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Fractional flow reserve (FFR) is the gold standard for the functional assessment of coronary arteries. The aim of this study was to evaluate the relation between angiography, QCA and FFR in borderline lesions on collateral donor coronary arteries. In addition, FFR is compared with the angiographic appearance of collaterals to infarction-related arteries and echocardiographically assessed viability of infarct related the LV wall. In 60 patients with previous IM and occluded IRA, functional assessment of borderline coronary stenosis (30-70% DS) on collaterals donor artery was performed. We have not found statistically significant differences in these parameters between groups with different angiographic appearances of collaterals and different viability of distal myocardium. However, we found higher FFR values in diabetic patients (p=0.018). Higher FFR values in diabetic patients reveal the negative effects of diabetes on collateral growth and myocardial viability.

Despite the wide usage of exercise ECG tests and Duke Treadmill Score (DTS) in clinical practice, no comparison between this scoring system and Fractional Flow Reserve (FFR) has yet been made, particularly in cases of angiographically verified borderline lesions. Thirty patients with single coronary lesions and angiographically assessed borderline stenosis (between 30-70%) and previously calculated intermediate values of DTS between -10 to +4 were examined using FFR. Adequate specificity and sensitivity (0.769 and 0.556, respectively) were in a more narrow range of -0.5 to -10. Sex and age did not have an influence on the DTS values. There was a correlation between the values of FFR and age (r=0.395, p=0.031) and between angiographic assessment of stenosis and quantitative coronary angiography (QCA) (r=0.648, p

Pheochromocytoma is a tumor that arises from adrenal medulla and it is characterized by increased secretion of catecholamines. The incidence of pheochromocytoma is 3 to 8 cases per million inhabitants, of which about 10 to 20% of diagnosed pheochromocytomas occurs in the pediatric population, with a higher frequency in boys. In 1.7% of the pediatric population with hypertension, the cause of hypertension is pheochromocytoma. Due to headaches and verified hypertension on twenty-four-hour holter blood pressure monitoring, the 13-year-old female patient underwent ultrasound, followed by scintigraphy and magnetic resonance imaging of the abdomen, which described an oval change above the right kidney about 4.5 cm in diameter suspected of pheochromocytoma. Twenty-four-hour urine cateholamines showed elevated noradrenaline values as much as 45 times higher than the reference range, as well as elevated Dopamine values. After adequate preparation with phenoxybenzamine and bisoprolol for two weeks, a right laparoscopic adrenalectomy was performed at the University Children's Clinic in Tirsova, which is also the first operation of this type in the pediatric population. Intraoperatively, the maximum value of tension was 180/120 mmHg. Pathohistological findings confirmed pheochromocytoma. Although a rare cause of hypertension in the pediatric population, young patients with newly diagnosed hypertension should be examined for possible pheochromocytoma. Laparoscopic adrenalectomy through both the lateral transabdominal and posterior retroperitoneoscopic approach is the gold standard for the treatment of pheochromocytomas in both the adult and pediatric populations.

Congenital adrenal hyperplasia is a disease in which a gene mutation, which is inherited in an autosomal recessive manner, causes a disorder in the synthesis of enzymes that create glucocorticoids, mineralocorticoids, or sex steroids from adrenal cholesterol. The incidence of the classic form of the disease ranges from 1:14000 to 1:18000 births. In the majority of cases, the disease is caused by mutations in the CYP21A2 gene that participates in the synthesis of the 21 Alpha-hydroxylase. Due to the lack of enzymes, the synthesis of cortisol is blocked with the accumulation of sex hormones. The classic form of the disease, or a simple virilizing form in which patients lose salt, is diagnosed in the infant period. In the non-classical or mild form of the disease, with late-onset, patients may be asymptomatic or with a milder form of virilization postnatally. The diagnosis is made based on 17-hydroxyprogesterone levels, in order to determine the deficiency of the 21 Alpha-hydroxylase enzyme. Common complications of the disease are adrenal crisis, hypoglycemia, infertility, and premature entry into puberty. Prenatal therapy is referred to as experimental treatment, while the basis of care is hydrocortisone replacement. In severe forms of the disease, patients are unable to produce enough cortisol in response to stress from gastroenteritis, surgery, trauma, or fever, requiring higher doses of hydrocortisone. In certain cases of genital uncertainty, surgical treatment is necessary. A multidisciplinary team of experts is necessary for adequate surveillance of the disease, in both childhood and adulthood.

Background/Aim. Liver damage, with potentially serious consequences, is not uncommon in hospitalized cardiac patients. The aim of our study was to determine the risk factor profile for liver damage in patients hospitalized from a deterioration of their acute or chronic cardiac illness. Methods. The study had observational case-control design with retrospective data collections from medical files of adult patients hospitalized in a tertiary health care center. The cases (n = 140) were subjects with novel liver injury (which emerged during hospital stay) and three control subjects were matched (age, date) for each case subject (n = 420). The primary outcome was hepatotoxicity (present or absent) and independent variables were proposed risk factors. Statistical analysis included descriptive methods, hypothesis testing and univariate and multivariate binary logistic regression, with p ≤ 0.05. Results. In the whole study population, there were 432 (77.1%) females and the mean age of patients was 64.1 years [standard deviation (SD) = 10.7, range 24–85 years]. The most common illnesses were coronary heart disease (n = 385), hypertension (n = 334) and arrhythmia (n = 115). Mean value of Charlson Comorbidity Index (CCI) score was 3.8 (SD=1.7; range 1-10) corresponding to estimated CCI 10-years survival rate of 54.4% (SD = 33.5%). In the group of cases, 114 (81.4%) of the patients had hepatocellular, 9 (6.4%) cholestatic and 17 (12.2%) mixed type of hepatic injury. Factors independently associated with hepatotoxic event were previous occasional alcohol intake odds ratio (OR) 96.47; 95% confidence interval (CI) 28.95–321.43; p < 0.001), amiodarone (OR 3.70; 95% CI 1.82–7.53; p < 0.001), enoxaparin (OR 3.29; 95% CI 1.79–6.05; p < 0.001), obesity (OR 2.78; 95% CI 1.15– 6.71; p < 0.023), atorvastatin (OR 2.67; 95% CI 1.33–5.38; p < 0.006) and CCI total score (OR 1.89; 95% CI 1.53–2.34; p < 0.001). Conclusion. Major factors associated with acute liver damage in patients hospitalized in cardiology ward of a tertiary health care institution were patient’s constitutional and habitual characteristics (occasional alcohol intake, obesity, CCI total score) and drugs with known hepatotoxic properties (amiodarone, enoxaparin, atorvastatin).

The World Health Organization has defined Diabetes mellitus as a disorder of metabolism of various causes, due to lack of secretion and / or action of insulin, with long-term hyperglycemia and altered metabolism of sugars, proteins and fats. Diabetes mellitus is the most widespread chronic non-infectious disease, with an increase in the frequency in childhood that could be the epidemic of the 21st century. The incidence is rapidly increasing in the world, while in the last thirty years in Serbia there has been an increase in the number of patients - especially in the group of small and preschool children. Exposure to the genetic, immune and environmental factors plays an important role in the etiology of the disease, but the underlying mechanisms remain unknown. Weeks before the final diagnosis, weakness, irresistible hunger, weight loss, increased thirst, pronounced diuresis, drying of the mucous membranes, skin pruritus and blurred vision could be present. Inadequate glycemic control and unregulated lipid status of children with type 1 diabetes are compatible with numerous complications and a higher risk of cardiovascular, peripheral vascular and cerebrovascular diseases. The therapy consists of insulin therapy, adequate daily physical activity, a variety of diets, overcoming stressful life situations and maintaining satisfactory metabolic control. By using intensive insulin therapy, the best control of the disease is achieved, while the frequency of possible complications is reduced.

Introduction. Myocardial infarction (MI) is characterized by a critical myocardial ischemia followed by an irreversible myocardial cell damage or death. Case report. We presented two similar clinical cases with the ST segment elevation myocardial infarction (STEMI) diagnosis due to a prolonged coronary artery spasm, but with different treatment options due to different basic patophysiological supstrates and clinical presentations. Conclusion. Coronary artery spasm is a very complex pathophysiological entity with a different medication therapy management. Although the percutaneous coronary intervention can be the first choice, the treatment strategy should be carefully planned

The subject of this paper was a research of physical and mechanical properties of LVL composed of peeled poplar veneers in core layers and only outer layers of beech peeled veneers, so as the examination of window frame glue joint strength produced of this material. LVL boards have been hot pressed in industrial conditions, using appropriate phenol formaldehyde (PP) adhesive. Samples for corner window frame glue joint strength testing were glued with PVAc D4 class adhesive. Statistical analysis showed that there were significant differences both in moisture content and density of LVL boards regarding their thickness, while in the case of hardness this difference did not exist. Examinations of LVL glue line shear strength showed that both phenol formaldehyde (PP) and PVAc D4 class adhesives fulfilled standard requirements. The results of corner window frame double tenon glue joint strength produced from combined poplar-beech veneer LVL indicated that such material could be used to produce window frame corner joint, strong enough to withstand the additional load, without an increase of the cross section.

Background/Aim. Children with type 1 diabetes typically spend one-third of the day in school and they should achieve the same level of diabetes management there as they do outside the school environment. The aim of this study was to identify problems in diabetes management in children with type 1 diabetes at school according to the perceptions reported by children and parents. Methods. This crosssectional survey was carried out at nine public hospitals in Serbia with a cohort of 6-18-year old children/adolescents. The parents were personally informed about the objectives of the survey and the necessity to involve their children. The self-reporting questionnaire included demographic information as well as some questions that helped to evaluate the general situation of children with type 1 diabetes at school. Results. The obtained results show that not all children test blood glucose levels at school (50% of children in the 6-10- year-old age group and 67.3% in the age group over 11 years) and that not all children receive insulin at school (81.1% vs 18.9%, and 57.7% vs 42.3%, respectively). The frequency of severe hypoglycemia was 2.7% in children and 3.3% in adolescents. A high proportion of teachers did not have diabetes training. Conclusion. This brief report about problems in children and adolescents with type 1 diabetes at school in Serbia indicates what happens in the school setting and suggests how to improve control of this disease and facilitate the complete integration of children with diabetes at school.

Background: Prediabetes is characterized by isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT), and combined IFG/IGT This study aimed to establish the prevalence of prediabetes and examine possible contributory factors in a cohort of obese adolescents. Methods: In this prospective study, we recruited 85 obese patients from the Obesity Clinic at the University Children's Hospital and 17 normal weight controls. All patients were of Caucasian origin, 60 males/42 females, aged 7.4-18.3 years, with at least Tanner 2 stage of puberty. Results: Depending on criteria we used, insulin resistance was confirmed in 62-100% of obese patients, predominantly in the group with BMI SDS > 3. oGTT revealed isolated impaired fasting glucose (IFG) in 13.9%, impaired glucose tolerance (IGT) in 20.8% and combined IFG and IGT only in 2.8% of the obese patients. Patients in the prediabetes group were older (14± 2.4 vs 12.8± 2.5 p=0.04) and had higher glucose levels (p

Introduction. Frasier syndrome (FS) is a genetic form of glomerulopathy, which results from mutations in the Wilms’ tumour suppressor gene (WT1). Proteinuria in FS has been traditionally considered unresponsive to any medication and FS inevitably progresses to end stage renal failure. Case Outline. We present a patient with FS who had atypical clinical manifestation and unusual beneficial antiproteinuric response to renin-angiotensin system (RAS) inhibitors given in combination with indomethacin. After 13 years of follow-up, the patient is now 17-year old with normal renal functions and no proteinuria. Conclusion. RAS inhibitors combined with indomethacin showed beneficial effect in our patient. Thus, this combination might be the initial treatment of patients with FS. If this treatment strategy was not satisfied for at least 3 months, then CsA would be considered to be administered taking account of the nephrotoxicity and the increased risk of malignancy. Further prospective study is required to clarify this issue. [Projekat Ministarstva nauke Republike Srbije, br. OI175079]

Introduction. Acute coronary syndrome, as unstable form of ischaemic heart disease, beside clinical presentation and electrocardiographic abnormalities, is characterized by increased value of troponin one of cardiospecific enzimes. Although troponin is a high specific and sensitive indicator of acute coronary syndrome, any heart muscle injury may induce its increasing, so there are some other diseases with the increased troponin value. Case report. We presented a female patient with chest pain, admitted because of suspicioun of acute coronary sindrome. Performed coronarography excluded ischemic heart disease. Considering symtomatology, electrocardiographic abnormalities, increased troponin and D-dimer values, as well as echocardiography finding we considered pulmonary embolism as a differential diagnosis, which was confirmed by pulmoangiography. Conclusion. Isolated increased troponin values are not enough for diagnosis of acute coronary syndrome.

Introduction. Diabetes mellitus type 1 (T1DM) in children is characterized by unstable course. A significant number of studies shows that introduction to insulin analogues treatment aims towards better control of the disease. Objective. The assessment of metabolic control in children with T1DM that were introduced to insulin analogue treatment after many years of treatment with classic (human) insulin. Methods. The study included 59 patients 2-19 years old (12.9±3.8) with T1DM, transferred from treatment with human insulin to insulin analogues treatment. Data were obtained directly from patients and their parents, as well as from medical records. Results. The introduction to insulin analogues treatment, leads to a decrease in the value of glycolized haemoglobin (HbA1c) after 6 months (9.27±1.68% vs 8.63±1:26%, p=0.06). Average daily dose of insulin expressed per IU/kg of classic and insulin analogue (1.04±0.38 vs 1.03±0.30; p>0.05), remained almost the same. In 39 examinees (66.1%), 6 months before the introduction to insulin analogue treatment, severe hypoglicemia was registered and 6 months after the introduction to insulin analogue treatment it appeared in only two examinees (3.4%) (p

Background/Aim. Hyperglicemia is common in patients with ST-elevation myocardial infarction (STEMI) and is associated with high risk of mortality and morbidity. Relationship between admission plasma glucose (APG) levels and mortality in diabetic and nondiabetic patients with STEMI needs further investigation. The aim of this study was to analyse the short- and longterm prognostic significance of APG levels in patients with STEMI with and without diabetes. Methods. This study included 115 patients with STEMI, 86 (74,8%) nondiabetic and 29 (25,2%) dibaetic patients, in which we performed a prospective analysis of the relationship between APG levels and shortand long-term mortality. Results. Comparison of APG levels between nondiabetic (8.32 ± 2.4 mmol/L) and diabetic (10.09 ± 2.5 mmol/L) patients showed statistically significantly higher average APG levels in diabetic patients (p = 0.001). In all patients observed who died either after one month or one year after STEMI, average APG values were significantly higher in comparison with those in survived patients. There was no statistical significance in average APG levels in the diabetic patients with STEMI who died after one month and those who survived (10.09 ± 2.68 vs 10.0 ± 2.51 mmol/L, respectively; p = 0.657), as well as those who died after one year and those who survived (10.1 ± 1.92 vs 10.09 ± 2.8 mmol/L, respectively; p = 0.996). There was, however, statistical significance in average APG levels in the nondiabetic patients with STEMI who died after one month and those who survived (9.97 ± 2.97 vs 7.91 ± 2.08 mmol/L, respectively; p = 0.001), as well as those who died after one year and those who survived (9.17 ± 2.49 vs 7.84 ± 2.24 mmol/L, respectively; p = 0.013). Conclusion. Acute hyperglicemia in the settings of STEMI worsenes the prognosis in patients with and without diabetes. Our study showed that nondiabetic patients with high APG levels are at higher risk of mortality than patients with a known history of diabetes.

The application of polymers for controlled drug delivery is influenced by no toxicity and solubility in different pH mediums. There already are existing pharmaceutical medicaments based on aqueous dispersion of an anionic copolymer methyl acrylate, methyl methacrylate and methacrylic acid. The aim of this work was to synthesise copolymers of methyl methacrylate and methacrylic acid and to estimate the effects of monomers ratio (1:1 and 1:2) on the molecular mass, polydispersity index, and solubility of obtained polymers. Acetone was used as a solvent because both monomers and the initiator azobisisobutyronitrile are soluble in it. FTIR method was used for functional group characterization, the gel permeation chromatography method for average molecular weights and the distribution of molecular weights determinations. High pressure liquid chromatography (HPLC) was applied for the estimation of residual monomers in obtained copolymers. The titration with ethanol solution of NaOH was used for assessing of monomer units in copolymers. The copolymer with the molar ratio of monomers 1:1 was soluble in water bufer with pH values higher then 6, while the copolymer with the molar ratio of monomers 1:2 was soluble in bufer with pH higher then 9.

Obesity is a multifactorial pathophysiological condition with an imbalance in biochemical, immunochemical, redox status and genetic parameters values. We aimed to estimate the connection between relative leucocyte telomere lengths (rLTL) - biomarker of cellular ageing with metabolic and redox status biomarkers values in a group of obese and lean children. The study includes 110 obese and 42 lean children and adolescents, both sexes. The results suggested that rLTL are significantly shorter in obese, compared with lean group ( P < 0·01). Negative correlation of rLTL with total oxidant status (TOS) (Spearman's ρ = -0·365, P < 0·001) as well as with C-reactive protein (Spearman's ρ = -0·363, P < 0·001) were observed. Principal component analysis (PCA) extracted three distinct factors (i.e. principal components) entitled as: prooxidant factor with 35 % of total variability; antioxidant factor with 30 % of total variability and lipid antioxidant - biological ageing factor with 12 % of the total variability. The most important predictor of BMI > 30 kg/m 2 according to logistic regression analysis was PCA-derived antioxidant factor's score (OR: 1·66, 95th Cl 1·05-2·6, P = 0·029). PCA analysis confirmed that oxidative stress importance in biological ageing is caused by obesity and its multiple consequences related to prooxidants augmentation and antioxidants exhaustion and gave us clear signs of disturbed cellular homoeostasis deepness, even before any overt disease occurrence.

Fatty acids play a crucial role in obesity development and in the comorbidities of obesity in both adults and children. This study aimed to assess the impact of circulating fatty acids on biomarkers of metabolic health of adolescents living with obesity. Parameters such as blood lipids, redox status, and leukocyte telomere length (rLTL) were measured alongside the proportions of individual fatty acids. The Mann-Whitney U test revealed that individuals with obesity exhibited an unfavorable lipid and redox status compared to the control normal weight group. The group with obesity also had lower plasma n-3 polyunsaturated fatty acids (PUFAs) and a higher ratio of n-6 to n-3 PUFAs than the control group. They also had a shorter rLTL, indicating accelerated biological aging. There was an inverse association of rLTL and plasma n-6-to-n-3 PUFA ratio. Future studies should explore the impact of recommended nutrition plans and increased physical activity on these parameters to determine if these interventions can enhance the health and well-being of adolescents with obesity, knowing that early obesity can track into adulthood.

Introduction: Effective diabetes self-management and collaborative responsibility sharing with parents are imperative for pediatric patients with type 1 diabetes mellitus, particularly as they gradually assume more self-care responsibilities. The primary goal of this study was to assess differences in adherence to self-care activities regarding sociodemographics and clinical characteristics in pediatric patients with type 1 diabetes. The secondary goal of this study was to understand the level of parental involvement in diabetes management and to assess the pediatric patients' behaviors (independent or dependent on disease self-management) that relate to sociodemographic and clinical characteristics., Methods: This was a comparative cross-sectional and correlational study. The study sample included 182 children and adolescents who had been diagnosed with type 1 diabetes at least 3 months prior. Data collection instruments included a sociodemographic and questionnaire about Adherence to self-care activities and parental involvement in diabetes self-management, as well as a documentation sheet for recording clinical data., Results: A majority of participants (71%) exhibited non-adherence to self-care tasks, despite 78.0% asserting their independence in diabetes self-management. Notably, insufficient parental involvement in administering insulin therapy significantly predicted severe hypoglycemic episodes., Conclusions: Pediatric patients dealing with type 1 diabetes demonstrate a substantial degree of autonomy in managing their condition, paradoxically coupled with self-reported non-adherence to critical self-care responsibilities. Notably, children (aged 8-12) rely more heavily on parental support, especially concerning insulin therapy administration. The study underscores the crucial role of parental engagement in insulin therapy, as its deficiency significantly predicts the likelihood of severe hypoglycemic episodes., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Smudja et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This paper presents the results of experimental testing of the bending strength and modulus of elasticity in edgewise bending of unreinforced and reinforced seven-layer LVL (laminated veneer lumber) poplar veneer panels. The aim of the research is to determine the influence of woven carbon fibers on the improvement of the bending properties and modulus of elasticity of LVL bending in the plane of the plate, as well as the influence of adhesives on the bending properties of the composite product, in order to test the potential of using this newly obtained material as a structural element. Bending was performed on small-scale samples. The main research task is the examination of three types of reinforcement, which differ from each other in position, orientation, and number of layers of reinforcement, using two different types of adhesives: epoxy adhesive and Melamine Urea Formaldehyde Resins (MUF). The composite material was produced in four different combinations in relation to the orientation and position of the reinforcement in the layup. The applied reinforcement is defined through three different configurations (EK1, EK2, and EK3) and a fourth control sample (EK4). Each configuration was produced by applying the two previously mentioned types of adhesives. The research findings showed that in the case of samples produced by applying CFRP (carbon fiber reinforced polymer) using epoxy adhesive, it significantly affected the increase in bending strength and flexural modulus of elasticity. The average improvement in bending strength is 32.9%, 33.2%, and 38.7%, i.e., the flexural modulus of elasticity is 54.1%, 50.7%, and 54.7%, respectively, for configurations EK1, EK2, and EK3, compared to control sample EK4. During the testing, the test samples from reinforced panels EK1 and EK2 showed partly plastic behavior up to the fracture point, while the diagram for the test samples from reinforced panels EK3 shows elastic behavior to a considerable extent, with a significantly smaller plastic behavior zone. This research proved the impossibility of using melamine-urea formaldehyde adhesive to form a composite product based on veneer and carbon fabric. The greatest contribution of this work is the experimentally verified and confirmed result of the possibility of applying poplar veneer to design structural elements in LVL using epoxy adhesive., Competing Interests: The authors declare no conflict of interest.

Aim : We aimed to single out admission predictors of acute respiratory distress syndrome (ARDS) in hospitalized COVID-19 patients and investigate the role of bioelectrical impedance (BIA) measurements in ARDS development. Method : An observational, prospective cohort study was conducted on 407 consecutive COVID-19 patients hospitalized at the University Clinical Center Kragujevac between September 2021 and March 2022. Patients were followed during the hospitalization, and ARDS was observed as a primary endpoint. Body composition was assessed using the BMI, body fat percentage (BF%), and visceral fat (VF) via BIA. Within 24 h of admission, patients were sampled for blood gas and laboratory analysis. Results : Patients with BMI above 30 kg/m 2 , very high BF%, and/or very high VF levels were at a significantly higher risk of developing ARDS compared to nonobese patients (OR: 4.568, 8.892, and 2.448, respectively). In addition, after performing multiple regression analysis, six admission predictors of ARDS were singled out: (1) very high BF (aOR 8.059), (2) SaO 2 < 87.5 (aOR 5.120), (3) IL-6 > 59.75 (aOR 4.089), (4) low lymphocyte count (aOR 2.880), (5) female sex (aOR 2.290), and (6) age < 68.5 (aOR 1.976). Conclusion : Obesity is an important risk factor for the clinical deterioration of hospitalized COVID-19 patients. BF%, assessed through BIA measuring, was the strongest independent predictor of ARDS in hospitalized COVID-19 patients.

Background: Early prediction of COVID-19 patients’ mortality risk may be beneficial in adequate triage and risk assessment. Therefore, we aimed to single out the independent morality predictors of hospitalized COVID-19 patients among parameters available on hospital admission. Methods: An observational, retrospective−prospective cohort study was conducted on 703 consecutive COVID-19 patients hospitalized in the University Clinical Center Kragujevac between September and December 2021. Patients were followed during the hospitalization, and in-hospital mortality was observed as a primary end-point. Within 24 h of admission, patients were sampled for blood gas and laboratory analysis, including complete blood cell count, inflammation biomarkers and other biochemistry, coagulation parameters, and cardiac biomarkers. Socio-demographic and medical history data were obtained using patients’ medical records. Results: The overall prevalence of mortality was 28.4% (n = 199). After performing multiple regression analysis on 20 parameters, according to the initial univariate analysis, only four independent variables gave statistically significant contributions to the model: SaO2 < 88.5 % (aOR 3.075), IL-6 > 74.6 pg/mL (aOR 2.389), LDH > 804.5 U/L (aOR 2.069) and age > 69.5 years (aOR 1.786). The C-index of the predicted probability calculated using this multivariate logistic model was 0.740 (p < 0.001). Conclusions: Parameters available on hospital admission can be beneficial in predicting COVID-19 mortality.

Non-classical congenital adrenal hyperplasia (NC-CAH) represents mild form of CAH with the prevalence of 0. 6 to 9% in women with androgen excess. Clinical and hormonal findings in females with NC-CAH are overlapping with other hyperandrogenic entities such as polycystic ovary syndrome hence causing difficulties in diagnostic approach. Metabolic consequences in subjects with NC-CAH are relatively unknown. We are lacking longitudinal follow of these patients regarding natural course of the disease or the therapeutic effects of the different drug regiments. Patients with NC-CAH similarly to those with classical form are characterized with deteriorated cardiovascular risk factors that are probably translated into cardiometabolic diseases and events. An increased preponderance of obesity and insulin resistance in patients with NC-CAH begin at young age could result in increased rates of metabolic sequelae and cardiovascular disease later during adulthood in both sexes. On the other hand, growth disorder was not proven in patients with NC-CAH in comparison to CAH patients of both gender characterized with reduced final adult height. Similarly, decreased bone mineral density and osteoporosis are not constant findings in patients with NC-CAH and could depend on the sex, and type or dose of corticosteroids applied. It could be concluded that NC-CAH represent a particular form of CAH that is characterized with specificities in clinical presentation, diagnosis, therapeutic approach and metabolic outcomes., (Copyright © 2019 Macut, Zdravković, Bjekić-Macut, Mastorakos and Pignatelli.)

Lung cancer is the most common cancer, and small-cell lung cancer (SCLC) accounts for around 20 % of lung cancers. SCLC has a neuroendocrine cellular origin, and the tumor cells usually express neuroendocrine markers. There have been major recent advances in the management of SCLC, and multimodal approaches are now the norm. An improved knowledge of the prognostic variables would assist in defining which patients were better candidates to receive these newer intensive therapies. This single-center retrospective study of 97 previously untreated and histologically proven SCLC patients analysed the circulating neuroendocrine markers chromogranin A (CGA), pro-gastrin-releasing peptide (ProGRP), and neuron-specific enolase (NSE) in addition to the other more classical variables. Fifty patients had limited-stage disease and 47 had extensive disease. Sixty patients had an ECOG performance status (PS) of 0-1 and 37 had PS 2-4. Median survival for the whole study population was 13 months. Univariate analysis and univariate Cox regression modeling found a statistically significant association between survival and PS, disease stage, and CGA, ProGRP, and NSE levels. Age and sex were not prognostic. A shorter survival time was found in patients with a PS equal to or >2, extensive stage disease, a serum CGA level >56 ng/ml, a serum ProGRP level >58 pg/ml, and a serum NSE level >19 ng/ml. This study has found that there is a potential role for ProGRP, NSE, and CGA in both staging and prognosing survival in SCLC patients.

Unlabelled: Diabetic ketoacidosis (DKA) has significant morbidity and mortality and is common at diagnosis in children. The aim of this study was to determine the frequency and clinical characteristics of DKA over a 20-year period among children diagnosed with type 1 diabetes mellitus (T1DM) at University children's hospital in Belgrade, Serbia. The study population comprised of 720 patients (366 boys) diagnosed with type 1 diabetes aged <18 years between January 1992 and December 2011. Of all patients diagnosed with T1DM, 237 (32.9 %) presented with DKA. The majority had either mild (69.6 %) or moderate (22.8 %) DKA. Sixty (55.0 %) of all children under 5 years had DKA compared to sixty-two (20.9 %) in the 5- to 10-year-old group and one hundred fifteen (36.6 %) in the 11- to 18-year-old patients (p<0.01), while 2.5 % of the entire DKA cohort were in real coma. During the later 10-year period, children less often had DKA at diagnosis compared with the earlier 10-year period (28.0 vs. 37.4 %) (p<0.01), but the frequency of severe DKA was higher in the age group <5 year and in the age group >11 year during 2002-2011, compared with the earlier 10-year period (12.9 vs. 3.4 %, p<0.01 and 17.1 vs. 3.8 %, p<0.01)., Conclusion: The overall frequency of DKA in children with newly diagnosed type 1 diabetes decreased over a 20-year period at our hospital. However, children aged <5 years and adolescents are still at high risk for DKA at diagnosis.

A computer-assisted method of preoperative planning was used to create virtual models of the deformed distal end of the radius after malunion of a fracture. By comparison with a similar model of the uninjured wrist, values were calculated for the angles and lengths to be corrected by osteotomy. Shifts of the distal fragment were analysed for 33 deformed wrists, 27 of which underwent corrective osteotomy and bone grafting. In more than half the cases there was dorsal or volar shift of 3 mm or more. The accuracy of the correction was measured by comparing the three-dimensional models before and after osteotomy with the model of the normal wrist. The volar and ulnar inclination angles of the articular surface of the radius and the radial length were regularly restored to normal.

Eighteen (18) obese patients with clinically confirmed obstructive sleep apnea syndrome (OSAS) and five (5) obese persons with no apnea crises noticed during sleep apart from occassional loud snoring, have been polysomnographically assessed. The obtained results show that the patients with apnea syndrome sleep very badly, and consequently, shortened sleep latency and frequent body movements, along with apneas, are regarded as the leading polysomnographic symptoms. Vigilance profile during sleep, that is, interchange and frequency of each of sleep stages (I, II, III, IV, REM) are similar in both tested groups. The suppression of restitutive stages of sleep (III, IV, REM) is considered to be a dominant characteristic of vigilance during sleep in obese persons and obese persons with manifest apnea syndrome. Relatively prolonged sleep latency in obese persons without manifest apnea syndrome indicates, however, restitutively higher quality of their nocturnal sleep. Contrary to the patients with apnea syndrome, they do not suffer from excessive evening somnolence, so that their daily alertness and sleep vigilance during night are of a better quality, although the lack of deep and REM sleep is observed in them as well.