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ZusammenfassungDas Merkel-Zell-Karzinom (MCC) stellt einen seltenen, jedoch hochaggressiven und rasch expandierenden malignen Hauttumor dar. Die periokuläre Region ist in etwa 10% der Fälle betroffen. Die aktuelle Therapieempfehlung des resektablen, nicht metastasierten MCC umfasst die chirurgische Totalexzision, allerdings sind bei Diagnosestellung bereits häufig Lymphknoten- oder Fernmetastasen vorhanden. Seit der Erstzulassung einer Immun-Checkpoint-Inhibitor-Therapie mit Avelumab für das metastasierte MCC im Jahr 2016 hat sich das mittlere Überleben im Vergleich zur zytostatischen Therapie erheblich gebessert bei gleichzeitig seltenerem Auftreten schwerwiegender therapieassoziierter unerwünschter Ereignisse. Weitere Immun-Checkpoint-Inhibitoren mit ersten vielversprechenden Ergebnissen sind derzeit noch in der klinischen Erprobung. Eine interdisziplinäre Betreuung an einem spezialisierten Zentrum mit Vorstellung in einem Tumorboard ist bei Patienten MCC aufgrund der komplexen Diagnostik, Therapie und Prognoseabschätzung essenziell.

Hemodialysis (HD) is known to affect ocular blood flow. This case-control study aims to evaluate macular and peripapillary vasculature in patients with end-stage renal disease (ESRD) receiving HD in comparison to matched controls. A total of 24 eyes of 24 ESRD patients receiving HD and 24 eyes of 24 healthy, age- and gender-matched control subjects were prospectively included in this study. Optical coherence tomography angiography was used to image the superficial (SCP), deep (DCP), and choriocapillary (CC) macular vascular plexus, as well as the radial peripapillary capillaries (RPC) of the optic disc. In addition, retinal thickness (RT) and retinal volume (RV) were compared between both groups. Flow density (FD) values of each retinal layer and data of parameters related to the foveal avascular zone (FAZ), as well as RT and RV, were analyzed using Mann–Whitney U tests. There was no significant difference in FAZ parameters between the two groups. Whole en face FD of the SCP and CC was noticeably reduced in the HD group in comparison to the control group. FD was negatively correlated with the duration of HD treatment. RT and RV were significantly smaller in the study group than in controls. Retinal microcirculation appears altered in patients with ESRD undergoing HD. Concurrently, the DCP appears more resilient towards hemodynamic changes in comparison to the other microvascular retinal layers. OCTA is a useful, non-invasive tool to investigate retinal microcirculation in ESRD patients.

We report the case of a 66-year-old female patient with rheumatoid arthritis and bilateral upper eyelid abscess under treatment with etanercept. Because bilateral upper lid abscesses due to a systemic cause are rare and cases of abscess formation under treatment with etanercept have been described in the literature, we discuss a possible connection between the bilateral upper lid abscess and the existing immunosuppressive medication.Wir präsentieren den Fall einer 66-jährigen Patientin, bei der sich unter Etanercept-Therapie bei rheumatoider Arthritis eine bilaterale Oberlidschwellung mit Abszedierung zeigte. Da das simultane und bilaterale Auftreten von Oberlidabszessen mit systemischer Ursache sehr selten ist und sich in der Literatur Fälle einer Abszedierung unter Etanercept-Therapie finden, diskutieren wir eine mögliche Verbindung zwischen der bilateralen Oberlidabszedierung und der bestehenden immunsuppressiven Therapie.

The aim of this study is to evaluate retinal and optic nerve head (ONH) perfusion in patients with systolic chronic heart failure (CHF) compared to healthy control subjects. Twenty-seven eyes of 27 patients with CHF (study group) and 31 eyes of 31 healthy subjects (control group) were prospectively included in this study. CHF Patients had a left ventricular ejection fraction (LVEF)

Mortality rate represents a number of deaths on a particular territory per time unit. There are general and specific mortalities. The aims at analysing the characteristics of mortality in Sumadija District for the time period ranging from 2010 – 2017. The study includes all death cases in the District of Sumadija in period 2010-2017, 34681 cases. The data are described and analysed with χ² test and linear trend. The trend analysis does not indicate any significant variations during the given time span. The gender analysis reveals that there is a significantly higher number of deceased persons among male population (52.2%, 47.8%, р The life expectancy of the inhabitants of Sumadija District is increasing over time. There was a slight decrease in the mortality rates during the observed time period. The highest number of the deceased people is 65 or more years old. Men have higher mortality rates throughout their lives. Natural death and non-communicable diseases are dominant. The most common causes of death are heart and blood vessels diseases, in women, and respiratory and neoplasm diseases, in men.

The LacriJet (FCI S. A. S. - France Chirurgie Instrumentation, Paris, France) represents a novel, simplified and preloaded system for monocanalicular or monocanaliculonasal nasolacrimal duct intubation. It is a further development of the Masterka and shall reduce the intubation time during the surgical procedure. The aim of the present study was to present first experiences with this system for different indications.All patients who underwent nasolacrimal duct intubation with the LacriJet at the University of Muenster Medical Center in the period from March to November 2019 were included. The postoperative outcome was evaluated 3 to 6 months later.In total, 12 nasolacrimal duct intubations with the LacriJet were performed at our center in the above-mentioned period. The main indication for intubation was congenital nasolacrimal duct obstruction (CNLDO). In addition, intubation was performed in cases with eye lid tumors involving the nasolacrimal duct, in a case of canalicular laceration and in a case of canaliculitis. In 3 cases, there was an early dislocation or a complete loss of intubation. Of these, 2 were cases with CNLDO and the third dislocation was due to manipulation by the patient. All in all, the functional results were satisfying.The use of the LacriJet is highly suitable for the treatment of CNLDO, stenting in canalicular laceration or lid tumours involving the lacrimal drainage system. However, the known disadvantages of monocanalicular intubation (dislocation, early loss of intubation) also occur with this type of system and a system briefing seems useful. The LacriJet therefore represents a modern and simple method for nasolacrimal duct intubation and can be used for various indications.Der LacriJet (FCI S. A. S. – France Chirurgie Instrumentation, Paris, Frankreich) stellt ein neuartiges, vereinfachtes und vorgeladenes System für eine monokanalikuläre bzw. monokanalikulonasale Tränenwegsintubation dar. Es ist als Weiterentwicklung des Masterkas zu sehen und soll die Intubationszeit während des operativen Eingriffs verkürzen. Ziel der vorliegenden Arbeit war es, eine erste Anwendung dieses Systems bei unterschiedlichen Indikationsstellungen darzustellen.Es wurden alle Patienten eingeschlossen, die im Zeitraum von März bis November 2019 an der Universitätsaugenklinik Münster eine Tränenwegsintubation mittels LacriJet erhielten. Das postoperative Ergebnis wurde 3 – 6 Monate später evaluiert.Insgesamt wurden im o. g. Zeitraum an unserer Klinik 12 Tränenwegsintubationen mit dem LacriJet bei unterschiedlichen Indikationsstellungen durchgeführt. Die Hauptindikation stellten kongenitale Tränenwegsstenosen dar. Weiterhin wurde eine Intubation zur Schienung bei tränenwegsnahen Lidtumoren, bei Lazeration des Canaliculus sowie bei Kanalikulitis durchgeführt. In 3 Fällen kam es zu einer frühzeitigen Luxation oder einem kompletten Verlust der Intubation, davon in 2 Fällen bei kongenitaler Tränenwegsstenose und in einem Fall nach Manipulation durch die Patientin. Insgesamt waren die funktionellen Ergebnisse zufriedenstellend.Die Nutzung des LacriJets ist zur Behandlung bei kongenitalen Tränenwegsstenosen, zur Schienung bei traumatischen Tränenwegsabrissen oder tränenwegsnahen Tumoren sehr praktikabel. Die bekannten Nachteile der monokanalikulären Intubation (Luxation, Intubationsverlust) treten allerdings auch bei dieser Art des Intubationssystems auf und eine Einweisung in das System scheint sinnvoll. Der LacriJet stellt damit eine moderne und einfache Methode zur Tränenwegsintubation dar und ist vielseitig einsetzbar.

© 2020 Elsevier Ltd. All rights reserved., Background: Hereditary transthyretin-mediated amyloidosis is a rare, inherited, progressive disease caused by mutations in the transthyretin (TTR) gene. We assessed the safety and efficacy of long-term treatment with patisiran, an RNA interference therapeutic that inhibits TTR production, in patients with hereditary transthyretin-mediated amyloidosis with polyneuropathy. Methods: This multicentre, open-label extension (OLE) trial enrolled patients at 43 hospitals or clinical centres in 19 countries as of Sept 24, 2018. Patients were eligible if they had completed the phase 3 APOLLO or phase 2 OLE parent studies and tolerated the study drug. Eligible patients from APOLLO (patisiran and placebo groups) and the phase 2 OLE (patisiran group) studies enrolled in this global OLE trial and received patisiran 0·3 mg/kg by intravenous infusion every 3 weeks with plans to continue to do so for up to 5 years. Efficacy assessments included measures of polyneuropathy (modified Neuropathy Impairment Score +7 [mNIS+7]), quality of life, autonomic symptoms, nutritional status, disability, ambulation status, motor function, and cardiac stress, with analysis by study groups (APOLLO-placebo, APOLLO-patisiran, phase 2 OLE patisiran) based on allocation in the parent trial. The global OLE is ongoing with no new enrolment, and current findings are based on the interim analysis of the patients who had completed 12-month efficacy assessments as of the data cutoff. Safety analyses included all patients who received one or more dose of patisiran up to the data cutoff. This study is registered with ClinicalTrials.gov, NCT02510261. Findings: Between July 13, 2015, and Aug 21, 2017, of 212 eligible patients, 211 were enrolled: 137 patients from the APOLLO-patisiran group, 49 from the APOLLO-placebo group, and 25 from the phase 2 OLE patisiran group. At the data cutoff on Sept 24, 2018, 126 (92%) of 137 patients from the APOLLO-patisiran group, 38 (78%) of 49 from the APOLLO-placebo group, and 25 (100%) of 25 from the phase 2 OLE patisiran group had completed 12-month assessments. At 12 months, improvements in mNIS+7 with patisiran were sustained from parent study baseline with treatment in the global OLE (APOLLO-patisiran mean change -4·0, 95 % CI -7·7 to -0·3; phase 2 OLE patisiran -4·7, -11·9 to 2·4). Mean mNIS+7 score improved from global OLE enrolment in the APOLLO-placebo group (mean change from global OLE enrolment -1·4, 95% CI -6·2 to 3·5). Overall, 204 (97%) of 211 patients reported adverse events, 82 (39%) reported serious adverse events, and there were 23 (11%) deaths. Serious adverse events were more frequent in the APOLLO-placebo group (28 [57%] of 49) than in the APOLLO-patisiran (48 [35%] of 137) or phase 2 OLE patisiran (six [24%] of 25) groups. The most common treatment-related adverse event was mild or moderate infusion-related reactions. The frequency of deaths in the global OLE was higher in the APOLLO-placebo group (13 [27%] of 49), who had a higher disease burden than the APOLLO-patisiran (ten [7%] of 137) and phase 2 OLE patisiran (0 of 25) groups. Interpretation: In this interim 12-month analysis of the ongoing global OLE study, patisiran appeared to maintain efficacy with an acceptable safety profile in patients with hereditary transthyretin-mediated amyloidosis with polyneuropathy. Continued long-term follow-up will be important for the overall assessment of safety and efficacy with patisiran.

Background/AimDacryocystorhinostomy (DCR) remains the gold standard therapy for nasolacrimal duct obstruction (NLDO), but is invasive and does not maintain the physiology of the lacrimal pathway. With transcanlicular microdrill dacryoplasty (MDP), there is a minimally invasive alternative surgical approach. This study aimed to present this modern lacrimal duct surgery technique and to evaluate its long-term success rate in a large study population.MethodsThe medical records of 1010 patients with acquired NLDO were retrospectively reviewed. Adult patients who had undergone transcanalicular MDP were included. The evaluation included the following parameters: age, gender, success rate, complication rate, obstruction grade and patient satisfaction. Long-term results regarding patient satisfaction and success rate were evaluated by a telephone survey. Only a complete resolution of symptoms was defined as success.Results793 eyes of 576 patients after transcanalicular MDP could be included in the study. The mean follow-up time was 8.7±0.9 years. Initial surgical success rate was 84.0%. At the time of the follow-up, 57.5% (n=229) still had full resolution of symptoms. The mean patient satisfaction with the procedure was 6.9±3.2 out of 10 points. Heavy bleeding occurred in two cases only (0.25%).ConclusionThis is the first study to show the success rate of microendoscopic lacrimal duct surgery after such a long follow-up period and in such a large study population. Transcanalicular MDP is a minimally invasive technique with a very low complication rate and can be used as an alternative procedure before performing more invasive lacrimal duct surgery such as DCR.

ZusammenfassungDie „punctate inner choroidopathy“ (PIC) geht nicht selten mit der Ausbildung einer choroidalen Neovaskularisation (CNV) einher. Die Identifizierung einer frischen CNV im Rahmen einer PIC ist häufig schwierig. Wir präsentieren einen Fall einer 30-jährigen Patientin mit morphologisch typischer PIC. Eine CNV konnte weder in der optischen Kohärenztomographie (OCT) noch in der Fluoreszeinangiographie (FAG) sicher identifiziert werden. Die OCT-Angiographie (OCT-A) hingegen zeigte eine umschriebene CNV. Der Fall lässt eine hohe Dunkelziffer von nicht diagnostizierten, klinisch stummen und nicht therapiebedürftigen sekundären CNVs im Rahmen von PIC vermuten.

Purpose To evaluate the retinal microvascular density using optical coherence tomography angiography (OCTA) in patients with systemic lupus erythematosus (SLE) treated with hydroxychloroquine (HCQ). Methods Nineteen eyes of 19 patients with SLE (study group) without HCQ retinopathy and 19 eyes of 19 healthy subjects (control group) were included in this study. The study group was divided into patients using HCQ for > 5 years (high-risk group) and < 5 years (low-risk group). The VD data of the 3 × 3 mm OCT angiogram of the superficial capillary plexus (SCP) and the choriocapillaris (VD-CC), the foveal avascular zone (FAZ) area and the central retinal thickness (CRT) were extracted and analyzed. Results VD in the en face SCP was significantly reduced in the high-risk group and the low-risk group compared with that in the control group (p < 0.001, p = 0.001) and in the high-risk group compared with the low-risk group (p = 0.007). Correlation analysis between the cumulative dose of HCQ and the VD of the study group revealed a negative correlation, but no statistical significance (p = 0.074). However, a significant positive correlation was observed for the low-risk group (p = 0.035). In patients with SLE, VD-CC was lower (p = 0.042) and the FAZ area larger (p = 0.019). CRT showed no difference between the groups (p = 0.183). Conclusion In this study, SLE patients showed a reduced VD in both groups. In patients treated with HCQ < 5 years, HCQ might have a protective effect on retinal microvasculature. Analysis of retinal microvascular density using OCTA could be useful in the diagnosis and monitoring of vascular alteration in patients with SLE.

Introduction:The number of hospitalized COVID patients varies in accordance with the waves of the pandemic. The aim of the study was to examine the characteristics of hospitalized COVID-19 patients and predictors of in-hospital died with special reference to the importance of comorbidity. Method: A retrospective cohort study that included all COVID patients hospitalized at the Clinical Center Kragujevac in 2020. The data contained in the Hospitalization Report are described, and the predictors of hospital mortality are defined by binary logistic regression. Results: 1336 COVID patients were hospitalized. The average age of the hospitalized patients was 58.1 ± 16.5 years, 2/3 of them were males. The largest number of hospitalized patients live in Kragujevac - 62.8%. During hospitalization, 19.4% (n = 206) of patients died, who were on average 13 years older (t = 14.13, df = 504.3, p Conclusion: COVID Patients with comorbidities require special attention because comorbidities affect the outcome of hospitalization.

Depression is the most frequent mental health problem in older age with serious consequences on personal, interpersonal and social level. The aim of this study was to determine the association of demographic factors, socio-economic factors and health status characteristics, with the presence of depressive symptoms in the elderly persons. The survey was conducted as a part of the national study “Health Survey of the Serbian population” in 2013. Data on the population aged 65 years and over were used for the purposes of this study (3540 respondents). PHQ-8 questionnaire was used to assess the presence of symptoms of depression. The relations between the presence of depressive symptoms, as a dependent variable, and a set of independent variables was examined by univariate and multivariate logistic regressions. Depression (PHQ-8 score≥10) was registered in 10% of the population aged 65 and above, wherein it was statistically significantly higher in women (12.7%) than in men (6.5%). Limitations in performing of daily activities showed to be the strongest predictor of depression in the elderly, while respondents who have had serious limitations had even six times more chanse to develop depression (OR=6.84). Respondents who rated their health as “bad or very bad” for 49.5% more frequently manifested depressive symptoms compared to those who evaluated their health as “very good or good” (OR=3.49). Respondents who have had two or more chronic diseases were three times more likely to have depression (OR=3.1) compared to people without chronic disease.

Tumoren des Tranensacks stellen eine insgesamt rare Entitat dar. Malignome sind dabei haufig mit einer hohen Mortalitatsrate vergesellschaftet. Nicht selten prasentieren sich Tranensacktumoren als Tranenwegsstenose und Dakryozystitis und werden erst intraoperativ entdeckt. Ziel dieser Arbeit war die retrospektive Analyse aller Falle mit Tranensacktumoren, die sich mit einer Tranenwegsstenose in den vergangenen 10 Jahren an unserer Augenklinik vorstellten. Alle Patienten, die im Zeitraum von 01/2009–12/2018 an der Universitatsaugenklinik Munster mit einer externen Dakryozystorhinostomie (DCR) versorgt wurden, wurden retrospektiv auf das Vorliegen eines Tranensacktumors analysiert. Erfasst wurden Symptomatik, klinischer und histopathologischer Befund, das diagnostische und therapeutische Vorgehen sowie der Langzeitverlauf. Insgesamt wurden 878 Patienten mit einer externen DCR an der Universitatsaugenklinik Munster in dem genannten Zeitraum behandelt, bei 13 Patienten konnte ein Tranensacktumor diagnostiziert werden. In 9 der 13 Falle lag ein malignes Lymphom vor, in 2 Fallen ein Plattenepithelkarzinom und in jeweils 1 Fall ein onkozytares Adenom und Transitionalzellpapillom. Neoplasien des Tranensacks konnen sich als Tranensackstenose bzw. Dakryozystitis maskieren und mussen bei untypischem klinischem Verlauf als Differenzialdiagnose in Betracht gezogen werden. Eine Biopsie im Rahmen einer externen DCR mit histopathologischer Untersuchung ist in solchen Fallen unerlasslich.

Wir prasentieren den Fall einer 68-jahrigen Patientin, die sich mit beidseitigem progredientem Visusverlust seit 4 Wochen in unserer Klinik vorstellte. Bei der Patientin war ein metastasiertes malignes kutanes Melanom bekannt, welches mit den Immun-Checkpoint-Inhibitoren Nivolumab und Ipilimumab behandelt wurde. Die ophthalmologische Untersuchung zeigte beidseits einen Vorderkammerreiz mit Endothelbeschlagen, Aderhautfalten und eine orangerote Verfarbung der Retina sowie linksseitig eine serose Netzhaut‑/Aderhautabhebung. Im Verlauf entwickelte die Patientin eine Poliosis und Vitiligo. Unter systemischer und lokaler Steroidtherapie zeigte sich eine deutliche Besserung des Befundes. Eine intravitreale Triamcinolon-Injektion fuhrte bei progressivem Makulaodem zur kompletten Regression desselben. Immun-Checkpoint-Inhibitoren konnen selten eine Vogt-Koyanagi-Harada-ahnliche Uveitis auslosen. Da sich der okulare Reizzustand durch lokale und systemische Steroide in der Regel gut kontrollieren lasst, sollte die Checkpoint-Inhibitor-Therapie wenn moglich bei gutem Ansprechen fortgefuhrt werden. Eine interdisziplinare Zusammenarbeit mit engmaschigen Kontrollen ist in diesen Fallen dringend erforderlich.

The aim of the work is to assess vulnerability degree of reproductive health in adolescent population in Serbia by analyzing their sexual behavior. The paper is based on data from a National health survey of the population in Serbia in 2013 (without Kosovo and Metohija region), conducted by the Ministry of Health of the Republic of Serbia. For the purposes of this study, the data used are referred to households and population of age 15 and over, so that the final number for analysis is a sample of 1722 respondents aged 15-24. The study included demographic characteristics of respondents (age, gender, settlement type, region) and the characteristics of reproductive health: sexual behavior, use of contraceptive protection, knowledge and attitudes towards HIV, protection of reproductive health. χ2 test was applied for testing differences in frequency of categorical variables. All results with a probability that equals to or is less than 5% (p≤0.05) are considered statistically significant. Among the respondents, there were more than half (53.5%) of sexually active adolescents. The highest percentage of them- 16.6% responded that they had first sexual intercourse at the age of 17. 53.4% of adolescents had sexual intercourse with one partner, 26.4% of respondents had sexual intercourse with two or more partners. The most commonly used contraceptive method was interrupted intercourse (coitus interruptus) with 34.7% of respondents.

Das primare Basalzellkarzinom (BCC) der Karunkel stellt eine auserst seltene Entitat dar. Insgesamt sind nur sehr wenige Falle in der Literatur beschrieben. Im Hinblick auf die S2k-Leitlinie „Basalzellkarzinom der Haut“ gelten das Augenlid, die Augenbraue und die Periorbitalregion als Zonen mit hohem Rezidivrisiko. Dabei gibt es aufgrund seiner Seltenheit kaum Daten fur das primare BCC der Karunkel. Dieser Arbeit liegen eine umfassende Literaturrecherche sowie eine Fallprasentation zugrunde. Wir prasentieren neben einer Literaturubersicht den Fall eines 58-jahrigen Patienten, der sich mit einem Karunkeltumor in unserer Klinik vorstellte. Die histopathologische Untersuchung ergab den Befund eines BCC der Karunkel, welches in toto exzidiert werden konnte und in einem Follow-up-Zeitraum von 6 Monaten nicht rezidivierte. Primare BCC der Karunkel mussen bei unklaren Karunkeltumoren als Differenzialdiagnose in Betracht gezogen werden. Die bisherigen Daten deuten zudem auf ein erhohtes Rezidivrisiko hin.

Zusammenfassung Hintergrund Die vorliegende Studie vergleicht die Ausprägung von Bewegungsartefakten bei Aufnahmen der optischen Kohärenztomografie-Angiografie (OCT-A) bei gesunden Probanden zwischen 2 OCT-A-Systemen verschiedener Hersteller mit unterschiedlicher technischer Ausstattung. Methodik In dieser Arbeit wurden 25 Augen von 25 gesunden Probanden (19 weiblich, mittleres Alter 31,12 ± 11,95 Jahre) ohne bestehende Augenerkrankungen oder zurückliegende Augenoperationen eingeschlossen. OCT-A-Aufnahmen wurden mit dem RTVue XR Avanti (Optovue Inc., Fremont, Kalifornien, USA) sowie mit dem Spectralis OCT-A-Modul (Heidelberg Engineering, Heidelberg, Deutschland) durchgeführt. In jeweils 2 Messungen der Makula (Optovue: 3 × 3 mm², äquivalent Heidelberg: 10 × 10°) je Proband mit aktivem Eye Tracking (ET) wurde die Ausprägung von Bewegungsartefakten im superfiziellen OCT-Angiogramm anhand eines Motion Artifact Scores (MAS) von 2 unabhängigen Readern erfasst. Ergebnisse Die Signalstärke (signal strength index, SSI) lag im Mittel bei 73,0 ± 7,8 (Optovue) und 39,6 ± 3,6 (Heidelberg), dies entsprach beim Optovue 73,0% des theoretischen Bestwerts (SSImax = 100 = 100%) und beim Heidelberg 79,2% der höchstmöglichen SSI (SSImax = 50 = 100%). Beide Geräte zeigten eine insgesamt geringe Artefaktausprägung mit einem entsprechend niedrigen MAS (mittlerer MAS [Optovue]: 1,32 ± 0,551; mittlerer MAS [Heidelberg]: 1,7 ± 0,789; p = 0,006). Die Übereinstimmung zwischen den beiden Readern lag bei beiden Geräten bei 88%. Ein Quilting/Banding zeigte sich in 20% (10/50, Optovue), resp. 6% (3/50, Heidelberg) aller Messungen, ein Stretching in 4% (2/50, Optovue) und in 6% (3/50, Heidelberg). Ein Vessel Doubling und Displacement zeigte sich jeweils in einer Optovue-Aufnahme (2%) und bei keiner Heidelberg-Aufnahme (0%). Blink Lines hingegen waren in 3 Heidelberg-Aufnahmen (6%) und in keiner Optovue-Aufnahme auffindbar (0%). Schlussfolgerung Beide Geräte ermöglichen trotz unterschiedlicher Soft- und Hardware im vorliegenden Kollektiv Aufnahmen mit nur geringer Ausprägung von Bewegungsartefakten. Jedoch kommen diese auch bei gesunden Probanden mit guter Fixation vor. Ferner zeigte sich eine hohe Übereinstimmung bei der Bildbeurteilung in Bezug auf den MAS zwischen den beiden Readern. Dennoch bleibt die Analyse von Bewegungsartefakten komplex und erfordert eine gewisse Erfahrung und genaue Betrachtung bei der Bewertung von OCT-A-Aufnahmen.

Introduction/Objective. Glaucoma is a chronic disease that impairs the optic nerve irreversibly and can lead to serious loss of vision and blindness. As the most frequent out of all, primary open-angle glaucoma has a worldwide incidence of 2.4 million. The objective of this article is to examine the characteristics of glaucoma hospitalization patterns in Central and West Serbia in the 2006?2017 period. Methods. This study was a retrospective analysis of glaucoma hospitalizations in the Kragujevac Clinical Center from 2006 to 2017 (n = 1,751). All hospitalizations were divided according to discharge diagnoses into the following three subgroups: primary open-angle glaucoma, the primary closure glaucoma, and secondary glaucoma and other glaucoma types. Results. The average hospitalization rate for glaucoma is 5/10,000 inhabitants. The lowest rate was recorded in 2013 (1.8/10,000) and the highest in 2015 (9.3/10,000). The rehospitalization rate ranged from 0.5/10,000 in 2013 to 6.9/10,000 in 2015, with an average of 2.4 patients per 10,000. The most common glaucoma was secondary glaucoma and other glaucoma types (44.6%), followed by primary open-angle glaucoma (37.9%) and primary closure glaucoma (17.5%). The average hospitalization length was 6.5 ? 4.9 days and it decreased from the average 9.7 ? 6.5 (2006) to 5.5 ? 3.7 days (2013) (p < 0.01) in all glaucoma types. Conclusion. There was a significant reduction of the hospitalization length in all glaucoma types in Central and West Serbia. The hospitalization rates varied with a significant increase since 2013, which is the consequence of the increase in rehospitalization rates.

Background: Comorbidities are major predictors of in-hospital mortality in stroke patients. The Charlson comorbidity index (CCI) and the Elikhauser comorbidity index (ECI) are scoring systems for classifying comorbidities. We aimed to compare the performance of the CCI and ECI to predict in-hospital mortality in stroke patients. Methods: We included patients hospitalized for stroke in the Clinical Center of Kragujevac, Serbia for the last 7 years. Hospitalizations caused by stroke, were identified by the International Classification of Diseases-10 (ICD-10) codes I60.0 - I69.9. All patients were divided into two cohorts: Alive cohort (n=3297) and Mortality cohort (n=978). Results: There were significant associations between higher CCIS and increased risk of in-hospital mortality (HR = 1.07, 95% CI = 1.01–1.12) and between higher ECIS and increased risk of in-hospital mortality (HR = 1.04, 95% CI = 0.99–1.09). Almost 2/3 patients (66.9%) had comorbidities included in the CCI score and 1/3 patients (30.2%) had comorbidities included in the ECI score. The statistically significant higher CCI score (t = -3.88, df = 1017.96, P

Background: The aim of the research was to compare the differences between the self-assessment of the health in the latest National Health Surveys research and in the one before that. Methods: We used the database of the latest National Health Survey in the Republic of Serbia (2013) and of the one before that (2006), as cross-sectional studies (n=29485). Logistic regression was used to predict the relationship between self-assessment of health and independent predictors. Results: Health condition of the interviewees improved according to their self-assessment. With aging respondents who poorly assessed their health; women assessed their health 1.7 and 1.6 times poorer in the latest research and in the one before that respectively. The odds ratio in patients diagnosed with some disease in the previous 12 months ranged from 2.15 (1.85 – 2.51) to 4.03 (3.22 – 5.05) in the latest research. The strongest predictor was sick leave in the past 12 months with 95% CI = 3.19 (1.87-5.44) in the latest research and 95% CI = 2.27 (1.67-3.08) in the one before that. Conclusion: There was an improvement of the health condition of individuals. Female interviewees, less educated, unemployed, the ones who have some disease and who were on a sick leave rated their health as bad.

The aim of this study is to evaluate retinal and optic nerve head (ONH) perfusion in patients with systolic chronic heart failure (CHF) compared to healthy control subjects.Twenty-seven eyes of 27 patients with CHF (study group) and 31 eyes of 31 healthy subjects (control group) were prospectively included in this study. CHF Patients had a left ventricular ejection fraction (LVEF) 50% and were classified by New York Heart Association (NYHA) class. OCT-A was performed using RTVue XR Avanti with AngioVue (Optovue, Inc, Fremont, CA, USA). The area of the foveal avascular zone (FAZ) and flow density (FD) data were extracted and analyzed.There was no significant difference in the signal strength index between the study group (group 1) and the control group (group 2) (ONH: p = 0.015; macula: p = 0.703). The difference in the area of the foveal avascular zone between the two groups was also not significant (p = 0.726). The flow density (whole en face) in the ONH (RPC) in group 1 was significantly lower compared to control (group 1 = 48.40 ± 2.48 (49.0 [46.7, 50.3]); group 2 = 50.15 ± 1.85 (50.6 [48.5, 51.70]); p = 0.008). There was a significant and strong correlation between LVEF and the macular flow density (whole en face) (superficial: rs = 0.605 deep: rs = 0.425, p 0.01).Patients with CHF showed reduced flow density compared with healthy controls. The reduced FD correlated with the LVEF and the functional (NYHA) class. Retinal perfusion as measured using OCTA might provide an insight into the global microperfusion and hemodynamic state of heart failure patients.

Background: Patients with oncological diseases often have mental disorders in the form of comorbidity. The aim of this study was to research the association of cancer with the presence of symptoms of depression and anxiety in primary health care patients. Methods: This prospective observational study done in 2020 included adult users of health care at the Health Center Trstenik, Central Serbia, aged 19 and over, both sexes, with a diagnosis of oncological disease. A research instrument to assess depressive symptoms is used PHQ-9 (The Patient Health Questionnaire) questionnaire, derived from PRIME MD- and (The Primary Care Evaluation of Mental Disorders), and the Beck Anxiety Scale (BAI) to register the presence of certain anxiety symptoms. Results: The largest percentage of patients had symptoms of mild (27.2%) or moderate depression (22%), while 18% reported symptoms of major depression. The level of depression was higher in older subjects, in the presence of chronic diseases with greater limitations of activity and the presence of difficulties in performing daily activities, with a more pronounced effect of pain on activity, the presence of stress. All subjects were characterized as persons with severe anxiety (score 26-63). The level of anxiety was higher in older respondents, in the presence of long-term illness, with greater limitations of activities and difficulties in performing daily activities, with a more pronounced influence of pain on performing activities and the influence of the media. Conclusion: Caring for the mental health of cancer patients must occupy a significant part of each country's national health policy.

Background: Repeated research while using the same methodology can be useful and it can enable relevant conclusions in the same health care system. The aim of our study was to perform comparative analysis of the agreement between admission and discharge diagnostic groups in period 2014-2017 with period 2006-2013 in the Clinical Center of Kragujevac, Serbia. Methods: The 5% simple, random sample was made from the basic set of all hospital reports from Clinical Centre Kragujevac, Serbia, in the period 01.01. 2014 - 31.12. 2017 (n=10228). The first four digits of ICD-10 codes at admission and discharge were compared for agreement. We used discharge diagnosis as a "golden standard". Statistical analysis was performed using Cohen’s Kappa statistic. Results: In the period 2014-2017, agreement between diagnosis among the most ICD10 groups increased in comparison with the period 2006-2013. Disagreements between diagnosis in the period 2014-2017 in comparation with period 2006-2013 was associated with increased length of stay in the hospital (7.5 vs. 9.1 days, P

Wir prasentieren den Fall einer 24-jahrigen Patientin, die sich in unserer Ambulanz mit permanentem Flimmern vor beiden Augen vorstellte. Das Flimmern, wie Schneegestober im Fernsehen, bestunde seit 1,5 Jahren und ware extrem storend. Visus, Gesichtsfeld und morphologischer Befund des vorderen Augenabschnitts und des Fundus waren beidseits unauffallig. Eine neurologische Untersuchung inklusive kranialer Magnetresonanztomographie (cMRT) und die visuell evozierten Potentiale (Muster-VEP) zeigten ebenfalls keine Auffalligkeiten. An Allgemeinerkrankungen bestand ausschlieslich eine Schizophrenie. Aufgetreten sei diese ebenfalls vor 1,5 Jahren unmittelbar nach Einnahme eines „Betaubungsmittel-Cocktails“ aus Amphetaminen, Halluzinogenen und Alkohol. In Zusammenschau der Befunde konnte die Diagnose einer „Hallucinogen Persisting Perception Disorder“ Typ II gestellt werden. Therapiemoglichkeiten bei dieser Erkrankung sind begrenzt, und nicht selten verbleibt die Symptomatik dauerhaft.

Studies in the alcohol consumption area are mostly related to the (ab)use of alcohol in young people. However, today, a growing number of researchers are emphasizing the clinical and public health significance of alcohol consumption in the elderly. In the WHO reports, harmful alcohol consumption is responsible for 5.3% of the global burden of the disease. The aim of this study was to investigate the prevalence of alcohol consumption among men and women aged 55 and over in Serbia and Hungary, leveraging data from the 2013 Serbian National Health Survey and from the 2014 Hungarian National Health Survey. Respondents aged 55 and over were analysed based on logistic multivariate models. The prevalence of alcohol consumption was 41.5% and 62.5% in Serbia and Hungary, respectively. It was higher among men in both countries, but among women, it was significantly higher in Hungary than in Serbia. The statistically significant predictors affecting alcohol consumption in Serbia included age, education, well-being index, long-term disease and overall health status, with marital status being an additional factor among men. In Hungary, education and long-term disease affected alcohol consumption in both sexes, while age and employment were additional factors among women. In both countries for both sexes, younger age, more significantly than primary education and good health, was associated with a higher likelihood of alcohol consumption.

ZusammenfassungDas adenoidzystische Karzinom der Tränendrüse (ACC) stellt einen seltenen malignen orbitalen Tumor mit insgesamt schlechter Prognose dar. Derzeitige Therapieansätze mit radikaler und lokaler Chirurgie, adjuvanter Bestrahlung und neoadjuvanter intraarterieller Chemotherapie werden kontrovers diskutiert. Wir präsentieren 3 Fälle von Patienten mit ACC mit unterschiedlichen Therapiekonzepten und diskutieren diese mit aktuellen Empfehlungen aus der Literatur.

Die foveale avaskulare Zone (FAZ) wurde in den letzten Jahrzehnten bereits haufig unter verschiedenen Gesichtspunkten analysiert, hauptsachlich mittels Fluoreszenzangiographie (FA). Durch die optische Koharenztomographie-Angiographie (OCTA) jedoch sind eine neuartige, nichtinvasive Untersuchung, Darstellung und quantitative Analyse derselben moglich geworden, was in den vergangenen Jahren zu vielen neuen Erkenntnissen, v. a. auch facherubergreifend, gefuhrt hat. In dieser Arbeit geben wir einen Uberblick uber die Untersuchung der FAZ mittels OCTA und die neuen Erkenntnisse, die in den letzten Jahren mittels OCTA gewonnen werden konnten. Dieser Arbeit liegt eine umfassende Literaturrecherche zugrunde. In vielen Studien konnte eine sehr gute Reproduzierbar- und Wiederholbarkeit der FAZ-Messungen durch die OCTA, auch im Geratevergleich, nachgewiesen werden. Bei Patienten mit okularen Pathologien wie z. B. nach retinalen Venenverschlussen und bei Patienten nach Netzhautchirurgie konnten Unterschiede zu gesunden Kontrollgruppen sowie Korrelationen zur Funktion gezeigt werden. Veranderungen der FAZ wurden auch bei Systemerkrankungen ohne Augenbeteiligung, so bei Diabetes mellitus ohne diabetische Retinopathie und bei neurologischen Erkrankungen wie bei der Alzheimer-Demenz festgestellt. Die FAZ kann mittels OCTA nichtinvasiv visualisiert und reproduzierbar quantifiziert werden. Die Grose der FAZ scheint bei unterschiedlichen retinalen und systemischen Erkrankungen verandert zu sein, was auch mit Veranderungen der Funktion korrelieren kann. Vor allem fehlen derzeit jedoch Langzeitstudien, die den diagnostischen Wert dieser Veranderungen im Krankheitsverlauf evaluieren.

Background There is increasing evidence for the involvement of cerebrovascular factors in Alzheimer's disease (AD). Objective To evaluate retinal and optic nerve head perfusion in patients with AD using optical coherence tomography angiography (OCTA), and to analyze the correlations of quantitative OCTA metrics with AD pathology and vascular cerebral lesions in AD patients. Methods 36 eyes of 36 patients with AD (study group) and 38 eyes of 38 healthy subjects (control group) were prospectively included in this study. OCTA was performed using RTVue XR Avanti with AngioVue. In addition, patients underwent a detailed ophthalmological and neurological examination including Mini-Mental State Examination, cerebral magnetic resonance imaging, and amyloid-β (Aβ) and tau levels in the cerebrospinal fluid (CSF). Results The flow density in the superficial retinal OCT angiogram of the macula in the study group was significantly lower compared to the control group (p = 0.001). There was a significant correlation between the flow density in the superficial retinal OCT angiogram of the macula, as measured using OCTA, and the Fazekas scale (Spearman's correlation coefficient = -0.520; p = 0.003). There was no significant correlation between the Aβ or tau levels in the CSF and the flow density data. Conclusion Patients with AD showed a reduced flow density in the radial peripapillary capillaries layer and in the superficial retinal OCT angiogram when compared with healthy controls. The reduced retinal flow density measured using OCTA is not specifically associated with AD pathology but is associated with the vascular cerebral lesions in AD.

Background/Aim. Non-communicable diseases (NCDs) are a major public health challenge worldwide. Although they are preventable, NCDs are the major global causes of morbidity and mortality, absenteeism, disability and premature death. The aim of this study was to examine socioeconomic inequalities in the prevalence of non-communicable diseases in Serbia. Methods. Data from the 2013 National Health Survey of the population of Serbia was used in this study. There were 13,765 adults interviewed, aged ? 20 years. We used multivariate logistic regression analyses with demographic and socioeconomic determinants of health as independent variables and prevalence of non-communicable diseases as a dependent variable. The minimum level of significance was p < 0.05. Results. Hypertension was the most prevalent NCDs (36.1%). The prevalence of multimorbidity was 47.1%. Multivariate logistic regression analysis showed that gender, age, place of residence, employment status and education were associated with the presence of NCDs. The odds ratio (OR) for age was 1.074 [95% confidence interval (CI) : 1.070?1.077). Women were at a higher risk of NCDs by 58.9% when compared to men (OR = 1.589; 95% 95% CI : 1.467?1.726). Respondents who lived in the rural areas were at a higher risk for NCDs by 14.1% compared to those who lived in urban areas (OR = 1.141; 95% CI : 1.047? 1.244). Odds ratio for unemployment was 1.227 (95% CI: 1.118?1.346). Respondents with primary education were at a higher risk for chronic diseases by 47.1% (OR = 1.471; 95% CI : 1.281?1.687) while those with secondary school were at a higher risk by 27.7% (OR = 1.277; 95% CI : 1.142?1.428) compared to respondents who had higher education. When it comes to Wealth Index, univariate logistic regression analysis showed that respondents who belonged to the poor and middle classes were at a higher risk for NCDs (OR = 2.031; 95% CI : 1.819?2.267; OR = 1.473; 95% CI : 1.343? 1.615) compared to respondents who belonged to the rich class. Multivariate logistic regression analysis did not show statistically significant correlations between the Wealth index and NCDs. Conclusion. Socioeconomic inequalities in health status are the major challenge and should be a target of national health policy in Serbia, not only because they represent social injustice but also because solving the health problems of underprivileged groups of the population can influence improvement of health status of the population as a whole.

Almost all countries in the world keep some form of hospital discharge report (HDR). Although there are many variations, every report contains such data as patient demographics, the main cause of hospitalization, comorbidities, the length of stay in hospital and outcome. The advantages of using data obtained from HDRs are numerous: The data from HDRs are already collected in a designated centre and thus easily available and relatively cheap; HDRs contain information for many previous years; they are sometimes more reliable than data obtained through any other method; and finally, they provide a large and representative database. HDRs databases can be connected with other databases using a unified patient identification number. The limitations of using data obtained through HDRs are as follows: inconsistencies in defining and coding diagnoses and applied procedures, common underestimations of comorbidity, limited possible applications in specific studies and partial coverage of inpatient institutions. The prediction that in the future, a growing number of diagnostic and treatment procedures will be performed on an outpatient basis will also limit the use of HDRs. When electronic recordkeeping becomes a practice, we may assume that these data will no longer be needed. There is no perfect model for collection and processing data regarding hospitalized patients. HDRs, with their advantages and disadvantages, currently represent the best way to perceive the size, type, quality and efficiency of the health care services provided to patients at the secondary and tertiary level.

We present a case of a 57-year-old woman who reported bilateral visual impairment since 2 weeks. She had a medical history of congenital, cyanotic heart failure. Funduscopic examination revealed serous retinal detachment on the left side, central subneurosensory detachment on the right side, retinal vessel tortuosity and multiple retinal haemorrhages in the periphery. As blood analysis showed a distinct increase in haemoglobin and haematocrit, hyperviscosity syndrome was suspected to have caused bilateral serous retinal detachment. Isovolemic haemodilution was performed in close cooperation with the cardiology department with repeated phlebotomy, which resulted in a significant reduction of subretinal fluid and, concurrently, an increase in visual acuity.

Objectives: The purpose of this study is to analyze epidemiological characteristics of suicide, as well as to emphasize possible risk factors. Methods: This is a retrospective study, covering the period of fifteen years (1996-2010), which aims at discovering the relevant factors which have an influence on suicidal behaviour. This research uses the data from the documentation of the Ministry of Internal Affairs of Serbia and Police Department in Kragujevac, hospitalization reports of patients treated at Psychiatric Clinic of the Clinical Centre Kragujevac, as well as the medical records of patients treated at the Health Centre Kragujevac. Χ2 test was applied to examine the influence of all selected factors on incidence of suicide and for this purpose SPSS statistical software package was used. Results: The analysis has shown that during the given period average suicide rate reached 11.8 per population of 100,000. The male to female suicide ratio of 3.6:1 obtained through this study suggests that men (78.4%) are more prone to suicide than women (21.6%). The highest number of suicides has been found within the age group of 65-year-olds (31.2%), while for the youngest age group (15-24 years) the lowest prevalence of 8.8% has been determined. In other words, the youngest subjects are 3.5 times less likely to commit suicide than the participants of the oldest age group. During the given period suicide was most often committed by married males and females with primary school education than by employed and retired people. The research has also revealed that most suicides came from urban areas (52.0%) and that the most common method of suicide is hanging (60.8%), followed by suicide by firearms, jumping from height, poisoning, and drowning. Conclusion: In order to prevent suicide, it is essential to collect and analyze all information concerning suicide victims.

CONTEXT: Clinical research suggests that vitamin D deficiency correlates with mental illnesses. OBJECTIVE: The aim was to prove that the patients from the psychiatric health care service in Serbia had higher vitamin D deficiency than patients from general practice. DESIGN: The study had a cross-sectional design. METHODS: The study included 47 patients aged 19 – 76 of both sexes with different mental disorders. We performed sample size calculation on available data for vitamin D deficiency in patients in health care facilities compared with the general population. The concentrations of vitamin D in serums were measured by HPLC (high performance/pressure liquid chromatography). RESULTS: The mean value of vitamin D (standard deviation) in the whole group of study subjects was 16.27(10.62) ng/mL; 68.1% of the patients had a deficiency of vitamin D (25(OH)D

Objective. The aim of the present study was to investigate the frequency of allergic rhinitis in dysphonic professional voice users and to assess the correlation between allergic rhinitis and demographic characteristics (sex, ages and years in occupation) and presence of laryngopharyngeal reflux, as comorbidity health condition. Methods. A total of 104 male and female dysphonic patients who came to the Department of Otorhinolaryngology, Health Centre Kragujevac, Serbia because of the presence of dysphonia symptoms and who used their voice more than 4 hours per day at job were included in the study. The patients underwent rigid or transnasal fiberoptic laryngoscopy with videostroboscopy to assess the causes of dysphonia. Descriptive analysis, Pearson Chi-Square Tests and Binary Logistic regression were carried out using the SPSS 19.0 statistical software package. Results. Frequency of allergic rhinitis in dysphonic professional voice users was 44.2%. The patients were 1.1 times more likely to have allergic rhinitis with each passing year of life. Allergic rhinitis is with each year in occupation 0.89 times less frequent and 0.035 times less often in patients with laryngopharyngeal reflux. Conclusion. In dysphonic professional voice users, it has been found that allergic rhinitis occurs rarely with each year in occupation, which means that allergic rhinitis is not a predisposing factor for developing dysphonia, but year in occupation are a protective factor when it comes to the appearance of allergic rhinitis in the examined population. Cilj. Cilj ovog rada bio je da se analizira učestalost alergijskog rinitisa kod profesionalnih korisnika glasa sa disfonijom, kao i povezanost između alergijskog rinitisa, demografskih karakteristika (pol, starost i dužina radnog staža) i laringofaringealnog refluksa u ispitivanoj populaciji. Metode. U studiju su uključena ukupno 104 ispitanika muškog i ženskog pola, koji su upućeni u Odeljenje za otorinolaringologiju Doma zdravlja Kragujevac, Srbija, zbog prisustva simptoma disfonije, a zaposleni su na poslovima koji zahtevaju upotrebu glasa više od četiri sata dnevno. Kod ispitanika je primenjena rigidna endovideostroboskopija ili transnazalna fibrooptička laringoskopija da bi se utvrdio uzrok disfonija. Statistička obrada podataka učinjena je primenom deskriptivne metode, Pirsonovog x2 testa i binarne logističke regresije, korišćenjem standardnog statističkog softverskog paketa SPSS 13.0. Rezultati. U ispitivanoj populaciji alergijski rinitis, identifikovan je kod 44,2% profesionalnih korisnika glasa sa disfonijom. U populaciji obuhvaćenoj istraživanjem alergijski rinitis se sa svakom godinom života 1,1 puta češće ispoljava, dok se sa svakom godinom radnog staža 0,89 puta ređe dijagnostikuje. Kod ispitivanih disfoničnih profesionalnih korisnika glasa, kod kojih je ustanovljen laringofaringealni refluks, alergijski rinitis je 0,035 puta ređe prisutan. Zaključak. Kod disfoničnih profesionalnih korisnika glasa, ustanovljeno je da se alergijski rinitis ređe javlja sa svakom godinom radnog staža, što znači da alergijski rinitis nije predisponirajući faktor za nastanak disfonije, već su godine radnog staža protektivni faktor kada je u pitanju pojava alergijskog rinitisa u ispitivanoj populaciji.