Publications (8)1.79 Total impact
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Article: Efficacy of combined antiviral therapy with pegylated interferon α-2a and ribavirin for chronic hepatitis C infection in intravenous drug users
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ABSTRACT: Introduction. Hepatitis C Virus infection represents not just a medical, but also a socio-economic problem. It is estimated that among 170 million infected, 60% belongs to the category of intravenous drug users (IDUs). Objective. The aim of this paper was to compare the response to the combined therapy of pegylated interferon alfa 2a and ribavirin, in the group of patients with HCV infection who were intravenous drug users (IDUs) and in patients who were identified in the other way of transmission of HCV. Also to identify the influence of the therapy on diseases of addiction, during the course of HCV infection and on the effects of the combined therapy of pegylated interferon alfa 2a and ribavirin. Methods. We conducted a retrospective-prospective study, on 60 patients, treated with combined antiviral therapy-pegylated interferon alfa 2a and ribavirin. 30 patients were from the group of IDUs, and 30 patients from other epidemiological groups. Results. There were significant differences between the age of the patients (30.2±7.1 vs. 39.3±11.2 years; p=0.002), but no significant difference in the duration of the HCV infection between the two groups of patients (8.9±7.4 vs. 13.1±7.0 years; p>0.05). A large number of the patients in the group of IDUs had a problem with the abstinence of the drug abuse. In this group, there was the influence of alcohol (30%) and other substances with potential hepatotoxicity: marihuana (23.3%) and psycho-active drugs (73.6%). Staging of the liver fibrosis was not influenced by those two parameters and was similar in both groups (p>0.05). The genotype 3a was dominant in intravenous drug users (50.0%) and genotype 1b in the control group of the patients (76.6%). In both groups, SVR was achieved at a higher percentage (86% vs. 70.00%; p>0.05), but among the intravenous drug users the relapses of HCV infection were at a lower percentage (3.3% vs. 20.0%; p=0.044). Side effects were noticed in solitary cases in both of the examined groups, but severe side effects were found only in the control group of the patients. Relapse of drug abuse was noticed in 6.66% of cases. Conclusion. We have registered that the group of intravenous drug users has the same or even better response to the antiviral therapy than other epidemiological groups and that the use of drugs does not change the course of HCV infection.Srpski Arhiv za Celokupno Lekarstvo. 01/2010; -
Article: Leptospirosis distribution related to freshwater habitats in the Vojvodina region (Republic of Serbia).
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ABSTRACT: The retrospective study (2002-2007) for human leptospirosis in Vojvodina was undertaken in order to describe the distribution of the disease in relation with some environmental factors. Regarding the presented results, the major detected number of leptospirosis cases concurs with stagnant waters, wetlands, fish pond areas and protected regions, which comprised the basis for mapping of the region in three risk zones: very high risk (incidence rate higher than 5.0), high risk (2.5-5.0) and medium risk of leptospirosis infection (1.0-2.5). During the investigated period, 97 cases were registered with an average of 13.85 cases per year: 2002, 32 cases; 2003, 7; 2004, 22; 2005, 16; 2006, 4 and 2007, 16. Out of these 97 cases only 5 were women. Serovars from 11 presumptive serogroups caused infection, with a predominance of Icterohaemorrhagiae and Bratislava, accounting for 72.72% of cases together. Icterohaemorrhagiae was the commonest infecting serogroup mostly connected with fish ponds. Case fatality ratio was 9.4%.Science in China Series C Life Sciences 10/2009; 52(10):965-71. · 1.61 Impact Factor -
Article: [Exercise induced rhabdomyolysis].
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ABSTRACT: Rhabdomyolysis is a potentially life-threatening disease, characterized by the release of intracellular calcium from skeletal muscles and can result in acute renal failure. A nineteen year old boy was admitted to the Clinic for Infective Diseases of Clinical Center Novi Sad. The disease was developing gradually and the symptoms were dizziness, muscle pain and dark color of urine. Due to the pathological level of aminotransferase he was hospitalized on the fourth day of the disease beginning with a suspicious diagnosis of acute viral hepatitis. In the hospital course of the disease, a further elevation of serum aminotransferases, creatine kinase and lactate dehydrogenase were registered. Additional serological analyses were done to exclude other possible causes of acute liver lesion. In the neurological status prolonged decontraction of quadriceps muscle was detected and the electromyography was suspicious on neuromyositis. Excessive muscular activity with the strenuous exercise is the leading, but very frequently overlooked, cause of rhabdomyolysis in healthy people. Excessive physical exercise may lead to elevation of the serum activity of aminotransferases and to suspicion of hepatitis.Vojnosanitetski pregled. Military-medical and pharmaceutical review 09/2009; 66(9):754-7. · 0.18 Impact Factor -
Article: [Treatment of chronic hepatitis C with PEG-interferon].
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ABSTRACT: Since the discovery of the hepatitis C virus, the etiology of chronic liver diseases has been revealed in great number of patients. However, the treatment of hepatitis C viral infection still hasn't been completely resolved. Antiviral and immunomodulatory effects of interferon, and antiviral effect on the nucleoside analogs were efficient only in small number of patients. Discovery of pegylated interferon brings progress in therapeutic success rates. Combined therapy with peginterferon alfa-2a (Pegasys) 180 mg once a week plus Ribavirin 800 mg a day during a 24-week period was conducted in 20 patients (13 were previously treated with standard antiviral therapy). The aim of this study was to determine the safety and the efficacy of therapy in our patients. Analysis of safety of the combined therapy was conduced in all 20 patients, and analysis of efficiency in 18 patients. Efficacy of the combined therapy was assessed regarding to biochemical response (normalization of aminotransferase activity at the end of therapy and at the end of 6-month follow-up) and virologic response (disappearance of RNA HCV in serum at the end of 6-month follow-up). 30% of treated patients experienced no troubles during treatment. Influenza-like symptoms, weight loss, depression, hair loss and reaction at the site of injection were mild and did not exclude patients from their usual activities in family, society and work place. Neutropenia, thrombocytopenia and anemia as well as elevated aminotransferase activity demanded periodical dose modification in 20% of patients. Unexpected unwanted effect emerged in one patient after cessation of therapy (pulmonary sarcoidosis). Good effects of combined therapy at the end of follow-up period showed biochemical and virologic response in 66% of patients. Combined therapy with Pegasys 180 mg/week and Ribavirin 80 mg/day is safe and well tolerated. Sustained biochemical and virologic response was achieved in 66% of patients.Medicinski pregled 56(9-10):427-30. -
Article: [On the development of the infectology service in Novi Sad].
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ABSTRACT: INTRODUCTION: Infectious diseases are a part of the history of this region. Devastating epidemics of plague, smallpox, and cholera were frequent during the 18th and the 19th centuries. Other infectious diseases were a serious problem as well: alimentary tract infections, scarlet fever, diphtheria, whooping cough. Geographic position, climate, migrations, as well as the tradition and lack of medical staff and medications, affected the frequency and outcome of infections. THE HISTORY OF THE TREATMENT OF INFECTIOUS DISEASES: Patients with infectious diseases were first treated at home. Later, a hospital in Visarion street was opened as an isolation facility and a hospital for homeless patients. The development of science and the education of medical personnel exerted the greatest influence on the control and later treatment of infectious diseases. These measures resulted in the establishment of the first specialized medical institutions in Novi Sad during the cholera outbreak in 1884. After that, temporary pediatric units were organized for the treatment of scarlet fever, diphtheria and smallpox. A ward for infectious diseases was founded in the The Great City Hospital in the second half of the 19th century (1892). The 20th century was a period of control and eradication of infectious diseases in Vojvodina (smallpox, malaria, diphtheria, polio). MODERN INFECTIOUS DISEASES: Nowdays, major infectious deseases include respiratory, alimentary and parasitic infections. However, new diseases are being registered as well - hemorrhagic fevers, Lyme disease, HIV infection. The Infectologic Service in Novi Sad was developed from an Infectology Departement as part of the Departement of Internal Diseases in the new Provincial Hospital (1909) to the independent Departement for Infectious Diseases (1945). Today, Clinic of lnfectious Diseases is an integral part of the Clinical Center of Vojvodina. DEPARTMENT OF INFECTIOUS DISEASES: The Department of Infectious Diseases of the Faculty of Medicine in Novi Sad was founded in 1960. Undergraduate studies started in 1963/64 for students of medicine and in 1978/79 jor dentistry students. Today. the faculty of the Department takes part in undergraduate studies of medicine, dentistry, health care, as well as in graduate programs. The faculty members are also taking part in specialization programs at the Faculty of Medicine. Infectious disease physicians are involved in the activities of the Infectology Section (founded in 1979) of the Society of Physicians of Vojvodine of the Medical Society of Serbia. The first president of the Infectology Section was Dr. Vera Mudrić, professor, infectologists, whereas Dr. Grozdana Canak, professor, was the vice-president from 2000-2004. The Infectology Section collaborates with various national and international societies for infectious diseases.Medicinski pregled 60(11-12):625-8. -
Article: [Use of antibiotics in general practice and at the Clinic for Infectious Diseases].
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ABSTRACT: Optimal pharmacotherapy includes utilization of the right drug, at the right time, right duration of therapy and adequate dosage. This study analyzed utilization of antimicrobial drugs at the Clinic of Infectious Diseases of the Clinical Center Novi Sad and in outpatients of the Outpatient General Service of the Health Center Novi Sad-Liman. Utilization of anti-infective agents was examined according to Anatomic-Therapeutic-Chemical Classification (group J). Drug utilization data were presented in Defined Daily Doses at the Clinic of Infectious Diseases of the Clinical Center Novi Sad in Defined Daily Doses per 100 bed-days, and in the Outpatient General Service of the Health Center Novi Sad-Liman in Defined Daily Doses/1000 inhabitants per day. At the Clinic of Infectious Diseases of the Clinical Center Novi Sad penicillins susceptible to beta-lactamase were established as most frequently used (39.33%) namely: benzylpenicillin (32.18%), quinolone antibacterial agents, ciprofloxacin (12.44%) and cephalosporins, cephalexin (8.25%). In the Outpatient General Service of the Health Center Novi Sad-Liman most frequently used were extended-spectrum penicillins (24.20%) namely: tetracyclines, doxycycline (18.98%), amoxicillin (18.27%), macrolides, roxithromycin (17.56%). At the Clinic of Infectious Diseases of the Clinical Center Novi Sad the decision on using antibiotics and establishing whether it was bacterial or virus infection in 92.13% cases was made on the basis of following analyses: throat and nasal swabs, urine culture, virus complement-binding reaction. In Outpatient General Service of the Health Center Novi Sad-Liman it was done only in 18.46%. Although treatment performed based on clinical picture and experience usually proves to be correct, antibiotic prescription policy should include antibiograms to provide optimal treatment and decrease the degree of resistance. Thus, medicine would be considered an exact science and it should be one of its goals of the 21st century.Medicinski pregled 55(5-6):233-40. -
Article: [Aminoglycoside antibiotics and post-antibiotic effects].
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ABSTRACT: Man has been fighting diseases for centuries. One of the major battles is against microorganisms and diseases they cause. A health education course was organized on prescribing aminoglycoside antibiotics and postantibiotic effect. The aim of the course was to change the prescription habits in our colleagues. The postantibiotic effect of aminoglycoside antibiotics as well as impact of subinhibiting doses on duration of postantibiotic effect requires modification of previous therapeutic protocols. Single daily dose has the same or even greater effect than multiple daily doses. The toxicity of aminoglycosides is not increased and remains the same or smaller in single daily regimens. The single daily dose regimen of aminoglycosides has been used in 63.6% of cases in Clinic for Infectious Diseases of the Clinical Center of Novi Sad, 41.2% in Outpatient Health Care Center of Novi Sad "Liman" and this regimen has not been used in General Practice Department, Children's Health Care Department and Ear, Nose and Throat Clinic at all. The twice daily regimen has been used instead. Doctors are aware of the postantibiotic effect, but vast majority are still bound to their old habits in regard to prescribing antibiotics. Our educational course failed to achieve its goal.Medicinski pregled 55(1-2):19-22. -
Article: [Immunomodulatory actions of antibiotics].
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ABSTRACT: Antimicrob drugs and immune system interaction has been studied since the pioneer works of Metchnikoff. After the introduction of antibiotics in clinical practice this area has attracted little attention of investigators, because of the lack of standards. This is the reason that the studying of the influence of antibiotics on immune system is still at its beginning. To point out the immunomodulatory action of some antibiotics on certain components of immune system. The literature findings show that antibiotics express immunomodulatory action on some components of immune system such as fagocytes (polymorphonucleary, macrophages, monocytes), cytokines, immunoglobulines, and on cellular immunity. The principles of antibiotics action on phagocyte are the inhibition of chemotaxis and oxidants production. Macrolides applied for a short time enhance the phagocytic functions while their long use leads to immunosupression. Some cephalosporines and rifampicin in therapeutic doses inhibit the oxydative metabolism, of macrophages. Tetracyclines, clindamycines, chloramphenicol and tobramycin inhibit the synthesis of superoxyd anione. The action of some antibiotics on cytokine and specific antibodies is also important. Cellular immunity can be affected as well. After administration of certain antibiotics it takes 1-2 weeks to reestablish normal cellular immunity, and for other even more. There is still no clear standing on real effects of antibiotics on the immune system. Clinicians should search for more information from this new-old field of investigation in order to give more adequate therapy to patients.Medicinski pregled 62(7-8):327-30.
