Sanamed

RISK FACTORS FOR POTENTIAL DRUG-DRUG INTERACTIONS OF ANALGESICS IN HOSPITALIZED UROLOGICAL PATIENTS

2026-01-26T11:22:13+01:00

Objective: To evaluate potential drug–drug interactions (pDDIs) involving analgesics in hospitalized urological patients and identify risk factors influencing their number.

Methods: This study involved a post hoc analysis based on data obtained from a retrospective observational cohort clinical study conducted at the Clinic of Urology, University Clinical Centre Kragujevac, Serbia. Of the original 220 patients, 191 who received analgesics were included. Daily pharmacotherapy data, along with demographic and clinical characteristics, were collected, while pDDIs were identified and classified using the Lexicomp Interaction Checker. Descriptive statistics were used to summarize the data. Multiple linear regression with backward elimination was used to identify independent predictors of the number of pDDIs.

Results: Analgesic-related pDDIs were detected in 175 patients (91.6%). Non-steroidal anti-inflammatory drugs (NSAIDs) were prescribed to 173 patients (90.6%), opioids to 53 (27.7%), and paracetamol to 54 (28.3%). The mean number of pDDIs per patient was 5.5 ± 5.5 (range 0–30). Category X interactions most frequently included NSAID combinations (diclofenac + ketorolac, ketorolac + metamizole), while category D interactions frequently involved enoxaparin + ketorolac and opioid–benzodiazepine pairs. Category C interactions were dominated by NSAID + potassium chloride and tramadol + ondansetron or atropine combinations. Multiple regression analysis identified diabetes, a higher number of prescribed drugs, and the use of NSAIDs or opioids as positive predictors of the number of pDDIs, whereas a cancer diagnosis was associated with a lower number.

Conclusion: Analgesic-related pDDIs affect the majority of hospitalized urological patients. Avoiding high-risk combinations, close monitoring, and multidisciplinary medication review in patients with risk factors may help reduce preventable harm.

HÜRTHLE-CELL CARCINOMA OF THE THYROID: CLINICOPATHOLOGIC FEATURES AND SURGICAL OUTCOMES AT A SINGLE INSTITUTION

2026-02-16T14:38:24+01:00

Background: Hürthle cell carcinoma (HCC) is a rare differentiated thyroid malignancy with variable biological behavior. This study evaluates clinicopathologic features, treatment patterns, and long-term outcomes in patients managed at a single tertiary institution.

Methods: We retrospectively reviewed medical records of patients with histologically confirmed HCC between January 2005 and December 2020. Demographics, tumor characteristics, surgical treatment, adjuvant radioactive iodine (RAI) therapy, recurrence, and survival were analyzed. Outcomes were compared with reported retrospective series and discussed in the context of current ATA guidelines.

Results: Forty-eight patients were identified (mean age, 58.7 ± 11.4 years; female-to-male ratio, 2.2:1). Mean tumor size was 38.5 ± 14.2 mm. Minimally invasive disease was present in 29 patients (60.4%), and widely invasive disease in 19 (39.6%). Total thyroidectomy was performed in 36 patients (75%), and lobectomy in 12 (25%). RAI therapy was administered to 30 patients (62.5%), predominantly in widely invasive cases. Median follow-up was 104 months (range, 24–192 months). Recurrence occurred in 8 patients (16.7%), with a median time to relapse of 78 months. Five- and ten-year overall survival (OS) rates were 91.3% and 81.5%, respectively. Disease-specific survival (DSS) was 95.6% at 5 years and 90.2% at 10 years. Ten-year disease-free survival (DFS) was 82.1%.

Conclusions: Our results support existing evidence that minimally invasive HCC carries an excellent prognosis, while widely invasive tumors have a higher risk of recurrence. Long-term follow-up is essential, given the potential for late recurrence. These findings are consistent with current ATA guidelines recommending risk-tailored treatment and surveillance strategies.

ASSOCIATION OF THE TP53 PIN3 16-BP DUPLICATION POLYMORPHISM WITH ORAL SQUAMOUS CELL CARCINOMA RISK AND PROGNOSIS

2026-02-20T17:10:12+01:00

Background/Aim: Oral squamous cell carcinoma (OSCC) is associated with multiple risk factors, including genetic variations such as the TP53 PIN3 16-bp duplication polymorphism. This study aimed to assess the association between this polymorphism and susceptibility to OSCC in the Montenegrin population and to evaluate its influence on OSCC prognosis and progression.

Materials and Methods: Genomic DNA extracted from 60 patients with OSCC and 71 cancer-free controls was analyzed using the polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) technique to identify TP53 PIN3 genotypes and allele frequencies. Clinical and pathological data, along with three-year follow-up outcomes, were also analyzed.

Results: During the follow-up period, 12 patients (20%) experienced local recurrence of disease and 6 patients (10%) developed regional metastases, with no distant metastases detected. No significant associations were observed between the PIN3 16-bp duplication polymorphism and patient age, tumor site, grade, disease recurrence, or metastasis (p > 0.05). A significant association between TP53 genotypes and advanced stage of disease was found (p = 0.006). There were no significant differences in disease-free survival among genotypes: A1A1 (28.26 ± 1.70 months), A1A2 (35.00 ± 0.94 months), and A2A2 (30.00 ± 5.20 months) (p = 0.38). Additionally, no significant differences in allele or genotype frequencies between patients and controls were observed (p > 0.05).

Conclusion. The TP53 PIN3 16-bp duplication polymorphism cannot be considered a risk factor for OSCC development in the Montenegrin population. Furthermore, this polymorphism does not modulate susceptibility to OSCC progression.

ERGONOMIC RISK AND MUSCULOSKELETAL PAIN IN DENTAL PRACTICE

2026-03-17T12:10:38+01:00

Objective: Ergonomics in dental practice plays a crucial role in maintaining professional health, as prolonged static postures and repetitive movements significantly increase the risk of work-related musculoskeletal disorders among dental professionals. Understanding ergonomic risk factors and their impact on musculoskeletal health is essential for identifying vulnerable groups and developing effective preventive strategies in dental practice.

Aim: The aim of this study was to assess the occurrence of musculoskeletal pain as a manifestation of work-related musculoskeletal disorders among dentists and to analyze its association with demographic characteristics, work habits, and dental specialization.

Materials and Methods: This cross-sectional study included 130 dentists from various dental specialties. Data were collected using a structured questionnaire addressing demographic variables, work habits, ergonomic conditions, and the presence of musculoskeletal pain. Descriptive statistical methods were applied, and chi-square tests were used to analyze associations between categorical variables, with statistical significance set at p < 0.05.

Results: The results indicated that the majority of participants experienced work-related musculoskeletal disorders, with prevalence increasing with age and length of professional experience. Occupational factors such as prolonged sitting or standing, improper working posture, lack of ergonomic chairs, and insufficient physical activity were significantly associated with the occurrence of work-related musculoskeletal disorders (p < 0.05). A statistically significant association was also observed between dental specialty and the presence of work-related musculoskeletal disorders (χ²(9) = 25.83; p < 0.01). The highest prevalence was reported among specialists in prosthodontics, pediatric dentistry, orthodontics, and endodontics, while lower prevalence was observed among oral surgeons, general dental practitioners, and periodontists.

Conclusion: These findings emphasize the importance of implementing ergonomic interventions, regular physical activity, and preventive strategies in dental practice to reduce the occupational risk of work-related musculoskeletal disorders.

PATIENT PERCEPTIONS AND EXPERIENCES OF ENDODONTIC TREATMENT IMPLICATIONS FOR ORAL HEALTH CARE

2026-05-07T12:31:59+02:00

Background: Endodontic treatment is an essential procedure for preserving natural teeth and preventing further oral health complications. However, patients’ perceptions, knowledge, and anxiety related to root canal treatment may influence their willingness to undergo the procedure and their overall satisfaction with dental care.

Aim: The aim of this study was to examine the association between demographic characteristics—such as gender, age, and educational level—and patients’ perceptions, attitudes, and expectations regarding endodontic treatment.

Materials and Methods: A cross-sectional study was conducted using an anonymous online questionnaire among patients residing in Sarajevo Canton. A total of 171 participants who had previously undergone endodontic treatment completed the questionnaire. The questionnaire collected demographic data and information about patients’ knowledge of endodontic treatment, previous treatment experience, satisfaction with the information provided by the dentist, perceived pain or discomfort, communication with the dentist, and overall treatment experience. Data were analyzed using IBM SPSS Statistics version 22. Descriptive statistics were used to summarize the data, while the independent samples Student’s t-test and one-way analysis of variance (ANOVA) were applied to assess differences between groups. Statistical significance was set at p < 0.05.

Results: The majority of participants were female (80.1%), and most had a university degree (60.8%). Male participants reported significantly higher satisfaction with the information provided, the dentist’s professionalism, and comfort during treatment compared to female participants (p < 0.05). Participants aged 41 years and older reported significantly higher satisfaction with communication, information provided, and overall treatment experience than younger age groups. Participants with a lower level of education reported significantly higher levels of pain or discomfort during or after treatment (p < 0.004).

Conclusion: Patients generally showed a positive perception of endodontic treatment. Effective communication, adequate patient education, and the dentist’s professionalism play an important role in reducing anxiety and improving patient satisfaction and treatment experience.

POST-LAPAROSCOPIC SHOULDER PAIN: A NARRATIVE REVIEW OF A FREQUENT POSTOPERATIVE SEQUELA

2026-02-20T17:09:10+01:00

While the adoption of laparoscopic surgery has enhanced patient safety, comfort, and satisfaction, a considerable number of patients experience post-laparoscopic shoulder pain (PLSP), which can slow recovery. The English-language literature was reviewed after searching major academic databases and engines, including PubMed, Google Scholar, ResearchGate, and Web of Science, to summarize the current understanding of the etiopathogenesis, associated risk factors, and management strategies for post-laparoscopic shoulder pain. The precise etiology remains undefined, and several theories have been proposed to explain PLSP. The most widely accepted theory suggests that PLSP is a form of referred pain caused by diaphragmatic irritation due to stretching from pneumoperitoneum or the presence of residual gases and fluids. Currently, there are no universally accepted protocols for either the prevention or treatment of PLSP; consequently, a wide range of modalities are applied based on the surgeon’s expertise and preference. There is a clear need to improve awareness of this condition to enable the standardization of management options, thereby optimizing patient outcomes.

PSYCHOTIC MANIFESTATIONS IN PRIMARY SJÖGREN’S SYNDROME: CLINICAL CHARACTERISTICS AND PATHOPHYSIOLOGICAL INSIGHTS

2026-04-27T09:41:37+02:00

Psychotic manifestations in primary Sjögren’s syndrome (SS) represent a rare but clinically meaningful complication of the disease. The aim of this paper was to analyze the clinical characteristics, potential pathophysiological mechanisms, therapeutic approaches, and outcomes of psychotic symptoms in patients with SS.

A narrative review of the available literature was conducted, with particular focus on case reports and small case series describing psychosis in the context of SS.

Psychotic manifestations in SS may arise from central nervous system involvement, immune-inflammatory mechanisms, cytokine dysregulation, and neurotransmitter alterations, as well as from corticosteroid therapy. Pro-inflammatory cytokines, particularly interleukin-6, have been linked to dopaminergic dysfunction and the emergence of positive psychotic symptoms. Corticosteroids may induce psychotic episodes depending on dose and duration of treatment. Chronic somatic symptoms, including ocular and oral dryness, pain, and fatigue, may be vulnerable to delusional misinterpretation. In several reported cases, psychotic symptoms improved following immunosuppressive therapy, supporting a potential immune-mediated subtype of psychosis in this population.

Psychosis in primary Sjögren’s syndrome likely has a multifactorial etiology. Early recognition of a possible autoimmune basis is essential, as treatment strategies may require immunomodulatory therapy in addition to standard psychiatric management.

TREND IN THE PLACEMENT OF PERMANENT AND TEMPORARY CENTRAL VENOUS CATHETERS FOR HEMODIALYSIS

2026-05-07T12:32:42+02:00

Dear Editor

Chronic kidney disease (CKD) is one of the fastest-growing diseases worldwide (1). As the world population ages, the incidence of renal failure is increasing globally, along with the prevalence of people receiving chronic dialysis. There are three renal replacement modalities: peritoneal dialysis (PD), transplantation (Tx), and hemodialysis (HD), HD being the most common form of dialysis, with a worldwide prevalence of 89%, with PD accounting for the remaining 11%. The standard approach for HD is the arteriovenous fistula (AVF), while an alternative vascular access device for HD, still the tunneled central venous catheter (CVC) (1,2), is a salvage vascular access option for HD, but it is still used in approximately one-quarter of prevalent patients worldwide, although it is associated with poor performance and higher risks (2).

The literature suggests that CVC remains the most commonly used vascular access option for HD, despite guidelines advising that AVFs should be used whenever possible. The risk of CVC has mostly focused on catheter-related bacteremia and/or has only evaluated tunneled CVCs (TCVKs) (3). CVCs were first used in a patient in 1969. Over time, indications for their use have become more numerous, such as parenteral nutrition, chemotherapy, and situations where peripheral venous access is not possible in patients in intensive care units. CVC placement involves the placement of a catheter in a large-lumen venous system, most commonly the internal jugular, subclavian, or femoral vein. Complications associated with CVC placement occur in 2–26% of cases, so its use is rare and is most often in acute renal failure (4).

Globally, almost three-quarters of patients on HD require a CVC (5,6). CVCs provide immediate access to hemodialysis in cases where high nitrogenous wastes, hyperkalemia, and anuria require urgent HD, but the use of a catheter is thought to increase the risk of complications associated with placement and long-term use (7).

In patients on HD, CVCs are used when other vascular access options are not available (8–11). Since the introduction of CVCs, catheters have been coated with heparin or antibiotics, and catheter-related complications are less common (12,13).

The literature suggests that CVC-associated bloodstream infections in patients on HD are an important cause of hospitalization, morbidity, and mortality. Eliminating bloodstream infections in the hemodialysis setting has been a focus of the Centers for Disease Control and Prevention (CDC) Coalition (14,15,16).

General preventive measures, including the use of asepsis and antisepsis, play a key role in the prevention and early detection of CVC-associated infections in patients on HD. Infection control surveillance, together with a team approach to care (doctor–nurse), significantly contributes to the reduction of CVC-related morbidity and mortality (4).

Our data from the Nephrology Clinic show that in 2025, out of approximately eighty patients on HD, 14 had a temporary or permanent CVC. Our HD center does not differ significantly from other centers in terms of the trend of CVC placement and the occurrence of complications, which can be explained by the correct placement and monitoring of therapeutic guidelines by anesthesiologists and nephrologists, and the correct maintenance and hygiene of CVCs by educated nurses in the dialysis center, Nephrology Clinic, Clinical Center of Montenegro, and the application of asepsis and antisepsis measures. Continuous evaluation, proper care and hygiene of dialysis catheters, and early detection of patients with end-stage renal disease are recommended in order to initiate HD on time and thereby prevent complications and reduce morbidity and mortality rates, with the aim of extending life expectancy and improving the quality of life of patients on HD.