bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathological elongations of the carotid arteries: Diagnostics and surgical treatment
Authors: Stanić Sanja , Sotirović Vuk , Tanasković Slobodan , Aleksić Nikola , Radak Đorđe
Published: February 2022

Pathological elongations of cervical blood vessels are relatively common, but their exact incidence in general population is still unknown. The history of intermittent symptoms of cerebrovascular insufficiency, which may be provoked by rotatory movements of the head and the neck, should raise suspicion of the presence of carotid artery redundancy. On the basis of the clinical features and modern diagnostic procedures, we can determine the hemodynamic significance of kinking and coiling. Maximal systolic velocity, measured by color duplex ultrasonography, is an important parameter for reaching the diagnosis. Arteriography, CT or classic, is reserved only for symptomatic cases of kinking and coiling. Although the largest amount of morphological information is provided by intra-arterial digital subtraction arteriography, the number of surgical decisions made on the basis of non-invasive tests has increased. Surgical reconstruction in patients with hemodynamically significant kinking/coiling ICA is a safe and effective method of ischemic stroke prevention, which relieves the symptoms of cerebral ischemia and improves cerebral perfusion.
Malignancy-related hyponatremia: Case report
Authors: Gluvić Zoran , Tica Jelena , Vujović Marina , Rašić-Milutinović Zorica , Popović-Radinović Vesna , Lačković Milena , Obradović Milan , Isenović Esma
Published: February 2022

Hyponatremia is a common electrolyte disorder in hospitalized patients. In the case of repetitive biochemically confirmed hyponatremia, it is necessary to find its cause. Case report: a 56-year-old woman was admitted to hospital due to leg cramps and malaise. Routine biochemical analysis revealed hypotonic hyponatremia and Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) was suspected. The cause of hyponatremia was not discovered by means of evaluating SIADH. The patient was simptomatically treated, and discharged in better general condition, with partially corrected hyponatremia. She was advised to restrict water intake and to repeat serum electrolytes and BUN regularly. Four months later, she presented with dyspnea and hyperglycemic syndrome, she was confused and her life was threatened. Beside severe hyponatremia and hyperglycemia, an urgent abdominal ultrasonography showed liver secondaries. Shortly after admission, the patient passed away. Unfortunately, the patient's family refused an autopsy, so the origin of neoplasia has remained unknown. It is necessary to do a thorough clinical evaluation of hypotonic hyponatremia. SIADH, as the most frequent cause of hypotonic hyponatremia, is often a paraneoplastic syndrome. Careful correction of hypotonic hyponatremia and management of the underlying disease is the mainstay of SIADH treatment.
The etiology, treatment and outcome of diabetic ketoacidosis and hyperosmolar coma
Authors: Melentijević Dragana , Beljić-Živković Teodora
Published: February 2022

Diabetic ketoacidosis (DKA) and nonketotic hyperosmolar hyperglycemic state (NHOK) are acute complications of diabetes mellitus (DM). The aim was to investigate precipitating factors, therapy and the result of the treatment of DKA and NHOK. The study included all the people who were admitted to the Clinical Department of Endocrinology, Diabetes and metabolism disease KBC "Zvezdara" in the state of DKA and NHOK between 2007 and 2010. During this period we treated 56 people, aged 51.8 ± 18.8 years. DKA was diagnosed in 54 patients, whereas NHOK was diagnosed in two patients. Type 1 DM was present in 26 (46.42%) patients and type 2 in 30 (53.57%) patients. In DKA average values of glucose were 32±8,85mmol / l, HbA1c-11.6±2,52%, pH 6.89±0,17, HCO3-7.40±5,03. In patients with NHOK average glucose was 60.35±15,14mmol / l, HbA1c-11.2±1,7%,pH 7.43±0,1, HCO3-19, 8±5,23. There was a significant difference in the glucose level (t(54) =6.03,p<0.01) as well as in bicarbonate level (t(54)=3.72,p=0.01) between DKA and NHOK. The most common precipitating factors were: infection in 26 (46.42%) cases, inadequate therapy in 24 (42.85%) cases, myocardial infarction and cerebral stroke in 2 (3.57%) cases. All the patients with NHOK and 16 with DKA had previously been on oral antihy-perglycemic drugs, while 29 patients with DKA had previously been on insulin therapy. Upon admission, the previous therapy was not in relation with the level of glucose and pH. Bicarbonate level was significantly higher in the group treated with oral therapy (t (43) = 2.16,p <0.05). The therapy was considered because of rehydration, fractionally giving boluses HM insulin, potassium compensation and treatment precipitating factors. Rehydration was achieved with an average of 5.6±1,65 liters on the first day,4.08±0,87l on the second day, and 3±0,01 liters on the third day of infusion solutions. The total daily dosage of insulin bolus HM on the first day was 81.04±27,97i.j, 59.64±17,60i.j. on the second day and 58.06±19,70i.j. on the third day. Maximum daily supplementation of potassium in the form of 7.4% KCL solution was 61±18,70mmol / l. Upon the end of the treatment, the total of 26 (46.42%) was discharged on basal-bolus human insulin therapy, 18 (32.14%) on the treatment of basal-bolus analogues, 11 (19.64%) on therapy insulin premix and metformin, while two (3.57%) were discharged on oral antihyperglycemic medications. The treatment outcome was successful in 50 people (89.3%), while death occurred in 6 (10.7%) cases. The most common complication was hypokalemia, present in 29 (51.78%) patients. Other complications were acute renal failure (3 people), acute respiratory distress syndrome (2 people), pulmonary edema (2 people) and gastrointestinal bleeding (1 person). Despite education and available medications for diabetes, acute complications of diabetes can still occur and are sometimes accompanied by dangerous complications.
Antibiotic ointment in the management of recurrent, community-acquired bacterial cystitis in women: Observational study
Authors: Aleksić Predrag , Bančević Vladimir , Aleksić Aleksandra , Bančević Maja
Published: February 2022

Acute bacterial cystitis is the most common form of community-acquired urinary tract infections in women. Uri-nary tract infections are the second most common reason for antibiotic prescription in the USA. There is a need for alternative treatments that would help to avoid the use of systematic antimicrobials thus reducing the incidence of microbial resistance and side effects of the drugs. The aim of this study is to evaluate the role of antibiotic ointment treatment in recurrent UTIs in women. We followed up 34 non-pregnant women with a previous history of recurrent UTIs who were instructed to apply antibiotic ointment Bacitracin/Neomycin, locally, on the external urethral meathus area, once a day, for 30 days. 88% of patients responded to the treatment, with no further recurrences in 67.6% of cases and there was a reduced (< 3 cases per year) recurrence in 20.5% of patients. Bacitracin/Neomycin ointment could be a safe, cheap and successful tool for recurrent UTIs in women. To our best knowledge, this is the first published pilot-study of topical antibiotic ointment usage in management and prevention of recurrent urinary tract infections. We need a double blinded, randomized study with a larger number of patients in order to collect more evidence to support this conclusion.
Diagnostic capability of Pulsar perimetry In early Primary open angle glaucoma
Authors: Bjelović Nevena , Senćanić Ivan , Trajković Goran
Published: February 2022

Aim: to assess the ability of Pulsar perimetry in detecting an early glaucomatous visual field damage in comparison with Optic coherent tomography (OCT), in early glaucoma. Material: Cross-sectional case study included 1 eye from 55 consecutive subjects containing: 27 healthy subjects and 28 patients with early Primary open angle glaucoma (POAG). Only 1 eye per subject was randomly selected, if both eyes met the inclusion criteria. Methods: All the patients underwent OCT and visual field examination in addition to full ophthalmic examinations. Receiver operating characteristic curves (ROC) were studied for all parameters. The sensitivity and specificity of the differences between normal and early glaucomatous eyes, the areas under the receiver operating characteristic curves (AROC) and positive, negative likelihood ratios were evaluated for all the single parameters and selected combined parameters. Results: Individuals with early POAG had significantly higher values of FLV at GCC, MD and sLV at Pulsar perim-etry compared to healthy individuals. There were 1.84% of cases with early glaucoma FLV, whereas there were 0.5% of cases with healthy eyes. Considering Pulsar perimetry, patients with early glaucoma had higher values of MD (0,23dB) and sLV (1,97dB), compared to MD (0,23dB) and sLV (1,62dB) in healthy individuals (p<0.05). The highest values of AROC had the following parametres: FLV AROC (0,648), MD AROC (0,691), sLV AROC (0,696). According to AROC we combined the best three single parameters, FLV at GCC, MD and sLV at Pulsar perimetry, using a logistical diagnostic model. The largest AROC obtained was at the value of 0.790. Conclusion: In conclusion, parameters obtained by OCT (FLV at GCC), and Pulsar perimetry (MD and sLV) were able to show the significant differences between early POAG patients and normal subjects. Combining parameters of FLV at GCC, MD and sLV at Pulsar perimetry showed higher diagnostic capability with those top three single parameters.
The assessment of risk factors for retinopathy of prematurity
Authors: Jojić Dragica , Draganović Dragica , Solomun Ljilja , Konjević Stojislav , Preradović Milan
Published: February 2022

Retinopathy of prematurity (ROP) is a potentially blinding eye disorder that primarily affects premature infants. Our study was conducted in order to determine which risk factors lead to the development of retinopathy of prematurity. This retrospective study included 108 newborns with birth weight (BW) < 1500 g and gestation age (GA) < 33 weeks, over the period of two years, who were treated at the Clinic of Pediatric, University Hospital, Clinic Centre Banja Luka. In all preterm children, the impact of risk factors conditioned preterm birth (gestational age and birth weight), parameters of general health status (respiratory distress syndrome, apnea, perinatal asphyxia, frequent use of blood derivatives, sepsis, hyperbilirubinemia) and parameters of the treatment with oxygen therapy. Out of 108 infants who fit the screening criteria, ROP was detected in 64 (59.2%) infants, 21(19.4%) of which had severe ROP requiring surgical intervention. Severe ROP was expressed in only 7.8% (5/64) of infants with GA > 30 weeks and in 12.5% (8/64) of infants with BW > 1250 g, compared to 25% (16/64) of infants with GA < 30 weeks and 20.3% (13/64) of infants with BW < 1250 g. The incidence of severe ROP was statistically significantly more frequent with progressively smaller birth weight BW < 1250 g (p <0.01) and the lower GA (gestational age) < 30 weeks (p <0.01). Using multiple logistic regression analysis for ROP, a long-term oxygen therapy (OR,15:54CI, 1.99-120.79) and a long duration of mechanical ventilation (OR,9.97; CI,3.06-32.51), there were obtained factors with a strong connection to the development of severe ROP. The following factors have a slightly lower correlation to the development of severe ROP: birth weight < 1250 g, gestation age < 30 weeks, respiratory distress syndrome, apnea, frequent use of blood derivatives and early sepsis. Prematurity and low birth weight are significant risk factors for the development of ROP. Compromised pulmonary function with long-term oxygen therapy and frequent use of blood derivatives are important factors in the development of severe ROP.
Pharmaceutical therapy of chronic venous disease
Authors: Radak Đorđe , Sotirović Vuk
Published: February 2022

Chronic venous disease (CVD) is a common condition and a global phenomenon that affects a significant part of the population worldwide. The majority of patients with CVD have symptoms that significantly affect their daily activities and deteriorate the quality of their life. Treatment modalities vary from medical and other types of conservative therapies , less invasive endovenous intervention to radical surgical procedures. The purpose of this article is to underline the importance of venoactive drugs in the treatment of patients with CVD.
The role of L-Arginine in cardiovascular system
Authors: Sudar-Milovanović Emina , Obradović Milan , Bajić Vladan , Bogdanović Nikola , Radak Đorđe , Isenović Esma
Published: February 2022

The essential amino acid, L-Arginine (L-Arg) has an important role in the cardiovascular system. Literature data show that L-Arg is the only substrate for the production of nitric oxide (NO), from which L-Arg develops its effects on the cardiovascular system. As a free radical, NO is synthesized in all mammal cells by L-Arg with the activity of NO synthase (NOS). In the states of hypertension, diabetes, hypercholesterolemia and vascular inflammation, a disorder occurs in the metabolic pathway of the synthesis of NO from L-Arg which all together bring alterations to blood vessels. Clinical studies show that L-Arg has an effect on thrombocytes, the process of coagulation and the fibrolytic system. All the new data summarized in this review suggest that L-Arg could be one of important therapeutic molecules for improving cardiovascular disorders.
The role of the nitric oxide synthases in brain ischemia during carotid endarterectomy
Authors: Bogdanović Nikola , Obradović Milan , Jasnić Nebojša , Spremo-Potparević Biljana , Unić-Stojanović Dragana , Radak Đorđe , Isenović Esma
Published: February 2022

According to the World Health Organization, 15 million people per year are affected by stroke. The most common cause of stroke is brain ischemia, which occurs in almost 85% of cases. Ischemia caused by thromboembolism is defined as permanently or temporarily decreased blood flow which prevents an adequate delivery of oxygen, glucose and other important nutrients, leading progressively to metabolic changes and cell apoptosis. Carotid endarterectomy (CEA) can cause hypoxic - ischemic states of the brain or acute brain ischemia (ABI) leading eventually to stroke. The main cause of ABI as a result of CEA is cerebral hypoperfusion caused by clamping of carotid arteries, when hypoxia occurs.. Hypoxia per se is one of the triggers of complex physiological responses in the body, including the release of various mediators of inflammation. One of these inflammatory mediators is nitric oxide (NO), a free radical which has numerous physiological effects and also plays an important role in the immune response of the organism. However, NO may be very harmful and cause cell and tissue damage. The lack of literature data on the role of endothelial NOS (eNOS) and inducible NOS (iNOS) during CEA, as well as the mechanisms of their regulation in ischemic conditions, suggest that intensifying future research in this field is very important. An insight into molecular mechanisms of iNOS activity and expression regulation will certainly help to develop new therapeutic strategies for treating harmful effects of free radicals, especially uncontrolled production of NO.
Diagnostic and therapeutic management of patients with adrenal incidentaloma
Authors: Bajcetić Danica , Tanasković Slobodan , Sotirović Vuk , Jovanović Marijana , Jovanović Predrag , Popov Petar , Nenezić Dragoslav , Despotović Biljana , Radak Đorđe
Published: February 2022

Routine and frequent use of computerized tomography (CT) angiography in vascular disease detection has led to frequent suprarenal gland abnormal findings that could, if undiagnosed, significantly complicate the course of the future treatment. The term adrenal incidentaloma refers to adrenal lesion discovered serendipitously during an imaging investigation. Adrenal incidentalomas do not constitute a single pathological entity. Major concerns are risks of malignancy and autonomous hormone secretion. The majority of all adrenal incidentalomas (approximately 79%) are nonfunctioning benign lesions. Among functioning lesions subclinical cortisol excess is most frequently found. All patients with adrenal incidentaloma should undergo clinical, biochemical, and imaging evaluation for malignancy and hormone production. In this review, we discuss the current issues in diagnostic and therapeutic management of patients with adrenal incidentaloma. Follow-up of patients with adrenal incidentalomas involves the assessment of growth and development of hormonal function. After this review analysis several useful protocols could be designed to help vascular surgeons to adequately treat patients with concomitant vascular disease and adrenal incidentaloma.
Vascular age and carotid intima-media thickness
Authors: Tepavčević Brankica , Radak Sandra
Published: February 2022

Measurement of carotid intima-media thickness with B-mode ultrasound is a noninvasive and highly reproducible technique for detecting and quantifying subclinical atherosclerosis. Several large, prospective, epidemiologic studies have shown that this method accurately identifies prevalence and incidence of cardiovascular disease, independently of traditional risk factors. The value of this method is that it can be used to determine patients' vascular age. Measurement of carotid intima-media thickness reveals current atherosclerotic burden, it is feasible in a clinical setting and it can be integrated into coronary heart disease risk assessment models. Vascular age is substitution for chronological age and it is used in order to improve coronary heart disease risk prediction taking current carotid atherosclerotic burden into account.
Esophageal atresia: Current approach in treatment
Authors: Vujović Dragana , Lukač Marija , Stojakov Dejan , Simić Dušica , Sinđić-Antunović Sanja
Published: February 2022

Esophageal atresia refers to a congenitally interrupted esophagus, with one or more fistulae present between the malformed esophagus and the trachea. The most frequent type is the one with distal tracheoesophageal fistula. If not diagnosed in time, it could cause severe respiratory complications , due to the aspiration of saliva, or direct flow of gastric secretions from below into the tracheobronchial tree. Surgical treatment of esophageal atresia demands a very precise operative technique, because of very limited possibilities for redo procedures. Results in the treatment of esophageal atresia, associated anomalies and postoperative complications are used in evaluation of both expert achievements of surgical team and institutional recommendations for certain pediatric hospitals. That is why the aim of the study is to evaluate our success in surgical treatment and to make a diagnostic and therapeutic algorithm for esophageal atresia. A retrospective study included 294 neonates treated from 1971-2013. The data are analyzed by comparing the incidence of different types of esophageal atresia, association with other congenital anomalies, treatment modalities of long-gap esophageal atresia and postoperative complications , as well as the outcome and survival rate over time. The results are analyzed using descriptive statistical method. The incidence of common esophageal atresia with distal tracheoesophageal fistula was 92,7 %; 5,1% with no fistula, 0,5% with two fistulae and 1,7% of H-type anomaly. The long-gap esophageal atresia was surgically treated in 3,4 % of cases. Various other congenital anomalies were associated in 48% of cases. The incidence of early complications including an anastomotic leak was about 5%; 1% of recurrent tracheoesophageal fistula and 7% of anastomotic structures. Gastroesophageal reflux as the main late postoperative complication, particularly problematic in patients with esophageal atresia occurs in 10% of cases in our series of patients. Developing surgical experience and neonatal intensive care units, the survival rate achieved 98%, which has certainly improved the outcome of surgical treatment, lowered the rate of postoperative complications and improved the quality of life, because most of the children who undergo a successful repair of esophageal atresia are relatively healthy.
The importance of microstructure of the middle ear in otosurgery
Authors: Đerić Dragoslava , Arsović Nenad , Blažić Srbislav
Published: February 2022

The purpose of this paper is to review important anatomical variations and relations in the middle ear that may occur on the human temporal bones. We presented findings of specimens that demonstrated morphological variations involved: the facial nerve canal, an internal carotid artery and upper jugular bulb and pointed out their clinical and surgical importance. The studies were performed on the large collection of the temporal bones (2000 temporal bone specimens) in our laboratory for anatomical and surgical examinations, over the period of many years. In our study the facial nerve dehiscence was commonly present just above the oval window, in about 65% of the specimens. The middle ear cavity is closely related to the internal carotid artery, which extends medially from the promontory. This part of the wall could be noticed since the carotid channel is always more or less protruded into the lumen of the tube. In some cases (2/150) we noticed a bone defect above the internal carotid artery up to the level of tympanic orifices. In 38 (25.3%) of the cases, we found that jugular bulb protruded into the cavum tympani, elevating its bottom. The absence of bone wall above the bulb, as well as its dehiscence, could make infection spread from the middle ear spaces more easily, thus possibly causing thrombophlebitis. A highly positioned jugular bulb in the cavum tympani could lead to difficulties in differential diagnosing. In cases with clinical symptoms of jugular foramen mass, it is important to make identification of an expanding process (cholesteatoma, paraganglioma, meningeoma), but also the presence of vascular anomalies. CT scan of the temporal bone, performed before any ear surgery, is the main modality for identification of such anomalies and preventing possible insults.
Risk of traveling by plane in patients with respiratory system disease
Authors: Pešut Dragica , Nagorni-Obradović Ljudmila , Žugić Vladimir , Roksandić-Milenković Marina , Milenković Branislava
Published: February 2022

In an attempt to meet desires and needs of the patients with pulmonary diseases who plan to travel by air craft, physicians might face complex problems. They are expected to estimate individual risk and need of oxygen supplementation that might be necessary. Sometimes, these patients are a source of infection to other passengers. Some international air travel guidelines offer precise and mandatory conditions, which should be fulfilled during the flight in case such a patient has to travel. Thus, patients with drug resistant tuberculosis are not permitted to travel at all, while all the other patients with pulmonary tuberculosis and other air born infections should not travel during the infectious period. Recent or uncured pneumothorax and hemoptisis are contraindications for travelling. Other patients with pulmonary diseases, especially those with manifested respiratory insufficiency should respect the rules, which include contacting air travel company prior to flight, sharing information about their health condition and asking for details on possibilities of oxygen supplementation while on board, currence voltage, and availability of plugs in the cabin where the devices for respiratory support might be put in, etc. A possibility of hypoxia during the flight is an important individual risk. Methods of hypoxia prediction and possibilities of oxygen supplementation in air craft cabin are in focus of current research.
The impact of obesity on development of cardiovascular diseases: Mini review
Authors: Soskić Sanja , Panić Anastasija , Isenović Esma
Published: February 2022

Obesity is considered to be a chronic metabolic disorder closely connected to the chronically low inflammation characterized by significant changes in the levels of adipokines and proinflammatory cytokines, as well as other molecules that have an impact on cardiovascular function. Therefore, obesity (especially central obesity) is considered to be a significant risk factor for the development of cardiovascular diseases, atherosclerosis, coronary artery disease, hypertension and left ventricular dysfunction being some of them. The increased accumulation of fat tissue around the heart and in the blood vessels, the increased levels of oxidative stress and the inflammatory state mutually interact in the process of cardiovascular disease occurrence. Lowering the amount of body weight could significantly contribute to reduction of cardiovascular diseases and the subsequent complications.
Leptin and its mechanism of action
Authors: Panić Anastasija , Soskić Sanja , Isenović Esma
Published: February 2022

Leptin is a hormone produced by the adipose tissue, which has effects on the central nervous system. Leptin is bound to its Ob receptor on hypo-thalamic neurons to inhibit feeding behavior and to increase sympathetically-mediated thermogenesis. In addition to anorexia and thermogenesis, leptin also has direct peripheral and central nervous system-mediated effects on the endocrine, vascular, hematopoietc, immune and musculoskeletal systems. Leptin accomplishes its effects using distributed network of leptin receptors and differential molecular signaling pathways. Leptinemia is increased in obesity because of increased adipocyte mass, but obese subjects exhibit resistance to the anorexic and metabolic effects of leptin. However, multiple studies have shown that leptin can increase sympathetic nerve activity to non-thermogenic tissues in rodents causing obesity-related hypertension. One potential explanation of this paradox is selective leptin resistance. Compared with large and persuasive number of studies on the sympathetic and blood pressure effects of leptin in experimental animals, relatively little attention was given to these effects of leptin in humans. This review article presents recent findings related to leptin and its mechanism of action, and also the role of leptin in patophysiological conditions.
Vitamin D and bronchial asthma
Authors: Dimić-Janjić Sanja , Milenković Branislava
Published: February 2022

Due to its imunomodulatory properties, vitamin D has a potentially growing role in chronic diseases: malignant, cardiovascular, autoimmune and chronic lung diseases. Asthma is chronic inflammatory disease of airways. Prevalence of asthma and prevalence of vitamin D insufficiency is constantly rising in past decades. According to the numerous study results we can hypothesize that vitamin D insufficiency can be important contributor to pathogenesis, stage, disease control and therapeutic response in asthma. Vitamin D has antimicrobial properties as well, because of its influence on catelicidin, human peptide produced by neutrophils, macrophages, skin, respiratory an digestive tract cells with wide antimicrobial activity (Gram-positive and Gram-negative bacteria, some viruses and fungus) (18). Recent studies provide growing evidence in favor of vitamin D supplementation in asthma.
The relationship between insulin resistance and cardiovascular system disorders
Authors: Vučević Danijela , Jorgačević Bojan , Radosavljević Tatjana , Radak Đorđe , Kovačević Davor
Published: February 2022

The metabolic syndrome is a cluster of more or less related metabolic and cardiovascular derangements including visceral obesity, insulin resistance , dislipidemia, hypertension and glucose intolerance. This syndrome is characterized by a primary cellular defect in insulin action due to disorders in insulin signal transduction (insulin is unable adequately to achieve its biological effects). Under these conditions, insulin resistance, in combination with hyperinsulinemia causes a numerous metabolic and cardiovascular disorders, that are leading cause of morbidity and mortality worldwide. From pathophysiological point of view, insulin resistance, as well as adipokines and fatty acids released from metabolically active visceral fat tissue, significantly contributes to development of many chronic diseases (diabetes mellitus /diabetes mellitus/ type 2, hypertension, accelerated atherosclerosis and its cardiovascular and cerebrovascular complications, nonalcoholic fatty liver disease, polycystic ovary syndrome and some malignant diseases / breast cancer, etc./). Having in mind increase of metabolic syndrome prevalence in future, it is necessary to take preventive actions to decrease risk factors (inappropriate diet rich in carbohydrates and saturated fat, obesity, smoking, sedentary lifestyle and physical inactivity). Except to lifestyle changes, usage of hypocaloric diet and increase level of physical activity, in patients with metabolic syndrome it is necessary to apply appropriate medical treatment of some components of the syndrome. Although a numerous studies related to this global medical problem are carrying out, scientists are still far from a complete understanding of the molecular basis of this problem.
"Personality of the frontal lobe" in patients with comorbidity of bipolar affective disorder and antisocial personality disorder
Authors: Popović Viktorija , Milanović Milena , Damjanović Aleksandar
Published: February 2022

Patients with comorbidity of antisocial personality disorder and bipolar affective disorder represent a specific category due to permeation of clinically frequent and most serious mood disorder and a personality disorder of a particularly destructive type such as antisocial personality disorder. Previous studies of comorbidity of bipolar affective disorder and antisocial personality disorder showed relatively high prevalence rates of bipolar affective disorder in patients with antisocial personality disorder. In patients with bipolar affective disorder with the presence of antisocial personality disorder it is expected that there is a deterioration of the primary symptoms of the disease, particulary in manic phases, which is the reason of investigation of these phenomena, and why it is essential. Professional community has been familiar with the impact of neuroanatomic and neurophysiological factors on bipolar affective disorder as well as with antisocial personality disorder for more than two centuries. The most common neuroanatomic studies of patients with bipolar affective disorder and antisocial personality disorder are related to injuries and defects of the frontal cortex in general, whereas neurophysiological tests indicate deficits in brain hemispheres, a low level of excitation of the central and peripheral nervous system, abnormal EEG findings and reduced skin conductivity. Experts have paid special attention to similarities between the so-called "frontal lobe personality" and patients with comorbidity of these disorders. Analysing some of the basic characteristics of patients with "frontal lobishness" and comparing some research results of neuroanatomic and neurophysiological characteristics of patients with comorbid bipolar disorder and antisocial personality disorder, we try to distance ourselves from the trend that the etiological basis of these disorders is far away from the neurophysiological basis.
Hybrid procedures in treatment of peripheral arterial disease
Authors: Matković Marko , Joković Vuk , Ilijevski Nenad , Radak Đorđe
Published: February 2022

Peripheral arterial disease is common in the developed world, affecting approximately 14% to 20% of the adult population. The determination of the best method of revascularization or treatment of symptomatic peripheral arterial disease (PAD) is based upon the balance between risk of a specific intervention and the degree and durability of the improvement that can be expected from this intervention. Hybrid revascularization combines open surgery with endovascular procedures to treat multilevel vascular disease. The use of hybrid procedures permits vascular reconstruction that is less invasive than traditional surgical repair. The optimal strategy for revascularization will continue to evolve, but surgery continues to play a significant role in managing patients with PAD.
Benefits and risks of endovascular treatment in patients with proximal vertebral artery stenosis
Authors: Babić Srđan , Nešković Mihajlo , Tanasković Slobodan , Sagić Dragan , Antonić Želimir , Popov Petar , Unić-Stojanović Dragana , Gajin Predrag , Matić Predrag , Radak Đorđe
Published: February 2022

Extracranial vertebral artery stenosis is an important cause of posterior circulation ischemic stroke. There are several therapeutic approaches in patients with vertebral artery (VA) stenosis, including medical, endovascular and surgical treatment. This review should summarize the literature concerning endovascular treatment (EVT) of extracranial VA stenosis. By scanning reference lists of other review articles and by searching electronic database MEDLINE by using major MESH term "vertebrobasilar insufficiency/therapy" from January 2010 to April 2015, studies that included patients of any race, age and sex with symptomatic or asymptomatic atherosclerotic stenotic VA disease were identified. Periprocedural transitory ischemic attack (TIA) and stroke, and death within 30 days of the treatment were our primary interest and symptom resolution was secondary outcome measure. We found 12 retrospective studies with prospectively collected data and one additional comparative study of VA angioplasty/stenting and medical treatment was found. Percutaneous luminal angioplasty or stenting alone, or their combinations were performed in 693 patients (726 lesions). Periprocedural TIA or stroke occurred in 14 out of 693 patients (2.0%) and 30 days mortality in 1 (0.15%). A wide range of restenosis rates (3-58%) was reported. The literature shows that EVT of extracranial VA stenosis is safe and efficient. The vast majority of patients remain symptom free after the procedure, despite the restenosis rate.
Analysis of the attitudes of women from rural and urban areas to non-tumor and tumor breast changes
Authors: Lazić Predrag , Lukić Darko , Ivić Duško , Babić Nenad , Paurević Spomenka
Published: February 2022

The prospective study, which ran from January 2011 to January 2015, included the respondents who were treated from various non-tumor breast changes and breast tumors. The respondents were divided into 2 groups. First one, group A (280 respondents), consisted of the respondents who are residing in the rural area. Second one, group B (343 respondents), consisted of the respondents who have residence in urban area. The aim is to analyze the attitude to non-tumor diseases and breast tumors by women of rural and urban environment. The observed parameters are the reasons for coming to the breast examination: palpable formation in the breast, regular examination, breast pain, breast swelling and other changes. Parameters to compare the results were time intervals from the detection of palpable formations to examination. There was no statistically significant difference in inflammatory diseases of the breast, except in the case of breast abscess formation which is more common in the group A. A statistically significant difference among the groups was not found in the incidence of benign and / or malignant tumors of the breast, neither. It turned out that immediately after tumor detection by palpation, 4 patients in group A went to examination the next day. Patients in group B went 3 times more often to examination after a few days of the initial palpation of the tumor than patients in group A. There are much more women in group A who after only one year from the moment of palpable formation came to examination. The number of women, who have come to examination after a few months and / or years, is almost identical. Patients in group A have less responsible attitude towards non-tumor diseases and breast tumors, so it is possible for this group to be in higher degree of risk of late diagnosis of malignant tumors.
Factors influencing the perception of drinking water
Authors: Banjanin Nikolina
Published: February 2022

Drinking water represents one of the basic needs of the human body, and it is necessary for its normal functioning. Many factors have impact on perception of drinking water quality and safety. But, opinions about their individual importance are conflicting. Level of customers' education has impact on perception of drinking water safety. Fear of potential health risk and consumers' origin affect the selection of the type of drinking water. Certainly, demographic characteristics such as gender and age are important. Very significant role in the perception of drinking water quality and safety have its organoleptic properties. The presence of chemicals in drinking water and information obtained by family and friends are also important. On perception of drinking water properties nutritional status and the level of family income have significant impact. Scientific investigations and their results have outstanding significance in determination of standards of safety and quality of drinking water. But, opinions and attitudes of consumers should be taken into account, as well as factors they consider and observe as important.
Fetal neurosonography and fetal behaviour
Authors: Rakić Snežana
Published: February 2022

The ultrasonographic monitoring of fetal neural development is one of the most important objectives in perinatal medicine. The aim of this study was to monitor neurological development and analyse fetal behaviour by using 4D ultrasound. We conducted a prospective study of 150 singleton pregnancies in order to monitor neurological development and analyse fetal behaviour by using 4D ultrasound. The study was done by using ultrasound machine MEDISON ACCUVIX XQ transvaginal and transabdominal 5MHz sound with Doppler flow. Fetal movements in the first trimester and fetal facial expressions in the third trimester were analysed. In the first trimester, tests were conducted in the 8th, 12th and 14th week of pregnancy. Embryonic/fetal activity in the first trimester begins with movements that represent the functional expression of early neonatal activity. Identification of first reflexes is a measure of neurological development in the second and third trimester of pregnancy. Development of the central nervous system is a complex process and it is reflected in the complexity of motor, sensory, cognitive and affective functions and patterns of behaviour. Fetal behavioural patterns correlate with the development of central nervous system, while the quality of fetal movements reveals the integrity of central nervous system. For the assessment of fetal brain function a prenatal neurological test (KANET) can be used. 4D ultrasound represents an important advancement in monitoring fetal neurological development and behaviour.
Surgical treatment of anorectal anomalies in children: Experience with 224 patients
Authors: Lukač Marija , Sinđić-Antunović Sanja , Vujović Dragana , Krstić Zoran , Petronić-Marković Ivana , Raičević Mirjana
Published: February 2022

Anorectal anomalies (ARA) are congenital malformations that are represented by a wide spectrum of defects. This report describes the authors' experience and results of surgical treatment of ARA. The aim of this study was to analyse the functional outcome in patients following standardized surgical treatment of ARA. A total of 224 patients (115 girls and 109 boys) were treated from 1988 to 2015 and the data were analysed. All patients underwent a follow-up by the author. Postoperative anorectal function was evaluated based on the ability to have voluntary bowel movement, soiling and constipation. In cases of faecal incontinence bowel management program was applied. In our series of 224 operated patients 52 (24%) had faecal incontinence. Bowel management program was implemented in those patients, with a success rate of 90,6 % immediately after the treatment started in hospital, with a decrease to 83,7 % at home. In puberty success rate increased to 95%. Malone's antegrade enema procedure (ACE procedure) was done in 9 patients. It was successful in 100% of cases in the first year, with complication rate of 44% afterwards (conduit stenosis and leakage). Bowel management program offers significant benefits to children with faecal incontinence after surgical treatment of ARA. The ACE procedure can be implemented in patients after successful bowel management. Although patients are satisfied with ACE procedure, complications are very common.
Rivaroxaban versus Dabigatran: A new era in venous thromboembolism treatment
Authors: Radak Đorđe , Đukić Nenad , Nešković Mihailo , Babić Srđan , Tanasković Slobodan , Popov Petar , Gajin Predrag
Published: February 2022

Considering the frequency of deep vein thrombosis and pulmonary embolism, the therapy of these two conditions takes an important place in vascular surgery. Among numerous therapeutic options, new oral anticoagulants, such as rivaroxaban or dabigatran, represent a great improvement in the treatment of venous thromboembolism. Searching MEDLINE base until December 1, 2015 using MESH term "Rivaroxaban versus Dabigatran in VTE", we found 7 studies investigating the usage of new oral anticoagulants in venous thromboembolism treatment. The total of 18,841 patients was enrolled. No head-to-head studies were found. Benefits such as lower therapy price, oral use and greater comfort for patients and health providers place new oral anticoagulants to the frontline of venous thromboembolism treatment. However, we need head-to-head studies to have a clear picture of these two drugs
The impact of donor organ quality on the outcome of a deceased donor kidney transplantation
Authors: Laušević Mirjana , Kravljača Milica , Milinković Marija , Brković Voin , Jovičić-Pavlović Svetlana , Naumović Radomir
Published: February 2022

Increasing disparity between the limited supply of deceased donor organs and the rising demand for kidneys has led to considering alternative strategies for expanding the availability of organs for transplantation. The first definition of expanded criteria donor contained four different donor risk factors for graft failure: age, history of hypertension, cerebrovascular accident as a cause of death and final pre-procurement creatinine > 133mmol/l. Marginal donors are also those with diabetes or those with anatomical abnormalities. Other factors such as donor maintenance, surgeon related factors, perfusion and transportation of organs also have an influence on donor organ quality. The survival benefits seen in recipients of marginal kidney transplants are inferior compared to those in recipients of standard criteria donor kidneys, but significantly better than in those remaining on kidney waiting list.
Neurogenesis and the impact of steroid hormones on behaviour
Authors: Rankov-Petrović Bojana , Rašić-Marković Aleksandra , Hrnčić Dragan , Stanojlović Olivera
Published: February 2022

It took almost a century to get over the dogma of impossibility of adult neurogenesis. A growing number of researches in the past few decades have brought phenomena of adult neurogenesis into light. Ideas of therapeutic possibilities of neural stem cells in managing brain stroke, traumatic brain and spinal cord injury, as well as growing number of neurodegenerative diseases, represent the basis of huge research projects. After the development of CNS is finished, neurogenesis continues in two regions of the adult brain: sub ventricular zone of lateral ventricles and sub granular zone of dentate gyri of hippocampus. The process of neurogenesis brings two main questions concerning the regulatory mechanism: which factors enhance or suppress it and what is the significance of the process in humans. Brain development is under crucial influence of steroid hormones (effects are mediated through gene interaction or by neuromodulation of ion channel), so their influence on behaviour cannot be neglected. Studies have shown that hormones modulate learning and memory, but the specific roles of each of them should be monitored under a wide context of time, pre-exposition test manipulation, training as well as type of testing. Stress is another important factor in the regulation of adult neurogenesis, but current results highlight the importance of the opposite direction as well and young neurons interaction activity with HPA axis. Neurosteroids (allopregnanolone, dihydroepiandrosterone) are synthesized in the brain, and their concentrations are found higher than in blood of mammals. A number of steroidogenic enzymes (rate limiting enzymes in synthesis from cholesterol) are targeted in the brain, spinal cord and peripheral nervous system. The significance of neurosteroids' existence in brain tissue is explored through experiments of epileptogenesis. Numerous researches are trying to determine whether and how hormone alterations in neuroplasticity and neurogenesis are related to changes in cognition. Progesterone has been shown to improve neurologic outcome in multiple experimental models but it failed to show effect through two phase III clinical trials in patients with traumatic brain injury.
The relationship between General Aggression Model and comorbidity of antisocial personality disorder and bipolar affective disorder
Authors: Popović Viktorija , Banjanin Nikolina , Milanović Milena , Damjanović Aleksandar
Published: February 2022

The General Aggression Model (GAM model) is a dynamic, social and cognitive development model that includes situational, individual and biological variables, based on the theories of social learning and social cognitive theories, as well as on a large number of theoretical and empirical arguments of many authors who are engaged in the study of aggression. The subject of our interest is the phenomenon of aggression in patients with bipolar affective disorder with the presence of antisocial personality disorder. The combined factors of aggressiveness in GAM model can be used to determine the presence, intensity or prediction of aggression in these patients. The General Aggression Model provides the division factors of aggressiveness into direct and indirect, such as personality factors, situations, environmental factors and biological factors.
The importance of early suspicion of non-melanocytic malignant skin cancer (NMSC) in primary and secondary health care
Authors: Paurević Spomenka , Lukić Darko , Grgić Jozo , Babić Nenad , Ivić Duško , Lazić Predrag
Published: February 2022

The prospective study, which took place from February 2011 to March 2014, included respondents who were sent for computerized dermoscopy because of non-melanocytic skin tumours. Respondents were divided into 2 groups. The first one, group A (45 respondents), consisted of respondents who had expressed concern about the observed changes in the skin and the desire for examination. The second one, group B (50 respondents) were respondents that did not come for examination due to changes on the skin, but for other reasons, so they had indirectly detected suspicious skin lesions. The aim of this study is to analyse the importance of early suspicion of non-melanocytic malignant skin tumours by specialists in primary and secondary health care. Parameters for comparison were respondents' subjective attitude of non-pigment skin lesions and dermoscopy and/or PH findings. It has been shown that changes in the skin that bleed are sometimes highly suspect of NMSC because group A had 5 such cases and NMSC was detected in 4 cases, and group B had 7 respondents with haemorrhage and there were 4 with NMSC. In group B, out of 12 respondents who said that they had found suspicious skin lesions caused by trauma, there were 8 NMSC, while in group A there were 3 cases, which is a statistically significant difference. In group B, out of 16 respondents who claimed that they had had suspicious skin changes dormant for years, NMSC has been proven in 3 cases, and in group A there was not NMSC which is also a statistically significant difference. It was confirmed that the claims of the respondents are unreliable and that all patients should be addressed to computer dermoscopy, in patients with visible changes that arise even a slightest suspicion of NMSC.