Sremska Kamenica Research Articles

Assessing the Impact of the Updated 2021 European Respiratory Society/American Thoracic Society Criteria on Bronchodilator Responsiveness in Asthma.

Introduction The European Respiratory Society/American Thoracic Society (ERS/ATS) Task Force released new technical standards on spirometry interpretation in 2021. Our study compares bronchodilator responsiveness (BDR) in asthma, evaluating the impact of the 2005 and 2021 ERS/ATS criteria and the influence of predictive equations. Methods A retrospective cohort study of adult patients with asthma was referred to spirometry with a BDR test at the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia. The study included adult patients with asthma who underwent BDR testing in the Department of Respiratory Pathophysiology at the institute and had available data on height, gender, age, race, and eosinophil count. Results Among 197 patients, 69 were men (35.0%), the median age was 47 years (interquartile range (IQR) 38-60), and a positive BDR test occurred in 50 (25.38%)according to the 2005 criteria and 42 (21.32%) according to 2021 criteria when using the Global Lung Initiative (GLI) reference equations. Strong agreement was observed between the ERS/ATS 2005 and 2021 criteria (Cohen's kappa index: 0.887, 95%, CI 0.810 to 0.963). Similar results were found with the Third National Health and Nutrition Examination Survey (NHANES III) and the European Community of Coal and Steel (ECCS) predictive equations. Positive BDR tests were common in patients with moderately severe and severe forced expiratory volume in one second (FEV1) impairment and were not associated with eosinophil count or total serum immunoglobulin E (IgE) levels. Conclusion The introduction of the 2021 ERS/ATS criteriadid not significantly alter the classification of BDR in the majority of asthma patients, ensuring diagnostic stability. Whichever criterion was used, positive BDR correlated with the extent of FEV1 impairment, but not asthma biomarkers.

Perioperative Challenges: Analysis of Surgical Complications in Screening Lung Carcinoma Patient.

Introduction In September 2020, the Institute for Pulmonary Diseases of Vojvodina (IPBV) started a lung cancer screening program using low-dose computed tomography (LDCT). Video-assisted thoracic surgery (VATS) lobectomy is the most effective treatment for early-stage lung cancer. However, the frequency of postoperative complications in VATS anatomical lung resections among patients enrolled in the screening program has not been adequately studied. This study aims to compare the frequency of surgical complications and length of hospital stay between patients enrolled in the screening program and a control group. Methods Retrospective, observational, monocentric, non-randomized study was conducted at the IPBV in Sremska Kamenica. The study included patients with a confirmed diagnosis of lung cancer who underwent anatomic pulmonary resection with mediastinal lymphadenectomy for therapeutic purposes. The patients were divided into two groups: the first group consisted of 34 patients who participated in the lung carcinoma screening program, while the second control group consisted of 102 patients. Over the past three years, all patients identified with nodules suspicious of malignancy during the screening program were sequentially enrolled in the screening group. For the control group, patients were selected based on a matching process to ensure valid statistical comparisons with the screening group. They were matched in a 3:1 ratio with patients from the screening group based on criteria including gender, disease stage, pathohistological type of cancer, tumor, node, and metastasis (TNM) stage of the disease, and degree of surgical resection. Patients were monitored for demographic parameters, smoking status, presence of comorbidities and prior oncological diseases, pulmonary function parameters, level of pre-operational risk, the number of lymph nodes removed by biopsies, spread through alveolar spaces (STAS), and the occurrence of complications after surgery (infection, bleeding, air leak, presence of adhesions), re-drainage, and length of hospital stay. Results The patients in the screening group had a higher incidence of infections, bleeding, prolonged air leak, and required re-drainage after surgery compared to the control group. Patients from the screening program with a high operative risk, prolonged air leak, and pleural adhesions had a statistically significant higher hospital stay longer than the control group. Conclusions This research emphasizes the importance of screening programs for detecting lung cancer in the early stages. However, it also highlights the need for further research to reduce surgical complications and improve therapeutic interventions for patients in the screening program.

Impact of risk factors, early rehabilitation and management of lymphedema associated with breast cancer: a retrospective study of breast Cancer survivors over 5 years

BackgroundBreast cancer-related lymphedema (BCRL) is a potentially disabling and often irreversible consequence of breast cancer treatment, caused by the mechanical incompetence of the lymphatic system, resulting in reduced drainage capacity and functional overload due to an excessive volume of interstitial fluid surpassing the system’s transport capacity in the arm. We wanted to determine the impact and explore the differences in independent risk factors for the occurrence of BCRL; incidence of BCRL over a five-year period at the Institute of Oncology Vojvodina in Sremska Kamenica and to answer the research question regarding the influence of the prehabilitation program on the overall incidence of BCRL during the observed five-year period.MethodsFrom 2014 to 2018, a retrospective study was conducted at the Institute of Oncology of Vojvodina in Sremska Kamenica, analyzing female patients who had undergone breast cancer surgery.ResultsThe study included 150 breast cancer patients who developed secondary lymphedema following surgery with the mean age of 59.2 ± 11.3 years. Fluctuations in hospitalization rates were observed over the five-year period, with the highest number of admissions in 2014 (24.0%) and a decline in 2018 (14.0%). The most common surgical procedure performed was left quadrantectomy (24.0%), followed by right quadrantectomy (20.0%) and left amputation (15.3%). The mean number of removed lymph nodes was 15.2 ± 6.1, with no statistically significant association between the number of removed lymph nodes and the manifestation of secondary lymphedema. The severity of secondary lymphedema varied based on patient age, with a higher incidence of moderate and severe lymphedema observed in patients aged 61 years and older. Patients who underwent radical surgery were more likely to experience severe lymphedema compared to those who had conservative surgery, although this difference was not statistically significant.ConclusionIn our study, the type of surgery, elapsed time since surgery, and the number of removed lymph nodes were not influencing factors for the occurrence of BCRL. However, concerning its severity, a greater number of systemic therapy modalities combined with radiotherapy were associated with a more frequent occurrence of mild and moderate BCRL. Also, the severity of BCRL varied among different age groups, with a higher incidence of moderate and severe lymphedema observed in patients aged 61 years and older. Ultimately, improving the quality of life for individuals affected by secondary lymphedema remains a crucial goal in the field of oncology.

Survival analysis of patients with rare tumors of the uterine corpus – carcinosarcoma

Background/Aim. Uterine carcinosarcoma (UCS), formerly known as malignant mixed M?llerian tumor, is a rare, aggressive malignancy of the female genital tract. The aim of this study was to analyze the most important clinical and pathohistological characteristics of UCSs on operated patients, as well as to determine which of those factors are affecting progression-free survival (PFS) and overall survival (OS) of patients. Methods. The study was conducted as a retrospective analysis of medical data documentation of patients with a diagnosis of UCS who were surgically treated at the Department of Gynecology, Clinic for Operative Oncology, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia, in 10 years? period (from the beginning of 2009 to the end of 2018). The analysis included data for a total of 31 patients. Results. Of all the examined parameters (age of the patient, clinical stage of the disease, histological grade, depth of myometrial invasion, and lymphovascular invasion ? LVI), the greatest influence on the choice of therapeutic procedure had a histological tumor grade. Conclusion. Our research showed the joint influence of the examined clinical and pathohistological factors on PFS and OS of patients with UCS. The only independent parameter that showed a statistically significant impact on survival is LVI.

Geotropism and oncogenic potential of HPV infections in cohort study populations in Vojvodina, North region of Serbia

Background/Aim: Geotropism of the human papillomavirus (HPV) represents the heterogeneous distribution of different genotypes worldwide. Aim of this study was to evaluate the prevalence of the HPV infection in women from Vojvodina, Serbia, according to cytological status and pathological changes of cervix - dysplasia and cancer. Methods: The research was conducted as a retrospective study at the Oncology Institute of Vojvodina and the Institute of Public Health of Vojvodina (IPHV). Data from the medical records of female patients treated for cervical intraepithelial neoplasia or cervical cancer at the Department of Gynaecology, Clinic for Surgical Oncology, Oncology Institute of Vojvodina in Sremska Kamenica in the period from 2016 to 2021 were used, as well as the laboratory findings of the IPHV for a group of patients with normal cytological results of the Papanikolau (PAPA) smear. Results: A total of 731 women, from 20 to 82 years of age, with different cytological results were enrolled. 567 samples were classified as NILM, while 164 samples belong to a group of abnormal histopathology (LSIL/HSIL/cervical cancer). The HPV genotyping assay was performed using the EUROArray HPV test to detect 30 HPV genotypes. In the overall number with normal cytological findings, HPV infection was verified in 242 (42.7 %) patients, of which 135 (55.8 %) were verified with high risk HPV, while 76 (31.4 %) were verified with a mixed group of HPV (Low risk/High risk HPV). Most prevalent genotypes were HPV 16, 31, 53, 51 and 18 in NILM cytological status. In the samples with the abnormal histopathology, the most prevalent genotypes were HPV 16, 33, 31 and 56, while 18 and 39 were equally verified. Genotype 16 was the most prevalent in the examined sample, with a higher prevalence in higher-grade histopathological findings: 18.8 % in LSIL, 31.9 % in HSIL and 75.0 % in cervical cancer samples. Infection with multiple associated genotypes of HPV was not correlated with histopathology. By comparing histopathological diagnosis and age, older patients had higher-grade lesions. Conclusion: Based on the estimated oncogenic potential of HPV genotypes as well as their prevalence in presented sample, it can be concluded that the nine-valent HPV vaccine for genotypes 6, 11, 16, 18, 31, 33, 45, 52 and 58 would have the potential to prevent HPV infection and the incidence of precancerous lesions and cervical cancer in about 85 % of women. Observing trends in the prevalence of HPV, especially HR HPV genotypes, can be important in the further strategy of applying secondary and primary prevention, as well as the application of HPV detection as part of co-testing or considering the introduction of HPV testing in the initial screening program.

Factorial analysis of N-acetylcysteine and propolis treatment effects on symptoms, life quality and exacerbations in patients with Chronic Obstructive Pulmonary Disease (COPD): a randomized, double-blind, placebo-controlled trial.

Standard treatment for chronic obstructive pulmonary disease (COPD) includes inhalation therapy along with mucoactive drugs. The aim of this study was to assess the efficacy and safety of orally administered mucolytic N-acetylcysteine and propolis (NACp) in COPD patients. A randomized, double-blind, prospective, interventional, 6 months study was conducted at the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia. Effects of daily NACp administration (600 mg, 1200 mg or placebo) on exacerbation, life quality (St. George's Respiratory Questionnaire-SGRQ), symptoms (COPD assessment test-CAT; Visual analogue cough scale-VAS; Leicester Cough Questionnaire-LCQ; Medical Research Council Dyspnoea scale-mMRC) and spirometric parameters in 120 COPD patients were assessed. Tests were conducted at three-time points: baseline, after three months and after 6 months of NACp treatment. Repeated measures ANOVA showed that pulmonary function parameters, 6-minute walk test and mMRC score did not significantly change during the study. Cough VAS and CAT scores were significantly different between groups as within experimental groups. LCQ and SGRQ scores did not differ between placebo, and both examined groups, but within each examined group statistically significant difference was confirmed in observed parameters during therapy. Factorial analysis and subsequent binary logistic regression revealed "Symptoms related factor" as the strongest predictor of exacerbation for supplemented groups (p<0.01). Treatment with high NACp for 6 months is safe and beneficial for cough and expectoration symptoms and improves the life quality. NACp significantly reduces acute exacerbation frequency in COPD patients by controlling COPD related symptoms.

Prospective Non-Randomized Study of Intraoperative Assessment of Surgical Resection Margin of Colo-Rectal Liver Metastases

The resection margin (RM) after resection of colorectal liver metastases (CRLM) can be assessed by the pathologist on the resected liver specimen (RLS) and by the surgeon intraoperatively. The aim of this study is to determine the degree of agreement on surgical (SA) and pathological (PA) assessment of the RM. This is prospective non-randomized double-blind study, CTG #NCT04634526. The study was conducted at the Oncology Institute of Vojvodina, Sremska Kamenica, Serbia. Experienced surgeons and pathologists assessed RM for every RLS. PA was a “gold standard”. RM of 1 mm or more was rated as negative (RM-). From 01 January 2015 to 30 April 2021, 170 patients were enrolled in the study with 376 RLS. Sensitivity of SA of RM+ was 56.9% (49/86) and specificity was 94.8% (275/290). There is moderate agreement in the assessment of RM+ between SA and PA (kappa test= 0.569). Recurrence rate for RM+ patients was 55,3% (21/38, p=0.029) for SA and 48.3% (29/60, p=0.103) for PA. Three years DFS for RM- and RM+ was 41.4% and 35.6% (p=0.014), respectively, by SA, and 42.3% and 31.4% (p=0.375), respectively, by PA. Means for DFS for RM- and RM+ was 29.6±2.25 months and 19.4±2,31 months by SA. Means for DFS for RM- and RM+ was 29.9±2,62 months and 22.2 ± 1.95 months by PA. Intraoperative assessment of RM- by surgeon of RLS is clinically meaningful. RM determined by surgeon has better prognostic impact on recurrence rate and 1- and 3-year DFS than standard histopathological assessment.

Development of bariatric/metabolic surgery in Vojvodina

The paper presents the chronological development of bariatric/metabolic surgery in Vojvodina, the region with the largest incidence of obesity in Serbia, and in which 13.2% of the population suffers from diabetes with a mortality of 15.7/100,000, which is one of the highest rates in Europe. Bariatric surgery began in the 1950s in the United States, with the consecutive development of various restrictive, malabsorptive, and combined procedures, which are intensified by the adoption of laparoscopic techniques. After initial, European knowledge and preparation of obese patients for surgery at the end of the 1970s, the first laparoscopic bariatric/metabolic interventions started in Vojvodina at the Clinical Center in Novi Sad in 2006. Next year, the multidisciplinary team for bariatric surgery was prepared in Slovenia and Austria, and the first interventions were performed in 2008 at the Clinic for Thoracic Surgery of the Institute in Sremska Kamenica, in the first-place laparoscopic sleeve gastrectomy. Since then, bariatric/metabolic surgery at this Institute have continuously been performed. By establishing international cooperation, three courses were held with demonstration operations in bariatric/metabolic surgery and the participation of eminent surgeons and other experts from the country and abroad. Several bariatric surgeries were performed on children (at the Children?s Surgery Clinic in Novi Sad), as well as in Sremska Mitrovica. Their own experience in this field has been published in the international literature and through several regional meetings dedicated to metabolic surgery.

Potrebe za suportivnom negom pacijentkinja nakon operacije karcinoma dojke

Introduction: Supporative care includes detection and providing necessary interventions to prevent, control or alleviate complications and side effects in order to improve the comfort and quality of life of cancer patients to meet their needs. The aim of this research was to determine the level of unsatisfied needs of patients after breast cancer surgery and also to determine connection with social demographic characteristics and risk factors. Material and methods: This study was conducted as a cros-ssectional study, on a sample of 40 patients that have undergone surgical breast cancer treatment at the Oncology Institute of Vojvodina in Sremska Kamenica during 2019. The instrument used in this research was Short form of the Supportive Care Needs Survey questionnaire (SCNS-SF34). It was used to determine the level and type of healthcare assistance needed by the patients. The questionnaire consisted of 34 questions that are divided through five domains. The higher score (min=1, max=5) indicates a higher need for support. Results: The average age of the patients was 61.5±12.8 years. The highest level of required healthcare support was determined in the domain of the Healthcare system and information, while the domain with lowest value was Sexuality. Statistically significant difference was discovered between the values of the Healthcare system and information and the educational level (p=0.03), which indicates that patients with a higher level of education have a bigger level of needs from this domain. Conclusion: This study provides information about patient needs for supportive care in daily life activities, after breast cancer surgery. The results of the research clearly indicate that patients after breast cancer surgery face unmet needs in all domains except sexuality.

Mortality of COVID-19 pneumonia during anticancer treatment in lung cancer patients

Background/Aim. The coronavirus disease 2019 (COVID-19) pandemic has multiple impacts on the management of cancer patients. Treatment of malignancies, including chemotherapy, targeted therapy, immunotherapy, and radiotherapy, can suppress the immune system and lead to the development of severe complications of COVID-19. The aim of this study was to determine the mortality of lung cancer (LC) patients in whom the COVID-19 was confirmed during active antitumor treatment. Methods. This retrospective study was conducted at the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia. All patients included in the study underwent active anticancer treatment at the time of diagnosis of COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was determined by a polymerase chain reaction (PCR) test. Patient data were collected using the institutional database and the observed period was from November 20, 2020, to June 5, 2021. Statistical analysis of the derived patient data used multivariate and univariate testing. Results. Out of 828 observed COVID-19 hospitalized patients, 81 were LC patients on active antitumor treatment. Patients were predominantly male (67.9%), smokers (55.6%), and with an average age of 66.5 years (range 43?83). The majority of patients (50.6%) had the Eastern Cooperative Oncology Group Performance Status (ECOG PS) 1, and 83.9% had at least one comorbidity. The most common comorbidities were arterial hypertension (66.7%), chronic obstructive pulmonary disease (COPD) (28.4%), and diabetes mellitus (21%). Obesity, congestive heart failure, and other cardiovascular diseases were present in 11%, 6.2%, and 7.4% of patients, respectively. The most common was adenocarcinoma (33.3%), followed by squamous (30.9%) and small-cell LC (24.7%). Predominantly, 63% of the patients were in stage III of the disease, and 33.3% were in stage IV. Metastases were most commonly present in the contralateral lung/pleura (14.8%), brain (6.2%), bone (3.7%), and liver (3.7%). Systemic anticancer therapy was applied in 37 out of 81 patients (45.6%), chest radiotherapy in 35 (43.2%), concurrent chemo-radiotherapy in 1 (1.2%), and other types of radiotherapy in 8 (9.87%) patients. The most common forms of systemic therapy were chemotherapy (35.8%), immunotherapy (7.4%), and targeted therapy (2.4%). The most common chemotherapy was a cisplatin-based regiment applied in 34.6% of patients. The mortality from COVID-19 was 19.8%. The statistical significance in relation to the type of treatment was not observed. Statistical significance was observed between mortality and the ECOG PS (p = 0.011). Conclusion. LC patients are dependent on antitumor treatment and, at the same time, highly susceptible to potential infection. In this study, we did not find statistically significant differences in mortality related to the type of antitumor treatment in COVID-19 positive LC patients. Further detailed research on a larger scale is needed in order to explore the effects of SARS-CoV-2 on cancer patients. All possible methods of protection against SARS-CoV-2 virus should be performed in order to minimize the risk of infection in all but especially in immunocompromised cancer patients.

Mogućnosti i modaliteti medicinske rehabilitacije kod pacijenata sa udruženom pojavom akutnog koronarnog sindroma i akutnog moždanog udara

Background: Being the most austere manifestation of ischaemic heart disease, acute coronary syndrome is one of the most frequent causes of urgent treatment and sudden death in both developed and developing countries as well. Acute stroke is the third cause of death in developed countries, after cardiovascular diseases and tumors, and second worldwide. Besides being a disease with high mortality, it is also a disease with a highest level of disability. Aim: To determine possibilities and modes of rehabilitation of patients with concomitant occurence of acute stroke and acute coronary syndrome. Methods: Retrospective study using hospitalized patients data. 5929 hospitalized patients treated at the Institute for cardiovascular diseases in Sremska Kamenica were analyzed from January 1st 2017 to December 31st 2019, without regarding sex and age. We entered data in created database and analyzed using descriptive statistics and chi-square test. Results: Concomitant stroke and acute coronary syndrome was found in 61 patient (1.0%). There were 32 males and 29 females. Average age was 68.82. Pneumonia occured more frequently in persons with concomitant occurrence of acute stroke and acute coronary syndrome than in persons with acute coronary syndrome without acute stroke. Regarding neurological and/or cardiological condition, only 3 patients (9.0%) were eligible for rehabilitation, and in all others it was delayed or contraindicated. Conclusion: Rehabilitation of patients with concomitant occurrence of acute coronary syndrome and acute stroke was complicated, with high risk, and required multidisciplinary approach to each patient individually.

Prospective Non-Randomized Study of Intraoperative Assessment of Surgical Resection Margin of Colo-Rectal Liver Metastases.

Introduction: More than 50% of patients with colorectal cancer (CRC) develop liver metastases during the natural course of disease. Surgical resection is currently the most potentially curative method in the treatment of colorectal liver metastases (CRLM). The goal of surgery is to achieve a negative resection margin (RM) of at least 1 mm, which provides the best prognosis for patients. The RM can be assessed by the pathologist of the resected liver specimen (RLS) and by the surgeon intraoperatively. The aim of this research paper is to determine the degree of agreement on intraoperative assessment of the RM by the surgeon and histopathological RM assessment by the pathologist.Material and methods: This prospective non-randomized double-blind study was approved by the Ethics Committee of the Oncology Institute of Vojvodina and registered on ClinicalTrials.gov #NCT04634526. The study was conducted at the Oncology Institute of Vojvodina, Sremska Kamenica, Serbia. An experienced hepatobiliary surgeon assessed RM for every specimen intra-operatively, immediately after CRLM resection. Resected CRLM lesions were analyzed by two experienced pathologists. These data were compared with pathological RM assessment as a “gold standard”. RM of 1 mm or more was rated as negative RM (RM-). Disease-free survival (DFS) and recurrence rate was calculated by RM status defined by surgeon and by pathologist.Results: From 01 January 2015 to 31 August 2019, 98 patients were enrolled in the study. There were 219 RLS with 245 CRLM. The surgeon registered positive RM (RM+) of <1mm in 41 (18.7%) RLS. Taking the result of the histopathological assessment (HPA) as the “gold standard”, it was determined that RM was true positive in 32 (14.6%) cases. False positive RM was found in 9 (4.1%) cases. False negative RM was found in 20 (9.1%) cases. True negative RM was found in 158 (72.2%) cases. Sensitivity of surgical assessment (SA) of RM+ was 61.5% (32/52). Specificity of SA of RM+ was 94.6% (158/167). The positive predictive value (PPV) was 78.0% (32/41), while the negative predictive value (NPV) was 88.8% (158/178). The overall accuracy of the RM+ SA was 86.8% (190/219). There was no statistically significant difference in the assessment of RM+ per RLS by surgeon and pathologists (p=0.061), but it was significant when analyses per patients was performed (p=0.017). Recurrence rate for RM+ patients was 48.1% (13/27, p=0.05) for SA and 35.0% (14/40, p=0.17) for HPA. Three year DFS for RM- and RM+ was 66.5% and 27.9% (p=0.04), respectively, by SA, and 64.8% and 42.1% (p=0.106), respectively, by HPA.Conclusion: Intraoperative assessment of RM- by surgeon of RLS is clinically meaningful. There is not a statistically significant difference in the assessment of RM+ by surgeon and pathologists per RLS, but it was statically significant on a per patient basis. RM determined by surgeon has better prognostic impact on recurrence rate and 1- and 3-year DFS than standard histopathological assessment.

Frequency and effects of seasonal flu vaccines on exacerbations of chronic obstructive pulmonary disease in Serbia

Background/Aim. The influenza virus is often the cause of exacerbations among chronic obstructive pulmonary disease (COPD) patients, especially during the winter season. However, vaccination rates are still below recommended even in developed countries. The aim of the study was to determine the rates and examine the effectiveness of immunization against seasonal influenza in preventing exacerbations among COPD patients in Serbia. Methods. The prospective cohort study of stable COPD outpatients was conducted over three years (between October 1, 2014, and September 30, 2017) at the Polyclinic Department of Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia. The rates and effects of seasonal flu vaccination on COPD exacerbation rates were evaluated using univariate and multivariate logistic regression analysis, taking into account comorbidity, age, and body mass index (BMI). Results. The study included 840 patients. The flu vaccination rate was 37.1%. Exacerbations occurred more frequently in unvaccinated patients [176 (31.9%) vs. 375 (68.1%), p = 0.043]. In elderly vaccinated patients (? 65 years) there were fewer exacerbations compared to unvaccinated patients [89 (56.0%) vs. 188 (69.4%), p = 0.005]. Lower frequency of exacerbations was also observed in vaccinated patients with comorbidities [165 (61.1%) vs. 327 (69.4%), p = 0.021] and low BMI [27 (64.3%) vs. 78 (83.9%), p = 0.011]. Multivariate logistic regression analysis identified BMI &lt; 21 kg/m2 [relative risk (RR): 0.490; 95% confidence interval (CI): 0.318?0.758; p = 0.001] and heart failure (RR: 2.734; 95% CI: 1.121?6.669; p = 0.027) as independent predictors of COPD exacerbations. Conclusion. Immunization for seasonal influenza in Serbia is below recommended rates. Flu vaccination was associated with a significant reduction in COPD exacerbation rates, particularly in elderly patients and patients with heart failure and low BMI.

Plum pox virus infection level in Prunus species growing along roadsides or in backyards in Vojvodina province

The present study was conducted on 106 leaf samples of Prunus species (44 plum, 47 myrobalan plum, 10 apricot, 3 peach, 1 blackthorn, and 1 sour cherry) collected from the Vojvodina province of Serbia and assessed for the presence of Plum pox virus (PPV) with the aim of establishing whether trees growing along roadsides and in backyards could be sources of PPV infection in commercial orchards. Analyses confirmed PPV infection in 68.2%, 38.6%, and 20% of plum, myrobalan plum and apricot samples, respectively. The infection level varied considerably across locations, with 80% noted in Uljma, followed by 69% in Sremska Kamenica, 60% in Becej, 50% in Temerin, 50% in Senta, 40% in Petrovaradin, 31% in Novi Sad, 30% in Susek, and 20% in Subotica. As no difference in infection rates was noted between young and older plum trees, the infections seemed to have occurred in their early life stage. Trees growing along roadsides were infected to a higher extent (89.6%) than those in backyards (66.6%). In some cases, symptomless trees were also proven to be PPV positive, indicating that they are a potentially important source of further virus infections. Due to the widespread presence of the virus, tolerant or hypersensitive cultivars are recommended for planting new orchards.

Adequacy of biopsy samples for epidermal growth factor receptor (EGFR) molecular testing in lung adenocarcinoma

Background/Aim. Adenocarcinoma of the lung is the most common histological type of lung cancer. The most reliable method in detecting epidermal growth factor receptor (EGFR) mutations is real-time polymerase chain reaction (PCR). It is recommended to sample three to five biopsy samples with a minimum of 200?400 preserved tumor cells. We analyzed the suitability of biopsy samples for EGFR molecular testing in lung adenocarcinoma. Methods. This retrospective analysis included 60 patients diagnosed with lung adenocarcinoma at the Institute for Pulmonary Diseases in Sremska Kamenica, Serbia from 2010 to 2015. Biopsy samples were obtained using transbronchial, bronchoscopic, or catheter biopsy procedures. All cases included the identification of morphometric parameters, the concentration of isolated DNA, and EGFR mutations. The proportion of tumors in biopsy samples was assessed in histological sections using computer-aided morphometry. Results. Biopsy samples were most commonly obtained by transbronchial biopsy (63%). In 35% of cases, there was either one or two biopsy samples. More than 10% of tumor cells were found in 68% of cases, while the majority of cases (33%) had between 200 and 500 tumor cells and only 8% of cases had between 20 and 50 tumor cells. The average concentration of DNA in all analyzed samples was 5.81 ng/?L and was significantly lower in samples provided by catheter biopsy. Only two cases with mutations were detected, and there was no statistically significant difference between the concentrations of isolated DNA in the wild type and mutated EGFR adenocarcinoma. Invalid results were found in 10% of cases. Conclusion. Biopsy samples are suitable for EGFR molecular testing in lung adenocarcinoma.

Inhalatory and intravenous colistin in treating ventilator-associated pneumonia due to acinetobacter species: Should we combine them?

Background/Aim. Acinetobacter is one of the most common causes of nosocomial infections, especially ventilatorassociated pneumonia (VAP). Considering the increased presence of multidrug-resistant microorganisms and the lack of novel antibiotics, colistin merged as the last-resort antibiotic for life threatening nosocomial infections. Intravenous use of antibiotics is accepted as a gold standard for the treatment of pneumonia, but additional administration of inhaled antibiotics in the treatment of VAP has shown to be advantageous in some clinical trials. The aim of this study was to investigate the effect of inhalatory colistin as an adjunct to intravenous colistin on the survival of patients with VAP caused by Acinetobacter species. Methods. We conducted a retrospective study to evaluate the efficacy of combination of inhalatory and intravenous colistin vs. intravenous colistin alone in 69 patients in the Intensive Care Units (ICU) with VAP caused by Acinetobacter baumannii. The patients were treated in the ICU at the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica (Serbia) in the period from January, 2013 to March, 2018. Baseline demographic data, severity of the disease, comorbidities, colistin regimen and length of the treatment were collected. The primary outcome was 28-day mortality. Results. Twenty seven of total 69 (39.1%) patients received combined intravenous and inhalatory colistin. Forty two (60.9%) patients received only intravenous colistin. Compared to the combined use of the drug (intravenous and inhalatory colistin), patients receiving intravenous colistin alone had a significantly increased risk of death during 28 days [25.9% vs. 61.9%, respectively; odds ratio (OR) 4.464, 95% confidence interval (CI) 1.539?2.925; p = 0.006]. Length of colistin use (&gt; 7 days) was also associated with reduced survival (OR 0.22; 95% CI 0.080?0.606; p = 0.003). After adjusting for baseline severity of the illness (APACHE score) and length of colistin treatment, patients receiving only intravenous colistin had greater 28-day mortality rate compared to patients receiving both intravenous and inhalatory colistin (OR 6.305; 95% CI 1.795?22.153; p = 0.004). Conclusion. Our results suggest that adding inhalatory to intravenous colistin might be beneficial in the treatment of VAP caused by Acinetobacter species.

Validation of Serbian version of chronic obstructive pulmonary disease assessment test

Background/Aim. The Chronic obstructive pulmonary disease (COPD) Assessment Test (CAT) is a simple and reliable tool designed to measure overall COPD related health status and complement physician assessment in routine clinical practice. Objective of this study was to evaluate the validity of the Serbian version of CAT. Methods. Study included 140 outpatients in the stable COPD, recruited from two centres: Clinic for Pulmonology, Clinical Center of Serbia, Belgrade, and Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica. All patients completed pulmonary function testing ? spirometry, the CAT and the modified Medical Research Council (mMRC) dyspnea scale at baseline visit. The CAT test-retest reliability was tested in 20 patients by the same investigator (physician). Results. We demonstrated that Serbian version of CAT had high internal consistency with Cronbach?s alpha 0.88. Test-retest analysis showed good correlation between CAT scores in two time points (Spearman?s ? = 0.681, p &lt; 0.01). In our study the CAT correlated moderately to mMRC scale (? = +0.57), weakly to FEV1 (? -0.214), was positively related to number of exacerbations, but did not showed exact regularity with change in the Global Initiative for Chronic Obstructive lung disease (GOLD) stage. Conclusion. The Serbian version of CAT is a reliable, simple and easy-to-use tool that can be used in everyday clinical practice to assess the health status of COPD patients in Serbia.

Studentska percepcija uloge sporta na Univerzitetu

The concept of university sports in Serbia is still dominantly based on occasional sports manifestations (competitions) for students. Mostly in the shape of single ad-hoc tournaments in different areas of sport or as competitions of student athletes within the University sports association. The current position of a majority of student population in terms of university sports in Serbia can be characterized as passive (spectators), while direct participants, who are recruited from the field of active competitive sports, have this only as an “additional” obligation within the sport they already practice in “their” sport clubs. Therefore, students’ perception of the role of sports/physical activity at university represents a very important determinant for creating adequate (new) program contents, concepts and for the implementation of physical education in higher education institutions in Serbia. The goal of this research, which is realised as an empirical non-experimental study, is to identify the attitude and opinion of students about the role of sport and organized physical exercising at university. The sample involved 227 students at the University of Novi Sad and Educons University from Sremska Kamenica. Survey was used as the basic research technique, and the instrument was constructed as a questionnaire whose basic semantic structure was based on similar instruments used in a few earlier studies. The results showed that the currently trend indicates a drop in regular practice of sport after enrolment in faculty, but youth positively perceive the role of sports at higher education institutions, clearly recognizing its importance in social interaction. Therefore, pedagogical implications of this research can certainly dominantly relate to management structures of higher education institutions in shape of a clear message about the necessity to introduce more intense education of all education stakeholders about the values and importance of physical activity (physical exercising) of youth. In that context, they also encourage changes in overall education policy in Serbia.

Metastatic cardiac tumors: from clinical presentation through diagnosis to treatment

BackgroundTo evaluate the prevalence of metastatic tumors involving the myocardium and study their presentation in order to increase awareness to their existence.MethodsPathological reports from Sheba Medical Center (Israel, January 1, 2010 through December 31, 2015) and medical records from The Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica (Serbia, 23 years period) were screened for cases of metastatic cardiac tumors. Medical, radiological and pathological data of identified cases was retrieved and reviewed.ResultsOut of thousands of registered cardiac surgeries we found less than a dozen cases of metastatic cardiac tumors classified as melanoma, carcinomas of lung, colon and kidney and sarcomas of uterine origin. We found that metastatic cardiac tumors comprised 15.8% of all the cardiac tumors.ConclusionsMetastatic cardiac tumors are extremely rare. As new diagnostic technologies and improved survival of oncological patients may increase the incidence of metastatic cardiac tumors in the future, awareness to their existence and knowledge of their presentation are key factors in their timely recognition.

Sestrinska procena simptoma kod pacijenata sa malignim oboljenjima

Introduction: One of the leading health problems in the female population is cancer of gynecological organs. The illness and medical treatment modalities cause many physical and / or psychological symptoms that have a negative impact on recovery and are an obstacle to the continuation of the expected functioning in both the daily and professional environments. Aim: To determine the prevalence of the most common physical and psychological symptoms in the patient population with gynecological carcinoma after surgery in relation to the localization of malignant tumors. Material and methods: The research was conducted according to the type of cross section study by interviewing patients suffering from gynecological carcinoma at the Institute for Oncology of Vojvodina in Sremska Kamenica, at the Clinic for operative oncology, Department of Gynecology in the period from December 2017 to February 2018. A brief version of the Symptom Assessment Scale - Short Form [MSAS-SF.] Was used to assess the symptoms. Data processing included methods of descriptive and inferential statistics, for the data analysis, the statistical package SPSS 21 for Windows was used. Results: The average values of all supplements are the highest in the group of subjects with ovarian cancer. The highest mean value had a Global Distress Indicator. The total MSAS score indicates that psychological symptoms are dominant in relation to physical symptoms, for example, in divorced women with a secondary education level. The lack of energy and concern were the most common symptoms regardless of the localization of the carcinoma. Conclusion: The results of the study indicate that patients with gynecologic and gynecologic cancer patients show a higher proportion of psychological symptoms than physical ones. In the domain of psychological symptoms, concern had the highest incidence, while in the supplements of physical symptoms the lack of energy was highlighted. Physical and psychological symptoms are most common in divorced women with secondary education.