Background and Objectives: Although carotid endarterectomy (CEA) is the gold standard in the treatment of carotid disease, a higher frequency of adverse outcomes can reduce its benefit. The aim of the present study is to identify factors related to myocardial infarction, stroke, death and restenosis as the late adverse outcomes of CEA. Materials and Methods: The retrospective cohort study included 1597 CEAs that were performed in 1533 consecutive patients at the Vascular Surgery Clinic in Belgrade from 2012 to 2017. Late adverse outcomes within 4 years after CEA were available for the majority of them. Data for myocardial infarction and stroke were available for 1223 CEAs, data for death for 1305 CEAs, and data for restenosis for 1162 CEAs. The association between possible risk factors and late adverse outcomes of CEA was analyzed using univariate and multivariate Cox and logistic regression analyses. Results: During follow-up, myocardial infarction occurred after 55, stroke after 68, death after 103 and restenosis after 121 CEAs. Two factors were the most frequent predictors of late adverse outcomes, i.e., the patient’s age and diabetes mellitus (DM). Age predicted all late adverse outcomes except restenosis, and DM predicted all of them. A predictor of myocardial infarction, besides age (HR 1.08, 95% CI 1.05–1.11) and DM (HR 1.60, 95% CI 1.11–2.29), was peripheral arterial disease (HR 1.81, 95% CI 1.17–2.78) in personal history. Predictors were only age (HR 1.04, 95% CI 1.01–1.08) and DM (HR 1.68, 95% CI 1.03–2.72) for stroke, as well as for death (HR 1.17, 95% CI 1.12–1.21 and HR 1.94, 95% CI 1.17–3.21, respectively). For restenosis, in addition to DM (HR 1.78, 95% CI 2.62), predictors were hyperlipidemia (HR 3.52, 95% CI 1.27–9.76) and urgent surgery (HR 3.51, 95% CI 1.06–11.65). Conclusions: CEA should be performed with special caution in the elderly and diabetic patients. Modification of other risk factors and precise medical therapy are necessary to reduce possible adverse outcomes.

Transcultural adaptation and validation of FACIT-TS-PS questionnaire to Serbian language. Standard forward and backward translation from English to Serbian language was performed. Pilot testing of FACIT-TS-PS was conducted on 12 patients with a confirmed diagnosis of malignant tumor. The study included 154 patients with malignant disease. The Questionnaire of Patient Satisfaction was used as a validated tool to evaluate concurrent validity of FACIT-TS-PS questionnaire. Reproducibility was tested on 30 subjects who answered the questionnaire for the second time two weeks later. Three FACIT-TS-PS subscales (Physician Communication, Treatment Staff Communication and Nurse Communication) demonstrated satisfactory construct validity using Cronbach’s alpha, the remaining two subscales (Technical Competence and Confidence & Trust) showed high ceiling effect. Treatment Staff Communication subscale showed large floor effect. Concurrent validity was demonstrated by correlation with the two dimensions of the Questionnaire of Patient Satisfaction. Satisfactory reproducibility was demonstrated on 30 patients who filled the questionnaire for the second time two weeks after initial interview. The Serbian version of FACIT-TS-PS with the omission of Treatment Staff Communication subscale could be used as a valid instrument to assess patient and treatment satisfaction in chronically ill patients in the Serbian population. Omission of Treatment Staff Communication subscale is necessary because it contains questions not relevant for patients in Serbian healthcare system.

A cohort study was conducted to examine the association of an increased body mass index (BMI) with late adverse outcomes after a carotid endarterectomy (CEA). It comprised 1597 CEAs, performed in 1533 patients at the Vascular Surgery Clinic in Belgrade, from 1 January 2012 to 31 December 2017. The follow-up lasted four years after CEA. Data for late myocardial infarction and stroke were available for 1223 CEAs, data for death for 1305 CEAs, and data for restenosis for 1162 CEAs. Logistic and Cox regressions were used in the analysis. The CEAs in patients who were overweight and obese were separately compared with the CEAs in patients with a normal weight. Out of 1223 CEAs, 413 (33.8%) were performed in patients with a normal weight, 583 (47.7%) in patients who were overweight, and 220 (18.0%) in patients who were obese. According to the logistic regression analysis, the compared groups did not significantly differ in the frequency of myocardial infarction, stroke, and death, as late major adverse outcomes (MAOs), or in the frequency of restenosis. According to the Cox and logistic regression analyses, BMI was neither a predictor for late MAOs, analyzed separately or all together, nor for restenosis. In conclusion, being overweight and being obese were not related to the occurrence of late adverse outcomes after a carotid endarterectomy.

The acute and chronic effects of dehydration on athletes' health are well known, but it is less known about the relationship between dehydration and sports performance. There is an overall consensus in the literature that dehydration ≥ 2% body mass represents a threshold at which endurance, as aerobic performance, becomes impaired. Dehydration degrades aerobic performance by various mechanisms, such as a decrease in VO2 max, a decrease in circulatory volume and consequent decrease in cardiac stroke volume. At higher levels of dehydration, there is an increase in heart rate, body temperature, carbohydrate oxidation and muscle glycogenolysis. The effect of dehydration on anaerobic sports performance, such as muscle strength and power, is less known. The high osmotic stress that usually accompanies high levels of intracellular dehydration can modulate the permeability of the blood-brain barrier, alter the neuronal firing of osmoreceptor cells in the hypothalamus, and potentially affect the excitability of motor output pathways. Studies have shown that acute dehydration impairs muscle strength and endurance and increases the perception of fatigue but without changes in markers of central and peripheral neuromuscular function. In addition to the physical, dehydration also affects the mental performance of athletes. Symptoms of dehydration (dry mouth, thirst, headache, fatigue) affect the athletes' cognitive functions and their cognitive resilience. Therefore, personalized rehydration strategies play a key role in athletes' safety during sporting activities, as well as in optimizing sports performance. In this paper, the role of dehydration on physical and mental athletes' performance will be reviewed, as well as the latest recommendations for adequate rehydration.

Introduction: Regular physical activity reduces the risk of cardiovascular diseases (CVD). The aim of this study was to examine the association of physical activity with the severity of carotid disease. Materials and methods: This cross-sectional study involved 506 patients from the Vascular Surgery Clinic at the Institute for Cardiovascular Diseases "Dedinje", who underwent carotid endarterectomy from 2012 - 2017 . The severity of carotid disease was assessed based on the degree of carotid stenosis, plaque type, and patients' symptomatic status before surgery. Patient physical activity data were collected using the standardized Baecke questionnaire. Univariate and multivariate logistic regressions were performed to examine the association between physical activity and the severity of carotid disease. Results: According to univariate analysis, there was no statistically significant association between any form of physical activity (occupational, sports, or recreational) and the degree of carotid stenosis, nor with other characteristics. Also, physical activity was not associated with complicated carotid plaque. The only characteristic associated with complicated carotid plaque was the use of oral anticoagulants in therapy (OR=2.91; 95% CI=1.12-7.52; p=0.028). The relationship between physical activity and symptomatic carotid disease was not observed, but according to multivariate analysis, the following factors were associated with symptomatic status: age (OR=0.97; 95% CI 0.94-0.99; p=0.016), gender (OR=0.64; 95% CI 0.44-0.99; p=0.028), family history of CVD (OR=0.63; 95%CI 0.43-0.94; p=0.022), use of clopidogrel (OR 1.79; 95% CI 1.18-2.71; p=0.006) and ACEIs in therapy (OR=1.60; 95% CI 1.02-2.53; p=0.041). Conclusion: Physical activity was not associated with carotid disease severity.