Correlation between antimicrobial consumption and antimicrobial resistance of Pseudomonas aeruginosa in a hospital setting: a 10-year study.

WHAT IS KNOWN AND OBJECTIVE: Antimicrobial resistance is one of the greatest threats to human health. One of the most important factors leading to the emergence of resistant bacteria is overuse of antibiotics. The purpose of this study was to investigate the correlation between antimicrobial usage and bacterial resistance of Pseudomonas aeruginosa (P. aeruginosa) over a 10-year period in the Clinical Center Nis, one of the biggest tertiary care hospitals in Serbia. We focused on possible relationships between the consumption of carbapenems and beta-lactam antibiotics and the rates of resistance of P. aeruginosa to carbapenems. METHODS: We recorded utilization of antibiotics expressed as defined daily doses per 100 bed days (DBD). Bacterial resistance was reported as the percentage of resistant isolates (percentage of all resistant and intermediate resistant strains) among all tested isolates. RESULTS AND DISCUSSION: A significant increasing trend in resistance was seen in imipenem (P < 0·05, Spearman ρ = 0·758) and meropenem (P < 0·05, ρ = 0·745). We found a significant correlation between aminoglycoside consumption and resistance to amikacin (P < 0·01, Pearson r = 0·837) and gentamicin (P < 0·01, Pearson r = 0·827). The correlation between the consumption of carbapenems and resistance to imipenem in P. aeruginosa shows significance (P < 0·01, Pearson r = 0·795), whereas resistance to meropenem showed a trend towards significance (P > 0·05, Pearson r = 0·607). We found a very good correlation between the use of all beta-lactam and P. aeruginosa resistance to carbapenems (P < 0·01, Pearson r = 0·847 for imipenem and P < 0·05, Pearson r = 0·668 for meropenem). WHAT IS NEW AND CONCLUSION: Our data demonstrated a significant increase in antimicrobial resistance to carbapenems, significant correlations between the consumption of antibiotics, especially carbapenems and beta-lactams, and rates of antimicrobial resistance of P. aeruginosa to imipenem and meropenem.

Monitoring of antibiotic consumption and development of resistance by enterobacteria in a tertiary care hospital.

WHAT IS KNOWN AND OBJECTIVE: Antibiotics are the most frequently used drugs in hospitalized patients, but studies have shown that the prescribed antibiotics may be inappropriate and may contribute to antibiotic resistance. We carried out a survey of antibiotic consumption and antibiotic resistance in our tertiary care university hospital, from 2005 to 2013. We focus on cephalosporins, one of the most prescribed groups of antibiotics in the tertiary health care. The objective was to identify any relationship between ceftriaxone consumption and resistance by enterobacteria. METHODS: Antibiotics consumption and antimicrobial resistance were monitored in the tertiary care university hospital from 2005 to 2013. Data on the use of antibiotics in surgical inpatients were obtained and expressed as defined daily doses per 100 bed days. Bacterial resistances were given as percentages of resistant isolates. RESULTS AND DISCUSSION: There was an increasing trend in cephalosporins consumption from 9·56 DBD (2005) to 23·32 DBD (2013), with ceftriaxone as the most frequently used cephalosporin, 3·6 DBD (2005) to 10·78 DBD (2013). E. coli and P. mirabilis resistance to ceftriaxone increased significantly from 22% in 2005 to 47% in 2013 and from 31% in 2005 to 60% in 2013, respectively. We found a significant correlation between ceftriaxone consumption and E. coli resistance (r = 0·895, P < 0·05). WHAT IS NEW AND CONCLUSION: Our study shows that cephalosporin consumption increased from 2005 to 2013, with ceftriaxone as the most prescribed antibiotic. E. coli and P. mirabilis resistance to ceftriaxone increased significantly over the study period. E. coli resistance increased with ceftriaxone consumption.

Dietary flavonoid intake and colorectal cancer risk: evidence from human population studies.

Flavonoids are biologically active polyphenolic compounds widely distributed in plants. More than 5000 individual flavonoids have been identified, which are classified into at least 10 subgroups according to their chemical structure. Flavonoids of 6 principal subgroups- flavonols, flavones, anthocyanidins, catechins, flavanones, and isoflavones- are relatively common in human diets. Flavonoids are a large and diverse group of phytochemicals and research into their anti-carcinogenic potential with animal and cellular model systems supports a protective role. Whether dietary intake of flavonoids is protective against colorectal cancer in humans cannot be easily extrapolated from cell line and animal findings. Epidemiological assessment of the relationship between dietary flavonoid intake and colorectal cancer is limited, with different case-control and cohort study design investigating different combinations of flavonoids. Epidemiologic studies on flavonoid intake and colorectal cancer risk that were conducted yielded inconsistent results, with positive, inverse, and null associations. Because only a very limited number of epidemiological studies have been conducted to examine the associations of dietary intake of flavonoids with colorectal cancer risk, it is premature to make public health recommendations at this time. However, the data to date are promising and emphasize the need for further investigation of these important bioactive plant compounds. This review summarises the epidemiological evidence from case-control and cohort studies on the associations of dietary flavonoid intake with the risk for colorectal cancer. The difficulties in investigating this topic and possibilities for further research are then discussed.

Current and future anti-HER2 therapy in breast cancer.

The therapeutic strategy for breast cancer with the use of targeted drugs is, at present, mainly focused on coping with HER2. Currently, lapatinib and trastuzumab are in widespread use. Virtually all completed and in progress clinical trials have demonstrated a significant enhancement in the rate of pathologic complete response (pCR), the primary endpoint in these studies, in cases of patients with HER2-positive breast cancer that received trastuzumab in the neoadjuvant setting. Use of lapatinib in the neoadjuvant setting should be considered experimental. When a 12-month course of trastuzumab was added to adjuvant chemotherapy, the disease-free survival (DFS) was greater and the overall survival (OS) was also greater. Although trastuzumab is approved as single-agent therapy, most patients are treated with trastuzumab plus cytotoxic agents. Trastuzumab, administered as single agent, produces durable objective responses and is well tolerated by women with HER2-overexpressing metastatic breast cancer that has progressed after chemotherapy for metastatic disease. Dual targeting approach with a combination of trastuzumab and lapatinib improved progression-free survival (PFS) as compared with lapatinib alone in patients with metastatic breast cancer who have not had a response to trastuzumab. The combination of pertuzumab plus trastuzumab plus docetaxel, as compared with placebo plus trastuzumab plus docetaxel, when used as first-line treatment for HER2-positive metastatic breast cancer, significantly prolonged PFS. Novel anti-HER2 targeted therapies are needed to utilise novel approaches to combat trastuzumab resistance.

Hypotensive, vasorelaxant and cardiodepressant activities of the ethanol extract of Sideritis raeseri spp. raeseri Boiss & Heldr.

Sideritis raeseri spp. raeseri Boiss & Heldr is a native plant from the Mediterranean region that is used due to its medicinal and culinary properties. The aim of this study was to evaluate the effects of ethanol extract of S. raeseri on the blood pressure, vascular and cardiac contractions. Arterial blood pressure was registered directly from the carotid artery in the anaesthetized rabbits. Aortic rings and the spontaneously beating atria were mounted in tissue bath. An intravenous injection of extract of S. raeseri (0.025-7.5 mg/kg) caused a dose dependent decrease of the arterial pressure and heart rate, with EC(50) value of 24.31±3.87 mg/kg and 88.14±7.51 mg/kg, respectively. In aortic preparations precontracted with KCl (80 mM), the extract of S. raeseri (0.005-1.5 mg/ml) elicited a vasodilatator action (EC(50) 0.11±0.008 mg/ml). In spontaneously beating rat atria, the extract of S. raeseri (0.005-1.5 mg/ml) produced decrease of chronotropic and inotropic activity (with EC(50) value of 0.63±0.03 mg/ml and 0.40±0.08 mg/ml). Administration of verapamil induced inhibition of force and rate of the atrial contraction. These results demonstrate that the ethanol extract of Sideritis raeseri spp. raeseri Boiss & Heldr can produce hypotension, vasodilatation, negative chronotropic and inotropic effects.

Case-control design as investigative approach to assessing cancer etiology: development and future perspectives.

The case-control method evolved out of analyses of series of cases. The analytic form of the case-control study can be found in the 19th century medical literature, but did not appear to be viewed as a special or distinct methodology. The first modern case-control study was the Janet Lane-Claypon's study of breast cancer in 1926, but the design was used only sporadically in medicine until 1950, when 4 published casecontrol studies linked smoking and lung cancer. These 1950s studies synthesized the essential elements of the case-control comparison, produced a conceptual shift within epidemiology, and laid the foundation for the rapid development of the case-control design in the subsequent half century. The powerful consistency of these case-control studies, and the replication of their findings in later prospective studies, promoted the general acceptance of the case-control study as a scientific tool in clinical research. Newer case-control studies have benefited from the advances in design, execution and analysis since 1950s. These advances include more rigorous selection and matching of case and control population, improved interviewing techniques, location of the design within a general framework of epidemiologic strategies for relating exposure to disease, understanding of the measures of effect, and application of increasingly sophisticated statistical procedures to findings. This review traces the development and future perspectives of the case-control design to assessing cancer etiology. With illustrations drawn primarily from the literature on its use and the value of its results to unravelling the etiology of malignant diseases, we tried to explore if the case-control approach firmly ensconced in epidemiology as investigational tool and rivals in importance the more straightforward cohort approach.

Survival of Campylobacter jejuni in chicken meat, chicken skin and chicken liver at low temperatures.

The aim of this study was to determine survival of Campylobacter jejuni (C. jejuni) in chicken meat, chicken skin medallions and chicken liver contaminated with this bacterium at +4 °C and -20 °C, after 24 hours of incubation. The survival of C. jejuni at +4 °C, -20 °C in chicken meat, chicken skin medallions and chicken liver were examined after 24 hours of incubation with C. jejuni. All samples were previously tested for the presence of Campylobacter species according to ISO 10272-1:2006. After 24 hours of incubation at +4 ° C, the number of survived C. jejuni in chicken meat slightly decreased on both non-selective and selective plates, but still in range of 10. After 24 hours of incubation at -20 ° C, the number of survived C. jejuni in chicken meat was in range of 10 cfu/ml on non-selective plate, with complete absence of growth on selective plate. After 24 hours of incubation, the number of survived C. jejuni in chicken liver increased on selective and non-selective plates (>10) at +4 ° C, while at -20 ° C there were no C. jejuni survived on both plates. 24 hours of incubation at both temperatures did not much influence the number of C. jejuni in chicken meet, while chicken skin medaillons allowed increase of the number of bacteria. Incubation of chicken liver at + 4° C allowed bacterial multiplication, while incubation at -20 ° C caused absence of survival (Tab. 1, Ref. 12).

Analysis of antibiotic utilization and bacterial resistance changes in a surgical clinic of Clinical Centre, Nis.

WHAT IS KNOWN AND OBJECTIVE: There is little published information about antibiotic utilization and resistance amongst hospital inpatients in Serbia. The purpose of this study was to analyse the variation of antibiotic utilization and the relation between antibiotic utilization and bacterial resistance. METHODS: This analysis was performed in the surgical clinic of one of the biggest Serbian tertiary hospitals, during 2005-2008. Data on the use of antibiotics in surgical inpatients were obtained and expressed as defined daily doses per 100 bed-days. Bacterial resistances were given as percentages of resistant isolates. Following the implementation of a restriction policy in 2005, the prescription of reserve antibiotics was placed under control. RESULTS AND DISCUSSION: During the investigation period the total consumption of antibiotics decreased significantly by 37·8%. Hospital aminoglycoside consumption continued to decrease from 25·1% of the total consumption in 2005 to 5·1% in 2008. During the same period there was a substantial decrease in the use of ceftriaxone (47·8%), ciprofloxacin and metronidazole. Reduction in Escherichia coli resistance to gentamicin correlated significantly with its utilization, while the resistance for all isolates decreased from 58·5% to 44·8%. WHAT IS NEW AND CONCLUSION: This analysis confirms the association between the use of antibiotics and the prevalence of resistance in a surgical clinic. Surveillance of bacterial resistance should be done periodically according to local guidelines for antibiotic therapy of surgical infections, as well as for external comparison.

Effects of anthocyanins and anthocyanin-rich extracts on the risk for cancers of the gastrointestinal tract.

Anthocyanins are the largest group of water-soluble pigments in the plant kingdom. Anthocyanins are responsible for most of the red, blue, and purple colors of fruits, vegetables, flowers, and other plant tissues or products. In recent years, numerous studies have shown that anthocyanins display a wide range of biological activities. This review summarises recent literature evidence on the association of anthocyanins and anthocyanin-rich extracts consumption with the risk for gastrointestinal tract cancer, concentrating on the results from in vivo animal model tumor systems, as well as data from human epidemiological studies. Potential cancer chemopreventive activities of anthocyanins were revealed from in vitro studies. In vivo animal model tumor systems showed that dietary anthocyanins inhibit cancers of the gastrointestinal tract. Some epidemiological studies have revealed protective effects of anthocyanins consumption on gastrointestinal cancer risk in humans. Pharmacokinetic data indicate that absorption of anthocyanins into the bloodstream of rodents and humans is minimal, suggesting that they may have little efficacy in tissues other than the gastrointestinal tract and skin. Future studies should be undertaken to determine if the anticancer effects of anthocyanins are due to the parent compounds and/or to their metabolites.

Breast cancer in women under 40 years of age.

PURPOSE: It is widely believed that breast cancer in young women is characterized by a relatively unfavorable prognosis and unusual pathological features. The aim of this study was to investigate clinicopathological and biological characteristics in young patients with breast cancer. METHODS: The study enrolled 1029 consecutive female breast cancer patients who were admitted to the Clinical Centre Nis between July 2002 and December 2008. RESULTS: 91 (8.8%) patients were under and 938 (91.2%) were over 40 years. The mean age was 35.9 years for those under 40 years and 58.3 for those older than 40 years. In both patient groups, left breast was most commonly involved; the most common primary tumor site was the upper lateral quadrant; the most common histological type was ductal carcinoma; histological and nuclear grade 2 was most common. In the younger group of patients, the proportion of patients with T3 and T4 disease was higher (13.0 vs. 9.3% and 16.5 vs. 12.0%), the number of patients with histological and nuclear grade 3 disease was higher (27.5 vs. 24.7% and 37.4 vs. 33.2%), the proportion of patients with 4-9 and >10 positive lymph nodes was higher (22.6 vs. 18.3% and 7.1 vs. 4.0%), and the percentage of family history of breast cancer was higher (5.5 vs. 3.1%), without statistically significant differences between the two age groups. Patients in the younger age group exhibited higher estrogen (ER)/progesterone (PR) receptor negativity (32.6 vs. 24.4%) (p<0.05). CONCLUSION: Although uncommon, breast cancer in young women is worth special attention. The underlying causes of the disease must be investigated in large population- based studies in the future.

Hormone sensitivity of primary breast carcinoma.

PURPOSE: This study was designed to evaluate hormonal sensitivity of primary breast cancer by way of determination of estrogen receptors (ER) and progesterone receptors (PR) status as an important prognostic and predictive parameter of breast cancer. METHODS: The study enrolled 449 breast cancer patients surgically treated at the Surgical Clinic Nis, in a period covering 3 years, who continued treatment at the Clinic of Oncology, Clinical Centre Nis. All of the patients were divided into 4 groups depending on the positive or negative status of ER and PR, and 2 subgroups, those with positive or negative HER2 status. Standard descriptive statistical parameters were calculated and several types of tests were applied: Student's t-test for paired and unpaired samples, chi-square test, Mantel- Haenszel test, Fisher's test of exact probability and binary logistic regression model. RESULTS: The level of ER and PR status positively correlated with patient age, postmenopausal status, lower clinical stage, lower histologic grade (HG) and nuclear grade (NG) and better prognosis. Amplification/overexpression of HER2 positively correlated with premenopausal status and ER negative breast cancer phenotype. According to the model of binary logistic regression, clinical stage and NG of the breast primary were significantly associated with hormonal sensitivity of the tumor. CONCLUSION: Measurements of receptor macromolecules in clinical oncology is very important, especially in breast cancer patients. ER and PR analysis is an integral part of breast cancer study since it can provide information essential for both treatment and prognosis.

Clinical and biological characteristics of breast cancer.

PURPOSE: in view of the crucial importance of early detection and diagnosis of breast cancer for subsequent treatment and prognosis, the aim of this study was to identify clinical and biological characteristics of breast cancer at the time of diagnosis. METHODS: the study enrolled 449 breast cancer patients in Clinical Centre Nis. Results were analyzed using Student's t-test for paired and unpaired samples, chi-square test, Mantel- Haenszel test and Fisher's test of exact probability. RESULTS: The average patient age was 56.2 ± 12 years (range 23-85). Seventyhorbar;three percent of the affected women were postmenopausal and 8.3% below 40 years of age. Operable disease was identified in 78% of the cases, and metastatic in 3.6%. TNM clinical stage IIA was identified in 27.6% of the patients, T2 in 49.2% and Tis in 0.9%. Almost 44% had negative axillary lymph nodes. Most common monolocalization of metastatic disease was the liver and the supraclavicular lymph nodes, and combined localization was the liver and bones. Histologic and nuclear grades 2 and ductal carcinoma were most common. Estrogen receptor positive (ER+) status was 3-fold higher than ER negative (ER-) status. Human epidermal growth factor receptor 2 (HER2) positive patients were most commonly ER-. The most common primary tumor site was the upper lateral quadrant. Left breast was more commonly involved. Radical surgery was the most common type of operation. CONCLUSION: in view of the unfavorable age of patients at the time of diagnosis and clinical and biological tumor characteristics, the results confirmed that it is of vital importance to provide breast cancer prevention, screening, and to organize breast cancer units according EUSOMA guidelines.

Risk factors for breast cancer: a hospital-based case-control study.

PURPOSE: The factors responsible for the genesis of breast cancer remain unclear. A case-control study was undertaken to investigate the possibility of an association between hypothesized risk factors and the development of breast cancer in Serbia. PATIENTS AND METHODS: This hospital-based case-control study comprised 120 new breast cancer cases and 120 hospital controls matched with respect to age (+/- 2 years). This study used a targeted and detailed questionnaire to obtain information from respondents. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated from multivariate conditional logistic regression models. RESULTS: Five independent predictors of breast cancer were: delayed age at first birth (OR=6.1, 95% CI=4.2-12.4), alcohol consumption (OR=4.8, 95% CI=1.9-12.4), family history of breast cancer in 2nd degree relatives (OR=2.5, 95% CI=1.4-4.3), never having breastfed (OR=5.2, 95% CI=1.4-18.5) and maternal death in childhood (OR=3.3, 95% CI=1.2-8.6). CONCLUSION: The results of this study confirmed that the aetiology of breast cancer in Serbia, as elsewhere, is complex. More research is needed to understand the interactions between factors that could affect vulnerability to breast cancer.

Suicide in the elderly 60 years of age and over in the south-east part of Serbia.

Some previous investigations indicated that economic crisis (inflation in Serbia 1993/94) have great influence on increasing suicide rates in Serbia. After that suicide decreased, despite the war and bombing in 1999, specially among the elderly people. A total of 453 suicides were registered on the territory of south-eastern Serbia during 1995-2001 years. Of them 295 (65.1%) were aged over 60 years. Generally linear trends of suicide among both genders from 1995 to 2001 decreased, but the slope of decreasing was grater among males than among females. The highest rates among the both genders were registered in the years with the maximum number of suicides, but the linear trends of rates have statistically important correlation with time (r>0.5). Average annual suicide rate among males was 42.5, and among women it was 18.7. The highest average annual suicide rate among men was observed in the age group 75 years and over (93.3), and the lowest in the age group 65-69 (20.6). Among males, in the all age group linear trends of suicide rates decreased, with the highest slope among 75 years and over and the lowest among 65-69 years. The highest suicide rate among females was registered in age group 75 years and over (25.6), the lowest in the age group 65-69 (13.5). The linear trends are similar as among males: downward trend was observed among all aged groups, with the highest slope among women 75 years and over. The most common way of suicide among men was hanging up (63%), poisoning and by firearms. There were no statistical differences between way of suicide and age groups. The most frequent way of suicide among females was hanging up (55%), poisoning (25%) and drowning (12%). There were statistically significant differences in drowning between age groups, 70-74 and 75 and over (p<0.05), and between poisoning and age groups 60-64 years and 75 years and over. Poisoning and drowning are statistically more frequent among women than among men.

The disinfection of water by microalloyed aluminium-based composite.

In the submitted paper the water disinfection capacity of the microalloyed aluminium based composite (MABC) was studied. MABC is material in the form of steel wire, plated with microalloyed aluminium. The effects of the composite are based on the very negative stationary potential of microalloyed aluminium, and its spontaneous dissolution in water with generation of AI(III) ions, and reduction of water with the generation of H2 and OH ions. As a final product of these reactions, a voluminous Al(OH)3 precipitate is formed. Having in mind its great efficacy in purification of different waters from many chemical pollutants we made the following hypothesis: reduction characteristics of the MABC surface, presence of Al(III) and OH ions, and coprecipitation on Al(OH)3, can be also toxic and destructive for bacteria in water. The experiments were carried out with the water model solutions (WMS) based on adapted natural surface water (NSW), inoculated with the Escherichia coli. All treatments were performed in the original semi-flow system (SFS), in which convection increases efficacy. The results show that approximately every 10 min the number of viable bacteria was reduced for about one log10 count, with the complete disinfected water phase as the outcome of the treatment. At the end of the treatment, the Al(OH)3 precipitate still contained a low amount of coprecipitated viable bacteria, which died within a relatively short period.

Epidemiology of breast cancer in the city of Nis, Serbia.

PURPOSE: Over the past 10 years, Serbia has been affected by a heavy economic and political crisis that in 1999 even led to war and bombardment. Numerous facts indicate that the crisis has resulted in low-level health protection, increasing mortality, as well as other deteriorating effects over the general health of the population. The aim of the study was to assess mortality trends in female breast cancer in the city of Nis prior to (1986-1993) and following (1995- 1999) the socio-economic crisis peak. MATERIALS AND METHODS: Population and hospital cancer registry data for the 1986-1999 period were used for analysis, as well as death certificate data for all women who lived and died in the city of Nis in the given period. Survival was calculated according to the Kaplan-Meier method. The rates were calculated per 100,000 inhabitants (1991 census) and were not standardized. RESULTS: A total of 455 women in the city of Nis died of breast cancer during 1986-1999. The polynomial trend in mortality revealed an increasing (1986-1992) and decreasing (1993-1996) tendency, although the first period showed a lower average mortality (28.7) than did the second one (30.45). Survival rates were calculated for the periods 1986- 1993 and 1995-1998. The 12-month survival rate was 84.7% in the first and 92% in the second period; the 24-month survival rate for the first period was 76.6% and 87.9% for the second; the 36-month survival was 67.7% in the first and 80.5% in the second period; the 4-year survival rate for 1986-1993 was 64.1% and 78.1% for 1995-1999. CONCLUSION: The socio-economic and political crisis has proved to affect breast cancer patients in Serbia. Overall, the mortality rate increased. Calculated upon division of the whole period into two, mortality shows an upward trend in the first period (1986-1992) and a downward trend in the second. Although 1993-1999 was more difficult for the Serbian and Yugoslavian population (manifested in the therapy of all diseases, including breast cancer), the diagnosis of breast cancer improved and the disease was detected at earlier stages, the result of which were better survival rates in the 1986-1992 period.

Diet and breast cancer.

Nutritional factors have been prominent among the environmental determinants of breast cancer hypothesized to account for the large increases in rates among offspring of migrants from countries with low incidence to countries with high incidence. The dominant hypothesis has been that high fat intake increases risk, but in addition to this possibility, several alternative hypotheses have been suggested, too.

The comparison of aluminium effects and its uptake by Escherichia coli in different media.

The investigation of the toxic effects and the uptake of aluminium by Escherichia coli in growth medium (GM) and in physiological solution (PS) have been studied. The toxicity was quantitatively determined according to the decrease of the colony forming units (CFU) in the physiological solution, that is its growth inhibition in the growth medium, vs. the aluminium concentration and incubation time, at pH 5.2, 6.2 and 7.2. The uptake of aluminium was investigated by determining the intracellular aluminium in dry weights (DW), by graphite fumace atomic absorption spectrophotometry, considering that aluminium adsorbed to the cell surface was removed by washing with EDTA solution. The results show that toxicity and accumulation increase with the increase of the aluminium concentration and incubation time. However, the linearity of these functions was lost at higher values, which indicate dependence on time and concentration saturation. The effect of pH was specific, and correlated with the form of aluminium in solution. The increase in toxicity as the pH decreases, suggests that the Al(H2O)6(3+) ion is the major toxic form, among the remaining present ones aluminium in aqueous media. The results also show that the aluminium in a concentration range from 0.10 to 10.0 mg/l toxic to E. coli in PS, was significantly less toxic for bacteria in the GM, mainly because of living conditions and the accessibility of free Al.

[Some insufficiently recognized risk factors for breast cancer]. / Neki nedovoljno ispitini faktori rizika za nastanak raka dojke.

INTRODUCTION: In the most developed countries female breast cancer is the main cause of death due to the most common malignancy in women [1]. Over the period 1975-1982 and 1982-1991 women in Serbia died most frequently of malignant tumours of the breast [2, 3]. A tendency to increase mortality rate of the disease was recorded in this period. The aim of this paper was to determine the importance of some insufficiently known breast cancer risk factors. MATERIAL AND METHODS: The study was based on a case-control study conducted from July 1993 to March 1994. The patients were selected at the Department of Oncology in Nish, and included 106 female patients with histologically documented breast cancer (a two-year diagnosis). Controls were individually matched to patients by age (+/-3 years) and number of patients with mild injuries, hospitalized at the Clinical Centre in Nish. All the examined subjects, from both groups, were interviewed by the same doctor using a target and detailed questionnaire about different risk factors of breast cancer. McNemar test was used in the study. RESULTS: The results are presented in Table 1. The results confirmed a significant positive association between breast cancer risk and psychological stressogenic events (RR = 4.40 95% CI = 2.30-8.40 p = 0.0000). With reference to a previous history of mastitis, a frequent positive history was found in the examined patients and it was statistically significant (RR = 7.50 95% CI = 2.99-18.83 p = 0.000). The risk of developing breast cancer was strongly related to alcohol consumption (RR = 4.11 95% CI = 2.05-8.24 p = 0.0001). Two environmental factors were significantly associated with breast cancer: occupational exposure to organic dust (RR = 3.80 95% CI = 1.41-10.20 p = 0.0066) and to pesticides (RR = 4.25 95% CI = 1.43-12.58 p = 0.0072). DISCUSSION: In our patients stressful life-events were significantly frequent. Most of them reported death or a serious illness of the spouse or of a close family member, marital divorce, son's military service, etc., within the two years prior to the disease. The evidences related to the possible role of stressful life-events in mammary tumorigenesis are insufficient and controversial. Becker [4] suggested that separation from parents before fourteen, marital problems and death of the husband correlated positively with breast cancer risk. For et al. [5] observed that a cancer group had a higher proportion of women who experienced death of the spouse or of a close family member. In contrast, the results of one recent study [6] confirmed no clear evidence that death of the husband or marital divorce were associated with an increased risk of breast cancer. Further investigation of the role of stress in the onset of breast cancer should take into account not only the number of stressful life-events, but also the personality of an individual and effect on her ability to cope with stress [7]. As in many studies [8-11], but not in all [12-14], our results suggested a significant positive association between breast cancer risk and alcohol consumption. Studies have indicated that the increased risk is associated with the type of beverage used [15], the level of consumption [11], but not with the years of consumption [8, 11, 16]. Alcohol consumption at an early age [17] and at the late age [16] increase the risk of breast cancer. Although certain biologic mechanisms for this association have been suggested, such as interference with the cell membrane permeability in breast tissue, exposure to circulating cytotoxic products of ethanol and altered hepatic function, none is generally accepted [17]. The question remains as to whether the increased risk is attributable to alcohol or to some other characteristics in women who drink alcoholic beverages compared with those who do not. We observed a positive correlation among breast cancer risk related to a positive history of mastitis, occupational exposure to organic dust and to pesticides.

[The significance of physical activity and anthropometric parameters for the development of breast cancer]. / Znacaj fizicke aktivnosti i antropometrijskih parametara za nastanak raka dojke.

The significance of physical activity and some anthropometric parameters (body mass, body height, body mass index) in breast cancer genesis was examined in the study. Anamnestic study included 106 women with breast cancer and 106 hospital controls, age-matched (+/-3 years). The data about risk factors for breast cancer genesis were collected by the targeted epidemiological questionnaire. The basic statistic parameters (mean, standard error) and t-test were calculated. The results indicated that physical activity and body height higher values appeared to be protective, while body mass and body mass index higher values could be considered as risk factors for breast cancer.