Papers by Marija Milenkovic
Serbian Journal of Anesthesia and Intensive Therapy, 2022
Srpski medicinski časopis Lekarske komore, 2022
Više od godinu i po dana traje borba protiv pandemije KOVID-19 oboljenja. Kao nezaobilazni deo na... more Više od godinu i po dana traje borba protiv pandemije KOVID-19 oboljenja. Kao nezaobilazni deo najnovijih protokola, razmatra se upotreba kortikosteroida i antikoagulanasa u lečenju, ali i u prevenciji komplikacija. Na ovom mestu, želimo da prikažemo prednosti, ali i mane, upotrebe kortikosteroidne i antikoagulantne terapije u infekciji Sars-KoV-2 virusom, u skladu sa dostupnim podacima. Na samom početku pandemije, uočena je veća učestalost trombotičkih događaja koji pogoršavaju tok i ishod oboljenja. Pokazalo se da povišene vrednosti D-dimera ne koreliraju sa postojanjem venske tromboze i nisu pouzdan dokaz duboke venske tromboze ili plućne tromboembolije. Prema Nacionalnom protokolu za lečenje obolelih od KOVID-19 infekcije (12. verzija), preporučuje se upotreba antikoagulantne terapije kod hospitalizovanih bolesnika. S obzirom na postojanje rizika od nastanka različitih neželjenih reakcija, poput krvarenja i heparinom uzrokovane trombocitopenije, potrebno je pažljivo ordiniranje antikoagulantne terapije, uz praćenje njenih efekata. Kada su u pitanju kortikosteroidi, naglasak je na njihovoj efikasnosti kod pacijenata sa umereno teškom i teškom kliničkom slikom koji zahtevaju kiseoničku potporu. Efikasnost kortikosteroidne terapije se ogleda u snižavanju mortaliteta, smanjenju potreba za mehaničkom ventilacijom i bržim prevođenjem obolelih iz jedinica intenzivnog lečenja, kao i kraćem trajanju hospitalizacije. Individualna procena koristi i rizika pri uključivanju ovih lekova u terapiju bolesnika sa potvrđenom infekcijom Sars-KoV-2 virusom je od vitalnog značaja za postizanje željenih efekata terapije.
Serbian Journal of Anesthesia and Intensive Therapy, 2022
Oxidative Medicine and Cellular Longevity, Jun 30, 2021
in the derivation and validation cohorts, respectively, indicating a high discriminative value of... more in the derivation and validation cohorts, respectively, indicating a high discriminative value of the proposed score. Conclusion. In the present study, AIDA score showed a valuable significance in estimating the mortality risk in patients with the severe form of COVID-19 disease at admission to ICU. Further external validation on a larger group of patients is needed to provide more insights into the utility of this score in everyday practice.
SSRN Electronic Journal
Background: Coagulation dysfunction represents a serious complication in patients during the COVI... more Background: Coagulation dysfunction represents a serious complication in patients during the COVID-19 infection, while fulminant thrombotic complications emerge as critical issues in individuals with severe COVID-19. In addition to a severe clinical presentation, comorbidities and age significantly contribute to the development of thrombotic complications in this disease. However, there is very little data on association of congenital thrombophilia and thrombotic events in the setting of COVID-19. Our study aimed to evaluate the risk of COVID-19 associated thrombosis in patients with congenital thrombophilia. Methods: This prospective, case-control study included patients with confirmed COVID-19 infection, followed 6 months post-confirmation. The final outcome was a symptomatic thrombotic event. In total, 90 COVID-19 patients, 30 with known congenital thrombophilia and 60 patients without thrombophilia within the period July 2020-November 2021, were included in the study. Evaluation of hemostatic parameters including FVIII activity and D-dimer was performed for all patients at 1 month, 3 months and 6 months post-COVID-19 diagnosis. Results: Symptomatic thrombotic events were observed in 7 out of 30 (23 %) COVID-19 patients with thrombophilia, and 12 out of 60 (20 %) without thrombophilia, P = 0.715. In addition, the two patient groups had comparable localization of thrombotic events, time to thrombotic event, effect of antithrombotic treatment and changes in FVIII activity, while D-dimer level were significantly increased in patients without thrombophilia. Conclusion: Our findings suggest that patients with congenital thrombophilia, irrespective of their age, a mild clinical picture and absence of comorbidities, should receive anticoagulant prophylaxis, adjusted based on the specific genetic defect.
Serbian Journal of Anesthesia and Intensive Therapy, 2021
At the end of December 2019, a certain number of patients with pneumonia of unknown etiology appe... more At the end of December 2019, a certain number of patients with pneumonia of unknown etiology appeared in the Chinese city of Wuhan. The etiological agent of corona virus disease (COVID-19) was identified as a virus from the Coronaviridae family called Novel Coronavirus, or SARS-CoV-2 (Severe Acute Respiratory Coronavirus 2). COVID-19 took on the proportions of a pandemic. Therapeutic options for COVID-19 include antiviral, anticoagulant, corticosteroid, biological, antibiotic, multivitamin, symptomatic therapy, and oxygen support. Corticosteroid immunosuppressive and anti-inflammatory role is helpful for a disease with immune response dysregulation and excessive cytokine production. The effect of corticosteroids in the treatment of COVID-19 depends on disease severity, the time of initiation, and the appropriate dose. Individual risk/benefit assessment is required before initiating treatment. Corticosteroids have beneficial effects on patients on oxygen support, especially on those ...
Surgeries, 2021
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Serbian Journal of Anesthesia and Intensive Therapy, 2018
Ultrazvuk (UZ) predstavlja mehaničke, longitudinalne, akustične talase čija je frekvenca preko 20... more Ultrazvuk (UZ) predstavlja mehaničke, longitudinalne, akustične talase čija je frekvenca preko 20.000 Hz. U dijagnostici se koriste ultarzvučni talasi frekvence od 2 do 20 MHz. UZ talase karakterišu sledeće veličine: brzina prostiranja, frekvenca, talasna dužina i amplituda. Prolaskom kroz ljudsko telo, a u interakciji sa različitim tkivima, dolazi do UZ slabljenja-atenuacije. Ova pojava je posledica apsorpcije, refleksije, refrakcije, disperzije i difrakcije ultrazvučnih talasa. Refleksija je odgovorna za nastanak ultrazvučne slike. U ultrazvučnoj sondi se nalaze piezoelektrični krstali koji imaju sposobnost da električne impulse pretvaraju u mehaničke (ultrazvučne) talase i obrnuto. Povezivanjem UZ aparata sa strujnim kolom, piezoelektrični kristali pretvaraju električne impulse u UZ talase. Pri interakciji sa materijom, neki od njih bivaju reflektovani/ odbijeni. Taj eho ponovo detektuju piezoelektrični kristali u UZ sondi i pretvaraju ga u električne imuplse, koji se u vidu tačaka prikazuju na ekranu. UZ sonda je i generator i prijemnik UZ talasa. Na osnovu reflektovanog eha u formi tačaka, formira se slika na ekranu. Intezitet reflektovanog eha predstavlja ehogenost tj. sposobnost neke strukture da stvara UZ talase. Tako razlikujemo anehogene, hipoehogne, hiperehogene i izoehogene strukture. Na osnovu frekvencije, rezolucije i penetracije ultrazvučnih talasa, sonde se dele na: konveksne, linearne i sektorske. Osnovo pravilo je da što je veća frekvencija UZ sonde, bolja je rezolucija slike, ali manja prodornost UZ talasa. Prilikom UZ pregleda, pojavljuju se forme koje ne predstavljaju anatomske strukture, već su posledica specifičnih tehnika pregleda i nazivaju se artefakti. Tu spadaju: aksutičko pojačanje, akustična senka, reverberacija i fenomen "ogledala".
Serbian Journal of Anesthesia and Intensive Therapy, 2019
Serbian Journal of Anesthesia and Intensive Therapy, 2019
Serbian Journal of Anesthesia and Intensive Therapy, 2018
Srpski arhiv za celokupno lekarstvo
Vitamin B1 (aneurin, thiamine) is a water-soluble vitamin necessary for the normal function of th... more Vitamin B1 (aneurin, thiamine) is a water-soluble vitamin necessary for the normal function of the nervous system, visual system and heart and is part of important enzymes in the body. Thiamine enables the normal use of glucose, other carbohydrates and proteins, and enables the supply of energy to the organism. The main sources of thiamine are exogenous and small amounts are synthesized by microorganisms of the human intestinal microbiome. Vitamin B1 cannot accumulate in the body, so signs of deficiency are quickly manifested. Hypovitaminosis B1 is seen in chronic ethyl abuse, persistent vomiting (as in some pregnant women) or after bariatric surgical procedures, but in a mild form it is present in the general population. Normal daily needs for vitamin B1 depend on calorie intake, and 0.4 mg should be ingested for every 1000 kcal.
Serbian Journal of Anesthesia and Intensive Therapy, 2019
Oxidative Medicine and Cellular Longevity, 2022
Introduction. Health care workers have had a challenging task since the COVID-19 outbreak. Prompt... more Introduction. Health care workers have had a challenging task since the COVID-19 outbreak. Prompt and effective predictors of clinical outcomes are crucial to recognize potentially critically ill patients and improve the management of COVID-19 patients. The aim of this study was to identify potential predictors of clinical outcomes in critically ill COVID-19 patients. Methods. The study was designed as a retrospective cohort study, which included 318 patients treated from June 2020 to January 2021 in the Intensive Care Unit (ICU) of the Clinical Hospital Center “Bezanijska Kosa” in Belgrade, Serbia. The verified diagnosis of COVID-19 disease, patients over 18 years of age, and the hospitalization in ICU were the criteria for inclusion in the study. The optimal cutoff value of D-dimer, CRP, IL-6, and PCT for predicting hospital mortality was determined using the ROC curve, while the Kaplan-Meier method and log-rank test were used to assess survival. Results. The study included 318 pa...
Oxidative Medicine and Cellular Longevity
Introduction. Mortality among critically ill COVID-19 patients remains relatively high despite di... more Introduction. Mortality among critically ill COVID-19 patients remains relatively high despite different potential therapeutic modalities being introduced recently. The treatment of critically ill patients is a challenging task, without identified credible predictors of mortality. Methods. We performed an analysis of 160 consecutive patients with confirmed COVID-19 infection admitted to the Respiratory Intensive Care Unit between June 23, 2020, and October 2, 2020, in University Hospital Center Bezanijska kosa, Belgrade, Serbia. Patients on invasive, noninvasive ventilation and high flow oxygen therapy with moderate to severe ARDS, according to the Berlin definition of ARDS, were selected for the study. Demographic data, past medical history, laboratory values, and CT severity score were analyzed to identify predictors of mortality. Univariate and multivariate logistic regression models were used to assess potential predictors of mortality in critically ill COVID-19 patients. Result...
Neuroepidemiology, 2006
Access to full text and tables of contents, including tentative ones for forthcoming issues: www.... more Access to full text and tables of contents, including tentative ones for forthcoming issues: www.karger.com/ned_issues
Srpski arhiv za celokupno lekarstvo
Sepsis is a medical emergency and therefore requires early identification and immediate managemen... more Sepsis is a medical emergency and therefore requires early identification and immediate management, which is not a matter of hours, but minutes. Since the first definition in 1991, sepsis remains a major challenge for clinicians and scientists. Despite significant advances in technology and therapy, mortality and cost of treatment are unacceptably high. Septic shock is the leading cause of mortality in critically ill patients. Cognitive impairment and functional disability were observed after survivors? long-term follow-up. Since its foundation in 2002, Surviving Sepsis Campaign aims to implement global strategies and to raise awareness of the challenges associated with sepsis. The implementation of guidelines and sepsis care bundles resulted in significant decrease in mortality. Hospital mortality is lower in hospitals with high versus low bundle compliance. Still, epidemiological data for sepsis are missing for low- and middleincome countries.
Srpski arhiv za celokupno lekarstvo
Introduction/Objective. The aim of this study was to determine independent predictors and the bes... more Introduction/Objective. The aim of this study was to determine independent predictors and the best trauma scoring system (REMS, RTS, GSC, SOFA, APPACHE II) of in-hospital mortality in patients with severe trauma at the Department of Emergency, Emergency Center, Clinical Center of Serbia, Belgrade. Methods. Longitudinal study included 208 consecutive patients with severe trauma. In order to determine independent survival contributors, univariate and multivariate Cox regression analyses were performed. The power of above-mentioned scoring systems (measured at admission to the Emergency center) to predict mortality was compared using the area under the curve (AUC). Results. There were 208 patients (159 male, 49 female), with the average age of 47.3 ? 20.7 years. Majority of patients were initially intubated (86.1%) on admission to the emergency department, and 59.6% patients were sedated before intubation. After finishing of diagnostic procedures, 17 patients were additionally intubate...
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Papers by Marija Milenkovic