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In the setting of intensive care units the incidences of multi-drug resistant gram-negative (MDR-GN) pathogens causing ventilator associated pneumonia (VAP) has increased, leading clinicians to use colistin. Our aim was to assess outcomes associated with the use of inhalation and intravenous colisitn versus only intravenous colistin in patients with MDR-GN VAP. A retrospective, single centre study at University Hospital Centre, Zagreb. Patients were divided in two groups, according to their administration of antibiotics – inhalation and intravenous (INH+IV) administration for 8 patients or intravenous only (IV) administration for 23 patients. The results showed that demographic and clinical characteristics and the gram negative pathogens isolated were similar between the two groups, except for K. pneumoniae, which was higher in the IV group. No statistically significant difference between the two groups were observed regarding intensive care unit mortality (P=0.951), sepsis (P=0.474), acute respiratory distress syndrome (P=0.548), length of ICU stay (P=0.686) and length of mechanical ventilation (P=0.858). A statistically significant difference was found regarding the eradication of pathogens in respiratory cultures (P= 0.018). The addition of inhalation to intravenous colistin in MDR-GN VAP improves microbiologic outcome, but does not improve ICU mortality in these patients. Larger prospective trials are warranted to confirm the benefit of adjunctive inhalation colistin as a MDR-GN VAP therapy in the critically ill.

Recent clinical studies in multiple sclerosis (MS) provide new data on the treatment of clinically isolated syndromes, on secondary progression, on direct comparison of immunomodulatory treatments and on dosing issues. All these studies have important implications for the optimized care of MS patients. The multiple sclerosis therapy consensus group (MSTCG) critically evaluated the available data and provides recommendations for the application of immunoprophylactic therapies. Initiation of treatment after the first relapse may be indicated if there is clear evidence on MRI for subclinical dissemination of disease. Recent trials show that the efficacy of interferon beta treatment is more likely if patients in the secondary progressive phase of the disease still have superimposed bouts or other indicators of inflammatory disease activity than without having them. There are now data available, which suggest a possible dose-effect relation for recombinant beta-interferons. These studies have to be interpreted with caution, as some potentially important issues in the design of these studies (e. g. maintenance of blinding in the clinical part of the study) were not adequately addressed. A meta-analysis of selected interferon trials has been published challenging the value of recombinant IFN beta in MS. The pitfalls of that report are discussed in the present review as are other issues relevant to treatment including the new definition of MS, the problem of treatment failure and the impact of cost-effectiveness analyses. The MSTCG panel recommends that the new diagnostic criteria proposed by McDonald et al. should be applied if immunoprophylactic treatment is being considered. The use of standardized clinical documentation is now generally proposed to facilitate the systematic evaluation of individual patients over time and to allow retrospective evaluations in different patient cohorts. This in turn may help in formulating recommendations for the application of innovative products to patients and to health care providers. Moreover, in long-term treated patients, secondary treatment failure should be identified by pre-planned follow-up examinations, and other treatment options should then be considered.

Vertiginous syndrome appears in more then 100 diseases, therefore subject of intensive investigation. Insufficient research has been done on vertiginous syndrome in patients on chronic program of haemodialisis. The aim of this study is to search anatomical and structural changes on blood vessels of the brain by neuroimaging techniques, as well as increased circulatory resistance on TCD, in patients on chronic program of haemodialysis.The research has been done on 30 patients with vertiginous syndrome, 22 males and 8 females, average age 45.9 years, average duration of haemodialysis 5.83 +/- 4.5. In all patients relevant diagnostic procedures had been done (EEG, TCD, audio vestibulogram, X-ray of cervical spine), and in 14 patients with increased circulatory resistance TCD we have done MRI and MRA of the brain. Pathological EEG has been found in 10%, 40% of the patients have had normal EEG finding, while 50% had slowing (non-specific disfunction) in EEG record.MRI and MRA had been done in 14 patients of average age 51.21 +/- 10.82. In 13 patients we had a pathological finding of MRI and MRA, while in one patient only we had normal finding of MRA, and another one patient with normal MRI scan. In 64.2% of the sample we have had cortical cerebral atrophy, in 57.1% cortical atrophy of cerebellum, while in 35.8% apart from the mentioned changes atrophy of cerebellar vermis had been found. In 71.4% of all patients cerebrovascular disease (stroke) could be identified. Atherosclerosis changes in blood vessels of anterior or posterior circulatory segment were found in 78.5% of the patients, while spasm of arteries had been registered in 21.4% of the sample.MRI and MRA of the brain brought light on aethiological aspect of vertigo in these patients. Results of our research indicate vascular aethiology of vertiginous syndrome in patients on chronic program of haemodialysis.

Neurologists in the main hospital in Sarajevo (Bosnia-Herzegovinia), we worked in the neurological department throughout the war and the siege of the town, from 1992/4/6 to 1995/12/15. We report on strokes which happened during that period, comparing stroke incidence and severity in relation to those two years before. We reviewed 3002 cases of stroke recorded in the neurological department registry from 01/01/90 to the end of the war.The activity of the department was reduced by about 40 p. 100, as was the population of the town. Yet the number of strokes decreased only by 26.5 p. 100. The comparative incidence of strokes increased by 25 p. 100 during the war. Sex ratio and age incidence were the same. The relative role of atherosclerosis, cardiac embolic sources, intracranial and meningeal hemorrhage remained the same. The incidence of intracranial hemorrhage increased by 20 p. 100. Death, evaluated after one month, increased by 36 p. 100. Death by intracranial hemorrhage increased by 30 p. 100, those by cardiac embolic infarction by 26 p. 100 and those by atherosclerosis by 20 p. 100. At the end of the first year of the war, mortality was 65 p. 100 in comparison with the previous year and death by meningeal hemorrhage increased by 74 p. 100 for the first two years of the war. The major changes in life conditions have produced change in medical conditions. Patients had to stop their treatment because there was no more medecine in the city, and, among others, no more drugs for anticoagulation, diabetes mellitus, cardiopathy.... In the hospital, medical doctors, nurses, drugs, food and even heating were missing. So stopping the treatment for vascular disease together with the high level of stress generated by daily shelling can explain the increase in stroke incidence and especially, the hemorragic cases. The poor life conditions which weakened people and the lack of treatment at the acute stage of the disease and also later, when secondary events occurred, can explain the high mortality observed.We recognize the bias of our study: the war itself, the condition in which we have carried out this work and the use of a hospital registry. Nevertheless, it seems that morbidity not directly due to the battle can change during a war like this one. This study also demonstrates, "a contrario", that preventive treatment and care of stroke at the acute phase, as they are currently recommended, are useful.

Aim To examine physical growth and nutritional status of school children in Novi Sad, during the school year 2010/2011 and determine differences in relation to primary and secondary school children. Methods On the medical examination of school children aged 7–14 (primary school) and 15–19 (secondary school) in Novi Sad we registered the total number of children: with normal weight (from –1.5SD to +1.5SD), obese (+1.5 to 3SD) and thin children (from-1.5SD to –3SD); of average height (from –1.5SD to+1.5SD), tall (+2SD, +3SD) and short (–2SD, –3SD) (nomogram provided by Vukovic). Results From the total number of the enrolled pupils(n=40861) we have examined 37.25% (n=15222): there were 12783 (83.98%) of average height, 2325 (15.27%) tall pupils and low height pupils 114 (0.75%); 11990 (78.77%) of well-nourished, obese 2404 (15.79%) and underweight children 828 (5.44%).After comparing the data from primary and secondary schools, a statistically significant difference, considering a total number of tall, short, obese, and thin pupils, was in favor of primary school children (p 0.05), and more obese children in primary schools (p>0.05). Conclusion During 2010/2011, the assessment of growth and nutritional status results of school children were in favor of primary school children. There were more children with normal weight children in secondary schools, and more obese children in primary schools, but the differences were not significant.

Purpose to examine the growth and nourishment of the school children in Novi Sad, in the school year 2010/2011 and 1996/1997 and determine differences in growth and nourishment between two school year periods. Methods During regular health checks in primary and secondary schools in Novi Sad, we registered a total number of children with average height (from –1.5 SD to +1.5 SD), tall (+2 SD, +3 SD), short (–2 SD, –3 SD), with normal weight (from –0.5 SD to +1 SD), obese (+1.5 SD to +3 SD), and thin pupils (from –1.5 SD to –3 SD). Results From the total of 40861 pupils (7–19 years) in school year 2010/2011, we examined 15222 (37.25%):11095 (41.52%) in primary and 4127 (29.19%) in secondary schools, and in school year 1996/1997, from the total of 23248 enrolled pupils, 20704 (89.05%) were examined, in primary schools 12135 (94.80%) and in secondary schools 8569 (82.01%). After comparing data from primary and secondary schools, in the school year 20010/2011, a statistically significant difference was in favor of primary school children, where there was the number of obese children (p=0.000) and thin children (p=0.000) in 2010/2011, while the number of obese children in secondary school in the school year 1996/1997accounts for obese (p=0.000) and thin children (p=0.000), which is favor of secondary school children. Conclusion Comparing the data between two school years, there were significantly more obese and thin children in 2010/2011 in primary schools, while in 1996/1997 there were more in secondary schools.