PONS - medicinski časopis

Risk factors associated with cognitive dysfunction in patients on peritoneal dialysis

Mira Novković Joldić, Violeta Knežević, Milica Knežević — Tue, 18 Feb 2025 21:13:47 +0100

Introduction: Cognitive impairments represent a significant global issue, as they deteriorate patients' quality of life, increase mortality and the number of hospitalizations, burden the healthcare system, and raise treatment costs. Aim of procedure: The aim of this research is to determine the prevalence of cognitive dysfunction in patients undergoing peritoneal dialysis. Material and Methods: A cross-sectional study was conducted in May 2024, at the University Clinical Center of Vojvodina, at the Clinic for <nephrology and clinical immunology. The study included 30 patients undergoing peritoneal dialysis. The Montreal Cognitive Assessment (MoCA) was used as the instrument for assessing cognitive dysfunction. The maximum score is 30, and a result of <25 was considered indicative of cognitive dysfunction. Results: Of the 30 patients, 55.2% were male. The most represented age category was ≥60 years, comprising 43.5%. Among comorbidities, hypertension was the most prevalent at 33.3%. Cognitive dysfunction was confirmed in 34% of the patients. A logistic regression model was applied to identify predictors of cognitive dysfunction, revealing that female patients and those over 60 years of age were at a higher risk for cognitive dysfunction. A positive correlation between the MMSE score and the total dialysis adequacy index Kt/V was also identified. Conclusion: Significant predictors of cognitive dysfunction in patients on peritoneal dialysis were female gender, age category (above 60 years), glucose levels, daily and weekly doses of vitamin D, and the dialysis adequacy index Kt/V.

Key words: cognitive dysfunction, peritoneal dialysis, risk factors

The influence of breast volume and age on the occurrence of severe forms of radiation dermatitis as a complication of postoperative 3D-conformal radiotherapy of the breast - one center experience

BOJAN RADOJIČIĆ, Mirko Dolić, Marija Radojičić — Thu, 08 Aug 2024 23:36:02 +0200

Introduction/goal. In the world, the incidence of breast cancer is constantly increasing, and according to the results of GLOBOCAN 2022, in the population of women, breast cancer is in the first place in terms of incidence and in the second place in terms of mortality. The modern approach to breast cancer treatment is multidisciplinary. Surgery, drugs and radiotherapy, as well as their combinations, are applied in the order that depends on the stage of the disease, general condition, comorbidities. The results of previous studies have proven that in selected patients with early breast cancer there is no statistically significant difference in overall survival between partial resection followed by radiation therapy and mastectomy, which rapidly increased the number of breast conserving surgery. In this regard, it is a challenge to carry out postoperative radiotherapy of the breast with as few consequences as possible for the surrounding organs (heart and lungs), but also to minimize early and late reactions of the skin as well as the breast itself and, accordingly, radiation dermatitis (RD) is the most common complication that occurs in patients treated with radiotherapy. The aim of the study was to determine whether breast volume and age have an influence on the occurrence of more severe forms of acute skin toxicity.

Methods. The research was conducted at the Radiotherapy Department of the Radiology Institute of the Military Medical Academy in Belgrade, and the study had a retrospective-prospective character. The study included data analysis of 42 patients who were diagnosed with early breast cancer. After a breast conserving surgery was performed on them, with or without adjuvant chemotherapy, they were advised to undergo further treatment with postoperative radiation therapy.

Results. All patients (100%) had a skin reaction. As treatment progressed and RD appeared or worsened, there was a tendency to increase in intensity of signs and symptoms. The percentage of mild forms of RD (gr I) was 52.4%, moderate (gr II) 35.7%, medium severe (gr III ) 11.9%, while there were no severe forms in the form of necrosis and ulceration. The average breast volume in RD grade I was 1542ml, grade II 1698ml, grade III 1988ml. The average age of subjects with acute RD grade I is 66 years, grade II 64 years and grade III 58 years.

Conclusion. Using the 3D conformal technique, in local postoperative radiation therapy of the breast in the standard mode of fractionation in the supination position, breast volume and age have no statistical significance on the degree of acute skin toxicity.

Personalized medicine and pharmacogenomics

Mitar Popović, Marina Jakšić — Thu, 27 Feb 2025 12:00:18 +0100

Personalized medicine refers to any clinical approach that emphasizes the systematic use of preventive, diagnostic, and therapeutic interventions based on genomic and family history data to enhance health outcomes. In this sense, personalized treatment is frequently referred to as genomic medicine. Personalized medicine has several health strategies that rely on the identification of molecular-genetic markers, including molecular diagnosis, prognosis, and disease monitoring; predictive genetics and preventive medicine; pharmacogenomics; targeted molecular therapy, and gene-based therapy. This paper presents a summary of current pharmacogenomics findings, as well as the field's expected future progress. Pharmacogenomics is the study of how the entire genome influences an individual's response to a medicine. The clinical application of pharmacogenomics enables clinicians to predict a patient's response to a specific therapy based on information obtained from genetic tests, and to select the appropriate drug, drug dose, and duration of therapy in order to achieve the best possible therapeutic response in the patient while minimizing unwanted side effects. This necessitates objective and evidence-based guidelines, as well as an adequate infrastructure for accessing pharmacogenomic data, such as via the patient's electronic health record. Although medicine has always been essentially "personalized," or tailored to each patient, personalized medicine now employs cutting-edge technology and knowledge in the fields of molecular genetics and genomics, allowing for a greater degree of personalization and significant progress in clinical medicine.

The Possibilities of Applying Ultrasound-Guided Percutaneous Electrolysis For Musculoskeletal Pain

Thu, 24 Oct 2024 22:09:41 +0200

Physical therapy is constantly evolving and adapting to new information and technologies in order to provide optimal care to patients with various musculoskeletal conditions. In this context, recent advances in technology and therapy methods has led to the introduction of new techniques, among which ultrasound-guided percutaneous electrolysis stands out. This technique, which combines the principle of electrotherapy (direct current) with percutaneous needle application, is becoming increasingly significant in the rehabilitation of patients with tendinopathies, myofascial pain syndromes, and other musculoskeletal conditions. The largest number of studies to date indicate its effectiveness, whether it is applied as an individual procedure, or in combination with other physical modalities and therapeutic exercises. The therapeutic effects were monitored in both the short and long term. The most adequate therapeutic protocols are still being sought after, considering that this technique has recently been introduced as a way of decreasing the symptoms and consequences of musculoskeletal pain. The aim of this research was to review the approaches and therapeutic protocols for the application of percutaneous electrolysis in the treatment of musculoskeletal pain. The research results indicate positive therapeutic effects, as well as the advantages of applying ultrasound-guided percutaneous electrolysis for musculoskeletal pain.

Contemporary approach to prevention and therapy of the no-reflow phenomenon

Zoran Stajić — Thu, 08 Aug 2024 23:34:25 +0200

No-reflow phenomenon is defined as a state of inadequate (incomplete) myocardial perfusion through a certain segment of the coronary circulation, in the absence of mechanical obstruction of the epicardial coronary artery, i.e. without the presence of significant residual stenosis, spasm, occlusive dissection or intracoronary thrombosis. The development of the no-reflow phenomenon in patients with acute myocardial infarction with ST elevation increases the risk of early clinical complications and mortality many times over. Early intrahospital complications are manifested in the form of hemodynamic instability, acute heart failure including cardiogenic shock, myocardial rupture, and arise as a result of the extension of the area of myocardial necrosis, malignant cardiac arrhythmias, conduction disorders and acute pulmonary edema. The aim of this review is to present the modern aspects of prevention and therapeutic possibilities in patients with the developed no-reflow phenomenon. Prevention involves the application of various strategies before the complete reopening of the occluded infarcted coronary artery, with the aim of preparing the coronary microcirculation for reperfusion. Preventive measures should be directed towards different pathophysiological mechanisms of the no-reflow phenomenon in order to be effective, from the reduction of the total ischemic time, to the application of various pharmacological and non-pharmacological measures. Application of therapeutic measures is necessary in case of unsuccessful prevention and development of no-reflow phenomenon. In this context, therapeutic agents should be effective during current and progressive myocardial circulation damage, and the modern method of primary percutaneous coronary intervention provides the possibility of delivering high local doses of pharmacological agents directly to the infarcted coronary artery, unlike traditional treatment using fibrinolytic therapy.

Microdeletions - Angelman syndrome

Miroslav Marković, Olivera Marković, Marija Marković — Fri, 28 Feb 2025 11:32:59 +0100

Abstract

The aim of the paper is to show the structural changes in the form of microdeletion malformations and the mechanisms of the origin of these two microdeletion syndromes, especially Angelman syndrome. In addition to the molecular mechanisms of origin, some of the most well-known microdeletion syndromes, their clinical, genetic and phenotypic characteristics are included. In addition to the broader picture of numerous syndromes that arise as a result of microdeletion changes, Angelman and Prader-Willi syndromes are particularly presented. The work refers to findings from the literature that explain the specificities of these syndromes, both in genotype, phenotype and clinical picture, as well as in other aspects of the psychomotor, speech-language and general health course of children and adults. The methods of molecular genetics within prenatal diagnostics are presented as significant preventive measures within the framework of genetic counseling and the prevalence of the occurrence of these all-pervading severe forms of the syndrome. Also, an overview of modern methods and techniques used in differential diagnosis and improving genetic counseling is given. By monitoring significant delays in all modalities of development and problems with general health functioning, some of the types of therapeutic interventions of the holistic and pharmacological-symptomatic type are included.

Key words: microdeletion syndromes, Angelman and Prader-Willi syndrome, multidisciplinary approach - prenatal counseling, pharmacological and defectological treatment

Lung tumor discovered during the pre-employment medical check-up of a candidate for work abroad - case report

Sat, 01 Mar 2025 10:51:45 +0100

Abstract

Introduction. Lung cancer is one of the most common and deadliest forms of cancer with a high mortality rate. Regular health check-ups play a crucial role in the early detection of malignant diseases, especially among employed individuals.

Aim. The aim of the paper is to present a case of a diagnosed lung tumor in a person who underwent pre-employment medical check-up in order to obtain a work visa for the purpose of employment abroad.

Case report. This paper presents the case of a 47-year-old architect who was diagnosed with a lung tumor during a preventive medical check-up for obtaining a work visa. The patient was a smoker without any health complaints. A chest X-ray revealed a well-defined shadow in the left lung field. Further diagnostic procedures (CT scan and bronchoscopy) confirmed the presence of a carcinoid (NET GR1). The tumor was successfully removed through surgery, and the patient received a positive opinion on work capability after a short rehabilitation period.

Conclusion. This case highlights the importance of preventive medical examinations that enable early detection and timely intervention, significantly improving the chances of successful treatment. Early detection of malignant diseases reduces the need for invasive treatments, lowers treatment costs, and improves patients' quality of life. However, challenges include false positive and negative results, which can lead to unnecessary interventions or false security. The role of occupational medicine is crucial in early detection, providing a unique opportunity to identify malignant diseases through regular check-ups. A multidisciplinary approach, including collaboration among oncologists, surgeons, radiologists, and pulmonologists, is essential for optimal planning and execution of treatment, contributing to the best possible outcomes for patients. In conclusion, this paper emphasizes the need for continuous educational programs and raising awareness about the importance of early lung cancer detection. Public education and the implementation of preventive health programs can significantly reduce lung cancer mortality. This case serves as a reminder for all healthcare professionals about the importance of a careful and thorough approach to each patient, because every medical check-up can be an opportunity to save a life.

Key words: tumor of the lungs, carcinoid, preventive medical check-up, occupational medicine