Cancer of unknown primary - incidence, mortality trend, and mortality-to-incidence ratio is associated with human development index in Central Serbia, 1999-2018: Evidence from the national cancer registry.

OBJECTIVES: The aim was to estimate the trend of incidence, mortality and mortality-to-incidence ratio (MIR) in Central Serbia in 1999-2018 and its possible association with the human development index (HDI). METHODS: In this study, cancer of unknown primary (CUP) was included as C77-C80 codes. Trend analysis was performed in the Joinpoint Regression Programme version 4.8.0.1. HDI combines life expectancy, educational attainment and gross national income. HDI values for Serbia are extracted from the global bank site. RESULTS: Joinpoint regression analysis of the age-standardised incidence rate of CUP showed a significantly increasing trend with annual percent change (APC) of 8.5% (95% confidence interval [CI] 3.0-14.3%) in males and 7.8% (95%CI 2.7-13.2) in females. The age-standardised mortality rate of CUP showed a significantly decreasing trend with APC of -1.7% (95%CI -2.8 to -0.5%) in males and -1.4% (95%CI -2.7 to -0.1%) in females. MIR showed a significantly decreasing trend with APC of -9.3% (95%CI -14.6 - -3.6%) in males and -7.1% (95%CI -10.5% to -4.2%) in females. The linear regression showed significant inverse association among HDI and the MIR of CUP in males (r2 = 0.464, p = 0.002) and in females (r2 = 0.612, p < 0.001). CONCLUSIONS: Decline of MIR was associated with HDI, suggesting that CUP prognosis follows socio-economic status.

Study of correlations between CT properties of retrieved cerebral thrombi with treatment outcome of stroke patients.

BACKGROUND: All the patients with suspected stroke are directed to whole-brain CT scan. The purpose of this scan is to look for early features of ischemia and to rule out alternative diagnoses than stroke. In case of ischemic stroke, CT diagnostics (including CT angiography) is used mainly to locate the occlusion and its size, while the Hounsfield Units (HU) values of the thrombus causing the stroke are usually overlooked on CT scan or considered not important. The aim of this study was to demonstrate that the HU value is relevant and can help in better treatment planning. PATIENTS AND METHODS: There were 25 patients included in the study, diagnosed with ischemic stroke in the middle cerebral artery (MCA) territory. In all patients, systemic thrombolysis was not successful and the mechanical recanalization was needed. The retrieved thrombi were also analyzed histologically for the determination of red blood cells (RBC) proportion. CT of the proximal MCA (M1) segment was analyzed for average HU value and its variability both in the occluded section and the symmetrical normal site. These CT parameters were then statistically studied for the possible correlations with different clinical, histological and procedure parameters using the Linear Regression and the Pearson correlation coefficient. RESULTS: Relevant positive correlations were found between average HU value of thrombus and outcome modified Rankin Scale (mRS), initial mRS, number of passes with thrombectomy device as well as RBC proportion. CONCLUSIONS: Results of the present study suggest that measured HU values in CT images of the cerebral thrombi may help in the assessment of thrombus compaction and therefore better treatment planning.

Trends in body height, body weight, BMI, and nutrition status from 1979 to 1987: a measurement-based analysis of 10, 954 male adolescents from the municipality of Bijelo Polje / Tendencias en la altura corporal, el peso corporal, el IMC y el estado nutricional de 1979 a 1987: un análisis basado en mediciones de 10. 954 adolescentes varones del municipio de Bijelo Polje

SUMMARY: This study aimed to consolidate data regarding body height, body weight, body mass index, and nutrition status of the entire young male population from the Municipality of Bijelo Polje in order to estimate trends from 1979 to 1987. The sample of respondents includes 10,954 young males divided into nine groups. The measurement sample includes body height, body weight, and body mass index based on two previous measures. The descriptive statistics were expressed as a mean and standard deviation for each variable, while the analysis of nutrition status was done based on body mass index (underweight, normal weight, pre-obese, obese). The results showed that a secular trend in the observed study period is not visible regarding body height, body weight, and body mass index. The contribution of this study is reflected in the fact that there were no previously published data for this period and this municipality; the data can significantly aid in monitoring the secular trends throughout Montenegro.

RESUMEN: Este estudio tuvo como objetivo consolidar los datos sobre la altura corporal, el peso corporal, índice de masa corporal y el estado nutricional de toda la población masculina joven del Municipio de Bijelo Polje con el fin de estimar las tendencias de 1979 a 1987. La muestra de encuestados incluyó 10.954 hombres jóvenes divididos en nueve grupos. Las mediciones incluyeron la altura corporal, el peso corporal y el índice de masa corporal basado en dos medidas anteriores. Las estadísticas descriptivas se expresaron como media y desviación estándar para cada variable, mientras que el análisis del estado nutricional se realizó con base en el índice de masa corporal (bajo peso, peso normal, pre-obesidad, obesidad). Los resultados mostraron que una tendencia secular en el período de estudio observado no es visible con respecto a la altura corporal, el peso corporal y el índice de masa corporal. La contribución de este estudio está basada en que no existían datos publicados previamente para este período y en este municipio; los datos pueden ayudar significativamente a monitorear las tendencias seculares en todo Montenegro.

Body height and its estimation utilizing shoulder blade length measurements of Montenegrin adolescents of both sexes / La altura del cuerpo y su estimación utilizando medidas de la longitud de la escápula de adolescentes montenegrinos de ambos sexos

SUMMARY: The purpose of this research is to determine a regression equation for estimation of stature from shoulder blade length measurements. The sample in this research comprised 1001 adolescents, all of whom were in their final year of high school (504 males and 497 females) among the population of Montenegrin adolescents. The stature and shoulder blade length measurements were taken according to the ISAK protocol, and the data were analyzed statistically. Linear regression analysis determined the prediction of and shoulder blade length on the criterion variable a body height at the significance level of p <0.05. These relations are presented by using a scatter diagram (Fig. 2). Thereby, we obtained the coefficient of determination, the multiple correlation coefficients, the partial correlation coefficient, the regression, t-test and standardized beta coefficient. The research study confirmed that shoulder blade length reliably predicts stature in both sexes of Montenegrin adolescents and revealed a very useful finding for physical anthropologists and experts from related fields. It was confirmed that there is a correlation between shoulder blade length and body height (males: 34.3 %, females: 38.8 %). Therefore, shoulder blade length proves to be a reliable predictor for the actual body height estimates.

RESUMEN: El propósito de esta investigación fue determinar una ecuación de regresión para estimar la estatura corporal a partir de las medidas de la longitud del escápula. La muestra estuvo compuesta por 1001 adolescentes, en su último año de estudios secundarios (504 hombres y 497 mujeres) entre la población montenegrina. Las medidas de estatura y longitud del escápula se tomaron de acuerdo con el protocolo ISAK y los datos se analizaron estadísticamente. El análisis de regresión lineal determinó la predicción y la longitud del escápula en la variable de criterio a altura corporal con un nivel de significación de p <0,05. Estas relaciones se presentan mediante un diagrama de dispersión. De ese modo, obtuvimos el coeficiente de determinación, los coeficientes de correlación múltiple, el coeficiente de correlación parcial, la regresión, la prueba t y el coeficiente beta estandarizado. El estudio confirmó que la longitud del escápula predice de manera confiable la estatura en ambos sexos de los adolescentes montenegrinos y reveló información muy útil para los antropólogos físicos y expertos de áreas relacionadas. Se confirmó que existe una correlación entre la longitud del escápula y la altura del cuerpo (hombres: 34,3 %, mujeres: 38,8 %). Por lo tanto, la longitud del escápula demuestra ser un predictor confiable de las estimaciones de la altura corporal real.

Knowledge about Cervical Cancer and Awareness of Human Papillomavirus (HPV) and HPV Vaccine among Female Students from Serbia.

Background and objectives: Persistent infection with carcinogenic human papillomavirus (HPV) is the leading cause of cervical cancer. The study explored students' knowledge about cervical cancer and awareness of human papillomavirus and the HPV vaccine. Materials and Methods: A questionnaire-based survey was carried out among 1616 first-year female college students at the University of Nis. It examined socio-demographic characteristics, measured the score of knowledge about cervical cancer, assessed awareness regarding HPV and the HPV vaccine and inquired about the source of information about cervical cancer and HPV. Results: The average cervical cancer knowledge score was 16.35 ± 7.92 (min 0, max 30), with medical professional education, parents' education level, place of residence and relationship status having significant effects on the score. The awareness about HPV and the HPV vaccine was low, with only 14.2% of students having heard about both HPV and its vaccine. The most commonly reported sources of information were the media, while the most competent one was organized health education. Conclusions: Health promotion campaigns and educational programs are necessary in order to reduce cervical cancer burden and should be directed particularly towards those who have demonstrated low cervical cancer knowledge and low awareness regarding HPV and its vaccine.

Mechanical recanalization for acute bilateral cerebral artery occlusion - literature overview with a case.

Background Acute bilateral internal carotid artery (ICA) and/or middle cerebral artery (MCA) occlusion is extremely rare and associated with poor clinical outcomes. There are only a few reports in the literature about mechanical thrombectomy being performed for acute bilateral occlusions. The treatment strategies and prognoses (clinical outcomes) are therefore unclear. Methods A systematic review of the literature was performed through several electronic databases with the following search terms: acute bilateral stroke, mechanical recanalization and thrombectomy. Results In the literature, we identified five reports of six patients with bilateral ICA and/or MCA occlusion treated with mechanical recanalization. Additionally, we report our experience with a subsequent contralateral large brain artery occlusion during intravenous thrombolytic therapy, where the outcome after mechanical thrombectomy was not dependent on the time from stroke onset but rather on the capacity of collateral circulation exclusively. Conclusions Acute bilateral cerebral (ICA and/or MCA) occlusion leads to sudden severe neurological deficits (comas) with unpredicted prognoses, even when mechanical recanalization is available. As the collateral capacity seems to be more important than the absolute time to flow restoration in determining the outcomes, simultaneous thrombectomy by itself probably does not lead to improved functional outcomes.

Retrieved cerebral thrombi studied by T2 and ADC mapping: preliminary results.

Background Recent advances in MRI technology makes it increasingly more competitive to CT also in the field of interventions. Multi-parametric MRI offers a significant amount of data relevant for characterization of human cerebral thrombi. Patients and methods Cerebral thrombi of 17 patients diagnosed with acute stroke were acquired by mechanical thrombectomy. The thrombi were subsequently scanned using a high spatial-resolution 3D T1-weighted MRI to obtain morphological characteristics of the thrombi and also by apparent diffusion coefficient (ADC) and transversal nuclear magnetic resonance (NMR) relaxation time (T2) mapping. The MRI results were analysed for possible correlations between thrombectomy procedure parameters (recanalization time and number of passes) and MR-measurable parameters (sample-mean ADC and T2, within-sample coefficient of variation of ADC and T2, and thrombus length). Results Both MRI mapping techniques enabled a good discrimination among thrombi regions of different water mobility and compaction. Within-sample coefficient of variation of ADC was found most sensitive for discrimination between the thrombi where thrombectomy procedure was performed in a single pass and those where is was performed in two or more passes (p = 0.03). Interestingly, negative correlation was found between the recanalization time and thrombus length (ρ = -0.22). Conclusions Preliminary results of presented study shows that pretreatment MRI assessment of thrombi in stroke patients could potentially ease stroke treatment planning. In this study it is shown that within-sample coefficient of variation of ADC could serve for prediction of possible complications during thrombectomy procedures.

Lumbar and abdominal muscles isometric potential in volleyball cadets / Potencial isometrico de músculos lumbares y abdominales en cadetes de voleibol

Given that a volleyball game requires a certain level of individual anthropological characteristics of young volleyball players to successfully act on situational conditions, and that interdisciplinary approach in the science study is the principal methodological orientation, subject of study in the field of sports is the anthropological status. The aim of this study was to analyze the possible differences in spinal lumbar and abdominal muscles isometric potential of prospective male and female. Sample included 42 subjects (15 male and 27 female subjects), male and female volleyball players, the cadet selection of Serbia, aged 14±0.5 years. Isometric muscle potential assessment was conducted using four standardized motor movement tasks, covering the following areas: static contraction of the flexors of the torso, static contraction of the extensors of the torso, static contraction of the left flexor of the torso, and static contraction of the right flexor of the torso. In addition to the descriptive statistics used, as basis statistics, the t-test for independent samples was used, to compare the mean values of parameters measured in two different groups of athletes ­ volleyball players (girls ­ boys). Descriptive indicators of the sample suggest greater values of deep spinal muscles isometric potential with boys in all study variables. Study results gained by the t-test of independent samples indicate that statistically significant difference exists between their mean results in variables of trunk flexor static contractions and trunk extensor static contractions, at the level 0.001. With other two variables, the values indicate that difference between genders is not significant but accidental. The results of this study regarding static contraction of the right and left lateral flexors of the torso show the lack of statistical significance between male and female cadet volleyball players.

Al considerar que un partido de voléibol requiere cierto nivel de características antropológicas individuales de los jóvenes jugadores de voléibol para actuar con éxito en condiciones situacionales, el enfoque interdisciplinario principal en el estudio de las ciencias del deporte es la orientación metodológica, como también lo es el estado antropológico de los jugadores. El objetivo de este estudio fue analizar las posibles diferencias en la columna lumbar y el potencial isométrico en los músculos abdominales masculinos y femeninos. En la muestra fueron incluidos 42 sujetos (15 varones y 27 mujeres) jugadores de voléibol masculino y femenino de la selección cadete de Serbia, de 14±0,5 años. Se realizó evaluación del potencial muscular utilizando cuatro tareas de movimiento de motor estandarizados en las siguientes áreas: la contracción estática de los flexores del torso, de contracción estática de los extensores del tronco, contracción estática del flexor izquierdo del torso, y la contracción estática del flexor derecho del torso. Además de las estadísticas descriptivas y las estadísticas de base utilizadas, se usó la prueba t para las muestras independientes para comparar los valores medios de los parámetros medidos en dos grupos diferentes de los deportistas - jugadores de voléibol (niñas - niños). Los indicadores descriptivos de la muestra sugieren mayores valores de potencial isométrico de los músculos espinales profundos en niños en todas las variables del estudio. Los resultados del estudio obtenidos por la prueba t de muestras independientes indicaron que existe una diferencia estadísticamente significativa entre los resultados medios en las variables de los flexores del tronco y en las contracciones estáticas de los extensores del tronco, en el nivel de 0,001. Con otras dos variables, los valores indicaron que la diferencia entre ambos sexos no es significativa pero es accidental. Los resultados de este estudio con respecto a la contracción estática del lado derecho y flexores laterales izquierdos del torso muestran la falta de significación estadística entre los jugadores masculinos y femeninos de voléibol.

Seroreactivity to Dirofilaria antigens in people from different areas of Serbia.

BACKGROUND: The Northern part of Serbia is hyperendemic-endemic for canine dirofilarioses. Considering this fact, many human dirofilarial infections could be expected, however only about 30 cases in Serbia have been described until today. Aims of this survey were to assess the people reactivity to the antigens of D. repens and D. immitis and to identify risk factors for the contact exposure. METHODS: Investigation included sera taken from 297 people (179 women and 118 men) living in different areas of Serbia (Pancevo, Novi Sad, Zajecar, Leskovac, Vranje, Nis, Pirot). Sera were analysed by means of two indirect enzyme-linked immunosorbent (ELISA) home-designed that use as antigens adult somatic/metabolic polyproteins of D. repens (DR) and D. immitis (DI), respectively. The results were elaborated using the statistical method of descriptive and quantitative analysis. RESULTS: Significant differences by area in the reactivity of human sera to dirofilarial antigens were not observed (p = 0.056). A high seroreactivity was demonstrated in people from the towns of northern Serbia (Pancevo = 27,1%; Novi Sad = 16,3%), as well as in people from Zajecar (eastern Serbia = 15,8%) and Vranje (southern Serbia = 15,1%). No differences were evidenced between people reactivity to polyproteins of the two dirofilarial species, nor differences related to the gender of examinees. Factor risks evidenced were: i) place of residence; ii) spending work time outdoors during the mosquito season; iii) spending time outdoors and nearby rivers, lakes, swamps or canals; unespectedly, iv) cat owning. CONCLUSION: The findings emerging from this investigation indicate that clinicians and public health authorities should pay greater attention to this zoonosis. Continuing education and training of physicians will greatly contribute to the knowledge of the actual impact of filarial worms on animal and public health, and allow for the planning of suitable measures to prevent the infections.

The prevalence of substance use among adolescents and its correlation with social and demographic factors.

UNLABELLED: BACKROUND/AIM: Adolescence is the period of greatest risk of starting to use substances: cigarette smoking, alcohol and illicit drugs. In the first decade of this millennium substance use among adolescents has increased. The aim of this study was to explore the prevalence of substances use among adolescents and its correlation with social and demographic factors. METHODS: The study was conducted among adolescents in Novi Sad during 2010-2011 and included 594 conveniently selected adolescents (275 male and 319 female), aged 15-19 years. A special questionnaire was used and statistical analysis performed in SPSS17. The correlation between parameters was evaluated by the Pearson correlation method and frequency differences were analysed using χ2 test and starting level was p < 0.05. RESULTS: The prevalence of substance use was statistically higher in males. Cigarettes were smoked daily by 21.45% males and 15.67% females (p < 0.01), alcohol was consumed by 81.6% males and 69.11% females (p < 0.001) and illicit drugs were used by 13.65% males and 8.30% females (p < 0.05). There was a positive correlation between smoking cigarettes and alcohol consumption, but negative between smoking cigarettes and the use of illicit drugs (p < 0.01). The prevalence of substance use was statistically higher among adolescents with poor achievement in school (p < 0.01), who lived in a broken home (illicit drugs p < 0.01) and who had more pocket money (cigarette smoking p < 0.01, and alcohol consumption p < 0.5). CONCLUSION: Stable family, lower amount of pocket money weekly and good school performance are protective factors in prevention of substances use among adolescents.

The impact of the July 2007 heat wave on daily mortality in Belgrade, Serbia.

OBJECTIVE: Mortality has been shown to increase with heat waves. Serbia experienced the hottest heat wave in July 2007. In this study, we examined patterns of non-traumatic excess mortality in Belgrade during this event. METHODS: The numbers of deaths observed during the 9-day heat wave were compared to those expected on the basis of mortality rates reported for the previous eight years and two following years. Excess mortality was analyzed by age, gender and cause of death. RESULTS: There was a total of 167 excess deaths (38%) between 16 and 24 July. People aged 75 years and older accounted for 151 (90%) of all excess deaths. An increase of mortality among elderly was 76% in comparison to the baseline mortality. Excess female mortality was over two times higher than excess male mortality (54% : 23%). The biggest increase in mortality was from diabetes mellitus (286%), chronic kidney disease (200%), respiratory system diseases (73%), and nervous system diseases (67%). Cardiovascular and malignant neoplasms mortality accounted for the highest absolute numbers of excess deaths (77 and 49, respectively). There was no decrease in mortality in the 60-day period after the heat wave. CONCLUSIONS: There are several causes of an increase in heat-related mortality. The most vulnerable population group is the elderly females.

Smoking habits, knowledge about and attitudes toward smoking among employees in health institutions in Serbia.

BACKGROUND/AIM: According to the number of active smokers, Serbia occupies a high position in Europe, as well as worldwide. More than 47% of adults are smokers according to WHO data, and 33.6% according to the National Health Survey Serbia in 2006. Smoking physicians are setting a bad example to patients, they are uncritical to this habit, rarely ask patients whether they smoke and rarely advise them not to smoke. These facts contribute to the battle for reducing the number of medical workers who smoke, as well as the number of smokers among general population. The aim of the study was to determine the smoking behavior, knowledge and attitudes and cessation advice given to patients by healthcare professionals in Serbia. METHODS: A stratified random cluster sample of 1,383 participants included all types of health institutions in Serbia excluding Kosovo. The self administrated questionnaire was used to collect data about smoking habits, knowledge, attitudes and cessation advice to patients given by health professionals in Serbia. RESULTS: Out of 1,383 participants, 45.60% were smokers, of whom 34.13% were physicians and 51.87% nurses. There were 46.4% male and 45.4% female smokers. The differences in agreement with the statements related to the responsibilities of health care professionals and smoking policy are significant between the "ever" and "never" smokers, and also between physicians and nurses. Twenty-five percent of nurses and 22% of doctors claimed they had received formal training. However, only 35.7% of the healthcare professionals felt very prepared to counsel patients, while 52.7% felt somewhat prepared and 11.6% were not prepared at all. CONCLUSIONS: According to the result of this survey, there are needs for more aggressive nationwide non-smoking campaigns for physicians and medical students. Experiences from countries where physicians smoke less and more effectively carry out smoking cessation practices need to be shared with Serbian physicians in order to improve their smoking behavior and smoking cessation practices.

Laparoscopic liver resection: Current role and limitations.

Laparoscopic liver resection (LLR) for the treatment of benign and malignant liver lesions is often performed at specialized centers. Technological advances, such as laparoscopic ultrasonography and electrosurgical tools, have afforded surgeons simultaneous improvements in surgical technique. The utilization of minimally invasive techniques for liver resection has been reported to reduce operative time, decrease blood loss, and shorten length of hospital stay with equivalent postoperative mortality and morbidity rates compared to open liver resection (OLR). Non-anatomic liver resection and left lateral sectionectomy are now routinely performed laparoscopically at many institutions. Furthermore, major hepatic resections are performed by pure laparoscopy, hand-assisted technique, and the hybrid method. In addition, robotic surgery and single port surgery are revealing early promising results. The consensus recommendation for the treatment of benign liver disease and malignant lesions remains unchanged when considering a laparoscopic approach, except when comorbidities and anatomic limitations of the liver lesion preclude this technique. Disease free and survival rates after LLR for hepatocellular carcinoma and metastatic colon cancer correspond to OLR. Patient selection is a significant factor for these favorable outcomes. The limitations include LLR of superior and posterior liver lesions; however, adjustments in technique may now consider a laparoscopic approach as a viable option. As growing data continue to reveal the feasibility and efficacy of laparoscopic liver surgery, this skill is increasingly being adopted by hepatobiliary surgeons. Although the full scope of laparoscopic liver surgery remains infrequently used by many general surgeons, this technique will become a standard in the treatment of liver diseases as studies continue to show favorable outcomes.

SIRS score on admission and initial concentration of IL-6 as severe acute pancreatitis outcome predictors.

BACKGROUND/AIMS: Early recognition of severe form of acute pancreatitis is important because these patients need more agressive diagnostic and therapeutical approach an can develope systemic complications such as: sepsis, coagulopathy, Acute Lung Injury (ALI), Acute Respiratory Distress Syndrome (ARDS), Multiple Organ Dysfunction Syndrome (MODS), Multiple Organ Failure (MOF). To determine role of the combination of Systemic Inflammatory Response Syndrome (SIRS) score and serum Interleukin-6 (IL-6) level on admission as predictor of illness severity and outcome of Severe Acute Pancreatitis (SAP). METHODOLOGY: We evaluated 234 patients with first onset of SAP appears in last twenty four hours. A total of 77 (33%) patients died. SIRS score and serum IL-6 concentration were measured in first hour after admission. RESULTS: In 105 patients with SIRS score 3 and higher, initial measured IL-6 levels were significantly higher than in the group of remaining 129 patients (72 +/- 67 pg/mL, vs 18 +/- 15 pg/mL). All nonsurvivals were in the first group, with SIRS score 3 and 4 and initial IL-6 concentration 113 +/- 27 pg/mL. The values of C-reactive Protein (CRP) measured after 48h, Acute Physiology and Chronic Health Evaluation (APACHE II) score on admission and Ranson score showed the similar correlation, but serum amylase level did not correlate significantly with Ranson score, IL-6 concentration and APACHE II score. CONCLUSION: The combination of SIRS score on admission and IL-6 serum concentration can be early, predictor of illness severity and outcome in SAP.

[Maternal smoking during pregnancy and socioeconomic factors as predictors of low birth weight in term pregnancies in Nis].

BACKGROUND/AIM: Low birth weight (LBW) is a result of preterm birth or intrauterine growth retardation, and in both cases is the strongest single factor associated with perinatal and neonatal mortality. It is considered that socioeconomic factors, as well as mothers bad habits, play the most significant role in the development of LBW, which explains notable number of researches focused on this particular problem. The aim of this study was to characterize socioeconomic factors, as well as smoking habits of the mothers, and their connection with LBW. METHODS: The questionnaire was carried out among mothers of 2 years old children (n = 956), born after 37 gestational weeks. The characteristics of mothers who had children with LBW, defined as < 2,500 g, (n = 50), were matched with the characteristices of mothers who had children > or = 2,500 g, (n = 906). For defining risk factors, and protective factors as well, we used univariant and multivariant logistic modeles. RESULTS: As significant risk factors for LBW in an univariant model we had education level of the mothers, smoking during pregnancy, smoking before pregnancy, the number of daily cigarettes, the number of cigarettes used during pregnancy, paternal earnings and socioeconomic factors. In a multivariant model the most significant factors were socioeconomic factors, education level of the mothers, paternal earnings and mothers smoking during pregnancy. CONCLUSION: Smoking during pregnancy and socioeconomic factors have great influence on LBW. Future studies should be carried out in different social groups, with the intention to define their influence on LBW and reproduction, as well. This should be the proper way of adequate health breeding planning for giving up smoking, the prevention of bad habits and melioration of mothers and children health, as the most vulnerable population.

The influence of different sub-bandage pressure values on venous leg ulcers healing when treated with compression therapy.

BACKGROUND: Venous leg ulcers (VLU) have a huge social and economic impact. An estimated 1.5% of European adults will suffer a venous ulcer at some point in their lives. Despite the widespread use of bandaging with high pressure in the treatment of this condition, recurrence rates range between 25% to 70%. Numerous studies have suggested that the compression system should provide sub-bandage pressure values in the range from 35 mm Hg to 45 mm Hg in order to achieve the best possible healing results. METHODS: An open, randomized, prospective, single-center study was performed in order to determine the healing rates of VLU when treated with different compression systems and different sub-bandage pressure values. One hundred thirty-one patients (72 women, 59 men; mean age, 59-years-old) with VLU (ulcer surface >3 cm(2); duration >3 months) were randomized into three groups: group A - 42 patients who were treated using an open-toed, elastic, class III compression device knitted in tubular form (Tubulcus, Laboratoires Innothera, Arcueil, France); group B - 46 patients treated with the multi-component bandaging system comprised of Tubulcus and one elastic bandage (15 cm wide and 5 cm long with 200% stretch, Niva, Novi Sad, Serbia); and group C - forty-three patients treated with the multi-component bandaging system comprised of Tubulcus and two elastic bandages. Pressure measurements were taken with the Kikuhime device (TT MediTrade, Soro, Denmark) at the B1 measuring point in the supine, sitting, and standing positions under the three different compression systems. RESULTS: The median resting values in the supine and standing positions in examined study groups were as follows: group A - 36.2 mm Hg and 43.9 mm Hg; group B - 53.9 mm Hg and 68.2 mm Hg; group C - 74.0 mm Hg and 87.4 mm Hg. The healing rate during the 26-week treatment period was 25% (13/42) in group A, 67.4% (31/46) in group B, and 74.4% (32/43) in group C. The success of compression treatment in group A was strongly associated with the small ulcer surface (<5 cm(2)) and smaller calf circumference (CC; <38 cm). On the other hand, compliance in group A was good. In groups B and C, compliance was poor in patients with small CC, but the healing rate was high, especially in patients with large ulcers and a large CC (>43 cm). CONCLUSION: The results obtained in this study indicate that better healing results are achieved with two or multi-component compression systems than with single-component compression systems and that a compression system should be individually determined for each patient according to individual characteristics of the leg and CC. Target sub-bandage pressure value (B1 measuring point in the sitting position) of the compression system needed for the ulcer healing could be determined according to a simple formula, CC + CC/2.

Mortality of Roma population in Serbia, 2002-2005.

AIM: To describe and compare mortality and population changes in the Roma and non-Roma population in Serbia in 2002 and 2005. METHODS: The number of cases of death were obtained from the 2002 and 2005 Mortality Database and population data from the Population Census 2002. Standardized sex specific rates of non-traumatic and traumatic mortality in 2002 and 2005 were calculated in relation to the European standard population. We presented population pyramid and aging index for both populations in 2002 and compared sex specific standardized traumatic and non-traumatic mortality rates and the average age of death for 2002 and 2005. The causes of death were coded according to the 10th revision of the International Classification of Diseases (ICD-10) groups, and the proportional mortalities in the year 2002 and 2005 were compared between the Roma and non-Roma population using chi2 test. RESULTS: Standardized mortality rates were higher in the Roma than in the general population. Non-traumatic mortality rate in Roma men in 2002 was 18.2 per 1000 and in slightly decreased to 18.0 per 1000 in 2005; it was significantly higher than in non-Roma men in both years (11.9 per 1000 in 2002 and 12.5 per 1000 in 2005; P<0.001). Standardized non-traumatic mortality rate in Roma women decreased significantly from 16.78 per 1000 in 2002 to 14.89 per 1000 in 2005 (P=0.014), but it was still significantly higher than in non-Roma women (8.46 per 1000 in 2002 and 8.84 per 1000 in 2005; P<0.001). Morbidity structure indicated that the most common causes of death in the Roma population were cardiovascular diseases, neoplasms, and respiratory system diseases. In relation to the general population respiratory system diseases were denoted as main causes of deaths in significantly higher percent (6% vs 3% in 2002 and 7% vs 4% in 2005; P<0.001) and cardiovascular diseases in significantly lower percent (44%:55% in 2002 and 46%:57%; P<0.001). CONCLUSIONS: Our data show that mortality rates in the Roma population are significantly higher than in the general population, and morbidity structure of the most common causes of death significantly different from that of general population.

A randomized trial of the Tubulcus multilayer bandaging system in the treatment of extensive venous ulcers.

BACKGROUND: Venous ulcers are a major health problem because of their high prevalence and associated high cost of care. Compression therapy is the most widely used treatment for this condition. The vast majority of published articles on compression therapy present the results in the treatment of venous ulcers usually up to 15 to 20 cm(2). However, there are no published data in English medical literature on the efficacy of compression therapy in the treatment of extensive venous ulcers (ulcers >20 cm(2) of more than 6 months' duration) with regard to healing rate, time to healing, and recurrence rate at 12 months after healing. METHODS: A total of 138 patients with extensive venous ulceration (ulceration surface, 20-210 cm(2); duration, 7 months to 28 years) were randomized into 2 groups: (1) a treatment group (72 patients who were treated by using a multilayer bandaging system with the Tubulcus (a heelless open-toed elastic compression device knitted in tubular form) and elastic bandages and (2) a control group (66 patients treated with a multilayer bandaging system with elastic bandages only). The patients were treated on an ambulatory basis; the primary end point of the study was complete ulcer healing at 500 days. The secondary end point was to assess the ulcer recurrence rate during continuation of below-knee compression of different degrees of compression. In the treatment group, patients were instructed to continue to wear the Tubulcus (35 mm Hg), and patients in the control group were instructed to wear compression stockings with compression of 20 to 25 mm Hg. The exclusion criteria from the study were heart insufficiency with an ejection fraction <35, an ankle-brachial pressure index less than 0.8, and pregnancy. RESULTS: The cumulative healing rate was 93% in the treatment group and was 51% in the control group (P < .001). The median healing time in the treatment group was 133 days (range, 28 to 464 days), and in the control group it was 211 days (range, 61 to 438 days). The recurrence rate at 12 months in the treatment group was 24% (16/67) and was 53% (18/34) in the control group (P < .05). After additional compression treatment with the same treatment protocol, all 16 recurrent ulcers in the treatment group healed. In the control group, the healing rate of recurrent ulcers was 89% (16/18). CONCLUSIONS: This study suggests that for extensive venous ulceration, multilayer compression therapy with the Tubulcus provides an extremely high healing rate. Compression of more than 30 mm Hg results in decreased ulcer recurrence. However, recurrence cannot be completely avoided.