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.

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

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.

Lekari opste medicine se cesto susrecu sa hitnim stanjima u svojoj praksi. Da bi se lekar brzo snasao u takvoj situaciji i primenio odgovarajucu terapiju pravovremeno, neophodno je da pri sebi ima pripremljenu odabranu kolekciju lekova koji mogu resiti sva ili gotovo sva hitna stanja. U lekarskoj torbi bi trebalo da se nađu sledeci lekovi: paracetamol (za blage do umerene bolove i povisenu temperaturu), morfin (za jake bolove), nalokson (za lecenje trovanja heroinom), ceftriakson (za meningokokni meningitis), salbutamol (za prekid napada bronhijalne astme), hidrokortizon (za prekid napada bronhijalne astme), glukagon (za tesku hipoglikemiju), glukoza (za blagu do umerenu hipoglikemiju), diazepam (za prekid febrilnih konvulzija ili epileptickog statusa), adrenalin (za anafilaksu i zastoj srca), atropin (za simptomatsku bradikardiju), hlorpiramin (za akutne alergijske reakcije), aspirin (za akutni infarkt miokarda), nitroglicerin (za akutni koronarni sindrom), metoklopramid (za mucninu i povracanje), haloperidol (za delirijum), metilergometrin (za krvarenje posle porođaja ili pobacaja), furosemid (za akutni edem pluca) i flumazenil (za trovanje benzodiazepinima). Za svaki od navedenih lekova lekar treba dobro da poznaje preporucene doze, indikacije, kontraindikacije i najvažnija upozorenja. Svi navedeni lekovi su dostupni na domacem tržistu ili putem specijalnog uvoza, tako da lekar opste prakse može da popuni svoju torbu svim potrebnim lekovima i efikasno i bezbedno zbrine svako od hitnih stanja.

ABSTRACT Introduction: Many factors concomitantly influence the quality of life of patients with schizophrenia in a long-stay psychiatric facility. Th e appropriate selection of antipsychotics and the intensity of their adverse effects exert a significant influence on the quality of life of these patients. Th e aim of this study was to identify the influence of antipsychotic-related factors on the quality of life of patients with schizophrenia. Methods: Th e study included 102 beneficiaries at the Institute for Accommodation of Adults “Male Pčelice” in Kragujevac. Th e patients were interviewed on in one day using the questionnaire issued by the World Health Organization. The specified data were obtained from the health files of the beneficiaries. We performed a comparison between patients receiving only atypical antipsychotics, typical antipsychotics or a combination thereof. Results: Th e patients who were receiving only atypical antipsychotics demonstrated better physical health quality of life scores in comparison to those who received combined antipsychotics (77.14 vs. 68.57; U = 332.0; p = 0.02). A statistically significant difference in the mental health quality of life domain was observed between groups of patients receiving various antipsychotic treatments (31.96 vs. 55.27 vs. 49.46; c2 = 7.02; p = 0.03). Conclusion: Patients in a long-stay psychiatric facility who received atypical antipsychotics demonstrated a better quality of life in comparison to those who received typical antipsychotics, possibly due to the superior safety profile of atypical antipsychotics and a greater feeling of individual contentment. SAŽETAK Uvod: Na kvalitet života osoba koje boluju od shizofrenije utiče mnogo faktora istovremeno. Kod pacijenata u institucionalnom smeštaju adekvatan izbor antipsihotika i intezitet neželjenih dejstva lekova ima veliki uticaj na kvalitet života ovih pacijenata. Cilj ove studije je bio da se utvrdi uticaj faktora vezanih za antipsihotike na kvalitet života pacijenata koji boluju od shizofrenije. Metode: Istraživanjem je obuhvaćeno ukupno 102 korisnika Zavoda za smeštaj odraslih lica „Male Pčelice” Kragujevac. Korisnici su ispitani u samo jednom izabranom danu korišćenjem upitnika Svetske zdravstvene organizacije. Određeni podaci su prikupljeni iz zdravstvenih kartona korisnika. Poređene su grupe korisnika koji koriste samo apitičan ili tipičan antipsihotik ili kombinaciju ove dve grupe antipsihotika. Rezultati: Korisnici koji koriste samo atipičan antipsihotik imaju bolji skor fi zičkog zdravlja od korisnika koji koriste kombinaciju antipsihotika (77,14 vs. 68,57; U = 332,0; p = 0,02). Postoji statistički značajna razlika u skoru domena psihičkog zdravlja u zavisnosti od grupe antipsihotika koji je korisniku propisan (31,96 vs. 55,27 vs. 49,46; c2 = 7,02; p = 0,03). Zaključak: Korisnici ustanove za dugotrajan smeštaj psihijatrijskih bolesnika koji primaju apitične antipsihotike imaju bolji kvalitet života u odnosu na pacijente koji primaju tipične antipsihotike, verovatno zbog manje izraženih neželjenih dejstava atipičnih antipsihotika i boljeg osećaja subjektivnog zadovoljstva.

BACKGROUND/AIM Recent studies have shown that biological treatments for rheumatoid arthritis can change the course of rheumatoid arthritis and improve functional ability of patients with rheumatoid arthritis. In spite of this fact, use of biological therapy is still limited by high prices of these medicines, especially in countries in socioeconomic transition. The aim of our study was to compare cost-effectiveness of a combination of tocilizumab and methotrexate with methotrexate alone for rheumatoid arthritis in Serbia, a country in socioeconomic transition. METHODS For the purpose of our study we designed a Markov model using data on therapy efficacy from the available literature, and data on the costs of health states calculated from records of actual patients treated in the Clinical Center Kragujevac, Serbia. The duration of one cycle in our model was set at one month, and the time horizon was 480 months (40 years). The study was done from the social perspective, and all the costs and outcomes were discounted for 3% per year. RESULTS Treating rheumatoid arthritis with disease-modifying antirheumatic drugs (DMARDs) alone was more cost-effective in comparison with a combination of biologic treatment with tocilizumab and DMARDs. The total costs for treating a patient with DMARDs for one year were on average 261,945.42 RSD, or 2,497.70 Euro and the total costs for treatment with tocilizimab plus DMARDs were on average 1,959,217.44 RSD, or 18,659.20 Euro. However, these results are susceptible to changes in costs and treatment effects of tocilizumab in patients with more severe forms of rheumatoid arthritis. CONCLUSION Our results show that the use of tocilizumab for rheumatoid arthrits in economic environment of Serbia is not cost-effective. Use of tocilizumab for treating rheumatoid arthritis can become affordable, if costs of its use become lower. In order to start using expensive biologic medicines in patients in transitional countries, special strategy and pricing policy of international pharmaceutical companies are necessary, which would include calculation of prices of biologic medicines on the basis of local pharmacoeconomic studies.

ObjectivesThe objective of this study was to estimate the prevalence of potential drug-drug interactions (DDIs) among outpatients of city region Novi Sad, Serbia, and to investigate predictors of potential DDIs.MethodsCross-sectional prescription database study was conducted. In the analysis were randomly included 10% outpatients with polypharmacy (n=4467), who visited Health Center over 1-month period (November 1–30, 2011). All drug combinations with potential for clinical significant DDIs were identified, according to Drug Interaction Facts by David S Tatro. A logistic regression analysis was conducted to examine patient and drug therapy characteristics as predictors of potential DDIs.ResultsThe prevalence of clinical significant potential DDIs was 33.31%. Odds of exposure were the highest among those aged 65 years or older (odds ratio (OR)=5.204; 95% confidence interval (CI) 2.694–10.052, p<0.001), those with ≥ 4 diagnosed diseases (OR=4.451; 95% CI 3.349–5.914, p<0.001), and those who used ≥ 5 drugs (OR= 5.735; 95% CI 4.876–6.747, p<0.001). Chronic diseases as well as their therapy also presented predictors of DDIs.ConclusionApproximately one-third of outpatients living in Novi Sad were exposed to potential DDIs. Based on the present results could be defined recommendations for the management potential clinical significant DDIs.

[Purpose] The extent of functional independence ultimately achieved by an individual patient will be influenced by a variety of medical and non-medical factors. [Subjects and Methods] this study included 419 patients with spinal cord lesions treated in the Clinic for Rehabilitation “Dr M. Zotovic”, Belgrade, Serbia, from January 2000 to December 2009. The patients were divided in two groups according to achievement of increase in Functional Independence Measure (FIM) score of more than 13 at discharge compared to admission. A variety of clinical variables were followed in both groups. [Results] one hundred twenty-one patients (28.9%) showed improvements in FIM score of ≤13, while 298 (71.1%) patients showed an increases in FIM score of >13 at discharge compared to admission. Better functional recovery was observed in patients with non-traumatic spinal cord lesions, lower neurological levels of the lesion (OR = 6.07), and in patients treated surgically, but the level of the spinal cord lesion was the most influential factor affecting outcome. [Conclusion] the patients with spinal cord lesions should not only be grouped by traumatic and non-traumatic lesions only, but also sub-categorized, according to the etiology, level of injury and treatment method.

Studies on the effects of microwaves on the growth of microbial cultures were searched for in biomedical journals indexed in MEDLINE from 1966 to 2012. The published studies showed that microwaves produce significant effects on the growth of microbial cultures, which vary from the killing of microorganisms to enhancement of their growth. The nature and extent of the effect depend on the frequency of microwaves and the total energy absorbed by the microorganisms. Low energy, low frequency microwaves enhance the growth of microorganisms, whereas high energy, high frequency microwaves destroy the microorganisms. However, neither the effects of a wide spectrum of frequencies nor the effects of a wide range of absorbed energies have been investigated.

Development of an available drug delivery system is of great interest considering the therapeutic effects of formulations with violate essential oils, especially assuming the fact that using essential oils as antimicrobial agents is a rather expanded in antimicrobial therapy nowadays. In this paper, the chitosan microparticles with encapsulated thyme essential oil were prepared in the emulsion by cross-linking method. The effect of thyme oil and glutaraldehyde initial concentrations on particle size, morphology, and particle size distribution was investigated. In addition, the influence of these parameters on the encapsulation of thyme oil in chitosan microparticles, concerning thyme oil loadings and encapsulation efficiency was also tested. The particles showed a spherical shape with an average diameter of 4.71±1.42 to 13.65±4.34 μm, depending on the concentration of the essential oil and glutaraldehyde that were used. The diameter of microparticles appeared to increase with increasing the thyme essential oil concentration, and decreased with the increase of glutaraldehyde concentration. It was shown that the concentration of glutaraldehyde did not affect the degree of encapsulation, but the increase in the initial concentration of thyme oil increased the degree of encapsulation of this essential oil in chitosan microparticles. All particles containing thyme essential oil, as well as essential oil of thyme itself showed significant antimicrobial activity against Staphylococcus aureus ATCC 25923, Esherichia coli ATCC 25922, Candida albicans ATCC 24433 and Enterococcus faecalis ATCC 25929. This study showed a great potential of the use of thyme essential oil as an antimicrobial agent, especially when encapsulated in a drug delivery system with controlled release of the active antimicrobial component.