Aleksandra Stankovic

Report: Treatment of medical waste in Nisava and Toplica districts, Serbia.

If there are no clearly defined management procedures, medical waste may represent a source of serious health hazards. Medical waste management was evaluated at the three hospitals in the Nisava and Toplica district, in Serbia. All the stages of existing waste management (segregation, collection, storage, transportation and disposal of waste) were examined by interviewing the personnel involved in the management of waste. The generated waste was a mixture of hazardous and non-hazardous waste. The study found that waste management performance in this district was poor and that there were problems in every stage of management. The results indicate that the waste generation rate was 1.92 kg bed— 1 day—1 and consisted of 98.7% general waste and 1.3% sharps. Inappropriate segregation practices were the biggest problem and led to increased quantities of general waste. There were no specific regulations for the segregation of the medical waste. None of the surveyed hospitals have a system to refine wastewater and there were no training courses about hospital waste management.

Black smoke air pollution and daily non-accidental mortality in Nis, Serbia

The short-term effects of ambient black smoke concentrations on total non-accidental, cardiovascular and respiratory mortalities in Nis, during the 2000-2003 period, were investigated.Daily measurements for black smoke (BS), as well as the daily number of deaths have been collected. Generalised linear models extending Poisson regression were applied. The e.ects of time trend, seasonal variations, days of the week, temperature, humidity and air pressure were adjusted.The per cent increase in the daily number of total deaths associated with a 10 μg/m3 increase in BS was 1.13% (0.08–2.20%). The e.ect size was slightly higher for cardiovascular mortality (1.25%, 95% CI: 0.53–1.97%). There was no signi.cant association between air pollution and respiratory mortality.These results indicate that current levels of ambient BS have signi.cant e.ects on total and cardiovascular mortalities in Nis.

Long-term ambient air pollution exposure and risk of high blood pressure among citizens in Nis, Serbia.

Abstract Epidemiological studies suggest that long-term exposure to air pollution increases the risk for high blood pressure (BP). The aim of our study is to evaluate any effects in BP in citizens exposed to long-term ambient air pollution. The subjects are 1136 citizens, aged 18–70 years, living for more than 5 years in the same home in the areas with a different level of air pollution. The air concentrations of black smoke and sulfur dioxide were determined in the period from 2001 to 2011. We measured systolic and diastolic BP and heart rate. Multivariate methods were used in the analysis. Alcohol consumption had the greatest influence on the incidence of hypertension as a risk factor (RR: 3.461; 95% CI: 1.72–6.93) and age had the least (RR: 1.23; 95% CI: 1.183–1.92). Exposure to air pollution increases risk for developing hypertension 2.5 times (95% CI: 1.46–4.49). Physical activity has proved to be statistically significant protective factor for the development of hypertension. Long-term exposure to low levels of main air pollutants is significantly associated with elevated risk of hypertension.

Air quality monitoring in NIS (SERBIA) and health impact assessment

The aim of this study is to indicate the significance of air quality monitoring and to determine the air quality fields for the assessment of air pollution health effects, with special attention to risk population. Radial basis function network was used for air quality index mapping. Between 1991 and 2005, on the territory of Nis, several epidemiological studies were performed on risk groups (pre-school children, school children, pregnant women and persons older than 65). The total number of subjects was 5837. The exposed group comprised individuals living in the areas with unhealthy AQI, while the control group comprised individuals living in city areas with good or moderate AQI. It was determined that even relatively low levels of air pollution had impact on respiratory system and the occurrence of anaemia, allergy and skin symptoms.

Fructose-rich diet differently affects angiotensin II receptor content in the nucleus and a plasma membrane fraction of visceral adipose tissue

The adipose tissue renin-angiotensin system (RAS) is proposed to be a pathophysiological link between adipose tissue dysregulation and metabolic disorders induced by a fructose-rich diet (FRD). RAS can act intracellularly. We hypothesized that adipocyte nuclear membranes possess angiotensin receptor types 1 and 2 (AT1R and AT2R), which couple to nuclear signaling pathways and regulate oxidative gene expression under FRD conditions. We analyzed the effect of consumption of 10% fructose solution for 9 weeks on biochemical parameters, adipocyte morphology, and expression of AT1R, AT2R, AT1R-associated protein (ATRAP), NADPH oxidase 4 (NOX4), matrix metalloproteinase-9 (MMP-9), and manganese superoxide dismutase (MnSOD) in adipose tissue of Wistar rats. We detected AT1R and AT2R in the nuclear fraction. FRD reduced the level of angiotensin receptors in the nucleus, while increased AT1R and decreased AT2R levels were observed in the plasma membrane. FRD increased the ATRAP mRNA level and decreased MnSOD mRNA and protein levels. No significant differences were observed for MMP-9 and NOX4 mRNA levels. These findings coincided with hyperleptinemia, elevated blood pressure and triglycerides, and unchanged visceral adipose tissue mass and morphology in FRD rats. Besides providing evidence for nuclear localization of angiotensin receptors in visceral adipose tissue, this study demonstrates the different effects of FRD on AT1R expression in different cellular compartments. Elevated blood pressure and decreased antioxidant capacity in visceral fat of fructose-fed rats were accompanied by an increased AT1R level in the plasma membrane, while upregulation of ATRAP and a decrease of nuclear membrane AT1R suggest an increased capacity for attenuation of excessive AT1R signaling and visceral adiposity.

Attitudes and Knowledge of Medical Students about Distance Learning / Stavovi i znanje studenata medicine o učenju na daljinu

Abstract Distance learning can be defined as education or training offered to participants at a different place, physically distant from the lecturer or sources of information. The difference in attitudes and knowledge of students about distance learning in relation to gender and year of studying was examined. The study sample included 371 students of the Faculty of Medicine in Niš (165 students were at the first year of studies and 206 students were at the sixth year of studies). Originally structured epidemiological questionnaire was distributed to students. Gender and age had no significant influence on students’ knowledge of distance learning. There was no statistically significant difference in taking positive attitudes about distance learning among medical students of the first and sixth year. Gender has statistically significantly affected the attitudes. E-learning does not eliminate the existing methods of learning, but it supplements them and greatly helps in teaching plans and programs. Sažetak Učenje na daljinu se može definisati kao obrazovanje ili obuka koja se nudi polaznicima na različitom mestu odnosno fizički udaljenim od predavača ili izvora informacija. Cilj rada je bio analiza stavova i znanja o učenju na daljinu studenata medicine, kao i utvrđivanje uticaja pola i starosnog doba na zauzumanje odredenog stava i znanja. Uzorak istraživanja je obuhvatio 371 studenata Medicinskog fakulteta u Nišu (165 studenata na prvoj godini studija i 206 studenata na sestoj godini studija). Studentima je podeljen originalni epidemioloski upitnik. Starosna dob i polna pripadnost nisu imale statisticki znacajan uticaj na znanja o ucenju na daljinu. Nije nađena statistička značajnost razlika u zauzimanju pozitivnih stavova o učenju na daljinu među studenatima medicine prve i seste godine studija. Polna pripadnost je statisticki znacajno uticala na zauzimanje određenog stava. E-učenje ne eliminiše postojeće metode učenja, već ih samo upotpunjuje i u mnogome pomaže u savlađivanju nastavnih planova i progarama.

[Influence of air pollution on pregnant women's health and pregnancy outcomes].

UNLABELLED Outdoor and indoor air pollution pollutants can be a potential cause to a lot of negative effects on the health of pregnant women and outcome of pregnancy. The objective of this paper was to estimate the influence of outdoor and indoor air pollution on the health of pregnant women and outcome of pregnancy. MATERIAL AND METHODS The study subjects were the pregnant women, non-smokers, who were not professionally exposed to air pollution. They were divided into the exposed group (n = 189) and control group (n = 178) during the exposure to outdoor air pollution. The data on exposure to sources of indoor air pollution (smoke produced by burning fossil fuels and passive smoking) during pregnancy were obtained from the questionnaire. Data on health condition and outcome of pregnancy were obtained from medical records of tested pregnant women. RESULTS The research results have shown that the frequency of anemia (OR = 6.76; 95% CI = 1.28-7.72), upper respiratory symptoms (OR = 9.53; 95% CI = 1.32-3.8) and bleeding (OR = 20.5; 95% CI = 2.03-6.97) was significantly higher in pregnant women exposed to outdoor air pollution as compared with the control group. The occurrence of upper respiratory symptoms (OR = 40.42; 95% CI = 2.96-8.91) and bleeding (OR = 53.21; 95% CI = 4.3-15.73) was significantly higher in pregnant women who had been exposed to fossil fuel smoke. Exposure to passive smoking had significant influence on the development of upper respiratory symptoms (OR = 34.58; 95% CI = 3.05-11.66).

Use of family planning methods by women in the municipality of Nis (Serbia)

The use of family planning methods reduces maternal mortality, prevents unwanted and high-risk pregnancies, the need for (un)safe abortion and protects from sexually transmitted diseases. The objective of the study was to assess the use of family planning methods by women in the municipality of Nis. We applied an observational cohort study that included 1,584 women age 15–49 who lived in the municipality of Nis. Data was collected through the opinion poll examination, which took place in the municipality of Nis from February to September 2002. We found 81.9% of interviewees having sexual relations protect themselves from unwanted pregnancy permanently or occasionally; 18.1% do not. Of interviewees who do not use protection and have sexual relations, 28.1% think it harms health and 27.7% think it is unsafe. Among women who use contraceptive protection, 57.9% use traditional (unsafe) methods while 42.1% use modern methods. Interviewees who use contraception mostly choose a particular method of their own accord without consultation (52.9%); 58.2% estimate their method of contraception as partly safe, 6.8% as unsafe and 35% as completely safe. As to the reason for contraception use, 40.4% state they already have their preferred number of children, 22.4% use contraception for health reasons, 17% because they are not married, 7.6% because of poor economic condition, and other reasons are present in significantly lesser percentages. Of the interviewees, 29.3% had intentionally interrupted pregnancies. The use of family planning methods is unsatisfactory. Therefore, it is necessary to promptly begin promoting protection of reproductive health and the use of modern family planning methods as a part of the nurturing of healthy lifestyles.

Indoor exposure to chemical and biological agents and health efects in primary school children

The aim of this study has been to estimate effects of indoor air pollutants on children’s health. An anamnestic retrospective study was done on 1074 children aged between 7 and 11 years old who lived in Nis (Serbia). An original questionnaire was used in an interview between training physicians and children’s parents. Interview data were processed by using Microsoft Excel and Epiinfo 6. The investigation determined that children who were more often exposed to combustion by-products had respiratory and nonspecific symptoms. Parental smoking was strongly associated with wheezing, bronchitis, headache and fatigue. There was no association between health and keeping pets, apart from partial nasal congestion. Presence of insects (e.g., cockroaches) and rats in households was a significant risk factor for all symptoms and diseases estimated except for asthma and pneumonia. Homes abundant in textiles were the cause of nasal congestion, wheezing and fatigue in children. Old mattresses were associated with respiratory symptoms, bronchitis, and nonspecific symptoms. It has been concluded that indoor air quality plays a major role in children’s health. Sources of indoor air pollution are present in every home. Being aware of the risks associated with indoor air quality problems, consequently, leads to their mitigation.

Transcriptome-driven integrative exploration of functional state of ureter tissue affected by CAKUT

Aims: (1) to identify the most dysregulated genes in ureter tissue affected by congenital anomalies of the kidney and urinary tract (CAKUT) and to extract the biological meaning of these markers; (2) to describe the key molecular networks in CAKUT and to provide expression validation of the genes selected from these networks. Main methods: Transcriptome data was obtained from ureter samples of CAKUT patients and controls by Illumina iScan microarray. Identification of differentially expressed genes was coupled with subsequent bioinformatics analyses. Expression of candidate genes was validated by qRT‐PCR. Key findings: Analysis of the transcriptome led to the identification of 78 commonly dysregulated genes in CAKUT tissue compared to controls. Integrative bioinformatic analyses of differentially expressed genes identified 7 major networks. The targets for qRT‐PCR validation were selected as members of the major molecular networks in CAKUT, which had both, the significant high fold change and biological relevance for CAKUT. By qRT‐PCR the substantial increase of LCN2, PROM1, SOSTDC1, and decrease of INA, RASD1 and TAC3 mRNA levels was confirmed. Significance: Since CAKUT is a leading cause of end‐stage renal disease in children, the search for molecular targets for postnatal therapy is of particular interest. Data described in this study represents the gene expression profile and significant molecular networks specific to human ureter affected by CAKUT. The discovery of impaired molecular factors and processes is the step towards the uncovering of the key mechanisms that reflect CAKUT postnatally and could lead to the affected tissue deterioration and end organ damage.