Dragan Veselinovic

Prognostic significance of intracranial pressure monitoring and intracranial hypertension in severe brain trauma patients.

Since without prospective randomized studies it is not possible to have a clear attitude towards the importance of intracranial pressure monitoring, this study was aimed at examining the prognostic effect of the intracranial pressure monitoring and intracranial pressure oriented therapy in severe brain trauma patients, and at defining optimal intracranial pressure values for starting the treatment. Two groups of patients were treated in the study, one consisted of 32 patients undergoing intracranial pressure monitoring and the second group of 29 patients without intracranial pressure monitoring in the control group. The study was prospective with groups randomized. There were 53% survivals in the intracranial pressure monitored patients and 34% in the control group, with no significant difference in the survival rate between the two groups (chi2=2.11; p=0.15; p>0.05). The average intracranial pressure in the patients with intracranial hypertension who died was 27 mm Hg, while in the patients who survived the average intracranial pressure was significantly lower (Students t test: t=2.91; p=0.008; p<0.01) and it was 18 mm Hg. We recommend starting intracranial pressure oriented therapy when the patients intracranial pressure exceeds 18 mmHg during 2 hours of monitoring.

Efficacy of TNF-α antagonist and other immunomodulators in the treatment of patients with ophthalmologic manifestations of Behcet's disease and HLA B51 positive vasculitis

BACKGROUND/AIM Behcets disease is genetically conditioned, immune-mediated multisystem occlusive vasculitis of small blood vessels, espesially venules, of unknown etiology. The aim of this study was to analyze the clinical features, disease activity and therapy of the patients with ophthalmologic manifestation of Behcets disease. METHODS In this study symptoms and signs of the disease were analyzed both prospectively and retrospectively during the active manifestation of the disease. The diagnosis was reached according to the International Criteria for Behcets Disease (2006). The treatment effects were evaluated based on the presence of the best corrected visual acuity and the inflammation of the vitreous humour before and after the application of our therapeutic method. The applied therapeutic modality consisted of the primary application of corticosteroid therapy in the active stage of the disease complemented with the choice of drugs from the immunosuppressive group. In this study there drugs were cyclosporine or methotrexate. A treatment refractory patients with poor vision prognosis were treated with a third drug, the biological preparation infliximab, a tumor necrosis factor-alpha (TNF-alpha) antagonist. RESULTS The mean age of 11 patients with ophthalmologic manifestation of Behcets disease was 50.6 years. HLA B-5 (51) was positive in 81% of the patients while 36% of the patients had positive pathergy test. Changes in affected eyes included vitritis (100%), posterior uveitis (45%), panuveitis (54%), retinal vasculitis (54%), cystoid macular edema (54%), and cystoid degeneration (18%). Increased intraocular pressure was observed in 27% of the patients. There was no statistically significant variation in disease activity parameters in any of the patients (p > 0.05). A statistically significant improvement in visual acuity (p < 0.05) and a high statistically significant decrease of inflammation of the worst affected eyes (p = 0.001) were detected. CONCLUSION Our therapeutic method is useful for producing the optimal therapeutic plan for the acute--chronic stage of the difficult ophtamological manifestation of Behcets desease as well as the prevention of relapse. However the high cost of the therapy and the potential complications should be taken into consideration when prescribing this therapy, especially a TNF-alpha antagonist.

Analysis of conjunctival bacterial flora in the preparation of patients for cataract surgery

Sažetak: Mikroorganizmi odgovorni za intraokularnu infekciju u ve ini sluč jev su identični o g nizmima koji postoje na okularnoj pov šini i očnim dneksim p cijent . Svrha preoperativne i postoperativne profilakse infekcija je da se smanji rizik infekcije iz bakterijske flore adneksa oka i da se eliminišu bakterije koje kontaminiraju ranu za vreme operacije. Cilj n šeg ist iv nj je mik obiološk n liz b kte ijske flo e ve nj če, p eope tivn e dik cij iste, u smislu profilakse endoftalmitisa nakon operacije katarakte i utv Ďiv nje efik snosti p imene ofloks cin 0,3% u edukciji b kte ij . U studiju je uključeno 120 p cijenata sa senilnom kataraktom, selektov nih n Klinici z očne bolesti Kliničkog cent u Nišu, podeljenih u dve g upe od po 60 pacijenata. Kontrolna grupa od 60 pacijenata nije dobila antibiotsku terapiju preoperativno. Druga grupa od 60 pacijenata je dobila lokalno, u vidu kapi ofloksacin 0,3%, četi i put dnevno, četi i d n p e ope cije i četi i put u dva sata pre operacije. Ispitivanje bakterijske flore ve nj če je v šeno u b isu ve nj če oba oka stand dnim mik obiološkim p ocedurama. Bris konjunktive je uziman svim pacijentima pri selekciji za operaciju (p vi b is), četi i d n p e ope cije (d ugi b is) i nepos edno p e početk ope cije i ulaska u operacionu salu (t e i b is). U kontrolnoj grupi pacijenata, nalaz prvog i drugog brisa ve nj če je bio pozitivan kod devetoro, a neg tiv n kod 51 p cijent . P i t e em b isu n l z se nije p omenio (9 pozitivnih i 51 negativan bris). Nije postoj l st tistički zn č jn zlik izmeĎu n l z p vog, d ugog i t e eg b is p cijen t kont olne g upe (χ2 test, p>0,05). U terapijskoj grupi pacijenata, nalaz prvog i drugog brisa ve nj če bio je pozitiv n u šest sluč jev , neg tiv n kod 54 p cijent . N l z t e eg b is ove g upe je bio ste il n kod svih 60 p cijen t . Utv Ďen je st tistički signifik ntn zlik izmeĎu n l z d ugog i t e eg b is p cijen t te pijske g upe, tj. postoji povez nost izmeĎu p imenjene te pije i ishod lečenj bolesnik (χ 2 test, p<0,05). MeĎu 15 pozitivnih nalaza brisa ve nj če, k o n jčeš i uz očnici infekcije n Ďeni su: Staphylococcus aureus (6 briseva) i Staphylococcus epidermidis (5 briseva), Enterobacter spp. (2 brisa), Proteus mirabilis i Pseudomonas aeruginoza sa po jednim brisom. Lokalno primenjen ofloks cin 0,3% četi i d n p e ope cije i četi i put u dv s t p e operacije je efikasan u eliminaciji bakterijske flore ve nj če i posti e ste ilnost u svim sluč jevim . Ključne reči: bakterijska flora, ve nj č , katarakta, profilaksa, endoftalmitis, ofloksacin 0,3%.

Prevalence of Chlamydia trachomatis in adults with chronic conjunctivitis in Nišava district

INTRODUCTION Chlamydia trachomatis causes many infections, including eye infections. They manifest as inclusion conjunctivitis and trachoma. The agent is transmitted by dirty hands, eyeliners, medical instruments and via swimming-pool water or, in neonates, by passage through an infected birth canal. Due to the nonspecific clinical features at the beginning of the infection and delayed application of symptomatic, anti-allergic and non-specific antibiotic therapy, Chlamydia aetiology is usually established only after laboratory diagnosis in the chronic stage of infection. OBJECTIVE Determining the frequency of Chlamydia trachomatis antigen in conjunctival and genital samples of adult patients with chronic conjunctivitis in Nisava district. METHODS Our retrospective study was carried out on 116 patients (63 female and 53 male) with clinical signs and symptoms of chronic conjunctivitis. Chlamydia trachomatis antigen was detected by a direct immunofluorescence test with labelled monoclonal antibodies. RESULTS From a total of 116 examined patients in 37 patients Chlamydia trachomatis antigen was detected; 17 female and 20 male. Thirty-three of the patients had a bilateral infection and four unilateral. Among 24 patients who were also tested for Chlamydia trachomatis antigen collected by ocular and genital swabs, 19 had conjunctivitis associated with urethritis/vaginitis. CONCLUSION The studied group of patients showed that the common cause of the chronic conjunctivitis were bacteria, but predominantly Chlamydia trachomatis. In most cases Chlamydia infection occurred bilaterally. The majority of patients had eye Chlamydia infection associated with genital Chlamydia infection. There was no statistically significant difference in the presence of the disease regarding gender.