Introduction: Adolescence (from the Latin adolescere, meaning "to become mature, to grow up") lasts from 10 to 19 years according to the definition of the World Health Organization. Adolescent pregnancy represents a significant medical and social challenge. The aim of this study was to compare epidemiological parameters and perinatal outcomes at the maternity ward in Zaječar over an 18-year period, specifically to analyze and compare the frequency and outcomes of deliveries among adolescent girls in Zaječar, and to present the incidence of adolescent births, newborn birth weight, mode of delivery, and employment status of adolescent mothers in 2007 compared to 2025 in Zaječar. Methods: A retrospective analysis of delivery records and medical histories of women who gave birth at the Gynecology and Obstetrics Department of the Health Center Zaječar, along with statistical data analysis. Results: The results show that the total number of deliveries almost halved from 2007 to 2025, from 555 to 298. The number of adolescent mothers also decreased from 46 (8.29%) in 2007 to 11 (3.69%) in 2025, which is statistically significant (χ² = 4.72; p = 0.029). The majority of newborns of adolescent mothers in 2007 were eutrophic, 39 (84.78%), with a mean birth weight of 2850 g ± 410, while in 2025 all newborns were eutrophic with a mean birth weight of 3100 g ± 350 g, but without a statistically significant difference (t = 1.41; p = 0.16). In both observed periods, deliveries were predominantly vaginal, although the frequency of cesarean sections was higher in 2025, without statistical significance (χ² = 1.56; p = 0.21). Adolescent mothers were predominantly unemployed in both periods. Conclusion: Comparative analysis shows that the proportion of adolescent deliveries significantly decreased from 8.28% in 2007 to 3.69% in 2025 (χ² = 4.72; p = 0.029). No statistically significant difference was found in birth weight (t = 1.41; p = 0.16). The frequency of cesarean sections was higher in 2025, but without statistical significance (χ² = 1.56; p = 0.21). In both 2007 and 2025, adolescent mothers were unemployed and economically dependent. One of the major tasks for obstetricians and gynecologists is to identify adolescents at risk and prevent behaviors leading to unintended pregnancy. Further work on primary prevention in local communities of Eastern Serbia is necessary.
Myotonic dystrophy type I (MD1) is a complex, slowly progressive multisystem disorder affecting not only muscles but also the eyes, heart, endocrine, reproductive, and central nervous systems. The disease is inherited in an autosomal dominant manner and is characterized by the phenomenon of genetic anticipation. A 34-year-old female patient was hospitalized for evaluation of progressive muscle weakness and hypotrophy. Neurological examination and electrodiagnostic testing revealed typical signs of MD1, confirmed by DNA analysis. The patient has a history of spontaneous miscarriages and prenatal complications, likely resulting from undiagnosed MD1. MD1 during pregnancy can lead to serious complications. Genetic counseling and assisted reproduction options are key to minimizing the risk of disease transmission.
Introduction: Colorectal cancer (CRC) is one of the most common gastrointestinal malignancies, and patients' nutritional status plays a crucial role in postoperative recovery. Aim: This study aimed to assess the impact of nutritional status on postoperative outcomes in patients undergoing colorectal cancer surgery. Materials and Methods: This observational study included 50 patients who underwent colorectal cancer surgery. Data on anthropometric, laboratory, and clinical parameters were collected, including body weight, BMI, NRS-2002, SGA, and mGPS. Surgical variables such as type and duration of the procedure, as well as postoperative complications classified according to the Clavien-Dindo classification, were also evaluated. Statistical analysis was performed using t-test, χ² test, ANOVA, and logistic regression to assess the impact of nutritional status on postoperative outcomes. Results: Anthropometric, laboratory, and clinical parameters were analyzed using validated nutritional screening tools (NRS-2002, SGA). The results showed that patients with higher nutritional risk had prolonged hospital stays and an increased risk of postoperative complications. Inflammatory status, measured by the mGPS score, was significantly correlated with recovery time. Nutritional interventions, including preoperative supplementation, demonstrated potential in improving treatment outcomes. Conclusion: This study confirms the importance of early nutritional screening and individualized nutritional support in reducing postoperative complications and improving the quality of life of patients with colorectal cancer.
Introduction: Burnout syndrome is a state of chronic stress associated with emotionally demanding work that a person is unable to cope with using their own self-help resources, resulting in exhaustion. The syndrome is always related to work and, in addition to emotional exhaustion, also includes depersonalization and a sense of reduced professional efficacy. The causes of burnout include: imbalance between an individual’s personal psychological resources and unfavorable working conditions; lack of autonomy in the workplace and control over work; work that conflicts with ethical and personal values; absence of recognition or support from the team or supervisors; and situations in which work goals do not align with the individual’s intrinsic motivations. Characteristics of burnout by profession: Among general practitioners, burnout is an increasingly common phenomenon with serious consequences for professional efficiency. Nurses are also significantly burdened by workload. In recent years, many studies have been published on burnout among employees in the telecommunications sector. Clinical picture: Symptoms of burnout include mental and psychological fatigue, reduced immune response leading to more frequent illnesses, recurrent headaches, back pain, muscle pain, feelings of anxiety when going to work, irritability and anger, as well as feelings of helplessness, failure, hopelessness, and loneliness. Individuals often require more time to complete routine tasks. Diagnosis: As many as 75–90% of all doctor visits are related to chronic stress, and patients often consult multiple specialists in search of a definitive diagnosis. A detailed medical history is essential, followed by physical examination and laboratory tests to exclude other clinical conditions. Burnout syndrome may also present with cardiac symptoms, neurological manifestations, or psychiatric disorders. Principles of treatment: Treatment focuses on managing the symptoms and signs of occupational burnout. Depending on the predominant symptoms, appropriate therapeutic approaches are prioritized. In developed centers, employees have access to art therapy, music therapy, mindfulness training, and counseling services. Role of psychiatrists and psychotherapists: Literature data indicate that some hospitals offer free mental health support and counseling services for their employees. Individuals experiencing burnout may hesitate to seek help and instead progressively deteriorate. Preventive measures: Promotion of a supportive work culture, psychological support, workload rationalization, and team collaboration. Conclusion: This paper presents the etiological factors contributing to burnout syndrome and highlights the characteristics of its clinical presentation to facilitate recognition of the condition. It outlines principles of treatment and emphasizes the importance of psychotherapeutic support in education and patient care. Burnout should be viewed as a systemic warning signal, and more flexible working hours should be considered for employees. Strategies aimed at improving work–life balance should be further developed.
Introduction: Chronic heart failure (CHF) represents the end stage of various cardiovascular diseases and is one of the leading causes of hospitalization and mortality in the elderly population. Decompensated chronic heart failure (DCHF), with or without acute exacerbation, often leads to circulatory congestion and fluid accumulation, with anasarca (generalized edema)being one of the most severe manifestations, along with cardiac cachexia. In addition to the four “pillars” of CHF treatment across different severity stages according to the New York Heart Association (NYHA) classification, diuretic therapy remains the cornerstone of treatment in the terminal stage with severe systemic congestion, such as anasarca. Diagnostic and therapeutic challenges are frequently present due to comorbidities such as chronic kidney disease and anemia. Case report: An 88-year -old male patient with a history of chronic heart failure with reduced left ventricular ejection fraction (HFrEF), permanent atrial fibrillation, and significant comorbidities: stage 3b chronic kidney disease and severe iron-deficiency anemia. On admission, the patient presented with dyspnea at rest, tachypnea, bilateral hydrothorax, severe edema of the lower legs and forearms (anasarca), and marked general weakness. Laboratory findings showed elevated NT-proBNP levels, markedly reduced hemoglobin (68 g/L), aggravated by hemodilution, and impaired renal function (glomerular filtration rate, GFR = 44 mL/min/1.73 m²). Echocardiography revealed left ventricular dilation (end-diastolic diameter, EDD= 59mm) and left atrial enlargement (left atrial volume index, LAVI = 45 mL/m²), an inferior wall scar with an aneurysm of the basal inferior segment, and anteroseptal -apical dyskinesia. The left ventricular ejection fraction was significantly reduced (EF = 37%). The right ventricular systolic pressure (RVSP) was 64 mmHg, global longitudinal strain (GLS) was 11.6%, and there were signs of grade II diastolic dysfunction (E/e’ = 15.0). The therapeutic approach included urgent parenteral administration of high-dose furosemide over three days in a day-hospital setting (the patient refused hospitalization and blood transfusion). Optimization of chronic therapy was performed, including the introduction of sacubitril/valsartan (ARNI) and sodium glucose co-transporter 2 (SGLT2) inhibitors, along with restriction of salt and fluid intake and more intensive correction of iron-deficiency anemia. During outpatient follow-up, significant improvement was achieved: marked diuresis, body weight reduction of 14 kg, excellent regression of edema, normalization of lung findings with a significant reduction in hydrothorax, improvement in EF to 47%, improvement in diastolic function (E/e’ = 13.6), and reduction of RVSP to 25 mmHg. Renal function normalized (GFR = 64 mL/min/1.73 m²), and hemoglobin increased to 128 g/L. Conclusion: This case report highlights the importance of individualized intravenous diuretic therapy in combination with contemporary pharmacological strategies in patients with the most severe form of decompensated chronic heart failure (NYHA class IV) with anasarca. Timely initiation of parenteral diuretics, optimization of baseline therapy, and correction of associated disorders led to significant clinical, echocardiographic, and laboratory improvement. This report emphasizes the importance of continuous monitoring of critically ill patients using ECG monitoring and other vital parameters, as well as therapy adjustment according to diuresis, body weight, blood pressure, heart rate, and echocardiographic parameters, to achieve optimal outcomes alongside the management of comorbidities in consultation with other specialties
