bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of quality of care in acute postoperative pain management
Authors: Milutinovic Dragana , Milovanovic Verica , Pjevic Miroslava , Martinov-Cvejin Mirjana , Cigic Tomislav
Published: December 2010

Background/Aim. Managing of acute postoperative pain should be of great interest for all hospital institutions, as one of the key components of patients satisfaction, which indicates quality, as well as the outcome of treatment. The aim of this study was to assess the quality of nursing care in managing acute postoperative pain and to establish factors which influence patients assessment of the same. Method. The investigation was conducted on the sample of 135 patients hospitalized in surgical clinics of the Clinical Centre of Vojvodina in Novi Sad in the form of cross-sectional study, by interviewing patients during the second postoperative day and collecting sociodemographic variables, type of surgical procedure and applied analgesic therapy which were taken from their medical documentation. The modified questionnaire of the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP) was used as the instrument of the investigation. The data were processed with suitable mathematical statistics methods such as multivariate analyses of variance (MANOVA), discriminative and other parametric procedures and methods. Roy's test, Pearson's coefficient contingency (?), multiple correlation coefficient (R) were conducted amongst other invariant procedures. Results. The mean score for the individual items of SCQIPP questionnaire was between 2.0 and 4.7 (scale range 1-5) and the percentage of patients answers 'strongly agree' ranged from 4.4 to 77%. The smallest number of positive answers were given by the patients for the item 'In order to assess pain intensity, some of the staff asked me at least once in the morning, in the afternoon and in the evening to show the number from 0-10'. Most of the patients (57%) evaluated severe pain during the previous 24 hours, as moderate pain, which represents significantly greater number of patients which complain of severe pain and mild pain (p < 0.001). The analysis of patients evaluation (MANOVA p < 0.05 and discriminative p < 0.05) indicates the existence of significant difference between the assessment of nursing care quality in managing acute postoperative pain as regards to clinics as the place for pain management, patient's sex and his expectations. Evaluation from 'communication' subscale gives the greatest contribution (24.9%) to the difference between the observed clinics, and the greatest contribution (25.7%) to the difference in evaluation of nursing care quality as regards to patients' sex has the evaluations from 'procedure' subscale. Conclusion. The results of this study show a useful evidence and identify aspects of nursing care in postoperative management of acute pain which are still to be improved. According to the patients' answers the priority should be given to a regular assessment of the intensity of postoperative pain and evaluation of the effects of analgesic therapy.
Anterior pituitary lobe atrophy as late complication of hemorrhagic fever with renal syndrome
Authors: Jovanovic Dragan , Kovacevic Zoran , Dragovic Tamara , Petrovic Marijana , Tadic Jelena
Published: December 2010

Introduction. Hemorrhagic fever with renal syndrome (HFRS) is acute infective multisystemic disease followed by febrility, hemorrhages and acute renal insufficiency. Bleeding in the anterior pituitary lobe leading to tissue necrosis occurs in acute stage of severe clinical forms of HFRS, while atrophy of the anterior pituitary lobe with diminution of the gland function occurs after recovery stage. Case report. We presented a patient with the development of chronic renal insufficiency and hypopituitarism as complication that had been diagnosed six years after Hantavirus infection. Magnetic resonance of the pituitary gland revealed atrophy and empty sella turcica. Conclusion. Regarding frequency of this viral infection and its endemic character in some parts of our country partial and/or complete loss of pituitary function should be considered during the late stage of HFRS.
Study of efficacy and safety of pharmacological stress tests in nuclear cardiology
Authors: Baskot Branislav , Rafajlovski Saso , Ristic-Angelkov Andjelka , Obradovic Slobodan , Gligic Branko , Orozovic Vjekoslav , Agbaba Nikola
Published: December 2010

Background/Aim. Treadmill test combined with myocardial perfusion scintigraphy (MPS) is a commonly used technique in the assessment of coronary artery disease. Many patients who cannot adequately perform exercise stress testing may nevertheless undergo pharmacological tests, most commonly with the vasodilator agents (adenosine and dipyridamole), as well as the positive inotropic agent dobutamine. Patients undergoing vasodilators stress testing with either dipyridamole or adenosine also perform simultaneous low-intensity exercise. The aim of this study was to compare various pharmacological stress tests alone or in combination with low intensity exercise as preparation for MPS in reagard to incidence of adverse effects, quality of diagnostic image and the acquisition initial time. Methods. A total of 2 205 patients underwent pharmacological stress tests. Pharmacological stress test with adenosine was applied in 493 patients. In 405 of them we performed concomitant low level exercise (50 W) by bicycle ergometar (AdenoEX). In 88 of them we performed adenosine abbreviated protocol (AdenoSCAN). In 1 526 patients we performed pharmacological stress test with dipyridamole. In 871 of them we performed concomitant low level exercise (50 W) by bicycle ergometar (DipyEX), and in 775 we used only dipyridamole protocol (DipySCAN). In 186 patients we used pharmacological stress test with dobutamine. We followed side effects of adenosine, dipyiridamole and dobutamine, compared results between protocols with concomitant low level exercise and vasodilatators only. We also compared image quality, and suggested time of acquisition after stress test. Results. We found numerous side effects especially with adenosine, but these effects were short-lived and not required active interventions. Benefit with concomitant exercise in booth AdenoEX and DipyEX included decreased side effects (AdenoEX vs AdenoSCAN 62% vs 87%, respectively, and DipyEX vs DipySCAN 37% vs 59%, respectively) improved safety and patients tolerance, improved target-to-background ratios because of less subdiaphragmal activity, and earlier acquisition time. Because of producing a lot of arrhythmias (in 49% of patients) dobutamin was considered a last choice for pharmacological stress testing. Conclusion. Safety and efficacy of vasodilatators (adenosine, dipyridamole) pharmacological stress tests are good, but with concomitant exercise even better. The safety and efficacy of adenosin are better than those of dipyridamole. AdenoEX protocol provides good safety and patients tolerance. In light of these benefits we recommend AdenoEX whenever possible. Dobutamine is the last pharmacological toll for MPS.
Treatment of subacute hepatitis B with lamivudine: A pilot study in Serbia
Authors: Delic Dragan , Nesic Zorica , Prostran Milica , Boricic Ivan , Svirtlih Neda
Published: December 2010

Background/Aim. The incidence of acute hepatitis B viral (HBV) infection in adults has increased in recent years in Serbia. Most icteric patients with acute hepatitis B resolve their infection and do not require treatment. Fulminant hepatitis B is a severe form of acute infection complicated by encephalopathy and liver failure. Subgroups of fulminant hepatitis B including hyperacute, acute and subacute are defined by the interval between jaundice and encephalopathy. Fulminant hepatic failure or subacute hepatitis B infection we observed in about 1% of all cases. In cases of fulminant hepatic failure or subacute form of HBV infection orthotopic liver transplantation can be life-saving operation, but in our country this procedure is difficult to achieve. Lamivudine has been established as a safe and effective antiviral agent for the treatment of chronic HBV hepatitis. Methods. In our pilot study performed at the Institute of Infectious and Tropical Diseases in Belgrade, Serbia in the period between 2002 and 2006 we treated 10 patients with clinically verified subacute HBV infection with lamivudine, 100 mg orally per day. Results. The most of the treated patients (9/10; 90%) survived subacute form of hepatitis B. After a few weeks of the treatment serum aminotransferase levels and other liver-function tests were normalized. Also, after a four-month lamivudine treatment all the patients lost HBsAg. Lamivudine was discontinued after six months in all the patients. In addition, six months after lamivudine was discontinued the patients remained well with normal results on liver-function tests. Conclusion. The obtained results suggest significant efficacy of lamivudine in patients with subacute hepatitis B. Also, we suggest that lamivudine therapy should be administered early in progression of subacute disease since it could be life-saving treatment in some patients, especially in the countries (like Serbia) where orthotopic liver transplantation is difficult to achieve.
Correlation between olfactory dysfunction and various clinical parameters in patients with multiple sclerosis
Authors: Kostic Jelena , Stefanova Elka , Pekmezovic Tatjana , Drulovic Jelena
Published: December 2010

Background/Aim. Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) characterized by myelin destruction and axon loss. Among various clinical manifestations of MS cognitive disorders are frequent. Olfactory disorders are also noticed but they are rarely considered in clinical practice. The aim of the present study was to examine frequency of olfactory dysfunction in patients with MS and its relationship to clinical parameters. Methods. Our study comprised 61 consecutive patients with definite MS who were hospitalized at the Department for Multiple Sclerosis and Other Immune- Mediated Disorders of CNS, Institute of Neurology, Clinical Center of Serbia, Belgrade, and 45 gender-, age- and education-matched healthy voluntaries. The Pocket Smell Test (PST) was used for examination of olfactory function. Cognitive functions were analyzed using the tests from the Brief Battery of Neuropsychological Tests: Paced Auditory Serial Addition Test 3-minute Version (PASAT 3'), Word List Generation (WLG) and Symbol Digit Modalities Test (SDMT). Results. Olfactory dysfunction was found in 26 (43%) MS patients and 5 (11%) controls (p = 0.001). Statistically significant positive correlation was found only between PST score and WLG scores (r = 0.297, p = 0.030). In comparison with the previously published normative values, our subjects with MS had decrease in the mean indices of the PASAT 3' in 28%, SDMT in 51% and WLG in 90% of the subjects. Conclusion. Olfactory dysfunction is frequent in our population of patients with MS. This disturbance correlates with the impairment of cognitive functions in these patients.
Assessment of diabetes mellitus type 2 treatment costs in the Republic of Serbia
Authors: Biorac Nenad , Jakovljevic Mihajlo , Stefanovic Danka , Perovic Sasa , Jankovic Slobodan
Published: December 2010

Background/Aim. High morbidity and mortality rates, chronic course of disease and numerous clinical complications, make diabetes mellitus (DM) type 2 bear significant financial burden for healthcare system of Serbia. The aim of this study was to compare true disease-related expenses measured in the random sample of patients originating from the Central Serbia in 2007 and national estimate of total expenses based on available evidence on antidiabetic drugs and insulins acquisition costs in the same fiscal year. Methods. The study design was prevalence-based, bottom-up cost of illness analysis. It was implemented on a randomized sample of 99 adults with confirmed diagnosis of DM type 2. During 2007 all direct (drug acquisition, medical services, medical devices usage) and indirect costs associated with their primary disease (premature death, impaired working ability, early retirement, absentism), were taken into account. Other approach was to calculate average national rate of antidiabetic drugs and insulin utilization and sales at the domestic market during the mentioned period of time. Taking into consideration available estimate from the Institute of Public Health of Serbia of 475 000 people with this disease at the national level, we were able to compare these data. Assuming that our sample was enough representative and that the structure of costs was approximately similar at the local and national level, we were able to calculate an estimate of total cost of the disease. All costs were expressed in Serbian official currency, dinar (CSD). Results. Values of costs measured per patient in our sample in a given year were for drug acquisition 20 352.45 CSD, medical services 24 338.26 CSD, medical devices 3 174.46 CSD and loss of productivity and absentism 5 547.78 CSD. There were 2 cases of early retirement due to the disease and no cases of dialysis treatment or premature death. A total number of sickness absence days of employed patients, was 1 025 and a total number of hospital treatment days was 360. A total amount of all costs was 53 412.96 CSD per patient per year. According to the National Medicines and Medical Devices Agency an overall value of oral antidiabetic drug sales for 2007 per patient was 1 835.32 CSD and for insulins and analogs 2 948.18 CSD. Conclusion. Comparing true size of national financial burden of DM type 2 with experiences of other authors, we can see that it is comparable with European OECD average. But, if the structure of expenses is taken into account, Serbia is more similar to those countries reported in the Third World economies. Our local findings on a sample of diabetic population show that real patient expenses were even 2.28 times higher than those estimated at the national level.
Contribution and significance of Heidelberg retinal tomography II in diagnostics of ocular hypertension and its conversion into primary open-angle glaucoma
Authors: Markovic Vujica , Kontic Djordje , Hentova-Sencanic Paraskeva , Bozic Marija , Marjanovic Ivan , Krstic Vera , Kovacevic Dragana
Published: December 2010

Background/Aim. A term 'ocular hypertension' is used when IOP is found to be > 21 mmHg on two consecutive occasions, in the absence of detectable glaucomatous damage. The aim of this study was to determine the significance and contribution of Heidelberg Retinal Tomography II (HRT II) results that show very early, subtle changes in retinal neurofibre layers (RNFL) in the optic nerve head that are specific for glaucoma itself (the loss of neuroretinal rim area and an increase of Cup/Disc ratio), but are not possible to register by an ophthalmoscope. Also, when the results of the functional tests remain unchanged, that confirms the conversion of ocular hypertension into glaucoma. Methods. During a 5-year study period (2002-2007), 29 patients with ocular hypertension were examined. The frequency of control examinations, based on the presence of risk factors for glaucoma development, was 3-6 months. The examination also included IOP measurements with Goldmann Applanation Tonometry (GAT), central corneal thickness (CCT) determination by pachymetry, the examination of chamber angle using indirect gonioscopy, visual field tests by computerized perimetry and also papillae nervi optici (PNO) examination by using HRT II. The application of HRT II enables a great number of stereometric parameters of optic disc, the most important being the rim area and Cup/Disc (C/D) ratio, which was followed during the control examination by each segment, as well as PNO in global. Results. In the examination period, three cases of conversion of ocular hypertension into a primary open-angle glaucoma were found. In the group of patients with ocular hypertension, HRT II results after six months did not show a significant increase in C/D ratio. No significant loss of rim area or rim volume was found either. In three cases of conversion, HRT II results after 3 months showed an increase of C/D ratio and also a significant loss in rim volume at first examination (0.413) comparing to the last one. Conclusion. In diagnosing ocular hypertension and its conversion to glaucoma, HRT II is used for quantitative evaluation of retinal topography and for quantitative monitoring of topographical changes, especially regarding the increase of C/D ratio and loss of rim volume tissue, which enables to see and register subtle structural changes in optic nerve head and RNFL that are so characteristic for glaucoma, which cannot be seen by an ophthalmoscope. With these results, according to risk factors for glaucoma, one can confirm the diagnosis of ocular hypertension and its conversion to primary open-angle glaucoma. In this study HRT II revealed conversion of ocular hypertension into glaucoma in 10% of the patients.
The importance of tests applied to evaluate the effectiveness of antiplatelet therapy in patients with recurrent coronary stent thrombosis
Authors: Grdinic Aleksandra , Vojvodic Danilo , Ilic Vesna , Magic Zvonko , Djukanovic Nina , Radovanovic Mina , Miljic Predrag , Obradovic Slobodan , Majstorovic Ivana , Cikota Bojana , Ostojic Miodrag
Published: December 2010

Background. Stent thrombosis is potentially lethal complication with huge economic burden. The role of insufficient response to antiplatelet therapy is still unclear reason for its occurrence. Case report. We presented 54-year-old man with recurrent stent thrombosis on the 4th, 9th and 12th day after the primary percutaneous coronary intervention in spite of double antiaggregation therapy (aspirin+ clopidogrel). All possible procedural causes were excluded and reimplantation of intracoronary stent was insufficient to resolve the problem, so four platelet tests were performed: flow cytometry, Platelet Function Analyzer-100 test, aggregometry, and determination of gene polymorphism for P2Y12 receptor (directly involved in the mechanism of thienopyridine), and GPIIbIIIa receptor (final receptor in aggregation). The patient was the carrier of the major haplotype H1H1 for P2Y12 receptor and minor A1A2 for GPIIbIIIa receptor. The results of all the performed tests showed insufficient antiplatelet effect of aspirin and sufficient response to thienopyridin (not to clopidogrel, but to ticlopidine). Conclusion. Performance of platelet function tests is necessary in the case of major adverse cardiac events especially stent thrombosis, after implantation of intracoronary stent.
Acute myocardial infarction following a hornet sting
Authors: Cvetkovic-Matic Danica , Asanin Milika , Matic Dragan , Ivanovic Branislava , Simic Dragan , Kalezic Nevena , Stojanov Vesna
Published: December 2010

Background. The occurrence of an acute myocardial infarction following a hornet sting has been very rarely reported in the previous literature. Pathogenetic mechanisms include direct action of the venom components on the coronary endothelium and allergic reaction with mediators released from mast cells. The anaphylactic reaction and venom components can produce acute coronary artery thrombosis. Case report. We reported a 45-year-old man with acute myocardial infarction after a hornet sting in the presence of anaphylaxis. We also discussed clinical implications and pathophysiological mechanisms of acute myocardial infarction caused by hymenoptera sting. Conclusion. A case report of this unusual acute myocardial infarction highlights the potential acute myocardial ischemia associated with hymenoptera sting which requests early diagnosis, thorough cardiovascular evaluation and appropriate treatment.
Influence of acclimatization on serum enzyme changes in soldiers during exertional heat stress
Authors: Radakovic Sonja , Maric Jelena , Surbatovic Maja , Vasiljevic Nadja , Milivojevic Mladen
Published: December 2010

Background/Aim. Exertional heat stress is common problem in military services. The aim was to examine changes in serum concentrations of some enzymes in soldiers during exertional heat stress test (EHST) as well as the effects of 10-days passive or active acclimatization in climatic chamber. Methods. Forty male soldiers with high aerobic capacity, performed EHST either in cool (20 ?C, 16 ?C Wet bulb globe temperature - WBGT), or hot (40 ?C, 25 ?C WBGT) environment, unacclimatized, or after 10 days of passive or active acclimation. Physiological strain was measured by tympanic temperatures (Tty) and heart rates (HR). Concentrations of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and creatine-kinase (CK) were measured in blood samples collected before and immediately after EHST. Results. Exertional heat stress test in hot conditions induced physiological heat stress (increase in Tty and HR), with significant increase in concentrations of all enzymes in unacclimatized group: ALT (42.5 ? 4.2 before vs 48.1 ? 3.75 U/L after EHST, p < 0.01), AST (24.9 ? 5.1 vs 33.4 ? 4.48 U/L, p < 0.01), LDH (160.6 ? 20.2 vs 195.7 ? 22.6 U/L, p < 0.001) and CK (215.5 ? 91.2 vs 279.1 ? 117.5 U/L, p < 0.05). In acclimatized soldiers there were no significant changes in concentrations of ALT and AST, while concentration of CK was significantly higher. Concentrations of LDH were significantly higher in all investigated groups, regardless of temperature conditions. Conclusion. In trained soldiers, 10-days passive or active acclimatization in climatic chamber can prevent increase in serum concentrations of ALT and AST, induced by exertional heat stress. Increase of serum concentrations of CK and LDH was induced by physical strain itself, with no additional effect of heat stress.
Role of lipid peroxidation in pathogenesis of senile cataract
Authors: Kisic Bojana , Miric Dijana , Zoric Lepsa , Dragojevic Ilija , Stolic Aleksandra
Published: December 2010

Background /Aim. Cataract is a structural, biochemical and optical change in the eye lens, which changes transmission and refraction of light rays reducing keenness and clarity of a figure on the retina. Its occurrence is highest in older people, over the age of 65 (45.9%), thus a certain degree of opacification exists practically in all people over the 70. Our research was directed to measuring of lipid peroxidation products in cataract lenses involved in early stages of cataractogenesis through oxidative stress and in the development of mature cataract. Methods. Clinical and biochemical research was carried out in 101 patients with cataract, 46 women and 55 men. The average age of the group was 72.47 (? = 7.98). According to the cataract maturity degree the patients were classified into two groups as follows: cataracta senilis incipiens (n = 41) and cataracta senilis matura (n = 60). Measuring of diene conjugates was carried out by spectrophotometer. Fluorescent lipid peroxidation products were measured by a spectrofluorophotometer, and malondialdehyde (MDA) concentration was measured by colorimeter as a product of a reaction with thiobarbituric acid (TBA). Result. Significantly higher diene conjugated concentration in lenses was measured in the patients with the diagnosis cataracta senilis incipiens (p < 0.001) as well as the intensity of fluorescent iminopropens (p < 0.001). Significantly higher MDA concentration in lens (p < 0.001) was measured in the patients with cataracta senilis matura. Conclusion. The lens structure changes caused by lipid peroxidation can, with other risk factors present, influence the occurrence and development of mature cataract. Some cataract types show different lipid peroxidation intensity with the most distinct changes in cataract which started as corticonuclear.
Implications of anesthetic techniques on patients' recovery in laparoscopic cholecystectomy
Authors: Stosic Biljana , Stojanovic Miroslav , Jankovic Radmilo , Radojkovic Milan , Ignjatovic Nebojsa
Published: December 2010

Background/Aim. Different techniques of general anesthesia are used for laparoscopic cholecystectomy (LC). The aim of the study was to establish the best anesthetic technique for achieving better results during awakening affecting not only patient's recovery, but activities of anesthesiological team, as well. Methods. The study was conducted as a prospective comparative clinical trial. The patients (n=90) were classified according to the applied anesthetic technique into two groups: Volatile Induction and Maintenance Anesthesia (VIMA) with sevofluran and Target Controlled Infusion (TCI). The results relating to parameters of recovery after anesthesia and surgery were compared between these two groups. The following parameters were analyzed: demographic patients' characteristics, duration of anesthesia, the times to eye opening, to respond to a command, to extubation, and to orientation, from the last anesthetic dose receiving until post anesthesia discharge (PAD), frequency of postoperative nausea, vomiting and agitation (PONVA). Results. In the examined groups there were no statistically significant differences in the duration of anesthesia (68.29 ? 6.47 vs 66.29 ? 11.97 min, p = 0.327). The time to eye opening was significantly shorter in the group VIMA compared to the group TCI (4.49 ? 1.20 vs 7.42 ? 1.25 min, p = 0.000), as well as the time to respond to a command (5.93 ? 1.12 vs 8.47 ? 1.08 min, p = 0.000). The patients anesthetized with VIMA technique were statistically significantly extubated earlier (6.84 ? 1.19 vs 9.69 ? 1.31 min, p = 0.000). Considering orientation time, there was also statistically significant difference between the two groups (7.51 ? 0.97 vs 11.60 ? 1.75 min, p = 0.000). There was no statistically significant difference in PAD time duration (19.42 ? 5.99 vs 20.80 ? 1.59 min, p = 0.142). There were no statistically significant differences in PONVA events between the examined groups. Conclusion. This study showed that VIMA technique with sevofluran in LC provides faster and more qualitative recovery of patients. Thus this technique should be applied in everyday anesthesiological procedures in LC, as well as in other minimally invasive videoendoscopic surgical procedures.
Breast reconstruction following amputation for cancer
Authors: Visnjic Milan , Kovacevic Predrag , Paunkovic Ljiljana , Djordjevic Goran , Budjevac Dragana , Visnjic Aleksandar
Published: December 2010

Background/Aim. Today, breast reconstruction is a widely accepted method in the treatment of breast cancer after modified radical mastectomy. Reconstruction methods are associated with an acceptable number of complications and reconstruction favorably impacts quality of life. The aim of the study was to present our experience in breast reconstruction. Methods. We presented here a four-year experience with 84 patients with breast reconstruction after modified radical mastectomy. Results. Implant reconstructions were most common, 44 (52.3%), with primary reconstruction in 31(70.4%) and secondary in 13 (29.5%) women. Lattisimus dorsi flap (LDF) and implant were utilized in 32 (38%) of the patients, with primary reconstruction in 24 (75%) and secondary in 8 (25%) women. Transversal rectus abdominis myocutaneous (TRAM) flap was rarely used - just in 8 (9.5%) patients and only for secondary breast reconstruction. Postoperatively, some early complications such as hematoma, seroma, infections and partial flap necrosis were observed in 10 (11.9%) patients. Late complications, such as implant rejection, hypertrophic scarring and hernias at the flap elevation site, were noted in 10 (11.9%) cases. Implant loss occurred in 5 (5.9%) cases. All the complications were successfully managed, and patients rated their reconstruction as follows: excellent, 49 (59%) cases; very good, 20 (24%), and good, 14 (16.8%). In one case, disease progression was observed 6 months after the primary breast reconstruction. Conclusion. Breast reconstruction is an acceptable method in the treatment of breast cancer in patients in the need for or with already performed mastectomy. The choice of reconstruction approach depends on the breast volume, patient's wish and experience of surgical team. Our results suggest the advantage of breast reconstruction with LDF with implant, since the technique is safe, complications relatively rare and easily manageable, and the results are excellent or very good in each woman.
Incidence and treatment outcome of oral lichen planus in Southeast Serbia in a 10-year period (1997-2007)
Authors: Kesic Ljiljana , Obradovic Radmila , Mihailovic Dragan , Radicevic Goran , Stankovic Sasa , Todorovic Kosta
Published: December 2010

Background/Aim. Lichen planus is a chronic, immunologic, mucocutaneous disease with a wide range of clinical manifestations. The aim of this retrospective study was to evaluate the most common forms of oral lichen planus (OLP) and its symptoms and to describe treatment responses in patients during 10-year period. Methods. The study was conduced on 163 OLP patients who came in the Department of Oral medicine and Periodontology between 1997 and September 2007. Each case was classified into one of four clinical subtypes: reticular, atrophic, erosive-ulcerative, bullous. Results. There was no significant difference in patients age. Women were found to be significantly more likely to have OLP (p < 0.001). Corticosteroids were effective in reducing symptoms, erythema and healing ulcers. Improvement was shown over a long term in 61.35% patients. Over the long term 38.65% patients maintained the same type of OLP or it became a more severe type. Two patients (1.22%) developed oral carcinoma during the follow-up period. Conclusion. The response of patients with erosive OLP to a short course of systemic corticosteroids often was quite remarkable. However, symptoms and signs tended to recur after this treatment. Periodic examinations, patient education, medical treatment, monitoring of side-effects as well as follow-up biopsies are necessary for management of OLP patients.
Clinical evaluation of oxidative stress in patients with diabetes mellitus type II: Impact of acute exercise
Authors: Kostic Nada , Caparevic Zorica , Marina Djordje , Ilic Sanja , Radojkovic Jana , Cosic Zoran , Bakic-Celic Vera
Published: December 2010

Background/Aim. Exercise is a well recognized model of oxidative stress and, also, an important tool in diabetes management. The aim of our study was to evaluate oxidative stress in patients with diabetes mellitus type 2 and to determine influence of acute exercise training on the investigated parameters. Methods. To evaluate oxidative stress in the patients, we determinated following parameters: triglycerides (TG), total cholesterol, low density lipoprotein cholesterol (LDL), oxidized LDL cholesterol (Ox LDL), superoxide dismutase (SOD), glutathione peroxidase (GSHPx), plasminogen activator inhibitor (PAI) which were measured at rest and immediately after the acute bout of cardiopulmonary exercise cycle-ergometer test. Results. In basal condition, diabetic patients compared to controls have significant higher values of TG (3.12 ? 1.09 vs 1.74 ? 0.9 mmol/L, p < 0.01), Ox LDL (84.73 ? 16.90 vs 79.00 ? 29.26 mmol/L, p < 0.05) and SOD enzyme activity (913.38 ? 120.36 vs 877.14 ? 153.18 U/g Hb, p < 0.05). During the acute exercise test, there was significant increase of Ox LDL in both the study patients (from 84.73 ? 16.90 to 92.33 ? 23.29 mmol/L, p < 0.05) and in the control group (from 79.00 ? 29.26 to 89.30 ? 29.07 mmol/L, p < 0.05). SOD activity was significantly increased in both groups during exercise, in diabetic patients from 913.38 ? 120.36 to 921.50 ? 130.03 U/gHb, p < 0.05, and in the controls from 877.14 ? 153.18 to 895.00 ? 193.49, U/gHb, p < 0.05. GSH-Px activity was significantly increased only in the diabetic patients after the acute exercise (from 45.04 ? 11.19 to 51.81 ? 15.07 U/gHb, p < 0.01), but not in the controls (from 44.63 ? 13.73 to 43.97 ? 25.97 U/gHb, p = ns). PAI significantly decreased during the exercise test, only in the healthy subjects (from 2.60 ? 0.35 to 2.22 ? 0.65, p < 0.05). Type 2 diabetic patients with complications had only significant increase in GSH-Px activity (from 47.10 ? 7.37 to 54.52 ? 11.97 U/gHb, p < 0.01). Conclusion. Elevated Ox LDL, SOD and GSH-Px levels are associated with acute exercise in type 2 diabetic patients. We suggest that it could be a compensatory mechanism to preventing free radicals tissue damage. We hypothesize that a physical training program induces an enhance of muscular and liver antioxidant enzymes activity and reduces oxidative stress. Further studies are needed to explore the relationship between exercise and antioxidant system in diabetic patients with and without complications.
Incidence of nasopharyngeal carcinoma in Belgrade during the period 1991-2005
Authors: Nesic Vladimir , Sipetic Sandra , Vlajinac Hristina , Miljus Dragan , Stosic-Divjak Svetlana , Jesic Snezana
Published: December 2010

Background/Aim. Nasopharyngeal carcinoma (NPC) is a relatively rare malignant disease, of which 80 000 individuals become ill around the world annually, which amounts to 0.7% of all carcinomas. The aim of this descriptive study was to analyze NPC incidence in Belgrade (the capital city of Serbia, with about 1.6 million inhabitants) during the period 1991-2005. Methods. In data analysis, crude rates age and sex specific rates, and standardized incidence rates were used. Standardization was performed by a direct method, using world population as the standard. Results. In Belgrade, during the observed 15-year-period, the number of new NPC patients totaled 118, of which 86 (72.9%) were male and 32 (27.1%) were female. The average standardized incidence rate for men was 0.52 per 100 000 and for women 0.16 per 100 000. In both sexes the incidence was very low before 40 years of age. In men, the greatest incidence rate of NPC was in the 50-59 years age group, and in women in those 60 and more years old. Furthermore, undifferentiated carcinoma of nasopharyngeal type was 3.6 times more often in comparison to squamous cell carcinoma. Conclusion. Belgrade belongs to a region with a low incidence rate of NPC. Further investigations are needed to explain higher frequency of undifferentiated carcinoma of nasopharyngeal type than squamous cell carcinoma.
Determination of infiltrative ductal breast carcinoma differentiation grade in biopsy imprints
Authors: Vukasinovic-Bokun Zorana , Bokun Radojka , Tatomirovic Zeljka
Published: December 2010

Background/Aim. In patients with breast carcinoma there are many risk factors for assessment of breast carcinoma maturity and prognosis. Besides histological type of differentiation, cytologic criteria for the evaluation grade of the differentiation of infiltrative ductal breast carcinomas are very important for prognosis. The aim of this study was to define cytologic criteria for grading of infiltrative ductal carcinomas of the breast. Methods. The imprints of intraoperative biopsies from 124 patients were studied. They were air-dried and stained by May-Gr?nwald Giemsa method. The features assessed were: the degree and type of cell clustering, nuclear diameter and pleomorphism, chromatin structure, number and features of nucleoli, the aspect of cytoplasm, noncellular background and the variability of cells and nuclei. According to these morphologic features the infiltrative ductal carcinomas of the breast could be classified into three grades of differentiation. Results. Cytologic and histologic differentation grade revealed disagreement among 34.6% of the imprints. In 9 of total 23 histologicaly well differentiated carcinomas, cytological differentation grade was moderately differentiated. In 63 carcinomas with histologic differentiation grade II, cytologic differentiation grade was good in 12 and poor in 16 carcinomas. Conclusion. Cytologic and histologic grading were not identical in 34.6% of the imprints what points out the need to further definition of diagnostic criteria, especially for grade II of differentiation.
Empirical antimicrobial therapy of acute dentoalveolar abscess
Authors: Matijevic Stevo , Lazic Zoran , Kuljic-Kapulica Nada , Nonkovic Zorka
Published: December 2010

Background/Aim. The most common cause of acute dental infections are oral streptococci and anaerobe bacteria. Acute dentoalveolar infections are usually treated surgically in combination with antibiotics. Empirical therapy in such infections usually requires the use of penicillin-based antibiotics. The aim of this study was to investigate the clinical efficiency of amoxicillin and cefalexin in the empirical treatment of acute odontogenic abscess and to assess the antimicrobial susceptibility of the isolated bacteria in early phases of its development. Methods. This study included 90 patients with acute odontogenic abscess who received surgical treatment (extraction of a teeth and/or abscess incision) and were divided into three groups: two surgicalantibiotic groups (amoxicillin, cefalexin) and the surgical group. In order to evaluate the effects of the applied therapy following clinical symptoms were monitored: inflammatory swelling, trismus, regional lymphadentytis and febrility. In all the patients before the beginning of antibiotic treatment suppuration was suched out of the abscess and antibiotic susceptibility of isolated bacteria was tested by using the disk diffusion method. Results. The infection signs and symptoms lasted on the average 4.47 days, 4.67 days, and 6.17 days in the amoxicillin, cefalexin, and surgically only treated group, respectively. A total of 111 bacterial strains were isolated from 90 patients. Mostly, the bacteria were Gram-positive facultative anaerobs (81.1%). The most common bacteria isolated were Viridans streptococci (68/111). Antibiotic susceptibility of isolated bacteria to amoxicillin was 76.6% and cefalexin 89.2%. Conclusion. Empirical, peroral use of amoxicillin or cefalexin after surgical treatment in early phase of development of dentoalveolar abscess significantly reduced the time of clinical symptoms duration in the acute odontogenic infections in comparison to surgical treatment only. Bacterial strains isolated in early stages of dentoalveolar abscess showed high sensitivity to amoxicillin and cefalexin.
Oxidative status evaluation in elite karate athletes during training process
Authors: Pesic Snezana , Jakovljevic Vladimir , Cubrilo Dejan , Zivkovic Vladimir , Jorga Vladimir , Mujovic Vujadin , Stojimirovic Biljana
Published: December 2010

Background/Aim. Oxidative stress is a state of disturbed balance between reactive oxygen species (ROS) and reactive nitrogen species (RNS) on the one hand, and antioxidative defense on the other. As a result of oxidative stress we have irreversible changes in cell function leading to pathological tissue changes, development of many diseases and fast aging process. Increased consumption of oxygen during exercise could be the cause of oxidative stress. The aim of the study was to establish oxidative status of elite karate athletes in the state of rest and after the loading, monitoring the parameters of oxidative stress and components of antioxidative defense in a treaining process. Methods. During training process, a group of 30 elite karate athletes was included in the study of prevalence. They were males, from 16 to 30 years of age. The examination was conducted both in resting condition and after the loading. Oxidative status was determined by the level of superoxide anion radical (O2-), hydrogen peroxide (H2O2) as prooxidants, and enzymes of the antioxidant defanse system: superoxide dismutase (SOD) and catalase (CAT). Results. There was a homogenous group of young athletes of normal weight and fats percentage. A significant decrease of O?2- after the load was founded, while the levels of H2O2 was significantly increased. Activity of SOD was not significantly changed after exsercise while that of CAT was significantly increased. Conclusion. In the long run a programmed physical exercise does not lead to oxidative stress, but an excessive physical load may cause its occurrence.
Cost-effectiveness of four immunomodulatory therapies for relapsingremitting multiple sclerosis: A Markov model based on data a Balkan country in socioeconomic transition
Authors: Jankovic Slobodan , Kostic Marina , Radosavljevic Marija , Tesic Danka , Stefanovic-Stoimenov Natasa , Stevanovic Ivan , Rakovic Sladjana , Aleksic Jelena , Folic Marko , Aleksic Aleksandra , Mihajlovic Ivana , Biorac Nenad , Borlja Jelena , Vuckovic Radosava
Published: December 2010

Background/Aim. A cost-effectiveness analyses of immunomodulatory treatments for relapsing-remitting multiple sclerosis (RRMS) in developed countries have shown that any benefit from these drugs is achieved at very high cost. The aim of our study was to compare the cost-effectiveness of five treatment strategies in patients diagnosed with RRMS (symptom management alone and in combination with subcutaneous glatiramer acetate, intramuscular interferon ?-1a, subcutaneous interferon ?-1a, or intramuscular interferon ?- 1b) in a Balkan country in socio-economic transition. Methods. The Markov model was developed based on the literature about effectiveness and on local Serbian cost calculations. The duration of a cycle in the model was set to a month. The baseline time horizon was 480 months (40 years). The societal perspective was used for costs and outcomes, and they were discounted for 3% annually. Monte Carlo micro simulation with 1000 virtual patients was done. Results. Significant gain with immunomodulatory therapy was achieved only in relapse-free years, while the time spent in health states EDSS 0.0-5.5 was longer with symptomatic therapy only, and gains in life years and QALYs were only marginal. One QALY gained costs more than a billion of Serbian dinars (more than 20 million US dollars), making each of the four immunomodulatory therapies costineffective. Conclusion. Our study suggests that immunomodulatory therapy of RRMS in a Balkan country in socioeconomic transition is not cost-effective, regardless of the type of the therapy. Moderate gain in relapse-free years does not translate to gain in QALYs, probably due to adverse effects of immunomodulatory therapy.
Malignant tumors of auricula and periauricular area
Authors: Bojanovic Mila , Zivkovic-Marinkov Emilija , Veselinovic Dragan , Bojanovic Aleksandar , Vuckovic Ivica
Published: December 2010

Background/Aim. Malignant tumors of auricula and periauricular area represent seven percent of all cutaneous tumors. They appear mostly in the sixth and seventh decade. According to histological type they are basocellular and planocellular carcinomas. The most frequent etiology is the sun exposition. The aim of this study was to analyze clinical and histological characteristics and therapy of malignant tumors of auricular and periauricular area. Methods. Totally 155 patients were treated in ORL Clinic, Clinical Center Nis during the period 1990-2006. The patients were treated surgically (59.35%), by radiotherapy (1.94%) and by combination of the two methods (38.71%). Results. Since the majority of tumors were small and presented on the helix, wedge excision and primary reconstruction were performed (136), while total (9) or partial (10) auriculectomy were done in a small number of the patients. For larger lesions (T4 - when lesion is greater than 4.0 cm) and neck metastasis invading cartilage or bone, parotidectomy (15), radical neck dissection (25) and temporal bone resection (9) were performed. Conclusion. Carcinoma of auricular and periauricular area should be confirmed by biopsy and histopathologic evaluation. In all cases an adequate excision, margin examination and observation of appropriate lymph node draining regions should be provided.
The c.-1639g>A polymorphism of the VKORC1 gene and his influence on the therapeutic response during oral anticoagulants use
Authors: Kovac Mirjana , Rakicevic Ljiljana , Maslac Aleksandar , Radojkovic Dragica
Published: December 2010

Background/Aim. A single nucleotide polymorphism c.- 1639G>A in the promoter region of vitamin K-epoxide reductase (VKORC1) gene has been found to account for most of the variability in response to oral anticoagulants (OA). The aim of the study was to determine the incidence and the effect of c.-1639G>A polymorphism on the acenocoumarol dosage requirements in the group of patients under stable anticoagulation, and to estimate the variability in response to OA. Methods. Our study included 200 consecutive patients requiring low (n = 43), medium (n = 127) and high (n = 30) acenocoumarol dose. Results. Out of 43 low dose patients, 40 (93 %) carried the A allele. The A allele was less frequent in the group of 30 patients requiring high dose: among these patients 13 (43.3%) carried the A allele in the heterozygous form and none of them carried AA genotype. The patients with GG genotype required 2.6 times higher dose than the patients carriers of AA genotype (p < 0.0001). In 33 patients (16.5%) the overdose occurred during the initiation of anticoagulant therapy and in 11 patients (5.5%) it was associated with bleeding. Out of the group of 33 overdosed patients, 27 and 6 patients carried AA and GA genotype, respectively (p < 0.000001). Conclusion. VKORC1 significantly influenced OA dose and predicted individuals predisposed to unstable anticoagulation. The carriers of AA genotype required 2.6 time lower doses of OA than the carriares of GG genotype. Pharmacogenetic testing could predict a high risk of overdose among 28.5 % of our patients - carriers of AA genotype, before anticoagulation therapy initiation.
Role of mucinohistochemical analysis in verification of malignant potential of colorectal adenoma
Authors: Radovanovic-Dinic Biljana , Katic Vuka , Nagorni Aleksandar , Stamenkovic Ivanka
Published: December 2010

Background/Aim. It is a general opinion that the biggest number of colorectal carcinoma (CRC) develops with the malignant alteration of colorectal adenomas (adenoma carcinoma sequence). Malignant potential of adenoma is in the function of its size, histological structure and the grade of dysplasia. An adequate analysis of colorectal adenomas helps their definition and timely removal, which significantly decreases carcinoma incidence. Mucin analysis can provide results which support the adenoma carcinoma sequence theory. The aim of the study was to present histochemical characteristics of adenomas and emphasize the significance of these analyses for the precise adenoma definition. Methods. This prospective study included analysis of 117 colorectal adenomas obtained by transcolonoscopic biopsy or polipectomy in 82 patients. The biopsy samples and the removed polyps were coloured by hematoxilin-eozin (HE) staining and histochemical stainings by Periodic Acid Schiff (AB-PAS) and High Iron Diamine/Alcian blue (HIDAB; pH=2.5) to prove mucins. Results. Sulphomucins are more often found in adenomas of the left colon than of the right one (p < 0.001). Sialomucins are more reactive in adenomas of the right colon (p < 0.001). Sulphomucins are more reactive in adenomas of < 10 mm diameter (p < 0.05). The reactivity of all mucins is in negative correlation with the degree of dysplasia (p < 0.001). There is a significant difference in the reactivity of sialomucins in adenomas of the same histological type but different degree of dysplasia (?2 = 25,743, df = 6, p < 0.001). Conclusion. The difference in the presence of mucins between adenomas of the left and right colons supports the theory of adenoma carcinoma sequence, since adenomas of the right colon are more protected by sialomucins and therefore less malignantly altered, which is consistent with CRC topography. Histochemical analysis of colorectum is significant for more accurate gradation of dysplasia and confirmation of malignant alteration. The negative correlation between the degree of dysplasia and the production of mucin indicates the significance of the degree of dysplasia in malignant potential of colorectal adenomas.