Mirjana Janicijevic-Petrovic

A toxic hepatitis caused the kombucha tea - case report.

Investigation of adverse reactions toxic substances in the liver is a challenge of modern hepatology. It should not be forgotten that toxic hepatitis may clinically be manifested as other diseases of the liver, where it must always be considered in the differential diagnoses of unexplained liver damage in poisoning with the kombucha tea. The pathogenesis and mechanism of liver damage in most of toxins is unknown. It may be experienced as an allergic and/or toxic reaction. Considering that various microorganisms already habituate on kombucha, between those are acid bacterias (from apple acid used for preparing) which are using the oxygen, and from the other side we have yeasts which are facultative anaerobes.

Tumor of orbit

The cavernous hemangiomas are the most common intra orbital tumors found in adults of the middle age. Although histological benign, they can encroach on intra orbital or the adjacent structures (optic nerve) and be considered anatomically or positional malignant. We present a case report of orbital cavernous hemangioma of right orbit in young women after pregnancy, from Topola near Kragujevac (Central Serbia) with visual compromise and its by trans-nasal endoscopic surgical management. Our patient was controlled and treated with the symptomatic therapy, topical therapy with artificial tears and surgical treatment. Our patient has optimal visual acuity of affected right eye after surgical treatment of orbital tumor. Surgical treatment of symptomatic orbital cavernous hemangioma is safe and effective, so that the cosmetic results are the important parameter to evaluate the clinical outcome.

Autologous Serum Eye Drops for Post-Chemical Injuries and Corneal Epithelial Defects

Abstract Aim: To evaluate success rate (efficacy, safety) in treatment of post-chemical injuries and corneal defects using autologous serum eye drops. Material and Methods: Authors reviewed 93 patients (116 eyes) hospitalized in Clinic of ophthalmology from 2010 to 2013, who had post-causoma corneal defects that were nonresponsive to conventional treatment and were treated with serum therapy. Authors correlated time of epithelialization of defects with rate of epithelial healing. Results: Authors investigated 93 patients (52 males, 41 females; aged 18 - 74) for treatment of corneal defects. Application of autologous serum therapy 56 (48.28%) of 116 eyes was healed in an average time of 4 weeks. Among 116 eyes, epithelial defects healed in 4 (3.45%) within 1 week, in additional 17 (14.65%) in 1-2 weeks, totalling 31 (26.72%) within 3 weeks. Five eyes (4.31%) completely healed at 5 week; three eyes (2.59%) had subsequent healing of epithelial defect at 6 week; 56 eyes completely healed within one month, and the remaining eight eyes healed within 1.5 month. Conclusion: Using serum therapy, it was managed to reduce time of healing from eleven weeks, which were necessary just couple years ago (before 2010) to four (maximum six) weeks to complete healing which are necessary today.

The efficacy of moxifloxacin in patients with bacterial keratitis

Background/Aim. Keratitis is a sociomedical problem of moderately developed countries. including Serbia, too. The incidence of bacterial keratitis in the world is about 20% in relation to all keratitis, but its frequency in Serbia is still not known. Bearing in mind the complications in the front segment of the eye after bacterial keratitis (ulcer, neovascularization, fibrosis) and decline in visual acuity, it was necessary to assess the efficacy of local therapy by moxifloxacin which will shorten the healing time and reduce complications. The aim of the study was to analyze the efficiency of shortening the treatment of bacterial keratitis with moxifloxacin. Methods. The study was designed as prospective, randomized, double-blind study. The study included 30 patients with diagnosed keratitis and locally applied antibiotic moxifloxacin, and 60 patients in a control group, with locally applied artificial tears. All participants were subjected to complete clinical ophthalmologic analysis (2015/16), for a period of 1–15 days after the application of therapies (healing time of corneal pathology). The following was determined in all patients: degree of hyperemia, degree of epithelial defect, level of corneal sensitivity, level of tear secretion and tear quality, degree of conjunctival secretion, degree of neovascularisation and corneal scarring, degree of visual acuity, score of subjective symptomatology and correlation of ophthalmological findings and subjective symptoms. Results. There was a statistically significant difference in times of therapeutic efficacy/clinical response between the study group patients who received moxifloxacin and the control group patients who received arteficial tears. Conclusion. Local application of moxifloxacin had therapeutic effect (total benefit) both in terms of the effective shortening of the healing time and also the reduction of the complications of bacterial keratitis, without unwanted effects.

Characteristics of chemical eye injuries

Introduction: Chemical eye injuries are described as trauma of the eye, which represent an urgent state in ophthalmology, and are mostly localized, on the anterior segment. Causes of injuries are acid, alkali, mixed and non identified agents. Diagnostic procedures are easy, but therapy is complex. Aim: to describe the historical characteristics of chemical eye trauma and analyze the causes as the most common agents involved in chemical injuries at tertiary level of referent region. Material and Methods: The retrospective study conducted on data of the chemical eye injuries presented at Clinic of ophthalmology in Clinical Centre of Kragujevac (Central Serbia) in past three years. One hundred and thirteen patients (164 eyes) who were presented from September, 2013 to September, 2015 for observation with chemical eye injuries were included in this study. Authors analyzed and showed the most important of historical characteristics: gender, age, categories of chemical agents and location of the accident. Results: Males were more often reported with injures than females (66.37% vs. 33.63%). The mean age across categories was 46-60 years (54, 47.79%). The most common categories of chemical agents: hydrochloric acid - 42 eyes (25.61%), acetic acid - 37 eyes (22.56%), quicklime - 37 eyes (22.56%), quenched - 24 eyes (14.63%) and mixed - 24 eyes (14.63%). The location where injury occurred was mostly at home - 84 eyes (51.22%) and at work - 80 eyes (48.78%). Conclusion: Correlation of references from this study and world references in the medium urban countries with dominators light industries was developed to be relatively identical. In frequency from this study allocated by chemical eye injury - males dominated professionally in social and private industry sector while female in households while maintaining general hygiene dominated it. Frequently bases were quenched and quicklime. The most common location was inside the home.

Effects of intra and postoperative steroid injection of pterygium surgery

Sažetak: Uvod: Pterigijum je degenerativno oboljenje konjunktive sa afekcijom rožnjače oka. Svrha: Cilj rada je da se utvrdi efekat intra i postoperativne primene steroida u tretmanu primarnog i rekurentnog pterigijuma sa intralezionom aplikacijom subkonjunktivalnih injekcija. Metode: U studiju je uključeno 62 pacijenta (79 očiju) sa primarnim pterigijumom, i 57 pacijenata (64 oka) sa rekurentnim pterigijumom. Aplikacije: Triamcinolon-acetonida (Kenalog-40) kod operacija pterigijuma vršene su u našoj Klinici za oftalmologiju od 3. maja 2010. do 3. maja 2013. Pre i postoperativno aplikovane su dve do tri subkonjunktivalne injekcije steroida sa kliničkim praćenjem i evaluacijom kliničkih znakova regresije primarnog i rekurentnog pterigijuma, a u korelaciji sa kontrolnom grupom. Rezultati: Kod svih naših ispitanika došlo je do kompletne rezolucije primarnog i rekurentnog pterigijuma. Rekurentni pterigijum se pojavljivao jedino kod očiju u kontrolnoj grupi, kao kompletni recidiv, kod kojih nije primenjena subkonjunktivalna steroidna terapija ni na jednoj od kontrola, nakon jednog, šest i dvanaest meseci. Zaključak: Za kompletnu rezoluciju primarnog i recidivantnog pterigijuma potrebna je primena jedna do dve intralezione, subkonjunktivalne steroidne injekcije. Ključne reči: primarni pterigijum, rekurentni pterigijum, hirurški tretman, Triamcinolon-acetonid

Congenital blindness and visual impairment cause infection or non infection.

Conflict of interest: none declared. Introduction Authors are from reference documentation to archive at Organization of Federation of blind and visually impaired in central Serbia (Kragujevac), by retrograde analysis, of 2007-2012, comprehend two groups by etiology–clinical characteristics of congenital blindness and visually impaired, caused infection or non infection example. Aim to analyze relationship between infectious and non infectious of congenital blindness and visually impaired in our referent region and compare with world references. Material/methods With 6-years analysis included the most frequency cases of congenital blindness and visually impaired in two groups, according to presence or absence infectious causes. From infectious causes of congenital blindness and visually impaired are included: CMV – infection, congenital rubella syndrome, congenital toxoplasmosis, congenital syphilis and rare mixed syndrome. From non infectious causes are included: retinitis pigmentosa, retinopathy prematurity, primary congenital glaucoma, Leber’s congenital amaurosis and rare syndrome. Results: From total number of registered blind and visually impaired – 1308 (100%), over the last 6 years, the registration was 349 (26.68%) with congenital blindness and visually impaired. From recorder with the number of the most common congenital blindness and visually impaired–194 (55.59%) with infections cause, and 155 (44.41%) non infection cause. Conclusion: Congenital blindness has shown permanent increase in past 6 years, in group with infectious and with non infectious causes. Congenital blindness and visually impaired of the most common etiology among registered members of our association in Kragujevac is subject of our correlation and global trends mentioned observation of these diseases.

„Obesity Paradox“ – Fiction or a Fact?

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“.

Treatment of Multiple Chalazions with Intralesional Kenalog-40 Injections in Juvenile Patient: A Case Report

Abstract Aim: To case report the efficacy of subcutaneous steroid injections in the treatment of multiple chalazions and to evaluate the safety of intralesional injection in primary and recurrent chalazions in juvenile patient. Case report: A 25-year-old man noticed lesions which appeared on upper lid during past three months. It was clinically presented with three focal, large and painful nodules in upper right eyelid. Inflammation process began on May the 1st of 2013. After one month in May 30th 2013 was directly administered synthetic steroid, Kenalog-40. Application of triamcinolone acetonide resulted in two satellite lesions, compared to the original, when the same incisions drained during the first surgery in July 5th 2013, with topical antibiotic-steroidal drugs and hot compresses. Second surgery was in July 26th 2013. Third surgery was performed in August 5st 2013 with second application of Kenalog-40. Combined treatment leads to recovery of clinical signs and inflammation of right upper eyelid with regressions of primary and recurrent chalazions. Conclusion: Two steroid subcutaneous injections produced complete resolution of multiple primary and recurrent chalazions. Clinical imperative was that recurrent or unusual refractory chalazions require referral to Hystopathological examination of curetting to exclude malignancy. Introduction Chalazion is commonly benign as collection of chronic inflammatory lipogranulomatous tissue formed from meibomian glands which are lining the tarsus of the eyelid that is the site of pathology in a chalazion. Numerous meibomian glands located in the tarsus release an oily secretion that creates the precorneal tear film. Blepharitis or eyelid inflammation produces debris which can occlude meibomian gland orifices. There are two types of chalazion - external and internal, depending of localization in the eyelid. The main symptoms of chalazion include redness, swelling and swollen eyelids with painful and hard nodule [1]. Differential diagnosis

Comparison of primary medicament therapy effects and primary argon laser trabeculoplasty on regulation of intraocular pressure and stability of perimetry findings in open angle glaucoma

INTRODUCTION/AIM Argon Laser Trabeculoplasty (ALT) is a recognized method for reducing intraocular pressure (IOP) in patients with open angle glaucoma. The aim of this study was to compare the effects of primary medicament therapy and primary ALT on IOP regulation and stability of perimetry findings. METHODS A total of 50 eyes of 35 patients were treated with primary ALT while 50 eyes of 36 patients were treated with primary medicament therapy with 0.5% timolol with 20, 0.005% latanoprost 18 and with 2% dorzolamid 12 eyes. IOP was controled at 3 months, and the visual field at 6 months during a 30-month follow-up period. RESULTS In the first 24 months of follow-up there was no statistically significant difference in percentage of eyes with successfully regulated IOP. At 27th and 30th month, in the group primarily treated with medicaments a statistically significant higher percentage of successfully regulated IOP was observed in 98%, and 96% of the eyes, respectively, while in the group primarily treated with ALT the decline in the percentage of successfully regulated IOP was observed in 78% and 76% of the eyes, (chi2-test, p = 0.002, p = 0.140). Both therapy groups showed stability of perimetry findings without statistically significant difference in the values of mean deviation (MD) index until the end of the monitoring period. The dynamics of change in MD index value showed a statistically significant greater decline in this parameter in subjects who had been primarily treated with medications during the last six months of follow-up, (two-factor analysis of variance with a repeated measurement, factor of time x type of therapy, p = 0.030). CONCLUSION Primary ALT equally successfully regulates IOP and restores stability of perimetry findings in patients with open angle glaucoma like the primary medicament therapy.