Martin Wawruch

The use of medications with anticholinergic properties and risk factors for their use in hospitalised elderly patients

The aims of the present study were to evaluate the use of drugs with anticholinergic properties in elderly patients and to identify risk factors that increase the patients chance of being given such medications.

Alcohol intoxication requiring hospital admission in children and adolescents: retrospective analysis at the University Children's Hospital in the Slovak Republic

Background. Few epidemiological studies have investigated the problem of children and adolescents taken to hospital with acute alcohol intoxication. Methods. We reviewed the medical records of children and adolescents aged ≤ 18 years hospitalized with alcohol intoxication alone in the University Childrens Hospital in Bratislava, Slovak Republic, during the years 1996–2005 and compared their characteristics between the first and the second 5-year time periods. Results. 537 patients (273 boys and 264 girls) were admitted to the hospital with intentional acute alcohol intoxication (1.5% of all admissions and 34.2% of all intoxications) between 1996 and 2005. The average age of the patients with alcohol intoxication presenting to hospital was 15.1 ± 1.7 and the youngest were 9-year-old children. The proportion of children admitted with alcohol intoxication increased every year (R2 = 0.935) (p < 0.001). The average blood alcohol concentration was 1.98 ± 0.57 g/L, and it increased in 2001–2005 in relation to the previous 5 years (p < 0.001). The highest estimated alcohol concentration (4.39 g/L) was found in the blood of a 17-year-old boy. The mean poisoning severity score was 1.53 ± 0.61 and had increased in line with blood alcohol concentration for the years 2001–2005 (p < 0.001). Conclusions. The results of this analysis emphasize the severity of underage alcohol consumption by young people in the Slovak Republic. Measures are needed to decrease alcohol abuse in children and adolescents.

Factors influencing the use of potentially inappropriate medication in older patients in Slovakia.

Background:  Although increasing attention has been given to the evaluation of use of potentially inappropriate medication in the older European Union (EU) member countries, information on this topic from Central and Eastern Europe is scarce.

Adverse drug reactions related to hospital admission in Slovak elderly patients

The aims of the present study were: to evaluate the prevalence of adverse drug reactions (ADRs) leading to hospitalization in elderly patients; to analyze the drugs which have been identified as having causal relationship with ADRs and to identify risk factors which predispose the patient to such ADRs. The study has been performed in 600 patients aged> or =65 years, hospitalized in a general hospital between 1 December 2003 and 31 March 2005. The ADRs recorded in patients documentation as one of the reasons for hospital admission were evaluated. ADRs leading to hospital admission were recorded in 47 (7.8%) patients. ADRs in 43 patients represented A-type ADRs which are preventable. The most frequent ADRs were cardiovascular disorders. According to the results of multivariate analysis ischemic heart disease (odds ratio (OR)=4.50; 95% confidence interval (CI)=1.36-14.88), depression (OR, 2.49; 95% CI, 1.08-5.77) and heart failure (OR, 2.08; 95% CI, 1.13-3.81) were the most important patient-related characteristics predicting ADRs leading to hospitalization. The majority of ADRs in elderly patients could be avoided. Regular re-evaluation of the medication as well as taking into account the specific features of elderly patients represent the most important tools for ADR prevention.

Neuroendocrine Activation during Combined Mental and Physical Stress in Women Depends on Trait Anxiety and the Phase of the Menstrual Cycle

The aim of this study was to investigate the influence of trait anxiety and menstrual cycle phase on neuroendocrine activation during combined mental and physical stress procedure in 40 healthy female subjects. Women at the upper (anxious) and lower (nonanxious) limits of the normal range of a trait anxiety scale were exposed to the stress procedure consisting of a mental component (Stroop test) and handgrip exercise. Salivary cortisol levels, cardiovascular parameters, and cognitive performance in the Stroop test were evaluated. Stress‐induced cortisol levels and the rise in systolic blood pressure were affected by both trait anxiety and menstrual cycle phase. The stress model used induced a significant cortisol elevation only in anxious women in the follicular phase. This group of women also exhibited greater increases in systolic blood pressure in response to handgrip exercise as compared to anxious ones in the luteal phase and to nonanxious women in either phase. In nonanxious women, stress‐induced cortisol levels positively correlated with cognitive performance. In contrast, a negative correlation trend was observed in anxious subjects. Thus, in subjects with low but not high trait anxiety, enhanced cortisol concentrations seem to be associated with better cognitive performance. The results suggest that women with high trait anxiety exhibit greater cardiovascular and hormonal sensitivity to stress stimuli during the follicular phase.

Factors influencing prognosis of pneumonia in elderly patients.

Background and aims: Polymorbidity reduces the survival of elderly patients with pneumonia. The aim of the proposed study was to identify factors determining mortality in such patients. Methods: From January 1, 1999 to December 31, 2001, 2870 patients were admitted to the Clinic of Geriatric Medicine, Faculty of Medicine, Comenius University, Bratislava. From these, 199 patients treated for pneumonia (average age ±SD 79.7±7.6 yr) were assigned to a retrospective study. 112 patients recovered and 87 died. The prognostic significance of the chosen factors was evaluated by comparing their incidence between the groups of surviving and non-surviving patients. Results: Prognosis for patients with pneumonia is worsened significantly by: older age; immobilization syndrome; incontinence of urine and feces; presence of some clinical and laboratory characteristics at the time of diagnosis of pneumonia (respiratory insufficiency, absence of fever, leukocytosis); pneumonia acquired in hospital; immunosuppressive therapy and comorbid conditions (congestive heart failure, chronic renal insufficiency, anemia, hepatic, psychiatric and neoplastic diseases). According to multivariate analysis, the most significant mortality-predicting characteristics were: immobilization (odds ratio (OR) 9.36; 95% confidence interval (CI) 3.92-22.33); congestive heart failure (OR 8.26; 95% CI 3.08-22.14); immunosuppressive therapy (OR 7.47; 95% CI 2.54–21.98) and psychiatric diseases (OR 4.53; 95% CI 1.94–10.58). Conclusions: Patients with immobilization, congestive heart failure, immunosuppressive therapy, or psychiatric diseases run a high risk of death and require intensive medical care.

Patient‐related characteristics associated with non‐persistence with statin therapy in elderly patients following an ischemic stroke

This study was aimed at evaluating the extent of non‐persistence with statin therapy in elderly patients after an ischemic stroke and identifying patient‐related characteristics that are risk factors for non‐persistence.

INTRODUCTION OF HEALTH TECHNOLOGY ASSESSMENT FOR MEDICINES IN SLOVAKIA.

OBJECTIVES The aim of our study was to describe approaches to health technology assessment (HTA) for medicines in the Slovak healthcare system and the related decision-making processes concerning reimbursement for medicines. METHODS Analysis of the Slovak legislative framework related to HTA and the reimbursement process for medicines was performed. Additionally, current practices of the Working Group for Pharmacoeconomics, Clinical Outcomes and Health Technology Assessment of the Slovak Ministry of Health were evaluated. RESULTS In Slovakia, there is always at least one treatment available in each determined therapeutic class with no co-payment. HTA is becoming an established method for the evaluation of cost-effectiveness of medicines in Slovak healthcare policy. The majority of decision makers within Slovakia support the idea of increased use of and the quality and efficiency of HTA methods. However, it is crucial to overcome several practical barriers to facilitate progress in the field of HTA in the Slovak Republic. CONCLUSIONS It can be seen that participation within the European Network for Health Technology Assessment (EUnetHTA JA 2 and EUnetHTA JA 3 projects) has significantly improved the quality of the process of HTA in Slovakia. Further legislative activities in this field are required due to the approved strategy for European Union cooperation on HTA.

DEL-FINE: a new tool for assessing the delirogenic properties of drugs of relevance for European pharmacotherapy

This article presents a list of potentially delirogenic properties of drugs that are currently of relevance to drug therapy in Europe, which was created through a Delphi process including experts from professions relevant to diagnosis and treatment of delirium. The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) defines delirium as a disturbance in attention, awareness and cognition that develops over a short period of time and fluctuates. Possible causes of delirium are manifold: usually delirium is considered to develop in a multifactorial way, caused by inalterable parameters, such as advanced age and pre-existing cognitive impairment and precipitated by modifiable parameters, such as the use of certain drugs or substance withdrawal. Delirium is a serious condition with a pronounced impact on morbidity, mortality and costs to the healthcare system. Circumstances and drugs that might precipitate or worsen delirium should therefore be avoided whenever possible. A list of drugs that might have a detrimental influence on the emergence and duration of delirium has been created using the terms “delirogenity” and “delirogenic” to describe the potential of a drug or withdrawal to cause or worsen delirium. The results are novel and noteworthy, as their focus is on substances relevant to European pharmacotherapy. Furthermore, they represent a methodical consensus from a group of experts of a wide variety of professions relevant to the prevention, diagnosis and treatment of delirium, such as nursing, pharmacy, pharmacology, surgical and internal medicine, neurology, psychiatry, intensive care and medicine, with working, teaching and scientific experience in several European countries practicing both in primary and secondary care.ZusammenfassungIn diesem Beitrag wird eine Aufstellung von Arzneimitteln vorgestellt, die für die aktuelle Pharmakotherapie in Europa relevant sind und die potentiell delirogene Eigenschaften aufweisen. Diese Liste wurde durch einen Delphi-Prozess, unter Mitbeteiligung von Berufen, die für die Delirdiagnose und -behandlung von Relevanz sind, erstellt. Das „Diagnostic and Statistical Manual of Mental Disorders 5“ (DSM 5) definiert ein Delir als eine Störung von Aufmerksamkeit, Bewusstsein und Wahrnehmung, die sich innerhalb kurzer Zeit entwickelt und fluktuiert. Die möglichen Ursachen für eine Delirentwicklung sind zahlreich: Generell geht man von einer multifaktoriellen Genese aus, die einerseits von vorgegebenen Parametern, wie vorgerücktem Alter oder bereits vorbestehenden kognitiven Einschränkungen, und andererseits durch modifizierbare Einflüsse, wie den Einsatz bestimmter Arzneimittel oder Substanzentzug, beeinflusst wird. Das Durchleben eines Delirs ist eine für die Betroffenen einschneidend grausame Erfahrung, die von einer deutlich erhöhten Morbidität, Mortalität und finanziellen Belastungen für das Gesundheitssystem begleitet wird. Begleitumstände und der Einsatz von Substanzen, die ein Delir auslösen oder verschlimmern können sollten daher tunlichst vermieden werden. Eine Liste von Arzneimitteln, die ein Delir auslösen und einen ungünstigen Einfluss auf dessen Dauer haben können, wurde erstellt. Dabei wurden die Termini „Delirogenität“ und „delirogen“ verwendet, um das Potenzial eines Wirkstoffs zu charakterisieren, der selbst oder durch seinen Entzug ein Delir auslösen oder verschlechtern kann. Die Ergebnisse besitzen insofern einen beachtenswerten Neuwert, als dass der Fokus auf Arzneimitteln lag, welche für die medikamentöse Therapie in Europa repräsentativ sind. Zusätzlich sind sie der Konsensus einer Expertengruppe, die ein breites Spektrums an Berufen repräsentiert, die für Prävention, Diagnose und Therapie des Delirs relevant sind, wie z.B. Pflege, Pharmazie, Pharmakologie, chirurgische und konservative Medizin, Psychiatrie, Neurologie und Intensivmedizin. Die Delphi-Gruppe wies Erfahrung in mehreren europäischen Ländern im extra- und intramuralen Bereich, sowie in Lehre und Wissenschaft auf.

Trends in vascular pharmacology research in the Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava

Trends in vascular pharmacology research in the Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava Research in the Department of Pharmacology started to focus intensively on fetal circulation in the 60s. Results of experiments contributed to clarification of the conversion of fetal circulation type to the adult type: the mechanism of the ductus arteriosus closure, examination of fetal and neonatal pulmonary vessel responses. In the early 80s, increased attention was dedicated to fetal vascular endothelium, later on to vascular reactivity in relation to the endothelium in adult animals. We developed original models of vascular endothelial damage using the perfusion method (repeated vasoconstrictive stimuli, deendothelization by air bubbles). We developed a new technique for in vitro endothelial loss quantification on Millipore filters. Under in vitro conditions, the protective effects of sulodexide and pentoxifylline on vascular endothelium were evaluated. In recent years were studied protective effects of selected substances in vivo in models of endothelial damage (e.g. stress, toxic tissue damage, diabetes mellitus, hypertension). The role of potassium channels in the hypertension model was studied in cooperation with the Czech Academy of Sciences. Assessment of vascular reactivity in the diabetic model was significantly improved by computer. In addition to experimental work, the department is solving problems of clinical pharmacology - especially drug risk evaluation (non-steroidal anti-inflammatory drugs). Recently, we have dealt with pharmacoepidemiological studies in geriatric patients and with cardiovascular risk of NSAIDs in relation to pharmacotherapy. The results of these studies may be an impulse for targeted problem solving in our experiments.