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Background/Aim. Given that frequent manipulation of the abutment during immediate loading can have a negative impact on the surrounding peri-implant hard and soft tissues, the concept “one abutment at one time” (OAO) has been introduced and documented in daily clinical practice. The aim of the study was to evaluate changes in peri-implant bone levels, clinical and radiographic parameters, and patient perspectives during the six-month follow-up period. Methods. The study was designed as a randomized controlled clinical trial. Patients with bilaterally healed sites in the posterior mandible received implants with a diameter of no less than 3.5 mm and a length of at least 8 mm. Based on randomization, patients were divided into a test group and a control group. Patients who were in the test group received implants that were immediately loaded with definitive abutments. In contrast, patients in the control group received implants where healing abutments were placed, followed by temporary abutments. Implants were immediately loaded with provisional restorations within the first seven days. They were delivered over the test group’s definitive abutment and the control group’s temporary abutment. Probing depth, bleeding on probing, clinical attachment level, plaque index, and keratinized tissue width were measured. Patient-Reported Outcome Measures and the Oral Health Impact Profile - 19 (OHIP-19) questionnaires were noted. Results. Out of 24 included patients, 22 completed the six-month follow-up. Peri-implant bone loss between study groups was comparable (mesial: t = -0.798, df = 21, p = 0.434; distal: t = 1.688, df = 21, p = 0.106), without statistical inter-group significance. OHIP-19 total scores significantly decreased after three months and remained similar six months after the implant placement in both groups without statistically relevant clinical inter-group changes. Conclusion. The OAO approach and provisional abutments showed comparable effectiveness regarding the immediate loading of posterior single implants.

Background and Objectives: Most patients who are successfully resuscitated from cardiac arrest remain comatose, and only half regain consciousness 72 h after the arrest. Neuroprognostication methods can be complex and even inconclusive. As mitochondrial components have been identified as markers of post-cardiac-arrest injury and associated with survival, we aimed to investigate cytochrome c and mtDNA in comatose patients after cardiac arrest to compare neurological outcomes and to evaluate the markers’ neuroprognostic value. Materials and Methods: This prospective observational study included 86 comatose post-cardiac-arrest patients and 10 healthy controls. Cytochrome c and mtDNA were determined at admission. Neuron-specific enolase (NSE) was measured after 72 h. Additional neuroprognostication methods were performed when patients remained unconscious. Cerebral performance category (CPC) was determined. Results: Cytochrome c was elevated in patients compared to healthy controls (2.029 [0.85–4.97] ng/mL vs. 0 [0.0–0.16], p < 0.001) but not mtDNA (95,228 [52,566–194,060] vs. 41,466 [28,199–104,708] copies/μL, p = 0.074). Compared to patients with CPC 1–2, patients with CPC 3–5 had higher cytochrome c (1.735 [0.717–3.40] vs. 4.109 [1.149–8.457] ng/mL, p = 0.011), with no differences in mtDNA (87,855 [47,598–172,464] vs. 126,452 [69,447–260,334] copies/μL, p = 0.208). Patients with CPC 1–2 and CPC 3–5 differed in all neuroprognostication methods. In patients with good vs. poor neurological outcome, ROC AUC was 0.664 (p = 0.011) for cytochrome c, 0.582 (p = 0.208) for mtDNA, and 0.860 (p < 0.001) for NSE. The correlation between NSE and cytochrome c was moderate, with a coefficient of 0.576 (p < 0.001). Conclusions: Cytochrome c was higher in comatose patients after cardiac arrest compared to healthy controls and higher in post-cardiac-arrest patients with poor neurological outcomes. Although cytochrome c correlated with NSE, its neuroprognostic value was poor. We found no differences in mtDNA.

Background and Objectives: Inadequate treatment of asthma and chronic obstructive pulmonary disease (COPD) might have a negative impact on their progression. Inhalation therapy is the cornerstone of pharmacotherapy for these conditions. However, challenges such as low adherence, negative attitudes, and misconceptions about inhaled medications still persist, impeding effective disease management. This study aimed to evaluate adherence, ascertain the level of disease control in asthma and COPD, explore potential misconceptions surrounding inhalation therapy among patients with obstructive lung diseases and the general population in Vojvodina, and evaluate the reliability of newly developed questionnaires employed in the study. Materials and Methods: This cross-sectional study utilized a battery of questionnaires encompassing sociodemographic data, the Asthma Control Test (ACT), the COPD Assessment Test (CAT), along with two novel questionnaires—one for assessing adherence and another for analyzing attitudes toward inhalation therapy. Statistical analyses were conducted using SPSS software, version 25.0. Results: The average ACT score among patients with asthma was 17.31, while it was 19.09 for the CAT questionnaire among COPD patients. The composite score on the newly developed adherence assessment questionnaire was 2.27, exhibiting a reliability coefficient lower than recommended (α = 0.468). Significant statistical differences emerged among sample subgroups regarding attitudes and misconceptions toward inhalation therapy. The reliability coefficient for this questionnaire was deemed satisfactory (α = 0.767). Conclusions: Adherence rates were notably suboptimal in both subgroups of the studied population. The disease control levels were higher among asthma patients, while they exhibited less prevalent misconceptions regarding inhalation therapy compared to COPD patients and the healthy population.

Introduction: Time is an essential category in the Emergency Department. The phone call duration, with the person who's calling, should be optimal in order to make sound decisions. If the phone call is due to a wrong number it should be made as shorter as possible. Objective: We aimed to show how long the conversations with the caller lasted, for calls that were qualified as having the wrong connection. Method. We used the electronic phone call database (194/94) for 2009. The data were put in a spreadsheet (Excel table) where they were sorted and researched. Out of the total of 739.742 calls we singled out 93.393, which makes 12.62%, and they were classified as the wrong connection. Due to the great variability in the upper scale of the values we cut the base for 5% of the shortest and longest calls. After the database cut 84.053 calls remained. The phone call duration was measured from the moment the receiver was picked up to the moment the line was disconnected. Results. Analyzing 84.053 wrong connections we came up with these results: minimal phone call duration was 6 seconds and maximal 194 seconds, with mean value of 30.28 seconds. Discussion. The number of wrong connections is huge in Emergency Departments all around the world (fire brigades, police, medical emergency) but there are no valid data on the time spent on those calls. Conclusion. Phone calls with wrong connection last too long. Therefore, operators and callers should be well educated.

Sarcoidosis is a multi-systemic disease of unknown etiology that is characterized by the formation of non-necrotizing and non-caseating granulomas in affected organs. Sarcoidosis granulomas can form in any organ, but the lungs and intrathoracic lymph nodes are the most commonly affected. Thyroid involvement in sarcoidosis is very rare, with prevalence estimates of 1–4.5% in case series of autopsied patients with systemic sarcoidosis. It is extremely rare for sarcoidosis to occur solely in the thyroid gland, but it is usually associated with the involvement of other organs, primarily the lungs and lymph nodes. Typical manifestations are diffuse goiter and solitary or multiple thyroid nodules. Thyroid function remains intact in the majority of cases, but sometimes it can result in hypothyroidism or hyperthyroidism. The diagnosis can be made after fine needle aspiration cytology, but usually it is diagnosed as an incidental finding while analyzing thyroidectomy tissue or during autopsy. Oral steroids are the cornerstone of thyroid sarcoidosis management, along with specific endocrinological treatment on some occasions. Given that we found only 71 reports of thyroid sarcoidosis available in the literature, we created and analyzed a cohort of 24 patients with thyroid sarcoidosis who were described in the literature in the 21st century and reported two additional cases of thyroid sarcoidosis.

Objective. Examine clinical manifestations, PCR test results, and visit outcomes in patients in COVID-outpatient clinics. Method. The survey was performed using the questionnaire, in February 2021. in patients in four COVID-outpatient clinics in Belgrade and one in Subotica. We got the data about their jobs, gender, age, present symptoms and comorbidities, PCR-testing, and visit outcomes. The data were processed using the software statistical package SPSS 17. Statistical significance was defined for level p

Introduction. A specific characteristic of the elderly is brittleness or fragility, and due to its prevalence, fragility needs to be understood as a public health priority. The aim of the study was to examine the association of functional and anthropometric parameters with fragility in persons over 65 years of age. Method. The study was designed as a cross-sectional study and included 446 elderly people. As research instruments, a general questionnaire was used to assess the functional status of the Tinetti test and, of anthropometric parameters, the circumference of the upper arm and the circumference of the middle part of the lower leg. We used the ch2 test and Pearson's correlation analysis as statistical tests. Results. Females had poorer functional status, walking, and balance compared to males (ch2 = 4.125; p

Background and Objectives: Before the introduction of griseofluvin, the use of X-ray radiation was the treatment of choice for tinea capitis. More than half a century later various types of tumors have been found to be associated with childhood irradiation due to tinea capitis, most commonly cancers of the head and neck, as well as brain tumors. The often unusually aggressive and recurrent nature of these tumors necessitates the need for repeated surgeries, while the atrophic skin with an impaired vascular supply due to radiation often poses an additional challenge for defect reconstruction. We present our experience in the surgical treatment of such patients. Materials and Methods: This is a retrospective cohort study. In this study, 37 patients treated for acquired defects of the scalp with a history of irradiation therapy due to tinea capitis in childhood were included in this study, 24 male and 13 female patients. The mean age at the first appointment was 60.6 ± 7.8, with the youngest included patient being 46 and the oldest being 75 years old. Patients’ characteristics, surgical treatment, and complications were analyzed and a reconstructive algorithm was developed. Results: Local flaps were used for reconstruction in 34 patients, direct sutures were used in 10 patients and 20 patients received split-thickness skin grafts for coverage of both primary and secondary defects for reconstruction of flap donor sites. One regional flap and one dermal substitute covered by an autologous skin graft were also used for reconstruction. Complications occurred in 43.2% of patients and were significantly associated with the presence of comorbidities (p = 0.001), aseptic bone necrosis (p = 0.001), as well as skin atrophy in frontal, occipital, and parietal region (p = 0.001, p = 0.042 and p = 0.001, respectively). A significant correlation between major complications and moderate skin atrophy was found only in the parietal region (p = 0.026). Conclusions: Unfortunately, many protocols developed for scalp reconstruction are not applicable in the setting of severe or diffuse scalp skin atrophy associated with high tumor recurrence rate and radiation-induced vascular impairment, such as in tinea capitis patients in Serbia. An algorithm has been developed based on the authors’ experience in managing these patients.

Background and Objectives: Knee osteoarthritis (KOA) is a widespread chronic joint disease characterized by functional limitations and pain. Functioning restrictions exert a detrimental impact on societal integration, relationships, and psychological well-being, resulting in significant emotional distress in KOA patients. The objective of this study is to examine how various risk factors impact the emotional well-being of individuals with KOA. Materials and Methods: This prospective cross-sectional study involved 154 postmenopausal women treated at the Special Hospital for Rheumatic Diseases in Novi Sad, Serbia. The experimental group comprised 97 individuals with chronic knee pain and structural knee damage (Kellgren–Lawrence (KL) scale II-IV), while the control group had 53 individuals with chronic knee pain but no structural knee damage (KL scale 0-I). The collected data consisted of sociodemographic factors, general characteristics, associated diseases, and laboratory results. Adequate anthropometric measurements were conducted, and all subjects were required to complete the SF-36 RAND questionnaire. Results: The analysis identified several variables that independently influenced emotional well-being. These included pain intensity (beta (β) 0.21; 95% CI: 0.03–0.20; p < 0.01), social functioning (beta (β) 0.47; 95% CI: 0.23–0.43; p < 0.001), physical functioning (beta (β) 0.23; 95% CI: 0.04–0.21; p < 0.01), and education level (8–12 years: beta (β) 0.25; 95% CI: 1.47–9.41; p < 0.01; >12 years: beta (β) 0.27; 95% CI: 2.51–12.67; p < 0.01). However, the multivariate model revealed that only social functioning (beta (β) 0.57; 95% CI: 0.27–0.53; p < 0.001) and education level (8–12 years: beta (β) 0.21; 95% CI: 1.10–8.260; p < 0.05; >12 years: beta (β) 0.21; 95% CI: 1.18–10.30; p < 0.05) were significantly associated with emotional well-being in KOA patients. Conclusions: The findings of this study indicate that a reduced social functioning and a lower educational attainment are linked to a poorer emotional well-being among patients with KOA.

Introduction: Aesthetic surgery procedures are generally done in a relatively healthy population and carry a rather low risk compared to other surgical specialties. The incidence of complications in aesthetic surgery varies greatly depending on the type, wound cleanliness regarding the anatomical site, complexity of the surgery, patient’s age, and comorbidities but is generally considered low. The overall incidence of surgical site infections (SSIs) in all aesthetic surgical procedures is around 1% in most of the literature while cases of necrotizing soft tissue infections are mostly found as individual reports. In contrast, treating COVID-19 patients is still challenging with many diverse outcomes. Surgical stress and general anesthesia are known mediators of cellular immunity impairment while studies regarding COVID-19 infection unquestionably have shown the deterioration of adaptive immunity by SARS-CoV-2. Adding COVID-19 to the modern surgical equation raises the question of immunocompetence in surgical patients. The main question of the modern post-lockdown world is: what could be expected in the postoperative period of perioperatively asymptomatic COVID-19 patients after aesthetic surgery? Case report: Here, we present a purulent, complicated, necrotizing skin and soft tissue infection (NSTI) after gluteal augmentation most likely triggered by SARS-CoV-2-induced immunosuppression followed by progressive COVID-19 pneumonia in an otherwise healthy, young patient. To the best of our knowledge, this is the first report of such adverse events in aesthetic surgery related to COVID-19. Conclusion: Aesthetic surgery in patients during the incubation period of COVID-19 or in asymptomatic patients could pose a significant risk for surgical complications, including severe systemic infections and implant loss as well as severe pulmonary and other COVID-19-associated complications.

Background and Objectives: Treatment of cancer patients during the COVID-19 pandemic has been a challenge worldwide. In accordance with the current recommendations for hepatocellular carcinoma (HCC) management during the COVID-19 pandemic, loco-regional therapy such as transarterial chemoembolization (TACE) was proposed with the purpose of achieving local tumor control and improving overall survival. The aim of this prospective cohort study was to evaluate the outcomes of TACE treatment in patients with HCC during the COVID-19 pandemic in comparison with the outcomes of patients treated in the pre-pandemic period. Materials and Methods: Between September 2018 and December 2021, 154 patients were managed by serial TACE procedures for different liver tumors. Ninety-seven patients met the study criteria and were divided into two groups: the study group n = 49 (patients treated from May 2020 to December 2021); the control group n = 48 (patients treated from September 2018 to May 2020). Results: The mean waiting time for TACE was significantly longer in the study group compared to the control group (p < 0.001). No significant difference in survival between the groups is noted (log-rank test p = 0.823). In multivariate analysis, the MELD score (HR 1.329, 95% CI 1.140–1.548, p < 0.001) remained a significant predictor of mortality. Conclusions: COVID-19 pandemic did not affect the final outcome of TACE treatment.

Background/Aim. For successful endodontic therapy, it is necessary to know root morphology. Therefore, the aim of our study was to analyze root canal morphology and root canal length of permanent molars in a Serbian population, using cone-beam computed tomography (CBCT). Methods. The study included a total of 305 maxillary molars, and 280 mandibular molars receiving cone-beam computed tomography examination and determined root numbers, canal morphology according to Vertucci classification, and canal lengths. Results were correlated with sex and tooth location in the jaw. Results. The mesiobuccal roots of first maxillary molars showed Vertucci type I in 45.7%, followed by type II in 29% of cases. For the second molar, Vertucci type I was found in 60.5% of cases in mesiobuccal canals. Palatal and distobuccal canals mostly presented Vertucci type I configuration. The mesial roots of mandibular molars had the highest frequency of two canals with Vertucci type IV as the most frequent for the first molar, and Vertucci type II for the second molar. Distal roots most commonly had one canal in both molars. Palatal canal length was the highest in maxillary first molars, with the mean value of 20.62 mm, while in second molars, the highest length value was for the mesiobuccal canal (20.09 mm). In both mandibular molars the mesial root canal was the longest one. Differences were found according to sex and tooth location in the jaw. Conclusion. Mesiobuccal roots of maxillary first molars had two canals; it was more frequently compared to second molars. Mesial roots of mandibular molars showed same frequency of two canals, and diversity in Vertucci types. Male patients tended to have higher complexity of root canal morphology compared to that of females. CBCT can improve understanding of the root canal morphology.

Introduction: Chronic obstructive pulmonary disease (COPD) is a chronic disease and it is estimated 20%-25% of patients remain undiagnosed. Objective: Review the approach of the general practitioner to diagnosing and treatment of COPD. Method: The study was conducted using the questionnaire, among the doctors who attended the Conference “General Medicine Days” that took place in Belgrade, from March 25th to March 26th, 2017. Data on age, gender, years of service, job location (town/village) and specialties: general practitioner (GP) or General Medicine Specialist (GMS) were obtained. Statistical processing was done in the SPSS 11.0 for Windows program. Results: The study included 330 physicians of both genders (88.68% women), average age 49.74 ± 10.5 years and years of service of 21.23 ± 10.55 years; 53.94% were GMS, and 87.27% of doctors worked in outpatient clinics in the city. The definition of COPD was knowledgeable to 74.85% of the participants and the clinical symptoms were recognized by 64.12% of the examined doctors. GPs gave more accurate answers than GMS (p=0.04), as well as doctors with up to 10 years of services (p=0.04), 81.46%, confirmed that bronco obstruction should be confirmed with spirometry, more doctors with up to 10 years of service (p=0.01). 46.38% of the examined doctors think spirometry could be performed at the PHC level. The spirometry finding are interpreted correctly by 61.7% of doctors. The pulmonary oximeter device owns 29.43% of doctors in their clinics, more often GPs (p=0.02) and doctors working in the rural clinics (p=0.02). 56% of doctors have an inhaler and use it regularly, more often doctors in rural outpatient clinics (p=0.02). For 56.56% of doctors, smoking cessation is the first step in COPD treatment. 78.12% think the therapy should be increased stepwise, and 55.32% of them self-initiated bronchodilator therapy (more often doctors with a years of practice of over 20 years, p=0.01). Conclusion: It is necessary to change the doctors` attitude in general practice towards COPD and to improve knowledge about diagnostics and therapy.

Background/Aim. Inflammatory bowel diseases (IBD), which include the ulcerative colitis (UC) and the Crohn’s disease (CD), are chronic diseases, the course of which is under the influence of numerous psychosocial factors. The aim of this study was the exploration of the personality traits of patients with IBD. Methods. This cross-sectional study has been conducted at the University Clinical Hospital Centre Zvezdara, Belgrade, Serbia. The study involved 150 patients suffering from IBD of both genders, out of which 50.7% and 49.3% of the patients suffering from UC and CD, respectively. The main inclusion criteria were: age 18 to 65 years and confirmed the diagnosis of UC or CD in remission. The sociodemographic and disease related data were collected from the hospital medical records. The personality traits related data were collected using the self-report forms of The Revised NEO Personality Inventory (NEO PI–R) and the inventory for the Assessment of Dysregulation (DELTA 10). Results. At the domain-level, the significant differences between IBD sample and normative sample were found in the Neuroticism (p < 0.01) and the Disintegration (p < 0.01). At the facet-level, the IBD sample scored significantly higher than the normative sample on Anxiety (p < 0.01), Assertiveness (p < 0.01), Tender-Mindedness (p < 0.01) and Dutifulness (p < 0.01), and the significantly lower scores on Warmth (p < 0.01), Excitement Seeking (p < 0.01), Positive Emotion (p < 0.01), Actions (p < 0.01), and on the all facets of Disintegration except Depression, Somatoform Dysregulation and Social Anhedonia (p < 0.01). The differences between UC and CD were found only at the facetlevel. The facets that adds the most predictive power to the discriminative function is the General Executive Impairment, followed by Warmth, Self-Discipline, Depression and Mania. Conclusion. The IBD patients showed to differ from the general population in terms of basic personality structure at the domain-level, and at the facet-level. The differences between the UC and CD patients can be found only at the facet-level. Screening of the personality traits and early detection of the IBD patients who are at a greater risk of mental disorders and bad psychosocial functioning can enable their adequate prevention and improve the course of the disease.

Background/Aim. The most frequent form of sternal defects is a single foramen, usually located at the distal half of the sternal body, with prevalence that varies among different ethnic populations. Clinical importance of these defects arises from various diagnostic and therapeutic sternal treatments and close location of heart, lungs and other vital organs of the chest cavity. The aim of this study was to determine the prevalence and morphometric characteristics of the sternal midline foramen in the population of central Serbia. Methods. The multidetector computed tomography (MDCT) chest images of 422 patients of both genders were analyzed. The radiological imaging was performed on 64- slice MDCT scanner (Aquilion 64, Toshiba, Japan). All scans were performed in the axial plane, with subsequent multiplanar reconstruction (MPR). Due to the angulation of the sternal body coronal curved-planar, the images were obtained in order to show the whole length of the sternum and the vertical diameter of the sternal foramen. The measurements were done using the commercially available software (Imaging Software ver. 4.1.14.0, Vital-Images). Results. The solitary foramen, located in the distal segment of the sternal body, was detected in 24 patients, representing 5.9% of the observed population with slightly higher prevalence in males. The average size of foramen was 3.9 × 4.2 mm. The mean distance from the skin was 12.7 ± 3.3 mm, the distance from skin to pericardium was on average 37.3 ± 8.2 mm, while the average distance from skin to pleura was 25 ± 5.9 mm. The average depth of foramen 8.7 ± 2 mm, while the mean distance from the posterior surface of foramen to pericardium was 12.7 ± 9.1 mm. Conclusion. The results presented in this paper confirmed the prevalence of 5.9% regarding the midline sternal foramen in the observed population. Serious complications of the sternal puncture could be prevented by prior MDCT imaging.

Introduction. Percutaneous vertebroplasty (PVP), as a mini-invasive approach in the treatment of patients with osteoporotic vertebral compression fractures (OVCFs), provides stabilization of the spine and relives pain. The most commonly it is applied in the 3–6 weeks before bending of the spine. Complete cessation of pain is easier to achieve if you treat “less mature” fractures. The aim of the report is to show that PVP is effective and safe for old fractures too. Case report. A 77-old patient suffered from a stable compression fracture of 3th lumbar (L3) vertebral body after minor trauma. This fracture was clinically and radiologically diagnosed. The conservative treatment that included lumbo-sacral orthosis (LSO), analgesic drugs and physical therapy, was primarily applied due to permanent pain and type of fracture. After a period of two months, pain persisted, but it was localized in a thoracic spinal segment with radiologically diagnosed fractured bodies of 8th (Th8) and 10th (Th10), thoracic vertebra without neurological deficit. Thoraco-lumbo-sacral orthosis (TLSO) was prescribed and after six months the indication for vertebroplasty of the Th8 and Th10 vertebral body was given. The pain relief had been achieved and the patient was discharged from the Clinic for Orthopedics on the postoperative day 2, and was symptom free during the follow-up period. Conclusion. In patients with stable OVCFs, PVP is an effective therapy for reducing pain and improving mobility of 6 months old fractures.

Background/Aim. The values of the Böhler’s angle (BA) are relevant parameters for diagnosis, management and prognosis of the calcaneal fracture and the outcome. Range of normal values of Böhler’s angle (BA) in adults varies depending on the examined population, age, gender or ethnicity. The aim of this study was to determine the range of normal values of the Böhler’s angle in the central part of Serbia. Methods. The lateral foot radiographs of 225 subjects (111 males and 114 females) without calcaneal fractures, divided into 6 age groups were observed to determine the normal values of the Böhler’s angle by using the IMPAX 6.5.2.114 Enterprise software. Obtained values for Böhler’s angle were compared among gender and groups using appropriate statistical tests. Results. The mean of Böhler’s angle in observed population was 34.06°, ranging from 25.1° to 49.5° and was higher in males than in females included in our study. Gender difference was statistically significant. The distribution of the mean BA across the age groups showed tendency of decreasing with age and the highest BA was found in the youngest group. Conclusion. The findings presented in this paper confirmed the existence of wide range of BA values as well as its gender and age differences.

Background/Aim. Preservation of an adequate posterior tibial slope (PTS) during total knee arthroplasty is crucial for the biomechanical stability and function of the knee joint. Studies that investigated anatomical features of the tibial plateau found significant gender and inter-population differences in all components of the PTS. The aim of this study was to establish reference values of PTS in Serbian population and to explore if there is any difference in the tibial plateau inclination between genders. Methods. We retrospectively reviewed 161 magnetic resonance images (MRIs) of the knee of adult patients examined in Medical Military Academy in Belgrade, Serbia, in a period from November 2011 to September 2014. Measurements of PTS components: medial tibial slope (MTS), lateral tibial slope (LTS), and coronal tibial slope (CTS) were performed through several steps, according to the suggestions in the recent literature. Obtained values for each tibial slope were compared between gender subgroups using appropriate statistical tests. Results. Mean values of each component of the posterior tibial slope for male vs. female subgroups were as follows: MTS 3.7° ± 2.8° vs. 5.1° ± 2.9°, LTS 4.2° ± 2.8° vs. 4.3° ± 2.7°, and CTS 3.9° ± 2.4° vs. 3.3° ± 1.9° respectively. The medial tibial slope was significantly higher in females than in males (p = 0.005). The mean value of the coronal tibial slope was greater in males without statistically significant difference (p = 0.105). Conclusion. This study demonstrated significant difference in MTS of the tibial plateau between males and females, being higher in the female subgroup.

Introduction. Musculoskeletal impairment is the most prevalent impairment in people over 65. The spine involvement is the most frequently reported. However, common regional pain syndromes usually arise from undefined mechanical, musculoskeletal or soft tissue disturbances. Use of imaging methods is becoming a mandatory tool in the clinical practice in order to achieve the prompt and accurate disease definition. Case report. The Caucasian 79-year-old-male patient attended with the history of an acute, piercing pain along the postero-medial side of the right Achilles tendon and the medial side of the right sole. According to the spine magnetic resonance imaging, X-rays and electrodiagnostic studies, diagnoses of the radicular, neurogenic pain and plantar fasciitis was suspected. However, the popliteal groove ultrasound assessment revealed the presence of hypertrophied semimembranosus- gastrocnemius bursa, compressing the popliteal neurovascular bundle. Conclusion. In patients with a symptomatology of peripheral neuropathy, use of imaging techniques such as ultrasound may be essential for accomplishing patients’ diagnostic approach.

Background/Aim. Damage of any element of pelvic floor leads to its functional damages, reflected in the occurrence of urinary incontinence, prolapse of pelvic organs, fecal incontinence and sexual dysfunction. Basic aim of our paper was to investigate the influence of various risk factors on pelvic floor muscle strength in women. Methods. The study included 90 female patients and examined how age, job, body weight and height, number of deliveries, sports activities, incontinence occurrence, previous prolapse-caused gynecological surgeries, other gynecological surgeries and other conservatively treated gynecological diseases influence the value of pelvic floor muscle strength. Pelvic floor muscle strength was measured using vaginal dynamometer. Results. Univariate regression analysis showed that parameters such as age, demanding job, body height, number of deliveries, sports activities, prolapse-caused gynecological surgeries, other gynecological surgeries and other gynecological diseases were in positive correlation with the values of pelvic floor muscle strength. In multivariate regression model, incontinence and gynecological operation of prolapse were singled out as independent risk factors. Conclusion. If risk factors that cause damage to pelvic floor muscle are known, it is possible to prevent the damages and improve the quality of women's life.

Introduction. Burkitt lymphoma (BL) is a high-grade, highrisk type of non-Hodgkin lymphoma characterized by a very rapid cell progression. Although BL is a rare cause of intussusceptions, it must arouse suspicion if the intussusception occurs outside the characteristic peak. Case report. A previously healthy 7-year-old boy was hospitalized for recurrent abdominal pain, loss of appetite and body weight, a fever of up to 38°C, persistent vomiting and with soft tumefaction ileocecally. Nuclear magnetic resonance (NMR) revealed intussusceptions due to a tumor mass, which was followed by a surgical procedure (right hemicolectomy and terminoterminal anastomosis). Histopathological examination confirmed the diagnosis of primary abdominal Burkitt lymphoma. In spite of the subsequent oncologic treatment lasting for four months, an undifferentiated mass was detected in the retroperitoneal space below the lower pole of the right kidney. Positron emission tomography (PET) scan was performed in order to detect the metabolic activity of the deposit in the retroperitoneal space. A high metabolic activity of Burkitt lymphoma confirmed its presence, as well as the need for additional surgical intervention for tumor extirpation. PET scan undoubtedly contributed to distinguishing the visibility of tumor cells and to the detection of the subcentimeter tumor mass. Conclusion. The timely diagnosis, high tumor sensitivity to chemotherapy as well as the great importance of PET scan in the early detection of tumor recurrence, significantly increase the survival rate in patients with BL.

Introduction. Calcium channel blockers and beta-blockers are among the most frequently ingested cardiovascular drugs in self-poisoning causing significant mortality. Intravenous lipid emulsion (ILE) is reported as a potentially novel antidote for treatment of acute poisoning caused by some of these drugs. Case report. We presented two cases of poisoning with these drugs. The case 1, a 24-year-old woman ingested amplodipine, metformin and gliclazide for self-poisoning. She presented with tachycardia and hypotension. Laboratory analyses revealed hyperglycaemia and metabolic acidosis. Despite the treatment which included fluid resuscitation, vasopressors, intravenous calcium, glucagon and ILE, circulatory shock occurred. The patient died 10 hours after admission due to cardiac arrest refractory to cardiopulmonary resuscitation. The case 2, a 41-year old man, was found in a coma with empty packages of nifedipine, metoprolol and diazepam tablets. On admission vital signs included Glasgow Coma Scale (GCS) of 3, weak palpable pulses, undetectable blood pressure, and irregular breathing with oxygen saturation of 60%. An electrocardiography showed AV block (Mobitz II) with ventricular rate of 44/min with progression to third degree of AV block. In attempt to increase heart rate and blood pressure the following agents were administered: atropine boluses, normal saline with dopamine, glucagon, calcium chloride and ILE. Temporary transvenous pacemaker was placed, electrical capture was recorded, but without improvement in haemodynamics. Three hours after admission cardiac arrest happened and cardiopulmonary resuscitation was unsuccessful. Conclusion. Intravenous lipid emulsion may be ineffective in acute poisonings with amlodipine, nifedipine or metoprolol.

Background/Aim. Introducing tyrosine kinase inhibitors (TKIs) has essentially changed curative approach, to be precise, clearly improved treatment efficacy for chronic myeloid leukemia (CML). Thus, the place and usage of allogeneic stem cell transplant (SCT) in CML treatment - as a former "nearly monopolistic" therapeutic manner - is nowadays controversial. The objective of this retrospective study was to evaluate the results obtained in the treatment of CML patients, with a particular attempt to define parameters critical for clinical benefit and superior overall outcome following allogeneic SCT. Methods. A total of 32 CML patients (27 in chronic phase and 5 with advanced disease), with female/male ratio 11/21, aged from 9 to 54 (32 in average) years, underwent allogeneic SCTs (1993 to 2009). The initial treatment for 25 patients was interferon alpha (IFN-α) with or without ARA-C, and additional 7 patients with no response to imatinib mesylat (IM). The time from diagnosis to SCT was approximately 12 (range 3- 37) months. The patient were categorized according to the risk for the disease, transplant-related mortality (TRM) scoring system, and stem cell (SC) source. The basic conditioning regimen was a combination of busulphan and cyclophosphamide (BuCy-2). Graft-versus-host disease (GvHD) was typically prevented with cyclosporine-A (CsA) and methotrexate (MTX). Results. Engraftment was observed in 26 (84.4%) patients, with polymorphonuclear (PMNs) and platelet (Plt) recovery on the 15th (range 10-22) and 19th (range 11-29) posttranspalnt days, respectively. Acute GvHD (aGvHD) had 13/26 (50%), and chronic GvHD (cGvHD) 10/21 (47.1%) patients. The incidence of overall TRM was 46.8% (15/32), while early death was noticed in 4 (12.5%) patients. A cause of death in 9 (28.1%) patients was cGvHD, in 2 (6.25%) patients infection, and in 3 (9.35%) cases disease-relapse was occurred. Fourteen (43.7%) of the patients are still alive, 9 from the low-risk group for TRM, with long-term survival from 1 to 16 years. Patients who received SCs from peripheral blood (PB) vs bone marrow (BM) had significantly faster engraftment (p < 0.05), lower oropharingeal mucositis rate (25% vs 70%; p < 0.05), but more frequent cGvHD (83.3% vs 30.3%; p < 0.05). A significantly improved (log-rank = 2.39; p < 0.01) overall survival (OS) was obtained in BM-setting. Conclusion. The results obtained in this study are in accordance with data from analogous clinical trials. Exactly, in the era of the new target therapy (TKI application), allogeneic SCT can be still a convenient therapeutic approach for well-selected CMLpatients, especially for those with initial high-risk disease and lower probability of TRM.

Background/Aim. Through its various activities, World Health Organization (WHO) contributed to increasing the understanding of the concept of quality of life. People with diabetes have a lower quality of life than people without chronic illnesses. The aim of this study was to examine the differences in the quality of life, related to health, in patients with diabetes mellitus (DM) type 2 by age, gender and type of therapy. Methods. We performed a cross-sectional study at the outpatient department of the Clinical Center in Novi Sad and the Health Center Ruma - General Practice. The group consisted of 90 patients with DM type 2, 41 men and 49 women. The age of respondents was from 40 to 80 years and they were classifed into four groups according to the ten-year age intervals. We applied WHO Quality of life questinnaire - BREF 100 composed of four domains: physical health, psychological health, social relationships and environment. The general questionnaire asks questions about socio-demographic data, duration of diabetes, the last value of blood glucose and glycosylated hemoglobin, training for self-control and its implementation, informing patients about their disease, therapy and its impact on daily activities and the presence of comorbidity. In statistical analysis the following tests were used: Student’s t-test, Ftest, ANOVA (one way). Results. The average duration of DM type 2 was 11.2 ± 9.2 years. Most of the patients (76%) were trained to self-control and 91% received enough information about their disease. Oral hypoglycemic preparations were used by 49%, insulin by 21%, and oral drugs and insulin by 29% patients while 1% were on a special regime of a diet therapy. Daily activities were performed without difficulties by over 29%, with some difficulties by 41% and 30% of patients who could not perform daily activities. The patients with DM type 2 had significantly lower scors in all 4 domains of quality of life (physical health, psychological health, social relations, environment). The biggest influence was on physical domains (51.31). Education level had an impact on physical and psychological domains. Comorbidity was found in 83% of the respondents. The most common were: arterial hypertension (63%), chronic cardiovascular disease (46%), neuropathy (23%), impaired vision 24%, elevated blood lipids (39%) and amputation of toes or feet (2.2%). The average value HbA1C in the group with comorbidity was 8.47% and in the group without comorbidity 6.46%. The subjects with comorbidity had low quality of life assessment in relation to the group without comorbidity: the domain of physical health (45.64 vs 79.66), psychological health (50.3 vs 76.86), social relations (52.97 vs 75.46) and environment (52.7 vs 75.06). Conclusion. Diabetes mellitus type 2 has negative influence on the quality of life. It contributes to the presence of comorbidity. The occurrence of comorbidity was associated with higher glucosylated HbA1C values. There was no difference in the assessment of quality of life regarding gender, age, or the type of therapy used. The quality of life was assessed as low in patients with comorbidity. However, certain personality characteristics play a decisive role in self-evaluation.

Background/Aim. Nucleus accumbens is a part of the ventral striatum also known as a drug active brain region, especially related with drug addiction. The aim of the study was to investigate the Golgi morphology of the nucleus accumbens neurons. Methods. The study was performed on the frontal and sagittal sections of 15 human brains by the Golgi Kopsch method. We classified neurons in the human nucleus accumbens according to their morphology and size into four types: type I - fusiform neurons; type II - fusiform neurons with lateral dendrite, arising from a part of the cell body; type III - pyramidal-like neuron; type IV - multipolar neuron. The medium spiny neurons, which are mostly noted regarding to the drug addictive conditions of the brain, correspond to the type IV - multipolar neurons. Results. Two regions of human nucleus accumbens could be clearly recognized on Nissl and Golgi preparations each containing different predominant neuronal types. Central part of nucleus accumbens, core region, has a low density of impregnated neurons with predominant type III, pyramidal-like neurons, with spines on secondary branches and rare type IV, multipolar neurons. Contrary to the core, peripheral region, shell of nucleus, has a high density of impregnated neurons predominantly contained of type I and type IV - multipolar neurons, which all are rich in spines on secondary and tertiary dendritic branches. Conclusion. Our results indicate great morphological variability of human nucleus accumbens neurons. This requires further investigations and clarifying clinical significance of this important brain region.

Background/Aim. Anatomical parameters of the bony components of the hip joint are essential for better understanding of etiopathogenesis of diseases like primary osteoarthrosis of the hip joint. The aim of this reserch was to examine the normal acetabular morphometry in Serbian population and to determine whether there are sex differences in anatomical parameters of the acetabulum among asymptomatic subjects. Methods. Pelvic radiographics of 320 adult asymptomatic patients (640 hips) were analyzed in 170 men and 150 women to determine the morphology of the acetabulum in Serbian population. For each hip the center edge angle of Wiberg (CEA), the acetabular angle of Sharp (AA), acetabular depth (AD), acetabular roof obliquity (ARO) and roof angle (RA) were measured. Results. The following average measurements for acetabulum geometry were obtained (X ± SD): CEA - 33.5 ± 6.5° (33.6 ± 5.8° in male, 33.3 ± 6.9° in female), AA - 38.0 ± 3.8° (37.5 ± 3.6° in male, 38.5 ± 3.9° in female), AD - 11.9 ± 2.8 mm (12.5 ± 2.7 mm in male, 11.2 ± 2.7 mm in female), ARO - 7.6 ± 5.7° (6.2 ± 4.9° in male, 9.0 ± 6.0° in female) and RA - 18.4 ± 10.0° (19.6 ± 8.5° in male, 17.1 ± 9.5° in female). There were significant differences in the CEA, AA, AD, ARO and RA related to gender (p < 0.01, t-test). Conclusion. There are significant gender differences in Serbian population for all the examined anatomical parameters of acetabulum. We found sex-related differences in acetabular morphology, female acetabulum being marginally more dysplastic than male acetabulum. There is also a clear tendency of female hips to be more dysplastic than male ones.

Background. Ovarian cancer is very rare in pregnancy. It is mainly of epithelial origin, low grade and low malignant potential. Case report. We presented a patient in which ultrasound confirmed the presence of clearly limited tumor in the left ovary when she was eight weeks pregnant. The results of 4D Color Doppler showed a central type of tumor vascularisation with resistance index (IR) less than 0.5. The Consultancy Board in Gynecology of the Institute for Oncology and Radiology of Serbia decided to remove the patient's left adnexa and intensively monitor the pregnancy period. The operation (Adnexectomia lateralis sinistra) was performed at 18th week of gestation. Histopathological analysis showed adenocarcinoma invasivum, endometroid well-differentiated type (histological grade I, nuclear grade 2). In 37th week of gestation, the patient gave birth to a male child by cesarean section. In the next 3 years the patient had no subjective interference, laboratory tests and ultrasonographic findings were normal. Conclusion. Ovarian cancer in pregnancy is usually asymptomatic and diagnosed during routine clinical and ultrasound examination. The color Doppler technique have particular importance in the diagnosis of pathological blood supply in tumors and in indication of malignant ovarian mass.

Background/Aims. Acute appendicitis (AA) remains a diagnostic challenge in children, despite ongoing researches. With an aim to facilitate making diagnosis of AA many scoring systems have been created; among them Alvarado score is the most popular. C-reactive protein (CRP) has proven significance for diagnosing AA in adults, but not in children. The aim of this study was to evaluate significance of Alvarado score, as well as CRP values, in making diagnosis of AA in children. Methods. This prospective six-month study was performed on 257 patients under the age of 15, admitted for acute abdominal pain in the Clinic of Pediatric Surgery and Orthopedics in the Clinical Centre of Niš. Alvarado score and CRP values were determined on admission and compared with final diagnosis on discharge. The patients were divided into two groups: group I - non operated patients with abdominal pain (n = 184) and group II - operated on patients for appendectomy (n = 73). Results. Values of Alvardo score were statistically significantly different between groups (group I: 4.9 ± 1.21, group II: 8.55 ± 1.32). Also, our results showed significantly high values of CRP measured in operated children (group I: 8.17 ± 4.7 mg/L, group II: 38 ± 26 mg/L). Values of validity parameters for Alvarado score were: sensitivity 90%, specifity 80%, positive predictive values 87%; for CRP 95%, 70% and 80%, respectively. Conclusion. Alvarado score and CRP are very useful adjuvant diagnostic tool for AA to a less experienced surgeon. High values of Alvarado score and CRP cannot be ignored neither at the same time, used as the sole diagnostic method for discriminating children with AA.

Background. Encephalocele presents a rare anomaly of central nervous system, developed as a consequence of neural tube closing defect during early embrional development, and it is described by a baggy formation which prolaborates through the pores of the scull, filled with brain tissue, cerebrospinal liquor and entwined with meninges. According to literature search, until this day, the earliest it can be ultrasonically detected is the 13th gestation week, with the appliance of three-dimensional ultrasound. Case report. We presented 25 years old patient, ultrasonically diagnosed with occipital fetal encephalocela at the 13th gestation week. A gestation sack was located in the right uteral corn of the two-corned uterus with one cervix. The diagnosis was confirmed also by trippled value of alpha-fetoprotein in maternal serum: 75,98 IU/mL. Conclusion. Ultrasonic examination is the method of choice for prenatal detection of a fetal anomaly. It is possible to diagnose encephalocele if it prominates above the limits of the scull.

Background/Aim. The main complication of the atherosclerotic abdominal aortic aneurism (AAA) is her rupture that begins with lesion in intima and rupture. The purpose of this work was to determine immunocytochemical and morphofunctional characteristics of the cells in aortic wall in ruptured atherosclerotic abdominal aortic aneurysm. Method. During the course of this study, 20 samples of atherosclerotic AAA were analyzed, all of them obtained during authopsy. The samples were fixed in 4% formalin and embedded in paraffin. Sections of 5 μm thickness were stained histochemically (of Heidenhain azan stain and Periodic acid Schiff - PAS stain) and immunocytochemically using a DAKO LSAB+/HRP technique to identify α-smooth muscle actin (α-SMA), vimentin, myosin heavy chains (MHC), desmin, S-100 protein, CD45 and CD68 (DAKO specification). Results. The results of our study showed that ruptured atherosclerotic AAA is characterized by a complete absence of endothelial cells, the disruption of basal membrane and internal elastic lamina, as well as a presence of the remains of hypocellular complicated atherosclerotic lesion in intima. On the plaque margins, as well as in the media, smooth muscle cells (SMCs) are present, which express a α-SMA and vimentin (but without MHC or desmin expression), as well as leukocyte infiltration, and a large number of foam cells. Some of the foam cells show a CD68-immunoreactivity, while the others show vimentin- and S-100 protein-immunoreactivity. Media is thinned out with a disorganized elastic lamellas, while adventitia is characterized by inflammatory inflitrate (infection). Conclusion. Rupture of aneurysm occurs from the primary intimal disruption, which spreads into thinned out media and adventitia. Rupture is caused by unstable atherom, hypocellularity, loss of contractile characteristics of smooth muscle cells in intima and media, neovascularization of the media, as well as by the activity of the macrophages in the lesion.

Background/Aim. Introduction of acetylcholine esterase inhibitors as a symptomatic treatment of Alzheimer's disease (AD) has additionally highlighted the importance of diagnostic markers in cerebrospinal fluid (CSF) for early AD diagnosis: low level of 42 amino acid form of amyloid-β peptide (Aβ42), and levels of tau protein (T-tau) and phosphorylated tau protein (P-tau). The aim of this study was to diagnostic potential of CSF biomarkers T-tau, P-tau and Aβ42 as biochemical markers for AD. Methods. Lumbar puncture was performed in 63 patients with AD and 26 control subjects who passed orthopedic surgery. The Innotest, ELISA sandwich test (Innogenetics - Belgium) was used for measuring the levels of T-tau, P-tau and Aβ42. Results. The patients and the control group did not differ in age, education and sex. Mean levels of CSF T-tau and P-tau were significantly higher in the patients with AD (p < 0.001) compared to the control group, in contrast to significantely lower CSF Aβ42 in AD group (p < 0.001). A significant progressive decrease of Aβ42, as well as significant progressive increase of T-tau and P-tau was found among AD subgroups (according to MMSE staging) and controls. Conclusion. The obtained results suggest that these biomarkers may be supportive in the diagnosis of AD, especially in the early course of the disease and could be used in the routine clinical practice considering the approaching target therapeutics.

Background/Aim. Graves-Basedow disease is a common multifactorial genetic syndrome, which is determined by several genes and environmental factors. The aim of the present study was to investigate the presence of risk factors for developing Graves-Basedow disease between the groups of individuals with and without Graves-Basedow disease, and to compare the presence of risk factors between the affected individuals with or without positive family history for Graves- Basedow disease. Methods. This cross-sectional study was conducted in Ćuprija (central Serbia) during a period from December 2001 to April 2002. The case group comprised 132 individuals diagnosed with Graves-Basedow disease. The control group comprised 130 subjects without any of endocrine diseases. All participants were interviewed at the Medical Center Ćuprija using structural questionnaire. Data were collected on basic demographic characteristics, exposure to various chemical and physical agents, stress, smoking and family history of Graves-Basedow disease. In statistical analysis chi-square test was used. Results. The individuals with Graves-Basedow disease were statistically significantly older (above 50) (p = 0.020), exposed to stress (p = 0.024) and to physical agents (p = 0.031), and had significantly (p = 0.000) more relatives with Graves-Basedow disease than those without the disease. Among the affected individuals with positive family history of Graves-Basedow disease the number of women was significantly higher (p = 0.000), than the affected individuals without positive family history of Graves- Basedow disease. Conclusion. In our study, as in many other, gender, age, positive family history of Graves-Basedow disease and exposure to physical agents were identified as potential risk factors for the increased incidence of Graves- Basedow disease. Different risk factors are probably responsible for developing Graves-Basedow disease among the affected individuals with or without positive family history of Graves-Basedow disease. .

Background/Aim. Ovary is the organ of the female reproductive system most commonly affected by metastases. The aim of the study was to determine the frequency and features of metastatic ovarian tumors (MOT) depending on the site of the primary malignant tumor. Methods. The study group consisted of 488 patients with histopathologically confirmed ovarian cancers treated at the Clinic of Oncology, Clinical Center Niš, in the period from 1 January 1998 to 31 December 2005. MOT were found in 41 patients. Regarding the site of the primary malignant tumor, those with secondary ovarian tumor were divided into two groups: group A - primary malignant tumor involving the genital organs (n = 30) and group B - primary malignant tumor of extragenital origin (n = 11). Results. MOT were confirmed in 8.40% (41/488) of the patients. Secondary ovarian malignancies were the consequence of endometrial carcinoma spreading in 73.17%, breast carcinoma in 19.51%, stomach carcinoma in 4.88% and colon carcinoma in 2.44% of the cases. No significant differences were found between the group A and group B by the factors of age, body mass index, parity and menopausal status. Contrary to the group A, metastatic tumors in the group B patients were more commonly asymptomatic (p < 0.001), bilateral (p < 0.05), with larger ovarian diameter (p < 0.05), associated with ascites (p < 0.001) and abdominal metastases (p < 0.01), all of statistical significance. Conclusions. Metastatic tumors made up 8.40% of ovarian neoplasmas. With non-genital primary tumors, secondary ovarian deposits were frequently asymptomatic, bilateral, associated with larger ovarian diameter, ascites and abdominal metastatic deposits, compared to malignant tumors of genital origin.

Background. Systemic amyloidosis is a rare disorder which usually occurs in aged persons and has a poor prognosis. Systemic amyloidosis can be primary, occasionally associated with multiple myeloma, or secondary, associated with another disease. Case report. We presented a 72-year-old male patient with periocular purpura ("racoon sign") and waxy papules, petechiae and ecchymoses on the neck and thoracic area. Purpuric macules were present also on the lips and tongue which was edematous (macroglossia). The skin lesions occurred two years earlier, the patient lost more than 15 kilograms of the body mass for less than a year. Immunoelectrophoresis of urine and serum demonstrated the presence of immunoglobulin light chains of the circulating monoclonal protein. Histopathological examination of skin lesions showed Congo red positive deposits in the derm. Cardiac evaluation revealed the signs of heart failure, and renal evaluation revealed nephrotic syndrome, with excessive protein lost. He was treated with oral melphalan and prednisolone, and died 7 days after starting the therapy due to heart failure. Conclusion. This patient considered as a rare case with systemic amyloidosis highlights the importance of histopathological and physical examination in any cases with periocular purpura, petechiae, ecchymoses and macroglossia.

Background. Adverse effects of dental cast alloys on the health of patients are the problem in clinical practice. The aim of this paper was to describe the case of a patient with discolorated gingivae in the presence of fixed dental restorations and used diagnostic and therapeutic procedures. Case report. A 30-year old patient, presented with the complaints about unsatisfactory esthetic of his fixed dental restorations. He complained about the greyish discoloration of gingivae, inappropriate color of the crowns, and a larger space between the central incisors. Both discolorated and normal gingivae around the fixed dental restorations were taken by excision and the samples of gingivae were examined histopathologically, and by using the Atomic Absorption Spectrophotometry test (AAS). Histopathological examination of the discolorated gingivae showed the presence of non-specific inflammation with a foreign body. AAS revealed the presence of various metals in the samples and the higher metal contents in the samples of discolorated gingivae as compared with the samples of normal gingivae. New metal-ceramic crowns were made for the patient. Conclusion. A main cause of greyish discoloration of gingivae was presence of a metal in gingival tissue. After the excision of discolorated gingivae old metalceramic crowns should be replaced with new crowns.

Background/Aim. Chronic myeloid leukemia (CML) represents a malignant myeloproliferative disease developed out of pluripotent hematopoietic stem cell that contains the fusion bcr-abl gene. Disorders that occur in the process of apoptosis represent one of the possible molecular mechanisms that bring about the disease progress. The aim of our study was to carry out the analysis of the presence of the amplification of the cmyc oncogene, as well as the analysis of the changes in the expression of Bcl-2 in the patients with CML. Methods. Our study included 25 patients with CML (18 in chronic phase, 7 in blast transformation). Using an immunohistochemical alkaline phosphatase-anti-alkaline phosphatase (APAAP) method, we analyzed the expression of cell death protein in the mononuclear bone marrow cells of 25 CML patients. By a differential PCR (polymerase chain reaction) method, we followed the presence of amplified c-myc gene in mononuclear peripheral blood cells. Results. The level of the expression of Bcl-2 protein was considerably higher in the bone marrow samples of the patients undergoing blast transformation of the disease. The amplification of c-myc gene was detected in 30% of the patients in blast transformation of the disease. Conclusion. The expression of Bcl-2 protein and the amplification of c-myc gene are in correlation with the disease progression.

Background/Aim. The efficacy and biocompatibility of hemodialysis have a singnificant impact on dialysis patient morbidity and mortality rate. The aim of our study was to compare the efficacy and biocompatibility of different hemodialysis modalities in our patients. Methods. A total of 55 patients were included in the study, and on the basis of dialysis modality, they were divided in four groups: group I - postdilution on-line hemodiafiltration (n = 15), group II - bicarbonate high-flux polysulphone hemodialysis (n = 15), group III - bicarbonate low-flux polysulphone hemodialysis (n = 15), and groupe IV - bicarbonate cuprophane hemodialysis (n = 10). The efficacy was evaluated on the basis of urea reduction rate (URR), urea Kt/V index and serum β2-microglobuline reduction rate, and the biocompatibility was evaluated on the basis of the leukocyte count fall during the first fifteen minutes of dialysis session, and of the serum C-reactive protein (CRP) level. Results. The highest mean URR was achieved in the group I (70.53 ± 6.49 %), and it was significantly higher in comparison with the average URR in the group IV (54.8 ± 6.35%) (p = 0.001). The average value of urea Kt/V index in the group I (1.48 ± 0.22) was significantly higher in comparison with the average value in the groupe II 1.30 ± 0.22 (p < 0.05), group III (1.05 ± 0.22), and group IV (0.98 + 0.22) (p = 0.001). Serum β2-microglobuline reduction rate was 68.93 ± 8.25% in the group I, and 58.86 ± 7.98% in the groupe II (p = 0.01). During the first 15 minutes of hemodialysis the leukocyte number was decreased by 12.57 ± 9.35% in the group I, 13.61 ± 9.64% in the group II, 18.3 ± 13.24 in the group III and 62.3 ± 15.4 in the group IV, on average. The mean serum level of CRP was 9.4 ± 6.47 mg/l in the group IV, and less than 3.5 mg/l in the group I of the patients (p = 0.001). Conclusion. Postdilution on-line hemodiafiltration in comparison with standard hemodialysis provided the more effective elimination of small and middle uremic toxins molecules and a significantly higher degree of biocompatibility. The patients treated with standard hemodialysis frequently do not achieve the minimal value of urea Kt/V index prescribed by National Kidney Foundation - Dialysis Outcomes Quality Inatiatives standards. These patients also have significantly higher serum CRP values which suggest the state of chronic microinflammation.

Panniculitides represent heterogenous group of disorders involving subcutaneous fat tissue, and are etiologically related to different causes including systemic diseases. Two female patients having subcutaneous sarcoidosis and panniculitis associated with dermatomyositis are presented in this paper. The first patient, (38 years of age), was with the nodes on forearms and lower legs, which occurred one month after hypophysectomy for adrenocorticoscopic (ACTH)-secreting pituitary adenoma, and showed histopathologically confirmed epithelioid, noncaseating granulomas in the subcutaneous fat tissue. Laboratory and radiographic findings were normal with the exception of positive rheumatoid factor and incompletely developed cysts in proximal phalanges of the hand. The second patient (56 years of age), was with subcutaneous nodes on the upper arm and the lateral chest wall, which were noticed several months after the diagnosis of dermatomyositis. Histopathological examination showed lobular pannicilitis with hyaline fibrosis and plasmocytic-lymphocytic infiltrate.

Introduction. Longitudinally extensive transverse myelitis (LETM) is a transversal myelitis that extends through three or more vertebral segments in length. Case report. A 52- year-old woman was hospitalized due to pain in the lumbar region, difficulty in walking, hypoesthesia of the anogenital area and urinary retention. In the past medical history, two years earlier, the patient had been diagnosed with transversal myelitis confirmed by MRI of the cervical spine and six months earlier, the patient was diagnosed with primary Sjögren’s syndrome (SS). During the current hospitalization MRI of the spinal cord revealed extensive inflammatory lesions of almost the whole spinal cord. Lumbar puncture (LP) revealed mild pleocytosis and slightly increased protein level. Isoelectric focusing of cerebrospinal fluid (CSF) and serum proteins was normal. Visual evoked potentials were normal. Serological testing excluded acute viral infections. Corticosteroid therapy was applied with good therapeutic response. Control MRI revealed regression of pathological changes in the spinal cord. Conclusion. A wide range of disorders can cause LETM, but usually the first line diagnosis is neuromyelitis optica (NMO). Based on the detection of NMO immunoglobulin G in the serum of affected patients, a variety of allied disorders were grouped under the name of NMO spectrum disorders, including recurrent myelitis associated with LETM and myelitis associated with autoimmune disorders such as SS. There have been only a few cases reported in the literature with recurrent LETM associated with non-organ specific autoimmune disorder.

Background. Atypical forms of pyoderma gangrenosum generally appear on the upper extremities; most frequently they are associated with myeloproliferative disorders, including osteomyelofibrosis. A response to systemic steroids is more pronounced than in classical form. Sometimes it may be the first sign of an underlying malignancy. Case report. We reported a patient with atypical pyoderma gangrenosum developed during the course of a myeloid malignancy - osteomyelofibrosis. The lesions occurred after a minor trauma. Painful blistering plaques, with an elevated, bluish-gray border were located on the dorsal aspect of hands. No skin malignancy was found. The lesions resolved rapidly to systemic steroids. Conclusion. Considering the unusual clinical presentation which makes the diagnosis difficult, as well as the fact that atypical forms of pyoderma gangrenosum can be the first sign of malignancies, especially myeloproliferative ones, recognizing this entity enables timely guiding future investigations toward their prompt detection.

Background. Pancreas divisum is the most common anomaly of the pancreas. This anomaly has been known as a possible cause of recurrent pancreatitis. Case report. We performed computerized tomography (CT) of the abdomen in 5 children in whom a divided pancreas was confirmed using endoscopic cholangiopancreatography. In a girl, who had three episodes of severe acute pancreatitis, a CT examination confirmed a completely divided embryonal dorsal and ventral primordium. We named this variant of the divided pancreas the "bilobular pancreas". Contrary to the remaining 4 children in whom the control of the number and severity of attacks, as well as the control of pancreatic pain were achieved by pharmacotherapeutics and an adequate diet, in the reported patient sphincteroplasty of the papilla duodeni minor resulted in a full control of the disease. Conclusion. The paper discussed the possibility that the variant of the divided pancreas, with anatomically completely separated ventral and dorsal pancreas and their ductal systems, is the key factor that determines the severity of pancreatic disease and an indication for sphincteroplasty of the papilla duodeni minor as the major therapeutic method.

Background/Aim. Phthalates are recognized as endocrine-disrupting compounds and are extensively present in a variety of everyday products. Chronic exposure to phthalates is suspected to be associated with a range of health disorders. The aim of the study was to examine the abundance of phthalate metabolites in the urine samples among adults in the Autonomous Province of Vojvodina, Serbia, and to determine the prevalence of phthalate metabolites in healthy individuals and those with metabolic disorders such as obesity and newly diagnosed type 2 diabetes mellitus (T2DM). Methods. For the study purpose, the first morning urine sample of 308 participants was screened for the presence of 10 phthalate metabolites: mono-ethyl phthalate (MEP), mono-(2-ethylhexyl) phthalate (MEHP), mono-n-butyl phthalate (MBP), mono-iso-allyl phthalate (MiAP), mono-n-allyl phthalate (MnAP), mono-cyclohexyl phthalate (MCHP), mono-benzyl phthalate (MBzP), mono-n-octyl phthalate (MOP), mono-n-propyl phthalate (MPP) and mono-methyl phthalate (MMP). Results. At least one phthalate metabolite was detected in the first morning urine sample in 50.32% of the examined population. The most frequently detected phthalate metabolites were MEP and MEHP. Out of all phthalate-positive participants, 38.3% of them had one, 10.7% had two, while 1.3% of participants had three phthalate metabolites in the first morning urine sample. A significant difference (p < 0.05) between groups was observed on MEP and MMP frequency, while border-line significant difference (p < 0.1) between groups was observed on MEHP and MCHP frequency. Conclusion. In the Vojvodina region, both healthy adults and those with metabolic disorders such as obesity and newly diagnosed T2DM are predominantly exposed to di-ethyl phthalate and di-(2-ethylhexyl)phthalate since MEP and MEHP were the most frequently detected phthalate metabolites. Further re-search is required in order to provide more details of the phthalates influence on the adverse health effects.

Introduction. Additional karyotype abnormalities in the Philadelphia-positive (Ph+) clone can emerge during the progression of chronic myeloid leukemia (CML) and are of-ten associated with the resistance to treatment with tyrosine kinase inhibitors (TKI). Sometimes, during the TKI treatment, karyotype abnormalities can appear in the Philadelphia-negative (Ph-) cells as well but do not seem to adversely affect the outcome except for chromosome 7 abnormalities. Case report. The patient presented was in the chronic phase of Ph+ CML with highly diverse karyotype abnormalities. The abnormalities appeared in three unrelated clones during the TKIs treatment, followed by the evolution of the disease into acute myeloid leukemia (AML). The primary Ph+ clone was revealed during the chronic phase of CML, and therapy with imatinib mesylate was commenced. After a three-year hematologic and cytogenetic remission period, the evolution of the primary clone was noticed. Nilotinib was introduced, leading to a good molecular response and the disappearance/loss of the Ph+ clone with additional abnormalities but with the appearance of the Ph-clone with trisomy 8. Finally, after 5.5 years of nilotinib therapy, the Ph-clone with monosomy 7 occurred during the deep molecular response for BCR-ABL. At that time, the FISH analysis for trisomy 8 was negative, but the rise in blast count was noticed in the bone marrow, and the diagnosis of the secondary AML was established soon after. Conclusion. The achievement of the deep molecular response in CML patients does not rule out regular cytogenetic testing of their bone marrow. This is of crucial importance for detecting adverse karyotype abnormalities leading to the development of the myelodysplastic syndrome and AML.

Background/Aim. C-shaped canals are a complex morphological variation of the tooth root canal system that, if present, could greatly affect the outcome of endodontic therapy. The prevalence of these canal configurations varies between the populations of different ethnic and geographical origins. Therefore, the goal of this study was to analyze the prevalence and morphology of mandibular second molar C-shaped canals in the population of Central Serbia. Methods. The study included a total of 1 99 mandibular second molars receiving a cone-beam computed tomography (CBCT) examination and determining the presence of C-shaped canal systems, their configuration, minimal wall thickness and its relative position on axial cross-sections at the coronal, middle, and apical level. Results. The prevalence of C-shaped mandibular second molars was 5.53%. C1 canal configuration was the most frequent at the coronal cross-section, while C2 configuration was the most frequent at middle and apical cross-sections. Minimal wall thickness decreased going apically, with the mean value of 1.01 mm at the coronal, 0.87 mm at the middle, and 0 .67 mm at the apical cross-sections. Minimal wall thickness was mostly directed lingually at all cross-sectional levels. Conclusion. C-shaped canals should be expected in mandibular second molars of the population of Central Serbia. CBCT was shown to be the most valuable technique to determine C-shaped canals and facilitate understanding of the C-shaped canal morphology; its implementation could improve the success of endodontic therapy, especially if the complex root canal configuration is present.

Introduction: General medicine is a specific scientific discipline and research is a constituting part of each medical discipline. Objective: We reviewed general physicians` (GPs) attitudes towards scientific research and their reasons for participating or not participating in them. Method: We made a specific questionnaire for the sake of this research. We got the data on age, gender, service periods, place of work (city/country), and specialty: GP or specialist in general medicine, as well as their opinions on research. We forwarded the questionnaire to 550 physicians' email addresses in November 2016. The acquired data were statistically processed using SPSS 20.0 for Windows. Results: The questionnaire was filled out by 233 physicians, of whom 83,3% were women, 67% specialists in general medicine, 68,7% physicians worked in city clinics; the average age of the participants was 46.46±10.29, the average service period 17.85±10.99 years. Out of the total number, 67.8% of the participants thought research was important and useful, even more so by specialists in general medicine, which was statistically significant (p=0.000). There were 71.2% of the physicians who already participated in the research projects, mostly working in the cities (p=0.008), physicians older than 50 (p=0.000), and physicians with service period >20 years (p=0,000). Physicians 30 or younger (p=0.017) and physicians with ≤ 10 years of service (p=0.002) thought research improved work quality. The most frequent reason for not participating in the research projects was lack of time due to a patient and administration overload. The most frequent reason for participating, for physicians with 11-20 and over 20 years of service, was improving work quality (p=0.007). Conclusion: Physicians think research is necessary and useful in general medicine and it improves work quality. The most frequent reason for not participating in the research projects was lack of time due to a patient and administration overload.

Introduction. Acute stroke is the second leading cause of death and the third leading cause of disability in the world. The main goal of the medical treatment is to provide the patient with thrombolytic therapy within 4.5 hours from symptom onset. The majority of patients experience first symptoms outside of health facilities, so the recognition of the symptoms, by the people who are present, is of great importance. Severe strokes, using an ambulance, and younger age coincide with decreased pre-hospital delay. Objective. We aimed to show how long is the pre-hospital delay of the patients with stroke symptoms and how it affects the patient`s treatment. Method. The research is a cross-sectional study of the ER, Belgrade, from 1.1.2015. to 31.12.2018. taking into account patients diagnosed with a stroke, suspected stroke, or TIA. Pre-hospital delay is a time from symptoms onset to the moment of seeing the physician. The patients were divided into three groups according to the delay time: up until 3h, 3-24h, and more than 24h. Statistical data processing was performed in SPSS 11 program, and statistical significance was defined at level p

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Job satisfaction is a complex psychological phenomenon and an extremely important factor of work quality and employees' work motivation. Considering that factors contributing to job (dis)satisfaction also affect work motivation, the level of job satisfaction is used in this psychometric cross-sectional study as an indicator of work motivation among a sample of 71 intensive care units (ICU) nurses in one of universities hospitals in Belgrade, Serbia. The level of job satisfaction was assessed by adapted and customized survey in Serbian language, based on famous Spector's Job Satisfaction Survey (JSS). Analyzing collected data, a high level of job dissatisfaction among participants of our study was founded. Taking into account the high degree of correlation between job satisfaction and work motivation, we concluded that the level of work motivation in the observed sample of ICU nurses was low at the moment of conducting this study, which could point to the existence of serious motivation problems in this field of the nursing profession, even though it is an employee sample from one institution, like in our study.

Introduction: Communication is a process of sending and receiving mes­sages, signals and information, between two or more persons. Objective: To assess knowledge of successful communication skills among general practitioners, and implementation of this knowledge in regular work. Method: The research instrument was the test: 'Communication skills in the general practitioners work' with 50 questions. 124 doctors were tested. Some questions had more than one correct answer, and some questions represented com­munication problems. Results of the test were analyzed with methods of descriptive statistics, using SPSS11.0 for Windows application. Results: Test was considered as successful if correct answers were given for 30 or more questions. Questions with two correct answers were considered correct if only one correct answer was indicated. In average, correct answers were given on 39.75±2.88 questions per test, and 123 doctors passed the test successfully. Answers to questions regarding defining of communication and its principal elements (verbal and Para verbal communication, empathy, active listening, formal and non formal communication), were correct in more than 50 %. In communication problem solving answers were correct in less than 10% of cases. Only one doctor correctly solved problem of communication with unsatisfied patient. Questions regarding non verbal communication were answered correctly in 96% of cases, but in the question regarding communication problem, 71% of doctors couldn't tell the importance of nonverbal communication. Conclusion: Results of the test show that general medicine doctors are skilled in communication, but that additional development is needed.