Serbian Medical Society - Section Kragujevac, Kragujevac
ACUTE CHOLECYSTITIS CAUSED BY GRANULOMATOSIS WITH POLYANGIITIS - A RARE CASE
The most commonly affected organs in Granulomatosis with polyangiitis (GPA) include kidneys and lungs, while presentation in other organ systems is rare. [1, 2, 3]. We hereby present a case of vasculitic changes in the gallbladder, as the initial manifestation of GPA. A 65-year-old woman presented with fever and generalized weakness and was admitted to hospital. Upon admission, physical examination revealed signs of dehydration, mild hypotension and tachycardia. There was no palpable tenderness in the abdomen, and Murphy’s sign was negative. Initial work-up revealed normocytic anemia, elevated markers of inflammation. Urinalysis revealed protein and red blood cells. Blood and urine cultures were negative, and no signs of inflammation were identified on radiographic imaging. Due to persisting fever and unresolved inflammatory process despite the usage of parenteral antibiotic treatment, a computed tomography (CT) was also performed and revealed calculous cholecystitis necessitating laparoscopic cholecystectomy. Histopathology of the resected gallbladder showed small-vessel vasculitis. Laboratory tests revealed positive proteinase-3-anti-neutrophil cytoplasmic antibodies (PR3-ANCA) with an onset of renal dysfunction. These results supported a diagnosis of granulomatosis with polyangiitis (GPA) and the patient was started with glucocorticoids and intravenous cyclophosphamide. After this treatment, the patient’s general condition stabilized, creatinine and C-reactive protein levels decreased, and anemia resolved as well. This case highlights the importance of considering vasculitis in patients with unexplained persistent fever and systemic symptoms, especially when common causes have been excluded.
SHORT-TERM OUTCOMES OF LAPAROSCOPIC COLORECTAL RESECTIONS FOR CANCER: A FIVE-YEAR SINGLE-CENTRE EXPERIENCE FROM SERBIA
Objective: To evaluate the short-term outcomes of laparoscopic colorectal resections for colorectal cancer in a single Serbian tertiary centre. Methods: A retrospective cohort study included 97 patients who underwent elective laparoscopic colorectal resections between January 2018 and March 2023. Demographic, perioperative, and oncologic data were analyzed. Primary outcomes were 30-day morbidity and mortality; secondary outcomes included operative time, conversion, re-intervention, length of stay, and lymph-node yield. Logistic regression identified independent predictors of complications. Results: The cohort comprised 59 men (60.8%) and 38 women (39.2%), with a median age of 71 years. Conversion to open surgery occurred in 6 patients (6.1%), while re-intervention was required in 3 (3.1%). The median operative time was 120 minutes for colonic and 175 minutes for rectal resections. Median lymph-node yield was 15, with all achieving R0 resection. The overall 30-day morbidity rate was 17.5%, with no perioperative deaths. General complications occurred in 12.4% and surgery-specific complications in 11.3%, with partial overlap. Median length of stay was 9 days, significantly longer in men and diabetic patients. Logistic regression confirmed cardiomyopathy as an independent predictor of postoperative complications (OR 7.5, p = 0.008). Conclusion: Laparoscopic colorectal resections in this series were associated with acceptable morbidity, no mortality, low conversion, and adequate oncologic quality. Cardiomyopathy was identified as a major perioperative risk factor, highlighting the need for tailored perioperative management.
THE ROLE OF ARTIFICIAL INTELLIGENCE IN GENERAL PRACTICE - CHALLENGES AND POTENTIAL RISKS
Artificial intelligence has a significant role in the field of primary health care and its application is becoming more common. Artificial intelligence helps doctors of general medicine on several levels, in high-quality diagnosis and therapy planning, and by processing a large amount of data, in providing more time for the implementation of sophisticated tasks. Despite its many advantages, it is believed that artificial intelligence can negatively affect the doctor-patient relationship. Artificial intelligence in general medicine represents a significant component in the further development of personalized medicine, individual approaches to treatment and quality health care for patients.
FORENSIC CHARACTERISTICS OF ROAD TRAFFIC ACCIDENTS - А SECULAR TREND STUDY
Objective: Оbjective of work is to determine the forensic characteristics of road traffic accidents in territory of Raška District for period from 2009 to 2024. Material and methodology: Observational, cross-sectional epidemiological study, in which a retrospective analysis of the characteristics of traffic accidents in Raška District of Republic of Serbia over past sixteen years was performed. Results: Total number of road traffic accidents in observed period was 18.092. The research analyzed data from 2.129 road traffic accident participants who had a positive blood alcohol concentration. Largest number of road traffic accidents occurred in city of Kraljevo, outside of a populated area. Largest percentage of participants were motor vehicle drivers (88.54%), male (93.2%), with an average age of around 40 years. Seasonal relationship was observed in occurrence of road traffic accidents (August, September), as well as a higher incidence on weekends. Participants who were in the stage of heavy drinking more often suffered serious bodily injury, while participants who were in a state of intoxication and light drinking more often suffered minor bodily injury. Conclusion: Road traffic accidents in the Raška District are the result of a combination of several factors, including driving under the influence of alcohol, traffic infrastructure, high population density in certain cities and specific characteristics of Ibar Highway.
PHONOLOGICAL AWARENESS IN PRESCHOOL CHILDREN WITH DEVELOPMENTAL LANGUAGE DISORDER
ABSTRACT Objectives. To determine the level of development of phonological awareness in children with developmental language disorder at the age of four to six years compared to children with typical language development. Methods. Ninety children aged 4 to 6, of both genders, divided into three groups, participated in the study. The Phonological Awareness Test was applied. The study was conducted during January and February 2024. Results. The analysis of the results showed that phonological awareness deficit was not more frequently manifested in children with developmental language disorder compared to children of typical development, as well as that there was no statistically significant difference in the manifestation of phonological awareness deficit in children with developmental language disorder in relation to gender, in terms that these problems are more frequently found in boys. Key words: developmental language disorder, phonological awareness, typical language development
Leiomyomas (myoma, fibromyoma or fibroid) are benign tumors of smooth muscle cells. They are predominantly localized in the body of the uterus, but they can also develop in the broad ligament, ovaries, cervix, Douglas space and round ligament. Their frequency ranges from 5.4 to 77%, depending on the population examined or the applied diagnostic technique. Most leiomyomas are asymptomatic, but can present with a wide range of symptoms. Treatment includes pharmacological treatment and surgical treatment. A patient with a leiomyoma of the Douglas space coexisted with leiomyomas of the uterine body. Apart from intense pain in the lower part of the stomach, she had no other symptoms. Abdominal ultrasound examination, transvaginal ultrasound examination and computer tomography revealed an enlarged, myomatous uterus and a tumoral change on the right ovary. In an extensive operation, the uterus and both fallopian tubes were removed. The final diagnosis of a tumor changes in Douglas' space, which was initially considered a potentially malignant tumor of the right ovary, was established by a pathohistological examination after the operation. Leiomyomas are relatively common benign tumors of the uterine body. Their early diagnosis during a gynecological examination enables timely treatment that avoids hysterectomy and maintains fertility. Leiomyomas of atypical localization have a low incidence and an unclear clinical picture, and their final diagnosis is predominantly made after surgery.
Assessment of indicators of children education in Serbia with implication to the health literacy
Introduction: Access to primary education is the basic right of every child. The aim of the work is to assess the status of the share of children of official primary school age who are not enrolled in school and sex differences, as well as the children enrolled in pre-school education, in Serbia, over a period of 15 years. Method: The research was conducted as an observational epidemiological study. The indicators analysed in this research are the "Share of children of official primary school age who are not enrolled in school" and the indicator "Gross rate of enrolment in preschool education", observation period from 2006 to 2021. Results: The average percentage of male children outside primary school education was 2.18%, while the percentage of female children was 2.14%. The lowest percentage was observed in 2006, and the highest increase in 2010. The linear regression showed a positive trend for both sexes. There was a significant difference in the percentage of boys and girls outside primary school education in Serbia. On average, almost 60% of children were enrolled in preschool institutions in Serbia, and this increase has shown a significant positive trend over observed time. Conclusion: Serbia stands at a crossroads where continued progress in education could lead to major gains in health literacy and equity. Addressing existing disparities with targeted and inclusive educational policies will be essential not only for achieving educational justice but also for building a healthier and more informed society.
The role of neurotrophins in acute coronary syndrome prognostic and diagnostic value of new biomarkers
Acute coronary syndrome (ACS) remains a leading cause of morbidity and mortality worldwide. While existing diagnostic and prognostic biomarkers have improved patient care, there's still a need for newer, more specific markers to enable more precise risk stratification and individualized treatment. Neurotrophins are a family of proteins essential for neuronal survival and function. In recent years, their role in cardiovascular diseases has become increasingly recognized. The aim of this review is to present current knowledge on the role of neurotrophins, primarily BDNF and NGF, in the pathophysiology of ACS, and to evaluate their potential as novel diagnostic and prognostic biomarkers. Analyzed studies indicate significant changes in neurotrophin levels during ACS, linking them to ischemia, reperfusion injury, inflammation, and myocardial remodeling. There's evidence that elevated or decreased levels of certain neurotrophins can predict short-term and long-term outcomes in patients with ACS. Further research, especially large multicenter studies, is necessary to confirm the value of neurotrophin measurement in ACS as a significant biomarker in clinical practice.
Effects of bile salts and hymecromone on gallstone recurrence in adult patients after laparoscopic cholecystolithotomy
Given the priority of organ preservation in modern surgery, optimising postoperative treatment, particularly following the removal of gallstones while preserving the gallbladder, is highly relevant. This study aimed to evaluate the effectiveness of comprehensive medical support in restoring gallbladder functionality and preventing the recurrence of gallstone disease (GSD) after organ-preserving cholecystolithotomy. The study was retrospective in design, covering the period from 2018 to 2024, and was conducted at a medical centre in Almaty, Kazakhstan, a country with a high prevalence of GSD. It included 115 patients aged 18 to 65 years who underwent cholecystolithotomy. Of these, 98 patients remained under dynamic observation for a specified follow-up period. Postoperative pharmacotherapy comprised ursodeoxycholic and taurodeoxycholic acids, hymecromone, broad-spectrum antibiotics to prevent infectious complications, analgesics for pain management, antispasmodics to relieve biliary tract spasms, and other medications, with dosages adjusted individually based on the patients’ conditions. To monitor gallbladder status and evaluate treatment effectiveness, ultrasound examinations (US) were performed preoperatively, postoperatively, and periodically during the observation period. The comprehensive assessment also included a general urine analysis conducted before and after surgery. The results of US indicated that complex drug therapy facilitated the normalisation of gallbladder wall size and thickness, as well as improved contractile function. Long-term follow-up revealed that 98.6% of patients retained normal gallbladder contractility, the recurrence rate of cholelithiasis was only 0.07%, and sludge formation was observed in 8.9% of cases. In conclusion, complex pharmacotherapy following cholecystolithotomy with gallbladder preservation is an effective approach for restoring organ function, preventing recurrent stone formation, and enhancing patients’ quality of life. The data obtained from this study can inform the development of clinical guidelines for the postoperative management of patients following gallstone removal with organ preservation.
Impact of anxIety on self-perceIved oral health among medIcal students
Background: Oral health can affect mental health in many ways, and vice versa. Anxiety significantly impact the oral health and can lead to gum disease, cavities, dry mouth and bruxism and can cause bad oral health habits. Aims of our study were to investigate the prevalence of anxiety among medical students and to determinate the impact of anxiety on oral health habits and self-perceived oral health. Methods: This study presents cross-sectional study. It included the medical students from the Faculty of Medical Sciences, University of Kragujevac, Serbia. The Zung Self-Rating Anxiety Scale (SAS) was used to quantify anxiety levels and Oral Health Questionnaire for Adults was used to assess the self-perceived oral health. Data was analysed using the SPSS software, chi-square test was performed to determinate correlation between categorical variables, and Bonferroni analysis was perform to identify the precise significance between groups. Results: The assessment of the self-perceived anxiety showed that 39% of students had symptoms of anxiety. Significant positive correlation was found between anxiety and gender and self-perceived gum condition. Significant negative correlation was found between anxiety and ashamed because of teeth, avoid smiling and using dental floss. The post hoc Bonferroni analysis revealed that women exhibited anxiety more often than men, better gum health was linked to lower anxiety, embarrassment about teeth or avoiding smiling was associated with higher anxiety, and unexpectedly, flossing was more common among anxious participants. Conclusion: The influence of anxiety on oral health is not sufficiently recognized a. We found high prevalence of anxiety among medical students and determined correlation with certain oral health aspects. Medical students are vulnerable group and promotion and preventive programs should be more available.
PSYCHODERMATOLOGY – FOCUS ON PSYCHIATRIC OUTCOMES OF THERMAL SKIN INJURIES
Psychodermatology represents the discipline that explores the complex interaction between the central nervous system and the skin and offers a lot of confirmations for bidirectional interconnection between the pathological alterations that affect both the skin and nervous system. Psychodermatological disorders can be classified into three principal groups: Psychophysiological disorders, Psychiatric disorders with dermatological symptoms, and Dermatological disorders with psychiatric symptoms, while other entities that appear in clinical practice are classified as Miscellaneous. Thermal skin injuries are classified in the category of dermatitis artefacta. It has been confirmed that burns do not affect somatic health components only, but also have a deep impact on the patient’s mental health and overall quality of life. Severe thermal skin injuries have been shown to also exert a significant systemic response that is finally accompanied by a visible impact on mental health. The major groups of markers that show the common type of alterations that connect cutaneous events (typical for thermal injury) and mental outcomes accompanied by burns are oxidative stress and inflammation markers, neurotransmitters, and neurotrophin system elements. The aim of this literature overview was to summarize some specific clinical entities for psychiatric/dermatological disorders that share the same underlying pathophysiological mechanisms, especially from the rarely evaluated direction (“skin to brain”) – psychiatric outcomes of thermal skin injuries.
CALCITONIN NEGATIVE MEDULLARY THYROID CARCINOMA
Medullary thyroid cancer (MTC) is a neuroendocrine neoplasm that arises from parafollicular C cells. Basal and stimulated calcitonin are used in screening, differential diagnosis, assessment of response to treatment and monitoring of MTC. Calcitonin-negative MTC (MTC with normal values of basal and stimulated calcitonin) is extremely rare (49 cases described in the literature). In the absence of appropriate disease predictors, the diagnosis of calcitonin-negative MTC is not easy and is often delayed. A patient with a nodule in the thyroid gland and diskettely elevated calcitonin values is shown. Calcium gluconate stimulation test and carcinoembryonic antigen were normal, and the existence of MTC was ruled out. After a year, the patient notices pain in the lower part of the spinal column. He is referred to rehabilitation treatment, which does not give significant results. Laboratory work-up determines elevated values of parathyroid hormone, scintigraphy shows an enlarged hyperactive lower left parathyroid gland, and thyroidectomy and lower left parathyroidectomy with lymphadenectomy are performed. Pathohistological examination revealed MTC pT1aNxMx. Immunohistochemical analysis was negative for calcitonin and thyroglobulin, positive for chromogranin A and thyroid transcription factor 1 (Thyroid transcription factor-1. Further randomized clinical trials are needed to identify appropriate predictors of calcitonin-negative MTC. Until then, it is necessary to keep in mind the existence of calcitonin-negative MTC that cannot be identified by basal and stimulated calcitonin and carcinoembryonic antigen.
Kawasaki disease - a single centre experience
Abstract Objective: To compare clinical symptoms, treatment, and outcomes between typical and atypical forms of Kawasaki disease (KD) in patients treated at our institution. Methods: A retrospective observational study was conducted at the Pediatric Clinic, University Clinical Center Niš, reviewing medical records of 17 patients diagnosed with KD between September 2017 and February 2024. Clinical characteristics, laboratory results, treatment regimens, and outcomes were compared between typical (n=12) and atypical KD (n=5) groups. Statistical analysis was performed using the R statistical computing environment. Results: Patients presented with high fever (>38.5 °C) at admission. Diagnosis was delayed in atypical KD cases compared to typical cases (9.6 ± 2.3 days vs. 7.92 ± 2.81 days, respectively). Echocardiographic abnormalities were present in 35% of all cases, including mild left ventricular dysfunction (n=2) and pericardial effusion (n=4). Treatment with intravenous immunoglobulins (IVIg) and aspirin led to significant clinical improvement in most patients. However, corticosteroids were added in 12% (n=2) of cases due to prolonged fever despite initial therapy. One atypical KD patient, diagnosed late, was treated with aspirin alone. Laboratory markers showed notable improvements post-treatment, particularly CRP reduction in typical KD from 77.33 ± 55.92 mg/L to 9.43 ± 7.04 mg/L. Conclusion: Both typical and atypical KD patients showed good short- and medium-term prognoses, with no significant complications noted during follow-up. However, delays in diagnosis, particularly among atypical cases, highlight the need for improved communication across healthcare levels. A larger, multicenter study is recommended to enhance patient management and outcomes. Keywords: vasculitis, pediatric, treatment, laboratory
The Role of the Neutrophil-to-Lymphocyte Ratio in the Development of Heart Failure in Patients with Concomitant Hypertension, Type 2 Diabetes, and Obesity
Objective. Arterial hypertension, type 2 diabetes mellitus (T2DM), and obesity increase cardiovascular risk, including heart failure (HF). The neutrophil-to-lymphocyte ratio (NLR), a systemic inflammation marker, has been linked to adverse cardiovascular outcomes, but its role in HF development remains unclear. This study evaluated NLR as a predictor of HF in these patients. Methods. A total of 293 patients with essential hypertension, T2DM, and obesity were enrolled in a prospective study. They were categorized into two groups: HF group (n=85) and non-HF group (n=208). NLR was calculated from complete blood count results. HF was diagnosed based on the 2023 ESC guidelines and confirmed via biomarkers (NT-proBNP) or echocardiography. Patients were followed for 24 months. Results. Patients who developed HF had significantly higher NLR (3.39 ± 1.23 vs. 2.66 ± 1.14, p<0.001). HF patients also had longer T2DM (12.75 ± 5.86 vs. 10.25 ± 4.39 years, p<0.001) and hypertension durations (18.87 ± 8.54 vs. 16.05 ± 7.14 years, p=0.004). A non-dipper blood pressure profile was more frequent in the HF group (36.5% vs. 20.7%, p=0.005). In multivariate regression, NLR (OR 1.383; 95% CI 1.073–2.222; p=0.037), non-dipper BP profile, and disease duration remained independent HF predictors. Conclusion. NLR is independently associated with HF onset in patients with hypertension, T2DM, and obesity. It may serve as a simple, cost-effective biomarker for HF risk stratification, facilitating early intervention and improved outcomes.
A brief screening instrument for the early identification of autism spectrum disorders in Serbia: A psychometric study of the Minute for autism (MAUT) instrument
Objective: This study evaluates the psychometric properties of a brief screening tool for autism spectrum disorder (ASD) within a cohort of children with neurodevelopmental disabilities and typically developing children. Methods: The study involved 306 children (208 boys, representing 68%; mean age 44.6 ± 13.6 months), with data collected from both parents and evaluators (including child psychiatrists, special education teachers, speech therapists, pedagogues, and preschool teachers). The prototype instrument, Minute for Autism (MAUT), consisting of 15 items assessing key ASD symptoms, was tested. Results: Analysis identified a single factor represented by 7 items in parental assessments (accounting for 53.3% of variance) and 10 items in evaluator assessments (accounting for 53.6% of variance), with primary indicators focusing on measures of social engagement. Four dominant items emerged: "the child looks at you when you speak or play with them," "the child addresses others," "the child talks," and "the child brings objects/toys to show you." These items demonstrated a sensitivity of 72.9% for parental assessments and 84.8% for evaluator assessments. The specificity for detecting ASD, as opposed to typical development, was high (94.1% for parents and 100% for evaluators), although it was lower for differentiating ASD from complex neurodevelopmental disorders (70.8% for parents and 46.2% for evaluators). Conclusion: The findings suggest that an instrument featuring only four items related to social engagement could be sufficiently effective for rapid and early ASD screening. Evaluators appeared more sensitive to ASD identification than parents, whereas parents were more accurate in distinguishing ASD from other disorders. The primary challenge remains in differentiating ASD from other neurodevelopmental disorders, where the instrument may produce false positives. Future studies should assess the instrument's efficacy in populations of at-risk children.
WORK STRESS, BURN-OUT SYNDROME AND PSYCHOLOGICAL CONSEQUENCES
Cilj: Cilj ovog istraživanja je bio sagledati značaj i posledice stresa na radnom mestu. Metode: Učinjena je deskriptivna opservaciona studija primenom strukturisanog upitnika (ankete) na uzorku radon aktivne populacije. Istraživanje je sprovedeno na teritoriji Beograda, Srbija, u vremenskom period koji je obuhvatio januar i februar 2023.godine, sa ukupnim brojem ispitanika od 50. Rezultati: Pokazano je da je u ukupnom uzorku najveći broj ispitanika bio ženskog pola i srednje stručne spreme. Većina nije bila zadovoljna uslovima rada i zaradom. Dalje, većina ispitanika je imala neki od somatskih simptoma kao posledicu permanentne izloženosti stresu. Najčešći modalitet za prevladavanje stresa je bio čitanje, potom sledi fizička aktivnost i šoping. Zaključak: Naše istraživanje je pokazalo da hronični stress neminovno dovodi do razvoja somatskih i psiholoških posledica što se apsolutno poklapa sa istraživanjima rađenim u svetu do sada. Veliki broj radon aktivne populacije izgara, a ako ovo traje kroz vreme, dovodi do sindroma izgaranja koji sa sobom nosi hroničnu depresiju kao deterirativnu i po celokupnu ličnost pojedinca devastirajuću konsekvencu. Ključne reči: sindrom izgaranja, stress na radu, hronična depresija
Spontaneous subcapsular renal hematoma as a cause of acute abdominal pain - a case report
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Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Continue 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Continue 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Continue 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Continue 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Message Header"/> <w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Salutation"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Date"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Body Text First Indent"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Body Text First Indent 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Note Heading"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Body Text 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Body Text 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Body Text Indent 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Body Text Indent 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Block Text"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="FollowedHyperlink"/> <w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/> <w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Document Map"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Plain Text"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="E-mail Signature"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Top of Form"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Bottom of Form"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Normal (Web)"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Acronym"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Address"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Cite"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Code"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Definition"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Keyboard"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Preformatted"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Sample"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Typewriter"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Variable"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Normal Table"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="annotation subject"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="No List"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline List 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline List 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline List 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table 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Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 7"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 8"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 7"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 8"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table 3D effects 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table 3D effects 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table 3D effects 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Contemporary"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Elegant"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Professional"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Subtle 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Subtle 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Web 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Web 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Web 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Balloon Text"/> <w:LsdException Locked="false" Priority="39" Name="Table Grid"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Theme"/> <w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/> <w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading"/> <w:LsdException Locked="false" Priority="61" Name="Light List"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/> <w:LsdException Locked="false" Priority="70" Name="Dark List"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/> <w:LsdException Locked="false" SemiHidden="true" Name="Revision"/> <w:LsdException Locked="false" Priority="34" QFormat="true" Name="List Paragraph"/> <w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/> <w:LsdException Locked="false" Priority="30" QFormat="true" Name="Intense Quote"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 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Name="Plain Table 4"/> <w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/> <w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 1"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 1"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 1"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 2"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 2"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 2"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 3"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 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Locked="false" Priority="47" Name="Grid Table 2 Accent 5"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 5"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 5"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 5"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 6"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 6"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 6"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 6"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 6"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 6"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 1"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 1"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 1"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 1"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 1"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 1"/> 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Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Link"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Spontaneous subcapsular renal hematoma (SSRH) is a potential cause of acute abdominal pain that does not represent a significant part in the etiology of acute abdominal pain. We present the case of a 69-year-old female patient who came to the surgical outpatient clinic because of sudden pain in the abdomen, predominantly right lumbar side. Ultrasonography revealed a heterogeneous change on the contour of the right kidney, and the diagnosis of subcapsular hematoma was confirmed by abdominal computed tomography (CT) scan. The cause of the hematoma could not be determined either by history (the patient mentions only arterial hypertension), or by laboratory or CT examination.
The role of tryptase in the human body: From normal to pathology
The purpose of the work was to investigate the effect of the tryptase enzyme on the functioning of the human body in normal and pathological conditions. A search for relevant studies in the PubMed, Scopus, GoogleScholar, ResearchGate and Web of Science databases, presented for 2014-2024, was performed. The study revealed that tryptase is an enzyme of mast cells and a marker for assessing their activity. Tryptase is involved in the regulation of the growth and development of mesenchymal cells, fibroblasts and endothelial cells, regulation of blood clotting, metabolic processes of connective tissue, and affects the contractility of smooth muscle cells. Under pathological conditions, impaired tryptase metabolism leads to excessive fibrosis, development of keloid scars, narrowing of kidney vessels, transplant rejection, development of inflammatory bowel disease, arthritis, psoriasis, atopic and contact dermatitis. The normal level of serum tryptase is 5 ng/ml. The threshold value of the enzyme is 11.4 ng/ml. Increased levels of this enzyme are found in 4-6% of the population. An increase in serum tryptase levels is diagnosed in hereditary pathologies (hereditary alpha-tryptasemia) and acquired diseases (mastocytosis, mast cell activation syndromes, monoclonal mast cell activation syndrome, anaphylaxis, chronic kidney disease). The clinical picture is characterized by lesions of the cardiovascular, gastrointestinal, respiratory, excretory, and integumentary systems and the development of anaphylaxis. The pathogenesis of the diseases is still under investigation, so the treatment of the described pathologies is mainly symptomatic. It is concluded that tryptase is the main biomarker of mast cell function, and that impaired metabolism of this enzyme leads to a number of severe, life-threatening pathologies.
THE IMPAKT OF DOMINANT CENTRAL NERVOUS SYSTEM INJURIES ON THE SURVIVAL OF TRAFFIC ACCIDENT VITIMS IN MONTENEGRO
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Name="List Table 7 Colorful Accent 6"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Introduction: Road traffic accidents are one of the ten leading causes of death worldwide. Every 23 seconds, one person is injured on the roads worldwide, which leads to significant consequences in terms of permanent disability for the injured and the burden on a country's healthcare system. The mortality rate in traffic accidents is highest among people aged 14 to 19, where central nervous system (CNS) injuries are predominant. The aim of this study was to examine the trend of mortality and injury frequency in traffic accidents in Montenegro as a result of CNS injuries. Methods: The research was designed as an observational case-control study. Participants in traffic accidents in Montenegro who sustained severe bodily injuries or fatal outcomes between 2011 and 2020 due to CNS injuries were selected. The "control" group consisted of individuals who survived the immediate period following their injuries. Results: In our study, there were 90 male participants (75.4%) with an average age of 39.97 ± 17.72 years, and 30 female participants (24.6%) with an average age of 41.60 ± 21.09 years (Independent samples T test, p=0.677). The most common immediate cause of death was brain tissue injury, isolated brain contusions – Laesio traumatica cerebri focalis (Contusio cerebri). There was a statistically significant impact of the presence of combined injuries on the outcome of traffic accidents, with a fatal outcome being most common in cases of polytrauma. Conclusion: Mortality in traffic accidents due to head injuries was most common in cases of polytrauma. To preventably address the mortality rate in traffic accidents in Montenegro, it is necessary to form an accessible network of trauma centers, especially those capable of treating CNS injuries.
Can leukotriene receptors inhibitors preserve cognitive functions in asthma patients?
Background: Recent research suggests that neuroinflammation may play a crucial role in age-related cognitive dysfunction. Studies have investigated the impact of leukotriene receptor inhibitors (LTR) antagonist montelukast, a medication commonly used to treat allergies and asthma, on the risk of developing dementia. The aim of this study was to compare cognitive functions in asthmatic patients who used and who don’t use montelukast and healthy controls. Method: In this study 50 asthmatic patients (age 67.34±6.44) (20 montelukast users and 30 montelukast nonusers) were matched with 50 healthy controls (age 68.08±5.95). Each participant was assessed with the Mini Mental State Examination (MMSE) and the Montreal Cognitive Test (MoCA). Memory coefficients (verbal, visual, general, delayed memory, and attention and concentration) were measured by Wechsler Memory Scale-Revised (WMS-R). Results: Orientation as MoCA subdomain was worse in patients with asthma compared to the control group (p=0.048). Asthmatic patients treated with montelukast had a significantly higher MoCA score (p=0.033) (dominantly due to delayed recall) (p=0.044) than patients without montelukast treatment. People with asthma on montelukast therapy showed statistically significantly better results on the MoCA test (p=0.037) compared to the control group (dominantly due to attention (p=0.032) and delayed recall (p=0.021)). Conclusion: Montelukast group compared to montelukast nonusers had better results on MoCA (dominantly due to delayed recall). Studies with a larger number of participants are needed to confirm the effect of montelukast on the cognitive status of the elderly.
SUCCESSFUL CARDIOPULMONARY RESUSCITATION USING A DEFIBRILLATOR PLACED IN A PUBLIC PLACE - CASE REPORT
SAŽETAK: Cilj: Rana defibrilacija ritmova koji se mogu defibrilirati povezana je sa poboljšanim preživljavanjem, ali je osiguravanje pravovremenog pristupa defibrilatorima predstavljalo značajan izazov. Do danas, razvoj javnih programa defibrilacije, koji uključuje postavljanje automatizovanih eksternih defibrilatora u javni prostor, bio je glavna strategija za rešavanje ovog izazova. Metode: Prikazan je slučaj 47-godišnjeg muškarca sa akutnim infarktom miokarda i VF. Analizirani su podaci ambulantnog protokola, anamneza i otpusne liste iz hitne pomoći, jedinice intenzivne nege. Rezultati: Pacijent je osjetio mučninu, vrtoglavicu, znojenje. Kćerka ga pronalazi na podu bez svijesti, ne diše. Otpočeo reanimaciji, i pozvana je hitna pomoć. Policija dolazi prva i upotrebljava AED defibrilator. Na monitoru defibrilatora registrje se VF i donijeta je odluka o primeni DC šoka. AED defibrilator isporučuje 5 šokova. Nakon DC šoka, pacijent počinje da diše. Hitna dolazi nakon 6 minuta i nastavlja se sa reanimacijom. Pacijent je prevezen u Urgentni centar. EKG tokom transporta pokazao je sinusni ritam od 100/min sa elevacijom ST segmenta u V1-V5 i depresijom ST segmenta V6. Vitalni parametri tokom transporta (CCS 11, SpO2 90% , krvni pritisak je nemerljiv) Pacijent je intubiran. Terapija Amoidaron amp 150mg/3m: 300mg IV Fentamed amp 0,5/10ml: 0,3 mgIV, Biropehen amp.0,5mg/5ml :0,4mg IV, Rocuroniumbromid kabl.50mg/5ml: 80mg/5ml: 80mg/1mg 0,3 mg IV U Hitnoj pomoći imao je tri epizode ventrikularne tahikardije. Nakon uspješne kardioverzije, pacijent je imao stabilan ritam. Pacijent je pripremljen za PCI, stent na LAD. Nakon katakterizacije, implantacije STENT i stabilizacije, primijenjena je terapijska hipotermija sa Hladnim Ringer laktatom 500 ml na 4°C intravenski. Temperatura je smanjena na 33°C i održavana je 24 sata. Zaključak: Što se prije započne CPR, to je bolji ishod. U prve 3 minute šansa za povratak spontane cirkulacije je 75%. Nakon 4 minute je 40%. Nakon 5 minuta šansa za povratak spontane cirkulacije je minimalna. Ključne riječi: zastoj srca, kardiopulmonalna reanimacija, AED, defibrilacija
From Symptoms to Survival: Tracking COVID-19 Patient Outcomes in an Outpatient Clinic
Background and Aim: The Coronavirus Disease 2019 (COVID-19) pandemic has significantly impacted public health, requiring a deeper understanding of its transmission, pathogenesis, and effective treatment strategies. This study aims to investigate the clinical outcomes of COVID-19 patients treated at an outpatient respiratory clinic, focusing on the impact of comorbidities on mortality rates. Methods: We conducted a retrospective cohort study at Al-Zahra Hospital's outpatient respiratory clinic, involving 524 patients diagnosed with COVID-19 through PCR tests or CT scans. The study focused on evaluating changes in clinical status, laboratory parameters, vital signs, and 28-day mortality rates after treatment. Results: An analysis of 524 COVID-19-confirmed participants demonstrated statistically significant correlations between mortality, history of cardiovascular disease, and diabetes (p < 0.05). However, the associations between mortality and diverse factors, such as gender, psychiatric disorders, neurological diseases, renal diseases, hypertension, and the number of vaccinations, were not statistically significant (p > 0.05). Conclusion: The study revealed increased COVID-19-related mortality rates in individuals particularly with cardiovascular disease and diabetes. No substantial correlation was observed between mortality and age, gender, other illnesses, and laboratory data.
RESILIENCE AND HEALTHY LIFESTYLES IN THE POPULATION OF NURSES, NURSING STUDENTS AND ADMINISTRATIVE WORKERS
Aim: The aim of this study is to determine whether resilience is associated with healthy lifestyles, defines as physical activity, dietary habits and proper sleep, in a population of nurses, students and administrative workers. Materials and methods: The study included a total of 290 respondents: 149 nurses, 71 clerks and 70 nursing students, from six different cities in the territory of Serbia, during the year 2022. To assess resilience, we used Brief Resilience Scale (BRS). In order to examine the influence of healthy lifestyles, we asked respondents to fill out a questionnaire which included general questionnaire about socio-demographic and lifestyle characteristics, International Physical Activity Questionnaire (IPAQ) and Mediterranean Diet Adherence Screener (MEDAS). Results: People who predominantly use olive oil in their diet as a main culinary fat are more resilient that those who do not use it (r = 0.024). There is no statistically significant difference between resilience and parameters of physical activity. Resilience is associated with sleep problems, optimism and place of living. Conclusion: The results of our study represent an important starting point for establishing strategies for building resilience, especially in the population of healthcare workers, considering that the majority of our sample consists of nurses. Such results take on a new dimension in times of major social global changes (recent coronavirus pandemic, wars), which result in the overloading of national health systems.
PREHOSPITAL CARE AND TREATMENT OF INJURED IN TRAFFIC ACCIDENTS
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<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 5"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 5"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 5"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 5"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 6"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 6"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 6"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 6"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 6"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 6"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 6"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Efikasna nega svih vrsta trauma kao posledica povređivanja u saobraćaju je prioritet u svim zdravstvenim sistemima. Svake godine mnogi od 1,35 miliona izgubljenih života na globalnom nivou mogu biti spaseni i veliki deo invaliditeta povređenih mogao bi da se spreči ako bi brze i kompetentne prebolničke usluge bile dostupne na mestu gde se nesreća dogodila. Godine 2016. svetska zdravstvena organizacija (SZO) izvestila je da su saobraćajne nesreće među 10 vodećih uzroka smrtnosti, posebno kod mlađe kategorije učesnika u saobraćaju gde dominiraju osobe muškog pola. Trijaža i protokol traume imaju za cilj da postojeće resurse sitema zdravstvene zaštite i civilnog sektora, upotrebe u korist što većeg broja povređenih. Smatra se da je vremenski interval između pojave saobraćajne nezgode i početka prve medicinske pomoći i zdravstvene nege, u određenom centru za traumu važan prediktor preživljavanja žrtve. Cilj ovog rada je bio, da se naglasi važnost korišćenja protokola prilikom zbrinjavanja povređenih i istaknuti značaj prehospitalnog zbrinjavanja i nege, za smanjenje motaliteta nakon povređivanja u saobraćaju. U ovom radu biće predstavljene informacije iz relevantnih izvora podataka: PubMed, MEDLAJN, SCOPUS i Srpskog citatnog ideksa i drugih relevantnih baza. Uvođenje i primena efikasnih trijažnih protokola, kao i formiranje lako dostupne mreže trauma centara, ključni su za poboljšanje prehospitalne nege i smanjenje smrtnosti. Ove mere omogućavaju brži odgovor na nesreće, optimalnu raspodelu resursa i poboljšanje ishoda za povređene, što je od suštinskog značaja za unapređenje sistema javnog zdravlja jedne države.
Peculiarities of titanium implants in patients with long-term absence of teeth and significant atrophy of hard and soft tissues of the jaws
Background/aim: The placement of artificial teeth in case of significant atrophy of hard and soft tissues of the jaws remains one of the most difficult problems in dentistry. The task was set to eliminate the unsolved problems by modernizing the existing methods of transplantation and implantation and analyzing the results of their application in clinical conditions. Materials and methods: In the period from 2002 to 2022, standard surgical dentistry operations of transplantation and implantation were performed in several dental clinics in Russia for 5,280 men and women aged 22 to 85 years. Of these, autogenic bone materials were used in 788 patients, and in 4492 patients, surgical operations were performed with transplantation of xenogenic OsteoBiol biomaterials. All patients were implanted with titanium implants Replace Select (Nobel Biocare, Switzerland). Results: It was shown that transplantation of autogenous bone and xenogenic biomaterials lasted on average about 2.5 and 1.5 hours and resulted in successful engraftment in 83% and 94% of cases (respectively). To exclude accidental perforation of Schneider's membrane during biomaterial transplantation in conditions of significant maxillary crest atrophy, a method of elevating the floor of the maxillary sinus under illumination with blue light from the nasal cavity was proposed. To improve the aesthetic result when placing the crown on the implant in the conditions of soft tissue deficiency around it the method of transplantation of autogenous material in the form of a round disk with a hole in the center for "dressing" on the implant is proposed. Conclusion: Modern dental technology makes it possible to restore significant defects of soft and bone tissues of the jaws and replace teeth in patients of all age groups.
Assessment of mothers awareness on acute malnutrition
Background and Aim: According to the American Society of Parenteral and Enteral Nutrition (ASPEN), pediatric malnutrition is defined as “an imbalance between nutrient requirement and intake, resulting in cumulative deficits of energy, protein, or micronutrients that may negatively affect growth, development, and other relevant outcomes.” The purpose of this study was to assess guardians’ awareness of Acute Malnutrition and its management in Ghana. Method: This qualitative research employed the grounded theory study design. 15 participants were interviewed from the SMALCHILD (Save the Malnourished Child) clinic of Holystic Nutrition Organization, Ghana. Microsoft Office Excel was used for analysing data. Results: In this current study, guardians shared their ideas on malnutrition and their previous knowledge of it before seeking for clinical services and four themes were generated: Signs and symptoms of Acute Malnutrition manifested reported by participants as manifested in their children, Misconceptions that participants had about Acute Malnutrition, Initial response by participants to treat Acute Malnutrition and How participants found out about clinical management of Acute Malnutrition. Conclusion: From this research, we observed that participants were able to identify some of the initial signs and symptoms for Acute malnutrition but had some misconceptions. Most thought that the condition was Asraam (which meant that a witch is a cause of that condition), and sought help from Asraam doctors with the use of herbal medications. This alone shows how important it is to educate guardians on Acute Malnutrition to prevent further complication of their children.
Revisiting Hill’s criteria: bridging historical foundations and modern epidemiological challenges
Causality is a cornerstone of epidemiological research, providing a framework for understanding the relationships between exposures and health outcomes. In his seminal 1965 paper, Sir Austin Bradford Hill proposed nine criteria to guide the evaluation of causal associations. These criteria - strength, consistency, specificity, temporality, biological gradient, plausibility, coherence, experiment, and analogy—continue to serve as foundational principles in modern epidemiology. However, the application of these criteria has evolved significantly in response to advances in scientific knowledge, statistical methodologies, and data availability. This paper revisits Hill’s criteria within the context of contemporary challenges and opportunities in public health research. It explores the nuanced interplay between causality and risk quantification, particularly in chronic and multifactorial diseases where direct causation is elusive. Through historical and modern examples, the paper illustrates the enduring relevance and adaptability of Hill’s framework. Additionally, the discussion emphasizes the importance of experimental and observational designs, the integration of advanced analytical techniques to emulate randomized trials, and the need to balance adherence to established principles with openness to novel discoveries. By revisiting Hill’s criteria, this work underscores their continuing utility in navigating the complexities of causality in a rapidly evolving scientific landscape.
Subepithelial connective tissue graft for root coverage and histologic evaluation: clinical case reports - A Case Series
Abstract The goal of periodontal surgery is to cover the exposed root completely or partially in teeth with gingival recession. This correction is important from an aesthetic and a functional point of view. Periodontal regeneration is visible only through histologic analysis. Histologic analysis can reveal the arrangement of the cells embedded in the periodontal-tissue attachment. Micro punch gum technique (2 mm) was used for biopsy. Three patients with gingival recessions were treated with subepithelial connective tissue graft (CTG) and clinical parameters and histological results were recorded. Complete coverage of the exposed root part was obtained in the three cases, and the histologic analysis revealed a selective settlement with ligament cells that are typical for the formation of connective tissue in periodontal regeneration. Histologic analysis showed keratinized sulcular epithelium with thin and tall extensions into the gingival connective tissue and a junctional epithelium which extended to new cementum. Also increased number of blood vessels and new insertion of the connective tissue was observed. If the clinical goal of periodontal surgery is complete coverage of gingival recessions, then the goal at the microscopic level is to obtain true periodontal regeneration. Key words: gingival recession, elastic fibers, collagen fibers, connective tissue.
Biomarkers of inflammation and multisystem tissue and organ damage in patients with COVID-19
Objective. The importance of in vitro laboratory diagnostic tests for COVID-19 lies in assessing disease severity, monitoring patients, therapeutic monitoring, and predicting disease prognosis. The aim of our study was to evaluate inflammation biomarkers in COVID-19 patients and their association with biomarkers of cardiomyocyte, liver, and kidney damage, and how they impact disease progression. Methods. The study included 50 patients, 38 (76%) male and 12 (24%) female, with an average age of 64.38 ± 10.95 years, treated for COVID-19 in 2021 at the Clinic for Infectious Diseases of the University Clinical Center Kragujevac. Biomarkers of inflammation, cardiomyocyte, liver, and kidney damage were analyzed at the beginning of hospitalization and on the tenth day using standard laboratory methods and autoanalyzers. Results. Analysis showed a significant increase in inflammation parameters on the tenth day of hospitalization compared to initial values: leukocytes (p=0.003), neutrophils (p=0.002), platelets (p<0.001), C-reactive protein (p<0.001), PCT (p=0.011), and IL-6 (p=0.004). Hepatocyte damage biomarkers (ALT (p=0.005), GGT (p=0.033)), and kidney function biomarkers (urea (p<0.001) and creatinine (p=0.042)) also increased significantly. Positive correlations were found between inflammation biomarkers and cardiomyocyte and hepatocyte damage at admission. CRP and PCT concentrations were associated with increased risk of cardiomyocyte damage, while neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) predicted heart and kidney damage. Conclusion. Systemic inflammation in COVID-19 patients leads to disruptions in body homeostasis, reflected in changes in inflammation biomarkers and multi-system tissue and organ damage. Monitoring these parameters can help predict disease progression and complications. Key words: biomarkers, COVID 19, inflammation, multisystem damage
The influence of tissue plasminogen activator, plasminogen activator inhibitor-1, and thrombin activable fibrinolytic inhibitor on the risk of venous thrombosis
Aim: The role of the fibrinolytic mechanism in venous thrombosis risk remains controversial. The study aimed to examine the influence of tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), and thrombin activatable fibrinolysis inhibitor (TAFI) on the risk of venous thrombosis. Methods: The research included 100 participants with deep vein thrombosis and 100 participants with no previous history of venous thrombosis. Global fibrinolytic activity was estimated by euglobulin clot lysis time (ECLT). The ELISA method was used for the determination of t-PA and TAFI concentrations. The chromogenic substrate method was used for the determination of PAI-1 concentrations. Results: A statistically significant difference was not obtained for t-PA and PAI-1 compared between patients and controls. Patients had a significantly higher concentration of TAFI when compared to controls. Relative risk analysis showed a three-fold increase in the venous thrombosis risk connected with suppressed fibrinolytic activity. The crude OR was 2.70 (95% CI 1.22-5.98) and adjustments for confounding yielded an OR of 3.02 (95% CI 1.26-7.22). TAFI concentrations showed influence on venous thrombosis risk, as crude OR was 2.18 (95% CI 1.19-3.99) and fully adjusted one stayed in the same range (OR 2.25; 95% CI 1.16-4.35) indicating a two-fold increase in venous thrombotic risk associated with increased TAFI concentrations. Conclusion: Suppressed functionality of the fibrinolysis mechanism triples the risk of occurrence of deep vein thrombosis while elevated TAFI level doubles the risk of this disease. There is no influence of plasminogen concentrations, t-PA, and PAI-1 levels on venous thrombosis risk.