Uvod: Ne postoji standardna, operativna definicija nezadovoljenih potreba za zdravstvenom zaštitom koja bi omogućila globalno praćenje i uporedivost između zemalja.
Jedna od definicija je da one predstavljaju razliku između zdravstvenih usluga koje se smatraju neophodnim za određeni zdravstveni problem i usluga koje su stvarno
dobijene.
Uprkos važnosti obezbeđivanja prava ljudi na zdravlje, trenutni načini merenja kvaliteta zdravstvenih usluga ne uključuju merenje nezadovoljenih zdravstvenih potreba. Na
76. Skupštini Svetske zdravstvene organizacije (SZO) (2023.), usvojena je rezolucija kojom se zahteva od generalnog direktora SZO da preispita važnost i izvodljivost
korišćenja nezadovoljenih potreba za zdravstvenim uslugama kao dodatnog indikatora za praćenje univerzalne zdravstvene pokrivenosti, na nacionalnom i globalnom nivou.
Cilj istraživanja je uporedna analiza neostvarenih potreba u populaciji starih u zemljama evropskog regiona, kao i analiza prediktora neostvarenih zdravstvenih potreba
populacije starih u Republici Srbiji (RS).
Metod: Kao izvor podataka korišćeno je EU-SILC (Survey on Income and Living Conditions) istraživanje koje se sprovodi u svim zemljama Evropske unije (EU), kao i podaci iz
Nacionalnog istraživanja zdravlja stanovništva, sprovedenog 2019. godine u RS u populaciji stanovništva 65 i više godina.
Rezultati istraživanja. U 2023. godini, 3,8% ljudi starosti 16 godina i više u EU imalo je nezadovoljene potrebe za lekarskim pregledom ili lečenjem. Iz razloga vezanih za
organizaciju i pružanje zdravstvenih usluga (preskupe usluge, predaleko putovanje ili liste čekanja), 2,4% ljudi u EU je imalo nezadovoljene zravstvene potrebe, a taj udeo se
kretao od 0,1% na Kipru i Malti do 11,6% u Grčkoj i 12,9% u Estoniji.
U EU postoji pozitivna korelacija izmedju starosne dobi i neostvarenih zdravstvenih potreba, ali to nije slučaj u svakoj zemlji pojedinačno.
Primer pozitivne korelacije je Grčka, gde je udeo najstarije dobne grupe sa neostvarenim potrebama bio skoro 30 procentnih poena veći nego udeo najmlađe dobne grupe (16-
44 godina). Suprotnost je Danska gde neostvarene potrebe dominiraju u najmlađoj starosnoj grupi, ali sa mnogo manjim opsegom razlike.
Prema rezultatima poslednjeg Nacinalnog istraživanja zdravlja stanovnika RS, 32% stanovnika starosti 65 i više godina nije ostvarilo potreban oblik zdravstvene zaštite.
Najčešći razlozi neostvarenih potreba su finansijski razlozi, potom liste čekanja, a zatim udaljenost i problemi sa prevozom. Finansijske probleme kao uzrok neostvarenih
potreba u 2013. godini navelo je 16,1% ispitanika starih 65 i više godina i 23,2% u 2019. Uočeni porast broja ispitanika kod kojih je izostala potrebna zdravstvena zaštita usled
finansijskih poteškoća statistički je značajan (p<0,05).
Loše materijalno stanje, muški pol, region Vojvodine i Beograda, loše zdravstveno stanje (samoprocena), prisustvo hroničnog poremećaja zdravlja, nezgode u kući u proteklih
mesec dana, bolovi koji uzrokuju ograničenja u obavljanju uobičajenih aktivnosti, korišćenje usluga dnevne bolnice, hitne medicinske pomoći i usluga tradicionalne medicine,
predstavljaju prediktore neostvarenih zdravstvenih potreba stanovništva starosti 65 i više godina u Republici Srbiji.
Zaključak: Neostvarene zdravstvene potrebe su važan pokazatelj nejednakosti u zdravlju i mogu se koristiti kao dopuna standardnim metodama u proceni nejednakosti na
nacionalnom i lokalnom nivou. One mogu dovesti do lošijih zdravstvenih ishoda, naročito najugroženijeg dela populacije, do visoke zdravstvene potrošnje i gubitka
produktivnosti za pojedince i društvo.
Ključne reči: Neostvarene zdravstvene potrebe, populacija starih, nejednakosti u zdravlju

U savremenom svetu gde se zarazne bolesti šire brže nego ikada, imunizacija ostaje naša najsnažnija odbrana. Vakcinacija je most koji povezuje
iskustva prošlih pandemija sa nadom u budućnost bez epidemija – zasnovana na znanju, solidarnosti i pravovremenoj zaštiti. Međutim, globalne krize
poput pandemije COVID-19, geopolitičkih tenzija i poremećaja u lancima snabdevanja pokazale su koliko su države koje zavise od uvoza vakcina
ranjive, naročito u vanrednim situacijama. U tom kontekstu, koncept „vakcinalne nezavisnosti“ postaje ne samo strateško, već i pitanje nacionalne
bezbednosti.
“Vakcinalna nezavisnost” podrazumeva sposobnost jedne države da razvija, proizvodi i distribuira vakcine za sopstvene potrebe. Osim što omogućava
pravovremen i adekvatan odgovor na izbijanje epidemija, ona doprinosi stabilnosti zdravstvenog sistema, jačanju poverenja građana, ekonomskom
razvoju i naučnoj autonomiji. Institut za virusologiju, vakcine i serume „Torlak“, sa tradicijom dugom jedan vek, predstavlja stub vakcinalne
bezbednosti Srbije i regiona. Obnova i modernizacija kapaciteta Instituta omogućila je ponovno pozicioniranje Srbije kao značajnog aktera u
regionalnoj vakcinalnoj politici. Tokom poslednjih godina, kroz strateška ulaganja i modernizaciju, Institut je napravio iskorak ka savremenim
biotehnološkim kapacitetima koji omogućavaju brži i efikasniji odgovor na izazove savremenih epidemija. Posebno važan iskorak predstavlja izgradnja
pogona za RNK (iRNK) tehnologiju, čime se Srbija svrstava među retke zemlje koje razvijaju i implementiraju ovu najsavremeniju platformu za
proizvodnju vakcina nove generacije. Ova tehnologija omogućava brzu prilagodljivost u razvoju vakcina protiv novih sojeva virusa, što je od presudnog
značaja u svetu brzih mutacija i pandemijskih pretnji. Pored toga, u okviru Instituta Torlak izgrađena je nova dijagnostička zgrada najvišeg
bezbednosnog nivoa – BSL3, koja omogućava rad sa visoko patogenim mikroorganizmima. Time je značajno ojačan kapacitet za pravovremenu i
preciznu laboratorijsku dijagnostiku zaraznih bolesti, ali i za razvoj i kontrolu bioloških preparata u skladu sa najvišim međunarodnim standardima.
Nacionalna „vakcinalna nezavisnost“ je oslonac zdravstvene bezbednosti svake države. Ona se ne gradi preko noći, već zahteva dugoročnu strategiju,
političku volju i ulaganje u naučno-istraživačku i proizvodnu infrastrukturu. Očuvanje i jačanje institucija poput Instituta Torlak od presudne je
važnosti za osiguranje dostupnosti vakcina, ali i za jačanje međunarodne saradnje i uloge Srbije u globalnim zdravstvenim okvirima.
Ključne reči: vakcine, vakcinalna nezavisnost, Institut Torlak, javno zdravlje, zdravstvena bezbednost, Srbija 

U 2023. godini, 7,8 miliona ljudi širom sveta novodijagnostikovano je sa tuberkulozom (TB), čime je TB ponovo postala vodeći uzrok smrti među
 zaraznim bolestima – nadmašivši COVID-19. Uprkos napretku u dijagnostici i lečenju, globalno opterećenje TB i dalje opada sporo, 1,5–2%
 godišnje. Na to utiču brojni faktori: velika baza osoba latentno inficiranih bacilom tuberkuloze bez manifestne aktivne bolesti, sve češći faktori rizika
 za endogenu reaktivaciju bolesti, globalno starenje populacije, sporo i nedovoljno otkrivanje slučajeva, niske stope izlečenja, rastuća otpornost na
 lekove i ko-infekcija sa HIV-om. Da bi se ostvario dalji napredak i eliminisala TB, neophodno je ubrzano ulaganje u inovacije. Prioriteti uključuju
 razvoj brzih dijagnostičkih testova koji se mogu koristiti na licu mesta, širu primenu digitalnih alata i veštačke inteligencije, stvaranje bezbednijih i
 efikasnijih lekova i kraćih režima lečenja, primenu vakcina za pre- i post-ekspoziciju, kao i povećanje dostupnosti novih alata i tehnologija u
 regionima sa najvećim opterećenjem.
 Ključne reči: tuberkuloza; opterećenje bolesti; dijagnostika; inovacije u lečenju; strategije eliminacije

The metabolic syndrome (MS) is a clinical entity of substantial heterogeneity, represented by the combination of obesity (especially central obesity),insulin resistance, impaired glucose tolerance, atherogenic dyslipidemia (high triglyceride levels and low levels of HDL-cholesterol (HDL-C)), and hypertension. Childhood obesity has become more common as a result of urbanization, bad diets, and more sedentary lifestyles.

The incidence of metabolic syndrome is ten times higher in children with obesity, and a special risk factor is the presence of obesity in the pediatric population, the classification of metabolic syndrome is based on standards set by the International Diabetes Federation (IDF).

Our goal is to summarize the diagnostic procedure of metabolic syndrome as well as comorbidity based on conventional methods and modern imaging procedures by analyzing the published papers.

Objective:

To investigate correlation between ultrasonically calculated urinary bladder weight and lower urinary tract symptoms (LUTS).

Methods:

3D and 2D measurement of parameters necessary to determine bladder weight: Inner and outer radius of the bladder, in 10 male and 10 female patients with LUTS, with urinary bladder filled to at least 200 ml of urine volume.

Results:

Average urinary bladder weight in males was 53,8 g and in female patient was 45,2 g. We found no statistically significant difference between male and female patients, all with LUTS. We also found that patients in LUTS have hypertrophied bladder, which means that urinary bladder mass should be larger and results in an increase of blader weight and both inner and outer radius of the urinary bladder, that should be detected ultrasonographically, but not too much over of pre- determined variations of normal bladder weight.

Conclusion:

Estimation of urinary bladder weight should be considered as non-invasive approach to patients with LUTS. However, it is more plausible to measure only urinary bladder wall thickness ultrasonically than to calculate urinary bladder weight without built-in software.

Introduction:

Diabetes insipidus (DI) is a disease that occurs due to inappropriate secretion of anti-diuretic hormone from the pituitary, or as a result of disorder in which the level of the kidneys cannot adequately respond to the secretion of this hormone. Also, it is known as central diabetes insipidus. The most common causes are head traumas, tumors of the hypothalamus and pituitary glands, inflammatory processes, histiocytosis, anomalies in the development of brain. It can appear in the form of familial diabetes insipidus or in certain syndromes (Wolfram syndrome). It is characterized by hypotonic polyuria higher than 3l/24h (which persists if even taking liquids stops), then by nocturia and compensatory polydipsia. Enuresis often occurs among children.

Case report:

A boy, aged 11, lives with his mother and brothers. Mother noticed that the boy was urinating frequently in last few months (diuresis 4.6 l/24h, and 3.25 l/24h). After two months, the boy developed double images and severe headaches, vomiting, inability to see, squinting in the right eye and headache in the back of the head. MNR of the endocranium indicates the presence of a tumor formation. The tumor was surgically removed, and the boy started with chemotherapy and radiotherapy. Due to persistent diabetes insipidus, the boy started using desmopressin-acetate - in tablet form. Active substance desmopressin - acts in the same way as the natural hormone vasopressin and regulates the kidney's ability to concentrate urine. The positive effect of taking the drug appeared after three weeks from the start of taking the therapy.

Conclusion:

Central (neurogenic) DI occurs as a result of a relative or absolute deficiency of antidiuretic hormone, which is responsible for the osmolality of body fluids. Based on this case, we want to show the importance of early diagnosis of the disease in order to improve the prognosis and the necessity of careful monitoring of these patients.

The discovery that sunlight can cure rickets was first scientifically confirmed in 1919. Shortly thereafter, in 1924, it was found that inactive lipids in the diet and skin are converted into antirachitic substances under the influence of UV light. Vitamin D (Vit D), also known as the "sunshine vitamin,"
was first identified in 1931. In recent decades, it has regained the focus of interest among the broader scientific community and dermatologists.
Specifically, certain dermatoses have been associated with low Vit D levels, leading to its supplementation in patients. On the other hand, some
dermatoses worsen with sun exposure, necessitating strict avoidance of sunlight and the therapeutic use of Vit D preparations.We are witnessing a
growing number of cases of melanoma and non-melanoma skin cancers, with excessive sun exposure being the primary etiological factor in most
cases. This paper provides a literature review on the historical discovery of Vit D and presents findings from studies examining Vit D levels not only in
various dermatoses but also in other diseases. The number of studies, as well as the spectrum of diseases in which the role of Vit D is being
investigated, continues to increase.

This article focuses on the sonographic axamination techique for evaluation of intracranial translucencies during the first trimester ultrasound scan. Appropriate knowledge of sonographic landmarks is the most important factor for evaluation normal as well as abnormal brain structure, and this examination may enable detection of open spina bifida and Arnold – Chiari anomaly at an early stage of fetal develpoment.

Introduction/Objective

The objective of this study was to examine the relationship between use of psychoactive substances among University students and diagnosed somatic or mental disorders.

Methods

The cross-sectional study was conducted in a population of 2,000 students of the Belgrade University. Four faculties (Medicine, Geography, Economics, Electrical Engineering) from which the students participating in this research were chosen by the method of random choice (by computer listing), conducted in the period April - June 2010.

Results

We observed that are more numerous students who used psychoactive substances among students with diagnosed somatic illnesses compared to those without them. Statistical significance was found among students who used tobacco (p=0.027), alcohol (p=0.002), sedatives (p&lt;0.001) and cannabis (p=0.021). Mental disorders are also connected to use of psychoactive substances. The statistical significance was achieved for all psychoactive substances except for alcohol.

Conclusion

Use of psychoactive substances is an important issue among University students with diagnosed somatic or mental disorder. Therefore, it is essential to recognize the symptoms and consequences of such behavior, and above all and connection thereof, the importance of prevention which may enhance better solution-seeking via proper education.

Introduction: Paraneoplastic pemphigus is an autoimmune bullous and erosive mucocutaneous syndrome associated with malignancy. First of all, it is associated with lymphoproliferative disorders, but also with solid tumors.

Case report: We present a 73-year-old female patient who developed polymorphic lesions on the skin and mucous membranes after treatment of nonHodgkin's lymphoma. Disseminated pale erythematous macules, exudative papules and plaques, papulovesicles, pustules, targetoid lesions and bullae are present on the skin, mostly with a flaccid roof, some with a hypopyon. Oral mucosal changes included erosions and ulcerations covered by fibrin deposits. Histopathological examination of several biopsies revealed the presence of interface dermatitis, eosinophils, necrotic keratinocytes, as well as intraepidermal cracks with acantholytic cells, dominated by eosinophils. Direct immunofluorescence microscopy of the perilesional skin showed fluorescent intraepidermal reticular IgG deposits, as well as segmental linear IgG deposits along the basement membrane zone. Indirect immunofluorescence microscopy revealed circulating IgG autoantibodies binding to monkey esophagus and rat bladder at a titer of 1:320. Initially, he was treated with systemic corticosteroid therapy, then, in consultation with a hematologist, rituximab therapy was indicated (375 mg/m2, 4 doses once a week). The patient died after the 2nd dose of rituximab.

Conclusion: Considering the different clinical, histopathological and immunological features, paraneoplastic pemphigus presents a challenge for the clinician. Knowledge of different clinical presentations, as well as individualization of therapy with a multidisciplinary approach, are of crucial importance.