The importance of occupational medicine in traffic accidents prevention

The aim of this study is the analysis of medical selection of drivers and candidates for car drivers sent to preliminary, periodic or special medical examination in the last ten years period. At the preliminary medical examination 2,3% of candidates were declared to be incapable, 8,2% of candidates had a limited driving ability. At the periodic medical examination 12,2% of drivers were declared to be incapable to driving and 28,7% of drivers had a limited driving ability. At the special medical examination 37,3% of drivers were declared to be incapable for driving and 53,9% of drivers had a limited driving ability. In our opinion, medical selection of drivers and candidates for car drivers is a significant preventive measure of traffic trauma.

Radiological picture of ophthalmic syndrome

It's common for the syndromes indicate to the author or authors who discovered them. The paper aims to show the image of X-rays and ophthalmic syndrome and to point out to those who can be recognized by the proper radiological and ophthalmologic examination. The work is based on knowledge and experience of the author and co-author of the acquired long experience in the profession, acquired many years of ophthalmology and radiological material, the papers presented in the relevant national and international journals, history and local and foreign literary press. Are shown in - Syndrom Stuger-Weber-Krabbe, Syndrome Wyburn-Mason, Syndrome Von Hippel-Lindau, Syndrome Crouzon, Syndrome Apertand Syndrome Saethre-Chotzen. The authors conclude that ophthalmic syndromes have their own specificity in radiologically-ophthalmologic image.

Are heated tobacco products (HTPs) a public health opportunity?

Heated tobacco products (HTPs) are a new, rapidly emerging category of tobacco products that are designed to heat the tobacco instead of burning it, thus substantially reducing the emission of harmful chemicals. Currently there is a debate about whether HTPs provide an opportunity for public health, to accelerate the decline in cigarette smoking prevalence and thereby smoking-related population harm. To answer this question, HTPs have to be scientifically substantiated to reduce the harm to the individual smoker, but they also have to be satisfying for adult smokers to maximize the number of adult smokers who switch, while minimizing the number of youths and non-smokers who initiate or relapse to these products, as well as minimizing the number of smokers who intend to quit who may use those products instead. In this article we present the evidence showing that switching to the THS reduces the negative health effects that are triggered by chronic exposure to the toxic substances generated during tobacco combustion and that lead to disease, compared to continuing smoking.

Dr. Eva Haljecka (1869-1947) first female surgeon and gynecologist in Serbia

Dr. Eva Haljecka, a Jew of Polish origin, was born on 1869 in Poland, died on 1949 in Yugoslavia, Belgrade, was the first woman surgeon and gynecologist-obstetrician in Serbia and Yugoslavia. Carried out on 1910 the first caesarean section in Niš. She was a duty manager in district hospital in Niš in three occasions - during the Balkan wars, in the World War I and after the World War I. Dr. Eva Haljecka was the first woman doctor of that time in Serbia who seek the full equality beetween male and female doctors and she was awarded for that. German newspaper Illustrirte Zeitung wrote about her and also about other women doctors - Draga Ljočić, Darinka Maletić-Banković, Marija Vučetić-Prita and Ljubica Đurić. Dr. Eva Haljecka accepted Serbia as a new homeland and made it for her all that he could.

Nicotine: From plants to people

Nicotine is naturally present in many crops, including but not limited to tobacco, eggplant, and tomatoes. Only in the tobacco plant is nicotine present in high enough quantities (~2% of dry weight) to have pharmacological effects. People have recognized the stimulating effects of the smoke created by burning dried tobacco leaves for thousands of years, and cigarette smoking remains the most common form of nicotine uptake from tobacco. Decades of epidemiologic data show that smoking causes a number of serious diseases (including cardiovascular diseases, lung cancer, and chronic obstructive pulmonary disease [COPD]). Undoubtedly, the best way to avoid the harm from smoking is to never start. For current smokers, quitting smoking altogether is the most effective way to reduce the risk of harm and smoking-related disease. Along with other aspects such as taste and ritual, nicotine is one of the reasons people smoke. Nicotine, while addictive and not risk-free, is not the primary cause of smoking-related diseases. Indeed, experts agree that smoking-related diseases are caused primarily by chronic exposure to the harmful constituents that are produced when tobacco is burning. Nevertheless, many people still mistakenly believe that nicotine is a major cause of tobacco-related diseases. While nicotine-containing products should not be used by certain groups of people - such as minors, people with or at risk of heart disease, diabetes, epilepsy, or seizure, pregnant or breast-feeding women or women who think they may be pregnant - delivery of nicotine by less harmful means can support public health goals by encouraging smokers who would otherwise continue smoking to switch to less harmful products. It is, therefore, pivotal to address the biggest misconceptions about nicotine to empower smokers to make informed decisions. In this article, we discuss basic facts about nicotine, its effects on the human body, as well as the risks related to nicotine consumption.

Processing and storage of blood components during the COVID-19 pandemic

The spread of the COVID-19 virus has a strong influence on blood collection, maintaining a stable supply of all blood components and the safety of the transfusion itself. SARS-CoV-2 has a long incubation period (1-14 days, on average 5-6 days, longest reported 24 days) and causes asymptomatic infection in a large number of patients, which is a great challenge in a recruitment of blood donors and achieving a safe transfusion. Precise recommendations and precautions have been adopted regarding the criteria for temporary refusal of blood donors during the COVID-19 pandemic, organization of mobile teams and collection sites, disposal of medical waste, examination of potential donors and mandatory body temperature measurement. Although transmission of COVID-19 via blood and blood components has not been demonstrated, some countries have also introduced mandatory NAT testing for SARS-CoV-2 as a part of blood screening testing. Also, proactive measures have been taken, such as temporary storage of blood in quarantine for 14 days after collection, while special attention is paid to efficient management of blood component stocks and development of a collection plan, in order to avoid shortage of certain blood components or their expiration. The first step in this regard is to revise the measures which have the aim for improving the usability of blood components, ie reducing waste of stocks, which primarily refers to the temporary extension of the shelf life of blood components. Extending the shelf life of erythrocytes (longer than 35 to 49 days, which is defined at the national level) should be considered as early as possible, because once a shortage of erythrocytes occurs, they will be issued long before the expiration date. Previous studies have not shown significant side effects of erythrocyte transfusion with extended shelf life, so it is possible to consider the flexibility of blood processing and erythrocyte storage conditions with mandatory internal process validation and component quality control. The shelf life of platelet concentrate should be extended from 5 days to 7 or even 8 days, with mandatory bacteriological testing or pathogen inactivation. Another option to increase the platelet supply for prophylactic purposes is to reduce the platelet dose by dividing the existing components. Frozen fresh plasma has the longest shelf life (up to 3 years), so maintaining stable reserves is much safer than for cellular components. Liquid plasma (never previously frozen) has a shelf life of 7-40 days, and can be used in conditions of reduced freezer capacity, shortage of staff working on blood processing or for the production of convalescent plasma. Pathogen inactivation of plasma and platelets allows 3-6 log reduction of SARS-CoV-2 and MERS-CoV. The decision to introduce some of the methods of pathogen inactivation should be made taking into account the costs and resources required for implementation. For countries that do not have pathogenic inactivation already in routine practice, its rapid introduction is a big task. For now, the risk of SARS-CoV-2 transmission through the blood appears to be very low, although our understanding of the virus and behavior during a pandemic will improve over time. In this regard, pathogen inactivation of convalescent plasma should also be considered.

Percutaneous coronary interventions in patient with hemophilia A, partial gastrectomy and recurrent myocardial infarction

Acute coronary syndrome is not rare in patients with haemophilia. We report a case of 55-year-old male patient with haemophilia A and gastric resection with Billroth II anastomosis with repeated STEMI and NSTEMI who was successfully treated by PTCA with stent implantation. Patient was admitted to the emergency department (April 2010). Coronary angiography revealed occlusion of mid-RCA, suboclusion of proximal LAD and also of medial Diagonal (Dg) brunch. Bare metal stent was implanted into the RCA. Two-years after (March 2012) patient was readmitted due to chest pain. Coronary angiography showed occluded posterior descendent artery from right coronary artery, subocluded proximal and medial LAD and first Diagonal brunch. Two Carbostents were implanted. There are no reports on the use of drug-eluting stent implantation in patients with hemophilia; however, with concerns about bleeding diathesis, bare-metal stents are regarded as safe. Our choice was new stent type, allowing more rapid reendothelialization, and minimizing the risk of stent thrombosis in the situation when the discontinuation of dual antiplatelet therapy. Antiplatelet therapy is important for preventing thrombus formation in the implanted stent even in patients with abnormal coagulation and high bleeding risk. New rapid-reendothelization stents may be the better choice in this group of patients.

Dr. Dragoljub Djordjević (1866-1942) founder and first head of Department Eye District Hospitals in Niš

Ophthalmologist Dr. Dragoljub Djordjević born on 29 December 1866, Belgrade (Serbia), and died on 20 January 1942 Belgrade (Yugoslavia). Author of the ophthalmology in Niš, the founder and first chief of the District Hospital eye department in Niš, the second eye department head of the General State Hospital in Belgrade, a warrior of the Balkan wars and the First World War, the holder of numerous war awards and decorations. He graduated from the Faculty of Medicine in Vienna 1893. The first job is received in Niš decree of August 4th 1894 when he was appointed fizikusa Niš district, district of Pirot. Specialization from eye diseases Dr Dragoljub Djordjević began 1894 in the eye clinic in Vienna (Austria-Hungary Empire), which quickly left and returned in Niš (Serbia), where at the hospital in Nis and the Military Hospital in Niš, diagnosed, treated and surgical treated eye disorders. Specialization from eye diseases finished 1903 by professor Dr. Ernst Fuchs with the University Eye Clinic in Vienna. He was appointed the first Chief District Hospital eye department in Niš 1910, which contains the full 16th voluntarily years, with interruptions during the wars. Dr Dragoljub Djordjević 1919 was appointed head of the second eye department of the State General Hospital in Belgrade. His knowledge of ophthalmology unselfish was conveyed to his student Dr. Zdravko Nižetić known by ophthalmologists ceratoplastics.

Differential diagnosis of lymphadenopathy

The majority of patients presenting with peripheral lymphadenopathy have easily identifiable causes that are benign or self-limited. Among primary care patients presenting with lymphadenopathy, the prevalence of malignancy has been estimated to be as low as 1.1 %. The critical challenge for the primary care physician is to identify which cases are secondary to malignancies or other serious conditions. Key risk factors for malignancy include older age, firm, fixed nodal character, duration of greater than two weeks, and supraclavicular location. Knowledge of these risk factors is critical to determining the management of unexplained lymphadenopathy. In addition, a complete exposure history, review of associated symptoms, and a thorough regional examination help determine whether lymphadenopathy is of benign or malignant origin. Unexplained lymphadenopathy without signs or symptoms of serious disease or malignancy can be observed for one month, after which specific testing or biopsy should be performed. While modern hematopathologic technologies have improved the diagnostic yields of fine-needle aspiration, excisional biopsy remains the initial diagnostic procedure of choice.

From nucleated to ex vivo manipulated stem cells: An updated biological and clinical synopsis

Hematopoietic stem cells (SCs) are responsible for the production and replacement (proliferation) of an extensive quantity of functionally competent blood cells (differentiation) during the entire life, while simultaneously maintaining the ability to reproduce themselves (self-renewal). A complex network of interactive substances and factors organize and protect the survival, maturation and multiplication of SCs. Hemobiological events in the bone marrow (BM) are synchronized and balanced by the extracellular matrix and microenvironment provided by stromal cells. These cells-including macrophages, fibroblasts, dendritic, endothelial and other cells-stimulate SCs by producing specific hematopoietic growth factors. Other cytokines secreted by stromal cells regulate the adhesion molecules positioned on SCs, allowing them to remain in the BM or migrate to an area where the respective cell type is needed. Thus, hematopoietic SCs could be defined as cells with high proliferative capacity and extensive potential to differentiate into all blood cells or some somatic cell types (SC plasticity)-such as cardiomyocytes, myocytes, osteocytes, chondrocytes, hepatocytes, and even endothelial cells. Recent increasing clinical use of cell-mediated therapeutic approaches has resulted in increased needs for SCs, but in superior operating procedures during their ex vivo manipulations. The aim of cell harvestings is to obtain a higher SC yield and improved viability or clonogenicity. The goal of optimized cryoinvestigation protocols is to get a minimized cell damages (cryoinjury). Despite the fact that different SC collection protocols and cell freezing practice are already in routine use, a lot of questions related to the optimal SC ex vivo manipulations are still unresolved. This review summarizes fundamental knowledge and methodological approaches, and recapitulates data enabling progress on constantly evolving research frontiers in the SC area. The studies (including also our investigations) that evaluated the efficiency and safety of SC-treatment (transplants and regenerative medicine) will be also concisely presented.