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INTRODUCTION: Complete appreciation of the cardiac venous system requires an understanding of its embryological basis, its usual patterns of distribution, and its common variations. AIM: The aim of our study was to improve our understanding of the coronary sinus morphometrical and topographical anatomy. METHODS: The investigations were carried out on 25 human hearts (from 11 male and 14 female persons of mean age 59.5; range: 40 to 75 years). The classic anatomical technique of microdissection (using neurosurgical microinstruments) was performed under the stereoscopic microscope on 10 specimens injected with a 10% formaldehyde solution. The arteries and veins of an additional 15 hearts were injected with methylmethacrylate and immersed in a 40% solution of NaOH for corrosion. Following washing out and drying, the obtained vascular casts were examined and measured. RESULTS: Coronary sinus (CS) extends from the opening of the oblique vein of the left atrium into the great cardiac vein, to its empty orifice into the right atrium. The length of CS varied between 22.4 and 41.4 mm (mean 33.0 ± 6.1 mm). The diameter of CS at its beginning was 5.0 - 9.6 mm (mean 6.6 ± 1.3 mm), and its diameter at its atrial mouth varied from 6.6 - 12.0 mm (mean 8.4 ± 1.6 mm). The CS had varied relationships to the branches of the left or right coronary arteries. It extended superficial and above the artery in 16 (64%) hearts, and close superficial to the artery in 9 (36%) cases. Duplication of the superior vena cava associated with an aberrant left hepatic vein was found in one case. The persistent left superior vena cava, which drained into the right atrium via the enlarged coronary sinus, was formed by the persistence of the left anterior cardinal vein. CONCLUSION: Our study shows that the coronary sinus, created in an early stage of embryological development, is an important collecting vessel receiving the main veins of the heart.

Introduction/Objective. Estimating the prevalence of non-communicable diseases (NCD), multimorbidities, and their association with self-rated health as well as satisfaction with healthcare. Methods. This cross-sectional study was conducted among ethnic Serb communities at Kosovo and Metohija during 2015−2016. Data of socio-demographic and lifestyle characteristics, self-rated health status and satisfaction with healthcare was obtained through a survey which included 1067 adults, 535 of whom reported presence of NCD. Multinomial regression was performed to analysis factors associated with self-rated health and self-rated satisfaction with the healthcare. Results. Presence of one NCD was reported by 50.1% respondents, whereas 23.1% of the respondents reported multimorbidity. While self-reported NCD presence was negatively associated with self-rated health (p = 0.001–0.016), no association between NCDs and satisfaction with healthcare was observed (p = 0.178–0.974). Being single (p = 0.011–0.017), lower educational level (p = 0.031–0.047), regular breakfast (p = 0.032), frequent vegetable intake (p = 0.009–0.029), no alcohol use (p = 0.010), shorter waiting time (p = 0.001–0.004) and sufficient finance for dental care (p = 0.021) were factors statistically significantly correlated with greater satisfaction with the healthcare. Conclusion. Presence of NCD was negatively associated with self-rated health status, while shorter waiting time and adequate finances were associated with higher level of satisfaction with the healthcare. The results of our study could be of the importance for policy makers in creating the more effective healthcare service in unstable political and security situations.

The COVID-19 virus pandemic had a drastic impact on the social lives of billions of people, hitting certain industries like a hurricane. What the answer will be to this and possible other occurrences of pandemics in the future will largely depend on the inventiveness of the researchers. Intellectual property is the first system to offer answers, opening patent bases to anyone developing new technologies to fight the COVID-19 pandemic. The need for the means of prevention, treatment, and care has caused thousands of different researches, which find inspiration and guidance for discovering new solutions in patents that already exist. Publication of scientific papers has never been so intense in any scientific field as in medicine since the fight against this virus began. The time since the beginning of the virus pandemic has shown that science and innovators are ready for such challenges, but the global health crisis has imposed a new challenge on the intellectual property system, which refers to the strict implementation of its rights at times when rapid and global effect is needed in order to avoid additional deterioration due to further circulation of the virus among the population, which inevitably leads to the emergence of new strains of the virus.

Thyroid storm is an acute and severe complication of thyrotoxicosis. It is characterized by high fever, sweating, tachycardia, and often heart failure too. The objectives of the paper is to present the case of a patient with thyroid storm developed after the trauma of the chest at previously apparently healthy individuals, diagnosed on the basis of clinical preview and based on the diagnostic criteria according to Burch and Wartofsky. The most common complication is Mb. Graves - Basedow, but often associated with multi-nodose goiter. Thyroid storm is the most severe form of thyrotoxicosis with a mortality rate of 8 to 25 %. Case report. We present an interesting case from our practice: thyroid storm caused after chest trauma in apparently healthy people, but with unrecognized hyperthyroidism and thyroid gland nodule. Conclusion. The objectives of this presentation were to raise awareness of the association between signs and symptoms of thyroid storm that dominate the clinical picture and complicate the initial presentation and the evolution of the situation caused by trauma. The treatment of hyperthyroidism resulted in conversion in sinus rhythm, withdrawal of symptoms and signs heart failure, and normalization of artery pressure.

The Protocol on Ozone Depleting Substances (ODS) was signed in 1987 in Montreal. The main goal of the protocol is the international consensus and action regarding the drastic decrease of production and use of these substances, which results in increased UV radiation and consequently has a negative impact on human health and ecosystem. Besides the review of the “legal and technical” implementation of the protocol until now and the withdrawal of ODS from use, this paper specially stresses the analysis of available research results regarding the positive impact on health, in correlation with the implementation of the Montreal Protocol (MP). Due to the results of the thirty-year-long use until now, the MP is referred to as one of the most successful international agreements, not only in the field of environmental protection, but also in the field of human health protection in relation to it, within a certain context. Besides the reduced negative impact of ultraviolet radiation (UV) to the ecosystem and people, we are also facing a reduced occurring trend of skin cancer, cataracts, and immune system diseases worldwide. Without the MP and its implementation, millions of people would have died because of UV radiation and the previously mentioned diseases. The treatment costs and the pressure to the health system in all the countries worldwide would have enormously increased because of that. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175030]

Introduction/Objective. Heroin is metabolized to 6-monoacetylmorphine (6-MAM) and morphine. The objective of this study is to examine 6-MAM, morphine, and codeine relationships in order to distinguish deaths related to heroin consumption from deaths related to morphine and/or codeine consumption. Methods. The autopsy blood and urine samples from 45 opioid drug addicts were examined. Gas chromatography/mass spectrometry was applied to evaluate morphine, 6-MAM, and codeine. Two groups were formed: 6-MAM-positive (n = 35) and 6-MAM-negative (n = 10). Results. Compared to the 6-MAM-negative group, blood morphine levels were higher in the 6-MAMpositive group (p = 0.022), while blood codeine levels were similar (p = 0.575). In the 6-MAM-negative group, the blood morphine/codeine ratio was 8.3, and it was 4.3 in the 6-MAM-positive group. There was no difference between the groups regarding urine morphine levels (p = 0.859). The urine morphine/ codeine ratio was 6.2 in the 6-MAM-negative group, whilst it was 32.2 in the 6-MAM-positive group. In the blood samples, morphine and codeine concentrations were significantly correlated (r = 0.607; p = 0.006). In urine samples, correlations between morphine and codeine (r = 0.766; p < 0.001), morphine and 6-MAM (r = 0.650; p < 0.001), as well as codeine and 6-MAM (r = 0.620; p < 0.001), were also significant. Conclusion. Analyses of 6-MAM and morphine/codeine ratio in blood and urine autopsy samples may be used as diagnostic tools to distinguish deaths related to the consumption of different opioid drugs.

Introduction: The intracranial part of the optic nerve is perfused by the upper hypophyseal and ophthalmic arteries. Standard anatomical textbooks have not dealt with the vasculature of this clinically important part of the central nervous system. Objective: To study morphological characteristics of perioptical arterial vascularization of the intracranial part of optic nerve. Material and methods: The study was conducted on 18 whole brains of both sexes (11 male and 7 female), from the age of 51-78 years, with no signs of changes in the structures of the central nervous system. The vasculature of the optic nerves was microdissected and examined under the stereoscopic microscope after injecting their arteries with a 10% mixture of India ink and gelatin, and fixation in a 5% solution of formalin. Results: Intracranial segment of the optic nerve was richly supplied, from both, the ventral and the dorsal side, strictly with penetrating branches which come from the pial arterial network originating from the internal carotid artery and the superior hypophyseal artery for the ventral nervous surface, and from the anterior cerebral artery for the dorsal nervous surface. Conclusion: In accordance with the objective, and based on the obtained results, we confirmed that intracranial segment of the optic nerve has a rich and very delicate vascular network.

Introduction/Objective. Compression, also called strain elastography imaging techniques, represent new echotomographic modality, which is a promising method for the differentiation of benign from malignant lesions, not only in the thyroid gland but also in other organs. The objective of this study is to evaluate the importance of compression elastography in the differentiation of benign and malignant thyroid nodules. Methods. We performed echotomographic examinations in B mode, and examinations using compression elastography in a total of 186 persons (152 females and 34 males, with the average age of 45.3 ± 13.5 years), with 264 nodules in the thyroid gland. Elastography was done in two steps: the first one through scoring elastographic figures, and the second one through the determination of the resistance index (strain ratio – SR). Results. Using elastography scores by Fukunari, 44 of 60 malignant nodules had a score of 3–4, while 152 of the 204 benign nodules had a score of 1–2. Using the receiver operating characteristic (ROC) analysis, the best cut-off point obtained using elastography scores was 2, with a sensitivity of 73.3% and specificity of 74.5%. Using the software-calculated SR we found that out of 89 nodules with SR ≥ 2.5, 52 were malignant nodules, while out of 175 nodules with SR < 2.5, 167 were benign nodules. Using the ROC analysis, the best cut-off point obtained using SR was > 2.5, with a sensitivity of 86.7%, and specificity of 81.9%. Conclusion. As a follow-up of standard echotomographic examination in B mode, compression elastography is a newly developed and promising technique in the differentiation of benign from malignant lesions. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175030]

Introducton/Objective. Insufficiency of relevant anatomic data and great neurological and neurosurgical significance were the reasons for this study with scientific and practical implications. The purpose was to determine, at the transverse in situ section of the head, the position and relations of the sylvian aqueduct of the mesencephalon by measuring its distances from particular brain and calvaria structures. Also, the aim was to determine the same distances according to axial sections by using MRI. Methods. The material consisted of twenty autopsy human heads. The section of the head was made at the level of the tentorial hiatus and the midbrain. After that, we measured the distances between the cerebral aqueduct and a) posterior border of the optic chiasm, b) upper border of the dorsum sellae, c) terminal bifurcation of the basilar artery, d) beginning of the straight sinus, e) internal occipital protuberance, f) tentorial edge (lateral from the aqueduct), and g) internal surface of the calvaria (lateral to the aqueduct). We determined the same distances by the MRI system. The measurements were made in 37 subjects. Results. The numerical data obtained by this study will be of benefit to neurosurgeons in choosing a surgical approach to the contents of the incisural space, and to neurologists for the exact localization of the lesion and interpretation of certain signs and symptoms. Conclusion. The results of a detailed examination of the sylvian aqueduct position and relations have shown that the use of MRI is the morphometric method of choice, because it is more precise for all the parameters monitored than in situ measurements. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175030]

As a mixed exocrine and endocrine gland pancreas has a very important role in the digestive tract. The juice of his exocrine part, which is released into the duodenum, carries more than 20 pancreatic enzymes, important for a normal process of digestion. Endocrine part of the gland, which consists of the islets-insula, actively participate in the metabolism of human organism, secreting two important hormones - insulin and glucagon. Because of its location, the pancreas is an extremely inaccessible organ for a physical examination. Despite of a large number of modern clinical methods for monitoring changes in the body, the detail knowledge of morphological characteristics of this gland is still very important. The material was taken from the cadaver of the fetus and newborn at the Institute of Pathology of the Faculty of Medicine. We classified samples of pancreas into three groups, with respect to age (from 3 months to neonates) and CS length. After dehydration and the molding compositions are cut at a thickness of between 6 and 10 microns. In addition to standard staining methods, some preparations are for identification of insula, painted by Grimelijus. In this study, we determined the morphological changes of the prenatal pancreas, from the third month of intrauterine fetal development, until the end of the fetal time and determine the dynamics of changes in the parenchyma and stroma. We could distinguish functional parts of the pancreas, in 10-11th week of development. In the first trimester of pregnancy, we have noticed an increase in parenchymal elements and the reduction of the stroma, which is slightly more pronounced in interlobular area, that clearly differentiating lobules. At the beginning of the second trimester of pregnancy, in the pancreas that are developing, we observed significant changes. The lobular structure of pancreas was clearly visible. Pancreatic acini are clearly differentiated and are in very close contact, since the stroma between them very reduced. Within almost all lobulus there are clearly expressed the islets of Langerhans, which are multiplied, different sizes, separated from the exocrine part by poorly expressed connective tissue. In the group of prematurely born children, we found that the morphology of the pancreas is very similar to the pancreas at the end of the fetal period.

Background/Aim. The optic nerve is anatomically observed in four segments: intrabulbar, orbital, canalicular, and cranial. According to the literature, the surface of the transversal cut of the nerve is different through it. The aim of this study was to evaluate the fascicular organisation of the optic nerve, throughout its three segments from the eye. Methods. Five pairs of optic nerves, obtained from the autopsies were examined. Using Heidenhain's (azan) staining, the cuts were prepared for microscopy. Morphometric analysis was performed using the stereological methods for morphometric cytology - the Weible’s testing system M42. The following measures were established: the surface of the transverse cut of the nerve, the entire surface of fasciculi, the entire surface of connective tissue and blood vessels, the number of fasciculi, the surface of a single fasciculus. Results. The surface of the transverse cut of the nerve was found to grow from the orbital to the cranial segment, as well as the entire surface of fasciculi. While their number is significantly lower in the cranial segment, the number of fasciculi varied slightly between the orbital and the canalicular segment. The surface of a single fasciculus grows from the bulb to the chiasma. There is probable a cause to believe that this may be due to fusion of the “small” fasciculi in the orbitocranial direction. Conclusion. There are significant differences among the examined parameters of the different parts of the optic nerve.

Background/Aim. Vascularisation of the distal, namely intracranial and intracanalicular parts of the optic nerve have not been explained in conventional textbooks of anatomy, while there have been explanations of proximal, that is intraorbital segment. The aim of this research was to study the pattern of arterial supply of the intracranial and intracanalicular part (the distal part) of human optic nerve. Methods. The optic nerve and the ophthalmic artery (OA), predominately in their intracranial and intracanalicular parts, were investigated in 25 human specimens by three different methods: macroscopic, stereomicroscopic, and histological observations. Mixture with 10% of India ink and gelatin was injected through the intracranial part of the internal carotid artery, and the most proximal part of the OA. Each optic canal specimen was fixed in formaldehyde and finally paraffin embedded, sectioned, and stained with Masson trichrome, Azan, Toluidin blue, and Van Gieson methods. Results. OA passed through the optic canal within the dural sheath of the optic nerve. In 44% of our specimens the OA was on the inferomedial side of the optic nerve at the entrance point to the optic canal. OA left the optic canal at its lateral border in the apex of the orbit in 72% of our specimens. The intracanalicular portion of the optic nerve receives arterial blood principally from the intracanalicular part of OA. OA gives one (72% of the specimens) to two branches that supply the intracanalicular part of the optic nerve. Each branch pierces the dura mater from below and then supplies the nerve through the pia mater. These arteries then terminate in a pial vascular network of continuous transverse centripetal arterioles and capillaries that surround each optic nerve. The rich anastomoses with branches of superior hypophyseal artery, from the cranial cavity, which take part in the optic nerve vascularization in its hole length, was observed. There were no intraaxial vessels in the intracranial and intracanalicular parts of the nerve in our specimens. Conclusion. These anatomical data offer important informations for understanding the variety of the pathology in the region of optic canal and orbitocranial junction, and is also useful for designing operative strategies. This report indicates the delicacy and vulnerability of the intracranial and intracanalicular capillary network to traumatic disruption.

The internal capsule and basal nuclei are supplied by perforating branches of the anterior cerebral artery (ACA), Heubner's artery, middle cerebral artery (MCA), internal carotid artery (ICA) and anterior choroidal artery (AChA). Some of the mentioned perforators vascularize both the internal capsule and basal nuclei, while some of them also perfuse the adjacent brain structures. Dorsal part of the anterior limb, knee and posterior limb of the internal capsule are commonly supplied by lateral MCA perforators. The intermediate part of the anterior limb is perfused by medial MCA perforators, while its ventral part is nourished by ACA perforators and Heubner's artery. The intermediate part of the knee is supplied by medial MCA perforators, while its ventral partis mostly vascularized by ICA and proximal AChA perforators. The intermediate part of the posterior limb is perfused by medial MCA perforators anteriorly and the proximal AChA perforators posteriorly. The ventral part is supplied by AChA perforators. The retrolenticular and sublenticular portions of the internal capsule are mainly nourished by distal AChA perforators. The caudate nucleus is supplied by perforators of the ACA, MCA and AChA, as well as by branches of the lateral posterior choroidal artery. Most of the putamen is vascularized by MCA perforators, and smaller parts by ACA and AChA perforators. The lateral segment of the globus pallidus is perfused by MCA perforators and partially by Heubner's artery and ACA, while its medial segment is supplied by ICA and AChA perforators. The ACA perforators, that most often originate from the initial 5.9 mm of the Al segment, range in number from 1 to 5 (mean, 2.2) and in diameter between 80 urn and 710 urn (average, 295 urn). Heubner's artery, which most often arises close to the anterior communicating artery, can be singular (72.5%), double (23%) or triple (4.5%). It varies in diameter from 190 urn to 1,600 um (average, 750 urn) and in length between 11 mmand36mm (mean, 22.4 mm). The MCA perforators, that most frequently originate from M1 segment (90.7%) and leptomeningeal branches (62.6%), range in number between 2 and 13 (mean, 8.1) and in diameter from 80 um to 1,300 um (mean, 520 um). Many perforators arise as individual vessels, and some of them with common trunks (70.8%). Medial and lateral group of these perforators can be distinguished. The ICA perforators, which more often arise close to the AChA originating site (35.4%) than from the ICA bifurcation point (10.4%), vary in number from 1 to 5 (average, 3) and in diameter between 70 μm and 500 um (mean, 236 μm). The AChA perforators that originate from its cisternal segment, range in number from 2 to 9 (mean, 4.5) and in diameter from 90 μm to 600 μm (mean, 325 μm).

This paper is based on piloting of blended learning as a transformative learning process in order to keep pace with technological innovation. Our redesign of the course was the intention of the use of blended learning as a tool for high-quality, meaningful and longer lasting knowledge, improvements in learning outcomes and greater engagement of students in learning. We chose Moodle platform as a highly sophisticated learning management system with many modules and its possibilities of application in the learning context to develop the online component as a supplement to classroom lessons. After conducting an analysis of the course and a questionnaire, we concluded that students use all the segments of the online component and they become more engaged, their assignments end on time and at the end they would express their satisfaction with the course redesign. Using the T-test for large independent samples there is statistically significantly better performance in the final test (p<0.01) for students who have used Moodle compared to students from the previous generation attending traditional classes, while in the theoretical part of the exam there are higher grades instead of middle, but without statistical significance (p>0.05), which leads us to the view that blended learning helps, above all, average students to upgrade and advance their knowledge. Considering that many of our student are athletes, blended learning is a good choice for them as they are professionally engaged in sports and they can follow the course and complete their assignments in addition to sports commitments. This piloting will serve as a parameter for future use of blended learning to be more adapted to the needs and objectives of students and eliminate any disadvantages. [ABSTRACT FROM AUTHOR]

Background/Aim. Vascularisation of the distal, namely intracranial and intracanalicular parts of the optic nerve have not been explained in conventional textbooks of anatomy, while there have been explanations of proximal, that is intraorbital segment. The aim of this research was to study the pattern of arterial supply of the intracranial and intracanalicular part (the distal part) of human optic nerve. Methods. The optic nerve and the ophthalmic artery (OA), predominately in their intracranial and intracanalicular parts, were investigated in 25 human specimens by three different methods: macroscopic, stereomicroscopic, and histological observations. Mixture with 10% of India ink and gelatin was injected through the intracranial part of the internal carotid artery, and the most proximal part of the OA. Each optic canal specimen was fixed in formaldehyde and finally paraffin embedded, sectioned, and stained with Masson trichrome, Azan, Toluidin blue, and Van Gieson methods. Results. OA passed through the optic canal within the dural sheath of the optic nerve. In 44% of our specimens the OA was on the inferomedial side of the optic nerve at the entrance point to the optic canal. OA left the optic canal at its lateral border in the apex of the orbit in 72% of our specimens. The intracanalicular portion of the optic nerve receives arterial blood principally from the intracanalicular part of OA. OA gives one (72% of the specimens) to two branches that supply the intracanalicular part of the optic nerve. Each branch pierces the dura mater from below and then supplies the nerve through the pia mater. These arteries then terminate in a pial vascular network of continuous transverse centripetal arterioles and capillaries that surround each optic nerve. The rich anastomoses with branches of superior hypophyseal artery, from the cranial cavity, which take part in the optic nerve vascularization in its hole length, was observed. There were no intraaxial vessels in the intracranial and intracanalicular parts of the nerve in our specimens. Conclusion. These anatomical data offer important informations for understanding the variety of the pathology in the region of optic canal and orbitocranial junction, and is also useful for designing operative strategies. This report indicates the delicacy and vulnerability of the intracranial and intracanalicular capillary network to traumatic disruption. [ABSTRACT FROM AUTHOR]