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Introduction: Primary dysmenorrhea is a common disorder in women, with a significant impact on quality of life. Aim: The objective of this academic study was to investigate the severity of dysmenorrhea in female students of the Faculty of Medicine in Novi Sad, to estimate the self-medication prevalence of primary dysmenorrhea, to identify the most commonly used conventional, herbal, homeopathic remedies and manner of their usage, as well as non-pharmacological measures in the treatment of primary dysmenorrhea. Material and Methods: This study was performed on a random sample of 100 respondents from different departments of the Faculty of Medicine in Novi Sad, from December 1st to December 15th, 2016. The data were obtained by using a standardized questionnaire. Results: The sample included 59 female medical students and 41 female students of the other study groups. Most of the respondents had medium expressed symptoms due to dysmenorrhea (48.0%). The most common symptoms were cramps and pain in the lower abdomen, anxiety, and appetite changes. 11% of respondents were absent from classes at the university minimum one day of each menstrual cycle, because of dysmenorrhea. 66% of respondents used drugs due to symptoms of dysmenorrhea. The most commonly used group of drugs were non-steroid anti-inflammatory drugs (75.76%), primarily ibuprofen (53.03%), and diclofenac (10.61%). Self-medication prevalence was 48.48%. Conclusion: According to the results of this study, dysmenorrhea symptoms significantly impact the quality of life.

This study has been aimed at evaluating knowledge, attitudes and behaviour of university students regarding the usage of antibiotics focusing on differences between medical and nonmedical students. This cross-sectional questionnaire-based study was performed on 800 students of the University of Novi Sad, Serbia. The identified predictors of adequate antibiotic knowledge were enrolled in medical program, higher grade average and appropriate use of antibiotics during last infection. Multivariate regression identified following predictors of self-medication: being medical student (B = 0.715; p

Introduction: Hypertension is a significant risk factor for stroke, myocardial infarction, and heart failure. Maintaining adequate blood pressure helps preventing cardiovascular complications. Aim: The aim of this study was to investigate the knowledge about hypertension and associated factors in controlling high blood pressure among hypertensive outpatients in the municipality of Bačka Topola, Republic of Serbia. Methods: The outpatients who visited their doctors and agreed to fill out an anonymous questionnaire were included in the survey conducted in March 2019 at the Primary Health Care Center of the municipality of Bačka Topola. The questions were related to the sociodemographic characteristics and medication-associated factors of significance for assessment of the outpatients' knowledge about antihypertensive drugs. Results: The mean age of patients was 62.9±10.7 years. Most frequently prescribed antihypertensive drugs were ACE inhibitors (80.8%) followed by beta blockers (46.8%), calcium channel blockers (22.6%) and diuretics (21%), fixed dose antihypertensive drugs were used by 4.8% patients. Majority of adequate knowledge participants had well controlled blood pressure (91.4%), while only 37.1% of average knowledge participants had well controlled blood pressure. The other factors related to poor blood pressure control and lower level of knowledge about hypertension were older age, female gender, lower level of education, less frequent visits to the GP, patients with more than one antihypertensive drug, patients with longer duration of hypertension treatment and patients who were not paying copayment for their antihypertensive drugs. Conclusions: The results of our study indicate that the patients' knowledge about hypertension and associated factors regarding the treatment of hypertension play an important role in maintaining blood pressure at the safe level. Therefore, educational campaigns are the key factors for the quality and satisfactory knowledge about use of antihypertensive drugs and management of hypertension.

Graphical abstract, Resveratrol was recognized as the major factor responsible for the beneficial properties of red wine. Several resveratrol-based dietary supplements are available, but their efficacy has not been sufficiently tested. This study was designed to examine the effect of resveratrol supplementation, using a commercially available product, on the metabolic status of experimental animals with induced hyperlipidemia or type 2 diabetes mellitus (T2DM). Hyperlipidemia was induced by feeding the rats a standard pellet diet supplemented with cholesterol. T2DM was induced by adding 10% fructose to drinking water and streptozotocin. Treatment with resveratrol-based supplement improved glycemic control in diabetic animals and significantly decreased serum low-density-lipoprotein (LDL) and triglyceride levels, concurrently increasing the high-density-lipoprotein (HDL) levels in animals with hyperlipidemia. Resveratrol-treated animals had improved tolerance to glucose loading. Supplementation did not induce alterations in parameters of liver and renal function. Findings indicate that commercial resveratrol supplement improves metabolic control in rats with induced hyperlipidemia and T2DM.

The aim of this study was to determine and describe trends in antibiotics utilization in Serbia over a ten-year period. Data were retrieved from publicly available annual reports (2010–2019). The results were expressed as Defined Daily Dose (DDD) per 1000 inhabitants per day (DID). All calculations were performed using the DDD values for the 2020 Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) version for each year of the study, to account for the DDD changes during the study period. Antibiotics were classified using the WHO Access, Watch, Reserve (AWaRe) classification. Total utilization of antibacterials for systemic use increased from 17.25 DID in 2010 to 28.65 DID in 2019. A statistically significant increasing trend in the use of the Watch category antibiotics was observed. A tendency towards use of broad-spectrum antibiotics, apparent by a statistically significant increase in the rate of utilization of broad-spectrum macrolides, quinolones and third-generation cephalosporins vs. narrow-spectrum ones, as well as a significant increasing trend in the use of quinolones was identified. Total antibiotic utilization was found to be well above the European average. Several specific problem areas were identified, which requires further efforts to improve antibiotic prescribing. The present study provides the information needed to facilitate antibiotic stewardship in Serbia further and proposes specific interventions to optimize antibiotic use in Serbia.

The beneficial medical properties of cannabis in treatment of variety of diseases have been widely recognized across many cultures (Zuardi, 2006, Aggarwal et al., 2009, Birdsall et al., 2016). At the end of the 19th century in Europe, cannabis was considered effective for the treatment of chronic pain, asthma, sleep disorders, depression, and loss of appetite (Guy et al., 2004, Manzanares et al., 2006, Sabo et al., 2013). Medical use of cannabis continued until the first half of the 20th century, when legal restrictions were introduced due to the psychoactive constituent - delta-9-tetrahydrocannabinol (THC), which is one of at least 113 cannabinoids identified in cannabis (Ben Amar, 2006, Horvat et al., 2007). In Serbia, cannabis is classified under narcotic drugs, and the production, sale and possession of cannabis for recreational use or any form of medical marijuana products is illegal (Law on Psychoactive Controlled Substances). Recently, a number of countries in Europe have introduced specific laws and programs to allow patients to use cannabis preparations to effectively relieve the symptoms of chronic pain, muscle cramps and spasticity in patients with multiple sclerosis, to alleviate nausea and vomiting and to improve weight gain and appetite in patients with AIDS (European Monitoring Centre for Drugs and Drug Addiction, 2017). Besides Netherlands, a country with more than 10 years of experience in medical cannabis use, medical cannabis has also been legalized in Italy, Spain, France, Romania and Czech Republic. As for the countries surrounding Serbia, Croatia and Macedonia are the most recent countries which have allowed the use of cannabis in medical purposes (Bifulco and Pisanti, 2015). As more countries in Europe and worldwide continue to change laws for medical marijuana use, public interest in medical cannabis legalization in Serbia is growing. When medical cannabis is legalized in Serbia, doctors will be the ones who will prescribe the products and answer to patients’ questions about its use, benefits and side effects. It is of immense importance to bear in mind specific harmful effects of cannabis, especially in young people. Cannabis is indicated as a possible risk factor for cardiovascular disease in young adults due to increased reporting of cardiovascular complications related to cannabis and their extreme seriousness (Jouanjus et al., 2014). Furthermore, exposure to cannabis during adolescence has been connected to deviations in the normal neurodevelopment, producing a brain particularly at risk of psychiatric disorders such as schizophrenia (Iannitelli et al., 2017, Quartini et al., 2017). Yet, prospective doctors may receive minimal education on this issue throughout the curriculum. A paucity of studies exist evaluating future health care professionals’ knowledge and attitude towards medical cannabis (Sabo et al., 2013, Ben Amar, 2006). In Serbia, one study evaluated beliefs about medical cannabis among fourth-year medical students, while another included only the final year students of pharmacy (Vujcic et al., 2017, Stojanovic et al., 2017). The aim of this study was to determine the frequency of recreational cannabis use among medical students and to explore their knowledge about therapeutic use/abuse, side effects and current legislation status of medical cannabis, as well as attitudes toward its legalization.

© 2020 Edizioni Scientifi che per l'Informazione su Farmaci e Terapia. A surveillance study was performed in an intensive care unit in the largest tertiary health care center in Vojvodina, Serbia from 2014 to 2018. Antibiotic prescription data were collated in the WHO anatomical therapeutic chemical (ATC)/defined daily dose (DDD) format, while antibiotic resistance was expressed as incidence density adjusted for total inpatient-days. Individual trends were determined by linear regression, while possible associations between antibiotic prescription and resistance were evaluated using cross-correlation analysis. An overall decrease in antibiotic utilization was observed. The prescription rates of piperacillin-tazobactam increased significantly, while consumption of 3rd and 4th generation cephalosporins and fluoroquinolones decreased. There were rising incidence densities of doripenem resistant Acinetobacter spp., piperacillin-tazobactam resistant Pseudomonas aeruginosa and carbapenem and colistin resistant Klebsiella pneumoniae. These results can serve as a basis for the development of antimicrobial stewardship strategies in the current setting.

Objective: Considering that adherence level affects diabetes treatment success and maintenance of glycemic control greatly, the aim of this study was to examine diabetes patients’ adherence to oral hypoglycemic agents (OHAs) and knowledge about their mechanism of action, dosing regimen, and side effects. Material and Methods: This cross-sectional study was conducted on a sample of 100 patients with type 2 diabetes in order to assess their knowledge of OHAs using anonymous questionnaires. Results: Most patients had used OHAs between 2 and 5 years (61.0%), where 78.0% were treated with metformin, and the remaining 22.0% were prescribed sulfonylurea derivatives. Besides drugs used for the treatment of type 2 diabetes, 58.0% of patients took another 1-3 drugs daily for the treatment of other conditions. Although 75.0% achieved a score of 5-6 out of the maximum score of 8, only 2.0% of respondents listed at least 2 side effects of the OHA they used, and none of them could explain its mechanism of action. Most of the information about OHAs was given to patients by endocrinologists (53.0%). Conclusion: More than half of participants considered their knowledge of OHAs insufficient. Results clearly indicate that the respondents were not sufficiently familiar with the mechanism of action and possible side effects of such medications. Information about OHAs given in written form as well as via community pharmacists would contribute to educating type 2 diabetes patients significantly.

An ongoing issue of expired medications accumulating in some households is a universal problem around the world. The aim of the study was to investigate the extent and structure of expired medications in Serbian households, and to determine which therapeutic groups generated the most waste.This was an observational, cross-sectional study conducted in households in the city of Novi Sad, Serbia. The study had been performed over 8 month period (December 2011 - July 2012) and it consisted of personal insights into the medication inventory in households.Of 1008 families, 383 agreed to participate and complete the questionnaire (38.3% response rate). In almost a half of households (44.4%), expired medications were maintained. The amount of expired medications was 402 items, corresponding to 9.2% of total medications presented in surveyed households. The majority of expired medications (64.7%) was in solid dosage (tablets, capsules, granules, lozenges), following semisolid (ointments, creams, gel, suppositories) and liquid dosage forms (drops, syrups). Expired medications in the households belonged mostly to 3 categories: antimicrobials for systemic use (16.7%), dermatological preparation (15.9%) and medications for alimentary tract and metabolism (14.2%).This study revealed that there were relatively large quantities of expired medications in Serbian households, with a high prevalence of antibiotics for systemic use, anti-inflammatory and antirheumatic products, and medications for alimentary tract and metabolism.Težava s kopičenjem zdravil s pretečenim rokom trajanja v gospodinjstvih je velik problem po vsem svetu. Cilj te študije je bil raziskati obseg in sestavo zdravil s pretečenim rokom trajanja v srbskih gospodinjstvih in določiti, katere terapevtske vrste zdravil predstavljajo največji odpad.Opazovalna, presečna raziskava je bila izvedena v srbskih gospodinjstvih v Novem Sadu. Trajala je osem mesecev (od decembra 2011 do julija 2012). Sestavljena je bila iz osebnega vpogleda v zalogo zdravil v gospodinjstvih.Od 1008 družin se jih je 383 odločilo za sodelovanje in izpolnilo vprašalnik (38,3-odstotna odzivnost). V skoraj polovici gospodinjstev (44%) so imeli zdravila s pretečenim rokom trajanja. Skupno sta bili najdeni 402 zdravili s pretečenim rokom trajanja, kar predstavlja 9,2% vseh zdravil v anketiranih gospodinjstvih. Večina zdravil s pretečenim rokom trajanja (64,7%) je bila v trdi obliki (tablete, kapsule, granule, lozenge), sledila so zdravila v poltrdni obliki (masti, kreme, geli, suspenzije) in tekočine (kapljice, sirupi). Večina zdravil s pretečenim rokom trajanja v gospodinjstvih pripada eni od naslednjih treh skupin: antimikrobna zdravila za sistemsko rabo (16,7%), dermatološki preparati (15,9%) in zdravila za bolezni prebavil in presnove (14,2%).Raziskava je pokazala, da je v srbskih gospodinjstvih shranjenih relativno veliko zdravil s pretečenim rokom trajanja. Najpogosteje se pojavljajo antibiotiki za sistemsko uporabo, protivnetni in antirevmatski pripravki ter zdravila za bolezni prebavil in presnove.

Background/Aim. Hypertension is one of the leading causes of cardiovascular morbidity and mortality and more than a half of all health insurance expenditures for reimbursed medicines are allocated to antihypertensive drugs in Serbia. The aim of this study was to identify the antihypertensive drug utilization patterns among hypertensive outpatients in the city of Novi Sad, Serbia, determine the adherence to clinical guidelines and address the economic aspects of current prescribing practices. Methods. This retrospective observational study was conducted in Novi Sad over a period of six months. The data on the number of packages, size of packages, and retail price of antihypertensives issued on prescription in outpatients with the diagnosis of essential arterial hypertension was collected from all state-owned pharmacies in Novi Sad. Drug consumption was analyzed using the Anatomical Therapeutic Chemical (ATC)/defined daily dose (DDD) methodology. Results. Total consumption of antihypertensives issued on prescription over 6 month period in the city of Novi sad, Serbia was 283,48 DDD per 1,000 inhabitans per day (DID). Angiotensin converting enzyme inhibitors (ACEi) were most commonly prescribed drugs, and were used 3 times more often than calcium channel blockers and 5 times more than betablockers. The consumption of diuretics and angiotensin receptor antagonists was low within all groups of outpatients. Both national and international guidelines state superiority and effectiveness of diuretics in treatment of hypertension in the elderly, but their consumption was unreasonable low despite the fact that over 70% of all antihypertensive drugs in the city of Novi Sad were dispensed in people aged > 60. The use of more expensive ACEi was observed, despite the guidelines deeming all the drugs of these class equally effective in treatment of hypertension. Conclusion. Large differences in utilization of different groups of antihypertensive agents were noted in this study. Underutilization of valuable, efficacious, and cost-effective thiazide diuretics and over use of expensive ACE inhibitors is unjustifiable. There is a potential for large savings with switching to low-price ACEi, modeling the practice of Scandinavian countries. [Projekat Ministarstva nauke Republike Srbije, br. III 41012]

Background Worldwide data indicate that self-medication is frequently used inappropriately. Although self-medication is encouraged in most of the countries by introducing over-the-counter drugs, it bears the risk of misuse of drugs issued on prescription due to low observance of legislation of medicines requiring prescription by some pharmacies. Objective The objective of this study was to explore the self-medication practice, with an emphasis on self-medication with prescription-only medications. Setting Households in Novi Sad city, Serbia. Method The study was conducted over 8 month period (December 2011–July 2012) and involved a random sample of households. The questionnaire-based study and personal insight into household drug supplies was performed by a trained interviewer. Main outcome measure Number of drugs obtained without prescription or without consulting a physician in surveyed households. Results The total number of drug items present in the 383 households was 4,384 with a median of 11 drugs per household. More than a half of drugs in households were prescription-only medication (58.5 %). Approximately one third of prescription-only medications were obtained without prescription. The most common drugs obtained without prescription were anti-inflammatory and antirheumatic products and antibacterials for systemic use. Ibuprofen and diclofenac were the most common self-medicated drugs. Number of prescription-only medications bought with ought prescription was significantly higher in households with children under 12 years of age compared to other types of households. Conclusion Our survey indicated that self-medication with prescription drugs appeared to be a rather common practice, which is far away from the concept of “responsible self-medication”, especially regarding antibiotics.

Aims The aims of this study were to assess patients’ non-adherence and associated factors to antidiabetic medication in the primary care setting in the eastern part of Bosnia and Herzegovina (BiH). Methods We conducted a retrospective chart review of 323 patients with type 2 diabetes mellitus (T2DM) attending the primary health care center of the Foca municipality in eastern part of BiH and measured adherence to antidiabetic medication. Adherence was measured using a pill count method. Results The majority of patients were treated with oral therapy (84.21%). Half of the patients (48%) treated pharmacologically were non-adherent and patients on oral and insulin combination therapy showed better adherence than those on oral therapy. Age (B = −0.749; p = 0.004), copayment (B = 0.549; p = 0.028) and oral therapy (B = 0.827; p = 0.045) were the strongest predictors of poor adherence. Conclusion About half of the patients were non-adherent to antidiabetic medication. Interventions oriented towards policy changes regarding availability of antidiabetic medication through copayment reductions, and providing healt education to younger population and patients on oral therapy could lead to better adherence among T2DM patients in eastern part of BiH.

Introduction: With the growing trend for legalization of cannabis and its derivatives in Serbia, pharmacists are likely to be consulted on the safety, efficacy, and drug-drug or drug-disease interactions of medical cannabis. Thus, the aim of our study was to assess pharmacy students’ knowledge and attitude toward medical cannabis use in Serbia to determine if additional education is needed. Subjects and methods: In the study students from the final year of the study program of integrated academic studies of pharmacy at the Faculty of Medicine, University of Novi Sad were asked to complete an anonymous questionnaire regarding their knowledge and attitudes on the use of cannabis and its derivatives in medical purposes. After giving their written informed consent, they were instructed by the researchers on how to complete the questionnaire. All questionnaires were administered between August 1, 2017 and August 15, 2017. The study was approved by the Ethical Committee of the Faculty of Medicine in Novi Sad; a total of 80 questionnaires were distributed. The questionnaire consisted of 3 groups of statements on which they should mark level of their agreement related to students’ knowledge about the use of cannabis and its derivatives in therapeutical purposes, potential negative effects, dispensing in a pharmacy and legalization of cannabis and its derivatives in medical purposes. Results: Although 91.2% of the respondents agreed that cannabis and its derivatives could potentially have therapeutical effects, much lower percentage of respondents (51.3%) were familiar with possible therapeutical effects of cannabis. The same percentage of respondents learned about therapeutical effects of cannabis from sources other than school. About third (31.3%) of our respondents thought that the use of cannabis and its derivatives in therapeutical purposes could cause their abuse and the similar percentage of respondents (33.8%) thought that issuing cannabis and its derivatives in the pharmacy could expose a pharmacist to the certain dangers such as insisting on the issuing without the prescription or robbery. About 90% of the respondents agreed it is necessary to create clear guidelines for the use of cannabis and its derivatives in therapeutical purposes and 76.3% of the respondents thought that doctor’s prescription is necessary for their dispensing in a pharmacy. Most of the respondents (75%) agreed that, based on the experiences of the countries which have approved the use of cannabis and its derivatives in therapeutical purposes, its use in those purposes should be approved in Serbia. Conclusion: The majority of pharmacy students supported medical cannabis legalization but only with strict legal regulations and clear guidelines for their use implemented. Further education of the pharmacist about therapeutical effect of cannabis is necessary.

Introduction The objective of this study was to investigate the knowledge, attitudes and behavior regarding antibiotics of the general population. Methods The study sample consisted of adult subjects who consulted general practitioners at health centers in Serbia and agreed to complete the questionnaire. A total of 668 questionnaires were distributed; 500 respondents completed the entire questionnaire (response rate 74.85%). Results The average age was 51.65 ± 16.56 years, 60.80% of the respondents were women. The median antibiotic knowledge score was 9. Predictors of adequate antibiotic knowledge were higher education level and a family member whose ocuppation was related to health-care. Overall, 58.4% of respondents believed that antibiotics could be used to treat common cold. Around a half of the respondents (47.2%) self-medicated with antibiotics at least once during their life-time, and around a quarter (24.2%) during the last treatment of infection. Patients with inadequate knowledge had 3 times higher chances of self-medicating with antibiotics compared to those with adequate knowledge. Although 98.20% of respondents claimed that antibiotic treatment should be started after a visit to a doctor and receiving a prescription, only 65.8% obtained antibiotics with prescription from a doctor during the last infection. Conclusions Although these results demonstrate that respondents had a relatively adequate level of knowledge regarding antibiotics use, some areas of misconceptions and improper behavior were identified. Therefore, further rationalization should be focused on educational campaigns targeting the behavior of patients with regard to antibiotic use.