Economic burden of breast cancer in northern Serbia.

Introduction: Breast cancer is the most common cancer in terms of incidence and mortality among all cancers in women in Vojvodina, the northern region of Serbia. In addition to the effectiveness and safety of therapy, it is important to put emphasis on the cost of treatment, as well as on the optimal allocation of limited resources. Objectives: This study aimed to assess the overall economic burden of breast cancer in Vojvodina, as well as the ratio of direct and indirect costs in 2019. Materials and methods: Costs were estimated using Cost of Illness (COI) evaluation, from a social perspective, based on the prevalence of the disease. The total costs included both direct and indirect expenditures. Direct costs associated with breast cancer comprised expenses linked to screening, hospital treatment, outpatient care, and prescribed medications. Indirect costs were estimated using a human capital approach, encompassing expenditures tied to lost productivity arising from sick leave, early retirement, and premature death. Results: The total cost of breast cancer in Vojvodina during 2019 was estimated to be 15 million euros. Among the total cost, direct costs accounted for 5 million euros, representing 34% of the overall expenses. Hospital treatment costs accounted for 76% of the direct costs, while screening costs represented 1%. Indirect costs amounted to 10 million euros, constituting 66% of the total cost. The primary driver was attributed to production losses caused by premature retirement, which accounted for 50% of the indirect costs. Conclusion: Breast cancer is a huge financial burden on both the health system and society in Vojvodina, accounting for 0.12% GDP. The dominance of indirect costs in total costs, can provide significant guidance to decision-makers in the healthcare system in terms of better allocation of limited resources to breast cancer prevention and early detection strategies.

Community pharmacists' challenges regarding adverse drug reaction reporting: a cross-sectional study.

OBJECTIVE: The effectiveness of the national drug safety monitoring program directly depends on the active participation of healthcare professionals in reporting suspected adverse drug reactions (ADRs). The aim of the study was to explore community pharmacists' comprehension of pharmacovigilance, their perspectives toward reporting ADRs and investigate the current practice of ADR reporting among pharmacists in Serbia. METHODS: This descriptive cross-sectional study was performed on a sample of pharmacists in Serbia between November 2019 and March 2020 using a pre-tested questionnaire distributed online. Eligible participants were community pharmacists in Serbia who were willing to participate in the study during the data collection period. Non-parametric statistical tests were performed in the analysis of knowledge, perspectives and ADR reporting. The validity and reliability of the survey were measured by exploratory factor analysis. RESULTS: The median knowledge score was 6 out of 10 (interquartile range 5-7, range 2-10). No significant differences in the knowledge scores of pharmacists were found based on weekly working hours (U = 24,805, p = .374), working experience (χ2 = 4.011, DF = 2, p = .135), being a member of a professional organization (U = 24,312, p = .209), or highest level of pharmacy qualification obtained (χ2 = 3.233, DF = 3, p = .506). Only 28.8% of pharmacists reported ADR at least once a year, while the majority of them have never reported any ADRs. CONCLUSIONS: Despite the community pharmacists' positive attitude toward adverse drug reporting and their role in the process, they show limited knowledge regarding the issue and highly prevalent under-reporting of ADRs. Educational programs are necessary to increase ADRs reporting.

PLASMA ENDOTHELIN-1 LEVELS AND ALBUMINURIA IN PATIENTS WITH TYPE 2 DIABETES MELLITUS.

INTRODUCTION: Microalbuminuria is a very important independent risk factor for the progression of renal diseases as well as diseases of the cardiovascular system. Pathophysiological mechanisms that lead to the development ofmicroalbuminuria in patients with diabetes are complex and they are a result of numerous factors. In the past decade, endothelin-1, the most potent vasoconstrictor peptide, was identified as animportant factor that significantly contributes to the functional and structural renal changes. The objective of this study was to investigate the relationship between plasma concentration of endothelin-1 and urinary albumin excretion in patients with type 2 diabetes mnellitus. MATERIAL AND METHODS: There were 76 patients with type 2 diabetes who were divided into those having normoalbuminuria (n-33), microalbuminuria (n=29) and macroalbuinuria (n=14), and 30 healthy controls. Plasma levels of endothelin-1 were measured by enzyme-linked immunosorbent assay. RESULTS: There were significant differences in plasma concentration of endothelin-1 among groups (P<0.01). The correlation between endothelin-1. albuminuria. proteinuria and glomercular filtration rate was significant. In multiple regression analyses the plasma concentration of endothelin-l was independently and significantly associated with albuminuria (ß=0.01, p=0.009), proteinuria =.02, p<0.001) and glon.erular filtration rate (P3=0ßl. pO-.P=)6).0Conclu- sion. Higher plasma concentrations of endothelin-1 are independently associated with the levels of urinary, excretion of albumin Whicw May morroborate tlse hpothesis of apotenstial role of this peptide inl th de- vepment of microalbUminuriauin diabetic necphrpathy.

The effect of angiotensin converting enzyme inhibition on effective renal plasma flow in patients with diffuse renal parenchymal diseases and hypertension.

INTRODUCTION: Angiotensin converting enzyme inhibitors are commonly used to treat various hypertensive conditions and in addition to lowering blood pressure these drugs affect the local renal hemodynamic status, thereby influencing the glomerular filtration rate and effective renal plasma flow. The study was aimed at determining whether angiotensin converting enzyme inhibitors can produce significant changes in effective renal plasma flow in patients with parenchymal renal disease and to assess whether the changes depend on the pre-existing functional status of the kidney. MATERIAL AND METHODS: The study included 80 subjects, 40 subjects with hypertension associated with diffuse renal parenchymal disease and 40 subjects with essential hypertension. All study subjects underwent the baseline effective renal plasma flow measurement and the repeated effective renal plasma flow measurement after administration of captopril. Effective renal plasma flow was determined by 131 I-hippuran clearance in blood samples taken at 20 and 30 minutes. RESULTS: Angiotensin converting enzyme inhibitors caused significant effective renal plasma flow changes in 55% of subjects with diffuse renal parenchymal disease and in 75% of subjects with essential hypertension. The effective renal plasma flow changes were more significant in subjects with preserved renal function (normal baseline effective renal plasma flow) compared to subjects with reduced baseline effective renal plasma flow. CONCLUSION: The application of angiotensin converting enzyme inhibitors in patients with diffuse renal parenchymal disease and in individuals with essential hypertension may result in significant hemodynamic changes in the kidney, accompanied by changes in effective renal plasma flow. The extent of the changes caused by angiotensin converting enzyme inhibitors depends on the preexisting functional status of the kidney.

Dysfunctional ectopic thyroid gland: a case report.

INTRODUCTION: Lingual thyroid gland is a rare anomaly of thyroid gland development, occurring more frequently in females. If it causes local symptomatology such as dysphagia, dysphonia or dyspnea it is diagnosed in childhood, however, if it is asymptomatic it is usually diagnosed in adulthood. CASE OUTLINE: We present a 23-year-old female patient in whom we diagnosed lingual thyroid gland coincidentally during diagnostic procedures of a concomitant disease. The application of 131I scintigraphy showed an oval field of intensive accumulation of radio markers in the zone of medial face line, around tongue base, with the absence of thyroid gland in its physiological position. Functional testing proved primary hypothyroidism and we started the application of substitution therapy. The application of levothyroxine resulted in reaching euthyroid state and the reduction of thyroid gland size. CONCLUSION: We present a very rare anomaly of the thyroid gland, and so far there have been no clear attitudes about further treatment. The general condition of the patient, age, the size of ectopic thyroid gland and the existence of local symptomatology or complications represent the factors that have influence on the choice of treatment method.

[Polyostotic Paget's disease of bone: diagnostic dilemma in detection of bone metastases from prostate cancer].

INTRODUCTION: Paget's disease of bone (osteitis deformans) is a rare metabolic disorder of bone remodeling with complex etiology. In the most cases, it is detected by coincidence, during nuclear medicine and radiological diagnostic procedures. Herein we report a case of advanced prostate cancer coexisting with asymptomatic Paget's disease. CASE REPORT: We present a 69-year-old patient, with biochemical recurrence two years after radical prostatectomy for localized prostate cancer and period of stable remission. During the evaluation of metastatic spread of prostate cancer, the bone scintigraphy with technetium diphosphonate showed diffuse areas of increased radiotracer uptake in the left leg long bones and focal changes in the axial part of the skeleton. Scintigraphic findings led to a differential diagnostic dilemma regarding etiology of bone changes, so it was supplemented by standard radiologic methods and laboratory evaluation of bone metabolism parameters. The existence of asymptomatic polyostotic Paget's disease and metastatic bone changes was found at the same time. CONCLUSION: Metastatic bone lesions, in this case from prostate cancer, and asymptomatic Paget's disease may closely resemble each other. They both need careful evaluation in order to determine the proper stages of malignant disease and selection of appropriate therapies for patients.

[Analysis of obesity prevalence in students from Novi Sad].

INTRODUCTION: Apart from assessing the nutrition status, the diagnosis of obesity also includes the assessment of mass and distribution of adipose tissue which provides revealing of latent types of obesity that hold higher health risks. The aim of our study was to assess the nutritional status and to analyze the prevalence of normal weight obesity and abdominal obesity in students from the University of Novi Sad. MATERIAL AND METHODS: The body mass index, waist circumference and body fat mass were assessed in the group of 371 students from the University of Novi Sad (their average age being 22.9 +/- 2.5 y). RESULTS: One-fifth of the study sample students were found to be overweight and obese, i.e. 21% and 1.1%, respectively. The frequency of overweight and obesity was higher in male respondents (overweight: 41.67% vs. 6.05%; obesity: 1.92% vs. 0.46%). Among the survey respondents, there were 4.6% of underweight students, all of whom were female students. Body fat was found to be increased in 11% of the students, the frequency being higher in the males. The phenomenon of obesity in normal body mass was recorded in 7% of the respondents, being more frequent in female students. The total of 5.6% of female students and 5.8% of male students had abdominal obesity. CONCLUSION: The survey results indicate the necessity and obligation to direct attention to regular and complete diagnostics of obesity in order to determine the size of fat body mass and its distribution. The presence of obesity in normal body mass among young, student population requires the comprehensive, detailed and timely diagnosis and treatment of this disease.