Chemotherapy-Induced Peripheral Neuropathy (CIPN) in Patients Receiving 4-6 Cycles of Platinum-Based and Taxane-Based Chemotherapy: A Prospective, Single-Center Study from Kosovo.

BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is most commonly associated with platinum-based drugs, taxanes, and vinca alkaloids. This prospective study from a single center in Kosovo aimed to evaluate CIPN in 120 patients receiving 4-6 cycles of platinum-based and taxane-based chemotherapy. MATERIAL AND METHODS One hundred twenty patients underwent neurological examination and nerve conduction studies (NCS) before chemotherapy, and after 4 to 6 cycles of treatment. Sixty patients were treated with platinum-based chemotherapy, 30 were treated with taxane-based chemotherapy, and 22 patients received a combination of platinum- and taxane-based chemotherapy. The most commonly used platinum-based compounds were oxaliplatin and carboplatin, whereas the most commonly used taxane medications were paclitaxel and docetaxel. Presence of neuropathy was confirmed with neurological examination of electrophysiological criteria applicable for polyneuropathies. Total Neuropathy Score (TNSr) was used to combine clinical and electrophysiological values. RESULTS Around 90% of patients self-reported neuropathic symptoms, and in 60% of them polyneuropathy was present in NCS. All sensory and motor nerves had significantly lower amplitudes (P<0.01). Platinum-based agents caused more pronounced decrease in ulnar nerve compound motor action potential (CMAP) (P<0.05); when used solely or in combination with taxanes, they caused significant decrease in tibial nerve CMAP (P<0.01). TNSr did not reach statistical significance between groups; only clinical muscle strength showed pronounced weakness in the combined protocol (P<0.05). CONCLUSIONS These findings support previous studies and show that CIPN, including sensory and motor symptoms, is commonly associated with chemotherapy. Platinum-based chemotherapy agents were more commonly associated with ulnar and tibial nerve damage in this study population.

Esomeprazole use is independently associated with significant reduction of BMD: 1-year prospective comparative safety study of four proton pump inhibitors.

Because of the efficacy of proton pump inhibitors (PPIs), their the use is increasing dramatically. The risk of adverse effects of short-term PPI therapy is low, but there are important safety concerns for potential adverse effects of prolonged PPI therapy. Findings from studies assessing the association between PPI use and bone mineral density (BMD) and/or fracture risk are contradictory. The aim of this study was to prospectively assess potential association of PPI treatment with the 12-month change in BMD of the lumbar spine, femur neck, and total hip. The study was performed in 200 PPI users and 50 PPI nonusers. Lumbar spine (L1-L4), femur neck, and total hip BMD were measured by dual-energy X-ray absorptiometry at the baseline and at 12 months. A total of 209 subjects completed the entire 12 months of the study and were included in the final analysis. A Wilcoxon signed-rank test showed that at 12 months PPI use was associated with statistically significant reductions in femur neck and total hip T scores (Z = -2.764, p = 0.005 and Z = -3.281, p = 0.001, respectively). A multiple linear regression analysis showed that only esomeprazole added significantly to the prediction of total lumbar spine and femur neck T scores (p = 0.048 and p = 0.037, respectively). Compared with the baseline, 12 months of PPI treatment resulted in lower femur neck and total hip BMD T scores. Among the four PPIs studied, esomeprazole was independently associated with significant reduction of BMD, whereas omeprazole had no effects on BMD. Considering the widespread use of PPIs, BMD screening should be considered in the case of prolonged PPI use.

Proton Pump Inhibitors Intake and Iron and Vitamin B12 Status: A Prospective Comparative Study with a Follow up of 12 Months.

BACKGROUND: Proton pump inhibitors (PPIs) represent the most widely prescribed antisecretory agents, but their prolonged use, may influence iron and vitamin B12 status, which could have important implications for clinical practice. AIM: We undertook this study aiming to investigate the association between PPIs use for 12 months and potential changes in iron and vitamin B12 status, as well as whether this potential association varies among four specific PPI drugs used in the study. METHODS: A total of 250 adult subjects were recruited into this study, of which 200 subjects were PPIs users while 50 subjects belonged to the control group. Serum iron, ferritin, vitamin B12, and homocysteine (Hcy) levels were measured before the start of the study and after 12 months. Mann - Whitney U test and Kruskal - Wallis test was used to compare the baseline characteristics of the study groups, while Wilcoxon test was used to analyse post - pre differences. RESULTS: Statistical analysis showed significant changes within PPIs group and specific PPIs subgroups between the two-time points in serum ferritin and vitamin B12 levels, respectively, while no significant changes in serum iron and homocysteine levels were shown. However, subsequent diagnosis of hypoferremia and hypovitaminosis B12 in the whole study sample at 12 months was established in only 3.8% and 2.9% of the subjects, respectively. CONCLUSION: PPIs use for 12 months did not result in clinically significant iron and/or vitamin B12 deficiency; thus, these findings argue routine screening under normal circumstances, although monitoring in elderly and malnourished may be of precious value.

Management of Coxa Vara Septica and Pseudoarthrosis of the Femoral Neck: A Case Report.

BACKGROUND Coxa vara and pseudoarthrosis of the femoral neck after septic hip arthritis is a very rare disease. The aim of this study was to present a case with pseudoarthrosis of the femoral neck, with coxa vara after neonatal septic arthritis of the right hip, and treatment of the pseudarthrosis with proximal femoral valgus osteotomy. CASE REPORT A 12-month-old female, who had suffered neonatal septic arthritis with a five-day history of fever and painful right hip now demonstrated painless limping to the right hip, pelvic obliquity, Trendelenburg-Duchenne gait, limitation of hip abduction, lower-extremity length discrepancy with 3.0 cm of shortening of right femur, and walking on her tiptoes. In addition, a viable femoral head, coxa vara, and pseudoarthrosis of the femoral neck were observed. At the age of 26-months, the patient had a realignment valgus osteotomy of the proximal femur and adductor tenotomy was performed. At the last follow-up postoperative evaluation, at the age of four and a half years, the patient showed successful consolidation of pseudoarthrosis, correction of Trendelenburg gait, restored right lower extremity alignment, and corrected lower-extremity length discrepancy. CONCLUSIONS In the case of coxa vara and pseudoarthrosis of the femoral neck, realignment of the proximal femoral valgus osteotomy and bone grafting of the pseudoarthrosis resulted in ossification of the femoral neck as the epiphyseal plate was placed at right angle to the compressive forces.

Proton pump inhibitor use for 12 months is not associated with changes in serum magnesium levels: a prospective open label comparative study.

BACKGROUND/AIMS: Proton pump inhibitors (PPIs) are a widely used class of drugs because of a generally acceptable safety profile. Among recently raised safety issues of the long-term use of PPIs is the increased risk of developing hypomagnesemia. As there have been very few prospective studies measuring serum magnesium levels before and after PPI therapy, we aimed to prospectively assess the potential association between PPI therapy for 12 months and the risk of hypomagnesemia as well as the incidence of new-onset hypomagnesemia during the study. In addition, the association of PPI therapy with the risk of hypocalcemia was assessed. MATERIALS AND METHODS: The study included 250 patients with normal serum magnesium and total calcium levels, who underwent a long-term PPI treatment. Serum magnesium, total calcium, and parathormone (PTH) levels were measured at baseline and after 12 months. RESULTS: Of the 250 study participants, 209 completed 12 months of treatment and were included in the statistical analysis. The Wilcoxon signed rank test showed no statistically significant differences in serum magnesium levels between measurements at two different time points. However, there were statistically significant differences in serum total calcium and PTH levels in PPI users. CONCLUSION: Stable serum magnesium levels were demonstrated after 12 months and no association between PPI use and risk of hypomagnesemia was shown in the general population. Significant reductions of serum total calcium levels were demonstrated among PPI users; nevertheless, further research is required before recommending any serum calcium and PTH level monitoring in patients initiated on long-term PPI therapy.

Relationship of weight and body mass index with bone mineral density in adult men from kosovo.

BACKGROUND AND OBJECTIVE: Body weight and body mass index (BMI) are considered strong predictors of osteoporotic fractures, though optimal BMI levels remain unsettled. There are several studies conducted on women about the relationship between BMI and bone mineral density (BMD), and just a few so far on men. Therefore, the objective of current study was to analyze the relationship between weight and BMI and BMD measured in lumbar spine (L1-L4), femur neck and total hip in 64 men from Kosovo. METHODS: This cross-sectional study included a population of 64 men divided into three BMI groups. Dual-energy X-ray absorptiometry (DEXA) measurements were done in all the study participants. RESULTS: Pearson's correlation analysis showed a significant positive correlation between weight and BMI and BMD in femur neck and in total hip, and a significant negative correlation between age and femur neck BMD. Age-adjusted linear regression analysis showed that weight and BMI had a significant positive association with BMD levels. CONCLUSION: Although the results show significant relationship between BMI and BMD, the negative relationship between age and femur neck BMD may serve as guidance to initiate early assessment of the BMD in this region as well as preventive measures of osteoporosis and fractures among ageing men population.

The incidence and clinical relevance of drug interactions in pediatrics.

OBJECTIVE: To investigate the prevalence of the major drug interactions in children and verify the rate and profile of drug interactions in hospitalized pediatric patients. MATERIALS AND METHODS: A retrospective study was designed and data collected from the files of hospitalized children in Pulmonology, Nephrology, and Gastroenterology wards of a Pediatric Clinic, from July 1999 to 2004. RESULTS: From the analyzed material, we detected 34 cases of interactions, of which 1 was pharmacodynamics interaction, 13 were pharmacokinetic interactions, and 20 of unknown mechanisms. According to the rate of significance, 4 cases were categorized in the first significance rate of interaction, 18 cases in the second significance rate, 1 case of the third significance rate, 4 cases of the fourth significance rate, and 7 cases of the fifth significance rate. According to onset of cases, 33 cases were of delayed onset, and according to severity of interactions, in 7 cases we noticed major severity interaction, in 19 cases moderate severity and in 8 cases minor severity. CONCLUSIONS: The presence of drug interactions is a permanent risk in the pediatric clinic. Then, we can conclude that continued education, computer system for prescriptions, pharmacotherapy monitoring of patients, and the pharmacist participation in the multidisciplinary team are some manners of improving the treatment to hospitalized patients.