Vodič za uređenje prostora u dečjem vrtiću: prostor u skladu sa Osnovama programa PVO ,,Godine uzleta"

Можда се питате зашто ви као васпитач треба да се толико бавите уређењем простора, чини вам се да вам то одузима сувише времена и енергије, у траженим променама простора осећате несигурност и губитак контроле? Ако желите да простор буде ваш савезник, да деца посвећено и предано учествују у ситуацијама игре и истраживања, да родитељи буду пријатно изненађени шта све може и ради његово дете у вртићу, да умете стручно да аргументујете зашто сте тако уредили простор и откуд толико неструктурираног материјала, онда морате разумети које функције простор има, како се простором подупире слика о детету из Основа програма и његова добробит, како се простор уређује тако да подупире делање детета кроз заједничко учешће у игри и истраживању. Читање овог приручника може вам у томе помоћи

Uticaj DOAK i DOAC-REMOVE® na testove koagulacije u toku testiranja trombofilije kod bolesnika lečenih primenom DOAK

Background/Aim. Direct oral anticoagulants (DOACs) administration significantly interferes with coagulation as-says. The aim of the study was to evaluate the effect of DOACs and DOAC-Remove® on coagulation assays dur-ing thrombophilia testing. Methods. The study was car-ried out from January 2019 to the end of June 2020. It in-cluded 30 DOAC-treated patients, 14 females and 16 males aged 23 to 63 (median age 47.6 years), tested for thrombophilia due to venous thromboembolism (VTE). Thrombophilia testing was performed using DOAC-Remove® tablets (activated charcoal). The results before and after DOAC-Remove® were compared. Results. Posi-tive lupus anticoagulant (LA) results were observed in 20% apixaban, 100% dabigatran, and 70% rivaroxaban-treated patients, while in samples after DOAC-Remove®, the LA positivity was observed only in one from the apix-aban group. Before DOAC-Remove®, the activated pro-tein C (APC) resistance (APC-R) was measurable in 40% dabigatran and 80% rivaroxaban-treated patients, while, after using DOAC-Remove®, the APC-R was measurable in all cases. Comparing the results obtained from the sam-ples before and after DOAC-Remove®, a difference was noted in relation to all dilute Russell's viper venom time (dRVVT) coagulation tests, except for the dRVVT ratio in the apixaban group. Clot-based methods for detecting the APC resistance were significantly affected by dabigatran and less by rivaroxaban. Conclusion. DOACs were prac-tically inactivated after the addition of the DOAC-Remove®, which made it possible to perform analyses for the LA and APC-R testing freely and obtain relevant re-sults.Uvod/Cilj. Primena direktnih oralnih antikoagulansa (DOAK) značajno utiče na testove koagulacije. Cilj rada bio je da se pro- ceni uticaj DOAK i DOAC-Remove® tableta (aktivni ugalj) na testove koagulacije tokom ispitivanja trombofilije. Metode. Istraživanjem, sprovedenim od januara 2019. do juna 2020. godine, obuhvaćeno je 30 bolesnika lečenih DOAK-om i testiranih na trombofiliju zbog venskog tromboembolzma (VTE). Bilo je 14 žena i 16 muškaraca, starosti od 23 do 63 godine (medijana 47,6 godina). Ispitivanje trombofilije izvršeno je upotrebom DOAC-Remove® tableta (aktivni ugalj). Upoređivani su rezultati pre i posle primene DOAC-Remove®. Rezultati. Pozitivni rezultati za lupus antikoagulantni (LA) test dobijeni su kod 20% bolesnika lečenih apiksabanom, kod 100% bolesnika lečenih dabigatranom i kod 70% lečenih riva- roksabanom, a u uzorcima posle DOAC-Remove® pozitivnost na LA dobijena je samo kod jednog bolesnika iz grupe lečnih apiksabanom. Pre primene DOAC-Remove®, rezistencija na aktivisani protein C (activated protein C resistance – APC-R) bila je merljiva kod 40% i 80% bolesnika lečenih dabigatranom, od- nosno rivaroksabanom, dok je posle primene DOAC- Remove®, APC-R bila merljiva u svim slučajevima. Upoređivanjem rezultata dobijenih iz uzoraka pre i posle primene DOAC-Remove®, primećena je razlika u odnosu na sve testove vremena koagulacije izvršene razblaženim Russell- ovim zmijskim otrovom (dilute Russell’s viper venom time – dRVVT), osim dRVVT u grupi bolesnika lečenih apiksabanom. Na koagulacionu metodu za otkrivanje APC-R značajno je uti- cao dabigatran, a manje rivaroksaban. Zaključak. Nakon primene DOAC-Remove® tableta, DOAK su praktično inaktivisani što je omogućilo izvođenje analiza za LA i APC-R i dobijanje relevantnih rezultata testova

Influence of Cyp2c19∗2 Gene Variant on Therapeutic Response during Clopidogrel Treatment in Patients with Carotid Artery Stenosis

Background: Despite the proven clinical effect of oral antiplatelet drugs, a considerable number of patients do not have an adequate response to clopidogrel. The aim of our study was to determine the influence of CYP2C19*2 loss-of-function variant allele on clopidogrel responsiveness in patients with carotid artery stenosis. Methods: One hundred and twelve patients with carotid artery stenosis undergoing endarterectomy were included in this one-year prospective study. All of them received clopidogrel (75 mg daily) for at least 30 days after the intervention. They were followed from the moment of hospital admission. CYP2C19*2 genotyping was performed by TaqMan Assay. The influence of CYP2C19*2 variant allele on clopidogrel platelet reactivity was determined using multiple-electrode aggregometry (MEA). Results: Genotyping results showed that 82 (73.2%) patients were homozygous for wild type, 29 (25.9%) were heterozygous for the CYP2C19*2 allele and 1 (0.9%) was CYP2C19*2 homozygous. After 24 hours, among those with the wild type 29.3% were clopidogrel responders, and in those with the CYP2C19*2 alleles 10%. In the wild type group, 74.4% were clopidogrel responders after 7 days of taking the drug; 82.9% after 30 days of clopidogrel introduction, respectively. In patients with the CYP2C19*2 alleles the number of responders increased up to 46.7% after 7 days; 53.3% after 30 days of taking the drug, respectively. The risk for being a low-responder is higher for the patients heterozygous for the CYP2C19*2 allele vs. wild type (OR 4.250, 95% CI 1.695-10.658, P lt 0.01). Conclusions: The CYP2C19*2 loss-of-function variant allele has significant influence on clopidogrel response in patients with carotid artery stenosis undergoing endarterectomy

Rationalized DNA sequencing-based protocol for genotyping patients receiving coumarin therapy

During the last decade genetic factors affecting coumarin therapy have been extensively investigated. The most important genes appear to be CYP2C9 and VKORC1, and different studies have shown that DNA testing can dramatically improve the safety and effectiveness of the therapy. However, the implementation of pharmacogenetic testing in everyday practice is still not a reality. Facilities and ability to get results before the start of therapy are very important. The implementation of specific methodology and equipment for particular type of diagnostics can represent a serious, even impossible, financial hurdle to overcome (especially in developing countries). For this reason, the use of every tool that contributes to rationalization of the existing methods can be a considerable asset. Therefore, we set the goal to rationalize our current DNA sequencing based protocol for analysis of the VKORC1 c.-1639G gt A, CYP2C9*2 and CYP2C9*3 variant alleles, in order to obtain shorter and easier procedure. Simplification of the protocol was achieved by setting up multiplex PCR and omitting DNA extraction. This rationalization of the existing DNA sequencing based procedure allows getting results in 12 hours. The new protocol was tested on 118 samples. Obtained results have shown full accordance to those obtained with previous, non-modified protocol. Therefore, given the circumstances, we consider that protocol for pharmocogenetic testing should be made more accessible - both to doctors and patients. It is one of the prerequisites in order to make genotyping prior to the therapy common practice

Factors mediating the depression in the adult obese outpatients

Introduction: The prevalence of obesity is rising to epidemic proportions at the alarming rate in both developed and underdeveloped countries around the world. Current prevalence data from individual national studies suggest that the obesity prevalence in the European countries ranges from 10% to 20% for men, and 10% to 25% for women. Health consequences of obesity imply both a number of fatal and non-fatal health problems (out of which the most common are cardiovascular problems, non-insulin dependent diabetes mellitus, cancers), and also a wide spectrum of psychological consequences from diminished self-esteem to clinical depression. Causal relationship between obesity and many chronic diseases is evidence- based. At the same time, there are marked differences in research data regarding causal obesity-depression relationship. Several studies have found no direct association between obesity and depression, while in others the prevalence of depression in obese patients was up to 50%. Gender, obesity grade, socioeconomic status and asking for professional help are named as moderators and mediators of this relationship. Among recommended screening methods, BDI-II is the most frequently used in the adult outpatient departments. Objective The aim of the study was to determine possible risk factors of depression in adult obese patients treated for obesity. Gender, obesity and education level as well as marital status were analyzed as possible moderators of depression-obesity relationship. Method The research included 267 patients, 38.0±14.6 years of age, who referred to the Outpatient Nutrition Department for dietetic consultation or nutritional medical therapy. Nutritional status was assessed by BMI (kg/mІ), calculated from measured values of body weight and height according to WHO recommendations. An estimate of the existence and/or depression level was investigated by Beck Depression Inventory - self administered questionnaire recommended for use in Serbian population. Results The results revealed higher average BDI score values in obese patients (F(267,1)=6.014, p=0.015) in comparison to their non-obese counterparts. In addition, the percentage of depressive obese patients was significantly higher (55.1%, χ2 (267.1)=22.64, p<0.001). There was significant correlation of BMI and BDI scores (r=0.246, p<0.001). The number of women with depression was significantly higher in comparison to men (χ2 (267.1)=4.261, p=0.039).Women also had higher average BDI score (p = 0.003). MANOVA showed that BDI score was influenced by gender (F(267.1)=8.936, p=0.030) and nutritional status ( F(267.1)=6.115, p=0.014), but combined effect of the abovementioned moderators was not significant. Conclusion Depression is ten times more frequent in obese patients undergoing the obesity treatment vs. general population and, therefore, screening for depression is needed. Special attention should be paid to women and more obese patients due to higher incidence of depression in these groups

Stress and mental health among medical students

Introduction. Medical studies bring many stressful activities to students. Prolonged stress can make adverse effects to mental health and lead to further professional burnout. Objective. The aim of this study was to assess the association of stress impact and adverse effects of medical studies with psychological distress among medical students. Methods. The cross sectional study was conducted on 367 fourth­year medical students of the Faculty of Medicine in Belgrade, by means of the anonymous questionnaire, containing: socio­demographic data, self­reported health status and stressful influences of studying activities. Mental health status was estimated by General Health Questionnaire (GHQ­12). Results. More than 50% of students perceive frequent feeling of psychic tension, and one third has problems with insomnia. Nearly one­half of students assessed their general stress level as moderate or high. Exams were estimated as high stressor in 63.1% of all students. Stressful effects of communication with teaching staff were reported by one quarter of the examinees. The scores of GHQ­12 were above the threshold in 55.6 % of all students. Mental health problems among students were most significantly associated with stressful experience during exams and contacts with teaching staff. Conclusion. Academic stress makes great influence on mental health of medical students. Reduction of stress effects should be directed to optimization of the examination process and improvement of communication skills. [Projekat Ministarstva nauke Republike Srbije, br. OI 175078

Clopidogrel High On-Treatment Platelet Reactivity in Patients with Carotid Artery Stenosis Undergoing Endarterectomy. A Pilot Study

Objectives: A considerable number of patients do not achieve an adequate response to clopidogrel. Our study aimed to evaluate genetic and non-genetic factors as possible risks for clopidogrel high on-treatment platelet reactivity (HTPR) in patients (n=112) with carotid artery stenosis undergoing endarterectomy (CEA). Methods: Using multiple-electrode impedance aggregometry (MEA) the antiplatelet effectiveness of clopidogrel was measured after 24 h, 7 and 30 days of clopidogrel treatment, which was introduced after elective CEA at a dose of 75 mg daily, for at least 30 days. Results: HTPR was observed among 25% patients after clopidogrel therapy for 30 days. Further analysis showed that 53.3% of patients carrying the CYP2C19*2 gene variant had clopidogrel-HTPR, while in the wild type group there were 14.6% (p lt 0.001). Multivariate logistic regression analysis identified the CYP2C19*2 variant allele (OR 4.384; 95% CI 1.296-14.833, p=0.017) and high total cholesterol level (OR 2.090; 95% CI 1.263-3.459, p=0.004) as the only independent risk factors for clopidogrel-HTPR. Conclusion: The CYP2C19*2 gene variant and high total cholesterol level were major factors for clopidogrel-HTPR in patients with carotid artery stenosis undergoing CEA

Clopidogrel High On-Treatment Platelet Reactivity in Patients with Carotid Artery Stenosis Undergoing Endarterectomy. A Pilot Study

Objectives: A considerable number of patients do not achieve an adequate response to clopidogrel. Our study aimed to evaluate genetic and non-genetic factors as possible risks for clopidogrel high on-treatment platelet reactivity (HTPR) in patients (n=112) with carotid artery stenosis undergoing endarterectomy (CEA). Methods: Using multiple-electrode impedance aggregometry (MEA) the antiplatelet effectiveness of clopidogrel was measured after 24 h, 7 and 30 days of clopidogrel treatment, which was introduced after elective CEA at a dose of 75 mg daily, for at least 30 days. Results: HTPR was observed among 25% patients after clopidogrel therapy for 30 days. Further analysis showed that 53.3% of patients carrying the CYP2C19*2 gene variant had clopidogrel-HTPR, while in the wild type group there were 14.6% (p lt 0.001). Multivariate logistic regression analysis identified the CYP2C19*2 variant allele (OR 4.384; 95% CI 1.296-14.833, p=0.017) and high total cholesterol level (OR 2.090; 95% CI 1.263-3.459, p=0.004) as the only independent risk factors for clopidogrel-HTPR. Conclusion: The CYP2C19*2 gene variant and high total cholesterol level were major factors for clopidogrel-HTPR in patients with carotid artery stenosis undergoing CEA