Clinical Center Kragujevac Research Articles

Pregnancy-Associated Plasma Protein-A and Free β-Human Chorionic Gonadotrophin in Relation with Oxidative Stress in Obese Pregnant Women: A Clinical Cross-Sectional Study.

Background: The pathophysiological mechanism underlying pregnancy complications is not entirely known. Although it is currently impossible to predict the occurrence of redox imbalance, it is possible to identify women with a high or medium risk of developing this disease prior to a negative outcome by non-invasive diagnostic methods. The Aim: This study aimed to examine the possible role of the parameter of oxidative stress (OS) measured in early pregnancy in the screening/treatment of obesity and its complications during pregnancy. Methods: This research was designed as a prospective observational cross-sectional clinical study which included 40 non-obese and 31 obese pregnant women between 11 and 13 g.w. who were managed in the Department of Obstetrics, University Clinical Center Kragujevac in Serbia. We collected anthropometric and clinical indicators, maternal and pregnancy factors, and measured prooxidative parameters from blood samples. Results: We observed significantly increased levels of the superoxide anion radical, hydrogen peroxide and the index of lipid peroxidation in the Obese group in comparison with the Non-Obese group and significantly decreased bioavailability of nitrites in the Obese group in comparison with the Non-Obese group. Conclusions: The determination of systemic parameters of OS in early pregnancy could be a good methodological approach in the screening/treatment of obesity during pregnancy and this approach should be followed for the screening of endothelial dysfunction in pregnancy which needs further monitoring and/or treatment.

Drug-Drug Interactions in Hospitalized Urological Patients: A Retrospective Cohort Study.

Exposure to potential drug-drug interactions (pDDIs) can be a notable source of avoidable drug-related harm that requires adequate management to prevent medical errors. We aimed to evaluate pDDIs and associated factors in hospitalized urological patients on admission, during hospitalization, and on discharge. A retrospective cohort study was conducted at the Clinic of Urology of the University Clinical Centre Kragujevac, Serbia. To detect pDDIs, we used Lexicomp, which categorizes pDDIs as follows: X (avoid combination), D (consider therapy modification), C (monitor therapy), B (no action needed), and A (no known interaction). Multiple linear regression analysis was used to identify factors associated with the number of pDDIs. More than half of the 220 included patients had at least one pDDI on admission and discharge (57.3% and 63.6%, respectively), whereas 95.0% had at least one pDDI during hospitalization. The total number and number of X, D, C, and B categories of pDDIs were the highest during hospitalization and the lowest on admission. Duration of hospitalization, arrhythmias, dementia, renal failure, cancer, surgery during hospitalization, number of prescribed drugs, and various pharmacological drug classes were risk factors for a higher number of pDDIs, while age, ischemic heart disease, hypertension, and development of infection during hospitalization were protective factors in at least one of the stages. The impact of renal colic depended on the stage and category of pDDI. More than half of the urological patients were exposed to at least one pDDIs at all stages. Medical professionals should regularly screen for pDDIs, particularly in patients with risk factors.

Predictors of Intrahospital Mortality in Aneurysmal Subarachnoid Hemorrhage after Endovascular Embolization.

Background and Objectives: Aneurysmal subarachnoid hemorrhage (ASAH) is defined as bleeding in the subarachnoid space caused by the rupture of a cerebral aneurysm. About 11% of people who develop ASAH die before receiving medical treatment, and 40% of patients die within four weeks of being admitted to hospital. There are limited data on single-center experiences analyzing intrahospital mortality in ASAH patients treated with an endovascular approach. Given that, we wanted to share our experience and explore the risk factors that influence intrahospital mortality in patients with ruptured intracranial aneurysms treated with endovascular coil embolization. Materials and Methods: Our study was designed as a clinical, observational, retrospective cross-sectional study. It was performed at the Department for Radiology, University Clinical Center Kragujevac in Kragujevac, Serbia. The study inclusion criteria were ≥18 years, admitted within 24 h of symptoms onset, acute SAH diagnosed on CT, aneurysm on DSA, and treated by endovascular coil embolization from January 2014 to December 2018 at our institution. Results: A total of 66 patients were included in the study-48 (72.7%) women and 18 (27.3%) men, and 19.7% of the patients died during hospitalization. After adjustment, the following factors were associated with in-hospital mortality: a delayed ischemic neurological deficit, the presence of blood in the fourth cerebral ventricle, and an elevated urea value after endovascular intervention, increasing the chances of mortality by 16.3, 12, and 12.6 times. Conclusions: Delayed cerebral ischemia and intraventricular hemorrhage on initial head CT scan are strong predictors of intrahospital mortality in ASAH patients. Also, it is important to monitor kidney function and urea levels in ASAH patients, considering that elevated urea values after endovascular aneurysm embolization have been shown to be a significant risk factor for intrahospital mortality.

Characteristics of Hospitalized COVID-19 Patients in Sumadija District in 2020

Abstract The number of hospitalized COVID patients varies in accordance with the waves of the pandemic. The aim of the study was to examine the characteristics of hospitalized COVID-19 patients and predictors of in-hospital died with special reference to the importance of comorbidity. A retrospective cohort study that included all COVID patients hospitalized at the Clinical Center Kragujevac in 2020. The data contained in the Hospitalization Report are described, and the predictors of hospital mortality are defined by binary logistic regression. 1336 COVID patients were hospitalized. The average age of the hospitalized patients was 58.1 ± 16.5 years, 2/3 of them were males. The largest number of hospitalized patients live in Kragujevac - 62.8%. During hospitalization, 19.4% (n = 206) of patients died, who were on average 13 years older (t = 14.13, df = 504.3, p <0.01), and stayed in the hospital 2 days shorter (Z = -5.36, p <0.01) when compared to discharged patients. 86.5% (n = 1155) of hospitalized patients had comorbidities, most often hypertension and other heart diseases, diabetes mellitus and renal failure. Statistically significant predictors of the lethal outcome of hospitalization were patients’ age (OR = 0.94 95% CI = 0.93-0.95), residence (OR = 0.84, 95% CI = 0.75-0.95), length of hospitalization (OR = 1.06, 95% CI = 1.04-1.09) and the presence of comorbidity as the strongest predictor (OR = 5.31, 95% CI = 2.37-11.89). COVID Patients with comorbidities require special attention because comorbidities affect the outcome of hospitalization.

Pharmacoeconomic Aspects of Treating Childhood Pneumonia - Cost of Illness Study Based on Data from Serbia

Abstract The pharmacoeconomic aspect of the treatment of pneumonia in the pediatric population is scarce analyzed in the countries of the Balkan region. This research aimed to determine the value of total hospital costs of treating childhood pneumonia from the Republic Fund of Health Insurance perspective. This retrospective cost of illness study was performed using the “from the bottom to the top” approach. It included 82 patients with childhood pneumonia who were treated at Clinical for pediatrics at Clinical Centre Kragujevac. The total costs of hospital treatment of pneumonia for the examined population were 4,095,293.73 RSD. The largest share in total hospital costs has the length of patient hospitalization (22%). The median total hospital costs per patient per year amounted to 40,249.91 RSD (4,793.10 - 142,149.63 RSD). Since the main determinants of overall costs of treating childhood pneumonia are the length of stay and noninvasive ventilation rate, therapeutic strategies should provide not only efficient treatment in compliance with current guidelines as also decreasing these determinants to offer a better pharmacoeconomic profile of childhood pneumonia.

IDENTIFICATION OF FACTORS INFLUENCING BIRTH WEIGHT, LENGTH, AND HEAD CIRCUMFERENCE

Newborn size at birth is an important indicator of fetal health, neonatal health, infant survival and childhood morbidity. The aim of our study was to assess and identify factors that significantly influence birth weight, length, and head circumference by performing a post hoc analysis of the data collected during the retrospective-prospective observational cohort study which was conducted at the Clinic for Gynecology and Obstetrics at the University Clinical Centre Kragujevac, Serbia. The influence of potential factors on birth weight, length, and head circumference was evaluated by multiple linear regression analysis. The study included 320 pregnant women and 332 newborns. Four factors had a significant negative effect on birth weight: smoking, twin pregnancy, use of methyldopa and corticosteroids during pregnancy. Smoking, twin pregnancy and corticosteroid use also had a significant negative effect on birth length. Negative effect on fetal head circumference at birth had smoking, use of corticosteroids and antibiotics during pregnancy. Maternal height and gestational age at birth showed a positive influence on fetal anthropometric measurements. Clinicians should pay attention to pregnant women with lower body height, twin pregnancy, who smoke and use corticosteroids, methyldopa and antibiotics.

Predicting the survival probability of functional neuroendocrine tumors treated with peptide receptor radionuclide therapy: Serbian experience.

Peptide receptor radionuclide therapy (PRRT) is a treatment option for well-differentiated, somatostatin receptor positive, unresectable or/and metastatic neuroendocrine tumors (NETs). Although high disease control rates seen with PRRT a significant number NET patients have a short progression-free interval, and currently, there is a deficiency of effective biomarkers to pre-identify these patients. This study is aimed at determining the prognostic significance of biomarkers on survival of patients with NETs in initial PRRT treatment. We retrospectively analyzed 51 patients with NETs treated with PRRT at the Department for nuclear medicine, University Clinical Center Kragujevac, Serbia, with a five-year follow-up. Eligible patients with confirmed inoperable NETs, were retrospectively evaluated hematological, blood-based inflammatory markers, biochemical markers and clinical characteristics on disease progression. In accordance with the progression og the disease, the patients were divided into two groups: progression group (n=18) and a non-progression group (n=33). Clinical data were compared between the two groups. A total of 51 patients (Md=60, age 25-75 years) were treated with PRRT, of whom 29 (56.86%) demonstrated stable disease, 4 (7.84%) demonstrated a partial response, and 14 (27.46%) demonstrated progressive disease and death was recorded in 4 (7.84%) patients. The mean PFS was a 36.22 months (95% CI 30.14-42.29) and the mean OS was 44.68 months (95% CI 37.40-51.97). Univariate logistic regression analysis displayed that age (p<0.05), functional tumors (p<0.05), absolute neutrophil count (p<0.05), neutrophil-lymphocyte ratio-NLR (p<0.05), C-reactive protein-CRP (p<0.05), CRP/Albumin (p<0.05), alanine aminotransferase-ALT (p<0.05), were risk factors for disease progression. Multivariate logistic regression analysis exhibited that functional tumors (p<0.001), age (p<0.05), CRP (p<0.05), and ALT (p<0.05), were independent risk factors for the disease progression in patients with NETs. Tumor functionality was the most powerful prognostic factor. The median PFS (11.86 ± 1.41 vs. 43.38 ± 3.16 months; p=0.001) and OS (21.81 ± 2.70 vs 53.86 ± 3.70, p=0.001) were significantly shorter in patients with functional than non-functional NETs respectively. The study's results suggest that tumor functionality, and certain biomarkers may serve as prognostic survival indicators for patients with NETs undergoing PRRT. The findings can potentially help to identify patients who are at higher risk of disease progression and tailor treatment strategies accordingly.

Dijagnostičko usaglašavanje presepsina, prokalcitonina, C-reaktivnog proteina i broja leukocita kod bolesnika kod kojih postoji sumnja na sepsu

Introduction/Aim. Agreement or disagreement of inflammatory parameters becomes important for making diagnosis when disparate values are encountered in a patient with suspected sepsis. The aim of our study was to test the agreement between the four commonly used tests for diagnosing systemic infection: white blood cell count (WBC), serum levels of C-reactive protein (CRP), procalcitonin and presepsin. Methods. This cross-sectional study included 479 adult patients hospitalized in the Clinical Center Kragujevac during 2019, who were suspected to have systemic infection and whose microbiological analyses were positive. Results. In a sample of hospital patients with isolated bacteria from the sites of suspected infection, the parameters of inflammation showed low agreement when used for diagnosing systemic infection. Only presepsin serum levels showed significant level of agreement with CRP and procalcitonin (Cohen's kappa = 0,257, p = 0,000Cohen's kappa = 0,169, p = 0,000, respectively, but also with low kappa values, while the agreement between CRP and procalcitonin was insignificant, as well as between the white cell count and the remaining three parameters. Conclusions. When disparate values of parameters of inflammation are encountered in a patient with suspected sepsis, a decision about antibiotic therapy should be based on either of the two pairs of parameters, presepsin/C-reactive protein or presepsin/procalcitonin.

Uloga serumske koncentracije vitamina D u predikciji toka i ishoda COVID-19 infekcije

Introduction/Aim. The coronavirus disease 2019 (COVID-19) pandemic had significant acute and long-term impact on people's health. As the available literature sources have shown that the premorbid conditions affect the course of COVID-19, we aimed to investigate the role of admission vitamin D concentration to predict the outcome of hospitalized COVID-19 patients. Methods. An observational, prospective cohort study was conducted on 329 COVID-19 patients hospitalized at the University Clinical Centre Kragujevac, between October and December 2021. Within 24 hours of admission, vitamin D level was measured from the peripheral venous blood. Medical history data and socio-demographic characteristics were obtained anamnestically and using Health Information System (COMTRADE, Serbia). Lethal outcome and intensive care unit (ICU) admission were considered primary end-points. Results. The prevalence of hypovitaminosis D on admission in our cohort was 27.7%. Both non-survivors and patients requiring ICU admission more frequently had hypovitaminosis D compared to survivors (42,9% versus 21,0%; p &lt; 0,001) and patients on a standard level of care (31,5% verus 25,3%; p = 0,029). Our research showed that vitamin D concentration &lt; 20 ng/mL was an independent predictor of mortality (aOR 2.142 [95% CI 1.226 - 3.744]). However, hypovitaminosis D upon hospital admission did not show a significant impact on ICU admission. Conclusion. Low vitamin D concentration on admission could be a significant predictor of outcome in hospitalized COVID-19 patients.

Using of endoscopic polypectomy in patients with diagnosed malignant colorectal polyp - The cross-sectional clinical study.

The aim of this study was to evaluate the efficacy of endoscopic polypectomy as a therapeutic treatment for malignant alteration of colorectal polyps. In a 5-year research, 89 patients were included, who were tested and treated at the University Clinical Center Kragujevac, Kragujevac, Serbia, with the confirmed presence of malignant alteration polyps of the colon by colonoscopy, which were removed using the method of endoscopic polypectomy and confirmed by the histopathological examination of the entire polyp. After that, the same group of patients was monitored endoscopically within a certain period, controlling polypectomy locations and the occurrence of a possible remnant of the polyp, in the period of up to 2 years of polypectomy. We observed that, with an increasing size of polyps, there is also an increase in the percentage of the complexity of endoscopic resection and the appearance of remnant with histological characteristics of the invasive cancer. The highest percentage of incomplete endoscopic resection and the appearance of remnant with histological characteristics of the invasive cancer were shown at malignant altered polyps in the field of tubulovillous adenoma. Eighteen patients in total underwent the surgical intervention. In conclusion, our data support the high efficacy of endoscopic polypectomy for the removal of the altered malignant polyp.

Nt-Probnp in Patients with Acute Myocardial Infarction Without Heart Failure

Abstract NT-proBNP is marker of acute heart failure. Recent investigation implicate its role in different cardiac and non-cardiac diseases and different mechanism of release in patients with STEMI and NSTEMI. Our study included 66 patients with diagnosis of acute myocardial infarction, hospitalized in Clinical Centre Kragujevac. We evaluated standard biochemical analysis including NTproBNP, electrocardiography, transthoracic echocardiography and coronary angiography. The most common cardiovascular risk factors were emotional stress (93,94%), and physical inactivity( 81,82%). NT-proBNP values were higher in patients with AMI vs health volunteers (943 vs. 162,5 pg/ml, p = 0,0001), NSTEMI vs STEMI patients (1427 pg/ml vs. 592 pg/m, p = 0,005), patients with culprit lesion on left vs right coronary artery (1421 vs. 548, p =0.02), and anterior vs inferior location AMI (1714vs. 625, p =0.022). We found positive correlation NT-proBNP values with CRP, urea, creatinine, and negative correlation with triglicerides, hemoglobin, left ventricular ejection fraction. Higher values of NT-proBNP values are recorded in patients with AMI, NSTEMI, anterior location AMI and with culprit lesion on left coronary artery.

The Influence of Treatment Modalities on the Quality of Life of Psoriasis Patients.

We aimed to identify the quality of life (QoL) of patients with psoriasis, to determine the possible differences depending on the therapeutic modalities (biologic, conventional treatment and phototherapy), and to examine other variables that could affect the success of the treatment. This research was a non-experimental, quantitative, observational study that included 183 psoriasis patients. The study was conducted from November 2021 to December 2022 at the University Clinical Center Kragujevac, Serbia. The following instruments were used: Dermatology Life Quality Index (DLQI), Psoriasis Area and Severity Index (PASI), as well as a general questionnaire that contained a set of questions which referred to sociodemographic data. There was a statistically significant difference in the average values of the DLQI score concerning the application of different therapeutic modalities (P<0.001). Biologic treatment was the modality with the lowest impairments in the QoL domain (average value of DLQI score 10.6±7.3), followed by patients on conventional treatment (average value of DLQI score 12.9±7.9), and the highest levels of impaired QoL were in patients who received phototherapy (average value of the DLQI score 13.7±9.3). Patients on biological therapy at all four time points individually (baseline, 4, 12 and 16 weeks) had the lowest average values of the DLQI score, i.e. the best QoL compared to subjects who received other therapy.

Comparing the Effectiveness of Laser Therapy, Medicaments and Surgical Treatment in Patients with Angle Closed Glaucoma

Abstract The study goal was to compare the efficiency of the medicaments, laser and surgical treatment in the patients with primary angle closure glaucoma (PACG) in order to achieve: normalization of intraocular pressure (IOP), maintaining the useful visual acuity and stabilization of visual field loss. All patients were treated at Clinic of Ophthalmology of Clinical Centre Kragujevac in Kragujevac, Serbia, in the period from June 15, 2010 to June 15, 2014. There were 116 patients in this study. They diagnosed with PACG, and they had been adequate selected for this study. They were treated with: medicaments; Nd:YAG (Neodymium:Yittrium Aluminum Garnet) laser iridotomy, and glaucoma surgery. Clinical ophthalmology controls have been introduced once or twice a month, and the vision field loss was tested three times every year. During the monitoring period of one year: no statistically significant difference occurred in terms of changes of the visual acuity among the three study-groups. The best IOP regulation was achieved after the laser treatment (53.4%), followed by the surgical treatment (28.5%), while the weakest was recorded in patients treated with the medicaments (18.1%). The percentage of the visual field loss was the biggest of patients treated with the medicaments (57%), and then the patients treated with the laser iridotomy (35%), while the least one occurred of the patients with the surgical treatment (23%). In the laser-treated group of 62 patients, the frequency of complications was 17.8%; while the out of 33 patients who had been treated (surgical), the frequency of complications was 19%. Laser iridotomy was shown to be effective of 89.5% of study-patients with PACG, while non-reactive studypatients underwent to the trabeculectomy. In addition to the high efficacy of Nd:YAG laser iridotomy in regulating of IOP values of the patients with PACG, the advantage of laser-method was in: the maneuvering of outpatients, it was easy to do, had a short lead time and was used in local anesthesia.

Factors affecting outcome in hospitalized patients treated according to recommendations from clinical pharmacologists.

Although some of the positive effects of consulting a clinical pharmacologist when using complex treatment schedules have been demonstrated, the factors determining treatment outcomes are largely unknown. A main aim of this study was to identify and analyze the factors associated with the treatment outcomes in hospital patients in whom a therapeutic plan proposed by a clinical pharmacologist had been accepted and implemented. The research was conducted as a retrospective cohort study on a random sample of 200 inpatients in the University Clinical Center Kragujevac, Serbia. The main outcome variables were i) in-hospital mortality, ii) inadequate clinical response to the therapy or pharmacological recommendations proposed by a clinical pharmacologist, iii) the total length of hospitalization, and iv) the length of hospitalization after consulting a clinical pharmacologist. The effect of putative predictors and confounders on the study outcomes were analyzed using multivariate regression models. Early integration of clinical pharmacologists in the course of patient treatment was associated with a reduction in the risk of a fatal outcome (OR=1.146; 95% CI, 1.006-1.305; p=0.040). Delay in consulting a clinical pharmacologist was associated with a longer overall length of patient hospitalization (B=1.592; 95% CI, 1.100-2.084; p=0.000). When the reasons for consulting a clinical pharmacologist involved the choice of drug or the occurrence of adverse drug reactions, the duration of hospitalization following the consultation was shorter by ~4 days (B=-4.337; 95% CI, -8.190 to -0.484; p=0.028) and 12 days (B= -12.024; 95% CI, -19.108 to -4.940; p=0.001), respectively. To achieve more favorable treatment outcomes in the case of difficult-to-treat hospital inpatients, clinical pharmacologists should be consulted early in the course of the disease, especially when the choice of drug is difficult, and the occurrence of adverse drug reactions is an important issue.

Hypovitaminosis D in infants: Evidence that increased intake of vitamin D reduces the incidence of allergic and respiratory disorders.

The study assessed the relationship between vitamin D status in infants and the presence of allergic and/or respiratory disorders. The study cohort comprised 81 hospitalized infants presenting at the Pediatric Clinic, University Clinical Center Kragujevac, Serbia, between January 2011 and June 2016. The age of the infants ranged from 29 days to 12 months. All infants received prophylactic doses of vitamin D3 of 400 IU/daily until the end of the first year of life regardless of whether they are fed with adapted infant formula (n=20) or breast milk (n=37) or concurrently both (n=24), up to the 5th month of life. The mean level of plasma 25(OH)D was 29.65ng/mL. Hypovitaminosis D (mean serum level of 25(OH)D < 30 ng/mL) was found in n = 38 infants of which 6 presented with severe vitamin D deficiency (level below 10 ng/mL), 13 presented with vitamin D deficiency (level between 10 and 20 ng/mL) and 19 had vitamin D insufficiency (levels between 20 and 30 ng/mL). The median vitamin D serum level in infants with allergic disease (n = 16) was 32.35 ng/mL and in infants with respiratory disease (n = 65) 28.99 ng/mL. Daily vitamin D3 supplementation with 400 IU in infants until the end of the first year of life is too low to provide optimal defense against respiratory and/or allergic conditions.

Testing of new instrument for measuring quality and diversity of nutrition in pregnancy.

Our aim was construction and development of a new questionnaire for assessing the quality and diversity of nutrition of pregnant women. This was a cross-sectional study. The novel questionnaire was developed through eight steps according with internationally accepted guidelines for questionnaire development. The questionnaire with 18 questions and answers according to the Likert's scale was created and called Balkan Food Quality and Diversity in Pregnancy Questionnaire-18 (BFQDPQ-18). Reliability testing and factor analysis of BFQDPQ-18 were carried out on a sample of 382 women in the third trimester of pregnancy whose pregnancy control and monitoring were performed at the Clinic for Gynecology and Obstetrics of the Clinical Center in Kragujevac, Serbia. The first test of reliability indicated high levels of internal consistency, with the Cronbach's alpha of 0.85 of the BFQDPQ-18. After dividing the BFQDPQ-18 into two parts of nine questions each by split-half method, the Cronbach's alphas were 0.799 and 0.716. The Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) was 0.878, and the Bartlett's test of sphericity: 1,892.206, p < 0.000. Factor analysis revealed four factors explained in total 51.99% of the variance: mean meal and snack, foods with a low degree of industrial processing, subjective assessment of dietary quality and starchy foods. The final version of the BFQDPQ-18 showed high reliability and good psychometric properties, so we believe it could be useful instrument for assessing the quality of nutrition of pregnant women.

Pharmacoeconomic aspects of hospital treatment of facial fractures - cost of illness study based on data from Balkan country with recent history of social and economic transition

Background/purpose: The incidence of facial fractures has a tendency to rise, which positively correlates with increasing total costs of treating this medical condition. The aim of this study was to identify the total costs of the hospital treatment of facial fractures and to analyze its main determinants. Materials and methods: This retrospective "cost-of-illness" study "from bottom to the top" approach was performed from the perspective of the Republic Health Insurance Fund. This study included 46 patients who were treated due to facial fractures at the Clinic for Maxillofacial Surgery at the Clinical Center Kragujevac in the period from the beginning of December 2017. to January 31, 2019. Results: The total costs of hospital treatment of all types of treated fractures amounted to 20,214.30€, and the average total cost per patient was estimated at 439.44±299.53€. The costs related to the length of hospitalization represented the largest part of the total direct costs, with a contribution of 31% and with a value of 6,329.30±80.18 €. Conclusions: Results of this pilot study pointed out that the total costs of treating facial fractures in the socio-economic sphere of Balkan countries are lower than in other health care systems, mostly due to differences in valuing medical services compared to countries within the European Union. Due to the rising incidence of injuries and obligatory hospital treatment of these conditions, this kind of pharmacoeconomic evaluation could contribute to the introduction of new therapeutic strategies for adequate allocation of resources within health systems.

Značaj rehabilitacije kod dekondicioniranog bolesnika nakon hospitalno lečene COVID-19 infekcije - prikaz slučaja

Introduction. The COVID-19 pandemic caused by the SARS-CoV-2 virus has led to significant public health problems, severe complications, and functional impairment in persons who have recovered from this disease. Case report. A 60-years-old male deconditioned patient was transferred from Corona 4 Center to the Center for Physical Medicine and Rehabilitation of the University Clinical Center in Kragujevac for a post-COVID rehabilitation due to pronounced muscle weakness and inability to walk. After functional testing, an individual rehabilitation plan was created and a kinesitherapy program was adjusted daily based on the patient's respiratory status. After the kinesitherapy program, Respivol was used-a volumetric medical device for breathing exercises in patients with respiratory difficulties. At the time of admission, the patient could not move independently, could not move from the lying to the sitting position on his own, and could not maintain balance in the sitting position. Hypotrophy caused by prolonged inactivity of the muscles of the whole body dominated the clinical picture. A six-week rehabilitation treatment performed on the patient showed a significant improvement in functionality (FIM test), muscle strength (manual muscle test), daily life activity (Barthel index), as well as a reduction of anxiety (GAD-7 scale). Conclusion. The goal of the rehabilitation program is to restore the patient's state of functionality before the initiation of COVID-19 treatment, so that they can perform their regular professional activities and achieve complete independence in performing activities of daily living (ADL).

Superoxide Dismutase 2 Val16Ala Polymorphism is Associated with Amiodarone-Associated Liver Injury

Abstract Association of SOD2 V16A single-nucleotide polymorphism (rs4880) with drug hepatotoxicity were reported but relationships with amiodarone prescriptions remained unexplored. Research was an exploratory, controlled prospective clinical trial. Patients hospitalized and treated in Clinical Center in Kragujevac, Serbia (in year 2017) were divided into experimental (using amiodarone, having liver injury, n=29, 19 males, the mean age 66.8±10.4 years), control A (neither amiodarone use nor hepatotoxicity, n=29, 19, 66.1±10.3) and control B group (using amiodarone, not having hepatotoxicity, n=29, 19, 66.8±9.8). From blood samples, among other routine biochemistry, genotyping for SOD2 polymorphism Val16Ala was conducted using real-time PCR method with TaqMan® Genotyping Master Mix and TaqMan® DME Genotyping Assay for rs4880. Patients taking amiodarone and having liver injury were mostly carriers of Val/Val (TT) genotype (13 of 24 patients, 54.2%) while Val/Ala (TC) and Ala/Ala (CC) genotypes prevailed in control group A (19 of 40, 47.5%) and control group B (9 of 23, 39.1%), respectively (2=10.409, p=0.034). Frequency of Val (T) and Ala (C) alleles were 0.51 and 0.49, respectively in the whole study sample (Hardy Weinberg equilibrium, 2=0.56, p=0.454). Carriers of TT genotype had significantly higher ALT (437.0±1158.0 vs 81.9131.5 U/L), total bilirubin (28.320.5 vs 15.313.0 mol/L) and total bile acid concentrations (10.910.2 vs 6.45.3 mol/L) compared to carriers of TC genotype (U=2.331, p=0.020, U=3.204, p=0.001 and U=2.172, p=0.030, respectively). Higher incidence of 47T allele of SOD2 was inpatients with amiodarone-associated liver injury as compared to patients on amiodarone not experiencing hepatotoxic effects.

Evaluation of Physiological Intracranial Calcifications in Children Using Computed Tomography

Abstract Physiological intracranial calcifications have an increasing prevalence with the age and can be found in both children and in adults. These calcifications are basically asymptomatic and their presence can only be noticed through neuro-imaging. The aim of the paper was to evaluate physiological intracranial calcifications in children using computed tomography, in our conditions. The study was designed as a retrospective, observational, nonrandomized clinical study. It was conducted at the Department of Radiology, Clinical Center Kragujevac, Serbia. The study included all the patients scanned by CT from 1st October, 2008. to 30th September, 2018.. The criteria for the inclusion were: the patients aged up to 18 years who underwent a non-contrast computed tomography in the observed period, with diagnosed intracranial calcifications that do not have pathological etiology. Our study included 420 patients. Out of them, 213 (50.7%) were boys and 207 (49.3%) were girls. The mean age was 12.47. We divided the patients into two age categories: the first one included the patients aged 1 to 10 years and the other one included the patients aged 11 to 18 years. Our study has demonstrated that physiological intracranial calcifications are the most frequent in habenula (28.1%), followed by the pineal gland (22.6%) and choroid plexus (18.8%). There is a small number of studies with the subject of physiological intracranial calcification distribution, especially in children. It is important to know in which locations we can expect physiological intracranial calcifications, as well as the age in which they become detectable by imaging, in order not to mix them with hemorrhages, pathological tumor or metabolic mineralization.