Miodrag Golubović - Academia.edu (original) (raw)

Papers by Miodrag Golubović

Srpski Arhiv Za Celokupno Lekarstvo, 2023

Introduction/Objective Nursing Activities Score (NAS) is one of the most accepted and widely used... more Introduction/Objective Nursing Activities Score (NAS) is one of the most accepted and widely used scores for assessing the workload of the nursing staff in regards of qualitative and quantitative adequacy. The aim of this study was to evaluate and analyze nursing workload in the cardiac surgery intensive care unit (CSICU) using the NAS in a contemporary set of patients undergoing heart surgery. Methods The study included 809 consecutive patients who had a major cardiac surgery in 2019 admitted to adult CSICU. Demographic data were collected from medical records [sex, age, type of treatment, length of stay (LOS), and discharge], EuroSCORE II, and NAS value. Results The majority of patients underwent a coronary (43.1%), valvular (32.6%), and combined (24.2%) cardiac surgery procedure. The average patient LOS in CSICU was 2.5 ± 3.4 days. The average NAS value in our sample was 100.8% ± 63.1%. NAS value during the first operative day was a poor marker of the outcome in terms of mortality (C-index 0.520, 95% CI-0.422-0.617, p = 0.676). Significant difference was observed in terms of average NAS value between the patients submitted to coronary surgery and combined surgery (p = 0.001). NAS has been shown to be useful for assessing activity in a CSICU, confirming the optimal workload of nurses, while higher NAS values in our hospital indicate increased workload compared to similar institutions. Conclusion NAS provided viable information regarding the care and hospitalization of patients in a CSICU. In accordance with NAS, the optimal level of nursing workload was established in our hospital settings.

Research Square (Research Square), Dec 11, 2020

Background: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disease... more Background: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disease that affects approximately one in 500 people. HCM is a recognized genetic disorder most often caused by mutations involving myosin-binding protein C (MYBPC3) and β-myosin heavy chain (MYH7) which are responsible for approximately three-quarters of the identi ed mutations. Methods: As a part of the international multidisciplinary SILICOFCM project (www.silicofcm.eu) the present study evaluated the association between underlying genetic mutations and clinical phenotype in patients with HCM. Only patients with con rmed single pathogenic mutations in either MYBPC3 or MYH7 genes were included in the study and divided into two groups accordingly. The MYBPC3 group was comprised of 48 patients (76%), while the MYH7 group included 15 patients (24%). Each patient underwent clinical examination and echocardiography. Results: The most prevalent symptom in patients with MYBPC3 was dyspnea (44%), whereas in patients with MYH7 it was palpitations (33%). The MYBPC3 group had a signi cantly higher number of patients with a positive family history of HCM (46% vs. 7%; p=0.014). There was a numerically higher prevalence of atrial brillation in the MYH7 group (60% vs. 35%, p=0.085). Laboratory analyses revealed normal levels of creatinine (85.5±18.3 vs. 81.3±16.4 µmol/l; p=0.487) and blood urea nitrogen (10.2±15.6 vs. 6.9±3.9 mmol/l; p=0.472) which were similar in both groups. The systolic anterior motion presence was signi cantly more frequent in patients carrying MYH7 mutation (33% vs. 10%; p=0.025), as well as mitral lea et abnormalities (40% vs. 19%; p=0.039). Calci cations of mitral annulus were registered only in MYH7 patients (20% vs. 0%; p=0.001). The difference in diastolic function, i.e. E/e' ratio between the two groups was also noted (MYBPC3 8.8±3.3, MYH7 13.9±6.9, p=0.079). Conclusions: Major ndings of the present study corroborate the notion that MYH7 gene mutation patients are presented with more pronounced disease severity than those with MYBPC3.

Research Square (Research Square), Aug 18, 2020

Background: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disease... more Background: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disease that affects approximately one in 500 people. HCM is a recognized genetic disorder most often caused by mutations involving myosin-binding protein C (MYBPC3) and β-myosin heavy chain (MYH7) which are responsible for approximately three-quarters of the identi ed mutations. Methods: As a part of the international multidisciplinary SILICOFCM project (www.silicofcm.eu) the present study evaluated the association between underlying genetic mutations and clinical phenotype in patients with HCM. Only patients with con rmed single pathogenic mutations in either MYBPC3 or MYH7 genes were included in the study and divided into two groups accordingly. The MYBPC3 group was comprised of 48 patients (76%), while the MYH7 group included 15 patients (24%). Each patient underwent clinical examination and echocardiography. Results: The most prevalent symptom in patients with MYBPC3 was dyspnea (44%), whereas in patients with MYH7 it was palpitations (33%). The MYBPC3 group had a signi cantly higher number of patients with a positive family history of HCM (46% vs. 7%; p=0.014). There was a numerically higher prevalence of atrial brillation in the MYH7 group (60% vs. 35%, p=0.085). Laboratory analyses revealed normal levels of creatinine (85.5±18.3 vs. 81.3±16.4 µmol/l; p=0.487) and blood urea nitrogen (10.2±15.6 vs. 6.9±3.9 mmol/l; p=0.472) which were similar in both groups. The systolic anterior motion presence was signi cantly more frequent in patients caring MYH7 mutation (33% vs. 10%; p=0.025), as well as mitral lea et abnormalities (40% vs. 19%; p=0.039). Calci cations of mitral annulus were registered only in MYH7 patients (20% vs. 0%; p=0.001). The difference in diastolic function, i.e. E/e' ratio between the two groups was also noted (MYBPC3 8.8±3.3, MYH7 13.9±6.9, p=0.079). Conclusions: Major ndings of the present study corroborate the notion that MYH7 gene mutation patients are presented with more pronounced disease severity than those with MYBPC3.

Acta Clinica Belgica, Jun 30, 2020

Introduction: Masses inside the heart can cause serious and life-threatening effects to the cardi... more Introduction: Masses inside the heart can cause serious and life-threatening effects to the cardiovascular system, mainly because of hemodynamic obstruction of the blood flow, either in the heart cavities themselves or remotely due to embolization. In this paper, we report a case of left ventricular tumor mass which presented with neurological symptoms due to multiple brain embolism. Case report: A 35-year-old female patient presented with right hemiparesis and dysarthria. Seven days prior to admission she had elevated body temperature and started taking antibiotics. Inflammatory markers were not elevated, and blood cultures were negative. Computerized tomography (CT) and magnetic resonance imaging (MRI) of the brain revealed multiple acute ischemic lesions. Echocardiography showed the presence of a lobular mass inside the left ventricle, which was attached to the basal segment of the lateral left ventricular wall. Based on the laboratory results and additional heart imaging (CT and MRI) the mass was primarily suspected to be a tumor. It was surgically removed. Microscopic analysis of the removed tissue revealed a non-specific endocardial inflammation with formed fresh fibrin thrombi on the surface. During the postoperative recovery intense physical rehabilitation was being performed, so the initial neurological deficit was completely withdrawn. Conclusion: Intracardiac masses can cause serious and potentially fatal complications that often present with dramatic clinical symptoms. Despite the comprehensive clinical, laboratory, and imaging investigations, intracardiac masses can be hard to distinguish until the definite microscopic analysis. However, with the right approach and multidisciplinary collaboration, they can be successfully managed.

Journal of Cardiac Surgery, 2022

Cardiovascular diseases are the leading cause of morbidity and mortality in pregnant women. On th... more Cardiovascular diseases are the leading cause of morbidity and mortality in pregnant women. On the other hand, cardiac surgery is not so common for pregnant women.

Netherlands Heart Journal, 2021

BackgroundAs coronavirus disease 2019 (COVID-19) has reached pandemic status, authors from the mo... more BackgroundAs coronavirus disease 2019 (COVID-19) has reached pandemic status, authors from the most severely affected countries have reported reduced rates of hospital admissions for patients with acute coronary syndrome (ACS).AimThe aim of the present study was to investigate the influence of the COVID-19 outbreak on hospital admissions and outcomes in ACS patients in a single high-volume centre in southeastern Europe.MethodsThis retrospective observational study aimed to investigate the number of hospital admissions for ACS, clinical findings at admission, length of hospitalisation, major complications and in-hospital mortality during the COVID-19 outbreak and to compare the data with the same parameters during an equivalent time frame in 2019. For the ST-elevated myocardial infarction (STEMI) subgroup of patients, changes in ischaemic times were analysed as well.ResultsThere was a significant reduction of 44.3% in the number of patients admitted for ACS during the COVID-19 outbre...

Medical review, 2020

Introduction. Acute kidney injury associated with cardiac surgery is a common and significant pos... more Introduction. Acute kidney injury associated with cardiac surgery is a common and significant postoperative complication. With a frequency of 9 - 39% according to different studies, it is the second most common cause of acute kidney injury in intensive care units, and an independent predictor of mortality. This study aimed to investigate the importance of preoperative hemoglobin and uric acid levels as risk factors for acute kidney injury in the postoperative period in cardiac surgery patients. Material and Methods. The study included a total of 118 patients who were divided into two groups. Each group included 59 patients; the fist group included patients who developed acute kidney injury and required renal replacement therapy, and the second included patients without acute kidney injury. Types of cardiac surgery included coronary, valvular, combined, aortic dissection, and others. All necessary data were collected from patient medical records and the electronic database. Results. ...

We report the case of a 62-year-old male patient, admitted for aortic valve replacement. Bilatera... more We report the case of a 62-year-old male patient, admitted for aortic valve replacement. Bilateral common carotid artery occlusion and bilateral internal carotid artery occlusion have been reported, as well as right vertebral artery occlusion. Aortic valve replacement was performed in the standard fashion using the cardiopulmonary bypass. No neurological deficit was apparent on emergence from anesthesia.

A persistent left superior vena cava is relatively common venous anomaly. But, the presence of pe... more A persistent left superior vena cava is relatively common venous anomaly. But, the presence of persistent left superior vena cava with the atresia of the right superior vena cava is a much rarer situation. The association of these anomalies with the drainage of the left hepatic vein into the right atrium is an extremely rare situation. Here we present one such case in the situs solitus and normocardia.

Vojnosanitetski pregled, 2019

Introduction. Implantation of left ventricular assist device (LVAD) improves survival and quality... more Introduction. Implantation of left ventricular assist device (LVAD) improves survival and quality of life in patients with end-stage heart failure. We reported a case of a severe gastrointestinal bleeding as a life threatening complication in early recovering postoperative period of continuous blood flow LVAD implantation. Case report. The patient had a history of heart failure due to ischemic cardiomyopathy with low systolic function, as an indication for LVAD implantation. The operation and the postoperative course were uneventful. On the 17th postoperative day, the patient developed severe anemia, which was followed by melena with blood clots. Endoscopic examinations revealed diffuse colonic bleeding. Oral anticoagulation therapy was discontinued, and fresh frozen plasma, K vitamin substitution, and human prothrombin complex were administered. The LVAD speed was reduced and subcutaneous administration of somatostatin analog octreotide was initiated. These measures successfully st...

Acta chirurgica Iugoslavica, 2010

Introduction: Despite modern surgical techniques, preoperative preventive use of antibiotics and ... more Introduction: Despite modern surgical techniques, preoperative preventive use of antibiotics and optimal treatment of operative site, surgical site infections (SSI) are significant medical problem in the countries worldwide. Objective: The aim of this paper was to estimate the frequency of SSI after open heart surgery and to identify the most frequent causes of these infections. Material and methods: A prospective cohort study was performed during the period from January 2008 to December 2009 at the Clinic of Cardiovascular Surgery of the Institute of Cardiovascular Diseases, Vojvodina. The surveillance was consistent throughout the study period. During hospitalization, patients were evaluated daily by the infection control nurse. Isolation, identification and sensitivity tests of causative agents to antimicrobial drugs, obtained from patients' material, were carried out by standard microbiological methods. The descriptive epidemiological method was used. The incidence rates of ...

Biomedical Human Kinetics, 2021

Study aim: To asses and compare the aerobic capacity and respiratory parameters in recreational b... more Study aim: To asses and compare the aerobic capacity and respiratory parameters in recreational basketball-engaged university students with age-matched untrained young adults. Material and methods: A total of 30 subjects were selected to took part in the study based on recreational-basketball activity level and were assigned to a basketball (BG: n = 15, age 22.86 ± 1.35 yrs., body height 185.07 ± 5.95 cm, body weight 81.21 ± 6.15 kg) and untrained group (UG: n = 15, age 22.60 ± 1.50 yrs., body height 181.53 ± 6.11 cm, body weight 76.89 ± 7.30 kg). Inspiratory vital capacity (IVC), forced expiration volume (FEV1), FEV1/IVC ratio, maximal oxygen consumption (VO2max), ventilatory threshold (VO2VT) and time to exhaustion, were measured in all subjects. Student T-test for independent Sample and Cohen’s d as the measure of the effect size were calculated. Results: Recreational basketball-engaged students (EG) reached significantly greater IVC (t = 7.240, p < 0.001, d = 1.854), FEV1 (t ...

Medicina, 2022

Background and Objectives: There is emerging evidence of the usefulness of left atrial strain (LA... more Background and Objectives: There is emerging evidence of the usefulness of left atrial strain (LAS) in the assessment of diastolic dysfunction (DD). In this study we assess the sensitivity and specificity of LAS, to determine cut-off values and their association to DD with increased left atrial pressure (LAP) in patients with well-treated arterial hypertension. Materials and Methods: We performed a cross-sectional study on 180 subjects with well-treated arterial hypertension. All patients underwent transthoracic echocardiography. Patients were divided into two groups: a group without increased LAP and/or DD and a group with increased LAP DD. Results: In multivariate logistic regression, LAS proved to be the strongest statistically significant predictor of DD with increased LAP (OR 0.834, p < 0.0005), with AUC 0.885 and a set cut-off value of 24.27% with high sensitivity of 78.9% and specificity of 84.6%. The set cut-off for LAS > 24.27% was significantly highly prevalent in th...

Medicinski pregled, 2013

Introduction: Percutaneous aortic valve implantation is an alternative that offers hope to patien... more Introduction: Percutaneous aortic valve implantation is an alternative that offers hope to patients who are too old or sick to undergo the conventional surgical aortic valve replacement. The aim of this study was to determine the number of high-risk patients with severe aortic stenosis, hospitalized at the Institute for Cardiovascular Diseases, who are the candidates for percutaneous aortic valve implantation. Material and Methods. The paper prospectively analyzed all patients diagnosed to have severe aortic stenosis who had been hospitalized at the Institute for Cardiovascular Diseases from April 1st, 2011 to October 31st, 2012. Each of these patients was analyzed in relation to the inclusive criteria for percutaneous aortic valve implantation. We analyzed the distribution of these risk factors in relation to age and gender, and the presence of aortic valve replacement surgery by age groups. Results. In the period from April 1st, 2011 to October 31st, 2012, 374 patients diagnosed t...

Vojnosanitetski pregled, 2011

Introduction/Aim. The most important clinically relevant cause of global cerebral ischemia is car... more Introduction/Aim. The most important clinically relevant cause of global cerebral ischemia is cardiac arrest. Clinical studies showed a marked neuroprotective effect of mild hypothermia in resuscitation. The aim of this study was to evaluate the impact of mild hypothermia on neurological outcome and survival of the patients in coma, after cardiac arrest and return of spontaneous circulation. Methods. The prospective study was conducted on consecutive comatose patients admitted to our clinic after cardiac arrest and return of spontaneous circulation, between February 2005 and May 2009. The patients were divided into two groups: the patients treated with mild hypothermia and the patients treated conservatively. The intravascular in combination with external method of cooling or only external cooling was used during the first 24 hours, after which spontaneous rewarming started. The endpoints were survival rate and neurological outcome. The neurological outcome was observed with Cerebra...

The study included 329 patients who had undergone isolated myocardial revascularization at the In... more The study included 329 patients who had undergone isolated myocardial revascularization at the Institute of Cardiovascular Diseases of Vojvodina from January 1 st to June 30 th , 2008. The data were collected prospectively and analyzed retrospectively. The patients who had undergone addi

Severe calcification of the ascending aorta (porcelain aorta) is a very difficult condition in ca... more Severe calcification of the ascending aorta (porcelain aorta) is a very difficult condition in cardiac surgery because of a high embolization potential during the process of cannulation, aortic cross-clamping and a particular difficulty to suture the proximal anastomosis. We described a case of a 68-year-old female referred to our Institute due to unstable angina. Further diagnostics revealed a severe high grade, multilevel fibrolipid symptomatic carotid stenosis and ostial left main coronary artery stenosis and a highly calcified ascending aorta and aortic arch. We performed simultaneous carotid segment replacement with the Dacron prosthesis and revascularisation of the left anterior descending coronary artery. Proximal venous anastomosis was created in the Dacron prosthesis of the right carotid artery. Perfusion of the patient was achieved via the graft sutured at the right subclavian artery due to impossibility of direct aortic cannulation.

Srpski Arhiv Za Celokupno Lekarstvo, 2023

Research Square (Research Square), Dec 11, 2020

Research Square (Research Square), Aug 18, 2020

Background: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disease... more Background: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disease that affects approximately one in 500 people. HCM is a recognized genetic disorder most often caused by mutations involving myosin-binding protein C (MYBPC3) and β-myosin heavy chain (MYH7) which are responsible for approximately three-quarters of the identi ed mutations. Methods: As a part of the international multidisciplinary SILICOFCM project (www.silicofcm.eu) the present study evaluated the association between underlying genetic mutations and clinical phenotype in patients with HCM. Only patients with con rmed single pathogenic mutations in either MYBPC3 or MYH7 genes were included in the study and divided into two groups accordingly. The MYBPC3 group was comprised of 48 patients (76%), while the MYH7 group included 15 patients (24%). Each patient underwent clinical examination and echocardiography. Results: The most prevalent symptom in patients with MYBPC3 was dyspnea (44%), whereas in patients with MYH7 it was palpitations (33%). The MYBPC3 group had a signi cantly higher number of patients with a positive family history of HCM (46% vs. 7%; p=0.014). There was a numerically higher prevalence of atrial brillation in the MYH7 group (60% vs. 35%, p=0.085). Laboratory analyses revealed normal levels of creatinine (85.5±18.3 vs. 81.3±16.4 µmol/l; p=0.487) and blood urea nitrogen (10.2±15.6 vs. 6.9±3.9 mmol/l; p=0.472) which were similar in both groups. The systolic anterior motion presence was signi cantly more frequent in patients caring MYH7 mutation (33% vs. 10%; p=0.025), as well as mitral lea et abnormalities (40% vs. 19%; p=0.039). Calci cations of mitral annulus were registered only in MYH7 patients (20% vs. 0%; p=0.001). The difference in diastolic function, i.e. E/e' ratio between the two groups was also noted (MYBPC3 8.8±3.3, MYH7 13.9±6.9, p=0.079). Conclusions: Major ndings of the present study corroborate the notion that MYH7 gene mutation patients are presented with more pronounced disease severity than those with MYBPC3.

Acta Clinica Belgica, Jun 30, 2020

Journal of Cardiac Surgery, 2022

Netherlands Heart Journal, 2021

Medical review, 2020

Vojnosanitetski pregled, 2019

Acta chirurgica Iugoslavica, 2010

Biomedical Human Kinetics, 2021

Medicina, 2022

Medicinski pregled, 2013

Vojnosanitetski pregled, 2011