Aleksandra Matic

Background: Data on the incidence and clinical and perinatal characteristics of infantile haemangiomas (IHs) in preterm infants are scarce, especially for those born at very low (VLGA) and extremely low gestational ages (ELGA). Objectives: We aimed to determine the current incidence of IHs in infants born at VLGA and ELGA and to evaluate the main perinatal and clinical characteristics of IHs among this population of patients. Methods: All infants born at VLGA and ELGA during a 10-year period at a single university tertiary-care clinic were included in the study. For each participant, the main perinatal characteristics of gestational age, birth weight, plurality of pregnancy, sex and whether conception occurred through artificial reproductive techniques were gathered. The clinical characteristics of IHs in the affected infants were examined. Results: In total, 870 infants born at VLGA/ELGA were enrolled during a 10-year study period. In 107 (12.3%), 1 or more IHs were found. Female sex and being conceived by artificial reproductive techniques were the most prominent risk factors for the appearance of IHs, while small-for-gestation-age status at birth showed a borderline association with a higher incidence. Among the affected infants born at VLGA/ELGA, 69.2% had a solitary IH, most commonly located on the trunk (41.4%). Complications were observed in 3.5% of patients. Topical or systemic beta-blocker therapy was administered in 16.8% of patients, with systemic propranolol causing adverse effects in only one infant. Conclusions: We observed that the frequency of IHs in infants born at VLGA/ELGA was 12.3%. The main perinatal risk factors for the occurrence of IHs in this group of infants were female sex and being conceived by artificial reproductive techniques.

Background/Aim. Venous leg ulcers (VLUs) are often colonized by various types of bacteria, which can lead to infection that requires empirical antibiotic therapy. Bacterial types and their antibiotic susceptibility vary widely over time and by geographic location. The aim of the study was to determine the change trends of causative bacteria and antibiotic susceptibility in patients with VLUs over the past two decades. Methods. The study was conducted at a tertiary care dermatovenereology clinic. Data on the microbiological analysis of ulcer swabs from patients with VLUs were collected over two consecutive months at three time points: 2001, 2014, and 2020. Results. The study included 250 patients divided into three groups. The first group (2001) had 111 participants, the second group (2014) had 64, and the third group (2020) had 75 participants. Out of the 250 swabs sent for microbiological testing, only 4 (1.6%) samples yielded negative results. In 2001, the bacteria identified were 31.83% Gram-positive (G+) and 68.13% Gram-negative (G-). In 2014, the ratio between G+ and G- bacteria was 27.18% vs. 72.82%. In 2020, the predominance of G-bacteria was even more pronounced, with 89.86% compared to 10.14% G+ (p < 0.001). In 2001, Pseudomonas (P.) aeruginosa (P. aeruginosa) (26.54%) was the predominant G-bacterium, and Staphylococcus (S.) aureus (24.78%) was the most common G+ bacterium. In 2014, P. aeruginosa (30.10%) and S. aureus (23.30%) remained prevalent. By 2020, P. aeruginosa (35.14%) increased further, while S. aureus (7.43%) decreased significantly (p < 0.001). Antibiotic sensitivity varied over the years, with older antibiotics showing decreased efficacy and newer classes demonstrating increased sensitivity. Conclusion. Throughout the study period, there was a notable shift toward G-bacterial dominance, particularly P. aeruginosa. Antibiotic resistance patterns also evolved. This study highlights the importance of local surveillance of bacterial flora of VLUs and antibiotic resistance profiles.

Aims: This study aimed to assess nursing workload in Cardiac Intensive Care Unit (CICU) after three cardiothoracic surgery procedures during first four postoperative days using Nursing Activities Score (NAS) and Nine Equivalents of Nursing Manpower Use Score (NEMS) systems, to compare their performance for that purpose and to investigate association between nursing workload and type of surgery.Design: A comparative study.Methods: The research environment includes CICU of the University Hospital for Cardiovascular Diseases in Serbia. A total of 808 patients who underwent coronary, valvular, or combined surgery, resulting in 2282 filled NAS and NEMS pairs chart. Statistical analysis was performed using SPSS‐19. The correlation between NAS and NEMS was tested by Spearman's correlation coefficient. Differences were considered statistically significant at p < 0.05.Results: The lowest median of cumulative NAS 176 (175‐257) and NEMS 76 (64‐91) had coronary surgery patients, the highest NAS 224.5 (178‐334.5) and NEMS 83 (69‐121) had those with combined surgery; this difference was statistically significant (p < 0.001). The median of both scores decreased after surgery, with the following values from the first to the fourth postoperative day: NAS from 104 (102‐105) to 81 (74‐85) and NEMS from 46 (42–46) to 30 (30–37). The difference in mean values of both scores between the first and the fourth postoperative day was statistically significant (p < 0.001). NAS and NEMS were in a positive, strong correlation (r = 0.913; p < 0.005).Conclusion: Both scores can be used to measure nursing workload, identify the required number of nurses in CICU, and support task allocation. NAS may have an advantage because it better describes extensive postoperative monitoring and care needed for cardiac surgery patients. Nursing workload is associated with type of surgery, with the highest workload measured in patients who underwent combined surgery procedure and on the first postoperative day.

Introduction. Pericardial effusion represents a significant medical issue with diverse origins, often associated with malignant conditions. This study aims to comprehensively analyze the demographic, clinical, and cytological aspects of pericardial effusion in patients treated at a tertiary center. Methods. This retrospective study included a four-year period and obtained fine needle aspiration cytology (FNAC) analysis results of pericardial effusion in 80 patients. Data covering demographics, reasons for hospitalization, and cytological analyses were collected and statistically evaluated. Results. The average age of participants was 67±12 years, with a slight male predominance. The primary reasons for hospitalization were impending cardiac tamponade (41%), massive effusions (27%), and cardiac decompensation (9%). Hemorrhagic and malignant effusions were prevalent cytologically. Malignant effusions were noted in 20% of cases, primarily originating from lung adenocarcinoma, and in approximately 15% of cases, served as an initial indicator of hidden malignancy. Conclusion. Understanding the demographic patterns, clinical presentations, and cytological types of pericardial effusion is crucial for timely diagnosis and treatment. This research highlights the significance of pericardial effusion as a potential indicator of an underlying malignancy and underscores the importance of early detection and intervention.

Background: Multifocal infantile hemangiomas (IHs) are focal cutaneous lesions affecting more than 1 anatomic site. The multifocal distribution pattern is the rarest form of IH manifestation, accounting for only 3-4% of all affected infants. This type of cutaneous IHs may be a marker for extracutaneous disease, with the liver being the most frequently affected organ. Methods: We investigated the clinical and epidemiological characteristics of a small case series of infants with multifocal IHs presenting with different clinical patterns, all diagnosed and treated in a regional tertiary-care pediatric clinic. Results: Four infants with multifocal IHs were included in the analysis. There were 3 girls and 1 boy. Three out of 4 infants were prematurely born (2 of them very preterm), while only 1 was full-term. Clinical patterns in all cases were quite different, but more than 20 cutaneous IHs were present in each of the patients. Two infants had multifocal liver hemangioma, but without complications. In 3 out of 4 patients, systemic propranolol therapy was introduced, with excellent response in two cases (both with liver involvement). Conclusion: With the increase in the number of cutaneous IHs, the probability of internal organ involvement, most often the liver, also increases. Evaluation for extracutaneous lesions is indicated in infants with 5 or more cutaneous IHs. Treatment of infants with multifocal IHs should be individualized and consider all rel

Introduction. Infantile hemangiomas (IHs) are the most common vascular tumors of infancy whose frequency increases with decreasing gestational age. Although rare, periorbital IHs (PIHs) have a high complication rate, with a substantial risk of impaired vision and aesthetic consequences. Because they are considered high-risk IH, such patients must be treated. In the available literature, there is little information about the treatment o f I Hs in very and extremely preterm newborns and infants. Case report. We present three male infants (one very and two extremely prematurely born) with PIHs involving the upper eyelid. In all three cases, IHs were solitary but with different subtypes according to soft-tissue depth (superficial, combined, deep). No additional congenital anomalies were found in any of these cases. An individualized approach to the management of each patient was applied. All infants were treated with oral administration of propranolol, with careful monitoring for potential side effects of the drug and adjustment of treatment, following their eventual occurrence. The introduction of oral propranolol was carried out in a hospital setting, with a gradual increase of the drug dose until the target dose was reached. Conclusion. In the case of PIH, an ophthalmologist is an inevitable part of the medical team. Very and extremely preterm infants are already under the supervision of an ophthalmologist due to mandatory screening for retinopathy of prematurity; how-ever, if they also have PIHs, monitoring must be particularly detailed and long-lasting.

Infantile hemangiomas with minimal or arrested growth (IH-MAGs) are a subtype of infantile hemangiomas (IHs), characterized by absent or minimal (equal or less than 25% of the total IH surface area) proliferation. They are less conspicuous than classical Ns, but can also be complicated by ulceration or can be misdiagnosed as capillary malformations. The literature on IH-MAGs is scarce, but with increasing interest in the literature. We investigated the clinical and epidemiological characteristics of IH-MAGs in a retrospective series of cases found in a regional tertiary-care pediatric clinic during a 7-year period. Eleven infants with 14 IH-MAGs were included in the analysis. There were 7 girls and 4 boys. Unlike the majority of other authors, we have found 7 premature and 4 full-term infants in our case series. Most of the IH-MAGs were classified as focal (78.57%), were present at birth (72.72%), and were located on the lower body, below the waist line (71.42%). In almost all infants, erythematous background as well as vasoconstricted patches and/or halos were present, while fine or coarse telangiectasias were observed mainly in full-term infants. A subtle proliferative component was observed in only one case on follow-ups. There were no ulcerations. The therapy - topical and oral beta-blocker - was introduced in two cases of IH-MAGs in the face region. Clinical characteristics of IH-MAGs in our case series were similar to those found in other studies on this subject. However, we found a significantly higher percentage of premature infants with IH-MAGs than in any available reference.

Introduction. Infantile hemangiomas (IHs) occur 3 to 4 times more frequently in preterm infants than in those born at term. Yet, data about efficacy and safety of topical therapy for IHs in preterm infants, especially in those born with very low gestational age (less than 33 gestational weeks) is very scarce. Case report. We reported five very preterm girls treated with topical timolol maleate 0.5% gel for superficial cutaneous IHs. In four infants topical timolol was applied on a single IH each, and in one infant two IHs were treated. Out of six treated IHs, one was located on the face, four on the trunk and one on the leg. They were regularly monitored for IH involution and potential adverse effects of timolol for 6?13 months of local treatment. Good therapeutic effect was achieved in all the presented infants, with no adverse effects related to topical administration of timolol-maleate. Conclusion. Topical timolol is an effective and safe therapy for superficial cutaneous infantile hemangiomas in very preterm infants. The treatment should be discussed in detail with parents and individualized management plan should be tailored for each infant in order to maximize the chances of a successful outcome, while avoiding adverse effects.

Iatrogenic anetoderma of prematurity (IAOP) represents a benign iatrogenic dermatosis characterized by focal, well-demarcated areas of atrophic skin in preterm infants. We present the cases of 5 infants diagnosed with IAOP during a 3-year period in a tertiary-care university hospital. Skin atrophy patches were absent at birth in all presented infants, and there was no family history of anetoderma. All of the infants were born with very low gestation and birth weight, with a clinical course that was complicated with several serious prematurity-related complications with consequent long periods of unstable vital functions and the need for continuous monitoring. Skin defects consistent with IAOP were located on the previous ECG electrode sites. IAOP changes in all the infants were in the form of oval patches of skin atrophy in the middle chest region, with an additional few small, round patches bellow the nipple on both sides in one girl. Diagnosis of IAOP was based on characteristic clinical findings. IAOP is rare, benign, but permanent skin injury in the most immature of infants, with a potential for considerable aesthetic and psychological burden. Due to the constant increase in survival of very and extremely preterm infants, more often without major developmental consequences, milder complications like IAOP will become more and more important.

Introduction. Hypertensive ischemic leg ulcer, also known as Martorell ulcer, is not very rare, but an under-recognized type of leg ulcer. It has specific clinical and histopathological characteristics. It occurs almost exclusively in patients with arterial hypertension. It is more common in women and in patients with type 2 diabetes. It is localized particularly in the laterodorsal distal third of the lower leg. This ulcer is extremely painful. Its clinical features may very much resemble pyoderma gangrenosum. Case Report. We are presenting a case of a 40-year-old obese male, who suffered from arterial hypertension during the past 26 years. His ulcer appeared spontaneously on the lateral aspect of the right lower leg and progressed gradually. From the very onset, the ulcer was extremely painful. At first, it was diagnosed as pyoderma gangrenosum and treated with systemic corticosteroids and immunosuppressants. Since the response to therapy was not satisfactory, the histopathology was revised and the diagnosis of hypertensive ischemic leg ulcer was made. After initial wound debridement and local negative pressure therapy, split-thickness skin grafting was performed. The pain disappeared right away almost completely and complete epithelization was achieved two weeks after skin grafting. Conclusion. It is important to consider Martorell ulcer in hypertensive patients with extremely painful ulcers of the lower leg. In order to establish the appropriate diagnosis, it is essential to take a deep skin biopsy and correlate the finding with a specific histopathological picture. It is the only way not to confuse hypertensive ischemic leg ulcer with pyoderma gangrenosum, since the management of the two conditions is completely different.