Prevalence and Treatment Outcomes of Childhood Acute Lymphoblastic Leukemia in Kosovo.

Advances in research, including novel biomarker identification and patient stratification, have significantly improved the therapy for childhood acute lymphoblastic leukemia (ALL), though access to improved healthcare services varies across geographical regions. In an effort to evaluate the advances in therapeutic approaches, we performed a retrospective analysis of childhood ALL in Kosovo. Our retrospective analysis included 225 cases diagnosed between 2008 and 2023, representing 52% of 429 diagnosed childhood cancers. The average annual incidence was 14, with a median age diagnosis of seven years, and a male predominance (59.54%). Patients were categorized into risk groups, with the majority (43%) in the standard-risk category. We identified five different treatment protocols for this study period. Over 61% of patients achieved remission after the first chemotherapy cycle and we observed a 20% mortality rate. Survival analysis showed that 55% and 40% of patients achieved 2-year and 5-year event-free survival (EFS), respectively, with significant differences across risk groups. Treatment advancements significantly correlated with improved survival rates, achieving a 5-year overall survival (OS) of 88% in the currently used standardized AIEOP-BFM-2009 protocol. Our study emphasizes the need for continued research and customized care strategies to enhance clinical outcomes.

Evaluation of parents' attitudes and practices related to antibiotic use for their children in Kosovo: a cross-sectional survey.

BACKGROUND: Self-medication and lack of patient adherence contribute to antibiotic misuse. This article describes parents' attitudes and practices regarding use of antibiotics by their children in Kosovo. METHODS: A cross-sectional survey was conducted during data collection. We surveyed a total of 453 parents of children aged 0-15 years, who had experiences with using antibiotics for their children. Correlation tests and regression analysis were used to explore the relationship between variables. RESULTS: Our findings showed that 42.2% of parents strongly agreed or agreed with the use of antibiotics as a means to cure a cold or flu in their child more quickly. In addition, 29.8% were not aware of antibiotic side effects. Non-compliance with antibiotic treatment was 35.8%, and 28.9% of surveyed parents suggested that they had pressured their pediatricians to prescribe antibiotics for their children. A total of 10.15% of parents had no information on antibiotic resistance, and 34.38% of parents responded that they did not believe that self-medication with antibiotics could lead to resistance. Regression analysis results indicated that gender and age group have a significant influence on the parents' decision that an antibiotic should be used in children with high fever (p < 0.001). CONCLUSIONS: Our findings suggest that antibiotic management by parents in Kosovo is not satisfactory, and more attention should be given to their knowledge of the side effects of antibiotics, bacterial resistance and reduction in the self-medication. Health education, adequate measures and interventions are needed to overcome this situation and ensure rational use of antibiotics in Kosovo.

Craniofacial Pain Management in Severe COVID-19 Patients During the Pandemic Peak in Kosovo: A Comprehensive Approach.

Background This cross-sectional study aims to evaluate pain management's success in limiting admissions and assesses remote care's effectiveness for optimal pain relief. By utilizing data from severe COVID-19 inpatients in Prishtina, Kosovo, this study offers insights into the challenges posed by the pandemic and innovative care approaches aimed at improving patient well-being. Methodology This cross-sectional study includes 55 patients with severe COVID-19 after hospital discharge. All study participants completed the questionnaire in the presence of a clinical pharmacologist. The questionnaire of this study consisted of three parts: sociodemographic data (first part), the Intensity and Characteristics of Toothache (IaCofT) and headache (second part), and pharmacological treatment of headache and dental pain (third part). The questionnaire on IaCofT and headache was created with some modifications of the Modified Dental Pain Screening Questionnaire (M-DePaQ). Descriptive statistics were conducted using Prism version 10.0.1 (Windows and Mac). Results According to the study data, 89.1% (n = 49) of the participants experienced pain during hospitalization with COVID-19, while 72.72% (n = 40) of them experienced pain after hospital discharge. Of the participants, 32.7% (n = 18) experienced dental pain, whereas 60% (n = 33) reported having headaches. Regarding the pain scale, more than two-thirds (n = 40, 72.72%) of the participants had moderate to moderately severe pain, and in 70.9% (n = 39) of the cases, the pain occurred episodically. The absolute majority (n = 53, 96.4%) of study participants reported the use of analgesics for pain management. Paracetamol (n = 46, 83.6%) and ibuprofen (n = 14, 25.5%) were the most commonly used analgesics for pain management. Conclusions This study highlighted the prevalence of headache and acute dental pain in these patients. The majority of the study participants were convinced by the healthcare system and were highly dependent on pharmacological treatment for headaches and acute toothache during the COVID-19 peak. The study results showed that the pain was proven to be successfully treated pharmacologically with analgesics such as paracetamol, ibuprofen, and diclofenac. Telemedicine is expected to become an important healthcare practice in the post-COVID-19 era. Therefore, the introduction of this service could be considered.

Correlation between parents and child's version of the child health survey for asthma questionnaire.

Background: The American Academy of Pediatrics Children's Health Survey for Asthma (CHSA) is a widely used instrument to assess various aspects of health and well-being in relation to asthma. There is a parent and a child version of this questionnaire and little is known about the concordance between these versions. Method: In a cross-sectional study conducted in 13 facilities, hospitals and outpatient clinics covering all areas of Kosovo, children with asthma aged 7-16 years were enrolled. Information about asthma diagnosis was obtained from the treating physician. Children and parents answered the CHSA, parent or child version (CHSA-C) as well as a number of questions about environmental conditions, health insurance and socio-demographic characteristics. Results: The survey included 161 Kosovar children with asthma and their caregivers. Although there were significant differences between parents and child versions regarding physical health, child activity and emotional health, with parents rating physical and emotional health higher and child activity lower, there were significant correlations (R > 0.7) for physical and child activity scales but only a low one (R = 0.25) for emotional health. Inspection of concordance for single items revealed very high correlations (>0.9) for all disease events, but a significant underestimation of the number of wheezing episodes by parents. Good agreement was found for statements about disease severity. Conclusions: The high correlation between information about children's health obtained from parents and children underlines the usefulness of parents as source of information on child's asthma. Impact of the disease on emotional health is, however, underestimated by parents.

Cemented stems in healthy elderly patients result in higher hypoxia despite a paradoxical lower femoral increase of intramedullary pressure.

PURPOSE: Hypoxia is a well-known complication in cemented arthroplasty; however, it is not known whether the level of hypoxia is related to the intramedullary pressure or to the age of the patient; therefore, we studied the intramedullary pressure and level of hypoxia in patients undergoing cemented arthroplasty. METHODS: A prospective study was performed during cemented arthroplasties in 25 patients with an average age of 66.2 ± 12.1 years old. The intramedullary pressure (IMP) was measured by placing a pressure transducer within the bone while simultaneously measuring the pulse oximetry arterial oxygen saturation (SpO2), pulse, and blood pressure. These variables were obtained immediately after spinal anaesthesia, five minutes after cementation, and 15 minutes after prosthesis insertion. RESULTS: One hundred percent of patients had hypoxia at some level, but 83% of elderly patients (older than 66.5 years) had hypoxia (SpO2 <94%) as compared to only 23% of younger patients (p = 0.006). In the group of young patients, IMP was roughly increased 32 times as compared with baseline level, with as consequences a decrease of 4% of SpO2 (from 98.3 to 94.15%); in the elderly group, the IMP was only increased 20 times, but a decrease of 6% of SpO2 (from 97.25 to 91%) was observed. CONCLUSIONS: This series demonstrated higher hypoxia in elderly healthy patients despite a paradoxical lower femoral increase of intramedullary pressure as compared with younger patients. This hypoxia is probably not only related to the cement but also to the patient's age with decline of maximum oxygen uptake capacity and increase bone porosity. CLINICAL TRIALS: ClinicalTrials.gov Identifier: NCT03930537 https://clinicaltrials.gov/ct2/show/NCT03930537.

Rivaroxaban improves vascular response in LPS-induced acute inflammation in experimental models.

Rivaroxaban (RVX) was suggested to possess anti-inflammatory and vascular tone modulatory effects. The goal of this study was to investigate whether RVX impacts lipopolysaccharide (LPS)-induced acute vascular inflammatory response. Male rats were treated with 5 mg/kg RVX (oral gavage) followed by 10 mg/kg LPS i.p injection. Circulating levels of IL-6, MCP-1, VCAM-1, and ICAM-1 were measured in plasma 6 and 24 hours after LPS injection, while isolated aorta was used for gene expression analysis, immunohistochemistry, and vascular tone evaluation. RVX pre-treatment significantly reduced LPS mediated increase after 6h and 24h for IL-6 (4.4±2.2 and 2.8±1.7 fold), MCP-1 (1.4±1.5 and 1.3±1.4 fold) VCAM-1 (1.8±2.0 and 1.7±2.1 fold). A similar trend was observed in the aorta for iNOS (5.5±3.3 and 3.3±1.9 folds reduction, P<0.01 and P<0.001, respectively), VCAM-1 (1.3±1.2 and 1.4±1.3 fold reduction, P<0.05), and MCP-1 (3.9±2.2 and 1.9±1.6 fold reduction, P<0.01). Moreover, RVX pre-treatment, improved LPS-induced PE contractile dysfunction in aortic rings (Control vs LPS, Emax reduction = 35.4 and 31.19%, P<0.001; Control vs LPS+RVX, Emax reduction = 10.83 and 11.48%, P>0.05, respectively), resulting in 24.5% and 19.7% change in maximal constriction in LPS and LPS+RVX respectively. These data indicate that RVX pre-treatment attenuates LPS-induced acute vascular inflammation and contractile dysfunction.

Tuberculosis drug safety and pharmacovigilance in health system of Kosova: A cross-sectional analysis.

BACKGROUND: Tuberculosis (TB) remains a significant worldwide social and life-threatening epidemiological problem. Because this disease requires multiple drug treatment and prolonged therapy for several months, followed by a high probability of adverse effects (AEs), we assessed AE monitoring for anti-TB drugs in the Health Care System of Kosova. METHODS: This survey was a cross-sectional analysis performed at the primary, secondary and tertiary health care levels in Kosova. We included 930 registered tuberculosis patients within three levels of this health system in our study. Furthermore, we interviewed 62 physicians and 71 nurses at TB health facilities. Data were collected from official TB registers and personal contact with patients for 12 months. RESULTS: The representative age group was 19 to 29 years (30.49%), followed by a group of patients aged >60 years (23.23%). Among 930 patients treated with TB drugs, the total incidence of adverse AEs was 29.03%. Female TB patients had a higher rate of AEs than did male patients (33.56% vs 28.84%, respectively). The highest incidence of registered AEs was recorded in the gastrointestinal system (270, 80.83%), followed by the central nervous system (CNS, 7.50%) and was lower in other organ systems. The reporting of anti-TB drug effects by medical staff (TB medical doctor and TB medical nurse) at different levels of TB medical settings occurred among 62.90% of medical doctors and 81.69% of nurses. Only 53.23% of medical doctors and 46.48% of nurses completed pharmacovigilance training. CONCLUSION: The pharmacovigilance approach in Health System of Kosova is not comprehensible and not systematic. The relatively low incidence of AEs among TB patients is due under reporting of these by medical staff. The knowledge, attitudes, and adherence of medical staff reveal low awareness for pharmacovigilance activities, and this concern should be addressed to reinforce this important issue for the safe treatment of TB patients.

Antibiotic utilisation in adult and children patients in Kosovo hospitals.

OBJECTIVES: There are no reliable data on antibiotic use in Kosovo hospitals. The aim of this survey was to monitor volumes and patterns of antibiotic use in hospitalised patients in order to identify targets for quality improvement. METHODS: Data on antimicrobial use were collected from seven hospitals in Kosovo during 2013 using the standardised point prevalence survey (PPS) methodology as developed by the ESAC (European Surveillance of Antimicrobial Consumption) and ARPEC (Antibiotic Resistance and Prescribing in European Children). The survey included all inpatients receiving an antimicrobial agent on the day of the PPS. RESULTS: Overall, 1667 patients were included in the study: adults 1345 (81%) and children 322 (19%). Of the hospital inpatients, 579/1345 (43%) adults and 188/322 (58%) children received at least one antibiotic during a hospital stay. The top three antibacterial subgroups (ATC level 3) were ß-lactam antibiotics, cephalosporins and aminoglycosides. In all hospital centres, the most commonly prescribed antibiotic was ceftriaxone (39% for adult and 36% for children). Antibiotics were administered mainly parenterally in 74% of adults and 94% of children. Empirical prescribing was higher in adults 498/579 (86%) and children 181/188 (96%), compared with targeted treatment based on susceptibility testing-81 (14%) and 8 (4%), respectively. CONCLUSIONS: Antibiotic use in Kosovo's hospitals is very high. Gathered data will be an important tool to identify targets for quality improvement and will support preparation of guidelines and protocols for the prudent use of antibiotics.

Dual Mobility Acetabular Cup Versus Hemiarthroplasty in Treatment of Displaced Femoral Neck Fractures in Elderly Patients: Comparative Study and Results at Minimum 3-Year Follow-up.

BACKGROUND: Hip fractures are serious injuries associated with relatively high mortality rates and disabilities, commonly seen in elderly persons. There is an ongoing debate regarding the advantages of various hip arthroplasty devices. This study aimed to analyze the long-term advantages of 2 different surgical procedures and assess if the dislocation rate, Harris Hip Score (HHS), and functional independence measure (FIM) are more favorable in dual mobility (DM) than those in hemiarthroplasty (HA). HYPOTHESIS: Dual mobility procedures provide better postoperative outcomes than HA in terms of HHS, FIM, and dislocation rate. MATERIALS AND METHODS: The survey was a prospective, comparative interventional single-blinded study performed at the University Clinical Center of Kosovo, a tertiary health-care institution. A total of 94 patients underwent DM or conventional bipolar HA for repair of displaced femoral neck fractures within 2 weeks of injury. Primary outcomes were postoperative dislocation rate, FIM, and HHS. Secondary outcomes included duration of surgery, estimated intraoperative blood loss, time to first postoperative full weight-bearing, time to walking ability with and without crutches, mortality rate, and postoperative infection rate. RESULTS: There were no significant differences for most parameters between the groups. We found a significant difference in the dislocation rate between the 2 groups, wherein there were no dislocations in the DM group and 3 dislocations in the HHS group (0% vs 6.4%). In terms of postoperative HHS at 12 months and 3 years, DM provided better outcomes (<0.034 and <0.014, respectively). DISCUSSION: Dual mobility compares favorably to HA in terms of dislocation rate and HHS, while no difference was found for FIM. In order to have a more complete overview, we recommend more intense long-term studies including several heterogeneous parameters to compare the clinical outcomes between DM and HA. LEVEL OF EVIDENCE WITH STUDY DESIGN: Level II.

Role of the Angiotensin Pathway and its Target Therapy in Epilepsy Management.

Despite extensive research on epileptogenesis, there is still a need to investigate new pathways and targeted therapeutic approaches in this complex process. Inflammation, oxidative stress, neurotoxicity, neural cell death, gliosis, and blood⁻brain barrier (BBB) dysfunction are the most common causes of epileptogenesis. Moreover, the renin⁻angiotensin system (RAS) affects the brain's physiological and pathological conditions, including epilepsy and its consequences. While there are a variety of available pharmacotherapeutic approaches, information on new pathways is in high demand and the achievement of treatment goals is greatly desired. Therefore, targeting the RAS presents an interesting opportunity to better understand this process. This has been supported by preclinical studies, primarily based on RAS enzyme, receptor-inhibition, and selective agonists, which are characterized by pleiotropic properties. Although there are some antiepileptic drugs (AEDs) that interfere with RAS, the main targeted therapy of this pathway contributes in synergy with AEDs. However, the RAS-targeted treatment alone, or in combination with AEDs, requires clinical studies to contribute to, and clarify, the evidence on epilepsy management. There is also a genetic association between RAS and epilepsy, and an involvement of pharmacogenetics in RAS, so there are possibilities for the development of new diagnostic and personalized treatments for epilepsy.

Correlation of Procalcitonin and C-Reactive Protein with Intra-Abdominal Hypertension in Intra-Abdominal Infections: Their Predictive Role in the Progress of the Disease.

AIM: To analyse the correlation of procalcitonin (PCT) and C-reactive protein (CRP) values with increased intra-abdominal pressure and to evaluate their predictive role in the progression of Intra-abdominal infections. MATERIALS AND METHODS: A non-randomized prospective study conducted in the group of 80 patients. We have measured the PCT, CRP and intra-abdominal pressure (IAP). RESULTS: According to IAH grades (G), there was a significant difference of PCT values: G I 3.6 ± 5.1 ng/ml, G II 10.9 ± 22.6 ng/ml, G III 15.2 ± 30.2 ng/ml (p = 0.045) until: CRP values were increased in all IAH groups but without distinction between the groups: GI 183 ± 64.5, GII 196 ± 90.2, GIII 224 ± 96.3 (p = 0.17). According to the severity of the infection, we yielded increased values of PCT, IAP and CRP in septic shock, severe sepsis and SIRS/sepsis resulting in significant differences of PCT and IAP. CONCLUSION: Based on the results of our research, we conclude that the correlation of PCT values with IAH grades is quite significant while the CRP results remain high in IAH but without significant difference between the different grades of IAH.

Pharmacotherapy Evaluation and Utilization in Coronary Artery Bypass Grafting Patients in Kosovo during the Period 2016-2017.

BACKGROUND: Coronary Artery Bypass Grafting (CABG) is realised in patients with critical or advanced disease of coronary arteries. There are different pharmacotherapeutic approaches which are used as management, treatment and preventive therapy in cardiovascular disease or related comorbidities. Performing a successful surgery, pharmacotherapy, and increase of bypass patency rate remains a serious challenge. AIM: This study aims to analyse the patient characteristics undergoing CABG and evaluation of their drug utilisation rate and daily dosages in the perioperative period. MATERIAL AND METHODS: Data were collected from 102 patients in the period 2016-2017 and detailed therapeutic prescription and dosages, patient characteristics were analysed before the operation, after the operation and visit after operation in the Clinic of Cardiac surgery-University Clinical Center of Kosovo. RESULTS: Our findings had shown that patients provided to have normal biochemical parameters in the clinic before the operation, and were related to cardiovascular diseases and comorbidities and risk factors with mainly elective intervention. The, however, higher utilisation of cardiovascular drugs such as beta blockers, diuretics, anticoagulants, statins and lower calcium blockers, ACEi, ARBs, hydrochlorothiazide, amiodarone were founded. ARBs, beta blockers, statins, nitrates and nadroparin utilisation decreased after operation and visit after the operation, whereas amiodarone only in the visit after the operation. Diuretics are increased after the operation which decreases in the visit after the operation. Regarding the daily dosage, only metoprolol was increased in the visit after operation (P < 0.001) and visit after operation (P < 0.05) whereas losartan and furosemide were increased (P < 0.01) and (P < 0.05) respectively. CONCLUSION: The study showed that beta blockers, statins, aspirin, nitrates (before the operation), furosemide and spironolactone are the most utilised drugs. However, we found low utilisation rate for ACEi, ARBs, clopidogrel, nadroparin, warfarin, xanthines, amiodarone, calcium blockers. Daily dosages were different compared to before CABG only in metoprolol, losartan, and furosemide.

Individualizing Treatment Approaches for Epileptic Patients with Glucose Transporter Type1 (GLUT-1) Deficiency.

Monogenic and polygenic mutations are important contributors in patients suffering from epilepsy, including metabolic epilepsies which are inborn errors of metabolism with a good respond to specific dietetic treatments. Heterozygous variation in solute carrier family 2, facilitated glucose transporter member 1 (SLC2A1) and mutations of the GLUT1/SLC2A2 gene results in the failure of glucose transport, which is related with a glucose type-1 transporter (GLUT1) deficiency syndrome (GLUT1DS). GLUT1 deficiency syndrome is a treatable disorder of glucose transport into the brain caused by a variety of mutations in the SLC2A1 gene which are the cause of different neurological disorders also with different types of epilepsy and related clinical phenotypes. Since patients continue to experience seizures due to a pharmacoresistance, an early clinical diagnosis associated with specific genetic testing in SLC2A1 pathogenic variants in clinical phenotypes could predict pure drug response and might improve safety and efficacy of treatment with the initiation of an alternative energy source including ketogenic or analog diets in such patients providing individualized strategy approaches.

Tuberculosis Treatment Adherence of Patients in Kosovo.

SETTING: The poor patient adherence in tuberculosis (TB) treatment is considered to be one of the most serious challenges which reflect the decrease of treatment success and emerging of the Multidrug Resistance-TB (MDR-TB). To our knowledge, the data about patients' adherence to anti-TB treatment in our country are missing. OBJECTIVE: This study was aimed to investigate the anti-TB treatment adherence rate and to identify factors related to eventual nonadherence among Kosovo TB patients. DESIGN: This study was conducted during 12 months, and the survey was a descriptive study using the standardized questionnaires with total 324 patients. RESULTS: The overall nonadherence for TB patient cohort was 14.5%, 95% CI (0.109-0.188). Age and place of residence are shown to have an effect on treatment adherence. Moreover, the knowledge of the treatment prognosis, daily dosage, side effects, and length of treatment also play a role. This was also reflected in knowledge regarding compliance with regular administration of TB drugs, satisfaction with the treatment, interruption of TB therapy, and the professional monitoring in the administration of TB drugs. CONCLUSION: The level of nonadherence TB treatment in Kosovar patients is not satisfying, and more health care worker's commitments need to be addressed for improvement.

Influence of Gender and Age on Average Dimensions of Arteries Forming the Circle of Willis Study by Magnetic Resonance Angiography on Kosovo's Population.

BACKGROUND: Circulus arteriosus cerebri is the main source of blood supply to the brain; it connects the left and right hemispheres with anterior and posterior parts. Located at the interpenducular fossa at the base of the brain the circle of Willis is the most important source of collateral circulation in the presence of the disease in the carotid or vertebral artery. AIM: The purpose of the research is to study the diameter and length of arteries and provide an important source of reference on Kosovo's population. METHODS: This is an observative descriptive study performed at the University Clinical Center of Kosovo. A randomised sample of 133 angiographic examinations in adult patients of both sexes who were instructed to exploration is included. RESULTS: The diameters and lengths measured in our study were comparable with other brain-cadaver studies especially those performed by MRA. All dimensions of the arteries are larger in male than female, except the diameter of PCoA that is larger in female (p < 0.05) and length of the ACoA (p < 0.05). Significant differences were found in diameters of arteries between the younger and the older age groups. CONCLUSION: Knowing the dimensions of the arteries of the circle of Willis has a great importance in interventional radiology as well as during anatomy lessons.

Arctigenin improves vascular tone and decreases inflammation in human saphenous vein.

The goal of this study was to test the effects of bioactive phenylpropanoid dibenzylbutyrolactone lignan arctigenin (ATG) in vascular tone. Human bypass graft vessel, from a saphenous vein (SV), were set up in organ bath system and contracted with potassium chloride (KCl, 40mM). Two concentration-response curves of noradrenaline (NE) (10nM-100µM) separated with an incubation period of 30min without (Control) or with ATG (3-100µM) were established. Inhibitors of nitric oxide, prostaglandins, K+ related channels or calcium influx were used to delineate the molecular mechanisms beyond ATG effects. To investigate anti-inflammatory actions, SV were treated with 10µM or 100µM ATG and incubated for 18h in the absence or presence of both interleukin-1beta (IL-1ß) and lipopolysaccharide (LPS) to mimic the physiological or inflamed tissue conditions. Proatherogenic and inflammatory mediators Interleukine-1 beta (IL-1ß), Monocyte Chemoattractant Proteine-1 (MCP-1), Tumor Necrosis Factor- α (TNF-α), Interleukine-6 (IL-6), Prostaglandin E2 (PGE2) and Interleukine-8 (IL-8) in the supernatant were measured. ATG significantly decreased vascular contractile response to NE. Moreover, it reduced contractions induced by KCl and cumulative addition of CaCl2. The mediators were significantly increased in inflammatory conditions compared to normal conditions, an effect which was inhibited by ATG (10 and 100µM). ATG reduces contractions in SV and decreases the production of proinflammatory-proatherogenic mediators, setting the stage for further evaluating the effect of ATG in cardiovascular diseases.

Antibiotic Utilization in Pediatric Hospitalized Patients - A Single Center Study.

BACKGROUND: Antibiotics are among the most commonly prescribed drugs in paediatrics. In most cases, antibiotics are started on an empirical basis, without proof of a bacterial infection, either before the start of therapy or afterwards. AIM: The main objective of this study was to analyse the consumption of antibiotics in hospitalised paediatric patients. MATERIAL AND METHODS: This retrospective study investigated the consumption of antimicrobials in defined daily doses (DDDs according to the Anatomical Therapeutical Chemical/DDD index) in Pulmonology, Gastroenterology and Nephrology Departments at Pediatric Clinic of the tertiary hospital. The data on the consumption of antimicrobials were collected for five years by using properly designed form. The consumption was related to days of hospital care. RESULTS: The most utilised antibiotics group in all three departments Pulmonology, Gastroenterology and Nephrology Departments were penicillins. Cephalosporins were mostly used in Pulmonology department. Metronidazole and Chloramphenicol were used in minimal quantities in all three departments. CONCLUSION: This study demonstrates that surveillance programs on antibiotic resistance should be established and accompanied by analyses of drug utilisation data which can aid in the creation of valid cross-national studies on antibiotic usage and resistance, to motivate improvements in prescribing and guideline-directed antibiotic prescribing.

The impact of bilateral vagotomy on the physostigmine-induced airway constriction in ferrets.

Vagal innervations have a great role in the respiratory function and are the main route of signal transmission from respiratory neural centers into the trachea and others conducting airways. We have investigated the role of central mechanisms related to vagal neural pathways and the cholinergic outflow in tracheobronchial smooth muscle tone and lung mechanics parameters. Parameters of lung mechanics such as lung resistance (RL), dynamic compliance (Cdyn) and pressure in bypassed tracheal segment (Ptseg) were measured before and after vagotomy and asphyxia test. Before vagotomy (BV), the control measurements were obtained and physostigmine was administered systemically, in increasing dose 10, 40 and 100µg/kg body weight (bw) with 15min interval between doses. After vagotomy (AV), administration of physostigmine with the same doses as BV has been done and the asphyxia challenge was conducted as per study protocol. The values of Ptseg and RL after physostigmine administration, BV vs. AV, respectively, at maximal dose of 100µg/kg bw were 32.5±3.3cm H2O, and 10.6±1.5cm H2O (p<0.0001); 0.16±0.04cm H2O/mL/s, and 0.067±0.006cm H2O/mL/s AV (P<0.05). The Cydn values were affected after physostigmine administration only at the lowest dose of 10µg/kg bw, and BV was 0.75±0.05mL/cm H2O vs. 0.53±0.04mL/cm H2O AV (P<0.004). Cholinergic outflow produced increases in tracheal tone, lung resistance and a decrease in dynamic compliance before, but not after vagotomy. Our results show the high impact of central neuronal mechanism in parameters of lung mechanics and respiration. This study indicates that vagal nerves have a crucial role, in the transmission of impulses initiated from central nervous system, in regulating the respiration by contraction or relaxation of airway smooth muscle tone.

The Predictive Role of Procalcitonin On the Treatment of Intra-Abdominal Infections.

AIM: This study aims to evaluate the algorithm of procalcitonin (PCT) and its role on the duration of antibiotics prescription for intra-abdominal infections. MATERIALS AND METHODS: This study is a prospective controlled study that is conducted in groups of 50 hospitalised patients and 50 controlled group patients. RESULTS: The results indicated that the average duration of antibiotic delivery to the PCT group was -10.6 days (SD ± 6.6 days), while in the control group -13.2 days (SD ± 4.2 days). These data showed a significant difference in the duration of antibiotic therapy and the monitoring role of PCTs in the prediction success of antibiotic treatment. The antibiotic delivery was longer in the septic shock 17 (SD ± 11.7) that corresponds to high PCT values of 67.8 (SD ± 50.9). Recurrence of the infection after the cessation of antibiotics occurred in 2 cases (4%) in the standard group, while it occurred in 3 cases (6%) in the control group. CONCLUSION: The treatment of the intra-abdominal infections based on the PCT algorithm shortens the duration of antibiotic treatment and does not pose a risk for the recurrence of the infection.