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Pain is a major health issue representing a leading cause of disability. It affects millions of adults worldwide and impose significant burdens on society, healthcare systems, and personal well-being. The management of chronic pain presents a major challenge for healthcare professionals, as there is no single or universally effective treatment. Conventional treatments such as opioids and nonsteroidal anti-inflammatory drugs are first line treatment, but they carry significant risks and limitations, including addiction, tolerance, dependence, adverse effects, especially when used long term. As a result, additional approaches are needed to provide effective and safe chronic pain relief. Non-pharmacological pain management strategies represent a promising domain especialy as a part of complementary tailored to individual needs and integrated to contemporary pain medicine.

Introduction/Objective. The purpose of the article is to analyze the efficiency of primary health care centers (PHCCs) in the city of Belgrade, using key performance indicators (KPIs). The main objective is to present the potentiality of the application of KPIs for improving primary health care services, in order to increase efficiency. Methods. As a tool for measuring the efficiency of PHCCs in Belgrade, this article defines a set of KPIs. Based on defined KPIs, a comparative analysis of PHCCs’ efficiency is conducted. Results. According to the values of the overall average efficiency rating according to all observed KPIs, the best-rated, i.e., the most efficient PHCC in Belgrade is Rakovica, and the lowest, i.e., the least efficient is the PHCC Zvezdara. It was noticed that the PHCCs Novi Beograd and Vračar are among the least efficient. Conclusion. The efficiency of primary health care can be measured by applying KPIs, and the observed results can be used as a basis for increasing the efficiency of health care services in the PHCCs in Belgrade. Based on the results, recommendations to PHCCs to improve the efficiency of health care services are: appropriate distribution of patients to selected physicians, measuring patient satisfaction, improving internal processes by engaging professional managers, increasing the ability and opportunities to apply new technologies and new knowledge, increasing the accuracy of the data used for detailed analyzes, motivate physicians to raise the level of awareness of their patients about the importance of preventive examinations.

Procedural sedation as an anesthesiological method performed in patients who are unable to tolerate the examination. Procedural sedation was defined for clinical situations which require conditions for performing a therapeutic or diagnostic procedure with protected spontaneous breathing, airway reflexes and hemodynamic stability, with absence of anxiety and pain. Endoscopic urological procedures represent a good therapeutic alternative to open surgical methods but with an incomparable advantage in diagnostics. Endoscopy experienced its expansion in the last 20 years as minimally invasive surgery. Cystourethroscopy is one of the most common procedures performed by a urologist. In a patient with an advanced bladder tumor, after examination with a cystoscope, bimanual palpation is performed requiring good muscle relaxation of the anterior abdominal wall. The Clinic for Urology and Nephrology has started with examination under a cystoscope during the sixties years of the last century. Originally without anesthesia condition, cystoscopies were performed under analgosedation conditions since 1980. Due to the length of the examination and the need to perform bimanual palpation examination this anesthetic approach was inadequate. Furthermore, cystoscopies were performed under general anesthesia, with the increasing dose of anxiolytics, followed with depolarizing muscle relaxants and hypnotics. Nowdays, cystoscopies are performed under general anesthesia, with inhalation anesthetic or propofol maintenance, both provided adequate conditions for examination. The changes of the anesthesiological method over time represents one of the testimonies of the evolutionary pharmacologicaly-technologicaly-personnel development of the anesthesiological specialty for the endoscopic procedure, which has not fundamentally and technically changed since the very beginning.

In this in silico study, it was investigated whether phycobilins (phycocyanobilin, phycoerythrobilin and phycourobilin) could be inhibitors of the activity of the main proteins of the SARS-CoV-2 virus. All chromophores exhibited a binding energy value of ≥–37 kJ mol-1 for PLpro-WT, PLpro- -C111S, helicase-ANP binding site, Nsp3-macrodomain, Nsp3-MES site and Nsp10/14-N7-Mtase. Phycocyanobilin showed the highest binding energy of –44.77 kJ mol-1 against the target protein PLpro-C111S. It was found that, apart from the hydrogen bonds and hydrophobic interactions, phycobilins also form electrostatic interactions with the SARS-CoV-2 proteins. The network of non-covalent interactions was found to be important for the stability of the examined virus proteins. All phycobilins have good pharmacokinetic and drug- -likeness properties. This study’s results suggest that the screened phycobilins could serve as promising drugs for the treatment of COVID-19 with further rigorous validation studies.

Low back pain occurs in the area of the back between the lower edge of the 12th rib and the lower edge of the gluteus, with or without spreading down the leg. LBP occurs as a result of a combination of the influence of various physical, psychological and social factors, lifestyle habits and style, associated comorbidities, as well as various health factors that can or cannot be influenced. What is common to all guides is the consensus that multidisciplinary rehabilitation is necessary and that removing psychological obstacles has a significant positive impact on recovery. A multidisciplinary approach to treatment must include at least one physical component of treatment and rehabilitation and at least one component from the biopsychosocial model (psychological, social, occupational-work). Almost all guides suggest NSAIDs as the first pharmacological treatment, followed by the addition of paracetamol and weak opioids.

Polycyclic aromatic hydrocarbons (PAHs) are considered as the pollutants of highest priority, and their remediation is of a global concern. The purpose of this study was to investigate the phytoremediation potential of Hedera helix (Hh) determining the content of 16 priority PAHs in its soil and root samples collected from the rural and industrial zones of the Bor's municipality (Serbia). The content of Ʃ16 PAHs in the soils was: 326.49 mg/kg at the site Borsko jezero to maximal 1937.64 mg/kg at the site Slatinsko naselje. The level of soil pollution (depending on the concentration of S16 PAHs), was high at many tested sites and it was under the significant influence of anthropogenic activities. The concentration for S16 PAHs in the samples of roots ranged from 480.71 mg/kg at the site Krivelj to 1748.32 mg/kg at the site Naselje Sunce. Interestingly, the extremely toxic benzo(a)pyrene, was not detected in the roots of Hh. Bioconcentration factors (BCFs) were applied to determine the capacity of Hh for PAH accumulation in the root, and consequently, for determination of its phytostabilization potential. In most cases, BCF values were higher at the locations from UI zone. The calculated BCFs were higher for LMW PAHs than for HMW PAHs. At the majority of the investigated locations, the tested plant species was especially successful in the root accumulation of the compounds such as acenaphthene, fluorene, anthracene, dibenzo(a,h)anthracene, and the sum of benzo(k)fluoranthene and benzo(b)fluoranthene. These findings showed that Hh can be successfully used in phytostabilization of many PAHs.

Studies have shown the importance of self-efficacy in the domain of risky sexual behaviour. The aim of this study was to examine the association of unwanted sexual intercourse among secondary-school students with socio-demographic factors and perceived self-efficacy, and to assess the effectiveness of the programme on reproductive health.

Introduction/Objective. The aim of this study is to identify and evaluate the use of New Mobility Score (NMS) in estimating functional recovery three months after total hip arthroplasty (THA). Methods. In total, 70 patients, aged > 60 years, underwent THA. Treatment group was subjected to the comprehensive rehabilitation program and control group to the standard one. Primary outcome was assessed with Harris Hip Score (HHS) and NMS, and secondary one by Medical Outcomes Health Survey (Short-Form Health Survey – SF-36). Questionnaires were collected before and three months after hip surgery. Results. Treatment group showed significant improvement three months postoperatively. The correlation in both groups between HHS and NMS was very strong (r > 0.700). Treatment group following surgery showed strong correlation between Recovery through Personal Care Services (PCS) and HHS and NMS (r > 0.700), moderate to strong between pain categories and HHS (r = 0.380; r = 0.583) and NMS (r = 0.424). Control group showed strong correlation between PCS and HHS (r = 0.704), and NMS (r = 0.568) and moderate to pain categories and HHS (r = 0.546; r = 0.466). The area under the curve (AUC) described the inherent validity of all measurement used AUCNMS = 0.724, p = 0.001, AUCHHS = 0.788, p = 0.000 and AUCPCS = 0.747, p = 0.001. Conclusion. The NMS could be successfully used in routine clinical assessment of elderly patients following THA. The trial is registered in ISRCTN Register with https://doi.org/10.1186/ISRCTN73197506.

Renal transplantation is the most common procedure in solid organ transplantation. Compered to dialysis, renal transplantation offers better quality of life and overall survival for patients. Due to the improvement of surgical technique, imunosupressive therapy and medical monitor-ing in general, the outcome of treatment has significantly improved today. The importance of the anesthesiologists and the correct performance of all procedures during this treatment has been shown in many studies related to the outcome. In addition to the correct selection of anesthesia drugs, it is very important to pay attention to the position-ing of the patient, adequate monitoring, careful fluid re-placement and the type of fluid intra-and postoperative, as well as adequate pain control after the procedure.

Background/Aim. Burnout syndrome is a psychological phenomenon that occurs as a response to chronic interpersonal stressors at work. It is manifested by emotional exhaustion, depersonalization and a sense of reduced personal accomplishment. The aim of the study was to examine the correlation between burnout syndrome, individual-psychological factors and social support among special and regular education teachers, as well as to determine differences of burnout syndrome dimensions between groups of teachers with different educational backgrounds. Methods. This non-experimental, cross-sectional correlation study included 317 teachers (122 special education teachers and 38 other teachers in special education for children with intellectual disabilities and 157 teachers from regular primary schools) from Belgrade. Maslach Burnout Inventory (MBI), Assertiveness Assessment Questionnaire Scale (A-Scale), Rosenberg Self-Esteem Scale (RSS), Teacher Self-Efficacy Scale (TSES), and Multidimensional Perceived Social Support Scale (MSPSS) were used in the study. Results. The highest prevalence of high levels of burnout were recorded on the emotional exhaustion subscale and were 38% for special education teachers, 47% for other teachers in special education, and 39% for teachers in regular education. The most important predictors of burnout in special education teachers were: for emotional exhaustion (self-esteem, efficiency of class management and seniority); for depersonalization (self-esteem, efficiency of class management and social support); for a sense of lower personal accomplishment (assertiveness, effective student learning and class management). The most important predictors of burnout in regular education teachers were: for emotional exhaustion (assertiveness, effective class management, social support and seniority); for depersonalization (self-esteem, effective student learning and seniority); for a reduced personal accomplishment (self-esteem, effective student learning and social support). Conclusion. Individual-psychological factors have emerged as an important predictor of burnout syndrome in the teaching profession, indicating the importance of examining the impact of these factors in other professions that are characterized by the specific demands for a deeper emotional investment during the work process.

Urosepsis is defined as sepsis caused by urinary tract infection (UTI). Urosepsis represents a quarter of all cases of sepsis in adults. Complications of UTIs are the most common risk factor for urosepsis development. These infections, especially pyelonephritis, often occur in patients with structural or functional malformations that interfere with normal urine flow. The problem of a significant increase in UTIs with multiresistant bacteria should be emphasized, especially in patients with recurrent UTI and their frequent treatments. As the urogenital tract is one of the most common sources of infection in sepsis in general, a detailed assessment of the tract should be carried out in all septic patients. Even though urosepsis is associated with a relatively good prognosis and lower mortality than sepsis of another etiology, it occurs rapidly and progresses at a significant speed. Since urosepsis is mainly the result of obstruction of the urinary tract, the development of septic shock can most often be prevented by implementing early deobstruction. Knowledge of the most common causes of urosepsis and the category of high-risk patients will provide clinicians with the tools with which to prevent its occurrence.

Background/Aim. The incidence of postoperative delirium (POD) after non-cardiac surgery is a problem not often recognized by many anesthesiologists. The objective of our study was to detect POD and its possible cause, in patients undergoing radical retropubic prostatectomy (RRP) under general anesthesia. Methods. After Ethical Committee approval, we enrolled 80 patients, ASA (the American Society of Anestesiology) status II, scheduled to undergo RRP un-der general anesthesia, in a prospective study. All patients completed MMSE tests (the Folstein Mini Mental State Ex-am) the evening before, and 48 hours after the surgery. Assessment for the presence and severity of delirium was per-formed using CAM (the Confusion Assessment Method), and an assessment of the degree of agitation and sedation using RASS (the Richmond Agitation and Sedation Scale). Results. The average preoperative MMSE score (28.59 ± 1.04) significantly decreased following the surgery (27.74 ± 1.52) (p < 0.0001). The average postoperative MMSE score trend descended in correlation to intraoperative bleeding (p = 0.036). The patients with higher pain scores had significant decline in MMSE after the surgery (28.75 vs. 26.25; p < 0.001). Five patients were considered positive for delirium, and four of them reported regular alcoholic drinks intake (> 1 drink per day) preoperatively (p < 0.0001). Based on RASS score, 13 patients (16.3%) were agitated or sedated, and they had statistically significantly higher intraoperative bleeding (p < 0.001). Conclusion. Results of this study emphasize the importance of proper preoperative evaluation; especially regarding the alcohol consumption since all the patients that developed POD reported moderate alcohol consumption. Further-more, greater intraoperative bleeding and postoperative pain scores did not influence the occurrence of delirium, but resulted in lower postoperative MMSE scores, which high-lights the importance of adequate intraoperative treatment of patients during surgery and anesthesia in order to reduce the risk of developing POD.

Cancer pain remains a significant clinical problem worldwide. Cancer pain causes are multifactorial and complex and varying with a variety of factors and processes related both to the tumor process and to the host itself. Even though the quality of pharmacologic pain management has improved in the last decades, 1 in 3 patients do not receive pain medication appropriate for the intensity of experienced pain. Chronic cancer pain in urologic patients has different traits, since this carcinoma might originate from various organ:, prostate, kidneys, adrenal glands, urinary bladder or the penis. Urogenital neoplasm very often metastasized into the bones (spine, pelvis and head bones) and they are associated with pathological fractures, hypercalcemia, and neurological deficits, which lead to a significant reduction in quality of life. Pain induced by bone metastases is nociceptive pain, but may also be associated with neuropathic pain if the tumor performs compression or invasion of the nerve, spinal cord or nerve plexus. In 70-90% of urological cancer patients pain can be adequately relieved by consistent adherence to the WHO cancer pain recommendations. However, additional pain relief therapies, such as radiation and psychosocial treatment of these patients have to be considered.

Severe trauma is a global public health issue, causing one in ten mortalities, and resulting in the annual worldwide death of more than 5.8 million people. The treatment of trauma patient begins at the scene of the accident, with the initiation of basic life support measures, and continues with hospital treatment to stabilize the patient's condition. Trauma patient treatment is characterized by demanding therapeutic and diagnostic measures. Over the past decade numerous guidelines for trauma patient care have been developed with the same aim to decrease mortality and morbidity. Guidelines implementation into daily clinical practice has significantly improved the survival of these patients worldwide. Care for a politraumatized patient begins at the scene of the accident, implementing basic life support mesasures. Airway management, control of external bleeding, initial fluid infusion, immobilization of the spine and pelvis, and rapid transport to the nearest emergency center are the main features of pre-hospital care protocols. At the Emergency center, the primary goals of care are stabilization and patient survival.

Introduction/Objective. The aim of this paper was to highlight and understand factors that influence the quality of healthcare services in Serbia in private and public health institutions. Methods. The data was collected during May of 2017 and June of 2017 through an on-field questionnaire. Out of 500 questionnaires in total, 406 were completed and returned, resulting in a response rate of 81.2%. Results. The following four most influential factors for patient satisfaction in Serbia’s healthcare sector were identified: admission process, doctor care, staff care, and technology tools. Conclusion. The model describes that 66.2 variance for the doctor care variable is based on three constructs: admission process, technology tools, and staff care. The hypothesis that technology tools will have a positive effect on staff care was not confirmed.

Background/Aim. Approaching art from the standpoint of optics and the artist’s eye pathology can sometimes explain the shift of the spectral colors in the work of some artists with cataract and aphakia. This may not be obvious in the paintings of other artists with the same eye pathology. The aim of this study was to create a timeline from the recently obtained details of the cataract surgery, his best corrected aphakic visual acuity, and the last paintings of the artist Jovan Bijelić. Methods. The research included primary and secondary source material: Bijelić’s paintings from all stages of his career, interviews with Bijelić and his eye surgeon, art criticism, sources with the description of Bijelić’s symptoms, hospital archives, discussion with art historians, comparison of his palette from different periods. Results. Jovan Bijelić was nearly blind from cataract in 1957. He underwent an unsuccessful cataract surgery in 1956, followed by enucleation of the operated eye. In 1958, 20/25–20/20 vision was regained, after the extracapsular cataract extraction and sector iridectomy in his right eye, with the posterior lens capsule discision afterwards. Xanthopsia and cyanopsia are not present in his art, which is not a representation of visualized objects. Conclusion. The response of Jovan Bijelić to cataract and aphakia was predominantly a change of his style.

Bacground/Aim. Techniques for replacing the corneal endothelium have been improved. The host-graft interface is the key to graft adhesion and visual recovery. The aim of this study was to establish graft stability after Descemet stripping with endothelial keratoplasty (DSEK), compare it to the graft stability after endothelial keratoplasty with the intact posterior corneal layers (nDSEK) in the rabbit cornea, and to investigate the nature of wound healing. Methods. Adult white rabbits (n = 20) were divided in two experimental groups: ten rabbits underwent monocular DSEK, and ten rabbits underwent endothelial keratoplasty without Descemet stripping (nDSEK). On the second postoperative day a horizontal dislocation of the graft was tried using the Lindstrom roller in each animal. Corneas were processed for the light microscopy study. Results. Rolling the Lindstrom instrument over the corneal surface did not cause horizontal dislocation in any of the operated eyes. In the DSEK group light microscopy revealed the lack of inflammation and fibrosis at the clearly distinctive donor-recipient interface (DRI). Retrocorneal membrane was found in two eyes. In nDSEK group, the host Descemet` s membrane (DM) was intact without endothelial cells, with good graft apposition, without inflammation, fibrosis, or retrocorneal membrane. Conclusion. This study suggests that there is no difference in graft stability in DSEK compared to nDSEK in rabbit corneas. Wounds healed at DRI by hypocellular scarring only in both experimental groups.

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Introduction. Urrets-Zavalia syndrome is an uncommon complication of the deep anterior lamellar keratoplasty in keratoconus. The manifestations of this syndrome are an irreversible mydriasis, iris atrophy and secondary glaucoma. Case report. Deep anterior lamellar keratoplasty was done for keratoconus with a presumably healed corneal hydrops in a 21-year-old Caucasian man. The graft remained clear, but the surgery was complicated by a fixed, dilated pupil, patches of iris atrophy, ectropium of the iris pigment layer and glaukomflecken in the lens. Conclusion. Although safer than penetrating keratoplasty, the deep anterior lamellar by not trying to secure an unhealed Descemet’s membrane with air. Instead, a new Descemet’s membrane transplanted within a penetrating graft is a safer choice.

Introduction. Ultrastructural changes in corneas of patients with diabetes mellitus have been previously described. Objective. The aim of this study was to compare central corneal thickness (CDR) values in diabetic patients without retinopathy at the stage of diabetic nonproliferative and proliferative retinopathy and CDR in a control group of healthy subjects. Methods. The study included 121 diabetic patients and 125 healthy subjects matched according to gender and age. Each patient underwent ophthalmological examination involving a dilated fundus examination and CDR measurement using the ultrasound pachymeter. The eyes of diabetic patients were classified according to Early Treatment Diabetic Retinopathy Study into three groups: without diabetic retinopathy (NDR), with nonproliferative diabetic retinopathy (NPDR) and a group with proliferative diabetic retinopathy (PDR). Only one eye of each subject was chosen for the study. Results. The mean CDR value was significantly higher in the diabetic group (570.52±31.81 μm) compared with the control group (541.42±27.82 μm). The difference between the two groups was statistically significant (p0.05). Conclusion. CDR of diabetic patients was higher compared to healthy subjects. The highest mean value of CDR was registered in the PDR group, followed by the NPDR and the NDR groups.

It has been verified that serum N-acetyl-β-D-glucosaminidase (NAG) activity is elevated in diabetes, but there are no reports about changes of the sialic acid (SA) content in the carbohydrate parts of NAG A form and its influence on total NAG activity changes in type 1 diabetes mellitus patients without and with secondary complications. NAG A forms were isolated, purified and characterized from the serum of 81 IDDM patients with and without secondary complications (retinopathy, polyneuropathy and nephropathy) and 25 healthy persons. The content of α-2,6-bound SA and isoenzyme patterns of purified A form, total NAG and A form activities were determined. In all diabetic groups, A form sialylation levels were 2-3.5 times lower compared to control, while their acidities (fractions with pI 4.25-5.1) increased, particularly with progression of secondary complications. Total serum NAG activities and percentages of A form were significantly higher (P

Introduction. Associated bone tissue defect and infection, commonly result in non-healing, i.e. by the development of infected tibial nonunion. Objective. The aim of the paper was to present experiences acquired in the treatment of this problem by the application of the Ilizarov method. Methods. The analyses enrolled 16 patients diagnosed with infected tibial nonunion. The Ilizarov method was used in all the patients, of type bilocal synchronous compressive-distractive or bilocal alternating compressive-distractive. Bone and functional results were classified as excellent, good, fair and poor. Total follow-up period of the patients was 48.77±41.57 months on the average. Results. Fifteen (93.75%) cases of nonunions were successfully healed. According to the laboratory findings of inflammation, the same patients were also successfully treated for local infection. The inequality of the lower limbs was also resolved by new bone formation of average length of 5.75±3.29 cm. Poor result was verified in one (6.25%) patient only. The patient satisfaction was scored 3.73±1.33 and physician’s satisfaction 4.33±1.11. Conclusion. The Ilizarov method with bone transport, because of being capable to solve simultaneously a local infection and tibial malalignement, and by substituting bone and soft tissue defects, thus enabling healing of until then unhealed bone, has shown as the best method in the treatment of this complex problem, infected tibial nonunions.

Introduction. Deep anterior lamellar keratoplasty (DALK) is intended for the surgical treatment of corneal pathology without the involvement of the endothelium. Sparing of the healthy host endothelium for lifetime is of utmost importance in young patients. Therefore, keratoconus is among the main indications for DALK. Outline of Cases. Two men, 22 and 28 years of age, underwent DALK for the treatment of progressive keratoconus, with low visual acuity, impossible to be corrected with gas-permeable contact lenses, due to the extreme conical protrusion of the cornea. Baring of Descemet’s membrane was achieved with lamellar dissection and peeling off the stroma. An 8.5 mm graft without the endothelium was sutured into an 8.0 mm bed. Both grafts remained clear and attached, without either ocular surface pathology or problems arising from sutures. The best corrected visual acuity was 20/25 and 20/40, with the astigmatism of 2.5 and 3.0 diopters, respectively. The follow-up was one year. Conclusion. This is the first presentation of DALK in our literature. The restoration of corneal transparency and stability, with sparing of the host endothelium, has put DALK among successful corneal tranplantation procedures. Together with Descemet stripping endothelial keratoplasty, which already accounts for almost a half of all our keratoplasties, it offers an alternative to penetrating keratoplasty.

Introduction. A Monteggia lesion is a dislocation of the radial head associated with a fracture with the proximal third of the ulna. It is rare in children and the dislocation of the radial head is often missed at the time of injury. There are a lot of described treatment methods: open reduction of the radial head and reconstruction of the annular ligament combined with ulnar osteotomy, the same method without reconstruction of the annular ligament, gradual lengthening and angulation of the ulna by Ilizarov method without the opening of radiocapitelar joint. Case Outline. A 14-year-old boy had been diagnosed with Monteggia lesion type Bado II three years before the admission to hospital. Previously nonoperatively treated, the missed radial head dislocation Bi-phase treatment had been done. Firstly, the distraction Ilizarov device was placed on the forearm, corticotomy of the ulna was done, distraction lasted fifteen days. Secondly, after achieving 1.5 cm of new bone and good level of the radial head, a reduction mechanism was incorporated into the Ilizarov device. The radiocapitelar joint was not opened, the reconstruction of the annular ligament was not done. After the radial head reduction and new bone maturation (1.5 months), the Ilizarov device was taken off. Conclusion. The described method of treatment has several important advantages: radial head reduction may be done without the joint opening, the recovery is very fast and easy after that; the elbow and forearm appear cosmetically very well after the operation; the treatment process is short, the arm is in use all the time, the absence from school is not needed, the achieved result is permanent.

Introduction. Simultaneous Descemet stripping endothelial keratoplasty, phacoemulsification, and intraocular lens implantation are indicated in Fuchs’ dystrophy with associated cataract. Compared to the standard method of the triple procedure which includes penetrating keratoplasty, this new method has the advantages of sutureless surgery, small limbal incision, faster recovery, less surface problems, less astigmatism, stronger tensile strength and more predictable calculation of the intraocular lens power. This is the first report of such a combination of procedures in our literature. Case report. A 76-year-old woman suffered from a gradual bilateral visual loss. The best corrected visual acuity was 20/60 (right eye) and finger counting at 1m (left eye). Corneal thickness was 590 μm and 603 μm, respectively. A marked cornea guttata and nuclear cataract were present in both eyes. Phacoemulsification, lens implantation, and Descemet stripping were done in the left eye. The posterior lamellar corneal graft, 8.0 mm in diameter and about 150 μm thick, was bent and inserted through the limbal incision. The air was injected into the anterior chamber to attach the graft to the recipient stroma. The cornea remained clear, and the transplant was attached during a two-year follow-up. Visual acuity was 20/40 after two months, and 20/25 after one year. Conclusion. The new technique proved itself as a good choice for the treatment of a mild Fuchs’ dystrophy associated with cataract.

Introduction. SWOT analysis is a managerial tool used to evaluate internal and external environment through strengths and weaknesses, opportunities and threats. Objective. The aim was to demonstrate the application of the SWOT analysis on the example of the Department for Paediatric Orthopaedics and Traumatology at the Institute of Orthopaedic Surgery 'Banjica' in Belgrade. Methods. Qualitative research was conducted during December 2008 at the Department for Paediatric Orthopaedics and Traumatology of the Institute of Orthopaedic Surgery 'Banjica' by applying the focus group technique. Participants were members of the medical staff and patients. In the first phase of the focus group brainstorming was applied to collect the factors of internal and external environment, and to identify strengths and weaknesses, opportunities and threats, respectively. In the second phase the nominal group technique was applied in order to reduce the list of factors. The factors were assessed according to their influence on the Department. Factors ranked by the three point Likert scale from 3 (highest impact) to 1 (lowest impact). Results. The most important strengths of the Department are competent and skilled staff, high quality of services, average hospital bed utilization, the Department providing the educational basis of the School of Medicine, satisfied patients, pleasant setting, and additional working hours. The weaknesses are: poor spatial organization, personnel unmotivated to refresh knowledge, lack of specifically trained personnel, inadequate sanitary facilities, and uncovered services by the Insurance Fund, long average hospital stay, and low economic status of patients. The opportunities are: legislative regulations, formed paediatric traumatology service at the City level, good regional position of the Institute, and extension of referral areas. The threats are: absent Department autonomy in the personnel policy of the Institute, competitions within the Institute, impossibility to increase the Department capacities, inadequate nutrition, low opportunities for expert training of the personnel, outdated equipment, and presence of informal payments. Conclusion. SWOT analysis is a frequently used managerial instrument, which enables the systematic approach in decision making process.

Introduction. Sutureless transplantation of endothelium on a thin stromal carrier was introduced under the name of Descemet stripping endothelial keratoplasty (DSEK) in 2004. It has become the treatment of choice of corneal oedema due to endothelial dysfunction. Objective. To investigate posterior lamellar graft attachment, central corneal thickness (CCT), astigmatism, and best corrected visual acuity (BCVA) during one-year follow-up. Methods. Surgery was performed on one eye of 11 patients with pseudophakic bullous keratopathy and Fuchs’ dystrophy. The graft thick 150-200 μm and 8.0 mm in diameter was detached manually. The carrier of the recipient cornea was created by DSEK. The graft was folded in half, introduced into the anterior orbital chamber through a 5.0 mm cut on the limbus and attached by air bubble along the internal side of the recipient cornea. CCT and astigmatism were evaluated by corneal topography, and graft attachment by biomicroscopy. Results. One year after surgery, all grafts remained attached. Primary graft failure occurred in three eyes, probably due to the crushing effect of the forceps. BCVA was 20/30 (2 eyes), and 20/40 (6 eyes), CCT 643-728 μm, and astigmatism 1.1 D to 2.9 D. The peak values were reached three months after surgery, and did not change much afterwards. Conclusion. This is the first report on the long-term results of DSEK in our literature. The results are similar to those obtained by more experienced DSEK surgeons, and suggest that this procedure is safe and successful.

Introduction Injuries of the distal femur are rare in children; however, they are frequently associated with complications. They are almost always physeal, most frequently Salter-Harris type II epiphyseolysis. The treatment of such injuries is similar in all physeal injuries. It is intended to provide growth plate recovery by gentle reduction and stable fixation thus preventing secondary complications, and also to provide decompression of the segment to solve the compartment syndrome and recover the neurovascular structures. Case Outline A seven-year old boy presented with a right knee injury while sleigh riding. He was admitted three weeks following the injury with distal femoral epiphysiolysis associated with peroneal palsy. A day after admission to our Institute the reduction was performed using the Ilizarov device. Physical therapy was started immediately after surgery, as well as walking with weight bearing on the operated leg. Five months after surgery the patient was anatomically and functionally recovered. Conclusion The presented method is recommended in the treatment of such injuries because of several reasons; reposition is simple and complete, there is no need to open the fracture site, fixation is stable, the growth plate is preserved, there is no need for additional external immobilisation, and physical therapy involving walking with weight bearing on the operated leg may be started immediately after surgery. .

Introduction. Septic pseudoarthroses of the tibia represent a relatively frequent complication of open fractures with a large soft tissue damage. They may be localized: in the proximal metaphysis, between the proximal and middle thirds, between middle and distal thirds, in the distal metaphysis. Case Outline. A case of a 52-year-old man with open fracture of the left tibia is presented. He fell from the height of 30 meters. The external fixation according to Mitkovic was performed in another institution. The patient was referred to our hospital nine months after the accident, with clear clinical and radiological signs of septic pseudoarthrosis of the tibia. The resection of septic pseudoarthrosis was done two weeks after admission. Three weeks later, another operation was performed, bilocal alternating distractive-compressive osteosynthesis according to Ilizarov. After eleven months Ilizarov frame was removed, with clinical, radiological signs of healing of pseudoarthrosis and complete curing of the infection. Five months after removal of the frame, the patient was fully anatomically and functionally recovered. Conclusion. Being satisfied with the achieved results and encouraged with the data from the literature, we recommend this method as the method of choice for the treatment of pseudoarthrosis of the tibia. The advantage consists of curing the infection using the natural bactericide power of the tissue and curing the bone defect, at the same time, and finally, producing the equalization of the legs.

Introduction. Unreduced elbow dislocation is every elbow dislocation older than one week. It may be treated non-operatively (with prereduction traction) or surgically. The treatment goals are: to reduce pain, to establish joint stability and movements. There are a lot of techniques described in literature, series are relatively small, mostly case reports. Multicentric studies have not been done. That is why there are no precisely defined therapeutic protocols. Every contribution in the field is valuable. Case Outline. A 43-year-old patient was admitted for the treatment of a three-month old unreduced elbow dislocation. Treatment has been done by Ilizarov method, using the reduction mechanism. The reduction process lasted two weeks. The Ilizarov device was removed two months after the operation, then physical therapy was started. Normal anatomical and functional findings were established five months following the operation. Conclusion. The presented method of treatment has been found as very useful, having in mind that it may solve two problems: difficult reduction and redislocation. Reduction may be done without the joint opening, step by step; retention of the reduced joint may be easily done. Physical therapy may be started without Ilizarov device removal, movements of flexion and extension may be improved without any lateral instability. There is no iatrogenic intraarticular damage, so there are no secondary joint degeneration, pains and invalidity.

In February 2016 the LIGO & VIRGO collaboration reported the discovery of gravitational waves in merging black holes, therefore, the team confirmed GR predictions about an existence of black holes and gravitational waves in the strong gravitational field limit. Moreover, in their papers the joint LIGO & VIRGO team presented an upper limit on graviton mass such as mg < 1.2 × 10−22 eV (Abbott et al. 2016). So, the authors concluded that their observational data do not show any violation of classical general relativity. We show that an analysis of bright star trajectories could constrain graviton mass with a comparable accuracy with accuracies reached with gravitational wave interferometers and the estimate is consistent with the one obtained by the LIGO & VIRGO collaboration. This analysis gives an opportunity to treat observations of bright stars near the Galactic Center as a useful tool to obtain constraints on the fundamental gravity law such as modifications of the Newton gravity law in a weak field approximation. In that way, based on a potential reconstruction at the Galactic Center we obtain bounds on a graviton mass.

Scientists worked in Saint-Petersburg (Petrograd, Leningrad) played the extremely important role in creation of scientific school and development of general relativity in Russia. Very recently LIGO collaboration discovered gravitational waves [1] predicted 100 years ago by A. Einstein. In the papers reporting about this discovery, the joint LIGO & VIRGO team presented an upper limit on graviton mass such as mg < 1.2 × 10−22eV [1, 2]. The authors concluded that their observational data do not show violations of classical general relativity because the graviton mass limit is very small. We show that an analysis of bright star trajectories could bound graviton mass with a comparable accuracy with accuracies reached with gravitational wave interferometers and expected with forthcoming pulsar timing observations for gravitational wave detection. This analysis gives an opportunity to treat observations of bright stars near the Galactic Center as a tool for an evaluation specific parameters of the black hole and also to obtain constraints on the fundamental gravity law such as a modifications of Newton gravity law in a weak field approximation. In that way, based on a potential reconstruction at the Galactic Center we give a bounds on a graviton mass.

The primary objective of this investigation was to assess the total polyphenolic content (TPC), identify and quantify individual polyphenols, and evaluate their radical scavenging activity (RSA), as well as determine the mineral composition in stem extracts from nine distinct Vitis vinifera varieties. The total phenolic content in grape stem extracts ranged from 34.87 to 76.95 mg gallic acid equivalents (GAE) per gram of dry weight (d.w.). These extracts exhibited significant free radical scavenging activity, ranging from 0.344 to 0.898 mmol Trolox equivalents (TE) per gram d.w. Stem extracts were predominantly characterized by flavan-3-ols, flavonols, and phenolic acids. Catechin and quercetin-3-glucuronide were identified as the most abundant components, with concentrations of up to 1.858 mg/g d.w. and 1.315 mg/g d.w., respectively. Potassium (K) emerged as the most abundant element in all samples, with content ranging from 7.297 mg/g d.w. to 16.695 mg/g d.w., followed by calcium (Ca), phosphorus (P), and magnesium (Mg). [ABSTRACT FROM AUTHOR]

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Analysis of microplastic (MP) occurrence in commercially relevant species is a prerequisite for food risk assessment. Using a standardized methodology, we aimed to investigate MP contamination in point-of-sale clams, mussels, and Crustacea shellfish collected from various markets (Belgium, Croatia, Serbia, and South Korea). An improved digestion protocol yielded ≥ 99.8% digestion efficiency for all species analyzed. In a total of 190 samples analyzed individually by microFTIR, MPs were identified in 43.68% of the samples with less than 1 MP/individual average (0–4 MP/individual, 0–1.35 MPs/g tissue). Significant differences between species were observed when considering samples contaminated with MPs, with Crustacea shellfish having the lowest MPs/g of edible tissue. Polystyrene, polypropylene, and polyethylene were dominant MPs found in clams and mussels, while polyamide, polyethylene terephthalate, and polyvinyl chloride were the most abundant in Crustacea shellfish. Our data do not support the bioaccumulation or biomagnification of MPs with the size of the animal in the shellfish group. MP contamination is more strongly associated with the type of shellfish than with the geographical origin of the market. [ABSTRACT FROM AUTHOR]