Vol 34, No 1-2 (2006)
Published: 01.01.2006.
Authors in this issue:
A. Ćorac, A. Hodža, A. Jovanović , A. Pavlović, A. Sekulić, B. Biševac, B. Biskupljanin, B. Kisić Božović, B. Petrović, B. Stanojević, C. Vujičić, D. Marjanović, D. Mikić, D. Mirić, D. Perić, D. Popović-Babić, D. Radović, D. Staletović, D. Stamenković, D. Stolić, D. Vukša, E. Vitić, G. Čukić, G. Komljenović, G. Šubarić-Gorgieva, G. Trajković, I. Bubanović, I. Dragojević, J. Ivanović, J. Mladenović, J. Rašić, L. Dejanović, L. Vitković, L. Žorić, Lj. Vojvodić, M. Apostolović, M. Bogavac, M. Bursać, M. Cvetković, M. Dragojević, M. Miletić, M. Mirković, M. Nikolić, M. Relić, M. Stanišić, M. Vukotić, N. Krstić, N. Milinčić, N. Naumović, N. Stanišić, N. Videnović, N. Vujačić, N.B. Mitić, P. Jovanović , P. Kuzmanović, R. Mitić, R. Mladenović, R. Perenić, R. Stolić, S. Aranđelović, S. Bulajić, S. Cvetkoviċ, S. Janićijević-Hudomal, S. Jovanović, S. Kapetanović, S. Leštarević, S. Mladenović, S. Munitlak, S. Pajović, S. Radosavljević, S. Rudnjanin, S. Samardžić, S. Smiljić, S. Sovtić, S. Stanišić, S. Stević, T. Novaković, V. Cvetković, V. Ivetić, V. Jakovljević, V. Jakšić, V. Mišolić, V. Perić, Z. Anðelković, Z. Bukumirić, Z. Milanović, Z. Sojević, Z. Stanojević,
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01.01.2006.
Original scientific paper
DRUG TRANSITION THROUGH THE BLOOD-BRAIN BARRIER AFTER THE RETROGRADE INTRAARTERIAL APPLICATIO
Transition of xenobiotics from blood into brain tissue is limited by the blood-brain barrier (BBB), a very selective functional barrier that excludes penetration of various substances, while allowing essential nutrients to enter into CNS. Transport of drugs through the intact BBB depends of their physico-chemical characteristics, the way of drug application and of anatomical and functional integrity of the barrier. The aim of this work was to examine penetration of quinine and lysinacetylsalicilate in vivo through the rat BBB, after the intraarterial injection via the a. axillaris in the course to CNS. The
experiment was done on anaesthetized Wistar rats, body weight 200-300 g. Test animals received injection of quinine (25 mg/kg) or LAS (90 mg/kg). Blood from the left jugular vein and brain samples (brain stem, cerebellum, right and left cerebral hemispheres) were taken in four minutes period. Quinine concentrations in rat brain were higher than in blood (ratio between blood/brain concentration was <1) while LAS concentrations in blood were permanently higher, according to their liposolubility. Maximal concentration in the brain tissue of both drugs are time dependent which indicated the useness of an active transport
S. Stević, V. Jakovljević, R. Mitić, L. Žorić, Z. Stanojević, Z. Bukumirić, S. Bulajić, M. Bursać, L. Vitković
01.01.2006.
Original scientific paper
EFFECTOFGLUCAGON ON HEMODYNAMIC VARIABLES, CATECHOLAMINE LEVELAND ELECTROLYTE LEVELIN THE CANINE SERA
Glucagon is polypeptide hormone derived from pancreas which in addition to its metabolic actions has also certain cardiovascular stimulatory effects. We've explored the effects of glucagon on hemodynamic variables (mean arterial pressure, heart rate and central venous pressure) and on catecholamine level and the electrolite level in the kanine sera. It was estimated that glucagon expressed the positive chronotropic effect and significantly lowers the central venous pressure while inconsiderably inceases mean arterial blood pressure. It also leads to transient (short-lasting) hipokaliemia and nonsignificant hipocalcemia. As the result of the action of the glucagone, the serum adrenaline concentrations were significantly increased while the serum noradrenaline concentratios were significantly decreased
Z. Milanović, A. Pavlović, P. Jovanović, D. Radović, S. Smiljić
01.01.2006.
Original scientific paper
SPECIFIC OCULAR FINDINGS ATPATIENTS ON DIALYSIS
Ocular changes at the patients on dialysis are numerous but unique,too. They are caused by primary end-stage renal disease, influence of dialysing itself and regular co-morbid condition. Purpose of this study is to indicate specific ocular finding among patients who are on dialysis. This prospective study assessed 81 patients on regular, chronic dialysis. They underwent complete ophthalmologic examination. The most common findings were the following: conjunctival calcification (53 eyes), cataract (43 eyes) and retinal microangio-pathies(atherosclerotic, hypertensive and occlusive-in total 168 eyes). All findings mentioned above were statistically significant (p<0. 001) regarding to normal population. Ophthalmologist must be familiar with those abnormalities what is necessary for pointing out on special systemic co-morbid condition at the patients on dialysis.
V. Jakšić, M. Mirković, L. Žorić, D. Vukša, D. Stamenković
01.01.2006.
Original scientific paper
FEAR OF ADOLESCENTS ADOLESCENTS FROM STOMATOLOGICAL OLOGICAL INTERVENTIONS
By this investigation an attempt has been done to explain the existence of fear in adolescents from stomatological treatment, by appraisal of fear through its two components (congenitive and physiological). Congenitive component of fear,
was followed by written questionnaire before the first stomatologic intervention (by the standard scale of general anxiety). In the investigation participated 100 adolescents. On the basis of analysis of the question mark the adolescents have been
placed into three groups: normal, pathological and increasingly anxious. During third visit (three stomatologic interventions) each patient was recived the placebo (vitamin C one half of the tablet, orally, 30 minutes before start of work of stomatology interventions which were identical, i.e. the sanitation of deep carries). Physiological component (sweating and voice) have been appraised by the method of clinical observation. All parameters were measured before all three stomatologic interventions. In this investigation, in parameters measured by clinical observation happened a diminution of strong small of sweating, trembling voice stammering in occasion of application of placebo therapy
D. Popović-Babić, V. Ivetić, M. Apostolović, N. Naumović, B. Biskupljanin
01.01.2006.
Original scientific paper
SYMPTOMS, SIGNS AND ABNORMAL CLINICALAND LABORATORY FINDINGS IN WORKERS IN THE CHLORINE-ALKALI ELECTROLYZE
Elementary mercury using as cathode in process chlorine-alkali electrolyze. Mercury vapor makes in process going in work setting atmosphere. Aim of the work is to examine whether symptoms, signs and abnormal clinical and laboratory findings are in the correlation with work in the chlorine-alkali electrolyze. Examination of air pollution work setting discovers that the major factor of air pollution is mercury vapor. On periodical view at 2000, 2002 and 2004 year was examine 571 respondent, and their diagnosis was entered in report, from which was separated symptoms, signs and abnormal clinical and laboratory findings. Workers on different workplaces are exposes in different degrees. Examinees were divided in a four group according to the grade of exposure: I group day by day exposed; II group sporadically exposed; III group earlier exposed; IV group not exposed. I, II and III group are workers which work in the process chlorine-alkali electrolyze. IV group was control group and her compose administration personal. The statistical testing differences of frequency between groups according to the grade of exposure is showed there is statistical significantly difference between I and III, and II and IV groups. We are concludes that symptoms, signs and abnormal clinical and laboratory findings, statistically significantly, there is in persons which are permanently and long term worked in the chlorine-alkali electrolyze setting, from persons which are not permanently expose or nonexpose
A. Ćorac, G. Trajković, M. Mirković, P. Kuzmanović, M. Vukotić, S. Samardžić, V. Mišolić
01.01.2006.
Original scientific paper
CORRELATION BETWEEN COLPOSCOPICAL AND HISTOPATOLOGICAL FINDINGS AT CARCINOMA PVU
Of 130 examined women who had not undergone a cytological and colposcopy check-up for at least a year, there were positive colposcopy: mosaic 39 (30,00 %), atipic vascularisation 15 (11,54 %) and suspect of invasive cervical cancer 1 (0,77 %). While the invasive carcinoma was ascertained most frequently at the ages of 40 to 59. The frequent incidence of severe displasia in subjects is 2,31 %, microinvasive cervical cancer 1,45 %, and the incidence of the invasive carcinoma is 3,85%.
S. Cvetkoviċ, B. Petrović, S. Stanišić, N. Milinčić, N. Stanišić
01.01.2006.
Original scientific paper
DIABETES MELLITUS, RISK FAKTOR FOR CANDIDA SKIN INFECTION
Diabetes mellitus is a typical example for connection betwen sickness of internal organs and the skin. The ratio betwen glycose level in a gram of skin and the amount of glycose in a mililiter of blood is higher in diabetes mellitus then normal. This implies that insulin regulates intracelular distribution of glycose in the skin. It is recessary for the keratinocyt growth and diferentiation, healing of wounds, but also for the fibroblast functioning in the derm. In diabetes mellitus acidofil is lowered, and glycolised colagen is increased, and fibroblasts in the extra produce fibronectin. Skin and visible mucosys infections caused by candida albicans in diabetes patients belong to the group of deseases that could be a consequence of a disbalanced metabolism. They are seen frequently, but not patognomic for these patients, becuse they are also possible in people whose metabolism is normal. Badly controlled or undiagnosed dibetes mellitus is often coupled with candida induced skin deseases. Sometimes candida infections are the first sign of diabetes. Dermatologist is often in position to discover the disease on the basis of skin symptoms, which gives possibility for regulation of the sickness on time and avoid complications. It is known that complications develop slower when diabetes is regulated. Skin alterations in candidiasys and its connection with diabetes are described briefly, with an attempl to explain patogenesys of their apearence.
Z. Sojević, T. Novaković, D. Staletović
01.01.2006.
Professional paper
HERNIAOFINGUINALREGION AND THEIR SURGICALTREATMENT
Ahernia occurs when the contents of a body cavity bulge out of the area where they are normally contained. These contents, usually portions of intestine or abdominal fatty tissue, are often enclosed in the thin membrane that naturally lines the inside of the cavity. Although the term hernia can be used for bulges in other areas, it most often is used to describe hernias of the lower torso (abdominal wall hernias). Hernias by themselves usually are harmless, but nearly all have a potential risk of having their blood supply cut off (becoming strangulated). If the hernia sac contents have their blood supply cut off at the hernia opening in the abdominal wall, it becomes a medical and surgical emergency. Aims of the paper were: 1. to reveal the prevalence of inguinal region hernias (IRH) among all patients being admitted to emergency ward of Surgery Clinic at Gracanica during 2006 and 2. to show treatment efficacy of each surgical methods used. Material and method: Clinical
Center Pristine, Surgery Clinic at Gracanica patients' medical records were analyzed. Prevalence of IRH was monitored during the time frame of 1 year (2006). Basic statistical methods were applied for data analyzing. Results and discussion: During the time observed, 504 patients underwent surgical treatment. Among them, 162 patients (32,14%) were operated on inguinal region hernias. IRHs were more prevalent in males - 146 cases (90,12%) in comparison to 16 cases in females
(9,88%). During the certain time period, IRHs were more prevalent in adults 101 cases (62,35%) than in children 61 cases (37,65%). The vast majority of all operated hernias, belong to group of inguinal hernias 156 cases (96,30%). At the same time, there were only 6 cases (3,70%) of femoral hernias. This observation is in concordance with the data published worldwide inguinal hernias make up 75% of all abdominal wall hernias and occur up to 25 times more often in men than women.
The study, also, revealed incarcerated hernia (part of the intestine or abdominal tissue that becomes trapped in the sac of a hernia) in 6 patients (3,70%) while recurrent hernia was found in 3 patients (1,85%). The most frequently used surgical approaches were: i) Ferrary method in 54 patients (33,33%; ii) Lichtenstein method in 42 patients (25,93%), and iii) Bassini method in 35 patients (22,22%). Postoperative complications were noted in 3 patients (1,85%). Conclusion: Based on the results obtained, one may conclude that efficacy of surgical method used in treatment of IRH is in indirect relation with the number of postoperative recidives the higher the number of hernia recurrences, the lower the efficacy of surgical method is
J. Mladenović, N. Videnović, D. Perić, M. Stanišić, A. Hodža, S. Mladenović, R. Mladenović, S. Aranđelović, A. Sekulić
01.01.2006.
Professional paper
UTERUS FACTOR AS A REASON OF REASON OF INFERTILITY OF THE WOMAN
The tests were made at deparment of infertility at the Gynecology and Obstretics Institute of Clinical Center of Serbia in the period from 01.01. untill 31.12.1998. The three hundred patients, on which hysterosalpingography (HSG) was made, and patients, on which chromolaparoscopy was made, were involved by prospectus studies. In the laparoscopy the larger anomalies of the uterus and significant hypoplasy coincide with HSG finding, while hypoplasy in the lower level or uterus arcuatus always can not be established by laparoscopy.The higher frequency of all pathological alterations of the uterus, except the myoma of the uterus, was established by HSG, relating to laparoscopy. Associate pathological alterations were established in the higher percent by HSG than by the laparoscopy, while the single changes were diagnosed in the lower percent.The deficit in the loading of the uterus by the constrast medium, also the changes at the endometrium, could be proved by HSG only. Intravasation can be identified by the both methods. In the diagnosis of the myoma of the uterus, laparoscopy is more important method than HSG.Pathological alterations of the uterus, especially higher anomalies of the uterus and hypoplasy were established in the higher percent by HSG than by the laparoscopy, but statistically the more significant difference was not established in the application of the both methods
B. Stanojević, Lj. Vojvodić, M. Bogavac
01.01.2006.
Professional paper
INITIAL RESULTS OF BICARBONATE HAEMODIALYSIS TREATMENT IN DIALYSIS CENTER IN KOSOVSKA MITROVICA INITIAL RESULTS OF BICARBONATE HAEMODIALYSIS TREATMENT IN DIALYSIS CENTER IN KOSOVSKA MITROVICA
Haemodialysis, as a drastic medical procedure, needs a modern technology for performing of qualitative depurative process. Trying to imitate a function of healthy kidneys, it provides survival without one vital organ. The aim of the study was a qualitative estimation by comparing laboratory and clinical parameters of one-year haemodialysis treatment with different dialysis methods. In all patients treated with chronicle haemodialysis in Dialysis Centre in Kosovaska Mitrovica, we performed a set of laboratory analyses, recorded hepatotrophic viruses and determined a quality of haemodialysis by the degree of urea elimination. There are 16 patients on chronicle haemodialysis, 11 female (68,75%) and 5 male (31,25); mean age, 52,46±16,89 years, mean time on dialysis was 58±51,835. An increase of hemoglobin concentration was correlated with bicarbonate heamodialysis initiation. (61,692±19,405 vs. 75.466±13,814; p=0,038). Cholesterol (5,32±1,522 vs. 4,34± 1,006; p=0,0481) and inorganic phosphorus (1,427±0,2327 vs. 1,692±0,260; p=0,0056) are biochemical factors that are in a reverse correlation with bicarbonate haemodialysis in our patients. The degree of urea elimination as a measure for haemodialysis adequacy was statistically significant indicator of an adequate dialysis and was correlated with bicarbonate haemodialysis initiation (t=8,571; df=1; p=0,0389)
R. Stolić, S. Radosavljević, A. Jovanović, V. Perić, S. Sovtić, D. Stolić, T. Novaković, G. Šubarić-Gorgieva
01.01.2006.
Professional paper
THE NATALITY OF SERBS IN KOSOV SERBS IN KOSOVO AND MET AND METOHIJA
The birthrate in Serbia has been falling and we are the last country in Europe according the number of newborn children. The aim of this study was to establish the birthrate trend during the period of five years on the territory of Central Kosovo and Metohija, according the data of Gynecology- Obstetrics Clinic/Gracanica, to indicate the importance of an improvement of women's health care, increase the birthrate and population growth rate. There was used a retrospective method of examination of the data from the maternity hospital register in Gracanica. There were also used the data from the death registry in the local community of Donja Gusterica and the records of students enrolled into the first grade of Primary School in Donja Gusterica. During the period from March 2002 to August 2005 there were born 1718 children (912 boys and 806 girls). There is almost no family on this territory with less than three children and there is a significant number of families with four or five children. The number of women who bore six times was 24, seven times was 13 and eight times was 11 while there were two women who born the ninth child and one woman who bore the eleventh child. During the five-year period, on the territory of local community of Donja Gusterica, there died 169 people while, at the same time, the number of students enrolled into the first grade of primary School was 293. An important contribution to growth of natality is an improvement of the women's health care. There was noticed a constant increase in number of newborn children for the mentioned period as well as a significant increase in population growth rate in Central Kosmet
R. Perenić, R. Stolić, S. Kapetanović, D. Stolić
01.01.2006.
Professional paper
THE INFLUENCE OF KALIUM LEVEL FOR BEGINING CARDIAC ARRHYTMIAS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
Hypokaliaemia can be cause for beginning cardiac arrhythmias in patients with acute myocardial infarction. The aim of this investigation is to determine correlation between kalium level in serum and cardiac arrhythmias and conveying, to note down in first 24 hours in patients with acute myocardial infarction (AMI). Patients in this study attended in department of Internal medicine(coronary department ) in hospital in Health center in Kosovska Mitrovica.In this prospective study for one years we analyzed 110 patients with diagnosis of acute myocardial infarction. We found that cardiac arrhythmias represented in the most noumber of patients in the first 24 hours from receiving in hospital- 83,63%.The patients have had the more noumber of complex VES(20,91%),SVT(18,18%) than other cardiac arrhythmias in the first 24 hours from their received in the hospital. The low level of kalium have note down in 9,09% patients. The comlex VES have represented in patients with low level of kalium as VF. In the presence of kalium level under the 4,0 the risk for ventricular arrhythmias is higher.SVT have had in 20% patients with acute myocardial infarction,SVB in 10%,SVES in 16%,VF in 7% patients with normal kalium level in serum as branch block and AV-block I, II, III degree. Hypokaliaemia have influence on represence of VES and VF, but have not influence on represence of supraventricular arrhythmias and the disorders of conveying.
N. Vujačić
01.01.2006.
Professional paper
THE STRUCTURE AND FUNCTION OF DENDRITIC CELLS
Dendritic cells (DCs) are antigen presenting cells which trace origin from bone marrow cells. These cells are discovered and described by Steinman i Cohn (1973) in peripheral lymphoid organs of mice. The cellular membrane of DCs are place of expression of plenty immunoregulatory molecules such as MHC class I and II, co stimulatory, and adhesion molecules, as well as many receptors for different cytokines. Armed on this way, DCs are one of the most effective antigen presenting and immunoregulatory cells. Moreover, role of DCs in development of immune reaction can be crucial due to they are one of the most important cellular “link” between native and adaptive immunity. DCs are engaged in mechanisms of antigen processing and presentation, induction of immune reaction, establishing immune tolerance and immune reaction regulation, balancing the immune reaction between autodestruction and protection of “self” cells. These functions makes that DCs play very important role in development of some pathological conditions and diseases such as autoimmunity, allergies and quality of anti-tumor and anti-microbe defense. Unbalanced immune reaction is hallmark of all cited diseases and immunopatological conditions, so that the function of DCs should be explored on the better way.
Z. Anðelković, S. Leštarević, N.B. Mitić, I. Bubanović, D. Marjanović
01.01.2006.
Professional reviews
MONITORING THE ADVERSE ADVERSE DRUG REACTIONS REACTIONS TODAY
One the of most importante charactersistics of drug is a drug safety. However, there is no absolute safety. Medicines are troughly tested in controlled clinical trials with limiting population and short duration. Experience has shown that much of our knowledge about a medicine becomes available during the subsequent prescribing practice. Therefore there is a need for continued monitoring medicines after granting of product licence for a new drug (phrmacovigilance). WHO international system for drug safety monitoring as maintained by the Upsala Monitoring Centre (UMC) in Sweden, has built up vastedatabase of reports of suspect adverse drug reactions, coming from national centres in 75 countries in all of the world. The international system products valuable information from countries around the world, to support regulatory follow-up and decision-making. Emphasis is on those signals that may remain at the national level, because of small numbers or absence of local reports. The aim of the WHO's international pharmacovigilance program is a safe and rational medicines evrywhere. In Serbia as of 2005. National Medical Devices Agency is acting on behalf of the Ministry of Health as National Centre for Adverse Drug Reactions. The form for reporting adverse effects of medicines, in both pre-marketing and post-marketing phase can be found and downloaded in Word format on the Agency`s web site www.alims.sr.gov.yu.
S. Janićijević-Hudomal, J. Rašić, R. Mitić, Z. Stanojević
01.01.2006.
Professional reviews
REACTIVE OXYGEN SPECIES
Reactive products of oxygen are among the most potent and omnipresent threats faced by the living organism. Intracellular accumulation of reactive oxygen species such as superoxide anion, hydrogen peroxide, hydroxyl radical, and peroxy radical, can arise from toxic insults or normal metabolic processes. These species may perturb the cell's natural antioxidant defence systems, resulting in damage to all of the major classes of biological macromolecules, including nuclear acids, proteins, carbohydrates and lipids. Oxidative stress has been defined as a disturbance in the prooxidant-antioxidant balance, resulting in potential cell damage. It has been implicated in several biological and pathological processes like ageing, inflammation, carcinogenesis, ischemia-reperfusion and in diseases including diabetes mellitus, atherosclerosis, and/or neurodegenerative diseases
B. Kisić Božović, D. Mirić, M. Dragojević, I. Dragojević
01.01.2006.
Professional reviews
DIABETIC NEPHROP IABETIC NEPHROPATHIA AND ACE INHIBIT ACE INHIBITORS
Diabetes is the most common cause of end-stage renal disease .in United States , Europa and Japan. Approximately 40% of patients with type 1 diabetes and 5-15% of patients with type 2 diabetes eventually develop end-stage renal disease. Risk factors for development of diabetic nephropathy include hyperglycemia, hypertension, positive family history of nephropathy and hypertension, and smoking. Key elements in the primary care of diabetes include glycemic control, blood pressure control, and screening for microalbuminuria. In general, the goal for glycemic control is a blood glucose level as close to normal (HbA C <7%) . Blood pressure control is at least as important as glucose control, especially after the onset of 1 renal damage, and blood pressure should be consistently <130/85. Screening for diabetic nephropathy involves monitoring at least yearly for urinary albumin excretion >30 mg per day. Microalbuminuria is defined as the urinary excretion of 30300 mg of albumin per day. Both glycemic control and rigorous control of blood pressure have significant impact on prevention and progression of diabetic nephropathy. Identification of patients with microalbuminuria selects a population of patients with increased mortality. Microalbuminuria screening should begin at the time of diagnosis. ACE inhibitors should be used when microalbuminuria is present regardless of the presence or absence of hypertension in type 1 diabetes and are widely.
used in normotensive patients with type 2 diabetes, as well.The effect of ACE inhibitors is probably not only via lowered
systemic blood pressure but also via direct effects on intraglomerular hemodynamics.
T. Novaković, S. Jovanović, S. Sovtić, S. Pajović, R. Stolić
01.01.2006.
Professional reviews
DIFFERENTIAL DIAGNOSIS OF PUSTULA MALIGNA
The pustula maligna is most often clinical form of antrax. Disease is today a relative Rarity, but its appearance (sporadic or in epidemia) always to be surprised, especially in the biology war. Antrax have a big significant and today, we analyzed clinical findings of pustula maligna and its differential diagnosis.
M. Relić, C. Vujičić, L. Dejanović, N. Krstić, J. Ivanović
01.01.2006.
Professional reviews
PLACE OF ZINK PREPARATION AS DIETETIC SUPPLEMENT IN NON-INSULIN-DEPENDENT DIABETES MELLITUS
Considering its importance in cell replication and differentiation, programmed cell death, DNA transcription, function of hormones, biological membranes and immunological system, zinc probably has a major role in enabling a proper
function of different tissues, organs and organic system in general. As an essential micronutrient wich is directly involved in metabolizm of insulin, zinc play important role in pathogenesis of diabetes mellitus and its complications. On the other hand, low zinc absorption and hyperzincuria in diabetic animals and humans have indicated that diabetics are more susceptibile to zinc deficiency compared to healthy persons. Inasmuch as zinc plays an important role in syntesis, storage and secretion of insulin as well as conformational integrity of insulin in the hexameric form, zinc deficiency may adversely affect the ability of the islet Numerous studies suggested that urinary zinc excretion was higher in diabetes mellitus, probably as result of hyperglycemia. In contribution, there are findings about correlation between urinary zinc excretion and blood glycosylated hemoglobin (HbA1c) levels in non-insulin dependent diabetic patients. Recent experimental investigations showed that zinc supplementation inhibited NF-kB activation in the pancreas and decreased the expression of inducibile nitric oxide synthase, a downstream target gene of NF-kB. The ability of zinc to modulate NF-kB activation in the diabetogenic pathway may be the key mechanism for zinc's protective effect and important criterion for choosing nutritional strategies for diabetes mellitus prevention.
Z. Stanojević, R. Mitić, S. Stević, Z. Bukumirić, B. Biševac, M. Miletić, S. Bulajić
01.01.2006.
Case Reports
ADJUNCTIVE HYPERBARIC OXYGEN THERAPY IN THE TREATMENT KLEBSIELLA OSTEOMYELITIS OF FEMUR (A CASE REPORT)
Klebsilla pneumoniae is the very rarely cause of osteomyelitis in adults, most commonly in the immunocompromised patients with extra-sceletal infections. Successful therapy of chronic refractory osteomyelitis included different orthopaedic methods of treatment, the long time antibiotics therapy and more and more freaquently treatment with adjuvant hyperbaric oxygenation. We report an uncommon case of patient with chronic postraumatic osteomyelitis cased by dissemination of Klebsilla pneumoniae from urinary tract to place of osteosinthesis of femur. Treatment of this case of chronic refractory Klebsilla osteomyelitis finished successfuly after treatment with hyperbaric oxygenation two years from start of desease.
D. Mikić, G. Komljenović, S. Rudnjanin, S. Munitlak
01.01.2006.
Case Reports
RISK MANAGEMENT AMONG PATIENTS WITH SY GUILIAIN-BARRE AND ACUTE CHIRURGICAL DISEASE - presentation of the case with focus on the needed establishment of the national database of the risk cases
Every anesthesiologist can meet during his/her work with the patients who are suffering from rare diseases and had to be treated with surgical procedures. In a large clinical centers availability of the equipment, mentors and continual professional education are factors that are making performances of anesthesiologist's much easier. Regional hospitals, including our own one, are in much disadvantaged position. Health Center Kosovska Mitrovica is providing health treatment from the territory of Kosovo and Metohija. Due to the limited freedom of movement, these patients have to be treated "immediately and at place". Through the presentation of the case of the patient with Guillain-Barre (GBS) syndrome, we would like to underline a need for the establishment of the informational availability system through Point-of-Care Call on Line Electronic Help (OLEH) programme as it would significantly reduce the incidents related to the injuries and death cases caused by anesthesiologist procedures. Presentation of the case: Female, 42 years of age, a neurological patient with a th number of years of diagnosed illness was accepted on 13 February 2006 at the surgical department due to the abdominal pain, constipation and difficult urination. It was identified and diagnosticallv confirmed that uterus cancer spread out towards the colon, jeopardizing the bladder. It was decided that surgical procedure is reouired. Anesthesiology risk management evaluation started from the introduction with GBS. The case reviled acute inflammatory neuropathy with denivelization as the outcome of the antibodies reaction on the peripheral nerves. Chronically occurred types fas it was our easel, could lead to disruptions in breading, weakening of the muscle structure, areflection, pareses of orofaringealy physique, ophtamoplegy, chvadriplegy and chronical lung hearth. Strategy of the anesthesiological approach within the risk management procedures considered safe guidance of the patient through the pre and post anesthesioloqical period. Problem occurred was related to the limited availability of the professional literature and on-place resources related to the holistic experiences in treatment of this kind of problematic cases. The only sure available guideline was related to the avoidance of the depolarizing relaxants, which we have practiced. Within the work, we have described in details pre. peri and post anesthesiological approaches towards this problem. Conclusion: Recognition of the risk factors and multidisciplinary approach showed efficient during the peri and early post operational period. We have to indicate that development of the basic disease could have been much slower if we had assistance in respect to at-hand available and holistic information's on the rare diseases focused on the anesthesiological treatments. Therefore, it is our opinion that more qualitative system of health insurance has to introduce implementation of the hospital services standards, monitoring of the implementation and establishment of the electronic database. Developed countries such are i.e. USA, France, Italy, etc, have already introduced similar practices aimed to reduce morbidity and mortality among the patients
M. Cvetković, V. Cvetković, M. Nikolić, E. Vitić
01.01.2006.
History of medicine
RELATIONS OF THEORY, STRATEGY AND TACTIC IN PREVENTIVE MEDICINE TYPHUS ENANTHEMATICUS IN SERBIA IN 1914/15 R
Synonym Louse borne typhus represents the connection between Typhus exanthematicus and body lousiness. The results of the experiment Nicolle 1909 definitely established that. It is not explored how well the fact that Typhus is transmitted by body lice was known by doctors who were the actors of events in Serbia in 1914/15 year. A number of them categorically stated that they weren't aware of the results of Nicolla's experiments. Those honest doctors accused themselves that the fact not knowing made that “people paid by several hundreds of heads”, it was concluded that “they didn't know the theory and practice of Typhus epidemiology”. They thought that the epidemic disease would have had another direction if that had known that fact. In 1914/1 Serbia was “Typhus land stomach, recurrent and mysterious and violent Typhus”. It was the place where hypothesis “that destroying lice could be adequate proceeding in repress epidemic of Typhus” could be checked. On the epidemic culmination there was no any act or mean for effective total massive destroying lice. Disinfestations were the hygiene measure until 1915 year, and that wasn't anti epidemic measure. The working aim is to show the paradoxes: of doctors' self-accusing and confirmation on existing of special measures against Typhus. Descriptive method. Inspection in: professional, historic, fictive, accounts of its travels reviewers and archive origin on Typhus in the First World War. In 1914/15 there was no special epidemiology of Typhus. There was no effective tactic mean for massive disinfestations. Until then, nobody was stopping epidemic of Typhus bys strategy of destroying lice and their eggs. They didn't completely trusted Nicolla because current authorities believed that Typhus could be transmitted also by droplets' way. In the actual moment of epidemic culmination, the public's opinion was that disinfestations would be successful. Self-accusing of national doctors appeared after the success of English military mission. Kujachitsh was writing about Nicolla's experiments and he was a participant in war in 1914/15 and so he didn't look for a disinfestations (depediculation) mean and he didn't also strictly expressed himself on lice importance. Hirschfield, Subotitsh were looking for a mean for massive disinfestations; according to the results, they weren't successful. Scientific theory of Nicolla, and its prompt review by Kujachitsh, might be the base for positive movements, but also for tendentious “inflaming imagination” - “what could be if…”. We'll support the opinion how (the most) rationally the success could be reached: 1) what was cumulatively hypothetic by proofs becomes cumulatively confirmed; 2) supporting better stages in reaching the truth. Further appearance of sick could be added to failure: a) of tactic solution; or/and b) a strategy; or/and even solidly proved c) start, experiment of Nicolla. Interdependence is maximal first not proved conditions that the following one is problematic. There were no intention to prove that “disinfestations was successful for eradication of Typhus”, and from that appeared the failure of chosen mean, organisation of proceeding and so on, it could influence valuation of strategic result, instead of having reliable knowing on disinfestations power as a motive for finding means. The fruit of the projection and emotions is a prejudice that Nikola's theories is self-sufficient in order to make epidemic resulted in significantly less number of victims from Typhus if that had been known because all of the rest would be just result; that Stammer's mean could be easy to find. All of this produced repentance and self-accusing a number of honest doctors and that was stressed further, and it was never put under consideration although it came only after final happening. Successful tactic solution was uncertain if it was going to be found at all. Ranges of tries were not successful (Subotitsh, Hirschfield and so on). Stammer's “Serbian barrel” was enough for stopping dangerous large epidemic scale. Hunter had a planned approach to eradicate Typhus by disinfestations (depediculation), he applied that new strategic measure in the whole territory of Serbia, in: the Army, national and displaced population, as well as among the prisoners. Mostly thanking to Nicolla, only after epidemic in Serbia in 1914/15 the adequate synonym to Typhus is “Lousy Typhus”. The special epidemiology of Typhus was not constituted until 1919, and so
the valuation of not knowing the theory and practice (of special epidemiology) of Typhus was not applicable to time in 1914/15. There are no guilty ones for death of Typhus in Serbia in 1915 among the doctors. Informing that lice transmit Typhus meant that in looking for disinfestations procedure “there was no more in obligation, but more in opportunity”. Success of Stammers classifies himself among the “unusual” ones. Success of English military mission with Hunter on the top, made that Golgotha exceeded into epopee. The typhus from then always used to lose its battle.
G. Čukić