Browsing by Author "Alempijevic, Djordje (55282549400)"

We present the case of a 42-year-old man, with a medical history of schizophrenic psychosis, who was found dead on the floor of his bedroom. At the autopsy, a bottle lid with a notched edge was found in the lower pharynx, partially obstructing the larynx and thus keeping the epiglottis in an open position. Airway obstruction was caused by edema and inflammation of the surrounding tissue. After removal of the foreign body, the tissue of the larynx was left with an impression of the bottle lid. The adjacent mucosa was swollen, hyperemic, partly necrotic, and covered with fibrin deposits. Also, foreign bodies were found in the stomach. The histological analysis of the hypopharynx showed severe nonspecific inflammation and necrosis of epithelium. The cause of death was a complication of subacute laryngeal obstruction caused by a foreign body. © 2018 Wolters Kluwer Health, Inc. All rights reserved.

Pseudoaneurysms arise from a disruption of arterial wall continuity and are most commonly related to a penetrating trauma, an arterial wall inflammation or iatrogenic causes. They differ from real aneurysms due to a lack of one or more layers of the arterial wall. The frequency of peripheral artery pseudoaneurysms in the upper extremities is less than in the lower extremities and its most common cause is a gunshot or a stab wound. The risk of a rupture is higher than in true aneurysms due to a lack of wall layers, therefore requiring surgical treatment in most cases. Here we describe an unusual case of an 8-year-old girl who presented to the emergency department complaining of swelling and pain in her left distal forearm. One month before admission she experienced a penetrating trauma in the same area due to a self inflicted stab wound. After clinical and duplex ultrasonography evaluation the tumefaction proved to be a posttraumatic pseudoaneurysm of the left radial artery. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.

Background: Healthcare-associated infections are infections that patients acquire during hospitalization or while receiving healthcare in other facilities. They represent the most frequent negative outcome in healthcare, can be entirely prevented, and pose a burden in terms of financial and human costs. With the development of new AI and ML algorithms, hospitals could develop new and automated surveillance and prevention models for HAIs, leading to improved patient safety. The aim of this review is to systematically retrieve, collect, and summarize all available information on the application and impact of AI in HAI surveillance and/or prevention. Methods: We conducted a systematic review of the literature using PubMed and Scopus to find articles related to the implementation of artificial intelligence in the surveillance and/or prevention of HAIs. Results: We identified a total of 218 articles, of which only 35 were included in the review. Most studies were conducted in the US (n = 10, 28.6%) and China (n = 5; 14.3%) and were published between 2021 and 2023 (26 articles, 74.3%) with an increasing trend over time. Most focused on the development of ML algorithms for the identification/prevention of surgical site infections (n = 18; 51%), followed by HAIs in general (n = 9; 26%), hospital-acquired urinary tract infections (n = 5; 9%), and healthcare-associated pneumonia (n = 3; 9%). Only one study focused on the proper use of personal protective equipment (PPE) and included healthcare workers as the study population. Overall, the trend indicates that several AI/ML models can effectively assist clinicians in everyday decisions, by identifying HAIs early or preventing them through personalized risk factors with good performance. However, only a few studies have reported an actual implementation of these models, which proved highly successful. In one case, manual workload was reduced by nearly 85%, while another study observed a decrease in the local hospital’s HAI incidence from 1.31% to 0.58%. Conclusions: AI has significant potential to improve the prevention, diagnosis, and management of healthcare-associated infections, offering benefits such as increased accuracy, reduced workloads, and cost savings. Although some AI applications have already been tested and validated, adoption in healthcare is hindered by barriers such as high implementation costs, technological limitations, and resistance from healthcare workers. Overcoming these challenges could allow AI to be more widely and cost-effectively integrated, ultimately improving patient care and infection management. © 2024 by the authors.

Background: Healthcare-associated infections are infections that patients acquire during hospitalization or while receiving healthcare in other facilities. They represent the most frequent negative outcome in healthcare, can be entirely prevented, and pose a burden in terms of financial and human costs. With the development of new AI and ML algorithms, hospitals could develop new and automated surveillance and prevention models for HAIs, leading to improved patient safety. The aim of this review is to systematically retrieve, collect, and summarize all available information on the application and impact of AI in HAI surveillance and/or prevention. Methods: We conducted a systematic review of the literature using PubMed and Scopus to find articles related to the implementation of artificial intelligence in the surveillance and/or prevention of HAIs. Results: We identified a total of 218 articles, of which only 35 were included in the review. Most studies were conducted in the US (n = 10, 28.6%) and China (n = 5; 14.3%) and were published between 2021 and 2023 (26 articles, 74.3%) with an increasing trend over time. Most focused on the development of ML algorithms for the identification/prevention of surgical site infections (n = 18; 51%), followed by HAIs in general (n = 9; 26%), hospital-acquired urinary tract infections (n = 5; 9%), and healthcare-associated pneumonia (n = 3; 9%). Only one study focused on the proper use of personal protective equipment (PPE) and included healthcare workers as the study population. Overall, the trend indicates that several AI/ML models can effectively assist clinicians in everyday decisions, by identifying HAIs early or preventing them through personalized risk factors with good performance. However, only a few studies have reported an actual implementation of these models, which proved highly successful. In one case, manual workload was reduced by nearly 85%, while another study observed a decrease in the local hospital’s HAI incidence from 1.31% to 0.58%. Conclusions: AI has significant potential to improve the prevention, diagnosis, and management of healthcare-associated infections, offering benefits such as increased accuracy, reduced workloads, and cost savings. Although some AI applications have already been tested and validated, adoption in healthcare is hindered by barriers such as high implementation costs, technological limitations, and resistance from healthcare workers. Overcoming these challenges could allow AI to be more widely and cost-effectively integrated, ultimately improving patient care and infection management. © 2024 by the authors.

BACKGROUND: Gas gangrene is a clostridium infection primarily of muscle tissue, most commonly caused by C. perfringens. Clinical diagnosis is usually made by local inspection of the wound: the infected tissue shows characteristic signs of tissue inflammation with blistered changes. The disease can starts suddenly, 4-6 hours after the injury, but most commonly the incubation period lasts 2-4 days. Without proper medical intervention, death occurs in 4-24 hours after the development of the first symptoms, but even with timely and adequate therapy, the lethality is very high (around 12%). Due to its fulminant course, in all cases with fatal outcomes, a forensic autopsy is an obligatory procedure. However, discovering the entrance gate and source of infection is not an easy task, especially in the absence of a traumatic injury. CASE PRESENTATION: Male, 27 years old, an intravenous heroin addict for about 10 years, injured his left leg in a traffic accident. He only visited the doctor after 5 days. Upon examination, it was determined that there were no externally visible injuries and no fracture, and he was given a splint immobilization for an ankle luxation. Twelve days after the accident (or 7 days after the immobilization) his mother found him unconscious. CONCLUSION: From medicolegal aspects, it’s important to have in mind even the less frequent paths of infection, in order to give an expert professional opinion on origin and cause of death. © 2021 Snežana Pavlekić, Dragan Ječmenica, Djordje Alempijevic.

Previous studies have revealed that the European Roma share close genetic, linguistic and cultural similarities with Indian populations despite their disparate geographical locations and divergent demographic histories. In this study, we report for the first time Y-chromosome distributions in three Roma collections residing in Belgrade, Vojvodina and Kosovo. Eighty-eight Y-chromosomes were typed for 14 SNPs and 17 STRs. The data were subsequently utilized for phylogenetic comparisons to pertinent reference collections available from the literature. Our results illustrate that the most notable difference among the three Roma populations is in their opposing distributions of haplogroups H and E. Although the Kosovo and Belgrade samples exhibit elevated levels of the Indian-specific haplogroup H-M69, the Vojvodina collection is characterized almost exclusively by haplogroup E-M35 derivatives, most likely the result of subsequent admixture events with surrounding European populations. Overall, the available data from Romani groups points to different levels of gene flow from local populations. © 2010 Wiley-Liss, Inc.

Previous studies have revealed that the European Roma share close genetic, linguistic and cultural similarities with Indian populations despite their disparate geographical locations and divergent demographic histories. In this study, we report for the first time Y-chromosome distributions in three Roma collections residing in Belgrade, Vojvodina and Kosovo. Eighty-eight Y-chromosomes were typed for 14 SNPs and 17 STRs. The data were subsequently utilized for phylogenetic comparisons to pertinent reference collections available from the literature. Our results illustrate that the most notable difference among the three Roma populations is in their opposing distributions of haplogroups H and E. Although the Kosovo and Belgrade samples exhibit elevated levels of the Indian-specific haplogroup H-M69, the Vojvodina collection is characterized almost exclusively by haplogroup E-M35 derivatives, most likely the result of subsequent admixture events with surrounding European populations. Overall, the available data from Romani groups points to different levels of gene flow from local populations. © 2010 Wiley-Liss, Inc.

Hunger strike of prisoners and detainees remains a major human rights and ethical issue for medical professionals. We are reporting on a case of a 48-year-old male sentenced prisoner, intravenous heroin user, who went on a hunger strike and died 15days later. Throughout the fasting period, the prisoner, who was capable of decision making, refused any medical examination. Autopsy findings were not supporting prolonged starvation, while toxicology revealed benzodiazepines and opiates in blood and urine. Cause of death was given as "heroin intoxication" in keeping with detection of 6-MAM. Legal and ethical issues pertinent to medical examination and treatment of prisoners on hunger strike are explored in accordance with legislation and professional ethical standards in Serbia. A recommendation for the best autopsy practice in deaths following hunger strike has been made. © 2011 American Academy of Forensic Sciences.

Hunger strike of prisoners and detainees remains a major human rights and ethical issue for medical professionals. We are reporting on a case of a 48-year-old male sentenced prisoner, intravenous heroin user, who went on a hunger strike and died 15days later. Throughout the fasting period, the prisoner, who was capable of decision making, refused any medical examination. Autopsy findings were not supporting prolonged starvation, while toxicology revealed benzodiazepines and opiates in blood and urine. Cause of death was given as "heroin intoxication" in keeping with detection of 6-MAM. Legal and ethical issues pertinent to medical examination and treatment of prisoners on hunger strike are explored in accordance with legislation and professional ethical standards in Serbia. A recommendation for the best autopsy practice in deaths following hunger strike has been made. © 2011 American Academy of Forensic Sciences.

The systematic exhumation of mass graves is becoming a frequent occurrence globally. Historically, it has been mostly anthropologists with their particular expertise in osteology that have been engaged by non-governmental organizations (NGO) to monitor mass grave exhumations and postmortem examinations, conducted by a host country or international forensic team, to ensure competence and a concern for justice. The excavation of graves and examination of their contents for the purposes of personal identification of victims and/or collection of evidence for prosecution require the creation of standards that meet international concerns for forensic investigation of the highest quality. However, many anthropologists are not experienced with large sites; do not have much, if any, expertise in archaeology; and are not equipped by training to assess the quality of a forensic pathologist's autopsy. This contribution is directed to both the NGO and the bio-archaeologist who are involved in the exhumation of mass graves. The experience and skills appropriate for the bio-archaeological monitor are outlined; similarly, the policies and standard operating procedures (SOP's) of the NGO that will enable the bio-archaeologist to perform their task are detailed. It is becoming increasingly clear that how a grave site was created, filled, and concealed, along with subsequent processes of site formation (e.g. slumping, robbing, animal scavenging and taphonomic alteration), require the expertise of a forensic archaeologist to discover and record site complexity along with associated forensic evidence. Similarly, the bodies themselves which are often skeletonized, fragmented and commingled pose challenges for the anthropologists and pathologists whose postmortem examinations must be critically evaluated. A model protocol for observations to make at the site as well as at the mortuary facility is provided to guide the monitor and to provide a structure for reports which are of standardized content suitable for international agencies concerned with mass grave investigation. © 2003 Elsevier Science Ireland Ltd. All rights reserved.

With the exception of exhumations of mass graves in Latin America, forensic dentists and odontologists are rarely involved in the examination of mortal remains recovered from mass graves. The cited reason is often that " there are no dental records-so what is the point"? In this presentation we review the published accounts of examination of remains arising from the conflict in the former Yugoslavia between 1991 and 1999 in which dental examinations are reported. There are roughly 30,000 missing persons of which more than 15,000 mortal remains have been identified, mostly based on DNA. There are 9 sources which describe postmortem dental examinations of 3919 sets of remains; of these, 23% were purported to have been identified specifically from dental information. Of the 8100 listed missing persons from the Srebrenica mass killings in 1995, we located 600 dental records. A sample of 263 charts was examined for information about first molar treatment as we are concerned that dental charting of individuals who lose their first molars may be incorrectly done if allowance is not made for mesial drift of the remaining molars. We found that of all the first molar extractions that are ever going to occur according to these dental charts, 63% have taken place by age 18. The majority of extracted first molars have a functional age of 17 years. We observe that an adult's remains from Srebrenica usually have only second and third molars, which have often drifted forward to occupy the position of the first molar creating the appearance of third molar agenesis. We conclude: that, since dental identifications of victims in mass graves and mass disasters is the exception rather than the rule, even in the absence of DNA-based identifications, international forensic odontologists have an ethical obligation to become more involved in examination of mass grave victims, that there must be more determined searches for antemortem dental records; that local dentists should be approached to participate in the examination of remains and lastly that dental examination and charting by anthropologists and pathologists may be grossly inaccurate. Furthermore, even in the absence of dental records, there is significant information about the individual to be obtained by an oral biologist since many families have useful memories about the oral status of their loved ones who went missing. © 2010 Elsevier Ireland Ltd.

Retrospective examination of 5-year autopsy material showed the presence of posttraumatic gastroduodenal ulcers (PGDU) in 17.7% of decedents deemed to be at risk. They were more common in males (77%) and in patients aged over 50. In the majority of cases (76%) the survival period was <12 days; in 16.5% it was < 48 h. PGDU developed most commonly in victims of polytrauma and isolated craniocerebral injury, with ISS values ≥16; patients with spinal cord injuries were at greatest risk. Most frequently affected was the stomach, exhibiting numerous, usually superficial lesions, while solitary acute and exacerbated chronic peptic ulcers were more common in the duodenum. Complications of PGDU developed in 40% of cases, mostly in the form of hemorrhage; in 20% of cases PGDU have contributed to death. Medicolegal aspects of PGDU are, most frequently, concerned with the causal relationship between trauma, PGDU, and fatal outcome, as well as the potential for allegations of medical negligence. © 2009 American Academy of Forensic Sciences.

Retrospective examination of 5-year autopsy material showed the presence of posttraumatic gastroduodenal ulcers (PGDU) in 17.7% of decedents deemed to be at risk. They were more common in males (77%) and in patients aged over 50. In the majority of cases (76%) the survival period was <12 days; in 16.5% it was < 48 h. PGDU developed most commonly in victims of polytrauma and isolated craniocerebral injury, with ISS values ≥16; patients with spinal cord injuries were at greatest risk. Most frequently affected was the stomach, exhibiting numerous, usually superficial lesions, while solitary acute and exacerbated chronic peptic ulcers were more common in the duodenum. Complications of PGDU developed in 40% of cases, mostly in the form of hemorrhage; in 20% of cases PGDU have contributed to death. Medicolegal aspects of PGDU are, most frequently, concerned with the causal relationship between trauma, PGDU, and fatal outcome, as well as the potential for allegations of medical negligence. © 2009 American Academy of Forensic Sciences.

It is generally accepted that victims of sexual assault sustain bodily injury. This study's objective was to determine specific characteristics and severity of injuries among victims of sexual violence in Belgrade. Retrospectively, we analyzed a subgroup of victims of sexual violence that was legally processed over a five-year period. We evaluated 113 cases of sexual crimes selected from the District Court of Belgrade in order to analyze the medical records. All victims were female, at average 24.1 years old (range 5-80 years). In more than half of the cases (52%) evaluated, a medical examination was completed on the day of assault, while 84% took place within 72 hours post-assault. Due to delayed referral, body examination was not conducted on 12 victims (10.6%). We noted one or more extra-genital injuries in 64 victims (63.4%), no injuries in 36 victims (35.6%), whereas for one victim the medical records were inconclusive. Injuries, predominantly bruises, were located on limbs (32%), face (23%), and torso (7%). Abrasions and contusions were less frequently present, while two victims sustained lacerations. The Clinical Injury Extent Score was used to rate the physical severity of the assault. The majority of victims (44%) sustained light injuries, 18% were moderate, while one victim had severe injuries. © 2006 Elsevier Ltd and AFP.

It is generally accepted that victims of sexual assault sustain bodily injury. This study's objective was to determine specific characteristics and severity of injuries among victims of sexual violence in Belgrade. Retrospectively, we analyzed a subgroup of victims of sexual violence that was legally processed over a five-year period. We evaluated 113 cases of sexual crimes selected from the District Court of Belgrade in order to analyze the medical records. All victims were female, at average 24.1 years old (range 5-80 years). In more than half of the cases (52%) evaluated, a medical examination was completed on the day of assault, while 84% took place within 72 hours post-assault. Due to delayed referral, body examination was not conducted on 12 victims (10.6%). We noted one or more extra-genital injuries in 64 victims (63.4%), no injuries in 36 victims (35.6%), whereas for one victim the medical records were inconclusive. Injuries, predominantly bruises, were located on limbs (32%), face (23%), and torso (7%). Abrasions and contusions were less frequently present, while two victims sustained lacerations. The Clinical Injury Extent Score was used to rate the physical severity of the assault. The majority of victims (44%) sustained light injuries, 18% were moderate, while one victim had severe injuries. © 2006 Elsevier Ltd and AFP.