a rare case of pacemaker lead endocarditis successfully treated with open heart surgery

Background: Cardiac device-related endocarditis has emerged as a serious complication in the era of advanced medical technology. Pacemaker related infections are rare and life-threatening with incidence from 0.06% to 7% and high mortality rate (30-35%). Diagnosis is hard, frequently delayed and could be even missed due to poor clinical findings. The average delay in diagnosis is 5.5 month. We report a case of the late-onset of pacemaker lead endocarditis caused by S. epidermidis successfully treated with open heart surgery. Case Report: Patient with persistent high fever for 11 month and suspicion for infective endocarditis was admitted in Cardiovascular Institute. No clinical signs of endocarditis were observed. TTE revealed large vegetation 30 × 17 mm attached to the atrial electrodes with high embolic potential. This finding was verified by transesophageal echocardiography (TEE), although CT scan did not reveal vegetation. Blood cultures were negative. A sternotomy with cardiopulmonary bypass was performed and electrodes were extracted with large vegetation. Intraoperative finding revealed large thrombus with vegetation around pacemaker leads. Cultures of the electrodes and vegetation revealed Staphylococcus epidermidis. Surgery was followed up with antibiotic treatment for 6 weeks. He has been followed up for the next 2 years, and without complications. Conclusion: The absence of criteria for endocarditis and negative blood cultures should not keep the physician from ruling out lead endocarditis. This complication carries high risk of mortality if left untreated

Prevalence of and contributing factors to overweight and obesity among the schoolchildren of Podgorica, Montenegro

Introduction/Objective. Childhood obesity is an emerging public health problem. The national prevalence of child overweight/obesity in Montenegro has increased by one third in the last decade. As the overwhelming majority of Montenegrin population is urban, investigation of obesity and correlates among urban children is of special public health interest. The aim of this study was to investigate the prevalence of and contributing factors to obesity among schoolchildren of Podgorica. Method. The sample included 1,134 schoolchildren (49.8% boys) aged 7–12 years, from 10 elementary schools in Podgorica. We measured children’s body mass, body height, and waist circumference to calculate body mass index (BMI) and waist-to-height ratio. The research instrument was a closed type of the original questionnaire. Nutritional status was assessed according to the criteria recommended by the American Centers for Disease Control and Prevention, World Health Organization and International Obesity Task Force. Results. Among the investigated children there were 21.2% and 6% overweight and obese children, respectively. Obesity was more frequent among boys (7.6%) compared to girls (4.4%). In a multiple regression, childhood obesity was positively related to the following: male gender, younger age, lower number of siblings, parental obesity, and low physical activity. Conclusion. One out of five urban Montenegrin schoolchildren is overweight/obese, with obesity being twice as frequent among boys compared to girls. A program against obesity among urban Montenegrin children should focus on the revealed contributing factors

Essential oils of two Nepeta species inhibit growth and induce oxidative stress in ragweed (Ambrosia artemisiifolia L.) shoots in vitro

In vitro shoot cultures of ragweed (Ambrosia artemisiifolia L.), an important weed and allergen species, were established and utilized to explore the phytotoxic effect of essential oils of Nepeta rtanjensis Diklic and Milojevic, and N. cataria L. Ragweed shoots were exposed to the atmosphere enriched with volatile compounds emitted from essential oils which differ in their qualitative and quantitative nepetalactone content. Essential oil of N. rtanjensis, an endemic and critically endangered perennial in Serbia, was characterized by high amounts of 4a alpha, 7 alpha, 7a beta-nepetalactone (trans, cis-nepetalactone), while essential oil of N. cataria, possessed high amounts of 4a alpha, 7 alpha, 7a alpha-nepetalactone (cis, trans-nepetalactone). After 2 weeks of exposure to Nepeta essential oil (2 and 4 \%, final nepetalactone concentrations), in vitro morphogenesis of ragweed shoots was significantly altered. Reduction in fresh weight of shoots and roots and rooting inhibition was observed together with prominent discoloration of shoots. Alterations in antioxidative defense system of ragweed shoots as a response to essential oils treatments were characterized by increased peroxidase activity and decreased catalase and superoxide dismutase activity. Generally, essential oil of N. cataria, which possesses cis, trans-stereoisomer of nepetalactone, had stronger inhibitory effect on shoot growth, catalase activity, and was more efficient in stimulating peroxidase activity. N. rtanjensis essential oil, and thus trans, cis-nepetalactone, was more efficient in inhibiting rooting and root growth, and in suppressing superoxide dismutase activity. Therefore, essential oils of N. rtanjensis and N. cataria might find another application as potential bioherbicides against highly invasive species such as ragweed.Serbian Ministry of Education, Science and Technological development {[}OI173024, III 41011

Early Outcomes of a Next-Generation Balloon-Expandable Transcatheter Heart Valve - The Myval System: A Single-Center Experience From Serbia

Transcatheter aortic valve implantation (TAVI) is one of the most effective treatments for severe aortic valve stenosis (AVS). Different genres and generations of transcatheter heart valves (THVs) are accessible, offering operators an opportunity to choose a patient-tailored device. In this single-center study, we present the outcomes of Serbian patients treated with next-generation Myval THV for severe symptomatic AVS. Myval THV was implanted in all consecutive patients who underwent TAVI at the Dedinje Cardiovascular Institute of Belgrade, Serbia between October 2020 and September 2021. The primary endpoint was device success on day 30. Secondary endpoints included 30-day all-cause mortality, cardiovascular death, stroke, moderate/severe paravalvular leak (PVL), and new permanent pacemaker implantation (PPI). TAVI was performed as per the European Society of Cardiology guidelines. The study comprised thirteen patients, aged 72±13 years with mean EuroSCORE (7.17%) and Society of Thoracic Surgeons (2.72%,) scores who underwent TAVI successfully with 92.3% using the percutaneous approach. Myval THV intermediate and extra-large sizes were implanted in 46% and 15% of patients, respectively. This acute procedure success rate was 100%. The primary composite endpoint of early device success was achieved in all patients. None of the patients had clinically significant aortic regurgitation or moderate/severe PVL. No patient experienced stroke, contrast-induced acute kidney injury, device-related vascular complications, or a new PPI. The all-cause mortality rate at 30 days was 0%. Myval THV system demonstrated a favorable safety/efficacy profile within 30 days post-procedure at a single center in Serbia. This is the first report of my experience with Myval THV from Serbia