Introduction. Lower leg fractures are most frequent of all fractures of long bones because a lower leg is very exposed part of a leg, especially it is anteromedial side of tibia, located immediately under skin. Aim of this paper is to analyse results of teatment of open and closed diaphysial tibial fractures using method of external fixation. Patients and methods. We analyzed the results of treatment of open and closed diaphysial tibial fractures using method of external fixation at Department of Ortopedics od Doboj hospital in period from 2005 until 2009. All patients with open fractures been treated first with surgical treatment of the wound up to 8 hours and with installation of external fixator. Patients with closed fractures which did not have satisfactory reposition have been installed external fixator which was worn from 4 to 8 weeks and then taken off, they have been applied a closed lower leg walking cast which was worn pending fracture healing verified by a clinical and xray examination. Patients in wich there was no healing process have undergone a subseqent surgical treatment which in all cases was positive. After surgical treatment all patients were sent for physical therapy. Results. Out of 124 patients with diaphysial tibial fractures, 56 (45,2%) were with open fractures and 68 of them (54,8%) were with closed fractures. After a primary treatment, there were 49 (87,5%) open fractures and 39 (57,4%) closed fractures with complications. Conclusion. Treatment of closed and open diaphysial tibial fractures by means of external fixation in open fractures as standard and selected closed fractures have shown good results with a small number of complications which were removed by a second surgical teatment. This method of treatment fractures is recommendable method in a primary as well as in final treatment of these fractures due to a positive treatment outcome.

INTRODUCTION: Internet addiction is a topic that is widely debated in scientific circles and the media. Students spend a lot of time in content-related activities online, neglecting common activities such as socializing, business obligations, learning, home affairs, etc., and have difficulty interrupting internet activities, even when they themselves recognize it is time for it. AIM: The aim of this research was to investigate Internet addiction among students of the Medical Care, Faculty of Medicine in Foca. MATERIAL AND METHODS: The research was conducted at the Medical Faculty in Foca in the period from 07.11. until 09.11.2016. year with health care students. The selected study design is a cross section study. The study covered 60 students, the first, second and third year of studies that were present on the days of the study and volunteered to participate in the research. RESULTS: The survey involved 60 respondents, of whom 21 are men (35%) and 39 women (65%), ages 18 to 24 years old. All of our respondents are Internet users. The largest percentage of respondents (66.7%) use the internet for 2 to 4 hours. The largest number of respondents first accessed the Internet at the age of 13 (21.7%). Most respondents use Facebook as a social network 56 (93.3%), while the least number of Twitter users. CONCLUSION: All of our respondents are Internet users, and the largest percentage of respondents (66.7%) use the internet for 2 to 4 hours. The largest number of respondents first accessed the Internet at the age of 13 (21.7%).

According to the World Health Organization, quality communication is one of the five skills that individuals need for a healthy and happy life, and the knowledge and skills of quality communication are a prerequisite for quality action for many professions. In order for healthcare professionals to tailor health communication to each patient individually and to provide high quality healthcare, it is essential that they have an insight into the health literacy status of their users. Given the large percentage of the illiterate population around the world, it is necessary to conduct health literacy research in some of our adapted measuring instruments in our country as well.

Objective: The primary aim of this study was to examine whether the perception of the patient’s disease and adherence to treatment process influence treatment outcomes of heart failure. The secondary aim was to analyze whether there were differences in perception and adherence in patients with heart failure in relation to anemia. Method. A cross-sectional study was carried out in 2015. One group consisted of 100 patients with heart failure and sideropenic anemia. The other group consisted of 100 patients without anemia. The standardized questionnaire was used to collect demographic data, the Brief Illness Perception Questionnaire to measure the patients’ perception of the disease and modified Clinician rating scale to assess patient’ s adherence. Results: The majority of respondents in the first group were women 63%, while in the second group there were 58% male and 42% female respondents. Respondents from the first group had statistically significantly lower adherence compared to respondents from the second group (χ2 = 23.28; p=0.05). A significant difference was found between the groups of subjects in comparison to the perception of disease control (χ2=18.03; p=0.05). Conclusion: The illness perception and treatment adherence have a significant impact on treatment outcomes of heart failure. Comorbidities, such as anemia, contribute to the patients’ perception of their disease and influence their adherence. Кey words: heart failure, sideropenic anemia, illness perception, adherence doi:10.5937/opmed1902029D

Background/Aim. Despite the widespread use of procalcitonin, C-reactive protein (CRP), and soluble CD14 subtype (sCD14-ST), their diagnostic accuracy in children with sepsis is not yet clear. The aim of the study was to establish and compare the diagnostic accuracy of procalcitonin, CRP, and sCD14-ST in children admitted to the hospital under suspicion of having sepsis. Methods. The study was designed as a retrospective cross-sectional study on children admitted to the Pediatrics Clinic in Kragujevac, Serbia, under suspicion of sepsis, during a 6-month period. Diagnostic accuracy was tested by the construction of receiver operating characteristic (ROC) curves and their comparison in terms of area under the curve (AUC). Results. Procalcitonin had the largest AUC [0.75; 95% confidence interval (CI) 0.63?0.88], followed by CRP (0.68; 95% CI 0.54?0.81) and sCD14-ST (0.65; 95% CI 0.52 ? 0.79). Differences between the areas under the ROC curves were not significant (CRP vs. procalcitonin z = 1.054, p = 0.291; CRP vs. sCD14-ST z = 0.238, p = 0.812; procalcitonin vs. sCD14-ST z = 1.089, p = 0.286). Conclusion. Our study showed relatively low sensitivity and moderate specificity of procalcitonin, C-reactive protein and sCD14-ST in diagnosing sepsis among children, as well as similar diagnostic accuracy of the three biomarkers.

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Drug-drug interactions (DDIs) with serious adverse consequences for patients at intensive care unit (ICU) occur with the prevalence of 5.3%. The aim of our study was to reveal the risk factors for potential DDIs among the ICU patients. This retrospective cohort analysis took place in the ICU of the Clinical Center Podgorica, Montenegro, between June 1, 2017 and September 30, 2018. The study was conducted as a chart review of the ICU patients (n = 99) who spent ≥ 2 days in the ICU. The main outcome measure was the number of DDIs per patient. Ninety-four percent of patients had at least one potential DDI, while 20% of patients had at least one potential DDI which required a change of therapy. The number of potential DDIs per patient according to the Medscape was 6.6 ± 9.1 and 3.8 ± 4.9 according to the Epocrates. A higher number of drugs (or therapeutic groups) prescribed per patient increased the number of potential DDIs, including those which required a change of therapy. The patients who were prescribed antiarrhythmics, anticoagulants or two antiplatelet drugs experienced more DDIs than patients without these therapeutic groups, while delirium, dementia and drug allergy were protective factors. The main limitation of our study was its uni-centerdness, which allowed for certain degree of bias. Routine screening of the ICU patients with high number of prescribed drugs who receive antiarrhythmics, anticoagulants or double antiplatelet therapy for potential DDIs may prevent a great deal of DDIs with potentially deleterious effects.

Pandrug-Resistant Pseudomonas Aeruginosa Isolated from Qualitative Endotracheal Aspirate Could Rather be Contaminant than Causative Agent of Respiratory Infections in Intensive Care Unit Patients: Case Study A Slobodan M. Janković1,2, Zorana М. Đorđević2, Danijela B. Jovanović2, Tatjana V. Vulović1,2 A 1 Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia 2 Clinical Center Kragujevac, Serbia

Background/Aim. There are several questionnaires for measuring intensity of nausea after drug administration, but they are either too settings specific (like those measuring chemotherapy-induced nausea), or they were not properly tested for reliability and validity. The aim of this study was to develop and validate a reliable instrument that can measure drug-induced nausea. Methods. The cross-sectional study for assessing reliability and validity of a questionnaire was performed. The questionnaire with 5 items and answers according to the Likert?s scale was developed during two brainstorming sessions of the research team. Its reliability, validity and temporal stability were tested on the sample of 128 outpatients taking iron salts orally. Results. The final version of the Drug-Induced Nausea Scale (DINS) with 5 items showed excellent reliability, both when rated by the investigators (Cronbach?s alpha 0.892) and by the patients themselves (Cronbach?s alpha 0.897). It was temporally stable, and both divergent and convergent validity tests had very good results. Factorial analysis revealed only one factor, which means that the whole scale is measuring only one phenomenon, intensity of nausea, as was originally intended. Conclusion. The DINS is reliable and valid instrument for measuring intensity of drug-induced nausea. Identification of patients with high intensity of druginduced nausea by this questionnaire will help prescribers to decide whether the therapy should be stopped or the patient switched to less emetogenic therapy.

Background/Aim. The Headache Under-Response to Treatment (HURT) questionnaire and the Migraine Disability Assessment Test (MIDAS), which are intended for assessing the headache-related disability, impact (MIDAS) and management (HURT), were not yet translated to Serbian and validated in the population of Serbia. The aim of this study was to translate the HURT and MIDAS from English to Serbian, to make necessary cultural adaptations and to test their psychometric properties in a sample of outpatients with the headache. Methods. The HURT and MIDAS questionnaires were translated and adapted according to the internationally accepted guidelines, and then tested on a sample of Serbian patients with various headache types. Internal consistency was checked through the calculation of Cronbach?s alpha for the questionnaires, and by correlation of each question with the corrected total score. The criterion validity of the translation was tested by correlating scores of individual items, domains and whole questionnaire with the headache characteristics (severity, duration, frequency), and convergent validity was tested by correlating the abovementioned scores with results of an instrument for measurement of headache-related quality of life. Results. There were 171 (79.2%) females and 45 (20.8%) male study participants. The mean age of the patients was 42.3 years, (standard deviation ? SD 13.35; range 18?75); 27 (12.5%) suffered from a migraine and 189 (87.5%) from the episodic tension-type headache (TTH). The Serbian translation of HURT and MIDAS questionneires showed excellent internal consistency, with high values of the Cronbach?s alpha: 0.764 and 0.731, respectively. The validity of the instruments in all aspects (criterion, convergent and discriminant validity) was also excellent for the whole sample and for the subgroup of patients with TTH, while the results for the patients with the migraine were less favorable. The factor analysis suggested the existence of one domain of MIDAS and two domains of HURT questionneires. Conclusion. The Serbian translations of HURT and MIDAS could be used as the reliable and valid specific instruments for measuring a headache-related disability, impact (MIDAS) and management (HURT) in the patients with TTH and probably in the patients with the migraine.

Background/Aim. Inappropriate prescribing of antibiotics to the patients with acute bronchitis is frequent event in clinical practice with potentially serious consequences, although majority of treatment guidelines do not recommend it. The aim of this study was to reveal risk factors associated with inappropriate prescribing of antibiotics to the patients with acute bronchitis in primary healthcare. Methods. This case/control study included the adult patients with acute bronchitis during the initial encounter with a general practitioner. Prescription of an antibiotic was an event that defined the case, and patients without prescribed antibiotic served as controls. Results. Antibiotics (mostly macrolides and beta-lactams) were prescribed to the majority of patients with diagnosis of acute bronchitis (78.5%). A significant association was found between antibiotic prescription rates and patient age, whether an attending physician is a specialist or not and the average number of patients a physician sees per day [ORadjustedwas 1.029 (1.007?1.052), 0.347 (0.147?0.818) and 0.957 (0.923?0.992), respectively]. Conclusion. When there is primary care encounter with patients suffering from acute bronchitis, older patients are more likely to receive inappropriate antibiotic prescription, especially if their physician is without specialist training and has less patient encounters in his/her office daily.