Medicinska istraživanja“ je recenzirani naučni časopis Medicinskog fakulteta Univerziteta u Beogradu, koji je prvi put objavljen 1971 godine, dakle, pre pola veka. Časopis „Medicinska istraživanja“ je prvenstveno posvećen publikovanju rezultata naučno-istraživačkog rada nastavnika i saradnika Medicinskog fakulteta, kao i drugih naučnika u oblasti biomedicinskih istraživanja. Časopis „Medicinska istraživanja“ objavljuje naučne radove na engleskom jeziku uz sažetak na srpskom jeziku i ima usvojenu politiku otvorenog pristupa (open access). Izlazi tri puta godišnje, dok se u četvrtoj svesci objavljuju i sažeci izlaganja na simpozijumu „Stremljenja i novine u medicini“. U časopisu „Medicinska istraživanja“ se objavljuju originalni i prethodno neobjavljeni radovi: a. originalni radovi u kojima se prvi put objavljuju rezultati sopstvenih istraživanja; b. pregledni radovi (Review), kritički i originalno prikazani (sa autocitatima); c. prikazi bolesnika i slučajeva (Case report). Radovi koji se objavljuju u časopisu „Medicinska istraživanja“ pripadaju oblastima: bazičnih biomedicinskih istraživanja, kliničkih istraživanja i preventivne medicine. U cilju stručne recenzije prispelih radova, Uređivački odbor časopisa je podeljen u tri sekcije: bazične, kliničke i preventivne nauke, a njihovim radom koordiniraju Urednici sekcija. Sekcija za statističku analizu podataka će biti uključena u evaluaciju statističkih podataka prispelih radova.
Medicinski fakultet Univerzitet u Beogradu
NAZALNA POLIPOZA: ETIOLOGIJA, DIJAGNOSTIKA I SAVREMENE MOGUĆNOSTI LEČENJA
Hronični rinosinuzitis sa nazalnim polipima (CRSwNP) predstavlja hronično heterogeno inflamatorno oboljenje koje se karakteriše značajnim narušavanjem disanja na nos, čula mirisa i kvaliteta života bolesnika. Etiopatogeneza je multifaktorijalna i u njoj učestvuju poremećaj epitelne barijere, disfunkcija mukocilijarnog klirensa, disbioza, biofilm, Staphylococcus aureus, eozinofilna/tip 2 inflamacija, lokalni IgE odgovor, tkivno remodelovanje, faktori sredine i brojni komorbiditeti. Posebno se ističe značaj prisustvo astme i intolerancije na aspirin i/ili nesteroidne antiinflamatorne lekove u sklopu koncepta inflamacije čitavog disajnog puta. Dijagnoza se postavlja isključivo na osnovu korelacije karakterističnih simptoma sa objektivnim nalazom kliničkog/endoskopskog pregleda nosa i kompjuterizovane tomografije sinusa. Veoma je važna procena težine bolesti, komorbiditeta i drugih diferencijalno-dijagnostičkih entiteta. Osnovu terapije čine intranazalni kortikosteroidi i ispiranje nosa fiziološkim rastvorom, dok se sistemski kortikosteroidi, endoskopska sinusna hirurgija i biološka terapija koriste kod težih, rekurentnih ili nekontrolisanih oblika bolesti. Dijagnostičko-terapijski pristup kod CRSwNP zahteva razlikovanje fenotipa i endotipa bolesti, prepoznavanje tip 2 inflamacije i aktivno lečenje pridruženih stanja, uz kontinuirano praćenje terapijskog odgovora pomoću simptoma, endoskopskog nalaza, kvaliteta života i potrebe za dodatnim intervencijama. Ovaj pregledni rad obuhvata aktuelne dokaze o etiopatogenezi, kliničkoj prezentaciji, kvalitetu života, dijagnostičkim kriterijumima i savremenim mogućnostima lečenja CRSwNP, oslanjajući se na sistematske preglede, kliničke vodiče i originalna istraživanja. Individualizovani pristup, dobra kontrola lokalne bolesti i komorbiditeta predstavljaju ključne aspekte za dugoročno poboljšanje ishoda lečenja.
Sva prava zadržana (c) 2026 Medicinska istraživanja
PORAST OBOLJEVANJA OD TUBERKULOZE U EVROPI ZBOG MIGRANTSKE KRIZE: URGENTNA INTEGRACIJA GLOBALNOG ZDRAVLJA U NACIONALNI TB PROGRAM
Poslednjih decenija u porastu su globalne migracije zbog ratova, sukoba, progona i prirodnih katastrofa. Rizik oboljevanja od tuberkuloze (TB) kod migranata razlikuje se zavisno od vrste migracija, socioekonomskog statusa, načina putovanja i tranzitnih rizika. Sačinjen je narativni pregled literature. Sumirani su podaci o dijagnostici aktivne TB kod migranata koji ulaze u Evropsku uniju/ Evropski ekonomski prostor i Veliku Britaniju, uključujući podatke o kliničkoj prezentaciji i kašnjenju u dijagnostici, ishodima lečenja TB osetljive na lekove, TB rezistentne na lekove kao i ko-infekciju TB i humanog imunodeficijentnog virusa (HIV). Pokazali smo da su migranti skloniji oboljevanju od tubekuloze, uključujući i povećan rizik za vanplućnu TB, TB rezistentnu na lekove i ko-infekciju TB i HIV. Preporuke oko kojih je postignut konsenzus obuhvataju skrining migranata na TB/latentnu TB (LTBI), minimalan paket lečenja za TB osetljivu na lekove i multirezistentnu TB, besplatnu zdravstvenu i preventivnu zaštitu za migrante sa ko-infekcijom HIV-om. Neophodna je posebna posvećenost prevenciji i lečenju TB u migrantskim populacijama u Evropskoj uniji/ Evropskom ekonomskom prostoru i Velikoj Britaniji. Ključne reči⁚ tuberkuloza, migranti, multirezistentna, HIV
PREDIKTIVNA VREDNOST CT MORFOLOŠKIH KARAKTERISTIKA U STRATIFIKACIJI METASTATSKOG RIZIKA GASTROINTESTINALNIH STROMALNIH TUMORA: NEZAVISNA ANALIZA DVA RADIOLOGA
Uvod: Gastrointestinalni stromalni tumori (GIST) mogu imati agresivno biološko ponašanje. Preoperativna procena rizika značajna je za planiranje lečenja. Stoga je cilj ove studije bio da proceni prediktivnu vrednost i reproduktivnost CT morfoloških karakteristika u identifikaciji visokorizičnih GIST-a korišćenjem nezavisne analize dva radiologa. Materijal i metode: Retrospektivna studija obuhvatila je 26 pacijenata sa histopatološki potvrđenim gastričnim GIST koji su podvrgnuti dvofaznom kontrastnom MDCT pregledu. Dva radiologa su nezavisno analizirala CT morfološke karakteristike- veličinu tumora, integritet mukoze, unutrašnju strukturu, oblik, obrazac rasta i prisustvo uvećanih krvnih sudova koji ishranjuju ili dreniraju tumor (EFDV). Na osnovu prekinute mukoze i EFDV, tumori su klasifikovani u visokorizičnu (HR) i niskorizičnu (LR) grupu, a nalazi su korelisani sa histopatološkim rezultatima. Rezultati: Histopatološka analiza potvrdila je HR GIST kod 10, a LR GIST kod 16 pacijenata. Odlično slaganje između radiologa zabeleženo je za procenu integriteta mukoze (κ=0,843) i strukture tumora (κ=0,923), dok je značajno slaganje postignuto za EFDV, oblik tumora, obrazac rasta i procenu rizika. Oba radiologa pokazala su visoku senzitivnost (90%) u identifikaciji HR GIST-a. Veći dijametar tumora, prekinuta mukoza, heterogena struktura, nepravilan oblik, endofitni rast i prisustvo EFDV bili su povezani sa HR tumorima, iako je specifičnost ostala ograničena zbog preklapanja imaging karakteristika. Zaključak: CT morfološke karakteristike predstavljaju značajne imaging biomarkere za preoperativnu stratifikaciju rizika gastričnih GIST-a. Prekinuta mukoza i EFDV bili su najznačajniji prediktori visokorizičnih tumora. Uprkos preklapanju imaging karakteristika između nisko- i visokorizičnih lezija, konvencionalna CT analiza može pomoći u identifikaciji agresivnih tumora i planiranju terapije.
KLINIČKI SPEKTAR I ISHOD ZBRINJAVANJA SUPRARENALNIH MASA KOD ODOJČADI: 17-GODIŠNJE ISKUSTVO TERCIJARNOG CENTRA
Uvod/Cilj: Učestalost suprarenalnih masa (SRM) kod novorođenčadi i odojčadi je u značajnom porastu, najviše zahvaljujući rutinskoj prenatalnoj i postnatalnoj ultrazvučnoj dijagnostici. Iako je hirurško lečenje u prošlosti bilo standard terapije, danas se kod malih, asimptomatskih masa zagovara konzervativni pristup. Cilj ove studije je analiza pristupa i ishoda SRM u tercijarnom centru tokom poslednje dve decenije. Materijal i metode: Retrospektivnom studijom je obuhvaćeno 39 pacijenata sa dijagnozom SRM u periodu od 2006. do 2023. godine. Evaluirani su klinički, radiološki (UZ, CT, MR) i laboratorijski podaci (VMA/HVA u urinu, NSE). Protokol praćenja podrazumevao je ultrazvučne preglede jednom u dve nedelje tokom prva tri meseca života, a nakon toga mesečne ili tromesečne kontrole do potpune rezolucije promene, uz medijanu praćenja od 16,6 meseci (opseg 1,9–89). Rezultati: SRM veće od 5 cm identifikovane su kod 18% pacijenata (7/39). Kod pet od ovih sedam pacijenata, učinjena je hirurška intervencija i potvrđena je dijagnoza neuroblastoma (NBL). Kod preostala dva pacijenta došlo je do spontane regresije mase. Kod 32 pacijenta sa masama manjim od 5 cm, inicijalno je primenjen konzervativni pristup. Osam pacijenata iz ove grupe (25%) je na kraju operisano, zbog povišenih vrednosti kateholamina u urinu, što se pokazalo kao pouzdan indikator NBL u našoj kohorti. Potpuna regresija zabeležena je kod ostalih pacijenata koji su lečeni konzervativno. Zaključak: Minuciozno praćenje malih SRM je bezbedno kod selektovanih pacijenata i smanjuje broj nepotrebnih hirurških intervencija bez ugrožavanja ishoda lečenja. Metaboliti kateholamina u urinu ostaju dragoceno sredstvo za identifikaciju visokorizičnih pacijenata kojima je neophodno hirurško lečenje.
INFEKCIJA BK POLIOMAVIRUSOM (BKPYV) KOD TRANSPLANTACIJE BUBREGA: KARAKTERISTIKE VIRUSA, GENETSKA RAZNOVRSNOST, REAKTIVACIJA, FAKTORI RIZIKA I LABORATORIJSKA DIJAGNOSTIKA
BK poliomavirus (BKPyV) je široko rasprostranjeni humani poliomavirus i više od 80% humane populacije je seropozitvno na BKPyV. Nakon primarne infekcije, koja je obično asimptomatska, BKPyV uspostavlja doživotnu perzistenciju u ćelijama bubrežnog epitela. Poslednjih godina, zbog upotreba snažnih imunosupresivnih lekova nakon transplantacije došlo je do povećanja učestalosti reaktivacije BKPyV kod pacijenata sa transplantiranim organima, izdvajajući BKPyV kao jedan od glavnih faktora rizika za gubitak kalema kod primalaca transplantiranog bubrega. Ovaj revijski rad pisan iz perspective virusologa daje detaljan uvid u BKPyV infekciju sa posebnim osvrtom na reaktivaciju posle transplantacije bubrega. Prvi deo rada pruža uvid u strukturu viriona, organizaciju genoma, životni ciklus, mehanizme doživotne perzistencije kao i osnovne epidemiološke podatke u vezi BKPyV infekcje. Mesto preplitanja osnovne i kliničke virusologije objašnjeno je kroz diverziteta BKPyV kao i klinički značaj istog. Dalje se u radu obrađuju klinički aspekti BKPyV infeckije, uključujući faktore rizika za reaktivaciju BKPyV, klinički značaj tipizacije izolata kao i značaj serotip specifičnog imuniteta. U drugom delu rada, naglasak je na mogućnostima laboratorijske dijagnostike BKPyV infekcije. Na kraju se nalaze aktuelne međunarodne preporuke za skrining i praćenje BKPyV infekcije u posttransplantacionom periodu. Ovaj revijski rad kombnovanjem virusoloških, kliničkih i dijagnostičkih aspekata, ističe složenost BKPyV infekcije nakon transplantacije bubrega. Takođe, ukazuje na potrebu za daljom optimizacijom monitoringa BKPyV infekcije, dodatnim istraživanjima kliničkog značaja virusnog diverziteta kao i unapređenje terapijskih protokola za kontrolu BKPyV infekcije nakon transplantacije bubrega.
Uvodnik za svesku 2, Vol. 59 (2026) časopisa „Medicinska istraživanja“
UJED OTROVNE ZMIJE SA FATALNIM ISHODOM U ZAPADNOJ SRBIJI - PRIKAZ RETKOG SLUČAJA
Uvod: Ujedi otrovnih zmija mogu izazvati širok spektar kliničkih manifestacija, od lokalnih efekata na tkiva do sistemskih komplikacija, uključujući rabdomiolizu, koagulopatiju, akutno oštećenje bubrega, neurološke i kardiološke poremećaje. Iako u zapadnoj Srbiji ujedi otrovnih zmija ne predstavljaju ozbiljan problem javnog zdravlja, može doći do ozbiljnih situacija, sa potencijalno fatalnim ishodima. Prikaz pacijenta: Opisali smo slučaj sedamdesetjednogodišnjeg muškarca koga je ujeo poskok u Bajinoj Bašti, u zapadnoj Srbiji. Javio se sa umorom, povraćanjem i otokom leve ruke jedan sat nakon ujeda. Njegova prethodna medicinska istorija uključivala je dijabetes melitus, moždani udar i operaciju cerebralne aneurizme. Na prijemu je bio hipotenzivan i dehidriran, sa lokalnim hematomom i trombocitopenijom. Primio je protivotrov, kortikosteroide, dopamin, antibiotike i suportivnu negu. Uprkos početnoj stabilizaciji, kod pacijenta su se razvili akutni respiratorni distres, akutno oštećenje bubrega, hipotenzija i periferna cijanoza, što je zahtevalo mehaničku ventilaciju i dvostruku inotropnu podršku. Laboratorijski nalazi su ukazivali na koagulopatiju i porast markera oštećenja organa. Uprkos intenzivnom lečenju, pacijent je podlegao komplikacijama. Zaključak: Slučaj koji smo predstavili prvi je prijavljeni smrtonosni ujed zmije u zapadnoj Srbiji u poslednjih 30 godina. Primarni patogeni mehanizam je verovatno bila diseminovana intravaskularna koagulacija izazvana otrovom. Ovaj slučaj ističe važnost produženog kliničkog i laboratorijskog praćenja, blagovremene suportivne terapije i svesti o teškim sistemskim komplikacijama nakon ujeda zmija, čak i u regionima sa istorijski niskom incidencom.
INTERVAL BEZ UDALJENIH METASTAZA I UKUPNO PREŽIVLJAVANJE KOD SARKOMA DOJKE: RETROSPEKTIVNA STUDIJA U TERCIJARNOM CENTRU
Pozadina: Sarkomi dojke (SD) predstavljaju retke, agresivne maligne tumore sa ograničenim dokazima o dugoročnim ishodima lečenja. Cilj ove studije bio je da opiše onkološke ishode i ispita kliničkopatološke faktore povezane sa intervalom bez udaljenih metastaza (DMFI) i ukupnim preživljavanjem (OS) kod pacijenata lečenih sa kurativnom namerom. Metode: Retrospektivno su analizirani pacijenti sa primarnim ili sekundarnim sarkomom dojke lečeni u jednom tercijarnom onkološkom centru u periodu od 2013. do 2025. godine. Pacijenti sa metastatskom bolešću u trenutku dijagnoze bili su isključeni. DMFI je definisan kao primarni, a OS kao sekundarni ishod. Preživljavanje je procenjivano Kaplan–Majerovom metodom i upoređivano log-rank testom. Eksplorativne ROC analize korišćene su za deskriptivnu stratifikaciju. Rezultati: Ukupno dvadeset šest pacijenata ispunilo je kriterijume uključenja u studiju. Angiosarkom je bio najčešći histološki podtip, uglavnom kao sekundarni tumor nakon prethodne radioterapije dojke. Medijana DMFI nije dostignuta, pri čemu je 71,5% pacijenata bilo bez udaljenih metastaza nakon tri godine, dok je medijana OS iznosila 31 mesec uz trogodišnje OS od 46,9%. Kraći DMFI bio je povezan sa višim patološkim T stadijumom, većom veličinom tumora, prisustvom tumorske nekroze, mlađim uzrastom i užim resekcionim marginama. Ukupno preživljavanje bilo je značajno povezano samo sa širinom resekcionih margina, koje su bile jedina varijabla povezana i sa DMFI i sa OS. Eksplorativne Cox-ove regresione analize nisu bile konkluzivne zbog ograničenog broja događaja. Zaključak: Tumorsko opterećenje, nekroza tumora, i starost bili su povezani sa DMFI, dok je jedino širina hirurških margina bila povezana i sa DMFI i sa OS, naglašavajući značaj adekvatne hirurške resekcije SD.
INTRAVENOZNA TERAPIJA GVOŽĐEM KOD SRČANE INSUFICIJENCIJE SA SNIŽENOM EJEKCIONOM FRAKCIJOM: DOKAZI IZ NOVIJIH KLINIČKIH ISPITIVANJA I META‑ANALIZA
Anemija je čest komorbiditet kod pacijenata sa srčanom insuficijencijom (SI) i utiče na njihov morbiditet i mortalitet. Iako je etiologija anemije kod ovih bolesnika višestruka, hronična inflamacija i nedostatak gvožđa najčešći su uzroci. Anemija je snažan prognostički pokazatelj kako u akutnoj, tako i u hroničnoj SI, dok nedostatak gvožđa, čak i u odsustvu same anemije pogoršava simptome, funkcionalni kapacitet i kvalitet života pacijenata. Kod hronične SI često se sreće funkcionalni nedostatak gvožđa, koji nastaje usled poremećaja korišćenja gvožđa, ali može koegzistirati sa apsolutnom deficijencijom, kada same zalihe gvožđa nedostaju. Terapija intravenskim gvožđem pokazala je brojne koristi u vidu poboljšanja funkcionalnog statusa, ublažavanja simptoma i redukcije stope ponovnih hospitalizacija. Na osnovu ovih dokaza, najnovije smernice Evropskog udruženja kardiologa preporučuju suplementaciju gvožda kod simptomatskih pacijenata sa srčanom slabošću i redukovanom ejekcionom frakcijom (HFrEF). Poslednje meta analize pokazuju trend ka smanjenju ukupne smrtnosti. Cilj ovog revijalnog članka je da prikaže trenutne uvide u značaj nedostatka gvožđa i terapijske efekte njegove nadoknade kod pacijenata sa HFrEF-om. Pravilno razumevanje ovog stanja i njegovo blagovremeno lečenje predstavljaju važan korak ka individualizovanom i sveobuhvatnom pristupu terapiji SI.
Sva prava zadržana (c) 2025 Medicinska istraživanja
RAZVOJ CILJANE FARMAKOTERAPIJE ZA FRAGILNI X SINDROM: MOLEKULARNA MEDICINA KAO KLJUČNO SREDSTVO U KLINIČKOJ FARMAKOLOGIJI
Puna mutacija i epigenetsko utišavanje gena FMR1 dovode do nedostatka njegovog proteina, FMRP, što rezultira fragilnim X sindromom (FXS). Iako je ostvaren značajan napredak u razumevanju molekularnih mehanizama koje su u osnovi FXS‑a, za ovaj neurorazvojni poremećaj još uvek ne postoji lek niti je odobrena ciljana farmakološka terapija. Trenutno lečenje se uglavnom oslanja na simptomatsku terapiju, koja često donosi ograničene koristi i ne utiče na osnovne molekularne uzroke poremećaja. Ovaj pregledni rad ukazuje na značaj integracije molekularnih saznanja u procesu razvoja lekova za FXS. Prikazan je pregled postojeće farmakoterapije, sa analizom njihovih prednosti i ograničenja, uz naglašavanje potrebe za terapijama koje ciljaju specifične puteve poremećene disfunkcijom FMR1 gena. Razmatrana su savremena i tekuća klinička ispitivanja, sa fokusom na to kako dublje razumevanje molekularne biologije FXS-a može doprineti razvoju efikasnijih i preciznijih terapijskih strategija. Na kraju, analizirani su ključni signalni putevi uključeni u patofiziologiju FXS-a i diskutovano je na koji način klinička farmakologija i molekularna medicina mogu zajednički doprineti razvoju personalizovanih terapija za osobe sa ovim složenim poremećajem.
DEVET NAJČEŠĆIH ZABLUDA U DIJAGNOSTICI I LEČENJU GLAUKOMA
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Cilj ovog preglednog rada je da se ukaže na najčešće zablude u dijagnostici i lečenju glaukoma, što bi trebalo da utiče na podizanje kvaliteta lečenja naših pacijenata. U revijskom radu su analizirani naučni radovi publikovani u PubMed databazi do 30.6.2025. godine sa ključnim rečima: glaukom, pogrešno shvatanje, merenje intraokularnog pritiska. Neke od najčešćih zabluda u dijagnostici i lečenju glaukoma su u vezi sa načinom merenja intraokularnog pritiska, vremenom kada se merenje obavlja, oduzimanjem-dodavanjem vrednosti prema nomogramu za pahimetriju, zabrani unosa kofeina kod glaukoma i preporukama za fizičku aktivnost kod svih oblika glaukoma. Iako je postignut značajan napredak u dijagnostici i lečenju glaukoma, i dalje postoje određene zablude među oftalmolozima koje se moraju rešiti kako bi se poboljšali ishodi lečenja i kvalitet života pacijenata.
PROCENA DIJAMETRA LUMENA GLAVNOG STABLA LEVE KORONARNE ARTERIJE KVANTITATIVNOM KORONARNOM ANGIOGRAFIJOM I OPTIČKOM KOHERENTNOM TOMOGRAFIJOM
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Priority="49" Name="List Table 4 Accent 3"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 3"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 3"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 3"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 4"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 4"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 4"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 4"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 4"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 4"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 4"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 5"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 5"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 5"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 5"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 5"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 6"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 6"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 6"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 6"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 6"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 6"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Link"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Uvod: Precizna procena dimenzija lumena glavnog stabla leve koronarne arterije (LM) od ključnog je značaja tokom perkutane koronarne intervencije (PCI). Kvantitativna koronarna analiza (QCA) se rutinski koristi u kliničkoj praksi, dok stepen njenog slaganja sa intravaskularnim modalitetima visoke rezolucije, poput optičke koherentne tomografije (OCT), u LM segmentu nije u potpunosti razjašnjen. Metode: U studiju je uključeno 30 bolesnika kod kojih je tokom praćenja sprovedena angiografija i OCT nakon PCI na LM. Analizirano je osam odgovarajućih parametara lumena dobijenih pomoću 2D QCA, 3D QCA i OCT. Razlike između metoda procenjivane su Friedmanovim testom, linearna povezanost analizirana je Pearsonovom korelacijom, dok je slaganje metoda ispitivano Bland–Altman analizom. Rezultati: Uočene su značajne razlike između modaliteta za većinu analiziranih parametara lumena. QCA je pokazala snažnu linearnu povezanost sa OCT za referentne i srednje vrednosti lumena, dok je povezanost bila slabija za ekstremne (minimalne i maksimalne) dimenzije. Bland–Altman analiza je pokazala mala prosečna odstupanja između QCA i OCT, ali uz široke granice slaganja, što ukazuje na izraženu interindividualnu varijabilnost uprkos konzistentnosti na nivou grupe. Zaključak: QCA obezbeđuje relativno konzistentne procene referentnih i srednjih dimenzija lumena u LM segmentu, ali pokazuje ograničenu korelaciju sa OCT, naročito za ekstremne vrednosti. Uprkos snažnoj linearnoj povezanosti, individualna varijabilnost merenja ostaje značajna, što potvrđuje OCT kao preferentni modalitet za preciznu procenu lumena, izbor veličine stenta i optimizaciju PCI na LM.
UTICAJ NAJZASTUPLJENIJIH BIOAKTIVNIH JEDINJENJA MEDITERANSKE ISHRANE NA SIGNALNI PUT OSTEOBLASTIMA POSREDOVANE DIFERENCIJACIJE OSTEOKLASTA: IN SILICO ANALIZA
Uvod: Kosti su osnovni elementi skeletnog sistema koji se neprekidno remodeluju. Osteoklasti vrše resorpciju kosti, dok osteoblasti formiraju novi koštani matriks i posredno utiču na diferencijaciju osteoklasta putem signalnih puteva u kojima učestvuju signalni molekuli: M-CSF, c-Fms, GRB2, ERK, PI3K i Akt. U cilju očuvanja zdravlja kostiju danas se sve značajnija pažnja posvećuje nutritivnim intervencijama, poput mediteranske dijete koja je bogata bioaktivnim jedinjenjima. Cilj ovog rada je in silico ispitivanje potencijalnih interakcija najzastupljenijih bioaktivnih jedinjenja mediteranske dijete sa navedenim proteinima signalnog puta diferencijacije osteoklasta. Materijali i metode: Formirana je biblioteka od 115 najzastupljenijih bioaktivnih jedinjenja mediteranske dijete identifikovanih iz literaturnih podataka. Strukture proteina dobijene kristalografijom korišćene su kao targeti u simulacijama molekularnog dokinga radi ispitivanja predikcije interakcija između liganada i receptora. Rezultati: Većina liganada nije ostvarila značajne interakcije sa ispitivanim proteinima (ΔG > −7 kCal/mol), osim u slučaju Akt proteina. Za ovaj protein identifikovan je veći broj liganada sa ΔG < −7 kCal/mol. Najpotentnijih 5 liganada (salvianolna kiselina, apigenin, diosmin, mangiferin i silbin) vezivali su se za aminokiselinske sekvence koje čine aktivno mesto receptora, ukazujući na mogući inhibicioni efekat. Zaključak: In silico analiza ukazuje da bioaktivne komponente mediteranske dijete poseduju potencijal za inhibiciju Akt proteina (protein kinaze B), čime se otvara perspektiva za njihovu primenu u modulaciji osteoklastne aktivnosti i razvoju novih strategija za očuvanje zdravlja kostiju.
ULOGA I ZNAČAJ MAGNETNE REZONANCE SRCA KOD HIPERTROFIČNE KARDIOMIOPATIJE
Uvod: Hipertrofična kardiomiopatija (engl. hypertrophic cardiomyopathy – HCM) je autozomno dominantna bolest kardiomiocita koja dovodi do njihovog zadebljanja i hipertrofije. 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6"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Link"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]-->da se dijagnostikuje hipertrofična kardiomiopatija pomoću MR srca kod pacijenata sa hipertrofijom miokarda leve komore, okarakteriše tkivo miokarda i odredi stepen fibroze ovom dijagnostičkom metodom. Metode: Studija je obuhvatila 51 pacijenta sa HCM dijagnostikovanom na MR srca (muškarci 27; žene 24) i sprovedena je na Univerzitetskom kliničkom centru Srbije, Centru za radiologiju. Svi prikupljeni podaci o pacijentima su uzeti iz zvanične medicinske dokumentacije, a tip studije je retrospektivna opservaciona studija. MR srca je kod 51 pacijenta pokazao postojanje HCM na osnovu klasičnog protokola snimanja rađenog na 1.5T Siemens aparatu uz davanje kontrastnog sredstva Gadolinijuma. U odnosu na distribuciju kontrasta u vidu Late Gadolinium Enhancement (LGE) MR srca omogućava otkrivanje fokalne fibroze, a samim tim i razlikovanje etiologije hipertrofičnog miokarda. Rezultati: Opstrukcija izlaznog trakta leve komore viđena je kod 9 (17.6%) pacijenata. Asimetrična HCM je registrovana kod 41 (80.4%) bolesnika. Prisustvo LGE detektovano je kod 39 (76,5%) pacijenata, najviše u predelu septuma (62.7%). Stepen fibroze procenjen je na medianu od 6% mase leve komore i medianu od 11 g fibroze po gramu mase leve komore. Zaključak: MR srca kao neinvazivna metoda predstavlja zlatni standard u tkivnoj karakterizaciji srčanog mišića. Detekcija fibroze miokarda i njeno kvantifikovanje, kao glavnog okidača za razvoj malignih srčanih aritmija, svrstava MR srca, ne samo u dijagnostički, već i u metod stratifikacije rizika od naprasne srčane smrti kod pacijenata sa hipertrofičnom kardiomiopatijom.
ULOGA OPTIČKE KOHERENTNE TOMOGRAFIJE ANGIOGRAFIJE U BOLESTIMA ZADNJEG SEGMENTA OKA
Optička koherentna tomografska angiografija (OCTA) je neinvazivna, kvantitativna alatka za snimanje mrežnjače i horoideje, sposobna da vizualizuje mikrovaskulaturu u tri dimenzije. Široko se koristi za dijagnostikovanje i praćenje odgovora na lečenje različitih bolesti prednjeg i zadnjeg segmenta oka. Sprovedena je sistematska pretraga relevantne literature, sa akcentom na period najintenzivnijeg razvoja i kliničke primene OCT angiografije. Ovaj rad ima za cilj da sumira trenutna znanja o primeni OCTA u dijagnozi i praćenju patologija zadnjeg segmenta.
PREOPERATIVNI KVALITET ŽIVOTA KOD PACIJENATA KOJI SE PODVRGAVAJU ELEKTIVNOJ OPERACIJI ZBOG KOLOREKTALNOG KARCINOMA
Uvod/Cilj rada: Kvalitet života povezan sa zdravljem (health-related quality of life, HRQoL) predstavlja važan višedimenzionalni koncept usmeren ka pacijentu kod kolorektalnog karcinoma (KRK). Međutim, podaci o preoperativnom HRQoL u hirurškim kohortama iz jugoistočne Evrope su ograničeni. Cilj rada bio je da se opiše preoperativni HRQoL kod pacijenata sa KRK koji se podvrgavaju elektivnom hirurškom lečenju, uporedi HRQoL između karcinoma kolona i rektuma i ispitaju sociodemografski i klinički faktori povezani sa preoperativnim HRQoL. Metode: Preoperativni HRQoL procenjen je pomoću upitnika Functional Assessment of Cancer Therapy–Colorectal (FACT-C) i Cleveland Clinic Colorectal Cancer Quality of Life Questionnaire (CCF-CaQL). Sociodemografski i klinički podaci prikupljeni su strukturisanim upitnikom i uvidom u medicinsku dokumentaciju. Poređenja su vršena prema lokalizaciji tumora, a faktori povezani sa ukupnim FACT-C skorom analizirani su univarijantnom i multivarijantnom linearnom regresijom. Rezultati: Srednja vrednost ukupnog CCF-CaQL skora iznosila je 92,3±20,4, a ukupnog FACT-C skora 98,8±18,2. Nisu utvrđene statistički značajne razlike u HRQoL između pacijenata sa karcinomom kolona i rektuma ni u jednoj domeni oba upitnika (sve p>0,05). U multivarijantnoj analizi, viši ASA skor bio je nezavisno povezan sa nižim ukupnim FACT-C skorom (B=-5,05; 95% CI -9,70 do -0,40; p=0,033). Zaključak: Preoperativni HRQoL kod pacijenata koji se podvrgavaju elektivnoj operaciji zbog KRK bio je umeren i nije se značajno razlikovao prema lokalizaciji tumora. Viši ASA skor bio je nezavisno povezan sa lošijim preoperativnim HRQoL.
In silico ispitivanje efekata gentamicina na lizozomalnu razgradnju lipida i transportni sistem između lizozoma i glatkog endoplazmatskog retikuluma
Uvod: Gentamicin je aminoglikozidni antibiotik sa ograničenom kliničkom upotrebom zbog pratećih neželjenih efekata grupisanih u dve velike grupe: nefrotoksičnost i ototoksičnost. Oštećenja nastala gentamicinom se vremenom akumuliraju i finalno dovode do smrti ćelija. U bubregu najvise su zahvaćene ćelije proksimalnih tubula, a u unutrašnjem uhu senzorne ćelije. Jedan od pretpostavljenih mehanizama toksičnosti je fosfolipidoza, poremećaj u kome dolazi do povećane akumulacije fosfolipida u ćeliji. Cilj: Cilj našeg rada je in silico utvrđivanje mehanizma dejstva gentamicina u nastanku fosfolipidoze na osnovu interakcije sa ključnim proteinima odgovornim za transport lipida između glatkog endoplazmatskog retikuluma i kasnih endozoma kao i enzima koji učestvuju u razgradnji lipida. Materijal i metode: U KEGG bazi smo definisali target proteine, a u Human Atlas bazi pratili njihove profile ekspresije i tkivne specifičnosti. Finalne kriterijume ispunjavalo je 9 proteina koje smo dalje ispitivali u AutoDock Vina programu, molekularnim dokingom. Rezultati: Većina ispitanih proteina se eksprimira u visokoj stopi u bubregu i odgovarajućim strukturama centralnog nervnog sistema. Rezultati dokinga su pokazali da je interakcija ORP1L proteina i gentamicina imala najnižu vrednost Gibsove slobodne energije i iznosila je -8,1 kCal/mol, dok je za protein STARD3 vrednost Gibsove slobodne energije bila najviša iznosila je -5,2kCal/mol. Aminokiselinske sekvence za koje se gentamicin vezivao na ispitivanim proteinima su bile slične u okviru istih familija proteina. Zaključak: Gentamicin u in silico uslovima ostvaruje interakcije sa proteinima koji učestvuju u lizozomalnoj degradaciji lipida i transportu između lizozoma i glatkog endoplazmatskog retikuluma.
TELEZDRAVSTVO U MENTALNOM ZDRAVLJU ADOLESCENATA: NARATIVNI PREGLED EFIKASNOSTI, PRIHVATLJIVOSTI I ETIČKO‑PRAVNIH RAZMATRANJA
Adolescenti imaju visoku zastupljenost mentalnih tegoba, ali se suočavaju sa značajnim preprekama u pristupu nezi. Telezdravstvo — koje obuhvata sinhronu teleterapiju, telefonske kontakte i digitalne intervencije za mentalno zdravlje (aplikacije, internet‑CBT) — se brzo proširilo globalno kao značajna intervencija u ovoj populaciji, naročito od pojave pandemije COVID‑19. Primarna svrha ovog narativnog preglednog rada jeste da prikaže sintezu dokaza o upotrebi telezdravstva u oblasti mentalnog zdravlja adolescenata, sa naglaskom na efikasnost, prihvatljivost/angažovanost, kliničku bezbednost i etičko‑pravna pitanja, uz poseban osvrt na regionalne regulatorne praznine. Prikazani podaci ukazuju da modaliteti telezdravstva (video, telefon i digitalne intervencije) mogu doprineti klinički značajnom poboljšanju kod mentalnih problema adolescenata (depresija, anksioznost) i u mnogim uslovima postižu ishode uporedivе sa standardnim lečenjem. Prihvatljivost među adolescentima je generalno visoka, ali varira i zavisi od privatnosti, upotrebljivosti platforme i percipiranog terapeutskog odnosa. Udaljena nega otvara specifične bezbednosne izazove (upravljanje suicidnošću i reagovanje u kriznim situacijama), a etičko‑pravni okvir je u mnogim regionima nedovoljno razvijen: zaštita podataka, pravila o pristanaku/saglasnosti maloletnika, licenciranje stručnjaka preko jurisdikcija i politike refundacije predstavljaju česte probleme. Dostavljeni izveštaji naglašavaju važne lokalne/regionalne nedostatke — ograničenu regulativu, infrastrukturne barijere i potrebu za formalnim protokolima i obukom kliničara. U zaključku, telezdravstvo predstavlja održivu modalitetnu opciju za negu mentalnog zdravlja adolescenata kada je implementirano uz jasne kliničke protokole, robusne mere zaštite podataka i pažnju posvećenu procedurama za pristanak i krizno postupanje. Potrebne su mere javne politike radi standardizacije pravno‑etičkih okvira, obezbeđivanja pravičnog pristupa i integracije telezdravstva u redovne usluge mentalnog zdravlja za adolescente. Ključne reči: telezdravstvo, adolescenti, mentalno zdravlje
Promene u hemostatskom sistemu kod kritično obolellih COVID-19 pacijenata
Uvod/cilj istraživanja: COVID-19 koagulopatija predstavlja poremećaj sistema hemostaze koji se javlja kod kritično obolelih bolesnika zaraženih SARS-CoV2 virusom i koja povećeva rizik od mortaliteta. Cilj istraživanja je procena promena hemostaznih parametara i određivanje njihovog prognostičkog značaja kod bolesnika sa teškom formom COVID-19 bolesti. Metode: Studija je dizajnirana kao retrospektivna kohortna studija, koja je obuhvatila 146 pacijenta lečenih od juna do septembra 2020. godine u Jedinici intenzivnog lečenja (JIL) Kliničko bolničkog centra ”Bežanijska Kosa” u Beogradu pod dijagnozom COVID-19 pneumonije. Uključujući kritetijumi su bili starost iznad 18 godina, dokazana aktuelna SARS-CoV2 infekcija i prijem u JIL. Rezultati: Tokom lečenja su preminulo je 82 bolesnika (56.2%), dok je 64 (43.8%) otpušteno nakon sprovedenog lečenja. Značajno više vrednosti D-dimera na prijemu u JIL, zabeležene su kod ispitanika koji su preminuli u toku lečenja 888 (1226,5) ng/ml u odnosu na osobe koje su otpuštene sa lečenja 666 (1207,3) ng/ml (p = 0,03). Razlike nisu dokazane za INR, aPTT i fibrinogen. Vrednosti D-dimera na prijemu u JIL više ili jednake 760ng/ml statistički su značajan prediktor smrtnog ishoda u toku hospitalizacije (p = 0,04). Zaključak: COVID koagulopatija predstavlja komplikaciju koja poveća mortalitet osoba zaraženih SARS-CoV2 virusom. Osnovno obeležje jeste stanje hiperkoagulabilnosti, koje se detektuje povišenim vrednostima D-dimera. Vrednosti D-dimera više ili jednake 760 ng/ml na prijemu u JIL mogu imati prognostički značaj za preživljavanje u toku hospitalizacije.
Sva prava zadržana (c) 2024 Medicinska istraživanja
UTICAJ FIZIČKE AKTIVNOSTI NA VREDNOST INTRAOKULARNOG PRITISKA: PREGLED LITERATURE
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<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 5"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 5"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 6"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 6"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 6"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 6"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 6"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 6"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 6"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Glaukom predstavlja hroničnu, progresivnu optičku neuropatiju i jedan je od vodećih uzroka ireverzibilnog slepila u svetu. Intraokularni pritisak (IOP) ostaje najvažniji i jedini dokazano promenljiv faktor rizika u nastanku i progresiji glaukoma. Fizička aktivnost ispoljava brojne sistemske efekte koji mogu direktno ili indirektno uticati na intraokularni pritisak i očnu perfuziju. Uticaj fizičke aktivnosti na IOP zavisi od tipa, intenziteta i trajanja vežbanja, kao i od individualnih karakteristika pacijenta. Aerobne vežbe povezane su sa akutnim smanjenjem intraokularnog pritiska u rasponu od 1 do 5 mmHg, što se objašnjava pojačanim oticanjem očne vodice, osmotskim promenama i uticajem simpatičkog nervnog sistema na njeno stvaranje. Dugotrajna i redovna aerobna aktivnost može dovesti i do trajnog smanjenja bazalnog intraokularnog pritiska za približno 2 do 4 mmHg, uz istovremeno poboljšanje očnog perfuzionog pritiska. Nasuprot tome, anaerobne i izometrijske vežbe visokog intenziteta, kao i položaji tela sa spuštenom glavom, uključujući pojedine položaje u jogi, mogu dovesti do prolaznog porasta intraokularnog pritiska, ponekad i do klinički značajnih vrednosti. Ovaj efekat se prvenstveno objašnjava porastom episkleralnog venskog pritiska, najčešće usled izvođenja Valsalvinog manevra. Klinički značaj ovih nalaza ogleda se u mogućnosti primene fizičke aktivnosti kao dopunske strategije u lečenju glaukoma. Umerena aerobna aktivnost može se preporučiti većini pacijenata, dok aktivnosti visokog intenziteta, naročito one koje uključuju izometrijski napor ili položaje sa spuštenom glavom, zahtevaju poseban oprez i individualizovan pristup. Dalja istraživanja su neophodna radi definisanja standardizovanih smernica i boljeg razumevanja dugoročnog uticaja fizičke aktivnosti na tok i progresiju glaukoma.
EVOLUCIJA SYNTAX SKORA (I, II AND II 2020): RAZVOJ, PRIMENA I OGRANIČENJA U SVAKODNEVNOJ KLINIČKOJ PRAKSI
Hirurška revaskularizacija miokarda je zlatni standard za revaskularizaciju miokarda u hroničnom koronarnom sindromu (HKS). Prve randomizovane studije koje su poredile implantaciju običnog metalnog stenta (BMS) sa aorto-koronarnom by-pass hirurgijom (CABG), pokazale su sličnu učestalost smrti i infarkta miokarda, a ređu pojavu ponovne revaskularizacije miokarda nakon CABG u odnosu na implantaciju BMS, dovele su do razvoja stentova sa oslobađanjem leka (DES) sa manjom učestalošću kliničke restenoze. Tokom godina, pojavila se potreba za objektivnom procenom i izračunavanjem rizika i koristi od hirurške ili perkutane revaskularizacije miokarda, davanje prednosti jednoj od ove dve metode, ili njihovom sličnom ishodu kod pojedinog bolesnika. SYNTAX skor I je korišćen za kvantitativnu procenu kompleksnosti koronarne stenoze kod bolesnika sa HKS. Ipak, dva glavna nedostatka SYNTAX skora I, 1) odsustvo procene funkcionalne značajnosti koronarne stenoze i 2) odsustvo kliničkih varijabli koje mogu da utiču na perioperativnu smrtnost, su delimično prevaziđene razvojem SYNTAX skora II koji je uzeo u obzir kliničke varijable koje su pokazale najveću udruženost sa smrtnošću (uzrast, klirens kreatinina, ejekciona frakcija leve komore, aterosklerotska bolest nezaštićenog glavnog stabla leve koronarne arterije, ženski pol, periferna vaskularna bolest i hronična opstruktivna bolest pluća) i SYNTAX skora II 2020 sa ekstenzijom kliničkog praćenja za desetogodišnju smrtnost. SYNTAX skor II i II 2020 potencijalno mogu da promene preporuku za revaskularizaciju miokarda koja je zasnovana samo na osnovu vrednosti SYNTAX I skora. Ovaj revijalni pregled ima za cilj da prikaže razvoj ova tri skora, njihovu pouydanost, prediktivni značaj i ograničenja u praktičnoj primeni kod pojedinih bolesnika sa HKS.
UNILATERALNI REKURVATUM KOLENA: PRIKAZ SLUČAJA
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Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Continue"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Continue 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Continue 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Continue 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Continue 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Message Header"/> <w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Salutation"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Date"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Body Text First Indent"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Body Text 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Name="Document Map"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Plain Text"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="E-mail Signature"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Top of Form"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Bottom of Form"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Normal (Web)"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Acronym"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Address"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Cite"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Code"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Definition"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Keyboard"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Preformatted"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Sample"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Typewriter"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Variable"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Normal Table"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="annotation subject"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="No List"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline List 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline List 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline 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SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 7"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 8"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 7"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 8"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table 3D effects 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table 3D effects 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table 3D effects 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Contemporary"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Elegant"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Professional"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Subtle 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Subtle 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Web 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Web 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Web 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Balloon Text"/> <w:LsdException Locked="false" Priority="39" Name="Table Grid"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Theme"/> <w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/> <w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading"/> <w:LsdException Locked="false" Priority="61" Name="Light List"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/> <w:LsdException Locked="false" Priority="70" Name="Dark List"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/> <w:LsdException Locked="false" SemiHidden="true" Name="Revision"/> <w:LsdException Locked="false" Priority="34" QFormat="true" Name="List Paragraph"/> <w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/> <w:LsdException Locked="false" Priority="30" QFormat="true" Name="Intense Quote"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 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Name="Plain Table 3"/> <w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/> <w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/> <w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 1"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 1"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 1"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 2"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 2"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 2"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 3"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 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Locked="false" Priority="46" Name="Grid Table 1 Light Accent 5"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 5"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 5"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 5"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 5"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 6"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 6"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 6"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 6"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 6"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 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Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Link"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Uvod: Genu recurvatum predstavlja deformitet kolena karakterisan hiperekstenzijom, nestabilnošću pri hodu i bolom. U rutinskoj ortopedskoj praksi se retko sreće, a podaci o optimalnim terapijskim strategijama su ograničeni. U prikazanom slučaju odsustvo traumatskog uzroka, pridružena varus malalignacija i jednostrana prezentacija dodatno su povećali kompleksnost deformiteta, uz progresivno pogoršanje tokom trogodišnjeg perioda praćenja. Cilj ovog rada je prikaz retkog slučaja jednostranog genu recurvatuma nepoznate etiologije lečenog korektivnom osteotomijom proksimalne tibije uz korekciju posteriornog tibijalnog nagiba, kao i prikaz postoperativnih rezultata uz kratak pregled literature. Prikaz slučaja: Prikazan je slučaj 32-godišnjeg pacijenta sa jednostranim genu recurvatum deformitetom i očuvanim zadnjim ukrštenim ligamentom (PCL), što je potvrđeno magnetnom rezonancom i artroskopijom. Preoperativno planiranje zasnovano je na MSCT analizi. Izvedena je otvorena klinasta korektivna osteotomija proksimalne tibije uz fiksaciju pločom. Pod kontrolom C-arm fluoroskopije postignuta je planirana korekcija i željeni posteriorni tibijalni nagib. Posteriorni tibijalni nagib povećan je sa 94° na 101°, čime je postignuta stabilizacija kolena i korekcija deformiteta. Zaključak: Korektivna osteotomija proksimalne tibije uz korekciju posteriornog nagiba predstavlja efikasnu terapijsku opciju u lečenju jednostranog genu recurvatuma nepoznate etiologije. Ova tehnika omogućava pouzdanu korekciju mehaničke osovine, stabilizaciju zgloba i povoljne kliničke rezultate uz relativno brz postoperativni oporavak.
SINDROM OVARIJALNE HIPERSTIMULACIJE: SAVREMENI PRISTUP PATOFIZIOLOGIJI, STRATIFIKACIJI RIZIKA, PREVENCIJI I LEČENJU
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Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Link"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Sindrom ovarijalne hiperstimulacije (OHSS) predstavlja potencijalno ozbiljnu jatrogenu komplikaciju kontrolisane ovarijalne stimulacije u postupcima asistirane reprodukcije. Uprkos značajnom napretku u savremenim stimulacionim protokolima i strategijama prevencije, OHSS i dalje ostaje važan klinički i bezbednosni izazov u savremenoj IVF praksi. Cilj ovog narativnog pregleda je da prikaže i kritički analizira savremena saznanja o patofiziologiji, faktorima rizika, kliničkoj prezentaciji, prevenciji i terapijskim pristupima ovom sindromu. Pregled literature obuhvatio je relevantne publikacije identifikovane u bazama PubMed/MEDLINE, Scopus i Web of Science, uključujući kliničke studije, kohortne analize, sistematske preglede i preporuke stručnih društava objavljene u periodu 2019–2026, uz selektivno uključivanje ranijih radova od značaja za razumevanje osnovnih mehanizama bolesti. Savremena saznanja ukazuju da je ključni patofiziološki mehanizam OHSS-a povećana vaskularna permeabilnost posredovana vaskularnim endotelijalnim faktorom rasta (VEGF), najčešće indukovana stimulacijom humanim horionskim gonadotropinom. Identifikacija pacijentkinja sa povećanim rizikom primenom biomarkera ovarijalne rezerve, individualizacija doze gonadotropina, primena GnRH antagonističkih protokola i GnRH agonist triggera, kao i strategija zamrzavanja svih embriona, značajno su doprineli smanjenju incidencije umerenih i teških oblika sindroma. Savremeni pristup OHSS-u zasniva se pre svega na prevenciji i personalizaciji stimulacionih protokola sa ciljem optimizacije reproduktivnih ishoda uz maksimalnu bezbednost pacijentkinja.
IMIDŽING VASKULARNIH ANOMALIJA AORTE I KRVNIH SUDOVA VRATA I GLAVE
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Vaskularne malformacije nastaju kao rezultat greške u razvoju krvnih i limfatičnih sudova formirajući abnormalne vaskularne strukture prisutne na rođenju. Obično rastu proporcionalno sa rastom deteta, mada postoje periodi ubrzanog rasta i širenja. Bez lečenja, vaskularne malformacije ne regrediraju. Mogu se klasifikovati prema hemodinamskim karakteristikama u dve grupe: na sporoprotočne anomalije (u koje spadaju kapilarne malformacije, limfatične malformacije i venske malformacije) i na brzoprotočne anomalije (u koje spadaju arteriovenske malformacije i arterijske malformacije). Incidenca AVM je u porastu; većina je klinički asimptomatska, dok je 12% pacijenata sa simptomima bolesti. U slučaju krvarenja, stopa mortaliteta je 10-15% sa mobiditetom u rasponu od 30 do 50%. Ne postoji polna predilekcija. Kompjuterizovana tomografska angiografija (CTA) i magnetno rezonantni imidžing (MRI) omogućavaju adekvatan izbor najboljeg terapijskog pristupa (operativnog ili interventnog) i rešavanje mogućih uzroka morbiditeta i mortaliteta uz procenu rizika od primene hirurškog, endovaskularnog ili radiološkog pristupa. Primenom savremenih imidžing tehnika moguće je vizuelizovati komplikacije kao na primer hemoragiju, moždani edem i atrofiju mozga. Glavni vid terapije je i dalje hirurški, ali embolizacija zauzima značajno mesto poslednjih godina. Savremene tehnike snimanja i razvoj novih stentova i embolizacionih materijala pruža mogućnost poboljašanja kvaliteta života pacijenata sa vaskularnim malformacijama.
PERIOPERATIVNO AKUTNO OŠTEĆENJE BUBREGA NAKON VELIKIH NEKARDIOHIRURŠKIH OPERACIJA: FAKTORI RIZIKA, KLINIČKI ISHOD I PREDIKTIVNA VREDNOST PERIOPERATIVNIH NUMERIČKO BODOVNIH SISTEMA
Uvod: Perioperativno akutno bubrežno oštećenje (AKI) predstavlja ozbiljnu komplikaciju nakon velikih nekardiohirurških operacija, povezanu sa povećanim mortalitetom, produženim boravkom u jedinici intenzivne nege i potrebom za renalnom supstitucionom terapijom (RRT). Cilj: Procena uticaja težine AKI i pridruženih faktora rizika na kliničke ishode nakon velikih abdominalnih hirurških intervencija, kao i evaluacija prognostičke vrednosti SPARK, APACHE II i SOFA skorova. Materijal i metode: Prospektivna kohortna studija sprovedena je u Hirurškoj jedinici intenzivne nege Kliničko-bolničkog centra „Bežanijska Kosa“ (Beograd) od januara do juna 2024. godine. Analizirano je 30 odraslih bolesnika sa perioperativnim AKI nakon velikih abdominalnih operacija. AKI je definisan prema KDIGO kriterijumima, a sepsa prema Sepsis-3 definiciji. Težina bolesti procenjivana je APACHE II i SOFA skorovima, dok je preoperativni rizik za AKI procenjivan SPARK indeksom. Rezultati: Prema KDIGO klasifikaciji, 26,7% bolesnika bilo je u stadijumu 1, 30,0% u stadijumu 2, a 43,3% u stadijumu 3. Intrahospitalni mortalitet iznosio je 30,0% i registrovan je isključivo kod bolesnika starijih od 60 godina. Mortalitet je bio značajno viši u KDIGO stadijumu 3 u odnosu na stadijume 1–2 (61,5% prema 5,9%; p=0,0016). SPARK je pokazao dobru diskriminativnu sposobnost za teški AKI, dok je APACHE II imao odličnu prognostičku vrednost za teški AKI i mortalitet. RRT je češće primenjivana u uznapredovalim stadijumima AKI. Zaključak: Perioperativni AKI bio je redak, ali klinički težak, sa nepovoljnim ishodima prvenstveno povezanim sa KDIGO stadijumom 3 i starijom životnom dobi. SPARK i naročito APACHE II korisni su za stratifikaciju rizika.
ANATOMSKA VARIJABILNOST I OBRASCI PNEUMATIZACIJE SFENOIDALNOG SINUSA : RADIOLOŠKA ANALIZA
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Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Link"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Uvod: Multidetektorska kompjuterizovana tomografija sfenoidalnog sinusa je najprecizniji metod za vizuelizaciju pneumatizacije sinusa i svih anatomskih varijacija. Cilj: Karakterizirati obrasce pneumatizacije sfenoidalnog sinusa i proceniti povezanost sa varijacijama u koštanim strukturama sinusa u odnosu na pol i starosne grupe. Metode: Retrospektivna CT analiza 127 pacijenata (43 muškarca i 84 žene). Obrasci pneumatizacije, proširenja baze lobanje i tipovi Vidian kanala su klasifikovani. Rezultati: Bilateralna povećana pneumatizacija sfenoidalnog sinusa pokazuje veoma jaku starosnu asocijaciju (p = 0,001), sa grupiranjem u sredovečnim (40–52) i starijim (≥ 66) grupama. Očuvana pneumatizacija sfenoidalnog sinusa desno pokazuje statistički značajnu povezanost sa polom (χ² = 3,90, p = 0,048), sa većim udelom muškaraca nego žena. Bilateralna pneumatizacija (BPP) : otkrivena je statistički značajna povezanost sa godinama (p = 0,019); pojedinci sa BPP su bili znatno mlađi. Preovlađuje sellarni tip (67,7%), sa čestim zadnjim i bočnim ekstenzijama. Konfiguracija dorzalnog sfenoidalnog sinusa je jedina varijanta koja pokazuje statistički značajnu povezanost sa godinama (χ² = 8.17, p = 0.043). Kompletan sellarni tip pokazuje jaku, konzistentnu pozitivnu povezanost sa pneumatizacijom prednjeg klinoidnog i pterygoidnog processusa na svim stranama (p ≤ 0.015, često < 0.001). Tip III Vidian kanala je zastupljen u ~ 40%. Vidian kanal Tip I je snažno povezan sa pneumatizacijom pterygoidnih processusa posebno bilateralno (p < 0,001 u svim slučajevima). Zaključci: Kohorta pokazuje visoko pneumatizovan, hirurški relevantan fenotip sfenoidalnog sinusa, prvenstveno razvojni, a ne simptomatski.
Incidenca srčanih zastoja (SZ) u pedijatrijskih bolesnika je manja odnosu na adultnu populaciju. Anatomske i fiziološke specifičnosti dečijeg doba doprinose da su uzroci SZ i ishodi reanimacije takođe drugačiji. Ključni faktori koji doprinose preživljavanju životno ugrožavajućeg događaja su brzo prepoznavanje i promptno preduzimanje kvalitetne reanimacije. Zato je prepoznavanje prediktora SZ veoma važno, jer oni nagoveštavaju razvoj nemilog događaja i izdvajaju bolesnika od ostalih. Pružanjem adekvantih mera lečenja u ovakvim situacijama moguće je prevenirati nastanak SZ. U odnosu na mesto dešavanja krucijalne razlike su u pristupu, sprovođenju reanimacionih postupaka, ishodu lečenja i edukaciji između vanbolničih i bolničkih dešavanja SZ koji se dešavaju u dečijem uzrastu.
RETINALNE VASKULARNE PROMENE KOD PACIJENATA SA HRONIČNOM OBSTRUKTIVNOM BOLEŠĆU PLUĆA
UVOD/CILJ Hronična opstruktivna bolest pluća (HOBP) je progresivna i inflamatorna bolest disajnih puteva koja često dovodi do kardiovaskularnih i mikrovaskularnih promena. Cilj ove studije bio je da se analizira mikrocirkulacija mrežnjače kod pacijenata sa HOBP korišćenjem optičke koherentne tomografske angiografije (OCTA). MATERIJALI I METODE Studija preseka. Analizirano je ukupno 44 ispitanika, uključujući 28 sa HOBP i 16 zdravih kontrola. Kriterijumi za uključivanje bili su ispitanici stariji od 18 godina sa potvrđenom dijagnozom HOBP na osnovu spirometrijskih parametara. REZULTATI Statistički značajne razlike su primećene između grupa za sledeće parametre: duboki kapilarni pleksus makule (p = 0,009), parafovealni (p = 0,026) i perifovealni region (p = 0,034). Značajna negativna korelacija je primećena između odnosa rezidualne zapremine i ukupnog kapaciteta pluća (RV/TLC) i gustine krvnih sudova u makularnom i perifovealnom površinskom kapilarnom pleksusu (p<0,05). Protok horiokapilarisa takođe je pokazao značajnu inverznu vezu sa odnosom RV/TLC. Što se tiče dubljih slojeva mrežnjače, naša analiza je otkrila značajnu negativnu korelaciju između protoka spoljašnje mrežnjače i forsiranog vitalnog kapaciteta (FVC). ZAKLJUČAK Praćenje promena OCTA parametara, posebno u vezi sa parametrima plućnog volumena, kao što su RV/TLC i FVC, zaključujemo da OCTA može pružiti vredne uvide u sistemsku vaskularnu progresiju i ukupnu težinu bolesti kod pacijenata sa HOBP.
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Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Link"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Ishemijska ili koronarna bolest srca (IBS) je vodeći uzrok smrti i nesposobnosti na globalnom nivou. Cilj ovog preglednog rada je da pruži uvid u epidemiologiju IBS sa fokusom na distribuciju, faktore rizika i prevenciju. Pretraga literature je sprovedena korišćenjem PubMed, Scopus i Google Scholar baza podataka kako bi se identifikovale relevantne studije objavljene u poslednjih deset godina. U 2019. godini od IBS bolovalo je 197.2 miliona ljudi, uzrokovale su 9,1 miliona smrtnih ishoda i 182,0 miliona DALY-ja (engl. disability-adjusted life years). Iako su standardizovane stope mortaliteta, DALY-ja i prevalencije od IBS u svetu opale, broj registrovanih slučajeva i dalje raste. Najviša prevalencija IBS se beleži u Srednjoj i Istočnoj Evropi i Centralnoj Aziji, a najniža u Južnoj Aziji. Faktori rizika za IBS se mogu podeliti na promenljive i nepromenljive. Glavni nezavisni faktori rizika kao što su pušenje, hipertenzija, dislipidemija, dijabetes, starost uzročno su nezavisno povezani sa nastankom oboljenja. Sredinski faktori (aerozagađenje, buka, klimatske promene) dodatno povećavaju rizik od IBS-a. Novonastali koncept eksposoma ukazuje da je za nastanak IBS važna kumulativna izloženost i zajednički uticaj svih faktora rizika u životnoj sredini. Nastanak IBS se može sprečiti primordijalnim (mere usmerane prema socijalnim determinantama zdravlja kao što su: urbanizacija, siromaštvo, pismenost, uslovi života i rada) i primarnim merama prevencije (modifikacija faktora rizika promenom načina života, medikamentozna terapija). IBS predstavljaju sve veći globalni zdravstveni problem, pogotovo u nerazvijenim zemljama, što je posledica starenja populacije, ograničenog pristupa zdravstvenoj zaštiti i prisustva brojnih faktora rizika što zahteva adekvatnu prevenciju i lečenje.
DEJSTVA ANTAGONISTA NMDA RECEPTORA NA AKUTNI POSTOPERATIVNI BOL
Uvod/Cilj istraživanja: Bol predstavlja multifaktorijalni proces sa štetnim efektima na ceo organizam. Randomizovana, otvorena pilot studija istražuje efekat preventivne kombinovane primene ketamina i magnezijum-sulfata na intenzitet postoperativnog bola nakon laparoskopske resekcije tumora debelog creva. Metod rada: Šezdeset pacijenata je randomizirano u ketamin-magnezijumsku (KM) i kontrolnu (C) grupu. Nakon uvoda u anesteziju, pacijentima KM grupe primenjena je i.v. bolus doza od 0,5 mg/kg ketamina, nakon čega sledi kontinuirana infuzija od 0,6 mg/kg/h koja traje do kraja operacije. Nakon bolus doze ketamina, takođe su dobijali magnezijum-sulfat 20 mg/kg u intravenskoj infuziji (5-10 minuta). Grupa C primila je samo infuziju 0,9% NaCl. Nakon buđenja (0h), intenzitet bola je poređen (0- 46h) između dve grupe. Rezultati: Mann-Whitney test je pokazao značajno (p<0,05) niže rezultate vizuelno analogne skale (VAS) u KM grupi 0, 1, 2, 10, 22 i 30 sati nakon operacije, i bez statističke značajnosti (p>0,05) za VAS rezultate nakon 6, 14, 18, 38 i 46 sati, u odnosu na C grupu. Ketamin i magnezijum-sulfat su značajno (p<0,05) smanjili postoperativnu potrošnju analgetika, povećali nivo sedacije u 0h postoperativno i povećali ukupno zadovoljstvo pacijenata tretmanom. Zaključak: Preventivna primena kombinacije ketamina i magnezijum-sulfata ima povoljno dejstvo na postoperativni bol posle laparoskopske resekcije tumora debelog creva.