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Background/Aim. There is limited data on the frequency of intracranial hemorrhage (ICrH) in the first wave [beta variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] and second wave (delta variant of SARS-CoV-2) coronavirus disease 2019 (COVID-19) pandemic. T he aim o f t his s tudy w as t o analyze the appearance of ICrH in COVID-19 patients (CP). Methods. Among 505 CP treated at the Special Hospital for Cerebrovascular Diseases "Sveti Sava" intermittently during the 2020--2021 period, ICrH was diagnosed in 76 (15.1%) patients. The available information from the medical records regarding clinical, demographic, as well as radiological data (multislice computed tomography examination of the endocranium) was collected and analyzed. Results. In the first wave, out of 308 CP, 63 (20.5%) were diagnosed with ICrH. In the second wave, out of 1 97 CP, I CrH w as diagnosed in 13 (6.6%) patients, which was a statistically significant difference (p < 0.002). There was no statistically significant difference for the presence of hypertension (p = 0.271), diabetes mellitus (p = 0.558), and chronic obstructive pulmonary disease (p = 0.794) among CP with ICrH comparing the two waves of the pandemic. However, a statistically significant difference was proven in the frequency of patients with atrial fibrillation and anticoagulant drug therapy (p = 0.021 each). There was no statistically significant difference in the frequency of patients with f ever ( p = 0.637), fatigue (p = 0.587), hemiparesis (p = 0.831), respiratory symptoms (p = 0.289), and loss of consciousness (p = 0.247). D-dimer values in the second pandemic wave were statistically significantly lower (p = 0.003). The combination of ischemic stroke and ICrH was six times more common in the second wave (p = 0.003). However, cerebral parenchymal hemorrhage was two times less frequent (p = 0.001) in the second wave but with statistically higher frequencies of multifocal (23.1%) and diffuse type (36.4%) of ICrH (p = 0.007). Combined hemorrhages, as well as subarachnoid and subdural subtypes, were more common in the second wave (23.1% each). Fatal outcomes occurred in 38.1% of patients in the first wave compared to 69.2% in the second wave (p = 0.039). Conclusion. In the first pandemic wave of COVID-19, ICrH in CP was significantly more frequent and D-dimer was singled out in laboratory analyses, the values of which were statistically significantly higher in comparison with second wave. In the second wave of COVID-19, parenchymal ICrH was less frequent and multifocal and diffuse ICrH were more common in CP with ICrH. The mortality rate was very high in the second wave. [ABSTRACT FROM AUTHOR]

Background: Multiple organ dysfunction syndrome (MODS) is common after sepsis and increases mortality. Lactate (Lac) can assess the prognosis of patients. Albumin (Alb) is closely associated with inflammatory response in sepsis patients. This work evaluated the predictive value of Lac/Alb for prognosis of sepsis patients. Methods: Data of 160 sepsis patients were retrospectively collected. Lac and Alb levels were measured upon admission, at 24 hours and 48 hours later. Using 0.45 as the cutoff value for Lac/Alb, patients were rolled into high-level (HL) and low-level (LL) groups. MODS rates and mortality rates were analyzed. Receiver operating characteristic (ROC) curves were utilized to evaluate the predictive value of 48-hour Lac/Alb for patient prognosis. Correlation between Lac/Alb and APACHE II and SOFA scores was assessed. Results: The 12-month follow-up revealed 52 deaths (32.5%), and MODS occurred in 49 cases (30.6%) on the 7th day. The MODS group possessed elevated Lac and Lac/Alb and decreased Alb to the N-MODS group (P<0.05), and similar results were observed by comparison the survival and death group (P<0.05). The sensitivity, specificity, and area under the ROC curve (AUC) of Lac/Alb in predicting MODS were 81.63%, 85.59%, and 0.89, respectively, while those in predicting death were 94.23%, 88.89%, and 0.91, respectively. Lac/Alb was positively correlated with APACHE II and SOFA scores (r=0.718 and 0.808, respectively). Conclusions: Lac/Alb was linked to MODS and mortality in sepsis patients and can be based to predict adverse outcomes. [ABSTRACT FROM AUTHOR]

Background/Aim. Patients in intensive care units (ICUs) often exhibit disturbances in the concentration of thyroid hormones (THs), even if they had no previous thyroid disorders. The aim of the study was to determine whether there is a correlation between THs and the survival rate in the ICU and whether these hormones have predictive capability for mortality rate assessment. Methods. The study included 41 patients (23 women and 18 men) divided into two groups: survivors (70.7%) and non-survivors (29.3%). In peripheral blood samples taken within the first 24 hrs after ICU admission, TH levels were measured: triiodothyronine (T3), thyroxine (T4), free T3 (FT3), free T4 (FT4), and thyroid stimulating hormone (TSH), as well as procalcitonin (PCT). The Sequential Organ Failure Assessment Score (SOFAS) was calculated for each patient. Results. A statistically significant difference between the study groups (survivor vs. non-survivor patients, p < 0.05) was found for PCT, SOFAS, T3, T4, and FT4. The area under the receiver operating characteristic (ROC) curve (AUC) – (AUROC) for the SOFAS was 0.991 [95% confidence in terval (CI): 0.898–1.000, p < 0.001], for T3 was 0.727 (95% CI: 0.566–0.854, p = 0.0097), for T4 was 0.793 (95% CI: 0.638–0.903, p = 0.0008), for FT3 was 0.707 (95% CI: 0.544–0.8389, p = 0.0299), and for FT4 was 0.795 (95% CI: 0.640–0.904, p = 0.0005). Compared to other parameters, T3 had higher sensitivity (91.67%), FT4 had higher specificity (93.10%), while SOFAS had both the highest sensitivity (91.67%) and specificity (96.55%) in relation to all other tested parameters. Multiple linear regression analysis showed that FT4 and T4 were significant predictors of survival time (β = -0.362, p = 0.012 and β = -0.356, p = 0.014, respectively). Conclusion. Among all examined THs, only FT4 and T4 showed strong predictive potential for assessing mortality in ICU patients. This study has highlighted the significance of assessing THs levels in critically ill patients. This is crucial because it opens the possibility of implementing specific therapies to rectify issues stemming from hormonal deficiencies. [ABSTRACT FROM AUTHOR]

Background/Aim. Multidetector computed tomography pulmonary angiography (MCTPA) has emerged as the most suitable method for diagnosing acute pulmonary embolism (APE) in hemodynamically stable patients. In addition to its diagnostic role, MCTPA facilitates the measurement and calculation of certain parameters that can be used as prognostic markers for outcomes in APE. Since the introduction of the method, there have been a lot of studies that pointed out there may be a significant difference in the prognostic value of MCTPA for APE concerning sex. Methods. The study population consisted of consecutive patients with a diagnosis of APE confirmed by MCTPA. Positive MCTPA findings and a diagnosis of APE were established if the patient had at least one segmental artery thrombus. APE severity was estimated using the simplified Pulmonary Embolism Severity Index (sPESI). Allcause and APE-related intrahospital deaths were the coprimary outcomes of this study. Results. In total, 1,612 patients were enrolled in the study (750 men and 862 women). Women with a centrally positioned pulmonary thrombus detected on MCTPA were more likely to die from PE-related death than those without one (10.4% vs. 4.2%, respectively; p = 0.016). Women with a right ventricle (RV) and left ventricle (LV) diameter ratio (RV/LV) > 1 died almost twice as often as those with a ratio ≤ 1 (15.5% vs. 8.6%, respectively; p = 0.017). Women with an RV/LV > 1 detected with MCTPA were significantly more likely to die from PE than those with a ratio ≤ 1 (11% vs. 5.2%, respectively; p = 0.017). Women who died from PE-related causes had a significantly higher value of the embolic burden score system (EBSS) than did the surviving women (18.00 vs. 11.00, respectively; p = 0.025). Independently of age, sPESI, and renal function, the presence of a central thrombus [odds ratio (OR) 2.278, 95% confidence interval (CI): 1.050–4.944, p = 0.037] and the RV/LV ratio > 1 (OR 2.015, 95% CI: 1.042–3.893, p = 0.037) were associated with intrahospital PE-related death in women. Conclusion. In women, MCTPA parameters, a centrally placed thrombus, the RV/LV ratio, and the EBSS had prognostic significance for PE-related mortality. The RV/LV ratio had prognostic significance for all-cause intrahospital mortality. In men, the MCTPA parameters had no prognostic significance for both overall and PErelated mortality. [ABSTRACT FROM AUTHOR]

Peripheral artery disease (PAD) is, along with ischemic heart disease and stroke, one of the three most significant diagnostic subgroups of cardiovascular diseases. According to prevalence estimates, the prevalence of PAD is <1% in persons aged <50 and 6% in persons aged >65. Analysis of the dynamics of PAD in the population has indicated a reduction of its incidence in EU15+ countries in the last 27 years, but with increasing mortality. The Republic of Croatia stands out among other Mediterranean countries due to its high cardiovascular burden, but there have been no systematic epidemiological studies on the dynamics of mortality from PAD. In the present study, regression analysis of age-standardized mortality rates due to PAD were used to show trends and timepoints with changes over time by region for the period from 2011 to 2020. The hospital information systems of two institutions were searched for diagnoses that are applied for coding PAD and related interventional and diagnostic procedures, supplemented by diagnoses used in previous studies. Data were obtained from the Croatian Institute of Public Health Mortality Database and were categorized five-yearinterval age groups, by sex, and by county. The National Classification of Statistical Regions from 2019 was used for regional classification, and age-standardized rates were calculated based on the Revised European Standard Population from 2013. Mortality increased in both men (3.09%) and women (2.94%), and there were significant regional differences in this trend for men in Adriatic Croatia and for both sexes in Northern Croatia. In men, the greatest increase was observed in the City of Zagreb, namely 3.71%, whereas the lowest and also the only negative value was found in Northern Croatia, namely -0.24%. In women, the greatest increase was in the City of Zagreb, i.e. 3.57%, and the lowest in Northern Croatia at 1.67%. In addition to raising awareness, this study on mortality trends facilitates improving our understanding of the epidemiological dynamics of this insufficiently diagnosed and treated, complex, and chronic disease. Improving clinical care for patients with PAD can be achieved by systemic screening of individual and clinically relevant data at medical institutions and merging this data in regional and national registries. [ABSTRACT FROM AUTHOR]

Peripheral artery disease (PAD) is, along with ischemic heart disease and stroke, among the most significant diagnostic subgroups of cardiovascular diseases and one of the leading public health issues. Approximately 17 million people are affected by this disease in the European Union. Its real incidence and prevalence are several times higher than the estimates for this disease, and it is insufficiently diagnosed. The Republic of Croatia has a high burden and mortality from cardiovascular diseases. The goal of this analysis was to calculate and compare the age-standardized mortality rates for PAD based on sex and on 2nd level statistical regions in Croatia in the period from 2011 to 2020. Hospital information systems were searched for diagnoses that are applied for coding death from PAD in clinical practice and for coding interventional and diagnostic procedures, which were also supplemented by diagnoses from other studies. Based on data from the Croatian Institute of Public Health Mortality Database from 2011 to 2020, we calculated proportional mortality, percentage change for 2020 in comparison with 2011, and age-specific rates per 100 000 inhabitants. Statistical analysis used descriptive and analytic statistical methods. Among the 16 799 people who died, 10 352 were women and 6447 were men. Diagnosis I70.9, Generalized and non-specific atherosclerosis, was the most common at 43.2%. The highest age-standardize mortality rates in men and women were found in Northern Croatia, and the lowest in Adriatic Croatia. There were significant differences between regions in age-standardized mortality rates in both sexes. This study also showed an increase in the trend since 2018. In order to reduce mortality from PAD, efforts should be invested in prevention and early diagnostics and implementing systematic data collection on clinical outcomes for patient treatment. [ABSTRACT FROM AUTHOR]

Introduction/Aim. The coronavirus disease 2019 (COVID-19) pandemic had significant acute and longterm impact on people's health. As the available literature sources have shown that the premorbid conditions affect the course of COVID-19, we aimed to investigate the role of admission vitamin D concentration to predict the outcome of hospitalized COVID-19 patients. An observational, prospective cohort study was conducted on 329 COVID-19 patients hospitalized at the University Clinical Centre Kragujevac, between October and December 2021. Within 24 hours of admission, vitamin D level was measured from the peripheral venous blood. Medical history data and socio-demographic characteristics were obtained anamnestically and using Health Information System (COMTRADE, Serbia). Lethal outcome and intensive care unit (ICU) admission were considered primary end-points. Results. The prevalence of hypovitaminosis D on admission in our cohort was 27.7%. Both non-survivors and patients requiring ICU admission more frequently had hypovitaminosis D compared to survivors (42,9% versus 21,0%; p < 0,001) and patients on a standard level of care (31,5% verus 25,3%; p = 0,029). Our research showed that vitamin D concentration < 20 ng/mL was an independent predictor of mortality (aOR 2.142 [95% CI 1.226 - 3.744]). However, hypovitaminosis D upon hospital admission did not show a significant impact on ICU admission. Conclusion. Low vitamin D concentration on admission could be a significant predictor of outcome in hospitalized COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background/Aim. Chronic obstructive pulmonary disease (COPD) is a chronic process that progresses with exacerbations. Various studies are carried out to predict mortality. Among the routine tests used to monitor and treat disease in the emergency department, special efforts are made to find those that are meaningful and diagnostic. The aim of the study was to compare the DECAF score and DECAF+Lactate score and examine the significance of the DECAF+Lactate score in predicting mortality in critically ill patients presenting with COPD exacerbation. Methods. This prospective multicentric study included 435 patients recruited from two centers. Patients who presented to the emergency department with acute COPD exacerbation and fit the definition of critically ill according to the quick Sequential Organ Failure Assessment (qSOFA) were included in the study. The prognostic values of the scores were compared using the receiver operating characteristic (ROC) curve analysis. The efficiency of scoring 28-day mortality was compared with logistic regression analysis. Results. For 435 patients, sensitivity, specificity, and area under the curve (AUC) were calculated for lactate, DECAF score, and DECAF+Lactate score, which were statistically significant in the ROC curve analysis for predicting mortality: 50%, 90.2%, 0.711, odds ratio (OR): 0.622 [95% confidence interval (CI): 1.573-2.203]; 57.6%, 64.3%, 0.654, OR: 0.618 (95%CI: 1.501-2.291); 60.1%, 75.4%, 0.744, OR: 0.790 (95%CI: 1.826-2.659), respectively. Each unit increase in the DECAF+Lactate score increased the risk of mortality by 2.203. Conclusion. As a result of our study, we believe that the DECAF+ Lactate score is a more effective scoring system than the DECAF score as a predictor of mortality in critically ill patients with COPD exacerbation. [ABSTRACT FROM AUTHOR]

Background/Aim. Patients who were treated with primary percutaneous coronary intervention (pPCI) and survived ventricular tachycardia (VT) and ventricular fibrillation (VF) in the first 48 hrs after ST-elevation myocardial infarction (STEMI) had, in most investigations, a similar long-term prognosis of the outcome, compared to those patients who did not have VT and VF during the first 48 hrs after STEMI. The aim of the study was to determine the association of myocardial infarction markers: creatine kinase-MB fraction (CK-MB), heart failure marker -- B-type natriuretic peptide (BNP), and systemic inflammation factor -- Creactive protein (CRP) with early VT and VF onset, in relation to patient mortality during the first six months after STEMI. Methods. The retrospective study included 971 patients with STEMI treated with pPCI for ten years. VF and sustained VT (sVT) were detected outside of the hospital and during the first 48 hrs of hospitalization. Results. During t he first 48 hrs from admission, 108 (11.1%) patients had life-threatening arrhythmias, of which 75 (69.4%) had VF, and 33 (30.6%) had sVT and were treated with direct current -- DC shock and intravenous amiodarone. Intrahospital mortality was significantly higher in patients with VF/sVT in the first 48 hrs compared to patients without VF/sVT (14.8% vs. 5.7%, p = 0.001). BNP level had higher accuracy in the prediction of six-month death than the maximum blood level of CRP in patients without VF/sVT after 48 hrs. However, in patients with early-onset malignant arrhythmias, BNP showed a lower level of accuracy in predicting the six-month mortality, as did the CRP values, which had almost the same level of accuracy. Admission glycemia had a much lower predictive value in both groups of patients compared t o BNP and CRP [ 0.705 (0.628-0.781), p < 0.001 and 0.662 (0.521-0.803), p = 0.046, respectively]. In either of the groups, maximum CK-MB levels were not significant in predicting the six-month all-cause mortality. Conclusion. Our study indicates that STEMI patients with early onset of VF and sVT, treated with pPCI, with a high BNP level, have a statistically significantly higher mortality rate compared to patients with a lower BNP level. [ABSTRACT FROM AUTHOR]

Copyright of Croatian Nursing Journal is the property of University of Applied Health Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Rad predstavlja sintezu iskustava populacione politike u svetu u dvadesetom veku. Prezentirane su mortalitetna politika, politika prema fertilitetu, politika prema starima i migratorna politika. Program akcije usvojen na kairskoj konferenciji posmatran je u kontekstu novih pristupa populacionoj politici. Politici u oblasti fertiliteta stanovništva je posvećen najveći deo ovog priloga, pre svega, zbog toga što je ona u najvećoj meri demografska politika i politika sa najviše nedoumica. Specifičnost problema rađanja u Srbiji uslovila je obuhvat iskustava razvijenih i nerazvijenih zemalja. Dat je što konkretniji izraz principa, ciljeva i mera. Obrađeno je i pitanje efikasnosti odnosno razlozi izostavljanja željenih efekata. Analiza je pokazala da osobine i rezultati dosadašnje politike u oblasti fertiliteta stanovništva i mere koje se predlažu za sledeće decenije otkrivaju krupne probleme koji se gotovo graniče sa nemoći i u razvijenim zemljama i u zemljama u razvoju, za razliku od mortalitetne i migratorne politike i političkog odgovora na starenje populacije. Pored nesumnjivog napretka u kvalitativnom smislu - rasprostranjenost, postavljena načela, principi i ciljevi, izgrađen institucionalni okvir - natalitetna politika nije dovoljno efikasna da reši populacioni problem. Akcije u prilog rađanja odnosno njegovog ograničavanja moraju biti intenzivnije, celovitije i istraživačke. Ekonomski razvoj koji bi respektovao demografski faktor u svetu koji se razvija i populaciona edukacija u razvijenom svetu se nameću kao mogući novi pravci politike. Međutim, veliki i možda najsloženiji problem koji populaciona politika treba da savlada nalazi se u sferi svesti - državnoj, političkoj, društvenoj i individualnoj.

U radu su sagledani osnovni pravci i intenzitet promena starosne strukture stanovništva SR Jugoslavije, njenih republika i pokrajina u periodu po završetku Drugog svetskog rata. Posebna pažnja je posvećena demografskim determinantama starenja stanovništva, naročito između 1961. i 1991. godine. Za procenu uticaja promena fertiliteta, mortaliteta i spoljnih migracija na transformaciju starosne strukture korišćen je metod projekcija. Analiza je zasnovana na rezultatima simulacije četiri modela stanovništva koja su konstruisana polazeći od inicijalne starosne strukture iz 1961. i na bazi različitih kombinacija pretpostavki o kretanjima fertiliteta i mortaliteta u narednih 30 godina. Efekti promene komponenti demografskog rasta na odvijanje procesa starenja su dobijeni poređenjem starosnih struktura modelskih populacija u 1991. godini. Autor zaključuje da je pad fertiliteta direktno ubrzavao starenje od baze starosne piramide, ali posredno i starenje s vrha. Promene u smrtnosti stanovništva su dvostruko delovale na proces starenja: zbog opadanja smrtnosti mladih one su ga usporavale, a istovremeno su ga ubrzavale zbog produžavanja očekivanog trajanja života starih. Posmatrano u celini, u SR Jugoslaviji je pad mortaliteta u periodu 1961-1991. uzrokovao sporije odvijanje starenja, ali je njegovo dejstvo na promenu starosne strukture stanovništva bitno manjeg značaja od suštinski suprotnog dejstva koje je bilo prouzrokovano promenama fertiliteta. Spoljne migracije tj. negativan migracioni saldo su na nivou SR Jugoslavije imale najmanjeg uticaja na proces starenja. lako je dejstvo migracija vrlo slabo, one su takođe uticale na ubrzanje procesa starenja.

The Spanish flu pandemic is considered the largest and most dangerous epidemic at the beginning of the 20th century affecting most of the world today. The Spanish flu pandemic did not bypass the territory of Croatia (at the time, Croatia was part of the Austro-Hungarian Monarchy), nor its southern coastal region of Dalmatia and the city of Split. Using the example of the city Split, the paper analyses the spatial and demographic determinants of population mortality from the Spanish flu between 1918 and 1919, i.e., from March 1918 to April 1919. The paper is based on the data of the Church Death registers kept in the Archbishop’s Archives in Split and newspaper articles. The analysis of the spatial distribution of mortality within urban settlements showed that the number of deaths per urban settlement was significantly influenced by population density but also by the socio-economic conditions of the war and post-war period. The paper analyses the articles of the New Age that refer to the Spanish flu for monitoring the course and spread of the disease, as well as the reading of information but also shaping of public opinion. Analysis of social and demographic aspects of mortality caused by the pandemic in 1918 and 1919 in Split did not indicate any deviations from other areas of Croatia and the rest of the world. In this way, the age-sex, spatial and social framework of mortality and the media framework are analogues to other national and foreign researched areas. [ABSTRACT FROM AUTHOR]

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Background/Aim. About 10% of patients diagnosed with systemic cancer had brain metastases in the central nervous system. Patients with diseased lungs, breasts, urinary and digestive tract, as well as melanoma of the skin, are increasingly treated by neurosurgeons due to their dissemination and creation of secondary deposits in the brain. The aim of the study was to assess the efficacy of treatment modalities for patients with brain metastasis according to their type - solitary or multiple, and also to the primary cancer site. Methods. The retrospective study was performed at the Clinic for Neurosurgery and the Clinic for Oncology from 2018 to 2020. One hundred and eleven patients with solitary changes in the brain and 122 patients with multiple changes were examined. Results. It was found that multiple metastases were more common in primary lung cancer, while single metastases were more common in adenocarcinoma. However, patients with primary adenocarcinoma died in a significantly higher number. Conclusion. Surgery and radiation remain the cornerstone of therapy for symptomatic lesions. We should strive to improve surgical techniques in the direction of less damage to the surrounding healthy tissue. Radiosurgery, as well as whole brain radiotherapy, remains the basic form in the treatment of multiple metastases. [ABSTRACT FROM AUTHOR]

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Background: COVID-19 covers a broad clinical spectrum, threatening global health. Although several studies have investigated various prognostic biochemical and hematological parameters, they generally lack specificity and are insufficient for decision-making. Beyond the neonatal period, NRBCs (nucleated red blood cells) in peripheral blood is rare and often associated with malignant neoplasms, bone marrow diseases, and other severe disorders such as sepsis and hypoxia. Therefore, we investigated if NRBCs can predict mortality in hypoxic ICU (Intensive Care Unit) patients of COVID-19. Methods: Seventy-one unvaccinated RT-PCR confirmed COVID-19 ICU patients was divided into those who survived (n=35, mean age=58) and died (n=36, mean age=75). Venous blood samples were collected in K3 EDTA tubes and analyzed on a Sysmex XN-1000 hematology analyzer with semiconductor laser flow cytometry and nucleic acid fluorescence staining method for NRBC analysis. NRBC numbers and percentages of the patients were compared on the first and seventh days of admission to the ICU. Results are reported as a proportion of NRBCs per 100 WBCs NRBCs/100 WBC (NRBC% and as absolute NRBC count (NRBC #, × 109/L). Results: NRBC 7th-day count and % values were statistically higher in non-survival ones. The sensitivity for 7th day NRBC value <0.01 (negative) was 86.11%, the specificity was 48.57%, for <0.02; 75.00%, and 77.14%, for <0.03; 61.11%, and 94.60%. Conclusions: In conclusion, our results indicate that NRBC elevation (>0.01) significantly predicts mortality in ICU hospitalized patients due to COVID-19. Worse, a high mortality rate is expected, especially with NRBC values of >0.03. [ABSTRACT FROM AUTHOR]

Background/Aim. The prognostic impact of complete atrioventricular (AV) block on the long-term prognosis of patients with ST-elevation myocardial infarction (STEMI) has not been fully determined. The aim of the study was to analyze the incidence and prognostic impact of complete AV block on in-hospital mortality (IHM) and 6-year mortality in STEMI patients treated with primary percutaneous coronary intervention. Methods. The study included 3,044 consecutive STEMI patients. Results. Complete AV block was registered only on admission in 144 (4.73%) patients; 125 (86.8%) patients with complete AV block had inferior infarction. A temporary pacemaker was implanted in 72 (50%) patients with complete AV block. No patient underwent permanent pacemaker implantation. IHM was significantly higher in patients with complete AV block than in patients w ithout c omplete A V b lock: 1 7.9% v s. 3.6%, r espectively, p < 0.001. In patients with heart block and inferior infarction, IHM was 13%, whereas IHM was 53% in patients with heart block and anterior infarction. When we analyzed patients discharged alive from the hospital, we also found a significantly higher long-term (6-year) mortality rate in those with complete AV block vs. patients without AV block: 7.8% vs. 3.4%, respectively, p < 0.001. Complete AV block was an independent predictor for IHM and 6-year mortality: IHM [odds ratio (OR) 2.94 95%, confidence interval (CI) 1.23-5.22; 6-year mortality hazard ratio (HR) 1.61, 95%, CI 1.10-2.37]. When subanalysis was performed in patients with inferior STEMI, complete AV block was an independent predictor of IHM a nd 6 -year mortality, while in patients with anterior STEMI, complete AV block was an independent predictor of IHM. Conclusion. In analyzed STEMI patients, complete AV block was transitory and was registered only on hospital admission. Although transitory, complete AV block remained a strong independent predictor of IHM and long-term mortality. [ABSTRACT FROM AUTHOR]

Negative demographic trends in Croatia (natural decrease, negative net migration and population aging) are increasingly influencing socio-economic development of the country. Already in early 21st century, the long term decrease of live births and the increase of deaths were recognized as destabilizing factors of population development in Croatia. After the Croatian accession to the EU, the concerns regarding future demographic development of the country raised even more due to intensive emigration to other EU countries, which coincided with the historically low birth rates and high death rates. The focus of this paper is on mortality trends in Croatia in the first two decades of the 21st century. In this period, mortality in Croatia was influenced by different socio-economic, demographic, and epidemiological factors. Given the lack of recent papers dealing with mortality in Croatia, the main aim of this paper is to provide an overview of the changes in selected mortality indicators and contribute to the discussion on recent mortality trends in Croatia. The results of this research indicate that Croatia experienced some positive changes regarding mortality (increase of life expectancy at birth and decrease of infant mortality rates in the first period, in particular), but, some of the trends are not favourable, particularly the changes in the causes of death. Although improvements were observed regarding the share of deaths caused by the diseases of the circulatory system, there was a notable increase in deaths caused by the endocrine, nutritional and metabolic diseases which can be attributed to the unhealthy lifestyle and various behavioural factors. [ABSTRACT FROM AUTHOR]

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Background/Aim. The role of antithrombin (AT) activity in predicting early mortality in patients with pulmonary embolism (PE), measured at an early stage of the disease, has not yet been investigated. Therefore, the aim of the study was to e xamine the predictive value of AT a ctivity for allcause 30-day mortality, measured in consecutive PE patients on admission to the hospital. Methods. This single-center clinical retrospective cross-sectional study followed consecutive patients with acute PE from 2014 to 2021. On admission to the hospital, venous blood was taken from patients for laboratory analyses including determination of AT activity. The basic parameters of the patients were recorded on admission, and through the univariate analysis, their connection with 30-day mortality was tested. The predictive significance of AT values for 30-day mortality was tested through quartile values by comparing the first quartile with all others together. Cox regression model analysis was used in the multivariate analysis where one parameter, marked as significant in the univariate analysis, was added to the basic model (AT, age, and risk affiliation in two groups). Results. A total of 378 PE patients were included in the study. The total all-cause 30-day mortality was 7.9% (30 patients). Patients with AT activity in the first quartile had significantly higher early mortality compared with those having AT activity in the other quartiles combined (log-rank p = 0.001). AT retained a significant predictive value for early mortality in the multivariate analysis despite the comorbidity present, which also significantly affected mortality. Conclusion. Low AT activity measured on admission in PE patients is a significant and independent predictor of 30-day mortality. [ABSTRACT FROM AUTHOR]

I 1919 bygde Tromsø kommune en demning i Slettaelva på den fjellrike Kvaløya vest for byen som de neste par årene ble koblet via et undersjøisk rør til byens vannforsyningssystem for å øke vannmengden og bedre kvaliteten på byens drikkevann. Nyttårsaften 1921 ble kvaløyvannet trykksatt i Tromsø sentrum. For å undersøke hvilken effekt dette hadde på barnedødeligheten, ble medisinalberetningene og et datasett med begravelser 1915–30 analysert med hensyn til aldersgrupper og dødsårsaker. Dødeligheten hadde tiltatt under første verdenskrig og fram til 1920, men fra 1921 sank antallet døde, mens antallet alvorlige tilfeller av diare fluktuerte. Spedbarns- og barnedødsfallene i aldersgruppen ett til fem år gikk avgjort ned, dog med en mindre økning i 1924. En sammenligning av perioden 1915 til 1921 med den lengre perioden 1922 til 1930 viste reduksjon i barns dødsfall pga. mage/tarmsykdommer.

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]

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Introduction: hypothyroidism is a common comorbidity in patients with heart failure, but its prognostic role is not completely clear. Aim: to investigate the occurrence of hypothyroidism in patients with acute heart failure (AHF) with reduced ejection fraction (AHF rEF) and with preserved ejection fraction (AHF pEF), and to examine the difference in the occurrence of repeated decompensation and mortality depending on hormonal status and left ventricular EF. Materials and methods: this was a retrospective, clinical study which included 106 patients hospitalized due to acute heart failure (AHF) at the Clinic of Heart Diseases, Blood Vessels and Rheumatism of the Clinical Center University of Sarajevo (CCUS). Thyroid hormones and left ventricular EF were determined for each patient, and the patients were divided into 4 groups. Three clinical outcomes were monitored during the period of 12 months: 1. number of rehospitalizations due to decompensation, 2. time to first rehospitalization, and 3. mortality. Results: We found that 32.1% of patients had euthyroidism, AHF and reduced EF (Eu-rEF), 27.4% of patients had euthyroidism, AHF and preserved EF (Eu-pEF), 25.5% of patients had hypothyroidism, AHF and preserved EF (Hypo-pEF) and 15.1% of patients had hypothyroidism, AHF and reduced EF (HyporEF). Patients in HFpEF group were predominantly females and they more often had hypertension (p<0.05) and hypothyroidism compared to patients with HFrEF. Decompensation was more frequent in the group with hypothyroidism and rEF compared to the hypo-pEF group (p=0.05). The shortest time to re-hospitalization was observed in the hypo-pEF group which was significantly shorter compared to the hypo-rEF group (105.27 vs 147.29 days, p=0.045). Mortality was higher in patients with hypothyroidism and pEF compared to the hypothyroidism and rEF group (29.6% vs 18.8%, p=0.055). Conclusion: patients with hypothyroidism and preserved EF (pEF) have a shorter rehospitalization time and higher mortality rate compared to patients with hypothyroidism and reduced EF. Determining the hormonal status of the thyroid gland in AHF, especially in patients with preserved EF, results in early recognition of a high-risk population. [ABSTRACT FROM AUTHOR]

Background/Aim. The novel severe acute respiratory syndrome coronavirus 2 (SARS Cov-2) has triggered a pandemic that causes a disease with complex clinical manifestations (coronavirus disease 2019, COVID-19). Soon it became clear that patients who had some comorbidities had a bigger chance of getting the severe form of COVID-19. The aim of the study was to investigate if there was a link between cardiac injury and COVID-19 severity and mortality in patients. Methods. All consecutive patients with laboratoryconfirmed COVID-19 were included and followed up until discharge or death from January 30, 2020, to April 5, 2020. Results. A total of 261 COVID-19 patients were included, and 29 (11.1%) had cardiac injury on admission. Patients with cardiac injury were older than those without cardiac injury (72.8 vs 55.8 years old) and more likely to be male (82.8% vs 42.2%). Patients with cardiac injury were also more likely to be smokers (31.0% vs 12.5%), more likely to have chronic cardiovascular disease (24.1% vs 7.8%), chronic pulmonary disease (17.2% vs 3.0%), and chronic kidney disease (10.3% vs 2.2%) compared to patients without cardiac injury. Laboratory findings suggested that patients with cardiac injury were more likely to have leukocyte counts > 10 × 109/L, pronounced lymphopenia, direct bilirubin, myohemoglobin, blood urea nitrogen, C-reactive protein, and pro-B-type natriuretic peptide but lower levels of serum total protein and estimated glomerular filtration rates compared to patients without cardiac injury. Patients with cardiac injury experienced more complications (72.4% vs 47.8%), including acute respiratory distress syndrome (20.7% vs 2.7%), acute kidney injury (10.3 vs 0.4%), severe COVID-19 (58.6% vs 11.6%) and death (55.2% vs 3.9%) compared to patients without cardiac injury. Multivariate analyses showed that cardiac injury was associated with an increased risk of severe COVID-19 [hazard ratio (HR) = 8.71, 95% confidence interval (CI) = 2.37−32.04] and death (HR = 20.84, 95% CI = 1.32−328.22). Conclusion. Cardiac injury on admission was associated with a higher risk of disease progression and death in patients with COVID-19. [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]

Introduction: Seizures are one of the most common pathologies in newborns. Their incidence is 1.5-3.5/1000 for term infants and 10-130/1000 for preterms. The most common causes of seizures in term infants are hypoxic-ischemic encephalopathy (HIE), cerebrovascular insult (CVI), cerebral malformations (CM), and metabolic disorders. For preterm infants: intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL) and infections. Clinical characteristics are diverse and subtle, and subclinical forms are common. The drug of the first choice is phenobarbitone. Newborns with seizures are more prone to developing neurological disturbances such as epilepsy and cerebral palsy. Methods: This is a clinical, observational research, one-year, retrospective, cross-sectional study conducted in the Department of neonatal intensive care and neonatology of the Clinic of Pediatrics KCUS. The study included 43 newborns who met the inclusion criteria. Results: We found that 7.19% of hospitalized newborns had seizures. A number of seizures were recorded in the group of term infants with an earlier time of seizures. The most common etiological causes were: HIE, IVH, infections, and CM. There was a frequent occurrence of metabolic disorders such as acidosis, blood sugar, and mineral (Ca, K, Na, and Mg) disorders. The median of the first day of onset of seizures in full-term infants is on the fourth day, while in premature infants it is on the sixth day of life. Phenobarbitone was mainly used to stop seizures, with great success. Overall mortality in children with seizures was 37.21%. Conclusions: Seizures are common in newborns, which, depending on the etiological cause, increase mortality, especially in preterm infants. Seizures in term infants occur earlier than in premature infants. The most common etiology of seizures in term infants are infections, hypoxemic-ischemic encephalopathy, intracranial hemorrhage, cerebral malformations, and cerebrovascular insult. In premature infants these are hypoxemic-ischemic encephalopathy, intracranial bleeding, and infections. In the initial treatment of neonatal convulsions, phenobarbitone is most often used, which has proven to be successful in the majority of cases. [ABSTRACT FROM AUTHOR]

Background: Enlargement of the pulmonary artery (PA) could be helpful in risk stratification by the chest CT on the admission of COVID-19 patients. Methods: This study aimed to associate PA diameter and overall mortality in COVID-19 pneumonia. We designed a retrospective study between January 2021 and May 2021 in tertiary-level hospitals in Gebze, Turkey. Subjects were evaluated in two groups according to their survivor status (survivors and non-survivors). Then biochemical, demographic, and clinical values were compared via the groups to define the predictive value of PA diameter on chest CT images. Results: In the enrolled 594 COVID-19 in-hospital patients (median age was 45 (34-58) years, 263patients (44.3%) were female. 44 patients (7.4%) died during hospitalization. Multivariate Cox-proportion regression model yielded main PA = 29 mm on admission showed that as independent predictors of death (long rank <0.001, median survival time 28 days). Cumulative survival rates were MPAD = 29 mm 45% and < 29 mm 90% yielded (p < 0.001). Conclusions: PA dilatation is strongly linked with in-hospital mortality in hospitalized patients with COVID-19 infection. Thus increased PA diameter on chest CT at admission may guide rapid and early diagnosis of high-risk patients. [ABSTRACT FROM AUTHOR]

Izbežna smrtnost se definiše kao smrt koja bi mogla biti izbegnuta adekvatnom i blagovremenom zdravstvenom zaštitom i merama javnog zdravlja i prevencije. Metod meri efikasnost zdravstvenog sistema kvantifikovanjem preuranjenih smrti (0–74) od određenih uzroka. Analiza izbežne smrtnosti u Srbiji, a u okviru ovog koncepta i kategorija sprečive i predupredive smrtnosti, data je za period 2010–2019. godine. Dekomponovanjem očekivanog trajanja života muškog i ženskog stanovništva prema starosti i uzroku smrti određen je doprinos izbežne smrtnosti promenama u očekivanom trajanju života u posmatranom periodu. Rezultati su pokazali da je najveći deo pozitivnih doprinosa nastao usled smanjivanja broja umrlih od bolesti i stanja koja pripadaju izbežnoj smrtnosti (oko 70%). Posmatrano po polu, smanjenje specifičnih stopa izbežne smrtnosti je veće kod muškaraca, naročito kod sredovečnih, gde su doprinosi preko 80%. Stope sprečive i predupredive smrtnosti uvek su više u muškoj populaciji, ali je smanjivanje standardizovanih vrednosti intenzivnije kod muškaraca u Srbiji. Verovatnoća događaja izbežne smrtnosti u muškoj populaciji pri živorođenju je oko 30% (kod žena je 18%). Hipotetičkom eliminacijom izbežne smrtnosti, porast očekivanog trajanja života pri živorođenju kod muškaraca mogao bi iznositi 6,3 godine, a kod žena 3,9. Najznačajniji pozitivan trend smanjenja izbežne smrtnosti jeste kod kardiovaskularnih bolesti i nasilnih uzroka smrti.

Introduction. The aim of this study was to evaluate the predictive value of the European System for Cardiac Operative Risk Evaluation II in adult patients with acquired heart diseases. Material and Methods. The research included a consecutive series of 6,031 patients who underwent coronary, valvular and combined cardiac surgical interventions in the period from January 15, 2015 to December 31, 2020. Model calibration was assessed by comparing the ratio of actual to expected postoperative mortality and using the Hosmer-Lemeshow test. The discriminative power was examined using the area under the receiver operating characteristic curve. Results. A total of 2,883 patients underwent isolated coronary surgery, 1,841 underwent valvular procedures, while a combined procedure was performed in 1,307 patients. The operative risk was moderately underestimated in the entire group, as well as in the group of patients who underwent surgical revascularization of the coronary arteries. In patients who underwent valvular surgery, the actual mortality rate was slightly overestimated, while in patients with combined procedures it was moderately underestimated. The European System for Cardiac Operative Risk Evaluation II showed excellent discriminative power in the whole group of patients undergoing surgery (area under the curve = 0.825, p < 0.0005). The cut-off value was 2.60, sensitivity 0.757 and specificity 0.750. The discriminative power of the model was excellent in the group of coronary patients (area under the curve = 0.810) as well as in the group with isolated valvular surgery (area under the curve = 0.815). In patients with combined procedures, the discriminatory power was very good (area under the curve = 0.775). Conclusion. The results of our single centre study show that European System for Cardiac Operative Risk Evaluation II predicts hospital mortality with satisfactory results in the entire group, but underestimates it when it comes to combined cardiac surgical procedures. The discriminative power of the model is excellent. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is characterized by gradual progressive loss of all kidney functions over a period of time. One-fifth of men and one-quarter of women over the age of 65 suffer from CKD. Given the growing incidence of diabetes and hypertension, which are the main causes of this disease, CKD is becoming one of the major global public health issues. Cardiovascular diseases are the leading cause of death in people with CKD, primarily heart-related conditions such as ischemic heart disease and heart failure. High-sensitivity troponins (hs-cTnT, hs-cTnI) are crucial biomarkers used in the detection of cardiac pathology. They are mostly used in the detection of acute coronary syndrome, but elevated values can be also observed in several other conditions. Studies have shown that serum troponin levels are elevated in more than two-thirds of patients with CKD on dialysis, even in those without any cardiovascular pathology. The aim of this review was to examine the literature and to determine the reason for troponin increase in patients with CKD, and to establish whether there is a connection between their increase and the mortality rate. A literature search revealed that patients with end-stage renal disease (ESRD) are at especially high risk of cardiovascular morbidity and mortality. Studies have also found a strong association of high-sensitivity troponins with cardiovascular and all-cause mortality in those patients. On the other hand, even though the function of troponins is very well-known, little is known about their production and excretion from the body. The theory that troponins are excreted by the kidneys is becoming widely accepted in scientific circles. New studies, some of which are Croatian, have demonstrated the presence of troponins in urine, but further research is needed to determine whether it is possible to use troponins in urine as potential biomarkers for cardiovascular and kidney disease. [ABSTRACT FROM AUTHOR]

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Background/Aim. The prediction role of gender in early mortality in patients with acute pulmonary embolism (PE) is still debatable. The aim of the study was to examine sexspecific factors in all-cause 30-day mortality in patients suffering from acute PE. Methods. Acute PE subjects (n = 532), 49.6% men, were derived from a "real-life" observational multicenter study. We assessed independent risk factors as predictors for early (one-month) fatal outcome in men, women and total population using univariate Cox regression analysis. Results. Age, obesity, hypertension, renal dysfunction, anemia, community-acquired pneumonia, and smoking history presented statistically significant sexspecific differences. One-month mortality was 13.7%, without significant difference in survival based on sex (Log Rank test; p = 0.324). Tachycardia at admission [hazard ratio (HR) = 2.61, p = 0.004], coronary artery disease (HR = 2.30, p = 0.047), immobilization four weeks prior to a PE episode (HR = 2.31, p = 0.018) and older age (HR = 1.03, p = 0.017) in women, while chronic obstructive pulmonary disease (COPD) (HR = 4.03, p < 0.001) and leukocytosis (HR = 1.19, p < 0.001) in men significantly increased one-month mortality risk. Conclusion. Patient's sex did not prove to be the independent predictor for 30-day mortality in PE patients. We found that tachycardia at admission, older age, coronary artery disease and limb immobilization four weeks prior to PE in women, whereas COPD and elevated leukocyte count in men were associated with higher chance of all-cause early mortality. [ABSTRACT FROM AUTHOR]

Background/Aim. Sepsis represents a significant global burden, with an estimated 48.9 million cases and 11.0 million sepsis-related deaths recently recorded worldwide. The aim of this observational study was to assess a prognostic value of some readily available routine biomarkers: presepsin, procalcitonin, C-reactive protein (CRP), white blood cell (WBC) count, platelet count, mean platelet volume (MPV), and lactate, as well as their combination regarding the outcome in a cohort of critically ill adult patients with secondary sepsis. Methods. A total of 86 critically ill patients with secondary sepsis due to peritonitis, pancreatitis, and severe trauma, admitted to the surgical intensive care unit, were enrolled in this prospective study. Blood samples for biomarker analysis were collected in three time points: on admission (the 1st day) and on the 3rd, and 5th day after admission. The Sequential Organ Failure Assessment (SOFA) score, the Simplified Acute Physiology Score (SAPS) II, and the Acute Physiology and Chronic Health Evaluation (APACHE) II score were calculated and recorded within the first 24 hours after admission (1st day). SOFA and SAPS II scores were recorded daily. The primary endpoint was hospital mortality. Results. Values of each applied score were expectedly significantly higher in nonsurvivors in all time points. Regarding investigated parameters, only presepsin levels were significantly higher in nonsurvivors in all time points; MPV levels on the 3rd and 5th day; serum lactate levels on the 3rd day; CRP levels and WBC count on the 5th day. Clinical accuracy of parameters in predicting lethal outcomes was investigated in all time points. On the 1st day, apart from all three scores, only presepsin demonstrated statistically significant discriminative power regarding outcome (AUC of 0.670). Apart from SAPS II and SOFA score, on the 3rd day presepsin, MPV, and lactate (AUCs of 0.716, 0.667, and 0.642, respectively) and on the 5th day presepsin, MPV, CRP, and WBC count (AUCs of 0.790, 0.681, 0.643 and 0.654, respectively) were good predictors of the lethal outcome. Composite bioscore (presepsin, MVP, and lactate) on the 3rd day had the highest AUC of 0.820 in comparison with individual scores and parameters. The independent predictor of the lethal outcome on the 1st day was presepsin (p < 0.05) and on the 3rd day MPV (p < 0.01). Conclusion. Composite bioscore is superior to routine biomarkers and established scoring systems in predicting mortality in adult critically ill patients with secondary sepsis. [ABSTRACT FROM AUTHOR]

Introduction. Acute kidney injury is a serious complication in critically ill patients in the intensive care units. The incidence varies from 20% to as high as 80%. Acute kidney injury is associated with expensive supportive therapy, high morbidity and poor outcomes. The aim of this study was to determine the incidence, causes, risk factors, treatment options and treatment outcomes of acute kidney injury in critically ill patients. Material and Methods. The study included 44 patients, with an average age of 67 ± 13.20 years. The data were collected during a three-month prospective study at the Department of Emergency Internal Medicine of the Clinical Center of Vojvodina, Novi Sad. Demographic data were collected from the medical records, as well as data on blood tests, comorbidities, use of nephrotoxic agents, and treatment of these patients. Results. Of the 44 patients who were included in the study, 20% developed acute kidney injury. De novo acute kidney injury was diagnosed in 51.22% and 48.78% of patients had acute-onchronic renal failure. The most common type of acute kidney injury was pre-renal, 80.95%. Comorbidities were present in all patients, most often arterial hypertension, in 52.4% of patients. Complete recovery of kidney function was found in 42.86% of patients and the mortality was 28.57%. Conservative therapy was used in 90.48% of patients, while 9.52% of patients required renal replacement therapy. Conclusion. De novo acute kidney injury was found in approximately half of the critically ill patients in the intensive care unit, mainly older patients with comorbidities. The most common type of acute kidney injury was pre-renal. Older age and comorbidities were associated with poor outcomes and high mortality. [ABSTRACT FROM AUTHOR]

Background/Aim. Defining renal replacement therapy (RRT) initiation in critically ill patients with acute kidney injury (AKI) has become an imperative for nephrologists and intensivists. The aim of this study was to determine 28-day survival and the renal function recovery in patients with AKI. Methods. A single-center retrospective study included 385 surgical and non-surgical patients with AKI and episode of AKI in chronic kidney disease who were admitted to the Emergency Center of Clinical Center of Vojvodina (Novi Sad, Serbia) between 2014 and 2017 and received RRT. Patients with the Kidney Disease Improving Global Outcomes (KDIGO) stage 2 AKI and/or volume overload were assigned to the "early" group with RRT (dialysis) start within 24 h of the diagnosis; patients with poor response to conservative treatment or evidence of clinical complications associated with AKI were assigned to the "late" RRT group. Results. Based on the retrospective analysis we found that 241 patients (62.6%) received "early" RRT within 24 h. Patients in the "early" RRT group had significantly higher survival compared to the "late" RRT group (63.9% vs. 36.1%; p = 0.001). The "early" RRT group had more patients with renal function recovery (56.8%), but without statistical significance (p = 0.514). The patients who started RRT within 24 hours with the Sequential Organ Failure Assessment (SOFA) score of 1-3 were twice likely to recover renal function in relation to the patients with the SOFA score of 4 or higher [odds ratio (OR) = 2.01; 95% confidence interval (CI): 1.37-2.95; p < 0.001], while septic patients had a 62% lower chance of renal function recovery in relation to non-septic patients (OR = 0.38; 95% CI: 0.18-0.82; p = 0.013). In the "late" RRT group, it was found that non-diabetic patients had 3.8 times greater chance for renal function recovery compared to diabetic patients (OR = 3.53; 95% CI: 1.27-9.83; p = 0.016). Conclusions. Patients with the early initiation of RRT had significantly improved 28-day survival. [ABSTRACT FROM AUTHOR]

Introduction. Spontaneous intracerebral hemorrhage is not a monophasic event, but a condition characterized by hematoma expansion with mechanical damage to the surrounding tissue. The development of multiple complications is associated with a high mortality rate of 40%. In order to make therapeutic decisions, it is important to know what factors predict the outcome in these patients. The aim of this study was to evaluate outcome prediction scales in patients with spontaneous intracerebral hemorrhage according to functional outcome at 7 and 30 days after the onset. Material and Methods. A three-year retrospective study (2017 - 2019) included 116 patients treated at the Emergency Center, Clinical Center of Vojvodina, Novi Sad, Serbia. The collected data included the National Institutes of Health Stroke Scale, the original intracerebral hemorrhage score, the modified Graeb score and Glasgow coma scale. Demographic data, localization, shape and volume of hematomas, as well as occurrence of intraventricular hemorrhage were compared. Results. In the group of 116 patients, male gender was dominant (82%) as well as the age over 65 years (56%); Glasgow coma scale: 1.5 interquartile range = 1 - 2 points, National Institutes of Health Stroke Scale 24, interquartile range = 15 - 32, intracerebral hemorrhage score 3 - 4 (68.1%). Intraventricular hemorrhage was found in 82.3% and oval hematoma in 71.6% of patients. The mortality rate was highest in the first 7 days (41.4%). The 7-day and 30-day mortality was significantly associated with the intracerebral hemorrhage score (p = 0.000) and the intracerebral hemorrhage volume (p = 0.014). Conclusion. Elderly men with known vascular risk factors are prone to spontaneous intracerebral hemorrhage. The intracerebral hemorrhage score and hematoma volume may be the potential indicators of poor outcome in the first 7 days of spontaneous intracerebral hemorrhage. [ABSTRACT FROM AUTHOR]

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Backgraund/Aim. Primary anti-neutrophil cytoplasmatic antibody (ANCA)-associated vasculitis are chronic multisystemic autoimmune diseases which include microscopic polyangitis (MPA), granulomatosis with polyangitis (WG), eosinophilic granulomatosis with polyangitis (EPGA; churgstrauss syndrome - CSS), and also a localized forms of illness. In our research, we studied clinical and serological parameters in patients, in order to find out which of them would be the best predictor of renal outcome in ANCAassociated vasculitis. Methods. Data from 42 patients with diagnose of MPA (9), WG (17), EPGA (0), CSS (0), and also idiopathic rapidly progressive glomerulonephritis (ROEB) without immune deposits (renal-limited vasculitis - 16) were analyzed. Cockroft formula was used for calculating the glomerular filtration in the moment of presenting the illness, and also after five year follow-up period. Other factors that were analyzed are: gender, age, type of ANCA antibodies, type of infections, stage of chronic kidney disease, need for heamodialysis and mortality. Results. Of a total of 42 patients, 17 (40.48%) were male. The average age of the patients at the time of diagnosis was 57.8 (± 10.44) years. Seventeen patients (40.48%) had a diagnosis of WG, 9 (21.43%) MPA, and 16 (38.09%) iRPGN. The presence of positive anti-proteinase (anti-PR3) antibodies was confirmed in 18 patients, and anti-MPO antibodies in 17 patients. Three patients had both subtypes of ANCA antibodies (anti-PR3 and anti-MPO). Initially, 12 patients required heamodialysis treatment. Twenty nine patients had a complete and 13 patients had partial remission. Out of the total number of patients, 8 patients (19.04%) developed the terminal renal failure stage, and ended up on a chronic dialysis program. During a five-year follow-up period, 12 patients (28.57%) resulted in death. The age of the patient proved to be statistically significant predictor of glomerular filtration rate (GFR) at the moment of presentation of the disease (p = 0.011). GFR t = 0 was statistically significant (p = 0.000) for the evaluation of kidney function outcomes in ANCAassociated glomerulonephritis. Conclusion. Kidney function in the moment of illness presentation, determined by GFR t = 0, is the most important significant factor for predicting renal outcome in ANCA-associated vasculitis, and also the mortality in these patients. [ABSTRACT FROM AUTHOR]

Background/Aim. Decision-making by the Heart Team is an established way of making appropriate decisions regarding the management of patients with coronary artery disease. In clinical practice, it is not infrequent to see changes in decisions made by different Heart Teams. However, clinical implications regarding changes in the Heart Team decisions are not clear. The aim of this study was to determine clinical implications of change in the Heart Team decision in patients in whom surgical myocardial revascularization was advised first but consequently changed to percutaneous coronary intervention (PCI). Methods. We retrospectively analyzed data for 1,501 patients admitted to a single tertiary care high-volume center for coronary artery bypass grafting (CABG). In all patients, decisions were made by the Heart Team prior to admission. Upon admission, decisions were reevaluated by another Heart Team. The decision regarding the mode of revascularization was changed in 73 (4.86%) of patients. Propensity matching was made with patients from the same population who underwent CABG. Patients in both groups were followed for major adverse cardiac events (MACE) and total mortality for 12 months. Results. PCI and CABG groups were balanced with respect to demographic and clinical characteristics. All patients had two- and three vessel disease, with similar incidence of left main stenosis (26% in the PCI group and 30.10% in the CABG group). EuroSCORE II was similar between the groups (2.48 ± 2.38 vs. 2.36 ± 2.92). During the follow-up period, a total of 5 (6.80%) MACE in the PCI group and 12 (5.80%) MACE in the CABG group were observed (log rank 0.096, p = 0.757). A total of 6 (8.20%) patients died in the PCI group, and 15 (7.30%) patients died in the CABG group (log rank 0.067, p = 0.796). Conclusion. Our data indicate that patients in whom CABG was advised first but consequently changed to PCI have a prognosis similar to CABG patients over 12 months after the index procedure. [ABSTRACT FROM AUTHOR]

Background/Aim. The evaluation of blood levels of cardiac troponin I (cTnI), D-dimer, B-type natriuretic peptide (BNP), and C-reactive protein (CRP) on admission and during the treatment of pulmonary embolism (PE) are the part of routine diagnostic process and estimation of mortality risk. The aim of this study was to evaluate the predictive value of these biomarkers on admission for all-cause 30-day mortality in consecutive PE patients regarding whether they classified as spontaneous, transiently provoked, or permanently provoked PE. Methods. This retrospective analysis was gained from the data of 590 PE patients from the Serbian University Multicenter Pulmonary Embolism Registry (SUPER). Patients had at least one of these biomarkers (BNP, CRP, cTnI, and D-dimer) measured during the first 24 hours upon admission. Results. Receiver operating characteristic (ROC) curve analyses demonstrated that BNP had the highest prognostic accuracy for 30-day mortality in patients (n = 219) who had data for all examined biomarkers. BNP provided an AUC of 0.785 (p < 0.001). Separately, BNP had the highest c-statistic for all three groups of patients. CRP had a modest predictive value for the 30-day all-cause mortality in the group with transient provoked PE. Troponin I had a very modest predictive value for the 30-day all-cause mortality only in patients with spontaneous PE, and D-dimer was a very weak predictor of this end-point only in patients with persistent provoked PE. Conclusion. Patients with spontaneous, transient provoked, and persistent provoked PE have a significantly different profile of blood biomarkers level with different prognostic significance for early all-cause mortality. [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]

Aim: To summarize our five-year experience in management of premature infants at our second level neonatal facility. Patients and methods: This prospective birth cohort study was performed at the Division of Neonatology (level 2), Department of Paediatrics, General hospital Pula during a five-year-period (January 1st 2012 – December 31st 2016). The study population included all live-born neonates born between 22nd and 37th gestational week. Results: During the above mentioned five-year-period, 289 premature infants were born at General Hospital Pula. One-hundred and sixty seven (58%) neonates were delivered vaginally and 122 (42%) were delivered by caesarean section. Nineteen (7%) neonates were born after in vitro fertilization. Infants were mostly male (N=167; 58%), and appropriate for gestational age (N=240; 83%). Also, the infants belonged mostly to the late-preterm group (N=245; 85%). Thirty-three premature infants (11%) were transferred to a tertiary paediatric centre and five neonates died (2%). The overall cost of hospital stay for hospitalized premature infants was 2,517,000 Croatian kunas (cost for one patient: median 4800, range 3,225-53,325); in euros, it was 335,600 (cost for one patient: median 640, range 430-7,110) respectively. The overall hospital stay was 10.01±8.30 days (median 8.00, range 1.00-67.00). Conclusion: Despite the great development of neonatal intensive care, the best prevention of complications related to prematurity is to prevent preterm labour. [ABSTRACT FROM AUTHOR]

Introduction. Bacterial blood infections during febrile neutropenia episodes are urgent medical conditions which were and still are the main cause of morbidity and mortality among patients with hematologic malignancies. The aim of this study was to determine the incidence and clinical characteristics of bacteremia, infectious agents, presence and incidence of antibiotic resistance, as well as the treatment outcome of bloodstream infections in patients with hematologic malignancies. Material and Methods. A three-year retrospective study included 107 patients with hematologic malignancies and positive blood culture results during febrile neutropenia. Results. The most common isolates were Gram-negative bacteria (58.5%), with Escherichia coli being the most frequent pathogen. The Gram-negative microorganisms were mostly sensitive to carbapenems in 70.7%, whereas sensitivity to other antibiotics was as follows: piperacillin/ tazobactam 62%, amikacin 58.5%, and third-generation cephalosporins 50.5%. Acinetobacter spp. was sensitive only to colistin (94.1%). The antibiotic sensitivity among Gram-positive bacteria was highest to linezolid (97.1%), followed by teicoplanin (81.4%) and vancomycin (81.4%). In our patients, the mortality rate during the first 28 days from the moment of positive isolates was high (37.4%). Most patients died within the first seven days. Bacterial blood infections caused by Gram-negative bacteria were associated with significantly higher mortality (χ² = 4.92, p = 0.026). Acinetobacter spp. was isolated in almost half of the patients with fatal outcome, of whom 62.5% died in the first 24 hours. Conclusion. Bacterial bloodstream infections are severe complications with a high rate of mortality in febrile neutropenic hematological patients. Gram-negative bacteria were the most common isolates in our Clinic, with high mortality. It is of utmost importance to constantly monitor the resistance of bacteria to antibiotics, as well as to prevent and control the spread of resistant strains. Antibiotics resistance patterns should regularly be followed. [ABSTRACT FROM AUTHOR]

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Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)