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Increased galectin-3 plasma concentration has been linked to an unfavorable outcome in patients with heart failure or atrial fibrillation (AF). There are no published data about the prognostic utility of galectin-3 and high-sensitivity C-reactive protein (hs-CRP) for long-term clinical outcome in the Non-ST elevation acute myocardial infarction (NSTEMI) patients with preexisting AF. Thirty-two patients with the first acute NSTEMI and preexisting AF and 22 patients without preexisting AF, were prospectively followed for fifteen months. Patients with AF had significantly higher galectin-3 plasma levels (p

The Skindex-29 instrument, which is intended for measuring the influence of skin diseases on quality of life, was developed and validated in several languages. However, a Serbian translation of the instrument is not available. The aim of this study was to translate the Skindex-29 from English to Serbian, to make necessary cultural adaptations, and to test its psychometric properties in a sample of outpatients with various skin diseases. The Skindex-29 was translated and adapted according to internationally accepted guidelines and then tested on a sample of Serbian outpatients with various skin diseases. Internal consistency was checked through calculation of Cronbach's alpha and Interclass Correlation Coefficient for the instrument's domains. The criterion validity of the translation was tested by correlating scores of domains with scores on the Serbian version of Dermatological Life Quality Index (DLQI).Validity of the construct was tested through comparison of the domains scores in groups of patients with different skin diseases. Fifty-three patients (18.6%) suffered from acne vulgaris, 48 (16.8%) from verrucae vulgares, 40 (14.0%) from psoriasis, 34 (11.9%) from an undetermined type of mild dermatitis, 20 (7.0%) from venous ulcers, 19 (6.7%) from eczema, and 71 (24.9%) from other skin diseases. The Serbian translation of Skindex-29 showed good internal consistency: Cronbach's alpha for Emotional, Symptoms, and Functioning domains was 0.885, 0.752, and 0.901, respectively. Validity of the instrument in all aspects (criterion, content, and construct validity) was satisfactory, yet the Symptoms domain could not discriminate well between more and less severe skin diseases. The Serbian translation of Skindex-29 appears to be a reliable and valid specific instrument for measuring the adverse influence of skin diseases on quality of life.

*Department of Cardiovascular Diseases, Clinical Center, Medical Faculty, University of Nis, Nis, Serbia; Department of Anesthesiology and Intensive Care, Institute for Mother and Child Health Care of Serbia “Dr Vukan upi ”, Belgrade, Serbia; Medical Faculty, University of Nis, Nis, Serbia; Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia; Clinic of Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; **Department of Cardiology, University Hospital Medical Center “Bežanijska kosa”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

According to current guidelines, all patients with a recent coronary artery stent placement should receive double antiplatelet therapy with a combination of aspirin plus clopidogrel to reduce the likelihood of acute and subacute stent thrombosis. The length of treatment depends on the type of the stent, with bare metal stents requiring at least 1 month and drug-eluting stents requiring 6 months of both antiplatelet drugs. The length of treatment of patients with acute coronary syndrome is 12 months of dual antithrombocite drugs. Atrial fibrillation carries a high risk for thromboembolic events and any patient with at least two moderate risk factors should be on oral anticoagulation with a vitamin K antagonist. Since atrial fibrillation and coronary artery disease with stent placement are common, it is not infrequent to treat patients with both these conditions, where triple antithrombotic therapy with aspirin, clopidogrel and oral antagonist of vitamin K would be needed. However, concerns about increased bleeding risk do exist and clinicians are uncertain about how to manage this diffi cult clinical situation-especially since there are no large randomised trials to guide clinical practice regarding this particular issue.

Dužnost nas lekara je da pacijentu pružimo najvise sto možemo u datom trenutku. Međutim, postoje trenuci kada mi želimo i hocemo da pacijentu pružimo najvise, ali zbog niza uticaja nismo to u stanju da uradimo. Ono o cemu želimo da vas upoznamo ovim radom jeste mogucnost da u kratkom roku ostvarite konsultaciju sa kolegom koji je udaljen od vas. Takav proces zove se telekonsultacija i omogucen je napretkom informacionih i telekomunikacionih tehnologija. U radu su prikazana tri slucaja koji ce na najbolji nacin pokazati funkcionisanje telemedicinskog procesa u svakodnevnoj stomatoloskoj praksi. Telemedicinska konsutlacija sprovedena u cilju zbrinjavanja pacijenata sa stomatoloskom patologijom predstavlja brz, efikasan, kvalitetan i pouzdan metod za resavanje nedoumica terapeuta, ali i potvrdu njegovih sigurnih stavova. Acta Medica Medianae 2012;51(1):49-55. Kljucne reci: telemedicina, XPA3 Online, zubi, proteza, stomatologija

Background: Spontaneous coronary artery dissection (SCAD) is generally considered a rare event, which can be fatal if not detected and treated in time (0.07 to 1.1% in the general population of patients with acute coronary syndrome). It represents an unusual cause of acute coronary syndrome (ACS), which is not associated with traditional risk factors. Most published cases of SCAD are associated with pregnancy and the existing atherosclerosis, while little is known about any other predisposing factors for the occurrence of this disease. There are many more results in the field of recognition of risk factors associated with the development SCAD than reaching an agreement on the therapeutic approach to this entity in the ACS. Methods: The aim of this study was to investigate the frequency of SDKA as the cause of acute coronary syndrome (ACS) during the four-year follow-up in the room for catheterization Clinic for Cardiovascular Diseases, Clinical Centre Nis, as well as to draw attention to this rare cause of ACS which chiefly occurs in youth population, requires an individual and specific therapeutic approach and secondary prevention. Current published literature data on this subject is also presented. Results: Our results showed that during the period from 01.02.2009 to 30.12.2012 in the department of interventional cardiology, 3530 consecutive coronary angiography in patients with acute coronary syndrome (ACS) were analyzed. Out of these, 1080 patients had a diagnosis of ACS with persistent STsegment elevation (STEMI) and the 2450 patients had a diagnosis of ACS without persistent ST-segment elevation (NSTEMI). Spontaneous coronary artery dissection as a cause of acute coronary syndrome was detected in 6 cases (0,16%). Conclusion: Method of treatment is determined by the weight and presentation of disease and is supported by the conservative strategy in otherwise stable patients with preserved flow in the affected artery. The challenge will be if chest pain is continued in the absence of ischemia, probably due to the change (active processes) in the blood vessel wall or influence on vascular tone. It is necessary to consider this possibility before joining revascularization in patients who only have symptoms but not signs of ischemia.

Background/objectives Contributions of fasting and postprandial blood glucose increments on level of inflammation and oxidative stress biomarkers in patients with stable ischemic heart disease (IHD) and diabetes mellitus type 2 (T2DM) was evaluated. Methodology Ninety T2DM patients (60 with IHD and 30 without IHD) treated with metformin and/or sulphonylurea were enrolled in cross-sectional nested case–control clinical study. The areas under the six-point daily glucose curve above the fasting glucose concentrations (AUCpp) and over 5.5mmol/L (AUCbg) were calculated to determine postprandial (AUCpp) and fasting (AUCbg-AUCpp) glucose increments. Malondialdehyde (MDA), protein carbonyl group (PCO), fibrinogen, C-reactive protein (hsCRP), leukocyte count and adhesion molecules ICAM-1 and VCAM-1 were determined. Results AUCbg-AUCpp 58.2 (95%CI 40.6–75.8) was higher in IHD group compared to non-IHD 36.9 (95%CI 23.5–50.2) mmol*h/L. They had significantly higher ICAM-1 (mean±SD) 72.70±30.6 vs. 60.22±22.6ng/mL and MDA 16.47±4.5 vs. 13.42±4.01μmol/g plasma proteins, but similar PCO, VCAM-1, fibrinogen, hsCRP concentration and leukocyte count. AUCpp positively correlated with MDA (r=0.45) and ICAM-1 (r=0.32) in the presence of IHD, and VCAM-1 (r=0.44) in the absence of IHD. AUCbg-AUCpp positively correlated with PCO (r=0.45) in the absence of IHD. The analysis revealed that AUCpp over turning point of 0mmol*h/L was associated with high MDA and ICAM-1 expression in diabetics with IHD. AUCbg-AUCpp over 30mmol*h/L leads to high oxidative protein modification in diabetics without IHD. Conclusion In T2DM patients with stable IHD, AUCpp at any point, significantly contributes to increasing of MDA and ICAM-1 expression. Fasting blood glucose increment showed significant correlation with carbonyl content in diabetics without IHD.

Elevated glucose level on admission in the number of emergency conditions, including acute myocardial infarction (AMI), is linked to worse outcomes, regardless of the current treatment. The introduction of primary percutaneous coronary intervention (PPCI) in therapy of AMI patients with ST segment elevation (STEMI) has improved the treatment of these patients. However, there are contradictory evidences regarding the impact of stressinduced hyperglycemia on the treatment outcome. The present study is aimed to indentify the effect of stress-induced hyperglycemia on in-hospital prognosis of patients with STEMI treated with AIM-PPCI. Prospective study included 116 patients with a diagnosis of first AMI-STEMI treated with PPCI at the Department of Cardiovascular Diseases, Clinical Center Nis in the period 2010-2011. Immediately after establishing the diagnosis, the patients with adequate medicament preparation were transferred into the angiography room for the coronary stent implantation. Laboratory analysis of the whole blood samples were done immediately after admission and in the next 24 hours. Receiver operator characteristic (ROC) analysis revealed that stress-induced hyperglycemia (glucose 11.2 mmol / L, an area under the curve of 0.812) is a delimiting factor for distinguishing the outcome and survival of patients on admission. The group of patients without stress-induced hyperglycemia had mortality rate about five times less (1/79 -1.2%) than the group of patients with stress-induced hyperglycemia (5/37 13.5%), p=0.041. Comparing these groups with the incidence of DM, stress-induced hyperglycemia had no significant effect on mortality in the group without DM (1/54 vs. 3/26, ns) and in the group with DM (1/25 vs. 1/11, ns). The cut-off value of glucose, obtained by ROC curve, is 11.2 mmol/L for stressinduced hyperglycemia in patients with STEMI treated with PPCI. This value could determine a significant gradient of risk: patients with glycemia

Our duty, as doctors, is to offer to our patients the best possible solutions at the moment. However, there are moments when we are ready and willing to offer the best, but because of the circumstances, we are unable to do that. This paper describes the possibility of effectuating consultation with our remote colleagues. The process has been termed teleconsultation and it has been made possible by the advent and development of new information and telecommunication technologies. The paper describes three of our cases which could best demonstrate the operation of the process of telemedicine in routine dentistry practice. Telemedicine consultation in the field of management of patients with dental pathologies is a rapid, effective, and reliable method of resolving therapeutic doubts and confirmation of management decisions.

Introduction. Elevated glucose levels on admission in many emergency conditions, including acute myocardial infarction (AMI), have been identified as a predictor of hospital mortality. Objective. Since there are no data in the literature related to stress hyperglycaemia (SH) in patients with both AIM and temporary electrical cardiac pacing, we aimed to investigate the influence of stress hyperglycaemia on the prognosis of patients with AMI and temporary electrical cardiac pacing. Methods. The prospective study included 79 patients with diagnosed AMI with ST-segment elevation (STEMI), admitted to the Coronary Care Unit of the Clinic for Cardiovascular Diseases, Clinical Centre Nis, from 2004 to 2007, who were indicated for temporary electrical cardiac pacing. The blood was sampled on admission for lab analysis, glucose levels were determined (as well as markers of myocardial necrosis - troponin I, CK-MB). Echocardiographic study was performed and ejection fraction was evaluated by using area length method. Results. The ROC analysis indicated that the best glycaemic level on admission, which could be used as a predictor of mortality, was 10.00 mmol/l, and the area under the curve was 0.82. In the group without SH, hospital mortality was 3-fold lower 11/48 (22.91%) compared to the group with SH 19/31 (61.29%), p1, lower ejection fraction and heart rate, as well as systolic blood pressure. Conclusion. The best cut-off value for SH in patients with AMI (STEMI) and temporary electrical cardiac pacing is 10 mmol/l (determined by ROC curve) and may be used in risk stratification; patients with glucose levels 10 mml/l. Our results suggest that SH is a more reliable marker of poor outcome in AMI patients with temporary pace maker, without previously diagnosed DM.

European Society of Cardiology Guidelines cite results of meta-analysis that the use of calcium channel blockers results in fewer angina episodes per week vs. long-acting nitrates. Moreover, we listed 12 reasons more to prefer amlodipine over long-acting nitrates, especially in stable angina pectoris patients with arterial hypertension. It may be the way to decrease polypharmacy without loosing efficacy. Some important advantages of amlodipine versus long-acting nitrate(s) are: amlodipine also treats hypertension, it helps reducing hypertensive target organ damages (e.g. left ventricular hypertrophy) and prevents morning blood pressure surge. Moreover, amlodipine can be given once daily (which improves adherence), it produces neither tolerance nor rebound, it has less side effects.

The aim of our study was to establish the efficiency of fibrin sealant in the prevention of pocket related complications in patients undergoing pacemaker implantation who are receiving anticoagulant treatment.The study was performed on 40 and 41 patients prospectively randomized into treatment and control groups who underwent pacemaker implantation procedure between January 2002 and July 2004 at the Pacemaker Center - Clinical Centre Nis, Serbia. Both groups of patients were receiving anticoagulant treatment with either heparin or warfarin. Surgical procedures between the groups differed only in the application of fibrin sealant prior to wound closure in the treatment group.In the treatment group, there were no pocket related complications while in the control group six patients (14.63%) had minor haematomas that required no treatment. Four patients (9.76%) had significant haematomas (two patients were treated conservatively while the other two needed reintervention). The INR in the treatment group was 2.76+/-0.85 and in the control group 2.65+/-0.79 (P=ns). In the follow-up period (2-27 months) no late complications were registered in either group.Fibrin sealant is an effective haemostatic agent. The results obtained in our study show that the administration of fibrin sealant in patients receiving anticoagulant treatment eliminates postoperative haematomas after pacemaker implantation.

Introduction. Losartan, the angiotensin type 1 receptor blocker (ARB) exercises its main antihypertensive effect by vasodilatation of peripheral arteries. Objective. The aim of this study was to evaluate the antihypertensive effect and safety of losartan in patients with mild and moderate arterial hypertension (AH). Methods. This was an open post-marketing study with losartan as monotherapy in previously treated or untreated patients with AH. Primary efficacy parameter was the percentage of patients that achieved target blood pressure after 8-week treatment with a single daily dose of losartan of 50-100 mg. Safety parameters were assessed according to the percentage of adverse events and metabolic effects of therapy. Results. The study included 550 patients with AH (59% female and 41% male), mean age 56.8±11.4 years, BMI=27±4 kg/m2. Losartan was applied in 31% of untreated and 69% of previously treatment-resistant patients After 8 weeks target blood pressure was achieved in 67.8% (SBP) and in 81.1% (DBP) of patients, respectively. The mean decrease was 21.8% for SBP and 21.1% for DBP (p lt 0.001). Out of all, 65% of patients achieved both target SBP and DBP values. Hydrochlorothiazide was added to the therapy in 11.6% of patients. There were no significant differences in drug efficacy between the entire group and subgroups of patients with diabetes mellitus and impaired renal function (p=ns). Adverse events were rare and metabolic effect was favorable. Conclusion. Monotherapy with losartan in a dosage of 50-100 mg applied during 8 weeks resulted in achieving target values of blood pressure in 65% of patient with mild and moderate hypertension, also including the patients with diabetes mellitus and impaired renal function. Losartan is a safe and metabolically neutral medication. Uvod. Losartan, blokator angiotenzinskog receptora tip 1 (ARB), antihipertenzivni efekat ostvaruje vazodilatacijom perifernih arterija. Cilj rada. Cilj studije je bio da se procene efikasnost i bezbednost primene losartana kod bolesnika s arterijskom hipertenzijom blagog i umerenog stepena. Metode rada. U otvorenoj postmarketinškoj studiji losartan je primenjen kao monoterapija kod bolesnika s prethodno lečenom ili nelečenom umerenom i blagom hipertenzijom tokom osam nedelja u dozi od 50 mg i 100 mg jednom dnevno, uz posmatranje promene procenta bolesnika kod kojih su dostignute ciljne vrednosti sistolnog (SAP) i dijastolnog arterijskog krvnog pritiska (DAP). Bezbednost primene leka procenjena je prema procentu neželjenih dejstava i metaboličkim efektima terapije. Rezultati. U studiju je uključeno 550 bolesnika (59% žena i 41% muškaraca) prosečne starosti od 56,8±11,4 godine i prosečnog indeksa telesne mase (BMI) od 27±4 kg/m2. Losartan je primenjen kod 31% nelečenih i 69% prethodno lečenih bolesnika ali s neregulisanom hipertenzijom. Posle osam nedelja ciljne vrednosti SAP su postignute kod 67,8% bolesnika, a DAP kod 81,1% (i SAP i DAP kod 65% bolesnika), s prosečnim smanjenjem SAP od 21,8% i DAP od 21,1% (p lt 0,001). Hidrohlorotijazid je dodat terapiji kod samo 11,6% bolesnika. Terapijski efekti se nisu statistički značajno razlikovali između svih bolesnika i podgrupa ispitanika sa dijabetes melitusom (DM) i smanjenom funkcijom bubrega. Neželjena dejstva leka su bila retka, a metabolički efekat bio je povoljan. Zaključak. Monoterapija losartanom dovodi do postizanja ciljnih vrednosti krvnog pritiska kod 65% bolesnika sa blagom i umerenom hipertenzijom tokom osam nedelja primene, uključujući i bolesnike sa DM i sa smanjenom funkcijom bubrega. Losartan je siguran i metabolički neutralan lek.