Introduction: Peptic ulcer is a chronic recurrent disease of the gastrointestinal tract, which most often occurs as gastric or duodenal ulcer. Peptic ulcer is characterized by certain geographical and temporal trends.

Objective: The aim of this study is to determine the frequency of gastric and duodenal ulcers among subjects who underwent esophagogastroduodenoscopy (EGDS) endoscopy due to dyspeptic complaints, as well as to analyze the trend of ulcer disease over a period of 10 years.

Material and Methods: The data of a total of 4074 subjects with an average age of 54.53 ± 15.03 years, both sexes, 1841 men and 2233 women, who underwent EGDS in 2005 and 2015 calendar years were retrospectively analyzed. Results: This study showed that the trend of ulcer disease significantly decreased in the observed ten-year period, accompanied by concomitant decrease in the prevalence of duodenal ulcers, while the frequency of gastric ulcers retained approximately at the same level. The results showed that men were at greater relative risk than women for the development of duodenal ulcers, in both calendar years. In the ten-year period, the average age of patients with ulcer disease increased by about 4 years, especially in the group with duodenal ulcer, and particularly within women with duodenal ulcer. Compared to 2005, the average age of subjects undergoing EGDS in 2015 increased by about 2 years, regardless of whether or not they were diagnosed with ulcer disease.

Conclusions: In the period 2005 - 2015, the age of patients with peptic ulcer tended to increase, whilst the prevalence of ulcer disease, especially duodenal ulcer, has decreased. The relative risk for duodenal ulcer in men was higher than in women. 

Introduction: Syncope is a sudden, short-lived, transient loss of consciousness associated with the inability to maintain postural tone. The aim of this paper is: to determine the frequency of syncope in children and adolescents in our conditions, to analyze the characteristics of syncopal episodes and clinical presentation in order to identify the etiology of seizures, and to provide diagnostic protocols, i.e. guidelines for streamlining clinical trials.

Methodology: The diagnosis of the disease was made clinically on the basis of well-taken anamnestic data and a detailed description of the quality of the attack, physical examination and routine laboratory analyzes: (CBC, glycemia, standard ECG). Additional tests were selectively performed: Holter ECG, ergometry, Tilt table test, Echocardiogram, NMR, EEG.

Results: Out of the total number of examined children in the outpatient Children’s Hospital, Department of Pediatric Cardiology, 139 patients (0.6%) reported due to short-term loss of consciousness. The largest number of children was between 15 and 18 years old. Ninety-two ( 66%) of those 139 were girls, and 47 (34%) were boys (p <0.05). Regarding the cause of syncope, it was found in 117 (84%) patients, and in 22 (16%) children the cause of syncope was unknown (p <0.05). Etiologically spreaking, syncope was divided into 3 groups: autonomic (vasovagal, situational, orthostatic, increased vagus tone in athletes) was the most common, in 88 patients (75%), cardiogenic in 5 (4%) and non-cardiogenic in 24 patients.(21%). There was also a recurrence of the attack. In two children, the syncopal attack was repeated 4 times.

CONCLUSION: Syncope most often occurs in teenagers and is mostly benign. To assess syncope, it is necessary to gather a detailed history of the attack, to conduct a detailed physical examination and routine laboratory analyzes: CBC, glycemia and standard ECG. Supplementary diagnostics should be performed exclusively in patients where there is a reasonable suspicion of heart disease or neurological diseases. 

Kawasaki disease (KD) is an acute, self-limited vasculitis of unknown etiology that occurs predominantly in children under the age of 5 years. In addition to the progress of modern medicine, the cause of KD is currently unknown and specific diagnostic tests for definitive diagnosis does not exist. The differential-diagnostic enigma is the exclusion of other diseases with similar clinical features. The primary treatment in the acute phase of KD is intravenous immunoglobulin (IVIG) and acetylsalicylic acid (ASA/aspirin). There is not a recommendation to a uniform therapeutic approach in refractory KD. The role of corticosteroids is still controversial, but there are studies that support its use as adjuvant treatment. Most patients have a good prognosis. The focus of future research should be the formulation of new algorithms for detection, differential diagnostic triage and treatment of KD. 

Introduction: This study highlights the importance of transitioning to a modern approach to outpatient surgery, analyzing the safety and feasibility of this treatment model in patients undergoing hemithyroidectomy or total thyroidectomy, with a focus on postoperative complications.

Materials and Methods: Data were collected from the medical records of 626 patients over a five-year period, from 2011 to 2015, at the Surgery Clinic of the "Dr Dragiša Mišović – Dedinje" in Belgrade. This period allowed for a reliable analysis of the safety and feasibility of outpatientthyroid surgery.

Results: A total of 97 hemithyroidectomies and 529 total thyroidectomies were performed. The average age of hemithyroidectomy patients was 51.24 years, and for total thyroidectomy patients, it was 54.88 years. The most common substrates were benign tumors (over 50%) for hemithyroidectomies and multinodular goiters (almost 50%) for total thyroidectomies. The average hospital stay was 1 day for hemithyroidectomies and 1.48 days for total thyroidectomies. Complications included postoperative bleeding (0.57%), subcutaneous hematoma (1.32%), subcutaneous seroma (2.08%), temporary hypocalcemia or hypoparathyroidism (18.9%), permanent hypocalcemia or hypoparathyroidism (0.76%), temporary vocal cord paralysis (2.65%), permanent vocal cord paralysis (1.89%), bilateral vocal cord paralysis (0.19%), and mortality (0%).

Conclusion: The study confirmed the feasibility and safety of outpatient thyroid surgery, with minimal complications and short hospital stays, especially for hemithyroidectomy, but careful postoperative monitoring is required for patients undergoing total thyroidectomy. 

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. 

Background: People with diabetes more often experienced severe clinical forms of COVID-19. However, it has been hypothesized that certain antidiabetic drugs may be associated with better outcomes in COVID-19 patients. The aim of this study was to analyze whether the COVID-19 pandemic influenced the change in consumption of antidiabetic drugs in Serbia.

Methods: This descriptive analysis was carried out using publicly accessible data obtained from the official website of the Medicines and Medical Devices Agency of Serbia during the period 2006-2022. The joinpoint regression analysis was applied to investigate the dynamics of antidiabetic drugs utilization over time.

Results: In the Republic of Serbia, this study analyzed the use of 28 antidiabetic drugs between 2006 and 2022.The results showed that at the beginning of the COVID-19 pandemic, there was an increase in consumption of dulaglutide (starting from 2020) and a decrease in consumption of insulin detemir (starting from 2019), insulin lispro (combined) and insulin lispro (fast-acting) (starting from 2020).

Conclusion: Our study revealed significant changes in the usage of certain antidiabetic drugs, such as increased consumption of dulaglutide and decreased use of various insulin types. These changes reflect the evolving strategies in diabetes treatment to better support patients during this global health crisis.

Key words: antidiabetic drugs, impact of Covid-19, consumption, Serbia

Uvod: Dispepsija je čest gastroenterološki sindrom koji značajno narušava kvalitet života. Infekcija bakterijom Helicobacter pylori (H. pylori) ključni
 je faktor u razvoju organske dispepsije, dok njena povezanost sa funkcionalnom dispepsijom ostaje predmet istraživanja.
 Cilj: Ispitati prevalenciju H. pylori infekcije kod pacijenata sa dispepsijom i njenu povezanost sa simptomima, endoskopskim nalazima i hematološkim
 parametrima
 Metode: Retrospektivna studija obuhvatila je 117 pacijenata sa dispepsijom pregledanih tokom 2023. godine na Internoj klinici KBC Priština-Gračanica
 u Lapljem Selu. Svi su podvrgnuti gornjoj gastrointestinalnoj endoskopiji i testiranju na H. pylori antigen u stolici. Analizirani su demografski podaci,
 simptomi, endoskopski i hematološki nalazi.
 Rezultati: H. pylori infekcija je potvrđena kod 63,25% pacijenata, bez značajne razlike između polova. Zabeležen je trend porasta prevalencije sa
 godinama, ali bez statističke značajnosti (p=0,060). Epigastrični bol (p=0,0068) i gorušica (p<0,0001) su bili značajno češći kod H. pylori pozitivnih
 pacijenata, dok su hronični gastritis (p=0,005) i duodenalni ulkus (p=0,029) bili dominantni endoskopski nalazi kod ove grupe. Značajno veći procenat
 H. pylori pozitivnih pacijenata imao je snižene vrednosti broja eritrocita i hemoglobina u odnosu na negativnu grupu (p<0,01). Prosečan hematokrit
 bio je niži u H. pylori pozitivnoj grupi (p=0,013), ali se nije značajno razlikovao od referentnih vrednosti.
 Zaključak: H. pylori infekcija je česta među pacijentima sa dispepsijom i povezana sa specifičnim simptomima, patološkim endoskopskim nalazima i
 hematološkim promenama. Testiranje na H. pylori je ključno u proceni dispepsije, dok H. pylori negativni pacijenti sa upornim simptomima zahtevaju
 dodatnu dijagnostiku.
 Ključne reči: Helicobacter pylori; dispepsija; simptomi; endoskopski nalaz; hematološki parametri

 Ruptura potkožne tetive ekstenzora policis longusa (EPL) je jedna od najčešćih povreda tetiva ekstenzora šake. Ova vrsta povrede može biti posledica
 trauma ručnog zgloba. Češće se javlja kao posledica degenerativne ili inflamatorne bolesti. Ponekad se to dešava bez predisponirajućeg stanja, zbog
 kontinuiranih pokreta savijanja i opružanja palca šake.
 Ruptura tetive EPL-a se obično dešava u predelu Listerove kvrge gde su trenja najveća. Kontinuirano ponavljanje mikrotrauma može da uzrokuje
 rupturu. Engkvist i Lundborg [1] su postavili hipotezu o patogenezi mehanizama ove povrede.  Smatrali su da nakon trauma ili zapaljenja formiran
 hematom unutar omotača tetive dovodi do povećanja pritiska u neelastičnom prostoru. Povećanje pritiska može izazvati promene u snabdevanju krvi i
 može dovesti do nekroze i rupture struktura tetiva. Nakon prekida kontinuiteta tetive EPL-a, retrakcija proksimalnog okrajka je praćena
 degenerativnim procesima koji ugrožavaju direktnu suturu.
 Predloženi su mnogi tretmani, artrodeza interfalangealnog (IP) zgloba palca ili transpozicija tetive ekstenzor indicis proprius (EIP) koju je razvio
 Mensch 1925. god. [1].
 Transpozicija tetive šake je hirurška procedura која uključuje repozicioniranje funkcionalne tetive како bi se obnovila funkcija oštećene tetive šake.
 Ova operacija ima za cilj da vrati pokret, funkciju i snagu šake.
 U ovom radu prenosimo naše iskustvo u lečenja traumatske rupture tetive EPL-a metodom transpozicije tetive EIP-a. Opisujemo operativnu tehniku
 transfera tetive EIP-a na tetivu EPL.
 Ključne reči: trasnpozicija tetive, ekstenzor policis longus, ekstenzor indicis proprius, funkcija.

 Uvod: Kognitivni pojačivači (KP) poboljšavaju kognitivne funkcije putem neurotransmitera CNS-a. Čine raznorodnu grupu supstanci koje se
 svakodnevno uzimaju kao napici nalik kafi, biljni lekovi i dijetetski suplementi (“meki pojačivači”) ili lekovi koji se koriste u lečenju bolesti
 (nootropici). Upotreba i zloupotreba su česte u studentskoj populaciji sa brojnim etičkim pitanjima.  
Cilj: Utvrđivanje informisanosti studenata medicine, njihovih stavova o upotrebi i stepenu rizika od neželjenog delovanja KP, na osnovu pretpostavke
 da je upotreba ovih supstanci redovna.
 Materijal I metode: Studija preseka je sprovedena po tipu anonimnog anketnog istraživanja na Medicinskom fakultetu Priština sa privremenim
 sedištem u Kosovskoj Mitrovici. U ispitivanju su dobrovoljno učestvovali studenti medicine prve tri godine integrisanih studija koji nisu položili ispit iz
 predmeta Farmakologija sa toksikologijom. Upitnik je obuhvatio socio-demografske podatke, podatke o koncentraciji i navikama u učenju, stepen
 informisanosti, procenu upotrebe i procenu rizika korišćenja KP. Stratifikacija uzorka je izvršena prema polu studenata, a Likert-ova skala je poslužila
 za rangiranje stavova ispitanika.
 Rezultati: Od ukupnog broja anketiranih (n=249) u konačnu statističku analizu podataka uključeno je 169 anketnih upitnika (M 32,5 %, Ž 67,5%).
 Najviše studenata je bilo sa druge godine studija (40%), dok je najviše studentkinja bilo sa prve godine (48,2%). Uočena je statistički značajna razlika
 između ispitivanih grupa u odnosu na godinu studiranja (p=0,009).  Informacije o KP su novina za 40,2% ispitanika (M 49,1%, Ž 36%). Da je o njihovoj
 primeni dovoljno informisano smatra 23,7 % ispitanika (M 20%, Ž 25,4%). Postoji statistički značajna razlika u upotrebi internet baza za informisanje o
 KP (p<0,001).Najveći broj studenata (71,6%) koristi internet za informisanje o KP, pri čemu je korišćenje internet baza bilo statistički značajno veće
 kod žena u odnosu na muškarce (M 56,4 %,Ž 78,9 %; p=0,002). Više od polovine ispitanika (50,3%) koristi Mediately bazu kao pouzdanu bazu podataka o
 lekovima. Od ukupnog broja studenata 40,8% upotrebljava neki od navedenih KP (M 43,6%, Ž 39,5%). Najčešći razlozi za upotrebu kod obe grupe
 ispitanika su poboljšanje koncentracije (M 27,3%, Ž 28,9%) i uspešnije polaganje ispita (M 25,5%, Ž 15,8%). Oba pola najviše koriste ginko bilobu (M
 29,1%, Ž 32,5%) i metilksantine (M 29,1%, Ž 17,5%). Studenti znatno češće upotrebljavaju kreatin u odnosu na studentkinje (M 20%; Ž 2,6%; p=0,003).
 Obe grupe studenata su prema medijani i interkvartilnom opsegu (25-75%) uočenog rizika od neželjenih reakcija rangirale kokain (M 9,0; Ž 9,0),
 metamfetamin (M 8,0; Ž 8,0) i amfetamin (M 8,0; Ž 7,0) kao najopasnije, dok je ginko biloba procenjena kao najbezbedniji KP (M 3,0; Ž 3,0). 
Zaključak: Većina studenata nije dovoljno informisana o kognitivnim pojačivačima, iako ih koriste samoinicijativno, radi postizanja boljih rezultata na
 studijama. Neophodno je studente uputiti na adekvatne izvore informisanja i organizovati vannastavne tribine i predavanja o bezbednosti i efikasnosti
 KP pre upotrebe. U skladu sa trendovima u svetu, može se očekivati porast zloupotrebe nootropika na univerzitetima i u našoj zemlji. Smatramo da bi
 trebalo ponoviti ili organizovati slično ispitivanje kroz par godina, po mogućstvu u većem obimu.
 Ključne reči: kognitivni pojačivači, informisanost studenata, stavovi studenata

Sveži prelomi u ortopedskoj hirurgiji i traumatologiji, dovode do hemodinamske nestabilnosti celokupnog organizma. Kod otvorenih preloma, stepen
 hemodinamske nestabilnosti organizma je značajno veći. Prioritet u lečenju svežih preloma ima DAMAGE CONTROL IN ORTHOPEDIC (DCO). DCO je
 invazivna procedura koja ima ulogu kako u stabilizaciji preloma, tako i u kontroli krvarenja. Prelomi dugih kostiju kao i prelom karlice su apsolutna
 indikacija za DCO. Slobodno možemo reći da ova procedura prestavlja prioritet u lečenju svežih preloma. Procedura je individualizovana u zavisnosti
 od težine povrede kao i  hemodinamskog statusa povređenog pacijenta. U ortopedskoj hirurgiji i traumatologiji kao standardna procedura u DCO
 koristi se spoljašnji fiksator po Mitkoviću. Ortopedski hirurzi moraju biti jako prisebni i obazrivi kod pregledapacijenata sa politraumom i da
 prepoznaju tkzv. trougao smrti. Trougao smrti čine: acidoza, hipotermija i koagulopatija. Svaka karika je medjusobno povezana jedna sa drugom
 dovode do ireverzibilnih promena u organizmu što za posledicu ima smrtni ishod. DCO se sprovodi u tri faze: 1) podrazumeva kontrolu kvarenja,
 smanjenje kontaminacija bakterijama, kao i privremenu fiksaciju preloma. Sve ovo je neophodno uraditi u roku od 1-2h.; 2)  obuhvata stabilizaciju
 vitalnih parametara u JIN-e kao i reanimacija pacijenta ordiniranjem neophodne terapije, krvi i krvnih derivata.; 3) podrazumeva definitivna metoda
 lečenja u smislu nastavka lečenja preloma spoljasnjim fiksatorom ili konverzija u neku drugu metodu lečenja.