Vojnosanitetski pregled

Construction of an early prediction model for exacerbation of pneumonia caused by Mycoplasma pneumoniae in children: an incremental value study based on dynamic changes in C-reactive protein and IgG subclasses

2026-06-25T14:53:14+02:00

Background/Aim. Exacerbation of Mycoplasma pneumoniae pneumonia (MPP) in children commonly manifests as severe or refractory disease. The aim of this study was to evaluate the predictive value of the dynamic percentage change in C-reactive protein – CRP (ΔCRP%) and immunoglobulin (Ig) G1 subclass for the exacerbation of MPP in children, and to determine whether their incorporation into the basic prediction model improves the prediction of disease exacerbation. Methods. This retrospective study included hospitalized pediatric patients diagnosed with MPP between 2020 and 2023, who were enrolled and stratified according to the occurrence of MPP exacerbation. Baseline clinical characteristics, laboratory parameters, serial CRP measurements (at 0 and 72 hrs), and IgG1–IgG4 subclass levels were collected. According to the predicted probabilities generated by the enhanced model, patients were categorized into three risk groups: low-risk (< 0.20), medium-risk (0.20–0.35), and high-risk (≥ 0.35). Results. Among the 512 pediatric patients, 110 (21.5%) experienced MPP exacerbation. Multivariate analysis identified fever duration, bilateral lung involvement, decreased lymphocyte percentage, elevated lactate dehydrogenase, increased D-dimer, higher ΔCRP% (per 10 percentage-point increase), and low IgG1 levels as independent predictors (p < 0.05). The enhanced model demonstrated superior discriminative performance, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.873, significantly higher than that of the basic model (0.792; p = 0.004). Risk stratification analysis showed a progressive increase in the observed exacerbation rate across the low-, medium-, and high-risk groups (approximately 10%, 30%, and 50%, respectively). Conclusion. Both ΔCRP% and low IgG₁ levels are independent predictors of MPP exacerbation in children. The incorporation of these markers significantly improves the model’s discrimination, calibration, and clinical utility for predicting the risk of disease progression.

Early diagnosis and optimization of intraoperative management strategies for posterior tibial tendon entrapment following ankle fractures in the elderly

2026-06-25T14:53:15+02:00

Background/Aim. Posterior tibial tendon (PTT) entrapment is a rare, often underdiagnosed, but severe complication of complex ankle fractures. The aim of the study was to determine the characteristics of PTT entrapment in elderly patients with ankle fractures, and to establish a predictive model based on preoperative available clinical and imaging data. Methods. The study enrolled a total of 130 elderly patients treated between 2019 and 2024. Data were retrospectively analyzed, and all patients completed a minimum follow-up period of 12 months. Using intraoperative confirmation as the gold standard, a basic clinical logistic regression (LR) model was compared with an imaging-enhanced LR model (incorporating fracture fragment count and PTT sheath involvement), a random forest (RF) model, and a support vector machine (SVM). Performance was validated via 5-fold cross-validation, area under the receiver operating characteristic (ROC) curve (AUC), calibration, and decision curve analysis (DCA). Results. PTT entrapment occurred in 29.2% (38/130) of patients, primarily located in the posterior fracture gap (68.4%) or medial malleolus (31.6%). Morphological findings included simple mechanical incarceration (50.0%), soft tissue adhesion (36.8%), and tendon surface injury (13.1%). The imaging-enhanced LR model significantly outperformed the basic model (AUC 0.89 vs. 0.72) and exceeded RF (0.85) and SVM (0.88) models. DCA demonstrated high net benefit across risk levels, and intraoperative findings showed high consistency with imaging-based predictions. Conclusion. PTT entrapment is common in elderly ankle fractures. An imaging-enhanced predictive model based on preoperative computed tomography fracture morphology and local anatomy enables effective risk assessment, providing a reliable reference for targeted intraoperative exploration and surgical management strategies.

Impact of prosthodontic rehabilitation on oral health-related quality of life in the Serbian Armed Forces personnel

2026-06-25T14:53:15+02:00

Background/Aim. Although prosthodontic rehabilitation restores the structural integrity of the stomatognathic system, its impact on patients’ oral health–related quality of life (OHRQoL) remains insufficiently explored, particularly within the military population. The aim of this study was to evaluate the association between the type of prosthetic rehabilitation and OHRQoL, with a specific focus on functional, esthetic, and psychosocial dimensions, as well as to investigate the relationship between these findings and objective oral health indicators. Methods. A cross-sectional study was conducted to assess patient-reported outcomes using the Oral Health Impact Profile-14 (OHIP-14) questionnaire. The study included active duty personnel of the Serbian Armed Forces with natural dentition, as well as personnel with fixed or removable prostheses. Dental status was evaluated through comprehensive clinical examinations conducted by two experienced examiners. Biological parameters included the Caries Activity Factor (CAF) index, the Community Periodontal Index of Treatment Needs (CPITN), the plaque index (PI), and the gingival index (GI). Chronic systemic disease was recorded and included as a covariate in the analyses. Nonparametric statistical tests and multivariable regression analyses were employed to identify independent predictors of OHRQoL. Results. Participants with prostheses reported significantly higher OHIP-14 scores than those with natural dentition (p < 0.0001). No significant differences were observed between fixed and removable prostheses in overall OHIP-14 scores, except within the functional limitation domain, in which fixed prostheses demonstrated a measurable advantage. Multivariable analysis identified oral status, CAF and CPITN indices, and the presence of chronic systemic diseases as independent predictors of OHRQoL, whereas PI, GI, and age were not statistically significant after adjustment. Conclusion. According to the results of this study, prosthetic rehabilitation is associated with improved functional outcomes, but it did not fully alleviate the psychosocial burden associated with tooth loss. The severity of biological oral diseases and general health status were significant predictors of OHRQoL, suggesting that these factors may influence overall quality of life.

Development and preliminary psychometric evaluation of the Psychological Safety Perception scale: an observational study among community pharmacists

2026-06-25T14:53:16+02:00

Background/Aim. Measuring psychological safety in the workplace is essential for creating an environment where individuals feel safe expressing themselves, thereby promoting optimal patient care. The aim of the study was to develop a reliable and concise scale with preliminary psychometric properties to measure psychological safety in community pharmacies. Methods. After scale development through content and face validity, a cross-sectional study was conducted in which data were collected from 216 community pharmacists. A test-retest component was subsequently performed on 32 pharmacists at baseline and after three months to assess the temporal stability of the scale. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), the Wilcoxon signed-rank test, and Spearman’s correlation coefficient (ρ) were used to evaluate the scale’s reliability, construct validity, and stability. Results. The scale was developed through multiple iterations: Version 1 (32 items), Version 2 (26 items), and Version 3 (15 items), all of which demonstrated high content and face validity (indices > 0.80) and internal consistency (Cronbach’s alpha = 0.92). Version 4 (10 items) was established through CFA, which suggested excluding certain items, resulting in excellent reliability (Cronbach’s alpha = 0.89) and fit parameters: χ²(35) = 65.81; p < 0.001; goodness of fit index – GFI = 0.94; comparative fit index – CFI = 0.97; Tucker-Lewis index – TLI = 0.96; root mean square error of approximation – RMSEA = 0.064; standardized root mean square residual – SRMR = 0.040. During psychometric evaluation, EFA revealed a one-factor structure, with the primary component explaining nearly 50% of the variance. The Wilcoxon signed-rank test indicated no significant difference in mean scores between baseline [mean = 50.72, standard deviation (SD) = 12.93] and retest after three months (mean = 50.69, SD = 12.59). Additionally, Spearman’s correlation coefficients showed strong correlations between baseline and three-month scores (ρ = 0.994; p < 0.001). Conclusion. The findings indicate promising preliminary psychometric properties, supporting the use of the developed scale to assess psychological safety perceptions in community pharmacies. However, further validation, including criterion, convergent, and discriminant validity testing, is required.

Visual acuity and anatomical outcomes of intravitreal aflibercept treatment in patients with center-involved diabetic macular edema – a retrospective longitudinal cohort study

2026-06-25T14:53:16+02:00

Background/Aim. Center-involved diabetic macular edema (CI-DME) is a major cause of vision loss in diabetes mellitus, characterized by retinal thickening (1 mm) in the central foveal zone. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents, such as aflibercept, are widely used to treat retinal edema and improve visual outcomes. The aim of the study was to evaluate anatomical and functional changes of the retina following intravitreal administration of aflibercept in patients with CI-DME. Methods. This retrospective longitudinal cohort study included 70 eyes in 50 patients with optical coherence tomography (OCT)-confirmed CI-DME [with central foveal thickness (CFT) ≥ 350 µm and best-corrected visual acuity (BCVA) ≥ 0.6 Snellen], treated with three monthly aflibercept injections. BCVA, CFT, and macular volume (MV) were measured using the Optovue RTVue XR OCT device at baseline and after 1, 3, and 6 months of treatment. Results. Mean patient age was 64.63 ± 7.79 years. Hypertension was the most prevalent comorbidity (72.0%). Over the six-month follow-up period, significant reductions were observed in mean CFT (459.00 µm to 379.92 µm, p < 0.001) and MV (9.05 mm³ to 8.44 mm³, p < 0.001) values. Although BCVA showed modest improvement, it did not reach statistical significance. Anatomical improvements align with aflibercept’s inhibition of VEGF-A and placental growth factor, which reduced vascular permeability. Conclusion. Intravitreal aflibercept significantly decreases retinal thickness and MV in patients with CI-DME, confirming its anatomical efficacy. Functional visual improvement was limited, possibly due to chronic retinal damage. In order to clarify the effect of intravitreal aflibercept on visual outcomes, longer-term studies with larger patient cohorts are required.

Pleural hydatidosis secondary to intrapulmonary echinococcosis: a case report

2026-06-25T14:53:17+02:00

Introduction. Hydatid cysts are most often found in the liver and lungs, while other locations are rarely involved. Pleural hydatidosis, whether primary or secondary, is rarely seen in clinical practice. Case report. In this article, we present a case of a 33-year-old woman who presented with cough and dyspnea. Initial chest X-ray showed a large right-sided pleural effusion. Pleural hydatidosis was suspected based on the findings of the computed tomography scan of the chest. Right thoracotomy and cystectomy were performed. Albendazole was administered postoperatively for 6 months, and during this period, liver function tests and abdominal ultrasonography showed no abnormalities. Conclusion. This case emphasizes that pleural hydatidosis should be suspected in patients with pleural effusions and large cystic formations found on imaging, especially in endemic areas.