Browsing by Author "Nikolić, Dejan (26023650800)"

Introduction. Aortic coarcation is a congenital condition mostly detected and treated during childhood. Adult patients with coarctation and associated cardiac lesions represent a challenge and a subject of debates concerning adequate treatment. We report 2 patients with aortic coartation when a surgical treatment was necessary. Case report. First patient was a 61-year-old male with previous mechanical aortic valve implantation. He underwent one stage surgical reconstruction of aortic coarctation and surgical repair of aneurysm of ascending aorta. The second patient was a 49-year-old female with aortic aneurysm, bicuspid aortic valve, severe aortic insufficiency and coarctation of aorta below branching of subclavian artery. She underwent the Bentall procedure and surgical repair of coarctation by bypass where the proximal anastomosis was made between the terminal part of Dacron graft and the lateral part of graft used for Bentall, while the distal anastomosis was made between the terminal part of Dacron graft and the lateral part of descending aorta below coarctation. The postoperative course and the follow-up of the patients of 3 and 1 year, respectively, were without complications. Conclusion. Single operation is a better choice in the patients with concomitant pathology such as the aortic aneurysm, or aortic valve disease. Each patient should be analyzed on a single basis, and a decision about a surgical technique and surgical course brought accordingly. © 2019 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Celiac disease is a multisystemic autoimmune disease induced by gluten in wheat, rye, and barley. It is characterized by polygenic predisposition, prevailing prevalence in members of the white population (1%), especially in close relatives (5–15%), very heterogeneous expression and frequent association with other autoimmune diseases (3–10%), as well as selective deficiency of IgA and Down, Turner, and Williams syndromes. The basis of the disease and the key finding in its diagnostics is gluten-sensitive enteropathy, i.e., non-specific inflammation of the small intestinal mucosa which resolves by gluten-free diet. In addition to enteropathy, whether symptomatic or asymptomatic, the disease is also characterized by various extraintestinal manifestations, and even very serious complications. Therapy is based on a lifelong gluten-free diet, so that the disorder, if diagnosed in time and treated consistently, has an excellent prognosis. © 2023, Serbia Medical Society. All rights reserved.

Introduction Idiopathic ulcerative colitis (IUC) represents a rare disease of childhood. It usually occurs at age over 10 years, and below that exceptionally rarely. Objective The aim of the paper was to analyze the clinical signs, symptoms and therapeutic procedures in children with IUC. Methods The aims of the paper were based on a sample of 17 children (11 male and 6 female, mean age 11.90±3.50 years; range 3.8-17.5 years) with IUC. The disease diagnosis was based on characteristic endoscopic and pathohistological findings. Results The basic signs of the disease involved chronic mucosal haemorrhagic diarrhoea which was confirmed in 16 of 17 patients, with body weight deficiency (10), recurrent abdominal pain (6), fever (5), slowed-down maturation (5), marked anorexia (4), and tenesmus (3). Two patients had recurrent aphthous stomatitis, 2 anal fissures, 2 arthralgia, one autoimmune hepatitis and one pyoderma gangrenosum. None of the children had longitudinal growth retardation. Elevated sedimentation rate and C-reactive protein in blood were registered in 11, sideropenia in 10, anaemia in 6 and hypoalbuminemia in 3 patients. The remission of proctosigmoiditis and left-sided colitis was achieved with aminosalicylates, and of pancolitis with the combination of aminosalicylates and glucocorticoids, except in cases of steroid-dependent colitis, which additionally required azathioprine. Conclusion The main signs of IUC in children are chronic mucous haemorrhagic diarrhoea, body weight loss and sideropenic anaemia, while the basic therapy consists of aminosalicylates, and in more severe cases of the disease the initial use of glucocorticoids and later azathioprine.

Introduction/Objective The aim of this paper was to examine proportion of patients with arterial abnormalities of feet due to age and severity degree of pes metatarsus varus (PMV), and to evaluate the treatment duration and outcome. Methods The prospective longitudinal study included 240 patients with congenital PMV classified into three age groups: group < 3 months of life (Group 1), group 3–9 months (Group 2), and group 9–12 months (Group 3). Three categories of PMV were analyzed: mild/moderate/severe. Groups with arterial anomalies (Group A) and without (Group B) were analyzed. Clinical outcome was graded as: good/satisfactory/poor. Results There is statistically significant difference in distribution of children regarding age and severity degree on first visit and presence of feet arterial abnormalities (p < 0.01). For Group A, younger children had longer physical therapy, while for Group B, older children had longer duration of physical therapy. Same trend applies as severity degree of foot deformity increase. In Group A, the most frequent treatment outcome was poor (for Group 1 – 46.7%; Group 2 – 60%; Group 3 – 62%), while in Group B for Group 1 and Group 2 it was frequently good (Group 1 – 90%; Group 2 – 40%), and for Group 3 frequently satisfactory (Group 3 – 53.3%). Conclusion In children with PMV it might be advisable to perform ultrasound evaluation of arterial structure of feet, and particularly in cases were such deformity is more severe. © 2019, Serbia Medical Society. All rights reserved.

Background/Aim. The hypercoagulable state and inflammation state in diabetics has been widely studied by previous researchers, but there is a lack of research about a possible impact of exercise training on this relationship. The aim of this study was to assess and compare correlation between the coagulation and inflammation status in patients with type 2 diabetes mellitus taking into account the gender differences as well as an impact of the 8-week exercise training on the correlation coefficient and parameters of the inflammation and coagulation state. Methods. A total of 60 patients in stable clinical condition and well-regulated diabetic status passed through all phases of the study. The exercise training included the exercise program as interval training with estimated intensity uphill to 75% of a maximal heart rate in particular individual, 5 times a week for 8 weeks, and walking for 30 minutes with a speed of 5 km/h, 5 times a week for 8 weeks. Further fibrinolytic, coagulation and inflammatory parameters were analyzed before and after the study: D-dimer, von Willebrand factor (vWF), fibrinogen, high sensitivity CRP (hs-CRP), leukocytes, thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT) and coagulation factors: FII, FV, FVII and FX. Results. Our research showed a statistically significant reduction in the mean vWF levels after intervention both at the males (p < 0.001) and females (p < 0.001). According to a correlation analysis between hs-CRP and fibrinogen, there was a positive correlation as baseline both at the males (p < 0.05, r = 0.492) and females (p < 0.01, r = 0.516) which became weaker in the males (p < 0.01, r = 0.449) and disappeared in the females (p < 0.05, r = 0.059) after intervention. The correlation which existed as baseline in the males between D-dimer and either hs-CRP (p < 0.01, r = 0.633) or fibrinogen (p < 0.01, r = 0.673) as well as the correlation between hs-CRP and FII (p < 0.01, r = 0.728), FV (p < 0.05, r = 0.366), FVII (p < 0.05, r = 0.373) coagulation as well as between D-dimer and FII (p < 0.01, r = 0.851), FVII (p < 0.05, r = 0.367)was absent in the females. Our research demonstrated a weakening correlations in the males after intervention between D-dimer and hs-CRP (p < 0.05, r = 0.378), between hs-CRP and FII (p < 0.01, r = 0.501), FV (p < 0.05, r = 0.298), FVII (p < 0.05, r = 0.351) as well as between D-dimer and FII (p < 0.01, r = 0.759), and FVII (p < 0.05, r = 0.296). The increase of the FX values (p < 0.05) in the females after intervention suggested the possible antiinflammatory effect of exercise training. Conclusion. According to previous research, the higher levels of vWF was associated with a risk of cardiovascular disease in people with type 2 diabetes mellitus and vWF may be a risk factor unique to these populations. We demonstrated that the 8-week exercise training can significantly reduce the value of vWF in the males and females, suggesting a potential beneficial effect on the endothelial function parameters. Our research demonstrated a stronger correlation between the coagulation and inflammation parameters as baseline in the males than in the females with type 2 diabetes mellitus. According to our results, the 8-week exercise training lead to a weakening of the strength of correlation between the coagulation and inflammation parameters in the males and complete disappearance of this correlation in the females, suggesting a unique effect of exercise training that should be explored in future research. © 2019, Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Aim To evaluate correlation of atherogenic risk factors between patients with retinal artery occlusion (RAO) and matched population, including those with central RAO and branch RAO. Methods Seventy-two participants from 2 groups were evaluated: a group with diagnosed RAO (first group; 45 participants) and a matched control group including those without RAO or any other ophthalmological disease (second group; 27 participants). From those with diagnosed RAO patients with central RAO and patients with branch RAO were evaluated separately. Additional parameters that were observed included body mass index (BMI), blood pressure, fasting glucose levels, triglycerides, LDL and HDL cholesterol fractions levels, presence of metabolic syndrome and hyperlipoproteinemia. Results There was a significant increase of LDL mean values in the group of patients with RAO. Hypertension (88.9%), hyperlipoproteinemia (68.9%) and metabolic syndrome (53.3%) were significantly more frequent in patients with RAO, while gender and diabetes mellitus were not in direct correlation with the development of RAO. The group of patients with RAO had no significantly higher values of BMI compared to the control. High density lipoprotein fraction was significantly higher in the group of patients with central RAO as compared with those with branch RAO. Conclusion Patients with atherogenic risk factors are more prone to the development of RAO. Furthermore, we demonstrated that HDL had more protective effects on smaller blood vessels (branch retinal artery) than on larger blood vessels (central retinal artery).

Introduction: Our study of genetic homozygosity degree includes an analysis of the presence, distribution and individual combination of 15 selected genetically controlled morphophysiological traits in the sample of patients with spinal dysraphia (N=35) and in the control-healthy group (N=50). OBJECTIVE Assuming that spinal dysraphia is a genetically controlled disease, we made a hypothesis that an increased homozygosity level, as well as the changed variability among patients, could be a population-genetic parameter for the prediction of the illness. METHOD Taking into consideration our experience, as well as the experience of numerous scientists who studied the nature of the inheritance of mono- and oligo-genically controlled qualitative traits, we applied a methodology to estimate the proportion of such homozygously recessive characters (HRC-test,). RESULTS This population-genetic study did not only show a statistically significant difference of the mean values of genetic homozygosity (SD 4.8±0.3; control 3.5±0.3), but of the differences in the type of distribution too, as well as the differences in the presence of certain individual combinations of such traits. Conclusion: Due to the fact that those genes which control such qualitative recessive traits are distributed in different human chromosomes, being their visible markers, this could indicate that degrees of genetic homozygosity are ostensibly greater in a sample of patients with spinal dysraphia compared to the control group of individuals.

Introduction/Objective The aim of the paper was to evaluate the short-term effectiveness of ultrasound treatment procedure on defined clinical parameters and changes of electrodiagnostic parameters at the median nerve in carpal tunnel syndrome patients. Methods Thirty-five patients (50 hands) were randomly divided into two groups: the experimental group (EG) (20 patients (29 hands)) and the control group (CG) (15 patients (21 hands)). Twenty sessions of ultrasound treatment were performed over a period of seven weeks and control examination was performed during the eighth week from the initial session. Clinical assessment parameters (pain intensity, superficial sensibility, and Tinel sign), and electrodiagnostic parameters (motor distal latency – mDL), median sensory nerve conduction velocity (SNCV), and median sensory nerve action potential (SNAP) were assessed both at baseline (T1) and at control (T2). Results There is significant improvement of pain intensity (T1 – 10.4/58.6/31; T2 – 65.5/27.6/6.9; p < 0.001) and superficial sensibility (T1 – 3.4/69/27.6; T2 – 44.8/34.5/20.7; p < 0.001) in the EG after the treatment. In the EG, there is significant reduction in frequency of positive Tinel’s sign (T1 – 100/0; T2 – 62.1/37.9; p < 0.001), and mDL significantly decreased after the treatment (T1 – 4.7 ± 1.3; T2 – 4.5 ± 1.2; p = 0.007), while SNAP (T1 – 20.2 ± 15.4; T2 – 24.4 ± 16.5; p < 0.001) and SNCV (T1 – 36.5 ± 9.8; T2 – 42.6 ± 9.7; p < 0.001) significantly increased. Conclusion Ultrasound treatment along with exercises have positive short-term effects and benefits on improvement of clinical and electrodiagnostic findings in individuals with carpal tunnel syndrome. © 2018, Serbia Medical Society. All rights reserved.

Background/Aim. There are studies stressing out that atherosclerosis is most common associated systemic condition in patients with retinal artery occlusion. The aim of this study was to analyze values of body mass index and lipid fractions in healthy individuals and patients with retinal artery occlusion. Methods. This study included 90 participants during a 6-year period. The population was divided into 2 groups: the group with the diagnosed retinal artery occlusion and the group without retinal artery occlusion. The observed parameters were as follows: body mass index, low and high density lipoproteins and triglycerides. Results. The study revealed no significant difference regarding body mass index and triglycerides values between the two evaluated groups, while low and high density lipoproteins values were significantly higher in the group of patients with retinal artery occlusion. Conclusions. The study demonstrated that body mass index and triglycerides have less important role in atherogenic pathogenesis of retinal artery occlusion, while low density lipoprotein is the fraction that is shown to be most potent in such etiological processes.

Introduction/Objective Idiopathic scoliosis (IS) is an orthopedic condition of multifactorial origin. The aim of our study was to evaluate the factors that are associated with IS in female population and factors associated with varicose veins in females with IS. Methods This retrospective-prospective cross-section study included 89 patients (the study group) and 87 controls. The following parameters were analyzed: body weight, body height, presence and the degree of varicose veins (the first, second, and third degree), and age (group in the range of 17–26 years, in the range of 27–36 years, and in the range of 37–46 years). Results The study group has significantly lower body weight (p = 0.046), significantly higher proportion of varicose veins (p < 0.001) compared to controls, significantly lower proportion of patients aged 27–36 years (p = 0.014), and significantly higher proportion of patients aged 37–46 years (p = 0.025) compared to controls. There is significantly higher proportion of patients in the study group with the first degree of varicose veins (p = 0.007). There is weak positive correlation between body weight and body height in the group of patients without varicose veins (R = 0.456) and in the group with the second degree of varicose veins (R = 0.291), while for the group with the first degree of varicose veins there is moderate positive correlation (R = 0.543). Conclusion Our preliminary findings point out that lower body weight and presence of varicose veins are significantly associated with IS. The group of patients with IS above 37 years of age tends to have significantly higher proportion of varicose veins. © 2017, Serbia Medical Society. All rights reserved.

Introduction/Objective Anemia is the most common extraintestinal manifestation of celiac disease (CD) in children. The aim of this study was to determine the frequency, severity and type of anemia in children with a classical CD, as well as the differences between anemic and non-anemic patients in their age, duration of illness, percentile body length or height, percentage of body weight (BW) deviation compared to ideal, and the degree of damage to the small intestine mucosa. Methods The study was based on a sample of 90 children, 56 females and 34 males, ages 7-90 (18.23 ± 12.7) months with classical CD. The diagnosis of CD is based on the ESPGHAN criteria from 1990 and 2012, and of anemia on the 2011 WHO reference values. Results Anemia was found in 47 (52.22%) patients, of which it was mild in 23 cases [hemoglobin (Hb) 100-109 g/L] and moderately severe in 24 (Hb 70-99 g/L), in 34 (72.34%) it was microcytic [mean cell volume (MCV) < 70 fl] and normocytic (MCV 70-87 fl) in 13 patients. Low serum iron levels (< 10.7 µmol/L) were found in 68 (75.56%), and hypoferritinemia (< 16 ng/ml) in 77 (85.56%) patients. Except for a greater deficit of BW in patients with anemia compared to those without anemia (-14.64 ± 9.60 vs. -8.56 ± 11.87%, p < 0.01), differences in other defined features were not significant. Conclusion Mild or moderate iron deficiency anemia occurs in slightly more than half of children with a classical type CD. In anemic compared to non-anemic patients, there is a significantly higher BW deficit, while differences in other characteristics typical for this type of disease are not significant. © 2019 Serbia Medical Society. All rights reserved.

Introduction/Objective Gilbert syndrome (GS) is the most common hereditary hyperbilirubinemia. As well as mild unconjugated hyperbilirubinemia, it is characterized by the excess of bilirubin monoglucuro-nide over diglucuronide in the bile and thus increases the risk of biliary calculosis. The aim of the study was to determine the importance of GS as a risk factor in the development of cholelithiasis in children. Methods The study included a sample of 31 children (14 male and 17 female, mean age 12.16 ± 4.11 years, range 3–16.75 years) with symptomatic cholelithiasis. The diagnosis of cholelithiasis was based on an ultrasonographic finding, and for GS the diagnosis was based on at least a double increase of unconjugated bilirubin fraction after a three-day hypocaloric diet (400 kcal per day). Results GS was confirmed in five or 16.13% of patients (three male and two female, mean age 14.71 ± 0.55 years, range 14–15.3 years). In addition to GS, in the history of the disease they all had some of the additional risk factors for the development of cholelithiasis. One of them had an identical problem as its mother, one had hereditary elliptocytosis, one had sudden weight loss, one was overweight, and one had premature birth and sepsis. Conclusion GS registers in one-sixth of children with cholelithiasis, but in none of them as the only risk factor for developing this disease. This finding suggests that GS is a risk factor for the development of cholelithiasis, but not sufficient in itself in that respect. © 2023, Serbia Medical Society. All rights reserved.

Background and Objectives: Treatment of cancer patients during the COVID-19 pandemic has been a challenge worldwide. In accordance with the current recommendations for hepatocellular carcinoma (HCC) management during the COVID-19 pandemic, loco-regional therapy such as transarterial chemoembolization (TACE) was proposed with the purpose of achieving local tumor control and improving overall survival. The aim of this prospective cohort study was to evaluate the outcomes of TACE treatment in patients with HCC during the COVID-19 pandemic in comparison with the outcomes of patients treated in the pre-pandemic period. Materials and Methods: Between September 2018 and December 2021, 154 patients were managed by serial TACE procedures for different liver tumors. Ninety-seven patients met the study criteria and were divided into two groups: the study group n = 49 (patients treated from May 2020 to December 2021); the control group n = 48 (patients treated from September 2018 to May 2020). Results: The mean waiting time for TACE was significantly longer in the study group compared to the control group (p < 0.001). No significant difference in survival between the groups is noted (log-rank test p = 0.823). In multivariate analysis, the MELD score (HR 1.329, 95% CI 1.140–1.548, p < 0.001) remained a significant predictor of mortality. Conclusions: COVID-19 pandemic did not affect the final outcome of TACE treatment. © 2022 by the authors.

Background/Aim. The published data indicate that the appearance of spinal deformities in children is significantly influenced by physical activity. The aim of our study was to examine the influence of physical activity on prevention and occurrence of spinal deformities in children. Methods. The study was conducted as observational, clinical study in the period from 2016 to 2018. Participants were children with spinal deformities, which were examined, for the first time, by physiatrists and pediatric surgeons. The sample included 100 children with spinal deformities, aged 7–17 years. The control group consisted of 100 children without spinal deformity, of similar age. The study instrument was a questionnaire based on a survey filled by children or parents/legal guardians. The questions were related to different parameters of the possible significance for the existence of spinal deformity and especially to the influence of physical activity. The collected data were processed using methods of descriptive and analytical statistics. Results. Scoliosis the most common deformity of the spinal column, represented in about 67% of children (p = 0.0006). Respondents from both groups did not differ significantly in terms of gender. Children in the group with spinal deformities were older (11.5 ± 3.1 years vs. 10.4 ± 3.1 years, p = 0.016), with increased body weight (43.9 ± 16.0 kg vs. 39.3 ± 16.6 kg, p = 0.046) and height (151.7 ± 17.2 cm vs. 145.8 ± 18.2 cm, p = 0.019), as well as with less physical activity (81.0% vs. 92.02%, p = 0.001). Over 80% of children were regularly engaged in physical activity, more often recreationally and on average 2.5–3 hours per week. Conclusion. Children in the spinal deformity group were significantly less involved in physical activity than the control group, but there was no significant difference in the frequency and duration of time spent in physical activities during the week. It is important for children to be involved in physical activities of a recreational nature, and according to our research, 3 hours during the week. © 2021 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Hip fracture in elderly people is associated with high morbidity and mortality. Therefore, it is important to identify risk factors that potentially influence outcomes after hip surgery. The main purpose of this study was to evaluate the relationship of anemia at admission and short-term outcomes after hip fracture. We studied 343 community-dwelling patients who underwent surgery for hip fracture from March 2009 to March 2010. Functional mobility at discharge, postoperative complications, hospital length of stay and in-hospital mortality were analyzed in respect to presence and severity of anemia at admission. Anemia (defined as hemoglobin levels < 13.0 g/dl for men and < 12.0g/dl for women) was present in 185 (53.9%) patients, of whom 54 (29.2%) were severely anemic (defined as hemoglobin level 10.0g/dl or below). In multivariate analysis anemia was associated with age, gender (female), type of fracture (intertrochanteric) and American Society of Anesthesiologists (ASA) classification (3 or 4), while severity of anemia was associated with recovery of ambulatory ability at discharge. There was no difference in the incidence of postoperative complication, in-hospital mortality and length of hospital stay between the groups at discharge. Overall anemia at admission is an indicator of poor general health status. Ambulatory recovery in hip fracture patients is independently related to severity of anemia at admission. © Versita Sp. z o.o.

Introduction. Pediatric stroke (PS) is a rare disease with the global incidence of 1.2 – 13/100,000, but nevertheless, is an important cause of disability in children. What makes it a challenging research topic is its alarming upsurge in the prevalence of 35%. The most prevalent motor deficit in that regard is hemiparesis in 50% to 80% of children with PS. Literature review. The following databases were used for the purpose of this study: PubMed, Medline, Scopus, Google Scholar. Asymptomatic clinical picture and a very rare use of indicated hyperacute recanalization therapy make rehabilitation the primary therapeutic approach in children affected with PS. The present studies suggest that the greater capacity of brain neuroplasticity in children can be relevant in recovery, but also indicate some specific consequences of injury made to a developing brain. Robotic neurorehabilitation (RNR) activates brain neuroplasticity, i.e. stimulates new motor learning which contributes to motor function recovery after brain damage. RNR, in combination with virtual reality, is able to expand the effects of conventional rehabilitation, the children find it interesting, and it motivates them to be actively involved in time-consuming, specific, high-intensity exercises. Motor recovery is intensified by learning and repetition of tasks, with a robot providing additional strength in the performance of movements, with continual measurements of objective parameters.Conclusion. The recommendations for use of RNR in children affected with PS are based on expert consensus and weak evidence, since there is lack of randomized, controlled studies. © 2024 University of Nis, Faculty of Medicine. All rights reserved.

Background/Aim. Among the various factors that can influ-ence continued postoperative back pain and/or leg pain, and functional disability after lumbar microdiscectomy are gender, depression, and pessimism. The aim of this study was to de-termine the correlations between these factors. Methods. The research was conducted after microdiscectomy on 198 patients (95 men and 103 women), with a mean age of 50.20 ± 10.26 years. The following questionnaires were used for examina-tions: for assessment of pain and its intensity and character - PainDETECT Test; for functional disability - Oswestry Low Back Pain Disability Questionnaire; for the presence and de-gree of depression - Beck Depression Inventory-II; and ques-tionnaire for the assessment of personal expectations (pessi-mistic/optimistic) about the treatment results. These assess-ments were carried out after microdiscectomy - just before rehabilitation treatment, one month later, and then 3 and 6 months after a microdiscectomy. Results. Depression (p < 0.01) and pessimism (p < 0.01) had significant negative influences on the pain and functional disability. The subjective sensation of pain was significantly higher in women than in men (p < 0.01), while men had a greater degree of functional disability (p < 0.01) than women. Conclusion. Pain and func-tional disability of the patients after lumbar microdiscectomy are significantly interconnected with gender, depression, and pessimism. The sensation of pain was higher in women, while men had a greater degree of functional disability. Globally, the intensity of pain and functional disability were significantly greater in patients with a higher degree of depression and pes-simism, and, by registering mentioned factors, it is possible to predict the postoperative results. © 2022 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction Recurrent aphthous stomatitis (RAS) is a relatively common oral mucosal lesion of unclear etiology. It occurs in otherwise healthy people, but also in various infectious and non-infectious diseases, including celiac disease (CD). We present an obese adolescent with RAS as the only clinical sign of CD. Case outline An adolescent aged 15 2/12 years come with very pronounced RAS in previous five months. He had no other difficulties. The patient was obese from the age of 12. Other data were without peculiarities. On admission he was 165 cm tall (P25), obese (BMI 27 kg/m2), in the final stage of puberty, with stretch marks in the distal areas of the abdomen, thighs and gluteus and very pronounced pain-sensitive aphthae in the buccal and labial mucosa accompanied by swelling of the lips and perioral region. Except for lower serum iron levels (8 μmol/l), routine laboratory blood tests were within the reference range. The serological test for CD was positive (antibodies to tissue transglutaminase IgA 78.5 U/ml, anti-endomysial antibodies IgA positive). Endoscopy revealed reflux esophagitis, without any other pathological findings. Stereomicroscopic and pathohistological analysis of the duodenal mucosa samples showed mild destructive enteropathy (Marsh IIIa). Pathohistological examination of the gastric mucosa revealed grade I-II lymphocytic gastritis. The urease test for Helicobacter pylori was negative. A gluten-free diet resulted in the withdrawal of aphthous stomatitis and no recurrence later. Conclusion Within the differential diagnostic analysis of the RAS causes, CD should also be considered. Additionally, obesity does not exclude the presence of CD. © 2020, Serbia Medical Society. All rights reserved.

Background and Objectives: Cardiac tamponade is managed through echo- or fluoroscopy-guided percutaneous pericardiocentesis. The European Society of Cardiology’s Working Group on Myocardial and Pericardial Diseases proposed a triage strategy for these patients. This study evaluated the triage score and compared the safety and efficacy of fluoroscopy- versus echo-guided procedures without additional visualization control. Materials and Methods: This prospective observational study included 71 patients with cardiac tamponade from February 2021 to June 2022. Pericardiocentesis was performed using fluoroscopy or echo guidance based on clinical assessment and catheterization laboratory availability, without the additional control of needle/guidewire position or ECG monitoring. Patients were followed for three months. Results: The study included 71 patients (52.1% female, mean age 59.7 ± 15.7 years). Malignancy was the most common comorbidity (59.2%). Echo criteria led to urgent procedures in 47.9%, with subcostal access used most often (60.6%), particularly in fluoroscopy-guided procedures (93.8%, p = 0.003). The success rate was 97.1%, with minor complications in 14% of patients. Diabetes and malignancy predicted complications regardless of access site or guiding method. The triage score did not affect complication rates or short-term mortality. Conclusions: Fluoroscopy- and echo-guided pericardiocentesis without additional visualization control showed no difference in safety or efficacy. Delaying the procedure for patients with a triage score ≥6, or performing it early for those with a low score, did not impact complication rates or mortality, which were more influenced by the progression of the underlying disease. © 2025 by the authors.

Introduction Guillain–Barre syndrome (GBS) is the most common cause of acute flaccid paralysis in healthy infants and children. Acute motor axonal neuropathy (AMAN) is a type of GBS characterized by motor syndrome with no sensory symptoms. Case outline Authors describe a six-and-a-half year old girl with atypical clinical presentation of AMAN with severe painful lower limbs and refusal of the leg reliance with typical findings on nerves conduction studies. Conclusion Despite the nerve conduction study findings, atypical forms of AMAN and GBS are possible. Pain symptoms must be taken very seriously and treated careful by the clinicians. © 2019, Serbia Medical Society. All rights reserved.