Objective. In recent years, interest in the collection and preservation of umbilical cord blood stem cells has increased substantially, owing to their therapeutic potential in a range of medical conditions. As highly accessible healthcare professionals, primary care pharmacists are frequently consulted on diverse medical issues. Consequently, it is imperative that they possess comprehensive knowledge, including a thorough understanding of stem cell applications and engage in ongoing professional development. This study aimed to assess the awareness, attitudes, and opinions of licensed pharmacists working in primary healthcare regarding the medical use of stem cells. Methods. A cross-sectional survey was conducted using anonymous questionnaires (Stem-KAAQ instrument) and was distributed to pharmacists (n=248) in primary healthcare settings across the Central part of Serbia. Data were collected from July 1 to August 1, 2022, and analyzed using IBM SPSS Statistics and MS Excel. Inclusion criteria encompassed current employment as a primary healthcare pharmacist in Serbia and voluntary informed consent to participate in the study. Results. The study involved 248 participants employed at the primary healthcare level with the mean age of 29.61±2.23 and most of them were women (82.3%). The most of them, 154 (62.1%) had never heard of the stem cell donor registry, while 94 (37.9%) were informed about its existence, which indicates poor awareness of healthcare professionals in general about stem cell donor registries; 216 (87.1%) of the respondents claimed that embryonic stem cells are capable of differentiating into any type of cell in the body, including the placenta. 86.3% of the respondents considered that cord blood stem cells are the same as embryonic stem cells, while 13.7% of them considered this statement to be incorrect. Also, 89.1% of the respondents believed that the collection of cord blood stem cells could not cause pain and possible harmful risks for the newborn and the mother. Interestingly, the knowledge related to the stem cell donor registry was significantly higher in employees from private sector. Conclusion. The analysis revealed no statistically significant differences in awareness, attitudes, or opinions between pharmacists working in public and private sectors, except for a significant difference regarding knowledge of the existence of a stem cell donor registry (p<0.05). The findings indicate that pharmacists in both the public and private primary care sectors possess different levels of knowledge and share similar attitudes toward stem cell applications, with the promiment awereness of the pharmacists employed in the private sector. The study highlights the critical importance of continuous education and training for pharmacists in the evolving field of regenerative medicine.
Objective. Hyperthyroidism represents a significant endocrine disorder, with the most common causes being Graves' disease (GD), toxic multinodular goiter (TMNG), and toxic adenoma (TA). Surgical treatment has an important place in the therapeutic algorithm, particularly in situations where medical therapy or radioactive iodine treatment is contraindicated or ineffective. To present the experience of the Department of Endocrine Surgery of the University Clinical Center Kragujevac in the surgical treatment of hyperthyroidism during the period 2018-2024. Methods. A retrospective analysis was conducted of 188 patients operated on for hyperthyroidism, out of a total of 480 patients who underwent surgery for thyroid diseases over a six-year period. The analyzed parameters included diagnosis type, type of surgical procedure, demographic data, incidence of carcinoma on definitive histopathological findings, and postoperative complications. Results. Among the 188 operated patients, 62 had GD, 65 had TMNG, and 61 had TA. In patients with GD, total thyroidectomy was performed in 55 cases and near-total thyroidectomy in 7 cases. In the TMNG group, total thyroidectomy was performed in 60 patients and near-total thyroidectomy in 5 patients. In all 61 patients with TA, lobectomy was performed. The mean age was 48.6 years for GD, 58.3 years for TMNG, and 46.5 years for TA. The female-to-male ratio was 5:1 in GD, 4:1 in TMNG, and 4:1 in TA. Thyroid micropapillary carcinoma was detected in 1 patient with GD, 5 patients with TMNG, and 2 patients with TA. Complications included seroma in 8 patients, hematoma in 4 patients, permanent recurrent laryngeal nerve paralysis in 2 patients, transient recurrent laryngeal nerve paralysis in 5 patients, and transient hypocalcemia in 14 patients. Conclusion. Surgical treatment of hyperthyroidism in our center has demonstrated favorable outcomes with a low rate of serious complications. The results are consistent with contemporary literature and confirm that surgery remains an important therapeutic option in appropriately selected indications.
Sepsis is a life-threatening organ dysfunction caused by an ineffective host response to infection. Some of the most prevalent disorders in sepsis are hemostatic disorders. Sepsis often develops a state of impaired anticoagulant activity and fibrinolysis suppression, called sepsis-induced coagulopathy. Damage to the fibrinolytic system has increasingly been considered a key factor in sepsis-induced coagulopathy. Impaired fibrinolysis in sepsis can contribute to undesirable outcomes such as microvascular thrombosis, organ dysfunction, and increased mortality. Given that one of the postulates related to sepsis is that prompt diagnosis and quick care are necessary, it would be of great importance to diagnose various forms of coagulopathies in sepsis at the beginning of their occurrence, for an adequate therapeutic approach. In this sense, easily accessible, routine diagnostic tests are necessary. Conventional laboratory tests for coagulopathies so far fail to fully define sepsis-induced coagulopathy. Particularly challenging is the testing of hypofibrinolysis in routine practice. The objectives of our study were to review the available scientific literature to investigate the relationship between inflammation and coagulation in sepsis, fibrinolysis disorders in sepsis-induced coagulopathy, to determine the importance of early recognition of these disorders in sepsis, and to investigate the available laboratory markers of fibrinolysis and coagulopathies.
Objective. The aim of this study was to assess oral hygiene habits, as well as awareness and knowledge among undergraduate students at a Faculty of Medicine in Bosnia and Herzegovina. Methods. This cross-sectional study was conducted at the Faculty of Medicine in Foča and included 333 students across three study programs: Medicine (M), Nursing (N), and Special Education and Rehabilitation (SER). The questionnaire was used to obtain demographic information, as well as data on oral hygiene habits and knowledge of oral health. Results. The largest proportion of students (56.2%) brush their teeth twice daily. A higher percentage of N and SER students brush their teeth longer than M students (p=0.004). Students most often replace their toothbrushes every 3 months or sooner (76.3%); 58.9% regularly visit a dentist; and 61% report no oral health problems. Only 14.4% of students believe that dental plaque dysbiosis is the cause of caries, while more than half of the students (53.5%) do not know the impact of dental plaque. Additionally, more than one-third of students (35.7%) are unaware of preventive measures for oral disease. A greater number of M and N students than SER students reported that oral health is related to cardiovascular disease (p=0.002), and more M students reported that it is related to cancer compared to SER students (p=0.032). Conclusion. The results of this study indicate limited knowledge of oral health among students across all three study programs, underscoring the need to improve oral health education for health sciences students.
The vein of Galen aneurysmal malformation (VGAM) is a rare congenital vascular malformation which can present in a newborn as high-output congestive heart failure and rarely as neonatal persistent pulmonary hypertension (PPHN). The objective of our study was to describe the clinical course and management of a newborn with VGAM, presenting as refractory PPHN, with an adverse short-term outcome. Following an urgent caesarean section, the newborn was admitted to our hospital's neonatal intensive care unit due to prematurity and signs of respiratory distress. Echocardiography excluded congenital heart disease, but revealed PPHN with near systemic pulmonary pressures. Sildenafil and a low-dose diuretic were started. After a brief improvement, the child's condition deteriorated, revealing suprasystemic PPHN, global ventricular dysfunction, and right-to-left shunting at the ductal and atrial levels. Anticongestive medications and inotropes were given in addition to sildenafil. A cranial ultrasound revealed a midline cystic formation measuring 13.7 x 13.2 mm with colour Doppler showing turbulent blood flow in the vein of Galen area, which was diagnostic for the vein of Galen malformation. Treatment of our patient included mechanical ventilation and other supportive measures, management of heart failure, and PPHN. However, the neonate remained in critical condition, and even though endovascular embolisation was considered, the transfer to a neurosurgical centre was impossible, and the baby succumbed to her disease. Even though the association of VGAM with PPHN is not common, in cases of systemic PPHN and heart failure refractory to treatment, AV malformations in the liver and brain should be ruled out.
Objective. To evaluate the short-term outcomes of laparoscopic colorectal resections for colorectal cancer in a single Serbian tertiary centre. Methods. A retrospective cohort study included 97 patients who underwent elective laparoscopic colorectal resections between January 2013 and March 2018. Demographic, perioperative, and oncologic data were analysed. Primary outcomes were 30-day morbidity and mortality; secondary outcomes included operative time, conversion, re-intervention, length of stay, and lymph-node yield. Logistic regression identified independent predictors of complications. Results. The cohort comprised 59 men (60.8%) and 38 women (39.2%), with a median age of 71 years. Conversion to open surgery occurred in 6 patients (6.1%), while re-intervention was required in 3 (3.1%). The median operative time was 120 minutes for colonic and 175 minutes for rectal resections. Median lymph-node yield was 15, with all achieving R0 resection. The overall 30-day morbidity rate was 17.5%, with no perioperative deaths. General complications occurred in 12.4% and surgery-specific complications in 11.3%, with partial overlap. Median length of stay was 9 days, significantly longer in men and diabetic patients. Logistic regression confirmed cardiomyopathy as an independent predictor of postoperative complications (OR 7.5, p = 0.008). Conclusion. Laparoscopic colorectal resections in this series were associated with acceptable morbidity, no mortality, low conversion, and adequate oncologic quality. Cardiomyopathy was identified as a major perioperative risk factor, highlighting the need for tailored perioperative management.
Objective. The objective of this work was to determine the forensic characteristics of road traffic accidents in Raška District territory for the period from 2009 to 2024. Methods. Observational, cross-sectional epidemiological study, in which a retrospective analysis of the characteristics of traffic accidents in Raška District of the Republic of Serbia over past sixteen years was performed. Results. Total number of road traffic accidents in observed period was 18,092. The research analyzed data from 2,129 road traffic accident participants who had a positive blood alcohol concentration. The largest number of road traffic accidents occurred in the city of Kraljevo, outside of a populated area. The largest percentage of participants were motor vehicle drivers (88.54%), male (93.2%), with an average age of around 40 years. The existence of a seasonal relationship was observed in occurrence of road traffic accidents (August, September), as well as a higher incidence on weekends. Participants who were in heavy drinking stage more often suffered serious bodily injuries, while participants who were in a state of intoxication and light drinking more often suffered minor bodily injuries. Conclusion. Road traffic accidents in Raška District are the result of a combination of several factors, including driving under the influence of alcohol, traffic infrastructure, high population density in certain cities and specific characteristics of Ibar Highway.
Artificial intelligence has a significant role in the field of primary health care and its application is becoming more common. Artificial intelligence helps primary care physicians on several levels, in disease prevention, high-quality diagnosis and therapy planning, and by processing a large amount of data, in providing more time for the implementation of sophisticated tasks. Despite numerous advantages, it is believed that the implementation of artificial intelligence can threaten the doctor-patient relationship, especially effective doctor-patient communication. Artificial intelligence in general practice represents a significant component in the further development of personalized medicine, individual approaches to treatment and quality health care for patients.
Leiomyomas (myoma, fibromyoma or fibroid) are benign tumors of smooth muscle cells. They are predominantly localized in the body of the uterus, but they can also develop in the broad ligament, ovaries, cervix, pouch of Douglas and round ligament. Leiomyomas in the pouch are very rare. A patient with a leiomyoma in the pouch of Douglas is presented. Apart from intense pain in the lower part of the abdomen, she had no other symptoms. Abdominal ultrasound examination, transvaginal ultrasound examination and computed tomography revealed an enlarged, leiomyomatous uterus, a tumoral change in the left ovary and moderate amounts of free fluid in the abdomen. In an extensive operation, the uterus and both fallopian tubes were removed. The diagnosis of leiomyoma in the pouch of Douglas, which was initially considered a tumor of the left ovary, was established by pathohistological examination. Leiomyomas in the pouch of Douglas have a low incidence and an unclear clinical picture. Their final diagnosis is predominantly established by pathohistological examination after surgery.
Objective. To determine the level of development of phonological awareness in children with developmental language disorder at the age of five to six years compared to children with typical language development. Methods. Ninety children aged 5 to 6, of both genders, divided into three groups, participated in the study. The Phonological Awareness Test was applied. The study was conducted during January and February 2024. Results. The analysis of the results showed that phonological awareness deficit was not more frequently manifested in children with developmental language disorder compared to children of typical development, as well as that there was no statistically significant difference in the manifestation of phonological awareness deficit in children with developmental language disorder in relation to gender, in terms that these problems are more frequently found in boys. Conclusion. The majority of research indicates that various components of phonological awareness in children with Developmental Language Disorder are less developed compared to their typically developing peers. However, certain studies show different results, similar to those obtained in this research; namely, that a phonological awareness deficit is more frequently observed in children with typical language development than in children with Developmental Language Disorder.
Acute coronary syndrome (ACS) remains the leading cause of morbidity and mortality worldwide. While existing diagnostic and prognostic biomarkers have improved patient care, there is still a need for newer, more specific markers to enable more precise risk stratification and individualized treatment. Neurotrophins are a family of proteins essential for neuronal survival and function. In recent years, their role in cardiovascular diseases has become increasingly recognized. The aim of this review is to present current knowledge on the role of neurotrophins, primarily brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF), in the pathophysiology of ACS, and to evaluate their potential as novel diagnostic and prognostic biomarkers. The studies analyzed indicate significant changes in neurotrophin levels during ACS, linking them to ischemia, reperfusion injury, inflammation, and myocardial remodeling. There is evidence that elevated or decreased levels of certain neurotrophins can predict short-term and long-term outcomes in patients with ACS. Further research, especially large multicenter studies, is necessary to confirm the value of neurotrophin measurement in ACS as a significant biomarker in clinical practice.
Objective. Access to primary education is the basic right of every child. The aim of the work is to assess the status of the share of children of official primary school age who are not enrolled in school, differentiated by gender, as well as the share of children enrolled in pre-school education, in Serbia, over a period of 15 years. Method. The research was conducted as an observational epidemiological study. The indicators analysed in this research are the "Share of children of official primary school age who are not enrolled in school" and the indicator "Gross rate of enrolment in preschool education", with observation period from 2006 to 2021. Results. The average percentage of male children outside primary school education was 2.18%, while the percentage of female children was 2.14%. The lowest percentage was observed in 2006, and the highest increase in 2010. The linear regression showed a positive trend for both sexes. There was a significant difference in the percentage of boys and girls outside primary school education in Serbia. On average, almost 60% of children were enrolled in preschool institutions in Serbia, and this increase has shown a significant positive trend over the observed period. Conclusion. Serbia stands at a crossroads where continued progress in education could lead to major gains in health literacy and equity. Addressing existing disparities with targeted and inclusive educational policies will be essential not only for achieving educational justice but also for building a healthier and more informed society.
Objective. This study aimed to evaluate the effectiveness of comprehensive medical support in restoring gallbladder functionality and preventing the recurrence of gallstone disease (GSD) after organ-preserving cholecystolithotomy. Methods. The study was retrospective in design, covering the period from 2018 to 2024, and was conducted at a medical centre "Gastroclinic" in Almaty, Kazakhstan, a country with a high prevalence of GSD. It included 115 patients aged 18 to 65 years who underwent cholecystolithotomy. Of these, 98 patients remained under dynamic observation for a specified follow-up period. To monitor gallbladder status and evaluate treatment effectiveness, ultrasound examinations (US) were performed preoperatively, postoperatively, and periodically during the observation period. Results. The results of US indicated that complex drug therapy facilitated the normalisation of gallbladder wall size and thickness, as well as improved contractile function. Long-term follow-up revealed that 98.6% of patients retained normal gallbladder contractility, the recurrence rate of cholelithiasis was only 0.07%, and sludge formation was observed in 8.9% of cases. In conclusion, complex pharmacotherapy following cholecystolithotomy with gallbladder preservation is an effective approach for restoring organ function, preventing recurrent stone formation, and enhancing patients' quality of life. Conclusion. The data obtained from this study can inform the development of clinical guidelines for the postoperative management of patients following gallstone removal with organ preservation.
Granulomatosis with polyangiitis (GPA) most commonly affects the kidneys and lungs, while the involvement of other organs is rare. We present a case of vasculitic changes in the gallbladder as the initial manifestation of GPA. A 65-year-old woman was admitted with fever and generalized weakness. Physical examination revealed signs of dehydration, mild hypotension and tachycardia without abdominal tenderness or a positive Murphy's sign. Laboratory evaluation revealed normocytic anemia and elevated markers of inflammation. Urinalysis revealed proteinuria and hematuria, but cultures and imaging were unremarkable. Despite empirical intravenous antibiotic therapy, the symptoms persisted. A subsequent computed tomography (CT) scan revealed calculous cholecystitis, leading to laparoscopic cholecystectomy. Histopathology of the gallbladder demonstrated small-vessel vasculitis. Further work-up revealed positive proteinase 3-anti-neutrophil cytoplasmic antibodies (PR3-ANCA) and declining renal function, consistent with a diagnosis of GPA. The patient was treated with glucocorticoids and intravenous cyclophosphamide, resulting in clinical and laboratory improvement. This case highlights the importance of considering systemic vasculitis in patients with persistent fever and non-specific systemic symptoms, especially when conventional causes are excluded. Gallbladder vasculitis, though extremely rare, can be the initial presentation of GPA.
Objective. Oral health can affect mental health in many ways, and vice versa. Anxiety significantly impacts oral health and it can lead to gum disease, cavities, dry mouth and bruxism. It can also cause bad oral health habits. The aims of our study were to investigate the prevalence of anxiety among medical students and to determinate the impact of anxiety on oral health habits and self-perceived oral health. Methods. This study presents cross-sectional study. It included the medical students from the Faculty of Medical Sciences, University of Kragujevac, Serbia. The Zung Self-Rating Anxiety Scale (SAS) was used to quantify anxiety levels and Oral Health Questionnaire for Adults was used to assess the self-perceived oral health. Data were analysed using the SPSS software, chi-square test was performed to determinate correlation between categorical variables, and Bonferroni analysis was performed to identify the precise significance between groups. Results. The assessment of self-perceived anxiety showed that 39% of students had symptoms of anxiety. Significant positive correlation was found between anxiety and gender and self-perceived gum condition. Significant negative correlation was found between anxiety and shame because of teeth, avoidance of smiling and the use of dental floss. The post hoc Bonferroni analysis revealed that women exhibited anxiety more often than men, better gum health was linked to lower anxiety, embarrassment about teeth or avoiding smiling was associated with higher anxiety, and unexpectedly, flossing was more common among anxious participants. Conclusion. The influence of anxiety on oral health is not sufficiently recognized. We found high prevalence of anxiety among medical students and determined correlation with certain oral health aspects. Medical students are vulnerable group and promotion and preventive programs should be more available.
Objective. Recent research suggests that neuroinflammation may play a crucial role in age-related cognitive dysfunction. Studies have investigated the impact of leukotriene receptor (LTR) antagonist montelukast, a medication commonly used to treat allergies and asthma, on the risk of developing dementia. The aim of this study was to compare cognitive functions in asthmatic patients who used montelukast, those who did not use it, and healthy controls. Methods. In this study 50 asthmatic patients (age 67.34±6.44; 20 montelukast users and 30 non-users) were matched with 50 healthy controls (age 68.08±5.95). Each participant was assessed using the Mini Mental State Examination (MMSE) and the Montreal Cognitive Test (MoCA). Memory coefficients (verbal, visual, general, delayed memory, and attention and concentration) were measured by Wechsler Memory Scale-Revised (WMS-R). Results. Orientation, as MoCA subdomain, was worse in patients with asthma compared to the control group (p=0.048). Asthmatic patients treated with montelukast had a significantly higher MoCA score (p=0.033), dominantly due to delayed recall, (p=0.044) than patients without montelukast treatment. People with asthma on montelukast therapy showed statistically significantly better results on the MoCA test (p=0.037) compared to the control group (dominantly due to attention (p=0.032) and delayed recall (p=0.021)). A multiple linear logistic regression model showed statistical significance (p=0.025). The use of montelukast had significant impact on the results of the MOCA test (p=0.012). Conclusion. Montelukast group had better results on MoCA (dominantly due to delayed recall) compared to montelukast non-users. Studies with a larger number of participants are needed to confirm the effect of montelukast on the cognitive status of the elderly.
Objective. The aim of this study was to look at the importance and consequences of stress in the workplace. Method. A descriptive observational study was performed using a structured questionnaire on a sample of the work-active population. The research was conducted in the territory of Belgrade, Serbia, in the time period that included January and February 2023, with a total number of respondents of 50. Results. It was shown that in the total sample, the most of respondents were female and had a secondary vocational education. Most were not satisfied with working conditions and earnings. Furthermore, most of the respondents had some of the somatic symptoms as a result of permanent exposure to stress. The most common modality for overcoming stress was reading, followed by physical activity and shopping. Conclusion. Our research has shown that chronic stress inevitably leads to the development of somatic and psychological consequences, which absolutely coincides with research done in the world so far. A large part of work-active population burns, and if this continues over time, it leads to burnout syndrome which brings with it chronic depression as a deteriorative and devastating consequence for the individual's entire personality.
Objective. Road traffic accidents are one of ten leading causes of death worldwide. Every 23 seconds, one person is injured on the roads worldwide, which leads to significant consequences in terms of permanent disability for the injured and the burden on a country's healthcare system. The mortality rate in traffic accidents is the highest among people aged 14 to 19, where central nervous system (CNS) injuries are predominant. The aim of this study was to examine the trend of mortality and injury frequency in traffic accidents in Montenegro as a result of CNS injuries. Methods. The research was designed as an observational case-control study. Participants in traffic accidents in Montenegro who sustained severe bodily injuries or fatal outcomes between 2011 and 2020 due to CNS injuries were selected. The "control" group consisted of individuals who survived the immediate period following their injuries. Results. In our study, there were 90 male participants (75.4%) with an average age of 39.97 ± 17.72 years, and 30 female participants (24.6%) with an average age of 41.60 ± 21.09 years (Independent samples T test, p=0.677). The most common immediate cause of death was brain tissue injury, isolated brain contusions - Laesio traumatica cerebri focalis (Contusio cerebri). There was a statistically significant impact of the presence of combined injuries on the outcome of traffic accidents, with a fatal outcome being most common in cases of polytrauma. Conclusion. Mortality in traffic accidents due to head injuries was most common in cases of polytrauma. To preventably address the mortality rate in traffic accidents in Montenegro, it is necessary to form an accessible network of trauma centers, especially those capable of treating CNS injuries.
Objective. The study's objective was to examine the impact of the tryptase enzyme on human physiological function in normal and diseased settings. Methods. Tryptase plays a role in regulating the growth and development of mesenchymal cells, fibroblasts, and endothelial cells, as well as in blood coagulation, metabolic activities of connective tissue, and the contractility of smooth muscle cells. Under pathological conditions, impaired tryptase metabolism leads to excessive fibrosis, development of keloid scars, narrowing of kidney vessels, transplant rejection, development of inflammatory bowel disease, arthritis, psoriasis, atopic and contact dermatitis. Results. The normal level of serum tryptase is 5 ng/ml. The threshold value of the enzyme is 11.4 ng/ml. Increased levels of this enzyme are found in 4-6% of the population. Increased serum tryptase levels are diagnosed in hereditary pathologies (hereditary Alpha-tryptasemia) and acquired diseases (mastocytosis, monoclonal mast cell activation syndrome, anaphylaxis, chronic kidney disease). The clinical picture is characterized by lesions of the cardiovascular, gastrointestinal, respiratory, excretory, and integumentary systems and the development of anaphylaxis. Conclusion. The pathogenesis of the diseases is still under investigation, so the treatment of the described pathologies is mainly symptomatic. It is concluded that tryptase is the main biomarker of mast cell function, and that impaired metabolism of this enzyme leads to a number of severe, life-threatening pathologies.
