Browsing by Author "Urošević, Aleksandar (58075718100)"

Introduction: Chronic hepatitis C virus (HCV) infection can progress to liver cirrhosis that causes bleeding from the gastrointestinal tract, liver failure and primary hepatocellular carcinoma. Use of standard therapeutic option consists of recombinant pegylated interferon alpha 2a/b with ribavirin in order to eradicate virus and prevent complications. Objective: The aim of investigation was to evaluate efficiency of combination therapy (pegylated interferon alpha 2a/b plus ribavirin) in patients with chronic HCV infection and to estimate predictive factors for successful treatment. Methods: A total of 387 patients with confirmed diagnosis of hepatitis C were evaluated (aged 18-65 years of both genders). Patients were treated with pegylated interferon alpha 2a/b and ribavirin according to a standard regimen lasting 24 or 48 weeks, dependent on virus genotype. Results: Negative HCV RNA (PCR assay) was recorded in 79.7% of patients at the end of treatment. Six months after completed therapy, negative HCV RNA, i.e. stained virologic response (SVR) was assessed in 70.5% of patients. Statistical summary of our results concerning SVR confirmed better efficiency of combination therapy for the following parameters compared to other investigated variables: age ≤40 (843% vs. 59.1%; p<0.0005), absence of cirrhosis (75.6% vs. 58.3%; p=0.003), lack of genotype 1 (86.6% vs. 61.8%; p<0.0005), and in patients who received full doses of pegylated interferon alpha 2a (78.3% vs. 633%; p=0.002). Conclusion: Combination therapy of recombinant pegylated interferon alpha 2a with ribavirin leads to SVR in the majority of treated patients (70.5%). Successful treatment depends on a variety of host and virus factors.

Introduction. Multifocal cerebritis is a rare and severe disease and just a several cases caused by Listeria monocytogenes were described in the literature. Case report. A 64 year old man was admitted to the hospital with disturbed consciounsness (Glasgow Coma Scale score: 9) after being febrile for 16 days with history of fever, headache and middle ear pain. He did not have any other comorbidities neither he was immunocompromised. Penicillin allergy was noted for him. On neurologic exam, meningeal or focal neurologic signs were not evident, but computed tomography (CT) brain scan with contrast injection showed 3 hypodense zones in the occipital and 1 in the right temporal lobe. Laboratory findings in blood and cerebrospinal fluid (CSF) were indicative for the infectious nature of changes in the endocranium (multifocal cerebritis). Initial therapy was the combination of cefotaxime, amikacin and metronidazole, but after the isolation of L. monocytogenes from CSF and blood culture, therapy was switched to co-trimoxazole. Recovery of consciouscness with establisment of alert state occurred after 6 days of co-trimoxazole administration. Total therapy took 36 days. During that period all clinical and laboratory parameters normalized. The patient was discharged as recovered, with sequelas of amnesia and slurring of speech. Conclusion. In the treatment of multifocal cerebritis caused by L. monocytogenes, adequate choice and long-term therapy with antibiotics are necessary. The drug of choice is ampicillin but in the case of allergy to it, co-trimoxazole is a good replacement. © 2020 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Background/Aim. The World Health Organization estimates that 3.2 billion people are at a risk of being infected with malaria. Thus, the adequate diagnostic protocols for malaria, especially those aimed at determining disease severity, are paramount both in endemic and non-endemic setting. The aim of this study was to identify the demographic, parositological, clinical and laboratory characteristics associated with severe malaria in a non-endemic settings. Methods. We analyzed 22 patients with severe malaria and compared their clinical and laboratory findings with those of the patients with non-severe malaria in a search of predictors of disease severity. All patients were treated at the Infectious and Tropical Diseases University Hospital, Clinical Centre of Serbia in Belgrade, Serbia from 2000 to 2010. Results. The average age of patients with with severe malaria was 44.86 ± 12.33 years and men predominated (95.45%). The patients with severe malaria were infected Plasmodium falciparum (P. falciparum) significantly more frequently compared with those with non-severe disease (p =0.047). Jaundice was the most commonly observed feature of severe malaria, followed by anemia and renal failure. The multifactor analysis of variance showed that thrombocytopenia (p = 0.05) and high serum tumor necrosis factor-alpha levels (p = 0.02) were significantly associated with the disease severity. Conclusion. A high index of suspicion for malaria should be maintained when evaluating febrile patients returning from the malaria endemic regions. The elevated serum tumor necrosis factor-alpha levels and thrombocytopenia are associated with severe malaria in non-endemic settings. © 2019, Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction Toxic liver injury is becoming greater problem in today´s hepatology. Until today more than 900 drugs, toxins and herbs have been identified that can cause different liver injury. There was no significant research of this problem in Serbia so far. The aim of this study is to present the patient with severe form of acute hepatitis, whose etiology is exclusively toxic. Case outline A 23-year-old male, from Belgrade, previously healthy, got sick with signs and symptoms that correlated with acute hepatitis. Biochemical analyses pointed to severe form of acute hepatitis with impending hepatocellular failure. The diagnosis of toxic liver injury was set. It was caused by the use of number substances and supplements: Ecstasy, whey protein, branched-chain amino acid (BCAA), creatine, high doses of vitamin D, glutamine, and multivitamin complex. He was treated with infusion, gastroprotective, and substitution therapy. During hospitalization, the patient’s symptoms disappeared with gradual normalization of biochemical analyses of the liver. When the patient’s condition was satisfying, blind percutaneous liver biopsy was performed, with the following pathohistological findings: Lobular hepatitis, with no fibrosis, etiology correlates to toxic. After a month and a half since the disease had begun, the patient fully recovered. Conclusion Increased number of persons with toxic liver injury is being registered in developed countries worldwide. Similar trend can be noted in Serbia as well. By presenting young previously healthy man with the severe form of toxic acute hepatitis and impending liver failure, we are pointing out the significance of this problem. Multidisciplinary approach is needed to reach the most effective solutions. © 2019, Serbia Medical Society. All rights reserved.

Introduction Acute liver failure is a rare and very complex clinical syndrome, a consequence of sudden and severe liver dysfunction. There are several causes of this condition (viruses, medications, toxins, metabolic, autoimmune and malignant diseases), but etiological agent often remains undiscovered. Case outline A 40-year-old male patient had suddenly taken ill with signs and symptoms of acute hepatitis, which was confirmed through biochemical analyses. The cause of acute liver failure was not determined. Despite all therapeutic measures, the clinical course of the disease was unfavorable: severe icterus, decreased synthetic function of the liver and hepatic encephalopathy developed. In the later, subacute course of the disease, ascites and episodes of hepatic encephalopathy developed, and biochemical findings indicated chronic hepatocellular failure. After three months of treatment in hepatic coma there was lethal outcome. Histopathological findings confirmed the diagnosis of decompensated liver cirrhosis of unknown origin. Conclusion The cause of acute liver failure often remains unclear; potential causes should be looked for in infections by unknown viruses or in exposures to toxins. The disease is most commonly presented as a subacute failure with the development of liver cirrhosis. Survival rate is low. © 2018, Serbia Medical Society. All rights reserved.

Introduction: Poststroke infections are the most common medical complications of stroke and can occur in up to 65% of patients. The aim of this study was to assess the rate of infectious complications during hospitalization of stroke patients and to evaluate the impact of infection in general, including each of the urinary tract infection (UTI), pneumonia, and sepsis, on fatal and poor functional outcome at discharge. Methods: This retrospective study enrolled patients who have been diagnosed with acute ischemic stroke treated in a 1-year period. Poor functional outcome at discharge was defined as severe invalidity and included patients with modified Rankin Scale score of 3-5. Univariate and multivariate analyses were performed. Results: We analyzed 133 patients with acute ischemic stroke. Poststroke infection occurred in 63 (47.4%) patients. The most common infection was UTI that was present in 27 (20.3%) patients. Multivariate logistic regression analysis after adjustment for confounders demonstrated that poststroke infection was an independent predictor of poor functional outcome (odds ratio [OR] 12.82, 95% confidence interval [CI] 4.09-40.0, P <.001) and death at discharge (OR 14.92, 95% CI 2.97-76.92, P = .001). When analyzing the impact of each infectious complication, multivariate logistic regression showed that UTIs were an independent predictor of poor functional outcome (OR 14.08, 95% CI 3.06-64.84, P = .001) and death (OR 9.81, 95% CI 1.46-65.68, P = .019) at discharge. Conclusion: Infection is a frequent poststroke complication and represents an independent predictor of poor functional and fatal early stroke outcome. © 2013 by National Stroke Association.

Background: West Nile virus neuroinvasive disease (WNND) occurs in less than 1% of infected people. Leukocytosis with lymphocytopenia, mild anaemia, thrombocytopenia, elevated liver and muscle enzymes and hyponatremia are occasionally present in patients with WNND. Cerebrospinal fluid (CSF) findings resemble other viral neuroinfections. The purpose of this study is to present some of the most important laboratory findings of our patients with WNND and to evaluate their correlation with fatal outcome. Methods: The study included 161 patients with WNND. Their blood and CSF samples were cytobiochemically analysed and the obtained variables were then tested for predictive significance of the disease outcome, or used for differentiation between two clinical syndromes (encephalitis vs meningitis). Results: West Nile encephalitis was present in 127 (78.9%) patients and West Nile meningitis was diagnosed in 34 (21.1%) cases. Leukocytosis was found in 45.9% patients. CRP level higher than 100 mg/L was registered only in those with encephalitis (p=0.020). CSF leukocyte count was 146±171 per microlitre, with slight lymphocytic predominance (mean 52%). Hypoglycorrhachia was registered in 9.3% of our patients with WNND. Twenty-eight (17.4%) patients died and all of them had encephalitis. Independent predictors of fatal outcome in WNND were serum CRP > 100 mg/L (p=0.011) and CSF proteins > 1 g/L (p=0.002). Conclusions: WNND usually affects older males. Prolonged neutrophilic predominance in CSF can occasionally be present, as well as hypoglycorrhachia. Patients with encephalitis, high serum CRP and high CSF protein level have a higher risk of fatal outcome. © 2016 Aleksandar Urošević et al.

Background: West Nile virus neuroinvasive disease (WNND) occurs in less than 1% of infected people. Leukocytosis with lymphocytopenia, mild anaemia, thrombocytopenia, elevated liver and muscle enzymes and hyponatremia are occasionally present in patients with WNND. Cerebrospinal fluid (CSF) findings resemble other viral neuroinfections. The purpose of this study is to present some of the most important laboratory findings of our patients with WNND and to evaluate their correlation with fatal outcome. Methods: The study included 161 patients with WNND. Their blood and CSF samples were cytobiochemically analysed and the obtained variables were then tested for predictive significance of the disease outcome, or used for differentiation between two clinical syndromes (encephalitis vs meningitis). Results: West Nile encephalitis was present in 127 (78.9%) patients and West Nile meningitis was diagnosed in 34 (21.1%) cases. Leukocytosis was found in 45.9% patients. CRP level higher than 100 mg/L was registered only in those with encephalitis (p=0.020). CSF leukocyte count was 146±171 per microlitre, with slight lymphocytic predominance (mean 52%). Hypoglycorrhachia was registered in 9.3% of our patients with WNND. Twenty-eight (17.4%) patients died and all of them had encephalitis. Independent predictors of fatal outcome in WNND were serum CRP > 100 mg/L (p=0.011) and CSF proteins > 1 g/L (p=0.002). Conclusions: WNND usually affects older males. Prolonged neutrophilic predominance in CSF can occasionally be present, as well as hypoglycorrhachia. Patients with encephalitis, high serum CRP and high CSF protein level have a higher risk of fatal outcome. © 2016 Aleksandar Urošević et al.