Summary The aim of this study was to analyze the reasons why the guidelines for post-splenectomy vaccination are not being followed. Considering that vaccination reduces the risk of overwhelming post-splenectomy infection, it is important to determine the reasons for inadequate vaccination after splenectomy. Our research was a qualitative study based on interviews with six surgeons, one general practitioner and three patients who underwent splenectomy, and on the review of patient’s medical charts and discharge summaries. This study has shown that health care team and patients lack sufficient knowledge about postsplenectomy vaccination. In addition, the study has shown that splenectomy registers, medical bracelets and up-to-date vaccination cards still have not become part of our current practice. Our study has shown that patient education and health care team education is crucial to follow the guidelines for post-splenectomy vaccination, which is similar to most other reports. In order to increase the level of post-splenectomy vaccination, we need to upgrade the education of health care teams and patients. Moreover, we need to start using splenectomy registers, medical bracelets and up-to-date vaccination cards. Sažetak Cilj ove studije bio je da se analiziraju razlozi zbog kojih se ne prate vodiči za postsplenektomijsku vakcinaciju. Imajuću u vidu da vakcinacija smanjuje rizik od ozbiljnih postsplenektomijskih sepsi, važno je da se odrede razlozi za neadekvatne vakcinacije nakon splenektomije. Naša studija je kvalitativna, bazirana na intervjuima sa šestoro hirurga, jednim lekarom opšte prakse i tri pacijenta koji su bili podvrgnuti splenektomiji, kao i na uvidima u kartone i otpusne liste bolesnika. Ustanovljeno je da zdravstveni tim i bolesnici imaju nedovoljno znanja o postsplenektomijskoj vakcinaciji. Takođe, ustanovljeno je da splenektomijski registri, medicinske narukvice, kao i karton vakcinacije i dalje nisu deo naše prakse. Naša studija je pokazala da je obrazovanje bolesnika, kao i medicinskog tima, krucijalno da bi se pratili vodiči za postsplenektomijsku vakcinaciju, što je u skladu sa rezultatima drugih studija. Kako bi se povećao stepen primene postsplenektomijske vakcinacije, neophodno je poboljšati edukaciju medicinskog tima i bolesnika, kao što je neophodno početi sa korišćenjem splenektomijskih registara, medicinskih narukvica i kartona vakcinacije.

Abstract Background. Endovascular embolization is a treatment of choice for the management of unruptured intracranial aneurysms, but sometimes is complicated with perianeurysmal oedema. The aim of our study was to establish incidence and outcomes of perianeurysmal oedema after endovascular coiling of unruptured intracranial aneurysms, and to reveal possible risk factors for development of this potentially serious complication. Methods. In total 119 adult patients with endovascular embolization of unruptured intracranial aneurysm (performed at Department for Interventional Neuroradiology, Clinical Center, Kragujevac, Serbia) were included in our study. The embolizations were made by electrolite-detachable platinum coils: pure platinum, hydrophilic and combination of platinum and hydrophilic coils. Primary outcome variable was perianeurysmal oedema visualized by magnetic resonance imaging (MRI) 7, 30 and 90 days after the embolization. Results. The perianurysmal oedema appeared in 47.6% of patients treated with hydrophilic coils, in 21.6% of patients treated with platinum coils, and in 53.8% of those treated with mixed type of the coils. The multivariate logistic regression showed that variables associated with occurrence of perianeurysmal oedema are volume of the aneurysm, hypertension, diabetes and smoking habit. Hypertension is the most important independent predictor of the perianeurysmal oedema, followed by smoking and diabetes. Conclusions. The results of our study suggest that older patients with larger unruptured intracranial aneurysms, who suffer from diabetes mellitus and hypertension, and have the smoking habit, are under much higher risk of having perianeurysmal oedema after endovascular coiling.

Headache frequently occurs after spinal anesthesia or after craniotomy, especially after removal of acoustic neuroma. Headache after spinal anesthesia is caused by leakage of liquor through dural puncture and decrease of intracranial pressure, while pain after craniotomy is consequence of operative injury of peri-cranial muscles and soft tissues. Epidural administration of morphine and intravenous administration of cosyntropine or aminophylline at the end of a surgical intervention may prevent postoperative headache, while caffeine, gabapentin, pregabalin, theophylline, hydrocortisone or cosyntropine are efficient in the treatment. Drugs are not efficient for prevention of headache after craniotomy, while parenteral codeine and/or acetaminophen can terminate this type of pain. Non-steroid antiinflammatory drugs should be avoided for treatment of post-craniotomy headache, due to their extraand intra-cranial adverse effects. Timely administration of appropriate drugs for prevention or treatment of postoperative headache significantly decreases suffering, hastens recovery and prevent chronic headache.

Introduction. The risk of metabolic abnormalities is greatly increased in schizophrenic patients started on an atypical antipsychotic medication. Patients with psychiatric disorders exceed mortality ranges resulting from, among others, increased risk of cardiovascular events. Other factors contributing to the development of metabolic syndrome include prolonged duration of illness, increasing age, female sex and lifestyle factors. Objective. This cross-sectional study was taken up to assess the prevalence of the metabolic syndrome (MetS) in schizophrenic patients receiving olanzapine monotherapy for at least six months and to determine the most important risk factors associated with metabolic syndrome presence in these patients. Methods. A total of 93 long term hospitalized schizophrenic patients (71 men, 22 women), had a screening of the following: case-history data, psychiatric scales, anthropometric measures, blood (fasting glucose, lipid status, C-reactive protein - CRP) and urine samples (microalbuminuria). Results. Prevalence of MetS according to International Diabetes Federation criteria in our study was 34.4%. The multivariate analysis distinguished the following significant predictors of MetS presence (in order of appearance): data about diabetes mellitus in family history (p=0.002), body mass index >25 kg/m2 (p=0.002), hyperlipidemia in family history (p=0.008), and elevated CRP value (p=0.042). Conclusion. High rate of MetS in patients treated with olanzapine in this study exceeds MetS prevalence in general population. Among observed parameters, our study pointed to several “high risk” predictors associated with MetS presence. Regular monitoring of cardiometabolic risk factors is highly recommended. Positive heredity distress mentioned above may direct a psychiatrist to prescribe some other drug than olanzapine in the long term treatment of schizophrenia.

INTRODUCTION Health-related quality of life (HRQL) of chronic patients has been researched as the ultimate goal of modern treatment of chronic diseases to improve patients'quality of life. OBJECTIVE The objective was to assess the reliability of the Serbian version of the Sickness Impact Profile (SIP) questionnaire on the sample of patients with chronic viral hepatitis. METHODS The research covered 102 patients with chronic hepatitis (47 type B and 55 type C). The assessment of the reliability of the SIP questionnaire was performed by testing the internal consistency of the questions by calculating the Cronbach's alpha coefficient. The factor analysis was used to assess whether the grouping of the questions within dimensions matches the distribution of the questions in the original English version of the questionnaire administered to U.S. patient population. RESULTS The Cronbach's alpha coefficient for the entire questionnaire is 0.925, 0.869 for the physical dimension, and 0.857 for the psychosocial dimension. After running a factor analysis of the psychosocial dimension, "emotional instability" was extracted as the key factor, confirming the results of previous research. Compared with the English version of the questionnaire, the Cronbach's alpha coefficient of the Serbian version does not diverge significantly, whereas the factor analysis confirms the classification of the questionnaire into two dimensions. CONCLUSION Our study has shown that the Serbian version of the SIP questionnaire is a reliable tool for assessing the HRQL of patients with chronic hepatitis B and C before starting treatment.

Imuna trombocitopenija izazvana lekovima (ITIL) nastaje kao posledica destrukcije ili neadekvatne aktivacije trombocita usled dejstva imunog sistema provociranog trenutnim ili pređasnjim prisustvom leka u organizmu. Incidencija ITIL-a je oko 10 slucajeva na 1,000,000 stanovnika tokom jedne godine. Postoje cetiri osnovna mehanizma nastanka ITIL-a: (1) vezivanje antitela zavisnih od lekova za trombocite; (2) blokada vezivanja fibrinogena za glikoproteinske IIb-IIIa receptore; (3) stvaranje autoantitela protiv trombocita koja nisu zavisna od prisustva leka; i (4) stvaranje imunih kompleksa lekova sa antitelima, sto dalje dovodi do aktivacije trombocita i nastanka tromboza. Kod svih oblika imune trombocitopenije izazvane lekovima najvažnije je po utvrđivanju smanjenog broja trombocita sto pre posumnjati da je uzrocnik određeni lek. Kljucni momenat u terapiji je prekid dalje primene leka-uzrocnika, dok se transfuzija trombocita daje samo u slucaju ekstremnog pada njihovog broja u krvi. Heparinom-indukovana trombocitopenije je izuzetak, jer zahteva i lecenje tromboza pomocu direktnih inhibitora trombina.

Objective Serum parameters of calcium homeostasis were measured based on previously published evidence linking osteoporotic fractures and/or bone/mineral loss with antipsychotics. Methods Prospective, four-week, time-series trial was conducted and study population consisted of patients of both genders, aged 35-85 years, admitted within the routine practice, with acute psychotic symptoms, to whom an antipsychotic drug was either introduced or substituted. Serial measurements of serum calcium, phosphorous, magnesium, 25(OH)D, parathyroid hormone, calcitonin, osteocalcin and C-telopeptide were made from patient venous blood samples. Results Calcium serum concentrations significantly decreased from baseline to the fourth week (2.42±0.12 vs. 2.33±0.16 mmol/L, p=0.022, n=25). The mean of all calcemia changes from the baseline was -2.6±5.7% (-24.1 to 7.7) with more decreases than increases (78 vs. 49, p=0.010) and more patents having negative sum of calcemia changes from baseline (n=28) than positive ones (n=10) (p=0.004). There were simultaneous falls of calcium and magnesium from baseline (63/15 vs. 23/26, p<0.001; OR=4.75, 95% CI 2.14-10.51), phosphorous (45/33 vs. 9/40, p<0.001; 6.06, 2.59-14.20) and 25(OH)D concentrations (57/21 vs. 13/35, p<0.001; 7.31, 3.25-16.42), respectively. Calcemia positively correlated with magnesemia, phosphatemia and 25(OH)D values. Parathyroid hormone and C-telopeptide showed only subtle oscillations of their absolute concentrations or changes from baseline; calcitonin and osteocalcin did not change. Adjustment of final calcemia trend (depletion/accumulation) for relevant risk factors, generally, did not change the results. Conclusion In patients with psychotic disorders and several risks for bone metabolism disturbances antipsychotic treatment was associated with the decrease of calcemia and changes in levels of the associated ions.

Background: Clinical development of antiepileptic drugs is demanding due to complex character of the disorder and to diversity of its forms and etiologies. Objective: The aim of this review was to suggest improvements in regulatory procedures for clinical development of antiepileptic drugs. Methods: The following databases of scientific articles were searched: MEDLINE, SCOPUS and SCINDEKS. In total 558 publications were retrieved. The types of articles selected were reviews, reports on clinical trials and letters to the Editor. Results: There are several changes of regulatory documents necessary for improving process of clinical development of antiepileptic drugs: preference of parallel groups design for add-on trials should be explicit; the non-inferiority design for monotherapy clinical trials should be acceptable; restrictive formulations when trials of antiepileptic drugs in children are in question should be avoided; requirements in regard to the efficacy measures should be harmonized among the regulatory bodies; proactive attitude towards discovery of adverse events; and precise requirements for clinical trials specifically designed to prove anti-epileptogenic effects should be made clear. Conclusion: Current regulatory documents are incomplete in many aspects; an international effort to improve and harmonize guidelines for clinical development of antiepileptic drugs is necessary for improvement of this process.

Aim : To gather and review data describing the epidemiology of schizophrenia and clinical guidelines for schizophrenia therapy in seven Central and Eastern European countries, with a focus on negative symptoms. Methods : A literature search was conducted which included publications from 1995 to 2012 that were indexed in key databases. Results : Reports of mean annual incidence of schizophrenia varied greatly, from 0.04 to 0.58 per 1,000 population. Lifetime prevalence varied from 0.4% to 1.4%. One study reported that at least one negative symptom was present in 57.6% of patients with schizophrenia and in 50–90% of individuals experiencing their first episode of schizophrenia. Primary negative symptoms were observed in 10–30% of patients. Mortality in patients with schizophrenia was greater than in the general population, with a standardized mortality ratio of 2.58–4.30. Reasons for higher risk of mortality in the schizophrenia population included increased suicide risk, effect of schizophrenia on lifestyle and environment, and presence of comorbidities. Clinical guidelines overall supported the use of second-generation antipsychotics in managing negative symptoms of schizophrenia, although improved therapeutic approaches are needed. Conclusion : Schizophrenia is one of the most common mental illnesses and poses a considerable burden on patients and healthcare resources alike. Negative symptoms are present in many patients and there is an unmet need to improve treatment offerings for negative symptoms beyond the use of second-generation antipsychotics and overall patient outcomes.

Oko 40 na svakih 100,000 stanovika u svim starosnim grupama svake godine prokrvari iz ulkusa želuca ili duodenuma. Smrtnost ovih pacijenta je i dalje visoka, između 8 i 10%, bez obzira na stalan napredak u modalitetima lecenja. Kod pacijenata koji krvare iz ulkusa treba sto pre uraditi endoskopiju i sprovesti direktnu lokalnu hemostazu mehanickim, hemijskim ili termickim metodama. Dok pacijent ceka na endoskopiju treba poceti sa intravenskom primenom visokih doza blokatora protonske pumpe, koja se nastavlja do isteka 72 sata od njenog uvođenja. Primena eritromicina oko sat vremena pre endoskopije povecava vidljivost unutrasnjosti želuca i olaksava endoskopsku terapiju. Intravensku primenu blokatora protonske pumpe treba nastaviti oralnim preparatima istih lekova tokom 7 nedelja, i ukoliko je pacijent pozitivan na Helicobacter pylori, sprovesti eradikacionu terapiju. Za uspesno izlecenje i prevenciju ponovnog krvarenja neophodni su optimalni izbor, raspored primene i doziranje lekova koji prate endoskopsku dijagnostiku i terapiju.

Background: To investigate the impact of schizophrenia on quality of life (QoL) of patients and caregivers in seven CEE countries, by conducting a literature search. Methods: Search was performed in publicly available databases to identify publications from 1995 to 2012 related to schizophrenia and QoL. Publications included those describing health-related QoL data of negative symptoms in patients with schizophrenia. Results: Out of an initial search of 2882 abstracts, 1587 were excluded based on duplication or preliminary screening of titles, and a further 1550 publications were excluded based on screening of the abstracts (1510) or full-texts (40). Thus, 37 primary publications related to QoL of patients with schizophrenia and caregivers were identified. Due to differences observed in the identified studies, it was not possible to make direct comparisons nor to pool data for analysis. However, it was consistently reported that schizophrenia greatly affected the QoL of patients and had a significant negative impact on the QoL of caregivers, such that their QoL was considered similar to the patients themselves. In addition, patients with schizophrenia experienced significant stigmatization and discrimination. In general, the presence of negative symptoms was not well-documented in the literature and available antipsychotics had limited impact on the treatment of negative symptoms. Conclusion: Schizophrenia significantly reduces QoL of patients and their caregivers. Further research is needed to better understand the drivers of impaired QoL caused by schizophrenia, in particular the negative symptoms of schizophrenia, and how best the burden of illness and associated stigmatization and discrimination may be reduced.

Abstract Acute pancreatitis represents an acute nonbacterial inflammation of the pancreas caused by a premature and ectopic activation of pancreatic digestive enzymes. Two of the most important genes in pancreatic autodigestion, PRSS1 and SPINK1, were implicated in the earliest discoveries of the genetic background of pancreatitis. However, the distribution of their variations displays interethnic variability, which could significantly affect the magnitude of their proposed effects on this disease worldwide. The aim of the present study was to investigate the distribution of the most important functional variations of PRSS1 (86A>T and 365G>A) and SPINK1 (101A>G), and their influence on the clinical course of acute pancreatitis in Serbian patients. The study enrolled 81 subjects, the severity of disease course was determined using the Atlanta Classification system, and the genotyping was conducted using a PCR-RFLP method. PRSS1 86A>T and 365G>A SNPs were not observed in the study population, while SPINK1 101A>G was present with the frequency of 0.62% (95% CI: 0.00, 3.83%). Due to extremely low frequencies or absences of examined variations, the proposed effect of these SNPs on the severity of acute pancreatitis could not be confirmed. The results do not support routine genotyping of either PRSS1 or SPINK1 in Serbs.