HEALTH CARE

GLOBAL GEOGRAPHY OF INFECTIVE ENDOCARDITIS PATHOGENS: ETIOLOGY AND RESISTANCE IN THE 21ST CENTURY

Saška Trnkić Andrejević — 2026-05-29

Introduction/Aim: The etiology of infective endocarditis is diverse and complex. It varies significantly depending on geographical region, socioeconomic conditions, healthcare availability, and the prevalence of predisposing factors. The aim of this paper is to analyze the global geographical distribution of infective endocarditis pathogens in the 21st century, focusing on regional differences in etiology, diagnostics, therapy, and antimicrobial resistance.

Methods: A secondary data analysis was conducted. Descriptive statistics were used to quantify pathogen frequency, the prevalence of resistant strains, and regional etiological differences.

Results: In developed regions (North America and Western Europe), Staphylococcus aureus predominates, often associated with healthcare settings (30–35%) and high rates of MRSA resistance (up to 28%). Conversely, in developing countries, streptococci remain more prevalent, alongside the persistence of rheumatic heart disease. The availability of transesophageal echocardiography (TEE) and surgical treatment is significantly higher in developed countries, which directly contributes to a lower mortality rate (14–15%) compared to resource-limited regions (22%).

Conclusion: Infective endocarditis has evolved into a disease associated with modern medicine and aging populations in developed countries, while in the rest of the world, it remains strongly associated with low socioeconomic conditions. High mortality and increasing resistance necessitate the global standardization of diagnostics and locally adapted therapeutic strategies.

DARIER DISEASE –A RETROSPECTIVE SERIES OF 67 CASES

Nađa Nišević — 2026-05-29

Introduction/Aim: Darier disease is a rare autosomal dominant genodermatosis caused by mutations in the ATP2A2 gene and characterized by distinct clinical and histopathological findings. The aim of this study was to present the epidemiological and therapeutic characteristics of patients with Darier disease treated at a tertiary care center over a fifteen-year period.

Methods: A retrospective cohort study including 67 patients diagnosed with Darier disease and treated at the Clinic of Dermatovenereology, University Clinical Center of Serbia, Belgrade, Republic of Serbia, was conducted. The diagnosis was established based on characteristic clinical presentation and histopathological confirmation. Epidemiological, clinical, and therapeutic characteristics were analyzed.

Results: Female predominance (66%) was observed in the study population, while the first skin lesions most commonly appeared during adolescence and early adulthood. Positive family history was recorded in 48% of patients, supporting the autosomal dominant inheritance pattern. Lesions were predominantly localized on the trunk (85%). Neuropsychiatric comorbidities were observed in 16% of patients. Topical therapy was used in all patients, whereas systemic retinoids were administered in 51% of patients, predominantly in generalized forms of the disease.

Conclusion: The results highlight the chronic course of the disease, marked phenotypic variability, and the need for individualized therapeutic approaches.

PROBIOTIC SUPPLEMENTATION FOR THE RESTORATION OF INTESTINAL MICROBIOTA IN NEWBORNS BORN BY CESAREAN SECTION

Ivana Stepanović — 2026-05-29

The early establishment of intestinal microbiota in newborns is significantly disrupted in children born by cesarean section, characterized by the absence of beneficial anaerobic bacteria and an increased proportion of opportunistic microorganisms. This initial dysbiosis is associated with an increased risk of allergies, infections, and other immune imbalances. Probiotic supplementation represents a strategy to correct these disorders. The use of specific strains, particularly from the genera Lactobacillus and Bifidobacterium, can accelerate the colonization of the intestinal microbiota to resemble that of vaginally born children. These probiotics modulate the immune response, reducing the Th2 profile and promoting anti-inflammatory signals, while simultaneously strengthening the intestinal barrier and enhancing the production of short-chain fatty acids. Clinical data indicate positive effects, including a reduction in gastrointestinal complaints and the incidence of necrotizing enterocolitis in preterm infants, as well as improved immune markers. The mechanisms of action include competition for resources, production of bacteriocins, and interaction with immune cells. Although existing evidence supports the potential of probiotics in restoring the microbiota, variability in studies highlights the need for long-term monitoring and standardized protocols to fully assess health outcomes in this population.

NUTRITIONAL INTERVENTIONS AND COGNITIVE OUTCOMES IN CHILDREN FROM TWO TO SIX YEARS OF LIFE

Ivana Stepanović — 2026-05-29

The development of cognitive abilities in children aged 2 to 6 years is significantly influenced by nutritional status. This research examines the effectiveness of nutritional interventions that depend on biological, social, and educational factors. Prenatal supplementation and higher maternal education are associated with more favorable cognitive outcomes, while children born with low birth weight show longer-lasting delays. The effectiveness of interventions varies. Multinutrient supplementation with five or more nutrients demonstrates a broader impact on cognitive functions compared to targeted supplementation. The period between 6 and 18 months of age is particularly important for the implementation of intervention programs. Integrating nutritional support with educational approaches that include structured play and physical activity can promote the parallel development of motor and cognitive skills. Methodological challenges include the need for randomized controlled trials, longer follow-up periods, and the use of laboratory biomarkers to assess nutrient status. Results indicate that the effects of interventions depend on the initial nutritional and health status of the child, the duration of treatment, and the social context. Recommendations for future work include expanding research to rural populations and children with special needs, standardizing measurement methods, and conducting long-term monitoring to assess the sustainability of benefits. This holistic approach emphasizes the importance of coordination between the health and education sectors to enhance cognitive development.

PAIN MEDICINES WITH SPECIAL REFERENCE TO TRAMADOL

Tatjana Ristić — 2026-05-29

Pain represents a significant medical and social problem because it affects daily functioning, as well as psychological, emotional and social well-being, causing significant economic and health problems. Pain control is one of the main goals of modern medicine, and the drugs used for this purpose are called analgesics. There is no one-size-fits-all medicine for every type of pain. That is why an individual approach to each patient is of key importance for the treatment and prevention of the recurrence of the disease. The aim is to demonstrate that the use of tramadol in relieving and reducing pain, with clearly defined indications, strictly controlled administration, precisely determined dosage and limited duration of use, can be an effective therapeutic option for the treatment of moderate and moderately severe pain when first-line medications are insufficiently effective or contraindicated. "The medicine is both medicine and poison at the same time!" When it is used according to the indications and instructions, it exerts its positive effect, and in the second case, when the indications, therapeutic doses, time intervals and length of therapy are not followed, it then exerts its negative effect. Healthcare professionals are required to assess the risk of addiction before starting therapy.

VOICE AND SPEECH IN PARKINSON'S DISEASE: CLINICAL CHARACTERISTICS OF HYPOKINETIC DYSPHONIA

Ivana Ilic Savic — 2026-05-29

Parkinson's disease is a chronic, progressive neurodegenerative disease that is primarily manifested by motor disorders, but significantly affects voice and speech. One of the frequent and clinically significant manifestations of the disease is hypokinetic dysphonia, which occurs as a result of central dopaminergic deficit and hypokinesia of muscles involved in respiration, phonation and articulation. The aim of this review is to present the basic neurological and clinical characteristics of Parkinson's disease, the mechanisms of hypokinetic dysphonia, as well as the voice, speech and paralinguistic characteristics of patients with this disease, while considering the implications for clinical and speech therapy practice. The search for relevant sources was carried out using Google Scholar Advanced Search and the Consortium of Libraries of Serbia for Unified Procurement (KoBSON), where modern sources from the fields of neurology, phoniatrics and speech therapy were analyzed. The results of the review indicate that voice and speech disorders, including hypophonia, monotony, reduced intonation variation and disorganized prosody, significantly impair communication and the quality of life of sufferers. Paralinguistic communication deficits, which contribute to the social isolation of patients, are especially pronounced. It is concluded that timely recognition of hypokinetic dysphonia and an interdisciplinary approach, along with active involvement in speech therapy treatment, is of key importance for preserving communication skills and improving the overall functioning of people with Parkinson's disease.

THE IMPLEMENTATION OF THE NURSING PROCESS IN A PERSON WITH MENTAL HEALTH PROBLEMS: A CASE REPORT

Ana Žigić — 2026-06-22

Introduction/Aim: The Nursing Process (NP) represents a fundamental, systematic, and individualized method of work in nursing that enables a holistic approach to the patient. Its application is of particular importance in psychiatric care, where the needs of users are complex and require continuous monitoring of subjective and objective indicators of mental state. The aim of this paper is to demonstrate the application of the NP in a person with a chronic mental disorder through a case report.

Case report: The research was conducted at the Home for Mentally Ill Persons "1. oktobar" in Stari Lec. The subject is a 61-year-old male patient with a medical diagnosis of F20.0 (paranoid schizophrenia). The patient has been institutionalized since 2013, and the clinical presentation is characterized by auditory hallucinations, rapid thought flow (tachypsychia), elevated mood (hyperthymia), and increased volitional activity (hyperbulia) without the realization of plans. Additionally, sleep disturbance (insomnia) and strained family relationships with the father were identified. By applying the NP, seven nursing diagnoses were identified. The care plan included 15 independent and 6 interdependent nursing interventions. Key nursing measures included: establishing a therapeutic relationship and trust; continuous monitoring and control of hallucinations; implementing a hygienic-dietary regimen to regulate sleep; guiding the patient during logorrheic speech; providing support in maintaining social contacts with his sons. The evaluation determined partial achievement of goals in terms of behavioral stabilization and better cooperation in self-care activities.

Conclusion: The case report confirms that the NP allows for a comprehensive assessment of the patient's needs and a clear definition of the nursing role within a multidisciplinary team. It is essential to implement the NP into mandatory nursing documentation at the national level to ensure the quality, continuity, and legal security in the treatment and care of persons with mental health disorders.