Can mindfulness-based interventions reduce PTSD symptoms? An umbrella review.

Post-traumatic stress disorder (PTSD) is a debilitating, often chronic condition with substantial cross-national lifetime prevalence. Although mindfulness-based interventions (MBIs) may help reduce PTSD symptoms, efficacy results are inconsistent. Despite many systematic reviews (SRs) examining MBIs for PTSD, SR quality has been neither evaluated nor synthesized. We conducted an umbrella review to summarize and evaluate existing evidence regarding MBIs for PTSD, identifying 69 SRs (27 meta-analyses), consisting of 83 primary studies. Using AMSTAR2 (a valid SR quality assessment tool), we evaluated each SR on key domains relevant to methodological rigor and rated the confidence of inferences. Results found SRs were 65.2% non-rigorous, 27.5% likely rigorous, and 7.2% rigorous; common limitations included inadequate risk of bias assessment, extractions not completed in duplicate, and lack of pre-registration, highlighting the need for higher quality SRs. We then performed a meta-meta-analysis to estimate the efficacy of MBIs to reduce PTSD symptoms, yielding a medium effect size (SMD=0.41, p < .001), derived from 22 meta-analyses (with replicable data) and 35 unique articles. Analyses were consistent across control conditions and MBI type (first-generation/narrow [i.e., MBIs with well-established protocols]) versus broad (i.e., other MBI types), comparable with second-line treatments (e.g., pharmacotherapy). Findings were narratively synthesized; areas for methodological improvements in MBI research were identified.

Validation and Cultural Adaptation of the Serbian Version of the Pediatric Outcome Data Collection Instrument (PODCI) in Children with Obstetrical Brachial Plexus Lesion.

Background and objectives: Pediatric Outcome Data Collection Instrument (PODCI) is among the most described scales developed to evaluate the physical status of children and adolescents with various musculoskeletal disorders. We aimed to translate PODCI from English to Serbian, culturally adopt items and domains, evaluate the temporal stability, internal consistency and the test−retest reliability of PODCISR in children with obstetrical brachial plexus lesion (OBPL), and finally, to test the construct validity of PODCISR against muscular manual test (MMT) Materials and Methods: The study included 48 eligible participants aged between 2 and 10 years with OBPL. The MMT was used to test the construct validity. Results: There were no significant differences (p > 0.05) between test and retest for all PODCISR domains. Correlations for all tested domains with MMT were statistically significant except for biceps muscle and domains II and IV. Cronbach's alpha value of the Global Functioning Scale was good and equaled 0.838 for test and 0.832 for retest session. Cronbach's α was more than 0.600 for all PODCISR domains except for Domain II and for Domain IV. The observed Test−Retest ICC for all PODCISR domains scores ranged from 0.899 to 0.996. Conclusion: The Serbian version of PODCI (PODCISR) was successfully translated and transculturally adopted. It has satisfactory temporal stability, construct validity and test−retest reliability as well as relevant internal consistency.

Management of Anesthesia in a Child with a Large Neck Rhabdoid Tumor.

OBJECTIVE: The aim of this paper was to report the management of anesthesia of a child with a large neck rhabdoid tumor. CLINICAL PRESENTATION AND INTERVENTION: A 9-month- old female patient underwent urgent neck tumor excision due to intratumoral bleeding from a large tumor that compressed and dislocated the trachea; therefore, intubation was expected to be difficult. Sevoflurane inhalation induction was utilized to maintain spontaneous respiration. Oral laryngoscopy revealed Cormack-Lehane grade 3 laryngeal view. The trachea was intubated using a reinforced tube on the third attempt. Fiberoptic bronchoscope-assisted intubation was planned as an alternative in case of conventional intubation failure. Anticipation of massive blood loss necessitated central venous catheterization. CONCLUSION: Establishing a safe airway, intubation during spontaneous breathing and invasive hemodynamic monitoring are crucial factors in the anesthetic management of pediatric patients with a large neck tumor.

Benign cystic mesothelioma of the peritoneum in a male child.

The benign cystic mesothelioma of the peritoneum is a rare lesion that occurs predominatly in women of reproductive age and has a high propensity for local recurrence. It is very rare in childhood, especially in boys, being reported in only 4 cases. A new case of benign cystic mesothelioma of the peritoneum in an 11-year-old boy is reported. The lesion occupied the entire left abdomen, arising from the transverse mesocolon, and it was accompanied by 4 small cysts. The patient had a coexistent right-sided renal agenesis. The mesothelial nature of the cysts epithelial lining cells was confirmed by immunopositivity for calretinin, cytokeratin 5/6, HBME1, and epithelial membrane antigen (EMA). No recurrence of the lesion was noted in the 7-month follow-up. Pathologists and clinicians should be aware of the existence of this rare entity in childhood to establish an accurate diagnosis and provide close follow-up after the surgery.

Characteristics of chronic hepatitis C among intravenous drug users: a comparative analysis.

Hepatitis C virus (HCV) usually evades the host's immune system and persists as a chronic infection. Intravenous drug users (IVDU) represent the majority of patients infected with HCV. Combined therapy of chronic hepatitis C (CHC) with peginterferon alpha-2a and ribavirin can be successful even when patients continue the intravenous drug use. In this study, we compared the characteristics of age, gender, genotype, and stage of fibrosis and the therapy outcome among IVDU and patients with no history of drug use. The study included 69 patients diagnosed with chronic hepatitis C, evaluated and treated at the Clinic for infectious diseases in Nis from 2005 to 2009. HCV RNA was detected by a polymerase chain reaction and the determination of genotypes was undertaken. Liver biopsies were examined histopathologically. Patients received a combined treatment of peginterferon alfa-2a and ribavirin. Therapy efficiency was evaluated based on the achievement of the sustained virological response (SVR). A comparison of characteristics was performed with the use of Mann-Whitney U test, chi-square (chi2) test and logistic regression. IVDU were significantly younger than patients in the control group. Prevalence of stage 1 fibrosis was significantly higher among IVDU. The therapy outcome is influenced by the patient's age and HCV genotypes. Each year added to one patient decreased the therapy efficiency by 8.1%, while genotypes 2 and 3 experienced a therapy which was 2.08 times more efficient than in other cases. IVDU represent a specific population different from non-using patients. However, they can be treated effectively if an adequate patient-doctor relationship is established.

[Laparoscopic operations in pediatric surgery]. / Laparoskopske operacije u decjoj hirurgiji.

From January 2003 to January 2004, laparoscopy was performed in 100 cases, aged from 10 months to 19 years. Diagnostic laparoscopy was applied in 39 patients, most often in nonpalpable testes (29), ovarian cysts (4), abdominal trauma (1), abdominal cysts (2) and intersex states (3). Ninety patients underwent operative laparoscopy: appendectomy (44), orchiopexy (2), orchiectomy (1), herniorrhaphy (1), varicocelectomy (8), adnexectomy (2), cholecystectomy (8), Fowler-Stephens procedure (1), abdominal cysts (2), ovarian cystectomy (6), subdiaphragmatic abscess (1), adhesiotomy (11), liver cysts (2) and splenectomy (1). Diagnostic laparoscopy has proved to be more reliable and less invasive method in comparison to previously used methods. Our conclusion is that operative laparoscopy has many advantages compared with some of the classical surgical procedures.

[Laparoscopic appendectomy in children--a new fashion or a privilege]. / Laparoskopska apendektomija kod dece--moda ili privilegija.

Whether laparoscopic appendectomy is superior to open appendectomy for simple and perforated appendicitis in children is still debatable. To answer this question, surgical experience of three experienced pediatric surgeons in a single institution was studied during one year in all cases of laparoscopic appendectomy. From January 2003 to January 2004, all laparoscopic appendectomies were reviewed for operative technique, advantages, disadvantages, operative time and length of stay. There were 44 laparoscopic appendectomies in children aged 4 to 19 years. Operating time dropped from 52 minutes at the beginning to less than 25 minutes at the end of year. Operating time in perforated appendicitis was slightly longer, from 58-65 minutes. Length of stay was 1-2 days for simple cases, and maximum 5 days for perforated ones. There were no postoperative complications such as abscess, bowel obstruction, bleeding, wound infection or mortality. Laparoscopic appendectomy is at least as safe and effective, if not superior to, as open appendectomy for both, simple and perforated appendicitis. Postoperative pain is less, and recovery is faster. Laparoscopic appendectomy is our procedure of choice in pediatric surgery.

[Surgery for neutropenic enterocolitis, a complication in acute lymphoblastic leukemia]. / Hirurske komplikacije neutropenijskog enterokolitisa kod akutne limfoblastne leukemija.

Neutropenic enterocolitis (NE) is an unusual acute complication of neutropenia, associated with leukemia and lymphoma. It has been observed mainly in the first phase of therapy when drugs are used in maximally tolerated dose. This is a case report of neutropenic enterocolitis in a patient with acute lymphoblast leukemia who received prednisone, vincristine, daunorubicin and L-asparaginase, with perforation of cecal and terminal ileum. Perforation and defect intestine wall was excised and sutured directly in two layers. Protective proximal loop ileostomy was performed at that time.

[Histopathologic and immunocytochemical changes in the liver in patients with chronic hepatitis C]. / Histopatoloske i imunocitohemijske promene u jetri bolesnika sa hronicnim hepatitisom C.

BACKGROUND: The presence of lymphocytes within the liver parenchyma is related to immunologically mediated liver damage in chronic hepatitis C. The aim of the study was to make histological, histochemical, and immunocytochemical assessment of liver biopsy specimens in patients with chronic hepatitis C virus (HCV) infection. METHODS: Biopsy specimens of 20 patients with chronic HCV disease were analyzed, using standard staining procedures to verify histologic liver lesions, as well as immunoenzymatic staining with monoclonal antibodies to detect CD4+ T-lymphocytes, B-lymphocytes, and macrophages. RESULTS: Micromorphologic characteristics of chronic active viral hepatitis C were present in all the patients, differing, however, by the level of their activity. Dominant changes were found within the portal space, consisting of mononuclear lympho-plasmocytic infiltration and macrophages. Immunocytochemical investigation of mononuclear and macrophageal infiltration showed the correlation between micromorphological findings and the degree of the activity. CONCLUSION: The presence of lymphocytic and macrophageal infiltration within the hepatic tissue directly correlated with the intensity of the liver damage. Analysis of the population of cellular infiltrate in the liver together with the monitoring of viremia level and the level of hepatocyte necrosis, could be useful tools for elucidation of the pathogenesis of chronic hepatitis C.

[An epidemic of tularemia in the Nish area]. / Epidemija tularemije u Niskom okrugu.

Tularaemia, as a rare disease, surprised medical workers in 1999 and 2000 when it was detected and diagnosed in 31 patients. In 1999 patients were registered in villages of the Sokobanja community, and in 2000 also in other communities in the district of Nish. Patients were peasants, mostly housewives. Glandular form of the disease was dominant. The main clinical symptoms were: tonsillitis, pain in the region of enlarged lymphatic glands and temperature, Biohumoral syndrome presented accelerated sedimentation of erythrocytes and elevated fibrinogen values. Antibody titer of Francisella tularensis was extremely high in the majority of patients. The disease was cured in all patients: in 27 patients after the first therapy, in 4 subjects after recidivation and 5 patients were surgically treated.