Motivational Factors Influencing the Choice of Medical Studies and Future Career Plans among Montenegrin Students.

Introduction: There is a concerning trend of emigration among highly educated individuals in Montenegro. This includes medical professionals who seek better job opportunities abroad. The aim of the present study was to identify the primary motivational factors driving Montenegrin medical students to pursue a career in medicine, and whether these factors undergo changes over the course of their studies. Methods: A cross-sectional study included 210 medical students in Montenegro, 27.62% were males, and 72.38% were females. The mean age of the students was 21.90 years (SD=3.05) (range 19-39). Their academic motivation was analysed using the Academic Motivation Scale, previously validated in various cultural contexts. Results: The results showed that autonomous motivation levels were higher than controlled motivation levels (p<0.001) among students in Montenegro, which has been previously associated with better learning outcomes. Students with medical doctors among their family members had higher extrinsic motivation related to rewards and punishments (extrinsic motivation with external regulation p=0.018). Amotivation showed a trend of increasing as the students got closer to graduation (p=0.057). Only 8.1% of students planned a career in primary healthcare, and 1% wished to specialize in family medicine. Conclusions: This study's findings, which indicate high levels of autonomous motivation among medical students, are of significant importance. They contribute to a comprehensive understanding of the motivation factors among medical students and young healthcare professionals in Montenegro. Moreover, they provide a basis for the implementation of strategic interventions to retain highly skilled medical professionals within the country's workforce, thereby addressing the concerning trend of emigration among this group.

Expression of CD105 but not of E-cadherin is associated with malignancy recurrence and disease-free interval in laryngeal cancer in men.

INTRODUCTION: In this study we analyzed CD105 (endoglin) and E-cadherin expression in laryngeal squamous cell carcinoma (LSCC) to evaluate their clinicopathologic significance. MATERIAL AND METHODS: Expression of CD105 and E-cadherin was examined immunohistochemically using paraffin-embedded archival tissues of 72 (35 glottic and 37 supraglottic) previously untreated LSCC male patients. The mean value of the positively-stained microvessels for CD105 counted in four hot spots for each case was used as the final intratumoralmicrovessel density (MVD). A staining score of E-cadherin was calculated based on the percentage of cells stained (0-100%). RESULTS: MVD was significantly higher in patients with advanced TNM stage (P = 0.004) and younger than 65 (P = 0.008). Nodal metastases were more frequent in the cases with low E-cadherin expression (P = 0.000). Tumor recurrence was associated with advanced TNM stage (P = 0.035) and high MVD (P = 0.002). A high MVD was an independent predictor of malignancy recurrence (P = 0.021). The log-rank test showed a significant difference in the disease-free interval in patients stratified according to the MVD value (P = 0.016). Spearman's rank correlation test did not show a significant correlation between E-cadherin and CD105 expression. CONCLUSIONS: CD105-assessed MVD and expression of E-cadherin are promising prognostic factors for the outcome of patients with LSCC. Increased expression of CD105 could help predict patients with an increased risk of developing loco-regional recurrence after surgical treatment. Decreased E-cadherin expression is a potential predictor of lymph node metastases.

Prognostic significance of a panel of two biomarkers (E-cadherin and CD105) in laryngeal cancer.

This study aimed to evaluate the clinicopathologic significance of the combined immunohistochemical expression of the epithelial-mesenchymal transition marker E-cadherin and the angiogenesis marker CD105 in laryngeal squamous cell carcinoma and assess correlation of their expression. Eighty-five patients who underwent complete resection as primary treatment were selected for this study. E-cadherin and CD105 expression levels were determined by immunohistochemistry. The receiver operating curve approach was applied to determine the cut-off value and separate patients with high and low expression of markers. The high-risk group ("CD105 high" and "E-cadherin low" expression) showed statistically significant correlations with age less than 66 years (p = 0.039), advanced T-status (T3-4) (p = 0.046), aggressive TNM stage (stage III-IV) (p = 0.003) and locoregional recurrence of disease (p = 0.004). In the Kaplan-Meier analyses, the high-risk group had significantly worse prognoses than other risk groups (log-rank test 2 = 9.415, p = 0.024). Spearman's correlation coefficient analysis showed a nonsignificant negative correlation between the expression of E-cadherin and CD105 (rho = -0.073, p = 0.505). Simultaneous consideration of E-cadherin and CD105 is a simple panel of markers to determine aggressive tumour phenotype with a higher risk of disease recurrence in patients with laryngeal cancer.

Validity, internal consistency, and test-retest reliability of the Montenegrin 10-item Voice Handicap Index.

The purpose of the this cross-sectional study was to assess clinical validity, internal consistency, and test-retest reliability of the adapted Montenegrin translation of the Voice Handicap Index 10 (VHI-10). It included 50 patients with voice disorders, divided into three subgroups according disease aetiology: structural, neurological, and functional and a control group of 50 vocally healthy participants. Mean patient VHI-10 score of 21.1±7.6 was significantly higher than the 2.3±2.5 score of controls (p<0.001). Each of the three patient subgroups also scored significantly higher than control (p<0.001). Spearman's rank correlation coefficient of 0.90 (p<0.001) indicated a very strong correlation between the Montenegrin VHI-10 score and self-reported perception of the severity of voice disorder. Excellent internal consistency was found in the patient group, with a Cronbach's alpha of 0.94. Test-retest reliability was also excellent, with intra class correlation coefficient of 0.98. The translated Montenegrin version of VHI-10 is a valid, reliable, and clinically useful tool for self-assessment of the severity of voice disorders in individuals with voice problems in daily practice and in research projects.

Tracheostomy in a patient with COVID-19: a case report.

Some of coronavirus disease 2019 (COVID-19) patients with prolonged ventilation may require tracheostomy, which is an aerosol-generating procedure and poses a significant risk of viral transmission. We report our experience of the management of a patient with COVID-19 who underwent surgical tracheostomy and describe several essential infection control principles. In our patient, on the 14th day after intubation, an open tracheostomy was carried out because of the prolonged tracheal intubation and unsuccessful extubation attempts. Meticulous attention was paid during surgery to decrease the infection risk. Appropriate protection, infection control and teamwork are essential to perform open tracheostomy in COVID-19 positive patients safely with minimal risks to healthcare professionals.

Visceral Adiposity Index is not Superior over Anthropometric Parameters with regards to Inflammation in Healthy Adolescent Girls.

OBJECTIVE: Better than simple anthropometric parameters, the visceral adiposity index (VAI) has recently been proposed as a predictor of cardiometabolic risk in adults. However, there are conflicting results on the associations of these parameters in children and adolescents. Therefore, we aimed to estimate this potential relationship between VAI, anthropometric parameters (i.e., body mass index [BMI], waist circumference [WC], and waist-to-height ratio [WHtR], respectively), and inflammation as measured by high-sensitivity C-reactive protein (hs-CRP) levels in a cohort of adolescent girls. METHODS: A total of 90 adolescent girls from 16 to 19 years old were included in cross-sectional study. Anthropometric and biochemical parameters (glucose, lipid parameters, and hsCRP) were measured. The VAI, derived from anthropometric and lipid parameters, calculated {[WC/36.58 + (1.89 × BMI)] × (triglycerides/0.81) × (1.52/HDL-cholesterol)} was calculated. RESULTS: A comparison of the receiver operating characteristic (ROC) curves showed that all the curves for the anthropometric parameters (e.g., BMI, WC, WHtR) had excellent discriminatory capability with regard to inflammation level status (low vs. high level) and significantly larger areas under the curve (AUC = 0.885, AUC = 0.863, AUC = 0.860, respectively; P < 0.001) than the ROC curve for VAI did (AUC = 0.686; P = 0.021). CONCLUSION: Visceral adiposity index is not superior over anthropometric parameters in relation to inflammation as measured by high sensitivity C-reactive protein in adolescent girls.

Cardiovascular Risk Assessed by Reynolds Risk Score in Relation to Waist Circumference in Apparently Healthy Middle-Aged Population in Montenegro.

Reynolds Risk Score (RRS) is regarded as a good screening tool for cardiovascular disease (CVD) risk. Since CVD is the leading cause of death in Montenegro, we aimed to assess the risk of CVD as assessed by RRS and to examine its association with cardiometabolic parameters in apparently healthy middle-aged population. In addition, we aimed to test whether obesity had an independent influence on RRS. A total of 132 participants (mean age 56.2±6.73 years, 69% females) were included. Body mass index (BMI), waist circumference (WC), blood pressure (BP) and biochemical parameters (fasting glucose, insulin, lipid parameters, creatinine and high sensitivity C-reactive protein) were determined. Insulin resistance (HOMA-IR) and glomerular filtration rate (eGFR) were calculated. Compared with females, a significantly higher number of males were in the high RRS subgroup (χ2=45.9, p<0.001). Furthermore, significantly higher fasting glucose (p=0.030), insulin, HOMA-IR, triglycerides (p<0.001 all), anthropometric parameters (e.g., BMI and WC; p=0.004 and p<0.001, respectively), and creatinine, but lower eGFR and HDL-c (p<0.001 both) were recorded in the high-risk subgroup compared with low and medium risk subgroups. In all participants, in addition to LDL-c, diastolic BP and creatinine, WC was independently positively associated with RRS (ß=0.194, p=0.006; ß=0.286, p=0.001; ß=0.267, p=0.001; and ß=0.305, p=0.019, respectively), and 40% of variation in RRS could be explained with this model. In conclusion, middle-aged population with higher WC should be screened for RRS in order to estimate CVD risk.

Relationship between Oxidative Stress, Inflammation and Dyslipidemia with Fatty Liver Index in Patients with Type 2 Diabetes Mellitus.

INTRODUCTION/AIM: Considering the high prevalence of non-alcoholic fatty liver disease (NAFLD) in individuals with type 2 diabetes mellitus (DM2), we aimed to investigate the potential benefit of determining markers of oxidative stress, inflammation and dyslipidemia for prediction of NAFLD, as estimated with fatty liver index (FLI) in individuals with DM2. METHODS: A total of 139 individuals with DM2 (of them 49.9% females) were enrolled in cross-sectional study. Anthropometric and biochemical parameters, as well as blood pressure were obtained. A FLI was calculated. RESULTS: Multivariate logistic regression analysis showed that high density lipoprotein cholesterol (HDL-c) and malondialdehyde (MDA) were independent predictors of higher FLI [Odds ratio (OR)=0.056, p=0.029; and OR=1.105, p=0.016, respectively]. In Receiver Operating Characteristic curve analysis, the addition of fatty liver risk factors (e. g., age, gender, body height, smoking status, diabetes duration and drugs metabolized in liver) to each analysed biochemical parameter [HDL-c, non-HDL-c, high sensitivity C-reactive protein (hsCRP), MDA and advanced oxidant protein products (AOPP)] in Model 1, increased the ability to discriminate patients with and without fatty liver [Area under the curve (AUC)=0.832, AUC=0.808, AUC=0.798, AUC=0.824 and AUC=0.743, respectively]. Model 2 (which included all five examined predictors, e. g., HDL-c, non-HDL-c, hsCRP, MDA, AOPP, and fatty liver risk factors) improved discriminative abilities for fatty liver status (AUC=0.909). Even more, Model 2 had the highest sensitivity and specificity (89.3% and 87.5%, respectively) together than each predictor in Model 1. CONCLUSION: Multimarker approach, including biomarkers of oxidative stress, dyslipidemia and inflammation, could be of benefit in identifying patients with diabetes being at high risk of fatty liver disease.

Association between unfavorable lipid profile and glycemic control in patients with type 2 diabetes mellitus.

BACKGROUND: Recent studies hypothesize that dyslipidemia can predict glycated hemoglobin (HbA1c) and could be important contributing factor to the pathogenesis of type 2 diabetes mellitus (DM2). Therefore, we aimed to evaluate the influence of lipid parameters on long-term glycemic control in DM2. MATERIALS AND METHODS: A total of 275 sedentary DM2 (mean [±standard deviation] age 60.6 [±10.0] years) who volunteered to participate in this cross-sectional study were enrolled. Anthropometric (body weight, body hight, and waist circumference), biochemical parameters (fasting glucose, HbA1c, lipid parameters, creatinine), as well as blood pressure were obtained. RESULTS: Total cholesterol (odds ratio [OR] =1.30, 95% confidence interval [CI] [1.02-1.66], P = 0.032), triglycerides (OR = 1.34, 95% CI (1.07-1.67), P = 0.010), and low density lipoprotein cholesterol (OR = 1.42, 95% CI [1.10-1.83], P = 0.006) were the independent predictors of higher HBA1c, and as they increased by 1 mmol/L each, probabilities of higher HBA1c increased by 30%, 34%, and 42%, respectively. Low level of high-density lipoprotein cholesterol (HDL-c) was found to be the independent predictor of higher HBA1c (OR = 0.44, 95% CI [0.20-0.67], P = 0.039), and increase in HDL-c by 1 mmol/L, reduced the probability of higher HBA1c by 56%. CONCLUSION: Unfavorable lipid profile can predict HbA1c level in DM2 patients. Early diagnosis of dyslipidemia, as well as its monitoring and maintaining good lipids control can be used as a preventive measure for optimal long-term glycemic control.

Immunoregulatory cytokines and chronic tonsillitis.

The purposes of the present study were to determine the distribution of cells producing cytokines: tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) in different morphological sections of tonsils in patients with tonsillar hypertrophy (TH) and recurrent tonsillitis (RT), to analyze the level of production of these cytokines in TH and RT and evaluate the potential of peripheral blood lymphocytes for production of interferon-γ (IFN-γ) and interleukin 4 (IL-4). Analyzed materials consisted of the tonsils after tonsillectomy and blood taken from patients right before tonsillectomy (study group) and blood taken from healthy donors (control group).We used histological and immunohistochemical method, morphometric methods for the quantification of TNF-α and IL- 6 producing cells and immunological methods for determining the concentration of IFN-γ and IL-4. Most of TNF-α producing cells are settled in the subepithelial region (55%). Numerical density of TNF-α producing cells in the crypt epithelium, subepithelial and interfollicular region was significantly higher in RT compared with TH. The concentration of IFN-γ is three times higher in RT then in TH. After the stimulation of peripheral blood lymphocytes in culture there was no significant increase in concentrations of IL- 4. The index of stimulation of IFN-γ was the highest in the RT, and of IL- 4 in TH. The production of Th1-type cytokines (TNF-α and IFN-γ) is higher in RT compared with TH. In both forms of tonsillitis, production of Th1-type cytokines is higher in relation to the production of Th2-type cytokines (IL-6 and IL-4).

Relationship of E-cadherin with cervical lymph node metastasis in laryngeal cancer.

E-cadherin, a 120 kDa transmembrane protein, plays an important role in malignant progression and tumour differentiation. The loss or reduction in E-cadherin expression has been found in several tumours including laryngeal squamous cell carcinoma. The present study aimed to investigate the prognostic implications of changes in expression of the E-cadherin in laryngeal carcinoma. E-cadherin expression was determined by immunohistochemistry in paraffin- embedded tissue specimens from 80 patients. A staining score was given based on the percentage of cells stained (0-100%). E-cadherin expression varied greatly among tissue samples from 2 to 72 (median 25). Using the median expression of E-cadherin as a cut- off 41 (51.3%) tumours were classified in the "low E-cadherin" group and the rest, 39 (48.7%) tumours, consisted the "high E-cadherin" group. We found significant differences in the staining scores of E-cadherin between those tumours with and without nodal metastases (p = 0.025) and advanced clinical stage (TNM stage III and IV) (p = 0.014). The results of a stepwise logistic regression analysis showed that E-cadherin staining score and the location of primary tumour were independent predictors of nodal metastases. The immunohistochemical determination of E-cadherin expression may be useful instrument to characterise the metastatic potential of carcinomas. Larger studies are needed to confirm the role of E-cadherin expression in predicting the behavior of laryngeal squamous cell carcinomas.

Small cell neuroendocrine tumor of the larynx--a small case series.

Neuroendocrine tumors are the most common nonsquamous types of laryngeal neoplasms. They are classified as typical carcinoids, atypical carcinoids, small-cell neuroendocrine carcinomas, and paragangliomas. The aim of the paper is to present four patients with small-cell neuroendocrine tumor arising in larynx. There were one woman and three men whose ages were 47-77 years; all of them had metastases when first seen. The clinical presentation and management of such type of tumor are discussed. Small-cell neuroendocrine carcinomas are very aggressive neoplasms. Patients could benefit from surgery, but radiotherapy and chemotherapy remain the treatment of choice. Examination of a large series is required to define the most useful diagnostic methods and the most successful treatment modalities.

Prevalence of smoking and other smoking-related behaviours among students aged 13 to 15 years in Montenegro: results from the Global Youth Tobacco Survey of 2008.

The Global Youth Tobacco Survey (GYTS) is an international study that provides data on youth tobacco use for development of tobacco control programs. It is a school-based survey that uses a standardised methodology for sampling, core questionnaire items, training protocol, field procedures, and data management. This article reports the findings from a GYTS conducted in Montenegro in 2008, which included 5723 adolescents. More than 30 % of students aged 13 to 15 tried smoking, 5.1 % smoked cigarettes, and 3.6 % of students used tobacco products other than cigarettes. Four in 10 ever smokers started to smoke before the age of 10. More than half the students reported secondary smoke exposure at home. Almost all (96.5 %) current smokers bought cigarettes in a store. Two in 10 students owned an artifact with a cigarette or tobacco brand logo on it. The GYTS study has shown that there is an urgent need to introduce effective child-oriented smoking prevention programmes in early elementary school classes. These should be accompanied by public awareness campaigns on smoke-free homes.

Clinicopathologic significance of CD105-assessed microvessel density in glottic laryngeal squamous cell carcinoma.

OBJECTIVE: Intratumoral microvessel density (MVD) determined with the use of antibodies to endoglin (CD105) is considered to be an important prognostic marker in a variety of malignancies. The purpose of this study has been to analyze the clinicopathologic significance of CD105-assessed MVD in SCCs primary localized in glottic region of larynx. METHODS: Surgical specimens from 40 patients with resected glottic squamous cell carcinomas were immunostained for CD105. CD105-assessed MVD was calculated at 400x magnification. Using the mean MVD as a cut-off, tumors were classified in the "high MVD" group and in the "low MVD" group. Clinicopathologic data were collected retrospectively. RESULTS: The mean MVD assessed by CD105 in considered glottic SCCs was 12.3 (standard deviation [SD]=3.65). MVD varied among tissue samples from 5 to 21 (median 12.5). High MVD was significantly correlated with a more aggressive tumor phenotype, including T3-T4 tumor (Fisher exact test, P=0.004) and advanced clinical stage (Fisher exact test P=0.026). Kruskal-Wallis test identified significant relation between pT stages and CD105-assessed MVD (P=0.011). CD105-assessed MVD was significantly related to malignancy recurrence presence/absence (Mann-Whitney U-test P=0.023). Logistic regression in multivariate modality showed that MVD (odds ratio [OR] 2.29, P=0.033, 95% confidence interval [CI] 1.06-7.53) and advanced T category (T3-T4) (OR 4.11, P=0.026, 95% CI 2.38-9.46) were significantly related to malignancy recurrence presence/absence. Cox regression analysis revealed that expression of CD105 (P=0.031) and N status (P=0.014) were the independent factors for disease-free survival. CONCLUSION: High expression of CD105 correlated significantly with advanced T status and locoregional recurrence. The present preliminary results suggest that CD105-assessed MVD in primary glottic squamous cell carcinomas may identify patients at risk of disease recurrence.

Prognostic relevance of CD105-assessed microvessel density in laryngeal carcinoma.

OBJECTIVE: To examine immunohistochemical expression of CD105 among patients with laryngeal cancer and investigate the prognostic significance of CD105-assessed microvessel density (MVD). STUDY DESIGN: Cross-sectional study. SETTING: University hospital. SUBJECTS AND METHODS: The study comprised 80 patients with laryngeal squamous cell carcinoma who underwent complete excision. Clinicopathological data were collected retrospectively. Immunohistochemical analysis was performed with CD105 (endoglin) antibody. Positive-stained microvessels for CD105 were counted on hot spots of tumors at x200 magnification. RESULTS: Average CD105-assessed MVD in considered laryngeal squamous cell carcinomas (SCCs) was 12.9 (SD 3.84). High expression of CD105 correlated significantly with advanced T (tumor) classification (P = 0.008), advanced TNM (tumor, node, metastasis) stage (P = 0.001), tumor recurrence (P = 0.001), and age > or =65 years (P = 0.026). The multivariate logistic regression showed that a high CD105+ MVD (odds ratio [OR] 4.27; P = 0.019) and advanced TNM stage (OR 3.72; P = 0.047) were independent markers of tumor recurrence. High MVD, advanced clinical stage, the presence of lymph node metastasis at the time of diagnosis, and age <66 years were associated with worse disease-free survival. Cox regression analysis revealed that expression of CD105 (P = 0.016) and advanced clinical stage (P = 0.05) were the independent factors for disease-free survival. CONCLUSION: The present results suggest that MVD evaluation with CD105 is a promising prognostic factor for the outcome of patients with laryngeal SCC. CD105-assessed MVD could help to identify patients with more aggressive disease and increased risk of developing malignancy recurrence after treatment.

CD105 expression as a measure of microvessel density in supraglottic laryngeal squamous cell carcinoma.

The purpose of the present study was to examine the expression of CD105 among patients with supraglottic laryngeal cancer and to assess the clinical relevance of CD105-assessed MVD. A total of 40 patients with supraglottic squamous cell carcinomas (SCCs) were included in the present study. Surgical specimens were immunostained for CD105 and MVD was calculated at 400x magnification. The rounded mean value of the vessel count in four fields for each case was used as the final MVD value. The mean MVD value assessed by CD105 in considered supraglottic SCCs was 13.5 (SD = 3.97). High MVD was significantly correlated with advanced (III and IV) clinical stage (Mann-Whitney U test P = 0.01) and malignancy recurrence presence/absence (Mann-Whitney U test P = 0.023). Spearman's rank correlation test showed significant correlation between high CD105-assessed MVD and pN+ category (rho = 0.337, P = 0.033), advanced Stage (III and IV) (rho = 0.402, P = 0.01) and developed locoregional recurrence (rho = 0.395, P = 0.012). The logistic regression showed that a high CD105+ MVD was the only independent marker of tumor recurrence (P = 0.029; odds ratio, 6.64; 95% CI, 1.218-36.152). The average MVD was significantly higher in patients with advanced TNM stage and in patients with locoregional recurrence of disease, suggesting that angiogenesis is closely related with clinical aggressiveness of tumor. CD105-assessed MVD in supraglottic laryngeal SSCs may identify patients at risk of recurrence of disease.

Tobacco use among youth: findings from the global youth tobacco survey in Montenegro.

Smoking is a burning healthcare and economy issue, especially in underdeveloped countries. The aim of this study was to determine the number of smokers among elementary school students in Montenegro and to assess the correlates of tobacco use. The study was done in 2003 using the World Health Organization Global Youth Tobacco Survey. Our data showed that children as young as ten years smoked. There were 3.6% permanent smokers and one in three students (30.6%) experimented with smoking. More than two thirds who smoked agreed that they should quit smoking, and three fourths tried to quit. This study has also shown that children talk too little about smoking in schools and are exposed to passive smoking at home and elsewhere. Activities to solve the elementary school smoking problem should include preventive programs to be introduced into regular school curricula because this is the only way to address the issue properly. In addition, legislation prohibiting indoor tobacco smoking should be implemented rigorously to protect children from passive smoking in public places.

Risk factors for laryngeal cancer in Montenegro.

Laryngeal cancer is the most common head and neck cancer. There might be many risk factors for laryngeal cancer. Smoking, especially cigarette smoking and alcohol are indisputable risk factors. The authors of this paper assessed the presumed risk factors in order to identify possible aetiological agents of the disease.A hospital-based case-control study was conducted. The study group consisted of 108 histologically verified laryngeal cancer patients and 108 hospital controls matched by sex, age (+/-3 years) and place of residence. Laryngeal cancer patients and controls were interviewed during their hospital stay using a structured questionnaire. According to multiple logistic regression analysis six variables were independently related to laryngeal cancer: hard liquor consumption (Odd Ratio/OR/=2.93, Confidence Interval/CI/95% = 1.17 to 7.31), consumption more than 2 alcoholic drinks per day (OR=4.96, CI 95% = 2.04 to 12.04), cigarette smoking for more than 40 years (OR=4.32, CI 95% = 1.69 to 11.06), smoking more than 30 cigarettes per day (OR=4.24, CI 95% = 1.75 to 10.27), coffee consumption more than 5 cups per day (OR=4.52, CI 95% = 1.01 to 20.12) and carbonated beverage consumption (OR=0.38, CI 95%=0.16 to 0.92). The great majority of laryngeal cancers could be prevented by eliminating tobacco smoking and alcohol consumption.