Browsing by Author "Parapid, Biljana (6506582242)"

Cardiovascular diseases are the leading cause of death among women, and the incidence among younger women has shown the greatest increase over the last decades, in particular for acute myocardial infarction (AMI). Moreover, the prognosis of women post-AMI is poor when compared with men of similar ages. Since the 1990s, an abundant literature has highlighted the existing differences between sexes with regard to presentation, burden, and impact of traditional risk factors and of risk factors pertaining predominantly to women, the perception of risk by women and men, and the pathophysiological causations, their treatment, and prognosis. These data that have been accumulated over recent years highlight several targets for improvement. The objective of this collaborative work is to define the actions required to reverse the growing incidence of AMI in women and improve the patient pathway and care, as well as the prognosis. We aim to provide practical toolkits for different health professionals involved in the care of women, so that each step, from cardiovascular risk assessment to symptom recognition, to the AMI pathway and rehabilitation, thus facilitating that from prevention to intervention of AMI, can be optimized. © 2024 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.

Purpose of Review: In the USA, the maternal mortality rate is one of the worst of developed countries. For Black women, this rate is even more stark and highlights the disparities in health care that disproportionately affect communities of color. Recent Findings: Regardless of socioeconomic status or education level, Black women are not immune to the inequities that exist in the delivery of maternal care. Cardiovascular disease has long been identified as the leading cause of pregnancy-related deaths and emerging research offers a window of opportunity to modify risk factors that contribute to heart disease. In tackling the crisis, solutions must be viewed along the life course of a woman—from childhood to menopause. Summary: Opportunities exist to improve maternal and pediatric outcomes through attention to interconception visits and optimization of Black maternal care. The impact of social determinants of health, including psychosocial stressors and racism, must be acknowledged and recognized as contributors to the ongoing Black maternal cardiovascular health crisis. Future health care delivery models for Black women must involve close collaborations between pediatricians, cardiologists, internists, and obstetricians to improve pregnancy-related outcomes. © 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Purpose of Review: In the USA, the maternal mortality rate is one of the worst of developed countries. For Black women, this rate is even more stark and highlights the disparities in health care that disproportionately affect communities of color. Recent Findings: Regardless of socioeconomic status or education level, Black women are not immune to the inequities that exist in the delivery of maternal care. Cardiovascular disease has long been identified as the leading cause of pregnancy-related deaths and emerging research offers a window of opportunity to modify risk factors that contribute to heart disease. In tackling the crisis, solutions must be viewed along the life course of a woman—from childhood to menopause. Summary: Opportunities exist to improve maternal and pediatric outcomes through attention to interconception visits and optimization of Black maternal care. The impact of social determinants of health, including psychosocial stressors and racism, must be acknowledged and recognized as contributors to the ongoing Black maternal cardiovascular health crisis. Future health care delivery models for Black women must involve close collaborations between pediatricians, cardiologists, internists, and obstetricians to improve pregnancy-related outcomes. © 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

At the beginning of the SARS Co V2 (COVID-19) pandemic, women worldwide represented the majority of health care workers. As part of the fight against the pandemic, women health care workers became a part of the significant frontline response. This led to unique challenges that affected women physicians as well as the women patients they were taking care of. The American College of Cardiology Women in Cardiology International Working Group set up a webinar to discuss the challenges being faced by women physicians and women patients in various parts of the world and look towards finding possible solutions for these issues in a webinar themed “WIC Global Perspectives: COVID-19. © 2020, Serbia Medical Society. All rights reserved.

[No abstract available]

Background and Objectives: Advanced lung cancer is usually manifested by endoluminal tumor propagation, resulting in central airway obstruction. The objective of this study is to compare the high dose rate brachytherapy treatment outcomes in non-small-cell lung cancer (NSCLC) depending on the treatment planning pattern—two-dimension (2D) or three-dimension (3D) treatment planning. Materials and Methods: The study was retrospective and two groups of patients were compared in it (a group of 101 patients who underwent 2D planned high-dose-rate endobronchial brachytherapy (HDR-EBBT) in 2017/18 and a group of 83 patients who underwent 3D planned HDR-EBBT between January 2021 and June 2023). Results: In the group of 3D planned brachytherapy patients, there was a significant improvement in terms of loss of symptoms of bronchial obstruction (p = 0.038), but no improvement in terms of ECOG PS (European Cooperative Oncology Group Performance Status) of the patient (p = 0.847) and loss of lung atelectasis (if there was any at the beginning of the disease) (p = 0.781). Two-year overall survival and time-to-progression periods were similar for both groups of patients (p = 0.110 and 0.154). Fewer treatment complications were observed, and 91.4% were in 3D planned brachytherapy (BT) patients. Conclusions: Three-dimensionally planned HDR-EBBT is a suggestive, effective palliative method for the disobstruction of large airways caused by endobronchial lung tumor growth. Independent or more often combined with other types of specific oncological treatment, it certainly leads to the loss of symptoms caused by bronchial obstruction and the improvement of the quality of life of patients with advanced NSCLC. Complications of the procedure with 3D planning are less compared to 2D planned HDR-EBBT. © 2024 by the authors.

Dual antiplatelet therapy (DAPT) and subsequent P2Y12 inhibitor monotherapy, particularly ticagrelor, is an emerging treatment strategy in patients undergoing percutaneous coronary intervention (PCI). This meta-analysis was designed to investigate whether short-term DAPT followed by ticagrelor monotherapy is associated with a favorable outcome as compared with standard DAPT (1–3 months of DAPT was termed “short-term” DAPT, 6–12 months DAPT was termed “standard” DAPT). The primary outcome was the composite of major adverse cardiovascular events (MACE) comprising myocardial infarction, stroke, and cardiovascular death. Secondary outcomes included all-cause mortality and net adverse clinical events (NACE; myocardial infarction, stroke, all-cause death, stent thrombosis, and major bleeding). The primary safety outcome was major bleeding. Three studies comprising 26,143 patients were included. The risk of MACE was similar between the two treatment groups (risk ratio (RR) 0.86, 95% confidence interval (CI), 0.72–1.02, P = 0.08, I2 = 22%). Short-term DAPT followed by ticagrelor monotherapy resulted in a 20% relative risk reduction of all-cause mortality (RR 0.80, 95% CI, 0.65–0.98, P = 0.03, I2 = 0%) and an 18% relative risk reduction of NACE (RR 0.82, 95% CI, 0.71–0.94, P = 0.005, I2 = 33%) as compared with standard DAPT. Short-term DAPT followed by ticagrelor monotherapy significantly decreased the risk of major bleeding (RR 0.67, 95% CI, 0.49–0.92, P = 0.01, I2 = 65%). In patients with acute coronary syndrome, short-term DAPT followed by ticagrelor monotherapy resulted in an unchanged ischemic risk but a significantly lower bleeding risk compared with standard DAPT. Short-term DAPT followed by ticagrelor monotherapy compared with standard DAPT resulted in a favorable safety and efficacy profile. Direct comparisons of aspirin vs. ticagrelor monotherapy following PCI are needed. © 2021 The Authors. Clinical Pharmacology & Therapeutics published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.

Dual antiplatelet therapy (DAPT) and subsequent P2Y12 inhibitor monotherapy, particularly ticagrelor, is an emerging treatment strategy in patients undergoing percutaneous coronary intervention (PCI). This meta-analysis was designed to investigate whether short-term DAPT followed by ticagrelor monotherapy is associated with a favorable outcome as compared with standard DAPT (1–3 months of DAPT was termed “short-term” DAPT, 6–12 months DAPT was termed “standard” DAPT). The primary outcome was the composite of major adverse cardiovascular events (MACE) comprising myocardial infarction, stroke, and cardiovascular death. Secondary outcomes included all-cause mortality and net adverse clinical events (NACE; myocardial infarction, stroke, all-cause death, stent thrombosis, and major bleeding). The primary safety outcome was major bleeding. Three studies comprising 26,143 patients were included. The risk of MACE was similar between the two treatment groups (risk ratio (RR) 0.86, 95% confidence interval (CI), 0.72–1.02, P = 0.08, I2 = 22%). Short-term DAPT followed by ticagrelor monotherapy resulted in a 20% relative risk reduction of all-cause mortality (RR 0.80, 95% CI, 0.65–0.98, P = 0.03, I2 = 0%) and an 18% relative risk reduction of NACE (RR 0.82, 95% CI, 0.71–0.94, P = 0.005, I2 = 33%) as compared with standard DAPT. Short-term DAPT followed by ticagrelor monotherapy significantly decreased the risk of major bleeding (RR 0.67, 95% CI, 0.49–0.92, P = 0.01, I2 = 65%). In patients with acute coronary syndrome, short-term DAPT followed by ticagrelor monotherapy resulted in an unchanged ischemic risk but a significantly lower bleeding risk compared with standard DAPT. Short-term DAPT followed by ticagrelor monotherapy compared with standard DAPT resulted in a favorable safety and efficacy profile. Direct comparisons of aspirin vs. ticagrelor monotherapy following PCI are needed. © 2021 The Authors. Clinical Pharmacology & Therapeutics published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.

In order to enhance cost-benefit value of the gestational diabetes mellitus screening (GDM) the concept of universal screening i.e., screening of all pregnant women for gestational diabetes, has mostly been abandoned in favor of the concept of selective screening. Selective screening implies that only women with risk factors are being screened for GDM. However, some recent studies have shown that with the application of the selective screening approach, some women with GDM may not receive proper and timely diagnosis. This review addresses the pros and cons of both concepts. It will also discuss screening methods and methods of preparation and performance of oral glucose tolerance test and the interpretation of its results. © 2023, Serbia Medical Society. All rights reserved.

It has been an entire century since the introduction of insulin into clinical practice, which, among other, led to improvements of fertility and pregnancy outcomes of women suffering from gestational diabetes. The prevalence of diabetes worldwide and in Serbia is high and tends to increase as a consequence of modern lifestyle. Nevertheless, modern diagnostic and therapeutic approaches enable people with diabetes to achieve and complete pregnancies without adverse outcomes. Gestational diabetes can be considered as non-communicable disease and efforts should be made to determine its effects on offspring. In the context of COVID-19 pandemic, diabetes mellitus was identified as an important risk factor for severe forms of the disease. © 2023, Serbia Medical Society. All rights reserved.

The challenges to academic and professional development and career advancement of women in cardiology (WiC), imposed by the pandemic, not only impinge the female cardiologists’ “leaky pipeline” but also make the “leakiness” more obvious. This consensus document aims to highlight the pandemic challenges WIC face, raise awareness of the gender equity gap, and propose mitigating actionable solutions derived from the data and experiences of an international group of female cardiovascular clinicians and researchers. This changing landscape has led to the need for highly specialized cardiologists who may have additional training in critical care, imaging, advanced heart failure, or interventional cardiology. Although women account for most medical school graduates, the number of WIC, particularly in mentioned sub-specialties, remains low. Moreover, women have been more affected by systemic issues within these challenging work environments, limiting their professional progression, career advancement, and economic potential. Therefore, it is imperative that tangible action points be noted and undertaken to ensure the representation of women in leadership, advocacy, and decision-making, and increase diversity in academia. Strategies to mitigate the negative impacts of the pandemic need to be taken during this COVID-19 pandemic to ensure WIC have a place in the field of Cardiology. © 2022 Edizioni Minerva Medica.

Background Body-mass index (BMI) and diabetes have increased worldwide, whereas global average blood pressure and cholesterol have decreased or remained unchanged in the past three decades. We quantified how much of the effects of BMI on coronary heart disease and stroke are mediated through blood pressure, cholesterol, and glucose, and how much is independent of these factors. Methods We pooled data from 97 prospective cohort studies that collectively enrolled 1·8 million participants between 1948 and 2005, and that included 57 161 coronary heart disease and 31 093 stroke events. For each cohort we excluded participants who were younger than 18 years, had a BMI of lower than 20 kg/m2, or who had a history of coronary heart disease or stroke. We estimated the hazard ratio (HR) of BMI on coronary heart disease and stroke with and without adjustment for all possible combinations of blood pressure, cholesterol, and glucose. We pooled HRs with a random-effects model and calculated the attenuation of excess risk after adjustment for mediators. Findings The HR for each 5 kg/m2 higher BMI was 1·27 (95% CI 1·23-1·31) for coronary heart disease and 1·18 (1·14-1·22) for stroke after adjustment for confounders. Additional adjustment for the three metabolic risk factors reduced the HRs to 1·15 (1·12-1·18) for coronary heart disease and 1·04 (1·01-1·08) for stroke, suggesting that 46% (95% CI 42-50) of the excess risk of BMI for coronary heart disease and 76% (65-91) for stroke is mediated by these factors. Blood pressure was the most important mediator, accounting for 31% (28-35) of the excess risk for coronary heart disease and 65% (56-75) for stroke. The percentage excess risks mediated by these three mediators did not differ significantly between Asian and western cohorts (North America, western Europe, Australia, and New Zealand). Both overweight (BMI ≥25 to <30 kg/m2) and obesity (BMI ≥30 kg/m2) were associated with a significantly increased risk of coronary heart disease and stroke, compared with normal weight (BMI ≥20 to <25 kg/m2), with 50% (44-58) of the excess risk of overweight and 44% (41-48) of the excess risk of obesity for coronary heart disease mediated by the selected three mediators. The percentages for stroke were 98% (69-155) for overweight and 69% (64-77) for obesity. Interpretation Interventions that reduce high blood pressure, cholesterol, and glucose might address about half of excess risk of coronary heart disease and three-quarters of excess risk of stroke associated with high BMI. Maintenance of optimum bodyweight is needed for the full benefits.

Metabolic changes occur due to the effects of placental hormones such as human chorionic gonadotropin and human placental lactogen in normal pregnancies. These effects enable the development of insulin resistance among all pregnant women, significantly pronounced in the third trimester. In pregnancies complicated by pre-gestational or gestational diabetes mellitus, these changes are more intensive as they affect the fetoplacental unit. In pregnancies complicated by diabetes the increased number of placental macrophages leads to the increased production of different cytokines which include leptin, tumor necro-sis factor alpha, and interleukins. This review addresses placental vascular changes that lead to adverse pregnancy outcomes, along with the effects of the maternal hyperglycemia and fetal hyperinsulinemia. © 2023, Serbia Medical Society. All rights reserved.

Introduction. Endocarditis is the most common cardiovascular manifestation of brucellosis with high mortality rate. Brucella is less accesable to antibiotic (but not for all) and relapse can occur after a various period of clinical latency. Case report. A 55-year-old farmer was diagnozed with acute systemic Brucella infection in May 2008 and treated with antibiotic therapy in regional hospital for two months and for three months after discharge. He began to feel myalgia, arthralgia, malaise, shortness of breath, abdominal pain, vomiting, diarrhoea and lost weight eight months after initial symptoms occured. Because symptoms progressed he was admitted to our hospital in February 2009. Based on a combination of epidemiological, clinical data (on admission he was catchetic, adynamic, dyspneic, hypotensive 80/50 mmHg, fever up to 39.5°C), positive serological Wright test for brucellosis (1: 5,120), and echocardiographic examination findings, the diagnosis of very severe relapse of brucellosis with mitral valve endocarditis, complicated with perforation of anterior mitral leaflet, severe mitral regurgitation and pulmonary hypertension was established. He was treated with a combined triple antibiotic therapy (vancomycin, ciprofloxacin and gentamicin, and swiched to regimen with doxycycline, gentamicin and imipenem, replacing gentamicin by rifampicin) for 4 weeks and for the next 2 weeks was receiving trimetoprime/sulfamethoxazole and rifampicin. The patients' condition was improved and he was operated. The diagnosis of infective endocarditis was confirmed intraoperatively. Mitral valve replacement was performed, and combined triple antibiotic treatment (amikacin + ciprofloxacin + cefazolin, for 2 weeks and cephazolin + doxycycline + rifampicin, for 2 weeks) was continued, following with two antibiotics (doxycycline + rifampicin) for 5 months. The patient completely recovered without any signs of infection 30 months postoperatively. Conclusion. A combined antibiotic therapy and surgery reduce complications and mortality associated with Brucella endocarditis and improve quality of patients' life.

The aim of the study was to evaluate the effects of hyperglycemia on nerve conduction in patients with newly diagnosed diabetes mellitus type 1, and to investigate the significance of early electrophysiological diagnostics in these patients. The study included 85 newly disclosed patients with type 1 diabetes mellitus, in the first three months after the disease. Nerve conduction velocities (NCV) of further nerves were evaluated: median, peroneal, tibial and sural nerve as well as late responses (F-wave and H-reflex). Metabolic control parameters that were evaluated included: glycemia rate on the day of investigation and HbA1c. All patients had poor metabolic control parameters. We found NCV slowing predominantly in the tibial nerve (in 82.4% of patients). Prolonged F-wave latency was disclosed in 72.9% of patients, while H-reflex was evoked in 27.1% of patients only. The most sensitive parameter in the early neurophysiologic diagnostics was the measurement of F-wave latency. Our study underline the significance of early neurophysiological diagnosis, since hyperglycemia can play an acute role in NCV slowing, despite the absence of clinical symptoms, particularly in the first three months after the diagnosis has been confirmed. © 2013 Versita Warsaw and Springer-Verlag Berlin Heidelberg.

Background To consider hemodynamic assessment of myocardial bridging (MB) adequate, it is believed that inotropic stimulation with dobutamine should be estimated because its dynamic nature depends on the degree of extravascular coronary compression. This study evaluated comparative assessment of hemodynamic relevance of MB using coronary flow velocity reserve (CFVR) measurements by transthoracic Doppler echocardiography (TTDE) with vasodilatative and inotropic challenges. Methods This prospective study included forty-four patients with angiographic evidence of isolated MB of the left anterior descending coronary artery (LAD) and systolic compression of ≥ 50% diameter stenosis. All patients were evaluated by exercise stress-echocardiography (ExSE) test for signs of myocardial ischemia, and CFVR of the distal segment of LAD during iv.infusion of adenosine (ADO:140 μg/kg/min) and iv.infusion of dobutamine (DOB:10-40 μg/kg/min), separately. Results Exercise-SE was positive for myocardial ischemia in 8/44 (18%) of patients. CFVR during ADO was significantly higher than CFVR during peak DOB (2.85 ± 0.68 vs. 2.44 ± 0.48, p = 0.002). CFVR during peak DOB was significantly lower in SE-positive group in comparison to SE-negative group (2.01 ± 0.16 vs. 2.54 ± 0.47, p < 0.001), but not for ADO (2.47 ± 0.51 vs. 2.89 ± 0.70, p = 0.168), respectively. Multivariable logistic analysis showed that CFVR peak DOB was the most significant predictor of functional significant MB (OR 0.011, 95%CI: 0.001–0.507, p = 0.021). Receiver-operating characteristic curves have shown that TTDE-CFVR obtained by high-dose of dobutamine infusion is better than those by adenosine regarding to functional status of MB (AUC 0.861, p = 0.004; AUC 0.674, p = 0.179, respectively). Conclusions Non-invasive CFVR measurement by TTDE during inotropic stimulation, in comparison to vasodilation, provides more reliable functional evaluation of MB. © 2016 Elsevier Ireland Ltd

Introduction: The present study aimed to establish the role of lipid abnormalities and inflammatory markers for developing cardiovascular risk, as well as to address the importance of obesity as a common comorbidity in patients with obstructive sleep apnea (OSA). Methods: The study was conducted as a prospective cohort study including 120 patients with newly diagnosed OSA between 2019 and 2020, at University Clinical Hospital Center “Bezanijska kosa”, Belgrade, Serbia. The diagnosis was established by polysomnography. In all patients, sociodemographic data, respiratory, lipid, and inflammatory parameters were collected and complete echocardiographic study and 24-h blood pressure monitoring were performed. Results: The mean patient age was 55.7 ± 13.8 years. Study population was mostly male (70.0%) and obese (56.7%). At least 30 apneas or hypopneas per hour were present in 39.0% of patients. A strong positive correlation was found between OSA severity and BMI (r = 0.562, p < 0.001), both associated with lipid, inflammatory and respiratory parameters, and cardiovascular profile of patients with OSA (p < 0.05 for all). Echocardiographic study and 24-h blood pressure monitoring parameters were in turn correlated with lipid and inflammatory markers (p < 0.05 for all). Conclusion: The results of this study support the important role of dyslipidemia and inflammation, as well as coexistence of obesity in the pathogenesis of numerous conditions linked with an increased risk of cardiovascular morbidity and mortality in patients with OSA. Copyright © 2022 Zdravkovic, Popadic, Klasnja, Milic, Rajovic, Divac, Manojlovic, Nikolic, Lukic, Rasiti, Mircetic, Marinkovic, Nikolic, Crnokrak, Lisulov, Djurasevic, Stojkovic, Todorovic, Lasica, Parapid, Djuran and Brajkovic.

Introduction: The present study aimed to establish the role of lipid abnormalities and inflammatory markers for developing cardiovascular risk, as well as to address the importance of obesity as a common comorbidity in patients with obstructive sleep apnea (OSA). Methods: The study was conducted as a prospective cohort study including 120 patients with newly diagnosed OSA between 2019 and 2020, at University Clinical Hospital Center “Bezanijska kosa”, Belgrade, Serbia. The diagnosis was established by polysomnography. In all patients, sociodemographic data, respiratory, lipid, and inflammatory parameters were collected and complete echocardiographic study and 24-h blood pressure monitoring were performed. Results: The mean patient age was 55.7 ± 13.8 years. Study population was mostly male (70.0%) and obese (56.7%). At least 30 apneas or hypopneas per hour were present in 39.0% of patients. A strong positive correlation was found between OSA severity and BMI (r = 0.562, p < 0.001), both associated with lipid, inflammatory and respiratory parameters, and cardiovascular profile of patients with OSA (p < 0.05 for all). Echocardiographic study and 24-h blood pressure monitoring parameters were in turn correlated with lipid and inflammatory markers (p < 0.05 for all). Conclusion: The results of this study support the important role of dyslipidemia and inflammation, as well as coexistence of obesity in the pathogenesis of numerous conditions linked with an increased risk of cardiovascular morbidity and mortality in patients with OSA. Copyright © 2022 Zdravkovic, Popadic, Klasnja, Milic, Rajovic, Divac, Manojlovic, Nikolic, Lukic, Rasiti, Mircetic, Marinkovic, Nikolic, Crnokrak, Lisulov, Djurasevic, Stojkovic, Todorovic, Lasica, Parapid, Djuran and Brajkovic.

[No abstract available]

Introduction/Objective New World Health Organization Classification of Head and Neck Tumors from 2017 has introduced significant changes, mainly considering tumors in the oropharyngeal region. New entities of HPV-positive and-negative squamous cell carcinomas have been acknowledged, not only based on the presence of an active viral infection and different tumor markers expression, but also because of their different histopathology, staging assessment, and prognosis. A retrospective study has been conducted, in order to determine p16 positivity in squamous cell carcinomas in oropharynx and in the oral cavity, and to see whether they differ in sex and age distribution. Methods The presence of viral infection was verified based on p16 immunochemistry staining, p16 being the surrogate marker for HPV infection. A total of 177 cases of squamous cell carcinomas in the oropharynx and the oral cavity, found in the archives of the Histopathology Laboratory of the Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, have been revised. Results Out of 177 cases, 50 (28.2%) were p16-positive. Compared with carcinomas in the oral cavity, p16 carcinomas were significantly more common in the oropharynx (34.3% in the oropharynx, compared to 10.3% in the oral cavity). Carcinomas in both regions were mostly associated with male sex (88.1% of all cases were in males), but p16 positivity was more common in females (11 out of 21 cases, 52.4%). The most common location of p16-positive carcinomas were palatine tonsils (41.03% of tonsillar carcinomas were p16-positive). Conclusion P16-positive squamous cell carcinomas were the most numerous in the oropharynx, i.e. palatine tonsils, and were more common in females. © 2020, Serbia Medical Society. All rights reserved.