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Background/Aim. Acoustic evoked potentials (AEPs) represent an electrophysiological method used in diagnosing pathological changes of the brain stem (BSt), the acoustic nerve (its peripheral and central part), in patients in coma, in the confirmation of cerebral death, etc. The response includes seven negative waves which are generated in the structures of the BSt vascularized by the arteries of the posterior circulation. However, in everyday practice, due to their constancy, the first five waves are followed. The vertebral artery hypoplasia (VAH) is assumed to affect the AEPs finding. The current definition of VAH includes the criterion that the diameter of the blood vessel is ≤ 2 mm and that the ratio of the diameter of the left and right vertebral artery is ≥ 1 : 1.7. VAH is found in 5.3% of cases of the total population and its presence increases the risk of posterior circulation stroke (PCS). The aim of this study was to show a higher frequency of pathological findings of AEPs in patients with VAH and PCS and demonstrate the characteristics of AEP in that group of patients. Methods. This prospective study included 163 patients diagnosed with PCS over a period of two years. Computed tomography (CT) and magnetic resonance (MR) imaging (MRI) established the diagnosis of PCS. Suspicion of VAH was found by Color Doppler ultrasonography and confirmed by CT and MR angiography. All patients underwent AEPs testing. Wave amplitudes and interwave latencies (IWL) were monitored. Results. There was no statistically significant difference between gender (χ2 = 1.823; p = 0.176) and age in relation to VAH (p = 0.815). A statistically significant greater number of patients with multiple PCS had a positive VAH finding (VAH group, 42.3%) compared to those without VAH (noVAH group, 26.6%) (χ2=4.278; p=0.038). A statistically significant greater number of pathological AEPs was found in the group of patients with PCS and VAH (χ2 = 4.899; p = 0.026). A statistically significant IWL change accompanied by low amplitude waves in the VAH group has been determined (χ2 = 4.465; p = 0.034). Conclusion. The distribution of VAH is not gender- or age-related. The frequency of pathological AEPs findings (presence of associated changes in wave amplitudes and prolonged IWL) is statistically significantly higher in patients with VAH and PCS.

Introduction: Selection of analgesics should be based on the World Health Organization (WHO) analgesic ladder, beginning with non-opioid analgesics in combination with adjuvants for mild pain, weak opioids with adjuvants are indicated for moderate pain, while potent opioids, non-opioids and adjuvants are recommended for severe pain. Methods: The facts presented in this paper are expanded by searching for recent literature data in the following index-data-bases: SCI index, PubMed, Google Scholar, Scopus, and by using adequate key words. The idea supporting this paper was to make practice easier for clinicians who are engaged in supportive oncology and to help in adequate and up-to-date malignant pain management in oncology patients in everyday practice. Topic: Initial opioid dose should be low, and long-acting opioid dose should be gradually increased and titrated considering daily requirements of short-acting opioid formulation due to pain breakthrough. It is mandatory for patients on long-acting opioid treatment to be provided with fast-acting medication for breakthrough pain treatment. The following long-acting strong opioids formulations are available in Serbia - oxycodone, oxycodone/ naloxone fixed combination, hydromorphone, tapentadol, fentanyl. A patient and his/her family should be warned about possible side effects of opioids, primarily morphine. There is great fear of prescribing opioid analgesics due to their possible side-effect of tory depression. Opiophobia is defined as exaggerated concern about the consequences of medical use of opioids. The risk of opioids is estimated to overweight the benefits of the treatment, resulting in the fact that they are not used where indicated. Avoiding opioid prescriptions is one of the biggest barriers for successful treatment of cancer pain. Conclusion: Oncology patients with moderate and severe pain have a constitutional right not to tolerate pain and they have a right to strong opioid treatment. Implementation of analgesic elevator is recommended. There should not be any fear of addiction or other side-effects that can be controlled, and the benefits greatly outweigh the risks of possible side-effects in these patients. Cancer pain management should be an equally important element of overall cancer treatment. Only by multimodal and multidisciplinary treatment approach satisfactory analgesic effects may be achieved while minimizing adverse side-effects.

Introduction: The policy concerning drugs represents a concentrated effort to achieve better health outcomes for all, with a particular focus on people's access to and rational use of medications. On the basis of pharmacoeconomic analyses, it is possible to modify established prescribing habits, it is possible to influence the creation of guidelines, development strategy and long-term health care planning. Aim: The aim of the work was to determine drugs with the highest expenditure in the Republic of Serbia, and to compare the results obtained in three consecutive years 2016, 2017 and 2018. Also, to analyze which are the most expensive medications listed in the National Register of Medications and what is the trend of changing them. Material and methods: The drug expenditure was monitored using the ATC/DDD methodology. It implies the classification of medications according to the internationally accepted ATC classification of drugs, while DDD, i.e. defined daily dose, is used as a statistical unit for consumption monitoring. The number of DDD/1,000 inhabitants per day provides an insight into how many inhabitants (out of 1,000 of them) used the observed medication and were exposed to its effects during one day. Results: The trend of expenditure of these medications was growing exponentially from 2016 to 2018. The most expensive medications per box are from group J - anti-infective drugs for systemic use and L - antineoplastics and immunomodulators, but their expenditure in the Republic of Serbia is very low. The drugs with the highest price per 1 DDD are: enzymes imiglucerase, laronidase and the biological medication basiliximab in all three years, but considering the indications and rare prescribing, the total cost for these drugs is not high. The largest funds in the Republic of Serbia for the mentioned period were spent on drugs such as: acetylsalicylic acid, paracetamol in combinations, trastuzumab, pantoprazole, amlodipine and rosuvastatin. Comparing the spending on L group of drugs in 2017 compared to 2016, there was a significant increase. Conclusion: The medications with the highest expenditure in the Republic of Serbia are used very little compared to countries with good pharmacotherapy practice. The most expensive drugs are those that are used for special and rare indications, and large amounts of money are not allocated for them as for some cheaper, but more frequently prescribed drugs.

According to the World Health Organization, the most common complication of chronic obstructive pulmonary disease (COPD) is chronic pulmonary heart disease (cor pulmonale chronicum). It represents myocardial hypertrophy of the right ventricle, dilatation and insufficiency of the right ventricle occurring as a result of changes in lung function/structure in the absence of left heart disease. The gold standard in detecting changes in right heart function in patients with COPD is an echocardiographic examination. The primary goal of this research was to determine the influence of the severity of COPD on the values of the right ventricular systolic function parameter, and the secondary goal of this research was to determine the frequency of tricuspid regurgitation in relation to the degree of COPD. For a detailed assessment of the systolic function of the right ventricle, which is important for the objectives of the study, the following parameters were performed: The fractional area change (FAC) of the right ventricle and tricuspid annular plane systolic excursion (TAPSE) in 44 patients with COPD which were divided into four groups according to the global initiative for obstructive lung disease (GOLD) criteria. There was no statistically significant difference between the groups for anthropometric indicators and FEV1 values (%) (p > 0.05).The Kruskal−Wallis test shows that the TAPSE index and FAC values are significantly higher in patients with severe and very severe COPD (p < 0.05). The results of our research show that echocardiographic parameters of the right ventricle such as TAPSE and FAC are very important for assessing its systolic function and that these values decrease proportionally with the progression of the COPD disease. [ABSTRACT FROM AUTHOR]

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