Review of Costing Tools Health System in Liberia

Review of Costing Tools Health System in Liberi

Unusual Clinical Presentation of Giant Extragenital Condyloma

Condylomata accuminatum (CA) is a human papillomavirus (HPV) related sexually transmitted infection (STI), clinically characterized by solitary or even clustered dark red or pink lesions solely affecting the anogenital area (1). CA involving the extragenital, non-mucosal skin has been sporadically reported (2- 4). Diagnosis of CA is usually straightforward when the lesions are located on the anogenital area. However, involvement of extragenital skin may pose a diagnostic challenge. Herein, we report a rare case of giant linear extragenital CA without coexisting genital lesions, diagnosed with a synergic intervention of dermatoscopy and clinics

Analiza kvaliteta vode reke Mlave na osnovu vodenih makroinvertebrata

Cilj rada je da se predstave rezultati ispitivanja kvaliteta vode reke Mlave, zasnovani na prisutnoj zajednici vodenih makroinvertebrata. Mlava, sa dužinom toka od 78 km i površinom sliva od 1885 km², jedna je od značajnijih pritoka Dunava u Srbiji. Kao najvažniji izvori komunalnog i industrijskog zagađenja mogu se izdvojiti gradovi Požarevac (70000 stanovnika; u donjem toku) i Petrovac na Mlavi (8000 stanovnika; srednji tok), kao i Žagubica (2600 stanovnika; gornji tok). Slivno područje, naročito u srednjem delu toka, je i pod uticajem spiranja sa poljoprivrednih površina, kao i komunalnih otpadnih voda iz brojnih manjih naselja. Negativni efekti, ovih antropogenih uticaja mogu biti još izraženiji, zbog specifične hidrologije, odnosno preovlađivanja stanja niskih voda u slivu ove reke. Uzorkovanje je izvršeno u julu 2013. godine. Kao parametri za ocenu kvaliteta vode, korišćeni su sledeći pokazatelji: Saprobni indeks (SI; Zelinka & Marvan), BMWP i ASPT skorovi, broj taksona grupa Ephemeroptera, Plecoptera and Trichoptera (EPT) i indeks diverziteta (SWI; Shannon-Wiener’s indeks). Ukupno 72 taksona makroinvertebrata su identifikovana. Insekti su bili najraznovrsnija komponenta, a u okviru njih najbrojnije su bile grupe Ephemeroptera (13 taksona) i Trichoptera (11 taksona). Najveća raznovrsnost zabeležena je na lokalitetu Leskovac (33 taksona). Većina taksona je tolerantna na određeni stepen organskog zagađenja (β –mezosaprobni i α–mezosaprobni organizmi), naročito u donjem delu toka (Rašanac i Požarevac). Vrednosti SI na svim lokalitetima upućuju na veoma dobar i dobar kvalitet vode (klase I i II). Vrednosti BMWP i ASPT ukazuju na veoma dobar kvalitet vode samo na lokalitetima u srednjem i donjem delu toka (Leskovac i Požarevac), dok je u gornjem delu toka, kvalitet vode, ili loš (BMWP), ili umeren do dobar (ASPT). I preostali pokazatelj (EPT), takođe, ukazuje na bolji kvalitet vode u donjem delu toka. Na osnovu svih korišćenih pokazatelja, kvalitet vode reke Mlave u julu 2013. godine se može oceniti kao dobar (klasa II)

Analiza kvaliteta vode reke Jablanice na osnovu zajednice vodenih makroinvertebrata

Cilj rada je da se prikažu rezultati ocene kvaliteta vode reke Jablanice (sliv Kolubare) zasnovane na prisutnoj zajednici vodenih makroinvertebrata. Jablanica je relativno kratka (25 km) desna sastavnica, koja u blizini Valjeva sa Obnicom (leva sastavnica) formira Kolubaru. Kolubara, kao poslednja veća pritoka Save, protiče kroz područje sa izraženim i različitim antropogenim uticajima. Sama Jablanica nastaje spajanjem većeg broja potoka sa obronaka planina Jablanik i Medvednik. U skladu sa zahtevima EU prilikom ocene stanja rečnih sistema neophodno je utvrđivanje referentnih uslova. Da bi se utvrdilo recentno stanje, i usaglašenost sa zahtevima za dostizanje referentnog statusa, izvršeno je ispitivanje ove reke u aprilu 2013. godine na tri lokaliteta gornjeg toka. Kao parametri za ocenu kvaliteta vode, korišćeni su sledeći pokazatelji: ukupan broj taksona, saprobni indeks (SI; Zelinka & Marvan), BMWP i ASPT skorovi, broj taksona grupa Ephemeroptera, Plecoptera and Trichoptera (EPT) i indeks diverziteta (SWI; Shannon-Wiener’s indeks). Zabeležena su ukupno 72 taksona makroinvertebrata. Kao najraznovrsnije grupe izdvajaju se Trichoptera (16 taksona) i Ephemeroptera (15 taksona). U odnosu na saprobnu vrednost, utvrđeno je da je većina prisutnih taksona osetljiva na organsko zagađenje (ksenosaprobni i oligosaprobni organizmi). Dobijene vrednosti praktično svih korišćenih pokazatelja kvaliteta vode, upućuju na veoma dobar status (klasa I), čime su ispunjeni uslovi da se ispitivani deo toka Jablanice može smatrati referentnim stanjem, za potrebe istraživanja sliva Kolubare. Puštanje u rad akumulacije u Rovnima (srednji tok Jablanice) može izmeniti zatečeno stanje, zbog čega je neophodan redovni monitoring

Review paper Being a vegetarian: health benefits and hazards

Although their anatomical features disclose the herbivorous nature of humans, an omnivorous diet can be considered an evolutionary advantage that has supported human survival. Over recent decades, vegetarianism has significantly increased in developed countries due to the support of scientific research, emerging supermarkets and restaurants, and easy-to-access soy products and healthy foods. According to current knowledge, vegetarian diets are associated with significantly lower prevalence of obesity and lower risk of cardiovascular mortality. However, while the overall risk of cancer is slightly lower in vegetarians, the findings regarding the location and type of cancer that can be prevented by vegetarian diets are inconclusive. In addition to this, it remains unclear whether health benefits of vegetarian diets can be attributed to the avoidance of meat, or to the increased intake of dietary fibre, n-6 fatty acids, vitamins C, B9 and E, potassium, magnesium and phyto-chemicals, or to both of these factors. As a vegetarian diet becomes more restrictive, intake of adequate daily energy and of n-3 fatty acids, essential amino acids, vitamin B12, zinc, calcium and iron becomes more difficult to achieve, which is particularly challenging in children who have higher nutrient requirements relative to body weight than adults

Complications of Laparoscopic Cholecystectomy: Our Experience from a Retrospective Analysis

AIM: The aim of this study was to evaluate the intraoperative and postoperative complications of laparoscopic cholecystectomy, as well as the frequency of conversions. MATERIAL AND METHODS: Medical records of 740 patients who had laparoscopic cholecystectomy were analysed retrospectively. We evaluated patients for the presence of potential risk factors that could predict the development of complications such as age, gender, body mass index, white blood cell count and C-reactive protein (CRP), gallbladder ultrasonographic findings, and pathohistological analysis of removed gallbladders. The correlation between these risk factors was also analysed. RESULTS: There were 97 (13.1%) intraoperative complications (IOC). Iatrogenic perforations of a gallbladder were the most common complication - 39 patients (5.27%). Among the postoperative complications (POC), the most common ones were bleeding from abdominal cavity 27 (3.64%), biliary duct leaks 14 (1.89%), and infection of the surgical wound 7 patients (0.94%). There were 29 conversions (3.91%). The presence of more than one complication was more common in males (OR = 2.95, CI 95%, 1.42-4.23, p < 0.001). An especially high incidence of complications was noted in patients with elevated white blood cell count (OR = 3.98, CI 95% 1.68-16.92, p < 0.01), and CRP (OR = 2.42, CI 95% 1.23-12.54, p < 0.01). The increased incidence of complications was noted in patients with ultrasonographic finding of gallbladder empyema and increased thickness of the gallbladder wall > 3 mm (OR = 4.63, CI 95% 1.56-17.33, p < 0.001), as well as in patients with acute cholecystitis that was confirmed by pathohistological analysis (OR = 1.75, CI 95% 2.39-16.46, p < 0.001).CONCLUSION: Adopting laparoscopic cholecystectomy as a new technique for treatment of cholelithiasis, introduced a new spectrum of complications. Major biliary and vascular complications are life threatening, while minor complications cause patient discomfort and prolongation of the hospital stay. It is important recognising IOC complications during the surgery so they are taken care of in a timely manner during the surgical intervention. Conversion should not be considered a complication.Â

Characterization of macrolide-resistant non-invasive pneumococci in the pre-vaccine era in Serbia

Numerous reports have confirmed that increased macrolide use in the treatment of respiratory tract infection has contributed to the emergence of antibiotic resistance worldwide. Studies have also shown that pneumococcal vaccine can reduce pneumococcal resistance. The aim of this study was to determine the prevalence of co-resistance to penicillin and other antibiotics in macrolide-resistant (MR) non-invasive pneumococcal isolates and to evaluate serotype distribution in resistant strains in the pre-vaccine era in Serbia. About 80% of MR isolates expressed the MLS phenotype with very high resistance to both erythromycin and clindamycin. A total of 132 (84.1%) MR isolates were multiresistant, i.e., they were resistant to erythromycin, penicillin, tetracycline, and trimethoprim–sulfamethoxazole. Among 157 MR pneumococci, 11 different serotypes were found. Four serotypes, 19F, 14, 6B, and 23F, accounted for 77.7% of all MR pneumococcal isolates. Among isolates with the cMLS phenotype, serotypes 19F and 14 were predominant, whereas serotype 6A was the most common among those with the M phenotype, followed by 14. In conclusion, co-resistance to macrolides and penicillin in our non-invasive pneumococcal isolates is high. The majority of tested strains (∼80%) belonged to the four serotypes (19F, 14, 6B, and 23F) that are included in all conjugate vaccine formulations

Prediction of Cervical Lymph Node Metastasis in Clinically Node-Negative T1 and T2 Papillary Thyroid Carcinoma Using Supervised Machine Learning Approach

Papillary thyroid carcinoma (PTC) is generally considered an indolent cancer. However, patients with cervical lymph node metastasis (LNM) have a higher risk of local recurrence. This study evaluated and compared four machine learning (ML)-based classifiers to predict the presence of cervical LNM in clinically node-negative (cN0) T1 and T2 PTC patients. The algorithm was developed using clinicopathological data from 288 patients who underwent total thyroidectomy and prophylactic central neck dissection, with sentinel lymph node biopsy performed to identify lateral LNM. The final ML classifier was selected based on the highest specificity and the lowest degree of overfitting while maintaining a sensitivity of 95%. Among the models evaluated, the k-Nearest Neighbor (k-NN) classifier was found to be the best fit, with an area under the receiver operating characteristic curve of 0.72, and sensitivity, specificity, positive and negative predictive values, F1 and F2 scores of 98%, 27%, 56%, 93%, 72%, and 85%, respectively. A web application based on a sensitivity-optimized kNN classifier was also created to predict the potential of cervical LNM, allowing users to explore and potentially build upon the model. These findings suggest that ML can improve the prediction of LNM in cN0 T1 and T2 PTC patients, thereby aiding in individual treatment planning