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The pharmacokinetics of meropenem are significantly altered in critically ill patients. A population pharmacokinetic study was designed to estimate typical values of meropenem clearance in critically ill patients and evaluate potential factors of influence.

Our aim was to compare the costs and efficacy of ambroxol in combination with imiglucerase with the costs and efficacy of imiglucerase only in the treatment of Gaucher disease type 2 (GD2) in the socio-economic settings of the Republic of Serbia, an upper-middle-income European economy.

Obesity is a chronic, complex, relapsing disease impacting healthcare systems and the economy worldwide. We aim to analyze the utilization trends of antiobesity drugs, and their reimbursement status on drug lists of health insurance funds (HIF) in selected European countries. The DDD/1000 inhabitants/day methodology is used for utilization trend analysis, where data from official national utilization reports were used. For the reimbursement status analysis of 5 antiobesity drugs (orlistat, semaglutide, liraglutide, naltrexone/bupropion, setmelanotide), the websites of national health insurance funds (HIF) of 22 European countries were screened. Trend analysis revealed fluctuation for almost all antiobesity drugs (the highest decrease seen for orlistat in Serbia, and the highest increase for liraglutide in Croatia). Novel antiobesity drugs show an increasing utilization trend in almost all the countries. In two out of three European countries, 437 antiobesity drugs are not covered by the HIF. Slovenia and Denmark reimburse most of the antiobesity drugs. The Netherlands is the only country where the cost of setmelanotide is paid by the HIF. Our results emphasize the importance of prioritizing the introduction and implementation of new strategies and reimbursement scheme models in global and national antiobesity policies.

Introduction: Making good teams are the base of management in general. A multidisciplinary medical team (MDT) is a group of health and care staff who are members of different professions and organizations (e.g. GPs, social workers, nurses), that work together to make decisions regarding the treatment of individual patients and service users. MDTs are engaged in both health and care settings. Methods: In this paper, the authors present information and views from valid professional-scientific sources (papers, books, brochures) about the basic principles and development of teams for medical healthcare that contribute to the development of the implementation of new concepts in health management (MH) for and against teamwork in this areas. Topic: A successful team relies on a well-composed human resource. Each of the member of team added their knowledge and skills to the prescribing process, so that decisions about the best therapy option, for example choice of antibiotics and dosages were made based on more evidence from the medical literature than if they were made by just one person. Clinical pharmacologists will certainly be necessary participants in such teams, because their knowledge of pharmacokinetics, side effects and efficacy of the selected drug is required. For successful personnel management in a team that is able to handle all the challenges and obstacles that multidisciplinary teamwork brings, appropriate education and professional skills of the main manager are required. An example of MDT in a modern therapeutic approach is the collaboration between hospital pharmacology and hospital transfusion. Teamwork has its advantages and disadvantages that a good leader can use or overcome. Conclusion: Multidisciplinary health teams often have the problem of immeasurable investments in order to achieve satisfactory therapeutic results. The formation of multidisciplinary teams in healthcare is a mandatory type of work in a successful healthcare institution. In addition to continuous medical education, it is desirable to introduce education for work in all positions in the health team. The most important goal of MDT is the well-being of the patient, which requires high ethical and professional qualities of the staff.

Although being very effective in the treatment of diabetes and a few other conditions, metformin (MTF) cannot be tolerated by many patients due to gastrointestinal (GI) complaints. A number of risk factors for intolerance were identified, but many are still controversial or uninvestigated. The aim of this study was to further investigate possible risk factors for the occurrence of GI complaints in patients on MTF therapy. A cross-sectional design was used for this multicentric study on adult patients visiting 50 community pharmacies in Montenegro. The patients were surveyed by semi-structured questionnaire after a service of a pharmacist was delivered, and their drugs dispensed. Uni- and multi-variate regression methods were used for processing the data.

Critical illness may disrupt nutritional, protective, immune, and endocrine functions of the gastrointestinal tract, leading to a state of gastrointestinal dysmotility. We aimed to identify factors associated with the occurrence of gastrointestinal dysmotility in critically ill patients. A cross-sectional retrospective study was conducted, using patient files as a source of data. The study included 185 critically ill patients treated in the intensive care unit of the University Clinical Center, Kragujevac, Serbia, from January 1, 2016, to January 1, 2022. Significant risk factors associated with some form of gastrointestinal dysmotility were acute kidney injury (with paralytic ileus, nausea, vomiting, and constipation), recent abdominal surgery (with ileus, nausea, vomiting, and constipation), mechanical ventilation (with ileus, and nausea), age (with ileus and constipation), and use of certain medication such as opioids (with ileus, gastro-esophageal reflux, nausea, vomiting, and constipation), antidepressants (with ileus, nausea, and vomiting), and antidiabetics (with ileus). On the other hand, Charlson comorbidity index had divergent effects, depending on the form of gastrointestinal dysmotility: it increased the risk of gastro-esophageal reflux but protected against ileus, nausea, and vomiting. In clonclusion, recognition of factors associated with gastrointestinal dysmotility should initiate preventative measures and, thus, accelerate the recovery of critically ill.

Purpose: When carrying out prosthetic rehabilitation of edentulous and partially edentulous patients, great attention is paid to the personal attitude of the patients, their satisfaction with oral health and psychosocial interaction due to tooth loss, as well as the treatment of the resulting disorders. This attention has led to the development of various instruments for examining the quality of life related to oral health. The aim of this study was to develop and validate a reliable instrument in the Serbian language suitable for measuring oral health-related quality of life in patients who have been rehabilitated with complete or partial dentures. Мaterials and Methods: The study was unicentric and cross-sectional, and assessed the reliability and validity of a newly developed instrument for measuring the oral health-related quality of life in denture wearers (OHRQoL-DW). It was conducted on a sample of 200 adults from Serbia, wearers of various types of dentures, with a mean age 66.9 ± 10.3 years and male/female ratio of 86/114 (43%/57%). Results: The definitive version of the OHRQoL-DW scale with 28 items showed very good reliability, with Cronbach’s alpha = 0.938. Good temporal stability of the questionnaire was demonstrated, and satisfactory results were obtained for divergent and convergent validity tests. Exploratory factorial analysis revealed four domains of oral health-related quality of life in denture wearers: physical, psychosocial, environmental and aesthetic. Conclusions: The OHRQoL-DW scale is a reliable and valid generic instrument for measuring the oral health-related quality of life in patients wearing dentures, which is one of the most important outcomes of oral health in prosthetic treatment. [ABSTRACT FROM AUTHOR]

Introduction: Optimal management of toxic megacolon as a consequence of Cl. difficile colitis is still matter of controversy, as well as timing of available therapeutic modalities. In this article we report a case of severe C. difficile colitis associated with toxic megacolon in a pregnant patient with Covid 19, who was successfully treated conservatively. Case Report: A 33-years old pregnant woman contracted SARS-CoV-2 in the 32nd week of pregnancy. She was admitted to regional hospital and treated extensively by wide-spectrum antibiotics. After the delivery she developed severe form of Cl. difficile colitis with toxic megacolon. In spite of severe clinical picture, the patient was treated conservatively, with high initial oral doses of vancomycin, with subsequent tapering. The outcome of the treatment was complete recovery and colonic functions were regained completely. Conclusion: In conclusion, our case shows that in younger patients, who were fit before occurrence of Cl. difficile colitis and toxic megacolon, conservative therapy should be tried as long as possible before turning to colectomy, since chances for cure without surgery are considerable.

Professional drivers’ knowledge about driving-impairing medications is not satisfactory. The aim of this study was to develop and test the reliability and validity of the questionnaires designed to measure the knowledge and attitude of professional drivers about the influence of various medications on driving ability.

This study aimed to identify risk factors for amlodipine-induced gingival enlargement, assess quality of life, and analyze gingival tissue. This cross-sectional study involved hypertensive patients on amlodipine, divided into groups with and without gingival enlargement. Assessments included sociodemographic data, clinical evaluations, and clinical parameters. Quality of life was assessed using OHIP-14 and WB-HRQoL scales. Gingival tissue samples were analyzed for oxidative status and key molecules using RT-PCR and colorimetric assays. The study included 32 patients with no significant sociodemographic differences between groups (p > 0.05). Patients with gingival enlargement had higher systolic blood pressure (139.63 ± 10.743 vs. 128.38 ± 7.249, p = 0.028) and higher OHIP-14 scores. The RT-PCR analysis showed significant differences in IL-6, TNF-α, IL-33, ST2, TGF-β1, FGF-2, CTGF, VEGF-D, and KGF expression. IL-6, TNF-α, ST2, and FGF-2 expression levels were lower in patients taking amlodipine, with and without gingival enlargement. TGF-β1 and CTGF expression levels were highest in patients with amlodipine-induced gingival enlargement. SOD activity was also highest in these patients, whereas MDA levels were higher in patients with gingival enlargement without amlodipine. Our study highlights the impact of amlodipine-induced gingival enlargement on oral health and quality of life, emphasizing fibrosis and oxidative stress, and suggests the need for integrated healthcare approaches and further research. [ABSTRACT FROM AUTHOR]

Translations of instruments for measuring quality of life developed in certain, mostly more developed, parts of the world usually do not cover regionally specific aspects of health-related quality of life, even after transcultural validation. The aim of this study was to develop and validate a reliable questionnaire in Serbian, Croatian, Bosnian, and Montenegrin languages suitable for measuring health-related quality of life in adults.

Purpose. This study was designed to characterize the psychometric properties of the Persian version of Fear of Hospitalization Scale (P-FHS). Design and Methods. In order to evaluate the validity and reliability of the translated scale, a cross-sectional design was employed. Ten experts evaluated the content validity of Fear of Hospitalization Scale (FHS) after it had been back-translated into Persian. With 612 patients having emergency surgery, construct validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The STROBE checklist for cross-sectional studies was followed. Findings. The results of EFA (n=306) showed that fear of hospitalization had three factors. These three factors accounted for 45.28% of the total variance. Also, these factors were confirmed by CFA (n=306) (root-mean-square error of approximation=(90% confidence interval)=0.050 (0.041, 0.058), goodness-of-fit index=0.945, comparative fit index=0.968, non-normal fit index=0.948, incremental fit index=0.968, Tucker-Lewis index=0.959). The coefficients of Cronbach's alpha, McDonald's omega, composite reliability, and maximum reliability for all three factors were greater than 0.7, demonstrating satisfied internal consistency. Practice Implication. According to the published results, the P-FHS is effective at measuring hospitalization anxiety in patients undergoing emergency surgery. It is advised that nurses in Iranian culture use a legitimate and trustworthy technique to pinpoint the causes of hospitalization anxiety in patients undergoing emergency surgery to give optimal care., Author(s): Hamid Sharif Nia [1]; Slobodan Janković [2]; Nasrin Hanifi (corresponding author) [3] 1. Introduction Isolation and fear are brought on by hospitalization in stressful inpatient settings [1]. While at [...]

Background/Aim. Despite the widespread use of procalcitonin, C-reactive protein (CRP), and soluble CD14 subtype (sCD14-ST), their diagnostic accuracy in children with sepsis is not yet clear. The aim of the study was to establish and compare the diagnostic accuracy of procalcitonin, CRP, and sCD14-ST in children admitted to the hospital under suspicion of having sepsis. Methods. The study was designed as a retrospective cross-sectional study on children admitted to the Pediatrics Clinic in Kragujevac, Serbia, under suspicion of sepsis, during a 6-month period. Diagnostic accuracy was tested by the construction of receiver operating characteristic (ROC) curves and their comparison in terms of area under the curve (AUC). Results. Procalcitonin had the largest AUC [0.75; 95% confidence interval (CI) 0.63–0.88], followed by CRP (0.68; 95% CI 0.54–0.81) and sCD14-ST (0.65; 95% CI 0.52 – 0.79). Differences between the areas under the ROC curves were not significant (CRP vs. procalcitonin z = 1.054, p = 0.291; CRP vs. sCD14-ST z = 0.238, p = 0.812; procalcitonin vs. sCD14-ST z = 1.089, p = 0.286). Conclusion. Our study showed relatively low sensitivity and moderate specificity of procalcitonin, C-reactive protein and sCD14-ST in diagnosing sepsis among children, as well as similar diagnostic accuracy of the three biomarkers.

Bacground/Aim. Treatment of neurological diseases usually requires polypharmacy, and it is crucial to detect potential drug-drug interactions (DDIs) and recognize risk factors on time, as consequences of DDIs could be serious. The aim of the study was to analyze risk factors for the occurrence and the number of potential DDIs among patients in a general neurological ward. Methods. This study was conducted with 144 inpatients in a general-care neurological department of a tertiary care hospital. The effects of risk factors for potential DDIs were evaluated by multiple linear regression. The study had retrospective cohort de-sign. Frequencies of various types of potential DDIs (according to severity) were discovered by Medscape, Epocrates and Micromedex online interaction checkers. Results. The number of prescribed drugs, age of a patient, value of the Charlson comorbidity index and prescription of an antidepressant increase risk of potential DDIs in a general neurology ward. On the other hand, being paralyzed, number of prescribers for a single patient, being bedridden for at least one day of hospitalization decreased the number of potential DDIs per patient. Number of prescribed drugs per patient [odds ratio (OR) = 1.466 ± 0.250; p = 0.000) and age (OR = 1.027 ± 0.026; p = 0.041)] increased, and number of prescribers per patient (OR = 0.056 ± 0.028; p = 0.016), especially if the patients were paralyzed (OR = 0.214 ± 0.294; p = 0.007), decreased the risk of contraindicated, serious, “use alternative” or major potential DDIs. Antidepressants increased the risk of absolute number of all monitor/modify potential DDIs (OR = 1.257 ± 0.726; p = 0.035). Conclusion. Frequency of potential DDIs among neurological patients is considerable and influenced to the largest extent by advanced age, comorbidities, total number of pre-scribed drugs per patient and concomitant use of antidepressants.

Introduction: Key problems when transferring results of pharmacoeconomic studies between countries are: relative infrequency of observational design, utilization of unreliable estimates of input parameters in many of modelling studies, not reporting variability of the study outputs (e.g. ICER, net monetary benefit) in a publication, and large differences in costs of healthcare services and drugs from country to country. Aim: The aim of this study was to estimate Incremental Cost-effectiveness Ratio (ICER) of denosumab vs. alendronate for treatment of osteoporosis in postmenopausal women in Serbia, using results of published pharmacoeconomic studies in United States of America (USA) and Japan. Material and Methods: The estimate of the ICER was made through the following steps: (1) scaling the ICER of the published studies to Serbian healthcare milieu using unit costs in Serbia, USA and Japan; (2) defining prior distribution of the ICER using adjusted results of the earlier published study; (3) defining sampling distribution of the ICER using adjusted results of the next published study; (4) estimating posterior distribution of the ICER and calculating the most probable values the ICER with Bayesian statistics. Results: The ICER of the prior distribution was 572,787.00 RSD, with 99% confidence interval from 1,116.00 to 998,051.00 RSD, and that of the sampling distribution 706,057.00 RSD, with 99% confidence interval from 1,122.00 to 999,308.00 RSD. The most probable ICER value from the posterior distribution was 752,912.00 RSD, with 99% confidence interval from 667,631.00 to 771,552.07 RSD. The estimated ICER was below one Gross Domestic Product (GDP) of Serbia per capita (the 2019 value: 780,063.60 RSD). Conclusions: Denosumab should be considered cost-effective in Serbia if one to three GDPs/capita/Quality Adjusted Life Year (QALY) gained is taken as the upper limit of willingness to pay by Serbian Health Insurance Fund.

Introduction: The clinical significance of potential drug-drug interactions (pDDIs), especially in the intensive care unit (ICU) manifested mostly as adverse drug reactions. Aim: The goal of this research was to conduct a focus group, in which the participants were decisionmakers in acute ischemic stroke patient treatment. Also, the aim was to reach a consensus, due to the Delphi process, between neurologists and clinical pharmacologists regarding this highly vulnerable group of patients. Material and Methods: In this academic research, so-called applied focus group (the goal was to reach practical decisions) and clinical focus group (determining motives, predeterminations, bias, prejudice and analyzing the behavior leading to a certain outcome) was done. Results: Continuing medical education of neurologists is needed regarding pDDIs and the use of an online pDDIs checker. Certain groups of patients with AIS are at particular risk of exposure to pDDIs. Certain drug groups are more likely to interact with other drugs. Conclusions: Defining medical recommendations/guidelines on evidence base medicine about pDDIs in patients with AIS would significantly contribute to reducing their frequency in this vulnerable patient population.

Introduction: Patients with Parkinson's disease are exposed to higher number of drugs on average than other elderly persons. Levodopa, of the mainstay of Parkinson's disease therapy, is frequently interacting with numerous drugs. Aim: The aim of this study was to identify predictors of potential drug-drug interactions (pDDIs) in hospitalized patients suffering from Parkinson's disease (PD). Material and Methods: This was a academic retrospective cross-sectional study in PD patients hospitalized at the Clinic of Neurology, Clinical Center Kragujevac. Medical records of hospitalized patients during the period 1.1.2017 - 31.12.2019 were analysed. The pDDIs were identified by means of Micromedex andLexi-Interact online softwares, and multivariate regression methods were used to reveal potential predictors of number of pDDIs per patient. Results: Micromedex detected 160 different pDDIs in 77.8% of 72 patients with PD. The most frequent pDDIs were those that involved aspirin (with bisoprolol, sertraline and perindopril). Predictors of pDDIs in general was total number of drugs, while use of antidepressants presented a significant risk factor for major pDDIs. Lexi-Interact revealed 310 pDDIs in 98.6% of patients. The three most common pDDIs were with levodopa (bisoprolol, clonazepam, perindopril). Total number of drugs, number of co-morbidities, hospitalization at the neurodegenerative ward, and use of antipsychotics were identified as the relevant predictors of pDDIs. Lexi-interact software detected significantly more pDDIs than Micromedex (p

Introduction: Drug rash with eosinophilia and systemic symptoms (DRESS syndrome) is a rare, severe, systemic, drug-induced hypersensitivity syndrome, the most frequently associated with anticonvulsants. Case Report: A 35-years-old woman with a history of depression and hypothyroidism developed fever 39.5°C, enlarged, painful neck and axillary lymph nodes, slight facial edema around the mouth, confluent maculopapular rash, and laboratory signs of hepatocellular injury, leukocytosis and lymphopenia, but with normal eosinophil count. The syndrome was evident two weeks after starting carbamazepine, and gradually decreased after withdrawal of this drug and introduction of corticosteroid therapy. Conclusion: If a patient is taking carbamazepine and develops skin rash as well as fever and swollen lymph nodes, the physician should always check for internal organ damage and possible DRESS syndrome.

Introduction. Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome (sy) to carbamazepine has a heterogeneous clinical presentation. The aim of this report is to indicate the efficacy of immunoglobulin G in the treatment of corticosteroidresistant DRESS sy. Case outline. An adolescent suffering from epilepsy treated with carbamazepine and Na-valproate was hospitalized for fever, elevated transaminases, lymphadenopathy, splenomegaly. There was an eruption of skin efflorescence daily. On the sixth day of hospitalization, the number of eosinophils increased to 24% (780/ml absolute number). There was no desired response to methylprednisolone during the first eight days of treatment or to prednisolone during further treatment, with concomitant administration of antihistamines from day one of hospitalization, to Na-valproate, metformin hydrochloride, elimination diets, and carbamazepine withdrawal. Significant clinical, hematologic, and biochemical improvement occurred the day after the first dose of intravenous immunoglobulin G (IVIG). Conclusion. We point out the need to change the DRESS sy treatment recommendations in favor of the IVIG (as soon as the third or fourth day of treatment) in patients in whom the treatment with corticosteroids has no effect. Until new cases of the proven role of IVIG in the treatment of DRESS sy are published, corticosteroids remain the first therapeutic choice.

Background/Aim. Liver damage, with potentially serious consequences, is not uncommon in hospitalized cardiac patients. The aim of our study was to determine the risk factor profile for liver damage in patients hospitalized from a deterioration of their acute or chronic cardiac illness. Methods. The study had observational case-control design with retrospective data collections from medical files of adult patients hospitalized in a tertiary health care center. The cases (n = 140) were subjects with novel liver injury (which emerged during hospital stay) and three control subjects were matched (age, date) for each case subject (n = 420). The primary outcome was hepatotoxicity (present or absent) and independent variables were proposed risk factors. Statistical analysis included descriptive methods, hypothesis testing and univariate and multivariate binary logistic regression, with p ≤ 0.05. Results. In the whole study population, there were 432 (77.1%) females and the mean age of patients was 64.1 years [standard deviation (SD) = 10.7, range 24–85 years]. The most common illnesses were coronary heart disease (n = 385), hypertension (n = 334) and arrhythmia (n = 115). Mean value of Charlson Comorbidity Index (CCI) score was 3.8 (SD=1.7; range 1-10) corresponding to estimated CCI 10-years survival rate of 54.4% (SD = 33.5%). In the group of cases, 114 (81.4%) of the patients had hepatocellular, 9 (6.4%) cholestatic and 17 (12.2%) mixed type of hepatic injury. Factors independently associated with hepatotoxic event were previous occasional alcohol intake odds ratio (OR) 96.47; 95% confidence interval (CI) 28.95–321.43; p < 0.001), amiodarone (OR 3.70; 95% CI 1.82–7.53; p < 0.001), enoxaparin (OR 3.29; 95% CI 1.79–6.05; p < 0.001), obesity (OR 2.78; 95% CI 1.15– 6.71; p < 0.023), atorvastatin (OR 2.67; 95% CI 1.33–5.38; p < 0.006) and CCI total score (OR 1.89; 95% CI 1.53–2.34; p < 0.001). Conclusion. Major factors associated with acute liver damage in patients hospitalized in cardiology ward of a tertiary health care institution were patient’s constitutional and habitual characteristics (occasional alcohol intake, obesity, CCI total score) and drugs with known hepatotoxic properties (amiodarone, enoxaparin, atorvastatin).

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

Introduction: The increasing resistance of Pseudomonas aeruginosa against cefepime requires a better understanding of hospital epidemiology in order to retain this drug as a therapeutic option. Aim: The aim of this study was to identify risk factors associated with healthcare associated infections (HAIs) caused by cefepime-resistant P. aeruginosa (CRPA), both in all patients with HAIs and in the subgroups of patients who died or who acquired infection with carbapenem-resistant P. aeruginosa. Methods: The academic study was designed as a combination of three nested case/ control studies within the cohort of patients with HAIs caused by P. aeruginosa regardless of localization, prospectively followed from January 2009 to December 2017 in a tertiary care hospital. The influence of risk factors on specific outcomes was estimated by adjusted odds ratios calculated from multivariate logistic regressions. Results: Our study showed that there are independent risk factors for CRPA infections: the existence of another HAI (p=0.001), hospitalization in ICU longer than one month (p=0.007), a longer stay in hospital prior to infection (p=0.004), longer use of mechanical ventilation (p=0.036), administration of antibiotics before infection (p

This observational clinical study was composed of two substudies: a non-comparative one (n = 166), testing only lysozyme-based compounds (LBCs), and a comparative substudy (n = 275), testing both LBCs and bicarbonate-based local compounds (BBCs) on the healing of oral mucositis during radio- or chemotherapy. The density of ulcerations has decreased significantly after the treatment with lysozyme in both substudies. The density of ulcerations in the radiotherapy group was lower in patients treated with LBCs compared to patients treated with BBCs (p < 0.001). In the chemotherapy group, reduction of ulceration density was similar with both LBCs and BBCs. The LBCs reduced pain intensity during the intake of solid food and speech more than BBCs in both patient cohorts (p < 0.05). In the radiotherapy cohort, pain intensity when consuming liquid foods was reduced more with LBCs than with BBCs (p < 0.05). No adverse events were recorded. This study demonstrates the advantages of treating oral mucositis during radiotherapy or chemo-therapy with LBCs.

The COVID-19 pandemic required rapid response to the needs of critically ill patients, and one of the solutions was re-purposing of drugs with wide spectrum of antiviral action for treatment of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. The re-purposing characteristically started with outof-label use in single or series of cases, to continue after the first promising results with randomised clinical trials. There are several drugs that are currently tested in ongoing clinical trials: antimalarials hydroxychloroquine and chloroquine, HIV protease inhibitors lopinavir/ritonavir, broad spectrum antivirals umifenovir (anti-influenza drug) and favipiravir, antiparasitary drug ivermectin and nucleotide analogue remdesivir. However, up to date only a few trials are completed and published, precluding definitive conclusions about efficacy and safety of these drugs. Until major clinical trials are completed, physicians who decide to use these drugs out-of-label should properly inform their patients of all potential risks and benefits and seek for their consent before administration of the drugs.

Introduction/Objective. Making a calculator that would recognize patterns of abnormal liver function tests and link them to the most probable etiology could help clinicians in their initial orientation towards a definitive diagnosis in patients with liver damage. The aim of our study was to design, construct, and validate a calculator that based on a pattern of abnormalities in liver function tests of a patient with liver damage would propose the most probable etiology. Methods. Patterns of abnormal liver function tests for certain etiology of liver damage were extracted from distributions of actual values taken from reports in medical literature about patients whose etiology of liver damage was proven by reliable diagnostic tests. After setting up the calculator with the patterns extracted, its diagnostic value was checked under real-life conditions, on a sample of patients with liver damage whose etiology was established by the gold standard of diagnostics (biopsy or else). The calculator validation study was carried out at the Military Medical Academy in Belgrade during a two-year period (2015–2016). Results. For all tested diagnoses, the calculator demonstrated a highly significant difference between the area under the receiver-operator curves’ values and the value of 0.5 (p < 0.001), and high level of sensitivity (more than 90%, except for the model for chronic hepatitis) as well as relatively high specificity (more than 75%) were noted, indicating good ability of the calculator to detect etiology of liver damage. Conclusion. New calculators showed satisfactory sensitivity and specificity for revealing major liver damage etiologies. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175007]

Introduction/Objective. Although effectiveness of atypical antipsychotics in patients with schizophrenia is mostly similar, there are significant differences in adverse effects rate and treatment costs, making comparison of their cost/effectiveness ratios essential for optimal drug choice. The aim of this study was to compare cost/effectiveness of aripiprazole and olanzapine in long-term treatment of schizophrenia. Methods. A four-state, three-month cycle Markov model was built to compare aripiprazole and olanzapine. The model assumed that patients who relapse on treatment with both aripiprazole and olanzapine are further treated with clozapine. The perspective of the National Health Insurance Fund was chosen, and the period covered by the model was 10 years. The model results were obtained after Monte Carlo microsimulation of a sample with 1,000 virtual patients. Both multiple one-way and probabilistic sensitivity analysis was made. Results. After base-case analysis aripiprazole was dominated by olanzapine, as net monetary benefit was negative (-390,341.96 Ѓ} 29,131.53 RSD) and incremental cost/effectiveness ratio (ICER) was above the willingness-to-pay line of one Serbian gross domestic product per capita per quality-adjusted life year (QALY) gained. Multiple one-way and probabilistic sensitivity analysis confirmed results of the base case simulation. Conclusion. Olanzapine has more beneficial cost/effectiveness ratio than aripiprazole for long-term treatment of schizophrenia in Serbian milieu. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175007]

Introduction: a gap between evidence-based recommendations for prescribing antipsychotics and its implementation in practice could be overcome by local guidelines. Aim: the aim of our study was to locally adapt the national guideline for schizophrenia and evaluate its impact on prescribing practice as well as on clinical and humanistic outcomes in a long-stay psychiatric hospital Dobrota in Kotor, Montenegro. Subjects and Methods: This was academic, prospective, IV phase interventional study, which measured outcome before and after investigators intervention within healthcare system. The study was conducted in two six-months phases separated by implementation of the local guidelines. Prescribing practices and treatment outcomes were monitored in both phases of the study. Results: Study included 111 patients. Although the guidelines did not influence total volume of prescribed antipsychotics, social functioning and environmental aspects of quality of life were improved. Conclusions: Writing and adopting the guidelines for local use might be associated with some benefit in humanistic outcomes, but multi-faceted intervention should be considered in order to achieve more substantial impact on prescribing practices and clinical outcomes.

Background/Aim. Nausea after oral administration of iron is frequent phenomenon (11% of patients) and it is believed to be consequence of accumulation of free radicals in mucosa of gastrointestinal tract. The aim of our study was to measure the extent of nausea in outpatients taking oral supplementation with iron, and to investigate possible factors that may have an influence on it. Methods. The study was of the cross-sectional type, and conducted on a sample of outpatients on oral iron supplementation. The sample was consecutive, including all patients coming to a community pharmacy for oral iron supply during the study period. Frequency and severity of nausea were measured by the 5- item Drug-Induced Nausea Scale (DINS). Results. The mean score of the DINS from the sample of 128 patients was 8.56 ± 5.07 (range from 5 to 25). Each additional cup of coffee per week increased the DINS score for 0.143 points, the history of gastrointestinal disease had protective effect and decreased the DINS score for 5.923 points. Conclusion. Frequency and severity of oral iron-induced nausea are not dependent on oral iron burden, but rather on coffee intake and previous experience of patients with symptoms of gastrointestinal diseases. Modification of diet and education about types and severity of symptoms of gastrointestinal diseases could be useful preventive measures to avoid or at least mitigate oral iron-induced nausea and/or vomiting.