Sandra Zivanovic

Clinical Benefits of n-3 PUFA and ɤ-Linolenic Acid in Patients with Rheumatoid Arthritis

(1) Background: Marine n-3 polyunsaturated fatty acids (PUFA) and ɤ-linolenic acid (GLA) are well-known anti-inflammatory agents that may help in the treatment of inflammatory disorders. Their effects were examined in patients with rheumatoid arthritis; (2) Methods: Sixty patients with active rheumatoid arthritis were involved in a prospective, randomized trial of a 12 week supplementation with fish oil (group I), fish oil with primrose evening oil (group II), or with no supplementation (group III). Clinical and laboratory evaluations were done at the beginning and at the end of the study; (3) Results: The Disease Activity Score 28 (DAS 28 score), number of tender joints and visual analogue scale (VAS) score decreased notably after supplementation in groups I and II (p < 0.001). In plasma phospholipids the n-6/n-3 fatty acids ratio declined from 15.47 ± 5.51 to 10.62 ± 5.07 (p = 0.005), and from 18.15 ± 5.04 to 13.50 ± 4.81 (p = 0.005) in groups I and II respectively. The combination of n-3 PUFA and GLA (group II) increased ɤ-linolenic acid (0.00 ± 0.00 to 0.13 ± 0.11, p < 0.001), which was undetectable in all groups before the treatments; (4) Conclusion: Daily supplementation with n-3 fatty acids alone or in combination with GLA exerted significant clinical benefits and certain changes in disease activity.

Plasma Homocysteine Concentrations In Patients With Rheumatoid Arthritis

Abstract In this study, we investigated the concentration of serum homocysteine (Hcy) in patients with rheumatoid arthritis (RA) compared with the control group and the connection between homocysteine and parameters of inflammation and disease activity. Sixty RA patients and 20 healthy controls were included in the study, and clinical examination and investigation were performed during which disease activity was assessed. Peripheral blood samples were used for all of the assays. Levels of Hcy were 33% higher in the RA patients than in the control subjects (mean +/− SD 11.79±3.72 μmol/L versus 8.90±1.38 μmol/L; p< 0.01). A significant correlation was found between parameters of inflammation (C-reactive protein) and homocysteine in patients (r=0.322, p=0.012). Patients with high disease activity had a significantly greater increase in homocysteine (p<0.05). An increase in plasma homocysteine in RA patients is related to the parameters of inflammation and disease activity. Elevated Hcy levels occur commonly in patients with RA and may explain some of the increased cardiovascular mortality seen in RA patients.

The Impact of Socioeconomic Characteristics and Lifestyles on Vitamin D Deficit in Mentally Ill Patients

Abstract Mental illnesses put patients at high risk for vitamin D deficit. The aim of the research is to examine the impacts of socioeconomic characteristics and lifestyles on vitamin D deficiency in mentally diseased patients. In this crosssectional study we used blood samples from patients who were treated for mental disorders at Specialist-consultative unit of the Health Center and Clinical Center Kragujevac from May-June 2014. The study used a questionnaire for the assessment of vitamin D status. The study included 220 subjects with different types of mental disorders. Normal values of vitamin D were detected in 16% of patients whereas 64% of patients had vitamin D deficiency. The patients with vitamin D deficit were in average 3 years older than that but the difference is not statistically significant (p>0.05). The patients with vitamin D deficiency were primarily female (p=0.003), people with high-school education from urban environment who lived in bad life conditions (p>0.05). Between patients with and without vitamin D deficiency there is no difference in cigarette consumption, in the number of cigarettes per day, in alcohol usage, in coffee consumption and in nutrition. However, the patients without vitamin D deficiency spent more time outside; during the past year were more exposed to sun and during the past seven days spent more than 30 minutes a day exposed to sunlight (p<0.01). These facts indicate that there is a current need for further research in this area.

A Case Report of Female Patient with Laryngeal Granuloma

Abstract The aim of this case report is to present the laryngeal granuloma in 23 year old female patient. Case outline: The 23 year old female was admitted for examination, because of long lasting, progressive hoarseness. In anamnesis, we found that she has undergone general anesthesia for 8 times, in the early childhood. We performing direct laryngoscopy with complete otorhinolaryngologic examination, rigid endovideostroboscopy and the large granuloma of the larynx was found. Conclusions: Laryngeal granuloma of vocal cords affected mainly men, except for cases associated with laryngeal intubation. We should keep in mind that postintubation laryngeal granuloma might develop after tracheal intubation, so care must be taken to avoid the potential complication.

Prevalence of Risk Factors Among Women With Osteoporosis

Abstract Osteoporosis is a progressive bone disorder that can be influenced by many different factors. A cross-sectional study has been conducted with the aim to assess the prevalence of risk factors as well as to identify the possible causes of improvement of the disease. Th e study population consisted of 97 women older than 35 who had previously been diagnosed with osteoporosis. Dualenergy X-ray Absorptiometry (DXA) scan was used to determine bone mineral density (BMD) in order to assess the current state of the disease. Th e participants were asked to complete a standardized IOF (International Osteoporosis Foundation) questionnaire. According to BMD measurements, 24.7% of women had normal bone density while 18.6% had T-score lower than -2.5. Th ere was a statistically significant correlation between T-score and the history of previous bone fractures. Besides, a relatively high prevalence of certain risk factors (such as underweight, early menopause, oophorectomy, thyroid and parathyroid disorders etc.) was observed in woman with osteoporosis

Laryngeal Manifestation of Forestier's Disease.

BACKGROUND: Forestier’s disease is a rare disorder involving bony growths that can occur in various parts of the spinal column, mostly asymptomatic, but these osteophytes, very rarely have been associated with serious complications. AIM: We report a 69-year-old man who was admitted at foniatric departement for evaluation of presenting hoarseness, dysphagia and laborious breathing. CASE PRESENTATION: Noninvasive endolaryngeal imaging and radiological examination revealed distortion of left side of the larynx pushing to the right due to bony mass of the anterior part of cervical spine which was prominent at the left side. The symptoms of the patient presented were caused by Forestier’s disease as found by the imiging. CONCLUSIONS: In clinical practice it is advisable to take into consideration Forestier’s disease as a possible cause of hoarseness and dysphagia in rare cases.

Experience Of Ocular Symptoms Among Allergic Rhinitis Patients Depending On The Type Of Aeroallergens

Abstract The aim of this study was to determine the frequency of ocular symptoms and compare the demographic and clinical characteristics in AR patients depending on sensitisation to various types of aeroallergens. Allergic rhinitis is defined as an IgE-mediated inflammation of the lining of the nose that is characterized by nasal symptoms, including nasal congestion, sneezing, itching of nose and runny nose. Patients suffering from allergic rhinitis frequently experience ocular symptoms such as ocular redness, eye itching and tears. The frequency of ocular symptoms in our study population was 27,6%. No statistical significance was found in the mean ages of the patients who did or did not experience ocular symptoms p>0,05 (p=0,243). Our results indicated that there were no statistical differences (p>0,05) among the groups of allergic rhinitis patients based on experiencing nasal symptoms according to the types of aeroallergens. Our results indicated that there were significant experiences of ocular symptoms in patients who were sensitised to outdoor aeroallergens (p<0,001) and significant sensitisation to both outdoor and indoor aeroallergens (p<0,05). Experiencing the examined ocular symptoms, including ocular redness, eye itching and tears, demonstrated highly statistical significance (p<0,001) among the groups of allergic rhinitis patients who were sensitised to indoor aeroallergens and outdoor aeroallergens, and there was statistical significance (p<0,05) among the groups of allergic rhinitis patients who were sensitised to indoor aeroallergens and both types of aeroallergens (indoor and outdoor). Ocular symptoms are more common in patients who are sensitised to outdoor aeroallergens.

Satisfaction of medical staff in primary health care of Sumadija district

Objective. The aim of this study was to evaluate different aspects of job satisfaction among employees as well as to evaluate the overall job satisfaction in health care institutions of the primary health care level in Sumadija district. Methods. Employee satisfaction survey was conducted in 10 primary health facilities in Sumadija district. We conducted a one-day survey of 1273 employees, using a uniform, anonymous questionnaire developed by the Ministry of Health of the Republic of Serbia within the program of improvement of the quality of health care facilities. Results. The data we obtained show that a little less than a half of the employees in healthcare institutions of the Republic of Serbia were satisfied with the work they performed. The results of logistic regression showed that, among the factors examined, the following had a statistically significant impact on the assessment of job satisfaction: adequacy of work equipment, possibility of professional development, support by superiors, comparison of satisfaction of 5 years ago and now. Conclusion. Job-related experience and satisfaction of the employees indicate the need for placement of employee satisfaction as a priority in the process of improving the quality of the health care system.

[Inflammation in knee osteoarthrosis--cause of aggravation].

INTRODUCTION Knee osteoarthrosis is a degenerative disease which induces intense trouble. MATERIAL AND METHODS The aim of the study was the parallel analysis of clinical and ultrasound examination in patients diagnosed with knee osteoarthrosis. A group of 88 patients underwent the clinical examination and the outflow and size of flexion were determined, the intensity of pain was assessed by the patients mark on VAS, the functional ability by HAQ index, and the size of effusion and synovitis by arthrosonography. RESULTS The minimal outflow was diagnosed in 34.1% of patients, medium in 22.7%, and significant in 4.5%. Synovitis was evident in 67% of patients, 17.0% had nodular, 30.7% diffuse and 19.3% nodular-diffuse type. Effusion was observed in 75% of patients. The average size of synovitis in suprapatellar recess (SR) in the patients with significant, medium and lateral outflow was 6.68 (2.93-10.04) mm (p = 0.000), 1.57 (0-5.53) mm (p = 0.006) and 6.18 (3.44-7.10) mm (p = 0.000), respectively. The grade of pain on VAS was the highest in patients with significant outflow 70 (60-95) (p = 0.014), effusion 60 (50-80) (p = 0.024) and nodular type of synovitis 70 (50-90) (p = 0.029). There was a significant correlation on VAS in the positive direction with the size of effusion (r = 0.238, p = 0.025) and synovitis in LR (r = 0.215, p = 0.044), HAQ index (r = 0.502, p = 0.000), and in the negative direction with the size of flexion (r = -0.346, p = 0.001). The average size of flexion in the patients with significant outflow was 90 (82.5-90) degrees (p = 0.000), HAQ index 1.99 (1.49-2.30) (p = 0.078). HAQ index depended on effusion in LR in the positive direction (p = 0.014). DISCUSSION AND CONCLUSION Clinically significant outflow is shown by arthrosonography as the biggest in SR, moderate and minimal only in LR. Moderate or significant outflow, effusion and nodular type of synovitis lead to intensive pain. Patients with bigger functional disability had intense pain, significant outflow in LR and significantly limited motions.