PREDICTIVE FACTORS FOR MAJOR ADVERSE CARDIAC EVENTS AFTER CAROTID ENDARTERECTOMY
Carotid endarterectomy (CEA) is a standard surgical procedure for stroke prevention in patients with carotid artery stenosis but carries a significant risk of major adverse cardiovascular events (MACE). By integrating clinical risk biomarkers, we aim to improve preoperative risk stratification and contribute to the development of personalized perioperative care strategies in this high-risk patient population. A total of 110 patients undergoing elective CEA in 2017 were prospectively enrolled. Preoperative clinical data, including suPAR, urea, and LVEF, were collected. MACE, defined as myocardial infarction, arrhythmias, heart failure, stroke, or cardiovascular death, was monitored for 30 days postoperatively. Statistical analysis included univariate and Cox regression modeling to assess predictors of MACE. Within 30 days post-CEA, 10 patients (9.1%) experienced MACE. These patients had significantly higher suPAR levels (7.04 ± 1.81 vs. 3.15 ± 1.01 ng/mL, p < 0.001), elevated serum urea (7.69 ± 2.25 vs. 6.14 ± 1.89 mmol/L, p = 0.024), and lower LVEF (48.9 ± 5.43% vs. 55.17 ± 7.8%, p = 0.007). Cox regression analysis identified suPAR as an independent predictor of 30-day MACE (HR = 2.144, p < 0.001). Elevated preoperative suPAR, increased serum urea, and reduced LVEF are associated with higher risk of MACE following CEA. Integrating these biomarkers into preoperative assessment may enhance cardiovascular risk stratification and guide perioperative management in high-risk patients.
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ENZALUTAMIDE-INDUCED HEART FAILURE WITH REDUCED EJECTION FRACTION
Prostate cancer is the second most common malignancy in men and the second leading cause of cancer death. Patients unfit for surgery, with locally advanced or metastatic disease, require androgen-deprivation therapy. In the past decade, enzalutamide and abiraterone were established in prostate cancer treatment. Their safety profile and clinical evidence showed a significant possibility of cardiovascular complications. Heart failure is more common in patients treated with abiraterone. We report a case of a patient with heart failure induced by enzalutamide. In the review of the literature, enzalutmaide-induced heart failure was encountered in only two cases. Further research on the influence of novel anti-androgen therapy on the cardiovascular system, personalized evaluation of the cardiovascular system, and risk stratification for potential cardiovascular adverse events before initiating therapy are needed.
EXPLORING BILIARY ILEUS: A RARE AND COMPLEX CLINICAL CASE
Biliary ileus is a rare complication associated with cholelithiasis. Although it accounts for less than 4% of small bowel obstructions in patients under 65 years of age, its prevalence rises to 25% in patients over 65 years of age. Physicians are faced with the decision of whether to opt for immediate closure of a single- or two-stage cholecystoenteric fistula or to wait for natural closure. A 62-year-old female patient presented to the surgical clinic with severe abdominal pain, predominantly on the right side, and a sensation of bloating. She reported symptoms of constipation, nausea, and vomiting. An emergency exploratory laparotomy was scheduled. During the surgical procedure, careful exploration revealed significant dilation of the proximal part of the intestine, and a gallstone was found in the jejunum. The gallstone was successfully removed, followed by closure of the enterotomy site. This report highlights a condition that is rarely seen in practice. In older patients presenting with clinical manifestations of bowel obstruction and chronic issues with the gallbladder, this rare disease should be considered, particularly in women and elderly patients.
AN IMPACT OF RADIOTHERAPY ON PSYCHО-EMOTIONAL CHARACTERISTICS OF CANCER PATIENTS
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</xml><![endif]--><!-- [if gte mso 10]> <![endif]--> The psychological distress that cancer patients endure can greatly affect their treatment experience and quality of life, making it crucial to understand the psycho-emotional effects of radiotherapy, an established cornerstone in cancer treatment, as this knowledge is vital for creating comprehensive care strategies that address both physical and mental health needs. The study investigated the psycho-emotional effects of radiotherapy in cancer patients with a focus on the interplay of radiotherapy with hormone therapy, biological therapy, and chemotherapy. Our results indicate that while psychological distress is prevalent among patients undergoing radiotherapy, changes in emotional competence, stress reactions, depression, and mature religiosity are similar to those experienced by healthy individuals. Notably, patients receiving radiotherapy exhibited significantly lower scores on the Interpersonal Reactivity Index (IRI), altruism, and the Beck Anxiety Inventory (BAI) compared to healthy controls, suggesting that, while anxiety and empathy fatigue did not increase, reduced altruism could reflect a preoccupation with personal health challenges. A higher externality score among radiotherapy patients indicates a search for external justifications for their illness. The introduction of hormone therapy significantly increased religiosity scores, enhancing emotional acceptance of illness, while biological therapy resulted in diminished religiosity, likely due to its unfamiliarity and associated skepticism. Importantly, chemotherapy did not significantly alter radiotherapy-induced psycho-emotional effects, reinforcing the notion that familiarity with treatment modalities can foster emotional resilience and a sense of control in patients. In conclusion, this study underscores the importance of addressing psycho-emotional well-being in comprehensive cancer care of radiotherapy-treated patients.
THE EFFECT OF AGEING ON MACROMORPHOMETRIC PARAMETERS AND HISTOLOGICAL CHARACTERISTICS OF BASOPHILIC AND ACIDOPHILIC PITUITARY CELLS: ANALYSIS OF MALE CADAVERS
The aim of this study was to examine the macromorphometric parameters including weight, height, width, volume and length of the pituitary gland, as well as the histological characteristics of the hormone-producing cells. The focus was on basophilic (gonadotropic-luteinizing hormone (LH) and corticotropic-adrenocorticotropic hormone (ACTH)) and acidophilic (somatotropic – growth hormone (GH) and mammotropic – prolactine (PRL)) cells in male cadavers, aiming to assess the characteristics of the pituitary gland in living individuals during ageing. The research included 15 male cadavers of different ages (44 and 89 years), which were divided into three groups. In the first group (I) there were cadavers aged 30 to 49, in the second (II) 50 to 69 years, and in the third (III) 70 years and older. The pituitary cells were immunohistochemically identified by the PAP method using the appropriate antibodies: LH (bLH 1:100), ACTH (hACTH 1:200), GH (hGH 1:200), and PRL (hPRL 1:300). Our results show that the width, height, weight and volume of the pituitary gland did not change significantly (p > 0.05) with ageing, while the length of the gland showed statistically significant changes between groups (p < 0.05). The length of the pituitary gland was significantly (p < 0.05) greater in age groups II and III, compared to group I. In conclusion, the results of the examined macromorphometric parameters showed that only the length of the pituitary gland changed significantly during ageing.
THE SYNERGY OF FORENSIC MEDICINE AND BLOODSTAIN PATTERN ANALYSIS IN DETERMINING THE MANNER OF DEATH
A forensic pathologist and a bloodstain pattern analyst are involved in determining the manner and the mechanism of death, but based on different scientific approaches. Our work presents the benefits of a holistic approach to forensic expertise. We have analyzed and described three cases. In all cases, the initial police investigation had concluded the wrong manner of violent death (accident, suicide, homicide), but the subsequent synergy of forensic autopsy and bloodstain pattern analysis (BPA) determined the true nature of death. BPA in Serbia is a relatively new forensic discipline. Police authorities (Crime scene evidence technicians) in Serbia are familiar with BPA, but according to our legislation, they are not allowed to provide expertise in the courtroom. The benefits of synergistic expertise in forensic medicine and BPA are more than evident in our cases. Therefore, the education of specialists in forensic medicine in BPA will be useful for solving suspicious and indistinct cases.
DELIBERATE SELF-POISONING IN ADOLESCENTS: A 3-YEAR SINGLE CENTRE STUDY
Adolescence represents a period during which a child, in a transition period to adulthood, undergoes significant changes, often accompanied by risky behaviors such as intentional self-poisoning. This study aimed to identify the sociodemographic characteristics of adolescents, substance distribution and the impact of school success and completeness of the nuclear family on self-poisoning incidents. A retrospective study examined the records of 412 patients treated at the Institute for Child and Youth Health Care of Vojvodina over a three-year period. The average age of the patients was 15.7 ± 1.8 years. The most commonly used substances were alcohol (67%), benzodiazepines (23.6%), and cannabis (5.8%). One-fifth of the subjects took at least two substances simultaneously, with a higher frequency among female adolescents who experienced more frequent episodes of repeated self-poisoning. Half of the subjects (51%) lived in complete nuclear families, and a significant difference was found regarding alcohol consumption compared to other subjects. There is a significant difference in the consumption of benzodiazepines and alcohol concerning academic success. Alcohol and benzodiazepine medications were most commonly used for self-poisoning, with a significant gender difference. Due to the widespread availability of benzodiazepine medications, they were the most frequently used drugs. Girls were at a higher risk of repeated self-poisoning. Adolescents living in complete nuclear families with excellent academic success more often consumed alcohol, while those from incomplete families with poor success more frequently consumed benzodiazepines.
RISK FACTORS OF PHANTOM LIMB PAIN IN PATIENTS WITH LOWER LIMB AMPUTATIONS
Phantom pain is a common and complex complication following limb amputation. Current pharmacological, psychological, and rehabilitative approaches are only partially effective, indicating the need for further research. This study aimed to examine risk factors associated with the occurrence of phantom pain in patients with lower limb amputations. A cross-sectional study was conducted at the Clinic of Medical Rehabilitation of the University Clinical Center of Vojvodina in Novi Sad, including 53 patients with acquired lower limb amputation in either the pre-prosthetic or prosthetic phase of rehabilitation. Data were collected from medical records and patient history regarding age, sex, presence of cardiovascular comorbidities, diabetes mellitus, various types of pain, body mass index, level of amputation, and characteristics of the residual limb. Statistical analysis was performed using JASP software, applying descriptive statistics, the Student’s t-test, the χ² test, and binary logistic regression to examine factors associated with the occurrence of phantom limb pain. Statistical significance was set at p < 0.05. Phantom limb pain was reported in 16 patients (30.18%). A statistically significant association was found between phantom pain and the level of amputation (p = 0.046), as well as the phase of rehabilitation (p = 0.011). The level of amputation and the phase of rehabilitation represent significant risk factors for the development of phantom limb pain.
THE EFFECT OF METFORMIN ON BIOCHEMICAL PARAMETERS IN PATIENTS WITH METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common form of chronic liver disease in the modern world. The importance of this condition is that it can progress to nonalcoholic steatohepatitis, which increases the risk of developing liver cirrhosis and hepatocellular carcinoma. The study aimed to examine the effects of metformin on achieving positive biochemical responses in patients with MASLD. The study included 146 patients, 96 men and 50 women, with MASLD diagnosed by ultrasound. Biochemical analyses were performed as well. The values of all parameters were measured at baseline, after three and after six months of therapy. On each visit, the body weight and body mass index (BMI) were obtained. All patients at baseline received 750 mg of metformin twice a day. There was a reduction in body weight, which was statistically significant after six months. The BMI decrease reached no statistical significance. Liver enzyme values showed a significant decrease in values relative to baseline after three and six months of metformin therapy. Serum cholesterol and triglyceride levels were reduced during treatment with metformin, and changes reached statistical significance at six months relative to baseline. There was a statistically significant decrease in the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) value after three and six months compared to baseline. Results showed that metformin may be an appropriate addition to diet, weight reduction, and physical activity, as it led improvements in metabolic parameters, with minimal adverse events and good tolerance of therapy.
THE OCCURRENCE OF DIFFERENT TYPES OF DEPRESSION IN PATIENTS WITH CERVICAL CANCER
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UnhideWhenUsed="true" Name="List Bullet 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Number 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Number 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Number 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Number 5"/> <w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Closing"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Signature"/> <w:LsdException Locked="false" Priority="1" SemiHidden="true" UnhideWhenUsed="true" Name="Default Paragraph Font"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Body Text"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Body Text Indent"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Continue"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Continue 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Continue 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Continue 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="List Continue 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Message Header"/> <w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Salutation"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Date"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Body Text First Indent"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Body Text 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Name="Document Map"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Plain Text"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="E-mail Signature"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Top of Form"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Bottom of Form"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Normal (Web)"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Acronym"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Address"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Cite"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Code"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Definition"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Keyboard"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Preformatted"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Sample"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Typewriter"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Variable"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Normal Table"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="annotation subject"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="No List"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline List 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline List 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline List 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Simple 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Simple 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Simple 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Classic 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Classic 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Classic 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Classic 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Colorful 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Colorful 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Colorful 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 7"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 8"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 7"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 8"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table 3D effects 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table 3D effects 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table 3D effects 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Contemporary"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Elegant"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Professional"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Subtle 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Subtle 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Web 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Web 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Web 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Balloon Text"/> <w:LsdException Locked="false" Priority="39" Name="Table Grid"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Theme"/> <w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/> <w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading"/> <w:LsdException Locked="false" Priority="61" Name="Light List"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/> <w:LsdException Locked="false" Priority="70" Name="Dark List"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/> <w:LsdException Locked="false" SemiHidden="true" Name="Revision"/> <w:LsdException Locked="false" Priority="34" QFormat="true" Name="List Paragraph"/> <w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/> <w:LsdException Locked="false" Priority="30" QFormat="true" Name="Intense Quote"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/> <w:LsdException Locked="false" Priority="19" QFormat="true" Name="Subtle Emphasis"/> <w:LsdException Locked="false" Priority="21" QFormat="true" Name="Intense Emphasis"/> <w:LsdException Locked="false" Priority="31" QFormat="true" Name="Subtle Reference"/> <w:LsdException Locked="false" Priority="32" QFormat="true" Name="Intense Reference"/> <w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/> <w:LsdException Locked="false" Priority="37" SemiHidden="true" UnhideWhenUsed="true" Name="Bibliography"/> <w:LsdException Locked="false" Priority="39" SemiHidden="true" UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/> <w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/> <w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/> <w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/> <w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/> <w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/> <w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 1"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 1"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 1"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 2"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 2"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 2"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 3"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 3"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 3"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 4"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 4"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 4"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 5"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 5"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 5"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 5"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 5"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 6"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 6"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 6"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 6"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 6"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 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</xml><![endif]--><!-- [if gte mso 10]> <![endif]--> When a person is diagnosed with a severe and life-threatening disease, experiences sudden hospitalization, undergoes surgical intervention or faces other treatment options threatening their bio-psycho-social integrity, it can create a stressful situation that may result in an acute stress reaction or adjustment disorders. The global aim of the research was to examine the impact of the type of cervical cancer therapy on the psychological status of patients and the occurrence of depression. The basic principle of the research was a comparative analysis of the results obtained using instruments to assess the degree of depression in the experimental and control groups. Within the first experimental group, a comparison was made between patients who underwent surgery and postoperative chemoradiation. Within the second experimental group, a comparison was made between patients who did not undergo surgery, but received radical chemoradiation therapy. The following research instruments were used: semi-structured psychiatric interview, gynecological parameters—local findings and stage of the disease, the Hamilton scale for depression. Univariate logistic regression analysis showed that patients before surgery (OR = 24.17; 95% PI: 4.81–121.57 and p < 0.001) and patients before radical chemoradiation (OR = 45.99; 95% PI: 8.70–243.15 and p < 0.001) had a significantly higher risk of depression than women from the control group. Radical hysterectomy is accompanied by an increase in depression in the preoperative period as well as after surgical treatment. Radical chemoradiation leads to an increase in depression to a greater degree compared to radical hysterectomy in the period before and after the treatment.
IMPACT OF ABCG2 421 C>A AND SLCO1B1 521T>C GENE POLYMORPHISM ON THE CONTROL OF LIPID STATUS IN PATIENTS ON ATORVASTATIN AND ROSUVASTATIN TREATMENT
Single nucleotide polymorphisms (SNPs) of SLCO1B1 gene (521T>C), encoding OATP1B1 transporter, and ABCG2 gene (421C>A), encoding BCRP transporter, may have impact on statin metabolism, consequently affecting their pharmacodynamic effects. This study aimed to examine the association between transporter gene polymorphisms and lipid status control in relation to the doses of statin administered. In addition, the serum activity levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were compared among carriers of different transporter genotypes. This cross-sectional pharmacogenetic study enrolled 102 patients with dyslipidemia who had been on atorvastatin or rosuvastatin treatment for more than 4 weeks. The values of lipid status parameters were collected from routine patient check-ups, and the transporter SNP was determined using the real-time PCR method. The frequencies of the mutant 521C and 421A alleles were 32.35% and 19.61%, respectively. Patients carrying the mutant A allele of ABCG2 421C>A, who were taking higher doses of atorvastatin, had significantly lower LDL-c than patients with the wild-type genotype. In addition, the presence of the variant 521C allele of the SLCO1B1 polymorphism resulted in better control of HDL-c in patients receiving higher doses of rosuvastatin. The obtained results did not show an association between AST and ALT activity and the examined SNPs. Our study demonstrates that the presence of the examined SNPs may be linked to the regulation of specific lipid parameters. Further research with a larger cohort and blood drug concentration measurements of statins is needed to better understand the polymorphism-dose-effect relationship.
PREOPERATIVE AND POSTOPERATIVE LIVER FUNCTION ANALYSIS AFTER LIVER RESECTION
Preoperative diagnostics and preparation of patients undergoing liver resection procedures are crucial for the outcome of surgical treatment. The study included 30 patients who underwent hepatectomy due to primary or secondary tumor changes. Preoperative and postoperative liver parenchyma status was monitored based on the determination of biochemical liver function parameters (alkaline phosphatase, aspartate transferase (AST), alanine transaminase (ALT), gamma-glutamyl transferase (γGT), bilirubin–total bilirubin (TBIL) and direct bilirubin (DBIL), lactate dehydrogenase (LDH), albumin) and metabolic syndrome parameters (glucose, urea, creatinine, blood pressure). This research provided valuable insights into the characteristics of liver tissue damage following resection, based on liver function monitoring. By applying modern data processing techniques and relevant literature, these findings can contribute to the refinement of therapeutic protocols and postoperative care strategies, offering useful guidance for improving treatment outcomes.
ESTIMATION OF WORKING CAPACITY AMONG WORKERS WITH ALLERGIC CONTACT DERMATITIS IN THE TEXTILE INDUSTRY
Working capacity is the physical, mental and intellectual capacity of the worker to perform certain work duties under specific conditions, all the while without harming their health. Should the sensitized person have repeated contact with a potential sensitizer during the performance of those duties, occupational allergic contact dermatitis may occur—skin inflammation of the eczema type, which can impact working capacity and even fully incapacitate the individual from performing those work duties. The aim of this paper was the estimate of the working capacity of 98 examined workers in the textile industry, 9 of whom have been diagnosed with allergic contact dermatitis. The medical part of the expertise for the estimate of working capacity encompassed a precise and comprehensive allergologic history, positive patch tests to certain potential allergens and responses to exposure—elimination test. The practical part of the estimate of the working capacity demanded a full job description, as well as a description of the conditions in which the specific job was performed. In estimating the working capacity of a patient with occupational contact dermatitis, we kept in perspective the psycho-social approach of the affected person, including their age, level of professional qualification, and the likelihood that the company would accept the suggestions given by medical and other professionals. Every case where we performed an estimate of the working capacity was done in isolation and with due respect for the individual.
CHANGING TRENDS IN THE DIAGNOSIS AND TREATMENT OF LIVER HYDATIDOSIS OVER A 60-YEAR PERIOD: EXPERIENCE OF A TERTIARY REFERRAL CENTER IN AN EUROPEAN ENDEMIC REGION
Serbia is a well-known endemic region for hydatid liver (LH) disease. Although surgery remains the primary treatment modality, significant changes have occurred in the diagnosis and treatment of this disease in recent years. The aim of this study was to retrospectively analyze the demographic and clinical characteristics of patients who had undergone surgical treatment for LH at a tertiary referral center over the past 60 years. The authors conducted a comparative analysis across three 20-year periods: period I (1960–1980), period II (1980–2000), and period III (2000–2020). The ratio of surgeries performed due to LH in the last period (1.23‰) was significantly lower than in the first two periods (5.15‰ and 4.86‰, respectively). A higher incidence in females (1:2.2), cyst localization, and rate of complications have remained consistent over time. The latest standard diagnostic procedures include Ultrasonography (US), Computed tomography (CT), Enzyme-linked immunosorbent assay (ELISA) and Indirect hemagglutination assay (IHA) test. While the management of LH shifts towards less invasive procedures, open surgery remains the gold standard. The tissue-sparing operations were performed in most cases (61.91%). However, there has been a slight increase in the radical surgeries, rising from 25.4% in the first period to 43.15% in the second and 46% in the third period. The surgical approach by Papadimitriou—partial cystopericystectomy plus omentoplasty (PCPCO)—may be the preferred method as it balances the need for radical treatment with tissue preservation in LH surgery. Minimally invasive techniques such as punation aspiration irrigation and respiration (PAIR) and laparoscopy have gradually been introduced over the last two periods, in a small number of carefully selected cases (increasing from 3.4% to 8.1%, respectively).
THE EFFECTS OF COCAINE USE ON THE COURSE AND OUTCOME OF PREGNANCY
The epidemic of drug addiction is a significant public health issue worldwide. Through easy availability of cocaine, its use by childbearing women may have deleterious effects on the course and outcome of pregnancy. Cocaine use during pregnancy causes: intrauterine growth retardation, abruptio of placenta, increased frequency of premature birth, premature rupture of the membranes, precipitous labor, meconium-stained amniotic fluid, stillbirth, neonatal necrotizing enterocolitis, neonatal bowel perforation, complete bilateral absence of the diaphragm, neonatal respiratory disorders, neonatal subcutaneous fat necrosis, sudden infant death syndrome, intimal fibromuscular dysplasia of numerous blood vessels, hearing impairment, retinal hemorrhages, fetal or maternal intracranial accident, rupture of the uterus, ruptured tubal ectopic pregnancy, placenta previa, changes in neonatal behavior, neonatal cardiac arrhythmias, various congenital anomalies, maternal myocardial infarction and long QT interval in a parturient. Retrospective studies have shown that intrauterine exposure to cocaine causes major malformations in newborns: congenital heart defects, genitourinary, brain and skull anomalies, absence of limbs, ankyloglossia, hypothalamic hamartoblastoma, and Poland-Möbius syndrome. Some authors suggest that there is a specific fetal cocaine syndrome and a link between the high incidence of autism and exposure to cocaine in utero. Cocaine is a neurobehavioral teratogen, as long-term monitoring of prenatally exposed children has shown deleterious effects of cocaine on their psychophysical development. Cocaine use during pregnancy can result in a wide range of adverse effects on pregnancy and its outcome.
CURRENT TREATMENT OPTIONS FOR CHILDREN AND ADOLESCENTS LIVING WITH HUMAN IMMUNODEFICIENCY VIRUS INFECTION
The goal of human immunodeficiency virus (HIV) infection treatment in both adults and children and adolescents is to achieve a stable virological response, i.e., undetectable viral load in the blood for more than six months and recovery of immunity. Antiretroviral treatment of children and adolescents living with HIV (C/ALHIV) is even more specific and more difficult due to poorer therapeutic adherence, longer duration of infection and consequent toxic effects as well as chronic microinflammation. Another complicating factor is the lack of adequate pediatric pharmaceutical co-formulations depending on the region. With progress and the emergence of innovative types of therapy and strict guidelines, C/ALHIV are improving their quality of life and immune status. The most used official guidelines are the recommendations of the European AIDS Clinical Society (EACS), the World Health Organization (WHO), and the Center for Disease Control and Prevention (CDC). According to them, along with local conditions and opportunities, national guidelines are formed at the level of individual countries.
SAFETY OF CONCURRENT INTRAVENOUS DRUG APPLICATION
Simultaneous application of multiple intravenous pharmaceuticals, during which they come into direct contact, is common in clinical practice. This is done with both intravenous infusions and injections. While it can be practically and clinically justified, this practice can only be safe for patients if all the combined products are mutually compatible. Physical and chemical incompatibility, with precipitation being the most common and important phenomenon, presents a possible health risk. Intravenous drugs and simple intravenous liquids both have the potential for displaying incompatibility. Over time, many studies utilizing various analytical methods have uncovered numerous inadequate combinations. However, the methodology of these studies is very heterogeneous; it is not always clear whether the results are clinically relevant, and many combinations have not been tested yet. It has also been shown that healthcare providers who are involved in therapy management sometimes do not possess enough knowledge about drug compatibility, although this can be improved with appropriate interventions. Furthermore, a precisely defined protocol for compatibility studies could aid interpretation and comparison of future research data. On the other hand, easily accessible databases and knowledge of alternative application methods for therapy could prevent incompatibilities in everyday work.
CERTAIN IMMUNE MECHANISMS INVOLVED IN NEONATAL SEPSIS DEVELOPMENT
Development of neonatal sepsis, especially in preterm neonates, is one of the main factors for high morbidity and mortality in the neonatal period. Preterm neonates, with incompletely matured immune system, have enhanced susceptibility to sepsis development, compared to term infants. Innate immune system activation represents the main protective mechanism, in preterm neonates, against sepsis development. Different components of the innate immune system provide basic protection, as well as they may serve as early biomarkers for neonatal sepsis development. In this review, we analyzed basic mechanisms of innate immune response to pathogen presence and different markers included in the initiation of the inflammatory process. Better understanding the mechanisms involved in sepsis development may provide earlier prediction of sepsis development and results in more potent therapeutic efficiency.
BREAST CANCER WITH LOW HER2 EXPRESSION STATUS - A NEW THERAPEUTIC ENTITY
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<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 5"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 5"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 5"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 5"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 6"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 6"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 6"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 6"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 6"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 6"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Link"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Targeted human epidermal growth factor receptor 2 (HER2) therapies used in the treatment of HER2-positive early and metastatic breast cancer (mBC) include monoclonal antibodies such as trastuzumab, pertuzumab and margetuximab, as well as antibody-drug conjugates (ADC) trastuzumab emtansine (T-DM1) and trastuzumab deruxtecan (T-DXd), and tyrosine kinase inhibitors such as tucatinib, lapatinib, and neratinib. The introduction of these drugs into clinical practice has dramatically improved the course of treatment for HER2-positive breast cancer. However, the clinical evaluation of trastuzumab, pertuzumab, and T-DM1 in the HER2-low group of patients did not show significant benefits. Consequently, these patients were classified as HER2-negative cancers and treated in accordance with the expression of hormone receptors (HR) or other biomarkers. Trastuzumab deruxtecan, an ADC, which initially demonstrated its efficacy in the treatment of metastatic HER2-positive breast cancer, and subsequently in breast cancer with low HER2 expression, classified as immunohistochemistry IHC 1+ and IHC 2+ with a negative fluorescence in situ hybridization (FISH) introduced into clinical practice a new entity of HER2 breast cancers called HER2-low tumors. Following the publication of the DESTINY-Breast04 study results, it is clear that low HER2 positivity can be considered a rational target for the treatment of breast cancer. The results have changed clinical practice in both HR-positive and HR-negative HER2-low metastatic breast cancer. Further research is necessary in order to standardize HER2 testing, prevent T-DXd-related side effects and resistance to therapy, and identify the optimal sequence of available therapeutic options. Future research should also explore the role of these drugs in the treatment of early HER2-low breast cancer.
PREOPERATIVE ASSESSMENT FOR NON-SMALL-CELL LUNG CANCER SURGERY
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QFormat="true" Name="Subtle Emphasis"/> <w:LsdException Locked="false" Priority="21" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/> <w:LsdException Locked="false" Priority="31" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/> <w:LsdException Locked="false" Priority="32" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/> <w:LsdException Locked="false" Priority="33" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Book Title"/> <w:LsdException Locked="false" Priority="37" Name="Bibliography"/> <w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Lung cancer is the most common malignant tumor and globally the leading cause of death from malignant diseases in the general population, accounting for approximately 25% of all cancer deaths. According to current data, approximately 7,000 people are diagnosed with lung cancer in Serbia annually, and about 5,000 die from the disease. Treatment for lung cancer is complex and multidisciplinary, with surgery playing a central role in stages I to III-A. Despite numerous studies confirming that surgical resection offers the best chance of recovery, only 20–30% of patients are eligible for surgery at the time of diagnosis. There are many reasons for this, including advanced disease, comorbidities, weakened respiratory function, and poor performance status. Considering that surgical lung resections are often accompanied by peri- and postoperative complications, a detailed preoperative risk assessment is crucial for determining the outcome of treatment. The remainder of this text will outline the currently valid guidelines and protocols for preoperative risk assessment, with a particular focus on high-risk patients (elderly, smokers, chronic obstructive pulmonary disease—COPD—patients, and obese individuals). It will also delve into the role of spirometric-diffusion parameters and stress tests in this assessment.
MAGNETIC RESONANCE IMAGING DIAGNOSIS OF AN OPEN SPINA BIFIDA DEFECT
Spinal neural tube defects are a group of disorders that allude to spina bifida, anencephaly, interspinal lipoma, congenital dermal sinus, simple tethered cord and other diseases that can cause neurological problems such as motor and/or sensory disorders and urinary and/or fecal incontinence. Usually, they can be diagnosed with a combined interpretation of alpha fetoprotein and ultrasound imaging. However, sometimes the ultrasound image quality is poor and necessitates the use of a higher resolution imaging technique – magnetic resonance imaging. A woman in her 18th week of pregnancy was scheduled for a routine prenatal check-up. Upon examination, a mild, yet, suspicious lemon sign of the fetus’s cranium had been observed. The sagittal view of the fetus’s spine was normal, however the transversal view of the spine could not be assessed. The complete ultrasound examination was of lower quality due to fetal and maternal factors. Thus, a decision for a fetal MRI had been made. The MRI scan confirmed an open spina bifida. Since MRI scanning is a greater tool than ultrasound, whenever it isn’t possible to conclusively diagnose a neural tube defect via ultrasound for any reason, an obstetrician should opt for an MRI scan to confirm the condition.
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ACUTE ASCENDING MEDIASTINITIS AND NECK PHLEGMON CAUSED BY PANCREATIC PSEUDOCYST: CASE REPORT
Acute mediastinitis is one of the most severely known infections with high mortality rate. Mediastinitis occurs most commonly as a descending infection, spreading from oral cavity or pharynx. The most common thoracic complications of pancreatic disease are reactive pleural effusion and pneumonia, while rare complications include pancreaticopleural fistula with massive pleural effusion or hemothorax and extension of pseudocyst into the mediastinum. Only 50 cases of mediastinal extension of pancreatic pseudocyst have been published in the last 75 years with only one case of neck involvement reported. We report a case of acute respiratory distress syndrome followed by toxic enzymatic hydropneumothorax, mediastinitis and neck phlegmon caused by pancreatic pseudocyst fistula in 45 years old man. After initial diagnostics emergency operation was performed by multidisciplinary team. Ascending mediastinitis caused by pancreatic pseudocyst required a prompt surgical intervention. Early detection and an aggressive approach are crucial. Treatment should include surgical debridement and broad-spectrum antibiotics followed by adequate supportive care.
DYSPHAGIA LUSORIA: A CASE REPORT OF A PATIENT WITH ABERRANT RIGHT SUBCLAVIAN ARTERY AND TRUNCUS BICAROTICUS
Aberrant right subclavian artery (ARSA) is a rare vascular anomaly. It is even more rarely associated with dysphagia and common carotid artery trunk—truncus bicaroticus (TB). Bayford described ARSA in 1794 and called it arteria lusoria, and this type of dysphagia—dysphagia lusoria. Infundibular extension to deviate ARSA was first described by Kommerell in 1936, therefore, it is called a Kommerell's diverticulum. A 69-year-old patient, MD, suffered from dysphagia and hoarseness, showing a weight loss of 9.5 kg, two months before the examination. Esophagoscopy revealed external compression of the posterior wall of the middle third of the esophagus. MSCT examination of the chest, as the most reliable non-invasive diagnostic tool, showed ARSA and Kommerell diverticulum with TB. The presence of ARSA is usually asymptomatic and accidentally located in examinations and autopsies. Dysphagia with a loss of body weight, if present, originate from the outer compression of ARSA to esophagus, while hoarseness occurs within Ortner cardiovocal syndrome. The patient was advised to undergo surgical treatment in case of deterioration of dysphagic disorder, and until then more frequent food consumption during the day, in small bites, and the use of proton pump inhibitor.
COMPLEXITY OF REHABILITATION AFTER SIMULTANEOUS BILATERAL INSTALLATION OF ENDOPROSTHESIS IN A PATIENT WITH DEVELOPMENTAL HIP DYSPLASIA: CASE REPORT
The gold standard for the treatment of advanced coxarthrosis is the installation of a total hip endoprosthesis. Degenerative hip disease occurs bilaterally in about 42%. The operation is usually performed first on one hip, and after at least 6 months on the other hip. Rarely, this operation is performed simultaneously on both hips, which represents a more demanding operation as well as rehabilitation. This paper is a case report of a patient with good results of functional recovery after bilateral simultaneous hip arthroplasty, who was followed prospectively from the 5th postoperative day until the end of the 3rd.month after surgery. The patient suffered from secondary bilateral coxarthrosis, which is the result of a developmental disorder of the hips. The good recovery results of this patient with simultaneous bilateral hip arthroplasty can be explained by the selection of a good patient selection for simultaneous bilateral arthroplasty, well-chosen endoprostheses, well-done surgery and timely and adequate rehabilitation.
ALCOHOL CONSUMPTION AMONG FIRST AND SECOND-YEAR UNIVERSITY STUDENTS IN NOVI SAD
Alcohol is the most consumed psychoactive substance worldwide. The aim of this study was to assess the prevalence of alcohol consumption among university students in Novi Sad and the association of socioeconomic characteristics and psychoactive substance use with alcohol consumption. The study was a cross-sectional survey of University of Novi Sad students in 2019, as part of the project “Health behaviours of students: benefits and risks” funded by the Provincial Secretariat for Higher Education and Scientific Research. The research involved 664 students from thirteen faculties. The study instrument was an online questionnaire, and alcohol consumption was classified by daily intake units. The association of socioeconomic characteristics and psychoactive substance use with alcohol use was analyzed using the Chi-square or Fisher’s exact test. Two of five students drank alcohol more than once a month (43.2%), and only 15.5% reported that they had never drunk alcohol. Half of the students (50.2%) reported binge drinking, with a higher prevalence among men than women (64.2% vs. 44.1%) (p < 0.001). Approximately 4% (3.8%) of students believed that peer influence led them to drink more alcohol than they otherwise would have, with a higher prevalence among young men than women (7.0% vs. 2.4%) (p < 0.001). The prevalence of heavy drinking and binge drinking was higher among smokers and illicit drug users (p < 0.001). The prevalence of alcohol use and binge drinking among university students in Novi Sad is high. Peers have a negative influence on student alcohol use. Heavy drinking and binge drinking were more prevalent among smokers and illicit drug users.
INFLUENCE OF VITAMIN C AND RIBWORT PLANTAIN EXTRACT ADDITION TO THE PROPOLIS EXTRACT ON THE VIABILITY OF FIBROBLASTS IN CELL CULTURE IN VITRO
Propolis is a honey bee product rich in biologically active substances that have been proved to have beneficial effects on human health. It is widely used in traditional medicine for the treatment of various not only respiratory but also skin disorders. Propolis can be used alone as a pure extract or with the addition of multiple plant extracts and antioxidants to achieve synergistic effects. The aim of this study was to examine the effects of different propolis extracts, commercially available on the market, on the viability of fibroblasts in cell culture in vitro. We examined the effect of three different propolis extracts: pure propolis extract (25%), propolis extract (10%) with added vitamin C and propolis extract (10%) with Ribwort Plantain extract and added vitamin C, on the viability of L929 fibroblasts, using the MTT test and microscopically. Concentration-dependent effect of all examined propolis extracts on the viability of fibroblasts was observed. Also, differences in the effect of examined extracts on cell viability were noticed related to the additions to the propolis extract, and the pattern was different in lower compared to the higher examined concentrations. The addition of vitamin C and Ribwort Plantain extract influences the effects of pure propolis. Using propolis in combination with plant extracts and bioactive substances may have beneficial effects, but it should be considered based on the indications for which these products are intended and the effects to be achieved.
IN VITRO WOUND HEALING ACTIVITY OF ALPHA-LIPOIC ACID
Chronic wounds represent a worldwide healthcare and socio-economic problem which significantly affects the patients’ quality of life. Healing of chronic wounds is a very complex process and requires constant wound management and treatment with agents that should stimulate wound healing. Alpha-lipoic acid (ALA) is a naturally occurring organosulfur compound with two thiol groups in its structure. It is a very potent antioxidant with other beneficial activities such as anti-inflammatory, anti-ageing and neuroprotective. This study aimed to investigate in vitro wound healing activity of ALA and its effect on the proliferation of L929 fibroblasts. Wound healing activity was examined using an in vitro ‘scratch’ assay, while the impact on cell proliferation was assessed using the MTT test. A concentration-dependent effect of ALA on fibroblasts’ proliferation was observed. ALA stimulated the wound closure and migration of fibroblasts in used in vitro wound healing model, which suggests that ALA can be used as a potent agent in various pharmaceutical formulations for wound management and wound healing.
COMPRESSIVE THERAPY SIDE EFFECTS DURING THE TREATMENT OF VENOUS LEG ULCERS
Venous ulceration arises as an end stage of chronic venous insufficiency. The application of an adequate level of compression therapy is the gold standard of treatment. The study to assess the frequency of complications from compression therapy used to treat venous ulcerations of the lower limbs, in relation to age and the level of compression applied. The study included 102 outpatients with venous ulceration treated at the Niš University Clinical Center's Clinic of Dermatovenereology. Ulcers were monitored within 24 weeks from the start of treatment. There were two groups of patients, ≥ 65 years old and < 65 years old, divided into two subgroups in relation to the degree of compression therapy. The following were monitored: sex, age, body mass index, area, localization and number of ulcerations, degree of granulation tissue and fibrin in the ulceration, presence of dermatitis, lipodermatosclerosis, infection, and duration of the disease. It was found that there was a statistically significant difference in the number of previous ulceration episodes, the size of the ulcerations and the duration of the disease between the examined groups. Additionally, a difference was found in the level of pain in relation to the degree of compression, as well as the risk of paresthesia in relation to age. A higher degree of compression therapy in both age groups led to an increase in the rate of patients with paresthesia and a higher level of pain sensitivity. The study showed no statistically significant risk of superficial necrosis and skin discoloration related to the age of patients.
ECHOCARDIOGRAPHIC ESTIMATES OF LEFT VENTRICULAR REMODELING IN MITRAL REGURGITATION ACCORDING TO THE TYPE OF SURGICAL CORRECTION: MITRAL VALVE REPAIR OR REPLACEMENT
The pathophysiology of chronic primary mitral regurgitation (MR) is primarily based on a degenerative process. Inadequate adaptation of the left ventricle (LV) due to volume loading leads to gradual dilatation and weakness. The only complete therapeutic option in this case is surgical intervention. This study was aimed at evaluating early echocardiographic parameters of LV remodeling in chronic primary MR between two types of operative correction, a mechanical mitral valve replacement (MVR) and mitral valve prosthetic ring annuloplasty (MVA). Using 2D and M-mode echocardiography, a number of variables were measured or calculated. In addition, the variables are assessed according to early postoperative LV dysfunction (LVD). Ejection fraction (EF) was < 50%. Thirty-six asymptomatic patients with primary severe MR (grade 3−4) undergoing surgical correction were included. The LV end-diastolic diameter improved significantly (6.11 ± 0.9 vs. 5.50 ± 0.7 cm) in both groups (p < 0.006) after interventions, while there were no significant differences in LV volumes between the groups. Immediate postoperative LV systolic dysfunction showed similar incidence in the groups (43%). A significant distinction between the groups was revealed in patients without LVD, that is, a higher preoperative forward LVEF in MVA compared to MVR patients. Interestingly, the opposite direction of forward LVEF change was seen in LVD between the groups. We can conclude that there are subtle differences in early postoperative echocardiographic parameters between the MVA and MVR procedures, reflecting subtle specificities of early LV remodeling in patients with chronic primary MR.
RESULTS OF THE COMPARATIVE STUDY ON THE ONSET AND FREQUENCY OF OCCUPATIONAL ALLERGIC CONTACT DERMATITIS AMONG WORKERS IN THE RUBBER AND CONSTRUCTION INDUSTRIES
Occupational skin diseases are changes in the skin and its adnexa which occur under the influence of various exogenous and endogenous factors. They can be caused by irritants or allergens (irritant or allergic contact dermatitis). To examine the impact of the work environment and occupational hazards concerning the occurrence of Occupational Allergic Contact Dermatitis (OACD), a study on workers in the rubber and construction industries diagnosed with contact dermatitis (CD) was conducted. The structure of the workers was presented according to sex, place of residence, age, qualifications, years of service, type of allergen and work position. The importance of medical, occupational, and social rehabilitation was emphasized, as well as prevention measures (professional orientation, education and health education of the workers). The following conclusion was reached—in the construction industry, men are more frequently affected and there is a higher risk of OACD, although a longer time of exposure is required. The causing allergens are varied. It is imperative to register those affected by the disease and to undertake the corresponding measures of treatment and prevention.