BACKGROUND/AIM Recent studies have shown that biological treatments for rheumatoid arthritis can change the course of rheumatoid arthritis and improve functional ability of patients with rheumatoid arthritis. In spite of this fact, use of biological therapy is still limited by high prices of these medicines, especially in countries in socioeconomic transition. The aim of our study was to compare cost-effectiveness of a combination of tocilizumab and methotrexate with methotrexate alone for rheumatoid arthritis in Serbia, a country in socioeconomic transition. METHODS For the purpose of our study we designed a Markov model using data on therapy efficacy from the available literature, and data on the costs of health states calculated from records of actual patients treated in the Clinical Center Kragujevac, Serbia. The duration of one cycle in our model was set at one month, and the time horizon was 480 months (40 years). The study was done from the social perspective, and all the costs and outcomes were discounted for 3% per year. RESULTS Treating rheumatoid arthritis with disease-modifying antirheumatic drugs (DMARDs) alone was more cost-effective in comparison with a combination of biologic treatment with tocilizumab and DMARDs. The total costs for treating a patient with DMARDs for one year were on average 261,945.42 RSD, or 2,497.70 Euro and the total costs for treatment with tocilizimab plus DMARDs were on average 1,959,217.44 RSD, or 18,659.20 Euro. However, these results are susceptible to changes in costs and treatment effects of tocilizumab in patients with more severe forms of rheumatoid arthritis. CONCLUSION Our results show that the use of tocilizumab for rheumatoid arthrits in economic environment of Serbia is not cost-effective. Use of tocilizumab for treating rheumatoid arthritis can become affordable, if costs of its use become lower. In order to start using expensive biologic medicines in patients in transitional countries, special strategy and pricing policy of international pharmaceutical companies are necessary, which would include calculation of prices of biologic medicines on the basis of local pharmacoeconomic studies.

ObjectivesThe objective of this study was to estimate the prevalence of potential drug-drug interactions (DDIs) among outpatients of city region Novi Sad, Serbia, and to investigate predictors of potential DDIs.MethodsCross-sectional prescription database study was conducted. In the analysis were randomly included 10% outpatients with polypharmacy (n=4467), who visited Health Center over 1-month period (November 1–30, 2011). All drug combinations with potential for clinical significant DDIs were identified, according to Drug Interaction Facts by David S Tatro. A logistic regression analysis was conducted to examine patient and drug therapy characteristics as predictors of potential DDIs.ResultsThe prevalence of clinical significant potential DDIs was 33.31%. Odds of exposure were the highest among those aged 65 years or older (odds ratio (OR)=5.204; 95% confidence interval (CI) 2.694–10.052, p<0.001), those with ≥ 4 diagnosed diseases (OR=4.451; 95% CI 3.349–5.914, p<0.001), and those who used ≥ 5 drugs (OR= 5.735; 95% CI 4.876–6.747, p<0.001). Chronic diseases as well as their therapy also presented predictors of DDIs.ConclusionApproximately one-third of outpatients living in Novi Sad were exposed to potential DDIs. Based on the present results could be defined recommendations for the management potential clinical significant DDIs.

[Purpose] The extent of functional independence ultimately achieved by an individual patient will be influenced by a variety of medical and non-medical factors. [Subjects and Methods] this study included 419 patients with spinal cord lesions treated in the Clinic for Rehabilitation “Dr M. Zotovic”, Belgrade, Serbia, from January 2000 to December 2009. The patients were divided in two groups according to achievement of increase in Functional Independence Measure (FIM) score of more than 13 at discharge compared to admission. A variety of clinical variables were followed in both groups. [Results] one hundred twenty-one patients (28.9%) showed improvements in FIM score of ≤13, while 298 (71.1%) patients showed an increases in FIM score of >13 at discharge compared to admission. Better functional recovery was observed in patients with non-traumatic spinal cord lesions, lower neurological levels of the lesion (OR = 6.07), and in patients treated surgically, but the level of the spinal cord lesion was the most influential factor affecting outcome. [Conclusion] the patients with spinal cord lesions should not only be grouped by traumatic and non-traumatic lesions only, but also sub-categorized, according to the etiology, level of injury and treatment method.

Development of an available drug delivery system is of great interest considering the therapeutic effects of formulations with violate essential oils, especially assuming the fact that using essential oils as antimicrobial agents is a rather expanded in antimicrobial therapy nowadays. In this paper, the chitosan microparticles with encapsulated thyme essential oil were prepared in the emulsion by cross-linking method. The effect of thyme oil and glutaraldehyde initial concentrations on particle size, morphology, and particle size distribution was investigated. In addition, the influence of these parameters on the encapsulation of thyme oil in chitosan microparticles, concerning thyme oil loadings and encapsulation efficiency was also tested. The particles showed a spherical shape with an average diameter of 4.71±1.42 to 13.65±4.34 μm, depending on the concentration of the essential oil and glutaraldehyde that were used. The diameter of microparticles appeared to increase with increasing the thyme essential oil concentration, and decreased with the increase of glutaraldehyde concentration. It was shown that the concentration of glutaraldehyde did not affect the degree of encapsulation, but the increase in the initial concentration of thyme oil increased the degree of encapsulation of this essential oil in chitosan microparticles. All particles containing thyme essential oil, as well as essential oil of thyme itself showed significant antimicrobial activity against Staphylococcus aureus ATCC 25923, Esherichia coli ATCC 25922, Candida albicans ATCC 24433 and Enterococcus faecalis ATCC 25929. This study showed a great potential of the use of thyme essential oil as an antimicrobial agent, especially when encapsulated in a drug delivery system with controlled release of the active antimicrobial component.

BACKGROUND/AIM Severe dental anxiety (SDA) is the most severe form of dental anxiety, thus the aim of this study was to determine the factors associated with SDA in students of health-related disciplines. METHODS In this case-control study the cases were students with severe dental anxiety. The study was conducted at the Faculty of Medical Sciences, University of Kragujevac, Serbia. The participants were undergraduate students attending lectures during spring semester 2010/2011 (n = 1,812). A random sample of 800 students was assessed for the association between various risk factors and the severe dental anxiety. The main outcome measures were the data on demographics, dental anxiety, habits concerning oral hygiene, nutrition, general anxiety and (co)morbidity which were collected from the study participants by semi-structured questionnaire. RESULTS Less frequent visits to the dentist (OR adjusted = 7.02 [2.65; 18.60]) and visiting the dentist only when there is a dental problem (OR adjusted = 8.08 [1.28; 50.93]) were associated with severe dental anxiety. The same was true for improper oral hygiene (OR adjusted = 4.25 [1.16; 15.60]). Factors as changing toothbrush more frequently (OR adjusted = 0.33 [0.14; 0.76]) and having chronic disease (OR adjusted = 0.01 [0.00; 0.09]) were inversely associated with severe dental anxiety. The level of education of students was not associated with severe dental anxiety. CONCLUSION Inappropriate oral hygiene, less frequent changes of a toothbrush and less frequent visits to the dentist are important risk factors for severe dental anxiety.

Studies on the effects of microwaves on the growth of microbial cultures were searched for in biomedical journals indexed in MEDLINE from 1966 to 2012. The published studies showed that microwaves produce significant effects on the growth of microbial cultures, which vary from the killing of microorganisms to enhancement of their growth. The nature and extent of the effect depend on the frequency of microwaves and the total energy absorbed by the microorganisms. Low energy, low frequency microwaves enhance the growth of microorganisms, whereas high energy, high frequency microwaves destroy the microorganisms. However, neither the effects of a wide spectrum of frequencies nor the effects of a wide range of absorbed energies have been investigated.

The aim of this study was to evaluate and compare the antimicrobial activity of four essential oils that belong to Lamiaceae family (sage, oregano, thyme) and eucalyptus oil. Gas chromatography coupled with mass spectrometry (GC-MS) revealed that the highest percent of essential oils 98.93% include three classes of compounds - monoterpene hydrocarbons, aromatic hydrocarbons and oxidized monoterpenes. The main components are oxidized monoterpenes: carvacrol (59.03%); thymol (36.12%), eucalyptol (20.66%), hydrocarbon monoterpenes: limonene (30.96%) and α-pinene (12.21%) and aromatic monoterpene, p-cymene (22.25%) All essential oils showed great potential of antimicrobial activity against several bacteria and yeast C. albicans, using the agar diffusion method with wells. Minimum inhibitory concentration (MIC) for the essential oils has been determined by the broth dilution method and valued in the range from 1 to 5 μL/m, depending on the essential oil and bacteria tested, and up to 100 μL/ml for C. albicans. The essential oils of Lamiaceae family exhibited a strong antibacterial activity for tested microorganisms, while the essential oils of thyme were especially recognized.

OBJECTIVE: Comparison of COPD financial burden and underlying factors, between Eastern upper middle income and a Western European high income, healthcare settings. METHODS: The patient sample was 433 in Belgium and 322 in Serbia, age ≥ 40, with spirometry and clinically confirmed COPD diagnosis. Belgian trial followed patients prospectively during 2006, using structured survey of clinicians in charge. Serbian trial conducted in 2008, retrieved data from clinical invoice database. Time horizon was one year and perspective of third party payers was taken into account for both studies. Clinical outcomes of interest were disease exacerbation, hospital admission and death. Economic inputs referred to COPD-attributable medical services consumption value during observed period of time. RESULTS: Average annual cost was 1,812.84 € for the Serbian patients and 1,738.13 €/year for the Belgian patients (not including the value of laboratory diagnostics or imaging techniques). Severity grade and duration of hospital admissions significantly directly correlated with overall cost in both populations. Pattern of diagnostic procedures requested and ATC classes of drug consumed to treat COPD remains similar and comparable in both countries. GDP per capita ratio in respective years (10.4: 37.4), exhibits the paradox of patient being much less affordable to treat in a less developed society. CONCLUSIONS: Burden of COPD in Europe is huge and, due to contemporary life style expected to grow further. We compared cost of illness structures between two societies with different macroeconomic past in healthcare financing and management. According to our findings, direct medical costs were driven by exacerbations and hospital admissions. Significantly cheaper human labor caused higher relative relevance of drug acquisition expenses in the East and higher portion of hospital admission costs in the West. More in-depth research of indirect COPD attributable costs (e.g. lost productivity, absenteeism, premature death etc) will be needed in future. It implies serious health policy necessities to provide accessibility of care.

BackgroundThe aim was to identify potential risk factors for lethal outcome in patients with delirium tremens (DT) treated in the psychiatric setting.MethodsIn a nested case-control study, a total of 190 medical records of patients with DT hospitalized at the Psychiatric Clinic in Serbia between 2002 and 2011 were reviewed and analyzed. The characteristics of patients who died (cases) were compared with those who survived (controls). For each case, two controls (matched for age, gender, and year of hospitalization) were randomly chosen.ResultsSignificant differences between cases and controls were found for serum potassium levels (p < 0.001), the number of hospitalizations (p < 0.001), and duration of hospitalization (p < 0.001). A significant association with lethal outcome was found for serum potassium levels even in the normal range (adjusted odds ratio 40.52; 95% CI 1.20, >1,000.00; p = 0.004).ConclusionsEven though the number and duration of psychiatric hospitalizations were identified as factors determining survival after admission for DT, only serum potassium levels were found to be significant. Patients with an increase in potassium (or absence of hypokalemia) may require more intensive treatment. Monitoring of serum levels of potassium is important not only as an indicator for replacement but also as an indicator of maladaptation.