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Background/Aim. The fundamental objective of primary percutaneous coronary intervention (PCI) in myocardial infarction is to provide early, complete, and sustained flow in the occluded artery that has led to myocardial ischemia or necrosis. The aim of this study was to determine the predictive power of a combination of GRACE, SYNTAX I, and SYNTAX II scores in predicting major adverse cardiovascular events (MACE) and one-year mortality in patients with ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) after primary PCI. Methods. The study included 400 patients who had their first acute myocardial infarction and underwent PCI. The patients were treated and followed for one year at the Clinical Hospital Center Zvezdara at the Department of Interventional Cardiology. By monitoring the defined clinical parameters, a comparative analysis of risk scores GRACE, SYNTAX I, and SYNTAX II was performed. Their sensitivity, specificity as well as predictive possibilities in predicting adverse outcomes were determined. Results. The incidence of MACE in our sample was 12.8%. Patients with STEMI entity had significantly higher values of GRACE, SYNTAX I, and SYNTAX II scores. The highest value for predicting the occurrence of MACE was shown by the SYNTAX II score (score value 29.3), with a sensitivity of 88.2% and a specificity of 76.8%. The GRACE score was a significant predictor of SYNTAX I and SYNTAX II scores. A two-way correlation was observed between the high score values of all three scores. Conclusion. The presented scores for the assessment of clinical and angiographic indicators showed good predictive power in assessing the outcome of adverse cardiovascular events in both clinical entities of acute myocardial infarction during one-year follow-up. By using the proposed scores to assess MACE, we can single out high-risk patients in order to prevent adverse events and reduce mortality. This suggests its suitability for clinical use in this patient population.

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Background/Aim. Interatrial conduction time is early marker of disturbed impulse propagation in adult with elevated blood pressure. The aim of our study was to evaluate significance of noninvasive echocardiographic marker of slow sinus impulse propagation (atrial conduction time) for the identification of persons with slightly elevated blood pressure and hypertension in adults. Methods. One hundred and forty nine adults with normal and elevated blood pressure were studied: 46 normotensive adults (group 1), 28 adults with elevated blood pressure and hypertension stage 1 (group 2) and 75 adults with hypertension stage 2 (group 3), based on the Joint National Committee 8 (JNC-8) hypertension guidelines. We studied P wave dispersion, reservoir function of the left atrium (LA), total emptying volume of the LA and total emptying fraction of the LA (LATEF). The atrial conduction time (ACT) was evaluated by the pulsed tissue Doppler, and expressed as interatrial and intraatrial conduction time. Results. The LATEF decreased progressively from the group 3 (64.8 ± 4.4%) to the group 2 (59.8 ± 5.2%) and the group 1 (55.6 ± 7.3%) (p < 0.001). The P wave dispersion (55.1 ± 9.8 ms vs. 46.8 ± 3.1 ms vs. 43.1 ± 2.6 ms; p < 0.01) and intra ACT were significantly prolonged only in the group 3 compared to the other groups (22.7 ± 11.0 ms vs. 8.4 ± 4.7ms vs. 5.6 ± 2.4 ms, respectively; p < 0.001). Inter ACT significantly increased from the group 1 to the group 2 and the group 3 (15.6 ± 3.9 ms vs. 24.6 ± 5.7 ms vs. 50.4 ± 20 ms, respectively; p < 0.05). Using a cut-off level of 19.5 ms, inter ACT could separate adults in the group 2 from the group 1 with a sensitivity of 85%, and specificity of 89% [area under receiver operating characteristic (ROC) curve 0.911]. Conclusion. Prolonged ACT estimated with the tissue Doppler may be useful for identification persons with slighty elevated blood pressure, and hypertension stage 1.

Background/Aim. Dental status and oral hygiene habits are poor in young population living in deprived socioeconomic conditions. The aim of this research was to ascertain oral hygiene habits in adolescents attending high schools in urban area, determine the incidence of tooth loss at the age of 15–16 years and the gender difference. Methods. The epidemiological cross-sectional study included 234 randomly selected high school students. The research instruments were questionnaire (focusing on socio-demographic characteristics, habits, attitudes and behavior related to general and oral health) and clinical examination (tooth loss, normative need for prosthodontics restorations and presence of restorations). Results. Gender-related data comparison revealed that 32.5% of girls and 8.1% of boys had at least one tooth extracted (p < 0.05). Also, 56.2% of girls and 75.7% of boys brushed their teeth twice a day. Caries complications were identified as the indication for tooth extraction in 82.8% of participants. The data analysis confirmed the correlation between gender and tooth loss as well as treatment needs. Tooth loss was correlated with oral hygiene habits and reasons for dental visits. Treatment need was also affected by the reasons for tooth extraction and the absence of adequate prosthodontics therapy (p < 0.05). Conclusion. Sociodemographic conditions significantly influenced the number of participants with extracted teeth. A prosthodontic treatment need was influenced by the reasons for tooth extraction, adolescents’ knowledge about the importance of adequate treatment and previous unpleasant experience.

Background/Aim. Factors determining the risk of Lyme disease (LD) may be followed in terms of the type of habitat. The evaluation of the risk of Borrelia burgdorferi (B. burgdorferi) transmission in humans on Ixodes ricinus (I. ricinus) tick habitats is done by means of the ecological risk index, which determines the tick habitat, abundance and infection rate. The aim of this paper was to determine the value of ecological risk index (potential and actual risk – PR and AR) on green areas in 9 pаrks in Belgrade and establish the correlation of this index with tick bites in humans. Methods. Ticks were collected in parks by means of the flag hour method and examined for the presence of LD cause in dark-field microscopic analysis. Point values were assigned to certain parameters and potential and actual risk index evaluated for each habitat. The data on tick bites from the surveyed habitats were obtained from the Protocol of patients bitten by ticks of the Sector for Preventive Medicine, Institute of Epidemiology, Military Medical Academy in Belgrade. Analysis of variance (ANOVA), Tukey test and Pearson ´s coefficient were used in statistical analysis of data. Results. In Belgrade´s park habitats a high PR of B. burgdorferi transmission was determined, while AR for 4 habitats was categorised as PR, and limited for other 5 habitats. Statistically, in terms of AR values the following habitats were significantly different (p < 0.05): Hаjd Pаrk and Tаšmаjdаn; Hаjd Pаrk and Kаlemegdаn; Hаjd Pаrk and Pionirski Pаrk; Hаjd Pаrk and Bаnovo Brdo; Topčider and Tаšmаjdаn; Topčider and Kаlemegdаn; Topčider and Pionirski Pаrk; Topčider and Bаnovo Brdo Park. A statistically significant correlation (p < 0.05) between bites of adults and the number of bites of infected adults with the AR value was established. Conclusion. In parks of Belgrade, there is a limited AR of B. burgdorferi transmission on the average. The AR values vary from limited to the potential, depending on the ecological features of habitat, the number of collected ticks and their infection rate. In view of the correlation of AR with the bites in humans, this index is significant for assessing LD risk.

Background/Aim. The first case of human Lyme borreliosis (LB) in Serbia was recorded in 1987. The number of reported LB cases has increased in the past decade. The aim of this study was to estimate the density of Ixodes ricinus (I. ricinus) ticks, the prevalence of Borrelia burgdorferi sensu lato (B. burgdorferi) in them, and entomological risk index (ERI) at 19 Belgrade localities which were grouped into three categories (forests, parkforests, parks). The values of ERI were compared with the number of tick bites in humans. Methods. Ticks were collected monthly by using the flag hours method and the infection rate was determined by using dark field microscopy. The ERI value was calculated for each locality where the ticks were collected. The related data about tick bites was obtained from the patient protocol of the Institute of Epidemiology, Military Medical Academy, Belgrade. Results. The total number of collected ticks, the number of nymphs and the infection rates of the nymphs were significantly higher in forests (p < 0.05) than park-forests and parks. Statistically, the ERI value was significantly higher in forests than parks of Belgrade (χ2 = 7.78, p < 0.01). In March and July, the ERI value was also significantly higher in forests, than park-forests (p < 0.01) and parks (p < 0.01). May was the month with the highest ERI value in each ecological category (forests p < 0.05; park-forests p < 0.01; parks p < 0.001). However, the number of tick bites in humans did not correlate with ERI values. Conclusion. The obtained results indicate that the risk of tick bite and human exposure to B. burgdorferi sensu lato is present at all selected localities in Belgrade. For a more comprehensive Lyme disease risk assessment the method of entomological risk index assessment should be combined with other methods, taking into consideration all tick stages and the behaviour and habits of people who may get infected B. burgdorferi sensu lato.

Background/Aim. Because patients in intensive care units usually have an urinary catheter, the risk of urinary tract infection for these patients is higher than in other patients. The aim of this study was to identify risk factors and causative microrganisms in patients with catheter-associated urinary tract infection (CAUTI) in the Surgical Intensive Care Unit (SICU) during a 6-year period. Methods. All data were collected during prospective surveillance conducted from 2006 to 2011 in the SICU, Military Medical Academy, Belgrade, Serbia. This case control study was performed in patients with nosocomial infections recorded during surveillance. The cases with CAUTIs were identified using the definition of the Center for Disease Control and Prevention. The control group consisted of patients with other nosocomial infections who did not fulfill criteria for CAUTIs according to case definition. Results. We surveyed 1,369 patients representing 13,761 patient days. There were a total of 226 patients with nosocomial infections in the SICU. Of these patients, 64 had CAUTIs as defined in this study, and 162 met the criteria for the control group. Multivariate logistic regression analysis identified two risk factors independently associated to CAUTIs: the duration of having an indwelling catheter (OR = 1.014; 95% CI 1.005-1.024; p = 0.003) and female gender (OR = 2.377; 95%CI 1.278-4.421; p = 0.006). Overall 71 pathogens were isolated from the urine culture of 64 patients with CAUTIs. Candida spp. (28.2%), Pseudomonas aeruginosa (18.3%) and Klebsiella spp. (15.5%) were the most frequently isolated microorganisms. Conclusions. The risk factors and causative microrganisms considering CAUTIs in the SICU must be considered in of planning CAUTIs prevention in this setting.

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Background/Aim. The first cases of the pandemic pH1N1 influenza virus infection was observed in the United States and Mexico in April 2009 and the first laboratory confirmed case in Serbia was registered in June 2009. The aim of this paper was to report on the investigation of the first confirmed outbreak of the 2009 pandemic H1N1 influenza in Serbia and to describe the clinical and epidemiologic findings from this investigation. Methods. Descriptive and analytical epidemiological methods were used. Data were collected from medical records of the Military School students and epidemiological questionnaire. Pandemic H1N1 infection was initially confirmed by the RT-PCR assay in nasopharyngeal and oropharyngeal swabs and subsequently by the complement fixation test in serum samples. Results. The attack rate of acute respiratory illness was 70.8% (204/288). Pandemic H1N1 virus infection was confirmed in 44 of 82 tested cases of acute respiratory illness (53.7%) The most common clinical manifestations of pandemic influenza H1N1 were fever (88.6%), cough (61.4%), malaise (38.6%), runny nose (36.4%), headache (29.6%), sore throat (20.5%) and muscle pain (15.9%). Conclusion. The findings from this investigation suggest that pandemic H1N1 influenza in a high military school was widespread but did not cause severe illness.

Background/Aim. A "new" pathogenic agent, verocytotoxin - producing Escherichia coli (VTEC) emerged in the last 20 years, causing an increased number of sporadic cases, as well as of outbreaks of diarrhoeal diseases. Humans and animals can be infected with VTEC, but their epidemiological importance as a reservoir of this agent is not quite clear, especially in the Balkan region. Therefore, the aim of this study was to investigate the frequency of isolation of VTEC from the intestinal tract of humans and animals and to determine the serogroups of the isolated strains. Methods. A total of, 3 401 stool samples from humans and 2 660 samples from five different species of domestic animals were tested for the presence of this pathogen. Results. VTEC was isolated from 20 (0.6%) humans stools and from 431 (16.2%) animal fecal samples (p < 0.001). Only 15 (3.3%) VTEC strains belonged to human infection-associated serogroups (O26, O55, O111, O128 and O 157), designated as enterohaemorrhagic E. coli (EHEC). The most known serogroup- O157 was identified in 6 (1.3%) of the isolated VTEC strains; of them, 1 (5%) was of human origin and 5 (1.2%) were animal strains. Conclusion. This study revealed that domestic animals were a more important reservoir of VTEC than humans, and that the isolated VTEC strains rarely belonged to O157, as well as to other EHEC serogroups that might explain rare sporadic cases and the absence of epidemic occurrence of diarrhoeal diseases caused by VTEC in this geographic region.

A ‘new’ group of pathogenic agents, enterohemorrhagic Escherichia coli (EHEC) (particularly the strains of O157 serogroup), emerged in the last 20 years causing an increased number of sporadic and epidemic diarrhoeal diseases with hemorrhagic enterocolitis as a most common clinical manifestation of the infection. As a consequence of the absorption and cytotoxic effect of the main virulence factor of these bacteria - verotoxin (shiga-toxin), in about 10% of the affected persons extraintestinal complications, most frequently hemolytic-uremic syndrome (HUS), occurred 7-14 days after an episode of diarrhoeal disease. The first case of hemorrhagic enterocolitis with the documented EHEC O157 infection in Yugoslavia is presented in this paper. Considering the existing expansion trend of these carriers, practitioners should be aware of them in case of the occurrence of diarrhoeal disease (particularly hemorrhagic enterocolitis), and keep these patients under control during the reconvalescence period because of potential development of extraintestinal complications, such as HUS.

Abstract Background It is often desirable to observe how a disease progresses over time in individual patients, rather than graphing group averages; and since multiple outcomes are typically recorded on each patient, it would be advantageous to visualise disease progression on multiple variables simultaneously. Methods A variety of vector plots and a path plot have been developed for this purpose, and data from a longitudinal Huntington's disease study are used to illustrate the utility of these graphical methods for exploratory data analysis. Results Initial and final values for three outcome variables can be easily visualised per patient, along with the change in these variables over time. In addition to the disease trajectory, the path individual patients take from initial to final observation can be traced. Categorical variables can be coded with different types of vectors or paths (e.g. different colours, line types, line thickness) and separate panels can be used to include further categorical or continuous variables, allowing clear visualisation of further information for each individual. In addition, summary statistics such as mean vectors, bivariate interquartile ranges and convex polygons can be included to assist in interpreting trajectories, comparing groups, and detecting multivariate outliers. Conclusion Vector and path plots are useful graphical methods for exploratory data analysis when individual-level information on multiple variables over time is desired, and they have several advantages over plotting each variable separately.