During the process of developing herbal drugs with antimicrobial action, one of the most important phases is testing of antimicrobial activity in vitro. The disk-diffusion method is performed in Petri dish, on solid feeding surface. The disks with definite concentrations of antibiotics, pure substances or plant extracts are placed on the top of feeding plates previously inoculated with pure bacterial culture. Growth of the bacterial culture depends on its susceptibility to a tested substance; if the substance has antibacterial effect, a clear zone free of bacteria will form around the disk. Minimal inhibitory concentration (MIC) of the tested substance is determined by extrapolation of the regression line: concentration of the tested substance/radius or surface of area where growth of bacteria was inhibited. This method of testing microbial susceptibility to antibiotics, pure substances or plant extracts is highly sensitive and specific.

High prevalence of metabolic syndrome in children and adolescents is seriuous problem of modern society. In order to prevent development of possible complications (cardiovascular diseases and diabetes mellitus type 2) later in life, early recognition of children at risk for developing metabolic syndrome is of great importance. Previous differences in criteria for diagnosis of metabolic syndrome in children and adolescents have been significantly decreased by new criteria issued by the International Diabetes Federation. From the aspect of prevention, key elements are proper nutrition and regular physical activity. In a view of treatment recommendations, initial steps should be regulation of energy balance in the diet and increase in physical activity; the drug treatment is reserved for patients with high risk of complications.

Congenital anomalies are the cause of 20.0-25.0% of cases of perinatal death, while 3.0% of children are born with malformations of varying size. We examined the predictive values and defined the credibility ratio of the combined test results. Sensitivity of the test is 94.0%, and specificity is 99.0%. The positive likelihood ratio [likelihood ratio test (LR+)] is 94.00; a negative likelihood ratio [likelihood ratio test (LR-)] is 0.06. The pretest probability that pregnant women carry a fetus with chromosomal abnormality is 1:250. Posttest odds after the combined test to discover this abnormality are 0.3760, and probability of the same case is 0.2732 if it happens that the test result is positive. The result of our study confirms the justification of combined test usage in routine clinical practice, since the posttest odds rate in the case of a positive screening increases several times over (almost 90 times); the probability of detecting a chromosomal abnormality was about 70 times.

PIH12 GOLD STAGE AND DURATION OF HOSPITAL ADMISSION DETERMINES SIZE AND STRUCTURE OF COPD RELATED DIRECT MEDICAL COSTS IN ELDERLY Jakovljevic M, Lazic Z, Jankovic S, Verhaeghe N, Annemans L The Medical Faculty University of Kragujevac, Kragujevac, Serbia; Clinical Center Kragujevac, Kragujevac, Serbia; Ghent University, Ghent, Belgium; Ghent University—Brussels University, Ghent, Belgium OBJECTIVES: COPD cost of illness assessment and its dependence on GOLD stage or duration of hospital admission. METHODS: The sample consisted of 186 elderly COPD patients. Chest physicians conducted follow-up and fi nancial data were obtained from administrative registry. Time horizon was one year and Health Insurance Fund perspective was selected. Included clinical endpoints were disease exacerbation and hospital admission. Economic data included all inpatient COPD-related medical goods and services consumption, and outpatient drug utilization. We excluded medical costs which did not arise from COPD. RESULTS: An average elderly COPD patient imposed c1745.41 of costs annually to the national health care budget. Severity grade (GOLD stage) and duration of all hospital admissions were signifi cantly and directly correlated with overall cost. Expenses structure per year was: c14.54 outpatient care, c126.97 inpatient drug consumption, c377.98 hospital admission (Intensive Care Unit admissions and specialist consultations included in daily price), c133.5 imaging diagnostics, c111.43 laboratory analysis, c26.67 therapeutic interventions, c70.32 consumables, c884 outpatient drugs consumption. Most expenses originating from drug acquisition were due to antibiotics prescribed for curing infections and mucolitics and antihistamine drugs consumption. Average number of hospitalizations per person was 1.45 with a duration of 12.84 days. Fifteen persons deceased. Average number of outpatient visits was 2.71 per person. CONCLUSIONS: Overall burden of COPD is mostly driven by outpatient drug consumption and exacerbations leading to hospital admissions. Relative relevance of drug acquisition expenses in our country is higher than in high-income societies, because of still signifi cantly lower human labour wages in the area. Pattern of diagnostic procedures requested and ATC drug classes consumed remains similar and comparable in most countries. More in-depth research of indirect COPD attributable costs e.g. lost productivity, absentism, premature death etc, will be needed in the future.

To accomplish therapeutic goal it is necessary to adjust the dose of medication to be right for every single patient. This procedure of dose adjustment is individualized dose regimen. First of all, pharmacokinetic aspects should be revised, including parameters such as resorption, distribution, metabolism and secretion of drug. For these purposes, the authors developed and clinically assessed the modified Bayesian method supported by original basic computer program. The aim of research was to compare frequency of adverse events in cases of individualized and empiric dose regimens of amitriptyline in the treatment of major depressive episode. Sixty subjects (32- 65 years old), with major depressive disorder (International Classification of Disease, 10th revision), were randomly assigned and single- blinded to take individualized (experimental group, n=30) or empiric (control group, n=30) doses of amitriptyline for 8 weeks. CGI scale and originally designed questionnaire were used for adverse events assessment. In experimental group, 69 complaints on nine different types of adverse effects were recorded during eight-week treatment period. Severe adverse events, such as confusion or arrhythmia, were not registered in this subgroup. In control group, 111 complaints on twelve different types of adverse effects were recorded. Most common were anticholinergic effects, but during the third and fourth week from baseline, some severe adverse events were observed: tremor (16%), fatigue (16%), in one of the subjects confusion occurred and arrhythmia in another. Analyzing of the results according to CGI scale for adverse events showed that, during the treatment period, adverse events were less frequent in experimental group. This was particularly obvious in the first four weeks of treatment, when statistically significant difference (p<0.05) was observed.

The mortality rate from cardiovascular diseases is high in Serbia. Analysis of antihypertensive drugs utilization is the basis for assessment of cardiovascular pharmacotherapy appropriateness. The aim of this study was to analyze the trend in antihypertensive drugs utilization among outpatients in Niš region, South Serbia compared to some Nordic countries (Norvay, Sweden) and Australia as well as to analyze trends in educational and drug promotion activities directed to primary healthcare workers within the same region. Using the ATC/DDD methodology, we analyzed the utilization of antihypertensive drugs dispensed on prescription in the Nis region over the 2003–2007 period. The study was retrospective, based on data obtained from Central City Pharmacy Nis. Educational and drug promotion activities were noted from the records of Medical Faculty, University of Nis, and from the records of local branches of pharmaceutical companies active in Serbia. Wilcoxon’s test was used in order to calculate the statistical significance of difference. A significant increase of 79.8% (153.8/ 276.6 DDD/inhabitants/day) in antihypertensive drug consumption was observed in the same period. This analysis showed there were substantial increases in the use of diuretics (134.7%), ACE inhibitors (79.5%) and calcium channel blockers (116.1%), especially amlodipin (241.2%). During the observed period, annual numbers of educational activities and of pharmaceutical sales representatives employed within the region increased for almost one fourth. This analysis pointed to a significant increase in the use of antihypertensive drugs in the Nis region, which was matched with increase in educational and drug promotion activities within the region, so that in 2006–2007 total consumption was approximate to some referential countries (Norvay, Sweden).