Browsing by Author "Stevanović, Predrag (24315050600)"

Objective: Cardiovascular disease (CVD) drugs have been frequently implicated in adverse drug reaction (ADR)-related hospitalizations. Drug–drug interactions (DDIs) are common preventable cause of ADRs, but the impact of DDIs in the CVD population has not been investigated. Hence, the primary aim of the study was to identify DDIs associated with ADRs in CVD patients at hospital admission. The second aim was to develop a simple tool to identify high-risk patients for DDI-related adverse events. Methods: An observational study was conducted on the Cardiology Ward of University Clinical Hospital Center. Data were obtained from medical charts. A clinical panel identified DDIs implicated in ADRs, using LexiInteract database and Drug Interaction Probability Scale. Statistics were performed using PASW 22 (SPSS Inc.). Results: DDIs contributed to hospital admission with a total prevalence of 9.69%. DDI-related ADRs affected mainly cardiac function (heart rate or rhythm, 41.07%); bleeding and effect on blood pressure were equally distributed (17.86%). Non-cardiovascular ADRs were found in 23.21% of DDIs. After admission, 73% of the identified DDIs led to changes in prescription. Prediction ability of calculated DDI adverse event probability scores was rated as good (AUC = 0.80, p <.001). Conclusions: CVD patients are highly exposed to adverse DDIs; about one in ten patients hospitalized with CVD might have a DDI contributing to the hospitalization. Given the high prevalence of CVD, DDI-related harm might be a significant burden worldwide. Identification of patients with high DDI adverse event risk might ease the recognition of DDI-related harm and improve the use of electronic databases in clinical practice. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.

[No abstract available]

Introduction/Objective Despite frequent side effects such as hypotension, spinal anesthesia (SA) is still one of the best anesthetic methods for elective cesarean section (CS). Intermittent, oscillometric, non-invasive blood pressure monitoring (NIBP) frequently leads to missed hypotensive episodes. The objective was to compare continuous non-invasive arterial pressure (CNAP) monitoring with NIBP in the terms of efficiency to detect hypotension. Methods In this study, we compared CNAP and NIBP monitoring for hypotension detection in 76 patients divided into two groups of 38 patients treated with ephedrine (E) or phenylephrine (P), during three-minute intervals, starting from SA, by the end of the surgery. Results In E group, significantly lower mean systolic blood pressure (SBP) values with CNAP compared with NIBP (p = 0.008) was detected. By monitoring CNAP, we detected 31 (81.6%) hypotensive patients in E group and significantly lower number, 20 (52.6%), with NIBP (p = 0.001), while in P group CNAP detected 34 patients (89.5%) and NIBP only 18 (47.3%), p = 0.001. By monitoring CNAP, we detected significantly higher number of hypotensive intervals in E and P groups (p < 0.001). Umbilical vein pH was lower within hypotensive compared with normotensive patients in E and P groups, with CNAP and NIBP, respectively (p < 0.001, p = 0.027 in E, and p = 0.009, p < 0.001, in P group). Conclusion CNAP is more efficient in hypotension detection for CS during SA, which allows faster treatment of hypotension, thus improving fetal and maternal outcome. © 2021, Serbia Medical Society. All rights reserved.

Background Drug–drug interactions represent one of the causes of adverse therapy outcomes through deteriorated efficacy or safety. However, the true extent of harm related to drug–drug interactions is not well established due to a lack of recognition and understanding. Objective The aim of this study was to investigate the association of potential drug–drug interactions with patients variables recorded at admission. Setting A cross-sectional correlation study was performed on the Cardiology ward of the University Clinical Hospital Center in Belgrade, Serbia. Method Data were retrospectively obtained from medical records and LexiInteract was used as the screening tool for potential drug–drug interactions. Main outcome measure Clinical and laboratory parameters recorded at the patients admission. Results A total of 351 patient records entered the analysis, with the mean age of 70 ± 10 years. The prevalence of potentially relevant drug–drug interactions was 61% (N = 213). After controlling for patient characteristics, nine potential drug–drug interactions were significantly associated with laboratory values outside the range and five potential drug–drug interactions with inadequate clinical parameter values. Potential drug–drug interactions were associated with abnormalities in blood count, metabolic parameters, electrolyte imbalance and renal function parameters. Association with inadequate control of systolic, diastolic blood pressure, as well as heart rhythm was also shown. Conclusion Drug–drug interactions were associated with patients clinical and laboratory findings. Our findings may assist in the identification of patients with increased likelihood of suboptimal therapy outcomes. Generating evidence through post-marketing drug–drug interactions research would lead to improvement in clinical decision-support systems, increased effectiveness and utilization in everyday clinical practice. © 2019, Springer Nature Switzerland AG.

Background Drug–drug interactions represent one of the causes of adverse therapy outcomes through deteriorated efficacy or safety. However, the true extent of harm related to drug–drug interactions is not well established due to a lack of recognition and understanding. Objective The aim of this study was to investigate the association of potential drug–drug interactions with patients variables recorded at admission. Setting A cross-sectional correlation study was performed on the Cardiology ward of the University Clinical Hospital Center in Belgrade, Serbia. Method Data were retrospectively obtained from medical records and LexiInteract was used as the screening tool for potential drug–drug interactions. Main outcome measure Clinical and laboratory parameters recorded at the patients admission. Results A total of 351 patient records entered the analysis, with the mean age of 70 ± 10 years. The prevalence of potentially relevant drug–drug interactions was 61% (N = 213). After controlling for patient characteristics, nine potential drug–drug interactions were significantly associated with laboratory values outside the range and five potential drug–drug interactions with inadequate clinical parameter values. Potential drug–drug interactions were associated with abnormalities in blood count, metabolic parameters, electrolyte imbalance and renal function parameters. Association with inadequate control of systolic, diastolic blood pressure, as well as heart rhythm was also shown. Conclusion Drug–drug interactions were associated with patients clinical and laboratory findings. Our findings may assist in the identification of patients with increased likelihood of suboptimal therapy outcomes. Generating evidence through post-marketing drug–drug interactions research would lead to improvement in clinical decision-support systems, increased effectiveness and utilization in everyday clinical practice. © 2019, Springer Nature Switzerland AG.

Aim: The aim was to describe the type and prevalence of potentially relevant drug-drug interactions (pDDIs) in a population of patients admitted for cardiovascular diseases (CVD), and management strategies for reducing the occurrence of pDDIs. Methods: A retrospective cross-sectional study was performed on Cardiology ward of University Clinical Hospital Center in Belgrade, Serbia. A total of 527 patients, with more than one prescription during hospital stay, were enrolled in this study. Data were obtained from medical records. LexiInteract was used as the screening tool. Results: At least one potentially relevant pDDI was identified in 83.9% of patients. Occurrence was significantly more prevalent in patients with higher number of drugs, multimorbidity, longer length of stay, arrhythmia, heart failure, infectious and respiratory disease. About 13% of pDDIs exposures were accompanied with concurrent renal or liver disease, as an additional risk for DDI manifestation. Among CVD, patients with a history of myocardial infarction possessed the highest additional risk. The most common potential clinical outcome was the effect on cardiovascular system 48.5%, renal function and/or potassium 22.3%, bleeding 9.5%, impaired glucose control 6.8% and digoxin toxicity 4.6%. Main management strategies to avoid X or D class included using paracetamol instead of NSAID or alternative NSAID (38%), alternative antibiotic or antifungal (20.4%), H2 receptor antagonist instead of PPI (8.3%), avoiding therapeutic duplication (7.3%), and alternative HMG-CoA reductase inhibitor (7%). Heart rate, blood pressure, electrolytes/potassium and blood glucose could have been employed in monitoring for potential consequence of 72.2% C class pDDIs. Conclusions: Use of drug interaction screening tools can be beneficial risk mitigation strategy for potentially relevant pDDIs in CVD patients. DDI screening software could be linked to the patient's laboratory results or clinical data regarding renal or liver function, as an approach to reinforce DDIs alert quality. © 2017 John Wiley & Sons Ltd

Possible immune system interactions due to vaccination and drugs used in general anesthesia represent a dilemma for pediatric anesthesiologists in everyday practice. Immunosuppression caused by anesthesia and surgical trauma can affect the immunization process and cause-specific unwanted reactions. On the other hand, side effects due to vaccination can confuse clinicians in the immediate postoperative course. Both the nature of the vaccine and the type of surgery determines the delay period of elective surgical intervention. This current topic aims to present the scientific facts about the complex interactions between vaccination, immunization, general anesthesia, and surgical trauma and to provide recommendations for preoperative preparation. © 2023, Serbia Medical Society. All rights reserved.