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Zorica Lazic,1 Ivana Stankovic,2 Branislava Milenkovic,3 Biljana Zvezdin,4 Sanja Hromis,4 Slobodan Jankovic,5 Vojislav Cupurdija1 1Faculty of Medical Sciences, University of Kragujevac, and Clinic for Pulmonology, Clinical Centre, Kragujevac, Serbia; 2Faculty of Medicine, University of Niš, and Clinic for Lung Diseases, Clinical Centre, Niš, Serbia; 3Faculty of Medicine, University of Belgrade, and Clinic for Pulmonology, Clinical Centre of Serbia, Belgrade, Serbia; 4Faculty of Medicine, University of Novi Sad, and the Institute for Pulmonary Diseases of Vojvodina, Novi Sad, Serbia; 5Faculty of Medical Sciences, University of Kragujevac, and Clinical Pharmacology Department, Clinical Centre, Kragujevac, SerbiaCorrespondence: Slobodan JankovicFaculty of Medical Sciences, University of Kragujevac, Svetozara Markovića Street, 69, Kragujevac, 34000, SerbiaEmail slobnera@gmail.comBackground: Establishing a regional/national/international registry of patients suffering from chronic obstructive pulmonary disease (COPD) is essential for both research and healthcare, because it enables collection of comprehensive real-life data from a large number of individuals.Objective: The aim of this study was to describe characteristics of COPD patients from the Serbian patient registry, and to investigate actual differences of those characteristics among the COPD phenotypes.Methods: The Serbian registry of patients with COPD was established in 2018 at University of Kragujevac, Faculty of Medical Sciences, based on an online platform. Entry in the Registry was allowed for patients who were diagnosed with COPD according to the following criteria: symptoms of dyspnea, chronic cough or sputum production, history of risk factors for COPD and any degree of persistent airflow limitation diagnosed at spirometry.Results: In the Serbian COPD registry B and D GOLD group were dominant, while among the COPD phenotypes, the most prevalent were non-exacerbators (49.4%) and then frequent exacerbators without chronic bronchitis (29.6%). The frequent exacerbator with chronic bronchitis phenotype was associated with low levels of bronchopulmonary function and absolute predominance of GOLD D group. Anxiety, depression, insomnia, hypertension and chronic heart failure were the most prevalent in the frequent exacerbator with chronic bronchitis phenotype; patients with this phenotype were also treated more frequently than other patients with a triple combination of the most effective inhaled anti-obstructive drugs: long-acting muscarinic antagonists, long-acting beta 2 agonists and corticosteroids.Conclusion: In conclusion, the data from the Serbian registry are in line with those from other national registries, showing that frequent exacerbators with chronic bronchitis have worse bronchopulmonary function, more severe signs and symptoms, and more comorbidities (especially anxiety and depression) than other phenotypes. Other studies also confirmed worse quality of life and worse prognosis of the AE-CB phenotype, stressing importance of both preventive and appropriate therapeutic measures against chronic bronchitis.Keywords: chronic obstructive pulmonary disease, patient registry, phenotypes

The aim of the present study was to investigate the distribution of CYP2C8 variants *3 and *5, as well as their effect on carbamazepine pharmacokinetic properties, in 40 epileptic pediatric patients on carbamazepine treatment. Genotyping was conducted using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), and allele-specific (AS)-PCR methods, and steady-state carbamazepine plasma concentrations were determined by high performance liquid chromatography (HPLC). The CYP2C8 *3 and *5 polymorphisms were found at frequencies of 17.5 and 0.0%, respectively. After dose adjustment, there was a difference in daily dose in CYP2C8*3 carriers compared to non carriers [mean ± standard deviation (SD): 14.19 ± 5.39 vs. 15.46 ± 4.35 mg/kg; p = 0.5]. Dose-normalized serum concentration of carbamazepine was higher in CYP2C8*3 (mean ± SD: 0.54 ± 0.18 vs. 0.43 ± 0.11 mg/mL, p = 0.04), and the observed correlation between weight-adjusted carbamazepine dose and carbamazepine concentration after dose adjustment was significant only in CYP2C8*3 non carriers (r = 0.52, p = 0.002). However, the population pharmacokinetic analysis failed to demonstrate any significant effect of CYP2C8 *3 polymorphism on carbamazepine clearance [CL L/h = 0.215 + 0.0696*SEX+ 0.000183*DD]. The results indicated that the CYP2C8*3 polymorphism might not be of clinical importance for epilepsy treatment in pediatric populations.

Nowadays, climate changes induce deviations in the composition of honey varieties characteristic of a specific geographic region. Therefore, according to Codex Alimentarius for honey, the slight variations in values of determined parameters cannot be strictly regarded as a sign of its adulteration. Here, modified methods are presented for preparing honey samples for inductively coupled plasma-optical emission spectroscopy (ICP-OES) analysis and the high-performance liquid chromatography (HPLC) method to use them as fast and reliable methods in the food industry. ICP-OES analysis suggested that all analysed honey samples are natural, and HPLC-DAD (diode-arrray detection) analysis on the flavonoids showed that one sample is probably not natural. Invertase activity showed an overlap with this HPLC-DAD finding but suggested more samples as possibly adulterated, which can be neglected due to possible thermal treatment of those natural samples, causing a decrease in invertase activity. Therefore, results obtained from the analyses of investigated honey samples based on the mineral content, number, and quantity of flavonoids, together with the invertase activity, indicated that the combination of analyses could be a reliable tool for determining the quality of honey samples.

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.

Schizophrenia is a chronic mental illness with a poor quality of life (QoL). The main aim of this study was to measure the QoL and factors that affect the QoL of patients with schizophrenia placed in a social welfare institution. This cross-sectional study included 287 patients with schizophrenia who were treated in a long-stay social care institution in which QoL was assessed using five different instruments: the World Health Organization Quality of Life scale, the EuroQoL Five-Dimension-Five-Level scale (including the visual analog scale), the Quality of Life Enjoyment and Satisfaction Questionnaire – Short Form, and the Brief Psychiatric Rating Scale. To determine the impact of patients’ characteristics on score values, multiple linear regression using backward elimination was employed. Due to non-normality in the distribution of the dependent variables, a Box–Cox power transformation was applied to each dependent variable prior to conducting multiple linear regression analysis. Results revealed that patients with schizophrenia have lower QoL. Our study revealed that age, level of education, type of accommodation, type of pavilion, age of onset of the disease, number of prescribed antipsychotics, number of psychiatric comorbidities, duration of therapy, and the number of daily doses of antipsychotics are dominant contributors to the QoL in patients with schizophrenia who were treated in social welfare institution.

Introduction: Platelets play an important role in the pathogenesis of COVID-19. Therefore, their parameters vary in different stages of the disease. The importance of plateletcrit in COVID-19 is not well known. Objective: To examine the diagnostic value of plateletcrit in COVID-19. Methods: From January to March and September-December 2021. during their initial visit to the COVID outpatient clinic at the Primary Healthcare Center Nis, we examined 440 patients who were experiencing possible COVID-19 symptoms. Following the examination, a complete blood count was performed, and they tested positive for COVID-19. We analyzed the plateletcrit in every lab sample collected during their first visit. The control group consisted of 60 patients from the "green zone" from January to December 2021, as well as 48 patients from the pre-COVID period, before 2020. Results: Lower plateletcrit was found in 48,4% of women and 63,3% of men in the first period. Out of the total of 111 patients, lower plateletcrit was found in 54,9%. in the second period lower plateletcrit was found in 72,2% of women and 85% of men. Out of the total number of 329 patients, lower plateletcrit was found in 78,7%. In the control group, from the "green zone" lower plateletcrit was found in 8,3% of 60 patients, and no decrease in plateletcrit levels was observed in 48 patients from the pre-COVID-19 era. Conclusion: Plateletcrit levels are decreased in many patients during their initial visit due to COVID-19. Symptoms. Therefore, variations in plateletcrit levels could raise concerns about potential COVID-19 infection.

Background/Aim. The cause of eosinophilia often remains unelucidated. The aim of the study was to analyze causes and treatment approaches in children with eosinophilia in pediatric tertiary care hospital. Methods. The medical records of children investigated for eosinophilia (based on the International Classification of Diseases code D72.1) were retrospectively reviewed in the University Children’s Hospital, Belgrade, Serbia, from December 2011 to December 2022. A total of 105 children (62 boys; male:female ratio was 1:4) aged one month to 16.5 years (median 7.7 years) were diagnosed with eosinophilia. After excluding 15 of them due to incorrectly assigned diagnosis based on relative eosinophil number only, the remaining 90 children were grouped according to the severity of eosinophilia (mild, moderate or severe). Results. Serological analysis con-firmed toxocariasis in six (6.7%) patients, while two (2.2%) had a confirmed nematode infestation (Ascaris lumbricoides and Enterobius vermicularis, respectively). Thirty-two (35.6%) children with eosinophilia and three with no true eosinophilia were diagnosed with helminthiasis ex juvantibus. Eosinophilia was ultimately explained by allergic/atopic conditions [19 (21.1%)], drug reactions [four (4.4%)], bacterial infections [nine (8.9%)], hematological problems [five (5.5%)], autoimmune disorders [three (3.3%)], unrelated congenital disorders (one), or as an isolated finding [seven (7.8%)]. In addition, one of the children without an increased absolute eosinophil number was diagnosed with eosinophilic esophagitis. A total of 56 (53.3%) children received anthelminthic treatment: 9 (90.0%) with severe eosinophilia, 19 (51.4%) with moderate, 23 (53.5%) with mild, and 5 (33.3%) children with no true eosinophilia. Most (42) of the children were given mebendazole only, while the remaining 14 (eight with severe, three with moderate, and three with mild) were also initially treated with mebendazole but subsequently shifted to albendazole due to the persistence of eosinophilia. In all treated children, eosinophilia and other relevant findings (if any) subsided in a matter of a few days to a few weeks after initializing treatment. Conclusion. Our results support the recommendation that unexplained eosinophilia of all levels of severity requires a standardized diagnostic approach. The results also provide some support for a potential rational basis for ex juvantibus administration of anthelminthic drugs in a fraction of children with eosinophilia without an obvious etiological explanation.

Introduction: Blood transfusion is the process of donating blood or blood components from a donor to a recipient of blood or blood components. Clinical pharmacology is a medical discipline created in the 20th century, that implies the most effective application of drugs, and it could be considered the culmination of all therapeutic procedures in medicine, or simply in the preservation of human health. Methods: Online search of pharmacology and transfusion literature was conducted using PubMed, Cochrane, Embase, and Scopus databases. Topic: Patient blood management (PBM) is a multidisciplinary multimodal patient-centered approach designed to minimize the use of allogeneic blood components in order to improve the clinical outcome of patient treatment. PBM consists of 3 main pillars with specific clinical goals. 1) First pillar: increasing red cell mass including clinical-pharmacological correction such as erythropoiesis stimulating agents (ESA) - iron and another drugs and optimizing the time for surgical intervention in relation to achieving the required hemoglobin value; 2) Second pillar: minimize blood loss through an adequate selection of surgical and anesthetic techniques, treatment with tranexamic acid (TXA) and autologous blood salvage, and the use of blood substitutes, 3) Third pillar: increasing the patient's tolerance to anemia through maximum improvement of pulmonary and cardiac function, optimizing ventilation, oxygenation and restrictive application of blood components. Clinically it is clear that clinical transfusiology and clinical pharmacology are part of each other originating from the fact that the use of classical medicine as well as the therapeutic use of blood achieves a therapeutic effect in order to improve the clinical status of the patient. Conclusion: Patient blood management implies health teams composed of clinical pharmacologist and clinical transfusiologist with other health care specialists making successful healthcare institutions. The most important thing is to monitor the development of new drugs, new transfusion solutions, and in this area, be especially careful when applying new drugs because of serious side effects that may occur. The agility of PBM is reflected in three pillars that must be harmonized and require continuous team education.

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.

Peltate trichomes have been the focus of botanical research for decades as the main secretory structures responsible for the production of essential oil and other specialized metabolites. For this study, samples of the plant material were obtained from the collection of the Institute for Medicinal Plant Research “Dr. Josif Pančić”. This study was conducted to perform morphological characterization, determination of the diameter and analysis of the distribution of peltate trichomes on leaves and calyces of selected commercial Lamiaceae species. In addition, the density of peltate trichomes on the leaves was determined. The analyses were carried out using a stereomicroscope and a scanning electron microscope. The leaves of all plant species bear peltate trichomes on the adaxial and abaxial leaf sides, with the highest density observed in Origanum heracleoticum (24.3 and 17.4 per mm2, re­spectively). Density was generally higher on the adaxial surface, with the exception of Mentha × piperita (higher density on the abaxial side) and Satureja montana (equal density on both leaf sides). The largest diameter of peltate trichomes was observed in leaves and calyces of S. montana (88.79 μm and 90.57 μm, respectively), while the smallest diameter was noticed in Origanum vulgare (about 65.00 μm). The plant species studied differ in appearance, diameter, distribution and density of the peltate trichomes. The results obtained indicate that micromorphological features could be valid parameters for the microscopic authentication of aromatic plants of which the representatives of the Lamiaceae are of par­ticular commercial importance.

The paper considers the sense of using the blank promissory note as a means of securing of consumer loan, while also questioning its purpose as means of security. The initial hypothesis is the legal absurdity of the same person being a debtor under the two different legal basis -promissory note and consumer loan. The same person is the guarantor for themselves - by signing the blank note they guarantee the performance of the consumer loan contract. That arrangement seems tautological having in mind that the same person, through two legal basis but with the same property, guarantees the performance of the underlying contract manifested in a consumer loan. This is the core proof of the absurdity of using the blank promissory note as collateral security.

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.

By examining debates on the Anthropocene era ignited by new materialist and posthumanist scholarship, this paper aims to discern how these perspectives can reframe the human-nature nexus. It also considers how various “developmentalist” approaches might assume the role traditionally held by the concept of human nature. The first section highlights concerns raised by posthumanist and neomaterialist scholars about the marginalized status of “nature”, life, and biology within dominant constructivist viewpoints. A central argument posits that notions like “denaturalization” and biopolitics amplify societal dominance over nature, pushing social theory towards an anthropocentric and potentially biologically indeterminate stance. Contrasting this, the second section delves into modern interpretations of the planet in social theory, inspired by the emergence of the Anthropocene. This lens reveals a dynamic, co-constitutive relationship, tilting less towards the unilateral commands of “nature” and more towards understanding the evolution of human life and societal structures within Earth’s expansive temporal and spatial realms. The third section further unpacks these developmental ideas by juxtaposing the theories of Bruno Latour and Tim Ingold. The paper contends that both approaches endeavor to illuminate the complex processes underpinning the evolution of life forms, underscoring the significance of culture. In conclusion, the intricate postnatural landscape of the Anthropocene necessitates a more integrated human-nature relationship. This calls for not only discarding dehumanizing facets of human nature, but also fostering a renewed sensibility - a deeper form of humanizing that acknowledges and celebrates our shared existence with other species and entities.