Halo 194 Scientific Journal of Emergency Medicine

SHORT BOWEL SYNDROME AND INTESTINAL FAILURE IN ADULTS: ANATOMY-DRIVEN PHENOTYPES, ADAPTATION BIOLOGY, AND CONTEMPORARY INTESTINAL REHABILITATION

2026-02-23T10:00:37+01:00

Short bowel syndrome (SBS) is the leading cause of chronic intestinal failure in adults and most commonly follows extensive small-bowel resection. The resulting loss of absorptive surface and regulatory feedback leads to a spectrum of malabsorption syndromes, ranging from compensated intestinal insufficiency to intestinal failure requiring long-term parenteral support. Clinical outcomes are determined less by residual length alone than by postoperative anatomy, particularly the presence of colon in continuity and preservation of distal ileum and the ileocecal region. The pathophysiology of SBS integrates reduced absorptive capacity, accelerated transit, gastric hypersecretion, disordered bile acid handling, microbiome perturbation, and impaired enteroendocrine signaling. Intestinal adaptation, driven by luminal nutrients and trophic hormones such as GLP-2, can partially restore function over months to years, enabling stepwise reduction of parenteral support in selected patients. Modern care is centered on structured intestinal rehabilitation delivered by multidisciplinary teams, combining individualized fluid–electrolyte strategy, optimized oral/enteral nutrition, targeted pharmacotherapy to control secretion and motility, prevention and management of catheter-related complications, and selective reconstructive surgery. Disease-modifying therapy with GLP-2 analogues can reduce parenteral support requirements in SBS-associated intestinal failure, while transplantation remains reserved for refractory, life-threatening complications. This review summarizes current concepts and evidence-based principles for diagnosis, phenotype stratification, rehabilitation, and long-term surveillance in adult SBS.

Keywords: short bowel syndrome; chronic intestinal failure; home parenteral nutrition; colon in continuity; intestinal adaptation; teduglutide; high-output stoma.

Health protection of detained or detained persons

2026-02-23T10:00:37+01:00

The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) has visited closed institutions in Serbia several times in the last thirty years and made observations on the access to health care of persons detained by the police.

The aim of the paper is to point out the legal framework relevant to the access to health care of detained persons, and that their health care should be equal to the protection of patients in the community. For this purpose, the authors have researched international and national regulations, as well as the CPT recommendations.

Medical practice in the community and in closed institutions must be based on the same ethical principles, which imply ensuring the same preventive measures, as well as treatment measures, i.e. comprehensive health care for detained persons/detainees, as is available to citizens in the community.

Unhindered access to health care implies that a detained person is provided with a medical examination. Impaired access to health care and an unsatisfactory level of it may indicate degrading or inhuman treatment.

Health workers who provide health care in detention facilities must be familiar with the rules of personal and general safety. At the same time, police officers must be familiar with the basic rules of the medical profession and ethics.

Modern optical approaches in the modulation of eye growth: a new era in the control of childhood myopia

2026-02-23T10:00:38+01:00

Myopia among preschool and school-aged children represents a growing public health concern, closely linked to reduced exposure to natural light and excessive use of digital devices. Global projections indicate that by 2050, nearly half of the world’s population will be affected by myopia. Optical strategies based on the principle of peripheral myopic defocus, such as HAL, DIMS, MiYOSMART, Stellest, and DOT lenses, have proven to be the most effective non-invasive methods for slowing myopia progression in children. Clinical studies confirm that these lenses reduce axial eye elongation by 50–80% compared to standard single-vision lenses, while maintaining binocular balance and minimal adverse effects. HAL lenses achieve the most stable effect, whereas the DIMS design shows greater efficacy in children with slower myopic progression. Long-term studies demonstrate that these optical approaches do not induce a rebound effect after discontinuation and are safe for prolonged use.

USE OF THE ALVARADO SCORE IN SUSPECTED ACUTE APPENDICITIS

2026-02-23T10:00:38+01:00

INTRODUCTION/OBJECTIVE Appendicitis is an inflammation of the appendix,with the appearance of symptoms in the first 24 hours.Clinically,it presents with pain in the abdomen,most often in the lower right quadrant,increased temperature,loss of appetite,nausea and vomiting.Due to the non-specificity of symptoms,scoring systems have been developed to facilitate diagnostic of suspected appendicitis.Objective is the use of the Alvarado score at the prehospital level in case of suspected acute appendicitis.CASE REPORT The Department of Emergency Medicine in Belgrade was sent a call for intervention due to abdominal pain.The periumbilical pain started last night,she had fever and nausea.Alvarado score was 6, the patient was transported to the ER where the diagnosis of acute appendicitis was confirmed.CONCLUSION Prehospital diagnostics of acute appendicitis is based on history and physical examination,where use of the Alvarado score can be very important,with the aim of reducing the risk of complications,morbidity and mortality.KEY WORDS alvarado, scabies, appendicitis, ripasa

When myocardial infarction is not only inferior: the importance of prehospital recognition of right ventricular infarction

2026-02-23T10:00:38+01:00

Introduction: Right ventricular myocardial infarction (RVI) occurs with complete occlusion of the right coronary artery proximal to the site of separation of the branches feeding the right ventricular wall. It rarely occurs independently, but it complicates about 50% of inferior infarctions. Clinically, it is recognized by the triad: hypotension, jugular venous distension and "clean" lungs. Vasodilators are contraindicated, while intravenous fluid replacement is the key of mennagement. Case report: A 50-year-old man complains of sudden shoulder pain, nausea and sweating. The ECG shows an infarction of inferior localization, with the greatest ST elevation in lead D3, combined with the clinical triad of RV infarction. ST elevation was also confirmed in V4R-V6R (Erhardt's sign). A rapid infusion of cristalloids was administrated, which led to an improvement in hemodynamics. Conclusion: Due to the worse prognosis of patients with right ventricular myocardial infarction and possible iatrogenic complications, early recognition and adequate treatment.