Srpski medicinski časopis Lekarske komore

NEW APPLICATIONS OF PLATELET-RICH PLASMA IN GYNECOLOGY

Mirjana Anđelić — Mon, 10 Mar 2025 14:08:01 +0100

Letter to the Editor on the Topic of New Applications of Platelet-Rich Plasma (PRP) in Gynecology and Obstetrics – Intrauterine Infusions and Intraovarian Injections.

PRECISION PUBLIC HEALTH PERSPECTIVE: IS GENOMIC POPULATION SCREENING A VIABLE OPTION FOR THE EARLY DETECTION OF RISKS FOR ONCOLOGICAL DISEASES? REFLECTIONS FROM SERBIA

Bosiljka Đikanović, Janko Janković, Milena Cavic — Mon, 24 Mar 2025 07:24:51 +0100

This paper aims to discuss the term precision public health and its application in the early detection of oncological diseases and genomic risks for these diseases. The use of artificial intelligence and genomic profiling are briefly elaborated on, including reflections on the current status of innovative approaches in the Republic of Serbia. An environment for big genetic and health data sets storage that is protected and interoperable needs to be created, in keeping with the findability, accessibility, interoperability, and reusability (FAIR) principles. Wider use of genomics in the early detection of risks for oncological diseases must meet the well-established criteria for population screening, which is currently not the case. The risk factors that can trigger the penetrance of genes, thus leading to oncological disease, are also well known, and are as follows: unhealthy environments including air pollution, smoking and exposure to second-hand smoke,
stress, unbalanced diet, and other harmful factors. Therefore, health governance bodies and health policy decision-makers should focus on building a healthy environment as much as on working on the technical and technological health information infrastructure necessary for further development of genomics and precision public health.

INTRACEREBRAL HEMORRHAGE AND THE USE OF VARIOUS TYPES OF ANTICOAGULANTS – CLINICAL PRESENTATION AND TREATMENT OUTCOMES

Mon, 17 Mar 2025 10:06:12 +0100

Introduction: Anticoagulant therapy plays a key role in the prevention and treatment of various vascular diseases, but it simultaneously increases the risk of hemorrhagic complications, including intracerebral hemorrhage (ICH). This study aimed to examine the outcomes of patients with ICH based on prior anticoagulant therapy.

Methods: This was a retrospective cohort study involving 37 out of 277 patients with ICH from the hospital registry treated between January and November 2024 at the Special Hospital for Cerebrovascular Diseases "Sveti Sava". All patients were divided into two groups: those treated with vitamin K antagonists (VKA) or direct oral anticoagulants (NOAC). The treatment outcome of patients at discharge and 90 days after discharge was determined using the modified Rankin Scale (mRS).

Results: In the group of patients previously treated with VKA, the mean mRS score at discharge was 4.6 ± 1.8, while in the group previously treated with NOAC therapy, it was 5.1 ± 1.7, with no statistically significant difference between the groups (p = 0.442). Additionally, no statistical significance was found in the mRS 90 days after discharge (p = 0.341). In the VKA-ICH group, the mean value was 4.3 ± 2.2, while in the other group, it was 4.9 ± 2. In the first group, the mortality rate was 58%, while in the second group, it was 76%.

Conclusion: Patients with ICH and prior VKA therapy showed no significant differences in treatment outcomes compared to patients with prior NOAC therapy.

HUMAN RESOURCE MANAGEMENT AT HOSPITAL PROVINCIAL DO NAMIBE – N'GOLA KIMBANDA, ANGOLA

Francisca da Caridade Felix Chitanga, Celina Malaquias — Fri, 28 Mar 2025 11:14:43 +0100

Human resource management in the health sector encompasses planning, recruitment, selection, training, career development, performance evaluation, and efforts to enhance the quality of life for workers. However, the sector is facing a crisis due to challenges in human resource management, including workforce shortages, inefficient role distribution, inadequate working conditions, skill gaps, and management strategies that fail to align with the needs of the population. This research aims to analyze human resource management at the Namibe Provincial Hospital “N’Gola Kimbanda” and develop an action plan for its improvement.

CORRELATION OF CYTOGENETICS AND GRADE OF BONE MARROW FIBROSIS IN PRIMARY MYELOFIBROSIS

Fri, 28 Mar 2025 12:13:57 +0100

Introduction/Aim: Primary myelofibrosis is a clonal myeloproliferative neoplasm characterized by bone marrow fibrosis and extramedullary hematopoiesis. Fibrosis often complicates bone marrow aspiration and biopsy, further hindering disease diagnosis. Despite this, cytogenetic analysis is possible from bone marrow aspirate or peripheral blood. Karyotype is an independent prognostic parameter in primary myelofibrosis. The prognostic significance of bone marrow fibrosis grade in primary myelofibrosis remains debatable. This study aimed to investigate the impact of bone marrow fibrosis on overall survival in patients with primary myelofibrosis, as well as to examine the correlation between karyotype and bone marrow fibrosis grade in these patients.

Materials and Methods: The study of the correlation between karyotype and bone marrow fibrosis grade included 120 out of 136 patients with primary myelofibrosis. We used the stratification of chromosomal abnormalities according to the recommendations of prognostic scoring systems: Lille, Mayo, International, and Dynamic International. Karyotype analysis was performed using the conventional cytogenetic method. Bone marrow biopsies of patients were stained using the Gordon-Sweet method.

Results: In 136 patients with primary myelofibrosis, no statistically significant difference in survival was observed (p = 0.084) regardless of the bone marrow fibrosis grade. Additionally, no correlation was found between karyotype or chromosomal aberrations of varying risk levels and bone marrow fibrosis grade (Lille p = 0.293; Mayo p = 0.108; International Prognostic Scoring System p = 0.086; Dynamic International Prognostic Scoring System p = 0.613) in 120 patients with primary myelofibrosis.

Conclusion: Although we did not establish a correlation between karyotype and bone marrow fibrosis grade, we believe that both parameters should be incorporated into new prognostic scoring systems for primary myelofibrosis.

SHOULD I STAY OR SHOULD I GO? PERCEPTIONS OF SERBIAN EMIGRANT MEDICAL WORKERS IN GERMANY

Sara Tintor — Tue, 01 Apr 2025 07:33:11 +0200

Background: Throughout history, various driving forces have influenced both forced and voluntary migrations of healthcare workers.

Objective: This study aims to obtain new insights into the work activities of foreign doctors from the Western Balkans practicing medicine in Germany.

Materials and methods: In 2023, a qualitative cross-sectional study was conducted to analyze physicians’ motivation for emigration from their home countries, their professional status development in Germany, the German legal system, and overall satisfaction of the physicians.

Results: The main findings highlight better salaries for doctors abroad and no development opportunities in their home countries as the main reasons for emigration. Immigrant physicians were mainly satisfied with their professional status development in Germany, but less satisfied with the German legal system.

Conclusion: Employing doctors from the Western Balkans can alleviate the burden on the German healthcare system caused by the significant shortage of skilled labor force.

PLASMA CELL LEUKEMIA

Predrag Đurđević, Danijela Jovanović — Mon, 24 Mar 2025 07:14:49 +0100

Plasma cell leukemia (i.e., plasmacytic leukemia) is a very rare and aggressive form of plasma cell dyscrasia characterized by a poor prognosis, short survival time, and a poor response to the administered therapy. Clinical manifestations vary, however, the extramedullary form of the disease is the most common, as are hypercalcemia, anemia, thrombocytopenia, impaired renal function, and increased lactate dehydrogenase concentration. Numerous cytogenetic abnormalities lead to greater proliferation, inhibition of apoptosis, and changes in the expression of adhesion molecules and chemokine receptors. Despite the introduction of new therapeutic modalities based on bortezomib, immunomodulatory drugs, and biological therapy, the therapeutic outcome is still unsatisfactory.

LOWER EYELID DIROFILARIOSIS: A RARE CASE OF OCULAR PARASITIC INFECTION WITH POSSIBLE ENDEMIC EXPOSURE

Dolika Vasović, Dejan M. Rašić, Ivan Marjanović, Tanja Kalezić, Margita Lučić — Mon, 10 Mar 2025 13:57:36 +0100

Introduction: Dirofilariosis, caused by the parasitic nematode Dirofilaria repens, is a zoonotic disease with rare ocular manifestations that are being increasingly reported in regions experiencing expanded parasite distribution. Infection in humans manifests as a localized inflammatory reaction and ocular involvement can lead to significant discomfort and diagnostic challenges. While often associated with travel to endemic areas, such as the Mediterranean region, dirofilariosis is also endemic in Serbia, which highlights the possibility of local transmission.

Case report: A 38-year-old female patient presented with unusual sensations of movement in her lower eyelid following a vacation in Greece. Clinical examination revealed localized swelling and a palpable moving mass in the lower eyelid. Surgical excision of the lesion was performed, and parasitological analysis confirmed the presence of Dirofilaria spp. Given that dirofilariosis is also endemic in Serbia, the possibility of pre-existing local infection before the patient’s trip cannot be excluded. The patient’s symptoms resolved completely after surgery, with no recurrence or complications noted during follow-up. This case underscores the need for considering parasitic infections in the differential diagnosis of eyelid masses, especially in patients who have recently traveled to or live in endemic areas.

Conclusion: This case highlights the clinical presentation and successful management of lower eyelid dirofilariosis, a rare ocular manifestation of Dirofilaria spp. infection. While a travel history to endemic regions can raise suspicion, endemicity in regions like Serbia necessitates factoring in the possibility of local transmission. Early detection and prompt surgical intervention are often curative. Further research is needed to understand local transmission dynamics and the ocular involvement of dirofilariosis in endemic areas, as well as complications that may arise due to inadequate diagnosis and treatment.

TREATMENT OF COVID-19 WITH CASIRIVIMAB/INDEVIMAB IN A PATIENT WITH CERVICAL SPINE INJURY: A CASE REPORT

Mon, 10 Mar 2025 14:03:15 +0100

Introduction/Aim: We present a patient suffering from COVID-19 with a cervical spine injury who was treated with the antiviral drug casirivimab/indevimab (Regen-CoV), monoclonal antibodies for COVID-19, during hospital treatment at the Batajnica Hospital of the University Clinical Center of Serbia.

Case report: The administration of the drug casirivimab/indevimab (Regen-CoV) prevented the development of a more severe picture of Covid-19 and led to the rapid negativization of the nasopharyngeal swab for SARS-CoV-2 in our patient who had a cervical spine injury. The patient underwent successful cervical spine surgery at the Institute for Orthopedic-Surgical Diseases in Banjica, which led to the recovery of the neurological deficits he had previously.

Conclusion: We showed another significant indication for using casirivimab/indevimab (Regen-CoV) in hospital conditions, which was off-label according to therapeutic protocols.

PERIPHERAL PARALYSIS OF THE FACIAL NERVE AS A MANIFESTATION OF NEUROENDOCRINE TUMOR OF THE MIDDLE EAR – CASE REPORT

Ana Miljković — Sat, 15 Mar 2025 07:43:27 +0100

Introduction: Acute idiopathic peripheral facial nerve paralysis is often linked to viral infections such as Herpes simplex virus type 1 reactivation. Neuroendocrine tumors (NETs) of the middle ear (MEANT) are rare and present with non-specific symptoms, including hearing loss, otalgia, and neuropathy, complicating early diagnosis.

Case report: Report the case of a 47-year-old patient treated for chronic otitis since 2020. In 2024, the onset of peripheral facial nerve paralysis prompted advanced diagnostics, including MRI, CT, biopsy, and immunohistochemical analyses, confirming MEANT. Treatment included surgical excision, gamma knife therapy, and regular tumor marker monitoring. A delayed diagnosis of the tumor highlighted the need for heightened clinical suspicion in cases of chronic ear pathology with atypical progression.

Conclusion: Neuroendocrine tumors of the middle ear are diagnostic and therapeutic challenges due to their rarity and non-specific presentation. Early recognition of peripheral facial nerve paralysis as a potential indicator of an underlying malignancy is critical. Multidisciplinary management, integrating advanced imaging, histopathological confirmation, surgical intervention, and adjuvant therapies, improves outcomes and minimizes relapse risks. General practitioners play a pivotal role in identifying early symptoms to reduce diagnostic delays.