Browsing by Author "Zivanovic, Dubravka (24170307900)"

The emergence of de novo or recurrent cutaneous eruptions in individuals with hematological diseases presents a challenge when determining whether they indicate secondary dissemination or an unrelated diagnosis. Eosinophilic eruption of hematoprolif-erative disease is a rare nonspecific manifestation accompanying lymphoproliferative disorders, including chronic lymphocytic leukemia (CLL). We present the case of a 70-year-old man with CLL in remission (previously treated with two 6-month cycles of fludarabine-cyclophosphamide plus rituximab, 2 and 5 years earlier) with an acute, disseminated polymorphic skin eruption. Skin biopsies from two sites (bulla and infiltrated nodule) were taken for histopathological examination. The pathologist reported giant spongiform vesicle formation with eosinophils with dermal and hypodermal inflammatory infiltrate composed of lymphocytes (pre-dominantly T cells, fewer B cells) and eosinophils. Secondary neoplasm dissemination and sarcoidosis were excluded by means of immunohistochemistry. A diagnosis of eosinophilic eruption of hematoproliferative disease in the CLL patient post-chemotherapy and without active disease was established. Two weeks after skin remission, the patient worsened with enlarged lymph nodes and a leukocyte count of 291 × 109/l. CLL relapse was confirmed. Leukocytapheresis was performed and ibrutinib 140 mg three times daily was prescribed. Our case underscores the importance of recognizing this relatively common but underreported eosinophilic eruption associated with hematoproliferative diseases. © 2023, Slovene Medical Society. All rights reserved.

Introduction: This brief picture-oriented case report focuses on typical skin lesions in a patient who developed Ecthyma gangrenosum and pseudomonal sepsis after extensive immunosuppressive therapy for Pemphigus vulgaris. Case presentation: The patient was immunosuppressed with high doses of glucocorticoids and azathioprine; the follow-up after the treatment was not carried out well due to the pandemic conditions and because the patient herself got a Covid infection, which resulted in the development of pseudomonal sepsis and Ecthyma gangrenosum. The outcome was fatal despite extensive broad-spectrum antibiotic therapy, plasmapheresis, and intravenous immunoglobulins. Conclusions: Infections with Pseudomonas aeruginosa have become a real concern in hospital-acquired infections, especially in critically ill and immunocompromised patients, because of multi-drug resistance in the first place. Copyright © 2023 Tomanovic et al.

Introduction: This brief picture-oriented case report focuses on typical skin lesions in a patient who developed Ecthyma gangrenosum and pseudomonal sepsis after extensive immunosuppressive therapy for Pemphigus vulgaris. Case presentation: The patient was immunosuppressed with high doses of glucocorticoids and azathioprine; the follow-up after the treatment was not carried out well due to the pandemic conditions and because the patient herself got a Covid infection, which resulted in the development of pseudomonal sepsis and Ecthyma gangrenosum. The outcome was fatal despite extensive broad-spectrum antibiotic therapy, plasmapheresis, and intravenous immunoglobulins. Conclusions: Infections with Pseudomonas aeruginosa have become a real concern in hospital-acquired infections, especially in critically ill and immunocompromised patients, because of multi-drug resistance in the first place. Copyright © 2023 Tomanovic et al.

[No abstract available]

We present three new cases of cutaneous polyarteritis nodosa with a follow-up ranging from 38 to 49 months, describing their clinical and histological findings, as well as treatment options leading to sustained remission. All patients met the criteria for di-agnosis. The presence of extracutaneous symptoms and laboratory analysis differed among our patients, as did various elements of the workup in comparison to published studies. We concluded that dapsone alone, or in combination with systemic steroids, proved superior and highly effective despite being less frequently used. More aggressive therapy for shorter intervals could lead to quicker remission of cutaneous lesions and symptoms without chronic relapses, which are commonly noted. © 2021, Slovene Medical Society. All rights reserved.

Background: Autoimmune pemphigus is a group of severe blistering diseases. Although corticosteroids have dramatically altered the prognosis of pemphigus, morbidity and mortality resulting from the adverse effects of systemic corticosteroids remain high. Dexamethasone-cyclophosphamide pulse (DCP) therapy was introduced to diminish the adverse effects of prolonged conventional daily dose regimens. Objective: To report our experience with the use of the DCP regimen in patients with autoimmune pemphigus. Methods: In the period 1998-2002, 72 patients with various forms of autoimmune pemphigus treated with DCP therapy were included, of whom 36 patients were previously treated with conventional corticosteroid therapy, and 36 were newly diagnosed patients. Results: Of the 72 patients, 43 completed treatment, while 13 patients did not respond adequately to the treatment and continued with the conventional daily regimen, nine patients were lost to follow-up, and seven patients died. Two of these deaths were probably a consequence of DCP therapy. Conclusion:DCPregimen is a beneficial treatment for patients with pemphigus, sparing the adverse effects of conventional regimens. © 2010 Adis Data Information BV. All rights reserved.

Generalized perforating granuloma annulare (GPGA) is a very rare form of granuloma annulare, with only 31 reported cases to the best of our knowledge. Furthermore, GPGA is a chronic disease that mimics many diseases, with no known exact etiology, resulting in a lack of specific clinical criteria leading to a lack of guidelines for diagnosis and therapy. In GPGA, papules are the predominant lesions followed by central crusting/scaling or umbilication; pustules, plaques, annular lesions or nodules are less frequent. We report a 66-year-old woman who presented with a 7-month history of mostly asymptomatic generalized infiltrated, flesh-colored to red-brown umbilicated or crusted papules. Histopathological findings were compatible with perforating granuloma annulare. Diagnostic workup revealed latent tuberculosis. To the best of our knowledge, this is the second published case of GPGA associated with latent tuberculosis and the first one that was successfully treated by isoniazid monotherapy. From our case we can speculate and support the theory that GPGA is a phenotypic granulomatous response to multiple etiologies and/or antigenic stimulation and that testing for tuberculosis should be seriously considered in the evaluation of patients with GPGA. © 2023 Dermatology Online Journal. All rights reserved.

The etiology of pemphigus vulgaris (PV) is multifactorial and includes genetic, environmental, hormonal, and immunological factors. Inheritance of certain Human class II leukocyte antigen (HLA) alleles is by far the best-established predisposing factor for the development of PV. Class II HLA alleles vary among racial/ethnic backgrounds.We have determined an association between HLA class II alleles and PV among the Serbian population. A total of 72 patients with confirmed diagnosis of PV were genotyped for HLA class II alleles. HLA frequencies were compared with unrelated healthy bone marrow donors. The statistical significance of differences between patients and controls was evaluated using Fisher’s exact test. The DRB1*04 and DRB1*14 allelic groups were associated with PV (P adj=4.45 × 10-13 and 4.06 × 10-19 respectively), while HLA-DRB1*11 was negatively associated with PV (P adj=0.0067) suggesting a protective role. DRB1*04:02, DRB1*14:04, DQB1*03:02 and DQB1*05:03 alleles were shown to be strongly associated with PV (P adj=1.63 × 10-12, 5.20× 10-7, 1.28× 10-6, and 4.44 × 10-5, respectively). The frequency of HLA DRB1*04-DQB1*03 and HLA DRB1*14-DQB1*05 haplotypes in PV patients was significantly higher than in controls (31.3% vs 8.8%, P adj =7.66 × 10-8 and 30.6% vs 6.3%, P adj=3.22 × 10-10, respectively). At high-resolution level, statistical significance was observed in HLA-DRB1*04:02-DQB1*03:02 and HLA-DRB1*14:04-DQB1*05:03 haplotypes (P adj=5.55 × 10-12, and P adj=3.91 × 10-6, respectively). Our findings suggest that HLA-DRB1*04:02, DRB1*14:04, HLA-DQB1* 03:02 and DQB1*05:03 alleles and HLA-DRB1*04:02-DQB1*03:02 and HLA-DRB1*14:04-DQB1*05:03 haplotypes are genetic markers for susceptibility for PV, while DRB1*11 allelic group appears protective in Serbian population. © 2016 John Wiley & Sons A/S.

The etiology of pemphigus vulgaris (PV) is multifactorial and includes genetic, environmental, hormonal, and immunological factors. Inheritance of certain Human class II leukocyte antigen (HLA) alleles is by far the best-established predisposing factor for the development of PV. Class II HLA alleles vary among racial/ethnic backgrounds.We have determined an association between HLA class II alleles and PV among the Serbian population. A total of 72 patients with confirmed diagnosis of PV were genotyped for HLA class II alleles. HLA frequencies were compared with unrelated healthy bone marrow donors. The statistical significance of differences between patients and controls was evaluated using Fisher’s exact test. The DRB1*04 and DRB1*14 allelic groups were associated with PV (P adj=4.45 × 10-13 and 4.06 × 10-19 respectively), while HLA-DRB1*11 was negatively associated with PV (P adj=0.0067) suggesting a protective role. DRB1*04:02, DRB1*14:04, DQB1*03:02 and DQB1*05:03 alleles were shown to be strongly associated with PV (P adj=1.63 × 10-12, 5.20× 10-7, 1.28× 10-6, and 4.44 × 10-5, respectively). The frequency of HLA DRB1*04-DQB1*03 and HLA DRB1*14-DQB1*05 haplotypes in PV patients was significantly higher than in controls (31.3% vs 8.8%, P adj =7.66 × 10-8 and 30.6% vs 6.3%, P adj=3.22 × 10-10, respectively). At high-resolution level, statistical significance was observed in HLA-DRB1*04:02-DQB1*03:02 and HLA-DRB1*14:04-DQB1*05:03 haplotypes (P adj=5.55 × 10-12, and P adj=3.91 × 10-6, respectively). Our findings suggest that HLA-DRB1*04:02, DRB1*14:04, HLA-DQB1* 03:02 and DQB1*05:03 alleles and HLA-DRB1*04:02-DQB1*03:02 and HLA-DRB1*14:04-DQB1*05:03 haplotypes are genetic markers for susceptibility for PV, while DRB1*11 allelic group appears protective in Serbian population. © 2016 John Wiley & Sons A/S.

Keratoacanthoma centrifugum marginatum (KCM) is a very rare variant of keratoacanthoma, characterized with progressive centrifugal growth, central healing, and atrophy. Due to its rarity and lack of distinctive histopathological features, KCM often raises diagnostic and therapeutic challenge. We present a case of a 76-year-old Caucasian woman with a single large tumor on her right shin that responded to oral retinoids. The patient presented history of local trauma. The tumor developed over the course of 20 months from a scar. To the best of our knowledge, this is the fifth case of KCM associated with mechanical trauma as a possible triggering factor. © 2020 Wiley Periodicals LLC.

The mental health of healthcare workers, especially the nursing staff in intensive care units, is crucial for the optimal functioning of healthcare systems during medical emergencies. This study implements a cross-sectional design to investigate the associations between nurses’ personal characteristics, workplace challenges, and job satisfaction with the increased perception of tension, stress, and pressure at the workplace (TSPW) before and during the COVID-19 pandemic. In 2021, we surveyed 4210 nurses from 19 intensive healthcare facilities in the capital of Serbia, Belgrade, and, at that time, collected data about their perceived TSPW before and during the COVID-19 pandemic. Our study identified six predictors of the increase in TSPW, as perceived by nurses: their work in COVID-19 infectious zones (OR = 1.446), exhaustion due to work under protective equipment (OR = 1.413), uncertainty and fear of infection (OR = 1.481), a high degree of superiors’ appreciation and respect (OR = 1.147), a high degree of patients’ attitudes (OR = 1.111), and a low degree of work autonomy (OR = 0.889). The study’s findings suggest that a solution to this issue is necessary to ensure that nurses are safe and able to alleviate the physical and mental strain that comes with prolonged use of protective equipment. Nurses on the frontline of the pandemic require better health protection, better conditions, and respect for their role. Strategies to promote mental health would help reduce nurses’ stress and increase job satisfaction. © 2024 by the authors.

The mental health of healthcare workers, especially the nursing staff in intensive care units, is crucial for the optimal functioning of healthcare systems during medical emergencies. This study implements a cross-sectional design to investigate the associations between nurses’ personal characteristics, workplace challenges, and job satisfaction with the increased perception of tension, stress, and pressure at the workplace (TSPW) before and during the COVID-19 pandemic. In 2021, we surveyed 4210 nurses from 19 intensive healthcare facilities in the capital of Serbia, Belgrade, and, at that time, collected data about their perceived TSPW before and during the COVID-19 pandemic. Our study identified six predictors of the increase in TSPW, as perceived by nurses: their work in COVID-19 infectious zones (OR = 1.446), exhaustion due to work under protective equipment (OR = 1.413), uncertainty and fear of infection (OR = 1.481), a high degree of superiors’ appreciation and respect (OR = 1.147), a high degree of patients’ attitudes (OR = 1.111), and a low degree of work autonomy (OR = 0.889). The study’s findings suggest that a solution to this issue is necessary to ensure that nurses are safe and able to alleviate the physical and mental strain that comes with prolonged use of protective equipment. Nurses on the frontline of the pandemic require better health protection, better conditions, and respect for their role. Strategies to promote mental health would help reduce nurses’ stress and increase job satisfaction. © 2024 by the authors.

The clinical triad of pyoderma gangrenosum, acne conglobata and hidradenitis suppurativa has been named PASH syndrome. Polycystic ovary syndrome (PCOS) is associated with hyperandrogenism and inflammation. Hidradenitis suppurativa, like acne vulgaris, may be a feature of hyperandrogenism. Obesity may be associated with both hidradenitis suppurativa and PCOS. We describe a possible association between PASH syndrome and PCOS. © 2016 The Australasian College of Dermatologists

[No abstract available]

Background and Objectives: In this study, we aimed to evaluate the effects of six weeks of pulmonary rehabilitation on functional and psychological outcomes in long-COVID patients. Material and Methods: The prospective clinical study included 46 patients that were diagnosed with COVID-19. A respiratory rehabilitation program was implemented for six weeks. Further valuables were tested before the beginning of the rehabilitation program (admission) and six weeks after (discharge): SpO2, heart rate, respiratory rate, Visual Analogue Scale (VAS) score, Borg score, Sit-to-Stand (StS) test number of repetition, distance of 6-Minute Walking Test (6MWT), Patient Health Questionnaire (PHQ) 9 score and Generalized anxiety disorder (GAD) anxiety score. These parameters were tested before the rehabilitation program on admission and at discharge and after the rehabilitation program on admission and at discharge. The results were presented with standard descriptive and analytical methods. Differences between the continuous variables before and after physical rehabilitation intervention were tested using the Wilcoxon test. Graphical analysis is presented with a box plot. Results: On discharge, in comparison with admission, the values of SpO2 were significantly lower (p = 0.007) before the 6MWT, and VAS scores were significantly higher (p = 0.036), while after the 6MWT, VAS scores were significantly lower (p < 0.001) as were Borg scores (p = 0.016). On discharge, in comparison with admission, the respiratory rate was significantly higher (p = 0.005) before the StS test, and Borg scores were significantly lower (p = 0.001), while after the StS test, SpO2 levels were significantly higher (p = 0.036) and VAS scores were significantly lower (p < 0.001), as were Borg scores (p = 0.008). After discharge, the values of the StS test were significantly higher (p = 0.011), PHQ9 scores were significantly lower (p < 0.001) and GAD anxiety scores were significantly lower as well (p = 0.005), while the distances measured in meters on the 6MWT were significantly increased (p < 0.001). Conclusions: A structured rehabilitation program in our study was shown to have beneficial effects on physiological, psychological and functional improvements in patients with long-COVID, and therefore it is advisable for these patients. © 2024 by the authors.

Background: Acne vulgaris is one of the most frequent visits to primary care physicians and dermatologists alike. Isotretinoin is the backbone of acne treatment. In most countries, depending on the health care system, isotretinoin is prescribed by dermatologists but primary care physicians are a part of the follow-up and interpreting analysis. Adverse effects of isotretinoin on the kidney and urinary system are mostly limited to sparse case reports. Specifically, gross and microscopic haematuria is not mentioned to be associated with isotretinoin. Lack of data regarding these adverse effects can lead to doubt regarding further patient management not only with dermatologists but also primary care physicians. Objective: We report a 16-year-old male patient with isotretinoin-induced haematuria with multiple episodes and subsequent challenge and de-challenge. No personal or familial history of nephrological disease was present. Ultrasound imaging and nephrology workup was within normal limits. Other aetiologies were excluded. Nephrology consult stated there was no contraindication for isotretinoin use and was reinstated at 0.6 m/kg/day. More frequent observation was indicated until completion of isotretinoin. Conclusion: Our case raises awareness to other dermatologists and primary care physicians that haematuria can be secondary to isotretinoin but not a contraindication for further use if asymptomatic and microscopic. More extensive evaluation and monitoring should be done if the patient is symptomatic with other abnormalities and symptoms. Urinalysis should be a part of routine follow-up monitoring in patients on isotretinoin. Furthermore, delineating and differentiating when to refer to a nephrologist is essential for physicians, patients, and the health care system overall. Lay summary Red blood cells in the urine (called haematuria), whether seen by the eye or seen only on urinalysis can be caused by many diseases and/or drugs. The most effective treatment of acne is isotretinoin and its side effects are for the most part known. Renal and/or urinary side effects are extremely rare. We report a 16-year-old male patient with isotretinoin-induced haematuria with multiple episodes and subsequent challenge and de-challenge. When isotretinoin was discontinued, no red blood cells were seen in the urine. When isotretinoin was reinstituted, red blood cells were seen once again in the urine. It is important for physicians to know of this rare side effect as it prevents unnecessary referrals to nephrologists, while on the other hand raises awareness of the connection and helps in understanding when isotretinoin should be potentially discontinued and patients referred. © The Author(s) 2023. Published by Oxford University Press. All rights reserved.