Therapeutic window of anticonvulsants is not a wide one, with phenytoin being one extreme, which can be classified as a narrow therapeutic index drug, since its ratio between the least toxic and the least effective concentration is less than twofold. In order to obtain marketing authorization, a generic anticonvulsant should demonstrate relative bioequivalence with its brand-name counterpart. However, although bioequivalent, generic anticonvulsants still do not have the same bioavailability as brand-name drugs, which may lead to larger fluctuations of steady-state plasma concentrations, and sometimes to loss of seizure control if a patient is switched from brand-name to generic or from generic to generic anticonvulsant. Generic anticonvulsants are effective, safe and affordable drugs for treatment of epilepsy, and patients could be successfully treated with them from the very beginning. It is switching from brand-name to generic anticonvulsant or from one generic anticonvulsant to another that should be avoided in clinical practice, since subtle differences in bioavailability may disturb optimal degree of seizure control to which the patient was previously successfully titrated.

Background: The need for institutionalisation of elderly people derives from high rate of comorbidity and ageing, which result in the decrease of cognitive and functional capacities of future residents. Critical point in the procedure of accommodation of the people with dementia and other chronic illnesses is statement of willingness to be accommodated. Results of numerous studies point out that the Mini Mental State Examination (MMSE) can be used as a screening test for rapid clinical assessment of legal capacities. Method: The group of 91 examinees under legal guardianship protection has been compared with the group of 57 users not being under legal guardianship, on the bases of their cognitive status. The MMSE was used for evaluation of cognitive status. Results: Between the examined groups, a significant statistical difference in total MMSE score was found (F=19, 847; DF=2, 145; p<0.001). Subjects with no legal guardian had much higher values of total MMSE score compared to the subjects under legal guardianship. There was a statistically significant difference in the recurrence rate of cognitive status categories between the examined groups (chi-square=29, 822; p<0.001). Conclusion: The total MMSE score significantly correlates with decision making and proper interest supporting capacities, i.e. with placing subjects under any type of guardianship, which makes plausible to consider applying this instrument in order to make a more exact assessment of decision making capacity. Karličić IS, Stašević M, Janković S. Cognitive status of persons under guardianship living in a social welfare institution. Open J Psychiatry Allied Sci. 2015;6:89-95.doi: 10.5958/2394-2061.2015.00003.8

Studentsí life can be perceived by the different prisms. On one hand, that is the happiest time of life while on the other side, that is a period that changes lifestyle habits. Numerous studying commitments over a school year can decrease certain extracurricular activities such as spending time outdoors, playing a sport or just walking and consequently lead to reduced exposure to sunlight, which is the major risk factor for vitamin D deficiency. Vitamin D is substantial for achieving and up keeping calcium homeostasis and consequently accomplishing skeleton health. Besides the aforementioned, there is a great number of studies that showed a whole variety of vitamin D effects on human body such as prevention of cancer, cardiovascular, autoimmune, infectious and respiratory diseases, and preservation of mental health (cognitive impairment and depression) (1ñ3). Our aim was to see how study load and some other factors correlate with vitamin D plasma levels of healthy students from the Faculty of Medical Sciences in Kragujevac. The study was approved by the Ethics Committee of the Faculty of Medical Sciences, University of Kragujevac, Serbia and the students signed informed consent for participation in the study. The study took place from April 2012 to August 2012. The students were from three different study courses (medicine, pharmacy and dentistry) and from various study years (from 1 to 5). Average vitamin D level (25-hydroxyvitamin D) in the study population of 86 students was 13.263 ± 4.86 ng/mL that was significantly below cut off point for sufficient vitamin D level (p < 0.001) (2). Vitamin D deficiency was observed in 88.37% participants. Sex, study course, average study score, average vitamin D food intake (calculated for period of 30 days before blood samples were taken), body mass index, biochemical parameters (phosphate level, urea, creatine, total protein) and endocrine parameters (FT4, TSH and PTH level) did not correlate with vitamin D plasma levels (p > 0.05). There was weak but significant correlation betwen level of vitamin D (25-hydroxyvitamin D) and calcium level (r = 0.228; p ≥ 0.05). However, the year of study influenced vitamin D levels (p ≥ 0.05): the students of the third year of study had the lowest average level while students of the fifth year had the highest average level of vitamine D, 11.825 ± 4.372 ng/mL and 15.397 ± 4.103 ng/mL, respectively (Fig. 1). We thought that reason for such results may be decreased exposure to sunlight of students in the third year in comparison with other years (p ≥ 0.05). In order to examine the influence of study load on variation of serum vitamin D level by biomedical students authors created a focus group that was composed of 15 graduated students by Faculty of SHORT COMMUNICATION

Background: Dry socket is a disturbance in the healing of tooth extraction, characterized by the absence of blood clot and persistence of intense pain. The aim of this study was to determine the costs of treating dry socket, as in Serbia, until now, there has been no adequate estimation of the expenses and cost structure for treating patients with dry socket. Material and Methods: The costs of treating dry socket were analyzed on the sample of 455 adults with confirmed diagnosis of dry socket. All the patients were treated at the Oral Surgery Department, Institute of Dental Medicine in Kragujevac, during 2012. Direct costs per patient, concerning the acquisition of medicines and medical supplies, as well as medical services, were recorded in accordance with the Blue Code Book of the National Health Insurance Fund. Results: Out of total 12.652 teeth extracted, 455patients (3.6%) were diagnosed with dry socket. Total direct cost for treating dry socket in 2012 was 1.298,58 ± 468.93 RSD per patient, of which 1.065,16 RSD ± 394.49 RSD (82.02%) was the total price of the service and 1. 298,58 ± 468.93 RSD (17.98%) was spent on dental supplies. Conclusion: The actual cost of treating dry socket in Serbia shows that there is a need for the implementation of the relevant preventive measures. Global economic crisis, worsens the constant lack of available resources in dental healthcare services. Dry socket, as one of the most frequent post-extraction complications, although quite harmless in terms of clinical prognosis represents substantial economic loss for Serbia.

Acute pancreatitis represents an acute nonbacterial infl ammation 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 signifi cantly aff ect the magnitude of their proposed effects on this disease worldwide. Th e 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 infl uence on the clinical course of acute pancreatitis in Serbian patients. Th e study enrolled 81 subjects, the severity of disease course was determined using the Atlanta Classifi cation 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 eff ect of these SNPs on the severity of acute pancreatitis could not be confi rmed. Th e results do not support routine genotyping of either PRSS1 or SPINK1 in Serbs.

OBJECTIVES The aim of our study was to develop a population pharmacokinetic (PPK) model for 25-hydroxyvitamin D clearance in a healthy young adult population in Serbia. METHODS Study sample consisted of 70 healthy young students of the Faculty of Medical Science, University of Kragujevac, Serbia, with a mean age and body mass index of 22.39 ± 1.82 years and 21.31 ± 2.69 kgm-2, respectively. Non-linear mixed-effect modeling (NONMEM) software was used for data analysis. A validation set of 16 participants was used to estimate the predictive performance of the pharmacokinetic model. RESULTS In the base model (without covariates), we had parameter estimates of 0.01 L/h for apparent clearance, 0.25 L for apparent volume of distribution, while value of minimum objective function (MOF) was 383.468. The full regression model was established by estimating the effects of 12 covariates. Mean intake of vitamin D from foods (DD) and value of phosphate in serum (PHO) were covariates included in the final model, while others were excluded in this process. The estimated value in the final MOF model was 274.555. The final regression model formula was: clearance (CL) (L/h) = 0.0711 + 0.738 x DD + 0.618 x PHO. CONCLUSIONS The PPK model obtained determined clearance of 25-hydroxyvitamin D in a healthy young adult population in Serbia. Mean intake of vitamin D from foods and serum phosphate level are the most important covariates that influence value of 25-hydroxyvitamin D clearance in healthy young adults.

Postoperative nausea and vomiting emerge during the first 240-48 hours from surgery. Prevalence of postoperative nausea and vomiting is as high as 30% among all patients undergoing surgery, and almost 80% among the patients with high risk of postoperative vomiting. Since postoperative nausea and vomiting create very unpleasant experience and could lead to serious complications, they should be either prevented or treated. There are several perioperative factors which may initiate postoperative vomiting: opioids, inhalation anesthetics, anxiety, adverse drug effects and transporting the patient. More than one neurotransmitter system is involved in regulation of nausea and vomiting: cholinergic, dopaminergic, serotonergic, histaminergic and neurokinin system. Procedures which may decrease prevalence of postoperative vomiting are: use of local or regional anesthesia instead of general one and use of propofol for anesthesia induction (prevalence of vomiting drops for 30%). Ondansetron, dexamethasone and droperidol are equally effective: when administered prophylactically, they decrease risk of posoprative vomiting for 25%. These drugs have additive effect, since their mechanisms of action are different. The patients with extreme risk of postoperative vomiting should receive long-acting antiemetic, like transdermal scopolamine or palonosetron, or combinations of two antiemetics. If a patient who already received antiemetic prophylaxis still develops nausea and vomiting, he or she should be treated by new antiemetic having another mechanism of action.

Potentilla species have been used in traditional medicine in the treatment of different ailment, disease or malady. Potentilla reptans (P. reptans) has been scarcely studied. The aim of this study was to test antioxidant and anti-inflammatory activity of P. reptans aerial part and rhizome. DPPH assay was used to measure antioxidant activity of aqueous plant extracts. Anti-inflammatory effect was evaluated by experimental animal model of phenol-in-acetone induced mice ear edema. DPPH radical-scavenging activity of both tested extracts was concentration dependent with IC50 values 12.11 μg/mL (aerial part) and 2.57 μg/mL (rhizome). Maximum anti-inflammatory effect (61.37%) was observed after administration of 10 mg/ear of the rhizome extract and it was 89.24% of effect induced by dexamethasone as a standard. In conclusion, P. reptans rhizome aqueous extract possesses anti-inflammatory effect and higher antioxidant activity than aerial part.

INTRODUCTION High prevalence of metabolic syndrome (MetS) in children and adolescents is a great concern of the modern society. OBJECTIVE bjective: Our aim was to determine the influence of previously investigated, but also and potentially novel risk factors for the development of metabolic syndrome in children and adolescents. METHODS Observational case-control clinical study was conducted involving children and adolescents with obesity/metabolic syndrome, treated on inpatient basis from January 2008 to January 2012 at the Pediatric Clinic of the Clinical Centre Kragujevac, Kragujevac, Serbia. The group of"cases"(n=28) included patients aged 10-16 years with the diagnosis of metabolic syndrome according to the International Diabetes Federation (IDF) criteria, while the control group included twice as many obese patients (n=56) matched to the compared group. RESULTS Presence of maternal gestational diabates (ORadjusted: 39.426; 95% Cl: 1.822-853.271; p=0.019), and/or lack of breastfeeding in the first six months of life (ORadjusted: 0.079; 95% CI: 0.009-0.716; p=0.024) were significant predictors for developing MetS. Also, microalbuminuria is associated with MetS in obese children and adolescants (ORadjusted: 1.686; 95% Cl: 1.188-2.393; p=0.003) CONCLUSION: Presence of maternal gestational diabetes and/or lack of infant breastfeeding are considered as relevant factors that may contribute to the increased risk of developing MetS syndrome, while microalbuminuria is frequently associated with MetS in obese children and adolescents.

1 Department of Pharmacology, Th e Faculty of Medical Sciences, University of Kragujevac, Serbia 2 Department of Economics, Center for Children and Childhood Studies, Rutgers University, the State University of New Jersey, U.S.A. 3 Department of Epidemiology & Community Health, School of Health Sciences & Practice, New York Medical College, U.S.A. 4 Clinic for Neurology and Psychiatry for Children and Youth, Clinical Center of Serbia, Belgrade, Serbia 5 Psychiatric Clinic, University Clinical Center Kragujevac, Serbia 6 Centre for Clinical Pharmacology, Medical Faculty, Military Medical Academy University of Defence, Belgrade Serbia 7 Faculty of Medical Sciences University of Kragujevac, Serbia 8 Primary Care Facility Svilajnac, Serbia

Two recent articles published in the consecutive issues of the Journal suggested that health professionals in Brazil have recently showed the rising interest for rational therapeutics including medical and economic consequences of widely prescribed drugs. Inspired with these efforts and taking into account limited resources of healthcare systems in many countries as well as recent worldwide financial crisis we decided to investigate whether there is a correlation between rational therapy publication rate and national indicators of welfare and healthcare investments. We have taken some of the indicators from the World Bank internet database of countries: total population (for 2012), gross domestic product per capita (GDPpc, for 2012) and health expenditure per capita (HEpc, for 2011). We have also DOI: 10.1590/1413-812320141912.10222014

Hypocalcaemia is a state with total calcium serum level below 2.25 mM/l. From the total serum calcium content, 50% is free and ionized, 40% is protein-bound and 10% is bound for organic anions. The most frequent causes of hypocalcaemia are iatrogenic hypoparathyroidism, magnesium deficit, disorders of vitamin D metabolism and chronic renal failure. Iatrogenic hypoparathyroidism is associated with low serum ionized calcium and low serum parathormone levels. There are two important clinical signs of hypocalcemia: Chvostek’s sign (twitches of upper lip after percussion on facial nerve over mandible) and Trousseau’s sign (carpal spasm after increasing pressure in blood pressure cuff placed about the upper arm for 20 milimeters above systolic pressure for 3-5 minutes). The following lab analyses should be performed when hypocalcaemia is an option: serum levels of calcium, magnesium, 25 – hydroxyvitamin, parathormone, potassium, sodium, chloride and bicarbonates. If hypocalcaemia is mild, it could be treated with oral calcium preparations, usually calcium carbonate, in a dose of 1 to 2 grams of elemental calcium daily. In more severe hypocalcaemia intravenous calcium-gluconate or calcium-chloride should be administered, as 10% solutions. These parenteral preparations of calcium should be diluted prior to the intravenous administration, and the administration should be longer than 20 minutes in order to avoid adverse effects on heart. If administration of calcium does not correct hypocalcaemia, oral vitamin D should be also prescribed. If this does not regulate calcaemia, from 0.25 tо 1 micrograms of 1,25-dihydroxyvitamin D (clacitriol) daily should be prescribed. Calcium serum levels should be kept within the lower part of normal serum concentration range.