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Open access

Jelena Petrović, Zoran Milošević and Ivan Petrović

Summary

School curriculum and syllabus of physical education sets in front of the pupils the objectives and tasks that could be, by their nature, both physical and socio-psychological while the level of mastering of the contents is measured with a mark that is seen as the result of efficiency of overall educational process at a certain education level. However, the mark in physical education is a composite of numerous factors, one of which is motivation that can be considered within a school environment as readiness for an active engagement of pupils during classes (contrary to passive and mechanical fulfilment of requirements and acting based on the teachers’ demand, or open and direct obstruction of a class, disturbing of discipline and refusal to actively implement the curriculum). Therefore, it is important to take pupils’ motivation into account in order to fulfilthe sense of physical education classes, remedy the potential shortcomings, and improve additionally the planned syllabus. The Scale for measurement of readiness for active involvement at physical education classes in elementary school has been designed with that aim since early adolescence is considered a critical period for adopting of healthy lifestyles and its metric characteristics have also been tested. The Scale consists of five levels, of Likert’s type and it consists of two sub-scales (Commitment and Winning) with nine statements in total.

With good psychometric characteristics, easy understanding, concise contents and short and simple setting it is recommended for further work and additional research in the field of motivation in physical education in both elementary and secondary school.

Open access

Biljana Popovska-Jovicic, Ivana Rakovic, Sara Petrovic, Petar Canovic, Dejan Petrovic, Sofija Sekulic, Ivan Jovanovic and Nemanja Jovicic

Abstract

Febrile conditions of unidentified origin are still unknown in modern medicine despite the development of diagnostic procedures. There are various agents of long-term temperature encompassing numerous infectious or non-infectious diseases.

The aim of this study was to determine if there was a statistically significant difference in the values of proinflammatory cytokines (IL-1, TNFα, IL-6) in patients who meet the criteria for febrile conditions of unidentified origin, between the group of infectious, malignant, rheumatic, “other” diseases and undiagnosed patients.

The study was conducted in the Immunology laboratory of the Center for Molecular Medicine and Stem Cells Research of the Faculty of Medical Sciences in Kragujevac. Blood samples were taken from patients tested at the Clinic for Infectious Diseases, of the Clinical Center of Kragujevac, in the period from 2014 to 2016. The study included 70 patients.

The measured values of the level of TNFα showed significantly higher values in a group of malignant diseases than in the group of infectious diseases, while the values of IL-1 and IL-6 did not show statistical significance.

TNFα can improve diagnosing in case of patients with an unknown febrile condition, which can shorten the length of the hospital stay and reduce the volume of performance of diagnostic procedures.

Open access

Marko Jović, Ivan Nikolić, Vera Todorović, Aleksandar Petrović, Vladimir Petrović and Tijana Denčić

Summary

In the reference literature, there are a few studies on the development of the lymphatic system in the liver, especially human. This study aims to establish the presence, time of appearance, distribution and representation of expression D2-40 molecule – a marker of lymph vessels endothelial cells during the fetal period of the human liver development.

The livers obtained from 20 human fetuses (10 male and 12 female), aged 12-37 gestational weeks, constituted our study material. Paraffin sections, 4 µm thick, were stained with hematoxylin and eosin for histological analysis, and with LSAB2/HRP method for immunohistochemistry using the D2-40 monoclonal antibody to mark lymphatic endothelial cells. The presence of lymphatic vessels was determined by morphometry, calculating their numerical and volume density.

The study showed that expression of D2-40 molecule was absent in the liver lymphatic vessels in the first trimester of development, while in the second trimester intensive D2-40 immunoreactivity was observed in the lymph vessels of the liver capsule, and low D2-40 immunopositivity of the lymph vessels in large portal spaces. In the third trimester, intensive D2-40 immunoreactivity was observed in the lymph vessels of the liver capsule and in the endothelium of numerous lymphatic vessels of various shape and size, located in the smaller and larger portal areas. Volume and numerical density of lymphatic vessels in the portal areas of the liver during fetal development increased from the second to the third trimester of pregnancy, which was proportional to the increase in volume density of the hepatic portal spaces. Based on the obtained results, a conclusion may be drawn that the lymph vessels in the liver can be identified in the first half of the second trimester, and their number was growing proportionally by the end of pregnancy.

Open access

Goran Davidovic, Violeta Iric-Cupic, Srdjan Milanov, Ivan Simic, Ziva Zivic and Mirjana Janicijevic-Petrovic

Abstract

Background: Many cardiovascular diseases are associated with obesity, but, despite this fact, obese people live longer than their normal-weight counterparts do. This phenomenon is called the „obesity paradox“.

Aim: Purpose was to investigate the impact of obesity on the final outcome; determine the connection between obesity and heart rate > 80 beats per minute and other risk factors, and presence of „obesity paradox“.

Material and Methods: Research included 140 patients with anterior wall acute STEMI treated in Coronary Unit, Clinical Center Kragujevac form January 2001-June 2006. Heart rate was calculated as the mean value of baseline and heart rate in the first 30 minutes after admission. Body mass index was calculated as the ratio of body weight in kilograms and body height in squared meters, and classified according to the WHO recomendations.

Results: More than 75% obese patients were in both groups, survivors and those who died. In the subgroup with heart rate > 80 results were similar. Obesity had no significant effect on mortality despite the fact that the large number of patients with fatal outcome was obese.

Conclusion: Correlation with acute myocardial infarction and elevated heart rate is evident, but obesity was not independent predictor for mortality which can only partly confirm presence of „obesity paradox“.

Open access

Marijola Mojsilović, Vuka Katić, Ivan Ilić, Biljana Radovanović, Bratislav Petrović, Miodrag Lazić and Marijana Krstić

Abstract

Peutz-Jeghers syndrome (PJS) is a rare genetic disorder with autosomal-dominant pleiotropic inheritance, variable penetrance and characteristic signs of the disease that predisposes persons to increased risk of developing cancer, particularly in the gastrointestinal tract and the breast. Due to genetic nature of disease, in the familial Peutz-Jeghers syndrome, a multiplication of symptoms in the three-generation family members was established.

This paper represents an insight into the anamnesis of PJS in one family over thirty-seven years of follow-up, and is part of the broader study of this disorder. Article presents family history, clinical and histological findings and multiplication of symptoms of PJS across three generations.

Over thirty-seven years, PJS has been present in this family in the form of only mucocutaneous pigmentation but without clinically manifested signs (father), or with both melanine hyperpigmentation and gastrointestinal hamartomatous polyposis (his daughter and her son).

The symptoms rose suspicion of the existence of PJS complication, i.e. carcinoid-like syndrome with watery diarrheas accompanied by constipations in the affected mother and son who were surgically treated. Diagnosis of PJS was histopathologically confirmed in both cases: the presence of the polyps with hamartomatous pattern and conspicuous hyperplasia of chromogranin-positive (EC and L cells) and serotoninpositive (EC) cells. Malignant transformation of PJ- removed polyps was not found. Besides hamartoma, polyps as well as a tubular adenoma were found, with a low degree dysplasia without malignant transformation (son).

The authors discuss the findings in relation to the important role of the gastrointestinal endocrine cell hyperplasia, not only for better understanding of the growth and clinical symptoms of the PJ polyposis, but also for new approach and the possible application of anti-hormonal therapy in the treatment of these patients in the future, that is not currently in use.

Open access

Braca Kundalić, Slađana Ugrenović, Ivan Jovanović, Natalija Stefanović, Vladimir Petrović, Jasen Kundalić, Miljana Pavlović and Vladimir Antić

Summary

The aim of our study was to analyze the changes of connective tissue sheaths of epi-, peri- and endoneurium of sural nerve during aging.

The study was conducted on sural nerve samples of 10 cases aged 9-80 years. The specimens were embedded in paraffin using standard procedures, after which 5-μm-thick cross-sections of nerve trunks were made and stained using Masson’s trichrome staining. After morphological analysis of fascicular structure and connective sheaths of the nerve, morphometric analysis was conducted using the software for digital image analysis “ImageJ”. Each investigated case was analyzed for total neural, epineurial and fascicular cross-section area, mean values of perineurial index, volume density of myelinated axons and of endoneurial content. To test the difference in mean values for statistical significance we used the Student’s T-test for small independent sample.

The number of fascicles was 5-13, while the majority of the nerves had less than 10 fascicles. Fascicular structure, which included the number of fascicles and epifascicular/fascicular area ratio, did not show significant changes during aging. Perineurial thickness /fascicle size ratio statistically significantly increased in the older investigated group (p<0.05). Myelinated fibres were of smaller diameter, with more irregular form and markedly less frequent in older cases. Quantitative analysis showed statistically significant decrease in volume density of myelinated fibres in the older group.

As results of applied investigation methods we found thickening of perineurial sheath of sural nerve during aging, as well as endoneurial fibrosis. Future investigations of age-related changes should focus on analysis of the components of extracellular matrix within perineurium and endoneurium.

Open access

Ivan Cekerevac, Vojislav Cupurdija, Ljiljana Novkovic, Zorica Lazic, Marina Petrovic, Olgica Gajovic and Romana Susa

Abstract

A male patient, 54 years old, was initially admitted to the hospital because of fatigue he felt during the last month and swelling of the lower legs. Upon hospital admittance, gas exchange analysis showed global respiratory failure: pO2=6.1 kPa, pCO2=10.9 kPa, pH=7.35, A-a gradient = 1.0. Due to the existence of hypercapnia and decompensated respiratory acidosis, the patient was connected to a device for non-invasive mechanical ventilation. Reduced chest mobility was noticed, and the respiratory index value was decreased. Radiographs of the chest and thoracic and lumbo-sacral spine showed marked changes on the spine attributable to ankylosing spondylitis (AS). Radiographs of the sacroiliac joints showed reduced sacroiliac joint intraarticular space with signs of subchondral sclerosis. The diagnosis of AS was set on the basis of New York Criteria (bilateral sacroiliitis, grade 3) and clinical criteria (back pain, lumbar spine limitation and chest expansion limitation). HLA typing (HLA B27 +) confirmed the diagnosis of AS. Pulmonary function test proved severe restrictive syndrome. Polysomnography verified the existence of severe obstructive sleep apnoea (AHI =73). This was a patient with newly diagnosed AS, with consequent severe restrictive syndrome and global respiratory failure with severe obstructive sleep apnoea. Thee patient was discharged from the hospital with a NIV (global respiratory failure) device for home use during the night.

Open access

Ivana Petrovic, Ivan Stankovic, Goran Milasinovic, Gabrijela Nikcevic, Bratislav Kircanski, Velibor Jovanovic, Srdjan Raspopovic, Nikola Radovanovic and Sinisa U. Pavlovic

Summary

Background: In the majority of patients with a wide QRS complex and heart failure resistant to optimal medical therapy, cardiac resynchronization therapy (CRT) leads to rever se ventricular remodeling and possibly to changes in cardiac collagen synthesis and degradation. We investigated the relationship of biomarkers of myocardial collagen meta bolism and volumetric response to CRT.

Methods: We prospectively studied 46 heart failure patients (mean age 61±9 years, 87% male) who underwent CRT im plantation. Plasma concentrations of amino-terminal pro peptide type I (PINP), a marker of collagen synthesis, and carboxy-terminal collagen telopeptide (CITP), a marker of collagen degradation, were measured before and 6 months after CRT. Response to CRT was defined as 15% or greater reduction in left ventricular end-systolic volume at 6-month follow-up.

Results: Baseline PINP levels showed a negative correlation with both left ventricular end-diastolic volume (r=−0.51; p=0.032), and end-systolic diameter (r=−0.47; p=0.049). After 6 months of device implantation, 28 patients (61%) responded to CRT. No significant differences in the base-line levels of PINP and CITP between responders and nonresponders were observed (p>0.05 for both). During follow-up, responders demonstrated a significant increase in serum PINP level from 31.37±18.40 to 39.2±19.19 μg/L (p=0.049), whereas in non-responders serum PINP levels did not significantly change (from 28.12±21.55 to 34.47±18.64 μg/L; p=0.125). There were no significant changes in CITP levels in both responders and non-responders (p>0.05).

Conclusions: Left ventricular reverse remodeling induced by CRT is associated with an increased collagen synthesis in the first 6 months of CRT implantation.

Open access

Zoran Jovanovic, Vesela Radonjic, Ratomir Jelic, Narcisa Petrovic-Subic, Ivan Soldatovic, Vera Terzic, Sladjan Stojilkovic and Dusan Djuric

Abstract

Apart from providing knowledge on the beneficial effects of drugs, practical psychopharmacotherapy also includes drug profiles of adverse effects, especially when medical comorbidity is present. The mechanism of action of many psychotropic drugs, mainly antipsychotics and antidepressants, is associated with prolongation of the QT interval and the occurrence of arrhythmias, specifically Torsade de pointes (TdP), which can be lethal. The aim of this pilot study was to confirm the prevalence of prolonged QTc interval in a sample of psychiatric patients taking psychopharmacs.

The present study included 41 patients who were already on psychopharmacs. The average value of the QTc interval in the observed sample was 413.8±23.3 ms. The most frequent psychopharmacotherapy was the combination of typical and atypical antipsychotics (24.4%), followed by monotherapy with antipsychotics (22%) and combined antidepressant and atypical antipsychotic therapy (22%). The average value of the QTc interval for male patients was 412.1±25.2 ms, whereas for female patients, it was 416.6±20.4 ms. No difference between sexes was confirmed (p=0.555). The correlation between the QTc interval and age of patients was positive but not statistically significant (p=0.072). The highest average (419.3±31.6 ms) and highest maximum (479 ms) values of the QTc interval were noted for patients undergoing combined therapy of antidepressants and atypical antipsychotics. Prolonged values of the QTc interval were observed for seven males and one female, and no patients exhibited pathological values.

This study confirmed previous research that found that prolongation of the QTc interval exists in patients in sample groups who take psychopharm acs, but not up to critical values.

Open access

Ivan Praznik, Marko Spasić, Ivan Radosavljević, Bojan Stojanović, Dragan Čanović, Dragče Radovanović, Zorica Savović, Radiša Vojinović, Živan Babić, Nela Đonović, Tanja Luković, Predrag Lazarević, Nataša Đorđević, Irena Kostić, Ivana Jelić, Jelena Petrović, Stefan Stojanović, Milena Jurišević, Iva Grubor, Ljiljana Nikolić, Ksenija Vučićević, Viktorija Artinović, Anđela Milojević, Marina Kostić, Srđjan Stefanović and Slobodan Janković

Summary

The aim of the paper was to determine the factors related to the initial therapy that may contribute to death from severe necrotizing acute pancreatitis and to analyze their clinical importance as well as possible additive effects.

A retrospective case-control study included all adult patients treated for severe necrotizing acute pancreatitis in the Clinical Center of Kragujevac, Serbia, during the five-year period (2006-2010.). The cases (n = 41) were patients who died, while the controls (n = 69) were participants who survived. In order to estimate the relationship between potential risk factors and observed outcome, crude and adjusted odds ratios (OR) with 95 % confidence intervals (CI) were calculated in logistic regression models.

Significant association with observed outcome was shown for the use of gelatin and/or hydroxyethyl starch (adjusted OR 12.555; 95 % CI 1.150-137.005), use of albumin (adjusted OR 27.973; 95 % CI 1.741-449.373), use of octreotide (adjusted OR 16.069; 95 % CI 1.072-240.821) and avoiding of enteral feeding (adjusted OR 3.933; 95 % CI 1.118-13.829), while the use of nonsteroidal anti-inflammatory drugs had protective role (adjusted OR 0.057; 95 % CI 0.004-0.805).

The risk of death in patients with predicted severe necrotizing acute pancreatitis could be reduced with avoidance of treatment with colloid solutions, albumin and octreotide, as well as with an early introduction of oral/enteral nutrition and use of nonsteroidal anti-inflammatory drugs.