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Ovarian tumors are a common entity in clinical practice. Tumors with an ovarian mass diameter exceeding 20 cm are termed giant ovarian tumors. Their prevalence is low, as most cases are diagnosed early during routine gynecological examinations or are incidental findings. A 34-year-old patient was admitted to the Clinic for Endocrinology for the initiation of a weight loss regimen and reevaluation of hyperthyroidism. She reported gaining about 70 kg since 2019, during which she was also diagnosed with hyperthyroidism. In September 2022 she underwent thyroid surgery (right lobe and isthmus removed); histopathology result: colloid cystic goiter, partly hyperplastic thyroid gland. Upon admission, her main complaints were abdominal pressure and shortness of breath. On examination, the patient was morbidly obese (BMI 62 kg/m²). Initial and repeated abdominal ultrasound showed a well-defined subcutaneous fluid collection measuring about 240 mm, creating cellulitis in the anterior abdominal wall. A gynecological examination revealed an anechoic formation measuring 110x80 mm behind and above the uterus. A CT scan of the abdomen without IV contrast showed a large cystic expansive tumor change in the right adnexa measuring 318x380x242mm with sharp contours, filled with serous fluid, and surrounded by a capsule, differential diagnosis: cystadenoma of the right ovary. The patient was presented to the Oncology and Radiology Institute of Serbia (IORS) for a multidisciplinary consultation, where it was decided to remove the tumor of the right ovary and the remaining left lobe of the thyroid gland in one operation. On September 21, 2023, the patient was operated at IORS, where the tumor weighing about 30 kg was removed. Histopathology results: 1. mucinous cystadenoma of the ovary; 2. colloid goiter micro and macrofollicular thyroid gland. Follow-up in January 2024 showed the patient without previously mentioned symptoms of dyspnea and abdominal pressure, with TSH 7.21, fT4 16.4 on a dose of 175mcg levothyroxine. The patient continued with a reduction diet at home.

Introduction/Objective. Neurological impairment and immobility in stroke patients can lead to numerous complications. This study aimed to evaluate the effect of cycling exercises with visual feedback combined with conventional rehabilitation on neurological and motor recovery, balance, walking speed and endurance, and activities of daily living (ADL) in patients after acute and subacute stroke. Methods. A randomized prospective controlled trial was applied to this research. One hundred and twenty-seven hemiplegic stroke patients who received in-hospital rehabilitation were randomly assigned into two groups. Both groups received conventional rehabilitation treatment. The experimental group had an extra 30 minutes of cycling exercises for the upper and lower extremities on a stationary ergocycle MOTOmed muvi. Both groups’ neurological status, upper and lower limb function, independence in ADL, balance, walking speed, and endurance were observed before and after the rehabilitation treatment. Outcome measures used were the National Institute of Health Stroke Scale (NIHSS), the modified Ashworth scale (MAS), the Brunnstrom Motor Evaluation Scale (BMES), upper and lower Fugl-Meyer assessment (FMA), the Barthel index (BI), the Berg Balance Scale (BBS), the six-minute walk test (6MWT) and the Timed Up and Go test (TUG). Results. The neurological recovery on the NIHSS scale, spasticity of the knee extensor measured by the MAS, the BMES and FMA-LE subscale for the affected leg, and the 6MWT presented more significant improvement in the experimental group than in the control group after the treatment (p < 0.05 for all three analyses). Conclusion. Cycling exercises with visual feedback combined with conventional rehabilitation could promote neurological recovery and improve the motor function of the affected leg and walking speed in patients recuperating after acute and subacute stroke.

Background/Objectives: Hypertrophic cardiomyopathy (HCM) is a common heart disorder characterized by the thickening of the heart muscle, particularly in the left ventricle, which increases the risk of cardiac complications. This study aims to analyze the expression of apoptosis-regulating genes (CASP8, CASP9, CASP3, BAX, and BCL2) in blood samples from HCM patients, to better understand their potential as biomarkers for disease progression. Methods: Quantitative real-time PCR (qPCR) was used to evaluate gene expression in blood samples from 93 HCM patients. The correlation between apoptosis-regulating genes was conducted and clinical parameters were integrated for feature importance and clustering analysis. Results: Most patients exhibited significant downregulation of CASP8, CASP9, and CASP3. In contrast, BAX expression was elevated in 71 out of 93 patients, while BCL2 was increased in 55 out of 93 patients. Correlation analysis revealed weak negative correlations between the BAX/BCL2 ratio and CASP gene expression. Conclusions: These findings suggest that reduced expression of apoptotic genes may indicate a protective cellular mechanism, which could serve as a biomarker for disease progression. Further studies are needed to investigate the potential for therapeutic modulation of these pathways to improve patient outcomes.

The primary objectives of asthma management during pregnancy are to achieve adequate symptom control, reduce the risk of acute exacerbations, and maintain normal pulmonary function, all of which contribute to ensuring the health and well-being of both the mother and the baby. The Global Initiative for Asthma (GINA) recommends that pregnant women with asthma continue using asthma medications throughout pregnancy, as the benefits of well-controlled asthma for both the mother and fetus outweigh the potential risks of medication side effects, poorly controlled asthma, and exacerbations. The classification of asthma medications by the US Food and Drug Administration (FDA) into categories A, B, C, D, and X is no longer applied. Instead, the potential benefits and risks of each medication during pregnancy and lactation are considered individually. The use of medications to achieve good asthma control and prevent exacerbations during pregnancy is justified, encompassing inhaled corticosteroids (ICS), some leukotriene receptor antagonists (LTRA), short-acting beta-2 agonists (SABA), long-acting beta-2 agonists (LABA), short-acting muscarinic antagonists (SAMA), long-acting muscarinic antagonists (LAMA), and, recently, biological therapies, even in the absence of definitive safety data during pregnancy.

Recent advances in regenerative medicine provide encouraging strategies to produce artificial skin substitutes. Gelatin scaffolds are successfully used as wound-dressing materials due to their superior properties, such as biocompatibility and the ability to mimic the extracellular matrix of the surrounding environment. In this study, five gelatin combination solutions were prepared and successfully electrospun using an electrospinning technique. After careful screening, the optimal concentration of the most promising combination was selected for further investigation. The obtained scaffolds were crosslinked with 25% glutaraldehyde vapor and characterized by scanning electron microscopy, energy-dispersive X-ray spectroscopy, and Fourier-transform infrared spectroscopy. The incorporation of antibiotic agents such as ciprofloxacin hydrochloride and gentamicin sulfate into gelatin membranes improved the already existing antibacterial properties of antibiotic-free gelatin scaffolds against Pseudomonas aeruginosa and Staphylococcus aureus. Also, the outcomes from the in vivo model study revealed that skin regeneration was significantly accelerated with gelatin/ciprofloxacin scaffold treatment. Moreover, the gelatin nanofibers were found to strongly promote the neoangiogenic process in the in vivo chick embryo chorioallantoic membrane assay. Finally, the combination of gelatin’s extracellular matrix and antibacterial agents in the scaffold suggests its potential for effective wound-healing treatments, emphasizing the importance of gelatin scaffolds in tissue engineering.

Abstract People resort to various questionable health practices to preserve or regain health - they intentionally do not adhere to medical recommendations (e.g. self-medicate or modify the prescribed therapies; iNAR), or use traditional/complementary/alternative (TCAM) medicine. As retrospective reports overestimate adherence and suffer from recall and desirability bias, we tracked the variations in daily questionable health behaviors and compared them to their retrospectively reported lifetime use. We also preregistered and explored their relations to a wide set of psychological predictors - distal (personality traits and basic thinking dispositions) and proximal (different unfounded beliefs and biases grouped under the term irrational mindset). A community sample (N = 224) tracked daily engagement in iNAR and TCAM use for 14 days, resulting in 3136 data points. We observed a high rate of questionable health practices over the 14 days; daily engagement rates roughly corresponded to lifetime ones. Both iNAR and TCAM were weakly, but robustly positively related. Independent of the assessment method, an irrational mindset was the most important predictor of TCAM use. For iNAR, however, psychological predictors emerged as relevant only when assessed retrospectively. Our study offers insight into questionable health behaviors from both a within and between-person perspective and highlights the importance of their psychological roots.

Ancient DNA research in the past decade has revealed that European population structure changed dramatically in the prehistoric period (14,000–3000 years before present, YBP), reflecting the widespread introduction of Neolithic farmer and Bronze Age Steppe ancestries. However, little is known about how population structure changed from the historical period onward (3000 YBP - present). To address this, we collected whole genomes from 204 individuals from Europe and the Mediterranean, many of which are the first historical period genomes from their region (e.g. Armenia and France). We found that most regions show remarkable inter-individual heterogeneity. At least 7% of historical individuals carry ancestry uncommon in the region where they were sampled, some indicating cross-Mediterranean contacts. Despite this high level of mobility, overall population structure across western Eurasia is relatively stable through the historical period up to the present, mirroring geography. We show that, under standard population genetics models with local panmixia, the observed level of dispersal would lead to a collapse of population structure. Persistent population structure thus suggests a lower effective migration rate than indicated by the observed dispersal. We hypothesize that this phenomenon can be explained by extensive transient dispersal arising from drastically improved transportation networks and the Roman Empire’s mobilization of people for trade, labor, and military. This work highlights the utility of ancient DNA in elucidating finer scale human population dynamics in recent history.

Pharmacovigilance as a science and group of activities related to detection, collection, analysis, understanding and prevention of adverse drug reactions (ADRs) is an essential activity in the regulatory system of drugs of any country. Defining increased patient safety as the main purpose of ADR reporting, a well-designed national pharmacovigilance system achieves its ultimate goal, i.e., protection of public health. In organizational and technical terms, the Republic of Serbia has a well-developed system of pharmacovigilance, created on the basis of a proven reliable system of the former SFR Yugoslavia, and carried out by the National Agency for Medicines and Medical Devices of Serbia (ALIMS), which conducts all organized activities aimed at strengthening the national system of ADR monitoring and reporting. Unlike the neighboring Croatia and Montenegro with similar pharmacovigilance systems, Serbia has only recently approached the WHO standard of 200 reports per million inhabitants despite a significant increase of 180 ADR reports per million inhabitants in 2019 (1251 in total). Considering this, our study aimed to provide a critical insight into the practice of pharmacovigilance in Serbia by pharmacoepidemiologic analysis of a ten-year period of ADR monitoring and reporting activities.

Acute basilar artery occlusion (BAO) may cause ischemia in the region of brainstem, parts of the thalamus, occipital lobes, and cerebellum, resulting in severe disability or mortality rate above 70%. Recurrent BAO has been described in only a small number of cases. We present a case of repeated mechanical thrombectomy (MT) for the tip of basilar artery (BA) reocclusion within 24 hours. A previously healthy 37-year-old male presented with occipital headache, nausea, vomiting, right-sided hemiparesis, within 30 minutes from the onset and NIHSS 18. The patient was vaccinated against COVID-19 with Pfizer-BioNTech vaccine seven days before the onset. On initial computed tomography (CT) scan, the pc-ASPECTS was 10 and CT angiography (CTA) showed the tip of BA thrombosis. Intravenous thrombolytic therapy was administered, followed by MT, achieving mTICI 3 and NIHSS 5 after the procedure. Within 24 hours from the first MT, there was neurological deterioration followed by coma. Urgent CT/CTA was performed and rethrombosis of BA was confirmed with pc-ASPECTS 10. MT was repeated with mTICI 2b. Stroke etiology was undetermined. After 17 days, the patient was discharged and referred to continue rehabilitation treatment. After 90 days of stroke, his NIHSS was 2 and mRS 1. We can consider that early recurrent BAO can be successfully treated with repeated MT.

Introduction. Basal cell carcinoma (BCC) is the most common non-melanoma skin cancer in Caucasians and one of the most frequent malignancies in general, especially in older adults. Squamous cell carcinoma is the most frequent tumor developing on chronic leg ulceration, while BCC rarely occurs and is often misdiagnosed. In addition, since older adults commonly have coexisting chronic vein insufficiency, the ulcerated BCC is frequently mistaken as being of venous origin. Outlines of cases. We present five cases of BCC presenting as chronic venous ulcers. Conclusion. Long-lasting ulcers with no healing tendency must be considered malignant until proven otherwise. Knowing the characteristics of malignant ulceration may help in early detection and treatment.

Introduction/Objective. The aim of our study was to retrospectively analyze data about efficacy and persistence on different anti-TNFα treatment in spondyloarthritis (SpA). Methods. We retrospectively analyzed SpA patients whose data were entered into the Serbian national SpA registry. All patients were divided in two groups: non-switcher (patients who were treated with one anti-TNFα) and switcher group (who has switched from first to second and third anti-TNFα). Disease activity was measured by the Ankylosing Spondylitis Disease Score and the Bath Ankylosing Spondylitis Disease Activity Index and functional status was measured by the Bath Ankylosing Spondylitis Functional Index. Results. We identified 290 SpA patients – 250 patients with axial SpA (axSpA) and 40 patients with peripheral SpA (pSpA). Among 250 patients with axSpA, 192 (76.8%) did not change first anti-TNFα, while 58 (23.2%) switched to the second and 14 (5.6%) switched to the third anti-TNFα. Among 40 patients with pSpA, 29 (72.5%) did not change first anti-TNFα while 11 (27.5%) switched to the second and three (7.5%) switched to the third anti-TNFα. Survival on the first anti-TNFα was 35.16 ± 28.5 months (switchers 29.41 ± 21.89 vs. non-switchers 36.89 ± 30.04). Аt the moment of this cross-section 37 (19.3%) patients still had very high disease activity, while only 75 (39%) patients had inactive disease. Conclusions. In real-life clinical practice in our country, as well as in others, there is reluctance to anti- TNFα switch in SpA patients. Administrative limitations and national reimbursement policy could be one of the main reasons limiting treat to target implementation in SpA patients. Additionally, specific drug efficacy on extra-articular manifestations is often the reason for choosing the first line medication or switching to the next one.

Introduction: Valproic acid (VPA) is a broad-spectrum drug primarily used in the treatment of epilepsy and bipolar disorder. It is not an uncommon occurrence for VPA to cause intoxication. The established treatment of VPA poisoning includes supportive care, multiple doses of activated charcoal, levocarnitine and hemodialysis/hemoperfusion. There is a clinically significant interaction between carbapenem antibiotics and VPA. By affecting enterohepatic recirculation, carbapenems can increase the overall VPA clearance from the blood of intoxicated patients. It is suggested that carbapenems could successfully be used as antidotes in the treatment of acute VPA poisonings. The aim: To evaluate the effectiveness of carbapenems in the treatment of patients acutely poisoned by VPA. Patients and methods: This retrospective study included patients acutely poisoned by VPA and treated with carbapenems at the Department of Clinical Toxicology at the Military Medicinal Academy in Serbia for a two-year period. Results: After the admission, blood concentrations of VPA kept increasing, reaching their peak at 114–724 mg/L, while the mental state of the patients continued to decline, prompting a decision to introduce carbapenems. After the introduction of carbapenems, the concentrations of the drug dropped by 46–93.59% (average 72%) followed by rapid recovery of consciousness. Ten out of eleven patients had positive outcomes, while one patient died. The most commonly observed complication in our group of patients was bronchopneumonia. Conclusions: The application of carbapenems for the management of acute VPA poisoning might be a useful and effective treatment option.

Introduction. With the beginning of the pandemic caused by the COVID-19 virus, restrictions on movement, the so-called “lockdown” were applied by many governments. As a result of these actions taken against the transmission of the COVID-19 virus, the use of digital devices has increased, i.e. the time spent in front of screens has increased. Methods. This paper dealt with a bibliometric analysis of scientific publications on the topic of screen time in children and adolescents during the COVID-19 pandemic. The Dimensions database was chosen as the data source. No time frame is given, but given the topic, publications from 2020-2023 are included in the analysis. The data were analyzed in the VOSviewer program, specified for bibliometric and visual data analysis. Results. Map of word co-occurrence show that there are three different clusters. In the red cluster, consisting of 53 terms, the most frequent terms are sleep (124), lifestyle (103) and restriction (83), while in the green cluster, consisting of 41 terms, family (126), education (88), relationship (86) are the most represented. The blue cluster consists of significantly fewer terms, 12 of them, of which anxiety (91), symptom (81), depression (58) are the most represented. Conclusion. Based on the bibliometric analysis, we can conclude that the scientists were mostly concerned with the impact of the screen time phenomenon on the physical health of children and adolescents. In addition, screen time has been linked to mental health, education and socio-emotional relationships.

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrotic, and fatal interstitial lung disease (ILD) of unknown etiology that primarily affects the elderly. Patients with IPF suffer from a heavy symptom burden and usually have a poor quality of life. Dyspnea and dry cough are predominant symptoms of IPF. Although pain is not considered one of the main symptoms of IPF, it can occur for a variety of reasons, such as hypoxia, coughing, muscle and nerve damage, deconditioning, and steroid use. The prevalence of pain in IPF patients varies greatly, ranging from around 30 to 80%, with the prevalence being estimated mostly among patients in the end-of-life period. It manifests itself in the form of muscle pain, joint discomfort, or back and chest pain. Approaches to the treatment of chronic musculoskeletal pain in patients with IPF include pharmacological and non-pharmacological measures that are also important to optimize the treatment of other symptoms (dyspnea and cough) and the optimal treatment of comorbidities. Given the scarcity of data on this symptom in the literature, this article summarizes what is currently known about the etiology and treatment of musculoskeletal pain in IPF.

Introduction/Objectives. The shape and size of the orbital cavity are important parameters in planning surgical interventions and have significance in anthropology and forensic medicine. The aim of this study was to determine the morphometric characteristics of orbital cavity in Serbian population and to examine if there are differences in examined parameters between Serbs and the Roma Community of Serbia. Methods. Using computer tomography and subsequent multiplanar reconstruction we analyzed orbits from 76 Serbian and 18 Roma healthy volunteers. There was no significant difference in age between the ethnicities. Results. The height and width of the left orbit and the height of the right orbit were significantly higher in Roma group, whereas the width of the right orbit was not statistically different between ethnicities. Orbital indices, however, for both left and right orbit did not significantly differ between Serbian and Roma examinees. Right orbital volume did not differ between the groups, but left orbits had significantly larger volumes in Roma population. Finally, biorbital and interorbital width were both significantly higher in Roma than in Serbian examinees. We could not show differences between sexes except for the biorbital width, which had lower values in Serbian, but not Roma women than in men. Conclusion. Taken together, our results indicate larger orbits, as well as greater distances between the eyes in Roma than in Serbian examinees.

Introduction. Technology has the potential to reduce isolation, increase independence, provide educational, financial and social opportunities for users, but there may still be barriers, especially for people with disabilities or sensory deficits. Therefore, it is very important to determine what science has been dealing with in this area, more precisely in the area of the deaf. The main aim of this paper was to map the progress and trends of scientific literature in the field of technology for the deaf (children and adults). Methods. A bibliometric analysis in VosViewer was performed to determine the set goals. The Dimensions database was chosen for literature analysis. The unit of analysis consisted of 1242 publications and VosViewer was applied. Results. The results show that this topic in science has experienced exponential growth in the last decade. Also, the most productive authors, journals, institutions and countries, as well as their collaboration network, were identified through a visual analysis of co-citations. Based on the analysis of co-words, we can draw a conclusion that the words: student, sign language, cochlear implant, classroom, parent, outcome are the most frequently repeated words, which would mean that the topics covered in this domain are mainly focused on children and their functioning in the environment and school system. Conclusion. Providing the main lines of research generated in this field allows scientists to follow the trends themselves. Also, therapists can use our analysis to identify sources that can indicate how and in what context deaf children can use technology.

Introduction. Visual-motor integration (VMI) is defined as the degree to which visual perception (VP) and finger-hand movements are well coordinated. The VMI consists of two components: VP and motor coordination (MC). The main goal of our research was to determine whether there are differences in age and gender categories in VMI, VP and MC scores, as well as whether there is a correlation between VMI and school success of younger school-aged children. Methods. Out of 103 student respondents, 52 were female (50.5%), aged 6 to 11 years (8.05 ± 1.44 years), divided into two groups according to age: 6–8 years (first, second and third grade) and 9–11 years (fourth to fifth grade). Data on the level of VMI were obtained by applying the following tests: Beery-Buktenica Developmental Test of VMI, VP test and MC test. Results. In the older age group of subjects, a significant difference was observed in the mean values of the score on the VMI (12.67 ± 1.92), VP (23.69 ± 3.21) and MC (24.34 ± 3.23) tests comparing to the younger group of subjects (9.98 ± 2.12; 20.80 ± 3.2; 19.65 ± 3.82) (p < 0.001), while the difference in the mean values of scores in relation to gender was not observed. A significant, positive and strong correlation was observed between the scores on the VMI, VP and MC test with the success of second to fifth grade students (p < 0.050). Conclusion. Given such a strong correlation between VMI and the success of younger students, we conclude that it is important that VMI disabilities are identified in time, so that these students can be referred for further assessment and receive the necessary support.

The aim was to perform adaptation and validation of the Perceived Implicit Rationing of Nursing Care. Implicit delaying of nursing care is an intermediate step, linking nurses with the quality of outcomes for patients and nurses, and it is the result of prioritization of health care measures within the assigned group of patients cared for by nurses. The Perceived Implicit Rationing of Nursing Care instrument is a tool used to assess the rationing of care in nursing practice. Study participants were nurses working at hospital wards in 4 university hospitals in the Republic of Croatia. The questionnaire was filled-in by 438 nurses. Data were collected between April and November 2018. After principal axis factoring, a single factor solution based on the correlation matrix was adopted. The measured construct is one-dimensional, and the extracted factor explains 47.2% of its variance. Additionally, the reliability of the whole questionnaire was determined by using the internal consistency coefficient Cronbach alpha on the Perceived Implicit Rationing of Nursing Care with 31 of 0.96 particles, which is extremely high internal consistency reliability. In conclusion, the study found a high level of reliability and validity of the translated Perceived Implicit Rationing of Nursing Care questionnaire, fully comparable to that of the original. The questionnaire can be used to assess the phenomenon of implicit care rationing in Croatian hospitals.

Introduction: Autoimmune pemphigus (AP) is one of the most severe dermatologic diseases. AP belongs to the group of organ-specific autoimmune disorders, with autoantibodies directed against cellsurface antigens on keratinocytes, mostly desmogleins. Three main types of AP have been described, depending on the clinical and histopathological features and the different target antigens: Pemphigus vulgaris (PV), Pemphigus foliaceus (PF), each with its own subtypes and paraneoplastic pemphigus (PNP). The clinical course and prognosis of AP depend on its subtype, therapeutic modalities and their side effects. The main goal of the treatment is to achieve and maintain remission without any systemic therapy or with minimal therapeutic doses ("maintenance therapy"). Aim: A retrospective study of hospitalized patients with various forms of AP, analysis of clinical course and evaluation of therapeutic modalities employed. Material and methods: A total of 158 inpatients with diagnosed AP, admitted to the Clinic of Dermatovenereology, Clinical Centre of Serbia, from 2013 to 2018, with a subsequent followup of 6 to 12 months, were included in this study. Demographic and clinical data as well as treatment approaches were analyzed using descriptive and analytic statistics. Results: The most common subtype encountered was PV (72.15%); in the largest number of patients (46.84%) the disease occurred between ages 39-59. Conventional corticosteroid treatment was most frequently used (67.41%), along with azathioprine (66.86%) as the most common immunosuppressive drug. In 60.8% of patients no side effects or disease complications were recorded. During the follow-up, at the end of 2018, 48.1% of patients achieved remission. Conclusion: We have shown a high incidence of PV. Treatment approaches used in our patients were in accordance with the pemphigus subtype and course of the disease. A significant number of patients achieved clinical remission.

Introduction. The success of endodontic treatment depends on the adequate biomechanical preparation and obturation of the entire root canal system. The untreated or poorly debrided/obturated root canals are among the most frequent causes of endodontic treatment failure. The endodontic treatment of maxillary molar has the highest failure rates due to the complexity of their root canal anatomy. The aim of the study is to present the endodontic treatment of maxillary second molar with two roots and two canals. Case report. The clinical case report presents the endodontic treatment of maxillary second molar with two roots and two canals in a patient, aged 32 years. After the analysis of preoperative diagnostic radiograph, opening the pulp chamber and access cavity preparation, two canal orifices were localized. After the biomechanical preparation, root canals were obturated with the Gutta-percha points and sealer during the same visit. Conclusion. Although maxillary second molar most commonly varies in terms of the number of root canals in the buccal roots, less common variations in anatomical and morphological traits, such as the presence of two roots and two canals, should be considered during endodontic treatment.

Post-stroke depression (PSD) is a severe and frequent stroke complication and one of the crucial factors for the outcome of rehabilitation and life quality after stroke. However, mood disorders frequently remain unnoticed and therefore untreated. The aim of the study was to examine all the potential risk factors and determine the independent predictors of early-onset depression after first-ever stroke, which would help identify high-risk patients, establish early diagnosis and timely treatment that would improve the course and prognosis of this disorder. This prospective study included 60 patients treated for their first-ever stroke; there were 30 patients diagnosed with depression and 30 patients without depression. The study included collection and analysis of all socio-demographic and clinical risk factors for PSD. Testing was performed two weeks after stroke. Depression was diagnosed according to the Mini International Neuropsychiatry Interview, DSM-IV diagnostic criteria, and depression severity was quantified by the Hamilton Depression Rating Scale. Cognitive impairment was assessed by the Mini Mental State Examination. Neurological deficit was assessed by the US National Institute of Health Stroke Scale. Our results showed that the independent predictors of early-onset depression after stroke were previous depressive episodes, cognitive dysfunction, and more severe neurological deficit.

Introduction: Nonsuicidal self-injury (NSSI) is defined as a separate entity in the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) as a "condition for further study". Although the NSSI is not driven by suicidal intention, studies do show its association with suicidal phenomena, but this relationship is still unclear. Aim: The aim of this paper was to examine the characteristics of the NSSI phenomenon among adolescents with disorders of emotion and behavior, with special emphasis on its association with suicidal behavior. Material and methods: The study included 100 older adolescents with depressive disorders, anxiety disorders, adjustment disorders and mixed disorders of conduct and emotion, who were treated in day hospital. The data was obtained from the existing medical records and included information on NSSI and suicidal phenomena, psychiatric symptoms, diagnoses, rating scales for depression and global functioning, and data from personal and family history. Results: In our sample, the NSSI was more common in girls, and among younger adolescents. When it comes to clinical characteristics, this phenomenon was associated with higher depression symptom scores at admission and discharge, the presence of hypobulia-anhedonia, panic attacks, tension and restlessness, hetero-aggressive manifestations, more frequent use of alcohol and borderline personality disorder. It was also significantly associated with the presence of suicidal ideation during life, as well as with more severe suicidality level. In NSSI patients, suicidal attempts were more common among those who were neglected in childhood, with younger age of maltreatment onset, those with lower global functioning on admission, with cognitive problems, and with problematic compliance at admission. Conclusion: The high prevalence of NSSI in our sample, as well as numerous clinical features associated with it, may speak in favor of this phenomenon as a separate diagnostic entity. The observed association with suicide can be of clinical significance in terms of directing preventive steps.

The aim of the present study is to investigate the antioxidant properties of the lichen Cetraria aculeata. Antioxidant activity of the methanol and ethyl acetate extracts of lichen was tested by different methods including determination of total phenolics content, determination of total antioxidant capacity, DPPH free radical scavenging activity, inhibitory activity towards lipid peroxidation, ferrous ion chelating ability and hydroxyl radical scavenging activity. The extracts of the lichen C. aculeata showed significant antioxidant activity. The methanol extract showed higher values for total phenolics and total antioxidant capacity compared to the ethyl acetate extract, while the ethyl acetate extract demonstrated better results for DPPH radical scavenging, inhibitory activity towards lipid peroxidation, chelating ability and hydroxyl radical scavenging than the methanol extract. This is the first report of the antioxidant properties of Cetraria aculeata growing in Serbia. The results of antioxidant activity indicate the application of this lichen as source of natural antioxidants that could be used as a possible food supplement, in the pharmaceutical industry and in the treatment of various diseases.

The aim of the present study is to investigate the antioxidant properties of the lichen Cetraria aculeata. Antioxidant activity of the methanol and ethyl acetate extracts of lichen was tested by different methods including determination of total phenolics content, determination of total antioxidant capacity, DPPH free radical scavenging activity, inhibitory activity towards lipid peroxidation, ferrous ion chelating ability and hydroxyl radical scavenging activity. The extracts of the lichen C. aculeata showed significant antioxidant activity. The methanol extract showed higher values for total phenolics and total antioxidant capacity compared to the ethyl acetate extract, while the ethyl acetate extract demonstrated better results for DPPH radical scavenging, inhibitory activity towards lipid peroxidation, chelating ability and hydroxyl radical scavenging than the methanol extract. This is the first report of the antioxidant properties of Cetraria aculeata growing in Serbia. The results of antioxidant activity indicate the application of this lichen as source of natural antioxidants that could be used as a possible food supplement, in the pharmaceutical industry and in the treatment of various diseases.

Carvedilol is a nonselective beta blocker/alpha-1 blocker, which is used for treatment of essential hypertension, chronic stable angina, unstable angina and ischemic left ventricular dysfunction. The aim of this study was to describe carvedilol population pharmacokinetic (PK) analysis as well as the validation of analytical procedure, which is an important step regarding this approach. In contemporary clinical practice, population PK analysis is often more important than standard PK approach in setting a mathematical model that describes the PK parameters. Also, it includes the variables that have particular importance in the drugs pharmacokinetics such as sex, body mass, dosage, pharmaceutical form, pathophysiological state, disease associated with the organism or the presence of a specific polymorphism in the isoenzyme important for biotransformation of the drug. One of the most frequently used approach in population PK analysis is the Nonlinear Modeling of Mixed Effects - NONMEM modeling. Analytical methods used in the data collection period is of great importance for the implementation of a population PK analysis of carvedilol in order to obtain reliable data that can be useful in clinical practice. High performance liquid chromatography (HPLC) analysis of carvedilol is used to confirm the identity of a drug and provide quantitative results and also to monitor the efficacy of the therapy. Analytical procedures used in other studies could not be fully implemented in our research as it was necessary to perform certain modification and validation of the method with the aim of using the obtained results for the purpose of a population pharmacokinetic analysis. Validation process is a logical terminal phase of analytical procedure development that provides applicability of the procedure itself. The goal of validation is to ensure consistency of the method and accuracy of results or to confirm the selection of analytical method for a given sample and drug. This study confirmed the importance of using valid analytical procedure for the purpose of carvedilol population pharmacokinetic analysis. Identification of demographic, pathophysiological and other factors that may influence the population carvedilol PK parameters gives the physician the possibility of a more comprehensive overview of the patient and better optimization of the therapeutical regimen.

Humeral supracondylar fractures are the second most common fractures seen in children and young teenagers (16.6%). They represent 60-70% of all the elbow fractures. The maximum incidence is found between the fifth and seventh year of age, slightly more often in boys and on non-dominant hand. We performed a retrospective study in our clinic which included 105 patients admitted to our facility during the period from January, 2008 to April, 2012. The included patients had humeral supracondylar fracture either type 2 or type 3 (Gartland classification). At the moment of admission the median age was 7.26 years. All the patients were treated during the first 12 hours, with no more than two attempts of closed reposition. Sixteen patients with type 2 fracture were treated by analgosedation, closed reduction followed by cast immobilization. All other patients were treated after induction of general anesthesia. Sixteen patients were treated by percutaneous fixation of the fragments after closed reduction and 73 were treated with open reduction and pinning with different number and positions of „К“ wires. None of the patients had deep tissue infection; four patients had pin site infection. Three patients had cubitus varus deformity, two patients had elbow contracture, five patients had temporary limitation in extension, and one patient had iatrogenic lesion of the ulnar nerve. This makes 14.2% complication rate in our series. All the fractures healed in the expected period (3–4 weeks). Bauman’s angle, carrying angle and functional factor were measured postoperatively. Closed reposition with pinning, using radiographic control, for the dislocated supracondylar humeral fractures is the safest, as well as the least time consuming and cost-effective method. We also suggest treating these fractures within 12 hours and conversion of closed into open reposition in case of lacking crepitations (possibility of interposition of soft tissues between fragments).

The increasing incidence of obesity among children and adolescents has become a problem in Serbia as in the rest of the world. Obesity is defined as a BMI of 97 or more percentile specific for sex and age, calculated as an individual's weight divided by the square of their height. Overweight is defined as a BMI greater than 90. percentile. The differentiation between simple exogenous obesity and morbid obesity is based mostly on clinical findings. The investigation of obese adolescent includes the recognition of related comorbidities and complications. Given its detrimental affects on public health and the costs of its management, prevention of obesity and its treatment in childhood and adolescence has gained significance. Dietary and exercise advice remains the mainstay of the medical management of obesity. In these respects, the prescription of minimally one hour of daily physical activity for obese children and adolescents and the maintenance of this regimen has become one of the two most important measures. Physical exercise facilitates weight loss by increasing energy expenditure and increasing basal metabolic rate through an increase in muscle mass. The second most important measure is dietary control. Unfortunately, lifestyle interventions alone rarely result in long-term weight loss and the majority of obese patients return to baseline weight within 3-5 years. In the midst of obesity-related health crisis, the case for safe and efficacious pharmacotherapies is clear. Unfortunately, drugs currently available for long-term weight management are limited in number and efficacy. At present, the most effective means of significant and sustained weight loss for obese patients is bariatric surgery. An effective treatment of obesity at early ages has a greater success rate as compared to interventions in adulthood.

Fractures of the greater trochanter rank amongst severe injuries of bone tissue. They occur most frequently in patients over 65 years of age, nearly all of whom are diagnosed with osteoporosis. Non-surgical treatment does not prove to be satisfactory and results in high mortality rate. Surgical treatment is a method of fracture treatment of the trochanteric region, which enables early activation and thus prevents numerous complications in bedridden patients. Gamma3 nails are one of the most state-of-the-art implants for trochanteric fracture fixation. The implant is easy to embed, which does not require a large surgical team. This implant embedding requires the least invasive surgery and complications are rare.This paper describes 47 patients who received surgical treatment and is focused on the first nine months of 2009. The patients were treated at the Orthopaedics Ward of Health Centre Valjevo. They were in their seventies, average age: 72.21 years, with female sex prevailing (63.82%). The outcome was as follows: excellent in 65.96%, good in 17.02% and satisfactory in 4.25% of patients. Surface infections occurred in 6.38% of patients. One implant broke.We had one death outcome in the early post-surgical treatment.Surgical treatment of trochanteric fractures by Gamma3 implants proved very effective as it resulted in few complications and numerous excellent functional and anatomic outcomes. Thus we recommend it as an option when decision on treatment of this type of fractures is made.

The Achilles tendon is the strongest tendon in the body, and its rupture appears to be the most common injury of the tendomuscular apparatus. This type of injury is more frequent in sportsmen, especially those who play tennis, gymnastics, skiing, handball, football, basketball and athletics. Also, the ruptures are common in people who engage in sports activities for recreation. They appear more often in males, in proportion of 3:1. It appears reciprocally in 25- 30% of the cases. The rupture is easily diagnosed by means of clinical examination (Thompson's test) and ultrasonography.The aim of the analysis was to point to the advantages of surgical treatment of a fresh Achilles tendon rupture as opposed to non-surgical treatment by plaster immobilization.The examination was performed on 35 patients, of which 16 (45,71%) were treated operatively and 19 (54,29%) were treated nonoperatively. The average age of the patients was 38.8 years, that is 37.1 for those treated operatively and 40.2 for those treated nonoperatively. Among the examinees, there were 29(82,86%) men and 6 (17,14%) women. The operative treatment method consisted of percutaneous suturing, whereas the nonoperative treatment involved the circular above the knee plaster immobilization. All operatively treated patients underwent the surgical treatment in the first 48 hours from the time when the injury had occured. Anesthesia was local and infiltrative.The obtained results showed that there were no unhealed ruptures or re-ruptures. In the group of patients who did not undergo the surgery, there was 1 re-rupture and 1 unhealed rupture, after which the surgical treatment had to be performed in both cases. In the group of operated patients there were no infections, however, 1 thromboembolism occured. Recovery of muscular strenght of the tendon and the realization of the full range of movement required less time in the operated patients. The ultrasonographic findings in the operated patients showed better consolidation of the rupture site, with less scar tissue formation.The conclusion, as a result of our experience, is that in the case of a fresh Achilles tendon rupture the priority must be given to surgical treatment by percutaneous suture, and each time when it is not possible to bring the ends of the tendon together.

Myxofibroliposarcoma is myxoid tumor of soft tissue. To make a right diagnose we have to follow up a few criteria, patholocical ones . Most important is a pleomorphism with cytologic atipia at least 10%.They arise most in superficial subcutaneous tissue or in dermis. The exact difference between low grade MFLSa and high grade MFLSa is not distincitve. However, the recurrent low grade myxofibroliposarcoma is infiltrative and knows to be aggressive. So, we can find metastatic nodes in mesenteria, lungs, kidneys, pleura and bones and other distant organs. This kind of tumor is very often in lower extremities of elderly patients. Prognosis is different from case to case. Treatment is surgical, sometimes includes chemotherapy and radiation.

A 21-year-old woman taking oral contraceptives presented with headaches, nausea, vomiting and somnolence. The next day she had a generalized tonic-clonic seizure after which her neurologicalcondition deteriorated. CT and MRI showed multiple cerebral haemorrhages, while MR venography revealed extensive dural sinusand venous thrombosis involving almost all sinuses, great cerebral vein of Galen and internal cerebral veins. Two weeks after initiation of the anticoagulant treatment the patient recoveredcompletely with complete recanalization of all cerebral sinuses and veins. Although the patient had conditions which were indicative ofpoor outcome, her neurological deficit improved completely, which correlated with recanalizationof the thrombosed vessels.

Abstract Associative memory (AM) is the ability to remember and retrieve multiple items bound together. Previous studies aiming to modulate AM by various transcranial electric stimulation (tES) techniques were inconclusive, although overall suggestive that tES could be a tool for AM enhancement. However, evidence from a direct comparison between different tES techniques is lacking. Here, in a sham-controlled cross-over experiment, we comparatively assessed the effects of three types of tES—anodal tDCS, theta-band transcranial alternating current stimulation (tACS), and theta-oscillatory tDCS (otDCS), delivered over the left posterior parietal cortex, during a short-term digit-color AM task with cued-recall. The effects were tested in 40 healthy young participants while both oscillatory tES were delivered at a previously determined individual theta frequency (4–8 Hz). All three active stimulations facilitated the overall AM performance, and no differences could be detected between them on direct comparison. However, unlike tDCS, the effects of which appeared to stem mainly from the facilitation of low-memory demand trials, both theta-modulated tACS and otDCS primarily promoted AM in high memory demand trials. Comparable yet differential effects of tDCS, theta tACS, and otDCS could be attributed to differences in their presumed modes of action.

Introduction/Objective A pressure ulcer is a localized injury to the skin and/or underlying tissue, usually over a bony prominence. It appears as a result of pressure or the combination of pressure and shear. Pressure ulcers can be identified within a wide variety of patient subpopulations and epidemiological and etiological aspects play a major role in their treatment. Methods A retrospective study of data analysis included 72 patients with pressure ulcers that were hospitalized and surgically treated in our institution over a five-year period. Main data features used in the analysis were sex, age, principal diseases, comorbidities, and biochemical indicators of malnutrition. The patients’ data was obtained from the existing patients’ records. Additionally, the study analyzed the method of treating pressure ulcers, types of reconstructive methods in surgical treatment, as well as the incidence rate of partial osteotomy. Results A total of 72 patients with pressure ulcers were included in this study, with a mean age of 54.7 ± 16.1 years. Three times more patients injured in traffic accidents were male (75% vs. 25%), while most of the patients with multiple sclerosis were female (85.7%). More than 95% of patients who had pressure ulcers of stage III or IV were treated surgically with a reconstructive method of transposition or rotation myocutaneous flap. Patients with stage IV pressure ulcer were usually treated with partial osteotomy. Conclusion Surgical reconstructive treatment with fasciocutaneous and myocutaneous flaps represents the gold standard for treating patients with pressure ulcers. These procedures provide reconstruction with adequate flap coverage and obliteration of dead space with well-vascularized tissue but with necessity of further implementation of antidecubitus measures.

Introduction/Objective. Osteoporosis is one of the most common comorbid disorders in depressive mood disorder. The aim of this study was to assess the association between the use of antidepressants and osteoporosis in patients with bipolar affective disorder (BPAD). Methods. The study included 73 inpatients, aged 50–72 years, male and female, hospitalized with a depressive episode of BPAD from 2016 to 2020 at the Clinic of Psychiatry, Clinical Centre of Vojvodina, divided into two groups: a) the first group (40) was treated with selective serotonin reuptake inhibitors (SSRIs) in combination with mood stabilizer (lithium carbonate/lamotrigine); b) the second group (33) was treated with mood stabilizer only. Study included two control groups as well. Clinical measurements of bone mineral density at lumbar spine and hip was made using dual energy X-ray absorptiometry. CrossLaps and levels of calcium and vitamin D were collected from blood samples. The data was analyzed by the analysis of variance and the Kruskal–Wallis test. Results. Osteoporosis was registered in 25% of patients in the first group and in 18% of patients in the second group, while osteopenia was observed within 40% of patients in the first group and in 37% of patients in the second group. There was significant difference in value of CrossLaps, and the level of 25(OH)D vitamin between the control groups and the first two groups, as well as in prevalence of osteoporosis and osteopenia. Conclusion. Depressive episodes in BPAD is connected with higher prevalence of osteoporosis. Patients treated with SSRIs have higher prevalence of osteoporosis than patients treated with mood stabilizers only.

Nealkoholna maščobna spremenjenost jeter pri otrocih je kronična bolezen jeter, ki nastane zaradi kopičenja maščob v jetrih. Tesno je povezana z debelostjo in nekaterimi drugimi dejavniki tveganja. Njena pogostost se v razvitem svetu v zadnjih letih strmo povečuje, predvsem na račun naraščajočega števila otrok z debelostjo. Večinoma ne povzroča težav in jo naključno odkrijemo v sklopu diagnosticiranja drugih bolezni ali ob sistematskih pregledih. Če bolezen spremljajo tudi znaki vnetja jeter, govorimo o nealkoholnem steatohepatitisu, ki lahko vodi v cirozo jeter in končno jetrno odpoved. Pri začetnem diagnosticiranju uporabljamo neinvazivne metode (krvne preiskave, ultrazvočno preiskavo), dokončno diagnozo pa v nekaterih primerih postavimo z jetrno biopsijo. Ob tem moramo izključiti druge bolezni jeter in druge vzroke zamaščenosti jeter. O načinu in pogo-stosti sledenja otrok z nealkoholno maščobno spremenjenostjo jeter se odločamo glede na prisotnost dejavnikov tveganja in stopnjo jetrnih sprememb. Pri zdravljenju je najbolj pomembna sprememba življenjskega sloga z zmanjšanjem telesne mase in dejavnikov tveganja ter povečanjem telesne dejavnosti. Zdravljenja z zdravili ali s prehranskimi dodatki zaradi pomanjkanja dokazov zaenkrat ne priporočamo. Praktični pristop k otroku z maščobno spremenjenimi jetri prikazujemo s predstavitvijo kliničnega primera.

Paediatric non-alcoholic fatty liver disease is a chronic liver disease resulting from excessive fat accumulation in the liver. It is closely associated with obesity and some other risk factors. In the last few years, its prevalence in the developed world has been increasing rapidly alongside paediatric obesity. It is generally asymptomatic and is accidentally dis-covered when diagnosing other diseases or during systematic examinations. The additional presence of inflammatory signs is characteristic of non-alcoholic steatohepatitis, which may progress to cirrhosis and end-stage liver disease. The initial diagnosis is based on non-invasive methods (blood tests, ultrasound), but in some cases, the definite diagnosis is based on liver biopsy. Other causes of liver disease and hepatic steatosis must be excluded. The frequency and methods of follow-up are dependent on the presence of risk factors and the severity of the liver changes. First-line treatment is based on lifestyle changes with weight reduction, minimizing risk factors and increasing physical activity. Medical treatment or nutritional supplements are currently not prescribed due to insufficient evidence. A practical approach to a child with fatty liver disease is illustrated by a case presentation.

Introduction. According to the data of the World Health Organization (WHO), mental illnesses are on the rise. The World Health Report estimates that today about 1 billion people suffer from mental and behavioral disorders or psychosocial problems such as those related to alcohol and drug abuse. Stigmatization of the mentally ill is one of the burning social problems of those people, and the attitudes and behavior of nurses/technicians significantly affect the self-stigmatization of patients, and thus their condition and recovery. The main aim of this study was to assess attitudes of nurses and nursing students towards patients with mental illnesses. Method. The research conducted is a cross-sectional study. The study covered two countries, Bosnia and Herzegovina and Serbia. In June and July 2018, 200 nurses and nursing students from the second to the fourth year of study were surveyed. Data were collected with original anonymous questionnaires, which was made for the purpose of this research. Results. Seventy percent of nurses believe that people with mental illness are discriminated against in our society, while there are statistically significant differences between respondents in relation to demographic characteristics (χ2 = 10.217; p = 0.037). Nurses working in psychiatric wards show a lower level of stigmatization compared to nurses working in other wards (χ2 = 25.553; p = 0.001). Nursing students have more negative attitudes towards mentally ill people compared to nurses (χ2 = 13.471; p = 0.009). Nurses from Serbia show a higher level of tolerance towards people with mental disabilities compared to nurses from Bosnia and Herzegovina (χ2 = 16.115; p = 0.003). Conclusion. The results of the research show that stigmatization of patients with mental illness still exists among health professionals. Undergraduate and continuing medical education of nurses should include more content related to access to the patient with mental dis orders, communication skills in psychiatry, mental health promotion and prevention of stigmatization.

Introduction/Objective. The objective of the study was to determinate which groups in the population of children are most prone to hand injuries and to identify the causes of the injuries with the aim of further developing better means of severe injuries prevention that can lead to invalidity. Methods. A retrospective epidemiological study was carried out, and included all children with hand injuries admitted to our hospital between January 1, 2010 and December 31, 2017; The data were collected and analyzed statistically using SPSSR. Significance was defined as p < 0.05. Results. The total number of patients was 254, 202 boys and 52 girls, with a mean age for both sexes 10.13 years (range1–17). The majority of patients were from an urban population 56.7% and 43.3% were from a rural area. Regarding the month in the year when the injury occurred, there were two peaks, in January and in May. The right hand was more affected, 53.2%, than the left, 45.6%, and both hands were affected in 1.8% of cases. Isolated soft tissue injuries (skin, muscles, tendons) were present in 59% of cases, isolated bone injuries (phalangeal and metacarpal bone fractures) in 15.3%, and both soft tissue and bone injuries in 25.7% of cases. The little finger was the most affected, followed by the long finger and thumb, index and ring finger, respectively. The most serious injuries were from explosive wounds caused by firecrackers and handling agricultural tools and engines. Conclusion. Hand injuries in childhood are common and can have devastating consequences. Developing prevention program by raising awareness about this issue is of vital importance.

Introduction/Objective. Coagulopathy induced by severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2) can be an underlying cause of cerebral venous sinus thrombosis (CVST), a less common type of stroke with a variable clinical presentation and high mortality rate. The objective of the paper is to present a series of CVST cases associated with SARS-CoV-2 infection. Methods. This retrospective study evaluated clinical, laboratory and radiological presentations, risk factors, barriers to diagnosis, treatment and outcome of patients with SARS-CoV-2 infection-induced CVST. Results. The study comprised six patients diagnosed with COVID-19-induced CVST during an 18-month period. The majority (66.7%) had no significant risk factors for developing CVST. The median time from the initial COVID-19 diagnosis to the onset of neurologic deficit was seven days (interquartile range 0.5–7 days). Clinical presentation comprised non specific neurological symptoms: headache (83.3%) and decreased consciousness (33.3%), together with elevated levels of D-dimer and inflammatory biomarkers. The transverse (n = 4, or 66.7%), superior sagittal sinuses (n = 3, or 50%) and sigmoid sinus (n = 2, or 33.3%) were most commonly affected. Five patients (83.3%) had minimal to no symptoms at discharge (mRS ≤ 2). In-hospital mortality in our current series was relatively high (16.7%). Conclusion. The high mortality rate of SARS-CoV-2-associated CVST urges clinicians to suspect CVST in patients with a history of COVID-19 infection presenting with non-specific neurological symptoms in order to provide proper treatment and prevent complications.

The concept of proper nutrition implies meeting the needs of the body concerning daily energy intake and a sufficient amount of nutrients and protective substances necessary to maintain the physiological functions of the body and its health. Nutrients are divided into macronutrients (proteins, carbohydrates and fats) and micro-nutrients (vitamins and minerals). Accelerated growth and development during adolescence increase nutrient requirements. Therefore, energy and nutrition requirements must meet the needs of adolescents. During the-ir growth and development, there is an increased need for vitamins and minerals, especially for calcium, iron, zinc and vitamin D. During intensive growth, adolescents require more vitamins, especially B-complex vitamins and vitamin C, the intake of calcium and phosphorus is necessary as well, and the insufficient needs for prote-ins affect the development of muscles and energy levels. Proper nutrition and eating habits during the period of growth are of the utmost importance for the appropriate physical, psychosocial and cognitive growth and development of a child. Eating disorders usually occur as a result of low or high energy intake, and the most common types of these disorders are anemia, anorexia and bulimia, obesity and comorbidities, and poor ea-ting habits. When it comes to the implementation of various programs concerning the prevention of bad ea-ting habits and eating disorders, the school management, expert teams and student parents should bear the overall responsibility. Once or twice a year, preventive check-ups and BMI measurements are recommended to identify eating disorders.

Introduction. Success in endodontic treatment depends upon the clinician's knowledge and ability to recogni-ze and diagnose the presence of anatomical and morphological variations of the root and canal system. Man-dibular canines are usually recognized as having one root and one root canal. In spite of the low incidence of mandibular canines with one root and two canals, their appearance should not be neglected due to the fact that the presence of a second canal in these teeth leads to difficulties in endodontic treatment. The aim of this case report is to describe mandibular canine with two root canals.Case presentation. 45-year-old patient presented for medical care due to the pain in a lower right canine. Cli-nical and radiographic examination revealed composite filling and caries with periapical radiolucent area and sensitivity to percussion in the mandibular right canine. By careful evaluation of the diagnostic radiology, it was observed that the mandibular canine had two canals. The patient was diagnosed with acute apical periodon-titis and root canal therapy was given following the standard protocols.Conclusion. Although the prevalence of two canals in mandibular canine is low, the clinician should always be mindful of variations in the number of canals for appropriate therapeutic management.

Introduction: Incidence of chest pain and discomfort varies in general population between 2 % and 5 %. Total prehospital delay involves two components: the time it takes for patients to recognise their symptoms as severe and seek medical attention, ie the decision-making time, and the time from seeking help to hospital admission, ie the transport time. Scope of the study was to analyse time loss in patients with chest pain hesitating to contact healthcare services, as well as distribution of acute myocardial infarction (AMI) and angina pectoris (AP) among them. Methods: Retrospective analysis of medical records of physicians working at the emergency medical services (EMS) Department of the City of Belgrade, Serbia, from 20 April 2006 to 22 July 2013 on a total of 5,310 completed field interventions. When placing a call to the EMS, 10.43 % of patients cited chest pain as a major symptom. After deducting all those ones who denied having the symptom on examination thereafter and those for whom there were no data, 349 patients remained, ie 6.57 % of the total number of calls available for analysis. Results: The average time between the onset of chest pain and the decision to call the EMS was 11.97 h, median 2 h and mode 1 h. Patient's minimum prehospital delay was 2 min and the maximum was 20 days. Most patients who experienced chest pain or discomfort waited less than an hour before calling the EMS. Most commonly diagnoses made for a symptom of chest pain were AMI and AP, ie AMI with 12.32 % of the total diagnoses, as well as the elevated arterial pressure. There were more female patients, with no difference found among the age groups. Conclusion: For the majority of patients with chest pain and discomfort presented in this paper the decision-making time was up to one hour, with cardiovascular causes being the at the top of the list.

Introduction. The anatomy and morphology of the roots and root canal systems of multi-rooted teeth, especially the molars, shows numerous variations. Preoperative radiography, in particular cone-beam computed tomography (CBCT), has exceptional significance in detecting anatomical variations and unusual root canal morphologies, which are extremely important to be familiar with in order to undertake successful endodontic therapy and minimize procedural errors. Outline of cases. This report presents cases of incidental diagnosis of an unusual root anatomy and root canal morphology of permanent molars in two patients. Diagnosis in the first case was made using orthopantomography and confirmed after extraction therapy. The second case reviled unusual root anatomy and root canal morphology of the permanent molar after preoperative CBCT imaging. Conclusion. Anatomical and morphological variations of roots and root canal systems can occur in any tooth. Clinicians should expect these variations, which should be thoroughly investigated when considering dental treatment.

Introduction/Objective. The aim of this study was to determine the effects of the estrogen and progesterone receptor status on angiogenesis, proliferation, and apoptosis of myoma cells in premenopausal (PreM) and postmenopausal (PostM) women. Methods. This was a cross section; clinical-experimental, retrospective, non-interventional study in the field of the study of fundamental pathogenesis mechanisms of disease using pathohistological materials from the existing archive. The research included 76 patients diagnosed with uterine leiomyomas, operatively treated in the Clinic for Gynecology and Obstetrics, Clinical Centre Kragujevac, Serbia. According to the menstrual status, we formed two experimental subgroups. The first group was PreM women (n = 35; 46.2 ± 5.02 years old), and the second group was PostM women (n = 41; 60.25 ± 5.41 years old). Hematoxylin-eosin staining for myoma and myometrium was conducted, as well as immunohistochemistry for ERα, ERβ, PRа, vascular endothelial growth factor, endoglin, Ki67, and caspase-3. Results. Progesterone receptor was overexpressed in myoma and myometrium of PreM compared to myoma and myometrium of PostM women. Expression of caspase-3 was a statistically significant increase in PostM women compared to PreM group. ERα and ERβ were not changed among groups neither in myoma nor in myometrium samples. Conclusion. According to our data, PRа had higher influence on apoptosis and cell growth than estrogen receptors. Since PRа was increased in PreM in both myoma and myometrium, probably this expression led further to lower expression of apoptotic marker in PreM women.

Introduction/Objective. Bacterial vaginosis (BV) is defined as disequilibrium of vaginal microbiota due to proliferation of Gram-negative/variable anaerobes and reduction/depletion of vaginal lactobacilli. Difficulties in interpreting microscopically categorized findings in diagnosis of BV need a molecular analysis of bacteria present in vaginal discharge of patients. In this regard, we performed real-time qPCR analysis of vaginal discharge samples with the goal to explore in which extent prevalence and amount of anaerobes, Gardnerella vaginalis and Atopobium vaginae, are related to findings obtained by microscopy. Methods. This study enrolled 111 asymptomatic pregnant women between 24 and 28 weeks of pregnancy. Gram-stained vaginal smears were evaluated microscopically. Afterwards, DNA of bacteria was extracted from Gram slides and real-time qPCR was performed with the aim to detect and quantify G. vaginalis and A. vaginae. Results. The data of our study showed that 53.2% of patients had normal results, while 20.7% and 26.1% of patients had intermediary (IMD) and BV results, respectively. G. vaginalis and A. vaginae were more frequently found in IMD and BV than in healthy patients; also, the average bacterial number of G. vaginalis and A. vaginae were significantly higher in BV and IMD than in the group with normal findings (p = 0.000). Comparing mutual relation of G. vaginalis and A. vaginae, the prevalence and number of G. vaginalis were in all groups significantly higher than A. vaginae. Conclusion. The data of our study have shown that in distinguishing normal from BV findings, quantification of bacteria may be more important than just molecular detection of bacteria. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. III41010]

The study aims to examine the latent structure of secondary traumatic stress (STS), its precursors, and the psychological effects of it on the population of service providers working with refugees passing through the Balkan route. A total of 270 service providers (57% female) of different professional backgrounds working directly with refugees took part in the study. Participants were assessed for STS using the Secondary Traumatic Stress Scale, the extent of secondary exposure to trauma (i.e., clients' traumatic experiences from the countries of origin and travel that were communicated to them directly), depression, anxiety, and quality of life. Comparisons of several confirmatory factor analyses following prominent PTSD conceptualizations showed that the model with three relatively distinct but highly correlated factors-intrusion, avoidance, and the blend of negative alterations in cognitions, mood, and reactivity (NACMR), had the best fit. STS has been shown to be positively correlated both with the amount of different traumatic experiences that were communicated to them as well as with the specific content of those experiences. Path analysis showed that the amount of secondary exposure to the clients' traumatic experiences during travel, but not in the country of origin, had exclusive relationships with all three factors of STS. NACMR demonstrated direct effects on anxiety and depression symptoms, while intrusions exhibited a direct effect on anxiety-related symptomatology only. The avoidance factor did not have any independent direct effects on anxiety or depression. Finally, the effects of STS factors on quality of life were fully mediated by an increase of depression-related symptomatology. Results provide evidence on the latent structure of the STS which partially deviates from the prominent models of PTSD thus questioning the isomorphism of two constructs on the empirical level. Additionally, findings provide insights on the cascade of events that make professionals working with traumatized people especially vulnerable to STS and broader psychological distress.

Introduction. Esophageal foreign bodies can cause a wide array of acute and delayed complications. The aim of this paper was to report a complication during endoscopic removal of a long esophageal foreign body. Case outline. An eight-month-old girl was admitted to our hospital due to an acute onset of dysphagia, drooling, and vomiting. From the result of a plain anteroposterior X-ray, the patient was found to have a long hairpin retained in her esophagus. During endoscopic removal using a polypectomy snare, the hairpin was found to be stuck in the hypopharynx. It could not be removed by moving the scope and placing the patient in different positions. Finally, the hairpin was pulled out using a pair of Magill forceps under the control of a laryngoscope. Conclusion. The Magill forceps can be a very useful tool if a foreign body is stuck in the hypopharynx during an endoscopic removal and should be readily available in any setting where this kind of endoscopic procedure is being performed.

In 1993 the European Academy of Allergy and Clinical Immunology was the first official organization to recognize that sublingual administration could be “promising route” for allergic desensitization. A few years later, the World Health Organization recommended this therapy as “a viable alternative to the injection route in adults.” The first meta-analysis showed sublingual allergen specific immunotherapy (SLIT) effectiveness for allergic rhinitis and another study showed SLIT can actually help prevent the development of asthma both in adults and in children. The main goal of this review article is to present insight into the most up-to-date understanding of the clinical efficacy and safety of immunotherapy in the treatment of pediatric patients with allergic rhinitis and asthma. A literature review was performed on PubMed from 1990 to 2015 using the terms “asthma,” “allergic rhinitis,” “children,” “allergen specific immune therapy.” Evaluating data from double-blind placebo-controlled randomized clinical trials (DB-PC-RCTs), the clinical efficacy (assessed as the reduction of symptom score and the need of rescue medicament) of SLIT for allergic rhinitis and allergic asthma, has been confirmed in various meta-analysis Outcomes such as rhinoconjunctivitis score and medication scores, combined scores, quality of life, days with severe symptoms, immunological endpoints, and safety parameters were all improved in the SLIT-tablet compared with placebo group. SLIT safety has been already proven in many DB-PC-RCTs and real-life settings. In accordance with all of the above mentioned, the goals for future trials and studies are the development of comprehensive guidelines for clinical practice on immunotherapy, embracing all the different potential participants. The importance of allergen immunotherapy is of special relevance in the pediatric age, when the plasticity and modulability of the immune system are maximal, and when preventative effects can be reasonably expected. [Projekat Ministarstva nauke Republike Srbije, br. III41004]

Introduction. Cerebral vasomotor reactivity (VMR) represents an autoregulatory response of the arterial trunks on the specific vasoactive stimuli, most commonly CO2. Objective. The aim of this retrospective study was to compare VMR in high-grade symptomatic (SCAS) and asymptomatic carotid stenosis (ACAS), using the apnea test to evaluate the hemodynamic status. Methods. The study included 50 patients who were hospitalized at the neurology and vascular surgery departments as part of preparation for carotid endarterectomy. We evaluated VMR by calculating the breath holding index (BHI) in 34 patients with SCAS and 16 patients with ACAS, with isolated high-grade carotid stenosis. We evaluated the impact of risk factors and collateral circulation on BHI, as well as the correlation between the degree of carotid stenosis and BHI. Results. A pathological BHI was more frequent in the SCAS group (p

Introduction. Granulomatosis with polyangitis (Wegener’s) is an antineutrophil cytoplasmic antibody (PR3-ANCA)-associated vasculitis, which commonly involves the upper and lower respiratory tracts and kidneys. Central nervous system involvement is reported in less than 11%, and rarely present at onset. Case Outline. We report the case of a 41-year-old male patient with a high disease activity, large organ involvement, as well as central nervous system manifestations presented at onset. Treatment with intravenous pulse methylprednisolone, followed by the pulsed doses of cyclophosphamide was induced. After 6 months of cyclophosphamide pulse therapy a remission was achieved. Next, azathioprine was used for maintenance during the next 18 months. There were no disease flares during 24-month follow-up. Conclusion. Granulomatosis with polyangitis (Wegener’s) with large organ involvement, affecting the central nervous system structures require a rapid diagnosis and intensive medication treatment in order to prevent or reduce irreversible damage. Our experience confirms the findings reported in the literature that the severe forms of the disease are associated with increased probability of achieving remission, which reflects increased responsiveness of such patients to immunosuppressant therapy.