Showing papers in "Srpski Arhiv Za Celokupno Lekarstvo in 2013"

Mesenchymal stem cells isolated from peripheral blood and umbilical cord Wharton's jelly.

Abstract: SUMMARY Introduction Mesenchymal stem cells (MSCs) are a promising tool for regenerative medicine, but due to the heterogeneity of their populations, different sources and isolation techniques, the characteristics defining MSCs are inconsistent. Objective The aim of this study was to compare the characteristics of MSCs derived from two different human tissues: peripheral blood (PB-MSCs) and umbilical cord Wharton's Jelly (UC-MSCs). Methods The PB-MSC and UC-MSC were isolated by adherence to plastic after gradient-density separa- tion or an explant culture method, respectively, and compared regarding their morphology, clonogenic efficiency, proliferating rates, immunophenotype and differentiation potential. Results MSCs derived from both sources exhibit similar morphology, proliferation capacity and mul- tilineage (osteogenic, chondrogenic, adipogenic and myogenic) differentiation potential. Differences were observed in the clonogenic capacity and the immunophenotype, since UC-MSCs showed higher CFU-F (colony-forming units-fibroblastic) cloning efficiency, as well as higher embryonic markers (Na- nog, Sox2, SSEA4) expression. When additional surface antigens were analyzed by flow cytometry (CD44, CD90, CD105, CD33, CD34, CD45, CD11b, CD235a) or immunofluorescent labeling (vimentin, STRO-1 and α-smooth muscle actin), most appeared to have similar epitope profiles irrespective of MSC source. Conclusion The results obtained demonstrated that both MSCs represent good alternative sources of adult MSCs that could be used in cell therapy applications.

Antioxidative status of saliva before and after non-surgical periodontal treatment.

Abstract: SUMMARY Introduction Oxidative stress and antioxidants play an important role in the pathogenesis of inflam- matory disease, including chronic periodontitis (CP) Saliva contains enzymatic (glutathione peroxidase - GPx, superoxide dismutase - SOD, etc) and non-enzymatic (albumin - ALB, uric acid - UA, glutathione, etc) antioxidants Objective The aims of this study were to investigate: a) level of SOD, GPx, UA, ALB and total antioxidative status (TAS) of saliva in CP patients before and after non-surgical treatment, and b) correlations between clinical periodontal parameters and levels of salivary antioxidants Methods Saliva was collected from 21 CP patients before and after non-surgical treatment The condi- tion of periodontium was assessed by plaque index, gingival index, bleeding on probing, probing depth and clinical attachment loss Level of investigated antioxidants (except GPx) and TAS was determined using colorimetric method and commercial kits GPx activity was determined using UV method and commercial kits Results After the treatment significant increase of UA, ALB, Gpx, TAS was detected (p 005) A significant correlation was observed between GPx and PI (r=0575, p=0008), SOD and GI (r=0525, p=0017) before therapy, and SOD and bleeding on probing (BP) (r=059, p=0006), TAS and BP (r=0453, p=0045) after therapy Conclusion These data suggest that levels of salivary antioxidants generally increase after non-surgical periodontal treatment Correlation between some clinical periodontal parameters and level of salivary antioxidants was found

Dilemmas in zirconia bonding: A review

Abstract: This article presents a literature review on the resin bond to zirconia ceramic. Modern esthetic dentistry has highly recognized zirconia, among other ceramic materials. Biocompatibility of zirconia, chemical and dimensional stability, excellent mechanical properties, all together could guarantee optimal therapeutical results in complex prosthodontic reconstruction. On the other hand, low thermal degradation, aging of zirconia as well as problematic bonding of zirconia framework to dental luting cements and tooth structures, opened the room for discussion concerning their clinical durability.The well known methods of mechanical and chemical bonding used on glass-ceramics are not applicable for use with zirconia. Therefore, under critical clinical situations, selection of the bonding mechanism should be focused on two important points: high initial bond strength value and long term bond strength between zirconia-resin interface. Also, this paper emphases the use of phosphate monomer luting cements on freshly air-abraded zirconia as the simplest and most effective way for zirconia cementation procedure today.

Occupational exposures to blood and body fluids among health care workers at university hospitals

Abstract: SUMMARY Introduction Occupational exposure to blood and body fluids is a serious concern of health care workers and presents a major risk of transmission of infections such as human immuno-deficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Objective The aim of this study was to determine the frequency and circumstances of occupational blood and body fluid exposures among health care workers. Methods Cross-sectional study was conducted in three university hospitals in Belgrade. Anonymous questionnaire was used containing data about demographic characteristics, self-reported blood and body fluid exposures and circumstances of percutaneous injuries. Results Questionnaire was filled in and returned by 216 health care workers (78.2% of nurses and 21.8% of doctors). 60.6% of participants-health care workers had sustained at least one needlestick injury during their professional practice; 25.9% of them in the last 12 months. Of occupational groups, nurses had higher risk to experience needlestick injuries than doctors (p=0.05). The majority of the exposures occurred in the operating theatre (p=0.001). Among factors contributing to the occurrence of needlestick injuries, recapping needles (p=0.003) and decontamination/cleaning instruments after surgery (p=0.001) were more frequent among nurses, while use of a needle before intervention was common among doctors (p=0.004). Only 41.2% of health care workers had reported their injuries to a supervisor in order to obtain medical attention. 50.2% of health care workers were vaccinated with three doses of hepatitis B vaccine. Conclusion There is a high rate of needlestick injuries in the daily hospital routine. Implementation of

Stress and mental health among medical students

Abstract: Introduction. Medical studies bring many stressful activities to students. Prolonged stress can make adverse effects to mental health and lead to further professional burnout. Objective. The aim of this study was to assess the association of stress impact and adverse effects of medical studies with psychological distress among medical students. Methods. The cross sectional study was conducted on 367 fourth­year medical students of the Faculty of Medicine in Belgrade, by means of the anonymous questionnaire, containing: socio­demographic data, self­reported health status and stressful influences of studying activities. Mental health status was estimated by General Health Questionnaire (GHQ­12). Results. More than 50% of students perceive frequent feeling of psychic tension, and one third has problems with insomnia. Nearly one­half of students assessed their general stress level as moderate or high. Exams were estimated as high stressor in 63.1% of all students. Stressful effects of communication with teaching staff were reported by one quarter of the examinees. The scores of GHQ­12 were above the threshold in 55.6 % of all students. Mental health problems among students were most significantly associated with stressful experience during exams and contacts with teaching staff. Conclusion. Academic stress makes great influence on mental health of medical students. Reduction of stress effects should be directed to optimization of the examination process and improvement of communication skills.

Analysis of polymorphism in the survivin gene promoter as a potential risk factor for head and neck cancers development.

Abstract: SUMMARY Introduction Association studies have shown that gene polymorphisms in various classes of genes can modulate cancer risk. The -31G/C polymorphism in the promoter of survivin gene, affects the expression of the anti-apoptotic protein survivin which in turn may predispose an individual to some types of cancer. Objective The aim of the study was to determine whether the survivin promoter -31G/C polymorphism could be a susceptibility factor for squamous cell carcinoma (SCC) of the oral cavity and basal cell car- cinoma (BCC) of the skin. Methods The DNA obtained from 88 patients with SCC, 60 patients with BCC and 111 healthy individuals was subjected to polymerase chain reaction-restriction fragment length polymorphism analysis (PCR- RFLP) in order to determine genotype and allele frequencies in patients and control groups. Logistic regression was used for cancer risk assessment. Results The following distribution of genotypes was obtained: CC genotype 15% in the SCC group, 13% in the BCC group and 12% in controls; CG genotype 41% in SCCs, 35% in BCCs, 48% in controls; GG genotype 44% in SCCs, 52% in BCCs and 40% in controls. Allelic frequencies were as follows: G allele 0.65 in SCCs, 0.69 in BCCs and 0.64 in the control group; C allele 0.35 in SCCs, 0.31 in BCCs and 0.36 in the control group. There was no statistically significant difference in allele or genotype frequencies between the patients and controls (p>0.05). Conclusion In Serbian population, -31G/C polymorphism in the promoter of the survivin gene cannot be considered as a risk factor for oral squamous cell carcinoma and skin basal cell carcinoma.

Etiological aspect of left-handedness in adolescents.

Abstract: INTRODUCTION: Lateralization of brain functions such as language and manual dominance (hand preferences and fine motor control) are most likely under genetic control. However, this does not preclude the effect of various environmental factors on functional brain lateralization. A strong association of non-right-handedness (left- and mixed-handedness) with various neurodevelopmental conditions (e.g. schizophrenia, autism, Rett syndrome) implies that in some cases, non-right-handedness may be acquired rather than inherited (i.e., pathologically determined). OBJECTIVE: The aim of the study was: (a) re-investigation of several known risk factors for left-handedness (age of mother and/or father, twin pregnancies, and birth order), and (b) examination of hitherto uninvestigated factors (type of birth, Apgar score, maternal smoking during pregnancy). METHODS: Putative, causative environmental agents for this shift in manual distributions are explored in a sample of 1031 high school students (404 males and 627 females) from Belgrade. Both pre-existing (age of parents, twin pregnancy, and birth order) and new (Apgar score, maternal smoking, type of birth) putative agents are examined. RESULTS: We found that maternal smoking and low Apgar score (2-6) can significantly increase risk for left-handedness (p=0.046 and p=0.042, respectively).The remaining factors showed no significant association with left-handedness in adolescents. CONCLUSION: Our study clearly demonstrates that left-handedness may be related to maternal smoking during pregnancy and a low Apgar score on birth. Language: en

Relationships between obesity, lipids and fasting glucose in the menopause.

Abstract: SUMMARY Introduction Menopause leads to the development of central adiposity, a more atherogenic lipid profile and increased incidence of metabolic syndrome independent of age and other factors. Objective The aim of the study was to investigate the relationships between anthropometric character- istics, sex hormones, lipids and fasting glucose in menopausal women. Methods The study included 87 menopausal women, who where divided into groups according to two criteria: BMI≥26.7 kg/m2 and BMI≥25 kg/m 2 . Anthropometric characteristics and blood pressure were measured. Blood was taken at 08.00 h for fasting glucose, triglycerides, cholesterol, HDL, LDL, apoli- poprotein A, apolipoprotein B, lipoprotein(a) (Lp(a)), C-reactive protein, fibrinogen, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), estradiol, progesterone, testosterone and sex hormone binding globulin (SHBG). Results Significant differences between groups were found for weight, BMI, waist, hips circumference, waist/hip ratio (WHR), systolic and diastolic blood pressure, Lp(a), FSH, LH, PRL (for systolic blood pres- sure p<0.05, for the rest p<0.01) and fasting glucose (p<0.05). In obese and overweight women with BMI≥26.7kg/m2 significant negative correlations were found for FSH and glucose, SHBG and LDL, SHBG and total cholesterol, SHBG and glucose, BMI and HDL, WC and HDL. In obese and overweight women with BMI≥25kg/m2 significant negative correlations were found for BMI and HDL, waist circumference (WC) and HDL, WHR and HDL, FSH and glucose, SHBG and glucose; significant positive correlations were between BMI and glucose, WC and glucose and WHR with triglycerides. Conclusion Gaining weight and decreased SHBG are related to dyslipidemia and increased fasting glu- cose confirming increased incidence of metabolic abnormalities in the menopause.

The Frequency of Chemical Injuries of the Eye in a Tertiary Referral Centre

Abstract: INTRODUCTION: Chemical injuries can occur under various circumstances and may cause serious damage to the anterior segment of the eye. OBJECTIVE: The aim of the study was to analyse the frequency of chemical injuries treated in a tertiary referral centre. METHODS: The medical records of consecutive patients admitted for the chemical injury of the eye to the Clinic for Eye Diseases in Belgrade between January 1999 and December 2008 were retrospectively analysed in order to obtain data about proportions of injuries, demographical characteristics of patients, circumstances under which injuries happened, the chemicals involved, the severity of injury according to the Roper-Hall classification and the length of hospitalization. RESULTS: Out of a total of 60,868 hospitalized patients, 148 (2.43/1,000) were treated for chemical injury of the eye, with the highest incidence observed during summer months. Men were over five times more often affected (84.5%) and most of the injured individuals belonged to the working-age population (mean age 44.4 +/- 16.2 years).The most common causative agents were alkalis (73.0%), while acids (18.2%) and other substances (8.8%) were less common. None of 35.1% patients for whom data were obtained used any protection while handling the chemicals. The vast majority of injuries were graded as grade II (31.1%) and III (42.6%) and the most severe ones were caused by alkalis. An average length of hospitalization was 17.7 +/- 24.1 days and correlated with the severity of injury. CONCLUSION: Chemical injuries are relatively common problem in the Emergency Ophthalmology. Constant education and usage of adequate protective equipment should be advised in order to prevent serious complications. Language: en

Spontaneous rupture of giant liver hemangioma: case report.

Abstract: SUMMARY Introduction Hemangioma is the most frequent benign solid tumor of the liver. It is well known that a giant liver hemangioma carries the risk of spontaneous rupture, followed by hemoperitoneum and hemorrhagic shock with possible fatal outcome. Case Outline This is a case report of the spontaneous rupture of a giant cavernous hemangioma of the liver in an 85-year old patient. The patient was presented with abdominal pain and hemorrhagic shock. Emergency ultrasonography and computed tomography of the abdomen showed a heterogeneous ruptured solid tumor of the right liver lobe, multiple cysts in the left lobe and massive hemoperitoneum. The patient was successfully managed by immediate exploratory laparotomy, surgical enucleation of the hemangioma under intermittent inflow vascular occlusion, temporary perihepatic packing and planned second look relaparotomy. Conclusion Immediate surgical procedure is indicated mandatory in unstable patients with a ruptured giant hemangioma of the liver. Surgical enucleation under intermittent inflow vascular occlusion and temporary perihepatic packing could be a life-saving procedure in those patients.

Prostaglandin E2 in apical tissue fluid and postoperative pain in intact and teeth with large restorations in two endodontic treatment visits.

Abstract: Introduction. Acute periapical inflammation is the most common cause of postoperative pain developing as a result of mechanical, chemical and/or microbial injury of periapical tissue. The major inflammatory event responsible for periapical pain is increased vasodilatation and vascular permeability, partly caused by prostaglandin E2, with consequent edema, which leads to the compression of nerve fibers. Objective. The aim of this study was to determine the concentrations of prostaglandin E2 in apical tissue fluid after endodontic treatment of intact and teeth with large restorations and to compare it with the occurrence and intensity of postoperative pain. Methods. Single-rooted teeth of 24 patients, selected for this study, were distributed into two groups: intact (group 1, n=27) and asymptomatic teeth with large restorations (group 2, n=20). Clinical examination of the involved teeth included the electric pulp test, recording pain on percussion, spontaneous pain, and a radiographic examination. Samples of apical tissues fluid were obtained from root canals at two treatment visits, and prostaglandin E2 concentrations were measured using radioimmunoassay. Pain intensity was assessed by visual analogue scale. Results. Prostaglandin E2 concentrations at the second visit, in teeth with large restorations, was significantly higher (36%) than at the first treatment visit (Wilcoxon signed rank test, p<0.05). Occurrence and intensity of spontaneous pain after the first visit were significantly higher in group 2 (p<0.05) than in group 1. Conclusion. These results suggest that the increased prostaglandin E2 concentration, caused by endodontic treatment of teeth with large restorations, is well correlated with the intensity of postoperative pain.

Genetic polymorphisms of paraoxonase 1 and susceptibility to atherogenesis.

Abstract: Introduction. Paraoxonase 1 (PON1) is a multifunctional enzyme associated with high-density lipoprotein particles (HDL). It is a cellular antioxidant that hydrolyses oxidized macromolecules, especially low-density lipoproteins (ox-LDL). Because increased oxidative stress is believed to play a crucial role in the initiation and propagation of atherosclerosis, coding (Q192R and L55M) and promoter (C(-107)T) region polymorphisms of pon1 gene, that are responsible for catalytic efficiency, activity and the level of the enzyme, have been of great interest as a potential markers of susceptibility for atherogenesis. Objective. The aim of the study was to assess possible association between these pon1 gene variants and clinical manifestations of the atherosclerosis and oxidative stress. Methods. A total of 60 angiographically documented patients with manifested atherosclerotic disease and 100 control individuals were analyzed. Genomic DNA was isolated from the peripheral blood cells and genotyping was performed using polymerase chain reaction followed by the restriction fragment length polymorphism (PCR-RFLP) analysis. Results No significant difference in allele and genotype frequencies of all three examined polymorphisms was found between the atherosclerotic patients and healthy controls. The obtained results could not support an association of pon1 gene variants with the oxidative stress and atherogenesis. Conclusion. These polymorphisms cannot be considered risk factors of atherosclerosis in Serbian population. A larger study is required in order to establish possible contribution of pon1 variants to atherosclerosis-related cardiovascular diseases.

The evolution of the female sexual response concept: Treatment implications

Abstract: Sexual dysfunctions have been the most prevalent group of sexual disorders and include a large number of populations of both sexes. The research of sexual behavior and treatment of women with sexual distress arises many questions related to differences in sexual response of men and women. The conceptualization of this response in modern sexology has changed over time. The objective of our paper was to present the changes and evolution of the female’s sexual response concept in a summarized and integrated way, to analyze the expanded and revised definitions of the female sexual response as well as implications and recommendations of new approaches to diagnostics and treatment according to the established changes. The lack of adequate empirical basis of the female sexual response model is a critical question in the literature dealing with this issue. Some articles report that linear models demonstrate more correctly and precisely the sexual response of women with normal sexual functions in relation to women with sexual dysfunction. Modification of this model later resulted in a circular model which more adequately presented the sexual response of women with sexual function disorder than of women with normal sexual function. The nonlinear model of female sexual response constructed by Basson incorporates the value of emotional intimacy, sexual stimulus and satisfaction with the relationship. Female functioning is significantly affected by multiple psychosocial factors such as satisfaction with the relationship, self-image, earlier negative sexual experience, etc. Newly revised, expanded definitions of female sexual dysfunction try to contribute to new knowledge about a highly contextual nature of woman’s sexuality so as to enhance clinical treatment of dysfunctions. The definitions emphasize the evaluation of the context of women’s problematic sexual experiences.

Serbian Translation of the 20-Item Toronto Alexithymia Scale: Psychometric Properties and the New Methodological Approach in Translating Scales

Abstract: Introduction Since inception of the alexithymia construct in 1970's, there has been a continuous effort to improve both its theoretical postulates and the clinical utility through development, standardization and validation of assessment scales Objective The aim of this study was to validate the Serbian translation of the 20-item Toronto Alexithymia Scale (TAS-20) and to propose a new method of translation of scales with a property of temporal stability Methods The scale was expertly translated by bilingual medical professionals and a linguist, and given to a sample of bilingual participants from the general population who completed both the English and the Serbian version of the scale one week apart Results The findings showed that the Serbian version of the TAS-20 had a good internal consistency reliability regarding total scale (α=086), and acceptable reliability of the three factors (α=071-079) Conclusion The analysis confirmed the validity and consistency of the Serbian translation of the scale, with observed weakness of the factorial structure consistent with studies in other languages The results also showed that the method of utilizing a self-control bilingual subject is a useful alternative to the back-translation method, particularly in cases of linguistically and structurally sensitive scales, or in cases where a larger sample is not available This method, dubbed as 'forth-translation', could be used to translate psychometric scales measuring properties which have temporal stability over the period of at least several weeks

[Impact of the level of metabolic control on the non-surgical periodontal therapy outcomes in diabetes mellitus type 2 patients--clinical effects].

Abstract: Introduction. Diabetes mellitus as a complex metabolic disease influences functioning of numerous organs. Chronic periodontitis is one of frequent diabetic complications. Objective. The aim of this study was to compare the clinical effects of non­surgical periodontal therapy between diabetes mellitus type 2 patients (DM type 2) and non­diabetic individuals (control group). Methods. Our study included 41 DM type 2 subjects and 21 non­diabetic individuals, all of them with chronic periodontitis. The diabetic group was divided into two subgroups based on the level of glycosylated hemoglobin (HbA1c) as follows: D1 - 18 subjects with good metabolic control (HbA1c<7%), and D2 - 23 subjects with poor metabolic (HbA1c≥7%). State of oral hygiene and periodontal clinical parameters of subjects, such as: plaque index (PI), gingival index (GI), papilla bleeding index (PBI), probing pocket depth (PPD) and clinical attachment level (CAL), were evaluated at the baseline and 3 months after scaling and root­planning. Results. ANOVA test showed that there was no statistically significant difference of treatment success between studied groups in relation to GI (p=0.52), PBI (p=0.36) and CAL (p=0.11). Reduction of PI and PPD in the control group (ΔPI=0.84; ΔPPD=0.35 mm) was significantly higher (p<0.05) than the reduction of PI and PPD in patients with the diabetes (group D1 ΔPI=0.60, ΔPPD=0.11 mm; group D2 ΔPI=0.53, ΔPPD=0.11 mm). Conclusion. Although there were differences in treatment success between DM subjects and non­diabetic individuals, they were not significant for the most measured parameters. The results of this study did not absolutely support the assumption that the level of glycemic control significantly affected the periodontal therapy outcome in diabetics.

Comparison of the Efficacy and Safety of Fixed Combination Travoprost/Timolol and Dorzolamide/ Timolol in Patients with Primary Open-Angle Glaucoma and Ocular Hypertension

Abstract: SUMMARY Introduction Combining two medications in one bottle may improve compliance by reducing the time required to administer drops and the frequency of the total number of medication bottles. Objective To compare the efficacy of reduced intraocular pressure (IOP) and safety of fixed combination travoprost 0.004%/timolol 0.5% vs. fixed combination dorzolamide 2%/timolol 0.5% in patients with primary open-angle glaucoma or ocular hypertension. Methods Prospective randomized clinical study included 60 patients divided into 2 groups. Follow-up was done at day 14 and 45 and month 3. IOP measurements were taken at each follow-up examination at 8 am, 10 am and 4 pm. Results Both fixed combinations reduced IOP significantly compared to initial values at all follow-ups (p<0.001). Mean pooled IOP at all visits and time points was slightly lower in the travoprost/timolol group compared with the dorzolamide/timolol group (16.13 mmHg vs. 16.15 mmHg). Mean IOP reduction from baseline ranged from -7.46 mmHg to -9.92 mmHg in the travoprost/timolol group and from -6.93 mmHg to -8.93 mmHg for the dorzolamide/timolol group. Mean (±standard error of the mean) reduction in diurnal IOP from baseline to 3 rd month was 8.96±2.79 in the travoprost/timolol group versus 8.07±2.91 in patients receiving dorzolamide/timolol fixed combination (p=0.196). The most frequent treatment- related adverse events were conjunctival hyperemia in the travoprost/timolol group, and dry eye and foreign body sensation in the dorzolamide/timolol group. Conclusion Travoprost/timolol fixed combination was slightly more effective than dorzolamide/timolol fixed combination in reducing mean diurnal IOP. Travoprost/timolol group resulted in an IOP reduction for up to 1.07 mmHg higher than dorzolamide/timolol group. Both fixed combinations were well toler- ated and safe.

Relationship between abdominal obesity and other cardiovascular risk factors: cross sectional study of patients with symptomatic carotid disease.

Abstract: SUMMARY Introduction Obesity, particularly visceral obesity, is considered one of major risk factors for cardiovas- cular events. Objectives The aim of the present study was to investigate relationship between abdominal obesity and other cardiovascular risk factors. Methods The cross-sectional study involved 657 consecutive patients with verified carotid atheroscle- rosis. Carotid atherosclerosis was estimated by high resolution B-mode ultrasonography. Abdominal obesity was defined as waist circumference >102 cm in men and >88 cm in women. Results Abdominal obesity was present in 324 (49.3%) participants. Multivariate analyses showed that abdominal obesity was significantly positively associated with female sex, increased Baecke 's Work Index of physical activity at work, years of school completed <12, metabolic syndrome, increased triglycerides, hyperglycemia and high serum uric acid. Smoking, alcohol consumption, physical inactivity, hyperten- sion, increased total cholesterol, increased HDL and LDL cholesterols, increased high sensitive C-reactive protein, increased fibrinogen, anti-lipid therapy and anti-diabetic therapy were not significantly related to abdominal obesity. Conclusion Abdominal obesity among patients with symptomatic carotid disease is significantly related to other cardiovascular risk factors, especially metabolic syndrome, metabolic syndrome components and high level of serum uric acid.

Tumor necrosis factor alpha gene polymorphism in serbian patients with sarcoidosis.

Abstract: Introduction. Sarcoidosis is a multisystemic disease of unknown etiology. Genetic factors play a considerable role in the onset of the disease. Tumor necrosis factor alpha (TNF-α) is a proinflammatory cytokine which plays an important role in the pathogenesis of the disease and the formation of granuloma by regulating cellular proliferation and apoptosis. Objective. The aim of this study was to investigate the role of TNF-α-308 G/A polymorphism in the development of sarcoidosis and to evaluate the association between the aforementioned type of polymorphism and the clinical course of the disease. Methods. Seventy patients with sarcoidosis and 50 healthy volunteers were genotyped for the TNF-α-308G/A polymorphism. Polymorphism variants were examined by PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) on the DNA isolated from blood leukocytes. Results. There were no significant differences in TNF-α-308A allele frequency distribution between sarcoidosis patients and the control group, but the TNF-α-308A allele was observed significantly more frequently in the sarcoidosis patients with Lofgren’s syndrome when compared with non-Lofgren’s patients. Conclusion. We have found that the TNF-α-308A variant is associated with Lofgren’s syndrome in Serbian patients with sarcoidosis.

Changes in the retrobulbar arterial circulation after decrease of the elevated intraocular pressure in men and women with primary open angle glaucoma

Abstract: SUMMARY Introduction An altered perfusion of the optic nerve head has been proposed as a pathogenic factor of glaucoma. Objective The aim of this study was to evaluate the changes of the hemodynamic parameters in the retrobulbar arterial circulation after decrease of the elevated intraocular pressure (IOP) in women and men with primary open angle glaucoma. Methods The study included 60 patients (33 males and 27 females) older than 50 years, with diagnosed and treated primary open angle glaucoma (77 eyes of 39 patients had increased IOP, >25 mm Hg). They were examined at the Clinic of Eye Diseases (complete ophthalmologic exam) and Clinic of Neurology, Clinical Center of Serbia, Belgrade, from December 2009 to December 2010. Imaging of hemodynamic parameters of three retrobulbar arterial vessels: ophthalmic, central retinal and posterior ciliary arteries with color Doppler was performed. Results Among women, hemodynamic arterial parameter of the peak-systolic velocity was increased in the central retinal artery and decreased in the ophthalmic artery and posterior ciliary arteries; end- diastolic velocity was increased in all three retrobulbar vascular levels; Pourcelot resistivity index was increased, but pulsatility index was decreased in all three vessels. Among men, peak-systolic velocity, end-diastolic velocity and pulsatility index were decreased in all three vessels; resistivity index was in- creased in the ophthalmic artery, but decreased in the central retinal artery and posterior ciliary arteries. There was a significant change of the ophthalmic artery pulsatility index in women, and the end-diastolic velocity of the ophthalmic artery in men. Conclusion There was a difference of the retrobulbar arterial circulation between women and men with primary open angle glaucoma after decrease of the elevated intraocular pressure. The role of vascular factors in the supply of the optic disc neuroretinal rim is important.

Diagnosis of bacterial vaginosis

Abstract: Bacterial vaginosis is a common, complex clinical syndrome characterized by alterations in the normal vaginal flora. When symptomatic, it is associated with a malodorous vaginal discharge and on occasion vaginal burning or itching. Under normal conditions, lactobacilli constitute 95% of the bacteria in the vagina. Bacterial vaginosis is associated with severe reduction or absence of the normal H2O2-producing lactobacilli and overgrowth of anaerobic bacteria and Gardnerella vaginalis, Atopobium vaginae, Mycoplasma hominis and Mobiluncus species. Most types of infectious disease are diagnosed by culture, by isolating an antigen or RNA/DNA from the microbe, or by serodiagnosis to determine the presence of antibodies to the microbe. Therefore, demonstration of the presence of an infectious agent is often a necessary criterion for the diagnosis of the disease. This is not the case for bacterial vaginosis, since the ultimate cause of the disease is not yet known. There are a variety of methods for the diagnosis of bacterial vaginosis but no method can at present be regarded as the best. Diagnosing bacterial vaginosis has long been based on the clinical criteria of Amsel, whereby three of four defined criteria must be satisfied. Nugent's scoring system has been further developed and includes validation of the categories of observable bacteria structures. Up-to-date molecular tests are introduced, and better understanding of vaginal microbiome, a clear definition for bacterial vaginosis, and short-term and long-term fluctuations in vaginal microflora will help to better define molecular tests within the broader clinical context.

Alcohol use among adolescents in Serbia

Abstract: Introduction. European School Survey Project on Alcohol and Other Drugs (ESPAD), the largest international research project, was conducted for the first time in Serbia in 2008. Objective. The objective was to analyze data obtained by ESPAD research on alcohol use among secondary school first grade students, and particularly the difference in the use of alcohol by gender, type of school students attend, their place of residence and the territory among secondary school students in Serbia in 2008. Methods. Attitudes and practice related to alcohol use of 6,553 secondary school first grade students were analyzed. A standardized, internationally approved questionnaire, structured and designed for self­filling was used on a stratified, one­stage sample of students. The data received from the ESPAD research were processed by χ2 test to test the significance of differences between the observed characteristics, with the conclusion level of p<0.01. Results. Over three­quarters of students can easily buy beer or wine. More than one half can buy spirits and alcopops. 89.1% of students drank alcoholic beverages at least once in a lifetime and 78.2% in the last year. At least once in a lifetime 42.2% of students were drunk and 29.7% in the last year. At least once in the last month 32.0% of students had five or more drinks in a row. Boys consumed alcohol more frequently and got drunk more often than girls (p<0.01). Conclusion. This research emphasizes the need for creating a prevention of alcohol use and alcohol abuse program among adolescents and more consistent application of the existing regulations aiming to decrease alcohol use among adolescents in Serbia.

Virtual histology study of atherosclerotic plaque composition in patients with stable angina and acute phase of acute coronary syndromes without ST segment elevation.

Abstract: Introduction. Rupture of vulnerable atherosclerotic plaques is the cause of most acute coronary syndromes (ACS). Postmortem studies which compared stable coronary lesions and atherosclerotic plaques in patients who have died because of ACS indicated high lipid-core content as one of the major determinants of plaque vulnerability. Objective. Our primary goal was to assess the potential relations of plaque composition determined by IVUS-VH (Intravascular Ultrasound - Virtual Histology) in patients with stable angina and subjects in acute phase of ACS without ST segment elevation. Methods. The study comprised of 40 patients who underwent preintervention IVUS examination. Tissue maps were reconstructed from radio frequency data using IVUS-VH software. Results. We analyzed 53 lesions in 40 patients. Stable angina was diagnosed in 24 patients (29 lesions), while acute phase of ACS without ST elevation was diagnosed in 16 patients (24 lesions). In the patients in acute phase of ACS without ST segment elevation IVUS-VH examination showed a significantly larger area of the necrotic core at the site of minimal lumen area and a larger mean of the necrotic core volume in the entire lesion comparing to stable angina subjects (1.84±0.90 mm2 vs. 0.96±0.69 mm2; p<0.001 and 20.94±15.79 mm3 vs. 11.54±14.15 mm3; p<0.05 respectively). Conclusion. IVUS-VH detected that the necrotic core was significantly larger in atherosclerotic lesions in patients in acute phase of ACS without ST elevation comparing to the stable angina subjects and that it could be considered as a marker of plaque vulnerability.

[Ondansetron, alfentanil and nitrous oxide in the prevention of pain on injection of propofol].

Abstract: Introduction. Propofol is a widely used intravenous anesthetic with a number of advantages over intravenous anesthetics used so far. The leading side effect is pain on injection. Objective. Aim of the study was to determine the impact of ondansetron, nitrous oxide and alfentanil on reducing pain during propofol application. Methods. The paper presents a prospective, randomized, single blind study. The study included 120 patients of ASA class I and II, who underwent elective surgery under general anesthesia using propofol for the induction of anesthesia. The patients were divided into four equal groups of 30 patients. The control group received a few milliliters of saline, N group the mixture of nitric oxide and oxygen, O group ondansetron and group A received alfentanil. In all patients, venous occlusion was performed for 60 seconds. Pain assessment was based on the criteria and the score by McCrirrick and Hunter. Results. Pain after the application of propofol was present in 47 (39.2%) patients. The highest frequency of pain was recorded in the control group (18, 60%), and significantly lower (p=0.009) in the patients who received ondansetron (8; 26.7%) and (p=0.020), alfentanil (9; 30%). The statistical analysis proved that there was a significant relationship between the groups and the scale of pain (χ2=13.849, p=0.031). Conclusion. Based on the results of our study we can conclude that intravenous ondansetron and alfentanil with venous occlusion can effectively prevent pain during IV use of propofol.

Laboratory monitoring of the haemostatic system changes during orthotopic liver transplantation

Abstract: Introduction. In liver diseases, all components of the haemostatic system are changed and the degree of dysfunction is proportional to hepatocellular damage. During the liver transplantation, values of haemostatic parameters show substantial changes, while postoperatively there is a gradual normalisation of the haemostatic system function. Objective The aim was to monitor the changes of the haemostatic system intraoperatively and postoperatively, including the dynamics at which physiological values of parameters are reached after transplantation. Methods. There were 17 cadaveric transplantations performed at the Clinical Centre of Vojvodina in the period from June 2008 to February 2012. The following parameters were tested: platelets, activated partial thromboplastin, prothrombin and thrombin time, fibrinogen, euglobulin clot lysis time, D-dimer, antithrombin and heparinemia. The results were presented intraoperatively in phases of transplantation, and postoperatively from day 1 to day 7, ending with postoperative day 14. Results. During transplantation, the most pronounced disorders among those observed are: thrombocytopenia (96±66.1×109/L), prolonged activated partial thromboplastin (1.80±0.8 R), prothrombin (1.59±0.4 R) and thrombin time (2.03±1.7 R), hypofibrinogenemia (2.13±0.5 g/L), hyperfibrinolysis (29±12.0 min), increase of D-dimer (1393±1220.4 ng/mL) and decrease of antithrombin (61±18.0%). Further monitoring after transplantation from postoperative day 1 revealed a gradual normalisation in the values, reaching physiological values for all parameters on postoperative day 14, except for the sustained high value of D-dimer (2606±1055.1 ng/mL). Heparinemia was within the prophylactic range (0.26±0 IU/mL). Conclusion. Thorough monitoring of the haemostatic system parameters in liver transplantations is of great importance, as it enables the use of optimal substitution therapy during and after transplantation, as well as an adequate postoperative thromboprophylaxis. Our study has shown normalisation of investigated laboratory parameters within 7-14 days after transplantation.

[Allergic fungal sinusitis--new aspects of clinical features, laboratory diagnosis and therapy].

Abstract: Allergic fungal sinusitis (AFS) is a chronic non-invasive disease. Hypersensitive immune response is usually initiated by allergens of filamentous fungi Aspergillus, Penicillium, Cladosporium, Fusarium, Bipolaris, Curvularia and Alternaria. AFS is a clinical and immune analogue of the allergic bronchopulmonary aspergillosis (ABPA) as the sinus exudate resembles that of the bronchoalveolar lavage (BAL) in ABPA. Patients with AFS are usually immunocompetent, atopic and males. The most common symptoms are headache, fullness in the paranasal sinuses, and difficult breathing through the nose. Clinically, there is a chronic mucosal inflammation and histopathologic finding shows allergic mucin and eosinophils. Specific staining methods, Gomori's Methenamine Silver (GMS) or periodic acid-Schiff (PAS), are used for microscopic visualisation of hyphae, which are, in addition to the isolated fungi, most reliable evidence of AFS. Computerized tomography (CT) of paranasal sinuses shows the areas of hyperdensity. In cases where AFS is complicated by the erosion of bone tissue, discontinuation of the sinus bone wall can be seen. Significant laboratory finding, which correlate highly with the AFS, are high immunoglobulin E (IgE) antibodies specific for fungi, detected by the skin prick test or in serum. Treatment is often surgical, and after removal of the allergic mucin, therapy involves oral and nasal corticosteroids, immunotherapy and locally applied antimycotics (with verified fungal etiology). During treatment, the total/specific IgE is monitored--concentration increases with the development of AFS, and decreases during the improvement process. Knowledge of the pathophysiological mechanisms of AFS is scarce, and represents the focus of further research in order to define an optimal diagnostic and therapeutic approach.

Nasal carriage of methicillin-resistant Staphylococcus aureus among medical students of Belgrade University

Abstract: Introduction Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) present the growing problem in the whole world. Carriage of MRSA is most frequent in the nose, and medical students come in contact both with patients and different persons in the community. Therefore, they may be significant for the transmission of MRSA from hospitals to out- of-hospital communities and vice versa. Objective. The aim of this study was to establish the carriage rate among students of the second, third and fourth year of study at the School of Medicine in Belgrade and to analyze their genotypic and phenotypic characteristics. Methods. In total 533 nasal samples were taken. The samples were incubated in Trypcase-soy broth supplemented with 6.5% NaCl, and thereafter the swabs were inoculated on mannitol salt agar supplemented with 2 µg/mL of oxacillin. The presence of nuc, mecA and Panton-Valentine leukocidin genes was examined by PCR. The characteristics of the MRSA strains were determined using: antibiotic susceptibility testing by Vitek2 System, SCCmec, agr typing and MLST. Results. MRSA was isolated from two of 533 investigated samples (0.37%). MRSA were isolated from the students of the second and third year of study. Profiles of strains were: ST80 (SCCmec type IV, agr type 3) and ST152 (SCCmec type V, agr type 1). MRSA strains were multiresistant. Conclusion. The nasal carriage rate of MRSA in population of medical students of the first year of study in Belgrade is low. Genotypic and phenotypic characteristics of MRSA strains indicate their community origin. MLST typing revealed that isolates belong to ST80 and ST152.

Family planning among women in urban and rural areas in Serbia

Abstract: Introduction. Family planning is an important aspect of population policy at the state level, because the demographic trends in Serbia are very unfavorable. Objective. The objective of this study was to examine the differences in family planning between the women in rural and urban areas of Serbia. Methods. This study represents the secondary analysis of the National Health Survey of the population in Serbia from 2006, which was conducted as a cross sectional study, on a representative sample of the population. Results. The respondents who used condoms as a method of contraception, were often younger, better educated, had better financial status, lived in Vojvodina, and had no children. Conclusion. Our study showed that there were differences in terms of family planning between the women of urban and rural areas, however, these differences could be explained by differences in age and education.

Peroxisome proliferator-activated receptor gamma as modulator of inflammation in pulmonary sarcoidosis.

Abstract: Peroxisome proliferator-activated receptor (PPAR) includes the family of ligand-activated transcription factors which belong to the group of nuclear hormone receptors and are connected to retinoid, glucocorticoid and thyroid hormone receptors. There are three subtypes of PPARs: PPARalpha (also known as NR1C3), PPARgamma (known as NR1C1) and PPARdelta (known as PPARbeta or NR1C2). All of them take part in the metabolism, cell proliferation and immune response. PPARgamma and PPARalpha are identified as important immunomodulators and potentially represent an anti-inflammatory target for respiratory diseases. PPARgamma deficiency in the lungs has been observed in the inflammatory diseases such as asthma, pulmonary alveolar proteinosis, fibrosis and sarcoidosis, as well as in the animal models of the lung inflammation. A small number of papers concerned with PPARgamma in sarcoidosis pointto the lowered activity of this factor in the alveolar macrophages and a lowered gene expression for the PPARgamma, while the activity is preserved in healthy individuals. At the same time, an increased activity of the nuclear factor kappa B (NF-kappaB) in the bronchoalveolar lavage has been recorded in patients with sarcoidosis. The reason for the decrease in the production of PPARgamma in sarcoidosis remains unknown. Several possible mechanisms are mentioned: genetic defect with lowered production, down-regulation due to the increased values of IFN-gamma or an increased decomposition of PPARgamma. Further investigation will explain the mechanisms regarding the decreased production of PPARgamma in sarcoidosis.

Ruptured corpus luteum cyst in early pregnancy: a case report.

Abstract: Introduction. Transvaginal sonography and human chorionic gonadotropin (hCG) testing are cornerstones of modern clinical practice in cases with the suspected ectopic pregnancy. In unclear cases, if the level of hCG is above the discriminatory zones, the use of uterine curettage is recommended. There is an increasing concern that strict observation of the guidelines would potentially harm otherwise normal early intrauterine pregnancies in certain cases. Case Outline. A 35-year-old woman was admitted to hospital due to a severe lower abdominal pain. Based on the positive pregnancy test and sonographic exams which failed to demonstrate intrauterine pregnancy, the diagnosis of ectopic pregnancy was presumed. Laparoscopy revealed ruptured corpus luteum cyst and the diagnosis was confirmed on histopathological finding. Postoperatively, normal intrauterine gestation was visualized. Conclusion. Since the diagnosis of early pregnancy and its complications can be misleading, in unclear cases, we support the expectative “wait and see” management consisting of serial hCG testing and repeated ultrasound examinations. Avoidance of uterine curettage in such unclear cases would further reduce the possibility of normal early pregnancy interruption.

Attitudes on alcohol and drinking patterns among youth in Serbia

Abstract: INTRODUCTION: Alcohol is most abused psychoactive substance among youth. Analyzing attitudes on alcohol, patterns and consequences we are getting inputs important for implementing evidence based preventive measures. OBJECTIVE: The aim of this study was to analyze drinking patterns and expectations and alcohol risk perception by gender and region and determine correlation between attitudes and one year prevalence of drinking. METHODS: The study used data from the European School Survey on Alcohol and Other Drugs, which was then conducted in 2008 in Serbia on a sample of 6,553 students aged 16 years. For data analysis descriptive and analytical statistic were used. RESULTS: The results show that nine out often students have had at least one alcoholic beverage during life and 5% have at least one alcohol beverage on more than 20 occasions during the last month. Students in Serbia have mainly positive expectations from alcohol, and the strongest potential drinking predictors in the previous year are expectation of having fun and the wish to feel relaxed. According to the participants, drinking 4-5 drinks on weekends (34.6%) is less risky than trying cannabis (52.0%). Boys have experienced problems caused by alcohol drinking more often than girls, while students from Vojvodina have performed badly in school in higher percentage than students from Belgrade and Central Serbia. CONCLUSION: In Serbia, girls drink less and perceive drinking as more risky in comparison to boys, while 16-year-old students from Vojvodina have more positive expectations but also more prominent problems caused by alcohol drinking. Additional education of the young on alcohol risk is recommended. Language: en