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PubMed1997

Development of an essential drugs list for Bosnia and Herzegovina.

Part of the impact of the war in ex-Yugoslavia and especially Bosnia and Herzegovina was to limit the supply of therapeutic drugs they had used before the war. The difficulties encountered made the health care system temporarily dependent on humanitarian assistance agencies which applied the concept of essential drugs; and, after initial difficulties, national health staff adapted to the need to prescribe from a very limited range of drugs. Meanwhile, national drug policy and procurement and prescribing practices were reviewed by working groups and a national List of Essential Drugs was drawn up by national experts with international support. This list has now been passed into legislation.

Analgesics↗

PubMed1994

Institute "Jakes"--an experiment which ceased to exist.

Institute "Jakes", which sheltered psychiatric patients, was apparently the most unorthodox part of the health care delivery system in the former Yugoslavia. Bosnian war led to severe destruction of the Institute and to death of many of its patients. The "Jakes" experience deserves attention and description.

Adult↗

PubMed1996

Ovarian carcinoma: modification of T4 lymphocytes after surgery and during chemotherapy.

OBJECTIVE: To examine the values of helper/inducer lymphocytes (T4), preoperatively, and during the chemotherapy, 1 and 3 months postoperatively in a prospective randomized study of women with cancer. The study included 30 surgically-treated patients with ovarian cancer at the Department of Obstetrics and Gynecology in Novi Sad, Yugoslavia. In the control group, 20 patients had no malignant ovarian tumor. Patients with ovarian cancer, besides surgical treatment, were treated with chemotherapy (CP protocol). Helper/inducer lymphocytes were defined by monoclonal antibody--CD4, conducted by laser flow cytometry. The average values of T4 lymphocytes in relation to control group (1.09 +/- 0.50), in IIIa, IIIb and IIIc stage of ovarian cancer decreased preoperatively (0.55 +/- 0.26), but increased in stages Ia and Ic (1.12 +/- 0.57) and in stage IV (0.31 +/- 0.51). Post surgery treatment (1 and 3 months) and during chemotherapy (CP protocol), the average values of T4 lymphocytes were lowered in relation to preoperative values.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2002

The P28T mutation in the GALK1 gene accounts for galactokinase deficiency in Roma (Gypsy) patients across Europe.

Galactokinase deficiency is an inborn error of metabolism that, if untreated, results in the development of cataracts in the first weeks of life. The disorder is rare worldwide, but has a high incidence among the Roma (Gypsies). In 1999, we reported the founder Romani mutation, P28T, identified in affected families from Bulgaria. Subsequent studies have detected the same mutation in Romani patients from different European countries. The screening of 803 unrelated control individuals of Romani ethnicity from Bulgaria, Hungary, and Spain has shown an overall carrier rate of 1:47 and an expected incidence of affected births about 1:10,000. Using disease haplotype analysis, the age of the P28T mutation was estimated at 750 y, preceding the splits of the proto-Roma into the numerous populations resident in Europe today. The findings suggest that the mutation has spread with the early diaspora of the Roma throughout Europe. Superimposed on this old distribution pattern is the new migration wave of the last decade, with large numbers of Roma moving to Western Europe as a result of the economic changes in the East and the wars in former Yugoslavia. The changing demographic pattern of Romani minorities can be expected to lead to a homogenization of the incidence of "private" Romani disorders and founder mutations. The P28T mutation is thus likely to account for a high proportion of galactokinase deficiency cases across Europe. Mutation-based pilot newborn screening programs would provide current incidence figures and help to design long-term prevention of infantile cataracts due to galactokinase deficiency.

Amino Acid Substitution↗

PubMed2000

Syphilis in Slovenia--on the threshold of the European Union.

The epidemiological situation of early syphilis (ES) in Slovenia is the subject matter of this report. After almost 25 years of decrease in Slovenia, ES is increasing again. The incidence of ES increased from 0.10 per 100,000 inhabitants in 1992 and 1993 to 1.82 in 1994 and 1.90 in 1995. In the years 1996-1998 there was a slight decrease at 1.25-1.45. The higher incidence of infections with ES is presumably the consequence of changed social conditions in the states of the former Eastern bloc and Yugoslavia, and of changing living conditions, and illegal prostitution in Slovenia. AIDS and HIV in Slovenia is still at an early stage and there is no apparent link into the same social groups as syphilis. The current epidemiological situation of sexually transmitted infections (STIs) in Slovenia and the conditions existing to the south and east of Slovenia warrant strict surveillance of STIs by the medical services.

Acute Disease↗

PubMed1985

PCB levels in breast milk: data from the UNEP/WHO pilot project on biological monitoring and some other recent studies.

The levels of polychlorinated biphenyls (PCBs) in human milk provide an index of exposure of the mother to these compounds and enable the intake by the breast-fed child to be estimated. For valid comparisons between different studies, concentrations should be expressed on a milk fat basis. In a recently completed UNEP/WHO pilot project on monitoring of organochlorine compounds in human milk in ten countries, great emphasis was placed on analytical quality assurance. To obtain comparable data, a common procedure, that of Sawyer, was adopted for quantitation of PCBs, using Aroclor 1260 as standard. In addition, certain criteria (e.g., age and parity) were established for selection of the mothers to be sampled. In contrast to the situation with p,p'-DDT and p,p'-DDE, the levels of PCBs in human milk fat were higher in the European countries and Japan than in China, India and Mexico. In fact, PCBs were not detected in human milk in the latter three countries. Although PCBs were detected in some samples in the USA, the median level was below the limit of detection of the method used there (1 mg/kg fat). The median PCB levels reported from Belgium, Israel, Japan and Yugoslavia were 0.81, 0.45, 0.35 and 0.63 mg/kg fat, respectively. Higher median levels were reported from Sweden and the Federal Republic of Germany (0.97 and 2.1 mg/kg fat, respectively). The German samples were not analyzed by the Sawyer method.

Adolescent↗

PubMed1998

Hyperproduction of erythropoietin in nonanemic lead-exposed children.

Lead (Pb) poisoning has numerous effects on the erythropoietic system, but the precise mechanism whereby high dose exposure causes anemia is not entirely clear. We previously reported that Pb exposure is associated with depressed serum erythropoietin (EPO) in pregnant women residing in a Pb mining town and in a nonexposed town in Kosovo, Yugoslavia. In a prospective study, we tested the hypothesis that blood Pb concentration (BPb) may be associated with depressed EPO in children. BPb, hemoglobin (Hgb), and serum EPO were measured at ages 4.5, 6.5, and 9.5 years in 211, 178, and 234 children, respectively. At 4.5 years of age, mean BPbs were 38.9 and 9.0 microg/dl in the exposed and nonexposed towns, respectively; BPbs gradually declined to 28.2 and 6.5 microg/dl, respectively, by age 9.5 years. No differences were found in Hgb at any age. At age 4. 5 years, a positive association between BPb and EPO (beta = 0.21; p = 0.0001), controlled for Hgb, was found. The magnitude of this association declined to 0.11 at age 6.5 years (p = 0.0103) and 0.03 at age 9.5 years (p = 0.39). These results were confirmed using repeated measures analyses. We concluded that in Pb-exposed children, the maintenance of normal Hgb requires hyperproduction of EPO. With advancing age (and continuing exposure), this compensatory mechanism appears to be failing, suggesting a gradual loss of renal endocrine function due to Pb exposure.

Age Factors↗

PubMed2000

Preventing psychological trauma in soldiers: the role of operational stress training and psychological debriefing.

Armed conflict is associated with significant long-term psychiatric morbidity. Interventions to reduce the incidence of psychiatric disorder following psychological trauma may be classified into three categories. Primary prevention includes the selection, preparation and training of individuals likely to be exposed to potentially traumatizing events. Secondary prevention comprises a variety of brief psychological techniques immediately or shortly after traumatizing life events, the best known of which is Psychological Debriefing. Tertiary interventions comprise the treatment of established PTSD and others. Psychiatric morbidity was studied in 106 British soldiers returning from UN peace-keeping duties in the former Republic of Yugoslavia. All 106 soldiers received an Operational Stress Training Package prior to their deployment and a randomly selected group also received a post-operational PD. Very low rates of PTSD and other psychopathology were found overall and the Operational Stress Training Package may have contributed to this. Elevated CAGE scores suggestive of significant alcohol misuse were observed in both groups and chemical avoidance behaviours arising from this may have masked psychopathology. CAGE scores diminished significantly in the debriefed group by the end of the follow-up period suggesting that PD may have been of benefit despite the apparent absence of PTSD. This study also demonstrates that a high incidence of psychiatric morbidity is not an inevitable consequence of military conflict.

Adolescent↗

PubMed2001

Using climate data to map the potential distribution of Culicoides imicola (Diptera: Ceratopogonidae) in Europe.

Culicoides imicola, a vector of bluetongue virus and African horse sickness virus, is principally Afro-Asian in distribution, but has recently been found in parts of Europe. A logistic regression model based on climate data (temperature, saturation deficit, rainfall and altitude) and the published distribution of C. imicola in Iberia was developed and then applied to other countries in Europe, to identify locations where C. imicola could become established. The model identified three temperature variables as significant determinants of the distribution of C. imicola in Iberia (minimum of the monthly minimum temperatures, maximum of the monthly maximum temperatures and number of months per year with a mean temperature > or = 12.5 degrees C). The model indicated that under current conditions, the distribution of C. imicola in Spain, Greece and Italy could be extended and the vector could potentially invade parts of Albania, Yugoslavia, Bosnia and Croatia. To simulate the effect of global warming, temperature values in the model were increased by 2 degrees C. Under these conditions, the potential spread of C. imicola in Europe would be even more extensive.

African Horse Sickness↗

PubMed1996

Intracranial aneurysms associated with moyamoya disease.

The authors examined 31 patients with moyamoya disease in Yugoslavia. Among them four intracranial aneurysms were disclosed, two in males and two others in females. The aneurysms, which were present in adult patients only, were diagnosed angiographically. Three of four patients died several days or weeks after onset of hemorrhage. The aneurysms were located within the basal abnormal vascular network, on a distal branch of the posterior cerebral artery, on the top of the basilar artery, and on the posterior branch of the middle meningeal artery. The moyamoya disease on the side of the individual aneurysms was most often stage III or IV.

Adult↗

PubMed2005

[Congenital pseudoarthrosis of the tibia treated with the free microvascular fibula].

Congenital pseudoarthrosis (CPT) of the lower leg is still a considerable therapeutic problem. There are many surgical and other procedures to manage pseudoarthrosis, but the results are not always satisfactory, unfortunately, and are accompanied by a big number of complications, even limb amputation in some cases. The most complicated surgical procedure is transplantation of the autogenous free microvascular fibula coil which has had the best results momentarily. We are showing a case of a 2.5-year old patient with congenital pseudoarthrosis of the lower leg previously treated unsuccessfully by a conventional surgical method. This is at the same time the first case of such operative treatment of CPT in the territory of Serbia and Montenegro as well as former Yugoslavia. The patient was operated in October 1992.

Child, Preschool↗

PubMedDate not supplied

[A sense of responsibility in health personnel as a cause of work-related stress].

INTRODUCTION: Job stress is a great problem in developed countries of the world, but in Yugoslavia, it is increased due to additional reasons associated with economic crisis in the society. Health services and health workers are in particularly difficult conditions. The aim of this paper was to examine sources and causes of job stress in health workers. MATERIAL AND METHODS: The research was undertaken among health workers treated at Health Centre "Hospital" in Novi Sad. The study group included health workers--doctors, nurses and laboratory workers, and the control group included the rest of non-medical staff. Adapted Siegrist questionnaire was used. Three factors were examined: extrinsic efforts (disturbances at work, sense of great job responsibility and the need for overtime work); intrinsinc efforts (major criticism, thinking about the job from the early morning, getting nervous because of minor problems, discontentment because of unsolved problems at work, relaxation at home and so on), and low reward (respect from the superiors and colleagues, support and security at workplace). Answers were scored indicating intensity (high, moderate, low, not at all). Statistic analysis included testing the level of significance in health workers in relation to non-medical staff (t test and Fisher's exact test). RESULTS: Applying the scoring system it has been established that health workers are exposed to greater job stress, great sense of very high job responsibility and frequent overtime work (p < 0.001) than the control group. In regard to answers from the second group--intrinsic effort and low reward, there was no statistiscal significance between the study and control group. Generally, high level of risk factors was established, especially presence of one or more risk factors. DISCUSSION: Job stress increases absenteeism, reduces work productivity, causes higher expenses of medical treatment, rehabilitation and staff retraining. It is of great importance to identify factors which cause job dissatisfaction in order to decrease them to the lowest level. CONCLUSION: High sense of responsibility in health workers is a course of job stress.

Adult↗

PubMedDate not supplied

[Lyme disease--new findings on its physiopathology, diagnosis, therapy and prevention].

INTRODUCTION: Lyme disease is a tick-borne disease caused by a spirochete Borrelia burgdorferi, which manifests as a multisystem disease of the skin, nervous system, heart and joints. Recently it is the most common vector-borne disease in Yugoslavia. NEW EPIDEMIOLOGICAL STUDIES: New epidemiological studies revealed that ticks can occasionally be infected not only by Borrelia burgdorferi, but also by some other microbes that can cause diseases in humans. Recently discovered the variable major protein-like sequence, antigenic variation of B. burgdorferi B 31 partly explains the ability of this organism to evade an active immune response. A key role in development of clinical symptoms associated with lyme disease belongs to the connection with ability of B. burgdorferi to induce and activate metallopeptidases and fibrinolytic enzymes, leading to extracellular matrix destruction. DIAGNOSIS AND TREATMENT: Diagnosis of Lyme borreliosis is made on the basis of clinical picture, exposure to ticks in endemic areas and serologic confirmation. It seems that polymerase chain reaction has little role in detection of B. burgdorferi in urine, blood, and spinal fluid samples, but it is most useful in evaluating the effectiveness of antibiotic therapy of Lyme arthritis. Infectious Diseases Society of America had prepared new guidelines for selective treatment of Lyme disease. Vaccination is still the best way of prevention for people living in high-risk areas.

Humans↗

PubMedDate not supplied

[The history of audiology].

INTRODUCTION: The paper presents historical data on development of audiology as a medical speciality. It gives the chronological overview of the most significant discoveries which have contributed to the progress and constant development of the science of hearing. The insights and discoveries encompass the ancient, medieval and contemporary medical science. THE TERM "AUDIOLOGY" AND FIRST ASSOCIATIONS OF AUDIOLOGISTS: The paper reviews the origin of the term "audiology" and the time of its occurrence. The First World Congress of Audiologists was held in 1948, and the Conference of Audiologists and Phoniatrists of Yugoslavia was established in 1974. HISTORICAL OVERVIEW: The ancient scientists and philosophers mentioned in the paper are as follows: Democritus, Hippocrates, Empedocles, Plato, Aristotle, and Galenus. Discoveries of Vesalius, Fallopio, Eustachio, Duverney, Schelhammer, Catugno and Helmholtz marked their epochs and made a great contribution to the development of the entire medical science, including audiology. A significant contribution to audiology was made by Schwartz in 1920 and Fletcher in 1926, constructors of audiometers. Fowler, Weigel and Fletcher promoted an audiogram in 1922. Wever and Bray first introduced the cochlear microphonic potentials. The first modern audiometer with a flat zero line for all pitches was constructed in 1937. In 1947, Bekesy constructed the automatic audiometer, and the theory of mobile waves was introduced in 1928. Fletcher and Steinberg promoted speech audiometries in 1929. Mendel and Goldstein described medium latency responses in 1969. The first hearing aids worn within the ear appeared in the same year. William House pioneered the cochlear implantation in adults in 1969, and the program of infant cochlear implants. Jewett described the evoked auditory potentials in 1970. James Jerger classified tympanometric curves into three tympanogram types (A, B, C). Portmann and Arran introduced transtympanic electrocochleography in 1971. Kemp introduced otoacoustic emission in 1978. INSTEAD OF CONCLUSION: finally, the paper lists the titles of available dissertations and sub-specialisations in the field of audiology defended in Novi Sad and Belgrade.

Audiology↗

PubMedDate not supplied

[Renovascular hypertension in a child with type 1 neurofibromatosis].

Arterial hypertension in pediatric patients with neurofibromatosis type 1 (NF 1) is usually due to renal artery stenosis (RAS) mainly involving the proximal part of the vessel. The treatment modalities are highly individualized. In severe and/or bilateral RAS, antihypertensive drugs are either ineffective or have the potential risk for acute renal failure, while percutaneous transluminal angioplasty (PTA) has limited success due to the ostial localization of RAS and the tough fibrotic tissue involved that is refractory to dilatation Renal autotransplantation has potential advantages when medical control and PTA/or bypass techniques failed. Here we report 5 year-old girl with NF 1 and hyponatremic hypertensive syndrome due to severe bilateral disease, occluded proximal part of the right artery and ostial stenosis (80%) of the left one. Only left kidney was identified on 99 m Tc DTPA, but the right one was visualized on the renal ultrasonography and in the late phase of arterial renography due to well developed collateral circulation. Multiple antihypertensive drugs (nifedipine, labetolol and minoxidil) in maximal doses and PTA failed to normalize BP while short term therapy with ACEI with NF1 and hyponatremic hypertensive syndrome due to severe bilateral renovascular disease; occluded proximal part of the right renal artery and ostial stenosis (80%) of the left one. Only left kidney was identified on 99 m Tc DTPA, but the right one was visualized on the renal ultrasonography and in the late phase of arterial renography due to well developed collateral circulation. Multiple antiphypertensive drugs (nifedipine, labetolol and minoxidil) in maximal doses and PTA failed to normalize BP while. short term therapy with ACEI, captopril induced transient acute renal failure. Autotransplantation of right kidney saved its function and improved BP control. Our current case Autotransplantation of right kidney saved its function and improved BP control. Our current case is illustrative for a difficult management of renovascular hypertension in children with NF1. This is the first and up to now the only case of autotransplantation performed in Yugoslavia.

Child, Preschool↗

PubMedDate not supplied

[Smallpox--in the past or not?].

Smallpox is a potentially deadly illness caused by the variola virus, an orthopoxvirus. Severe illness followed by blister-like body rash is the sign of smallpox. Smallpox symptoms develop about 12 days after exposure. V. variole can spread very readily by aerosol, which may lead to explosive epidemics. For centuries, smallpox has been a worldwide cause of death, killing about 30% of the infected people. In 1972, the epidemic of smallpox in ex-Yugoslavia was the largest postwar smallpox epidemic in Europe. The total number of the affected was 175, out of whom 35 with fatal outcome, accounting for 20% of mortality. However, after a decade-long vaccination effort, the last natural case of smallpox occurred in 1977. The only way to prevent smallpox epidemic is by vaccination and patients' isolation. The possibility of future bioterrorism attacks, which may cause a new outbreak of smallpox and return variola, is very serious. World population is not immune, because of lack of vaccination. In 1980, the World Health Organization (WHO) declared the disease fully eradicated.

Humans↗

PubMed2004

[Results of treatment of cyanotic heart defects in children].

Cyanotic heart diseases are relatively rare, but they are severe and heterogeneous congenital heart diseases, which require complex surgery. Development of different advanced surgical procedures, such as arterial switch operation (ASO), Fontan and its modifications, Norwood etc. operations, as well as better perioperative care significantly improved survival rate and quality of life of these children. The study group included 308 children treated for cyanotic heart disease in Yugoslavia, in the period January 2000 to July 2004. Some of them (239, 77.6%) were treated at the University Children's Hospital in Belgrade, and others (69, 22.4%) in different institutions abroad. The age of the operated patients varied between 1 day and 19 years (median 12 months). The patients (pts) were divided into four groups, according to the disease and type of the operation. In the whole group of 308 patients treated due to cyanotic heart disease, there were 232 (75.3%) cases with open heart surgery and 76 (24.7%) with closed procedures. The mortality rate was significantly different between disease/operation groups, and age groups. Average mortality rates differed from 11.8% for palliative procedures to 12.5% for complete corrections. Mortality rate and achieved surgical results in treatment of children with cyanotic heart diseases were significantly worse than those published by leading cardiac surgery centers in the world. However, there is a clear tendency in introducing new surgical procedures, lowering the age at which the operation is done and decreasing the mortality rates.

Adolescent↗

PubMedDate not supplied

[Necrotizing fasciitis caused by group A streptococcus].

The first case of the confirmed necrotizing fasciitis caused by Group A Streptococcus in Yugoslavia was presented. Male patient, aged 28, in good health, suddenly developed symptoms and signs of severe infective syndrome and intensive pain in the axillary region. Parenteral antibiotic, substitutional and supportive therapy was conducted along with the radical surgical excision of the necrotizing tissue. The patient did not develop streptococcal toxic shock syndrome thanks to the early established diagnosis and timely applied aggressive treatment. He was released from the hospital as completely cured two months after the admission.

Adult↗