Clinical-parasitological Screening for Respiratory Capillariosis in Cats in Urban Environments.

Respiratory capillariosis is a widely distributed zoonotic parasitic disease caused by the nematode Capillaria aerophila (Trichocephalida, Trichuridae) that commonly infects wild carnivores but also cats and dogs. This retrospective study aims to describe cases of respiratory capillariosis in cats from the city of Belgrade, Serbia. Between 2015 and 2019, a total of 155 pet cats with or without respiratory symptoms were submitted to physical examination and parasitological examination of the feces. All cats lived indoor but had free access to outdoor. In suburban settlements, wild carnivores commonly share their living environments with owned cats and dogs. It can be assumed that more intense urbanization spreading into the natural habitats of will carnivores creates the opportunity for closer and more frequent contacts between the population of cats and feral carnivores which might increase the risk of feline contamination. The findings confirm the existence of capillaries in cats in urban areas of the city of Belgrade, contribute to a better understanding of the epidemiology of this nematode and warn that, because of close contacts between cats of pets and humans, capillaries can cause human infection.

Soil and Sand Contamination with Canine Intestinal Parasite Eggs as a Risk Factor for Human Health in Public Parks in Nis (Serbia).

Regarding geographical distribution and clinical relevance, the most common canine geohelminths are Toxocara canis, ancylostomatids, and Trichuris vulpis. Canine intestinal parasites from the soil and sand present an important potential serious human health hazard, especially for the children preschool and school - age. This paper aimed to establish the degree of contamination of soil and sand with zoonotic parasites from the canine feces and the degree of risk they could pose for human health in public places and playgrounds in the city of Nis. Our parasitological study involved 200 soil samples and 50 sand samples from the public parks in the city of Nis in southeastern Serbia (43°19'15″N, 21°53'45″ E). From several locations, about 100 g of soil and sand was collected based on the bioclimatic indices. Parasitological diagnosis was performed using conventional qualitative and quantitative coprological methods, abiding by the recommendations about the diagnosis of parasitic diseases. In 38 - 46 % of soil samples and 40 % of sand samples seven species of endoparasites were diagnosed. In the samples of soil, a medium and high degree of contamination with the ascarid T. canis (14 - 22 %) was detected, as well as a low and medium degree of contamination with ancylostomatids (4 - 12 %), and in the samples of sand, a variable degree of contamination with the helminths T. canis (26 %) and A. alata (16 %) was found. A statistically significant difference was found in the contamination with A. alata eggs between the samples of sand and samples of soil. The studied public surfaces represent the reservoir of zoonotic parasites, which is a public health problem requiring a synergistic action of several factors to be successfully resolved, i.e. the implementation of prevention, surveillance, and control measures.

A systematic UHPLC Q-ToF MS approach for the characterization of bioactive compounds from freeze-dried red goji berries (L. barbarum L.) grown in Serbia: Phenolic compounds and phenylamides.

The aim of this study was to identify and characterise different classes of bioactive compounds from freeze-dried red goji berries (RGB) grown in Serbia, using ultra-high-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UHPLC Q-ToF MS). In addition, this study aims to demonstrate the importance of applying the advanced UHPLC Q-ToF MS technique in the identification of various biocompounds. The analysis showed the presence of 28 phenolic compounds, 3 organic acids, and 26 phenylamides. The 2-O-ß-d-glucopyranosyl-l-ascorbic acid (AA-2ßG) was identified by UHPLC Q-ToF MS and quantified by standardised UHPLC-DAD method. Most of the compounds detected were derivatives of caffeic acid and ferulic acid, followed by quercetin derivatives. Among the phenylamides, several glucosylated caffeoyl and/or dihydrocaffeoyl derivatives of spermidine and spermine were characterized, confirming their recent characterization. Some glycosylated/non-glycosylated putrescine derivatives and caffeoyl-dihydrocaffeoyl-feruloyl spermidines were identified in goji berriesfor the first time. Their tentative structures and fragmentations were proposed.

Probing motor dynamics at the muscle level-Acoustic myography in Parkinson's disease.

Acoustic myography (AMG) noninvasively probes muscle activity. We explored whether AMG captures abnormal motor activity in patients with Parkinson's disease (PD) and how this activity is modulated by antiparkinsonian medication. Twenty patients with PD underwent AMG of the biceps, triceps, extensor carpi radialis longus, and adductor policis muscles of the more affected arm during active and passive movements, using a mobile AMG device (CURO, Denmark). AMG and assessment of motor symptoms were performed in a pragmatic off-medication state, as well as one and 3 h after oral intake of 200 mg levodopa. Three AMG parameters were calculated using the CURO analysis system. Motor efficiency was expressed by the E-score, muscle fiber recruitment by the temporal T-score, spatial summation by the S-score, and S/T ratio. Twenty age- and sex-matched healthy subjects served as controls. Group mean values were statistically compared using unpaired two-tailed adjusted t-test and ANOVA with Tukey´s correction for multiple comparison (p ≤ 0.05). For the biceps and extensor carpi radialis longus muscles, the active movement S:T ratio was lower in PD relative to healthy controls. The E-score was also lower during active and passive flexion/extension movements in the off-medication state. No significant between-group differences in the AMG scores were noted for the triceps muscle during active or passive movements. The active S:T ratio and the E-score during active elbow flexion and extension may offer a useful means to quickly assess abnormal motor activity and the effect of drug treatment in PD.

The influence of coil-skull distance on transcranial magnetic stimulation motor-evoked responses.

We have investigated the effects of changing the coil-to-skull distance on the motor-evoked responses (MEP) induced with two different magnetic stimulator coils (80 mm round and figure-of-eight coil) at rest and during voluntary muscle contraction. The changes in MEP latency, amplitude and silent period (SP) duration induced by stimulation directly upon the skull, and 1 cm away from the skull were analyzed by computing the probability density distribution (PDD) for the responses obtained from all subjects. This measure corresponds to the finite probability that the event occurs within a given area. Overall, the results were consistent with a distance-induced decrease in magnetic field strength. However, the increase in coil-to-skull distance induced a higher probability of longer latencies in active muscle when stimulating with either coil. Also, stimulating at a distance with the figure-of-eight coil increased the probability of a longer SP duration. The stimulation strength at the two distances was comparable because it was set based on the motor threshold obtained for each distance. Therefore, our results are not entirely compatible with the established exponential drop in magnetic field with increasing distance. Rather, they suggest that a more complex set of interactions occurs in the cortex. The results imply that distinct patterns of cortical network activation may exist related to the distance-induced alterations when the coil is moved away from the skull. Further studies are required to elucidate the precise nature of the distance-related interactions of the magnetic field with the cortex.

Improving agricultural production of domestic rabbits in Serbia by follow-up study of their parasitic infections.

A study was made on the prevalence of some parasitic infections appearing in domestic rabbits obtained from individual breeders in Serbia in order to improve the agricultural production of these animals. Aside from economic reasons (meat production and reproduction) rabbits are bred for the research purposes, and races are kept as household pets. For these reasons, among others, it is important to gain knowledge of medical culprits including causes of parasitic diseases that compromise their health, well-being and cause economic losses. This parasitological research was conducted in the period from 2010 to 2015 in 8 epidemiological regions of Serbia, on 433 rabbits as representative samples of different races (154 individuals up to 1 years of age and 279 individuals older than 5). Out of the total number of examined rabbits parasitic infections were established in 82.68% of animals. We detected 3 species of endoparasites (Eimeria spp., Trichostrongylus spp., and Passalurus ambiguus) and 3 species of ectoparasites (Scabies from genera Sarcoptes, Psoroptes and Notoedres). In "kits" (small rabbits) coccidiosis was the most prevalent disease (50.65%), while in older animals trichostrongilidosis was common (39.07%). The most represented scabies infection was with the species Psoroptes cuniculi (12.01%). Aiming at better control on the health of rabbits, there is a growing need for continual monitoring of parasitic infections including appropriate diagnosis, application efficient therapeutic protocols and control measures.

Oxidative stress indicators are elevated in de novo Parkinson's disease patients.

In order to determine the baseline state of oxidative stress indices in drug-free patients with Parkinson's disease (PD), we analyzed cerebrospinal fluid (CSF) and peripheral blood samples of 34 subjects in disease stages I-III, according to the Hoehn & Yahr scale, compared with controls. The results showed a highly significant increase in malondialdehyde content in CSF (p < 0.001) in the patients with PD. We also found significant differences in peripheral blood parameters between the two groups: malondialdehyde content was increased in patients with PD (p < 0.05), as was the activity of antioxidative defense enzymes, glutathione reductase, Cu, and Zn-superoxide-dismutase (p < 0.05). The production of a highly reactive oxygen species--superoxide radical (p < 0.05) was also increased. These findings indicated an important role of oxidative stress in PD evolution and progress. The increased levels of reactive oxidative species (malondialdehyde content and superoxide radical production) in peripheral blood, and excessive activity of protective enzymatic systems (glutathione reductase Cu, and Zn-superoxide-dismutase) could indicate an additional systemic reaction related to a chronic oxidative stress state in the brain.

GABAB receptors as a common target for hypothermia and spike and wave seizures: intersecting mechanisms of thermoregulation and absence epilepsy.

In the current study the link among the γ-hydroxybutyrate (GHB)/pentylenetetrazole (PTZ)-induced absence-like seizures and concomitant decreases in the core temperature, as well as electroencephalographic (EEG) activity during rewarming from deep hypothermia produced by a drug-free protocol were investigated. During the rewarming period after deep cooling, most Wistar rats suffered from bilaterally synchronous spike and waves with no or mild behavioral correlates. Spike and wave seizures were temperature-dependent and were initially registered when body temperature (Tb) reached 25-27°C, but mostly during the mild hypothermia of 0.3-1.3°C (Tb of 36.3-37.3°C). In chemical absence models, spike and wave discharges were also closely accompanied by mild systemic hypothermia, as both PTZ- and GHB-induced temperature decreases ranged from about 1-1.4°C respectively, together with EEG markers of absence activity. Thus, throughout the different experimental designs, the occurrence of spike and wave discharges was always related to a mild (0.3-1.4°C) decrease of Tb. Benzodiazepine diazepam as the GABAA-positive allosteric modulator and CGP 62349 as the selective antagonist of GABAB receptors were used to determine if their well-known anticonvulsant properties also affect hypothermia elicited by these drugs. Finally, during the course of spontaneous rewarming from deep hypothermia, another selective GABAB-blocking agent, CGP 35348, was used to elucidate if GABAB inhibitory system could be critically implicated in the generation of hypothermia-dependent spike and waves. Diazepam prevented both the PTZ-induced hypothermia and electrographic absence seizures, but these two beneficial effects did not occur in the GHB model. Even though diazepam delayed GHB-induced maximal temperature decrease, the GHB effects remained highly significant. The GABAB antagonist CGP 62349 completely prevented hypothermia as well as absence seizures in both chemical models. Likewise, spike and wave discharges, registered during the spontaneous rewarming from deep hypothermia, were completely prevented by CGP 35348. These findings show that systemic hypothermia should definitely be regarded as a marker of GABAB receptor activation. Moreover, the results of this study clearly show that initial mild temperature decrease should be considered as strong absence-provoking factor. Hypothermia-induced nonconvulsive seizures also highlight the importance of continuous EEG monitoring in children undergoing therapeutic hypothermia after cardiac arrest. Since every change in peripheral or systemic temperature ultimately must be perceived by preoptic region of the anterior hypothalamus as the primary thermoregulatory and sleep-inducing center, the preoptic thermosensitive neurons in general and warm-sensitive neurons in particular, simply have to be regarded as the most probable candidate for connected thermoregulatory and absence generating mechanisms. Therefore, additional studies are needed to confirm their potential role in the generation and propagation of absence seizures.

Homeostatic modulation of stimulation-dependent plasticity in human motor cortex.

Since recently, it is possible, using noninvasive cortical stimulation, such as the protocol of paired associative stimulation (PAS), to induce the plastic changes in the motor cortex, in humans that mimic Hebb's model of learning. Application of TMS conjugated with peripheral electrical stimulation at strictly coherent temporal manner lead to convergence of inputs in the sensory-motor cortex, with the consequent synaptic potentiation or weakening, if applied repetitively. However, when optimal interstimulus interval (ISI) for induction of LTP-like effects is applied as a single pair, Motor evoked potential (MEP) amplitude inhibition is observed, the paradigm known as short-latency afferent inhibition (SLAI). Aiming to resolve this paradox, PAS protocols were applied, with 200 repetitions of TMS pulses paired with median nerve electrical stimulation, at ISI equal to individual latencies of evoked response of somatosensory cortex (N(20)) (PAS(LTP)), and at ISI of N(20) shortened for 5 msec (PAS(LTD)) - protocols that mimic LTP-like changes in the human motor cortex. MEP amplitudes before, during and after interventions were measured as an indicator based on output signals originating from the motor system. Post-intervention MEP amplitudes following the TMS protocols of PAS(LTP) and PAS(LTD) were facilitated and depressed, respectively, contrary to MEP amplitudes during intervention. During PAS(LTP) MEP amplitudes were significantly decreased in case of PAS(LTP), while in the case of PAS(LTD) an upward trend was observed. In conclusions, a possible explanation for the seemingly paradoxical effect of PAS can be found in the mechanism of homeostatic modulation of plasticity. Those findings indicate the existence of complex relationships in the development of plasticity induced by stimulation, depending on the level of the previous motor cortex excitability.

Startle stimuli exert opposite effects on human cortical and spinal motor system excitability in leg muscles.

Increased excitability of the spinal motor system has been observed after loud and unexpected acoustic stimuli (AS) preceding H-reflexes. The paradigm has been proposed as an electrophysiological marker of reticulospinal tract activity in humans. The brainstem reticular formation also maintains dense anatomical interconnections with the cortical motor system. When a startling AS is delivered, prior to transcranial magnetic stimulation (TMS), the AS produces a suppression of motor evoked potential (MEP) amplitude in hand and arm muscles of healthy subjects. Here we analyzed the conditioning effect of a startling AS on MEP amplitude evoked by TMS to the primary motor leg area. Ten healthy volunteers participated in two experiments that used a conditioning-test paradigm. In the first experiment, a startling AS preceded a suprathreshold transcranial test stimulus. The interstimulus interval (ISI) varied between 20 to 160 ms. When given alone, the test stimulus evoked a MEP amplitude of approximately 0.5 mV in the slightly preinervated soleus muscle (SOL). In the second experiment, the startling AS was used to condition the size of the H-reflex in SOL muscle. Mean MEP amplitude was calculated for each ISI. The conditioning AS suppressed MEP amplitude at ISIs of 30-80 ms. By contrast, H-reflex amplitude was augmented at ISIs of 100-200 ms. In conclusions, acoustic stimulation exerts opposite and ISI-specific effects on the amplitude of MEPs and H-reflex in the SOL muscle, indicating different mechanism of auditory-to-motor interactions at cortical and spinal level of motor system.

Paired-associative stimulation can modulate muscle fatigue induced motor cortex excitability changes.

The aim of this study was to examine whether the changes of the motor cortex excitability induced by muscle fatigue could be affected by prior or subsequent intervention protocol supposed to induce opposing excitability changes. For this purpose we used paired associative stimulation (PAS) method, where peripheral nerve stimuli were associated with transcranial magnetic stimulation (TMS) of the motor cortex at a fixed interstimulus interval of 25 ms. The PAS protocol used is known to produce a long lasting, long-term potentiation (LTP) like change of cortical plasticity manifested by significant increase in motor evoked potentials (MEPs) amplitude. In this study, we confirmed significant MEP size reduction following fatigue, which had been already reported in the literature. When PAS was applied either immediately before or after muscle fatigue protocol, the excitability changes were largely occluded and MEP sizes remained close to baseline levels. However, in spite of the effects on cortical excitability, conditioning with PAS did not cause any change in target fatigue measure, the endurance point, which remained the same as when fatiguing protocol was applied alone. The present results demonstrate that fatigue-related changes in cortical excitability can be modulated by either prior or subsequent excitability promoting activity. They also suggest that muscle fatigue associated changes in motor cortical excitability probably represent non-specific activity-related plasticity, rather than a direct expression of the so-called central fatigue.

TMS-assisted neurophysiological profiling of the dopamine receptor agonist cabergoline in human motor cortex.

Dopamine plays a broad role in motor control and practice-dependent plasticity. Here we tested, in eight healthy subjects, the effects of the dopamine receptor agonist cabergoline on motor cortical excitability because the state of motor cortex can strongly influence practice-dependent plasticity. Cabergoline enhances practice-dependent plasticity but the mechanisms are unknown. We used transcranial magnetic stimulation for testing of motor cortical excitability. A single dose of 2 mg of cabergoline increased short-interval intracortical inhibition, a measure of excitability of GABA-dependent inhibitory neural circuits, and decreased various excitatory measures (motor evoked potential amplitude and short-interval intracortical facilitation). Other measures of motor cortical (motor threshold, cortical silent period duration), spinal (peripheral silent period duration, F-wave) and neuromuscular excitability (maximum M-wave) remained unchanged. This shift in the balance from excitation to inhibition may assist, by improving the 'signal-to-noise ratio' in motor cortex, in the positive modulating effect of cabergoline on practice-dependent plasticity.

[Treatment of acute migraine attacks]. / Lecenje akutnih napada migrene.

Considering that migraine patients ask for the physician's help in outpatient clinics and hospitals due to the acute attacks dominated by headaches, the latest research in pathophysiology and pharmacotherapy of migraine, directed the aim of this research to investigate the efficiency of dihydroergotamine in the treatment of the acute attacks of migraine headaches and to define a treatment program of the acute migraine headaches for the out patient and in patient conditions. The investigations were performed in 34 patients of the middle age and younger, of both sexes, with the established clinical diagnosis of a common migraine, with no history of coronary disease, ischemic brain disease, kidney and hepatic deficiency, and who were not for different reasons, Under the prophylactic therapy. Patients were randomly divided into two equal groups. The first group was treated i.m. with dihydroergotamine (1 mg) in combination with metoclopramide (10 mg). In case of insufficient effect the dose was repeated after one and eight hours after the first dose. The second group was treated with diclofenac (75 mg) and metoclopramide (10 mg), using the same pattern. The results investigation showed the significantly better effect of dihydroergotamine regarding the onset and the intensity of the positive effect. It was concluded that in case of acute attacks of migraine headaches in younger patients with no history of coronary disease, ischemic brain disease, kidney and hepatic deficiency, dihydroergotamine with metoclopramide administered i.m. could be used as a therapy of choice in all treatment conditions.

[Sensitivity of atherosclerosis indices in patients with ischemic brain disease]. / Senzitivnost pojedinih indeksa ateroskleroze kod bolesnika sa ishemijskom bolescu mozga.

Epidemiological studies suggest that dyslipoproteinemias and hyperlipoproteinemias present one of the most important risk factors in the development of atherosclerosis and its complications. The aim of this study was to find out which of the lipid status disorders in patients with ischemic brain disease was the most important risk factor in the development of cerebral atherosclerosis. Patients with ischemic brain disease were examined in the acute and subacute phase. Total blood cholesterol, low density lipoproteins (LDL) and high density lipoproteins (HDL) as well as of apolipoproteins A1 and B were determined. Correlations (atherogenic indices) of some lipid components with the severity of clinical course and echo-angiographic finding were determined. It was concluded that the highest correlation with the cerebral atherosclerosis severity degree existed with the level of apoA1 and apoB apolipoproteins, followed by correlation of LDL and HDL cholesterol, and the lowest correlation was found between HDL and the total cholesterol. Accordingly, apolipoproteins, i.e., apoA1/apoB indices are the most sensitive markers of the risk for atherogenesis.

Oxidative stress and Parkinson's disease.

The aim of this study was to determine the baseline state of oxidative stress indices in drug-naive patients with Parkinson's disease (PD). Cerebrospinal fluid (CSF) and peripheral blood samples of 31 subjects, in disease stages I-III, according to Hoehn & Yahr scale, were analyzed and compared with the control group. Highly significant increase of malondialdehyde content in CSF (p < 0.001) was found, as well as significant differences in peripheral blood parameters: malondialdehyde content was increased in patients with PD (p < 0.05), and also the activities of antioxidative defense enzymes, gluthathion reductase, Cu, Zn-superoxide-dismutase (p < 0.05), and the production of highly reactive oxygen species-superoxide radical (p < 0.05). Those findings indicated the important role of oxidative stress in Parkinson's disease evolution and progress. The findings of increased amount of reactive oxidative species (malondialdehyde content and superoxide radical production) in peripheral blood, and excessive activity of protective enzymatic systems (gluthathion reductase Cu, Zn-superoxid-dismutase) suggested the additional systemic reaction related to chronic oxidative stress state in the brain.

[Magnetic resonance findings and cerebrospinal fluid parameters in the evaluation of blood-brain barrier status and multiple sclerosis activity]. / Nalazi magnetske rezonanci i likvorskih parmetara u proceni stanja krvno-mozdane barijere i aktivnosti multiple skleroze.

The diagnosis of disseminated demyelinating disease of central nervous system (DDD CNS) was established on clinical criteria, cerebrospinal fluid (CSF) analyses, electrophysiological and neuro-radiological examinations. The aim of this investigation was to perform an analysis of the state of blood-brain barrier and activity of demyelinating process in the patients, by the comparison of CSF findings and results of magnetic resonance (MR) examinations using paramagnetic contrast. Investigations were performed in 30 patients with DDD CNS in the phase of clinical impairment, without immunosuppressive/immunomodulatory therapy in the last 3 months. The results revealed the absence of correlation between CSF and MR findings, as in connection with the damage of blood-brain barrier, so in relation to immunologic activity of the disease. In the study are discussed the causes of these disparities that are the probable sequela of heterogenicity of physiopathologic events and disease forms inside DDD CNS.

[Gabapentin as adjuvant therapy in the treatment of refractory partial epilepsy]. / Gabapentin kao dodatna terapija u lecenju rezistentne parcijalne epilepcije.

With the aim to evaluate the clinical efficacy and tolerability of gabapentin as an adjuvant therapy in patients with refractory partial epilepsy we conducted an open-randomized study, with 12-weeks follow-up period. The study included 18 epilepsy patients with unsatisfactorily controlled seizures, in spite of the treatment with 1 or 2 first line antiepileptic drug. Gabapentin was administered in a total daily dose between 900-1200 mg. Our results showed seizure frequency reduction by more than 50% in 72.2% patients, while the most frequent adverse effects were vertigo (16.67%) and ataxia (11.11%).

[The electrophysiological diagnosis of carpal tunnel syndrome]. / Elektrofiziologicheskaia diagnostika zapiastnogo tunnel'nogo sindroma.

Electrophysiological investigations were carried out both in patients with carpal tunnel syndrome (CTS) and in healthy individuals. The evoked potentials were examined during stimulation of sensitive branches of n. medianus and of other nerves. The most sensitive and important for diagnosis appeared to be the electrophysiological test of alteration of responsive reaction to the stimulation of the sensitive branch of n. medianus for 4 finger and the considerable difference of evoked reactions on stimulation of skin palm branch and branch of the 1-st finger of n. medianus. The diagnostic importance of these indices corresponds well to anatomical and pathophysiological characteristics of CTS.

[Sensitivity of electrophysiologic tests in the diagnosis of carpal tunnel syndrome]. / Senzitivnost elektrofizioloskih metoda ispitivanja u dijagnostici sindroma karpalnog tunela.

According to anatomic characteristics of median nerve branches and pathophysiological basis of the carpal tunnel syndrome (CTS), significant difference in sensitivity of some electrophysiological parameters in the diagnosis of this syndrome was presumed. The aim of this study was to analyze characteristics of some abnormalities of electrophysiological parameters and to determine their frequency in the carpal tunnel syndrome. Investigation was performed on 34 patients with the carpal tunnel syndrome and 30 neurologically healthy subjects. EMGs of the tenar muscles, terminal latency parameters for the median nerve and sensory conductivity of the median nerve branches including cutaneous palmar branch and ulnar nerve branches of the ring finger were examined and analyzed. Results have shown that abnormalities were most frequently found in sensory conductivity parameters for median nerve branch of the ring finger. Significant difference between sensory conductivity parameters for cutaneous palmar branch and median nerve branch of the thumb was also found. These results were discussed in terms of current knowledge about anatomic characteristics of the hand innervation and pathophysiology of the carpal tunnel syndrome. It was concluded that the most frequent physiological findings could be used as a highly sensitive test for reliable and early diagnosis of CTS.

Cerebral infarction vs. intracranial hemorrhage--validity of clinical diagnosis.

In aim to improve the validity of clinical diagnosis of acute supratentorial ischemic cerebral infarction vs. intracranial hemorrhage, two different scoring systems were analyzed, each separately and combined, on one hundred eighty-eight patients sample. Results suggested higher sensitivity and positive predictive value for Guy's Hospital score, giving it higher importance in detection of hemorrhage, while combined application of both systems, in cases with identical findings, provided sensitivity 0.95 and 0.92 negative predictive value, in certain diagnosis category. A review of complete results disclosed that application of both systems separately didn't provide satisfactory diagnostic gain in differential diagnosis of that syndrome on our sample, while combined application provided high level of accuracy, eliminating simultaneously a significant proportion of patients (43.62%), as a category of uncertain diagnosis.