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Background/Aim. The COVID-19 pandemic had a significant impact on the healthcare system, particularly healthcare providers such as nurses/medical technicians, who were obliged to adhere to strict procedures and manage their time effectively during shifts. The aim of this study was to identify internal strengths, weaknesses, threats, and challenges in palliative care management during the C OVID-19 pandemic from the perspective of nurses/medical technicians. Methods. A cross-sectional study was conducted on a 100% sample of nurses/medical technicians working in hospital-based palliative care in two clinics in Belgrade (47 respondents in total). The research instrument was a Questionnaire on Employee Satisfaction. The survey was conducted during September and October 2022. Results. Assessing the job satisfaction of nurses/ medical technicians revealed moderate job satisfaction (3.43), which was mostly influenced by appropriate financial compensation and the implementation of measures to prevent and control the spread of the COVID-19 infection. The dimensions of management that were significantly related to respondents’ satisfaction were motivation and adequacy of hygienic conditions and measures to control COVID-19 (χ2 = 62.83, p = 0.004 and χ2 = 36.42, p = 0.006, respectively). Conclusion. Nurses/medical technicians who experience stress at work in regular conditions tend to react the same way in different conditions, such as those related to COVID-19 infection. The most difficult challenge that the management faces is the recognition of the importance of the work of nurses/medical technicians by the community. Therefore, it is vital to respect and support the most important professional values of nurses/medical technicians, such as valuable achievements, the importance of professional challenges, personal growth and development, and independence in practice.

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.

Background/Aim. Reslizumab is humanized monoclonal antibody produced by recombinant DNA technology which binds to circulating interleukin-5 (IL-5) and down-regulates the IL-5 signaling pathway. Reslizumab is indicated for the add-on maintenance treatment of patients 18 years and older with severe eosinophilic asthma phenotype whose symptoms were inadequately controlled with inhaled corticosteroids. The aim of this meta-analysis was to assess the efficacy and safety of reslizumab compared to placebo in patients suffering from inadequately controlled, moderateto- severe asthma with elevated blood eosinophil counts. Methods. Our meta-analysis was based on systematic search of literature and selection of high-quality evidence according to pre-set inclusion and exclusion criteria. The effects of reslizumab and placebo were summarized using Review Manager (RevMan) 5.3.5 and heterogeneity was assessed by the Cochrane Q test and I² values. Several types of bias were assessed and publication bias shown by Funnel plot and Egger’s regression. Results. The meta-analysis included 5 randomized, placebo-controlled clinical trials. Reslizumab 3.0 mg/kg produced substantial improvements in forced expiratory volume in 1. second (FEV 1) (mean difference 0.15 [0.10, 0.21]) and in forced vital capacity (FVC) (mean difference 0.21 [0.09, 0.32]) over the 15 or 16-week treatment period, substantial decrease versus placebo in Asthma Control Questionnaire (ACQ) score (mean difference -0.28 [-0.41, -0.16]), and substantial increase vs. placebo from baseline in Asthma Quality of Life Questionnaire (AQLQ) total score (mean difference 0.24 [0.06, 0.43]). Also, reslizumab 3.0 mg/kg caused less adverse events versus placebo (OR 0.67 [0.51, 0.88]), especially asthma worsening (OR 0.53 [0.36, 0.77]) or bronchitis (OR 0.42 [0.24, 0.74]). Conclusion. On the basis of published clinical trials reslizumab could be considered as an effective and safe therapeutic option for severe, poorly controlled eosinophilic asthma for the time being. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175007]

Antifungal activity of commercial sample of Boswellia carteri essential oil against selected micromycetes was evaluated in vitro using a microatmosphere method. When compared with biocide Sanosil S003, used as positive control, the tested essential oil showed moderate antifungal activity. The most susceptible fungi to oil treatment were Stachybotrys chartarum and Trichotecium roseum. For both fungi, mycelia growth inhibition of 85% was recorded at oil concentration of 100 μL mL-1. The tested essential oil caused inhibition of S. chartarum sporulation as well as depigmentation of conidiа, which is very significant since melanin contributes to virulence, survival and endurance of pathogenic fungi spores. Aspergillus niger was the least susceptible isolate to essential oil treatment. Mycelial growth of this fungus was not inhibited by any oil concentrations used in the experiment.

Background/Aim. Benign prostatic hyperplasia (BPH) is one of the most common disease among males aging 50 years and more. The rise of the prevalence of BPH is related to aging, and since duration of life time period has the tendency of rising the prevalence of BPH will rise as costs of BPH treatment will and its influence on health economic budget. Dutasteride is a new drug similar to finasteride, inhibits enzyme testosterone 5-alpha reductase, diminish symptoms of BPH, reduce risk of the complications and increases quality of life in patients with BPH. But, the use of dutasteride is limited by its high costs. The aim of this study was to compare cost effectiveness of dutasteride and finasteride from the perspective of a purchaser of health care service (Republic Institute for Health Insuranse, Montenegro). Меthods. We constructed a Markov model to compare cost effectivenss of dutasteride and finasteride using data from the available pharmacoeconomic literature and data about socioeconomic sphere actual in Montenegro. A time horizon was estimated to be 20 years, with the duration of 1 year per one cycle. The discount rate was 3%. We performed Monte Carlo simulation for virtual cohort of 1,000 patients with BPH. Results. The total costs for one year treatment of BPH with dutasteride were estimated to be 6,458.00 € which was higher comparing with finasteride which were 6,088.56 €. The gain in quality adjusted life years (QALY) were higher with dutasteride (11.97 QALY ) than with finasteride (11.19 QALY). The results of our study indicate that treating BPH with dutasteride comparing to finasteride is a cost effective option since the value of incremental cost-effectiveness ratio (ICER) is 1,245.68 €/QALY which is below estimated threshold (1,350.00 € per one gained year of life). Conclusion. Dutasteride is a cost effective option for treating BPH comparing to finasteride. The results of this study provide new information for health care decision makers about treatment of BPH in socioeconomic environment which is actual both in Montenegro and other countries with a recent history of socioeconomic transition.

Background/Aim. Chronic hepatitis C (CHC) is often associated with injectable drug users and human immunodeficiency virus coinfection for which there is stigmatization in society. The aim of this study was to identify the presence of stigma and discrimination of patients with CHC, as well as the influence of sociodemographic factors on the occurrence of stigmatization. Methods. A cross-sectional study was performed. Patients with CHC and conducted antiviral therapy completed an anonymous structured questionnaire consisting of sociodemographic questions and Hepatitis C stigma scale. Results. Out of 154 patients 61.7% were male and 72.1% from the city; 59.7% have completed secondary school; 61.7% were employed before the disease while 31.8% after the disease; 45.5% were unsatisfactory with financial situation; 54.5% were married; 37.7% lived with a spouse and children; 86.4% in their own house/apartment; 5.2% of the patients were abandoned by their partners, while 35.7% consumed drugs. A statistical significance of the stigma score was found in those who lived in the city (p = 0.018), unmarried (p = 0.005), abandoned by the partners after the diagnosis of CHC (p < 0.001), drug users (p = 0.002) and those living with parents (p = 0.034). Univariate regression analysis singled out as significant: residence (p = 0.018), living with their parents (p = 0.046), abandonment by a partner (p < 0.001) and drug use (p = 0.002). A multivariate regression model of independent variables singled out abandonment by partners (Beta = 5.158, p = 0.007). Men disagree significantly with the two elements inside stigma [not the same as the others (p = 0.035)] and hurt by the reaction of others (p = 0.047)). Conclusion. The presence of stigma in patients with CHC was proven. The results indicate the need to strengthen anti-stigma programs that will reduce their psychological and social problems and reduce stigmatization in society.

Psychophysical capabilities of individuals in terms of work in the modern systems of today are not the only factor that their performance and achievement of results depend on. The context is much broader, starting from work conditions at their work place, through physical and climate factors, social environment and support, down to psychophysical status of an individual, his/her general work efficiency and risk from getting professional illnesses. Although the mechanisms and causes of fatigue occurring at work have long been a subject of study and interest in the area of psychophysiology of work, the fact is that to the day there has been no unique and generally accepted definition of fatigue, not only due to complex causes of its origin, but also due to complexity and diversity of its manifestations. Factors that are subject of study may be grouped into areas of contents of work, organization of work or work environment, and they significantly affect working ability and its misbalance, needs, capabilities and requirements to be met by an individual at a work place. Similarly to the concept of stress at work, fatigue as a reversible physiological occurrence manifests itself in physiological, i.e. health-related, psychological and professional areas, which in the long run affects total performance and efficiency of an individual, and results in unfit behavior, mental problems or physical illness. Keeping this in mind, it is important that a professional department and personnel management in organizations and institutions should react in a timely manner in order to prevent, detect and eliminate the factors that bring an individual at work to chronicle fatigue, therefore, to reduced performance and productivity at work.

Background/Aim. Recent studies have shown that biological treatments for rheumatoid arthritis can change the course of rheumatoid arthritis and improve functional ability of patients with rheumatoid arthritis. In spite of this fact, use of biological therapy is still limited by high prices of these medicines, especially in countries in socioeconomic transition. The aim of our study was to compare costeffectiveness of a combination of tocilizumab and methotrexate with methotrexate alone for rheumatoid arthritis in Serbia, a country in socioeconomic transition. Methods. For the purpose of our study we designed a Markov model using data on therapy efficacy from the available literature, and data on the costs of health states calculated from records of actual patients treated in the Clinical Center Kragujevac, Serbia. The duration of one cycle in our model was set at one month, and the time horizon was 480 months (40 years). The study was done from the social perspective, and all the costs and outcomes were discounted for 3% per year. Results. Treating rheumatoid arthritis with diseasemodifying antirheumatic drugs (DMARDs) alone was more cost-effective in comparison with a combination of biologic treatment with tocilizumab and DMARDs. The total costs for treating a patient with DMARDs for one year were on average 261,945.42 RSD, or 2,497.70 Euro and the total costs for treatment with tocilizimab plus DMARDs were on average 1,959,217.44 RSD, or 18,659.20 Euro. However, these results are susceptible to changes in costs and treatment effects of tocilizumab in patients with more severe forms of rheumatoid arthritis. Conclusion. Our results show that the use of tocilizumab for rheumatoid arthrits in economic environment of Serbia is not cost-effective. Use of tocilizumab for treating rheumatoid arthritis can become affordable, if costs of its use become lower. In order to start using expensive biologic medicines in patients in transitional countries, special strategy and pricing policy of international pharmaceutical companies are necessary, which would include calculation of prices of biologic medicines on the basis of local pharmacoeconomic studies. [Projekat Ministarstva nauke Republike Srbije, br. 175007]

Background/Aim. A cost-effectiveness analyses of immunomodulatory treatments for relapsing-remitting multiple sclerosis (RRMS) in developed countries have shown that any benefit from these drugs is achieved at very high cost. The aim of our study was to compare the cost-effectiveness of five treatment strategies in patients diagnosed with RRMS (symptom management alone and in combination with subcutaneous glatiramer acetate, intramuscular interferon β-1a, subcutaneous interferon β-1a, or intramuscular interferon β- 1b) in a Balkan country in socio-economic transition. Methods. The Markov model was developed based on the literature about effectiveness and on local Serbian cost calculations. The duration of a cycle in the model was set to a month. The baseline time horizon was 480 months (40 years). The societal perspective was used for costs and outcomes, and they were discounted for 3% annually. Monte Carlo micro simulation with 1000 virtual patients was done. Results. Significant gain with immunomodulatory therapy was achieved only in relapse-free years, while the time spent in health states EDSS 0.0-5.5 was longer with symptomatic therapy only, and gains in life years and QALYs were only marginal. One QALY gained costs more than a billion of Serbian dinars (more than 20 million US dollars), making each of the four immunomodulatory therapies costineffective. Conclusion. Our study suggests that immunomodulatory therapy of RRMS in a Balkan country in socioeconomic transition is not cost-effective, regardless of the type of the therapy. Moderate gain in relapse-free years does not translate to gain in QALYs, probably due to adverse effects of immunomodulatory therapy.

Guided by the idea that the presence of a heterocyclic aromatic core and tyramine moiety, under the umbrella of a single molecular scaffold could bring interesting biological properties, herein we present synthesis, characterization, with two crystal structures reported, and biological evaluation of some tyramine derivates. Cytotoxic and antimigratory potential was addressed by using a colorectal cancer cell line as a model system. Although possessing no cytotoxic effects, two compounds have shown strong antimigratory potential in low doses, with no effect on healthy MRC‐5 cells. Evaluation of their antimicrobial activities suggested prominent antimicrobial activity, where Compound 4 outperformed streptomycin against Escherichia coli and Proteus mirabilis. Hormone‐dependent types of cancer, such as prostate, ovary, and breast, are highly dependent on human sex hormone–binding globulin (SHBG) blood levels. A molecular docking study has shown that 1 has high affinity to bind and therefore compete with natural steroids for the SHBG steroid‐binding site. DNA‐binding study have shown that 4 interacts with CT‐DNA in a groove‐binding mode. In silico ADME/T study revealed that all compounds have suitable physicochemical properties for oral bioavailability and druglikeness, while toxicity tests for 1, 4, and 6 suggested potential for mutagenicity (4, 6), hepatotoxicity (6), and skin sensation (1). [ABSTRACT FROM AUTHOR]

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]

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