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The aim of this study was to assess whether heart failure (HF) could be a risk factor for adverse drug reactions (ADRs) among hospitalized older adults. This study included 19,496 patients admitted to community- and university-based hospitals in Italy (mean age 70 +/- 14 years; 49.7% female). ADRs were identified in 207 of the 2,413 (8.6%) patients with HF and in 855 (5.0%) of the 17,083 patients without HF (P < 0.001). After adjusting for potential confounders, HF was shown to be associated with an increased likelihood of experiencing an ADR (odds ratio (OR) 1.29; 95% confidence interval (CI) 1.06-1.56). After stratifying the sample by gender, the association continued to be seen in the women (OR 1.58; 95% CI 1.22-2.05) but not in the men (OR 0.99; 95% CI 0.74-1.34). In conclusion, HF appears to be associated with a higher rate of ADRs among hospitalized patients. Gender may influence the effect of HF on the risk of ADRs.

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BACKGROUND: Although increasing attention has been given to the evaluation of use of potentially inappropriate medication in the older European Union (EU) member countries, information on this topic from Central and Eastern Europe is scarce. OBJECTIVES: The aims of the present study were: to identify risk factors enhancing the probability of use of potentially inappropriate medication in hospitalized older patients under the conditions of the Slovak healthcare system and to compare our results with previously published European studies. METHODS: The evaluation was performed in 600 patients aged > or =65 years, hospitalized in a general hospital between 1 December 2003 and 31 March 2005. To identify the use of potentially inappropriate medication, the Beers 2003 criteria were applied. Particular socio-demographic and clinical characteristics, as well as comorbid medical conditions were evaluated among possible factors enhancing the probability of use of potentially inappropriate medication. RESULTS: At least one potentially inappropriate medication was prescribed to 126 (21%) of 600 patients. Multivariate analysis identified polypharmacy [odds ratio (OR) 2.38; 95% confidence interval (CI): 1.50-3.79], depression (OR 2.03; 95% CI: 1.08-3.82), immobilization (OR 1.87; 95% CI: 1.16-3.00) and heart failure (OR 1.73; 95% CI: 1.13-2.64) as factors associated with an increased risk of use of inappropriate medication. In contrast, patients aged > or =75 years had a lower risk of being prescribed potentially inappropriate medication (OR 0.58; 95% CI: 0.39-0.88). CONCLUSIONS: Polypharmacy, immobilization, heart failure and depression were documented as predictors of use of potentially inappropriate medication. In depressive patients, drugs other than antidepressants contributed to the extensive use of potentially inappropriate medication. The observed prevalence of use of potentially inappropriate medication in older hospitalized Slovak patients was lower than the prevalence previously documented in Poland and the Czech Republic, but higher than in Croatia and Turkey. The identified risk factors were consistent with previous findings from other parts of Europe.

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Drug prescribing in the old age is burdened by a significant number of prescribing errors often resulting in high rate of adverse drug events associated with increased morbidity, health care utilization and health costs. The revised 2003 Beers' Criteria represent the most widely used method for identification of high risk ("potentially inappropriate") medication in elderly persons. A standardized method for evaluating omission of potentially beneficial drugs has been lacking. The Beers' Criteria consist of the list of selected drugs with high potential of adverse drug events in old age and clinical conditions with relative contraindications of selected drugs (drug-disease interactions). Prescribing of these drugs should be avoided in older patients. However, several limitations prevent wider use of Beers' Criteria: several outdated drugs or drugs unavailable in Europe are listed, some controversial drugs with specific indications are on the list, drug-drug interaction and drug class duplications are not mentioned, and last but not least low user friendliness was criticized. To overcome these limitations, new STOPP and START Criteria were developed in 2007 to serve as a screening tool for comprehensive assessment of safety and quality of prescription in patients 65 years and older. In the current review article Czech version of both criteria are presented for the first time in the Czech literature. Using STOPP Criteria potentially inappropriate drugs are identified in drug regimen which could be stopped altogether or replaced by a safer drug alternative. Concomitant use of START Criteria will help the prescribing physician to consider the benefit of starting new drugs in selected clinical situations. Both screening tools represent a new method for improving quality of geriatric prescribing in clinical practice.

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BACKGROUND: Population of seniors in the Czech Republic consumes more than 35 % of all prescribed medications. Currently, Czech seniors take on the average 4-5 prescribed drugs. However, our knowledge about factors influencing drug compliance is scarce particularly in seniors with polypharmacotherapy. Non-compliance can contribute to treatment failure and increases the risk of adverse drug reactions. The aim of the study is to compare drug compliance in the elderly in 11 European countries and to assess the impact of demographic and drug-related factors on non-compliance to medication. METHODS AND RESULTS: Cross-sectional comparative study in 3881 elderly subjects living in the community receiving home-care services in 11 European countries participating in ADHOC (Aged in Home Care) study. In the sample of Czech subjects we performed in-depth analysis of causes and factors associated with non-compliance in patients with polypharmacotherapy. 12.5% (n=456) of European seniors were non-compliant with prescribed medication with significantly higher prevalence of non-compliance in the CR (33.5 %) and Germany (17.0 %). In the Czech sample following non-compliance risk factors have been identified: taking > or = 7 drugs per os (OR= 2.2), 10 single applications/day (OR= 2.5), more than twice daily dosing (OR= 2.4), problems with drug preparation (OR= 4.6), polypharmacotherapy 5 years and longer (OR= 5.5) and drug preparation without supervision or help (OR= 2.8). The highest prevalence of non-compliance was found for antidepressants (80 %), antiasthmatics (68 %), fibrates (60 %), nonsteroidal antiinflammatory drugs, vasodilatators, anticoagulants/antiplatelet drugs and nootropics (50 %). Among the most common causes, patients reported forgetting to take the drug (74.3 % patients), mistrust in drug effect (10.6%) and fear of taking "too many drugs" (8.6 %). CONCLUSIONS: Non-compliance to prescribed drug regimen is a prevalent problem in one third of the Czech seniors and was found to be the highest among 11 European countries. Doctors prescribing to older people have to monitor purposefully compliance and strenghten co-operation and motivation of the patient to adhere with prescribed drug regimen. Particularly in seniors with polypharmacotherapy it seems necessary to simplify drug regimen as much as possible. In elderly patients with physical disability, cognitive impairment or depression supervision and/or help of another person with drug preparation and application may improve drug compliance.

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PURPOSE: The aim of the present study was to determine the risk perception of potentially inappropriate drug treatment of elderly patients by Slovak physicians. In Slovakia, a list of such drugs is not available. METHODS: The study sample consisted of 600 patients aged > or =65 years hospitalized at the Department of Internal Medicine in a Slovak general hospital between 1 December 2003 and 31 March 2005. The use of potentially inappropriate drugs at the time of hospital admission and discharge was compared. Potentially inappropriate drug use was defined by Beers 2003 criteria. In addition, 206 physicians were asked to mark the drugs that they considered potentially inappropriate for elderly patients out of a list provided in a questionnaire analysis. RESULTS: Out of 600 patients 20.2% and 20% were treated with at least one potentially inappropriate drug at the time of hospital admission and discharge, respectively. Hospitalization had no significant influence on the number of potentially inappropriate medicines used. The most frequently prescribed potentially inappropriate drugs were digoxin >0.125 mg/day and ticlopidine. Out of 206 responding physicians only 4.9% considered ticlopidine as potentially inappropriate for elderly patient. On the other hand, more than 20% of respondents were aware of the potential inappropriateness of amitriptyline, diazepam and chlordiazepoxide. Mentioned drugs were observed in less than 2% of study population (n = 600). CONCLUSIONS: The results of the questionnaire analysis in physicians as well as the prevalence of potentially inappropriate medication demonstrate that Slovak clinicians are aware of the risk of certain treatments in elderly patients.

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OBJECTIVES: The aim of the study was to assess the intake (by various routes of exposure) of polycyclic aromatic hydrocarbons (PAH) by children living in a Czech city, and its effect on excretion of 1-hydroxypyrene (1-OHP) in summer and winter periods. METHODS: Four groups of children (3-6 years old) were chosen: (1) two groups from a kindergarten situated in the city center with a higher traffic density ("polluted" area); (2) two groups from a kindergarten situated in a green zone of the same city ("non-polluted" area). Food consumption was recorded in all children and PAH intake from foodstuffs was estimated. Ambient air samples were collected from the playground and inside the kindergartens. Soil samples were collected too. Morning and evening urine samples were collected during sampling days. RESULTS: In both seasons, the mean outdoor total PAH concentration (sum of 12 individual PAH) in the -polluted" area was approximately three-times higher than that in the "non-polluted" area. Indoor concentration in the "polluted" area was more than six-times higher than that in the "non-polluted" area in summer, and almost three-times higher in winter. The same trend was observed for pyrene and for the sum of carcinogenic PAH. The contribution to the total pyrene absorbed dose from food consumption was much more important than that from inhalation and from ingestion of soil dust. Significantly higher urinary concentrations of 1-OHP (evening samples) were found in children from the "polluted" kindergarten in both seasons. The number of significant relationships between 1-OHP and pyrene absorbed dose was weak. CONCLUSIONS: Food seems to be the main source of total pyrene and total PAH intake in small children, even under relatively higher air PAH exposure in the city. Estimated pyrene ingestion from soil had a negligible contribution to the total pyrene absorbed dose. Urinary 1-OHP seems to be an uncertain (non-sensitive) marker of the environmental inhalation exposure to pyrene (PAH) if the pollution of air by pyrene (PAH) is not excessive and the pyrene (PAH) dose by this route is much less than by ingestion. Usefulness of the urinary 1-OHP as an indicator of overall environmental exposure to PAH needs further investigation.

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1 Objectives of this study were (1) to compare concentrations of individual polycyclic aromatic hydrocarbons (PAH) in air of polluted and nonpolluted area of Czech Republic during winter and summer periods and (2) to verify if urinary 1-hydroxypyrene (1-OHP), as supposed practical biological marker, permits the assessment of spacial and temporal variations in environmental PAH exposure. 2 The study population consisted of three groups: (1) a group of 22 physical exercise students who regularly train outside, from the university situated in a polluted town, spending 14 days in winter and 14 days in summer in 'non-polluted' mountains; (2) a control group of 22 residents from the town and (3) a control group of 18 residents from the mountains. 3 The total PAH concentrations (sum of 13 individual PAH) were 19.3 and 104.6 ng/m3 in town and in mountains, respectively, during summer and 86.6 and 261 ng/m3 during winter. 4 Median 1-OHP levels ranged between 0.03 and 0.13 mumol/mol creatinine for controls and between 0.04 and 0.12 mumol/mol creatinine for students. No relationship was found between pyrene levels in air and group means of urinary 1-OHP. Our results show that other factors (probably PAH in food) contribute in masking air pollution influence on urinary 1-OHP levels in subjects non-occupationally exposed to PAH.

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The authors describe the mass incidence of haemolytic-uraemic syndrome (HUS) in five children from one community. They draw attention to the importance of collaboration with communal hygienists and food hygienists in epidemiological investigations of haemolytic-uraemic syndrome. In view of the necessity of early collection of biological material, specimens and examination of contacts, the authors draw attention to the importance of adhering to compulsory notification of HUS.

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The described ELISA reaction is suggested as a method for examination of antitoxoplasmatic IgG antibodies. It is a simple, i.e. three-layer sandwich with the following layers: 1. antigen 2. the examined serum either in serial dilution or single dilution 1:300 and 3. a peroxidase anti-IgG conjugate with a final conclusive step, i.e. a substrate solution with OPD. Sera and conjugate are allowed to bind for 30 mins. at 37 degrees C and the substrate solution with OPD is allowed to act for 15 mins., also at 37 degrees C, and thus the entire reaction lasts about two and half hours. The authors describe alternative procedures with standard serum of a known number of international units (I.U.) or without it, evaluated optically or by a photometer. In the version with standard serum evaluated optically we compare the different localization of equally stained wells in the series of serially diluted (4n) examined and standard serum and thus we assess, based on the different dilutions the number of I.U. in the examined serum. If we compare the sera with the serum standard by means of a photometer, we examine them in a single dilution of 1:300 and compare the resulting optical density (OD) with the calibration curve made with four dilutions of the standard. The calibration curve is plotted on a scale which straightens it approximately at an angle close to the optimal 45 degrees and which makes it possible to take readings of interpolated international units.(ABSTRACT TRUNCATED AT 250 WORDS)

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In seeds of the lentil Lens esculenta Moench., subsp. microsperma (Baumg.) Barulina, a nonspecific phytohemagglutinin was found, the properties of which differ from those of the previously described lentil hemagglutinins. The phytohemagglutinin is not adsorbed to the Sephadex matrix; its hemagglutinating activity is different towards erythrocytes of different human blood groups of the ABO system. The isolated phytohemagglutinin preparation is homogeneous by disc polyacrylamide and starch gel electrophoreses and by gel chromatography on Bio-Gel P-100. Ultracentrifugation of the phytohemagglutinin yields a single symmetrical peak with S20,W of 3.9 S. From the sedimentation data, a molecular weight of 53 300 was calculated. Phytohemagglutinins of similar properties were shown to be present also in other cultivars of Lens esculenta, subsp. microsperma.

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