Publications by authors named "Ana Pejčić"

29 Publications

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A review of published cases of Stevens-Johnson syndrome and toxic epidermal necrolysis associated with the use of acetaminophen.

Cutan Ocul Toxicol 2021 Jun 21:1-33. Epub 2021 Jun 21.

Department of Anatomy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.

Purpose: Acetaminophen (paracetamol) is a widely used analgesic and antipyretic. In several studies, its use was associated with the occurrence of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). This narrative review aimed to explore and summarize available cases of SJS/TEN suspected to be associated with acetaminophen reported in the literature.

Materials And Methods: Electronic searches were conducted in PubMed/MEDLINE, Web of Science, Scopus and Serbian Citation Index (SCIndeks). Case reports or case series which reported detailed clinical description of the patients diagnosed with SJS, TEN or SJS/TEN overlap which was caused or suspected to be most likely caused by acetaminophen with available full text were included in the review.

Results: Twenty-nine publications describing a total of 36 patients which satisfied inclusion criteria were included in the review. The age of the patients ranged from 3 to 77 years (median: 32.5 years). There were 15 female (41.7%) and 15 male (41.7%) patients, while for 6 patients (16.7%) gender was not reported. TEN, SJS and SJS/TEN overlap were diagnosed in 24 (66.7%), 10 (27.8%) and 2 (5.6%) patients, respectively. Reported time from the first dose of acetaminophen to the onset of the first symptoms of SJS/TEN ranged from promptly to 21 days, with a median of 3 days. Use of some form of supportive and symptomatic care was reported in 28 patients (77.8%). Systemic corticosteroids were reported to be administered in 25 patients (69.4%) and intravenous immunoglobulin in 16 patients (44.4%). All patients survived. Long-term consequences (sequelae) were reported in 5 patients (13.9%).

Conclusions: Clinicians should be aware that SJS/TEN may be an adverse effect of acetaminophen and keep in mind that its prompt recognition and withdrawal of the culprit drug along with supportive care is of utmost importance.
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http://dx.doi.org/10.1080/15569527.2021.1942896DOI Listing
June 2021

Effect of the local probiotics in the therapy of periodontitis A randomized prospective study.

Int J Dent Hyg 2021 May 8. Epub 2021 May 8.

Department of Periodontology and Oral medicine, Medical faculty, University of Nis, Nis, Serbia.

Objectives: The use of local probiotics in the therapy of periodontitis is reflected in their ability to antagonize periodontopathogens and modulates the immune response of the host to the presence of pathogenic microorganisms. The aim of this study was to investigate the use of local probiotics in the treatment of periodontitis as an adjunctive therapy to scaling and root planning (SRP).

Methods: The study involved 80 patients diagnosed with periodontitis. All participants underwent SRP therapy. Semi-solid probiotic was then locally applied to the periodontal pocket in randomly selected patients for the test group (40 of them). The other 40 patients were in the control group. Clinical parameters including periodontal pocket depth (PPD), bleeding on probing (BOP) and plaque index (PI) were measured at baseline, and at 7 and 30 days after treatment.

Results: Seven days after the applied therapy in the test and control group, there was a significant decrease in the values or BOP (p < .001), while the values of other parameters did not show a statistically significant difference (p < .05). One month after the therapy in both groups, there was a statistically significant difference in the values of all clinical parameters (p < .001).

Conclusions: Based on the results of this pilot study, it can be said that, during periodontal treatment, topical application of probiotics in combination with SRP increases the effectiveness of conventional non-surgical therapy of periodontitis.
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http://dx.doi.org/10.1111/idh.12509DOI Listing
May 2021

Delirium associated with the use of macrolide antibiotics: a review.

Authors:
Ana V Pejčić

Int J Psychiatry Clin Pract 2020 Oct 7:1-14. Epub 2020 Oct 7.

Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.

Objective: This review aimed to explore and summarise available cases of delirium suspected to be associated with the use of macrolide antibiotics reported in the literature and the United States Food and Drug Administration's Adverse Event Reporting System (FAERS) database.

Methods: Electronic searches of the literature were conducted in four online databases: PubMed/MEDLINE, Scopus, Web of Science and Serbian Citation Index (SCIndeks). A search of FAERS database was also conducted to supplement the findings of the literature search. Descriptive statistics, narrative summation and tabulation of the extracted data were made.

Results: Cases of delirium which satisfied inclusion criteria were found for clarithromycin, azithromycin, erythromycin and telithromycin. Delirium was described in patients of various age groups, including children. Drug-drug interactions may have contributed to its occurrence in some of the cases. Average time to onset of delirium was 2.5 days for azithromycin and 3.3 days for clarithromycin.

Conclusions: Considering that these drugs may be a possible cause of delirium, clinicians should be aware that timely recognition of this possible side effect can lead to earlier discontinuation of the culprit drug, reduce time spent in a delirious state and improve patients' outcomes.KEY POINTSCases of delirium which satisfied inclusion criteria were found for clarithromycin, azithromycin, erythromycin and telithromycin.Cases of delirium were described in patients of various age groups, including children.Drug-drug interactions may have contributed to the occurrence of delirium in some of the cases.Time to onset of delirium ranged from 2 to 3.5 days (mean: 2.5 days) for azithromycin and from 1 to 7 days (mean: 3.3 days) for clarithromycin.Cessation of the macrolide antibiotic seems to be the best management strategy, although some of the patients may, in addition, require antipsychotics.
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http://dx.doi.org/10.1080/13651501.2020.1828933DOI Listing
October 2020

Stevens-Johnson syndrome and toxic epidermal necrolysis associated with the use of macrolide antibiotics: a review of published cases.

Authors:
Ana V Pejčić

Int J Dermatol 2021 Jan 17;60(1):12-24. Epub 2020 Aug 17.

Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.

Macrolides are one of the most commonly prescribed antibiotics. In several studies, their use was associated with the occurrence of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). This review aimed to explore and summarize available cases of SJS/TEN suspected to be associated with the use of macrolide antibiotics reported in the literature. Electronic searches were conducted in PubMed/MEDLINE, Web of Science, Scopus, and Serbian Citation Index (SCIndeks). Twenty-five publications describing a total of 27 patients were included. Cases of SJS/TEN which satisfied inclusion criteria were found for azithromycin (n = 11), clarithromycin (n = 7), erythromycin (n = 5), roxithromycin (n = 2), and telithromycin (n = 2). The age of the patients ranged from 2 to 77 years (median: 29 years). There were 14 female (51.9%) and 13 male (48.1%) patients. SJS was diagnosed in 16 patients (59.3%), TEN in 10 patients (37.0%), and SJS/TEN overlap in one patient (3.7%). Time to onset of the first symptoms ranged from 1 to 14 days (median: 3 days). All patients received some form of supportive and symptomatic care. Systemic corticosteroids were reported to be administered in 12 patients (44.4%) and intravenous immunoglobulin in five patients (18.5%). Three patients (11.1%) died. Considering that SJS/TEN is a severe and potentially life-threatening reaction, physicians should be aware that they could be adverse effects of macrolide antibiotics and keep in mind that prompt recognition of SJS/TEN and discontinuation of the culprit drug in combination with supportive care is essential.
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http://dx.doi.org/10.1111/ijd.15144DOI Listing
January 2021

Bleeding Index and Monocyte Chemoattractant Protein 1 as Gingival Inflammation Parameters after Chemical-Mechanical Retraction Procedure.

Med Princ Pract 2020 2;29(5):492-498. Epub 2020 Apr 2.

Department of Prosthodontics, Dental School, University of Belgrade, Belgrade, Serbia.

Objective: A widely used chemical-mechanical method of gingival retraction can cause gingival tissue damage. The aim of this study was to test the influence of the chemical-mechanical gingival retraction procedures on the gingival bleeding index (GBI) and the salivary concentration of monocyte chemoattractant protein 1 (MCP-1) as an indicator of inflammatory changes in the gingiva.

Materials And Methods: The effects of 2 different retraction agents (aluminum chloride and ferric sulfate) were compared, particularly their tissue damaging effect during tooth preparation. Therefore, GBI values and the salivary concentration of MCP-1 were assessed during the chemical-mechanical method of gingival retraction in a homogenous group of respondents. The subjects (n = 60) were divided into 2 experimental groups (G1 and G2) regarding the need for tooth preparing and making artificial crowns. Each group was further divided into 2 subgroups (R1 and R2) according to the type of the gingival retraction agent used (aluminum chloride and ferric sulfate).

Results: Compared to the values at the study start, a statistically significant increase in GBI and salivary MCP-1 (p < 0.001) 1 day after gingival retraction agent application was observed in both experimental groups. After 72 h, the values were lower than in the second observation period but still statistically significantly higher compared to the study start (p < 0.001), which indicated the reversibility of the tissue changes.

Conclusion: Higher values of the investigated parameters were observed in the group of subjects with prepared teeth, and clinical changes were more pronounced after the use of ferric sulfate.
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http://dx.doi.org/10.1159/000506878DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7511686PMC
April 2020

Antimicrobial treatment of invasive infections: Systematic review.

J Chemother 2019 Oct 25;31(6):297-306. Epub 2019 May 25.

Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac , Kragujevac , Serbia.

can cause serious infections in immunocompromised patients. The aim of this systematic review was to establish what invasive infections in humans are caused by and to evaluate the optimal choice of antibiotics for their treatment. MEDLINE, EBSCO, SCOPUS, SCINDEKS and GOOGLE SCHOLAR were systematically searched for clinical trials, observational studies, case reports or case series describing invasive infections with in patients of any age. may cause invasive infections of various tissues in hospitalized patients. In the great majority of cases it was susceptible to co-trimoxazole, levofloxacin and ceftazidime. In about three fourths of the cases, the treatment was successful, while less than 20% of the patients died. is increasingly associated with serious invasive infections in hospitalized patients and due to growing trend of resistance to almost all antibiotics requires a careful approach to patients who is harboring this bacterium.
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http://dx.doi.org/10.1080/1120009X.2019.1620405DOI Listing
October 2019

Determination of Salivary Myeloperoxidase, Immunoglobulin E, and Tumor Necrosis Factor-α after Complete Denture Insertion.

Med Princ Pract 2019 8;28(4):347-351. Epub 2019 Mar 8.

Department of Microbiology, Faculty of Medicine, University of Nis, Nis, Serbia.

Objective: To detect activities of salivary myeloperoxidase (MPO) and concentrations of salivary tumor necrosis factor (TNF)-α as indicators of inflammatory reaction and salivary immunoglobulin E as an indicator of allergic reaction after complete insertion of acrylic dentures.

Subjects And Methods: Complete dentures were made for a uniform group of elderly patients, and saliva samples were taken immediately before they were given to the patients, as well as 2, 3, 7, and 30 days after insertion of the dentures, with simultaneous monitoring of changes in the oral mucosa.

Results: After 7 and 30 days of wearing upper and lower complete dentures, nonsignificant increases in salivary MPO and TNF-α were proven to be indicators of inflammation. No changes were observed in the values of salivary immunoglobulin E during a 30-day observational period, which excluded the appearance of allergic reactions to acrylic materials in the tested group of patients.

Conclusion: A nonsignificant increase in the levels of MPO was observed on day 7; it decreased after 30 days. TNF-α also tended to increase in a nonsignificant manner.
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http://dx.doi.org/10.1159/000499429DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639651PMC
June 2020

Antimicrobial treatment of Kocuria kristinae invasive infections: Systematic review.

J Chemother 2019 May 28;31(3):109-119. Epub 2019 Jan 28.

a Faculty of Medical Sciences, University of Kragujevac , Kragujevac , Serbia.

Objective of this systematic review was to establish whether and what invasive infections in humans were caused by Kocuria kristinae, and to evaluate outcomes of administered antibiotic treatment. MEDLINE, EBSCO, SCOPUS, SCINDEKS and GOOGLE SCHOLAR were systematically searched for primary case reports or case series describing invasive infections with K. kristinae. K. kristinae is a pathogen microorganism that could cause invasive infections of various tissues in patients of any age. Majority of the patients had K. kristinae isolated from blood. It was also found in peritoneal fluid, pus, sputum, synovial fluid, bile, fluid from abdominal abscess, throat swab, urine catheter tip and mid-stream urine. Antibiotic treatment was almost universally effective, with only one death reported. Susceptibility was highest to vancomycin, linezolid, rifampicin, teicoplanin, tigecycline, cefotaxime, ampicillin/sulbactam, minocycline and meropenem. Initial treatment of Kocuria kristinae infections should involve parenteral vancomycin in combination with some other antibiotic to which it is susceptible.
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http://dx.doi.org/10.1080/1120009X.2018.1542551DOI Listing
May 2019

Drug-drug interactions in patients with acute coronary syndrome across phases of treatment.

Intern Emerg Med 2019 04 27;14(3):411-422. Epub 2018 Nov 27.

Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića 69, Kragujevac, 34000, Serbia.

The objective of this study is to evaluate potential drug-drug interactions (pDDIs) and risk factors for pDDIs in three phases of an acute coronary syndrome (ACS) treatment: from the point of first medical contact to the coronary angiography (first phase), after coronary angiography to the last day of hospitalization (second phase), and at discharge from hospital (third phase). This retrospective observational cohort clinical study was conducted at the Clinic for Cardiology of the Clinical Centre Kragujevac, a public tertiary care hospital in Kragujevac, Serbia. Micromedex interaction checker was used to detect pDDIs. This study included 245 ACS patients. All patients were exposed to at least one pDDI in all the phases of treatment. Mean total number of pDDIs was 9.47 ± 6.07, 10.11 ± 6.92, and 6.29 ± 3.66 in first, second, and third phases, respectively. Age, > 6 h from the beginning of the symptoms to admission, primary PCI, STE-ACS, COPD, delirium, hyperlipidemia, hypertension, obesity, systolic blood pressure at admission, TIMI risk score at admission, ALT, LDL, number of physicians who prescribed drugs to a single patient, number of prescribed drugs, and various pharmacological classes increased risk of pDDIs. Mechanical ventilation, dementia, and drug allergy noted in the medical documentation protected against them. Effects of heart failure, diabetes, and aPTT depended on phase of treatment and severity of pDDI. In conclusion, physicians should be vigilant to the possibility of pDDIs in patients harbouring factors that may increase their rate.
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http://dx.doi.org/10.1007/s11739-018-1994-8DOI Listing
April 2019

Drug-drug interactions in patients receiving hematopoietic stem cell transplantation.

Expert Opin Drug Metab Toxicol 2019 Jan 27;15(1):49-59. Epub 2018 Nov 27.

a Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia.

Introduction: Recipients of hematopoietic stem cell transplantation (HSCT) are exposed to numerous drugs in both pre- and post-transplantation period, which creates an opportunity for drug-drug interactions (DDIs); if clinically relevant DDIs happen, the risk of adverse treatment outcomes is increased. Areas covered: This review is focused on DDIs in recipients of HSCT that were observed and published as clinical trials, case series or case reports. Relevant publications were found by the systematic search of the following online databases: MEDLINE, SCOPUS, EBSCO, and SCINDEX. Expert opinion: The most important DDIs involve cytostatic or immunosuppressant drug on one side, and antimicrobial drugs on the other. The majority of clinically relevant interactions have pharmacokinetic character, involving drug metabolizing enzymes in the liver. Antifungal azoles inhibit metabolism of many cytostatic and immunosuppressant drugs at cytochromes and increase their plasma concentrations. Macrolide antibiotics and fluoroqunolones should be avoided in HSCT recipients, as they have much larger potential for DDIs than other antibiotic groups. HSCT recipients increasingly receive new immunomodulating drugs, and further observational studies are needed to reveal unsuspected DDIs with clinical relevance.
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http://dx.doi.org/10.1080/17425255.2019.1552256DOI Listing
January 2019

Authors' reply to Rare diseases in Romania - a response to 'Transposition and implementation of EU rare diseases policy in Eastern Europe'.

Expert Rev Pharmacoecon Outcomes Res 2018 08 26;18(4):349-350. Epub 2018 Jun 26.

b Department of Social Medicine and Public Health, Faculty of Public Health , Medical University of Plovdiv , Plovdiv , Bulgaria.

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http://dx.doi.org/10.1080/14737167.2018.1491143DOI Listing
August 2018

Access to orphan drugs - comparison across Balkan countries.

Health Policy 2018 06 26;122(6):583-589. Epub 2018 Apr 26.

Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Vasil Aprilov 15 A Blvd, 4002 Plovdiv, Bulgaria; Institute for Rare Diseases, Maestro Georgi Atanasov 22 Str, 4023 Plovdiv, Bulgaria. Electronic address:

The aim of this study was to compare orphan drug access in a sample of Balkan countries: five EU Member States (Bulgaria, Croatia, Greece, Romania, Slovenia) and two EU Candidates (Serbia, Montenegro). The comparative analysis was based on a cross-sectional study and included medicinal products with an active orphan designation and market authorisation on January 1, 2017. Access to orphan drugs is an ongoing challenge in these countries. Three clusters of countries were identified in terms of orphan drug access: Greece and Slovenia, making the top tier, Romania, Bulgaria, and Croatia, being in the middle, and EU Candidates, Serbia and Montenegro, forming the bottom tier, where a substantial number of EU market approved orphan drugs was not even registered. Available public health resources and market size are probably among the contributing factors for such inequalities. Sizeable part of EMA market authorised orphan medicinal products is not even priced in the Balkan countries. This is a serious issue, which is putting rare disease patients from this region in a particularly vulnerable situation. There is a need for further improvement in accessibility of orphan drugs in the Balkan countries. Cross-border collaboration in the field of pricing, health technology assessment, and reimbursement negotiation of orphan drugs may help to address these challenges.
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http://dx.doi.org/10.1016/j.healthpol.2018.04.009DOI Listing
June 2018

Transposition and implementation of EU rare disease policy in Eastern Europe.

Expert Rev Pharmacoecon Outcomes Res 2017 Dec 10;17(6):557-566. Epub 2017 Oct 10.

d Global Health, Economics and Policy, Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia.

Introduction: А series of European Union (EU) political decisions have made rare diseases one of the cornerstones of the common European health policy. Adopted in 2009, Council Recommendation on an action in the field of rare diseases aimed to serve as a policy-making guideline. However, the implementation report, which followed it, neither performed detailed cross-country comparison, nor assessed the impact of the policies. Areas covered: A 10-indicator set was elaborated to structure the review and to describe rare disease activities in 14 Eastern European countries. Expert commentary: Taking into account all indicators, EU member states outperform candidate and potential candidate countries in terms of rare disease policy planning and implementation. Hungary is the top performer, followed by Bulgaria and Czech Republic. Non-EU countries form the bottom tier, with Serbia being the best ranked among them. While EU adhesion is a major facilitator for planning and adopting rare disease policies, local stakeholders are the triggering factor for their successful implementation. European reference networks are likely to be the future of rare disease activities in the EU. They need to synchronize and closely collaborate with all important EU projects in the field of rare diseases if they are to achieve their objectives.
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http://dx.doi.org/10.1080/14737167.2017.1388741DOI Listing
December 2017

Growth of Global Publishing Output of Health Economics in the Twenty-First Century: A Bibliographic Insight.

Front Public Health 2017 11;5:211. Epub 2017 Aug 11.

Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.

Background: Strong growth of interdisciplinary sciences might find exceptional example in academic health economics. We decided to observe the quantitative output in this science since the beginning of the twenty-first century.

Methods: Electronic search of the published literature was conducted in four different databases: one medical database-MEDLINE/PubMed, two general databases-Scopus/Elsevier and Web of Science (WoS), and one specialized health economic database-NHS Economic Evaluation Database (EED). The applied combination of key words was carefully chosen to cover the most commonly used terms in titles of publications dealing with conceptual areas of health economics. All bibliographic units were taken into account.

Results: Within the time horizon from January 1, 2000 to December 31, 2016, without language or limitations on bibliographic unit types, we identified an output ranging approximately from 60,345 to 88,246 records with applied search strategy in MEDLINE/PubMed, Scopus/Elsevier, and WoS. In NHS EED, we detected 14,761 records of economic evaluations of health interventions during the period in which database was maintained and regularly updated. With slightly more than one-third of the identified records, USA clearly dominates in this field. United Kingdom takes a strong second place with about 12% of identified records. Consistently, USA and UK universities are the most frequent among the top 15 affiliations/organizations of the authors of the identified records. Authors from Harvard University contributed to the largest number of the identified records.

Conclusion: There is a clear evidence of both the upward stream of blossoming in health economics publications and its acceleration. Based on this bibliographic data set, it is difficult to distinguish the actual impact growth of this output provided dominantly by academia with modest contribution by pharmaceutical/medicinal device industry and diverse national government-based agencies. Further insight into the citation track record of these individual publications could provide helpful upgrade and a perspective on ongoing development.
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http://dx.doi.org/10.3389/fpubh.2017.00211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5554506PMC
August 2017

Risk factors for potential drug-drug interactions in intensive care unit patients.

J Crit Care 2018 Feb 14;43:1-6. Epub 2017 Aug 14.

University of Kragujevac, Faculty of Medical Sciences, Department of Gynecology and Obstetrics, Svetozara Markovića 69, 34000 Kragujevac, Serbia.

Purpose: To determine risk factors for each severity-based category of potential drug-drug interactions (DDIs) encountered at intensive care unit (ICU) patients.

Methods: This was a retrospective cohort analysis of patients treated at the ICU of the Clinical Center Kragujevac, a public tertiary care hospital in Kragujevac, Serbia. Three interaction checkers were used to reveal drug-drug interactions: Medscape, Epocrates and Micromedex.

Results: The study included 201 patients, 66.19±16.11 years of age. Average number of DDIs per patient ranged from 10.49±8.80 (Micromedex) to 29.43±21.51 (Medscape). Antiarrhythmic or anticonvulsant drug prescription, Charlson Comorbidity Index, male sex, length of hospitalization, number of drugs or therapeutic groups prescribed and surgery increased the risk of DDIs in ICU patients, while presence of delirium or dementia and transfer from emergency department to ICU protected against.

Conclusions: The rate of the DDIs in ICU patients at a tertiary care hospital is high, and adversely influenced by number of drugs or drug groups prescribed per patient, antiarrhythmic or anticonvulsant drug prescription, comorbidities, length of hospitalization and surgery. On the other hand, presence of cognitive deficit and transfer from emergency department to ICU protect ICU patients from the DDIs.
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http://dx.doi.org/10.1016/j.jcrc.2017.08.021DOI Listing
February 2018

Evaluation of brivaracetam: a new drug to treat epilepsy.

Expert Opin Pharmacother 2017 Sep 28;18(13):1381-1389. Epub 2017 Jul 28.

a Faculty of Medical Sciences, Department of Pharmacology and Toxicology , University of Kragujevac , Kragujevac , Serbia.

Introduction: High prevalence of therapy-resistant epilepsy demands development of anticonvulsants with new mechanisms of action. Brivaracetam is an analogue of levetiracetam which binds to the synaptic vesicle protein 2A (SV2A) and decreases release of excitatory neurotransmitters. Areas covered: Relevant published studies were searched for by predefined strategy in MEDLINE, EBSCO and SCINDEKS electronic databases. Brivaracetam is effective as adjunctive therapy for uncontrolled partial-onset seizures with or without secondary generalization in patients 16 years and older with epilepsy. It reduces baseline-adjusted focal seizure frequency per week from 7.3 to 12.8% over placebo. Adverse events rate in patients with brivaracetam is not higher than in patients with placebo. Expert opinion: Brivaracetam is an important step forward in the treatment of therapy-resistant partial-onset seizures with or without secondary generalization. Its development was systematic and targeted. Due to its efficacy and excellent safety profile, it is likely that brivaracetam will be often prescribed. In future, efficacy and safety of brivaracetam should be tested in monotherapy settings and also in the first-line therapy of partial-onset seizures.
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http://dx.doi.org/10.1080/14656566.2017.1359260DOI Listing
September 2017

Pharmaceutical expenditure dynamics in the Balkan countries.

J Med Econ 2017 Oct 7;20(10):1013-1017. Epub 2017 Jun 7.

b Health Economics and Pharmacoeconomics, Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia.

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http://dx.doi.org/10.1080/13696998.2017.1333514DOI Listing
October 2017

Commentary: Growth of Global Health Spending Share in Low and Middle Income Countries.

Authors:
Ana V Pejcic

Front Public Health 2017 14;5:52. Epub 2017 Mar 14.

Faculty of Medical Sciences, University of Kragujevac , Kragujevac , Serbia.

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http://dx.doi.org/10.3389/fpubh.2017.00052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5348507PMC
March 2017

Risk factors for dysmenorrhea among young adult female university students.

Ann Ist Super Sanita 2016 ;52(1):98-103

Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.

Objectives: The aim of this study was to investigate associated risk factors for dysmenorrhea in a sample of Serbian university students.

Methods: A case-control study was conducted among undergraduate students (n = 288) attending lectures during 2014/2015 academic year at the Faculty of Medical Sciences, University of Kragujevac.

Results: The only significant associations were between dysmenorrhea and age at menarche (OR adjusted = 0.74; 95% CI 0.58-0.95; p = 0.017), family history of dysmenorrhea (OR adjusted = 3.39; 95% CI 1.74-6.63; p = 0.000), duration of menstrual flow (OR adjusted = 1.52; 95% CI 1.16-1.99; p = 0.002) and smoking at least one cigarette a day (OR adjusted = 5.09; 95% CI 1.83-14.15; p = 0.002). The factors associated with dysmenorrhea were not interacting with each other.

Conclusion: Our results suggest that earlier age at menarche, longer duration of menstrual flow, prior family history of dysmenorrhea and smoking at least one cigarette a day are important risk factors associated with dysmenorrhea. Smoking cessation should be strongly encouraged.
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http://dx.doi.org/10.4415/ANN_16_01_16DOI Listing
February 2017

Therapeutic efficacy of clindamycin gel as an adjunct to scaling and root planing therapy in chronic periodontal disease.

Acta Clin Croat 2015 Mar;54(1):46-51

Clindamycin, a lincosamide antibiotic, has been under-recognized as an antimicrobial agent for use in dentistry. The aim of the present work was to evaluate clinical efficacy of 2% clindamycin gel in addition to the basic mechanical periodontal therapy. At baseline, scaling and root planing (SRP) was performed at all 50 subjects (control group and test group). Clindamycin gel was applied after SRP only in the test group. Clinical measurements including periodontal pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP) and plaque index (PI) were done at baseline, and at 3 and 6 months after treatment. Compared to baseline, the PPD and CAL values significantly decreased in the test group (p < 0.05) and were statistically lower (p < 0.05) compared to control group. PPD reduction of 2.42 mm was obtained in the test group and could be generally considered as clinically significant. A PPD reduction greater than 2 mm indicated that clindamycin gel could be used efficiently as an adjunct to SRP. Also, between-group difference in BOP and PI scores was statistically significant 6 months after treatment. In conclusion, the application of clindamycin gel in combination with SRP enhanced the efficacy of non surgical periodontal therapy in reducing pocket depth and improving attachment levels in chronic periodontitis subjects and had additional benefits over mechanical therapy alone.
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March 2015

Evaluation of medicinal interventions for the management of oral submucous fibrosis: a systematic review of the literature.

J Contemp Dent Pract 2014 Nov 1;15(6):812-7. Epub 2014 Nov 1.

Professor, Department of Oral and Maxillofacial Surgical and Medical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia.

Oral submucous fibrosis is a chronic, progressive scarring disease associated with both significant morbidity including pain and limited mouth opening and an increased risk for malignancy. This systematic review evaluated the different medicinal (i.e. nonsurgical) interventions available for the management of oral submucous fibrosis. An automated literature searches of online databases from January 1960 to December 2013 were performed and only studies with high level of evidence based on the guidelines of the Oxford Centre for evidence-based medicine were selected. Thirteen studies (3 randomized controlled trials and 10 clinical trials/controlled clinical trials) were included and drugs like steroids, hyaluronidase, human placenta extracts, chymotrypsin and collagenase, pentoxifylline, nylidrin hydrochloride, iron and multivitamin supplements including lycopene were used. There is a clear lack of evidence on the available drug treatment for oral submucous fibrosis and further high quality randomized controlled trials are needed to evaluate the different therapeutic agents.
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http://dx.doi.org/10.5005/jp-journals-10024-1623DOI Listing
November 2014

Effect of periodontal treatment in renal transplant recipients.

Med Princ Pract 2014 20;23(2):149-53. Epub 2013 Dec 20.

Department of Periodontology and Oral Medicine, Medical Faculty, University of Nis, Nis, Serbia.

Objective: To evaluate the effect of periodontal treatment on gingival overgrowth in a group of renal transplant patients.

Subjects And Methods: Twenty-five renal transplant recipients receiving immunosuppressive therapy with cyclosporine A (CsA) were randomly assigned to 2 groups. Group 1 (n = 15) included patients who had been specifically referred to a dental clinic to prevent gingival overgrowth and were given full periodontal therapy. Group 2 (n = 10) was comprised of patients who did not receive any professional periodontal cleaning. Patients from both groups were examined to determine their periodontal status before and after 3, 6 and 12 months in terms of their plaque index, gingival index and gingival overgrowth. During the examination, their overall health was stable.

Results: For group 1, the scores were 1.89 (baseline), 0.98 (6 months) and 0.56 (12 months), and hence there were significant reductions (p = 0.0001). The gingival indices were 1.71 (baseline), 0.76 (6 months) and 0.35 (12 months), and the reductions were also significant (p = 0.0001). A significant association was observed between poor oral hygiene and the degree of gingival overgrowth. The 1-year post-treatment follow-up showed that patients in group 1 did not develop gingival overgrowth due to the use of CsA as group 2 did without prior periodontal therapy.

Conclusion: Oral hygiene status was the most important variable related to the development and degree of gingival overgrowth due to the use of CsA.
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http://dx.doi.org/10.1159/000357274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5586861PMC
October 2014

[Association between chronic periodontitis and serum lipid levels].

Vojnosanit Pregl 2012 Sep;69(9):771-7

Odeljenje za parodontologiju i oralnu medicinu, Medicinski fakultet, Univerzitet u Nisu, Nis, Srbija.

Background/aim: Periodontitis is a local inflammatory process mediating destruction of periodontal tissues triggered by bacterial insult. However, this disease is also characterized by systemic inflammatory host responses that may contrbute, in part, to the recently reported increased risk for systemic diseases, including an altered lipid metabolism. On the other hand, many people in the world are affected by hyperlipidemia, which is a known risk faktor for atherosclerosis. The aim of this study was to determine the relationship between periodontal disease and blood lipid levels.

Methods: A total of 50 patients with periodontitis included in this study had no documented history of recent acute coronary events. The healthy, non-periodontal subjects (comparison group) comprised 25 subjects. All the patients were periodontology examined and completed a medical history. Dental plaque index, probing depth, gingival index bleeding on probing and clinical attechment levels were recorded. Blood samples were taken on admission for measurements of serum total cholesterol, triglycerides, hight density lipoprotein cholesterol (HDL-cholesterol), and low density lipoprotein cholesterol (LDL-cholesterol).

Results: The obtained results showed that mean levels of cholesterol (6.09 +/- 1.61 mmol/L), triglycerdes (2.19 +/- 1.67 mmol/l) and LDL cholesterol (4.09 +/- 1.40 mmol/L) in individuals with periodontitis were higer, and levels od HDL (1.43 +/- 0.51 mmol/L) was lower than those of individuals without periodontitis (4.86 +/- 1.37; 1.14 +/- 0.71; 3.18 +/- 0.64; 1.53 +/- 0.32 mmol/L, respectively).

Conclusion: This study confirms a significant relationship between periodontal disease, regardless its intensity, and blood lipid levels in the studied population. The results imply that periodontitis may be a risk factor and may contribute to the pathogenesis of atherosclerosis and cardiovascular diseases (CVD). However, future prospective randomized studies have to determine whether periodontal disease is a risk factor for the occurence of CVD.
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http://dx.doi.org/10.2298/vsp1209771pDOI Listing
September 2012

White blood cell count in different stages of chronic periodontitis.

Acta Clin Croat 2011 Jun;50(2):159-67

Department of Periodontology and Oral Medicine, University of Nii, Serbia.

Periodontal disease is considered to be an inflammatory disorder that is related to the accumulation of oral microbial biofilm and the host response to this accumulation. The host reaction to gingival microorganisms is characterized in part by increase in the polymorphonuclear leukocyte counts, which is one of the most important steps in host defense. Exaggerated leukocytes and neutrophils of host response are a very important component in the pathogenesis of periodontal disease. The purpose of this study was to investigate the relationship between white blood cell count and periodontal disease in subjects with moderate and severe periodontitis and in control subjects with healthy periodontal tissues. Leukocytes for the present study were obtained from peripheral venous blood of 50 patients with moderate periodontitis, 50 patients with severe periodontitis and 25 healthy subjects. The clinical parameters of periodontitis including plaque index, bleeding on probing and gingival index were determined in all study subjects. In both moderate and severe periodontitis, the results indicated a significantly higher count ofneutrophils (P < 0.001), as well as of both lymphocytes and total leukocytes (P < 0.05). The values of clinical parameters (plaque index, gingival index and bleeding on probing) also showed significant between-group differences (P < 0.005 and P < 0.001, respectively). It is possible that there is a significant relationship between total leukocyte count, neutrophil count and different forms of periodontal disease.
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June 2011

Effect of periodontal treatment on lipoproteins levels in plasma in patients with periodontitis.

South Med J 2011 Aug;104(8):547-52

Department of Periodontology and Oral Medicine, Dental Clinic, Medical Faculty, University of Nis, Nis, Serbia.

Objectives: Recent epidemiological studies have shown that individuals with periodontitis have a significantly increased risk of developing coronary heart disease. In addition to conventional risk factors, dyslipidemia may be associated with this increased risk.

Methods: We measured concentration of lipids in patients with moderate to severe periodontitis before and 3, 6 and 12 months after local periodontal treatment. A total of 50 participants with periodontitis and 25 participants without periodontitis were included in the analyses. Lipoproteins were measured by using serological analyses of the Central Biochemical Laboratory in Clinical Center in Nis. Periodontal health indicators included the plaque index, gingival bleeding index, and periodontal disease status (defined by pocket depth and attachment loss). Patients were non-surgically treated with mechanical debridement of calculus once a week for 1 month.

Results: The results show a significant relation between indicators of poor periodontal status and serum level lipoproteins. Periodontal therapy resulted in a significant reduction of local inflammation and tissue destruction as reflected in reduced pocket depth and reduced bleeding indices. The levels of lipoproteins after therapy seemed to be lower than those reported before treatment in patients with periodontitis compared with healthy ones. Lipoproteins were significantly decreased after treatment (P < 0.005) except high-density lipoprotein cholesterol which was not significantly reduced (P > 0.05).

Conclusion: This pilot study shows that periodontal disease significantly affects the serum levels of lipoproteins and suggests that following successful periodontal treatment decreases serum lipid concentration. This study suggests also that lipoproteins are possible intermediate factors that may link periodontal disease to elevated cardiovascular risk.
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http://dx.doi.org/10.1097/SMJ.0b013e3182242eaaDOI Listing
August 2011

Association between Periodontopathogens and CRP Levels in Patients with Periodontitis in Serbia.

J Dent Res Dent Clin Dent Prospects 2011 18;5(1):10-6. Epub 2011 Mar 18.

Teaching assistent, Department of Periodontology and Oral Medicine, Medical Faculty, University of Nis, Serbia.

Background And Aims: Recent epidemiological studies have shown that individuals with periodontitis have a significantly higher risk of developing coronary heart disease, which might be attributed to the complex microbiota in the dental plaque. Periodontopathogens have been reported as risk factors for cardiovascular disease. This study evaluated association of chronic periodontitis and periodontopathogens with CRP in systemically healthy Serbian adults.

Materials And Methods: Serum C-reactive protein levels were measured in 24 patients with moderate periodontitis, 26 patients with severe periodontitis, and 25 periodontally healthy subjects. Periodontal health indicators included gingival bleeding on probing and periodontal disease status. Patients with moderate periodontitis had low attachment loss and pocket depths of <4 mm. Patients with severe periodontitis had high AL and pocket depth of >5 mm. The control group with healthy gingiva had gingival sulcus of <2 mm and no attachment loss. Presence of periodontopathogens in subgingival plaque samples was analyzed by polymerase chain reaction.

Results: The periodontal parameters and CRP levels were significantly higher in the patients with periodontitis. Patients who had both severe and moderate periodontitis had higher mean CRP levels. The percentage of subjects with elevated CRP leves of >5 mol/L was greater in the higher clinical AL group compared to the group with less attachment loss. Presence of periodontopathogens was also associated with elevated CRP levels and poor periodontal status.

Conclusion: PD and subgingival periodontopathogens are associated with increased CRP levels. These findings suggest that periodontal infection may contribute to systemic inflammatory burden in otherwise healthy individuals.
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http://dx.doi.org/10.5681/joddd.2011.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3429984PMC
October 2012

The effects of low level laser irradiation on gingival inflammation.

Photomed Laser Surg 2010 Feb;28(1):69-74

Department of Periodontology and Oral Medicine, Medical Faculty, University of Nis, Nis, Serbia.

Objective: The goal of this study was to analyze the effects of low level laser irradiation treatment and conservative treatment on gingival inflammation.

Background: It is widely accepted today that the primary etiological factor for the onset of periodontitis is dental plaque, although the exact mechanism of damage remains unknown. Inflammation is a basic response of periodontal tissue to damage and serves as a fast first line of defense against damage and infections. The treatment of gingivitis and periodontitis has gone through various stages: from the simplest, classical treatment methods, through improved radical interventions, to a new era marked by laser technology. Low level laser irradiation has an anti-inflammatory effect, both general and local.

Materials And Methods: The research was done on patients who had chronic periodontal disease (mild periodontitis) with expressed clinical symptoms of gingival inflammation. All patients in the study underwent conservative treatment. After conservative therapy, the patients from the experimental group were subjected to 10 low level laser treatment sessions. Both groups underwent regular follow-up visits 1, 3, and 6 months after treatment, which involved only clinical examination using plaque index (PI), gingival index (GI), and bleeding on probing index (BOP index).

Results: A considerable decrease in all three indexes after the application of both therapies was noticed. The follow-up visits revealed the difference in index values. With laser therapy, the values of indexes decreased steadily, whereas with conservative therapy they increased up to a certain point, but did not reach the pre-therapy values.

Conclusions: A general conclusion can be drawn that low level laser irradiation (semiconductor, 670 nm) can be used as a successful physical adjuvant method of treatment, which, together with traditional periodontal therapy, leads to better and longer-lasting therapeutic results.
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http://dx.doi.org/10.1089/pho.2008.2301DOI Listing
February 2010

[Low-power laser therapy in the treatment of parodontopathy].

Vojnosanit Pregl 2007 Dec;64(12):845-50

Medicinski fakultet Nis, Odeljenje za parodontologiju i oralnu medicinu, Nis, Srbija.

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http://dx.doi.org/10.2298/vsp0712844pDOI Listing
December 2007