Browsing by Author "Prijić, Sergej (20734985500)"

Objective: Background: Case Report: Conclusions: Rare disease Scimitar syndrome (SCS) is a rare congenital cardiopulmonary malformation, characterized by anomalous pulmonary venous drainage from the right lung associated with aortopulmonary collateral arteries and pulmonary hypoplasia. The variant described in the case presented here, with total anomalous right pulmonary venous drainage into the superior and inferior vena cava, can be expected in 2% of patients with scimitar syndrome. To the best of our knowledge, the association between the variant of SCS and coarctation of aorta described in our patient has never been reported before in the literature. A female newborn with a gestational age of 35 weeks presented with a rare combination of scimitar syndrome and aortic coarctation. The patient had a variant of SCS that included anomalous drainage of the right upper and lower pulmonary vein into the superior and inferior vena cava, respectively; relative right lung hypoplasia; and right lower lobe sequestration supplied by aortopulmonary collateral arteries that originated from the truncus coeliacus. The diagnosis was confirmed with computed tomography angiography after resection of the aortic coarctation with extended end-to-end anastomosis. Subsequently, interventional closure of the collateral artery supplying the right lower lobe was performed with an AMPLATZER™ Vascular Plug 4. The patient’s clinical course was complicated by suspicious acute endocarditis and chylous pleural effusion. After a prolonged hospitalization, she was discharged in clinically stable condition. The diagnosis of SCS should be considered when pulmonary hypertension persists after coarctation repair in a child with dextroposition of the heart and right lung hypoplasia. Successful treatment of this rare combination of conditions calls for teamwork by highly experienced specialists. © Am J Case Rep, 2020.

Introduction The Hickman catheter is a tunneled, open-type catheter often implanted in children for long-term intravenous treatment. Their application can cause numerous complications. Catheter breakage and dislocation of fragments to the intravascular system is a rare but life-threatening condition. When a complication occurs, depending on the patient’s clinical condition, the first step is transcutaneous endovascular removal of the catheter’s fragment. If this is not possible, surgical thoracotomy is necessary. The objective of this article was to present a case of breakage and dislocation of Hickman catheter in a pediatric patient, as well as the diagnostic and therapeutic approach to complications. Case outline We report a 14-month-old child who had a Hickman catheter because he was undergoing treatment for acute juvenile myelomonocytic leukemia. Due to a malfunction of the catheter, the existing catheter had to be removed. During the surgical procedure, a breakage and dislocation of the catheter fragment occurred. A chest X-ray and an echocardiography confirmed the position of the catheter fragment in the right atrium. A transcutaneous endovascular procedure was successfully performed to remove the fragment of the catheter. Conclusion Numerous complications can occur during the insertion, management, and removal of long-term catheters. It is necessary to periodically control the catheter’s position by chest X-ray and ultrasound of the heart and neck. If a particular complication is detected, an individual approach to treatment with the lowest risk to the patient should be chosen. Dislocated fragments of the Hickman catheter can be safely removed by endovascular transcatheter procedures. © 2024, Serbia Medical Society. All rights reserved.

Introduction/Objective Although cardiac tumors in the pediatric population are found infrequently, their occurrence is constant and with occasional variations. The purpose of this study is to show our experience with surgical options of these masses in two leading national university-level pediatric centers over four decades. Methods This retrospective study is presenting a total number of 24 surgically treated pediatric patients who have been operated on 1998–2020. There were 16 children with primary masses and eight children with metastatic cardiac tumors. Two patients with tumor-like intracardiac masses were not included in the series but had been mentioned as diagnostic challenges. Our patients did not have cardiac transplantation options. Results The average age of our patients was five and a half years, and the most frequent operated tumor was the cardiac myxoma. Four children had neurological symptoms. There were two deaths, one in the primary tumor group and one metastatic patient misdiagnosed as a primary tumor in the early ages of our department. We had two recurrent cases, a girl with Carney complex, and an infant with an extremely rare form of cardiac malignancy after a myxoma extraction. One child required a permanent pacemaker insertion. Conclusion Although rare, the pediatric cardiac tumors can be a source of different life-threatening conditions and lifelong sequelae. Therefore, special considerations should be paid to the diagnostic and surgical modalities of their treatment. © 2023, Serbia Medical Society. All rights reserved.

Introduction/Objective The anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is rare congenital disease, which causes myocardial ischemia and subsequent heart failure in infants. The aim is early and mid-term follow up evaluation of the heart function after surgical repair of ALCAPA. Methods Investigation was retrospective and included medical records of the ALCAPA patients treated surgically, between 2009 and 2017, at the tertiary referent heart center. Results Five patients (four girls) with coronary anomaly were included in the study. All patients had significantly increased left ventricular end diastolic diameter (z-score 6.6 ± 2.43) and left atria size (z-score 3.09 ± 0.37), along with decreased systolic function (ejection fraction 34.8 ± 7.4% and fractional shortening 15.5 ± 3.4%). The surgery was performed on average at the age of 8.2 ± 7.8 months. Operative treatment was associated with early improvement in echocardiographic parameters (except the size of the left atria). Patients were followed for 4.5 ± 2.6 years. Improvement in echocardiographic parameters was age-related. Patients under four months had recovery early after surgery, those treated at 5.5–6 months of age had normalization after 12 months, and patient who was recognized in the second year of life had late recovery (after ≥ 24 months). Conclusion Operative treatment in the first 3–4 months of life is related with the most favorable prognosis and rapid normalization of the echocardiographic parameters. © 2019, Serbia Medical Society. All rights reserved.

Unselective use of antibiotics to treat children with COVID-19 is one of the major issues during the pandemic in Serbia. Thus far, there has been no evidence about the predictors of multiple antibiotic use in the treatment of children with COVID-19. The purpose of this study was to assess the prevalence of antibiotic use, as well as to examine demographic and clinical factors associated with a greater number of antibiotics and with a longer antibiotic treatment administered to hospitalized children with COVID-19 during the lockdown in Serbia. This study included all children who were hospitalized from 6 March to 31 May 2020 at the only pediatric COVID-19 hospital, and who were confirmed to have SARS-CoV-2 infection. Demographic, clinical, and laboratory data were collected from medical records. The antibiotic treatment included the use of azithromycin, cephalosporin (ceftriaxone), ampicillin-amikacin, and hydroxychloroquine. The overall prevalence of antibiotics use in children hospitalized with COVID-19 regardless of age was 47.2% (43.3% in children aged 1–5 years and 44.4% in those aged 5–17 years). In children aged 1–5 years, not having a family member affected by COVID-19 (B = −1.38, 95% confidence interval [CI] −2.43, −0.34, p = 0.011), having pneumonia on chest X-ray (B = 0.81, 95%CI 0.34, 1.29, p = 0.002), being a boy (B = −0.65, 95%CI −1.17, −0.13, p = 0.018), and having higher C-reactive protein (CRP) values on admission (B = 0.12, 95%CI 0.07, 0.17, p = 0.001) were associated with the administration of a higher number of antibiotics. These factors, along with having fever (B = 3.20, 95%CI 1.03, 5.37, p = 0.006), were associated with a longer duration of antibiotic treatment in children aged 1–5 years. In children aged 5–17 years, having pharyngeal erythema (B = 1.37, 95%CI 0.61, 2.13, p = 0.001), fever (B = 0.43, 95%CI 0.07, 0.79, p = 0.018), and pneumonia on chest X-ray (B = 0.91, 95%CI 0.53, 1.29, p = 0.001), not having rhinorrhea (B = −1.27, 95%CI −2.47, −0.08, p = 0.037), being a girl (B = 0.52, 95%CI 0.08, 0.97, p = 0.021), and having higher CRP values on admission (B = 0.04, 95%CI 0.01, 0.06, p = 0.006) were associated with the administration of a higher number of antibiotics. These factors, not including the absence of rhinorrhea, were associated with a longer duration of antibiotics treatment in children aged 5–17 years. Demographic, epidemiological, clinical, and laboratory parameters were associated with the use of multiple antibiotics and a longer duration of antibiotic treatment both among children aged 1–5 years and those aged 5–17 years. © 2022 by the authors.

Unselective use of antibiotics to treat children with COVID-19 is one of the major issues during the pandemic in Serbia. Thus far, there has been no evidence about the predictors of multiple antibiotic use in the treatment of children with COVID-19. The purpose of this study was to assess the prevalence of antibiotic use, as well as to examine demographic and clinical factors associated with a greater number of antibiotics and with a longer antibiotic treatment administered to hospitalized children with COVID-19 during the lockdown in Serbia. This study included all children who were hospitalized from 6 March to 31 May 2020 at the only pediatric COVID-19 hospital, and who were confirmed to have SARS-CoV-2 infection. Demographic, clinical, and laboratory data were collected from medical records. The antibiotic treatment included the use of azithromycin, cephalosporin (ceftriaxone), ampicillin-amikacin, and hydroxychloroquine. The overall prevalence of antibiotics use in children hospitalized with COVID-19 regardless of age was 47.2% (43.3% in children aged 1–5 years and 44.4% in those aged 5–17 years). In children aged 1–5 years, not having a family member affected by COVID-19 (B = −1.38, 95% confidence interval [CI] −2.43, −0.34, p = 0.011), having pneumonia on chest X-ray (B = 0.81, 95%CI 0.34, 1.29, p = 0.002), being a boy (B = −0.65, 95%CI −1.17, −0.13, p = 0.018), and having higher C-reactive protein (CRP) values on admission (B = 0.12, 95%CI 0.07, 0.17, p = 0.001) were associated with the administration of a higher number of antibiotics. These factors, along with having fever (B = 3.20, 95%CI 1.03, 5.37, p = 0.006), were associated with a longer duration of antibiotic treatment in children aged 1–5 years. In children aged 5–17 years, having pharyngeal erythema (B = 1.37, 95%CI 0.61, 2.13, p = 0.001), fever (B = 0.43, 95%CI 0.07, 0.79, p = 0.018), and pneumonia on chest X-ray (B = 0.91, 95%CI 0.53, 1.29, p = 0.001), not having rhinorrhea (B = −1.27, 95%CI −2.47, −0.08, p = 0.037), being a girl (B = 0.52, 95%CI 0.08, 0.97, p = 0.021), and having higher CRP values on admission (B = 0.04, 95%CI 0.01, 0.06, p = 0.006) were associated with the administration of a higher number of antibiotics. These factors, not including the absence of rhinorrhea, were associated with a longer duration of antibiotics treatment in children aged 5–17 years. Demographic, epidemiological, clinical, and laboratory parameters were associated with the use of multiple antibiotics and a longer duration of antibiotic treatment both among children aged 1–5 years and those aged 5–17 years. © 2022 by the authors.

Severe and reproducible low-renin hypertension responsive to salt restriction and amiloride-thiazide therapy in a 13-year-old otherwise asymptomatic boy suggested Liddle syndrome. This assumption was strengthened by a positive family history of hypertension poorly responsive to conventional treatment or sudden deaths under 40 years of age in four generations. DNA analysis of the beta and gamma subunits of the epithelial sodium channel revealed a heterozygous mutation c.C1852T (p.Pro618Ser) in the SCNN1B gene in the patient and in both his hypertensive mother and uncle. A PubMed search revealed 21 different disease-causing mutations reported to date, all but two clustering in the cytoplasmic C-terminal regions of either beta (16 mutations) or gamma (5) subunit, leading to a three- to eightfold increase in the amiloride-sensitive sodium current. Inter- and intrafamilial variability in both hypertension and hypokalemia were disclosed, which may not be obligatory among the subjects carrying a Liddle mutation. Conclusion: Liddle syndrome should be considered as a cause of hypertension in children or adolescents particularly with suppressed renin activity. Early diagnosis and appropriately tailored treatment avoid complications of long-term unrecognized or inappropriately managed hypertension. © Springer-Verlag 2011.

Introduction The arterial “switch” operation has been the operation of choice for children born with Dtransposition of the great arteries (D-TGA) for more than 30 years in countries with developed pediatric cardiac surgery program. After two decades of successful treatment of these children with the atrial “switch” corrections (Mustard or Senning operative techniques), the arterial “switch” operation (ASO) had been introduced as a routine technique in one pediatric cardiac center in Serbia. Objective The aim of this study was the analysis of the identified risk factors involved with the ASO in the preoperative, operative and postoperative period and their impact on the survival of the operated children. Methods A retrospective nonrandomized study of 52 operated patients with D-TGA by the ASO in the period between May 1, 2003 and December 31, 2011, divided into two groups. The data collection consisted of preoperative, operative and postoperative factors during the in-hospital stay and until the discharge from the hospital. Descriptive and differential statistical methods were used for analysis. Results Ten individual risk factors were identified as significant for the immediate survival of children operated with the ASO technique. Conclusion The arterial “switch” surgical operative technique is a complex neonatal/young infant procedure in which the preoperative status carried a significant risk as well as the surgical technique itself. These results differ from the results published throughout the world and are a representation of an evolutionary process of one center in Serbia starting the ASO procedure. © 2015, Serbia Medical Society. All rights reserved.