Superior mesenteric arteriovenous fistula (SMAVF) is an extremely infrequent vascular disorder. It is characterized by abnormal, direct communication between high-pressure superior mesenteric artery (SMA) and low-pressure superior mesenteric vein (SMV). This shunt allows blood to bypass the intestinal capillary bed and produces hypertension in the portal circulation. Although SMAVF can be congenital, the majority of cases reported have been due to abdominal trauma or iatrogenic causes. These fistulas originate from an undetected injury to SMA and SMV and can present several days to several years later, usually following bowel-related surgery. Manifestations of SMAVF include a wide variety of symptoms such as mild abdominal pain, diarrhea and weight loss. Due to the often obscured presence of the fistula, complications related to long-standing arteriovenous (AV) shunt and high portal blood pressure are potentially fatal. The most serious complications are congestive heart failure and portal hypertension, which may lead to gastro-esophageal variceal bleeding (1). General mortality for untreated cases of portal arteriovenous fistula (AVF) is estimated at about 26% (2). Here, we report a case of delayed presentation of acquired SMAVF in a male adult after small bowel resection.

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Since the WHO declared the COVID-19 pandemic in March 2020, the disease has spread rapidly leading to overload of the health system and many of the patients infected with SARS-CoV-2 needed to be admitted to the intensive care unit (ICU). Around 10% of patients with the severe manifestation of COVID-19 need noninvasive or invasive mechanical ventilation, which represent a risk factor for Acinetobacter baumannii superinfection. The 64 A. baumannii isolates were recovered from COVID-19 patients admitted to ICU at General Hospital “Dr Laza K. Lazarević” Šabac, Serbia, during the period from December 2020 to February 2021. All patients required mechanical ventilation and mortality rate was 100%. The goal of this study was to evaluate antibiotic resistance profiles and virulence potential of A. baumannii isolates recovered from patients with severe form of COVID-19 who had a need for mechanical ventilation. All tested A. baumannii isolates (n = 64) were sensitive to colistin, while resistant to meropenem, imipenem, gentamicin, tobramycin, and levofloxacin according to the broth microdilution method and MDR phenotype was confirmed. In all tested isolates, representatives of international clone 2 (IC2) classified by multiplex PCR for clonal lineage identification, blaAmpC, blaOXA-51, and blaOXA-23 genes were present, as well as ISAba1 insertion sequence upstream of blaOXA-23. Clonal distribution of one dominant strain was found, but individual strains showed phenotypic differences in the level of antibiotic resistance, biofilm formation, and binding to mucin and motility. According to PFGE, four isolates were sequenced and antibiotic resistance genes as well as virulence factors genes were analyzed in these genomes. The results of this study represent the first report on virulence potential of MDR A. baumannii from hospital in Serbia.

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Likvefakcija se pojavljuje kao jedan od sporednih efekata jakih zemljotresa. Može se definisati kao fenomen transformacije stabilnog i čvrstog tla u stanje guste tečnosti. Likvefakcija se može desiti pod uticajem zemljotresa ili drugog dinamičkog opterećenja u slučaju visokog nivoa zasićenosti tla. Glavni faktori koji utiču na likvefakcioni potencijal tla su nizak indeks zbijenosti i visok stepen zasićenja vodom. Opasnost leži u fatalnom preturanju objekata što izaziva dalja oštećenja i diferencijalnom slijeganju konstrukcija koja nastaju usljed naglog gubitka čvrstoće. U radu je prikazana analiza potencijala za pojavu likvefakcije i predstavljene različite mjere zaštite protiv likvefakcije.