A rare case of melanoma of the rectum hemorrhoid nodule

Anorectal melanoma (AM) is an aggressive and very rare malignancy. The aim of this case report is to present a case of anorectal melanoma that occured in hemorrhoidal node after a colorectal surgery. A patient aged 69 years was treated at the Oncology Institute of Vojvodina for histopathological (HP) verified melanoma of the anorectum (S100, HMB45 and Melan A positive) localized in the hemorrhoidal node. Wide local excision was made. Three months after the operation secondary deposits ocurred at the site of the colorectal anasthomosis, stomach, lung and brain. Polymerase chain reaction analysis of tumor DNA found no mutation in the BRAF V600 gene. Five months after the operation the patient is still alive and on supportive and symptomatic therapy. Despite its rarity, AM should always be considered in unusual anorectal lesions first at all in hemorrhoid nodules.

Chest pain and prehospital delay

Aim was to show the duration of chest pain in patients with Angina pectoris (AP) and acute coronary syndrome (ACS) prior to reporting to the ambulance as well as the patients' self management of the pain. Materials and methods. The study was done between 1st August 2014th and 1st October 2018th in the infirmary of EMS in Belgrade. The study involved 161 patients, out of 9437 patients in total, who were treated by one doctor and with confirmed or suspected diagnosis of an ACS or AP. Results. Patients with AP most commonly waited between 2-24 hours, while the patients with ACS waited <1h from the pain onset until contacting EMS. Most patients with MI (17) as well as with AP (79) did not take any kind of therapy, while some patients administered one or more drugs in order to relieve the pain. In patients with AP, the drugs of choice were antihypertensive medications (17.42%) and in MI patients Nitroglycerin and analgesics (31.03%). All patients previously diagnosed with MI and AP have self-administered Nitroglycerin in 12.42% of cases. Conclusion. Patients with AP wait longer when having chest pain before calling EMS from patients with ACS, but their self-administered drugs of choice were antihypertensive medications. Nitroglycerine as the first appropriate drug of choice is used less and in most cases patients even do not have it readily available.

Swallowing disorders during and after the treatment of larynx cancer

Dysphagia is a swallowing disorder that is characterized by difficulty to swallow and to control saliva as well as by feeding difficulties. Dysphagia is a common symptom of laryngeal cancer, or a consequence of surgical treatment as well as radiotherapy and chemotherapy of this neoplasma. The patients after laryngectomy are at risk of developing malnutrition, and aspiration pneumonia. Removal of anatomical structures and reorganization of remaining tissues has a significant impact on the physiology of swallowing. For most patients, safe swallowing is the main feature of a positive treatment outcome. Swallowing therapy is important before, during and after treatment of larynx cancer. The aim of this paper is to explore a correlation between swallowing disorders and laryngeal cancer treatment, and to understand the anatomical and physiological bases of dysphagia treatment.

Comparison of efficiency of medium molecular weight uremic toxin removal between high-flux hemodialysis and postdilution online hemodiafiltration

Introduction. Conventional high-flux hemodialysis effectively removes uremic toxins of medium molecular weight of 0.5-15 (20) kDa, while postdilution online hemodiafiltration effectively removes uremic toxins of medium molecular weight in the range of 0.5-60 kDa. AIM. The aim of the study was to compare the efficacy of b2-microglobulin removal from the patient serum during a single session of conventional high-flux hemodialysis and postdilution online hemodiafiltration. METHOD. Eighty-five patients treated with conventional high-flux hemodialysis and thirty patients treated with postdilution online hemodiafiltration were examined. The main parameter for assessing the removal efficiency of medium molecular weight uremic toxins was serum b2microglobulin concentration before and after a single session of conventional high-flux hemodialysis and postdilution online hemodiafiltration. The following were used for statistical analysis: Kolmogorov-Smirnov test, Student's T test and Mann-Whitney U test. RESULTS. In patients treated with postdilution online hemodiafiltration, the average total convective volume was 21.38 ± 2.97 liters per session. The b2-microglobulin reduction index for the FX CorDiax 600 dialysis membrane was 61.76 ± 7.32%, while for the FX CorDiax 800 dialysis membrane it was 74.69 ± 6.51%. The albumin reduction index for the FX CorDiax 600 membrane was 3.48 ± 1.28%, and for the FX CorDiax 800 dialysis membrane it was 6.01 ± 2.97%. There is a highly statistically significant difference between the reduction index of b2-microglobulin and albumin, for two different dialysis modalities and two different dialysis membranes (p < 0.01). CONCLUSION. Postdilution online hemodiafiltration is more efficient in removing b2-microglobulin from patient serum, compared to conventional high-flux hemodialysis. Albumin loss during a single session of high-flux hemodialysis is lower compared to a single session of postdilution online hemodiafiltration. With both dialysis modalities, albumin loss is less than 4.0 g/4h. High-flux hemodialysis effectively prevents the development of dialysis-related amyloidosis, while postdilution online hemodiafiltration effectively prevents not only the development of dialysis-related amyloidosis, but also the development of resistance to erythropoietin and atherosclerotic cardiovascular diseases in the population treated with regular dialysis.

Dynamics of indicators of the endothelium morphofunctional state of the brain microcirculatory bed vessels in rats with nitrite-induced Alzheimer's type dementia on the background of mesenchymal stem cell administration

Objective. The aim of this study was to assess the vascular endothelium morphofunctional state of the brain microcirculatory bed in rats with nitrite-induced Alzheimer's type dementia on the background of stem cells administration. Methods. 14 days after the experiment's end, the endothelin-1, VEGF-A, eNOS, von Willebrand factor were determined in blood serum by the enzyme immunoassay and photometric methods in rats with a model of nitrite-induced dementia (14 and 28 days of sodium nitrite intraperitoneal introduction) with and without mesenchymal stem cells (MSCs) administration. The brain slices were stained according to the Einarson's method and immunohistochemically by staging the reaction with antibodies to VEGF. Results. With an increase in the sodium nitrite administration period, the degree of damage of brain capillaries and neurons increased, dystrophy of "surviving" neurons developed and ability to produce VEGF decreased. After 14 days of "regeneration period" in groups without MSCs administration, further stimulation of VEGF production by endotheliocytes, cortex and hippocampus neurons of varying degrees was observed. In groups where stem cells were introduced, the number of capillaries increased, with endothelial hyperplasia in some cases. Conclusion. In animals with nitrite-induced dementia, dose-dependent damage to the endothelium of the capillary bed is noted. From the first day damage the vascular regeneration can be proved by VEGF expression. The stem cells administration more effectively stimulates capillary regeneration, as evidenced by a noticeable increase of the number of brain capillaries.

LOKALNI VODIČ ZA PRIMENU LEKOVA KOD PACIJENATA OBOLELIH OD COVID-a 19

Cilj. U Republici Srbiji do danas nije bilo vodiča za primenu lekova kod pacijenata obolelih od COVID-a 19 koji su autorizovani i publikovani u stručnoj ili naučnoj literaturi, ili su dostupni na zvaničnim internet stranicama Ministarstva zdravlja odnosno ustanova zdravstvenog karaktera. Cilj ovog rada je da prikaže lokalni vodič za primenu lekova kod pacijenata sa COVID-om 19, kao i postupak njegove izrade i usvajanja. Metode. Predlog vodiča je izradila radna grupa na osnovu rezultata sistematskog pretraživanja medicinske literature i provere kvaliteta pronađenih publikacija iz kategorije “vodiči kliničke prakse”. Predlog radne grupe je razmatran i usvojen na sednicama Komisije za lekove i Komisije za kvalitet Univerzitetskog kliničkog centra Kragujevac. Rezultati. Preporuke vodiča su gradirane prema tipu pacijenata, i sve imaju isti stepen, kao i isti kvalitet dokaza na kojima su zasnovane. Tipovi pacijenata su formirani prema težini oboljenja i potrebi za respiratornom potporom, kao i prema riziku za razvoj sekundarne bakterijske infekcije. Zaključak. Lokalni vodič za primenu lekova kod pacijenata obolelih od COVID-a 19 je izrađen i usvojen u kratkom vremenskom roku, primarno zbog potrebe za njegovom hitnom primenom. Revizija ovog vodiča je planirana nakon 6 meseci od datuma njegovog usvajanja.

THE INFLUENCE OF NUTRITION AND LIFESTYLES ON BONE HEALTH IN PATIENTS WITH SCHIZOPHRENIA AND DEPRESSION

Objective. The aim of this paper is the influence of nutrition and pattern behaviors on bone health in people with mental health disorders. Methods. At the Clinic for Psychiatry of the Clinical Center of Kragujevac and at the Department of Neuropsychiatry of the Specialist-Consultative Service of Kragujevac Health Care Center a cross-sectional study has been conducted. The survey included 46 patients from the age of 22 to 81, both genders, with schizophrenia as a diagnosis for mental disorders and depression determined by a psychiatrist. Quantitative testing of calcium, magnesium, phosphorus, sodium and potassium has been performed by standard biochemical methods. Vitamin D has been determined by HPLC method (high performance/pressure liquid chromatography) i.e. by a liquid chromatography under high pressure. Results. In the whole group of patients tested, 58.7% of patients were physically active and the patients with schizophrenia (p = 0.026) were less physically active. Out of the total number, 67% of patients eat irregularly and this habit is more present in patients with schizophrenia (p = 0.003). In terms of the presence of certain nutrients, fish is more represented in the nutrition of people suffering from depression. Three patients (6.5%) reported osteoporosis in their medical history, one of whom had a spontaneous fracture. In the anamneses (6.5%) of the patients stated that their parents had had spontaneous bone fractures. Low values ​​of 25 (OH) D in the serum were present in both study groups. Conclusion. Unhealthy life styles, low level of Vitamin D found in people who have mental health disorders represent risk factors for the reduced bone mass. The results of our research indicate the need for timely identification of potential risk factors and improvement of prevention in order to raise awareness of the importance of healthy lifestyles and behavior modification.

SUDDEN DEATH SYNDROME CAUSED BY CARDIAC TUMOR

Cardiac tumors are rare (occurring in 0.002-0.3% of autopsies) in all age groups, but they are of clinical relevance due to the affected organ (1). They are classified into primary (benign and malignant) and secondary (metastatic). Myxoma is the most common primary benign cardiac tumor which is usually derived from the multipotent mesenchymal cells of the septum within the left atrium, and due to its localization, it can be considered as "functionally malignant". In autopsy series, it accounts for approximately 50% and in surgical series for up to 80% of all primary cardiac tumors (2). This paper presents a case of cardiac myxoma which is echocardiographically diagnosed in a 34-year-old woman who died suddenly, several days before the scheduled surgery. The diagnosis of the disease was confirmed after the autopsy, by a routine haematoxylin-eosin (H&E) staining method and an additional immunohistochemistry method (IHC). By presenting a rare clinical case, we emphasize the fact that every diagnosed cardiac tumor requires immediate cardiac surgery without delay. Keywords: cardiac tumors, myxoma, autopsy

Recurrent hemoptysis caused by arteriovenous malformation

Pulmonary arteriovenous malformation is a rare disorder of pulmonary vascularization. We are going to describe the case of recurring hemoptysis with a patient who was diagnosed late with pulmonary AV malformation. The 68-yearold patient was hospitalized for the fourth time in the Clinic for Pulmonology, Clinical Center of Kragujevac due to recurring hemoptysis. Bronchoscopy was conducted which showed no signs of bleeding nor new changes in the bronchial lumen. MSCT of the chest eliminated the possibility of bronchiectasis as the cause for hemoptysis. Chest MSCT was repeated, and it was without evolutionary aspect when compared to the previous one. In April 2019, at the Military Medical Academy in Belgrade, the patient had bronchoscopy performed, the results were normal, and the examination was completed with exploration, along with selective angiography, where AV shunt could be seen on the left side. Since the diameter of the left bronchial artery was less than 2 mm, it was not possible to place the micro-catheter and do embolization, but hemostasis was done by manual compression, which lasted for 10 minutes. After six months of follow-up examinations, no complications were registered with the patient. The method of choice for diagnosing PAV malformation is bronchial angiography, while other chest radiographic methods are not reliable. Embolization is the method of choice for treating this disorder.

Correlation between laboratory parameters and COVID-19 treatment outcome

Objective. The aim of this study was to explore the baseline characteristics and correlation of the C-reactive protein, D-dimer, Ferritin and human serum albumins, with the treatment outcome of COVID-19 infection. Methods. Our study was conducted in the Clinic for infectious diseases at the University Clinical Center Kragujevac during the time frame from November 1st 2020 to February 1st 2021. It was designed as case series and it included patients of age greater than 18 years and positive Polymerase Chain Reaction test or serological (antigen) test on SARS-COV-2 who were treated at our clinic. Results. A significant correlation was found between human serum albumins (g/L) with the outcome variable p=0.009, while correlation coefficient was 0.466. Furthermore, the lower level of albumins was significantly correlated with the intrahospital mortality, with p=0.007 and correlation coefficient 0.484. Conclusion. Our study results suggest that hypoalbuminemia could be possibly used as a significant prognostic factor for intrahospital mortality in COVID-19 patients.