Srpski medicinski časopis Lekarske komore

BIOPSYCHOSOCIAL AND PSYCHIATRIC ASPECTS OF INFIDELITY

2026-06-30T22:36:41+02:00

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 issues, as well as long-term impairment of trust and intimacy.

Conclusion: Infidelity should not be regarded solely as a moral or social issue, but as a complex clinical and societal phenomenon with substantial implications for mental health, partnership, and family stability. A comprehensive understanding of its biopsychosocial mechanisms enables more effective psychiatric and psychotherapeutic interventions aimed at improving individual and partnership functioning through the development of self-awareness, responsibility, and resilience.

THE PREDICTIVE SIGNIFICANCE OF EOSINOPHILIA IN PERIPHERAL BLOOD IN PATIENTS WITH HODGKIN LYMPHOMA

2026-06-30T22:36:41+02:00

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 between the leukocyte count, the eosinophil count, the hemoglobin level, the erythrocyte sedimentation rate, CRP values, the clinical stage, IPS, and the maximum diameter of the measured lymph nodes (p > 0.05). However, the analysis showed a statistically significant association between eosinophilia and therapeutic response (p = 0.024), indicating its potential prognostic significance.

Conclusion: Peripheral blood eosinophilia was shown to be a potential predictor of therapeutic response, but not a predictor of tumor mass size. Clinical and radiological diagnostics remain the standard for assessing tumor burden.

EVALUATION OF STATISTICAL METHODS APPLIED IN OBSERVATIONAL STUDIES IN NEUROLOGY

2026-06-30T22:36:42+02:00

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 statistical assumptions and proper sample size planning in order to further improve the quality and reliability of future research.

OBESITY, INFLAMMATION AND HFpEF – PARTS OF THE SAME CIRCULUS VITIOSUS

2026-06-30T22:36:42+02:00

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 and enable a more individualized treatment approach.

THE LESER–TRÉLAT SIGN AS A PARANEOPLASTIC MANIFESTATION OF MALIGNANCY: A REVIEW OF THE LITERATURE

2026-06-30T22:36:42+02:00

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.

CONTEMPORARY APPROACHES TO THE PREVENTION OF GESTATIONAL DIABETES: PHARMACOLOGICAL INTERVENTIONS AND DIETARY SUPPLEMENTS – A NARRATIVE REVIEW

2026-06-30T22:36:42+02:00

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.

DESCEMET MEMBRANE ENDOTHELIAL KERATOPLASTY (DMEK): CLINICAL OUTCOME OF THE FIRST 52 CONSECUTIVE CASES PERFORMED IN 2022 AND 2023

2026-06-30T22:36:43+02:00

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.

A RARE CASE OF PRIMARILY MISDIAGNOSED GIANT MALIGNANT MIXED GERMINATIVE MEDIASTINAL TUMOR IN A YOUNG MALE PATIENT, SURGICALLY REMOVED BY “COLISEUM” APPROACH

2026-06-30T22:36:43+02:00

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.

PERIOPERATIVE DYNAMICS OF INTRAOCULAR PRESSURE DURING CONTINUOUS ESKETAMINE ANALGOSEDATION IN COMBINED CATARACT AND GLAUCOMA SURGERY: A CASE REPORT

2026-06-30T22:36:43+02:00

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.