Sandra Sipetic-Grujicic

Prognostic significance of non-muscle-invasive bladder tumor history in patients with upper urinary tract urothelial carcinoma

OBJECTIVE To evaluate the prognostic factors for survival and disease recurrence in patients treated surgically for upper tract urothelial carcinoma (UTUC), focusing especially on the impact of history of non-muscle-invasive bladder cancer. PATIENTS AND METHODS A single-center series of 221 consecutive patients who were treated surgically for UTUC between January 1999 and December 2010 was evaluated. Patients who had a history of bladder tumor at a higher stage than the upper tract disease, preoperative chemotherapy, or previous contralateral UTUC were excluded. None of the patients included in this study had distant metastasis at diagnosis of UTUC. In total, 183 patients (mean age 66 years, range 36-88) were then available for evaluation. Tumor multifocality was defined as the synchronous presence of 2 or more pathologically confirmed tumors in any upper urinary tract location (renal pelvis or ureter). All patients were treated with either open radical nephroureterectomy (RNU) or open conservative surgery. Recurrence-free probabilities and cancer-specific survival were estimated using the Kaplan-Meier method and Cox regression analyses. RESULTS Fifty-one patients (28%) had previous carcinoma not invading bladder muscle. Previous history of non-muscle-invasive bladder cancer was significantly associated with tumor multifocality (P < 0.001), concomitant bladder cancer (P < 0.001), higher tumor stage (P = 0.020), and lymphovascular invasion (P = 0.026). Using univariate analyses, history of non-muscle-invasive bladder cancer was significantly associated with an increased risk of both any recurrence (HR = 2.17; P = 0.003) and bladder-only recurrence (HR = 3.17; P = 0.001). Previous carcinoma not invading bladder muscle (HR = 2.58; P = 0.042) was an independent predictor of bladder-only recurrence. Overall 5-year disease recurrence-free (any recurrence and bladder-only recurrence) survival rates were 66.7% and 77%, respectively. Previous history of non-muscle-invasive bladder cancer was not associated with cancer-specific survival. Our results are subject to the inherent biases associated with high-volume tertiary care centers. CONCLUSIONS Patients with previous history of non-muscle-invasive bladder cancer had a higher risk of having multifocal and UTUC with higher tumor stages (pT3 or greater). History of bladder tumor was an independent predictor of bladder cancer recurrence but had no effect on non-bladder recurrence, and cancer-specific survival in patients who underwent surgical treatment of UTUC.

Upper urinary tract transitional cell carcinoma: location is not correlated with prognosis.

Study Type – Therapy (case series)

Multivariate Analysis of Prognostic Factors in Male Breast Cancer in Serbia

BACKGROUND The aim of this study was to analyze the demographic and clinical characteristics of male breast cancer patients in Serbia, and furthermore to determine overall survival and predictive factors for prognosis. MATERIALS AND METHODS In the period of 1996-2006 histopathological diagnosis of breast cancer was made in 84 males at the Institute for Oncology and Radiology of Serbia. For statistical analyses the Kaplan-Meier method, long-rank test and Cox proportional hazards regression model were used. RESULTS The mean age at diagnosis with breast cancer was 64.3±10.5 years with a range from 35-84 years. Nearly 80% of the tumors showed ductal histology. About 44% had early tumor stages (I and II) whereas 46.4% and 9.5% of the male exhibited stages III and IV, respectively. Only 7.1% of male patients were grade one. One-fifth of all patients had tumors measuring ≤2 cm, and 14.3% larger than 5 cm. Lymph node metastasis was recorded in 40.4% patients and 47% relapse. Estrogen and progesterone receptor expression was positive in 66.7% and 58.3%, respectively. Among 14.3% of individuals tumor was HER2 positive. About two-thirds of all male patients had radical mastectomy (66.7%). Adjuvant hormonal (tamoxifene), systematic chemotherapy (CMF or FAC) and adjuvant radiotherapy were given to 59.5%, 35.7% and 29.8% patients respectively. Overall survival rates at five and ten years for male breast cancer were 55.0% and 43.9%, respectively. According to the multivariate Cox regression predictive model, a lower initial disease stage, a lower tumor grade, application of adjuvant hormone therapy and no relapse occurrence were significant independent predictors for good overall survival. CONCLUSIONS Results of the treatment would be better if disease is discovered earlier and therefore health education and screening are an imperative in solving this problem.

Risk factors for Clostridium difficile infection in surgical patients hospitalized in a tertiary hospital in Belgrade, Serbia: a case–control study

BackgroundThe objective of this study was to investigate independent risk factors (RFs) connected with healthcare-associated (HA) Clostridium difficile infection (CDI) in surgical patients, its frequency per surgical wards and in-hospital-mortality at a single hospital.MethodsRisk factors for the infection were prospectively assessed among surgical patients with laboratory confirmed HA CDI and compared with a control group without HA CDI.ResultsThe overall incidence rate of HA CDI was 2.6 per 10000 patient-days. Significant independent RFs for HA CDI were the use of carbapenems (P = 0.007, OR: 10.62, 95% CI: 1.93–58.4), the admission to intensive care unit (P = 0.004, OR:3.00, 95% CI:1.41–6.40), and the administration of 3rd generation cephalosporins (P = 0.014, OR:2.27, 95% CI:1.18–4.39). Patients with HA CDI had significantly higher in–hospital mortality compared to controls (P: 0.007; OR: 8.95; 95% CI: 1.84–43.43).ConclusionsCDI is an important HA infection in population of surgical patients and this study emphasizes the importance of the wise use of antibiotics, and other infection control strategies in order to prevent HA CDI, and to decrease the incidence and in-hospital mortality rate.

Comparison of Male and Female Breast Cancer Incidence and Mortality Trends in Central Serbia

BACKGROUND To compare breast cancer incidence and mortality trends in Central Serbia between males and females in the period 1999-2009. MATERIALS AND METHODS In this descriptive study, mortality data were obtained from the National Statistics Institute and morbidity data were derived from Institute of Public Health of Serbia for the period of interest. RESULTS Breast cancer is a leading cancer in the female population of Central Serbia, whereas in male population it is not on the list of 10 leading localizations, concerning both incidence as well as mortality. In the period 1999-2009 the average standardized incidence rates of breast cancer were 60.5/100,000 in women and 1.4/100,000 in men, while average standardized mortality rates were 20.4/100,000 and 0.4/100,000. The average standardized incidence and mortality rates were about 45 times higher in females than males. Male breast cancer comprises approximately 2.1% of all breast cancer cases. The average age-specific mortality and incidence rates increased with age in both sexes. In the observed period standardized mortality rates of breast cancer increased significantly only in men (y=0.320+0.021?, p=0.044). CONCLUSIONS The increase of breast cancer incidence in both sexes and mortality in men, indicate an urgent need for Serbian health professionals to apply existing cancer control and preventive measures. Male breast cancer is more present than in other world regions, with an outstanding increase of mortality, which demands a timely identification (screening) and adequate treatment. A national policy including mammography should be considered in the light of the newest findings.

Low Back Pain among Medical Students in Belgrade (Serbia): A Cross-Sectional Study

Aim To examine the prevalence of low back pain, to identify self-perceived triggers of low back pain, and to investigate the impact of perceived pain on the daily activities and mood among medical students. Methods This cross-sectional study enrolled 459 fourth year students at the Faculty of Medicine in Belgrade during December 2014. The anonymous questionnaire was used for data collection. In data analysis, the chi-square test and t-test were used. Results The lifetime prevalence of low back pain was 75.8%, 12-month prevalence 59.5%, and point prevalence 17.2%. Chronic low back pain was experienced by 12.4% of the students. Both the lifetime (p=0.001) and the 12-month (p=0.001) low back pain prevalence rates were significantly higher among female medical students. Mental stress during an exam period (p=0.001), sitting at the university (p=0.002), fatigue (p=0.043), improper body posture (p=0.005), and lack of exercise (p=0.001) as self-perceived triggers of low back pain were significantly more often reported by female students, compared to males. Regarding daily functioning, the experience of low back pain mostly affects students sleeping (14.6%) and walking (12.0%). Conclusions The prevalence of LBP is high among Belgrade medical students and significantly affects their everyday functioning.

Characteristics of gonorrhea and syphilis cases among the Roma ethnic group in Belgrade, Serbia

BACKGROUND The Roma ethnic group is the largest and most marginalized minority in Europe, believed to be vulnerable to sexually transmitted infections. AIM The purpose of the study was to investigate frequency and characteristics of gonorrhea and syphilis among the Roma population in Belgrade. METHODS Data from the City Institute for Skin and Venereal Diseases to which all gonorrhea and syphilis cases are referred were analyzed. RESULTS During the period of 2010-2014 sexually transmitted infections were more frequent among Roma than in rest of Belgrade population. Average percentages of Roma among all reported subjects with syphilis and those with gonorrhea were 9.6% and 13.5%, respectively, while the percentage of Roma in the total Belgrade population was about 1.6%. Roma with syphilis and gonorrhea were more frequently men (75%), most frequently aged 20-29 years (43.4%), never married (64.5%), with elementary school or less (59.2%), unemployed (80.3%), and heterosexual (89.5%). Among Roma 10.5% were sex workers and 68.4% did not know the source of their infection. Significant differences between Roma cases and other cases in Belgrade in all characteristics observed were in agreement with differences between Roma population and the total population of Serbia. CONCLUSION The present study confirmed the vulnerability of the Roma population to sexually transmitted infections.

AB1149 The ability of the health system to identify the burden of rheumatoid arthritis in serbia: a eular survey

Objectives to estimate the rheumatoid arthritis (RA) prevalence in two urban regions of Serbia, covering the northern and the southern part, under the European League Against Rheumatism (EULAR) prevalence survey; to assess the ability of the health system to recognize and treat patients with RA. Methods The survey was conducted in four Serbian towns: Belgrade in the north and three towns in the south: Cacak (Moravicki region), Uzice (Zlatiborski region) and Krusevac (Rasinski region), covering 36.5% of the total Serbian population with more than 99% Caucasians, mostly orthodox Serbs (83%), <4% Hungarians, Roms and Bosnians and a minority of other nationalities. The first-detection phase of the study comprised previously translated and validated telephone Questionnaire usage with 33 items covering signs, symptoms, self-reported diagnosis and classification criteria for RA (ACR 1987) (1). Diagnoses were confirmed by rheumatologists in a second-confirmation phase. Prevalence results were standardized for age and sex with regard to Serbian population (national census 2002). Confirmed RA cases were asked two more questions: “How long had you had symptoms before you were given the diagnosis of RA” and “How had you been treated for that period of time”. Results 6213 people were contacted and 63.6% answered the survey; joint pain was reported by 1,799 persons, and joint pain accompanied with joint swelling by 606 persons. A total of 23 RA cases were identified; 2 newly diagnosed. The standardized RA prevalence estimates were 0.30% (95% confidence interval [95% CI] 0.09;0.51) for the north, e.g. 0.09 (95% CI 0.08;0.26) for men and 0.49% (95% CI 0.19;0.79) for women. RA prevalence estimates were 0.42% (0.12;0.72) for the south; 0.28 (0.00;0.56) for men and 0.55% (0.09;1.00) for women, with the female to male ratio 5,5:1 in the north and 2:1 in the south. Time period from the first symptoms occurence to the RA diagnosis was 17.7 (13.2) months for the northern part and 25.0 (16.9) for the southern; 20.6 (14.9) for Serbia; in that period patients were mostly treated with NSAIDS (82%) and physical therapy (30%); short-lasting corticosteroids were given to 13%, peroral corticosteroids to 4% and no patients were treated with DMARDS. Conclusions RA prevalence in the southern and northern part of Serbia is in line (0.42% [95% CI 0.12;0.72]) vs 0.30% [95% CI 0.09;0.51]), being more frequently presented in females as compared to males (five times more in the north and two times more in the south). Delay in diagnosis as compared to the first symptoms occurence was 21 months and during that time no patients were treated with DMARDS. References Zlatkovic-Svenda MI, Stojanovic RM, Milenkovic MP, Vlajinac HD, Le Bihan E, Guillemin F. Adaptation and validation of a telephone questionnaire – Serbian version for case detection of rheumatoid arthritis and spondyloarthropathy (multicentric Eular study). Clin Exp Rheumatol. 2007;25 (1): 75–84. Disclosure of Interest None declared

Human papillomavirus and anal carcinoma knowledge in men who have sex with men in Belgrade, Serbia.

To evaluate the level of knowledge among men who have sex with men regarding human papillomavirus (HPV), anal cancer screening, and HPV vaccine.

THU0358 The Ability of the Health System to Identify the Burden of Spondyloarthritis in Two Regions of Serbia: A Eular Survey

Objectives To determine spondyloarthritis (SpA) prevalence in two different regions of Serbia, as part of the European League Against Rheumatism (EULAR) prevalence survey; to assess the ability of the health system to identify and treat patients with SpA. Methods Survey comprised a two-stage approach with a sample of urban population in 2 areas: Belgrade, located in the north and Cacak, Uzice and Krusevac in the south, covering 36.5% of the total Serbian population. In a detection phase, every 100-th telephone number was contacted to answer a previously validated screening telephone questionnaire. Confirmation of cases was by contact with the patients rheumatologist or rheumatological examination. Prevalence results were standardized for age and sex according to Serbian population (national census 2002). Confirmed SpA cases were asked two more questions: “How long had you had symptoms before you were given the diagnosis of SpA” and “How had you been treated for that period of time”. Results 6213 people were contacted; 63.6% answered the survey; 66 were examined. A total of 16 SpA cases were identified (5 newly diagnosed). The standardized SpA prevalence for the north was 0.28% (95% confidence interval [95% CI] 0.08;0.48); 0.31 (95% CI 0.00;0.65) for men and 0.25% (95% CI 0.01;0.49) for women; for the south 0.42% (0.02;0.82); 0.41 (0.02;0.81) for men and 0.43% (0.04;0.82) for women. Mean (SD) time (months) to SpA diagnosis was 23.6 (24.9) for the north and 13.6 (11.3) for the south; 19.2 (20.2) for Serbia. Before they were given the SpA diagnosis, all patients were treated with NSAIDS, but mostly “on demand” (56.2%), some of them with physical therapy (43.7%) and benzodiazepins (18.7%). Conclusions SpA prevalence in Serbia does not differ much between southern and northern part of the country as well as between women and men. Diagnostic delay for SpA is 19 months and most of the patients were inadequately treated for that period of time. One third of the revealed SpA cases were not diagnosed previously. Disclosure of Interest None declared