Dejan Vulovic

Consulting clinical pharmacologist about treatment of inpatients in a tertiary hospital in Serbia

Dear Editor, Clinical pharmacology specialists give many services in various healthcare systems all over the world, but the most complex and responsible one is advising other specialties about treatment of difficult, and often critical, patients in tertiary care hospitals [1–3]. Usually, other clinical specialties call a clinical pharmacologist for a help only when they cannot see any further option to treat a patient who is either deteriorating or not improving as expected [3]. Since clinical pharmacology services are still developing in many regions, it is of interest to present experiences with effects of consulting clinical pharmacologist on treatment outcomes from places where such services have considerable history. Clinical pharmacology department in a tertiary care Clinical Center, Kragujevac, Serbia, was founded back in 1995 and have five fully employed specialists of clinical pharmacology, who on average give about 4000 consultations to other specialists annually. The department is funded by the National Health Insurance Fund, in the same manner as other specialty services, and it is integrated in postgraduate training of future clinical pharmacologists. During the 15-month period from January 2015 to March 2016, the clinical pharmacologists (CPs) were consulted 5137 times for 4692 patients (39 % females and 71 % males), whose average age was 61.67 ± 17.26 years. For 4176 patients, the CPs were consulted only once and for 516 patients, twice or more times. Daily workload per clinical pharmacologist on duty was between five and ten patients, and on average, 30 min was spent per consultation. Primary diagnoses of the patients are shown in the Table 1. After clinical examination of the patients for whom they were consulted and getting introduced with a patient’s history and files, the CPsmade certain interventions, which are shown in Table 2. The acceptance rate of the interventions by other clinical specialists who asked for consultation was 90.3 %. The outcome of the interventions suggested by the CPs and accepted by clinical specialists was improved in the patient’s status in 70.6 %, continuation of the same status in 0.9 %, and deterioration in 28.5 %. The vast majority of consultations was about the choice and/or dosing of antimicrobial drugs, and the most frequent infection sites in the patients were blood (55.4 %), respiratory tract (10.8 %), and skin and soft tissues (10.1 %). A few recent publications presented their experiences with consultations of clinical pharmacologists asked for by the other clinical specialists. In 1-year study from Udine, Italy, the focus was on consultations based on therapeutic monitoring of linezolid [4], and the CPs * Slobodan M. Janković slobnera@gmail.com

Tumor of orbit

The cavernous hemangiomas are the most common intra orbital tumors found in adults of the middle age. Although histological benign, they can encroach on intra orbital or the adjacent structures (optic nerve) and be considered anatomically or positional malignant. We present a case report of orbital cavernous hemangioma of right orbit in young women after pregnancy, from Topola near Kragujevac (Central Serbia) with visual compromise and its by trans-nasal endoscopic surgical management. Our patient was controlled and treated with the symptomatic therapy, topical therapy with artificial tears and surgical treatment. Our patient has optimal visual acuity of affected right eye after surgical treatment of orbital tumor. Surgical treatment of symptomatic orbital cavernous hemangioma is safe and effective, so that the cosmetic results are the important parameter to evaluate the clinical outcome.

Accessory Auricles - Report of Two Cases

Abstract Accessory auricle is a rare anomaly with an estimated incidence rate of 0.2-0.5%. The most common form of this malformation is the accessory tragus. It may be a sign of other syndromes, such as oculo-auriculo-vertebral dysplasia (Goldenhar’s syndrome). In this paper, we describe two cases of accessory auricle with a focus on diagnosis and surgical treatment.

Atypical primary melanoma of the umbilicus: A case report

Introduction. The umbilicus (omphalos; the navel; belly button; tummy button) is important in a medical and psychosocial context. Umbilical tumors are rare and can be benign or malignant, primary or secondary. The most common are malignant metastatic tumors, especially The Sister Mary Joseph Nodule, an eponym for the umbilical metastasis of intra-abdominal malignant tumors. Primary melanoma of the umbilicus is very rare, there is few literature data about it and its incidence is not well known. Therefore, the aim of this study was to present a patient with a rare localization of the primary skin melanoma, that was, also, of atypical form, large and involved the whole umbilicus and surrounding skin. Case Report. In this report, the patient had nodular red tumor which involved the whole umbilicus. Tumor had rapid growth. In the differential diagnosis, the tumor most by resembled a pyogenic granuloma. After the surgery, the histopathological finding showed the primary nodular skin melanoma (Clark V, Breslow 10 mm, positive for: vimentim S – 100 protein, melan – A and HMB – 45, and negative for EMA, with moderately high proliferative activity). Conclussion. According to literature data, this is 27th case of the primary melanoma of the umbilicus since 1916 when it was first reported. By presenting this rare clinical case, we emphasize that any skin lesion that is removed, must be sent to a histopathologic analysis.

Congenital blindness and visual impairment cause infection or non infection.

Conflict of interest: none declared. Introduction Authors are from reference documentation to archive at Organization of Federation of blind and visually impaired in central Serbia (Kragujevac), by retrograde analysis, of 2007-2012, comprehend two groups by etiology–clinical characteristics of congenital blindness and visually impaired, caused infection or non infection example. Aim to analyze relationship between infectious and non infectious of congenital blindness and visually impaired in our referent region and compare with world references. Material/methods With 6-years analysis included the most frequency cases of congenital blindness and visually impaired in two groups, according to presence or absence infectious causes. From infectious causes of congenital blindness and visually impaired are included: CMV – infection, congenital rubella syndrome, congenital toxoplasmosis, congenital syphilis and rare mixed syndrome. From non infectious causes are included: retinitis pigmentosa, retinopathy prematurity, primary congenital glaucoma, Leber’s congenital amaurosis and rare syndrome. Results: From total number of registered blind and visually impaired – 1308 (100%), over the last 6 years, the registration was 349 (26.68%) with congenital blindness and visually impaired. From recorder with the number of the most common congenital blindness and visually impaired–194 (55.59%) with infections cause, and 155 (44.41%) non infection cause. Conclusion: Congenital blindness has shown permanent increase in past 6 years, in group with infectious and with non infectious causes. Congenital blindness and visually impaired of the most common etiology among registered members of our association in Kragujevac is subject of our correlation and global trends mentioned observation of these diseases.