Efficacy and safety of bevacizumab in the treatment of adult gliomas: a systematic review and meta-analysis

ObjectiveTo assess the efficacy and safety of bevacizumab (BEV) in patients with glioma.DesignSystematic review and meta-analysis.ParticipantsAdults aged 18 years and above, whose histology was confirmed to be malignant glioma.Primary and secondary outcome measuresThe main indicators included progression-free survival (PFS) rate and overall survival (OS) rate, and the secondary indicators were adverse reactions.ResultsA total of 11 clinical centre trials were included in this study for meta-analysis, including 2392 patients. The results of the meta-analysis showed that the median PFS rate of the BEV group was significantly higher than that of the non-BEV group (p<0.00001). When comparing PFS between two groups, we found that the PFS in the BEV group was higher than that in the non-BEV group at 6 months (OR 3.31, 95% CI 2.74 to 4.00, p<0.00001), 12 months (OR 2.05, 95% CI 1.70 to 2.49, p<0.00001) and 18 months (OR 1.31, 95% CI 1.02 to 1.69, p=0.03). But at 24 months (OR 0.83, 95% CI 0.50 to 1.37, p=0.47), there was no significant difference between the two groups. At 30 months (OR 0.62, 95% CI 0.39 to 0.97, p=0.04), the PFS of the BEV group was lower than that of the non-BEV group. Moreover, The results showed that BEV had no significant effect on improving OS, but the adverse reaction in BEV group was significantly higher than that in non-BEV group.ConclusionThe evidence suggests that BEV can significantly prolong the PFS of patients with glioma within 18 months and shorten the PFS of patients after 30 months. This limitation may be related to the subgroup of patients, the change of recurrence mode, the optimal dose of drug, the increase of hypoxia, the enhancement of invasiveness and so on. Therefore, it is necessary to carry out more samples and higher quality large-scale research in the future.

Prevalence of Diarrheagenic E. Coli Among Hospitalized Children in a Clinical Centre

Introduction. Escherichia coli is a common cause of acute diarrhea mainly in young children and, less frequently, in elderly or immunosuppressed patients. Many types of E. coli are part of the normal enteric flora, but can cause urinary tract or nervous system infections. Objective. To study the prevalence of the main types and serogroups of diarrheagenic E. coli among hospitalized children with enteric infections. Material and methods. Over a period of 5 years, 1,160 hospitalized children with acute diarrhea syndrome were studied. Fecal samples underwent culturing, biochemical and phenotypic identification. Results. Among the studied patients, 112/1,160 children (9.7%) had diarrhea caused by E. coli, and only 4 of the isolates were lactose-negative. The most common was diarrhea caused by ETEC – 65/112 (58.0%), followed by EPEC – 38/112 (33.9%), and in third place – EHES 9/112 (8.0%). We did not isolate EIEC types. Depending on the group of E. coli, we observed some differences in the clinical presentation and specifics in the distribution of patients by age. Conclusion. The study shows that this causative agent is common among Bulgarian children with diarrhea. Unfortunately, in Bulgaria the microbiological network is still not able to adequately respond to the challenges of the extended serodiagnosis for detection of diarrheagenic E. coli, which is performed in Western Europe and North America.

Correction of psychoemotional and vascular-autonomic dysfunction with patients suffering from endometrial disease under the influence of complex radon, laser, and drug treatment

The research objective is to develop a program to correct psycho-emotional and vascular-autonomic dysfunction with patients suffering from adenomyosis using complex radon, laser and drug treatment. Material and methods. There were 100 women with adenomyosis complicated by psycho-emotional and vascular-autonomic dysfunction from the age of 23 up to 37 years old who underwent treatment at a branch of Pyatigorsk Clinic of North Caucasian Federal Scientific and Clinical Centre of Federal Medical and Biological Agency of Russia. The patients were divided into 2 groups by a randomized method: the main group received radon, laser and drug therapy with Melaxen, the group of comparison received radon and laser therapy. Results. A comparative analysis showed the expediency of including adaptogens in the complex of sanatorium-and-spa treatment of patients with endometrial disease: the improvement of clinical symptoms in the main group compared to the group of comparison was more frequent by 1.36 times; normalization of vegetative management in the main group occurred with 72% of the patients compared to 52% in the group of comparison; in the main group the decrease in the intensity of anxious disorders was 2.64 times (p 0.01), against 1.46 times in the group of comparison (p 0.05); normalization of concentration of peptide and steroid hormones in blood serum in the main group was with 64% of the patients versus 42% in the group of comparison. Conclusion. Inclusion of Melaxen in the complex of traditional sanatorium-and-spa treatment of patients with adenomyosis (radon and laser therapy) provides significant improvement of neuroendocrine system, psycho-emotional, vegetative-vascular status.

Lung abscess as a complication of COVID-19

Introduction/Objective: A lung abscess is a localized purulent inflammation of lung tissue with necrosis and colliquation. We are presenting a rare case of lung abscess formation as a result of the COVID-19 viral infection. Case report: An 81-year-old male patient with typical complaints (fever, malaise, fatigue) was examined at a designated medical centre for COVID patients. A positive PCR test and radiology findings confirmed a COVID-19 infection. Medication was prescribed according to protocol and he was sent home. During the night, 36 hours after the onset of the first symptoms, the patient developed breathing difficulties and a persistent, irritating dry cough. He was admitted to the Covid Hospital Karaburma, where he received treatment for 35 days. On the 22nd day after being released, the patient was examined at the Emergency Medical Centre, Clinical Centre of Serbia, complaining of dyspnoea, occasional hemoptysis and fatigue. The working diagnosis was pulmonary embolism. A multislice CT scan was ordered only to reveal a pulmonary abscess at the base of the left lung. Conclusion: A lung abscess is a rare, but possible complication of a COVID-19 infection. Therefore, patients should be regularly monitored for an extended period of time following hospitalization.

Liver transplantation in hepatic cirrhosis: the experience of work of the Federal Siberian research clinical centre

Prevalence and mortality in terminal stages of diffuse liver diseases amount to 60 %. Foremost, liver transplantation is required by hepatic cirrhosis patients with life expectancy below one year or low quality of life conditioned by the disease. Over the past decade, it has become apparent that only orthotropic liver transplantation is a radical, eff ective and life-saving treatment for hepatic cirrhosis patients. Th is article reports our own results of operative treatment provided for 13 patients using orthotropic liver transplantation advised in relation to diff erent reasons. Th e patients underwent surgery at the surgical department of the Federal Siberian Research Clinical Centre under FMBA of Russia. The earliest outcomes observed during the postoperative period and the structure of complications have been analysed. A clinical case of successful orthotropic liver transplantation is presented. It is postulated that development of this fi eld leads to correction of indications to transplantation and the number of absolute contraindications decreases. Consequently, a possible increase in the number of patients advised to undergo transplantation is to be expected.

Effect of using HEART score in patients with chest pain at the emergency department of University Clinical Centre of the Republic of Srpska

Introduction. Recent data show that 1/5 of patients with chest pain in the emergency room (ER) have an acute coronary syndrome that requires admission and treatment. Current guidelines have endorsed the HEART score for admission, observation or discharge in individual patients. We aimed to assess performance of the HEART score at the University Clinical Centre of the Republic of Srpska. Methods. Between March 1 and March 31, 2019, all patients with chest pain who presented at ER were evaluated. The HEART score for each patient was calculated, and patients were stratified based on the HEART score recommendation, i.e. low-, intermediate-and high-risk. Patients were followed 6 weeks for major adverse cardiac events (MACE). Results. Out of a total of 144 included patients, 23 had low-risk (0-3) HEART scores, while 73 and 48 patients had intermediate-risk (4-6) and high-risk (7-10) HEART scores, respectively. The discordance among intuitive judgments by clinicians and the HEART score advice became typically obtrusive in patients with excessive (7-10) HEART score rankings: 25 out of 48 (52.1%) patients had been discharged, while the remaining 22 patients had been admitted and 1 person was observed. In population with HEART score rankings 4-6, MACE became recognized in 1/73 (1.4%) while in patients with excessive HEART score rankings (values 7-10), MACE befell in 5/48 (10.4%). Only one patient who was discharged experienced MACE. The ROC analysis of the HEART score revealed a value of 0.78, suggesting a good performance in discriminating between low-and high-risk patients. Conclusion. Discordance between clinical decision and HEART score recommendation was not associated with severe clinical consequences.

Errata

1. In the Case report titled ?A fatal case of fulminant myocarditis caused by influenza A virus? by Mila Kovacevic, Ilija Srdanovic, Milana Jarakovic, Dragana Bogdanovic, Milenko Cankovic, published in the Vojnosanitetski Pregled 2019; 76(12): 1290-6. (https://doi.org/10.2298/VSP170928017K), there was an error in the byline. The correct byline is: Mila Kovacevic*?, Ilija Srdanovic*?, Milana Jarakovic*, Dragana Bogdanovic*, Golub Samardzija*?, Milenko Cankovic*? *Institute of Cardiovascular Diserases of Vojvodina, Sremska Kamenica, Serbia; ?University of Novi Sad, ?Faculty of Medicine, Novi Sad, Serbia. The correction has been made to the online version of that issue of the Journal which is available at: http://www.vma.mod.gov.rs/vsp12-2019.pdf 2. In the Case report titled ?Psychogenic diabetes insipidus - A case report of behavioral psychotherapy? by Miodrag M. Stankovic, Jelena Stevanovic, Aleksandra Stojanovic, Sandra Stankovic, published in the Vojnosanitetski Pregled 2020; 77(12): 1332-5. (https://doi.org/10.2298/VSP180527188S), there was an error in the byline. The correct byline is: Miodrag M. Stankovic*?, Jelena Stevanovic?, Aleksandra Stojanovic*, Jelena Kostic*?, Sandra Stankovic? University of Nis, *Faculty of Medicine, Nis, Serbia; Clinical Centre Nis, ?Center for Mental Health Protection, ?Clinic for Children?s Internal Diseases, Nis, Serbia; ?General Hospital, Leskovac, Serbia The correction has been made to the online version of that issue of the Journal which is available at: http://www.vma.mod.gov.rs/vsp-12-2020.pdf <br><br><font color="red"><b> Link to the corrected article <u><a href="http://dx.doi.org/10.2298/VSP170928017K">10.2298/VSP170928017K</a></b></u> <br><br><font color="red"><b> Link to the corrected article <u><a href="http://dx.doi.org/10.2298/VSP180527188S">10.2298/VSP180527188S</a></b></u>

Surgical Stabilization of Flail Chest after Blunt Trauma

Traumatic flail chest is segment of the chest wall, which is caused by multiple fractures or by separation of bone structure (at least three sequential broken ribs or separated into two fracture lines). These injuries are mainly seen in polytrauma patients. Chest trauma is the third most common injury in trauma patients (8). Early surgical intervention, as definedas being within 24-72 hours after the trauma, should be performed, assuming other potentially life-threatening injuries have been treated (9-10). Aim of the Study: Our aim is to show the therapeutic benefits of surgical treatment (operative stabilization) of the flail chest. Material and Methods: We retrospective analyzed patients who underwent surgery at the Clinic for Thoracic Surgery, University Clinical Centre of the Republic of Srpska, Banja Luka, in the period from 01.12.1997. - 31.10.2020. Results: 68 patients with average age of 53.57 years with traumatic flail chest were surgicaly treated in the twenty-three year period at the Clinic of Thoracic Surgery, University Clinical Centre of the Republic of the Srpska, Banja Luka. The average length of a hospital stay was 15 days. Survival rate in the operated group was 91.43%. Conclusion: If conservative measures such as internal stabilization, the use of analgesics, antibiotics, oxygen therapy and airway toilet does not lead to stabilization of respiratory function, surgical chest wall stabilization is necessary.