Association between Duration of Dialysis and Helicobacter Pylori Infection in Dialysis Patients at the University Clinical Hospital Mostar.

INTRODUCTION: Association of Helicobacter pylori (HP) infection with the length of dialysis in dialysis patients is contradictory. This study was conducted in order to determine the association between the duration of dialysis and the HP infection status in the dialysis patients. Furthemore, biochemical parameters were monitored in two subject groups that were included in this study. SUBJECTS AND METHODS: The study included 51 patients on chronic hemodialysis program who had gastrointestinal symptoms. The subjects were divided in two groups per the length of dialysis treatment. In this study we analyzed age, gender, the time period since the onset of the chronic hemodialysis program, body mass index, biochemical parameters, and whether the patients have arterial hypertension and/or diabetes. The presence of HP antigen was determined in the stool samples with use of he UlcoGnost AG test plate. RESULTS: The incidence of HP infection in hemodialysis patients, with some of the gastrointestinal symptoms, was 25.5%. Patients on hemodialysis for less than 24 months had lower incidence of HP infection than those on hemodialysis program for more than 24 months. HP positive and HP negative subjects were also compared by gender, age, biochemical parameters and body mass index. There was no statistical significant difference between the groups in any of those characteristics. When comparing the HP status of the subjects with the presence of arterial hypertension and diabetes, no statistically significant difference was found between the groups. CONCLUSION: This study showed negative correlation between HP infection and the length of hemodialysis program. Analysis of age, gender, body mass index, biochemical parameters, presence of arterial hypertension and/or diabetes showed no statistically significant difference was found between the hemodialysis patients who were HP positive and those who were HP negative. Additional studies are needed to elucidate the correlation mechanism between the HP infection and the duration of dialysis, in order to examine how long the dialysis time period is the most susceptible to HP infection, and then to improve the prognosis of patients with renal disease.

Inappropriate Use of Topical Corticosteroides in the Dermatology Outpatient.

INTRODUCTION: Topical corticosteroids are group of drugs which have anti-in?ammatory, immuno-suppressive, anti-proliferative and vasoconstrictive effects and are among the most commonly prescribed medication, important and efficacious for management of various dermatological disorders. Strict implementation of the existing regulations is the need of the hour to prevent their widespread abuse. Aim of the study was to investigate the usage of topical corticosteroids therapy with the recipe of a doctor and without it. SUBJECTS AND METHODS: The subjects were patients who visited Pharmacies in Mostar from April to July 2020 and were buying topical corticosteroids with or without a recipe or medical report from the doctor. 80 subjects completed a questionnaire themselves included: the way of buying a topical corticosteroids, the information about using topical corticosteroids earlier, the information about subject's visits to the doctor; the length of time using topical corticosteroids, the type of topical corticosteroids used, the part of body the topical corticosteroids was applied on. RESULTS: A total of 80 subjects were treated in the observed period, 58.8% were female. 72.5% subjects had already used local corticosteroids, 62.50% purchased the drug at the recommendation of the pharmacist, 66.30% had no recent diagnosis or no diagnosed disease at all, 21.25% used the drug for more than a month, the most often purchased one was moderate potent local corticosteroid Betamethasone diproprionate 0.05%. Most commonly subjects applied local corticosteroids on arms (50%). CONCLUSION: Strict regulations regarding only prescription-based dispensing of local corticosteroids must be put into practice. This will hopefully bring down both the extremes of ever increasing cases of steroid-induced dermatoses in everyday dermatology practise on one hand and the irrational fears of using TCs in well justified indications on the other.

Characterization of the CYP3A4 Enzyme Inhibition Potential of Selected Flavonoids.

Acacetin, apigenin, chrysin, and pinocembrin are flavonoid aglycones found in foods such as parsley, honey, celery, and chamomile tea. Flavonoids can act as substrates and inhibitors of the CYP3A4 enzyme, a heme containing enzyme responsible for the metabolism of one third of drugs on the market. The aim of this study was to investigate the inhibitory effect of selected flavonoids on the CYP3A4 enzyme, the kinetics of inhibition, the possible covalent binding of the inhibitor to the enzyme, and whether flavonoids can act as pseudo-irreversible inhibitors. For the determination of inhibition kinetics, nifedipine oxidation was used as a marker reaction. A hemochromopyridine test was used to assess the possible covalent binding to the heme, and incubation with dialysis was used in order to assess the reversibility of the inhibition. All the tested flavonoids inhibited the CYP3A4 enzyme activity. Chrysin was the most potent inhibitor: IC50 = 2.5 ± 0.6 µM, Ki = 2.4 ± 1.0 µM, kinact = 0.07 ± 0.01 min-1, kinact/Ki = 0.03 min-1 µM-1. Chrysin caused the highest reduction of heme (94.5 ± 0.5% residual concentration). None of the tested flavonoids showed pseudo-irreversible inhibition. Although the inactivation of the CYP3A4 enzyme is caused by interaction with heme, inhibitor-heme adducts could not be trapped. These results indicate that flavonoids have the potential to inhibit the CYP3A4 enzyme and interact with other drugs and medications. However, possible food-drug interactions have to be assessed clinically.

Efficacy and Safety of Azelaic Acid Nanocrystal-Loaded In Situ Hydrogel in the Treatment of Acne Vulgaris.

Acne vulgaris is a common, multifactorial, inflammatory skin disease affecting the pilosebaceous unit. Topical therapy is the first choice in the treatment of mild to moderate acne, and azelaic acid (AZA) is one of the most commonly used drugs. The aim of this study was to evaluate the safety and efficacy of a low-dose azelaic acid nanocrystal (AZA-NC) hydrogel in the treatment of mild to moderate facial acne. The study was designed as a double-blind, randomized controlled trial. Patients were randomized to treatment with AZA-NC hydrogel, 10%, or AZA cream, 20%, administered in quantities of approximately 1 g twice daily for 8 weeks. Efficacy of therapy was measured by the number of lesions and safety by the frequency and severity of adverse events. At week 8, the success rate of treatment with AZA-NC hydrogel, 10%, was 36.51% (p < 0.001) versus 30.37% (p < 0.001) with AZA cream. At week 8, treatment with AZA-NC hydrogel, 10%, resulted in a significant reduction in total inflammatory lesions from baseline of 39.15% (p < 0.001) versus 33.76% (p < 0.001) with AZA cream, and a reduction in non-inflammatory lesions from baseline of 34.58% (p < 0.001) versus 27.96% (p < 0.001) with AZA cream, respectively. The adverse event rate was low and mostly mild.

Sensitive Skin in the Population of Herzegovina-Neretva County: Prevalenceand Clinical Data.

INTRODUCTION: Sensitive skin has been described as a syndrome defined by the occurrence of unpleasant sensations (stinging, burning, pain, pruritus, and tingling sensations) in response to stimuli that normally should not provoke such sensations. Although often transient, and in many cases unaccompanied by visual dermatological responses, sensitive skin affects the quality of life. The aim of this survey was to assess the prevalence of sensitive skin and collect clinical data on sensitive skin in the population of Herzegovina-Neretva County. SUBJECTS AND METHODS: The survey included a total of 73 participants, 45 female and 28 male, aged 20 years and above, with a diagnosis of sensitive skin syndrome (SSS) confirmed by physicians. A dermatological exam assessing skin type, phototype and skin sensitivity was performed. The survey collected an assortment of information including demographics and included customized standardized questionnaires that closely examine skin sensitivity and the burden of sensitive skin. RESULTS: Findings concurred with existing evidence that individuals with sensitive skin represent almost half the examined population. The prevalence of perceived sensitive skin was significantly higher in females than in males. The main skin symptom was itching, followed by prickling, warmth and numbness. Our results clearly show that there is a burden of sensitive skin. CONCLUSION: This study investigated the prevalence of sensitive skin and the burden of sensitive skin in the population of Herzegovina-Neretva County. It is the first to focus on sensitive skin among Herzegovina-Neretva County population. Further studies are needed to bolster epidemiological data and physiological pathways of sensitive skin syndrome.

Preparation of in situ hydrogels loaded with azelaic acid nanocrystals and their dermal application performance study.

Azelaic acid (AZA) is a dicarboxylic acid that is topically used in the treatment of acne and rosacea since it possesses antibacterial and keratolytic activity. The primary objective of this study was to develop an AZA nanocrystal suspension. It is expected that improved solubility and dissolution rate will result in advanced biopharmaceutical properties, primarily the dermal bioavailability. Furthermore, a topical nanocrystal AZA-loaded hydrogels composed of Pluronic® F127 and hyaluronic acid mixture that are able to deliver AZA into the stratum corneum and deeper skin layers were considered. This study was conducted in order to: 1) determine the effect of non-ionic Polysorbate 60 on the stabilization and particle size of the AZA nanocrystals, as well as the effect of Pluronic® F127, used as an in situ gelation agent, and hyaluronic acid on the viscoelastic properties and the drug release of composed hydrogels, 2) determine the relationship between the rheological properties of the gels and the penetration of AZA into the stratum corneum. The composed hydrogels revealed pseudoplastic flow behaviour. The increase in Pluronic® F127 concentration induced a domination of elastic over viscous behaviour of the gels. The gel containing 15% of Pluronic® F127, 1% of hyaluronic acid and lyophilised 10% nanocrystal AZA suspension was considered to be an optimal formulation, since it possessed the rheological and drug delivery properties desirable for an in situ gelling platform for dermal application.