Improved methods for targeting HIV testing among patients most likely to be infected are required; HIDES I aimed to define the methodology of a European wide study of HIV prevalence in individuals presenting with one of eight indicator conditions/diseases (ID); sexually transmitted infection, lymphoma, cervical or anal cancer/dysplasia, herpes zoster, hepatitis B/C, mononucleosis-like illness, unexplained leukocytopenia/thrombocytopenia and seborrheic dermatitis/exanthema, and to identify those with an HIV prevalence of >0.1%, a level determined to be cost effective. A staff questionnaire was performed. From October 2009– February 2011, individuals, not known to be HIV positive, presenting with one of the ID were offered an HIV test; additional information was collected on previous HIV testing behaviour and recent medical history. A total of 3588 individuals from 16 centres were included. Sixty-six tested positive for HIV, giving an HIV prevalence of 1.8% [95% CI: 1.42–2.34]; all eight ID exceeded 0.1% prevalence. Of those testing HIV positive, 83% were male, 58% identified as MSM and 9% were injecting drug users. Twenty percent reported previously having potentially HIV-related symptoms and 52% had previously tested HIV negative (median time since last test: 1.58 years); which together with the median CD4 count at diagnosis (400 cell/uL) adds weight to this strategy being effective in diagnosing HIV at an earlier stage. A positive test was more likely for non-white individuals, MSM, injecting drug users and those testing in non-Northern regions. HIDES I describes an effective strategy to detect undiagnosed HIV infection. All eight ID fulfilled the >0.1% criterion for cost effectiveness. All individuals presenting to any health care setting with one of these ID should be strongly recommended an HIV test. A strategy is being developed in collaboration with ECDC and WHO Europe to guide the implementation of this novel public health initiative across Europe.

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.

Acrylic based resins are frequently used in daily dental practice. The most common use of the materials includes denture bases and denture liners, temporary crowns and orthodontic appliances. In the mouth, properties and functional efficiency of applied acrylic resins depend on internal factors related to the methods and conditions of polymerization and on external factors that are related to the environment in which the material is placed. Residual monomer, which is released as a result of interaction of both sets of factors is often associated with irritation, inflammatory and allergic reactions of oral mucosa. The aim of this paper is to review literature dealing with the conditions of polymerization and biodegradation of acrylic resins under certain conditions in the oral cavity and their impact on oral health (reviewed literature available on Medline database during the past two decades.) Conclusion: Methods and conditions of acrylate polymerization, on the one hand, and properties of saliva, chewing and the presence of microorganisms in the oral cavity, on the other hand, can be considered responsible for the release of residual monomers. Clinically significant events followed by redness and erosion of the oral mucosa, burning sensation and burning mucosa and tongue, may be due to the effects of released, potentially cytotoxic, residual monomers.