Aleksandra Ilic

Scoring Systems in Assessing Survival of Critically Ill ICU Patients.

Background The aim of this study was to determine which of the most commonly used scoring systems for evaluation of critically ill patients in the ICU is the best and simplest to use in our hospital. Material/Methods This prospective study included 60 critically ill patients. After admittance to the ICU, APACHE II, SAPS II, and MPM II0 were calculated. During further treatment in the ICU, SOFA and MPM II were calculated at 24 h, 48 h, and 72 h and 7 days after admittance using laboratory and radiological measures. Results In comparison with survivors, non-survivors were older (p<0.01) and spent significantly more days on mechanical ventilation (p<0.01). ARDS was significantly more common in patients who survived compared to those who did not (chi-square=7.02, p<0.01), which is not the case with sepsis (chi-square=0.388, p=0.53). AUROC SAPS II was 0.690, and is only slightly higher than the other 2 AUROC incipient scoring systems, MPM II and APACHE II (0.654 and 0.623). The APACHE II has the highest specificity (81.8%) and MPM II the highest sensitivity (85.2%). MPM II7day AUROC (1.0) shows the best discrimination between patients who survived and those who did not. MPM II48 (0.836), SOFA72 (0.821) and MPM II72 (0.817) also had good discrimination scores. Conclusions APACHE II and SAPS II measured on admission to the ICU were significant predictors of complications. MPM II7day has the best discriminatory power, followed by SOFA7day and MPM II48. MPM II7day has the best calibration followed by SOFA7day and APACHE II.

Influence of spinal and general anesthesia on the metabolic, hormonal, and hemodynamic response in elective surgical patients.

Background The aim of the study was to determine the significance of spinal anesthesia in the suppression of the metabolic, hormonal, and hemodynamic response to surgical stress in elective surgical patients compared to general anesthesia. Material/Methods The study was clinical, prospective, and controlled and it involved 2 groups of patients (the spinal and the general anesthesia group) who underwent the same surgery. We monitored the metabolic and hormonal response to perioperative stress based on serum cortisol level and glycemia. We also examined how the different techniques of anesthesia affect these hemodynamic parameters: systolic arterial pressure (AP), diastolic AP, heart rate (HR), and arterial oxygen saturation (SpO2). These parameters were measured before induction on anesthesia (T1), 30 min after the surgical incisions (T2), 1 h postoperatively (T3) and 24 h after surgery (T4). Results Serum cortisol levels were significantly higher in the general anesthesia group compared to the spinal anesthesia group (p<0.01). Glycemia was significantly higher in the general anesthesia group (p<0.05). There was a statistically significant, positive correlation between serum cortisol levels and glycemia at all times observed (p<0.01). Systolic and diastolic AP did not differ significantly between the groups (p=0.191, p=0.101). The HR was significantly higher in the general anesthesia group (p<0.01). SpO2 values did not differ significantly between the groups (p=0.081). Conclusions Based on metabolic, hormonal, and hemodynamic responses, spinal anesthesia proved more effective than general anesthesia in suppressing stress response in elective surgical patients.

Meta-analysis of the changes in correlations between depression instruments used in longitudinal studies.

BACKGROUND Correlations between instruments measuring the same construct reflect their concurrent validity. Little is known about changes in correlations between such instruments employed in studies with repeated assessment. The aim of this meta-analysis was to examine the changes in correlations between depression instruments in the course of longitudinal studies. METHODS A literature search was conducted using MEDLINE and PsycINFO for the period from 1960 to 2013. The total number of collected articles was 3723, of which 61 were included. Three meta-analyses were performed for the changes in correlations between each pair of the three depression scales: Hamilton Rating Scale for Depression (HAMD), Montgomery-Asberg Depression Rating Scale (MADRS) and Beck Depression Inventory (BDI). The effect size in these meta-analyses was obtained by the z-transformation of correlation coefficients. RESULTS Correlations between depression scales increased over time in 52 studies. Significant changes in correlation coefficients were found for correlations between HAMD and BDI (p<0.001) and for correlations between HAMD and MADRS (p<0.001). An increase in correlations between the scales was associated with a decrease in depression scores and increase in their variability. LIMITATIONS Univariable and multivariable meta-regression models were not obtained in all three meta-analyses because of the lack of data. CONCLUSIONS A finding that correlations between depression instruments tended to increase over time has significant implications for assessment of the concurrent validity of these instruments. In longitudinal designs it is important to estimate correlations between depression scales over time because different thresholds for scale correlations indicate acceptable concurrent validity at different times.

12. Right ventricle in gestational hypertension

Introduction It is unknown if and how right ventricle changes during gestational hypertension. Purpose The purpose of this study was to determine right ventricle dimensions, systolic and diastolic function changes in gestational hypertension (GH) Methods Study included 60 pregnant women. 35 with GH and 25 normotensives as control. Echocardiography was performed to evaluate right ventricle and atrial size (RV diastolic diameter at the base and mid level, proxymal and distal dimension of outlet tract, RA volume) systolic function (TAPSE, FAC, S′, IVCT, ET, GLS), RV index of myocardial performance (RIMP), and diastolic function (E/A, EDT, E/e’, RAVsI, IVRT) of the right ventricle. Echo was performed in the third trimester and 6 weeks after delivery. Results 1. Participants with GH during pregnancy had normal values of right ventricle and atrial size, systolic function, and diastolic function except E/e’, whose mean value was 6.354+-2.100. 2. Women with GH had larger RA volume (33.66 ± 11.8 vs 24.75 ± 9.1, p  3. Some parameters of diastolic function did differ: E/a was significantly lower in group with hypertension(1,1 ± 0,26 vs 1,4 ± 0,21 p  4. All changed echocardiographic parameters became improved six weeks after delivery, the difference persisted only in s’ (0.119 ±  0.014 vs 1,45 ± 0,021 p  Conclusion Right ventricle dimensions are not significantly affected by gestational hypertension. Both systolic and diastolic function of right ventricle changed in gestational hypertension during pregnancy. After delivery, changes were reversible, but only s’ remained lower, as a suggestion of not fully recovered systolic function.

The Prevalence of the Most Important Risk Factors Associated with Cervical Cancer

Introduction/ Goals: The aim of our study was to point out the importance of the risk factors associated with cervical cancer in an asymptomatic population. Methodology: The study included 860 patients in the period from January 2017 to January 2018, which covered more than 80% of the targeted population in this municipality over the one year study, according to the National Program for Cervical Cancer Prevention in Montenegro. Results: The incidence of PAP III results was statistically significantly higher in women between 40 and 45 years of age compared to other age groups (p< 0.001). PAP III was statistically significant high in subjects who had vaginal delivery (p<0.001), and was statistically significantly more frequent in women with more than two children (p = 0.011), while all the subjects with positive PAP results III had children. PAP III results were statistically significantly higher in subjects who had sexual intercourse before the age of 18 (p< 0.001), and were statistically significantly more frequent in subjects who were on oral contraceptives (p< 0.001). PAP III test results also show a significant difference related to cigarette consumption (p< 0.001). PAP III results were significantly more frequent in subjects with grade III vaginal cleanliness compared to grade II vaginal cleanliness (p<0.001). Conclusion: The number of patients with cervical cancer in Montenegro increased in the period from June 2016 to June 2017, compared to previous years, even though the National Program for Cervical Cancer Prevention that aimed to reduce the number of such patients has been in use in Montenegro since 2011.