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Poremećaj pažnje s hiperaktivnošću (attention deficit hyperactivity disorder, u daljem nastavku teksta - ADHD) je najrasprostranjeniji neurorazvojni poremećaj kod dece i adolescenata, s procenjenom globalnom učestalošću između 5% i 12%. Učestalost ADHD-a zajedno s tikovima je značajno veća nego što bi se očekivalo. Deca koja su dijagnostikovana s ADHD-om znatno češće imaju i hronične tikove (chronic tic disoreder, u daljem nastavku teksta - CTD) u poređenju s onima koji nemaju ADHD. Kada se ADHD javlja zajedno s poremećajem tikova, lečenje može biti izazovno. Kroz ovaj prikaz, nadamo se osvetljavanju jedinstvenih izazova i potencijalnih strategija lečenja ove komorbidnosti. Devetogodišnji dečak primljen na Kliniku za psihijatariju zbog hiperaktivnosti, slabe koncentracije i pažnje, kao i motornih tikova u vidu izraženog treptanja, plaženja i klimanja glavom. Primljen radi dopunskih dijagnostičkih procedura i eventualnog uvođenja diferentne psihofarmakoterapije. Psihološkim testiranjem dobijeno da je globalno intelektualno postignuće u kategoriji proseka, međutim registrovan nesklad između verbalnih i manipulativnih sposobnosti. Tokom hospitalizacije na osnovu opservacije i psihološkog celokupnog testiranja, kao i korišćenjem testova (SNAP – IV granične vrednosti) nije semoglo direktno ukazati na postojanje hiperkinetskog poremećaja, te preporučeno šestomesečno praćenje i nastavak logopedsko-defektološkog tretmana. U međuvremenu praćen od strane nadležnog psihijatra tokom kojeg se na osnovu psihodijagnostičkih procena zaključuje da postoji deficit pažnje sa hiperaktivnošću. Po isključenju kontraindikacija, uvedena psihostimulativna terapija metilfenidatom u dozi od 18mg. Doza titrirana nakon dva meseca do 36mg kada se postiže zadovoljavajući terapijski odgovor. Uvođenje metilfenidata nije imalo značajnijeg uticaja na tikove, ali nije dolazilo ni do pogoršanja te vrste tegoba. Poremećaj ponašanja i funkcionalni poremećaji povezani s ADHD-om imaju negativne uticaje na akademske, socijalne i porodične aspekte. Za razliku od osoba koje se samo suočavaju sa Turetovim sindromom (TS), oni koji imaju i TS i ADHD imaju izraženije teškoće u oblastima poput planiranja, radne memorije, inhibicione funkcije i vizualne pažnje. Kliničari koji leče pacijente sa tikovima i ADHD-om mogu razmotriti korišćenje metilfenidata za rešavanje simptoma ADHD-a. Međutim, važno je da kliničari razgovaraju o ovom pitanju sa starateljima prilikom propisivanja leka i pažljivo prate pacijente zbog opreza navedenog u informacijama o leku. [ABSTRACT FROM AUTHOR]

Background/Aim. Previous studies showed that mild cognitive impairment (MCI) was more common in patients with comorbidities and those using medications that disrupt the homeostasis of vitamin B12. The aim of our study was to determine which of these factors are significantly associated with MCI, as well as which are the most significant risk factors for predicting its occurrence. Methods. The data have been prospectively collected for 200 adults (35-65 years old) in primary care settings enrolled in the clinical study with the case-control approach. Results. By applying the X2 test for independence, we have determined that the MCIs and the use of proton-pump inhibitors (PPIs) (p < 0.0005), as well as metformin (p < 0.0005), are independent factors. In addition, a significantly higher percentage of subjects who had MCI also had a peptic ulcer and diabetes mellitus type 2 (T2DM). Direct logistic regression has been implemented in order to estimate the influence of many probability factors on whether the study patients would have the MCI. Two variables made statistically significant contributions to the model, and these are the serum concentrations of vitamin B12 [odds ratio (OR) = 0.953; 95% confidence interval (CI) 0.936-0.971; p < 0.001] and T2DM (OR = 6.681; 95% CI 1.305-34.198; p = 0.023). Conclusion. The absolute and relative risk associations of exposure to medicines and MCI is lower than those of comorbidities and MCI. Serum concentrations of vitamin B12, as well as the presence of T2DM, have the greatest statistically significant influence on predicting MCI. [ABSTRACT FROM AUTHOR]

Aim: The main objective of the study is to examine clinical characteristics in relation to age and complications, and to find predictors that affect the likelihood of complications and the negative outcome in hospitalized patients with influenza. Respondents and methods: The study included all hospitalized patients with clinically and/ or laboratory-proven influenza at the Clinic for Infectious Diseases of the Clinical Hospital Center Osijek in the period from December 2018 to April 2019. The survey was conducted on 128 respondents. Clinical, demographic, microbiological, radiological, biochemical, and hematological data were collected and analyzed from the History of the disease. Results: Research has shown that higher age is associated with a more severe form of the clinical picture of influenza and a complicated course of the disease. Urea with a value of more than 9.2 mmol / L and an age higher than 78 years proved to be useful as predictors of the negative outcome, and female sex and CRP with a resolution point of more than 128.9 mg / L as predictors of the presence of pneumonia. Complications are generally more common in patients with a longer clinical course of the disease and higher values of inflammatory parameters when admitted to the hospital. Conclusion: The results of the study indicate the undisputed severity of the clinical picture, the level of laboratory disorders, the occurrence of complications, and the impact of age and comorbidity in patients with influenza. Further systematic monitoring of patients and prospective studies are needed to finally define specific early predictors of the severity of the clinical picture, for the purpose of timely and effective treatment and a more favorable disease outcome. [ABSTRACT FROM AUTHOR]

Introduction. Adenocarcinoma is the most common prostatic malignancy, where clinical management, the Gleason score, and recent updates in prostate cancer staging play critical roles. Mantle cell lymphoma (MCL) originates from the malignant transformation of B lymphocyte in the outer edge of the lymph node follicle, with pathognomonic overexpression of cyclin D1. We present a rare case of two simultaneous neoplasms occurring in the same patient. Case report. During the hospital preoperative examinations in a 68-year-old patient planned for radical prostatectomy, using multislice computed tomography, a tumor mass confined to the prostate, but also excessive lymph node enlargement, was revealed. Tissue specimens were analyzed after the hematoxylin and eosin staining was performed, as well as an immunohistochemical (IH) biomarker panel. Having performed a thorough histological examination, a diagnosis of prostatic adenocarcinoma was made, with a Gleason score 3 + 4 = 7 and Grade Group 2 of the International Society of Urological Pathology (ISUP). Microscopic analysis of lymph node involvement showed unexpected, diffuse proliferation of small lymphoid cells with irregular nuclei, wide mantle zone, and hyalinized blood vessels. After using IH staining for specific markers, another diagnosis was set, and it was non-Hodgkin MCL. Conclusion. A prostatic adenocarcinoma can rarely coexist with an undiagnosed lymphoproliferative disease, such as non-Hodgkin MCL in our case. [ABSTRACT FROM AUTHOR]

Introduction: Acute lymphoblastic leukemia is a malignant disease characterized by the proliferation of precursor B-cells, Tcells or less often, precursors of NK-cells. B-cell acute lymphoblastic leukemia is more common in patients >60 years of age compared to patients <60 years of age (89% vs. 66%), and cytogenetic abnormalities such as t(9;22) (Ph+) are more common in older than younger patients (36% against 19%). Elderly patients often have a poor status and comorbidities, so poor disease outcome is more common. Clinical and biological features: B cell acute lymphoblastic leukemia is more common in patients >60 years of age compared to patients <60 years of age (89% vs 66%) and cytogenetic abnormalities such as t(9;22) are more common in older vs. younger (36% vs. 19%). Therapy: The elderly and patients with comorbidities require less intensive therapy, based on corticosteroids, vincristine and asparaginase, while avoiding anthracyclines and alkylating agents, due to the high mortality associated with treatment. For “unfit” patients with Ph-positive acute lymphoblastic leukemia, tyrosine kinase inhibitors with reduced-intensity chemotherapy or corticosteroids alone are recommended. For t(9;22) negative patients, low-dose corticosteroid chemotherapy with or without immunotherapy is recommended. For patients with T-cell acute lymphoblastic leukemia, chemotherapy with venetoclax may be an option. Conclusion: The introduction of targeted therapy has changed treatment options in acute lymphoblastic leukemia. For elderly patients, targeted therapy is a necessary modality since standard chemotherapy leads to a poor outcome due to its toxicity and ineffectiveness. [ABSTRACT FROM AUTHOR]

Introduction. Acute kidney injury is a serious complication in critically ill patients in the intensive care units. The incidence varies from 20% to as high as 80%. Acute kidney injury is associated with expensive supportive therapy, high morbidity and poor outcomes. The aim of this study was to determine the incidence, causes, risk factors, treatment options and treatment outcomes of acute kidney injury in critically ill patients. Material and Methods. The study included 44 patients, with an average age of 67 ± 13.20 years. The data were collected during a three-month prospective study at the Department of Emergency Internal Medicine of the Clinical Center of Vojvodina, Novi Sad. Demographic data were collected from the medical records, as well as data on blood tests, comorbidities, use of nephrotoxic agents, and treatment of these patients. Results. Of the 44 patients who were included in the study, 20% developed acute kidney injury. De novo acute kidney injury was diagnosed in 51.22% and 48.78% of patients had acute-onchronic renal failure. The most common type of acute kidney injury was pre-renal, 80.95%. Comorbidities were present in all patients, most often arterial hypertension, in 52.4% of patients. Complete recovery of kidney function was found in 42.86% of patients and the mortality was 28.57%. Conservative therapy was used in 90.48% of patients, while 9.52% of patients required renal replacement therapy. Conclusion. De novo acute kidney injury was found in approximately half of the critically ill patients in the intensive care unit, mainly older patients with comorbidities. The most common type of acute kidney injury was pre-renal. Older age and comorbidities were associated with poor outcomes and high mortality. [ABSTRACT FROM AUTHOR]

Introduction. Abdominal aortic aneurysm diameter is one of the most important parameters in the diagnostic and therapeutic algorithm for aneurysm follow-up. Currently, two therapeutic modalities are used: open surgery and endovascular aortic repair. The aim of this study is to analyze the impact of the maximum transverse diameter of the abdominal aortic aneurysm on the incidence of general and specific complications. Material and Methods. The retrospective study included 75 patients with infrarenal abdominal aortic aneurysm who underwent endovascular aortic repair in the period from July 2008 to January 2020. The patients were divided into two groups: group A with an abdominal aortic aneurysm size ≤ 5.9 cm, and group B with an abdominal aortic aneurysm size ≥ 6.0 cm. Results. A total of 41.3% of patients presented with a maximum transverse aneurysm diameter of ≤ 5.9 cm, and 58.7% of patients had ≥ 6.0 cm. Of comorbid diseases, chronic obstructive pulmonary disease was more prevalent in patients with a large abdominal aortic aneurysm (group A 25.8%; group B 59.1%). None of the other comorbidities showed a statistically significant difference between the two groups of patients. Early complications were present in a total of 14.7% of patients, of which 12.9% of patients with a small and 15.9% with a large abdominal aortic aneurysm. Late complications occurred in a total of 18.7% of patients, in 9.7% of patients with a small and 25% of patients with a large abdominal aortic aneurysm. Conclusion. Patients with abdominal aortic aneurysms with a maximum transverse diameter of 6 cm and larger, present with a higher rate of late postoperative complications, increase in aneurysmal sac on control multislice computed tomography angiography, and have a worse prognosis compared to patients with smaller abdominal aortic aneurysms. [ABSTRACT FROM AUTHOR]

Background/Aim. Contrast echocardiography (CE) is an echocardiographic modality where ultrasound contrast echocardiographic agent (CEA) is introduced peripherally for the image enhancement. The aim of this study was to present the initial clinical experience of the use of CEA Optison™ (GE Healthcare, Princeton, NJ) at the Institute for Cardiovascular Diseases of Vojvodina, Serbia and prospectively monitor the occurrence of possible side effects. Methods. A total of 357 patients were referred for resting or stress echocardiographic examinations, with an approved indication for CEA administration. The average age of patients was 63.3 years (range, 21-92 years), 62% of them were men. Most of the patients (77.31%) had some form of ischemic heart diseases. Hypertension was the most frequent risk factor (77.03%), but 57 patients had diabetes mellitus and 33 patients had chronic kidney disease as comorbidity. Most (90.5%) of the patients were on beta blocker therapy, 83.5% of them on angiotensin converting enzyme/angiotensin receptor blockers. Majority (80.3%) of the patients received single or dual (49.5%) antiagregation therapy, 74 (26.3%), of them were on anticoagulation therapy, 55.1% of the patients were taking diuretics. The global ejection fraction (EF) was preserved in 39.85% of them, the majority (136 of them), had left ventricle (LV) impairment, with an EF less than 50%. Patients were followed up for 30 minutes after CEA administration for potential side effects. In 118 patients, vital signs (heart rate, oxygen saturation, body temperature, systolic and diastolic blood pressure) were measured before and 30 minutes after CEA administration. Results. The administration of CEA was not associated with side effects. Diastolic blood pressure drop and heart rate increase were statistically, but not clinically significant (p = 0.027 and p = 0.028, respectively). Conclusion. Changes in analyzed vital signs were clinically non relevant. CE is a safe noninvasive diagnostic modality for patients undergoing rest and stress echocardiography. [ABSTRACT FROM AUTHOR]

Background/Aim. A type of personality and negative emotional reactions could be important for clustering biological risk factors for a cardiovascular disease in patients with arterial hypertension (AH). This study investigated if the patients with AH and psychological characteristics of the Distressed Type of personality with elevated anxiety/depression/aggression, have a higher risk of metabolic syndrome (MS) and explored value of the assessed parameters for MS occurrence. Methods. A total of 85 patients with AH were included in the cross-sectional observational study. Type D Scale-14 (DS-14) was used to detect Type D (Distressed) personality. The Hospital Anxiety and Depression Scale (HADS) assessed the levels of anxiety and depression and the Buss Perry Aggression Questionnaire (BPAQ) was used for the assessment of aggression. The explored biological parameters included: blood pressure, lipid status, body mass index (BMI), the occurrence of diabetes mellitus (DM) and MS. Results. Type D patients were frequently more anxious, aggressive and had more frequent MS compared to non-type D. Type D females were younger, more anxious and had a greater prevalence of DM than those with non-type D personality. A multivariate analysis revealed that in type D personality patients with AH, depression had predictive value for MS. Conclusion. The occurrence of both MS and AH was in correlation with the type D personality, anxiety and depression. Early detection/treatment of depression in patients with AH and Type D personality could decrease a risk of metabolic syndrome. [ABSTRACT FROM AUTHOR]

Introduction. The development of inflammatory bowel disease during the treatment with tumor necrosis factor-a inhibitors is seen in patients with ankylosing spondylitis. Crohn's disease is the mainly developing form, and etaner-cept is the most frequently associated agent. Although thrombocytosis in patients with ankylosing spondylitis and inflammatory bowel diseases is often seen due to chronic inflammation, iron deficiency anemia or drug administration, presence of essential thrombocythemia is not common. To our knowledge, there is no published data of coexistence of these three diseases in one patient. Case report. We reported a 35-year-patient with simultaneous presentation of ankylosing spondylitis and essential thrombocythemia. Due to hepatotoxicity of initial treatment with sulfasal-azine and metotrexate, tumor necrosis factor-α inhibitor (etanercept) was introduced. Both diseases were well controlled until Crohn's disease emerged. Two years after switching from etanercept to adalimumab all three coexisting diseases were in remission. Conclusion. Treatment with tumor necrosis factor-a inhibitors significantly improved clinical outcome of patients with chronic inflammatory diseases. However, the appearance of adverse effects may cause a discontinuation or change of a drug. The existence of comorbidities additionally complicates the treatment of such patients. [ABSTRACT FROM AUTHOR]

Background/Aim. Depression is the most prevalent mental disorder which affects approximately 7% of the world's older population. This study aimed at examining the prevalence of depression among older adults and its relations to chronic illnesses. Methods. Study was conducted within the National Health Survey of the Serbian population in 2013. The questionnaires used as instruments in this study were created in accordance with the questionnaires of the European Health Interview Survey - Second Wave. The Patient Health Questionnaire-8 (PHQ-8) was used to evaluate the presence of depressive symptoms. The relations between depression symptoms (a dependent variable) and a set of independent variables were examined with univariate and multivariate logistic regression analyses. Results. The study showed that there was a 10.0% prevalence of depression within this population with statistically significant differences between the genders - 12.6% of women and 6.5% of men. The multivariate analysis revealed that multimorbidity [odds ratio (OR) = 1.89], c hronic p ain (OR = 2.35) a nd s elf-evaluations of poor health (OR = 8.37) were strongly associated to depression. In terms of individual chronic illnesses, the study showed that strokes double the odds of developing depression (OR = 1.82) while the deformities of lower spine increased this odds by 27%. Conclusion. Depression is very frequent in older persons who suffer from chronic diseases and medical conditions. It is crucial to enable adequate screening in primary healthcare institutions in order to diagnose depression in its early stages and start its treatment as soon as possible. [ABSTRACT FROM AUTHOR]

Introduction. The aim of the study was to evaluate the correlation between different levels of examined comorbidities using the Cumulative Illness Rating Scale for Geriatrics and motor Functional Independence Measure test in the elderly after hip fracture. Material and Methods. The study included 203 geriatric patients, 65 years of age and older, who were referred to a rehabilitation program at the Institute for Rehabilitation after hip fracture. The following comorbidities were analyzed: cardiac, vascular, and respiratory. The motor component of Functional Independence Measure was used to assess functional recovery. The Cumulative Illness Rating Scale for Geriatrics was used to calculate the comorbidity index. The patients were assessed on 4 different occasions: on admission, on discharge, 3 months after discharge, and 6 months after discharge. The short-term and long-term efficiency of rehabilitation treatment was measured. Results. There is a significant difference in mo- tor Functional Independence Measure scores between different levels of vascular (p = 0.010) and respiratory (p = 0.047) comorbidities only on admission, while at other times of observation no significant difference (p > 0.05) was found. The highest level of correlation was found in level 3 comorbidity severity index for cardiac comorbidity (discharge/3 months) (Pearson’s correlation - R = 0.938) and vascular comorbidity (discharge/3 months) (R = 0.912), and level 2 comorbidity severity index for respiratory comorbidity (discharge/3 months) (R = 0.941). Conclusion. Rehabilitation treatment of the elderly after hip fracture plays a significant role both in short-term and long-term recovery, particularly in the functional domains even in persons with significant comorbidities. Early inclusion and an individually designed rehabilitation program with continuous monitoring of the elderly after hip fractures results in functional improvement and better quality of life. [ABSTRACT FROM AUTHOR]

Background/Aim. Patients with acute coronary syndrome (ACS) and diabetes mellitus (DM) have an increased risk of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI), which is not estimated sufficiently-multidimensionally in terms of type and severity of the ACS and/or DM and angiographic findings. The study was intended to validate and develop an index of metabolic, angiographic, anatomic and clinical risk factors for one-year MACE after conducted PCI in patients with ACS and DM. Methods. A prospective cross-sectional study was performed in patients with DM and ACS. In the PCI period the following risk factors were recorded: 1) age and metabolic variables - glycosylated hemoglobin (HbA1c), total cholesterol, and triglycerides l evels in the blood; 2) endocrinological variables - DM therapy and type of DM; 3) ACS modality; 4) radiological/anatomical variable - SYNTAX score, and 5) clinical variables in modified age, creatinine, ejection fraction (ACEF) score. One-year MACE were recorded. Results. From a total of 136 consecutive patients, 55 of them developed at least one MACE in oneyear follow-up. A high predictive risk index was evaluated that a ssessed p articular or associated risks for one-year MACE (cstatistic = 0.879) in the study population, defined by: SYNTAX score > 21, modified ACEF score > 1.38, HbA1c = 8%, triglyceridemia = 2.3 mmol/L in patients with insulin therapy, and ACS modality - unstable angina pectoris. The constructed risk index for one-year MACE (MACERI) had better predictive characteristics than SYNTAX score (c statistic = 0.798), as well as ACF score (c statistic = 0.744). Conclusion. MACERI can potentially have great application in future risk factors studies for one-year MACE in patients with DM and ACS who underwent PCI, because with it the effects of these factors are measured multidimensionally at valid and accurate manner. [ABSTRACT FROM AUTHOR]

Introduction. Endovascular revascularization is a peripheral artery disease therapy used to improve blood flow in blood vessels. The objective of this study was to analyze the types and prevalence of comorbidities in patients with indications for carotid artery revascularization, as well as early results of endovascular carotid artery revascularization in relation to periprocedural complications. Material and Methods. This retrospective study was conducted from October 2014 to October 2019 and included 96 patients. Descriptive and comparative statistical analysis was performed in all patients, male and female, and those with both symptomatic and asymptomatic carotid diseases. Results. The study included 96 patients, of whom 69.8% were male and 30.2% were female. A successful endovascular procedure was performed in 89.6% of patients, while in 10.4% of patients the procedure failed. The distribution of patients by sex, age and the duration of procedure, showed a statistically significant difference (p < 0.05) in the age (p = 0.0003) and duration of the procedure (p = 0.022). The comparison of two groups of patients, with symptomatic and asymptomatic carotid atherosclerotic disease, hyperlipoproteinemia (p = 0.015) showed a statistically significant difference (p < 0.05) between the two groups. Conclusion. Endovascular revascularization has a high success rate in the treatment of atherosclerotic disease of the carotid arteries as well as low periprocedural morbidity and mortality. The analysis of gender-related differences, we concluded that endovascular revascularization lasts significantly longer in female patients, and that the average age is significantly higher in male patients compared to females. We also concluded that hyperlipoproteinemia is a major risk factor for carotid artery disease. [ABSTRACT FROM AUTHOR]

Introduction. Diseases associated with immunoglobulin E hypersensitivity, such as allergic rhinitis, may have different clinical expressions. Patients with allergic rhinitis often have associated diseases, comorbidities, which supports the concept of allergy as a systemic disease. The aim of this study was to evaluate the incidence and types of comorbidities in allergic rhinitis. We also evaluated the possible effects of certain clinical and demographic parameters on the onset of comorbidities. Material and Methods. This retrospective, observational, and cross-sectional study included patients with a clinical diagnosis of allergic rhinitis treated at the Department of Ear, Nose and Throat in the period from October 2011 to April 2013. The collected data were analyzed using the Statistical Analysis System (Institute Inc. NC, USA) program, version 9.1.3. Results. The study included 319 patients with allergic rhinitis. Allergic rhinitis was intermittent in 30.7% of cases, persistent in 37.9%, and persistent with seasonal exacerbation in 31.3% of patients. We found that 86.8% of patients had some form of comorbidity. The most common were conjunctivitis (50.2%), almost equal percentage of asthma (29.8%) and chronic rhinosinusitis (28.8%), followed by otitis media with effusion (8.8%), atopic dermatitis (5.2%), urticaria (4.1%), and laryngitis (3.8%). Persistent allergic rhinitis, with persistent nasal obstruction as the dominant symptom, was significantly associated with chronic rhinosinusitis. Positive family history was significantly associated with the occurrence of asthma and allergic rhinitis. Conclusion. The results of our study showed that allergic rhinitis is rarely an isolated condition and it should always be observed in the context of the allergic respiratory syndrome. [ABSTRACT FROM AUTHOR]

Background/Aim. Patients suffered from chronic alcoholic disease very often have depression and cardiomyopathy. Treatment with several antidepressants is associated with prolonged QT interval, ventricular arrhythmias and sudden death. The aim of this study was to investigate the relation between the severity of depression, serum levels of gamma-glutamyl transferase (GGT), as a marker of liver damage, and the possible influence of paroxetine use on duration of QT interval in patient who started treatment of chronic alcoholic dependence. Methods. The study included 147 male patients (older than 18 years of age) suffering from alcohol addiction, who were also diagnosed with depressive disorder on the basis of DSM-IV criterion and positive Hamilton Rating Scale for Depression (HRSD) at the beginning of hospitalization. Out of total number of patients, 49 were randomly selected to be treated with antidepressant paroxetine at a dose of 20 mg once daily during 20 days. The global QTc interval was automatically determined. Results. By applying the generalised linear model, the statistically significant positive correlation between the length of QTc interval and serum values of GGT, that is, intensity of alcoholism (p = 0.002) and values of the HRSD score, that is, intensity of depression (p = 0.021) was established in the sample of 147 depressed alcoholic patients before the application of paroxetine. In spite of the vulnerability of patients due to the heart damage and the liver dysfunction arising from alcohol consumption, as well as altered patients' drugs metabolism, no elongation of QTc interval resulting from the application of paroxetine was established. The length of QTc interval 20 days after paroxetine administration was 401.43 ms and before paroxetine administration it was 403.31 ms. The difference in QTc interval length (after and before paroxetine administration) was ?QTc = - 1.88 ms (p = 0.524). Conclusion. The results indicated that the severity of depression and GGT serum levels positively correlated with the length of QT interval. On the other hand, paroxetine after 20 days of usage did not prolong QT interval. [ABSTRACT FROM AUTHOR]

Background/Aim. The ability to comprehend and produce irony and deception is rarely explored in people with intellectual disability (ID) or dual diagnoses (DD). The ability to understand irony and deception appears to be related to many cognitive skills, but some authors point out that the theory of mind is one of the most important factors for this ability. This research was conducted to determine the linguistic aspects of production and comprehension of irony and deception in adults with ID and DD, as well as the relationship of these abilities with theory of mind. Methods. The sample consisted of 120 people with ID aged between 20 and 56. Half of the sample comprised people with DD. Four subscales from the Assessment Battery for Communication were used to assess the participants' abilities to produce and comprehend irony and deception. False-belief tasks from "appearance-reality" category were used in theory of mind assessment. The level of intellectual functioning was measured by the Raven's progressive matrices, while the Peabody Picture Vocabulary Test was used to assess speech comprehension ability. Results. The results show that participants with DD and ID comprehend and produce false statements better than ironic ones. Participants with ID were more successful in production than in comprehension tasks of both false and ironic statements, while the same was true for participants with DD only for ironic statements. Participants with ID were significantly more successful than participants with DD in irony comprehension tasks. In participants with ID, first-order theory of mind significantly correlated only with the ability to produce irony, and second-order theory of mind significantly correlated with producing irony and deception. There were no significant correlations between theory of mind and producing and comprehending irony and deception in participants with DD. Conclusion. Although differences in some aspects of assessed abilities were found between the two groups of participants, the similarities in the profile of these abilities were dominant. Results of variability can be explained by differences in speech comprehension ability more than by differences in nonverbal intellectual functioning or theory of mind acquisition. Future studies should assess the influence of other cognitive factors. [ABSTRACT FROM AUTHOR]

Introduction. Recent studies have shown that diagnostic differences in the opinion whether some case is a psychotic subtype of posttraumatic stress disorder (PTSD) or a comorbid psychotic disorder still exist. In a case of mental disorders, a specific nature of military environment requires a detailed evaluation of abilities for military service (MS). Case report. A 34-year old male noncommissioned officer (NCO) showed symptomatology of PTSD (according to the Diagnostic and Statistical Manual of Mental Disorders - DSM-IV) after experiencing a traumatic event in peacetime conditions. In addition to experiencing trauma as an adult, the patient was also exposed to early-age trauma, when his father committed suicide. After a pharmacotherapy and cognitive behavioral therapy treatment, he was remitted and returned to his duty. Triggered by new stress caused by unfavorable environmental factors (occupational environment), psychotic phenomenology appeared. After two years of psychiatric treatment, patient was evaluated unfit for MS. Conclusion. Early-age trauma and/or PTSD are predispositions for a comorbid psychotic disorder, while the diagnostic entity of psychotic subtype of PTSD requires further research. Evaluation of MS abilities in patients with psychotic disorder based on our clinical experience, will require a psychiatric treatment for at least two years, which is in accordance with a research conducted in the British Army. [ABSTRACT FROM AUTHOR]

Background/Aim. The Chronic obstructive pulmonary disease (COPD) Assessment Test (CAT) is a simple and reliable tool designed to measure overall COPD related health status and complement physician assessment in routine clinical practice. Objective of this study was to evaluate the validity of the Serbian version of CAT. Methods. Study included 140 outpatients in the stable COPD, recruited from two centres: Clinic for Pulmonology, Clinical Center of Serbia, Belgrade, and Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica. All patients completed pulmonary function testing - spirometry, the CAT and the modified Medical Research Council (mMRC) dyspnea scale at baseline visit. The CAT test-retest reliability was tested in 20 patients by the same investigator (physician). Results. We demonstrated that Serbian version of CAT had high internal consistency with Cronbach's alpha 0.88. Test-retest analysis showed good correlation between CAT scores in two time points (Spearman's ρ = 0.681, p < 0.01). In our study the CAT correlated moderately to mMRC scale (ρ = +0.57), weakly to FEV1 (ρ -0.214), was positively related to number of exacerbations, but did not showed exact regularity with change in the Global Initiative for Chronic Obstructive lung disease (GOLD) stage. Conclusion. The Serbian version of CAT is a reliable, simple and easy-to-use tool that can be used in everyday clinical practice to assess the health status of COPD patients in Serbia. [ABSTRACT FROM AUTHOR]

Background/Aim. Coxarthrosis is a chronic degenerative joint disorder which occurs in approximately 4% of population, and bilateral occurrence is estimated at 42%. Patients with bilateral coxarthrosis can undergo bilateral hip replacement in one or two stage procedure. Aim of this article was to present our experience in simultaneous bilateral hip arthroplasty, and to recommend it in patients with adequate indications. Methods. We processed data for 113 patients of both genders, operated at the Clinic for Orthopedic Surgery and Traumatology of the Military Medical Academy in Belgrade, Serbia from 2005 until 2015 where single stage bilateral hip arthroplasty was performed. Identical operative technique was applied in all patients as well as standard antibiotic and thromboprophylactic treatment. Follow-up period was 30 days postoperatively. Results. Mean age of patients was 56 ± 10.2 years, whereby 45 (39.8%) of them were males and 68 (60.2%) females. Primary coxarthrosis was etiologic factor for the majority of patients, 69 (61.1%). Postoperative hospitalization duration was 10.3 days on average (range from 3 to 34 days). We noticed the following complications: one luxation of the endoprosthesis, one deep infection and one thrombosis of the leg. There was no mortality. Majority of operated patients were grouped as the American Society of Anesthesiologists (ASA) scores 1-3. Mean blood transfusion was 1,275 mL (range from 300 to 2,830 mL). Conclusion. One stage bilateral hip arthroplasty can be performed routinely and safely in facilities with possibility for interdisciplinary approach and adequate selection of patients. Data from our study which indicate significantly increased need for blood substitution, emphasize the need to introduce contemporary perioperative blood loss management principles. The rate of complications observed in our study was within rates published in the literature concerning hip arthroplasty. [ABSTRACT FROM AUTHOR]

Background/Aim. Patients (pts) with tumors often have other diseases or conditions in addition to their index cancer which are generally referred to as comorbidities. Due to the fact that well known risk factors for development of squamocellular head and neck cancers (HNSCC) such as tobacco and alcohol abuse can also damage other important organs, pts with this type of cancer are suitable for analyzing the influence of comorbid conditions on prognosis of the disease. The aim of our work was to assess the prevalence of comorbidities, most frequent conditions and their prognostic impact on overall survival in this particular population. Methods. Between July 2002 and January 2007 in the Institute for Oncology and Radiology of Serbia, 100 pts with locoregionally advanced, inoperable HNSCC were initially treated with neoadjuvant chemotherapy regimen, cytarabine- 5 fluorouracil-cisplatinum. Median age of pts was 55 years, most of them (91%) were males with median number of applied chemo cycles being 4. Data on comorbidities were collected in prospective manner from various sources prior to the treatment. For grading of the severity of comorbid conditions, the Adult Comorbidity Evaluation 27 (ACE-27) comorbidity index was used with four degree scale (0-3). The average follow-up of pts was 15 months with range from 3-59 months. Results. Comorbidities were present in 69 (69%) pts, and 31 (39%) pts had no comorbidities prior to the treatment. Among pts with comorbid conditions prevailed alcoholics, active and former (71%), pts with chronic lung diseases (25%) and cardiovascular diseases (18%). Overall comorbidity score was defined according to the highest ranked single ailment, except in the case where two or more grade 2 ailments occured in different organ systems in which case the overall comorbidity score was designated as grade 3. Median overall survival for the whole group was 12 months. Median ACE-27 score was grade 1 (range 0-3) which was observed in 43 (43%) pts. Pts without comorbidities survived significantly longer than those with any kind of comorbidity (p = 0.0089), and the same was observed comparing survival of pts without comorbidities and those with comorbidity index 2 and 3 taken together (p = 0.0047). Results of other intergroup comparisons were of no statistic significance. Conclusion. Comorbidity is important prognostic variable in patients with locoregionally advanced HNSCC and should be properly assessed prior to therapy. [ABSTRACT FROM AUTHOR]

Background/Aim. Peripheral nervous system affection in people with lung cancer is commonly associated with paraneoplastic neuropathy. However, clinical studies evaluating the frequency, clinical, and electrophysiological characteristics of peripheral neuropathies which are not related to onconeuronal antibodies, in this, on average, older population of patients, are very rare. The aim of this study was to define the frequency, as well as clinical and electrophysiological characteristics of idiopathic neuropathies in patients suffering from lung cancer in early stages of the diseases. Methods. Clinical and electrophysiological data of 105 elderly subjects (age 63.4 ± 7.8 years) suffering from lung carcinoma who underwent extensive neurological and electrophysiological evaluation (nerve conduction studies) between 2013-2018 were estimated. Exclusion criteria were "classical" paraneoplastic neurological syndromes with onconeuronal antibodies present, as well as patients with typical known causes of peripheral neuropathy (e.g. diabetes, alcoholism, chronic renal insufficiency, vitamin deficiencies, etc.). Results. There were 19.1% patients with clinically manifest neuropathies, with additional 37.1% patients with only electrophysiological abnormalities. The most frequent pathophysiological pattern was axonal pathology (71.2%) with predominantly distal and symmetrical distribution (86.4%). Conclusion. Patients with lung cancer in the early stages of the disease show a high incidence of clinically minor damage of the nerves, according to the pattern of chronic sensomotor distal neuropathy, with predominance of axonal damage. These findings underline the importance of a detailed clinical and electrophysiological evaluation in this category of patients who are without the typical etiological factors for peripheral neuropathies since, during cancer therapy, patients undergo a series of treatments with additional risk for the development/aggravation of neuropathy. [ABSTRACT FROM AUTHOR]

Introduction. Deep vein thrombosis and pulmonary embolism, known as venous thromboembolism, constitute a major global burden of disease. Both entities share the same risk factors. Psoriasis is a common, chronic skin disease. It also presents multisystemic inflammation, mainly affecting skin and joints, but it is also associated with the significant cardiovascular and metabolic states and comorbidities, on the so-called "psoriatic march". Case report. We presented a 78-year-old female patient, with psoriasis associated with pulmonary embolism which is accidentally discovered. We did not find any other predisposing factor of this disease (primary or secondary thrombophilia), except hyperhomocysteinemia. The patient was treated with low molecular weight heparin (enoxaparin), followed by the administration of an oral vitamin K antagonist (warfarin sodium) in the weight adjusted regimens. Additionally, we recommended vitamin B complex, including folate. Supposed link between hyperhomocysteinemia and psoriasis was the decreased serum folate level as the result of increased vitamin utilization in the skin because of increased DNA synthesis. Conclusion. The reported case reflects existing literary knowledge about the increased risk of VTE and arterial thromboembolic events in the psoriatic patients. The highest risk appears in the patients with a severe disease and may be a consequence of systemic inflammation and hyperhomocysteinemia. [ABSTRACT FROM AUTHOR]

Introduction. Abdominal aortic aneurysm and its rupture have been often studied over the years, and numerous risk factors for aneurysm rupture have been considered, including atmospheric pressure. The effect of atmospheric pressure has not yet been sufficiently investigated, although studies have been conducted on its possible impact on aneurysms. The aim of this study was to determine the presence of comorbidity as well as the impact of atmospheric pressure on the incidence of abdominal aortic aneurysm ruptures. Material and Methods. All patients who underwent abdominal aortic aneurysm rupture at the Clinic of Vascular and Endovascular Surgery of the Clinical Center of Vojvodina in the period from January 1, 2014 to December 1, 2018 were included in this study. The retrospective study was conducted using patient medical records, computer data, additional clinical records, and discharge reports. Data on atmospheric pressure in the territory of Vojvodina were collected from the Republic Hydrometeorological Institute of Serbia. Results. The number of cases with abdominal aortic aneurysm rupture was found to be higher at higher atmospheric pressure than expected at that altitude, in as much as 95% of cases, most often in the fall. Conclusion. We concluded that there is a significant correlation between high atmospheric pressure and the incidence of abdominal aortic aneurysm rupture, but the exact mechanism of this impact remains to be studied in some further studies. [ABSTRACT FROM AUTHOR]

Background/Aim. Inappropriate prescribing of antibiotics to the patients with acute bronchitis is frequent event in clinical practice with potentially serious consequences, although majority of treatment guidelines do not recommend it. The aim of this study was to reveal risk factors associated with inappropriate prescribing of antibiotics to the patients with acute bronchitis in primary healthcare. Methods. This case/control study included the adult patients with acute bronchitis during the initial encounter with a general practitioner. Prescription of an antibiotic was an event that defined the case, and patients without prescribed antibiotic served as controls. Results. Antibiotics (mostly macrolides and beta-lactams) were prescribed to the majority of patients with diagnosis of acute bronchitis (78.5%). A significant association was found between antibiotic prescription rates and patient age, whether an attending physician is a specialist or not and the average number of patients a physician sees per day [ORadjusted was 1.029 (1.007-1.052), 0.347 (0.147-0.818) and 0.957 (0.923-0.992), respectively]. Conclusion. When there is primary care encounter with patients suffering from acute bronchitis, older patients are more likely to receive inappropriate antibiotic prescription, especially if their physician is without specialist training and has less patient encounters in his/her office daily. [ABSTRACT FROM AUTHOR]

Psoriasis is one of the most common chronic skin diseases with the prevalence of 1.6-3% in general population, therefore it is an important public health issue. It is an inflammatory immunomediated disorder that manifests as a eritematosquamous dermatosis with plaques on predilection areas. Psoriasis is not a life-threatening disease itself, however cardiovascular risk factors connected to it may lead to a lethal outcome. Metabolic syndrome is diagnosed in patients with psoriasis more often than in general population, especially in female patients older than 40 years old with a longer and more severe form of psoriasis. Etiology of the metabolic changes is still not completely understood, although there is evidence that metabolic changes are not exclusively the result of long active disease, but can precede the first onset of symptoms. T helper (Th) Th1- and Th17-cells-mediated immunological response systemically present in psoriasis contributes to the development or deterioration of diabetes mellitus, high blood pressure and obesity. Treatment of psoriasis is based on the management of skin disease and its comorbidities adjusted to individual patient. Use of methotrexate and biological agents such as infliximab, adalimumab and etanercept has shown lower rates of mortality, myocardial infarction and stroke with improvement of endothelial function in regards to patients treated with other therapeutical options. Approach to a patient suffering from psoriasis needs to be comprehensive and multidisciplinary, involving the management of psoriasis, prevention, early diagnosis and adequate management of its comorbidities. [ABSTRACT FROM AUTHOR]

Background/Aim. Primary biliary cholangitis (PBC) is an immune-mediated chronic cholestatic disease of liver, with a slow progression. The aim of our study was to determine the correlation of PBC, atrophic gastritis (AG) and gluten-sensitive enteropathy (GSE), to identify the macroscopic and histopathological modifications of gastric and duodenal mucosa which occur in PBC and to analyze the frequency of these changes compared to a control group. Methods. This study included 50 patients with PBC and 46 control subjects with the dyspeptic symptoms, without liver disease. All of the examined subjects underwent esophagogastroduodenoscopy. Macroscopic and histopathological findings of the gastric and duodenal mucosal samples were recorded and analyzed. Results. There was no statistically significant association between the PBC and AG, or between the PBC and Helicobacter pylori infection. There was a highly significant difference in the frequency of Helicobacter pylori infection and the presence of GSE in the patients in the control group compared to those with PBC. Conclusions. The patients with PBC are at a lower risk for Helicobacter pylori infection and atrophic gastritis. Testing for GSE in the PBC patients may be beneficial, considering the higher incidence of GSE amongst these patients. GSE represents a risk factor for the presence of PBC and the patients with GSE are nearly four times more likely to have PBC. [ABSTRACT FROM AUTHOR]

Introduction. An abdominal aortic aneurysm is a permanent focal dilation of the blood vessel wall to about 1.5 times larger than the normal diameter. Clinically, it may be divided into symptomatic and asymptomatic. It is still discussed whether patients with symptomatic non-ruptured abdominal aortic aneurysm benefit more from emergency or delayed surgical treatment. The aim of the study was to evaluate the results of the symptomatic non-ruptured aneurysms in regard to the diameter of ruptured and non-ruptured symptomatic aneurysms and the impact of the time elapsed from admission to surgery on its outcome. Material and Methods. The retrospective study included all 133 patients who underwent surgery due to symptomatic non-ruptured or ruptured abdominal aortic aneurysm at the Clinic of Vascular and Endovascular Surgery during the previous 3 years. Results. Out of a total of 133 patients, 75.19% underwent surgery in the first 24 hours after admission, while the rest 24.81% of patients were operated later. Intraoperative complications were recorded only in patients with ruptured aneurysms, 4% had cardiac arrest and 1.5% of patients had fatal outcome. The inhospital mortality was 16.67% in patients with non-ruptured aneurysm of the abdominal aorta operated in the first 24 hours, and 9.91% in patients who were operated after 24 hours after admission. Conclusion. Early elective surgery is a method of choice in the treatment of symptomatic non-ruptured aneurysm of the abdominal aorta. However, surgical treatment in the first 24 hours is associated with a higher mortality rate than surgery after 24 hours after admission. Also, there is no statistically significant difference in the diameter of ruptured and non-ruptured symptomatic aneurysms, but the average size of the aneurysm diameter is higher in ruptured than in non-ruptured aneurysms, which confirms the fact that the increase in diameter increases the risk of aneurysm rupture. [ABSTRACT FROM AUTHOR]

The relationship between the attention deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD) and tics is primarily discussed through genetic, neurobiological, neurocognitive and neurochemical substrates of reduced impulse control. The comorbidity of these disorders in children and adolescents is not a rarity. In our 14-year-old patient, ADHD and simple motor tics were diagnosed at pre-school age and OCD at the age of 10. We diagnosed these disorders by DSM-IV criteria and semi-structured interviews based on it. In a multimodal treatment we used techniques from cognitive behavioural psychotherapy, psychoeducation and parental support, sensory integration therapy with a assistance dog, neurofeedback, medication therapy (methylphenidate, fluvoxamine), group therapy aimed at enhancing social skills and expressing emotions, individualized approach to learning in school with a personal assistant. We discuss the complexity of treatment of clinical presentation complicated by comorbidity and emotional distress, and some known and possible links between these disorders. Treatment of ADHD demands multimodal approach and cooperation of different professionals. Among other things, timely recognition of associated symptoms and other psychiatric disorders and their linkage is very important to prevent intensification of symptoms and signs of the disorder and to determine therapeutic guidelines. Further investigation is needed. [ABSTRACT FROM AUTHOR]

Background/Aim. Hip fracture is one of the leading causes of death in elderly population. We evaluated the impact of gender differences on mortality rate in elderly patients with hip fracture. Methods. The study included all hospitalized elderly patients (aged over 65 years) with hip fracture during 2013. The patients were classified into four risk groups in accordance with institutional Şişli Etfal risk factor assessment scale ISERFAS to estimate postoperative mortality. Clinical, laboratory and risk score results were gender matched between survived and deceased patients. Hospital mortality was monitored as well as mortality at intervals of three and six months. The prediction effect of gender and overall risk variables on mortality rate were determined by univariate and multivariate logistic regression analyses. Results. The complete sample included 434 female and 163 male patients. Average age of men was 77.95 years and 79.18 years for women. Femoral neck fracture was more often seen in women (44.5%), but with no statistically significant difference (p = 0.57). Significant difference between the genders in relation to the risk score values was determined (p = 0.024). It was observed that the values of risk score was lower in the female patients and higher in the male patients. Cumulative mortality was 6% during hospital stay, 17.8% after three months and 25% after six months, respectively. In-hospital and six months after the hip fracture, the mortality rates were similar in both genders. The mortality rate was significantly higher in male patients (p = 0.035) three months after the hip fracture. The overall risk observed at all mortality intervals was a significant predictor by itself (p = 0.000). Independent gender prediction effect disappeared in joint effects of patients' overall risk. Conclusion. Gender can be defined as a significant mortality predictor in patients with hip fracture. A risk assessment system to estimate postoperative mortality for hip fractures would be helpful in planning treatment for each patient. [ABSTRACT FROM AUTHOR]

Background/Aim. Suicide is a significant public health problem worldwide. Numerous factors contribute to suicide. The aim of this study was to investigate the characteristics of suicide in the city of Niš in the period 2001-2010. Methods. The retrospective study consisted of 608 persons divided into three groups: suicide committers with mental disorders, somatic disorders or without registered disorders. Data on socio-demographic characteristics, previous suicide attempts, methods of suicide and presuicidal syndrome were obtained from the Police Directorate for the city of Niš, Ministry of Internal Affairs, Republic of Serbia and from the Statistical Office of the Republic of Serbia. Results. Persons with mental disorders were the most prevalent group of people who committed suicide (54.3%), followed by persons without registered disorders (31.9%) and with somatic disorders (13.8%). Persons with mental disorders who committed suicide were most often divorced, with high school education, monthly salary and with at least one previous suicide attempt. The hanging was the most frequent method of committing suicide in all investigated groups, followed by self-poisoning using drugs or liquid substances. The presuicidal syndrome was significantly more frequent among persons with mental disorders compared to persons with somatic disorders or without registered disorders others (45.8% vs. 16.7%, and 45.8% vs. 28.4% respectively p < 0.001). Conclusion. Although the persons with mental disorders are in the greatest risk of suicide, they are under medical care. In this regard, the prevention programs should be directed towards persons with severe somatic disorders and to old persons without registered disorders. [ABSTRACT FROM AUTHOR]

Introduction. Hepatitis C virus (HCV) infection is one of the factors which can lead to a chronic liver disease and hepatocellular carcinoma. There have been several reports on the association of oral lichen planus with hepatic disorders, i.e. hepatitis C infection in particular. Considering the controversies about the association of lichen planus with HCV infection on one hand and considerable impact of hepatitis C on the occurrence of chronic liver disease on the other hand, we investigated the association between lichen planus and HCV infection in Sanandaj City. Methods. This cross sectional study included 168 patients with lichen planus, who were referred to the Dermatology Clinic of Besat Hospital between 2014 and 2016. The diagnosis of lichen planus was made by our dermatologist and HCV antibody titer was determined for every patient. Results. Mean age of the patients was 39.7±13.3 years and mean duration of the disease was 14.8 months. 107 (63.7%) patients were men. The highest frequency of lichen planus was recorded in the housewives (30.4%). In 52 (31%) patients the genital area was involved and it was the most common site. In 6 (3.6%) patients the oral mucosa was involved and it was the least common site in our study. Only 4 (2.7%) patients had family history of lichen planus. None of 168 patients included in this study was found to have HCV infection. Conclusion. In this study, we found no relationship between lichen planus and HCV infection. Yet, the exact mechanism underlying the occurrence of lichen planus in the patients with HCV infection has not been determined. Therefore more studies on this subject are recommended. [ABSTRACT FROM AUTHOR]

Background/Aim. The co-occurrence of depression and tobacco smoking among treat ed alcoholics is frequent, but understudied. Some findings suggest that there are some shared etiological factors, but a few clinical researches of personality dimensions among patients with these comorbidities were done. The personality dimensions, the pattern of cigarette use and depression and correlation of personality and depression among inpatient alcoholics were explored. Methods. One hundred primary male inpatient alcoholics were consecutively recruited. The eighty-six of them complete d study and were compared with 30 age-matched, healthy male subjects. A semi-structured clinical interview related to sociodemographics, the pattern of cigarette and alcohol use and family history data was applied. According to cut-off on the Hamilton Depression Rating Scale (HDRS), the alcoholics were divided into depressive and non -depressive subgroups resulting in half of alcoholics in each subgroup. The Eysenck personality questionnaire (EPQ) was completed. Student's t-test for differences and Pearson's test for correlation were used. Results. There were no significant sociodemographic differences between groups. Alcoholics were more frequent smokers (86% vs. 50%). They did not start drinking earlier, but they started smoking earlier, with higher daily cigarettes use than controls. On average, alcoholics had mild depression after detoxification. The personality dimensions did not show differences between groups, except neuroticism. The neuroticism showed significantly higher level among alcoholics vs. controls (12.72 ± 5.19 vs. 5.00 ± 3.36 respectively) and among depressive vs. non-depressive alcoholics (15.07 ± 4.89 vs. 10.37 ± 4.40 respectively). The depression correlated only with neuroticism (r = 0.487, p < 0.001). Conclusions. The majority of detoxified alcoholics were smokers who started smoking earlier, with mild depression and higher neuroticism compared to controls. Our results suggest that the alcoholics with high neuroticism may experience higher depression and may require more intensive integrative treatment. [ABSTRACT FROM AUTHOR]

The most common and most signifi cant comorbid psychiatric disorder in patients with obesity is depression. Studies in the general and clinical population indicate that there is a bidirectional correlation between depression and obesity. Chronic depression appears as a precursor or as a factor that generate the onset of obesity. On the other hand, research shows that obesity is one of the main predictors of the onset of depression. In addition, studies have found that women have a greater chance of occurring comorbid depression versus male population. There is no single and one and only mechanism for linking the simultaneous occurrence of depression and obesity in one person, but that a many pathological conditions are involved. Particular attention should be paid to the biological (endocrinological) factors as well as the psychological factors that may or may not be related. For the time being, there is certain evidence and experience that certain antidepressants, primarily bupropion and fl uoxetine, are associated with weight loss. On the other hand, it has already been noted that some antidepressants (primarily tricyclic antidepressants, paroxetine and mirtazapine) are associated with the onset of body mass gain and consequent obesity. It is therefore important to know which of the antidepressants has some effect on the body mass and on the basis of that information psychiatrists could determine what antidepressant to prescribe in each individual case. [ABSTRACT FROM AUTHOR]

Background/Aim. Early treatment failure (ETF) in patients hospitalized for community-acquired pneumonia (CAP) is associated with prolonged hospitalization, increased risk of mortality and high treatment costs. The aim of this study was to analyze the relative importance of factors influencing ETF in hospitalized adult patients with CAP that are still insufficiently explored. Methods. A retrospective case-control study was carried out on a sample of 126 adult patients treated for serious CAP at the Clinic for Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia, during the 5-year period (2007-2011). The cases (n = 63) were consecutive patients with ETF, observed within the three days upon the admission to hospital, while the control group consisted of the equal number of randomly selected patients without such an outcome. The association between potential risk/protective factors and ETF was estimated using logistic regression analysis. Results. The coexistence of gastrointestinal disorders [adjusted odds ratio (OR) 18.83, 95% confidence interval (CI) 1.15-309.04], higher CURB-65 (C - confusion; U - urea 7 mmol/L; R - respiratory rate ≥ 30 breaths/min; B - systolic blood pressure < 90 mmHg or diastolic blood pressure ≤ 60 mmHg; 65 - age ≥ 65 years) score on admission (adjusted OR 2.57, 95%CI 1.05- 6.25), initial use of nonsteroidal anti-inflammatory drugs (NSAIDs) in hospital (adjusted OR 38.19, 95%CI 3.61-404.51) and previous outpatient use of inhaled corticosteroids (adjusted OR 22.41, 95%CI 1.03-489.06) were found to be significant risk factors for ETF. On the other hand, older age and use of antibiotics before the hospitalization were associated with a significantly lower chance of experiencing ETF, reducing the odds for 98% and almost 90%, respectively. Conclusion. The avoidance of the routine in-hospital use of NSAIDs as well as the outpatient use of appropriate antibiotics may be beneficial for patients hospitalized for CAP in terms of reducing the risk of ETF. The CURB-65 score could be a better predictor of ETF than Pneumonia Severity Index. Further prospective studies are required to confirm these findings. [ABSTRACT FROM AUTHOR]

Background/Aim. Acute pancreatitis is an inflammatory condition having the significant mortality rate in the case of severe forms of the disease. The aim of this study was to investigate putative factors of increased mortality in patients with acute pancreatitis with contradictory prior evidence, and to reveal factors that were insufficiently explored previously. Methods. This prospective cohort study with nested case/control design included all adult patients treated for acute pancreatitis in the Clinical Center of Kragujevac, Serbia, during the 3-year period (from October 2011 to December 2014). The cases (n = 19) were patients who died, while the controls (n = 113) were patients who survived. The associations between putative risk factors and the study outcomes were tested by univariate and multivariate logistic regressions, and expressed as crude and adjusted odds ratios (OR) with corresponding 95% confidence intervals (CI). Results. Significant association with the lethal outcome in acute pancreatitis was found for advanced age (adjusted OR 1.12, 95%CI 1.02-1.23), presence of significant comorbidities (adjusted OR 10.62, 95%CI 1.01-111.39), higher interleukin-8 (IL-8) value on third day from onset of symptoms (adjusted OR 1.05, 95%CI 1.02-1.08), use of tramadol and/or morphine (adjusted OR 47.34, 95%CI 3.21-699.08), the Bedside index for severity in acute pancreatitis (BISAP) score ≥ 3 in the first 24 hours (adjusted OR 48.11, 95%CI 3.14-736.29), and prophylactic use of antibiotics (adjusted OR 0.07, 95%CI 0.01-0.85). Conclusion. Advanced age, significant comorbidities, use of tramadol and/or morphine and more severe disease as assessed by BISAP score can increase the risk of death in acute pancreatitis, while prophylactic use of antibiotics may have a protective role. [ABSTRACT FROM AUTHOR]

Introduction. Isolated cataplexy, without the presence of narcolepsy, is a relatively rare condition, and can be regarded as attacks of motor inhibition with loss of muscle tone and areflexia. The diagnosis of cataplexy relies on the clinical presentation and medical history and it is rarely confirmed by video-polygraph. We here described a female patient treated for prolactinoma who developed isolated cataplexy. Case report. A 53-year-old female treated with bromocriptine for a macroprolactinoma presented with sudden episodes of weakness and toneless legs leading to falls and injuries on several occasions. Cardiovascular evaluation was completely normal. Psychiatric evaluation showed no psychotic phenomenology or suicidal ideas. Pituitary imaging showed empty sella with a remnant sellar mass with infra- and parasellar extension. Neurological examination revealed mild obstructive sleep hypopnea/apnea. Electroencephalographic monitoring during sleep and awakening did not show appearance of epi potentials. HLA haplotyping was positive for HLADR3,16; DR51;DQ1 allele, confirming a diagnosis of isolated cataplexy. Treatment included tricyclic antidepressants and reduction of bromocriptine dosage with resolution of cataplexy. Conclusion. We reported the first case of isolated cataplexy most probably associated with dopamine agonist treatment for prolactinoma. [ABSTRACT FROM AUTHOR]

Introduction. Thymus plays an important role in the maturation of T-lymphocytes and in the development of immune tolerance. Its involution comes after puberty. If thymic tissue remains preserved in an advanced age it is considered to be the thymus persistens. According to the available data, 5% of patients with a thymoma have some of the autoimmune disorders. Medical data on the systemic lupus erythematosus (SLE) association with the thymus persistens are scarce. Case report. A 29-year-old patient was diagnosed with SLE at the age of 12. She was treated with continuous doses of corticosteroids and an antimalarial drug (chloroquine). After ten years, the first, and then two more recurrences of the disease with the last recurrence in 2011 occurred. The performed laboratory analyses indicated the disease activity. The radiography of thorax showed a change on the right lung, with enlarged mediastinal shadow. Therefore the multislice computed tomography (MSCT) of thorax was made. The pathohistology findings confirmed that the change on the right lung was focus of chronic pneumonitis, while the change in mediastinum was thymus persistens. The thymectomy was performed. Due to pneumonitis, the treatment of SLE was continued with corticosteroids, antimalarial drug and pulse doses of cyclophosphamide. The patient received six monthly and six quarterly pulsed doses of the drug. The remission of the disease maintained all the time. Conclusion. The disorder of thymic function should be considered as a possible cause in the development of SLE. Though the effect of thymectomy is difficult to assess, patients should be carefully monitored. [ABSTRACT FROM AUTHOR]

Background/Aim. Helicobacter (H.) pylori is a widespread bacterium and its involvement in pathogenesis of gastric diseases is well-known. However, H. pylori role in etiology of other histologically similar conditions, especially recurrent aphthous stomatitis (RAS) is still controversial. Research regarding H. pylori and its association with RAS, as well as the treatment options were always conducted on patients with diagnosed gastric problems. The aim of this study was to determine whether H. pylori is present in the oral cavity of patients suffering from RAS but without any symptoms or medical history of gastric disease. Methods. A total of 15 patients with RAS participated in the study. None of the participants suffered from any gastrointestinal disorders. Two dental plaque samples from each participant were collected. The first was analyzed using rapid urease test and the second one was put in transport medium and sent for cultivation. The sensitivity of H. pylori to antibiotics was established using disk diffusion method of sensitivity testing for every patient individually and adequate therapy was prescribed. Results. Before the treatment the mean annual recurrence rate of RAS was 8.1 ± 2.1, with the average number of lesions being 3.9 ± 1.9. During the 12-month observation period after the eradication therapy, none of the patients reported recurrence of aphthous lesions. The treatment was successful in all cases. Conclusion. This study shows that RAS can be effectively treated by successful eradication of oral H. pylori, and that RAS could be possibly considered as an early warning sign of potential gastric infection by H. pilory. [ABSTRACT FROM AUTHOR]

Introduction. Lipidized dermatofibromas represent rare and often underrecognized variants of dermatofibromas. Histologically, dermatofibromas are composed of fibroblast-like spindle cells, foam cells, giant cells, siderophages, lymphocytes, capillaries, collagen fibers, and hyaline dermal collagen fibers. Lipidized dermatofibromas are characterized by numerous foam cells, Touton giant cells, and hyalinized wiry collagen in the stroma. Case report. We present a case of a 31-year-old woman with a history of hypothyroidism and alopecia areata, presenting with an enlarging 8 mm, firm erythematous nodule on her upper-mid back. Biopsy examination showed a cellular proliferation of spindle cells with peripheral collagen trapping and cholesterol clefts with associated foam cells and sclerosis, staining weakly positive for Factor XIIIa and negative for CD34. The diagnosis of a benign lipidized dermatofibroma was rendered. Conclusion. Lipidized dermatofibromas are rare histologic variants of dermatofibromas, biologically indolent, and should be distinguished from other cutaneous foamy histiocytic lesions, particularly xanthomas, which may alter patient management. [ABSTRACT FROM AUTHOR]

Almost all countries in the world keep some form of hospital discharge report (HDR). Although there are many variations, every report contains such data as patient demographics, the main cause of hospitalization, comorbidities, the length of stay in hospital and outcome. The advantages of using data obtained from HDRs are numerous: The data from HDRs are already collected in a designated centre and thus easily available and relatively cheap; HDRs contain information for many previous years; they are sometimes more reliable than data obtained through any other method; and finally, they provide a large and representative database. HDRs databases can be connected with other databases using a unified patient identification number. The limitations of using data obtained through HDRs are as follows: inconsistencies in defining and coding diagnoses and applied procedures, common underestimations of comorbidity, limited possible applications in specific studies and partial coverage of inpatient institutions. The prediction that in the future, a growing number of diagnostic and treatment procedures will be performed on an outpatient basis will also limit the use of HDRs. When electronic recordkeeping becomes a practice, we may assume that these data will no longer be needed. There is no perfect model for collection and processing data regarding hospitalized patients. HDRs, with their advantages and disadvantages, currently represent the best way to perceive the size, type, quality and efficiency of the health care services provided to patients at the secondary and tertiary level. [ABSTRACT FROM AUTHOR]

Introduction. Hereditary hemorrhagic telangiectasia and inherited thrombophilia are genetic disorders with quite opposite clinical manifestation. The main characteristic for hereditary hemorrhagic telangiectasia is recurrent bleeding, while the main characteristic for hereditary thrombophilia is thrombosis. The association between hereditary hemorrhagic telangiectasia and inherited thrombophilia in the same patient is rare. Case report. We presented a 32-year-old female with recurrent gastrointestinal hemorrhage and epistaxes, during a 9-year period. Hereditary hemorrhagic telangiectasia was established according to "Curaçao" criteria. Three of four criteria have been present: spontaneous recurrent epistaxis, multiple telangiectasias (nose) and visceral lesions (gastric angiodysplasias, jejunal telangiectasias, arterio- venous jejunal fistula). Pulmonary thromboembolism was the first manifestation of thrombophilia; the diagnosis was confirmed by genetic testing. Therapy of hemorrhage with tranexamic acid (anti-fibrinolytic agent; its use increases risk of thrombosis) was unsuccessful. Remission was achieved by thalidomide. The initial therapy for pulmonary thromboembolism included aspirin (that have an increased risk of bleeding), but aspirin had to be discontinued because of massive hematemesis. Unfortunately, a year later, anticoagulant therapy combined with the proton pump inhibitors, were introduced, because of a new thrombosis. One month after, the patient was still on this therapy, without new episodes of bleeding and thromboembolic events. Conclusion. Hereditary hemorrhagic telangiectasia and inherited thrombophilia could be unrecognized for years, partly due to the lower degree of clinical suspicion. Early diagnosis and the appropriate choice of therapy are essential for reducing serious consequences and to improve quality of life. [ABSTRACT FROM AUTHOR]

Introduction: Ап incarceration of inguinal hernia is a life-threatening condition and represents the most frequent complication, particulariy in the elderly patients. It may compromise vascularisation of the contents of the hernia. A surgical treatment of the incarcerated inguinal hernia represents one of the most frequent surgical interventions in elderly patients and it grovvs proportionally with the age. Aim of the Study: The aim of the study is to investigate some of the factors that may have an impact on the incarcerated inguinal hernias surgical treatment outcome in elderly patients. Patients and Methods: The study included 149 patients classified in two groups: the study group (> 60 years of age), which included 96 patients, and the control group (< 60 years of age), which included 53 patients, treated in the period from Јапиагу 1st, 2012 to December 31st, 2016 at the Clinic of General and Abdominal Surgery UCC RS Banja Luka. Results: Most of the patients had right inguinal hernia (51.16% in the study group, 60.37% in the control group). 82 patients (85.41%) of the study group suffered from some of the accompanying chronic diseases, opposite to 20 patients (37.73%) of the control group. Polypropylene mesh was implanted in 105 (70.47%) patients, while the tension technique was performed in 44 (29.53%) patients. The duration of incarceration longerthan 24 h (p=0.015), previous abdominal surgery (p=0.001), the American Society of Anaesthesiologists physical status classification system (ASA classification) (p=0.033) and the presence of chronic diseases (p=0.01) appeared to be statistically significant risk factors for performing intestinal resection in the study group, while in the control group, they represented riskfactors, but not at the level of statistical significance (p > 0.05), except for the duration of incarceration (p=0.007). A higher ASA stage (p=0.001), is the most important risk factor for lethal outcome in both groups of patients. Conclusion: Incarcerated inguinal hernia is a very serious and demanding surgical problem, particularly in elderly patients. A higher ASA score and the presence of bowel resection are the most important risk factors related to very difficult complications. [ABSTRACT FROM AUTHOR]

Introduction. Fahr's syndrome is a rare, slowly progressive, neurodegenerative disorder, characterised by extensive, bilateral, and symmetrical basal ganglia calcification. It is associated with neuropsychiatric manifestations and gradually progressive cognitive impairment. Fahr's syndrome is the secondary form of brain calcification that is caused by various metabolic, infectious, or degenerative diseases. Case report. We presented a middle-aged male with Fahr's syndrome due to primary idiopathic hypoparathyroidism. Clinical diagnosis was based on signs and symptoms of hypocalcemia, progressive neuropsychiatric illnesses, laboratory evidence of hypoparathyroidism, and radiological signs of calcifications in the basal ganglia. The patient improved after only a few days of intravenous rehydration and calcium substitution, followed by oral supplemental calcitriol. Conclusion. Timely recognition of idiopathic and iatrogenic hypoparathyroidism allows appropriate treatment that can prevent the development and clinical manifestations of Fahr's syndrome and potentially slow its progression. [ABSTRACT FROM AUTHOR]

Introduction. Aortoiliac occlusive disease and abdominal aortic aneurysm in patients with renal insufficiency on hemodialysis can significantly influence the success of renal transplantation. In the recent past, advanced atherosclerosis was considered as contraindication for renal transplantation. Complicated creation of vascular anastomoses and progression of occlusive or aneurysmal disease were the main reasons. Case report. We presented a 52-year-old man with a 5-year history of end-stage renal disease on haemodialysis. The patient was previously excluded from renal transplantation program because of severe aortoiliac atherosclerosis and abdominal aortic aneurysm. Resection of abdominal aortic aneurysm with occlusion of the iliac arteries and reconstruction with aortobifemoral synthetic grafts was performed and followed by cadaveric renal transplantation. Conclusion. Advanced atherosclerotic disease in aortoiliac segment requires elective vascular surgical reconstruction, as part of preparation for renal transplantation in patients with end-stage renal disease. [ABSTRACT FROM AUTHOR]

Introduction. Systemic lupus erythematosus (SLE) is a systemic idiopathic autoimmune inflammatory disease, with multiple organ involvement. Severe vaso-occlusive retinopathy is a rare, sight threatening lupus-related manifestation of the disease, which is more common in patients with coexisting antiphospholipid syndrome. Case report. We reported a 36-year-old female with severe vaso-occlusive retinopathy that manifested in the absence of antiphospholipid syndrome. In a 4-year follow-up, despite aggressive systemic corticosteroid and immunosuppressive therapy and panretinal laserphotocoagulation treatment, the disease progressed to retinal neovascularisation, neovascular vitreoretinopathy, neovascular glaucoma and, consecutively, severe visual loss. As the final option for preservation of visual function, pars plana vitrectomy with laserphotocoagulation was performed and had good results. Progression of ophthalmological findings indicated the progression of the systemic disease, as well as neurolupus. Conclusion. Severe vaso-occlusive retinopathy occurred as the ophthalmological manifestation of SLE in the absence of antiphospholipid syndrome, but correlated with neurolupus and led to visual deterioration despite the treatment. [ABSTRACT FROM AUTHOR]

Introduction. The material used for root-end filling has to be biocompatible with adjacent periapical tissue and to stimulate its regenerative processes. Tricalcium silicate cement (TSC), as a new dental material, shows good sealing properties with dentin, high compression strengths and better marginal adaptation than commonly used rootend filling materials. Although optimal postoperative healing of periapical tissues is mainly influenced by characteristics of end-root material used, it could sometimes be affected by the influence of systemic diseases, such as diabetes mellitus (DM). Case report. We presented apical healing of the upper central incisor, retrofilled with TSC, in a diabetic patient (type 2 DM) with peripheral neuropathy. Standard root-end resection of upper central incisor was accompanied by retropreparation using ultrasonic retrotips to the depth of 3 mm and retrofilling with TSC. Postoperatively, the surgical wound healed uneventfully. However, the patient reported undefined dull pain in the operated area that could possibly be attributed to undiagnosed intraoral diabetic peripheral neuropathy, what was evaluated clinically. Conclusion. Although TSC presents a suitable material for apical root-end filling in the treatment of chronic periradicular lesions a possible presence of systemic diseases, like type 2 DM, has to be considered in the treatment outcome estimation. [ABSTRACT FROM AUTHOR]

Background/Aim. Psoriasis as multisystemic inflammatory disease is related with an increased cardiometabolic risk. The aim of the study was to analyze risk biomarkers, peripheral and renal arteries ultrasonography and echocardiography for subclinical atherosclerosis and metabolic disease in 106 subjects (66 psoriasis patients and 40 controls, 20 eczema patients and 20 healthy volunteers). Methods. In all exameenes following parameters were analyzed: body mass index (BMI), C-reactive protein, Ddimer, serum amyloid A (SAA), apolipoprotein (Apo) A1, ApoB, ApoB/Apo A1 index, fasting glucose, C-peptide, fasting insulinemia, homeostatic model assessment-insulin resistance (HOMA-IR), HOMA-β-cell, lipid profile, serum uric acid concentration (SUAC), 24-h proteinuria and microalbuminuria. Carotid, brachial, femoral and renal arteries ultrasonography, as well as echocardiography was also performed. Results. Five of 66 (7.6%) psoriasis patients had metabolic syndrome (not present in both control groups). The following variables were increased in patients with psoriasis compared to both control groups: BMI (p = 0.012), insulinemia (p < 0.001), HOMA-IR (p = 0.003), HOMA-β cell (p < 0.001), SUAC (p = 0.006), ApoB/ApoA1 ratio (p = 0.006) and microalbuminuria (p < 0.001). Also, increased C-peptide (p = 0.034), D-dimer (p = 0.029), triglycerides (p = 0.044), SAA (p = 0.005) and decreased ApoA1 (p = 0.014) were found in the psoriasis patients compared to healthy controls. HDL cholesterol was decreased in the psoriasis patients compared to the control group of eczema patients (p = 0.004). Common carotid (CIMT) and femoral artery intima-media thickness (FIMT) was significantly greater (p < 0.001) and the maximal flow speed (cm/s) in brachial artery significantly decreased (p = 0.017) in the patients with psoriasis in comparison to both control groups. In multivariate logistic regression analysis, after the adjustment for confounding variables, the most important predictor of CIMT and FIMT was the diagnosis of psoriasis (p < 0.001). Conclusion. Cardiometabolic risk biomarkers and ultrasonographic signs of early atherosclerosis are correlated with the diagnosis of psoriasis, and not to generalized eczema. Psoriasis was found to be an independent risk factor for subclinical atherosclerosis. [ABSTRACT FROM AUTHOR]

Introduction. Synchronous occurrence of lymphomas and other cancers, mostly carcinomas are well established. The most of cases describe chronic lymphocytic leukemia as the leading lymphoproliferative disease with the tendency towards secondary malignancies development. Mantle cell lymphoma (MCL) has been described in only 2 cases to co-occur with prostate adenocarcinoma (PAC). There are scarce data about the connection between MCL and urology cancers. We presented the first case of synchronous occurrence of MCL and PAC in the same patient in Serbia. Case report. A 64-year-old male initially presented with fatigue, splenomegaly, and bicytopenia. The bone marrow biopsy specimen revealed extensive infiltration with MCL. During lymphoma staging procedure prostate enlargement (57 mm) was accidentally found by multislice- computed tomography (MSCT). The serum prostate specific antigen (PSA) was elevated (52 ng/mL; normal values ≤ 4 ng/mL). Transrectal ultrasound biopsy revealed PAC. High Gleason score determined high-risk locally advanced PAC. The patient underwent treatment with chemotherapy and hormone therapy due to the existence of double malignancies. Cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) was applied for MCL, and luteinizing hormonereleasing hormone (LHRH) agonist, triptorelin, for PAC. Partial response was obtained for MCL, and stable disease for PAC. In a 1.5-year observation period the patient was still disease progression free for both of malignancies. Conclusion. This case points aut that elderly males are in need for careful observation during the staging procedure for lymphoma. The literature data suggest that MCL patients are in increased risk for urologic malignancies development. However, the etiologic connection between these two entities, except male gender and older age, remains unclear. [ABSTRACT FROM AUTHOR]