The safety of enoxaparine use in elderly with acute myocardial infarction

Background/Aim. Enoxaparin (ENOX), the lowmolecular- weight heparin, used in acute myocardial infarction (AMI) could lead to hemorrhage. The aim of this study was to determine whether bleeding was more often in AMI patients older than 65 or 75 years who receive ENOX or unfractionated heparin (UFH). Methods. Among the patients with AMI hospitalized during three successive months receiving ENOX or UFH, three group of parameters were investigated: demographic, ischemic and bleeding TIMI criteria. Results. Among 85 hospitalized patients with signs of AIM, there were 35 (41.2%) old 65 years or less, 32 (38.5) old 66-75 years and 18 (21.2%) older than 75 years. In AMI elderly patients, according to the received ENOX/UFH: ischemic complication (18.2 vs. 21.4%) were insignificantly lower and the number of lethal outcomes (18,2 vs. 17,8%) were insignificantly more often in ENOX group; represented only by one patient (age beyond 75 years), major and non-major bleeding events occurred only in UFH group. Conclusion. The ENOX usage in AMI in patients older than 65 years did not show any significant difference in efficacy and bleeding rate comparing to UFH

Stomatološki tretman starih ljudi sa hendikepom

Introduction. The growing population of the elderly people and a proportional increase in the number of the elderly with different types of disabilities, necessitates a multidisciplinary approach to the assessment of their oral health and dental treatment. The ultimate aim is to retain a pain-free functional dentition and decrease the risk of future disease. Material and Methods. A PubMed search was performed and the authors contributed their experience in implementing preventive and therapeutic measures. Oral health problems of the elderly with disabilities. Two main factors influence the oral health: multimorbidity and polypharmacy. Oral health problems expected in this population are teeth abrasion, teeth fractures, root caries, periodontitis and problems with wearing dentures due to stomatitis caused by Candida albicans. Oral health assessment and treatment guidelines. This article provides guidelines for assessment and treatment planning, taking into consideration multimorbidity, polypharmacy, dementia and capacity of caregivers. Preventive measures. Preventive measures are crucial for long-term oral health of this population, and this paper provides guidelines for preventive treatment depending on the degree of functional dependence. Prosthetic treatment. Although some elderly with disabilities are suitable for conventional prosthetic treatment, often there are contraindications and specific considerations that must be taken into account. Conclusion. Oral health needs of the elderly people with disabilities should not be neglected and the success of treatment depends on the education of dental professionals and cooperation with other health professionals of the medical team.Uvod. Zbog rastuće populacije starih ljudi i proporcionalnog povećanja učestalosti broja starih ljudi sa različitim tipovima hendikepa, multi disciplinarni pristup proceni njihovog oralnog zdravlja je neophodan. Krajnji cilj je postići funkcionalnu denticiju bez bolova i smanjiti rizik od budućih oboljenja. Materijal i metode. Pretraživanje literature u bazi PubMed je obavljeno, ali je takođe iskustvo autora u primeni preventivnih i terapijskih mera uzeto u obzir. Problemi oralnog zdravlja starih ljudi sa hendikepom. Dva glavna razloga imaju uticaj na oralno zdravlje: multi morbiditet i polifarmacija. Problemi oralnog zdravlja koji se očekuju u ovoj populaciji su abrazija zuba, frakture zuba, karijes korena, parodontopatija i problemi sa nošenjem proteza usled stomatitis uzrokovanog kandidom (Candida albicans). Procena oralnog zdravlja i smernice za planiranje tipa tretmana. Ovaj članak obezbeđuje korisne smernice za procenu i planiranje tretmana, uzimajući u obzir multi morbiditet, polifarmaciju, demenciju i kapacitet negovatelja. Preventivne mere. Preventivne mere su ključne za dugotrajni uspeh oralnog zdravlja ove populacije i ovde su prikazane smernice za preventivne mere u zavisnosti od stepena funkcionalne zavisnosti. Protetski tretman. Iako su neki stari ljudi sa hendikepom pogodni za konvencionalni protetski tretman, većina ovih pacijenata ima neke kontra indikacije i specifičnosti koje treba uzeti u obzir. Zaključak. Potrebe za oralnim zdravljem starih ljudi sa hendikepom ne smeju biti zanemarene, a uspeh tretmana zavisi od edukacije stomatologa kao i saradnje sa ostalim specijalistima medicinskog tima

Stavovi, znanje i praksa negovatelja u održavanju oralnog zdravlja korisnika domova za stara lica u Srbiji

Background/Aim. Within the elderly population, residents in nursing homes, there is a greather risk of caries, periodontal disease and teeth loss. Assistance of caregivers in maintaininig good oral hygiene besides improving oral health can improve of residents general health and the quality of their lives. The aim of this study was to examine the attitudes of caregivers and knowledge about oral health, as well as the practice regarding oral care they apply at nursing homes in Serbia. Methods. The survey was conducted at the Gerontology Center Belgrade, consisting of four nursing homes located in the urban area. The study included 58 caregivers. They were contacted on working days, in all work shifts, during January, February and March of 2013. They were asked to fill in a self-administered questionnaire consisting of 26 closed-type questions. Results. The care-givers mostly considered that it was very important to take care of oral health of the residents, but 69% responded that the level of their oral health was low or very low. As the main barriers to oral hygiene maintenance, the caregivers indicated lack of time. The caregivers had more knowledge about periodontal disease than about the main cause of caries and its prevention. Formal medical education had the influence on the knowledge about oral diseases. Oral hygiene procedures carried out by the mayority of caregivers were denture cleaning and tooth brushing. Conclusion. The caregivers were aware of the limitations in everyday oral care of nursing homes residents in Serbia, although solving these problems requires the involvement of the entire public health service.Uvod/Cilj. U grupi starijih osoba, stanovnika domova za stara lica, postoji povećani rizik od nastanka karijesa, periodontalne bolesti i gubitka zuba. Pomoć u održavanju dobre oralne higijene, pored toga, može uticati i na opšte zdravstveno stanje i kvalitet života stanovnika domova za stara lica. Cilj ovog istraživanja bio je da se ispitaju stavovi i znanje negovatelja o oralnom zdravlju, kao i praksa koju primjenjuju u domovima za stara lica u Srbiji. Metode. Istraživanje je sprovedeno u ustanovi Gerontološki Centar Beograd, koji se sastoji od četiri doma za stara lica, locirana u urbanom području. U istraživanju je učestvovalo 58 negovatelja, s kojima smo kontaktirali radnim danima, u svim radnim smenama, tokom januara, februara i marta 2013. godine. Oni su zamoljeni da samostalno ispune upitnik sastavljen od 26 pitanja zatvorenog tipa. Rezultati. Negovatelji uglavnom smatraju da je veoma važno brinuti se o oralnom zdravlju korisnika domova, ali 69% je odgovorilo da je nivo oralnog zdravlja korisnika nizak ili vrlo nizak. Za glavnu prepreku u održavanju oralne higijene korisnika domova, negovatelji su označili nedostatak vremena. Njegovatelji su imali više znanja o parodontalnim bolestima, nego o glavnom uzročniku karijesa i njegovoj prevenciji. Formalno medicinsko obrazovanje imalo je uticaj na njihovo znanje o oralnim bolestima. Čišćenje proteza i pranje zuba su najčešće primenjivani postupci negovatelja u održavanju oralne higijene korisnika domova. Zaključak. Negovatelji su svesni ograničenja u svakodnevnom održavanju oralnog zdravlja korisnika domova za stara lica u Srbiji, kao i da rešavanje tih problema zahteva uključivanje celokupnog javnog zdravstvenog sektora

Genetički polimorfizam glutation S-transferaze P1 (GSTP1) Ile105Val i osetljivost na aterogenezu kod pacijenata sa dijabetesom tipa 2

One of the characteristics of type 2 diabetes mellitus (T2DM) is the state of persistent oxidative stress (OS) that has been implicated in the pathogenesis of diseases such is atherosclerosis mainly through chronic hyperglycemia that stimulates production of reactive oxygen species (ROS) and increases OS. Glutathione S-transferase P1 (GSTP1) is a member of the cytosolic GST superfamily. It plays an important role in neutralizing OS as an enzyme. Also, it participates in regulation of stress signaling and protects cells against apoptosis via its noncatalytic ligand-binding activity. GSTP1 Ile105Val functional polymorphism influences protein catalytic activity and stability and the aim of this study was to determine whether this gene variation influences susceptibility to atherogenesis in T2DM patients. A total of 240 individuals (140 patients with T2DM, accompanied with clinical manifestations of atherosclerosis, and 100 healthy controls) were included in this study. Genomic DNA was isolated from peripheral blood cells and genotyping was performed using polymerase chain reaction followed by restriction fragment length polymorphism (PCR-RFLP) analysis. We obtained no statistically significant differences in the distribution of alleles and genotypes between cases and controls (P>0.05) but association between Ile/Val (OR=0.6, 95%CI=0.35-1.05, P=0.08) and Val/Val (OR=0.45, 95%CI=0.18-1.11, P=0.08) genotypes and disease approached significance (P=0.08). Our results indicated that a larger study group is needed to establish the true relationship between potentialiy protective allele Val and the disease, and to determine the influence of other GSTP1 polymorphisms on atherogenesis in T2DM patients.Jedna od osobina tipa 2 dijabetes mellitus (T2DM) je stanje perzistentnog oksidativnog stresa (OS) koji je sastavni deo patogeneze bolesti kao što je ateroskleroza i to najčešće putem hronične hiperglikemije koja stimuliše nastanak reaktivnih vrsta kiseonika (tzv ROS) i povećava nivo OS. Glutation S-transferaza P1 (GSTP1) pripada superfamiliji citosolnih GST. Kao enzim, ima važnu ulogu u neutralizaciji OS. Takođe, učestvuje u regulaciji signalnog puta stresa ali i štiti ćelije od apoptoze putem nekatalitičke ligand-vezujuće aktivnosti. Funkcionalni polimorfizam Ile105Val GSTP1 gena utiče na katalitičku aktivnost proteina i na njegovu stabilnost i cilj ove studije je bio da se utvrdi da li ova genska varijanta utiče na osetljivost na aterogenezu kod pacijenata sa T2DM. Ukupno 240 osobe (140 pacijenata sa T2DM i nekom od kliničkih manifestacija ateroskleroze i 100 zdravih kontrola) je bilo uključeno u ovu studiju. Genomska DNK je izolovana iz ćelija periferne krvi a genotipizacija je urađena primenom reakcije lančane polimeraze posle koje je urađena analiza dužine restrikcionih fragmenata (PCR-RFLP analiza). Nismo dobili statistički značajne razlike u raspodeli alela i genotipova između obolelih i kontrola (P>0.05) ali asocijacija između Ile/Val (OR=0.6, 95%CI=0.35-1.05, P=0.08) i Val/Val (OR=0.45, 95%CI=0.18-1.11, P=0.08) genotipova i bolesti se približila značajnosti (P=0.08). Naši rezultaati pokazuju da je potrebna veća grupa ispitanika da bi se utvrdila prava veza između potencijalno protektivnog alela Val i bolesti kao i da bi se utvrdio uticaj drugih polimorfizama gena GSTP1 na aterogenezu kod T2DM pacijenata

Genetic polymorphism of glutathion S-transferase P1 (GSTP1) Ile105Val and susceptibility to atherogenesis in patients with type 2 diabetes mellitus

One of the characteristics of type 2 diabetes mellitus (T2DM) is the state of persistent oxidative stress (OS) that has been implicated in the pathogenesis of diseases such is atherosclerosis mainly through chronic hyperglycemia that stimulates production of reactive oxygen species (ROS) and increases OS. Glutathione S-transferase P1 (GSTP1) is a member of the cytosolic GST superfamily. It plays an important role in neutralizing OS as an enzyme. Also, it participates in regulation of stress signaling and protects cells against apoptosis via its noncatalytic ligand-binding activity. GSTP1 Ile105Val functional polymorphism influences protein catalytic activity and stability and the aim of this study was to determine whether this gene variation influences susceptibility to atherogenesis in T2DM patients. A total of 240 individuals (140 patients with T2DM, accompanied with clinical manifestations of atherosclerosis, and 100 healthy controls) were included in this study. Genomic DNA was isolated from peripheral blood cells and genotyping was performed using polymerase chain reaction followed by restriction fragment length polymorphism (PCR-RFLP) analysis. We obtained no statistically significant differences in the distribution of alleles and genotypes between cases and controls (P>0.05) but association between Ile/Val (OR=0.6, 95%CI=0.35-1.05, P=0.08) and Val/Val (OR=0.45, 95%CI=0.18-1.11, P=0.08) genotypes and disease approached significance (P=0.08). Our results indicated that a larger study group is needed to establish the true relationship between potentialiy protective allele Val and the disease, and to determine the influence of other GSTP1 polymorphisms on atherogenesis in T2DM patients. [Projekat Ministarstva nauke Republike Srbije, br. 175075

Health-related quality of life in elderly patients hospitalized with chronic heart failure

Background: Chronic heart failure is a very common condition in the elderly, characterized not only by high mortality rates, but also by a strong impact on health-related quality of life (HRQOL). Previous studies of HRQOL in elderly heart failure subjects have included mostly outpatients, and little is known about determinants of HRQOL in hospitalized elderly population, especially in Serbia. In this study, we tried to identify factors that influence HRQOL in elderly patients hospitalized with chronic heart failure in Serbia. Methods: The study population consisted of 136 patients aged 65 years or older hospitalized for chronic heart failure. HRQOL was assessed using the Minnesota Living with Heart Failure questionnaire. Predictors of HRQOL were identified by multiple linear regression analysis. Results: Univariate analysis showed that patients with lower income, a longer history of chronic heart failure, and longer length of hospital stay, as well as those receiving aldosterone antagonists and digoxin, taking multiple medications, in a higher NYHA class, and showing signs of depression and cognitive impairment had significantly worse HRQOL. Presence of depressive symptoms (P lt 0.001), higher NYHA class (P=0.021), lower income (P=0.029), and longer duration of heart failure (P=0.049) were independent predictors of poor HRQOL. Conclusion: Depressive symptoms, higher NYHA class, lower income, and longer duration of chronic heart failure are independent predictors of poor HRQOL in elderly patients hospitalized with chronic heart failure in Serbia. Further, there is an association between multiple medication usage and poor HRQOL, as well as a negative impact of cognitive impairment on HRQOL. Hence, measures should be implemented to identify such patients, especially those with depressive symptoms, and appropriate interventions undertaken in order to improve their HRQOL

Multiple arterial disease in clinical practice

There is a significant correlation among obliterate lesions of coronary carotid and peripheral arteries of the lower arteries at the same time. This pointed out that whenever clinical manifestations of obliterate disease of peripheral arteries are present. There is also need for routine examination of existent coronary artery disease. In the case of concomitant significant coronary and carotid vascular disease there is a question what should be operated first. The most vascular centres prefer carotid endarterectomy before aortocoronary bypass, and if there is nonstable coronary disease simultaneous carotid endarterectomy and aortocoronary bypass should be carried out

Prospective follow-up of nebivolol in the treatment of arterial hypertension

Introduction. Nebivolol, a third-generation beta-blocker (BB) shows a highly selective beta-blockade and specific vasodilating effects due to getting free nitro-oxide from the dysfunctional endothelium. Objective. The aim of the study was to investigate the antihypertensive effect of nebivolol in patients with arterial hypertension (AH) of both sexes. Methods. Systolic and diastolic blood pressure (BP), heart rate and serum glycemia, creatinin, cholesterol and trygliceride were measured after a 6-week treatment with a single 5 mg dose of nebivolol once daily so as to assess its efficacy and metabolic effects, as well as its tolerance by using a questionnaire answered by physicians and patients. Results. Out of 520 patients with mild or moderate AH, 430 (82.7%) were treated with nebivolol as monotherapy. After a 6-week treatment with nebivolol, with very good tolerability and neutral metabolic effects, systolic BP was significantly decreased (in male from initial 165±19 to 129±12 mm Hg, and female from initial 169±22 to 132±15 mm Hg at the end of the study; average decrease 22.3%, p<0.001) and as well as diastolic BP (male from initial 103±12 to 79±6 mm Hg and female from initial 100±9 to 82±7 mm Hg, average decrease 22.6%; p<0.001). Conclusion. After a 6-week treatment nebivolol significantly decreased systolic and diastolic BP in patients with mild and moderate AH, independently of the sex

Articles on elderly in Serbian medical journals

Introduction Population aging is a feature of all countries in the world. According to statistics, the Republic of Serbia is one of the countries with the majority of the elderly. Taking this into account, are articles on the elderly well represented in domestic medical journals? Objective The aim of the paper was to determine whether there was a sufficient number of articles on the elderly in domestic medical journals. Methods The articles on the elderly were searched using search engines in domestic and foreign medical journals for the last 5 years compared with the number of articles on children in the same publications for the same period. Results In the Serbian Citation Index, 11 articles on the topic of the elderly, and 487 on children were registered. In Srpski arhiv za celokupno lekarstvo, there was registered only one article on the topic of the elderly, and 30 on children. In Vojnosanitetski pregled, 2 articles on the elderly and 13 on children were registered (p<0001). For the last five years, in the New England Journal of Medicine, there were 593 articles on the elderly and 759 articles on children; in the JAMA, there were 63 articles on the elderly and 303 articles on children; and in The Lancet, in the last five years, 46 articles on the elderly and 148 articles on children were published. Conclusion The themes of the elderly were rarely represented in Serbian medical journals. This has reduced the interest of physicians in medical problems of this growing population of patients and further sent them away from making standards in the diagnosis and treatment of the elderly

Caregivers’ attitudes, knowledge and practices of oral care at nursing homes in Serbia

Background/Aim. Within the elderly population, residents in nursing homes, there is a greather risk of caries, periodontal disease and teeth loss. Assistance of caregivers in maintaininig good oral hygiene besides improving oral health can improve of residents general health and the quality of their lives. The aim of this study was to examine the attitudes of caregivers and knowledge about oral health, as well as the practice regarding oral care they apply at nursing homes in Serbia. Methods. The survey was conducted at the Gerontology Center Belgrade, consisting of four nursing homes located in the urban area. The study included 58 caregivers. They were contacted on working days, in all work shifts, during January, February and March of 2013. They were asked to fill in a self-administered questionnaire consisting of 26 closed-type questions. Results. The care-givers mostly considered that it was very important to take care of oral health of the residents, but 69% responded that the level of their oral health was low or very low. As the main barriers to oral hygiene maintenance, the caregivers indicated lack of time. The caregivers had more knowledge about periodontal disease than about the main cause of caries and its prevention. Formal medical education had the influence on the knowledge about oral diseases. Oral hygiene procedures carried out by the mayority of caregivers were denture cleaning and tooth brushing. Conclusion. The caregivers were aware of the limitations in everyday oral care of nursing homes residents in Serbia, although solving these problems requires the involvement of the entire public health service.Uvod/Cilj. U grupi starijih osoba, stanovnika domova za stara lica, postoji povećani rizik od nastanka karijesa, periodontalne bolesti i gubitka zuba. Pomoć u održavanju dobre oralne higijene, pored toga, može uticati i na opšte zdravstveno stanje i kvalitet života stanovnika domova za stara lica. Cilj ovog istraživanja bio je da se ispitaju stavovi i znanje negovatelja o oralnom zdravlju, kao i praksa koju primjenjuju u domovima za stara lica u Srbiji. Metode. Istraživanje je sprovedeno u ustanovi Gerontološki Centar Beograd, koji se sastoji od četiri doma za stara lica, locirana u urbanom području. U istraživanju je učestvovalo 58 negovatelja, s kojima smo kontaktirali radnim danima, u svim radnim smenama, tokom januara, februara i marta 2013. godine. Oni su zamoljeni da samostalno ispune upitnik sastavljen od 26 pitanja zatvorenog tipa. Rezultati. Negovatelji uglavnom smatraju da je veoma važno brinuti se o oralnom zdravlju korisnika domova, ali 69% je odgovorilo da je nivo oralnog zdravlja korisnika nizak ili vrlo nizak. Za glavnu prepreku u održavanju oralne higijene korisnika domova, negovatelji su označili nedostatak vremena. Njegovatelji su imali više znanja o parodontalnim bolestima, nego o glavnom uzročniku karijesa i njegovoj prevenciji. Formalno medicinsko obrazovanje imalo je uticaj na njihovo znanje o oralnim bolestima. Čišćenje proteza i pranje zuba su najčešće primenjivani postupci negovatelja u održavanju oralne higijene korisnika domova. Zaključak. Negovatelji su svesni ograničenja u svakodnevnom održavanju oralnog zdravlja korisnika domova za stara lica u Srbiji, kao i da rešavanje tih problema zahteva uključivanje celokupnog javnog zdravstvenog sektora