Browsing by Author "Dučić, Siniša (22950480700)"

Purpose: The incidence of developmental dysplasia of the hip (DDH) is higher in Eastern Europeans and Middle Easterners. This study aimed to establish consensus among experts in this geographical area on the management of DDH before walking age. Methods: Fourteen experienced orthopedic surgeons agreed to participate in a four-round online consensus panel by the Delphi method. The questionnaire included 31 statements concerning the prevention, diagnosis, and treatment of DDH before walking age. Results: Consensus was established for 26 (84%) of 31 statements. Hip ultrasonography is the proper diagnostic tool under six months in DDH; universal newborn hip screening between three and six weeks is necessary; positive family history, breech presentation, female gender, and postnatal swaddling are the most important risk factors; Ortolani, Barlow tests, and limitation of abduction are the most important clinical findings; Pavlik harness is the first bracing preference; some Graf type IIa hips and all Graf type IIb and worse hips need abduction bracing treatment; the uppermost age limit for closed and open reductions is 12 months and 12–24 months, respectively; anatomic reduction is essential in closed and open reductions, postoperative MRI or CT is not always indicated; anterior approach open reduction is better than medial approach open reduction; forceful reduction and extreme positioning of the hips (> 60° hip abduction) are the two significant risk factors for osteonecrosis of the femoral head. Conclusion: The findings of the present study may be useful for clinicians because a practical reference, based on the opinions of the multinational expert panel, but may not be applicable to all settings is provided. © The Author(s) under exclusive licence to SICOT aisbl 2023.

Introduction Intraventricular hemorrhage occurs in almost one fifth of prematurely born children. Due to present complications, such as hydrocephalus and neurological deficit, it endangers the child's life, therefore there is the need for understanding and prevent risk factors as well as the need for finding most optimal methods of treatment. Objective The aim of the study was to point out the current therapeutic modalities of the treatment of posthemorrhagic hydrocephalus in prematurely born children. Methods The study included 60 patients divided into two groups of 30 patients treated at the University Children's Hospital of Belgrade in the period 2003-2008. Results Treatment outcome of the control group of patients treated by standard methods was influenced by gestational age (p=0.024), head circumference on birth (p=0.043), body mass on birth (p=0.006), Apgar score on birth (p<0.001), peripartum asphyxia (p<0.001), cardiorespiratory arrest (p<0.001), respiratory distress (p=0.002) and intraventricular hemorrhagic grade (p<0.001). As statistically significant predictors of the poor treatment outcome of the experimental group of patients treated by using Ommaya reservoir were identified: low body mass on birth (p<0.05), low Apgar score (p<0.05), prolonged number of days on assisted ventilation (p<0.05), presence of peripartum asphyxia (p<0.05) and cardiorespiratory arrest (p<0.05). Conclusion No statistically significant difference was detected in the outcome between the patients treated by the standard method and those with installed Ommaya reservoir. However, the difference of 10% in mortality between the two groups may be clinically significant so that further studies of larger samples are necessary.

Introduction/Objective Benign transient hyperphosphatasemia (BTH) is a pathogenetic insufficiently clear clinical entity that is mostly seen in infants and young children. The objective of this paper is to present our experience regarding the age of occurrence, the conditions of the discovery, and the length of duration of BTH in children. Methods The study was realized on a sample of 18 children, nine boys and nine girls, aged 10–42 (21.06 ± 9.35) months with BTH. The diagnosis of BTH is based on the absence of bone and hepatobiliary diseases, and its spontaneous disappearance over the course of several months. Results One patient was in the first year, 13 in the second, three in the third, and one in the fourth. Isolated high activity of serum alkaline phosphatase, which was 2.04–21.9 (8.05 ± 5.31) times above the upper reference value for the corresponding age, in 14 cases it was found during the acute diarrhea, and in four with acute rhinopharyngitis, of which in two complicated with otitis media. The cause of diarrhea in six cases was rotavirus, in two Campylobacter, and in one adenovirus, and otitis media in one case was caused by Streptococcus pneumoniae, while in others, etiologic factors of infection were not identified. Spontaneous normalization of serum alkaline phosphatase activity was recorded between one and three months after the onset. Conclusion BTH is a harmless biochemical disorder that spontaneously subsides within three months after initial observation. It is found randomly as a routine laboratory finding most often within the treatment of acute gastrointestinal and respiratory infections. © 2020, Serbia Medical Society. All rights reserved.

Celiac disease is a multisystemic autoimmune disease induced by gluten in wheat, rye, and barley. It is characterized by polygenic predisposition, prevailing prevalence in members of the white population (1%), especially in close relatives (5–15%), very heterogeneous expression and frequent association with other autoimmune diseases (3–10%), as well as selective deficiency of IgA and Down, Turner, and Williams syndromes. The basis of the disease and the key finding in its diagnostics is gluten-sensitive enteropathy, i.e., non-specific inflammation of the small intestinal mucosa which resolves by gluten-free diet. In addition to enteropathy, whether symptomatic or asymptomatic, the disease is also characterized by various extraintestinal manifestations, and even very serious complications. Therapy is based on a lifelong gluten-free diet, so that the disorder, if diagnosed in time and treated consistently, has an excellent prognosis. © 2023, Serbia Medical Society. All rights reserved.

Introduction Natural course of aneurysms that occur on blood vessels of the brain singles out the need for understanding the mechanism of the occurrence of aneurysm wall rupture and identification of anatomic characteristics as predictive factors for hemorrhage to occur. Objective In this study we comparatively present results of our researches and experimental models on animals. Methods We made a comparative analysis of anatomical characteristics of blood vessels of the brain and aneurysms obtained on the basis of digital subtraction angiography and intraoperative finding. In this article we review recent research in the anatomic characteristics of intracranial aneurysms and parent blood vessels. We present a series of 185 aneurysms (ruptured and unruptured) dissected at the Neurosurgical Clinic of Clinical Center of Serbia in Belgrade. Results Inclination angle may be considered as the vital predesposing factor for intracranial aneurysm rupture. In aneurysms that ruptured it was 139.748±27.242°, while in unruptured aneurysms it was considerably smaller and amounted to 100.882±22.001° (p<0.01). Conclusion Inclination angle may be regarded as the vital predisposing factor since it differs considerably in unruptured and ruptured aneurysms. Aneurysms with blood stream angle smaller than 115° have very small probability of rupture, while blood stream angle bigger than 150° presents a high risk of rupture.

Treating complicated wounds in the pediatric population using traditional wet to moist wound dressing methods is not always appropriate due to the frequent need to change dressings daily or even a number of times a day, causing distress to the patient. Topical negative pressure is a method that allows for fewer dressings and provides localized benefits, thus accelerating wound healing. The merits of this therapy have been proven in studies on adults, but research on the pediatric population is scarce. Here we intend to present the results of negative pressure wound therapy (NPWT) on 34 pediatric patients (study group) and compare them with 24 patients (control group) treated with the traditional wet to moist dressing for complicated wounds. The results show that topical negative pressure wound therapy is a safe method that downgrades a wound from a complicated to a simple one and allows definitive coverage using a simpler technique with fewer wound dressings. The scars of the patients in the study group exhibited a better result on a visual scar scale. The patients in the control group had a shorter hospital stay. Based on the recorded results, we were able to make treatment recommendations. © 2023 by the authors.

Aim: This study aimed to improve osteosarcoma chemoresponsiveness prediction by optimization of computational analysis of MRIs. Patients & methods: Our retrospective predictive model involved osteosarcoma patients with MRI scans performed before OsteoSa MAP neoadjuvant cytotoxic chemotherapy. Results: We found that several monofractal and multifractal algorithms were able to classify tumors according to their chemoresponsiveness. The predictive clues were defined as morphological complexity, homogeneity and fractality. The monofractal feature CV for Λ(G) provided the best predictive association (area under the ROC curve = 0.88; p <0.001), followed by Y-axis intersection of the regression line for box fractal dimension, r² for FDM and tumor circularity. Conclusion: This is the first full-scale study to indicate that computational analysis of pretreatment MRIs could provide imaging biomarkers for the classification of osteosarcoma according to their chemoresponsiveness. © 2021 Future Medicine Ltd.. All rights reserved.

Aim: This study aimed to improve osteosarcoma chemoresponsiveness prediction by optimization of computational analysis of MRIs. Patients & methods: Our retrospective predictive model involved osteosarcoma patients with MRI scans performed before OsteoSa MAP neoadjuvant cytotoxic chemotherapy. Results: We found that several monofractal and multifractal algorithms were able to classify tumors according to their chemoresponsiveness. The predictive clues were defined as morphological complexity, homogeneity and fractality. The monofractal feature CV for Λ(G) provided the best predictive association (area under the ROC curve = 0.88; p <0.001), followed by Y-axis intersection of the regression line for box fractal dimension, r² for FDM and tumor circularity. Conclusion: This is the first full-scale study to indicate that computational analysis of pretreatment MRIs could provide imaging biomarkers for the classification of osteosarcoma according to their chemoresponsiveness. © 2021 Future Medicine Ltd.. All rights reserved.

Introduction Closed reduction and percutaneous pinning are the most widely used treatment options for displaced supracondylar humerus fractures in children, but there is still no consensus concerning the most preferred technique in injuries of the extension type. Objective The aim of this study was to compare three common orthopaedic procedures in the treatment of displaced extension type supracondylar humerus fractures in children. Methods Total of 93 consecutive patients (66 boys and 27 girls) referred to our hospital with Gartland type II or III extension supracondylar humeral fractures were prospectively included in the study over a six-year period. At initial presentation 48 patients were classified as Gartland type II and 45 as Gartland type III fractures. The patients were subdivided into three groups based on the following treatment modality: closed reduction with percutaneous pinning, open reduction with Kirschner wires (K-wires) fixation, and closed reduction with cast immobilisation. The treatment outcome and clinical characteristics were compared among groups, as well as evaluated using Flynn’s criteria. Results Excellent clinical outcome was reported in 70.3% of patients treated with closed reduction with percutaneous pinning and in 64.7% of patients treated with open reduction with K-wire fixation. The outcome was significantly worse in children treated with closed reduction and cast immobilisation alone, as excellent outcome is achieved in just 36.4% of cases (p=0.011). Conclusion Closed reduction with percutaneous pinning is the method of choice in the treatment of displaced pediatric supracondylar humeral fracture, while open reduction with K-wire fixation is as a good alternative in cases with clear indications. © 2016, Serbia Medical Society. All rights reserved.

Introduction/Objective Anemia is the most common extraintestinal manifestation of celiac disease (CD) in children. The aim of this study was to determine the frequency, severity and type of anemia in children with a classical CD, as well as the differences between anemic and non-anemic patients in their age, duration of illness, percentile body length or height, percentage of body weight (BW) deviation compared to ideal, and the degree of damage to the small intestine mucosa. Methods The study was based on a sample of 90 children, 56 females and 34 males, ages 7-90 (18.23 ± 12.7) months with classical CD. The diagnosis of CD is based on the ESPGHAN criteria from 1990 and 2012, and of anemia on the 2011 WHO reference values. Results Anemia was found in 47 (52.22%) patients, of which it was mild in 23 cases [hemoglobin (Hb) 100-109 g/L] and moderately severe in 24 (Hb 70-99 g/L), in 34 (72.34%) it was microcytic [mean cell volume (MCV) < 70 fl] and normocytic (MCV 70-87 fl) in 13 patients. Low serum iron levels (< 10.7 µmol/L) were found in 68 (75.56%), and hypoferritinemia (< 16 ng/ml) in 77 (85.56%) patients. Except for a greater deficit of BW in patients with anemia compared to those without anemia (-14.64 ± 9.60 vs. -8.56 ± 11.87%, p < 0.01), differences in other defined features were not significant. Conclusion Mild or moderate iron deficiency anemia occurs in slightly more than half of children with a classical type CD. In anemic compared to non-anemic patients, there is a significantly higher BW deficit, while differences in other characteristics typical for this type of disease are not significant. © 2019 Serbia Medical Society. All rights reserved.

Introduction/Objective Gilbert syndrome (GS) is the most common hereditary hyperbilirubinemia. As well as mild unconjugated hyperbilirubinemia, it is characterized by the excess of bilirubin monoglucuro-nide over diglucuronide in the bile and thus increases the risk of biliary calculosis. The aim of the study was to determine the importance of GS as a risk factor in the development of cholelithiasis in children. Methods The study included a sample of 31 children (14 male and 17 female, mean age 12.16 ± 4.11 years, range 3–16.75 years) with symptomatic cholelithiasis. The diagnosis of cholelithiasis was based on an ultrasonographic finding, and for GS the diagnosis was based on at least a double increase of unconjugated bilirubin fraction after a three-day hypocaloric diet (400 kcal per day). Results GS was confirmed in five or 16.13% of patients (three male and two female, mean age 14.71 ± 0.55 years, range 14–15.3 years). In addition to GS, in the history of the disease they all had some of the additional risk factors for the development of cholelithiasis. One of them had an identical problem as its mother, one had hereditary elliptocytosis, one had sudden weight loss, one was overweight, and one had premature birth and sepsis. Conclusion GS registers in one-sixth of children with cholelithiasis, but in none of them as the only risk factor for developing this disease. This finding suggests that GS is a risk factor for the development of cholelithiasis, but not sufficient in itself in that respect. © 2023, Serbia Medical Society. All rights reserved.

Introduction/Objective The classic type of celiac disease (CD) is most common in children under two years of age. The aim of this study was to investigate whether breastfeeding, particularly breastfeeding during gluten introduction, and timing of gluten introduction, influence the onset of CD at this age. Methods We retrospectively analyzed medical records of 93 children, 40 in the first and 53 in the second year, with a classic CD diagnosed at the University Children’s Hospital, Belgrade between 2000 and 2010. The diagnosis of CD was based on the criteria of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) from 1989. Results Duration of breastfeeding reduced the onset of the CD in the first year p = 0.039 (OR = 1.43 95% CI 1.019–1.899). Also, breastfeeding at the time of gluten introduction significantly delayed the age at diagnosis (F = 1.671, t = 2.39, p = 0.029). The timing of gluten introduction did not affect the age of occurrence of CD in these group of children. Conclusion Longer breastfeeding, and breastfeeding at the time of gluten introduction, postponed the onset of classic CD in patients up to two years. The association between the occurrence of CD and the time of introduction of gluten in this age group of patients has not been established. © 2019, Serbia Medical Society. All rights reserved.

Intolerance of gluten containing cereals (wheat, rye, and barley) is an etiopathogenetically heterogeneous and relatively common problem of modern man. It occurs as an adverse immune-mediated condition in genetically predisposed individuals. According to the pathogenetic mechanism of intolerance to the components of these cereals, it is classified into celiac disease as an autoimmune disease, wheat allergy as an allergic disease, and non-celiac gluten sensitivity as a non-autoimmune and non-allergic disease. Each of these disorders is characterized by specific intestinal and/or extraintestinal manifestations, which resolve on a gluten-free diet. This review article presents the basic characteristics of these disorders in accordance with modern knowledge. © 2024, Serbia Medical Society. All rights reserved.

Introduction Isolated dislocation of the pisiform bone is a very rare condition due to robust ligamentous attachments that stabilize the pisiform to the carpus. This type of injury is usually a result of direct trauma to the ulnar and volar aspect of the wrist. Case outline We present an isolated dislocation of the pisiform, with no other carpal bone injuries, treated successfully with closed reduction. Diagnosis was based on clinical findings, plain radiographs, and computer tomography examination of the wrist. Elongation and partial rupture of the pisometacarpal ligament was found on magnetic resonance imaging. Conclusion Fracture and dislocation of the pisiform is an extremely rare injury in children, which could be easily neglected or misdiagnosed. Closed reduction with plaster cast immobilization should always be considered as the first method of treatment in the pediatric population, since the conservative approach provides excellent results. © 2019 Serbia Medical Society. All rights reserved.

Introduction/Objective Isolated hypertransaminasemia (IHTS) is a common, benign, and transient appearance in patients with celiac disease (CD). The aim of this study is to determine the frequency of IHTS in children up to two years old with clinically classical CD, as well as its connection with the onset of the first symptoms of the disease, the age of diagnosis, the clinical and laboratory nutritional parameters, and the degree of damage of small intestinal mucosa. Methods The study was based on a sample of 82 children, 55 female and 27 male, ages 7-24 (14.28 ± 4.41) months. The diagnosis of CD was based on the revised ESPGHAN criteria and the activity of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) by standard laboratory methods. Results IHTS was found in 39 (47.56%) patients, 27 of whom (69.23%) had elevated levels of both transaminases and 12 of only one - eight of AST and four of ALT. The increase in relation to the aforementioned reference value for ALT was 1.1-10.08 (1.67 ± 1.73), and for AST it was 1.08-7.91 (1.56 ± 1.29) times. In patients with IHTS compared to those with normal transaminasemia, the age of onset of CD was significantly lower (9.83 ± 3.69 vs. 12.95 ± 4.43 months, p = 0.001), as well as the age of diagnosis (12.97 ± 3.88 vs. 15.47 ±4.56 months; p = 0.01), while the differences in the other observed parameters were not significant. Conclusions IHTS occurs in almost half of children up to two years old with classical CD. Hypertransaminasemia is in most cases mild and significantly more frequent in patients with earlier clinical expression of the CD. © 2019, Serbia Medical Society. All rights reserved.

Introduction/Objective Celiac disease (CD) is the result of a polygenic predisposition and gluten-con-taining diet. The aim of this study was to determine the prevalence and clinical forms of CD in siblings of children with verified disease. Methods The study included 83 siblings, aged 1.5–27 (11.77 ± 6.2) years, of 64 children with CD diagnosed according to ESPGHAN criteria (1990/2012). In addition to a detailed history and clinical examination, serum levels of IgA and antibodies to tissue transglutaminase (AtTG) IgA and IgG classes were determined in all subjects. All with elevated AtTG levels underwent multiple duodenal enterobiopsy. The diagnosis of CD was confirmed by the finding of characteristic histological changes. Results The diagnosis of CB was made in 13 of 83 subjects (15.67%). Nine of them had an asymptomatic form of the disease, while in the others the disease was clinically manifested – in three the form was classical, in one it was accompanied by severe malnutrition (-26.80%), and in one the manifestation was nonclassical (only short stature). Except for sideropenia and hypoferritinemia in four patients, of which two with hemoglobin below the reference value, standard laboratory findings were within normal limits. Conclusion Our research shows that the prevalence of CD in siblings of children with verified disease is 15.67%. It is mostly detected in its asymptomatic form. In accordance with this, routine application of serological screening for CD in this population group is necessary for its timely diagnosis and treatment. © 2023, Serbia Medical Society. All rights reserved.

Introduction Pseudoachondroplasia (PSACH) is an autosomal dominant osteochondrodysplasia due to mutations in the gene encoding cartilage oligomeric matrix protein. It is characterized by rhizomelic dwarfism, limb and vertebral deformity, joint laxity and early onset osteoarthrosis. We present the girl with the early expressed and severe PSACH born to clinically and radiographically unaffected parents. Case Outline A 6.5-year-old girl presented with short-limbed dwarfism (body height 79.5 cm,

Introduction Recurrent aphthous stomatitis (RAS) is a relatively common oral mucosal lesion of unclear etiology. It occurs in otherwise healthy people, but also in various infectious and non-infectious diseases, including celiac disease (CD). We present an obese adolescent with RAS as the only clinical sign of CD. Case outline An adolescent aged 15 2/12 years come with very pronounced RAS in previous five months. He had no other difficulties. The patient was obese from the age of 12. Other data were without peculiarities. On admission he was 165 cm tall (P25), obese (BMI 27 kg/m2), in the final stage of puberty, with stretch marks in the distal areas of the abdomen, thighs and gluteus and very pronounced pain-sensitive aphthae in the buccal and labial mucosa accompanied by swelling of the lips and perioral region. Except for lower serum iron levels (8 μmol/l), routine laboratory blood tests were within the reference range. The serological test for CD was positive (antibodies to tissue transglutaminase IgA 78.5 U/ml, anti-endomysial antibodies IgA positive). Endoscopy revealed reflux esophagitis, without any other pathological findings. Stereomicroscopic and pathohistological analysis of the duodenal mucosa samples showed mild destructive enteropathy (Marsh IIIa). Pathohistological examination of the gastric mucosa revealed grade I-II lymphocytic gastritis. The urease test for Helicobacter pylori was negative. A gluten-free diet resulted in the withdrawal of aphthous stomatitis and no recurrence later. Conclusion Within the differential diagnostic analysis of the RAS causes, CD should also be considered. Additionally, obesity does not exclude the presence of CD. © 2020, Serbia Medical Society. All rights reserved.

Introduction Guillain–Barre syndrome (GBS) is the most common cause of acute flaccid paralysis in healthy infants and children. Acute motor axonal neuropathy (AMAN) is a type of GBS characterized by motor syndrome with no sensory symptoms. Case outline Authors describe a six-and-a-half year old girl with atypical clinical presentation of AMAN with severe painful lower limbs and refusal of the leg reliance with typical findings on nerves conduction studies. Conclusion Despite the nerve conduction study findings, atypical forms of AMAN and GBS are possible. Pain symptoms must be taken very seriously and treated careful by the clinicians. © 2019, Serbia Medical Society. All rights reserved.

Introduction/Objective Child abuse is a significant public health problem in modern society. Many cases of violence against children remain undetected. Serbia has no official protocols for medical examination of abused children. The aim of the study is an analysis of the social, clinical and radiological characteristics of physical abuse of children under three years of age that required hospital treatment. Methods This retrospective study included 98 physically injured children admitted to the University Children’s Hospital in the period from 2013 to 2015, with suspected physical abuse. In addition to the history of injuries, complete clinical examinations and standard laboratory analyses were performed in all children, as well as X-ray examination in children with apparent or suspected skeletal injury. Ultrasound examination and computerized tomography or magnetic resonance imaging were performed in selected patients. Final diagnosis of abuse was established by multidisciplinary assessment team. The children were divided into two groups - those with proven and those with suspected abuse. Results Most of 98 children who were suspected of being abused (92%) were from one or both unemployed parents, 68% were male, 60% were first-born, and 44% younger than one year. Ninety-two percent of the children had skeletal fractures, 19% of whom had two or more fractures. The commonest fracture was a linear skull fracture, which was detected in 51% of the cases. Abuse was confirmed in only five of 98 suspected cases. Conclusion Among the known social risk factors for abuse of children, the low economic status of the family was the most frequent one in our analyzed sample. The most common injury is a linear skull fracture. A national guideline for medical investigating of abused children is required. © 2017, Serbia Medical Society. All rights reserved.