Introduction Pseudomonas aeruginosa is well-known cause of hospital infections with high morbidity and mortality rates [1]. According to the National Nosocomial Infections Surveillance System (NNISS), P. aeruginosa is responsible for approximately 8% of all hospital infections. It was the most frequent cause of ventilator-associated pneumonias (VAP), the fourthrated on the list of causes of hospital urinary infections, and fifth cause of surgical site infections according to frequency of occurence (2). Infections caused by P. aeruginosa are difficult to control and treat due to its high rate of resistance to antibiotics and to the limited number of available antibiotics with efficacy against P. aeruginosa. During the last decade, an increase in resistance to imipenem and meropenem was observed among many strains of Gram-negative bacteria, and especially among isolates of P. aeruginosa [3,4,5]. Numerous studies have also shown that carbapenem-resistant P. aeruginosa (CRPA) is frequently simultaneously resistant to other antipseudomonal antibiotics, making the treatment very difficult [6]. A number of risk factors for the emergence of CRPA-caused hospital infections was identified, including spending time in an intensive care unit and/or prior use of certain antibiotics [7,8,9,10]; however, for the majority of factors, the strength of the association was either low or equivocal. Sound knowledge of the risk factors and quantification of their influence on hospital infections are important for proper prevention and treatment of the CRPA-caused nosocomial infections. The aim of this study was to identify risk factors associated with the CRPA-caused hospital infections.

Communication process gives to physician necessary information for establishing diagnosis and prescribing therapy, and helps to a patient to gain confidence in his doctor and the prescribed treatment. The communication between doctor and his patient is enhanced by the following: openness and conscientiousness of the physician, serious approach to the patient, participation of the patient in decision-making, advanced age and higher education of the patient. On the other hand, communication is less efficient if the doctor has longer employment status, if he/her avoids disclosure of all relevant information to the patient, if he/her is emotionally separated from the patient, if the time for an encounter is limited, if the patient is passive and with unrealistic expectations, and if the doctor is expressing himself/herself unclearly.   In order to improve communication with patients, doctors should follow these recommendations: keeping eye contact with a patient, releasing tension from his/her body language, taking detailed patient history with active listening and without interrupting of a patient, speaking clearly and slowly, using language understandable to a patient, treating patients with equality, disclosing all relevant information to the patient and sharing decision-making with the patient. Adequate communication between doctor and patient always brings better treatment outcomes.

Urinary tract infections are common bacterial diseases and also a frequent reason for prescribing antibiotics. Knowledge about the type of pathogens and their resistance patterns may help the clinician to choose the correct treatment. In this study, the prevalence and the resistance pattern of the main bacteria responsible for urinary tract infections оf hospitalized patients in Clinical centar Kragujevac was evaluated throughout a tree-year period. Cross-sectional study in the hospital settings was conducted and urine samples were collected from 662 patients with urinary tract infections and tested using standard procedures. The disk-diffusion method on Mueller-Hinton agar according to Clinical and Laboratory Standards Institute guidelines (CLSI) was performed for assessment of antimicrobial susceptibility. The most frequently isolated pathogen were Klebsiella spp. (219 isolates, i.e. 33,1%), Proteus mirabilis (107 isolates, i.e. 16,2%), Enterobacter (86 isolates, i.e. 13%), Escherichia coli (82 isolates, i.e. 12,4%), Pseudomonas aeruginosa (70 isolates, i.e. 10,6%), Enterococcus spp (39 isolates, i.e. 5,9% ) and Proteus vulgaris (38 isolates, i.e. 5,7%). Group of patients older than 65 years was the largest one 426 (64,4%). Gram negative bacteria showed the highest degree of resistance (92.3% - 100%) to penicillins (ampicillin, amoxicillin, amoxicillin + clavulanic acid) and third-generation cephalosporins (cefotaxime, ceftriaxone and ceftazidime) (88.3% - 98, 4%), while Gram positive Enterococcus spp showed the highest degree of resistance to aminoglycosides (gentamicin and amikacin) (96.8% - 100%) and fluoroquinolone ciprofliksacin (100%). The lowest resistance rate of the studied Gram negative pathogens was to carbapenems (imipenem and meropenem) and piperacillin / tazobactam (6.9% - 35.5%), while the lowest level of resistance of gram positive Enterococcus spp was found to glycopeptide antibiotics (vancomycin and teicoplanin) (3.0% - 3.3%). When choosing antibiotics, the pharmacokinetics and pharmacodynamics, renal and liver function, adverse reactions with other drugs, as well as the results of susceptibility testing should be taken into consideration. According to our data, empiric treatment for Klebsiella spp, Proteus mirabilis, Enterobacter, Escherichia coli, Pseudomonas aeruginosa and Proteus vulgaris should include carbapenems or piperacillin / tazobactam, and when it comes to Enterococcus spp , glycopeptide antibiotics are appropriate choice.

INTRODUCTION Almost all individual antipsychotics are classified into the intermediate pregnancy risk category as no or limited data exist about human pregnancy outcomes. We presented the case of zuclopenthixol decanoate using in two successive pregnancies of the same woman, which had not been published in the available peer-reviewed literature. CASE REPORT A middle-age female subject who suffered from schizophrenia received zuclopenthixol decanoate injection during her two consecutive pregnancies. About four and a half months before diagnosis of the first pregnancy (to approximately 3.5 years after psychosis emergence), zuclopenthixol decanoate (400 mg every other week, im injection) was introduced to the treatment protocol (due to previous non-compliance with haloperidol and risperidone). A significant clinical improvement was achieved and the dose during pregnancy was reduced to 200 mg once monthly and maintained to date. In both pregnancies the women gave birth to healthy girls who have been developing normally until now, at their ages of 6 months and of 3.5 years. During pregnancy and after giving birth to children the mothers' psychiatric status and her social functioning were significantly improved and are still stable. Close monitoring of the mother's health, a multidisciplinary approach to both her treatment and the monitoring of pregnancies as well as the complete compliance with the prescribed drug protocol were likely to be crucial for the therapeutic success. CONCLUSION A favorable outcome of the present case suggests that the zuclopenthixol decanoate is a rational therapeutic option for pregnant women suffering from psychosis when the expected benefit exceed the potential risk, but a definitive evidence for its safety requires large, controlled studies.

This article reviews a population pharmacokinetics studies conducted during the past few years in Serbia. Studies have included three the most frequently used antiepileptic drugs (valproate, carbamazepine and lamotrigine) and different populations of epileptic patients: children, adults and heterogeneous population composed of both children and adults. The review compares obtained values of population pharmacokinetic models of clearance of these drugs, and factors that are significantly determined, making brief comments on the results of other authors on the same topic. Individualization of drug dosage is the basis of rational therapy, and factors of variability will always be subject of scientific research.

Considering high prices of biologic drugs, using a cost-effective option for treatment of patients with rheumatoid arthritis who did not respond well to first biologic drug would have highly beneficial impact on health insurance budget. The aim of this study was to explore impact on budget of Republic Fund for Health Insurance (RFHI) caused by replacing etanercept with rituximab for treatment of rheumatoid arthritis patients who failed to respond to the first-line biologic drug. A Markov model with 5 states was constructed, having eight 6-months cycles. The perspective of the RFHI was used in the model, and annual savings in Serbia caused by using rituximab instead of etanercept were calculated. Using rituximab instead of etanercept for treatment of 20% of rheumatoid arthritis patients who failed to respond to the first-line biologic drug in would lead to absolute annual savings of 144,115,218.09 ± 431,906,009.46 RSD. The annual drug budget of RFHI would be decreased for 0.24 ± 0.73 %, while total annual budget of RFHI would drop for 0.07 ± 0.21 % . Based on the results of our study, using rituximab instead of etanercept for treatment of rheumatoid arthritis patients who failed to respond to the first-line biologic drug is a cost-effective option in Serbia, which would bring significant savings to RFHI.

IntroductionDuring normal pregnancy there are significant changes in hypothalamic-pituitary-adrenal axis, with increased levels of plasma cortisol and adrenocorticotropic hormone which sometimes reach values observed in patients with Cushing’s syndrome. Cushing’s syndrome (CS) is rarely encountered during pregnancy, but is associated with serious maternal and fetal complications.Case presentationA 31-year-old female was admitted to our institution four weeks after delivery. Physical examination revealed moon face, purple striae throughout the abdomen, bruising over the legs, a dorsocervical fat pad and hirsutism. She delivered a eutrophic preterm newborn at 34 weeks gestation, without any maternal or fetal complications during delivery. Imaging showed a mass in the right suprarenal gland with a normal pituitary. After four weeks the patient underwent a right adrenalectomy. The mass was eventually identified as an adrenocortical adenoma.ConclusionIn our case the diagnosis of CS was established only after pregnancy, which enabled the development of numerous adverse consequences secondary to increased plasma cortisol. If CS is recognized during pregnancy, treatment and its timing could be carefully chosen according to the patient’s individual characteristics.