Učinak dipping profila gestacijske hipertenzije na majčine simptome i fizikalne nalaze, porođajnu težinu i prijevremeni porođaj

The study aimed to determine if the non-dipping pattern of blood pressure (BP) influences preterm delivery in gestational hypertension (GH), but also maternal clinical findings and birth weight. Sixty women with GH, i.e. 30 women with a dipping BP profile (control group) and 30 non-dippers (study group), were included in the study. Echocardiography was performed in all subjects, as well as ambulatory blood pressure monitoring (ABPM) during third trimester. ABPM was repeated 6-8 weeks after delivery. Thirteen women with preterm delivery were classified as non-dippers and only four as dippers (p=0.01). The average and peak systolic and diastolic night-time BP had negative linear correlation with birth weight (p<0.0005). Total vascular resistance (p<0.0005) and mass index (p=0.014) were significantly higher as compared with women with term delivery, while ejection fraction (EF) (p=0.007) and circumferential systolic velocity (p=0.042) were significantly reduced in the preterm delivery group. Multivariate binary logistic regression identified the average night-time systolic BP, left ventricular mass index and EF as independent predictors of preterm delivery. Study results suggested a relationship of the non-dipping BP pattern in GH with preterm delivery, birth weight, and maternal clinical findings.Cilj ovoga istraživanja bio je utvrditi povezanost non-dipping profila krvnog tlaka (KT) s prijevremenim porođajem, porođajnom težinom novorođenčeta te kliničkim i ehokardiografskim parametrima kod žena s gestacijskom hipertenzijom (GH). Istraživanje je obuhvatilo 60 žena s GH, 30 s dipping profilom KT (kontrolna skupina) i 30 non-dippera (ispitna skupina). Sve žene podvrgnute su kompletnoj ehokardiografiji i 24-satnom ambulantnom praćenju krvnog tlaka (ambulatory blood pressure monitoring, ABPM) tijekom trećeg trimestra, a ABPM je ponovljen 6-8 tjedana nakon porođaja. Ukupno 17 žena imalo je prijevremeni porođaj. Trinaest žena s prijevremenim porođajem imalo je non-dipping profil KT, dok su samo četiri žene imale dipping profil KT (0,01). Prosječni i maksimalni sistolički i dijastolički noćni KT imali su negativnu linearnu korelaciju s porođajnom težinom (p<0,0005). Ukupna vaskularna rezistencija (p<0,0005) i indeks mase miokarda lijeve klijetke (p=0,014) bili su znatno viši u skupini žena s prijevremenim porođajem, dok su parametri sistoličke funkcije, tj. ejekcijska frakcija (EF) (p=0,007) i brzina cirkumferentnog skraćenja miokarda lijevog ventrikla (p=0,042) bili statistički značajno sniženi u skupini žena s prijevremenim porođajem. Multivarijatna regresijska analiza pokazala je da su prosječni noćni sistolički KT, indeks mase lijevog ventrikla i EF identificirani kao nezavisni prediktori prijevremenog porođaja. Rezultati istraživanja pokazali su da postoji povezanost između non-dipping profila KT s prijevremenim porođajem, porođajnom težinom novorođenčeta i poremećajem hemodinamskog statusa majke u GH

Spatial-temporal and Trend Analysis of the Traffic Accidents in the AP Vojvodina (northern Serbia)

The objective of this paper is to analyse the spatial-temporal pattern of traffic accidents using ten years of data from 2011 to 2020 for the Autonomous Province of Vojvodina, northern part of Serbia. The spatial pattern of traffic accident hot spots and their temporal evolution were identified on the municipality level of the study area using hot spot analysis (Getis–Ord Gi*) techniques within the GIS environment. Trends in the traffic accidents on the municipality level were analysed using Mann-Kendall statistic. In majority of municipalities there were no trend detected. In 15 out of 45 local administrative units some kind of trend in the number of traffic accidents, fatalities and injuries was detected. In only two municipalities, Bački Petrovac and Žabalj, trend in the number of traffic accidents is decreasing, while in seven is increasing, Bačka Palanka, Bačka Topola, Kanjiža, Kikinda, Mali Iđoš, Novi Kneževac and Vrbas. In only three municipalities decreasing trend in the number of traffic fatalities was detected, Bačka Topola, Novi Bečej and Titel. Also, five municipalities have decreasing trend in traffic injuries, Opovo, Sečanj, Vršac, Zrenjanin and Žabalj. Hot spot analysis on the number of traffic accidents and traffic injuries detected hot spots in seven municipalities – Bački Petrovac, Beočin, Irig, Novi Sad, Sremski Karlovci, Temerin and Žabalj. In the hot spot analysis on the number of traffic fatalities, there were no hot spots detected. The hot spot analysis on the traffic casualties weighted number showed similar results to the hot spot analysis on the traffic accidents, with only difference regarding persons in tractors. In this category, hot spots were detected in two municipalities – Nova Crnja and Žabalj. This research holds potential to enhance traffic safety by directing targeted safety measures toward identified hot spots. Such measures could ultimately lead to a reduction in traffic accidents, consequently curbing the number of both fatalities and injuries

Spatial-temporal and trend analysis of traffic accidents in AP Vojvodina (North Serbia)

The objective of this study is to analyse the spatial-temporal patterns of traffic accidents using data from 2011 to 2020 for the AP Vojvodina. The spatial-temporal patterns of traffic accident hotspots were identified at the municipality level using the Getis–Ord Gi⁎ statistic in ArcGISPro software. Trends in traffic accidents were analysed using the Mann-Kendall (MK) statistic. A certain trend in the number of traffic accidents, fatalities, and injuries was detected in 15 out of 45 municipalities. In two municipalities, the trend in the number of traffic accidents is decreasing, while in seven, it is increasing. In three municipalities, a decreasing trend in the number of traffic fatalities was observed. A decreasing trend in traffic injuries was identi fied in five municipalities. Hotspot analysis on the number of traffic accidents and traffic injuries revealed hotspots in seven municipalities, while no hotspots were detected in the number of traffic fatalities. In the traffic casualties weighted number, persons in tractors, hotspots were identified in two municipalities. This research has the potential to enhance traffic safety by directing targeted safety measures towards identified hotspots. Such measures could ultimately lead to a reduction in traffic accidents, consequently curbing the number of both fatalities and injuries

Spatial-temporal and Trend Analysis of the Traffic Accidents in the AP Vojvodina (northern Serbia)

The objective of this paper is to analyse the spatial-temporal pattern of traffic accidents using ten years of data from 2011 to 2020 for the Autonomous Province of Vojvodina, northern part of Serbia. The spatial pattern of traffic accident hot spots and their temporal evolution were identified on the municipality level of the study area using hot spot analysis (Getis–Ord Gi*) techniques within the GIS environment. Trends in the traffic accidents on the municipality level were analysed using Mann-Kendall statistic. In majority of municipalities there were no trend detected. In 15 out of 45 local administrative units some kind of trend in the number of traffic accidents, fatalities and injuries was detected. In only two municipalities, Bački Petrovac and Žabalj, trend in the number of traffic accidents is decreasing, while in seven is increasing, Bačka Palanka, Bačka Topola, Kanjiža, Kikinda, Mali Iđoš, Novi Kneževac and Vrbas. In only three municipalities decreasing trend in the number of traffic fatalities was detected, Bačka Topola, Novi Bečej and Titel. Also, five municipalities have decreasing trend in traffic injuries, Opovo, Sečanj, Vršac, Zrenjanin and Žabalj. Hot spot analysis on the number of traffic accidents and traffic injuries detected hot spots in seven municipalities – Bački Petrovac, Beočin, Irig, Novi Sad, Sremski Karlovci, Temerin and Žabalj. In the hot spot analysis on the number of traffic fatalities, there were no hot spots detected. The hot spot analysis on the traffic casualties weighted number showed similar results to the hot spot analysis on the traffic accidents, with only difference regarding persons in tractors. In this category, hot spots were detected in two municipalities – Nova Crnja and Žabalj. This research holds potential to enhance traffic safety by directing targeted safety measures toward identified hot spots. Such measures could ultimately lead to a reduction in traffic accidents, consequently curbing the number of both fatalities and injuries

Spatial-temporal and trend analysis of traffic accidents in AP Vojvodina (North Serbia)

The objective of this study is to analyse the spatial-temporal patterns of traffic accidents using data from 2011 to 2020 for the AP Vojvodina. The spatial-temporal patterns of traffic accident hotspots were identified at the municipality level using the Getis–Ord Gi⁎ statistic in ArcGISPro software. Trends in traffic accidents were analysed using the Mann-Kendall (MK) statistic. A certain trend in the number of traffic accidents, fatalities, and injuries was detected in 15 out of 45 municipalities. In two municipalities, the trend in the number of traffic accidents is decreasing, while in seven, it is increasing. In three municipalities, a decreasing trend in the number of traffic fatalities was observed. A decreasing trend in traffic injuries was identi fied in five municipalities. Hotspot analysis on the number of traffic accidents and traffic injuries revealed hotspots in seven municipalities, while no hotspots were detected in the number of traffic fatalities. In the traffic casualties weighted number, persons in tractors, hotspots were identified in two municipalities. This research has the potential to enhance traffic safety by directing targeted safety measures towards identified hotspots. Such measures could ultimately lead to a reduction in traffic accidents, consequently curbing the number of both fatalities and injuries

Clinical use of optical coherence tomography and fractional flow reserve

Introduction. The aim of each diagnostic method is to serve as a guide in deciding about the right patient treatment. During myocardial revascularization the decision to perform revascularization is usually not easy to make, especially in case of borderline stenosis. It has been proven that it is not enough to base morphological evaluation of coronary artery vessel stenosis solely on angiography. It is necessary to include additional modern diagnostic methods for functional analysis and detailed morphological analysis using fractional flow reserve (FFR) and optical coherence tomography (OCT), respectively. Case reports. In the first case report we showed the significance of morphological analysis using OCT and proved that it was not lumen stenosis. The second and the third case reports showed the complementarity between functional analysis (FFR) and morphological analysis (OCT) of stenosis in solving a complex coronary disease. The fourth case report showed the significance of OCT in dealing with the recurrent stent restenosis. Conclusion. By these short case reports we confirmed that percutaneous coronary intervention (PCI) guided by angiography is definitely not enough in deciding about myocardial revascularization especially in patients with a complex coronary disease. In certain cases FFR and OCT procedures can be complementary methods and improve quality of revascularization, particularly in the case of recurrent in-stent restenosis

Recanalization of coronary artery chronic total occlusion by retrograde approach

Introduction. Chronic total occlusion (CTO) is defined as a 100% obstruction of the blood vessel lumen with Thrombolysis in Myocardial Infarction grade 0 flow in the occluded segment at least three months old. Advancement of technological devices and techniques used during the percutaneous coronary interventions (PCI) in the past years brought more success in blood vessel recanalization. According to the latest guidelines for myocardial revascularization, the CTO treatment should be considered when there are symptoms or objective proof of viability or ischemia in the occluded area. The aim of this work is to present two cases with a recanalization of the coronary artery CTO by the retrograde approach. Outline of cases. The first patient had a single vessel coronary disease which led to a decision to first attempt PCI. During the attempt of antegrade recanalization, the guidewire penetrated subintimally, risking blood vessel dissection below the occluded area as well as serious complications. Retrograde approach enabled easier and safer passing of guidewire through the occlusion and then successful establishment of the antegrade flow. In the second case, the antegrade approach was also first attempted. Since it could not pass through the occluded area despite changing several guidewires, the strategy was changed during the intervention. It was continued with the retrograde approach, which led to the successful revascularization. Conclusion. These two cases demonstrate that retrograde approach and new technological improvements in dedicated guidewires can be implemented in everyday angiography practice for successful recanalization of CTO lesions

Clinical characteristic and management of elderly patients with myocardial infarction

Introduction/Objective. Population of elderly people is increasing and modern medicine is faced with the problem of large morbidity and mortality from cardiovascular diseases in this age group. Modern treatment strategies have not been sufficiently investigated in the elderly, therefore these people often receive suboptimal treatment. The aim of the study was to evaluate clinical characteristic, cardiac risk factors, management strategies and early outcome in the elderly patient with ST elevated myocardial infarction (STEMI). Methods. This retrospective study included 217 consecutive patients, aged ≥ 70 years (mean age 77.6 ± 4.9 years, 103 men, 114 women) with STEMI admitted to the Institute of Cardiovascular Diseases of Vojvodina. We have analyzed patients’ clinical characteristics, risk factors, left ventricular function and treatment strategies in relation to in-hospital outcome. Results. First clinical symptom was chest pain in 209 (96.3%) of patients. On admission, 35 (16.1%) patients were with severe signs of heart failure (Killip class III–IV). Duration of symptom onset to hospital admission was 14.7 ± 28.6 hours. Out of 217 patients, 168 (77.4%) patients received reperfusion treatment, including primary percutaneous coronary ntervention (PPCI) in 164 (75.6%) patients, and fibrinolytic therapy in 4 (1.8%) patients. Hospital mortality was 26.3% (57 patients). PPCI was univariate predictor of lower in-hospital mortality, whereas multivariate predictors of in-hospital mortality were cardiogenic shock (OR 67.095; 95% CI (6.845–657.646); p < 0.001) and low ejection fraction (OR 0.901; 95% CI (0.853–0.963); p = 0.001). Conclusion. In elederly patients presenting with STEMI, PPCI was asscoiated with lower mortality, whereas cardiogenic shock and lower ejection fraction were independent predictors of worse prognosis after STEMI

Left Atrial Strain as a Predictor of Left Ventricular Diastolic Dysfunction in Patients with Arterial Hypertension

Background and Objectives: There is emerging evidence of the usefulness of left atrial strain (LAS) in the assessment of diastolic dysfunction (DD). In this study we assess the sensitivity and specificity of LAS, to determine cut-off values and their association to DD with increased left atrial pressure (LAP) in patients with well-treated arterial hypertension. Materials and Methods: We performed a cross-sectional study on 180 subjects with well-treated arterial hypertension. All patients underwent transthoracic echocardiography. Patients were divided into two groups: a group without increased LAP and/or DD and a group with increased LAP DD. Results: In multivariate logistic regression, LAS proved to be the strongest statistically significant predictor of DD with increased LAP (OR 0.834, p 24.27% was significantly highly prevalent in the group of DD with increased LAP 78.9% when compared to the group without increased LAP 15.4%, p Conclusion: The findings of this study suggest that LAS could be a useful and highly sensitive and specific marker in the evaluation of DD. There is the potential for using LAS in everyday practice as a standard parameter in diastolic function assessment

Characteristics and Outcomes of Patients with Acute Coronary Syndrome and COVID-19

Acute coronary syndrome (ACS) in patients with COVID-19 is triggered by various mechanisms and can significantly affect the patient’s further treatment and prognosis. The study aimed to investigate the characteristics, major complications, and predictors of mortality in COVID-19 patients with ACS. All consecutive patients hospitalized from 5 July 2020 to 5 May 2021 for ACS with confirmed SARS-Co-2 were prospectively enrolled and tracked for mortality until 5 June 2021. Data from the electronic records for age and diagnosis, matched non-COVID-19 and COVID-19 ACS group, were extracted and compared. Overall, 83 COVID-19 ACS patients, when compared to 166 non-COVID ACS patients, had significantly more prevalent comorbidities, unfavorable clinical characteristics on admission (acute heart failure 21.7% vs. 6.6%, p p p p p p < 0.01. Concomitant ACS and COVID-19 is linked to underlying comorbidities, adverse presenting features, and poor outcomes. Urgent strategies are needed to improve the outcomes of these patients