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Background/Aim. As significant advances in cancer treatment have occurred over the past decades, the crucial questions in oncology nowadays are not related only to the treatment of the illness but also to the quality of life (QOL) of patients. The aim of our study was to explore which set of determinants (clinical, functional, affective, or social) has the greatest impact on explaining QOL in women who live with the diagnosis of breast cancer. Methods. The research was conducted on 64 women (with a mean age of 58.36 ± 11.30) while undergoing radiation therapy at the Oncology Institute of Vojvodina, Serbia. Quality of Life Instrument - Breast Cancer Patient Version (QOL-BC) questionnaire was used for evaluation of physical, psychological, social, spiritual, and general well-being, the Upper Extremity Functional Index (UEFI) was applied for the assessment of the upper extremity function, the Depression, Anxiety, and Stress Scale-21 Items (DASS-21) was used for measuring symptoms of depression, anxiety, and stress, the Medical Outcomes Survey, Social Support Survey (MOS-SSS) served for evaluation of social support; demographic and clinical data of patients were also collected. Results. Analysis of Variance (ANOVA) with repeated measures [F(2.03, 127.80) = 20.24, p < 0.001] showed that in our sample, physical QOL was significantly better from all other domains, while social QOL was significantly lower from both physical and psychological aspect. A hierarchical regression analysis [F(8, 55) = 7.16, p < 0.001, R2 = 0.51] showed that patients who received adjuvant chemotherapy and experienced high levels of stress and poor social support usually had diminished general QOL. Introduction of affective-related variables [ΔR2 = 0.16, p(ΔF) < 0.01] and social support [ΔR2 = 0.05, p(ΔF) < 0.05] led to a significant increase in proportion of explained variance over and above the clinical and functional variables. Conclusion. Our results indicate that psychological and social resources are more important in predicting QOL compared to clinical and functional factors. At the same time, the social, psychological, and spiritual well-being of patients is significantly worse compared to the physical QOL, meaning that there is still much left to be done regarding the progress from a purely somatic to a holistic approach in the treatment of breast cancer. [ABSTRACT FROM AUTHOR]

Background/Aim. Population aging and the increase in the prevalence of chronic diseases led to a rise in the number of people who live with more than one disease. The aim of the study was to determine the prevalence and predictors of multimorbidity in the working-age population (WAP) of Serbia. Methods. The study is part of "The 2019 Serbian National Health Survey", a c ross-sectional study conducted on a representative stratified two-stage sample. For this paper, a representative data sample for 9,473 persons of the WAP (aged 15--64 years) was used. Multimorbidity was defined as the co-occurrence of two or more of 13 chronic conditions. Data on chronic conditions were self-reported, and data on body mass and body height were measured. Multivariable logistic regression was used to assess predictors of multimorbidity. Results. Multimorbidity prevalence among WAP was 12.0%, and it was significantly higher among women (13.3%) than in men (10.6%). The predictors of multimorbidity were: female gender, increasing age, lower level of education, lower income, unemployment, retirement, widowhood, and divorce. Being overweight and obese were associated with higher odds of multimorbidity in both men and women. Conclusion. Multimorbidity is an important public health problem amongst WAP in Serbia due to its high prevalence, especially among vulnerable groups, and its inequality in frequency among different socioeconomic groups. [ABSTRACT FROM AUTHOR]

Background/Aim. There is no available published data about the use of long-acting injectable paliperidone palmitate (PP) in schizophrenia patients in the Republic of Serbia. The aim of this study was to assess hospitalization rates before and after the switch to once-monthly long-acting injectable PP in schizophrenia patients, as well as their compliance with this drug. Methods. We conducted a retrospective cross-sectional study in which hospitalization rates were evaluated 12 months before and 12 months after the switch to once-monthly long-acting injectable PP in 113 schizophrenia patients. The age of the enrolled patients was between 18 and 66 years. Results. The average age of the enrolled patients was 38.36 ± 11.62 years. Among them, 77 (68.1%) were male, and 36 (31.9%) were female. Out of the total number of 113 patients treated with once-monthly injectable PP, 78 (69.03%) were on monotherapy, while 35 (30.97%) had one additional oral antipsychotic (risperidone, olanzapine, aripiprazole, or clozapine). Out of the total number of 113 patients, 68 (60.18%) were not hospitalized in the 12-month period before the switch to once-monthly long-acting injectable PP, while 45 (39.82%) were hospitalized in the same period. Given that 8 patients out of the total number of 113 were excluded from therapy due to an adverse event or their own decision in the period after the switch to PP, the analysis of the hospitalization rate after the switch to PP was performed for the remaining 105 patients, of which 9 (8.57%) were hospitalized in the period after the switch to PP, and 96 (91.43%) were not. Conclusion. Our results show high compliance in the treatment with once-monthly injectable PP and a positive impact of treatment with this drug on low hospitalization rate in a 12-month period in patients with schizophrenia. Considering the availability of this drug in the Republic of Serbia, these results encourage the use of once-monthly injectable PP as an important therapeutic option in schizophrenia patients. [ABSTRACT FROM AUTHOR]

Background/Aim. Numerous histopathological parameters, such as cartilage penetration, perineural and lymphovascular invasion, presence of metastatic tissue in regional lymph nodes (LNs), extranodal extension (ENE) of nodal metastases, as well as the presence of cancer tissue on resection borders, are all important factors influencing survival in patients with laryngeal squamous cell carcinoma (LSCC). The a m of the study was to determine if there is an association between cancer surface area (CSA) and these histopathological characteristics. The presence of ENE of metastatic tissue in regional LNs was also investigated. Methods. In a retrospective study, one hundred and forty cases of LSCC were revised and processed after total laryngectomy . The cases were found in the archives of the Histopathology Laboratory of the Clinic for Otorhinolaryngology and Maxillofacial Surgery, University Clinical Center of Serbia. Results. A significant difference was found in CSA depending on cancer penetration into the thyroid cartilage, perineural invasion, and positive resection margins. Cancers with larger CSA were more common in the advanced T stage. Metastases were found in 36 out of 72 (50%) neck LN samples submitted for evaluation. The difference in CSA was also found depending on the presence of metastatic tissue in regional LNs. ENE was present in 69.4% of involved LNs, and it was more frequent in LNs 3 cm in size or larger. Conclusion. There is a significant difference in CSA depending on the presence of cartilage penetration, perineural invasion, presence of cancer tissue on resection borders, and presence of metastases in regional LNs. Larger cancers tend to be of a higher T stage. ENE is more common in LNs 3 cm in size or larger. [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. Regular check-ups with a dentist are an important component of general oral hygiene habits. In addition to regular visits to a dentist, this includes the ongoing knowledge upgrade in the field of oral health as well as the application of preventive measures recommended by the selected dentist. The aim of this study was to determine the link between dental visits and independent sociodemographic factors and smoking in the adult population in Serbia. Methods. This cross-sectional study represents an analysis of 2013 National Health Survey for the population of Serbia (without the data on Kosovo and Metohija population). The study included 13,404 adults of 20 years of age and older. The mean age of participants was 51.7 years, including 7,221 (53.9%) females and 6,183 (46.1%) males. In order to determine possible predictors of a dental visit, a multivariate logistic regression model was implemented. A visit to a dentist was a dependent variable, while the independent variables were: sex, age, marital status, type of settlement, region, education, employment status, Wealth Index and smoking status. Results. Significant differences were observed between categories of dental visit and all independent variables except marital and smoking status. In the multivariate model, the odds of visiting a dentist in the period "12 months or longer" vs. "in the last 6 months" were the highest among older respondents [odds ratio (OR) = 1.03; 95% confidence interval (CI) = 1.02-1.04], from a rural area (OR = 1.17; 95% CI = 1.03-1.32), with a low (OR = 2.55; 95% CI = 2.12-3.07) and middle education level (OR = 1.76; 95% CI=1.54-2.00), the unemployed (OR=1.20; 95% CI = 1.06-1.37), those who belong to poorer (OR = 1.30; 95% CI = 1.08-1.54) or the poorest class (OR = 1.71; 95% CI = 1.38-2.12) and smokers (OR = 1.13; 95% CI = 1.01-1.26). Conclusion. The study demonstrated that sociodemographic factors and smoking are important factors related to a visit to a dentist. This study can help to advance regular visits to a dentist and programs of health education focusing on oral health and smoking cessation as well. [ABSTRACT FROM AUTHOR]

Background/Aim. A very limited amount of data regarding the rehabilitation outcome of surgical patients with COVID-19 is available in the current literature. The aim of this study was to point out the characteristics of early rehabilitation of these patients and determine the predictors of rehabilitation outcomes. Methods. The study was designed as a prospective clinical trial. It included patients who had surgical treatment from April 1, 2022, to March 31, 2023, at the University Clinical Center of Vojvodina, Serbia and either had positive results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) preoperatively or developed coronavirus disease 2019 (COVID-19) within 72 hrs after surgery. The rehabilitation program was planned for each patient according to the type of surgical treatment, age, clinical presentation and severity of the COVID-19, length of immobilization, and comorbidities. Rehabilitation treatment (RT) started with a minimum of one 30-minute daily session, up to three 30-minute sessions daily. Patients were assessed at the beginning of RT and discharge. Outcomes were assessed with the Modified Borg Scale (MBS) for dyspnoea, Barthel index (BI) for activities of daily living, Six-Minute Walk T est (6MWT) f or e xercise tolerance, and Timed up and Go (TUG) test for balance and lower limb mobility. Results. A total of 81 patients were included in the study. RT was successful for 42 patients (24 female and 18 male) with an average age of 62.10 ± 20.07 years. These patients exhibited significant functional improvement, which was measured by all tests that assessed rehabilitation outcome at discharge: BI (p < 0.001), MBS (p < 0.001), 6MWT (p < 0.001), and TUG test (p < 0.001). The remaining 31 patients had unsuccessful RT. The binary logistic regression analysis has shown that age (p = 0.009), cardiovascular disease (p = 0.017), and malignancy (p = 0.022) were significant predictors of rehabilitation outcome. Conclusion. Results of the present study implicate that individually tailored RT during the acute phase of COVID-19 in surgical patients is very challenging. Advanced age, cardiovascular disease, and malignancy are predictors of unfavorable outcomes, and careful consideration is needed when planning the treatment for these patients. [ABSTRACT FROM AUTHOR]

Background/Aim. Adverse pregnancy outcomes such as preeclampsia (PE), placental abruption (PA), fetal intrauterine growth restriction (IUGR) and stillbirth could be recognized by prenatal screening. The objective of this study was to predict IUGR by using first-trimester extremely low pregnancy-associated plasma protein-A (PAPP-A), extremely low free beta-human chorionic gonadotropin (free βhCG) levels, and extremely high Pulsatility-index (PI) of uterine arteries, as single and combined predictors for IUGR development. Methods. This was a prospective first-trimester study analyzing singleton pregnancies at 11-13+6 weeks' gestation who underwent routine first-trimester screening at the Department of High Risk Pregnancy of the Clinic for Gynecology and Obstetrics „Narodni front“, University of Belgrade, Serbia. First-trimester screening for PAPP-A, free βhCG, and PI was performed in nulliparous, normotensive women with extremely low PAPP-A (PAPP-A ≤ 0.52 unit multiple of median - MoM) and/or extremely low free βhCG (free βhCG ≤ 0.56 MoM) and/or extremely high PI (PI ≥ 2.52). Results. Of 85 pregnant women included in the final analysis, 14 (16.5%) developed IUGR. PAPP-A ≤ 0.52 MoM and PI ≥ 2.52, as single categorical variables, found to be with high predictable values for IUGR development (odds ratio - OR = 3.064, 95% confidence interval - CI= 0.634-14.810, p = 0.046, and OR = 2.129, 95% CI = 0.449-10.713, p = 0.021, respectively). Furthermore, the receiver operating characteristic (ROC curve identified PAPP-A and PI as continuous variables to be significant predictors of IUGR (area under curve - AUC = 0.671, 95% CI = 0.521-0.820, p = 0.045, and AUC = 0.744, 95% CI = 0.587-0.902, p = 0.004, respectively). Conclusion. The present study suggests that the first trimester extremely low PAPP-A and increased Doppler-PI levels are single predictors of IUGR. Described model could be used in a routine daily clinical practice in resource limited settings where other parameters are not available for the prediction of IUGR development. [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. Thymoma is the most common mediastinal tumor. The treatment procedures are based on the results from the research of retrospective studies because they are not frequent tumors. The aim of this work was to define common clinical features, therapeutic aspects, survival and recurrence free survival. Methods. This study was performed in the Clinic for Pulmonology, Clinical Centre of Serbia, Belgrade from January 1993 to December 2013. We analyzed 62 patients with histopathologically proven thymoma. The results were obtaind from medical history, physical exam, chest X-ray and/or computed tomography and operational findings or diagnostic procedure reports. Thymomas were clasiffied according to the World Health Organization classifying system, based on histopathological findings, and staged according to the Masaoka-Koga staging system. Results. There were more female (54.8%) patients. Patients were mostly in the seventh decade of life. One third (29%) of the patients were asymptomatic. Cough was the dominant symptom. Myasthenia gravis was the most common paraneoplastic syndrome (12.9%). Solitary tumor was the most common in our patients (61.3%), as well as the tumors larger than 5 cm (52.5%), and noninvasive thymomas (52.5%). The majority of patients (40%) were in the stage I of the disease. The operative approach was conducted in most of the patients (88.7%). A statistically significant difference in survival was in women, patients with solitary tumor, non-invasive thymomas, patients in the stage I of the disease, and those who were operated. The dimension of the tumor mass approached the conventional level of significance. Conclusion. In patients with thymomas, statistically significant survival rate predictors are gender, presence of solitary tumor mass, tumor invasiveness, clinical stage and surgical treatment of the disease. [ABSTRACT FROM AUTHOR]

Background/Aim. Domestic violence against women is a significant public health problem resulting in serious health and social consequences, for women and their families. The aim of this study was to analyze the sociodemographic characteristic of women who were exposed to domestic violence, as well as the impact of violence on women's health. Methods. Data from cross-sectional study from the 2013 National Health Survey in Serbia were used analyzing 6,320 women aged 20-75 years. Univariate and multivariate logistic regression analyses were implemented to assess the association of exposure to domestic violence against women with sociodemographic characteristics, as well as with selected health indicators and health risk behaviors. Results. Out of total number of examined women, 307 (4.9%) reported that they experienced physical and/or psychological violence in the last 12 months. Divorced or separated women, poor women and women with poor social support had greater odds for exposure to domestic violence. Women who had experienced domestic violence were less likely to perceived their health as good than women who had not experienced domestic violence [adjusted odds ratio (AOR) = 0.47; 95% confidence interval (CI) = 0.32-0.71], and more likely to report severe or very severe pain (AOR = 2.41; 95% CI = 1.74-3.33), stress and pressure exposure (AOR = 2.62; 95% CI = 1.89-3.64) and depression (AOR = 3.24; 95% CI = 2.08-5.03). Exposure to violence was also associated with the use of sleeping pills or sedative (AOR = 2.21; 95% CI = 1.67-2.93), with frequent use of alcohol (AOR = 1.42; 95% CI = 1.08-1.86) and abortion (AOR = 3.11; 95% CI = 1.48-6.54). Conclusion. Women, victims of domestic violence are more likely to have physical and mental disorders compared to women who are not victims of domestic violence. Violence prevention demands a multisectoral approach, in which the health sector has a central role that includes early identification and recognition of abuse, appropriate care as well as documenting and reporting violence. [ABSTRACT FROM AUTHOR]

Background/Aim. Trabeculectomy is a safe procedure which effectively reduces the intraocular pressure (IOP). IOP is the most frequent indicator of success after glaucoma surgery. The aim of this work was to evaluate the long-term pressure control in primary open-angle glaucoma (POAG) and in pseudoexfoliative glaucoma (XFG) after primary trabeculectomy without the use of mitomycin-C (MMC), 3 to 5 years after trabeculectomy. Methods. This study involved a retrospective evaluation of 332 consecutive patients (352 eyes), 174 patients (188 eyes) with POAG (mean age of 64.0 ± 8.6 years) and 158 patients (164 eyes) with XFG (mean age of 70.7 ± 8.9 years) who underwent primary trabeculectomy between January 2007 and December 2009 at the Clinic for Eye Diseases, Clinical Center of Serbia in Belgrade. A successful control of IOP was defined as achieving IOP ≤ 21 mmHg without medication (complete success), or with a single topical medication (qualified success). Results. According to the type of glaucoma POAG/XFG preoperative IOP was 28.4 ± 6.3/30.4 ± 8.4 mmHg, respectively (p = 0.311) and last postoperative IOP was 16.9 ± 5.2/18.7 ± 5.9 mmHg, respectively (p = 0.681). According to the Kaplan-Meier survival curve, the complete success in the group with POAG in 1, 3 and 5 years were 85%, 75% and 58% and in the group with XFG were 82%, 70% and 56%, respectively. There was no statistically significant difference in the complete success rates between the patients with POAG and XFG. Conclusion. The primary goal of surgery was to achieve a sufficiently low IOP without additional medication, thus preventing progression of glaucomatous damage. In our study, the complete success in the group with POAG was achieved in 75% and 58% of the patientsin the period of 3 and 5 years after surgery, respectively and in the group with XFG complete success was achieved in 70% and 56% of the patients respectively. [ABSTRACT FROM AUTHOR]

Introduction. Smederevo is the only town in Serbia with a steel factory, whose exhausts contribute to air pollution. Therefore, the city conducts continuous monitoring of air quality. In recent years, high levels of particulate matter (PM), including coarse (PM10) and fine (PM2.5) particles in the air have frequently been recorded. The aim of this study was to assess association between exacerbation of asthma or chronic obstructive pulmonary disease (COPD) in adults and air pollution or meteorological conditions. Methods. The study was conducted in the secondary care General Hospital in Smederevo covering approximately 81, 000 inhabitants living in the area of about 7 km around the automatic station for air quality monitoring from which the verified data were collected. Data on patients were obtained from medical records. The correlation between the incidence of diseases exacerbation and the number of days with exceedance of air pollutants limit level per month, as well as meteorological conditions, was tested with parametric Pearson bivariate correlation test in program SPSS. Results. The study population consisted of adults registered as asthma or COPD suffering patients (n = 1,624) with 570 episodes of remarkable exacerbations (moderate or severe) of the disease in 2011. Asthma exacerbation was significantly more frequent in women than in men. The number of days with high levels of PM2.5 per month was statistically significantly associated with the total number of exacerbation (moderate and severe of both asthma and COPD) episodes among the female patients. There was also a statistically significant association between the number of days with PM2.5 exceedance and the number of moderate exacerbations in the subgroups of nonsmokers and obese patients. A significant correlation of the number of days with the exceedance of PM10 limit level was shown only for the subgroup of obese, non-smoking patients with moderate exacerbation. A significant negative association with the average ambient temperature was proven for the obese female patients and obese non-smoking patients with moderate asthma exacerbations. The number of COPD exacerbation was in positive correlation with the average air pressure for the subgroup of female smokers, but the connection with air pollution was not proven. Conclusion. Exposure to airborne particles in the town of Smederevo, mainly to PM2.5, and to low temperature may trigger asthma exacerbation requiring emergency care. The most vulnerable may be women and obese patients. [ABSTRACT FROM AUTHOR]

Background/Aim. The availability of thrombopoietin receptor agonists (TPO-RA) for treating primary immune thrombocytopenia (ITP) has transformed its management over the last decade. The aim of this study was to assess the efficacy of TPO-RA in adults with chronic ITP treated at the University Clinical Center of Serbia. Methods. A total of 2 8 a dult I TP p atients (10 m ales and 18 females), who were given eltrombopag and/or romiplostim, were enrolled in the study. Data on demographic characteristics, ITP duration, previous therapeutic modalities, comorbidities, concomitant therapy both for comorbidities and ITP, indications for TPO-RA, bleeding episodes before and during TPO-RA, TPO-RA doses, adverse events, and response rates were collected from the patientsf medical records. TPO-RAs were administered in patients with chronic refractory ITP when splenectomy was contraindicated/unfeasible and as preparation for splenectomy. Favorable treatment response was defined as a stable platelet count. 50 ~ 109/L. Results. A total of 22 (78.57%) and 14 (50.0%) patients were treated with eltrombopag and romiplostim, respectively. A good treatment response (GTR) was achieved in 81.8% of the patients receiving eltrombopag and 71.4% of those treated with romiplostim. The nonresponders to eltrombopag (4 patients) and those who had lost their response to eltrombopag (4 patients) were switched to romiplostim. Six of 8 patients achieved a GTR. At the time of TPO-RA initiation, 46.4% of the patients used concomitant ITP therapy, which was ceased in all those with a G TR. T he f ollowing a dverse e ffects of T PORA were registered: transaminitis and transient ischemic attack for eltrombopag. one patient each, and pulmonary embolism in one romiplostim-treated patient. Conclusion. Our study showed that TPO-RAs are an effective and safe treatment option since the majority of patients achieved stable remission without bleeding episodes. [ABSTRACT FROM AUTHOR]

Introduction. A single pass albumin dialysis (SPAD) is a form of extracorporeal liver support system for removing albumin-bound toxins and water-soluble substances that accumulate in liver failure (LF). Case report. We presented three patients hospitalized for LF and treated using the SPAD at the University Clinical Center of Vojvodina, Serbia, from 2018 to 2019. Two of the patients presented with acute LF and one with acute-on-chronic LF. A total of 6 SPAD sessions were performed on each patient, resulting in decreased serum bilirubin and bile acid levels and hepatic encephalopathy grade. On discharge from the hospital, the liver function was improved in all the patients. Conclusion. SPAD removes the hepatotoxic substances without improvement of synthetic liver function. It represents a supportive treatment for LF patients who do not respond to the standard of care, offering a longer time for bridging to organ transplantation or spontaneous recovery of the liver function. [ABSTRACT FROM AUTHOR]

Background/Aim. Approximately one-third of individuals with only one cardiovascular (CV) risk factor or without any, as well as 40% of individuals with a concentration of cholesterol less than average, die from CV diseases (CVD). Recent studies underlined the significant role of inflammation in atherosclerosis and its complications. The aim of this study was to analyze the association of high-sensitivity Creactive protein (hs-CRP) with traditional risk factors for coronary heart disease. This is the first such study in Serbia. Methods. This is an observational cross-sectional study, which included active-duty military personnel of similar socio-epidemiological and economic characteristics. Plasma hs-CRP and traditional CV risk factors were evaluated. The relative CV risk was staged as low (hs-CRP < 1 mg/L), intermediate (hs-CRP between 1 and 3 mg/L), and high (hs-CRP > 3 mg/L). The Systematic Coronary Risk Evaluation (SCORE) system was used for absolute CV risk assessment and total risk (fatal and non-fatal events). Results. The study included 205 participants, average age of 39 (35-43) years, with median and interquartile range values of hs-CRP 0.80 mg/L (0.43-1.75 mg/L), with average hs-CRP values of 0.71 mg/L in participants younger than 40 years of age and 1.2 mg/L in the older than 40 years. The difference in hs-CRP values between these two groups was statistically significant (p = 0.006). There was a significant positive correlation between hs-CRP and age (r = 0.266, p < 0.001), weight (r = 0.223, p = 0.001), body mass index (BMI) (r = 0.344, p < 0.001), diastolic hypertension (r = 0.190, p = 0.007), LDL cholesterol (r = 0.152, p = 0.032), triglycerides (r = 0.144, p = 0.039), number of risk factors (r = 0.210, p < 0.003), as well as negative correlation with HDL cholesterol concentration (r = -0.148, p < 0.035). There was no significant correlation between hs-CRP concentration and total cholesterol (r = 0.131, p = 0.062). According to hs-CRP values, high CVD risk was found in 17.7% of participants older than 40 years of age, and based on SCORE system staging, 90% of participants have intermediate CVD risk. The results of stepwise multiple regression analyses showed that BMI was independently associated with an hs-CRP concentration in the group younger than 40 years of age. Among the older participants, age was found to be associated with concentration of fibrinogen. Conclusion. In the population of active military personnel in the Republic of Serbia, hs-CRP is correlated with some of the risk factors for CVD, and only BMI is independently correlated with hs-CRP in those under 40 years of age. Levels of plasma hs-CRP are increased with aging, implying that hs-CRP measurement may provide a more accurate assessment of the individual overall risk profile for CVD in the Serbian military personnel population. [ABSTRACT FROM AUTHOR]

Background/Aim. Growing waiting lists for cardiac surgery have become a real problem in the Republic of Serbia, imposing serious difficulties in patient-surgeon communication. The aim of the study was to determine the current state of the institutional informed consent policy before elective cardiac surgical procedures in light of actual national legislation. Methods. An anonymous, voluntary survey was conducted among 200 consecutive patients at the Clinic for Cardiac Surgery, University Clinical Centre of Serbia, from September to December 2019, after signing an official institutional consent form. A targeted questionnaire was created to determine the quantity and quality of patients' information about general and the most important aspects of cardiac surgical care. Results. The mean age of respondents was 66.2 years, with male predominance (68.0%), homogenous ethnicity, and low-to-middle (84.0%) education levels. A significant percentage had no information on the type of surgery (16.0%), extracorporeal circulation (46.0%), anaesthesia (56.0%) and transfusion (51.5%). Of those having some information, 7.0-20.0% graded them sufficient. The worst situation was recorded concerning risks of disease and surgical treatment, where 88.0% of patients had no information and almost 90.0% had some information and graded them as non-sufficient. Surprisingly, 81.5% of patients signed the consent form without any prior discussion with the operating surgeon. For 56.0% of patients, the information in the actual consent form was clear and sufficient. While 85.5% of patients claimed the importance, the others (14.5%) were not interested to know the most relevant information about their disease and surgery. Conclusion. The results unambiguously indicate an unacceptably low level of our patients' information about the cardiac surgical procedure, extracorporeal circulation, anesthesia, transfusion, and estimated risk. The majority of them (85.5%) comprehends the importance and expects timely and adequate information. An extremely high percentage (81.5%) of patients had no chance to discuss the procedure with the operating surgeon. Both surgical indifference and insufficient knowledge of professional, ethical, and legal importance are the most important reasons for the actual informed consent policy in cardiac surgery. [ABSTRACT FROM AUTHOR]

Bacground/Aim. Endovascular treatment of thoracic aortic diseases is an adequate alternative to open surgery. This method was firstly performed in Serbia in 2004, while routine usage started in 2007. Aim of this study was to analyse initial experience in endovacular treatment of thoracic aortic diseses of three main vascular hospitals in Belgrade -- Clinic for Vascular and Endovascular Surgery of the Clinical Center of Serbia, Clinic for Vascular Surgery of the Military Medical Academy, and Clinic for Vascular Surgery of the Institute for Cardiovascular Diseases "Dedinje". Methods. Between March 2004. and November 2010. 41 patients were treated in these three hospitals due to different diseases of the thoracic aorta. A total of 21 patients had degenerative atherosclerotic aneurysm, 6 patients had penetrating aortic ulcer, 6 had posttraumatic aneurysm, 4 patients had ruptured thoracic aortic aneurysm, 1 had false anastomotic aneurysm after open repair, and 3 patients had dissected thoracic aneurysm of the thoracoabdominal aorta. In 15 cases the endovascular procedure was performed as a part of the hybrid procedure, after carotidsubclavian bypass in 4 patients and subclavian artery transposition in 1 patient due to the short aneurysmatic neck; in 2 patients iliac conduit was used due to hypoplastic or stenotic iliac artery; in 5 patients previous reconstruction of abdominal aorta was performed; in 1 patient complete debranching of the aortic arch, and in 2 patients visceral abdominal debranching were performed. Results. The intrahospital mortality rate (30 days) was 7.26% (3 patients with ruptured thoracic aneurysms died). Endoleak type II in the first control exam was revealed in 3 patients (7. 26%). The patients were followed up in a period of 1-72 months, on average 29 months. The most devastating complication during a follow-up period was aortoesofageal fistula in 1 patient a year after the treatment of posttraumatic aneurysm. Conversion was performed with explantation of stent-graft and open aortic in situ recontruction, followed by esophagectomy and the creation of cervical and gastrical stoma. Conclusion. Having in mind initial results of the 3 main vascular clinics in Belgrade, Serbia, economical situation in our country, as well as the published international results, endovascular treatment of thoracic aortic diseases is indicated in hemodinamicaly unstable patients with acute traumatic aneurysm, or in stabile patients older than 65, as well as in case of chronic diseases of the thoracic aorta in patients with significant comorbid conditions or in patients older than 65 years. Endovascular procedures on the thoracic aorta could be performed, hower, only in high-volume centers with experience in routine open surgery of thoracic aorta. [ABSTRACT FROM AUTHOR]

Background/Aim. Influenza A (H1N1) re-emerged in the human population during 2009. The aim of this study was to describe characteristics, laboratory findings, clinical presentation and treatment outcome among patients with influenza A (H1N1) infection. Methods. The study was performed at the Institute for Pulmonary Diseases of Vojvodina including all the patients hospitalized at the Intensive Care Unit or High Dependency Unit with confirmed, probable or suspected Influenza A (H1N1) infection between November 6th, 2009 and April 13th, 2010. Results. Among 64 patients Influenza A (H1N1) infection was confirmed by rt-PCR in 50, defined as probable in 7 and as suspected in 6 patients. There was an equal number of male and female patients. Their mean age was 46 years (SD ± 12.1). None of the patients were vaccinated against influenza. Comorbidities were present in 37 (58%) patients. There were 29 (45%) obese patients. Three patients were pregnant. The median time from symptom onset to hospital admission was 5 days (IQR 4-7). At admission, the median Modified Early Warning Score (MEWS) was 4 (IQR 3-6). The most common presenting symptoms were cough (100%) and fever (89%). The mean oxygen saturation at admission was 85.3% (SD 9.0). Auscultatory finding of wheesing in the absence of a chronic lung disease was found in 10 (15.6%) patients. Leukopenia was noted in 23 (35.9%) patients, and thrombocytopenia in 14 (21.9%) patients. Aspartate aminotransferase values were elevated in 41 (64.1%) patients, alanine aminotransferase in 32 (50%) patients, and creatine kinase in 36 (56.2%) patients. Opacities on an initial chest radiograph were predominantly patchy and the median number of the lung fields involved was 1 (IQR = 0-3). The non-survivors had statistically significantly higher MEWS at admission (p = 0.0001), lower oxygen saturation (p = 0.001), more lung fields involved on an initial chest radiograph (p = 0.006), wheezing in the absence of chronic lung disease (p = 0.02) and elevated aspartat aminotransferase (p = 0.02) and creatine kinase (p = 0.03). Acute respiratory disstress developed in 21 (32.9%) patients, and mechanical ventilation was required in 23 (36.1%) patients. Septic shock developed in 12 (18.7%) patients, and 19 (29.7%) patients had a multi-organ dysfunction. The overall hospital mortality was high -- 20.3% (95% CI, 11.3%-32.2%; n = 13), and especially so among the patients who required mechanical ventilation -- 56.5% (95% CI, 36.8%-74.4%). Conclusion. Timely initiation of antiviral therapy and early recognition of critically ill are important factors for reducing mortality. [ABSTRACT FROM AUTHOR]

Background/Aim. Children and adolescents who enter a child welfare system are at higher risk of suffering from mental disorders, physical health, and/or social and educational problems than the general population of the same age is. This study was organized with the aim to evaluate the general characteristics of quality of life (QOL) in children and adolescents living in residential and foster care in Serbia. Methods. Two hundred and sixteen children and adolescents, aged 8-18 years, from residential and foster care and 238 children and adolescents from the general population participated in the study. QOL was assessed using the Pediatric Quality of Life Inventory (PedsQL) -- Serbian version. Three groups were created: residential care group (RCG), foster care group (FCG), and control group (children and adolescents from biological families -- CG). Descriptive data were calculated for all questionnaires' scores, while t-test and ANOVA were used to compare them. Results. The mean value of the total PedsQL was lower in the RCG, 67.47 ± 17.75, than in the FCG and the CG, 88.33 ± 11.27 and 80.74 ± 11.23, respectively. Additionally, the RCG reported lower all PedsQL Scale scores, but the lowest value was for the psychosocial domain. These differences were statistically significant (F value ranged from 17.3 to 49.89, p < 0.000). However, only the scores of the RCG were statistically different from the FCG and the CG, while the differences between the FCG and the CG were statistically insignificant (p > 0.05). Conclusion. Children and adolescents living in residential care have significantly poorer QOL than those living in foster care or in biological families. On the other side, QOL in children and adolescents from foster care is similar to the one of those living in biological families. [ABSTRACT FROM AUTHOR]

Background/Aim. Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in general population. The aim of the study was to compare all-cause mortality and cardiovascular mortality in patients with lone and idiopathic AF to correspondent mortality in general population of Serbia. Methods. A longitudinal observational study included the patients with nonvalvular AF as the main indication for inhospital and/or outpatient treatment in the Clinical Center of Serbia, during a period 1992-2007, if the latest date of first diagnosed AF was early January 2003; in that way, the total follow-up could last at least 5 years (minimum 1 year prospectively), or until death. Principles of oral anticoagulation, heart rhythm and frequency control during the study period were conducted according to the latest international guidelines for diagnosis and treatment of AF in the study period. Lone and idiopathic AF were defined as AF in patients without any underlying disease, younger than 60 years (lone AF) or older (idiopathic AF). To compare mortality of the study population with mortality of general population we used the standardized mortality ratio (SMR) and chi-square test with p < 0.05 as a level of statistical significance. Results. Out of 442 patients with AF and no underlying disease, aged 47 ± 12.6 years, with mean follow-up of 11.5 ± 7.2 years, 12 patients (2.7%) died: 7 patients of non-cardiovascular causes and 5 patients (1.1%) of cardiovascular death. When compared to the general population of Serbia, all-cause mortality and cardiovascular mortality in the patients with lone and idiopathic AF were not higher than in general population (p < 0.05). Conclusion. All-cause mortality and cardiovascular mortality of patients with lone and idiopathic AF are similar to all-cause mortality and cardiovascular mortality in general population of Serbia. [ABSTRACT FROM AUTHOR]

Background/Aim. Hand injuries in agriculture are characterized by massive destruction of all tissues, frequent amputations of finger, hand and often the whole extremity. These injuries are mutilant and can cause death. The aim of this paper was to show the specificities of hand injuries in agriculture in regard to hand injuries of other etiology. Methods. We analyzed patients that were treated in the Departement for Plastic and Reconstructive Surgery, Clinical Center Vojvodina, during a five-year period (2003-2007) because of hand injuries. Results. In a five-year period there were 366 patients hospitalized because of hand injuries, out of whom 36 injuries were related to agricultural machinery use. In both groups the number of patients trended to increased, with male gender being dominant. Most of the patients were young or middle-aged men. In agricultural injuries most of the patients were in the group of 41-50-year old (30%), while in the other group, the patients were younger (21-30-year old). Hand injuries in agriculture resulted in finger amputation in 92%, while in the other group that number was much smaller (13%). Skin defect reconstruction in agricultural injuries required complex methods of skin grafting or skin flaps in more than 71%, while this was necessary in only 10% of other hand injuries. Conclusion. Hand injuries in agriculture are very mutilant and often result in conquassation and finger amputation. A possibility to preserve tissue damaged in this way is very limited, and skin closer usually requires complex methods. [ABSTRACT FROM AUTHOR]

Background: Brugada syndrome (BS) is a disorder characterized by syncope or sudden death associated with one of several electrocardiographic (ECG) patterns characterized by incomplete right bundle branch block and ST elevation in the anterior precordial leads. Patients with BS are prone to develop ventricular tachyarrhythmias that may lead to syncope, cardiac arrest, or sudden cardiac death. Case report. A 58-year-old woman is the first described case of Brugada syndrome in Serbia with intermittent typical changes in basic electrocardiography (ECG): ST segment elevation in the precordial chest leads like dome or coved major form or type I. For the last 27 years the patient had suffered of palpitations and dizziness, without syncopal events. Her sister had died suddenly during the night in sleep. During 24-hour Holter monitoring the patient had ventricular premature beats during the night with R/T phenomenon and during the recovery phase of exercise testing had rare premature ventricular beats as the consequence of parasympatethic stimulation. Late potentials were positive. Echocardiography revealed left ventricular ejection fraction of 60%. We performed coronary angiography and epicardial coronary arteries were without significant stenosis and structural heart disease was excluded. In the bigining of the electrophysiological study ECG was normal, and after administration of Propaphenon i.v. Brugada syndrome unmasked with appearance of type I ECG pattern. A programed ventricular stimulation induced non sustained ventricular tachycardia. One-chamber implantable cardioverter defibrillator was implanted and the patient was treated with a combination od amiodarone and metoprolol per os. After one-year follow-up, there were no episodes of ventricular tachycardia and ventricular fibrillation. Conclusion. Brugada syndrome is a myocardial disorder which prognosis and therapy are related to presence of ventricular fibrillation or ventricular tachycardia. Electrophysiologicaly induced malignant ventricular disorders class I are indication for implantation of cardioverter defibrilator, as also occurred in presented patient. [ABSTRACT FROM AUTHOR]

Background/Aim. Diabetes mellitus (DM) as a complex metabolic disease influences functioning of numerous organs. Therefore, frequent diabetic complication is chronic periodontitis. The aim of the study was to investigate the influence of various risk factors, like age, sex, duration of DM, oral hygiene, on oral manifestations of diabetes. Methods. The group of diabetics included 52 adult patients, 18-79-year of age, both sexes (33 females, 19 males) out of which 35 patients were with diabetes mellitus type I and 17 with type II. Mean age of the patients was 54.6 years and the mean duration of diabetes was 11.1 years. The controls consited of 67 volunteers from the city of Belgrade, 19-24-year of age, both sexes (47 females, 20 males) with no paradonthopathy and non-systemic diseases. Estimation of periodontal status of the patients was performed by measuring dental plaque index, gingival index and periodontal pockets' depth. Results. The results suggest an increased incidence and severity of periodontitis in diabetic patients. It was established that duration of diabetes, patients' age and bad oral hygiene had a negative influence on status of remained teeth in diabetics, while the sex had no influence on parameters monitored. Conclusion. Indices of oral hygiene level and periodontal status (dental plaque index, gingival index and periodontal pockets' depth) were significantly worsened in patients with diabetes. Negative influence on remained teeth had patients' age (>50 years), duration of diabetes (> 20 years) and bad oral hygiene. About half of the patients had a total or partial bridge suggesting that periodontitis is significant complication of diabetes mellitus. [ABSTRACT FROM AUTHOR]

Background/Aim. The Critical Incident Technique (CIT) is a qualitative research method for measuring consumer satisfaction by collecting and analyzing information on participants and their activities. This method allows participants to present their detailed experiences related to a particular service in the way they perceive them. The aim of this study was to examine patients' perceptions of an incident that occurred in community pharmacies using CIT and determine recommendations for improving the quality of pharmacy services. Methods. A qualitative study using an interview based on the CIT was conducted in three pharmacies in Serbia, on the territory of Kruševac city. The entire course of the interviews was audiorecorded, which provided detailed research. Results. A total of 68 critical incidents were collected and divided into two groups: positive (37) and negative (31), depending on the (dis)satisfaction of patients with the services of pharmacists in community pharmacies. The following thematic clusters of pharmacy services were covered: accessibility of community-based pharmaceutical services, pharmacist behavior, patient counseling, dispensing drugs and/or medical devices, compounding, and pharmacy sales/commercial practice. Conclusion. The results show that the CIT is a useful tool for evaluating and improving pharmaceutical services. Based on the data collected, various aspects of community pharmacy services can be improved, and further research should be carried out. [ABSTRACT FROM AUTHOR]

Background/Aim. The absence of clear guidance in the definition, diagnostics, and indications for renal replacement treatment (RRT) is present. The aim of this study was to help outlining future clinical work in improving the treatment outcome and reducing complications of acute kidney injury (AKI) based on the current clinical practice. Methods. The questionnaires were distributed among physicians of different specialties who participated voluntarily and anonymously. The questionnaire was drawn up in accordance with the standard clinical practice. Results. We conducted a multicentric web survey among nephrologists (46.8%) and other physicians in Serbia. The sample consisted of 119 participants, out of which 78.9% filled out the survey forms correctly and were, therefore, included in the analysis. Most of them responded that the nephrologist indicates (76.8%) and prescribes (74.5%) continuous renal replacement therapy (CRRT). The application of the Kidney Disease Improving Global Outcomes (KDIGO) 2 criterion for "early" start of CRRT used 74.5% of the respondents, and 91.5% of them started "late" initiation of CRRT in the presence of complications associated with AKI or poor response to conservative treatment. Regarding the clinical experience of the respondents, 74.5% of them marked the "early" start of CRRT within 12 hours, whereas 56.4% of them considered the start of CRRT after 48 h as "late". The most commonly used modality was continuous venous hemodiafiltration (37.6%). Most participants used heparin as an anticoagulant (95.7%) with an average life span of filters less than 24 h (71.3%) and 25 mL/kg/h efficiency target dialysis effluent dose (45.2%) during CRRT. The most common complications of CRRT were hypotension (55.3%) and catheter-related infections (29.8%). Conclusion. The "early" start of CRRT is considered favorite by the majority of the participants. According to the obtained data, standardization of the strategy in the diagnostics and treatment of AKI is necessary. [ABSTRACT FROM AUTHOR]

Background/Aim. Functional imaging, including diffusion-weighted magnetic resonance imaging (DWI MRI) and apparent diffusion coefficient (ADC) map, provides promising results in discrimination benign from malignant pelvic and inguinal lymph nodes in patients with gynecological malignancies. The aim of the study was to assess diagnostic performances of DWI in differentiation between benign and malignant pelvic and inguinal lymph nodes in patients with gynecological malignancies. Methods. The prospective clinical study was conducted at the Clinical Center of Vojvodina, Serbia, from 2013 to 2016, comprising 80 patients with malignant gynecological tumors. Preoperatively, all patients underwent MRI examination, followed by standard surgical treatment with complete pelvic and/or inguinal lymphadenectomy. A combination of ADC value criteria and size-based criteria yields MRI the following diagnostic performances in discrimination between benign and malignant lymph nodes: sensitivity 95%, specificity 92%, overall accuracy 92.5%, positive predictive value 46%, and negative predictive value 99.6%. Histopathological examination of surgically removed material and lymph nodes separated in pelvic and inguinal anatomic groups was performed after the surgery. Results. A total of 2,320 lymph nodes were mapped and histopathologically examined in 80 patients included in the study. Metastases in lymph nodes were histopathologically confirmed in 28 (35%) patients. Measured ADC values were significantly lower in metastatic (mean ± standard deviation (SD), ADC: 0.8725 × 10-3 ± 0.0125 × 10-3 mm2/s) than benign lymph nodes (mean ± SD, ADC: 1.116 × 10-3 ± 0.1848 × 10-3 mm2/s; p = 0.001). If ADC value of 0.860 × 10-3 mm2/s was determined as a cut-off value for discrimination between benign and malignant lymph nodes, DWI sensitivity was 89%, specificity 85%, and overall accuracy was 86%, positive predictive values 30%, and negative predictive value 99%. Conclusion. DWI MRI sequence is a fast, simple, non-invasive method that aids significantly to MRI diagnostic performances in discrimination between benign and malignant pelvic and inguinal lymph nodes. [ABSTRACT FROM AUTHOR]

Introduction. The exact prevalence of benign familial neonatal epilepsy (BFNE) is unknown due to the likelihood of overlooking the disease and not diagnosing the affected patients correctly. The rare autosomal dominant inherited disorder usually occurs within a few days after birth of an otherwise healthy newborn, and disappears after one to four months. Most patients develop no psychomotor deficiencies, nor any other forms of seizures. The disorder is most commonly linked to the KCNQ2 gene, with mutations located on the chromosome 20q13.33 which cause voltage-gated potassium channel changes. This clinically rare condition manifests itself in repeated tonic-clonic episodes of focal and generalized convulsions which are effectively treated with antiepileptic therapy. Case report. We presented a five-day old affected male infant, with genetically proven KCNQ2 gene mutation, in addition to a positive familial history of epilepsy. Seizures did not reoccur after several episodes in the fifth day of life and further psychomotor development of the child proved normal. Conclusion. Neonatal seizures have extensive differential diagnosis. However, BFNE should be suspected when the most common neonatal seizure causes have been excluded, and factors, such as the hereditary factor, in addition to the typical clinical course resembling BFNE, can be observed. Genetic identification of BFNE has resulted in easier and more specific diagnosis of this rare disorder and is therefore the gold standard in its diagnostics. [ABSTRACT FROM AUTHOR]

Background/Aim. Kidney tumors account for 2-3% of all tumors. Renal cell carcinoma (RCC) is the tenth most common malignancy. Sunitinib is used as the first treatment line in patients with a good and intermediate prognosis. The aim of this study was to analyze the risk factors, frequency, and adverse drug reactions (ADRs) of sunitinib in patients with metastatic RCC. Methods. The retrospective study included 170 patients treated at the Clinic for Oncology of the Clinical Center of Montenegro, Urology Clinic of the Clinical Center of Serbia, and Clinic for Oncology of the Clinical Center Niš. As a data source, we used patient medical histories and/or electronic patient records. ADRs were characterized by using Rawlins and Thompson classification. Each ADRs severity was assessed in accordance with the World Health Organization criteria. Causality was assessed using the Naranjo probability scale. Results. ADRs of sunitinib occurred in 152 (89.4%) patients. ADRs were 89% type A and 11% type C. Disorders of the blood and lymphatic system, gastrointestinal disorders, and disorders of the skin and subcutaneous tissue were the most common manifestations of ADRs of sunitinib. Causality assessment was most commonly classified as certain (60%). Serious ADRs occurred in 4.5% of patients. Most patients recovered without consequences. The most common manifestations of ADRs were: leukopenia, hypothyroidism, thrombocytopenia, diarrhea, stomatitis, asthenia, and hypertension. All ADRs were expected. The number of concomitant medications and the duration of therapy proved to be the most significant risk factors for ADR to sunitinib. Conclusion. Our study shows that the incidence of ADRs of sunitinib in patients with kidney cancer is high. The ADRs were mostly moderate and mild in intensity and occurred as a consequence of the pharmacological action of the drug. It is necessary to conduct continuous education of medical oncologists in the field of monitoring safe drug use, as well as patients on sunitinib therapy, in order to improve their awareness of the sunitinib ADRs and the risk factors that lead to them, with the aim of reducing their frequency. [ABSTRACT FROM AUTHOR]

Background/Aim. Surgical registries and databases are especially valuable in monitoring the performances in cancer treatment and detecting potential problems. For Serbian patients with colorectal cancer (CRC), data regarding the treatment received, the factors that may impact the outcome, and whether or not treatment is successful and appropriate are not currently captured. The aim of this study was to establish a collection of a consensus dataset capturing surgical treatment of CRC at multiple public hospitals across Serbia and estimate outcome in CRC patients subjected to surgical treatment in the period 2010-2014. Methods. The study encompassed all 52 public CRC surgical units in Serbia. Numerical data on all patients who underwent operative CRC resection were included. An electronic database was created and overseen by the First Surgical Clinic of the Clinical Center of Serbia, Belgrade. Data were collected independently using a specifically designed standardized questionnaire, including the number of operated patients, localization of the primary tumor, type of surgical intervention, type and urgency of surgical intervention, and postoperative mortality. Results. A total number of 22,037 colorectal surgical procedures was performed in Serbia in the period 2010-2014 (approximately 4,400 per year). It was shown that 78.5% of the total number of procedures were elective and 21.5% were emergency. The most common cause of emergency surgeries was ileus (3,618 cases, 76.4%), while the less common causes were perforation (899 cases, 18.9%) and bleeding (216 cases, 4.5%). Postoperative mortality during the study period expressed as a percentage of all interventions for CRC was 2.8% on average with a slight increasing tendency. At the end of the study period, 127 doctors were educated for performing colonoscopy. Conclusion. The main outcome of this study was the establishment of the necessary preconditions for the multicenter data collection involving large numbers of CRC patients. The study supported the premise that the development of the national database for surgical treatment of CRC is achievable and could provide valuable insight into the routine surgical management of CRC in Serbia, creating a significant resource for further research. [ABSTRACT FROM AUTHOR]

Background/Aim. To date, there has been no populationbased neonatal anthropometric chart published in Serbia. Charts based on infants born in a single hospital (hospitalbased) in the 1990s are still widely used in our country, as well as the Alexander chart. The aim of this s tudy was to construct population-based centile, gender-specific charts for birth weight and length for singleton infants born in Southeast Serbia from 24 to 42 weeks of gestation and to compare them with other previously published charts. Methods. Data on 39,842 singleton live infants, delivered from 2006 to 2015 in three maternity wards in Southeast Serbia (Niš, Prokuplje, and Aleksinac), were analyzed. Results. The inclusion criteria met 37,169 newborns. Preterm births were relatively uncommon (5.25%). Estimated centile charts for male and female birth weights and lengths were constructed showing the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th centiles. Conclusion. Our birth weight percentiles provide a population norm for singleton infants adjusted for gender, born in Southeast Serbia. These references are both of epidemiological and clinical use. There is a need for large-scale research that will include a larger number of preterm newborns which were represented in limited numbers in our study. There is also a need for setting up the gold standard method for the precise determination of the gestational age, i.e. the use of the early fetal ultrasound. [ABSTRACT FROM AUTHOR]

Background/Aim. After having established an indication for surgery, some patients experience sense of fear, unpleasantness and embarrassment due to the expectance of adverse consequences of surgical intervention. Recently an instrument for measuring fear of surgery - the Surgical Fear Questionnaire (SFQ) - was developed and validated on a sample of Dutch patients awaiting surgery. The objective of this study was to translate the SFQ to Serbian language, make cultural adaptation of the translation and test its reliability and validity in a sample of outpatients in Serbia. Methods. The SFQ was translated and adapted according to the accepted international standards (double forward translation, harmonization, backward translation, and piloting). The study was multicentric, involving patients from 7 cities in 3 countries: Serbia, Montenegro, Bosnia and Hercegovina. It was conducted at state-owned health facilities. The sample was of consecutive nature and consisted of 330 outpatients who visited specialists of either internal medicine or general surgery. Results. Translated SFQ showed excellent reliability, both when rated by the investigators (Cronbach's alpha 0.915), and by the patients themselves (Cronbach's alpha 0.917). It is temporally stable, and both divergent and convergent validity tests had good results. Factorial analysis revealed one domain on the whole study sample and two domains like in original on the subsample of patients without experience with surgery in general anesthesia. Conclusion. Identification of patients with high level of fear of surgery by this questionnaire should help clinicians to administer measures which may decrease fear and prevent avoidance of absolutely necessary surgery by such patients. [ABSTRACT FROM AUTHOR]

Background/Aim. Ocular trauma is a significant cause of visual impairment worldwide. The aim of the study was to analyze clinical characteristics of patients with penetrating eye injuries with retained intraocular foreign body (IOFB) in posterior segment of the eye. Methods. The retrospective study enrolled medical records of consecutive patients hospitalized in a five year period (2012-2016) in a tertiary referral center in Serbia. Surgical repair included pars plana vitrectomy and IOFB removal. Postoperative results were evaluated using the best corrected visual acuity (BCVA). Results. Out of 130 patients who suffered penetrating eye injury with retained IOFB, 72 had IOFB in posterior segment of the eye (43 in retina, 25 in vitreous, 3 in ciliary body, 1 on the optic nerve). Patients were predominantly young adults (aged 44.3 ± 14.9 years, 97.2% men). Average BCVA at admission was poor (0.27 ± 0.38, measured by Snellen chart), and 52.8% of patients had BCVA of counting fingers at 1 m eter or less. T he m ajority of patients had corneal wound (70.8%), medium sized IOFB (48.6%), iris injury (61.1%) and traumatic cataract (69.4%). Complications included retinal detachment (16.7%) and endophthalmitis (15.3%). Two patients had the eye enucleated due to severe endophthalmitis, which could not be otherwise controlled. Significant risk factors for postoperative outcome were: initial BCVA (p < 0.001), ocular hypotony (p = 0.013), medium size of IOFB (p = 0.037), presence of traumatic cataract (p = 0.036), retinal detachment (p = 0.032) and endophthalmitis (p = 0.045). Conclusion. Treatment of posterior segment penetrating eye injuries remains a challenge due to high frequency of low initial visual acuity, retinal detachment and endophthalmitis, all of which are risk factors for poor visual outcome. Patients with better initial BCVA, normal intraocular pressure and small IOFB have better postoperative results. [ABSTRACT FROM AUTHOR]

Introduction. The device thrombosis is one of the most serious complications of the left ventricle assist device implantation with a high mortality and morbidity rate. Case report. A 59-year-old male was implanted by left ventricular assist device Heart Mate II as a bridge to transplantation seventeen months before the onset of a potentially fatal complication - the thrombosis with the complete obstruction of the device. Despite the aggressive pharmacological treatment following the initial suspicion of the pump thrombosis, the patient condition got worse with the final "pump off" alarm that marked the discontinuance of the pump work as a result of the complete obstruction by the thrombus. An appropriate occurrence of an adequate donor resulted in a successful surgical treatment - the heart transplantation. Conclusion. The urgent heart transplantation by the first priority rank, or the device replacement, although technically extremely demanding procedures, are successful treatment options for these patients. [ABSTRACT FROM AUTHOR]

Background/Aim. It is still under debate in what sense and extent can chorionicity impact the pregnancy outcome of twins without gestational complications specific for monochorionicity. The study aimed to evaluate the effect of chorionicity on healthy twin pregnancy outcome. Methods. The study included patients with uncomplicated twin pregnancies after first trimester that were checked-up and delivered at the Clinic of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade during three years (2010-2013). Data regarding mother's age, comorbidities, parity, presence and type of gestational complications, chorionicity, mode and time of pregnancy ending, birth-weight and Apgar score of twins were determined. Obtained data were compared and statistically analyzed. Results. The study included 361 women with mean age of 33 years. Regardless of chorionicity, twins were mostly born during the 36th gestational week and received Apgar score = 8. Only three monochorionic twins were stillborn, two preterm (29 and 32 gestational week) and one in term (35 gestational week) delivery. Contrary, no intrauterine fetal deaths were recorded. Monochorionicity negatively correlated with having live-born twins (OR = 0.023; CI = [0.001-0.609]; p = 0.024), but was not associated with twins condition at birth, i.e. Apgar score (p = 0.345), pregnancy ending time (p = 0.578) or any other twins characteristic. However, premature preterm membrane rupture and earlier gestational week of pregnancy ending were important confounding factors for relationship between chorionicity and pregnancy outcome. Conclusion. Monochorionicity increases risk for adverse pregnancy outcomes even for uncomplicated, healthy twin pregnancy, but has no influence on the condition of twins who survive until term. If appropriate surveillance and therapy are applied, both healthy twins can be delivered at term regardless of chorionicity. [ABSTRACT FROM AUTHOR]

Background/Aim. Interventional neuroradiology procedures expose patients to ionizing radiation. The aim of this study was to assess doses received by patients during interventional neuroradiology procedures and to establish dose range with an estimate of risk from adverse consequences of irradiation. Methods. Our study describes series of patients submitted to diagnostic and/or therapeutic procedures at the Department of Interventional Neuroradiology, Clinical Center Kragujevac, Serbia, from December 1, 2014 to December 1, 2016. The following variables were considered for this study: kerma-area product, air kerma and fluoroscopy exposure time; peak skin dose and effective dose calculated from the kerma-area product. Results. Median kerma-area product was 87.802 Gy·cm2, 78.567 Gy·cm2, 117.626 Gy·cm2; effective dose was 12.731 mSv, 11.392 mSv, 17.056 mSv; peak skin dose was 0.456 Gy, 0.409 Gy, 0.612 Gy, and estimated brain dose was 254.62 mGy, 227.84 mGy, 341.12 mGy, for diagnostic, therapeutic and combined procedures, respectively. Conclusion. Interventional neuroradiology procedures show significant variability in radiation dose, due to patient constitution, radiologist expertise and equipment factors. Knowing the doses can have a great benefit for patients and medical and paramedical stff in terms of prevention of possible deterministic and stochastic effects of the radiation. [ABSTRACT FROM AUTHOR]

Introduction. Malignant melanoma is a tumor that develops from melanocytes, so this type of tumor can occur in any part of body containing the cells. Melanoma is less common than other skin tumors. It is very aggressive type of skin tumor with very early metastases and accounts for 75% of cases of death due to skin tumor. In the initial phase the tumor growth is horizontal. Early detection of changes is very important. Over time, as the tumor gets the vertical growth phase, occurrence of metastases depends on the depth of invasion (Breslow). Malignant melanoma metastasizes to regional lymph nodes, but also in the liver, lung, brain and almost any place that can be populated by the haematogenous route. Case report. We reported two cases of patients who were urgently surgically treated in the Emergency Center of Vojvodina, Serbia, with the clinical signs and symptoms of ileus. In both cases, the ileum resection was performed with terminal ileostomy. Histological analysis was performed and through morphology and immunohistochemical profile, in both cases, the diagnosis was metastatic malignant melanoma in the ileum. Conclusion. In patients with diagnosed malignant melanoma of the skin with symptoms of abdominal pain and/or anemia, application of modern imaging techniques is imperative in order to obtain an early diagnosis of gastrointestinal metastases of this tumor, because the rapid detection and radical resection may contribute to the overall survival of these patients. [ABSTRACT FROM AUTHOR]

Background/Aim. The protective effect of periconceptional folic acid supplementation in reducing the risk of neural tube defects (NTDs) and other adverse pregnancy outcomes has been scientifically confirmed. The present study aimed to assess knowledge, attitudes, and practice (KAP) of community pharmacists and pharmacy technicians with regards to counselling women of reproductive age on adequate folate intake. Methods. The cross-sectional study was conducted among the nationwide stratified sample of pharmacists and pharmacy technicians, practicing in both private and state-owned community pharmacies in Serbia. The detailed literature review, expert consultation and pre-testing were employed in the questionnaire development. The descriptive and inferential statistical analyses were performed using the SPSS software ver. 22. Results. Among 730 survey participants, 96.6% correctly identified types of deformities that could be prevented by folic acid and 77.0% recognized recommended dosage for women capable of becoming pregnant. However, fewer were able to recognize the optimal timing for folic acid supplementation (61.1%) and the proper dose for the NTD recurrence prevention (42.9 %). While 43.2% of pharmacy technicians thought that it was not their responsibility to provide a counselling concerning the measures for the prevention of congenital anomalies, only 4.7% of licensed pharmacists and none of the interns were of that opinion (χ² = 198.287; df = 4;p < 0.001). The majority of respondents (54.7%) reported provision of informative consultation concerning folic acid once a week, or few times a month, while only 10 stated to do so on a daily basis. In addition, based on self-report, only 36.7% of participants communicates information and advice regarding adequate folate status at their own initiative, while the rest addresses this topic only on the patients request, i. e., reactively. Conclusion. Although participants acknowledged the importance of their role in preconception health promotion, our findings revealed certain knowledge gaps as well as dominantly reactive counselling practice. Tailored educational interventions and professional support are needed to improve the engagement of community pharmacy personnel in this area of public health. [ABSTRACT FROM AUTHOR]

Background/Aim. Oral diseases appear to be the major risk factors for tooth loss, but social factors and other determinants could play an important role as well. The aim of this study was to determine whether the possible independent sociodemographic risk factors and depressive disorders could contribute to the tooth loss in the adult population of Serbia. Methods. This cross-sectional study analysed the 2013 National Health Survey results for the population of Serbia (without the data for Kosovo and Metohia population). The sample was selected to provide the statistically reliable estimates at the national level. Study included 13,519 adults of 20 years of age, or above. The mean age of participants was 49.9 years including 6,998 (51.8%) females and 6,518 (48.2%) males. The number of missing teeth was dependent variable while the independent variables were: gender, age, marital status, education, employment status, Wealth Index, smoking status, body mass index (BMI), milk and milk products intake, fruit intake excluding juices, vegetable and salad intake (excluding potato), and depression. To measure the current depression, the standardized and validated the Patient Health Questionnaire (PHQ)-8 score was used. Edentulism (complete or partial) was defined as a loss of natural teeth. In order to determine the predictors of tooth loss, the bivariate and multivariate logistic regression models were implemented for all types of tooth loss. Results. The significant differences were observed among the categories of edentulism in relation to independent variables except vegetable and salad intake. The prevalence of all missing teeth was highest in the females, the respondents with a low level of education, inactive, underweight (BMI < 18.5) and respondents with moderately severe depressive episodes (PHQ-8 score 15 to 19). In the multivariate model, we found that the demographic factors (age, living with a partner), socioeconomic factors (primary and secondary education, Wealth Index), smoking, BMI, the PHQ-8 score and the depressive symptoms were significantly associated with partial tooth loss. Conclusion. Study demonstrated that sociodemographic and lifestyle factors as well as the symptoms of depresssion are also important factors related to the tooth loss. This study can help to advance the need for health programs focusing on education, smoking cessation, dietary habits as well as regular visits to the dentist. [ABSTRACT FROM AUTHOR]

Background/Aim. Fluoride has beneficial effect on dental caries prevention and enables high hardness of enamel. However, fluoride intake above optimal levels can have adverse effects on teeth and bones, especially in young children during the period of intense growth and teeth development. The aim of this study was to assess fluoride intake from water and toothpaste among 3-year-old children in Belgrade, Serbia, in the municipalities of Vračar and Novi Beograd. Methods. A questionnaire for the parents (n = 40) was used to provide information on the water consumption (tap and/or bottled water) and the brand of toothpaste used by children as well as the frequency of tooth brushing and the amount of toothpaste during brushing. Fluoride concentrations in water and toothpaste samples were determined electrochemically by using fluoride-selective electrode. Fluoride intake was estimated through a mathematical model commonly used by the U.S. Environmental Protection Agency. Results. The obtained results indicate no significant difference in daily fluoride intake through drinking water and toothpaste in 3-year-old children in Vračar (n = 19) compared to Novi Beograd (n = 21) (p > 0.05). However, all estimated fluoride levels (0.089-0.625 mg/day) are significantly lower than the optimal daily intake level for caries protection (0.7 mg/day for children up to 4 years, FNB-USA National Institute of Medicine) and two to six times lower than tolerable upper fluoride level for the children of same age (1.3 mg/day, FNB-USA National Institute of Medicine). Furthermore, calculated daily fluoride intake per kilogram body weight confirm very low fluoride intake by water and toothpaste in children of investigated municipalities in Belgrade, being significantly below the recommended an adequate intake (0.05 mg/kg/day, EFSA). Conclusion. This preliminary study has shown that daily fluoride intake in 3-year-olds is lower than tolerable upper fluoride level, even not sufficient for the prevention of dental caries. [ABSTRACT FROM AUTHOR]

Background/Aim. The era of direct-acting antiviral (DAA) regimen in the treatment of chronic hepatitis C virus (HCV) started in 2011. The aim of this study was to assess the antiviral efficacy and safety of DAA regimen, ombitasvir (OBV)/paritaprevir (PTV)/ritonavir (r) + dasabuvir (DSV) + ribavirin (RBV), in patients with chronic HCV infection, genotype 1. Methods. The real-life data were collected. The study was multicentric and included seven infectious diseases and hepatology departments in Serbia. A total of 21 patients were enrolled in the OBV/PTV/r + DSV + RBV early access program, 20 of which were previously treated with pegylated interferon + RBV, while 1 was treatment-naive. All patients received the adequate doses of these antiviral drugs. RBV was not given to the patients with HCV genotype 1b infection according to the therapeutic protocol. For the majority of patient, the treatment duration lasted for 12 weeks. For the patients with liver cirrhosis, who were infected with HCV genotype 1a, the duration of treatment was 24 weeks. Viremia was assessed at four points in time: at baseline, 4 weeks after the treatment beginning (rapid viral response, RVR), 12 or 24 weeks after the treatment beginning (end of treatment response -- ETR) and 12 weeks after the end of treatment (sustained viral response -- SVR). SVR, as a confirmation of the absence of HCV was considered as endpoint of successful treatment. Results. Complete RVR, ETR and SVR were achieved in 64.71%, 85.71% and 95.24% of the patients, respectively. Only 3 patients had mild adverse effects which did not required dose reduction. Conclusion. The treatment of the patients with a chronic HCV infection with OBV/PTV/r + DSV + RBV resulted in excellent antiviral activity and tolerability. [ABSTRACT FROM AUTHOR]

Background/Aim. In the last two decades the incidence of recurrent Clostridium difficile infection (CDI) has risen. The aim of this study was to determine the risk factors for the recurrent CDI among patients hospitalized with the initial CDI. Methods. We conducted a retrospective clinical trial at the Clinic for Infectious Diseases, Clinical Center of Vojvodina, Serbia, between January 2010 and January 2016. We enrolled 488 patients with the initial CDI who were treated with oral vancomycin (125 mg, 4 times per day) or oral metronidazole (400 mg, 3 times per day) for 10 days. After the completion of therapy, there was 60 days of the follow-up period for the assessment of the rates of relapse. To determine the risk factors for the CDI relapse, we compared the demographics, clinical and laboratory characteristics of the patients who had a relapse with the patients who had a stable clinical response. Results. Of the 488 cases, 29.09% recurred. The relapse occured in 22.72% patients who received vancomycin and in 36.60% patients treated with metronidazole metronidazole (p = 0.038). A statistically significant effect on the CDI relapse had the comorbidities such as a malignancies (19.52% vs 8.82%, p = 0.023) and the postoperative CDI (25.67% vs 10.29%, p = 0.035), hipoalbuminemia (< 25 g/L) (70.27% vs 41.94%; p = 0.034) and the concomitant antibiotic therapy (50.67% vs 20.29%; p = 0.031). The persistence of C. difficile toxin in the stool at the end of treatment was registered in 22.32% of patients treated with metronidazole vs 9.09% of patients given vancomycin (p = 0.03). Conclusion. Our data suggest that the important risk factors for the CDI relapse are comorbidities (surgery within a month before developing CDI and malignancy), hipoalbuminemia (< 25g/L) and concomitant non-CDI antibiotics therapy. Vancomycin is more effective than metronidazole in the elimination of C. difficile toxins. The presence of C. difficile toxins in the stool after the successful completion of the initial CDI therapy does not affect significantly the occurrence of relapse. [ABSTRACT FROM AUTHOR]

Background/Aim. Chlamydia trachomatis infection (CTI) is an increasing public health problem worldwide and is the most frequent sexually transmitted infection. Studies conducted in many armed forces worldwide showed that CTI is common within military population and generate significant healthcare costs. The aim of this study was to estimate the prevalence of CTI among members of the Serbian Armed Forces (SAF) and to determine risk factors for this infection. Methods. The study was designed as a cross-sectional survey and consisted of completing a questionnaire and chlamydial testing. The questionnaire was divided into two question groups: one was about demographic/service related characteristics and the other was about behavioral patterns/ habits. Chlamydia trachomatis real time polymerase chain reaction (Real-TM PCR) was used for detection of pathogen genome specific sequence in the male urethral swabs and in the female endocervical swabs. All data collected were used to compare military personnel with and without CTI. Risk factors independently associated with CTI were identified by the stepwise multivariate logistic regression analysis (MLRA) of variables selected by the univariate logistic regression analysis (ULRA), with a limit for entering and removing variables from the model at 0.05. Results. The overall prevalence of CTI was 55 of 356 respondents (15.4%; 95% CI 0.5--2.7%). The ULRA identified that CTI was significantly associated with several characteristics: number of sexual partners during previous year (p = 0.008), knowledge about symptoms of CTI (p = 0.035), tattooing (p = 0.035) and married or in stable relationship (p = 0.022). The MLRA revealed that number of different sexual partners during last year was independent risk factor of CTI (p = 0.026; OR : 0.344; 95% CI: 0.13--0.88). Conclusion. CTI is significant problem in male and female military personnel in the SAF. The number of different sexual partners during previous year was independently associated with CTI. These finding indicates that screening for CTI should be undertaken in the SAF, to reduce rates of CTI in the SAF and to prevent morbidity due to this infection. [ABSTRACT FROM AUTHOR]

Background/Aim. Analysis of air quality in Serbia indicates that the city of Niš belongs to a group of cities characterized by the third category of air quality (excessive air pollution). The aim of the study was to analyze the degree of causality between ambient air quality affected by particulate matter of 10 μm (PM10) and carbon monoxide (CO) and the incidence of respiratory diseases in preschool children in the city of Niš. Methods. We quantified the influence of higher PM10 concentrations and carbon monoxide comprising motor vehicle exhausts in the city of Niš on the occurrence of unwanted health effects in preschool children by means of the hazard quotient (HQ), individual health risk (Ri), and the probability of cancer (ICR). The methodology used was according to the US Environmental Protection Agency (EPA), and it included basic scientific statistical methods, compilation methods, and the relevant mathematical methods for assessing air pollution health risk, based on the use of attribute equations. Results. Measurement of ambient air pollutant concentrations in the analyzed territory for the entire monitoring duration revealed that PM10 concentrations were significantly above the allowed limits during 80% of the days. The maximum measured PM10 concentration was 191.6 μg/m³, and carbon monoxide 5.415 mg/m³. The incidence of respiratory diseases in the experimental group, with a prominent impact of polluted air was 57.17%, whereas the incidence in the control group was considerably lower, 41.10%. There were also significant differences in the distribution of certain respiratory diseases. Conclusion. In order to perform good causal analysis of air quality and health risk, it is very important to establish and develop a system for long-term monitoring, control, assessment, and prediction of air pollution. We identified the suspended PM10 and CO as ambient air pollutants causing negative health effects in the exposed preschool children population. [ABSTRACT FROM AUTHOR]

Background/Aim. The differential diagnosis of fever of unknown origin (FUO) includes more than 200 different diseases and conditions. The aim of this study was to identify the most frequent causes of FUO among adult patients according to gender and age. Methods. The study included 74 patients examined from June 2010 to June 2013 at the Infectious Disease Clinic, Clinical Center Kragujevac in Serbia, according to the defined criteria for FUO. The patients were divided according to the diagnosis into four groups: infectious, malignant, rheumatic and “other diseases”. A cause of febricity could not be estabilshed in a portion of subjects, and they comprised the group of undiagnosed cases. Results. Infectious diseases were dominant in the study, followed by rheumatic diseases, which were most frequently found in women and the elderly. The diseases recognised as the most common causes of febricity were subacute thyroiditis, subacute endocarditis, Still’s disease, rheumatic polymyalgia with or without temporal arteritis, and cytomegalovirus infection. In 44% of the patients, the final diagnosis was composed of only six clinical entities. Conclusion. The importance of establishing the diagnosis of rheumatic disease is especially emphasised, in line with other authors’ research indicating the number of these diseases is on the rise. The diagnostic approach to FUO should always be directed to the known frequency of diseases. [ABSTRACT FROM AUTHOR]

Background/Aim. Dental anxiety leads to avoidance of dental treatment and could lead to impaired oral health. The aim of this study was to determine the reliability of the Serbian version of Children's Fear Survey Schedule Dental Subscale (CFSS-DS) and the relations between dental anxiety and oral health status in a sample of Serbian schoolchildren. Methods. The CFSS-DS scale was translated into Serbian and administered to 231 (12-year old) patients of the Pediatric Dental Department, Public Health Center Čukarica, Belgrade. The number of healthy, decayed, missing and filled teeth (DMFT score) in children was determined by a clinical exam. Results. The average CFSS-DS score was 26.47 ± 10.33. The girls reported higher anxiety than the boys (p < 0.05). Most common fears were drilling, choking, going to the hospital and anesthesia. Lower CFSS-DS scores were recorded in children with all healthy teeth (p < 0.05). Children with higher CFSS-DS scores mostly visit the dentist due to pain or parental insistence, and those with lower anxiety scores more often visited dentist due to regular check-ups or non-invasive treatments (p < 0.01). A high value of the Cronbach's coefficient of internal consistency (a = 0.88) was found in the entire scale. Conclusion. The Serbian version of CFSS-DS questionnaire is reliable and valid psychometric instrument for evaluation of dental fear in Serbian children. Dental anxiety negatively affects dental attendance and oral health of the examined schoolchildren. [ABSTRACT FROM AUTHOR]

Background/Aim. Cancer, one of the leading causes of mortality in the world, imposes a substantial economic burden on each society, including Serbia. The aim of this study was to evaluate the major cancer cost drivers in Serbia. Methods. A retrospective, in-depth, bottom-up analysis of two combined databases was performed in order to quantify relevant costs. End-of-life data were obtained from patients with cancer, who deceased within the first year of the established diagnose, including basic demographics, diagnosis, tumour histology, medical resource use and related costs, time and cause of death. All costs were allocated to one of the three categories of cancer health care services: primary care (included home care), hospital outpatient and hospital inpatient care. Results. Exactly 114 patients were analyzed, out of whom a high percent (48.25%) had distant metastases at the moment of establishing the diagnosis. Malignant neoplasms of respiratory and intrathoracic organs were leading causes of morbidity. The average costs per patient were significantly different according to the diagnosis, with the highest (13,114.10 EUR) and the lowest (4.00 EUR) ones observed in the breast cancer and melanoma, respectively. The greatest impact on total costs was observed concerning pharmaceuticals, with 42% of share (monoclonal antibodies amounted to 34% of all medicines and 14% of total costs), followed by oncology medical care (21%), radiation therapy and interventional radiology (11%), surgery (9%), imaging diagnostics (9%) and laboratory costs (8%). Conclusion. Cancer treatment incurs high costs, especially for end-of-life pharmaceutical expenses, ensued from medical personnel tendency to improve such patients' quality of life in spite of nearing the end of life. Reimbursement policy on monoclonal antibodies, in particular at end-stage disease, should rely on cost-effectiveness evidence as well as documented clinical efficiency. [ABSTRACT FROM AUTHOR]

Background/Aim. Norovirus (NoV), formerly Norwalk-like virus is the most common cause of acute gastroenteritis in humans of all ages. It is known that 90% of viral gastroenteritis and about 60-85% of all outbreaks of gastroenteritis, especially in the territory of United States of America, Europe and Japan are caused by this virus. For the countries of the northern hemisphere, individual cases and outbreaks of acute NoV gastroenteritis appear in seasonal pattern, mainly during the winter months. The aim of this study was to describe characteristics of acute gastroenteritis with the established NoV etiology in Serbia. Methods. The study group included 88 patients with the symptoms of acute gastroenteritis, throughout the year 2010 and 2011. From all the patients, stool samples were taken less than three days from the onset of symptoms. Detection of NoV in stool samples was performed by commercial qualitative immunochromatography assay. Statistical analysis included application of χ² test, Mann-Whitney U-test, Kruskal-Wallis's test, Spearman's rank correlation test and logistic regression analysis. Results. Outbreaks of acute gastroenteritis caused by NoV were recorded to be the most common in children with the incidence of infection of 50% in the age group 0-15 years. Analysis of individual symptoms in the NoV proven infection, showed that diarrhea was the most common symptom, followed by vomiting especially in small children, while abdominal pain was most common in elderly (≥ 65 years). The presence of frequent vomiting, more than 4 times/day, indicated NoV infection in the women, while for men the infection was always presented with diarrhea. Conclusion. The obtained results confirmed that small children and elderly are the most susceptible to NoV infection and that outbreaks are more frequent in the winter months. Those who consumed food in restaurants and other public facilities were not at higher risk for NoV infection. [ABSTRACT FROM AUTHOR]

Introduction. The number of humans infected by Fasciola hepatica is increasing worldwide. Humans can become accidental hosts by ingesting drinking water or plants contaminated with metacercariae. Case report. We reported a case of a 68-year-old Serbian woman, in which the diagnosis of acute fasciolosis had been established after serious diagnostic concerns. Based on clinical picture (episodic right upper quadrant abdominal pain, febrility and generalized body pain) and biochemical analyses (high eosinophilia and high activity of alkaline phosphatase), she was appointed as suspected to the acute fasciolosis. Stool and duodenal aspirate exams were negative for Fasciola ova. In the absence of adequate serologic diagnostic for fasciolosis in Serbia, the diagnosis was confirmed using enzyme immunoassays and immunoblot at the Institute for Tropical Diseases in Hamburg, Germany. Soon after triclabendazole was administered, the symptoms disappeared and biochemical values returned to normal. Conclusion. The diagnosis of human fasciolosis may be problematic and delayed, especially in non endemic areas, because physicians rarely encounter this disease and a long list of other diseases must be considered in the differential diagnosis. The syndrome of eosinophilia, fever, and right upper quadrant abdominal pain suggest acute fasciolosis. Unclear source does not rule out fasciolosis. [ABSTRACT FROM AUTHOR]

Background/Aim. Endobronchial tuberculosis (EBTB) is a specific type of pulmonary tuberculosis which often affect the tracheobronchial tree, and can be microbiologically and/or pathohistologically confirmed. The aim of the study was to determine the clinical features and diagnostic aspects of EBTB. Methods. This retrospective study was conducted at the Clinic for Lung Diseases, Clinical Center of Serbia, Belgrade, from January 1997 to December 2007. All patients with EBTB confirmed by bronchoscopy with biopsy during a study period were analysed. Data included the patient's medical history, a physical exam, chest X-ray, mycobacterial analysis of sputum samples, endoscopic types and patohistological confirmation. Results. In the study, 57.6% of the patients were males. The most frequent symptoms were cough (71.2%), malaise (54.2%), fever (49.2%), weight loss (40.7%), and hemoptysis (13.6%). Most of the patients were diagnosed within 30 days of symptoms onset. Sputum examination showed acid-fast bacilli in 31.4% of the patients, while sputum culture for tuberculosis bacilli were positive in 55.9% of the patients. The most common radiographic localization was in the upper lung lobes (63.5%). Cavities were present in 60.4% of the patients. The most common endoscopic subtype determined by bronchoscopy were nonspecific bronchitis (39.9%) and edematous-hyperemic subtype (36.4%). Conclusion. EBTB was more frequent among men, and among people in their fifties in our country. Detailed bronchoscopic examination, correlated with clinical and laboratory findings, will improve diagnostic rate and provide timely therapy. [ABSTRACT FROM AUTHOR]