Hospital In Belgrade Research Articles

Geriatrics in Serbia nowadays

<p>The first hospital department for the treatment of elderly people in the world was founded by Laza Lazarević in Belgrade in 1881. The Division of Geriatrics of the Department of Internal Medicine at the City Hospital in Belgrade was founded in 1963, as the first one in the former Yugoslavia. The first regional department within the field of gerontology was founded at the Medical Faculty in Belgrade in 1995. In 1998, the first university textbook on geriatrics was published in Belgrade. Geriatrics exists as a subspecialization of internal or general medicine. In the last few decades, the subspecialization format has changed from subspecialization in gerontology, through the specialization in geriatrics, to the current format. In Serbia, the health activists in the field of geriatrics and gerontology are gathered by Gerontological Society of Serbia and are also members of Geriatric Section of the Serbian Medical Society. Health professionals, geriatricians and gerontologists, are members of the Serbian Association of Geriatricians and Gerontologist, which is a member of the European Geriatric Association. Currently, Serbia has more than 1.3 million inhabitants over 65 years of age. By 2050, it is estimated that one-third of the Serbian citizens will belong to the elderly population. The benefits each country has from the health professionals educated in the field of geriatrics are the following: better quality of life of elderly patients, reduction in mortality rate and increased life expectancy of the elderly, decrease in the percentage of rehospitalization of elderly patients, as well as reduction in health care costs.</p>

Influenza A H1N1 virus infection among pregnant women in a tertiary hospital in Belgrade, Serbia.

Pregnant women are at higher risk of developing severe influenza. Our aim was to analyze clinical course and risk factors for fatal outcome in pregnant women with influenza (H1N1) infection. This retrospective study enrolled eleven pregnant women with confirmed Influenza A (H1N1) infection treated in the Clinic for Infectious and Tropical Diseases, Belgrade, Serbia in a 6-years period. The mean age of pregnant women was 28.9 ± 5.2 years, and mean gestational age was 23.1 ± 7.0 weeks. Nine (81.8%) pregnant women had pneumonia (six had interstitial and three had bacterial pneumonia). Pregnant women developed pneumonia more often than other women in the reproductive period, but without statistical significance (81.8% vs. 65.7%, p = 0.330, OR (95% CI) 2.35 (0.47-11.80)). Nine (81.8%) pregnant women recovered. None of them experienced preterm delivery or abortion. Two women (18.2%) died due to acute respiratory distress syndrome. In one of them fetal death occurred one day before she died. The other one was performed caesarean section three days before death. Her newborn and children of all recovered women were healthy at birth. Prolonged time to initiation of oseltamivir and higher body mass index were statistically significantly associated with fatal outcome (p = 0.002, and p = 0.007, respectively). Gestational week of pregnancy, the etiology of pneumonia and comorbidity were not found to be risk factors for death (p = 0.128, p = 0.499 and p = 1.000, respectively). Pregnant women with H1N1 infection are at higher risk of pneumonia and death than other women in the reproductive period. Early antiviral therapy reduces the risk of unfavorable outcome.

Occurrence of Clostridium difficile infections in Serbia and high proportion of PCR ribotype 027 strains in two hospitals in Belgrade

BackgroundThe incidence of Clostridium difficile infections (CDI) in the Clinical Center of Serbia (CCS) and the entire Serbia has been constantly rising in the previous 5 years. We aimed to study C. difficile PCR-ribotypes isolated from patients hospitalized at two healthcare institutions: CCS and Specialized Hospital for Cerebrovascular Diseases “Sveti Sava” (SS), both of them from Belgrade, and to investigate the incidence rates of CDI in hospital settings in Serbia, from 2009 to 2013. MethodsThe Bacteriology laboratory database at Clinic for Infectious and Tropical Diseases of CCS was queried from January 1, 2009 to December 31, 2013 for all patients who underwent immunochromatographic toxin A and/or toxin B stool testing and C. difficile stool culture for suspected infection caused by this bacterium. Toxigenic culture was not performed. Ninety- six C. difficile isolates were then selected and characterized by PCR-ribotyping. These were obtained from 94 patients hospitalized in different clinics of CCS and SS from November 2011 to December 2013. ResultsAmong 6164 stool samples sent to Bacteriology laboratory for culture of C. difficile and toxin detection during the study period, 1775 (28.8%) were positive, displaying linear trend of growth. From 96 isolates, typed by PCR-ribotyping, majority (85; 88.54%) belonged to PCR-ribotype 027. The remaining 11 isolates belonged to PCR-ribotypes 014/020 (3 isolates), 015, SLO 191 (two isolates each), 017, 018, 070 and 001/072 (one isolate each). ConclusionOur results demonstrated that C. difficile PCR-ribotype 027 is by far predominant in two hospital settings in Belgrade, at least since 2011.

P22.01: Fetal echocardiography and pregnancy outcome in Serbia

To analyse the influence of fetal echocardiography on pregnancy outcome after prenatal diagnosis of congenital heart defects in tertiary institution in Serbia. This is the first and the largest study of this type in our country. We analysed 14500 fetal echocardiography exams in period 1991-2014 which were performed at Clinic of Gynecology and Obstetrics, Clinical Centre of Serbia and University Children's Hospital in Belgrade. Obtained data was presented descriptively, by percentage and indicators of diagnostic accuracy: sensitivity and specificity. Among total of 9055 examined fetuses, pathological finding on the fetal heart was found in 638 cases. The most common congenital heart defects were structural anomalies of the fetal heart in 81%, of which 13.3% were HLHS and 11.2% VSD. Of all fetuses with diagnosed congenital heart defects, 295 (46.2%) were born alive and had good postnatal prognosis. In group of liveborn, the highest survival rate was observed in children with shunt defects (24%) and arrhythmias (33,5%). Fetal demise occurred in 17 (2.7%) of pregnancies. In early neonatal period died 68 (10.6%). Pregnancy was terminated in 40.4% cases with isolated severe congenital heart defects or in cases with concomitant fetal anomalies or chromosomopathies. Some sort of intervention was required in 110 fetuses (17,2%). Postnatal surgical correction of congenital heart disease underwent 75 (11,7%) neonates. Postoperatively died 9 (1,4%) neonates. Sensitivity of fetal echocardiography in our group was 95,92%, specificity 99,91%. Fetal echocardiography had high influence on pregnancy outcome in our study given the fact that Serbia is still country in transition with limited options for congenital heart defects treatment. Despite relatively high percentage of terminated pregnancies in cases with poor prognosis, good outcome was achieved in cases with correctible fetal heart defects.

Risk factors for Clostridium difficile infection in surgical patients hospitalized in a tertiary hospital in Belgrade, Serbia: a case\u2013control study

BackgroundThe objective of this study was to investigate independent risk factors (RFs) connected with healthcare-associated (HA) Clostridium difficile infection (CDI) in surgical patients, its frequency per surgical wards and in-hospital-mortality at a single hospital.MethodsRisk factors for the infection were prospectively assessed among surgical patients with laboratory confirmed HA CDI and compared with a control group without HA CDI.ResultsThe overall incidence rate of HA CDI was 2.6 per 10000 patient-days. Significant independent RFs for HA CDI were the use of carbapenems (P = 0.007, OR: 10.62, 95% CI: 1.93–58.4), the admission to intensive care unit (P = 0.004, OR:3.00, 95% CI:1.41–6.40), and the administration of 3rd generation cephalosporins (P = 0.014, OR:2.27, 95% CI:1.18–4.39). Patients with HA CDI had significantly higher in–hospital mortality compared to controls (P: 0.007; OR: 8.95; 95% CI: 1.84–43.43).ConclusionsCDI is an important HA infection in population of surgical patients and this study emphasizes the importance of the wise use of antibiotics, and other infection control strategies in order to prevent HA CDI, and to decrease the incidence and in-hospital mortality rate.

Temperature, pH and Trimethoprim-Sulfamethoxazole Are Potent Inhibitors of Biofilm Formation by Stenotrophomonas maltophilia Clinical Isolates.

Stenotrophomonas maltophilia, an opportunistic pathogen usually connected with healthcare-associated infections, is an environmental bacterium. Intrinsic resistance to multiple antibiotics, with different virulence determinants in the last decade classified this bacterium in the group of global multiple drug resistant (MDR) organism. S. maltophilia clinical isolates, were collected from tertiary care pediatric hospital in Belgrade, Serbia to investigate influence of different factors on biofilm formation, kinetics of biofilm formation for strong biofilm producers and effect of trimethoprim-sulfamethoxazole (TMP/SMX) on formed biofilm. Most of the isolates (89.8%) were able to form a biofilm. Analysis of biofilm formation in different growth conditions showed that changing of temeperature and pH had the stronggest effect on biofilm formation almost equally in group of cystic fibrosis (CF) and non-CF strains. TMP/SMX in concentration of 50 μg/ml reduced completely 24 h old biofilms while concentration of 25 μg/ml effects formed biofilms in a strain dependent manner. Among strains able to form strong biofilm CF isolates formed biofilm slower than non-CF isolates, while shaking conditions did not affect biofilm formation. Swimming motility was detected in both CF and non-CF isolates, however more motile strain formed stronger biofilms. This study suggests that temperature, pH and TMP/SMX had the strongest influence on biofilm formation in analyzed collection of S. maltophilia. A positive correlation between motility and strength of formed biofilm was demonstrated.

Contribution of architect Danilo Vladisavljevic to the transformation of the public space of Belgrade in the late nineteenth and early twentieth century

Architect Danilo Vladisavljević belongs to the generation of architects who, at the turn of the XIX century, left a significant mark in the Serbian architecture. His public buildings in Belgrade, which were mainly designed in cooperation with other architects, contributed to the representativeness of the city, which, at that time, began to intensively take on the characteristics of major European centres. The main feature of his work was a pluralist style, which involved evoking romanticism, use of academic postulates and art nouveau facades. He built various residential buildings for influential citizens and implemented pioneering urban projects on the territory of Belgrade, Military Hospital Complex in Vračar. He also built facilities for military purposes such as the military barracks in Niš, Valjevo and Smederevska Palanka and two hotels in a prestigious location at the very centre of Belgrade - the 'Splendid' and the 'Union'. Especially fruitful was his collaboration with the engineer Miloš Savčić on multi-storey outlet buildings such as The Trade and Export Bank, Vračar Savings Bank and the industrial complex of the Belgrade Slaughterhouse. During this cooperation, Danilo Vladisavljević was responsible for the facades and for further development of Miloš Savčić's designs. His collaboration with architect Svetozar Jovanović on the Officers' Cooperative Building produced one of the most representative examples of secession architecture in Belgrade. In the process of transforming public spaces in Belgrade, architect Vladisavljević particularly gave important contribution through cooperation with Milo Savčić in realization of the complex of the Belgrade Slaughterhouse, as well as the pioneering urban complex of the Military Hospital in Belgrade. As an important architect from the turn of the XIX century, Danilo Vladisavljević deserves contextualization and actualization in Serbian architectural historiography, and his structures should be treated as an important part of the Serbian architectural heritage.

Transcatheter closure of patent ductus arteriosus using Flipper coil and Amplatzer Duct Occluder: Ten-year experience from a single center

Introduction/Objective. Transcatheter closure is a well-established procedure for treatment of patent ductus arteriosus (PDA). We aimed to make a comparison between transcatheter PDA occlusion with Flipper coil and Amplatzer Duct Occluder (ADO) and to determine the incidence and significance of procedural complications. Methods. Between November 2004 and October 2014, 148 patients were eligible for transcatheter PDA closure at the University Children?s Hospital in Belgrade, Serbia. The median age was 5.9 years (the range of 0.9 years to 17.3 years) and the median weight was 21 kg (the range of 8.8 kg to 94 kg). Follow-up evaluations with Doppler echocardiogram were performed at one day, three months, and one and two years after the PDA occlusion. Results. Median narrowest PDA diameter was 1.5 mm (the range of 0.5 mm to 5.6 mm). Flipper coil was used for PDA closure in 84 (59.2%) and ADO in 58 patients (40.8%). There was no significant difference in the rate of immediate complete closure between the coil and the ADO group (86.9% vs. 75.9%, p = 0.089), but a significantly higher rate of complete closure was achieved with ADO at one day (83.3% vs. 98.3%, p = 0.004), three months (85.7% vs. 100%, p = 0.002), and both one and two years after the implantation (91.7% vs. 100%, p = 0.041). In total, 12 complications occurred during the procedure, seven of which with coil and five with ADO occlusion of PDA. Conclusion. Transcatheter closure of PDA using both coils and ADOs is a very safe and effective procedure. ADO proved superior to coil in terms of complete closure rate as early as one day after the procedure.

The effects of the socioeconomic status of Serbian families children with coeliac disease on gluten-free diet

Objective. To determine the effects of the socioeconomic characteristics of Serbian families with coeliac children (education level, employment, number of family members, monthly family income) on a gluten-free diet outcomes, as measured by serologic tests (tTG). Methods. The sample included 116 parents and the same number of children and adolescents (N = 116) diagnosed with the coeliac disease who had followed a gluten-free diet for at least a year. Children were aged 5-18 years. The research was carried out at the University Children's Hospital in Belgrade and the Institute of Mother and Child Health 'Dr Vukan Čupić' in Belgrade. The research was conducted during the period April-December 2016. The instruments used in the research were the Socioeconomic Survey Questionnaire and the Documentation Sheet, both specially designed for the purpose of this study. Results. The results of our study have shown that the mean age of mothers was 39.6 years and fathers 43.4 years. Parent respondents reported completed secondary education in 58% (116) of all cases. 46.55% of mothers and 35.34% fathers of the examined children with coeliac disease were not permanently employed. 82.76% of parents were married. Four-member families were most common. Considering the specific needs, 51% of the parents perceived their income level as very low and low. Serologic tests confirmed the efficacy of the therapy in 25.86% (30/116) of the children. Conclusion. The poor success of a gluten-free diet in the coeliac children and adolescents pointed out to the major impact of a lower socioeconomic status of their families. Taking into account all the difficulties in the implementation of a gluten-free dietary restrictions for children in Serbia, it becomes clear that the engagement of the whole society, and not just the members of their families, is necessary.

Genotypic and Phenotypic Characterization of Stenotrophomonas maltophilia Strains from a Pediatric Tertiary Care Hospital in Serbia.

BackgroundStenotrophomonas maltophilia is an environmental bacterium and an opportunistic pathogen usually associated with healthcare-associated infections, which has recently been recognized as a globally multi-drug resistant organism. The aim of this study was genotyping and physiological characterization of Stenotrophomonas maltophilia isolated in a large, tertiary care pediatric hospital in Belgrade, Serbia, hosting the national reference cystic fibrosis (CF) center for pediatric and adult patients.MethodsWe characterized 42 strains of cystic fibrosis (CF) and 46 strains of non-cystic fibrosis (non-CF) origin isolated from 2013 to 2015 in order to investigate their genetic relatedness and phenotypic traits. Genotyping was performed using sequencing of 16S rRNA gene, Pulse Field Gel Electrophoresis (PFGE) and Multi locus sequencing typing (MLST) analysis. Sensitivity to five relevant antimicrobial agents was determined, namely trimethoprim/sulfamethoxazole (TMP/SMX), chloramphenicol, ciprofloxacin, levofloxacin and tetracycline. Surface characteristics, motility, biofilm formation and adhesion to mucin were tested in all strains. Statistical approach was used to determine correlations between obtained results.ResultsMost of the isolates were not genetically related. Six new sequence types were determined. Strains were uniformly sensitive to all tested antimicrobial agents. The majority of isolates (89.8%) were able to form biofilm with almost equal representation in both CF and non-CF strains. Swimming motility was observed in all strains, while none of them exhibited swarming motility. Among strains able to adhere to mucin, no differences between CF and non-CF isolates were observed.ConclusionsHigh genetic diversity among isolates implies the absence of clonal spread within the hospital. Positive correlation between motility, biofilm formation and adhesion to mucin was demonstrated. Biofilm formation and motility were more pronounced among non-CF than CF isolates.

Improving the Diagnosis of Children with 22q11.2 Deletion Syndrome: A Single-center Experience from Serbia.

The incidence of the 22q11.2 microdeletion among children who have at least two out of five major clinical criteria for 22q11.2 deletion syndrome. Prospective study. University Childrens Hospital in Belgrade, Serbia between 2005 and 2014. 57 patients with clinical characteristics of 22q11.2 deletion syndrome. Standard G-banding cytogenetic analysis was performed in all children, and the 22q11.2 genomic region was examined using fluorescence in situ hybridization (FISH). For patients with no deletion detected by FISH, multiplex ligation-dependent probe amplification (MLPA) analysis was also done in order to detect cryptic deletions of this region and to analyze other genomic loci associated with phenotypes resembling the syndrome. A selected group of patients diagnosed to have 22q11.2 microdeletion by FISH underwent MLPA testing in order to characterize the size and position of deletion. The frequency of 22q11.2 microdeletion among children with at least two of the five major characteristics of 22q11.2 deletion syndrome (heart malformations, facial dysmorphism, T-cell immunodeficiency, palatal clefts and hypocalcemia/hypoparathyroidism). Typical 22q11.2 microdeletion was detected in 42.1% of patients; heart malformation were identified in all of them, facial dysmorphism in 79.2%, immunological problems in 63.6%, hypocalcemia in 62.5% and cleft palate in 8.3%. A higher detection rate compared to one-feature criterion is obtained when at least two major features of 22q11.2 deletion syndrome are taking into consideration. The criteria applied in this study could be considered by centers in low-income countries.

Non-alcoholic fatty liver disease is associated with insulin resistance and lipid accumulation product in women with polycystic ovary syndrome.

What are the most relevant factors associated with non-alcoholic fatty liver disease (NAFLD) in women with polycystic ovary syndrome (PCOS)? Insulin resistance (IR) and lipid accumulation product (LAP) are independently associated with NAFLD in PCOS. Obesity and IR are frequently present in both women with PCOS and subjects having NAFLD. The coexistence of PCOS and NAFLD might synergistically increase the risk for both type 2 diabetes (T2DM) and cardiovascular disease (CVD). LAP, calculated from waist circumference (WC) and triglycerides (TGs) concentrations [(WC-58) × TGs], has been shown to represent an integrated marker of cardiometabolic risk in women with PCOS. This cross-sectional study included 600 Caucasian women diagnosed with PCOS by the Rotterdam criteria between May 2008 and May 2013. The study was done at the university hospitals in Belgrade, Serbia and Thessaloniki, Greece. All subjects underwent anthropometric measurements and analyses of fasting blood glucose, insulin, lipids, total testosterone and SHBG, as well as liver tests (transaminases, γ-glutamyltransaminase, total bilirubinand alkaline phosphatase). Calculations for a NAFLD liver fat score (NAFLD-LFS) (with, accordingly, determination of metabolic syndrome and testing for T2DM) as well as homeostasis model assessment of IR (HOMA-IR), LAP as a marker of visceral adiposity, and free androgen index (FAI) were performed. We evaluated the prevance of NAFLD and analyzed associations of the above variables with NAFLD. NAFLD was more prevalent in patients with PCOS than in controls (50.6 versus 34.0%, respectively). Women with PCOS had higher readings for WC, LAP, insulin and HOMA-IR, total cholesterol and TGs than controls (P < 0.001). In PCOS women, the NAFLD-LFS significantly (P < 0.001) correlated with WC, BMI, glucose, HOMA-IR, TGs, LAP and FAI. In multivariate logistic regression, HOMA-IR and LAP were independently associated with NAFLD (P ≤ 0.001). A possible weakness of the study may be the absence of structural confirmation of liver status. Hovewer, liver biopsy is invasive, difficult to perform in large populations and carries some risk of complications while magnetic resonance spectroscopy does not provide any information regarding the presence of fibrosis and is not routinely available. Another possible limitation could be the measurement of total testosterone by radioimmunoassay, which can be inaccurate when determining low levels of testosterone. Finally, fewer controls than subjects in the study group could have affected the significance of the results. There is a debate on the most accurate clinical method for diagnosing liver disease as an early predictor of T2DM and CVD in general population and in PCOS women. There current study provided data on this issue from a cohort of Caucasian women with PCOS. The study was supported by a research grant by the Serbian Ministry of Science and Education (grant nos 41009 and 175032). All authors have no competing interests.

A Comparative Analysis of Laparoscopic Appendectomy in Relation to the Open Appendectomy in Children / Uporedna Analiza Laparoskopske Apendektomije U Odnosu Na Otvorenu Apendektomiju Kod Dece

Abstract Acute inflammation of the appendix in childhood usually requires an appendectomy. Surgical methods are open appendectomy (OA) and laparoscopic appendectomy (LA). Both have the same goal of removing the appendix. Data collected from the medical records of children who underwent hospitalization and operation for acute appendicitis have been retrospectively analysed and statistically processed. The patients underwent surgery in 2010 at University Children’s Hospital in Belgrade, and the methods that were used were open appendectomy (OA) and laparoscopic appendectomy (LA). The analysed data refer to gender, age, length of hospital stay, surgery duration, use of pain management therapy, and antibiotic therapy, complications during surgery, complications after surgery, re-hospitalizations, and reoperations. A total of 218 children underwent an appendectomy operation, of which 158 (72.5%) underwent OA and 60 (27.5%) underwent LA. The average age of patients who had OA was 11.44 years, and 10.87 years for those who underwent LA. The surgery duration was significantly longer for LA (45.3 vs. 42.1 minutes, p = 0.003). The total number of postoperative complications was lower in LA (1 vs. 12), but there was no statistically significant difference. The number of hospital stay days was significantly lower in LA (3.48 vs. 5.45 days), with a high statistical difference, p = 0.00. The advantages of LA compared with OA are shorter hospital stay, lower total number of intraoperative and postoperative complications, and fewer reoperations. The advantage of OA compared with LA is shorter surgery duration.

Determinants of job satisfaction of healthcare professionals in public hospitals in Belgrade, Serbia - cross-sectional analysis

The quality of health care significantly depends on the satisfaction of the employees. The objective of this study was to establish the level of professional satisfaction of healthcare professionals in state hospitals in Belgrade, Serbia, and to determine and to rank the factors which impact on their satisfaction or dissatisfaction. Professional satisfaction survey was designed and conducted as a cross-sectional study in 2008. Completed questionnaires were returned by 6,595 healthcare professionals from Belgrade's hospitals. Statistical analysis was performed using the Student's t-test, χ² test and ANOVA. Factor analysis was applied in order to define determinants of professional satisfaction, i.e. dissatisfaction. This study showed that the degree of professional satisfaction of Serbian healthcare professionals was low. The main causes of professionals'dissatisfaction were wages, equipment, the possibility of continuous medical education/training and the opportunities for professional development. Healthcare professionals with university education were more satisfied with all the individual aspects of job satisfaction than those with secondary school and college education. There were significantly more healthcare professionals satisfied with their job among males, older than 60 years, in the age group 50-59 years, with managerial function, and with 30 or more years of service. Development strategy of human resources in the Serbian health care system would significantly improve the professional satisfaction and quality of the provided health care.

Effect of age, sex and the insulin regiment on insulin needs in children and adolescents suffering from diabetes mellitus type 1

INTRODUCTION: The purpose of this study was to generate insulin dose (ID) percentiles for children and adolescents with type 1 diabetes mellitus (DM1) having the opportunity to assess this important parameter in relation to age and sex. Individual intensive substitution of insulin is vital for achieving optimum metabolic control in children and adolescents suffering from type 1 diabetes. AIM OF THE STUDY: The aim of this study is: to examine the basic factors which determine daily insulin needs; to establish average insulin doses of the examinees of different ages and sexes and to present them in the form of figures - percentile tables. METHODS: Medical documentation of 100 examinees (55 girls and 45 boys), ages 2-18 were analyzed at the Children's University Hospital in Belgrade in the period between August 1994 and August 2002. All the examinees achieved a satisfactory metabolic control of diabetes after the period of the remission of the disease. The examinees had the conventional insulin therapy (KITh) and intensive therapy (IITh), and they were all using humane insulins. RESULTS: On the basis of the data analysis it has been established that the average insulin dose at ages 3-9 is 0.8 IJ/kg/24h in both sexes, and that from the age of 10 the need for insulin considerably increases with metabolic control deteriorating at the same time. Insulin needs are the greatest during adolescence, especially in girls (1.20 IJ/kg/24h). The ranges of insulin doses show that every child needs an individual approach and estimate of insulin needs. CONCLUSION: It has been concluded that daily insulin needs grow with the growth of chronological age (0.8 before adolescence and 1.16 IJ/kg/24h in adolescence) and that girls get greater insulin doses than boys, especially during adolescence. Insulin needs shown in percentiles (P5 - P95) and presented in the form of figures enable fast and simple visualization of the range of insulin doses at different ages (figures 2 and 3). It is evident that there is a considerable deterioration of metabolic control during adolescence.

Femoral neck fractures in children and the role of early hip decompression in final outcome.

Femoral neck fractures in children are very rare and account for about 1% of all paediatric fractures. The aim of this retrospective study was to analyse the clinical and radiographic outcome in paediatric femoral neck fracture and to review the role of early decompression of the hip in the final outcome. The study was performed at the Department of Paediatric Orthopaedics and Traumatology, University Children's Hospital in Belgrade, Serbia from January 1996 to January 2010. The study included 28 patients, 12 female and 16 male, aged 4-14 years. Patients who were aged over 14 years or who had pathological femoral neck fractures or metabolic disturbances were excluded from the study. The type of neck fracture was determined according to the Delbet and Colonna classification. The patients were treated using different surgical procedures: closed reduction and cast immobilisation, closed reduction and percutaneous fixation with Kirschner wires (K-wires), closed reduction and fixation with cannulated screws and open reduction with Wagner plate stabilisation. The final outcome was evaluated using the clinical outcome (based on the Howorth-Ferguson scale), radiographic outcome and occurrence of complications. The median age of patients included in the study was 10.75 years and the average follow up was 9 years. According to the Delbet classification, there was one patient with type I, eight patients with type II, 16 patients with type III and three patients with type IV femoral neck fracture. Based on the Colonna classification, there were 23 displaced and five non-displaced femoral neck fractures. Decompression of the hip was performed in 21 patients. Avascular necrosis (AVN) developed as the main complication in 11 patients. The final outcome was excellent in 14 patients, good in four patients and poor in 14 patients. Our study unequivocally confirms the positive effect of urgent treatment on the incidence of AVN as well as on the outcome. We have established a 12-hour interval after injury as an optimal time limit for commencing treatment. Unambiguously positive effects of hip decompression on the incidence of AVN were also noted. We found similar efficiency for open and needle hip decompression.

OCCUPATIONAL DOSE ASSESSMENT IN INTERVENTIONAL CARDIOLOGY IN SERBIA.

The objective of this work is to assess the occupational dose in interventional cardiology in a large hospital in Belgrade, Serbia. A double-dosimetry method was applied for the estimation of whole-body dose, using thermoluminescent dosemeters, calibrated in terms of the personal dose equivalent Hp(10). Besides the double-dosimetry method, eye dose was also estimated by means of measuring ambient dose equivalent, H*(10), and doses per procedure were reported. Doses were assessed for 13 physicians, 6 nurses and 10 radiographers, for 2 consequent years. The maximum annual effective dose assessed was 4.3, 2.1 and 1.3 mSv for physicians, nurses and radiographers, respectively. The maximum doses recorded by the dosemeter worn at the collar level (over the apron) were 16.8, 11.9 and 4.5 mSv, respectively. This value was used for the eye lens dose assessment. Estimated doses are in accordance with or higher than annual dose limits for the occupational exposure.

Molecular typing, pathogenicity factor genes and antimicrobial susceptibility of vancomycin resistant enterococci in Belgrade, Serbia.

In this study the distribution of species and antimicrobial resistance among vancomycin resistant enterococci (VRE) recovered from clinical specimens obtained from five hospitals in Belgrade was analyzed. Strains were further characterized by pulsed-field gel electrophoresis (PFGE). Polymerase chain reaction (PCR) was used to investigate the presence of vanA and vanB genes and pathogenicity factor genes. Identification of 194 VRE isolates revealed 154 Enterococcus faecium, 21 Enterococcus faecalis, 10 Enterococcus raffinosus and 9 Enterococcus gallinarum. This study revealed existence of 8 major clones of VRE. PCR determined vanA gene to be present in all of the VRE studied. Esp and hyl genes were present in 29.22% and 27.92% of E. faecium, respectively, and in 76.19% and 0 of E. faecalis, respectively. Esp and hyl genes were not found more frequently in members of predominant clones of E. faecium than in single isolates; nor was their presence connected to invasiveness.

Beginnings of nursing education and nurses’ contribution to nursing professional development in Serbia

The oldest records of developmental beginnings of patients' healthcare relate to the first hospital founded by St. Sava at the monastery Studenica in 1199. The profile of the Kosovian girl became the hallmark of nursing profession in Serbia. The first school for midwives was founded in 1899 at the Department of Gynecology and Obstetrics of the General State Hospital in Belgrade. However, there were no other schools for nurses in Serbia until the foundation of the School for Midwives of the Red Cross Society in 1021. Until then the healthcare of patients and the injured was carried out by self-taught volunteer nurses with completed short courses of patients' healthcare. The first course for male and female nurses was organized by the Serbian Red Cross at the beginning of the First Serbian-Turkish War in 1876. During wars with Serbian participation in 19th and 20th centuries with Serbian participation, nurses gave a remarkable contribution being exposed to extreme efforts and often sacrificing their own lives. In war times great merit belongs to the members of the humanitarian society the Circle of Serbian Sisters founded in Belgrade in 1903, which was the resource of a great number of nurses who became the pride of nursing profession. Generations of nurses were educated on their example. In 2004 the annual award "Dušica Spasić" was established which is awarded to the best medical nurse is Serbia. Dušica Spasić was a medical nurse that died at her workplace, when aged 23 years, nursing the sick from variola.

Ketoacidosis at presentation of type 1 diabetes mellitus in children: a retrospective 20-year experience from a tertiary care hospital in Serbia

Diabetic ketoacidosis (DKA) has significant morbidity and mortality and is common at diagnosis in children. The aim of this study was to determine the frequency and clinical characteristics of DKA over a 20-year period among children diagnosed with type 1 diabetes mellitus (T1DM) at University children's hospital in Belgrade, Serbia. The study population comprised of 720 patients (366 boys) diagnosed with type 1 diabetes aged <18 years between January 1992 and December 2011. Of all patients diagnosed with T1DM, 237 (32.9 %) presented with DKA. The majority had either mild (69.6 %) or moderate (22.8 %) DKA. Sixty (55.0 %) of all children under 5 years had DKA compared to sixty-two (20.9 %) in the 5- to 10-year-old group and one hundred fifteen (36.6 %) in the 11- to 18-year-old patients (p<0.01), while 2.5 % of the entire DKA cohort were in real coma. During the later 10-year period, children less often had DKA at diagnosis compared with the earlier 10-year period (28.0 vs. 37.4 %) (p<0.01), but the frequency of severe DKA was higher in the age group <5 year and in the age group >11 year during 2002-2011, compared with the earlier 10-year period (12.9 vs. 3.4 %, p<0.01 and 17.1 vs. 3.8 %, p<0.01). The overall frequency of DKA in children with newly diagnosed type 1 diabetes decreased over a 20-year period at our hospital. However, children aged <5 years and adolescents are still at high risk for DKA at diagnosis.