Browsing by Author "Kostic, Sanja (54682060000)"

Background/Aim. Breast cancer comprises about 25% of all female cancers, and its incidence is increasing. New diagnostic procedures and therapeutic modalities have increased treatment success rates as well as patient survival. The goal of contemporary treatment is not only patient survival, but also a better quality of life (QoL). The objective of this study was to assess the effect of age at diagnosis on the QoL of patients with breast cancer before and after surgery. Methods. We analyzed QoL in 170 female patients (43 patients < 50 and 127 patients ≥ 50 years) diagnosed with breast cancer (I and II stage) a month before and after surgical treatment, using the European Organisation for Research and Treatment of Cancer (EORTC QLQ-C30) questionnaire and specific version for breast cancer patients (EORTC QLQ-BR23). Results. The QLQ-C30 questionnaire showed that surgical treatment significantly decreased all domains of the patients' QoL in both age groups. Agerelated differences were present in sexual functioning and pleasure independently of surgical treatment, with higher scores in the group of younger women. The analysis of data obtained using the QLQ-BR23 questionnaire revealed a lower QoL after surgical treatment in almost all dimensions regardless of patients' age. Conclusion. The results of our study pointed out statistically significant differences in the QoL domains of sexual functioning, and sexual enjoyment between women in both age groups independently of surgical treatment. The QoL was better in the younger age group. Surgical breast cancer treatment negatively affected patients QoL independently of age. © 2020 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Background and Objectives: The prevalence of depressive symptoms during pregnancy is about 20%, and 10–15% in the postpartum period. Suicide is a worrying cause of death among women in these periods. Although ICD-10 lacks specific definitions for perinatal depression (it is planned in ICD-11), the DSM-5 defines it. Various etiological factors and treatment options are being investigated. This study aimed to examine potential etiological factors in order to contribute to potential preventive and therapeutic approaches. Material and Methods: A prospective study at the Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, from October 2023 to January 2024 was conducted. Two hundred and five healthy women were surveyed before giving birth (37+ gestational weeks) and 2 weeks and 2 months after childbirth. The following factors were examined: sociodemographic, psychological, and obstetric (using a specially designed questionnaire); relationship quality (DAS-32); and depression, anxiety, and stress symptoms (EPDS; DASS-21). Results: Depression frequency was 26.3% before childbirth, 20% in the second week, and 21.9% in the second month after delivery. DASS-21 test results showed a statistically significant correlation before delivery and two weeks postpartum (p = 0.02). Factors that are significantly associated with the presence of depressive symptoms include the following: before childbirth—miscarriages (p < 0.01); in the second week after childbirth—personal experiences of a difficult birth (p < 0.01), cesarean delivery instead of planned vaginal delivery (p = 0.03), and application of epidural anesthesia (p = 0.04); and in the second month after childbirth—satisfaction with financial status (p = 0.035). Relationship quality is significantly correlated with DASS-21 test results before childbirth, in the second week, and in the second month after childbirth (p < 0.01), and it is significantly different in women with and without depressive symptoms (before childbirth, in the second week, and in the second month after childbirth, p < 0.01). Conclusions: There are risk factors that can be addressed preventively and therapeutically during pregnancy and in labor. This could be achieved through psychotherapy, partner support, and appropriate management of labor. © 2024 by the authors.

Cirrhotic cardiomyopathy (CCM) is a diagnostic entity defined as cardiac dysfunction (diastolic and/or systolic) in patients with liver cirrhosis, in the absence of overt cardiac disorder. Pathogenically, CCM stems from a combination of systemic and local hepatic factors that, through hemodynamic and neurohormonal changes, affect the balance of cardiac function and lead to its remodeling. Vascular changes in cirrhosis, mostly driven by portal hypertension, splanchnic vasodilatation, and increased cardiac output alongside maladaptively upregulated feedback systems, lead to fluid accumulation, venostasis, and cardiac dysfunction. Autocrine and endocrine proinflammatory cytokines (TNF-alpha, IL-6), as well as systemic endotoxemia stemming from impaired intestinal permeability, contribute to myocardial remodeling and fibrosis, which further compromise the contractility and relaxation of the heart. Additionally, relative adrenal insufficiency is often present in cirrhosis, further potentiating cardiac dysfunction, ultimately leading to the development of CCM. Considering its subclinical course, CCM diagnosis remains challenging. It relies mostly on stress echocardiography or advanced imaging techniques such as speckle-tracking echocardiography. Currently, there is no specific treatment for CCM, as it vastly overlaps with the treatment of heart failure. Diuretics play a central role. The role of non-selective beta-blockers in treating portal hypertension is established; however, their role in CCM remains somewhat controversial as their effect on prognosis is unclear. However, our group still advocates them as essential tools in optimizing the neurohumoral pathologic axis that perpetuates CCM. Other targeted therapies with direct anti-inflammatory and antioxidative effects still lack sufficient evidence for wide approval. This is not only a review but also a comprehensive distillation of the insights from practicing clinical hepatologists and other specialties engaged in advanced approaches to treating liver disease and its sequelae. © 2024 by the authors.

Background and Objectives: Forceps delivery is a crucial obstetrical technique that has become increasingly underutilized in favor of cesarean delivery, despite the numerous complications related to cesarean sections. The major concerns with regard to assisted vaginal birth (AVB) are safety and long-term consequences. We aimed to investigate a neurological outcome of neonates and children at the age of 7 who were born via forceps delivery. This would greatly improve informed decision making for both mothers and obstetricians. Materials and Methods: A single-arm cohort study was conducted from January 2012 to December 2016 among 49 women and their children born via forceps delivery at the Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia. The Sarnat and Sarnat classification was used to evaluate the neurological status of neonates, and logistic regression analysis was employed to explore the association with perinatal factors. Long-term neurological outcomes were assessed using the Griffiths Mental Development Scale and a questionnaire for parents based on the Motor and Social Development (MSD) scale, which was derived from the Bayley-III Scale. Results: The main indication for forceps delivery was maternal exhaustion (79.6%), followed by fetal distress (20.4%). A pathological neurological status was observed in 16.3% of newborns, with pathological ultrasound of the CNS in 3%. A statistically significant association was observed with the Apgar score, with an odds ratio of 0.575 (95% CI: 0.407–0.813, p = 0.002) and perinatal asphyxia, with an odds ratio of 9.882 (95% CI: 1.111–87.902, p = 0.04). However, these associations were unlikely to be related to the mode of delivery. Long-term adverse neurological outcomes were seen in three cases, which accounts for 6.4%. These included mild disorders such as delayed milestone, speech delay, and motor clumsiness. Conclusions: The present study highlights the safety of forceps delivery regarding children’s neurological outcomes at 7 years of age. This is an important contribution to the modern management of labor, especially in light of increasing rates of cesarean deliveries worldwide. © 2024 by the authors.

Background/Aims: Malnutrition appears to be a major and noticeable problem for hospitalized patients and often present in patients with gastrointestinal diseases. This study attempts to evaluate differences in nutritional status parameters and nutritional state differences among hospitalized patients with various gastrointestinal diseases and disorders. Methodology: Our study included 154 males and 146 females, aged 18-84 years old, with various gastrointestinal diseases and disorders. All patients underwent baseline nutritional assessment, including subjective global assessment (SGA), anthropometric measurements, bioelectrical impedance analysis (BIA), and biochemical markers. Results: Prevalence of malnutrition was 45.7%. The highest prevalence was detected among patients suffering from gastrointestinal malignancies and chronic pancreatitis. All parameters decreased with malnourishment levels, except CRP and in-hospital stay which rose with malnourishment grade. SGA and length of hospital stay negatively correlated with all analyzed variables of nutritional assessment, except CRP. Conclusions: Patients suffering from gastrointestinal malignancies, inflammatory bowel disease and peptic ulcer disease have more pronounced level of malnutrition. Body mass index, triceps skin fold thickness, mid-arm circumference, MAMC, wrist circumference, total protein level, albumin, cholesterol, glucose level, lymphocyte count, basal metabolic rate, body fat mass, fat free mass, muscle mass, total body water and resistance appeared to be inversely correlated with malnutrition. However, CRP level correlated positively with the malnutrition severity. SGA malnutrition level is dependant of hospitalization length. © H.G.E. Update Medical Publishing S.A.

Background/Aim: Hyperhomocysteinaemia is linked to higher level of acetylcholinesterase (AChE) in brain, but there is insufficient information on influence of homocysteine (Hcy) and gasotransmitters on cardiac AChE. Thus, the aim of this study was to evaluate the influence of certain gasotransmitter inhibitors in Hcy-induced changes on rat cardiac AChE activity. Methods: Research was performed on 72 male Wistar albino rats distributed into 6 groups: 1) Control group - saline (1 ml 0.9% NaCl ip); 2) DL-Hcy (8 mmol/kg ip DL homocysteine (DL-Hcy); 3) L-NAME (10 mg/kg ip Nω-Nitro-L-arginine methyl ester (L-NAME), inhibitor of NO production); 4) DL-PAG (50 mg/kg ip DL-propar- gylglycine (DL-PAG), inhibitor of H2S production); 5) DL-Hcy+L-NAME (8 mmol/ kg ip DL-Hcy + 10 mg/kg ip L-NAME); and 6) DL-Hcy+DL-PAG (8 mmol/kg ip DL-Hcy + 50 mg/kg ip DL-PAG). All tested substances were administered in a single dose, intraperitoneally, 60 minutes before animals’ sacrifice. AChE activity was measured in the rats’ cardiac tissue homogenate. Results: Administration of Hcy and L-NAME induced significant decrease in AChE activity compared with control condition. Administration of DL-PAG, DL-Hcy+L- NAME and DL-Hcy+DL-PAG did not change AChE activity compared with the control group. Conclusion: The effects of acute Hcy administration on the cardiac AChE activity are partially mediated via interaction with tested gasotransmitters. © 2019, Faculty of Medicine, University of Banja Luka. All rights reserved.

Background: The importance of homocysteine (Hcy) is increasingly recognized in last few decades as an independent risk factor for atherosclerosis and thrombosis, but there is lack of data referring to influence of Hcy on plasma oxidative stress parameters as well as the role of gasotransmitters in these effects. Therefore, this study aim was to assess the role of gasotransmitter inhibitors in Hcy-induced effects on plasma oxidative stress in rats. Material and Methods: Study involved 96 male Wistar albino rats divided into 8 groups: 1) Control group - saline (1ml 0.9% NaCl i.p.,); 2) DL-Hcy (8 mmol/kg i.p. DL homocysteine (DL-Hcy); 3) L-NAME (10 mg/kg i.p. Nω-Nitro-L-arginine methyl ester (L-NAME), inhibitor of NO production); 4) ZnPPR IX (30 mol/kg i.p. protoporphyrin IX zinc (ZnPPR IX), inhibitor of CO production); 5) DL-PAG (50 mg//kg i.p. DL-propargylglycine (DL-PAG), inhibitor of H2S production); 6) DL-Hcy+L-NAME (8 mmol/kgi.p. DL-Hcy + 10 mg/kg i.p. L-NAME); 7) DL-Hcy+ZnPPR IX (8 mmol/kgi.p. DL-Hcy + 30 mol/kg i.p. Zn PPR IX), and 8) DL-Hcy+DL-PAG (8 mmol/kg i.p. DL-Hcy + 50 mg//kg i.p. DL-PAG). In all experimental groups, tested substances were administered in a single dose, intraperitoneally, 60 minutes before animals’ euthanasia. In the collected blood samples malondialdehyde concentration, catalase, glutathione peroxidase and superoxide dismutase activity were measured. Results: Applied substances induced rapid and strong increase of plasma antioxidant enzymatic activity probably as a compensatory response to its pro-oxidant influence. Conclusion: The effects of Hcy on the activity of plasma antioxidant enzymes are in part mediated via interaction with gasotransmitters. © 2019 Djuric et al.

Purpose: A multidisciplinary approach to the treatment of patients with malignant diseases requires adequate venous access in order to safely administer chemotherapy, blood transfusion and blood products, antibiotics, rehy-dratation and total parenteral nutrition. The insertion of the central venous catheter (CVC), its use and its maintenance can be accompanied by multiple complications.; Methods: Fifty cancer patients were retrospectively enrolled in this study. The obligatory inclusion criterion was an implanted CVC of the port-a-cath type, inserted for chemotherapy administration. This study included patients who had their catheters inserted in the period from 2001 to 2012.; Results: The median patient age was 44 years (range 28-68). Thirty five patients (70%) were female and 15 (30%) male. The port-a-cath had been used from Ito 40 months (16.8±9 months on average). Breast cancer was the most frequent malignancy (18 patients, 36%). The overall incidence of reported complications was 38%. The most common complications were infections and thromboembolic events, each with an incidence of 10 %. The malposition and disconnection of the port-a-cath were in second place, each with an incidence of 6%.; Conclusion: Insertion of the CVC carries the possibility of serious complications (thrombosis, infections, occlusions). However, correct implantation and handling performed by experienced and trained surgical and other medical staff significantly decrease the incidence of these complications. The use of the CVC has greatly improved the quality of life and also decreased the morbidity and mortality of the cancer patients in our study.

Purpose: A multidisciplinary approach to the treatment of patients with malignant diseases requires adequate venous access in order to safely administer chemotherapy, blood transfusion and blood products, antibiotics, rehy-dratation and total parenteral nutrition. The insertion of the central venous catheter (CVC), its use and its maintenance can be accompanied by multiple complications.; Methods: Fifty cancer patients were retrospectively enrolled in this study. The obligatory inclusion criterion was an implanted CVC of the port-a-cath type, inserted for chemotherapy administration. This study included patients who had their catheters inserted in the period from 2001 to 2012.; Results: The median patient age was 44 years (range 28-68). Thirty five patients (70%) were female and 15 (30%) male. The port-a-cath had been used from Ito 40 months (16.8±9 months on average). Breast cancer was the most frequent malignancy (18 patients, 36%). The overall incidence of reported complications was 38%. The most common complications were infections and thromboembolic events, each with an incidence of 10 %. The malposition and disconnection of the port-a-cath were in second place, each with an incidence of 6%.; Conclusion: Insertion of the CVC carries the possibility of serious complications (thrombosis, infections, occlusions). However, correct implantation and handling performed by experienced and trained surgical and other medical staff significantly decrease the incidence of these complications. The use of the CVC has greatly improved the quality of life and also decreased the morbidity and mortality of the cancer patients in our study.