The influence of cardiovascular diseases of the drivers on the occurrence of traffic accidents

The aim of this study was to establish the prevalence and influence of cardiovascular disorders on the occurrence of traffic accidents. The test group consisted of 620 drivers with certain cardiovascular disorders: hypertension (52.9%), arrhythmia (28.4%), coronary artery disease (10.9%), and thromboangiitis obliterans (7.7%). The behaviour of drivers with cardiovascular disorders (test group) and healthy drivers (control group) in the traffic was followed up in the five-year period. All traffic accidents caused by them were noted. Control and test groups were similar regarding the other factors that could have caused traffic accidents. We have observed that the drivers from the test group had caused traffic accidents more frequently and in average had significantly higher number of traffic accidents compared to the drivers in the control group. Drivers from the test group had longer reaction time to acoustic and visual stimulation, respectively, that could be the explanation for more frequent accidents. Results of this study suggest the need for better supervision of the drivers and the improvement of the regulations of the health conditions that must be fulfilled.

[Spongiform encephalopathies in animals and humans]

Spongiform encephalopathies include several diseases of animals and humans: sheep and goat scrapie, bovine spongiform encephalopathy (BSE). Creutzfeldt-Jakob disease (CJD) in humans and its new variant (vCJD). Common characteristics of these diseases are long-term incubation, slow and progressive course, spongiform changes within nerve tissue, neuron loss and astrocytosis. Causative agent responsible for spongiform encephalopathy is prion (PrPsc) and it represents a posttranslationally modified host protein (PrPc) which normally exists and is produced in the cells. Development of certain diseases can be influenced by genetic factors, because of mutations in the PrP gene. Pathogenesis of these diseases is still not clear. In experimental peripheral infection the ineffective agent is first detected in the spleen and lymph nodes, and then it neurally spreads to the CNS. Bearing in mind that etiology, pathogenesis and mutual connection of spongiform encephalopathies have not been completely explained yet, caution and strict veterinary and sanitary measures are of great importance.

Occupational profile and cardiac risks: mechanisms and implications for professional drivers

Of the population of 900 drivers, 419 drivers with changes in the circulatory system were enrolled in the study, and the control group consisted of 150 healthy drivers. In both groups there were professional and non-professional drivers. Traffic accidents caused by these drivers were registered over a five-year period. Drivers with cardiovascular diseases and professional drivers were more frequently responsible for accidents than healthy and non-professional drivers. The comparison between the group studied and the controls indicated over a two-fold increase in the number of accidents caused by sick drivers.

Oxidative stress and Parkinson's disease

The aim of this study was to determine the baseline state of oxidative stress indices in drug-naive patients with Parkinson's disease (PD). Cerebrospinal fluid (CSF) and peripheral blood samples of 31 subjects, in disease stages I-III, according to Hoehn & Yahr scale, were analyzed and compared with the control group. Highly significant increase of malondialdehyde content in CSF (p < 0.001) was found, as well as significant differences in peripheral blood parameters: malondialdehyde content was increased in patients with PD (p < 0.05), and also the activities of antioxidative defense enzymes, gluthathion reductase, Cu, Zn-superoxide-dismutase (p < 0.05), and the production of highly reactive oxygen species-superoxide radical (p < 0.05). Those findings indicated the important role of oxidative stress in Parkinson's disease evolution and progress. The findings of increased amount of reactive oxidative species (malondialdehyde content and superoxide radical production) in peripheral blood, and excessive activity of protective enzymatic systems (gluthathion reductase Cu, Zn-superoxid-dismutase) suggested the additional systemic reaction related to chronic oxidative stress state in the brain.

An attempt to establish an in vitro-in vivo correlation: case of paracetamol immediate-release tablets

The purpose of this study was to investigate the possibility of developing different levels of in vitro-in vivo correlation for immediate-release paracetamol tablets using in vitro dissolution data obtained under various experimental conditions. The influence of agitation intensity and pH value of the dissolution media was investigated. The level B approach, using statistical moment analysis led to poor correlation results. The results obtained by numerical deconvolution in order to study level A correlation indicated that good correlation should be sought with moderate levels of agitation (beyond 50 rpm in rotating basket apparatus). Results obtained by numerical convolution showed the highest level of correlation, level A, with one-to-one relationship between observed and predicted in vivo profiles.

The influence of Eudragit type on the dissolution rate of acetylsalicylic acid from matrix tablets

The effect of four Eudragits used as matrix substances on the physical characteristics of tablets and on the dissolution rate of acetylsalicylic acid has been investigated. The concentration of matrix substance necessary for achieving the appropriate effect of sustained release of acetylsalicylic acid (ASA) depends on the type of Eudragit used. For tablets prepared using Eudragit RS-100, Eudragit L-100-55 and Eudragit S-100, the acceptable dissolution rate of ASA was obtained with only 3% of polymer. In the case of Eudragit RL-100, to obtain the same effect, 10% of polymer was required. The dissolution data were evaluated on the basis of theoretical dissolution equations and by linear transformation of dissolution curves. The following mathematical models were employed: zero order equation, first order kinetics, Hixon-Crowell's cube root kinetics and diffusion model. The results indicated that the fitness of the kinetic model was dependent on the type of Eudragit used.

[Problems and perspectives in child health care]

Health care protection of children in Vojvodina is of particular importance regarding the negative natural birth rate. In spite of difficult economic situation, health care of children in Vojvodina is permanently carried out and would be significantly better in quality if the education of subspecialized personnel, space facilities, technological innovations, computerization and continuous education were available. Introduction of microanalytic laboratory techniques is essential for monitoring of prematures. Propagation of natural nutrition is an obligation of pediatricians. Respiratory diseases are still on the top of morbidity pyramid but tuberculosis is evidently in increase. An important health care problem is the expansion of allergic diseases. The progressive incidence of insulin-dependent diabetes is also evident. The spheres of juvenile gynecological endocrinology and andrology are still underdeveloped and that also applies to adolescent medicine. Toxicology remains an ongoing problem in pediatrics due to an increased number of accidental poisoning. Pediatricians-gastroenterologists are lacking while paediatric hepatology should be brought into more advanced state. Bone marrow and stem cells transplantation is in the responsibility of the Centre for haematology and oncology. Nephrology department lacks children's haemodialysis, ultrasound biopsy of kidneys, urodynamic analyses and new staff facilities. The increased number of survivals in case of children with with sequeles inevitably asks for better development of rehabilitation, prolonged treatment and teamwork. Intensive care and therapy department requires new staff and high technology capacities. Development of children's surgery department inevitably means the reconstruction of space facilities, modern equipment and new subspecializations. Preventive outpatient service is performed through systematic examinations. ultrasound diagnostics of hips, auditive screening and educational program activities related to addiction and veneral diseases. Genetic health of the population is supremely covered by the Center for Medical Genetics, with the tendenca for development of molecular genetics. It is necessary to develop rehabilitation service, prolonged treatment and teamwork. Diagnostic of convulsive conditions should be advanced with more refined diagnostic methods.

[Analysis of the health status of intoxicated motor vehicle drivers and the effect of therapeutic and health education programs]

The analysis of health state of drivers sent for an extra health examination for the estimation of driving capability for the driving of motor vehicle in alcoholic state was presented. The study included 380 drivers who were found driving drunk by traffic police (studied group) and 180 drivers of control group sent for an extra health examination for some other reason. The disorders in psychomotor sphere were noticed in the drivers of studied group and it was determined that they had caused significantly larger number of traffic accidents in last five-year period compared to the drivers of control group. The alcohol consumption in driving population represents significant medical, social, economic and traffic problem. The control of driver's alcoholism, the sending of alcoholic drivers to an extra health examination for the repeated estimation of driving capability and including in therapeutic and health-educational program can present significant measure of the primary prevention of road traffic traumatism which is on the constant increase.

[Reliabilty of the antibiogram and plasmid profile in detection of epidemic strains of Shigella sonnei]

The aim of the study was to investigate and compare the type of resistance to antibiotics and plasmid profile of Shigellae sonnei isolated at epidemics of bacillary dysentery to determine which method was most reliable in the identification of epidemic strains of that bacteria. It was investigated 130 isolates of Sh. sonnei isolated from the stools of patients in 14 epidemics of bacillary dysentery in Yugoslav Army and citizens in period from 1987 to 1993 year. On the basis of identity of studied features of all isolates originated from one epidemic, epidemic strains of Sh. sonnei could be identified in 10 (71.4%) of 14 studied epidemics by means of plasmid profile, and in 8 (57.1%) epidemics by means of determination of resistance type to antibiotics. According to that, the method of plasmid profile analysis is more reliable in identification of Sh. sonnei epidemic strains compared to the method of determination of resistance type to antibiotics.

[Psoriatic arthritis: case report of acute HLA-B27 positive polyarthritis preceding the onset of typical skin changes]

Psoriasis usually occurs many years before development of arthritis. This is a case report of a patient with acute polyarthritis affecting both peripheral joints and the left sacroiliac joint, preceding the appearance of typical skin manifestations for almost two months. A 44-year-old male mechanic was admitted to our institution for acute additive polyarthritis. Inflammatory synovitis primarily affected large peripheral joints (knees, ankles) in an asymmetrical pattern, with a concomitant development of unilateral sacroiliitis and later with asymmetrical involvement of several proximal and distal interphalangeal joints of the hands and feet. There were also signs of enthesopathy of the right heel. Arthritis was not proceeded by infection of the lower genital or gastrointestinal tract or serological and bacteriological evidences of streptococcal or HIV infection. Laboratory findings showed an erythrocyte sedimentation rate (92 in the first hour), positive histocompatibility antigen HLA-B27 and an increased level of acute phase reactants. Almost two months after affecting the locomotor system a typical psoriatic rash developed, first affecting the scalp and then spreading over the trunk and extremities. It was accompanied by severe onychodystrophy. The patient underwent intensive treatment with methylprednisolone (1.5 mg/kg) and cyclosporine A with significant results.

Oxidative and antioxidative activity in the patients with disseminated demyelinating disease of central nervous system

Considering the basic pathologic process and current knowledge of the physiopathologic mechanisms in the active phase of disseminated demyelinating disease of central nervous system, the increase of oxidative processes was assumed in the patients with that disease in the phase of clinical impairment. The aim of the research was to study some indices of oxidative processes and activity of antioxidative enzymes in such patients. The research was performed on blood samples (erythrocyte hemolysate and plasma) and cerebrospinal fluid of 30 patients with disseminated demyelinating disease of central nervous system during the clinical impairment and during the increase of immunologic activity in intrathecal space. The patients were of younger age, in the acute phase or with the shorter disease duration (up to 3 years). Control group was formed of 12 patients examined for lesions of intervertebral disks in lumbosacral region. The research results demonstrated the increase of superoxide anion production, the elevation of lipid peroxidation followed by the increase of superoxide dismutase and glutathione reductase activation. It was concluded that the signs of simultaneous increase of oxidative processes and antioxidative activity, but also the oxidative impairment of lipid structures existed in the studied patients during the acute phase.

[The Miles-Thompson-Bricker method of total pelvic exenteration in malignant tumors of the rectum with urinary bladder infiltration]

The radical method of surgical treatment of malignant rectal neoplasms, total pelvic exenteration by Miles-Thompson-Bricker, was introduced in the Clinic for General and Vascular Surgery of Military Medical Academy in October, 1993, 45 years after the first operation of that kind in the world. This method of surgical treatment was indicated in 3% of our patients with malignant neoplasms of the distal part of rectum that infiltrated the urinary bladder. The life of patients with two stomas though not easy, was prolonged.

[Changes in F-response parameters in supraspinal lesions of the central nervous system]

Since the F response is the result of antidromic activation of limited number of alpha motor neurons, the motor neurons excitability level can be investigated and established by analyzing parameter values of F response. The excitability of alpha motor neurons is the result of balance between excitatory and inhibitory influences of mainly supraspinal origin. The aim of this study was to perform the analysis of basic parameters of the F response in the lesions of pyramidal, extrapyramidal and cerebellar system, and to determine the eventual predictive value of the F response in lesion outcome. The investigations were carried out in 65 patients and 30 neurologically healthy subjects in control group. The patient group consisted of 38 patients with pyramidal lesions due to ischemic stroke, 15 patients with Parkinson's disease and 12 patients with vascular cerebellar lesions. The F response investigations were repeated monthly during 12 months in 12 patients with ischemic stroke. The results showed significant increase in F amplitude and frequency. These changes were in positive correlation with the increase of spastic muscular tone. In patients with cerebellar lesions decreased amplitude and frequency of F response were in positive correlation with the reduction of muscle tone. It was concluded that the measurement of the F response parameters might be reliable marker of the alpha motor neurons excitability and might have predictive value in the early phase of ischemic stroke.

Morphologic characteristics of primary nonperforative intestinal blast injuries in rats and their evolution to secondary perforations

Five hundred and fifty Wistar rats were investigated to determine the frequency of secondary intestinal perforations after exposure to nonperforating blasts and the evolution of the morphological changes from hematoma through to necrosis and gangrene. The animals were observed at different times for a period of 14 days from the moment that the injury was inflicted. Microscopic findings showed that alterations began in the mucosal layer where they were most extensive, then spread to the submucosal layer, muscular layer, and serosal layer, respectively. Examination of the intestinal wall revealed an evolution of the injury from hematoma to necrosis to gangrene, resulting in secondary intestinal perforation. The secondary wounds had centrifugal patterns, opposite those of the original wound pathways. Based on these observations, the mechanism of evolution of primary nonperforating intestinal blast injury into secondary intestinal perforations is presented.

[Immunologic response in patients with atopic dermatitis]

It is a well known fact that atopic dermatitis, as one of the clinical manifestations of atopic syndrome, is characterized by a number of immunologic disorders. In 17 patients with atopic dermatitis we examined: systemic cellular immunity, production of total serum IgE, specific IgE to certain aero-allergens, cutaneous hypersensitivity of an early type to aero-allergens and chemotaxis activity of neutrophils and monocytes. Increased production of IgE proved to be the main disorder which confirms increased values of the total IgE in serum, specific IgE to inhalatory allergens and cutaneous hypersensitivity of an early type to inhalatory allergens in 11 (64.70%) patients. In regard to aero-allergens the most common atopics are pollens and Dermatophagoides pteronyssinus. Decreased number of CD8+ T-lymphocytes and decreased chemotaxis activity of neutrophils was established in some cases.

Emergency treatment and early fluid resuscitation following electrical injuries

Injuries caused by high-tension electrical current are rare, but pathophysiologically unique with destructive effects. As a form of thermal trauma, electrical injuries represent a connection of skin burns and deep tissue destruction unpredictable in its depth which mostly resembles a crush injury. Emergency treatment measures begin with the separation from the electrical contact if any and prompt transport to the nearest institution with all means for cardiorespiratory resuscitation and complete recovery. Resuscitation of the patient after electric shock continues then with fluid replacement using special formula modified for such cases, correction of acidosis and myoglobinuria and finally with escharotomy and fasciotomy which is most often necessary.

[Pathogenic mechanisms of importance for the development of secondary hyperparathyroidism in chronic renal insufficiency]

Secondary hyperparathyroidism is a complex pathophysiologic event which we examined in hundred patients Sixteen of them belonged to the control with normal renal function, and the rest of them were categorised into four subgroups according to the actual level of chronic renal failure, determined by GFR a.i. by endogenous creatinine clearance. We determined the serum level of parathormone (C-PTH) and plasma concentration of phosphate and calcium in all of patients. In 43 of them we measured serum level of 1.25 dihydroxycholecalcipherol and ionised calcium. Our results suggested an important parallelism between parathormone hypersecretion (GFR +/- 58.3 ml/min), 1.25 dihydroxycholecalcipherol hypovitaminosis (GFR +/- 50.7 ml/min) and hypocalcemia (GFR +/- 47.7 ml/min) which connect them in very strong relationship. Even if secondary hyperparathyroidism in chronic renal failure is caused by numerous factors, it appears that the hypovitaminosis of 1.25 dihydroxycholecalcipherol with consequent hypocalcemia and phosphate retention acts as a main movement of this complex pathophysiology mechanism.

[The effect of drivers' health status on the occurrence of traffic accidents]

The analysis of the influence of the drivers' health condition on the occurrence of traffic accidents was presented. The tested group consisted of 930 drivers with diseases or conditions that demanded the constant health control and monitoring. Control group was composed of 320 completely healthy drivers. Both groups were approximately similar in relation to the other factors that could influence the occurrence of traffic accidents. The behavior of these drivers was followed up in the four-years period. The results suggested that drivers with certain diseases and conditions, (psychological-psychiatric conditions and diseases, arterial hypertension, diabetes mellitus, hearing and sight impairments, varices cruris, stomach and duodenal ulcers) significantly more often cause the traffic accidents, compared to healthy drivers. The need for constant and rigorous health selection for drivers is imposed in order to alleviate the epidemic of traffic traumatism.