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Background/Aim. Hypervolemia is an important risk factor for the development of cardiovascular morbidity and mortality in patients treated with regular hemodialysis. There is still no reliable method for assessing the status of volemia in these patients. The aim of the study was to assess the status of volemia in patients treated with regular hemodialysis by measuring the parameters of the inferior vena cava (IVC) and bioimpedance. Methods. The effect of hemodialysis treatment on ultrasound parameters of the IVC, as well as on the parameters measured by bioimpedance, was examined before and after hemodialysis. The values of the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) were measured both before and after hemodialysis. Forty-five patients were involved in this non-interventional cross-section study, including the patients treated with standard bicarbonate dialysis. According to the interdialytic yield, the patients were divided into three groups: I (up to 2,000 mL), II (2,000–3,000 mL), and III (over 3,000 mL). Results. The values of the IVC parameters and the parameters measured with bioimpedance were significantly lower after treatment with hemodialysis (p < 0.005). The third group of patients had a significantly higher total fluid volume in the body com-pared to the group I, as well as a significantly greater volume of extracellular fluid (p < 0.005). The significantly lower values of NT-proBNP in all groups (p < 0.005) were detected after hemodialysis. After treatment with hemodialysis, a positive correlation was observed between the concentration of NT-proBNP in the serum and the extracellular/intracellular water ratio. However, the correlation between NT-proBNP concentration and total fluid measured by bioimpedance spectroscopy did not reach statistical significance. Conclusion. Measurement of the IVC ultrasound parameters and volemia parameters using bioimpedance significantly contributes to the assessment of the status of volemia. Nevertheless, it cannot be used as a separate parameter, only in combination with all other methods.

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Introduction/Objective. Peritoneal dialysis is a method of treating patients in the terminal phase of renal failure (end-stage renal disease). Peritonitis represents most severe and most common complication of peritoneal dialysis. The most common peritonitis causes are Gram negative microorganisms: Staphylococcus-coagulase-negative, Staphylococcus aureus, Streptococcus sp, Neisseria sp. Gram negative microorganisms are: Pseudomonas sp, Enterococcus, Klebsiella sp, Proteus sp, Acinetobacter sp. The aim of the study was to examine the incidence of peritonitis and to determine the differences between patients with and without peritonitis and catheter infection. Other goals of the work were: the most frequent causes of peritonitis, the outcome of treatment, the influence of the length of treatment on the development of peritonitis, the influence of the peritoneal dialysis adequacy on the development of peritonitis, the influence of anemia, nutritional status, iron status, secondary hyperparathyroidism (Ca, P, CaxPO4, parathormone), protein status – albumin and the effect of acid uricum on the development of peritonitis. Methods. Retrospectively, 84 patients were analyzed of peritoneal dialysis (2012–2016) at the Kragujevac Center for Nephrology and Dialysis of Clinical Center. The diagnosis of peritonitis was based on clinical picture, biochemical analyses, leukocyte in sediment of dialysis, findings of peritoneal-culture, signs of inflammation (C-reactive protein, leukocytes). The analysis included: the most common causes, the outcome of treatment, the influence of the length of treatment, the influence of the peritoneal dialysis adequacy, the influence of anemia, the influence of iron status, the influence of secondary hyperparathyroidism, the influence of protein status - albumin, and the effect of acid uricum on the development of peritonitis. Results. In total, 22 patients had one, six patients had two, six patients had three, six patients more than three episodes of peritonitis. The difference in mean values of the number of erythrocytes, hemoglobin, hematocrit, iron, albumin, diastolic pressure, systolic pressure between patients with peritonitis, and those without it, were statistically significant (p < 0.05). The difference in mean values of calcium (Ca), phosphor (P), CaxPO4, uricum value, parathormone, peritoneal dialysis adequacy, systolic pressure was not statistically significant (p > 0.05). The incidence of peritonitis and death were not associated (p = 1.000). Conclusion, Peritonitis is severe complication of peritoneal dialysis. Anemia and nutritional status are risk factors that affect the development of peritonitis in patients on peritoneal dialysis.

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Introduction. Situs inversus totalis (SIT) represents a total vertical transposition of the thoracic and abdominal organs which are arranged in a mirror image reversal of the normal positioning 1. We presented a successful pre-dialysis kidney transplantation from a living sibling donor with SIT and the longest donor follow-up period, along with analysis of the reviewed literature. Case report. The pair for pre-dialysis kidney transplantation included a 68-year-old mother and 34-year-old daughter at low immunological risk. Comorbidities evidenced in kidney donors with previously diagnosed SIT, included moderate arterial hypertension and borderline blood glucose level. Explantation of the left donor kidney and its placement into the right iliac fossa of the recipient were performed in the course of the surgical procedure. A month after nephrectomy, second degree renal failure was noticed in the donor. A 20-month follow-up of the donor’s kidney and graft in the recipient proved that their functions were excellent. Conclusion. In donors with previously diagnosed SIT the multidisciplinary approach, preoperative evaluation of the patient and detection of possible vascular anomalies are required to provide maximum safety for the donor.

Introduction. Renal artery stenosis (RAS) is narrowing of one or both renal arteries or their branches. Clinically significant stenosis involves narrowing of the lumen, which is approximately 80%. The two most common causes of its occurrence are atherosclerosis and fibromuscular dysplasia. Percutaneous transluminal renal angioplasty (PTRA) with stent implantation is an effective treatment modality that leads to lower blood pressure and improvement of kidney function. Case report. We presented 4 patients with significant stenosis of one or both renal arteries followed by the development of arterial hypertension and renal insufficiency. The causes of RAS were atherosclerosis in two patients and fibromuscular dysplasia in one patient. One of the patients had renal artery stenosis of transplanted kidney that developed 9 month after transplantation. In all the patients, in addition to clinical signs, doppler screening suspected the existence of significant renal artery stenosis. The definitive diagnosis was made by applying computed tomographic angiography (CTA) of renal arteries in 3 of the patients and in 1 patient by percutaneus selective angiography. All the patients were treated by application of PTRA with stent implantation followed by improvement/normalization of blood pressure and kidney function. Conclusion. Application of PTRA with stent implantation is an effective treatment of significant stenosis of one or both renal arteries followed by renal insufficiency.

Background/Aim. Tremendous breakthrough in solid organ transplantation was made with the introduction of calcineurin inhibitors (CNI). At the same time, they are potentially nephrotoxic drugs with influence on onset and progression of renal graft failure. The aim of this study was to evaluate the outcome of a conversion from CNIbased immunosuppressive protocol to sirolimus (SRL) in recipients with graft in chronic kidney disease (CKD) grade III and proteinuria below 500 mg/day. Methods. In the period 2003-2011 24 patients (6 famale and 18 male), mean age 41 ± 12.2 years, on triple immunosuppressive therapy: steroids, antiproliferative drug [mycophenolate mofetil (MMF) or azathiopirine (AZA)] and CNI were switched from CNI to SRL and followe-up for 76 ± 13 months. Nine patients (the group I) had early postransplant conversion after 4 ± 3 months and 15 patients (the group II) late conversion after 46 ± 29 months. During the regular outpatient controls we followed graft function through the serum creatinine and glomerular filtration rate (GFR), proteinuria, lipidemia and side effects. Results. Thirty days after conversion, in all the patients GFR, proteinuria and lipidemia were insignificantly increased. In the first two post-conversion months all the patients had at least one urinary or respiratory infection, and 10 patients reactivated cytomegalovirus (CMV) infection or disease, and they were successfully treated with standard therapy. After 21 ± 11 months 15 patients from both groups discontinued SRL therapy due to reconversion to CNI (10 patients) and double immunosuppressive therapy (3 patients), return to hemodialysis (1 patient) and death (1 patient). Nine patients were still on SRL therapy. By the end of the follow-up they significantly improved GFR (from 53.2 ± 12.7 to 69 ± 15 mL/min), while the increase in proteinuria (from 265 ± 239 to 530.6 ± 416.7 mg/day) and lipidemia (cholesterol from 4.71 ± 0.98 to 5.61 ± 1.6 mmol/L and triglycerides from 2.04 ± 1.18 to 2.1 ± 0.72 mmol/L) were not significant. They were stable during the whole follow-up period. Ten patients were reconverted from SRL to CNI due to the abrupt increase of proteinuria (from 298 ± 232 to 1639 ± 1641/mg day in 7 patients), rapid growth of multiple ovarian cysts (2 patients) and operative treatment of persisted hematoma (1 patient). Thirty days after reconversion they were stable with an insignificant decrease in GFR (from 56.10 ± 28.09 to 47 ± 21 mL/min) and significantly improved proteinuria (from 1639 ± 1641 to 529 ± 688 mg/day). By the end of the follow-up these patients showed nonsignificant increase in the serum creatinine (from 172 ± 88 to 202 ± 91 mmol/L), decrease in GFR (from 56.10 ± 28.09 to 47 ± 21 mL/day) and increased proteinuria (from 528.9 ± 688 to 850 ± 1083 mg/min). Conclusion. In this small descriptive study, conversion from CNI to SRL was followed by an increased incidence of infections and consecutive 25-50% dose reduction in the second antiproliferative agent (AZA, MMF), with a possible influence on the development of glomerulopathy in some patients, which was the major reason for discontinuation of SRL therapy in the 7 (29%) patients. Nine (37.5%) of the patients experienced the greatest benefit of CIN to SRL conversion without serious post-conversion complications.

Background. In countries without a national organization for retrieval and distribution of organs of the deceased donors, problem of organ shortage is still not resolved. In order to increase the number of kidney transplantations we started with the program of living unrelated - spousal donors. The aim of this study was to compare treatment outcome and renal graft function in patients receiving the graft from spousal and those receiving ghe graft from living related donors. Method. We retrospectively identified 14 patients who received renal allograft from spousal donors between 1996 and 2009 (group I). The control group consisted of 14 patients who got graft from related donor retrieved from the database and matched than with respect to sex, age, kidney disease, immunological and viral pretransplant status, the initial method of the end stage renal disease treatment and ABO compatibility. In the follow-up period of 41 ± 38 months we recorded immunosuppressive therapy, surgical complications, episodes of acute rejection, CMV infection and graft function, assessed by serum creatinine levels at the beginning and in the end of the follow-up period. All patients had pretransplant negative cross-match. In ABO incompatible patients pretransplant isoagglutinine titer was zero. Results. The patients with a spousal donor had worse HLA matching. There were no significant differences between the groups in surgical, infective, immunological complications and graft function. Two patients from the group I returned to hemodialysis after 82 and 22 months due to serious comorbidities. Conclusion. In spite of the worse HLA matching, graft survival and function of renal grafts from spousal donors were as good as those retrieved from related donors.

Background. Systemic lupus erithematodes (SLE) is chronic, often febrile, multisystemic disease unknown origin and relapsing course which affects connective tissue of the skin, joints, kidney and serous membranes. Gastrointestinal manifestations are rarely the first sign of systemic lupus erythematosus. Case report. We presented a female patient, 35 years old, whose first symptoms of SLE were paralitic ileus (chronic intestinal pseudo-obstruction) and polyserositis (pleural effusion and ascites). Except for high parameters of inflammation, leucopenia and thrombocytopenia, all immunological and laboratory tests for SLE were negative in the onset of the disease. During next six months the patient had clinical signs of paralitic ileus several times and was twice operated with progressive malabsorptive syndrome. The full picture of SLE was manifested seven months later associated with lupus nephritis. Treatment with cyclophosphamide, corticosteroids and total parenteral nutrition (30 days) induced stable remission of the disease. Conclusion. The SLE can be initially manifested with gastroenterological symptoms without any other clinical and immunologic parameters of the disease. If in patients with SLE and gastrointestinal tract involvement malabsorption syndrom is developed, a treatment success depends on both immunosupressive therapy and total parenteral nutrition.

Rheumatoid arthritis (RA) is predominantly an intraarticular inflammatory and autoimmune disease that involves different autoantibodies and effector mechanisms. The aim of the study was to determine the utility of Circulating Immune Complexes (CIC) and complement components (C3c, C4) as possible markers for the disease activity in laboratory diagnostics. In a cross-section study 59 patients, according to the clinical criteria, were categorized into two groups: group with moderate (MA, n=24), and group with severe activity (SA, n=35) of RA. The concentration of CIC, C3c and C4 in sera (S) and synovial fluids (SF) was examined by an immunonephelometric method in both groups and compared with values in the control group (n=15) of patients with lesions of the menisci. Obtained results showed that there was no statistical significance in the values of C3c and C4, in both biological fluids, among all tested groups. Significant differences were found in the levels of CIC in both fluids, while testing the parameters (x ± SD, IU/mL) in the sera of groups with SA and MA of RA: 7.43 ± 13.40; 3.01 ± 2.92 (p

Background/Aim. Due to improved methods for removal of ABO isoagglutinins and novel immunosuppressive protocols, short and long term outcome in blood group incompatible is similar to blood group compatible kidney transplantation. The aim of this study was to determine the efficacy of our original method for removal of ABO isoagglutinins from the blood in ABO-incompatible kidney allograft recipients. Method. Between 2006 and 2008 twelve patients were transplanted from ABO incompatible living donors. Titers of ABO isoagglutinins were 4-128 (IgG). Immunosuppressive therapy started 14 days before kidney transplantation with rituximab, followed by a triple therapy (prednisone + tacrolimus + mycophenolate mofetil) and the first plasma exchange (PE) procedure, in which one plasma volume was substituted with albumin and saline on day 7 before transplantation. For selective extracorporeal immunoadsorption, the removed plasma was mixed with donor blood type filtered red blood cells, centrifuged and the supernatant separated and preserved. In the next PE procedure, the removed plasma was replaced with immunoadsorbed plasma, and so on. Titers of ABO agglutinins, renal allograft function and survival were followed-up. Results. The pre-transplant treatment consisting of 1-5 PE procedures and immunosuppressive therapy resulted in target ABO agglutinins titers below 4. During a 10-24 month follow-up three patients had an early acute rejection, one patient acute rejection and hemolytic anemia, two patients surgical complications and one of them lost his graft. In the post-transplant period, the titers of ABO antibodies remained below 4. All the patients had stable kidney allograft function with mean serum creatinine ±SD of 129 ± 45 μmol/l at the end of the study. Conclusion. Our method for removal of ABO antibodies was effective in a limited series of patients and short-term follow-up.

Background/Aim. Cyclosporine (CyA) therapeutic drug monitoring (TDM) through the measurement of drug concentration in blood two hours after the administration (C2), and/or according to the calculated value of the area under the concentration - time curve during the first four hours following administration (AUC0−4) shows favourable correlation with clinical manifestations in patients with kidney transplantation (Tx). The aim of this study was to analyze clinical efficiency and usability of TDM CyA through C2 and AUC0-4 in the group of our kidney transplanted patients during the first 24 months following Tx. Methods. The study included 50 patients who had undergone kidney Tx using living donors at the Clinic of Nephrology Military Medical Academy, from 1996 to 2003. The first group (group C2) consisted of 25 patients in whom CyA dose was adjusted according to the target C2 and AUC0−4 (calculated by the regression formula based on C1, C2 and C3), while the second group (group C0) consisted of 25 "historical" patients in whom the dose of this drug was adjusted according to C0. Results. On the 6th day the average daily dose of CyA in the group C2 was 10.1±0.8 mg/kg, while in the group C0 it was 7.6±1.6 (p < 0.05). One month following the Tx, daily drug doses were quite similar in the two observed groups (6.2 mg/kg in C0 and 6.6 mg/kg in group C2, p = NS). In the group C2, target C2/AUC 0−4 (C2 1 700 ng/ml, AUC0−4 4 400 ng·h/ml) on the sixth day was achieved in 36.3%, and on day 14 in 76% of the patients. The target AUC 0−4, in relation with C2, in each observed time interval was reached in the higher number of patients. Maximum CyA concentrations in the group C2 were registered 2 hours following the administration (C2), when compared with the concentrations registered after the first and the third hour (C1 and C3). In relation with C1 and C3, C2 concentration correlated most favorably with AUC 0−4, both on the 6th (r = 0.85) and on the 9th day (r = 0.87). During the first three months following the Tx, in the group C0, 10 episodes (40%) of acute cell rejection (AR) were registered, while in the group C2, two episodes (8%, p = 0.07) were registered; in the observed period covering the first two years, a total of 13 (52%) AR episodes in the group C0 and 5 AR episodes (20%) in the group C2 (p = 0.03) were registered. All of five episodes of steroid resistant AR were registered in the group C0. In the group C2, all five patients with AR had lower C2 during AR: the average C2 at the moment of AR was 933.8 ng/ml, and in the patients without rejections was 1 364.2 ng/ml (p = 0.008). In the same group, the average C0 at the moment of AR was 263.2 ng/ml, and 240.0 ng/ml (p = 0,486) in the patients without AR. In the C0 group, average C0 concentration at the moment of AR was 227.1 ng/ml, while in the patients without AR it was 227.7 ng/ml (p = 0.95). Totally 68% of the patients showed signs of acute CyA nephrotoxicity during the first year in the group C2, and 52% in the group C0 (p = 0.38). In seven patients (28%) of the group C2 and six patients of the group C0 (24%, p = 0.96) in the first two years following Tx, administration of CyA was interrupted due to nephrotoxicity. Overall graft function was good in both groups during the period of two years. One graft was lost in the group C0 due to chronic allograft nephropathy. The patients in the group C2 had better early and the same late graft function. Five patients in the group C2 who did not reach the target C2/AUC during the first 30 days, did not have more AR or worse graft function, comparing with the patients who reached the target concentrations. Conclusion. In the patients with CyA TDM through with the C2 and AUC0−4., AR frequency was considerably lower, and AR episodes had a milder flow than in those with CyA TDM through the C0. The drug concetration in blood two hours after administration (C2) was a good predictor of acute graft rejection, while C0 failed to point to the patients with the insufficient drug concentration. Higher drug doses were administered in the group C2 during the first month following Tx, and these patients did not show significantly higher frequency of acute nephrotoxicity and more frequent requirement of the drug use interruption. Graft function in both groups was good during the period of two years. CyA dose determination through C2 and AUC0-4 is efficient TDM method, relatively simple for use in day to day clinical practice.

Background/Aim. Any forms of mercury have toxic action on the majority of organs, especially kidneys. The major source of professional exposure to mercury are departments for the production of chlorine which use mercury as catode. The aim of the study was to prove that chronic exposure to elementary mercury low concentrations could cause asymptomatic damages of the kidneys. Methods. A total of 40 workers from the factory "HIP Petrohemija" Pančevo, of the mean age 45±8 years, who were exposed to the effects of mercury for more than 20 years within the production procedure, and 20 workers from the factory "Panonijaplast" Pančevo, of the mean age 44±7 years, who were not exposed to mercury nor to other nephrotoxic agents, were submitted to laboratory analysis, renal function testing, and determination of mercury concentration in urine. Mercury concentration was also measured in the air of working premises of the factory. Results. The performed measurements confirmed that the concentrations of mercury at any tested working place in the Department of Electrolysis were not more than the maximally permitted concentration for an 8-hour exposition. In the exposed group (40 examinees) 75% of the examinees had mercury in urine in the concentration < 0.1 μmol/l, while in 25% of them it was 0.1-0.75 μmol/l. In the control group (20 examinees) all of the examinees showed to have < 0.1 mol/l mercury in urine. There was determined a positive corelation between the concentration of mercury in urine and the value of β2-microglobulin (p < 0.05), as well as between the corrcentration of mercury in urine and γGT activity (p < 0.05), and between the concentration of mercury in urine and the value of retinol-binding protein (p < 0.01). Conclusion. In 25% of the examinees excretion of mercury was significantly higher than in the control group. The frequency of asymptomatic renal tubular lesions and dysfunction of moderate extent were found to be higher in the exposed group than in the control one.

Background/Aim. Idiopathic retroperitoneal fibrosis (IRF) is an uncommon disease characterized by a retroperitoneal fibrotic tissue that often involve the ureters, leading to the obstructive nephropathy and variable impairment of renal function. Findings strongly suggest an autoimmune etiology. Surgery, medical treatment with immunosuppressive drugs, or a combination of both are proposed. The optimal treatment has not been established yet. The aim of this study was to present our experience with combined immunosuppressive therapy of IRF, steroids (S) and mycophenolate mofetil (MMF). Methods. We prospectively followed four patients with IRF from January 2004 to December 2006. Three patients had an active disease with bilateral hydronephrosis. In the two of them acute renal failure was presented, and ureteral catheters were inserted in one in order to manage ureteral obstruction. One patient has came to our unit with a relapse of IRF and incipient chronic renal failure after the prior therapy with ureterolysis and immunosuppressive drugs (azathioprine and tamoxifen). All patients received steroids and MMF. Two patients were treated with intravenous methylprednisolone pulses (250 mg each), for three consecutive days, followed by oral prednisone 0.5 mg/kg/day. The other two patients received oral prednisone at the same dose. Prednisone was gradually tappered to a maintenance dose of 10 mg/kg/day. Simultaneously, all patients received MMF, initially 1 g/day with the increase to 2 g/day. Results. After four weeks of the therapy all symptoms disappeared, as well as a hydronephrosis with a decrease of erythrocyte sedimentation rate and Creactive protein (CRP) to normal level in all patients. Three patients remain in remission untill the end of the follow up. One patient had a relapse because of stopping taking the therapy after six months. He was treated by oral prednisone 0.5 mg/kg/day, which was gradually decreased. After twelve weeks hydronephrosis disappeared and CRP returns to the normal level. Conclusion. The combination of steroids and mycophenolate mofetil led to the remission of IRF with a strong and quick immunosuppressive effect. It also provided avoiding the long-term use of high steroid dose and surgical procedures. .

Background: One of the most important strategies in research and development of new anticancer agents is the tumor-specific induction of apoptosis. The effects of semisynthetic derivative of vitamin E, (α-TOS, D-α-tocopheryl succinate), appear to be largely restricted to malignant cells. Methods: We investigated the in vivo effects of intraperitoneally administered α-TOS on vitality of Ehrlich ascites carcinoma cells (EAC) in mice, as well as the influence of α-TOS on specific activity of enzymes involved in antioxidative mechanisms in EAC cells. Results: According to our results, the intraperitoneal application of α-TOS induces the decrease of the EAC vitality, and the statistically significant alteration of the glutathione-dependent enzyme activity in EAC cells. Conclusion: We may conclude that α-TOS is an important micronutrient, with significant impact on vitality and metabolism of malignant cells.

Background. One of the critical limitations for the administration of the chemotherapy is the toxicity affecting normal tissue. The main target organs for 5-fluorouracil (5-FU) toxicity in humans and experimental animals are the gastrointestinal tract, bone marrow, and skin. The cytotoxic effects of antimetabolite chemotherapy are based on their role as substrates for the same transport processes and enzymes involved in anabolism and catabolism as the natural substrates. The main goal of our study was to analyze the dose-dependent antiproliferative effects of 5-FU on intestinal mucosa, enterotoxic potential of 5-FU in experimental animals and to test possible protective role of glutamine. Methods. In our study, we used Sprague Dawley rats. The control group of rats included 50 animals, while the groups where either 5-fluorouracil (5-FU) alone or 5-FU and glutamine were administered included 200 animals. All experimental animals were further stratified according to the experimental model (25 animals in each of 8 experimental subgroups of animals). The 5-FU was administered by intraperitoneal application in single dose of 0, 100, 200, 300, and 400 mg of 5-FU per kg of body weight. Water solution of 1% glutamine was prepared daily and administered orally, in volume of 200 ml, for 7 days continuously, after the 7th day of 5-FU administration. Experimental animals were sacrificed 7 days after the administration of 5-FU. The isolation of enterocytes was performed according to the method of Kralovansky et al. In cell homogenate obtained by described method, we determined the protein content using the Biuret method and the DNA content using the Burton reagent. The activities of enzymes alkaline phosphatase (ALP), glutathione S-transferase (GST), glutathione reductase (GR), and glutathione peroxidase (GPX) were determined by kinetic method. All paraffin samples of the small intestine were stained by haematoxiline and eosine(HE method). All the experiments were done in duplicate and analyzed by standard statistical methods. All the experiments were done in duplicate and analyzed by standard statistical methods. Results: Our results of enterotoxicity induced by intraperitonealy administered 5-FU showed statistically significant decrease of DNA content in small intestine samples of experimental animals, decrease in activity of intestinal alkaline phosphatase enzyme and the increase in glutathione-dependent enzymes. The glutamine supplementation reduced 5-FU intestinal toxicity. Conclusion: Intestinal alkaline phosphatase is a good marker of the dose-dependent enterotoxicity induced by 5-fluorouracil.

Background. Multiple myeloma is a plasmaproliferative disease characterized by the uncontrolled proliferation of a pathogenic plasma cell clone engaged in the production of monoclonal immunoglobulin. This condition affects the bone marrow, but it can be manifested in any other organ or tissue. The urinary bladder involvement is extremely rare. Case report. We reported a 70-year-old male with the history of multiple myeloma, receiving chemotherapy containing melphalan and prednisone (MP). Two years after the treatment, there was a renal failure associated with oligoanuria, hematuria and bilateral hydronephrosis. The urine cytology tests revealed the atypical cells, so was suspected obstructive uropathy to be caused by urothelium cancer. However, only upon the cystoscopy and biopsy performed on the urinary bladder mass, plasmacytoid infiltration diagnosis was confirmed. This extremely rare variant was presented throughout the illness period and proved to be resistant to the administered chemotherapy. Conclusion. When renal failure associated with hematuria and bilateral hydronephrosis is presented in a patient with multiple myeloma, this unusual and rare extramedular localization should be also considered.

Background/Aim. The efficacy and biocompatibility of hemodialysis have a singnificant impact on dialysis patient morbidity and mortality rate. The aim of our study was to compare the efficacy and biocompatibility of different hemodialysis modalities in our patients. Methods. A total of 55 patients were included in the study, and on the basis of dialysis modality, they were divided in four groups: group I - postdilution on-line hemodiafiltration (n = 15), group II - bicarbonate high-flux polysulphone hemodialysis (n = 15), group III - bicarbonate low-flux polysulphone hemodialysis (n = 15), and groupe IV - bicarbonate cuprophane hemodialysis (n = 10). The efficacy was evaluated on the basis of urea reduction rate (URR), urea Kt/V index and serum β2-microglobuline reduction rate, and the biocompatibility was evaluated on the basis of the leukocyte count fall during the first fifteen minutes of dialysis session, and of the serum C-reactive protein (CRP) level. Results. The highest mean URR was achieved in the group I (70.53 ± 6.49 %), and it was significantly higher in comparison with the average URR in the group IV (54.8 ± 6.35%) (p = 0.001). The average value of urea Kt/V index in the group I (1.48 ± 0.22) was significantly higher in comparison with the average value in the groupe II 1.30 ± 0.22 (p < 0.05), group III (1.05 ± 0.22), and group IV (0.98 + 0.22) (p = 0.001). Serum β2-microglobuline reduction rate was 68.93 ± 8.25% in the group I, and 58.86 ± 7.98% in the groupe II (p = 0.01). During the first 15 minutes of hemodialysis the leukocyte number was decreased by 12.57 ± 9.35% in the group I, 13.61 ± 9.64% in the group II, 18.3 ± 13.24 in the group III and 62.3 ± 15.4 in the group IV, on average. The mean serum level of CRP was 9.4 ± 6.47 mg/l in the group IV, and less than 3.5 mg/l in the group I of the patients (p = 0.001). Conclusion. Postdilution on-line hemodiafiltration in comparison with standard hemodialysis provided the more effective elimination of small and middle uremic toxins molecules and a significantly higher degree of biocompatibility. The patients treated with standard hemodialysis frequently do not achieve the minimal value of urea Kt/V index prescribed by National Kidney Foundation - Dialysis Outcomes Quality Inatiatives standards. These patients also have significantly higher serum CRP values which suggest the state of chronic microinflammation.

BACKGROUND: Rapidly proliferating crypt cells of the intestinal epithelium, the precursors of the mature enterocytes, are extremely sensitive to the effects of cytostatic agents. We investigated the effects of the methotrexate on rat intestinal mucosa in order to get the information on biochemical indicators of intestinal damage. METHODS: Biochemical parameters were investigated in isolated intestinal mucosa of Sprague-Dawley rats, previously treated with methotrexate by intraperitoneal administration. Glutamine was dissolved in water and administered orally. RESULTS: The activity of glutaminase and alkaline phosphatase showed the enzymatic response to different doses of methotrexate. The activity of both enzymes was significantly lower in the mucosa of treated animals, compared to control group. CONCLUSION: Minimal mucosal damage and regeneration time is dose dependent and influenced by the dosage schedule of antitumor therapy.

Introduction. Hemorrhagic fever with renal syndrome (HFRS) is acute infective multisystemic disease followed by febrility, hemorrhages and acute renal insufficiency. Bleeding in the anterior pituitary lobe leading to tissue necrosis occurs in acute stage of severe clinical forms of HFRS, while atrophy of the anterior pituitary lobe with diminution of the gland function occurs after recovery stage. Case report. We presented a patient with the development of chronic renal insufficiency and hypopituitarism as complication that had been diagnosed six years after Hantavirus infection. Magnetic resonance of the pituitary gland revealed atrophy and empty sella turcica. Conclusion. Regarding frequency of this viral infection and its endemic character in some parts of our country partial and/or complete loss of pituitary function should be considered during the late stage of HFRS.

Organized crime refers to activities that have many characteristics of regular business, but are in fact illegal. It usually includes illegal gambling, prostitution, wholesale theft, racketeering and other illegal activities. Opposing organized crime, simply speaking, is the struggle of state - governmental institutions, i.e., the legal - official legal system that respects regulations - positive laws and interstate agreements against highly organized persons and groups of the illegal system who, without any reservations or scruples, strive as soon as possible, secretly and not choosing the means to achieve the goal - the planned material profit. In the theoretical part of the research of this scientific paper, with the application of the methods of content analysis, comparative methods, analysis and deduction, the field of criminal operations was dealt with, the concept and forms of combating organized crime were defined, and an analysis of the court verdicts for 2020, 2021 and 2022 by criminal cases that had characteristics of organized crime, after which a conclusion was made. [ABSTRACT FROM AUTHOR]

The information-seeking process of nautical tourists is essential for their decision-making when choosing a specific destination. Modern destination marketing is constantly changing due to the development of new technologies that are meant to attract and retain nautical tourists. Nautical destination managers use modern communication to build and maintain a better image and develop destinations as brands which can function sustainably even in the times of crisis. This paper examines modern and traditional marketing sources of information about Montenegro and Croatia as nautical tourist destinations. It was revealed that the largest share of the informed tourists had previous experience with a destination or were informed through internet sources. The results confirmed that the internet is increasingly used by the surveyed tourists, i.e., there is an increase in promotion through digital marketing tools in both destinations. The comparison of the trends between 2012 and 2021 indicated three common sources of information in both destinations: previous experience, the internet and the recommendations of friends and relatives. The study is based on cross-tabulation analysis which detects the differences in the method of obtaining information by the tourists whose age, gender and education level varied. The practical implication of this paper is the development of destination marketing in the Eastern Adriatic region. More precisely, the study might help the creators of developmental policies and destination operators to choose appropriate marketing strategies in order to adequately position a destination in the market. [ABSTRACT FROM AUTHOR]

Somatic cells (SCs) in milk, which include epithelial cells from the gland and blood cells, are present in milk during the normal course of milking. Increase in SCs is found in mastitis-affected dairy cows and can be a useful indicator for estimating mammary health and milk quality worldwide. The aim of this study was to determine whether there was a pattern of somatic cell count (SCC) in mastitis-affected cows on three different farms. The study was conducted on three dairy farms of high milk-producing cattle breeds in Vojvodina during 2021. Samples were taken from 15 cows from each farm, all of the cows being diagnosed with clinical and subclinical mastitis. The SCC in milk samples was determined by the microscopic reference method according to the standard (SRPS EN ISO 13366-1:2010) of the Institute for Standardization of Serbia. The value of SCC was considered as high if >200.000 cells/mL, as this is the threshold indicating secretion disorder. In order to examine the differences between the observed three farms, one-factor analysis of variance (ANOVA) was applied, while a post-hoc LSD test was used for determination of statistically significant differences between the SCC in cows on three different farms. The mean values of the SCC on Farms 1, 2 and 3 were 7,055,266.67, 2,619,893.33 and 552,000 cells/mL, respectively. Based on the results, a statistically significant difference (p

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Introduction: Digestive tract bleeding is a clinical problem that requires hospitalization. Hemorrhages from the upper parts of the digestive system have an incidence of 150/100000 persons per year and are the reason for 1.5% of all emergency hospitalizations. The most common cause of bleeding is gastroduodenal ulcer and erosion in three quarters of cases. Endoscopic haemostatic and gastric acidity status are the most important in the treatment of patients. Aim: To analyze the causes of bleeding from the upper parts of digestive tract and the justification for the urgent gastroscopy. The study was conducted at the Clinical Center Kragujevac in Kragujevac, Serbia. Methods: The study included patients (200) who reported to the emergency room of the Emergency Medicine Center with the clinical picture of bleeding from the upper parts of the digestive tract. Results: Most patients had ulcerative changes at gastric level (58.6%). The most common symptom was melena present in 152 patients. Endoscopic therapy was administered to 44 patients, with 38 patients (86.4%) resulting in arresting bleeding. Conclusion: Hemorrhages from the upper parts of the digestive tract are most commonly caused by peptic ulcers, more common in older, male patients. The first form of diagnosis and therapy is endoscopy, with an efficacy greater than 70%. [ABSTRACT FROM AUTHOR]

With the fall of the medieval Serbian state under Turkish rule, every culture, including medicine, died out, and the people resorted to folk medicine and self-taught doctors, i.e. empiricists. Serbs began to get educated in Vienna and Pest, and there were Serbian doctors in Novi Sad already at the beginning of the 18th century. At that time, the first doctors with diplomas appeared in Serbia, but mostly as personal doctors of the Belgrade pasha or Knez Miloš, i.e. his brother Jevrem in Šabac. In the fourth decade of the 19th century, the first military doctors set out, and the newly created four military district commands got their doctors. The Serbian Medical Association started the first medical journal, "Serbian Archives" in 1874. Josif Pancic is writing the first textbook in natural sciences, and Dr. Acim Medovic is writing the first textbook on forensic medicine. Before the First Serbian-Turkish War, the civilian ambulance numbered 69 doctors, 10 medical assistants, 26 pharmacists, and five pharmacy assistants, while the military ambulance had 19 doctors, five medical assistants, one pharmacist, and four pharmacy assistants. Health was initiated but also the establishment of the Ministry of Health and the higher education institution of the Medical Faculty in Belgrade. Guided by the oath, expertise, and experience, the doctors of that time made a significant effort to improve and develop medicine in Serbia in the 19th century.

Mastitis is one of the most common and costly diseases affecting dairy cows worldwide. Since antibiotic resistance has become a global threat to both animal and human health, it is becoming more urgent to continuously search for new therapeutical alternatives for the control and treatment of bovine mastitis. Hence, our research aimed to test the therapeutic use of two essential oils (EOs) based on their chemical composition, antibacterial and antioxidant potential. The present study was conducted by collecting milk samples from the cows diagnosed with clinical or subclinical mastitis with the aim of isolating and identifying bacterial strains. The antioxidant potential of essential oils of Menthae piperitae (MP) and Melissa officinalis (MO) was evaluated in several in vitro assays. In the MP EO, a total of 38 compounds were identified, with menthol as the dominant compound, whereas in MO EO 51 compounds were identified. Furthermore, the values of minimal inhibitory concentrations (MICs) and minimal bactericidal concentrations (MBCs) have been used to quantitatively measure the antibacterial activity of each essential oil. In accordance with which, MP EO samples exhibited a higher degree of antibacterial activity than MO EO. Thus, EOs have been shown to be promising alternatives to antibiotics because of their availability, biodegradability, and lower risk of side effects as compared with conventional, antimicrobial treatment. Nevertheless, further clinical studies are needed to test the potential role of EOs in treating mastitis in dairy cows.

Bovine mastitis is an important disease in the dairy industry responsi­ble for the welfare and significant economic losses in dairy cows. The treatment of choice for mastitis is the administration of antibiotics. However, this therapeutic choice has some disadvantages including presence of antibiotics residues in the milk, low cure rate as well as rapid increase in antibiotic-resistant pathogens. Therefore, new alternative approaches to antibiotics were investigated by different groups of researchers in order to find an effective approach for bovine mastitis therapy. This review was conducted in order to analyze different publications on usage of essential oils in relation to bovine mastitis. There are many in vitro studies for evaluating the antimicrobial efficacy of essential oils against many mastitis associated pathogens. In addition, numerous of tested essential oils have shown good efficacy with a wide range of minimal inhibitory concentrations (MICs) and minimal bactericidal concentrations (MBCs). On the other hand, only several in vivo studies have focused on therapeutic effects of essential oils. Moreover, recent studies indicate the possibility of using essential oils in the fight against biofilm which could be promising fight against bovine mastitis since unsuccessful antibiotic treatment can be associated with the presence of biofilms.