Srpski medicinski časopis Lekarske komore

PREVENTION AND MANAGEMENT OF VACCINE HESITANCY

Christopher A. Reis, Robert M. Jacobson — Sun, 08 Mar 2026 22:28:13 +0100

Vaccine hesitancy refers to the delay in accepting or refusing vaccines despite the availability of vaccination services. Well-conducted studies and trials reviewed in this article support methods both to prevent and manage vaccine hesitancy. Clinicians should know which vaccines their patients are due to receive and should use every encounter to address this issue. Research shows clinicians’ recommendations increase vaccine uptake. Recommendations that patients perceive as stronger have a greater effect in increasing vaccine uptake. Using presumptive language to phrase the recommendation is more effective than presenting the vaccine conversationally as an option for the patient. When the patient counters the strong recommendation with hesitancy, the clinician should engage the patient with motivational interviewing, perhaps using a four-step process called the “Four A’s”.

NAVIGATING COVID-19 IN PREGNANCY: CARE PATHWAYS AND SYSTEM CHALLENGES IN KAZAKHSTAN – A QUALITATIVE STUDY

Zhansaya Nurgaliyeva, Nataliya Glushkova — Mon, 16 Mar 2026 07:24:52 +0100

Introduction: International studies conducted during the COVID-19 pandemic have shown that pregnant women often experienced significant barriers to timely and appropriate care. However, much of the existing evidence is derived from quantitative surveillance or from settings with well-established digital infrastructure and standardized clinical pathways, which may not reflect the realities of many middle-income health systems. This study aims to qualitatively explore the experiences of pregnant women and healthcare professionals regarding COVID-19 care pathways, including symptom recognition, outpatient management, and hospitalization, in Almaty, Kazakhstan.

Methods: The present study applied a qualitative, descriptive, phenomenological design to explore how pregnant COVID-19 patients and healthcare professionals experienced the organization of care during the pandemic. The study included 24 participants from local primary health care and hospital settings in Almaty, Kazakhstan. Fifteen healthcare professionals and nine pregnant or postpartum women voluntarily and anonymously provided informed consent to in-depth semi-structured interviews, either face-to-face or via secure video conferencing, between May and August 2023.

Results: Healthcare professionals reported that COVID-19 substantially altered maternal health care due to increased workload, fear of infection, and a shift toward remote care. Uncertainty regarding pregnancy-specific clinical guidelines and standard operating procedures (SOPs) contributed to reliance on general protocols and informal practices, while delayed hospitalization was linked to symptom denial, fear of admission, self-treatment, and system constraints. Pregnant and postpartum women commonly misinterpreted COVID-19 symptoms as pregnancy-related or mild illness, leading to self-medication and delayed help-seeking. Follow-up was largely unstructured and based on communication via phone or messages. The experience of care varied, ranging from timely clinical support to inconsistent monitoring and preference for home-based management.

Conclusion: The study offers detailed insights into a fragile and fragmented COVID-19 care pathway for pregnant women in primary and hospital care settings in Almaty. Several priorities for strengthening care organization for pregnant women with COVID-19 and for future public health emergencies include improving continuity of care, reducing delays in escalation, and enhancing the safety of maternal health services during infectious disease outbreaks.

DEPRESSIVE SYMPTOMS AMONG FAMILY MEMBERS PROVIDING INFORMAL CARE FOR PATIENTS RECEIVING HOME-BASED CARE: A PHQ-9 CROSS-SECTIONAL STUDY

Nikola Gavrilović — Tue, 10 Mar 2026 20:13:00 +0100

Introduction/Objective: Family members providing informal care for patients receiving home-based care represent a population at increased risk of developing depressive symptoms. The aim of this study was to assess the presence and severity of depressive symptoms using the PHQ-9 questionnaire and to examine the association between depressive symptoms and caregivers’ daily functioning.

Methods: A descriptive-analytical cross-sectional study was conducted among 77 family caregivers of patients enrolled in the Home Care Service of the Health Center Subotica between March and September 2025. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Statistical analysis included the t-test, Mann–Whitney U test, Kruskal–Wallis test, and Spearman’s correlation coefficient.

Results: The mean PHQ-9 score was 8.48 ± 6.14. A score ≥ 10 was recorded in 30 (38.9%) participants. Minimal or mild depressive symptoms were present in 47 (61.1%) caregivers. No statistically significant differences in PHQ-9 scores were observed according to caregiver sex (p = 0.423) or the patient’s primary diagnosis (p = 0.183). In the overall sample, a statistically significant weak positive correlation was found between PHQ-9 score and the self-reported impact of symptoms on daily functioning (r = 0.294; p = 0.009).

Conclusion: Depressive symptoms are present in a substantial proportion of family caregivers providing home-based care. The intensity of depressive symptoms is associated with greater impairment in daily functioning, highlighting the importance of systematic monitoring of caregivers’ mental health.

IMPACT OF LEFT VENTRICULAR GEOMETRY, EXPRESSED AS INTERVENTRICULAR SEPTAL AND POSTERIOR WALL THICKNESS, ON THE OUTCOME OF ACUTE ISCHEMIC STROKE

Mon, 16 Mar 2026 18:37:14 +0100

Introduction/Objective: Acute stroke represents a significant component of the overall health burden of the population. Parameters obtained by transthoracic echocardiography are well-established predictors of outcomes in cardiovascular diseases, while increasing evidence indicates their importance in predicting outcomes in neurovascular disorders.

This study aims to test the hypothesis that changes in left ventricular geometry, expressed as an increase in left ventricular wall thickness, represent a useful marker of poor outcome in patients with acute ischemic stroke.

Materials and methods: The methodology was based on the analysis of echocardiographic variables in 167 patients with acute ischemic stroke, together with variables of the modified Rankin Scale assessed at hospital discharge, used as an indicator of functional outcome.

Results: The study indicates a correlation between the thickness of both the interventricular septum and the posterior wall of the left ventricle, on the one hand, and the functional status of patients, on the other. The results confirmed the study hypothesis, demonstrating that an increase in interventricular septal thickness and/or posterior left ventricular wall thickness is associated with a higher probability of unfavorable outcome.

Conclusion: Both evaluated echocardiographic parameters showed positive predictive value in relation to functional outcomes.

THE PREVALENCE OF METABOLIC DISORDERS AND HYPERTENSION IN WOMEN DURING PERIMENOPAUSE AND MENOPAUSE

Mon, 23 Mar 2026 06:50:50 +0100

Introduction/Objective: Cardiometabolic diseases, including type 2 diabetes (T2D) and cardiovascular disease, and their associated factors, such as hypertension, dyslipidemia, insulin resistance, and obesity, are among the leading causes of morbidity and mortality. At a young age, the prevalence of cardiometabolic diseases is higher in men than in women, but this female advantage gradually disappears with aging, particularly after menopause, when cardiometabolic risk factors accumulate.

Our research aimed to highlight the prevalence of metabolic disorders and their association with hypertension in women during perimenopause and menopause.

Method: The study included 200 middle-aged women: 131 (65.5%) perimenopausal women who had experienced typical perimenopausal signs for more than 6 months, and 69 (34.5%) menopausal women with absent menstrual cycles for more than 12 months, aged 50-59 years. The patients visited their physician for a routine preventive examination in December 2024.

Results: Hypertension was statistically significantly more common in women in menopause (84.1%) compared to premenopausal women (p < 0.001). Women in menopause had significantly higher rates of metabolic disorders, increased body mass and obesity, with 66.7% of the participants affected, as well as a larger waist circumference in 63.8% of the participants (p = 0.003). Menopausal women had statistically significantly higher levels of triglycerides, LDL cholesterol, and total cholesterol than premenopausal women (p = 0.002). Among women going through menopause, diabetes mellitus was statistically substantially more prevalent, affecting 27% of them (p = 0.002). Premenopausal women had a statistically significantly greater prevalence of hypothyroidism (14.7%) than did menopausal women (4.3%) (chi-square = 4.905, p = 0.027). These two groups of participants did not differ significantly in terms of sedentary habits, smoking, or family history of hypertension.

Conclusion: Type 2 diabetes, obesity, dyslipidaemia, and hypertension were all substantially more common in menopausal women. Preventive screenings are therefore crucial for women going through menopause and perimenopause to promptly detect and treat cardiometabolic disorders and prevent more serious cardiovascular diseases.

LABORATORY PARAMETERS AND THEIR RELATIONS WITH DISEASE OUTCOME IN PATIENTS WITH NON-HODGKIN FOLLICULAR LYMPHOMA – SINGLE CENTRE FIVE-YEAR FOLLOW-UP

Mon, 23 Mar 2026 06:54:51 +0100

Introduction/Objective: Follicular lymphoma, a subtype of non-Hodgkin lymphoma, is the second most common non-Hodgkin lymphoma and the most frequent indolent lymphoma. Although rare, this disease may exhibit aggressive behavior, a tendency toward complications, as well as resistance to administered therapy and frequent relapses.

This study aimed to analyze laboratory parameters at the time of diagnosis and their association with disease outcome, complications, treatment response, and survival.

Material and methods: A total of 47 patients diagnosed with follicular lymphoma between 2018 and January 2024 were analyzed at our center. Baseline laboratory parameters included complete blood count, hemostasis parameters (PT, aPTT, fibrinogen, D-dimer), and biochemical parameters. During the course of the disease, treatment response to first-line therapy, progression-free survival, and overall survival were evaluated.

Results: Complete blood count parameters, as well as most biochemical parameters, showed no correlation with disease course. Complete remission was achieved in patients with lower LDH levels (p = 0.029), while overall survival was longer in patients with lower fibrinogen levels (p = 0.019), a higher percentage of monocytes (p = 0.007), and lower D-dimer levels (p = 0.000). Progression-free survival was associated with lower fibrinogen levels (p = 0.019), lower D-dimer levels (p = 0.031), lower LDH levels (p = 0.019), and a higher percentage of peripheral blood monocytes (p = 0.005). Patients with initially elevated D-dimer levels had a PFS of 24.50 ± 4.81 months, whereas those with D-dimer levels within the reference range had a PFS of 36.48 ± 5.99 months (p = 0.015).

Conclusion: In our center's experience, hemostasis parameters, particularly fibrinogen and D-dimer, showed a significant correlation with disease course.

AGING AS A MODULATOR OF MULTIPLE SCLEROSIS PATHOPHYSIOLOGY

Jasmina Đuretić — Mon, 16 Mar 2026 07:30:37 +0100

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

SURGICAL TREATMENT OF RADIATION-INDUCED ANTERIOR CHEST WALL OSTEOSARCOMA AFTER BREAST CARCINOMA: A CASE REPORT

Mon, 26 Jan 2026 13:56:49 +0100

Introduction/Objective: Radiotherapy for breast cancer can rarely lead to radiation-induced osteosarcoma (RIOS), a highly aggressive malignancy. This article aims to present the specificity of the surgical treatment applied and the level of aggressiveness of this rare malignant tumor.

Case report: A 63-year-old female patient was admitted to the Chest Surgery Department of the Military Medical Academy due to a large exulcerated sternal mass releasing a purulent secretion, initially misdiagnosed as recurrent breast carcinoma 15 years post-treatment, and anemia. Biopsy confirmed high-grade osteosarcoma following prior radiotherapy. After metastasis was ruled out, the patient received neoadjuvant chemotherapy and underwent radical resection of the sarcoma, sternum, anterior III–VII ribs, and adjacent soft tissues. Chest wall reconstruction was achieved using titanium bars, clips, and a latissimus dorsi myocutaneous flap. Upon local recurrence, further resection of the manubrium and anterior II ribs, with soft tissues, was performed. A year after the initial operation, a suspicious subcutaneous mass in the left pectoral region was excised for histopathological analysis.

Conclusion: RIOS of the chest wall exhibits a more aggressive course and worse prognosis than sporadic chest wall sarcomas, with higher rates of recurrence despite wide resection, as demonstrated in this case. Reconstruction with titanium bars and clips, after extensive anterior chest wall resection, provides a rigid and feasible alternative for restoring stability. This case underscores the importance of recognizing RIOS as a rare but serious late complication of breast cancer radiotherapy and highlights the complexity and specificity of surgical management and reconstruction for optimal outcomes.

PENILE FRACTURE ASSOCIATED WITH URETHRAL INJURY – CASE REPORT

Mon, 23 Mar 2026 10:50:51 +0100

Introduction: Penile fracture is a rare urologic emergency that may occur when the erect penis is injured, most often during sexual intercourse. In 10%-21% of cases, it is associated with urethral injury. The diagnosis is most often made by clinical examination, but additional diagnostic methods are useful in evaluating the site of rupture of the corpora cavernosa and detecting urethral injury. This medical emergency requires urgent surgical management as delays are associated with worse outcomes.

Case report: A 43-year-old man reported to the Emergency Center of the University Clinical Center of Serbia due to an injury to the erect penis during sexual intercourse. The anamnestic data were that he had felt pain and heard a “popping” sound, upon which sudden detumescence of the penis occurred and penile hematoma appeared, as well as blood during urination. Suspicion of a penile fracture was established on clinical examination. An ultrasound examination showed a rupture of the tunica albuginea of the right cavernous body, and retrograde urethrocystography revealed a rupture of the penile urethra. The patient underwent surgery that same evening. The surgical approach was a median penoscrotal incision, followed by suturing of the right cavernous body and penile urethra through a gently placed urinary catheter. Postoperative recovery was uneventful. During follow-up examinations, the patient reported normal erections, regular urination and satisfaction with the appearance of his penis.

Conclusion: Penile fracture is a rare urologic emergency, which is relatively rarely associated with urethral injury. The presentation of our case indicates the importance of initial ultrasound and radiographic diagnostics. In the case where the site of injury is present preoperatively, a ventral penoscrotal incision may be a suitable surgical approach. Timely recognition and surgical treatment of penile fracture associated with urethral injury gives excellent functional results.

AXILLARY BRACHIAL PLEXUS BLOCK UNDER PROCEDURAL SEDATION FOR ARTERIOVENOUS FISTULA FORMATION IN A CHILD WITH END-STAGE RENAL DISEASE – A CASE REPORT

Lazar Jakšić, serbian serbian , serbian serbian — Sat, 21 Mar 2026 07:34:11 +0100

Introduction/Objective: Arteriovenous (AV) fistula formation has become the gold standard for hemodialysis vascular access. The use of brachial plexus blocks (BPB) for antebrachial AV fistula formation in adults provides not just adequate analgesia but a potentially positive effect on primary fistula patency. Additionally, the resultant state of surgical anesthesia may enable the surgery to be performed under procedural sedation.

Case report: A 12-year-old patient was admitted for AV fistula formation for the purpose of hemodialysis due to end-stage renal disease. Kyphoscoliosis of the thoracic spine, the patient’s short neck with limited mobility, and her short stature posed a potential difficulty for intubation. Despite a recently resolved upper respiratory tract infection, which raised suspicion of airway hyperreactivity, the decision was made to proceed with surgical treatment and perform an axillary BPB under procedural sedation. Basic monitoring of vital functions was applied, with oxygen support at 3 l/min via mask. The ultrasound-guided block was performed using 8 ml of 0.5% levobupivacaine (1.4 mg/kg) and 5 ml of 2% lidocaine (3.33 mg/kg). During the one-hundred-minute surgical procedure, the patient maintained hemodynamic and respiratory stability and spontaneous breathing. The patient awoke without complications and was referred to the hospital ward. Her pain was managed with acetaminophen, as needed. The total perioperative opioid consumption was limited to the induction dose of 0.83 μg/kg of fentanyl.

Conclusion: In this pediatric case, the use of axillary BPB provided adequate analgesia with minimal opioid administration for the formation of an AV fistula. It also enabled the surgical team to avoid an expectedly difficult intubation. One needs to keep in mind the maximum safe dose of local anesthetics, the nuances of their use in children with comorbidities, as well as the potential complications, among which local anesthetic systemic toxicity is the most important.

PERIBULBAR ANESTHESIA WITH TARGETED INTRAVENOUS ESKETAMINE ANALGOSEDATION DURING ENUCLEATION: A CONTEMPORARY NARRATIVE REVIEW

Margita Lučić, Dolika Vasović — Sun, 08 Mar 2026 22:22:00 +0100

Introduction: Enucleation is an invasive ophthalmic procedure accompanied by pronounced nociceptive and reflex stimuli, representing a significant anesthesiological challenge, particularly in elderly and comorbid patients. Contemporary anesthesiology trends increasingly favor the use of regional anesthesia combined with targeted analgosedation as a safer alternative to general anesthesia.

Aim: To present current concepts of peribulbar anesthesia combined with targeted intravenous esketamine-guided analgosedation during enucleation, with special emphasis on hemodynamic stability, prevention of the oculocardiac reflex, control of perioperative pain, postoperative nausea and vomiting, and the feasibility of integrating this technique into day-surgery protocols.

Methods: A narrative review of contemporary literature in the fields of ophthalmic and regional anesthesia was conducted, focusing on the pharmacological properties of esketamine, the mechanisms of action of the peribulbar block, and the clinical aspects of their combined use during enucleation.

Conclusion: Peribulbar anesthesia combined with esketamine-guided targeted analgosedation represents a safe and effective contemporary anesthesiological approach for performing enucleation, particularly in elderly and comorbid patients. This approach provides stable hemodynamics, preserved spontaneous respiration, adequate pain control, a low incidence of postoperative nausea and vomiting, and rapid functional recovery, with the potential for application within a day-surgery setting.