Post VV-ECMO Weaning Hyperinflammation-Can Prophylactic Hemoadsorption Treatment Prevent Complications?

Acute respiratory distress syndrome (ARDS) is a severe clinical condition characterized by acute respiratory failure and a high mortality risk despite conventional mechanical ventilatory support. Veno-venous extracorporeal membrane oxygenation (vvECMO) has emerged as an effective life-support technology for patients with ARDS. However, complications may arise following the decannulation of vvECMO, with a relatively frequent development of systemic hyperinflammation (SHI). Among the various treatment strategies for SHI, the use of hemoadsorption with CytoSorb® has shown promising results in removing excessive levels of cytokines and attenuating the hyperinflammatory response. In this case series, we present three critically ill patients with ARDS secondary to pneumonia who underwent vvECMO and subsequently received prophylactic hemoadsorption with CytoSorb® following decannulation as a part of our clinical practice. This case series aims to describe the potential positive effects of hemoadsorption in preventing the development of SHI after vvECMO decannulation in ARDS patients.

Does adjunctive hemoadsorption provide benefit in the management of ischemia-reperfusion syndrome following near-drowning? A case report.

Drowning remains a significant global health concern, claiming over 300,000 lives annually, with a disproportionate impact on young individuals in low-and middle-income countries. Conventional mechanical ventilation, while common, falls short in addressing the hypoxemia and hypercapnia often observed in severe near-drowning cases. Veno-venous extracorporeal membrane oxygenation (vvECMO) emerges as a critical intervention for cardiopulmonary failure post-drowning. This case report delves into the pivotal role of ischemia-reperfusion injury (IRI) in a near-drowning-related pathology. Following the initial insult, reoxygenation exacerbates the inflammatory cascade, resulting in a surge of pro-inflammatory mediators. In this context, CytoSorb®, a hemoadsorption cartridge, demonstrates promise by effectively removing these mediators from circulation. This report outlines its application in a critically ill adolescent patient who experienced near-drowning, presenting a compelling case for CytoSorb as an adjunctive therapy in managing IRI-induced hyperinflammation.

Arsenic occurrence in drinking water supply systems in ten municipalities in Vojvodina Region, Serbia.

Vojvodina, a northern region of Serbia, belongs to the Pannonian Basin, whose aquifers contain high concentrations of arsenic. This study represents arsenic levels in drinking water in ten municipalities in Serbia. Around 63% of all water samples exceeded Serbian and European standards for arsenic in drinking water. Large variations in arsenic were observed among supply systems. Arsenic concentrations in public water supply systems in Vojvodina were much higher than in other countries in the Pannonian Basin.

Continuous medical education (CME) of general practitioners (GP) in primary health care settings in the field of identification and diagnosis of alcoholism.

Institute of Public Health of Serbia (IPHS) is developing new function related to better monitoring of alcohol related diseases and injuries, actions focusing on alcohol as a lifestyle related factor using integrated strategic approaches for both population and individual risk reduction. In that regard the long term objective of the IPHS is to study, monitor, promote and safeguard public health--from the point of view of mental health and alcohol abuse--by means of research, development and the provision of expert services. Starting point in the aforementioned need for the capacity building in the area of mental health and alcohol abuse is the Program of education of general practitioners (GPs) in primary health care settings for identification and diagnosis of alcoholism. This is because GPs have the widest contact with the general population. Their education related to recognition of alcohol abuse and appropriate diagnostic tools application is first, but very important step in providing direction of the health service and other sectors for problem solving and would bring the largest benefit for the whole population. In the year 2010 National program against alcohol abuse and alcoholism will be developed. Program of education of GPs is very important complementary activity which outcome will have great impact on the National program implementation.

Smoking habits of employees in public-health institutes.

UNLABELLED: This study's aim is to gain the insight on smoking prevalence at the Institutes of Public Health in Serbia. METHOD: All Institutes of Public Health in Serbia have participated in the study. All employees have participated in an epidemiology survey, which is used to collect data. RESULTS: The questionnaire on smoking was completed by 83,2% (2458) of employees in the public-health institutes and institutions in the Republic of Serbia. The questionnaire was filled in by 27,1% males, and 72,95% females, in other words, the gender ratio was 1:2,7 respectively, which corresponds to gender ratio of the total number of employees in these institutes and institutions. Smoking prevalence among the employees according to the Occupation: Of the total number of questioned employees in Serbian public-health institutes and institutions 1078 are smokers (43,8%). Smoking habits among the employees according to occupation are as follows: Physician smokers 31.1% (134), Secondary-school medical staff smokers 48.1% (507), and non-medical staff smokers 45.0% (437). CONCLUSION: Even though medical personnel hold a key-role in smoking prevention and quitting smoking, smoking among them is at a high rate. Taking into consideration that institutes and institutions of public health have a promotional anti tobacco and prevention role, the first step in carrying out the National strategy of tobacco control should be the appliance of the Codex of behavior of medical personnel in tobacco control, and the decrease in the number of smokers among the employees in health institutes.

HIV-related risk behaviors among Roma youth in Serbia: results of two community-based surveys.

PURPOSE: The Roma constitute a large ethnic minority in Serbia, and are one of the poorest and most marginalized groups in Europe. Roma youth may be at high risk for hepatitis C, HIV, and other sexually transmitted infections, but little is known about the prevalence of these infectious diseases, HIV-related knowledge, and risky sexual behaviors in this vulnerable population. METHODS: We used a respondent-driven sampling to conduct biobehavioral surveys of Roma youth (aged 15-24 years) in Belgrade and Kragujevac, and to document HIV-related knowledge and risky sexual behaviors, health-seeking behaviors, and seroprevalence of HIV, hepatitis C virus (HCV), and syphilis. RESULTS: Four hundred eleven Roma youth participated in this study. One participant had HIV, four had HCV, and none had syphilis. Risky sexual behaviors were highly prevalent, especially among male subjects: 36.2% (Belgrade) and 45.1% (Kragujevac) had sexual debut before the age of 15 years; 53.9% (Belgrade) and 61.1% (Kragujevac) had more than one sexual partner in the past year; 11.5% (Belgrade) and 4.6% (Kragujevac) reported engaging in commercial sex; and 4.0% (Belgrade) and 3.2% (Kragujevac) reported having anal sex with other men. Among female subjects aged <25 years, 33.5% (Belgrade) and 25.7% (Kragujevac) reported having an abortion. One-quarter of all participants answered all five HIV knowledge questions correctly. CONCLUSIONS: Fortunately, the current prevalence of HIV, HCV, and syphilis is low; however, the high prevalence of reported risky behaviors suggests that Roma youth in Serbia are at high risk of contracting sexually transmitted infections.

[Microcystin-LR in surface water of Ponjavica River].

BACKGROUND/AIM: Cyanobacterial toxins befall a group of various compounds according to chemical structure and health effects on people and animals. The most significant in this large group of compounds are microcystins. Their presence in water used for human consumption causes serious health problems, liver beeing the target organ. Microcystins are spread all over the world. Waterblooms of cyanobacterias and their cyanotoxins are also common in the majority of surface waters in Serbia. The aim of this study was to propose HPLC method for determination of mikrocystin-LR, to validate the method and to use it for determination of microcystin-LR in the surface water of the river Ponjavica. The Ponjavica is very eutrophic water and has ideal conditions for the cyanobacterial growth. METHODS: Sample of water form the Ponjavica river were collected during the summer 2008. Coupled columns (HLB, Sep-Pak), were used for sample preparation and HPLC/PDA method was used for quantification of microcystin-LR. RESULTS: Parameters of validation show that the proposed method is simple, fast, sensitive (0.1 mg/L) and selective with the yield of 89%-92%. The measuring uncertainty of +/- 5% was obtained. The obtained results for surface water show that microcystin concentration reached the maximum level during August and September (1.5 microg/L). The value is higher than maximum allowable concentration of microcystin in drinking water (1 microg/L) proposed by WHO. CONCLUSION: This study contributes to the issue of pollution of the National Park Ponjavica. Besides, literature data and WHO clearly point out harmfulness of cyanobasterias and their toxins and implicate the necessity of legislation concerning determination and monitoring of these toxins in our country. Method used for quentification of mycrocystin-LR was shown to be sensitive, selective, rapid and simple and could be recommended for routine determination of this toxin.