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Background/Aim. Open pelvic fractures are devastating, rare injuries with high mortality. Leading causes of mortality are the following: hemorrhage, infection, and associated injuries. The aim of this study was to point out methods of treating these injuries and a great number of prognostic mortality factors. Methods. In the period from January 2011 to December 2015, 221 patients with pelvis ring fractures were treated at three large clinical centers in Serbia, of which 13 (5%) patients had an open fracture type. We have classified pelvic ring fractures according to the Young-Burgess classification. We have classified injuries according to Gustilo at I, II, and III degrees, and the location of the wound according to Faringer classification was distributed in zone I, II, and III. Urogenital and intra-abdominal injuries were monitored, and the severity of injuries was determined according to Severity Score Injury (ISS) and Trauma Score (TS). Results. There were 6 (46%) women and 7 (54%) men with an average age of 41 year (13--76). Injuries from traffic trauma were dominant. The most common causes of pelvic ring fracture were antero-posterior compression -- 6 (46%), lateral compression -- 4 (31%), and vertical force in 3 (23%) patients. Dominant injuries were types I and II according to Gustilo and zone I according to the Faringer classification. There were 6 (46%) patients with urogenital injuries and the same number with intra-abdominal injuries, of which 3 (23%) patients had been treated with colon resection and diversion. Due to abundant hemorrhage and hypovolemic shock, two patients died, and another one died after three days due to sepsis and multisystem organ failure. Conclusion. Open pelvic fractures have a high mortality rate due to: hemorrhage, infection, associated abdominal and genitourinary tract injuries, ISS > 25, TS < 8, and the age of patients > 65 years. [ABSTRACT FROM AUTHOR]

Background/Aim. The coronavirus disease 2019 (COVID-19) pandemic has multiple impacts on the management of cancer patients. Treatment of malignancies, including chemotherapy, targeted therapy, immunotherapy, and radiotherapy, can suppress the immune system and lead to the development of severe complications of COVID-19. The aim of this study was to determine the mortality of lung cancer (LC) patients in whom the COVID-19 was confirmed during active antitumor treatment. Methods. This retrospective study was conducted at the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia. All patients included in the study underwent active anticancer treatment at the time of diagnosis of COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was determined by a polymerase chain reaction (PCR) test. Patient data were collected using the institutional database and the observed period was from November 20, 2020, to June 5, 2021. Statistical analysis of the derived patient data used multivariate and univariate testing. Results. Out of 828 observed COVID-19 hospitalized patients, 81 were LC patients on active antitumor treatment. Patients were predominantly male (67.9%), smokers (55.6%), and with an average age of 66.5 years (range 43-83). The majority of patients (50.6%) had the Eastern Cooperative Oncology Group Performance Status (ECOG PS) 1, and 83.9% had at least one comorbidity. The most common comorbidities were arterial hypertension (66.7%), chronic obstructive pulmonary disease (COPD) (28.4%), and diabetes mellitus (21%). Obesity, congestive heart failure, and other cardiovascular diseases were present in 11%, 6.2%, and 7.4% of patients, respectively. The most common was adenocarcinoma (33.3%), followed by squamous (30.9%) and small-cell LC (24.7%). Predominantly, 63% of the patients were in stage III of the disease, and 33.3% were in stage IV. Metastases were most commonly present in the contralateral lung/pleura (14.8%), brain (6.2%), bone (3.7%), and liver (3.7%). Systemic anticancer therapy was applied in 37 out of 81 patients (45.6%), chest radiotherapy in 35 (43.2%), concurrent chemoradiotherapy in 1 (1.2%), and other types of radiotherapy in 8 (9.87%) patients. The most common forms of systemic therapy were chemotherapy (35.8%), immunotherapy (7.4%), and targeted therapy (2.4%). The most common chemotherapy was a cisplatin-based regiment applied in 34.6% of patients. The mortality from COVID-19 was 19.8%. The statistical significance in relation to the type of treatment was not observed. Statistical significance was observed between mortality and the ECOG PS (p = 0.011). Conclusion. LC patients are dependent on antitumor treatment and, at the same time, highly susceptible to potential infection. In this study, we did not find statistically significant differences in mortality related to the type of antitumor treatment in COVID-19 positive LC patients. Further detailed research on a larger scale is needed in order to explore the effects of SARS-CoV-2 on cancer patients. All possible methods of protection against SARS-CoV-2 virus should be performed in order to minimize the risk of infection in all but especially in immunocompromised cancer patients. [ABSTRACT FROM AUTHOR]

Background/Aim. Surgical registries and databases are especially valuable in monitoring the performances in cancer treatment and detecting potential problems. For Serbian patients with colorectal cancer (CRC), data regarding the treatment received, the factors that may impact the outcome, and whether or not treatment is successful and appropriate are not currently captured. The aim of this study was to establish a collection of a consensus dataset capturing surgical treatment of CRC at multiple public hospitals across Serbia and estimate outcome in CRC patients subjected to surgical treatment in the period 2010-2014. Methods. The study encompassed all 52 public CRC surgical units in Serbia. Numerical data on all patients who underwent operative CRC resection were included. An electronic database was created and overseen by the First Surgical Clinic of the Clinical Center of Serbia, Belgrade. Data were collected independently using a specifically designed standardized questionnaire, including the number of operated patients, localization of the primary tumor, type of surgical intervention, type and urgency of surgical intervention, and postoperative mortality. Results. A total number of 22,037 colorectal surgical procedures was performed in Serbia in the period 2010-2014 (approximately 4,400 per year). It was shown that 78.5% of the total number of procedures were elective and 21.5% were emergency. The most common cause of emergency surgeries was ileus (3,618 cases, 76.4%), while the less common causes were perforation (899 cases, 18.9%) and bleeding (216 cases, 4.5%). Postoperative mortality during the study period expressed as a percentage of all interventions for CRC was 2.8% on average with a slight increasing tendency. At the end of the study period, 127 doctors were educated for performing colonoscopy. Conclusion. The main outcome of this study was the establishment of the necessary preconditions for the multicenter data collection involving large numbers of CRC patients. The study supported the premise that the development of the national database for surgical treatment of CRC is achievable and could provide valuable insight into the routine surgical management of CRC in Serbia, creating a significant resource for further research. [ABSTRACT FROM AUTHOR]

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Introduction. Abdominal aortic aneurysm and its rupture have been often studied over the years, and numerous risk factors for aneurysm rupture have been considered, including atmospheric pressure. The effect of atmospheric pressure has not yet been sufficiently investigated, although studies have been conducted on its possible impact on aneurysms. The aim of this study was to determine the presence of comorbidity as well as the impact of atmospheric pressure on the incidence of abdominal aortic aneurysm ruptures. Material and Methods. All patients who underwent abdominal aortic aneurysm rupture at the Clinic of Vascular and Endovascular Surgery of the Clinical Center of Vojvodina in the period from January 1, 2014 to December 1, 2018 were included in this study. The retrospective study was conducted using patient medical records, computer data, additional clinical records, and discharge reports. Data on atmospheric pressure in the territory of Vojvodina were collected from the Republic Hydrometeorological Institute of Serbia. Results. The number of cases with abdominal aortic aneurysm rupture was found to be higher at higher atmospheric pressure than expected at that altitude, in as much as 95% of cases, most often in the fall. Conclusion. We concluded that there is a significant correlation between high atmospheric pressure and the incidence of abdominal aortic aneurysm rupture, but the exact mechanism of this impact remains to be studied in some further studies. [ABSTRACT FROM AUTHOR]

Background/Aim. Stroke remains one of the leading causes of death and disability worldwide. The aim of the study was to determine the nursing care-associated predictors of in-hospital mortality in the patients with acute ischemic stroke (AIS) who were hospitalized at the Department of Emergency Neurology. Methods. Prospective cohort study included 59 consecutive patients with AIS admitted to the Department of Emergency Neurology, Neurology Clinic, Clinical Center of Serbia, Belgrade. The patients were followed until discharge or death. For exploring a relationship between the outcome of patients with AIS and different groups of factors, the univariate and multivariate Cox proportionate hazard regression models were used. Results. There were 32 male and 27 female patients with AIS. The mean age was 62.5 ± 15.2 years. The average duration of hospitalization was 11.1 ± 9.6 days (median 8 days; range 1-54 days). Almost 80% of patients (47/59; 79.7%) were admitted to the stroke unit, while 12 (20.3%) patients were admitted to the intensive care unit. In the univariate Cox regression analysis the significant variables (p < 0.05) were the Morse score (p = 0.030) and the type of admission unit (p = 0.029). The multivariate predictive model revealed that the type of admission unit (stroke unit vs conventional unit) [hazard ratio (HR) = 0.16; p = 0.032] was the independent predictor of in-hospital mortality in the patients with AIS. Conclusion. The results of this study showed an important role of nursing staff in the recovery of the AIS patients, as well as that admission to the stroke units versus the conventional units is the independent predictor of decreased in-hospital mortality. [ABSTRACT FROM AUTHOR]

Background/Aim. Reliable and comparable analysis of health risks is an important component of evidence-based and preventive programs. The aim of this study was to analyze the impact of the most relevant avoidable risk factors on the burden of the selected conditions in Serbia. Methods. Attributable fractions were calculated from the survey information on the prevalence of a risk factor and the relative risk of dying if exposed to a risk factor. The population-attributable risks were applied to deaths, years of life lost due to premature mortality (YLL), years of life with disability (YLD) and disability adjusted life years (DALY). Results. More than 40% of all deaths and of the total YLL are attributable to cigarette smoking, over-weight, physical inactivity, inadequate intake of fruit and vegetables, hypertension and high blood cholesterol. Alcohol consumption has in total a beneficial effect. According to the percent of DALY for the selected conditions attributable to the observed risk factors, their most harmful effects are as follows: alcohol consumption on road traffic accidents; cigarette smoking on lung cancer; physical inactivity on cerebrovascular disease (CVD), ischemic heart disease (IHD) and colorectal cancer; overweight on type 2 diabetes; hypertension on renal failure and CVD; inadequate intake of fruit and vegetables on IHD and CVD, and high blood cholesterol on IHD. Conclusions. This study shows that a high percentage of disease and injury burden in Serbia is attributable to avoidable risk factors, which emphasizes the need for improvement of relevant preventive strategies and programs at both individual and population levels. Social preferences should be determined for a comprehensive set of conditions and cost effectiveness analyses of potential interventions should be carried out. Furthermore, positive measures, derived from health, disability and quality of life surveys, should be included. [ABSTRACT FROM AUTHOR]

Background/Aim. Lip, oral cavity and pharynx malignant tumors account for 3.7% of all cancer deaths worldwide, with significant geographic variations in frequency and distribution. The aim of this descriptive epidemiologic study was to analyze the mortality rate of lip, oral cavity and pharynx malignant tumors in Serbia proper within a period 1991-2009. Methods. Mortality rates standardized directly using the world population as the standard were used in data analysis. Linear trend and regression analyses were used to analyze rate trends in mortality. Results. The Serbian population demonstrated an increase in the mortality of lip, oral cavity and pharynx malignant tumors (y = 3.32 + 0.03 x ; p = 0.002; average annual percent change = + 0.8). The male population showed a significant increase in mortality trend (y = 5.90 + 0.03 x ; p = 0.020; % change = + 0.9), while the female population did not show a significant increase in mortality. The male/female cancer mortality ratio was 5.5:1. Mortality rates for lip, oral cavity and pharynx cancer increased with age in both genders, with rates being the highest in the population aged 85 and older. Increasing trends of lip, oral cavity and pharynx cancer mortality were observed in males aged 50-54; the average annual percent change was + 7.4 % (95% CI, 6.2-9.0). The population of both genders aged 55-59 demonstrated an increase in lip, oral cavity and pharynx cancer mortality, the increase being + 1.8% (95% CI, 1.4-2.2) in men and + 34.3% (95% CI, 28.4-40.2) in women. Conclusion. The increasing trend in lip, oral cavity and pharynx cancer mortality points to the necessity to investigate etiology and improve primary and secondary prevention measures. [ABSTRACT FROM AUTHOR]

Introduction. In the mid-twentieth century, the health care of women and children was inadequate in the post-war Yugoslavia, including the city of Novi Sad, due to the severe post-war reality: poverty in the devastated country, shortage of all commodities and services and especially of medical supplies, equipment and educated staff. Out-of-Hospital Maternity Unit. One of the serious problems was parturition at home and morbidity and mortality of the newborns and women. Soon after the World War II the action programme of improving the women's health was realized on the state level by establishing out-of-hospital maternity units but under the expert supervision. The Maternity unit at 30 Ljudevita Gaja Street in Novi Sad played a great role in providing skilled birth attendance at mainly normal deliveries. With a minimal number of medical staff and modest medical equipment, about 2000 healthy babies were born in this house. Motherhood Home. After 5 years of functioning in that way, this unit was transformed into the Motherhood Home and became a social and medical institution for pregnant women and new mothers. Regardless of the redefined organization concept the curative and preventive health care as well as women and children social protection programmes were provided successfully for the next 12 years. Although the Motherhood Home was moved into the Women Health Centre of Novi Sad and later into the former Maternity Hospital in Sremski Karlovci, its great importance for women and children's health care remained unchanged. In 1979 the overall social situation and mostly economic issues led to its closing. Epilogue. The house in Gajeva Street is now used as the municipality office. However, this house with its story recommends itself to become a house for a special social function, such as a museum of medical history of Novi Sad. A small investment could make it possible to collect, preserve and display the valuable records of our past, which is something we do owe to the generations to come. [ABSTRACT FROM AUTHOR]

Bacground/Aim. Endovascular treatment of thoracic aortic diseases is an adequate alternative to open surgery. This method was firstly performed in Serbia in 2004, while routine usage started in 2007. Aim of this study was to analyse initial experience in endovacular treatment of thoracic aortic diseses of three main vascular hospitals in Belgrade -- Clinic for Vascular and Endovascular Surgery of the Clinical Center of Serbia, Clinic for Vascular Surgery of the Military Medical Academy, and Clinic for Vascular Surgery of the Institute for Cardiovascular Diseases "Dedinje". Methods. Between March 2004. and November 2010. 41 patients were treated in these three hospitals due to different diseases of the thoracic aorta. A total of 21 patients had degenerative atherosclerotic aneurysm, 6 patients had penetrating aortic ulcer, 6 had posttraumatic aneurysm, 4 patients had ruptured thoracic aortic aneurysm, 1 had false anastomotic aneurysm after open repair, and 3 patients had dissected thoracic aneurysm of the thoracoabdominal aorta. In 15 cases the endovascular procedure was performed as a part of the hybrid procedure, after carotidsubclavian bypass in 4 patients and subclavian artery transposition in 1 patient due to the short aneurysmatic neck; in 2 patients iliac conduit was used due to hypoplastic or stenotic iliac artery; in 5 patients previous reconstruction of abdominal aorta was performed; in 1 patient complete debranching of the aortic arch, and in 2 patients visceral abdominal debranching were performed. Results. The intrahospital mortality rate (30 days) was 7.26% (3 patients with ruptured thoracic aneurysms died). Endoleak type II in the first control exam was revealed in 3 patients (7. 26%). The patients were followed up in a period of 1-72 months, on average 29 months. The most devastating complication during a follow-up period was aortoesofageal fistula in 1 patient a year after the treatment of posttraumatic aneurysm. Conversion was performed with explantation of stent-graft and open aortic in situ recontruction, followed by esophagectomy and the creation of cervical and gastrical stoma. Conclusion. Having in mind initial results of the 3 main vascular clinics in Belgrade, Serbia, economical situation in our country, as well as the published international results, endovascular treatment of thoracic aortic diseases is indicated in hemodinamicaly unstable patients with acute traumatic aneurysm, or in stabile patients older than 65, as well as in case of chronic diseases of the thoracic aorta in patients with significant comorbid conditions or in patients older than 65 years. Endovascular procedures on the thoracic aorta could be performed, hower, only in high-volume centers with experience in routine open surgery of thoracic aorta. [ABSTRACT FROM AUTHOR]

Introduction Stroke is the third cause of mortality both in men and in women throughout the world. In Serbia, stroke is the first cause of mortality in women older than 55 years of age and the second cause of death in men of the same age. Both ischemic heart diseases and ischemic stroke correlate with the same predisposing, potentially modifiable risk factors (hypertension, abnormal blood lipids and lipoproteins, cigarette smoking, physical inactivity, obesity, diabetes mellitus). Stroke does not usually occur on its own. Patients with stroke have a high prevalence of associated medical problems. These conditions may predict the stroke ("preexisting conditions"), occur for the first time after stroke ("post-stroke complications"), or present as manifestations of preexisting medical conditions after stroke. Risk factors Risk factors for stroke are divided into the three groups: risk factors which cannot be influenced on such as: age, gender, positive family history of stroke, race; those which are modifiable such as: hypertension, diabetes mellitus, smoking cigarettes, obesity, physical inactivity and the third group consists of potential risk factors for stroke (consumption of alcohol, hormones, changes in fibrinolysis, changes in blood. Conclusion Stroke remains a leading cause of long-term disability and premature death of both men and women. Consequently, stroke survivors are often handicapped and doomed to sedentary lifestyle which restrains performance of activities of daily living, increases the risk for falls, and may contribute to a higher risk for recurrent stroke and cardiovascular disease. Prevention of stroke is still a great medical and social problem. Further studies are required to investigate potential risk factors for the occurrence of stroke as well as the measures of primary and secondary prevention. [ABSTRACT FROM AUTHOR]

Background/Aim. Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in general population. The aim of the study was to compare all-cause mortality and cardiovascular mortality in patients with lone and idiopathic AF to correspondent mortality in general population of Serbia. Methods. A longitudinal observational study included the patients with nonvalvular AF as the main indication for inhospital and/or outpatient treatment in the Clinical Center of Serbia, during a period 1992-2007, if the latest date of first diagnosed AF was early January 2003; in that way, the total follow-up could last at least 5 years (minimum 1 year prospectively), or until death. Principles of oral anticoagulation, heart rhythm and frequency control during the study period were conducted according to the latest international guidelines for diagnosis and treatment of AF in the study period. Lone and idiopathic AF were defined as AF in patients without any underlying disease, younger than 60 years (lone AF) or older (idiopathic AF). To compare mortality of the study population with mortality of general population we used the standardized mortality ratio (SMR) and chi-square test with p < 0.05 as a level of statistical significance. Results. Out of 442 patients with AF and no underlying disease, aged 47 ± 12.6 years, with mean follow-up of 11.5 ± 7.2 years, 12 patients (2.7%) died: 7 patients of non-cardiovascular causes and 5 patients (1.1%) of cardiovascular death. When compared to the general population of Serbia, all-cause mortality and cardiovascular mortality in the patients with lone and idiopathic AF were not higher than in general population (p < 0.05). Conclusion. All-cause mortality and cardiovascular mortality of patients with lone and idiopathic AF are similar to all-cause mortality and cardiovascular mortality in general population of Serbia. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The aim of this study was to analyze hospital morbidity and mortality of adolescents in Vojvodina in 2004. MATERIAL AND METHODS: The analyzed data for hospital morbidity were obtained from the Reports on diseases and conditions of hospitalized patients in the Service for stationary-hospital treatment. Hospital mortality was analyzed on the basis of Documentation tables of vital statistics of Republic of Serbia. In order to have better insight into the pathology, the adolescents were divided by sex and age (the younger ones from 10-14 years, and the older ones, from 15-19 years). RESULTS: The hospital morbidity of adolescents in Vojvodina in 2004 was 47/1,000 adolescents, while in 1983 it was 53/1,000 adolescents. The most frequent indications for hospitalization of the adolescents were respiratory, digestive diseases, and injuries, poisoning and consequences of an external factor influences. The overall mortality rate was 39.68/100,000 adolescents and in 1988 44.74/100,000 adolescents. Hospital mortality rate in Vojvodina in 2004 was 16.18/100,000 adolescents and in 1986 11.65/100,000 adolescents. The male adolescents most frequently died in hospitals because of tumors, and female ones because of injuries, poisoning and consequences of external factor influences. DISCUSSION AND CONCLUSION: Morbidity structure was not changed compared to the previous period. Older and female adolescents were more frequently hospitalized. There was a decrease in adolescent mortality for 15.5% compared to the previous 15 years. Hospital mortality rate was higher than before. Older adolescents had three times the death rate of younger. Mortality rates for male adolescents were three times rates for females. Programs for adolescents' health care must be implemented fully, with engagement of whole community services, in order to prevent and cure diseases adequately and to enhance quality of life. [ABSTRACT FROM AUTHOR]

Introduction Adolescents are the healthiest age group of the population but many studies show that period of adolescence is marked by significant morbidity and mortality. Health indicators of adolescent population have been getting worse during past decades. The aim of this study was to determine mortality rate of adolescents in the Republic of Serbia to determine most common causes of death in adolescence and to explore regional differences in adolescent mortality. Materials and methods: Documentation tables of vital statistics in the Republic of Serbia in 2004, and Documentation Tables of Census 2002 were used The causes of mortality were classified according to ICD 10. Results and discussion Specific morality rate in the Republic of Serbia is 32.08 on 100,000 adolescents. The leading causes of death in adolescence are injuries, malignancies and non specified causes, and there are significant regional differences, as well as gender and age differences. The mortality rate of male adolescents is about 2.4 times higher than the mortality rates in female adolescents. The mortality rate of older adolescents is significantly higher than mortality rate of younger adolescents. The mortality of adolescents is higher in Vojvodina than in Central Serbia. Precise data of external causes of death do not exist in vital statistics in our country. Conclusion The mortality of adolescents is high, especially for older male adolescents (15 to 19 years of age) and majority of deaths among adolescents could he prevented. It is necessary to improve data of vital statistics to get better insight into causes of adolescent death. [ABSTRACT FROM AUTHOR]

During the period between 1990 and 2002 in Belgrade population, almost every second person aged 30-69 years, died of some cardiovascular disease (CVD). Men, as compared to women, had higher standardized mortality rates from CVD (1.7 times), ischemic heart diseases (2.5 times), other heart diseases (1.6 times), and cerebrovascular diseases (1.3 times). During that period, the mortality from CVD increased by 18.6% in men, and by 10.0% in women. The increase in cerebrovascular disease mortality was 32.6% for men and 17.2% for women. Mortality from ischemic heart disease decreased twice as much in men (17.0%) than in woman (8.5%). In both sexes, the average age-specific mortality rates from CVD rised with the age. In women, the average age-specific mortality rates were 5 years behind those in men. In both sexes aged 30-34 years, the average mortality rate from CVD increased by 22.2% in men and by 14.1% in women, respectively. [ABSTRACT FROM AUTHOR]