Vojnosanitetski pregled

Up-to-date approach in diagnosis and treatment of primary mediastinal B-cell lymphoma

Thu, 27 Mar 2025 13:54:35 +0100

Effects of sufentanil in combination with dexmedetomidine for patient-controlled intravenous analgesia after renal transplantation

Jun Ma, Yawen Yang, Linhao Sun, Tingting Wu — Thu, 27 Mar 2025 14:09:11 +0100

Background/Aim. Nowadays, the most convenient analgesic method is patient-controlled intravenous injection of one or more adjuvant drugs. The aim of our study was to evaluate the effects of sufentanil plus dexmedetomidine for patient-controlled intravenous analgesia (PCIA) after renal transplantation. Methods. Seventy-eight patients receiving living-related renal transplantation under general anesthesia were selected. Radioisotope scanning was performed, and the single glomerular filtration rate of the unilateral kidney was ≥ 40 mL/min/1.73 m². The control group (CG) and observation group (OG) (39 patients in each group) were analgesic with sufentanil and sufentanil plus dexmedetomidine, respectively. When the Visual Analogue Scale (VAS) score exceeded 4 points, 0.05 mg/kg oxycodone was intravenously injected for remedial analgesia. Plasma levels of endothelin, urea nitrogen, and creatinine were measured by radioimmunoassay. Heart rate (HR), mean arterial pressure, oxygen saturation, VAS score, and sedation score were recorded before anesthesia and after surgery. Analgesic remediation rate, number of effectively pressing the PCIA pump, and incidence rate of adverse reactions within 48 hrs after surgery were recorded. Results. HR of OG was significantly lower than that of CG 6 and 12 hrs after surgery (p < 0.05). VAS score of OG was lower than that of CG 6, 12, and 24 hrs after surgery (p < 0.05). OG had a lower postoperative remedial rate, number of effectively pressing the PCIA pump, and incidence rates of nausea and vomiting (p < 0.05) compared to CG. Endothelin, urea nitrogen, and creatinine levels significantly decreased after surgery compared with those before anesthesia (p < 0.05). The levels of OG were lower than those of CG at each time point after surgery (p < 0.05). Conclusion. Sufentanil plus dexmedetomidine can be safely and effectively used for PCIA after renal transplantation, with superior outcomes to those of sufentanil alone.

Factors associated with physician burnout syndrome: a comparative analysis

Marko Stojanović, Nataša Rančić, Miodrag Stojanović — Thu, 27 Mar 2025 14:17:44 +0100

Background/Aim. Burnout syndrome (BS) can occur in doctors at different levels of health care. The aim of this study was to identify the prevalence of BS and compare the differences among physicians in health institutions in Southeast Serbia (SES). Methods. A multicenter, questionnaire-based cross-sectional study was conducted among 373 physicians (252 female and 121 male) from primary, secondary, and tertiary care institutions in SES from 2023 to 2024. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was applied. Results. A significantly higher score on the emotional exhaustion (EE) subscale was observed in physicians older than 55 years (p < 0.001) and those with more than 25 years of work experience and more than 14.5 years of specialist experience. Higher EE scores were also observed in doctors with specialization (p < 0.001), then, in those in managerial positions (p = 0.031), in doctors with additional engagement in private practice (p = 0.019), those with more than two duties per week (p = 0.008), and physicians who assessed that their greatest job burden was dealing with a large number of patients during the workday (p < 0.001). A significant increase in depersonalization (DP) subscale values was associated with age above 53.5 years, additional engagement in private practice (p = 0.015), shift work (p = 0.049), and physicians who assessed that their greatest job burden was dealing with a large number of patients during the workday (p < 0.001). A significant increase in personal achievement subscale values was observed among doctors in managerial positions (p = 0.004). The highest percentage of physicians from tertiary care institutions had high EE and low personal achievement values, while the highest percentage of physicians from primary care institutions had high DP values. Conclusion. Doctors in health institutions in SES have a moderate degree of BS. Additional research into BS and the factors that contribute to its occurrence is needed, as well as taking appropriate preventive and corrective measures at each of the three levels of health care.

Importance of ultrasound measurement of the liver and spleen size in the diagnosis of comorbidity with malaria and COVID-19

Dušan Krstić, Boban Krstić, Milica Djokić, Nemanja Rančić — Thu, 27 Mar 2025 14:31:42 +0100

Background/Aim. With the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, patients who had malaria and COVID-19 simultaneously were also noticed. Hepatosplenomegaly is characteristic and almost always present in patients with malaria (without associated COVID-19). A significant increase in the size of the liver and spleen clearly indicates the possible development of severe malaria. The aim of this study was to determine the effect of COVID-19 on liver and spleen size in patients with malaria. Methods. This study was conducted while the authors were working in the Serbian Military Hospital of the United Nations Multidimensional Integrated Stabilization Mission (MINUSCA-UN) in Bangui, Central African Republic. Data from 1,710 patients who underwent ultrasound examination of the abdomen, where the diameters of the liver and spleen were monitored, were analyzed. The total number of examined patients was divided into four groups: group with 816 control patients without malaria (C group), 480 with active malaria (M⁺), 353 patients who had malaria in the past 2–6 months (M^past), and 61 patients with active malaria and active COVID-19 (M⁺Cov⁺). Results. The liver size was significantly greater in the M⁺, M^past, and M⁺Cov⁺groups of respondents compared with the C group. Statistically significant spleen enlargement was observed only in the M⁺group but not in the M⁺Cov⁺group compared to the C group. Conclusion. There is no enlargement of the spleen in patients with a coinfection with the severe acute respiratory syndrome coronavirus 2 and Plasmodium malariae. Therefore, in the presence of clear splenomegaly, we can indicate, with a high probability, the absence of COVID-19 while waiting for the results of the polymerase chain reaction test, even in the first hours of hospitalization.

Evaluation of clinical application effect of traditional Chinese medicine fumigation technology on postoperative patients with anorectal diseases

Tianyang Xie, Zichen Zhang, Liu Liu — Thu, 27 Mar 2025 14:40:36 +0100

Background/Aim. Treatment after anorectal surgery plays a key role in wound healing and reducing complications. The aim of this study was to assess the clinical efficacy of traditional Chinese medicine (TCM) fumigation in the postoperative management of anorectal diseases, comparing TCM fumigation with conventional treatments. Methods. This study included 100 anorectal disease patients who underwent surgery at Anhui Chest Hospital, China, from October 2021 to October 2023. The patients were randomly split into two groups – observation and control (50 patients each). TCM fumigation was administered to the observation group, while the control group received potassium permanganate sitz baths. Both groups received 14 days of treatment. The research assessed visual analog scale (VAS), symptom eradication, wound healing, serum substance P (SP) and interferon-gamma (IFN)-γ levels, and therapy efficacy before and after treatment. Side effects were also examined in both groups. Results. The overall effective rate for the observation group was 96%, and for the control group, it was 86%. The observation group’s clinical efficacy exceeded the control group’s clinical efficacy. VAS for pain in both groups dropped after treatment, after which the observation group had lower scores than the control group. The observation group had less anal distension, wound edema, wound fluid, and recovery time than the control group. Within both groups, higher levels of SP and lower levels of IFN-γ in serum were recorded after treatment compared to their pre-treatment values. After treatment, higher levels of SP and lower levels of IFN-γ were recorded in the observed group compared to the control group. The observation group had fewer side effects than the control group (6% vs. 28%). Conclusion. TCM fumigation techniques may increase clinical efficacy, mitigate clinical symptoms, surgical adverse effects, discomfort, and accelerate wound healing following anorectal disorders.

Anti-inflammatory properties of an A3 adenosine receptor agonist, piclidenoson, in a model of human peripheral blood mononuclear cell culture

Thu, 27 Mar 2025 14:52:38 +0100

Background/Aim. Piclidenoson (CF101, IB-MECA), a selective agonist of the A3 adenosine receptor (A3AR), is used in clinical trials for the treatment of psoriasis. Emerging data from in vitro and in vivo studies suggest that piclidenoson possesses anti-inflammatory and immunomodulatory properties, but its action on human peripheral blood mononuclear cells (PBMCs) remains unknown. The aim of this study was to examine the anti-inflammatory effects of piclidenoson in a model of phytohaemagglutinin (PHA)-stimulated human PBMCs culture. Methods. Human PBMCs were isolated from the venous blood of healthy donors (n = 4) and treated with different concentrations of piclidenoson. Flow cytometry and the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) test were used to determine cell viability, while the MTT method and the carboxyfluorescein succinimidyl ester (CFSE) staining method were used to analyze the effect of piclidenoson on cell proliferation. Levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-1β, IL-23, IL-36, IL-5, interferon (IFN)‐γ, IL-17, and IL-10 were measured using a specific sandwich enzyme-linked immunosorbent assay (ELISA). Results. The results of cytotoxicity tests showed that the highest applied concentration of piclidenoson (1,500 nM) reduced the metabolic activity of PBMCs (p < 0.05) and increased the percentage of late apoptotic (p < 0.05) and necrotic cells (p < 0.01). Non-toxic concentrations (250, 500, and 1,000 nM) decreased the proliferation of PBMCs (p < 0.05) compared to the control cells. These concentrations also decreased the production of TNF-α (p < 0.001). Piclidenoson at concentrations of 250 and 1,000 nM reduced the production of IL-23 (p < 0.05) while the concentrations of 500 and 1,000 nM reduced the production of IL-36 (p < 0.05). Piclidenoson at 1,000 nM increased IL-1β production, while other concentrations decreased its production (p < 0.01). The highest concentration (1,000 nM) inhibited the production of IL-5 (p < 0.05) and IFN-γ (p < 0.01) while all applied concentrations inhibited the production of IL-17 (p < 0.001). Furthermore, piclidenoson increased the production of IL-10 in all applied concentrations (p < 0.01). Conclusion. At non-toxic concentrations, piclidenoson exerts anti-inflammatory properties associated with the inhibition of proliferation and modulation of cytokine production in PHA-stimulated PBMCs culture.

Differences in the response of various urogynecology synthetic grafts to infection by Staphylococcus epidermidis: an experimental animal study

Thu, 27 Mar 2025 15:00:50 +0100

Background/Aim. Polypropylene synthetic meshes are used in urogynecology for the primary treatment of stress urinary incontinence. Infection of the graft could influence the outcome of the surgery as well as the adequate tissue reinforcement. The aim of the study was to compare responses to infection in six different synthetic grafts. Methods. The study included six different grafts, with polypropylene as their major component, used for the primary repair of full-thickness abdominal wall defects in male Wistar rats. From a total of 144 Wistar rats, six groups of 24 animals each were created. Each group consisted of 12 animals for noninfected and 12 animals for infected graft testing. In the subgroups for infected graft testing, grafts were inoculated with isolates of Staphylococcus epidermidis. After six weeks, the animals were sacrificed, and groups were compared for inflammatory response, collagen quantification, and abdominal wall reinforcement. The inflammatory response was calculated as the total number of inflammatory cells under a magnification of ×200, including polymorphonuclears, foreign body giant cells, and macrophages. Collagen quantification was determined by colorimetric measurement of hydroxyproline for alkaline hydrolysates. Abdominal wall reinforcement was determined as minimal disintegration load on a standardized shredding device. In order to detect bacterial biofilm and characterize collagen fibers, scanning electron microscopy (SEM) of fresh samples was performed. Results. Reinforcement of the abdominal wall with a titanium-coated polypropylene graft was most significantly degraded by the infection (p < 0.001). The inflammatory response was the most prominent in the infected multifilament polypropylene graft compared to the low-weight polypropylene graft, titanium-coated graft, and multifilament polypropylene graft with polyglactin (p < 0.01). In terms of collagen deposition, the greatest differences of all grafts were noted between noninfected and infected low- and high-weight monofilament polypropylene grafts (p < 0.01). Using SEM, biofilm formation was detected, and collagen fibers were described as immature. Conclusion. The results of this experimental animal study suggest that infection of synthetic urogynecology grafts results in a significant reduction in tissue reinforcement. In addition, the negative effects of the infection are the most pronounced in multifilament and semi-absorbable multifilament grafts.

Crack lung – a case report

Mira Vasiljević, Sanja Šarac, Rade Milić, Biljana Lazović-Popović — Thu, 27 Mar 2025 15:12:08 +0100

Introduction. Crack cocaine (CC), a potent form of cocaine, is well-known for its rapid and intense effects on the central nervous system. Its detrimental impact on the respiratory system is often disregarded. This type of cocaine originates from cocaine hydrochloride, a compound extracted from the leaves of the coca plant (Erythroxylum coca). Through various pathophysiological mechanisms, its pharmacokinetics and interaction with the respiratory system contribute to acute and chronic lung damage. Case report. We present a 35-year-old male with progressive dyspnea and chronic lung damage caused by long-term abuse of CC. Morphological changes in the lungs along with abnormalities in pulmonary function tests were also observed. The patient was treated with a combination of medication therapy and enrolled in a detoxification support program. The applied therapeutic measures led to a gradual reduction in symptoms and significant improvement in pulmonary function tests. Conclusion. CC-induced lung damage represents a clinical challenge with profound implications for patient health and well-being. Substance abuse counseling, relapse prevention strategies, and social support services are key components of comprehensive treatment to support patient recovery and prevent relapse.