BACKGROUND Recent studies have shown that dronedarone is associated with significantly fewer adverse effects and treatment discontinuations, and a trend toward reduced all-cause mortality, compared with amiodarone. Introduction of dronedarone in clinical practice is limited by its higher cost than amiodarone, propafenone, and sotalol. AIM To estimate cost-effectiveness of dronedarone versus amiodarone, propafenone, and sotalol in patients with atrial fibrillation (AF). METHODS We constructed a Markov model, which was then simulated by Monte Carlo simulation using 1,000 virtual patients. Costs and outcomes were estimated from the societal perspective and discounted at 3% annually. A lifetime horizon and three-month cycle length were used. The main outcome measurement was the number of years spent without stroke. Values of transition probabilities and therapy outcomes were estimated from available literature. The prices of health services and drugs were obtained from the Republic Institute for Health Insurance Tariff Book and Drug List A and from the drug developer. RESULTS Cost-effectiveness shows that the dronedarone treatment option has the most advantageous relationship, where, for one year without a stroke, the total cost is €1,779.23. In the case of the amiodarone therapy option, for one year without a stroke €3,845.10 is needed, for propafenone €4,674.20, while for sotalol the sum is €14,973.89. Estimated annual costs for patients with first-detected AF in Serbia were €610. CONCLUSIONS The results of our model indicate that dronedarone is a cost-effective therapy compared with amiodarone, propafenone, and sotalol in patients with AF, if the outcome measurement is the number of years spent without stroke.

Introduction/Aim. Benign prostatic hyperplasia (BPH) is one of the most frequent diseases in men older than 50 years, and it is closely linked to ageing process. Considering rising life expectancy, further increase in prevalence of BPH could be expected.  The aim of our study was to analyze costs of treating patients with BPH in Montenegro, in order to estimate their impact on health budget. М ethods . The BPH treatment costs were analyzed in a random sample of 47 male patients, 50 years of age or older, taken from the population of patients with BPH treated in Hospital Niksic, Montenegro, during year 2013. The patients were in one of the five health states: mild symptoms of BPH, moderate symptoms of BPH, severe symptoms of BPH, acute urinary retention , and transurethral resection of the prostate (TURP). Only direct medical costs were taken into account when calculating costs of each health state. The costs were calculated on the basis of utilization of services, drugs and materials, taken from the patients’ medical records, and utilization figures were multiplied with prices recognized by the Health Insurance Fund, Montenegro. Total number of patients with BPH in Montenegro was taken from the database of Institute for Public Health, Montenegro. The costs are expressed in euros (EUR). Results. Average annual costs of treating a patient with certain BPH health state were: mild BPH - 266,63 ЕUR, moderate BPH - 343,26 EUR, severe BPH - 413,51 EUR, acute urinary retention - 493,93 ЕUR and  TURP - 1.013,16 ЕUR. Total costs of treating all patients with BPH in Montenegro are 2.338.008,66 ЕUR; this amount makes 1,43% of total Montenegrian health budget. The largest part of the costs make medication acquisition costs, especially those spent for finasteride (196.341,11 ЕUR) and antimicrobials. According to the data generated by Montenegrian Drug Agency, annual turnover of all drugs indicated for treatment of BPH in 2011 was 595.948,74 ЕUR, and from this amount, 251.157,66 ЕUR was paid by Montenegrian Health Insurance Fund. During the period 2006 – 2011, number of patients with BPH increased for 370%, and the annual amount spent for BPH drugs increased for 373%. Conclusion. Costs of treating BPH in Montenegro make significant percent of total healthcare costs, and there is trend of increase in costs due to constant increase in number of patients with BPH in Montenegro.

INTRODUCTION Problems with polypharmacy, adverse drug reactions and non-adherence are especially frequent among elderly nursing home residents. OBJECTIVE The aim of our study was to evaluate effectiveness of a specific form of staff education on appropriateness of prescribing in a cluster of nursing homes for the elderly. METHODS The study was designed as before-and-after trial of educational intervention on appropriateness of prescribing in nursing homes for the elderly. In total 20 nursing homes located in Belgrade, Serbia were included in the study with 104 elderly residents and 27 caring physicians. Appropriateness of prescribing was checked against Beers, START and STOPP criteria, before and 6 months after the intervention. RESULTS There were 349 inappropriately prescribed drugs according to Beers criteria before the intervention and 37 drugs six months after the intervention. According to STOPP criteria there were 70 drugs inappropriately prescribed before the intervention, and 20 drugs 6 months after. When both criteria are taken together, there is a significant difference between the average number of inappropriate drugs per patient before (3.4±0.5) and after (0.6±0.7) educational intervention (t=38.902; p<0.001). Finally, before the intervention 143 appropriate drugs were omitted according to START criteria, while 6 months after the intervention there were only 67 omissions. CONCLUSION Simple, but well targeted educational interventions may improve polypharmacy and decrease inappropriate prescribing rate, contributing to a better care of elderly patients in nursing homes.

ABSTRACT Acute pancreatitis (AP) is a common, potentially lethal, acute inflammatory process with a highly variable clinical course. The aim of this study was to analyse early changes in the serum concentrations of pro- and anti-inflammatory cytokines in the peripheral blood of patients with the interstitial form of acute pancreatitis (IAP) and necrotic acute pancreatitis (NAP), especially in those patients who had lethal outcomes. The prospective study enrolled 52 patients who were divided into IAP (65.38% of patients) and NAP (34.62% of patients) groups. The serum levels of interleukins (IL) 6, 8 and 10, together with tumour necrosis factor (TNF)-alpha were measured on the 1st and 3rd day of hospitalisation. Significantly higher values of IL-6, IL-8 and IL-10 were found on day 1 and 3 in NAP than in IAP. IL-6 was significantly higher on both days of measurement, whereas IL-10 on the first day and IL-8 on the third day were significantly higher in the group of patients who did not survive in comparison with patients who had the interstitial form of AP. In conclusion, the data from this study showed that immune suppression and excessive immune stimulation in the first three days after admission could indicate the development of NAP and a potentially lethal outcome.

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.