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Background/Aim. Coagulation disorders could be a cause of menorrhagia in women of reproductive age. The aim of the study was to estimate frequency of coagulation disorders and design an appropriate algorithm for detection of coagulation disorders. Methods. We investigated coagulation in 115 women (36.1 ? 9.6 years) with anamnestic data of menorrhagia, verified using semiquantitative method ? Pictorial Bleeding Assessment Chart (PBAC) with score ? 100. Results. Menorrhagia was objectively verified in sixty-four women (55.7%) and in comparison with those with normal menstruation they had higher PBAC score of menstrual cycle [median (Md) = 150.0 vs. Md = 50.0; p < 0.001] but not its duration (7.2 ? 2.1 days vs. 7.3 ? 1.9 days; p > 0.05). Coagulation defects was found in 12 (10.4%) women ? decreased F IX: Ac in 4 (3.5%), decreased F VII: Ac in 1 (0.9%), decreased F X: Ac in 1 (0.9%), decreased F XI: Ac in 1 woman (0.9%), while 5 (4.3%) women matched criteria for mild von Willebrand disease (VWD) type 1. Women with coagulation disorders had prolonged prothrombin time (PT) [Md = 13.1 s, range: 12.2?14.8 s vs. Md = 12.5 s, range 10.6?18.3 s; p = 0.032]. Anemia was diagnosed in 61 (53.0%) women. The strongest predictor of the hemostasis disorder was menorrhagia (Quotient of probability 0.018), then anemia presence (12.43), P? (2.35), menstrual cycle duration (1.16) and the PBAC score (0.98). Conclusion. The results of the study indicate the need to form a diagnostic algorithm for hemostasis disorders, primarily VWD. Sophisticated analysis of hemostasis is required, especially if predictive factors of statistical models are detected: objectively verified menorrhagia, anemia, prolonged menstrual cycle, PBAC score > 100 and extended PT.

Disorders and morphological abnormalities affecting the adrenal gland, could lead to profound clinical consequences, owing to its biochemical structure-activity and morphological characteristics. The recent focus on theranostic approach has led to a need for tumors characterization and early diagnosis at the molecular level. Many radiotracers have been developed with specific imaging characteristics for the adrenal tumors, by exploiting different physiological mechanisms of uptake and metabolism. The aim of present study is to provide a prospective confirmation of 131I-MIBG and 99mTc-HYNIC-TOC scintigraphy, for the evaluation of patients with known or suspected tumors of the adrenal region. The research is designed as a cross-sectional observational study of the clinical correlates and diagnostic accuracy of radionuclide-based imaging methods in relation to in vitro analysis, clinical manifestations and morphological characteristics of these tumors. Furthermore, the present study also evaluates the usefulness and the clinical impact of each radiopharmaceutical for the detection and management of tumors, and functional imaging modality as well. Visual scintigraphic appearance of an increased focal tracer uptake in the suspected tumor site revealed that 99mTc-HYNIC-TOC is highly sensitive and reliable tumor-seeking radiotracer for adrenal tumors, but does not distinguish between adenoma and pheochromocytoma, and the existence of hormone secreting adrenocortical tumor cells. However, 131IMIBG scintigraphy is highly sensitive and specific method only in differentiating catecholamine-secreting adrenal tumors. Clinical significance of this research is in the accurate localization of adrenal tumors, and is of paramount importance for an algorithmic diagnostic approach and management, and provide the rationale to different therapeutic possibilities.

Background The aim of this study was to evaluate the behavioral uptake and ability to diagnose pituitary adenoma (PA) using tumor-seeking radiopharmaceuticals, and to provide a semiquantitative analysis of tracer uptake in the pituitary region. Patients and methods The study included 33 (13 hormonally active and 20 nonfunctioning) patients with PA and 45 control participants without pituitary involvement. All patients (n=78) underwent single photon emission computed tomography (SPECT) imaging with technetium-99m-labeled hydrazinonicotinyl-tyr3-octreotide (99mTc-HYNIC-TOC), dimercaptosuccinic acid (99mTc(V)-DMSA) and hexakis-2-methoxyisobutylisonitrile (99mTc-MIBI). A semiquantitative analysis of abnormal uptake was carried out by drawing identical regions of interest over the pituitary area and the normal brain on one transverse section that shows the lesion most clearly. The pituitary uptake to normal brain uptake (P/B) ratio was calculated in all cases. Results The result of this study confirms that the SPECT semiquantitative method, with all three tracers, showed statistically significant differences between the PA group and the controls. However, 99mTc-HYNIC-TOC scintigraphy could have the highest diagnostic yield because of the smallest overlap between the P/B ratios between adenoma versus nonadenoma participants (the receiver operating characteristic curve P/B ratio cut-off value was 13.08). In addition, only 99mTc-MIBI SPECT have the diagnostic potential to detect secreting PAs, with statistically significant differences between groups (P

Introduction/The aim: The aim of this study is the assessment of sexual behavior and habits of medical and non-medical students in Belgrade. The research is designed as cross-sectional study conducted in the period from November until January 2016/2017. An anonymous and standardized questionnaire from the “National Health Survey” research protocol was used and variables of interest were added. A total of 1268 randomly selected students participated, from higher education institutions in Belgrade (College for Health Studies “Milutin Milankovic, Medical College of applied sciences in Zemun, Belgrade, Business Academy and Faculty of Security Studies in Belgrade). Results: Respondents from both groups almost had sexual relations with the opposite sex, although 2.2% of students of medical profession and 1.7% of non-medical profession had sexual relations with the same sex. Condoms are most often contraceptive measures used in both groups, (>40%). The most common reason for not using condom in both groups were partner's trust or reducing pleasure during intercourse (p

Background/Aim. Depression and anxiety problems are a major public health concern due to their high prevalence rates, difficult treatment, and often chronic course. This study examined the impact of somatic symptoms on depressive and anxiety symptoms among university students in Serbia. Methods. A cross-sectional study was performed among 1,940 students using a questionnaire specially designed for this study which included presence of Somatic and Non-specific Mental Symptoms (SNMS), Beck Depression Inventory and Beck Anxiety Inventory. The presence of somatic and associated non-specific mental symptoms over the last six months served as the basis for creating a new variable called SNMS score. Results. Receiver operating characteristic (ROC) curve showed that the SNMS score might be a very good marker for the distinction of students with or without depressive symptoms (area = 0.754, p < 0.05). The threshold value was 8.50 (sensitivity 67.6%, specificity 69.4%). Binary logistic regression showed that Odds ratio was 1.052 [95% confidence interval (CI) 1.045?1.059], which means that an increase in the value of the SNMS score by 1 increases the risk of depressive symptoms by 5.2%. ROC curve showed that the SNMS score might be an excellent marker for the distinction of students with or without anxiety symptoms (area = 0.800, p < 0.05). Limit value (cut-off) was 7.50 (sensitivity 74.2%, specificity 71.6%). Binary logistic regression showed that odds ratio was 1.056 (95% CI 1.049?1.064), which means that increasing the value of SNMS score by 1 increases the risk of anxiety symptoms by 5.6%. Conclusion. The SNMS score might be a state marker for the screening and distinction of students with depressive symptoms, and excellent state marker for screening and making distinction between students with anxiety symptoms and the students who do not have these symptoms.

The first part of the paper emphasises the need for education about death (death education) in early formal education, for which the author provides arguments from the psychological, sociological and biblio-therapeutic perspectives. The reality, however, shows that the education about death cannot be created easily, let alone implemented, within the current school curriculum: there is no empty slot in the curriculum that could be filled with it, nor are there teachers in Serbia competent enough to carry out the burden of such education. Still, if there is no room for a complete course, we should not give up on the idea of introducing partial education on the topic of death within the existing individual school subjects. Therefore, in the second part of the paper, we offer one possible approach to this topic in the Serbian language and literature classes through the interpretation of poetry for children with the motive of death in its center. Based on the interdisciplinary observation of the phenomenon of death, we will point out the aspects of discussion on this topic that can be involved in the interpretation of literary texts inside the classroom - this could also be helpful in discussing with pupils the topic that has the status of a taboo in modern education.

OBJECTIVE The aim of this study was to evaluate the screening performances of abnormal ductus venosus (DV) blood flow for the detection of heart defects in chromosomally normal fetuses with increased nuchal translucency (NT) thickness at 11-13 + 6 weeks' gestational in a population of singleton pregnancies. METHODS During an 8-year period, all singleton pregnancies from 11 + 0 to 13 + 6 weeks were scanned for NT and DV blood flow assessment. Two groups of cases with abnormal NT were evaluated: NT ≥ 95th and NT ≥ 99th centile. DV waveforms were considered to be abnormal if the a-wave was reversed or absent (R/A). RESULTS Addition of DV R/A a-wave to either NT ≥ 95th or NT ≥ 99th percentile increased specificity (p

Hereditary hemorrhagic telangectasia (HHT) or Rendu-Osler-Weber syndrome, is a rare genetic disorder with autosomal dominance and variable penetrance. The typical findings of the disease are telangiectasias in skin and mucous membranes, and arteriovenous malformations presenting in the organs like lung, intestine, brain and liver. It is characterized by the classic triad of recurrent epistaxis, mucocutaneous telangiectasias and visceral hemorrhages, with familial occurrence. This article describes a case of HHT of an adult patient, associated with multiple angiodysplasic injuries in the nasal mucosa, upper gastrointestinal tract, lungs and who presents continuous blood loss, resulting iron deficiency anemia. Based on clinical and diagnostic findings, we diagnosed this case as HHT, which has rarely been reported in our literature.

The cigarette smoking of younger population has been an issue of growing concern globally, since young people already face various life situations which can enhance the occurrence of depression and anxiety disorders. Aim and objective. The aim of this study is to determine the prevalence of cigarette smoking and its correlates of depressive and anxiety symptoms in university students population. Methods. The study was conducted as cross sectional study of average on the sample of 1940 university students by using a self-assessment standardized questionnaire of World Health Organization. The survey, in addition to questions concerning the cigarette smoking habits in youth, also includes the Beck Depression inventory and Beck Anxiety Inventory. Results. Based on the results of this study, the prevalence of cigarette smoking in students population is about 18%. The depressive symptoms were significantly related to the cigarette smoking (p

Objective. Previous experience in the treatment of multivessel coronary artery disease using PCI showed satisfactory short-term, but inferior long-term results in comparison to CABG. Certain groups of patients with multi-vessel disease treated with PCI may have long-term results equal to CABG. In the decision making process there is, apart from the angiographic finding, a need for careful evaluation of the patient's clinical state, treatment goals, previous knowledge and experience in order to reach the decision in the best interest of the patient. The aim of the study is to compare the outcome of PCI and TAXUS stent implantation with CABG in patients with multi-vessel coronary artery disease one year after the intervention. Methods. Our study included 114 patients in PCI group and 93 in CABG group, which were treated during 2004 and 2005. The outcome was expressed as the rate of MACCE which comprises death, reinfarction, CVI and reinterventions. Results. After one year follow-up composite MACCE rate was 17.5% in the PCI group and 14% in the CABG group (p=0.486). The rate of re-interventions between the PCI and CABG groups was 11,5% and 4.3% (p=0.064). There was no statistically significant difference between the incidence of MACCE (p=0.486) or between the frequency of reintervention between the groups (p=0.064). Conclusion. PCI with TAXUS stents implantation at one year follow up is equally effective as CABG in the treatment of multi-vessel coronary artery disease.

Almost all the studies of athlete's heart have been carried out on adult and older adolescent players; hence the limited data on the cardiac response to exercise in the beginning of the active sports career in the youngest athletes. The study was designed to examine the physiological limits of left ventricle (LV) cavity size and wall thickness in elite footballers at the preadolescent age, it the beginning of the active sports career. Ninety-four highly trained male footballers (mean aged 12.85±0.84) competing in the Serbian Football League and 47 age-matched healthy male controls, aged 12-14, were enrolled in the study. All the echocardiographic findings were adjusted to BSA(-0.5), while left ventricle mass (LVM) was additionally adjusted to BSA(-1.5). Reference ranges were defined as values of 5-95th centile according to the mean values in both groups. The proportions of the footballers with LV dimensions outside expected ranges were additionally noted. The data indicate significant increases in absolute values of LV dimensions, aortic root size and left atrium (p0.001) in preadolescent professional footballers compared with the values expected for age-matched controls, whereas there are no differences in absolute values of ventricular septal and posterior wall thickness, LV wall thickness and LVM (p0.05). Upon body-size adjustments, significant increases were observed in all echocardiographic parameters (p0.001). Our data indicate an early cardiac remodeling, already apparent in pre-adolescence, even after a short period of training.

The aim of this study was to evaluate the screening performances of abnormal ductus venosus (DV) blood flow for the detection of heart defects in chromosomally normal fetuses with increased nuchal translucency (NT) thickness at 11-13 + 6 weeks' gestational in a population of singleton pregnancies.During an 8-year period, all singleton pregnancies from 11 + 0 to 13 + 6 weeks were scanned for NT and DV blood flow assessment. Two groups of cases with abnormal NT were evaluated: NT ≥ 95th and NT ≥ 99th centile. DV waveforms were considered to be abnormal if the a-wave was reversed or absent (R/A).Addition of DV R/A a-wave to either NT ≥ 95th or NT ≥ 99th percentile increased specificity (p 0.001 and p 0.001, respectively), but not screening performances in detection of major heart defects (p = 0.73 and p = 0.91, respectively). Combination of DV R/A a-wave with NT ≥ 95th or NT ≥ 99th centile correlated with right heart defects (p = 0.024 and p = 0.013, respectively).In chromosomally normal fetuses, addition of abnormal DV a-wave to increased NT does not improve screening performances of NT in detection of major hearts defects in first trimester. However, there is correlation of such parameter with right heart defects and AV septal defects.

Aim. To assess the correlation between left ventricle remodeling induced by physical training with QTc duration in preadolescent professional football players. Material and methods. Ninety-four highly trained male footballers (mean aged 12,85±0,84) competing in the Serbian Football League (at least 7 training hours/ week) and 47 age-matched healthy male controls were enrolled in the study. Main outcome measures: They were screened by ECG and echocardiography at a tertiary referral cardio center. The control group had sedentary life style (less than 2 training hours/week). QTc values and left ventricle dimensions were compared in these two groups. Results. In all participants, normal values of QTc interval were registered. Mean QTc in athletes was significantly higher compared to non-athletes (419,89±13,07 msec vs 399,78±13,27 msec) (p