Assessment of Retinal Microangiopathy in Patients with Balkan Endemic Nephropathy Using Optical Coherence Tomography Angiography-A Pilot Study.

Background and Objectives: It is well known that alterations in microvascular structure and function contribute to the development of ocular, renal, and cardiovascular diseases. Accordingly, the presence of fundus vascular changes in patients suffering from chronic kidney disease (CKD) and Balkan endemic nephropathy (BEN) may provide information of prognostic value regarding the progression of renal disease. This study aimed to examine the associations between clinical characteristics and retinal optical coherence tomography angiography (OCTA) parameters in patients with BEN and compare them with those in CKD. Materials and Methods: This pilot study, conducted from March 2021 to April 2022, included 63 patients who were divided into two groups: the first group consisted of 29 patients suffering from BEN, and the second was a control group of 34 patients with CKD. Demographic, laboratory, clinical, and medication data were noted for all the patients included in this study. Each eye underwent OCT angiography, and the results were interpreted in accordance with the practical guide for the interpretation of OCTA findings. Results: Statistically significantly higher levels of total serum protein and triglycerides were recorded in the BEN group than in the CKD group, while the level of HDL cholesterol was lower. Based on the performed urinalysis, statistically significantly higher values of total protein and creatinine were detected in patients with CKD compared to the BEN group. It was demonstrated that the OCTA vascular plexus density of certain parts of the retina was in significant association with systolic and diastolic blood pressure, creatinine clearance, urinary creatinine, total cholesterol, diabetes mellitus type 2, age, body mass index, total serum and urinary protein, sCRP, and diuretic and antihypertensive treatment. Conclusions: In comparison with CKD, BEN leads to more significant disturbances in retinal vasculature density.

The influence of different sub-bandage pressure values in the prevention of recurrence of venous ulceration-A ten year follow-up.

OBJECTIVE: The aim of this study was to establish the efficacy of three different strengths of compression systems in the prevention of venous leg ulcer (VLU) recurrences during a 10-year follow up period. METHODS: An open, prospective, randomized, single-center study included 477 patients (240 men, 237 women; mean age 59 years). Patients were randomized into three groups: Group A) 149 patients (allocated to wear elastic stocking 18-25 mmHg). Group B) 167 patients (wearing compression device exerting 25-35 mmHg), and Group C) 161 patients (treated with multilayer compression system exerting 35-50 mmHg). RESULTS: Overall, 65% (234/360) of patients had recurrent VLU within 10 years. Recurrence occurred in 120 (96%) of 125 in group A, in 89 (66.9%) of 133 patients in group B and in 25 (24.5%) of 102 patients in group C (p < 0.05). CONCLUSION: Compression systems with the higher compression class provide lower recurrence rate.

Unintentional Fall-Related Mortality among the Elderly in Serbia: Importance of Death Reporting Quality.

Background: Falls have been one of the leading causes of injury-related deaths among the elderly, having an increasing trend in many countries. We investigated trends of fall-related mortality among people aged ≥65 yr in Serbia. Methods: Based on official data, we calculated unintentional fall-related mortality rate (MR) from 1998 to 2017, using join point regression analysis to determine annual percentage changes (APC). Starting from 2005, doctors from Serbian Public Health Institute have been controlling the quality of death certificates. Results: In the 1998-2004 period, MR decreased in men and women aged 65-74 and men aged ≥85 (by -12.4; -13.0; and -15.1% yearly) followed by an upward trend in men and women aged 65-74 (by 76.3 vs.40.2%yearly) from 2004 to 2007 and men aged ≥85 (by 13.7% yearly) from 2004 to 2017. MR decreased among women aged ≥85 (by -9.8% yearly) from 1998 to 2008 and then increased (by 9.0% yearly) from 2008 to 2017. In men and women aged 75-84, an increase of MR (by 7.4 vs.3.1%) was observed during the entire study period. In all age groups, except women aged ≥85, significant negative correlation was found between fall-related deaths and ill-defined and unknown causes of deaths. Conclusion: Control of death certificates by physicians from the Institute of Public Health led to the better reporting of the increasing trend of fall-related mortality among the elderly. Policy makers must investigate risk factors for fall and then adopt national guidelines for prevention and treatment of fall-related injury.

Mortality from external causes among 1-14 years old children in Serbia, 1997-2016.

OBJECTIVES: Globally, child mortality from external causes is in decline, but it is still among the leading causes of child deaths. The aim of this first national study was to determine trends of mortality rates from external causes among children aged 1-14 years in Serbia. METHODS: Mortality data were collected from the database of the Statistical Office of Serbia. Joinpoint analysis was used to assess the average annual percentage change (APC) and the corresponding 95% confidence interval (CI) in mortality from 1997 to 2016. RESULTS: In the 1997-2016 period, there were 1,388 child deaths from external causes. They contributed to 29.4% of child mortality in total, from 34.8% in 1997 to 21.8% in 2016. Mortality rate was two times higher among boys (8.1 per 100,000) than girls (4.1 per 100,000). Transport accidents (37.6%), followed by drowning and submersion (18.2%), represented more than half of all deaths due to external causes. Since 1997, mortality rate showed a significant downward trend in boys by -5.4% (95% CI -6.8 to -3.9) yearly for unintentional injuries and significantly by -10% (95% CI -19.0 to 0.1) yearly for intentional injuries. Among girls, death rate for unintentional injuries decreased significantly by -7.1% (95% CI -9.0 to -5.1) yearly and decreased insignificantly for intentional injuries by -2.1% (95% CI -15.3 to 13.1) yearly. CONCLUSIONS: The external causes of death, despite the substantial decline in mortality, are still present among children aged 1-14 years in Serbia. Therefore, implementation of nationwide programmes for prevention of external causes of death is urgent.

Violent deaths among adolescents in Serbia: past, present and future.

OBJECTIVES: The aim of the study was to determine the trend and methods of violent deaths (suicide and homicide) in adolescents aged 15-19 years in Serbia. METHODS: Mortality database was drawn from the Statistical Office of Serbia from the 1997-2019 period. To calculate the annual percentage change (APC) of mortality rate (MR) with corresponding 95% confidence interval we used join point regression analysis. Statistical analyses were also performed using the chi-square test and Spearman's rho correlation. RESULTS: The average suicide rate was 3.65 per 100,000 and homicide rate was 1.36 per 100,000 adolescents. The boys to girls ratio was 4.2 for suicides and 2.7 for homicides. Among girls, suicide rate significantly decreased (APC -20.7%; 95% CI -32.5 to -6.8) and homicide rate insignificantly decreased (APC -19.3%; 95% CI -37.8 to 5.1). Among boys, suicide rate significantly decreased (APC -4.6%; 95% CI -7.0 to -2.0) as well as homicide rate (APC -7.7%; 95% CI -11.5 to -4.3). The most common method of suicide was hanging (195, 44.3%) and nearly one third (198, 32.6%) of violent deaths were caused by firearms. Significantly negative correlation was observed between the Human Development Index (HDI), gross domestic product (GDP) per capita and MR due to suicides and homicides among both genders (p < 0.05). CONCLUSIONS: Increase of GDP and HDI, national preventive intervention and strict application of the provisions of the law regarding the possession and storage of weapons must be implemented in order to continue reducing violent deaths among adolescents.

Subjective sensitivity to noise and non-auditory health effects among adults in Nis, Serbia.

OBJECTIVE: The aim of this study was to examine subjective sensitivity to noise of the citizens of Nis and its impact on their non-auditory health effects. METHODS: This study was designed as a cross-sectional questionnaire survey among 908 adult residents of Nis, Serbia, of whom 387 were men (42.6%) and 521 women (57.4%). Streets with day Leq ≥ 55 dB(A) and night Leq ≥ 45 dB(A) were regarded as noisy and those with day Leq ≤ 55 dB(A) and night Leq ≤ 45 dB(A) were regarded as quiet, in accordance with WHO recommendations. Noise sensitivity was measured with the Weinstein's Noise Sensitivity Scale. Logistic regression analysis was used to assess the impact of noise sensitivity on non-auditory health effects. RESULTS: The study showed that the values of the Weinstein's Noise Sensitivity Scale were significantly higher for those surveyed in the noisy zone. Multiple regression analysis revealed a significant impact of noise sensitivity on night-sleep duration (p = 0.04), subjective assessment of sleep quality (p < 0.01) and daily rest disruption (p < 0.001). CONCLUSION: Based on the study results, it can be confirmed that noise sensitivity has an important role in causing non-auditory health effects among adults.

Predictors of Cardiovascular Events in Hypertensive Patients with High Cardiovascular Risk.

Background and objectives: A long-term therapeutic strategy in hypertensive patients equally depends on measured arterial blood pressure values and total determined cardiovascular risk. The aim of the adequate hypertensive patient treatment is both the reduction in arterial blood pressure and the reduction of all preexisting modifiable risk factors, prevention of target organs damage, and adverse cardiovascular events. The aim of this study was to determine independent predictors of cardiovascular events in patients with hypertension and high cardiovascular (CV) risk, and whether the modifiable risk factors could affect long-term prognosis in the studied population. Materials and Methods: This prospective study included 142 hypertensive patients (65% females), mean age 63.1±8 years, with high CV risk. Each participant was followed for 6.2 years. Results: During the follow-up period, the incidence of non-fatal and fatal CV events was 19.7%, CV mortality 7%, and total mortality 9.9%. Our multivariate analysis showed that plaques in both carotid arteries (p = 0.042), diabetes mellitus (p = 0.042) and cholesterol at the beginning of the study (p = 0.016) were significantly associated with an increased risk of CV events. Patients' age (p = 0.009), intima-media thickness (p = 0.001) and diabetes mellitus (p = 0.042) were significantly associated with an increased risk of CV mortality, and age (p = 0.007) and cholesterol (p = 0.002) were independent variables significantly associated with increased total mortality rates. Conclusions: The results of the present study showed that the main predictors of adverse CV events in high-risk hypertensive patients were years of age, cholesterol levels, diabetes, intima-media thickness, and carotid arteries plaques.

Trends and Causes of Neonatal Mortality in Serbia, 1997-2016

Background: Regardless of the notable reduction in infant deaths worldwide over the last 30 years, the proportion of neonatal mortality in total child mortality is increasing. Aims: To perform a trend analysis of neonatal mortality in Serbia. Study Design: Descriptive observational study. Methods: Joinpoint regression was used to analyze neonatal mortality data for the years 1997 to 2016 that were obtained from the Statistical Office of Serbia. Results: The trend in the neonatal mortality rate decreased significantly by -5.6% (95% CI: -6.5 to -4.6) per year from 1997 to 2007, and by -2.6% (95% CI: -3.7 to -1.5) per year from 2007 to 2016. The neonatal mortality rate for certain conditions originating in the perinatal period decreased by -6.2% (95% CI: -7.5 to -4.9) per year during the years from 1997 to 2006, and by -1.9% (95% CI: -3.1 to -0.7) per year from 2006 to 2016. Among these conditions, disorders related to short gestation and low birth weight, not elsewhere classified, showed an upward trend by 8.5% (95% CI: 6.2 to 10.8) per year during the entire study period. From 1997 to 2016, a significant decrease in the neonatal mortality rate was detected in cases of congenital malformations, deformations, and chromosomal abnormalities, by -5.0% (95% CI: -6.1 to -4.0) per year. The neonatal mortality rate for cases of symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified, decreased by -8.1% (95% CI: -11.0 to -5.2) yearly. Conclusion: The neonatal mortality rate in Serbia decreased between 1997 and 2016, excluding deaths due to short gestation and low birth weight. Therefore, prevention of short gestation and low birth weight should be the highest public priority.

A randomized trial of class 2 and class 3 elastic compression in the prevention of recurrence of venous ulceration.

BACKGROUND: Venous leg ulcers (VLUs) are a major health problem because of their high prevalence and associated high cost of care. Despite the widespread use of compression, treatment recurrence rates remain high. Numerous studies have suggested that regular use of compression stockings reduces VLU recurrences. However, there are limited data concerning how long compression hosiery should be worn after ulcer healing and which class of compression hosiery achieves better results in the prevention of VLU recurrences. METHODS: An open, prospective, randomized, single-center study with a 5-year follow-up was performed to establish the efficacy of two different strengths of knee-high compression hosiery (class 2 and class 3) in the prevention of VLU recurrences. The study included patients with recently healed venous ulcers and no significant arterial disease, rheumatoid disease, diabetes mellitus, and restriction in range of ankle movement. Overall, 361 patients were randomized, and 308 patients (170 men, 138 women; mean age, 59 years) completed the study. Patients were randomized into two groups: group A, 186 patients who wore a heel-less open-toed elastic class 3 compression device knitted in tubular form (Tubulcus; Laboratoires Innothera, Arcueil, France); and group B, 175 patients who wore a class 2 elastic stocking (Rudo, Nis, Serbia). All patients were instructed to wear compression stockings continuously for the first 2 years of follow-up (both during the day and at night). In the third, fourth, and fifth years of follow-up, patients were instructed to wear elastic stockings during the day only. The main outcome measures were recurrence of leg ulceration and compliance with the treatment. RESULTS: Rates of ulcer recurrence after the 5 years of follow-up were 28.98% for the compression class 3 group and 60% for the compression class 2 group (P < .001, log-rank test). Patients in the compression class 3 group experienced significantly longer absolute (46 vs 40 months; P < .001, Mann-Whitney U test) and proportional (77% vs 67%; P < .001, Mann-Whitney U test) ulcer-free time after 5 years than those in the compression class 2 group. Rates of noncompliance after 5 years were 10.23% for the compression class 3 group and 6.25% for the compression class 2 group (P = .188, χ2 test). CONCLUSIONS: The results obtained in this study suggest that class 3 compression stockings provide a statistically significant lower recurrence rate compared with the class 2 compression stockings.

Does short-term air pollution exposure have effects on blood pressure and heart rate in healthy women in the city of Nis, Serbia?

OBJECTIVE: Epidemiological research has shown that air pollution is associated with cardiovascular events, but little is known about short-term effects on blood pressure (BP) and heart rate (HR) in Serbian population. The present study assessed the short-term association between black smoke (BS) and sulphur dioxide (SO2) levels in urban air and the daily values of blood pressure and heart rate in 98 healthy nonsmoking female volunteers. METHODS: Generalized regression model was fitted controlling for temperature, relative humidity, air pressure, season, and the day of the week. RESULTS: There was no association between short-term air pollution exposure and BP and HR, the exposure showed a tendency toward a decrease of diastolic BP and HR, but with no statistical significance. CONCLUSION: The present findings did not support the conclusion that current levels of ambient BS and SO2 may have an effect on blood pressure and heart rate in women.

Streptococcus pyogenes as the cause of vulvovaginitis and balanitis in children.

BACKGROUND: Streptococcus pyogenes (group A Streptococcus) is the etiological agent of perineal infection in children, consisting of perianal infection, vulvovaginitis and balanitis. If it is not properly diagnosed and treated, it can persist for many months and can cause severe complications. Furthermore, treatment with penicillin can be followed by failures and recurrences. METHODS: We report here the prevalence of S. pyogenes isolates in genital tract specimens from girls (n = 1692) with symptoms of vulvovaginitis and from boys (n = 52) with balanitis in the municipality of Nis, Southeast-Serbia (the Western Balkans) in a 10 year period, and the seasonal distribution, patient age and sensitivity to bacitracin and antimicrobial drugs used in the treatment of streptococcal infection. RESULTS: Streptococcal vulvovaginitis was diagnosed in 2.30% of examinees. Of those cases, 64.10% were detected from April to September, and it was most common (71.79%) in girls aged 3-7 years. Streptococcal balanitis was diagnosed in two instances: in a 4-year-old boy and in a 7-year-old boy. S. pyogenes strains resistant to bacitracin were identified in five girls. Two isolates with M phenotype and five isolates with cMLSB phenotype were identified. CONCLUSIONS: Streptococcal vulvovaginitis was diagnosed less often in the present study, but it was still far more common than streptococcal balanitis in childhood. Bacitracin resistance of S. pyogenes strains should be taken into account in routine microbiological identification, and the detection of S. pyogenes isolates resistant to erythromycin requires surveillance in the present geographical territory.

Changes in respiratory function impairment following the treatment of severe pulmonary tuberculosis - limitations for the underlying COPD detection.

BACKGROUND: During the treatment phase of active pulmonary tuberculosis (PTB), respiratory function impairment is usually restrictive. This may become obstructive, as a PTB-associated airflow obstruction (AFO) or as a later manifestation of underlying COPD. PURPOSE: The aim of the study was to examine the potential causes and risks for AFO development in PTB by exploring the aspects of spirometry limitations and clinical implications for the underlying COPD detection, taking into account various confounding factors. PATIENTS AND METHODS: Prospective, nest case-control study on 40 new cases of PTB with initial restrictive respiratory function impairment, diagnosed and treated according to the directly observed treatment short course (DOTS) strategy. RESULTS: From all observed patients, 37.5% of them developed AFO upon the completion of PTB treatment, with significantly increased average of forced vital capacity (%) (P<0.01). Their changes in forced expiratory volume in the first second (%) during the PTB treatment were strongly associated with the air pollution exposure in living (0.474%-20.971% for 95% confidence interval [CI]; P=0.041) and working environments (3.928%-20.379% for 95% CI; P=0.005), initial radiological extent of PTB lesions (0.018%-0.700% for 95% CI; P=0.047), leukocyte count (0.020%-1.328% for 95% CI; P=0.043), and C-reactive protein serum level (0.046%-0.205% for 95% CI; P=0.003) compared to the other patients. The multivariate logistic regression analysis model shows initial radiological extent of pulmonary tuberculosis lesions (OR 1.01-1.05 for 95% CI; P=0.02) and sputum conversion rate on culture (OR 1.02-1.68 for 95% CI; P=0.04) as the most significant predictors for the risk of AFO development. CONCLUSION: AFO upon PTB treatment is a common manifestation of underlying COPD, which mostly occurs later, during the reparative processes in active PTB, even in the absence of major risk factors, such as cigarette smoking and biomass fuel dust exposure. Initial spirometry testing in patients with active PTB is not a sufficient and accurate approach in the detection of underlying COPD, which may lead to their further potential health deterioration.

Changes in stroke mortality trends and premature mortality due to stroke in Serbia, 1992-2013.

OBJECTIVES: To determine mortality trends and premature mortality due to stroke in Serbia in 1992-2013 period. METHODS: We obtained mortality database from the Statistical Office of Serbia. RESULTS: From 1992 to 2005, age-standardized mortality rates (ASRs) per 100,000 for all stroke increased, with annual percentage change (APC) of 1.01 % in men and 1.05 % in women. From 2005 to 2013, ASRs decreased, with APC of -4.93 % in men, and -5.63 % in women. In men, years of life lost (YLLs) for all stroke deaths were 21,710 in 1992; 22,193 in 2003 and 17,464 in 2013, with average years of life lost (AYLLs) of 3.46, 2.89 and 3.00, respectively. In women, YLLs were 33,508 in 1992; 35,130 in 2003 and 21,676 in 2013, with AYLLs of 4.65; 3.57 and 2.97. CONCLUSIONS: From 1992 to 2013, ASRs and YLLs for all stroke showed two segment trends in Serbia, with increase in the first, and decrease in the second period. Due to the shorter AYLLs and longer life tables, in 2013 stroke deaths occurred at >4 years older age in both sexes than in 1992.

Comparison of weight and length at birth of non-Roma and Roma newborn in Serbia.

OBJECTIVES: Roma infants tend to be smaller and are diagnosed as SGA more often than non-Roma infants, suggesting that specific anthropometric norms for these infants may be useful. We aimed to construct population-based centile, gender-specific charts for birth weight and length for singleton Roma infants born from 35 to 42 weeks of gestation and to compare it with anthropometric data of non-Roma infants. METHODS: We analyzed data on 27,602 non-Roma (53 % males) and 2235 Roma (51 % males) singleton live infants delivered from 2006 to 2012 in South East Serbia. The LMS method was used to estimate the birth weight and length centiles. RESULTS: Roma infants were up to 12 % lighter and up to 4 % shorter than non-Roma infants. Estimated centile charts for Roma males and females were constructed showing the 3rd, 10th, 25th, 50th, 75th, 90th and 97th centiles. CONCLUSIONS: We created the separate centile charts for Roma ethnic group. The sample size was sufficient to demonstrate differences in mean birth weights and lengths of at term infants born during the study period.

Ocular fundus abnormalities in patients with Balkan endemic nephropathy and other chronic kidney diseases.

AIM: The aim of this study was to examine the ocular fundus pathology in patients with Balkan endemic nephropathy (BN) and chronic kidney diseases (CKD). METHODS: The study included 51 patients with BN from the South Morava River region in Serbia, and 102 subjects with different stages of chronic renal diseases, matched according to age and gender, obtained from a database used in a recently published study. All patients had visited Outpatient Department of the Clinic of Nephrology, Clinical Center Nis. All patients underwent routine ophthalmic examinations. RESULTS: There were significantly more (P < 0.001) patients with age-related macular degeneration (AMD) in the group with BN (31.37 %) than in those with CKD (5.88 %). Multivariate logistic regression analysis confirmed that the significant factors related to AMD in the group with BN were albuminuria (P < 0.05) and proteinuria (P < 0.05); in CKD patients, the level of HDL (P < 0.05), while negative correlation with the level of triglyceride was registered (P < 0.05). There was no association between estimated glomerular filtration rate and AMD. The significant factors related to retinopathy in the group with BN are age (P < 0.05) and serum creatinine values (P < 0.05), in patients with CKD increasing age (P < 0.001) and DM (P < 0.05). CONCLUSION: Ocular fundus pathology in patients with BN is similar to the pathology of other CKD, but with significantly more AMD (about four times), probably related to the genetic/epigenetic factors.

Adverse Effects of Pharmacological Therapy of Benign Prostatic Hyperplasia on Sexual Function in Men.

INTRODUCTION: The development of effective medications makes pharmacological therapy of BPH the dominant mode of treatment today. It improves urinary symptoms and prevents disease progression while producing side effects on male sexual function. OBJECTIVE: The aim of the study is to present the effects of BPH pharmacological treatment on the occurrence of sexually adverse effects in men: changes in sexual desire, erectile, ejaculatory and the orgasmic function. METHODS: A prospective study involving 156 BPH patients.The average age was 61.16 ± 2.97. Four groups of 39 patients each were formed.The 4 groups were administered tamsulosin (alpha-blocker), finasteride (5-alpha reductase inhibitor), combination therapy (tamsulosin and finasteride) respectively, while the control group received no treatment. PSS-QoL, IIEF and MSHQ-EjD questionnaires were used to evaluate the symptoms of voiding and sexual function. Follow-up examinations were performed 3 and 6 months into treatment. RESULTS: Voiding symptoms improved in all groups receiving therapy. The side effects on the sexual function in all these groups include significant disorders of ejaculation and the orgasmic function. Ejaculation disorders: tamsulosin (-4.38 ± 2.55; p < 0.001), combined therapy (-3.89± 2.84) and finasteride (-1.49 ± 2.52). Orgasmic function disorders: tamsulosin (-1.03 ± 1.94), combined therapy (-0.76 ± 2.07) and finasteride (-0.54 ± 1.68). Complete absence of ejaculation was experienced by 23% of patients on combined therapy, 15% on tamsulosin and 5% on finasteride. CONCLUSION: Pharmacological therapy of BPH improved voiding symptoms producing different effects on male sexual function. The main adverse effect on sexual function in men is the deterioration in ejaculation or the absence thereof. Clinical consideration of BPH should include the elements of male sexual function, patients' age, the characteristics and effects of each group of drugs.

Placental growth factor and placental protein 13 in patients with Balkan endemic nephropathy, a worldwide disease.

BACKGROUND: Balkan endemic nephropathy (BEN) is a chronic tubulointerstitial kidney disease occurring in people living in along the tributaries of the Danube River. The aim of the study was to determine serum level and urinary excretion of placental growth factor (PlGF) and placental protein 13 (PP13) in patients with BEN. METHODS: Thirty patients with BEN from the South Morava River region of Serbia and 18 controls were studied. Age of patients was 74 yr (53-87) and 73 yr (66-83) in controls. RESULTS: In patients with BEN, serum creatinine was significantly higher than in controls (129.7 vs. 83.2 µmol/L, respectively), but GFR was lower in patients than in controls (40.7 vs. 54.6 mL/min). Serum PlGF was significantly higher in BEN patients than in controls (9.90 vs. 6.80 pg/mL), urinary excretion being significantly lower in patients (0.20 vs. 0.90 pg/mmol creat.). Serum PP13 was significantly lower in BEN patients (208.2 vs. 291.0 pg/mL). Urinary excretion of PP13 was also significantly lower in BEN patients than in controls (32.5 vs. 182.5 pg/mmol creat). In multivariate regression analysis BEN, sex and age were significant determinants of the observed changes in PlGF and PP13. CONCLUSION: Important changes of PlGF and PP13 in patients with BEN were demonstrated, where kidney disease, female sex, and the age have been significant determinants.

Epithelial ovarian cancer with CD117 phenotype is highly aggressive and resistant to chemotherapy.

AIM: CD117 expression has a pathogenic role in many malignancies, including ovarian carcinoma. The aim of the present study was to examine the correlation of stemness-associated marker CD117 with the clinicopathologic features of epithelial ovarian cancer and patient survival. MATERIAL AND METHODS: The analysis included 240 primary ovarian carcinomas (OC) diagnosed during the period from 2005 to 2011 in the region of South Serbia. Age, pathohistological characteristics, presence and size of residual tumor, choice of therapy and response to the therapy were studied. RESULTS: Residual tumors were more frequently present in the patients with positive CD117 expression (18.1% vs 8.0%; P < 0.05). Chemotherapy according to paclitaxel/carboplatin protocol was more frequent in the patients with positive CD117 expression (70.9% vs 54.2%; P < 0.05), while carboplatin monotherapy was more frequent in the patients with negative CD117 expression (18.0% vs 6.4%; P < 0.05). Median survival time in patients with CD117-positive mucinous and endometrioid OC was significantly shorter, at 20 and 26.8 months, respectively. Median survival in serous OC was not related to CD117 expression. CONCLUSION: Residual tumors and chemotherapy treatment were more frequent in patients with positive CD117 expression. The outcome was dependent on the type of OC; a worse outcome, including a shorter survival, was documented in the mucinous and endometrioid OC cases.

Osteoporosis--a risk factor for cardiovascular diseases: a follow-up study.

INTRODUCTION: Cardiovascular (CV) diseases and bone fractures due to osteoporosis are the leading causes of death in the elderly. OBJECTIVE: The aim of this study was to demonstrate a correlation between the overall risk for CV events, and low bone density in postmenopausal women, and its impact on the incidence of serious CV events. METHODS: Our prospective study involved 300 postmenopausal women. All the examinees were divided into three groups based on their measured bone density: Group I--84 examinees with osteoporosis; Group II--115 examinees with osteopenia; and Group III--101 examinees with normal bone density. In all examinees the overall ten-year risk for a fatal CV event was calculated using the SCORE system tables. RESULTS: After a 36-month follow-up, CV events occurred in 19 (6.3%) examinees. Significant differences in the incidence of CV events were demonstrated between the patients with osteoporosis, osteopenia, and normal bone density (χ2 = 28.7; p < 0.001), as well as between those with a high and low CV risk (χ2 = 22.6; p < 0.001). Multivariate logistic regression analysis showed that smoking (OR: 2.23; 95% CI: 1.02 to 6.19; p = 0.035), and increase of overall CV score (OR: 1.36; 95% CI: 1.17 to 1.58; p < 0.001) are associated with increased CV event risk, while the increase of T score value is associated with decreased risk of CV event (OR: 0.42; 95% CI: 0.25 to 0.73; p = 0.002). CONCLUSION: Measurement of bone density with a standard assessment of the total CV risk could be useful for selecting women who need intensive prevention and treatment of atherosclerosis.

Improvement of sexual function in men with benign prostatic hyperplasia by pharmacologic therapy.

INTRODUCTION: Benign prostatic hyperplasia (BPH) causes disorders of voiding and sexual function. Phar- macologic therapy reduces symptoms of voiding thus impacting sexual function. OBJECTIVE: To determine sex life status in men with BPH before and after pharmacologic treatment adapted to achieve satisfactory sexual function. METHODS: We studied 117 sexually active BPH patients, not previously treated for BPH. After clinical examinations, symptoms of voiding, sexual and ejaculatory function were measured using standardized IPSS, IIEF and MSHQ-EjD questionnaires. After obtaining patients' personal opinion about the importance of their sex life, therapy was chosen and possible side effects explained. Three groups of 39 patients each were formed.The first group was treated with alpha-blocker, tamsulosin, the second with 5-alpha reductase inhibitor, finasteride, while the third group was administered a combination therapy. The complete examination procedure was repeated after 3 and 6 months of therapy. RESULTS: The average age of patients was 61.34 ± 3.04 years. Eighty-seven percent reported that their sex life was important to a certain degree. Satisfaction with their sex life was reported by 47% of patients before treatment and by 67% of respondents 6 months after treatment. Questionnaire scores indicated general improvement of sexual function in all groups, which was statistically significant compared to baseline only in the group on tamsulosin alpha-blocker (2.95 ± 7.81; p = 0.028). The overall satisfaction with sex life as a component of sexual function, improved significantly in the group on the combined therapy (0.78 ± 1.81; p = 0.012). CONCLUSION: Before BPH treatment sexual function should be assessed and therapy customized to the patient's expectations. Side effects of drugs should be presented especially to patients who emphasize the importance of sex life. In the manifested stages of the disease overall satisfaction with sex life may be improved by combined therapy comprising 5-alpha reductase inhibitors and third generation alpha blockers. In earlier stages, BPH alpha blockers monotherapy may improve overall sexual function.