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

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.

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

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.

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.

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.