THORACIC EPIDURAL AS THE SOLE ANESTHETIC TECHNIQUE FOR COLORECTAL SURGERY IN AWAKE PATIENTS WITH SEVERE RESPIRATORY DYSFUNCTION
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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]--> The report presents a case of major abdominal surgery performed in an awake patient with a high surgical risk due to severe chronic obstructive pulmonary disease. Elective sigmoid colon resection was successfully performed under thoracic epidural anesthesia as the sole anesthetic technique. The patient remained awake and moderately sedated throughout the procedure, which was well tolerated. The applied anesthetic approach itself, which has been proven to reduce the intraoperative and postoperative risks of cardiac, respiratory, and gastrointestinal complications, significantly contributed to a faster postoperative recovery with minimal complications. In a situation where the risk of general endotracheal anesthesia outweighs its benefits, thoracic epidural anesthesia was opted for as the sole anesthetic technique. This approach avoided potentially severe complications, while the additional advantages of epidural anesthesia and analgesia accelerated recovery, especially in a high-risk patient.
Copyright (c) 2026 Acta medicae Medianae
DIGITAL WORKFLOW FOR THE CORRECTION OF A GUMMY SMILE
Excessive gingival display during smiling, known as a “gummy smile,” can negatively affect a patient’s aesthetic appearance and self-confidence. The digital workflow for correcting this condition involves the use of technologies such as intraoral scanning, Cone Beam Computed Tomography (CBCT) diagnostics, and Computer-Aided Design (CAD) and Computer-Aided Manufacturing (CAM) systems for the fabrication of surgical guides. This paper presents a clinical case in which a digital protocol was used to plan and execute gingivoplasty with the aid of a surgical guide. The results demonstrated high precision, minimal invasiveness, and predictable aesthetic correction. The application of digital technologies enhances communication with patients, reduces treatment time, and increases procedural safety, making it an effective approach in aesthetic dentistry.
EFFECT OF GESTATIONAL AGE, BODY WEIGHT AND SERUM CREATININE CONCENTRATION ON SERUM VANCOMYCIN CONCENTRATION IN THE TREATMENT OF NEONATAL SEPSIS: A SINGLE-CENTER PILOT STUDY
Neonatal sepsis is a serious medical condition characterized by systemic infection in infants younger than 28 days. Therapy for late neonatal sepsis is a combination of vancomycin and meropenem. The aim of this single-center pilot study is to examine the influence of newborn body weight, gestational age, and creatinine values on the serum concentration of vancomycin in the treatment of neonatal sepsis. The study included 13 patients admitted to the Pediatrics Clinic University Clinical Center Niš, with a diagnosis of neonatal sepsis in the period from June to October 2024. The value of serum vancomycin between 10 and 15 µg/ml was recorded in 38.5% of subjects, which is preferred therapeutic range. Due to the small sample size, the effect of gestational age, body weight, and serum creatinine concentration on serum vancomycin concentration weren’t found to be statistically significant. However, descriptive statistics show that a significant difference can be found between these groups, suggesting a potential effect worth further investigation.
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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 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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 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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 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<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 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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 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</xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Primary vaginal melanoma is a rare type of mucosal melanoma accounting for 0.3% to 0.8% of all melanomas in women and less than 3% of all vaginal malignancies. A 78-year-old female presented with complaints of vaginal tingling, vaginal watery vaginal discharge, and dysuria lasting for four months, with a gradual increase in symptom frequency over time. The patient underwent complete tumor excision. Immunohistochemical analysis showed that the tumor cells were strongly positive for SOX10, HMB-45, and S100 proteins. Histopathological examination of the entire tumor revealed epithelioid melanoma cells in the vertical (invasive) growth phase with no evidence of a preceding radial growth phase. Most tumor cells contained dark-brown intracellular pigment. Superficial microscopic ulceration was present. The Breslow tumor thickness was 12 mm. Tumor-infiltrating lymphocytes were non-brisk, and the mitotic rate was 15 mitoses per mm2. Lymphovascular invasion was present, while perineural and intraneural infiltration were not noticed. Tumor regression and microscopic satellites were absent. The deep resection margin was free of tumor cells. According to the AJCC 8th edition melanoma staging system, the tumor was classified as stage IIC (T4b, N0, M0). Surgical resection with wide local excision remains the mainstay in the treatment of this aggressive disease with poor overall survival. Mucosal melanoma arising in the vaginal wall is often clinically indiscernible; therefore, prompt biopsy and timely, accurate diagnosis are of crucial importance.
HORMONE IMBALANCE IN A PATIENT WITH HYPOGONADISM AND CRANIAL BASE TOXOPLASMOSIS
Toxoplasmosis is a globally prevalent infection caused by the protozoan parasite Toxoplasma gondii (T. gondii) and represents a widespread and highly adaptable parasitic disease. This case report describes alterations in endocrine function in a patient with T. gondii infection. A 45-year-old man was examined by a neurosurgeon due to visual impairment and intermittent headaches. Magnetic resonance imaging of the brain revealed an extracranial presentation characterized by symmetrical subcentimeter cystic lesions at the skull base. There were no signs of intracranial involvement or abnormalities of the sella turcica. The patient had secondary hypogonadism with decreased levels of both luteinizing hormone and follicle-stimulating hormone. However, T. gondii infection did not result in an increase in testosterone levels. This rare case of a patient with T. gondii infection and hypogonadism highlights the requirement for further research to better understand the pathophysiological mechanisms underlying endocrine alterations associated with this parasite.
EFFECTS OF PROLONGED EXPOSURE TO CIGARETTE SMOKE ON PHENOTYPE AND FUNCTION OF INNATE IMMUNE CELLS IN THE LUNGS
Cigarette smoke contains various toxic compounds that can alter the phenotype and function of immune cells within the lungs. To investigate how extended exposure to cigarette smoke affects innate immune cells (including neutrophils, macrophages, dendritic cells (DCs), natural killer (NK) cells, and natural killer T (NKT) cells), we exposed BALB/c mice to cigarette smoke for 4 or 8 weeks, with control animals being exposed to air. The cigarette smoke was generated using an LM1 Borgwaldt smoking machine. Flow cytometry analysis and intracellular staining of lung-infiltrated immune cells revealed that prolonged exposure to cigarette smoke notably increased the number of inflammatory cluster of differentiation (CD14) receptor-expressing neutrophils, tumor necrosis factor-α (TNF-a)-producing NK and NKT cells, and inflammatory cluster of differentiation (CD40)-expressing macrophages. Additionally, significantly higher numbers of interleukin-12 (IL-12) and interleukin-23 (IL-23) producing DCs were observed in the lungs of mice exposed to cigarette smoke for 8 weeks compared to those exposed to air. Moreover, a greater number of TNF-α, IL-12, and IL-23-producing macrophages, along with TNF-α-producing neutrophils, NK, and NKT cells, were found in the lungs of mice exposed to cigarette smoke for 8 weeks compared to those exposed for 4 weeks. In conclusion, prolonged cigarette smoke exposure promotes an inflammatory phenotype in lung-infiltrating innate immune cells, contributing to the progression and worsening of inflammatory lung diseases.
ACUTE DISTAL TIBIOFIBULAR SYNDESMOTIC INJURIES IN ANKLE FRACTURES
A stable tibiofibular syndesmosis articulation maintains the tibiofibular alignment and is necessary for normal ankle function. An ideal syndesmotic reduction and stabilization strategy should replicate the orientation and stabilizing forces of the syndesmotic ligaments. The aim of this study is to evaluate the outcomes of operative treatment for tibiofibular syndesmosis rupture associated with malleolar fractures. This study presents patients with tibiofibular syndesmosis disruption treated at the Orthopedic Clinic of the Clinical Center in Niš from January 2017 to January 2019. The subjects included individuals with malleolarfractures accompanied by tibiofibular syndesmosis injuries. Treatment involved malleolar fixation and transfixation of the tibiofibular syndesmosis. Radiographic, clinical, operative and statistical methods were used to evaluate the study objectives. In the group of 46 subjects with tibiofibular syndesmosis rupture, there were 28 (61%) men and 18 (39%) women, with age ranging from 18 to 79 years (mean age = 43.6 ± 9.6 years). The predominant cause of injury was slipping and falling in 32 patients (70%), followed by falls from a height in 9 patients (19%), and traffic accidents in 5 patients (11%). According to the Lauge‒Hansen classification, 27 (59%) patients sustained supination-external rotation type injuries. Based on the final functional treatment outcome assessed using the Olerud-Molander scoring system, the average ankle score was 87 points (range 55 to 100). Among the patients, 34 (74%) achieved excellent or good results: 24 (52%) had excellent outcomes (score from 90 to 100 points), and 10 (22%) had good outcomes (80 to 89 points). Satisfactory outcomes were observed in 7 (15%) patients, while poor outcomes were recorded in 5 patients (11%). Our results indicate that stable and timely surgical reconstruction and fixation of the malleolus and tibiofibular syndesmosis enable functional restoration and recovery of the ankle joint with a low rate of complications.
INFLUENCE OF WORK POSTURE ON THE OCCURRENCE OF DISORDERS OF THE MUSCULOSKELETAL SYSTEM AMONG WORKERS IN THE TOBACCO INDUSTRY
Musculoskeletal system disordes (MSDs) require special attention because they represent one of the leading causes of absence from work and disability in the world. In addition to affecting the quality of life itself, they greatly reduce the ability to work, and can occur at any age. Their multi-factorial etiologies primarily caused by the interaction of an unhealthy lifestyle and workplace conditions that vary in different occupations. This research aimed to examine the prevalence of musculoskeletal system disorders among workers of the Niš Tobacco Industry (Niš TI), as well as the influence of the position of workers and other work-related factors on the occurrence of musculoskeletal disorders. Out of a total of 426 workers examined during the 2022 systematic examination, 69 (16.2%) workers were found to have musculoskeletal disorders. Musculoskeletal disorders were more prevalent in workers in the direct production sector (standing position), 61 (88.41%), in female workers (40.6%), and are also associated with overweight and old age of workers. The high frequency of musculoskeletal disorders among Niš TI employees indicates that it is necessary to take adequate prevention, control, and risk reduction measures for the occurrence of diseases and injuries of the musculoskeletal system, all with the aim of reducing the frequency of diseases, reducing the risk of disability, improving the quality of life, and increasing work ability.
PREVALENCE OF BURNOUT AND FATIGUE AMONG HEALTHCARE WORKERS OF A SECONDARY HEALTHCARE INSTITUTION IN BELGRADE DURING THE SARS-COV-2 PANDEMIC
Burnout has been recognized increasingly globally as a major concern, affecting the physical and mental well-being of Healthcare Workers (HCWs). A cross-sectional study was conducted among the healthcare workers in Special Hospital for Rehabilitation and Orthopedic Prosthetics using the following questionnaires: Maslach Burnout Inventory–Human Services Survey (MBI–HSS) for measuring the three aspects of burnout syndrome: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA); Fatigue Severity Scale (FSS) for assessing the presence and degree of fatigue, and sociodemographic characteristics of respondents collected through a general questionnaire. Only fully completed questionnaires, 65 of the total of 79, were included in the study. The majority of participants were females (73.8%), married (61.5%), university degree holders (52.3%), homeowners (66.2%), and those earning above the minimum (81.5%). One third of study participants experienced the death of a close person due to coronavirus disease 2019 (COVID-19). High level of EE was observed in 41.5% of employees. Moderate to high level of DP was recorded in 36.9% of participants, and 40% exhibited a low level of PA. Emotional exhaustion was positively correlated with the FSS. Depersonalization showed a statistically significant positive correlation with the FSS. The length of vacation as the demographic characteristic was also positively correlated with the FSS. Two factors were found to be associated with high levels of EE among HCWs, and those were higher fatigue and lower monthly earnings.
THE INFLUENCE OF NIGHT WORK, DIET, ALCOHOL CONSUMPTION, AND CIGARETTE SMOKING ON THE STRESS LEVEL OF SECURITY WORKERS
Night work, characteristic of occupations such as security guard work, presents unique challenges to workers’ health on biological, psychological, and social levels. Circadian rhythms are disrupted due to night shifts, leading to sleep disorders, increased stress, and metabolic imbalances. This study analyzes how age group, night work, smoking, alcohol consumption, diet, and body mass index (BMI) affect stress levels among security workers. A sample of 154 workers was assessed through surveys and standardized stress measurement tools. Key findings indicate significant effects of night work, age, smoking, alcohol consumption, and BMI on stress levels, with a balanced diet being associated with reduced stress. Practical suggestions include promoting healthy habits to reduce stress and improve workers’ overall health. Night work, typical jobs such as security guard work, poses distinct challenges to worker health on biological, psychological, and social levels. Circadian rhythms, which regulate biological processes in the body, are disrupted due to shift work, especially night shifts, potentially leading to sleep disorders, increased stress, metabolic disturbances, and poor eating habits. Lack of sleep and improper diet contribute to reduced work performance and increase the risk of chronic illnesses such as diabetes and cardiovascular diseases. Additionally, alcohol and cigarette use are often coping mechanisms for stress and insomnia, further exacerbating health issues. The research aimed to analyze how different age groups, night work, smoking, alcohol consumption, diet, and BMI influence stress levels in security workers, with a special focus on how night shifts shape health habits and overall well-being. The study was conducted on a sample of 154 workers from various age groups and work environments, using a survey to assess work-related habits, health, diet, smoking, alcohol use, and BMI measurement. The results show that age group and night work significantly affect stress levels; older workers and those on night shifts report higher levels of stress. Smoking and alcohol use further increase stress, while BMI shows a significant impact on stress, particularly during night shifts. A balanced diet is associated with reduced stress. The conclusion is that night work, age, smoking, alcohol consumption, BMI, and diet significantly influence stress levels among security workers, and changes in unhealthy habits can help reduce stress.
PROGNOSTIC FACTORS FOR LOCOREGIONAL RECURRENCES AFTER SUPRACRICOID LARYNGECTOMY
Supracricoid laryngectomy, also named open partial horizontal laryngectomy type II (OPH II), involves resection of the ventricular folds, vocal folds, paraglottic space, thyroid cartilage, optionally up to one arytenoid cartilage, and, depending on whether it is an OPH II A or B, of the epiglottis. Locoregional control of the disease is a complex phenomenon that includes the characteristics of the tumor, the patient and genetic factors. This study aimed to identify factors indicating an increased possibility of locoregional recurrences following supracricoid laryngectomy. Retrospective study included 104 patients who underwent supracricoid laryngectomy at the Otorhinolaryngology and Head and Neck Surgery Clinic of the University Clinical Center of Vojvodina in the period 2002–2020. Pathohistologically verified TN stage, thyroid cartilage invasion, positive margins, vascular invasion, positive Delphi lymph node and extranodal extension of metastatic disease were estimated as predictive factors for locoregional recurrences. The median time for a local recurrence was 22 months (9.5–59.5), and the median time for regional recurrence was 21 months (10–38.5). Statistical significance in local recurrences of the disease was recorded in the presence of pathohistologically confirmed positive margins (p = 0.033) and vascular invasion (p = 0.029). The statistical significance of vascular invasion was also observed in regional (p = 0.041) and locoregional recurrences (p = 0.004). Pathohistologically confirmed higher T stage showed statistical significance in the occurrence of regional metastases (p = 0.035). Pathohistologically confirmed vascular invasion stands out as an independent factor that should be paid attention to in further postoperative therapeutic care in order to achieve high-quality locoregional control of the disease, while in local control, along with vascular invasion, the importance of positive resection margins is also emphasized.
BEHAVIORAL PATTERNS IN ONLINE GAMBLING IDENTIFIED THROUGH ARTIFICIAL INTELLIGENCE AND PSYCHIATRIC METHODS
This study examined behavioral patterns in online gambling by using advanced technologies such as artificial intelligence (AI), machine learning, and the Internet of Behavior (IoB). The digital revolution has significantly increased access to online gambling, leading to the emergence of complex behavioral patterns among players. While many enjoy gambling as a form of recreation, the growing availability of online gambling poses a risks of addiction. The key role of AI and machine learning lies in the early detection of risky behavior among players. Algorithms can analyze gameplay data to identify patterns indicative of problematic behavior, including excessive spending and "chasing losses", which is the tendency to continue gambling or increase bets to recover losses. Appropriate interventions at the right time can mitigate the risk of developing gambling addiction. This research specifically focused on the use of machine learning and neural networks Multilayer Perceptron (MLP) to identify different player types, analyzing data from a group of online slot game players in the Republic of Srpska. Based on experience in clinical practice, models were trained on a sample of 200 players and tested on a broader group of 11,657 players to predict the risky behavior of players who played online slot games. Future research directions suggest the implementation of personalized tools for player control and support, with an emphasis on promoting responsible gambling and protecting public health. The results were evaluated using player data from the Republic of Srpska, a market governed by regulations designed to protect online gambling participants. This analysis underscored the role of regulatory frameworks and educational initiatives in mitigating the risk of gambling addiction.
ENZYME REPLACEMENT THERAPY IN PATIENTS WITH TYPE 1 GAUCHER DISEASE: A SINGLE-CENTER EXPERIENCE
Gaucher disease (GD) is a lysosomal storage disorder inherited in an autosomal recessive pattern. The underlying cause of the disease is a mutation within the gene that encodes the enzyme glucocerebrosidase. Accumulation of glucocerebrosidase within macrophages in the liver, spleen, and bone marrow, and rarely in the lungs and other organs, occurs due to deficient enzyme synthesis, impaired enzyme function, or saposin C deficiency (an enzyme activator). Clinical classification of GD is based on the absence (type 1) or presence (types 2 and 3) of central nervous system manifestations. Levels of β-glucocerebrosidase in leukocytes, as well as the levels of serum chitotriosidase, are measured to establish the definitive diagnosis of GD. Accumulation of β-glucocerebrosidase causes numerous multisystem complications (anemia, thrombocytopenia, hepatomegaly, splenomegaly, skeletal and neurological changes). Since 1991, enzyme replacement therapy (ERT) has been used in the treatment of GD. The study presents treatment outcomes in patients with type 1 GD treated with ERT using taliglucerase alfa at the Clinic of Hematology, Allergology and Clinical Immunology, University Clinical Center Niš. Between January 2016 and January 2025, taliglucerase alfa was administered to five patients with type 1 GD who either did not respond to previous therapy or because the drug donation was discontinued. All patients responded well to treatment, with no reported adverse effects. Administration of taliglucerase alfa resulted in significant improvement of anemia, thrombocytopenia, and organomegaly, as well as improvement in bone status.
PERFORMANCE ASSESSMENT OF THREE PHENOTYPIC TESTS FOR CARBAPENEMASE DETECTION IN ENTEROBACTERALES
Carbapenemase-producing Enterobacterales (CPE) pose a significant threat in hospital settings, especially in intensive care units, from both therapeutic and epidemiological perspectives. Rapid identification is crucial. This study aimed to evaluate the three phenotypic methods used in routine diagnostics. The study included 56 clinical isolates of carbapenem-resistant Enterobacterales collected from patients hospitalized at the University Clinical Center (UCC) in Niš. Among these isolates, 52 were confirmed as carbapenemase producers, while four lacked carbapenemase genes. Genotypic detection was performed using multiplex polumerase chin reachon targeting the bla Klebsiella pneumoniae carbapensemae (KPC), bla Verona integron-encoded Metallo-beta-lactamase (VIM), bla New Delhi metallo-beta-lactamase (NDM), and bla-Beta lactamase (OXA)-48 genes. The evaluated phenotypic methods included the NG-Test Carba 5, the RAPIDEC Carba NP test (RCNP), and a commercial combination disk test (CDT)—KPC, MBL, and OXA-48 Confirm Kit: Carbapenemases. Multiplex PCR revealed: 2 KPC producers; 24 NDM producers; 16 OXA-48-like producers; 10 isolates producing both NDM and OXA-48 enzymes. One isolate of Enterobacter cloacae was identified as a co-producer of NDM, KPC, and OXA-48 enzymes, and one isolate of Klebsiella pneumoniae was identified as a co-producer of NDM and KPC enzymes. The sensitivity and specificity of the NG-Test Carba 5 were 98.08% and 100.00%, respectively. In the Carba NP test, after 120 minutes, sensitivity and specificity were 90.38% and 100%, respectively. For the CDT method, the sensitivity and specificity for detecting metallo-β-lactamases using dipicolinic acid were 80.56% and 100%, respectively, while for detecting class D carbapenemases using temocillin, they were 95.65% and 100%, respectively. The best results in detecting specific classes of carbapenemases were achieved with the NG-Test Carba 5 and the CDT method. These methods could be employed for rapid and reliable detection of carbapenemases in routine diagnostics.
INTRAHOSPITALNA I MIKROBIOLOŠKA ANALIZA NA KLINICI ZA ANESTEZIOLOGIJU I INTENZIVNU TERAPIJU TERCIJARNE ZDRAVSTVENE USTANOVE U JEDNOGODIŠNJEM PERIODU
Naziv intrahospitalne infekcije ili nozokomijalne infekcije podrazumeva infekcije koje se javljaju kod pacijenata u zdravstvenim ustanovama a nisu bile prisutne u vreme njihovog prijema u zdravstvenu ustanovu i manifestuju se u prvih četrdeset osam sati posle prijema. Češće su u zemljama u razvoju (od 5,7% do 19,1%) nego u razvijenim zemljama (od 3,5% do 12%). Antimikrobna rezistencija predstavlja globalni problem koji nastaje kao posledica upotrebe antimikrobnih lekova. Neopravdana upotreba antibiotika dovodi do razvoja bakterijske rezistencije i promene uzročnika infekcije odgovornih za intrahospitalne infekcije. Ove vrste infekcija produžavaju dužinu bolničkog lečenja, dovode do invaliditeta i povećavaju morbiditet i mortalitet. Najčešći tipovi intrahospitalnih infekcija jesu pneumonija povezana sa upotrebom respiratora, infekcije krvi izazvane upotrebom centralnog venskog katetera, urinarne infekcije uzrokovane kateterom i infekcije hirurških rana. Cilj ove studije bio je da se odrede najčešći bakterijski uzročnici intrahospitalnih infekcija, kao i da se prikaže distribucija uzročnika prema vrsti biološkog materijala. Ova retrospektivna studija se sprovodila na Klinci za anesteziologiju i intenzivnu terapiju Univerzitetskog kliničkog centra u Nišu od početka do kraja 2024. godine. Od pacijenata se uzimao biološki materijal: krv, bris prepona, bris usne duplje, bris rane, bris pazuha, bris čmara, urin, endotrahealni aspirat, bris nosa, obični aspirat, sadržaj drena, saržaj trbušne duplje, vrh centralnog venskog katetra, vrh drena, bronhoaspirat i drugo. Sav biološki materijal poslat je u mikrobiološku laboratoriju radi dobijanja biograma i antibiograma. Pokazalo se da je ukupan broj materijala bio 1464: 232 (15,85%) uzorka krvi, 179 (12,23%) briseva prepona, 166 (11,34%) briseva usne duplje, 132 (9,02%) brisa rane, 122 (8,33%) brisa čmara, 108 (7,38%) briseva pazuha, 106 (7,24%) uzoraka urina, 94 (6,42%) endotrahealna aspirata, 63 (4,30%) brisa nosa, 56 (3,83%) aspirata, 43 (2,94%) sadržaja drenova, 15 (1,02%) sadržaja trbušne duplje, 15 (1,02%) vrhova centralnih venskih katetera, 11 (0,75%) vrhova drena, 10 (0,68%) aspirata iz bronhija i 112 (7,65%) ostalih uzoraka. Distribucija bakterija prema vrsti bila je sledeća: Klebsiella sp. 20,15%, Enterooccus faecalis 19,26%, Acinetobacter sp. 14,41%, Pseudomonas aeruginosa 7,9%, Escherichia coli 7,17%, Staphylococcus epidermidis 4,99%, Proteus mirabilis 3,96%, Enterococcus faecium 2,94%, Enetrobacter sp. 2,94% i Staphylococcus sp. 2,19%. Klebsiella sp. je bila dominantno prisutna u brisu usne duplje (3,28%), Enterococcus faecium u brisu prepona (5,60%), Acinetobacter sp. u endotrahealnom aspiratu (1,91%), Pseudomonas aeruginosa u brisu rane (2,25%), a Escherchia coli u brisu čmara (1,84%). Intrahospitalne infekcije izuzetno loše utiču na hospitalizovane pacijente. Dovode do dugotrajnog invaliditeta, produženog vremena boravka u bolnici i lečenja, povećanja smrtnosti, potrošnje medicinskih resursa i troškova lečenja. Uzročnici ovih infekcija zavise kako od bolničkih uslova, tako i od samih pacijenata i antibiotika koje prepisuju lekari. Trebalo bi da postoje smernice za davanje antibiotika u svakom regionu u skladu sa najčešćim uzročnicima i samom rezistencijom na antibiotike, budući da bi to pomoglo zdravstvenim radnicima pri odabiru najadekvatnije antimikrobne terapije za hospitalizovane pacijente.
COMPARISON OF THE McGRATH VIDEOLARYNGOSCOPE AND THE MACINTOSH LARYNGOSCOPE FOR ENDOTRACHEAL INTUBATION IN SURGICAL PATIENTS WITHOUT PREDICTORS OF A DIFFICULT AIRWAY
The study analyzed and compared the effectiveness of the McGrath MAC videolaryngoscope and the Macintosh laryngoscope for endotracheal intubation in patients without predictors of a difficult airway undergoing elective surgery. The study included 60 patients randomly divided into two groups, each consisting of 30 patients: the McGrath (MG) and Macintosh (MAC). The primary objective of our study was to determine and compare the duration of intubation and laryngeal view according to Cormack−Lehane grade (CL). Secondary objectives were the comparison of duration of laryngoscopy, first attempt intubation success rate, number of intubation attempts, adverse events (mucosal trauma, desaturation SpO2 < 90%, dental damage), number of failed attempts, Backward Upward Rightward Pressure (BURP) maneuver and the use of bougie. The results of the study showed that the CL grade I was significantly more frequent in the MG group compared to the MAC group (80% vs. 40%, p = 0.004). Duration of laryngoscopy was significantly shorter in the MG group in comparison to the MAC group (7.87 ± 1.70 vs. 6.00 ± 0.95, p < 0.001). However, there was no statistically significant difference between the groups in duration of intubation (26.03 ± 1.32 s vs. 28.30 ± 5.66 s in the MG and MAC, respectively, p = 0.057). Successful intubation on first attempt was in 96.7% of patients in the MG group and in 86.7% of patients in the MAC group (p = 0.350). During laryngoscopy BURP maneuver was significantly more frequent in the MAC group (p = 0.024). Regarding complications, there were no significant differences between the groups. In patients without predictors of a difficult airway undergoing elective surgery, the McGrath significantly improves glottis view, reduces duration of laryngoscopy and the requirement for BURP maneuver. Regarding intubation time and the rate of successful intubation on first attempt, the Macintosh and McGrath are comparable.
THE SIGNIFICANCE OF QUANTITATIVE SENSORY TESTING IN PATIENTS WITH CHRONIC MUSCULOSKELETAL PAIN
Quantitative Sensory Testing (QST) provides objective, reproducible data, which can help confirm a diagnosis or monitor treatment outcomes in patients with chronic musculoskeletal pain (CMSP). QST has the potential to become an integral part of routine clinical evaluations in a variety of chronic musculoskeletal conditions. QST can detect early sensory changes before they are clinically obvious. QST procedures are non-invasive, making them suitable for repeated assessments and monitoring over time. The standardization of testing protocols is essential for obtaining reliable results. Impaired Conditioned Pain Modulation (CPM) could serve as a biomarker for central sensitization in chronic pain conditions, helping clinicians identify patients whose pain is centrally mediated. QST has the potential to become an integral part of routine clinical evaluations in a variety of chronic musculoskeletal conditions. QST is particularly useful for evaluating the impact of physical therapies, exercise programs, and psychological interventions.
UNDERSTANDING THE RISK FACTORS ASSOCIATED WITH VIOLENT BEHAVIOR IN SCHIZOPHRENIA
This review examines the risk factors associated with violent behavior in individuals with schizophrenia, highlighting public perceptions and empirical evidence in this area. While schizophrenia affects approximately 1% of the population, research indicates that 5% of homicide offenders have been diagnosed with the disorder. Public stereotypes link mental illness with aggression, yet studies show only a modest association between schizophrenia and violent behavior. Proposed risk factors include younger age, male gender, unemployment, economic disadvantage, childhood abuse, and poor anger management. Substance misuse, particularly among individuals with schizophrenia, significantly increases the risk of violence, while the duration of untreated psychosis is also correlated with a higher likelihood of violent behavior. Individuals experiencing first-episode psychosis face an elevated risks of violence prior to receiving treatment. Research indicates that symptoms such as hallucinations and delusions correlate with aggressive behavior, with personality disorders, particularly antisocial personality disorder, identified as significant predictors. It is important to note that while individuals with schizophrenia typically demonstrate lower rates of violence, the existence of comorbid conditions or acute psychotic symptoms can markedly increase the associated risk. Early identification and appropriate treatment can help reduce these risks and improve community safety.
TUMOR NECROSIS FACTOR-α AND MONOCYTE CHEMOATTRACTANT PROTEIN-1 AS BIOMARKERS IN CHRONIC MYELOID LEUKEMIA
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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]--> Chronic myeloproliferative neoplasms (MPN) are specific clonal hematopoietic stem-cell disorders that continuously and without interruption activate the physiologic signal-transduction pathways necessary for normal and adequate hematopoiesis. A marked proinflammatory milieu in chronic myeloid leukemia (CML) is led by many interleukins. This study aimed to evaluate differences in plasma levels of tumor necrosis factor- α (TNF-α) and monocyte chemoattractant protein (MCP-1) between chronic-phase CML patients and healthy individuals as controls. The study included 50 consecutive patients diagnosed with CML in the chronic phase and under the standard tyrosine kinase inhibitor (TKI) treatment, as well as 20 healthy controls. Blood concentrations of tumor necrosis factor-α (TNF-α) and monocyte Chemoattractant protein-1 (MCP-1) were measured by the enzyme-linked immunosorbent assay method. The levels of MCP-1 were higher in patients than in controls (334.37 vs. 172.18 pg/ml, p = 0.006), while no difference was determined for TNF-α. There is great importance of MCP-1 and IL-6 as novel, strong, and predictive plasma biomarkers for treatment-free remission in CML. Additional and future research in this field will be of special and great importance in understanding the pathophysiology and treatment of myeloproliferative diseases.
FIRST-LINE PHARMACOTHERAPY OF CHEMOTHERAPY-INDUCED PERIPHERAL NEUROPATHY
Chemotherapy-induced peripheral neuropathy (CIPN) is a very common adverse event iatrogenically caused by the administration of neurotoxic chemotherapy protocols in oncology patients. Of the chemotherapeutics—oxaliplatin, cisplatin, carboplatin, docetaxel, paclitaxel, vinblastine and vincristine—bortezomib shows the greatest neurotoxicity. Recommendations for the first line of pharmacotherapy of this side effect of chemotherapy are gabapentinoids (pregabalin and gabapentin), antidepressants (amitriptyline, duloxetine, venlafaxine, desvenlafaxine), as well as topical application of lidocaine. Adequate pharmacotherapy of CIPN implies an individualized approach for each patient and compliance with guidelines for recommended first-line pharmacotherapy, first, in the form of monotherapy and later, depending on tolerability and achieved analgesic response, in the form of polytherapy with first-line drugs. If there is no adequate analgesic response to polytherapy with first-line drugs, only then is it necessary to switch to the second line of therapy. Treatment of CIPN leads to an adequate quality of life due to the reduction of the neuropathic component of pain, a reduction in depression and anxiety and the expected completion of the planned chemotherapy cycles, and consequently, a better prognosis of the underlying oncological disease of these patients.
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.
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.
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.
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.
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.
AN IMPACT OF RADIOTHERAPY ON PSYCHО-EMOTIONAL CHARACTERISTICS OF CANCER PATIENTS
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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]--> 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 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.
THE OCCURRENCE OF DIFFERENT TYPES OF DEPRESSION IN PATIENTS WITH CERVICAL CANCER
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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.
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.
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.