Performance of Charlson and Elixhauser Comorbidity Index to Predict in-Hospital Mortality in Patients with Stroke in Sumadija and Western Serbia.

BACKGROUND: Comorbidities are major predictors of in-hospital mortality in stroke patients. The Charlson comorbidity index (CCI) and the Elikhauser comorbidity index (ECI) are scoring systems for classifying comorbidities. We aimed to compare the performance of the CCI and ECI to predict in-hospital mortality in stroke patients. METHODS: We included patients hospitalized for stroke in the Clinical Center of Kragujevac, Serbia for the last 7 years. Hospitalizations caused by stroke, were identified by the International Classification of Diseases-10 (ICD-10) codes I60.0 - I69.9. All patients were divided into two cohorts: Alive cohort (n=3297) and Mortality cohort (n=978). RESULTS: There were significant associations between higher CCIS and increased risk of in-hospital mortality (HR = 1.07, 95% CI = 1.01-1.12) and between higher ECIS and increased risk of in-hospital mortality (HR = 1.04, 95% CI = 0.99-1.09). Almost 2/3 patients (66.9%) had comorbidities included in the CCI score and 1/3 patients (30.2%) had comorbidities included in the ECI score. The statistically significant higher CCI score (t = -3.88, df = 1017.96, P <0.01) and ECI score (t = -6.7, df = 1447.32, P <0.01) was in the mortality cohort.Area Under the Curve for ECI score was 0.606 and for CCI score was 0.549. CONCLUSION: Both, the CCI and the ECI can be used as scoring systems for classifying comorbidities in the administrative databases, but the model's ECI Score had a better discriminative performance of in-hospital mortality in the stroke patients than the CCI Score model.

Searching for lichen indicator species: the application of self-organizing maps in air quality assessment-a case study from Balkan area (Serbia).

The subject of this paper is the possibility of using self-organizing map (SOM) in the biomonitoring studies. We used lichens as biomonitors to indicate different degrees of air quality. This research included all of 88 lichen species that was collected at 75 investigated points. These lichen species showed the different responses to air pollution. The air quality was assessed by IAP (index of atmospheric pollution) values. The IAP values were calculated for all of investigated points on the territory of four natural and one urban ecosystem. Calculated IAP values were in range of 10 to 75. On the basis of the lichen data and IAP values, we have employed SOM analysis that distinguished three clusters (A, B, and C). It presented lichen indicator species for each cluster: 16 species for cluster A, 18 species for cluster B, and two species for cluster C. This paper presents a useful method to find indicator species.

Factors influencing participation in breast cancer opportunistic screening in Belgrade, Serbia.

PURPOSE: To assess the motivation and barrier factors influencing participation of women in opportunistic breast cancer screening in Belgrade, Serbia, and to detect changes in these factors over time. METHODS: A cross-sectional study has been carried out at the Institute for Oncology and Radiology of Serbia in 2009 and 2016 among women aged 40 to 69 years from Belgrade who came at the Institute for opportunistic breast cancer screening. The demographic characteristics, data regarding breast exams practices, screening motivators and barriers and sources of information on breast cancer were collected by self-administered questionnaire. RESULTS: The questionnaire was completed by 478 women in 2009 and 453 in 2016, with increase in women reporting regular mammograms or at least one previous mammogram (from 30.1% to 58.6%, p=0.000). In 2009, the most frequent motivating factors were health maintenance (36%), friend's advice, TV, cancer in the family or fear of breast cancer; in 2016, advice from gynecologist (significant increase from 10.9% to 37.7%, p=0.000), health maintenance, family cancer and fear of cancer. The most frequent reasons for not going to exams regularly were absence of breast problems, crowded doctor's offices and no family breast cancer. CONCLUSIONS: These findings provide information on motivation and barrier factors that may influence women's decision to participate in opportunistic breast cancer screening. Those factors have changed over time and the role of physicians has increased significantly. Further exploration of motivating and barrier factors and the extent of their association with actual women's behavior would be helpful for the development of interventions to improve organized and opportunistic screening participation.

Vitamin D Deficiency and Associated Factors in Patients with Mental Disorders Treated in Routine Practice.

This research aimed to investigate factors associated with vitamin D deficiency and to provide data about its prevalence in patients suffering from different psychiatric illnesses. The study had a cross-sectional design and it included 220 patients of both genders, aged from 19-81 y, with a wide range of mental disorders (F00-F89), and treated in routine ambulatory and hospital practice. The researchers collected data from three sources: medical records, a study questionnaire and biochemical analysis of patients' serum samples (concentration of vitamin D measured as 25(OH)D, calcium, phosphorus, magnesium, sodium and potassium). Data were analyzed using descriptive statistics, methods for hypothesis testing and binary logistic regression, at the p≤0.05 level. A total of 140 patients (64%) had a deficiency of vitamin D (<12 ng/mL), and 45 (20%) had inadequate vitamin D serum levels (12-20 ng/mL), while 35 (16%) had sufficient vitamin D serum concentrations (>20 ng/mL). Among variables related to demographics, life style habits, mental illness, comorbid disorders and drugs, two of them, female gender (odds ratio (OR)=2.5, 95% confidence interval (CI)=1.3-4.9, p=0.006) and using clozapine (OR=15.6, 95% CI 1.7-144.7, p=0.02), were significantly associated with vitamin D deficiency. Physical activity (OR= 0.4, 95% CI 0.2-0.9, p=0.02), exercising (OR=0.2, 95% CI <0.1-0.7, p=0.02) and offal in the diet (OR=0.5, 95% CI 0.3-0.9, p=0.03) significantly aggregated in the patients who had a 25(OH)D serum concentration above the deficiency cut-off level. Patients with mental disorders are at high risk for vitamin D deficiency, particularly females and clozapine users as well as those having no adequate physical activity or dietary habits.

Phytochemical study and antioxidant, antimicrobial and anticancer activities of Melanelia subaurifera and Melanelia fuliginosa lichens.

The aim of this study was to investigate antioxidant, antimicrobial and anticancerous activity of Melanelia subaurifera and Melanelia fuliginosa. The phytochemical analysis was determined by HPLC-UV method. Antioxidant activity was evaluated by DPPH and reducing power assay while antimicrobial activity was determined by minimal inhibitory concentration. The cytotoxic activity was tested using MTT method. The method for quantification of 2'-O-methyl anziaic acid and lecanoric acid in these lichens using RF-HPLC was also developed and validated. The depsides (lecanoric acid, gyrophoric acid, atranorin, anziaic acid and 2'-O-methyl anziaic acid), and dibenzofurane (usnic acid) were identified in these lichens. The antioxidant activity (IC50) of lichens extracts ranged from 121.52 to 424.51 µg/ml. 2'-O-Methyl anziaic acid showed the highest antimicrobial activity with MIC ranging from 0.0625 to 1 mg/ml. M. subaurifera extract showed the highest cytotoxic activity against the tested cell lines (IC50 = 9.88 to 31.64 µg/ml).

Biopharmaceutical Potential of Two Ramalina Lichens and their Metabolites.

This paper studies the phytochemical analysis of the acetone extracts of the Ramalina fraxinea and Ramalina fastigiata lichens and the antioxidant, antimicrobial and antitumour activities of these species and their constituents. The phytochemical analysis of two Ramalina species was evaluated using HPLC-UV test. The depsides (evernic acid, obtusatic acid, sekikaic acid and atranorin), depsidones (protocetraric acid) and dibenzofurane (usnic acid) were identified from these lichens. Antioxidant activity was evaluated by DPPH assay, reducing power assay and by measuring the amounts of total phenolics in extracts. Antimicrobial activity was tested towards five bacterial and 10 fungal species, using broth microdilution method to determine the minimum inhibitory concentration. Cytotoxic activity was tested using MTT method on the human epithelial carcinoma (Hela), human lung carcinoma (A549) and human colon carcinoma (LS174) cells. As a result of the study, tested samples showed strong free radical scavenging activity with I50 values within the range of 285.45-423.51 µg/mL. Absorbance for reducing power was found to be from 0.0043 to 0.1747. The total amount of phenol concentrations in extracts of Ramalina fraxinea and Ramalina fastigiata was 32.63 and 33.49 µg PE/mg, respectively. Methyl evernate showed the strongest antimicrobial properties with the least measured MIC value being 0.125 mg/mL. In addition, all samples exhibited strong anticancer activities against tested cells (I50 values were between 24.63 and 161.37 µg/mL). These results indicate that lichen appears to be a possible natural biopharmaceutical.

Agreement between admission and discharge diagnoses: Analysis by the groups of international classification of diseases, 10th revision.

Background/Aim: Admission diagnosis represents the diagnosis of an illness, injury or condition due to which a patient is referred to hospital to be admitted. Discharge diagnosis represents the main reason of illness or condition due to which a patient is admitted. The aim of this study was to analyze the agreement between admission diagnostic groups and discharge diagnostic groups of patients in the Clinical Center Kragujevac in the period from January 1, 2006 to December 31, 2013 on the basis of the hospitalization report. Methods: From the basic set of reports, 5% of random samples were singled out and they contained 20,422 reports. Out of the given number of reports, 18,173 hospitalization reports were complete and then further analyzed in the paper. Admission diagnostic groups given by the primary care doctor were compared with discharge diagnostic groups filled out by the practicing physician in the hospital ward from which a patient was discharged. The agreement of these two diagnostic groups was an indication of the high-quality performance of the primary care doctor. Agreement analysis was conducted using Cohen's Kappa statistics. Restuls: Agreement analysis showed that the values of the Kappa coefficient for the five leading admission diagnostic groups were in the range of κ = 0.61 to κ = 0.94. The values of the Kappa coefficient for the five most common discharge diagnostic groups were in the range of κ = 0.55 to κ = 0.81. Conclusion: Hospitalization report is a reliable individual report on inpatient care, so it could be used in determining the degree of agreement between admission diagnostic groups and discharge diagnostic groups.

Are local clinical guidelines useful in promoting rational use of antibiotic prophylaxis in caesarean delivery?

OBJECTIVES: To identify changes in prescribing patterns of antibiotic prophylaxis in caesarean delivery after introduction of local clinical guidelines. To identify changes in outcomes of prescribing antibiotics following the implementation of local clinical guidelines on antibiotic prophylaxis. SETTING: University of Belgrade, Medical School, Clinic of Gynaecology and Obstetrics "Narodni front" Belgrade, Serbia. METHOD: A quantitative retrospective analysis of antibiotic use before (January-June 2005), and following (January-June 2006) implementation of guidelines on antibiotic prophylaxis in two wards. Patients who underwent caesarean section prior to (261) and following (281) introduction of local guidelines, participated in this study. MAIN OUTCOME MEASURES: Drug utilization cost presented as the number of DDD/100 bed days/eur, the average duration of hospital stay, number of wound infections. RESULTS: There was a significant change in prescribing patterns of antibiotic prophylaxis in caesarean section following introduction of local guidelines. The use of ceftriaxone, amikacin and metronidazole decreased (57.47% vs. 11.74%; 9.19% vs. 4.27%; 61.69% vs. 46.26%, respectively). On the other hand, the use of "older" antibiotics such as gentamicin, cefuroxime, cefazolin and ampicillin increased (14.56% vs. 29.18%; 9.2% vs. 17.44%; 9.58% vs. 45.2% and 0% vs. 3.9%, respectively). DDD/100 bed days/eur analysis revealed a 47% decrease of total cost for prophylactic antibiotic treatment in caesarean section following local guideline implementation. In contrast, rate of wound infections and duration of hospital stay were not significantly different in both groups. CONCLUSION: In an attempt to ensure cost-effective prophylactic use of antibiotics in caesarean delivery, local clinical guidelines were introduced. They resulted in changes in prescribing patterns of antibiotics. There was a significant decrease in use of 'third' generation of cephalosporin's whereas the use of "older" antibiotics with proven efficacy and safety increased. In contrast, there was no significant change in treatment outcomes such as wound infection and average hospital stay.