Urgent hybrid approach in treatment of the acute myocardial infarction complicated by the ventricular septal rupture

Introduction. Ventricular septal rupture (VSR) in the acute myocardial infarction (AMI) is a rare but very serious complication, still associated with high mortality, despite significant improvements in pharmacological and surgical treatment. Therefore, hybrid approaches are introduced as new therapeutical options. Case Outline. We present an urgent hybrid approach, consisting of the initial percutaneous coronary intervention (PCI) of the infarct-related artery, followed by immediate surgical closure of the ventricular septal rupture, for treatment of high risk, hemodynamically unstable female patient with AMI caused by one-vessel disease and complicated by VSR and cardiogenic shock. Since the operative risk was also very high (EUROSCORE II 37%), this therapeutic decision was based on the assumption that preoperative PCI could promptly establish blood flow and thereby lessen the risks, duration and complexity of urgent cardiosurgical intervention, performed on the same day. This approach proved to be successful and the patient was discharged from the hospital on the fifteenth postoperative day in stable condition. Conclusion. In selected cases, with high operative risk and unstable hemodynamic state due to AMI complicated by VSR, urgent hybrid approach consisting of the initial PCI followed by surgical closure of VSR may represent an acceptable treatment option and contribute to the treatment of this complex group of patients

Relationship between the type of atrial fibrillation and thromboembolic events

Background/Aim. Atrial fibrillation (AF) increases the risk for ischemic stroke and other thromboembolic (TE) events. Aim of the study was to examine the relationship between clinical types of atrial fibrillation (AF) and (TE) events. Methods. This longitudinal, observational study included patients with nonvalvular AF as main indication for in-hospital and/or outpatient treatment in the Cardiology Clinic, Clinical Center of Serbia during a period 1992-2007. The treatment of AF was based on the International Guidelines for diagnosis and treatment of AF, correspondent to given study period. Clinical types of AF were defined according to the latest ACC/AHA/ESC Guidelines for AF, from 2006. Diagnosis of central and systemic TE events during a follow-up was made exclusively by the neurologist and vascular surgeon. Results. During a follow-up of 9.9 ± 6 years, TE events were documented in 88/1 100 patients (8%). In the time of TE event 46/88 patients (52.3%) had permanent AF. The patients with permanent AF were at baseline significantly older and more frequently had underlying heart disease and diabetes mellitus. Cumulative TE risk during follow-up was similar for patients with paroxysmal and permanent AF, and significantly higher as compared to TE risk in patients with persistent AF. However, multivariate Cox proportional hazard regression analysis with independent variables clinical types of AF at baseline and in the time of TE event, clinical and echocardiographic characteristics and therapy for prevention of TE complications at baseline and at the time of TE event, did not reveal independent predictive value of clinical type of AF for the occurrence of TE events during a follow-up. Conclusion. TE risk in patients with AF does not depend on clinical type of AF. Treatment for prevention of TE events should be based on the presence of well recognized risk factors, and not on the clinical type of AF

Fenomenološke karakteristike nasilja u partnerskim vezama studenata univerziteta u Beogradu

Предмет рада је испитивање феноменолошких карактеристика насиља у партнерским везама студената Универзитета у Београду, односно, испитивање распрострањености и структуре насиља, појавних облика и карактеристика насиља у партнерским везама ове популације. У оквиру теоријског дела рада дат је преглед дефиниција основних појмова, преглед истраживања о распрострањености и структури партнерског насиља у свету и Србији, као и осврт на полемику о родној перспективи партнерског насиља, чиниоцима и разлозима за пријављивање/непријављивање партнерског насиља јавним сервисима и значајним појединцима и преглед истраживања о распрострањености и карактеристикаma партнерског насиља међу студентском популацијом. Циљ емпиријског истраживања је био да се дође до података о распрострањености, структури, појавним облицима и карактеристикама насиља у партнерским везама студентске популације исптивањем виктимизације и извршења насиља, као и долажење до података о агилности студената да се обрате за помоћ надлежним владиним и невладиним организацијама у ситуацијама насиља и значајним појединцима из њиховог окружења. Истраживање је спроведено на узорку од 134 испитаника коршћењем анкетног упитника. Испитивањем виктимизације и извршења партнерског насиља утврђена је преваленција насиља за психичко, физичко и претње физичким насиљем, сексуално насиље и прогањање, као и статистичка значајност за одређене облике насиља и њихове манифестације у односу на пол испитаника. Добијени су подаци коме се најчешће испитаници обраћају за помоћ, као и који су најчешћи разлози који представљају баријере за тражење помоћи, утврђена је статистичка значајност за неке од разлога у односу на пол испитаника.The subject of the paper is to examine the phenomenological characteristics of violence in the partner relationships of students of the University of Belgrade, that is, to examine the distribution, structure, manifestations and characteristics of violence in partner relationships in this population. Within the theoretical part of the paper, an overview of the definitions of the basic concepts is given, as well as an overview of the research on the distribution and structure of partner violence in the world and Serbia, and a review of the polemics about the gender perspective of partner violence, the factors and reasons for reporting / not reporting partner violence to public services and important individuals, and a review of the research on the prevalence and characteristics of partner violence among student population. The aim of the empirical research was to obtain data on the distribution, structure, manifestation forms and characteristics of violence in the partner relationships of the student population, examined through victimization and self-reporting of perpetration, as well as providing information on students agility to seek help from competent governmental and non-governmental organizations and from significant individuals from their surroundings. The survey was conducted on a sample of 134 respondents using the survey questionnaire. The prevalence of psychological, physical and threats of physical violence, sexual violence and stalking was examined through victimization and self-reporting perpetration of violence, as well, statistical significance for certain types and manifestations of violence was found in relation to sexes. Data were obtained about most often choice of helping services, and what are the most common barriers for help seeking, statistical significance was established for some of the barriers in relation to sexes

Fenomenološke karakteristike nasilja u partnerskim vezama studenata univerziteta u Beogradu

Предмет рада је испитивање феноменолошких карактеристика насиља у партнерским везама студената Универзитета у Београду, односно, испитивање распрострањености и структуре насиља, појавних облика и карактеристика насиља у партнерским везама ове популације. У оквиру теоријског дела рада дат је преглед дефиниција основних појмова, преглед истраживања о распрострањености и структури партнерског насиља у свету и Србији, као и осврт на полемику о родној перспективи партнерског насиља, чиниоцима и разлозима за пријављивање/непријављивање партнерског насиља јавним сервисима и значајним појединцима и преглед истраживања о распрострањености и карактеристикаma партнерског насиља међу студентском популацијом. Циљ емпиријског истраживања је био да се дође до података о распрострањености, структури, појавним облицима и карактеристикама насиља у партнерским везама студентске популације исптивањем виктимизације и извршења насиља, као и долажење до података о агилности студената да се обрате за помоћ надлежним владиним и невладиним организацијама у ситуацијама насиља и значајним појединцима из њиховог окружења. Истраживање је спроведено на узорку од 134 испитаника коршћењем анкетног упитника. Испитивањем виктимизације и извршења партнерског насиља утврђена је преваленција насиља за психичко, физичко и претње физичким насиљем, сексуално насиље и прогањање, као и статистичка значајност за одређене облике насиља и њихове манифестације у односу на пол испитаника. Добијени су подаци коме се најчешће испитаници обраћају за помоћ, као и који су најчешћи разлози који представљају баријере за тражење помоћи, утврђена је статистичка значајност за неке од разлога у односу на пол испитаника.The subject of the paper is to examine the phenomenological characteristics of violence in the partner relationships of students of the University of Belgrade, that is, to examine the distribution, structure, manifestations and characteristics of violence in partner relationships in this population. Within the theoretical part of the paper, an overview of the definitions of the basic concepts is given, as well as an overview of the research on the distribution and structure of partner violence in the world and Serbia, and a review of the polemics about the gender perspective of partner violence, the factors and reasons for reporting / not reporting partner violence to public services and important individuals, and a review of the research on the prevalence and characteristics of partner violence among student population. The aim of the empirical research was to obtain data on the distribution, structure, manifestation forms and characteristics of violence in the partner relationships of the student population, examined through victimization and self-reporting of perpetration, as well as providing information on students agility to seek help from competent governmental and non-governmental organizations and from significant individuals from their surroundings. The survey was conducted on a sample of 134 respondents using the survey questionnaire. The prevalence of psychological, physical and threats of physical violence, sexual violence and stalking was examined through victimization and self-reporting perpetration of violence, as well, statistical significance for certain types and manifestations of violence was found in relation to sexes. Data were obtained about most often choice of helping services, and what are the most common barriers for help seeking, statistical significance was established for some of the barriers in relation to sexes

ANALIZA UTICAJA DUGOTRAJNE IZLOŽENOSTI ZAGAĐENJA VAZDUHA NA ZDRAVLJE ŽENA U NIŠU (SRBIJA)

The aim of this study was to investigate the impact of long-term exposure to air pollution on women’s health through the analysis of studies dealing with this problem in Niš (Serbia). This chapter provides an overview of the methodology used in the studies carried out in the city of Nis. We analyzed the period of long-term exposure to air pollution, air pollution exposure measures, type of pollutants, study population and its characteristics and the criteria for specific health effects which had been investigated. The studies included in this paper have shown that long-term exposure of women to low concentration of outdoor air pollutant is associated with prevalence of respiratory symptoms and diseases. Also, the results suggest that long term exposure before pregnancy to relatively low levels of some air pollutants is not associated with a pregnancy-induced hypertension but is strongly associated with anemia.Cilj ovog rada je bio da se ispita uticaj dugotrajne izloženosti zagađenju vazduha na zdravlje žena kroz analizu studija koje se bave ovim problemom u gradu Nišu (Srbija). Ovo poglavlje daje pregled metodologije koja se koristi u studijama koje su sprovedene u gradu Nišu. Analizirali smo period dugotrajne izloženosti zagađenju vazduha, metode merenja zagađujućih materija u vazduhu, vrste polutanata, ispitanike i njihove karakteristike i kriterijumima za specifične zdravstvene efekte koji su istraživani. Studije uključene u ovom radu pokazali su da među ženama dugotrajna izloženost niskim koncentracija zagađiujućim materija iz vazduha je povezana sa prevalencom respiratornih simptoma i bolesti. Takođe, rezultati sugerišu da dugotrajno izlaganje polutantima iz vazduha pre nije bio povezan sa porastom krvnog pritiska u trudnoći ali je značajno bio povezan sa nastankom anemije

A comparative analysis of the influence of different types of Carbopol® on the release rate of lithium-carbonate from matrix tablets

Background/Aim. Hydrophilic matrix tablets represent the most commonly used oral dosage form. Carbomers used in the concentration of 10%-30% for preparation of matrix tablets, may significantly affect the profile of drug release due to the formation of hydrogel matrix tablets. The aim of this study was to compare the influence of different types of Carbopol® (carbomers in the pharmacopoeia) on the release rate of lithium-carbonate and other pharmaceutical, technological, physical and chemical properties of the prepared formulations of matrix tablets. Methods. Three different formulations of matrix tablets were made according to direct compression method. The tablets were of the following composition: carbomer, lactose monohydrate, magnesium-stearate, lithiumcarbonate in the proportion 75 : 120 : 5 : 300. The first formulation was made with Carbopol® 971P NF, the second one with Carbopol® 974 P NF and the third one with Carbopol® 71G NF. The quantity of lithium-carbonate was determined according to the BP 2009, pharmaceutical and tecnological properties were examined in accordance with the regulations of Ph. Jug. V, whereas the release rate of lithium-carbonate from the formulations was examined by the application of dissolution test, prescribed in the monography ’Lithium Carbonate Extended-Release Tablets’ in USP 26. Results. The profile of lithium-carbonate release from matrix tablets with Сarbopol ® 974P NF entirely complies with the regulations of USP 26, whereas the values obtained from the analysis of matrix tablets with Сarbopol® 971P NF and Сarbopol® 71G NF were considerably lower than the prescribed ones. In all the investigated formulations the content of the drug, mass variation and tablet hardness comply with the regulations set in pharmacopoeia. Conclusion. In the formulation of matrix tablets with lithium-carbonate, by the application of carbomers in the concentration of 15%, with Сarbopol® 974 P NF a favourable lithium-carbonate release profile was achieved, whereas in the formulations with Сarbopol® 971P NF and Сarbopol® 71G NF, the release rate was significantly lower than that given in the USP 26 monography

Possible risk for gestational trophoblastic neoplasm in perimenopause and menopause

Gestational Trophoblastic Neoplasms (GTN) are group of diseases which are known as fertilization disorders and may appear as Complete hydatidiform mole, Mole partialis, Invasive mole, Placental site trophoblastic tumor, Choriocarcinoma. Malignant disease precedes in approxi mately 50% of patients. All cases of GTN must be registrated. The Followe up programme period may last 6 months to 2 years until three sequential beta hCG values are negative. The risk of repeated GTN is low but patient has to be informed that risk is 1 : 74. GTN can appear in perimenopausal or menopausal women. That is the reason why each rapid enlargement of uterus especially with uterine bleeding followed with multiple cystic formations (grape like cysts) needs a serious examination on GTN. Patient can complain of nausea, vomiting, painful breasts or hiperthyoidism. Legal abortion can precede GTN in perimenopausal women. In the great number of women with GTN the last pregnancy was 5 or more than 5 years before GTN is diagnosed. During 5 year period from june 1999. till june 2004, 58 GTN cases were diagnosed on our Department. 7 women with confirmed GTN were in perimenopause or menopause. All cases were hystologicalu confirmed with clinical low clinical score. In 1999. (March-June) unpowerishment Uranium was used during war in Former Yugoslavia. Potential effect on reproductive potential could be analyzed after collecting data from the whole territory of Serbia and Montenegro in next years. All GTN patients are clinically, laboratory and ultrasonographicaly examined and staged according to FIGO 2002. recommendation

Pelvic inflammatory diseases in perimenopause and menopause

Introduction: In the gynecological profession Pelvic Inflammatory Disease (PID) has a significant role due to its frequency, many complications and high costs of treatment Aim: The aim of this study was to investigate frequency and complications caused by these diseases, and used methods of treatment. Methods: The research was conducted in Clinic of Obstetrics and Gynecology 'Narodni Front', Belgrade, and included all consecutive patients diagnosed with PID during the period from year 2007 to 2010. The diagnosis of PID was set on the basis of: gynecological examination, test analysis (leucocytes, sedimentation, platelets, CRP, CA125), and ultrasound examination. A clinical criterion is divided into minimal and additional. The study included 112 patients. There were 33.93% of women in perimenopause/menopause (experimental group), while the control group consisted of 66.07% female subjects. Results: The frequency of surgically treated patients in experimental and control group was: 44.74% : 39.19% (χ2 test; p > 0.05). Women in experimental group used Intrauterine Device (IUD) more than other patients 57.89% : 13.15% (χ2 test; p = 0.0001). A link was established between the use of intrauterine devicela in (χ2 test; p = 0.0516), patients’ irregular control of IUD (χ2 test; p = 0.0114) and surgical treatments of women in experimental group. The conservative treatment usually applies dual antibiotic therapy. Costs of surgically treated patients are around 1300 and conservatively treated around 210 €. Conclusion: Women in perimenopause and menopause are not exposed to higher risks of contracting PID. Women in perimenopause and menopause which use intrauterine device and don’t have regular controls, have higher risk of surgical treatments in case of pelvic inflammatory disease. Costs of treatment are 6-7 times in lower with conservatively treated patients compared to operatively treated ones

Successful implementation of rituximab in patients with severe refractory forms granulomatosis with poliangiitis

Introduction. Wegeners’s granulomatosis is a disease characterized by granulomatous inflammation of the upper and/or lower respiratory tract, glomerulonephritis with varying degrees of small vessel vasculitis and classic anti-neutrophil cytoplasmic antibodies (c-ANCA) findings. The treatment uses different modalities of immunosuppressive therapy which does not always lead to remission. We presented the efficacy of biological therapy in a patient with refractory form of the Wegeners’s granulomatosis. Case report. A 23-years-old patient, was treated in August, 2011 at the Clinic of Otorhinolaryngology and Maxillofacial Surgery of the Clinical Center of Serbia because of suppurative otitis media, resulting twice in mastoidectomy. On the day 7 after the surgery, hemoptysis and fever occurred. Considering lung x-ray that showed presence of the round soft-tissue changes on both sides, nonspecific inflammatory syndrome in laboratory analysis and positive c-ANCA (1 : 160) with high titers the antibodies to the proteinase 3 (anti-PR 3), Wegener's granulomatosis was diagnosed. Due to the fact that administration of glucocorticoids, cyclophosphamide and immunomodulatory dose of immunoglobulin did not lead to clinical remission, it was decided to apply rituximab. After its application clinical remission occurred and it lasted fifteen months. Conclusion. Application of biologic therapy might be successful in the treatment of patients with severe form of refractory granulomatosis with polyangiitis

Cervical poorly differentiated adenocarcinoma with dominant choriocarcinomatous pattern: A case report

Introduction. Gestational trophoblastic neoplasm (GTN), choriocarcinoma in coexistence with primary cervical adenocarcinoma, is a rare event not easy to diagnose. Choriocarcinoma is a malignant form of GTN but curable if metastases do not appear early and spread fast. Case report. We presented choriocarcinoma in coexistence with primary cervical adenocarcinoma in a 48-year-old patient who had radical hysterectomy because of confirmed cervical carcinoma (Dg: Carcinoma porto vaginalis uteri FIGO st I B1). Histological findings confirmed cervical choriocarcinoma with extensive vascular invasion and apoptosis but GTN choriocarcinoma was finally confirmed after immunohystochemical examinations. Preoperative serum human gonadotropine (beta hCG) level stayed unknown. This patient did not have any pregnancy-like symptoms before the operation. The first beta hCG monitoring was done two months after the operation and found negative. According to the final diagnosis the decision of Consilium for Malignant Diseases was that this patient needed serum hCG monitoring as well as treatment with chemotherapy for high-risk GTN and consequent irradiation for adenocarcinoma. Conclusion. The early and proper diagnosis of nonmetastatic choriocarcinoma of nongestational origine in coexistence with cervical carcinoma is curable and can have good prognosis