INTRODUCTION High prevalence of metabolic syndrome (MetS) in children and adolescents is a great concern of the modern society. OBJECTIVE bjective: Our aim was to determine the influence of previously investigated, but also and potentially novel risk factors for the development of metabolic syndrome in children and adolescents. METHODS Observational case-control clinical study was conducted involving children and adolescents with obesity/metabolic syndrome, treated on inpatient basis from January 2008 to January 2012 at the Pediatric Clinic of the Clinical Centre Kragujevac, Kragujevac, Serbia. The group of"cases"(n=28) included patients aged 10-16 years with the diagnosis of metabolic syndrome according to the International Diabetes Federation (IDF) criteria, while the control group included twice as many obese patients (n=56) matched to the compared group. RESULTS Presence of maternal gestational diabates (ORadjusted: 39.426; 95% Cl: 1.822-853.271; p=0.019), and/or lack of breastfeeding in the first six months of life (ORadjusted: 0.079; 95% CI: 0.009-0.716; p=0.024) were significant predictors for developing MetS. Also, microalbuminuria is associated with MetS in obese children and adolescants (ORadjusted: 1.686; 95% Cl: 1.188-2.393; p=0.003) CONCLUSION: Presence of maternal gestational diabetes and/or lack of infant breastfeeding are considered as relevant factors that may contribute to the increased risk of developing MetS syndrome, while microalbuminuria is frequently associated with MetS in obese children and adolescents.

1 Department of Pharmacology, Th e Faculty of Medical Sciences, University of Kragujevac, Serbia 2 Department of Economics, Center for Children and Childhood Studies, Rutgers University, the State University of New Jersey, U.S.A. 3 Department of Epidemiology & Community Health, School of Health Sciences & Practice, New York Medical College, U.S.A. 4 Clinic for Neurology and Psychiatry for Children and Youth, Clinical Center of Serbia, Belgrade, Serbia 5 Psychiatric Clinic, University Clinical Center Kragujevac, Serbia 6 Centre for Clinical Pharmacology, Medical Faculty, Military Medical Academy University of Defence, Belgrade Serbia 7 Faculty of Medical Sciences University of Kragujevac, Serbia 8 Primary Care Facility Svilajnac, Serbia

Postoperative nausea and vomiting emerge during the first 240-48 hours from surgery. Prevalence of postoperative nausea and vomiting is as high as 30% among all patients undergoing surgery, and almost 80% among the patients with high risk of postoperative vomiting. Since postoperative nausea and vomiting create very unpleasant experience and could lead to serious complications, they should be either prevented or treated. There are several perioperative factors which may initiate postoperative vomiting: opioids, inhalation anesthetics, anxiety, adverse drug effects and transporting the patient. More than one neurotransmitter system is involved in regulation of nausea and vomiting: cholinergic, dopaminergic, serotonergic, histaminergic and neurokinin system. Procedures which may decrease prevalence of postoperative vomiting are: use of local or regional anesthesia instead of general one and use of propofol for anesthesia induction (prevalence of vomiting drops for 30%). Ondansetron, dexamethasone and droperidol are equally effective: when administered prophylactically, they decrease risk of posoprative vomiting for 25%. These drugs have additive effect, since their mechanisms of action are different. The patients with extreme risk of postoperative vomiting should receive long-acting antiemetic, like transdermal scopolamine or palonosetron, or combinations of two antiemetics. If a patient who already received antiemetic prophylaxis still develops nausea and vomiting, he or she should be treated by new antiemetic having another mechanism of action.

Background: The need for institutionalisation of elderly people derives from high rate of comorbidity and ageing, which result in the decrease of cognitive and functional capacities of future residents. Critical point in the procedure of accommodation of the people with dementia and other chronic illnesses is statement of willingness to be accommodated. Results of numerous studies point out that the Mini Mental State Examination (MMSE) can be used as a screening test for rapid clinical assessment of legal capacities. Method: The group of 91 examinees under legal guardianship protection has been compared with the group of 57 users not being under legal guardianship, on the bases of their cognitive status. The MMSE was used for evaluation of cognitive status. Results: Between the examined groups, a significant statistical difference in total MMSE score was found (F=19, 847; DF=2, 145; p<0.001). Subjects with no legal guardian had much higher values of total MMSE score compared to the subjects under legal guardianship. There was a statistically significant difference in the recurrence rate of cognitive status categories between the examined groups (chi-square=29, 822; p<0.001). Conclusion: The total MMSE score significantly correlates with decision making and proper interest supporting capacities, i.e. with placing subjects under any type of guardianship, which makes plausible to consider applying this instrument in order to make a more exact assessment of decision making capacity. Karličić IS, Stašević M, Janković S. Cognitive status of persons under guardianship living in a social welfare institution. Open J Psychiatry Allied Sci. 2015;6:89-95.doi: 10.5958/2394-2061.2015.00003.8

Two recent articles published in the consecutive issues of the Journal suggested that health professionals in Brazil have recently showed the rising interest for rational therapeutics including medical and economic consequences of widely prescribed drugs. Inspired with these efforts and taking into account limited resources of healthcare systems in many countries as well as recent worldwide financial crisis we decided to investigate whether there is a correlation between rational therapy publication rate and national indicators of welfare and healthcare investments. We have taken some of the indicators from the World Bank internet database of countries: total population (for 2012), gross domestic product per capita (GDPpc, for 2012) and health expenditure per capita (HEpc, for 2011). We have also DOI: 10.1590/1413-812320141912.10222014

Hypocalcaemia is a state with total calcium serum level below 2.25 mM/l. From the total serum calcium content, 50% is free and ionized, 40% is protein-bound and 10% is bound for organic anions. The most frequent causes of hypocalcaemia are iatrogenic hypoparathyroidism, magnesium deficit, disorders of vitamin D metabolism and chronic renal failure. Iatrogenic hypoparathyroidism is associated with low serum ionized calcium and low serum parathormone levels. There are two important clinical signs of hypocalcemia: Chvostek’s sign (twitches of upper lip after percussion on facial nerve over mandible) and Trousseau’s sign (carpal spasm after increasing pressure in blood pressure cuff placed about the upper arm for 20 milimeters above systolic pressure for 3-5 minutes). The following lab analyses should be performed when hypocalcaemia is an option: serum levels of calcium, magnesium, 25 – hydroxyvitamin, parathormone, potassium, sodium, chloride and bicarbonates. If hypocalcaemia is mild, it could be treated with oral calcium preparations, usually calcium carbonate, in a dose of 1 to 2 grams of elemental calcium daily. In more severe hypocalcaemia intravenous calcium-gluconate or calcium-chloride should be administered, as 10% solutions. These parenteral preparations of calcium should be diluted prior to the intravenous administration, and the administration should be longer than 20 minutes in order to avoid adverse effects on heart. If administration of calcium does not correct hypocalcaemia, oral vitamin D should be also prescribed. If this does not regulate calcaemia, from 0.25 tо 1 micrograms of 1,25-dihydroxyvitamin D (clacitriol) daily should be prescribed. Calcium serum levels should be kept within the lower part of normal serum concentration range.

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

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