or urban areas. The study has shown that self-treatment is common –17 percent of respondents in VP groupadmitted that they practice self-treatment, in SP group the rate was 8 percent. In the SP group, 45.5 percent of questioned patients reported that they do not read the medicinal products’ informational leaflet, in the VP group – 65 percent of respondents. Statistically significantly more patients in SP group knew about food and drug interactions and timing importance with food and drugs comparing with the VP group (p

Augmented renal clearance (ARC) is a relatively new phenomenon in clinical practice, that can affect vancomycine excretion. The aim of the study was to analyse the influence of augmented renal clearace (ARC) for vancomycine concentration (VCS). This was a perspective pilot trial. As it was impossible to gather subjects, the retrospective analysis of cases was made. The phenomenon of ARC is still difficult to identify. Routine research practice makes it hard to gather enough information for the hyperhydration effect on the occurrence of PIK research in Lithuanian University of Health Sciences Kaunas Clinics. CKD-EPICREA 2009 formula is more specific and correlates stronger with VCS than than CG. In patients with ARC therapeutic vancomycine doses usually are not reached. Younger patients had ARC more frequently. Realation between mechanical ventilation, vasopressors and ARC was not found.

The aim. To evaluate therapeutic effect of bone marrow mesenchymal stem cells for treating acute kidney injury in experimental nephrotoxicity model in vivo. The tasks of the research. (1) To isolate, cultivate and characterize bone marrow mesenchymal stem cells; (2) To describe mesenchymal stem cell culture as a potential experimental pharmaceutical product based on stem cells; (3) To evaluate therapeutic effect of experimental pharmaceutical product based on bone marrow mesenchymal stem cells in acute kidney injury model in vivo. Materials and methods. The experiment was performed in Lithuanian University of Health Sciences, Institute of Physiology and Pharmacology. It consisted of two main steps. First step was mesenchymal stem cells isolation from rat’s bone marrow, cultivation, characterization and preparation for injection. Second step was nephrotoxicity model in vivo applying cell therapy. During this experiment, animals were divided into three groups, each group containing 6 animals: control group (healthy animals), acute kidney injury (GM) group (just gentamicin injections 80 mg/kg/d i.p. for 7 consecutive days), GM group applied BM-MSCs cell therapy (gentamicin injections 80 mg/kg/d i.p. for 7 consecutive days). Single BM-MSCs (1×106 cells 500 µl; serum free i.v.) injection was given to the BM-MSCs group animals 24 hours after the last gentamicin injection. Physiological and biochemical parameters were evaluated on 0, 8, 14, 21 experiment days. Results. Rat‘s bone marrow mesenchymal stem cells were successfully isolated and characterized. These cells expressed CD90 and did not expressed CD45, CD34 and CD117 (c-kit) surface markers. In vivo experiments showed a statistically significant reduction in serum creatinine levels and increased creatinine concentration in urine and statistically insignificantly increased glomerular filtration rate in rats that were submitted to stem cell therapy, comparing with those who were not treated with stem cell injection. Conclusions. Bone marrow mesenchymal stem cells demonstrate high proliferation potency and express mesenchymal, but not hematopoietic, endothelial or stem cell growth factor receptor surface 8 markers. The cell therapy demonstrates capacity to improve kidney function recovery and should be explored more as a potential and innovative tool for acute kidney injury treatment.

The World Health Organization states the expenditures on medicaments rise every year, but their major part (according to various sources, almost 50 %) is used improperly: patients take unnecessary medicaments and do not purchase necessary ones; medicaments are used in higher or suboptimal doses; the optimum duration of treatment is ignored; it causes lower working ability, premature mortality and higher expenditures on health care. It is known on the basis of literature data the discipline of medicament use can depend on the group of medicaments taken by the patient. As Lithuania does not have any comparable data yet, we decided to assess the discipline in a few different groups of medicaments – groups of short-term and long-term medicament use.

Objective of the work: The purpose of this quantitative retrospective comparative study was to register possible cases of augmentedted renal clearance (ARC) in patients of Hospital of Lithuanian University of Health Sciences and analyse the differences in assessments of cases of Augmented Renal Clearance and the drug therapy problems related to ARC. Tasks: To achieve the objective, several tasks were performed: 1) to register possible ARC patients cases as assessed by Cocroft-Gault and their possible associated reasons; 2) to analyse differences in three equations used for GFR estimation: Cocroft-Gault, MDRD simplified, and CKD-EPI. 3) compare the therapies of the patients and determine the drugs that are in risk of being underdosed when ARC is present. Methodology: An ARC survey (appendix 1) was filled about patients from various departments of Clinics during the period of 2013 03 04 – 2014 08 15. All patients were selected according serum creatinine values that were 50 µmol/l. or less. Two goups of patients were assigned for analysis: patients were grouped according Cocroft - Gault creatinine clearance values: (1) ARC group A CrCl >130 ml./min and (2) comparative Non-ARC group B CrCl 90-130 ml./min. Data were analyzed by using descriptive and comparative statistical analysis, considering statistically significant difference between the groups if p value was 130 ml./min. ir (2) palyginamąją B grupę – CrCl 90-130 ml./min. Duomenys buvo analizuojami naudojant palyginamąją ir aprašomąją statistiką. Skirtumai tarp grupių buvo laikomi statistiškai reikšmingi, kai p reikšmė buvo

Siauro terapinio indekso vaistų vartojimas ir farmakokinetikos tyrimų interpretavimas reikalauja specialių farmakokinetikos žinių. Mokslinės literatūros šaltiniuose teigiama, jog gydymo procese dalyvaujant klinikiniams vaistininkams vaistų vartojimas yra optimizuojamas. Lietuvoje panašios vaistininkų veiklos nėra, todėl tyrimo tikslas buvo įvertinti siauro terapinio indekso vaistų vartojimo racionalumą ir nustatyti klinikinės farmacijos paslaugos poreikį stacionarinio gydymo įstaigoje. Darbo uždaviniai: nustatyti ir įvertinti farmakoterapinių problemų, siejamų su siauro terapinio indekso vaistų (vankomicino, ciklosporino, digoksino, gentamicino) vartojimu, paplitimą tretinio lygio ligoninėje; kiekybiškai ir kokybiškai įvertinti nustatytų farmakoterapinių problemų rizikos veiksnius; įvertinti vankomicino farmakokinetikos stebėsenos praktiką ligoninės skyriuose; įvertinti farmacininko konsultacijos įtaką vankomicino farmakokinetikos stebėsenai. Tyrimui pasirinktų siauro terapinio indekso vaistų farmakokinetikos tyrimų analizė atskleidė klinikinės farmacijos paslaugos poreikį optimizuojant tokių vaistų vartojimą Lietuvos ligoninėse. Nustatytų farmakoterapinių problemų rizikos veiksnių analizė identifikavo praktikoje dar visuotinai nepripažintą padidintą inkstų klirensą ir jo reikšmingą įtaką vaistų veiksmingumui. The prescription of narrow therapeutic index drugs (NTID) and interpretation of pharmacokinetic measurements require special pharmacokinetic knowledge. Scientific publications report that active participation of clinical pharmacists in the treatment process results in optimization of the drugs use. In Lithuania, there are no similar services provided by pharmacists up till now. Aim of the study: to evaluate the rationality of the use of NTIDs and to determine the demand for clinical pharmacy services in hospitals. Objectives of the study: to identify and evaluate the prevalence of drug-related problems associated with the use of NTIDs (vancomycin, cyclosporine, digoxin, and gentamicin) in the tertiary-level hospital; to perform quantitative and qualitative analysis of risk factors for the identified drug-related problems; to evaluate the practice of pharmacokinetic vancomycin monitoring in hospital departments; to evaluate the influence of pharmacist intervention on pharma¬cokinetic vancomycin monitoring. The analysis of pharmacokinetic measurements of NTIDs selected for this study revealed the demand for clinical pharmacy services while optimizing NTIDs use in the Lithuanian hospitals. The analysis of risk factors associated with the identified drug-related problems identified augmented renal clearance, which is not widely acknowledged in practice, and its significant impact on the effectiveness of drugs.

Acceleration of the regeneration process is necessary for severe full-thickness skin injuries, such as burns, trauma or chronic ulcers. The aim of this dissertation was to investigate the influence of bone marrow-derived stem cells on skin regeneration using full-thickness wound model in BALB/c mouse. Lin¯ cells were isolated and identified. Regenerative properties of purified cells were evaluated in vitro. Wound healing after Lin¯ cells transplantation was examined histologically and cytokine gene expression was determined by quantitative RT-PCR. The results revealed that Lin¯ population is heterogeneous and contains distinct undifferentiated cell types. In vitro experiments showed that skin tissue extracellular matrix components enhance proliferation and migration of Lin¯ cells. Histologic analysis indicated that inhibition of inflammation, re-epithelization, formation of skin appendages and extracellular collagen, were most effective after cell transplantation with type I collagen. Quantitative analysis revealed that transplanted Lin¯ cells decrease expression of proinflammatory cytokine TNF-α and increase anti-inflammatory IL-10 expression. Also, gene expression of growth factors TGF-β and VEGF, which enhance regeneration, was improved in different healing phases. The results obtained provide additional knowledge for possible therapeutic application of stem/progenitor cells in difficult-to-heal wounds. Odos žaizdų regeneracijos skatinimas yra aktualus pažeidus didelį paviršiaus plotą bei giliuosius audinio sluoksnius. Šio darbo tikslas buvo ištirti kaulų čiulpų Lin¯ ląstelių įtaką odos regeneracijai in vivo, taikant BALB/c linijos pelių visų odos sluoksnių pažeidimo modelį. Darbo metu buvo išskirtos bei identifikuotos Lin¯ ląstelės. Jų regeneracinės savybės buvo įvertintos in vitro. Buvo atlikta histologinė gyjančio audinio analizė bei nustatyti citokinų genų raiškos pokyčiai. Rezultatai parodė, kad Lin¯ ląstelių populiacija yra heterogeniška, sudaryta iš nediferencijuotų ląstelių. Nustatyta, kad odos tarpląstelinės medžiagos komponentai skatina Lin¯ ląstelių proliferaciją ir migraciją in vitro. Histologinė analizė parodė, kad po ląstelių transplantacijos I tipo kolageno gelyje anksčiausiai prasideda uždegimo slopinimas, greičiausiai baigiamas reepitelizacijos procesas, atsinaujinusioje dermoje susiformuoja tvarkingai išsidėsčiusios pagalbinės odos struktūros bei natyviam audiniui būdingas tarpląstelinės medžiagos kolagenas. Atlikus kiekybinę analizę nustatyta, kad po Lin¯ ląstelių transplantacijos sumažėja uždegiminio citokino TNF-α raiška bei padidėja priešuždegiminio IL-10 raiška. Skirtingose gijimo stadijose padidėja augimo veiksnių, skatinančių audinio regeneraciją, TGF-β ir VEGF genų raiška. Gauti rezultatai papildo žinias, reikalingas vystyti metodus, skirtus sutrikusio gijimo žaizdų regeneracijos skatinimui.

Magistro baigiamajame darbe analizuojama nepakankamai veiksmingo gydymo ambulatorinėmis sąlygomis ir su juo susijusio gydytojų nurodymų nesilaikymo problema. Darbo tikslas – nustatyti nedrausmingo gydymosi ambulatorinėmis sąlygomis proporcijas ir galimas priežastis tarp LSMUL Kauno klinikų Nefrologijos skyriuje stacionarizuotų pacientų, kuriems ambulatorininėmis sąlygomis taikytas gydymas nebuvo pakankamai veiksmingas. Tyrimo metu nustatyta, kad didžiajai daliai stacionarizuotų pacientų ambulatorinis gydymas nebuvo pakankamai veiksmingas. Įvertinta, kad daugiau negu du trečdaliai šių pacientų vaistus vartojo nedrausmingai. Nepakankamos žinios apie ligą, motyvacijos trūkumas, užmiršimas išgerti vaistus arba jų nutraukimas esant gerai savijautai – būdingi daugiau negu trečdaliui nedrausmingų pacientų. Tai rodo, jog, atsižvelgiant į aukštus nepakankamai veiksmingo ambulatorinio gydymo rodiklius, paciento apsilankymo pas sveikatos priežiūros specialistą metu, tikslinga atkreipti dėmesį į paciento vaistų vartojimo ypatumus. Užtikrintas ir aiškus pacientų informavimas apie nesigydymo riziką bei nedrausmingumo problemos akcentų diegimas socialinėje erdvėje galėtų prisidėti prie naujo požiūrio į paciento atsakomybę už savo sveikatos būklę formavimo, teigiamų gydymo rezultatų suvokimo, demotyvacinių mechanizmų vystymosi mažinimo. The study analyzes the problem of insufficiently effective outpatient treatment and the related problem of medication non-adherence. The aim of the study is to investigate, among patients hospitalized in the nephrology sector, both the prevalence of non-adherence and the possible causes for which their ambulatory treatment was not sufficiently effective. It was found that majority of outpatient treatment cases were not sufficiently effective. It is estimated that more than two-thirds of these patients were non-adherent. The inadequate knowledge about the disease, lack of motivation, forgetfulness and discontinuation of drug use when feeling well were incident to over than one third of non-adherent patients. This suggests that, given the high rates of insufficiently effective outpatient treatment, it is appropriate to draw attention to the patient's medication-use peculiarities. Moreover, informing the patient about possible threats of non-adherence and a more social implementation of the treatment may help the patients to understand the positive results of the treatment and reduce the development of their demotivating mechanisms.

Objective of work: the aim of this study was to conduct a retrospective, quantitative, descriptive survey accompanied with a comparative statistical research, in which cases of patients with augmented renal clearance were examined and analyzed regarding the similarities and differences between them and their relevance for possible under-dosage of predominantly renally excreted drugs. Tasks: 1. to detect all cases of lower than 50 µmol/L Scr measurements and calculate possible ARC using Cockcroft-Gault equation in a defined period of time in a Lithuanian hospital in Kaunas. 2. To compare the performance of 3 different equations to distinguish the ARC as assessed by Cockcroft-Gault equation from non-ARC cases. 3. To analyze possible reasons associated with these ARC cases. 4. To search for the cases when predominantly renally excreted drugs were prescribed to these patients. Tikslas darbo: Šio tyrimo tikslas buvo atlikti a posteriori, kiekybinį aprašomąjį tyrimą Kartu su lyginamosios statistinių tyrimų, kuriais atvejais pacientai, sergantys inkstų papildyta klirensas buvo išnagrinėti ir išanalizuoti apie panašumus ir skirtumus tarp jų ir jų svarbą galimo nepakankamo dozę daugiausia išsiskiria pro inkstus narkotikų. Uždaviniai: 1. Aptikti bet mažesnis negu 50 mmol / l SCR matavimų bylas ir apskaičiuoti galimą ARC naudojant Kokrofto-Gault lygtis nustatytą laiką, Lietuvos ligoninę Kaune. 2. Norėdami palyginti iš 3 skirtingų lygčių atskirti ARC, įvertintas Kokrofto-Gault lygtį kokybės iš ne ARC atvejais. 3. Išanalizuoti galimas priežastis, susijusias su šių ARC atvejais. 4. Norėdami ieškoti atvejai, kai daugiausia išsiskiria pro inkstus narkotikų buvo nustatyta, kad šiems pacientams.