Srpski medicinski časopis Lekarske komore
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description: The Serbian Medical Journal of the Medical Chamber is a journal published by the Medical Chamber of Serbia as a publisher with the Institute for Medical Research of the University of Belgrade as co-publisher. The Journal publishes previously unpublished original professional and scientific papers, reviews, short communications, editorials, letters to the editor, meta-analyses, case reviews, current topics, book reviews, papers on the history of medicine and more, from all fields of medicine, pharmacy and dentistry, therefore contributing to the promotion and development of the profession and science. The Journal is published in print and electronic form four times per year.
publisher: Lekarska komora Srbije
language: en
publication name: Srpski medicinski časopis Lekarske komore
issn: 2737-971X
items: DESCEMET MEMBRANE ENDOTHELIAL KERATOPLASTY (DMEK): CLINICAL OUTCOME OF THE FIRST 52 CONSECUTIVE CASES PERFORMED IN 2022 AND 2023
items: PERIOPERATIVE DYNAMICS OF INTRAOCULAR PRESSURE DURING CONTINUOUS ESKETAMINE ANALGOSEDATION IN COMBINED CATARACT AND GLAUCOMA SURGERY: A CASE REPORT
items: A RARE CASE OF PRIMARILY MISDIAGNOSED GIANT MALIGNANT MIXED GERMINATIVE MEDIASTINAL TUMOR IN A YOUNG MALE PATIENT, SURGICALLY REMOVED BY “COLISEUM” APPROACH
items: OBESITY, INFLAMMATION AND HFpEF – PARTS OF THE SAME CIRCULUS VITIOSUS
items: EVALUATION OF STATISTICAL METHODS APPLIED IN OBSERVATIONAL STUDIES IN NEUROLOGY
items: THE LESER–TRÉLAT SIGN AS A PARANEOPLASTIC MANIFESTATION OF MALIGNANCY: A REVIEW OF THE LITERATURE
items: CONTEMPORARY APPROACHES TO THE PREVENTION OF GESTATIONAL DIABETES: PHARMACOLOGICAL INTERVENTIONS AND DIETARY SUPPLEMENTS – A NARRATIVE REVIEW
items: THE PREDICTIVE SIGNIFICANCE OF EOSINOPHILIA IN PERIPHERAL BLOOD IN PATIENTS WITH HODGKIN LYMPHOMA
items: BIOPSYCHOSOCIAL AND PSYCHIATRIC ASPECTS OF INFIDELITY
items: PERIBULBAR ANESTHESIA WITH TARGETED INTRAVENOUS ESKETAMINE ANALGOSEDATION DURING ENUCLEATION: A CONTEMPORARY NARRATIVE REVIEW
items: PENILE FRACTURE ASSOCIATED WITH URETHRAL INJURY – CASE REPORT
items: AXILLARY BRACHIAL PLEXUS BLOCK UNDER PROCEDURAL SEDATION FOR ARTERIOVENOUS FISTULA FORMATION IN A CHILD WITH END-STAGE RENAL DISEASE – A CASE REPORT
items: SURGICAL TREATMENT OF RADIATION-INDUCED ANTERIOR CHEST WALL OSTEOSARCOMA AFTER BREAST CARCINOMA: A CASE REPORT
items: AGING AS A MODULATOR OF MULTIPLE SCLEROSIS PATHOPHYSIOLOGY
items: LABORATORY PARAMETERS AND THEIR RELATIONS WITH DISEASE OUTCOME IN PATIENTS WITH NON-HODGKIN FOLLICULAR LYMPHOMA – SINGLE CENTRE FIVE-YEAR FOLLOW-UP
items: DEPRESSIVE SYMPTOMS AMONG FAMILY MEMBERS PROVIDING INFORMAL CARE FOR PATIENTS RECEIVING HOME-BASED CARE: A PHQ-9 CROSS-SECTIONAL STUDY
items: IMPACT OF LEFT VENTRICULAR GEOMETRY, EXPRESSED AS INTERVENTRICULAR SEPTAL AND POSTERIOR WALL THICKNESS, ON THE OUTCOME OF ACUTE ISCHEMIC STROKE
items: THE PREVALENCE OF METABOLIC DISORDERS AND HYPERTENSION IN WOMEN DURING PERIMENOPAUSE AND MENOPAUSE
items: NAVIGATING COVID-19 IN PREGNANCY: CARE PATHWAYS AND SYSTEM CHALLENGES IN KAZAKHSTAN – A QUALITATIVE STUDY
items: PREVENTION AND MANAGEMENT OF VACCINE HESITANCY
items: COEXISTENCE OF POLYCYTHEMIA VERA AND MULTIPLE MYELOMA: A CASE REPORT
items: NEONATAL BILATERAL HYPHEMA: A RARE PRESENTATION AND CLINICAL IMPLICATIONS
items: ONCO-HYPERTENSION – A NEW CLINICAL ENTITY IN MODERN MEDICINE
items: INTERSTITIAL LUNG DISEASE AND BULLOUS PEMPHIGOID ASSOCIATED WITH DIRECT ORAL ANTICOAGULANT USE: A CASE REPORT OF LITERATURE-BASED PHARMACOVIGILANCE SIGNAL DETECTION
items: OSTEOPOROSIS IN AUTOIMMUNE DISEASES
items: EFFECTS OF CONTROLLED PHYSICAL TRAINING IN PATIENTS WITH HEART FAILURE
items: MORPHOLOGICAL CHANGES IN KIDNEYS AND CLINICAL PRESENTATION IN PATIENTS WITH PRIMARY AND SECONDARY MEMBRANOUS NEPHROPATHY
items: HEATWAVES AND HEALTHCARE: BRIDGING DATA AND FRONTLINE PRACTICE
items: THIRTY YEARS OF FAMILY MEDICINE SPECIALTY IN POLAND: A CASE STUDY OF ITS INSTITUTIONALIZATION, PRACTICE, AND PATIENT PERCEPTION WITHIN PRIMARY HEALTHCARE
items: SCLEROCHOROIDAL CALCIFICATION MIMICKING CHOROIDAL OSTEOMA: A CASE REPORT

DESCEMET MEMBRANE ENDOTHELIAL KERATOPLASTY (DMEK): CLINICAL OUTCOME OF THE FIRST 52 CONSECUTIVE CASES PERFORMED IN 2022 AND 2023
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description: Introduction/Objective: Corneal endothelial dysfunction is the most frequent indication for corneal transplantation in the developed countries. Shortly after its first appearance, Descemet membrane endothelial keratoplasty (DMEK) has been widely accepted due to its numerous advantages. Our aim is to report clinical outcome of DMEK in patients with dysfunction of corneal endothelium. Material and method: We analyzed clinical outcome of DMEK of the first 52 consecutive cases. Parameters analyzed were as follows: best corrected visual acuity (BCVA), tomography, central corneal thickness, anterior segment optical coherent tomography (AS-OCT), and posterior segment OCT where needed. All parameters were measured before and up to six months after the surgery. Results: DMEK was successful in 46 out of 52 eyes that underwent surgery. All eyes (100%) with good visual potential reached BCVA ≥ 20/40, and 57% reached ≥ 20/25. A partial graft detachment occurred in 8 eyes, which after repeated air injection into the anterior chamber resulted in graft reattachment and a clear cornea. Six eyes experienced primary graft failure which required second surgery. Conclusion: Our series showed an excellent outcome of DMEK, concerning the rate of visual rehabilitation and potential serious complications. The main complication was an early partial graft detachment, which did not affect the final surgical outcome.
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creator: Vesna Jovanović
creator: Zora Ignjatović
rights: Copyright (c)
date: 2026-06-22
publication date: 2026-06-22
doi: 10.5937/smclk7-64493

PERIOPERATIVE DYNAMICS OF INTRAOCULAR PRESSURE DURING CONTINUOUS ESKETAMINE ANALGOSEDATION IN COMBINED CATARACT AND GLAUCOMA SURGERY: A CASE REPORT
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description: Introduction: Perioperative management of patients with glaucoma requires a precise balance between maintaining systemic hemodynamic stability and preserving adequate ocular perfusion pressure. The effects of esketamine on intraocular pressure (IOP) during glaucoma surgery remain insufficiently investigated. Case report: We report the case of a 45-year-old female patient diagnosed with cataract and chronic glaucoma, without significant associated comorbidities, who underwent combined phacoemulsification with intraocular lens implantation and trabeculectomy. The surgical procedure was performed under subtenon anestesia, combined with targeted continuous esketamine analgosedation at a subanesthetic dose, administered as a continuous infusion at a rate of 0.25 mg/kg/h. During the perioperative period, hemodynamic parameters, peripheral oxygen saturation, pain intensity, level of sedation, and intraocular pressure were monitored at multiple predefined perioperative time points. The baseline intraocular pressure was 39 mmHg; following stabilization of sedation, it decreased to 26 mmHg, with a further reduction to 11 mmHg observed in the early postoperative period. No hemodynamic instability, respiratory depression, or need for additional supportive analgesia was recorded during surgery. Conclusion: This case report suggests that continuous subanesthetic esketamine analgosedation is a feasible option during combined cataract and glaucoma surgery performed under sub-Tenon’s anesthesia, providing stable hemodynamics, preserved spontaneous respiration, good patient cooperation, and a favorable early perioperative intraocular pressure profile in the presented case. Further prospective studies are required to confirm these findings.
subject: Case reviews
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creator: Margita Lučić
creator: Ivan Marjanović
creator: Dolika D. Vasović
rights: Copyright (c)
date: 2026-06-08
publication date: 2026-06-08
doi: 10.5937/smclk7-63920

A RARE CASE OF PRIMARILY MISDIAGNOSED GIANT MALIGNANT MIXED GERMINATIVE MEDIASTINAL TUMOR IN A YOUNG MALE PATIENT, SURGICALLY REMOVED BY “COLISEUM” APPROACH
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description: Introduction: Mixed germ cell tumor (MGCT) is most common in younger patients and is localized primarily to the gonads. After reviewing the literature, we concluded that there are only a few cases of mediastinal MGCT – primary mediastinal MGCT accounts for about 10–15% of all mediastinal malignancies and up to 3% of all MGCT. Mediastinal MGCT with more than three pathological components, such as yolk sac tumor, teratoma, and embryonal carcinoma, has not been reported previously in the reviewed literature. Our patient had two more components (carcinoma and seminoma). Case report: The patient was a 40-year-old male who presented with chest pain and fever; chest CT showed a giant mass in the right pleural space, with a maximal diameter of 120 mm. Bronchoscopic findings were normal, and bronchial biopsies were negative. A combined open and VATS approach was used, which revealed NSCLC. The patient underwent chemotherapy, but the next CT scan of the thorax showed progression. Decision was made to perform surgical treatment – salvage pneumonectomy with “coliseum” approach. Intraoperatively, it was verified that the tumor origins were in the mediastinum, so the whole tumor was removed. The whole right lung was in atelectasis, but was not infiltrated by tumor – full reexpansion of the right lung was established during the surgery. The patient tolerated surgery well. Definitive PH finding showed that it was a mixed malignant germinative tumor. Urology findings and the postoperative full-body CT showed no signs of residual or recurrent tumor. Conclusion: The patient was initially misdiagnosed and treated with chemotherapy after the conclusion that he was not a candidate for surgical treatment. Primarily planned salvage surgery for this young patient ended as radical surgery and without the need for pneumonectomy.
subject: Case reviews
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creator: Mlađana Savić
creator: Aleksandar Ristanović
creator: Miloš Petković
creator: Nebojša Marić
rights: Copyright (c)
date: 2026-06-19
publication date: 2026-06-19
doi: 10.5937/smclk7-64838

OBESITY, INFLAMMATION AND HFpEF – PARTS OF THE SAME CIRCULUS VITIOSUS
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description: Introduction/Objective: Heart failure with preserved ejection fraction (HFpEF) accounts for more than half of chronic heart failure cases, and obesity is among its most common comorbidities, which has reached epidemic proportions and is associated with the progressive deterioration of HFpEF. Oxidative stress and systemic inflammation, largely driven by visceral adipose tissue, promote endothelial dysfunction, coronary microvascular injury, myocardial remodeling and stiffness through fibrosis, the key pathophysiological mechanisms in HFpEF. This review paper aims to summarize current evidence on the epidemiological association between obesity and HFpEF, as well as the pathophysiological mechanisms linking these conditions. It also presents clinical and experimental findings demonstrating that obesity, HFpEF, and inflammation constitute interconnected components of one and the same circulus vitiosus. Methods: This review draws upon relevant literature and clinical research retrieved from the PubMed, NCBI, and ResearchGate databases, focusing primarily on the underlying pathophysiological mechanisms and evidence derived from clinical trials. Particular emphasis was placed on modern weight-management pharmacotherapies (SGLT2 inhibitors, GLP-1 receptor agonists) and management of major comorbidities (DM, AHT, OSA, and NAFLD), with the aim of reducing the considerable burden of morbidity and mortality in this growing patient population. Results: Better understanding of the interacting mechanisms in obesity and HFpEF supports development of therapeutic strategies such as dual GLP-1/GIP agonists and anti-cytokine approaches aimed at reducing systemic inflammation and the risk of HFpEF worsening, with potential improvements in functional capacity and quality of life. Conclusion: Obesity is a major comorbidity in HFpEF, with inflammation playing a central role in pathogenesis. Targeted anti-inflammatory and metabolic therapies show potential to reduce morbidity and mortality …
subject: Reviews
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creator: Katarina Milisavljević
creator: Aleksandra Petrović
creator: Filip Jelić
creator: Dimitrije Zdravković
creator: Marija Zdravković
rights: Copyright (c)
date: 2026-06-08
publication date: 2026-06-08
doi: 10.5937/smclk7-65653

EVALUATION OF STATISTICAL METHODS APPLIED IN OBSERVATIONAL STUDIES IN NEUROLOGY
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description: Introduction/Objective: Statistical methods play a key role in the planning, analysis, and interpretation of results in medical research. Due to the complexity of neurological diseases and the heterogeneity of study populations, the proper application of statistical methods in neurology is particularly important for drawing reliable clinical conclusions. This study aims to evaluate the application of statistical methods in observational studies in neurology, with special emphasis on the frequency of the use of different statistical techniques, the adequacy of their application, and the interpretation of results. Materials and methods: A literature search of the MEDLINE/PubMed database was conducted for all publications available up to December 1, 2024, using the term “neurology” with the application of the filter “observational study.” After applying the inclusion and exclusion criteria, 95 observational studies published between 2013 and 2024 were randomly selected for analysis. Two researchers independently extracted the data using a previously designed data collection form. Results: A retrospective design was identified in 53.7% of studies, while 46.3% were prospective. Ethical approval was reported in 78.9% of studies. Assessment of the normality of distribution was presented in 29.5% of studies. The most commonly used statistical tests were the chi-square test (46.3%), T-test (36.8%), Fisher’s exact test (36.8%), and the Mann–Whitney test (33.7%). Regression analysis was applied in 33.7% of studies. Sample size planning was clearly reported in only 10.5% of studies. The application of the T-test was statistically significantly more frequent in studies that reported a previous assessment of the normality of distribution (p < 0.001). Conclusion: The results indicate that statistical methods in observational neurological studies are generally applied adequately and in accordance with data characteristics. However, greater attention should be devoted to testing sta…
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creator: Jelena Tomašević
creator: Mirjana Pajčin
creator: Dejana Stanisavljević
creator: Nenad Milošević
creator: Smiljana Kostić
creator: Milena Stanić
rights: Copyright (c)
date: 2026-06-19
publication date: 2026-06-19
doi: 10.5937/smclk7-67463

THE LESER–TRÉLAT SIGN AS A PARANEOPLASTIC MANIFESTATION OF MALIGNANCY: A REVIEW OF THE LITERATURE
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description: Introduction/Objective: The Leser–Trélat sign is a paraneoplastic dermatosis characterized by the sudden, eruptive appearance and rapid increase in number and size of multiple seborrheic keratoses, often accompanied by intense pruritus. This clinical presentation may raise suspicion of an underlying malignancy. Although its exact pathophysiological mechanism remains unclear, tumor-derived growth factors are believed to stimulate keratinocyte proliferation, contributing to the abrupt development of lesions. In the literature, the Leser–Trélat sign is most frequently associated with gastrointestinal adenocarcinomas, particularly gastric carcinoma, but it has also been reported in connection with other solid tumors and hematologic malignancies. Given its potential association with occult neoplasm, the appearance of the Leser–Trélat sign warrants a thorough clinical evaluation and systematic diagnostic workup, as timely recognition may facilitate early detection of the underlying malignancy. The aim of the paper is to analyze data from the available literature on the etiology, pathogenesis, and clinical associations of the Leser–Trélat sign with various malignancies, and to evaluate its diagnostic and prognostic significance in contemporary clinical practice. Methods: A literature review was conducted using the PubMed database, including available original articles, review papers, case reports, and case series. The search was performed using the following keywords: “Leser–Trélat sign”, “paraneoplastic dermatosis”, “seborrheic keratoses”, and “malignancy”. Conclusion: Awareness of the Leser–Trélat sign and a multidisciplinary approach to investigating its association with malignancies are crucial for the early detection of neoplasms. Recognition of the Leser–Trélat sign may enable the diagnosis of malignancy at a stage when therapeutic response is more favorable, thereby significantly improving disease prognosis.
subject: Reviews
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creator: Jelena Milović
rights: Copyright (c)
date: 2026-06-08
publication date: 2026-06-08
doi: 10.5937/smclk7-65275

CONTEMPORARY APPROACHES TO THE PREVENTION OF GESTATIONAL DIABETES: PHARMACOLOGICAL INTERVENTIONS AND DIETARY SUPPLEMENTS – A NARRATIVE REVIEW
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description: Introduction/Objective: Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications and an important public health concern, with increasing prevalence driven by rising obesity and insulin resistance. This study aimed to review current evidence on preventive strategies for GDM, including lifestyle interventions, supplementation, and pharmacological approaches. Material and methods: A literature review was conducted using MEDLINE, Scopus, and PubMed databases for the period from 2000 to 2025. Peer-reviewed studies addressing GDM prevention were included, while studies focused exclusively on treatment of established GDM, animal studies, articles not available in full text, and those not published in English were excluded. Study selection was performed independently by two authors, and in cases of discrepancy, consensus was reached among all authors. Results: Elevated pre-pregnancy and gestational body mass index is the most important modifiable risk factor for GDM. Lifestyle interventions, including maintenance of normal body weight, a balanced diet, and regular physical activity, represent the most effective preventive strategy, with physical activity showing the greatest impact. Among supplements, myo-inositol shows potential to reduce GDM incidence and improve glycemic control, whereas evidence for vitamin D, probiotics, and omega-3 fatty acids remains inconsistent. Metformin may reduce GDM risk in high-risk populations, particularly in women with polycystic ovary syndrome, but findings are heterogeneous, and concerns remain regarding long-term offspring outcomes. Conclusion: Lifestyle modification and dietary regimen remain the cornerstone of GDM prevention. Pharmacological therapy and dietary supplements may have a potential role in high-risk groups; however, there is insufficient evidence to support their routine use. Further large-scale studies are needed to establish optimal prevention strategies.
subject: Reviews
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creator: Radmila Sparić
creator: Marta Stojković
creator: Ivana Babović
creator: Jovana Plešinac
creator: Natalija Pavlović
creator: Sara Simanić
creator: Snežana Plešinac
rights: Copyright (c)
date: 2026-06-09
publication date: 2026-06-09
doi: 10.5937/smclk7-66736

THE PREDICTIVE SIGNIFICANCE OF EOSINOPHILIA IN PERIPHERAL BLOOD IN PATIENTS WITH HODGKIN LYMPHOMA
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description: Introduction/Objective: Hodgkin lymphoma (HL) is a rare neoplasm of the lymphatic system and is one of the most common cancers in the young adult population. Histopathologically, 95% of Hodgkin lymphoma is classic Hodgkin lymphoma (cHL). Eosinophilia, both peripherally and in tissues, is relatively common in patients with HL, especially in the nodular sclerosis and mixed cellularity subtypes. Its presence indicates a complex interaction between tumor cells and the immune system. In addition to eosinophilia present in the tissue sample, eosinophilia is also detected in the peripheral blood. The study aimed to analyze HL patients by sex, age, clinical stage, the International Prognostic Score (IPS), and B symptoms, as well as to determine the association between tumor mass size and the complete blood count, erythrocyte sedimentation rate (ESR), the C reactive protein (CRP) level, the clinical stage, and the IPS, with special reference to the significance of eosinophilia in peripheral blood as a predictor of tumor mass size and therapeutic response. Materials and methods: A retrospective analysis of 58 new cases of HL, diagnosed and treated at the Clinic for Hematology of the University Clinical Center Kragujevac, was performed between December 31, 2018, and December 31, 2023. Data was obtained from written medical records. The initial blood laboratory parameters at diagnosis were analyzed, and the therapeutic response was assessed after the first-line therapy was administered. IBM SPSS Statistics, Version 23, software was used for statistical data processing. Statistical significance was defined at p < 0.05. Results: At presentation, the observed population had advanced disease – CS III (27.6%) and CS IV (39.7%); B symptoms were present in 76% of the patients, and a high IPS was registered in 48.3% of the subjects. Bulky mediastinal mass was present in 48.3% of patients, while 34.3% of patients presented with nonmediastinal localization. No correlation was found betwe…
subject: Original articles
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creator: Snežana Sretenović
creator: Danijela Jovanović
creator: Ana Dragović
creator: Sanja Aleksić
rights: Copyright (c)
date: 2026-06-17
publication date: 2026-06-17
doi: 10.5937/smclk7-63863

BIOPSYCHOSOCIAL AND PSYCHIATRIC ASPECTS OF INFIDELITY
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description: Introduction/Objective: Infidelity is a complex biopsychosocial phenomenon with significant implications at the individual, relational, and family levels. Although traditionally viewed within moral, cultural, or social frameworks, contemporary evidence highlights the interplay of biological, psychological, and social determinants in the etiology of this phenomenon. Infidelity has been associated with attachment disorders, impulsivity, neurobiological and hormonal influences, traumatic experiences, personality pathology, and addictive behaviors. Its consequences may include severe mental health issues and disruption of partner relations and family stability. The present study aims to analyze the biopsychosocial and psychiatric aspects of infidelity in intimate and family relationships, with particular emphasis on etiological factors, clinical manifestations, and consequences for mental health, partner relationships, and family dynamics. Material and methods: This is a narrative review of relevant national and international literature in psychiatry, clinical psychology, family therapy, evolutionary psychology, and neurobiology. The analysis included studies addressing genetic predispositions, hormonal and neurotransmitter mechanisms, attachment patterns, personality traits, sociocultural determinants, and psychiatric outcomes associated with infidelity. Results: Infidelity is a multifactorial phenomenon. Biological contributors include genetic variability, hormonal and neurotransmitter influences, and activation of dopaminergic reward pathways. Psychological factors include insecure attachment styles, sensation seeking, narcissistic and borderline personality traits, childhood trauma, and impaired impulse control. Social determinants encompass cultural norms, occupational environments, and contemporary relationship models. Consequences of infidelity may include depression, anxiety, post-traumatic stress disorder, suicidal ideation, domestic violence, substance abuse i…
subject: Invited paper
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creator: Mila Goldner-Vukov
rights: Copyright (c)
date: 2026-06-21
publication date: 2026-06-21
doi: 10.5937/smclk7-66170

PERIBULBAR ANESTHESIA WITH TARGETED INTRAVENOUS ESKETAMINE ANALGOSEDATION DURING ENUCLEATION: A CONTEMPORARY NARRATIVE REVIEW
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description: Introduction: Enucleation is an invasive ophthalmic procedure accompanied by pronounced nociceptive and reflex stimuli, representing a significant anesthesiological challenge, particularly in elderly and comorbid patients. Contemporary anesthesiology trends increasingly favor the use of regional anesthesia combined with targeted analgosedation as a safer alternative to general anesthesia. Aim: To present current concepts of peribulbar anesthesia combined with targeted intravenous esketamine-guided analgosedation during enucleation, with special emphasis on hemodynamic stability, prevention of the oculocardiac reflex, control of perioperative pain, postoperative nausea and vomiting, and the feasibility of integrating this technique into day-surgery protocols. Methods: A narrative review of contemporary literature in the fields of ophthalmic and regional anesthesia was conducted, focusing on the pharmacological properties of esketamine, the mechanisms of action of the peribulbar block, and the clinical aspects of their combined use during enucleation. Conclusion: Peribulbar anesthesia combined with esketamine-guided targeted analgosedation represents a safe and effective contemporary anesthesiological approach for performing enucleation, particularly in elderly and comorbid patients. This approach provides stable hemodynamics, preserved spontaneous respiration, adequate pain control, a low incidence of postoperative nausea and vomiting, and rapid functional recovery, with the potential for application within a day-surgery setting.
subject: Other articles
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creator: Margita Lučić
creator: Dolika Vasović
rights: Copyright (c)
date: 2026-03-08
publication date: 2026-03-08
doi: 10.5937/smclk7-63921

PENILE FRACTURE ASSOCIATED WITH URETHRAL INJURY – CASE REPORT
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description: Introduction: Penile fracture is a rare urologic emergency that may occur when the erect penis is injured, most often during sexual intercourse. In 10%-21% of cases, it is associated with urethral injury. The diagnosis is most often made by clinical examination, but additional diagnostic methods are useful in evaluating the site of rupture of the corpora cavernosa and detecting urethral injury. This medical emergency requires urgent surgical management as delays are associated with worse outcomes. Case report: A 43-year-old man reported to the Emergency Center of the University Clinical Center of Serbia due to an injury to the erect penis during sexual intercourse. The anamnestic data were that he had felt pain and heard a “popping” sound, upon which sudden detumescence of the penis occurred and penile hematoma appeared, as well as blood during urination. Suspicion of a penile fracture was established on clinical examination. An ultrasound examination showed a rupture of the tunica albuginea of the right cavernous body, and retrograde urethrocystography revealed a rupture of the penile urethra. The patient underwent surgery that same evening. The surgical approach was a median penoscrotal incision, followed by suturing of the right cavernous body and penile urethra through a gently placed urinary catheter. Postoperative recovery was uneventful. During follow-up examinations, the patient reported normal erections, regular urination and satisfaction with the appearance of his penis. Conclusion: Penile fracture is a rare urologic emergency, which is relatively rarely associated with urethral injury. The presentation of our case indicates the importance of initial ultrasound and radiographic diagnostics. In the case where the site of injury is present preoperatively, a ventral penoscrotal incision may be a suitable surgical approach. Timely recognition and surgical treatment of penile fracture associated with urethral injury gives excellent functional results.
subject: Case reviews
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creator: Nebojša Prijović
creator: Branko Stanković
creator: Milan Radovanović
creator: Veljko Šantrić
creator: Uroš Babić
rights: Copyright (c)
date: 2026-03-23
publication date: 2026-03-23
doi: 10.5937/smclk7-64882

AXILLARY BRACHIAL PLEXUS BLOCK UNDER PROCEDURAL SEDATION FOR ARTERIOVENOUS FISTULA FORMATION IN A CHILD WITH END-STAGE RENAL DISEASE – A CASE REPORT
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description: Introduction/Objective: Arteriovenous (AV) fistula formation has become the gold standard for hemodialysis vascular access. The use of brachial plexus blocks (BPB) for antebrachial AV fistula formation in adults provides not just adequate analgesia but a potentially positive effect on primary fistula patency. Additionally, the resultant state of surgical anesthesia may enable the surgery to be performed under procedural sedation. Case report: A 12-year-old patient was admitted for AV fistula formation for the purpose of hemodialysis due to end-stage renal disease. Kyphoscoliosis of the thoracic spine, the patient’s short neck with limited mobility, and her short stature posed a potential difficulty for intubation. Despite a recently resolved upper respiratory tract infection, which raised suspicion of airway hyperreactivity, the decision was made to proceed with surgical treatment and perform an axillary BPB under procedural sedation. Basic monitoring of vital functions was applied, with oxygen support at 3 l/min via mask. The ultrasound-guided block was performed using 8 ml of 0.5% levobupivacaine (1.4 mg/kg) and 5 ml of 2% lidocaine (3.33 mg/kg). During the one-hundred-minute surgical procedure, the patient maintained hemodynamic and respiratory stability and spontaneous breathing. The patient awoke without complications and was referred to the hospital ward. Her pain was managed with acetaminophen, as needed. The total perioperative opioid consumption was limited to the induction dose of 0.83 μg/kg of fentanyl. Conclusion: In this pediatric case, the use of axillary BPB provided adequate analgesia with minimal opioid administration for the formation of an AV fistula. It also enabled the surgical team to avoid an expectedly difficult intubation. One needs to keep in mind the maximum safe dose of local anesthetics, the nuances of their use in children with comorbidities, as well as the potential complications, among which local anesthetic systemic toxicity is the m…
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creator: Lazar Jakšić
creator: serbian serbian
rights: Copyright (c)
date: 2026-03-21
publication date: 2026-03-21
doi: 10.5937/smclk7-64342

SURGICAL TREATMENT OF RADIATION-INDUCED ANTERIOR CHEST WALL OSTEOSARCOMA AFTER BREAST CARCINOMA: A CASE REPORT
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description: Introduction/Objective: Radiotherapy for breast cancer can rarely lead to radiation-induced osteosarcoma (RIOS), a highly aggressive malignancy. This article aims to present the specificity of the surgical treatment applied and the level of aggressiveness of this rare malignant tumor. Case report: A 63-year-old female patient was admitted to the Chest Surgery Department of the Military Medical Academy due to a large exulcerated sternal mass releasing a purulent secretion, initially misdiagnosed as recurrent breast carcinoma 15 years post-treatment, and anemia. Biopsy confirmed high-grade osteosarcoma following prior radiotherapy. After metastasis was ruled out, the patient received neoadjuvant chemotherapy and underwent radical resection of the sarcoma, sternum, anterior III–VII ribs, and adjacent soft tissues. Chest wall reconstruction was achieved using titanium bars, clips, and a latissimus dorsi myocutaneous flap. Upon local recurrence, further resection of the manubrium and anterior II ribs, with soft tissues, was performed. A year after the initial operation, a suspicious subcutaneous mass in the left pectoral region was excised for histopathological analysis. Conclusion: RIOS of the chest wall exhibits a more aggressive course and worse prognosis than sporadic chest wall sarcomas, with higher rates of recurrence despite wide resection, as demonstrated in this case. Reconstruction with titanium bars and clips, after extensive anterior chest wall resection, provides a rigid and feasible alternative for restoring stability. This case underscores the importance of recognizing RIOS as a rare but serious late complication of breast cancer radiotherapy and highlights the complexity and specificity of surgical management and reconstruction for optimal outcomes.
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creator: Stevan Čičić
creator: Aleksandar Ristanović
creator: Mladen Prcović
creator: Nebojša Marić
creator: Mlađana Savić
rights: Copyright (c)
date: 2026-01-26
publication date: 2026-01-26
doi: 10.5937/smclk7-63424

AGING AS A MODULATOR OF MULTIPLE SCLEROSIS PATHOPHYSIOLOGY
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description: The number of older patients with multiple sclerosis is rising significantly, including individuals with late-onset disease (after age 50) and very late-onset disease (after age 60). Aging affects the immune and nervous systems, contributing to a shift in the clinical course towards a progressive pattern and increasing the risk of disease progression independent of relapse activity (PIRA). Additionally, late-onset multiple sclerosis is characterised by a more frequent progressive phenotype, fewer inflammatory relapses, and a shorter time to disability accumulation. Immune system aging (immunosenescence) leads to a reduced diversity of the T-cell receptor repertoire, changes in the number and function of CD4+ and CD8+ T lymphocytes, and an imbalance between effector and regulatory T cells. At the central nervous system level, aging contributes to neurodegeneration through increased oligodendrocyte degeneration, microglial dysfunction, iron accumulation, oxidative stress, mitochondrial dysfunction, and diminished neuroprotective mechanisms. Reduced proliferation and differentiation of neural stem cells, as well as structural and functional changes in glutamate receptors, primarily N-methyl-D-aspartate receptors, further compromise neuroprotective and reparative processes. Understanding the interactions between aging and the pathophysiological mechanisms of multiple sclerosis is crucial for developing targeted therapeutic strategies for the increasing population of older patients with multiple sclerosis. This paper aims to examine, through an integrative review of the available literature, the role of the aging process in modulating key pathophysiological mechanisms of multiple sclerosis.
subject: Reviews
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creator: Jasmina Đuretić
rights: Copyright (c)
date: 2026-03-16
publication date: 2026-03-16
doi: 10.5937/smclk7-64495

LABORATORY PARAMETERS AND THEIR RELATIONS WITH DISEASE OUTCOME IN PATIENTS WITH NON-HODGKIN FOLLICULAR LYMPHOMA – SINGLE CENTRE FIVE-YEAR FOLLOW-UP
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description: Introduction/Objective: Follicular lymphoma, a subtype of non-Hodgkin lymphoma, is the second most common non-Hodgkin lymphoma and the most frequent indolent lymphoma. Although rare, this disease may exhibit aggressive behavior, a tendency toward complications, as well as resistance to administered therapy and frequent relapses. This study aimed to analyze laboratory parameters at the time of diagnosis and their association with disease outcome, complications, treatment response, and survival. Material and methods: A total of 47 patients diagnosed with follicular lymphoma between 2018 and January 2024 were analyzed at our center. Baseline laboratory parameters included complete blood count, hemostasis parameters (PT, aPTT, fibrinogen, D-dimer), and biochemical parameters. During the course of the disease, treatment response to first-line therapy, progression-free survival, and overall survival were evaluated. Results: Complete blood count parameters, as well as most biochemical parameters, showed no correlation with disease course. Complete remission was achieved in patients with lower LDH levels (p = 0.029), while overall survival was longer in patients with lower fibrinogen levels (p = 0.019), a higher percentage of monocytes (p = 0.007), and lower D-dimer levels (p = 0.000). Progression-free survival was associated with lower fibrinogen levels (p = 0.019), lower D-dimer levels (p = 0.031), lower LDH levels (p = 0.019), and a higher percentage of peripheral blood monocytes (p = 0.005). Patients with initially elevated D-dimer levels had a PFS of 24.50 ± 4.81 months, whereas those with D-dimer levels within the reference range had a PFS of 36.48 ± 5.99 months (p = 0.015). Conclusion: In our center's experience, hemostasis parameters, particularly fibrinogen and D-dimer, showed a significant correlation with disease course.
subject: Original articles
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creator: Danijela Jovanović
creator: Snežana Sretenović
creator: Sanja Aleksić
creator: Ana Dragović
creator: Ivana Andrejević
rights: Copyright (c)
date: 2026-03-23
publication date: 2026-03-23
doi: 10.5937/smclk7-63730

DEPRESSIVE SYMPTOMS AMONG FAMILY MEMBERS PROVIDING INFORMAL CARE FOR PATIENTS RECEIVING HOME-BASED CARE: A PHQ-9 CROSS-SECTIONAL STUDY
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description: Introduction/Objective: Family members providing informal care for patients receiving home-based care represent a population at increased risk of developing depressive symptoms. The aim of this study was to assess the presence and severity of depressive symptoms using the PHQ-9 questionnaire and to examine the association between depressive symptoms and caregivers’ daily functioning. Methods: A descriptive-analytical cross-sectional study was conducted among 77 family caregivers of patients enrolled in the Home Care Service of the Health Center Subotica between March and September 2025. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Statistical analysis included the t-test, Mann–Whitney U test, Kruskal–Wallis test, and Spearman’s correlation coefficient. Results: The mean PHQ-9 score was 8.48 ± 6.14. A score ≥ 10 was recorded in 30 (38.9%) participants. Minimal or mild depressive symptoms were present in 47 (61.1%) caregivers. No statistically significant differences in PHQ-9 scores were observed according to caregiver sex (p = 0.423) or the patient’s primary diagnosis (p = 0.183). In the overall sample, a statistically significant weak positive correlation was found between PHQ-9 score and the self-reported impact of symptoms on daily functioning (r = 0.294; p = 0.009). Conclusion: Depressive symptoms are present in a substantial proportion of family caregivers providing home-based care. The intensity of depressive symptoms is associated with greater impairment in daily functioning, highlighting the importance of systematic monitoring of caregivers’ mental health.
subject: Original articles
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creator: Nikola Gavrilović
rights: Copyright (c)
date: 2026-03-10
publication date: 2026-03-10
doi: 10.5937/smclk7-63023

IMPACT OF LEFT VENTRICULAR GEOMETRY, EXPRESSED AS INTERVENTRICULAR SEPTAL AND POSTERIOR WALL THICKNESS, ON THE OUTCOME OF ACUTE ISCHEMIC STROKE
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description: <!-- [if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:RelyOnVML/> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!-- [if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:HyphenationZone>21</w:HyphenationZone> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:EnableOpenTypeKerning/> <w:DontFlipMirrorIndents/> <w:OverrideTableStyleHps/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!-- [if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="false" DefSemiHidden="false" DefQFormat="false" DefPriority="99" LatentStyleCount="371"> <w:LsdException Locked="false" Priority="0" QFormat="true" Name="Normal"/> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 1"/> <w:LsdException Locked="false" Priority="9" SemiHidden="true" UnhideWhenUsed="true" QFormat="true" Name="heading 2"/> <w:LsdException Locked="false" Priority="9" SemiHidden="true" UnhideWhenUsed="true" QFormat="true" Name="heading 3"/> <w:LsdException Locked="false" Priority="9" SemiHidden="true" UnhideWhenUsed="true" QFormat="true" Name="heading 4"/> <w:LsdException Locked="false" Priority="9"…
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creator: Dejan Munjiza
creator: Biljana Georgievski-Brkić
creator: Filip Vitošević
creator: Ljubica Dimitrijević
creator: Marjana Vukićević
rights: Copyright (c)
date: 2026-03-16
publication date: 2026-03-16
doi: 10.5937/smclk7-64559

THE PREVALENCE OF METABOLIC DISORDERS AND HYPERTENSION IN WOMEN DURING PERIMENOPAUSE AND MENOPAUSE
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description: Introduction/Objective: Cardiometabolic diseases, including type 2 diabetes (T2D) and cardiovascular disease, and their associated factors, such as hypertension, dyslipidemia, insulin resistance, and obesity, are among the leading causes of morbidity and mortality. At a young age, the prevalence of cardiometabolic diseases is higher in men than in women, but this female advantage gradually disappears with aging, particularly after menopause, when cardiometabolic risk factors accumulate. Our research aimed to highlight the prevalence of metabolic disorders and their association with hypertension in women during perimenopause and menopause. Method: The study included 200 middle-aged women: 131 (65.5%) perimenopausal women who had experienced typical perimenopausal signs for more than 6 months, and 69 (34.5%) menopausal women with absent menstrual cycles for more than 12 months, aged 50-59 years. The patients visited their physician for a routine preventive examination in December 2024. Results: Hypertension was statistically significantly more common in women in menopause (84.1%) compared to premenopausal women (p < 0.001). Women in menopause had significantly higher rates of metabolic disorders, increased body mass and obesity, with 66.7% of the participants affected, as well as a larger waist circumference in 63.8% of the participants (p = 0.003). Menopausal women had statistically significantly higher levels of triglycerides, LDL cholesterol, and total cholesterol than premenopausal women (p = 0.002). Among women going through menopause, diabetes mellitus was statistically substantially more prevalent, affecting 27% of them (p = 0.002). Premenopausal women had a statistically significantly greater prevalence of hypothyroidism (14.7%) than did menopausal women (4.3%) (chi-square = 4.905, p = 0.027). These two groups of participants did not differ significantly in terms of sedentary habits, smoking, or family history of hypertension. Conclusion: Type 2 diabetes, obes…
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creator: Sonja Smiljić
creator: Srna Šapić
creator: Vojkan Nestorović
creator: Zvezdan Milanović
creator: Mirjana Dejanović
creator: Andrijana Karanović
rights: Copyright (c)
date: 2026-03-23
publication date: 2026-03-23
doi: 10.5937/smclk7-64151

NAVIGATING COVID-19 IN PREGNANCY: CARE PATHWAYS AND SYSTEM CHALLENGES IN KAZAKHSTAN – A QUALITATIVE STUDY
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description: Introduction: International studies conducted during the COVID-19 pandemic have shown that pregnant women often experienced significant barriers to timely and appropriate care. However, much of the existing evidence is derived from quantitative surveillance or from settings with well-established digital infrastructure and standardized clinical pathways, which may not reflect the realities of many middle-income health systems. This study aims to qualitatively explore the experiences of pregnant women and healthcare professionals regarding COVID-19 care pathways, including symptom recognition, outpatient management, and hospitalization, in Almaty, Kazakhstan. Methods: The present study applied a qualitative, descriptive, phenomenological design to explore how pregnant COVID-19 patients and healthcare professionals experienced the organization of care during the pandemic. The study included 24 participants from local primary health care and hospital settings in Almaty, Kazakhstan. Fifteen healthcare professionals and nine pregnant or postpartum women voluntarily and anonymously provided informed consent to in-depth semi-structured interviews, either face-to-face or via secure video conferencing, between May and August 2023. Results: Healthcare professionals reported that COVID-19 substantially altered maternal health care due to increased workload, fear of infection, and a shift toward remote care. Uncertainty regarding pregnancy-specific clinical guidelines and standard operating procedures (SOPs) contributed to reliance on general protocols and informal practices, while delayed hospitalization was linked to symptom denial, fear of admission, self-treatment, and system constraints. Pregnant and postpartum women commonly misinterpreted COVID-19 symptoms as pregnancy-related or mild illness, leading to self-medication and delayed help-seeking. Follow-up was largely unstructured and based on communication via phone or messages. The experience of care varied, ranging from…
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creator: Zhansaya Nurgaliyeva
creator: Nataliya Glushkova
rights: Copyright (c)
date: 2026-03-16
publication date: 2026-03-16
doi: 10.5937/smclk7-64476

PREVENTION AND MANAGEMENT OF VACCINE HESITANCY
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description: Vaccine hesitancy refers to the delay in accepting or refusing vaccines despite the availability of vaccination services. Well-conducted studies and trials reviewed in this article support methods both to prevent and manage vaccine hesitancy. Clinicians should know which vaccines their patients are due to receive and should use every encounter to address this issue. Research shows clinicians’ recommendations increase vaccine uptake. Recommendations that patients perceive as stronger have a greater effect in increasing vaccine uptake. Using presumptive language to phrase the recommendation is more effective than presenting the vaccine conversationally as an option for the patient. When the patient counters the strong recommendation with hesitancy, the clinician should engage the patient with motivational interviewing, perhaps using a four-step process called the “Four A’s”.
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creator: Christopher A. Reis
creator: Robert M. Jacobson
rights: Copyright (c)
date: 2026-03-08
publication date: 2026-03-08
doi: 10.5937/smclk7-62537

COEXISTENCE OF POLYCYTHEMIA VERA AND MULTIPLE MYELOMA: A CASE REPORT
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description: Introduction: Polycythemia vera (PV) is a chronic myeloproliferative neoplasm characterized by the clonal proliferation of erythroid, myeloid, and megakaryocytic lineages, most commonly associated with the JAK2 V617F mutation. Multiple myeloma (MM), on the other hand, is a malignant plasma cell neoplasm characterized by clonal proliferation of plasma cells in the bone marrow and the secretion of monoclonal immunoglobulin. The coexistence of PV and MM in the same patient is extremely rare, as these disorders originate from distinct hematopoietic lineages. Case report: We report the case of a patient with long-standing PV who subsequently developed MM, highlighting the diagnostic and therapeutic challenges of this unusual association. Conclusion: The prognosis of patients with concomitant hematologic malignancies depends on the type and aggressiveness of the diseases, the clinical stage at the time of detection, and the adequacy of the therapeutic approach. This case highlights the importance of avoiding automatic attribution of new clinical symptoms to a pre-existing diagnosis. A broad differential diagnosis should always be maintained, with each new symptom evaluated individually, allowing for early recognition of additional hematologic pathology and timely initiation of appropriate treatment.
subject: Case reviews
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creator: Sanja Aleksić
rights: Copyright (c)
date: 2025-12-16
publication date: 2025-12-16
doi: 10.5937/smclk6-62466

NEONATAL BILATERAL HYPHEMA: A RARE PRESENTATION AND CLINICAL IMPLICATIONS
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description: Introduction: Neonatal hyphema, defined as intraocular bleeding into the anterior chamber, is a rare condition that requires immediate ophthalmologic evaluation. Unlike traumatic hyphema commonly seen in older children and adults, neonatal hyphema is typically associated with non-traumatic etiologies such as birth-related mechanical stress, hematologic disorders, congenital infections, or vascular anomalies. Bilateral involvement is particularly uncommon and necessitates a comprehensive systemic and ophthalmologic workup to rule out serious underlying pathology. Case report: A female neonate was delivered at term via spontaneous vaginal delivery with normal Apgar scores and without perinatal complications. Shortly after birth, blood was observed in the anterior chambers of both eyes, more prominently in the right eye. Ophthalmologic examination confirmed bilateral hyphema with preserved corneal clarity. Systemic evaluation including complete blood count, coagulation studies, and TORCH serology ruled out coagulopathies and congenital infections. The patient was treated conservatively with topical atropine and corticosteroids. During hospitalization, the hyphema gradually resolved without evidence of elevated intraocular pressure or synechiae formation. The newborn was discharged with scheduled ophthalmologic follow-up to monitor for potential late complications. Conclusion: This case underscores the importance of early recognition and multidisciplinary management of neonatal hyphema, particularly when both eyes are affected. Although birth trauma remains a common cause, thorough diagnostic evaluation is essential to exclude hematologic and infectious etiologies. Given the rarity of bilateral neonatal hyphema, additional case reports and studies are needed to enhance understanding of its etiology, optimal management, and long-term outcomes.
subject: Case reviews
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creator: Dolika D. Vasović
creator: Jelica Pantelić
creator: Dejan M. Rašić
rights: Copyright (c)
date: 2025-09-29
publication date: 2025-09-29
doi: 10.5937/smclk6-57525

ONCO-HYPERTENSION – A NEW CLINICAL ENTITY IN MODERN MEDICINE
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description: Cardiovascular and oncological diseases represent an inevitable part of everyday medical practice at all levels of health care. Apart from common risk factors, these diseases are associated in other ways, and the potential cardiotoxicity of antineoplastic drugs is particularly significant. One of the frequent forms of cardiotoxicity is hypertension. Considering that it can manifest at any time during antineoplastic therapy and also after the completion of specific oncological treatment, onco-hypertension is a clinical entity that should always be kept in mind when caring for oncology patients. Regular arterial blood pressure checks in this population are necessary to ensure timely recognition and treatment of onco-hypertension and to carry out oncological treatment safely. Although the guidelines for the treatment of onco-hypertension are similar to the general recommendations for hypertension, some specificities primarily concern the choice of antihypertensive drugs and exceptions to target arterial blood pressure values depending on the stage of the oncological disease and its prognosis. It is crucial to recognize the time to stop cardiotoxic antineoplastic therapy or reduce the dose of the antineoplastic drug to avoid life-threatening cardiovascular complications. Numerous additional factors encountered in oncology patients, such as comorbidities, the presence of pain or other administered drugs, significantly contribute to the complexity of onco-hypertension. Given that this is a very sensitive population exposed to a specific type of psychological stress, the possibility of the "white coat effect" as well as masked hypertension should also be considered.
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creator: Jelena Petrović
creator: Marija Radomirović
creator: Ivana Petrović Đorđević
rights: Copyright (c)
date: 2025-11-18
publication date: 2025-11-18
doi: 10.5937/smclk6-61727

INTERSTITIAL LUNG DISEASE AND BULLOUS PEMPHIGOID ASSOCIATED WITH DIRECT ORAL ANTICOAGULANT USE: A CASE REPORT OF LITERATURE-BASED PHARMACOVIGILANCE SIGNAL DETECTION
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description: Introduction/Objective: Direct oral anticoagulants (DOACs) have significantly improved the prevention and management of thromboembolic disorders owing to predictable pharmacokinetics, simplified dosing, and reduced monitoring compared to vitamin K antagonists. However, as clinical use increases, emerging evidence suggests that DOACs may also cause rare but clinically important non-hemorrhagic adverse events, such as interstitial lung disease (ILD) and bullous pemphigoid (BP). The aim of this study is to present and evaluate drug safety signal cases reported in the existing literature and to contextualize them in order to enhance clinician awareness of rare pulmonary and dermatologic adverse events associated with DOAC therapy. Case report: This report describes signal detection of ILD in 11 elderly male patients following exposure to apixaban, dabigatran, or edoxaban, with latency periods ranging from several days to four years. Most patients showed clinical improvement following drug discontinuation and corticosteroid therapy; however, two experienced fatal outcomes. We additionally report a signal detection case of rivaroxaban-associated bullous pemphigoid in an 86-year-old male with multiple comorbidities, who fully recovered following rivaroxaban withdrawal and corticosteroid therapy, with no recurrence after one year of treatment with apixaban. Conclusion: Prompt recognition and management are crucial for favorable outcomes. These cases underscore the importance of pharmacovigilance and the need for continued investigation to elucidate mechanisms and risk factors for such reactions.
subject: Case series
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creator: Nikica Hadži-Nikolić
rights: Copyright (c)
date: 2025-12-16
publication date: 2025-12-16
doi: 10.5937/smclk6-62059

OSTEOPOROSIS IN AUTOIMMUNE DISEASES
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description: Introduction: Osteoporosis is one of the most common extra-articular complications in many chronic inflammatory rheumatic diseases, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and systemic lupus erythematosus. Methods: We searched the PubMed, Scopus, and Web of Science databases for studies published within the last 10 years. This is a review article. Results: Most studies on postmenopausal women have found a correlation between high levels of pro-inflammatory markers and increased bone loss. Literature data indicate a link between a low risk of major osteoporotic fractures, hip fractures, and non-vertebral fractures in patients with PsA who are on disease-modifying therapies. Patient assessment in autoimmune rheumatic inflammatory diseases includes medical history, clinical examination, fracture risk assessment, laboratory tests, and bone densitometry. The lack of adequate diagnosis and treatment of osteoporosis is influenced by factors such as insufficient knowledge about osteoporosis and its therapeutic benefits, concerns about potential side effects of treatment, low motivation, and inadequate patient education on the subject. Several methods have been developed to reduce prescribing errors and oversights, with the Fracture Liaison Service proving to be the most effective. Strategies for managing osteoporosis include patient education, lifestyle modifications, fall prevention, proper nutrition, disease activity control, and the introduction of osteoporosis medication. Conclusion: Despite significant advances in prevention, diagnosis, and treatment, the prevalence of osteoporosis remains high and requires timely recognition and a more comprehensive approach. Assessing risk factors for falls and fractures, as well as recovery potential, is crucial in patients with autoimmune rheumatic inflammatory diseases.
subject: Reviews
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creator: Snežana Tomašević-Todorović
creator: Nataša Ilić
creator: Damjan Savić
creator: Sandra Jelčić
rights: Copyright (c)
date: 2025-12-22
publication date: 2025-12-22
doi: 10.5937/smclk6-59361

EFFECTS OF CONTROLLED PHYSICAL TRAINING IN PATIENTS WITH HEART FAILURE
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description: Heart failure (HF) is a clinical syndrome characterized by cardiac symptoms (e.g., breathlessness, ankle swelling, and fatigue), which may be accompanied by signs (e.g., elevated jugular venous pressure, pulmonary crackles, and peripheral edema). Patients with HF often experience frequent hospitalizations, impaired quality of life, and shortened life expectancy. They also have decreased exercise capacity, primarily due to impaired hemodynamics within the active skeletal muscles. Patients with HF should undergo a cardiopulmonary exercise test to assess their activity level and type, as well as to perform risk stratification. The initial step should include evaluating the patient’s current exercise capacity and needs, then creating a personalized exercise program that details the types of exercises, their intensity, repetitions, duration in minutes per session, and the number of days per week allocated for training. Cycling (either on a stationary or regular bicycle) and walking are recommended because they are aerobic, dynamic forms of exercise. Aerobic training should be performed 3–5 times a week (30–60 minutes per session), with emphasis on interval training. This type of training enhances skeletal muscle strength and endurance, leading to increased muscle mass. In patients with heart failure and cachexia, resistance training is advised, combining both isotonic and isometric exercises. This type of training should be performed twice a week for 12 to 20 minutes per session. Resistance training also enhances skeletal muscle strength and endurance and encourages muscle growth. Physical training enhances skeletal muscle mass, fiber diameter, strength, endurance, and exercise capacity.
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creator: Filip Stoičkov
creator: Ivan Stoičkov
creator: Viktor Stoičkov
rights: Copyright (c)
date: 2025-12-16
publication date: 2025-12-16
doi: 10.5937/smclk6-62342

MORPHOLOGICAL CHANGES IN KIDNEYS AND CLINICAL PRESENTATION IN PATIENTS WITH PRIMARY AND SECONDARY MEMBRANOUS NEPHROPATHY
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description: Introduction/Aim: Membranous nephropathy (MN) typically presents as nephrotic syndrome and may be idiopathic (primary MN, pMN) or occur secondary to other diseases (secondary MN, sMN). Given the differing therapeutic approaches, this study aimed to compare clinical and pathohistological parameters between patients with pMN and sMN. Methods: Through a retrospective analysis of kidney biopsy samples diagnosed at the Institute of Pathology, Faculty of Medicine, Belgrade, between 2011 and 2023, 99 patients with membranous nephropathy were identified. These patients were divided into two groups: patients with pMN (n = 44) and patients with sMN (n = 55). Clinical and pathohistological parameters (by optical and immunofluorescence microscopy) were compared among study participants. Results: While males more frequently suffered from MN, females more frequently had sMN (p = 0.036). Haematuria was more common in subjects with sMN (p = 0.009). Proteinuria values were significantly higher among patients with pMN (p = 0.018), related to a significantly greater decrease in serum total protein values in them (p = 0.011). Endocapillary proliferation was significantly more frequent among those with sMN (p = 0.032). Marked positivity of several immunofluorescent markers was significantly more common in subjects with sMN: IgA, IgM, C1q, κ-chains, and λ-chains (p < 0.050). Conclusion: Females are more commonly affected by sMN. Characteristics of sMN include presence of haematuria, endocapillary hypercellularity and immunofluorescence positivity for markers not seen in pMN (IgA, IgM, C1q), while characteristics of pMN include significantly higher levels of proteinuria, accompanied by significantly reduced serum protein values.
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creator: Danijel Milivojević
creator: Maja Pecić
creator: Gorana Nikolić
creator: Ana Mioljević
creator: Voin Brković
creator: Marko Baralić
creator: Petar Đurić
creator: Aleksandar Janković
creator: Sanja Radojević Škodrić
creator: Maja Životić
rights: Copyright (c)
date: 2025-12-18
publication date: 2025-12-18
doi: 10.5937/smclk6-62894

HEATWAVES AND HEALTHCARE: BRIDGING DATA AND FRONTLINE PRACTICE
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subject: Invited paper
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creator: Margo Tonnelier
rights: Copyright (c)
date: 2025-12-22
publication date: 2025-12-22
doi: 10.5937/smclk6-61317

THIRTY YEARS OF FAMILY MEDICINE SPECIALTY IN POLAND: A CASE STUDY OF ITS INSTITUTIONALIZATION, PRACTICE, AND PATIENT PERCEPTION WITHIN PRIMARY HEALTHCARE
type: item
description: Background: Family medicine (FM) specialty in Poland was introduced in the early 1990s as part of broader health reforms aimed at restructuring primary healthcare (PHC) and improving access, continuity, and coordination of care. Despite three decades of development, FM continues to face systemic and professional challenges within the Polish healthcare system. Objective: This study used a case study approach to explore the evolution of family medicine specialty in Poland, examining its institutional foundation, specialist training, its role in PHC delivery, and patient satisfaction with services. Methods: An explanatory case study design was employed, drawing on policy documents, training curricula, peer-reviewed literature, and national statistics. Thematic analysis was guided by a framework for case study evaluation in healthcare systems. Results: Family medicine specialty has gained full recognition as a clinical and academic specialty in Poland. However, only a minority of PHC physicians are formally trained in FM. While the postgraduate training program aligns with European standards, it lacks longitudinal assessment and consistent quality of supervision. Patients report generally high satisfaction with interpersonal aspects of care but rate family medicine lower than specialist services in areas such as communication, empathy, and emotional support. The specialty also faces recruitment difficulties, with many FM residency slots unfilled despite financial incentives. Conclusion: Family medicine specialty in Poland has achieved significant structural milestones but remains underutilized and undervalued within the broader PHC system. Reforms should prioritize strengthening its educational pathways, improving working conditions, and addressing public perceptions. Enhancing communication skills and increasing the visibility of family physicians could improve both patient satisfaction and the attractiveness of the specialty.
subject: Reviews
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creator: Mateusz Guziak
rights: Copyright (c)
date: 2025-09-21
publication date: 2025-09-21
doi: 10.5937/smclk6-60277

SCLEROCHOROIDAL CALCIFICATION MIMICKING CHOROIDAL OSTEOMA: A CASE REPORT
type: item
description: Introduction: Sclerochoroidal calcifications are uncommon, benign ocular findings characterized by the deposition of calcium and phosphate within the sclera and adjacent choroid. These lesions are most frequently discovered incidentally during routine ophthalmologic evaluation, particularly in elderly individuals, and may resemble more serious intraocular pathologies. Case report: We present the case of a 62-year-old male patient referred for evaluation of a subretinal lesion in the peripheral retina of the left eye, initially detected during a routine ophthalmologic examination. The patient was asymptomatic, with no visual complaints. Fundus examination revealed a yellowish, placoid lesion with indistinct borders located suprapapillary, between the superior vascular arcades. B-scan ultrasonography demonstrated high internal reflectivity with posterior acoustic shadowing. Fluorescein angiography revealed a hypofluorescent lesion without leakage or staining. The lesion remained stable over several years, and systemic workup showed no evidence of metabolic abnormalities. Based on clinical and imaging findings (B-scan ultrasonography and fluorescein angiography), the diagnosis of sclerochoroidal calcification was established. Conclusion: Sclerochoroidal calcifications may clinically and ultrasonographically mimic more serious intraocular lesions. B-scan ultrasonography and fluorescein angiography, play a key role in distinguishing these benign findings from other conditions. In asymptomatic patients without signs of progression, annual follow-up is recommended, with no need for therapeutic intervention.
subject: Case reviews
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creator: Dolika Vasović
creator: Dejan M. Rašić
creator: Mirjana Mitrović
rights: Copyright (c)
date: 2025-09-12
publication date: 2025-09-12
doi: 10.5937/smclk6-57759