Srpski medicinski časopis Lekarske komore

HEATWAVES AND HEALTHCARE: BRIDGING DATA AND FRONTLINE PRACTICE

2025-12-29T22:21:30+01:00

Heatwaves and related environmental events expose critical vulnerabilities in overburdened health systems and underscore the need to integrate clinical and environmental data to support timely public health interventions. However, healthcare professionals’ participation in data collection is often limited by high workloads and fragmented, restrictive health information system architectures. This article explores strategies to strengthen the link between public health data production and clinical response to mitigate the health risks associated with heatwave events. Field immersion programs for epidemiologists enhance understanding of operational constraints and promote the design of pragmatic interventions. However, the lack of standardized health measures and a widely accepted conceptual framework limits the effectiveness of heatwave epidemiology. We argue that such approaches can systematically improve the validity, applicability, and equity of public health research and practice, and propose a framework for standardized health monitoring during heatwaves.

MORPHOLOGICAL CHANGES IN KIDNEYS AND CLINICAL PRESENTATION IN PATIENTS WITH PRIMARY AND SECONDARY MEMBRANOUS NEPHROPATHY

2025-12-29T22:21:30+01:00

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.

OSTEOPOROSIS IN AUTOIMMUNE DISEASES

2025-12-29T22:21:31+01:00

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.

ONCO-HYPERTENSION – A NEW CLINICAL ENTITY IN MODERN MEDICINE

2025-12-29T22:21:31+01:00

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.

EFFECTS OF CONTROLLED PHYSICAL TRAINING IN PATIENTS WITH HEART FAILURE

2025-12-29T22:21:31+01:00

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.

INTERSTITIAL LUNG DISEASE AND BULLOUS PEMPHIGOID ASSOCIATED WITH DIRECT ORAL ANTICOAGULANT USE: A CASE REPORT OF LITERATURE-BASED PHARMACOVIGILANCE SIGNAL DETECTION

2025-12-29T22:21:31+01:00

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.

NEONATAL BILATERAL HYPHEMA: A RARE PRESENTATION AND CLINICAL IMPLICATIONS

2025-12-29T22:21:32+01:00

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.

COEXISTENCE OF POLYCYTHEMIA VERA AND MULTIPLE MYELOMA: A CASE REPORT

2025-12-29T22:21:32+01:00

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.