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Background/Aim. Hypervolemia is an important risk factor for the development of cardiovascular morbidity and mortality in patients treated with regular hemodialysis. There is still no reliable method for assessing the status of volemia in these patients. The aim of the study was to assess the status of volemia in patients treated with regular hemodialysis by measuring the parameters of the inferior vena cava (IVC) and bioimpedance. Methods. The effect of hemodialysis treatment on ultrasound parameters of the IVC, as well as on the parameters measured by bioimpedance, was examined before and after hemodialysis. The values of the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) were measured both before and after hemodialysis. Forty-five patients were involved in this non-interventional cross-section study, including the patients treated with standard bicarbonate dialysis. According to the interdialytic yield, the patients were divided into three groups: I (up to 2,000 mL), II (2,000?3,000 mL), and III (over 3,000 mL). Results. The values of the IVC parameters and the parameters measured with bioimpedance were significantly lower after treatment with hemodialysis (p < 0.005). The third group of patients had a significantly higher total fluid volume in the body com-pared to the group I, as well as a significantly greater volume of extracellular fluid (p < 0.005). The significantly lower values of NT-proBNP in all groups (p < 0.005) were detected after hemodialysis. After treatment with hemodialysis, a positive correlation was observed between the concentration of NT-proBNP in the serum and the extracellular/intracellular water ratio. However, the correlation between NT-proBNP concentration and total fluid measured by bioimpedance spectroscopy did not reach statistical significance. Conclusion. Measurement of the IVC ultrasound parameters and volemia parameters using bioimpedance significantly contributes to the assessment of the status of volemia. Nevertheless, it cannot be used as a separate parameter, only in combination with all other methods.

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The unstoppable process of demographic aging of population has profound consequences on the economic, health, social and political spheres of society, because of the specific and diverse needs of the older population. The aim of the study was to examine gender differences of health care utilization among elderly in Serbia. The survey was conducted as a part of the national study "Health Survey of the Serbian population" in 2013. In the past year, 87.4% of the older population visited their chosen doctor. Women were significantly more likely to use primary health care compared to men, while the frequency of hospitalization is significantly higher in men. When it comes to female population, age, region of residence and financial situation stood out as the most important predictors of primary care services usage. In men, the residence stood out as the most important predictor of primary health care services usage. Multivariate binary logistic regression distinguishes gender, education and region of residence as the most important factors associated with hospital treatment.

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Background: We aimed to examine the quality of life of children who engage in regular physical activities. Methods: We conducted a cross-sectional study with intersectional 301 children (182 boys and 119 girls) involved in regular sporting activities and the control group of 100 children (67 boys and 33 girls), not involved in extracurricular sports. Children in both groups were from 8 to 13 years, attending elementary school, and without any associated illnesses. The quality of life (QOL) was assessed using the Quality of Life questionnaire Kidscreen-27 version for parents. For comparison of groups, we used χ2 test, and for comparison of mean values among groups we used ANOVA test. Results: More boys were engaged in sport than girls and the choice of sport is gender-dependent (P

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Galectin 3 plays a significant role in the development of chronic renal failure, particularly end-stage renal disease (ESRD). The aim of our study was to investigate the association between Gal-3 and biochemical parameters and primary disease in ESRD patients, by exploring the polymorphisms

BackgroundThe aims of our study are related to examining the relevance of teachers' attitudes toward the implementation of inclusive education. In addition, its subject is related to the implications on inclusive education policies, limitations of the existing study along with the recommendations for our future research endeavors.MethodsThe research is a cross-sectional study type. The sample included 64 primary school teachers in the lower grades of primary school (grades 1–4), selected by using simple random sampling, in three primary schools on the territory of Belgrade, Serbia in 2021 (26, 17, and 21 primary school teachers). The Questionnaire for Teachers, which was used as a research instrument, was taken from the Master's Thesis Studen Rajke, which was part of the project “Education for the Knowledge Society” at the Institute for Educational Research in Belgrade. Dependent variables measured in the study referred to the attitudes of primary school teachers toward inclusive education. Categorical variables are represented as frequencies and the Chi-square test was used to determine if a distribution of observed frequencies differed from the expected frequencies.ResultsOne in three teachers (32.8%) thought that inclusion was useful for children with disabilities (29.7%), of them thought that schools did not have the conditions for inclusive education, whereas one in four teachers (25.0%) believed that inclusion was not good. No statistically significant differences were found in the attitudes of professors, when observed in terms of their gender, age and length of service.ConclusionInvesting more resources and time in developing and implementing special education policies can promote successful inclusive education.

Introduction/Objective. Serbia has been burdened with one of the highest cervical cancer incidence and mortality rates in Europe. The objective of the study was to estimate the prevalence and factors associated with compliance to cervical cancer screening among women in the general population. Methods. The study used the data from 2013 National Health Survey of the population of Serbia. Logistic regression analysis was further used to examine demographic and socio-economic factors which affect the disparities in cervical cancer screening practices among the female population. Results. Every third woman (35.4%) has never done a Pap test in her lifetime. The highest percentage of respondents did their Pap tests after they were recommended by doctors (52.3%); 45% of women did it on their own initiative, and only 2.7% did it after they had been summoned to participate in an organized screening by their doctor. The multivariate logistic regression analysis revealed that the most important factors in women who had never undergone Pap tests were the following: age (being within the youngest or the oldest age group), rural residence and low level of education, poor socio-economic status, and marital status (have never married). Conclusion. Further strategies and interventions for improving cervical cancer incidence and mortality rates should be focused on socially and economically endangered population groups in order to reduce disparities in cervical cancer screening more effectively.

Introduction: Goodpasture syndrome is a rare autoimmune syndrome with alveolar hemorrhages and glomerulonephritis caused by circulating antibodies against the glomerular basement membrane. Anti-glomerular-basement-membrane were administered against a non-collagen (NC-1) 3 chain of collagen type IV, which was found at the highest concentration in the basal membrane of renal and pulmonary capillaries. The aim of case report is a clinical overview of this rare and severe syndrome. Case report: The patient, 22-years-old was sent to the Center of Urgent Medicine of Clinical Center Kragujevac from General Hospital of Paraćin because of blood poisoning, fever, symptoms and signs of renal and respiratory weakness, and suspected of Wegener's disease. Antibodies were taken on the basement membrane of the glomerulus were resulted of enormously high. After due to the clinical and immunology diagnosis of Goodpasture syndrome, plasmapheresis treatment was initiated. The standard hemodialysis was continued. Following the guidelines protocols, patient received pulse dozes of cytostatics, corticosteroids, etc. Conclusion: The case report of our patient points to the necessity of multidisciplinary approach of the expert team, consisting of a nephrologist, pulmonologist, clinical pharmacologist and other specialists. The prognosis is good, if treatment is started before irreversible pulmonary and/or renal changes (respiratory and/or renal insufficiency). Goodpasture syndrome often progresses rapidly, so it can be fatal if it's delayed with the diagnosis and the treatment. Patients with Goodpasture's syndrome require adequate socio-medical care as a rare and severe syndrome.

Introduction/Objective. The most frequent postoperative complication of a successfully performed phacoemulsification cataract surgery is the development of posterior capsule opacification (PCO). It is caused by the proliferation and migration of the remaining residual epithelial cells. The objective of this study was to investigate the influence of two different intraocular lenses and two different anti-inflammatory drugs on the development of PCO in one-year follow-up period. Methods. Investigation included 120 patients (120 eyes), equally divided into four groups. The first two groups included patients who used non-steroid anti-inflammatory drug (NSAID) postoperatively, while the other groups had corticosteroid therapy. The first and third group got hydrophilic intraocular lenses (IOL), the second and fourth group had hydrophobic IOL. Software program EPCO 2000 was used for the analysis of PCO. Student?s t-test, Wilcoxon test, and ANOVA were used for data analysis and p < 0.05 value was accepted as statistically significant. Results. After the first three postoperative months, patients from NSAID groups had mean PCO score 0.25 ?} 0.03, which was statistically significant higher (p = 0.042) comparing to corticosteroid groups. At the end of the investigation, the best result in PCO preventing was seen in the group of patients with hydrophobic IOL and corticosteroid therapy, with the mean PCO score of 0.47 ?} 0.08. Conclusion. This study has revealed that IOL made of acrylic hydrophobic material seemed to be the right choice when choosing intraocular lens to prevent PCO development. On the other hand, NSAID and corticosteroid therapy have showed similar results in preventing postoperative intraocular inflammation. This fact can be very useful in situations when corticosteroids must be used with great caution.

Depression is the most frequent mental health problem in older age with serious consequences on personal, interpersonal and social level. The aim of this study was to determine the association of demographic factors, socio-economic factors and health status characteristics, with the presence of depressive symptoms in the elderly persons. The survey was conducted as a part of the national study “Health Survey of the Serbian population” in 2013. Data on the population aged 65 years and over were used for the purposes of this study (3540 respondents). PHQ-8 questionnaire was used to assess the presence of symptoms of depression. The relations between the presence of depressive symptoms, as a dependent variable, and a set of independent variables was examined by univariate and multivariate logistic regressions. Depression (PHQ-8 score≥10) was registered in 10% of the population aged 65 and above, wherein it was statistically significantly higher in women (12.7%) than in men (6.5%). Limitations in performing of daily activities showed to be the strongest predictor of depression in the elderly, while respondents who have had serious limitations had even six times more chanse to develop depression (OR=6.84). Respondents who rated their health as “bad or very bad” for 49.5% more frequently manifested depressive symptoms compared to those who evaluated their health as “very good or good” (OR=3.49). Respondents who have had two or more chronic diseases were three times more likely to have depression (OR=3.1) compared to people without chronic disease.

Background/Aim. Analysis of prevalence and correlation of contraceptive use among women of reproductive age (15 to 49 years) in Serbia. Methods: Raper is based on data from a national health survey of the population of Serbia in 2013 (no data for Kosovo and Metohija). For the purposes of study, the data on households and population age 15 and over were used, so that the final sample for analysis entered 3.634 women of reproductive eage. χ2 test was applied to test the difference in frequency of categorical variables. Logistic regression analysis was applied to examine the correlates of female contraceptive use in Serbia. Results with probability that is equal to or les sthan 5% (p≤0.05) were considered statistically significant. Results: Overall contraceptive prevalence in women of reproductive age was 34.8%. Five variables had a significant connection with the use of contraceptives among women: age, education, marital status, residence region, index of wellbeing. Two variables had no statistical significance in study: employment status, type of settlement. Conclusions: Based on results, we can conclude that the prevalence of use of contraceptives among women in Serbia is relatively low and therefore reproductive health of women is endangered to agre at extent.

Introduction: Patient safety is the identification, analysis and correction of risk events in order to make healthcare safe and risk reduction to the patient at the lowest possible level. The Aim: The aim of this paper is to determine the frequency and type of unwanted events in the statehospitals of the three districts (Sumadija, Pomoravlje and Raska) in the period from 2012 to 2015. Methods: A retrospective study of patient safety indicators was conducted for six general hospitals in three districts (Sumadija, Pomoravlje and Raska district). Data on patient safety indicators are obtained from the report on Quality Indicators for the period from 2012 to 2015. Statistical analysis of the collected data included descriptive statistics (tabulations and graphic display) and the linear trend. Results: In the observed general hospitals of three districts (Sumadija, Pomoravlje and Raska) in the period 20122015, the most common unwanted events are infections of the operative site, infections in the intensive care unit and repeated operations in the same region, with the lowest reported iatrogenic damage during surgical intervention. Although the large number of infections have occurred in departments of stationary health facilities, the overall rates of these adverse events in general hospitals show the downward trend in years of observation. Of the total rates of unwanted events in the period 20122015, there is the trend of growth in the overall rate of decubitus and thromboembolic complications. Conclusion: Introduce enhanced monitoring of the proper record keeping of unwanted events. Educate patients and their families about the prevention of unwanted events and the importance of respecting the code of conduct in stationary health facilities.

Galectin 3 plays a significant role in the development of chronic renal failure, particularly end-stage renal disease (ESRD). The aim of our study was to investigate the association between Gal-3 and biochemical parameters and primary disease in ESRD patients, by exploring the polymorphisms LGALS3 rs4644, rs4652, and rs11125. A total of 108 ESRD patients and 38 healthy controls were enrolled in the study. Genotyping of LGALS3 gene rs4644, rs4652, and rs11125 polymorphisms was performed by polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP). By multivariate logistic regression analysis, we found that LGALS3 rs4644 CC and rs4652 AA genotypes were significantly associated with a higher risk for lower hemoglobin, higher level of parathyroid hormone, and also occurrence of diabetes mellitus and arterial hypertension. The CAA haplotype was significantly more common in patients with diabetes, low hemoglobin level, and normal PTH level. It has been observed as well that the ACT haplotype was more common in patients with low glomerular filtration, low PTH, and normal hemoglobin level. We found that the LGALS3 rs4644 and rs4652 gene polymorphism may be involved in the pathogenesis and appearance of complications in ESRD patients and thus could be considered a new genetic risk factor in this population.

University students are a specific adolescent population which is preparing to take participation in different domains of a society as its integral and creative part. Chronic noncommunicable diseases have a major impact on women’s reproductive health, so their adverse epidemiological situation has significant effects on reproductive health in general. Since non-communicable chronic diseases have been a growing burden on reproductive health, the aim of this paper is asses of reproductive behavior and risk factors of non-communicable disease in female student population on Faculty of Medical Sciences University of Kragujevac. This study was conducted as a prospective cross-sectional study. The sample includes 59 female students of The Faculty of Medical Sciences, University of Kragujevac. The study was conducted in three stages based on the methodology and instruments recommended by STEPwise Approach to Noncommunicable Disease Risk Factor Surveillance of the World Health Organization (STEPS). About 71.2 % of the participants reported that they had a sexual intercourse. In average, the respondents were 18 years old (SD±1.222) at the time of their first sexual intercourse. At that point, a little less than one third of them did not use any type of protection (31.7%). During the last sexual intercourse, about 65.5% did not use protection. About 22.5% of our subjects have morning glycemia with prediabetes values (glycemia cut off ≥ 5.5mmol/L). Hypercholesterolemia is present in 3.4% of the respondents (cut off ≥ 5,2mmol/l). Most respondents are eutrophic (18.8% preobese and 2.1% obese). The android obesity type is the least frequent (about 10%). This results indicates that female students has unhealthy habits in terms of their reproductive health and preventive measures. This activity indicaty a wide array of preventive action which will aim at preserving reproductive health and health in general.

Introduction/Objective. Dry eye development after phacoemulsification is a very common complication of cataract surgery. Combined with other risk factors, such as pseudoexfoliation (PEX), this complication becomes more frequent. The aim of this study was to expose the influence of phacoemulsification associated with PEX on the development of dry eye in patients who underwent cataract surgery. Methods. The study included 160 eyes (160 patients) who underwent phacoemulsification. The patients were divided into four groups (n = 40 patients). Groups I and II involved patients without PEX. The patients from Group II were prescribed artificial tears (AT) postoperatively. The patients from Groups III and IV had a presentation of PEX. The patients from Group IV got AT postoperatively. Ocular Surface Disease Index, the tear breakup time (TBUT) test, fluorescein staining, and Schirmer?s test served as ?dry eye? tests in this study. The ?2 test and paired t-test were used for data analysis. Results. Measurements were taken for every patient preoperatively, on the first and the seventh day after the surgery, one month and three months, and one year after the surgery. The tests showed postoperatively developed dry eye in all the groups, with the recovery of the tear film within three months, except for Group III. The highest statistical significance (p < 0.001) was recorded between Groups II and III, three and 12 months after the surgery. Values of TBUT (6.09 ? 1.29 seconds) and Schirmer?s test (8.91 ? 2.14 mm) in Group III strongly indicated that dry eye was still present one year after phacoemulsification. The greatest recovery of the tear film was recorded in Group II in all the measurements. Conclusion. The study showed how strongly PEX and the use of AT affect the tear film during the first postoperative year. Based on our experience, we highly recommend the use of AT after performing phacoemulsification.

Introduction/Objective. The objectives of the paper are to assess the causes of low vision (LV) in pediatric population in Montenegro and to evaluate the influence of low vision aids (LVA) on reading performance regarding the speed of reading and the understanding of the read text. Methods. A prospective study was conducted on 40 ?treatable? LV children what represent all registered LV children in Montenegro. All participants read the same text before and after using LVA. Reading rate was calculated as the number of words read per minute. Functional speed of reading was calculated as the ratio of the rate of reading and the understanding of the read text multiplied by 100. Results. The study comprised 40 LV children with the mean age of 12.60 ? 4.06 years (20 boys and 20 girls). The most common cause of LV in children were premature retinopathy (10/40 or 25%), retinitis pigmentosa (8/40 or 20%), optic nerve anomaly (5/40 or 13%), degenerative myopia (4/40 or 10%), macular dysgenesis (4/40 or 10%), Stargardt disease (3/40 or 7%), optic nerve atrophy (2/40 or 5%), and albinism (2/40 or 5%). Nystagmus was found in 11 LV children or 28% of the group. LVA were prescribed to all of them. Reading speed before vs. after LVA use was 36.58 ? 35.60 vs. 73.83 ? 27.05 words/minute (p < 0.001), while functional reading was 26.00 ? 30.43 vs. 59.41 ? 29.34 (p < 0.001). Conclusion. LV children demonstrate a significant improvement in reading performance by using LVA.

Background/Aim. The integrity of outer retinal structures, primarily the photoreceptor layer, is important because of its direct correlation with visual acuity. The aim of this study was to investigate the correlation between best-corrected visual acuity (BCVA), the foveal photoreceptorinner segment/outer segment (IS/OS) junction and external limiting membrane (ELM) in patients with neovascular age-related macular degeneration (NVAMD) after the treatment with bevacizumab, as well as the correlation between the above-mentioned parameters and different types of neovascular membrane, classified by fluorescein angiography (FA). Methods. The study included 82 patients with NVAMD, treated with intravitreal bevacizumab. All patients underwent a basic ophthalmological examination, FA and optical coherence tomography (OCT). Based on the results of FA, all the patients were divided into two main groups ? type I (the occult and minimally classic) and type II (classic and predominantly classic) of the choroidal neovascular membrane (CNV). The OCT images revealed either the presence or the absence of IS/OS and ELM. Results. After the treatment, the mean best corrected visual acuity improved significantly in both groups (p < 0.01). Preserved IS/OS and ELM were registered in a smaller number of patients as compared to the condition before the treatment (p < 0.01). After the treatment, the mean BCVA was significantly better in patients with preserved IS/OS and ELM (p < 0.01). In addition, we registered a higher number of patients with preserved ELM in the first group than in the second group (p < 0.01), whereas there was no significant difference in the integrity of IS/OS between the groups (p > 0.05). Conclusion. The patients with preserved IS/OS and ELM achieved better final visual acuity as compared to the patients without preserved IS/OS and ELM. In our patients, the absence of IS/OS and ELM were more frequent in type II (classic and predominantly classic) CNV than in type I (the occult and minimally classic) CNV.

Introduction/Aim. Pseudoexfoliation syndrome (XPS) is age related systemic disorder characterized by increased production and accumulation of elastic micro-fibrillar material in different tissues of the body: skin, connective tissue portions of visceral organs, periphery blood vessels and the eye, as well. The aim of our study was to determine the significance of atherosclerotic changes in the carotid arteries in the development of XFS and pseudoexfoliation glaucoma (XFG). Methods. Our study included 120 patients - 40 patients per each of three defined groups: XFS group, XFG group and age- and sex-matched control subjects (control group) without XFG. Blood samples were collected from the patients before cataract surgery. Serum levels of lipid profiles (total cholesterol, LDL, HDL and triglycerides) were analyzed by standard laboratory techniques. Standard ultrasonography of the carotid blood vessels was performed on all participants. Results. Lipid’s profile was disturbed in patients with XFS and XFG with statistical significance (p

Serbia is an upper-middle income Eastern European economy. It has inherited system of health provision and financing, which is a mixture of Soviet Semashko and German Bismarck models. So far, literature evidence on long-term trends in health spending remains scarce on this region. Observational descriptive approach was utilized relying on nationwide aggregate data reported by the Republic Health Insurance Fund (RHIF) and the Government of Serbia to the WHO office. Consecutively, the WHO Global Health Expenditure Database1 was used. Long-term trends were extrapolated on existing data and underlying differences were analyzed and explained. The insight was provided across two distinctively different periods within 2000–2016. The first period lasted from 2000 till 2008 (the beginning of global recession triggered by Lehman Brothers' bankruptcy). This was a period of strong upward growth in ability to invest in health care. Spending grew significantly in terms of GDP share, national and per capita reported expenditures. During the second period (2009–2016), after the beginning of worldwide economic crisis, Serbia was affected in a way that its health expenditure growth in PPP terms slowed down effectively fluctuating around plateau values from 2014 to 2016. Serbia health spending showed promising signs of steady growth in its ability to invest in health care. Consolidation marked most of the past decade with certain growth rates in recent years (2017–2019), which were not captured in these official records. The future national strategy should be devised to take into account accelerated population aging as major driver of health spending.

Pterygium is an ocular disease characterised by the growth of fibrovascular conjunctiva on the cornea. It occurs more often in men, at an older age, and in individuals exposed to ultraviolet radiation. Surgical treatment is the primary treatment for pterygium and there are two common procedures for pterygium excision. In the first method, the head of the pterygium is separated from the corneal surface using a surgical blade. The second method is based on avulsion. Other approaches to excising the pterygium include the use of argon laser and excimer laser. Because of a high recurrence rate, adjuvant therapies, including radiotherapy, chemotherapy, and graft procedures, are used after pterygium excision. These procedures have become the standard long-term treatments for pterygium. Radiotherapy is based on beta irradiation. Chemotherapy includes the use of mitomycin C, 5-fluorouracil, bevacizumab, and loteprednol etabonate. Graft procedures include amniotic membrane grafts and conjunctival autografts. Many surgeons believe that using mitomycin C and conjunctival autografts provides the best outcomes in terms of recurrence, cosmetics and patient satisfaction.

The aim of this study is to analyze the health status of the population in Central Serbia, in order to identify priority health problems. As a source of data, authots use the reports about diseases, conditions and injuries services for the health care of preschool children, services for school health, health care services for the adult population and services for the health care of women's health centers in Central Serbia in 2015. On the territory of Central Serbia, leading cause of morbidity in children of preschool and school age are diseases of the respiratory system. Cardiovascular diseases and respiratory diseases dominate in the structure of morbidity in the adult population, as well as high blood pressure as a single disease, while in the female population the most common are diseases of genitourinary tract.

History and medicine were an integral part of life-being of blind serbian acters. One of the main actors was half-blind serbian ruler, Stefan of Decani and whose name was associated with first ophthalmologic hospital and precursor of the eye`s injuries care. After, national reputation as Stefan Blind Righteous, ruler of the Serbian despot between 1458. and 1459. (member of Brankovic`s dinasty), and he was blinded by eye injuries burns. The famous national was also Filip Visnjic, as blind minstrel and authentic creator of serbian folk traditions, with sequels as a child, by bilateral infective panuveitis.

To the Editor, All acute poisonings represent urgent conditions in medicine, no matter what clinical features are. Patients with acute poisoning make 3-5% of the total number of patients treated in emergency medical services "poisoning", and can be accidental, suicidal and murderous. Making (providing) accurate diagnosis is often difficult because it implies the identification of poison; that is not always possible of auto and heteroanamnesis data, physical examination (checkup) of the patient, and clinical symptoms of poisoning are used for making the diagnosis (1). Patient with symptoms of acute poisoning is immediately taken in emergency room where doctor specialist of emergency medicine or doctor specialist of internal medicine undertakes medical examination which implies: fast estimation of need for respiratory support and mechanical ventilation, or cardiorespiratory reanimation; monitoring of vital functions; measuring of arterial blood pressure, heart rate, arterial oxygen saturation by pulse-oximetry, electrocardiographic record of heart rate, x-ray lung recording; consultations with neurologist, surgeon, neurosurgeon, psychiatrist, or if it is necessary with doctors of other specialties; provision of venous line; applying of intravenous saline solution or intravenous sugar solution(dextrose solution); taking blood samples urgently; according to estimation testing blood on methyl-alcohol or ethyl-alcohol, or testing urine on psychoactive substances; estimation of consciousness; identification of signs of external physical injuries; nasogastric intubation in case of acute peroral poisoning except in case of poisoning by corrosive substances (acids, bases) when there are contraindications; this procedure is repeated until the stomach contents are clear after that activated carbon is given to a patient (2). If a patient is unconscious, the one needs to be intubated in order to protect the airways. After that nasogastric intubation is being done, after all activated carbon is given to a patient; if a patient is conscious and the collaboration can be established, the vomiting is caused by drinking hot water and after that activated carbon is given to a patient; after initial treatment in resuscitation room patients who are respiratory at risk (affected) of who have disturbances of consciousness are hospitalized in stationary rooms of Clinical Emergency Center, and those who have symptoms of light poisoning, they are taken in internist ambulance for observation and psychiatrist is consulted about the clinical conditions of them (3). The poisoning time of observation is estimated on the stabilization of vital parameters, improving the state of consciousness, as well, as the development of possible complications depending on the time of ingestion, type of toxic substance, the time of reporting poisoning to doctors and present co-morbidity. Antidote therapy is used for poisoning in which it is indicated. Atropine® is used for poisoning by organo-phosphates, Naloxane® is used for poisoning by opiates, Aneksat® is used for poisoning by benzodiazepines, ethyl-alcohol is used for poisoning by methyl-alcohol and ethylene-glycol. Measures of extracorporeal detoxification like hemodialysis, hemoperfusion with activated carbon and plasma-pheresis are used in the stationary room of Clinical Emergency Center. Symptomatic and supportive therapy is also used. It is the base in the treatment of all acute poisoning because of a small number of antidotes. Toxic effects of organophosphate insecticides appear because of irreversible inhibition of enzymes of acetyl-cholinesterase which causes accumulating of acetylcholine in the central and peripheral nervous system, and in other tissues and organs. Clinical effects of accumulated acetylcholine are reflected in four clinical syndromes. Acute cholinergic crisis – the most important clinical syndrome that appears after a few minutes, but it also may appear in twelve hours after consuming the poison. Effects are classified into three categories: muscarinic, nicotinic and central. Muscarinic effects are represented by intensified bronchial secretion, bronchial spasm, intensified perspiration, hypersalivation, lacrimation, incontinence of urine and feces, sickness and vomiting, bradycardia, hypotension, and myosis. Nicotinic effects are shown by muscular fasciculation, spasms, paralyzation of diaphragm, areflexia, respiratory insufficiency, hypertension, tachycardia and pupil dilation. Effects by CNS are anxiety, headache, tremor, confusion, convulsion, and depression of the respiratory system. The intermediate syndrome – neurology signs that are shown in the period of 24 to 96 hours after acute cholinergic crisis (muscular weakness of neck flexor; respiratory muscles, as well, as muscles of extremities dominant; delayed peripheral neuropathy, lesions of other organs). Every single patient who has been poisoned by chemical compounds of the group of organophosphate insecticides is attended by the aforementioned protocol for acute poisoning (4). If the clinical status of the patient is specific, there is a possibility of taking the patient's blood and sending it for analyzes in the Toxicology Lab of Military Medical Academy in Belgrade. If it is possible, take biological material (urine, blood, lavage) for proving (substantiating) the poison and its metabolites (that could be important as a piece of evidence at the court). Specific therapy for these poisonings means giving of: Atropine® in the dosage of 1 to 2mg intravenously on every five minutes until the signs of hyper-atropinisation (dry lungs, dryness of skin and mouth, tachycardia, face(flushing) redness, mydriasis with decreasing dosage in correlation with the clinical features, so far signs of cholinergic crisis exist; reactivators (actifiers) of cholinesterase (compounds of the group of oximes–pralidoxime in the dosage of 1 g intravenously or intramuscularly in the salt solution on every 4 to 6 hours during the first 48 hours, and it is usually given to a patients for seven days); Diazepam® (anticonvulsants in dosage of 10 mg in every 8 hours intravenously whose purpose is preventing convulsion effect of accumulated acetylcholine); symptomatic and supportive therapy (correction of acid-base and electrolyte imbalance)(5). The role of hemodialysis in acute poisoning has repented as an indispensable treatment for acute poisoning, today(6).

Optic nerve avulsion is a very rare but an extremely devastating complication of the eye injuries. The optic nerve is violently disinserted of the retina, choroid and vitreous, and lamina cribrosa drawn from the scleral rim. We reported the case of the older male person, who attempted suicide by firing a gun in the region of the abdomen and the right temple. After the provided clinical assistance which consisted of removing the spleen and disposal stab wound to the abdomen, under the general anesthesia, followed by the operation of the right eye injured, or enucleation of the eyeball with the reconstruction of conjunctival sac. Right eye was enucleated ovum of the forensic expertise (the histopathological examination) which confirmed the complete acute section of the optic nerve. The patient was connected to the resuscitation apparatus because of the acute deep coma and after seven days he died.

Introduction: Chemical eye injuries are described as trauma of the eye, which represent an urgent state in ophthalmology, and are mostly localized, on the anterior segment. Causes of injuries are acid, alkali, mixed and non identified agents. Diagnostic procedures are easy, but therapy is complex. Aim: to describe the historical characteristics of chemical eye trauma and analyze the causes as the most common agents involved in chemical injuries at tertiary level of referent region. Material and Methods: The retrospective study conducted on data of the chemical eye injuries presented at Clinic of ophthalmology in Clinical Centre of Kragujevac (Central Serbia) in past three years. One hundred and thirteen patients (164 eyes) who were presented from September, 2013 to September, 2015 for observation with chemical eye injuries were included in this study. Authors analyzed and showed the most important of historical characteristics: gender, age, categories of chemical agents and location of the accident. Results: Males were more often reported with injures than females (66.37% vs. 33.63%). The mean age across categories was 46-60 years (54, 47.79%). The most common categories of chemical agents: hydrochloric acid - 42 eyes (25.61%), acetic acid - 37 eyes (22.56%), quicklime - 37 eyes (22.56%), quenched - 24 eyes (14.63%) and mixed - 24 eyes (14.63%). The location where injury occurred was mostly at home - 84 eyes (51.22%) and at work - 80 eyes (48.78%). Conclusion: Correlation of references from this study and world references in the medium urban countries with dominators light industries was developed to be relatively identical. In frequency from this study allocated by chemical eye injury - males dominated professionally in social and private industry sector while female in households while maintaining general hygiene dominated it. Frequently bases were quenched and quicklime. The most common location was inside the home.

Toxigenic strains of Clostridium difficile are the major cause of intestinal tract diseases of hospitalized patients. For a long time, Clostridium difficile was considered to produce both types of toxins (A+/B+ strain). However, the investigations conducted in the last ten years point to the existence of clinically significant isolates which produce only toxin B, i.e. toxin A negative. Toxigenic strains Clostridium difficile are present in our country so this bacterium sort has to be considered in differential causal diagnosis of diarrhea syndrome. Considering that it can cause a difficult form of the disease, it is an obligation to establish the presence of some toxins in stool samples of patients and/or production of some toxins in liquid culture of isolates.

Introduction/Aim: The goal of our study was to analyze the epidemiological`s characteristics of ocular hypertension, as well as the influence of chronic risk factors on glaucoma development (conversion in glaucoma). We tried to make some entries for solving this complex ophthalmological problem. Material /Methods: From 2009 to 2015, a retrospective control study was performed on 121 patient with diagnoses of bilateral ocular hypertension and without disease progression/conversion of glaucoma (by standard protocols of diagnosis and basic procedures) on tertiary level at Clinic of Ophthalmology, Clinical Centre of Kragujevac, Serbia.. The authors analyzed epidemiological characteristics: sex, age groups, positive/negative family history and personal history with chronic risk factors (one and/or two) of ocular hypertension. The data obtained from this study were statistically analyzed in SPSS program, version 20.00. Results: As for the patients, 69 of them (57.02%) were male and 52 female (42.98%). Dominant age group was between 40-49 (42.15%) and then group between 50-59 (40.50%) years of age. Anamnesis data indicated the absence of family anamnesis 71 (58.68%). Risk factors for ocular hypertension were presented in 103 (85.13%) patients, 18 of them (14.87%) did not respond. One risk factor - cardiovascular disease was noted in 83 (68.59%), with two risk factors - cardiovascular diseases and diabetes mellitus in 20 patients (16.53%) and with PEX syndroma at other respondents. Conclusion: Ocular hypertension is not a common disease, but with risk factors, such as older age, positive family history, and chronic risk factors syndicated, represents a serious clinical and social problem, so the question remains for ophthalmologists - pro or against therapy? Those in favor of therapy would state the safety and protection from conversion/progression of glaucoma; but those  against therapy would only mention adequate monitoring of patients.

Introduction. Diabetes mellitus is as old as the human race. Retinopathy, being one of complications of diabetes mellitus, is the most common cause of blindness. This study was aimed at analyzing the correlation between retinopathy and duration of disease, metabolic control, and obesity. Material and Methods. The study sample consisted of 135 patients divided into the experimental group of 90 patients with retinopathy and the control group of 45 patients without retinopathy. The patients were examined according to standard protocols: anamneses, endocrinology, ophthalmology exams, biochemical analyses, and anthropometric measurements. Results. The average age of patients was 60.13 ± 9.29 in the experimental group, while it was 57.55 ± 4.85 in the control group. The average duration of disease was 11.71 ± 5.8 and 14.40 ± 7.68 in the control group experimental group, respectively. The following statistically essential differences between the control and experimental group were found: in duration of disease (11.71 ± 5.85; 14.40 ± 7.68; r = 0.000), in glycemia (7.02 ± 2.20; 8.34 ± 3.18; p = 0.000), in glycosylated hemoglobin A1C (HbA1C) (7.16 ± 1.37; 8.22 ± 2.05; r = 0.000), in triglycerides (1.92 ± 0.72; 2.63 ± 1.60; r = 0.001), and in body mass index (23.94 ± 2.65; 27.66 ± 15.13; r = 0.000). Conclusion. There is a positive correlation between duration of disease, glycosylated hemoglobin A1C, triglycerides, body mass index - obesity and retinopathy. A significant statistical correlation among those parameters has been found in patients with diabetic retinopathy.

Authors report the case of a 59-year old woman with bilateral posterior lens luxation in vitreous, medically controlled glaucoma and corneal adherent leucoma with vascularization in whom Marfan syndrome was diagnosed. The patient underwent complete clinical eye and systemic examinations and blood samples were drawn for mutational screening of fibrillin1 gene (FBN1). The patient was diagnosed with Marfan syndrome on clinical basis do to genetic testing revealed a new heterozygous mutation in the FBN1 gene and described with ocular signs. The patient required pars plane vitrectomy with lensectomy, or Ahmed valve implantation in vitreous to control glaucoma secondary, but the finally treatment was without surgical modules from recommendation of referent expert team. In our patient glaucoma secondary was under therapy control.

Objective. Aim of article was to show analysis of increase/ decrease number of various close contusion of eye between hospital and ambulance patients with epidemiology characteristics. Methods. Of 444 patients with traumatic ocular injuries (hematoma palpebral, suffusion conjunctiva, erosion corneal, hyphema, iridodialysis, cataract/subluxatio of lens, haemorrhage chorioretinal and trauma orbit/optic nerve, who were referred by ophthalmologists from Clinical Centre of Kragujevac, evaluated and included in retrospective study from 2007 to 2012. Epidemiological characteristics included: sex, age, time (calendar), location of professional trauma, address (urban, rural) and treatments of injury (number of hospital and ambulance). Statistical analysis was done with SPSS program, version 20.00 (Chi-square test, Kruskal-Wallis test; p-value include the exact value unless, it is less than 0.01). Results. The total number of patients with contusion was 444 which 197 (44.37%) were treated in hospital and 247 (55.63%) by ambulance. Relationship of hospitalized and outpatients, the contusion injuries in favor of first only in 2007, 51 (56.66%), and increased outpatient injury is higher in all of remaining 2008 - 2012, except in 2010 where ratio of hospitalized/ ambulance was equivalent 32 (32.07%). Conclusion. The most of injuries were 342 (77.03%) men, aged 20-50 years - 166 (37.39%), in autumn months from September to December - 214 (48.20%), with sport activities - 166 (37.39%) and in urban areas - 230 (51.80). The number of hospital is declining, and number is growing ambulance is changing slightly, but total number of violations evidently is declining by 6 years.

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Aim: To case report the efficacy of subcutaneous steroid injections in the treatment of multiple chalazions and to evaluate the safety of intralesional injection in primary and recurrent chalazions in juvenile patient.Case report: A 25-year-old man noticed lesions which appeared on upper lid during past three months. It was clinically presented with three focal, large and painful nodules in upper right eyelid. Inflammation process began on May the 1st of 2013. After one month in May 30th 2013 was directly administered synthetic steroid, Kenalog-40. Application of triamcinolone acetonide resulted in two satellite lesions, compared to the original, when the same incisions drained during the first surgery in July 5th 2013, with topical antibiotic-steroidal drugs and hot compresses. Second surgery was in July 26th 2013. Third surgery was performed in August 5st 2013 with second application of Kenalog-40. Combined treatment leads to recovery of clinical signs and inflammation of right upper eyelid with regressions of primary and recurrent chalazions.Conclusion: Two steroid subcutaneous injections produced complete resolution of multiple primary and recurrent chalazions. Clinical imperative was that recurrent or unusual refractory chalazions require referral to Hystopathological examination of curetting to exclude malignancy.

Objective. Retrobulbar neuritis is the inflammation of optical nerve which is localized behind the eye. Patients with multiple sclerosis are adequate for our examination, because of well-known association between these two diseases. Methods. The study included 64 patients, divided in 4 groups, during last five years, during hospitalizations and outpatient controls. We analyzed demographic characteristics, neuro-ophthalmological clinical symptoms, diagnostic tests and the effectiveness of therapy. Results. The greatest number of patients was young women, from urban regions, treated primarily during the winter time of the year. Temporal pallor of optic head was always present in clinical status. The loss of visual acuity appeared in 64%, MRI findings were positive at 56%, positive cerebrospinal fluid findings were at 43% subjects. VEP examination was positive at 84%, ocular sequels at 67% and neurological disturbances occurred in 48% subjects. Incidence of relapse of retrobulbar neuritis was found in 16% of patients with normal MRI in the period of five years. After the treatment with corticosteroids, the appearance of plaques was delayed for 2 years at almost all patients. A good recovery of patients appeared after 2-3 weeks of corticosteroid treatment. The good results with interferon beta-1b therapy were achieved in 76% of patients. In our patients, prolongation of relapse-remitting status of retrobulbar neuritis during multiple sclerosis evolution was about 2 years. Conclusion. Retrobulbar neuritis is an important health problem in many patients suffering from multiple sclerosis.

Background/Aim. Graves? ophthalmopthy is one of the most common causes of exophthalmos as well as the most common manifestation of Graves? disease. The treatment of Graves? ophthalmopathy includes ophthalmological and endocrinological therapy. The aim of this study was to clinically evaluate the patients with Graves? ophthalmopathy treated with corticosteroids. Methods. Evaluation of 21 patients was performed in the Ophthalmology Clinic and Endocrinology Clinic, Clinical Centre Kragujevac, in the period from 2009 to 2010. They were treated with pulse doses of intravenous corticosteroids. They were referred to ophthalmologist by endocrinologist in euthyroid condition in the active phase of Graves? ophthalmopathy (ultrasonography of orbit findings and positive findings of antithyroid stimulating hormone receptor antibody - anti-TSH R Ab). The clinical activity score (CAS) and NO SPECS classification for evaluation of disease severity were used. Ophthalmological examination includes: best corrected visual acuity, slit-lamp exam, Hertels? test, direct ophthalmoscopy and ultrasonography of the orbit. Results. According to our results 76.19% of the patients were female; mean age of the patients was 35.2 ? 5.6 years. According to CAS classification after 6 months of the treatment recovery was shown in 23.81% of the patients, partial amelioration in 47.62% and no clinical amelioration in 28.57% of the patients. We achieved better results with male, young patients with high clinical activity score. Good results were observed after the first dose of corticosteroids, much better CAS after the third dose, which maintained until 6 months after the first treatment. Conclusion. Our results signify that intravenous pulse dose of corticosteroids treatment of the patients with Graves? ophthalmopthy is safe, comfortable, clinically justified and accessible for the clinicians and patients. Positive results are achieved after the first dose with increasing trend up to the third dose, which was maintained for the next three months.

Retinal artery occlusions are rare in people younger than 30 years, and the great number of them has detectable etiological disorder. Visual acuity disturbances in pregnant women were documented infrequently and in the simultaneous presence of toxemia during pregnancy or with some hematological or heart disorders. A 26-year old woman-primigravida at 31 weeks' gestation presented with sudden decreased vision in her right eye early in the morning. Fundus examination indicated for retinal arterial spasm. Complete blood examination, obstetric and internal examination must be performed in such cases. We can conclude that this case is preliminary experience and that we can expect retinal arterial occlusion in pregnant patients with hypotension, disturbed lipid profile and mild anemia. Early effective treatment can be useful in the struggle for vision gain.

Retrospective 5-year study based on general and ophthalmic history records, and including 268 eyes (174 patients), aged 50 years and over. Ophthalmological examination involved visual acuity, measuring of intraocular pressure, slit lamp examination and indirect ophthalmoscopy. Type of surgical treatment was tailored for each patient (extra capsular cataract extraction, phaco-emulsiphication).Preoperative slit lamp examination showed phacodonesis in 17.91% (47), iridodonesis in 2.98% (8), pigment dispersion in 6.72% (18), lens subluxation in 4.85% (13) on the total. Extra capsular cataract extraction was performed in 36.94% (99) and phaco-emulsiphication in the others. Analysis of intra operative complications showed: posterior capsular rupture 17.91% (48), zonular dialysis or break 5.97% (16), lens subluxation 1.86% (5), intraocular bleeding 2.98% (8), vitreous loss 13.80% (37). Postoperative complications include: anterior chamber reaction 45.90% (123), intraocular lens tilt 15.67% (42), endothelial decompensation 21.64% (58), subluxation/luxation IOL 3.73% (10), secondary cataract 21.46% (58), pigment dispersion 37.68% (101), increased IOP 13.80% (37), residual lens matter 13.80% (37), hyphema 3.73% (10), posterior synechiae 6.72% (18), iris prolapsus 2.73% (8).Cataract surgery in PES will frequently encounter small pupils, shallow anterior chambers, posterior adhesions, weak zonular support, partial subluxation or complete dislocation of lens. Authors presented the best possible approach on PES and surgical methods for patients with cataract with special accent of possible surgical complications.

The cavernous hemangiomas are the most common intra orbital tumors found in adults of the middle age. Although histological benign, they can encroach on intra orbital or the adjacent structures (optic nerve) and be considered anatomically or positional malignant. We present a case report of orbital cavernous hemangioma of right orbit in young women after pregnancy, from Topola near Kragujevac (Central Serbia) with visual compromise and it's by trans-nasal endoscopic surgical management. Our patient was controlled and treated with the symptomatic therapy, topical therapy with artificial tears and surgical treatment. Our patient has optimal visual acuity of affected right eye after surgical treatment of orbital tumor. Surgical treatment of symptomatic orbital cavernous hemangioma is safe and effective, so that the cosmetic results are the important parameter to evaluate the clinical outcome.

Primary open-angle glaucoma (POAG) is defined as a chronic and progressive disease. Date suggested that it is the second most common cause of the blindness in the world. Blindness, as global problem, is partially consequences of poor health insurance, low medical education, etc. The only modifiable risk factor for glaucoma is intraocular pressure. Cost of the antiglaucomatous treatment increased by prescribing and using wide spectrum of antiglaucomatous drugs. If an ophthalmologist is not satisfied with glaucomatous disease control, need for the laser or surgical treatment is appeared. Disease stadium also determines the cost of the treatment. The social and economic burden of glaucoma can be changed by increased life expectancy, older population age and higher per capita GDP. Unique opinion about cost effectiveness cannot be reached, due to nonconforming findings of many studies. Treatment approach must be individualized to every patient, according to the disease's stadium, availability of therapeutic modalities and approaches, life expectancy and the level of GDP. Efficacy, compliance and potential side-effects of prescribed medication also determine the proper treatment choice.

Conflict of interest: none declared. Introduction Authors are from reference documentation to archive at Organization of Federation of blind and visually impaired in central Serbia (Kragujevac), by retrograde analysis, of 2007-2012, comprehend two groups by etiology–clinical characteristics of congenital blindness and visually impaired, caused infection or non infection example. Aim to analyze relationship between infectious and non infectious of congenital blindness and visually impaired in our referent region and compare with world references. Material/methods With 6-years analysis included the most frequency cases of congenital blindness and visually impaired in two groups, according to presence or absence infectious causes. From infectious causes of congenital blindness and visually impaired are included: CMV – infection, congenital rubella syndrome, congenital toxoplasmosis, congenital syphilis and rare mixed syndrome. From non infectious causes are included: retinitis pigmentosa, retinopathy prematurity, primary congenital glaucoma, Leber’s congenital amaurosis and rare syndrome. Results: From total number of registered blind and visually impaired – 1308 (100%), over the last 6 years, the registration was 349 (26.68%) with congenital blindness and visually impaired. From recorder with the number of the most common congenital blindness and visually impaired–194 (55.59%) with infections cause, and 155 (44.41%) non infection cause. Conclusion: Congenital blindness has shown permanent increase in past 6 years, in group with infectious and with non infectious causes. Congenital blindness and visually impaired of the most common etiology among registered members of our association in Kragujevac is subject of our correlation and global trends mentioned observation of these diseases.

We described a patient with bilateral iris metastases resulted from prostatic cancer. Slit lamp and ultrasonography examination of the both eye demonstrated tumor of the iris, as an amelanotic vascular mass located on the superior temporal quadrant. On open biopsy revealed undifferentiated tissue that stained strongly positive for prostate carcinoma, confirming the diagnosis of metastasis prostate adenocarcinoma. Early diagnostic procedures are essential for the causal therapy of prostate carcinoma as the primary neoplasm.

We present a patient with a corneal ulcer of the right eye, with eye protrusion and without anamnesis of cancer. On CT examination there was a bulky soft tissue mass in the cranial aspect of the right orbit, without increasing in signal intensity after injection of contrast. Open biopsy revealed undifferentiated tissue that stained strongly positive for breast carcinoma, confirming the diagnosis of metastases of breast carcinoma.