Dynamics of the Serbian EU accession process : key issues and the challenges of state democratisation in an era of populism

The current Serbian authorities (aligned with the Serbian Progressive Party) have pushed Serbia towards effective reforms over the past several years and improved its image on the international arena through an intensified diplomatic offensive after 2015. This has led to a situation in which the Serbian state became a political and economic partner in both regional and integration projects. The latter is demonstrated by the arduous but progressive accession process to the European Union. After 2000, international and Serbian public opinion greeting the end of the regime of Slobodan Milošević expected rapid democratisation of the state based on statements by Serbian politicians who had declared a West European course of the state. The short-lived rule of Prime Minister Zoran Đinđić, confirmed this; however, the policy of his successors was no longer so unambiguous. For almost a decade, Serbia oscillated between populism and declared democratisation, without making major changes, expected by both society and the European Union. When after the year 2012 the Serbian Progressive Party came to power (the party was founded as a conservative grouping and had radical roots), it seemed that the Serbian state would be pushed towards a more conservative, anti-European and nationalist direction. However, that did not happen. Opinion about the last six years of the group’s rule is varied. This paper aims to try to answer the question whether during the party’s rule, Serbia has been democratising and whether in this era of nationalist movements and populism, the country has a chance at real democratisation and finishing the pro- cess of accession to the EU

Spolne razlike u raspodjeli rizičnih čimbenika, težini i ishodu ishemijskog moždanog udara

The aim of the study was to identify differences in baseline characteristics and outcomes of men and women with acute ischemic stroke. Ischemic stroke was confirmed by CT scan or autopsy in patients admitted to the 2nd Department of Neurology, Institute of Psychiatry and Neurology in Warsaw, Poland from 1995 to 2007. Male and female patients were compared for risk factors, state of activity prior to stroke, stroke type according to Oxfordshire Community Stroke Project classification, diagnostic test findings, and early 30-day outcome. Data on 1379 women and 1155 men admitted with ischemic stroke were analyzed. The mean age of female and male patients was 74.3 and 68.8 years, respectively. Women were more often disabled prior to stroke, hypertensive, diagnosed with atrial fibrillation or heart failure, and had impaired consciousness at admission, whereas men were more likely to smoke, abuse alcohol and have a history of myocardial infarction or transient ischemic attack. A higher percentage of female stroke patients suffered from total anterior circulation syndrome than males (21.2% and 14.0%, respectively). Internal carotid artery stenosis over 70% was reported in 10.8% of women and 19.1% of men. The 30-day mortality and poor outcome rates were significantly higher in women than men (17.2% vs. 13.1% and 59.9% vs. 46.2%). After adjusting for casemix in multivariate analysis, female sex was independently associated with a higher risk of an early poor outcome. In conclusion, the risk factor distribution, clinical characteristics, diagnostic test findings, and early outcomes were different between female and male ischemic stroke patients. Female sex was associated with poorer prognosis, indicating that more intensive acute and long-term global care may be needed to improve the outcome among female stroke patients.Cilj studije bio je utvrditi razlike u osnovnim značajkama i ishodu između muškaraca i žena s akutnim ishemijskim moždanim udarom. Ishemijski moždani udar potvrđen je kompjutorskom tomografijom ili pri autopsiji u bolesnika primljenih na Drugi neurološki odjel Zavoda za psihijatriju i neurologiju u Varšavi, Poljska, od 1995. do 2007. godine. Bolesnici i bolesnice uspoređeni su u odnosu na rizične čimbenike, stanje aktivnosti prije moždanog udara, vrst moždanog udara prema klasifikaciji Oxfordshire Community Stroke projekta, nalaze dijagnostičkih pretraga i rani 30-dnevni ishod. Analizirali su se podatci za 1379 žena i 1155 muškaraca s ishemijskim moždanim udarom. Srednja dob bolesnica bila je 74,3 godine, a bolesnika 68,8 godina. Žene su češće imale invalidnost prije moždanog udara, kao i hipertenziju, atrijsku fibrilaciju ili srčano zatajenje, te poremećaj svijesti kod prijma, dok je kod muškaraca češće zabilježena navika pušenja, zlouporaba alkohola te povijest infarkta miokarda ili prolaznog ishemijskog napadaja. Bolesnice su u većem postotku patile od sindroma ukupne prednje cirkulacije nego muškarci (21,2% prema 14,0%). Stenoza unutarnje karotidne arterije veća od 70% zabilježena je u 10,8% žena i 19,1% muškaraca. Smrtnost unutar 30 dana i stope lošeg ishoda bile su značajno više u žena negoli u muškaraca (17,2% prema 13,1%, odnosno 59,9% prema 46,2%). Nakon prilagodbe za casemix u multivarijatnoj analizi ženski spol bio je neovisno udružen s većim rizikom za rani loš ishod. U zaključku, raspodjela rizičnih čimbenika, te kliničke značajke, nalazi dijagnostičkih pretraga i rani ishodi razlikovali su se između muških i ženskih bolesnika s ishemijskim moždanim udarom. Ženski spol bio je udružen s lošijom prognozom, ukazujući na potrebu intenzivnije akutne i dugoročne opće skrbi kako bi se poboljšao ishod bolesti među bolesnicama s ishemijskim moždanim udarom

Współpraca pomiędzy lekarzem i personelem pielęgniarskim w procesie diagnozowania i leczenia trombolitycznego chorych w ostrym okresie udaru mózgu

In accordance with the WHO (World Health Organization) definition applicable since 1980, stroke (BS) is a disease syndrome characterized by a sudden occurrence of focal or generalized cerebral dysfunctions, which last longer than 24 hours, unless they are fatal. Thrombolytic therapy is currently the recommended and most effective method of treatment of recent ischemic stroke. The success of treating stroke equally depends on the appropriate organization of the entire team caring for the patient.In order to efficiently conduct thrombolytic treatment in a patient with acute ischemic stroke, medical and nursing staff working in the Department of Stroke Treatment should have the following skills: high level of professional responsibility, high professional competence, have the ability to cooperate in a team and establish interpersonal contacts, including those with the patient and their family. Team members should make difficult decisions jointly, analyze and modify their activities so that treatment could be implemented as soon as possible while maintaining the utmost discretion and clinical alertness.This article was prepared in order to summarize and organize available knowledge on the cooperation between the doctor and nursing staff in the diagnosis and thrombolytic therapy of patients in the acute stroke period. (JNNN 2019;8(1):37–43)Zgodnie z obowiązującą już od 1980 r. definicją WHO (Światowa Organizacja Zdrowia), udar mózgu (UM) to zespół chorobowy cechujący się nagłym wystąpieniem ogniskowych lub uogólnionych zaburzeń funkcji mózgowia, które utrzymują się dłużej niż 24 godziny, o ile nie doprowadzą wcześniej do zgonu. Leczenie trombolityczne jest obecnie zalecaną i najskuteczniejszą metodą leczenia świeżego udaru niedokrwiennego mózgu. Sukces leczenia udaru mózgu w równej mierze zależy od dobrej organizacji całego zespołu opiekującego się chorym.W celu sprawnego przeprowadzenia leczenia trombolitycznego u pacjenta z ostrym udarem niedokrwiennym mózgu personel lekarski jak i pielęgniarski pracujący w oddziale Leczenia Udaru Mózgu powinien posiadać następujące umiejętności: wysoki poziom odpowiedzialności zawodowej, wysokie kompetencje zawodowe, posiadać umiejętność współpracy w zespole oraz nawiązywania kontaktów interpersonalnych w tym również z pacjentem i jego rodziną. Trudne decyzje członkowie zespołu powinni podejmować wspólnie, a swoje działania analizować i modyfikować tak aby leczenie wdrażać jak najszybciej przy zachowaniu jak najwyższej rozwagi i czujności klinicznej.Niniejszy artykuł powstał w celu podsumowania i uporządkowania dostępnej wiedzy na temat współpracy pomiędzy lekarzem i personelem pielęgniarskim w procesie diagnozowania i leczenia trombolitycznego chorych w ostrym okresie udaru mózgu. (PNN 2019;8(1):37–43

Retrospektywna analiza pacjentów w aspekcie rozpowszechniania nadużywania alkoholu wśród chorych z udarem mózgu leczonych w Oddziale Neurologii

Introduction. Alcohol is a drug that is harmful to many organs, especially the brain, and may contribute to worse recovery in stroke patients treated in a neurological ward. There are few works in the literature dealing with alcohol-related problems in patients with stroke.Aim. Assessment of the prevalence of alcohol abuse in stroke and its impact on the diagnostic and therapeutic process in groups of patients diagnosed with harmful alcohol consumption or alcohol dependence syndrome.Material and Methods. The material consisted of 2770 medical records of patients hospitalized in the Department of Neurology with the Stroke Treatment Sub-Department at the Specialist Hospital of Stanisław Staszic in Piła from January 1 to December 31, 2015, which were analysed in terms of alcohol abuse by patients. Patients with stroke (40 people) were analysed in detail. The results of laboratory tests, risk factors, gender and age of the patients were analysed. The following methods of scientific research were used in the study: analysis of medical records, statistical analysis of quantitative and qualitative data with the use of STATISTICA v. 13.3 computer program by StatSoft.Results. There were 40 patients with ischemic and haemorrhagic stroke who abused alcohol in total (29.85%). Among patients with stroke, 70% presented harmful drinking, 30% — alcohol dependence syndrome. More than two risk factors for stroke were reported more frequently in the group of patients with stroke who abused alcohol than in those with stroke but did not abuse alcohol (38.8% vs. 30.0%; p = 0.0561). In laboratory studies, stroke patients who abused alcohol compared to non-drinkers had a statistically significantly higher red blood cell (MCV) volume, higher levels of the liver enzymes ASPAT and ALAT; p < 0.05.Conclusions. The lack of real information on the amount of alcohol consumed by a patient can make the diagnostic and therapeutic process very difficult, and thus delay the full diagnosis and implementation of the appropriate therapy. The study should be extended to include a prospective assessment. In order to increase the detection of alcohol abuse in patients, an objective interview, psychological assessment focused on the problem would be necessary, and the use of questionnaires with short, simple but precise questions that would allow to quantify the alcohol problem in a patient. (JNNN 2020;9(4):145–151)Wstęp. Alkohol jest używką, która oddziałuje szkodliwie na wiele narządów, a zwłaszcza na mózg i może przyczyniać się do gorszego zdrowienia pacjentów z udarem mózgu leczonych w oddziale neurologicznym. W literaturze mało jest prac poruszających problemy alkoholowe u pacjentów z udarem mózgu.Cel. Ocena rozpowszechnienia nadużywania alkoholu w udarach mózgu i wpływ na proces diagnostyczno-terapeutyczny w grupach pacjentów, u których zdiagnozowano picie alkoholu szkodliwe lub zespół zależności alkoholowej.Materiał i metody. Materiał stanowiło 2770 historii chorób pacjentów hospitalizowanych w Oddziale Neurologii z Pododdziałem Leczenia Udarów Mózgu w Szpitalu Specjalistycznym im. Stanisława Staszica w Pile w okresie 01.01.–31.12.2015 r., które analizowano pod kątem nadużywania alkoholu przez pacjentów. Szczegółowej analizie poddano chorych z udarem mózgu (40 osób). Analizie poddano wyniki badań laboratoryjnych, czynniki ryzyka, płeć i wiek chorych. W pracy posłużono się następującymi metodami badań naukowych: analiza dokumentacji medycznej, analiza statystyczna danych o charakterze ilościowym i jakościowym z wykorzystaniem programu komputerowego STATISTICA v. 13.3 firmy StatSoft.Wyniki. Pacjentów z udarem mózgu niedokrwiennym i krwotocznym nadużywających alkohol łącznie było 40 (29,85%). Spośród pacjentów z udarem mózgu 70% prezentowało picie szkodliwe, 30% — zespół zależności od alkoholu. W grupie pacjentów z udarem nadużywających alkohol w porównaniu do pacjentów z udarem ale nie nadużywających alkoholu częściej odnotowano występowanie powyżej dwóch czynników ryzyka udaru (38,8% vs 30,0%; p = 0,0561). W badaniach laboratoryjnych pacjenci z udarem nadużywający alkohol w porównaniu do nie pijących mieli znamiennie statystycznie większą objętość krwinki czerwonej (MCV), wyższy poziom enzymów wątrobowych ASPAT i ALAT; p < 0,05.Wnioski. U pacjentów z udarem mózgu należy zwracać szczególną uwagę na to czy nadużywają alkohol. Brak prawdziwej informacji na temat ilości spożywanego przez pacjenta alkoholu może bardzo utrudniać proces diagnostyczno-terapeutyczny i tym samym opóźnia postawienie pełnej diagnozy i wdrożenie właściwej terapii. Badanie należałoby rozszerzyć o ocenę prospektywną. W celu zwiększenia wykrywalności nadużywania alkoholu u pacjentów konieczny byłby wywiad obiektywny, ocena psychologiczna ukierunkowana na ten problem, zastosowanie ankiet z krótkimi, prostymi, ale precyzyjnymi pytaniami, które pozwoliłyby oszacować problem alkoholowy w sposób ilościowy u pacjenta. (PNN 2020;9(4):145–151) &nbsp

Inducible nitric oxide synthase in duodenum of children with Giardia lamblia infection.

The investigation were performed on children with Giardia lamblia infection, diagnosed on the basis of positive stool tests for Giardia antigen (Elisa) or by microscopical detection of trophozoites in duodenal fluid. In duodenal biopsies morphological studies and immunohistochemical reaction for inducible nitric oxide synthase (iNOS) were performed. The control group was made up of duodenal tissue of children with excluded giardiasis and inflammation of the upper part of gastrointestinal tract. The duodenal biopsies from children without Giardia lamblia infection were found to have a high immunoreactivity for iNOS in enterocytes, the cells of intestinal crypts, endothelial cells of vessels and connective tissue cells of lamina propria. In children with giardiasis: in some biopsies the expression of iNOS was as high as in control group, in others was weaker detectable and the shortening of intestinal villi was seen. There were also duodenal biopsies with the lack of immunoreactivity for iNOS, with shorter villi and a large amount of mucus in the intestinal epithelium. Beside of goblet cells, also enterocytes were loaded with mucus. The pathological changes may cause malabsorption and also may have a negative influence on the defense of the intestinal wall against Giardia lamblia infection. The different morphological and immunohistochemical results in the duodenum of children with giardiasis can elucidate a variety of clinical symptoms from asymptomatic to severe infection