Browsing by Author "Nesic, Dejan (26023585700)"

Cardiovascular (CV) manifestations are common (35%–100%) in the multisystem inflammatory syndrome in children. Our study aimed to analyze treatment impact and CV involvement in patients with multisystem inflammatory syndrome in children. The retrospective cohort included 81 patients treated between April 2020 and December 2021 (9.3 ± 4.6 years). Elevated cardiac troponin I and pro-B-type natriuretic peptide were observed in 34.2% and 88.5% of patients, respectively. Myocardial dysfunction was observed in 50.6%. Children older than 10 years had a 4-fold increased risk of myocardial dysfunction (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.4–8.9; p = 0.006). A moderate negative correlation was proved between left ventricular ejection fraction and C-reactive protein (rr = −0.48; p < 0.001). More than one-fifth of the patients presented with shock. Coronary artery dilatation was observed in 6.2% of patients. Mild pericardial effusion was detected in 27.1% of children. On standard electrocardiogram, 52.6% of children had negative T waves in the inferior and/or precordial leads; transient QTc prolongation was registered in 43% of patients. Treatment failure was observed in 19 patients. Patients initially treated with intravenous immunoglobulins had 10-fold higher chances for treatment failure than patients treated with corticosteroids (OR 10.6, 95% CI 3.18–35.35; p < 0.001). CV manifestations were observed in more than half of the patients, with acute myocardial dysfunction being the most common, especially in children older than 10 years. We established a negative association between the degree of elevation of inflammatory markers and left ventricular ejection fraction. Patients treated with intravenous immunoglobulins who had CV manifestations had treatment failures more frequently than patients treated with corticosteroids. © 2022 Krasic et al.

Cardiovascular (CV) manifestations are common (35%–100%) in the multisystem inflammatory syndrome in children. Our study aimed to analyze treatment impact and CV involvement in patients with multisystem inflammatory syndrome in children. The retrospective cohort included 81 patients treated between April 2020 and December 2021 (9.3 ± 4.6 years). Elevated cardiac troponin I and pro-B-type natriuretic peptide were observed in 34.2% and 88.5% of patients, respectively. Myocardial dysfunction was observed in 50.6%. Children older than 10 years had a 4-fold increased risk of myocardial dysfunction (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.4–8.9; p = 0.006). A moderate negative correlation was proved between left ventricular ejection fraction and C-reactive protein (rr = −0.48; p < 0.001). More than one-fifth of the patients presented with shock. Coronary artery dilatation was observed in 6.2% of patients. Mild pericardial effusion was detected in 27.1% of children. On standard electrocardiogram, 52.6% of children had negative T waves in the inferior and/or precordial leads; transient QTc prolongation was registered in 43% of patients. Treatment failure was observed in 19 patients. Patients initially treated with intravenous immunoglobulins had 10-fold higher chances for treatment failure than patients treated with corticosteroids (OR 10.6, 95% CI 3.18–35.35; p < 0.001). CV manifestations were observed in more than half of the patients, with acute myocardial dysfunction being the most common, especially in children older than 10 years. We established a negative association between the degree of elevation of inflammatory markers and left ventricular ejection fraction. Patients treated with intravenous immunoglobulins who had CV manifestations had treatment failures more frequently than patients treated with corticosteroids. © 2022 Krasic et al.

Introduction: Neurofibromatosis type 1 (NF type 1) is an autosomal dominant disease with typical clinical manifestations, such as skin lesions, Lisch nodules, optic pathway gliomas, and neurofibromas, caused by the mutation of the NF1 gene. Visual evoked potentials (VEP) present a measure of the electrophysiological response of visual cortex to a visual stimulus. The role of VEP in the pathophysiology of NF type 1 is very complex and requires additional research. The Aim: We examined the differences between NF type 1 patients with normal and altered VEP and analyzed the correlation between the prolongation of P100 latency and disease severity. Materials and methods: Two groups were formed: a control group and a study group with NF type 1 patients. Based on the control group analysis, a threshold value for a normal VEP finding of 116 ms was obtained, and it was used to divide the study group into subgroups with normal and altered VEP. We proceeded with examining the differences in clinical manifestations of the disease between the subgroups, after which we checked if there is a correlation between the prolongation of the P100 latency and the severity of the clinical picture according to the Riccardi scale. Statistical analysis was performed using the Pearson chi-square test and the Spearman correlation test in the program SPSS 28.0, with levels of statistical significance p = 0.05 and p = 0.001. Results: In the group with the abnormal VEP we found a statistically significant more frequent occurrence of optic tract glioma (p = 0.008), tumors (p = 0.032), epilepsy (p = 0.043), and cognitive disorders (p = 0.028), while the other clinical signs had an equal prevalence in both groups. A moderately strong correlation (rs = 0.665) was observed between the prolongation of P100 latency and the severity of the clinical picture. Conclusion: Our results showed the important role of VEP in the description of clinical phenotypes of NF type 1. The authors of the study propose VEP to be included in the diagnostic algorithms designed for patients with NF type 1. Copyright © 2024 Jancic, Zarkovic, Nikolic, Ivancevic, Rovcanin and Nesic.

Introduction: Neurofibromatosis type 1 (NF type 1) is an autosomal dominant disease with typical clinical manifestations, such as skin lesions, Lisch nodules, optic pathway gliomas, and neurofibromas, caused by the mutation of the NF1 gene. Visual evoked potentials (VEP) present a measure of the electrophysiological response of visual cortex to a visual stimulus. The role of VEP in the pathophysiology of NF type 1 is very complex and requires additional research. The Aim: We examined the differences between NF type 1 patients with normal and altered VEP and analyzed the correlation between the prolongation of P100 latency and disease severity. Materials and methods: Two groups were formed: a control group and a study group with NF type 1 patients. Based on the control group analysis, a threshold value for a normal VEP finding of 116 ms was obtained, and it was used to divide the study group into subgroups with normal and altered VEP. We proceeded with examining the differences in clinical manifestations of the disease between the subgroups, after which we checked if there is a correlation between the prolongation of the P100 latency and the severity of the clinical picture according to the Riccardi scale. Statistical analysis was performed using the Pearson chi-square test and the Spearman correlation test in the program SPSS 28.0, with levels of statistical significance p = 0.05 and p = 0.001. Results: In the group with the abnormal VEP we found a statistically significant more frequent occurrence of optic tract glioma (p = 0.008), tumors (p = 0.032), epilepsy (p = 0.043), and cognitive disorders (p = 0.028), while the other clinical signs had an equal prevalence in both groups. A moderately strong correlation (rs = 0.665) was observed between the prolongation of P100 latency and the severity of the clinical picture. Conclusion: Our results showed the important role of VEP in the description of clinical phenotypes of NF type 1. The authors of the study propose VEP to be included in the diagnostic algorithms designed for patients with NF type 1. Copyright © 2024 Jancic, Zarkovic, Nikolic, Ivancevic, Rovcanin and Nesic.

Internet addiction is a novel and relatively uninvestigated form of dependence that is fairly common in adolescent population. Previous research has indicated that it may be associated with other mental health problems, such as dysthymic mood and narcissistic behavior. In our study, we tested the existence and strength of relationship between Internet addiction, self-esteem and narcissism in a student population. On a sample of 244 students, we also investigated social networking activities, such as number of self-portrait photographs (“selfies”), and their potential connection with self-esteem and narcissism. Each participant completed a questionnaire consisting of Young Internet Addiction Test, Rosenberg Self-Esteem scale, and Narcissistic Personality Inventory. There was a statistically significant negative correlation between internet addiction score and self-esteem. Internet addiction increased as self-esteem decreased and vice versa. On the other hand, there was a positive correlation between internet addiction and narcissism. NPI score and number of self-portrait photographs (selfies) on Facebook were also in a positive relationship. Conversely, NPI score increased as the self-esteem decreased. The results of the study are in accordance with our previous findings on Internet use and mental health, confirming that Internet addiction is a potentially a serious public health problem. © 2017 Elsevier B.V.

Internet addiction is a novel and relatively uninvestigated form of dependence that is fairly common in adolescent population. Previous research has indicated that it may be associated with other mental health problems, such as dysthymic mood and narcissistic behavior. In our study, we tested the existence and strength of relationship between Internet addiction, self-esteem and narcissism in a student population. On a sample of 244 students, we also investigated social networking activities, such as number of self-portrait photographs (“selfies”), and their potential connection with self-esteem and narcissism. Each participant completed a questionnaire consisting of Young Internet Addiction Test, Rosenberg Self-Esteem scale, and Narcissistic Personality Inventory. There was a statistically significant negative correlation between internet addiction score and self-esteem. Internet addiction increased as self-esteem decreased and vice versa. On the other hand, there was a positive correlation between internet addiction and narcissism. NPI score and number of self-portrait photographs (selfies) on Facebook were also in a positive relationship. Conversely, NPI score increased as the self-esteem decreased. The results of the study are in accordance with our previous findings on Internet use and mental health, confirming that Internet addiction is a potentially a serious public health problem. © 2017 Elsevier B.V.

Decellularized corneas offer a promising and sustainable source of replacement grafts, mimicking native tissue and reducing the risk of immune rejection post-transplantation. Despite great success in achieving acellular scaffolds, little consensus exists regarding the quality of the decellularized extracellular matrix. Metrics used to evaluate extracellular matrix performance are study-specific, subjective, and semi-quantitative. Thus, this work focused on developing a computational method to examine the effectiveness of corneal decellularization. We combined conventional semi-quantitative histological assessments and automated scaffold evaluations based on textual image analyses to assess decellularization efficiency. Our study highlights that it is possible to develop contemporary machine learning (ML) models based on random forests and support vector machine algorithms, which can identify regions of interest in acellularized corneal stromal tissue with relatively high accuracy. These results provide a platform for developing machine learning biosensing systems for evaluating subtle morphological changes in decellularized scaffolds, which are crucial for assessing their functionality. Copyright © 2023 Pantic, Cumic, Valjarevic, Shakeel, Wang, Vurivi, Daoud, Chan, Petroianu, Shibru, Ali, Nesic, Salih, Butt and Corridon.

Decellularized corneas offer a promising and sustainable source of replacement grafts, mimicking native tissue and reducing the risk of immune rejection post-transplantation. Despite great success in achieving acellular scaffolds, little consensus exists regarding the quality of the decellularized extracellular matrix. Metrics used to evaluate extracellular matrix performance are study-specific, subjective, and semi-quantitative. Thus, this work focused on developing a computational method to examine the effectiveness of corneal decellularization. We combined conventional semi-quantitative histological assessments and automated scaffold evaluations based on textual image analyses to assess decellularization efficiency. Our study highlights that it is possible to develop contemporary machine learning (ML) models based on random forests and support vector machine algorithms, which can identify regions of interest in acellularized corneal stromal tissue with relatively high accuracy. These results provide a platform for developing machine learning biosensing systems for evaluating subtle morphological changes in decellularized scaffolds, which are crucial for assessing their functionality. Copyright © 2023 Pantic, Cumic, Valjarevic, Shakeel, Wang, Vurivi, Daoud, Chan, Petroianu, Shibru, Ali, Nesic, Salih, Butt and Corridon.

Objective: Myocarditis has spontaneous resolution in 50% of patients. Our study aimed to define risk factors for developing dilated cardiomyopathy (DCM) and death in pediatric patients with acute myocarditis (AM). Methods: The retrospective cohort study included all patients with treated AM. The Mother and Child Health Institute from January 2011 to March 2019. Results: In the study, 62 patients were included, 40 boys and 22 girls (11.15±5.86 years) with AM. Twelve out of sixty-two children had acute fulminant myocarditis. Four patients died in the acute phase of AM, and 11 developed DCM. Follow up was 27.14±36.52 months. Patients with poor outcome (DCM development) were under the age of seven (odds ratio [OR] 10.1; p=0.003), more likely to be girls (OR 4.6; p=0.03), and had fulminant myocarditis (OR 27.0; <0.001). An ejection fraction (EF) <55% and fractional shortening (FS) <30% increased risk of DCM 13- and 5-fold, respectively, but patients with EF between 40 and 55% remain at highest risk of developing DCM. There was a 12-fold increased risk for DCM in patients with left ventricular end-diastolic diameter Z score >2+. The receiver operator curve showed that the lactate dehydrogenase (LDH) cut-off value for developing DCM was 1780 mmol/l (sensitivity 80%, specificity 100%). Conclusion: Acute fulminant myocarditis was an independent risk factor for DCM. Children with EF between 40 and 50% at admission were at highest risk of developing DCM. Lactate dehydrogenase value could be a significant prognostic value for the outcome of pediatric myocarditis. © 2021 Sociedade Portuguesa de Cardiologia

Objectives: The bicuspid aortic valve (BAV) is the most common congenital heart defect. Patients with BAV frequently develop aortopathy, which depends on the dysfunction and morphotype of the BAV. Aim: The aim of our study was to compare the echocardiography and cardiac magnetic resonance (CMR) findings in BAV patients, and to define the risks of BAV dysfunction and aortopathy. Methods: The retrospective study included 50 patients (68% male) with BAV, with an average age of 13.6 ± 3.9 years, who underwent a transthoracic echocardiographic examination and CMR at our institute from 2012 to 2020. Results: The BAV types were evaluated significantly differently by echocardiography and CMR (p = 0.013). 54% of patients had BAV insufficiency on echo and 70% on echo CMR. It was more prevalent in males, older patients, and patients with a higher body surface area. By comparing the degree of insufficiency measured by echo (1+, IQR 0–1), and CMR (0, IQR 0–1), a significant difference was observed (p = 0.04), while a moderate positive correlation was proved (rr = 0.4; p = 0.004). Stenosis was registered in 44% of patients by echo, while 58% had stenosis on CMR. The peak pressure gradient measured by echo was significantly higher than the velocity on CMR (41, IQR 22.7–52.5 mmHg vs. 23, IQR 15.5–35.0 mmHg; p = 0.002). Aortopathy was registered in 76% of patients on echo and 78% on CMR; 38% of patients had severe aortic dilatation on echo and 54% on CMR (p = 0.003). Patients with BAV stenosis on echo had more frequent dilatation of the tubular ascending aorta (15/24 pts; p = 0.02). All patients with BAV insufficiency on CMR had aortopathy (p = 0.04) and had enlargement of the sinus of Valsalva and sinotubular junction. In patients with associated coarctation, the development of aortopathy occurred less frequently than those without coarctation (7/39 vs. 32/39; p = 0.003). The Bland-Altman method, a specific type of scatterplot that is used to visualize the results of comparing two measures, demonstrated the existence of agreement between the two methods, and a level of agreement between the methods of 95% was demonstrated. Conclusion: Our study indicated significant differences in the measured BAV morphotype and dysfunction when comparing the two diagnostic methods. On the other hand, moderate to strong correlations were found in the evaluated parameters, which indicates the importance of performing noninvasive diagnostic procedures in the follow-up of these patients. 2024 Krasic, Zec, Topic, Popovic, Nesic, Zdravkovic and Vukomanovic.

Background: Acute myocarditis (AM) is defined as inflammation of the myocardium. The aim of our study is a comparative analysis of the differences between AM related and unrelated to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: The retrospective study included children with AM treated from January 2018 to November 2020. Results: The study included 24 patients; 7 of 24 had AM related to SARS-CoV-2 and they were older than 7. They were more likely to have abdominal pain (P = 0.014), headache (P = 0.003), cutaneous rash (P = 0.003), and conjunctivitis (P = 0.003), while fulminant myocarditis was commonly registered in AM unrelated to SARS-CoV-2 (P = 0.04). A multisystem inflammatory syndrome in children associated with COVID-19 was diagnosed in six adolescents. Patients with AM related SARS-CoV-2 had lower serum cardiac troponin I (cTnI) (P = 0.012), and platelets (P < 0.001), but had a higher C-reactive protein (CRP) value (P = 0.04), and N-terminal-pro hormone BNP in comparison to patients with AM unrelated to SARS-CoV-2. The patients with AM related to SARS-CoV-2 had significant reduction of CRP (P = 0.007). Inotropic drug support was used for shorter durations in patients with AM related to SARS-CoV-2, than in others (P = 0.02). Children with AM related to SARS-CoV-2 had significant improvement of left ventricle systolic function on the third day in hospital (P = 0.001). Patients with AM unrelated to SARS-CoV-2 AM had more frequent adverse outcomes (P = 0.04; three died and four dilated cardiomyopathy). Conclusions: In contrast to patients with AM unrelated to SARS-CoV-2, patients with AM related to SARS-CoV-2 had a higher CRP value, polymorphic clinical presentation, shorter durations of inotropic drugs use as well as prompt recovery of left ventricle systolic function. © 2021 Lippincott Williams and Wilkins. All rights reserved.

Background and Objectives: Recurrence of pericarditis (ROP) is an important complication of the acute pericarditis. The aim of this study was to analyse the influence of aetiology, clinical findings and treatment on the outcome of acute pericarditis. Methods: Data were retrospectively collected from medical records of patients treated from 2011 to 2019 at a tertiary referent heart paediatric center. Results: Our investigation included 56 children with idiopathic and viral pericarditis. Relapse was registered in 8/56 patients, 2/29 (7.41%) treated with nonsteroidal anti-inflammatory drugs (NSAID) and 6/27 (28.57%) treated with corticosteroids (CS) and NSAID. Independent risk factors for ROP were viral pericarditis (p = 0.01, OR 31.46), lack of myocardial affection (p = 0.03, OR 29.15), CS use (p = 0.02, OR 29.02) and ESR = 50 mm/h (p = 0.03, OR 25.23). In 4/8 patients the first recurrence was treated with NSAID and colchicine, while treatment of 4/8 patients included CS. Children with ROP treated with CS had higher median number of recurrence (5, IQR: 2-15) than those treated with colchicine (0, IQR: 0-0.75). Conclusions: Independent risk factors for recurrence are CS treatment, viral aetiology, pericarditis only and ESR = 50 mm/h. Acute pericarditis should be treated with NSAID. Colchicine and NSAID might be recommended in children with the first ROP. © 2019 by the authors. Licensee MDPI, Basel, Switzerland.

Background: Certain lifestyle characteristics, such as dietary patterns, physical activity, and maintenance of recommended body weight, low-risk alcohol consumption and non-smoking are associated with the lower likelihood for the development of chronic-non communicable disease in the general population. These lifestyles are called health promoting behaviors (HPBs). We aimed to examine the prevalence of the HPBs among the women of reproductive age in Serbia and the factors associated with the compliance with four or more of these behaviors. Methods: The study was the secondary analysis of the data from the National Health survey in Serbia from 2019 that examined social, health status, mental health (using PHQ-8) and lifestyle characteristics of the general population in Serbia. Results: The prevalence of compliance with four or more HPBs was 22%. Among the HPBs the most frequent was a non-risky alcohol consumption reported by 2585 participants (99.2%), followed by normal weight (201869.2%) and non-smoking (1469-69%), daily fruit and vegetables intake (969-33.2%) and sufficient aerobic PA (216-7.9%). Multivariate logistic regression analysis with four or more HPBs as an outcome variable showed that the association of compliance with four or more HPBs with tertiary education (OR 1.91, 95% CI: 1.32-2.76) use of prescription medications (OR: 0.62, 95% CI: 0.44-0.87) and score on PHQ-8 (OR: 0.88, 95% CI: 0.79-0.98). Conclusion: There is a need for deeper promotion of health-related behaviors among all educational and vocational groups, including health promotion activities at the primary health care level, which is available to the entire population. © 2024 Todorovic et al.

There is compelling evidence that postexercise heart rate recovery (HRR) is a valid indicator of sympaticovagal balance. It is also used in prescription and monitoring of athletic training. The purpose of our study was to determine HRR after maximal exercise among elite athletes with respect to age. A total of 274 elite male Caucasian athletes were randomly selected from the larger sample and divided into two groups: adolescent (group Y) and adult athletes (≥18 years; group A). They performed maximal cardiopulmonary exercise testing on a treadmill. Heart rate recovery was calculated as the rate of decline of HR from peak exercise to rates 1, 2 and 3 min after cessation of exercise (HRR1, HRR2 and HRR3). A significantly higher HRR1 was found in group A (29·5 ± 15·6 versus 22·4 ± 10·8, P<0·001), but HRR3 was higher in group Y (82·7 ± 10·2 versus 79·9 ± 12·25; P = 0·04). Stepwise multivariate linear regression analysis showed that, among all subjects, the HRR1 alone was independently associated with age (P<0·001). The maximal oxygen consumption (VO2 max) was in a negative relationship with HRR1 and in a positive one with HRR3 (P<0·05) with respect to all athletes. The HRR during 3 min postexercise should be reported for the purpose of better assessing functional adaptation to exercise among elite athletes as well as the age-associated differences in recovery. Higher values of HRR1 should be expected in older athletes, and HRR3 could be used as an index of aerobic capacity, irrespective of age. © 2015 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd

There is compelling evidence that postexercise heart rate recovery (HRR) is a valid indicator of sympaticovagal balance. It is also used in prescription and monitoring of athletic training. The purpose of our study was to determine HRR after maximal exercise among elite athletes with respect to age. A total of 274 elite male Caucasian athletes were randomly selected from the larger sample and divided into two groups: adolescent (group Y) and adult athletes (≥18 years; group A). They performed maximal cardiopulmonary exercise testing on a treadmill. Heart rate recovery was calculated as the rate of decline of HR from peak exercise to rates 1, 2 and 3 min after cessation of exercise (HRR1, HRR2 and HRR3). A significantly higher HRR1 was found in group A (29·5 ± 15·6 versus 22·4 ± 10·8, P<0·001), but HRR3 was higher in group Y (82·7 ± 10·2 versus 79·9 ± 12·25; P = 0·04). Stepwise multivariate linear regression analysis showed that, among all subjects, the HRR1 alone was independently associated with age (P<0·001). The maximal oxygen consumption (VO2 max) was in a negative relationship with HRR1 and in a positive one with HRR3 (P<0·05) with respect to all athletes. The HRR during 3 min postexercise should be reported for the purpose of better assessing functional adaptation to exercise among elite athletes as well as the age-associated differences in recovery. Higher values of HRR1 should be expected in older athletes, and HRR3 could be used as an index of aerobic capacity, irrespective of age. © 2015 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd

The novel coronavirus disease (COVID-19) may induce multisystem inflammatory syndrome (MIS) in children, which may be associated with Kawasaki-like disease and cardiac injury. In this study, we presented three male adolescents with MIS and myocardial injury admitted to the hospital during the peak of COVID-19 pandemic. All of the three patients had a history of fever, gastrointestinal symptoms, polymorph rash, non-exudative conjunctivitis, and signs of acute myocarditis (AM). One of them had renal failure. Previously, they did not have an acute infection. Upon admission, they were hypotensive and tachycardic. A nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on reverse transcription-polymerase chain reaction (PCR) assay was negative, but neutralizing viral antibodies were positive. In combination with blood tests, electrocardiogram, echocardiography, and computerized tomography, a MIS associated with acute myocarditis with mild to moderate systolic dysfunction and dilated coronary arteries were diagnosed. Two of three patients had shock syndrome and required inotropic support. All patients were treated with intravenous immunoglobulins (Ig). The second patient had a fever up to 102.2°F (39°C) 3 days after intravenous Ig. Further, he was treated according to protocols for refractory Kawasaki disease, with an intravenous methylprednisolone pulse therapy and aspirin. After a few hours, he became afebrile and the clinical signs disappeared. The favorable short-term outcome may reflect early recognition and adequate therapy; however, the long-term outcomes are currently unknown. © The Author(s) (2021).

Background: Multisystem inflammatory syndrome in children (MIS-C) associated with being infected with coronavirus-19 (COVID-19) is a life-threatening condition resulting from cytokine storm, increased synthesis of reactive oxygen species (ROSs), and hyperinflammation occurring in genetically predisposed children following an infection with SARS-CoV-2. Aim: The primary aims of our study were to identify changes in the activity of antioxidant enzymes in erythrocytes and total oxidative status in plasma after being treated with methylprednisolone (MP). Methods: A prospective cohort study of 67 children (56.7% male) under 18 with MIS-C being treated with MP was conducted at the Mother and Child Health Institute from January 2021 to April 2022. The impact of the therapy was assessed on the basis of the clinical condition, haematological and biochemical blood parameters, and echocardiographic findings. Results: 59.7% of patients presented cardiovascular (CV) manifestations, while myocardial dysfunction was observed in half of all patients (50.7%). A severe clinical course was observed in 22/67 patients. Children with CV involvement had a significantly higher relative concentration of B lymphocytes and lower relative concentration of NK cells than patients without CV issues (p < 0.001 and p = 0.004, respectively). Patients with severe MIS-C had a lower relative count of NK cells than those with moderate MIS-C (p = 0.015). Patients with myocardial dysfunction had a higher total oxidative plasma status (TOPS) than children without (p = 0.05), which implicates pronounced oxidative stress in the former cohort. In patients with shock, lower erythrocytes superoxide dismutase (SOD) activity was observed on admission compared to patients without shock (p = 0.04). After MP was administered, TOPS was significantly reduced, while catalase (CAT) and SOD activity increased significantly. Treatment failure (TF) was observed in 6 patients, only females (p=0.005). These patients were younger (p=0.05) and had lower CAT activity on admission (p=0.04) than patients with favorable treatment responses. In the group of patients with TF, TOPS increased after treatment (before 176.2 ± 10.3 mV, after 199.0 ± 36.7 mV). Conclusion: MP leads to rapid modulation of TOPS and increases the activity of antioxidant enzymes in erythrocytes resulting in clinical and echocardiographic improvement. Based on the observed changes in the activity of the antioxidant enzymes, we can conclude that s hydrogen peroxide is the dominant ROS in patients with MIS-C. Patients with TF showed reduced CAT activity, whereas the treatment with MP led to pronounced oxidation. This implies that low CAT activity may be a contraindication for using MP. Copyright © 2023 Krasic, Vukomanovic, Ninic, Pasic, Samardzija, Mitrovic, Cehic, Nesic and Bajcetic.

Background: Multisystem inflammatory syndrome in children (MIS-C) associated with being infected with coronavirus-19 (COVID-19) is a life-threatening condition resulting from cytokine storm, increased synthesis of reactive oxygen species (ROSs), and hyperinflammation occurring in genetically predisposed children following an infection with SARS-CoV-2. Aim: The primary aims of our study were to identify changes in the activity of antioxidant enzymes in erythrocytes and total oxidative status in plasma after being treated with methylprednisolone (MP). Methods: A prospective cohort study of 67 children (56.7% male) under 18 with MIS-C being treated with MP was conducted at the Mother and Child Health Institute from January 2021 to April 2022. The impact of the therapy was assessed on the basis of the clinical condition, haematological and biochemical blood parameters, and echocardiographic findings. Results: 59.7% of patients presented cardiovascular (CV) manifestations, while myocardial dysfunction was observed in half of all patients (50.7%). A severe clinical course was observed in 22/67 patients. Children with CV involvement had a significantly higher relative concentration of B lymphocytes and lower relative concentration of NK cells than patients without CV issues (p < 0.001 and p = 0.004, respectively). Patients with severe MIS-C had a lower relative count of NK cells than those with moderate MIS-C (p = 0.015). Patients with myocardial dysfunction had a higher total oxidative plasma status (TOPS) than children without (p = 0.05), which implicates pronounced oxidative stress in the former cohort. In patients with shock, lower erythrocytes superoxide dismutase (SOD) activity was observed on admission compared to patients without shock (p = 0.04). After MP was administered, TOPS was significantly reduced, while catalase (CAT) and SOD activity increased significantly. Treatment failure (TF) was observed in 6 patients, only females (p=0.005). These patients were younger (p=0.05) and had lower CAT activity on admission (p=0.04) than patients with favorable treatment responses. In the group of patients with TF, TOPS increased after treatment (before 176.2 ± 10.3 mV, after 199.0 ± 36.7 mV). Conclusion: MP leads to rapid modulation of TOPS and increases the activity of antioxidant enzymes in erythrocytes resulting in clinical and echocardiographic improvement. Based on the observed changes in the activity of the antioxidant enzymes, we can conclude that s hydrogen peroxide is the dominant ROS in patients with MIS-C. Patients with TF showed reduced CAT activity, whereas the treatment with MP led to pronounced oxidation. This implies that low CAT activity may be a contraindication for using MP. Copyright © 2023 Krasic, Vukomanovic, Ninic, Pasic, Samardzija, Mitrovic, Cehic, Nesic and Bajcetic.

Background: In multisystem inflammatory syndrome in children (MIS-C) temporarily associated with coronavirus disease-19 (COVID-19), myocardial damage has been reported. Materials and Methods: A retrospective observational cohort study included children under 18 who had a myocardial injury related to COVID-19 treated in mother and child health institute from April 2020 to August 2020. Myocardial injury related to COVID-19 was manifested by elevated serum cardiac troponin and NT-proBNP with LV dysfunction, arrhythmias, and coronary arteries (CAs) dilatation or aneurysms. During the short-term follow-up, cardiac testing (electrocardiography, laboratory analysis, echocardiography, 24-h Holter monitoring, exercise stress test, and cardiac magnetic resonance) was performed. Results: Six male adolescents (14.7 ± 2.4 years) were included in the analysis (2/6 had MIS-C shock syndrome). All patients had elevated acute-phase reactants and NT-proBNP, whereas troponins were elevated in 5/6 patients. Echocardiography revealed left ventricular (LV) systolic dysfunction (EF 45.2 ± 6.9%); 2/6 had dilated CAs. IVIG was prescribed to all patients with MIS-C. Four patients required inotropic drug support. During hospitalization, a significant reduction of CRP, LDH, NT-proBNP, and D-dimer (P < 0.05) was registered. LV systolic function recovery was registered 3 days after applied therapy (P < 0.001). None of the patients developed dilated cardiomyopathy or CA aneurysms. Conclusions: With early recognition and adequate MIS-C therapy, children recovered entirely, maintained in the short-term follow-up period. © 2020 Wolters Kluwer Medknow Publications. All rights reserved.

Introduction: The ability of airline pilots to maintain a good level of sleep goes a long way in ensuring operational effectiveness with regard to safety as well as personal health. The study assesses the risk factors for sleep quality of airline pilots in Serbia with the objective of determining those factors, both occupational and lifestyle that are paramount in assisting with sleep health. Methods: A cross-sectional study was conducted on a total of 66 Serbian commercial pilots, and the Pittsburgh Sleep Quality Index (PSQI) was used to assess their sleep quality. Demographic, occupational, lifestyle, biological and psychological variables were obtained through validated questionnaires. Multivariate logistic regression was used to determine the predictors of poor sleep quality (PSQI ≥5). Results: Overall sleep quality was poor in 65.2% of the participants. Significant factors associated with poor sleep quality included years of experience (OR = 1.17, p = 0.007) and levels of stress (OR = 2.87, p = 0.004). Particular lifestyle variables, including factors such as coffee intake, had initial relationships with sleep quality but were not significant in the multivariate models. With regard to age, a significant univariate association was also revealed but was dropped in the final model because of collinearity with years of experience. Conclusion: Serbian commercial pilots have a relatively high risk of inadequate sleep associated with years of experience and levels of stress. There is a need to implement organization-wide changes such as stress management schemes in order to improve sleep quality among pilots, and foster prioritizing well-being. Copyright © 2025 Stojanović, Nesic, Maksimović, Terzić-Šupić, Todorović, Topalović, Vlaisavljević and Ilić Živojinović.