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Background/Aim. The role of the complex sepsis-related immune response has not been fully clarified and remains a subject matter of investigation. Nowadays, sepsis is considered a dynamic syndrome characterized by many, often antagonistic phenomena, ranging from hyperinflammation to anergy and immunoparalysis. The aim of the study was to determine, based on the level of pro- and anti-inflammatory mediators in critically ill patients with secondary sepsis, whether the cytokine profile differs according to the type of bacterial causative agent, as well as to assess the prognostic value regarding the outcome. The outcome measure was in-hospital mortality. Methods. Blood serum samples were taken from 125 critically ill patients admitted to the Surgical Intensive Care Unit with severe secondary sepsis as a consequence of peritonitis, pancreatitis, or trauma. The average age of the patients was 57.7 ± 17.3 years. Of the total number of patients, 84 (67.2%) were males, and 41 (32.8%) were females. The levels of pro-inflammatory interleukin (IL)-1α, IL-1β, IL-6, IL-8, IL-12р70, IL-17А, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, IFN-γ-inducible protein-10 (IP-10), monocyte chemoattractant protein-1(MCP-1), macrophage inflammatory protein (MIP)-1α and MIP-1β, as well as anti-inflammatory mediators IL-4, IL-10, IL-13, IL-27, IL- 31, and IL-33, were determined at three time intervals – on the day of admission (the first day) and then on the third and fifth day. The type of the bacterial causative agent was determined using standard microbiological analyses. Results. On the third day of measurement, significant differences in the cytokine levels regarding the nature of bacteremia were determined in all pro- and anti-inflammatory cytokines, except for IL-8. In general, the lowest levels were observed in patients with polymicrobial blood cultures. On the first and fifth days of measurement, no significant differences in the cytokine levels regarding the nature of bacteremia were found. The only significant predictor of the fatal outcome on the first measurement day was IL-17А, Area Under the Receiver Operating Characteristic (ROC) Curve (AUC) of 0.665 (95% confidence interval 0.519–0.791; р = 0.034) in the patients with secondary sepsis as a complication of peritonitis. Conclusion. According to the type of bacterial causative agent, the lowest levels of cytokines have been observed in patients with the polymicrobial blood culture. The low level of IL-17А on the first day of measurement is a good predictor of a fatal outcome in patients with peritonitis as an underlying condition of secondary sepsis. On the other hand, the levels of other cytokines correlated with the out-come only on the fifth day of measurement, and they were higher in survivors than in non-survivors.

Pepper is one of the most important vegetable species in Serbia. The use of pepper fruits is very often determined by their type. Tomato-shaped pepper is a fruit type suitable for the pickle processing industry because of its thick pericarp. In this study, several lines of light-yellow tomato-shaped peppers were evaluated in the open field with the aim to develop new variety with appropriate fruit characteristics and without anthocyanin colouration. Eight of selected lines originated from two crosses while two lines originated from variety Novosađanka. Fruit weight, fruit length, fruit width, fruit index, pericarp thickness, number of locules, and Brix were measured in technological maturity. According to the obtained data, lines 17 and 24 will be used for further selection process. Line 17 was chosen because of the highest pericarp thickness and high fruit weight and line 24 because of the high content of total soluble solids.

Introduction. Melanoma is a solid aggressive tumor characterized by the malignant transformation of melanocytes. To date, only about 35 primary and about 30 metastatic malignant melanomas of the bladder have been reported. Our objective is to report a rare case of secondary tumor of urinary bladder. Case outline. A 57-year-old man presented to the Urologic Clinic due to lower urinary tract symptoms. The urologist indicated transurethral resection (TUR). His medical history was significant for cutaneous malignant melanoma resected 3 years prior, which were localized at scapular region on the left side. Microscopic examination of the TUR specimen showed several fragments of ureter mucosa with presence of tumor and focally with normal urothel. Tumor cells were markedly atypical and polygonal in a solid pattern. The nuclei were large with variation in size and prominent eosinophilic nucleoli. Also, there were present areas with abundant brown pigment. Immunohistochemical analysis of tumor cells showed positivity for Melan A and HMB45 and negativity for GATA3. Molecular analysis showed that BRAF was mutated. Conclusion. The incidence of malignant melanoma is high and increasing, but the urinary bladder is a rare location of metastasis. However, both primary and metastatic melanomas can occur in the bladder, so the urologist and the pathologist have to consider it when it is the primary site of onset, or when it represents the first symptomatic metastasis.

Gestational hypertension (GH) and preeclampsia (PE) are associated with the onset of hypertension. This study aimed to investigate whether the blood pressure (BP) pattern in GH is associated with the prevalence of hypertension later in life. In this prospective cohort study pregnant women screened for GH underwent medical history, laboratory analysis, ambulatory blood pressure monitoring (AMBP), and transthoracic echocardiography (with left ventricular global longitudinal strain (LVGLS)) assessment. Overall, 138 GH (67 non-dippers and 71 dippers), 55 preeclamptic, and 72 normotensive pregnant controls were included. Women were followed in the postpartum period, first after 6 weeks and later on, for the occurrence of hypertension. The median follow-up was 8.97 years (8.23; 9.03). Non-dippers and PE compared with normotensives and dippers had a higher prevalence of hypertension onset (p < 0.01), as well as significantly reduced absolute values of LVGLS during pregnancy, after delivery, and at the time of onset of hypertension during follow-up (p < 0.01). Night-time diastolic BP, LVGLS, age, and left ventricular ejection fraction were the strongest predictors of postpartum onset of hypertension. The non-dipping BP pattern in GH was significantly associated with the onset of hypertension later in life, as well as with decreased systolic function. [ABSTRACT FROM AUTHOR]

Seed as a highly-valuable resource is preserved in collections for many years. Although the seed is kept under optimal conditions, monitoring of germination and the presence of fungi during seed preservation is of great importance. Therefore the aim of this paper is to examine the seed health status and germination of 43 onion accessions kept in the timespan for 15 years in the Institute of Field and Vegetable Crops collection. Germi­nation of seed samples varied from 7-93%. The presence of fungi in the collection was determined on 33 tested samples. Fungi from the genera Acremonium, Alternaria, Aspergillus, Cladosporium, Epicoccum, Fusarium and Penicillium were developed. The following Fusarium species identified on the seeds were F. proliferatum, F. graminearum, F. sporotrichioides, F. solani, F. pseudograminearum and F. equiseti. Based on factor analysis, Fusarium and Penicillium affected germination, while the occurrence of Alternaria species on onion seed is connected to the year of harvest.

Background/Aim. Randomization allows for study groups to be formed so that they are similar in all characteristics except outcomes. The aim of this study was to examine the frequency of randomization methods and their effect on achieving baseline balance in cluster randomized studies conducted in schools. Methods. A literature search of the Medline bibliographic database showed that the total number of collected articles in the full text was 343, out of which 81 were eligible for inclusion. Each publication was reviewed by two independent reviewers, and data were extracted and analyzed. Results. Stratification was the most commonly applied randomization method, reported in 28 trials (34.6%). There was no statistically significant difference in the number of subjects and clusters, as well as in cluster size between trial groups in studies in which simple randomization was applied. However, there was a statistically significant difference in the number of subjects and clusters between groups in trials in which restricted randomization methods were used. Yet, there was no difference in the cluster size. Conclusion. Although there is no difference in the size of clusters between trial arms, either at the level of the entire sample or in relation to randomization methods applied, additional research should be conducted on a larger sample in order to establish the effect of randomization methods on baseline balance, when the size of clusters is in question.

Intrduction. Tacrolimus (fujimycin or FK506) is a potent immunosuppressive drug with growing usage. It is usually used in prevention of transplanted organ rejection. Its use is highly valuable, but like other immunosupressants, it has adverse effects. One of them is optic neuropathy. Case report. A 47-year-old white male patients who had received tacrolimus therapy for nine years, after kidney transplantation, developed a subacute, painless vision loss on both eyes. He was thoroughly examined on different possible optic neuropathies and other causes of vision loss. After exclusion of other possible causes, the diagnosis of toxic optic neuropathy was established. His therapy was converted to cyclosporine, by his nephrologist, but his vision had improved only slightly. Conclusion. Toxic optic neuropathies are presented in everyday ophthalmological practice, but they are underestimated. Diagnosis can be demanding, especially when it comes to drugs and substances whose possible toxic effect on the optic nerve is not widely known. Unlike other adverse effects of tacrolimus therapy on nervous system, optic neuropathy can causes great and permanent functional impairment.

Background: There is evidence that right ventricular (RV) contractile function, especially its coupling with the pulmonary circulation, has an important prognostic value in patients with left ventricular dysfunction. Aims: This study aimed to identify the best echocardiographic parameters of RV function and pulmonary artery systolic pressure (PASP) alone or in the form of the index of right ventricular-pulmonary artery coupling (RV-PA coupling) to determine the best predictor of 1-year major adverse cardiovascular events (MACE), which were defined as cardiovascular death and cardiac decompensation in heart failure patients with reduced ejection fraction (HFrEF). Methods and results: The study enrolled 191 HFrEF patients (mean age 62.28 ± 12.79 years, 74% males, mean left ventricular ejection fraction (LVEF) 25.53 ± 6.87%). All patients underwent clinical, laboratory, and transthoracic echocardiographic (TTE) evaluation, focusing on assessing RV function and non-invasive parameters of RV-PA coupling. RV function was evaluated using fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), and peak tricuspid annular systolic velocity (TAS'). PASP was estimated by peak tricuspid regurgitation velocity (TRVmax) and corrected by assumed right atrial pressure relative to the dimension and collapsibility of the inferior vena cava. The TAPSE/PASP and TAS'/PASP ratios were taken as an index of RV-PA coupling. During the follow-up (mean period of 340 ± 84 days), 58.1% of patients met the composite endpoint. The independent predictors of one-year outcome were shown to be advanced age, atrial fibrillation, indexed left atrial systolic volume (LAVI), LVEF, TAPSE/PASP, and TAS'/PASP. TAS'/PASP emerged as the strongest independent predictor of prognosis, with a hazard ratio (HR) of 0.67 (0.531–0.840), p < 0.001. Reconstructing the ROC curve 0.8 (0.723–0.859), p < 0.001, we obtained a threshold value of TAS'/PASP ≤ 0.19 (cm/s/mm Hg) (sensitivity 74.0, specificity 75.2). Patients with TAS'/RVSP ≤ 0.19 have a worse prognosis (Log Rank p < 0.001). Conclusions: This study confirmed previously known independent predictors of adverse outcomes in patients with HfrEF—advanced age, atrial fibrillation, LAVI, and LVEF—but non-invasive parameters of RV-PA coupling TAPSE/PASP and TAS'/PASP improved risk stratification in patients with HFrEF. Variable TAS'/PASP has been shown to be the most powerful, independent predictor of one-year outcome. [ABSTRACT FROM AUTHOR]

Mycoplasma hominis, Ureaplasma urealytium and Candida species (Candida spp.) are potentially pathogenic strains of microorganisms that can often be found in the genital tract of healthy women. However, the mentioned strains with additional factors can lead to numerous complications. The research aimed to determine the one-year prevalence of infection with Mycoplasma and Ureaplasma in pregnant and non-pregnant patients, as well as the correlation of infection with Candida spp. The study included 206 outpatients 30.8 ± 7 years of average age treated for symptoms of vaginal infection at the Department of Gynaecology and Obstetrics of the Clinical Hospital Center of Kosovska Mitrovica. All patients were tested for Mycoplasma and Ureaplasma by taking a standard vaginal and cervical smear. Cultures were seeded according to standard protocols. Out of 206 patients, 71 were pregnant. A positive test for Mycoplasma was found in 32 patients, Ureaplasma in 96, and 52 patients in the entire sample had vaginal candidiasis. Six pregnant women were positive for Mycoplasma and 29 for Ureaplasma. Vaginal candidiasis was significantly more common in pregnant patients compared to non-pregnant patients (n = 40, p = 0.046). Ureaplasma infection was associated with candidiasis in 33 patients (p = 0.005). Almost half of the patients (46.6%) tested positive for Ureaplasma. In pregnant women, the most common infection was with Candida spp. Ureaplasma infection was often associated with vaginal candidiasis in the entire sample, and one should be careful in the treatment of these infections and rationally use antibiotics in correlation with the clinical findings with preventive use of vaginal antimycotics. [ABSTRACT FROM AUTHOR]

Introduction. Mucinous tubular and spindle cell carcinoma of the kidney (MTSCC) is a rare and recently described subtype of renal cell carcinoma (RCC). As its name indicates, the tumor is composed of three morphological structures: tubules consisted of cuboidal cells, spindle cells, and extracellular mucus. Case report. A 59-year-old female patient was admitted to the Emergency Center of the Clinical Center of Vojvodina due to injuries sustained in a traffic accident. After diagnostic procedures, computer tomography (CT) revealed a large asymptomatic cyst of the upper pole of the left kidney as an incidental finding. Four months later, after recovering from traumatic injuries, a control CT confirmed a well-circumscribed tumor, 90 mm in diameter, confined to a kidney, and a radical nephrectomy was performed. Histopathological evaluation showed that the necrotic tumor mass consisted of tubules made of cuboidal cells and cords made of spindle cells separated by pale mucinous material in some areas, while other tumor parts were of dense cellularity without mucin. No atypia was found. Conclusion. MTSCC is a variant of papillary RCC, thus, it is usually mistaken with papillary RCC with sarcomatoid differentiation. Because of the same immunoprofile as papillary RCC, histomorphology is imposed as the gold standard for making the diagnosis. MTSCC is a tumor with a generally favorable prognosis, and complete surgical excision appears to be adequate treatment, but single cases with metastatic disease have been reported. In this case, there were no signs of the dis-ease one year after surgery.

Background/Aim. Contrast echocardiography (CE) is an echocardiographic modality where ultrasound contrast echocardiographic agent (CEA) is introduced peripherally for the image enhancement. The aim of this study was to present the initial clinical experience of the use of CEA Optison™ (GE Healthcare, Princeton, NJ) at the Institute for Cardiovascular Diseases of Vojvodina, Serbia and prospectively monitor the occurrence of possible side effects. Methods. A total of 357 patients were referred for resting or stress echocardiographic examinations, with an approved indication for CEA administration. The average age of patients was 63.3 years (range, 21–92 years), 62% of them were men. Most of the patients (77.31%) had some form of ischemic heart diseases. Hypertension was the most frequent risk factor (77.03%), but 57 patients had diabetes mellitus and 33 patients had chronic kidney disease as comorbidity. Most (90.5%) of the patients were on beta blocker therapy, 83.5% of them on angiotensin converting enzyme/angiotensin receptor blockers. Majority (80.3%) of the patients received single or dual (49.5%) antiagregation therapy, 74 (26.3%), of them were on anticoagulation therapy, 55.1% of the patients were taking diuretics. The global ejection fraction (EF) was preserved in 39.85% of them, the majority (136 of them), had left ventricle (LV) impairment, with an EF less than 50%. Patients were followed up for 30 minutes after CEA administration for potential side effects. In 118 patients, vital signs (heart rate, oxygen saturation, body temperature, systolic and diastolic blood pressure) were measured before and 30 minutes after CEA administration. Results. The administration of CEA was not associated with side effects. Diastolic blood pressure drop and heart rate increase were statistically, but not clinically significant (p = 0.027 and p = 0.028, respectively). Conclusion. Changes in analyzed vital signs were clinically non relevant. CE is a safe noninvasive diagnostic modality for patients undergoing rest and stress echocardiography.

Background/Aim. In planning the extraction of posterior teeth, it is necessary to determine their position and correlation with the surrounding anatomical structures. The aim of this study was to perform Cone Beam Computed Tomography (CBCT) analysis in order to evaluate the predictive value of specific orthopantomography (OPT) radiographic signs in determining the proximity of posterior upper teeth to the maxillary sinus and lower teeth to the mandibular canal. Methods. In a prospective study, 460 cases out of 423 patients were analyzed. Seven OPT radiographic signs were assessed to determine the correlation of the third molars to the mandibular canal, while five radiographic signs were followed to determine the correlation of the maxillary sinus floor to the upper posterior teeth. For each OPT radiographic sign, a precise analysis of the axial slices of the CBCT was performed. Results. Interruption of the white line is a radiographic sign showing statistically significant interruption of the integrity of the mandibular canal on the CBCT axial slices (p = 0.002). Also, diversion of the inferior alveolar canal at the axial sections showed statistically significant interruption of the continuity of the mandibular canal (p = 0.003). A radiographic sign, Darkening of the root, showed super-imposition of the anatomical structures, a close relationship with the tooth but often with preserved mandibular canal integrity (p < 0.001). Absence of lamina dura, interruption of the maxillary sinus floor's cortex, and projection of the root apices in the sinus cavity were radiographic signs that were statistically the most commonly associated with interruption of maxillary sinus integrity on CBCT axial slices (p < 0.001). Conclusion. The results of our study indicate that the presence of certain radiographic signs on the OPT may have predictive significance. The exact relationship between anatomical structures and posterior teeth cannot be accurately estimated on OPT. The precise position of the molars and correlation to the mandibular canal and the maxillary sinus can be accurately determined by CBCT imaging.

In this paper author discusses the characteristics of discourse on modern terrorism. When it comes to the terrorism ordinary people gain knowledge mostly through media. The influence of specific image of terrorism is not limited to citizens who live in countries which faced with a terrorist threat or concrete attack but goes further to the different part of the world, some of them very far from the possibility of terrorist attack. Demystification of discourse on modern terrorism begins with analysis of the phenomenological dimension of modern terrorism, in terms of being defined and assigned. We can talk about two different approaches: older and newer, in understanding the terrorism. The new approach gains momentum with the events of 11 September and took shape after similar events on European continent. At the core of understanding of modern terrorism is the discourse on religious-based Islamic terrorism. Specific discourse on modern terrorism affects how it is understood by the general public, and it influences, in particular, the creation of stereotypes about a modern terrorists and the spread of fear of terrorism. The formation and maintenance of stereotypes about modern terrorism, which emphasizes the role of Islam and members of the Islamic community in planning and carrying out terrorist actions, creates a growing gap among people, especially in countries affected by terrorist attacks. The discourse on modern terrorism also implies an appropriate perception of the risk of terrorism all over the world. From that point of view risk of terrorism is real and constant. Similar situation is in Serbia and in that sense the results of limited research about perception of terrorism in Serbia presented in work show to a certain extant the existence of such global influence.

Introduction. Solitary fibrous tumor is a neoplasm that arises most commonly from the pleura, but can occur at other sites. Intrapulmonary solitary fibrous tumor has been rarely reported and therefore is not well recognized. Case outline. We report a case of an asymptomatic 63-year-old woman in whom a large, well-circumscribed mass was incidentally revealed on chest X-ray during preparation for ergometric cardiac testing. Chest computed tomography revealed an abnormal nodule in the lower right lung lobe. Mediastinal and hilar lymphadenopathy was not detected. After transthoracic fine needle aspiration, cytology showed a finding suspicious for spindle cell tumor. Consequently, right anterolateral thoracotomy with right lower lobectomy was performed. On gross examination, the lower right lobe was almost completely replaced with abnormal, white-yellow, well-demarcated solid nodule measuring 13.5 cm in its largest diameter surrounded by a pseudocapsule. After histological examination and applied immunohistochemical analysis, a diagnosis of intrapulmonary solitary fibrous tumor of low malignant potential was set. Due to the presence of unfavorable prognostic parameters (tumor size, as well as the presence of hypercellularity), more frequent follow-up check-ups were recommended. Eighteen months after surgery, the patient remained uneventful, with no evidence of tumor recurrence. Conclusion. Intrapulmonary solitary fibrous tumor is a rare entity challenging for diagnosis, because variegated histology and variability of its growth patterns can resemble other soft tissue tumors. The treatment of choice is complete excision with clear surgical margins, but since morphology cannot be a reliable predictor of clinical behavior, the patients need a long-term follow-up.

Introduction/Objective. Body fat percentage (BFP) is the most reliable indicator of the nutritional status. For clinical practice, it is important but also insufficiently examined whether the determination of BFP should be relied exclusively on the latest methods or whether classical anthropometric methods are also reliable. The aim was to investigate the correlation between the results of BFP measuring using a contemporary method of bioimpedance and classic methods of skin fold thickness (SFT) and body mass index (BMI). Method. There were 279 patients of the Dietetic Counseling Center of the Institute for Public Health in Niš who were included in the research during 2015. BFP was determined using three classic anthropometric methods: SFT over the triceps, SFT over the scapula, and BMI. OMRON BF 302 apparatus was used for BFP measuring using the bioimpedance method. Results. Using single-factor analysis of variance we found a statistically significant difference between the mean values of the BFP obtained with bioimpedance and those obtained with anthropometric methods (F = 24.19, p < 0.05). Post hoc analysis revealed a statistically significant difference between the BFP determined with bioimpedance and SFT over the triceps and the scapula, while the anthropometric method based on BMI gave the results similar to those from bioimpedance. Conclusion. We show that the most reliable anthropometric method of determination of BFP is that based on BMI, as its results correlate best with those obtained with a contemporary method of bioimpedance.

Introduction: The circle of Willis is the major source of collateral blood flow between the carotid and vertebrobasilar system. Its potential depends on the presence and size of arteries that vary greatly among normal individuals and therefore their adequate observation by a radiologist is necessary. Aim: Determine the type of the circle of Willis and their frequency. Determine the type, frequency and localization of anatomical variants of arteries, as well as their average diameter. Compare these variables according to the age and gender of the examinees. Material and methods: A retrospective study was performed at the Center for Radiology of the Clinical Center Nis during 2017. All subjects underwent CT or MR angiography according to a standard endocranial protocol. The anterior and posterior parts of the circle were specially observed, with an emphasis on the presence or absence of anatomical variants of the arteries, with the measurement of their diameter. The obtained data were classified into variants of the front or rear part of the ring as well as the type of ring according to integrity. The frequency of these variables and their comparison by sex and age were measured. Results: The research included 92 examinees. According to the configuration of the Willis arterial ring, the adult type was the most often represented (71.7%). The most common type in terms of integrity was partially complete. The most common anatomical variants obtained in our work was aplasia of AcoA (27.2%) and aplasia of one or both PCoA (21%). PcoA hypoplasia was occured in women with a frequency of 13.5% while in men it was not present. Conclusion: Adequate understanding of the morphology of the circle of Willis by radiological methods is a good guide for neurosurgical and radiological intervention procedures. In this way, potentially significant neurological complications and the risk of morbidity and mortality could be reduced.

In this paper, the author discusses the social context of moral panic, ie the role of various social factors in the creation of moral panic. Starting from the known mechanisms of moral panic (traditional and newer), the author considers the roles of the subjects of informal and formal social control in this process. In that sense, it stands out the activity of various moral activists as representatives of the informal social structure who, by propagating the importance of moral protection, often participate in the process of creating of many moral panics. On the other hand, the activities of formal social control bodies are regulated by an appropriate legal frame-work whose task is to solve the problem of crime in society. This implies a professional attitude of the police, the prosecution and the courts in terms of combating crime. The author points out the problem of the participation of the representatives of these bodies in the creation and development of moral panic, considering it in the context of the culture of control, ie its elements, emphasizing especially the role of the police. The author connects all the mentioned segments of the social function of moral panic with the role of the media as an unavoidable factor in the process of moral panic. At the end of the paper, the author emphasizes the importance of the role of the media in raising awareness of the importance of individual actions of all social actors in order to avoid their participation in the creation of moral panic that unfavorable affects on solving the problem of crime.

Background/Aim. Periodontal disease is an inflammatory disease that occur in the tissues surrounding the teeth in response to bacterial biofilm accumulation (dental plaque). Among others, Tannerela forsythia (Tf) was recognized as one of the most significant and specific bacterial species in periodontal pocket („red complex“ bacteria). Atherosclerosis is a progressive narrowing of arteries that may lead to occlusion, as a consequence of lipid deposition. It underlies coronary heart disease (80%), as well as myocardial and cerebral infarctions. Increasing evidence over the past decade suggests a link between periodontal disease and atherosclerosis, where Tf can enter the systemic circulation directly or indirectly, and be present in atherosclerotic blood vessels. Therefore, the aim of this study was to detect the presence of Tf in atheromatous plaques obtained from different blood vessels in patients with chronic periodontitis. Methods. Ninety patients (male 61, female 29) with periodontal disease and atherosclerosis [recruited for either carotid artery stenosis requiring endartectomy or percutaneous transluminal coronary angioplasty (PTCA)] were included in this study. Clinical periodontal examinations consisted of plaque index (PI) (according to Silness Lӧu), gingival index (GI) (according to Lӧe Silnes), sulcus bleeding index (according to Mühleman-Son) and periodontal probing depth (PPD). Presence of Tf in periodontal pockets and atherosclerotic vessels was detected using polymerase chain reaction (PCR) method with positive control Tf ATCC 43037. Results. Tf was present in subgingival plaques of 68 (75.6%) of the patients, while its presence in atheromatous plaques were registered in 42 (53.3%) of the patients. It was significantly present in coronary blood vessels (41.7%), followed by carotid arteries (35.4%) and a. abdominalis aneurism (12.5%), a. mamaria (8.5%) and a. femoralis (2.1%) while in a. iliaca Tf was not detected at all. Conclusion. The present study suggests strong relationship between periodontal inflammation and atherogenesis; therefore, it should be considered as potential risk factor for atherosclerosis. Accordingly, it would be necessary to control periodontal disease in order to reduce mortality and morbidity associated with atherosclerosis.

Introduction. Partial atrioventricular septal defect (AVSD) is a form of congenital heart disease (CHD) rarely detected in adults. Infective endocarditis represents a severe complication that carries a substantial risk. Case report. We here reported a case of a 43-year-old female with previously diagnosed adult CHD (partial AVSD and bicuspid aortic valve) presented to the hospital with fever and malaise 14 days prior to admission. On the lung computed tomography scan inflammatory consolidations were found and dual antibiotic therapy (ceftazidime and clarithromycin) was administered without significant regression of pulmonary inflammatory consolidations. The antibiotic treatment was continued with amoxicillin/clavulanic acid combined with levofloxacin and metronidazole. Transthoracic and transesophageal echocardiography revealed a large vegetation (dimension, 3.6 x 1.8 cm) attached to the septal leaflet of the tricuspid valve floating between right atrium and right ventricle through tricuspid valve with high embolic potential. Endocarditis team reached a decision for immediate surgical intervention. The operative findings revealed the partial AVSD, common atrioventricular valve with cleft of the anterior mitral leaflet in the A2 segment and detached and cleft septal leaflet of the tricuspid valve. Vegetation (size 4 x 3 cm) was attached to the septal side of the tricuspid annulus, basal segment of the anterior mitral leaflet and edge of the atrial septal defect freely floating between right atrium, right ventricle and left atrium. Excision of the vegetation and AVSD plastics were done, as well as the reconstruction of the mitral and tricuspid annuli and leaflets. The treatment was continued with antibiotics and completed in 18 days with full recovery. Conclusion. Early and precious diagnosis and optimal management that combines both conventional and surgical approaches are crucial for reducing the risk of complications and mortality in patients with infective endocarditis in grown-up congenital heart disease.

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Hypertrophic cardiomyopathy (HCM) is among the most common forms of cardiomyopathies, with a prevalence of 1:200 to 1:500 people. HCM is caused by variants in genes encoding cardiac sarcomeric proteins, of which a majority reside in MYH7, MYBPC3, and TNNT2. Up to 40% of the HCM cases do not have any known HCM variant. Genotype–phenotype associations in HCM remain incompletely understood. This study involved two visits of 46 adult patients with a confirmed diagnosis of HCM. In total, 174 genes were analyzed on the Next-Generation Sequencing platform, and transthoracic echocardiography was performed. Gene-specific discriminative echocardiogram findings were identified using the computer vision library Fast AI. This was accomplished with the generation of deep learning models for the classification of ultrasonic images based on the underlying genotype and a later analysis of the most decisive image regions. Gene-specific echocardiogram findings were identified: for variants in the MYH7 gene (vs. variant not detected), the most discriminative structures were the septum, left ventricular outflow tract (LVOT) segment, anterior wall, apex, right ventricle, and mitral apparatus; for variants in MYBPC3 gene (vs. variant not detected) these were the septum, left ventricle, and left ventricle/chamber; while for variants in the TNNT2 gene (vs. variant not detected), the most discriminative structures were the septum and right ventricle. [ABSTRACT FROM AUTHOR]

Introduction. The incidence of aortic dissection ranges 3–5 cases per 100,000 person-years. In women under the age of 40 who acquire aortic dissection, almost half of the cases happen during pregnancy. Case outline. We report a case of a 22-year-old pregnant woman in the 16th gestational week with a history of arterial hypertension and known aortic dilatation, who was admitted with aortic dissection. She underwent the Bentall procedure, in which her aortic valve, ascending aorta, and proximal part of the aortic arch were replaced using valved composite graft. On the next day, the evacuation abortion was made, since the fetus didn’t survive the operation. Six years later, the patient stopped taking anticoagulation therapy and was admitted for prosthetic valve thrombosis, which was successfully treated with intravenous heparin. One year later, the patient died of a myocardial infarction due to coronary thromboembolism, confirmed on autopsy. Conclusion. Preconceptional counseling in women with a known aortic disease is of the utmost importance. Aortic dissection in pregnant women is an acute life-threatening condition for both mother and fetus that should be managed by a multidisciplinary team. After a mechanical heart valve implantation, lifetime oral anticoagulants are mandatory.

Introduction/Objective. Heroin is metabolized to 6-monoacetylmorphine (6-MAM) and morphine. The objective of this study is to examine 6-MAM, morphine, and codeine relationships in order to distinguish deaths related to heroin consumption from deaths related to morphine and/or codeine consumption. Methods. The autopsy blood and urine samples from 45 opioid drug addicts were examined. Gas chromatography/mass spectrometry was applied to evaluate morphine, 6-MAM, and codeine. Two groups were formed: 6-MAM-positive (n = 35) and 6-MAM-negative (n = 10). Results. Compared to the 6-MAM-negative group, blood morphine levels were higher in the 6-MAMpositive group (p = 0.022), while blood codeine levels were similar (p = 0.575). In the 6-MAM-negative group, the blood morphine/codeine ratio was 8.3, and it was 4.3 in the 6-MAM-positive group. There was no difference between the groups regarding urine morphine levels (p = 0.859). The urine morphine/ codeine ratio was 6.2 in the 6-MAM-negative group, whilst it was 32.2 in the 6-MAM-positive group. In the blood samples, morphine and codeine concentrations were significantly correlated (r = 0.607; p = 0.006). In urine samples, correlations between morphine and codeine (r = 0.766; p < 0.001), morphine and 6-MAM (r = 0.650; p < 0.001), as well as codeine and 6-MAM (r = 0.620; p < 0.001), were also significant. Conclusion. Analyses of 6-MAM and morphine/codeine ratio in blood and urine autopsy samples may be used as diagnostic tools to distinguish deaths related to the consumption of different opioid drugs.

Introduction The ventricular septal defect (VSD) incidence today is less than 1%. It presents with a rapid clinical deterioration and acute heart failure. A loud systolic murmur appears over the precordium. Doppler echocardiography is the golden standard for diagnosis. Case Report A female patient was admitted to the hospital with the diagnosis of an acute myocardial infarction with the involvement of the inferior wall and right ventricle. At admission, a loud systolic murmur above the precordium was noted and an emergency echocardiography was performed. A suspected interruption of the interventricular septum continuity was registered at the inferoseptal level. An emergency coronography was immediately performed to uncover a subocclusion of the medial segment of the right coronary artery. Ventriculography was performed in the same act and passage of contrast was registered from the left ventricle to the right at the septal level. A cardiac surgeon was consulted, but the patient died while being prepared for surgery. Conclusion Keeping in mind the high mortality rate, a prompt diagnosis and aggressive treatment with a timely surgical intervention are necessary to enable a favorable outcome. Poor prognosis parameters are advanced age and a myocardial infarction involving the inferior wall, which were both present in our patient.