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Background. Mortality rates following aneurysmal subarachnoid haemorrhage (aSAH) have decreased due to improvements in diagnoses and the management of complications, as well as early obliteration of the aneurysms. Neurogenic pulmonary oedema (NPO) is a clinical syndrome associated with an acute increase in intracranial pressure and a release of catecholamines into the circulation. This study investigated independent predictors of unfavourable outcomes (Glasgow Outcome Scores 1, 2 or 3) in patients with aSAH. Materials and methods. A total of 262 patients with aSAH (162 females) were included in this prospective study. Clinical characteristics were assessed, and electrocardiographic, serum cardiac and inflammatory biomarker measurements were recorded on admission. Outcomes were assessed three months after admission. Univariate and multivariate analyses of these data were used to predict unfavourable outcomes. Results. A total of 156 patients (59.54%) had unfavourable outcomes. Compared to those who had favourable outcomes, patients with unfavourable outcomes were significantly older (54.37 ± 10.56 vs. 49.13 ± 10.77 years; p < 0.001) and had more severe aSAHs (Hunt and Hess grades ≥ 3: 82.7% vs. 39.6%; p < 0.001). Patients with unfavourable outcomes were more likely to have NPO (10.3% vs. 2.8%; p = 0.023), hydrocephalus (34.0% vs. 20.8%; p = 0.02), and aneurysm reruptures (28.2% vs. 3.8%; p < 0.001). Independent predictors of an unfavourable outcome included Hunt and Hess grades ≥ 3 (odds ratio [OR], 4.291; 95% confidence interval [CI], 2.168–8.491; p < 0.001), increased systolic blood pressure on admission (OR, 1.020; 95% CI, 1.002–1.038; p = 0.03), increased heart rate (HR) on admission (OR, 1.024; 95% CI, 1.001–1.048; p = 0.04), and aneurysm rerupture (OR, 4.961; 95% CI, 1.461–16.845; p = 0.01). Conclusions. These findings suggest that aneurysm reruptures, as well as increased blood pressure and HR, are associated with unfavourable outcomes in patients with aSAH.

Background The aim of this study was to estimate whether the stress, lack of social support, and poor emotional relationships influence the recurrence of AD in adults. Methods Case-control study comprised 66 outpatients with AD and 132 controls with different skin diseases believed to be slightly influenced by psychosomatic factors. Participants were treated at the Department of Dermatology - Military Medical Academy and City Department for Skin and Venereal Diseases from January to June 2014. Stressful life events were assessed using the Paykel's Interview for Recent Life Events. The attachment relationship and perceived social support were assessed with the Experiences in Close Relationships Scale and with the Multidimensional Scale of Perceived Social Support, respectively. Univariate and multivariate logistic regression analyses were applied. Results AD patients had significantly higher anxiety scores when initiating a close emotional relationship and when avoiding an affective attachment (OR = 1.49; CI = 1.13-1.97; P = 0.005 and OR = 1.63; CI = 1.16-2.30; P = 0.005, respectively). Perceived social support from family and friends was significantly lower among cases compared to controls (OR = 0.93; CI = 0.88-0.98; P = 0.009 and UO = 0.94; CI = 0.89-0.99; P = 0.027, respectively). Conclusions AD patients had higher anxiety scores, and those with low social support tended to have more frequent disease recurrence. The number of stressful life events did not differ between studied groups.

Background Previous studies suggest that alopecia areata (AA) may significantly affect patient quality of life (QoL). There are no studies that assess QoL in Serbian AA patients. Objectives This study aims to assess the impact of AA on patients' QoL in comparison to patients affected by other skin diseases and to determine the impact of sociodemographic and clinical characteristics of AA patients on QoL. Methods A hospital-based cross-sectional study of 60 patients with AA was conducted at the Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade between April 2012 and June 2013. The severity of hair loss was assessed using the Severity of Alopecia Tool (SALT). Patients' self-assessment of QoL was measured by three self-administered questionnaires: The Short Form-36 Health Survey (SF-36), Dermatology Life Quality Index (DLQI) and The Skindex-29. Results Sixty AA patients (16 males and 44 females) with mean age of 37.35 ± 14.26 years completed the questionnaires. We confirmed that QoL of our AA patients was impaired. Compared with patients suffering from psoriasis, atopic dermatitis and onychomycosis AA patients presented significantly better QoL. Severity of disease (SALT) correlated only with personal relationship – dimension of DLQI (ρ = 0.29, P < 0.05) and social functioning – dimension of Skindex (ρ = 0.26, P < 0.05). No correlation was observed between severity of the disease and SF-36 subscales. AA patients with depression had significantly worse QoL in daily activities, leisure, work or school and personal relationships – DLQI dimensions, and emotions and social functioning – Skindex subscales. Conclusion Our study demonstrates that AA influences QoL, but to a lesser degree than observed for psoriasis, atopic dermatitis and onychomycosis.

Objectives This research was undertaken to investigate the knowledge and attitudes regarding Human Papillomavirus infection and the Human Papillomavirus (HPV) vaccine among pediatricians who work in primary health care and to determine their intention to recommend the HPV vaccine as an important measure for the primary prevention of cervical cancer. We assessed the factors associated with the intention to recommend the vaccine. Study Design This cross-sectional study was conducted in March and April 2012. This research included all pediatricians who worked with school children in public primary health care institutions in Belgrade. A research instrument questionnaire had been designed for this study. Results The response rate was 78.7%. The knowledge of pediatricians related to HPV infection and the HPV vaccine was estimated as poor. However, pediatricians recognized the need for additional education in this field. The most-frequently reported barrier to HPV vaccination was the financial concern (68.2%). Alternatively, according to the pediatricians, the most common parental barrier to vaccination was the lack of information on the vaccine (67.2%). Nearly two-thirds of the pediatricians were willing to recommend the vaccine (60.2%). The factors associated with the pediatricians' intention to recommend the vaccine included the parents' attitudes. Conclusion The majority of pediatricians accept the HPV vaccine and recommend it to their patients. It is necessary to improve cooperation between parents and pediatricians to increase immunization coverage and develop national consulting strategies with a focus on the prevention of HPV infection.

Biofilm represents a protected mode, which allows bacteria to survive and proliferate in a hostile environment. Little is known whether the ability to form biofilms is a characteristic of all groups of A streptococcal (GAS) strains and whether there is a relationship between biofilm formation and a clinical source of isolates. A capsule physically covers superficial adhesins and other proteins, essential in bacterial attachment, as the first step in biofilm formation. It is also possible that hyaluronic acid could form part of the complex extracellular polymer matrix of biofilms and contribute to the three-dimensional architecture of the biofilm. The aim of this study was to investigate if there are differences in adherence and biofilm production between GAS strains with different pathogenic potential, and the possible role of the capsule in this process. A total of 122 isolates were divided into three groups: noninvasive (NI), low invasive (LI) and highly invasive (HI). Adherence, SpeB and biofilm production were tested before and after hyaluronidase treatment. There was no difference in adherence between untreated GAS strains, but after capsule removal, NI and HI isolates adhered significantly better than the LI group. Before treatment, isolates of the HI group were the worst biofilm producers, but after capsule removal, they became the best biofilm producers. There was no difference in SpeB production among GAS isolates, regardless of the hyaluronidase treatment.

Neurogenic pulmonary edema (NPE) is a clinical syndrome characterized by the acute onset of pulmonary edema after a significant central nervous system (CNS) insult. NPE occurs as a result of release of catecholamines into the blood immediately after aneurysm rupture. The aim of this study is to investigate the connection between the value of cardiac biomarkers on admission and incidence of NPE in patients with aneurysmal subarachnoid hemorrhage (SAH). A total of 262 SAH patients (162 women, 100 men) were prospectively included in the study. Clinical characteristics, electrocardiographic (ECG) changes, serum cardiac and inflammatory biomarkers were measured on admission and on the day of development of NPE. These data were analyzed in order to predict the development NPE. Nineteen patients (7.25%) developed NPE. Comparison revealed that patients who subsequently developed NPE, sustained more severe SAH. Cardiac damage was more severe in these patients, as represented by significantly higher mean values of all examined cardiac biomarkers (P = 0.000), except for troponin I value that was significantly lower (P = 0.000). Multivariate regression analysis revealed that elevated troponin I (OR, 4.980; 95% CI, 1.27-19.49; P = 0.021) and white blood cell count (OR, 22.195; 95% CI, 3.99-123.50; P = 0.000) are predictors of NPE. Significantly higher values of cardiac biomarkers were observed in SAH patients complicated with NPE. Elevated values of cardiac biomarkers appear to play an active role in prediction of NPE, although white blood cell count may be involved in the prediction of NPE. There is an influence of SAH therapy on predictors of NPE.

Background/Aim. Elevation in adduction is the most common pattern of vertical strabismus, and it is mostly treated with surgery. The results of weaking of inferior oblique muscle are very changeable. The aim of this study was to evaluate binocular vision using sensory tests before and one and six months after the surgery. Methods. A total of 79 children were divided in two groups: the first, with inferior oblique muscle of overaction (n = 52), and the second with dissociated vertical deviation (DVD), and primary inferior oblique muscle overaction (n = 27). We tested them by polaroid mirror test (PMT), Worth test at distance and near, fusion amplitudes on sinoptofore, Lang I stereo test and Wirt-Titmus stereo test. We examined our patients before and two times after the surgery for vertical strabismus. Results. Foveal suppression in the group I was found in 60.5% of the patients before, and in 56.4% after the surgery. In group II Foveal suppression was detected in 64.7% of the patients before, but in 55.6% 6 months after the surgery with PMT. Worth test revealed suppression in 23.5% of the patients before, and in 40.7% after the vertical muscle surgery. Parafoveal fussion persisted in about 1/3 of the patients before the surgery, and their amplitudes were a little larger after the surgery in the group I patients. Lang I stereo test was negative in 53.9% before and 51.9% after the surgery in the group I, and in 48.2% of the patients before and after the surgery in the group II patients. Wirt-Titmus stereo test was negative in 74.5% of the patients before and in 72.9% after the surgery in the group I, but in the group II it was negative in 70.8% before and in 68.0% of the patients 6 months after the surgery. Conclusion. Binocular responses were found after surgery in 65.7% of the patients the group I and in 55.6% patients the group II. There was no significant difference between these two groups, but binocular responses were more often in the patients of the group I.

To investigate possible relationships between diet and risk for bladder cancer in Serbia, the hospital-based case-control study was carried out. This study included 130 newly diagnosed bladder cancer patients and the same number of controls matched by sex, age (%+/-%2 years) and type of residence (rural or urban). Dietary information was obtained by using a food frequency questionnaire. Initial case-control comparisons were based on tertiles of average daily intake of control group. The odds ratios (ORs) were computed for each tertile, with the lowest tertile defined as the referent category. All variables (food items) significantly related to bladder cancer were included in multivariable logistic regression analysis. According to this analysis, risk factors for bladder cancer appeared to be consumption of liver (OR=6.60, 95%CI=1.89-23.03), eggs (OR=3.12, 95%CI=1.10-8.80), pork (OR=2.99, 95%CI=1.16-7.72), and pickled vegetable (OR=3.25, 95%CI=1.36-7.71). A protective effect was found for dietary intake of kale (OR=0.21, 95%CI=0.06-0.73), cereals (OR=0.19, 95%CI=0.06-0.62), tangerines (OR=0.21, 95%CI=0.07-0.68), cabbage (OR=0.27, 95% CI=0.11-0.68), and carrots (OR=0.15, 95%CI=0.05-0.41). The study indicated a potentially important role for dietary fat and pickled vegetables in bladder carcinogenesis. An inverse association was recorded between consumption of fruits, vegetables and cereals, and the development of bladder cancer.

Sixty rural patients with upper urothelial tumors (UUT) have been followed for 10-14 years after they underwent surgery. Residential history revealed that 21 of them spent at least 20 years in an area where the Balkan nephropathy (BN) was endemic. These patients experienced a better survival than those who had not been exposed in BN foci. An opposite finding of the only author who previously tried to quantify survival in the same region by a similar approach was explained by two main reasons: his failure to control a considerable age difference between the two groups, and a restriction of his analysis only to the early stages of the tumors.