Profesionalna izloženost krvi i tjelesnim tekućinama zdravstvenih radnika u općim bolnicama u Srbiji

The risk of occupational bloodborne infections (HBV, HCV, and HIV) among healthcare workers remains a serious issue in developing countries. The aim of this study was to estimate occupational exposure to bloodborne infections among general hospital workers in Serbia. This cross-sectional study was conducted in the spring of 2013 and included 5,247 healthcare workers from 17 general hospitals. The questionnaire was anonymous, self-completed, and included sociodemographic information with details of blood and bodily fluid exposure over the career and in the previous year (2012). Significant predictors of sharps injuries were determined with multiple logistic regressions. The distribution of accidents in 2012 was equal between the genders (39 %), but in entire career it was more prevalent in women (67 %). The most vulnerable group were nurses. Most medical doctors, nurses, and laboratory technicians reported stabs or skin contact with patients’ blood/other bodily fluid/tissue as their last accident. Healthcare workers from the north/west part of the country reported a significantly lower number of accidents over the entire career than the rest of the country (p<0.001). The south of Serbia stood out as the most accident-prone in 2012 (p=0.042).Rizik od profesionalnih krvnoprenosivih bolesti (HBV, HCV, HIV) među zdravstvenim radnicima i dalje je ozbiljan problem u zemljama u razvoju. Cilj presječnoga ispitivanja, koje je provedeno u proljeće 2013. i u kojem je sudjelovalo 5.247 ispitanika iz 17 općih bolnica, bio je procijeniti profesionalnu izloženost zdravstvenih radnika u Srbiji krvnoprenosivim bolestima. Upitnik je bio anoniman i sadržavao je opće podatke i podatke o prethodnoj izloženosti krvi i tjelesnim tekućinama. Korištena je analiza multiple logističke regresije za određivanje značajnih prediktivnih čimbenika ubodnih incidenata. U prethodnoj godini broj ozljeda bio je jednak i u muškoj i u ženskoj populaciji (39 %), a tijekom cijelog radnog staža prevalencija je bila viša u ženskoj populaciji (67 %). Najveći broj ozljeda imale su medicinske sestre/tehničari. Najveći broj liječnika, medicinskih sestara i laboratorijskih radnika kao posljednji incident navode ubod ili kontakt kože s krvlju pacijenta, drugim tjelesnim tekućinama ili tkivima. Razlike među regijama bile su značajne u sjevernom/zapadnom području Srbije, gdje je rizik od incidenata bio niži tijekom cijelog radnog staža (p<0,001), i na jugu, gdje je rizik tijekom prethodne godine bio povišen (p=0,042)

Ima li sindrom izgaranja nastavnika na poslu sezonski karakter?

The aim of this cross-sectional study was to compare occupational burnout in two groups of teachers from the district of Bijeljina (Bosnia and Herzegovina) measured with the Serbian version of the Maslach Burnout Inventory survey for workers in human services (MBI-HSS) at the beginning (group 1) and the end of the school year 2018/2019 (group 2) to see if there are seasonal differences. The questionnaire also included standard sociodemographic data and job description (primary and/or secondary school position, length of service, and overtime work). The prevalence of emotional exhaustion and depersonalisation was low in both groups. However, emotional exhaustion and depersonalisation scores significantly shifted to higher values between the beginning and the end of the school year. We also found a statistically significant association between emotional exhaustion and overtime and between depersonalisation and work in a secondary school (p<0.05). These findings invite further research of occupational burnout seasonality in schoolteachers, preferably by following up cohorts which would be controlled for sociodemographic and work-related variables.U ovom je presječnom istraživanju uspoređena prevalencija sindroma izgaranja na poslu u dvjema skupinama nastavnika na području Bijeljine u Bosni i Hercegovini te je procijenjen njegov sezonski karakter. Sindrom izgaranja na poslu mjeren je na početku (skupina I.) i na kraju školske 2018./2019. godine (skupina II.). Za potrebe ovoga istraživanje korištena je srpska inačica Maslachina upitnika izgaranja na poslu za stručnjake pomagačkih zanimanja (izv. Maslach Burnout Inventory Survey for Workers in Human Services, krat. MBI-HSS). Upitnik je uključivao i standardne sociodemografske podatke, kao i podatke o radnomu mjestu (rad u osnovnoj i/ili srednjoj školi, dužina radnog staža i prekovremeni rad). Prevalencija emocionalne iscrpljenosti i depersonalizacije bila je niska u objema skupinama ispitanika na početku mjerenja, ali se na kraju školske godine povećala. Utvrđena je statistički značajna razlika između emocionalne iscrpljenosti i prekovremenoga rada, kao i između depersonalizacije i rada u srednjim školama (p<0,05). Rezultati istraživanja upućuju na potrebu daljnjeg ispitivanja sezonskoga karaktera sindroma izgaranja na nastavničkom poslu, po mogućnosti kohortnim istraživanjem kojim bi se pratile sociodemografske i radne varijable ispitanika

Povezanost kliničkih karakteristika i morfoloških parametara s rupturom aneurizme prednje komunikacijske arterije

We analyzed aneurysm morphology, demographic and clinical characteristics in patients with anterior communicating artery (ACoA) aneurysms to investigate the risk factors contributing to aneurysm rupture. A total of 219 patients with ACoA aneurysms were admitted to our hospital between January 2016 and December 2020, and morphological and clinical characteristics were analyzed retrospectively in 153 patients (112 ruptured and 41 unruptured). Medical records were reviewed to obtain demographic and clinical data on age, gender, presence of hemorrhage, history of hypertension, diabetes, heart disease, and kidney disease. Morphological parameters examined on 3-dimensional digital subtraction angiography included aneurysm size, neck diameter, aspect ratio, size ratio, bottleneck ratio, height/width ratio, aneurysm angle, (in)flow angle, branching angle, number of aneurysms per patient, shape of the aneurysm, aneurysm wall morphology, variation of the A1 segment, and direction of the aneurysm. Male gender, aspect ratio, height/width ratio, non-spherical and irregular shape were associated with higher odds of rupture, whilst controlled hypertension was associated with lower odds of rupture, when tested using univariate logistic regression model. In multivariate model, controlled hypertension, presence of multiple aneurysms, and larger neck diameter reduced the odds of rupture, while irregular wall morphology increased the risk of rupture. Regulated hypertension represented a significant protective factor from ACoA aneurysm rupture. We found that ACoA aneurysms in male patients and those with greater aspect ratios and height/width ratios, larger aneurysm angles, presence of daughter sacs and irregular and non-spherical shapes were at a higher risk of rupture.Analizirali smo morfologiju aneurizme, demografske i kliničke karakteristike u bolesnika s aneurizmom prednje komunikacijske arterije (ACoA) kako bismo istražili čimbenike rizika koji doprinose rupturi aneurizme. Ukupno je 219 bolesnika s aneurizmom ACoA primljeno u našu bolnicu u razdoblju od siječnja 2016. do prosinca 2020. godine, a morfološke i kliničke karakteristike analizirane su retrospektivno u 153 bolesnika (112 puknutih i 41 neprekinuta). Pregledani su medicinski zapisi kako bi se dobili demografski i klinički podaci za dob, spol, prisutnost krvarenja, povijest hipertenzije, dijabetes, srčane bolesti i bolesti bubrega. Morfološki parametri ispitani na trodimenzionalnoj digitalnoj subtrakcijskoj angiografiji uključivali su veličinu aneurizme, promjer vrata, odnos između normalne visine aneurizme i širine vrata aneurizme (aspect ratio), odnos između visine aneurizme i prosječnog promjera svih krvnih žila povezanih s aneurizmom (size ratio), odnos između širine fundusa aneurizme i širine vrata aneurizme (bottleneck ratio), odnos između najveće normalne visine aneurizme i širine aneurizme (height/width ratio), kut aneurizme, ugao ulaska tijeka krvne struje u fundus aneurizme (inflow angle), kut grananja, broj aneurizma po bolesniku, oblik aneurizme, morfologiju stijenke aneurizme, varijaciju segmenta A1 i smjer aneurizme. Muški spol, odnos između normalne visine aneurizme i širine vrata aneurizme, odnos između najveće normalne visine aneurizme i širine aneurizme, nesferičan i nepravilan oblik bili su povezani s većim izgledima za puknuće, dok je kontrolirana hipertenzija bila povezana s manjom vjerojatnosti puknuća kada je testirano primjenom modela s univarijatnom logističkom regresijom. U multivarijatnom modelu su kontrolirana hipertenzija, prisutnost više aneurizma i veći promjer vrata smanjili izglede za puknuće, dok je nepravilna morfologija stijenke povećala rizik od puknuća. Regulirana hipertenzija predstavlja značajan zaštitni čimbenik od pucanja aneurizme ACoA. Utvrdili smo da su aneurizme ACoA u muških bolesnika i one s većim odnosom između normalne visine aneurizme i širine vrata aneurizme te one s većim odnosom između najveće normalne visine aneurizme i širine aneurizme, većim kutovima aneurizme, prisutnošću kćeri vrećica te nepravilnim i nesferičnim oblicima u većem riziku od puknuća

Exploring the endocrine disrupting potential of lead through benchmark modelling – Study in humans

Exposure to low levels of a toxic metal lead (Pb) affects human health, and its effect as an endocrine disruptor has been reported. However, the precise role of Pb in endocrine health is still unclear because no dose-response relationship has been established for such an effect. The present study aimed to examine blood Pb levels (BLLs) in relation to serum levels of free triiodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), and insulin in 435 nonoccupationally exposed Serbian subjects (218 women, 217 men, 18–94 years of age, mean age 48). In addition, benchmark dose (BMD) values were calculated for these endocrine endpoints using the PROAST 70.1 software. An explicit dose-response dependency between BLL and TSH, fT3, fT4, testosterone, and insulin serum levels was evident from BMD modelling. The results support the positive association between BLLs and serum insulin levels, with observed dose-response and calculated BMD values of 1.49 and 0.74 μg Pb/dL in males and females, respectively. Collectively, our findings reported potential endocrine-disrupting effects of Pb at the environmental exposure levels experienced by current Serbian population. They also strengthen the notion that the blood Pb threshold level for an endocrine effect is low

Izloženost živi i funkcija štitaste žlezde: postoji li veza?

Mercury (Hg) is one of the most important environmental pollutants with endocrine- disrupting properties. There is little data from epidemiological studies describing the dose- response relationship between toxic metal levels and hormone levels. The aim of this study was to use the nearest neighbor matching analysis to determine the difference in Hg concentration in healthy/sick subjects with thyroid disease and to use Benchmark modeling to determine the dose- response relationship between Hg levels in the blood and thyroid-stimulating hormone (TSH) and thyroid hormones in serum. Blood samples were collected and used for Hg measurement using the ICP-MS method, and separated serum was used for hormone analysis. The study showed the existence of a statistically significant difference in Hg levels measured in healthy and sick subjects and the existence of a dose-response relationship between Hg and all measured hormones, with a narrow interval obtained for the Hg-TSH pair. The results of this research support the use of the Benchmark dose approach for the purpose of analyzing data from human studies, and our further research will be focused on examining the impact of low doses on animal models in order to determine more precise effects of low doses on the organism.Živa (Hg) je jedan od najznačajnijih zagađivača životne sredine sa osobinama endokrinog ometača. Malo je podataka iz epidemioloških studija koji opisuju odnos doza-odgovor između nivoa toksičnih metala i nivoa hormona. Cilj ovog rada bio je da primenom nearest neighbor matching analize utvrdi razliku u koncentraciji Hg kod zdravih/obolelih ispitanika od bolesti štitaste žlezde i da primenom Benchmark modelovanja utvrdi odnos doza-odgovor između nivoa Hg u krvi i tireostimulišućeg hormona (TSH) i tiroidnih hormona u serumu. Uzorci krvi su sakupljeni i korišćeni za merenje Hg uz pomoć ICP-MS metode, a izdvojeni serum korišćen je za analizu hormona. Studija je pokazala postojanje statistički značajne razlike u nivoima Hg koji su izmereni kod zdravih i bolesnih ispitanika i postojanje odnosa doza-odgovor između Hg i svih merenih hormona, pri čemu je uzak interval dobijen za Hg-TSH par. Rezultati ovog istraživanja podržavaju upotrebu Benchmark dose pristupa u svrhu analize podataka iz humanih studija, a naša dalja istraživanja će biti usmerena na ispitivanje uticaja niskih doza na životinjskim modelima, u cilju utvrđivanja preciznijih efekata niskih doza na organizam

Ultrasonographic assessment of the maxillary artery and middle meningeal artery in the infratemporal fossa

Purpose: To investigate with Doppler ultrasonography the maxillary and middle meningeal arteries in the infratemporal fossa, and describe their hemodynamic characteristics. Methods: We included 24 female and 11 male volunteers without vascular diseases, with a median age of 43 years. We used the acoustic window, enlarged by subjects half-opening their mouth, located below the zygomatic arch, in front of temporo-mandibular joint, to reach the maxillary and middle meningeal arteries. Results: In the 35 subjects, 112 arteries were visualized successfully: 60 maxillary (85.7%), and 52 middle meningeal arteries (74.3%), at a depth of 2.40 and 2.50 cm, respectively. Their blood flow was directed anteriorly and away from the probe. While all the measured hemodynamic characteristics differed significantly between the maxillary and the middle meningeal artery (P < 0.001), there was no significant difference between male and female subjects, nor between the left or the right side. Conclusions: The maxillary and middle meningeal arteries can be insonated in the infratemporal fossa through the easily accessible acoustic window below the zygomatic arch, when the patient holds his mouth half open. They can be differentiated by their ultrasonographic characteristics and blood flow features

Evaluating a primary healthcare centre's preparedness for disasters using the hospital safety index: Lessons learned from the 2014 floods in Obrenovac, Serbia

Various organizations have endeavored to develop assessment methods for the identification and management of weaknesses in hospital disaster preparedness. Although the largest number of patients receive their regular care at the primary level, there is no internationally validated tool for the rapid safety assessment of primary health care centers (PHC). Flooding accounts for almost 50% of all disasters related to weather, and climate models consider these events as highly probable in the future. In May 2014, heavy rain caused floods affecting around 1.6 million people in Serbia, leaving the municipality of Obrenovac most severely impacted. This paper aims at assessing the safety of PHC Obrenovac using the Hospital Safety Index (HSI), evaluating the usefulness of HSI for safety assessment of PHCs, and drawing lessons from the 2014 floods. PHC Obrenovac had an overall safety index of 0.82, with structural, nonstructural safety, and disaster management indices of 0.95, 0.74, and 0.75, respectively, implying it is likely to function in disasters. A detailed analysis of individual HSI items underlined the necessary improvements in the field of emergency power and water supply, telecommunication, and emergency medical supplies, which rendered the PHC non-functional during the 2014 floods. Most items were considered of same relevance for primary healthcare centers as for hospitals, excluding some items in the medical equipment, patient care, and support services. Fine-tuning the HSI to primary healthcare settings, officially translating it into different languages, facilitating scoring and analysis could result in a valid safety evaluation tool of primary healthcare facilities

St. Ignatius, Flathead Reservation, Montana.

Postcard of the St. Ignatius Mission on the Flathead Reservation in Montana.picture postcar

Factors Associated with the Antibiotic Treatment of Children Hospitalized for COVID-19 during the Lockdown in Serbia

Unselective use of antibiotics to treat children with COVID-19 is one of the major issues during the pandemic in Serbia. Thus far, there has been no evidence about the predictors of multiple antibiotic use in the treatment of children with COVID-19. The purpose of this study was to assess the prevalence of antibiotic use, as well as to examine demographic and clinical factors associated with a greater number of antibiotics and with a longer antibiotic treatment administered to hospitalized children with COVID-19 during the lockdown in Serbia. This study included all children who were hospitalized from 6 March to 31 May 2020 at the only pediatric COVID-19 hospital, and who were confirmed to have SARS-CoV-2 infection. Demographic, clinical, and laboratory data were collected from medical records. The antibiotic treatment included the use of azithromycin, cephalosporin (ceftriaxone), ampicillin-amikacin, and hydroxychloroquine. The overall prevalence of antibiotics use in children hospitalized with COVID-19 regardless of age was 47.2% (43.3% in children aged 1–5 years and 44.4% in those aged 5–17 years). In children aged 1–5 years, not having a family member affected by COVID-19 (B = −1.38, 95% confidence interval [CI] −2.43, −0.34, p = 0.011), having pneumonia on chest X-ray (B = 0.81, 95%CI 0.34, 1.29, p = 0.002), being a boy (B = −0.65, 95%CI −1.17, −0.13, p = 0.018), and having higher C-reactive protein (CRP) values on admission (B = 0.12, 95%CI 0.07, 0.17, p = 0.001) were associated with the administration of a higher number of antibiotics. These factors, along with having fever (B = 3.20, 95%CI 1.03, 5.37, p = 0.006), were associated with a longer duration of antibiotic treatment in children aged 1–5 years. In children aged 5–17 years, having pharyngeal erythema (B = 1.37, 95%CI 0.61, 2.13, p = 0.001), fever (B = 0.43, 95%CI 0.07, 0.79, p = 0.018), and pneumonia on chest X-ray (B = 0.91, 95%CI 0.53, 1.29, p = 0.001), not having rhinorrhea (B = −1.27, 95%CI −2.47, −0.08, p = 0.037), being a girl (B = 0.52, 95%CI 0.08, 0.97, p = 0.021), and having higher CRP values on admission (B = 0.04, 95%CI 0.01, 0.06, p = 0.006) were associated with the administration of a higher number of antibiotics. These factors, not including the absence of rhinorrhea, were associated with a longer duration of antibiotics treatment in children aged 5–17 years. Demographic, epidemiological, clinical, and laboratory parameters were associated with the use of multiple antibiotics and a longer duration of antibiotic treatment both among children aged 1–5 years and those aged 5–17 years