Population toxicokinetics of carbamazepine and its metabolite carbamazepine-10,11-epoxide in adults.

BACKGROUND: Carbamazepine is one of the most commonly used antiseizure medications. Although carbamazepine pharmacokinetics in epileptic patients is well described, much less is known about these processes in the patients who experienced self-poisoning episode by this drug. Therefore, the aim of our investigation was to perform population toxicokinetics of carbamazepine and its metabolite carbamazepine-10,11-epoxide in adults. RESEARCH DESIGN AND METHODS: Software program NONMEM and the ADVAN2 TRANS2 subroutine were used for establishing a population toxicokinetic model for the estimation of clearance and volume of distribution based on of the sum values of carbamazepine and carbamazepine-10,11-epoxide concentrations. RESULTS: Our results indicated that the adult patients' ability to eliminate carbamazepine and carbamazepine-10,11-epoxide following acute carbamazepine self-poisoning was strongly associated with the high levels of CRP and ASP, as well as by the treatment with sedation. CONCLUSIONS: Our study should provide better understanding of the toxicokinetics of carbamazepine taken in overdose and better management of patient population admitted to hospital.

Risk factors for recurrent vulvovaginal candidiasis.

BACKGROUND/AIM: Recurrent vulvovaginal candidiasis is relatively frequent condition, and may have serious health consequences, like chronic vulvovaginal pain syndrome. The aim of our study was to determine possible risk factors for recurrent vulvovaginal candidiasis in non-pregnant females within the reproductive age. METHODS: The design of our study was of a case-control type. Case and control patients were selected from the gynecological patients at six primary care facilities in Serbia and in Montenegro. The data on the patients' health condition, concomitant therapy and diseases were taken from their records, and the data on habits were obtained by unstructured interview. For potential risk factors crude odds ratios were calculated, and then adjusted by logistic regression. RESULTS: A total of fifty-one patients had four or more episodes of vulvovaginal candidiasis during the last year (cases), and 132 patients with one to three episodes of vulvovaginal candidiasis were sampled as controls, matched by age. The only two significant associations were found between recurrent vulvovaginal candidiasis and continual wearing of panty liners during the last year (Odds ratio - OR adjusted: 3.97; confidence interval--CI: 1.57-10.02;p = 0.004), and between recurrent vulvovaginal candidiasis and predominant use of vaginal tampons during menstruation in the last year (OR adjusted: 4.25; CI: 1.11-16.27;p = 0.035). The synergistic effect was observed for the concurrent continual wearing of panty liners during the last year and self-medication with antimycotics. CONCLUSIONS: Local factors, like wearing of panty liners or use of tampons during menstruation, may promote recurrence of vulvovaginal candidiasis, especially in patients who practice self-medication with antimycotics.

[Malignant tumors of the colon and rectum]. / Maligni tumori kolona i rektuma.

The authors present their five year long experience in surgical treatment of colorectal cancer at Zvornik Health Center. 77 patients diagnosed with colorectal cancer underwent surgery during the five year period (1998-2002). This number represented about 2% of the total number of surgeries performed during the same time period. 80% of surgical interventions were elective, (82 patients), and 20% urgent (35 patients). Standard surgical procedures were applied in determining of the anatomical location of the pathological substrate. Aggravating factors in successful application of surgical intervention in treatment of colorectal cancer are: late diagnosis of colorectal cancer, low level of health education of the population, inadequate training of the physicians in primary health care, nonexistent national program for early detection of noninfectious diseases. In cases where colorectal cancer was diagnosed in an advanced stage, two-stage treatment and multi modal approach in combination with chemotherapy were treatments of choice. Incidence of colorectal cancer is still on the rise.