HOTEL DESIGN AND ADAPTIVE REUSE: FROM HISTORIC PALACES TO THE CITY’S DILAPIDATED STRUCTURES

Abstract. At the time of changing economic circumstances, adaptation and conversion of historic structures is an increasingly popular approach. Some historical buildings are very suitable for the revitalization into the modern hotels. The paper analyzes the relationship of the hotel, the city and its architectural heritage, as well as some of the factors that led to the eruption of alternative models of hotels, shown through a series of successful solutions. Many challenges of hotel design in historic buildings are listed and corresponding solutions are offered. Some methodological directions are indicated, and certain guidelines and principles for further activities in this field are formulated. In conclusion their applicability in practice is discussed, and certain disadvantages and limitations are listed.Key words: historic building, hotel, adaptation, revitalization, architecture, design

Metabolic syndrome in children and adolescents

High prevalence of metabolic syndrome in children and adolescents is serious problem of modern society. In order to prevent development of possible complications (cardiovascular diseases and diabetes mellitus type 2) later in life, early recognition of children at risk for developing metabolic syndrome is of great importance. Previous differences in criteria for diagnosis of metabolic syndrome in children and adolescents have been significantly decreased by new criteria issued by the International Diabetes Federation. From the aspect of prevention, key elements are proper nutrition and regular physical activity. In a view of treatment recommendations, initial steps should be regulation of energy balance in the diet and increase in physical activity; the drug treatment is reserved for patients with high risk of complications.

Community-acquired urinary tract infections: Causative agents and their resistance to antimicrobial drugs

Background/Aim. Urinary tract infections (UTIs) are among the most common infections in outpatients. The aim of this study was to define the causative agents of urinary tract infections and their resistance to antimicrobial drugs in the urban area of central Serbia, as well as to evaluate eventual differences associated with age and gender of the patients. Methods. This retrospective study analysed data taken from routine, consecutively collected urine cultures of outpatients with symptomatic UTIs, collected from the Department of Microbiology, Institute of Public Health in Kragujevac, Serbia, from January 2009 to December 2013. Results. There were 71,905 urine cultures, and 24,713 (34.37%) of them were positive for bacterial pathogens. The most common pathogen was Escherichia coli (E. coli) (56.56%), followed by Klebsiella spp. (16.20%), Proteus spp. (14.68%), Enterococcus spp. (5.29%) and Pseudomonas aeruginosa (3.74%). E. coli and Enterococcus spp. isolation rates were lower in males ≥ 60 years old (23.71% and 4.87%, respectively), while Klebsiella spp. was more prevalent in this group (32.06%). The most common causative agents isolated from 15–29 years old male patients were Enterococcus spp. and Pseudomonas aeruginosa (13.28% each). Among women, the isolation rate of E.coli was high in all age groups (around 70%). Proteus spp. was frequently isolated from females ≤ 14 years old (13.27%), while Klebsiella spp. was the most frequent in the oldest age female group (10.99%). Conclusion. Choice of antibiotics for treatment of UTIs should be governed not only by the local resistance patterns, but also by gender and age of patients

Community-acquired urinary tract infections: Causative agents and their resistance to antimicrobial drugs

Background/Aim. Urinary tract infections (UTIs) are among the most common infections in outpatients. The aim of this study was to define the causative agents of urinary tract infections and their resistance to antimicrobial drugs in the urban area of central Serbia, as well as to evaluate eventual differences associated with age and gender of the patients. Methods. This retrospective study analysed data taken from routine, consecutively collected urine cultures of outpatients with symptomatic UTIs, collected from the Department of Microbiology, Institute of Public Health in Kragujevac, Serbia, from January 2009 to December 2013. Results. There were 71,905 urine cultures, and 24,713 (34.37%) of them were positive for bacterial pathogens. The most common pathogen was Escherichia coli (E. coli) (56.56%), followed by Klebsiella spp. (16.20%), Proteus spp. (14.68%), Enterococcus spp. (5.29%) and Pseudomonas aeruginosa (3.74%). E. coli and Enterococcus spp. isolation rates were lower in males ≥ 60 years old (23.71% and 4.87%, respectively), while Klebsiella spp. was more prevalent in this group (32.06%). The most common causative agents isolated from 15–29 years old male patients were Enterococcus spp. and Pseudomonas aeruginosa (13.28% each). Among women, the isolation rate of E.coli was high in all age groups (around 70%). Proteus spp. was frequently isolated from females ≤ 14 years old (13.27%), while Klebsiella spp. was the most frequent in the oldest age female group (10.99%). Conclusion. Choice of antibiotics for treatment of UTIs should be governed not only by the local resistance patterns, but also by gender and age of patients

Risk factors for healthcare-acquired urinary tract infections caused by multi-drug resistant microorganisms

Introduction. Healthcare-acquired urinary tract infections (HAUTI) make up to 40% of all healthcareacquired infections and contribute significantly to hospital morbidity, mortality, and overall cost of treatment. Objective. The aim of our study was to investigate possible risk factors for development of HAUTI caused by multi-drug resistant pathogens. Methods. The prospective case-control study in a large tertiary-care hospital was conducted during a five-year period. The cases were patients with HAUTI caused by multi-drug resistant (MDR) pathogens, and the controls were patients with HAUTI caused by non-MDR pathogens. Results. There were 562 (62.6%) patients with MDR isolates and 336 (37.4%) patients with non-MDR isolates in the study. There were four significant predictors of HAUTI caused by MDR pathogens: hospitalization before insertion of urinary catheter for more than eight days (ORadjusted = 2.763; 95% CI = 1.352-5.647; p = 0.005), hospitalization for more than 15 days (ORadjusted = 2.144; 95% CI = 1.547-2.970; p < 0.001), previous stay in another department (intensive care units, other wards or hospitals) (ORadjusted = 2.147; 95% CI = 1.585-2.908; p < 0.001), and cancer of various localizations (ORadjusted = 2.313; 95% CI = 1.255-4.262; p = 0.007). Conclusion. Early removal of urinary catheter and reduction of time spent in a hospital or in an ICU could contribute to a decrease in the rate of HAUTI caused by MDR pathogens

Long-term treatment with olanzapine in hospital conditions: Prevalence and predictors of the metabolic syndrome

Introduction. The risk of metabolic abnormalities is greatly increased in schizophrenic patients started on an atypical antipsychotic medication. Patients with psychiatric disorders exceed mortality ranges resulting from, among others, increased risk of cardiovascular events. Other factors contributing to the development of metabolic syndrome include prolonged duration of illness, increasing age, female sex and lifestyle factors. Objective. This cross-sectional study was taken up to assess the prevalence of the metabolic syndrome (MetS) in schizophrenic patients receiving olanzapine monotherapy for at least six months and to determine the most important risk factors associated with metabolic syndrome presence in these patients. Methods. A total of 93 long term hospitalized schizophrenic patients (71 men, 22 women), had a screening of the following: case-history data, psychiatric scales, anthropometric measures, blood (fasting glucose, lipid status, C-reactive protein - CRP) and urine samples (microalbuminuria). Results. Prevalence of MetS according to International Diabetes Federation criteria in our study was 34.4%. The multivariate analysis distinguished the following significant predictors of MetS presence (in order of appearance): data about diabetes mellitus in family history (p=0.002), body mass index >25 kg/m2 (p=0.002), hyperlipidemia in family history (p=0.008), and elevated CRP value (p=0.042). Conclusion. High rate of MetS in patients treated with olanzapine in this study exceeds MetS prevalence in general population. Among observed parameters, our study pointed to several “high risk” predictors associated with MetS presence. Regular monitoring of cardiometabolic risk factors is highly recommended. Positive heredity distress mentioned above may direct a psychiatrist to prescribe some other drug than olanzapine in the long term treatment of schizophrenia

FACTORS ASSOCIATED WITH ESTIMATE OF HIGH TERATOGENIC RISK IN FEMALES EXPOSED TO ANTI-INFECTIVE AND ANTI-INFLAMMATORY DRUGS DURING PREGNANCY

ABSTRACT Introduction. Considering that small number of drugs are completely safe for use during pregnancy, right choice and adequate risk assessment is extremely important. Objective. The aim of this study was to analyze factors associated with estimate of high teratogenic risk (as judged by clinical pharmacologist) in pregnant females who were prescribed anti-infective drugs or mild analgesics. Methods. A cross-sectional study included 284 pregnant women who came for an advice about teratogenic risk to clinical pharmacologist in Clinical Centre Kragujevac, Serbia during the period from 1997 to 2012. All of included pregnant women were prescribed mild analgesics and/or anti-infective drugs during the first 3 months of pregnancy. The data were collected from patient files and by phone interviews. Results. Clinical pharmacologists estimated the risk of teratogenicity as “high” in pregnant females who were using tetracyclines or propionic acid derivatives. Disorders of development reported by mothers during phone interviews were associated with cephalosporin use during first 3 months of pregnancy, while miscarriages or abortions happened more often in women who used a tetracycline. Conclusions. Estimate of risk from congenital anomalies after use of drugs during pregnancy, which make clinical pharmacologists as part of their routine healthcare services, depends on amount of published data about previous experiences with specific drugs during the first 3 months of pregnancy. Key Words: pregnancy; drugs; risk of teratogenicity; risk estimat

Cost-effectiveness of four immunomodulatory therapies for relapsingremitting multiple sclerosis: A Markov model based on data a Balkan country in socioeconomic transition

Background/Aim. A cost-effectiveness analyses of immunomodulatory treatments for relapsing-remitting multiple sclerosis (RRMS) in developed countries have shown that any benefit from these drugs is achieved at very high cost. The aim of our study was to compare the cost-effectiveness of five treatment strategies in patients diagnosed with RRMS (symptom management alone and in combination with subcutaneous glatiramer acetate, intramuscular interferon β-1a, subcutaneous interferon β-1a, or intramuscular interferon β- 1b) in a Balkan country in socio-economic transition. Methods. The Markov model was developed based on the literature about effectiveness and on local Serbian cost calculations. The duration of a cycle in the model was set to a month. The baseline time horizon was 480 months (40 years). The societal perspective was used for costs and outcomes, and they were discounted for 3% annually. Monte Carlo micro simulation with 1000 virtual patients was done. Results. Significant gain with immunomodulatory therapy was achieved only in relapse-free years, while the time spent in health states EDSS 0.0-5.5 was longer with symptomatic therapy only, and gains in life years and QALYs were only marginal. One QALY gained costs more than a billion of Serbian dinars (more than 20 million US dollars), making each of the four immunomodulatory therapies costineffective. Conclusion. Our study suggests that immunomodulatory therapy of RRMS in a Balkan country in socioeconomic transition is not cost-effective, regardless of the type of the therapy. Moderate gain in relapse-free years does not translate to gain in QALYs, probably due to adverse effects of immunomodulatory therapy