Nutritional status of pregnant women - effects on the course and pregnancy outcome

Introduction. In recent decades, obesity has taken on epidemic proportions and is becoming one of the most significant public health problems today. The results of clinical and epidemiological studies show that obese pregnant women can be considered a high risk group, given the increased risk of maternal and fetal complications. The aim of this study was to examine the relationship between pregnant women?s nutritional status and the development of arterial hypertension, gestational diabetes and obstetric cholestasis during pregnancy, as well as the impact of pregnant women?s nutritional status on newborn birth weight and vital parameters at birth, assessed by Apgar score. Material and Methods. This retrospective study included 71 pregnant women who were divided into two groups, depending on the nutritional status. The first group included 28 pregnant women with a body mass index < 25 kg/m? or less, whereas the second group included obese pregnant women with a body mass index > 30 kg/m? or more. Birth protocol data were used for the newborns. Results. In obese pregnant women, the termination of pregnancy by cesarean section was statistically significant more frequent (p < 0.05). Newborns of obese mothers had a statistically lower Apgar score at 5 minutes, while higher body weight of newborns and a lower Apgar score at 1 minute were at the limit of statistical significance (p = 0.068). Arterial hypertension was more common in obese pregnant women (p = 0.014), while gestational diabetes (p = 0.42) and obstetric cholestasis (p = 0.51) were more common in obese pregnant women, but without statistical significance. Conclusion. Obesity in pregnancy is a risk factor for the development of hypertension, a higher incidence of cesarean section, and a lower Apgar score of newborns.

Bloodstream infections in patients with hematologic malignancies and febrile neutropenia - a single center experience

Introduction. Bacterial blood infections during febrile neutropenia episodes are urgent medical conditions which were and still are the main cause of morbidity and mortality among patients with hematologic malignancies. The aim of this study was to determine the incidence and clinical characteristics of bacteremia, infectious agents, presence and incidence of antibiotic resistance, as well as the treatment outcome of bloodstream infections in patients with hematologic malignancies. Material and Methods. A three-year retrospective study included 107 patients with hematologic malignancies and positive blood culture results during febrile neutropenia. Results. The most common isolates were Gram-negative bacteria (58.5%), with Escherichia coli being the most frequent pathogen. The Gram-negative microorganisms were mostly sensitive to carbapenems in 70.7%, whereas sensitivity to other antibiotics was as follows: piperacillin/ tazobactam 62%, amikacin 58.5%, and third-generation cephalosporins 50.5%. Acinetobacter spp. was sensitive only to colistin (94.1%). The antibiotic sensitivity among Gram-positive bacteria was highest to linezolid (97.1%), followed by teicoplanin (81.4%) and vancomycin (81.4%). In our patients, the mortality rate during the first 28 days from the moment of positive isolates was high (37.4%). Most patients died within the first seven days. Bacterial blood infections caused by Gram-negative bacteria were associated with significantly higher mortality (?2 = 4.92, p = 0.026). Acinetobacter spp. was isolated in almost half of the patients with fatal outcome, of whom 62.5% died in the first 24 hours. Conclusion. Bacterial bloodstream infections are severe complications with a high rate of mortality in febrile neutropenic hematological patients. Gram-negative bacteria were the most common isolates in our Clinic, with high mortality. It is of utmost importance to constantly monitor the resistance of bacteria to antibiotics, as well as to prevent and control the spread of resistant strains. Antibiotics resistance patterns should regularly be followed.

Nosocomial infections in a pediatric surgical intensive care unit: An unicentric cross-sectional study

Introduction. Nosocomial infections are a common complication in patients hospitalized in intensive care units. The aims of this research were to examine the incidence of nosocomial infections in patients admitted to the pediatric surgical intensive care unit, the impact of hospital length of stay and type of surgical disease on the incidence of nosocomial infections, the frequency of microorganisms causing nosocomial infections and their antibiotic susceptibility profile. Material and Methods. Data on 50 subjects were extracted from the database. The following data were taken from the medical histories of the examinees: age, sex, diagnosis, number of days at the hospital before admission to the intensive care unit, number of days in the intensive care unit, levels of C-reactive protein, applied antimicrobial drugs, isolated microorganisms and their susceptibility to antibiotics. Results. The incidence of nosocomial infections in the study period was 52%. Patients who developed nosocomial infection remained longer in the intensive care unit than those who did not develop it (p = 0.003). Patients with the diagnosis of acute abdomen had a statistically significantly higher incidence of nosocomial infections compared to other patients (p = 0.001). Gram-negative bacteria were the most commonly isolated pathogens (46.8%). Acinetobacter baumanii proved to be the most resistant species in this study, since 80% of the strains did not show sensitivity to any of the tested antibiotics. Conclusion. Nosocomial infections are present in slightly more than half of the patients treated at the pediatric surgical intensive care unit. Patients who developed nosocomial infections stayed longer in the pediatric surgical intensive care unit, which had negative consequences for their health and treatment costs.

Analysis of academic self-efficacy of medical students learning English for specific purposes

Introduction. English for Specific Purposes focuses on teaching and learning subject specific knowledge which includes specific language skills that particular learners need for a specific purpose. Self-efficacy is determined by subjective beliefs about one?s own abilities, which also applies to the academic setting of studying English for Specific Purposes. Academic self-efficacy represents the conviction of students about their own abilities to successfully fulfil academic tasks at designated levels. The goal of this research is to examine the degree of academic self-efficacy of medical students who learn English for Specific purposes at the Faculty of Medicine of the University of Novi Sad, with respect to their gender, year of study, grade achieved in the previous course in English, and the length of learning English before enrolling in the Faculty. Material and Methods. The study included 58 medical students. The researchers used the College Academic Self-Efficacy Scale questionnaire developed by Owen and Froman (1988) to assess academic self-efficacy. Results. Three significant factors were identified: general self-competence, communication with the professor, and attendance at lectures, with general self-competence being the most significant factor. Considering the independent variables, only the grade showed statistical significance. Establishing the grade as such a significant predictor can be explained by the fact that good grades and a high grade point average are presented as very desirable outcomes. However, a good grade does not necessarily mean having better knowledge or correct use of language. Conclusion. Further research into this topic is necessary, with expanding the number of participants, study programs and variables.

Grover’s disease in a patient with atopic dermatitis - a case report

Introduction. Grover?s disease is characterized by pruriginous polymorphic rash with a variable course and duration. Although the etiology is still unknown, the disease is often associated with other dermatoses, malignant diseases, use of certain medications, as well as immunosuppression. Case Report. We report a case of a 70-year-old male patient who was referred for examination to the Clinic of Dermatovenereology Diseases, Clinical Center of Vojvodina, due to a rash that lasted for nine months. The first lesions on the skin appeared around the nipples as exudative eczematous plaques. A few months later, identical lesions appeared on the lower legs. During treatment with systemic antihistamines and topical corticosteroids, there were episodes of transient improvements and re-exacerbations. In the meantime, erythematous brownish, round and oval papules appeared on the abdomen and the back, accompanied by intense itch. Laboratory findings revealed eosinophilia and elevated serum immunoglobulin E levels. A skin biopsy of the back lesion was performed and the histopathological examination confirmed the diagnosis of Grover?s disease. After the systemic treatment using corticosteroids and antihistamines, with gradual dose reduction and application of topical corticosteroids and emollients, complete regression of the skin lesions was achieved. Conclusion. Since the clinical manifestations of the disease may be nonspecific and discrete, dermatopathological analysis is of crucial importance in making the correct diagnosis. In patients with atopy, the treatment with systemic corticosteroids, antihistamines and topical agents may lead to regression of skin lesions with a significant improvement in the quality of life.

Correlation of cardiovascular and respiratory comorbidities with motor functional independence in the elderly after hip fracture

Introduction. The aim of the study was to evaluate the correlation between different levels of examined comorbidities using the Cumulative Illness Rating Scale for Geriatrics and motor Functional Independence Measure test in the elderly after hip fracture. Material and Methods. The study included 203 geriatric patients, 65 years of age and older, who were referred to a rehabilitation program at the Institute for Rehabilitation after hip fracture. The following comorbidities were analyzed: cardiac, vascular, and respiratory. The motor component of Functional Independence Measure was used to assess functional recovery. The Cumulative Illness Rating Scale for Geriatrics was used to calculate the comorbidity index. The patients were assessed on 4 different occasions: on admission, on discharge, 3 months after discharge, and 6 months after discharge. The short-term and long-term efficiency of rehabilitation treatment was measured. Results. There is a significant difference in motor Functional Independence Measure scores between different levels of vascular (p = 0.010) and respiratory (p = 0.047) comorbidities only on admission, while at other times of observation no significant difference (p > 0.05) was found. The highest level of correlation was found in level 3 comorbidity severity index for cardiac comorbidity (discharge/3 months) (Pearson?s correlation - R = 0.938) and vascular comorbidity (discharge/3 months) (R = 0.912), and level 2 comorbidity severity index for respiratory comorbidity (discharge/3 months) (R = 0.941). Conclusion. Rehabilitation treatment of the elderly after hip fracture plays a significant role both in short-term and long-term recovery, particularly in the functional domains even in persons with significant comorbidities. Early inclusion and an individually designed rehabilitation program with continuous monitoring of the elderly after hip fractures results in functional improvement and better quality of life.

Effects of positive end-expiratory pressure, carbon dioxide and body position on intracranial pressure measured by ultrasound assessment of optic nerve sheath diameter

Introduction. The optic nerve is surrounded by layers of meninges and cerebrospinal fluid, which is why intracranial pressure affects the optic nerve sheath. Noninvasive measurement of the optic nerve sheath diameter is simple, accurate, repeatable and with minimal side effects. Effects of positive end-expiratory pressure on intracranial pressure. The application of positive end-expiratory pressure plays a significant role in improving gas exchange, but it leads to an increase in intrathoracic and central venous pressure, cerebral blood volume, reduces arterial and cerebral perfusion pressure and thus futher increases intracranial pressure. The effect of positive end-expiratory pressure depends on basal intracranial pressure and respiratory system compliance. Effects of carbon dioxide on intracranial pressure. Hypercapnia leads to cerebral vasodilatation and increases cerebral blood flow and intracranial pressure. Hypocapnia reduces intracranial pressure, but its prolonged effect may lead to cerebral ischemia. Effects of body position on intracranial pressure. Body position affects intracranial pressure, primarily by affecting cerebral venous drainage. Conclusion. Body position, application of positive end-expiratory pressure, and changes in carbon dioxide can affect intracranial pressure, which is why its monitoring is of importance. Numerous studies show that their effects on intracranial pressure can be easily monitored by ultrasound assessment of optic nerve sheath diameter.

Ticagrelor in unstable carotid stenosis - a case report

Introduction. Ticagrelor is an oral, reversible, direct-acting inhibitor of adenosine diphosphate receptor P2Y12, which has a faster onset of action and stronger inhibition of platelet aggregation than clopidogrel. Case Report. This case report describes a 54-year-old male patient with repeated, transient ischemic attacks due to ipsilateral, significant carotid stenosis registered by carotid duplex ultrasound. In addition to aspirin, clopidogrel and rosuvastatin were added to the therapy. Despite optimal treatment, the patient was continuously unstable with frequent but transient neurological symptoms. A magnetic resonance imaging of the brain showed acute, cortical-subcortical ischemic lesions in the left frontal and parietal lobes, while the computed tomography angiography of the endocranium showed progression of findings and occlusion of the left common carotid artery. Subsequently, laboratory platelet aggregation analysis confirmed aspirin resistance and poor response to clopidogrel. Episodes of transient ischemic attacks were stabilized after the exclusion of dual antiplatelet therapy and introduction of ticagrelor. After that, the patient?s symptoms did not recur and he remained stable. Conclusion. The incidence of resistance to antiplatelet therapy in patients with stroke or transient ischemic attack varies greatly and ranges from 3% to 85% for aspirin, and 28% to 44% for clopidogrel. Our case showed that platelet aggregation analysis is reasonable if patients with transient ischemic attack or minor acute ischemic stroke are neurologically unstable, despite optimal medical treatment and when other therapeutic options, such as carotid revascularization, are not indicated. In such situations, ticagrelor may be a suitable alternative to dual antiplatelet therapy.

Conservative approach in the management of ectopic pregnancy

Introduction. Ectopic pregnancy is defined as the implantation of a fertilized ovum outside the uterine cavity and it is one of the leading causes of maternal morbidity and mortality. Localization and risk factors. The most common localization of ectopic pregnancy is within the fallopian tube, while other localizations include abdominal organs, ovaries, scars after previous cesarean sections, and cervix. Risk factors for ectopic pregnancy include previous fallopian tube injuries, infertility including multiple embryo transfers, use of contraceptives, smoking, older age, prior history of ectopic pregnancy, intentional abortions. Diagnostic procedures. Measurement of serum beta-human chorionic gonadotropin levels along with certain ultrasonography signs, i.e. extrauterine gestational sac, with a present yolk sac and/or embryo, with or without a cardiac activity, have the highest degree of reliability in making the diagnosis, whereas uncertain signs, such as ?blob? and ?bagel? signs, also have a high positive predictive value. Therapeutic modalities. Ectopic pregnancy can be treated by surgical, medical or expectant management. Expectant and medical management are reserved for hemodynamically stable patients who are adequately informed and where monitoring and control are possible. Conservative treatment. Before the initiation of treatment with methotrexate, it is necessary to rule out a vital intrauterine pregnancy, and consider the contraindications for methotrexate therapy, based on detailed medical history and laboratory tests. The Clinic of Obstetrics and Gynecology of the Clinical Center of Vojvodina uses a two-dose protocol by which methotrexate is administered intramuscularly and which has proven to be highly successful with few side effects. Surgical treatment modalities. Candidates for emergency laparoscopy or laparotomy are women who are hemodynamically unstable and who should not receive methotrexate. Conclusion. In properly selected patients, the success rate of methotrexate therapy is around 93%.

Association between infant and young child feeding patterns and speech and language disorders

Introduction. Feeding patterns include manners in which a child is fed during infancy and early childhood in order to provide him with appropriate nutrients that will enable his proper growth and development. The purpose of the present study was to determine the association between the dominant feeding patterns in early childhood and the manifestation of speech and language disorders in children aged 3 to 6 years. Material and Methods. A crosssectional study was conducted during 2020 - 2021 and it included 100 children of typical development, aged 3 to 6 years. The research used the Child Development Inventory, as a developmental screening instrument. The questionnaire on feeding patterns was designed for the purpose of this research. For data entry and processing, the Statistical Package for the Social Sciences 20.0 software was used. Results. There were no significant differences between the age categories of children in terms of deviations in the development of expressive and receptive speech. Most of the examined children (55%) were bottle-fed, whereas the remaining 45% were breastfed. A significantly higher percentage of bottle-fed children showed a deviation in the development of expressive and receptive speech compared to children who were breastfed for at least the first 6 months (74.5% versus 8.9%). Conclusion. Bottle-fed children showed a greater number of deviations in the development of both expressive and receptive speech, compared to breastfed children. Deviations in speech and language development were registered at each examined age, which means that speech and language disorders are not detected and treated in a timely manner.