Background: Left over medication widely used in hospitals for the treatment of various diseases including malignant illnesses, stand to represent a hazardous form of healthcare waste. According to regulations in the Republic of Serbia dating back to 2009, all healthcare facilities are obligated to separate, label and safely put away said leftover medication, i.e. forward it to authorised operators in order to be securely shipped and properly taken care of abroad. Pharmaceutical waste can lead to dire consequences on a patient's or medical employee's health, as well as cause simultaneous damage to the environment, both work and not. The main aim of this research is the assessment of the state of Serbian hospitals as is, from the perspective of dealing with pharmaceutical waste. Also, the research's objective is to examine the factors that affect the way healthcare waste is handled and the respectful aftermath of their alterations in healthcare institutions. Methods: For the realization of this survey, a special questionnaire was developed, concocted with regard to the margins set out by WHO, in order to promptly assess the management of healthcare waste in hospitals, which had beforehand been pretested. The research was carried out as a cross-sectional study of the representative hospital sample of the secondary and tertiary level of healthcare facilities in the public domain, in November 2014. Results: The questionnaire was completed by 60 hospitals, which typifies a representative number of said facilities in the Republic of Serbia and which covers more than 85% of inpatient capacity within the public sector's network of healthcare hospitals defined by the Bylaw (referred to as the Network of healthcare facilities in Serbia). Conclusion: Tertiary level hospitals, meaning clinical centres, clinicalmedical centres and institutes that offer highly specialized healthcare services and have an admittedly larger number of hospital beds, have a more evolved system of sorting pharmaceutical waste and do away with grander amounts of it on a yearly basis. Establishing a safe and law-abiding management of pharmaceutical waste in hospitals will come to wholly enhance the management of hazardous waste in the healthcare system.

Proper Healthcare Waste Management (HCWM) was introduced in the Republic of Serbia in 2007 with the support of the European Union. Since then, the amounts of waste treated, prior to landfill, have steadily increased and more and more healthcare institutions adopted HCWM systems. In parallel large numbers of healthcare workers were trained in proper HCWM. This study quantifies the progress made. The study analysed the period 2009 to 2012 using three methods of data collection. On basis of data collected, it has been established that with a population of just over seven million, Serbia generates between 4,500 and 5,000 tonnes of infectious waste on an annual basis of which some 20% originates from the treatment of outpatients , 75% from the treatment of in-patients and 5% from micro-biological laboratory tests. While in 2009 only one third of this waste was treated prior to disposal, this fraction has increased to two thirds in 2011. The data also show that more than 90% of healthcare facilities have developed individual healthcare waste management plans up from less than 20% in 2009. In every healthcare facility there are at least 2 people trained in healthcare waste management, and in total there are approximately 3000 staff members who received formal HCWM training provided through the Institute for Public Health. Healthcare waste management is continuously improving in the Republic of Serbia and is well established in more than 85% of healthcare facilities. There are still issues to be improved especially regarding treatment on healthcare waste other than infectious waste.

APSTRAKT Cilj. Cilj istraživanja je analiza uticaja različitih faktora zdravstvene zaštite na upravljanje medicinskim otpadom. Metod. Istraživanje je sprovedeno kao studija preseka na reprezentativnom uzorku bolničkih ustanova sekundarne i tercijerne zdravstvene zaštite u mreži državnih zdravstvenih ustanova, u novembru 2014.godine. Za potrebe istraživanja razvijen je i korišćen posebno dizajniran upitnik, sačinjen na osnovu modela upitnika Ujedinjenih nacija i Svetske zdravstvene organizacije za brze procene upravljanja medicinskim otpadom u bolničkim ustanovama. Rezultati. Korišćenjem Mann Whitney U-testa utvrđena je statistički značajna razlika između ustanova na sekundarnom (MD=23.393, N=43) i tercijernom nivou zdravstvene zaštite (MD=40000, N=17) (U=198, p=0.006) u vezi generisanih količina medicinskog otpada. Ustanove tercijernog nivoa zdravstvene zaštite generišu statistički značajno veće količine opasnog medicinskog otpada u svim evidentiranim tokovima otpada (U=198, p=0,006). Statistički značajna razlika je utvrđena u odnosu na nivo zdravstvene zaštite u odnosu na generisanje medicinskog otpada (U=198, p=0.006), patoanatomskog otpada (U=132, p=0.000), i farmaceutskog otpada (U=221, p=0.018) u bolničkim ustanovama. Ustanove tercijerne zdravstvene zaštite proizvode statistički značajno veće količine opsanog medicinskog otpada u svim analiziranim tokovima (U=198, p=0,006). Zaključak. Utvrđena je direktna i jaka povezanost između ukupnog broja bolničkih kreveta, ostvarenih bolničkih dana, kao i broja obučenih radnika u oblasti upravljanja medicinskim otpadom, koji su i izdvojeni kao glavni faktori zdravstvene zaštite koji utiču na upravljanje opasnim medicinskim otpadom. Ključne reči: uklanjanje medicinskog otpada; zdravstvene ustanove; organizacija i administracija.

Introduction/Background Epithelial ovarian cancer (EOC) is the most lethal gynecological malignancy, with relapse occurring in about 70% of advanced cases with poor prognosis. The aim of the study was to evaluate functional visceral fat activity (VAT) evaluated by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) as a predictor of metastases in EOC. Methodology We enrolled study protocols and PET/CT data of 398 CRC patients; 345 patients were subsequently excluded for various reasons. The remaining 53 patients with histologically confirmed adenocarcinoma, carcinoma and cystadenocarcinoma were then prospectively assessed and underwent 18 F-FDG PET/CT after a surgical treatment and chemotherapy. Age, histology, stage, and tumor grade were recorded. Functional VAT activity was measured by maximum standardized uptake value (SUVmax) using 18F-FDG PET/CT and tested as a predictor of later metastases in eight abdominal locations (RE -

follow-up of 13.5 months, half of the patients had no evidence of disease. Conclusion Our institutional experience comprising intensive clinical and emotional management of vulvar carcinoma radiotherapy provides a proactive approach involving frequent assessment, initiated breaks and emotional support, all facilitating improvement in historically low treatment compliance.