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Search Results: 1 - 10 of 1466 matches for " Joveli? Aleksandra "
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Distal renal tubular acidosis as a cause of osteomalacia in a patient with primary Sj gren's syndrome
JoveliAleksandra,Stefanovi? Du?an
Vojnosanitetski Pregled , 2005, DOI: 10.2298/vsp0510769j
Abstract: Background. One half of the patients with primary Sj gren’s syndrome has extraglandular manifestations, including renal involvement. The most frequent renal lesion is tubulo-interstitial nephritis, which manifests clinically as distal tubular acidosis and may result in the development of osteomalacia. Case report. In a 29 - year-old female patient, with bilateral nephrolithiasis, the diagnosis of primary Sj gren’s syndrome, tubulo-interstitial nephritis, distal renal tubular acidosis, and hypokalemia were established. She was treated for hypokalemia. Two years later she developed bone pains and muscle weakness, she wasn’t able to walk, her proximal muscles and pelvic bones were painful, with radiological signs of pelvic bones osteopenia and pubic bones fractures. The diagnosis of osteomalacia was established and the treatment started with Schol’s solution, vitamin D and calcium. In the following two months, acidosis was corrected, and the patient started walking. Conclusion. In our patient with primary Sj gren’s syndrome and interstitial nephritis, osteomalacia was a result of the long time decompensate acidosis, so the correction of acidosis, and the supplementation of vitamin D and calcium were the integral part of the therapy.
Relationship between C-reactive protein and features of the metabolic syndrome in military pilots in the Serbia and Montenegro
JoveliAleksandra,Ra?en Goran,Joveli? Stojan,Markovi? Marica
Vojnosanitetski Pregled , 2005, DOI: 10.2298/vsp0511811j
Abstract: Background/Aim. C-reactive protein is an independent predictor of the risk of cardiovascular events and diabetes mellitus in apparently healthy men. The relationship between C-reactive protein and the features of metabolic syndrome has not been fully elucidated. To assess the cross-sectional relationship between C-reactive protein and the features of metabolic syndrome in healthy people. Methods. We studied 161 military pilots (agee, 40±6 years) free of cardiovascular disease, diabetes mellitus and active inflammation on their regular annual medical control. Age, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, triglycerides, fasting glucose, glycosylated hemoglobin, blood pressure, smoking habit, waist circumference and body mass index were evaluated. Plasma C-reactive protein was measured by the immunonephelometry (Dade Behring) method. Metabolic syndrome was defined according to the National Cholesterol Education Program Expert Panel. Results. The mean C-reactive protein concentrations in the subjects grouped according to the presence of 0, 1, 2 and 3 or more features of the metabolic syndrome were 1.11, 1.89, 1.72 and 2.22 mg/L, respectively (p = 0.023) with a statistically, significant difference between those with 3, and without metabolic syndrome (p = 0.01). In the simple regression analyses C-reactive protein did not correlate with the total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, body mass index and blood pressure (p > 0.05). In the multiple regression analysis, waist circumference (β = 0.411, p = 0.000), triglycerides to high density lipoprotein cholesterol ratio (β = 0.774, p = 0.000), smoking habit (β = 0.236, p = 0.003) and triglycerides (β = 0.471, p = 0.027) were independent predictors of C-reactive protein. Conclusions. Our results suggested a cross-sectional independent correlation between the examined cardiovascular risk factors as the predominant features of metabolic syndrome and C-reactive protein in the group of apparently healthy subjects. The lack of correlation of C-reactive protein with the total cholesterol and low density lipoprotein cholesterol in our study may suggest their different role in the process of atherosclerosis and the possibility to determine C-reactive protein in order to identify high-risk subjects not identified with cholesterol screening.
Cigarette smoking in military pilots and intima-media thickness of the carotid arteries
Joveli? Stojan,Hajdukovi? Zoran,JoveliAleksandra,Ra?en Slavica
Vojnosanitetski Pregled , 2005, DOI: 10.2298/vsp0505365j
Abstract: Background. It is well known that smoking is associated with an increase in arterial wall thickness. However, most studies of this problem have been undertaken in age and sex heterogeneous groups, as well as in patients with already present other conventional risk factors. The aim of this study was to assess the effect of cigarette smoking on arterial wall thickness of the common carotid artery in asymptomatic pilots. Methods. The imaging of intima media thickness of the posterior wall of the distal 1 cm of both common carotid arteries was performed using a B mode ultrasound device, in 39 pilots (37.05 ± 6.66 years), for whom smoking was the single cardiovascular risk factor. Comparisons were made with 49 non-smokers (35.12 ± 7.39 years). Results. The posterior walls of both common carotid arteries were thicker in smokers (left, p < 0.05; right, p > 0,05). Intima-media thickness was significantly lower on the right side than on the left side in both smokers and nonsmokers (p < 0.01). Conclusion. Cigarette smoking as the single cardiovascular risk factor was associated with the wall thickness of the carotid arteries in our study. This finding indicated that early atherosclerosis was already present in pilots - smokers entering middle age.
Effects of tirofiban and percutaneous coronary intervention in an old patient with acute myocardial infarction and cardiogenic shock
?anji Tibor,JoveliAleksandra,Srdanovi? Ilija,Petrovi? Milovan
Medicinski Pregled , 2010, DOI: 10.2298/mpns1002117c
Abstract: A 75 year old man presented in our institutiton with acute inferoposterior and right ventricular ST-segment elevation myocardial infarction and cardiogenic shock, 40 minutes after the pain onset. He was pretreated with 300 mg of aspirin, 600 mg of clopidogrel, and was taken to the catheterization laboratory. Door to needle time was 35 minutes. Primary percutaneous coronary intervention with bare-metal stent implantation first in infarct related right coronary artery, with subsequent high-bolus dose (25 fig/kg) tirofiban, and then in suboccluded RCx were done. The procedures were done during the cardio-pulmo-cerebral reanimation because of relapsing ventricular fibrillation, with final TIMI 3 coronary flow established. Subsequently, intraaortic balloon pump was inserted. Echocardiography taken on the second day showed globaly hypokinetic left ventricle, with 10% ejection fraction and competent valves. During the next three weeks of hospital follow-up, there were no major adverse cardiac events, a transient azotemia and fall in hemoglobin concentration without major bleeding, and no episodes of severe thrombocytopenia were recorded. After six months, the patient was without chest pains, 2/3 class according to the New York Heart Association, without major adverse events, and echocardiographic left ventricular ejection fraction increment for 30%.
Late ventricular potentials in risk assessment of the occurrence of complex ventricular arrhythmia in patients with myocardial infarction and heart failure
?osi? Zoran,Tav?iovski Dragan,JoveliAleksandra,Romanovi? Radoslav
Vojnosanitetski Pregled , 2004, DOI: 10.2298/vsp0406589c
Abstract: Aim. To determine the prognostic significance of late ventricular potentials on signal-averaged electrocardiogram and left ventricular ejection fraction for the occurrence of complex ventricular arrhythmia in patients treated with accelerated tissue-type plasminogen activator, using the rapid protocol, within six months of acute myocardial infarction. Methods. In this analytic observational prospective study patients were divided into four groups: patients with left ventricular ejection fraction bellow 40% and late ventricular potentials, patients with left ventricular ejection fraction bellow 40% and without late ventricular potentials, patients with left ventricular ejection fraction over 40% and late ventricular potentials, and patients with left ventricular ejection fraction over 40% and without late ventricular potentials. Complex ventricular arrhythmias (Lown grade IVa, IVb, and V) were recorded using standard electrocardiography and 24-hour Holter monitoring 21, 60, and 90 days after acute myocardial infarction, respectively. Serial recordings of signal-averaged electrocardiogram were obtained 30, 90, and 180 days after acute myocardial infarction. Left ventricular ejection fraction was determined by echocardiography between 15 and 21 days after acute myocardial infarction. Multivariant logistic regression analysis was used to evaluate the relation between late ventricular potentials and left ventricular ejection fraction with the occurrence of complex ventricular arrhythmias. Sensitivity, specificity, positive and negative predictive values of late ventricular potentials and left ventricular ejection fraction for the occurrence of complex ventricular arrhythmias were determined. Results. The prospective study included 80 patients (73% men), mean age 64 ± 3.5 years. Complex ventricular arrhythmias were recorded in 34 (42.5%) of patients, all 17 (50%) of which were from the first group (p<0.01). Complex ventricular arrhythmias were recorded in 25 (73.5%) patients with late ventricular potentials, and in 23 (67.6%) patients with left ventricular ejection fraction bellow 40%. Left ventricular ejection fraction bellow 40% and late ventricular potentials represented independent predictors for the occurrence of complex ventricular arrhythmias (RR=14.33, p<0.01). When combined with left ventricular ejection fraction bellow 40%, late ventricular potentials had sensitivity (0.50), specificity (0.93), and positive predictive accuracy (0.85) higher than late ventricular potentials alone (0.44, 0.67, and 0.37, respectively) for the occurrence of complex vent
Urgent percutaneous coronary intervention leads to a decrease in serum concentrations of soluble CD40 ligand
Ratkovi? Nenad,Romanovi? Radoslav,JoveliAleksandra,Gligi? Branko
Vojnosanitetski Pregled , 2010, DOI: 10.2298/vsp1009732r
Abstract: Background/Aim. Inflammation as a consequence of vascular injury after percutaneous coronary intervention (PCI) is a pathological substrate of restenosis and of its complications. The aim of the study was to examine perprocedural inflammatory response expressed by soluble CD40 ligand (sCD40L) and C-reactive protein (CRP) in patients treated with PCI and dual antiplatelet therapy. Methods. The experimental group included 52 patients (80.8% men, age 60 ± 9 years) with angina pectoris treated by PCI (22 urgent PCI) with stent implantation, and dual antiplatelet therapy (tienopiridins and aspirin), according to the current recommendations for the execution of the intervention. The control group consisted of 8 patients (70.5% men, age 59 ± 7 years) with angina pectoris, who had undergone coronarography taking aspirin 3 days prior to it. In all the patients 24 hours before and after the PCI concentrations of CRP and sCD40L in the blood were determined. Results. In the experimental group, the concentration of sCD40L was lower as compared to the control (p < 0.02). In 34 (65%) patients postprocedural decrease in sCD40L was recorded, in 18 (34.6%) of them increase, while in 50 (96%) patients there was a rise in CRP. The patients with postprocedural fall in sCD40L hod greater preprocedural concentration of sCD40L (p < 0.001), and less postprocedural concentration of sCD40L (p < 0.001), compared to the group with an increase in sCD40L after the PCI, while CRP levels tients treated with emergency PCI compared to elective patietns had a postprocedural decrease in sCD40L (p = 0.02). Increase in the level of CRP was higher in the group with emergency PCI in relation to elective PCI (p < 0.01). Conclusion. Emergency PCI procedures in the treatment of patients with unstable angina pectoris lead to a postprocedural fall in the serum concentration of sCD40L. Dual antiplate therapy with tienopiridins and aspirin inhibits the release of sCD40L. Regardless a clinical presentation of coronary disease PCI leads to an postprocedural increase in concentrations of CRP in the serum.
Exercise induced rhabdomyolysis
Ru?i? Maja,Fabri Milotka,Pobor Marta,JoveliAleksandra
Vojnosanitetski Pregled , 2009, DOI: 10.2298/vsp0909754r
Abstract: Introduction. Rhabdomyolysis is a potentially life threatening disease, characterized by the release of intracellular calcium from skeletal muscles and can result in acute renal failure. Case report. A nineteen year old boy was admitted to the Clinic for Infective Diseases of Clinical Center Novi Sad. The disease was developing gradually and the symptoms were dizziness, muscle pain and dark color of urine. Due to the pathological level of aminotransferase he was hospitalized on the fourth day of the disease beginning with a suspicious diagnosis of acute viral hepatitis. In the hospital course of the disease, a further elevation of serum aminotransferases, creatine kinase and lactate dehydrogenase were registered. Additional serological analyses were done to exclude other possible causes of acute liver lesion. In the neurological status prolonged decontraction of quadriceps muscle was detected and the electromyography was suspicious on neuromyositis. Conclusion. Excessive muscular activity with the strenuous exercise is the leading, but very frequently overlooked, cause of rhabdomyolysis in healthy people. Excessive physical exercise may lead to elevation of the serum activity of aminotransferases and to suspicion of hepatitis.
Therapeutic hypothermia and neurological outcome after cardiac arrest
Petrovi? Milovan,Pani? Gordana,JoveliAleksandra,?anji Tibor
Vojnosanitetski Pregled , 2011, DOI: 10.2298/vsp1106495p
Abstract: 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 Cerebral Performance Category Scale (CPC). Follow-up was 30 days. Results. The study was conducted on 82 patients: 45 patients (age 57.93 ± 14.08 years, 77.8% male) were treated with hypothermia, and 37 patients (age 62.00 ± 9.60 years, 67.6% male) were treated conservatively. In the group treated with therapeutic hypothermia protocol, 21 (46.7%) patients had full neurological restitution (CPC 1), 3 (6.7%) patients had good neurologic outcome (CPC 2), 1 (2.2%) patient remained in coma and 20 (44.4%) patients finally died (CPC 5). In the normothermic group 7 (18.9%) patients had full neurological restitution (CPC 1), and 30 (81.1%) patients remained in coma and finally died (CPC 5). Between the two therapeutic groups there was statistically significant difference in frequencies of different neurologic outcome (p = 0.006), specially between the patients with CPC 1 and CPC 5 outcome (p = 0.003). In the group treated with mild hypothermia 23 (51.1%) patients survived, and in the normothermic group 30 (81.1%) patients died, while in the group of survived patients 23 (76.7%) were treated with mild hypothermia (p = 0.003). Conclusion. Mild therapeutic hypothermia applied after cardiac arrest improved neurological outcome and reduced mortality in the studied group of comatose survivors.
Influence of orlistat therapy on serum insulin level and morphological and functional parameters of peripheral arterial circulation in obese patients
Hajdukovi? Zoran,JoveliAleksandra,?ivoti?-Vanovi? Mirjana,Ra?en Slavica
Vojnosanitetski Pregled , 2005, DOI: 10.2298/vsp0511803h
Abstract: Background/Aim. Insulin resistance is related to accelerated atherosclerosis, whereas weight loss is associated with the increasing insulin sensitivity, the improvement of functional and the morphological parameters of arterial circulation, and the reduction of cardiovascular morbidity and mortality. The aim of our study was to evaluate the influence of orlistat treatment on serum insulin level and functional and morphologic parameters of peripheral arterial circulation. Methods. We conducted a prospective, randomized, double blind, placebo controlled study. Thirty patients with body mass index over 30 kg/m2 normotensive, nonsmokers, without clinically manifested cardiovascular disease or diabetes were randomly assigned either orlistat (120 mg, 3 times daily; n = 20) or placebo (n = 10) in a double blind manner. All of the patients were on individually calculated hypocaloric diet. The follow-up period was 24 weeks. Arterial pressure, fasting serum glucose and insulin level, triglycerides, total cholesterol and low density lipoprotein-cholesterol were determined at the beginning, following 3 and 6 months. Also, the intima media thickness of right superficial femoral artery and the mean blood flow velocity were determined with ultrasonography. Results. Inside the period of 3 and 6 months, there were the greater reductions of body mass index, arterial pressure, fasting glucose and insulin level, total cholesterol, low density lipoproteins, as well as the greater reductions of mean velocity blood flow and peripheral pulse pressure in the orlistat group vs the placebo group (p < 0.01). Greater reductions in the waist circumference and intima media thickness were registered following 6 months in the orlistat vs the placebo group (p < 0.01). Conclusion. In the group of obese patients orlistat therapy reduced risk factors, serum insulin level and improved early arterial functional changes as assessed with the reductions of the mean velocity blood flow and peripheral pulse pressure following 3 months. The regression of morphological changes, as assessed with the reduction in intima media thickness, was feasible over the six month period.
Psoriatic arthritis: A retrospective study of 162 patients
Pavlica Ljiljana,Peri?-Hajzler Zorica,JoveliAleksandra,?ekler Boris
Vojnosanitetski Pregled , 2005, DOI: 10.2298/vsp0509613p
Abstract: Aim. The aim of our study was to determine the prevalence of psoriatic arthritis in the patients with psoriasis and to analyze retrospectively the results of a 34-year multidisciplinary management of the patients with psoriatic arthritis. Methods. The study included 162 out of 183 treated patients with psoriatic arthritis, aged 48 ± 15 years. All the patients satisfied the current diagnostic criteria for psoriasis and psoriatic arthritis according to the American College of Rheumatology. Results. Psoriatic arthritis developed in 183 (9.3%) out of 1976 patients with psoriasis. Time interval for establishing the diagnosis was 4 years. A positive family history of the disease had 15.0% of the studied patients. Its onset was most often at 42 years of age in 70.4% of the cases, and 2 months to 59 years after the appearance of psoriasis. Psoriatic arthritis without psoriasis appeared in 1.8% of the patients. A severe form of arthritis had 64.2% of the patients, mainly the patients with scalp psoriasis (χ2=3.2; p<0.05). Nail changes had 35% of the patients. Distal interphalangeal joints were involved in 63.6%, axial skeleton in 36.4%, oligoarthritis in 45.0%, polyarthritis in 55.0%, and mutilating form in 6.8% of the patients. Elevated Erythrocyte Sedimentation Rate was reveald in 61.7% of the patients. Immunoglobulin M (IgM) rheumatoid factor was altered in 4.3% of the patients. The human leukocyte antigen (HLA) typing in the 28 patients were: A2 32.0%, A3 18.0%, Al and A9 14.0%, A28 and A29 3.5%, B8 and B16 14.0%, B5 and B12 11.0%, B13,B15, B18, B27 and B35 7.0%. Radiologic changes were most often in hand and foot joints, less frequently in the knees and quite infrequently in hips and shoulders joints. Sacroiliitis was found in 46.4% of the patients. Psoriasis was treated with topical corticosteroids and salicylic ointments in all the patients, ultraviolet (PUVA therapy) in 5.6% and retinoids in 4.3% of them. Artrithis was treated with nonsteroidal anti-inflammatory drugs, with systemic corticosteroids 41.3% and with disease modified antirheumatic drugs, most frequently methotrexate, 59.9% of the patients. Radionuclide synovectomy was performed in 6.8%, surgery in 6.2% and physical therapy in all the patients. Conclusion. Psoriatic arthritis developed in 9.3% of the psoriatic patients. Time interval for establishing the diagnosis was long, and there were no specific laboratory findings. All the synovial joints could be involved in the psoriatic process. Scintigraphy should be used only in case of early suspected sacroiliitis. The treatment of psoriatic arthr
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