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Memon L.,Clinical Center Bezanijska Kosa | Spasojevic-Kalimanovska V.,University of Belgrade | Bogavac-Stanojevic N.,University of Belgrade | Kotur-Stevuljevic J.,University of Belgrade | And 3 more authors.
Disease Markers | Year: 2013

Objectives. The study was designed to evaluate associations between symmetric dimethylarginine (SDMA), inflammation, and superoxide anion (O 2 -) with endothelial function and to determine their potential for screening of endothelial dysfunction in patients with chronic kidney disease (CKD) and renal transplant (RT) recipients. Materials and Methods. We included 64 CKD and 52 RT patients. Patients were stratified according to brachial artery flow-mediated dilation (FMD). Results. Logistic regression analysis showed that high SDMA and high sensitive C-reactive protein (hs-CRP) were associated with impaired FMD in CKD and RT patients, after adjustment for glomerular filtration rate. The ability of inflammation, SDMA, and O 2 - to detect impaired FMD was investigated by receiving operative characteristic analysis. Hs-CRP (area under the curves (AUC) = 0.754, P < 0.001), IL-6 (AUC = 0.699, P = 0.002), and SDMA (AUC = 0.689, P = 0.00 7) had the highest ability to detect impaired FMD. SDMA in combination with inflammatory parameters and/or O 2 - had better screening performance than SDMA alone. Conclusions. Our results indicate a strong predictable association between hs-CRP, SDMA, and endothelial dysfunction in CKD patients and RT recipients. The individual marker that showed the strongest discriminative ability for endothelial dysfunction is hs-CRP, but its usefulness as a discriminatory marker for efficient diagnosis of endothelial dysfunction should be examined in prospective studies. © 2013 Lidija Memon et al.


Memon L.,Clinical Center Bezanijska Kosa | Spasojevic-Kalimanovska V.,University of Belgrade | Stanojevic N.B.,University of Belgrade | Kotur-Stevuljevic J.,University of Belgrade | And 3 more authors.
Journal of Clinical Laboratory Analysis | Year: 2013

Background: The aim of the study was to determine the clinical usefulness of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and symmetric dimethylarginine (SDMA) for detection of renal and left ventricular (LV) diastolic dysfunction in chronic kidney disease (CKD) patients and renal transplant (RT) recipients. Methods: We included 98 CKD and 44 RT patients. We assessed LV function using pulsed-wave Doppler ultrasound. Diastolic dysfunction was defined when the E:A ratio was <1. Results: Independent predictors of NT-proBNP levels were age, creatinine, and albumin in CKD patients and age and urea in RT patients. Determinants of SDMA in CKD patients were glomerular filtration rate (GFR) and NT-proBNP and creatinine in RT patients. In RT patients with diastolic dysfunction, NT-proBNP and SDMA were significantly higher than in patients without diastolic dysfunction (F = 7.478, P < 0.011; F = 2.631, P < 0.017). After adjustment for GFR, the differences were not seen. In CKD patients adjusted NT-proBNP and SDMA values for GFR were not significantly higher in patients with diastolic dysfunction than in patients without diastolic dysfunction. Conclusions: NT-proBNP is useful for detection of LV diastolic dysfunction in RT recipients. When evaluating both NT-proBNP and SDMA it is necessary to consider GFR as a confounding factor. © 2013 Wiley Periodicals, Inc.


Baletic N.,Military Medical Academy | Malicevic H.,Clinical Center Bezanijska Kosa | Petrovic Z.,Institute for Otorhinolaryngology and Maxillofacial Surgery | Marinkovic-Eric J.,Institute for Statistics | Peric A.,Military Medical Academy
European Archives of Oto-Rhino-Laryngology | Year: 2010

Any endoscopic diagnostic procedure that iscapable of giving exact information on laryngeal lesions without damaging the tissue has essential advantages over standard biopsy. Tissue autofluorescence is deWned as a natural ability of tissue to fluoresce when exposed to a certain light wavelength. This feature is a consequence of the presence of fluorophores in the tissues, which are activated by a narrow wavelength range. However, due to their biochemical and biophysical characteristics, laryngeal precancerosis and cancer do not fluoresce when exposed to blue light. In the present study, we used Pentax's System of Autofluorescent Endoscopy (SAFE 1000) to detect auto-fluorescence disturbances from laryngeal mucosa. Diagnostic parameters (sensitivity and specificity) of the microlaryngoscopy (MLS) and SAFE 1000 in the diagnosis of laryngeal precancerosis and carcinoma were compared and discussed. We have found that SAFE had a better sensitivity with regard to mentioned laryngeal pathology, but MLS had better specificity than SAFE. The overall diagnostic sensitivity in the diagnostics of laryngeal atypical hyperplasia and cancer with SAFE was 89%, as opposed to 73% with MLS. Diagnostic specificity of SAFE for all cases of laryngeal carcinomas and atypical hyperplasia was 78%. The specificity of MLS in diagnostics of laryngeal carcinomas cases was 98%, while that for cases of atypical hyperplasia was 100%. Many other conditions that have impact on autofluorescent features of laryngeal mucosa were also discussed. © Springer-Verlag 2009.


Gajic I.,University of Belgrade | Mijac V.,University of Belgrade | Ranin L.,University of Belgrade | Andjelkovic D.,Clinical Center Bezanijska kosa | And 2 more authors.
Srpski Arhiv za Celokupno Lekarstvo | Year: 2013

Introduction Streptococcus pneumoniae is one of the leading causes of bacterial meningitis and sepsis. Invasive pneumococcal disease is a significant medical problem worldwide, particularly in children, due to a huge increase of pneumococcal resistance to antibiotics. Objective The aim of the study was to investigate the antimicrobial susceptibility pattern of invasive pneumococcal isolates, as well as to determine whether decreased S. pneumoniae susceptibility to antibiotics was related to a particular serotype. Methods Antimicrobial susceptibility to 19 antibiotics was determined in 58 invasive pneumococcal strains that were collected from seven regional centers during the period July 2009 to February 2011 in the National Reference Laboratory for streptococci and pneumococci. Results The overall nonsusceptibility rate to penicillin was detected in 34% of pneumococcal isolates and to erythromycin in 36%. Higher resistance rates were observed among children than among adults. Penicillin resistance rate was 65% in children versus 22% in adults, while erythromycin nonsusceptibility rate was 47% in children versus 32% in adults. Co-resistance to penicillin and erythromycin was detected in 21% strains, mostly isolated from children. Multiresistance was found in one third of isolates. All strains were susceptible to vancomycin, linezolid, fluoroquinolones, telithromycin and rifampicin, while 23 (40%) isolates were susceptible to all tested antibiotics. The most common resistant serotypes were 19F and 14. Conclusion The study has revealed that penicillin and macrolide resistance among invasive pneumococcal isolates is very high in Serbia. This emphasizes the need for continuous monitoring for invasive pneumococcal disease to document the serotype distribution and antimicrobial susceptibility pattern.


Pavlovic S.,Clinical Center Bezanijska Kosa | Stevic Z.,University of Belgrade | Milovanovic B.,Clinical Center Bezanijska Kosa | Milicic B.,Institute of Medical Statistics and Informatics | And 3 more authors.
Amyotrophic Lateral Sclerosis | Year: 2010

The aim of this study was to investigate autonomic cardiac control in patients with amyotrophic lateral sclerosis (ALS). Fifty-five patients with sporadic ALS (28 female and 27 male; average age 56.00 ± 10.34 years) were compared to 30 healthy controls (17 female and 13 male; average age 42.87 ± 11.91 years). Patients with previous history of cardiac disease, diabetes mellitus, and impaired respiratory function were excluded from the study. Cardiovascular autonomic tests according to Ewing, power spectrum analysis of RR variability (low- and high-frequency bands - LF and HF, LF/HF index), real-time beat-to-beat ECG signal monitoring with heart rate variability analysis and baroreflex function analysis were carried out in all patients. Time-domain parameters of heart rate variability (mean RR interval, SDNN, SDANN, SDNN index, rMSSD and pNN50%) were obtained from 24-h ECG monitoring. ALS patients had a significantly higher score of sympathetic (p <0.01) and parasympathetic (p <0.001) dysfunction, as well as of the overall score of autonomic dysfunction (p <0.001). LF/HF index was significantly increased; baroreflex sensitivity and time-domain parameters of heart rate variability were highly significantly decreased in ALS patients (p <0.001). Our results demonstrated impaired cardiac autonomic control in ALS with marked parasympathetic dysfunction and sympathetic predominance. © 2010 Informa UK Ltd.


Peric S.,University of Belgrade | Rakocevic-Stojanovic V.,University of Belgrade | Nisic T.,University of Belgrade | Pavlovic S.,Clinical Center Bezanijska Kosa | And 4 more authors.
Journal of the Neurological Sciences | Year: 2011

Objective: To evaluate cardiac autonomic control in patients with myasthenia gravis (MG) and thymoma. Materials and methods: The study was performed on 21 patients with MG and thymoma and the same number of matched healthy volunteers. Standard cardiovascular reflex tests according to Ewing and baroreflex sensitivity (BRS) at rest was applied. Spectral analysis of heart rate variability (HRV) at rest was assessed using a 20-minute ECG recording (normalized low- and high-frequency bands-LFnu-RRI, HFnu-RRI and LF/HF-RRI) Time-domain analysis of HRV was derived from 24-hour ECG monitoring. Results: Overall autonomic score according to Ewing was significantly increased in patients with MG and thymoma (p < 0.05), mostly due to parasympathetic dysfunction. Time-domain parameters representing the overall and long-term sympathetic activity of HRV did not differ significantly between the two groups (p > 0.05), but there was a significant decrease in measures of the short-term vagal variations in HRV (p < 0.01). HFnu-RRI was lower, while LFnu-RRI and LF/HF-RRI were higher in patients with MG and thymoma in comparison to healthy controls but these differences were not of statistical significance (p > 0.05). BRS at rest was highly significantly reduced in patients group (p < 0.01). Conclusions: Our results showed mainly parasympathetic cardiac impairment in patients with myasthenia gravis and thymoma. Since autonomic dysfunction may lead to cardiac conduction abnormalities and sudden death, the investigation of autonomic nervous system function in these patients may be significant in everyday clinical practice. © 2011 Elsevier B.V. All rights reserved.


Peric S.,Institute of Neurology | Rakocevic-Stojanovic V.,Institute of Neurology | Stevic Z.,Institute of Neurology | Basta I.,Institute of Neurology | And 4 more authors.
Acta Neurologica Belgica | Year: 2010

The aim was to assess factors that might influence health-related quality of life (HRQoL) in patients with two different neuromuscular disorders - myotonic dystrophy type 1 (DM1) and amyotrophic lateral sclerosis (ALS). A cross-sectional study was performed on 79 patients with DM1 and 74 with ALS. The HRQoL was evaluated by SF-36, Serbian version. Depressive and anxiety symptoms were assessed using the Hamilton rating scale for depression and the Hamilton rating scale for anxiety respectively. Severity of muscular involvement in DM1 was measured with MRC scale and severity of ALS with ALSFRSr score. The mean total score as well as all domain scores of SF-36 were similar in DM1 and ALS patients (p > 0.05), except that ALS patients experienced less bodily pain (p < 0.05). Depressiveness was found in 51% and marked anxiety in 38% of DM1 patients. Emotional status and severity of muscular involvement emerged as significant independent contributing factors to the total SF-36 in DM1 patients (p < 0.05). Only 3% of ALS patients showed depressiveness and 4% anxiety symptoms. The factors found to contribute to HRQoL in ALS patients were severity of disease and educational level of patients (p < 0.05). We found significant percentage of potentially treatable emotional disturbances which together with severity of disease significantly contributed to HRQoL in DM1 patients. On the other hand, in ALS patients depressiveness and anxious symptoms were uncommon and the factors found to contribute to HRQoL were severity of disease and educational level.


Stanisavljevic N.S.,Clinical Center Bezanijska Kosa | Marisavljevic D.Z.,Clinical Center Bezanijska Kosa
Journal of B.U.ON. | Year: 2010

Purpose: To estimate weight and body composition changes during R-CHOP combination therapy in patients with non-Hodgkin's lymphoma (NHL) and their impact on dose intensity (DI) and toxicity. Methods: We prospectively evaluated body composition inpatients with NHL before starting chemotherapy (visit 1), before the 3rd cycle (visit 2) and before the 6th cycle (visit 3). Body composition was assessed by bioelectrical impedance analysis (BIA) and confirmed by anthropometric measurements. Results: Thirty patients with NHL were studied. There was no weight change from visit 1-2, but weight increased from visit 2-3 (-1.36±1.89 kg) and from visit 1-3 (-1.93±3.21 kg). Patients with weight gain had significantly better overall response rate (p=0.013) and 5-year survival rate (p <0.01). Fat mass increased from visit 1-2 (-1.068±1.72 kg; p=0.002), from visit 2-3 (-1.32±1.89 kg; p=0.001) and from visit 1-3 (-2.502±3.23 kg; p=0.001). There was no statistically significant change in lean body mass (LBM) during chemotherapy. Total body water changed significantly from visit 1-2 (-0.08±2.55l kg; p=0.097), from wit 2-3 (-1.036±1.10 kg; p=0.001) andfrom wit 1-3 (-1.89±3.2l kg; p=0.004). The average relative DI (ARDI) of the R-CHOP regimen was 90% and the rate of complete remission was 63.3%. Overall hematologic toxicity was evident in 14 (46.7%) patients. There was statistical significance between concentrations of cyclophosphamide and doxorubicin (mg/kg fat and mg/kg LBM) whether overall hematologic toxicity was present or not. Conclusion: Patients in the study gained weight during chemotherapy with unfavorable changes in body composition. Attempt has been made to identify clinical variables to predict patients at risk for hematologic toxicity, but an approach for individualizing drug dosing should be continued. © 2010 Zerbinis Medical Publications.


Stojanovic A.,Clinical Center Bezanijska Kosa
Acta Facultatis Medicae Naissensis | Year: 2015

Lower airways are sterile, but many researchers have reported the existence of bronchial colonization with pathogenic and non-pathogenic microorganisms in smokers and patients with chronic obstructive pulmonary disease (COPD) and lung cancer. The aim of this study was to determine the existence and type of bronchial colonization in patients with non-small cell lung cancer (NSCLC), as well as to determine whether colonization depends on patient's age, smoking habit, pulmonary function and body mass index (BMI). Another aim was to estimate whether colonization causes early postoperative complications. Fifty-five subjects with pathohistologically confirmed non-small cell lung cancer in the resectable stage and good performance status (ECOG 0 or 1) participated in this cross-sectional study. We assessed patient's degree of smoking, calculated their BMI and determined the existence and severity of chronic obstructive pulmonary disease if there was one. The patients underwent a flexible bronchoscopy when biopsy samples were taken with protected specimen brush (PSB) and bronchoalveolar lavage (BAL); the retrieved samples were inoculated. Colonization was marked by an increase in the number of bacteria, yielding >103CFU/L. In our study, bronchial colonization was found in 21 patients (38%). Potentially pathogenic microorganisms were isolated in 13 patients (Streptococcus pneumonia was found in five patients, Streptococcus B haemoliticus and Pseudononans in three patients each, Haemophilus influencae and Enterobacter in one patient each). Potentially non-pathogenic microorganisms were isolated in 8 patients (Streptococcus viridans was found in 7 patients and Achromobacter xylosoxidans in 1 patient). Patients' sex, age, smoking habit, body mass index and severity of chronic obstructive pulmonary disease were not statistically significant for developing bronchial colonization. Only one operated patient developed postoperative pneumonia, but he had not previously been diagnosed with bronchial colonization. © 2015 Acta Facultatis Medicae Naissensis.


PubMed | Clinical Center Bezanijska Kosa
Type: Journal Article | Journal: Journal of clinical laboratory analysis | Year: 2013

The aim of the study was to determine the clinical usefulness of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and symmetric dimethylarginine (SDMA) for detection of renal and left ventricular (LV) diastolic dysfunction in chronic kidney disease (CKD) patients and renal transplant (RT) recipients.We included 98 CKD and 44 RT patients. We assessed LV function using pulsed-wave Doppler ultrasound. Diastolic dysfunction was defined when the E:A ratio was <1.Independent predictors of NT-proBNP levels were age, creatinine, and albumin in CKD patients and age and urea in RT patients. Determinants of SDMA in CKD patients were glomerular filtration rate (GFR) and NT-proBNP and creatinine in RT patients. In RT patients with diastolic dysfunction, NT-proBNP and SDMA were significantly higher than in patients without diastolic dysfunction (F = 7.478, P < 0.011; F = 2.631, P < 0.017). After adjustment for GFR, the differences were not seen. In CKD patients adjusted NT-proBNP and SDMA values for GFR were not significantly higher in patients with diastolic dysfunction than in patients without diastolic dysfunction.NT-proBNP is useful for detection of LV diastolic dysfunction in RT recipients. When evaluating both NT-proBNP and SDMA it is necessary to consider GFR as a confounding factor.

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