High concentrations of pesticides and toxic metal pollutants in the environment, often present in surface waters in nature, can accumulate in wild animals and are a significant public health concern. Serbia is a moderately developed, south European country in transition, with a long tradition in agriculture, particularly in the northern part, Vojvodina. Our study aimed to assess the presence of pesticides and to measure concentrations of toxic metals in the district of Backi Petrovac, Vojvodina. Water samples were analyzed from canals, ditches, fish from the canals and wild animals caught in the Backi Petrovac district. We identified nine pesticides in water samples. Of all detected pesticides, one was a hormonal disruptor. There were no pesticides in animals, fish and organs in a concentration above the limit of detection (LOD) in observed periods. The concentrations of toxic metals detected in superficial water (Cd, Pb, Hg, As, Mn, Cu) were below the permitted limits, as well as the concentrations of Cd, Pb, Hg, As and Mn in the whole bodies of fish. Concentrations in kidneys and livers of wild animals (rabbit and roe deer) were below the permitted limits, with the exception of cadmium, whose concentrations in some animal samples were above the permitted limit. Based on the obtained results, we concluded that in the developed agricultural region unencumbered by heavy industry, pollution by pesticides and heavy metals can be controlled.

The aim of this study was to determine and describe trends in antibiotics utilization in Serbia over a ten-year period. Data were retrieved from publicly available annual reports (2010–2019). The results were expressed as Defined Daily Dose (DDD) per 1000 inhabitants per day (DID). All calculations were performed using the DDD values for the 2020 Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) version for each year of the study, to account for the DDD changes during the study period. Antibiotics were classified using the WHO Access, Watch, Reserve (AWaRe) classification. Total utilization of antibacterials for systemic use increased from 17.25 DID in 2010 to 28.65 DID in 2019. A statistically significant increasing trend in the use of the Watch category antibiotics was observed. A tendency towards use of broad-spectrum antibiotics, apparent by a statistically significant increase in the rate of utilization of broad-spectrum macrolides, quinolones and third-generation cephalosporins vs. narrow-spectrum ones, as well as a significant increasing trend in the use of quinolones was identified. Total antibiotic utilization was found to be well above the European average. Several specific problem areas were identified, which requires further efforts to improve antibiotic prescribing. The present study provides the information needed to facilitate antibiotic stewardship in Serbia further and proposes specific interventions to optimize antibiotic use in Serbia.

A surveillance study was performed in an intensive care unit in the largest tertiary health care center in Vojvodina, Serbia from 2014 to 2018. Antibiotic prescription data were collated in the WHO anatomical therapeutic chemical (ATC)/defined daily dose (DDD) format, while antibiotic resistance was expressed as incidence density adjusted for total inpatient-days. Individual trends were determined by linear regression, while possible associations between antibiotic prescription and resistance were evaluated using cross-correlation analysis. An overall decrease in antibiotic utilization was observed. The prescription rates of piperacillin-tazobactam increased significantly, while consumption of 3rd and 4th generation cephalosporins and fluoroquinolones decreased. There were rising incidence densities of doripenem resistant Acinetobacter spp., piperacillin-tazobactam resistant Pseudomonas aeruginosa and carbapenem and colistin resistant Klebsiella pneumoniae. These results can serve as a basis for the development of antimicrobial stewardship strategies in the current setting.

This study investigated the chemical and nutritional profile and antioxidative properties of cultivated Coprinus comatus . Proximate analysis revealed that C. comatus is rich in carbohydrates, dietary fibres and proteins, and could also be a valuable source of phenolics. Additionally, fat content is low, consisting mainly of polyunsaturated and omega-3 fatty acids. Furthermore, the safety profile of C. comatus is satisfactory, with all elements of toxicological importance within the proposed limits. Oral treatment with C. comatus for 42 days improved the antioxidant capabilities and ameliorated carbon tetrachloride-induced liver damage in rats, marked by decreased serum aminotransferase levels and lipid peroxidation intensity. Glutathione concentrations increased in a dose-dependent manner. Histological morphometric and immunohistochemical analysis confirmed antioxidative and hepatoprotective potential. These findings imply that cultivated C. comatus could be considered a nutraceutical, having beneficial nutrient and therapeutic properties.

Objective: This study aimed to examine the contents of home pharmacies and medication use, as well as storage and disposal habits in urban and rural households in Serbia. Material and Methods: This prospective research was conducted within 70 households in Novi Sad (urban setting) and Laćarak (rural setting) from October 1, 2015 to January 15, 2016. The data were collected using a standardized questionnaire, as well as by direct examination of drugs stored in households. Results: The most common groups of drugs stored were cardiovascular drugs, drugs for the nervous system, antirheumatic products and antimicrobials. A high percentage of drugs for the alimentary tract were found stored in Laćarak, while drugs for the respiratory tract were discovered in Novi Sad. Prescription only medications (POMs) made up 69.7% of all medications in Laćarak and 60.6% in Novi Sad. POMs were purchased independently in high amounts (13.2% in Laćarak and 9.1% in Novi Sad). Presence of expired medications was higher in Laćarak (12.0%) than Novi Sad (5.8%). Over two-thirds of the households stored medications properly; however, only 10.0% of respondents reported the proper disposal of unused medications. Conclusion: The structures of home pharmacies in Novi Sad and Laćarak differ, which implies different healthcare needs. The practice of self-medicating was noted both in Novi Sad and Laćarak. While Laćarak residents rely more on the advice of friends and family, Novi Sad residents buy medicine mostly without any consultation. Medications in both environments are stored properly in the majority of households, but mostly disposed of improperly together with household waste.

Antibacterial drugs, including fluoroquinolones, can exert their therapeutic action only with adequate penetration at the infection site. Multiple factors, such as rate of protein binding, drug liposolubility and organ blood-flow all influence ability of antibiotics to penetrate target tissues. Microdialysis is an in vivo sampling technique that has been successfully applied to measure the distribution of fluoroquinolones in the interstitial fluid of different tissues both in animal studies and clinical setting. Tissue concentrations need to be interpreted within the context of the pathogenesis and causative agents implicated in infections. Integration of microdialysis -derived tissue pharmacokinetics with pharmacodynamic data offers crucial information for correlating exposure with antibacterial effect. This review explores these concepts and provides an overview of tissue concentrations of fluoroquinolones derived from microdialysis studies and explores the therapeutic implications of fluoroquinolone distribution at various target tissues.

Introduction: Osteoporosis is the most common metabolic bone disease. Aim: This study aimed to measure the utilization of drugs affecting bone structure and mineralization in Serbia from 2013 to 2016, and to compare this data with that from countries with well-developed pharmacotherapeutic practice, such as Finland, Norway, and Denmark. Methods: The utilization of drugs is estimated using the Anatomical Therapeutic Chemical/Defined Daily Dose (DDD) methodology. The amount of total drugs consumed has been expressed in the number of Defined Daily Dose on 1000 inhabitants per day (DDD/1000 inhabitants/day). Results: In 2016, a total of 2.91 DDD/1000 inh/day of all drugs was used in Serbia of which 75.26% belonged to bisphosphonates, whereas they made 37.15% in Finland, 81.56% in Norway and 77.84% in Denmark of the total utilization of M05 drugs subclass. The most frequently used bisphosphonate in Serbia in 2013 was alendronic acid, while in 2016 it was ibandronic acid. In three compared countries the rate of utilization among bisphosphonates was the highest for alendronic acid. The level of other bisphosphonates' utilization in Serbia, as well as the utilization of strontium ranelate, is constantly low compared to other drugs. In comparison to other countries, the utilization of denosumab in Serbia is multiple folds lower, however with an upward trend. Conclusions: The utilization of drugs affecting bone structure and mineralization in the examined period in Serbia compared to Finland, Norway and Denmark is three to six fold lower. Furthermore, there is a difference between the structure of prescribed and consumed drugs.

The beneficial medical properties of cannabis in treatment of variety of diseases have been widely recognized across many cultures (Zuardi, 2006, Aggarwal et al., 2009, Birdsall et al., 2016). At the end of the 19th century in Europe, cannabis was considered effective for the treatment of chronic pain, asthma, sleep disorders, depression, and loss of appetite (Guy et al., 2004, Manzanares et al., 2006, Sabo et al., 2013). Medical use of cannabis continued until the first half of the 20th century, when legal restrictions were introduced due to the psychoactive constituent - delta-9-tetrahydrocannabinol (THC), which is one of at least 113 cannabinoids identified in cannabis (Ben Amar, 2006, Horvat et al., 2007). In Serbia, cannabis is classified under narcotic drugs, and the production, sale and possession of cannabis for recreational use or any form of medical marijuana products is illegal (Law on Psychoactive Controlled Substances). Recently, a number of countries in Europe have introduced specific laws and programs to allow patients to use cannabis preparations to effectively relieve the symptoms of chronic pain, muscle cramps and spasticity in patients with multiple sclerosis, to alleviate nausea and vomiting and to improve weight gain and appetite in patients with AIDS (European Monitoring Centre for Drugs and Drug Addiction, 2017). Besides Netherlands, a country with more than 10 years of experience in medical cannabis use, medical cannabis has also been legalized in Italy, Spain, France, Romania and Czech Republic. As for the countries surrounding Serbia, Croatia and Macedonia are the most recent countries which have allowed the use of cannabis in medical purposes (Bifulco and Pisanti, 2015). As more countries in Europe and worldwide continue to change laws for medical marijuana use, public interest in medical cannabis legalization in Serbia is growing. When medical cannabis is legalized in Serbia, doctors will be the ones who will prescribe the products and answer to patients’ questions about its use, benefits and side effects. It is of immense importance to bear in mind specific harmful effects of cannabis, especially in young people. Cannabis is indicated as a possible risk factor for cardiovascular disease in young adults due to increased reporting of cardiovascular complications related to cannabis and their extreme seriousness (Jouanjus et al., 2014). Furthermore, exposure to cannabis during adolescence has been connected to deviations in the normal neurodevelopment, producing a brain particularly at risk of psychiatric disorders such as schizophrenia (Iannitelli et al., 2017, Quartini et al., 2017). Yet, prospective doctors may receive minimal education on this issue throughout the curriculum. A paucity of studies exist evaluating future health care professionals’ knowledge and attitude towards medical cannabis (Sabo et al., 2013, Ben Amar, 2006). In Serbia, one study evaluated beliefs about medical cannabis among fourth-year medical students, while another included only the final year students of pharmacy (Vujcic et al., 2017, Stojanovic et al., 2017). The aim of this study was to determine the frequency of recreational cannabis use among medical students and to explore their knowledge about therapeutic use/abuse, side effects and current legislation status of medical cannabis, as well as attitudes toward its legalization.

Aims: The aims of this study were to assess patients' non-adherence and associated factors to antidiabetic medication in the primary care setting in the eastern part of Bosnia and Herzegovina (BiH). Methods: We conducted a retrospective chart review of 323 patients with type 2 diabetes mellitus (T2DM) attending the primary health care center of the Foca municipality in eastern part of BiH and measured adherence to antidiabetic medication. Adherence was measured using a pill count method. Results: The majority of patients were treated with oral therapy (84.21%). Half of the patients (48%) treated pharmacologically were non-adherent and patients on oral and insulin combination therapy showed better adherence than those on oral therapy. Age (B = -0.749; p = 0.004), copayment (B =0.549; p = 0.028) and oral therapy (B = 0.827; p = 0.045) were the strongest predictors of poor adherence. Conclusion: About half of the patients were non-adherent to antidiabetic medication. Interventions oriented towards policy changes regarding availability of antidiabetic medication through copayment reductions, and providing healt education to younger population and patients on oral therapy could lead to better adherence among T2DM patients in eastern part of BiH. (C) 2017 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

There are no national estimates for the prevalence of DM in Bosnia and Herzegovina (BiH), available data is extrapolated from neighboring countries. This study aimed to determine the prevalence of DM, as well as utilization of antidiabetic drugs (ADs) and exposure rates of DM patients to ADs in the eastern region of the Republic of Srpska (RS), BiH. For external reference, data were compared to that from Serbia, Hungary and Norway. Data on the number of all adult patients with DM type 1 and 2 in the three municipalities in the eastern region of RS were obtained from medical records. The use of ADs in the RS, Serbia, Hungary and Norway for the year of 2013 was analysed by ATC/Defined Daily Dose methodology. The exposure of DM patients to ADs was expressed in percentage. The recorded DM prevalence in the three observed municipalities was 6.65%, with high proportion of type 1 compared to type 2 DM (25.32% to 74.68%). The total consumption of ADs recorded in our study was similar to those in Norway, but lower than in Serbia and Hungary. The percentage of theoretical exposure of each patient to ADs was only 78,24%, similar to that in Serbia (80.6%), whereas Norway and especially Hungary had exceptionally good exposure rates (103,8 and 126.5%). High proportion of type 1 DM patients recorded in our study indicates the insufficient detection of DM, especially type 2, whereas the low exposure rate of patients with DM to ADs indicates that even the registered patients with DM are undertreated. There is an urgent need for interventions in prevention and treatment of DM in BiH.

OPINION article Front. Public Health, 24 July 2018Sec. Health Economics Volume 6 - 2018 | https://doi.org/10.3389/fpubh.2018.00193

There is little published information about antibiotic utilization in outpatients in Serbia. The objective of this study was to determine the amount and structure of outpatient antibiotic use in South Backa District (SBD) in Serbia, to assess prescibing quality of antibiotics and to compare with results from Scandinavian countries. Data on the antibiotic use were collected from all private and state-owned pharmacies from January through March 2008 in SBD. Results were expressed as the number of defined daily doses/1,000 inhabitants/day. The drug utilization 90% method was also used. Penicillins were the most frequently used antibiotic subgroup in SBD (35.20%), followed by cephalosporins (19.16%) and macrolides (13.18%). Thirteen drugs accounted for 90% of total antibiotics consumption (DU90% segment). The average cost/DDD within the DU90% segment was 0.95 euros, whereas the average cost/DDD beyond the DU90% segment was 1.89 euros, indicating that less expensive antibiotics were more frequently used. High use of ampicillin, third-generation cefalosporins, co-trimoxazole, and gentamicin, will aggravate the alarming problem of resistance in Serbia. Differences in the amount and structure of antibiotic consumption between SBD and Scandinavian countries indicate the need of updated national guidelines for rational antimicrobial drug use in Serbia.

Background Irregular antibiotic use, including self-medication contributes to the development of antibiotic resistance. One method of accessing antibiotic use in the community is through obtaining an in house inventory of drugs. Objective The aim of this study was to investigate the extent of storage and self-medication with antibiotics agents in households in Novi Sad, Serbia. Setting Households in Novi Sad. Method The study was performed during a 4-month period (October 2015–January 2016) using a sample of 112 households in Novi Sad, Serbia. Two trained interviewers performed the survey by visiting each household. The study consisted of making an inventory of all drugs in household and a semi-structured interview about drug use practices and perceptions. Main outcome measure Number of antibiotics obtained without prescription. Results Out of 112 surveyed households, antibiotics were encountered in 55 (49.1%). Antibiotics constituted 11.98% (92/768) of total number of drug items in households. Out of all antibiotics in households, 41 (44.57%) were not in current use, and presented left-overs from previous treatment. Antibiotics were usually acquired with prescription (67, 67.7%), while about a quarter of packages were used for self-medication—purchased at pharmacy without prescription (19, 20.65%) or obtained through friends or family member (6, 6.52%).The most commonly used antibiotics for self-medication was amoxicillin (reported indications included common cold, cough, pharyngitis and tooth-ache). Conclusion Antibiotics were present in large share of households in Novi Sad. Self-medication with antibiotics and sale of antibiotics without prescription represent an important problem in Serbia.

The purpose of this systematic review was to determine the practice of medication disposal around the world and get insight into possible association between environmental awareness and people's behavior regarding this issue. A literature search (2005-2015) was performed to identify reports with quantitative data on disposal practices published in peer-reviewed literature. The most common method for disposal of unused medications in households is disposal in the garbage (Kuwait, United Kingdom, Lithuania, Qatar, Serbia, Ghana, Bangladesh, Malta and Saudi Arabia). The practice of flushing drugs into the sewage system still takes place in New Zealand, USA and Bangladesh. Only in Sweden and Germany, practice of returning drugs to pharmacy was practiced to a larger extent. The environmental impact of improper medication disposal is expected in countries with poorly functioning waste management schemes (Middle Eastern, Asian and African countries). Lack of the adequate information and clear instructions on proper manners of drug disposal was reported in many surveyed countries (USA, New Zealand, Bangladesh, Malta and Ireland). Clear and definite connection between knowledge about environmental detrimental effects of improper drug disposal and the preference towards disposal methods could not be established. Many respondents were generally concerned with issues of inadequate medicines discarding but the behavior regarding disposal of unused drugs often did not equate the awareness (Serbia, USA, Kuwait, Malta and UK). The current data emphasizes the global issue of improper medicine disposal, prevalent in environmentally-aware people.

INTRODUCTION:The objective of this study was to investigate the knowledge, attitudes and behavior regarding antibiotics of the general population. METHODS:The study sample consisted of adult subjects who consulted general practitioners at health centers in Serbia and agreed to complete the questionnaire. A total of 668 questionnaires were distributed; 500 respondents completed the entire questionnaire (response rate 74.85%). RESULTS:The average age was 51.65 ± 16.56 years, 60.80% of the respondents were women. The median antibiotic knowledge score was 9. Predictors of adequate antibiotic knowledge were higher education level and a family member whose ocuppation was related to health-care. Overall, 58.4% of respondents believed that antibiotics could be used to treat common cold. Around a half of the respondents (47.2%) self-medicated with antibiotics at least once during their life-time, and around a quarter (24.2%) during the last treatment of infection. Patients with inadequate knowledge had 3 times higher chances of self-medicating with antibiotics compared to those with adequate knowledge. Although 98.20% of respondents claimed that antibiotic treatment should be started after a visit to a doctor and receiving a prescription, only 65.8% obtained antibiotics with prescription from a doctor during the last infection. CONCLUSIONS:Although these results demonstrate that respondents had a relatively adequate level of knowledge regarding antibiotics use, some areas of misconceptions and improper behavior were identified. Therefore, further rationalization should be focused on educational campaigns targeting the behavior of patients with regard to antibiotic use.

Introduction: With the growing trend for legalization of cannabis and its derivatives in Serbia, pharmacists are likely to be consulted on the safety, efficacy, and drug-drug or drug-disease interactions of medical cannabis. Thus, the aim of our study was to assess pharmacy students’ knowledge and attitude toward medical cannabis use in Serbia to determine if additional education is needed. Subjects and methods: In the study students from the final year of the study program of integrated academic studies of pharmacy at the Faculty of Medicine, University of Novi Sad were asked to complete an anonymous questionnaire regarding their knowledge and attitudes on the use of cannabis and its derivatives in medical purposes. After giving their written informed consent, they were instructed by the researchers on how to complete the questionnaire. All questionnaires were administered between August 1, 2017 and August 15, 2017. The study was approved by the Ethical Committee of the Faculty of Medicine in Novi Sad; a total of 80 questionnaires were distributed. The questionnaire consisted of 3 groups of statements on which they should mark level of their agreement related to students’ knowledge about the use of cannabis and its derivatives in therapeutical purposes, potential negative effects, dispensing in a pharmacy and legalization of cannabis and its derivatives in medical purposes. Results: Although 91.2% of the respondents agreed that cannabis and its derivatives could potentially have therapeutical effects, much lower percentage of respondents (51.3%) were familiar with possible therapeutical effects of cannabis. The same percentage of respondents learned about therapeutical effects of cannabis from sources other than school. About third (31.3%) of our respondents thought that the use of cannabis and its derivatives in therapeutical purposes could cause their abuse and the similar percentage of respondents (33.8%) thought that issuing cannabis and its derivatives in the pharmacy could expose a pharmacist to the certain dangers such as insisting on the issuing without the prescription or robbery. About 90% of the respondents agreed it is necessary to create clear guidelines for the use of cannabis and its derivatives in therapeutical purposes and 76.3% of the respondents thought that doctor’s prescription is necessary for their dispensing in a pharmacy. Most of the respondents (75%) agreed that, based on the experiences of the countries which have approved the use of cannabis and its derivatives in therapeutical purposes, its use in those purposes should be approved in Serbia. Conclusion: The majority of pharmacy students supported medical cannabis legalization but only with strict legal regulations and clear guidelines for their use implemented. Further education of the pharmacist about therapeutical effect of cannabis is necessary.

Introduction. Depleted uranium radiation and pollution with polychlorinated biphenyls resulting from bombings the territories of Serbia as well as the additional long-term stress may have affected the function of thyroid gland. The objective of this study was to determine the trend of drug utilization in the treatment of thyroid dysfunction during pregnancy in Novi Sad. Material and Methods. Women who had given birth at the Department of Gynecology in 1989, 1999, 2007 and 2011 were interviewed during a one-month period about thyroid diseases in the pregnancy as well as the drugs they had taken. Results. Not a single pregnant woman was reported to have a thyroid disorder in 1989 and 1999, while in 2007 four women were reported to have a thyroid dysfunction. In 2011, fourteen out of 18 women with thyroid dysfunction were using levothyroxine and in most cases hypothyroidism was diagnosed as autoimmune Hashimoto thyroiditis. Conclusion. The study results suggest the necessity of performing more detailed analyses of the correlation between the frequency of the thyroid gland dysfunction and the effects of environmental pollution in Serbia.

BACKGROUND/AIM:Hypertension is one of the leading causes of cardiovascular morbidity and mortality and more than a half of all health insurance expenditures for reimbursed medicines are allocated to antihypertensive drugs in Serbia. The aim of this study was to identify the antihypertensive drug utilization patterns among hypertensive outpatients in the city of Novi Sad, Serbia, determine the adherence to clinical guidelines and address the economic aspects of current prescribing practices.METHODS:This retrospective observational study was conducted in Novi Sad over a period of six months. The data on the number of packages, size their, and retail price of antihypertensives issued on prescription in outpatients with the diagnosis of essential arterial hypertension was collected from all state-owned pharmacies in Novi Sad. Drug consumption was analyzed using the Anatomical Therapeutic Chemical (ATC)/ defined daily dose (DDD) methodology.RESULTS:Total consumption of antihypertensives issued on prescription over a 6-month period in the city of Novi sad, Serbia was 283.48 DDD per 1,000 inhabitans per day (DID). Angiotensin converting enzyme inhibitors (ACEi) were most commonly prescribed drugs, and were used 3 times more often than calcium channel blockers and 5 times more than beta-blockers. The consumption of diuretics and angiotensin receptor antagonists was low within all the groups of outpatients. Both national and international guidelines state superiority and effectiveness of diuretics in treatment of hypertension in the elderly, but their consumption was unreasonable low despite the fact that over 70% of all antihypertensive drugs in the city of Novi Sad were dispensed in people aged > 60. The use of more expensive ACEi was observed despite the guidelines deeming all the drugs of this class equally effective in treatment of hypertension.CONCLUSION:Large differences in utilization of different groups of antihypertensive agents were noted in this study. Underutilization of valuable, efficacious, and cost-effective thiazide diuretics and overuse of expensive ACE inhibitors is unjustifiable. There is a potential for large savings with switching to low-price ACEi, modeling the practice of Scandinavian countries.