BIOMEDICINSKA ISTRAŽIVANJA

Volume 10, No 1, June 2019.


ORIGINAL SCIENTIFIC ARTICLES

Characteristics of perioptic and intraoptic arterial vascularization of extracranial segment of optic nerve

Radmila Balaban-Đurević, Samra Hajrović, Siniša Šolaja, Vanja Pljevaljčić, Valvita Reçi, Stefan Kulić, Milan Milisavljević

Biomedicinska istraživanja 2019; 10(1):1-7 doi:10.7251/BII1901001B

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Characteristics of perioptic and intraoptic arterial vascularization of extracranial segment of optic nerve

Radmila Balaban-Djurević1, Samra Hajrović2, Siniša Šolaja3, Vanja Pljevaljčić1, Valvita Reçi4, Stefan Kulić5, Milan Milisavljević6


1University of East Sarajevo, Faculty of Medicine Foča, Department of Anatomy, Foča, The Republic of Srpska,
Bosnia and Herzegovina
2General Hospital, Ophthalmology Division, Novi Pazar, Serbia
3University Hospital Foča, The Republic of Srpska, Bosnia and Herzegovina
4State University of Tetovo, Faculty of Medicine, Department of Anatomy, Tetovo, The Republic of North Macedonia
5Health Care Center, Nikšić, Montenegro
6University of Belgrade, Faculty of Medicine, Institute of Anatomy, Belgrade, Serbia

Introduction. The optic nerve is supplied by the arterial branches of the superficial pial plexus and direct intraneural branches. The aim of the study was to study the morphological characteristics (origin, number of arteries, calibers, and branching pattern) of perioptic arterial vascularization and intraoptic vascular network of the extracranial sections of the optic nerve: analicular and intraorbital.
Methods. The study included 18 pairs of the optic nerves of both sexes (11 males and 7 females), aged 51 to 78 years, with no signs of changes in the structures of the nervous system. The vasculature of the optic nerves was microdissected and examined under the stereoscopic microscope, after injecting their arteries with 10% mixture of India ink and gelatin, and 5% formaline fixation.
Results. The intracanalicular part of the optic nerve received fine blood vessels from the ophthalmic artery, usually in two branches in 29 (82.9%) cases, while in 6 (17.1%) specimens there was only one branch for the nerve. The intraorbital segment of the optic nerve was supplied by two interconnected systems of blood vessels, peripheral and axial, both coming from the central retinal artery.
Conclusion. On the basis of the obtained results, it has been confirmed that both segments of the optic nerve have a rich and very delicate vascular network. The superficial pial arterial plexus of the intracanalicular segment of the optic nerve has been identified as the only source of its vascular supply. The intraorbital part of the optic nerve has two interconnected systems of blood vessels: peripheral and axial.
Keywords: optic nerve, arteries, perioptic ascularization, intraoptic vascularization

Effects of short-term combination therapy with insulin on glycoregulation and insulin secretory function in patients with type 2 diabetes mellitus and secondary failure to treatment with oral antidiabetic agents

Aleksandra Grbić, Gabrijela Malešević, Slavko Grbić, Milorad Grujičić, Vesna Jelača

Biomedicinska istraživanja 2019; 10(1):8-14 doi:10.7251/BII1901008G

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Effects of short-term combination therapy with insulin on glycoregulation and insulin secretory function in patients with type 2 diabetes mellitus and secondary failure to treatment with oral antidiabetic agents

Aleksandra Grbić1,2, Gabrijela Malešević1,2,
Slavko Grbić1,2, Milorad Grujičić1,2, Vesna Jelača3


1University Clinical Center of the Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
2University of Banja Luka, Faculty of Medicine, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
3Dr Mladen Stojanović Hospital, Prijedor, The Republic of Srpska, Bosnia and Herzegovina

Introduction. Secondary failure to treatment with oral antidiabetic agents is defined as the absence of a favorable reaction to the oral therapy which had proved effective in the previous course of the treatment. The aim of the study is to investigate the residual effects of the short-term combination therapy with insulin on glycoregulation and insulin secretory function.
Methods. The sample comprised 53 patients with type 2 diabetes mellitus (DM2) and secondary failure to treatment with oral antidiabetic agents who had been receiving combination therapy (basal insulin plus metformin) for three months. Following the evaluation of acute effects of insulin therapy, the patients had been receiving oral antihyperglycemic medications, used at the time of secondary failure, for three months, after which the residual effects of insulin therapy were estimated.
Results. Three-month combination therapy significantly improved glycoregulation (fasting glycemia: 9.4 mmol/l vs. 6.1 mmol/l; postpransial glycemia: 11.5 mmol/l vs. 7.3mmol/l; daily glycemic profile: 10.0 mmol/l vs. 7.2 mmol/l) and insulin secretory parameters (insulinemia: 16.63 mU/l vs. 10.8 mU/l; C-peptid: 1.53 μg/ml vs. 1.81 μg/ml) compared with the period when secondary failure to oral therapy was observed (acute effects). Three months after the insuline therapy, glycoregulation and insulin secretory function were slightly poorer– residual effects (glycemia: 7.1mmol/l; postpransial glycemia: 8.3 mmol/l; daily glycemic profile: 8.4mmol/l; insulinemia: 13.3mU/l; C-peptid: 1.72 μg /ml).
Conclusion. The reinclusion of oral antidiabetic agents after short-term insulin therapy led to mild deterioration in insulin secretory function. Nevertheless, all observed parameters of metabolic status were significantly better compared with the period prior to short-term use of insulin.
Keywords: type 2 diabetes mellitus, secondary failure of oral antidiabetic agents, combination therapy, C-peptide, insulin

Analysis of effect of antidepressant drug venlafaxine on length of QT interval in patients with depressive disorder and alcohol dependence

Sanja Vukadinović Stojanović, Zlatan Stojanović

Biomedicinska istraživanja 2019; 10(1):15-23 doi:10.7251/BII1901015V

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Analysis of effect of antidepressant drug venlafaxine on length of QT interval in patients with depressive disorder and alcohol dependence

Sanja Vukadinović Stojanović1, Zlatan Stojanović2


1University Clinical Center of the Republic Srpska, Banja Luka, Тhe Republic of Srpska, Bosnia and Herzegovina
2University of Banja Luka, Faculty of Medicine, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina

Introduction. Depressive disorder is common in patients with the diagnosis of alcoholism. Comorbidity of depression and alcoholism significantly worsens the clinical status of patients and represents a major therapeutic challenge. The aim of the study was to investigate the effect of the antidepressant drug venlafaxine on the length of QT interval in patients with depressive disorder and alcohol dependence.
Methods. The research included 49 male patients (>18 years of age) with alcohol dependence, who were also diagnosed with depressive disorder by using DSM-IV criterion and positive Hamilton Rating Scale for Depression (HRSD) at the very beginning of hospitalization. The patients had been given 37.5 mg of the antidepressant drug venlafaxine twice a day for twenty days. The global QTc interval (12 leads) was determined automatically using ECG device Schiller Cardiovit AT-1, which used “SCHILLER ECG Measurement and Interpretation Software for Children and Adult ECGs”. Statistical data processing was performed using SPSS 16.0 programme package for Windows.
Results. There was a statistically significant positive association between HRSD score (depression intensity) and the serum levels of creatine kinase isoenzyme MB, i.e. the degree of myocardial damage (p = 0.048). A statistically significant positive correlation between serum gamma-glutamyltransferase levels and the length of QTc interval (p < 0.001) was also found. There was no statistically significant difference in the length of QTc interval before and after venlafaxine administration
(p = 0.827), and the average prolongation of the QTc interval was 0.776 ms (95% CI = -6.323 ms−7.874 ms).
Conclusion. In our study, we did not prove the negative effect of antidepressant drug venlafaxine on QT interval in patients with depressive disorder and alcohol dependence. In patients with alcohol dependence, the therapy for depression must have a priority due to the proven negative association between depression and the degree of myocardial damage.
Keywords: alcohol dependence, depression, comorbidity, QT interval, venlafaxine

Acoustic characteristics of voice in examinees with moderately-severe hearing loss

Sladjana Ćalasan, Mirjana Petrović-Lazić, Nadica Jovanović-Simić, Snežana Babac

Biomedicinska istraživanja 2019; 10(1):24–29 doi:10.7251/BII1901024C

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Acoustic characteristics of voice in examinees with moderately-severe hearing loss.

 

Sladjana Ćalasan¹, Mirjana Petrović-Lazić², Nadica Jovanović-Simić², Snežana Babac²


¹University of East Sarajevo, Faculty of Medicine, Foča, The Republic of Srpska, Bosnia and Herzegovina
²University of Belgrade, Faculty of Special Education and Rehabilitation, Belgrade, Serbia

Introduction.Voice is the result of vocal cord vibrations and resonance effects of the vocal tract, therefore, the instrumental monitoring of the vibrations themselves is one of the essential aspects of objective instrumental assessment of voice. Inadequate height and volume, as well as increased nasality, represent the basic characteristics of voice in hearing-impaired persons. The aim of the study was to perform a detailed analysis of the acoustic structure of vowel /a/ in the hearing-impaired persons and in those with normal hearing and voice.
Methods. The sample comprised 40 participants, aged 17 to 20 years (18.50 ±1.13), both sexes (50% males), divided into two groups. The first group consisted of 20 participants with moderately-severe hearing loss (56-70 dB), while the second group included 20 normal-hearing participants. Members of both groups were equal to each other in sex and age (± 3 months). The research was conducted in secondary schools, the Faculty of Medicine in Foča, as well as in Special School with a Student’s Dormitory “Bubanj” in Niš during May 2018.
Results. A statistically significant difference between hearing-impaired and normal-hearing speakers was found in 11 out of 14 tested acoustic parameters of vowel /a/: Standard Deviation of Fundamental Frequency (STD), Absolute Jitter (Jitta), Percentage of Jitter (Jitt), Relative Average Perturbation (RAP), Fundamental Frequency Variation (vFo), Shimmer (Shdb), Percentage of Shimmer (Shim), Amplitude Perturbation Quotient (APQ), Noise-to-Harmonic Ratio (NHR), Soft Phonation Index (SPI) and Frequency Tremor Intensity Index (FTRI) whereby the hearing-impaired participants showed higher values of the above-mentioned parameters.
Conclusion: The obtained results show pathological changes in the voice of hearing-impaired persons, as well as the need for voice rehabilitation.
Keywords: voice disorders, acoustic voice analysis, moderately-severe hearing loss

Impact of education on quality of life of laryngectomized patients before and after vocal rehabilitation

Mila Bunijevac, Mirjana Petrović-Lazić, Siniša Maksimović

Biomedicinska istraživanja 2019; 10(1):30–37 doi:10.7251/BII1901030B

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Impact of education on quality of life of laryngectomized patients before and after vocal rehabilitation

Mila Bunijevac1,  Mirjana Petrović-Lazić2,3, Siniša Maksimović1,4


1Public Health Hospital “St Vračevi”, Bijeljina, The Republic of Srpska, Bosnia and Herzegovina
2Clinical and Hospital Center “Zvezdara”, Clinic of ENT and MFS, Belgrade, Serbia
3University of Belgrade, Faculty of Special Education and Rehabilitation, Belgrade, Serbia
4University of Banja Luka, Faculty of Medicine, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina

Introduction. Larynx carcinoma is one of the most common malignant tumors of the upper aerodigestive tract that causes the change in normal anatomical relationships in the neck, which leads to communication and social interaction disorders. The aim of the paper is to examine the impact of education on the quality of life of laryngectomized patients.
Methods.The study included 50 laryngectomized patients, aged 51 to 83 years. The subjective voice assessment was carried out using the Voice Handicap Index (VHI) and the University of Michigan Head & Neck Quality of Life Instrument (HNQOL). The patients filled in the questionnaires before and after vocal rehabilitation.
Results. The comparison of average scores of all examined laryngectomized patients before and after vocal rehabilitiation showed a statistically significant difference in the total score on VHI scale (107.20 ± 8.46 vs. 21.32 ± 13.29; p < 0.001), HNQO scale (52.50 ± 17.71 vs. 93.57 ± 6.36; p < 0.001), as well as on all subscales. Prior to vocal rehabilitation, there was no statistically significant difference between the scores on these two scales in patients with different level of education. After vocal rehabilitation, there was a statistically significant difference between the patients with secondary education and the ones with tertiary education in the scores on all VHI subscales, and total VHI score (23.60 ± 13.54 vs. 18.83 ± 11.59; p = 0.012), as well as in the scores for individual domains and the total score of HNQOL instrument (88.90 ± 6.58 vs. 99.80 ± 4.25; p = 0.048).
Conclusion. Vocal rehabilitation after total laryngectomy had a positive effect on patients’ quality of life, and patients with higher education showed a tendency towards better quality of life compared to the ones with lower education.
Keywords: total laryngectomy, education, vocal rehabilitation, quality of life

Analysis of stress level and burnout syndrome among physicians of different medical specialties in primary health care

Kosana Stanetić, Brankica Marković, Verica Petrović, Bojan Stanetić

Biomedicinska istraživanja 2019; 10(1):38–46 doi:10.7251/BII1901038S

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Analysis of stress level and burnout syndrome among physicians of different medical specialties in primary health care

Kosana Stanetić1,2, Brankica Marković1, Verica Petrović1,2, Bojan Stanetić2,3


1Dom zdravlja, Banja Luka, Republika Srpska, Bosna i Hercegovina
2Univerzitet u Banjaluci, Medicinski fakultet, Banja Luka, Republika Srpska, Bosna i Hercegovina
3Univerzitetski klinički centar, Banja Luka, Republika Srpska, Bosna i Hercegovina

Introduction. Burnout syndrome is a common problem among healthcare workers. The aim of the study was to investigate the level of stress, components of burnout syndrome and the most common causes of workplace stress among the physicians working in the Primary Health Care Center Banja Luka, after which the obtained results concerning family physicians and the physicians of other specialties were compared.
Methods. The observational study was conducted by interviewing physicians during the period March to May 2018. All employed physicians were provided with the following questionnaires: The socio-demographic questionnaire, The questionnaire for self-assessment of the level of stress, The questionnaire about the most frequent causes of stress at work and the Maslach Burnout Inventory.
Results. The study included 211 physicians, out of a total of 246 physicians (127 family physicians and 84 physicians of other specialties) working in the Primary Health Care Center Banja Luka. There was a significantly higher level of stress (p = 0.011), emotional exhaustion (p < 0.001) and depersonalization (p < 0.001) among family physicians compared to the physicians of other specialties. There was a significant difference in the presence of all causes of stress among family physicians, except the stress concerning the patients requiring emergency care. The multivariate logistic regression analysis found that stress was significantly associated with emotional exhaustion in both groups and with personal accomplishment in family physicians. In family physicians, there was a significant association between a high level of depersonalization and personal accomplishment. In physicians of other specialties significant association was found between education and emotional exhaustion as well as personal accomplishment, and between female gender and high level of depersonalization.
Conclusion. The level of stress and the burnout syndrome were considerably more present in family physicians compared to physicians of other specialties.
Keywords: stress, burnout syndrome, causes of stress, family physicians, primary health care

Aggressive behavior among women with intellectual disabilities receiving institutional long-term care

Bojana Mastilo, Bojana Vuković, Stevan Šeatović, Sladjana Ćalasan

Biomedicinska istraživanja 2019; 10(1):47–55 doi:10.7251/BII1901047M

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Aggressive behavior among women with intellectual disabilities receiving institutional long-term care

Bojana Mastilo1, Bojana Vuković1, Stevan Šeatović2, Sladjana Ćalasan1


1University of East Sarajevo, Faculty of Medicine Foča, The Republic of Srpska, Bosnia and Herzegovina
2PI “Sunce”, Prijedor, The Republic of Srpska, Bosnia and Herzegovina

Introduction. Aggressive behavior is defined as the behavior of such intensity, frequency and duration that it seriously threatens the physical safety of a person/persons or the one which seriously limits their social functioning. The aim of the paper is to determine the intensity and forms of aggression in institutionalized women with intellectual disabilities, in relation to the severity of their intellectual disability, age, as well as the length of stay in the institutional settings.
Methods. The sample comprised 115 female examinees receiving institutional long-term care in PI “The Center for People with Disabilities” in Visegrad. The Adult Scale of Hostility and Agression, Reactive/Proactve A- SHARP (Matlock & Aman, 2011) was used for the assessment of aggressive behavior.
Results. The results revealed that women with mild intellectual disabilities showed high aggression on all subscales, with the highest scores on the Hostility subscale (26.37 ± 7.37). In the group of examinees aged ≥51 years, there was a statistically significant difference on the Verbal aggression subscale compared to the group of women aged ≤30 years (13.89 ± 9.23 vs. 6.12 ± 9.39; p = 0.025). In the group of examinees who had stayed in the institutional settings for ≥10 years, a display of hostile aggression was more extreme compared to the group of patients with shorter length of stay in the institutional settings (22.49 ±11.22 vs. 17.58 ± 13.14; p = 0.033).
Conclusion. Women with mild intellectual disabilities showed the highest level of aggressive behavior on all subscales, whereby the highest scores were recorded on the Hostility subscale. Women aged ≥51 years showed the highest level of verbal aggression, while the examinees who had stayed in the institutional settings for ≥10 years displayed the highest level of hostile aggression towards others.
Keywords: aggressive behavior, intellectual disability, institution

Partnership relations of persons with anxiety and depressive disorders

Mira Spremo, Nada Vaselić

Biomedicinska istraživanja 2019; 10(1):56–63 doi:10.7251/BII1901056S

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Partnership relations of persons with anxiety and depressive disorders

Mira Spremo1,2, Nada Vaselić3


1University Clinical Center Banja Luka,,Psychiatry Clinic, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
2University of Banja Luka, Faculty of Medicine, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
3University of Banja Luka, Faculty of Philosophy, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina

Introduction. The presence of anxiety and depressive disorders in at least one partner adversely affects the quality of partnership relations. The aim of the study is to determine the degree of partner relationship satisfaction in relation to the existence of anxiety and depressive disorders.
Methods. The sample included 107 subjects divided into two groups depending on the presence of the above-mentioned disorders: Group 1, 52 examinees with anxiety and depressive disorders; Group 2, 55 examinees without diagnosed anxiety and depressive disorders. The following questionnaires were used: The Spielberger State-Trait Anxiety Inventory- STAI, The Beck’s Depression Inventory – BDI, The Relationship Assessment Scale- RAS and The Socio-demographic questionnaire.
Results. There was no a statistically significant difference between the two groups in socio-demographic characteristics, but the substance use disorder (χ2 = 20.90, p < 0.001) and fears in the family (χ2 = 13.62, p < 0.001) were more prevalent among the members of group 1 compared to the control group. The patients who were diagnosed with anxiety and depressive disorders achieved higher scores on all the scales. There was a statistically significant difference of high intensity between group 1 and group 2 on the Relationship Satisfaction Scale (25.56 ± 6.86 vs. 30.26 ± 4.47; p < 0.001). There was a statistically significant negative correlation between depression and anxiety as personality trait and current state and the Relationship Satisfaction Scale, whereby there was the strongest correlation between the Scale and anxiety as personality trait (p < 0.01).
Conclusion. The results of the study indicate the connection between anxiety and depressive disorders and partnership relations, which can be the starting point for the relationship education and counseling, as well as for the further research in this field.
Keywords: anxiety and depressive disorders, partnership relations

 

CASE SERIES

 

Switching therapy in patients with age-related macular degeneration, diabetic macular edema and cistoid macular edema due to retinal vein occlusion

Dijana Risimić, Jelena Karadžić, Miroslav Jeremić, Nada Avram

Biomedicinska istraživanja 2019; 10(1):64–70 doi:10.7251/BII1901064R

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Switching therapy in patients with age-related macular degeneration, diabetic macular edema and cistoid macular edema due to retinal vein occlusion

Dijana Risimić1,2, Jelena Karadžić1,2, Miroslav Jeremić2, Nada Avram3


1University of Belgrade, Faculty of Medicine, Belgrade, Serbia
2Clinic for Eye Diseases, Clinical Centre of Serbia, Belgrade, Serbia
3University Hospital, Foča, The Republic of Srpska, Bosnia and Herzegovina

Introduction. Intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents has revolutionized the management of age-related macular degeneration (AMD), diabetic macular edema (DME), macular edema in retinal vein occlusions (RVO), and other retinal diseases accompanied by neovascular and macular edema. The aim of the study is to show the effect of switching from bevacizumab to aflibercept in patients with recalcitrant wet AMD as the best clinical approach and regimen for patients with neovascular and macular edema accompanied retinal diseases.
Methods. All our patients received the intravitreal injections of 1.25 mg (0.1 mL) bevacizumab as the first treatment option, and we switched to aflibercept or triamcinolon acetonid when the therapy including bevacizumab seemed not to be effective enough, according to visual acuity and optical coherent tomography (OCT) findings.
Case presentations. We presented four cases: two patients with wet AMD, one patient with macular edema due to central retinal vein occlusion (CRVO) and one patient with DME in non-proliferative diabetic retinopathy (nPDR). The majority of our patients felt visual and anatomical improvement. Some patients felt anatomical improvement although their visual acuity did not improve. Switch to aflibercept had prolonged the positive effect of bavacizumab for approximately 2 months. When regular therapy including bevacizumab was reintroduced, the therapeutic effect would be prolonged. The effective clinical approach was not only the switching therapy but the combination therapy as well. Individual treatment approach and pro re nata regimen were most commonly used in our patients.
Conclusion. Switching anti-VEGF drug showed positive results in patients with refractory or recurrent wet AMD and macular edema.
Keywords: vascular endothelial growth factor agents, wet age-related macular degeneration, macular edema, switching therapy

 

REVIEWS

 

Preoperative treatment of locally advanced gastrointenstinal cancer

Ljiljana Vasić

Biomedicinska istraživanja 2019; 10(1):71–82 doi:10.7251/BII1901071V

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Preoperative treatment of locally advanced gastrointenstinal cancer

Ljiljana Vasić


Clinical Center Kragujevac, Center for Oncology and Radiology, Department of Radiotherapy, Kragujevac, The Republic of Serbia

Surgical treatment of locally advanced gastrointestinal cancer alone does not exhibit satisfactory local disease control and survival rate. The advantage of using radio and chemotherapy at this stage is to reduce the likelihood of developing local recurrence with an extension of survival time, while the disadvantages are the increase in postoperative mortality and morbidity. The subject of many studies has been to determine the localization in which preoperative treatment is justified, as well as the order for applying radio and chemotherapy, without endangering the patient’s life. This paper summarizes the current findings on the investigated problem suggesting that preoperative treatment has influenced the change in surgical indications for the treatment of cancer in this region. The use of preoperative treatment in esophagus, stomach, rectum and anus cancer is justified since it reduces the likelihood of developing local recurrence. Nevertheless, it does not increase the survival rate where patients with the rectal and stomach cancer are concerned. Furthermore, preoperative treatment increases the postoperative mortality and morbidity of esophagus and anus cancer, while its use in the treatment of pancreatic cancer is still the subject of many clinical studies. In surgery, preoperative treatment has led to modification in the techniques used in the treatment of rectal cancer, as well as to the reconsideration of the extent of lymphadenectomy of the esophagus and stomach cancer, while in the case of anus cancers, surgical treatment is not considered to be the initial form of curative therapy at this stage.
Keywords: preoperative treatment, locally advanced stage, gastrointestinal tract, radiotherapy, chemotherapy, recurrence, survival rate

Neoadjuvant therapy for HER2-positive breast cancer

Nikolina Dukić, Zdenka Gojković, Nenad Lalović, Jelena Vladičić-Mašić, Dragana Jokanović, Srđan Mašić, Slađana Popović, Olivera Čančar

Biomedicinska istraživanja 2019; 10(1):83–90 doi:10.7251/BII1901083D

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Neoadjuvant therapy for HER2-positive breast cancer

Nikolina Dukić1,2, Zdenka Gojković3, Nenad Lalović2,4,
Jelena Vladičić-Mašić1,2, Dragana Jokanović1,2, Srđan Mašić2, Slađana Popović1,2, Olivera Čančar1,2


1University Hospital Foča, Center for Internal Medicine, The Republic of Srpska, Bosnia and Herzegovina.
3University Clinical Center of the Republic Srpska, Clinics in Oncology, Banja Luka, The Republic of Srpska,
Bosnia and Herzegovina.
4University Hospital Foča, Surgery Branch, The Republic of Srpska, Bosnia and Herzegovina.
2University of East Sarajevo, The Faculty of Medicine, Foča, The Republic of Srpska, Bosnia and Herzegovina

The human epidermal growth receptor 2 (HER2, c-erb-B2) is present in 15-20% of breast cancer at the time of diagnosis. Overexpression of HER2 receptor is associated with more aggressive form of breast cancer. Trastuzumab is a human monoclonal antibody that blocks the signaling pathways of cell proliferation by binding to the HER2 receptor. Due to the possible occurrence of resistance to trastuzumab (binds to the subdomain of II HER2 receptor and thus achieves the ligand-independent inhibition of cell proliferation), another monoclonal antibody pertuzumab was produces in the course of time (binds to the subdomain of IV HER2 receptor and thus achieves the ligand-dependent inhibition of cell proliferation), forming the basis of dual HER2 receptor blockade. Numerous studies have shown the benefits of administering trastuzumab and pertuzumab, initially in metastatic, and then in adjuvant and neoadjuvant regimens. Neoadjuvant (preoperative) therapy is given in inoperable tumors, in patients at high risk of poor outcomes (HER2-positive tumors, nodus positive tumors, inflammatory breast cancer, large tumors), as well as in additional risk factors – HR negative tumors where no beneficial effect is expected from the hormonal therapy in the adjuvant setting. Neoadjuvant therapy also provides an “in vivo” insight into the tumor response to neoadjuvant therapy. A pathological complete response (pCR) is an early parameter of the effectiveness of neoadjuvant therapy which also allows us to discover the sensitivity of the tumor in time and make a decision on adjuvant treatment. pCR has a predictive and prognostic value. Namely, the rate of pCR is associated with desease-free survival and overall survival. On the basis of the rate of pCR, numerous studies have shown that there are subgroups of HER2-positive breast cancer: subgroup of hormone receptor-negative tumors that have a higher response rate to the existing anti-HER2 therapy and HER2-positive breast carcer; the subgroup of hormone-dependent tumors in which an adequate pCR rate is not achieved by existing therapeutic options, which represents a new area of research and the possibility for finding new treatment strategies.
Keywords: breast carcer, HER2 receptor, neoadjuvant therapy, pCR, trastuzumab, pertuzumab

Clinical characteristics, prognosis and outcome of patients with repaired tetralogy of Fallot

Biljana Milinković, Dejan Bokonjić, Bojan N. Joksimović, Verica Prodanović

Biomedicinska istraživanja 2019; 10(1):91–100 doi:10.7251/BII1901091M

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Clinical characteristics, prognosis and outcome of patients with repaired tetralogy of Fallot

Biljana Milinković1, Dejan Bokonjić2, Bojan N. Joksimović2, Verica Prodanović1


1University Hospital Foča, The Republic of Srpska, Bosnia and Herzegovina
2University of East Sarajevo, Faculty of Medicine, Foča, The Republic of Srpska, Bosnia and Herzegovina

Progress in diagnosis and treatment has led to a significant improvement in the fate of children born with tetralogy of Fallot, with the perioperative mortality of 2-3% and a 30-year survival rate of 90%. However, the majority of these patients have residual postoperative morphological and hemodynamic disorders, as well as heart rhythm disorders, primarily due to the volume loading of the right ventricle caused by chronic pulmonary regurgitation. Improved surgical techniques have reduced early mortality to less than 3%, but the annual mortality rate has increased 20-30 years after initial surgical remediation, mainly due to unwanted cardiac events. In longitudinal monitoring of patients after repair of tetralogy of Fallot, early detection of morphological and hemodynamic residual disorders both in asymptomatic and symptomatic patients is of great importance. The purpose of this is a timely identification of new therapeutic measures (e.g. pulmonary valve replacement) in order to improve the course and outcome of treatment. Cardiovascular magnetic resonance imaging is a diagnostic method that provides the most precise and accurate estimation of individual parameters of cardiac dysfunction and poor outcomes. Furthermore, it plays a significant role in defining the predictive ability of individual parameters. Previous research has shown that the increase in mortality risk coincides with progressive dilation and right ventricular dysfunction, by means of ventriculo-ventricular interaction and left ventricular dysfunction. Identification of parameters that can predict the high-risk patients for future unwanted cardiac events such as ventricular tachycardia and cardiac insufficiency can assist the customization of a therapeutic approach leading to improvement in quality of life and patient’s survival rate.
Keywords: tetralogy of Fallot, right ventricular dysfunction, cardiovascular magnetic resonance imaging,
prognosis

 

FOR PRACTICE

 

Prevention of viral infection transmission in dental practice

Jovana Hrisa Samardžija, Biljana Mijović, Marina Milinković

Biomedicinska istraživanja 2019; 10(1):101–108 doi:10.7251/BII1901101S

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Prevention of viral infection transmission in dental practice

Jovana Hrisa Samardžija, Biljana Mijović, Marina Milinković


University of East Sarajevo, Faculty of Medicine Foča, The Republic of Srpska, Bosnia and Herzegovina

Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) are the main bloodborne pathogens and are of considerable interest for the dental team. In dentist’s surgery, HBV, HCV and HIV infections can be transmitted via direct contact with blood and saliva containing blood, or via indirect contact with contaminated dental instruments during and after work. The use of sharp dental instruments at work, as well as the treatment of patients who feel pain and are under stress, present risk factors for exposure incident development. For this reason, special measures to protect against viral infections should be imposed. A vaccine presents specific protection against HBV. Non-specific protection includes the protection of staff and patients, specific approach while working with contaminated dental instruments, specific hygiene of working surfaces and equipment in the dentist’s surgery, as well as medical waste disposal. Prevention of exposure is the primary strategy leading to the reduction in occupational infections. In addition to this, for HBV, HCV and HIV infections a post-exposure prophylaxis is prescribed, the application of which has a satisfactory efficiency.
Keywords: hepatitis B virus, hepatitis C virus, human immunodeficiency virus, dental service, specific and non-specific protective measures