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Petrović S, Tarabar D, Ćujić D, Stamenkovic D, Petrović M, Rančić N, Subota V, Perišić N, Bezmarević M. A Prospective Observational Study Analyzing the Diagnostic Value of Hepcidin-25 for Anemia in Patients with Inflammatory Bowel Diseases. Int J Mol Sci 2024; 25:3564. [PMID: 38612376 PMCID: PMC11011637 DOI: 10.3390/ijms25073564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 04/14/2024] Open
Abstract
Iron deficiency (IDA) and chronic disease (ACD) anemia are complications of inflammatory bowel diseases (IBDs). Therapeutic modalities in remission and active IBD depend on the type of anemia. This study evaluated the link between hepcidin-25, proinflammatory cytokines, and platelet activation markers as biomarkers of anemia and inflammation in active IBD and remission. This prospective observational study included 62 patients with IBD (49 with ulcerative colitis and 13 with Crohn's) and anemia. Patients were divided into Group I (no or minimal endoscopic signs of disease activity and IDA), Group II (moderate and major endoscopic signs of disease activity and mild ACD), and Control group (10 patients with IBD in remission, without anemia). We assessed the difference among groups in the levels of CRP, hemoglobin (Hgb), serum iron, ferritin, hepcidin-25, interleukins, TNF-α, IFN-γ, soluble CD40 ligand, and sP-selectin. Hepcidin-25 levels were significantly higher in Group II versus Group I (11.93 vs. 4.48 ng/mL, p < 0.001). Ferritin and CRP values showed similar patterns in IBD patients: significantly higher levels were observed in Group II (47.5 ng/mL and 13.68 mg/L) than in Group I (11.0 ng/mL and 3.39 mg/L) (p < 0.001). In Group II, hepcidin-25 was positively correlated with ferritin (ρ = 0.725, p < 0.001) and CRP (ρ = 0.502, p = 0.003). Ferritin was an independent variable influencing hepcidin-25 concentration in IBD patients, regardless of disease activity and severity of anemia. IBD hepcidin-25 best correlates with ferritin, and both parameters reflected inflammation extent and IBD activity.
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Affiliation(s)
- Stanko Petrović
- Medical Faculty of the Military Medical Academy, University of Defence, 11 000 Belgrade, Serbia; (D.S.); (M.P.); (N.P.); (M.B.)
- Clinic for Gastroenterology and Hepatology, Military Medical Academy, University of Defence, 11 000 Belgrade, Serbia
| | - Dino Tarabar
- Clinic for Gastroenterology, University Hospital Center “Dr. Dragiša Mišović”, 11 050 Belgrade, Serbia;
| | - Danica Ćujić
- Institute for Application of Nuclear Energy, University of Belgrade, 11 000 Belgrade, Serbia;
| | - Dusica Stamenkovic
- Medical Faculty of the Military Medical Academy, University of Defence, 11 000 Belgrade, Serbia; (D.S.); (M.P.); (N.P.); (M.B.)
- Department of Anesthesiology and Intensive Care, Military Medical Academy, 11 000 Belgrade, Serbia
| | - Marijana Petrović
- Medical Faculty of the Military Medical Academy, University of Defence, 11 000 Belgrade, Serbia; (D.S.); (M.P.); (N.P.); (M.B.)
- Clinic for Nephrology, Military Medical Academy, 11 050 Belgrade, Serbia
| | - Nemanja Rančić
- Centre for Clinical Pharmacology, Military Medical Academy, University of Defence, 11 000 Belgrade, Serbia;
| | - Vesna Subota
- Institute of Medical Biochemistry, Military Medical Academy, University of Defence, 11 000 Belgrade, Serbia;
| | - Nenad Perišić
- Medical Faculty of the Military Medical Academy, University of Defence, 11 000 Belgrade, Serbia; (D.S.); (M.P.); (N.P.); (M.B.)
- Clinic for Gastroenterology and Hepatology, Military Medical Academy, University of Defence, 11 000 Belgrade, Serbia
| | - Mihailo Bezmarević
- Medical Faculty of the Military Medical Academy, University of Defence, 11 000 Belgrade, Serbia; (D.S.); (M.P.); (N.P.); (M.B.)
- Unit for Perioperative Nutrition, Department of Hepatobiliary and Pancreatic Surgery, Clinic for General Surgery, Military Medical Academy, University of Defence, 11000 Belgrade, Serbia
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Đurić-Petković D, Šuljagić V, Begović-Kuprešanin V, Rančić N, Nikolić V. Vaccine Effectiveness against SARS-CoV-2 Infection during the Circulation of Alpha, Delta, or Omicron Variants: A Retrospective Cohort Study in a Tertiary Hospital in Serbia. Vaccines (Basel) 2024; 12:211. [PMID: 38400194 PMCID: PMC10893379 DOI: 10.3390/vaccines12020211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
The COVID-19 pandemic prompted rapid vaccine development and deployment worldwide. Despite widespread vaccination efforts, understanding the effectiveness of vaccines in hospitalized patients remains a critical concern. This retrospective cohort study, conducted at a tertiary healthcare centre in Serbia, tracked patients hospitalized during different waves of COVID-19 variants-Alpha, Delta, and Omicron. Data collection included demographics, comorbidities, symptoms, and vaccination status. Among 3593 patients, those with prior exposure to COVID-19 cases or hospital treatment showed higher positivity rates. Symptom prevalence varied across waves, with coughs persisting. Patients without chronic diseases were more frequent among those testing negative. Vaccine effectiveness varied, with Sinopharm demonstrating a 45.6% effectiveness initially and Pfizer-BioNTech showing an effectiveness of up to 74.8% within 0-84 days after the second dose. Mixed-dose strategies, notably Sinopharm as a primary dose followed by a Pfizer-BioNTech booster, suggested increased protection. Despite substantial vaccination availability, a significant portion of hospitalized patients remained unvaccinated. This study underscores the dynamic nature of vaccine effectiveness and advocates for booster strategies to address evolving challenges in combating COVID-19, particularly in hospitalized patients.
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Affiliation(s)
| | - Vesna Šuljagić
- Department of Healthcare-Related Infection Control, Military Medical Academy, 11000 Belgrade, Serbia
- Medical Faculty, Military Medical Academy, University of Defence, 11000 Belgrade, Serbia; (V.B.-K.); (N.R.)
| | - Vesna Begović-Kuprešanin
- Medical Faculty, Military Medical Academy, University of Defence, 11000 Belgrade, Serbia; (V.B.-K.); (N.R.)
- Clinic for Infectious and Tropical Diseases, Military Medical Academy, 11000 Belgrade, Serbia
| | - Nemanja Rančić
- Medical Faculty, Military Medical Academy, University of Defence, 11000 Belgrade, Serbia; (V.B.-K.); (N.R.)
- Centre for Clinical Pharmacology, Military Medical Academy, 11000 Belgrade, Serbia
| | - Vladimir Nikolić
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
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Rabrenović V, Petrović M, Rabrenović M, Pilčević D, Rančić N. The significance of biomarkers of inflammation in predicting the activity of Lupus nephritis. J Med Biochem 2024; 43:116-125. [PMID: 38496018 PMCID: PMC10943464 DOI: 10.5937/jomb0-43457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/14/2023] [Indexed: 03/19/2024] Open
Abstract
Background Lupus nephritis (LN) is one of the most severe manifestations of systemic lupus erythematosus (SLE). There are increased studies examining the role of different markers that would facilitate diagnosis, LN activity monitoring, relapse occurrence, and the right time to introduce maintenance therapy. We aimed to examine the importance of determining the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), systemic immuneinflammatory index (SII) and systemic inflammatory response index (SIRI) in LN, comparing their significance with other standard parameters of active disease. Methods The clinical examination included 66 patients (34 with active and 32 with LN in remission) and 23 healthy controls. The investigated parameters were CRP, CBC, creatinine, albumin, GFR, C3, C4, ANA, anti-ds DNA Ab, in urine: sediment analysis, SLEDAI/r, proteinuria 24h and Up/cre. We determined the derived markers: NLR, PLR, SIRI, and SII and their correlation with other parameters of active disease.
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Affiliation(s)
| | | | | | - Dejan Pilčević
- Military Medical Academy, Clinic of Nephrology, Belgrade
| | - Nemanja Rančić
- Military Medical Academy, Centre for Clinical Pharmacology, Belgrade
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Šuljagić V, Đurić-Petković D, Lazić S, Mladenović J, Rakonjac B, Opačić D, Ljubenović N, Milojković B, Radojević K, Nenezić I, Rančić N. Epidemiological Predictors of Positive SARS-CoV-2 Polymerase Chain Reaction Test in Three Cohorts: Hospitalized Patients, Healthcare Workers, and Military Population, Serbia, 2020. Int J Environ Res Public Health 2023; 20:3601. [PMID: 36834297 PMCID: PMC9967496 DOI: 10.3390/ijerph20043601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its resulting coronavirus disease 2019 (COVID-19) has caused a fast-moving pandemic. Diagnostic testing, aimed to identify patients infected with SARS-CoV-2, plays a key role in controlling the COVID-19 pandemic in different populations. (2) Methods: This retrospective cohort study aimed to investigate predictors associated with positive polymerase chain reaction (PCR) SARS-CoV-2 test results in hospitalized patients, healthcare workers (HCWs), and military personnel (MP) during 2020, before the widespread availability of COVID-19 vaccines. Persons with a positive test result were compared with persons with a negative test result in three cohorts during the study period. (3) Results: A total of 6912 respondents were tested, and 1334 (19.3%) of them had positive PCR SARS-CoV-2 test results. Contact with a known COVID-19 case within 14 days (p < 0.001; OR: 1.48; 95% CI: 1.25-1.76), fever (p < 0.001; OR: 3.66; 95% CI: 3.04-4.41), cough (p < 0.001; OR: 1.91; 95% CI: 1.59-2.30), headache (p = 0.028; OR: 1.24; 95% CI: 1.02-1.50), and myalgia/arthralgia (p < 0.001; OR: 1.99; 95% CI: 1.65-2.42) were independently associated with positive PCR SARS-CoV-2 test results in the cohort of MP. Furthermore, fever (p < 0.001; OR: 2.75; 95% CI: 1.83-4.13), cough (p < 0.001; OR: 2.04; 95% CI: 1.32-3.13), headache (p = 0.008; OR: 1.76; 95% CI: 1.15-2.68), and myalgia/arthralgia (p = 0.039; OR: 1.58; 95% CI: 1.02-2.45) were independently associated with positive PCR SARS-CoV-2 test results in the cohort of HCWs. Moreover, independent predictors of positive PCR SARS-CoV-2 test results in hospitalized patients were contact with a known COVID-19 case within 14 days (p < 0.001; OR: 2.56; 95% CI: 1.71-3.83), fever (p < 0.001; OR: 1.89; 95% CI: 1.38-2.59), pneumonia (p = 0.041; OR: 1.45; 95% CI: 1.01-2.09), and neurological diseases (p = 0.009; OR: 0.375; 95% CI: 0.18-0.78). (4) Conclusions: According to data gathered from cohorts of hospitalized patients, HCWs, and MP, before the widespread availability of COVID-19 vaccines in Serbia, we can conclude that predictors of positive PCR SARS-CoV-2 test results in MP and HCWs were similar. Accurate estimates of COVID-19 in different population groups are important for health authorities.
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Affiliation(s)
- Vesna Šuljagić
- Department of Healthcare-Related Infection Control, Military Medical Academy, 11000 Belgrade, Serbia
- Medical Faculty, Military Medical Academy, University of Defence, 11000 Belgrade, Serbia
| | | | - Srđan Lazić
- Medical Faculty, Military Medical Academy, University of Defence, 11000 Belgrade, Serbia
- Institute of Epidemiology, Military Medical Academy, 11000 Belgrade, Serbia
| | - Jovan Mladenović
- Institute of Epidemiology, Military Medical Academy, 11000 Belgrade, Serbia
| | - Bojan Rakonjac
- Institute of Microbiology, Military Medical Academy, 11000 Belgrade, Serbia
| | - Dolores Opačić
- Institute of Epidemiology, Military Medical Academy, 11000 Belgrade, Serbia
| | - Nenad Ljubenović
- Institute of Epidemiology, Military Medical Academy, 11000 Belgrade, Serbia
| | - Biljana Milojković
- Institute of Epidemiology, Military Medical Academy, 11000 Belgrade, Serbia
| | - Katarina Radojević
- Torlak Institute of Virology, Vaccines, and Serums, 11000 Belgrade, Serbia
| | - Ivana Nenezić
- Department of Healthcare-Related Infection Control, Military Medical Academy, 11000 Belgrade, Serbia
| | - Nemanja Rančić
- Medical Faculty, Military Medical Academy, University of Defence, 11000 Belgrade, Serbia
- Centre for Clinical Pharmacology, Military Medical Academy, 11000 Belgrade, Serbia
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Taušan Ð, Rančić N, Kostić Z, Ljubenović N, Rakonjac B, Šuljagić V. An assessment of burden of hospital-acquired pneumonia among abdominal surgical patients in tertiary university hospital in Serbia: A matched nested case-control study. Front Med (Lausanne) 2022; 9:1040654. [PMID: 36569168 PMCID: PMC9780448 DOI: 10.3389/fmed.2022.1040654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
Background In the population of abdominal surgical patients hospital-acquired pneumonia (HAP) significantly increases morbidity and mortality. Patients and methods Through regular hospital surveillance of patients who received abdominal operations, we identified postoperative HAP from 2007 to 2019. In an initial nested case-control study, every surgical patient with HAP was compared with three control patients without HAP. Control patients were matched to the cases by age, gender, the American Society of Anesthesiologists score, and type of surgical operation. Also, the patients with HAP, who died were compared with those who survived. Results Multivariate logistic regression analysis (MLRA) revealed that other postoperative infections, length of intensive care unit stay, use of H2RA, use of PPI/ H2RA, multiple transfusion, and use of vancomycin in surgical prophylaxis were independent RFs for occurrence of HAP. Also, MLRA identified that age, lenght of hospital stay, use of mechanical ventilation and ceftriaxone in HAP therapy were indepedenttly associated with poor outcome of HAP. All Acinetobacter baumannii isolates were resistant to aminoglycoside antimicrobial agents and showed carbapenem resistance. The most frequently used antibiotics in patients with HAP and without HAP were vancomycin and metronidazole, respectively. Conclusion Our study provided an insight into the burden of HAP in abdominal surgical patients, and highlighted several priority areas and targets for quality improvement.
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Affiliation(s)
- Ðorde Taušan
- Pulmonology Clinic, Military Medical Academy, Belgrade, Serbia
| | - Nemanja Rančić
- Center for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia,Medical Faculty, University of Defence, Belgrade, Serbia
| | - Zoran Kostić
- Medical Faculty, University of Defence, Belgrade, Serbia,Clinic for General Surgery, Military Medical Academy, Belgrade, Serbia
| | - Nenad Ljubenović
- Institute of Epidemiology, Military Medical Academy, Belgrade, Serbia
| | - Bojan Rakonjac
- Institute of Medical Microbiology, Military Medical Academy, Belgrade, Serbia
| | - Vesna Šuljagić
- Medical Faculty, University of Defence, Belgrade, Serbia,Department of Healthcare-Associated Infection Prevention and Control, Military Medical Academy, Belgrade, Serbia,*Correspondence: Vesna Šuljagić
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Vekić B, Pilipović F, Dragojević-Simić V, Živić R, Radovanović D, Rančić N. IMPLEMENTATION OF THE NATIONWIDE ELECTRONIC HEALTH RECORD SYSTEM IN SERBIA: CHALLENGES, LESSONS LEARNED, AND EARLY OUTCOMES. Acta Clin Croat 2022; 61:488-495. [PMID: 37492366 PMCID: PMC10364109 DOI: 10.20471/acc.2022.61.03.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/21/2020] [Indexed: 07/27/2023] Open
Abstract
Objectives Many countries around the world have recognized the need for using an electronic health record (EHR) system. However, there is limited literature that could serve as a guide during a lengthy and challenging process of planning, development, and implementation of the e-Health system. Since the EHR system was recently introduced in Serbia, the purpose of this communication is to describe our experience and lessons learned along the way. Methods The key personnel involved in the implementation of the EHR system in Serbia that began in 2015 conducted in 2019 a retrospective narrative review of the process and early outcomes. Results An incremental approach in the planning, development, and implementation of the nationwide EHR system was taken. The process was split into phases with the gradual introduction of different regions of the country. The gradual shift from the existing to a new workflow for the prospective users was also implemented. The significant milestones were the achievement of quick legislative changes, the hiring of a professional team of experts in the field, the provision of timely and appropriate information and training to prospective users, the close collaboration between the implementation team and the Ministry of Health and mutual understanding of the aims and expectations, and the flexibility in accepting the evolving nature of the process, goals, and the system model. Conclusions A successful implementation of the nationwide EHR system is feasible providing careful planning, the assembly of a multi-disciplinary team, the use of a stepwise approach, the early and continued involvement of the intended users, and the willingness to make adjustments along the way. The end-result sets the stage for the reform of the health care system itself.
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Affiliation(s)
- Berislav Vekić
- Department of Surgery, Clinical Centre "Dr Dragisa Misovic", University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Filip Pilipović
- Institute for Orthopedic and Surgical Diseases "Banjica", Belgrade, Serbia
| | - Viktorija Dragojević-Simić
- Centre for Clinical Pharmacology, Military Medical Academy; Medical Faculty, University of Defence, Belgrade, Serbia
| | - Rastko Živić
- Clinical Centre "Dr Dragisa Misovic", University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Dragče Radovanović
- University of Kragujevac, Serbia, Faculty of Medical Sciences, Kragujevac, Serbia
| | - Nemanja Rančić
- Centre for Clinical Pharmacology, Military Medical Academy; Medical Faculty, University of Defence, Belgrade, Serbia
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Perić A, Rančić N, Dragojević-Simić V, Milenković B, Ljubenović N, Rakonjac B, Begović-Kuprešanin V, Šuljagić V. Association between Antibiotic Use and Hospital-Onset Clostridioides difficile Infection in University Tertiary Hospital in Serbia, 2011–2021: An Ecological Analysis. Antibiotics (Basel) 2022; 11:antibiotics11091178. [PMID: 36139957 PMCID: PMC9495030 DOI: 10.3390/antibiotics11091178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
This ecological study is the largest to date examining the association between rates of antibiotic use (AU) and hospital-onset (HO) Clostridioides difficile infection (CDI) in a tertiary university hospital in Serbia. There was no clear trend in the incidence of HO-CDI over time. Total utilization of antibacterials for systemic use increased from 38.57 DDD/100 bed-days (BD) in 2011 to 56.39 DDD/100 BD in 2021. The most commonly used antibiotics were third-generation cephalosporins, especially ceftriaxone, with maximum consumption in 2021 (19.14 DDD/100 BD). The share of the Access group in the total utilization of antibiotics ranged from 29.95% to 42.96% during the observed period. The utilization of the Reserve group of antibiotics indicated a statistically significant increasing trend (p = 0.034). A statistically significant difference in the consumption of medium-risk antibiotics from 2011 to 2021 was shown for penicillins and a combination of sulfamethoxazole and trimethoprim. The consumption of cefotaxime showed a statistically significant negative association with the rate of HO-CDI (r = −0.647; p = 0.031). Ampicillin and the combination of amoxicilline with clavulanic acid have shown a negative statistically significant correlation with the ID of HO-CDI (r = −0.773 and r = −0.821, respectively). Moreover, there was a statistically significant negative correlation between consumption of “medium-risk antibiotics” and the rate of HO-CDI (r = −0.677). The next challenging step for the hospital multidisciplinary team for antimicrobials is to modify the antibiotic list according to the Access, Watch, and Reserve classification, in such a way that at least 60% of the AU should be from the Access group, according to the World Health Organization recommendation.
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Affiliation(s)
- Aneta Perić
- Department for Pharmacy, Military Medical Academy, 11000 Belgrade, Serbia
- Medical Faculty, Military Medical Academy, University of Defence, 11000 Belgrade, Serbia
| | - Nemanja Rančić
- Medical Faculty, Military Medical Academy, University of Defence, 11000 Belgrade, Serbia
- Centre for Clinical Pharmacology, Military Medical Academy, 11000 Belgrade, Serbia
- Correspondence:
| | - Viktorija Dragojević-Simić
- Medical Faculty, Military Medical Academy, University of Defence, 11000 Belgrade, Serbia
- Centre for Clinical Pharmacology, Military Medical Academy, 11000 Belgrade, Serbia
| | - Bojana Milenković
- Department for Pharmacy, Military Medical Academy, 11000 Belgrade, Serbia
| | - Nenad Ljubenović
- Institute of Epidemiology, Military Medical Academy, 11000 Belgrade, Serbia
| | - Bojan Rakonjac
- Institute of Medical Microbiology, Military Medical Academy, 11000 Belgrade, Serbia
| | - Vesna Begović-Kuprešanin
- Medical Faculty, Military Medical Academy, University of Defence, 11000 Belgrade, Serbia
- Clinic for Infectious and Tropic Diseases, Military Medical Academy, 11000 Belgrade, Serbia
| | - Vesna Šuljagić
- Medical Faculty, Military Medical Academy, University of Defence, 11000 Belgrade, Serbia
- Department of Healthcare-Related Infection Control, Military Medical Academy, 11000 Belgrade, Serbia
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Miljković MN, Rančić N, Kovačević A, Cikota-Aleksić B, Skadrić I, Jaćević V, Mikov M, Dragojević-Simić V. Influence of Gender, Body Mass Index, and Age on the Pharmacokinetics of Itraconazole in Healthy Subjects: Non-Compartmental Versus Compartmental Analysis. Front Pharmacol 2022; 13:796336. [PMID: 35784683 PMCID: PMC9240599 DOI: 10.3389/fphar.2022.796336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Abstract
Itraconazole is a triazole antifungal agent with highly variable pharmacokinetics, with not yet fully identified factors as the source of this variability. Our study aimed to examine the influence of body mass index, gender, and age on the first dose pharmacokinetics of itraconazole in healthy subjects, using pharmacokinetic modeling, non-compartmental versus compartmental ones. A total of 114 itraconazole and hydroxy-itraconazole sets of plasma concentrations of healthy subjects of both genders, determined using a validated liquid chromatographic method with mass spectrometric detection (LC-MS), were obtained for pharmacokinetic analyses performed by the computer program Kinetica 5®. Genetic polymorphism in CYP3A4, CYP3A5, CYP1A1, CYP2C9, and CYP2C19 was analyzed using PCR-based methods. Multiple linear regression analysis indicated that gender had a significant effect on AUC as the most important pharmacokinetics endpoint, whereas body mass index and age did not show such an influence. Therefore, further analysis considered gender and indicated that both geometric mean values of itraconazole and hydroxy-itraconazole plasma concentrations in men were prominently higher than those in women. A significant reduction of the geometric mean values of Cmax and AUC and increment of Vd in females compared with males were obtained. Analyzed genotypes and gender differences in drug pharmacokinetics could not be related. Non-compartmental and one-compartmental models complemented each other, whereas the application of the two-compartmental model showed a significant correlation with the analysis of one compartment. They indicated a significant influence of gender on itraconazole pharmacokinetics after administration of the single oral dose of the drug, given under fed conditions. Women were less exposed to itraconazole and hydroxy-itraconazole than men due to poorer absorption of itraconazole, its more intense pre-systemic metabolism, and higher distribution of both drug and its metabolite.
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Affiliation(s)
- Milijana N. Miljković
- Centre for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia
- Medical Faculty of the Military Medical Academy, University of Defence in Belgrade, Belgrade, Serbia
- *Correspondence: Milijana N. Miljković,
| | - Nemanja Rančić
- Centre for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia
- Medical Faculty of the Military Medical Academy, University of Defence in Belgrade, Belgrade, Serbia
| | - Aleksandra Kovačević
- Centre for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia
- Medical Faculty of the Military Medical Academy, University of Defence in Belgrade, Belgrade, Serbia
| | - Bojana Cikota-Aleksić
- Centre for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia
- Medical Faculty of the Military Medical Academy, University of Defence in Belgrade, Belgrade, Serbia
| | - Ivan Skadrić
- Institute of Microbiology and Immunology, University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Vesna Jaćević
- Medical Faculty of the Military Medical Academy, University of Defence in Belgrade, Belgrade, Serbia
- Department for Experimental Toxicology and Pharmacology, National Poison Control Centre, Belgrade, Serbia
- Department for Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czechia
| | - Momir Mikov
- Institute for Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Viktorija Dragojević-Simić
- Centre for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia
- Medical Faculty of the Military Medical Academy, University of Defence in Belgrade, Belgrade, Serbia
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Pandrc M, Ratković N, Perić V, Stojanović M, Kostovski V, Rančić N. PREVALENCE OF TRADITIONAL CARDIOVASCULAR RISK FACTORS FOR CORONARY ARTERY DISEASE AND ELEVATED FIBRINOGEN AMONG ACTIVE MILITARY PERSONNEL IN REPUBLIC OF SERBIA: A CROSS-SECTIONAL STUDY. J Med Biochem 2021; 41:221-229. [PMID: 35510206 PMCID: PMC9010046 DOI: 10.5937/jomb0-33428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background It is well known that less than 1% of the population achieves ideal cardiovascular health, and 65% of patients do not have their conventional risk biomarkers under control. Military service has its own particularities that may contribute to cardiovascular risk. Methods To define the preventive strategy goals, we analysed the prevalence of traditional cardiovascular risk factors for coronary artery disease and elevated fibrinogen among active military personnel in the Republic of Serbia. Results The cross-sectional study included 738 individuals older than 20 years, mostly between 31 and 40 years old. The mean value of SBP for the whole group was 122.39± 9.42 mmHg, and for the DBP, it was 79.94±6.56 mmHg. Among active military personnel, 72.7% (533) had prehypertension, and 13.8% (101) was hypertensive. Both body mass and BMI index among the observed age subgroups were found to increase with the age of the patients and cholesterol values. HDL cholesterol values also differed statistically significantly between age subgroups, with the proportion of individuals with HDL less than 1.5 mmol/L in all subgroups being about 85%, the only in the 41-50 age group was lower, 76.4%. LDL cholesterol and the proportion of individuals who had LDL 3.5 increases with the age of patients, and an identical trend was recorded with triglycerides. With ageing, fibrinogen levels increased. Conclusions Those findings considering cardio and cerebrovascular risk factors would help create a new approach for primary prevention for these categories of individuals.
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Affiliation(s)
- Milena Pandrc
- Military Medical Academy, Clinic for Urgent Internal Medicine, Belgrade
| | - Nenad Ratković
- Military Medical Academy, Sector for treatment, Belgrade
| | - Vitomir Perić
- University of Defence in Belgrade, Military Medical Academy, Medical Faculty, Belgrade
| | | | - Vanja Kostovski
- University of Defence, Military Medical Academy, Clinic for Cardiothoracic Surgery, Belgrade
| | - Nemanja Rančić
- Military Medical Academy, Center for Clinical Pharmacology, Belgrade
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Luketina-Šunjka M, Rančić N, Subotić S, Jakovljević M. COMPLEMENTARY AND ALTERNATIVE MEDICINE IN SERBIA: A LITERATURE REVIEW. AMM 2020. [DOI: 10.5633/amm.2020.0313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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11
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Rančić N, Jovanovski A, Stevanović J, Stamatović R, Kostić D, Sekulić I, Vekić B, Vasić-Vilić J. RADIOLOGICAL CHARACTERISTICS OF PERIOSTEAL REACTIONS. amm 2020. [DOI: 10.5633/amm.2020.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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12
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Raščanin S, Rančić N, Dragović S, Jovanović M. EMBRYONIC STEM CELLS: WHERE DO WE STAND AT THE MOMENT? amm 2019. [DOI: 10.5633/amm.2019.0320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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13
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Dragojević-Simić V, Kovačević A, Jaćević V, Rančić N, Djordjević S, Kilibarda V, Mikov M, Bokonjić D. Bioequivalence study of two formulations of itraconazole 100 mg capsules in healthy volunteers under fed conditions: a randomized, three-period, reference-replicated, crossover study. Expert Opin Drug Metab Toxicol 2018; 14:979-988. [PMID: 30028640 DOI: 10.1080/17425255.2018.1503649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The aim of the study was to evaluate the bioequivalence of two itraconazole 100 mg capsule formulations. RESEARCH DESIGN AND METHODS The single-center, open-label, randomized, three-period, three-sequence, reference-replicated, cross-over study included 38 healthy subjects under fed conditions. In each study period (separated by a 14-day washout), a single oral dose of the test (T) or reference (R) product was administered. Blood samples were collected at pre-dose and up to 72.0 h after administration. The calculated pharmacokinetic parameters, based on the plasma concentrations of itraconazole and hydroxy itraconazole, were AUC0-72h, AUC0-∝, Cmax, Tmax, T1/2 and Kel. RESULTS The 90% CI for the test/reference geometric means ratio for the parent compound, itraconazole, was in the range from 85.29% to 116.07% for AUC0-72h. Since the coefficient of variation (CV) for the reference product was 44.95% for Cmax, the 90% CI for this parameter for itraconazole was 93.49-133.78%, which was within the proposed limits of the EMA for bioequivalence of 72.15-138.59%. During the study, 4 subjects encountered a total of 14 mild adverse events. CONCLUSIONS The use of the reference-scaling approach with 3-period design (TRR, RTR, and RRT) was an efficient way to demonstrate that two commercially available oral itraconazole formulations met the predetermined bioequivalence criteria.
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Affiliation(s)
- Viktorija Dragojević-Simić
- a Centre for Clinical Pharmacology , Military Medical Academy , Belgrade , Serbia.,b Medical Faculty of the Military Medical Academy , University of Defense in Belgrade , Belgrade , Serbia
| | - Aleksandra Kovačević
- a Centre for Clinical Pharmacology , Military Medical Academy , Belgrade , Serbia.,b Medical Faculty of the Military Medical Academy , University of Defense in Belgrade , Belgrade , Serbia
| | - Vesna Jaćević
- b Medical Faculty of the Military Medical Academy , University of Defense in Belgrade , Belgrade , Serbia.,c National Poison Control Centre , Military Medical Academy , Belgrade , Serbia.,d Department of Chemistry, Faculty of Science , University of Hradec Kralove , Hradec Kralove , Czech Republic
| | - Nemanja Rančić
- a Centre for Clinical Pharmacology , Military Medical Academy , Belgrade , Serbia.,b Medical Faculty of the Military Medical Academy , University of Defense in Belgrade , Belgrade , Serbia
| | - Snežana Djordjević
- b Medical Faculty of the Military Medical Academy , University of Defense in Belgrade , Belgrade , Serbia.,c National Poison Control Centre , Military Medical Academy , Belgrade , Serbia
| | - Vesna Kilibarda
- b Medical Faculty of the Military Medical Academy , University of Defense in Belgrade , Belgrade , Serbia.,c National Poison Control Centre , Military Medical Academy , Belgrade , Serbia
| | - Momir Mikov
- e Institute for Pharmacology, Clinical Pharmacology and Toxicology , University of Novi Sad, Faculty of Medicine , Novi Sad , Serbia
| | - Dubravko Bokonjić
- b Medical Faculty of the Military Medical Academy , University of Defense in Belgrade , Belgrade , Serbia
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Jovičić M, Hinić D, Drašković M, Obradović A, Nikić-Đuričić K, Rančić N, Perković-Vukčević N, Ristić-Ignjatović D. Psychometric properties of the rass scale in the Serbian population. J Affect Disord 2016; 189:134-40. [PMID: 26433761 DOI: 10.1016/j.jad.2015.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 07/08/2015] [Accepted: 07/09/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | - Darko Hinić
- Faculty of Science, University of Kragujevac, Serbia.
| | | | | | | | - Nemanja Rančić
- Medical Faculty, Military Medical Academy, University of Defence, Serbia
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15
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Rančić N, Dragojević-Simić V, Vavić N, Kovačević A, Šegrt Z, Drašković-Pavlović B, Mikov M. Tacrolimus concentration/dose ratio as a therapeutic drug monitoring strategy: the influence of gender and comedication. VOJNOSANIT PREGL 2015; 72:813-822. [PMID: 26554114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
UNLABELLED BACKGROUND/AIM. A combination of tacrolimus and other drugs such as corticosteroids has been commonly used immunosuppressive regimens. On the other hand, there is a growing body of evidence that male and female may differ in their response to the equal drug treatment. The aim of the study was to estimated the use of tacrolimus concentration/dose (C/D) ratio for the assessment of the influence of gender differences and comedication on tacrolimus exposure in renal transplant recipients. METHODS. This prospective case series study included 54 patients, in which the unit of monitoring was outpatient examination (1,872) of the renal transplant patients. The patients were monitored in the period 2010-2014, starting one month after the transplantation. Tacrolimus trough concentrations (TTC) were measured by chemiluminescence microparticles immunoassay. RESULTS. TTC and the tacrolimus C/D ratio were significantly lower in the females comparing with the males. Contrary to the males, in the females a significant increase of the tacrolimus daily dose (TDD) per body weight and TTC, along with the corticosteroid dose increase, was not accompanied by any significant changes in the tacrolimus C/D ratio; in different corticosteroid doses faster elimination of tacrolimus was found with the exception of the doses > 0.25 mg/kg. In the patients treated with proton pump inhibitors, mainly with pantoprazole TDD per body weight and TTC were significantly higher, while the tacrolimus C/D ratio was significantly lower compared to the patients without this treatment. In the patients treated with calcium channel blockers, TDD per body weight was significantly lower (particularly with amlodipine). while the tacrolimus C/D ratio was higher compared to the patients who were not treated by them. CONCLUSION A lower tacrolimus exposure was detected in females in comparison to males. When gender differences were considered in the context of different corticosteroid doses, faster elimination of tacrolimus in the females was also seen, with the exception of the doses > 0.25 mg/kg. Tacrolimus exposure in the pantoprazole-treated patients was significantly less expressed, while in patients treated with CCB amplodipine the tacrolimus C/D ratio was significantly higher in comparison with the patients not treated with them.
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Dobričić V, Marković B, Milenković N, Savić V, Jaćević V, Rančić N, Vladimirov S, Čudina O. Design, Synthesis, and Local Anti-Inflammatory Activity of 17β-Carboxamide Derivatives of Glucocorticoids. Arch Pharm (Weinheim) 2014; 347:786-97. [DOI: 10.1002/ardp.201400165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 07/03/2014] [Accepted: 07/09/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Vladimir Dobričić
- Faculty of Pharmacy, Department of Pharmaceutical Chemistry; University of Belgrade; Belgrade Serbia
| | - Bojan Marković
- Faculty of Pharmacy, Department of Pharmaceutical Chemistry; University of Belgrade; Belgrade Serbia
| | - Nikola Milenković
- Faculty of Pharmacy, Department of Pharmaceutical Chemistry; University of Belgrade; Belgrade Serbia
| | - Vladimir Savić
- Faculty of Pharmacy, Department of Organic Chemistry; University of Belgrade; Belgrade Serbia
| | - Vesna Jaćević
- National Poison Control Centre; Military Medical Academy; Belgrade Serbia
| | - Nemanja Rančić
- Centre for Clinical Pharmacology; Medical Faculty Military Medical Academy; University of Defence; Belgrade Serbia
| | - Sote Vladimirov
- Faculty of Pharmacy, Department of Pharmaceutical Chemistry; University of Belgrade; Belgrade Serbia
| | - Olivera Čudina
- Faculty of Pharmacy, Department of Pharmaceutical Chemistry; University of Belgrade; Belgrade Serbia
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Jakovljević M, Ranković A, Rančić N, Jovanović M, Ivanović M, Gajović O, Lazić Z. Radiology Services Costs and Utilization Patterns Estimates in Southeastern Europe—A Retrospective Analysis from Serbia. Value Health Reg Issues 2013; 2:218-225. [DOI: 10.1016/j.vhri.2013.07.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Zečević Luković T, Ristić B, Jovanović Z, Rančić N, Ignjatović Ristić D, Cuković S. Complex regional pain syndrome type I in the upper extremity - how efficient physical therapy and rehabilitation are. Med Glas (Zenica) 2012; 9:334-340. [PMID: 22926373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 02/17/2012] [Indexed: 06/01/2023]
Abstract
AIM To evaluate the effects of early started combined therapy in Complex Regional Pain Syndrome-1 (CRPS-1) on the upper extremities. METHODS The study included 36 patients in the first stadium of CRPS-1 on the upper extremities The mean age of patients was 42.6±14.6, the majority of them (26 of 36) were females. The right side of the upper extremity was affected much more then the left side. They were treated by combined therapy including analgetics, electrotherapy, magneto therapy and kinesitherapy. The average length of observation was 172.1 days (from 90 to 250 days). The average length of treatment was 91.5±42.16 days. Intensity of pain, swelling of the extremity, the change in skin coloration and cutaneous manifestations were assessed three times, at the beginning of the treatment, after 6 weeks and at the end of the treatment. RESULTS The pain was registered in all patients at visit 1 (average pain intensity was 5.70 ±1.44 on 100 mm visual analogue scale), and it was progressively decreased during the treatment from 3.60±1.22 at the second visit to 0.34±0.68 at the third visit. Vasodilatation was registered in 30 (83.33%) patients and skin temperature asymmetries was found in 21 (58.33%) patients. The difference of size was detected in 30 (83.33%) patients at the first visit compared to four (11.11%) patients at the end of the treatment. There were six (16.66%) patients without swelling at the beginning compared to 26 (72.22%) at the end of the treatment (p less than 0.000). Complete healing was achieved in 32 patients (88.88%). CONCLUSION The carefully chosen physical agents in combination with analgesic and non-steroidal anti-inflammatory drugs may benefit in patients with CRPS-1 on the upper extremity if the treatment starts as soon as possible.
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Affiliation(s)
- Tanja Zečević Luković
- Center for Physical Medicine and Rehabilitation, Clinical Center, Kragujevac, Serbia.
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Rančić N, Ignjatović Ristić D, Radovanović S, Kocić S, Radević S. Sociodemographic and clinical characteristics of hospitalized patients after suicide attempt: a twenty-year retrospective study. Med Glas (Zenica) 2012; 9:350-355. [PMID: 22926376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 05/28/2012] [Indexed: 06/01/2023]
Abstract
AIM To determine the frequency and distribution of suicide attempts relating to the manner of execution and other demographic an clinical characteristics, as well as to point to possible risk factors. METHODS A retrospective anamnestic study was conducted covering a twenty-year period (1990 to 2010) which included 715 patients (310 males and 405 females), who were hospitalized and treated at the Psychiatric Clinic of the Clinical Center in Kragujevac following a suicide attempt. RESULTS The incidence rate of suicide attempts was 19.5 per 100,000 citizens. The number of suicide attempts was found to be greater in females, 405 (56.5%). The greatest number of individuals was younger (25 to 34 years of age), 149 (20.9%) and the average age of the population attempting suicide was 42.6 years. The predominant mental disorder preceding the suicide attempt was depression, 346 (48.4%). The method most frequently used in the attempt was poisoning in both genders, 395 (55.3%) often by benzodiazepine overdose. The greatest number of suicide attempts occurs in spring and summer, 400 (over 50%). CONCLUSION An increased number of hospitalizations due to suicide attempts was noted, therefore, special attention should be paid to detection and treatment of depression disorders and patients who have attempted suicide repeatedly.
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Affiliation(s)
- Nemanja Rančić
- School of Medicine, University of Kragujevac; Kragujevac, Serbia.
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