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Prostate cancer (Pca) is among the most common malignant diseases in men and the fourth leading cause of death worldwide. Surgery and radical radiotherapy (RT) remain the gold standard for the treatment of localized or locally advanced prostate cancer. The efficiency of radiotherapy treatment is limited by toxic side effects due to dose escalation. Cancer cells often develop radio-resistant mechanisms that are related to the DNA repair, inhibition of apoptosis or changes in cell cycle. Based on our earlier research on biomarkers that are involved in those cellular mechanisms (p53, bcl-2, NF-kb, Cripto-1 and Ki67 proliferation) and correlation with clinico-pathological parameters (age, PSA value, Gleason score, grade group, prognostic group), we created the numerical index for risk of tumor progression in patients with radioresistant tumors. For each of these parameters, the strength of association with disease progression was statistically assessed, and a specific number of points was assigned proportional to the strength of the correlation. Statistical analysis identified an optimal cut-off score of 22 or more as an indicator of significant risk for progression with a sensitivity of 91.7% and a specificity of 66.7%. The scoring system in the retrospective receiver operating characteristic analysis showed AUC of 0.82. The potential value of this scoring is the possibility of identifying patients with clinically significant radioresistant Pca.

Background: Neurons are highly energy-dependent and highly specialized cells, showing great sensitivity to oxidative stress (OS). This study aimed to contribute to the further elucidation of the role of OS in the pathogenesis of amyotrophic lateral sclerosis (ALS). Matherial and methods: We assessed nitric oxide () and superoxide dismutase (SOD) levels in cerebrospinal fluid (CSF) of 24 sporadic ALS (sALS) patients (13 of them presented with spinal form while 11 patients had bulbar form) and 20 controls (CG).Results: The obtained SOD levels in sALS patients were lower than those in CG (p 0.05). There were significant negative correlations between SOD and NO levels in all sALS patients (r = 0.31, p=0.025). Significant correlation between SOD and functional rating scale as well as disease progression index were recorded in patients with sALS (r=0,618 r= 0.425 p < 0.01), while NO levels were significantly associated with disease progression only (r=0.348 p < 0.01). Conclusion: The data presented here clearly support the role of impaired oxidant/antioxidant balance in the pathogenesis of ALS. The CSF SOD and NO level might serve as a useful biomarker for functional disorder and progression of the disease, but these facts need to be reevaluated in future research which should be performed on a large cohort of ALS patients

Introduction/Objective. Serbia has been burdened with one of the highest cervical cancer incidence and mortality rates in Europe. The objective of the study was to estimate the prevalence and factors associated with compliance to cervical cancer screening among women in the general population. Methods. The study used the data from 2013 National Health Survey of the population of Serbia. Logistic regression analysis was further used to examine demographic and socio-economic factors which affect the disparities in cervical cancer screening practices among the female population. Results. Every third woman (35.4%) has never done a Pap test in her lifetime. The highest percentage of respondents did their Pap tests after they were recommended by doctors (52.3%); 45% of women did it on their own initiative, and only 2.7% did it after they had been summoned to participate in an organized screening by their doctor. The multivariate logistic regression analysis revealed that the most important factors in women who had never undergone Pap tests were the following: age (being within the youngest or the oldest age group), rural residence and low level of education, poor socio-economic status, and marital status (have never married). Conclusion. Further strategies and interventions for improving cervical cancer incidence and mortality rates should be focused on socially and economically endangered population groups in order to reduce disparities in cervical cancer screening more effectively.

Guillain-Barre syndrome (GBS) is an acute disease of the peripheral nerves and their roots. Quality of life (QoL) in the first year after acute episode of GBS is still underresearched area. The aim of our study was to investigate QoL in GBS patients during a 6-month follow-up period.Multicentric, prospective study included 74 adult patients with GBS (54% males). GBS disability scale (GDS) was used to assess functional disability (severe disability GDS 2), and Individualized Neuromuscular Quality of Life Questionnaire (INQoL) to asses QoL. Patients were tested on day 14, day 28, month 3, and month 6 from symptom onset.Disability as measured by GDS improved during time (P .01). INQoL scores also improved during time (P .01) but were not able to differentiate between day 14 and day 28, and some scores also did not make difference between month 3 and 6 (pain, social relations, emotions and total INQoL score; P .05). Pooled GDS scores correlated with pooled INQoL scores, especially with independence, activities, and weakness subscores (P .01). Multiple linear regression analysis showed that GDS at day 14 (β = .52, P .01) and fatigue score at day 14 (β = .41, P .01) were independent predictors of the worse GDS at month 6 (adjusted RDuring a 6-month follow-up period of GBS patients, we observed a gradual recovery of patients' disability and QoL. Our study confirms the importance of patient-reported outcomes and their ability to capture some important issues that are omitted by classic ability measures such as GDS.

The aim of the work is to assess vulnerability degree of reproductive health in adolescent population in Serbia by analyzing their sexual behavior. The paper is based on data from a National health survey of the population in Serbia in 2013 (without Kosovo and Metohija region), conducted by the Ministry of Health of the Republic of Serbia. For the purposes of this study, the data used are referred to households and population of age 15 and over, so that the final number for analysis is a sample of 1722 respondents aged 15-24. The study included demographic characteristics of respondents (age, gender, settlement type, region) and the characteristics of reproductive health: sexual behavior, use of contraceptive protection, knowledge and attitudes towards HIV, protection of reproductive health. χ2 test was applied for testing differences in frequency of categorical variables. All results with a probability that equals to or is less than 5% (p≤0.05) are considered statistically significant. Among the respondents, there were more than half (53.5%) of sexually active adolescents. The highest percentage of them- 16.6% responded that they had first sexual intercourse at the age of 17. 53.4% of adolescents had sexual intercourse with one partner, 26.4% of respondents had sexual intercourse with two or more partners. The most commonly used contraceptive method was interrupted intercourse (coitus interruptus) with 34.7% of respondents.

Objectives: The coronavirus disease 2019 (COVID-19) is the largest pandemic of our times. We wanted to investigate the impact of COVID-19 pandemic on the psychological status, quality of life (QoL) and quality of sleep (QoS) of myasthenia gravis (MG) patients. Methods: Data on the epidemiological and clinical characteristics of MG were collected. We used a self-designed questionnaire (consisting of 12 questions), a revised 15-item Myasthenia Gravis Quality of Life Questionnaire (MGQOL15r), a 36-item health survey of the Medical Outcomes Study Short Form (SF36), Pittsburgh sleep quality index (PSQI), Hamilton scales for the assessment of anxiety (HAM-A), and depression (HAMD) were used. We reassessed patients who were tested three years ago using the same questionnaires. Results: The study included 64 MG patients. We noticed a statistically significant difference between the results obtained three years ago and the results from April 2020 in PSQI scores (P < 0.01). MGQOL15r, SF36, and PSQI scores correlate with severe clinical manifestation, high scores on HAM-A and HAM-D (P < 0.01). Higher scores on HAM-D and fear that MG symptoms will be worse if the patient gets an upper respiratory infection were independent predictors of the lower SF36 scores. Regarding MGQOL15r-independent predictors of the higher score were higher scores on HAM-D. Conclusions: There is a significant impact of the COVID-19 epidemic on the psychological status and especially on the quality of sleep of MG patients. Healthcare organizations need to provide professional therapeutic advice and psychosocial support for this population of patients during the pandemic.

Guillain-Barre syndrome (GBS) is an acute auto-immune polyradiculoneuropathy. A huge variety of GBS incidence and mortality rates has been noted across the world. The objective of the present multi-centric study was to assess the incidence and mortality rates of GBS during a 10-year period in Serbia. We collected data of adult GBS patients who were hospitalized from 2009 to 2018 in all five tertiary healthcare centers in Serbia. The incidence rates per 100 000 inhabitants with 95% confidence intervals (CI) were calculated and further corrected for the estimated number of patients hospitalized in secondary centers. Mortality rates were also assessed. GBS was considered severe if patients were not able to walk at least 10 m without assistance. Six hundred and forty GBS patients were registered in tertiary centers in a 10-year period. The proportion of severe cases was 75% at nadir, and 52% on discharge. GBS incidence rate in Serbia was 1.1 per 100 000 inhabitants, and estimated incidence if patients from secondary centers included 1.2 per 100 000. Peak incidence was observed during the sixth decade of life. During the acute phase, 5.6% of GBS patients died, while overall 9.7% of them died during 6-month period from disease onset. This study contributes to our knowledge about GBS epidemiology. Results will allow us to improve the diagnosis and treatment of GBS patients in Serbia.

There is a lot of evidence pertaining to the ethiopathogenetic importance of oxidative stress in a number of autoimmune diseases, including some immune-mediated neurological diseases such as multiple sclerosis. However, the role of oxidative stress and oxidative status in patients with myasthenia gravis is still an under-researched area. The aim of our research was to compare serum total and direct bilirubin, albumin, total proteins and creatinine levels in myasthenia gravis (MG) patients with healthy controls, and patients with multiple sclerosis (MS). The subjects were divided into three groups (92 MG patients, 68 healthy controls and 74 MS patients). All MG patients were newly diagnosed, classified with MGFA Clinical Classification, and divided into two groups regarding onset age (early < 50 years, late ≥50 years), sex (male, female), thymus pathology (present, absent). Serum antioxidant status was significantly lower in MG and MS group compared to the healthy controls (p < 0.05). There was no significant difference in serum antioxidant status between patients with MG and those with MS. Regarding MGFA Classification we have not found any correlation with serum levels of measured parameters. Our findings suggested that there was a potential role of oxidative process in MG pathology. Among the analyzed parameters, direct bilirubin showed significantly lower value in women, the elderly and in the group of MG patients with pathologically altered thymus gland.

It has been previously shown that patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) who are unemployed or retired have worse quality of life. The aim of this study was to assess predictors of early retirement in CIDP. One hundred five patients with CIDP were included. Following measures were used: questionnaire on employment status, Medical Research Council Sum Score, INCAT disability score, Beck Depression Inventory, and Krupp's Fatigue Severity Scale. At the moment of testing, 2% of patients were students, 15% were employed, 9% were unemployed due to CIDP, 9% were unemployed but not due to CIDP, 28% were retired early due to disability caused by CIDP, and finally 37% were in old-age pension. Mean age when patients retired due to CIDP was 50 ± 8 years. Mean time from CIDP onset to retirement was 2.7 ± 2.3 years. Older age at onset, lower education, and more severe weakness at the time of diagnosis were significant predictors of early retirement due to CIDP. Retired patients were 12 times more likely to suffer from depression, compared to employed patients (OR = 12.2, 95% CI = 1.41-100, P < 0.01), and eight times more likely to have fatigue (OR = 8.2, 95% CI = 1.89-35.82, P < 0.01). Older patients with lower education and more severe weakness at the time of diagnosis were most likely retired due to CIDP. Early retirement was associated with depression and fatigue. Therefore, maintaining employment should be an important aim in the management of CIDP patients.

A majority of patients with Guillain-Barre syndrome (GBS) have tendency of a good recovery. Our aim was to evaluate the outcome of the disease 1 and 3 years after GBS symptom onset. METHODS During 2014, GBS was diagnosed in 82 patients in seven tertiary healthcare centers. Neurological follow-up was conducted in 57 (70%) patients after 1 year, and in 54 (66%) after 3 years. Functional disability was estimated according to the GBS disability scale (GDS), with a score of 0-3 indicating mild disability and a score of 4-6 indicating severe disability during acute phase, whereas a score >1 indicated poor recovery on follow-ups. Visual analog scale was used to assess sensory symptoms and musculoskelatal pain, and Krupp's Fatigue Severity Scale was used to asses fatigue. RESULTS Poor functional outcome was found in 39% of GBS patients at year 1 and 30% at year 3. Paresthesias/dysesthesias were detected in 60% of patients after 1 year and 43% after 3 years. Musculoskeletal pain was present in 40% of patients at year 1 and 33% at year 3. Significant fatigue after 1 year was found in 21% of subjects and after 3 years in 7%. Parameters associated with poor functional outcome after 1 year were age >55 years (p=0.05), severe disability at admission (p1 indique une recuperation difficile au moment des suivis. L'echelle visuelle analogue (EVA) a aussi ete utilisee pour evaluer leurs symptomes sensoriels et leurs douleurs musculo-squelettiques. Enfin, l'echelle de gravite de la fatigue de Krupp a ete utilisee pour evaluer leur degre de fatigue. Resultats: La premiere annee, on a observe une pietre amelioration des capacites fonctionnelles chez 39% des patients atteints du SGB; pour la troisieme annee, cette proportion etait de 30%. Au bout d'un an, on a aussi detecte la presence de paresthesie/dysesthesie chez 60% des patients; pour la troisieme annee, cette proportion etait de 43%. Des douleurs musculo-squelettiques ont ete rapportees chez 40% des patients apres un an; deux ans plus tard, ce pourcentage chutait a 33%. Enfin, un etat de fatigue important a ete note chez 21% des patients au bout d'un an; ce pourcentage n'etait plus que de 7% au bout de trois ans. Les parametres associes a une pietre amelioration des capacites fonctionnelles au bout d'un an etaient l'âge (>55 ans; p=0,05) ainsi qu'une incapacite severe au moment de leur admission (p

Amyotrophic lateral sclerosis (ALS) is recognized as a progressive neurodegenerative disorder of unknown origin. Oxidative stress (OS) is considered as one of the most challenging hypothesis in the disease pathogenesis. The aim of this study was to contribute to the understanding of what extent there is involvement of OS in ALS.We assessed Advanced Oxidation Protein Products (AOPP) and total thiol (-SH) groups in cerebrospinal fluid (CSF) of 24 ALS patients (13 of them presented with spinal form while 11 patients had bulbar form) and 20 controls (CG).The obtained AOPP levels in ALS patients were higher than those in CG (p0.001), while -SH groups showed lower values compared to CG (p0.001). The AOPP values were higher in ALS patients with bulbar compared with ALS patients with common spinal manifestation (p0.001). There were no differences in -SH group's levels among these different clinical forms (p0.05). The negative correlation between AOPP and the levels of -SH groups was confirmed (p0.01). Significant mild correlations between tested parameters and functional rating scale as well as disease progression index were recorded for both of tested parameters in spinal form of ALS (p0.01).The data presented here clearly support the fact that OS is involved in patophysiology of ALS, where oxidation of -SH groups represents an important aspect of protein oxidation. The CSF AOPP level and -SH groups may serve as potential useful biomarker for functional disorder and progression of the disease in the spinal form of ALS.

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a chronic disease which can lead to many functional impairments, and like most other chronic disorders it might significantly affect quality of life (QoL). Information about QoL in patients with CIDP from developing countries is still lacking. We, therefore, sought to complete these data mosaic by investigating QoL in patients with CIDP from Serbia and surrounding countries. Our study comprised 106 patients diagnosed with CIDP. QoL was investigated using the Serbian version of the SF-36 questionnaire. The Medical Research Council 0-5 point scale, INCAT motor and sensory scores, Krupp's Fatigue Severity Scale, and Beck Depression Inventory were also used. Factors that significantly correlated with SF-36 total score in univariate analysis were included in the multiple linear regression analysis. Physical domains of the SF-36 were more affected than mental, and the overall score was 56.6 ± 25.4. Significant predictors of worse SF-36 score in our patients with CIDP were severe fatigue (β = - 0.331, p

OBJECTIVES: At a time of global health crisis, fear, anxiety, and stress levels increase. The effects of protracted social isolation, and media related misinformation's about the coronavirus disease 2019 (COVID-19) resulting in increased fear/stress related to the insufficiently known illness. The aim was to assess the influence of the COVID-19 health crisis on patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). METHODS: A cross-sectional study on 29 adult CIDP patients was performed. The Medical Research Council scale was used to evaluate muscle strength. The degree of functional disability was measured using the Inflammatory Neuropathy Cause and Treatment disability scale. The overall quality of life (QoL) was self-estimated on a 0-100 numeric rating scale. We also used a specifically designed 22-question-survey about COVID-19. RESULTS: Regarding the COVID-19 pandemic, 62% of CIDP patients were concerned. The daily activities of 55% of patients were negatively influenced by the pandemic. During the COVID-19 outbreak, 21% of patients reported their CIDP got worse. In 39% of CIDP patients, the influence of the pandemic on CIDP therapy was reported (reducing the dose or time interval or even discontinuation). The mean value of the self-estimated QoL was 64 ± 19. Independent predictors of worse QoL were age of patients (beta = -0.35, p

Diabetic polyneuropathy (DN) is the most frequent neurological complication in diabetes mellitus (DM) patients. This study examines dyslipidemia and levels of lipid peroxidation in the plasma and erythrocytes of patients with type 2 DM in relation to the presence or absence of DN, and analyzes the possible impact of gender in the course of DN. There were no statistically significant differences between genders in the clinical or electrophysiological findings of DN (p > 0.05). The lipid parameters approached higher values in all DM patients in comparison to the control subjects (p 0.05). The obtained TBARS values in plasma and erythrocytes were higher in DM patients than in the control subjects. TBARS values in all study patients with DN (women and men) approached higher values than in the patients without DN (p > 0.05), but the only significant difference was found in the erythrocytes in women with DN compared to those without DN (p < 0.05). Based upon the data presented here, the lipid peroxidation in the cell and disturbed lipid profile that we observed in patients with type 2 DM and DN are more pronounced in women than in men. This suggests that women have a relatively higher risk for DN than men.

Matrix metalloproteinases (MMPs) are proteolytic enzymes that are involved in a variety of physiological and pathological processes, including those in CNS. In this study, plasma values of MMP-3 and MMP-9 have been compared in clinically isolated syndrome (CIS) and relapsing-remitting multiple sclerosis (RRMS) patients during their acute attacks, in relation to the biological activity of disease. Therefore, we compared the MMPs plasma values regarding Expanded Disability Status Scale (EDSS), progression index of disease (PID), acute brain lesion volume seen on magnetic resonance imaging (MRI) and index of blood-brain barrier (BBB) permeability destruction. The obtained results demonstrated higher plasma values of MMPs in both study groups than control values (p 0.05). No statistical significances have been detected comparing the obtained values of both enzymes between CIS and RRMS group (p 0.05). In both CIS and RRMS groups, the patients with higher EDSS showed higher MMPs plasma values (p 0.05). The MMPs values were also significantly higher in both study patients with higher total number comparing to those with lower number of MRI brain lesion (p 0.05) (beyond MMP-3 in RRMS). All obtained correlations, between MMPs and EDSS, PID, volume of MRI Gd-enhancement brain lesions, and index of BBB permeability, were positive (p 0.05.) This study demonstrates alterations of both tested MMPs with closed correlation with the disease biological activity. Although MMPs are being implicated in the pathogenesis of acute neuroinflammation, the MMPs modulation might be useful in the future design of disease modifying therapy with the specific target profile.

Introduction. Extrapulmonary small cell carcinoma is a rare, prognostically bad tumor category. Primary, it can be localized in every organ, even in the ovary, where, due to its clinical specificities, it represents a challenge in diagnosis, as well as in therapy. Small cell ovarian carcinoma (SCOC) is biologically very aggressive malignant tumor of unknown histogenesis. We presented a rare case of SCOC with hypercalcemia of aggressive course and fatal outcome in a postmenopausal woman at International Federation of Gynecology and Obstetrics (FIGO) Ia stage. Case report. A 60-year-old woman, Caucasian, came to the doctor because of discomfort in the lower abdomen and pain of greater intensity in last few days. Ultrasound examination and CT scan of the abdomen confirmed the presence of large adnexal masses of cystic-solid appearance with the largest diameter of 13 cm, regular structure of the other gynecological organs, without verifying the existence of metastatic deposits. All the results of laboratory analysis gave normal values, except for calcium, which was elevated. Explorative laparotomy with complete hysterectomy, bilateral salpingo-oophorectomy, dissection of lymph nodes and omentectomy were conducted. Based on pathohistological analysis of the operative material, SCOC at FIGO Ia stage was diagnosed. No complications were observed in a postsurgery period and after 10 days the patient was discharged in a good condition and with normal calcemia. The treatment was continued with concurrent radiotherapy and chemotherapy. However, in spite of overall treatment, the disease progressed, and the patient died of disseminated metastatic disease, 26 months after the diagnosis. Conclusion. Small cell carcinoma localized in the ovary is generally a tumor category with bad prognosis depending on the stage of the disease.

To date, generic questionnaires have been used to investigate quality of life (QoL) in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients. Although these measures are very useful, they are not usually precise enough to measure all specific characteristics of the disease. Our aim was to investigate QoL using the neuromuscular disease-specific questionnaire (individualized neuromuscular quality of life, INQoL) in a large cohort of patients with CIDP. Our study comprised 106 patients diagnosed with CIDP. INQoL questionnaire, Medical Research Council (MRC) sum score, Inflammatory Neuropathy Cause and Treatment (INCAT) disability score, Visual Analogue Pain Scale, Beck Depression Inventory, and Krupp's Fatigue Severity Scale were used in our study. Physical domains of INQoL were more affected than mental, and the overall score was 57 ± 25. Significant predictors of higher INQoL score in our patients with CIDP were severe fatigue (β = 0.35, p

The aim of this study was to define features of Guillain-Barre syndrome in a large cohort of patients from three Western Balkans countries. Data from adult Guillain-Barre syndrome (GBS) cases from 2009 to 2013 were retrospectively obtained from all tertiary health care centers. During the 5-year period, 327 new cases of GBS were identified with a male to female ratio of 1.7 : 1. The most common GBS variants were demyelinating (65%) and axonal (12%). At nadir 45% of patients were chair-bound, confined to bed, or required assisted ventilation, while 5% died. The crude incidence of GBS in Serbia and Montenegro was 0.93 per 100,000 population, and age-adjusted incidence according to the world standard population was 0.86 per 100,000. Incidence was particularly high in 50- to 80-year-old men. Statistically significant seasonal variations of GBS were not observed. This study of patients with GBS in the Western Balkans allows us to prepare the health system better and to improve the management of patients. This study also opens opportunities for international collaboration and for taking part in the multinational studies on GBS.

Background Micro and macrovascular disease is the most frequent cause of morbidity and mortality of the patients with diabetes mellitus. The resent investigations have pointed out the relationship between endothelial dysfunction and the progression of these diabetic complications, suggesting the crucial role of nitric oxide, vasodilator molecule of endothelial origin, in these events, including diabetic symmetric polyneuropathy. Material and methods The present study encompassed 100 individuals with diabetes mellitus type II and diabetic distal symmetric polyneuropathy (DSP). Nitrate + nitrite concentration, 3-nitrotyrosine, S-nitrosothiols, ADMA and SDMA levels and arginase activity were determined compared to the control group consisted of 50 age and sex matched voluntary blood donors. Results NO 2 + NO 3 concentrations, as well as 3-nitrotyrosine, S-nitrosothiol, ADMA and SDMA levels were significantly higher in patients with DSP compared to the control group. Plasma arginase activity in the patients with diabetic DSP was significantly lower compared to the values in plasma of control subjects. Conclusion The obtained results confirmed that nitrate + nitrite, 3-nitrotyrosine, S-nitrosothiols, ADMA, SDMA and arginase activity determination in plasma of patients with diabetic DSP could be useful in monitoring the disease development and in assesing the therapy effects.

Adult mouse LSK cells unable to undergo autophagy contain fewer HSCs, accumulate mitochondria, and fail to reconstitute lethally irradiated mice., The role of autophagy, a lysosomal degradation pathway which prevents cellular damage, in the maintenance of adult mouse hematopoietic stem cells (HSCs) remains unknown. Although normal HSCs sustain life-long hematopoiesis, malignant transformation of HSCs leads to leukemia. Therefore, mechanisms protecting HSCs from cellular damage are essential to prevent hematopoietic malignancies. In this study, we crippled autophagy in HSCs by conditionally deleting the essential autophagy gene Atg7 in the hematopoietic system. This resulted in the loss of normal HSC functions, a severe myeloproliferation, and death of the mice within weeks. The hematopoietic stem and progenitor cell compartment displayed an accumulation of mitochondria and reactive oxygen species, as well as increased proliferation and DNA damage. HSCs within the Lin−Sca-1+c-Kit+ (LSK) compartment were significantly reduced. Although the overall LSK compartment was expanded, Atg7-deficient LSK cells failed to reconstitute the hematopoietic system of lethally irradiated mice. Consistent with loss of HSC functions, the production of both lymphoid and myeloid progenitors was impaired in the absence of Atg7. Collectively, these data show that Atg7 is an essential regulator of adult HSC maintenance.

Recurrent Guillain-Barre syndrome (RGBS) episodes appear in up to 6% of Guillain-Barre syndrome (GBS) patients. The purpose of this study was to identify patients with previous episodes of GBS and to assess their clinical features in a large cohort of adult GBS patients. GBS patients hospitalized at tertiary centers in three Balkan countries were included in the study (n = 404). We identified 13 (3.2%) patients with recurrent GBS (RGBS). The male to female ratio was 3: 1. All RGBS patients had two episodes of the disease. The most common GBS subtype in both episodes of the disease was acute inflammatory demyelinating polyradiculoneuropathy (AIDP) (77%, first episode; 85%, second episode). Around 23% of patients presented with a different variant during the second GBS attack. Disability seems to be equally severe at both episodes (P > 0.05). Recurrent GBS was registered in 3% of our GBS patients. The majority of them were younger males. Different GBS subtypes were found to recur.

Loss of kidney function underlies many renal diseases. Mammals can partly repair their nephrons (the functional units of the kidney), but cannot form new ones. By contrast, fish add nephrons throughout their lifespan and regenerate nephrons de novo after injury, providing a model for understanding how mammalian renal regeneration may be therapeutically activated. Here we trace the source of new nephrons in the adult zebrafish to small cellular aggregates containing nephron progenitors. Transplantation of single aggregates comprising 10-30 cells is sufficient to engraft adults and generate multiple nephrons. Serial transplantation experiments to test self-renewal revealed that nephron progenitors are long-lived and possess significant replicative potential, consistent with stem-cell activity. Transplantation of mixed nephron progenitors tagged with either green or red fluorescent proteins yielded some mosaic nephrons, indicating that multiple nephron progenitors contribute to a single nephron. Consistent with this, live imaging of nephron formation in transparent larvae showed that nephrogenic aggregates form by the coalescence of multiple cells and then differentiate into nephrons. Taken together, these data demonstrate that the zebrafish kidney probably contains self-renewing nephron stem/progenitor cells. The identification of these cells paves the way to isolating or engineering the equivalent cells in mammals and developing novel renal regenerative therapies.

The aim of this investigation was to examine normal acetabular morphometry, its sex dimorphism and the acetabular dysplasia rate in Serbian adults. For each hip, the centre-edge angle of Wiberg, the acetabular angle of Sharp, acetabular depth and acetabular roof obliquity were measured. The center-edge angle of Wiberg correlated negatively with the acetabular angle of Sharp and acetabular roof obliquity, but positively correlated with acetabular depth. Our results suggest that the prevalence of acetabular dysplasia in the Serbian population is lower than in Western countries. We confirmed the existence of significant gender differences in acetabular morphology among the subjects of our study. These sex-related differences in acetabular morphology were the cause for more dysplastic female acetabula compared with male acetabula.

Endometriosis is a clinical disorder defined by the presence of functional endometrial tissue outside the uterine cavity. Depending on the localization of the endometrial tissue related to the pelvis, the endometriosis can be classified either as intrinsic or extrinsic. The prevalence of endometriosis is difficult to determine. Statistical data show that endometriosis could be associated both with female infertility (20%) and pelvic pains (24%), while in 4.1% of affected women, endometriosis has asymptomatic forms. The total prevalence of endometriosis is estimated to be between 5-10%. A 35-year-old woman from Knic, Serbia, was admitted to the Obstetrics and Gynecology Clinic of the Clinical Center in Kragujevac for surgical treatment of a suspicious swelling in the pubic region. Following surgical intervention, a nut-sized tumor was removed and sent for both pathohistological and immunohistochemical analysis. The results confirmed the presence of subcutaneous endometriosis positive for both estrogen and progesterone receptors. Endometriosis is usually described as a steroid hormone-dependent change that resembles the eutopic endometrial tissue characteristic for the presence of both glandular and stromal tissues. Given the fact that endometrial lesions are estrogen-dependent tumors, a crucial factor in the development of endometriosis is a late exposure to the hormone, mostly estrogen. Spontaneous subcutaneous endometriosis is rarely observed, but it could be assumed if there is recurrent pelvic pain which intensifies during menstruation. Given the fact that endometriosis coexists with different autoimmune diseases, multidisciplinary approaches are required for its proper diagnosis. .

The presence of two genital tumors at the same time is a relatively unknown fact. They are rare and account for 0,63% of all genital malignancies. If endometrial carcinoma has affected only endometrium, then this is called stage (IA), if endometrial carcinoma has affected only one half of the miometrium, this is (IB), while (IIIA) tumor spreads to serosa or adnexa. In carcinoma localized on the ovary, without rupture of the capsule, the stage is (IA), while ovary carcinoma that affected the oviduct or uterus is (IIA).A female, 55 years old, was hospitalized in the Gynecology and Obstetrics Clinic Kragujevac, Clinical Center Kragujevac because of the surgical operation, and the tumor that filled the whole of the small pelvis. Immunohistochemically, the expressions of ER, PR and HER 2 receptors were determined.Women with independent primary endometrial uterus and ovary tumors have the prognosis similar to those of women with a separate form of this disease.Risk factors and clinical indicators of results in women with synchronized tumors are different from those based on histological division. Women with synchronized tumors are mostly younger, obese, premenopausal and barren. Patients with serious endometrial carcinomas look like patients with ovary carcinomas. In the future, it will be necessary to provide better evaluation of etiology of these diseases. In addition, the molecular diagnoses of tumor in endometrium and ovary will provide us with real confirmation.

Prognosis for both mother and baby is more uncertain in breech presentation compared to the head presentation in the front neck position.Great dilemma and danger in vaginal breech delivery is in the estimation of the existence of possible cephalo-pelvic disproportion. Because of this, an adequate external examination is needed and determination of breech measures. In very obese women, the following must be taken into account: bigger deposits of fatty tissue in the pelvis, and accordingly, decreasing of the pelvic area. The basic aim of the research was to determine whether breech measures and normal BMI influence the breech delivery occurrence. The conducted case control study included 564 mothers who delivered babies at the Obstetrics and Gynecology Clinic, Clinical Center Kragujevac, in the period from January 1, 2000 to December 12, 2002. Of them, 282 had breech deliveries and 282 had head presentation deliveries. Only singleton pregnancies were considered. The following parameters were examined: bispinal diameter, bicrystalline diameter, bitrohanteric diameter, conjugata externa and normal BMI - BMI (Body Mass Index).Significantly the highest possibility of BI SP measures is 21-25 cm, 30% have higher values, and 5% have lower values. Significantly higher possibility of BI CR measures, in both groups, ranges from 27-28 cm (83%). Possibilities are equal for BI TR measures up to 30 cm and from 31-32 cm. 24-27 % of examined women from both groups have values of the measures C Ex less than 18 cm. Normal BMI is most frequent, followed by I degree obesity.

Breech presentation implies vertical position of the fetus, accounting for 3-4% of all monofetal deliveries. Perinatal morbidity and mortality are significantly higher in breech deliveries than in head presentation deliveries.The aim of the investigation was to examine the association between the anamnestic and population characteristics of the breech deliveries and the same characteristics in the head deliveries.Study group included 282 mothers who had breech deliveries and 282 mothers in control group who had head presentation deliveries. All the babies were delivered at the Clinic of Obstetrics and Gyneclogy Kragujevac.The population sample - the subject of the study encompassed mothers from Sumadija region with the center in Kragujevac as the capital and biggest city in the region.Distribution of probabilities according to profession or education of mothers was similar in both groups. The mean age of the mothers in both groups was 26.8 years. Significantly, the largest number of mothers from both groups was between 20 and 29 years of age, e.g. 70 %.With significantly high probability, the pregnancy progression in both groups was positive (85%), without maintaining pregnancy. The presence of associated disease was significantly higher, especially hypertension and diabetes in mothers who had breech deliveries compared to mothers who had head presentation deliveries.

Mother’s breast milk is the best product that the new born infant could be fed with. It contains nutritious matters necessary for growth and progress of the new born infants, ideally adapted for the baby. This is not only the food. It provides the support for protection against infections.The aim of the investigation was to establish whether the newborn condition right after the birth and anthropometric measures affect entering the baby friendly program. The study was conducted during 2003 in OGC CC Kragujevac and included 216 new born infants included in baby friendly program and 216 new born infants outside the program.The following parameters in newborn infants were observed: Apgar score, body mass, body length, head circumference.Significantly most often in both examined groups (73 up to 75%), the value of Apgar score of the new born infants was in the interval 9 – 10 and it did not affect the selection into baby friendly program.New born infants from baby friendly program statistically had significantly greater weight than the infants outside the program-on average for about 80 g. The greater weight positively affects entering the baby friendly program.Body length and infant head circumference did not statistically significantly differed between the examined groups.Statistically important difference in body mass can be justified by higher surveillance of pregnant women from the program. The treatment should reflect in controlled nourishment, avoidance of all harmful causes like consumption of cigarettes and alcoholic drinks, which are proven risks for the newborn infants from such pregnancies to have lesser body mass. The advantage of greater body mass lies in the fact that after the childbirth, the relative loss of the body weight is lesser compared to the infants outside the program.

Najcesci uzrok pneumotoraksa u jedinicama intenzivne nege je barotrauma. Pojava, rana dijagnostika i brzo i efikasno lecenje tenzijskog pneumotoraksa kod bolesnika na mehanickoj ventilaciji predstavljaju i veliki izazov. Kod bolesnika koji su ventilisani pod pozitivnim pritiskom, u slucaju pojave bilo kakvog poremecaja treba obavezno posumnjati na tenzijski pneumotoraks i preduzeti sve mere da se on potvrdi ili iskljuci. Kasno utvrdjena dijagnoza tenzijskog pneumotoraksa i neblagovremeno sprovedeno adekvatno lecenje predstavljaju veliki rizik od smrtnog ishoda.

From the standpoints of both basic research and biotechnology, there is considerable interest in reaching a clearer understanding of the diversity of biological mechanisms employed during lignocellulose degradation. Globally, termites are an extremely successful group of wood-degrading organisms and are therefore important both for their roles in carbon turnover in the environment and as potential sources of biochemical catalysts for efforts aimed at converting wood into biofuels. Only recently have data supported any direct role for the symbiotic bacteria in the gut of the termite in cellulose and xylan hydrolysis. Here we use a metagenomic analysis of the bacterial community resident in the hindgut paunch of a wood-feeding 'higher' Nasutitermes species (which do not contain cellulose-fermenting protozoa) to show the presence of a large, diverse set of bacterial genes for cellulose and xylan hydrolysis. Many of these genes were expressed in vivo or had cellulase activity in vitro, and further analyses implicate spirochete and fibrobacter species in gut lignocellulose degradation. New insights into other important symbiotic functions including H2 metabolism, CO2-reductive acetogenesis and N2 fixation are also provided by this first system-wide gene analysis of a microbial community specialized towards plant lignocellulose degradation. Our results underscore how complex even a 1-microl environment can be.

X-linked adrenoleukodistrophy is a severe neurodegenerative disorder with impaired very long chain fatty acid metabolism. The disease associated ABCD1 gene encodes a peroxisomal membrane protein which belongs to the superfamily of ATP-binding cassette transporters. We investigated eight male X-ALD patients diagnosed among 142 suspected patients referred for investigation. Plasma levels of very long chain fatty acids were measured at our laboratory using capillary gas chromatography. Eight cases of childhood X-ALD were diagnosed. This is the first published series of Serbian patients with X-ALD. In addition, diagnosis identifies carriers, which could be benefit for genetic counselling and prenatal diagnosis.

Various studies and extensive researches, particularly during recent years, on the advantages of breastfeeding and the use of breast milk in infant`s nourishment, have stressed its immeasurable benefit to mothers, infants, family and society. The objective of the research was to ascertain demographic and anamnestic factors affecting the implementation of the baby friendly program. The study was undertaken at OGC CC Kragujevac and based on data from 432 women. The mean age of the examinees was 25,9 years and they were 6 months younger than the corresponding examinees from similar world researches. In most cases, the examinees were from urban areas and lived in bigger families, which did not affect the implementation of the program. With equal probability, it was the first or second pregnancy and in most cases, there were no hospitalizations during the pregnancy in both tested groups. Medications are more often used during the implementation of the baby friendly program. The reason for positive influence of the use of medications during the pregnancy on implementation of the baby friendly program probably lies in better supervision of the pregnancy. The gestation age did not influence the selection into the program. By means of higher level of supervision and by the use of medications during pregnancy, we can positively influence mother`s and infant`s starting with the baby friendly programme implementation.

Contagious diseases present the leading causes of getting diseased and mortality in different parts of the world, regardless of improved socio-economic life conditions. The most important among them are the diseases which can be spread by air and water. Immunization against contagious diseases presents the most effective form of prevention, ending, elimination and, where possible, eradication of disease. When there are good programs of immunization properly implemented, and when they greatly cover the population which they refer to, the changes in frequency of vaccinable diseases can be observed, eg. contagious nosological entities that could be prevented by vaccination. Certain vaccines protect from bacterial or viral infections and reduce the possibility of infection, that is, prevent its transmission. The objective of the research is to point to the results of conducting the compulsory systematic immunization and to examine the effect of immunization on spreading of some respiratory vaccine-preventable diseases within Sumadija Region. This study shows the scope of immunization and spreading of some respiratory vaccine-preventable diseases, before all morbilli, parottitis epidemica, rubella and pertussis, in Sumadija Region for the last ten years. By means of great scope of compulsory immunization, the aforementioned respiratory vaccine-preventable diseases could be prevented.

INTRODUCTION Copper and zinc have significant antiatherogenic effect influencing activity of antioxidant enzyms (giutathion-peroxidase i superoxid-dismutase), mechanism of apoptosis and other mechanisms. Few studies showed increased copper and zinc concentration in atherosclerotic plaque in comparison to normal vascular tissue. AIM The aim of the study was to compare copper and zinc concentrations in carotid artery tissue without significant atherosclerotic changes and human ulcered atherosclerotic plaque. MATERIAL AND METHODS Study was conducted on 66 patients. Carotid endarterectomy due to the significant carotid atherosclerotic changes with cerebrovascular disorders was performed in 54 patients (81.8%). Control group consisted of 12 patients (18.2%) without carotid atherosclerotic changes operated due to the symptomatic kinking and coiling of carotid artery. Operated group consisted of 38 man (62.96%) and 16 woman (37.04%). Control group had the same number of patients: six men (50%) and six women (50%). Preoperatively, all patients were examined by vascular surgeon, neurologist and cardiologist. Duplex sonografy of carotid and vertebral arteries was performed by Aloca DSD 630 ultrasound with mechanical and linear transducer 7.7 MHz. Indication for surgical treatment was obtained according to non-invasive diagnostic protocol and neurological symptoms. Copper and zinc concentration in human ulcered atherosclerotic plaque and carotid artery segment were estimated by spectophotometry (Varian AA-5). RESULTS Average age of our patients was 59.8?8.1 years. For males average age was 76.1 ?9.8 years. And for females 42.4?5.8 years. In group with carotid endarterectomy female patients were significantly younger than male patients (p

The aim of this study was to define features of Guillain-Barré syndrome in a large cohort of patients from three Western Balkans countries. Data from adult Guillain-Barré syndrome (GBS) cases from 2009 to 2013 were retrospectively obtained from all tertiary health care centers. During the 5-year period, 327 new cases of GBS were identified with a male to female ratio of 1.7 : 1. The most common GBS variants were demyelinating (65%) and axonal (12%). At nadir 45% of patients were chair-bound, confined to bed, or required assisted ventilation, while 5% died. The crude incidence of GBS in Serbia and Montenegro was 0.93 per 100,000 population, and age-adjusted incidence according to the world standard population was 0.86 per 100,000. Incidence was particularly high in 50- to 80-year-old men. Statistically significant seasonal variations of GBS were not observed. This study of patients with GBS in the Western Balkans allows us to prepare the health system better and to improve the management of patients. This study also opens opportunities for international collaboration and for taking part in the multinational studies on GBS.

Background Cross-reactivity between penicillins or cephalosporins and carbapenems is anticipated as all have a beta lactam ring. However, the true incidence of immunoglobulin (Ig)E-mediated cross-reactivity is not known. Methods A systematic review was conducted to collect and combine all published data on children and adults reported to have a clinical history of IgE-mediated hypersensitivity to a penicillin and/or cephalosporin who were subsequently given a carbapenem. Reactions were classified as proven, suspected, or possible IgE-mediated and non-IgE-mediated. Results Ten studies and 12 case reports describing 854 participants fit the study criteria. For patients with previous proven, suspected, or possible IgE-mediated penicillin reactions (N = 838), the incidence of any type of suspected hypersensitivity reaction to a carbapenem was 36/838 (4.3%; 95% confidence interval [CI], 3.1%-5.9%) and the incidence of proven (1/838), suspected (0/838), or possible (19/838) IgE-mediated reactions was 20/838 (2.4%; 95% CI, 1.6%-3.7%). Of the subset of patients with positive penicillin skin tests (n = 295), only 1 had a hypersensitivity reaction (0.3%; 95% CI, .06%-1.9%), and this was a possible IgE-mediated reaction. For patients with previous proven, suspected, or possible IgE-mediated cephalosporin reactions (N = 12), the incidence of any type of hypersensitivity reaction to a carbapenem was 3/12 (25%); this included 2 non-IgE-mediated reactions and 1 possible IgE-mediated reaction. Conclusions The cross-reactivity between penicillins and carbapenems for IgE-mediated reactions is very low, but caution is still advised. Cross-reactivity rates may be higher between cephalosporins and carbapenems; however, minimal data are available.

Background. Ectopic mammary gland tissue is a residual tissue that persists during the embryologic development along ectodermal primitive milk streaks. Incomplete involution anywhere along the primitive milk streak can result in accessory or ectopic mammary tissue. Case report. A woman, 27-year old, admitted to Obstetrics and Gynecology Clinic Kragujevac for surgery, of goose-egg size, vulva tumor, of elastic consistency. Menarche started in 12 years of age, with the regular menstrual cycle, without previous gynecological diseases. The woman had one pregnancy terminated by cesarean section because of the multiple (twin) pregnancy. Excision of the tumor was completely done in the total endotracheal anesthesia. Pathohistologic (PH) findings was: Dysplasia fibrosa cystica simplex mammae, with focuses of sclerosing adenosis. Expression of estrogen (ER) and progesterone receptors (PR) were positive. Conclusion. Ectopic mammary tissue in vulva in adult period is very rarely seen, and can be changed pathologically as well as normally positioned breast tissue into benign cystic changes, benign tumors, adenomas and fibroadenomas and tumors. Cells with low ER/PR receptor level grow independently of estrogene stimulation and they could be resistant to hormonal therapy effects.

According to the data presented by WHO and UNICEF, more than a million of children all around the world die every year, because they have not been breastfeeded or some other form of the food has been given to them too early. The other million of children are of poor health because of malnutrition and because of the lack of disease prevention. The basic aim of the research was to determine which parameters could influence the change in attitude towards baby friendly program, as well as its confirmation. In the procedure of program evaluation realization ’’friendship with babies ’’ or ’’the best for the babies’’,generally accepted under the term, 'BABY FRIENDLY' program, the pool was conducted among the mothers from the study, by the specially designed questionnaire. The total number of mothers participating in the pool was 432, 216 mothers in baby friendly program and the same number of mothers outside the aforesaid program. Experiences from previous pregnancies and deliveries have the influence on the decision related to acceptance of specific treatment during the current pregnancy and delivery. In about 70 to 80% of cases, on the maternity hospital admittance, the expectance of the mothers from both groups was that the program should be useful. On hospital discharge with significantly high possibility, the answer about the program usefulness in both groups was positive (80 up to 90%). The consequence of change in attitude towards baby friendly program is the consequence of the applied program.