CORRESPONDENT IVANA STAŠEVIĆ KARLIČIĆ Clinic for psychiatric disorders “Dr Laza Lazarević”, Belgrade, Serbia ivanastasevic73@gmail.com doi:10.5937/pramed1604101S

Polymorphonuclear neutrophils make about 60-70% of all leucocytes in adults. Neutropenia is defined by neutrophil count below 1.5 h 109/l. It could be classified as mild, moderate and severe, based on the following absolute neutrophil count: 1-1.5 h 109/l, 0.5-1 h 109/l, and < 0.5 h 109/l. Incidence of drug-induced neutropenia is 3-10 cases per million. Drug-induced neutropenia emerges suddenly, and develops a few hours to 1-2 days after administration of the offending drug. There are several mechanisms of neutropenia induced by non-cytotoxic drugs: (1) drug binding to neutrophil membrane, formation of hapten and induction of immune response which destroys neutrophil; (2) induction of neutrophil apoptosis; (3) formation of immune complexes; (4) induction of autoantibodies and complement activation with destruction of neutrophils; (5) dose-dependent inhibition of granulopoesis; and (6) direct toxic effect on myeloid precursors. Treatment of patients with drug-induced neutropenia consists of the offending drug discontinuation, maintenance of strict hygiene and administration of granulocyte-colony stimulating factors in the case of severe neutropenia.

Introduction Healthcare-acquired urinary tract infections (HAUTI) make up to 40% of all healthcareacquired infections and contribute significantly to hospital morbidity, mortality, and overall cost of treatment. Objective The aim of our study was to investigate possible risk factors for development of HAUTI caused by multi-drug resistant pathogens. Methods The prospective case-control study in a large tertiary-care hospital was conducted during a five-year period. The cases were patients with HAUTI caused by multi-drug resistant (MDR) pathogens, and the controls were patients with HAUTI caused by non-MDR pathogens. Results There were 562 (62.6%) patients with MDR isolates and 336 (37.4%) patients with non-MDR isolates in the study. There were four significant predictors of HAUTI caused by MDR pathogens: hospitalization before insertion of urinary catheter for more than eight days (ORadjusted = 2.763; 95% CI = 1.352–5.647; p = 0.005), hospitalization for more than 15 days (ORadjusted = 2.144; 95% CI = 1.547–2.970; p < 0.001), previous stay in another department (intensive care units, other wards or hospitals) (ORadjusted = 2.147; 95% CI = 1.585–2.908; p < 0.001), and cancer of various localizations (ORadjusted = 2.313; 95% CI = 1.255–4.262; p = 0.007). Conclusion Early removal of urinary catheter and reduction of time spent in a hospital or in an ICU could contribute to a decrease in the rate of HAUTI caused by MDR pathogens.

BACKGROUND/AIM Benign prostatic hyperplasia (BPH) is one of the most common disease among males aging 50 years and more. The rise of the prevalence of BPH is related to aging, and since duration of life time period has the tendency of rising the prevalence of BPH will rise as costs of BPH treatment will and its influence on health economic budget. Dutasteride is a new drug similar to finasteride, inhibits enzyme testosterone 5-alpha reductase, diminish symptoms of BPH, reduce risk of the complications and increases quality of life in patients with BPH. But, the use of dutasteride is limited by its high costs. The aim of this study was to compare cost effectiveness of dutasteride and finasteride from the perspective of a purchaser of health care service (Republic Institute for Health Insuranse, Montenegro). METHODS We constructed a Markov model to compare cost effectivenss of dutasteride and finasteride using data from the available pharmacoeconomic literature and data about socioeconomic sphere actual in Montenegro. A time horizon was estimated to be 20 years, with the duration of 1 year per one cycle. The discount rate was 3%. We performed Monte Carlo simulation for virtual cohort of 1,000 patients with BPH. RESULTS The total costs for one year treatment of BPH with dutasteride were estimated to be 6,458.00 € which was higher comparing with finasteride which were 6,088.56 €. The gain in quality adjusted life years (QALY) were higher with dutasteride (11.97 QALY) than with finasteride (11.19 QALY). The results of our study indicate that treating BPH with dutasteride comparing to finasteride is a cost effective option since the value of incremental cost-effectiveness ratio (ICER) is 1,245.68 €/QALY which is below estimated threshold (1,350.00 € per one gained year of life). CONCLUSION Dutasteride is a cost effective option for treating BPH comparing to finasteride. The results of this study provide new information for health care decision makers about treatment of BPH in socioeconomic environment which is actual both in Montenegro and other countries with a recent history of socioeconomic transition.

Neuroleptic malignant syndrome (NMS) is a life-threatening, often fatal idiosyncratic reaction to neuroleptic or other drug therapies that antagonise the central dopaminergic neurotransmission. The clinical presentation of NMS is very heterogeneous. The lack of specific levels of symptom severity in currently used diagnostic criteria dims the diagnosis of NMS. Therefore differential diagnosis is of priority, because NMS is a diagnosis of exclusion. The aim of this paper is to present a complex clinical picture in a patient that after a differential diagnostic exclusion of other medical conditions and intoxications is diagnosed as NMS. Case reports such as these help raise awareness of this clinical issue.

BACKGROUND/AIM Urinary tract infections are still the most frequent complications in patients with spinal cord injury (SCI). The aim of this study was to analyze the factors influencing development of urinary tract infections during rehabilitation in patients with SCI. METHODS This retrospective case/control study including 540 patients with SCI which were rehabilitated in the Clinic for Rehabilitation "Dr Miroslav Zotović" between January 2000 and December 2009. We used patient files and other available medical documentation for obtaining information contained in this study, such as the manner of bladder emptying, the type of neurological disorder of the bladder, the neurological level and completeness of a lesion, the injury etiology, treatment method, secondary complications and associated injuries, kidney and bladder calculosis, age and sex. RESULTS Out of the total number of patients included in the study, 152 (28.1%) were without urinary tract infections, whereas 388 (71.9%) had urinary tract infections. There were 389 (72%) male and 151 (28%) female patients. The average age of patients without urinary tract infections was 51.0 ± 15.4 years, whereas the mean age of patients with urinary tract infections was 44.3 ± 16.9 years. The results of our study showed that the occurrence of urinary tract infections during rehabilitation in patients with SCIs was associated with the following factors: combined injuries (OR = 3.5), anemia (OR = 5.67), type of the bladder functional disorder (OR = 40-60) and crystals in urine (OR = 7.54). CONCLUSION The physicians should take precautions and try to make the early diagnosis and rapid appropriate treatment of urinary tract infections in patients with SCI who also have functional bladder disorder, combined spinal injuries, anemia or urine crystals.