Prevalence and surgical management of pubic hypertrophy in hypospadias patients: results from a high-volume surgeon

ABSTRACT Introduction: Pubic hypertrophy, defined as an abnormal and abundant round mass of fatty tissue located over the pubic symphysis, is frequently underestimated in patients with hypospadias. We examined the prevalence of this condition, as well as the outcomes associated with its surgical treatment. Material and methods: Within 266 hypospadias patients treated at our clinic, we assessed the prevalence of pubic hypertrophy, and we schematically described the surgical steps of pubic lipectomy. Multivariable logistic regression (MLR) tested for predictors of pubic hypertrophy. Finally, separate MLRs tested for predictors of fistula and any complications after pubic lipectomy. Results: Of 266 hypospadias patients, 100 (37.6%) presented pubic hypertrophy and underwent pubic lipectomy. Patients with pubic hypertrophy more frequently had proximal hypospadias (44 vs. 7.8%), disorders of sex development (DSD) (10 vs. 0.6%), cryptorchidism (12 vs. 2.4%), and moderate (30°-60°) or severe (>60°) penile curvature (33 vs. 4.2%). In MLR, the location of urethral meatus (proximal, Odds ratio [OR]: 10.1, p<0.001) was the only significant predictor of pubic hypertrophy. Finally, pubic lipectomy was not associated with increased risk of fistula (OR: 1.12, p=0.7) or any complications (OR: 1.37, 95% CI: 0.64-2.88, p=0.4) after multivariable adjustment. Conclusions: One out of three hypospadias patients, referred to our center, presented pubic hypertrophy and received pubic lipectomy. This rate was higher in patients with proximal hypospadias suggesting a correlation between pubic hypertrophy and severity of hypospadias. Noteworthy, pubic lipectomy was not associated with increased risk of fistula or any complications.

Frequency of COPD in health care workers who smoke / Frequência de DPOC em profissionais de saúde que fumam

ABSTRACT Objective: COPD is one of the major causes of morbidity and mortality worldwide. Health care providers should counsel their smoking patients with COPD to quit smoking as the first treatment step. However, in countries with high prevalences of smoking, health care workers may also be smokers. The aim of this study was to determine the frequency and severity of COPD in health care workers who smoke. Methods: This was a cross-sectional study. All health care workers who smoke, from nine health care centers in Serbia, were invited to participate in the study and perform spirometry. The diagnosis of COPD was based on a post-bronchodilator FEV1/FVC ratio of < 0.70. All patients completed the COPD Assessment Test and the Fagerström Test for Nicotine Dependence. Results: The study involved 305 subjects, and 47 (15.4%) were male. The mean age of the participants was 49.0 ± 6.5 years. Spirometry revealed obstructive ventilatory defect in 33 subjects (10.8%); restrictive ventilatory defect, in 5 (1.6%); and small airway disease, in 96 (31.5%). A diagnosis of COPD was made in 29 patients (9.5%), 25 (86.2%) of whom were newly diagnosed. On the basis of the Global Initiative for COPD guidelines, most COPD patients belonged to groups A or B (n = 14; 48.2%, for both); 1 belonged to group D (3.6%); and none, to group C. Very high nicotine dependence was more common in those with COPD than in those without it (20.7% vs. 5.4%, p = 0.01). Conclusions: In this sample of health care workers, the frequency of COPD was comparable with that in the general population. The presence of COPD in health care workers who smoke was associated with higher nicotine dependence.

RESUMO Objetivo: A DPOC é uma das principais causas de morbidade e mortalidade em todo o mundo. Os provedores de cuidados de saúde deveriam aconselhar seus pacientes fumantes com DPOC a parar de fumar como primeiro passo de tratamento. Entretanto, em países com altas prevalências de tabagismo, os profissionais de saúde também podem ser fumantes. O objetivo deste estudo foi determinar a frequência de DPOC e sua gravidade em profissionais de saúde que fumam. Métodos: Trata-se de um estudo transversal. Todos os profissionais de saúde fumantes de nove centros de saúde na Sérvia foram convidados a participar do estudo e realizar espirometria. O diagnóstico de DPOC baseou-se em VEF1/CVF pós-broncodilatador < 0,70. Todos os pacientes preencheram o COPD Assessment Test e o Fagerström Test for Nicotine Dependence. Resultados: Participaram do estudo 305 indivíduos, e 47 (15,4%) eram do sexo masculino. A média de idade dos participantes foi de 49,0 ± 6,5 anos. A espirometria revelou defeito ventilatório obstrutivo em 33 indivíduos (10,8%), defeito ventilatório restritivo em 5 (1,6%) e doença das vias aéreas pequenas em 96 (31,5%). O diagnóstico de DPOC foi feito em 29 pacientes (9,5%), 25 (86,2%) dos quais foram recém-diagnosticados. Com base nas diretrizes da Global Initiative for Chronic Obstructive Lung Disease, a maioria dos pacientes com DPOC ficou no grupo A ou B (n = 14; 48,2%, para ambos); 1 ficou no grupo D (3,6%) e nenhum ficou no grupo C. Um grau muito alto de dependência de nicotina foi mais comum nos indivíduos com DPOC que naqueles sem a doença (20,7% vs. 5,4%; p = 0,01). Conclusões: Nesta amostra de profissionais de saúde, a frequência de DPOC foi comparável à observada na população geral. A presença de DPOC em profissionais de saúde que fumam relacionou-se com maior dependência de nicotina.

Analysis of risk factors and clinical manifestations associated with Clostridium difficile disease in Serbian hospitalized patients

Abstract Clostridium difficile is the leading cause of infectious diarrhoea in hospitalized patients. The aim of this study was to determine the risk factors important for the development of hospital-acquired Clostridium difficile-associated disease and clinical manifestations of Clostridium difficile-associated disease. The clinical trial group included 37 hospitalized patients who were selected according to the inclusion criteria. A control group of 74 hospitalized patients was individually matched with cases based on hospital, age (within 4 years), sex and month of admission.Clostridium difficile-associated disease most commonly manifested as diarrhoea (56.76%) and colitis (32%), while in 8.11% of patients, it was diagnosed as pseudomembranous colitis, and in one patient, it was diagnosed as fulminant colitis. Statistically significant associations (p < 0.05) were found with the presence of chronic renal failure, chronic obstructive pulmonary disease, cerebrovascular accident (stroke) and haemodialysis. In this study, it was confirmed that all the groups of antibiotics, except for tetracycline and trimethoprim-sulfamethoxazole, were statistically significant risk factors for Clostridium difficile-associated disease (p < 0.05). However, it was difficult to determine the individual role of antibiotics in the development of Clostridium difficile-associated disease. Univariate logistic regression also found that applying antibiotic therapy, the duration of antibiotic therapy, administration of two or more antibiotics to treat infections, administering laxatives and the total number of days spent in the hospital significantly affected the onset of Clostridium difficile-associated disease (p < 0.05), and associations were confirmed using the multivariate model for the application of antibiotic therapy (p = 0.001), duration of antibiotic treatment (p = 0.01), use of laxatives (p = 0.01) and total number of days spent in the hospital (p = 0.001). In this study of patients with hospital-acquired diarrhoea, several risk factors for the development of Clostridium difficile-associated disease were identified.

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

Abstract 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.

Seroprevalence of Borrelia burgdorferi in occupationally exposed persons in the Belgrade area, Serbia

Lyme disease (LD) is a natural focal zoonotic disease caused by Borrelia burgdorferi, which is mainly transmitted through infected Ixodes ricinus tick bites. The presence and abundance of ticks in various habitats, the infectivity rate, as well as prolonged human exposure to ticks are factors that may affect the infection risk as well as the incidence of LD. In recent years, 20% to 25% of ticks infected with different borrelial species, as well as about 5,300 citizens with LD, have been registered in the Belgrade area. Many of the patients reported tick bites in city’s grassy areas. The aim of this study was to assess the seroprevalence of B. burgdorferi in high-risk groups (forestry workers and soldiers) in the Belgrade area, and to compare the results with healthy blood donors. A two-step algorithm consisting of ELISA and Western blot tests was used in the study. Immunoreactivity profiles were also compared between the groups. The results obtained showed the seroprevalence to be 11.76% in the group of forestry workers, 17.14% in the group of soldiers infected by tick bites and 8.57% in the population of healthy blood donors. The highest IgM reactivity was detected against the OspC protein, while IgG antibodies showed high reactivity against VlsE, p19, p41, OspC, OspA and p17. Further investigations in this field are necessary in humans and animals in order to improve protective and preventive measures against LD.

Skeletal Manifestations of Hydatid Disease in Serbia: Demographic Distribution, Site Involvement, Radiological Findings, and Complications

Although Serbia is recognized as an endemic country for echinococcosis, no information about precise incidence in humans has been available. The aim of this study was to investigate the skeletal manifestations of hydatid disease in Serbia. This retrospective study was conducted by reviewing the medical database of Institute for Pathology (Faculty of Medicine in Belgrade), a reference institution for bone pathology in Serbia. We reported a total of 41 patients with bone cystic echinococcosis (CE) during the study period. The mean age of 41 patients was 40.9+/-18.8 years. In 39% of patients, the fracture line was the only visible radiological sign, followed by cyst and tumefaction. The spine was the most commonly involved skeletal site (55.8%), followed by the femur (18.6%), pelvis (13.9%), humerus (7.0%), rib (2.3%), and tibia (2.3%). Pain was the symptom in 41.5% of patients, while some patients demonstrated complications such as paraplegia (22.0%), pathologic fracture (48.8%), and scoliosis (9.8%). The pathological fracture most frequently affected the spine (75.0%) followed by the femur (20.0%) and tibia (5.0%). However, 19.5% of patients didn't develop any complication or symptom. In this study, we showed that bone CE is not uncommon in Serbian population. As reported in the literature, therapy of bone CE is controversial and its results are poor. In order to improve the therapy outcome, early diagnosis, before symptoms and complications occur, can be contributive.

Screen viewing, body mass index, cigarette smoking and sleep duration in Belgrade University student population: results of an observational, cross-sectional study / Asociación entre el tiempo dedicado a actividades sedentarias e índice de masa corporal en estudiantes universitarios en Belgrado

Background: Subjects that spend more time working on computers or watching television could have a higher body mass index. Aim: To assess the relationship between time spent in front of a screen and studying, body mass index (BMI), smoking, and sleep duration among university students. Material and Methods: A cross-sectional study of 734 randomly selected students aged 21 ±2 years (450 females) that responded an anonymous, structured questionnaire about time spent watching television or in front of a computer, time spent studying, number of daily hours of sleep, smoking habits and number of daily meals. Body mass index was also calculated for all subjects Results: Among males, the number of daily sleep hours, time spent working with computers and number of daily meals were significantly higher and time spent studying was significantly lower than females. Nonsmokers ate a significantly higher number of meals and spent less time watching television. No association was observed between time spent in front of a screen and number of sleep hours of body mass index. Conclusions: Men and smokers spend more time working in computers. There is no association between body mass index and time spent in front of screens.

Antecedentes: Aquellos individuos que trabajan en computadores o ven televisión por mucho tiempo pudieran tener un índice de masa corporal mayor. Propósito: Evaluar la asociación entre el tiempo ocupado viendo televisión o trabajando en el computador, índice de masa corporal, hábito de fumar y horas diarias de sueño en estudiantes universitarios. Material y Métodos: Se efectuó un estudio transversal de 734 estudiantes elegidos al azar de 21 ±2 años de edad (450 mujeres), que respondieron una encuesta acerca del número de horas que pasaban viendo televisión, trabajando en un computator o estudiando, el número de horas diarias de sueño, hábito tabáquico y número diario de comidas. Además se calculó el índice de masa corporal de los encuestados. Resultados: Los hombres dormían más horas por día, pasaban más tiempo trabajando en computadores o viendo televisión y estudiaban menos horas por día que las mujeres. Los no fumadores comían más comidas por día y permanecían menos horas viendo televisión. No hubo una asociación significativa entre el número de horas enfrente de una pantalla o la cantidad de horas diarias de sueño con el índice de masa corporal. Conclusiones: Los hombres y los fumadores pasan más tiempo viendo televisión o trabajando en computadores. No se observó una relación entre el tiempo que se permanece frente a una pantalla y el índice de masa corporal.

Frequency and characteristics of metabolic syndrome in patients with symptomatic carotid atherosclerosis / Frecuencia y características del síndrome metabólico en pacientes con estenosis carotídea sintomática

Background: Metabolic syndrome (MetS) is associated with increased risk of carotid atherosclerosis. Aim: To estimate the frequency of MetS in patients with symptomatic carotid atherosclerotic disease, and to compare clinical, biochemical and ultrasonographic characteristics of patients with and without MetS. Material and methods: Cross-sectional study of 657 consecutive patients (412 males) with symptomatic carotid atherosclerotic disease. Carotid atherosclerosis was estimated by high resolution B-mode ultrasonography. National Cholesterol Education Program (NCEP) M criteria were used for estimation of MetS. Results: Metabolic syndrome was present in 55.6 percent of studied patients. Among patients with metabolic syndrome there was a significantly higher proportion of women, and mean values ofbody weight, body mass index, waist circumference, percentage of body fat, systolic and diastolic blood pressure, serum triglycerides, total cholesterol and glucose were significantly higher. Mean values of high density lipoprotein cholesterol and alcohol consumption were significantly lower in patients with MetS. No differences between patients with or without MetS, were observed for age, smoking, mean values of low density lipoprotein cholesterol, high sensitive C-reactive protein and fibrinogen, and for degree of carotidstenosis or severity of clinical manifestations. Conclusion: Half of these patients with carotid stenosis have features of the metabolic syndrome.

Antecedentes: El síndrome metabólico se asocia a un mayor riesgo de ateroesclerosis carotídea. Objetivo: Evaluar la frecuencia de síndrome metabólico en pacientes con ateroesclerosis carotídea sintomática y comparar las características clínicas, bioquímicas y ultrasonográficas en pacientes con y sin síndrome metabólico. Material y método: Estudio transversal de 657 pacientes consecutivos (412 varones) con ateroesclerosis carotídea sintomática. El síndrome metabólico fue diagnosticado de acuerdo a los criterios del National Cholesterol Education Program (NCEP) III. la ateroesclerosis carotídea se investigó mediante ultrasonografía de alta resolución modo B. Resultados: Se diagnosticó síndrome metabólico en 55.6 por ciento de los pacientes estudiados. Entre los sujetos portadores del síndrome había una mayor proporción de mujeres y el peso, índice de masa corporal, circunferencia de cintura, porcentaje de grasa corporal, presión arterial sistólica y diastólica y niveles séricos de triglicéridos, colesterol total y glicemia fueron mayores. los valores promedio de colesterol HDI y de consumo de alcohol fueron significativamente menores en los pacientes con síndrome metabólico. los pacientes con el síndrome consumían menos alcohol y tenían niveles de colesterol HDI más bajos. No se encontraron diferencias entre sujetos con y sin síndrome metabólico en edad, tabaquismo, lipoproteínas de baja densidad, proteína C reactiva ultrasensible, fibrinógeno, grado de estenosis carotídea o severidad de sus manifestaciones clínicas. Conclusiones: la mitad de estos pacientes con estenosis carotídea tiene un síndrome metabólico.