Browsing by Author "Filipović, Tamara"

Background and Objectives: Treatment of cancer patients during the COVID-19 pandemic has been a challenge worldwide. In accordance with the current recommendations for hepatocellular carcinoma (HCC) management during the COVID-19 pandemic, loco-regional therapy such as transarterial chemoembolization (TACE) was proposed with the purpose of achieving local tumor control and improving overall survival. The aim of this prospective cohort study was to evaluate the outcomes of TACE treatment in patients with HCC during the COVID-19 pandemic in comparison with the outcomes of patients treated in the pre-pandemic period. Materials and Methods: Between September 2018 and December 2021, 154 patients were managed by serial TACE procedures for different liver tumors. Ninety-seven patients met the study criteria and were divided into two groups: the study group n = 49 (patients treated from May 2020 to December 2021); the control group n = 48 (patients treated from September 2018 to May 2020). Results: The mean waiting time for TACE was significantly longer in the study group compared to the control group (p < 0.001). No significant difference in survival between the groups is noted (log-rank test p = 0.823). In multivariate analysis, the MELD score (HR 1.329, 95% CI 1.140−1.548, p < 0.001) remained a significant predictor of mortality. Conclusions: COVID-19 pandemic did not affect the final outcome of TACE treatment.

Background: In the published literature there is scarce data on the importance of acute rehabilitation in patients suffering from COVID-19 disease. Aim: Evaluation of the feasibility of respiratory and neuromuscular rehabilitation treatment in stable acute COVID-19 inpatients. Design: The study was designed as an observational prospective investigation of two cohorts respectively identified as Mild/Moderate and Stable Severe COVID-19 disease. All patients received a rehabilitation treatment consisting of breathing exercises, range of motion exercises and strengthening exercises, with the main difference in intensity and progression of treatment, depending on individual capacity of patient. Setting: Inpatients with diagnosed mild to moderate, or stable severe COVID-19 infection were included in the study. Population: Acute COVID-19 inpatients. Methods: Patients were divided into two groups depending on the severity of disease: "mild to moderate group" (MMG) and "stable severe group" (SSG). Functional outcomes included the Barthel Index (BI), Six Minute Walk Test (6MWT), Borg Scale for dyspnea, "Time Up and Go" Test (TUG), "Sit To Stand" test (STS), "One Leg Stance Test" (OLST) and Beck Depression Inventory (BDI) were evaluated at baseline and after rehabilitative treatment, on discharge. Results: We included 147 acute COVID-19 inpatients (75 male and 72 female), mean aged 63.90±13.76 years. There were noticeable statistically significant improvements in all observed measurements in both groups. Comparison between groups showed significant difference in MMG compared to SSG in all functional outcomes: TUG (P<0.001), STS (P<0.001), OLST (P<0.001), BDI (P=0.008), BI (P<0.001), and Borg scale for dyspnea (P<0.001). Despite the significant improvements of BI in SSG, the obtained values showed that the patients were still not functionally independent. Conclusions: Acute respiratory and neuromuscular rehabilitation program is a feasibile, but also effective and safe method for improving functional status in patients with COVID-19 infection. Clinical rehabilitation impact: Results of the present study implicate that a supervised early rehabilitation program, implemented in the treatment of patients with COVID-19 disease in the acute phasis a feasible way for significant improvement of patient's functional outcomes. Early rehabilitation should be included into clinical protocols for the treatment of patients with COVID-19.

Osteoporoza je hronično sistemsko oboljenje skeleta koga karakteriše smanjenje koštane gustine i poremećaj mikroarhitekture kosti, sa povećanim rizikom od frakture. Povećanje osteoklastne aktivnosti, povećava ekspresiju matriks-metaloproteinaza (MMP-9 i MMP-2), što povećava resorpciju kosti i degradaciju ekstracelularnog matriksa i kolagena tipa I. Cilj rada: U cilju objašnjenja patofizioloških mehanizama odgovornih za nastanak osteoporoze u ovom istraživanju pokušali smo da utvrdimo faktore koji utiču na aktivnost i diferencijaciju osteoklasta i osteoblasta i njihovu dinamiku promene uslovljenu primenom odgovarajućeg tretmana. Osnovni ciljevi ovog istraživanja bili su da se utvrdi uticaj 12-nedeljnog specifično dizajniranog programa vežbi na promenu funkcionalnog statusa i promenu enzimske aktivnosti MMPaza i TIMPa-1 u serumu pacijentkinja sa dijagnostikovanom postmenopauzalnom osteoporozom. Sledeći cilj istraživanja odnosio se na ispitivanje povezanosti funkcionalnih genskih polimorfizama (PM) rs243866 za MMP-2 i rs3918242 za MMP-9 i funkcionalnog statusa naših pacijentkinja nakon primene programa vežbi, kao i definisanje najzastupljenijh faktora rizika za osteoporozu u ispitivanoj populaciji. Sekundarni ciljevi predstavljali su utvrđivanje uticaja programa vežbi na smanjenje straha od pada i povećanje znanja o osteoporozi. Metod: Ukupno 97 pacijentkinja sa dijagnostikovanom osteoporozom je metodom randomizacije nasumično raspoređeno u 2 grupe, grupa koja vežba (VG) i kontrolna grupa (KG), u odnosu 1:1. Pacijentkinje iz VG imale su specifično dizajniran program vežbi, pod kojim se podrazumevalo sprovođenje aerobnih vežbi, treninga snage i izdržljivosti i vežbi balansa. Pacijentkinje iz KG nisu učestvovale u programu vežbi za vreme trajanja istraživanja. Pacijentkinje su u ponovljenim merenjima biohemijski i klinički testirane po 3 puta, u sledećem vremenskim intervalima: pre započinjanja korišćenja terapije (programa vežbi i medikamentozne terapije), posle 4 i 12 nedelja od primene iste u cilju utvrđivanja efekata programa vežbi na ispitivane parametre. Prisustvo i aktivnost MMP-aza u serumima određena je metodom zimografije, dok je aktivnost TIMP-a1 određena ELISA metodom. Procena funkcionalnog statusa pacijentkinja vršena je testovima “ustani i kreni” (TUG), “ustani i sedni”(STS) i testom “stajanja na jednoj nozi” (OLST). Procena straha od pada (FES-I) i znanja o osteoporozi (OKAT-S) utvrđeni su pre početka i 12 nedelja posle primene tretmana. Molekularno-genetičke analize obuhvatile su detekciju genotipova za polimorfizme: rs243866 u genu za MMP-2, Real time PCR metodom i rs3918242 u MMP-9 genu metodom lančane reakcije polimerizacije (PCR) i restrikcije produkata reakcije restrikcionim enzimom. Ispitivanje uticaja dobijenih genotipova na funkcionalni ishod pacijentkinja, posle 12 nedelja, u VG, utvrđena je procenom korelacije ovih genotipova sa razlikom u postignutim TUG, STS i OLST testovima. U statističkoj analizi su korišćene metode deskriptivne i inferencijalne statističke analize (analiza varijanse za ponovljena merenja). Izvršena je registracija istraživanja na sajtu www.clinicaltrial.gov (ClinicalTrials.gov identifier, NCT number: NCT03816449). Rezultati rada: Poređenjem biohemijskih parametara, odnosno vrednosti enzimske aktivnosti MMP-9, MMP-2 i TIMP-1 na početku istraživanja, pre započinjanja terapije, između posmatranih grupa nije postojala statistički značajna razlika za posmatrane aktivnosti.U VG registrovano je statistički značajno smanjenje aktivnosti MMP-9 i MMP-2 i povećanje TIMP-a 1 nakon 12 nedelja. Ove promene nisu registrovane u KG. Komparativnom analizom efikasnosti tretmana među grupama zaključeno je da je VG imala bolji tretman...