Cost Analysis of Health Examination Screening Program for Ischemic Heart Disease in Active-Duty Military Personnel in the Middle-Income Country

Cardiovascular diseases, including ischemic heart disease, are the most common causes of morbidity and death in the world, including Serbia, as a middle-income European country. The aim of the study was to determine the costs of preventive examinations for ischemic heart disease in active-duty military personnel, as well as to assess whether this was justified from the point of view of the limited health resources allocated for the treatment of the Republic of Serbia population. This is a retrospective cost-preventive study which included 738 male active-duty military personnel, aged from 23 to 58. The costs of primary prevention of ischemic heart disease in this population were investigated. Out of 738 subjects examined, arterial hypertension was detected in 101 subjects (in 74 of them, arterial hypertension was registered for the first time, while 27 subjects were already subjected to pharmacotherapy for arterial hypertension). Average costs of all services during the periodic-health-examination screening program were euro76.96 per subject. However, average costs of all services during the periodic-health-examination screening program for patients with newfound arterial hypertension and poorly regulated arterial hypertension were euro767.54 per patient and euro2,103.63 per patient, respectively. Since periodic-health-examination screening program in military personnel enabled not only discovery of patient with newfound arterial hypertension but also regular monitoring of those who are already on antihypertensive therapy, significant savings of euro690.58 per patient and euro2,026.67 per patient can be achieved, respectively. As financial resources for providing health care in Serbia, as a middle-income country, are limited, further efforts should be put on screening programs for ischemic heart disease due to possible significant savings

Antivazokonstriktorni efekt pinacidila na izolovanoj radijalnoj arteriji

Pinacidil, a previously studied potassium channel opener (PCO), is a potent antihypertensive agent in animals and humans. Its mechanism of action is not completly defined. The aim of our study was to investigate the antivasoconstricting effect of pinacidil on the isolated RA and to study whether this effect is endothelium-dependent. Contractions of isolated RA rings with intact endothelium were provoked by electrical field stimulation (EFS, 20 Hz) or exogenously applied noradrenaline (NA, 10 μM). Pinacidil (10 nM-0.1 mM) produced a concentration-dependent inhibition of both EFS- and NA-evoked contractions (p>0.05). NO synthesis inhibitor, L-NAME (10 μM) and the guanylate cyclase inhibitor, methylene blue (10 μM) did partly antagonize NA-evoked contractions and were without effect on EFSinduced contractions. Thus, the antivasoconstrictor effect of pinacidil on RA is partly endothelium-dependent and probably mediated via cGMP-dependent NO-pathway.Pinacidil je 'otvarač' kalijumovih kanala (OKK) koji ima snažno antihipertenzivno dejstvo na životinjama i ljudima. Mehanizam dejstva pinacidila još uvek nije u potpunosti definisan. Zato je cilj naše studije bio da ispitamo da li je antivazokonstriktorno dejstvo pinacidila na izolovanoj radijalnoj arteriji (RA) čoveka endotel zavisno. Kontrakcije prstenova RA sa očuvanim endotelom su prouzrokovane električnom stimulacijom (EFS, 20 Hz) ili spolja dodatim noradrenalinom (NA, 10 μM). Pinacidil (10 nM - 0.1 mM) je prouzrokovao koncentracijski-zavisnu inhibiciju EFS- i NA-kontrakcija bez značajne razlike u senzitivnosti (p>0.05). Inhibitor sinteze NO-a, L-NAME (10 μM) i inhibitor gvanilat ciklaze, metilensko plavo (10 μM) su delimično antagonizovali inhibitorni efekt pinacidila na NA-kontrakcije. Nasuprot ovome, oni nisu uticali na efekt pinacidila na EFS-kontrakcije. Možemo da zaključimo da pinacidil ima antivazokonstriktorni efekt na RA kada su kontrakcije izazvane električnom strujom ili noradrenalinom. Ovaj efekt pinacidila je delom endotel zavisan, ali samo kada su kontrakcije izazvane spolja dodatim noradrenalinom