Assessment of Sexual Health and Use of Cervical Cancer Screening among the Female Working Population.

Background: Cervical cancer occupies a significant place in the overall structure of morbidity and mortality in developing countries. We focused on the sexual health and use of cervical cancer screening among the female working population of reproductive age in Central Serbia. Methods: The research was conducted as a cross-sectional study, according to the methodology Stepwise approach to noncommunicable disease risk factor surveillance WHO. The study population consisted of 1182 female working population aged 18-49 years, living on the territory of Central Serbia. The method of simple random sampling was utilized in the research itself. An anonymous standardized questionnaire was used as a research tool. Results: During the first sexual intercourse, 38.9% of the participants reported not having used any of the contraceptives, whereas 74.5% of the participants reported not having used them during their last sexual intercourse and 26.1% of the respondents reported not having had a single Pap smear in their lifetime. The multivariate logistic regression analysis singled out the following factors in women who reported not having done a Pap smear in their lifetime as the most significant ones: age - the youngest age group (OR = 3.30, CI = 1.80-6.04), unemployment (OR = 2.87, CI = 0.07-3.40), women who had never been married or had never been in a common-law marriage (OR = 2.55, CI = 1.40-4.66) and individuals with a medium education level (OR = 2.63, CI = 1.67-4.14). Conclusion: In Serbia, all the activities should be directed towards increasing the levels of awareness and knowledge on sexual health and cervical cancer screening services.

Laboratory Puzzle of Oxidative Stress, Parameters of Hemostasis and Inflammation in Hospitalized Patients with COVID-19.

Bearing in mind that coronavirus disease (COVID-19) is associated with a wide range of laboratory abnormalities, the aim of this study was to examine the importance of determining the parameters of oxidative stress and antioxidant protection as well as markers of inflammation and hemostasis in hospitalized patients with COVID-19. The study population included 105 patients with severe COVID-19 and 65 healthy control subjects. The parameters of oxidative stress and the activity of enzymes of the antioxidant system were determined from the obtained samples using spectrophotometric methods. Standard laboratory methods were performed for the determination of the biochemical and hematological parameters. Patients with COVID-19 showed a significantly higher level of pro-oxidative parameters (hydrogen peroxide (H2O2) and the index of lipid peroxidation in the form of thiobarbituric acid-reactive substances (TBARSs)) and a significantly lower activity of the antioxidant system (catalase (CAT)). Patients with COVID-19 had significantly higher values of inflammation parameters (C-reactive protein (CRP), procalcitonin (PCT), ratio of the number of neutrophils to lymphocytes (NLR), and ratio of the number of platelets to lymphocytes (PLR)) and parameters of hemostasis (activated partial thromboplastin time (aPTT), prothrombin time (PT), D-dimer, fibrinogen) than the control healthy subjects. In addition, changes in hemostatic parameters correlated positively with inflammatory markers in the group of patients with COVID-19. The early determination of hemostasis parameters and the parameters of inflammation can help in the prediction of poor prognosis in COVID-19 patients.

Social support score in patients with malignant diseases-with sociodemographic and medical characteristics.

Introduction: Social support as a complex construct has a positive influence not only on a patient's condition but also on the process of the patient's emotional adjustment to cancer. The goal of this study is to investigate aspects of the level of social support in oncology patients and its interconnection with sociodemographic and medical variables. Method: The study was conducted as a prospective observational study in 2020, including 250 patients aged 19 and over, both sexes, with a diagnosis of oncological disease. The research was conducted in the Department of General Medicine of the Health Center Trstenik, Central Serbia, after approval by the Ethics Committee of the Health Center Trstenik, Central Serbia. A social support assessment questionnaire (Oslo-3 Social Support Scale) was used as a research instrument. Results: Data collected from the entire study population showed that bad social support was present in almost 90% of cases. Univariate and multivariate regression analysis showed a statistically significant influence of the following variables on the bad social support: education level, activity limitation, difficulties in performing daily activities, the impact of pain on the performance of activities, the need for additional help with activity, the need for help at home, unfulfilled needs for health care, means of information, anxiety score and depression score. Conclusion: Interventions to increase social support may be important for enhancing mental health and quality of life in cancer patients.

Children's Internet use and physical and psychosocial development.

Introduction: Internet use (IU) commonly refers to sedentary lifestyle and may be addictive, especially among children. The aim of this study was to investigate the relationship between IU and some aspects of child physical and psychosocial development. Methodology: We conducted a cross-sectional survey by using a screen-time based sedentary behavior questionnaire and Strengths and Difficulties Questionnaire (SDQ)-among 836 primary school children in the Branicevo District. The children's medical records were analysed for vision problems and spinal deformities. Their body weight (BW) and height (BH) were measured and body mass index (BMI) was calculated as BW in kilograms divided by BH in meters squared (kg/m2). Results: The average age of respondents was 13.4 (SD 1.2) years. The mean duration of daily Internet use and sedentary behavior was 236 (SD 156) and 422 (SD 184) minutes, respectively. There was no significant correlation between daily IU and vision problems (near sightedness, farsightedness, astigmatism, strabismus), and spinal deformities. However, daily Internet use is significantly associated with obesity (p < 0.001) and sedentary behavior (p = 0.01). There was significant correlation between emotional symptoms with total Internet usage time, and total sedentary score (p < 0.001 for both, r = 0.141 and r = 0.132, respectively). There was a positive correlation between the total sedentary score of children and hyperactivity/inattention (r = 0.167, p < 0.001), emotional symptoms (r = 0.132, p < 0.001), and conduct problems (r = 0.084, p < 0.01). Conclusion: In our study, children's Internet use was associated with obesity, psychological disturbances and social maladjustment.

Predicting the survival probability of functional neuroendocrine tumors treated with peptide receptor radionuclide therapy: Serbian experience.

Introduction: Peptide receptor radionuclide therapy (PRRT) is a treatment option for well-differentiated, somatostatin receptor positive, unresectable or/and metastatic neuroendocrine tumors (NETs). Although high disease control rates seen with PRRT a significant number NET patients have a short progression-free interval, and currently, there is a deficiency of effective biomarkers to pre-identify these patients. This study is aimed at determining the prognostic significance of biomarkers on survival of patients with NETs in initial PRRT treatment. Methodology: We retrospectively analyzed 51 patients with NETs treated with PRRT at the Department for nuclear medicine, University Clinical Center Kragujevac, Serbia, with a five-year follow-up. Eligible patients with confirmed inoperable NETs, were retrospectively evaluated hematological, blood-based inflammatory markers, biochemical markers and clinical characteristics on disease progression. In accordance with the progression og the disease, the patients were divided into two groups: progression group (n=18) and a non-progression group (n=33). Clinical data were compared between the two groups. Results: A total of 51 patients (Md=60, age 25-75 years) were treated with PRRT, of whom 29 (56.86%) demonstrated stable disease, 4 (7.84%) demonstrated a partial response, and 14 (27.46%) demonstrated progressive disease and death was recorded in 4 (7.84%) patients. The mean PFS was a 36.22 months (95% CI 30.14-42.29) and the mean OS was 44.68 months (95% CI 37.40-51.97). Univariate logistic regression analysis displayed that age (p<0.05), functional tumors (p<0.05), absolute neutrophil count (p<0.05), neutrophil-lymphocyte ratio-NLR (p<0.05), C-reactive protein-CRP (p<0.05), CRP/Albumin (p<0.05), alanine aminotransferase-ALT (p<0.05), were risk factors for disease progression. Multivariate logistic regression analysis exhibited that functional tumors (p<0.001), age (p<0.05), CRP (p<0.05), and ALT (p<0.05), were independent risk factors for the disease progression in patients with NETs. Tumor functionality was the most powerful prognostic factor. The median PFS (11.86 ± 1.41 vs. 43.38 ± 3.16 months; p=0.001) and OS (21.81 ± 2.70 vs 53.86 ± 3.70, p=0.001) were significantly shorter in patients with functional than non-functional NETs respectively. Conclusion: The study's results suggest that tumor functionality, and certain biomarkers may serve as prognostic survival indicators for patients with NETs undergoing PRRT. The findings can potentially help to identify patients who are at higher risk of disease progression and tailor treatment strategies accordingly.

Can MDCT Enhancement Patterns Be Helpful in Differentiating Secretory from Non-Functional Adrenal Adenoma?

Background and Objectives: Primary adrenal tumors (AT) are a heterogeneous group of neoplasms due to their functional heterogeneity, which results in the diverse clinical presentation of these tumors. The purpose of this study was to examine cross-sectional imaging characteristics using multi-detector computed tomography (MDCT) to provide insight into the lesion characterization and functional status of these tumors. The radionuclide imaging using Technetium-99m radiolabeled hydrazinonicotinylacid-d-phenylalanyl1-tyrosine3-octreotide (99mTc-HYNIC-TOC), was also used in the diagnostic evaluation of these tumors. Materials and Methods: This cross-sectional study included 50 patients with confirmed diagnoses of AT (21 hormone-secreting and 29 non-functional) at the University Clinical Center, Kragujevac, Serbia, during the 2019-2022 year period. The morphological and dynamic characteristics using MDCT were performed, using qualitative, semi-quantitative, and quantitative analysis. Absolute washout (APW) and relative washout (RPW) values were also calculated. A semi-quantitative analysis of all visual findings with 99mTc-HYNIC-TOC was performed to compare the tumor to non-tumor tracer uptake. Results: A statistically significant difference was found in the MDCT values in the native phase (p < 0.05), the venous phase (p < 0.05), and the delayed phase (p < 0.001) to detect the existence of adrenal tumors. Most of these functional adrenocortical lesions (n = 44) can be differentiated using the delayed phase (p < 0.05), absolute percentage washout (APW) (p < 0.05), and relative percentage washout (RPW) (p < 0.001). Furthermore, 99mTc-HYNIC-TOC could have a high diagnostic yield to detect adrenal tumor existence (p < 0.001). There is a positive correlation between radionuclide imaging scan and APW to detect all AT (p < 0.01) and adrenocortical adenomas as well (p < 0.01). Conclusions: The results can be very helpful in a diagnostic algorithm to quickly and precisely diagnose the expansive processes of the adrenal glands, as well as to learn about the advantages and limitations of the mentioned imaging modalities.

Differences Regarding Knowledge of Sexually Transmitted Infections, Sexual Habits, and Behavior Between University Students of Medical and Nonmedical Professions in Serbia.

Aim: The aim of this study is to assess the knowledge of sexually transmitted infections (STIs), sexual habits, and behavior among students of medical and nonmedical students in Serbia. Methodology: The cross-sectional study of 1,273 university students of four undergraduate institutions in Serbia, two of medical and two of nonmedical orientation. A standardized questionnaire, prepared in line with the questionnaire of the European health research-the second wave (European Health Interview Survey-EHIS wave 2), according to defined internationally accepted indicators, was used as a survey instrument. Results: Statistically significant difference (p < 0.001) between medical and nonmedical student groups was determined for the following parameters: naming four of five STIs (29.1 vs. 13.4%), knowledge about vaccines against some STIs (26.0 vs. 17.0%), relationship between HPV infection and cervical malignancy (48.2 vs. 16.7%) engaged in the sexual relations (87.9 vs. 76.4%), never used a condom (15.2 vs. 10.4%), underwent gynecological or urological examination (66.7 vs. 44.1%), and tested to one of STIs (10.5 vs. 4.9%). Conclusion: Both student groups have limited knowledge on possible consequences that risky sexual behavior has for reproductive health. Promotion of knowledge about STIs, awareness of all complications, and consequences of these infections certainly affect the reduction of risky behavior.

Clinical usefulness of 99mTc-HYNIC-TOC, 99mTc(V)-DMSA, and 99mTc-MIBI SPECT in the evaluation of pituitary adenomas.

BACKGROUND: The aim of this study was to evaluate the behavioral uptake and ability to diagnose pituitary adenoma (PA) using tumor-seeking radiopharmaceuticals, and to provide a semiquantitative analysis of tracer uptake in the pituitary region. PATIENTS AND METHODS: The study included 33 (13 hormonally active and 20 nonfunctioning) patients with PA and 45 control participants without pituitary involvement. All patients (n=78) underwent single photon emission computed tomography (SPECT) imaging with technetium-99m-labeled hydrazinonicotinyl-tyr-octreotide (Tc-HYNIC-TOC), dimercaptosuccinic acid (Tc(V)-DMSA) and hexakis-2-methoxyisobutylisonitrile (Tc-MIBI). A semiquantitative analysis of abnormal uptake was carried out by drawing identical regions of interest over the pituitary area and the normal brain on one transverse section that shows the lesion most clearly. The pituitary uptake to normal brain uptake (P/B) ratio was calculated in all cases. RESULTS: The result of this study confirms that the SPECT semiquantitative method, with all three tracers, showed statistically significant differences between the PA group and the controls. However, Tc-HYNIC-TOC scintigraphy could have the highest diagnostic yield because of the smallest overlap between the P/B ratios between adenoma versus nonadenoma participants (the receiver operating characteristic curve P/B ratio cut-off value was 13.08). In addition, only Tc-MIBI SPECT have the diagnostic potential to detect secreting PAs, with statistically significant differences between groups (P<0.001), with an receiver operating characteristic curve P/B ratio cut-off value of 16.72. CONCLUSION: A semiquantitative analysis of increased focal tracer uptake in the sellar area showed that Tc-HYNIC-TOC is a highly sensitive and reliable tumor-seeking agent for detecting PA, whereas Tc-MIBI SPECT is a highly sensitive and specific method in differentiating hormone-secreting pituitary tumor.

The prevalence and socioeconomic correlates of depressive and anxiety symptoms in a group of 1,940 Serbian university students.

UNLABELLED: BACKGROUND/AIM. Mental health of university students is under increasing concern worldwide, because they face challenges which predisposes them to depression and anxiety. The aim of this study was to identify demographic and socioeconomic variables associated with depressive and anxiety symptoms among university students. METHODS: This cross-sectional study on 1,940 university students was performed using a questionnaire including demographic and socioeconomic variables, Beck Depression Inventory and Beck Anxiety Inventory. RESULTS: The prevalence of depressive symptoms in students was 23.6%, while the prevalence of anxiety symptoms was 33.5%. The depressive symptoms were significantly related to the study year (p = 0.002), type of faculty (p = 0.014), satisfaction with college major choice (p < 0.001), satisfaction with grade point average (p < 0.001). Female students (odds ratio--OR = 1.791, 95% confidence interval--CI = 1.351-2.374), older students (OR = 1.110, 95% CI = 1.051-1.172), students who reported low family economic situation (OR = 2.091, 95% CI = 1.383-3.162), not owning the room (OR = 1.512, 95%CI = 1.103-2.074), dissatisfaction with graduate education (OR = 1.537, 95% CI = 1.165-2.027) were more likely toshow depressive symptoms. The anxiety symptoms were significantly related to study year (p = 0.034), type of faculty(p < 0.001), family economic situation (p = 0.011), college residence (p = 0.001) satisfaction with the college major choice (p = 0.001), and satisfaction with graduate education(p < 0.001). Female students (OR = 1.901, 95% CI =1.490-2.425), and students who reported parents high expectations of academic success (OR = 1.290, 95% CI =1.022-1.630) were more likely to show anxiety symptoms. CONCLUSION: This is one of the largest study examining mental disorders in a sample of university students in Serbia. These findings underscore the importance of early detections of mental problems and prevention interventions in university students.

Screening performances of abnormal first-trimester ductus venosus blood flow and increased nuchal translucency thickness in detection of major heart defects.

OBJECTIVE: The aim of this study was to evaluate the screening performances of abnormal ductus venosus (DV) blood flow for the detection of heart defects in chromosomally normal fetuses with increased nuchal translucency (NT) thickness at 11-13 + 6 weeks' gestational in a population of singleton pregnancies. METHODS: During an 8-year period, all singleton pregnancies from 11 + 0 to 13 + 6 weeks were scanned for NT and DV blood flow assessment. Two groups of cases with abnormal NT were evaluated: NT ≥ 95th and NT ≥ 99th centile. DV waveforms were considered to be abnormal if the a-wave was reversed or absent (R/A). RESULTS: Addition of DV R/A a-wave to either NT ≥ 95th or NT ≥ 99th percentile increased specificity (p < 0.001 and p < 0.001, respectively), but not screening performances in detection of major heart defects (p = 0.73 and p = 0.91, respectively). Combination of DV R/A a-wave with NT ≥ 95th or NT ≥ 99th centile correlated with right heart defects (p = 0.024 and p = 0.013, respectively). CONCLUSIONS: In chromosomally normal fetuses, addition of abnormal DV a-wave to increased NT does not improve screening performances of NT in detection of major hearts defects in first trimester. However, there is correlation of such parameter with right heart defects and AV septal defects.

Is there a link between Hashimoto's thyroiditis and primary hyperparathyroidism? A study of serum parathormone and anti-TPO antibodies in 2267 patients.

According to various authors, thyroid disorders like Hashimoto's thyroiditis (HT), diffuse goiter or multinodular goiter, Graves' disease, medullary or papillary carcinoma could be found in a number of patients with primary hyperparathyroidism (PHPT). This association is more common in elderly women. Neck irradiation, lithium treatment and elevated TSH levels have been suggested as some of the possible causes of this co-existance. The aim of this study was to investigate and determine the prevalence of patients having both HT and PHPT, and the possible relation between these two diseases. We conducted a prospective study during three and a half years. This study included 45,231 patients, which were referred by their general practitioner or endocrinologist, under suspicion of having thyroid and/or parathyroid disease. In these patients we measured serum levels of the following parameters: anti-thyroid peroxidase antibodies (antiTPO-Ab), anti-thyroglobulin antibodies (Tg-Ab), anti-TSH-receptor antibodies (TSHR-Ab), thyroid-stimulating hormone (TSH), parathyroid hormone (PTH) and calcium (Ca). In 2,267 of these 45,231 patients (5.01%) we noticed elevated antiTPO-Ab (3542±3407IU/mL), with statistical significant difference from normal values (normal range 0-70IU/mL), P<0.05, and normal levels of other antithyroid antibodies (Tg-Ab, TSHR-Ab). All patients with elevated antiTPO-Ab were assumed to have HT. Within this group, 43 patients (1.89%) also had elevated serum levels of PTH (112.4±33.2pg/mL, normal range 8-76pg/mL) as well as elevated serum levels of calcium (2.92±0.06mmol/L, normal range 2.2-2.65mmol/L). These laboratory findings, accompanied with clinical symptoms, satisfied the criteria for PHPT. The mean age in this subgroup was 60.5±12.2 years. All 2,267 patients had normal or slightly elevated TSH levels. In conclusion, although the reported rate of prevalence of PHPT in the general population is about 0.3%, our results indicated a 1.89% occurrence of PHPT in 2267 patients with HT in central Serbia. This may be due to the autoimmune inflammatory process in HT supporting PHPT to PTH or calcium supporting HT or to common genetical predisposition of both entities.

Echocardiographic study of early left ventricular remodeling in highly trained preadolescent footballers.

Almost all the studies of athlete's heart have been carried out on adult and older adolescent players; hence the limited data on the cardiac response to exercise in the beginning of the active sports career in the youngest athletes. The study was designed to examine the physiological limits of left ventricle (LV) cavity size and wall thickness in elite footballers at the preadolescent age, it the beginning of the active sports career. Ninety-four highly trained male footballers (mean aged 12.85±0.84) competing in the Serbian Football League and 47 age-matched healthy male controls, aged 12-14, were enrolled in the study. All the echocardiographic findings were adjusted to BSA(-0.5), while left ventricle mass (LVM) was additionally adjusted to BSA(-1.5). Reference ranges were defined as values of 5-95th centile according to the mean values in both groups. The proportions of the footballers with LV dimensions outside expected ranges were additionally noted. The data indicate significant increases in absolute values of LV dimensions, aortic root size and left atrium (p<0.001) in preadolescent professional footballers compared with the values expected for age-matched controls, whereas there are no differences in absolute values of ventricular septal and posterior wall thickness, LV wall thickness and LVM (p>0.05). Upon body-size adjustments, significant increases were observed in all echocardiographic parameters (p<0.001). Our data indicate an early cardiac remodeling, already apparent in pre-adolescence, even after a short period of training.