Browsing by Author "Simić, Jelena (57201274633)"

People who inject drugs (PWIDs) experience high rates of hepatitis C virus (HCV) infection, primarily due to needle sharing and limited healthcare access, resulting in a disproportionate disease burden within this population. This prospective study evaluated treatment outcomes in 432 adult patients with chronic hepatitis C (CHC) treated with direct-acting antivirals (DAAs) at the University Clinical Center of Serbia. Patients were categorized into two groups based on a history of drug addiction: PWIDs (163, 37.7%) and non-PWIDs (269, 62.3%). The PWID group was further categorized into subpopulations of problematic PWIDs (39, 23.9%), ex-PWIDs (124, 76.1%), and PWIDs on OST (96, 58.9%). The PWID group demonstrated significantly lower treatment adherence, with an intention-to-treat (ITT) rate of 82.8%, compared to 96.3% in the control group (p < 0.001). In contrast, no significant differences were observed in per-protocol (PP) outcomes between the two groups. Additionally, PWIDs were significantly younger (p < 0.001) and had higher rates of psychiatric disorders (p < 0.001), alcohol abuse (p < 0.001), and HCV genotype 1a (p < 0.001). Advanced fibrosis was predictor of PP treatment failure among PWIDs, while mood disorders and alcohol use disorder were associated with interruptions before the scheduled completion time. For non-PWIDs, older age and advanced fibrosis emerged as key predictors of PP treatment failure. The loss to follow-up was most commonly observed in the problematic PWID subgroup (p = 0.001). These findings highlight the importance of addressing barriers in PWIDs through integrated care strategies that concurrently manage addiction and HCV. © 2024 by the authors.

People who inject drugs (PWIDs) experience high rates of hepatitis C virus (HCV) infection, primarily due to needle sharing and limited healthcare access, resulting in a disproportionate disease burden within this population. This prospective study evaluated treatment outcomes in 432 adult patients with chronic hepatitis C (CHC) treated with direct-acting antivirals (DAAs) at the University Clinical Center of Serbia. Patients were categorized into two groups based on a history of drug addiction: PWIDs (163, 37.7%) and non-PWIDs (269, 62.3%). The PWID group was further categorized into subpopulations of problematic PWIDs (39, 23.9%), ex-PWIDs (124, 76.1%), and PWIDs on OST (96, 58.9%). The PWID group demonstrated significantly lower treatment adherence, with an intention-to-treat (ITT) rate of 82.8%, compared to 96.3% in the control group (p < 0.001). In contrast, no significant differences were observed in per-protocol (PP) outcomes between the two groups. Additionally, PWIDs were significantly younger (p < 0.001) and had higher rates of psychiatric disorders (p < 0.001), alcohol abuse (p < 0.001), and HCV genotype 1a (p < 0.001). Advanced fibrosis was predictor of PP treatment failure among PWIDs, while mood disorders and alcohol use disorder were associated with interruptions before the scheduled completion time. For non-PWIDs, older age and advanced fibrosis emerged as key predictors of PP treatment failure. The loss to follow-up was most commonly observed in the problematic PWID subgroup (p = 0.001). These findings highlight the importance of addressing barriers in PWIDs through integrated care strategies that concurrently manage addiction and HCV. © 2024 by the authors.

Introduction Kounis syndrome (KS) represents an acute coronary syndrome (ACS) induced by a hypersensitivity reaction. First described by Kounis and Zavras in 1991, KS today represents an infrequently diagnosed clinical syndrome. Three different KS variants have been defined: type I vasospastic allergic angina, type II allergic myocardial infarction, and type III stent thrombosis. Outlines of cases This paper presents three cases of type II KS causing anaphylactic ACS. In the first case, a 66-year-old female presented with dyspnea, dizziness, and electrocardiography findings suggesting ACS after she was stung by a bee. In the second case, we present a 64-year-old female admitted to the Emergency Department with chest pain after an anaphylactic reaction due to an iodine contrast injection used for a thoracic computed tomography scan. In the third case, an 80-year-old female presented with chest pain, palpitation, and skin rash shortly after administration of the intravenous anesthetic propofol during elective malignant colon tumor surgical intervention. All patients were treated at the Cardiology Clinic, University Clinical Center of Serbia. Conclusion The primary mechanism of KS corresponds to the release of inflammatory mediators during a hypersensitivity reaction triggered by different sources. Although well known, constant reminders of this cause of ACS are needed. © 2024, Serbia Medical Society. All rights reserved.

Background: Atrial fibrillation (AF) is associated with the development and progression of chronic kidney disease (CKD). This study evaluated the impact of long-term rhythm outcome after catheter ablation (CA) of AF on renal function. Methods and results: The study group included 169 consecutive patients (the mean age was 59.6 ± 10.1 years, 61.5% were males) who underwent their first CA of AF. Renal function was assessed by eGFR (using the CKD-EPI and MDRD formulas), and by creatinine clearance (using the Cockcroft–Gault formula) in each patient before and 5 years after index CA procedure. During the 5-year follow-up after CA, the late recurrence of atrial arrhythmia (LRAA) was documented in 62 patients (36.7%). The mean eGFR, regardless of which formula was used, significantly decreased at 5 years following CA in patients with LRAA (all p < 0.05). In the arrhythmia-free patients, the mean eGFR at 5 years post-CA remained stable (for the CKD-EPI formula: 78.7 ± 17.3 vs. 79.4 ± 17.4, p = 0.555) or even significantly improved (for the MDRD formula: 74.1 ± 17.0 vs. 77.4 ± 19.6, p = 0.029) compared with the baseline. In the multivariable analysis, the independent risk factors for rapid CKD progression (decline in eGFR > 5 mL/min/1.73 m2 per year) were the post-ablation LRAA occurrence (hazard ratio 3.36 [95% CI: 1.25–9.06], p = 0.016), female sex (3.05 [1.13–8.20], p = 0.027), vitamin K antagonists (3.32 [1.28–8.58], p = 0.013), or mineralocorticoid receptor antagonists’ use (3.28 [1.13–9.54], p = 0.029) after CA. Conclusions: LRAA after CA is associated with a significant decrease in eGFR, and it is an independent risk factor for rapid CKD progression. Conversely, eGFR in arrhythmia-free patients after CA remained stable or even improved significantly. © 2023 by the authors.

Background: Atrial fibrillation (AF) is associated with the development and progression of chronic kidney disease (CKD). This study evaluated the impact of long-term rhythm outcome after catheter ablation (CA) of AF on renal function. Methods and results: The study group included 169 consecutive patients (the mean age was 59.6 ± 10.1 years, 61.5% were males) who underwent their first CA of AF. Renal function was assessed by eGFR (using the CKD-EPI and MDRD formulas), and by creatinine clearance (using the Cockcroft–Gault formula) in each patient before and 5 years after index CA procedure. During the 5-year follow-up after CA, the late recurrence of atrial arrhythmia (LRAA) was documented in 62 patients (36.7%). The mean eGFR, regardless of which formula was used, significantly decreased at 5 years following CA in patients with LRAA (all p < 0.05). In the arrhythmia-free patients, the mean eGFR at 5 years post-CA remained stable (for the CKD-EPI formula: 78.7 ± 17.3 vs. 79.4 ± 17.4, p = 0.555) or even significantly improved (for the MDRD formula: 74.1 ± 17.0 vs. 77.4 ± 19.6, p = 0.029) compared with the baseline. In the multivariable analysis, the independent risk factors for rapid CKD progression (decline in eGFR > 5 mL/min/1.73 m2 per year) were the post-ablation LRAA occurrence (hazard ratio 3.36 [95% CI: 1.25–9.06], p = 0.016), female sex (3.05 [1.13–8.20], p = 0.027), vitamin K antagonists (3.32 [1.28–8.58], p = 0.013), or mineralocorticoid receptor antagonists’ use (3.28 [1.13–9.54], p = 0.029) after CA. Conclusions: LRAA after CA is associated with a significant decrease in eGFR, and it is an independent risk factor for rapid CKD progression. Conversely, eGFR in arrhythmia-free patients after CA remained stable or even improved significantly. © 2023 by the authors.

This study, conducted at two university-based infectious disease clinics, included 216 patients with chronic hepatitis C. The primary objective was to assess the positive and negative predictive values, sensitivity, and specificity of achieving a sustained virological response (SVR) at 4 weeks compared to 12 weeks post-therapy. The results demonstrated a maximum sensitivity of 100% for achieving SVR at 12 weeks after reaching SVR at 4 weeks for all analyzed genotypes, except for genotype 1b treated with EBR/GZR therapy, where the specificity was 75%. Additionally, younger age and less advanced liver fibrosis were identified as independent predictors of achieving a sustained virological response at both 4 and 12 weeks. The significant normalization of various biochemical parameters was observed after treatment, indicating an overall improvement in liver function. This study suggests that shortening the monitoring period to 4 weeks might be effective for younger patients without significant fibrosis, potentially reducing loss to follow-up, which is a critical issue in HCV treatment. These findings align with the “test and treat” approach. Further research is needed to confirm these findings and incorporate them into official guidelines, which could simplify and enhance the effectiveness of HCV treatment protocols, aiding global efforts to eliminate HCV as a public health issue by 2030. © 2024 by the authors.

This study, conducted at two university-based infectious disease clinics, included 216 patients with chronic hepatitis C. The primary objective was to assess the positive and negative predictive values, sensitivity, and specificity of achieving a sustained virological response (SVR) at 4 weeks compared to 12 weeks post-therapy. The results demonstrated a maximum sensitivity of 100% for achieving SVR at 12 weeks after reaching SVR at 4 weeks for all analyzed genotypes, except for genotype 1b treated with EBR/GZR therapy, where the specificity was 75%. Additionally, younger age and less advanced liver fibrosis were identified as independent predictors of achieving a sustained virological response at both 4 and 12 weeks. The significant normalization of various biochemical parameters was observed after treatment, indicating an overall improvement in liver function. This study suggests that shortening the monitoring period to 4 weeks might be effective for younger patients without significant fibrosis, potentially reducing loss to follow-up, which is a critical issue in HCV treatment. These findings align with the “test and treat” approach. Further research is needed to confirm these findings and incorporate them into official guidelines, which could simplify and enhance the effectiveness of HCV treatment protocols, aiding global efforts to eliminate HCV as a public health issue by 2030. © 2024 by the authors.

Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, low- and middle- income countries had less access to monoclonal antibodies, such as tocilizumab (TCZ), compared to high-income countries. This retrospective cohort study aimed at evaluating the impact of a delayed TCZ administration on patient outcomes, and at determining the optimum timing of TCZ initiation for COVID-19 pneumonia in Serbia. Methodology: The study included 150 patients who received TCZ at a tertiary referral center. The outcomes analyzed in this study were the need for an intensive care unit (ICU) treatment and mortality. Results: The multiple Cox proportional hazard model suggested that the delay in TCZ administration was an independent predictor of needing ICU treatment and mortality. The receiver operating characteristic (ROC) curve showed that patients who received TCZ after 7.5 days since the onset of symptoms had 74.4% higher chances of needing ICU treatment. Receiving TCZ after 9.5 days since the onset of symptoms, increased the chances of mortality by 78.9%. The multiple Cox proportional hazard model suggested that TCZ administration after 7.5 days since the onset of symptoms increased the hazard for ICU admission by 24.5%; and the hazard of mortality increased by 46.1% after 9.5 days since the onset of symptoms. Conclusions: This study emphasizes the importance of timely administration of TCZ in COVID-19 pneumonia. Better outcomes were observed when TCZ was administered up to 7.5 days since the onset of symptoms. Copyright © 2025 Beronja et al.

Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, low- and middle- income countries had less access to monoclonal antibodies, such as tocilizumab (TCZ), compared to high-income countries. This retrospective cohort study aimed at evaluating the impact of a delayed TCZ administration on patient outcomes, and at determining the optimum timing of TCZ initiation for COVID-19 pneumonia in Serbia. Methodology: The study included 150 patients who received TCZ at a tertiary referral center. The outcomes analyzed in this study were the need for an intensive care unit (ICU) treatment and mortality. Results: The multiple Cox proportional hazard model suggested that the delay in TCZ administration was an independent predictor of needing ICU treatment and mortality. The receiver operating characteristic (ROC) curve showed that patients who received TCZ after 7.5 days since the onset of symptoms had 74.4% higher chances of needing ICU treatment. Receiving TCZ after 9.5 days since the onset of symptoms, increased the chances of mortality by 78.9%. The multiple Cox proportional hazard model suggested that TCZ administration after 7.5 days since the onset of symptoms increased the hazard for ICU admission by 24.5%; and the hazard of mortality increased by 46.1% after 9.5 days since the onset of symptoms. Conclusions: This study emphasizes the importance of timely administration of TCZ in COVID-19 pneumonia. Better outcomes were observed when TCZ was administered up to 7.5 days since the onset of symptoms. Copyright © 2025 Beronja et al.