Contents
17.02.2025.
Professional paper
DAMAGE CONTROL U TRAUMATOLOGIJI
Sveži prelomi u ortopedskoj hirurgiji i traumatologiji, dovode do hemodinamske nestabilnosti celokupnog organizma. Kod otvorenih preloma, stepen
hemodinamske nestabilnosti organizma je značajno veći. Prioritet u lečenju svežih preloma ima DAMAGE CONTROL IN ORTHOPEDIC (DCO). DCO je
invazivna procedura koja ima ulogu kako u stabilizaciji preloma, tako i u kontroli krvarenja. Prelomi dugih kostiju kao i prelom karlice su apsolutna
indikacija za DCO. Slobodno možemo reći da ova procedura prestavlja prioritet u lečenju svežih preloma. Procedura je individualizovana u zavisnosti
od težine povrede kao i hemodinamskog statusa povređenog pacijenta. U ortopedskoj hirurgiji i traumatologiji kao standardna procedura u DCO
koristi se spoljašnji fiksator po Mitkoviću. Ortopedski hirurzi moraju biti jako prisebni i obazrivi kod pregledapacijenata sa politraumom i da
prepoznaju tkzv. trougao smrti. Trougao smrti čine: acidoza, hipotermija i koagulopatija. Svaka karika je medjusobno povezana jedna sa drugom
dovode do ireverzibilnih promena u organizmu što za posledicu ima smrtni ishod. DCO se sprovodi u tri faze: 1) podrazumeva kontrolu kvarenja,
smanjenje kontaminacija bakterijama, kao i privremenu fiksaciju preloma. Sve ovo je neophodno uraditi u roku od 1-2h.; 2) obuhvata stabilizaciju
vitalnih parametara u JIN-e kao i reanimacija pacijenta ordiniranjem neophodne terapije, krvi i krvnih derivata.; 3) podrazumeva definitivna metoda
lečenja u smislu nastavka lečenja preloma spoljasnjim fiksatorom ili konverzija u neku drugu metodu lečenja.
Saša Jovanović
17.02.2025.
Professional paper
TRANSPOZICIJA TETIVE EKSTENZOR INDICIS PROPRIJUS ZA EKSENZOR POLICIS LONGUS U CILJU REKONSTRUKCIJE EKSTENZIJE PALCA - PRIKAZ SLUČAJA
Ruptura potkožne tetive ekstenzora policis longusa (EPL) je jedna od najčešćih povreda tetiva ekstenzora šake. Ova vrsta povrede može biti posledica
trauma ručnog zgloba. Češće se javlja kao posledica degenerativne ili inflamatorne bolesti. Ponekad se to dešava bez predisponirajućeg stanja, zbog
kontinuiranih pokreta savijanja i opružanja palca šake.
Ruptura tetive EPL-a se obično dešava u predelu Listerove kvrge gde su trenja najveća. Kontinuirano ponavljanje mikrotrauma može da uzrokuje
rupturu. Engkvist i Lundborg [1] su postavili hipotezu o patogenezi mehanizama ove povrede. Smatrali su da nakon trauma ili zapaljenja formiran
hematom unutar omotača tetive dovodi do povećanja pritiska u neelastičnom prostoru. Povećanje pritiska može izazvati promene u snabdevanju krvi i
može dovesti do nekroze i rupture struktura tetiva. Nakon prekida kontinuiteta tetive EPL-a, retrakcija proksimalnog okrajka je praćena
degenerativnim procesima koji ugrožavaju direktnu suturu.
Predloženi su mnogi tretmani, artrodeza interfalangealnog (IP) zgloba palca ili transpozicija tetive ekstenzor indicis proprius (EIP) koju je razvio
Mensch 1925. god. [1].
Transpozicija tetive šake je hirurška procedura која uključuje repozicioniranje funkcionalne tetive како bi se obnovila funkcija oštećene tetive šake.
Ova operacija ima za cilj da vrati pokret, funkciju i snagu šake.
U ovom radu prenosimo naše iskustvo u lečenja traumatske rupture tetive EPL-a metodom transpozicije tetive EIP-a. Opisujemo operativnu tehniku
transfera tetive EIP-a na tetivu EPL.
Ključne reči: trasnpozicija tetive, ekstenzor policis longus, ekstenzor indicis proprius, funkcija.
Aleksandra Petrović
01.12.2021.
Professional paper
Obesity and consequent changes in the body
Obesity is one of the most common chronic, non-infectious diseases in the world and our country, and it is characterized by excessive accumulation of fat tissue in the body and an increase in body weight. The increase in the number of obese people is an important global health problem. Obesity is associated with cardiometabolic and psychosocial comorbidities, and may also affect years of healthy life and reduce life expectancy. Numerous factors, such as biological predisposition, socioeconomic factors and environmental factors, interact and influence the development and maintenance of obesity. Excess adipose tissue in the body and its dysfunction is associated with inflammation and increased risk of metabolic, mechanical and mental complications. It is very important to monitor the incidence of obesity and its impact on the development of chronic non-communicable diseases and life expectancy due to the development and implementation of strategies to prevent the increase in the number of obese people.
Bojana Kisić, Dragana Puhalo-Sladoje, Dijana Mirić, Dragiša Rašić, Tatjana Novaković
01.12.2021.
Professional paper
Cor triatriatum sinister as an incidental finding in elderly woman
Cor triatriatum is a rare condition. It comprises around 0.1% to 0.4% of all congenital heart malformations. There are two types of this anomaly: cor triatriatum sinister (CTS), which is more common and accounts for 92% of all cases, and cor triatriatum dexter (CTD). This condition usually presents at an early age and is diagnosed mainly during early childhood. In some patients, who have less severe cases of CTS, diagnosis could be made in adulthood. We report an unusual case of a 78-year-old woman who was diagnosed with CTS for the first time. The patient was admitted to the cardiology department with symptoms of chest pain and dyspnoea. Physical examination revealed diffusely diminished breath sounds, with focal wheezing, and irregular heart rate, with no murmurs, while blood pressure was 140/90 mmHg. A transthoracic echocardiogram revealed an accessory membrane in the left atria suggestive of CTS.
Dalila Šačić, Mirza Šačić, Mirsad Šačić
01.12.2021.
Professional paper
Fructose metabolism: The pathogenic potential of a little molecule
In recent decades, the use of fructose in diet has increased worldwide, and coincided with increase of obesity, metabolic syndrome, diabetes, and non-alcoholic liver disease. This review presents molecular aspects of fructose metabolism, its characteristics and contemporary knowledge about control mechanisms in order to answer how this small molecule can exert pathogenic effects. When present in small, physiological amounts, fructose actually exerts protective glycoregulatory effects. However, long-term exposure to supraphysiological amounts of fructose creates conditions for the development of certain pathological states. In such conditions, lipogenesis is intensified causing dyslipidemia, gluconeogenesis is also intensified leading to hyperglycemia and compensatory hyperinsulinemia, while insulin signaling through IP3K/Akt is blocked. Moreover, exposure to high fructose levels can induce inflammation, redox balance disruption and a decline in energy synthesis. It is most likely that the ability of the liver to metabolize large amounts of fructose and the absence of autoregulatory and hormonal control mechanisms are responsible for pathogenic potential of fructose.
Dijana Mirić, Bojana Kisić, Dragana Pavlović, Ilija Dragojević, Sladoje Puhalo
01.12.2021.
Professional paper
Analysis of the characteristics of traffic trauma
Introduction: It is estimated that an average of 1,308 people die in traffic accidents in the world every day. Traffic accidents are caused by factors of the road, vehicles and the human factor, which occur alone or in combination with other factors in over 90% of cases. Material and methods: The retrospective systematic research included all cases of traffic trauma that were brought to the admission surgical outpatient clinic in the Clinical Hospital Center Kosovska Mitrovica in the period from January 2020 to December 2022. Results: In the observed period, 126 patients were registered. The age of the respondents differs statistically according to gender (p=0.030), and the highest frequency is male (81.8%) in the working population (18-59 years). The age of the subjects showed no statistical association with the types of injuries in traffic trauma (p=0.151). Friday and Saturday are the days with the highest risk (25.3% of injuries), and Sunday is the day with the least number of injuries (3.6%). The lowest number of injuries was recorded from January to May (n=12, 9.5%), and the highest was in the period August to October (n=54, 42.9%). A male patient, 20 years old, an alcoholic, required urgent surgical treatment (splenectomy) due to abdominal injuries. Alcoholism and the age of the subjects did not show statistical significance (p=0.495), and 24.6% of patients had a diagnosis of alcoholism. The age of the subjects showed a statistical association with hospitalization (p=0.004), male gender and age between 18-59 years. Only 2 patients required transport to a highly specialized facility. The fatal outcome showed a statistically significant correlation with the age of the respondent (p=0.016), there was only one patient (between 12-18 hours), a female, 85 years old as a passenger of a motor vehicle. Conclusion: The results of our study indicate a statistically significantly more frequent injury and hospitalization of male patients, that Friday and Saturday are the days of greatest risk and that the fatal outcome occurs in extremely elderly patients. Our findings favour the need to raise public awareness through the media, public actions and forums.
Mladen Kasalović, Aleksandar Jakovljević, Nikola Miljković, Gojko Igrutinović, Milica Milentijević, Aleksandra Milenković
01.12.2021.
Professional paper
Importance of postoperative pain and possibilities of prevention and treatment
The paper presents the importance of acute postoperative pain, the risk factors for its occurrence and intensity, instruments for its measurement and assessment, as well as the possibilities of prevention and treatment. The fact that post-surgical pain represents not only a subjective unpleasant experience for the patient, but also a factor that significantly contributes to complications and unfavorable outcomes of surgical treatment is well known. Despite that, postoperative pain can be seen very often. To successfully prevent and relieve pain, it is necessary to establish a possible cause-and-effect relationship between the occurrence and intensity of postoperative pain, type of surgical intervention, anesthesia technique, demographic characteristics of patients, comorbidities, chronic therapy, and family and socioeconomic factors. Besides the application of recommendations from the current guidelines and protocols for the prevention and treatment of post-surgical pain to achieve positive treatment outcomes, an individual approach to each patient and the application of multimodal analgesia techniques that include the use of different classes of analgesics, co-analgesics, and non-pharmacological measures, based on modern ERAS-protocols aimed at accelerated recovery after surgical intervention should also be employed.
Anka Tošković, Marina Stojanović, Ksenija Jovanović, Jovan Jozić, Milan Jovanović, Nevena Kalezić
01.12.2021.
Professional paper
Lichen planus disseminatus partim vesiculosus after COVID-19 vaccine
Introduction: Lichen planus is an autoimmune inflammatory disease that can be associated with infections, drugs and vaccines. As concerning the potential triggering effect of vaccine, there is evidence a few cases of new-onset lichen planus that appeared after COVID vaccine, particularly the Pfizer/BioNTech vaccine. Case report: This report is a case of a newonset lichen planus triggered by the Pfizer/BioNTech vaccine administration in a healthy young female. Dermatological examination revealed polygonal, itchy, erythematous papules on trunk, upper and lower limbs, that coalesced into brownish plaques in the ankles, flexural wrist and knee. No mucosal involvement was noted. In view of the clinical picture, the timing of the skin eruption with respect to the vaccine and the histopathologic findings, a vaccine-induced lichen planus triggered by the COVID-19 vaccine has been diagnosed. Conclusion: Lichen planus or lichenoid-like eruption as a cutaneous manifestation following COVID-19 vaccines are rare, and the pathogenesis for its development is still unclear. Clinical trials showed that the leading vaccines upregulate Tcell response (Th1) and incrementing inflammatory cytokines involved in the pathogenesis of autoimmune diseases, such as lichen planus. Although we still do not completely understand its pathogenesis, dermatologists should be aware of the possibility and keep an eye out for worsening or debut of this disease after the COVID-19 vaccine. Vaccinated patients should be monitored for skin manifestations, and dermatological evaluation should be offered, when needed.
Dragica Milosavljević, Milijana Relić, Mirjana Stojanović-Tasić
01.12.2021.
Professional paper
The impact of body weight on the secondary osification centers development and the term of closure of the anterior fontanelle in infants
Introduction: during the infant development, the organ growth is influenced by genetic factors, diet, hormones and many neuropeptides. The secondary ossification center in the hip joint begins to form around the 4th month of life. Primary dentition begins at the age of 5-6 months with the emergence of the central incisor in the maxilla. At birth, 6 fontanelles are present between the plate bones of the cranium. The largest is the anterior or large fontanelle. Objective of our research is to analyze the development of the secondary ossification center in the femoral head in relation to dentition and closure of the anterior fontanelle closure as well as influence of childrens' birth weight and current weight on these processes. Methodology: The study included 284 infants, male and female, aged 3 to 8 months. Clinical examination of the musculoskeletal system, anthropomentric measurements and ultrasonographic findings of the hip joint were performed at the Pediatric Clinic of the Clinical Hospital Center Pristina in Gracanica. Results: The development of secondary ossification centre correlated with child's age, dentition, anterior fontanelle closure, birth weight and delivery method, as well as actual body weight. Anterior fontanelle size was inversely related to age, body weight and secondary ossification. Conclusions: According to regression analysis, body weight is the only factor that has a direct and independent impact on the onset and progression of ossification process. Every additional kilogram of a child's body weight accelerates secondary ossification by 1.3-3.77 times.
Snežana Marković-Jovanović, Aleksandar Jovanović, Radojica Stolić, Milica Popović, Danijela Ivanović
01.12.2021.
Professional paper
Prevention of micronutrient deficiencies in the elderly
The ageing process is characterized by numerous changes in the body that negatively affect the health, lifestyle and diet of the elderly. An adequate and balanced diet plays a vital role in the quality of life of the elderly, including physical, mental and social health. Physiological decline in food intake in the elderly is a risk factor for certain micronutrient deficiencies such as osteoporosis, anaemia and decreased immunity. To prevent these public health diseases, it is suggested to promote the intake of foods of animal origin (offal, meat) to prevent iron and vitamin B group deficiency. An adequate intake of anthocyanidins, fruits and vegetables with blue-purple pigments is recommended for the prevention of anaemia. Adequate intake is also important, i.e. intake of at least two portions of dairy products per day and fish products per week in combination with physical activity can provide adequate intake of calcium and vitamin D for the prevention of osteoporosis. The intake of fresh or minimally processed foods has played a significant role in ensuring an adequate intake of vitamin C, which, in addition to improving iron absorption and preventing anaemia, also affects the proper functioning of the immune system. For the same reason, it is recommended to take vitamin A from offals or beta-carotene from yellow-brown and orange fruits and vegetables. In general, appropriate nutritional interventions can be effective and financially effective forms of preventing and treating micronutrient deficits, thus improving the overall quality of life of the elderly
Dora Serenče, Hajnalka Požar
