Browsing by Author "Milic, Natasa (7003460927)"

Objective: To identify the risk factors of the adverse outcomes following surgery for the acute bowel obstruction (ABO). Methods: Annual cross-section included patients undergoing surgery for the acute bowel obstruction, at the Clinic for Emergency Surgery, from December 2009 to December 2010. Patients had non-resection procedures or bowel resection with the intestinal anastomosis or temporary intestinal diversion. Demographic and perioperative data as well as outcome results were collected. Stepwise logistic regression was used to build models predicting 30-day morbidity and mortality and derive risk index values. Results: Out of 272 patients, 145 underwent non-resection surgical procedures and 127 underwent bowel resection. The median ICU stay and median hospital stay was significantly higher among patients who underwent bowel resection (p=0,001 and p<0.0001,respectively). Morbidity was 37.1%. In multivariate analysis, the variables with the highest risk values included age over 65 years and ASA class 4-5, for 30-day morbidity. The overall 30-day mortality was 10.3%. For 30-day mortality, age over 65 years, comorbidity conditions, ASA class 4-5 and malignant etiology of ABO were the variables with the highest risk values. Conclusions: Advanced age and ASA score with delayed operation were the risk factors significantly associated with the increased complication rate, while the advanced age and ASA score, comorbidity and malignant etiology were the risk factors significantly associated with the increased death rate. Surgery type was not a predictor of the adverse outcomes. Identification of risk factors is useful to predict outcomes and provide supportive care to high-risk patients undergoing surgery for ABO.

The primary aim of this audit was to assess mean pain scores and type of analgesia used in the 5 days following epidural catheter removal in liver resection patients. The second aim was to determine whether postepidural pain intensity was influenced by the duration of epidural analgesia. Methods: Medical notes of 82 consecutive patients who underwent liver resection between January 2008 and April 2009 were obtained. Data regarding duration of epidural analgesia, the rate and type of analgesic solution used, pain scores post epidural analgesia, and postepidural analgesia were analyzed retrospectively. Results: Epidural analgesia was used for 4 days (range 2-6). Pain scoring became less vigilant as the postoperative days progressed. Pain scores on day 1 post epidural catheter removal were significantly higher than those on day 2 (0.6±0.8 vs 0.3±0.4, t-test, p = 0.047). The 6 principal analgesics prescribed to patients after epidural removal were paracetamol (98%), diclofenac (58%), dihydrocodeine (52%), tramadol (38%), morphine (16%) and oramorph (10%). Most patients received two or three analgesics. There was no correlation between duration of epidural analgesia and pain score. Conclusions: Postoperative pain still occurs in liver resection patients following epidural analgesia, particularly on day one. Pain assessment was insufficient and different analgesic modalities were used. There needs to be clear plan regarding pain assessment and treatment. Pain intensity does not correlate with the duration of epidural analgesia used. © 2011 Nova Science Publishers, Inc.

Background: Research involves the systematic collection and analysis of data to enhance understanding of a particular phenomenon. Participation in medical research is crucial for advancing healthcare practices. However, there has been limited focus on understanding the factors that motivate medical students to engage in research. Additionally, in the era of e-learning, the easy accessibility of online resources has contributed to a widespread ‘copy-paste culture’ among digital-native students, which is recognized in academia as plagiarism. Existing studies suggest that a contributing factor to the increasing prevalence of plagiarism is students’ limited understanding of this act. The purpose of this study was to assess medical students’ attitudes toward research and plagiarism, and to evaluate the psychometric properties of the Attitudes Toward Research (ATR) and Attitudes Toward Plagiarism (ATP) questionnaires. Methods: This was a multicenter study conducted among medical undergraduate and postgraduate students attending the three medical universities who were involved in research. Students’ attitudes toward research and plagiarism were assessed using the ATR and ATP questionnaires. The research instruments underwent translation and cultural adaptation in accordance with internationally accepted methodology. The psychometric properties of the ATR and ATP, including validity and reliability, were assessed. Confirmatory factor analysis was used to test the model’s fit to the data. Results: The ATR and ATP questionnaires were completed by 793 medical students who were involved in research (647 undergraduates and 146 PhD students). Cronbach’s alpha coefficients of 0.917 and 0.822 indicated excellent and good scale reliability for the ATR and ATP questionnaires, respectively. The five-and three- factor structures of ATR and ATP have been validated with maximum likelihood confirmatory analysis, and the results demonstrated an adequate level of model fit (TLI = 0.930, CFI = 0.942 and TLI = 0.924, CFI = 0.943, respectively). Medical students showed a high degree of positive attitudes toward research and favorable scores across all three domains of attitudes toward plagiarism. In multivariate regression models, age was found to be positively associated with favorable attitudes of research usefulness, positive attitudes, relevance to life subscales and total ATR scale (p < 0.001), while PhD study level was related to research anxiety (p < 0.001) and favorable attitudes across all three ATP domains (p < 0.001). Conclusion: Medical students who were involved in research showed a high degree of favorable attitudes toward research and plagiarism. Adjusting medical school curricula to include research courses would broaden the students’ interest in scientific research and maximize their impact on the full preservation of research ethics and integrity. © The Author(s) 2024.

Background: Research involves the systematic collection and analysis of data to enhance understanding of a particular phenomenon. Participation in medical research is crucial for advancing healthcare practices. However, there has been limited focus on understanding the factors that motivate medical students to engage in research. Additionally, in the era of e-learning, the easy accessibility of online resources has contributed to a widespread ‘copy-paste culture’ among digital-native students, which is recognized in academia as plagiarism. Existing studies suggest that a contributing factor to the increasing prevalence of plagiarism is students’ limited understanding of this act. The purpose of this study was to assess medical students’ attitudes toward research and plagiarism, and to evaluate the psychometric properties of the Attitudes Toward Research (ATR) and Attitudes Toward Plagiarism (ATP) questionnaires. Methods: This was a multicenter study conducted among medical undergraduate and postgraduate students attending the three medical universities who were involved in research. Students’ attitudes toward research and plagiarism were assessed using the ATR and ATP questionnaires. The research instruments underwent translation and cultural adaptation in accordance with internationally accepted methodology. The psychometric properties of the ATR and ATP, including validity and reliability, were assessed. Confirmatory factor analysis was used to test the model’s fit to the data. Results: The ATR and ATP questionnaires were completed by 793 medical students who were involved in research (647 undergraduates and 146 PhD students). Cronbach’s alpha coefficients of 0.917 and 0.822 indicated excellent and good scale reliability for the ATR and ATP questionnaires, respectively. The five-and three- factor structures of ATR and ATP have been validated with maximum likelihood confirmatory analysis, and the results demonstrated an adequate level of model fit (TLI = 0.930, CFI = 0.942 and TLI = 0.924, CFI = 0.943, respectively). Medical students showed a high degree of positive attitudes toward research and favorable scores across all three domains of attitudes toward plagiarism. In multivariate regression models, age was found to be positively associated with favorable attitudes of research usefulness, positive attitudes, relevance to life subscales and total ATR scale (p < 0.001), while PhD study level was related to research anxiety (p < 0.001) and favorable attitudes across all three ATP domains (p < 0.001). Conclusion: Medical students who were involved in research showed a high degree of favorable attitudes toward research and plagiarism. Adjusting medical school curricula to include research courses would broaden the students’ interest in scientific research and maximize their impact on the full preservation of research ethics and integrity. © The Author(s) 2024.

Background: Concerns have been raised about discrepancies in COVID-19 mortality data, particularly between preliminary and final datasets of vital statistics in Serbia. In the original preliminary dataset, released daily during the ongoing pandemic, there was an underestimation of deaths in contrast to those reported in the subsequently released yearly dataset of vital statistics. Objective: This study aimed to assess the accuracy of the final mortality dataset and justify its use in further analyses. In addition, we quantified the relative impact of COVID-19 on the death rate in the Serbian capital’s population. In the process, we aimed to explore whether any evidence of cause-of-death misattribution existed in the final published datasets. Methods: Data were sourced from the electronic databases of the Statistical Office of the Republic of Serbia. The dataset included yearly recorded deaths and the causes of death of all citizens currently living in the territory of Belgrade, the capital of the Republic of Serbia, from 2015 to 2021. Standardization and modeling techniques were utilized to quantify the direct impact of COVID-19 and to estimate excess deaths. To account for year-to-year trends, we used a mixed-effects hierarchical Poisson generalized linear regression model to predict mortality for 2020 and 2021. The model was fitted to the mortality data observed from 2015 to 2019 and used to generate mortality predictions for 2020 and 2021. Actual death rates were then compared to the obtained predictions and used to generate excess mortality estimates. Results: The total number of excess deaths, calculated from model estimates, was 3175 deaths (99% CI 1715-4094) for 2020 and 8321 deaths (99% CI 6975-9197) for 2021. The ratio of estimated excess deaths to reported COVID-19 deaths was 1.07. The estimated increase in mortality during 2020 and 2021 was 12.93% (99% CI 15.74%-17.33%) and 39.32% (99% CI 35.91%-39.32%) from the expected values, respectively. Those aged 0‐19 years experienced an average decrease in mortality of 22.43% and 23.71% during 2020 and 2021, respectively. For those aged up to 39 years, there was a slight increase in mortality (4.72%) during 2020. However, in 2021, even those aged 20‐39 years had an estimated increase in mortality of 32.95%. For people aged 60‐79 years, there was an estimated increase in mortality of 16.95% and 38.50% in 2020 and 2021, respectively. For those aged >80 years, the increase was estimated at 11.50% and 34.14% in 2020 and 2021, respectively. The model-predicted deaths matched the non-COVID-19 deaths recorded in the territory of Belgrade. This concordance between the predicted and recorded non-COVID-19 deaths provides evidence that the cause-of-death misattribution did not occur in the territory of Belgrade. Conclusions: The finalized mortality dataset for Belgrade can be safely used in COVID-19 impact analysis. Belgrade experienced a significant increase in mortality during 2020 and 2021, with most of the excess mortality attributable to SARS-CoV-2. Concerns about increased mortality from causes other than COVID-19 in Belgrade seem misplaced as their impact appears negligible. © Dane Cvijanovic, Nikola Grubor, Nina Rajovic, Mira Vucevic, Svetlana Miltenovic, Marija Laban, Tatjana Mostic, Radica Tasic, Bojana Matejic, Natasa Milic.

The objective of this study was to offer new approach for selection of persons with asymptomatic bladder cancer (BC) and highly risky persons for the BC occurrence. Also, it is a part of the BC screening protocol (study is ongoing). Study populations were 100 newly diagnosed (diagnosis maximum 1-year old) males with BC and 100 matched (by sex and age ±5 years) controls (not oncology patients from the same hospital). A hospital based, matched case-control study was done. Statistical analysis comprised of four steps: t-test, univariate logistic regression, multivariate logistic regression, and scoring. The fifth step comprised of two changes, deleting one variable and addition of another variable. Six variables were statistically significant: Caucasian men over 45 years age, tobacco smoking over 40 pack-years, occupational and/or environmental exposure to the proved BC carcinogens over 20 years, macrohematuria, difficulty urinating, BC in relatives up to fourth degree of kinships, and they were used for an easy and fast selection of the individuals with high risk for BC occurrence and BC asymptomatic patients (optimal selection at the population level). The final results showed highly significant probability (p < 0.001), with area under ROC curve of 0.913, negative predictive values of 89.7% (95% CI 10.3-100%), and a specificity of 78%. Positive predictive value was 80.5% (95% CI 19.5-100%) and a sensitivity of 91%. It is possible to recruit asymptomatic BC patients (primary prevention) by using this model, as well as persons with high risk for BC occurrence (primordial prevention). This study is the first part of the BC screening protocol and the second part of the BC screening protocol study is ongoing (urine analysis). © 2023 the author(s), published by De Gruyter.

Objectives: We sought to determine whether blended learning is an effective strategy for acquiring competence in public health biostatistics. Methods: The trial was conducted with 69 Masters’ students of public health attending the School of Public Health at University of Belgrade. Students were exposed to the traditional and blended learning styles. Blended learning included a combination of face-to-face and distance learning methodologies integrated into a single course. Curriculum development was guided by competencies as suggested by the Association of Schools of Public Health in the European Region (ASPHER). Teaching methods were compared according to the final competence score. Results: Forty-four students were enrolled in the traditional method of education delivery, and 25 to the blended learning format. Mean exam scores for the blended learning group were higher than for the on-site group for both the final statistics score (89.65 ± 6.93 vs. 78.21 ± 13.26; p < 0.001) and knowledge test score (35.89 ± 3.66 vs. 22.56 ± 7.12; p < 0.001), with estimated large effect size (d > 0.8). Conclusions: A blended learning approach is an attractive and effective way of acquiring biostatistics competence for Masters of Public Health (MPH) graduate students. © 2017, Swiss School of Public Health (SSPH+).

Increased angiogenesis in BCR-ABL1 negative myeloproliferative neoplasms (MPNs) has been recognized, but its connection with clinical and molecular markers needs to be defined. The aims of study were to (1) assess bone marrow (BM) angiogenesis measured by microvessel density (MVD) using CD34 and CD105 antibodies; (2) analyze correlation of MVD with plasma angiogenic factors including vascular endothelial growth factor, basic fibroblast growth factor, and interleukin-8; (3) examine the association of MVD with clinicopathological and molecular markers. We examined 90 de novo MPN patients (30 polycythemia vera (PV), primary myelofibrosis (PMF), essential thrombocythemia (ET)) and 10 age-matched controls. MVD was analyzed by immunohistochemistry “hot spot” method, angiogenic factors by immunoassay and JAK2V617F, and CALR mutations by DNA sequencing and allelic PCR. MVD was significantly increased in MPNs compared to controls (PMF > PV > ET). Correlation between MVD and plasma angiogenic factors was found in MPNs. MVD was significantly increased in patients with JAK2V617F mutation and correlated with JAK2 mutant allele burden (CD34-MVD: ρ = 0.491, p < 0.001; CD105-MVD: ρ = 0.276, p = 0.02) but not with CALR mutation. MVD correlated with leukocyte count, serum lactate dehydrogenase, hepatomegaly, and splenomegaly. BM fibrosis was significantly associated with CD34-MVD, CD105-MVD, interleukin-8, and JAK2 mutant allele burden. JAK2 homozygote status had positive predictive value (100%) for BM fibrosis. Patients with prefibrotic PMF had significantly higher MVD than patients with ET, and we could recommend MVD to be additional histopathological marker to distinguish these two entities. This study also highlights the strong correlation of MVD with plasma angiogenic factors, JAK2 mutant allele burden, and BM fibrosis in MPNs. © 2016, Springer-Verlag Berlin Heidelberg.

Background and Objectives: Pain during and after the procedure remains the leading concern among women undergoing cesarean section. Numerous studies have concluded that the type of anesthesia used during a cesarean section undoubtedly affects the intensity and experience of pain after the operation. Materials and Methods: This prospective cohort study was conducted at the Clinic for Gynecology and Obstetrics, Clinical Center “Dragisa Misovic—Dedinje”, Belgrade, Serbia. Patients at term pregnancy (37–42 weeks of gestation) with an ASA I score who delivered under general (GEA) or regional anesthesia (RA) by cesarean section were included in the study. Following the procedure, we assessed pain using the Serbian McGill questionnaire (SF–MPQ), Visual Analogue Scale (VAS) and the pain attributes questionnaire at pre-established time intervals of 2, 12, and 24 h after the procedure. Additionally, time to patient’s functional recovery was noted. We also recorded the time to the first independent mobilization, first oral intake, and lactation establishment. Results: GEA was performed for 284 deliveries while RA was performed for 249. GEA had significantly higher postoperative sensory and affective pain levels within intervals of 2, 12, and 24 h after cesarean section. GEA had significantly higher postoperative VAS pain levels. On pain attribute scale intensity, GEA had significantly higher postoperative pain levels within all intervals. Patients who received RA had a shorter time to first oral food intake, first independent mobilization, and faster lactation onset in contrast to GEA. Conclusions: The application of RA presented superior postoperative pain relief, resulting in earlier mobilization, shorter time to first oral food intake, and faster lactation onset in contrast to GEA. © 2022 by the authors.

The key to the successful management of pancreatic cystic neoplasm (PCN), among which intraductal papillary mucinous neoplasm (IPMN) is the one with the highest risk of advanced neo-plasia in resected patients, is a careful combination of clinical, radiological, and histopathological findings. This study aims to perform the comparison of a preoperative evaluation with pathological reports in IPMN and further, to evaluate and compare the diagnostic performance of European evidence-based guidelines on pancreatic cystic neoplasms (EEBGPCN) and Fukuoka Consensus guidelines (FCG). We analyzed 106 consecutive patients diagnosed with different types of PCN, among whom 68 had IPMN diagnosis, at the Clinical Center of Serbia. All the patients diagnosed with IPMNs were stratified concerning the presence of the absolute and relative indications according to EEBGPCN and high-risk stigmata and worrisome features according to FCG. Final histopathology revealed that IPMNs patients were further divided into malignant (50 patients) and benign (18 pa-tients) groups, according to the pathological findings. The preoperative prediction of malignancy according to EEBGPCN criteria was higher than 70% with high sensitivity of at least one absolute or relative indication for resection. The diagnostic performance of FCG was shown as comparable to EEBGPCN. Nevertheless, the value of false-positive rate for surgical resection showed that in some cases, overtreating patients or treating them too early cannot be prevented. A multidisciplinary approach is essential to adequately select patients for the resection considering at the same time both the risks of surgery and malignancy. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Background/Objectives: Mild traumatic brain injury (mTBI) is a leading cause of pediatric emergency department visits, particularly among children under three years old. Although computed tomography (CT) is the gold standard for diagnosing intracranial injuries, its use in young children poses radiation risks. Identifying reliable clinical indicators that justify CT imaging is essential for optimizing both patient safety and resource utilization. Objective: This study aimed to evaluate CT findings in children under three years of age with mTBI and no focal neurological deficits, as well as to identify clinical predictors associated with skull fractures and intracranial injuries. Methods: A retrospective analysis was conducted on 224 children under 36 months who presented with mTBI to a tertiary pediatric hospital from July 2019 to July 2024. Demographic data, injury mechanisms, clinical presentation and CT findings were evaluated. Univariate and multivariate regression analyses were performed to identify risk factors associated with skull fractures and intracranial injuries. Results: Falls accounted for 96.4% of injuries, with the majority occurring from heights of 0.5–1 m. The parietal region was the most frequently affected site (38%). Skull fractures were present in 46% of cases and were primarily linear (92.8%). Intracranial hematomas were identified in 13.8% of cases, while brain edema was observed in 7.6%. Significant predictors of skull fractures included age under 12 months (p < 0.001), falls from 0.5–1 m (p = 0.005), somnolence (p = 0.030), scalp swelling (p = 0.001) and indentation of the scalp (p = 0.016). Parietal bone involvement was the strongest predictor of both skull fractures (OR = 7.116, p < 0.001) and intracranial hematomas (OR = 4.993, p < 0.001). Conversely, frontal bone involvement was associated with a lower likelihood of fractures and hematomas. Conclusions: The findings highlight key clinical indicators that can guide decision-making for CT imaging in children with mTBI. Infants under 12 months, falls from moderate heights and parietal bone involvement significantly increase the risk of fractures and intracranial injuries. A more refined diagnostic approach could help reduce unnecessary CT scans while ensuring the timely identification of clinically significant injuries. © 2025 by the authors.

The widely used current International Prognostic Scoring System (IPSS) for primary myelofibrosis (PMF) is based on clinical parameters. The objective of this study was to identify additional prognostic factors at the time of diagnosis, which could have an impact on the future treatment of patients with PMF. We conducted a study of 131 consecutive PMF patients with median follow-up of 44 months. Data on baseline demographics, clinical and laboratory parameters, IPSS, grade of bone marrow fibrosis (MF), as well as influence of concomitant comorbidities were analyzed in terms of survival. Comorbidity was assessed using the Adult Comorbidity Evaluation-27 (ACE-27) score and the hematopoietic cell transplantation comorbidity index. An improved prognostic model of survival was obtained by deploying the MF and ACE-27 to the IPSS. A multivariable regression analyses confirmed the statistical significance of IPSS (P < 0.001, HR 3.754, 95 % CI 2.130-6.615), MF > 1 (P = 0.001, HR 2.694, 95 % CI 1.466-4.951) and ACE-27 (P < 0.001, HR 4.141, 95 % CI 2.322-7.386) in predicting the survival of patients with PMF. When the IPSS was modified with MF and ACE-27, the final prognostic model for overall survival was stratified as low (score 0-1), intermediate (score 2-3) and high risk (score 4-6) with median survival of not reached, 115 and 22 months, respectively (P < 0.001). Our findings indicate that the combination of histological changes, comorbidity assessment and clinical parameters at the time of diagnosis allows better discrimination of patients in survival prognostic groups and helps to identify high-risk patients for a poor outcome. © 2014 Springer Science+Business Media New York.

The widely used current International Prognostic Scoring System (IPSS) for primary myelofibrosis (PMF) is based on clinical parameters. The objective of this study was to identify additional prognostic factors at the time of diagnosis, which could have an impact on the future treatment of patients with PMF. We conducted a study of 131 consecutive PMF patients with median follow-up of 44 months. Data on baseline demographics, clinical and laboratory parameters, IPSS, grade of bone marrow fibrosis (MF), as well as influence of concomitant comorbidities were analyzed in terms of survival. Comorbidity was assessed using the Adult Comorbidity Evaluation-27 (ACE-27) score and the hematopoietic cell transplantation comorbidity index. An improved prognostic model of survival was obtained by deploying the MF and ACE-27 to the IPSS. A multivariable regression analyses confirmed the statistical significance of IPSS (P < 0.001, HR 3.754, 95 % CI 2.130-6.615), MF > 1 (P = 0.001, HR 2.694, 95 % CI 1.466-4.951) and ACE-27 (P < 0.001, HR 4.141, 95 % CI 2.322-7.386) in predicting the survival of patients with PMF. When the IPSS was modified with MF and ACE-27, the final prognostic model for overall survival was stratified as low (score 0-1), intermediate (score 2-3) and high risk (score 4-6) with median survival of not reached, 115 and 22 months, respectively (P < 0.001). Our findings indicate that the combination of histological changes, comorbidity assessment and clinical parameters at the time of diagnosis allows better discrimination of patients in survival prognostic groups and helps to identify high-risk patients for a poor outcome. © 2014 Springer Science+Business Media New York.

Patients with EuroSCORE <2 are usually considered to have a low surgical risk and the lowest mortality. In our study preoperative factors in a group of 250 consecutive low-risk patients (EuroSCORE<2), who underwent frst isolated coronary artery by-pass surgery during 1999 and 2000., were analyzed. Cumulative follow-up period was 1178.48 patient-years and the primary clinical outcome was all-cause mortality. Patients̀ average age was 59.2±7.5 yr. The following preoperative risk factors of increased 5-year mortality were identifed: older age (P<0.001), smoking, prior non-recent myocardial infarction and reinfarction, anteroseptal localization of myocardial infarction (P<0.001), poor ejection fraction<=35% (P<0.001), dilatative cardiomyopathy (P<0.001), wall motion systolic index >2 (P<0.001), left atrial dilatation (P<0.001), mitral regurgitation more than 2+ (P<0.001), presence of left main disease, triple vessel coronary artery disease (P<0.001), absence of collaterals (P<0.001) and presence of more than 3 distal anastomoses. Through the present study it has been shown that it is possible to identify a subgroup of patients with low operative mortality and excellent 5-year survival after surgical treatment for coronary artery bypass surgery using preoperative clinical, echocardiographic, coronarographic and intraoperative data, even in diffcult conditions of the civil war in the region. © Versita Sp. z o.o.

Introduction: Obstructive sleep apnea (OSA) is a serious condition linked with various metabolic disorders and associated with increased all-cause and cardiovascular mortality. Although the potential mechanisms of pathophysiological processes related to OSA are relatively well known, the data regarding the correlation between obstructive sleep apnea, dyslipidemia, and systemic inflammation are still inconclusive. Methods: The study was conducted as a retrospective cohort study including 328 patients with newly diagnosed obstructive sleep apnea during the period between April 2018, and May 2020, in University Clinical Hospital Center “Bezanijska kosa”, Belgrade, Serbia. Polysomnography was performed in all patients according to the protocol. Numerous demographic, antropometric, laboratory, and clinical data were correlated to Apnea-Hypopnea Index (AHI) as a dependent variable, with a particular review on the relation between lipid abnormalities, inflammatory parameters, and obstructive sleep apnea severity. Multivariate logistic regression model was used to assess predictors of severe OSA (AHI ≥30 per hour). Results: A total of 328 patients were included in the study. The mean age of the patients was 54.0 ± 12.5 years and more than two-thirds were male (68.8%). The majority of the patients had an AHI of at least 30 events per hour. Patients with severe OSA were more frequently male, obese, hypertensive and hyperlipidemic, and had increased neck circumference (both male and female patients). One hundred and thirty-two patients had metabolic syndrome. Patients with severe OSA more frequently had metabolic syndrome and significantly higher levels of glucose, creatinine, uric acid, AST, ALT, CK, microalbumine/creatinine ratio, triglyceride, total cholesterol, HDL, total cholеsterol to HDL‐C ratio, CRP, and ESR. In the multivariate linear regression model with AHI (≥30 per hour) as a dependent variable, of demographic and clinical data, triglycerides ≥1.7 mmol/L and CRP >5 mg/L were significantly associated with AHI≥30 per hour. Conclusion: The present study on 328 patients with newly diagnosed obstructive sleep apnea revealed significant relation of lipid abnormalities, inflammatory markers, and other clinically important data with obstructive sleep apnea severity. These results can lead to a better understanding of the underlying pathophysiological processes and open the door to a new world of potentially useful therapeutic modalities. Copyright © 2022 Popadic, Brajkovic, Klasnja, Milic, Rajovic, Lisulov, Divac, Ivankovic, Manojlovic, Nikolic, Memon, Brankovic, Popovic, Sekulic, Macut, Markovic, Djurasevic, Stojkovic, Todorovic and Zdravkovic.

Introduction: Obstructive sleep apnea (OSA) is a serious condition linked with various metabolic disorders and associated with increased all-cause and cardiovascular mortality. Although the potential mechanisms of pathophysiological processes related to OSA are relatively well known, the data regarding the correlation between obstructive sleep apnea, dyslipidemia, and systemic inflammation are still inconclusive. Methods: The study was conducted as a retrospective cohort study including 328 patients with newly diagnosed obstructive sleep apnea during the period between April 2018, and May 2020, in University Clinical Hospital Center “Bezanijska kosa”, Belgrade, Serbia. Polysomnography was performed in all patients according to the protocol. Numerous demographic, antropometric, laboratory, and clinical data were correlated to Apnea-Hypopnea Index (AHI) as a dependent variable, with a particular review on the relation between lipid abnormalities, inflammatory parameters, and obstructive sleep apnea severity. Multivariate logistic regression model was used to assess predictors of severe OSA (AHI ≥30 per hour). Results: A total of 328 patients were included in the study. The mean age of the patients was 54.0 ± 12.5 years and more than two-thirds were male (68.8%). The majority of the patients had an AHI of at least 30 events per hour. Patients with severe OSA were more frequently male, obese, hypertensive and hyperlipidemic, and had increased neck circumference (both male and female patients). One hundred and thirty-two patients had metabolic syndrome. Patients with severe OSA more frequently had metabolic syndrome and significantly higher levels of glucose, creatinine, uric acid, AST, ALT, CK, microalbumine/creatinine ratio, triglyceride, total cholesterol, HDL, total cholеsterol to HDL‐C ratio, CRP, and ESR. In the multivariate linear regression model with AHI (≥30 per hour) as a dependent variable, of demographic and clinical data, triglycerides ≥1.7 mmol/L and CRP >5 mg/L were significantly associated with AHI≥30 per hour. Conclusion: The present study on 328 patients with newly diagnosed obstructive sleep apnea revealed significant relation of lipid abnormalities, inflammatory markers, and other clinically important data with obstructive sleep apnea severity. These results can lead to a better understanding of the underlying pathophysiological processes and open the door to a new world of potentially useful therapeutic modalities. Copyright © 2022 Popadic, Brajkovic, Klasnja, Milic, Rajovic, Lisulov, Divac, Ivankovic, Manojlovic, Nikolic, Memon, Brankovic, Popovic, Sekulic, Macut, Markovic, Djurasevic, Stojkovic, Todorovic and Zdravkovic.

OBJECTIVES: Studies on the clinical value of parameters of hemostasis in predicting pancreatitis-associated complications are still scarce. The aim of this prospective study was to identify the useful hemostatic markers for accurate determination of the subsequent development of organ failure (OF) during the very early course of acute pancreatitis (AP). METHODS: In 91 consecutive primarily admitted patients with AP, prothrombin time, activated partial thromboplastin time, fibrinogen, antithrombin III, protein C, plasminogen activator inhibitor 1, d-dimer, and plasminogen were measured in plasma within the first 24 hours of admission and 24 hours thereafter. Two study groups comprising 24 patients with OF and 67 patients without OF were compared. RESULTS: Levels of prothrombin time, fibrinogen, and d-dimer on admission were significantly different between the OF and non-OF groups, and all these parameters plus antithrombin III were significantly different 24 hours later. A d-dimer value of 414.00 μg/L on admission was the best cutoff value in predicting the development of OF with sensitivity, specificity, and positive and negative predictive values of 90%, 89%, 75%, and 96%, respectively. CONCLUSIONS: Measurement of plasma levels of d-dimer on the admission is an accurate method for the identification of patients who will develop OF in the further course of AP. Copyright © 2009 by Lippincott Williams & Wilkins.

OBJECTIVES: Studies on the clinical value of parameters of hemostasis in predicting pancreatitis-associated complications are still scarce. The aim of this prospective study was to identify the useful hemostatic markers for accurate determination of the subsequent development of organ failure (OF) during the very early course of acute pancreatitis (AP). METHODS: In 91 consecutive primarily admitted patients with AP, prothrombin time, activated partial thromboplastin time, fibrinogen, antithrombin III, protein C, plasminogen activator inhibitor 1, d-dimer, and plasminogen were measured in plasma within the first 24 hours of admission and 24 hours thereafter. Two study groups comprising 24 patients with OF and 67 patients without OF were compared. RESULTS: Levels of prothrombin time, fibrinogen, and d-dimer on admission were significantly different between the OF and non-OF groups, and all these parameters plus antithrombin III were significantly different 24 hours later. A d-dimer value of 414.00 μg/L on admission was the best cutoff value in predicting the development of OF with sensitivity, specificity, and positive and negative predictive values of 90%, 89%, 75%, and 96%, respectively. CONCLUSIONS: Measurement of plasma levels of d-dimer on the admission is an accurate method for the identification of patients who will develop OF in the further course of AP. Copyright © 2009 by Lippincott Williams & Wilkins.

Background. Development of abdominal compartment syndrome (ACS) in patients with severe acute pancreatitis (SAP) has a strong impact on the course of disease. Number of patients with this complication increases during the years due more aggressive fluid resuscitation, much bigger proportion of patients who is treated conservatively or by minimal invasive approach, and efforts to delay open surgery. There have not been standard recommendations for a surgical or some other interventional treatment of patients who develop ACS during the SAP. The aim of DECOMPRESS study was to compare decompresive laparotomy with temporary abdominal closure and percutaneus puncture with placement of abdominal catheter in these patients. Methods. One hundred patients with ACS will be randomly allocated to two groups: I) decompresive laparotomy with temporary abdominal closure or II) percutaneus puncture with placement of abdominal catheter. Patients will be recruited from five hospitals in Belgrade during two years period. The primary endpoint is the mortality rate within hospitalization. Secondary endpoints are time interval between intervention and resolving of organ failure and multi organ dysfunction syndrome, incidence of infectious complications and duration of hospital and ICU stay. A total sample size of 100 patients was calculated to demonstrate that decompresive laparotomy with temporary abdominal closure can reduce mortality rate from 60% to 40% with 80% power at 5% alfa. Conclusion. DECOMPRESS study is designed to reveal a reduction in mortality and major morbidity by using decompresive laparotomy with temporary abdominal closure in comparison with percutaneus puncture with placement of abdominal catheter in patients with ACS during SAP. Trial registration. ClinicalTrials.gov Identifier: NTC00793715. Copyright © 2010 Radenkovic et al.

Lymphoma patients are at increased risk of thromboembolic events but thromboprophylaxis in these patients is largely underused. We sought to develop and validate a simple model, based on individual clinical and laboratory patient characteristics that would designate lymphoma patients at risk for thromboembolic event. The study population included 1,820 lymphoma patients who were treated in the Lymphoma Departments at the Clinics of Hematology, Clinical Center of Serbia and Clinical Center Kragujevac. The model was developed using data from a derivation cohort (n = 1,236), and further assessed in the validation cohort (n = 584). Sixty-five patients (5.3%) in the derivation cohort and 34 (5.8%) patients in the validation cohort developed thromboembolic events. The variables independently associated with risk for thromboembolism were: previous venous and/or arterial events, mediastinal involvement, BMI>30 kg/m2, reduced mobility, extranodal localization, development of neutropenia and hemoglobin level < 100g/L. Based on the risk model score, the population was divided into the following risk categories: low (score 0-1), intermediate (score 2-3), and high (score >3). For patients classified at risk (intermediate and high-risk scores), the model produced negative predictive value of 98.5%, positive predictive value of 25.1%, sensitivity of 75.4%, and specificity of 87.5%. A high-risk score had positive predictive value of 65.2%. The diagnostic performance measures retained similar values in the validation cohort. Developed prognostic Thrombosis Lymphoma – ThroLy score is more specific for lymphoma patients than any other available score targeting thrombosis in cancer patients. Am. J. Hematol. 91:1014–1019, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.