Milica Jaric, Katarina Katic, Andrea Djuretic, Vesna Stojanovic, Milica Milojkovic
Introduction. During the development and spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic, a new inflammatory response syndrome arised in newborns and was designated as the multisystem inflammatory syndrome in neonates (MISN). Case report. A term infant girl with fever and diagnosed SARS-CoV-2 infection was admitted to hospital. In laboratory findings lactate dehydrogenase, ferritin, interleukin-6, and D-dimer values were elevated. Upon admission, dual parenteral antibiotic therapy (ceftazidime, vancomycin) and low molecular weight heparin (LMWH) therapy was started. After 5 days of febrility with negative microbiological analyses and further deterioration of laboratory findings, intravenous immunoglobulin (IVIg) therapy was administered at a dose of 2 g/kg for one day, then methylprednisolone at a dose of 1 mg/kg/day for 4 days, after which the reduction of corticosteroid therapy was performed with prednisone. One day after IVIg administration, the newborn became afebrile, with the gradual normalization of laboratory findings. The newborn was discharged after 16 days of hospitalization. Two weeks after discharge, the use of LMWH was stopped. After seven days, the D-dimer value increased significantly. The anticoagulant therapy was restarted. After a month of LMWH administration, the D-dimer value completely normalized, and the therapy was stopped. Conclusion. In this case after the applied therapy for multisystem inflammatory syndrome in children, there was cessation of febrility and gradual normalization of laboratory parameters, which confirms that the newborn in this case probably had MIS-N. The prolonged elevated Ddimer value was most probably a consequence of inflammation as part of the multisystem inflammatory syndrome.
{"title":"Neonatal multisystem inflammatory syndrome during acute SARS-COV-2 infection","authors":"Milica Jaric, Katarina Katic, Andrea Djuretic, Vesna Stojanovic, Milica Milojkovic","doi":"10.2298/vsp230322047j","DOIUrl":"https://doi.org/10.2298/vsp230322047j","url":null,"abstract":"Introduction. During the development and spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic, a new inflammatory response syndrome arised in newborns and was designated as the multisystem inflammatory syndrome in neonates (MISN). Case report. A term infant girl with fever and diagnosed SARS-CoV-2 infection was admitted to hospital. In laboratory findings lactate dehydrogenase, ferritin, interleukin-6, and D-dimer values were elevated. Upon admission, dual parenteral antibiotic therapy (ceftazidime, vancomycin) and low molecular weight heparin (LMWH) therapy was started. After 5 days of febrility with negative microbiological analyses and further deterioration of laboratory findings, intravenous immunoglobulin (IVIg) therapy was administered at a dose of 2 g/kg for one day, then methylprednisolone at a dose of 1 mg/kg/day for 4 days, after which the reduction of corticosteroid therapy was performed with prednisone. One day after IVIg administration, the newborn became afebrile, with the gradual normalization of laboratory findings. The newborn was discharged after 16 days of hospitalization. Two weeks after discharge, the use of LMWH was stopped. After seven days, the D-dimer value increased significantly. The anticoagulant therapy was restarted. After a month of LMWH administration, the D-dimer value completely normalized, and the therapy was stopped. Conclusion. In this case after the applied therapy for multisystem inflammatory syndrome in children, there was cessation of febrility and gradual normalization of laboratory parameters, which confirms that the newborn in this case probably had MIS-N. The prolonged elevated Ddimer value was most probably a consequence of inflammation as part of the multisystem inflammatory syndrome.","PeriodicalId":23531,"journal":{"name":"Vojnosanitetski pregled","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135440467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Milan Aksic, Katarina Djurdjevic, Slobodan Kapor, Laslo Puskas, Drazan Eric, Lazar Stijak, Dubravka Aleksic, Dejan Aleksandric, Milos Malis, Vuk Djulejic
Background/Aim. The radial nerve is the largest terminal branch of the posterior cord of the brachial plexus. Upon leaving the axilla, it moves to the posterior compartment of the arm, where it makes close contact with the humerus. By penetrating the lateral intermuscular septum, it enters the anterior compartment, and in the very proximity of the lateral epicondyle, it divides into two terminal branches. This nerve is characterised by remarkable variability, the knowledge of which is of utmost importance in the fields of orthopaedics and traumatology. The aim of the study was to examine the radial nerve, including two parameters: the location and the way of termination, with a particular emphasis on the clinical implications. Methods. Research was conducted on 54 upper extremities. After careful dissection, variations in the location and way of termination of the radial nerve were observed on both the right and left hands. Collected data were then analysed using Microsoft Office Excel. Results. According to the proposed classification of the location of the radial nerve termination into types A and B, we observed the higher incidence of type A (64.8%) compared to type B (35.2%). In addition, we observed twice the percentage of type B in women compared to men. There were differences in the distribution of types A and B between the left and right arms, but there were no variations in the way of termination of the radial nerve. Conclusion. The present study showed an important complexity in the domain of radial nerve anatomy with significant clinical implications. With that in mind, it is crucial for every patient that the limits of safe zones be defined while performing surgical procedures in the elbow to protect the radial nerve and its branches from iatrogenic injuries.
{"title":"Cadaveric study of anatomical variations of the radial nerve and its clinical significance","authors":"Milan Aksic, Katarina Djurdjevic, Slobodan Kapor, Laslo Puskas, Drazan Eric, Lazar Stijak, Dubravka Aleksic, Dejan Aleksandric, Milos Malis, Vuk Djulejic","doi":"10.2298/vsp230714052a","DOIUrl":"https://doi.org/10.2298/vsp230714052a","url":null,"abstract":"Background/Aim. The radial nerve is the largest terminal branch of the posterior cord of the brachial plexus. Upon leaving the axilla, it moves to the posterior compartment of the arm, where it makes close contact with the humerus. By penetrating the lateral intermuscular septum, it enters the anterior compartment, and in the very proximity of the lateral epicondyle, it divides into two terminal branches. This nerve is characterised by remarkable variability, the knowledge of which is of utmost importance in the fields of orthopaedics and traumatology. The aim of the study was to examine the radial nerve, including two parameters: the location and the way of termination, with a particular emphasis on the clinical implications. Methods. Research was conducted on 54 upper extremities. After careful dissection, variations in the location and way of termination of the radial nerve were observed on both the right and left hands. Collected data were then analysed using Microsoft Office Excel. Results. According to the proposed classification of the location of the radial nerve termination into types A and B, we observed the higher incidence of type A (64.8%) compared to type B (35.2%). In addition, we observed twice the percentage of type B in women compared to men. There were differences in the distribution of types A and B between the left and right arms, but there were no variations in the way of termination of the radial nerve. Conclusion. The present study showed an important complexity in the domain of radial nerve anatomy with significant clinical implications. With that in mind, it is crucial for every patient that the limits of safe zones be defined while performing surgical procedures in the elbow to protect the radial nerve and its branches from iatrogenic injuries.","PeriodicalId":23531,"journal":{"name":"Vojnosanitetski pregled","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135838151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Djenic, Branko Milovanovic, R. Romanovic, S. Stojkovic, Andjelko Hladis, M. Spasić, B. Dzudovic, Dragan Dulović, Z. Jovic, S. Obradovic
Introduction. The left main stem coronary artery (MSCA) thrombosis is a rare, but potentially lethal manifestation of the acute coronary syndrome. The standard approach in treating such patients is the primary percutaneous coronary intervention or coronary artery bypass graft surgery. In some cases, depending on the morphological appearance of the thrombus, findings and flow rates assessed on coronary angiography, clinical conditions, and cardiologist?s experiences, another method of treatment may be a conservative approach using the antithrombotic therapy. Case report. A 37 year-old male was admitted to the emergency room with symptoms of an acute myocardial infarction with an ST-elevation in diaphragmal localization. Using emergency coronary angiography we have visualized a thrombus at the ostial and proximal part of the left MSCA, with no complete obstruction of the blood flow. Initially, dual antithrombotic therapy (ticagrelor and acetylsalycilic acid) was applied, and in the further procedure , it was decided to introduce glycoprotein (GP) IIb/IIIa platelet receptor inhibitor (tirofiban) as an intracoronary bolus (0.3 ?g/kg) and later as continuous infusion (0.1 ?g /kg/min). Four days later, a control angiography and intravascular echocardiography were performed, and it was decided to continue the treatment using conservative therapy, without a pPCI procedure. The patient was discharged in a good condition with no signs of illness on the eighth day after hospital admission for home recovery, with planned frequent follow-ups in the future. Conclusion. In the case of non-obstructive thrombotic masses without significant atherosclerotic stenotic lesions, conservative treatment modality with the use of aggressive antithrombotic therapy may be considered.
{"title":"Acute coronary syndrome in a young patient with ECG presentation of acute inferior myocardial infarction and acute thrombosis of left main stem coronary artery","authors":"N. Djenic, Branko Milovanovic, R. Romanovic, S. Stojkovic, Andjelko Hladis, M. Spasić, B. Dzudovic, Dragan Dulović, Z. Jovic, S. Obradovic","doi":"10.2298/vsp210428017d","DOIUrl":"https://doi.org/10.2298/vsp210428017d","url":null,"abstract":"Introduction. The left main stem coronary artery (MSCA) thrombosis is a rare, but potentially lethal manifestation of the acute coronary syndrome. The standard approach in treating such patients is the primary percutaneous coronary intervention or coronary artery bypass graft surgery. In some cases, depending on the morphological appearance of the thrombus, findings and flow rates assessed on coronary angiography, clinical conditions, and cardiologist?s experiences, another method of treatment may be a conservative approach using the antithrombotic therapy. Case report. A 37 year-old male was admitted to the emergency room with symptoms of an acute myocardial infarction with an ST-elevation in diaphragmal localization. Using emergency coronary angiography we have visualized a thrombus at the ostial and proximal part of the left MSCA, with no complete obstruction of the blood flow. Initially, dual antithrombotic therapy (ticagrelor and acetylsalycilic acid) was applied, and in the further procedure , it was decided to introduce glycoprotein (GP) IIb/IIIa platelet receptor inhibitor (tirofiban) as an intracoronary bolus (0.3 ?g/kg) and later as continuous infusion (0.1 ?g /kg/min). Four days later, a control angiography and intravascular echocardiography were performed, and it was decided to continue the treatment using conservative therapy, without a pPCI procedure. The patient was discharged in a good condition with no signs of illness on the eighth day after hospital admission for home recovery, with planned frequent follow-ups in the future. Conclusion. In the case of non-obstructive thrombotic masses without significant atherosclerotic stenotic lesions, conservative treatment modality with the use of aggressive antithrombotic therapy may be considered.","PeriodicalId":23531,"journal":{"name":"Vojnosanitetski pregled","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68334313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Petrovic, A. Nagorni, G. Bjelakovic, Daniela Benedeto-Stojanov, Biljana Radovanović-Dinić
Introduction/Aim. A significant number of patients with liver cirrhosis who underwent screening endoscopy do not have esophageal varices (EV) or have varices that do not require prophylactic therapy. Given the invasiveness of the procedure, the need to develop non-endoscopic methods in predicting the presence of EV is reasonable. The aim of the study was to determine the significance of clinical, biochemical and ultrasonic parameters in the prediction of EV. Methods. The study included 59 patients with cirrhosis of the liver, 39 (66.1%) patients with EV and 20 (33.9%) patients without EV. In the group of patients with EV, 22 (56.4%) patients had small EV and 17 (46.3%) patients had large EV. Clinical parameters that included Child Pough (CP) score, ascites, and splenomegaly were evaluated. In all participants, complete blood count, liver function tests, abdominal ultrasound and gastroscopy were performed, and a platelet count/spleen diameter ratio (PC/SD) was calculated. Results. Univariate logistic regression analysis showed that independent risk factors for the occurrence of EV were: CP B class (OR 6.67, p=0.003) and CP C class (OR 23.33, p=0.005) relative to class A, ascites (OR 7.78, p =0.001), spleen size (OR 1.035, p =0.016), bilirubin (OR 1.065, p=0.007), albumin (OR 0.794, p =0.001), protrombin time (PT) (OR 0.912, p<0.001), INR (OR 231.364, p <0.001), platelet count? Plc (OR 0.989, p =0.023), PC/SD ratio (OR0.999, p=0.034). In a multivariate model, it was shown that a decreased Plc was a statistically significant risk factor for the presence of EV (OR 0.983, p =0.023). Leukopenia and the size of the right liver lobe were found to be statistically significant factors for the occurrence of large EV. Based on the ROC curve for the PC/SD ratio, the cut-off value of the test was obtained - 907 (907.11), with a negative predictive value of 76.4% for large EV. Conclusion. The cut-off value of PC/SD < 907 has a predictive value for the occurrence of large EV.
{"title":"Noninvasive assessment of the presence and size of esophageal varices","authors":"G. Petrovic, A. Nagorni, G. Bjelakovic, Daniela Benedeto-Stojanov, Biljana Radovanović-Dinić","doi":"10.2298/vsp220915008p","DOIUrl":"https://doi.org/10.2298/vsp220915008p","url":null,"abstract":"Introduction/Aim. A significant number of patients with liver cirrhosis who underwent screening endoscopy do not have esophageal varices (EV) or have varices that do not require prophylactic therapy. Given the invasiveness of the procedure, the need to develop non-endoscopic methods in predicting the presence of EV is reasonable. The aim of the study was to determine the significance of clinical, biochemical and ultrasonic parameters in the prediction of EV. Methods. The study included 59 patients with cirrhosis of the liver, 39 (66.1%) patients with EV and 20 (33.9%) patients without EV. In the group of patients with EV, 22 (56.4%) patients had small EV and 17 (46.3%) patients had large EV. Clinical parameters that included Child Pough (CP) score, ascites, and splenomegaly were evaluated. In all participants, complete blood count, liver function tests, abdominal ultrasound and gastroscopy were performed, and a platelet count/spleen diameter ratio (PC/SD) was calculated. Results. Univariate logistic regression analysis showed that independent risk factors for the occurrence of EV were: CP B class (OR 6.67, p=0.003) and CP C class (OR 23.33, p=0.005) relative to class A, ascites (OR 7.78, p =0.001), spleen size (OR 1.035, p =0.016), bilirubin (OR 1.065, p=0.007), albumin (OR 0.794, p =0.001), protrombin time (PT) (OR 0.912, p<0.001), INR (OR 231.364, p <0.001), platelet count? Plc (OR 0.989, p =0.023), PC/SD ratio (OR0.999, p=0.034). In a multivariate model, it was shown that a decreased Plc was a statistically significant risk factor for the presence of EV (OR 0.983, p =0.023). Leukopenia and the size of the right liver lobe were found to be statistically significant factors for the occurrence of large EV. Based on the ROC curve for the PC/SD ratio, the cut-off value of the test was obtained - 907 (907.11), with a negative predictive value of 76.4% for large EV. Conclusion. The cut-off value of PC/SD < 907 has a predictive value for the occurrence of large EV.","PeriodicalId":23531,"journal":{"name":"Vojnosanitetski pregled","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68339302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Stanković, Nemanja Turkovic, S. Dobrić, N. Rančić
Background/Aim. Diclofenac, a non-selective inhibitor of cyclooxygenase, with analgesic, anti-inflammatory and antipyretic effects, is one of the most prescribed nonsteroidal anti-inflammatory drugs (NSAIDs). The aim of the study was to analyse prescribing patterns of diclofenac systemic formulations at the outpatient care settings (OCS) in Montenegro, in patients with cardiovascular (CV) disease (CVD) and patients with risk factors for CVD, during the period 2016-2020. Methods. The retrospective, national, drug utilisation study, included patients with CVD, to whom prescribing of diclofenac is contraindicated and patients with risk factors for CVD, for which diclofenac can be prescribed, but with increased precaution. Primary health care information system (PHCIS) has been used as source of medical data for these patients. Results. Within the observed period, prescribing and consumption of diclofenac systemic formulations, dominantly oral formulations in 75 mg dose, increased by 36.9 % (from 4.6 of defined daily doses (DDD) /1,000 inhabitants/day in 2016 to 6.3 DDD/1,000 inhabitants/day in 2020). The rising trend in prescribing diclofenac was also noted in patients with CVD/ risk factors for CVD, for which diclofenac prescribing is contraindicated/precautioned. Out of the overall number of patients who were prescribed diclofenac in 2016, 2017, 2018, 2019 and 2020, 16%, 18%, 24%, 15% and 20% of them, respectively, had a CVD/ risk factor for CVD. The highest number of CV patients (39.7%), who were contraindicated for prescribing of diclofenac, had ischemic heart disease (they had been prescribed 40.7% DDD/1,000 inhabitants/day of diclofenac of overall prescribed medicine for this group of patients). The highest number (77.4%) of patients who could be prescribed the drug, but with increased precautions, had hypertension and they were prescribed in 77.2% of DDD/1,000 inhabitants/day of diclofenac of overall prescribed drug for this group of patients. Conclusion. Despite undertaken regulatory measures aimed at safer prescription of diclofenac to patients with CVD or risk factors for CVD, this medicine is still widely prescribed, even in cases representing contraindications for its use.
{"title":"Prescribing patterns of diclofenac in patients with risk or at high risk for cardiovascular diseases in outpatient care settings in Montenegro","authors":"M. Stanković, Nemanja Turkovic, S. Dobrić, N. Rančić","doi":"10.2298/vsp221229021s","DOIUrl":"https://doi.org/10.2298/vsp221229021s","url":null,"abstract":"Background/Aim. Diclofenac, a non-selective inhibitor of cyclooxygenase, with analgesic, anti-inflammatory and antipyretic effects, is one of the most prescribed nonsteroidal anti-inflammatory drugs (NSAIDs). The aim of the study was to analyse prescribing patterns of diclofenac systemic formulations at the outpatient care settings (OCS) in Montenegro, in patients with cardiovascular (CV) disease (CVD) and patients with risk factors for CVD, during the period 2016-2020. Methods. The retrospective, national, drug utilisation study, included patients with CVD, to whom prescribing of diclofenac is contraindicated and patients with risk factors for CVD, for which diclofenac can be prescribed, but with increased precaution. Primary health care information system (PHCIS) has been used as source of medical data for these patients. Results. Within the observed period, prescribing and consumption of diclofenac systemic formulations, dominantly oral formulations in 75 mg dose, increased by 36.9 % (from 4.6 of defined daily doses (DDD) /1,000 inhabitants/day in 2016 to 6.3 DDD/1,000 inhabitants/day in 2020). The rising trend in prescribing diclofenac was also noted in patients with CVD/ risk factors for CVD, for which diclofenac prescribing is contraindicated/precautioned. Out of the overall number of patients who were prescribed diclofenac in 2016, 2017, 2018, 2019 and 2020, 16%, 18%, 24%, 15% and 20% of them, respectively, had a CVD/ risk factor for CVD. The highest number of CV patients (39.7%), who were contraindicated for prescribing of diclofenac, had ischemic heart disease (they had been prescribed 40.7% DDD/1,000 inhabitants/day of diclofenac of overall prescribed medicine for this group of patients). The highest number (77.4%) of patients who could be prescribed the drug, but with increased precautions, had hypertension and they were prescribed in 77.2% of DDD/1,000 inhabitants/day of diclofenac of overall prescribed drug for this group of patients. Conclusion. Despite undertaken regulatory measures aimed at safer prescription of diclofenac to patients with CVD or risk factors for CVD, this medicine is still widely prescribed, even in cases representing contraindications for its use.","PeriodicalId":23531,"journal":{"name":"Vojnosanitetski pregled","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68340438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Kostić, Z. Perisic, D. Kutlešić-Kurtović, Bojan Maričić, S. Apostolovic, D. Stanojević, G. Koraćević, S. Dakić, N. Bozinovic, Katarina Kostic, Jelena Milosevic, M. Lazarević
Introduction. Kounis syndrome is a simultaneous manifestation of acute coronary syndrome with conditions associated with mast cell activation, such as allergies or anaphylactic reactions. We present early stent thrombosis in female with atopic constitution without previous aterosclerosis of coronary arteries. Case report. A 50-year-old female with typical anginal pain was addmited to Clinic for Cardiology, UCC Nis. She had passed by a linden tree in bloom, few hrs before, and immediately after felt chest pain, paresthesia and numbnes in her left hand, throat tightness, heaviness of the tongue, and swelling of the lips. Symptoms stopped for 60 min after taking 10 mg of loratadine. 30 min after addmision ECG showed ST elevation in D2, D3, aVF, V6. She underwent an emergency percutaneous coronary intervention (PCI) procedure. Occlusive thrombosis was seen in the ostium of the left anterior descending (LAD) coronary artery. Sirolimus-coated stent was placed with Thrombolysis in Myocardial Infarction (TIMI) 3 flow obtained. A few hrs later, patient reported a new onset of chest pain followed by ventrucular fibrilation (VF), DC shock and occurence of new ST segment elevation in aVR, V1-V3. Repeated angiography showed acute in-stent trombotic occlusion. Baloon angioplasty was performed which restored TIMI 3 flow in LAD. Anticoagulant and corticosteroid therapy was administered. Three days following an intervention, optical coherence tomography (OCT) imiging showed no signs of aterosclerosis and restenosis, adequate stent expansion and apposition. Conclusion. Coronary agiography proved type I Kounis syndrome after the exposure to an allergen, and type III Kounis syndrome developed shortly after stent placement. Newly described causes of acute and subacute stent thrombosis in type III Kounis syndrome are stent-associated hypersensitivity reactions.
{"title":"Early stent thrombosis in Kounis syndrome - a case report","authors":"T. Kostić, Z. Perisic, D. Kutlešić-Kurtović, Bojan Maričić, S. Apostolovic, D. Stanojević, G. Koraćević, S. Dakić, N. Bozinovic, Katarina Kostic, Jelena Milosevic, M. Lazarević","doi":"10.2298/vsp230424037k","DOIUrl":"https://doi.org/10.2298/vsp230424037k","url":null,"abstract":"Introduction. Kounis syndrome is a simultaneous manifestation of acute coronary syndrome with conditions associated with mast cell activation, such as allergies or anaphylactic reactions. We present early stent thrombosis in female with atopic constitution without previous aterosclerosis of coronary arteries. Case report. A 50-year-old female with typical anginal pain was addmited to Clinic for Cardiology, UCC Nis. She had passed by a linden tree in bloom, few hrs before, and immediately after felt chest pain, paresthesia and numbnes in her left hand, throat tightness, heaviness of the tongue, and swelling of the lips. Symptoms stopped for 60 min after taking 10 mg of loratadine. 30 min after addmision ECG showed ST elevation in D2, D3, aVF, V6. She underwent an emergency percutaneous coronary intervention (PCI) procedure. Occlusive thrombosis was seen in the ostium of the left anterior descending (LAD) coronary artery. Sirolimus-coated stent was placed with Thrombolysis in Myocardial Infarction (TIMI) 3 flow obtained. A few hrs later, patient reported a new onset of chest pain followed by ventrucular fibrilation (VF), DC shock and occurence of new ST segment elevation in aVR, V1-V3. Repeated angiography showed acute in-stent trombotic occlusion. Baloon angioplasty was performed which restored TIMI 3 flow in LAD. Anticoagulant and corticosteroid therapy was administered. Three days following an intervention, optical coherence tomography (OCT) imiging showed no signs of aterosclerosis and restenosis, adequate stent expansion and apposition. Conclusion. Coronary agiography proved type I Kounis syndrome after the exposure to an allergen, and type III Kounis syndrome developed shortly after stent placement. Newly described causes of acute and subacute stent thrombosis in type III Kounis syndrome are stent-associated hypersensitivity reactions.","PeriodicalId":23531,"journal":{"name":"Vojnosanitetski pregled","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68341085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background/Aim. Psoriasis is a chronic multisystem, inflammatory and immune-mediated dermatological disease of a relapsing nature. It does not only affect objective parameters such as skin and joint, with different intensity involvement with changes and the degree of changes but also significantly affects the health-related quality of life. The aim of the study was to determine the clinical severity and quality of life of patients with moderate to severe psoriasis and to examine the association between those parameters before and after the treatment. Methods. This cross-sectional study included 183 patients diagnosed with moderate to severe psoriasis. The severity of the clinical picture was determined by calculating Psoriasis Area and Severity Index (PASI) by a dermatologist, while the quality of life was assessed using Dermatology Life Quality Index (DLQI) questionnaire and the Psoriasis Life Stress Inventory (PLSI). Disease severity and quality of life were measured at the baseline visit and after 16th week of therapy. Results. The average PASI score at the beginning of therapy was 23.1?6.5, while after the 16 weeks, this value was 4.36?4.86. The DLQI score was 20.8?5.0 at the start of therapy and 6.20?6.16 after 16 weeks. The PLSI score was 35.37?8.84 initially and 12.75?12.82 after the 16 weeks of therapy. On the assessment of the correlation between the PASI and PLSI, the PASI score was found to be in a high positive correlation with the PLSI (r=0.702, ?<0.001) in the 16th week of therapy, but the correlation is moderate between the DLQI and PASI (r=0.683, ?<0.001). We failed to find any significant differences between PASI and DLQI scores (r=0.080, ?=0.284) and between PASI and PLSI scores (r=0.109, ?=0.140) in the baseline. Conclusion. Patients with severe psoriasis experience a significant reduction in their quality of life, accompanied by a high level of psychosocial stress. Observed improvements in quality of life have shown a moderate correlation, while lower levels of psychosocial stress have strongly correlated with the severity of the clinical presentation. This may indicate a complex interaction between psychological factors and physical health in patients with psoriasis.
{"title":"Correlation between clinical severity and quality of life in moderate to severe psoriasis patients: Real-world evidence","authors":"Ardea Milidrag, Teodora Safiye, Medo Gutic, Milena Zlatanovic, Svetlana Radevic, Ana Ravic-Nikolic","doi":"10.2298/vsp230401050m","DOIUrl":"https://doi.org/10.2298/vsp230401050m","url":null,"abstract":"Background/Aim. Psoriasis is a chronic multisystem, inflammatory and immune-mediated dermatological disease of a relapsing nature. It does not only affect objective parameters such as skin and joint, with different intensity involvement with changes and the degree of changes but also significantly affects the health-related quality of life. The aim of the study was to determine the clinical severity and quality of life of patients with moderate to severe psoriasis and to examine the association between those parameters before and after the treatment. Methods. This cross-sectional study included 183 patients diagnosed with moderate to severe psoriasis. The severity of the clinical picture was determined by calculating Psoriasis Area and Severity Index (PASI) by a dermatologist, while the quality of life was assessed using Dermatology Life Quality Index (DLQI) questionnaire and the Psoriasis Life Stress Inventory (PLSI). Disease severity and quality of life were measured at the baseline visit and after 16th week of therapy. Results. The average PASI score at the beginning of therapy was 23.1?6.5, while after the 16 weeks, this value was 4.36?4.86. The DLQI score was 20.8?5.0 at the start of therapy and 6.20?6.16 after 16 weeks. The PLSI score was 35.37?8.84 initially and 12.75?12.82 after the 16 weeks of therapy. On the assessment of the correlation between the PASI and PLSI, the PASI score was found to be in a high positive correlation with the PLSI (r=0.702, ?<0.001) in the 16th week of therapy, but the correlation is moderate between the DLQI and PASI (r=0.683, ?<0.001). We failed to find any significant differences between PASI and DLQI scores (r=0.080, ?=0.284) and between PASI and PLSI scores (r=0.109, ?=0.140) in the baseline. Conclusion. Patients with severe psoriasis experience a significant reduction in their quality of life, accompanied by a high level of psychosocial stress. Observed improvements in quality of life have shown a moderate correlation, while lower levels of psychosocial stress have strongly correlated with the severity of the clinical presentation. This may indicate a complex interaction between psychological factors and physical health in patients with psoriasis.","PeriodicalId":23531,"journal":{"name":"Vojnosanitetski pregled","volume":"235 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135599369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aleksandar Djordjević, J. Todić, S. Šimić, D. Lazic, Z. Vlahović, Ljiljana Subaric
Backgraund/Aim. One of the inconvenience of the cement retained fixed implant supported restorations is the residual cement which is found on the superstructure after the cementation procedure and was considered as a risk factor for the occurrence of periimplantitis. Methods. The research was conducted in vitro conditions on casts obtained after implant placement. The abutments are (milled) at the level of the gingiva, subgingivally 1.5 mm and subgingivally 3 mm. Zirconium dioxide ceramic restorations were cemented with the standard cementation technique, the cementation technique using teflon tape and the precementation method using a replica of the abutment made using the silicone and 3D printed replica. The amount of residual cement was measured by photograph analysis. Adobe Photoshop was used for software analysis of photographs and determination of cement surface. Statistical procedures were performed in the SPSS program and the Kruskal-Wallis test was used for data analysis. Results. A comparative analysis of the effectiveness of cementation techniques at the gingival margin level revealed that there is a statistically significant difference in the amount of residual cement in relation to the cementation technique (p < 0.001). Analyzing the cementation technique effectiveness at the level of finis line the 1.5 mm subgyngivaly it was established that there was a statistically significant difference in the amount of residual cement compared to the cementation technique (p = 0.001). Comparing the effectiveness of cementing techniques at the 3 mm subgingival finish line level, it was established that there was a statistically significant difference in the amount of residual cement compared to the cementing technique (p < 0.001). Conclusion. Subgingival localization significantly affects the amount of residual cement in fixed prosthetic restorations on implants. Applying precementing techniques significantly reduces the amount of residual cement.
{"title":"Effectiveness of different cementation techniques on the amount of remaining excess cement depending on the crown-abutment margin level","authors":"Aleksandar Djordjević, J. Todić, S. Šimić, D. Lazic, Z. Vlahović, Ljiljana Subaric","doi":"10.2298/vsp221110016d","DOIUrl":"https://doi.org/10.2298/vsp221110016d","url":null,"abstract":"Backgraund/Aim. One of the inconvenience of the cement retained fixed implant supported restorations is the residual cement which is found on the superstructure after the cementation procedure and was considered as a risk factor for the occurrence of periimplantitis. Methods. The research was conducted in vitro conditions on casts obtained after implant placement. The abutments are (milled) at the level of the gingiva, subgingivally 1.5 mm and subgingivally 3 mm. Zirconium dioxide ceramic restorations were cemented with the standard cementation technique, the cementation technique using teflon tape and the precementation method using a replica of the abutment made using the silicone and 3D printed replica. The amount of residual cement was measured by photograph analysis. Adobe Photoshop was used for software analysis of photographs and determination of cement surface. Statistical procedures were performed in the SPSS program and the Kruskal-Wallis test was used for data analysis. Results. A comparative analysis of the effectiveness of cementation techniques at the gingival margin level revealed that there is a statistically significant difference in the amount of residual cement in relation to the cementation technique (p < 0.001). Analyzing the cementation technique effectiveness at the level of finis line the 1.5 mm subgyngivaly it was established that there was a statistically significant difference in the amount of residual cement compared to the cementation technique (p = 0.001). Comparing the effectiveness of cementing techniques at the 3 mm subgingival finish line level, it was established that there was a statistically significant difference in the amount of residual cement compared to the cementing technique (p < 0.001). Conclusion. Subgingival localization significantly affects the amount of residual cement in fixed prosthetic restorations on implants. Applying precementing techniques significantly reduces the amount of residual cement.","PeriodicalId":23531,"journal":{"name":"Vojnosanitetski pregled","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68340128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Jovanovic, M. Bezmarevic, S. Petkovic, B. Milev, M. Mitrović, M. Jocic, M. Jovanovic, D. Mirković
Intrahepatic lithiasis (IHL) is a disease that occurs in middle-aged and elderly people. Presentations of IHL in young are rare and considerations in the differential diagnosis include primary sclerosing cholangitis, recurrent pyogenic cholangitis, bile acid transporter defect, Caroli's disease and other known genetic diseases. Treatment is often complex, all in order to prevent complications. In this report, we describe the diagnosis and treatment, with application of flexible ureteroscope of 4 Fr, of a younger patient with intrahepatic lithiasis. Case report. A 25-year-old man appeared with a known diagnosis of IHL and recurrent attack of abdominal pain that required medical treatment. Magnetic resonance imaging of abdomen showed segmental stenosis of the left bile duct and segmental bile duct for lateral section with intraductal calculi and its proximal dilatation and mild dilatation of the bile ducts for liver segments two and three. During surgery, a cholangiography and ultrasonography of the liver were performed. Through choledochotomy the bile ducts were flushed and extirpation of the several calculi was performed. Inspection of bile ducts was done with a choledochscope, and the remaining concrements were removed with a flexible ureteroscope. Conclusion. Segmental liver bile ducts may be explored with flexible ureteroscope, without bile ducts injury or trauma. In selected cases, isolated lithiasis in one liver lobe and absence of concomitant diseases, IHL can be treated surgically without liver resection. This case is unique because we did not perform liver resection but duct stone extraction which was appropriate treatment since there was no recurrence during 2-year follow-ups.
{"title":"Rare primary intrahepatic lithiasis in young patient","authors":"M. Jovanovic, M. Bezmarevic, S. Petkovic, B. Milev, M. Mitrović, M. Jocic, M. Jovanovic, D. Mirković","doi":"10.2298/vsp230201034j","DOIUrl":"https://doi.org/10.2298/vsp230201034j","url":null,"abstract":"Intrahepatic lithiasis (IHL) is a disease that occurs in middle-aged and elderly people. Presentations of IHL in young are rare and considerations in the differential diagnosis include primary sclerosing cholangitis, recurrent pyogenic cholangitis, bile acid transporter defect, Caroli's disease and other known genetic diseases. Treatment is often complex, all in order to prevent complications. In this report, we describe the diagnosis and treatment, with application of flexible ureteroscope of 4 Fr, of a younger patient with intrahepatic lithiasis. Case report. A 25-year-old man appeared with a known diagnosis of IHL and recurrent attack of abdominal pain that required medical treatment. Magnetic resonance imaging of abdomen showed segmental stenosis of the left bile duct and segmental bile duct for lateral section with intraductal calculi and its proximal dilatation and mild dilatation of the bile ducts for liver segments two and three. During surgery, a cholangiography and ultrasonography of the liver were performed. Through choledochotomy the bile ducts were flushed and extirpation of the several calculi was performed. Inspection of bile ducts was done with a choledochscope, and the remaining concrements were removed with a flexible ureteroscope. Conclusion. Segmental liver bile ducts may be explored with flexible ureteroscope, without bile ducts injury or trauma. In selected cases, isolated lithiasis in one liver lobe and absence of concomitant diseases, IHL can be treated surgically without liver resection. This case is unique because we did not perform liver resection but duct stone extraction which was appropriate treatment since there was no recurrence during 2-year follow-ups.","PeriodicalId":23531,"journal":{"name":"Vojnosanitetski pregled","volume":"17 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68340331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Gačić, B. Ilić, Jovana Bakalovic, Marija Mitrovic, Jovana Kuzmanovic-Pficer, Bojan Jovičić, Bojan Janjic
Background/Aim. The shortcomings of the orthopantomography (OPG) method and radiographic misinterpretations may lead to poor treatment planning and complications during or after the third molar extraction. The aim of this study was to determine the validity and reliability of OPG findings concerning post-extraction wisdom tooth root morphology, as well as whether the degree of clinical expertise affects assessment accuracy. Methods. The cross-sectional study included 200 patients who were referred for third molar extraction. Preoperative OPGs were evaluated by examiners classified by their level of experience into three groups: students, residents, and professors. True root morphologies were recorded after the extraction, and the accuracy of the assessment was evaluated using various statistical tests. Results. The majority of assessments were accurate for the lower and upper third molars with a single root. The professor group was the most accurate when compared to the other two groups (p = 0.0015). Weighted Kappa values for intra-respondent accuracy gradually increased from the student to professor group (0.06, 0.28, 0.34, respectively). The highest discrepancy in inter-respondent accuracy was determined between the student and professor groups (poor; ?w = 0.25584). Conclusion. In this study are not achieved results which confirm reliability of panoramic acquisition for detection of accurate third molars root morphology. The level of clinical experience affects diagnostic accuracy, but complex clinical cases should be evaluated by different methods.
{"title":"The reliability of dental panoramic tomographs in determining the upper and lower third molar root morphology","authors":"B. Gačić, B. Ilić, Jovana Bakalovic, Marija Mitrovic, Jovana Kuzmanovic-Pficer, Bojan Jovičić, Bojan Janjic","doi":"10.2298/vsp230302029g","DOIUrl":"https://doi.org/10.2298/vsp230302029g","url":null,"abstract":"Background/Aim. The shortcomings of the orthopantomography (OPG) method and radiographic misinterpretations may lead to poor treatment planning and complications during or after the third molar extraction. The aim of this study was to determine the validity and reliability of OPG findings concerning post-extraction wisdom tooth root morphology, as well as whether the degree of clinical expertise affects assessment accuracy. Methods. The cross-sectional study included 200 patients who were referred for third molar extraction. Preoperative OPGs were evaluated by examiners classified by their level of experience into three groups: students, residents, and professors. True root morphologies were recorded after the extraction, and the accuracy of the assessment was evaluated using various statistical tests. Results. The majority of assessments were accurate for the lower and upper third molars with a single root. The professor group was the most accurate when compared to the other two groups (p = 0.0015). Weighted Kappa values for intra-respondent accuracy gradually increased from the student to professor group (0.06, 0.28, 0.34, respectively). The highest discrepancy in inter-respondent accuracy was determined between the student and professor groups (poor; ?w = 0.25584). Conclusion. In this study are not achieved results which confirm reliability of panoramic acquisition for detection of accurate third molars root morphology. The level of clinical experience affects diagnostic accuracy, but complex clinical cases should be evaluated by different methods.","PeriodicalId":23531,"journal":{"name":"Vojnosanitetski pregled","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68340417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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