Maja Surbatovic - Academia.edu (original) (raw)
Papers by Maja Surbatovic
Critical Care Medicine
OBJECTIVES: To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of... more OBJECTIVES: To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. DESIGN: A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and therapeutic data were collected. Patients were grouped as having Candida, Gram-positive, Gram-negative, and combined Candida/bacterial bloodstream infection. Outcome data were assessed at intensive care unit and hospital discharge. SETTING: EPIC II included 1265 intensive care units in 76 countries. PATIENTS: Patients in participating intensive care units on study day. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Of the 14,414 patients in EPIC II, 99 patients had Candida bloodstream infections for a prevalence of 6.9 per 1000 patients. Sixty-one patients had candidemia alone and 38 patients had combined bloodstrea...
The Lancet, 2012
Background Clinical outcomes after major surgery are poorly described at the national level. Evid... more Background Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfi rmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe.
Vojnosanitetski pregled. Military-medical and pharmaceutical review
SAŽETAK Sindrom intrakranijalne hemoragije obuhvata više kliničkih entiteta, među kojima se po zn... more SAŽETAK Sindrom intrakranijalne hemoragije obuhvata više kliničkih entiteta, među kojima se po značaju, učestalosti i potrebi brzog prepoznavanja i terapijskog reagovanja izdvajaju subarahnoidalna i intracerebralna hemoragija (SAH i IH). Cilj našeg istraživanja je bio da potvrdimo, odnosno utvrdimo ulogu, značaj i mjesto faktora rizika-udruženih oboljenja u odnosu na ishod i prognozu IH. Ispitivanjem je obuhvaćeno 50 bolesnika sa intracerebralnom hemoragijom koji su liječeni konzervativnim tretmanom na Klinici za neurologiju, Klinici za anesteziologiju i intenzivnu terapiju i Klinici za urgentnu internu medicinu naše ustanove. Svim bolesnicima je utvrđivan stepen neurološkog i funkcionalnog deficita (Kanadska neurološka skala, odnosno Bartelov indeks funkcionalne sposobnosti), postojanje poremećaja stanja svijesti (Glazgov koma skalom), postojanje hipertenzivne bolesti (oftalmoskopski pregled), poremećaj glikoregulacije (dnevni profil glikemije). Utvrđivan je stepen zloupotrebe alkohola, množenjem dnevne količine popijenog alkohola sa stažom zloupotrebe. Nakon završetka liječenja ponovo je utvrđivan stepen neurološkog i funkcionalnog deficita i stepen poremećaja stanja svijesti. Potvrda subarahnoidalne ili intracerebralne hemoragije je vršena pomoću pregleda mozga komjuterizovanom tomografijom unutar prvih 48 sati od ispoljavanja kliničke fenomenologije. Rezultati ispitivanja su analizirani primjenom parametrijskih statističkih metoda (studentov t-test), odnosno biserijalnom korelacijom i linearnom regresionom analizom. U nastanku i razvoju sindroma intrakranijalne hemoragije, (SAH i IH), veliki značaj imaju faktori rizika, odnosno udružena oboljenja. Među ovim faktorima rizika vodeće mjesto pripada arterijskoj hipertenziju. Zloupotreba alkohola sa druge strane predstavlja najznačajniji nepovoljni prediktivni pokazatelj lošeg ishoda ovog sindroma. Udruženost više faktora rizika predstavlja višestruko i nelinearno povećanje rizika najtežih ishoda IH. Zaključno se može reći da jasno definisana patogenetska povezanost faktora rizika i IH sa jedne, odnosno poznavanje ključnih patofizioloških procesa tokom ovog sindroma sa druge strane daju nove činjenice za formiranje višeznačnog preventivnog terapijskog programa ovog ozbiljnog kliničkog entiteta. Ključne reči: intracerebralna hemoragija, učestalost, faktori rizika _____________________________________________________________ ABSTRACT The intracranial haemorrhage syndrome encompasses several clinical entities, of which subarahnoid and intracerebral haemorrhage (SAH and ICH) are the most important with respect to their incidence and importance of prompt recognition and initiation of therapy. The aim of the study was to determine, i.e. confirm the role and importance of risk factors -associated disorders with respect to the outcome and prognosis. The study included 50 patients with ICH, treated conservatively in our hospital. All the patients underwent examinations for the grade of neurological and functional deficit (the Canadian Neurological Scale and the Barthel Index), impairment of consciousness (the Glasgow Coma Score), presence of hypertension (ophtalmoscopy), glycoregulation disturbance (daily glycemia profile), and alcohol habits (daily alcohol intake multiplied by length of alcohol consumption). After the treatment, the assessments of neurological and functional deficits, and impairment of consciousness were repeated. SAH and ICH were confirmed using computer tomography within the first 48 hours after the clinical presentation. Study results were analyzed using parametric statistical methods, and the biserial correlation and linear regression analysis. Risk factors, i.e. associated diseases play an important role in the genesis and development of intracranial haemorrhage. Hypertension is the most readily recognized 1 Vojnomedicinska akademija, Beograd, Institut za radiologiju 2 Vojnomedicinska akademija Beograd, Klinika za neurologiju, Klinika za anesteziologiju i intenzivnu terapiju 3 Vojnomedicinska akademija, Beograd, Klinika za kardiologiju, 4 Vojnomedicinska akademija, Beograd, Klinika za oftalmologiju
Vojnosanitetski pregled. Military-medical and pharmaceutical review
Septic encephalopathy (SE) is a common term indicating the development of signs of progressing ce... more Septic encephalopathy (SE) is a common term indicating the development of signs of progressing cerebral dysfunction and is associated with the presence of microorganisms and their toxins in the blood. Aim of this investigation was to analyze the frequency of this complication considering the consciousness disorders in quantitative sense and prognosis of the survival in patients with SE. The investigation comprised patients (n = 54) with positive hemoculture and signs of septic syndrome by the accepted criteria (fever, clinical signs of infection, respiratory frequency, heart rate, plasma lactate, oliguria). Patients with confirmed cerebral injury, hemorrhage or cerebral ischemia were excluded from the study. Lumbar punction and CT-scan of the brain were performed in all patients in order to exclude visible lesions of cerebral parenchyma and eventual presence of cerebral nervous system (CNS) infection as the causes of sepsis. Results of the investigation demonstrated that in 30 (55%)...
Acta chirurgica iugoslavica
During the general reaction to trauma, acute phase proteins are synthetized. The aim of the prosp... more During the general reaction to trauma, acute phase proteins are synthetized. The aim of the prospective study was to determine CRP concentrations in sera of war casualties during the first 14 posttraumatic days, and to establish the correlation between these changes and severity of trauma. Subjects were 79 war casualties. Controls: 33 blood donors. METHODS: Injury severity was determined according to ISS and CRP concentrations with immunonephelometric analysis. Blood samples were collected 12 hours after trauma, then on the 1st, 2nd, 5th and 14th posttraumatic day. In war casualties CRP values were significantly increased (56.257.53 mg/dl after 12 hrs, 107.0976.08 on 1st, 144.3570.23 on 2nd, 71.42558.66 on 5th and 37.656.14 on 14th posttraumatic day; p). Significant differences were observed between groups with ISS and ISS12 (p) in first two days and later between group with ISS24 (144.1766.94 mg/dl on 5th and 111.588.5 on 14th posttraumatic day) and others (p). CONCLUSIONS: During ...
Vojnosanitetski pregled. Military-medical and pharmaceutical review
Vojnosanitetski pregled. Military-medical and pharmaceutical review
Exertional heat stress is a common problem in military services. The aim of this study was to exe... more Exertional heat stress is a common problem in military services. The aim of this study was to exemine changes in body water and serum concentrations of some electrolites in soldiers during exertional heat stress (EHST), as well as effects of 10-day passive or active acclimation in a climatic chamber. Forty male soldiers with high aerobic capacity, performed EHST either in cool (20 degrees C, 16 degrees C WBGT-wet bulb globe temperature), or hot (40 degrees C, 25 degrees C WBGT) environment, unacclimatized, or after 10 days of passive or active acclimation. The subjects were allowed to drink tap water ad libitum during EHST. Mean skin (Tsk) and tympanic (Tty) temperatures and heart rates (HR) measured physiological strain, while sweat rate (SwR), and serum concentrations of sodium, potassium and osmolality measured changes in water and electrolite status. Blood samples were collected before and immediately after the EHST. Exertional heat stress in hot conditions induced physiological...
General Physiology and Biophysics
Arterial base deficit/excess (BD/E) is commonly used marker of metabolic acidosis in critically i... more Arterial base deficit/excess (BD/E) is commonly used marker of metabolic acidosis in critically ill patients, but requires an arterial puncture and blood gas analysis. We hypothesized that serum bicarbonate (HCO3), which can be routinely obtained, strongly correlates with arterial BD/E and provides equivalent predictive information. In addition, we evaluated predictive value of simplified acute physiology score III (SAPS III). Total of 152 critically ill surgical patients were included in retrospective analysis. On admission to intensive care unit sets of simultaneously obtained paired laboratory data, including an arterial blood gas and serum chemistry panel with serum HCO3 were obtained. Very strong correlation between BD/E and simultaneously measured serum HCO3 levels was found (r = 0.857, R(2) = 0.732, p < 0.01). The serum HCO3 level reliably identified a significant metabolic acidosis (AUC = 0.761, p < 0.05). BD and SAPS III were good predictors of mortality (AUCs 0.70 an...
Scientific research and essays
The basic aim of this work was to examine possibilities for introducing a new biotechnological tr... more The basic aim of this work was to examine possibilities for introducing a new biotechnological treatment for preparation, storage and further purifying the suspension of leukocytes ("buffy coat" (BC)), intended for production of human interferon-alpha (hIFN-α α α α) and human interferon-gamma (hIFN-γ γ γ γ). Three hundred and eighty four units of BC were examined. They were divided into three series of 128 BC units each -one control series (KSBC) and two experimental series to which 10% dextran solution (ESBC-I) or 6% hydroxyethyl starch solution (ESBC-II) were added. The lowest titer (297929 IU) of hIFN-α α α α ensued from KSBC, a higher titer from ESBC-I (317184 IU) and the highest titer from ESBC-II (364406 IU). We also found that the lowest hIFN-γ γ γ γ titer was produced from KSBC (48142 IU), a somewhat larger one from ESBC-I (67571 IU), and the highest titer was obtained from ESBC-II (73428. IU). This study has demonstrated the positive influence of modified biotechn...
Vojnosanitetski pregled. Military-medical and pharmaceutical review
Exertional heat stress is a common problem in military services. Considering the coagulation abno... more Exertional heat stress is a common problem in military services. Considering the coagulation abnormalities are of major importance in development of severe heat stroke, we wanted to examine changes in hemostatic parameters in soldiers during exertional heat stress test as well as the effects of a 10-day passive or active acclimatization in a climatic chamber. A total of 40 male soldiers with high aerobic capacity performed exertional heat stress test (EHST) either in cool [20 degrees C, 16 degrees C wet bulb globe temperature (WBGT)], or hot (40 degrees C, 29 degrees C, (WBGT) environment, unacclimatized (U) or after 10 days of passive (P) or active (A) acclimatization. Physiological strain was measured by tympanic temperatures (Tty) and heart rates (HR). Platelet count (PC), antithrombin III (AT), and prothrombin time (PT) were assessed in blood samples collected before and immediately after the EHST. EHST in hot conditions induced physiological heat stress (increase in Tty and HR)...
Vojnosanitetski pregled. Military-medical and pharmaceutical review
Vojnosanitetski pregled, 2015
Vojnosanitetski pregled, 2007
Vojnomedicinska akademija, *Sektor za preventivnu medicinu, § Klinika za anesteziologiju i intenz... more Vojnomedicinska akademija, *Sektor za preventivnu medicinu, § Klinika za anesteziologiju i intenzivnu terapiju, Beograd, Srbija; † Institut za medicinska istraživanja, Beograd, Srbija; Vojska Crne Gore, ‡ Vazduhoplovna baza, Podgorica, Crna Gora Apstrakt Uvod/Cilj. Toplotni stres usled fizičkog napora predstavlja čest problem u vojnoj službi. Cilj ovog rada bio je da se ispita promena bilansa vode i pojedinih elektrolita u serumu vojnika izloženih toplotnom stresu usled fizičkog napora, kao i uticaj desetodnevne pasivne, odnosno aktivne aklimatizacije na tu promenu. Metode. Četrdeset vojnika muškog pola, visoke aerobne sposobnosti, bilo je izloženo fizičkom naporu submaksimalnog intenziteta u termoneutralnoj (20 ºC, 16 ºC WBGT) ili toploj sredini (40 ºC, 25 ºC WBGT), i to neaklimatizovani, ili nakon desetodnevne pasivne ili aktivne aklimatizacije u klimatskoj komori. Unos vode u toku testa bio je ad libitum. Kao pokazatelji fiziološkog opterećenja u toplotnom stresu usled fizičkog napora određivane su: srednja kožna (Tsk) i timpanična (Tty) temperatura, frekvencija srčanog rada, a od pokazatelja vodenoelektrolitskog statusa: intenzitet znojenja (SwR), serumske koncentracije natrijuma, kalijuma i osmolalnost. Uzorci krvi uzimani su pre i odmah nakon testa. Rezultati. Fizički napor u toploj sredini izazvao je fiziološki odgovor na toplotni stres (povećanje Tty, srčane frekvencije i intenziteta znojenja), uz značajno sniženje koncentracije natrijuma (sa 140,6±1,52 na 138,5±1,0 mmol/l, p < 0,01) i osmolalnosti (sa 280,7±3,8 na 277,5±2,6 mOsm/kg, p < 0,05) u neaklimatizovanoj grupi. Aklimatizovani ispitanici nisu pokazali značajne promene ispitivanih parametara, uprkos sličnom intenzitetu toplotnog opterećenja, merenog preko povećanja timpanične temperature, frekvencije srčanog rada i intenziteta znojenja. Zaključak. Desetodnevna pasivna ili aktivna aklimatizacija u veštačkim uslovima, kod utreniranih vojnika dovodi do ublažavanja vodeno-elektrolitskog disbalansa (naročito sniženja serumske koncentracije natrijuma i osmolalnosti) kao posledice toplotnog stresa usled fizičkog napora. Ključne reči: aklimatizacija; vojnici; napor, fizički; voda-elektroliti, balans; toplota.
Military medicine, 2007
The aim of this study was to assess the prognostic value of tumor necrosis factor (TNF) alpha, in... more The aim of this study was to assess the prognostic value of tumor necrosis factor (TNF) alpha, interleukin (IL)-8, IL-4, and IL-10 in combat casualties. Fifty-six casualties with severe trauma (blast and explosive) who developed sepsis and 20 casualties with the same severity of trauma without sepsis were enrolled in this study. Fifty-five casualties developed multiple organ dysfunction syndrome; 36 died. Blood was drawn on the first day of trauma. Concentrations of IL-8, TNF-alpha, IL-4, and IL-10 were determined in plasma using enzyme-linked immunosorbent assays. Mean values of IL-8 were 230-fold, IL-10 were 42-fold, and TNF-alpha were 17-fold higher in trauma and sepsis group (p < 0.01). Mean values of IL-8 were 60-fold, TNF-alpha were 43.5-fold, and IL-10 were 70-fold higher in the multiple organ dysfunction syndrome group (p < 0.01). Mean values of IL-8 were 2.3-fold and IL-10 were 1.4-fold higher in nonsurvivors and TNF-alpha were 2.2-fold higher in survivors (p < 0.0...
Military medicine, 2007
This study investigates the effects of exertional heat stress and acclimation status on physiolog... more This study investigates the effects of exertional heat stress and acclimation status on physiological and cognitive performance. Forty male soldiers performed an exertional heat stress test (EHST) either in a cool (20 degrees C, 16 degrees C wet bulb globe temperature), or in a hot environment (40 degrees C, 29 degrees C wet bulb globe temperature), unacclimatized, or after 10 days of passive or active acclimation. Mean skin and tympanic (Tty) temperatures and heart rates (HR) measured physiological strain. A cognitive test (the computerized Cambridge Neuropsychological Test Automated Batteries attention battery) is administered before and immediately after EHST. EHST in hot conditions induced physiological heat stress (increase in Tty and HR), which caused mild deficits in attention in U group (decreased number of correct responses, and prolonged movement time). Acclimated (passive and active) soldiers suffered no detrimental effects of exertional heat stress, despite almost the sa...
Vojnosanitetski pregled. Military-medical and pharmaceutical review
Severe sepsis and trauma complicated with multiple organ dysfunction syndrome (MODS) are among th... more Severe sepsis and trauma complicated with multiple organ dysfunction syndrome (MODS) are among the leading causes of death in intensive therapy units, with mortality rate exceeding 50%. The outcome is not determined only by infection or trauma, but also by the intensity of immuno-inflammatory response, which is essential for host defence, but if uncontrolled leads to MODS. Pro-inflammatory cytokines (tumor necrosis factor-alpha--TNF-alpha, IL-1, IL-8, IL-12, IFN-gamma, etc.) represent a part of this immuno-inflammatory response to an insult. The results of the clinical investigation of correlation between pro-inflammatory cytokines (IL-8, IL-12, TNF-alpha, IFN-gamma), the outcome (survivors, non-survivors), and the severity (systemic inflammatory response syndrome--SIRS--less severe, and MODS--more severe) in polytraumatised patients with sepsis are presented in this paper. Mean values of IL-8 were 1.3-fold higher in non-survivors (p<0.05), and 60-fold higher in MODS group (p<...
Srpski arhiv za celokupno lekarstvo, 2011
Vojnosanitetski pregled, 2009
Vojnomedicinska akademija, *Zavod za preventivnu medicinu, † Klinika za nefrologiju, ‡ Klinika za... more Vojnomedicinska akademija, *Zavod za preventivnu medicinu, † Klinika za nefrologiju, ‡ Klinika za anesteziologiju i intenzivnu terapiju, § Klinika za očne bolesti, Beograd, Srbija;
The Scientific World Journal, 2013
Critically ill patients suffer a high rate of nosocomial infection with secondary sepsis being a ... more Critically ill patients suffer a high rate of nosocomial infection with secondary sepsis being a common cause of death. Usage of antibiotics and catecholamines is often necessary, but it can compromise complex immune response to infection. This review explores influence of these life-saving drugs on host immune response to severe infection.
Critical Care Medicine
OBJECTIVES: To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of... more OBJECTIVES: To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. DESIGN: A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and therapeutic data were collected. Patients were grouped as having Candida, Gram-positive, Gram-negative, and combined Candida/bacterial bloodstream infection. Outcome data were assessed at intensive care unit and hospital discharge. SETTING: EPIC II included 1265 intensive care units in 76 countries. PATIENTS: Patients in participating intensive care units on study day. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Of the 14,414 patients in EPIC II, 99 patients had Candida bloodstream infections for a prevalence of 6.9 per 1000 patients. Sixty-one patients had candidemia alone and 38 patients had combined bloodstrea...
The Lancet, 2012
Background Clinical outcomes after major surgery are poorly described at the national level. Evid... more Background Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfi rmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe.
Vojnosanitetski pregled. Military-medical and pharmaceutical review
SAŽETAK Sindrom intrakranijalne hemoragije obuhvata više kliničkih entiteta, među kojima se po zn... more SAŽETAK Sindrom intrakranijalne hemoragije obuhvata više kliničkih entiteta, među kojima se po značaju, učestalosti i potrebi brzog prepoznavanja i terapijskog reagovanja izdvajaju subarahnoidalna i intracerebralna hemoragija (SAH i IH). Cilj našeg istraživanja je bio da potvrdimo, odnosno utvrdimo ulogu, značaj i mjesto faktora rizika-udruženih oboljenja u odnosu na ishod i prognozu IH. Ispitivanjem je obuhvaćeno 50 bolesnika sa intracerebralnom hemoragijom koji su liječeni konzervativnim tretmanom na Klinici za neurologiju, Klinici za anesteziologiju i intenzivnu terapiju i Klinici za urgentnu internu medicinu naše ustanove. Svim bolesnicima je utvrđivan stepen neurološkog i funkcionalnog deficita (Kanadska neurološka skala, odnosno Bartelov indeks funkcionalne sposobnosti), postojanje poremećaja stanja svijesti (Glazgov koma skalom), postojanje hipertenzivne bolesti (oftalmoskopski pregled), poremećaj glikoregulacije (dnevni profil glikemije). Utvrđivan je stepen zloupotrebe alkohola, množenjem dnevne količine popijenog alkohola sa stažom zloupotrebe. Nakon završetka liječenja ponovo je utvrđivan stepen neurološkog i funkcionalnog deficita i stepen poremećaja stanja svijesti. Potvrda subarahnoidalne ili intracerebralne hemoragije je vršena pomoću pregleda mozga komjuterizovanom tomografijom unutar prvih 48 sati od ispoljavanja kliničke fenomenologije. Rezultati ispitivanja su analizirani primjenom parametrijskih statističkih metoda (studentov t-test), odnosno biserijalnom korelacijom i linearnom regresionom analizom. U nastanku i razvoju sindroma intrakranijalne hemoragije, (SAH i IH), veliki značaj imaju faktori rizika, odnosno udružena oboljenja. Među ovim faktorima rizika vodeće mjesto pripada arterijskoj hipertenziju. Zloupotreba alkohola sa druge strane predstavlja najznačajniji nepovoljni prediktivni pokazatelj lošeg ishoda ovog sindroma. Udruženost više faktora rizika predstavlja višestruko i nelinearno povećanje rizika najtežih ishoda IH. Zaključno se može reći da jasno definisana patogenetska povezanost faktora rizika i IH sa jedne, odnosno poznavanje ključnih patofizioloških procesa tokom ovog sindroma sa druge strane daju nove činjenice za formiranje višeznačnog preventivnog terapijskog programa ovog ozbiljnog kliničkog entiteta. Ključne reči: intracerebralna hemoragija, učestalost, faktori rizika _____________________________________________________________ ABSTRACT The intracranial haemorrhage syndrome encompasses several clinical entities, of which subarahnoid and intracerebral haemorrhage (SAH and ICH) are the most important with respect to their incidence and importance of prompt recognition and initiation of therapy. The aim of the study was to determine, i.e. confirm the role and importance of risk factors -associated disorders with respect to the outcome and prognosis. The study included 50 patients with ICH, treated conservatively in our hospital. All the patients underwent examinations for the grade of neurological and functional deficit (the Canadian Neurological Scale and the Barthel Index), impairment of consciousness (the Glasgow Coma Score), presence of hypertension (ophtalmoscopy), glycoregulation disturbance (daily glycemia profile), and alcohol habits (daily alcohol intake multiplied by length of alcohol consumption). After the treatment, the assessments of neurological and functional deficits, and impairment of consciousness were repeated. SAH and ICH were confirmed using computer tomography within the first 48 hours after the clinical presentation. Study results were analyzed using parametric statistical methods, and the biserial correlation and linear regression analysis. Risk factors, i.e. associated diseases play an important role in the genesis and development of intracranial haemorrhage. Hypertension is the most readily recognized 1 Vojnomedicinska akademija, Beograd, Institut za radiologiju 2 Vojnomedicinska akademija Beograd, Klinika za neurologiju, Klinika za anesteziologiju i intenzivnu terapiju 3 Vojnomedicinska akademija, Beograd, Klinika za kardiologiju, 4 Vojnomedicinska akademija, Beograd, Klinika za oftalmologiju
Vojnosanitetski pregled. Military-medical and pharmaceutical review
Septic encephalopathy (SE) is a common term indicating the development of signs of progressing ce... more Septic encephalopathy (SE) is a common term indicating the development of signs of progressing cerebral dysfunction and is associated with the presence of microorganisms and their toxins in the blood. Aim of this investigation was to analyze the frequency of this complication considering the consciousness disorders in quantitative sense and prognosis of the survival in patients with SE. The investigation comprised patients (n = 54) with positive hemoculture and signs of septic syndrome by the accepted criteria (fever, clinical signs of infection, respiratory frequency, heart rate, plasma lactate, oliguria). Patients with confirmed cerebral injury, hemorrhage or cerebral ischemia were excluded from the study. Lumbar punction and CT-scan of the brain were performed in all patients in order to exclude visible lesions of cerebral parenchyma and eventual presence of cerebral nervous system (CNS) infection as the causes of sepsis. Results of the investigation demonstrated that in 30 (55%)...
Acta chirurgica iugoslavica
During the general reaction to trauma, acute phase proteins are synthetized. The aim of the prosp... more During the general reaction to trauma, acute phase proteins are synthetized. The aim of the prospective study was to determine CRP concentrations in sera of war casualties during the first 14 posttraumatic days, and to establish the correlation between these changes and severity of trauma. Subjects were 79 war casualties. Controls: 33 blood donors. METHODS: Injury severity was determined according to ISS and CRP concentrations with immunonephelometric analysis. Blood samples were collected 12 hours after trauma, then on the 1st, 2nd, 5th and 14th posttraumatic day. In war casualties CRP values were significantly increased (56.257.53 mg/dl after 12 hrs, 107.0976.08 on 1st, 144.3570.23 on 2nd, 71.42558.66 on 5th and 37.656.14 on 14th posttraumatic day; p). Significant differences were observed between groups with ISS and ISS12 (p) in first two days and later between group with ISS24 (144.1766.94 mg/dl on 5th and 111.588.5 on 14th posttraumatic day) and others (p). CONCLUSIONS: During ...
Vojnosanitetski pregled. Military-medical and pharmaceutical review
Vojnosanitetski pregled. Military-medical and pharmaceutical review
Exertional heat stress is a common problem in military services. The aim of this study was to exe... more Exertional heat stress is a common problem in military services. The aim of this study was to exemine changes in body water and serum concentrations of some electrolites in soldiers during exertional heat stress (EHST), as well as effects of 10-day passive or active acclimation in a climatic chamber. Forty male soldiers with high aerobic capacity, performed EHST either in cool (20 degrees C, 16 degrees C WBGT-wet bulb globe temperature), or hot (40 degrees C, 25 degrees C WBGT) environment, unacclimatized, or after 10 days of passive or active acclimation. The subjects were allowed to drink tap water ad libitum during EHST. Mean skin (Tsk) and tympanic (Tty) temperatures and heart rates (HR) measured physiological strain, while sweat rate (SwR), and serum concentrations of sodium, potassium and osmolality measured changes in water and electrolite status. Blood samples were collected before and immediately after the EHST. Exertional heat stress in hot conditions induced physiological...
General Physiology and Biophysics
Arterial base deficit/excess (BD/E) is commonly used marker of metabolic acidosis in critically i... more Arterial base deficit/excess (BD/E) is commonly used marker of metabolic acidosis in critically ill patients, but requires an arterial puncture and blood gas analysis. We hypothesized that serum bicarbonate (HCO3), which can be routinely obtained, strongly correlates with arterial BD/E and provides equivalent predictive information. In addition, we evaluated predictive value of simplified acute physiology score III (SAPS III). Total of 152 critically ill surgical patients were included in retrospective analysis. On admission to intensive care unit sets of simultaneously obtained paired laboratory data, including an arterial blood gas and serum chemistry panel with serum HCO3 were obtained. Very strong correlation between BD/E and simultaneously measured serum HCO3 levels was found (r = 0.857, R(2) = 0.732, p < 0.01). The serum HCO3 level reliably identified a significant metabolic acidosis (AUC = 0.761, p < 0.05). BD and SAPS III were good predictors of mortality (AUCs 0.70 an...
Scientific research and essays
The basic aim of this work was to examine possibilities for introducing a new biotechnological tr... more The basic aim of this work was to examine possibilities for introducing a new biotechnological treatment for preparation, storage and further purifying the suspension of leukocytes ("buffy coat" (BC)), intended for production of human interferon-alpha (hIFN-α α α α) and human interferon-gamma (hIFN-γ γ γ γ). Three hundred and eighty four units of BC were examined. They were divided into three series of 128 BC units each -one control series (KSBC) and two experimental series to which 10% dextran solution (ESBC-I) or 6% hydroxyethyl starch solution (ESBC-II) were added. The lowest titer (297929 IU) of hIFN-α α α α ensued from KSBC, a higher titer from ESBC-I (317184 IU) and the highest titer from ESBC-II (364406 IU). We also found that the lowest hIFN-γ γ γ γ titer was produced from KSBC (48142 IU), a somewhat larger one from ESBC-I (67571 IU), and the highest titer was obtained from ESBC-II (73428. IU). This study has demonstrated the positive influence of modified biotechn...
Vojnosanitetski pregled. Military-medical and pharmaceutical review
Exertional heat stress is a common problem in military services. Considering the coagulation abno... more Exertional heat stress is a common problem in military services. Considering the coagulation abnormalities are of major importance in development of severe heat stroke, we wanted to examine changes in hemostatic parameters in soldiers during exertional heat stress test as well as the effects of a 10-day passive or active acclimatization in a climatic chamber. A total of 40 male soldiers with high aerobic capacity performed exertional heat stress test (EHST) either in cool [20 degrees C, 16 degrees C wet bulb globe temperature (WBGT)], or hot (40 degrees C, 29 degrees C, (WBGT) environment, unacclimatized (U) or after 10 days of passive (P) or active (A) acclimatization. Physiological strain was measured by tympanic temperatures (Tty) and heart rates (HR). Platelet count (PC), antithrombin III (AT), and prothrombin time (PT) were assessed in blood samples collected before and immediately after the EHST. EHST in hot conditions induced physiological heat stress (increase in Tty and HR)...
Vojnosanitetski pregled. Military-medical and pharmaceutical review
Vojnosanitetski pregled, 2015
Vojnosanitetski pregled, 2007
Vojnomedicinska akademija, *Sektor za preventivnu medicinu, § Klinika za anesteziologiju i intenz... more Vojnomedicinska akademija, *Sektor za preventivnu medicinu, § Klinika za anesteziologiju i intenzivnu terapiju, Beograd, Srbija; † Institut za medicinska istraživanja, Beograd, Srbija; Vojska Crne Gore, ‡ Vazduhoplovna baza, Podgorica, Crna Gora Apstrakt Uvod/Cilj. Toplotni stres usled fizičkog napora predstavlja čest problem u vojnoj službi. Cilj ovog rada bio je da se ispita promena bilansa vode i pojedinih elektrolita u serumu vojnika izloženih toplotnom stresu usled fizičkog napora, kao i uticaj desetodnevne pasivne, odnosno aktivne aklimatizacije na tu promenu. Metode. Četrdeset vojnika muškog pola, visoke aerobne sposobnosti, bilo je izloženo fizičkom naporu submaksimalnog intenziteta u termoneutralnoj (20 ºC, 16 ºC WBGT) ili toploj sredini (40 ºC, 25 ºC WBGT), i to neaklimatizovani, ili nakon desetodnevne pasivne ili aktivne aklimatizacije u klimatskoj komori. Unos vode u toku testa bio je ad libitum. Kao pokazatelji fiziološkog opterećenja u toplotnom stresu usled fizičkog napora određivane su: srednja kožna (Tsk) i timpanična (Tty) temperatura, frekvencija srčanog rada, a od pokazatelja vodenoelektrolitskog statusa: intenzitet znojenja (SwR), serumske koncentracije natrijuma, kalijuma i osmolalnost. Uzorci krvi uzimani su pre i odmah nakon testa. Rezultati. Fizički napor u toploj sredini izazvao je fiziološki odgovor na toplotni stres (povećanje Tty, srčane frekvencije i intenziteta znojenja), uz značajno sniženje koncentracije natrijuma (sa 140,6±1,52 na 138,5±1,0 mmol/l, p < 0,01) i osmolalnosti (sa 280,7±3,8 na 277,5±2,6 mOsm/kg, p < 0,05) u neaklimatizovanoj grupi. Aklimatizovani ispitanici nisu pokazali značajne promene ispitivanih parametara, uprkos sličnom intenzitetu toplotnog opterećenja, merenog preko povećanja timpanične temperature, frekvencije srčanog rada i intenziteta znojenja. Zaključak. Desetodnevna pasivna ili aktivna aklimatizacija u veštačkim uslovima, kod utreniranih vojnika dovodi do ublažavanja vodeno-elektrolitskog disbalansa (naročito sniženja serumske koncentracije natrijuma i osmolalnosti) kao posledice toplotnog stresa usled fizičkog napora. Ključne reči: aklimatizacija; vojnici; napor, fizički; voda-elektroliti, balans; toplota.
Military medicine, 2007
The aim of this study was to assess the prognostic value of tumor necrosis factor (TNF) alpha, in... more The aim of this study was to assess the prognostic value of tumor necrosis factor (TNF) alpha, interleukin (IL)-8, IL-4, and IL-10 in combat casualties. Fifty-six casualties with severe trauma (blast and explosive) who developed sepsis and 20 casualties with the same severity of trauma without sepsis were enrolled in this study. Fifty-five casualties developed multiple organ dysfunction syndrome; 36 died. Blood was drawn on the first day of trauma. Concentrations of IL-8, TNF-alpha, IL-4, and IL-10 were determined in plasma using enzyme-linked immunosorbent assays. Mean values of IL-8 were 230-fold, IL-10 were 42-fold, and TNF-alpha were 17-fold higher in trauma and sepsis group (p < 0.01). Mean values of IL-8 were 60-fold, TNF-alpha were 43.5-fold, and IL-10 were 70-fold higher in the multiple organ dysfunction syndrome group (p < 0.01). Mean values of IL-8 were 2.3-fold and IL-10 were 1.4-fold higher in nonsurvivors and TNF-alpha were 2.2-fold higher in survivors (p < 0.0...
Military medicine, 2007
This study investigates the effects of exertional heat stress and acclimation status on physiolog... more This study investigates the effects of exertional heat stress and acclimation status on physiological and cognitive performance. Forty male soldiers performed an exertional heat stress test (EHST) either in a cool (20 degrees C, 16 degrees C wet bulb globe temperature), or in a hot environment (40 degrees C, 29 degrees C wet bulb globe temperature), unacclimatized, or after 10 days of passive or active acclimation. Mean skin and tympanic (Tty) temperatures and heart rates (HR) measured physiological strain. A cognitive test (the computerized Cambridge Neuropsychological Test Automated Batteries attention battery) is administered before and immediately after EHST. EHST in hot conditions induced physiological heat stress (increase in Tty and HR), which caused mild deficits in attention in U group (decreased number of correct responses, and prolonged movement time). Acclimated (passive and active) soldiers suffered no detrimental effects of exertional heat stress, despite almost the sa...
Vojnosanitetski pregled. Military-medical and pharmaceutical review
Severe sepsis and trauma complicated with multiple organ dysfunction syndrome (MODS) are among th... more Severe sepsis and trauma complicated with multiple organ dysfunction syndrome (MODS) are among the leading causes of death in intensive therapy units, with mortality rate exceeding 50%. The outcome is not determined only by infection or trauma, but also by the intensity of immuno-inflammatory response, which is essential for host defence, but if uncontrolled leads to MODS. Pro-inflammatory cytokines (tumor necrosis factor-alpha--TNF-alpha, IL-1, IL-8, IL-12, IFN-gamma, etc.) represent a part of this immuno-inflammatory response to an insult. The results of the clinical investigation of correlation between pro-inflammatory cytokines (IL-8, IL-12, TNF-alpha, IFN-gamma), the outcome (survivors, non-survivors), and the severity (systemic inflammatory response syndrome--SIRS--less severe, and MODS--more severe) in polytraumatised patients with sepsis are presented in this paper. Mean values of IL-8 were 1.3-fold higher in non-survivors (p<0.05), and 60-fold higher in MODS group (p<...
Srpski arhiv za celokupno lekarstvo, 2011
Vojnosanitetski pregled, 2009
Vojnomedicinska akademija, *Zavod za preventivnu medicinu, † Klinika za nefrologiju, ‡ Klinika za... more Vojnomedicinska akademija, *Zavod za preventivnu medicinu, † Klinika za nefrologiju, ‡ Klinika za anesteziologiju i intenzivnu terapiju, § Klinika za očne bolesti, Beograd, Srbija;
The Scientific World Journal, 2013
Critically ill patients suffer a high rate of nosocomial infection with secondary sepsis being a ... more Critically ill patients suffer a high rate of nosocomial infection with secondary sepsis being a common cause of death. Usage of antibiotics and catecholamines is often necessary, but it can compromise complex immune response to infection. This review explores influence of these life-saving drugs on host immune response to severe infection.