Katarina Janicijevic

A toxic hepatitis caused the kombucha tea - case report.

Investigation of adverse reactions toxic substances in the liver is a challenge of modern hepatology. It should not be forgotten that toxic hepatitis may clinically be manifested as other diseases of the liver, where it must always be considered in the differential diagnoses of unexplained liver damage in poisoning with the kombucha tea. The pathogenesis and mechanism of liver damage in most of toxins is unknown. It may be experienced as an allergic and/or toxic reaction. Considering that various microorganisms already habituate on kombucha, between those are acid bacterias (from apple acid used for preparing) which are using the oxygen, and from the other side we have yeasts which are facultative anaerobes.

Updates on the Treatment of Pterygium

Abstract Pterygium is an ocular disease characterised by the growth of fibrovascular conjunctiva on the cornea. It occurs more often in men, at an older age, and in individuals exposed to ultraviolet radiation. Surgical treatment is the primary treatment for pterygium and there are two common procedures for pterygium excision. In the first method, the head of the pterygium is separated from the corneal surface using a surgical blade. The second method is based on avulsion. Other approaches to excising the pterygium include the use of argon laser and excimer laser. Because of a high recurrence rate, adjuvant therapies, including radiotherapy, chemotherapy, and graft procedures, are used after pterygium excision. These procedures have become the standard long-term treatments for pterygium. Radiotherapy is based on beta irradiation. Chemotherapy includes the use of mitomycin C, 5-fluorouracil, bevacizumab, and loteprednol etabonate. Graft procedures include amniotic membrane grafts and conjunctival autografts. Many surgeons believe that using mitomycin C and conjunctival autografts provides the best outcomes in terms of recurrence, cosmetics and patient satisfaction.

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.

Autologous Serum Eye Drops for Post-Chemical Injuries and Corneal Epithelial Defects

Abstract Aim: To evaluate success rate (efficacy, safety) in treatment of post-chemical injuries and corneal defects using autologous serum eye drops. Material and Methods: Authors reviewed 93 patients (116 eyes) hospitalized in Clinic of ophthalmology from 2010 to 2013, who had post-causoma corneal defects that were nonresponsive to conventional treatment and were treated with serum therapy. Authors correlated time of epithelialization of defects with rate of epithelial healing. Results: Authors investigated 93 patients (52 males, 41 females; aged 18 - 74) for treatment of corneal defects. Application of autologous serum therapy 56 (48.28%) of 116 eyes was healed in an average time of 4 weeks. Among 116 eyes, epithelial defects healed in 4 (3.45%) within 1 week, in additional 17 (14.65%) in 1-2 weeks, totalling 31 (26.72%) within 3 weeks. Five eyes (4.31%) completely healed at 5 week; three eyes (2.59%) had subsequent healing of epithelial defect at 6 week; 56 eyes completely healed within one month, and the remaining eight eyes healed within 1.5 month. Conclusion: Using serum therapy, it was managed to reduce time of healing from eleven weeks, which were necessary just couple years ago (before 2010) to four (maximum six) weeks to complete healing which are necessary today.

Socio-Medical Aspects of Depression among Elderly Adults in Serbia

Abstract Depression is the most frequent mental health problem in older age with serious consequences on personal, interpersonal and social level. The aim of this study was to determine the association of demographic factors, socio-economic factors and health status characteristics, with the presence of depressive symptoms in the elderly persons. The survey was conducted as a part of the national study “Health Survey of the Serbian population” in 2013. Data on the population aged 65 years and over were used for the purposes of this study (3540 respondents). PHQ-8 questionnaire was used to assess the presence of symptoms of depression. The relations between the presence of depressive symptoms, as a dependent variable, and a set of independent variables was examined by univariate and multivariate logistic regressions. Depression (PHQ-8 score≥10) was registered in 10% of the population aged 65 and above, wherein it was statistically significantly higher in women (12.7%) than in men (6.5%). Limitations in performing of daily activities showed to be the strongest predictor of depression in the elderly, while respondents who have had serious limitations had even six times more chanse to develop depression (OR=6.84). Respondents who rated their health as “bad or very bad” for 49.5% more frequently manifested depressive symptoms compared to those who evaluated their health as “very good or good” (OR=3.49). Respondents who have had two or more chronic diseases were three times more likely to have depression (OR=3.1) compared to people without chronic disease.

Tear Film Stability in Patients with Pseudexfoliation

Abstract Pseudoexfoliation syndrome is an age related disorder, characterized by abnormal fibrous fiber production and accumulation in different visceral organs as well as in the eye and periocular tissues. Hystological examination recorded the presence of the pseudoexfoliation in the conjunctiva, and they can disturb the accessory lacrimal gland and goblet cell function. This can explain tear film instability in patients with pseudoexfoliations. In our study, we examined the tear film stability in patients with and without pseudoexfoliation, using Schirmer test and tear break up time test. Our results indicated that patients with pseudoexfoliation had lower values of Schirmer and tear break up time tests than patients without it. Pseudoexfoliation is the main reason for the instability of the tear film, because of its negative impact on the conjucntival goblet cells. In conclusion, ophthalmologists must have these data on their mind in the process of the pseudoexfoliation glaucoma treatment and controlling.

Socioeconomic inequalities and non-communicable diseases in Serbia: National health survey

Background/Aim. Non-communicable diseases (NCDs) are a major public health challenge worldwide. Although they are preventable, NCDs are the major global causes of morbidity and mortality, absenteeism, disability and premature death. The aim of this study was to examine socioeconomic inequalities in the prevalence of non-communicable diseases in Serbia. Methods. Data from the 2013 National Health Survey of the population of Serbia was used in this study. There were 13,765 adults interviewed, aged ≥ 20 years. We used multivariate logistic regression analyses with demographic and socioeconomic determinants of health as independent variables and prevalence of non-communicable diseases as a dependent variable. The minimum level of significance was p < 0.05. Results. Hypertension was the most prevalent NCDs (36.1%). The prevalence of multimorbidity was 47.1%. Multivariate logistic regression analysis showed that gender, age, place of residence, employment status and education were associated with the presence of NCDs. The odds ratio (OR) for age was 1.074 [95% confidence interval (CI) : 1.070–1.077). Women were at a higher risk of NCDs by 58.9% when compared to men (OR = 1.589; 95% 95% CI : 1.467–1.726). Respondents who lived in the rural areas were at a higher risk for NCDs by 14.1% compared to those who lived in urban areas (OR = 1.141; 95% CI : 1.047– 1.244). Odds ratio for unemployment was 1.227 (95% CI: 1.118–1.346). Respondents with primary education were at a higher risk for chronic diseases by 47.1% (OR = 1.471; 95% CI : 1.281–1.687) while those with secondary school were at a higher risk by 27.7% (OR = 1.277; 95% CI : 1.142–1.428) compared to respondents who had higher education. When it comes to Wealth Index, univariate logistic regression analysis showed that respondents who belonged to the poor and middle classes were at a higher risk for NCDs (OR = 2.031; 95% CI : 1.819–2.267; OR = 1.473; 95% CI : 1.343– 1.615) compared to respondents who belonged to the rich class. Multivariate logistic regression analysis did not show statistically significant correlations between the Wealth index and NCDs. Conclusion. Socioeconomic inequalities in health status are the major challenge and should be a target of national health policy in Serbia, not only because they represent social injustice but also because solving the health problems of underprivileged groups of the population can influence improvement of health status of the population as a whole.

Socioeconomic Factors Associated with Psychoactive Substance Abuse by Adolescents in Serbia

Adolescence is a period of transition from childhood to adulthood, characterized by efforts to achieve the objectives related to the expectations of the culture, as well as the requirements of the physical, mental, emotional, and social development. It has its own characteristics in the biological, psychological, and social terms, with a process of identity formation, the development of social, and moral norms of behavior (McCabe et al., 2017). Adolescence is a period of great settings in which experimentation with psychoactive substances is common and can, in some cases, lead to the development of long-term addictive behavior (Jeannin et al., 2013). Psychoactive substances include licit, illicit, and prescribed psychoactive medications. Alcohol and cigarette are among the licit and controlled drugs, while marijuana, cocaine, heroin, lysergic diethylamide (LSD), crack, and ecstasy are illicit drugs (Kassa et al., 2014). The use of psychoactive substances in adolescents is often associated with a socioeconomic factors, such as gender, age, type, race, ethnicity, family, and social structures, socioeconomic status of the family (Gebreslassie et al., 2013). Significant risk factors for psychoactive substances use among adolescents were poor parental involvement in the child’s education, conflictual family relationships, and drug abuse by the parents, friends, and neighbors (Kpozehouen et al., 2015; Pisarska et al., 2016). Also, parental alcoholism, parental divorce before age 18, and parental death before age 18 increased the odds of abuse psychoactive substances (Vaughan et al., 2017). Socioeconomic environment in which young people were raised as children predicts their behavior in young adulthood. Understanding this relationship, is an important step in identifying persons at risk (Tobler et al., 2000). In order to identify the risk factors and protective factors associated with psychoactive substances abuse among young people, it is very important tomeasure how socioeconomic factors influence the attitudes and behavior of young toward the use of psychoactive substances (Carter et al., 2010; Patrick et al., 2012).

Characteristics of chemical eye injuries

Introduction: Chemical eye injuries are described as trauma of the eye, which represent an urgent state in ophthalmology, and are mostly localized, on the anterior segment. Causes of injuries are acid, alkali, mixed and non identified agents. Diagnostic procedures are easy, but therapy is complex. Aim: to describe the historical characteristics of chemical eye trauma and analyze the causes as the most common agents involved in chemical injuries at tertiary level of referent region. Material and Methods: The retrospective study conducted on data of the chemical eye injuries presented at Clinic of ophthalmology in Clinical Centre of Kragujevac (Central Serbia) in past three years. One hundred and thirteen patients (164 eyes) who were presented from September, 2013 to September, 2015 for observation with chemical eye injuries were included in this study. Authors analyzed and showed the most important of historical characteristics: gender, age, categories of chemical agents and location of the accident. Results: Males were more often reported with injures than females (66.37% vs. 33.63%). The mean age across categories was 46-60 years (54, 47.79%). The most common categories of chemical agents: hydrochloric acid - 42 eyes (25.61%), acetic acid - 37 eyes (22.56%), quicklime - 37 eyes (22.56%), quenched - 24 eyes (14.63%) and mixed - 24 eyes (14.63%). The location where injury occurred was mostly at home - 84 eyes (51.22%) and at work - 80 eyes (48.78%). Conclusion: Correlation of references from this study and world references in the medium urban countries with dominators light industries was developed to be relatively identical. In frequency from this study allocated by chemical eye injury - males dominated professionally in social and private industry sector while female in households while maintaining general hygiene dominated it. Frequently bases were quenched and quicklime. The most common location was inside the home.

Infections caused by Clostridium difficile bacterium

Toxigenic strains of Clostridium difficile are the major cause of intestinal tract diseases of hospitalized patients. For a long time, Clostridium difficile was considered to produce both types of toxins (A+/B+ strain). However, the investigations conducted in the last ten years point to the existence of clinically significant isolates which produce only toxin B, i.e. toxin A negative. Toxigenic strains Clostridium difficile are present in our country so this bacterium sort has to be considered in differential causal diagnosis of diarrhea syndrome. Considering that it can cause a difficult form of the disease, it is an obligation to establish the presence of some toxins in stool samples of patients and/or production of some toxins in liquid culture of isolates.