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Introduktion: Uppskattningsvis 40% av alla magnetresonanstomografiska (MRT) undersökningar som görs i Europa och USA utförs med gadoliniumbaserade kontrastmedel. Under det senaste decenniet har det i flera studier uppmärksammats att ansamling av gadolinium sker i olika strukturer i hjärnan. Patienter med multipel skleros följs regelbundet upp med MRT undersökningar och MRT med kontrastförstärkning är den vanligaste metoden för att urskilja nytillkomna patologiska förändringar. Utveckling inom teknologi och metoder inom artificiell intelligens har visat att det finns anledning att kartlägga om röntgensjuksköterskans arbete med undersökningar och läkemedel som administreras till patienter kan förändras så att det förebygger ansamling av gadolinium. Syfte: Syftet med denna litteraturöversikt var att kartlägga ansamlingen av gadoliniumkontrastmedel hos patienter med multipel skleros och hur artificiell intelligens kan tillämpas vid MRT för att minska användning av gadoliniumkontrast. Metod: Allmän litteraturöversikt där vetenskapliga artiklar av kvantitativ studiedesign har sökts fram genom databaserna CINAHL och PubMed. Resultat: Både makrocykliska och linjära gadoliniumbaserade kontrastmedel ansamlas i de basala ganglierna. Genom tillämpning av AI och CAD går det att framställa bilder med fullgod bildkvalitet och samtidigt reducera mängden kontrastmedel som administreras till patienten. Slutsats: Det behövs mer forskning om gadoliniumansamling för att nya rutiner och metoder ska kunna implementeras. Ansamling av gadolinium visar att det finns skäl att fortsätta utveckla nya metoder för uppföljning av sjukdomsförloppet hos MS-patienter. När det gäller AI inom medicinsk bilddiagnostik och magnetresonanstomografi finns många utvecklingsmöjligheter som kan bidra till minskning av gadoliniumbaserad kontrast i framtiden. Fortsatt forskning inom deep learning och CAD kan i framtiden utvecklas så att röntgensjuksköterskan får en mer självbestämmande funktion i bildframställning vid MRT, men även ett mer självständigt arbete i hanteringen av farmaka. Dessutom kan denna utveckling bidra till att röntgensjuksköterskans multidiciplinära samverkan med radiologer stärks och bidrar till en positiv utveckling med kortare granskningstider, bättre hantering av patienter, optimerade undersökningar, minskning av undersökningstider och kortare vårdköer. Introduction: Approximately 40% of all magnetic resonance imaging (MRI) scans performed in Europe and the United States are performed with gadolinium based contrast agents. Over the past decade, several studies have shown a gadolinium deposition in various structures in the brain. Patients with multiple sclerosis are regularly followed up with MRI with contrast enhancement is the most common method for distinguishing new pathological changes. Developments in technology and methods in artificial intelligence have shown that there is reason to map out whether the radiographers work with examinations and drugs administered to patients can be changed so that the accumulation of gadolinium is prevented. Aim: The purpose of this literature review was to examine the accumulation of gadolinium contrast agents in patients with multiple sclerosis of gadolinium contrast agents in patients with multiple sclerosis and how artificial intelligence can be applied in MRI to reduce the use of gadolinium based contrast agents. Methods: General literature review where scientific articles of a quantitative nature have been searched through the databases CINAHL and PubMed. Results: Both macrocyclic and linear gadolinium based contrast agents are retained in the basal ganglia. With artificial intelligence and CAD, it is possible to obtain data with good quality and at the same time reduce the amount of gadolinium based contrasts to patients. Conclusions: More research on gadolinium accumulation is needed for new routines and methods to be implemented. Accumulation of gadolinium shows that there is reason to continue to develop new methods for monitoring the course of the disease in MS patients. Concerning AI in medical imaging and magnetic resonance imaging, there are many development opportunities that can contribute to the reduction of gadolinium contrast in the future. Continued research in deep learning and CAD can be developed in the future so that the X-ray nurse has a more self-determining function in image production in MRI, but also a more independent work in the management of pharmacies. In addition, this development can contribute to the X - ray nurse's multidisciplinary collaboration with radiologists is strengthened and contributes to a positive development in shorter examination times, better management of patients, optimized examinations, reduction of examination times and shorter care queues.

The negative symptoms of schizophrenia are less known aspects of the illness although they often mark its course and outcome. Negative symptoms refer to loss of function, and they are associated with poor outcomes. It is considered that they are more prominent with the longer duration of illness.To determine the negative symptoms in the patients with schizophrenia with regard to the duration of illness.A cross-sectional study was conducted in 60 consecutive outpatients with schizophrenia. Two groups were formed regarding the duration of illness (⩽2 years, and3 years). The negative symptoms were established with the Brief Negative Symptom Assessment - BNSA.Average score of negative symptoms in the group with the shorter duration of illness was 8.37±2.94, and in the group with longer duration was 10.73±2.86. Independent Samples Test was significant p=0.003, t-2.367, and therefore the difference between scores on BNSA within groups was significant. Moderate size effect was found (p = 0.69).Negative symptoms of schizophrenia are more prominent with the longer duration of illness.

Background/Aim. Drug-drug interactions involving antimicrobials present important and often unrecognized complications of pharmacotherapy which can be prevented. The aim of the present study was to identify the frequency and type of potential drug-antimicrobial agent interactions among outpatients and to define recommendations for their management. Methods. Crosssectional prescription database study was conducted. The analysis randomly included 823 patients who visited Health Center Novi Sad over 1-month period (November 1?30, 2011) and had prescribed ? 2 drugs where at least one drug was antimicrobial agent for systemic use. All interacting drug combinations involving antimicrobials were identified according to Drug Interaction Facts. Additionally, based on the compendium, potential interactions were classified into categories: pharmacological mechanisms, potential clinical outcomes and management advice. Results. Overall, 88 potential clinically significant drug-antimicrobial agent interactions were identified among 69 (8.4%) exposed outpatients [the mean age 61.7 years (SD ? 15.4); the mean number of prescribed drugs 7.5 (SD ? 2.9); 56.5% females]. The most common identified potential interacting pairs were benzodiazepines undergoing oxidative metabolism and clarithromycin or erythromycin, and aminophylline and ciprofloxacin. In 83.0% of all cases underlying mechanism was pharmacokinetic involving primary inhibition of metabolic pathways mediated by CYP3A4 and CYP1A2 isoenzymes. Excessive sedation (22.7%), cardiotoxicity (20.5%), miscellaneous aminophylline adverse effects (13.6%), and bleeding (10.2%) were the most frequently implicated potential clinical outcomes. Risk for adverse interactions could be managed by close monitoring of simultaneous administration of drugs (37.5%), different risk-modifyng strategies (31.8%), and avoiding combinations (30.7%). Conclusion. Among outpatients, there was common potential for clinically significant interactions involving antimicrobials. Information based on the results of the present study could be integrated in existing computerized physician order entry system in the Health Center as a form of clinical support.

Introduction: Cardiac autonomic neuropathy (CAN) is important, but often neglected complication of diabetes, that substantially contributes to diabetes-related morbidity and mortality. The majority of diabetic patients have subclinical CAN. Therefore, screening for CAN in patients with diabetes is essential. The aim of this study was to assess the prevalence of subclinical CAN in real-life clinical setting at primary health care institution. We also aimed to determine, which routine clinical and laboratory parameters could serve as predictors of CAN. Methods: We conducted a cross-sectional, prospective, observational study that included 50 consecutive patients with type 2 diabetes treated in the primary health care institution. Gender, age, duration of diabetes, glycated hemoglobin (HbA1c) levels, electrocardiogram, blood pressure, the presence of paresthesia, deep and superficial neuropathy, foot skin lesions and the presence of pulselessness of artery dorsalis pedis and tibialis posterior were recorded. The diagnosis of CAN was made if the patients met two out of three criteria: postural hypotension, increased resting heart rate and corrected QT interval prolongation. Results: Patients had a median age of 59.0 (51.0 – 64.0) years and median duration of diabetes of 9.0 (6.0 – 11.0) years. CAN was present in 19 patients (38%). Patients with CAN had greater duration of diabetes and 2% higher HbA1c. They also had higher prevalence of peripheral neuropathy, foot skin lesions and peripheral artery disease. The presence of peripheral deep neuropathy was the best predictor of CAN with a specificity of 64.5% (45.4 – 80.8) and sensitivity of 79.0% (54.4 – 93.9). Conclusion: CAN is a common complication in our cohort of patients with diabetes. Simple routine clinical and laboratory parameters may be useful in detecting patients at high risk for CAN.

Despite multistep efforts many asthma patients remain symptomatic. Anti-inflammatory activities of curcumin were shown. Aim was to analyse the add-on therapy with curcumin on inflammatory parameters, lung function, disease control and quality of life in asthma patients. 150 non-smokers with moderate partially controlled asthma were treated during 3 months with stable moderate dose of inhaled glucocorticoids and divided into three groups (n=50): curcumin group (receiving curcumin 500 mg per os twice daily), placebo and control group. Before study, sputum eosinophils (sEo), blood eosinophils (bEo), high sensitive C-reactive protein (hsCRP), predicted forced expiratory volume in first second (FEV1%), Asthma Control Test (ACT) and Asthma Quality of Life Questionnaire (AQLQ) were similar between groups. After study, FEV1%, ACT and AQLQ were improved in all groups, but these improvements were more prominent in curcumin group than in placebo and control. Additionally curcumin group only showed improvement in sEo, bEo and hsCRP. Furthermore, curcumin group showed also more frequent clinically significant improvement in ACT score (change>3) and in AQLQ score (change≥0.5) when compared to placebo and control. However, placebo and control showed similar distribution in FEV1%, ACT, AQLQ, hsCRP, sEo and bEo after study. This is the first placebo controlled and single-blind study to suggest that add-on therapy with curcumin could improve lung function, disease control and quality of life in moderate partially controlled asthma. Future studies may benefit from a larger sample size, longer study duration, double blind design, different dose of curcumin and/or improvements in oral bioavailability.

Sputum eosinophils might predict response to inhaled corticosteroids (ICS) in patients with advanced chronic obstructive pulmonary disease (COPD). Induction of sputum requires expertise and may not always be successful. Aim was to investigate correlation and predictive relationship between peripheral blood eosinophils (bEo) and sputum eosinophils (sEo), and impact of peripheral blood eosinophilia on outcome of COPD exacerbation. 120 current smokers with COPD (GOLD group C) (57.4 ± 0.92 years, M/F ratio 1.4), with no blood (≥7% or >0.43x10 9 /L) nor sputum (≥3%) eosinophilia, were treated with moderate dose of ICS and long-acting bronchodilatator during stable disease, but systemic corticosteroids and antibiotics during exacerbation. According to sputum eosinophilia (≥4%) during exacerbation, patients were divided into eosinophilic (n=45) and non-eosinophilic group (n=75). In stable disease, bEo and sEo were similar in both groups ( p >0.05). During exacerbation, bEo and sEo were significantly higher in eosinophilic group (eosinophilic vs. non-eosinophilic: blood: 1.42 ± 0.39 x10 9 /l vs. 0.23 ± 0.02 x10 9 /l, p

Despite intensive treatment, considerable proportion of patients with asthma remains symptomatic. Anti-inflammatory activity of curcumin has been shown. Aim: analyse the impact of add-on therapy with curcumin in asthma patients on inflammatory parameters, lung function and asthma control. During 2 months, 100 non-smokers (46.8±12.4 years, F/M ratio 1.04) with moderate, partially controlled asthma were treated with moderate dose of inhaled glucocorticoids (IGK) with no changes in dose. Patients were divided into two groups (n=50): curcumin group receiving curcumin 500 mg per os twice daily and control group. Before study, sputum and blood eosinophils (Eo), blood neutrophils, high sensitive C-reactive protein (hsCRP), predicted forced expiratory volume in first second (FEV1%), Asthma Control Test (ACT) and Asthma Quality of Life Questionnaire (AQLQ) were similar between groups. After study, in curcumin group blood Eo count and hsCRP decreased, and FEV1, ACT and AQLQ increased significantly (before vs. after study: Eo: 5.9±0.6 vs. 4.1±0.4; hsCRP: 4.2±0.3 vs. 3.4±0.2; FEV1%: 77.7±0.8 vs. 83.9±0.5; ACT: 14.5 (6,19) vs. 18 (14,21); AQLQ: 3.4±0.2 vs. 4.1±0.2). There was no change in the control group. Compared to control curcumin group showed significantly lower blood Eo and hsCRP and higher FEV1% (curcumin vs. control: Eo: 4.1±0.4 vs. 5.4±0.5; hsCRP: 3.4±0.2 vs. 4.0±0.3; FEV1%: 83.9±0.5 vs. 78.3± 0.8), and improved ACT and AQLQ (ACT change>3: 72% vs. 28%; AQLQ change>0.5: 54% vs. 32%) after study. Add-on therapy with curcumin in patients with moderate partially controlled asthma seems to improve response to IGK regarding lung function, asthma control and quality of life. Further placebo controlled trials are needed.

Introduction: Factors of cardiovascular risk (CVR) are often grouped in cases with diabetes mellitus (DM) with significant increasment of risk for CV disease . The aim of this research is to determine the frequency of CVR and and total CVR in cases with DM and to investigate connection of CRP of other factors of CVR in total cardiovascular risks. Material and methods: In 92 cases with DM weist values were taken as well as body mass index (BMI), blood pressure, sugar in blood, cholesterol, triglycerides, C reactive protein (CRP) and according to SCORE system the 10 year period of CVR were determined. Results: Out of 92 tested cases with age 55,22± 8,3 years, 63,05% were males and 36,95% were women, 81,5% were with values of sugar in blood >7mmol/l, 44,6% were with values of HbA1C>7% and 63,0% >6,5%. The value of cholesterol were >4,5mmol/l in 87%, triglycerides >1,7mmol/l in 78.3% of tested cases. 81,5% of tested cases were overweight and 49% with larger weight values. Average cardiovascular factor according to SCORE system was 3, 92± 3,7% with significant difference among sexes (M-4,86; W-2,32, p3mg/l) 52% of tested cases were with high cardiovascular risk. There is significant positive correlation between CRP and cholesterol level (p

Disturbances of muscle and skeleton system are related to pain, functional damages and inability to work. Measure of life quality offers a sequence of data on illness influence on everyday functioning. The aim of this paper is evaluation of life quality in cases with degenerative illnesses of locomotive system and influence of sex, age, weist and BMI on life quality. Epidemiologic research was conducted on 71 tested subjects with diagnosis of chronical degenerative reumatical illness. Tested subject were measured weist values, BMI was determined and all of them fulfilled EQ5D questionnaire for life quality assessment. According to VAS scale their health condition was evaluated. Life quality of tested subjects was decreased especially in department of depression and increased concern (2.30 – 2.57) as well as pain and discomfort (2.11 – 2.31). We didn't determine statistically significant sex influence (p> 0,05), age, (p> 0,05) weist values (p> 0,05) or BMI (p> 0,05) our tested subjects life quality. According to VAS scale health condition of tested subjects is low (6, 76 ± 1,04).

Introduction: Cardiovascular diseases (CVD) are the leading death cause in modern world and are the most public health problem. WHO program for CVD contains: prevention, command and follow up of CVD in global level. Aim: Investigate CVD frequency in family medicine team in 2012.year (one year period of time) and qualitative management prevention and clinical services management quality of CVD together with recommended standards. Patients and methods: clinical revision of clinical standard practice patients with CVD was provided in Family medicine team in Public Health Centre Tuzla for the period of time from January 01 2012 - December 31 2012. For quality of realized services, AKAZ standards were based for: chapter 2. Health promotion and diseases prevention 2.5. preventive clinical services; chapter 3. Clinical services, standard 3.1. Coronary diseases and standard 3.2. TIA and Stroke. From CVD register next parameters had been used: age, gender, disease diagnose, therapy, blood pressure values, total cholesterol values, ß blockers therapy, anticoagulant therapy prescription, smoker status, stop smoking recommendation and influenza vaccination recommendation. Statistical approach: All results were taken in Excel program and statistically analyzed. Descriptive standard tests were taken with measurement of central tendency and dispersion. For significant differentials achieved with χ² chances relation was taken (Odds Ratio-OR) with 95% relevant security. All tests were leveled in statistical significant from 95% (p

Introduction: High blood pressure is the cause of almost 13 % of all deaths in the world. DASH (Dietary Approaches to Stop Hypertension) is „gold standard“ in diet recommended by American Society of Hypertension, American Heart Association and Dietary Guidelines for Americans 2010 for reduction many CV risk factors including hypertension. Non-pharmacological treatment of hypertension through DASH dietary program with reduction of salt intake can significantly reduce high values of blood pressure and decrease general cardiovascular risks. Goal: The aim of this research is to determine the prevalence of hypertension among miners in Banovici coal mine and amount of salt taken in meals during work time. Material and methods: We inspected the medical documentation and registers for all employees in coal mine Banovici in order to provide calculation of hypertension prevalence. Based on reports and company standards on grocery usage and average amount of salt used in preparation of one meal in coal mine kitchen, we have calculated the average consumption of salt of one employee per meal. Results: There are 2700 of employees in coal mine Banovici with average life age of 46 years. From them 694 (25.7%) miners have arterial hypertension. Also 707023 kg of salt is being spent for preparation of meals in coal mine kitchen on yearly basis. Employees take between 4-9 grams of salt per one meal excluding the salt contained in bread. Conclusion: the amount of salt intake per one meal in the coal mine kitchen is larger from daily doses recommended by ACC/AHA.