Clinical Hospital Center Zvezdara

Belgrade, United States

Clinical Hospital Center Zvezdara

Belgrade, United States
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Jankovic R.J.,University of Niš | Jankovic R.J.,Center for Anesthesiology and Reanimatology | Markovic D.Z.,Center for Anesthesiology and Reanimatology | Sokolovic D.T.,University of Niš | And 2 more authors.
Minerva Anestesiologica | Year: 2017

European Society of Cardiology (ESC)/ European Society of Anesthesiology (ESA) highlighted that anesthesiologist has a leading role in perioperative cardiovascular assessment and management in the year of 2014. During cardiovascular assessment one can rely on cooperation of multidisciplinary specialists like: other anesthesiologists, cardiologists and surgeons. For the purpose of precise systematization and decision making the Lee Score or NSQUIP database can be used besides the traditionally used ASA Score. Additional help is provided with specific palette of cardiac biomarkers like: cardiac troponins T, cardiac troponins I, C-reactive protein, N-Terminal pro-brain natriuretic peptide, brain natriuretic peptide, etc. Biomarkers are considered to represent a foundation of evidence based medicine and they help anesthesiologists in the decision-making process. They increase the chance to achieve the best clinical outcome for each patient. An ideal biomarker does not exist and therefore new research are currently being conducted with the aim to find and declare more specific biomarkers like heart-Type fatty acid-binding protein, micro RNA, PAMP and high sensitivity troponins T.


Bajcetic M.,University of Belgrade | Kearns G.L.,Childrens Mercy Hospital | Jovanovic I.,University of Belgrade | Brajovic M.,Clinical Hospital Center Zvezdara | And 4 more authors.
Current Pharmaceutical Design | Year: 2015

Background: The paucity of marketed drug products that have been adequately studied in infants and children and subsequently, licensed (or labeled) for pediatric use has caused abundant use of off-label and unauthorized products in this patient population. In those instances where insufficient pharmacologic or therapeutic information exists for children, the potential for off-label use of medicines to result in therapeutic misadventure does as well. In the USA, a series of regulatory measures have been introduced since 1997 which have increased both the number and scope of pediatric drug trials and also, fostered the development of ageappropriate drug formulations by pharmaceutical companies. Provisions of these regulations for previously marketed drugs include the potential for a company to be granted 6 months of marketing exclusivity, thereby providing them with a financial incentive. For new drugs being developed that have potential pediatric use, the regulations mandate the inclusion of children in the drug development process. In the EU comparable measures have been very recently (Jan 2007) signed into European law to overcome the therapeutic orphan status of the infants and children of Europe. Method: The aims of this study was to compare the availability of age-appropriate oral formulations labeled for use in children less than 12 years of age in Serbia, Germany and USA in 2007, and to investigate if certain drug groups of therapeutic importance to children had fewer medicines appropriately labeled for pediatric patients available. The primary sources of information for determining the ageappropriate oral dosage forms, and their licensing and labeling status were the official manuals on drug information and national formularies in 2007. Finding: The general availability of oral drugs was the highest in the USA (304), followed by Germany (235) and Serbia (156). From all these oral drugs the availability of labeled age-appropriate pediatric dosage formulations was only between 21.2% and 47.7%. Moreover, there were striking differences between the three countries in the availability of labeled age-appropriate formulations for certain drug groups such as cardiovascular (absent in Serbia) and antiparasitic drugs (absent in Serbia and Germany). Interpretation: Our data suggest that significant country-to-country differences continue to exist in both the number and type of oral drug formulations that have pediatric labeling. Potential contributing factors include country-specific differences in the drug regulatory process, capacity for pharmaceutical development and the regulatory lag time associated with the implementation of drug regulation specifically addressing pediatric product development and labeling. We hypothesize that the new European regulation concerning medicines and children will improve the current unacceptable situation. © 2015 Bentham Science Publishers.


Pantelic M.,Clinical Hospital Center Zvezdara | Pervulov S.,Clinical Hospital Center Zvezdara
Medicinski Casopis | Year: 2012

Varicocele is one of the most common causes of infertility in men. A large number of varicocele patients are asymptomatic and discovered after examination by physician because of infertility. This paper reviews the most recent data available on the management of varicocele. It will discuss the advantages and limitations associated with each treatment modality for varicocele. The most common therapeutic methods are surgical ligation and embolization of internal spermatic veins. Embolization of internal spermatic veins is a minimally invasive procedure, performed on outpatient basis, under local anesthesia, the recovery period of patients is short, and the risk of complications is minimal. The use of embolization can provide a safe and effective approach aiming to eliminate varicocele, preserve testicular function and increase fertility.


Bajcetic M.,University of Belgrade | Brajovic M.,Clinical Hospital Center Zvezdara | Korkut-Tesic R.,Childrens Hospital Korkut Tesic
Journal of Medical Biochemistry | Year: 2010

Pharmacotherapy of pediatric diseases represents a major challenge considering that the majority of medicines in everyday practice have not been pediatrically evaluated. The efficacy of therapy depends to a large extent on the knowledge of pathophysiological processes in the children organism at different ages. Therefore, research in that direction is of the utmost importance. An imbalance in the production of free oxygen/nitrogen species and parameters of antioxidative protection is a significant factor in many diseases (e.g. heart failure, pulmonary hypertension, asthma, neonatal sepsis, cancer etc.) in children of different age groups. Reactive oxygen/nitrogen species serve as cell signaling molecules for normal biologic processes. An increase in their generation can cause damages which can disrupt normal physiological cellular processes and eventually cause cell death. This review outlines the previous assessments of oxidative stress parameters in children of different ages for some diseases. Also, the potential diagnostic and therapeutic possibilities for the oxydative stress parameters in children have been considered.


Objective. Cardiac troponin I is a biochemical marker that reflects damage to myocardial cells, which has been used for years in Clinical Hospital Center "Zvezdara", Belgrade. Chemiluminescence immunoassay (Siemens Immulite 1000) was regularly used for determination of cardiac troponin I in sera of the patients. Aiming to improve the turnaround time for troponin I determination, it was considered to introduce a new method, electrochemiluminescence essay, by using Roche Cobas e411 analyzer. Methods. We investigated a novel, candidate method for determination of serum cardiac troponin I before its eventual adoption in clinical routine and it was compared with the one already applied in our laboratory. Comparison of cardiac troponin I concentrations essayed with the use of Roche Cobas e411analyzer (x) and of Siemens Immulite 1000 analyzer (y) was performed on serum samples of 94 adult patients, both genders, with signs and symptoms of acute myocardial infarction. Results. Analysis of results revealed regression equation of y=1.91x + 4.67; correlation coefficient was 0.92. In 15 out of 94 patients (16%) results obtained by two methods in the same sample disagreed. In such subjects, the result of troponin I determined with one method indicated presence of acute myocardial infarction, but with the other it was below the diagnostic cut-off value. Conclusion. Between the concentrations of troponin I determined with compared methods there was no proper agreement, expressed by the correlation coefficient and regression equation. Interpretation of results in about every sixth patient would point to conflicting conclusion in diagnosis of acute coronary event.


Svetel M.,University of Belgrade | Smiljkovic T.,Clinical Hospital Center Zvezdara | Pekmezovic T.,University of Belgrade | Kostic V.,University of Belgrade
Acta Neurologica Belgica | Year: 2012

The aim of this study was to estimate the prevalence and risk factors for the development of hallucinations in patients with Parkinson's disease (PD). This crosssectional study included 180 consecutive, non-demented patients with PD. Out of them, 24 patients (13%) experienced some kind of hallucinations. Visual hallucinations were present in 22/24 (90%) subjects. Univariate logistic regression analysis has shown relationship between presence of hallucinations and the following variables: age of patients (p = 0.025), PD duration (p = 0.001), duration of levodopa treatment (p = 0.001), total daily dose of levodopa (p = 0.033), presence of levodopa-induced dyskinesia (p = 0.002) and their duration (p = 0.021), and experience of nightmares (p = 0.042). Hallucinations were also associated with higher scores of the UPDRS (p = 0.001), HDRS (p = 0.001) and the NPI total score (p = 0.001), and higher H-Y stages of the disease (p = 0.001). Multivariate regression analysis has demonstrated that the duration of PD (p = 0.024) as well as NPI total score (p = 0.002) was significant independent risk factors for hallucinations in PD. © Belgian Neurological Society 2012.


Smiljkovic T.,Clinical Hospital Center Zvezdara
Srpski Arhiv za Celokupno Lekarstvo | Year: 2010

Introduction: Sleep problems, common in Parkinson's disease (PD), are the consequence of the neurodegenerative process, as well as of neurochemical changes on one side, and of drug intake on the other side. Objective: To estimate the frequency of sleep problems and its correlation with the disease, therapy and demographic factors in patients with idiopathic Parkinson's disease. Methods: The study enrolled 65 consecutive patients who fulfilled criteria for idiopathic PD. The original questionnairewas performed to obtain demographic, disease and treatment data. The patients were tested with standardized scales: unified PD rating scale (UPDRS) and Hoehn and Yahr staging scale (HY scale). Mini mental stage examination (MMSE) was performed for the evaluation of cognitive status. Parkinson's disease sleep scale (PDSS) was applied for the assessment of sleep problems. Results: There were 37 male and 28 female patients. Negative correlations (p<0.01) were found between mean total PDSS and mean total UPDRS, as well as the mean scores of each part of UPDRS and HY stage. There was no difference in PDSS scores regarding gender. Analyzing each item in the PDSS scale, the lowest score was obtained for item 8 (nocturia). We did not find any difference in total PDSS scores between the patients on d-agonist and those who did not take d-agonist. Regarding amantadin, intake there were differences between groups for items concerning nocturnal motor symptoms. Conclusion: Patients in advanced stages of the disease and worse motility have more prominent sleep problems. Drug therapy has important impact on sleep quality in patients with PD.


Zugic A.,Serbian Institute for Medicinal Plant Research Dr Josif Pancic | Dordevic S.,Serbian Institute for Medicinal Plant Research Dr Josif Pancic | Arsic I.,University of Niš | Markovic G.,Clinical Hospital Center Zvezdara | And 3 more authors.
Industrial Crops and Products | Year: 2014

There is a growing research interest on investigation of appropriate alternatives of natural origin to synthetic additives used in food products. The aim of this study was to investigate correlation of chemical composition of the best known biomarker plants from the locality of Vrujci Spa, Serbia with their antioxidant activity in vitro, in terms of their potential usage as feedstock materials in the food industry. Total phenolic (TP), total tannins (TT) and total flavonoid (TF) contents were determined using spectrophotometric methods. Qualitative and quantitative analyses of major phenolics by high-performance liquid chromatography (HPLC) were also used. Major phenolic acids identified in analyzed species were chlorogenic, caffeic and ferulic acid, while predominant flavonoids were flavonols (hyperoside, rutin, isoquercitrin, quercetin) and, in lesser extent flavones (luteolin, apigenin and their 7-O-glucosides). Vitexin 2-O″-rhamnoside was found only in Crataegus species. Antioxidant capacity was estimated by the following methods: 1,1-diphenyl-2-picrylhydrazyl radical (DPPH) test and ferric reducing antioxidant power (FRAP). Majority of investigated plants had high levels of phenolics and exhibited noteworthy antioxidant activity. Moreover, a positive linear correlation was found between TP and TT with antioxidant capacities regarding both methods used. The plants showing the highest antioxidant activities were Veronica officinalis, Mentha pulegium and Fragaria vesca. Hypericum perforatum demonstrated by far the most potent antioxidant activity, as well as TP and TT content. Our results indicate that, in addition to their traditional usage in folk medicine, these plants represent a valuable source of natural antioxidants, and thus may be considered as great potential for the food industry, representing possible alternatives to synthetic additives. © 2013 Elsevier B.V.


PubMed | National Institute of Public Health and Clinical Hospital Center Zvezdara
Type: Review | Journal: Wiener klinische Wochenschrift | Year: 2016

Heart failure (HF) is arapidly growing public health problem and the leading cause of morbidity, mortality, and hospitalization in populations> 65years. The elderly HF patients have an increased prevalence of HF with preserved ejection fraction and comorbidities, may present with atypical symptoms and signs, have ahigher risk for adverse drug reactions, and worse prognosis as compared with younger patients. Moreover, there is alack of evidence-based therapies for this population because they are underrepresented in the clinical trials. The elderly are less likely to be evaluated by acardiologist and to be treated in accordance with recommendations of the current HF guidelines. Although the treatment is improving, it is still suboptimal; therefore, HF in elderly patients requires mobilization of public health services and improvement of treatment strategies.


PubMed | University of Belgrade, Clinical Hospital Center Zvezdara and c European Center for Peace and Development
Type: Journal Article | Journal: Amyotrophic lateral sclerosis & frontotemporal degeneration | Year: 2016

Our aim was to assess the incidence, survival and its prognostic factors in ALS patients from the area of the City of Belgrade, Serbia. A retrospective analysis included 325 probable or definite ALS cases from all five Belgrade neurology departments in the period 1992-2009. Each patient was regularly followed up during the disease until death or until 31 December 2009. Results showed that the average annual ALS incidence rate was 1.11 per 100,000 inhabitants. Male predominance was registered, except for patients with ALS onset after the age of 80 years. Mean survival from the first symptoms was 4.40.2 years. Cumulative probability of survival was 71% for two years, 24% for five years, and 17% for seven years. Patients with diagnostic delay longer than 1.6 years had a 1.4-times better chance for survival (p <0.01). Spinal-onset patients on riluzole therapy had 1.8-times better survival (p<0.01). Patients with early-onset ALS and higher ALSFRS-R score at initial evaluation also had somewhat better survival (p<0.05). In conclusion, the average annual ALS incidence rate was 1.11 per 100,000 inhabitants. Longer survival was observed in patients with early onset, longer diagnostic delay, less functional impairment at the time of diagnosis, and riluzole treatment.

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