Risk Factors for Potential Drug-Drug Interactions in Outpatients with Dyslipidemia

Background

Patients with dyslipidemia are usually multimorbid and require polypharmacy. Therefore, it is important to identify potential drug-drug interactions (pDDIs) in time to prevent their consequences. We aimed to identify and analyze risk factors contributing to their occurrence to guide health professionals.

Methods

A prospective cross-sectional study of 216 outpatients with dyslipidemia was conducted from May 2021 to April 2022 in Podgorica, the capital of Montenegro. pDDIs were identified using Medscape, Epocrates, and Drugs online interaction checkers. Multivariate regression analysis was performed to evaluate the potential predictors of interactions.

Results

pDDIs were detected in 212 (98.1%) participants, whereas pDDIs with high clinical significance were detected in 25.46%, 40.74%, and 58.8% of subjects by Drugs, Epocrates, and Medscape, respectively. Polypharmacy emerged as a risk factor for the occurrence of pDDIs in all three checkers in each category of clinical significance. The use of non-steroidal anti-inflammatory drugs and antiplatelet drugs contributes to the incidence of severe pDDIs B=1.014, 95%CI 0.681-1.346, P=0.000 and B=0.492, 95%CI 0.286-0.698, P=0.000, by Epocrates and Medscape respectively. The number of prescribers per patient was a protective factor against moderate pDDI B= -0.858, 95%CI -1.572-(-0.144), P=0.019 and B= -0.956, 95%CI -1.671-(-0.241), P=0.009, by Medscape and Epocrates, respectively, but a risk factor for the occurrence of minor pDDIs B=0.373, 95%CI 0.033-0.712 P=0.032 and B=0.143, 95%CI 0.042-0.244, P=0.006, by the same checkers.

Conclusion

Knowledge of the risk factors contributing to the occurrence of pDDIs is important for the development and implementation of strategies for their prevention, and given the high prevalence of dyslipidemia, understanding these factors seems crucial nowadays.

Lung cancer mortality in Montenegro, 1990 to 2015

Aim

To analyze the trend of lung cancer mortality in Montenegro from 1990 to 2015.

Methods

Data on lung cancer mortality were collected from death certificates obtained from the Statistical Office of Montenegro for the period 1990-2009 and the Institute for Public Health for the period 2010-2015. Population data were obtained from the Statistical Office of Montenegro. Rates were age-standardized to the World Standard Population, and mortality trends were analyzed with the joinpoint regression.

Results

In 2015, lung cancer accounted for 5.44% of all deaths and 22.92% of all cancer deaths. It was the leading cause of all cancer deaths and the third-leading cause of all deaths. A joinpoint was observed in 2004 in women and in the entire population, and in 2005 in men. The overall mortality rates increased from 1990 to 2004 by an average of 3.91% per year and decreased from 2004 to 2015 by an average of 1.95%; which in the entire observed period resulted in an average increase of 1.3% per year. A particularly strong growth rate was observed in women, even 7.14% in the period from 1990 to 2004.

Conclusion

The observed increase in lung cancer mortality warrants improved tobacco control.

Determination of Microelements in Human Milk and Infant Formula Without Digestion by ICP-OES

The concentrations of zinc (Zn), iron (Fe) and copper (Cu) in both human milk and infant formula were determined using a new sample preparation method, by inductively coupled plasma - optical emission spectometry (ICP-OES) and flame atomic absorption spectrometry (FAAS). Human milk samples were diluted in ultrapure water. The infant formula of powder samples (suitable for an infant 1-6 months of age) and standard reference material (SRM-1849) were analyzed in parallel. The results have shown that FAAS method was more sensitive for Fe determination in human milk while ICP-OES was more sensitive for both Zn and Cu detection. The limit of quantification for both Zn and Cu was 5 μg L-1 and 10 μg L-1 for Fe and the recovery for Zn, Fe and Cu was ranged from 90% to 94%, 97% to 103% and 90% to 102%, respectively. Mean concentrations of Zn, Fe, and Cu in human milk samples were 5.35, 0.47 and 0.83 mg L-1, respectively while these values in infant formula were ranged from 3.52-4.75 mg L-1, 3.37-4.56 mg L-1 and 0.28-0.41 mg L-1, respectively. Despite the sample complexity, the proposed method using dilution of milk samples with water was simple, rapid, effective and accurate. ICP-OES was a better method for Zn determination while FAAS was a better method for Fe determination. In the case of Cu both methods were comparable.

Rising incidence of childhood type 1 diabetes in Montenegro

INTRODUCTION

The incidence rate of childhood type1 diabetes continues to rise across Europe by an average of approximately 3–4% per annum.

OBJECTIVE

The aim of this study was to examine incidence and trends of type 1 diabetes in children aged 0–14 years in Montenegro from 1997 to 2011.

METHODS

This was a prospective study. Primary case ascertainment was from a diabetes register, and a secondary independent data source was from hospital notifications. Case ascertainment was 100% complete using the capture-recapture method. Standardized incidence rates were calculated and trends estimated using the Poisson regression.

RESULTS

A total of 298 children (157 boys and 141 girls) were diagnosed with type 1 diabetes before 15 years of age during 1997–2011. The mean age-standardized incidence was 15.0/100,000 persons (95% CI: 12.3–17.6) during this period, increasing from 11.7/100,000 in 1997 to 18.8/100,000 in 2011. The agespecific rates per 100,000 persons per year were 10.7, 17.2, and 18.2 at ages 0–4 years, 5–9 years, and 10–14 years, respectively. A significant linear trend in incidence (p = 0.002) has been observed over time, with an average annual increase of 4.2%. The increase in incidence was present in both genders, with the largest relative increase in the 0–4 years age group for boys (11.0%; p = 0.006).

CONCLUSION

The incidence of type 1 diabetes in Montenegro children continues to increase. We need further monitoring and additional research in order to explain the cause.

Assessment of Ecological Risk of Heavy Metal Contamination in Coastal Municipalities of Montenegro

Assessment of heavy metal concentrations in the soil samples of urban parks and playgrounds is very important for the evaluation of potential risks for residents, especially children. Until recently, there has been very little data about urban parks pollution in Montenegro. To evaluate the sources of potential contamination and concentration of heavy metals, soil samples from coastal urban parks and kindergartens of Montenegro were collected. Based on the heavy metal concentrations, multivariate analysis combined with geochemical approaches showed that soil samples in coastal areas of Montenegro had mean Pb and Cd concentrations that were over two times higher than the background values, respectively. Based on principal component analysis (PCA), soil pollution with Pb, Cd, Cu, and Zn is contributed by anthropogenic sources. Results for Cr in the surface soils were primarily derived from natural sources. Calculation of different ecological contamination factors showed that Cd is the primary contribution to ecological risk index (RI) origins from anthropogenic, industry, and urbanization sources. This data provides evidence about soil pollution in coastal municipalities of Montenegro. Special attention should be paid to this problem in order to continue further research and to consider possible ways of remediation of the sites where contamination has been observed.

RECENT INCIDENCE OF TYPE 1 DIABETES MELLITUS IN MONTENEGRO: A SHIFT TOWARD YOUNGER AGE AT DISEASE ONSET

In the last several decades, a great number of studies have pointed to a dramatic increase of type 1 diabetes mellitus (T1DM) incidence in the whole world, especially in younger age groups. Therefore, the aim of the study was to assess changes in the age distribution at onset of T1DM in Montenegro children aged < 15 years during a 15-year period (1997-2011) and analyze the seasonal pattern. Primary case ascertainment was from diabetes register, secondary and tertiary independent data sources were hospital case records and register of children receiving free test stripes in pharmacy. Standardized incidence rates were calculated using the Poisson regression. Case ascertainment was 100% complete using the capture-recapture method. The mean age-standardized incidence was 18.6/100,000 (95% CI: 13.0-24.1) from 2007 to 2011 compared with 13.4/100,000 95% CI, 11.5-15.5) from 1997 to 2006. The incidence of T1DM increased predominantly in younger age groups. Relative increase of incidence per 5-year period was largest in boys aged 0-4 and 5-9 years: 64.7% (95% CI: 20.6-10.7; p = 0.004) and 52.8% (95% CI: 16.9-88.8; p = 0.004), respectively. Seasonality in monthly case counts of T1DM was apparent. The greatest number of cases were diagnosed during autumn and winter months. In conclusion, the onset of T1DM was found to occur at an ever younger age in Montenegro children. Our results indicated a seasonal pattern of the disease onset.