Injectable interferon beta-1b for the treatment of relapsing forms of multiple sclerosis

Multiple sclerosis (MS) is chronic inflammatory and demyelinating disease with either a progressive (10%–15%) or relapsing-remitting (85%–90%) course. The pathological hallmarks of MS are lesions of both white and grey matter in the central nervous system. The onset of the disease is usually around 30 years of age. The patients experience an acute focal neurologic dysfunction which is not characteristic, followed by partial or complete recovery. Acute episodes of neurologic dysfunction with diverse signs and symptoms will then recur throughout the life of a patient, with periods of partial or complete remission and clinical stability in between. Currently, there are several therapeutic options for MS with disease-modifying properties. Immunomodulatory therapy with interferon beta-1b (IFN-β1b) or -1a, glatiramer and natalizumab shows similar efficacy; in a resistant or intolerant patient, the most recently approved therapeutic option is mitoxantrone. IFN-β1b in patients with MS binds to specific receptors on surface of immune cells, changing the expression of several genes and leading to a decrease in quantity of cell-associated adhesion molecules, inhibition of major histocompatibility complex class II expression and reduction in inflammatory cells migration into the central nervous system. After 2 years of treatment, IFN-β1b reduces the risk of development of clinically defined MS from 45% (with placebo) to 28% (with IFN-β1b). It also reduces relapses for 34% (1.31 exacerbations annually with placebo and 0.9 with higher dose of IFN-β1b) and makes 31% more patients relapse-free. In secondary-progressive disease annual rate of progression is 3% lower with IFN-β1b. In recommended doses IFN-β1b causes the following frequent adverse effects: injection site reactions (redness, discoloration, inflammation, pain, necrosis and non-specific reactions), insomnia, influenza-like syndrome, asthenia, headache, myalgia, hypoesthesia, nausea, paresthesia, myasthenia, chills and depression. Efficacy of IFN-β1b in relapsing-remitting MS is higher than that of IFN-β1a, and similar to the efficacy of glatiramer acetate. These facts promote IFN-β1b as one of the most important drugs in the spectrum of immunological therapies for this debilitating disease

SMALL AND MEDIUM SIZE ENTERPRISES AS SUPPORT TO DEVELOPMENT OF AGRIBUSINESS OF REPUBLIC OF SERBIA

Development of strong and competitive sector of small and medium enterprises has very important role in process of total transition in Republic of Serbia. This sector should be one of the guidelines of economical development in the future, like in developed countries. Within the ²Strategy of development of SME and entrepreneurship in Republic of Serbia from 2003 to 2008² government of the Republic of Serbia, not accidentally, placed, among many other sectors (which are expected to contribute and boost economical development, increase the employment rate, and realize increased foreign export earnings), the sector of agricultural products processing. It can be concluded that significant contribution from agriculture to improvement of overall economic status is expected. Accession to EU should be considered not only as the opportunity, but also as a serious task in agriculture restructuring. However, aggravating circumstance, in regard to export of agricultural and food products, first of all to EU countries, is the fact that this market is under strict protective measures within the policy of agriculture and measures of agrarian protectionism. In such conditions, it is very difficult for producers and food processors to enter such closed markets. Considering the flexibility of small and medium enterprises with regard to production programs, as well as their capability to adjust to economical trends, it can be expected that they become one of the most important subjects of support of agribusiness development in Republic of Serbia.SME, agribusiness development, transition, market, Agribusiness, Agricultural Finance, Community/Rural/Urban Development,

Factors associated with death in intensive care unit patients with ventilator-associated pneumonia

Background: The incidence of ventilator-associated pneumonia (VAP) among patients on mechanical ventilation ranges from 15% to 25%, and mortality ranges from 33% to 38%. Aim: The aim of our study was to analyse the importance of previously uninvestigated potential risk factors for death in intensive care unit (ICU) patients with VAP. Methods: A case-control design was chosen for this study. The study population consisted of all patients who developed ventilator-associated pneumonia in the central ICU of a tertiary care hospital (n = 65) during a period of 6 months. Cases (n=45) included patients who died during their treatments in the ICU, if their primary cause of death was ventilator-VAP. Controls (n=20) included patients with VAP who survived their treatments in the ICU and who subsequently were subsequently transferred to other hospital wards. Results: Significant associations were found between death and age over 65 (ORadjusted = 10.66; CI: 1.22, 93.12; p = 0.032), death and infection upon admission to the ICU (ORadjusted = 434.39; CI: 3.07, 61449.65; p = 0.016), and death and administration of ceftriaxone prior to VAP (ORadjusted = 69.32; CI: 1.74, 2768.92; p = 0.024). A synergistic effect on death was found only for age over 65 and infection upon admission to the ICU. Conclusions: ICU patients with VAP experience have increased risk of mortality if they receive ceftriaxone prophylactically, if they have an infection upon admission to the ICU and if their age is advanced

Analysis of risk factors for occlusions of a synthetic femoropopliteal bypass graft

© 2015, Institut za Vojnomedicinske Naucne Informacije/Documentaciju. All rights reserved. Background/Aim. Femoropopliteal bypass is a revasculariza-tion technique of lower extremities with excellent outcome. The great saphenous vein is the best graft material, but if it is not adequate or has been removed, synthetic grafts are an useful al-ternative. Graft occlusion is the most significant complication with the most serious consequences. The aim of this study was to analyse predictive factors for the synthetic femoropopliteal bypass occlusions. Methods. This retrospective case-control study included all patients who underwent synthetic femoropop-liteal bypass due to peripheral arterial occlusive disease at the Vascular Surgery Center, Clinical Center of Kragujevac, Serbia, from 2007 to 2013. The cases group were the patients with femoropopliteal graft occlusion (n = 44), with the control group consisted of the patients without such an outcome (n = 88). Re-sults. Significant effects to occlusion were: concomitant cardio-vascular disease (adjustedOR 27.05; 95% CI 4.74; 154.35), a type of femoropopliteal bypass (adjustedOR 16.50; 95% CI 4.05; 67.24), previous vascular intervention (adjustedOR 4.67; 95% CI 1.20; 18.14), clinical stage of the disease (adjustedOR 3.73; 95% CI 1.94; 7.18), administration of postoperative oral anticoagulant therapy (adjustedOR 0.05; 95% CI 0.01; 0.23) and the use of angiotensin converting enzyme inhibitors (adjustedOR 0.14; 95% CI 0.03; 0.70). A significant synergism was shown for the following combina-tions of the observed risk factors: type of femoropopliteal bypass and cardiovascular disease, type of femoropopliteal bypass and previous vascular intervention, previous vascular intervention and cardiovascular disease, previous vascular intervention and beta blockers, cardiovascular disease and diabetes, type of femoropopliteal bypass and antiaggregant therapy, clinical stage of disease and cardiovascular disease, previous vascular interven-tion and antiaggregant therapy. Conclusion. Concomitant car-diovascular disease, below-knee femoropopliteal bypass, ad-vanced stage of vascular disease and non-use of anticoagulant therapy and angiotensin-converting enzyme inhibitors are the significant predictors of graft occlusion after synthetic femoro-popliteal bypass. Their synergistic effect determines the impor-tance of diabetes, use of beta blockers and platelet antiaggregant therapy

Impact of educational intervention on prescribing inappropriate medication to elderly nursing homes residents

© 2015, Serbia Medical Society. All rights reserved. Introduction Problems with polypharmacy, adverse drug reactions and non-adherence are especially frequent among elderly nursing home residents. Objective The aim of our study was to evaluate effectiveness of a specific form of staff education on appropriateness of prescribing in a cluster of nursing homes for the elderly. Methods The study was designed as before-and-after trial of educational intervention on appropriateness of prescribing in nursing homes for the elderly. In total 20 nursing homes located in Belgrade, Serbia were included in the study with 104 elderly residents and 27 caring physicians. Appropriateness of prescribing was checked against Beers, START and STOPP criteria, before and 6 months after the intervention. Results There were 349 inappropriately prescribed drugs according to Beers criteria before the intervention and 37 drugs six months after the intervention. According to STOPP criteria there were 70 drugs inappropriately prescribed before the intervention, and 20 drugs 6 months after. When both criteria are taken together, there is a significant difference between the average number of inappropriate drugs per patient before (3.4±0.5) and after (0.6±0.7) educational intervention (t=38.902; p<0.001). Finally, before the intervention 143 appropriate drugs were omitted according to START criteria, while 6 months after the intervention there were only 67 omissions. Conclusion Simple, but well targeted educational interventions may improve polypharmacy and decrease inappropriate prescribing rate, contributing to a better care of elderly patients in nursing homes

Direct medical costs of COPD diagnosis and treatment, Eastern vs. Western European country : examples of Serbia and Belgium

OBJECTIVE: Comparison of COPD financial burden and underlying factors, between Eastern upper middle income and a Western European high income, healthcare settings. METHODS: The patient sample was 433 in Belgium and 322 in Serbia, age ≥ 40, with spirometry and clinically confirmed COPD diagnosis. Belgian trial followed patients prospectively during 2006, using structured survey of clinicians in charge. Serbian trial conducted in 2008, retrieved data from clinical invoice database. Time horizon was one year and perspective of third party payers was taken into account for both studies. Clinical outcomes of interest were disease exacerbation, hospital admission and death. Economic inputs referred to COPD-attributable medical services consumption value during observed period of time. RESULTS: Average annual cost was 1,812.84 € for the Serbian patients and 1,738.13 €/year for the Belgian patients (not including the value of laboratory diagnostics or imaging techniques). Severity grade and duration of hospital admissions significantly directly correlated with overall cost in both populations. Pattern of diagnostic procedures requested and ATC classes of drug consumed to treat COPD remains similar and comparable in both countries. GDP per capita ratio in respective years (10.4: 37.4), exhibits the paradox of patient being much less affordable to treat in a less developed society. CONCLUSIONS: Burden of COPD in Europe is huge and, due to contemporary life style expected to grow further. We compared cost of illness structures between two societies with different macroeconomic past in healthcare financing and management. According to our findings, direct medical costs were driven by exacerbations and hospital admissions. Significantly cheaper human labor caused higher relative relevance of drug acquisition expenses in the East and higher portion of hospital admission costs in the West. More in-depth research of indirect COPD attributable costs (e.g. lost productivity, absenteeism, premature death etc) will be needed in future. It implies serious health policy necessities to provide accessibility of care

A questionnaire for assessing fear of radiotherapy in oncology patients

© 2018, University of Kragujevac, Faculty of Science. All rights reserved. Radiotherapy is a frequently prescribed and highly effective form of treatment of oncology patients. However, many patients feel rational or irrational fear of the application of radiotherapy, which may provoke mental and physical stress, anxiety, growing anger and hostility, thus reducing quality of life. The aim of this study was to develop, reliability test and validate a questionnaire for assessing the level of fear of radiotherapy in oncology patients. We performed a prospective qualitative study based on the development, validation and reliability testing of the questionnaire developed for assessing radiotherapy-caused fear in oncology patients treated in the Centre for Oncology and Radiology, Department of Radiotherapy, Clinical Centre Kragujevac. The study included 154 patients and the final version of the questionnaire integrated 15 questions. After the elimination of inappropriate questions the Cronbach coefficient α was 0.946. The questionnaire consists of two factors which represent 57.423% and 6.925%, making a total of 64.348% of the variance of the questionnaire. The results of our study show that the questionnaire used is a unique, reliable and valid instrument for assessing the level of fear of radiotherapy in oncology patients the application of which will allow us to identify patients with elevated levels of fear of radiotherapy

Inflammatory Bowel Diseases (Crohn's Disease and Ulcerative Colitis): Cost of Treatment in Serbia and the Implications

BACKGROUND: Although the costs of treating inflammatory bowel disease (IBD) in developed countries are well established, they remain largely unknown in countries with recent histories of socio-economic transition including Serbia. OBJECTIVE: To estimate the costs of treatment including the resources used by patients with IBD in Serbia from a societal perspective. This includes both Crohn's disease and ulcerative colitis. METHODS: This cost-of-illness study was conducted to identify direct, indirect and out-of-pocket costs of treating patients with IBD in Serbia. Patients with IBD (n = 112) completed a semi-structured questionnaire with data concerning their utilisation of heath-care resources and illness-related expenditures. All costs were calculated in Republic of Serbia dinars (RSD) at a 1-year level (2014) and subsequently converted to Euros. Median values and ranges were reported to avoid potential distortions associated with mean costs. RESULTS: Median total direct costs and total indirect costs per patient per year in patients with Crohn's disease were 192,614.32RSD (€1602.97) and 28,014.00RSD (€233.13) and 142,267.15RSD (€1183.97) and 21,436.00RSD (€178.39), respectively, in patients with ulcerative colitis. In both groups, the greatest component of direct costs was hospitalisation. CONCLUSIONS: Costs of IBD in Serbia are lower than in more developed countries for two reasons. These include the fact that expensive biological therapy is currently under-utilised in Serbia and prices of health services are largely controlled by the State at a low level. The under-utilisation of biologicals may change with the advent of biosimilars at increasingly lower prices