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Milenković Z, Momčilović S, Ignjatovic A, Tasić-Otašević S. Is Antihelminthics Necessary in Postoperative Treatment of Intraventricular Neurocysticercosis? A Systematic Review. World Neurosurg 2024; 181:e533-e550. [PMID: 37879434 DOI: 10.1016/j.wneu.2023.10.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/18/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Patients with intraventricular neurocysticercosis (IVNCC) may require cerebrospinal fluid diversion surgery for late-onset hydrocephalus in the postsurgical period. Controversy exists regarding cysticidal treatment. Our main objective was to compare surgically treated cases of IVNCC that received postoperative anthelmintics with those that did not regard the incidence and treatment of late-onset hydrocephalus. METHODS We searched the Medline database and extracted the following data: age, gender, stage of development of cysticercosis, type of operation, frequency of delayed hydrocephalus, cerebrospinal fluid diversion surgery, outcome, and follow-up. RESULTS We analyzed 130 articles on intraventricular cysticercosis and identified 117 cases of isolated IVNCC and 314 patients in the case-control series who met inclusion criteria. There was no significant difference in postoperative delayed hydrocephalus between isolated IVNCC and case-control study groups. Children under the age of 16 received anthelmintic drugs more frequently during the postoperative period. Statistical relevance was observed in all patient groups regarding the application of steroids in favor of cysticidal therapy Endoscopy was a better option than craniotomy for cases of isolated IVNCC and case-control studies. Other variables were not relevant. CONCLUSIONS Patients who received antihelminths did not show a statistically significant reduction in delayed hydrocephalus compared to individuals who did not receive after surgical resection of the parasite. Corticosteroid therapy prevailed in people who have been treated with anthelmintics. Children under the age of 16 were administered anthelmintic drugs more frequently during the postoperative period. Endoscopy was the preferred method for all groups, but some patients with cysts in the fourth ventricle required a craniotomy.
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Affiliation(s)
- Zoran Milenković
- General Hospital "Sava Surgery", Kej 29 decembra 2, Niš, Serbia.
| | - Stefan Momčilović
- Plastic and Reconstructive Surgery Clinic, Clinical Center Niš, Niš, Serbia
| | - Aleksandra Ignjatovic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Suzana Tasić-Otašević
- Department of Microbiology and Immunology, Faculty of Medicine, University of Niš, Niš, Serbia
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Veskovic J, Cvetkovic M, Tahirovic E, Zdravkovic M, Apostolovic S, Kosevic D, Loncar G, Obradovic D, Matic D, Ignjatovic A, Cvetkovic T, Posch MG, Radenovic S, Ristić AD, Dokic D, Milošević N, Panic N, Düngen HD. Depression, anxiety, and quality of life as predictors of rehospitalization in patients with chronic heart failure. BMC Cardiovasc Disord 2023; 23:525. [PMID: 37891464 PMCID: PMC10612261 DOI: 10.1186/s12872-023-03500-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/06/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Chronic heart failure (CHF) is a severe condition, often co-occurring with depression and anxiety, that strongly affects the quality of life (QoL) in some patients. Conversely, depressive and anxiety symptoms are associated with a 2-3 fold increase in mortality risk and were shown to act independently of typical risk factors in CHF progression. The aim of this study was to examine the impact of depression, anxiety, and QoL on the occurrence of rehospitalization within one year after discharge in CHF patients. METHODS 148 CHF patients were enrolled in a 10-center, prospective, observational study. All patients completed two questionnaires, the Hospital Anxiety and Depression Scale (HADS) and the Questionnaire Short Form Health Survey 36 (SF-36) at discharge timepoint. RESULTS It was found that demographic and clinical characteristics are not associated with rehospitalization. Still, the levels of depression correlated with gender (p ≤ 0.027) and marital status (p ≤ 0.001), while the anxiety values were dependent on the occurrence of chronic obstructive pulmonary disease (COPD). However, levels of depression (HADS-Depression) and anxiety (HADS-Anxiety) did not correlate with the risk of rehospitalization. Univariate logistic regression analysis results showed that rehospitalized patients had significantly lower levels of Bodily pain (BP, p = 0.014), Vitality (VT, p = 0.005), Social Functioning (SF, p = 0.007), and General Health (GH, p = 0.002). In the multivariate model, poor GH (OR 0.966, p = 0.005) remained a significant risk factor for rehospitalization, and poor General Health is singled out as the most reliable prognostic parameter for rehospitalization (AUC = 0.665, P = 0.002). CONCLUSION Taken together, our results suggest that QoL assessment complements clinical prognostic markers to identify CHF patients at high risk for adverse events. CLINICAL TRIAL REGISTRATION The study is registered under http://clinicaltrials.gov (NCT01501981, first posted on 30/12/2011), sponsored by Charité - Universitätsmedizin Berlin.
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Affiliation(s)
- Jovan Veskovic
- Department of Internal Medicine, Cardiology, CVK, Charité University Medicine Berlin, 13353, Berlin, Germany.
- Scirent Clinical Research and Science, 13353, Berlin, Germany.
| | - Mina Cvetkovic
- Department of Internal Medicine, Cardiology, CVK, Charité University Medicine Berlin, 13353, Berlin, Germany
| | - Elvis Tahirovic
- Scirent Clinical Research and Science, 13353, Berlin, Germany
| | - Marija Zdravkovic
- Department of Cardiology, Faculty of Medicine, University Clinical Hospital Center Bezanijska Kosa, University of Belgrade, Belgrade, 11000, Serbia
| | - Svetlana Apostolovic
- Department for Cardiovascular Diseases, Clinical Centre Niš, University of Niš, Niš, 18000, Serbia
| | - Dragana Kosevic
- Institute for Cardiovascular Diseases Dedinje, Department of Cardiology, Belgrade, 11000, Serbia
| | - Goran Loncar
- Institute for Cardiovascular Diseases Dedinje, Department of Cardiology, Belgrade, 11000, Serbia
- Faculty of Medicine, Department of Cardiology, University of Belgrade, University Clinical Center of Serbia, Belgrade, 11000, Serbia
| | - Danilo Obradovic
- Heart Center of Leipzig, University of Leipzig, 04289, Leipzig, Germany
| | - Dragan Matic
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, 11000, Serbia
| | | | | | | | - Sara Radenovic
- Department of Internal Medicine, Cardiology, CVK, Charité University Medicine Berlin, 13353, Berlin, Germany
| | - Arsen D Ristić
- Faculty of Medicine, Department of Cardiology, University of Belgrade, University Clinical Center of Serbia, Belgrade, 11000, Serbia
| | - Danilo Dokic
- Scirent Clinical Research and Science, 13353, Berlin, Germany
| | - Nenad Milošević
- Scirent Clinical Research and Science, 13353, Berlin, Germany
| | - Natasa Panic
- Scirent Clinical Research and Science, 13353, Berlin, Germany
| | - Hans-Dirk Düngen
- Department of Internal Medicine, Cardiology, CVK, Charité University Medicine Berlin, 13353, Berlin, Germany.
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, 13353, Berlin, Germany.
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Mitic V, Stojanovic D, Deljanin Ilic M, Petrovic D, Ignjatovic A, Milenkovic J. Biomarker Phenotypes in Heart Failure with Preserved Ejection Fraction Using Hierarchical Clustering-A Pilot Study. Med Princ Pract 2023; 32:000534155. [PMID: 37734333 PMCID: PMC10659697 DOI: 10.1159/000534155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 09/14/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVES We hypothesized the existence of distinct phenotype-based groups within the very heterogeneous population of patients of heart failure with preserved ejection fraction (HFpEF) and using an unsupervised hierarchical clustering applied to plasma concentration of various biomarkers. We sought to characterize them as "biomarker phenotypes" and to conclude differences in their overall characteristics. SUBJECTS AND METHODS A cross-sectional study was conducted on 75 patients with HFpEF. An agglomerative hierarchical clustering was performed using the concentrations of cardiac remodeling biomarkers, BNP and cystatin C. RESULTS According to the obtained heat map of this analysis, we concluded two distinctive biomarker phenotypes within the HFpEF. The "remodeled phenotype" presented with significantly higher concentrations of cardiac remodeling biomarkers and cystatin C (p < 0.001), higher prevalence of myocardial infarction (p = 0.047), STEMI (p = 0.045), atrial fibrillation (p = 0.047) and anemia: lower erythrocytes count (p=0.037), hemoglobin concentration (p = 0.034) and hematocrit (p = 0.046), compared to "non-remodeled phenotype". Echocardiography showed that patients within "remodeled phenotype" had significantly increased parameters of left ventricular remodeling: left ventricular mass index (p < 0.001), left ventricular mass (p = 0.001), diameters of the interventricular septum (p = 0.027) and posterior wall (p = 0.003) and function alterations, intermediate pauses duration >2.0 seconds (p < 0.006). CONCLUSION Unsupervised hierarchical clustering applied to plasma concentration of various biomarkers in patients with HFpEF enables the identification of two biomarker phenotypes, significantly different in clinical characteristics and cardiac structure and function, whereas one phenotype particularly relates to patients with reduced ejection fraction. These findings imply distinct underlying pathophysiology within a unique cohort of HFpEF.
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Affiliation(s)
- Valentina Mitic
- Department for Cardiovascular Diseases, Institute for Treatment and Rehabilitation “Niska Banja”, Niska Banja, Serbia
| | - Dijana Stojanovic
- Department of Pathophysiology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Marina Deljanin Ilic
- Department for Cardiovascular Diseases, Institute for Treatment and Rehabilitation “Niska Banja”, Niska Banja, Serbia
- Department of Internal Medicine, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Dejan Petrovic
- Department for Cardiovascular Diseases, Institute for Treatment and Rehabilitation “Niska Banja”, Niska Banja, Serbia
- Department of Internal Medicine, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Aleksandra Ignjatovic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Nis, Nis, Serbia
- Center of Informatics and Biostatistics in Healthcare, Institute for Public Health, Nis, Serbia
| | - Jelena Milenkovic
- Department of Pathophysiology, Faculty of Medicine, University of Nis, Nis, Serbia
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Stojanovic D, Stojanovic M, Milenkovic J, Velickov A, Ignjatovic A, Milojkovic M. The Multi-Faceted Nature of Renalase for Mitochondrial Dysfunction Improvement in Cardiac Disease. Cells 2023; 12:1607. [PMID: 37371077 DOI: 10.3390/cells12121607] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
The cellular mechanisms and signaling network that guide the cardiac disease pathophysiology are inextricably intertwined, which explains the current scarcity of effective therapy and to date remains the greatest challenge in state-of-the-art cardiovascular medicine. Accordingly, a novel concept has emerged in which cardiomyocytes are the centerpiece of therapeutic targeting, with dysregulated mitochondria as a critical point of intervention. Mitochondrial dysfunction pluralism seeks a multi-faceted molecule, such as renalase, to simultaneously combat the pathophysiologic heterogeneity of mitochondria-induced cardiomyocyte injury. This review provides some original perspectives and, for the first time, discusses the functionality spectrum of renalase for mitochondrial dysfunction improvement within cardiac disease, including its ability to preserve mitochondrial integrity and dynamics by suppressing mitochondrial ΔΨm collapse; overall ATP content amelioration; a rise of mtDNA copy numbers; upregulation of mitochondrial genes involved in oxidative phosphorylation and cellular vitality promotion; mitochondrial fission inhibition; NAD+ supplementation; sirtuin upregulation; and anti-oxidant, anti-apoptotic, and anti-inflammatory traits. If verified that renalase, due to its multi-faceted nature, behaves like the "guardian of mitochondria" by thwarting pernicious mitochondrial dysfunction effects and exerting therapeutic potential to target mitochondrial abnormalities in failing hearts, it may provide large-scale benefits for cardiac disease patients, regardless of the underlying causes.
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Affiliation(s)
- Dijana Stojanovic
- Department of Pathophysiology, Faculty of Medicine, University of Nis, 18000 Nis, Serbia
| | - Miodrag Stojanovic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Nis, 18000 Nis, Serbia
- Center of Informatics and Biostatistics in Healthcare, Institute for Public Health, 18000 Nis, Serbia
| | - Jelena Milenkovic
- Department of Pathophysiology, Faculty of Medicine, University of Nis, 18000 Nis, Serbia
| | - Aleksandra Velickov
- Department of Histology and Embryology, Faculty of Medicine, University of Nis, 18000 Nis, Serbia
| | - Aleksandra Ignjatovic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Nis, 18000 Nis, Serbia
- Center of Informatics and Biostatistics in Healthcare, Institute for Public Health, 18000 Nis, Serbia
| | - Maja Milojkovic
- Department of Pathophysiology, Faculty of Medicine, University of Nis, 18000 Nis, Serbia
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Stankovic M, Stojanovic A, Ignjatovic A, Elsabbagh M, Gonzalez M, Yusuf A, Ibrahim A, Shikako-Thomas K, Stojanov J, Stankovic M. THE CHALLENGES OF CAREGIVERS OF CHILDREN WITH AUTISM SPECTRUM DISORDERS COMORBIDITY DURING THE COVID-19 PANDEMIC IN SERBIA. Psychiat Danub 2022; 34:587-594. [DOI: 10.24869/psyd.2022.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Stojanovic D, Mitic V, Stojanovic M, Milenkovic J, Ignjatovic A, Milojkovic M. The Scientific Rationale for the Introduction of Renalase in the Concept of Cardiac Fibrosis. Front Cardiovasc Med 2022; 9:845878. [PMID: 35711341 PMCID: PMC9193824 DOI: 10.3389/fcvm.2022.845878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/25/2022] [Indexed: 12/17/2022] Open
Abstract
Cardiac fibrosis represents a redundant accumulation of extracellular matrix proteins, resulting from a cascade of pathophysiological events involved in an ineffective healing response, that eventually leads to heart failure. The pathophysiology of cardiac fibrosis involves various cellular effectors (neutrophils, macrophages, cardiomyocytes, fibroblasts), up-regulation of profibrotic mediators (cytokines, chemokines, and growth factors), and processes where epithelial and endothelial cells undergo mesenchymal transition. Activated fibroblasts and myofibroblasts are the central cellular effectors in cardiac fibrosis, serving as the main source of matrix proteins. The most effective anti-fibrotic strategy will have to incorporate the specific targeting of the diverse cells, pathways, and their cross-talk in the pathogenesis of cardiac fibroproliferation. Additionally, renalase, a novel protein secreted by the kidneys, is identified. Evidence demonstrates its cytoprotective properties, establishing it as a survival element in various organ injuries (heart, kidney, liver, intestines), and as a significant anti-fibrotic factor, owing to its, in vitro and in vivo demonstrated pleiotropy to alleviate inflammation, oxidative stress, apoptosis, necrosis, and fibrotic responses. Effective anti-fibrotic therapy may seek to exploit renalase’s compound effects such as: lessening of the inflammatory cell infiltrate (neutrophils and macrophages), and macrophage polarization (M1 to M2), a decrease in the proinflammatory cytokines/chemokines/reactive species/growth factor release (TNF-α, IL-6, MCP-1, MIP-2, ROS, TGF-β1), an increase in anti-apoptotic factors (Bcl2), and prevention of caspase activation, inflammasome silencing, sirtuins (1 and 3) activation, and mitochondrial protection, suppression of epithelial to mesenchymal transition, a decrease in the pro-fibrotic markers expression (’α-SMA, collagen I, and III, TIMP-1, and fibronectin), and interference with MAPKs signaling network, most likely as a coordinator of pro-fibrotic signals. This review provides the scientific rationale for renalase’s scrutiny regarding cardiac fibrosis, and there is great anticipation that these newly identified pathways are set to progress one step further. Although substantial progress has been made, indicating renalase’s therapeutic promise, more profound experimental work is required to resolve the accurate underlying mechanisms of renalase, concerning cardiac fibrosis, before any potential translation to clinical investigation.
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Affiliation(s)
- Dijana Stojanovic
- Institute of Pathophysiology, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Valentina Mitic
- Department of Cardiovascular Rehabilitation, Institute for Treatment and Rehabilitation "Niska Banja", Niska Banja, Serbia
| | - Miodrag Stojanovic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Niš, Niš, Serbia.,Center of Informatics and Biostatistics in Healthcare, Institute for Public Health, Niš, Serbia
| | - Jelena Milenkovic
- Institute of Pathophysiology, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Aleksandra Ignjatovic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Niš, Niš, Serbia.,Center of Informatics and Biostatistics in Healthcare, Institute for Public Health, Niš, Serbia
| | - Maja Milojkovic
- Institute of Pathophysiology, Faculty of Medicine, University of Niš, Niš, Serbia
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7
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Ljubisavljevic M, Ignjatovic A, Djordjevic V, Pesic MH, Ljubisavljevic S. Depression, Anxiety, Stress, and Health-Related Quality of Life Among Patients With Medication Overuse Headache in a Tertiary Headache Center: A Cross-Sectional Study. J Neuropsychiatry Clin Neurosci 2022; 33:132-143. [PMID: 33626886 DOI: 10.1176/appi.neuropsych.20070189] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The investigators examined the association of patient-related and headache-related parameters and the effect of medication overuse headache (MOH); the occurrence of depression, anxiety, and stress; and the importance of different domains of health-related quality of life in these associations. METHODS Eighty-three patients (women, N=72, men, N=11; mean age, 40.54 years, SD=11.58), who were first diagnosed with MOH during the study period were included in the analyses. The Headache Impact Test-6 (HIT-6), the 36-item Short-Form Survey (SF-36) Questionnaire for quality of life, and the Depression Anxiety Stress Scales were used. RESULTS The findings revealed mild depression, moderate anxiety, and stress, as well as changes in all examined health domains, in the study patients (p<0.05). Risk factors were identified for higher HIT-6 scores (role functioning/physical functioning [odds ratio=0.977, p=0.024] and social functioning [odds ratio=0.963, p=0.032]); for depression (emotional well-being [odds ratio=0.928, p=0.007], social functioning [odds ratio=0.950, p=0.009], and the presence of comorbidity [odds ratio=5.417, p=0.013]); for anxiety (age [odds ratio=1.091, p=0.007], MOH duration [odds ratio=1.422, p=0.047], emotional well-being [odds ratio=0.933, p=0.012], and social functioning [odds ratio=0.943, p=0.001]); and for stress (emotional well-being [odds ratio=0.902, p<0.001]). CONCLUSIONS MOH has a significant negative impact on the personal, family, and social life of patients and is associated with depression, anxiety, and stress. Patients' age, duration of MOH, presence of comorbidities, and adverse effects of physical, emotional, and social dysfunction are particularly important contributors to the negative effects of MOH.
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Affiliation(s)
- Marina Ljubisavljevic
- Center for Mental Health Protection, Clinical Center of Niš, Niš, Serbia (M. Ljubisavljevic, Djordjevic); Faculty of Medicine, University of Niš, Niš, Serbia (Ignjatovic, Djordjevic, S. Ljubisavljevic); Institute for Public Health, Niš, Serbia (Ignjatovic); Faculty of Phylosophy, University of Niš, Niš, Serbia (Hadzi Pesic); and Clinic for Neurology, Clinical Center of Niš, Niš, Serbia (S. Ljubisavljevic)
| | - Aleksandra Ignjatovic
- Center for Mental Health Protection, Clinical Center of Niš, Niš, Serbia (M. Ljubisavljevic, Djordjevic); Faculty of Medicine, University of Niš, Niš, Serbia (Ignjatovic, Djordjevic, S. Ljubisavljevic); Institute for Public Health, Niš, Serbia (Ignjatovic); Faculty of Phylosophy, University of Niš, Niš, Serbia (Hadzi Pesic); and Clinic for Neurology, Clinical Center of Niš, Niš, Serbia (S. Ljubisavljevic)
| | - Vladimir Djordjevic
- Center for Mental Health Protection, Clinical Center of Niš, Niš, Serbia (M. Ljubisavljevic, Djordjevic); Faculty of Medicine, University of Niš, Niš, Serbia (Ignjatovic, Djordjevic, S. Ljubisavljevic); Institute for Public Health, Niš, Serbia (Ignjatovic); Faculty of Phylosophy, University of Niš, Niš, Serbia (Hadzi Pesic); and Clinic for Neurology, Clinical Center of Niš, Niš, Serbia (S. Ljubisavljevic)
| | - Marina Hadzi Pesic
- Center for Mental Health Protection, Clinical Center of Niš, Niš, Serbia (M. Ljubisavljevic, Djordjevic); Faculty of Medicine, University of Niš, Niš, Serbia (Ignjatovic, Djordjevic, S. Ljubisavljevic); Institute for Public Health, Niš, Serbia (Ignjatovic); Faculty of Phylosophy, University of Niš, Niš, Serbia (Hadzi Pesic); and Clinic for Neurology, Clinical Center of Niš, Niš, Serbia (S. Ljubisavljevic)
| | - Srdjan Ljubisavljevic
- Center for Mental Health Protection, Clinical Center of Niš, Niš, Serbia (M. Ljubisavljevic, Djordjevic); Faculty of Medicine, University of Niš, Niš, Serbia (Ignjatovic, Djordjevic, S. Ljubisavljevic); Institute for Public Health, Niš, Serbia (Ignjatovic); Faculty of Phylosophy, University of Niš, Niš, Serbia (Hadzi Pesic); and Clinic for Neurology, Clinical Center of Niš, Niš, Serbia (S. Ljubisavljevic)
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Stajic Z, Milicevic D, Kafedzic S, Aleksic A, Cerovic M, Tasic M, Andjelkovic Apostolovic M, Ignjatovic A, Zornic N, Obradovic G, Jovanovic V, Jagic N, Neskovic AN, Davidovic G. Predicting no-reflow phenomenon prior to primary percutaneous coronary intervention using a novel probability risk score derived from clinical and angiographic parameters. Eur Rev Med Pharmacol Sci 2022; 26:759-770. [PMID: 35179742 DOI: 10.26355/eurrev_202202_27984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE We aimed to create a clinically usable probability risk score for prediction of no-reflow (NRF) phenomenon prior to primary percutaneous coronary intervention (PPCI). PATIENTS AND METHODS This single-center and retrospective study included 1254 patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent PPCI. Patients were randomly assigned into two groups in the ratio 2:1, the derivation dataset (n=840) and validation dataset (n=414). Independent predictors of NRF were identified and combined to create a prediction model using univariate and multivariate regression analysis in the derivation dataset. The risk score was tested and validated by calculating area under the receiver operating characteristic (ROC) curves in the derivation and validation datasets, respectively. RESULTS Five significant, independent predictors of NRF were identified: age ≥ 65 years (odds ratio [OR]: 2.473, 95% confidence interval [CI]: 0.389-1.484, p < 0.01), heart rate ≥ 89 bpm (odds ratio [OR]: 1.622, 95% confidence interval [CI]: 0.024-0.945, p < 0.05), Killip class ≥ II (odds ratio [OR]: 1.914, 95% confidence interval [CI]: 0.024-1.306, p < 0.01), total ischemic time ≥ 268 min (odds ratio [OR]: 2.652, 95% confidence interval [CI]: 0.493-1.565, p < 0.01), and thrombus burden G≥4 (odds ratio [OR]: 8.351, 95% confidence interval [CI]: 0.344-15.901, p < 0.01). The risk score was created combining these predictors with assigned points. The overall score ranged from 0 to 17 points. The optimal cutoff value of the risk score was 11 points (area under curve [AUC]: 0.772, 95% confidence interval [CI]: 0.729-0.815, sensitivity 71.21%, specificity 70.34%, positive predictive value 30.92%, negative predictive value 92.91%, p < 0.001). The ROC curve for the validation group showed good discriminant power. CONCLUSIONS We developed a novel risk score based on five clinical and angiographic parameters, which might be a useful clinical tool for prediction of NRF in STEMI patients prior to PPCI with an acceptable accuracy.
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Affiliation(s)
- Z Stajic
- Department of Cardiology, Clinical Hospital Center Zemun, Belgrade, Serbia.
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Stojanovic D, Mitic V, Stojanovic M, Petrovic D, Ignjatovic A, Milojkovic M, Dunjic O, Milenkovic J, Bojanic V, Deljanin Ilic M. The Discriminatory Ability of Renalase and Biomarkers of Cardiac Remodeling for the Prediction of Ischemia in Chronic Heart Failure Patients With the Regard to the Ejection Fraction. Front Cardiovasc Med 2021; 8:691513. [PMID: 34395559 PMCID: PMC8358392 DOI: 10.3389/fcvm.2021.691513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/10/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Renalase has been implicated in chronic heart failure (CHF); however, nothing is known about renalase discriminatory ability and prognostic evaluation. The aims of the study were to assess whether plasma renalase may be validated as a predictor of ischemia in CHF patients stratified to the left ventricular ejection fraction (LVEF) and to determine its discriminatory ability coupled with biomarkers representing a range of heart failure (HF) pathophysiology: brain natriuretic peptide (BNP), soluble suppressor of tumorigenicity (sST2), galectin-3, growth differentiation factor 15 (GDF-15), syndecan-1, and cystatin C. Methods: A total of 77 CHF patients were stratified according to the LVEF and were subjected to exercise stress testing. Receiver operating characteristic curves were constructed, and the areas under curves (AUC) were determined, whereas the calibration was evaluated using the Hosmer-Lemeshow statistic. A DeLong test was performed to compare the AUCs of biomarkers. Results: Independent predictors for ischemia in the total HF cohort were increased plasma concentrations: BNP (p = 0.008), renalase (p = 0.012), sST2 (p = 0.020), galectin-3 (p = 0.018), GDF-15 (p = 0.034), and syndecan-1 (p = 0.024), whereas after adjustments, only BNP (p = 0.010) demonstrated predictive power. In patients with LVEF <45% (HFrEF), independent predictors of ischemia were BNP (p = 0.001), renalase (p < 0.001), sST2 (p = 0.004), galectin-3 (p = 0.003), GDF-15 (p = 0.001), and syndecan-1 (p < 0.001). The AUC of BNP (0.837) was statistically higher compared to those of sST2 (DeLong test: p = 0.042), syndecan-1 (DeLong: p = 0.022), and cystatin C (DeLong: p = 0.022). The AUCs of renalase (0.753), galectin-3 (0.726), and GDF-15 (0.735) were similar and were non-inferior compared to BNP, regarding ischemia prediction. In HFrEF patients, the AUC of BNP (0.980) was statistically higher compared to those of renalase (DeLong: p < 0.001), sST2 (DeLong: p < 0.004), galectin-3 (DeLong: p < 0.001), GDF-15 (DeLong: p = 0.001), syndecan-1 (DeLong: p = 0.009), and cystatin C (DeLong: p = 0.001). The AUC of renalase (0.814) was statistically higher compared to those of galectin-3 (DeLong: p = 0.014) and GDF-15 (DeLong: p = 0.046) and similar to that of sST2. No significant results were obtained in the patients with LVEF >45%. Conclusion: Plasma renalase concentration provided significant discrimination for the prediction of ischemia in patients with CHF and appeared to have similar discriminatory potential to that of BNP. Although further confirmatory studies are warranted, renalase seems to be a relevant biomarker for ischemia prediction, implying its potential contribution to ischemia-risk stratification.
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Affiliation(s)
- Dijana Stojanovic
- Institute of Pathophysiology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Valentina Mitic
- Department of Cardiovascular Rehabilitation, Institute for Treatment and Rehabilitation "Niska Banja", Niska Banja, Serbia
| | - Miodrag Stojanovic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Nis, Nis, Serbia.,Center of Informatics and Biostatistics in Healthcare, Institute for Public Health, Nis, Serbia
| | - Dejan Petrovic
- Department of Cardiovascular Rehabilitation, Institute for Treatment and Rehabilitation "Niska Banja", Niska Banja, Serbia.,Department of Internal Medicine, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Aleksandra Ignjatovic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Nis, Nis, Serbia.,Center of Informatics and Biostatistics in Healthcare, Institute for Public Health, Nis, Serbia
| | - Maja Milojkovic
- Institute of Pathophysiology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Olivera Dunjic
- Institute of Pathophysiology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Jelena Milenkovic
- Institute of Pathophysiology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Vladmila Bojanic
- Institute of Pathophysiology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Marina Deljanin Ilic
- Department of Cardiovascular Rehabilitation, Institute for Treatment and Rehabilitation "Niska Banja", Niska Banja, Serbia.,Department of Internal Medicine, Faculty of Medicine, University of Nis, Nis, Serbia
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Stankovic S, Vukovic R, Vorgucin I, Zdravkovic V, Folic N, Zivic S, Ignjatovic A, Rancic N, Milenkovic T, Todorovic S, Mitrovic K, Jesic M, Sajic S, Bojic V, Katanic D, Dautovic S, Cvetkovic V, Saranac L, Markovic S, Tucakovic T, Lesovic S, Ljubojevic M, Ilic T, Vrebalov M, Mikic M, Jelenkovic B, Petrovic R, Saric S, Simić D, Cukanovic M, Stankovic M. First report on the nationwide prevalence of paediatric type 1 diabetes in Serbia and temporal trends of diabetes ketoacidosis at diagnosis-a multicentre study. J Pediatr Endocrinol Metab 2021; 34:225-229. [PMID: 33544544 DOI: 10.1515/jpem-2020-0405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/15/2020] [Indexed: 12/30/2022]
Abstract
We aimed to collect data on all paediatric patients who were diagnosed with type 1 diabetes mellitus (T1DM) between the years 2000 and 2019 in Serbia and estimate for the first time its prevalence. Also, the trends of diabetes ketoacidosis (DKA) occurrence at the time of diagnosis are monitored. We collected and retrospectively analysed the data of patients <19 years with newly diagnosed T1DM. T1DM was diagnosed in 3134 patients (53.2% male). Total number of youth <19 years with T1DM was 1735 with prevalence of 135.25/100000 at the end of study period. T1DM was diagnosed most frequently between the ages of 5 and 11 years (42.1%). At the time of diagnosis, 35.7% presented in DKA. The incidence and severity of DKA were more significant at the youngest age (p<0.001). There were significant annual percentage increase (2.2%) in the number of new cases of DKA (p=0.007). Conclusion: This first report of nationwide prevalence of T1DM in youth shows that Serbia is among countries with high prevalence of T1DM in youth. System changes are needed in order to provide better quality of health care to these patients.
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Affiliation(s)
- Sandra Stankovic
- Pediatric Endocrinology, Children Clinic, Medical Faculty, Nis, Serbia
| | - Rade Vukovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Belgrade, Serbia
| | - Ivana Vorgucin
- Endocrinology, Institute for Children and Youth Health Care of Vojvodina, Medical Faculty, Novi Sad, Serbia
| | - Vera Zdravkovic
- Department of Endocrinology, University Children Hospital, Medical Faculty, Belgrade, Serbia
| | - Nevena Folic
- Paediatric Clinic, Clinical Centre Kragujevac, Medical Faculty, University of Kragujevac, Serbia
| | - Sasa Zivic
- Department of Endocrinology, Pediatric Clinic, Faculty of Medicine Nis, University of Nis, Nis, Serbia
| | - Aleksandra Ignjatovic
- Department of Medical Statistics, University of Niš, Faculty of Medicine Niš, Nis, Serbia
| | - Natasa Rancic
- Epidemiology, University of Nis Faculty of Medicine, Nis, Serbia
| | - Tatjana Milenkovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Belgrade, Serbia
| | - Slađana Todorovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Belgrade, Serbia
| | - Katarina Mitrovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Belgrade, Serbia
| | - Maja Jesic
- Department of Endocrinology, University Children Hospital, Medical Faculty, Belgrade, Serbia
| | - Silvija Sajic
- Department of Endocrinology, University Children Hospital, Medical Faculty, Belgrade, Serbia
| | - Vlada Bojic
- Department of Endocrinology, University Children Hospital, Medical Faculty, Belgrade, Serbia
| | - Dragan Katanic
- Endocrinology, Institute for Children and Youth Health Care of Vojvodina, Medical Faculty, Novi Sad, Serbia
| | - Slavica Dautovic
- Endocrinology, Institute for Children and Youth Health Care of Vojvodina, Novi Sad, Serbia
| | | | - Ljiljana Saranac
- Department of Endocrinology, Pediatric Clinic, Faculty of Medicine Nis, University of Nis, Nis, Serbia
| | - Slavica Markovic
- Paediatric Clinic, Clinical Centre Kragujevac, Medical Faculty, University of Kragujevac, Serbia
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Ljubisavljevic M, Ignjatovic A, Ljubisavljevic S. The Ruminative Thought Style with Associated Anxiety Influences the Occurrence of Medication-Overuse Headache. J Clin Neurol 2021; 17:419-427. [PMID: 34184450 PMCID: PMC8242321 DOI: 10.3988/jcn.2021.17.3.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE To determine the relationships between the ruminative thought style, parameters of psychological distress, and the occurrence of medication-overuse headache (MOH). METHODS The study included 164 subjects: 83 patients (11 males and 72 females) who were first diagnosed as MOH, and 81 healthy subjects (22 males and 59 females) as a control group (CG). The study participants were aged 40.2±11.9 years (mean±standard deviation), and they were assessed using the Ruminative Thought Style Questionnaire and Depression Anxiety Stress Scales. RESULTS The degree of rumination was higher in patients with MOH than in the CG (p<0.001). Among patients with MOH, females, patients with comorbidities, and those who overuse combined analgesic therapy had a higher degree of rumination (p=0.038, p=0.008, and p=0.015, respectively). In both the MOH patients and CG, the degree of rumination was directly correlated with depression, anxiety, and stress (r=0.473-0.557, p<0.001, for MOH; r=0.303-0.322, p<0.005, for CG). Rumination and anxiety were associated with MOH [odds ratio (OR)=1.123, 95% confidence interval (CI)=1.071-1.178, p<0.001; OR=1.091, 95% CI=1.005-1.185, p=0.039; respectively]. The analysis of the mediation model showed that the link between rumination and MOH is largely direct (86%), and to a lesser extent is additionally influenced by anxiety as a mediator (14%). CONCLUSIONS A ruminative thought style is associated with MOH both directly and via anxiety. Psychological strategies aimed at decreasing ruminative responses and anxiety could be useful in the prevention of MOH in selected patients.
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Affiliation(s)
| | | | - Srdjan Ljubisavljevic
- Faculty of Medicine, University of Niš, Clinic for Neurology, University Clinical Center of Niš, Niš, Serbia.
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Stojanovic D, Mitic V, Stojanovic M, Petrovic D, Ignjatovic A, Stefanovic N, Cvetkovic T, Kocic G, Bojanic V, Deljanin Ilic M. The partnership between renalase and ejection fraction as a risk factor for increased cardiac remodeling biomarkers in chronic heart failure patients. Curr Med Res Opin 2020; 36:909-919. [PMID: 32297799 DOI: 10.1080/03007995.2020.1756233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective: Heart failure (HF) represents a huge socio-economic burden. It has been demonstrated, experimentally, that renalase, a newly discovered protein, prevents cardiac hypertrophy and adverse remodeling, which is seen in HF. We postulated the following aims: to investigate associations of renalase with biomarkers of cardiac remodeling: galectin-3, soluble suppression of tumorigenicity, (sST2), growth differentiation factor 15 (GDF-15) and syndecan-1, myocardial stretch (BNP) and cardio-renal axis (cystatin C) in HF patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) to determine whether renalase, in combination with left ventricular ejection fraction (LVEF), represents a risk factor for plasma elevation in biomarkers.Methods: We classified HF patients (n = 76) according to LVEF (preserved/reduced), applied a median plasma renalase (113 ng/mL) as a cut-off value (low/high) and created four subgroups of HF patients: HFpEF/low renalase (n = 19), HFrEF/low renalase (n = 19), HFrEF/high renalase (n = 32) and HFpEF/high renalase (n = 6). A control group (n = 35) consisted of healthy volunteers.Results: Plasma concentrations of evaluated biomarkers were determined using an ELISA technique and were highest in HF patients with reduced EF (p < .001, respectively), and renalase's positive correlations were obtained relating to all biomarkers: galectin-3 (r = 0.913; p < .001), sST2 (r = 0.965; p < .001), GDF-15 (r = 0.887; p < .001), syndecan-1 (r = 0.922; p < .001), BNP (r = 0.527; p < .001) and cystatin C (r = 0.844; p < .001) and strong and negative correlation with LVEF (r = -0.456, p < .001). Increased renalase, regardless of the EF (preserved/reduced), was shown to be an independent risk factor for an increase in all evaluated cardiac remodeling biomarkers, p < .001, respectively. However, increased renalase and reduced EF was the only independent risk factor for BNP and cystatin C elevation, p < .001, respectively. Results after multivariable adjustments (age/gender) were identical.Conclusion: When elevated plasma renalase and HF are present, regardless of EF being reduced or preserved, that represents a significant risk factor for increase in cardiac remodeling biomarker plasma concentrations. However, only elevated renalase and reduced EF demonstrated significance as a risk factor for BNP and cystatin C plasma elevation. Renalase may be considered a promising molecule for the improved predictive abilities of conventional biomarkers and is worthy of further investigation.
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Affiliation(s)
- Dijana Stojanovic
- Faculty of Medicine, Institute of Pathophysiology, University of Nis, Nis, Serbia
| | - Valentina Mitic
- Institute for Treatment and Rehabilitation "Niska Banja", Niška Banja, Serbia
| | - Miodrag Stojanovic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Nis, Nis, Serbia
- Institute for Public Health, Nis, Serbia
| | - Dejan Petrovic
- Institute for Treatment and Rehabilitation "Niska Banja", Niška Banja, Serbia
- Department of Internal Medicine, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Aleksandra Ignjatovic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Nis, Nis, Serbia
- Institute for Public Health, Nis, Serbia
| | - Nikola Stefanovic
- Department of Pharmacy, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Tatjana Cvetkovic
- Faculty of Medicine, Institute of Biochemistry, University of Nis, Nis, Serbia
| | - Gordana Kocic
- Faculty of Medicine, Institute of Biochemistry, University of Nis, Nis, Serbia
| | - Vladmila Bojanic
- Faculty of Medicine, Institute of Pathophysiology, University of Nis, Nis, Serbia
| | - Marina Deljanin Ilic
- Institute for Treatment and Rehabilitation "Niska Banja", Niška Banja, Serbia
- Department of Internal Medicine, Faculty of Medicine, University of Nis, Nis, Serbia
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Ljubisavljevic S, Ignjatovic A, Ljubisavljevic M. Headache secondary to nontraumatic brain hemorrhage: a single-center, retrospective clinical study. Arch Med Sci 2019; 19:1028-1036. [PMID: 37560737 PMCID: PMC10408032 DOI: 10.5114/aoms.2019.90356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/14/2019] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION The predictive accuracy of clinical and paraclinical findings for headache occurrence in patients having nontraumatic intracerebral hemorrhage (ICH) was tested. MATERIAL AND METHODS The medical records of 341 consecutive nontraumatic ICH patients (106 females and 235 males), average age 56.2 ±7.7 years, presenting with headache (25.5%) and without a headache (74.5%), over a period of 5 years, were retrospectively analyzed. RESULTS The presence of focal neurological symptoms (OR = 0.129, 95% CI: 0.044-0.372, p = 0.000), loss of consciousness (OR = 0.174, 95% CI: 0.060-0.504, p = 0.001), body temperature (OR = 0.586, 95% CI: 0.389-0.882, p = 0.010), and the values of C-reactive protein (OR = 0.989, 95% CI: 0.978-0.999, p = 0.048) at admission, as well as the presence of hematoma in the basal ganglia (OR = 0.308, 95% CI: 0.159-0.596, p = 0.000) and the presence of arterial hypertension in the medical history (OR = 0.478, 95% CI: 0.230-0.991, p = 0.047), are recognized as negative predictors for headache occurrence in ICH. The regular use of antihypertensive therapy is a prominent positive predictor for headache occurrence in ICH (OR = 1.906, 95% CI: 1.075-3.381, p = 0.027). Patients presenting with headache had a favorable clinical outcome compared to those without headache in ICH presentation (p < 0.001). CONCLUSIONS The present results might be clinically useful for considering further diagnostic and therapeutic procedures as early as possible in patients with symptoms clinically suggestive of ICH, with and without headache in ICH clinical presentation. These data require confirmation in a prospective large-scale study.
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Affiliation(s)
- Srdjan Ljubisavljevic
- Faculty of Medicine, University of Nis, Nis, Serbia
- Clinic for Neurology, Clinical Center Nis, Nis, Serbia
| | - Aleksandra Ignjatovic
- Faculty of Medicine, University of Nis, Nis, Serbia
- Institute for Public Health, Nis, Serbia
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Radovanović-Dinić B, Tešić-Rajković S, Ignjatovic A, Grgov S. Thrombin activatable fibrinolysis inhibitor as an indicator of the severity of acute pancreatitis. Turk J Gastroenterol 2018; 29:488-493. [PMID: 30249565 DOI: 10.5152/tjg.2018.17666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS Thrombin Activatable Fibrinolysis Inhibitor (TAFI), in addition to suppressing fibrinolysis, can be involved as a natural anti-inflammatory molecule in the inflammatory process in acute pancreatitis (AP). The goal of this study was to discover the significance of early determination of the values of TAFI in the assessment of the severity of AP. MATERIALS AND METHODS The prospective study included 92 patients with AP. In accordance with the revised Atlanta classification, we divided all patients into 3 groups (I-mild AP, II- moderate AP and III-severe AP). All patients were further classified into group A (mild AP) and group B (moderate and severe AP) with the aim of separating the patients with complicated and potentially bad prognosis. Biochemical markers, inflammatory biomarkers, coagulation parameters and TAFI were analyzed in all patients. RESULTS The level of TAFI were significantly higher among the patients with the complicated form (group B) of AP (p=0.002). The analysis of the ROC curve in regard to the inflammatory biomarkers (fibronectin and CRP) has shown that TAFI possesses the best discriminatory ability for complicated forms of AP (AUC=0.724, p=0.013), with the sensitivity of 83.30% and the specificity of 56.00%. CONCLUSION The level of TAFI in plasma is higher in patients with moderate or severe AP. Determining the level of TAFI as a single parameter has a greater significance in the early estimation of the severity of AP than inflammatory biomarkers that we have analyzed.
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Affiliation(s)
- Biljana Radovanović-Dinić
- Clinic for Gastroenterology and Hepatology, Clinical Centre, Niš, Serbia; University of Niš School of Medicine, Niš, Serbia
| | | | - Aleksandra Ignjatovic
- University of Niš School of Medicine, Niš, Serbia; Department of Medical Statistics, University of Niš School of Medicine, Niš, Serbia
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Tiodorovic-Zivkovic D, Argenziano G, Lallas A, Thomas L, Ignjatovic A, Rabinovitz H, Moscarella E, Longo C, Hofmann-Wellenhof R, Zalaudek I. Age, gender, and topography influence the clinical and dermoscopic appearance of lentigo maligna. J Am Acad Dermatol 2015; 72:801-8. [DOI: 10.1016/j.jaad.2015.01.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/16/2015] [Accepted: 01/19/2015] [Indexed: 12/17/2022]
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East JE, Ignjatovic A, Suzuki N, Guenther T, Bassett P, Tekkis PP, Saunders BP. A randomized, controlled trial of narrow-band imaging vs high-definition white light for adenoma detection in patients at high risk of adenomas. Colorectal Dis 2012; 14:e771-8. [PMID: 22958651 DOI: 10.1111/codi.12014] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM The study aimed to investigate whether narrow-band imaging (NBI) can enhance adenoma detection in patients at high risk for adenomas compared with high-definition white-light endoscopy (WLE). High risk was defined as three or more adenomas at last colonoscopy, history of colorectal cancer and positive faecal occult blood test. METHOD Two hundred and fourteen patients were randomized 1:1 to examination with NBI or WLE. The primary outcome measure was the proportion of patients with at least one adenoma detected. Secondary outcomes included total adenomas and polyps, flat adenomas, nonadenomatous polyps, advanced adenomas and patients with three or five or more adenomas. A post hoc analysis to examine the effect of endoscopist and bowel preparation was performed. RESULTS There was no significant difference in the proportion of patients with at least one adenoma: NBI 73%vs WLE 66%, odds ratio 1.40 (95% CI 0.78-2.52), P = 0.26. There was no significant difference for any secondary outcome measure except for the number of flat adenomas which was significantly greater with NBI [comparison ratio 2.66 (95% CI 1.52-4.63), P = 0.001]. Post hoc analysis indicated that one of three endoscopists performed significantly better for adenoma detection with NBI than WLE [comparison ratio 1.92 (95% CI 1.07-3.44), P = 0.03]. Good bowel preparation was associated with significantly improved adenoma detection with NBI [comparison ratio 1.55 (95% CI 1.01-2.22), P = 0.04] but not with fair preparation. CONCLUSION Overall NBI did not improve detection compared with WLE in a group of patients at high risk for colorectal adenomas, but specific subgroups might benefit.
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Affiliation(s)
- J E East
- Wolfson Unit for Endoscopy, St Mark's Hospital, Imperial College London, London, UK
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Adamczak M, Koleganova N, Nyengaard JR, Ritz E, Wiecek A, Slabiak Blaz N, Yi Chun DX, Alexandre H, Sandrine GS, Olivier T, Isabelle E, Christophe L, Guy T, Pierre Francois W, Jean-Philippe R, Yvon L, Eric R, Muller-Krebs S, Muller-Krebs S, Weber L, Tsobaneli J, Reiser J, Zeier M, Schwenger V, Tinel C, Samson M, Bonnotte B, Mousson C, Machcinska M, Machcinska M, Bocian K, Wyzgal M, Korczak-Kowalska G, Ju MK, Huh KH, Park KT, Kim SJ, Cho BH, Kim CD, So BJ, Leee S, Kang CM, Joo DJ, Kim YS, Bocian K, Zarzycki M, Sobich A, Korczak-Kowalska G, Matsuyama M, Hase T, Yoshimura R, Koshino K, Sakai K, Suzuki T, Nobori S, Ushigome H, Brikci-Nigassa L, Chargui J, Touraine JL, Yoshimura N, Cantaluppi V, Medica D, Figliolini F, Migliori M, Mannari C, Dellepiane S, Quercia AD, Randone O, Tamagnone M, Messina M, Manzione AM, Ranghino A, Biancone L, Segoloni GP, Camussi G, Turk TR, Zou X, Rauen U, De Groot H, Amann K, Kribben A, Eckardt KU, Bernhardt WM, Witzke O, Lidia G, Wouter C, Yvon L, Eric A, Yann LM, Guy T, Christian N, Marie E, Pierre M, Zineb A, Miriana D, Annick M, Marc A, Daniel A, Wornle M, Ribeiro A, Motamedi N, Grone HJ, Cohen CD, Schlondorff D, Schmid H, Teplan V, Banas M, Banas B, Steege A, Bergler T, Kruger B, Schnulle P, Yard B, Kramer BK, Hoger S, Xavier MP, Sampaio-Norton S, Gaiao S, Alves H, Oliveira G, Xavier MP, Sampaio-Norton S, Gaiao S, Alves H, Oliveira G, Xavier MP, Sampaio-Norton S, Gaiao S, Alves H, Oliveira G, Zaza G, Rascio F, Pontrelli P, Granata S, Rugiu C, Grandaliano G, Lupo A, Wohlfahrtova M, Wohlfahrtova M, Brabcova I, Balaz P, Janousek L, Lodererova A, Honsova E, Wohlfahrt P, Viklicky O, Grabner A, Grabner A, Kentrup D, Edemir B, Sirin Y, Pavenstadt H, Schober O, Schlatter E, Schafers M, Schnockel U, Reuter S, Rascio F, Pontrelli P, Accetturo M, Gigante M, Gigante M, Tataranni T, Zito A, Schena A, Schena FP, Stallone G, Gesualdo L, Grandaliano G, Maillard N, Masson I, Lena A, Manolie M, Eric A, Christophe M, Lassen CK, Keller AK, Moldrup U, Bibby BM, Jespersen B, Cvetkovic T, Velickovic Radovanovic R, Pavlovic R, Djordjevic V, Vlahovic P, Stefanovic N, Sladojevic N, Ignjatovic A, Rong S, Menne J, Haller H, Suszdak P, Tomczuk P, Gueler F, Nelli S, Sara D, Salma EK, Naoufal M, Tarik M, Mohamed Z, Guislaine M, Mohamed Gharbi B, Benyounes R, Lu X, Rong S, Shushakova N, Menne J, Kirsch T, Haller H, Gueler F, Bockmeyer CL, Bockmeyer CL, Ramackers W, Wittig J, Agustian PA, Klose J, Dammrich ME, Kreipe H, Brocker V, Winkler M, Becker JU, Agustian PA, Bockmeyer CL, Wittig J, Becker JU, Bockmeyer CL. Transplantation - basic. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Riegersperger M, Plischke M, Steiner-Boker S, Seidinger D, Winkelmayer W, Sunder-Plassmann G, Vlahovic P, Vlahovic P, Cvetkovic T, Djordjevic V, Velickovic-Radovanovic R, Stefanovic N, Ignjatovic A, Sladojevic N, Cademartori V, Massarino F, Parodi EL, Russo R, Sofia A, Fontana I, Viviani GL, Garibotto G, Mai M, Mai W, Taner B, Wadei H, Prendergast M, Gonwa T, Martin J, Martin J, Aurore S, Aline CS, Nicolas M, Manolie M, Catherine S, Eric A, Christophe M, Brakemeier S, Liefeldt L, Glander P, Waiser J, Lachmann N, Schonemann C, Zukunft B, Illigens P, Schmidt D, Wu K, Rudolph B, Neumayer HH, Budde K, Pallardo Mateu L, Gavela Martinez E, Sancho Calabuig A, Crespo Albiach J, Beltran Catalan S, Gavela Martinez E, Kanter Berga J, Kimura T, Yagisawa T, Ishikawa N, Sakuma Y, Hujiwara T, Nukui A, Yashi M, Duraes J, Malheiro J, Fonseca I, Rocha A, Martins LS, Almeida M, Dias L, Castro-Henriques A, Cabrita A, Mai M, Mai W, Wadei H, Prendergast M, Gonwa T, Volpe A, Quaglia M, Menegotto A, Fenoglio R, Izzo C, Airoldi A, Terrone C, Stratta P, Ahmed B, Mireille K, Nilufer B, Annick M, Karl Martin W, Anh-Dung H, Dimitri M, Philippe M, Judith R, Daniel A, Liefeldt L, Glander P, Glander P, Lan Y, Schmidt D, Heine C, Budde K, Neumayer HH, Schmidt D, Glander P, Glander P, Budde K, Neumayer HH, Liefeldt L, Quaglia M, Quaglia M, Capone V, Izzo C, Menegotto A, Fenoglio R, Airoldi A, Stratta P, Grace B, Clayton P, Cass A, Mcdonald S, Yagisawa T, Yagisawa T, Yashi M, Kimura T, Nukui A, Fujiwara T, Sakuma Y, Ishikawa N, Iwabuchi T, Muraishi O, Torregrosa V, Barros X, Martinez de Osaba MJ, Paschoalin R, Campistol JM, Hassan R, El-Hefnawy A, Soliman S, Shokeir A, Cobanoglu Kudu A, Gungor O, Kircelli F, Altinel E, Asci G, Ozbek SS, Toz H, Ok E, Sandrini S, Setti G, Valerio F, Possenti S, Torrisi I, Polanco N, Garcia-Puente L, Gonzalez Monte E, Morales E, Gutierrez E, Bengoa I, Hernandez A, Caballero J, Morales JM, Andres A, Sgarlato V, Sgarlato V, Comai G, La Manna G, Moretti I, Grandinetti V, Martelli D, Scolari MP, Stefoni S, Valentini C, Valentini C, Persici E, La Manna G, Cappuccilli ML, Sgarlato V, Liviano D'arcangelo G, Fabbrizio B, Carretta E, Mosconi G, Scolari MP, Feliciangeli G, Grigioni FW, Stefoni S, Apicella L, Guida B, Vitale S, Garofalo G, Russo L, Maresca I, Rossano R, Memoli B, Carrano R, Federico S, Sabbatini M, Carta P, Zanazzi M, DI Maria L, Caroti L, Miejshtri A, Tsalouchos A, Bertoni E, Sezer S, Erkmen Uyar M, Colak T, Bal Z, Tutal E, Kalaci G, Ozdemir Acar FN, Jacquelinet C, Bayat S, Pernin V, Portales P, Szwarc I, Garrigue V, Vetromile F, Delmas S, Eliaou JF, Mourad G, Huber L, Huber L, Slowinski T, Naik M, Glander P, Liefeldt L, Schmidt D, Neumayer HH, Budde K, Nakai K, Fujii H, Kono K, Goto S, Ishimura T, Takeda M, Fujisawa M, Nishi S, Pereira Paschoalin R, Paschoalin R, Torregrosa JV, Barros Freiria X, Duran Rebolledo CE, Sanchez Escuredo A, Sole M, Campistol JM, Youssouf S, Tabbasm F, Bell R, Al-Jayyousi R, Warwick G, Grall A, Treguer L, Essig M, Lecaque C, Noel N, Buchler M, Bertrand D, Rivalan J, Braun L, Villemain F, Hurault de Ligny B, Totet A, Pestourie N, Toubas D, Nevez G, Le Meur Y, Nour el Houda B, Mustapha H, Wafaa F, Inass L, Rambabova Bushljetikj I, Rambabova Bushljetikj I, Masin-Spasovska J, Spasovski G, Popov Z, Sikole A, Ivanovski N, Raimundo M, Guerra J, Teixeira C, Santana A, Silva S, Mil Homens C, Gomes Da Costa A, Loredo D, Cleres M, Gondolesi G, Gutierrez LM, Fortunato RM, Descalzi V, Raffaele P. Transplantation - clinical II. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gupta S, Saunders BP, Fraser C, Kennedy RH, Ignjatovic A, Sala S, Marshall S, Suzuki N, Vance M, Thomas-Gibson S. The first 3 years of national bowel cancer screening at a single UK tertiary centre. Colorectal Dis 2012; 14:166-73. [PMID: 21689280 DOI: 10.1111/j.1463-1318.2011.02567.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM St Mark's Bowel Cancer Screening Centre commenced screening in October 2006 as a contributor to the national programme. The first 35 months' experience is reported. METHOD Individuals with a positive faecal occult blood test (FOBT) were offered colonoscopy or alternatives if they had significant comorbidity. All screening data were collected prospectively. RESULTS Of the 98 815 FOBT kits issued, 42 523 were returned (43% uptake; 20.79% men). In total, 1339/1488 (90%) FOBT-positive participants attended the nurse clinic (57% men). Of these, 1057 had an index colonoscopy, 115 had a computed tomography colonoscopy (CTC) and eight had a flexible sigmoidoscopy. Five hundred and seventeen (44%) procedures were 'normal' (no polyps/cancers). Eighty (6%) individuals had colorectal cancer. The polyp detection rate in index procedures, including colonoscopy, CTC and flexible sigmoidoscopy, was 50%. The adenoma detection rate of all colonoscopies was 62.8%. The median polyp size was 5 (1-80) mm. In total, 1200 colonoscopies were performed by five accredited colonoscopists (96% completion rate). There were 13 (1%) adverse events with < 1 in 500 patients undergoing polypectomy requiring a transfusion. There was one 30-day postsurgical mortality, one perforation and no colonoscopy-related mortality. Almost all 39/40 (97%) patients in the BCS programme felt that the findings were adequately explained compared with 21/32 (64%) elective patients (P < 0.001) within the same unit. CONCLUSIONS At this bowel cancer screening single centre, colonoscopy completion rates were high (unadjusted caecal intubation rate of 96%) and complication rates were low. In contrast to other published data, the uptake and cancer-detection rates were lower.
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Affiliation(s)
- S Gupta
- Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, UK
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Jankovic S, Babic M, Barudzic N, Bogojevic J, Vasic O, Vucicevic M, Dragojevic M, Ivanovic A, Ignjatovic A, Markovic A, Milovanovic J, Miloradovic J, Miladinovic S, Petrovic M. Effects of a Facebook profile devoted to drug use in pregnancy on the discovery of inappropriate drug use by pregnant females in the former Yugoslav republics. Ser J Exp Clin Res 2012. [DOI: 10.5937/sjecr1201003j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Stojanov D, Ilic M, Bosnjakovic P, Zivkovic M, Jolic S, Vukasinovic N, Ignjatovic A, Ilic B, Benedeto-Stojanov D. New ischemic brain lesions on diffusion-weighted MRI after carotid artery stenting with filter protection: frequency and relationship with plaque morphology. AJNR Am J Neuroradiol 2011; 33:708-14. [PMID: 22194373 DOI: 10.3174/ajnr.a2840] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE CAS carries an inherent risk of distal cerebral embolization, precipitating new brain ischemic lesions and neurologic symptoms. Our purpose was to evaluate the frequency of new ischemic lesions found on DWI after protected CAS placement and to determine its association with plaque morphology. MATERIALS AND METHODS Fifty patients (mean age 65.13 ± 7.08 years) with moderate and severe internal carotid artery stenosis underwent CAS with distal filter protection. Fibrolipid and fibrocalcified plaque morphology was determined by sonography according to the relative contribution of echogenic and echolucent material, and by multisection CT using plaque attenuation. There were 46.81% of patients with fibrolipid and 53.19% with fibrocalcified plaques. DWI was performed before and 24 hours after CAS. RESULTS Seven (14.89%) patients showed new lesions. Four (8.51%) had 6 new lesions inside the treated vascular territory. Three had a single lesion and 1 patient had 3 lesions (mean: 1.5 ± 1). Most lesions (66.66%) were subcortical, with a mean diameter of 9 mm (range 5-15 mm). All lesions occurred in the area supplied by the middle cerebral artery and were clinically silent. A significant relationship was found between plaque morphology and the appearance of new lesions. Patients with fibrolipid plaques had a significantly higher number of new lesions compared with patients with fibrocalcified plaques (P = .041). The absolute risk of new lesions in the fibrolipid group was 18.18%. CONCLUSIONS New ischemic lesions were observed in the treated vascular territory in 8.51% of patients. The appearance of new ischemic lesions was significantly related to the plaque morphology. Fibrolipid plaques were associated with higher numbers of new lesions.
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Affiliation(s)
- D Stojanov
- Institute of Radiology, Clinical Center Nis, Nis, Serbia
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Radovanovic D, Ponorac N, Ignjatovic A, Stojiljkovic N, Popovic T, Rakovic A. Specific alterations of physiological parameters in competitive race walkers. Acta Physiol Hung 2011; 98:449-455. [PMID: 22173026 DOI: 10.1556/aphysiol.98.2011.4.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Race walking is the technical and athletic expression of fast walking and it can be considered as a type of endurance performance. The purpose of this study was to examine whether 12 weeks of a specially designed training program results in the further training enhancement of endurance performance and the related physiological parameters in already well-trained race walkers competing at the national and international level. The investigation protocol consisted of determining the maximal oxygen uptake (VO2peak) and related gas exchange values using an automated cardiopulmonary exercise system and of determining blood lactate variables (aerobic threshold - LTAer and the maximal lactate steady state - MLSS) during walking with proper technique at 8, 10, 12 and 14 km·h-1 for 4 minutes without rest in between. Thereafter, the speed on the treadmill was increased by 0.5 km·h-1 every two minutes until exhaustion to determine VO2peak. After 12 weeks of a specially designed endurance training, statistically significant increases in VO2peak (61.8±8.5 mL·kg-1·min-1 pre vs. 66.9±9.5 mL·kg-1·min-1 post training; p<0.05) and blood lactate variables (VO2-LTAer and VO2-MLSS; p<0.05) were noted. The obtained results suggest that the applied training program can improve endurance and race performance in previously well trained race walkers.
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Affiliation(s)
- Dragan Radovanovic
- Faculty of Sport and Physical Education, University of Nis, Nis, Serbia.
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Wilson JM, Duncan AN, Ignjatovic A, Wong K, Babu ED, Kelley CJ. Inguinal herniae: Valuable clues to concurrent abdominal pathology: A series of case studies describing unusual findings in 'routine' hernia operations which demonstrate the need for thorough surgical training. Int J Surg Case Rep 2011; 2:198-200. [PMID: 22096726 DOI: 10.1016/j.ijscr.2011.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 05/17/2011] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The case series presented here demonstrates that the pathology encountered during inguinal hernia repair can often provide clues to concurrent pathology; the well trained surgeon's broader medical knowledge can lead to earlier diagnosis. PRESENTATION OF CASES The case series examines four cases of men presenting with inguinal hernias, who were found to have concurrent abdominal pathology after further investigation of the intraoperative findings of the surgeon. DISCUSSION Operating surgeons not only require the necessary surgical skills to deal with the unexpected, but must also rely on their ability to think laterally when interpreting atypical incidental findings during 'routine' procedures. CONCLUSION Experience and knowledge gained through a surgeon's career is essential to enable them to correctly interpret their intraoperative findings and potentially diagnose concurrent pathology. The authors believe that surgical care practitioners, trained in just 2 years, would lack these essential skills.
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Affiliation(s)
- J M Wilson
- Dept Gen Surgery, St. Mark's Hospital, Harrow, Middlesex, HA1 3UJ, United Kingdom
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Ignjatovic A, East JE, Guenther T, Hoare J, Morris J, Ragunath K, Shonde A, Simmons J, Suzuki N, Thomas-Gibson S, Saunders BP. What is the most reliable imaging modality for small colonic polyp characterization? Study of white-light, autofluorescence, and narrow-band imaging. Endoscopy 2011; 43:94-9. [PMID: 21271465 DOI: 10.1055/s-0030-1256074] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND STUDY AIMS In vivo optical diagnosis of small colorectal polyps has potential clinical and cost advantages, but requires accuracy and high interobserver agreement for clinically acceptability. We aimed to assess interobserver variability and diagnostic performance of endoscopic imaging modalities in characterizing small colonic polyps. METHODS High quality still images of 80 polyps < 1 cm were recorded using white-light endoscopy (WLE), autofluorescence imaging (AFI) and narrow-band imaging with and without magnification (NBI and NBImag). All images were assessed for quality, prediction of polyp histology, and vascular pattern intensity (with NBI) by nine experienced colonoscopists (four experts in advanced imaging) from five UK centers. Interobserver agreement (kappa statistic), sensitivity, specificity, and accuracy were calculated compared with histopathological findings. RESULTS Interobserver agreement for predicting polyp histology using NBImag was significantly better for experts (κ = 0.63, substantial) compared with nonexperts (κ = 0.30, fair; P < 0.001), and was moderate for all colonoscopists with WLE, AFI and NBI. Interobserver agreement for vascular pattern intensity using NBI was 0.69 (substantial) for experts and 0.57 (good) for nonexperts. NBImag had higher sensitivity than WLE (experts, 0.93 vs. 0.68, P < 0.001; nonexperts, 0.90 vs. 0.52, P < 0.001) and higher overall accuracy (experts, 0.76 vs. 0.64, P = 0.003; nonexperts 0.61 vs. 0.40, P < 0.001). AFI had worse accuracy than WLE for both expert colonoscopists (0.53 vs. 0.64, P = 0.02) and nonexperts (0.32 vs. 0.40, P = 0.04). CONCLUSIONS Of the imaging modalities tested, NBImag appeared to have the best overall accuracy and interobserver agreement, although not adequate for in vivo diagnosis. NBI and AFI did not have better sensitivity, specificity, or accuracy compared with WLE.
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Affiliation(s)
- A Ignjatovic
- Wolfson Unit for Endoscopy, St. Mark's Hospital, Harrow, Middlesex, UK.
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Affiliation(s)
- A Ignjatovic
- Wolfson Unit for Endoscopy, Imperial College, St Mark's Hospital, London, UK.
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Ignjatovic A, Burling D, Ilangovan R, Clark SK, Taylor SA, East JE, Saunders BP. Flat colon polyps: what should radiologists know? Clin Radiol 2010; 65:958-66. [PMID: 21070898 DOI: 10.1016/j.crad.2010.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 05/11/2010] [Accepted: 05/28/2010] [Indexed: 02/06/2023]
Abstract
With the recent publication of international computed tomography (CT) colonography standards, which aim to improve quality of examinations, this review informs radiologists about the significance of flat polyps (adenomas and hyperplastic polyps) in colorectal cancer pathways. We describe flat polyp classification systems and propose how flat polyps should be reported to ensure patient management strategies are based on polyp morphology as well as size. Indeed, consistency when describing flat polyps is of increasing importance given the strengthening links between CT colonography and endoscopy.
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Affiliation(s)
- A Ignjatovic
- Intestinal Imaging Centre, St Mark's Hospital, Harrow, Middlesex, UK
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Ignjatovic A, Saunders BP. A clinical case of delayed caecal perforation. Gut 2009; 58:1170; author reply 1170-1. [PMID: 19592699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Bourreille A, Ignjatovic A, Aabakken L, Loftus EV, Eliakim R, Pennazio M, Bouhnik Y, Seidman E, Keuchel M, Albert JG, Ardizzone S, Bar-Meir S, Bisschops R, Despott EJ, Fortun PF, Heuschkel R, Kammermeier J, Leighton JA, Mantzaris GJ, Moussata D, Lo S, Paulsen V, Panés J, Radford-Smith G, Reinisch W, Rondonotti E, Sanders DS, Swoger JM, Yamamoto H, Travis S, Colombel JF, Van Gossum A. Role of small-bowel endoscopy in the management of patients with inflammatory bowel disease: an international OMED-ECCO consensus. Endoscopy 2009; 41:618-37. [PMID: 19588292 DOI: 10.1055/s-0029-1214790] [Citation(s) in RCA: 263] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Crohn's disease and ulcerative colitis are lifelong diseases seen predominantly in the developed countries of the world. Whereas ulcerative colitis is a chronic inflammatory condition causing diffuse and continuous mucosal inflammation of the colon, Crohn's disease is a heterogeneous entity comprised of several different phenotypes, but can affect the entire gastrointestinal tract. A change in diagnosis from Crohn's disease to ulcerative colitis during the first year of illness occurs in about 10 % - 15 % of cases. Inflammatory bowel disease (IBD) restricted to the colon that cannot be characterized as either ulcerative colitis or Crohn's disease is termed IBD-unclassified (IBDU). The advent of capsule and both single- and double-balloon-assisted enteroscopy is revolutionizing small-bowel imaging and has major implications for diagnosis, classification, therapeutic decision making and outcomes in the management of IBD. The role of these investigations in the diagnosis and management of IBD, however, is unclear. This document sets out the current Consensus reached by a group of international experts in the fields of endoscopy and IBD at a meeting held in Brussels, 12-13th December 2008, organised jointly by the European Crohn's and Colitis Organisation (ECCO) and the Organisation Mondiale d'Endoscopie Digestive (OMED). The Consensus is grouped into seven sections: definitions and diagnosis; suspected Crohn's disease; established Crohn's disease; IBDU; ulcerative colitis (including ileal pouch-anal anastomosis [IPAA]); paediatric practice; and complications and unresolved questions. Consensus guideline statements are followed by comments on the evidence and opinion. Statements are intended to be read in context with qualifying comments and not read in isolation.
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Affiliation(s)
- A Bourreille
- Institut des Maladies de l'Appareil Digestif, CHU, Université de Nantes, Nantes, France
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Suljovrujic E, Ignjatovic A, Srdanov VI, Mitsumori T, Wudl F. Intermolecular energy transfer involving an iridium complex studied by a combinatorial method. J Chem Phys 2004; 121:3745-50. [PMID: 15303942 DOI: 10.1063/1.1765094] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A recently developed combinatorial method utilizing angular dependence of evaporation rate was used to create compositional spread thin film libraries of Tris(2-pyridin-2-yl-indolizino[3,4,5-ab] isoindole-C(1), N('))iridium(III) [Ir(pin)(3)] and 4,4(')-N,N(')-dicarbazol-biphenyl (CBP) composite, with the molar fraction of Ir(pin)(3) complex varying in the 0.0003<chi(Ir(pin)(3) )<0.96 range. Spatially correlated absorbance and photoluminescence (PL) measurements were used to quantify luminescence quenching of photo-excited CBP molecules by the Ir(pin)(3) complex as a function of the average distance between two molecules. It was found that the CBP-->Ir(pin)(3) energy transfer proceeds by the Forster mechanism with the Forster radius of 30 A. The CBPxIr(pin)(3) composite has the highest photoluminescence quantum efficiency approximately 0.95, for chi(Ir(pin)(3) )=0.03 and is characterized by a structured green emission (lambda(max)=538 nm) originating from the ligand-centered (pi-pi(*))(3) state of the Ir(pin)(3) complex. On the contrary, the PL spectra of Ir(pin)(3) bulk are characterized by a weak red emission (lambda(max)=673 nm) attributed to the lowest metal-to-ligand charge transfer state. A statistical analysis based on a binomial distribution indicates that the emission from the (pi-pi(*))(3) state is quenched in Ir(pin)(3) molecules that are in a direct contact with each other.
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Affiliation(s)
- E Suljovrujic
- Institute for Quantum Engineering, Science and Technology, University of California, Santa Barbara, California 93106, USA
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