Browsing by Author "Babić, Dragan (7102518871)"

Background. High consumption of benzodiazepines (BDZ) occurs in populations exposed to stress. In the last decade of the 20th century, when the population of Serbia experienced increasing economic hardships due to the civil war in former Yugoslavia, UN sanctions and air raids in 1999, diazepam became the most frequently prescribed drug. This period was also characterized by the free marketing of all drugs, which made them available without prescription. Objective. To investigate the consumption and the pattern of use of BDZ in the population of Belgrade and Serbia in the period of 1990-2001. Materials and Methods. Data on benzodiazapines prescribing and on wholesale in general population of Belgrade and Serbia were collected. In a cross-sectional study of drug prescribing in general practice data were obtained from 1800 patient records in the primary health care centers in Serbia. Statistical analysis was performed by using standard non-parametric tests. Results. Annual rates of BDZ prescribing in Belgrade from 1990 to 1999 were rather uniform (approx. 25 DDD/1000 inhabitants/day), with slight tendency to decrease. In Serbia as a whole, there were significant differences in the annual prescribing rates over the period 1998-2000. The wholesale of BDZ in Serbia significantly increased between 1991 and 2001, with the peak of 133 DDD/1000 inhabitants/day in 1999. The wholesale of BDZ was significantly greater that the rates of prescribing in corresponding years. Over the 10 year period, the numbers of visits to GPs and psychiatrists and the number of neurotic diagnoses were significantly reduced. The use of BDZ in psychiatric hospital increased significantly in 1999 as compared to 1998, although the number of admissions and the occupancy of hospital beds were reduced. In primary health care, diazepam was the most frequently prescribed drug predominantly for non-psychiatric diagnoses. Conclusions. It is concluded that in the last decade, the utilization of BDZ was increased in the population of Belgrade and Serbia, indicating a clear trend to self-medication, particularly in the period of acute war crisis. Copyright © 2004 John Wiley & Sons, Ltd.

Between February 1992 and November 1996 we treated 30 newly diagnosed acute promyelocytic leukaemia (APL) patients either with oral all-trans- retinoic acid (ATRA) alone (45 mg m-2) or with a simultaneous combination of ATRA (45 mg m-2), daunorubicin (DNR, 50 mg/m-2 for 3 days) and cytosine arabinoside (ARA-C, 200 mg m-2 for 7 days). There were 15 patients in each group. Patients with a white blood cell count < 5 x 109/1 at diagnosis received only ATRA as an induction therapy. Patients with initial white blood cell count > 5 x 109/1 received a combination of ATRA, DNR and ARA-C as an induction therapy. Within the first 20 days of induction, there were two early deaths in the group of patients receiving only ATRA, and six early deaths in the group of patients treated with a combination of ATRA and chemotherapy. Ten out of 13 patients (76.9%) receiving ATRA only achieved complete remission (CR) whereas seven out of nine patients (77.8%) receiving ATRA with chemotherapy achieved CR. Initial median peripheral white blood cell counts were significantly lower in the group of patients treated with ATRA alone (2.3 x 109/1) than in the group of patients receiving ATRA and chemotherapy (14.0 x 109/1). Morphological evidence of differentiation was noted in all patients entering CR. Patients in both groups who achieved CR received one course of standard '3+7' chemotherapy (DNR 45 mg m-2,1-3 days, ARA-C 200 mg m-2, 1-7 days) followed by two courses of standard '2+5' chemotherapy (DNR 50 mg m-2 1-2 days, ARA-C 200 mg m-2 1-5 days) as a consolidation therapy. Patients not achieving remission (three out of 13 in the ATRA group and two out of nine in ATRA+chemotherapy group) did not respond to salvage chemotherapy and all died within 3 months of diagnosis. Only one out of 10 patients (10%) in CR, treated with ATRA is in relapse after 18 months. In patients treated with ATRA alone two out of 10 (20%) survived 58 months following diagnosis whereas in the ATRA+chemotherapy group one out of seven has already survived their 58th month since diagnosis. Four out of eight patients with an early death died of retinoic acid syndrome. Other toxicities due to ATRA were minimal (cheilitis, xerosis, dermatitis, diarrhoea, liver damage or pseudotumor cerebri).

Between February 1992 and November 1996 we treated 30 newly diagnosed acute promyelocytic leukaemia (APL) patients either with oral all-trans- retinoic acid (ATRA) alone (45 mg m-2) or with a simultaneous combination of ATRA (45 mg m-2), daunorubicin (DNR, 50 mg/m-2 for 3 days) and cytosine arabinoside (ARA-C, 200 mg m-2 for 7 days). There were 15 patients in each group. Patients with a white blood cell count < 5 x 109/1 at diagnosis received only ATRA as an induction therapy. Patients with initial white blood cell count > 5 x 109/1 received a combination of ATRA, DNR and ARA-C as an induction therapy. Within the first 20 days of induction, there were two early deaths in the group of patients receiving only ATRA, and six early deaths in the group of patients treated with a combination of ATRA and chemotherapy. Ten out of 13 patients (76.9%) receiving ATRA only achieved complete remission (CR) whereas seven out of nine patients (77.8%) receiving ATRA with chemotherapy achieved CR. Initial median peripheral white blood cell counts were significantly lower in the group of patients treated with ATRA alone (2.3 x 109/1) than in the group of patients receiving ATRA and chemotherapy (14.0 x 109/1). Morphological evidence of differentiation was noted in all patients entering CR. Patients in both groups who achieved CR received one course of standard '3+7' chemotherapy (DNR 45 mg m-2,1-3 days, ARA-C 200 mg m-2, 1-7 days) followed by two courses of standard '2+5' chemotherapy (DNR 50 mg m-2 1-2 days, ARA-C 200 mg m-2 1-5 days) as a consolidation therapy. Patients not achieving remission (three out of 13 in the ATRA group and two out of nine in ATRA+chemotherapy group) did not respond to salvage chemotherapy and all died within 3 months of diagnosis. Only one out of 10 patients (10%) in CR, treated with ATRA is in relapse after 18 months. In patients treated with ATRA alone two out of 10 (20%) survived 58 months following diagnosis whereas in the ATRA+chemotherapy group one out of seven has already survived their 58th month since diagnosis. Four out of eight patients with an early death died of retinoic acid syndrome. Other toxicities due to ATRA were minimal (cheilitis, xerosis, dermatitis, diarrhoea, liver damage or pseudotumor cerebri).

Objective: To characterize the antitoxoplasma activity of clindamycin in a murine model of acute toxoplasmosis. Methods: Rates of survival and mean survival times of Swiss Webster mice infected intraperitoneally with 106-102 tachyzoites of the RH strain of Toxoplasma gondii treated with clindamycin or sulfamethoxazole (positive control) or untreated (negative control) were compared. Survivors were submitted to examination of untreated brain tissue preparations, intraperitoneal and peroral subinoculations of brain tissue homogenates into fresh mice, and to pathohistology, including immunohistochemistry, of brain and lungs. Results: The effect of clindamycin treatment (400 mg/kg/day) on infected Swiss Webster mice was inoculum size dependent, ranging from no survivals in animals infected with 106 parasites, to 100% survivals with an inoculum of 102. Treatment initiated 24 h before and at time of infection prolonged mean survival times comparably to sulfamethoxazole, and significantly when compared to untreated controls. In contrast, treatment initiated 48 h postinfection with an inoculum of 106 did not postpone death. In the clindamycin-treated survivors, there was no biological or histologic evidence for the persistence of toxoplasma. Conclusions: The results obtained show that at an appropriate parasite dose/drug dose ratio, clindamycin is strongly toxoplasmacidal in a murine model of acute toxoplasmosis.

The aim of our study was to determine rate of occurrence and appearance of hyperostosis frontalis interna (HFI) in females and correlation of this phenomenon with ageing. The sample included 248 deceased females: 45 of them with different types of HFI, and 203 without HFI, average age 68.3 ± 15.4 years (range, 19-93), and 58.2 ± 20.2 years (range, 10-101), respectively. According to our results, the rate of HFI was 18.14%. The older the woman was, the higher the possibility of HFI occurring (Pearson correlation 0.211, N = 248, P = 0.001), but the type of HFI did not correlate with age (Pearson correlation 0.229, N = 45, P = 0.131). Frontal and temporal bone were significantly thicker in women with than in women without HFI (t = -10.490, DF = 246, P = 0.000, and t = -5.658, DF = 246, P = 0.000, respectively). These bones became thicker with ageing (Pearson correlation 0.178, N = 248, P = 0.005, and 0.303, N = 248, P = 0.000, respectively). The best predictors of HFI occurrence were respectively, frontal bone thickness, temporal bone thickness, and age (Wald. coeff. = 35.487, P = 0.000; Wald. coeff. = 3.288, P = 0.070, and Wald. coeff. = 2.727, P = 0.099). Diagnosis of HFI depends not only on frontal bone thickness, but also on waviness of internal plate of the frontal bone, as well as the involvement of the inner bone surface. Copyright © 2010 by Lippincott Williams & Wilkins.

Simon's bleedings are stripe-like hemorrhages on the ventral surface of the intervertebral disks of the lumbar part of the spinal column. The aims of this study were to determine the appearance frequency of Simon's bleedings in cases of hanging and in other cases of asphyxiations and to determine if the age of the deceased was in correlation with the occurrence of Simon's bleedings. A prospective autopsic study included 147 cases of hanging, 39 other asphyxiation deaths, and 461 deaths other than asphyxiation (blunt trauma, natural deaths, etc.). Simon's bleedings were present in 62.8% cases of hanging and in 61.5% cases of other types of asphyxiations. Simon's bleedings are not specific for hanging (χ 2∈=∈0.022, p∈>∈0.05). Simon's bleedings were less frequent in other cases. It was established that the older the person was, the possibility of Simon's bleedings to occur would be less (Spearman's correlation coefficient∈=∈-0.225, p∈<∈0.001; Wald coefficient∈=∈29.798, p∈<∈0.001). In the cases of hanging, there is statistically significant difference in average age between the groups with and without Simon's bleedings (t∈=∈2.875, p∈=∈0.017). The older the person was, the lower the likelihood of Simon's bleedings to occur: if the person was more than 60 years old, there was 70% probability of not having Simon's bleedings, and if older than 70, this probability would rise to 88% (Wald coefficient∈=∈7.609, p∈=∈0.021). In older persons who died due to hanging, throat skeleton fractures accompanied by local hemorrhage could be considered as a vital sign. In younger persons, where throat skeleton fractures are less frequent, Simon's bleedings could be the vital sign of premortem hanging. Simon's bleedings, in cases of asphyxiation, most likely occur due to agonal convulsions and forced movements in lumbosacral part of spinal column. Additional factor for the appearance of Simon's bleedings in hanging is traction of body and especially this part of spinal column due to gravity. © 2009 Springer-Verlag.

A fat embolism is a known and common complication of blunt force injuries, especially pelvic and long bones fractures. The aim of this study was to determine the importance of a patent foramen ovale (PFO) in developing systemic fat embolism (SFE) and eventually fat embolism syndrome (FES) in patients suffering from orthopaedic blunt injuries and consequent lung fat embolism. The sample was divided: 32 subjects with a sealed foramen ovale (SFO), and 20 subjects with a PFO. In our sample, there was no difference in either the incidence of renal fat embolism in subjects with PFO compared to those with SFO (Fisher's exact test 0.228, p = 0.154) or in the grade of renal fat embolism (Pearson Chi-square 2.728, p = 0.435). However, there was a statistically significant correlation between the grade of lung fat embolism and the number of fractured bones for the whole sample (Spearman's rho 0.271, p = 0.052), but no correlation between the grade of lung fat embolism and the ISS or NISS (Pearson correlation 0.048, p = 0.736, and 0.108, p = 0.445, respectively). In our study, the presence of fat emboli in the kidney, i.e. SFE, could effectively be predicted by the grade of lung fat embolism (the moderate and slight grades of lung fat embolism were better predictors than the massive one: logistic regression - Wald. Coeff. = 11.446, p = 0.003, Wald. Coeff. = 10.553, p = 0.001, and Wald. Coeff. = 4.128, p = 0.042), and less effectively by presence of PFO (Wald. Coeff. = 2.850, p = 0.091). This study pointed out that lung and SFE are not pure biomechanical events, so the role of a PFO is not crucial in developing a lung fat embolism into a systemic embolism: the fat embolism is more of a biochemical and pathophsyiological event, than a biomechanical one. The appearance of a patent foramen ovale associated with a systemic fat embolism should be less emphasised: maybe arteriovenous shunts and anastomosis between the functional and nutritive, i.e. systemic circulation of lungs play a more important role in developing a SFE than a PFO. © 2010 Elsevier Ltd. All rights reserved.

The aim of this study was to determine the frequency of brainstem pontomedullar lacerations among fatally injured car occupants in head-on collisions, as well as the concomitant cranial injuries, and to establish a possible underlying mechanism for brainstem laceration. Brainstem pontomedullar lacerations (PML) are often associated with fractures of the skull base (hinge, ring or pyramidal fractures) or with cervical spine fractures. Out of 705 cases of deceased car occupants involved in head-on car collisions, some form of head injury was present in 447 cases (63.4%). These cases included 353 men and 94 women with an average age of 38.2±15.8 years (range 16-89 years). The collected cases included 229 drivers, 164 front-seat and 54 rear-seat passengers. PML were present in 67 of these cases (15%), 50 men and 17 women with an average age of 42.9±15.6 years (range 15-77 years), including 32 drivers, 26 front-seat and 9 rear-seat passengers. In all of these cases the brainstem laceration was partial and the depth varied approximately from 4mm to 8mm. To understand the mechanisms by which PML occurs, we classified the head impact areas into frontal, lateral, posterior and chin area, depending on the injuries to the soft tissue of the head and scalp, as well as facial and cranial fractures. Injury impact area of the head was a good predictor of PML occurrence (χ2=131.112, df=3, p=0.000). Chin impact was most often associated with PML-38 cases (Wald. coeff.=5.805, df=1, p=0.016). Presence or absence of mandibular fracture was significant for PML occurrence (χ2=11.413, df=1, p=0.001): persons without mandibular fracture have 2.3 times greater risk for PML than those with fracture (odd ratio=7.196). Among the observed skull base fractures, the best predictor of PML was ring fracture (Wald. coeff.=30.729, df=2, p=0.000). Our study showed that PML was present in a significant number of car occupants sustaining head injuries in head-on collisions (15%). Impact to the chin with or without a ring fracture to the skull base most often led to this fatal injury, probably after collision with the dashboard. © 2010 Elsevier Ireland Ltd.