Background: In the last decade, regenerative therapies have become one of the leading disease modifying options for treatment of knee osteoarthritis (OA). Still, there is a lack of trials with a direct comparison of different biological treatments. Our aim was to directly compare clinical outcomes of knee injections of Bone Marrow Aspirate Concentrate (BMAC), Platelet-rich Plasma (PRP), or Hyaluronic acid (HA) in the OA treatment. Methods: Patients with knee pain and osteoarthritis KL grade II to IV were randomized to receive a BMAC, PRP, and HA injection in the knee. VAS, WOMAC, KOOS, and IKDC scores were used to establish baseline values at 1, 3, 6, 9, and 12 months. All side effects were reported. Results: A total of 175 patients with a knee osteoarthritis KL grade II-IV were randomized; 111 were treated with BMAC injection, 30 with HA injection, and 34 patients with PRP injection. There were no differences between these groups when considering KL grade, BMI, age, or gender. There were no serious side effects. The mean VAS scores after 3, 7, 14, and 21 days showed significant differences between groups with a drop of VAS in all groups but with a difference in the BMAC group in comparison to other groups (p < 0.001). There were high statistically significant differences between baseline scores and those after 12 months (p < 0.001) in WOMAC, KOOS, KOOS pain, and IKDC scores, and in addition, there were differences between these scores in the BMAC group in comparison with other groups, except for the PRP group in WOMAC and the partial IKDC score. There were no differences between the HA and PRP groups, although PRP showed a higher level of clinical improvement. Conclusions: Bone marrow aspirate concentrate, Leukocyte rich Platelet Rich Plasma, and Hyaluronic acid injections are safe therapeutic options for knee OA and provide positive clinical outcomes after 12 months in comparison with findings preceding the intervention. BMAC could be better in terms of clinical improvements in the treatment of knee OA than PRP and HA up to 12 months. PRP provides better outcomes than HA during the observation period, but these results are not statistically significant. More randomized controlled trials and high quality comparative studies are needed for direct correlative conclusions.

Tick-borne encephalitis (TBE) is a zoonotic flaviviral infection that is a growing public health concern in European countries. The aims of this research were to detect and characterize tick-borne encephalitis virus (TBEV) in Ixodes ricinus ticks at presumed natural foci in Serbia, and to determine seroprevalence of TBEV IgG antibodies in humans and animals. A total of 500 I. ricinus ticks were examined for the presence of TBEV by real-time RT-PCR, and conventional nested PCR and sequencing. To determine TBEV seroprevalence, 267 human sera samples were collected, as were 200 sera samples from different animal species. All sera samples were examined by ELISA for the presence of anti-TBEV antibodies. To exclude cross-reactivity, all sera samples were tested for anti-West Nile virus (WNV) antibodies and all human sera samples were also tested for anti-Usutu virus antibodies by ELISA. Results of this preliminary study indicated TBEV activity in Serbia at two microfoci. Several decades after the previous documentation of TBEV in Serbia, we have demonstrated the presence of TBEV in I. ricinus questing nymphs (prevalence 2% and 6.6% at the two different localities) and anti-TBEV antibodies in humans (seroprevalence 0.37%). Moreover, we show for the first time TBEV seroprevalence in several animal species in Serbia, including dogs (seroprevalence 17.5%), horses (5%), wild boars (12.5%), cattle (2.5%), and roe deer (2.5%). None of the goats tested was positive for anti-TBEV IgG antibodies. TBEV isolate from I. ricinus tick in this study belonged to the Western European subtype. To understand the true public health concern in Serbia, detailed epidemiological, clinical, virological, and acarological research are required. This is important for implementation of effective control measures to reduce the incidence of TBE in Serbia.

SUMMARY -Th ere is limited evidence showing that elevated arterial blood pressure in surgical patients may be associated with increased perioperative risk; however, cardiovascular instability frequently occurs during anesthesia. Th e most commonly used anesthetic agents, both intravenous and inhalation ones, produce a decrease in arterial blood pressure. Magnesium, acting as a natural calciumchannel blocker, induces direct and indirect vasodilatation, thus playing a role in the treatment of arterial hypertension. In this research, we assessed the eff ects of magnesium sulfate on cardiovascular stability in patients undergoing diverse planned surgical procedures (abdominal, orthopedic, urology) under general balanced anesthesia, who were diagnosed with arterial hypertension grade 1 and 2. Th e research encompassed 100 patients of both sexes, aged from 20 to 65. Immediately before induction of anesthesia with propofol, the patients in the experimental group (50 study subjects) received 30 mg/ kg bolus dose and magnesium sulfate infusion at 10 mg/kg/h, whereas the subjects in the control group (50 patients) were administered normal saline. Anesthesia was achieved and maintained with sevofl urane, fentanyl and rocuronium. Th e hemodynamic variables of mean arterial pressure and heart rate were measured every fi ve minutes, starting immediately before magnesium infusion. Statistical analysis of the categorized values of mean arterial pressure and heart rate revealed a statistically signifi cant between-group diff erence at 60 th and 90 th minute of anesthesia. In conclusion, magnesium sulfate as an adjuvant to anesthesia in patients with arterial hypertension reduces hemodynamic changes during anesthesia.

The comparison of the quality of life of patients in both groups showed no statistically significant difference. Therefore, we were not able to prove the hypothesis about the superior quality of life of those patients who had suffered from a runnired anterior cruciate linament only.

Introduction. The advancement of patient safety culture within a health institution is the basic component of reduction of errors and the improvement of the general quality of healthcare. The aim of this study was to assess the patient safety culture by means of Hospital Survey on Patient Safety Culture in the Serbian setting. Material and Methods. The survey was conducted in five health institutions in the form of cross section study, which included 1,435 health care workers. Results. Nine dimensions have been selected out of 37 items by explorative factor analysis. The total percentage of positive response was 51%. The highest (70%) and the lowest (33%) percentage of positive responses were obtained in the dimensions "Overall perceptions of safety" and "Nonpunitive response to errors", respectively. More than half of the respondents assessed the patient safety as excellent/very good. In the last 12 months, more than half of the respondents have not reported an adverse event. Conclusions. The survey results indicate that changes are necessary in all domains of patient safety culture. Healthcare policy makers have to take responsibility for the implementation of safety culture in every health institution. Patient safety culture can be observed and advanced by full commitment of all those involved in the health care system, understanding both the causes of adverse events and errors, as well as by applying efficient methods to reduce them to the minimum.

Introduction. Rupture of lateral collateral ligament of the knee is most often joined with other ligament ruptures. Isolated rupture of this ligament is rare and there are few papers about treatment options and results. Here we reported a case of isolated lateral collateral ligament rupture and the treatment outcome. Case report. A patient, 22 years old male, injured his left knee while playing American football. While landing on the outstretched left leg, he felt a sudden pain in his knee. The patient could not continue the competition. Initial orthopedic examination revealed lateral opening and further diagnostic procedure (magnetic resonance imaging) revealed isolated grade III rupture of lateral collateral ligament with avulsion fracture of the fibular head, and distension of anterior and posterior cruciate ligaments. Patient was surgically treated with metal sutures passed through conjoined tendon and proximal fibula. Postoperatively patient worn above knee cast for 6 weeks and after that he was included in rehabilitation. Three and six years after this injury, the patient has still been professional football player with no symptoms and no clinical instability of the knee despite radiological and computed tomography verified pseudoarthrosis of the fractured fibular head fragment. Conclusion. Early diagnostic and absence of additional injuries of the knee leads to a faster and full functional recovery of patients with isolated avulsion fracture of the fibular head, while surgical treatment provides knee stability with no residual ligament instability during sports activities.Apstrakt lečenje obezbeđuje stabilnost kolena i povratak sportskim aktivnostima.

Introduction. In the treatment of various orthopedic conditions, regenerativetherapies, including platelet rich plasma and autologous stem-cell therapy, have recently been advancing. Knee cartilage lesions are a debilitating disease resulting in fibrillation and subsequent degradation which can also involve the subchondral bone and lead to the development of osteoarthritis. Bone marrow mesenchymal stem cells are a heterogeneous mixture of cells involved in cartilage formation and regenerative repair, whereas other mesenchymal stem cells have the capacity to play a role as immunomodulatory and trophic factors. Nowadays, stem-cell therapy is widely used for the treatment of knee osteoarthritis and cartilage lesions. The purpose of this study was to evaluate preliminary clinical data of treatment of knee osteoarthritis with stem cell injection and treatment of osteochondral lesions with stem-cell scaffold. Material and Methods. Stem cells were obtained by concentrating the content taken with aspiration needles from the bone marrow my means of Arthrex Angel Bone Marrow Aspirate Concentrate centrifuge. Results. The study sample consisted of 39 patients who were included in knee osteoarthritis treatment. Surgical implantation was performed in 7 patients from the osteochondral group. In the first group, an average Visual Analogue Scale pain felt before intervention decreased statistically significantly three days after the intervention (from 7.27 to 2.12, p?0.05) and remained 1.2 until the check-up after 3 months. The same results were achieved in the average Western Ontario and McMaster Universities Arthritis Index score (prior to intervention = 51.5; after 1 month = 72 and after 3 months = 76). For the second group, an average preintervention Visual Analogue Scale pain decreased statistically significantly three days after intervention (from 8.1 to 2.7) and remained 1.2 until the check-up after months. The same results were achieved on the Knee injury and Osteoarthritis Outcome Score pain (p?0.05). Both procedures were proved as safe providing pain relief and function improvement of treated knee joints.

Introduction. For multiply traumatized or polytraumatized patients, the preservation of normal limb function with minimal complication is the highest priority. The supreme principle of the Ilizarov techique is to achieve limb stability with equality, without deformities, with sufficient muscle function and full range of joint movement with minimal risk of infection. It is also of great importance to decrease the length of immobility with the least possible number of surgical procedures. Material and Methods. We present a retrospective and partially prospective study with the analysis of the Ilizarov apparatus application for managing acute traumatic fractures, bone fracture complications and other orthopedic conditions eligible for treatment with this technique. This study covers our experiences and results gained in the period from 2003 to 2016. The analysis included a broad spectrum of orthopedic and traumatology conditions such as acute fractures, non-union fractures, malunion fractures, pseudoarthrosis, congenital and acquired bone deformities and the final treatment after total knee joint replacement failures. Results. After a long follow-up time, the long-term results were assessed by estimating the results of clinical examinations, X-ray evaluations, Association for the Study and Application of the Method of Ilizarov bone and functional scoring system and Karlstrom and Olerud functional scoring system evaluations. Conclusion. The introduction of the Ilizarov method at our Department 13 years ago has justified its application in everyday clinical practice by achieving excellent results in the treatment of the most complicated orthopedic and trauma conditions.