Pregnancy-related severe pelvic girdle pain caused by unilateral noninfectious sacroiliitis. A case report and literature review.

Pelvic girdle pain during and after pregnancy is the clinical syndrome of persistent musculoskeletal pain localized in the posterior and/or anterior aspect of the pelvis originating from sacroiliac joints and/or pubic symphysis due to dynamic instability. We report the case of severe and disabling postpartum pelvic girdle pain caused by unilateral noninfectious sacroiliitis which resolved after 2 months by nonsteroidal anti-inflammatory drug and physical therapy. A short literature review is given on epidemiology, etiology, clinical presentation, therapy, and prognosis of pregnancy-related pelvic girdle pain.

Inadequate use of preventive strategies in patients receiving NSAIDs.

OBJECTIVE: Little is known about the factors that influence the decision to use NSAIDs in combination with gastroprotective drugs. The aims of this observational study were to evaluate the extent to which NSAID users are prescribed concomitant gastroprotective drug regimens ('preventive strategies'), and to determine how patient risk factors for NSAID-associated gastrointestinal toxicity and physician prescribing preferences influenced the decision to prescribe a gastroprotective drug in combination with an NSAID. DESIGN AND PATIENTS: The study was conducted on 29 June 2004 and comprised 109 eligible adult patients hospitalised at the Clinical Hospital Center, Zagreb. Use of NSAIDs and gastroprotective drugs, risk factors for NSAID-associated gastrointestinal toxicity, and physician prescribing preferences were monitored throughout the study. RESULTS: Sixty-six percent of patients receiving proton pump inhibitors or histamine H(2)-receptor antagonists with NSAIDs had no risk factors for gastrointestinal toxicity. Furthermore, 29% of patients who used NSAIDs had risk factors for gastrointestinal toxicity but were not receiving gastroprotective drugs. Even though patients at risk of NSAID-associated gastrointestinal complications had higher odds of receiving preventive strategies (odds ratio 1.25), the absolute rate of utilisation of these therapies in at-risk populations was unacceptably low (69%). However, the strongest independent correlation for gastroprotective drug use was the prescribing physician, with an odds ratio of 6.40. CONCLUSION: This study demonstrates that an individual physician's prescribing style largely determines the odds of receiving preventive strategies with NSAID treatment and is more important than the patient's risk factors for gastrointestinal toxicity.

[A model for monitoring drug prescribing in general practice]. / Model pracenja propisivanja lijekova u opcoj medicini.

When prescribing drugs, general practitioners at the same should satisfy the requirements of medical science and their vocation, being aware of their task of a rational disposal of the limited resources allocated for health care. The aim of the paper was to determine the characteristics of monitoring model for drug prescription in general practice, taking into consideration the characteristics of the population, morbidity, drugs and physicians. A prospective monitoring of prescribing drug during one month was carried out in six doctor's offices of general practice/family medicine at the Dugave-Travno Health Station of the Novi Zagreb Health Center. In processing data on patients, drugs and physicians the following were used: distribution description and analysis, pair's tests and General Factorial Anova. Out of 3397 patients who visited the above mentioned doctor's offices, 2320 (68.3%) patients were prescribed 4796 prescriptions--an average of 2.07 prescriptions per patient (from 2.00 to 2.42). The total cost of drug prescription was 360,117.33 kunas (from 43,632 to 77,910 kunas). The number of prescriptions and the cost of prescribed drugs increased significantly in terms of statistics with the age of patients (Spearman's correlation coefficient 0.2263; p < 0.001). By General Factorial Anova statistically significant difference was determined in the cost variable among the physicians with the impact of covariate age and number of prescriptions. Professionally, the most appropriate and most rational prescribing was observed among physicians who had the highest educational level and the longest experience in practice. In order to analyze and assess the appropriatness of drug prescription in general practice, the first essential step is to collect data on what is being prescribed, for whom it is being prescribed, and to enable access to data for physicians. This paper has indicated some of the characteristics of a monitoring model for drug prescription in general practice. Formulation and implementation of this model would considerably promote the professional appropriateness and rationality in drug prescription in general practice.

Acute upper respiratory tract infections and indications for tonsillectomy in children. I. Immunoglobulin synthesis in the palatine tonsil tissue.

Current viewpoints and practice concerning indications for tonsillectomy are presented. The annual specific risk for upper respiratory infection in children aged up to 15 is 1.1. The risk is higher in the youngest age group, in whom it rises to 1.8, decreasing with age and being lowest among children aged 12-15 years (0.5). The proportion of tonsillitis among acute upper respiratory tract infections is highest in the age group up to 3 years (36.9%); at the age of 4-5 years it is 37.1%, and is lowest among children aged 12-15 years (21.9%). The risk of tonsillitis caused by streptococci is highest among children aged up to 5 years. Statistical significance of differences in the synthesis of immunoglobulins (G, M, A and sA) and lysozymes in the palatine tonsil tissue of tonsillectomized children and healthy volunteers was tested by non-parametric tests for independent samples. Significant differences of the above mentioned syntheses were found in all entities studied. Any contribution to the documentation on the nature and cause of each tonsillitis in childhood is of great clinical value, because it is the only basis for rational consideration of indications for tonsillectomy.