Analiza faktora koji utiču na neuspeh lečenja vanbolničke pneumonije kod hospitalizivanih pacijenata

Uvod. Rani neuspeh u lečenju (RNL) kod pacijenata sa vanbolnički stečenom pneumonijom (CAP) koji zahtevaju hospitalizaciju relativno se često sreće u rutinskoj kliničkoj praksi i predstavlja ozbiljan javno-zdravstveni problem širom sveta s obzirom da je udružen sa prolongiranim boravkom u bolnici, većim rizikom od smrtnog ishoda i znatnim povećanjem troškova lečenja. Cilj. Primarni cilj ove studije bio je da analizira relativni značaj faktora koji utiču na pojavu RNL kod odraslih hospitalno lečenih pacijenata zbog CAP, sa posebnim osvrtom na potencijalno promenljive faktore koji u prethodnim studijama nisu ili su nedovoljno bili ispitivani. Metode. Sprovedena je retrospektivna studija tipa slučaja-kontrola na uzorku od 126 odraslih pacijenata lečenih zbog težih oblika CAP na Klinici za plućne bolesti Kliničkog centra Srbije u Beogradu, u periodu 01.01.2007- 31.12.2011. godine. “Slučajeve” su činili 63 uzastopno odabrana pacijenta sa opserviranim RNL u toku prva tri dana nakon prijema u bolnicu, dok se kontrolna grupa sastojala od identičnog broja nasumično izabranih pacijenata kod kojih takav ishod nije zabeležen, a koji su usklađeni sa svakim od „slučajeva“ prema polu, starosti i vremenskom periodu prijema u bolnicu. Povezanost između potencijalnih faktora rizika, odnosno protektivnih faktora i RNL procenjena je logističkom regresionom analizom. Rezultati. Udružena gastrointestinalna oboljenja (korigovani OR 18,83; 95%CI 1,15- 309,04), viši CURB-65 skor na prijemu (korigovani OR 2,57; 95%CI 1,05-6,25), inicijalna primena nesteroidnih antiinflamatornih lekova (NSAIL) u bolnici (korigovani OR 38,19; 95%CI 3,61-404,51) i prethodno ambulantno lečenje inhalacionim kortikosteroidima (korigovani OR 22,41; 95%CI 1,03-489,06), predstavljaju značajne faktore rizika za pojavu RNL. S druge strane, starije životno doba i upotreba antibiotika zbog iste infekcije pre prijema u bolnicu povezani su sa znatno nižim rizikom od razvoja ETF, smanjujući pritom šansu za 98%, odnosno za blizu 90%. Pojava RNL u ispitivanoj populaciji pacijenata značajno je povezana sa rizikom od smrtnog ishoda (χ2=7,461; p<0,01). Zaključak. Izbegavanje rutinske primene NSAIL u bolničkim uslovima i upotreba odgovarajućih antibiotika pre hospitalizacije mogu biti korisni za pacijente obolele od CAP kod kojih je indikovano bolničko lečenje u smislu smanjenja rizika za nastanak RNL. CURB-65 skor na prijemu u bolnicu može biti bolji prediktor RNL od indeksa težine pneumonije (PSI). Dodatne prospektivne studije su potrebne kako bi se potvrdili ovi nalazi.Background. In routine clinical practice early treatment failure (ETF) in patients hospitalized for community-acquired pneumonia (CAP) is relatively common and represents a serious public health problem due to its significant association with prolonged hospitalization, increased risk of mortality and higher treatment costs. Aim: The primary goal of this study was to analyze relative importance of factors influencing ETF in hospitalized adult patients with CAP, with emphasis on potentially modifiable factors that still has been insufficiently explored. Methods. A retrospective case-control study was carried out on a sample of 126 adult patients treated for serious CAP at the Clinic for Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia, during the 5-year period (2007-2011.). The cases (n=63) were consecutive patients with ETF, observed within the three days upon the admission to hospital, while the control group consisted of the equal number of randomly selected patients without such an outcome who were matched with each case by gender, age and time of hospitalization. The association between potential risk/protective factors and ETF was estimated using logistic regression analysis. Results. The coexistence of gastrointestinal disorders (adjusted OR 18.83, 95%CI 1.15- 309.04), higher CURB-65 score on admission (adjusted OR 2.57, 95%CI 1.05- 6.25), initial use of nonsteroidal anti-inflammatory drugs (NSAIDs) in hospital (adjusted OR 38.19, 95%CI 3.61-404.51) and previous outpatient use of inhaled corticosteroids (adjusted OR 22.41, 95%CI 1.03-489.06) were found to be significant risk factors for ETF. On the other hand, older age and use of antibiotics before the hospitalization were associated with a significantly lower chance of experiencing ETF, reducing the odds for 98% and almost 90%, respectively. The occurrence of ETF was significantly associated with increased risk of mortality (χ2=7,461; p<0,01) in our patients. Conclusions. The avoidance of routine in-hospital use of NSAIDs as well as outpatient use of appropriate antibiotics may be beneficial for patients hospitalized for CAP in terms of reducing risk of ETF. The CURB-65 score could be better predictor of ETF than Pneumonia Severity Index. Further prospective studies are required to confirm these findings

Digital Manufacturing as a basis for the development of the Industry 4.0 model

The digital manufacturing (DM) is base for Industry 4.0, that have following dimensions: (i) digital manufacturing based on advanced digital-oriented technologies, (ii) smart products (advanced production mode and new characteristics), and (iii) smart supply - chain (procurement of raw materials and delivery of finished products). Bidirectional exchange of information in collaborative production, using it exchange also for digital platforms of design of the innovative products. This paper presents developed model of Serbian digital factory with selected examples, specifically for the Manufacturing Execution System (MES) area

Digital Manufacturing as a basis for the development of the Industry 4.0 model

The digital manufacturing (DM) is base for Industry 4.0, that have following dimensions: (i) digital manufacturing based on advanced digital-oriented technologies, (ii) smart products (advanced production mode and new characteristics), and (iii) smart supply - chain (procurement of raw materials and delivery of finished products). Bidirectional exchange of information in collaborative production, using it exchange also for digital platforms of design of the innovative products. This paper presents developed model of Serbian digital factory with selected examples, specifically for the Manufacturing Execution System (MES) area

Side effects and treatment initiation barriers of sodium-glucose cotransporter 2 inhibitors in heart failure: a systematic review and meta-analysis

Aims Physicians are sometimes reluctant to initiate guideline-directed therapy in patients with heart failure and reduced ejection fraction (HFrEF) due to concerns of adverse events. We explored the risk of hypotension, volume depletion, and acute kidney injury (AKI) on sodium–glucose cotransporter 2 (SGLT2) inhibitors in HFrEF populations. Methods and results We determined summary risk ratios (RRs) by conducting a meta-analysis on reported aforementioned adverse events on SGLT2 inhibitors from randomized controlled trials. We explored robustness of meta-analyses by computing fragility and/or reverse fragility index (FI or RFI) and its corresponding fragility quotient (FQ or RFQ) for each outcome. A total of 10 050 patients with HFrEF entered the final meta-analysis. Hypotension was reported in 4.5% (219/4836) on SGLT2 inhibitors and in 4.1% (202/4846) on placebo (RR 1.09, 95% confidence interval [CI] 0.91–1.31, p = 0.36). An RFI of 21 and RFQ of 0.002 suggest robust findings for hypotension. Volume depletion occurred in 9.4% (473/5019) on SGLT2 inhibitors and in 8.7% (438/5031) on placebo (RR 1.07, 95% CI 0.95–1.21, p = 0.25), respectively. RFI of 19 and RFQ of 0.001 suggest moderately robust findings for volume depletion. AKI was reported in fewer patients (1.9% [95/4888]) on SGLT2 inhibitors than on placebo (2.8% [140/4899]) providing lower incidence of AKI (RR 0.69, 95% CI 0.51–0.93, p = 0.02). FI of 14 and RFQ of 0.001 suggest moderately robust findings for AKI. Conclusion Sodium–glucose cotransporter 2 inhibitor therapy is not associated with a clinically relevant risk of hypotension and volume depletion. Its use reduces the risk of AKI. This analysis supports current guideline recommendations on early use of SGLT2 inhibitors

Detection of Rhizomucor pusillus on sunflower seed

The accelerated ageing test method (AA), agar plate method (A) and blotter method (B) have been used to detect the Rhizomucor pusillus and other mycobita on 24 samples of sunflower seed. Sterilised and unsterilised sunflower seeds have been incubated at 25ºC and 42ºC in the dark for 72 and 144 hours. The fungus was not detected in any sample at 25ºC, not even after 144 h incubation of seeds. The fungal frequency ranged from 58.3 (B method) to 75.0% (A method) and from 4.2% (B method) to 16.7% (AA method) after 72 h incubation of unsterilised and sterilised samples at 42ºC, respectively. The fungal incidence was 25.5% (AA method), 21.9% (A method) and 20.3% (B method) after 72 h incubation of unsterilised seed, and 2% on sterilised seed in all three applied methods. By extended incubation of unsterilised and sterilised seeds up to 144 h at 42°C the frequency and incidence of the fungus did not significantly change. The results of the present research show that the AA test method, widely applied in seed longevity testing, can be used as a simple and efficient method for the detection of R. pusillus as well as other mycobiota on sunflower seed. Furthermore, these are the first data on determining the presence of R. pusillus in Serbia

[Testing the effects of the presence of uranium in drinking water from individual wells in the village of Dubravica in the Braničevo District on public health] [Ispitivanje posledica prisustva urana u vodi za piće iz individualnih bunara u selu dubravica u braničevskom okrugu po zdravlje stanovništva]

The village of Dubravica is partially located over the western lignite deposits of the Kostolac basin. The examination of the dry residue obtained from drinking water from two individual wells by X-ray diffraction analysis, based on a typical peak, showed the presence of uranium in drinking water. The indirect method by Rajković and associates showed that, in sample I, the concentration of uranium in drinking water was 85.5 percent higher (3.71 μg/L) and that the concentration of uranium in sample II was only 22 percent lower (1.56 μg/L) than the Maximum Allowable Concentration (MAC) values required by the Regulations (2 μg/L). Analysis of the result of the introduction of uranium in the human body has shown that this way brings 0.84 to 2 mg of uranium in the human organism per annum or 0.09 to 0.22 mg of uranium is deposited annually in the kidney. Assessment of the potential health risk due to the presence of uranium in drinking water indicated that the population using drinking water from wells will be threatened by uranium in a short time interval. Regarding the long-term risk, the calculation has indicated that in the first sample of drinking water, about 25 inhabitants, and in the case of the second sample of drinking water, 10 inhabitants out of 1000 inhabitants are endangered. As the kidney is the organ in which uranium is deposited (accumulated) to the greatest extent, its presence causes weakening and failure of kidney function, which can destroy 75 percent of kidney function until the manifestation of the first clinical symptoms. This phenomenon is observed among the population along the rivers the Kolubara, the Drina, the Sava and the Morava and is called endemic nephropathy. The elements found in trace amounts (Pb, Cd, Si), live agents (bacteria and viruses), fungal plant toxins, genetic factors and immune mechanism can be listed as possible causes. However, uranium in drinking water has not been listed so far. The tests performed in this study clearly show the role of uranium in the epidemic, endemic nephropathy, which is growing and which is not at the acute phase of the disease but has already progressed to renal failure and end-stage kidney disease. Official data on the rise of endemic nephropathy and diabetes and increasing their share in diseases, as well as overall mortality rates, which amount to 18.19%, clearly indicate that the role of uranium in the Braničevo district environment should not be ignored. Since there are settlements on the terrain to be investigated, uranium and its migration through the environment must be monitored as all conditions for its migration are unfortunately favourable

Management of roe deer population (Capreolus capreolus L.) in Serbia

ABSTRACT The research was conducted during the 2018/19 hunting year at three hunting grounds: "Barajevska reka" - "Takovo" and "Jadar". The average density of Roe deer in hunting grounds varied from 48.67 to 74 individuals per 1,000 ha of hunting-productive area. However, when observing the number of individuals per 1,000 ha of total hunting area, the density varies from 16.07 individuals to 34.72 individuals. The determined gender ratio at the hunting ground "Jadar" was (M: F = 1: 0.93). At the hunting ground "Takovo", the gender ratio was (M: F = 1: 1.22), while at the hunting ground "Barajevska reka" the ratio was (M: F = 1: 1.59). The average fertility of Roe deer was 1.67 embryos per individual, or 1.75 embryos per pregnant female. Depending on the study area, the real growth varied from 0.54 to 0.73 fawns per female. Loss in Roe deer are caused mostly by biotic factors. The determined average age of shot individuals varied depending on the hunting ground from 3.53 to 5.24 years. The current state of Roe deer populations in Serbia varies between analyzed hunting grounds, but the overall situation is quite unsatisfactory, especially in terms of density, gender ratio and age structure of culled individuals

Side effects and treatment initiation barriers of sodium-glucose cotransporter 2 inhibitors in heart failure: a systematic review and meta-analysis.

AIMS: Physicians are sometimes reluctant to initiate guideline-directed therapy in patients with heart failure and reduced ejection fraction (HFrEF) due to concerns of adverse events. We explored the risk of hypotension, volume depletion, and acute kidney injury (AKI) on sodium-glucose cotransporter 2 (SGLT2) inhibitors in HFrEF populations. METHODS AND RESULTS: We determined summary risk ratios (RRs) by conducting a meta-analysis on reported aforementioned adverse events on SGLT2 inhibitors from randomized controlled trials. We explored robustness of meta-analyses by computing fragility and/or reverse fragility index (FI or RFI) and its corresponding fragility quotient (FQ or RFQ) for each outcome. A total of 10 050 patients with HFrEF entered the final meta-analysis. Hypotension was reported in 4.5% (219/4836) on SGLT2 inhibitors and in 4.1% (202/4846) on placebo (RR 1.09, 95% confidence interval [CI] 0.91-1.31, p = 0.36). An RFI of 21 and RFQ of 0.002 suggest robust findings for hypotension. Volume depletion occurred in 9.4% (473/5019) on SGLT2 inhibitors and in 8.7% (438/5031) on placebo (RR 1.07, 95% CI 0.95-1.21, p = 0.25), respectively. RFI of 19 and RFQ of 0.001 suggest moderately robust findings for volume depletion. AKI was reported in fewer patients (1.9% [95/4888]) on SGLT2 inhibitors than on placebo (2.8% [140/4899]) providing lower incidence of AKI (RR 0.69, 95% CI 0.51-0.93, p = 0.02). FI of 14 and RFQ of 0.001 suggest moderately robust findings for AKI. CONCLUSION: Sodium-glucose cotransporter 2 inhibitor therapy is not associated with a clinically relevant risk of hypotension and volume depletion. Its use reduces the risk of AKI. This analysis supports current guideline recommendations on early use of SGLT2 inhibitors

DFT Analysis of Hyperfine Couplings in d and f metal complexes with Tetrahydro Borate Ligands

Metal complexes with BH4 - ligands show extravagant structural and dynamic properties, and possess many important and applicable qualities (potent reducing agents and catalysts, materials for hydrogen storage). Electron paramagnetic resonance (EPR) is very important for the characterization of complex compounds, determination of their electronic configuration and geometry. Also, Density Functional Theory (DFT) can predict EPR parameters and explain them more profoundly. Of particular importance is the analysis and prediction of hyperfine coupling constants for lanthanide complexes with BH4 - ligands, given that there is not much data in the literature. Within this paper hyperfine coupling constants of d and f metal complexes with BH4 - ligands have been determined by DFT calculations, and analyzed in detail. Calculations predicted that proton hyperfine coupling constants are very small in the case of complexes of f elements, and are present only due to weak polarization. The increase of covalence and the number of unpaired electrons does not significantly affect the change of constants of BH4 - ligands, but only of protons that are bound by σ bonds.XI Serbian Ceramic Society Conference - Advanced Ceramics and Application : new frontiers in multifunctional material science and processing : program and the book of abstracts; September 18-20, 2023; Belgrad