Scientific journal Zdravstvena zaštita (journal Health care), which is published by the Chamber of health institution of Serbia since 1972, publishes unpublished original expert and scientific papers, review articles, short announcements, introductions, letters to the editor, meta – analysis, depictions of the patients, current topics, depictions of scientific books and conferences, among other things related to the field of medicine, stomatology, pharmacology, biochemistry and health management. In this way, the magazine contributes to promotion and development of science, as well as expertise and scientific and research work. Most preeminent experts of different profiles and with different scientific titles publish their scientific and research papers in the journal. By means of conveying the selected texts, the pages of Health care represent the testimony, of both the pioneering work of the Chamber, and a kind of history of health care in Serbia alike. Electronic publishing of the journal Health care has been conducted since January 2019, and it is available in the regime of open access since September 2019. Open access enables reading free of charge, downloading, saving, printing and using writings published in the journal to any user that has an internet access. All papers published in Health care can be downloaded for free on the journal’s website: www.komorazus.org.rs/jurnal. The journal is published four times a year. Prior to publishing in Health care, all writings are subject of an internal review (preliminary review of the writing by the editor and/or editorial board) as well as an external review (independent reviews by the experts form the given field, while respecting the anonymity of the author of the review and the author of the paper). Final decision on whether the paper is going to be published is reached on the basis of expertly, ethical, and statistical review. Control for plagiarism is performed before the paper is published, which implies comparing the manuscript to all original texts in the available databases. Papers must be written in the English language, with summaries in both Serbian and English languages, and in the transitional period, until September of 2020, in Serbian and English languages, with summaries in Serbian and English languages. Papers published in the journal Health care are indexed by: SCIndeks - Serbian Citation Index, COBISS.SR – ID 3033858 and doi Serbia.
THE IMPLEMENTATION OF THE NURSING PROCESS IN A PERSON WITH MENTAL HEALTH PROBLEMS: A CASE REPORT
Introduction/Aim: The Nursing Process (NP) represents a fundamental, systematic, and individualized method of work in nursing that enables a holistic approach to the patient. Its application is of particular importance in psychiatric care, where the needs of users are complex and require continuous monitoring of subjective and objective indicators of mental state. The aim of this paper is to demonstrate the application of the NP in a person with a chronic mental disorder through a case report. Case report: The research was conducted at the Home for Mentally Ill Persons "1. oktobar" in Stari Lec. The subject is a 61-year-old male patient with a medical diagnosis of F20.0 (paranoid schizophrenia). The patient has been institutionalized since 2013, and the clinical presentation is characterized by auditory hallucinations, rapid thought flow (tachypsychia), elevated mood (hyperthymia), and increased volitional activity (hyperbulia) without the realization of plans. Additionally, sleep disturbance (insomnia) and strained family relationships with the father were identified. By applying the NP, seven nursing diagnoses were identified. The care plan included 15 independent and 6 interdependent nursing interventions. Key nursing measures included: establishing a therapeutic relationship and trust; continuous monitoring and control of hallucinations; implementing a hygienic-dietary regimen to regulate sleep; guiding the patient during logorrheic speech; providing support in maintaining social contacts with his sons. The evaluation determined partial achievement of goals in terms of behavioral stabilization and better cooperation in self-care activities. Conclusion: The case report confirms that the NP allows for a comprehensive assessment of the patient's needs and a clear definition of the nursing role within a multidisciplinary team. It is essential to implement the NP into mandatory nursing documentation at the national level to ensure the quality, continuity, and legal security in the treatment and care of persons with mental health disorders.
PAIN MEDICINES WITH SPECIAL REFERENCE TO TRAMADOL
Pain represents a significant medical and social problem because it affects daily functioning, as well as psychological, emotional and social well-being, causing significant economic and health problems. Pain control is one of the main goals of modern medicine, and the drugs used for this purpose are called analgesics. There is no one-size-fits-all medicine for every type of pain. That is why an individual approach to each patient is of key importance for the treatment and prevention of the recurrence of the disease. The aim is to demonstrate that the use of tramadol in relieving and reducing pain, with clearly defined indications, strictly controlled administration, precisely determined dosage and limited duration of use, can be an effective therapeutic option for the treatment of moderate and moderately severe pain when first-line medications are insufficiently effective or contraindicated. "The medicine is both medicine and poison at the same time!" When it is used according to the indications and instructions, it exerts its positive effect, and in the second case, when the indications, therapeutic doses, time intervals and length of therapy are not followed, it then exerts its negative effect. Healthcare professionals are required to assess the risk of addiction before starting therapy.
VOICE AND SPEECH IN PARKINSON'S DISEASE: CLINICAL CHARACTERISTICS OF HYPOKINETIC DYSPHONIA
Parkinson's disease is a chronic, progressive neurodegenerative disease that is primarily manifested by motor disorders, but significantly affects voice and speech. One of the frequent and clinically significant manifestations of the disease is hypokinetic dysphonia, which occurs as a result of central dopaminergic deficit and hypokinesia of muscles involved in respiration, phonation and articulation. The aim of this review is to present the basic neurological and clinical characteristics of Parkinson's disease, the mechanisms of hypokinetic dysphonia, as well as the voice, speech and paralinguistic characteristics of patients with this disease, while considering the implications for clinical and speech therapy practice. The search for relevant sources was carried out using Google Scholar Advanced Search and the Consortium of Libraries of Serbia for Unified Procurement (KoBSON), where modern sources from the fields of neurology, phoniatrics and speech therapy were analyzed. The results of the review indicate that voice and speech disorders, including hypophonia, monotony, reduced intonation variation and disorganized prosody, significantly impair communication and the quality of life of sufferers. Paralinguistic communication deficits, which contribute to the social isolation of patients, are especially pronounced. It is concluded that timely recognition of hypokinetic dysphonia and an interdisciplinary approach, along with active involvement in speech therapy treatment, is of key importance for preserving communication skills and improving the overall functioning of people with Parkinson's disease.
PROBIOTIC SUPPLEMENTATION FOR THE RESTORATION OF INTESTINAL MICROBIOTA IN NEWBORNS BORN BY CESAREAN SECTION
The early establishment of intestinal microbiota in newborns is significantly disrupted in children born by cesarean section, characterized by the absence of beneficial anaerobic bacteria and an increased proportion of opportunistic microorganisms. This initial dysbiosis is associated with an increased risk of allergies, infections, and other immune imbalances. Probiotic supplementation represents a strategy to correct these disorders. The use of specific strains, particularly from the genera Lactobacillus and Bifidobacterium, can accelerate the colonization of the intestinal microbiota to resemble that of vaginally born children. These probiotics modulate the immune response, reducing the Th2 profile and promoting anti-inflammatory signals, while simultaneously strengthening the intestinal barrier and enhancing the production of short-chain fatty acids. Clinical data indicate positive effects, including a reduction in gastrointestinal complaints and the incidence of necrotizing enterocolitis in preterm infants, as well as improved immune markers. The mechanisms of action include competition for resources, production of bacteriocins, and interaction with immune cells. Although existing evidence supports the potential of probiotics in restoring the microbiota, variability in studies highlights the need for long-term monitoring and standardized protocols to fully assess health outcomes in this population.
NUTRITIONAL INTERVENTIONS AND COGNITIVE OUTCOMES IN CHILDREN FROM TWO TO SIX YEARS OF LIFE
The development of cognitive abilities in children aged 2 to 6 years is significantly influenced by nutritional status. This research examines the effectiveness of nutritional interventions that depend on biological, social, and educational factors. Prenatal supplementation and higher maternal education are associated with more favorable cognitive outcomes, while children born with low birth weight show longer-lasting delays. The effectiveness of interventions varies. Multinutrient supplementation with five or more nutrients demonstrates a broader impact on cognitive functions compared to targeted supplementation. The period between 6 and 18 months of age is particularly important for the implementation of intervention programs. Integrating nutritional support with educational approaches that include structured play and physical activity can promote the parallel development of motor and cognitive skills. Methodological challenges include the need for randomized controlled trials, longer follow-up periods, and the use of laboratory biomarkers to assess nutrient status. Results indicate that the effects of interventions depend on the initial nutritional and health status of the child, the duration of treatment, and the social context. Recommendations for future work include expanding research to rural populations and children with special needs, standardizing measurement methods, and conducting long-term monitoring to assess the sustainability of benefits. This holistic approach emphasizes the importance of coordination between the health and education sectors to enhance cognitive development.
DARIER DISEASE –A RETROSPECTIVE SERIES OF 67 CASES
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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]--> Introduction/Aim: Darier disease is a rare autosomal dominant genodermatosis caused by mutations in the ATP2A2 gene and characterized by distinct clinical and histopathological findings. The aim of this study was to present the epidemiological and therapeutic characteristics of patients with Darier disease treated at a tertiary care center over a fifteen-year period. Methods: A retrospective cohort study including 67 patients diagnosed with Darier disease and treated at the Clinic of Dermatovenereology, University Clinical Center of Serbia, Belgrade, Republic of Serbia, was conducted. The diagnosis was established based on characteristic clinical presentation and histopathological confirmation. Epidemiological, clinical, and therapeutic characteristics were analyzed. Results: Female predominance (66%) was observed in the study population, while the first skin lesions most commonly appeared during adolescence and early adulthood. Positive family history was recorded in 48% of patients, supporting the autosomal dominant inheritance pattern. Lesions were predominantly localized on the trunk (85%). Neuropsychiatric comorbidities were observed in 16% of patients. Topical therapy was used in all patients, whereas systemic retinoids were administered in 51% of patients, predominantly in generalized forms of the disease. Conclusion: The results highlight the chronic course of the disease, marked phenotypic variability, and the need for individualized therapeutic approaches.
GLOBAL GEOGRAPHY OF INFECTIVE ENDOCARDITIS PATHOGENS: ETIOLOGY AND RESISTANCE IN THE 21ST CENTURY
Introduction/Aim: The etiology of infective endocarditis is diverse and complex. It varies significantly depending on geographical region, socioeconomic conditions, healthcare availability, and the prevalence of predisposing factors. The aim of this paper is to analyze the global geographical distribution of infective endocarditis pathogens in the 21st century, focusing on regional differences in etiology, diagnostics, therapy, and antimicrobial resistance. Methods: A secondary data analysis was conducted. Descriptive statistics were used to quantify pathogen frequency, the prevalence of resistant strains, and regional etiological differences. Results: In developed regions (North America and Western Europe), Staphylococcus aureus predominates, often associated with healthcare settings (30–35%) and high rates of MRSA resistance (up to 28%). Conversely, in developing countries, streptococci remain more prevalent, alongside the persistence of rheumatic heart disease. The availability of transesophageal echocardiography (TEE) and surgical treatment is significantly higher in developed countries, which directly contributes to a lower mortality rate (14–15%) compared to resource-limited regions (22%). Conclusion: Infective endocarditis has evolved into a disease associated with modern medicine and aging populations in developed countries, while in the rest of the world, it remains strongly associated with low socioeconomic conditions. High mortality and increasing resistance necessitate the global standardization of diagnostics and locally adapted therapeutic strategies.
CRANIOFACIAL METASTASES OF GASTROINTESTINAL ADENOCARCINOMA: A DIAGNOSTIC CHALLENGE
Introduction/Aims: Adenocarcinomas of gastrointestinal origin rarely metastasize to the craniofacial region. Such manifestations, especially when associated with suspected leptomeningeal involvement, are characterized by high aggressiveness and a very poor prognosis. The aim of this paper is to present a rare case of a massive craniofacial metastasis from an adenocarcinoma with an atypical presentation and a fulminant clinical course. Case Report: A retrospective analysis of the medical records of a 74-year-old female patient was performed. The patient was admitted to the Emergency Center due to a sudden disturbance in the level of consciousness. Radiology revealed a massive frontoparietal lesion with extensive destruction of craniofacial bones and invasion of the orbit, sphenoid and temporal bones, and the infratemporal fossa. No primary intraparenchymal brain lesions were observed, but radiological findings suggested leptomeningeal involvement. Metastases were also detected in the liver and vertebral bodies (Th1, L1, L3). Histopathological and immunohistochemical analysis of the craniofacial mass biopsy confirmed an adenocarcinoma with an immunophenotype indicative of gastrointestinal origin. Despite intensive multidisciplinary treatment, the clinical course was fulminant, resulting in a lethal outcome on the fourth day of hospitalization. Conclusion: Craniofacial metastases of adenocarcinoma can be the first manifestation of an occult gastrointestinal malignancy. Extensive bone destruction and suspected leptomeningeal dissemination lead to an extremely unfavorable outcome. This case highlights the importance of rapid diagnosis and a high degree of clinical suspicion in patients presenting with atypical cranial bone lesions and acute neurological deterioration.
SPECIFICS OF NURSING CARE FOR PATIENTS WITH AFFECTIVE MOOD DISORDERS
Introduction/Aim: Affective mood disorders (AMD) are among the most common psychiatric illnesses of the modern era, with a growing prevalence among the younger population. Unipolar depression, as the most frequent form, represents one of the leading global causes of disease burden and suicide mortality. The aim of this paper is to analyze the specific aspects of nursing care and the role of the nurse in the therapeutic treatment of patients with AMD. Methods: The study applied the method of analyzing professional and scientific literature available in electronic databases (PubMed, NCBI, SCIndex, Google Scholar). The following keywords were used: "affective mood disorders", "nursing care", "nursing interventions", "nurse". The literature that was published in the period 2014-2024 was searched Results: The most prevalent forms of AMD are depressive and bipolar disorders. The etiology is complex, with psychosocial stressors and trauma playing a significant role. Nurses, through therapeutic communication and continuous monitoring, contribute crucially to patient stabilization and the implementation of the therapeutic plan. Conclusion: AMD is characterized by high prevalence and predominance of female gender. Improving the care process through a holistic approach and the standardization of interventions significantly contributes to the quality of treatment and the reduction of the risk of complications.
ENDOCRINE AND IMMUNOLOGICAL ALTERATIONS IN SEVERE TRAUMA: CONTEMPORARY BIOMARKERS, PROGNOSTIC FACTORS, AND CLINICAL IMPLICATIONS
Severe trauma triggers a complex and dynamic response of the organism that includes simultaneous endocrine, immunological and metabolic alterations with a direct impact on the clinical course and treatment outcome. Hypothalamic-Pituitary-Adrenal (HPA) axis activation, changes in the secretion of catecholamine, disorders of the thyroid function and imbalance of the inflammatory response are key components of the systemic response to traumatic stress. The aim of this review article was to systematize endocrine and immunological biomarkers that have prognostic relevance in patients with severe trauma based on contemporary literature, as well as to review their clinical implications in intensive care medicine. Relevant papers published in the period 2014 to 2025 were reviewed in order to analyze changes in cortisol and catecholamine concentrations, Critical Illness-related Corticosteroid Insufficiency (CIRCI) Syndrome, Non-Thyroid Illness Syndrome (NTIS), as well as inflammatory biomarkers such as Interleukin-6 and C-reactive protein. Special attention was paid to their role in predicting mortality, development of multiple organ dysfunction, respiratory deterioration and septic complications. Available data indicate that early disorders of endocrine axes, especially abnormal patterns of cortisol and thyroid reactions have a significant prognostic values, while inflammatory and transcriptomic biomarkers allow more precise risk stratification in the early stages of critical disease. The integration of endocrine, immunological and metabolic biomarkers with clinical parameters and demographic characteristics of patients is the basis of a modern, personalized approach in the treatment of severe trauma. Further research should be directed towards standardization of diagnostic criteria, optimal sampling time and evaluation of therapeutic interventions, with the aim of improving outcomes and reducing mortality in critically ill patients.
ROLE OF MICROBIOLOGY AND INFLAMMATORY BIOMARKERS IN PLANNING RECONSTRUCTIVE TREATMENT OF CHRONIC WOUNDS: LITERATURE REVIEW
Chronic wounds represent a significant clinical and public health burden, with increasing prevalence among elderly and patients with diabetes and vascular diseases. Proper planning of reconstructive treatment requires a comprehensive understanding of microbiological processes and inflammatory biomarkers reflecting wound status. The aim of this study was to analyze contemporary approaches to the diagnosis and planning of reconstructive treatment of chronic wounds, emphasizing the role of microbiology and inflammatory biomarkers. Review of 18 studies published between 2010 and 2025 was presented in the paper, focusing on microbial profiles, inflammatory markers, and reconstructive treatment modalities. The most common microorganisms are Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii. Elevated CRP and IL-6 levels correlate with infection and poor graft outcomes, while normalization indicates readiness for reconstruction. Epidemiological data show an 8–10% annual increase in chronic wound prevalence in Europe, alongside rising bacterial resistance. Microbiological evaluation and biomarker monitoring should be integral to reconstructive planning protocols in chronic wounds. This approach improves outcome prediction, reduces postoperative complications, and promotes rational therapy use.
RISK FACTORS FOR ACUTE MYOCARDIAL INFARCTION IN THE REPUBLIC OF SERBIA
Background/Aim: Acute myocardial infarction (AMI) is a leading cause of morbidity and mortality from cardiovascular diseases (CVD) globally. The development of the disease is strongly associated with the presence and interaction of multiple risk factors – non-modifiable (sex, age, family history) and modifiable (hypertension, dyslipidemia, smoking, obesity, physical inactivity, diabetes mellitus, stress). The aim of this study is to analyze the prevalence of key risk factors for AMI among patients with acute coronary syndrome (ACS) treated in coronary care units in the Republic of Serbia (2006–2011), as well as in the general population of Serbia (2012–2022). Furthermore, these findings are compared with European and global averages to better understand the burden of risk factors and provide additional insight into the need for improved national preventive interventions. Methods: A descriptive epidemiological study was conducted. Data on the prevalence of risk factors in hospitalized patients with acute coronary syndrome (ACS) for the period 2006–2011 were retrieved from the annual publications of the "Dr Milan Jovanović Batut" Institute of Public Health of Serbia – the National Registry for Acute Coronary Syndrome. The prevalence of the same risk factors in the general population of the Republic of Serbia for the period 2012–2022 was analyzed using national and international secondary data sources, including reports from the World Health Organization (WHO), the Global Adult Tobacco Survey (GATS), the Global Burden of Disease Study (GBD), the National Health Surveys from 2013 and 2019, and the European Health Interview Survey (EHIS). Risk factors were defined in accordance with the methodology of the data sources used and current international guidelines. Results: A high prevalence of all analyzed risk factors was recorded among patients with ACS hospitalized in coronary care units in the Republic of Serbia. In 2011, approximately 35% of patients were recorded as smokers at the time of hospitalization (active smokers), about 73% had arterial hypertension, approximately 28% had diabetes mellitus, about 20% had obesity (BMI ≥30 kg/m²), and roughly 37% were physically inactive. More than half had dyslipidemia and a positive family history, while approximately 31% reported elevated psychosocial stress. Trend analysis for the 2012–2022 period indicates persistently high values of these modifiable risk factors in the general population, which match or exceed the levels recorded among hospitalized ACS patients in the preceding period. Conclusion: The findings of this study indicate a persistently high prevalence of modifiable risk factors in the Republic of Serbia, which transitioned from the ACS patient population (2006–2011) to the general population over the following decade (2012–2022). These trends, which are more unfavorable than the European average, highlight the urgent need for integrated preventive strategies targeting modifiable risk factors to reduce the overall cardiovascular burden in the Republic of Serbia.
INCIDENCE OF ACUTE MYOCARDIAL INFARCTION IN THE REPUBLIC OF SERBIA FROM 2006 TO 2022
Introduction/Aim: Cardiovascular diseases represent the leading cause of mortality worldwide and were responsible for more than 19.8 million deaths in 2022, accounting for 32% of all deaths according to World Health Organization data. Of all deaths due to cardiovascular diseases, as many as 85% were caused by acute myocardial infarction and stroke. The highest number of deaths occurs in countries with low and middle incomes. The aim of this study was to analyze trends in the incidence of acute myocardial infarction in the Republic of Serbia from 2006 to 2022. Methods: Data on newly diagnosed cases of acute myocardial infarction for the period 2006–2022 were obtained from the National Registry for Acute Coronary Syndrome, maintained by the Institute of Public Health of Serbia “Dr Milan Jovanović Batut”, as well as from official Health Statistical Yearbooks of the Republic of Serbia for the observed period. Crude incidence rates (CR) and age-standardized incidence rates adjusted to the European and world standard populations (ASR-E and ASR-W) were analyzed. Results: During the observed period, a decline in age-standardized incidence rates adjusted to the European standard population (ASR-E: 170.9 → 147.4) and to the world standard population (ASR-W: 118.2 → 101.8 per 100,000 population) was observed. Incidence rates varied over time, with the highest age-standardized incidence rate adjusted to the European standard population recorded in 2009 (183.7 per 100,000), and the lowest in 2017 (132.3 per 100,000) (Figure 1). The highest age-standardized incidence rate adjusted to the world standard population ranged from 126.1 per 100,000 in 2009 to 91.0 per 100,000 in 2017. Conclusion: The reduction in age-standardized incidence rates of acute myocardial infarction in the Republic of Serbia from 2006 to 2022 is likely the result of improved control of cardiovascular risk factors, including wider use of statins and modern antihypertensive therapies in primary and secondary prevention, as well as the effectiveness of national preventive programs such as public education on symptom recognition, healthy diet and physical activity, and smoking cessation campaigns. In addition, the development of networks of catheterization laboratories for emergency interventions in Serbia has enabled faster patient management, thereby influencing clinical outcomes and the incidence of recurrent myocardial infarction.
CHALLENGES IN MANAGING THE REPRODUCTIVE CELL DONATION PROGRAM PROCESS IN SERBIA
Introduction/Aim: This study examines the governance challenges in Serbia's egg and sperm donation system. The necessity of donors importing donated reproductive cells requires coordination among clinics, regulatory agencies, and international tissue banks. The main objective is to analyse the roles, responsibilities of key institutions and stakeholders in the donation program, exploring opportunities for system improvement through clinical alignment and analysis of implementation in Fertility clinics. Methods: A descriptive statistical method was applied to the data collected using a questionnaire sent to IVF clinics, utilising the Resposinble, Accoutable, Consulted and Informed (RACI) matrix to define institutional roles, and conducting a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis based on the RACI matrix results. Results: RACI analysis revealed that the Ministry of Health bears the highest number of information responsibilities, confirming its leading, regulatory, and supervisory role. Based on the questionnaire, Clinical Embryologists handle most documentation tasks, including packaging and shipping (47.1%) and communication with tissue banks (58.8%). Most respondents (41.2%) reported that documentation errors rarely occur, while non-compliances from foreign banks were very uncommon (70.6%), and the Ministry's institutional support was viewed as limited. Conclusion: The results highlight a system with unclear and limited strategic communication, utilising the RACI matrix, which proved to be useful in clarifying institutional roles. The SWOT analysis emphasised both strengths (professional capacity) and threats, highlighting that excessive centralisation of roles can overload an institution and slow down processes. Future research should focus on quantitative analyses of clinical outcomes related to the origin and quality of donated material, as well as comparative evaluations of communication between institutions, banks and regulatory bodies.
Ischemic heart disease (IHD) is the leading cause of death globally, while in Serbia, it is responsible for more than 45% of all deaths, which is significantly above the average in the European Union. It occurs as a result of atherosclerosis of coronary arteries, and the main risk factors include smoking, hypertension, dyslipidemia, diabetes, obesity, physical inactivity, unhealthy diet and stress. Prevention as the foundation of public health and health policies of each country includes a range of measures and activities aimed at preserving and improving health, preventing the occurrence of diseases and complications, as well as reducing mortality and disability in the population at the primordial, primary, secondary and tertiary level. Key measures include the adoption of healthy lifestyle habits: balanced Mediterranean diet, regular physical activity (at least 150 minutes of moderate exercise per week), maintaining a healthy weight and quitting smoking. Controlling biological risk factors, such as hypertension, diabetes and high cholesterol, is also essential. A screening program within primary prevention plays an important role in the early detection of individuals at increased risk for IHD. Secondary prevention includes adequate treatment and measures to prevent further complications in patients who already suffer from IHD. This includes pharmacological therapy (antiaggregation drugs, beta-blockers, statins), invasive procedures such as coronary interventions or bypass surgery, as well as changing unhealthy habits. Tertiary prevention is aimed at patient rehabilitation, the reduction of complications and the improvement of the quality of life. Although recommendations for prevention are clearly defined, their implementation emerged as a challenge in Serbia. Better coordination, continuous education of the population and improvement of the health care system, especially in the field of post-hospital rehabilitation, are necessary. A comprehensive, integrated approach that includes public health and medical interventions is crucial for the long-term reduction of the burden of IHD in Serbia.
VOICE DISORDERS IN TRANSGENDER PERSONS: ETIOLOGY, CLINICAL PICTURE AND THERAPEUTIC APPROACHES
Voice disorders in transgender people represent a significant challenge in the process of gender affirmation, because the voice directly affects the perception of gender identity and psychosocial well-being. The aim of this paper is to provide a comprehensive overview of the etiology, clinical picture and therapeutic approaches of voice disorders in transgender people. Hormonal, anatomical and psychosocial factors influencing voice changes, typical symptoms and acoustic characteristics, as well as various treatment methods, including vocal therapy, phonosurgery and a multidisciplinary approach, were analyzed. Hormone therapy in trans men leads to significant voice changes, while in trans women it is often not enough to achieve the desired gender perception, and additional vocal therapy or phonosurgery is needed. Vocal therapy, when necessary, phonosurgery are effective methods for voice correction, and a multidisciplinary approach enables optimal outcomes and improvement of quality of life. However, the lack of standardized protocols and longitudinal studies highlights the need for further research and individualization of therapy. In conclusion, successful intervention in voice disorders in transgender persons requires the integration of medical, speech therapy and psychological methods, with the aim of achieving voice function that is consistent with gender identity and supporting psychosocial well-being.
FUNCTIONAL PROFILE AND ASSOCIATED IMPAIRMENTS IN SCHOOL-AGED CHILDREN WITH CEREBRAL PALSY IN SERBIA
Introduction/Aim: Cerebral palsy is a permanent and heterogeneous condition that requires continuous, comprehensive support from multiple service providers, including healthcare professionals. Information on functional characteristics of individuals with cerebral palsy is necessary for effective service planning and counselling families in a clinical context. However, no national database or register is available in Serbia. This descriptive and exploratory study aimed to examine functional characteristics and frequency of associated impairments in a sample of school-aged children with cerebral palsy in Serbia. Methods: A convenience sample of 117 children and adolescents with cerebral palsy (56.4% male), aged 7–18 years (M = 13.23, SD = 3.36), was analysed. Data on cerebral palsy type, gross motor function, fine manual and bimanual abilities, intellectual functioning, sensory impairments (visual, hearing), epilepsy, and general health problems were extracted from available medical, educational, and psychological records. Descriptive statistics were used for analysis. Results: Spastic cerebral palsy was the most common type (65.8%), frequently accompanied by intellectual disability (67.5%), visual impairment (33.3%), and epilepsy (24.7%). Nearly two-thirds (64.1%) of participants had two or more associated impairments. The majority exhibited limitations in ambulation, manual performance, and fine motor skills. Conclusion: The basic functional characteristics and frequency of associated impairments were generally in line with national and international reports, with some differences observed in comorbidity patterns. The high prevalence of multiple health and developmental challenges underscores the urgent need for a national cerebral palsy registry in Serbia.
EVALUATION OF PLANNING AND CONSUMPTION OF MEDICAL RESOURCES IN PRIMARY HEALTH CARE IN SERBIA
Introduction/Aim: Efficient planning and consumption of medicines, medical and sanitary supplies, and laboratory reagents within the framework of Serbia's primary health care directly affect therapy availability, service quality, and the rational use of budgetary resources. Although a formal framework for centralized procurement exists, practice reveals significant discrepancies in criteria, procedures, and institutional approaches. The aim of this study was to examine how health care institutions plan their needs, what decision-making criteria they use, and the role of the Republic Health Insurance Fund (RHIF) in the evaluation and implementation of these plans. Methods: A quantitative study was conducted among 136 primary health care institutions and 26 RHIF branches, using a questionnaire designed in accordance with valid regulations and professional methodological guidelines. Data were analyzed in the Excel environment, using a binary matrix and thematic classification of responses. Results: Most institutions (84.6%) rely on historical consumption and RHIF guidelines, while only 8.8% use economic criteria. A multicriteria approach is used by just 5.1% of institutions. Internal evaluation is absent in 26.5% of cases, and information systems are mostly used for administrative purposes. A pattern of planning without analytical verification was observed, along with frequent shifting of responsibility to RHIF, which stated in its response that it did not perform evaluations nor apply analytical tools. Conclusion: Although the planning system formally meets regulatory requirements, it lacks an analytical foundation and functional evaluation. Establishing a standardized model based on clinical, economic, and epidemiological indicators, along with an active evaluative role of RHIF and two-way institutional feedback, represents a key step toward more rational and equitable management of health care resources.
INCIDENTAL FINDING OF CONTRALATERAL BREAST CANCER IN CONTRALATERAL PROPHYLACTIC MASTECTOMY SPECIMEN: A CASE REPORT
Introduction/Aim: Prophylactic mastectomy may be performed in women with high genetic or familial risk, or unilaterally alongside therapeutic mastectomy. Although malignancy is not expected in prophylactic specimens, incidental contralateral breast cancer (CBC) may alter management and prognosis. The aim of this study is to present a clinical case of the incidental finding of contralateral breast carcinoma (CBC) in a tissue specimen obtained through contralateral prophylactic mastectomy (CPM) in a 46-year-old patient who had been initially diagnosed with ductal carcinoma in situ (DCIS) in the opposite breast. Case report: We report a 46-year-old woman initially diagnosed with ductal carcinoma in situ (DCIS) of the right breast. After declining adjuvant radiotherapy, she opted for bilateral nipple-sparing mastectomy with direct-to-implant reconstruction. Histopathology confirmed DCIS with a focal invasive component in the right breast and unexpectedly revealed three microscopic focuses of DCIS in the contralateral breast, alongside fibrocystic changes and atypical ductal hyperplasia. Discussion: The annual incidence of CBC is estimated at 0.5-0.75%. Examination of contralateral prophylactic mastectomy (CPM) specimens may uncover high-risk lesions (ADH, ALH, LCIS) or, rarely, invasive carcinoma. Such findings highlight the diagnostic potential of CPM and the importance of multidisciplinary evaluation when selecting candidates for risk-reducing surgery. Conclusion: Although CPM does not consistently improve overall survival, it can contribute to individualized risk reduction, simplified surveillance, and reduced anxiety in selected patients. This case underscores its diagnostic value in detecting occult contralateral malignancy and reinforces the need for personalized surgical planning within a multidisciplinary framework.
PREOPERATIVE, INTRAOPERATIVE AND POSTOPERATIVE PREDICTORS ASSOCIATED WITH COMPLICATIONS AND SURVIVAL OF PATIENTS AFTER COLORECTAL RESECTION
Colorectal cancer is the third most commonly diagnosed form of all cancers, and the second deadliest cancer worldwide. The International Agency for Research on Cancer (IARC) estimates that the global burden of colorectal cancer on society will increase by 60%, representing more than 2.2 million new cases and 1.1 million deaths by the year 2030. The aim of this review paper is to show which predictors, at hat point in the course of the disease, and in what way they influence the occurrence of postoperative complications and the survival of patients with colorectal cancer. Elevated levels of inflammatory markers, poor nutritional status, a higher category of the ASA (American Society of Anesthesiologists) physical status classification, and poor lifestyle habits represent significant independent predictors of poor survival and increase the risk of developing postoperative complications after resection. Intraoperatively, longer duration of the operation and significant blood loss during surgery contribute to poor outcomes. Postoperative complications (anastomotic leakage, postoperative bleeding, intra-abdominal abscess, stoma complications, general complications) independently increase the risk of mortality after surgery.
LONG-TERM TREND OF BLADDER CANCER MORTALITY IN SERBIA, 1991-2024: A JOINPOINT REGRESSION ANALYSIS
Introduction/Aim: Bladder cancer is among the main urological diseases. Bladder cancer mortality trends vary significantly worldwide. This research sought to assess temporal trends in deaths due to bladder cancer in Serbia. Methods: This was a population-based descriptive epidemiological study. Bladder cancer mortality data were obtained from an official database. Direct standardization with the World standard population was used to compute the age-standardized rates (ASRs) per 100,000. Joinpoint regression analysis was employed to assess temporal trends in bladder cancer mortality using the average annual percentage change (AAPC) alongside its 95% confidence interval (95% CI) over the 1991-2024 period. Results: During the period 1991-2024, almost 20,000 deaths due to bladder cancer (about 15,000 among men and 5,000 among women) occurred in Serbia. Average annual ASR of mortality from bladder cancer was notably higher among males than females (5.94 versus 3.87 per 100,000, respectively). Significant increases in bladder cancer mortality trends were recorded for both males (AAPC=0.6%; 95% CI=0.4 to 0.9) and females (AAPC=1.3%; 95% CI=1.0 to 1.5). The male and female trends were not parallel, as the final selected model rejected parallelism (p = 0.008). A significant increase in bladder cancer mortality in women was recorded in middle age (age groups 55 to 69 years), while in men a more pronounced increase was observed in older people (age groups 70 and older). Conclusion: An increase in bladder cancer mortality during more than three decades in Serbia implies that further analytical research is needed.
ATTITUDES AND KNOWLEDGE OF PARENTS OF SCHOOL CHILDREN ABOUT HPV INFECTION AND VACCINATION IN THE COUNTRIES OF THE FORMER YUGOSLAVIA: REVIEW
In 2022, cervical cancer was the fourth most common cancer among women worldwide, with over 660,000 new cases annually. It is caused by persistent infection with the human papillomavirus (HPV). The key measures for cervical cancer prevention are screening (Pap test) and the HPV vaccine. As of 2023, six types of HPV vaccines are available worldwide. According to the World Health Organization (WHO) strategy, if vaccination coverage of girls up to the age of 15 were to reach 90%, the disease could be eliminated. However, WHO member states have not yet exceeded a coverage rate of 55%, while the countries of the former Yugoslavia show significantly lower rates. The aim of this review paper is to analyze parents’ attitudes and knowledge regarding HPV vaccination of their children in the countries of the former Yugoslavia. Electronic databases (PubMed, Scopus, and Google Scholar) were searched using the following keywords in English: parental attitudes, vaccine acceptance, vaccine hesitancy, and HPV vaccine. Four articles meeting the inclusion criteria were identified. The analyzed studies showed that pediatricians’ recommendations have the greatest influence on parents’ acceptance of HPV vaccination. Studies conducted in Serbia found that girls are vaccinated more often than boys. Parents stated that HPV vaccination is insufficiently promoted, and that more attention should be dedicated to this issue in the future. It has been observed that parents are the target population for implementing educational interventions on HPV infection and vaccination in order to achieve higher coverage with this vaccine.
PERIPHERAL NERVE SHEATH TUMORS: CLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS – A RETROSPECTIVE CASE SERIES OF 46 PATIENTS
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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]--> Introduction/Aim: Peripheral nerve sheath tumors (PNSTs) represent a diverse group of neoplasms arising from Schwann cells and fibroblasts of peripheral nerves. Their heterogeneous nature and variable association with neurofibromatosis (NF) syndromes necessitate a comprehensive understanding of their epidemiological and clinical profiles. The aim of this study was to analyze the clinical and epidemiological characteristics of persons with peripheral nerve sheath tumors (PNSTs) diagnosed during the last five years. Methods: In this stusy, the retrospective analysis of 46 patients with histologically confirmed peripheral nerve sheath tumors was conducted. All subjects were included in the study in the period from January 1st, 2020 to January 1st, 2025. All necessary data were collected from the medical records of these patients. Demographic data, tumor type, anatomical location, presence of neurofibromatosis, time from symptom onset to surgery, and clinical manifestations were evaluated. Results: Schwannomas were the most common tumor type (73.9%), followed by malignant peripheral nerve sheath tumors (MPNSTs) (15.2%) and neurofibromas (10.9%). The most frequent tumor localization was the upper extremities. Neurofibromatosis type 1 (NF1) was present in 19.6% of patients. Conclusion: Peripheral nerve sheath tumors are predominantly benign and most commonly located in the upper extremities. Neurofibromatosis remains an important risk factor, particularly in patients with multiple lesions.
THE IMPACT OF BEHAVIORAL RISK FACTORS ON INFERTILITY
Behavioral factors are modifiable risk factors that can significantly influence the development of various health conditions and diseases. Literature suggests that these factors may also have a detrimental effect on fertility. The aim of this review paper was to present the contribution of behavioral factors to the development of infertility in both sexes through the analysis of scientific literature, and to propose preventive measures. The following databases were searched: MEDLINE, PubMed, and KOBSON. Subsequently, an analysis was conducted on the collected data from clinical and other epidemiological studies published over the past 30 years. Research findings indicate that diets rich in dietary fiber, omega-3 fatty acids, plant-based proteins, vitamins, and minerals positively influence fertility in both men and women. Conversely, diets high in processed foods, trans fats, and refined carbohydrates have been shown to have a negative impact on fertility. Moderate physical activity plays a critical role in maintaining an optimal body mass index and improving ovarian function. However, intensive physical activity, due to its effect on the hypothalamic-pituitary axis, can lead to hypothalamic amenorrhea and subsequent infertility. Smoking, alcohol abuse, and the use of psychoactive substances adversely affect fertility in both sexes, as well as fetal development. A balanced and healthy diet, moderate physical activity, prevention of sexually transmitted infections, and the design and implementation of targeted infertility prevention strategies can significantly improve fertility outcomes and contribute to safe motherhood.
SrpsEFIKASNOST HPV VAKCINE U PREVENCIJI RAKA GRLIĆA MATERICE I DRUGIH MALIGNOMAki
Human papillomavirus (HPV) infection is one of the most widespread sexually transmitted infections globally, responsible for a significant number of cases and deaths annually. It is one of the risk factors for cervical cancer, oral and pharyngeal cancer, vaginal cancer, vulvar cancer, penile cancer, and anal cancer, and it also causes genital warts. The introduction of licensed, globally recognized prophylactic HPV vaccines (e.g., Cervarix, Gardasil, Gardasil 9, Cecolin, Walrinvax, and Cervavac), based on virus-like particles (VLPs) made from viral protein components but without the virus's genetic material, has significantly contributed to reducing the number of cervical cancer cases, especially in highly developed countries where screening tests (Pap tests) are also used. Despite the introduction and implementation of these vaccines, HPV-related malignancies continue to be a global problem. The aim of this review is to analyze the effectiveness of the HPV vaccine in preventing cervical cancer and other malignant tumors.
AGING AS AN INDICATOR OF CHANGES IN VOICE AND SPEECH QUALITY
During the aging process, certain changes occur in the voice and speech. A person's voice changes during aging, becoming more unstable, less flexible, and hoarseness occurs. This study aims to analyze the effects of aging on voice frequency, voice intensity, and the rhythm and tempo of speech. The literature was studied using electronic databases, in particular Google Scholar Advanced Search and the Serbian Library Consortium for Coordinated Acquisition - KoBSON. The results show that there is a deterioration in the acoustic parameters of the voice (voice frequency and intensity) with age. It has also been observed that the aging process in the voice is more pronounced in women than in men. This can be explained by hormonal changes that are especially pronounced in women during menopause. After the age of sixty, the intensity of the voice becomes lower regardless of the person's gender. Depending on the person's age, the rhythm and tempo of speech also change. It was found that older subjects take longer to pronounce certain sounds, which is associated with a delay in the onset of phonation when pronouncing alveolar and bilabial sounds, which is most often attributed to jaw degradation. Studies show that voice and speech aging occurs gradually and as expected, with clearly expressed consequences for everyday life, which should be taken into account in clinical practice in order to improve the quality of life of older people.
CHARACTERISTICS OF PATIENTS WITH GONORRHEA AND SYPHILIS TREATED AT THE CITY INSTITUTE FOR SKIN AND VENEREAL DISEASES IN BELGRADE IN 2016 AND 2024
Introduction/Aim: Gonorrhea and syphilis are common bacterial sexually transmitted infections, with a continuous increase being recorded worldwide. This rise is explained by the increase in risky sexual behaviors, meeting sexual partners through mobile applications, engaging in chemsex, as well as more frequent testing for these sexually transmitted infections among vulnerable groups. The aim of this study was to determine whether there are differences in the characteristics of patients with gonorrhea and syphilis treated at the City Institute for Skin and Venereal Diseases in Belgrade during 2016 and 2024, and to identify factors that influence the current epidemiological situation related to gonorrhea and syphilis. Methods: Data on basic demographic characteristics, sexual orientation, HIV status, and history of previous sexually transmitted infections among patients with gonorrhea and syphilis were collected from electronic medical records and partner notification forms of individuals diagnosed with these infections. The statistical analysis of the data was performed using the χ² test and Student's t-test. Results: Patients diagnosed with gonorrhea in 2024, compared to those diagnosed in 2016, were significantly more often male (p<0.001), unmarried (p<0.001), had a higher level of education (p<0.001), were employed (p<0.001), foreign citizens (p<0.001), with a homosexual orientation (p<0.001), had a history of both gonorrhea and syphilis in their personal medical records (p<0.001), and were more often diagnosed with gonorrhea through sampling from extra genital sites (p<0.001). Patients diagnosed with syphilis in 2024, compared to those from 2016, were significantly more often unmarried (p<0.001), had a higher level of education (p<0.05), were employed (p<0.001), foreign citizens (p=0.01), with a homosexual orientation (p=0.001), and had a history of both gonorrhea and syphilis in their personal medical records (p=0.01). Conclusion: More frequent testing for gonorrhea and syphilis among men who have sex with men, conducted by non-governmental organizations and as part of HIV pre-exposure prophylaxis programs, modern diagnostic methods for gonorrhea using samples from the rectum and pharynx, engagement in risky sexual behavior involving chemsex, as well as migration driven by the war in Ukraine, have all contributed to the observed differences in the characteristics of individuals diagnosed with gonorrhea and syphilis in Belgrade during the years under study.
MICROPHOTOGRAPHIC ATLAS OF NORMAL HISTOLOGY (1925) — PIONEERING CONTRIBUTION OF ALEXANDER Đ. KOSTIĆ TO MEDICAL EDUCATION
During its early years, the Faculty of Medicine faced numerous challenges, one of which was the lack of medical literature, especially in the Serbian language, which was particularly pronounced. In histology, an additional challenge was the presentation and identification of microscopic specimens during practical classes because it relied solely on drawings. An innovation in teaching was introduced in 1925 with the Microphotographic Atlas of Normal Histology, authored by Aleksandar Kostić. It was the first histological atlas intended for students of the Medical Faculty in Belgrade and one of the first in the world to contain complete microphotographs. Kostić prepared the set of microphotographs for the atlas in the Photography Department, established at the Institute in 1924. By publishing this atlas, Aleksandar Kostić established his scientific-photographic mission, making him a pioneer in medical photography both in Serbia and in the then Kingdom of Serbs, Croats, and Slovenes.
THE IMPORTANCE OF THE PASTEUR INSTITUTE IN NOVI SAD FOR THE PREVENTION AND CONTROL OF RABIES IN THE REPUBLIC OF SERBIA
Rabies is a deadly zoonotic disease that occurs in more than 150 countries and represents a public health issue for over three billion people worldwide. In Europe, rabies in animals is present in Ukraine, Belarus, Poland, Moldova, Russia, and Romania, with isolated cases reported in other countries as well. The highest number of human rabies cases is found in Asia and Africa. The aim of this review paper is to present the significance of the Pasteur Institute in Novi Sad in the control and prevention of rabies in the Republic of Serbia. Data for this paper were collected from various databases (Web of Science, PubMed, Google Scholar), bulletins, etc. The Pasteur Institute in Novi Sad is the National Reference Health Institution for rabies in the Republic of Serbia. All activities necessary in the fight against rabies are covered within this institution: providing anti-rabies protection to people at risk of rabies through the administration of cell culture rabies vaccines and human rabies immunoglobulin (HRIG); preventive immunization of high-risk populations; providing expert methodological assistance and professional supervision of the work of 27 anti-rabies stations (ARS) in the Republic of Serbia; supplying HRIG and rabies vaccines to all ARS; establishing doctrinal and professional medical guidelines in the field of anti-rabies protection; monitoring the occurrence of rabies; preparing reports and informing ARS and government authorities about every registered case of rabies in the country; proposing and implementing measures for its control; diagnosing rabies within the national reference laboratory for rabies; and controlling the achieved immunity following the immunization of people and animals. The regional project of oral vaccination of foxes against rabies has been implemented in the territory of the Republic of Serbia since 2010, and monitoring of vaccination effectiveness has been conducted since 2011. In the Republic of Serbia, urban rabies was eliminated in 1980, as was the last case of human rabies in the territory of the province of Kosovo and Metohija, while the last case of sylvatic rabies in foxes in Serbia was registered in 2018. In order to eradicate rabies, synchronized activities of the health and veterinary services are necessary, as well as cooperation at the local, national, and international levels.
PREDICTORS OF INTENTION TO USE FUNCTIONAL APPLICATIONS FOR MOBILE HEALTH IN THE REPUBLIC OF SERBIA USING THE EXPANDED UTAUT2 METHOD
Introduction/Aim: Health mobile applications provide an opportunity for each user to proactively monitor and manage their health. The mHealth mobile application uses the latest technology with the aim of making healthcare more accessible and affordable to more users. The aim of this paper was to identify factors, defined according to the expanded UTAUT2 (Unified Theory of Acceptance and Use of Technology) model, which have an impact on the intention to use mobile health applications (mHealth) in the Republic of Serbia. Methods: The cross-sectional study included 64 respondents (opportunity sample), former students, teachers and associates of the Academy of Vocational Studies in Western Serbia, who filled out an online questionnaire in the period May - November 2024. Cronbach's coefficient α, Pearson correlation coefficient and regression analysis were used in the data analysis. Results: Five of the 7 elements (Performance Expectancy - PE, Effort Expectancy - EE, Social Influence - SI, Price Value - PV and Facilitating Conditions - FC) of the UTAUT2 model are significant predictors of respondents' intention to accept and use mHealth mobile application services. Habit (H) elements and hedonic motivation (HM) have no significant effect on the use of mHealth mobile applications. Correlation analysis indicates that behavioral intention (BI) correlates significantly strongly positively with EE, facilitating conditions - FC and PE, and significantly positively but weakly with SI and PV. No significant correlation was found with HM and H. Conclusion: Further research in this area is necessary, especially research related to the testing and use of a specific mobile application for mHealth according to the elements of the UTAUT2 model.