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Objectives: We assessed the children with complex heart anomalies who undergone operative intervention of any form of Fontan intervention and analyzed them for thromboembolic complications after Fontan procedure performed at the Pediatric Clinic of Pristina.Background: Thromboembolic complications are a major cause of early and late mortality in children with single-ventricle congenital heart defects who have undergone a Fontan procedure.Thrombosis is an important and unpredictable complication, not only after Fontan operation but also associated with each stage of single-ventricle palliation. It is an important cause of morbidity, particularly when it leads to pulmonary embolism or stroke, and contributes to mortality.Methodology: The research was conducted at the Pediatric Clinic in the Cardiology and Intensive Care Service, during 2018-2021. The study includes patients who have undergone tertiary level intervention - one of the forms of the Fontan procedure, the research included 40 patients aged 0 -19 years. The children were divided into two groups: the group 29 patients using Aspirin therapy and the group of 11 patients without Aspirin therapy. In children after admission, laboratory tests were performed: hemogram, bleeding time, coagulation time, INR, PTT, and PT.Results: The mean age of children with antithrombotic therapy was 6.03 years (DS ± 5.84 years), those without therapy 3.27 years (DS ± 5.44 years). Aspirin as antithrombotic therapy was applied to 29 patients at a dose of 15 to 115 mg / 24 hours. In 6 patients the dose was less than 3-5 mg / kg body weight.Thepatients with congenital heart malformations after Fontan procedure receiving antithrombotic therapy are 1.4 times more likely to have reduced prothrombin time.Conclusions: Fontan procedure in children has been gratifying, with most survivors now leading lives of good quality into adulthood.

Background: Bronchial asthma is a chronic disease recognized as an important public health issue worldwide, causing a major global health burden. Due to its complex nature and varying characteristics, asthma has been a great challenge for public health. Objective: This article aims to determine the relationship between asthma severity and mental well-being among children with asthma in Kosovo. Methods: In a cross-sectional study conducted in 13 hospitals and outpatient clinics covering all areas of Kosovo, children with asthma aged 7 to 16 years were enrolled. Children and parents answered a questionnaire about socio-demographic characteristics and the Children Strengths and Difficulties Questionnaire (SDQ). Asthma severity was assessed according to the GINA (Global Initiative for Asthma) guidelines and categorized into two levels (IMPA, intermittent and mild persistent asthma; MSPA, moderate and severe persistent asthma). Results: Overall, 161 children with asthma and their caregivers were included. Strengths and difficulties questionnaire showed borderline or abnormal scores in about ¼ of children. A comparison of asthma severity groups for the different scales of the SDQ showed a statistically significant increase in emotional problems (p=0.009). Conclusion: Diminished mental health and emotional problems are relevant in children with a more severe course of the disease and should be taken into account in counseling parents and patients.

Hypoxia is a well-known complication in cemented arthroplasty; however, it is not known whether the level of hypoxia is related to the intramedullary pressure or to the age of the patient; therefore, we studied the intramedullary pressure and level of hypoxia in patients undergoing cemented arthroplasty. A prospective study was performed during cemented arthroplasties in 25 patients with an average age of 66.2 ± 12.1 years old. The intramedullary pressure (IMP) was measured by placing a pressure transducer within the bone while simultaneously measuring the pulse oximetry arterial oxygen saturation (SpO2), pulse, and blood pressure. These variables were obtained immediately after spinal anaesthesia, five minutes after cementation, and 15 minutes after prosthesis insertion. One hundred percent of patients had hypoxia at some level, but 83% of elderly patients (older than 66.5 years) had hypoxia (SpO2

AIM: To analyse the correlation of procalcitonin (PCT) and C-reactive protein (CRP) values with increased intra-abdominal pressure and to evaluate their predictive role in the progression of Intra-abdominal infections.MATERIALS AND METHODS: A non-randomized prospective study conducted in the group of 80 patients. We have measured the PCT, CRP and intra-abdominal pressure (IAP).RESULTS: According to IAH grades (G), there was a significant difference of PCT values: G I 3.6 ± 5.1 ng/ml, G II 10.9 ± 22.6 ng/ml, G III 15.2 ± 30.2 ng/ml (p = 0.045) until CRP values were increased in all IAH groups but without distinction between the groups: GI 183 ± 64.5, GII 196 ± 90.2, GIII 224 ± 96.3 (p = 0.17). According to the severity of the infection, we yielded increased values of PCT, IAP and CRP in septic shock, severe sepsis and SIRS/sepsis resulting in significant differences of PCT and IAP.CONCLUSION: Based on the results of our research, we conclude that the correlation of PCT values with IAH grades is quite significant while the CRP results remain high in IAH but without significant difference between the different grades of IAH.

The goal of this study was to test the effects of bioactive phenylpropanoid dibenzylbutyrolactone lignan arctigenin (ATG) in vascular tone. Human bypass graft vessel, from a saphenous vein (SV), were set up in organ bath system and contracted with potassium chloride (KCl, 40mM). Two concentration-response curves of noradrenaline (NE) (10nM-100μM) separated with an incubation period of 30min without (Control) or with ATG (3-100μM) were established. Inhibitors of nitric oxide, prostaglandins, K+ related channels or calcium influx were used to delineate the molecular mechanisms beyond ATG effects. To investigate anti-inflammatory actions, SV were treated with 10μM or 100μM ATG and incubated for 18h in the absence or presence of both interleukin-1beta (IL-1β) and lipopolysaccharide (LPS) to mimic the physiological or inflamed tissue conditions. Proatherogenic and inflammatory mediators Interleukine-1 beta (IL-1β), Monocyte Chemoattractant Proteine-1 (MCP-1), Tumor Necrosis Factor- α (TNF-α), Interleukine-6 (IL-6), Prostaglandin E2 (PGE2) and Interleukine-8 (IL-8) in the supernatant were measured. ATG significantly decreased vascular contractile response to NE. Moreover, it reduced contractions induced by KCl and cumulative addition of CaCl2. The mediators were significantly increased in inflammatory conditions compared to normal conditions, an effect which was inhibited by ATG (10 and 100µM). ATG reduces contractions in SV and decreases the production of proinflammatory-proatherogenic mediators, setting the stage for further evaluating the effect of ATG in cardiovascular diseases.

Vagal innervations have a great role in the respiratory function and are the main route of signal transmission from respiratory neural centers into the trachea and others conducting airways. We have investigated the role of central mechanisms related to vagal neural pathways and the cholinergic outflow in tracheobronchial smooth muscle tone and lung mechanics parameters. Parameters of lung mechanics such as lung resistance (RL), dynamic compliance (Cdyn) and pressure in bypassed tracheal segment (Ptseg) were measured before and after vagotomy and asphyxia test. Before vagotomy (BV), the control measurements were obtained and physostigmine was administered systemically, in increasing dose 10, 40 and 100μg/kg body weight (bw) with 15min interval between doses. After vagotomy (AV), administration of physostigmine with the same doses as BV has been done and the asphyxia challenge was conducted as per study protocol. The values of Ptseg and RL after physostigmine administration, BV vs. AV, respectively, at maximal dose of 100μg/kg bw were 32.5±3.3cm H2O, and 10.6±1.5cm H2O (p

Background. Globally, the level of antibiotic prescription in dental care is increasing each year, and evidence shows a high level of antibiotic misuse. Objectives. The survey was conducted to determine the antibiotic prescription pattern in primary dental care in Kosovo, to analyze prescription habits, to identify eventual misuses of antibiotics and to facilitate the formulation of standards for the rational prescription of these drugs. Material and methods. The data of 1,825 registered patients for a 1-year period was randomly collected and analyzed concerning antibiotic use and presented by Defined Daily Doses [DDD]/1,000 inhabitants/day as per the standards of WHO methodology. Results . The prescription rate of antibiotics in the general number of registered patients was 7.9%. The total consumption of antibiotic drugs in dental primary care was 2.17 DDD/1,000 inhabitants/day. The total number of individual antibiotics during the survey was 6 agents. The most used antibiotic was Co-amoxiclav (J01CR02) with 1.16 DID, followed by Amoxicillin (J01CA04) 0.78 DID. While other individual antibiotics were used significantly less, with Ceftriaxone (J01DD04), with a 0.11 DID, Cefalexin (J01DB01), with a 0.09 DID, Procaine Benzyl Penicillin (J01CE09), with a 0.02 DID, and Gentamicin (J01GB03), with a 0.01 DID. Conclusions . The results of survey indicate a high and irrational prescription of antibiotics in primary dental care in Kosova. The prescription of broad-spectrum antibiotics may have a negative impact in destroying commensal flora and triggering bacterial resistance. The use of broad-spectrum antibiotic, especially parenteral antibiotics, should be replaced with more narrow-spectrum oral antibiotics, and a more restrictive prescription pattern should be put in place. For the qualitative improvement of prescription of these drug groups, we recommend the implementation of a restrictive antibiotic policy.

Background Tuberculosis (TB) remains a significant worldwide social and life-threatening epidemiological problem. Because this disease requires multiple drug treatment and prolonged therapy for several months, followed by a high probability of adverse effects (AEs), we assessed AE monitoring for anti-TB drugs in the Health Care System of Kosova. Methods This survey was a cross-sectional analysis performed at the primary, secondary and tertiary health care levels in Kosova. We included 930 registered tuberculosis patients within three levels of this health system in our study. Furthermore, we interviewed 62 physicians and 71 nurses at TB health facilities. Data were collected from official TB registers and personal contact with patients for 12 months. Results The representative age group was 19 to 29 years (30.49%), followed by a group of patients aged >60 years (23.23%). Among 930 patients treated with TB drugs, the total incidence of adverse AEs was 29.03%. Female TB patients had a higher rate of AEs than did male patients (33.56% vs 28.84%, respectively). The highest incidence of registered AEs was recorded in the gastrointestinal system (270, 80.83%), followed by the central nervous system (CNS, 7.50%) and was lower in other organ systems. The reporting of anti-TB drug effects by medical staff (TB medical doctor and TB medical nurse) at different levels of TB medical settings occurred among 62.90% of medical doctors and 81.69% of nurses. Only 53.23% of medical doctors and 46.48% of nurses completed pharmacovigilance training. Conclusion The pharmacovigilance approach in Health System of Kosova is not comprehensible and not systematic. The relatively low incidence of AEs among TB patients is due under reporting of these by medical staff. The knowledge, attitudes, and adherence of medical staff reveal low awareness for pharmacovigilance activities, and this concern should be addressed to reinforce this important issue for the safe treatment of TB patients.

BACKGROUND: Antibiotics are among the most commonly prescribed drugs in paediatrics. In most cases, antibiotics are started on an empirical basis, without proof of a bacterial infection, either before the start of therapy or afterwards.AIM: The main objective of this study was to analyse the consumption of antibiotics in hospitalised paediatric patients.MATERIAL AND METHODS: This retrospective study investigated the consumption of antimicrobials in defined daily doses (DDDs according to the Anatomical Therapeutical Chemical/DDD index) in Pulmonology, Gastroenterology and Nephrology Departments at Pediatric Clinic of the tertiary hospital. The data on the consumption of antimicrobials were collected for five years by using properly designed form. The consumption was related to days of hospital care.RESULTS: The most utilised antibiotics group in all three departments Pulmonology, Gastroenterology and Nephrology Departments were penicillins. Cephalosporins were mostly used in Pulmonology department. Metronidazole and Chloramphenicol were used in minimal quantities in all three departments.CONCLUSION: This study demonstrates that surveillance programs on antibiotic resistance should be established and accompanied by analyses of drug utilisation data which can aid in the creation of valid cross-national studies on antibiotic usage and resistance, to motivate improvements in prescribing and guideline-directed antibiotic prescribing.

Setting. The poor patient adherence in tuberculosis (TB) treatment is considered to be one of the most serious challenges which reflect the decrease of treatment success and emerging of the Multidrug Resistance-TB (MDR-TB). To our knowledge, the data about patients’ adherence to anti-TB treatment in our country are missing.Objective. This study was aimed to investigate the anti-TB treatment adherence rate and to identify factors related to eventual nonadherence among Kosovo TB patients.Design. This study was conducted during 12 months, and the survey was a descriptive study using the standardized questionnaires with total 324 patients.Results. The overall nonadherence for TB patient cohort was 14.5%, 95% CI (0.109–0.188). Age and place of residence are shown to have an effect on treatment adherence. Moreover, the knowledge of the treatment prognosis, daily dosage, side effects, and length of treatment also play a role. This was also reflected in knowledge regarding compliance with regular administration of TB drugs, satisfaction with the treatment, interruption of TB therapy, and the professional monitoring in the administration of TB drugs.Conclusion. The level of nonadherence TB treatment in Kosovar patients is not satisfying, and more health care worker’s commitments need to be addressed for improvement.

Despite extensive research on epileptogenesis, there is still a need to investigate new pathways and targeted therapeutic approaches in this complex process. Inflammation, oxidative stress, neurotoxicity, neural cell death, gliosis, and blood⁻brain barrier (BBB) dysfunction are the most common causes of epileptogenesis. Moreover, the renin⁻angiotensin system (RAS) affects the brain’s physiological and pathological conditions, including epilepsy and its consequences. While there are a variety of available pharmacotherapeutic approaches, information on new pathways is in high demand and the achievement of treatment goals is greatly desired. Therefore, targeting the RAS presents an interesting opportunity to better understand this process. This has been supported by preclinical studies, primarily based on RAS enzyme, receptor-inhibition, and selective agonists, which are characterized by pleiotropic properties. Although there are some antiepileptic drugs (AEDs) that interfere with RAS, the main targeted therapy of this pathway contributes in synergy with AEDs. However, the RAS-targeted treatment alone, or in combination with AEDs, requires clinical studies to contribute to, and clarify, the evidence on epilepsy management. There is also a genetic association between RAS and epilepsy, and an involvement of pharmacogenetics in RAS, so there are possibilities for the development of new diagnostic and personalized treatments for epilepsy.

Objectives There are no reliable data on antibiotic use in Kosovo hospitals. The aim of this survey was to monitor volumes and patterns of antibiotic use in hospitalised patients in order to identify targets for quality improvement. Methods Data on antimicrobial use were collected from seven hospitals in Kosovo during 2013 using the standardised point prevalence survey (PPS) methodology as developed by the ESAC (European Surveillance of Antimicrobial Consumption) and ARPEC (Antibiotic Resistance and Prescribing in European Children). The survey included all inpatients receiving an antimicrobial agent on the day of the PPS. Results Overall, 1667 patients were included in the study: adults 1345 (81%) and children 322 (19%). Of the hospital inpatients, 579/ 1345 (43%) adults and 188/ 322 (58%) children received at least one antibiotic during a hospital stay. The top three antibacterial subgroups (ATC level 3) were beta-lactam antibiotics, cephalosporins and aminoglycosides. In all hospital centres, the most commonly prescribed antibiotic was ceftriaxone (39% for adult and 36% for children). Antibiotics were administered mainly parenterally in 74% of adults and 94% of children. Empirical prescribing was higher in adults 498/ 579 (86%) and children 181/ 188 (96%), compared with targeted treatment based on susceptibility testing-81 (14%) and 8 (4%), respectively. Conclusions Antibiotic use in Kosovo's hospitals is very high. Gathered data will be an important tool to identify targets for quality improvement and will support preparation of guidelines and protocols for the prudent use of antibiotics.

INTRODUCTION: The aim of the study is to assess the state of the use of antibiotics in dairy cattle in Kosovo according to different diagnosis as directed by treatment protocol and to evaluate the methods of their application in dairy cattle. METHODS: We've visited over 80% of dairy farms throughout the territory of Kosovo in 2013. Assessment was carried out through a specific questionnaire, which identifies problems with medical treatment of cattle, the number of cattle treated and untreated, description of dose and type of drugs used, as well as the duration of drugs issuance. RESULTS: In Kosovo for the treatment of sick cows are mainly used beta lactams and sulfonamides. The drugs were not given only to sick cattle by their diagnosis, but they were given to healthy cattle too, as a preventative therapy, mainly through intramuscular route. CONCLUSION: We conclude that the dairy cattle were not treated correctly as directed by the treatment protocol. In Kosovo's general health system there are no rules and procedures on monitoring and recording the expenditures on antibiotics.

Monogenic and polygenic mutations are important contributors in patients suffering from epilepsy, including metabolic epilepsies which are inborn errors of metabolism with a good respond to specific dietetic treatments. Heterozygous variation in solute carrier family 2, facilitated glucose transporter member 1 (SLC2A1) and mutations of the GLUT1/SLC2A2 gene results in the failure of glucose transport, which is related with a glucose type-1 transporter (GLUT1) deficiency syndrome (GLUT1DS). GLUT1 deficiency syndrome is a treatable disorder of glucose transport into the brain caused by a variety of mutations in the SLC2A1 gene which are the cause of different neurological disorders also with different types of epilepsy and related clinical phenotypes. Since patients continue to experience seizures due to a pharmacoresistance, an early clinical diagnosis associated with specific genetic testing in SLC2A1 pathogenic variants in clinical phenotypes could predict pure drug response and might improve safety and efficacy of treatment with the initiation of an alternative energy source including ketogenic or analog diets in such patients providing individualized strategy approaches.

BACKGROUND: Coronary Artery Bypass Grafting (CABG) is realized in patients with critical or advanced disease of coronary arteries. There are different pharmacotherapeutic approaches which are used as management, treatment and preventive therapy in cardiovascular disease or related comorbidities. Performing a successful surgery, pharmacotherapy, and increase of bypass patency rate still remains a serious challenge.AIM: The aim of this study is to analyze the patient characteristics undergoing CABG and eval-uation of their drug utilization rate and daily dosages in the perioperative period.MATERIAL AND METHODS: Data were collected from 102 patients in the period 2016-2017 and detailed therapeutic prescription and dosages, patient characteristics were analyzed before the operation, after the operation and visit after operation in the Clinic of Cardiac surgery-University Clinical Center of Kosovo.RESULTS: Our findings have shown that patients provided to have normal biochemical parameters in the clinic before the operation, and were related to cardiovascular diseases and comorbidities and risk factors with mainly elective intervention. However higher utilization of cardiovascular drugs such as beta blockers, diuretics, anticoagulants, statins and lower calcium blockers, ACEi, ARBs, hydrochlorothiazide, amiodarone were founded. ARBs, beta blockers, statins, nitrates and nadroparin utilization decreased after operation and visit after the operation, whereas amiodarone only in the visit after the operation. Diuretics are increased after the operation which decreases in the visit after the operation. Regarding the daily dosage, only metoprolol was increased in the visit after operation (P < 0.001) and visit after operation (P < 0.05) whereas losartan and furosemide were increased (P < 0.01) and (P < 0.05) respectively.CONCLUSION: The study showed that beta blockers, statins, aspirin, nitrates (before the operation), furosemide and spironolactone are the most utilized drugs. However, we found low utilization rate for ACEi, ARBs, clopidogrel, nadroparin, warfarin, xanthines, amiodarone, calcium blockers. Daily dosages were different compared to before CABG only in metoprolol, losartan, and furosemide.

Aim: This study aims to evaluate the algorithm of procalcitonin (PCT) and its role on the duration of antibiotics prescription for intra-abdominal infections.Materials and Methods: This study is a prospective controlled study that is conducted in groups of 50 hospitalised patients and 50 controlled group patients.Results: The results indicated that the average duration of antibiotic delivery to the PCT group was -10.6 days (SD ± 6.6 days), while in the control group -13.2 days (SD ± 4.2 days). These data showed a significant difference in the duration of antibiotic therapy and the monitoring role of PCTs in the prediction success of antibiotic treatment. The antibiotic delivery was longer in the septic shock 17 (SD ± 11.7) that corresponds to high PCT values of 67.8 (SD ± 50.9). Recurrence of the infection after the cessation of antibiotics occurred in 2 cases (4%) in the standard group, while it occurred in 3 cases (6%) in the control group.Conclusion: The treatment of the intra-abdominal infections based on the PCT algorithm shortens the duration of antibiotic treatment and does not pose a risk for the recurrence of the infection.

BACKGROUND: Circulus arteriosus cerebri is the main source of blood supply to the brain; it connects the left and right hemispheres with anterior and posterior parts. Located at the interpenducular fossa at the base of the brain the circle of Willis is the most important source of collateral circulation in the presence of the disease in the carotid or vertebral artery.AIM: The purpose of the research is to study the diameter and length of arteries and provide an important source of reference on Kosovo’s population.METHODS: This is an observative descriptive study performed at the University Clinical Center of Kosovo. A randomised sample of 133 angiographic examinations in adult patients of both sexes who were instructed to exploration is included.RESULTS: The diameters and lengths measured in our study were comparable with other brain-cadaver studies especially those performed by MRA. All dimensions of the arteries are larger in male than female, except the diameter of PCoA that is larger in female (p < 0.05) and length of the ACoA (p < 0.05). Significant differences were found in diameters of arteries between the younger and the older age groups.CONCLUSION: Knowing the dimensions of the arteries of the circle of Willis has a great importance in interventional radiology as well as during anatomy lessons.

Objective: To determine the effect of moderate-intensity aerobic exercise on the quality of life (QOL) and physical functioning in breast cancer survivors. Materials and Methods: We randomly assigned 62 breast cancer survivors to an exercise (N = 30) or control group (N = 32). The exercise group trained at a moderate intensity progressing from 25 to 40 min over a 10-week period. The control group did not train. Outcomes were assessed at baseline and postintervention. The primary outcomes were overall QOL - as assessed by the functional assessment of cancer therapy-breast (FACT-B) scale. Secondary outcomes were changes in various subscales of overall QOL, and changes in body composition outcomes: body weight, body mass index, and changes in performance in a 12 min walk test (12MWT). Results: Sixty-two of 73 women randomized (84.9%) completed the study. There were no significant differences amongst the two groups at baseline for any variable. In the exercise group significant improvements were demonstrated for the FACT-B (13.4 points, P < 0.003), functional assessment of cancer therapy-general (FACT-G) (9.16 points, P < 0.008), the functional well-being subscale (P < 0.010), and the emotional well-being subscale (P < 0.035) compared to the control group. No significant changes in body weight or BMI were observed. Exercise group showed a significant increase in 12MWT (P < 0.009). Conclusion: We conclude that 10 week of moderate-intensity aerobic exercise program significantly improves QOL and physical functioning in breast cancer survivors. Future studies are needed to evaluate the effectiveness of similar exercise programs over longer periods of time and involving a greater number of breast cancer survivors.

Although azithromycin is extensively used in the treatment of respiratory tract infections as well as skin and skin-related infections, pharmacokinetics of azithromycin in extracellular space fluid of soft tissues, i.e., one of its therapeutic target sites, are not yet fully elucidated. In this study, azithromycin concentration-time profiles in extracellular space of muscle and subcutaneous adipose tissue, but also in plasma and white blood cells, were determined at days 1 and 3 of treatment as well as 2 and 7 days after the end of treatment. Of all compartments, azithromycin concentrations were highest in white blood cells, attesting for intracellular accumulation. However, azithromycin concentrations in both soft tissues were markedly lower than in plasma both during and after treatment. Calculation of the area under the concentration-time curve from 0 to 24 h (AUC 0–24 )/MIC 90 ratios for selected pathogens suggests that azithromycin concentrations measured in the present study are subinhibitory at all time points in both soft tissues and at the large majority of observed time points in plasma. Hence, it might be speculated that azithromycin's clinical efficacy relies not only on elevated intracellular concentrations but possibly also on its known pleotropic effects, including immunomodulation and influence on bacterial virulence factors. However, prolonged subinhibitory azithromycin concentrations at the target site, as observed in the present study, might favor the emergence of bacterial resistance and should therefore be considered with concern. In conclusion, this study has added important information to the pharmacokinetic profile of the widely used antibiotic drug azithromycin and evidentiates the need for further research on its potential for induction of bacterial resistance.

Antibiotic drugs are a very important drug group considering their frequent use, safety profile and their impact on bacterial resistance induction. Aim: To investigate the utilization of antibiotic drugs at the University Dentistry Clinical Center of Kosovo (UDCCK). Methodology: Retrospective and descriptive study. Patient records were used as a data source collected for a period of 3 months. The total number of registered outpatients in the UDCCK was 1117 patients. The data analysis was performed using the WHO methodology and results were expressed in DDD per 1000 inhabitants per day. Results: The total prescription of antibiotics at UDCCK was 7.18 DDD/ 1000 inhabitants/day. Antibiotics were prescribed for 86 or 7.70% of patients. The most commonly prescribed antibiotic was Amoxicillin with clavulonic acid 3.12 (43.45%) DDD, followed by Metronidazole 2.31 DDD and Amoxicillin 1.25 DDD. Erythromycin and Cefalexin were prescribed evidently less compared to other antibiotics (0.38 and 0.12 DDD/1000 inhabitant/day, respectively). Conclusions: The quantitative analysis showed no rationality of prescription of antibiotics in UDCCK. Generally, the use of antibiotics in both departments of UDCCK is higher compared to other countries. We recommend the implementation of restrictive prescription standards for antibiotics.

Objective: To investigate the correlation of the immunoassay and chromatography method for quantitative measurement of two antiepileptic drugs (AED), carbamazepine (CBZ) and phenytoin (PHT) and determination of relation between the CBZ and it’s metabolite carbamazepine 10,11epoxide (CBZ-E). Additionally we investigated whether there is a diff erence in the determination of serum concentration of CBZ and PHT when measured in two diff erent labs by high performance liquid chromatography (HPLC). Materials and methods: This study was carried out on 102 blood samples (72 CBZ and 30 PHT) collected from epileptic outpatients. Plasma concentrations of CBZ and PHT were determined by validated HPLC (Shimadzu and Agilent) and the CEDIA-immunoassay method. Results: The correlations of serum concentrations of CBZ between CEDIA and HPLC1 and between CEDIA and HPLC2 were good (R = 0.97 for both techniques). Even better correlation was found between concentrations of CBZ measured by the two HPLC systems (R = 0.99). Similar, for PHT, we found good correlation between CEDIA and the two systems of HPLC (HPLC1 and HPLC2, R = 0.98) and between the two systems of HPLC of R =0.98. The moderate correlation coeffi cient was found between serum concentrations of CBZ and its metabolite CBZ-E, measured in two labs by diff erent HPLC (R = 0.49 and 0.43, respectively; P < 0.001). Conclusion: We observed good correlation for estimation of CBZ and PHT concentration obtained by means the immunoassay and two diff erent HPLC. The possibility of measurement of CBZ-E could be advantage of chromatography in comparison with immunoassay.

Naim R Haliti,1 Fehim R Haliti,2 Ferit K Koçani,3 Ali A Gashi,4 Shefqet I Mrasori,3 Valon I Hyseni,5 Samir I Bytyqi,5 Lumnije L Krasniqi,2 Ardiana F Murtezani,5 Shaip L Krasniqi5 1Department of Forensic Medicine, Faculty of Medicine, University of Prishtina “Hasan Prishtina”, 2Department of Children Dentistry, University Dentistry Clinical Center of Kosovo, 3Department of Oral Disease, University Dentistry Clinical Center of Kosovo, 4Department of Oral Surgery, University Dentistry Clinical Center of Kosovo, 5Institute of Pharmacology and Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Prishtina “Hasan Prishtina”, Prishtina, Kosovo Background: Because Kosovo has no reliable information on antimicrobial and analgesic use in dental practice, the survey reported here evaluated the antibiotic and analgesic prescriptions in the Oral Surgery Department of the University Dentistry Clinical Center of Kosovo (UDCCK).Methods: The data of 2,442 registered patients for a 1-year period were screened and analyzed concerning antibiotic and analgesic use as per standards of rational prescription.Results: Dentistry doctors prescribed antibiotics significantly more often than analgesics. Antibiotics were prescribed in 8.11% of all cases, while only 1.35% of total prescriptions were for analgesics. The total consumption of antibiotic drugs in the UDCCK was 4.53 Defined Daily Doses [DDD]/1,000 inhabitants/day, compared with only 0.216 DDD/1,000 inhabitants/day for analgesics. From a total number of 117 patients, 32 patients received combinations of two antibiotics.Conclusion: Pharmacotherapy analysis showed that the prescription rates of antibiotics and analgesics in the UDCCK are not rational in terms of the qualitative aspects of treatment. For the qualitative improvement of prescription of these drug groups, we recommend the implementation of treatment guidelines following rational standards. Keywords: antibiotic, analgesics, Anatomic Therapeutic Classification, DDD/1,000 inhabitants/day, rational standards

BACKGROUND Lateral epicondylitis, or tennis elbow, is a common overuse syndrome of the extensor tendons of the forearm. When the condition is chronic or not responding to initial treatment, physical therapy is initiated. The objective of this study is to compare the effectiveness of corticosteroid injections with physiotherapeutic interventions (ultrasound and exercise) for the treatment of chronic lateral epicondylitis. MATERIAL AND METHODS We performed a randomized controlled trial of 12 weeks' duration in patients with chronic lateral epicondylitis. We randomly assigned 49 subjects to an exercise group (n=25), who received ultrasound and exercise, and a control group (n=24), who were treated with local infiltration of 1mL triamcinolone acetonide (10mg/mL) and 1mL lidocaine 2%. To evaluate the subjects, three instruments were used: pain intensity, measured with a Visual Analogue Scale (VAS), functional disability, measured with the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire, and painfree grip strength. All subjects were evaluated before treatment and at the 6th and 12th week. RESULTS There were no significant differences between the two groups with regard to any variable at baseline (p>0.05). In the exercise group, significant improvements were demonstrated for VAS, PRTEE pain score, PRTEE function score and pain free grip strength, compared to the control group. The exercise group reported a significantly greater increase in all variables at 12 weeks than did the control group (p

Background and objective: There is paucity of evidence in southeastern Europe and Kosovo regarding dairy products consumption and association with bone mineral density (BMD). Therefore, the objective of present study was to assess calcium intake and dairy products consumption and to investigate relationship with total hip BMD in a Kosovo women sample. Methods: This cross-sectional study included a sample of 185 women divided into respective groups according to total hip BMD. All the study participants completed a food frequency questionnaire and underwent dual-energy X-ray absorptiometry (DEXA) to estimate BMD. Nonparametric tests were performed to compare characteristics of the groups. Results: The average dietary calcium intake was 818.41 mg/day. Only 16.75% of the subjects met calcium recommended dietary reference intakes (DRIs). There were no significant differences between low BMD group and normal BMD group regarding average dietary calcium intake, but it was significantly higher in BMDT3 subgroup than in BMDT2 and BMDT1 subgroups. Conclusions: The results of this study demonstrate significant relationship of daily dietary calcium intake with upper BMD tertile. Further initiatives are warranted from this study to highlight the importance of nutrition education.

For macrolides, clinical activity but also the development of bacterial resistance has been attributed to prolonged therapeutic and subtherapeutic concentrations. Although erythromycin is a long-established antimicrobial, concomitant determination of the pharmacokinetics of erythromycin and its metabolites in different compartments is limited. To better characterize the pharmacokinetics of erythromycin and its anhydrometabolite (anhydroerythromycin [AHE]) in different compartments during and after the end of treatment with 500 mg of erythromycin four times daily, concentration-time profiles were determined in plasma, interstitial space of muscle and subcutaneous adipose tissue, and white blood cells (WBCs) at days 1 and 3 of treatment and 2 and 7 days after end of therapy. In WBCs, concentrations of erythromycin exceeded those in plasma approximately 40-fold, while free concentrations in plasma and tissue were comparable. The observed delay of peak concentrations in tissue might be caused by fast initial cellular uptake. Two days after the end of treatment, subinhibitory concentrations were observed in plasma and interstitial space of both soft tissues, while 7 days after the end of treatment, erythromycin was not detectable in any compartment. This relatively short period of subinhibitory concentrations may be advantageous compared to other macrolides. The ratio of erythromycin over AHE on day 1 was highest in plasma (2.81 ± 3.45) and lowest in WBCs (0.27 ± 0.22). While the ratio remained constant between single dose and steady state, after the end of treatment the concentration of AHE declined more slowly than that of the parent compound, indicating the importance of the metabolite for the prolonged drug interaction of erythromycin.

Neuronal and axonal degenerative changes in motor vagal neurons (DMNV) and sensory vagal neurons (nTS) in the medulla oblongata in newborns were studied. Material was taken from the autopsies of newborns, live and dead newborns, in different gestational weeks (aborted, immature, premature and mature). 46 cases were studied. Material for research was taken from the medulla oblongata and lung tissue. Serial horizontal incisions were made in the medulla oblongata (± 4 mm), commencing from the obex, where the DMNV and nTS vagal nuclei were explored. Fixed cuttings in buffered formalin (10%) were used for histochemical staining. Serial cuttings were done with a microtome (7 µm). Pulmonary infections, being significant (p0.05), have an important place when studying respiratory distress (RD) in newborns. Morphological changes of nerve cells in DMNV and nTS nuclei in the medulla oblongata in newborns in different gestational weeks are more emphasized in matures in comparison to aborted and immature (p0.05). Depending on the lifetime of dead newborns, neuronal morphological changes in vagus nerve nuclei are significant (p0.05). Therefore, it can be concluded that pulmonary infections are often caused due to dramatic respiratory distress in newborns, while hypoxaemic changes in the population of vagus nerve neurons in respiratory distress are more emphasized in matures.

In this work, effect of phentolamine as antagonist of alpha-1 adrenergic receptor in patients with bronchial asthma and with obstructive chronic bronchitis was studied. Parameters of the lung function are determined by body plethysmography. Raw and ITGV were registered and SRaw was calculated as well. Aerosolization is done with standard aerosolizing machines--Asthma with a possibility of aerosolization of 0.5 ml per minute. Results gained by this research shows that blockage of alpha-1 adrenergic receptor with phentolamine (10 mg by inhalator and intravenous ways and 20 mg by inhalator ways) has not changed significantly (p0.1) the bronchomotor tonus of tracheobronchial tree, by comparing it with the inhalation of natrium chloride solution with percentage of 0.9% (p0.1), or of hexoprenaline (2 inh x 0.2 mg) and atropine 1 mg/ml (p0.01). This suggests that the activity of alpha-1 adrenergic receptor in the smooth musculature is not a primary mechanism that causes reaction in patients with increased bronchial reactibility, in comparison to agonists of beta2--adrenergic receptor and cholinergic antagonists that expresses their significant action in reduction of specific resistance of airways.

It is a well-known fact that tablets are the most ordinary medicines in daily practice, which along with capsules represents about 70% of pharmaceutical preparations. Experimenting with paracetamol tablets of 500 mg dose was scope of this study. Study of formulation, preparation, quality control, and follow-up of the paracetamol stability in tablets was conducted. Carefully analyzing the physical--chemical properties of the paracetamol, in particular to the high number of excipients utilized in the preparation of tablets (diluting, connective, analyzing, and lubricant excipients), and by researching an considerable number of bibliographic sources, we have conceived four different formulations of the paracetamol tablets 500 mg. Preparation of tablets was realized by the humid method of granulation. Quality control of the paracetamol tablets was performed by implementing a series of trials and analyses forecasted in latest editions of most recognized pharmacopoeias. From these trials and analyses, we can mention as follows: reactions of identification, diameter, and average mass, time of analysis, velocity of dissolution and determination of 4-aminophenol. Requirements deriving from the abovementioned trials and analyses were accomplished, excluding the velocity of dissolution that was not accomplished in two of the last formulation (3 and 4). Since this trial is very important in regard to the quality of solid pharmaceutical forms, two of the abovementioned formulations are considered as inappropriate to be used in practice. From the four formulations of paracetamol tablets, results shows that 1st and 2nd are most appropriate formulations due to its simplicity in preparation and practice to be produced industrially. Defining of the timely depending content of the paracetamol in tablet was performed by the implementing of two contemporary methods of spectrophotometry in UV zone and chromatography in the liquid phase with high pressure (HPLC). Just as it was expected, results of these analyses showed that acting substance did not incur any alteration during the period of storage and that alterations of the analyses results in between these two methods are almost inconsiderable ones.

In this study, the effect of dopamine as agonist dopaminergic receptor and alpha and beta adrenergic receptor was studied both in vivo. The effect of tolazoline as an antagonist of alpha-2 adrenergic receptor was also studied in patients with bronchial asthma and persons with increased bronchial reactibility. Parameters of the lung function are determined by body plethysmography. Raw and ITGV were registered and SRaw was calculated as well. Aerosolization is done with standard aerosolizing machines – Asema. Results gained in vivo shows that stimulation of alpha adrenergic receptor with dopamine (4 μg and 300 μg) causes significant contraction (p > 0.1) of the smooth bronchial musculature. Whereas, blockage of alpha-2 adrenergic receptor with tolazoline (20 mg by inhalator ways) does not change the bronchimotor tonus significantly (p>0.1) when compared to the stimulation of beta-2 adrenergic receptor with hexoprenaline (2 inh. x 0.2 mg) and blocker of cholinergic receptor - ipratropium (2 inh. x 1 mg). Reaction of the smooth musculature to dopamine suggests that this substance may cause constriction through alpha adrenergic receptors. Reaction may also be intermediated in indirect ways through dopaminergic receptor of the cholinergic transmission, with intracellular inhibition of the creation of cAMP.

Therapeutic monitoring of antiepileptic drugs is important in process of optimisation of therapy of epileptic patients. Carbamazepine (CBZ) and Lamotrigine (LMT) are important drugs in therapy of epileptic patients which requires the monitoring of concentration of these drugs in serum. Ourstudy aim was the comparison and interpretation of the results of routine therapeutic monitoring of Carbamazepine and Lamotrigine in spotlight of antiepileptic therapy optimisation. We have analyzed 74 blood samples of epileptic patients who were in therapy with Carbamazepine or Lamotrigine. High pressure liquid chromatographywas used in determiningthe serum concentration of above mentioned drugs. Results of our study show the positive correlation between dosage and serum concentration of CBZ. (r = 0.78). The correlation coefficient between the dosage and serum concentration of LMT is higher than CBZ (r = 0.825). In the process of monitoring of serum concentration of CBZ, very important issue is the serum concentration of active metabolite named to carbamazepine-10,11-epoxide (CBZE). The correlation coefficient between the CBZ and its active metabolite was r = 0.57. During analysis of correlation between blood sampling time from last dose intake and serum concentration of respective drug in both drugs (CBZ and LMT) we have found the negative small correlation (r = -0.256 and r = -0.288). The results of our study contribute to other studies which confirm the complexity of therapeutic drug monitoring (TDM) process in general and particularly for CBZ and LMT. The process of TDM requires the selection of adequate analytical method and right appropriate interpretation of the serum concentration of these drugs.

Kosovo as a newer state, characterized with political, economical and cultural transition is touched by suicide phenomenon. Aim of this survey is to analyze prevalence of suicide in Kosova for period 2000-2008 and in particular for 2007-2008.Survey is retrospective one and data were taken from Statistical Office of Kosova and Kosovar Police Service report. Cases are analysed due to demographic characteristics as sex, age group, years, dwelling place, months, week days and methods of suicides.After the war there is an increase of suicides as it is presented with basic index. For year 2000, there is an increase of 122% compared with cases on 1983, then the highest increase is for 2001 with 711.1%. After 2005 there is a slight decrease of suicides with trend of y = 58-8X. Due to sex, suicides are significantly higher at males than females for both years, with 78.9% for 2007 and 74.5% for 2008. The highest number of suicides is found at age groups 21-30 and 31-40 years with 21.1% for 2007 and 21-30 and 41-50 years with 25.5% for 2008. Average age for suicide victims is 42 years for 2007 and 44 years for 2008. Suicides are more frequent at rural places but not significantly. Greatest percentage of suicides was on July with 21.1% for 2007 and June and October with 15.7% for 2008. On 2007 the highest percentage of suicides was on Wednesdays with 21.1% and on 2008 was on Tuesdays with 19.6%. Due to the time of day, the most frequent time for suicides was 16-18.00 for 2007 and for 2008 the greatest percentage of suicide is on unknown time with 27.5%. The most frequent method of suicide was hanging for both years, with 64.9% for 2007, and 52.9% for 2008, fire arm with 14% for 2007 and 21.6% for 2008 and poisoning with 5.3% for 2007 and 11.8% for 2008. Suicides are most frequent at rural places but not significantly.Suicides due to sex are significantly higher in males than females in all age groups. Average age of suicide victims is rising from 42 years for 2007 to 44 years for 2008. Suicides are more frequent at rural places and the greatest percentage of suicides due to months was on July for 2007 and June and October for 2008, on Wednesdays for 2007 and Tuesdays for 2008. PROPOSED MEASURES: Suicides are consequence of socioeconomic, psychological and political problems as unemployment and poverty. For challenging suicide phenomenon there is a need for multi-sectoral approach involving health and non health sector as politics, labor, education and media.

Actions of acetylcholine (ACh), histamines, serotonins (5-HT) and prostaglandins (PGF2-alfa) in concentrations of 10-4, 10-3, 10-1 and 10-1 mol/dm3 were analyzed in vitro conditions in isolated specimens of tracheas of 24 pigs, 7 guinea pigs, and dead persons for different reasons (8), in the presence and without presence of propranolol. Whilst, research regarding actions of aerosolized histamines (10 mg, 1%, 2 min), in the presence and without the presence of aerosolized propranolol (20 mg, 2%, 2 min) was done in vivo in 6 healthy persons. Study results show that propranolol does not emphasize contraction of the airways smooth musculature as induced by ACh, histamine, 5-HT and PGF2-alfa in vitro conditions (p>0,1). Also, in vivo we found a non-significance of tracheal smooth musculature constriction (p>0,1).

The development of neuron cells in vagal nerve nuclei in medulla oblongata was studied in vitro in live newborns and stillborns from different cases. Morphological changes were studied in respiratory nuclei of dorsal motor centre (DMNV) and nucleus tractus solitarius (NTS) in medulla oblongata. The material from medulla oblongata was fixated in 10μ buffered formalin solution. Fixated material was cut in series of 10μ thickness, with starting point from obex in ± 4 mm thickness. Special histochemical and histoenzymatic methods for central nervous system were used: cresyl echt violet coloring, tolyidin blue, Sevier-Munger modification and Grimelius coloring. In immature newborns (abortions and immature) in dorsal motor nucleus of the vagus (DMNV) population stages S1, S2, S3 are dominant. In neuron population in vagal sensory nuclei (NTS) stages S1, S2 are dominant. In more advanced stages of development of newborns (premature), in DMNV stages S3 and S4 are seen and in NTS stages S2 and S3 are dominant. In mature phase of newborns (maturity) in vagal nucleus DMNV stages S5 and S6 are dominant, while in sensory nucleus NTS stages S4 and S5 are dominant. These data suggest that neuron population in dorsal motor nucleus of the vagus (DMNV) are more advanced in neuronal maturity in comparison with sensory neuron population of vagal sensory nucleus NTS. This occurrence shows that phylogenetic development of motor complex is more advanced than the sensory one, which is expected to take new information’s from the extra uterine life after birth (extra uterine vagal phenotype)