No abstract

Pain represents a complex experience which can be approached by various medicines. Non-opioid and opioid analgesics are the most common drugs used to manage different types of pain. The increased attention nowadays to pain management entailed concomitantly more frequent adverse drug reactions (ADRs) related to analgesic use. Drug-drug interactions can be sometimes responsible for the adverse effects. However, a significant proportion of analgesic ADRs are preventable, which would avoid patient suffering. In order to draw the attention to analgesics risks and to minimize the negative consequences related to their use, the present review comprises a synthesis of the most important safety issues described in the scientific literature. It highlights the potential risks of the most frequently used analgesic medicines: non-opioid (paracetamol, metamizole, non-steroidal anti-inflammatory drugs) and opioid analgesics. Even if there is a wide experience in their use, they continue to capture attention with safety concerns and with potential risks recently revealed. Acknowledging potential safety problems represents the first step for health professionals in assuring a safe and efficient analgesic treatment with minimum risks to patients. Taking into consideration all medical and environmental factors and carefully monitoring the patients are also essential in preventing and early detecting analgesic ADRs.

A significant number of analgesic ADRs could be prevented, and being aware of their contributing factors promotes efficient analgesia with minimum risks to the patients.

Background and aimsThe nutritional disorders are modifiable predisposing factors of the current leading causes of morbidity and premature mortality, such as cardiovascular diseases, diabetes and cancers. An early recognition of appropriate interventions could decrease the burden of medical costs and increase the healthy life expectancy. The aims of our study were the description of nutritional status, its associated factors, and the detection of eating disorders among Romanian medical students of the “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca.MethodsA cross-sectional study was conducted during the 2015–2016 academic year, including medical students from all study years, by an online questionnaire. The statistics, both descriptive and inferential, were calculated using EpiInfo.ResultsA total of 222 students from the University Romanian section were included, with a sex-ratio (men:women) of 0.22. The average body mass index of the medical students included was 21.3±3.3 kg/m2, for females it was 20.7±3 kg/m2 and for males 23.9±3.1 kg/m2. For the nutritional disorders such as overweight, the prevalence among males (30%) had a net predominance (p<0.001) over females (4.4%), while for underweight, it was prevalent only for female students (20.3%). Overweight was associated with low academic performance (odds ratio (OR)=7.2; 95% confidence interval (95% CI): 1–53.94), smoking (OR=2.4; 95% CI: 1–5.76) and binge drinking (OR=3; 95% CI: 1.26–7.25). Eating disorders were reported by 25.7% of the students and were significantly more prevalent in students in the second academic study cycle (47.4%; 95% CI: 34.7–60.3%) and in students with jobs (7%; 95% CI: 2.3–16.1%).ConclusionsIn this survey, two different distribution models of nutritional disorders for both genders were identified, with the predominance of overweight among men. Eating disorders were more prevalent among students in the second study cycle and those with jobs at the same time.

The aim of the study was to assess the polyphenolic profile, anti-inflammatory and antinociceptive activity of Arctium lappa, a medicinal plant traditionally used in the treatment of gout, hepatitis and other inflammatory disorders. Polyphenolic profile of a hydro-glycero-ethanolic extract from Arctium lappa roots (ALE) was evaluated by HPLC-MS method. Antiinflammatory effect of the Arctium lappa extract (ALE) was determined by carrageenan-induced rat paw oedema test, while antinociceptive effect was determined by acetic acid induced writhing test in mice and Randall Selitto test in rats. HPLC-MS analysis of the extract showed the presence of chlorogenic acid (158.9 μg/mL) and quercitrin (14.4 μg/mL). The administration of ALE reduced the oedema formation in the carrageenan-induced rat paw oedema test, especially at dose of 500 mg/kg, the results being statistically significant and dose-dependent. Also, ALE showed statistically significant and dosedependent antinociceptive effects in the acetic acid induced writhing test in mice and Randall Selitto test in rats. The results of the pharmacological experiments suggest that the anti-inflammatory and antinociceptive effects of the Arctium lappa extract (ALE) may be related to the ability of polyphenols such as chlorogenic acid to inhibit the synthesis and release of some proinflammatory mediators. Our experimental data justify the traditional use of this plant in the management of some inflammatory diseases.

The results of national safety studies are essential for decision-making at the regulatory level and have also educational implications for prescribing patterns. The aim of this study was to analyze the adverse drug reactions (ADRs) of analgesic medicines spontaneously reported to Pharmacovigilance and Risk Management Service of the Romanian National Agency for Medicines and Medical Devices between 2011 and 2015. For the 71 reports, patients had a mean age of 39.8 years; 60.6% of patients were female, and 38% male and 1.4% were unknown. Reporters were mainly physicians (74.7%), and 52.1% of ADR reports were transmitted through marketing authorization holders. Of the serious ADRs (32.4%), 34.7% led to hospitalization or prolonged hospitalization. The most frequent ADRs reported were skin and subcutaneous tissue disorders (25.8%) and general disorders and administration site conditions (19.2%). Metamizole, alone or in combination, was the main analgesic suspected in almost 15.5% of the cases and remains one of the most popular analgesics in Romania. Ten cases were assessed as preventable or potentially preventable (14%), of which two cases were serious. Even if the level of reporting is still low, this study conducted on ADRs of analgesics reported to the national pharmacovigilance center represents an essential step toward promoting the rational use of analgesics in Romania.

This cross-sectional study aimed to determine the use of neuroenhancers, the motivations and factors associated with their use in French and Romanian university students. Students from two universities in France (Rouen and Opal Coast University) and one in Romania (Cluj-Napoca) were asked to complete a self-administered anonymous questionnaire, either online or on paper, about the use of three different categories of substance: Prescription drugs (methylphenidate, modafinil, and beta-blockers), drugs of abuse (alcohol, cannabis, cocaine, and amphetamines), and soft enhancers (coffee, vitamins, caffeine tablets, and energy drinks). In total, 1110 students were included: The users were 2.2% for prescription drugs, 4.3% for drugs of abuse, and 55.0% for soft enhancers. Students used neuroenhancement to stay awake for study (69.3%), to improve concentration (55.5%), to decrease stress (40.9%), and to improve memory (39.6%). Neuroenhancement was considered to meet expectations by 74.4% of users. The factors associated with the use of drugs of abuse were frequent binge drinking (Adjusted Odds Ratio—AOR: 6.49 [95% CI: 2.53–16.6]), smoking (AOR: 5.50 [95% CI: 2.98–10.14]), having a student job (AOR: 2.42 [95% CI 1.13–5.17]), and being male (AOR: 2.23 [95% CI:1.21–4.11]). No significant associations with eating disorders were detected for any of the three categories of substances. University students reported neuroenhancement with prescription drugs, drugs of abuse, and mainly soft enhancers. These substances were used mainly to increase the waking hours. Educational programs in universities seem to be required in order to increase student awareness of the problems caused by neuroenhancements, and to decrease the associated risks by changing students’ attitudes and beliefs.

The aim of the present study was to evaluate the pharmaceutical market of analgesic medicines in Romania during 2011-2015. A retrospective descriptive analysis was conducted on sales data provided by IQVIA (formerly IMS Health). Data corresponded to the volume of analgesic sales in hospital and retail pharmacies, split up in units and value (EUR), in prescription only (POM) and over-the-counter (OTC) medication and by region. Data was estimated to cover 95% of the Romanian market. From 2011 to 2015, the analgesic pharmaceutical market increased by 18.7% in value and by 6.1% in units. It was mainly assured by the retail distribution channel (95%), both for OTC and POM. The highest sales (6.3 units/capita, 12.3 EUR/capita) were found for the capital, Bucharest, while the lowest for counties of the NorthEast region of Romania (3.5 units/capita, 6.0 EUR/capita). In the context of an increasing analgesic market, programs that promote rational use of these medicines should be a priority at present for the Romanian healthcare system. Rezumat Obiectivul studiului a fost evaluarea pieței farmaceutice a medicamentelor analgezice în România în perioada 2011-2015. Sa realizat o analiză descriptivă retrospectivă pe baza datelor privind vânzările de medicamente analgezice furnizate de IQVIA (fostă IMS Health). Datele au cuprins volumul vânzărilor de analgezice în farmaciile comunitare și de spital, exprimat în unități standard și valoare (EUR), în funcție de regimul de eliberare a medicamentelor (doar pe bază de prescripție medicală (POM) și over-the-counter (OTC)) și de regiuni. Estimativ, datele au acoperit 95% din piața farmaceutică din România. Din 2011 până în 2015, piața farmaceutică a analgezicelor a crescut cu 18,7% în valoare și cu 6,1% în unități. A fost asigurată, în principal, de vânzările în farmaciile comunitare (95%), atât pentru medicamentele POM cât și pentru cele OTC. Cele mai mari vânzări (6,3 unități/locuitor, 12,3 EUR/locuitor) au fost descrise pentru București, iar cele mai mici pentru nord-estul României (3,5 unități/locuitor, 6,0 EUR/locuitor). În contextul unui consum în creștere pentru analgezice, programele care promovează utilizarea rațională a acestor medicamente ar trebui să constituie în prezent o prioritate pentru sistemul de sănătate din România.