Clinical Center Kragujevac Research Articles

Encephalopathy During H1N1 Influenza a Virus Infection / Encefalopatija Kod Infekcije Virusom Influence A Podtip H1N1

Abstract Influenza virus type A is known for its capacity to transform its antigenic structure and create new viral subtypes. The clinical picture varies from non-febrile, mild upper respiratory tract infection to severe or fatal pneumonia. Neurological complications include encephalitis, encephalopathy, Reye’s syndrome and other neurological diseases. Patients with encephalopathy exhibit a disturbed state of consciousness lasting more than 24 hours, and patients with encephalitis exhibit high temperature, focal neurological signs and pathological CSF results in addition to disturbed state of consciousness. A 54-year old, previously healthy male farmer was hospitalized at the Clinic for Infectious Diseases of the Clinical Centre Kragujevac on the fifth day of disease. In addition to general symptoms of the disease, the clinical picture was dominated by a disturbed state of consciousness (Glasgow Coma Scale score <8). The aetiological agent was an H1N1 influenza A virus, which was isolated from nasopharyngeal secretions. No other causes of infection were demonstrated from both serum and cerebrospinal fluid specimens. Interstitial pneumonia was detected by radiographic examination of the chest. There were also some changes present in the EEG. The patient was cured without consequences. Because our country is in a whirlwind of pandemic H1N1 virus activity, we should think of all the possible complications that this virus can produce regardless of the epidemiological data and the clinical picture.

Erratum: The article „Congenital upper eyelid coboloma with ipsilateral eyebrow hypoplasia” [Urodjeni defekt gornjeg kapka sa istostranom hipoplazijom obrve]. Vojnosanit pregl 2012; 69(9): 809-811. (DOI:10.2298/VSP1209809V).

The authors and their affiliations were listed as follows: Dejan Vulovic+, Marijan Novakovic??, Tatjana Sarenac?, Mirjana Janicijevic-Petrovic?, Nenad Petrovic?, Suncica Sreckovic?, Sasa Milicevic?, Branislav Piscevic? +Centre for Plastic Surgery, ?Clinic for Ophthalmology, Clinical Centre Kragujevac, Kragujevac, Serbia; ?Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade, Serbia; ?Medical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia Listed the authors and their affiliations should read as: Dejan Vulovic+, Marijan Novakovic??, Tatjana Sarenac?, Mirjana Janicijevic-Petrovic?, Nenad Petrovic?, Suncica Sreckovic?, Sasa Milicevic?, Branislav Piscevic? +Centre for Plastic Surgery, ?Clinic for Ophthalmology, Clinical Centre Kragujevac, Kragujevac, Serbia; ?Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade, Serbia; ?Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia <br><br><font color="red"><b> Link to the corrected article <u><a href="http://dx.doi.org/10.2298/VSP1209809V ">10.2298/VSP1209809V</a></b></u>

Headache in patients undergoing general anesthesia

Objective. Postoperative headache can be one of the complications that occur after waking the patient from general anesthesia. The aim of this study was to evaluate the prevalence of postoperative headaches after general anesthesia, in our conditions. Methods. Our study was designed as a comparative, open, non-randomized clinical study, carried out in a routine clinical practice. It was conducted at the departments of thoracic, abdominal, vascular, orthopedic surgery and gynecology, in the Clinical Center in Kragujevac. The study involved patients who signed the informed consent before the study and who were operated at these departments and underwent general anesthesia during the time frame from 01/03/2016 to 01/04/2016. Results. The results of this study showed that the frequency of postoperative headache after general anesthesia was 9%. Patients rated intensity of these headaches on a visual analogue scale. The mean value of this scale of the study participants was 0.33±1.3. It was found that alcohol consumption is an important factor associated with the development of postoperative headache after general anesthesia (p=0.035). Conclusion. Assessing frequency of postoperative headache after general anesthesia is significant both for patients and for doctors, because it puts the emphasis on the headache as a postoperative complication. Therefore, it is necessary to pay attention at this type of headache and affect the reduction of its frequency and improve the quality of life of patients after waking up from general anesthesia.

Relentless placoid chorioretinitis: A case report

Relentless placoid chorioretinitis is an entity which belongs to the group of an atypical intermediate form of primary inflammatory choriocapillaropathies, resembling both acute posterior multifocal placoid pigment epitheliopathy and serpiginous choroiditis, but the retinal distribution and clinical course are not the same. Because of this similarity this entity was termed “AMPPiginous”. This entity was first described by Jones et al. in 2000. The aim of our case report is to present a very specific case where the clinical course was progressive, with loss of vision in the affected eye. A 31-year-old man, with no previous ophthalmic diseases, was hospitalized at the Clinic of Ophthalmology, Clinical Center Kragujevac, because of a reduction of vision in the right eye, and scotoma and metamorphopsia in the left eye. The clinical course of retinal lesions in the left eye resembled the changes observed in acute posterior multifocal placoid pigment epitheliopathy, and the right eye changes were between acute posterior multifocal placoid pigment epitheliopathy and serpiginous choroiditis. The diagnosis of relentless placoid chorioretinitis was confirmed after clinical, laboratory, immunological, virological, and angiography examinations. The progressive clinical course of the disease, complemented by multimodal imaging and extensive laboratory diagnostics, has led us to the diagnosis of relentless placoid chorioretinitis. The combined anti-inflammatory and immunomodulatory therapy led to the stabilization of visual acuity of the left eye as opposed to the right, where there has been no recovery.

Fever of unknown origin: Most frequent causes in adults patients.

The differential diagnosis of fever of unknown origin (FUO) includes more than 200 different diseases and conditions. The aim of this study was to identify the most frequent causes of FUO among adult patients according to gender and age. The study included 74 patients examined from June 2010 to June 2013 at the Infectious Disease Clinic, Clinical Center Kragujevac in Serbia, according to the defined criteria for FUO. The patients were divided according to the diagnosis into four groups: infectious, malignant, rheumatic and "other diseases". A cause of febricity could not be estabilshed in a portion of subjects, and they comprised the group of undiagnosed cases. Infectious diseases were dominant in the study, followed by rheumatic diseases, which were most frequently found in women and the elderly. The diseases recognised as the most common causes of febricity were subacute thyroiditis, subacute endocarditis, Still's disease, rheumatic polymyalgia with or without temporal arteritis, and cytomegalovirus infection. In 44% of the patients, the final diagnosis was composed of only six clinical entities. The importance of establishing the diagnosis of rheumatic disease is especially emphasised, in line with other authors' research indicating the number of these diseases is on the rise. The diagnostic approach to FUO should always be directed to the known frequency of diseases.

Analysis Of Clinical, Haematological And Biochemical Parameters In Patients With Infectious Mononucleosis

AbstractPrimary infection with Epstein-Barr virus (EBV) usually occurs in early childhood and often does not present clinical symptoms. More than 90% of adults are infected with this virus. A primary infection that occurs in adolescence or adulthood is usually clinically presented as infectious mononucleosis with a triad of symptoms: fever, lymphadenopathy and pharyngitis. Our retrospective study included 51 patients with a median age of 17 (9-23) years and serologically confirmed infectious mononucleosis. All patients with infectious mononucleosis were treated at the Clinic for Infectious Diseases at the Clinical Center in Kragujevac during 2013. We analysed the clinical, haematological and laboratory parameters of patients. The aspartate-aminotransferase levels were increased in 40 patients, with a mean value of 116.24 (±93.22); the alanine-aminotransferase levels were increased in 44 patients, with a mean value of 189.24 (±196.69). Lymphadenopathy was the most common clinical feature upon admission in 49 patients (96%); 38 patients (74.5%) had splenomegaly, and 20 (39%) had hepatomegaly. Twenty-six patients (51%) had leukocytosis with lymphocytosis, while 15 (75%) of the 20 who had a normal leukocyte count also had lymphocytosis. In the present study, we updated the clinical, haematological and laboratory parameters, which may lead to the establishment of an accurate diagnosis and promote further treatment of the patients.

The Prevalence of Pain in Adults with Multiple Sclerosis: A Multicenter Cross-Sectional Survey.

Examination of prevalence, intensity and associations of pain in persons with multiple sclerosis (MS). Multicenter, international cross-sectional survey. Patients were recruited from seven MS centers: in Serbia (Clinic of Neurology, Clinical Center of Serbia, Belgrade; Clinic of Neurology, Military Medical Academy, Belgrade; Clinic of Neurology, Clinical Center Kragujevac; Clinic of Neurology, Clinical Center Nis; Department of Neurology, General Hospital-Uzice), in Republic of Srpska-Bosnia and Herzegovina (Clinic of Neurology, Clinical Center Banja Luka) and in Croatia (University Department of Neurology, Sestre Milosrdnice University Hospital Center, Zagreb). Six hundred and fifty consecutive MS patients diagnosed according to the Revised McDonald criteria (2005), from the aforementioned centers, over the period of 6 months. A semistructured questionnaire was administered during a face-to-face interview with neurologists who also performed Expanded Disability Status Scale (EDSS), the Hamilton Rating Scale for Depression (HDRS) and Hamilton Rating Scale for Anxiety (HARS). To recognize predictive factors for the presence of pain, the linear regression analysis was used. Lifetime prevalence of pain was 66.5% (point prevalence = 44.3%). The prevalence of the comorbidity of pain and depression was 29.1%. Older age (P < 0.001), primary-progressive MS (P = 0.034), higher EDSS score (P = 0.008), higher scores of HDRS (P < 0.001), and HARS (P < 0.001) were significantly associated with pain. Finally, in our multivariate linear regression analysis, anxiety (P < 0.001) was the independent predictor of pain. We confirmed high prevalence of pain, affecting approximately more than half of patients during the course of MS. Pain in MS is associated with disability, depression and, especially with anxiety, which has significant implications for treatment.

PP.01.34

Objective: Microvascular angina includes a heterogeneous group of patients with typical chest pain, positive exercise stress test and angiographically smooth coronary arteries. Coronary heart disease is the most common type of heart disease and includes: stable angina pectoris, unstable angina pectoris, myocardial infarction without ST segment elevation (NSTEMI) and myocardial infarction with ST segment elevation (STEMI). The aim of this study was to examine differences in the values of mean arterial pressure in patients with microvascular angina and patients with CAD including: stable angina, unstable angina, STEMI and NSTEMI. Design and method: This study included 375 patients, of whom 75 with microvascular angina and 300 patients with CAD (75 patients with stable angina, 75 patients with unstable angina, 75 patients with NSTEMI and 75 patients with STEMI) who were treated at the Clinic for Cardiology, Clinical Centre Kragujevac in the period from 2005. to 2013. All patients with MVA were taken into account, while patients with CAD were randomised using randomising tables. Blood pressures were measured 30 minutes after admission. Mean arterial pressure was calculated as the sum of diastolic pressure and one-third of pulse pressure. All data was entered into SPSS and statistically processed using descriptive and analytical methods. Results: Values of mean arterial pressure were significantly different between patients with MVA and patients with CAD, with higher values in patients with CAD (98.07 ± 11.67 versus 103.27 ± 14.41; p = 0.001). When comparing values of mean arterial pressure between the groups (MVA vs. stable angina, unstable angina, NSTEMI and STEMI), significantly higher values were noticed between patients with MVA and NSTEMI (98.07 ± 11.67 versus 104.38 ± 14.11; p = 0.003) and patients with MVA and STEMI (98.07 ± 11.67 versus 109.04 ± 18.05; p < 0.001), while there was no significantly difference between patients with MVA and stable angina (98.07 ± 11.67 versus 100.27 ± 11.45; p = 0.246) and patients with MVA and unstable angina (98.07 ± 11.67 versus 99.40 ± 11.12; p = 0.475). Conclusions: Values of mean arterial pressure were significantly different between patients with MVA and CAD, more precisely between patients with MVA and patients with NSTEMI and STEMI, while the significance was not present between patients with MVA and stable and unstable angina pectoris.

Analysis of risk factors for occlusions of a synthetic femoropopliteal bypass graft.

Femoropopliteal bypass is a revascularization technique of lower extremities with excellent outcome. The great saphenous vein is the best graft material, but if it is not adequate or has been removed, synthetic grafts are an useful alternative. Graft occlusion is the most significant complication with the most serious consequences. The aim of this study was to analyse predictive factors for the synthetic femoropopliteal bypass occlusions. This retrospective case-control study included all patients who underwent synthetic femoropopliteal bypass due to peripheral arterial occlusive disease at the Vascular Surgery Center, Clinical Center of Kragujevac, Serbia, from 2007 to 2013. The cases group were the patients with femoropopliteal graft occlusion (n = 44), with the control group consisted of the patients without such an outcome (n = 88). Significant effects to occlusion were: concomitant cardiovascular disease (adjustedOR 27.05; 95% CI 4.74; 154.35), a type of femoropopliteal bypass (adjustedOR 16.50; 95% CI 4.05; 67.24), previous vascular intervention (adjustedOR 4.67; 95% CI 1.20; 18.14), clinical stage of the disease (adjustedOR 3.73; 95% CI 1.94; 7.18), administration of postoperative oral anticoagulant therapy (adjustedOR 0.05; 95% CI 0.01; 0.23) and the use of angiotensin converting enzyme inhibitors (adjustedOR 0.14; 95% CI 0.03; 0.70). A significant synergism was shown for the following combinations of the observed risk factors: type of femoropopliteal bypass and cardiovascular disease, type of femoropopliteal bypass and previous vascular intervention, previous vascular intervention and cardiovascular disease, previous vascular intervention and beta blockers, cardiovascular disease and diabetes, type of femoropopliteal bypass and antiaggregant therapy, clinical stage of disease and cardiovascular disease, previous vascular intervention and antiaggregant therapy. Concomitant cardiovascular disease, below-knee femoropopliteal bypass, advanced stage of vascular disease and non-use of anticoagulant therapy and angiotensin-converting enzyme inhibitors are the significant predictors of graft occlusion after synthetic femoropopliteal bypass. Their synergistic effect determines the importance of diabetes, use of beta blockers and platelet antiaggregant therapy.

Health care–acquired infections in neonatal intensive care units: Risk factors and etiology

A 1-year prospective cohort study of health care-acquired infections was conducted at the neonatal intensive care unit of the University Clinical Centre Kragujevac, Serbia. The incidence rate of neonates with health care-acquired infections was 18.6%, and the incidence rate of the infections themselves was 19.4%. The incidence density of the health care-acquired infections was 9.1 per 1,000 patient days. The independent risk factors for health care-acquired infections were birth weight, length of hospitalization, duration of mechanical ventilation, and Apgar score. More than half of all isolated microorganisms were Klebsiella-Enterobacter (39.3%) and Escherichia coli (25.0%).

Risk factors for the development of metabolic syndrome in obese children and adolescents.

High prevalence of metabolic syndrome (MetS) in children and adolescents is a great concern of the modern society. bjective: Our aim was to determine the influence of previously investigated, but also and potentially novel risk factors for the development of metabolic syndrome in children and adolescents. Observational case-control clinical study was conducted involving children and adolescents with obesity/metabolic syndrome, treated on inpatient basis from January 2008 to January 2012 at the Pediatric Clinic of the Clinical Centre Kragujevac, Kragujevac, Serbia. The group of"cases"(n=28) included patients aged 10-16 years with the diagnosis of metabolic syndrome according to the International Diabetes Federation (IDF) criteria, while the control group included twice as many obese patients (n=56) matched to the compared group. Presence of maternal gestational diabates (ORadjusted: 39.426; 95% Cl: 1.822-853.271; p=0.019), and/or lack of breastfeeding in the first six months of life (ORadjusted: 0.079; 95% CI: 0.009-0.716; p=0.024) were significant predictors for developing MetS. Also, microalbuminuria is associated with MetS in obese children and adolescants (ORadjusted: 1.686; 95% Cl: 1.188-2.393; p=0.003) CONCLUSION: Presence of maternal gestational diabetes and/or lack of infant breastfeeding are considered as relevant factors that may contribute to the increased risk of developing MetS syndrome, while microalbuminuria is frequently associated with MetS in obese children and adolescents.

Correlation Between Cervical Cytology and Histopathological Cervical Biopsy Findings According to the Bethesda System / Stepen Korelacije Cervikalne Citologije Po Bethesda Klasifikaciji Sa Patohistološkim Nalazima Cervikalne Biopsije

ABSTRACT The Pap test (Pap smear) is a morphological cytodiagnostic test that reveals premorbid and early stages of cervical cancer through the use of cervicovaginal cytology. The present study was conducted at the Department of Gynecology and Obstetrics, Clinical Center Kragujevac, from January 01, 2013, to December 1, 2013, with patients who were part of the national screening program and who used a secondary cytological examination (Pap test) performed using a conventional method. The patients were grouped according to the results of a Pap smear and histopathological findings. The classification of cytological smears was performed in accordance with the Bethesda system. The hypotheses established in this study were statistically tested. The greatest number of cytological findings was NILM. However, the most frequent abnormal cytological findings in terms of percentage were ASC-US. After secondary cervical findings of 8.1% of the total number of women, biopsies were performed. In 68.57% of the biopsies performed, CIN was present in all of them, with the most frequent ones being LSIL (50.6%), HSIL (10.4%) and CA Invasiva (0.5%). This study, using the X2 test, confirmed that cervical cytology and biopsy results are dependent features (sig. = 0.036), between which there is a medium association (Cramer’s V = 0.176). In the ASC-US cytological findings, small percentages of CIN1 and CIN2 were detected. Cervical cytology in this study presented high sensitivity, specificity, positive and negative predictive value. As a relatively inexpensive, painless and easily approachable method, cervical cytology fully substantiates its implementation in diagnostic procedures as well as in organized screening programs.

Incidenca hromozomskih aberacija otkrivenih prenatalno metodom amniocenteze u Opstoj bolnici Uzice u periodu 2006-2014. godine

Objective. The main objective of this paper is to present for the first time results of prenatal diagnosis, the incidence of chromosomal aberrations, in the General Hospital Uzice, with special reference to trisomy 21. Methods. This study included a group of 749 pregnant women who underwent invasive prenatal diagnosis using amniocentesis between September 2006th to the August 2013th at the Department of Gynecology and Obstetrics. The total number of delivered women during the same time period was 12 447. Karyotype analysis of in vitro cultured fetal cells was performed using standard techniques on Cytogenetic Department, Clinical Center Kragujevac. All collected data were analyzed and even acknowledge the graphic. Results. Cytogenetic analysis revealed 29 fetal chromosomal abnormalities (3,9%). From the total number of chromosomal aberrations was revealed 14 unbalanced chromosomal rearrangements (48%) and 15 balanced chromosomal aberrations (52%). The seven trisomy of chromosome 21, one triploidy, one deletion, one duplication, two mosaic trisomies, two numerical aberrations of sex chromosomes were detected. The balanced chromosomal rearrangements revealed 15 inversion of chromosome 9. Trisomy 21 makes 24% of all total chromosomal aberrations and 50% of unbalanced rearrangmants. The incidence of Down syndrome prenatally dijagnostifi kovanog is one of 107 amnion.

Cost-effectiveness analysis of tocilizumab in combination with methotrexate for rheumatoid arthritis: A Markov model based on data from Serbia, country in socioeconomic transition

Recent studies have shown that biological treatments for rheumatoid arthritis can change the course of rheumatoid arthritis and improve functional ability of patients with rheumatoid arthritis. In spite of this fact, use of biological therapy is still limited by high prices of these medicines, especially in countries in socioeconomic transition. The aim of our study was to compare cost-effectiveness of a combination of tocilizumab and methotrexate with methotrexate alone for rheumatoid arthritis in Serbia, a country in socioeconomic transition. For the purpose of our study we designed a Markov model using data on therapy efficacy from the available literature, and data on the costs of health states calculated from records of actual patients treated in the Clinical Center Kragujevac, Serbia. The duration of one cycle in our model was set at one month, and the time horizon was 480 months (40 years). The study was done from the social perspective, and all the costs and outcomes were discounted for 3% per year. Treating rheumatoid arthritis with disease-modifying antirheumatic drugs (DMARDs) alone was more cost-effective in comparison with a combination of biologic treatment with tocilizumab and DMARDs. The total costs for treating a patient with DMARDs for one year were on average 261,945.42 RSD, or 2,497.70 Euro and the total costs for treatment with tocilizimab plus DMARDs were on average 1,959,217.44 RSD, or 18,659.20 Euro. However, these results are susceptible to changes in costs and treatment effects of tocilizumab in patients with more severe forms of rheumatoid arthritis. Our results show that the use of tocilizumab for rheumatoid arthrits in economic environment of Serbia is not cost-effective. Use of tocilizumab for treating rheumatoid arthritis can become affordable, if costs of its use become lower. In order to start using expensive biologic medicines in patients in transitional countries, special strategy and pricing policy of international pharmaceutical companies are necessary, which would include calculation of prices of biologic medicines on the basis of local pharmacoeconomic studies.

„Obesity Paradox“ – Fiction or a Fact?

Background: Many cardiovascular diseases are associated with obesity, but, despite this fact, obese people live longer than their normal-weight counterparts do. This phenomenon is called the „obesity paradox“. Aim: Purpose was to investigate the impact of obesity on the final outcome; determine the connection between obesity and heart rate > 80 beats per minute and other risk factors, and presence of „obesity paradox“. Material and Methods: Research included 140 patients with anterior wall acute STEMI treated in Coronary Unit, Clinical Center Kragujevac form January 2001-June 2006. Heart rate was calculated as the mean value of baseline and heart rate in the first 30 minutes after admission. Body mass index was calculated as the ratio of body weight in kilograms and body height in squared meters, and classified according to the WHO recomendations. Results: More than 75% obese patients were in both groups, survivors and those who died. In the subgroup with heart rate > 80 results were similar. Obesity had no significant effect on mortality despite the fact that the large number of patients with fatal outcome was obese. Conclusion: Correlation with acute myocardial infarction and elevated heart rate is evident, but obesity was not independent predictor for mortality which can only partly confirm presence of „obesity paradox“.

Nosocomial urinary tract infections caused by Pseudomonas aeruginosa and Acinetobacter species: Sensitivity to antibiotics and risk factors

Pseudomonas aeruginosa and Acinetobacter species frequently cause intrahospital urinary tract infections (IUTI), contributing to increased hospital morbidity and mortality. Our objective was further exploration of possible risk factors for development of IUTI caused by P aeruginosa and Acinetobacter spp, including their resistance to various antibiotics. The prospective case control study was conducted in Clinical Center Kragujevac, Serbia, during the period January 2009 to December 2011 and covered all patients with IUTI according to the Centers for Disease Control and Prevention criteria. The patients classified as "cases" had an IUTI caused by P aeruginosa or Acinetobacter spp. The control patients were matched to the cases and selected randomly from the remaining patients. There were 79 cases (11.9%) and 586 (88.1%) controls in the study. According to the multivariate binary logistic regression, there were 3 significant predictors of P aeruginosa and Acinetobacter spp IUTI: male sex (odds ratio [OR], 0.423; 95% confidence interval [CI]: 0.251-0.711; P = .001), stay in another hospital ward before emergence of IUTI (OR, 1.704; 95% CI: 1.013-2.864; P = .044), and previous use of penicillins and their combinations with inhibitors of β-lactamases (OR, 2.643; 95% CI: 1.044-6.692; P = .040). Knowing that IUTI caused by above-mentioned bacteria are especially frequent among male patients, after previous use of penicillins, and in patients who spent some time previously at other wards, sound strategies for prevention of such infections in clinical practice should be developed.

Tonsillectomy complications in children and adults

Tonsilectomy is one of the most commom surgerys, although its number has been decreasing since seventies. It is consider a routine procedure, but it is not free of risk and can have numerous complications. Aim of our study is to determine complications of clasic technique tonsilectomy in general endotracheal anestesia in children and adults that required intervention. This is a retrospective study of 2325 tonsilectomies done in the period from 2001 till 2010 at ENT Clinic, Clinical Centre Kragujevac. Out of 2325 tonsilectomies 1935(83%) were done in children, while 390(17%) were done in adults. In children 1167(60%) were pure adenectomies, while the rest, 768(40%) were tonsilectomies. Complications that required intervention were present in 1.6% of patients. Bleeding that required revision and hemostasis in ER has developed in 15(0.6%) patients, 12 (3.07) children and 3 (0.15%) adults. One child has a severe bleeding after adenectomy which required posteral tamponade. One adult developed severe bleeding that required ligate of a.carotis externa. High body temperature and dehidration developed in 23 (1.18%) children which required pediatrian examination. One child developed appendicitis, and three of them pneumonia. The most common tonsilectomy complication inadults is bleeding, and in children elevated body temperature and dehidration.

Profile of urinary tract infections pathogens and their antimicrobial resistance patterns during three-year period (2009-2011) in the Clinical center Kragujevac

Urinary tract infections are common bacterial diseases and also a frequent reason for prescribing antibiotics. Knowledge about the type of pathogens and their resistance patterns may help the clinician to choose the correct treatment. In this study, the prevalence and the resistance pattern of the main bacteria responsible for urinary tract infections of hospitalized patients in Clinical centar Kragujevac was evaluated throughout a tree-year period. Cross-sectional study in the hospital settings was conducted and urine samples were collected from 662 patients with urinary tract infections and tested using standard procedures. The diskdiffusion method on Mueller-Hinton agar according to Clinical and Laboratory Standards Institute guidelines (CLSI) was performed for assessment of antimicrobial susceptibility. The most frequently isolated pathogen were Klebsiella spp. (219 isolates, i.e. 33.1%), Proteus mirabilis (107 isolates, i.e. 16.2%), Enterobacter (86 isolates, i.e. 13%), Escherichia coli (82 isolates, i.e. 12.4%), Pseudomonas aeruginosa (70 isolates, i.e. 10.6%), Enterococcus spp (39 isolates, i.e. 5.9% ) and Proteus vulgaris (38 isolates, i.e. 5.7%). Group of patients older than 65 years was the largest one 426 (64.4%). Gram negative bacteria showed the highest degree of resistance (92.3% - 100%) to penicillins (ampicillin, amoxicillin, amoxicillin + clavulanic acid) and third-generation cephalosporins (cefotaxime, ceftriaxone and ceftazidime) (88.3% - 98, 4%), while Gram positive Enterococcus spp showed the highest degree of resistance to aminoglycosides (gentamicin and amikacin) (96.8% - 100%) and fluoroquinolone ciprofliksacin (100%). The lowest resistance rate of the studied Gram negative pathogens was to carbapenems (imipenem and meropenem) and piperacillin / tazobactam (6.9% - 35.5%), while the lowest level of resistance of gram positive Enterococcus spp was found to glycopeptide antibiotics (vancomycin and teicoplanin) (3.0% - 3.3%). When choosing antibiotics, the pharmacokinetics and pharmacodynamics, renal and liver function, adverse reactions with other drugs, as well as the results of susceptibility testing should be taken into consideration. According to our data, empiric treatment for Klebsiella spp, Proteus mirabilis, Enterobacter, Escherichia coli, Pseudomonas aeruginosa and Proteus vulgaris should include carbapenems or piperacillin / tazobactam, and when it comes to Enterococcus spp, glycopeptide antibiotics are appropriate choice.

The incidence of Down syndrome in newborns at the Department of Obstetrics and Gynecology of the Clinical center Kragujevac during the period 2007-2012

Objective. The main objective of this study was to determine the incidence of Down syndrome in newborn infants diagnosed prenatally and in newborn children in Kragujevac. Methods. This retrospective study included groups of 1208 pregnant women and 10,712 mothers aged 14-55 years, who came to the Gynecology and Obstetrics Clinic, Clinical Center Kragujevac during the period 2007-2012. Cells of amniotic fluid, taken during amniocentesis between 16 and 18 weeks of pregnancy, were cultured for 12 days and, after cytogenetic processing, stained and analyzed with light microscopy. Data were analyzed and presented descriptively. Results. During the four year period, between January 2007 and December 2011, 8 cases of Down syndrome were diagnosed by amniocentesis of 1208 amnions, which resulted in incidence of 1 in 151 amnions. Also, there were 15 cases of liveborn children with Down syndrome in 10822 liveborn babies, which made an incidence of 1 in 721 liveborns. The total of 1070 pregnancies were with mothers older than 35 years at the time of labor and 5 of 15 liveborn babies with Down syndrome were from mothers belonging to this group. Also, 9464 pregnancies were with mothers aged 18-35 years and in this group there were the last 10 cases of Down syndrome. There were 8 fetuses with Down syndrome, all diagnosed with trisomy 21, and all 8 aborted by choice of the Ethical committee of the Clinical Center Kragujevac. Conclusion. The decision of not having prenatal diagnostics for pregnancies, some by late amniocentesis, some by the decision of the family, resulted in Down syndrome liveborns.

Incidenca gojaznosti u trudnoći na teritoriji Kragujevca

Aim. Research of frequency and outcomes of overweight and obesity among pregnant women in Kragujevac area. Method. In this study 162 pregnant women were observed since November 2012 until January 2013, whose Body Mass Index was measured at the beginning of pregnancy and their gain weight was observed during pregnancy. Database was collected from health records of Health Center Kragujevac and from protocols of delivery from childbirth center of Clinical Center Kragujevac. Body Mass Index was stratified into four groups, and connection among these groups and complications in perinatal period was displayed by x2 statistic method with a probability of p≤0,05. For the purpose of this study we used a questionnaire about nourishment designed by Public Health Institute of Serbia 'Dr Milan Jovanović-Batut' in 2006. Results. Incidence of overweight is 22,83%, of obesity 4,32%, and of gain weight 38,89% among pregnant women. The connection is detected between Body Mass Index and following effects: gestational diabetes (x2=21,091; p=0,000), weight of newborn children (x2=29,103; p=0,000) and parity (X2=41,039; p=0,000). Conclusion. Increased body mass before pregnancy is associated with the complications in perinatal period.