The purpose of this study was to determine and compare the outcomes of tuberculosis (TB) treatment among Human Immunodeficiency Virus (HIV) co-infected TB patients, and identify factors associated with these outcomes. A quantitative cross-sectional analytic design was used. Patient level secondary data was collected and analysed for the study. A total of 575 TB patients, including 360 non-HIV infected, 169 HIV co-infected and 46 without a documented HIV status, were enrolled. The overall treatment success rate was 91.5%, and HIV co-infected TB patients had a high rate (11.8%) of unfavourable outcomes. The cure rate was significantly lower (10.1% versus 24.2%) and the death rate higher in HIV co-infected patients (8.3% versus 2.5%). Age and TB classification were significantly associated with treatment outcome. No association was found with starting ART, Cotrimoxazole prophylactic treatment or enrolment in HIV care, but 22% of HIV co-infected TB patients were taking ART when they developed TB disease / Health Studies / M.A. (Public Health)

<p>Ova studija je bila prospektivnog karaktera. Uz dopu&scaron;tenje etičkog komiteta Kliničkog centra Vojvodine istraživanje je sprovedeno na Klinici za ortopedsku hirurgiju i traumatologiju i obuhvatilo je 60 pacijenata mu&scaron;kog pola, koji su metodom slučajnog izbora na randomizirani način uključeni u ispitivanje, a koji se aktivno i profesionalno bave fudbalom, ko&scaron;arkom ili odbojkom,&nbsp; primljenih na Kliniku za ortopedsku hirurgiju radi artroskopske rekonstrukcije pokidanog prednjeg ukr&scaron;tenog ligamenta. U ispitivanje su uključeni samo oni pacijenti koji su dali potpisani informisani pristanak da učestvuju u ispitivanju, koji su zadovoljii sve kriterijume za uključivanje i koji nisu imali niti jedan kriterijum za isključivanje iz studije. Kriterijumi za uključivanje u studiju&nbsp; podrazumevali su sledeće: da je pacijent&nbsp; primljen na Kliniku za ortopedsku hirurgiju i traumatologiju Kliničkog centra Vojvodine u Novom Sadu radi operativnog lečenja prekida prednjeg ukr&scaron;tenog ligamenta kolena, da je potpisao informisani pristanak za uključivanje, da je starosne dobi od 18 do 45 godina, da se aktivno i profesionalno bave fizičkom aktivno&scaron;ću regulisanom pravilima (fudbal, odbojka, ko&scaron;arka). Kriterijumi za isključivanje pacijenata iz istraživanja bili su sledeći: prisustvo udružene povrede i spolja&scaron;njeg pobočnog ligamenta koja zahteva operativno lečenje, pojava težih op&scaron;te &ndash; hirur&scaron;kih komplikacija, želja pacijenta da bude isključen iz daljeg ispitivanja, bez obaveze da tu svoju odluku obrazloži. U prvoj fazi konstruisan je aparat, digitalni goniometar, uz pomoć kojeg je urađen eksperimentalni deo ovog ispitivanja i napravljena je baza podataka sa poljima za upis deskriptivnih i antropometrijskih parametara. Potom je uz pomoć aparata svim ispitanicima testirana sposobnost propriocepcije (JPS). Testiranje&nbsp; je obavljeno preoperativno na povređenom i nepovređenom ekstremitetu, u dva maha: odmah po zadavanju ciljnog ugla od 35&deg; i nakon 5 minuta. Druga faza je obavljena minimum 6 meseci nakon operativnog lečenja, hirur&scaron;kom, artroskopskom rekonstrukcijom pokidanog prednjeg ukr&scaron;tenog ligamenta kost-tetiva-kost tehnikom (bone-tendo-bone, BTB). Klinički pregled&nbsp; svakog pacijenta je podrazumevao proveru rezultata Lachman testa (pozitivan/negativan), Lysholm i IKDC bodovne skale za koleno i to preoperativno a potom i tokom postoperativnog kontrolnog pregleda. Po uzoru na mnoge sajtove renomiranih ortopedskih organizacija (http://www.orthopaedicscore.com/), naparavljen je on-line upitnik na Google drive-u gde su u elektronskom obliku prikupljani podaci za skale koje smo koristili. Dobijeni rezultati su za svaku skalu ponaosob potom prebacivani u Excel i dalje&nbsp; obrađivani adekvatnim statističkim alatkama u adekvatnom programu. U rezultatima je uočeno da dobijena razlika u preciznosti pozicioniranja potkolenice sa o&scaron;tećenim ligamentarnim aparatom kolena u odnosu na nepovređenu nogu pre hirur&scaron;ke rekonstrukcije prednjeg ukr&scaron;tenog ligamenta ne pokazuje statistički značajnu razliku. Međutim, postojala je statistički značajna razlika u brzini kojom se postiže zadati ugao, tj. povređena noga imala je veći intenzitet ugaonog uspona &scaron;to ukazuje na kvalitativne razlike u samom obrascu pokreta. Takođe, na ovom uzorku dobijeno je da postoji statistički značajna razlika u preciznosti pozicioniranja potkolenice sa o&scaron;tećenim ligamentarnim aparatom kolena u odnosu na nepovređenu nogu nakon hirur&scaron;ke rekonstrukcije prednjeg ukr&scaron;tenog ligamenta tj. pacijenti su nakon rekonstrukcije statistički značajno &raquo;prebacivali&laquo; zadatu vrednost od 35&deg;. Test pozicioniranja ekstremiteta za ovo ispitivanje konstruisanim aparatom se pokazao kao senzitivna i specifična dijagnostička procedura gubitka sposobnosti propriocepcije usled kidanja prednjeg ukr&scaron;tenog ligamenta.</p> / <p>In this prospective study examined group consisted&nbsp; of&nbsp; 60&nbsp; male&nbsp; patients&nbsp; with&nbsp; an anterior&nbsp; cruciate&nbsp; ligament&nbsp; tear&nbsp; and&nbsp; all participants&nbsp;&nbsp; were&nbsp;&nbsp; at&nbsp;&nbsp; the&nbsp;&nbsp; time&nbsp;&nbsp; before injury&nbsp;&nbsp; actively&nbsp;&nbsp; playing&nbsp;&nbsp; afootball, basketball&nbsp; or&nbsp; volleyball.&nbsp; The&nbsp; study&nbsp; was conducted&nbsp; at&nbsp; the&nbsp; Clinic&nbsp; for&nbsp; Orthopaedic Surgery&nbsp;&nbsp;&nbsp; and&nbsp;&nbsp;&nbsp; Traumatology&nbsp;&nbsp;&nbsp; Clinical Center&nbsp; of&nbsp; Vojvodina&nbsp; in&nbsp; Novi&nbsp; Sad&nbsp; where participants&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; were&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; admitted&nbsp;&nbsp; for arthroscopic ligament reconstruction. All participants&nbsp; were&nbsp; informed&nbsp; of&nbsp; the&nbsp; study by&nbsp;&nbsp; their&nbsp;&nbsp; clinicians&nbsp;&nbsp; and&nbsp;&nbsp; gave&nbsp;&nbsp; written consent. Thee exclusion criteria were the following:&nbsp;&nbsp;&nbsp; occurrence&nbsp;&nbsp;&nbsp; of&nbsp;&nbsp;&nbsp; combined cruciate&nbsp; ligament&nbsp; with&nbsp; lateral&nbsp; collateral ligament&nbsp;&nbsp; injury&nbsp;&nbsp; that&nbsp;&nbsp; required&nbsp;&nbsp; surgical treatment;&nbsp; occurrence&nbsp; of&nbsp; more&nbsp; serious general&nbsp;&nbsp;&nbsp; surgical complications; the patient&rsquo;s&nbsp; wish&nbsp; to&nbsp; be&nbsp; excluded&nbsp; from further&nbsp; research&nbsp; without&nbsp; an&nbsp; obligation&nbsp; to give&nbsp;&nbsp; any&nbsp;&nbsp; further&nbsp;&nbsp; explanation&nbsp;&nbsp; to&nbsp;&nbsp; his decision.&nbsp; In&nbsp; the&nbsp; first&nbsp; stage&nbsp; of&nbsp; the&nbsp; study, an&nbsp; apparatus&nbsp; called&nbsp; digital&nbsp; goniometer was&nbsp;&nbsp; constructed,&nbsp;&nbsp; which&nbsp;&nbsp; was&nbsp;&nbsp; used&nbsp;&nbsp; to conduct&nbsp;&nbsp; the&nbsp;&nbsp; experimental&nbsp;&nbsp; part&nbsp;&nbsp; of&nbsp;&nbsp; the study,&nbsp; and&nbsp; a&nbsp; database&nbsp; with&nbsp; fields&nbsp; for inserting&nbsp; descriptive&nbsp; and&nbsp; anthropometric parameters was made. Next, by using the apparatus,&nbsp; all&nbsp; subjects&nbsp; were&nbsp; tested&nbsp; for proprioception&nbsp; ability&nbsp; (JPS).&nbsp; The&nbsp; tests were&nbsp; performed&nbsp; preoperatively&nbsp; on&nbsp; the injured&nbsp; and&nbsp; the&nbsp; uninjured&nbsp; limb&nbsp; in&nbsp; two instances:&nbsp; straight&nbsp; after&nbsp; determining&nbsp; the target&nbsp;&nbsp; angle&nbsp; of&nbsp;&nbsp; 35&deg;&nbsp; and&nbsp;&nbsp; 5&nbsp;&nbsp; minutes afterwards.&nbsp;&nbsp;&nbsp; The&nbsp;&nbsp;&nbsp; second&nbsp;&nbsp;&nbsp; stage&nbsp;&nbsp;&nbsp; was performed&nbsp; postoperatively&nbsp; in&nbsp; the&nbsp; same maner,&nbsp;&nbsp; following&nbsp;&nbsp; a&nbsp;&nbsp; minimal&nbsp;&nbsp; 6-month period&nbsp;&nbsp;&nbsp; after&nbsp;&nbsp;&nbsp; a&nbsp;&nbsp;&nbsp; surgical&nbsp;&nbsp;&nbsp; arthroscopic reconstruction&nbsp;&nbsp;&nbsp; of&nbsp;&nbsp;&nbsp; the&nbsp;&nbsp;&nbsp; torn&nbsp;&nbsp;&nbsp; anterior cruciate&nbsp; ligament&nbsp; by&nbsp; bone-tendon-bone (BTB) technique. The clinical evaluation of&nbsp; each&nbsp; patient&nbsp; involved&nbsp; Lachman&nbsp; test (positive / negative), Lysholm and IKDC scales,&nbsp;&nbsp; first&nbsp;&nbsp; pre-operatively&nbsp;&nbsp; and&nbsp;&nbsp; then during&nbsp;&nbsp; post-operative&nbsp; check&nbsp; up assessment.&nbsp; Following&nbsp; the&nbsp; example&nbsp; of many&nbsp; websites&nbsp; or&nbsp; eminent&nbsp; orthopaedic organisations (http://www.orthopaedicscore.com/),&nbsp;&nbsp; an online&nbsp;&nbsp; survey&nbsp;&nbsp; was&nbsp;&nbsp; made&nbsp;&nbsp; on&nbsp;&nbsp; Google Drive,&nbsp;&nbsp;&nbsp;&nbsp; where&nbsp;&nbsp;&nbsp;&nbsp; data&nbsp;&nbsp;&nbsp;&nbsp; was&nbsp;&nbsp;&nbsp;&nbsp; collected electronically&nbsp; for&nbsp; the&nbsp; scales&nbsp; used.&nbsp; The results were then transferred to Excel for each&nbsp; scale,&nbsp; to&nbsp; be&nbsp; further&nbsp; processed&nbsp; by using&nbsp;&nbsp; adequate&nbsp;&nbsp; statistic&nbsp;&nbsp; tools&nbsp;&nbsp; in&nbsp;&nbsp; an adequate&nbsp;&nbsp;&nbsp;&nbsp; programme.&nbsp;&nbsp;&nbsp;&nbsp; The&nbsp;&nbsp;&nbsp;&nbsp; results indicated&nbsp; that,&nbsp; when&nbsp; compared&nbsp; with&nbsp; the uninjured&nbsp; leg,&nbsp; a&nbsp; resulting&nbsp; disparity&nbsp; in precision&nbsp; of&nbsp; positioning&nbsp; the&nbsp; lower&nbsp; leg with&nbsp; a&nbsp; damaged&nbsp; ligament&nbsp; apparatus&nbsp; of the&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; knee&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; before&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; the&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; surgical reconstruction&nbsp; of&nbsp; the&nbsp; anterior&nbsp; cruciate ligament&nbsp; was&nbsp; not&nbsp; considered&nbsp; statistically significant.&nbsp;&nbsp;&nbsp; However,&nbsp;&nbsp;&nbsp; there&nbsp;&nbsp;&nbsp; was&nbsp; a statistically&nbsp; significant&nbsp; difference&nbsp; in&nbsp; the speed&nbsp;&nbsp; of&nbsp;&nbsp; attaining&nbsp;&nbsp; a&nbsp;&nbsp; specified&nbsp;&nbsp; angle which indicates qualitative differences in the&nbsp; motion&nbsp; pattern&nbsp; itself.&nbsp; Furthermore, this&nbsp;&nbsp;&nbsp;&nbsp; sample&nbsp;&nbsp;&nbsp;&nbsp; study&nbsp;&nbsp;&nbsp;&nbsp; resulted&nbsp;&nbsp; in&nbsp; a statistically&nbsp; significant&nbsp; difference&nbsp; in&nbsp; the precision&nbsp;&nbsp; of&nbsp;&nbsp; positioning&nbsp;&nbsp; of&nbsp;&nbsp; lower leg&nbsp; with&nbsp;&nbsp;&nbsp;&nbsp; the&nbsp;&nbsp;&nbsp;&nbsp; damaged&nbsp;&nbsp; knee&nbsp; ligament apparatus&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; after&nbsp;&nbsp; the&nbsp;&nbsp; surgical reconstruction&nbsp; of&nbsp; the&nbsp; anterior&nbsp; cruciate ligament,&nbsp;&nbsp;&nbsp; when&nbsp;&nbsp;&nbsp; compared&nbsp;&nbsp;&nbsp; with&nbsp;&nbsp;&nbsp; the uninjured&nbsp; leg,&nbsp; i.e.&nbsp; after&nbsp;&nbsp; the reconstruction,&nbsp; the&nbsp; patients&nbsp;&nbsp; had&nbsp;&nbsp; a significantly&nbsp;&nbsp; higher&nbsp;&nbsp; degree&nbsp;&nbsp; of&nbsp;&nbsp; flexion than&nbsp;&nbsp; the&nbsp;&nbsp; targeted&nbsp;&nbsp; 35&deg;.&nbsp;&nbsp; The&nbsp;&nbsp; test&nbsp;&nbsp; for positioning&nbsp; extremities,&nbsp; performed&nbsp; with the&nbsp;&nbsp;&nbsp; specially&nbsp;&nbsp;&nbsp; constructed&nbsp;&nbsp;&nbsp; apparatus, proved&nbsp; to&nbsp; be&nbsp; a&nbsp; sensitive&nbsp; and&nbsp; specific diagnostic procedure for determining the loss&nbsp; of&nbsp; proprioceptic&nbsp; ability&nbsp; due&nbsp; to anterior cruciate ligament tear.</p>

<p>Uvod: Pacijenti sa akutnim infarktom miokarda sa ST elevacijom treba da budu podvrgnuti reperfuzionoj terapiji, pre svega pPCI, bez obzira na životnu dob, ali zbog&nbsp; veće učestalosti komorbiditeta, faktora rizika za koronarnu bolest i vi&scaron;esudovne koronarne bolesti, kod pacijenata starije životne dobi, odluka o reperfuzionoj terapiji treba da se donese sa dobrom procenom odnosa rizik &ndash; benefit. Cilj: Utvrđene su razlike u kliničkoj slici, angiografskom nalazu, terapijskom pristupu, toku i ishodu akutnog infarkta miokarda sa ST elevacijom u starih osoba u odnosu na mlađu životnu dob (mlađi od 75 godina). Materijal i metode: U studiju je uključeno 240 pacijenata sa akutnim infarktom miokarda sa ST elevacijom, podeljeni u dve komparabilne grupe (120 bolesnika starijih i kontrolna grupa 120 mlađih od 75 godina), koji su izabrani metodom slučajnog izbora, po redosledu prijema u bolnicu. Za pacijente iz obe grupe popunjavan je upitnik, a tretirani su po jedinstvenom protokolu lečenja. Rezultati: U ispitivanom uzorku, u grupi bolesnika starijih od 75 godina reperfuziona terapija je bila primenjena u 85% slučajeva. Intrahospitalni mortalitet za ceo uzorak je 11,7% i u skladu je sa drugim istraživanjima [27]. Mortalitet u grupi pacijenata preko 75 godina je bio 12,5%, a u grupi pacijenata sa manje od 75 godina 10,8% (p=ns). Zaključak: Klinička slika bolesti kod bolesnika starije životne dobi je če&scaron;će atipična &scaron;to korelira sa drugim studijama [31, 35], a tok bolesti komplikovaniji i ishod lo&scaron;iji. Kod bolesnika starijih od 75 godina če&scaron;ća je vi&scaron;esudovna koronarna bolest. Primarna perkutana koronarna intervencija u akutnom infarktu miokarda sa ST elevacijom u pacijenata starije životne dobi potvrđuje benefit u lečenju, toku i ishodu bolesti.</p> / <p>Introduction: Patients with ST segment acute myocardial infarction should undergo reperfusion therapy, PCI in the first place, no matter their life age. However, due to high frequency of comorbidities, risk factors for coronary disease and multi-vessel coronary disease, the decision of reperfusion therapy in elderly patients should be made according to the good evaluation or risk benefit ratio. Aim: The differences have been determined in the clinical picture, angiographic finding, therapeutic approach, course and outcome of ST segment acute myocardial infarction in elderly patients in relation to younger life age (less than 75 years). Material and methods: The study included 240 patients with ST segment acute myocardial infarction. They were randomly divided into two comparable groups according to the date of their hospitalization (120 patients older than 75 and control group of 120 patients younger than 75 years). Both groups of patients filled out the survey and were treated according to the same protocol. Results: In the examined sample of the group of patients older than 75 the reperfusion therapy was performed in 85% of cases. Intrahospital mortality for the entire sample was 11.7% and is in coherence with other researches [27]. Mortality in the group of patients older than 75 years was 12.5%, and it was 10.8% (p=ns) in the group of patients younger than 75.&nbsp; Conclusion: Clinical picture of disease in elderly patients is atypical thus correlating with other studies [31, 35], and course of illness more complicated and with a worse outcome. Multi-vessel disease is more common in patients older than 75 years. Primary percutaneous coronary intervention in STEMI in elderly patients confirms benefits in treatment, course and outcome of disease.</p>

<p>Uvod: Sepsa je jedan od vodećih uzroka smrtnosti u jedinicama intenzivnog lečenja i van njih uprkos implementaciji novih dijagnostičkih i terapijskih protokola &scaron;irom sveta. Multiorganska disfunkcija (MODS), koja predstavlja najtežu formu nepovoljnog toka sepse, je u osnovi svojih patofiziolo&scaron;kih de&scaron;avanja obeležena promenama, koje se de&scaron;avaju na nivou kapilara, pre svega u endotelu. Poremećaji koagulacije koji se javljaju kao posledica ovih promena u endotelu su prepoznati kao jedan od dijagnostičkih kriterijuma prema najnovijim smernicama za dijagnostiku i lečenje sepse, međutim njihov značaj u predviđanju toka i ishoda ovog oboljenja jo&scaron; uvek nije precizno definisan. Cilj istraživanja: Odrediti koncentraciju markera endotelne aktivacije, aktivacije koagulacije, aktivnost prirodnih inhibitora koagulacije i funkcionalnost fibrinolize kod obolelih od sepse u odnosu na njihove vrednosti u zdravoj populaciji. Ispitati mogućnost upotrebe markera endotelne disfunkcije i pokazatelja poremećaja mehanizma hemostaze za postavljanje dijagnoze sepse i predikciju pojave komplikacija. Ispitati mogućnost upotrebe markera endotelne disfunkcije i pokazatelja poremećaja mehanizma hemostaze za procenu ishoda kod obolelih od sepse. Materijal i metode: Istraživanje je sprovedeno analitičkom metodom u formi studije preseka, a obuhvatilo je pacijente lečene na Odeljenju anestezije i reanimacije Urgentnog centra Kliničkog centra Vojvodine i na Klinici za infektivne bolesti Kliničkog centra Vojvodine, u Novom Sadu. Istraživanje je sprovođeno tokom 2012. i 2013. godine u trajanju od dve godine. U studiju je bilo uključeno 180 ispitanika od kojih je 150 imalo postavljenu dijagnozu sepse,a 30 ispitanika su činili kontrolnu grupu su klinički i biohemijski zdravih ispitanika, dobrovoljni davaoci krvi. Ispitanici su kategorisani u četiri grupe u odnosu na kliničko stanje i laboratorijske nalaze unutar prvih 24 časa od prijema: bolesnici sa sepsom, te&scaron;kom sepsom, septičkim &scaron;okom i multiorganskom disfunkcijom na prijemu. Nakon kategorizacije ispitanika, izračunati su APACHE II i SOFA numerički pokazatelji procene težine bolesti ispitanika. U roku 24 časa od trenutka postavljanja dijagnoze sepse, iz uzoraka krvi ispitanika, izvr&scaron;ene su predviđene laboratorijske analize u cilju praćenja endotelne aktivacije, aktivacije koagulacije i inhibicije antikoagulantnih mehanizama. U toku 48 časova od prijema, bolesnici koji nisu imali MODS na prijemu su intenzivno praćeni u cilju evidentiranja razvoja multiorganske disfunkcije, dok su bolesnici koji su imali MODS praćeni radi evidentiranja perzistiranja ili eventualne rezolucije MODS-a. Zdravstveno stanje bolesnika je praćeno tokom 28 dana od trenutka uključivanja u studiju i nakon tog perioda je evidentiran ishod lečenja u smislu preživljavanja ili smrtnog ishoda. Statistička analiza je izvr&scaron;ena pomoću statističkog paketa IBM SPSS 20 Statistics. Podaci su predstavljeni tabelarno i grafički, a statistička značajnost određivana je na nivou p&lt; 0,05. Rezultati: Vrednosti biolo&scaron;kih markera endotelne aktivacije i aktivacije koagulacije su statistički značajno povi&scaron;ene kod obolelih od sepse u odnosu na njihove vrednosti u zdravoj populaciji, dok su vrednosti prirodnih inhibitora koagulacije statistički značajno snižene kod obolelih od sepse u odnosu na njihove vrednosti u zdravoj populaciji. Vrednosti APTT-a, PT-a, D-dimera, fibrinogena, prirodnih inhibitora koagulacije i markera endotelne aktivacije (endokan i vWF antigena i aktivnosti) imaju značajan i veoma visok dijagnostički potencijal. Vrednosti biomarkera endotelne disfunkcije i pokazatelja poremećaja hemostaznog mehanizma su značajni prediktori komplikacija kod bolesnika sa sepsom. APTT, PT, D-dimer, broj trombocita, vrednosti priorodnih inhibitora koagulacije, trombomodulina, endokana i ETP-a su jednako validni u inicijalnoj proceni toka kliničke slike sepse kao i prediktivni APACHE II i SOFA skorovi. Koncentracija trombomodulina, D-dimera, ETP-a i PC su dobri prediktori nastanka MODS-a u prvih 48 časova u toku sepse. Endokan, PT, APTT, koncentracija fibrinogena, prirodnih inhibitora koagulacije i vrednosti ETP-a su značajni u predikciji mortaliteta kod bolesnika sa sepsom. Zaključci: Ukoliko bi pokazatelji aktivacije endotela i mehanizma hemostaze bili inkorporirani u određeni sistem skorovanja u cilju procene težine bolesti u smislu ishoda kod bolesnika sa sepsom, to bi moglo doneti doprinos boljoj klasifikaciji bolesnika, te primeni pravovremene i adekvatne terapije u cilju postizanja pozitivnog ishoda kod bolesnika sa sepsom. Prilikom interpretacije pokazatelja inflamacije i koagulacije neophodno je steći uvid u celokupnu sliku pro-i antikoagulantnih de&scaron;avanja koja se odvijaju tokom sepse, odnosno adekvatno proceniti pravac toka disbalansa mehanizma hemostaze da bi se eventualnim terapijskim merama mogao postići pozitivan učinak.</p> / <p>Introduction: Sepsis is one of the main causes of death in intensive care units and other hospital wards in spite of implementation of new sepsis treatment guidelines in everyday hospital practice worldwide. Changes that occur in the microvasculature, affecting primarily endothelial cell, are the basis of the pathophysiology of multiorgan dysfunction (MODS) in sepsis. Coagulation abnormalities which occur as a consequence of endothelial changes are recognized as diagnostic criteria for sepsis, but significance of these changes in the outcome prognosis and prediction of the course of sepsis is still not accurately defined. Aims: Evaluation of hemostasis related parameters and endothelial activation biomarkers values in patients with sepsis and healthy volunteers. Determination whether the levels of hemostasis-related parameters and biomarkers of endothelial activation have diagnostic significance and are they associated with MODS development and persistence in the first 48 hours of hospitalization and 28-day mortality in patients with sepsis. Material and methods: This is cross-sectional study conducted in 2012 and 2013 in the Department of Anesthesia and Reanimation at the Emergency Center of the Clinical Center of Vojvodina and in the Clinic of Infectious Disease at the Clinical Center of Vojvodina. 150 patients who fulfilled criteria for diagnosis of sepsis were included in the study. Patients were divided into 4 groups: sepsis, severe sepsis, septic shock and MODS. 30 healthy volunteers, blood donors were the control group. After the categorization of patients, during the first 24 hours of hospitalization, predictive APACHE II and SOFA scores were calculated. Hemostasis related parameters and endothelial activation biomarkers concentrations were determined within the first 24 hours of the onset of the disease. To assess the development of complication of the disease, patients were monitored for 48 hours for MODS development and persistence or resolution and for 28 days from the onset of sepsis for outcome assessment. Data were analyzed using SPSS 20.0 software and are presented in tables and graphs, statistical significance was set at p&lt; 0,05. Results: Biomarkers of endothelial and coagulation activation are significantly higher in patients with sepsis in comparison to their values in healthy volunteers, while concentrations of natural anticoagulants are significantly lower in patients with sepsis than in healthy volunteers. APTT, PT, D-dimer, fibrinogen, natural anticoagulants and biomarkers od endothelial activation (endocan and vWF antigen and activity) have diagnostic significance in patients with sepsis. Hemostasis related parameters and endothelial activation biomarkers are good prognostic factors for complication development in patients with sepsis. APTT, PT, D-dimer, platelet count, natural anticoagulants, thrombomodulin, endocan and ETP are equally valuable in early prediction of sepsis development as APACHE II and SOFA scores. Thrombomodulin, D-dimer, ETP and PC are good predictors of MODS development during the first 48 hours from sepsis onset. Endocan, PT, APTT, fibrinogen concentration, values of natural anticoagulants and ETP values are significant in 28-day mortality prediction in patients with sepsis. Conclusion: A combination of markers of endothelial dysfunction with widely used ICU scores and organ failure assessment could contribute to an early recognition of complication development and consequent death in patients with sepsis. It is necessary to obtain the full insight in pro-and anticoagulant dynamic evaluation while interpreting coagulation and inflammation processes in sepsis development, in order to accurately lead early resuscitation therapy.</p>

<p>Dijabetesna retinopatija je među vodećim uzročnicima stečenog slepila, kako u razvijenim zemljama, tako i zemljama u razvoju. Dijabetesna retinopatija je jedna od<br />najče&scaron;ćih komplikacija Dijabetes Mellitus-a. U sklopu dijabetesne retinopatije jedan od najranijih razloga koji dovodi do pada vidne o&scaron;trine je dijabetični makularni edem (DME). Pad vidne o&scaron;trine kod pacijenata sa dijabetesom naru&scaron;ava njihov kvalitet života i umanjuje radnu sposobnost. Dosada&scaron;nji oblik lečenja laserfotokoaguacijom makule, nije dao zadovoljavajuće rezultate. U novije vreme sve vi&scaron;e je zastupljeno farmakolo&scaron;ko lečenje edema koje podrazumeva intrvitrealnu aplikaciju lekova iz grupe inhibitora vaskularnog endotelnog faktora rasta (VEGF inhibitori), koji dovodi do stabilizacije zidova krvnih sudova.&nbsp;<br />Cilj ove studije je da se ispita efikasnost lečenja DME uz pomoć intravitrealno aplikovanih lekova iz grupe inhibitora vaskularnog endotelnog faktora rasta u odnosu na konvencionalno do sada priznato lečenje laserfotokogulacijom makule.&nbsp;<br />Efikasnost lečenja je procenjivana na dva načina: anatomski, na osnovu smanjenja centralne makularne debljine izražene u &mu;m, merene metodom optičke koherentne tomografije, i funkcionalno, na osnovu pobolj&scaron;anja vidne o&scaron;trine koja je izražavana u log MAR jedinicama. U ovoj prospektivnoj, randomiziranoj kliničkoj studiji sa minimumom praćenja od 6 meseci, u eksperimentalnoj grupi tretiran je 51 pacijent,<br />odnosno 84 oka aplikacijom bevacizumaba (anti VEGF agens) u dozi od 1,25 mg, sa ili bez dodatnog laser tretmana.&nbsp;<br />Uz prosečno 2,46 inekcije postignuta je prosečna redukcija centralne makularne debljine od 139,15 &mu;m.&nbsp; Dobijene vrednosti su nakon svake aplikovane doze su značajno bolje u odnosu na početnu. Edemi sa većom centralnom makularnom debljinom su zahtevali tretman sa većim brojem inekcija. Kod većih edema je postignuta i veća redukcija centralne makularne debljine. U odnosu na vidnu o&scaron;trinu u eksperimentalnoj grupi postignuto je pobolj&scaron;anje od 0,135 log MAR jedinica. Efekat lasera kao samostalne terapije u kontrolnoj grupi (50 pacijenata, 92 oka) nije bio<br />značajan ni u pogledu smanjenja centralne makularne debljine kao ni na osnovu pobolj&scaron;nja vidne o&scaron;trine. Tretman bevacizumabom samostalno ili u kombinaciji sa laserom je efikasniji u tretmanu DME u odnosu na konvencionalni tretman laserfotokoaguacijom koji potvrđeno dovodi do stabilizacije stanja. Značaj ove studije je potvrda efikasnosti i bezbednosti jednog novog oblika lečenja koji samostalno ili u kombinaciji sa laser tretmanom predstavlja novi protokol lečenja dijabetičnog makularnog edema.</p> / <p>Diabetic retinopathy is among the leading causes of acquired blindness in developed countries, as well as in developing countries. Diabetic retinopathy is one of the most frequent Diabetes Mellitus complications. Within diabetic retinopathy, diabetic macular edema (DME) is one of the earliest causes of the loss of visual acuity. Impaired vision causes decline in life quality in diabetic patients and it decreases their<br />working ability. Up to this date, laser photocoagulation treatment has not given<br />satisfactory results. Recently, new promising treatment forms have emerged, including the intravitreal application of vascular endothelium growth factor (VEGF inhibitors), which lead to stabilization of the vessel wall. The aim of this study is to evaluate the efficacy of DME treatment consisting of intravitreal&nbsp; VEGF inhibitor application alone or as a part of combined treatment (intravitreal VEGF inhibitor plus laser photocoagulation) compared with conventional laser treatment alone. The effect of treatment was evaluated according to morphological parameters by measuring central macular thickness (CMT) in &mu;m with optical coherence tomography, and according to functional parameter by visual acuity in log MAR scale. In this prospective randomized clinical trial, with minimum follow up of 6 months, in experimental group 51 patient, or 84 eyes were treated with bevacizumab (VEGF inhibitor) in 1.25 mg dosage, alone or in combination with laser. The mean reduction in was 139.15 &mu;m, which was achieved with 2.46 doses on average. The difference between the final and initial CMT values after each dos age was tatistically significant.<br />Edemas with high central macular thickness required high number of intraviteal<br />aplicatons and the reduction was higher. In our study, mean visual acuity improved significantly in 0.135 log MAR. In control group (50 patient, 92 eyes) treated with laserphotocolagulation alone, the effect on visual acuity and central acular thickness was not statistically significant. The treatment with bevacizumab alone or in combined<br />treatment is more effective in treating DME than conventional macular laser treatment alone, from both - anatomical and functional perspective. The importance of this study is confirmation of the efficacy and safety of a new form of treatment and the introduction of a new protocol for the treatment of diabetic macular edema.</p>

<p>Uvod: Iz rezultata brojnih randomiziranih kliničkih studija proizi&scaron;le su smernice u koijma se navodi da je upotreba neinvazivne ventilacije (NIV), uz farmakolo&scaron;ku terapiju, indikovana kod svih bolesnika sa te&scaron;kom egzacerbacijom hronične opstruktivne bolesti pluća (HOBP), i to sa najvi&scaron;im nivoom preporuke. Dokazano je da se upotrebom NIV-a smanjuje broj intubacija, uz smanjenje mortaliteta ali i skraćenje dužine bolničkog lečenja. S obzirom da je nekada ventilatorna potpora bila pružana isključivo u jedinicama intenzivne nege, a da je kapacitet ovakvih odeljenja gotovo stalno popunjen, postavlja se pitanje adekvatnog okruženja unutar bolnice gde se bezbedno i efikasno može primeniti neinvazivna ventilacija, ali gde se i na vreme mogu prepoznati rani znakovi njene neuspe&scaron;ne primene, nakon čega trebaobezbediti pravovremenu endotrahealnu intubaciju. Stoga su rađene brojne studije u cilju izdvajanja ranih prediktora ishoda neinvazivne ventilacije - kako u cilju ranog prepoznavanja neuspeha NIV-a i omogućavanja pravovremene intubacije, tako i u cilju stratifikacije pacijenata sa različitim stepenom rizika za neuspeh, uz obezbeđivanje adekvatnog nivoa nege i monitoringa za sve bolesnike. Ciljevi: Ciljevi istraživanja su da se utvrdi koji pokazatelji koreliraju sa neuspe&scaron;nim ishodom primene neinvazivne mehaničke ventilacije kod bolesnika sa te&scaron;kom egzacerbacijom hronične opstruktivne bolesti pluća, kako bi se kreirao prognostički model ishoda lečenja, te da se se na osnovu prognostičkog modela stratifikuju bolesnici prema stepenu rizika za neuspeh NIV-a i u skladu sa njim predloži adekvatan stepen monitoringa, odnosno kliničko okruženje za bezbedno i efikasno pružanje ventilatorne potpore. Metodologija: U Institutu za plućne bolesti Vojvodine u Sremskoj Kamenici sprovedeno je prospektivno opservaciono istraživanje u trajanju od 39 meseci, u koje je uključeno 250 konsekutivnih bolesnika hospitalizovanih zbog te&scaron;ke egzacerbacije HOBP-a sa respiratornom acidozom. NIV je primenjen u modu pritiskom podržane ventilacije ventilatorima marke Covidien tipa Airox Supportair, uz upotrebu oronazalne maske. Početni parametri su podrazumevali upotrebu ekspiratornog pozitivnog pritiska u disajnim putevima - EPAP-a od 5 cm H2O i inspiratornog pozitivnog pritiska u disajnim putevima IPAPa od 12 cm H20, koji su u potom titrirani ka ciljnim vrednostima IPAPa od 15-20 cmH2O, a u skladu sa kliničkim odgovorom. Za svakog bolesnika evidentirani su: pol, starost, ranija primena dugotrajne oksigenoterapije u kućnim uslovima, primena NIV-a tokom prethodnih hospitalizacija, komorbiditeti preko Charlson indeksa, vreme proteklo od početka hospitalizacije do započinjanja NIV-a, vrednosti pH, bikarbonata, PaCO2 i PaO2 u gasnim analizama arterijske krvi pre započinjanja NIV-a, inicijalna SpO2 i odnos PaO2/FiO2, zatim promena vrednosti pH, PaCO2 i PaO2 u gasnim analizama arterijske krvi sat vremena nakon početka primene NIV-a, inicijalni vitalni parametri - srčana frekvenca, respiratorna frekvenca, stanje svesti procenjeno Glazgov koma skalom (GCS), telesna temperatura, sistolni arterijski pritisak, diureza, a potom zbirni modifikovani ranoupozoravajući bodovni skor (MEWS-modified early warning score), prisustvo i opseg konsolidacija na radiogramu grudnog ko&scaron;a, saradnja bolesnika, te mesto primene NIV-a. Kao primarni ishod istraživanja definisan je neuspeh neinvazivne mehaničke ventilacije: intubacija ili smrtni ishod u toku hospitalizacije uzrokovan respiratornom insuficijencijom. Svaki potencijalni prediktor neuspeha je prvo evaluiran uz pomoć univarijantne analize, a potom su svi faktori rizika za koje je univarijantnom analizom utvrdjena statistička značajnost analizirani uz pomoć multivarijantne logističke regresije, u cilju utvrdjivanja adekvatnih statističkih modela. Rezultati: Od ukupno 250 bolesnika NIV je uspe&scaron;no primenjen kod 164 bolesnika (65.6%). Ukupno 139 (59.3%) bolesnika bilo je mu&scaron;kog pola, a prosečna starost svih ispitanika bila je 67 godina. Bolesnici sa neuspe&scaron;nim ishodom NIV-a imaju, prema univarijantnoj analizi: statistički značajno veće vrednosti Charlson indexa (p=0.002, OR 1.293, 95%CI 1.103-1.516), konsolidacije u &ge;2 kvadranata (p=0.000, OR 5.384, 95%CI 2.487-11.655), duže vreme od početka hospitalizacije do započinjanja NIV-a (p=0.0034, OR 1.005, 95%CI 1.000-1.009), tahikardiju (p=0.031, OR 2.292, 95%CI 1.080-4.864), vrednost GCS &le;11 (p=0.042, OR 1.000, 95%CI 0.165-0.969), veći MEWS skor (p=0.000, OR 1.708, 95%CI 1.410-2.068), niže vrednosti inicijalnog pH (p=0.004, OR 0.002, 95%CI 0.000-0.147), slabiju saradnju (p=0.000, OR 2.102, 95%CI 0.145-0.339). Mesto gde je sprovedena NIV je značajno uticalo na ishod &ndash; &scaron;anse za neuspe&scaron;an ishod su bile dvostruko veće kod bolesnika ventiliranih na op&scaron;tem odeljenju (p=0.006, OR 2.102, 95%CI 1.236-3.574). Kao nezavisni prediktori neuspeha nakon multivarijantne logističke regresije pokazali su se vrednosti Charlson-ovog indexa (p=0.043, OR 1.246, 95%CI 1.007-1.541), MEWS skora (p=0.010, OR 1.394, 95%CI 1.083-1.795), inicijalne vrednosti pH (p=0.030, OR 0.642, 95%CI 0.430-0.958) i stepena saradnje (p=0.000, OR 0.230, 95%CI 0.141-0.376). Zaključci: Bolesnici sa visokim vrednostima Charlson-ovog indeksa (preko 6 bodova) i MEWS-ovog skora (preko 4 boda), te niskom inicijalnom pH vredno&scaron;ću arterijske krvi (ispod 7.29) i niskim stepenom saradnje (manjim od 4) su bolesnici koji imaju povi&scaron;en stepen rizika za neuspe&scaron;an ishod primene neinvazivne ventilacije. Bolesnici visokog stepena rizika treba da se zbrinjavaju i neinvazivno ventiliraju na odeljenjima poluintenzivne i intenzivne nege, dok se bolesnici sa manjim stepenom rizika mogu inicijalno neinvazivno ventilirati i na op&scaron;tim odeljenjima, uz adekvatan monitoring i nadzor obučenog osoblja.</p> / <p>Introduction: Clinical guidelines that have evolved from the results of numerous randomized clinical trials state that the use of non-invasive ventilation (NIV), in addition to pharmacological therapy, is necessary in all patients wih severe exacerbation of chronic obstructive pulmonary disease (COPD) - at the highest level of recommendation. It has been proven that the use of NIV leeds to reduction in mortality, intubation rates, and the length of stay in hospitals. Since ventilatory support in past was only delivered in intensive care units, and bearing in mind that their capacities are limited, there is a question of an adequate setting within a hospital where NIV can be used safely and efficiently, and where potential early signs of failure will be timely recognized and patient intubated, if necessary. Consequently, the studies were performed in order to identify early predictors of NIV outcome &ndash; in order to recognize NIV failure and necessity for transition towards invasive ventilation, but also in order to stratify the patients according to the level of risk, which will then dictate the necessary level of care and monitoring. Goals: This research is aimed at identification of parameters that correlate with failure of non-invasive ventilation in patients with severe exacerbation of COPD, in order to create prognostic model of outcome, which will then enable stratification of patients according to the risk of NIV failure. The model is to be used in order to determine adequate level of care and monitoring, that is, a setting within a hospital, for provision of efficent and safe ventilatory support for all patients. Methods: This 39-month prospective observational study was performed at the Institute for Pulmonary Diseases of Vojvodina in Sremska Kamenica, which included 250 consecutive patients hospitalized due to severe exacerbation of COPD with respiratory acidosis. NIV was applied as pressure support mode of ventilation with the ventilators brand Covidien, type Airox Supportair, with oro-nasal mask. Initial parameters were: expiratory positive airway pressure &ndash; EPAPof 5 cm H2O and inspiratory positive airway pressure - IPAP of 12 cm H20, which were further adjusted towards the IPAP of 15-20 cmH2O, or according to the clinical response. The following data were recorded for each patient: sex, age, earlier longterm oxygen therapy, NIV episode during the previous hospitalizations, co-morbidities through Charlson index, time elapsed from admission to NIV initiation, initial blood gas values: pH, bicarbonates, PaCO2 and PaO2, initial SpO2 and PaO2/FiO2, the subsequent changes inthe blood gas values after one hour: pH, PaCO2 and PaO2, initial vital signs - heart rate, respiratory rate, consciousness level by Glasgow coma scale (GCS), body temperature, sistolic blood pressure, urine output, and then modified early warning score - MEWS, presence of consolidation on chest X-ray, tolerance, setting where NIV was applied. Primary outcome was NIV failure defined as endotracheal intubation or death during hospitalization caused by respiratory failure. All variables were first tested with univariate analysis, and those with statistical significance were further subjected to multivariate logistic regression, in order to generate an adequate statistical model. Results: Amongst the total of 250 patients, NIV was successfully applied in 164 patients (65.6 %). There were 139 (59.3%) male patients, and average age was 67. According to the univariate analysis, patients with NIV failure had: higher Charlson index (p=0.002, OR 1.293, 95%CI 1.103-1.516), consolidation in &ge;2 quadrants (p=0.000, OR 5.384, 95%CI 2.487-11.655), longer time from admission to NIV initiation (p=0.0034, OR 1.005, 95%CI 1.000-1.009), increased heart rate (p=0.031, OR 2.292, 95%CI 1.080-4.864), GCS &le;11 (p=0.042, OR 1.000, 95%CI 0.165-0.969), higher MEWS score (p=0.000, OR 1.708, 95%CI 1.410-2.068), lower initial pH (p=0.004, OR 0.002, 95%CI 0.000-0.147), poorer tolerance (p=0.000, OR 2.102, 95%CI 0.145-0.339). The setting were NIV was applied influenced the outcome &ndash; odds for NIV failure were twice as high for the patients on general wards (p=0.006, OR 2.102, 95%CI 1.236-3.574). After the multivariate logistic regression, the following variables were identified as independent predictors of outcome: Charlson index (p=0.043, OR 1.246, 95%CI 1.007- 1.541), MEWS score (p=0.010, OR 1.394, 95%CI 1.083-1.795), initial pH (p=0.030, OR 0.642, 95%CI 0.430-0.958) and tolerance (p=0.000, OR 0.230, 95%CI 0.141-0.376). Conclusions: Patients with higher Charlson index (&gt; 6 points) and MEWS score (&gt;4 points), lower initial pH (&lt;7.29) and tolerance (&lt;4) are at a higher risk for nonivasive ventilation failure. High-risk patients should be admitted and ventilated at high dependency or intensive care units, while the low-risk patients may receive non-invasive ventilatory support on general wards, with adequate monitoring and under the trained staff supervision.</p>

<p>Kompleksnost visokoenergetskih preloma platoa i pilona tibije i njihova udruženost sa značajnim povredama mekog tkiva oko pripadajućeg zgloba veoma je dobro opisana. Lečenje ima za cilj da multifragmentarni prelomi platoa i pilona tibije postanu stabilni, artikularno poravnani, bezbolni, da koleno i skočni zglob budu pokretni i da se minimizira rizik do nastanka posttraumatskog osteoartritisa. Aparat po Ilizarovu sa nategnutim iglama, koristi opterećenje da stvori jedinstvenu podr&scaron;ku za zglob i stabilnu imobilizacju preloma da se postigne njegovo srastanje. Ovo omogućuje ranu pokretljivost zgloba bez rizika od gubitka redukcije. Cilj istraživanja je procena i poređenje rezultata lečenja unutarzglobnih vi&scaron;ekomadnih preloma kostiju proksimalnog i distalnog okrajka potkolenice tretiranih spoljnjim unilateralnim rigidnim fiksatorom i aparatom po Ilizarovu primenom ASAMI ko&scaron;tanog skoring sistema i funkcionalnog skoring sistema po Karlstrom &ndash; Olerudu.Takođe je jedan od ciljeva istraživanja bio da se uoče faktori koji utiču na različite rezultate lečenja unutarzglobnih vi&scaron;ekomadnih preloma kostiju gornjeg i donjeg okrajka potkolenice tretiranih spoljnim unilateralnim rigidnim fiksatorom i aparatom po Ilizarovu. Istraživanje je dizajnirano kao kontrolisana komparativna klinička studija a podaci su se prikupljali retrospektivno i delom prospektivno na osnovu medicinske dokumentacije od 2008. do 2013. godine. Studija je u potpunosti izvedena na Klinici za ortopediju i traumatologiju Kliničkog centra Vojvodina u Novom Sadu. Studija je obuhvatila ukupno 103 ispitanika kod kojih je u toku 2008 do 2013. godine postavljena dijagnoza unutarzglobnog vi&scaron;ekomadnog preloma gornjeg ili donjeg okrajka tibije. Ispitanici koji su obuhvaćeni ovim kliničkim istraživanjem razvrstani su u tri grupe: Prvu grupu od 53 ispitanika činili su oni sa vi&scaron;ekomadnim unutarzglobnim otvorenim ili zatvorenim prelomima gornjeg ili donjeg okrajka kostiju potkolenice lečenih isključivo spoljnjim unilateralnim rigidnim fiksatorom. Drugu grupu ispitanika, njih 31, činili su oni sa vi&scaron;ekomadnim unutarzglobnim otvorenim ili zatvorenim prelomima gornjeg ili donjeg okrajka kostiju potkolenice lečenih isključivo aparatom po Ilizarovu. Treću grupu činila su 19 ispitanika sa vi&scaron;ekomadnim unutarzglobnim otvorenim ili zatvorenim prelomima gornjeg ili donjeg okrajka kostiju potkolenice koji su lečenje započeli spoljnjim unilateralnim rigidnim fiksatorom, a u kasnijem periodu zbog nastalih komplikacija (lo&scaron;e srastanje, produženo srastanje, nesrastanje, infekcija, pseudoartroza) lečenje nastavili konverzijom spoljnjeg unilateralnog rigidnog fiksatora u aparat po Ilizarovu. Osnovni izvor podataka za prikazano istraživanje bio je protokol formiran za svakog bolesnika pojedinačno, istorije bolesti i poliklinička evidencija. Za potrebe istraživanja dizajniran je protokol istraživanja gde su se prikupljeni podaci analizirali hronolo&scaron;ki : podaci o pacijentu, klinički nalaz na prijemu, postoperativni tok, monitoring aparata, klinički nalaz na otpustu i klinički nalaz na kontrolama od 6, 12 i 18 meseci. Kliničke nalaze na kontrolama na 6, 12 i 18 meseci beležili smo upotrebom skoring sistema ASAMI ( Udruženja za istraživanje i primenu metoda po Ilizarovu) &ndash; za ko&scaron;tane rezultate, i Karlstrom &ndash; Oleruda za procenu funkcionalnih rezultata. Neki do najvažnih rezultata dobijenih prilikom ovog istraživanja jesu da je najbrže vreme srastanja imala grupa Ilizarov, nakon 16&plusmn;2 nedelja. Grupa konverzija zabeležila je prosečno vreme srastanja u 17&plusmn;2 nedelji, dok je kod ispitanika u grupi fiksator zabeženo srastanje u 21&plusmn;4 nedelji. Pojava povr&scaron;nih i dubokih infekcija značajno je veća kod grupe tretiranih spoljnim unilateralnim fiksatorom nego kod grupa tretiranih aparatom po Ilizarovu. Vreme postizanje ranog, punog oslonca na operisani ekstremitet je značajno kraće kod grupe Ilizarov i konverzija nego kod grupe fiksator. Procena ko&scaron;tanih rezultata kori&scaron;ćenjem ASAMI bodovnog sistema ko&scaron;tanog srastanja ukazuje na statistički značajno bolje rezultate kod grupa Ilizarov i konverzija u odnosu na grupu spoljnji fiksator u periodu praćenja i analize na 6,12 i 18 meseci. Funkcionalni rezultati primenom sistema funkcionalne evaluacije po Karlstrom &ndash; Olerudu govore u prilog značajno statistički boljim rezultatima kod grupe Ilizarov i konverzija u odnosu na grupu spoljni fiksator u periodima praćenja i analize na 6,12 i 18 meseci. Na osnovu dobijenih rezultata dolazimo do zaključka da je tretman ispitanika sa multifragmentarnim, intraarikularnim prelomima gornjeg i donjeg okrajka kostiju potkolenice znatno efikasniji aparatom po Ilizarovu &scaron;to sveukupno daje smernice za brži i kvalitetniji oporavak ispitanika i njihov povratak svakodnevnim aktivnostima sa &scaron;to manjim posttraumatskim sekvelama.</p> / <p>The complexity of high-energy fractures of the tibia plateau and pilons and their association with significant violations of the soft tissue around the corresponding joint is well described in the literature. Main aim of the treatment is to multiple fractures of the tibia plateau and pilon become stable, articularly aligned, without pain, and with full motion in the knee and ankle joint with minimum risk for post-traumatic osteoarthritis. Ilizarov apparatus with taut needles is used to create a unique load support for the ankle and create conditions for good healing. This strong stability allows early joint movement, without risk of loss position of fracture parts. The aim of this research is assessment and comparation of the results of treatment, for intraarticular multiple fractures of the proximal and distal part of lower leg tretaed with unilateral external rigid fixator and Ilizarov apparatus, with ASAMI bone scoring system and functional scoring sistem by Karlstrom &ndash; Olerud. One of the goals of the study was to detect factors which affecting different treatment results of the intraarticular multiple fractures of the proximal and distal part of lower leg, tretaed with unilateral external rigid fixator and Ilizarov apparatus. The study was designed as a controlled comparative clinical study and data were collected retrospectively and prospectively form medical records from 2008 to 2013. The study has been fully implemented at the Department for orthopedic surgery and traumatology in the Clinical Center of Vojvodina in Novi Sad and included 103 patients who had intraarticular multiple fractures of the proximal and distal part of tibia. Subjects covered in this clinical study were classified into three groups: The first group of 53 patients were with intraartiulary multifragmentary open or closed fractures of the upper or distal part of lower leg, treated exclusively with unilateral external rigid fixator. The second group included 31 patients with intraarticular open or closed fractures of the upper or distal lower leg, treated exclusively with Ilizarov apparatus. 19 patients made the third group with intraarticulary open or closed fractures of the upper or distal lower leg, which were treated at the begining with unilateral external rigid fixator and later because of the complications (poor or prolonged healing, nonunion, infection and pseudoarthrosis) tretment was continued by Ilizarov apparatus. The main source of data for this study was protocol wich was established for each patient individually. In this protocol collected data analyzed by date: patient data, clinical findings at admission, postoperative course, monitoring apparatus, clinical findings at discharge and clinical findings at the controls which were at 6, 12 and 18 months after surgery. Clinical findings at control examinations (6, 12 and 18 months after surgery), we recorded by scoring system ASAMI (Association for the Study and Application of the Methods of Ilizarov) - that represent the results of the bone healing, and Karlstrom - Olerud for assessment functional outcomes. The most important results were: the fastest time of bone union was in the group of Ilizarov, and it was after 16 &plusmn; 2 weeks and the third group (conversion group) recorded an average time after 17 &plusmn; 2 weeks, while the patients in the first group (external fixator) had average time of union after 21 &plusmn; 4 week. The appearance of superficial and deep infection was significantly higher in the group treated with unilateral external fixator than in the group treated by the Ilizarov apparatus. Fastest full weight bearing on the injured leg, had patients in the group treated with Ilizarov apparatus. Evaluation of results using bone ASAMI fusion scoring system indicating a statistically significantly better results in the conversion and Ilizarov group compared to the group of external fixator in the period of monitoring at 6,12 and 18 months after surgery. Functional results by Karlstrom - Olerud scoring system show statistically significantly better results in the Ilizarov and conversion group contrary to the external fixator group in periods of monitoring at 6,12 and 18 months. Based on these results we conclude that the treatment of subjects with intraarticulary, multifragmentary fractures of the upper and lower part of the lower leg are more efficient after Ilizarov apparatus which provides overall guidance for faster and better recovery of patients and their return to their daily activities with minimal post-traumatic sequelae.</p>

<p>Studija je imala za cilj da pokaže značaj primene PET/CT pregleda u planiranju radiolo&scaron;ke terapije kod pacijenata obolelih od Hočkinovog linfoma. U Vojvodini je 2009. godine prema podacima Registra za maligne neoplazme Vojvodine incidence za Hočkinov limfom iznosila 2,7 na 100 000 dok je mortalitet bio 1,1 na 100 000 stanovnika. Na osnovu dostupnih podataka Registra za maligne neoplazme Vojvodine beleži se porast incidence u protekloj deceniji. Procenat obolelih u Vojvodini u korelaciji je sa podacima koje navodi i Međunarodna agencija za istraživanje raka iz Liona (IARC). U Evropi i u Sjedinjenim Američkim Državama postoji bimodularna kriva incidence po starosti koja pokazuje maksimalne vrednosti u period između 20 i 30 godina i nakon 55. godine. S obzirom da od Hočkinovog limfoma dominantnije obolevaju mlađe osobe a da bolest ima dobru prognozu neophodno je iznaći nove načine za inicijalno određivanje stadijuma bolesti, kao i metode koje mogu da unaprede kvalitet lečenja. Jedan od načina je primena &scaron;to savremenijih dijagnostičkih metoda. PET-CT je imidžing metoda koja poslednjih godina zauzima značajno mesto u određivanju stadijuma malignih bolesti kao i u proceni odgovora na primenjenu terapiju. Fuzionisanjem skenova PET-a i CT-a dobija se PET-CT slika koja prikazuje funkcionalno stanje pojedinih tkiva i organa (PET) sa anatomskim detaljima (CT). Cilj istraživanja je bio da se utvrdi prednost PET-CT pregleda u planiranju radioterapije kod pacijenata sa supradijafragmalnom lokalizacijom bolesti. Nakon postavljanja dijagnoze Hočkinovog limfoma kod pacijenata je urađen PET-CT i planiranje radiolo&scaron;ke terapije. Zračna terapija je planirana na osnovu nalaza PET-CT-a i njegovom fuzijom sa CT-om za planiranje radiolo&scaron;kog lečenja. Dobijeni planovi su poređeni sa onim koji su rađeni standardnom 3D konformalnom tehnikom bez fuzije. Poređeni su klinički volumeni (CTV) i planirani volumen (PTV) kao i razlike u njihovoj obuhvaćenosti preskribovanom dozom. Pokazano je da postoji statistički značajna razlika u ciljnim volumenima kao i u njihovoj obuhvaćenosti. Posmatrani su takođe i rizični organi- srce, pluća, dojke, &scaron;titasta žlezda, kičmena moždina i doze koje oni prime. Dokazano je da su sa statističkom značajno&scaron;ću dozna opterećenja na navedene rizične organe manja kada se planiranje vr&scaron;i na osnovu fuzije sa PET-CT-om, te se na osnovu toga može reći da će i očekivane manifestacije kasne toksičnosti biti manje. Istraživanjem je potvrđena hipoteza da PET/CT ima veliku prednost u planiranju radioterapije jer smanjuje zapremine ciljnih volumena i doprinosi pobolj&scaron;anju kvaliteta radiolo&scaron;kog lečenja.</p> / <p>This study aimed to prove that the use of PET/CT in radiotherapy planning makes a material change in the course of the treatment of the patients with Hodgkin&#39;s lymphoma. According to the data from the Registry of malignant neoplasms in Vojvodina, incidence of Hodgkin&#39;s lymphoma in Vojvodina in 2009 was 2.7 per 100 000, while the mortality rate was 1.1 per 100 000 inhabitants. Based on the available data, the said Register recorded an increase in the incidence over the past decade. The percentage of patients who were registered in Vojvodina is in correlation with the data cited by the International Agency for Research on Cancer in Lyon (IARC).In Europe and in the United States the disease has a bi-modular distribution distribution with the highest frequency rate in persons ageing from 20-30 years and people older than 55 years. Due to the fact that the dominant Hodgkin&#39;s lymphoma affects young people and having in mind the good prognosis of the disease, it is necessary to find a new modality for the initial staging of disease and methods which can improve the quality of treatment. PET/CT is the imaging method which has in recent years had an important role in the staging of malignancies, as well in the evaluation of response to therapy. PET/CT image is obtained by fusing PET scans with CT and it show functional status of certain tissues and organs (PET) with anatomical details (CT).The object of this study was to show that PET/CT examinations are preferred imaging method in radiotherapy planning in patients with localized disease above the diaphragm. After they had been diagnosed with HL, patients underwent PET/CT scan which was later used for delineation in radiotherapy planning. In this study, radiation therapy was planned on the basis of the findings of PET /CT and its fusion with CT for planning radiological treatment. The resulting plans were compared with those made using standard 3D conformal technique without fusion. Clinical volume (CTV) and the planned volume (PTV) and the differences in their coverage with the prescription dose in both plans were also compared. The study has shown a statistically significant difference in the target volume and their coverage. In addition, the dose which receive organs at risk was also examined. It has been shown that organs at risk were exposed to lower doses when using PET/CT fusion in radiotherapy planning and consequently, less incidence of late toxicity is to be expected. The study confirmed the hypothesis that PET /CT has a great advantage in the planning of radiotherapy because it reduces the volume of the target volume and improves the quality of radiation treatment.</p>

<p>Karcinomi pluća su najče&scaron;ći uzrok oboljevanja i umiranja od malignih tumora u Svetu. Neodjuvantna terapija kod bolesnika sa lokalno uznapredovalim (IIIA-IIIB) karcinomom pluća i zahvaćenim N2 limfnim čvorovima jedan je od modusa multimodalnog lečenja bolesnika sa nemikrocelularnim karcinomima pluća (NSCLC) u cilju pobolj&scaron;anja ishoda njihovog lečenja. Ovakav pristup podrazumeva prevođenje bolesnika iz vi&scaron;eg u niži stadijum bolesti - &bdquo;downstaging&rdquo;. Do danas nije utvrđena povezanost između pojedinih obrazaca tumorskog odgovora i vrste terapije. S obzirom na značaj kompletnog patolo&scaron;kog odgovora i tumorske regresije u prognozi ishoda lečenja, iznalaženje ove povezanosti je od značaja za dizajniranje budućih neoadjuvantnih trajala. Prilikom utvrđivnja histolo&scaron;ke slike tumorske regresije veoma je važno i merenje areje rezidualnog tumora (ART). Kako je veličina tumora jedan od prognostičkih faktora za bolesnike sa NSCLC koji nisu primali neoadjuvantnu terapiju tako je i merenje ART, za razliku od makroskopske veličine tumora, jedan od prognostičkih faktora za bolesnike sa NSCLC koji su primali neoadjuvantnu terapiju. Krajnji cilj neoadjuvantne terapije trebalo bi da bude resektabilnost i &bdquo;downstaging&rdquo; koji bi mogao da obezbedi u specifičnim kliničkim situacijama i sveukupni onkolo&scaron;ki benefit. Osnovni ciljevi ove doktorske disertacije su bili: da se objektivizira procena veličine ART u tumorskom tkivu pluća i limfnih čvorova; da se proceni povezanost povr&scaron;ine ART sa veličinom tumora na postoperativnom hirur&scaron;kom materijalu posle neoadjuvantne terapije; da se analizira i proceni povezanost histomorfolo&scaron;kih parametara kod tumorske regresije indukovane neoadjuvantnom terapijom i spontane tumorske regresije u tumorima pluća i limfnih čvorova na&nbsp; postoperativnom hirur&scaron;kom materijalu i u zavisnosti od histolo&scaron;kog tipa karcinoma; da se proceni povezanost kliničkog odgovora na neoadjuvantnu terapiju prema kriterijumima Svetske Zdravstvene Organizacije i histolo&scaron;kih parametara u tumorima pluća i limfnim čvorovima na postoperativnom hirur&scaron;kom materijalu nakon neoadjuvantne terapije; da se proceni povezanost patolo&scaron;kog ypTN sa kliničkim ycTN stadijumom bolesti i stepena tumorske regresije indukovane neoadjuvantnom terapijom i patolo&scaron;kog ypTN i da se proceni povezanosti između kliničke i patolo&scaron;ke zahvaćenosti N2 limfnih čvorova posle neoadjuvantne terapije. Merenje ukupne veličine očuvanih ART je najznačajniji objektivni parametar u proceni stepena tumorske regresije. Veličina rezidualnog tumora nije u korelaciji sa veličinom tumora posle neoadjuvantne terapije. Postoji signifikantna razlika u patohistolo&scaron;koj slici tumorske regresije indukovane neoadjuvantnom terapijom i spontane tumorske regresije. Ne postoji signifikantna razlika između histolo&scaron;kog tipa tumora i histolo&scaron;ke slike tumorske regresije. Ne postoji signifikantna povezanost između kliničkog odgovora i stepena tumorske regresije nakon neoadjuvantne terapije. Ne postoji korelacija između kliničkog i patolo&scaron;kog stadijuma bolesti posle neoadjuvantne terapije. Ne postoji korelacija između stepena tumorske regresije indukovane neoadjuvantnom terapijom i ypTN stadijuma bolesti. Ne postoji korelacija između kliničke i patolo&scaron;ke zahvaćenosti N2 limfnih čvorova posle neoadjuvantne terapije. Stepen regresije tumora i merenje ART posle neoadjuvantne terapije određen histopatolo&scaron;kom analizom reseciranog tumora je najobjektivniji kriterijum za procenu hemioterapijskog odgovora i predviđanja ishoda lečenja pacijenata.</p> / <p>Lung cancers are the most common cause of morbidity and mortality from malignant tumors in the World. The neodjuvant therapy in patients with locally advanced (IIIA-IIIB) lung cancer and affected N2 lymph nodes is one of the modes of multimodal treatment of patients with non-small cell lung cancer (NSCLC) in order to improve the outcome of their treatment. This involves converting patients from a higher to a lower stage of the disease - &quot;downstaging&quot;. There has been no significant connection between some forms of tumor response and types of therapy. Given the importance of complete pathological responses and tumor regression in the prediction of treatment outcomes, finding this relationship is of importance for the design of future neoadjuvant trails. In determining the histological tumor regression is very important measurement of area of residual tumor (ART). As the size of the tumor is one of the prognostic factors in patients with NSCLC who did not receive neoadjuvant therapy so the measurement of ART, as opposed to the macroscopic size of the tumor, one of the prognostic factors in patients with NSCLC, who had received neoadjuvant therapy. The ultimate goal of neoadjuvant therapy should be resectability and &quot;downstaging&quot; that could provide overall oncology benefit in specific clinical situations. The main objectives of this thesis were: to objectively estimate the size of ART in tumor tissue of lung and lymph nodes; to estimate the relation between the surface of ART with the size of the tumor on postoperative surgical material after neoadjuvant therapy; to analyze and estimate the relation between histomorphological parameters in tumor regression induced by neoadjuvant therapy and spontaneous tumor regression in tumors of the lung and lymph nodes in the postoperative surgical material and depending on the histological type of cancer; to estimate the relation between clinical response to neoadjuvant therapy according to criteria of the World Health Organization and histological parameters in lung tumors and lymph nodes in the postoperative surgical material after neoadjuvant therapy; to estimate the correlation of the pathological ypTN with clinical ycTN stage of the disease and the degree of tumor&nbsp; regression induced by neoadjuvant therapy and pathological ypTN and estimation of the relation between clinical and pathological involvement of N2 lymph nodes after neoadjuvant therapy. Measurement of the total size of the preserved ART is the most important objective parameter in the assessment of the grade of tumor regression. Size of residual tumor did not correlate with the size of the tumor after neoadjuvant therapy. There was a significant difference in the histological picture of tumor regression induced by neoadjuvant therapy and spontaneous tumor regression. There was no significant difference between the histologic type of tumor and histological tumor regression. There is no significant correlation between clinical response and the grade of tumor regression after neoadjuvant therapy. There is no correlation between clinical and pathological staging of the disease after neoadjuvant therapy. There is no correlation between the grade of tumor regression induced by neoadjuvant therapy and ypTN stage of the disease. There is no correlation between the clinical and the pathological involvement of the N2 lymph nodes to neoadjuvant therapy. The grade of tumor regression and measurement ART after neoadjuvant therapy determined by histopathological analysis of the resected tumor is the most objective criterion for evaluation of chemotherapeutic response and prediction of treatment outcome in patients.</p>

<p>UVOD. Sekundarni limfedem ruke je relativno česta komplikacija nakon lečenja raka dojke. Iako se kompleksna dekongestivna terapija smatra &ldquo;zlatnim standardom&ldquo; &quot;, jo&scaron; uvek postoji kontroverza o tome da li dodavanje presoterapije daje bolji terapijski efekat. Stoga je cilj ovog istraživanja bio uporediti efikasnost kompleksne dekongestivne fizikalne terapije (KDFT) u odnosu na kompleksnu dekongestivnu fizikalnu terapiju sa presoterapijom na funkcionalni status, nivo bola i kvalitet života kod pacijentkinja sa sekundarnim limfedemom ruke nakon lečenja raka dojke. MATERIJAL I METODE. Prospektivna, randomizovana, paralelna, nemaskirana studija je obuhvatila 108 pacijentkinja sa sekundarnim limfedemom ruke, prosečne starosti 56,8 &plusmn; 8,5 godina, koje su zavr&scaron;ile operativno lečenje raka dojke pre 57,4 &plusmn; 46,2 meseca. One su randomizovane u 2 grupe: KDFT grupa (kontrolna) ili KDFT+presoterapija grupa (eksperimentalna). Protokol KDFT se sastojao od nege kože, manuelne limfne drenaže, kratkoelastične vi&scaron;eslojne bandaže i vežbi. Osim toga, eksperimentalna grupa je primala presoterapiju (intermitentnu pneumatsku kompresiju), 30 minuta dnevno pri pritisku od 40 mm Hg. Oba protokola su se provodila jednom dnevno, pet dana sedmično tokom 3 sedmice. Ispitanice su podučavane za nastavak samostalnog sprovođenja nege kože, manuelne limfne drenaže i vežbi, kao i za no&scaron;enje kompresivnog rukava, 3 meseca nakon zavr&scaron;etka lečenja. Mere ishoda. Obim ruke, obim pokreta u zglobu ramena, snaga stiska &scaron;ake, vizuelna analogna skala za bol, upitnik Nesposobnost ruke, ramena i &scaron;ake (DASH) za funkciju ruke i upitnik Funkcionalna analiza lečenja raka dojke dojke sa subskalom 4+ za ruku (FACT-B4+) za kvalitet života su ocenjeni pre, neposredno nakon i 3 meseca nakon zavr&scaron;etka lečenja. Za statističku obradu dobijenih podataka kori&scaron;ćene su deskriptivne metode, analiza varijanse (ANOVA) za ponovljena merenja, analiza kovarijanse, Man-Vitni test, hi-kvadrat test i Fi&scaron;erov egzaktni test, prema potrebi. REZULTATI. Od ukupno 108 randomizovanih ispitanica, analizirane su 102 (51 u svakoj grupi). Nije bilo značajnih razlika u demografskim i kliničkim karakteristikama između dve grupe. ANOVA je pokazala značajan uticaj vremena za sve ispitivane varijable (p &lt;0,01), ali ne i značajnu interakciju vreme-grupa (0,07 &le; p &le; 0,99). Tačnije, nije bilo značajne razlike između dve ispitivane grupe u stepenu smanjenja limfedema, obimu pokreta u ramenu, snazi stiska &scaron;ake, nivou bola, DASH skoru i skorovima kvaliteta života merenim FACT -B4+, na kraju tretmana, i nakon 3 meseca praćenja. ZAKLJUČAK. Dodavanje presoterapije kompleksnoj dekongestivnoj terapiji, ne doprinosi boljem ishodu lečenja kod pacijentkinja sa limfedemom ruke nakon operacije karcinoma dojke u poređenju sa samo dekongestivnom terapijom.</p> / <p>BACKGROUND. Secondary lymphedema of the arm is a relatively common complication after breast cancer surgery. Although complex decongestive therapy is considered the &ldquo;golden standard&rdquo;, there is still a controversy as to whether adding pressotherapy is of any value. Thus, the aim of this study was to compare the efficacy of complex decongestive therapy (CDT) against complex decongestive therapy combined with a pressotherapy on functional status, pain, and quality of life in patients with secondary lymphedema of the arm after breast cancer treatment. METHODS. In this prospective, randomized, parallel, non-blind study, we recruited 108 women, mean age 56.8&plusmn;8.5 years, with secondary arm lymphedema who completed breast cancer surgery 57.4&plusmn;46.2 months earlier. They were randomly assigned to a CDT group (control) or CDT+pressotherapy group (experimental). The CDT protocol consisted of skin care, manual lymphatic drainage, short stretch multi-layer compression bandages, and exercises provided by therapists. In addition to that, the experimental group received pressotherapy (intermittent pneumatic compression) for 30 minutes per day at a pressure of 40 mmHg. The treatments were administered once a day, five days a week, for 3 weeks. The subjects were instructed to continue administering the skin care, manual lymphatic drainage, compression sleeve and exercises on their own for 3 months after the end of treatment. Outcome measures. Arm circumference, shoulder range of motion, grip strength, visual analog scale for pain, Disability of the Arm, Shoulder and Hand questionnaire (DASH) for the overall arm function, and Functional Analysis of Cancer Treatment- Breast 4+ (FACT-B4+) for quality of life were assessed before, immediately after, and at 3 months after the end of treatment. The statistical analyses included descriptive methods, analysis of variance (ANOVA) for repeated measures, analysis of covariance, Mann-Whitney U- test, chi-square test, and Fisher&rsquo;s exact test, as appropriate. RESULTS. From a total of 108 subjects randomly assigned, 102 completed the entire protocol (51 in each group), and their data were analyzed. There were no significant differences in demographic and clinical characteristics between the two groups. The ANOVA revealed significant main effect of Time for all studied variables (p &lt; 0.01), but no significant group-by-time interaction (0.07 &le; p &le; 0.99). More specifically, there was no significant difference between the two groups in the degree of lymphedema reduction, shoulder range of motion, grip strength, pain, DASH score, and FACT-B4+ scores either at the end of treatment or at 3-month follow up. CONCLUSIONS. Combining CDT with pressotherapy is no more efficacious than providing CDT alone in patients who present with chronic arm lymphedema after completing breast cancer treatment.</p>