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

Removal of heavy metals from aqueoussolutions through the use of modified fly ashand bottom ash from thermal power plant

Zagađujuće materije iz otpadnih voda mogu se ukloniti različitim naprednim tehnikama prečišćavanja. Proces adsorpcije može se primeniti za uklanjanje teških metala iz otpadnih voda primenom brojnih materijala. U termoelektranama (TE) kao sporedni proizvod procesa sagorevanja uglja nastaju pepeo i šljaka. Cilj ovog rada je ispitivanje adsorpcionih svojstava pepela i šljake dodatkom cementa i kreča za uklanjanje jona teških metala (Cu2+, Zn2+, Pb2+ i Cd2+) iz vodenih rastvora. U radu su predstavljeni rezultati ispitivanja upotrebe modifikovanih oblika pepela i šljake kao adsorpcionog materijala. Najveću efikasnost uklanjanja ispitivanih jona pokazali su uzorci pepela i šljake iz TE Kostolac i TE Morava uz dodatak kreča, dok je uzorak pepela iz TE Kostolac uz dodatak cementa pokazao najmanji stepen izluživanja. Izvršena je selekcija materijala za dalja istraživanja koja obuhvataju optimizaciju procesa adsorpcije i karakterizaciju materijala.Pollutants can be removed from wastewater by a variety advanced techniques for wastewater treatment. The adsorption process can be utilized for the removal of heavy metals from wastewater using numerous of materials. Fly ash and bottom ash are produced as a by-products of coal combustion in thermal power plants (TPP). The aim of this work has been to investigate the adsorption properties of a mixture made by adding cement and lime in fly ash and bottom ash to remove heavy metal ions (Cu2+, Zn2+, Pb2+ and Cd2+) from aqueous solutions. This paper presents the results of a modified form of fly ash and bottom ash used as an adsorbent material. The highest removal efficiency of investigated ions has been found in samples of fly ash and bottom ash from TPP Kostolac and TPP Morava with the addition of lime, while the pattern of ash from TPP Kostolac with the addition of cement showed the smallest leaching level. A selection of the material needs to be made in order to carry out further research that includs the optimization of the adsorption process and better char acterizing of adsorbent materials.29. Međunarodni kongres o procesnoj industriji - PROCESING ′16 : zbornik radova ; 2-3. jun, Beogra

Health care facilities preparedeness for responding to industrial hazards - Case study of health facility in Obrenovac, Serbia

U skladu sa opštim načelima datim kroz Sendai i Hjogo konvencije u oblasti upravljanja rizicima u uslovima katastrofa (Hyogo and Sendai Framework for Disaster Risk Management) izazvanim prirodnim i antropogenim faktorima, na teritoriji opštine Obrenovac sprovedeno je istraživanje spremnosti zdravstvenih ustanova da odgovore na potencijalne industrijske akcidente. Lokalne zdravstvene ustanove su javni objekti koji predstavljaju prvi nivo u hijerarhiji pružanja pomoći lokalnom stanovništvu u slučaju industrijskih hazarda manjih ili većih razmera. S tim u vezi, stepen njihove opremljenosti predstavlja imperativ u upravljanju rizicima od katastrofa na nekom području. Kroz istraživanje indeksa bezbednosti lokalne zdravstvene ustanove u Obrenovcu (doma zdravlja) utvrđene su postojeće mogućnosti za odgovor na industrijske katastrofe i dat predlog mera koje bi trebalo sprovesti u cilju unapređenja kvaliteta usluga u slučaju akcidenata. Kroz rad će biti prikazana metodologija u oblasti definisanja otpornosti zdravstvenih objekata, kroz utvrđivanje indeksa bezbednosti bolnica (hospital safety index), propisanog od strane Svetske zdravstvene organizacije, mogućnost primene ove metode evaluacije na zdravstvenim ustanovama u Srbiji, prezentovani rezultati istraživanja i dat predlog mera za prevazilaženje organizacionih, tehničkih i arhitekonskograđevinskih problema u objektima zdravstvene ustanove u Obrenovcu.Based on the Hyogo and Sendai Framework for Disaster Risk Management caused by natural or human factors, a study was conducted on the territory of Obrenovac municipality regarding the readiness of health care facilities to respond to potential industrial accidents. Local health care facilities are public service provider which often represent the primary level in the hierarchy of providing health care services to the local population in case of smaller or larger industrial accidents. Through our paper we will present the methodology used for calculating the hospital safety index defined by the World Health Organization, the possibility to apply this method of evaluation on health care facilities in Serbia, the preliminary results of our studies and suggested procedures for overcoming organizational, architectural, and construction problems in the primary health care facility of Obrenovac.Urednici: Miroslav Stanojević, Aleksandar Jovovi

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

Modelovanje odnosa doza‐odgovor između nivoa Pb i Cd u tkivima karcinoma testisa i prostate i nivoa testosterona

Exposure to lead (Pb) and cadmium (Cd) poses risk to human health. It is known that these metals have toxic impact on male reproductive system, leading to physiological disorders and infertility. Limited data indicates the carcinogenic potential of Pb, while Cd has been recognized as carcinogen. Benchmark dose-effect modeling can be applied to data from human, animal and ecotoxicological studies with the aim to obtain Benchmark dose (BMD), starting point in human health risk assessment. The aim of this study was to use Benchmark modeling to determine the dose-effect relationship between Pb and Cd levels in tissues of testicular and prostate cancer patients and serum testosterone levels. The study was conducted at the Clinical Center of Serbia, and included 104 patients with prostate and testicular cancer. Cd and Pb levels (ng/g) were measured by atomic absorption spectrophotometry in isolated healthy surrounding and carcinoma-affected tissues. Testosterone levels (ng/mL) were measured using the chemiluminescence immunoassay (CLIA) method. Dose-effect modeling was performed using PROAST70.1 software with continuous data. The dose dependence was obtained between Cd levels in tumor tissue and testosterone levels (BMD: 0.0024 ng Cd/g, prostate cancer and 0.0038 ng Cd/g, testicular cancer). Dose dependence was obtained between Cd levels in healthy surrounding tissue and testosterone levels (BMD: 0.0092 ng Cd/g). No dose dependence was obtained when modeling Pb levels as a dose. The data from this study indicate a potential link between Cd and testosterone levels, i.e. potential association of Cd exposure with male reproductive health.Izloženost olovu (Pb) i kadmijumu (Cd) predstavlja rizik po zdravlje ljudi. Poznato je da ovi metali deluju toksično na muški reproduktivni sistem dovodeći do poremećaja fizioloških funkcija i neplodnosti. Ograničen broj studija ukazuje na kancerogeni potencijal Pb, dok je Cd poznatihumani karcinogen. Benchmark modelovanje odnosa doza-efekat se teoretski može primeniti na podacima iz humanih, animalnih i ekotoksikoloških studija, sa ciljem dobijanja Benchmark doze (BMD) kao polazne tačke u proceni rizika po zdravlje ljudi. Cilj ovog rada bio je da se Benchmark modelovanjem utvrdi odnos doza-efekat između nivoa Pb i Cd u tkivima karcinoma testisa i prostate pacijenata i nivoa testosterona u serumu. Studija je sprovedena na Kliničkom centru Srbije i uključila je 104 pacijenta sa karcinomom prostate i testisa. Nivoi Cd i Pb (ng/g) su izmereni metodom atomske apsorpcione spektrofotometrije u izolovanim zdravim okolonim i karcinomom zahvaćenim tkivima. Nivoi testosterona (ng/mL) su mereni pomoću metode direktnog kompetitivnog hemiluminiscentnog imunoeseja (CLIA). Modelovanje odnosa doza-efekat je vršeno pomoću PROAST 70.1 softvera (RIVM, Holandija) uz upotrebu kontinuiranih podataka. Dozna zavisnost je dobijena između nivoa Cd u tumorskom tkivu i nivoa testosterona gde je BMD vrednost iznosila 0,0024 ng Cd/g (karcinom prostate) i 0,0038 ng Cd/g (karcinom testisa). Dozna zavisnost je dobijena i za modelovanje odnosa nivoa Cd u zdravom tkivu i testosterona, sa BMD vrednošću 0,0092 ng Cd/g. Pri modelovanju nivoa Pb nije dobijena dozna zavisnost. Podaci ove studije ukazuju na potencijalnu vezu između nivoa Cd u tkivu i nivoa testosterona, ukazujući na efekte izloženosti ovom metalu na muško reproduktivno zdravlje.VIII Kongres farmaceuta Srbije sa međunarodnim učešćem, 12-15.10.2022. Beogra

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