A Framework for Enhancing and Updating Study Programs in Public Health and Medical Informatics Fields in Montenegro.

Montenegro plans to enhance and modernize the curricula and programs in public health fields in line with EU standards and hence the Erasmus-Phelim project developed a framework to develop, implement, and evaluate the education process. A stepwise approach consisting of three dimensions per step was implemented for workshop development. For the evaluation, a train-the-trainer approach was developed and a self-regulation concept consisting of three phases was applied. Semi-structured interviews with the workshop participants were conducted and results suggested that self-regulation is an understandable concept and can be applied as a training and knowledge transfer method.

The Stratified Framework for Enhancement of Study Programs in Public Health in Montenegro.

Montenegro plans to enhance its educational system in the area of health information management, in accordance with well-known EU best practices. Within the Erasmus+ project PH-ELIM, a Stratified Framework was developed to provide education of public health professionals making them highly skilled to support the nation in creating a sustainable and flexible health system, in providing good quality health, in protecting citizens against health threats, all by a cost-effective and straightforward approach. The objective of this presentation is to present the intermediate results of the Framework and lessons learned until now.

[Clinical assessment of major artery vasomotor endothelial function: methodology and importance for evaluating aging as a cardiovascular risk factor]. / Klinicka procena vazomotorne funkcije endotela magistralnih arterija: metodologija i znacaj za evaluaciju starenja kao faktora kardiovaskularnog rizika.

UNLABELLED: AGING AS A CARDIOVASCULAR RISK FACTOR: Atherosclerosis is the major cause of mortality in the Western world (>50%) as well as in Serbia and Montenegro (>60%). Atherosclerosis/arteriosclerosis functional and structural vascular changes as a consequence of angina pectoris, myocardial infarction, transient ischemic cerebrovascular attacks, stroke, ischaemic attacks in peripheral circulation and/or thromboembolic complications. Aging, lipids (oxidized LDL), infective agents, inflammation, increased glucose level, hypertension, smoking, increased homocysteine level, oxidative stress etc. are recognized as factors which lead to endothelial dysfunction and cause atherosclerosis. Thus, in response to such attacks endothelium releases different substances like: nitric oxide, prostacyclin, endothelium-derived hyperpolarizing factor (EDHF), endothelin, bradykinin, angiotensin II, free oxygen radicals etc. which could be involved in the pathogenesis of atherosclerosis. Atherosclerosis/arteriosclerosis begins with endothelial vasomotor and anti-thrombotic dysfunction and it is of strategic importance to discover this condition earlier. In regard aging, both higher thickness and stiffness of arterial blood vessels appear following an incidence of cardiovascular diseases. DIAGNOSTIC METHODS: Over the last decade non-invasive, echosonographic method for visualization of carotid intima-media thickness (indicator of arteriosclerosis/atherosclerosis) was introduced in clinical practice. However, it is also used to compare brachial artery diameter changes, linear velocity and bloodflow which are estimated during basal conditions, during ischemia, during reactive hyperemia (endothelium/independent phase) as well as with left ventricular mass index. DISCUSSION AND CONCLUSION: Due to aging there is a decreased response to reactive hyperemia, increased carotid intima-media thickness and increased left ventricular mass, but there is a lack of time-dependent correlation. First endothelial dysfunction occur twenty years before any manifestations appear--as typical vascular and ventricular remodeling. During this period certain markers, for example homocysteine, and diagnostic procedures are important parts of primary prevention.

[Effects of platelet single passage on coronary circulation in the isolated guinea-pig heart: focus on the L-arginine: nitric oxide system]. / Efekat jednokratne pasaze trombocita na koronarnu cirkulaciju izolov anog srca zamorceta: fokus na l-arginin:NO sistem.

INTRODUCTION: In order to evaluate endothelial response to platelet single passage through coronary vascular bed, experiments on isolated guinea-pig hearts perfused by the Langendorff method at constant pressure were performed. MATERIAL AND METHODS: Platelet single passage was performed with platelet-rich plasma obtained from healthy volunteers, as well as from patients with acute myocardial infarction. Hearts, isolated from guinea-pigs of either sex were perfused with Krebs-Hensenleit buffer. After a stabilization period of 30 minutes at 70 cm H2O, coronary perfusion pressure decreased to 30 cm H2O and increased to 120 cm H2O. After basic protocol, hearts were perfused with PRP, PRP-AMI alone or in combination with nitric oxide synthase inhibitor, N(omega)-nitro-L arginine methyl ester (L-NAME)--30 M, and nitrite outflow (NO2-) was measured. RESULTS: Basal (at 70 cm H2O) coronary flow (CF) and NO2- was 4.71+/-0.43 ml/min and 0.55+/-0.13 nmol/min/g wt. PRP induced significant decrease of CF at all values of CPP (from 32% at 30 cm H2O to 27% at 120 cm H2O), with parallel NO2- reduction (from 25% to 28%). When L-NAME, 30 M was added, PRP was much less effective: CF was reduced from 13% to 5%, with parallel changes of NO2- (reduction of 10% at all CPP values). PRP-AMI induced higher degree of CF reduction (from 42% to 44%) with NO2 reduction from 23% to 35%. PRP-AMI after applied L-NAME induced also less CF-reduction (from 18% to 12%), with similar NO2- reduction (from 18% to 12%). CONCLUSION: Our findings show that effects of platelet single passage through coronary vascular bed should be affected by NO in isolated guinea-pig hearts.

[Common carotid artery intima-media thickness, carotid atherosclerosis and subtypes of ischemic cerebral disease]. / Debljina intima-medija kompleksa zajednicke karotidne arterije, karotidna ateroskleroza i suptipovi ishemicnog mozdanog udara.

INTRODUCTION: Common carotid artery intima-media thickness (CCA-IMT) measurements are widely used to study atherosclerosis. CCA-IMT is a useful outcome measure in clinical studies and intervention trials because it reflects early stages of atherosclerosis and cardiovascular risk. The present study examined the relationship between common carotid artery intima-media thickness and ischemic brain infarction. MATERIAL AND METHODS: The present study examined the association between CCA-IMT and incidence of ischemic stroke and its subtypes in 75 cases and 21 controls. Cases with internal borderzone infarction (IBI) were consecutively recruited and classified into subtypes using CT and Bamford's classification. It classifies cerebral infarctions regarding vascular territory using clinical features to determine the size and site of infarction. These subtypes included: total anterior circulation infarctions (TACIs), partial anterior circulation infarctions (PACIs), posterior circulation infarctions (POCIs), and lacunar infarctions (LACIs). Controls were recruited among individuals hospitalized at the same institution and matched for age and sex. Patients and control subjects underwent B-mode ultrasonographic measurements of IMT of the far wall of both common carotid arteries. RESULTS: Of 75 patients with acute ischemic stroke, 10 (14%) were classified as TACIs, 34 (45%) had PACIs, 12 (16%) had POCIs and 19 (25%) had LACIs. Mean CCA-IMT was higher in investigation group (1.03+/-0.18 mm) than in controls (0.85+/-0.18 mm; p<0.0001). The difference in CCA-IMT between investigation group and controls was significant and the relation between CCA-IMT and IBI remained unchanged after adjustments of main cardiovascular risk factors. Regarding the subtypes of IBI, IMT values were significantly higher in patients with TACIs and PACIs versus those with LACIs and POCIs. CONCLUSIONS: An increased CCA-IMT was established in all subtypes of IBI and was significantly higher in those with anterior circulation infarctions versus posterior circulation and lacunar infarctions. This study points to importance of noninvasive measurement of CCA-IMT with ultrasonographic techniques as a diagnostic tool for selecting patients at high risk for IBI and identifying different subtypes of ischemic stroke.