SCIWOCTET is a cervical spine injury (CSI) with objective signs of myelopathy, due to trauma, without evidence of ligament injury or bone fractures on x-ray and computed tomography (CT) images. It is ...rare, found in about 3% of patients with CSI. Perioperative manipulation of these patients may cause secondary spinal cord injury. The challenge for the anesthesiologist is to manage an airway with as little movement of the patient's head and neck as possible. A patient is presented after a fall from a motorbike. At hospital admission, he had neurological deficit in the innervation area of the cervical spinal cord. Multi-slice CT of the head and cervical spine was without signs of acute bone trauma. Magnetic resonance imaging was performed and the diagnosis met the criteria defining SCIWOCTET. Elective cervical spine surgery under general anesthesia was performed, the patient was intubated with a rigid bronchoscope using manual in-line immobilization. The selection of instruments and procedures is emphasized. Other procedures, techniques and instruments that can be used for airway management and their influence on the movement of the patient's head and neck are listed. It is concluded that rigid bronchoscopy with the application of manual in-line immobilization is suitable for emergency and elective intubation of patients with cervical spine pathology.
Pretilost je često povezana s komorbiditetnim stanjima (opstruktivna apneja u snu, hipertenzija, šećerna bolest tipa 2…). Anestezija temeljena na opioidima povećava rizik od kritičnih respiracijskih ...događaja tijekom oporavka od kirurškog zahvata, pogoršava učestalost i težinu postoperativne mučnine i povraćanja te dovodi do hiperalgezije. Zbog navedenog cilj je izbjeći ili značajno smanjiti primjenu opioida kod kirurškog zahvata na morbidno pretilim bolesnicima. Ovo daje prednost kombinaciji opće i regionalne anestezije. Prikazana su dva slučaja uzdužne resekcije želuca kod morbidno pretilih bolesnika uz anesteziju bez primjene opioida. Primijenjen je obostrani torakalni paravertebralni blok s levobupivakainom i deksametazonom postavljen uz pomoć ultrazvuka na razini Th 4 i Th 7. U operacijskoj dvorani napravljena je indukcija propofolom i esmeronom, a anestezija je održavana istim lijekovima. Na početku operacije pacijentima je za analgeziju dan metamizolnatrij hidrat, a na kraju operacije paracetamol. Ekstubirani su u jedinici za prijeanestezijski i postanestezijski nadzor. Nakon buđenja pacijenti su bili bez bolova, bez mučnine, imali su osjećaj zatezanja šavova i drena kod pomicanja. Na odjelu su dobili nesteroidni antireumatik, a tegobe koje su imali nisu bile posljedica kirurgije niti anestezije. Tijekom razdoblja praćenja (do kirurške kontrole nakon četiri tjedna) pacijenti nisu osjećali bolove vezano uz operaciju. Provedena je anestezija bez opioida, postignuta je odgovarajuća kontrola boli uz brzi oporavak aktivnosti crijeva i ranu mobilnost pacijenata.
SCIWOCTET is a cervical spine injury (CSI) with objective signs of myelopathy, due to trauma, without evidence of ligament injury or bone fractures on x-ray and computed tomography (CT) images. It is ...rare, found in about 3% of patients with CSI. Perioperative manipulation of these patients may cause secondary spinal cord injury. The challenge for the anesthesiologist is to manage an airway with as little movement of the patient's head and neck as possible. A patient is presented after a fall from a motorbike. At hospital admission, he had neurological defcit in the innervation area of the cervical spinal cord. Multi-slice CT of the head and cervical spine was without signs of acute bone trauma. Magnetic resonance imaging was performed and the diagnosis met the criteria defining SCIWOCTET. Elective cervical spine surgery under general anesthesia was performed, the patient was intubated with a rigid bronchoscope using manual in-line immobilization. The selection of instruments and procedures is emphasized. Other procedures, techniques and instruments that can be used for airway management and their influence on the movement of the patient's head and neck are listed. It is concluded that rigid bronchoscopy with the application of manual in-line immobilization is suitable for emergency and elective intubation of patients with cervical spine pathology. Key words: Anesthesia; Cervical spinal cord injury; SCIWOCTET; Airway; Rigid bronchoscope; Bonfls SCIWOCTET je ozljeda vratne kraljeznice s objektivnim znakovima mijelopatije uslijed traume, bez dokaza ozljede ligamenata ili prijeloma kostiju na prikazima rtg i kompjutorizirane tomografje (CT). Navedena ozljeda je rijetka, nadena je kod 3% bolesnika s ozljedom vratne kraljeznice. Svako postupanje s ovim bolesnicima moze izazvati sekundarnu ozljedu kraljeznicne mozdine. Izazov za anesteziologa je zbrinjavanje disnoga puta, uz sto manji pomak glave i vrata bolesnika. Prikazuje se bolesnik nakon tupe ozljede uslijed pada s motora. Kod prijma Glasgowska ljestvica kome (GCS) bila 15, uz neuroloski ispad iz inervacijskog podrucja vratne kraljeznicne mozdine. Multi-slice CT glave i vratne kraljeznice nije pokazala znakova akutne kostane traume. Naknadno je ucinjena magnetska rezonanca, a dijagnoza je ispunjavala kriterije koji definiraju SCIWOCTET. Na bolesniku je izvedena elektivna kirurgija vratne kraljeznice u opcoj anesteziji. Intubiran je rigidnim bronhoskopom uz primjenu manualne in-line imobilizacije (MILI). Poslijeoperacijski dolazi do poboljsanja neuroloskog defcita. U prikazu slucaja naglasen je odabir instrumenata i postupaka (rigidni bronhoskop uz MILI), u cilju sto manjeg pomicanja glave i vratne kraljeznice bolesnika. Navedeni su drugi postupci, tehnike i instrumenti koje je moguce rabiti za zbrinjavanje disnoga puta i njihov utjecaj na pomak glave i vrata bolesnika. Moze se zakljuciti da je rigidna bronhoskopija uz MILI prikladna za hitnu i elektivnu intubaciju bolesnika s patologijom vratne kraljeznice. Kljucne rijeci: Anestezija; Ozljeda vratne kraljeznice; SCIWOCTET; Disni put; Rigidni bronhoskop; Bonfls
Bilateral retrobulbar optic neuritis in young adults are most often caused by demyelinate disease (MS). In all cases where MS was eliminated, we have used selected tests regarding to history, ...clinical findings and differential diagnosis. Diagnosis of Lyme disease is approved by diagnostic criteria proposed by Center for Control and Prevention of disease. In our case diagnosis of Lyme disease was established by history of illness, clinical findings and positive serlological tests.
Knowledge of the relationship between soil sampling density and spatial autocorrelation with interpolation accuracy allows more time- and cost-efficient spatial analysis. Previous studies produced ...contradictory observations regarding this relationship, and this study aims to determine and explore under which conditions the interpolation accuracy of chemical soil properties is affected. The study area covered 823.4 ha of agricultural land with 160 soil samples containing phosphorus pentoxide (P2O5) and potassium oxide (K2O) values. The original set was split into eight subsets using a geographically stratified random split method, interpolated using the ordinary kriging (OK) and inverse distance weighted (IDW) methods. OK and IDW achieved similar interpolation accuracy regardless of the soil chemical property and sampling density, contrary to the majority of previous studies which observed the superiority of kriging as a deterministic interpolation method. The primary dependence of interpolation accuracy to soil sampling density was observed, having R2 in the range of 56.5–83.4% for the interpolation accuracy assessment. While this study enables farmers to perform efficient soil sampling according to the desired level of detail, it could also prove useful to professions dependent on field sampling, such as biology, geology, and mining.
In order to obtain compounds with better biological activity and lower toxicity, numerous modifications have been made to the cisplatin and carboplatin molecules. The aim of the study was to examine ...the in vitro antiproliferative activity of two new carboplatin analogues and their effect on both the cell cycle and the induction of apoptosis. Carboplatin and analogues were tested on four human cell lines: myelogenous leukemia K562, colon adenocarcinoma HT-29, breast adenocarcinoma MCF-7 and lung fibroblasts MRC-5. Cell lines were exposed to commercial and synthesized carboplatin and two carboplatin analogues. Their growth inhibition was measured by the MTT test after 24 h incubation. The cell cycle modulation and induction of apoptosis were analyzed by flow cytometry on MCF-7 cell line. After 24 h exposure, both carboplatin analogs induced dose-dependent cytotoxicity in all tested cell lines. The most sensitive was MCF-7 cell line. Tested substances showed moderate cytotoxicity against healthy MRC-5 cells. Flow cytometry analysis showed that both analogues modulated the cell cycle, increasing cell population in sub-G1 phase. The same response in the form of the apoptosis induction was also obtained with the Annexin-V test. Apoptosis induction was confirmed with double-fluorescence staining method. Two new carboplatin analogues strongly inhibit the growth of MCF-7 breast cancer cells, inducing apoptosis and changes in cell cycle distribution.
Introduction. The COVID-19 pandemic caused by the SARS-CoV-2 virus has led to significant public health problems, severe complications, and functional impairment in persons who have recovered from ...this disease. Case report. A 60-years-old male deconditioned patient was transferred from Corona 4 Center to the Center for Physical Medicine and Rehabilitation of the University Clinical Center in Kragujevac for a post-COVID rehabilitation due to pronounced muscle weakness and inability to walk. After functional testing, an individual rehabilitation plan was created and a kinesitherapy program was adjusted daily based on the patient's respiratory status. After the kinesitherapy program, Respivol was used-a volumetric medical device for breathing exercises in patients with respiratory difficulties. At the time of admission, the patient could not move independently, could not move from the lying to the sitting position on his own, and could not maintain balance in the sitting position. Hypotrophy caused by prolonged inactivity of the muscles of the whole body dominated the clinical picture. A six-week rehabilitation treatment performed on the patient showed a significant improvement in functionality (FIM test), muscle strength (manual muscle test), daily life activity (Barthel index), as well as a reduction of anxiety (GAD-7 scale). Conclusion. The goal of the rehabilitation program is to restore the patient's state of functionality before the initiation of COVID-19 treatment, so that they can perform their regular professional activities and achieve complete independence in performing activities of daily living (ADL).
Tick-borne encephalitis (TBE) is a zoonotic flaviviral infection that is a growing public health concern in European countries. The aims of this research were to detect and characterize tick-borne ...encephalitis virus (TBEV) in Ixodes ricinus ticks at presumed natural foci in Serbia, and to determine seroprevalence of TBEV IgG antibodies in humans and animals. A total of 500 I. ricinus ticks were examined for the presence of TBEV by real-time RT-PCR, and conventional nested PCR and sequencing. To determine TBEV seroprevalence, 267 human sera samples were collected, as were 200 sera samples from different animal species. All sera samples were examined by ELISA for the presence of anti-TBEV antibodies. To exclude cross-reactivity, all sera samples were tested for anti-West Nile virus (WNV) antibodies and all human sera samples were also tested for anti-Usutu virus antibodies by ELISA. Results of this preliminary study indicated TBEV activity in Serbia at two microfoci. Several decades after the previous documentation of TBEV in Serbia, we have demonstrated the presence of TBEV in I. ricinus questing nymphs (prevalence 2% and 6.6% at the two different localities) and anti-TBEV antibodies in humans (seroprevalence 0.37%). Moreover, we show for the first time TBEV seroprevalence in several animal species in Serbia, including dogs (seroprevalence 17.5%), horses (5%), wild boars (12.5%), cattle (2.5%), and roe deer (2.5%). None of the goats tested was positive for anti-TBEV IgG antibodies. TBEV isolate from I. ricinus tick in this study belonged to the Western European subtype. To understand the true public health concern in Serbia, detailed epidemiological, clinical, virological, and acarological research are required. This is important for implementation of effective control measures to reduce the incidence of TBE in Serbia.
Respiratory exercise in post-COVID-19 significantly improves pulmonary function, exercise capacity and quality of life. Our study aimed to investigate the effect of respiratory exercise on partial ...pressures of oxygen, carbon dioxide and oxygen saturation in arterial blood and anxiety assessed by the GAD-7 scale in the acute phase of COVID-19 infection.
The study was conducted at the Clinical Center, Kragujevac, from June to July 2020. The study was a prospective clinical trial and included 62 patients with the acute-phase of COVID-19 infection (61.3% males, mean age 60.82 ± 11.72). The duration of the comprehensive pulmonary rehabilitation program was 14 days ± 2.28 days. Oxygen saturation and heart rate were determined by using the pulse oximeter, oxygen flow, and arterial blood gas analysis values by using the gas analyzer. The anxiety assessment was measured using the Generalized Anxiety Disorder (GAD-7).
The values of oxygen saturation significantly differed before and after the respiratory exercise sessions (95.77 vs 98.02, respectively;
< .001). After the respiratory exercise program, significantly lower values of the GAD-7 scale were observed compared to the values before the respiratory exercise program (
= .049). A significant negative correlation was observed between oxygen saturation after respiratory exercise and age and presence of chronic obstructive pulmonary disease (ρ = -0.329;
= .013; ρ = -0.334;
= .009, respectively). GAD-7 score after respiratory exercise negatively correlated with chronic obstructive pulmonary disease and malignancy (ρ = -0.285;
= .025; ρ = -0.350;
= .005, respectively).
The respiratory exercise program significantly improves oxygen saturation and anxiety levels in COVID-19 patients.
Background/Aim. Diabetic polyneuropathy is a common chronic complication in patients with diabetes mellitus. The aim of this study was to determine the importance of applied physical procedures on ...the functional status of diabetic polyneuropathy patients compared to the group of respondents treated by alpha-lipoic acid. Methods. Sixty sub-jects were divided into two groups: group A ? diabetic polyneuropathy patients treated with physical procedures, and group B ? diabetic polyneuropathy patients treated with alpha-lipoic acid. The study has lasted for three diagnostic and therapeutic cycles, each lasting for 16 days with a time between cycles of 6 weeks. Results. Manual muscle test, range of motion, Michigan Neuropathy Screening Instrument, and Berg balance scale values showed statistically significant improvement at the end of testing group A respondents, while no improvement was shown in group B respondents. Conclusion. The application of the combined physical procedures shows clear benefits for the improvement of muscle strength and mobility of the ankle joint in respondents with diabetic polyneuropathy.
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