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Renal transplantation is the most common procedure in solid organ transplantation. Compered to dialysis, renal transplantation offers better quality of life and overall survival for patients. Due to the improvement of surgical technique, imunosupressive therapy and medical monitor-ing in general, the outcome of treatment has significantly improved today. The importance of the anesthesiologists and the correct performance of all procedures during this treatment has been shown in many studies related to the outcome. In addition to the correct selection of anesthesia drugs, it is very important to pay attention to the position-ing of the patient, adequate monitoring, careful fluid re-placement and the type of fluid intra-and postoperative, as well as adequate pain control after the procedure.

Introduction: Given the increasing occurrence of pregnancy at a relatively older age in the current clinical practice, many therapeutic approaches characteristically used in the elderly population are becoming an important consideration point for the clinicians. Antiplatelet drugs: The safety of antiplatelet drug administration in pregnancy should be brought into a sharper focus regarding both mother and child. It is a complex clinical task since the pregnancy is followed by many changes potentially affecting the drug choice - increased blood coagulability, changes in platelet aggregation, and pharmacokinetic alternations of the drug itself. Acetylsalicylic acid, as the most commonly used antiplatelet drug, appears to be mostly safe and effective for mother and fetus in many conditions occurring during pregnancy when used in low doses. However, although considered generally safe, its use requires careful approach due to many drug and pregnancy specificities. On the other hand, evidence showing adequate clinical use of P2Y12 receptor antagonists (clopidogrel, ticagrelor, prasugrel, and ticlopidine) are scarce. Cases showing their use in clinical practice are emerging and the future practice and treatment approach might be changed with the new cases becoming available. Conclusion: Regardless of the drug, pregnancy itself and any indication for the treatment used in this patient population are typically complex and require well-coordinated management by the interdisciplinary clinical team.

Introduction: Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the peripheral or central nervous system. The central neuropathic pain includes thalamic pain syndrome, pain related to multiple sclerosis, poststroke pain, post spinal cord injury pain. Almost 60% of patients with spinal cord injuries have neuropathic pain whose treatment requires great socioeconomic support for a long time. Case Report: Male, 56 years old, previously healthy, was examined at the Outpatient pain Clinic, Clinical Centre of Serbia. He complained about a strong pain in both legs and a sense of tightening around the trunk. The pain was present on rest and getting worse on mobilization, intensity 7-10/10 by NRS. In 2008. after falling into the shallow water, he sustained comminuted C7 fracture resulting in quadriplegia. He was operated and regained motor skills in both arms with some residual sensory deficits. Detailed neurological examination diagnosed the presence of neuropathic pain in the trunk (T4-L1 dermatome being the worst pain with hyperalgesia, dysesthesia, hyperpathia), with sensitivity fairly preserved. Regarding therapy, only fentanyl patches helped with the dose increase but tightening sense persisted. Combined lidocaine and ketamine infusion was applied - the response was temporarily good. The patient still feels pain and uses fentanyl patches, baclofen and physical therapy. Discussion: Treatment of neuropathic pain represents a great socioeconomic problem even for developed countries because there is no benefit of conventional pharmacologic therapy in long-term use. Also, neuromodulatory therapy methods provide the most benefits for this group of patients but demand trained personnel and use of expensive equipment. Conclusion: This case is a good example of difficulties regarding treatment of this type of chronic pain in a developing country: limits of pharmacotherapy, no trained doctors for implantation of neuromodulatory devices, high price of neuromodulatory devices.

Introduction: Pain is a subjective experience. Perception of the pain intensity is influenced by multiple factors including genetic, socio-economic and psychological factors. Chronic non-cancer pain represents the socioeconomic burden. In adolescent population, osteoid osteoma has an incidence of 10-12% in all symptomatic benign bone tumors. Nonsteroid anti-inflammatory drugs (NSAIDs) are the most frequently used medications for non-cancer pain treatment. Case report: Male, 17 years old, complained about moderate low back pain. Clinical examination was performed and subsequent diagnostic procedures (ultrasound examination of abdomen, nuclear magnetic resonance examination, and radiographic examination of lumbal spine) revealed discopathia and left leg sensory neuropathy. After examination by a pediatrician, physical medicine specialist and an orthopedic surgeon, he started using analgesic (ibuprofen 600 mg), vitamins and physical treatment. Diclofenac 75 mg was added for severe pain management. Haematuria, eosinophylia, decreased creatinine clearance were consequences of NSAIDs toxic nephritis. NSAIDs were stopped and patient reffered to pain specialist - different focuses of pain were suspected. Subspecialist verified pricking and heating sensation in upper leg, severe hip pain without functional deficit and dominating neuropathic pain originating from spinal nerve compression. New radiography reveiled presence of osteoid osteoma of the hip, and after orthopedic consultation, surgery (biopsy of tumor and tumor extirpation) was performed. In the postoperative period, strong pain disappeared, pregabalin was introduced and neuropathic pain was reduced by 20% and low back pain by 30%. Discussion: NSAIDs are the first line treatment of wide range of pain states. NSAIDs can cause numerous serious side effects including acute interstitial nephritis. Conclusion: Multiple causes and types of pain can exist simultaneously, therefore detailed physical examination, followed by other diagnostic Pre primene analgetika, neophodno je izvršiti detaljan klinički pregled i dijagnostičke pretrage, čime bi se smanjila nekritična primena NSAIL.

Antiplatelet drugs are often used on a regular basis as a part of primary or secondary prevention of cardiovascular diseases. Patients on antiplatelet therapy often require Noncardiac Surgery and in this situation the current issue becomes antiplatelet drug suspension timing whether it is safe, and how to overcome the lack of their implementation in the perioperative period. Venous thromboembolism is a major public health issue and one of the leading causes of mortality in general. It is also the cause of significant mor­bidity inducing short- and long-term complications. It has been demonstrated that anticoagulant therapy is effective in the prevention of Venous thromboembolism although it may be a potential cause of bleeding. However, benefit-risk ratio of widespread used postoperative prophylactic antico­agulation therapy is highly positive inpatients with moderate or high risk of deep vein thrombosis.

Diabetic peripheral neuropathies (DPN) are a heterogeneous group of disorders caused by neuronal dysfunction in patients with diabetes. Among all acquired polyneuropathy, diabetic polyneuropathy is the most common, and therefore the most important one. Approximately 50% of patients with diabetes develop peripheral neuropathy. Distal symmetrical polyneuropathy (DSPN) with painful diabetic neuropathy, occurring in around 20% of diabetes patients, and diabetic autonomic neuropathy (DAN) are the most common manifestations of DPN. Optimal glucose control represents the only broad- ly accepted therapeutic option though evidence. A number of symptomatic treatments are recommended in clinical guidelines for the management of painful DPN, including antidepressants, γ-aminobutyric acid analogues, opioids, and topical agents. The current treatment of DPN is largely symptomatic, the other therapy direction is focused on pathogenetic process of disease, and there is some evidence that the use of alfa-lipoic acid, aldose reductase inhibitors and fat-solubile vitamin-B may have beneficial effect in terms of development of microangiopathy in patients with diabetes.

Introduction: The current number of women in the reproductive phase (from 15 to 45 years) in Europe is estimated at about 105 million, with about 5 million children annually born in average. About 1% of pregnancies among women in Europe are complicated by heart disease, the risk of cardiovascular disease in pregnant women being further increased by the fact that ever older women are giving birth. Methods: Preparing this paper is based on a systematic PubMed search of existing professional databases and accessible medical journals and textbooks dealing with this subject matter. Topic: Being certainly drugs with the best anticoagulant effect in situations of high risk for thrombosis, especially in patients with mechanical prosthetic heart valves during pregnancy, vitamin K antagonists (VKA) on the other hand also entail a well-known dose-related risk of embryo toxicity, genotoxicity, and hemorrhage in the fetus and in the mother. The choice of appropriate anticoagulant depends on the stage of pregnancy. In accordance with the North-American guidelines (American College of Chest Physicians - ACCP) for women already on oral vitamin K antagonists actively trying to conceive frequent pregnancy tests, and substitution of VKA with heparin drugs when pregnant are recommended rather than VKA replacement with low molecular weight heparin (Low Molecular Weight Heparin - LMWH) when planning a pregnancy. Heparin derivatives have no embryo toxic and fetotoxic characteristic effects of VKA but they are less effective at preventing valve thrombosis, due to which they have recently been superseded by improved techniques for monitoring effects of heparin, with a mentioned made that low molecular weight heparin used in high therapeutic doses requires obligatory (on a weekly basis) monitoring of anti-factor Xa coagulation activities. Conclusion: Adequate anticoagulant therapy during pregnancy requires an analysis of risk factors for thrombosis, hemorrhage risk, consideration of comorbidities in pregnant women, especially renal function, especially taking into account the gestational age. Though it must be admitted that there is no absolutely safe anticoagulant therapy during pregnancy, a choice of the safest option regarding the stated risks for the mother and the child is of paramount importance.

Introduction Rhabdomyolysis is a rare, but serious and potentially fatal adverse reaction of the statin application that may be developed in any time of therapy. It is characterized by massive destruction of muscles associated with the large increase of creatine kinase (CK) leading to myoglobinuria and potential acute renal failure. Combined statin-fibrate therapy increases the risk of rhabdomyolysis, especially in elderly and diabetic patients. Case report An 81-year-old male was admitted to Coronary Care Unit of the Emergency Center, Clinical Center of Serbia (CCS) with the clinical picture and electrocardiogram of the acute anterior wall myocardial infarction complicated with pulmonary edema. Laboratory tests on admission showed higher elevated values of serum creatinine 179 μmol/L and BUN 9.2 mmol/L (eGFR 32 mL/min/1.73m2), CK 309 U/L (on day 2: 3476 U/L) and mixed hyperlipidemia (total cholesterol 10.3 mmol/L, HDL 2.26 mmol/L, TG 4.85 mmol/L). The patient was treated with thrombolysis medication therapy (Alteplase), anticoagulant and dual antiplatelet therapy, diuretics, organic nitrates, angiotensin-converting enzyme (ACE) inhibitors, antibiotics, and proton pump inhibitors. During seven days, his therapy included combined pravastatin 20 mg and fenofibrate (160 mg), which was discontinued due to pains and weakness of muscles and significantly elevated CC to 7080 U/L (upper limit 200 U/L), but no significant deterioration of renal function was observed. Discontinuation of therapy resulted in CC level normalization and improvement of clinical condition. Conclusion Combined statin and fibrate therapy requires strict clinical control and monitoring of CK i transaminases. Four-time or higher increase of CK requires discontinuation of therapy. In addition, patients are advised to report immediately any pains in muscles, sensibility, weakness or cramps.

Erectile dysfunction (ED) is a disorder, which basically can have organic nature, psychological or mixed. ED is not a rarity, and data on its prevalence vary, depending on the areas in which the survey was conducted, followed by a period of research and the definition of the disorder. Most of the men associate ED problem with using drugs, especially cardiac. Even though there is some truth in it, mainly the real causes of ED are not well known even to professionals. Contemporary studies of risk factors for cardiovascular disease, particularly coronary heart disease, have shown the clear link between erectile dysfunction and coronary heart disease, wherein ED first manifests. While, ED precedes the onset of symptoms of coronary heart disease and show to the patient and the physician a clear signal of the direction for conducting diagnostic tests and further treatment in the interest of the health of patients. Endocrine, and neurological disorders, as well as bad habits in addition to the cardiac and kidney disease, lead to ED. It is known also, that the use of cardiac medicines may contribute to ED occurrence. Better knowledge of adverse reactions to medicines, a better understanding of the nature of the disease and the implementation of necessary diagnostic procedures, with a good choice of medication, contribute to solving problems related to ED. If all mentioned do not help, there is the possibility of using new drugs to correct ED.

Heparin-induced thrombocytopenia (HIT) type II is an acquired thrombophylic state and life-threatening immune complication of a heparin treatment mainly clinically manifested by marked thrombocytopenia, frequently by arterial and venous thrombosis, and sometimes by skin changes. Functional assay as heparin aggregation test and 14C-serotonin release assays are used in diagnostics as well as antigen assays of which detection tests for heparin-platelet factor 4 antibodies are most frequently used. Considering the fact that there is no single reliable assays for HIT II detection available, sometimes it is necessary to combine both of the above-mentioned types of assays. We present the case of a 57-year-old patient with an acute anterior myocardial infarction with cardiac insufficiency of III and IV degree according to Killip, recurrent ventricular fibrillation and diabetes mellitus type II developing thrombocytopenia to 37x10 9/l accompanied with typical skin changes. The diagnosis was confirmed by the heparin aggregation test. The second patient aged 70 undergoing the treatment for anteroseptal myocardial infarction and reinfarction of the inferior wall complicated by a cardiogenic shock and acute right bundle branch block developed thrombocytopenia 59x10 9/I on the third day of the heparin therapy, with the remark that he had received a heparin therapy during the first infarction as well. Antibodies against heparin-platelet factor 4 were detected by particle gel ID-HPF4 immunoassay. In both patients, the disease had a lethal outcome despite all then available therapeutic measures applied. Further on we discuss advantages of certain types of tests, a therapy doctrine, need for urgent therapeutic measures, inclusive of the administration of anitithrombins, avoidance of harmful procedures like low-molecular-weight heparins administration and prophylactic platelet transfusion as well as preventive measures.

Background/Aim. Patients in intensive care units (ICUs) often exhibit disturbances in the concentration of thyroid hormones (THs), even if they had no previous thyroid disorders. The aim of the study was to determine whether there is a correlation between THs and the survival rate in the ICU and whether these hormones have predictive capability for mortality rate assessment. Methods. The study included 41 patients (23 women and 18 men) divided into two groups: survivors (70.7%) and non-survivors (29.3%). In peripheral blood samples taken within the first 24 hrs after ICU admission, TH levels were measured: triiodothyronine (T3), thyroxine (T4), free T3 (FT3), free T4 (FT4), and thyroid stimulating hormone (TSH), as well as procalcitonin (PCT). The Sequential Organ Failure Assessment Score (SOFAS) was calculated for each patient. Results. A statistically significant difference between the study groups (survivor vs. non-survivor patients, p < 0.05) was found for PCT, SOFAS, T3, T4, and FT4. The area under the receiver operating characteristic (ROC) curve (AUC) – (AUROC) for the SOFAS was 0.991 [95% confidence in terval (CI): 0.898–1.000, p < 0.001], for T3 was 0.727 (95% CI: 0.566–0.854, p = 0.0097), for T4 was 0.793 (95% CI: 0.638–0.903, p = 0.0008), for FT3 was 0.707 (95% CI: 0.544–0.8389, p = 0.0299), and for FT4 was 0.795 (95% CI: 0.640–0.904, p = 0.0005). Compared to other parameters, T3 had higher sensitivity (91.67%), FT4 had higher specificity (93.10%), while SOFAS had both the highest sensitivity (91.67%) and specificity (96.55%) in relation to all other tested parameters. Multiple linear regression analysis showed that FT4 and T4 were significant predictors of survival time (β = -0.362, p = 0.012 and β = -0.356, p = 0.014, respectively). Conclusion. Among all examined THs, only FT4 and T4 showed strong predictive potential for assessing mortality in ICU patients. This study has highlighted the significance of assessing THs levels in critically ill patients. This is crucial because it opens the possibility of implementing specific therapies to rectify issues stemming from hormonal deficiencies. [ABSTRACT FROM AUTHOR]

Introduction Today, there are many drugs for the treatment of a large number of indicator areas. Significant financial resources are invested in research with the aim of introducing reliable therapeutics to therapy.Therefore, it is necessary to provide health care professionals exact information about new therapies. The overall process of scientific data, ideas and information exchange is possible through numerous communications of modern IT tools. Methodology According to the Law, key information on registered drug is included in the Summary of Product Characteristics (SPC) for health professionals, which is harmonized with EU directives and regulations (SmPC).Protocol content and structure of the information provided in SPC is determined in the guidelines of the EU, therefore, a unique set of data is established for all the drugs registered in Serbia. Topic This paper presents the key segments of SPC, with special reference to the description of the regulations that are required for data related to indications, mechanism of action, dosage, contraindications, side effects, interactions and other important information regarding the profile of the drug, which are standardized and harmonized with the structure of identical documents which operate at the EU level, or EMEA. Conclusions SPC is the regulatory determined technical document on medicinal products in the RS in which there are listed scientifically proven, clinical and pharmacological data and information on the profile of the drug, which are essential for health professionals - doctors and pharmacists in the implementation of pharmacotherapy in our society.This document is the starting point for the development of applied Pharmacoinformatics and it includes a range of activities important for the development of appropriate manuals and makes available data and information for monitoring indicators of the national policy on drugs and modern effective drugs treatment. [ABSTRACT FROM AUTHOR]

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Heparin-induced thrombocytopenia (HIT) type II is an acquired thrombophylic state and life-threatening immune complication of a heparin treatment mainly clinically manifested by marked thrombocytopenia, frequently by arterial and venous thrombosis, and sometimes by skin changes. Functional assay as heparin aggregation test and 14C-serotonin release assays are used in diagnostics as well as antigen assays of which detection tests for heparin-platelet factor 4 antibodies are most frequently used. Considering the fact that there is no single reliable assays for HIT II detection available, sometimes it is necessary to combine both of the above-mentioned types of assays. We present the case of a 57-year-old patient with an acute anterior myocardial infarction with cardiac insufficiency of III and IV degree according to Killip, recurrent ventricular fibrillation and diabetes mellitus type II developing thrombocytopenia to 37 x 10(9)/l accompanied with typical skin changes. The diagnosis was confirmed by the heparin aggregation test. The second patient aged 70 undergoing the treatment for anteroseptal myocardial infarction and reinfarction of the inferior wall complicated by a cardiogenic shock and acute right bundle branch block developed thrombocytopenia 59 x 10(9)/l on the third day of the heparin therapy, with the remark that he had received a heparin therapy during the first infarction as well. Antibodies against heparin-platelet factor 4 were detected by particle gel ID-HPF4 immuno-assay. In both patients, the disease had a lethal outcome despite all then available therapeutic measures applied. Further on we discuss advantages of certain types of tests, a therapy doctrine, need for urgent therapeutic measures, inclusive of the administration of antithrombins, avoidance of harmful procedures like low-molecular-weight heparins administration and prophylactic platelet transfusion as well as preventive measures.

HEPARIN-INDUCED THROMBOCYTOPENIA (HIT): Management of heparin-induced thrombocytopenia (HIT) and treatment options have significantly changed recently. Heparin may induce two types of thrombocytopenia. Type I, occurring earlier with a much higher rate of incidence (5-30%), is characterized by mild thrombocytopenia without significant clinical manifestations. Type II, is less frequent (0.5-2%), life threatening immune type, develops following a period of minimum 5-7 days upon introduction of heparin therapy (patients earlier treated with heparin are excluded). Type II heparin-induced thrombocytopenia with severely reduced platelet count may be clinically manifested by thrombosis in 20-50% cases within the period of 30 days. HIT is suspected in persons resistant to heparin with relatively reduced platelet count, though HIT is described in person with normal platelet counts, as well. None of available assays used for HIT detection is completely reliable. Sensitivity of a highly specific platelet aggregation assay is only 36%, sensitivity and specificity of 14C-serotonin release assays amounts to 95%, while ELISA using a heparin/platelet factor-4 target has a sensitivity of 85%. Thus, it is sometimes necessary to combine functional and antigen assays. Furthermore, new classes of antigen assays, like antibody detection tests of complexes between heparin and neutrophil-activating peptide-2 as well as those between heparin and interleukin-8, have been used. CURRENT THERAPY OPTIONS: Current therapy options exclude formerly applied low-molecular-weight heparins due to the existing cross-reactivity of 80-100%. Danaparoid sodium exhibits in vitro cross-reactivity of 10-61%, clinically manifested in less than 5% of patients. Two drugs are drugs of choice in HIT type II treatment: lepirudin, especially in patients without renal failure, and argatroban, particularly in patients with renal failure. The following procedures and agents are also efficient: asmapheresis in the first four days, high-dose intravenous gammaglobulin, antiaggregans, especially ADP antagonists, aspirin, dipirydamole, dextran, prostacyclin analagoues, thrombolytic therapy as well as thromboembolectomy. Oral anticoagulants are not administered in active HIT type II, in deep vein thrombosis with high international normalized ratio (INR) and thrombin-antithrombin complexes, and low protein C levels to avoid the possibility of venous limb gangrene development. They can be administered in a stable phase, when the thrombin generation is controlled by previous administration of one of the above-mentioned alternative anticoagulants.