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Article: [Modalities in the treatment of obstructive breathing in sleep].

Vukčević, Miodrag

Glas. Srpska akademija nauka i umetnosti. Odeljenje medicinskih nauka

2011 , Issue 51, Page(s) 75–83

Abstract: The goals of OSAS therapy are to improve daytime symptoms especially excessive sleepiness, prevent neurocognitve, metabolic and cardiovascular consequences and quality of life in patients with sleep apnea. A variety of therapy exist starting from general ...

Abstract	The goals of OSAS therapy are to improve daytime symptoms especially excessive sleepiness, prevent neurocognitve, metabolic and cardiovascular consequences and quality of life in patients with sleep apnea. A variety of therapy exist starting from general measures that include weight reduction, change in life style, postional therapy, oral devices, upper airway surgery and pharmacotherapy. However, CPAP has been demonstrated to be the most important and highly effective therapy in these disorders. CPAP therapy dramatically improves symptoms and decreases cadriovascular and metabolic consequences stoping the occurence of the apneas. Hoewer, not all patients tolerate CPAP especially patients with milder forms of the disease. The individualised approach wich pay attention to different phenotypes and genotype could select patients for selecitively acting treatment modalities such us mandibular advancement devices and electical stimulation of the upper airway muscles.
MeSH term(s)	Continuous Positive Airway Pressure ; Humans ; Sleep Apnea, Obstructive/therapy
Language	Serbian
Publishing date	2011
Publishing country	Serbia
Document type	English Abstract ; Journal Article ; Review
ZDB-ID	604240-5
ISSN	0371-4039
ISSN	0371-4039
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Article ; Online: Prevention of venous thromboembolism with rivaroxaban and apixaban in orthopedic surgery

Antonijević Nebojša / Kanjuh Vladimir / Živković Ivana / Jovanović Ljubica / Vukčević Miodrag / Apostolović Milan

Srpski Arhiv za Celokupno Lekarstvo, Vol 148, Iss 9-10, Pp 613-

2020 Volume 620

Abstract: Numerous limitations and side effects of standard anticoagulants require administering new anticoagulant drugs. New peroral anticoagulants of Factor Xa inhibitor group have more advantages, the key ones being: substantial reductions in specific nutrition ...

Abstract	Numerous limitations and side effects of standard anticoagulants require administering new anticoagulant drugs. New peroral anticoagulants of Factor Xa inhibitor group have more advantages, the key ones being: substantial reductions in specific nutrition limitations and drug interaction, no need for routine laboratory monitoring and greatly improved therapy predictability. Rivaroxaban, a selective peroral Factor Xa inhibitor is more effective compared with enoxaparin for venous thromboembolism (VTE) prophylaxis in major orthopedic interventions. Though several single trials demonstrated no difference in hemorrhagic complications, certain meta-analyses with rivaroxaban showed a higher incidence of hemorrhage. Apixaban, a peroral reversible inhibitor of factor Xa approved for the prevention of VTE, compared with European-approved doses of enoxaparin has the efficacy almost equal to the North-American-approved enoxaparin doses without a significant difference in bleeding rates, though АDVANCE I study points towards lower bleeding rates in patients treated with apixaban. To clarify the contradictory results of the recent meta-analysis related to the comparison between the stated factor X inhibitors and various comparator enoxaparin regimens as well as related to the risk for symptomatic PTE and total bleeding events following major orthopedic surgery, new research will be required. Specificities of rivaroxaban and apixaban, already constituting, according to modern recommendations, an integral part of the VTE prophylaxis protocols after major orthopedic interventions, will enable the establishment of personalized protocols aimed at developing an improved safety profile of each individual patient.
Keywords	prevention ; venous thromboembolism ; rivaroxaban ; apixaban ; Medicine ; R
Subject code	610
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Serbian Medical Society
Document type	Article ; Online
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Article: [How to solve the problem of sleep apnea?].

Vukcević, Miodrag

Glas. Srpska akademija nauka i umetnosti. Odeljenje medicinskih nauka

2007 , Issue 49, Page(s) 69–76

Abstract: The future of solving the problem of sleep apnea necessitates the systematic organization of activities that would include: 1) increase in the awareness of the significant prevalence of sleep apnea and its influence on health and economic burden in the ... ...

Abstract	The future of solving the problem of sleep apnea necessitates the systematic organization of activities that would include: 1) increase in the awareness of the significant prevalence of sleep apnea and its influence on health and economic burden in the population via media and educational campaign; 2) establishment of the work groups that will find the answers and set the scientific research according to the needs posed by the sleep diseases; 3) Check the existing and develop new diagnostic and therapeutic methods with special reference to home monitoring with the creation of the national research network which will connect researchers and their programs and research centers; 4) Organization at the national level of educational centers and laboratories that will adequately respond to the needs of the pathology present in the population.
MeSH term(s)	Biomedical Research/organization & administration ; Humans ; Sleep Apnea Syndromes
Language	Serbian
Publishing date	2007
Publishing country	Serbia
Document type	English Abstract ; Journal Article
ZDB-ID	604240-5
ISSN	0371-4039
ISSN	0371-4039
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Article: The Predictive Value of Risk Factors and Prognostic Scores in Hospitalized COVID-19 Patients.

Brajkovic, Milica / Vukcevic, Miodrag / Nikolic, Sofija / Dukic, Marija / Brankovic, Marija / Sekulic, Ana / Popadic, Viseslav / Stjepanovic, Mihailo / Radojevic, Aleksandra / Markovic-Denic, Ljiljana / Rajovic, Nina / Milic, Natasa / Tanasilovic, Srdjan / Todorovic, Zoran / Zdravkovic, Marija

Diagnostics (Basel, Switzerland)

2023 Volume 13, Issue 16

Abstract: Introduction: Risk stratification in patients with COVID-19 is a challenging task. Early warning scores (EWSs) are commonly used tools in the initial assessment of critical patients. However, their utility in patients with COVID-19 is still undetermined. ...

Abstract	Introduction: Risk stratification in patients with COVID-19 is a challenging task. Early warning scores (EWSs) are commonly used tools in the initial assessment of critical patients. However, their utility in patients with COVID-19 is still undetermined. Aim: This study aimed to discover the most valuable predictive model among existing EWSs for ICU admissions and mortality in COVID-19 patients. Materials and methods: This was a single-center cohort study that included 3608 COVID-19 patients admitted to the University Clinical Hospital Center Bezanijska Kosa, Belgrade, Serbia, between 23 June 2020, and 14 April 2021. Various demographic, laboratory, and clinical data were collected to calculate several EWSs and determine their efficacy. For all 3608 patients, five EWSs were calculated (MEWS, NEWS, NEWS2, REMS, and qSOFA). Model discrimination performance was tested using sensitivity, specificity, and positive and negative predictive values. C statistic, representing the area under the receiver operating characteristic (ROC) curve, was used for the overall assessment of the predictive model. Results: Among the evaluated prediction scores for 3068 patients with COVID-19, REMS demonstrated the highest diagnostic performance with the sensitivity, PPV, specificity, and NPV of 72.1%, 20.6%, 74.9%, and 96.8%, respectively. In the multivariate logistic regression analysis, aside from REMS, age ( Conclusions: Among all evaluated EWSs to predict mortality and ICU admission in COVID-19 patients, the REMS score demonstrated the highest efficacy.
Language	English
Publishing date	2023-08-11
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662336-5
ISSN	2075-4418
ISSN	2075-4418
DOI	10.3390/diagnostics13162653
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Article ; Online: Diagnosis and treatment of adult asthma patients in Serbia: a 2022 experts group position statement.

Vukoja, Marija / Kopitovic, Ivan / Lazic, Zorica / Milenkovic, Branislava / Stankovic, Ivana / Tomic-Spiric, Vesna / Zvezdin, Biljana / Hromis, Sanja / Cekerevac, Ivan / Ilic, Aleksandra / Vukcevic, Miodrag / Dimic-Janjic, Sanja / Stjepanovic, Mihailo

Expert review of respiratory medicine

2022 Volume 16, Issue 11-12, Page(s) 1133–1144

Abstract: Introduction: Asthma is the most common non-communicable chronic lung condition across all ages. Epidemiological data indicate that many asthma patients in Serbia remain undiagnosed and untreated. The implementation of recent global advances in asthma ... ...

Abstract	Introduction: Asthma is the most common non-communicable chronic lung condition across all ages. Epidemiological data indicate that many asthma patients in Serbia remain undiagnosed and untreated. The implementation of recent global advances in asthma management is limited due to the lack of a systematic approach, drug availability and regulatory affairs. In addition, the global coronavirus disease pandemic has posed a significant challenge, particularly in resource-limited settings. Areas covered: In this paper, we propose an algorithm for treating adult asthma patients in Serbia. We performed PubMed database search on published asthma clinical trials and guidelines from 1 January 2015 to 10 March 2020. The consensus process incorporated a modified Delphi method that included two rounds of e-mail questionnaires and three rounds of national asthma expert meetings. We focus on 1) objective diagnosis of asthma, 2) the implementation of up-to-date therapeutic options, and 3) the identification and referral of severe asthma patients to newly established severe asthma centers. Expert opinion: Regional specificities and variations in healthcare systems require the adaptation of evidence-based knowledge. Practical, clinically oriented algorithms designed to overcome local barriers in healthcare delivery may facilitate timely and adequate asthma diagnosis and the local implementation of current advances in asthma management.
MeSH term(s)	Humans ; Adult ; Serbia ; Asthma/therapy
Language	English
Publishing date	2022-12-12
Publishing country	England
Document type	Journal Article
ZDB-ID	2479146-5
ISSN	1747-6356 ; 1747-6348
ISSN (online)	1747-6356
ISSN	1747-6348
DOI	10.1080/17476348.2022.2153674
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Article ; Online: Surgical treatment of symptomatic patellofemoral malalignment

Apostolović Milan / Vukčević Miodrag / Vučković Vladimir / Vukomanović Boris / Slavković Nemanja / Đuričić Goran / Antonijević Nebojša / Čučilović Oskar

Vojnosanitetski Pregled, Vol 75, Iss 12, Pp 1190-

Do we need an ideal patellofemoral congruency to solve the symptoms?

2018 Volume 1196

Abstract: Background/Aim. The aim of this prospective nonrandomized study was to test functional results of different surgical strategies in the operative treatment of symptomatic patellofemoral malalignment. Our hypothesis was that immediate extensive surgery ... ...

Abstract	Background/Aim. The aim of this prospective nonrandomized study was to test functional results of different surgical strategies in the operative treatment of symptomatic patellofemoral malalignment. Our hypothesis was that immediate extensive surgery does not have serious advantage comparing to “step by step” procedure, regarding the main symptoms and functional end result. We wanted to check whether obtaining ideal surgical patellofemoral congruency is an essential prerequisite for subsidence of the major symptoms of patellofemoral malalignment. Methods. The study included 35 patients with patellofemoral malalignment who had persistant major symptoms: patellar pain and slipping, 3 months after nonoperative treatment. Divided into three groups, they all underwent the realignment surgery, but in different extent and sequence: immediate extensive surgery, step by step surgery, and only proximal realignment. Their overall functional scores as well as major symptoms were assessed at the beginning, after the surgery, and during the 3-years follow-up period and then, compared at the end. Results. There was no significant difference in the functional results among the groups, neither at the beginning (p = 0.1318) nor at the end of the study (p = 0.3996), but the results at the beginning compared to those at the end of the study showed a statistically significant difference in all three groups (p1 = 0.005062; p2 = 0.011719; p3 = 0.000352). The same result was in regard to the major symptoms. Conclusion. The study confirmed that insisting on immediate extensive surgery in order to achieve precise and complete congruency of the patellofemoral joint, did not prove its advantage over the less invasive, individual surgical approach concerning functional scores and major symptoms.
Keywords	patellofemoral malalignment ; functional score ; patellofemoral pain ; Medicine (General) ; R5-920
Subject code	616
Language	English
Publishing date	2018-01-01T00:00:00Z
Publisher	Military Health Department, Ministry of Defance, Serbia
Document type	Article ; Online
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Article: Obstructive Sleep Apnea Is Associated With Low Testosterone Levels in Severely Obese Men.

Tančić-Gajić, Milina / Vukčević, Miodrag / Ivović, Miomira / Marina, Ljiljana V / Arizanović, Zorana / Soldatović, Ivan / Stojanović, Miloš / Đogo, Aleksandar / Kendereški, Aleksandra / Vujović, Svetlana

Frontiers in endocrinology

2021 Volume 12, Page(s) 622496

Abstract: Background: Disrupted sleep affects cardio-metabolic and reproductive health. Obstructive sleep apnea syndrome represents a major complication of obesity and has been associated with gonadal axis activity changes and lower serum testosterone ... ...

Abstract	Background: Disrupted sleep affects cardio-metabolic and reproductive health. Obstructive sleep apnea syndrome represents a major complication of obesity and has been associated with gonadal axis activity changes and lower serum testosterone concentration in men. However, there is no consistent opinion on the effect of obstructive sleep apnea on testosterone levels in men. Objective: The aim of this study was to determine the influence of obstructive sleep apnea on total and free testosterone levels in severely obese men. Materials and methods: The study included 104 severely obese (Body Mass Index (BMI) ≥ 35 kg/m Results: There was a significant difference between AHI groups in age (29.1 ± 7.2, 43.2 ± 13.2, 45.2 ± 10.2 years; p < 0.001), BMI (42.8 ± 5.9, 43.2 ± 5.9, 47.1 ± 7.8 kg/m Conclusion: Obstructive sleep apnea is associated with low TT and FT levels in severely obese men.
MeSH term(s)	Adult ; Anthropometry ; Body Mass Index ; Cross-Sectional Studies ; Humans ; Male ; Metabolic Syndrome/complications ; Middle Aged ; Obesity, Morbid/blood ; Obesity, Morbid/complications ; Oxygen/metabolism ; Polysomnography/adverse effects ; Sleep Apnea, Obstructive/blood ; Sleep Apnea, Obstructive/complications ; Testosterone/blood ; Treatment Outcome ; Young Adult
Chemical Substances	Testosterone (3XMK78S47O) ; Oxygen (S88TT14065)
Language	English
Publishing date	2021-07-26
Publishing country	Switzerland
Document type	Journal Article ; Observational Study
ZDB-ID	2592084-4
ISSN	1664-2392
ISSN	1664-2392
DOI	10.3389/fendo.2021.622496
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Article ; Online: Contribution of novel anticoagulants fondaparinux and dabigatran to venous thromboembolism prevention

Antonijević Nebojša / Kanjuh Vladimir / Živković Ivana / Jovanović Ljubica / Vukčević Miodrag / Apostolović Milan

Srpski Arhiv za Celokupno Lekarstvo, Vol 143, Iss 3-4, Pp 230-

2015 Volume 236

Abstract: The data that episodes and sequels of venous thromboembolism (VTE) are recorded in a significant percentage of patients receiving standard anticoagulants as VTE prophylaxis (unfractionated, low-molecular-weight heparin and vitamin K inhibitors) as well ... ...

Abstract	The data that episodes and sequels of venous thromboembolism (VTE) are recorded in a significant percentage of patients receiving standard anticoagulants as VTE prophylaxis (unfractionated, low-molecular-weight heparin and vitamin K inhibitors) as well as the fact that these drugs have significant limitations and that they may cause serious side-effects in some patients indicate the need for the introduction of new anticoagulant drugs. Fondaparinux, a selective inhibitor of Factor Xa, administered following major orthopedic surgeries having a high risk for the development of VTE, is more efficient than enoxaparin sodium used in European and North-American approved doses. The increased incidence of major bleeding (excluding fatal) due to fondaparinux could be perhaps lowered by dosage reduction in patients with a mildly decreased creatinine clearance. Dabigatran, a peroral direct thrombin inhibitor, administered for VTE prophylaxis in elective hip and knee surgery, showed in to date studies the efficacy comparable (if dabigatran is given in both dosage regimes of 150 mg and 220 mg daily) or superior (if dabigatran is given at a dose of 220 mg daily) to enoxaparin administered in European-approved doses, while North American-approved doses of enoxaparin were superior than dabigatran in VTE reduction. No significant differences in bleeding rates were determined in any of the study groups. We consider that the introduction of new anticoagulants, including fondaparinux and dabigatran, will contribute to the establishment of a better safety profile and efficacy, and will also enable adequate therapy individualization for each patient depending on his/hers clinical characteristics. The introduction of novel peroral anticoagulants will, inter alia, significantly contribute to improvement in the quality of life, release the patient from numerous limitations in nutrition, interreaction, frequent laboratory monitoring, and also significantly improve therapeutic predictability. [Projekat Ministarstva nauke Republike Srbije, ...
Keywords	prevention ; venous thromoembolism ; fondaparinux ; dabigatran ; Medicine ; R
Subject code	610
Language	English
Publishing date	2015-01-01T00:00:00Z
Publisher	Serbian Medical Society
Document type	Article ; Online
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Article ; Online: Successful treatment of laryngomalacia and bilateral vocal cord paralysis with continuous positive airway pressure

Sovtić Aleksandar / Minić Predrag / Vukčević Miodrag / Rodić Milan

Medicinski Pregled, Vol 63, Iss 3-4, Pp 285-

2010 Volume 288

Abstract: Introduction Laryngomalacia is the most frequent congenital anomaly of airways, and it may cause obstructive sleep apneas. The associated vocal cord paralysis may aggravate the symptoms of upper airway obstruction. Case report In a 14 month old boy ... ...

Abstract	Introduction Laryngomalacia is the most frequent congenital anomaly of airways, and it may cause obstructive sleep apneas. The associated vocal cord paralysis may aggravate the symptoms of upper airway obstruction. Case report In a 14 month old boy severe laryngomalacia and bilateral vocal cord paralysis were diagnosed by flexible bronchoscopy. A sleep study showed a severe obstructive sleep apnoea (OSA). The patient was ventilated at home via the face mask with non invasive mechanical ventilation (CPAP) for a year. The level of pressure had to be set at 7cm H2O to correct desaturation with an improvement in mean SpO2. On the follow up bronchoscopic examination laryngomalatia was improved, vocal cord paralysis persisted and sleep study revealed significant improvement. Discussion In the patient with severe laryngomalatia and bilateral vocal cord paralysis with OSA conservative treatment with CPAP was used instead of a surgical intervention. Non invasive ventilation was used every night, for at least 6 hours, without adverse events. Invasive measurement of transdiaphragmatic pressure is the best way of titrating of CPAP level. This case report suggests the efficacy of noninvasive titrating of CPAP level by the hemoglobin oxygen saturation trend measurement. Conclusion In case of severe laryngomalatia and associated vocal cord paralysis, followed by OSA non invasive ventilation by nasal CPAP represents an effective and safe alternative to surgery.
Keywords	laryngomalacia ; vocal cord paralysis ; apnea ; continuous positive airway pressure ; infant ; bronchoscopy ; diagnosis ; Medicine (General) ; R5-920 ; Medicine ; R ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Subject code	610
Language	Serbian
Publishing date	2010-01-01T00:00:00Z
Publisher	Serbian Medical Society, Society of Physicians of Vojvodina, Novi Sad
Document type	Article ; Online
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Article ; Online: Initial respiratory specimen bacteriology and isolates susceptibility to antimicrobials in promptly intubated chronic obstructive pulmonary disease adults - single-center two-year experience

Gluvić Zoran / Mitrović Bojan / Radojević Biljana / Krasnjuk Andrej / Panić Miloš / Miličević Predrag / Vukčević Miodrag / Tomašević Ratko / Putniković Biljana / Nešković Aleksandar N.

Srpski Arhiv za Celokupno Lekarstvo, Vol 147, Iss 7-8, Pp 410-

2019 Volume 415

Abstract: Introduction/Objective. Chronic obstructive pulmonary disease (COPD) exacerbation is mostly triggered by infectious agents and seriously compromises the patient’s quality of life and predicts a poor outcome of the disease as well. If the signs of the ... ...

Abstract	Introduction/Objective. Chronic obstructive pulmonary disease (COPD) exacerbation is mostly triggered by infectious agents and seriously compromises the patient’s quality of life and predicts a poor outcome of the disease as well. If the signs of the probable bacterial cause of COPD exacerbation are presented in an intubated patient, initial antimicrobial management must be launched. Depending on the results of the respiratory system sample cultures, the initial antimicrobials can be changed or continued. The objective of this study is to present in-hospital suggestions regarding the use of the initial antimicrobial management of urgently intubated COPD adults with the probable bacterial cause of exacerbations, considering the source of bacterial acquisition (i.e. facility- or community-acquired bacteria). Methods. The cross-sectional study covered 51 patients urgently intubated on admission to the medical Intensive Care Unit of the Zemun Clinical Hospital Center during 2015/2016. The patients were divided into two groups: community-acquired (n = 26) and facility-acquired infection group (n = 25). The respiratory system samples were processed in the Microbiology Laboratory. Results. Acinetobacter and Pseudomonas spp. were the most frequently isolated bacteria in both groups, followed by Staphylococcus aureus and Klebsiella spp. as the third most frequent bacteria in the community- and facility-acquired group, respectively. The parallel use of tigecycline and aminoglycosides proved to cover a sensitive microbial spectrum in 52% of examinees of the community-acquired and 32% of examinees of the facility-acquired group. Conclusion. The present study suggests the initial management of intubated adults with probable bacterial infection-induced COPD exacerbation by the parallel use of tigecycline and aminoglycosides. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 173033]
Keywords	COPD ; Mechanical Ventilation ; Anti-Bacterial Agents ; Medicine ; R
Language	English
Publishing date	2019-01-01T00:00:00Z
Publisher	Serbian Medical Society
Document type	Article ; Online
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