Browsing by Author "Erceg, Predrag (18133470500)"

Introduction/Objective The aim of this study is to identify and evaluate the use of New Mobility Score (NMS) in estimating functional recovery three months after total hip arthroplasty (THA). Methods In total, 70 patients, aged > 60 years, underwent THA. Treatment group was subjected to the comprehensive rehabilitation program and control group to the standard one. Primary outcome was assessed with Harris Hip Score (HHS) and NMS, and secondary one by Medical Outcomes Health Survey (Short-Form Health Survey – SF-36). Questionnaires were collected before and three months after hip surgery. Results Treatment group showed significant improvement three months postoperatively. The correlation in both groups between HHS and NMS was very strong (r > 0.700). Treatment group following surgery showed strong correlation between Recovery through Personal Care Services (PCS) and HHS and NMS (r > 0.700), moderate to strong between pain categories and HHS (r = 0.380; r = 0.583) and NMS (r = 0.424). Control group showed strong correlation between PCS and HHS (r = 0.704), and NMS (r = 0.568) and moderate to pain categories and HHS (r = 0.546; r = 0.466). The area under the curve (AUC) described the inherent validity of all measurement used AUCNMS = 0.724, p = 0.001, AUCHHS = 0.788, p = 0.000 and AUCPCS = 0.747, p = 0.001. Conclusion The NMS could be successfully used in routine clinical assessment of elderly patients following THA. The trial is registered in ISRCTN Register with https://doi.org/10.1186/ISRCTN73197506. © 2022, Serbia Medical Society. All rights reserved.

Small intestine mucosa is often affected with malabsorptive, autoimmune and inflammatory pathological processes. However, morphometric data on the healthy human small intestine mucosa, especially ileum, are scarce. We aimed to obtain histoquantitative data on the healthy jejunal and ileal mucosa and assess the effects of gender and ageing on these parameters. Computer-aided morphometric analysis was performed on 24 jejunal and 25 ileal biopsy samples collected upon routine endoscopy screening of healthy persons with a family history of intestinal malignancy. Subjects were distributed in four groups according to age and sex: adult (<60 years) and elderly (>60 years) males, and adult (<60 years) and elderly (>60 years) females. Results were statistically analyzed with Mann-Whitney U test. Jejunal mucosal thickness was significantly reduced in elderly subjects (p<0.05), especially in elderly females compared to adult ones (p<0.05). Jejunal villi were significantly wider in adult than in the elderly subjects (p<0.05), whereas ileal villi were significantly wider in elderly compared to adult subjects (p<0.01) and in male compared to female subjects (p<0.05). No statistically significant differences were found in other histoquantitative parameters (mucosa epithelium height, crypt numerical density, villous height, crypts and villous perimeter, diameter and epithelium height) of jejunal and ileal mucosa. This study provides complete morphometric data on the healthy human jejunum and the first relevant data on the healthy ileal mucosa, thus representing a valuable morphometric reference for future histoquantitative studies of human small bowel mucosa in both healthy and disease affected individuals.

In the past couple of centuries, scientists proposed great number of aging theories but neither of them appears to be fully satisfactory. In the statistical sense, we are dealing with an even greater challenge because large array of factors affects the aging process. Although at this point the most of these factors are well known, it is the very fact of their innumerability that complicates approaches to the issue at hand. Both in life and in medicine, the cause behind an effect can rarely be unequivocally determined. Thus, it appears that through out human history longevity has been primarily affected by eradication of diseases, especially by eradication of infectious diseases and introduction of the vaccines. For that reason, maybe we should not be referring to this issue as the «fountain of youth» but rather as the «vaccine of youth». The postulate that genetic instability is the precipitating factor both of aging and cancer has withstood many tests and keeps on being reaffirmed. For this reason, it is legitimate to pose a question of whether long-lived individuals may be those with «selfish» genes and more stable genetic material. They certainly cannot avoid aging, but aging in such individuals could be delayed due to steady character of their genome, which is less susceptible to mutations. On the population level, they constitute minority because stable genome would represent an obstacle to successful evolution of the species. If this was not the case, we might not be writing all these texts today.

In the past couple of centuries, scientists proposed great number of aging theories but neither of them appears to be fully satisfactory. In the statistical sense, we are dealing with an even greater challenge because large array of factors affects the aging process. Although at this point the most of these factors are well known, it is the very fact of their innumerability that complicates approaches to the issue at hand. Both in life and in medicine, the cause behind an effect can rarely be unequivocally determined. Thus, it appears that through out human history longevity has been primarily affected by eradication of diseases, especially by eradication of infectious diseases and introduction of the vaccines. For that reason, maybe we should not be referring to this issue as the «fountain of youth» but rather as the «vaccine of youth». The postulate that genetic instability is the precipitating factor both of aging and cancer has withstood many tests and keeps on being reaffirmed. For this reason, it is legitimate to pose a question of whether long-lived individuals may be those with «selfish» genes and more stable genetic material. They certainly cannot avoid aging, but aging in such individuals could be delayed due to steady character of their genome, which is less susceptible to mutations. On the population level, they constitute minority because stable genome would represent an obstacle to successful evolution of the species. If this was not the case, we might not be writing all these texts today.

Introduction/Objective The aim of this study was to analyze the usefulness and accuracy of artificial neural networks in the prognosis of infarcted patients with previous myocardial surgical revascularization. Methods The 13 predictor variables per patient were defined as a data set. All the patients were divided into two groups randomly: the training group and the test group, of 1090 patients each. The evaluation of the neural network performance was organized by using the original data, as well as the complementary test data, containing patient data not used for training the network. In generating the file of comparative results, the program compared the actual outcome for each patient with the predicted one. Results All the results were compared with 2 × 2 contingency table constructed from sensitivity, specificity, accuracy, and positive–negative prediction. The network was able to predict the outcome with the accuracy of 96.2%, sensitivity of 78.4%, specificity of 100%, positive predictivity of 100%, and negative predictivity of 96%. There was not efficient prognosis of infarcted patients previously operated on using linear discriminant analysis (accuracy 68.3%, sensitivity 66.4%, and positive predictivity 30.2%). Conclusion This study suggest that a neural network was better for almost all parameters in outcome prognosis of infarcted patients with previous myocardial surgical revascularization. © 2021, Serbia Medical Society. All rights reserved.

Background: We investigated the traditional and new bio- markers as predictors of cardiovascular mortality in the func- tionally disabled elderly who are living in a community. Methods: This prospective study included 253 participants (78.3% women) aged 65 and over who were monitored for 32 months. Receiver operating curve analysis and the Cox proportional hazard model were used to identify univariate and multivariate predictors of cardiovascular mortality. The Kaplan-Meier survival curve and Log rank test were used for survival analysis. Results: During the study, 43.1% participants died from car- diovascular diseases. Cutoff points of multivariate predictors were used to build a score system. The risk score was positive in patients with three or more of the following predictors: albumin <40 g/L, body mass index <25 kg/m2, total serum bilirubin <10.5 (imol/L, blood urea nitrogen >6.5 mmol/L and high-sensitivity C-reactive protein >2.25 mg/L. The rel- ative risk for cardiovascular mortality for someone with a positive vs. negative score was 3.91 (95% Cl: 2.55-5.98; P< 0.001). There was no change in risk after adjustment for age; sex, traditional cardiovascular risk factors, comorbidities and a number of disabilities. Conclusions: Presence of lo* grade inflammation, malnulri tion and early signs of renal dy sfunction are essential for car- diovascular risk among the functional disabled elderly and may be assessed using the proposed new inflammatory m3lnuhffion-renal involved score (1MRIS).

Background: We investigated the traditional and new bio- markers as predictors of cardiovascular mortality in the func- tionally disabled elderly who are living in a community. Methods: This prospective study included 253 participants (78.3% women) aged 65 and over who were monitored for 32 months. Receiver operating curve analysis and the Cox proportional hazard model were used to identify univariate and multivariate predictors of cardiovascular mortality. The Kaplan-Meier survival curve and Log rank test were used for survival analysis. Results: During the study, 43.1% participants died from car- diovascular diseases. Cutoff points of multivariate predictors were used to build a score system. The risk score was positive in patients with three or more of the following predictors: albumin <40 g/L, body mass index <25 kg/m2, total serum bilirubin <10.5 (imol/L, blood urea nitrogen >6.5 mmol/L and high-sensitivity C-reactive protein >2.25 mg/L. The rel- ative risk for cardiovascular mortality for someone with a positive vs. negative score was 3.91 (95% Cl: 2.55-5.98; P< 0.001). There was no change in risk after adjustment for age; sex, traditional cardiovascular risk factors, comorbidities and a number of disabilities. Conclusions: Presence of lo* grade inflammation, malnulri tion and early signs of renal dy sfunction are essential for car- diovascular risk among the functional disabled elderly and may be assessed using the proposed new inflammatory m3lnuhffion-renal involved score (1MRIS).

Purpose: Previous research has shown that poor health-related quality of life (HRQOL) is associated with adverse long-term prognosis in patients with heart failure (HF); however, there have been inconsistencies among studies and not all of them confirmed the prognostic value of HRQOL. In addition, few studies involved elderly patients and most focused on all-cause mortality and HF-related hospitalization as outcomes. The aim of our study was to determine whether HRQOL is a predictor and an independent predictor of long-term cardiac mortality, all-cause mortality, and HF-related rehospitalization in elderly patients hospitalized with HF. Patients and methods: This prospective observational study included 200 elderly patients hospitalized with HF in Serbia. HRQOL was measured using the Minnesota Living with Heart Failure questionnaire (MLHFQ). The median follow-up period was 28 months. The primary outcome was cardiac mortality, and all-cause mortality and HF-related rehospitalization were secondary outcomes. Survival analysis was conducted using the Kaplan–Meier method and Cox-proportional hazards regression. Results: Subjects with poor HRQOL (higher than the median MLHFQ score) had a higher probability of cardiac mortality (P=0.029) and HF-related rehospitalization (P=0.001) during long-term follow-up. Poor HRQOL was an independent predictor of cardiac mortality (HR: 2.051, 95% CI: 1.260–3.339, P=0.004), all-cause mortality (HR: 1.620, 95% CI: 1.076–2.438, P=0.021), and HF-related rehospitalization (HR: 2.040, 95% CI: 1.290–3.227, P=0.002). Conclusion: HRQOL is an independent predictor of long-term cardiac mortality in elderly patients hospitalized with HF. It also independently predicts all-cause mortality and HF-related rehospitalization. HRQOL could be used as a complementary clinical predictive tool in this patient population. © 2019 Erceg et al.

Purpose: To present an insight of the situation of geriatric medicine in Balkan countries, as it was presented in the context of the 2nd pre-congress seminar of the 16th European Geriatric Medicine Society (EuGMS) Congress Athens 2021. Methods: Representatives from 8 Balkan countries (Albania, Croatia, Greece, Republic of North Macedonia, Romania, Serbia, Slovenia, Turkey) answered 3 questions to reflect the state of geriatric medicine in their country: education on geriatrics; systems/methods for assessment of functional status and frailty; pre-operative risk assessment. An open discussion followed. Results: Undergraduate education in geriatric medicine seems underestimated in medical faculties of Balkan countries, whereas a high heterogeneity is observed at a post-graduate level. Only a few Balkan countries have geriatric medicine as a recognized medical specialty or subspecialty. Functional status and frailty are only sporadically assessed, and pre-operative risk assessment is very rarely performed with a geriatric focus. Scarcity of expertise and structures relevant to geriatric medicine seems to be common. Developing a training curriculum and geriatrics-related structures are two interconnected aspects. Cooperation among physicians and multidisciplinary teams are essential for the practice of geriatric medicine. A functional geriatric network is eventually necessary and ambulatory geriatric expertise is probably a feasible and clinically relevant starting point. Providing pragmatic solutions to the pressing challenges in variable clinical settings, supplementing and working in harmony with existing components of each health system, is probably the most convincing strategy to gain political support in developing geriatric medicine. Conclusion: Balkan countries share common experiences and challenges in developing geriatrics. Whilst the principles of geriatric medicine are perhaps universal, proposed solutions should be adapted to each country’s specific circumstances. Cooperation of the Balkan countries could promote in each the development of geriatric medicine. EuGMS is willing to foster relevant actions. © 2020, European Geriatric Medicine Society.

Purpose: To present an insight of the situation of geriatric medicine in Balkan countries, as it was presented in the context of the 2nd pre-congress seminar of the 16th European Geriatric Medicine Society (EuGMS) Congress Athens 2021. Methods: Representatives from 8 Balkan countries (Albania, Croatia, Greece, Republic of North Macedonia, Romania, Serbia, Slovenia, Turkey) answered 3 questions to reflect the state of geriatric medicine in their country: education on geriatrics; systems/methods for assessment of functional status and frailty; pre-operative risk assessment. An open discussion followed. Results: Undergraduate education in geriatric medicine seems underestimated in medical faculties of Balkan countries, whereas a high heterogeneity is observed at a post-graduate level. Only a few Balkan countries have geriatric medicine as a recognized medical specialty or subspecialty. Functional status and frailty are only sporadically assessed, and pre-operative risk assessment is very rarely performed with a geriatric focus. Scarcity of expertise and structures relevant to geriatric medicine seems to be common. Developing a training curriculum and geriatrics-related structures are two interconnected aspects. Cooperation among physicians and multidisciplinary teams are essential for the practice of geriatric medicine. A functional geriatric network is eventually necessary and ambulatory geriatric expertise is probably a feasible and clinically relevant starting point. Providing pragmatic solutions to the pressing challenges in variable clinical settings, supplementing and working in harmony with existing components of each health system, is probably the most convincing strategy to gain political support in developing geriatric medicine. Conclusion: Balkan countries share common experiences and challenges in developing geriatrics. Whilst the principles of geriatric medicine are perhaps universal, proposed solutions should be adapted to each country’s specific circumstances. Cooperation of the Balkan countries could promote in each the development of geriatric medicine. EuGMS is willing to foster relevant actions. © 2020, European Geriatric Medicine Society.

Objective: Long QT syndrome (LQTS) poses a significant risk of torsade de pointes, particularly in older patients due to agerelated changes in cardiac repolarization and increased susceptibility to medication-induced QTc interval prolongation. Despite the increased risk, data on medication-related LQTS remain limited, leading to this study on its prevalence, characteristics, and risk factors, along with QT-prolonging drug use in older patients. The study aimed to identify clinical and medication-related predictors of LQTS and evaluate the burden of co-prescribed QT-prolonging medications in this population. Subjects and Methods: This prospective study at a tertiary care hospital included initial and follow-up ECGs, with medication details were collected. Statistical analyses compared variables, including QTc intervals and medication use, between patients with and without LQTS. Results: The study included 128 adults aged 65 or older, with 27.3% presenting LQTS on admission, increasing to 42.2% after 7 days of hospitalization. Patients with LQTS had a higher prevalence of QTc interval-prolonging medications, list 1 medications, and atrial fibrillation. Laboratory changes and medication use were observed, with significant increases in QTc interval and list 1 medication administration. Male sex and amiodarone use were identified as predictors of LQTS during hospitalization. Conclusion: The study reports a high prevalence of prolonged QTc interval and LQTS in older inpatients. Proton pump inhibitors were frequently prescribed despite their QTc-prolonging potential. This underscores the need of close monitoring and awareness of QTc prolongation risks in older patients, advocating for routine ECG assessments and vigilant management of modifiable risk factors, especially the electrolytes. © 2025 The Author(s). Published by S. Karger AG, Basel.

Objective: To determine whether arm and upper body exercises in addition to the standard rehabilitation programme improve outcomes after hip arthroplasty. Design: Prospective, parallel, randomized, controlled trial. Setting: Orthopaedic and rehabilitation departments. Subjects: A total of 70 patients >60 years of age, who underwent hip replacement, out of 98 eligible candidates after exclusion criteria were implemented. Interventions: The study group took part in the supplementary arm and upper body exercise programme to be compared with the standard rehabilitation programme group. Main outcome: The primary outcome was a Harris Hip Score. Secondary outcomes were: Hand grip strength and Medical Outcomes Study 36-Item Short-Form Health Survey. Outcomes were assessed preoperatively, two weeks after surgery and at 12 weeks follow-up. Results: In the intervention group, significant improvements were found: in functional ability - Harris Hip Score after two (mean difference = 4.7 points) and 12 (mean difference = 5.85 points) weeks; in muscle strength - handgrip for both hands (mean difference for dominant hand = 4.16 and for the other hand = 2.8) after 12 weeks; and in role-physical dimension SF-36 Health Survey (mean difference = 6.42 points) after 12 weeks. Conclusion: Results of this study indicate that arm and upper body exercises in addition to the standard rehabilitation programme improve outcomes 12 weeks after hip arthroplasty. © The Author(s) 2016.

Objective: To determine whether arm and upper body exercises in addition to the standard rehabilitation programme improve outcomes after hip arthroplasty. Design: Prospective, parallel, randomized, controlled trial. Setting: Orthopaedic and rehabilitation departments. Subjects: A total of 70 patients >60 years of age, who underwent hip replacement, out of 98 eligible candidates after exclusion criteria were implemented. Interventions: The study group took part in the supplementary arm and upper body exercise programme to be compared with the standard rehabilitation programme group. Main outcome: The primary outcome was a Harris Hip Score. Secondary outcomes were: Hand grip strength and Medical Outcomes Study 36-Item Short-Form Health Survey. Outcomes were assessed preoperatively, two weeks after surgery and at 12 weeks follow-up. Results: In the intervention group, significant improvements were found: in functional ability - Harris Hip Score after two (mean difference = 4.7 points) and 12 (mean difference = 5.85 points) weeks; in muscle strength - handgrip for both hands (mean difference for dominant hand = 4.16 and for the other hand = 2.8) after 12 weeks; and in role-physical dimension SF-36 Health Survey (mean difference = 6.42 points) after 12 weeks. Conclusion: Results of this study indicate that arm and upper body exercises in addition to the standard rehabilitation programme improve outcomes 12 weeks after hip arthroplasty. © The Author(s) 2016.

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