Đorđe Božović1, Nedeljka Ivković1, Maja Račić2, Siniša Ristić3 1University of East Sarajevo, Faculty of Medicine, Department of Oral Rehabilitation, Foča, Republic of Srpska, Bosnia and Herzegovina; 2University of East Sarajevo, Faculty of Medicine, Department for Primary Care and Public Health, Foča, Republic of Srpska, Bosnia and Herzegovina; 3University of East Sarajevo, Faculty of Medicine, Department of Basic Medical Sciences – Physiology, Foča, Republic of Srpska, Bosnia and Herzegovina

Maja N. Račić1, Srebrenka H. Kusmuk1, Srđan R. Mašić1, Nedeljka M. Ivković2, Vedrana R. Joksimović1, Jelena M. Matović1 1Department for primary health care and public health, Faculty of medicine, University of East Sarajevo, Bosnia and Herzegovina 2Department of Dentistry, Faculty of medicine, University of East Sarajevo, Bosnia and Herzegovina Impact of the physician-patient relationship on the treatment outcomes of arterial hypertension Оригинални радови / Original Articles

Ventilator-associated pneumonia (VAP) incidence, causative pathogens, and resistance patterns are different between countries and intensive care units (ICUs). In Europe, resistant organisms have progressively increased in the last decade. However, there is a lack of data from Serbian ICUs. The aims of this study were to evaluate etiology and antimicrobial resistance for pathogens causing VAP in ICU patients, to examine whether there were differences between pathogens in early-onset and late-onset VAP and to identify mortality in patients with VAP after 30 and 60 days of hospitalisation. A retrospective cohort study was conducted in the respiratory ICU and all adult patients diagnosed with VAP from 2009 to 2014, were included. Gram negative organisms were the major pathogens (80.3%). The most commonly isolated was Acinetobacter spp (59.8%). There was statistical significant increase in incidence of infection with Klebsiella pneumoniae (8.9% vs 25.6%, p = 0.019). Extensively drug-resistant strains (XDR) were the most common (78.7%). Late-onset VAP was developed in 81.1% of patients without differences between pathogens in comparison with early-onset VAP. Acinetobacter spp was susceptible to tigecycline and colistin with a significant increase in resistance to ampicillin/sulbactam (30.2% vs 58.6%; p = 0.01). Resistance rate of Pseudomonas aeruginosa and Klebsiella pneumoniae to carbapenems was 38% and 11%, respectively. In methicillin-resistant Staphylococcus aureus no resistance was observed against vancomycin and linezolid. In conclusion, Gram negative organisms were the primary cause of bacterial VAP of which the most common was the XDR strain of Acinetobacter spp. Patients with early- and late-onset VAP have the same pathogens.

Background/Aim. Early treatment failure (ETF) in patients hospitalized for community-acquired pneumonia (CAP) is associated with prolonged hospitalization, increased risk of mortality and high treatment costs. The aim of this study was to analyze relative importance of factors influencing ETF in hospitalized adult patients with CAP that are still insufficiently explored. Methods. A retrospective case-control study was carried out on a sample of 126 adult patients treated for serious CAP at the Clinic for Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia, during the 5-year period (2007-2011.). The cases (n=63) were consecutive patients with ETF, observed within the three days upon the admission to hospital, while the control group consisted of the equal number of randomly selected patients without such an outcome. The association between potential risk/protective factors and ETF was estimated using logistic regression analysis. Results. The coexistence of gastrointestinal disorders (adjusted OR 18.83, 95%CI 1.15-309.04), higher CURB-65 score on admission (adjusted OR 2.57, 95%CI 1.05-6.25), initial use of nonsteroidal anti-inflammatory drugs (NSAIDs) in hospital (adjusted OR 38.19, 95%CI 3.61-404.51) and previous outpatient use of inhaled corticosteroids(adjusted OR 22.41, 95%CI 1.03-489.06) were found to be significant risk factors for ETF. On the other hand, older age and use of antibiotics before the hospitalization were associated with a significantly lower chance of experiencing ETF, reducing the odds for 98% and almost 90%, respectively. Conclusions. The avoidance of routine in-hospital use of NSAIDs as well as outpatient use of appropriate antibiotics may be beneficial for patients hospitalized for CAP in terms of reducing risk of ETF. The CURB-65 score could be better predictor of ETF than Pneumonia Severity Index. Further prospective studies are required to confirm these findings.

Background/Aim. Acute pancreatitis is an inflammatory condition having the significant mortality rate in the case of severe forms of the disease. The aim of this study was to investigate putative factors of increased mortality in patients with acute pancreatitis with contradictory prior evidence, and to reveal factors that were insufficiently explored previously. Methods. This prospective cohort study with nested case/control design included all adult patients treated for acute pancreatitis in the Clinical Center of Kragujevac, Serbia, during the 3-year period (from October 2011 to December 2014). The cases (n = 19) were patients who died, while the controls (n = 113) were patients who survived. The associations between putative risk factors and the study outcomes were tested by univariate and multivariate logistic regressions, and expressed as crude and adjusted odds ratios (OR) with corresponding 95% confidence intervals (CI). Results. Significant association with the lethal outcome in acute pancreatitis was found for advanced age (adjusted OR 1.12, 95%CI 1.02–1.23), presence of significant comorbidities (adjusted OR 10.62, 95%CI 1.01–111.39), higher interleukin- 8 (IL-8) value on third day from onset of symptoms (adjusted OR 1.05, 95%CI 1.02–1.08), use of tramadol and/or morphine (adjusted OR 47.34, 95%CI 3.21–699.08), the Bedside index for severity in acute pancreatitis (BISAP) score ≥ 3 in the first 24 hours (adjusted OR 48.11, 95%CI 3.14–736.29), and prophylactic use of antibiotics (adjusted OR 0.07, 95%CI 0.01–0.85). Conclusion. Advanced age, significant comorbidities, use of tramadol and/or morphine and more severe disease as assessed by BISAP score can increase the risk of death in acute pancreatitis, while prophylactic use of antibiotics may have a protective role.

Background/aim. Ganaxolone is an allopregnanolone analogue devoid of hormonal activity which potentiates inhibitory action of GABA through positive allosteric modulation of GABA-A receptor. This review summarizes preclinical and clinical development of ganaxolone for treatment of epilepsy in children and adults. Methods. Published preclinical and clinical studies with ganaxolone were retrieved from multiple searches of MEDLINE and SCINDEKS databases of published scientific articles. Published European and USA patents with ganaxolone were also used as data source for writing this article, as well as the feedback from the company which is developing ganaxolone (Marinus Pharmaceuticals). Results. Ganaxolone prevented seizures in animal models of partial and generalized tonic-clonic seizures, while in the models of absence seizures it was either ineffective or prolonged spike wave discharge. Phase I clinical trials pointed to linear pharmacokinetics of ganaxolone, its high protein-binding and metabolism in the liver, and predominant excretion in feces. Ganaxolone showed certain efficacy as add-on therapy against partial seizures with or without secondary generalization in adult patients and a phase III clinical trial is currently being prepared to test ganaxolone in this indication. Although tried in several small studies on children suffering from infantile spasms, it failed to produce significant response. Conclusions. If future clinical trials confirm efficacy of ganaxolone as add-on therapy in adult patients with partial onset seizures, it could become useful adjunct to existing anti-epileptic therapy of patients who did not achieve satisfactory seizure control. [Projekat Ministarstva nauke Republike Srbije, br. 175007]

Background/Aim. Dental appearance plays an important role in practically all personal social interactions. The main factors that define the dental appearance are tooth colour, shape and position, quality of restoration, and the general position of the teeth in arch, especially in the anterior region. The aim of this study was to evaluate the impact of dental status (tooth shape, fracture, dental and prosthetic restorations and presence of plaque) on patient's satisfaction with the dental appearance, controlling for the age and gender. Methods. A total of 700 Caucasian subjects (439 women) aged 18-86 (median 45 years) participated in the cross-sectional study. Study included clinical examination and self-administrated questionnaire based on self-perceived aesthetics and satisfaction with the appearance of their maxillary anterior teeth. Results. A regression analysis demonstrated that presence of dental plaque, tooth fracture, composite fillings and crowns had significant independent contribution and were negative predictors of satisfaction with teeth appearance. Participants with presence of plaque on upper teeth (p < 0.001), fractures (p = 0.005), composite fillings (p < 0.001) and crowns (p = 0.032) were less satisfied than those without it. Model explains 12% or variance of general satisfaction with the appearance of maxillary frontal teeth (p < 0.001) and the major contributors are composite fillings (5.3%) and plaque (3.2%). Tooth shape, age and gender were not significant predictors of satisfaction. Conclusion. Satisfaction with the teeth appearance is under the influence of many factors with significant negative influence of presence of dental plaque, fractures, composite restorations, and crowns.

Aim: The objective of this study was to determine the oxidative status of saliva and plasma in diabetic children, by analyzing advanced oxidation protein products (AOPPs) and total antioxidant capacity (TAC). Materials and methods: Study included 60 patients with diabetes mellitus type I (DMT1) aged 12.45 ± 2.65 years, and 40 healthy age-matched controls. The AOPP and TAC of the plasma and saliva samples were determined using a commercial QuantiChromTM Antioxidant Assay Kit (DTAC-100) for TAC determination, and Immunodiagnostic AG [enzyme-linked immunosorbent assay kit for AOPP]. Results: Values of salivary and plasma AOPP were lower in diabetic patients than in healthy controls, while value of TAC was clinically and significantly higher in plasma of controls, and clinically higher in saliva of healthy control group, compared with diabetic patients. Average value of hemoglobin A1c (HbA1c) was 7.58 ± 0.85%. Conclusion: Results of this study showed that diabetes mellitus as a condition, with well-controlled HbA1c, has no influence on AOPP levels in saliva and plasma, while TAC levels of saliva and plasma are lower in diabetic patients, which means that DMT1 has an influence on the TAC.

Kosana D. Stanetić1, Suzana M. Savić1, Bojan M. Stanetić2, Olja M. Šiljegović3, Bojana S. Đajić4 1Primary Health Center Banja Luka, Department of family medicine, Medical faculty, University of Banja Luka, Bosnia and Herzegovina 2Department of Cardiology, University Clinical Center of the Republic of Srspka, Banja Luka, Bosnia and Herzegovina 3Primary Health Center Doboj, Bosnia and Herzegovina 4Primary Health Center Gradiška, Bosnia and Herzegovina The prevalence of polypharmacy in elderly: a cross section study from Bosnia and Herzegovina Оригинални радови / Original Articles

A prospective study, which lasted from September 2014 to October 2016, covered the subjects who were examined for various benign tumor changes on the skin. The examinees were divided into 2 groups. The first group A (92 examinees) was composed of the examinees who inhabited a rural area. The second group B (98 examinees) was consisted of examinees who lived in an urban environment. The analyzed examinees gravitate towards rural and urban areas of Banja Luka, Gradiska, Stanari, Prijedor and Teslic in Bosnia and Herzegovina. The aim of this study is to analyze the attitude of examinees from rural and urban areas towards skin tumors. Parameters that were used for comparison of results are: personal attitude to skin tumors and previous skin examinations. There was no statistically significant difference in terms of prejudices among the respondents: that there is no risk of skin cancer, if a person is not exposed to the sun, and/or if changes in the skin are innate, as well as in the number of examinees who said they were not afraid of a skin tumor. In group A the number of examinees that have no opinion about skin tumors is three times higher, while in group B the number of examinees who said that they had a phobia of skin cancer is three times higher. It turned out that regular self-examination of the skin in group A is performed only by 7 (7.6%) examinees, while in group B it is done by 21 (21.5%) examinees, which proved to be statistically significantly different. Occasionally skin examination by a specialist family doctor (and/or a dermatologist) has been performed by 3 (3.3%) examinees of group A and 10 (10.3%) from group B. 4 (4.1%) examinees from group B and no one from group A perform dermoscopic examination occasionally. It was found that regular dermoscopy inspections or skin examinations by a specialist family doctor and/or dermatologist have not been done by any examinees from both analyzed groups. Attitude toward skin tumors of group A is more leisurely (less responsible), so for that group there is a possibility of higher risk degree for late diagnosis of malignant skin tumors.