Browsing by Author "Trajkovic, Goran Z. (9739203200)"

Cannulation technique has the potential to impact arteriovenous fistula (AVF) function. The aim of this research was to determine the impact of cannulation technique on the length of the functioning AVFs in older adult patients on hemodialysis. The study included 110 participants with fistula thrombosis who had used area technique or rope ladder technique. Biochemical parameters, gender, demographic, and clinical variables were determined. Patients who used the area cannulation technique differed significantly from patients using the rope ladder technique with regard to duration of hemodialysis (p < 0.001), outcome of the AVF revision (p = 0.045), and positioning of the anastomosis (p = 0.013). The group that used the area cannulation technique had a longer duration of hemodialysis, proximal anastomoses, and more successful revisions of AVFs. Copyright© by the American Nephrology Nurses Association.

Purpose: The number of elderly patients with end-stage kidney disease is on the rise. Nonalcoholic fatty liver disease (NAFLD) is characterized by parenchymal fat accumulation in patients without information about alcohol abuse. The aim of our study was to determine correlation between NAFLD and cardiovascular diseases in elderly hemodialysis patients. Methods: The examination was organized as observational and cross-sectional study in elderly patients on hemodialysis. An abdominal ultrasound examination was made in order to define NAFLD. Intima-media thickness of the carotid arteries was quantified by Doppler ultrasound. Biochemical parameters, gender, anthropometric characteristics, duration, adequacy of hemodialysis, blood pressure, smoking and cardiovascular disease were determined. Respondents were divided into a group with NAFLD (37/72 patients, 51 %) and group without NAFLD (35/72 patients, 49 %). Results: Patients with NAFLD have significantly more cardiovascular disease (p = 0.017) as well as significantly higher values of intima-media thickness of the carotid arteries (p = 0.03) in correlation with patients without NAFLD. Patients without NAFLD have a statistically lower triglyceride (p = 0.04), aspartate aminotransferase (p = 0.006), alanine aminotransferase (p = 0.013) and gamma-glutamyl transpeptidase (p = 0.029) compared to patients with NAFLD. Patients with cardiovascular disease have a higher risk of NAFLD; likewise, patients with NAFLD have a three times higher chance for developing cardiovascular diseases (OR 3.01). Conclusion: Elderly patients on hemodialysis with cardiovascular disease have a higher risk of NAFLD; likewise, patients with NAFLD have a three times higher chance for developing cardiovascular diseases. © 2016, Springer Science+Business Media Dordrecht.

Background: Violence in the workplace is a serious social and public health problem. The objective of this study was to estimate the prevalence of workplace violence and to identify potential predictors of workplace violence at Serbian Primary Health Care (PHC) centres. Methods: A cross-sectional study was conducted between October 2012 and July 2013. The sample consisted of medical and non-medical staff employed at PHC centres in Belgrade, Serbia. Among 1757 currently presented at work, 1526 returned the questionnaires. The data were collected by questionnaire Workplace Violence in the Health Sector - Country Case Studies, developed by the ILO/ICN/WHO/PSI. Binary logistic regression was conducted to assess the association between exposure to workplace violence and sociodemographic and work-related characteristics. Results: The prevalence of workplace violence, was 803 (52.6%), with 147 (18.3%), exposed to physical violence. Multiple logistic regression models indicated that the following work-related characteristics were positive associated of workplace violence with working between 18:00 and 07:00 h [odds ratio (OR): 1.37, 95% confidence interval (CI): 1.08-1.73], nurses as a professional group (OR: 1.91, 95% CI: 1.16-3.17), working with preschool children (OR: 0.56, 95% CI: 0.34-0.91). There was negative association of workplace violence with encouragement to report violence (OR: 0.61, 95% CI: 0.49-0.76) and the number of staff in the same work setting (OR: 0.73, 95% CI: 0.56-0.96). Conclusions: More than half of employees in Belgrade PHC centres were exposed to different types of workplace violence. There is a need for interventions to protect health workers and provide safer workplace environments. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association.

Background: Physical rehabilitation is an important segment in the treatment of hemodialysis patients as they often have numerous comorbidities, functional constraints and severe disabilities resulting from physical inactivity. Aim: To determine the effect of strength training program on muscle mass in patients on hemodialysis. Methodology: The study was organized in the Center for Hemodialysis, Kosovska Mitrovica, Serbia for the duration of 8 weeks. It involved 25 patients, 18 (72%) men and 7 (28%) women, of average age 52.9 ± 14 years, who had received chronic hemodialysis for 3 x 3-4 hours for at least 3 months using commercially available dialysers. During the first two hemodialyses, twice a week for 15-20 minutes, exercises were performed with a load to increase muscle mass of the upper and lower extremities together with isometric muscle contractions to strengthen the quadriceps, as well as a lateral flexion of the spinal column. Measurements were made before and after exercise. Routine laboratory analyses, oxygen saturation, demographic, anthropometric and clinical characteristics of the subjects were also evaluated. Results: After exercise oxygen saturation (p = 0.04) and venous pressure (p = 0.009) were significantly lower than pre-exercise values. Muscle strength of the fist (p = 0.001), the upper arm (p = 0.005) and forearms (p <0.001) also differed significantly before and after exercise. After exercise lower extremity muscles were significantly stronger, both in relation to the left and right muscles of the shin and thighs. Left side (p = 0.002) and right-side (p = 0.017) spinal column flexion was significantly higher after exercise. Conclusion: The study confirmed the positive effect of strength training program on the size of the exercising muscles, lateral flexion of the spinal column and venous pressure. © 2018 A. CARBONE Editore. All rights reserved.

Introduction: Arteriovenous fistulas (AVFs) are the preferred form vascular access for hemodialysis (HD), as they have a low rate of complications and durable function. The aim of our investigation was to analyze the factors that might influence the function of AVFs. Methods: Data were taken from the computerized patient record system in the Clinic of Urology and Nephrology, Clinical Center, Kragujevac, Serbia, for a 2-year period. We analyzed patients who had requested re-creation of AVFs as a secondary procedure. During this period 112 patients, 73 (65%) men and 39 (35%) women, had AVF thromboses. All relevant clinical and laboratory parameters that could affect the function and survival of AVF were evaluated. Findings: In univariate logistic regression analysis, statistically significant predictors influencing the duration of the fistula were magnesium (P < 0.001), triglycerides (P = 0.041), smoking (P = 0.001), antiplatelet therapy (P < 0.001), and type of HD (bicarbonate vs. hemodiafiltration) (P < 0.001). In the multiple logistic regression model, high concentrations of magnesium (B = 7434; P < 0.001) and antiplatelet therapy (B - 1.042; P = 0.04) were significantly associated with the length of AVF function. Discussion: After successful establishment of an AVF, there is a compelling need to maintain fistula patency. Factors that affect functioning of the AVFs are presently under intense scrutiny. According to our results, some clinical factors may determine long term fistula duration, such as concentration of the magnesium and antiplatelet therapy. © 2017 International Society for Hemodialysis

Purpose: Magnesium insufficiency is a pro-atherogenic factor involved in endothelial dysfunction, atherosclerosis, and vascular calcification. Our aim was to examine the role of magnesium in the development of arteriovenous fistula complications in hemodialysis. Methods: This was a retrospective clinical investigation of data from 88 patients who were divided into two groups: those with and without arteriovenous fistula complications. We examined the influence of sex, demographics, and clinical and laboratory parameters. The existence of fistula stenosis was determined by measuring Doppler flow, while B-mode ultrasound was used to detect plaques and evaluate the carotid artery intima–media thickness. Results: Patients with arteriovenous fistula complications had significantly higher leukocyte counts (p = 0.03), platelet counts (p = 0.03), phosphate concentrations (p = 0.044), and alkaline phosphatase concentrations (p = 0.04). Patients without complications had significantly greater blood flow through the arteriovenous fistula (p < 0.0005), higher magnesium concentrations (p = 0.004), and a lower carotid artery intima–media thickness (p = 0.037). The magnesium level was inversely correlated with leukocyte (p = 0.028) and platelet (p = 0.016) counts. The magnesium concentration was significantly lower in patients with carotid artery plaques (p = 0.03). Multiple linear regression, using magnesium as the dependent variable in patients with arteriovenous fistula complications, indicated statistically significant correlations with platelet (p = 0.005) and leukocyte (p = 0.027) counts and carotid plaques (p = 0.045). Conclusions: Hypomagnesemia is a significant pro-atherogenic factor and an important predictor of arteriovenous fistula complications. © 2016, Springer Science+Business Media Dordrecht.

Introduction: Metabolic syndrome is considered as one at the most important public health problems and in hemodialysis patients it is one of the main factors of mortality. The aim of the study was to determine the predictive parameters of the mortality of patients with metabolic syndrome. Materials and methods: In a nine-year study, the outcome of the clinical treatment of 108 hemodialysis patients was analyzed, divided into a group of patients with metabolic syndrome and group of patients without metabolic syndrome. The demographic, anthropometric, clinical and laboratory characteristics of the examinees were evaluated. Results: Mortality of patients with metabolic syndrome was 28.1% and in the group of patients without metabolic syndrome 13.2%. Statistically significant difference was found between the group of patients with and without metabolic syndrome in comparison with body mass index (p <0.001), age (p = 0.027), diabetic nephropathy (p <0.001), number of comorbidities (p <0.001), the number of leukocytes (p = 0.043), total proteins (p = 0.044), albumin (p = 0.001), calcium (p = 0.016), glycemia (p = 0.002) and creatinine (p = 0.032). Predictive parameters of survival in patients on hemodialysis with metabolic syndrome are the body mass index (B - 0.056; SE 0.008; p <0.001) and diabetic nephropathy (B 0.397; SE 0.098; p <0.001). Conclusion: Lower body mass index and diabetic nephropathy are, in our study, the predictive parameters of mortality of patients on hemodialysis. © 2019 A. CARBONE Editore. All rights reserved.

Introduction: Decreased respiratory muscle strength in patients with cystic fibrosis (CF) may cause progressive exercise intolerance during cardiopulmonary exercise testing (CPET), and may contribute to the development of chronic respiratory insufficiency. The aim of this study is to evaluate exercise tolerance during CPET of children and adults with clinically stable CF who exhibit different respiratory muscle strength. Methods: Sixty-nine clinically stable CF subjects aged 8-33 years underwent spirometry, body plethysmography, CPET, and respiratory muscle strength measurement. Respiratory muscle strength was measured using maximal inspiratory pressures (Pimax) and maximal expiratory pressures (Pemax). Participants were stratified into three groups according to Pimax values:below normal (≤80% predicted), normal (81-100% predicted), and above normal ( > 100% predicted). A similar stratification of participants was made according to Pemax values. The oxygen consumption on peak load (VO2peak) was expressed relative to BM (VO2peak/kg), relative to BM raised by the exponent of 0.67 (VO2peak/kg0.67) and as log-linear adjustment of VO2peak (VO2peak/kg-alo). Results: Participants with low Pemax values had a lower mean maximum load per kilogram/predicted (Wmax; p = 0.001) VO2peak/kg (p = 0.006), VO2peak/kg0.67 (p = 0.038) and VO2peak/kg-alo (p = 0.001). There were no significant differences in exercise tolerance parameters with regard to Pimax values. Stepwise multiple linear regressions confirmed that Pemax (B = 24.88, β = 0.48, p < 0.001) was the most powerful predictor of Wmax. There were no statistically significant differences in age, lung function parameters, exacerbation score, or respiratory muscle strength according to gender. Conclusions: In subjects with clinically stable CF, expiratory muscle strength is associated with a decrease in exercise performance during CPET and can predict exercise intolerance. Increase in expiratory muscle strength by patient specific rehabilitation protocols would result in improvement of exercise tolerance. © 2018 Sovtic, Minic, Markovic-Sovtic and Trajkovic.

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