University Hospital Center Dr Dragiša Mišović

Vimentin expression as a prognostic marker in pancreatic cancer: a systematic review and meta-22 analysis 23 The authors apologize for this error and state that this does not change the scientific conclusions of 34 the article in any way. The original article has been updated.

Background: Increasing antimicrobial resistance has directed studies toward investigating the antimicrobial activity of thymol, as well as the antibiofilm and antioxidant potential of its emulsions (with Tween 80) against multidrug-resistant (MDR) K. pneumoniae isolates. Methods: A microdilution assay was used to estimate thymol’s antibacterial potential against 10 clinical isolates (labeled 1–10). The dynamic light scattering technique was used to measure the particle size diameter (Zavg) of formulated emulsions. The antibiofilm potential of emulsions was assessed in vitro using a crystal violet assay and ex vivo on a surgical drain through a colony-forming unit assay. Antioxidant activity was screened by using the DPPH assay. Results: The MIC values were ≤1.5 mg/mL for strains 1 and 7 and <0.5 mg/mL for the other strains. Emulsions E250:500, E250:750, E300:750, and E500:750 were stable and homogeneous, with a Zavg of approx. 200 nm (128.4 ± 0.8 nm for E250:750). These emulsions significantly reduced the biofilm biomass of strains 3 and 7 (50.6–74.32% and 34.60–59.8% of inhibition, respectively), with the strongest activity observed for E250:500 and E500:750. Antibiofilm potential was confirmed ex vivo, with E500:750 showing the highest efficacy (ΔLogCFU 2.60 and 2.68 for strains 3 and 7). E250:750 demonstrated the highest capacity to neutralize the DPPH• radical. Conclusions: Thymol and its emulsions exhibited antibacterial and antibiofilm activity against MDR K. pneumoniae isolates, along with the proven antioxidant properties of the emulsions.

BackgroundAnatomical variations in the neurovascular structures of the hand have critical implications for surgical procedures, diagnostic accuracy, and nerve conduction studies. This study examined the morphology of the superficial palmar arch (SPA), the course of common digital palmar (CDP) arteries relative to Kaplan’s line, and the prevalence and types of Berrettini anastomosis.MethodsThirty-six embalmed cadaveric upper limbs (18 right, 18 left) from the Universities of Belgrade and St Andrews were dissected following standard anatomical protocols. Specimens with visible trauma or deformity were excluded. The SPA was classified as complete or incomplete. Origins of CDP artery distances from Kaplan’s line were measured and analyzed for sex differences using the t- test (p < 0.05). Median-ulnar nerve communications were identified and categorized as Type I (ulnar to median), Type II (median to ulnar), or Type III (bidirectional/multiple).ResultsComplete SPAs were observed in 55.6% (n=20) of specimens, predominantly in males, while 44.4% (n=16) showed incomplete patterns, more frequently in females. CDP arteries were significantly farther from Kaplan’s line in male specimens (p < 0.05). The Berrettini anastomosis was present in 33.3% (n=12) of hands, with Type III being most common (66.7%, n=8/12), and no Type I anastomoses were identified.ConclusionsOur findings highlight clinically significant variations in hand neurovascular anatomy, with notable sex-based differences in SPA configuration and arterial topography. The frequent occurrence of complex Berrettini anastomoses underscores the importance of detailed anatomical awareness to avoid complications in hand surgery and to enhance diagnostic procedures.

Abstract Background and Aims Chronic pain is a common health problem among maintenance hemodialysis (HD) patients. Its multifactorial origin may be related to underlying renal disease, comorbidities, or dialysis treatment itself. Nevertheless, there is a lack of consistent data quantifying the burden of chronic pain in this population and its association with quality of life (QoL). This study aimed to examine the prevalence and characteristics of chronic pain in patients treated with chronic HD, and assess its relationship with QoL and perceived social support. Method This cross-sectional study involved 120 maintenance HD patients. General demographic, clinical and laboratory data were collected from the patient's medical records. The Brief Pain Inventory was used to evaluate determinants of chronic pain: prevalence, pain severity and pain interference with daily activities. Pain chronicity was specified by persisting or recurring pain for at least 3 months. Quality of life (QoL) was assessed with a 36-item Short-Form Health Survey (SF36), yielding two summary measures: the Physical Component Summary (PCS), defined by dimensions of physical functioning, physical role, bodily pain and general health; and the Mental Component Summary (MCS), which includes dimensions of vitality, social functioning, role emotional and mental health. Higher scores indicated better QoL. The Multidimensional Scale of Perceived Social Support (MPSS) was used to measure individual perception of support. Results were analyzed with adequate descriptive statistics, T-test for parametric data and Hi-square or Fisher's exact test for frequencies. Results The study population included 71 (59%) males, mean age 62.9 ± 11.01 years, dialysis vintage 4–283 months (Med 54), body mass index 24.6 ± 4.5. Diabetes, secondary hyperparathyroidism and hypertension were present in 37%, 23.3% and 87.5% of cases respectively. Charlson's Comorbidity Index was 6.13 ± 2.23. Only 12.5% of patients lived alone, whereas others resided with spouses, children, or both (31.7%, 21.7% and 34.2% respectively). Two-thirds of patients (80; 66.7%) suffered from chronic pain. Pain severity was reported as mild, moderate or severe by 57.5%, 27.5% and 15.0% of subjects respectively. The patients rated pain interference with daily activity as none, mild, moderate and strong in 17.5%, 15.0%, 36.3% and 31.3% of cases respectively. The majority reported one (41.3%) or two (25.0%) areas affected with pain, most commonly the knees (26.%) and lumbosacral region (19%). Half of the patients (50.5%) used pain medications, while 74.4% practised alternative methods for pain relief. Only 8.9% reported successful pain management. The majority of patients perceived high social support (85.8%) Patients with chronic pain had significantly lower PCS (41.0 ± 19.7 vs 60.0 ± 19.4; P &amp;lt; 0.001), MCS (54.4 ± 22.9 vs 68.0 ± 22.5; P = 0.003), and total SF36 score (47.7 ± 19.8 vs 64.0 ± 19.4; P &amp;lt; 0.001), indicating significantly worse QoL compared to patients without pain. Patients with perceived lower social support also had significantly lower PCS (37.5 ± 20.1 vs 49.0 ± 21.4; P = 0.04), MCS (43.1 ± 19.3 vs 61.5 ± 23.3; P = 0.003), and total SF36 score (40.3 ± 19.0 vs 55.3 ± 20.7; P = 0.06). There was no significant difference in pain severity (4.9 ± 2.9 vs 3.8 ± 1.9, P = 0.095) and pain interference (4.3 ± 2.8 vs 4.0 ± 2.8, P = 0.688) between patients with moderate and high social support respectively. Patients with moderate support reported significantly less painful spots (2.5 ± 2.2 vs 4.0 ± 3.7, P = 0.048). Conclusion Maintenance HD patients are commonly affected by chronic pain which significantly impacts their QoL. Patients mostly perceived high social support, which was associated with better QoL. Pain is generally undermanaged in HD population and strategies are needed to address this matter systematically.

Coronavirus disease 2019 (COVID-19) rapidly became a global pandemic with clinical manifestations ranging from asymptomatic infection to life-threatening illness. While physician assessment of disease severity is largely objective, patient perception of illness is often influenced by psychosocial and demographic factors. This study aimed to explore determinants of illness perception among patients hospitalized with COVID-19. A cohort of 262 patients with confirmed SARS-CoV-2 infection was evaluated. Baseline characteristics included age, gender, smoking history, body mass index, and sociodemographic information (relationship status, education, employment, and physical activity). Disease severity was assessed using chest computed tomography (CT) scans. Illness perception was measured with the Brief Illness Perception Questionnaire (BIPQ). The median patient age was 56.3 years, and 65.6% were male. More than half (56.5%) had completed higher education, 90% were married or in a relationship, 57.6% were unemployed, and 85.9% reported no regular physical activity. Male patients demonstrated higher absolute CT scores (p = 0.018) but lower BIPQ scores. Severe pneumonia, as defined by CT findings, correlated with longer hospitalization, although no significant differences in total BIPQ scores were observed across CT severity groups. Illness perception was not influenced by education (p = 0.43), employment (p = 0.096), or physical activity (p = 0.94). However, relationship status significantly affected total BIPQ scores (p = 0.034). The study found BIPQ useful for rapid illness perception assessment, recommended for routine practice. Socio-economic factors influenced responses, while CT severity did not. Linking CT scores with BIPQ may identify patients at risk of psychological distress.

Endothelial dysfunction (characterized by reduced vasodilation or vasoconstriction, oxidative stress, inflammation, and pro-thrombotic condition) is a critical factor in the pathophysiology of various cardiovascular conditions, and the application of anesthetics can affect this dysfunction. Patients undergoing major surgery, especially cardiovascular surgery, are at increased risk of endothelial dysfunction. The impact of anesthetics on endothelial function can vary depending on the specific agent, dosage, duration of exposure, comorbidities, etc. Certain anesthetics, especially at higher doses, may increase the production of reactive oxygen species (ROS), leading to oxidative stress and endothelial dysfunction through reduced nitric oxid (NO) availability. Some anesthetics can modulate inflammatory responses, either by suppressing or exacerbating inflammation, or may affect the permeability of the endothelium, potentially leading to pulmonary edema and disruption of the blood-brain barrier. Anesthetics can influence endothelial glycocalyx. Understanding anesthetics effects is crucial for optimizing anesthetic management, particularly in patients with pre-existing cardiovascular issues. Therefore, the aim of this review is to critically evaluate the effects of different classes of anesthetics on endothelial function and oxidative stress. Specifically, we address how anesthetics influence NO bioavailability, endothelial glycocalyx integrity, inflammatory and oxidative pathways, and clinical outcomes in surgical patients. By summarizing current evidence, we aim to highlight mechanistic insights and identify potential perioperative strategies to minimize endothelial dysfunction.

This study evaluates the influence of general anesthesia (GA) and spinal anesthesia (SA) on physiological and oxidative stress in parturients undergoing elective cesarean section, one of the most frequently performed surgical procedures worldwide. A total of 101 pregnant women were included, categorized into GA (n = 51) and SA (n = 50) groups. Blood samples were collected at three time points: one hour before surgery (Measurement 1), at umbilical cord clamping (Measurement 2), and two hours post-surgery (Measurement 3). Biomarkers of oxidative stress, complete blood count, and levels of biochemical parameters were measured. In second and/or third measurement, biochemical blood analysis showed increased prolactin and cortisol levels, followed by spike of glucose and insulin in the GA group. However, levels of tri-iodothyronine were reduced in both groups in the third measurement. Glutathione S-transferase (GST) activity was increased in both groups in third measurement. The results showed increased concentrations of total SH groups and decreased concentrations of non-protein SH groups in the GA group during Measurement 2. Lymphocyte count was found to be predictor of GST levels. The results indicate more a pronounced endocrine response in GA group and speak in favor of spinal anesthesia. Both kinds of anesthesia are equally safe in terms of the oxidative status of the tissue.

Background and Objectives: The study aimed at identification and analysis of adverse COVID-19 outcomes (admission to intensive care units due to COVID-19, acute respiratory distress syndrome, mechanical ventilation, and death) among hospitalized pregnant and nonpregnant women, which are critical for informed decision-making in obstetric diagnostics and healthcare. Materials and Methods: This was a retrospective observational study conducted on a series of inpatient pregnant women comparatively followed up with nonpregnant women hospitalized between 15 July 2020 to 20 January 2022 across multidisciplinary hospitals in three cities of Kazakhstan. Following group matching with propensity score for COVID-19 disease severity, residence status, and age, the study ultimately included 156 participants, of whom 50% were pregnant, from an initial sample of 314 female inpatients diagnosed with COVID-19. All findings were considered statistically significant at a p-value < 0.05. Results: Laboratory investigations revealed significantly elevated levels of erythrocyte sedimentation rate, creatinine, neutrophils, platelet count, alanine aminotransferase, aspartate aminotransferase, lymphocyte count, and C-reactive protein in pregnant inpatients compared to nonpregnant inpatients. Furthermore, pregnant women exhibited significantly higher levels of D-dimer (2402.97 ng/mL vs. 793.91 ng/mL) and procalcitonin (0.398 ng/mL vs. 0.134 ng/mL) compared to their nonpregnant counterparts. Overall, 16.88% of the pregnant women were admitted to the intensive care unit, whereas among the nonpregnant women, only 2.6% were hospitalized. The most lethal outcomes (8.3%) occurred among pregnant women, while for nonpregnant women, there were two cases (1.3%). Conclusions: Pregnant women diagnosed with COVID-19 may exhibit more severe clinical symptoms and encounter more adverse outcomes compared to their nonpregnant counterparts. Future research should incorporate larger matched samples to comprehensively explore the association between additional factors and clinical conditions.

Introduction: An emergency situation must not disturb the optimal growth and development of any child. Very important factors in preserving family health and the successful functioning of the family are the application of appropriate knowledge and skills, patience, humanity and continuous teamwork of parents and experts who deal with the early development of children. Objective: This research work is related to the improvement of the health care system for children by applying adequate measures of early intervention in an emergency situation. The goal is to determine the level of cooperation between health professionals and parents in pediatric practice. Methods: The research was conducted in 2020 at the KBC "Dr Dragiša Mišović - Dedinje". The sample included 122 parents of hospitalized children and 63 health workers and associates. The program SPSS (Statistical Package for Social Sciences) version 25.0 was applied, the measures of descriptive statistics, frequencies and percentages were used. Results:The results show that (95.1%) parents recognize the importance of their own involvement in the implementation of early interventions during emergency situations in cooperation with the health team, they (86.9%) are of the opinion that this way the health services will be of better quality. The opinion that the participation of parents in the application of early interventions is significant is held by (76.2%) health professionals, while (4.8%) believe that their participation is not desirable, almost one fifth is not sure. The employees of the pediatric departments included in the research are almost unanimous (95.2%) about the importance of applying RI in the health care of children, while they (85.7%) emphasize the harm of denying early interventions. Conclusion: The multidisciplinary cooperation of all actors who directly and indirectly deal with providing early interventions during an emergency situation is crucial for better quality of health services.