Background/Objectives: Antipsychotic drug utilization has changed substantially over recent decades, reflecting evolving prescribing practices, drug availability, and treatment guidelines. Methods: This study analyzed national antipsychotic consumption in Serbia from 2006 to 2024 using official data from the Medicines and Medical Devices Agency of Serbia. Utilization was expressed as defined daily doses per 1000 inhabitants per day, and trends were assessed using linear and joinpoint regression analyses. Results: Total antipsychotic utilization increased from 4.35 to 14.42 DDD/1000 inhabitants/day, representing a 231.5% increase. This growth was predominantly driven by atypical antipsychotics, whose utilization increased from 1.16 to 10.91 DDD/1000 inhabitants/day (+840.2%). In contrast, typical antipsychotic utilization remained relatively stable in absolute terms. The share of atypical antipsychotics increased from 26.7% in 2006 to 75.6% in 2024, while the atypical: typical utilization ratio increased from 0.36 to 3.10. Atypical antipsychotics surpassed typical agents in 2013. Marked increases were observed for olanzapine, quetiapine, aripiprazole, paliperidone, risperidone, and clozapine, while chlorpromazine and fluphenazine declined. Conclusions: These findings demonstrate a substantial increase in overall antipsychotic utilization in Serbia and a pronounced structural shift toward atypical agents, highlighting the need for continued monitoring of prescribing trends, safety outcomes, and population-level treatment patterns.

Background/Objectives: Bilateral thoracoscopic sympathectomy (BTS) is the definitive treatment for primary focal hyperhidrosis, yet postoperative pain remains an undertreated consequence with no established analgesic consensus. This study compared three analgesic regimens on pain trajectory, opioid consumption, and functional recovery following BTS. Methods: In this prospective observational cohort study, 300 patients undergoing BTS were allocated in a non-randomized manner reflecting institutional practice to three parallel cohorts (n = 100 each): Group 1 received systemic opioids alone; Group 2 received opioids plus pre-emptive local anesthetic wound infiltration; and Group 3 received opioids plus thoracoscopic-guided intercostal nerve block (ICNB). Primary outcomes included pain intensity on the Numerical Rating Scale and total opioid consumption. Results: ICNB patients reported significantly lower mean peak pain scores (3.8 ± 1.7) versus local infiltration (4.6 ± 1.9) and opioid-only groups (5.2 ± 2.1; p < 0.001). Total opioid consumption was reduced by 38% in the ICNB group (12.4 ± 4.8 mg vs. 20.1 ± 6.3 mg; p < 0.001). Moderate-to-severe pain occurred in 42.0% of ICNB patients versus 74.0% of controls (p < 0.001). ICNB was independently associated with reduced moderate-to-severe pain (adjusted odds ratio (AOR) 0.31; 95% confidence interval (CI) 0.17–0.56; p < 0.001). ICNB patients returned to normal activities faster (median 3 vs. 5 days; p = 0.008) with higher satisfaction (91.0% vs. 78.0%; p = 0.044). Conclusions: In this observational cohort, ICNB was associated with significantly lower postoperative pain scores, reduced opioid consumption, and faster functional recovery following BTS. These findings suggest that ICNB may be an effective adjunct analgesic strategy for ambulatory BTS, pending confirmation in randomized controlled trials.

ABSTRACT Background: Interaction between healthcare professionals and patients is a complex process influenced by communication, environmental, individual, and organizational factors. Objective: To synthesize qualitative and quantitative evidence and identify key characteristics of effective interaction between patients and nurse anesthetists during the perioperative period. Methods: A systematic literature search was conducted in PubMed, MEDLINE, CINAHL, Embase, and the Cochrane Library to identify qualitative and quantitative studies examining factors influencing interaction between patients and nurse anesthetists in the perioperative setting. Results: Both facilitators and barriers to effective interaction were identified. Facilitators included respectful, patient-centered care, a supportive work environment, and clear, timely communication. Barriers included negative staff attitudes, procedural stress, interpersonal conflicts, exposure to violence, and communication challenges such as low speech volume, unclear articulation, and limited language proficiency. Effective communication was associated with improved patient safety, enhanced team cohesion, and more efficient information exchange. However, increased reliance on advanced technology may reduce patient engagement and interpersonal communication within the healthcare team. Conclusion: Nurse anesthetists play a critical role in supporting patients during potentially stressful perioperative experiences. Organizational factors, time constraints, and communication strategies may influence the quality of patient–provider interaction. Further research is needed to determine how these factors can be optimized to improve perioperative care and patient outcomes.

Abstract Hemorrhagic cystitis (HC) in children is most associated with infection or treatment-related toxicity, whereas other cases remain uncommon. We report a 5-year-old boy presenting with recurrent painless gross hematuria in whom a structured, stepwise evaluation excluded glomerular, infectious, structural, and systemic causes. Cystoscopy revealed diffuse mucosal inflammation with focal hemorrhagic changes involving the bladder neck and posterior wall, consistent with noninfectious HC. In the absence of an identifiable etiology and with persistent symptoms, management was directed toward restoring urothelial barrier integrity using intravesical hyaluronic acid (HA). The clinical response was rapid, with resolution of gross hematuria after the first instillation, followed by sustained remission and progressive endoscopic improvement. The treatment was well tolerated, and the patient remained disease-free at 12 months of follow-up. This case highlights the diagnostic complexity of unexplained hematuria in children and supports a potential role of urothelial barrier dysfunction in the pathogenesis of noninfectious HC.

OBJECTIVE To investigate reported paper mill involvement among retracted systematic reviews and meta-analyses (SR/MAs), and to compare retracted SR/MAs with and without reported paper mill involvement with respect to temporal patterns, disciplinary profile, country recorded in the database, and retraction characteristics. STUDY DESIGN AND SETTING Cross-sectional study based on the Retraction Watch database. Records were screened to identify retracted SR/MAs. Reported paper mill involvement was assigned only when explicitly stated in the Retraction Watch record or associated retraction information; fake peer review was coded separately. Group comparisons used the Pearson chi-square and Mann-Whitney U tests. Associations with reported paper mill involvement were estimated using univariable Poisson regression with robust variance and reported as prevalence ratios (PRs) with 95% confidence intervals (CIs). These analyses were treated as exploratory, non-inferential internal contrasts within the dataset of already retracted SR/MAs. RESULTS Among 69,163 retracted publications in the Retraction Watch dataset, 1,071 (1.5%) were identified as retracted SR/MAs. Of those, 191 (17.8%) were paper mill-associated and 880 (82.2%) were not. In the database country field, China was recorded for 732/1,071 retracted SR/MAs (68.3%) and 177/191 SR/MAs with reported paper mill involvement (92.7%). The annual number of paper mill-associated SR/MAs peaked in 2023 (n=152). Within this restricted dataset, paper mill-associated SR/MAs had a longer median time to retraction (511 vs 459 days; p=0.024), more frequent results-related concerns (89.0% vs 30.0%), data issues (53.4% vs 17.5%), referencing concerns (53.9% vs 13.6%), and ethical concerns (8.9% vs 2.6%) (all p<0.001), and less frequent multi-country authorship (8.9% vs 17.6%; p=0.004). In univariable Poisson regression analyses restricted to retracted SR/MAs, larger observed proportions of reported paper mill involvement were seen among records linked to China in the database country field (PR 5.86, 95% CI 3.45-9.93), more recent publication years (PR 1.20 per 1-year increase, 95% CI 1.16-1.23), the medical broad domain (PR 3.66, 95% CI 1.66-8.08), and records with results-related concerns (PR 11.88, 95% CI 7.68-18.39). These PRs should not be interpreted as likelihoods, risks, or rates beyond the analyzed Retraction Watch subset. CONCLUSION In this Retraction Watch-based analysis, reported paper mill involvement was identified in 191/1,071 retracted SR/MAs (17.8%). These records were most often linked to China in the database country field (177/191; 92.7%) and clustered in recent years, particularly 2023. These findings should be interpreted as descriptive patterns within detected and retracted records, not as country-level rates, comparative performance indicators, or estimates of the true prevalence of paper mill activity.

Chronic kidney disease is increasingly recognised as a systemic disorder with important neurological consequences, including cognitive impairment. However, the field remains challenging because CKD-related cognitive decline involves diverse uremic toxins, overlapping vascular, inflammatory, metabolic, endothelial, and neurodegenerative pathways, inconsistent cognitive screening practices, and no unified treatment strategy. Within this context, the kidney–brain axis provides a useful framework for integrating renal dysfunction, toxin retention, systemic inflammation, blood–brain barrier disruption, and cognitive vulnerability. Of these mechanisms, uremic neurotoxicity offers a biologically credible connection between compromised renal clearance and cerebral dysfunction. Retained solutes such as indoxyl sulfate, p-cresyl sulfate, indole-3-acetic acid, trimethylamine-N-oxide, urea, guanidino compounds, lanthionine, quinolinic acid, and homocysteine may induce endothelial injury, oxidative stress, neuroinflammation, mitochondrial dysfunction, excitotoxicity, and glial activation. Although these pathways are supported by experimental and translational studies, direct causal evidence in humans remains limited, and most clinical data should currently be interpreted as associative rather than definitive proof of causality. These processes converge on neuronal and synaptic vulnerability and may elucidate the distinctive cognitive profile associated with chronic kidney disease, particularly deficits in attention, processing speed, and executive function. This review summarizes the most recent evidence on the epidemiology and clinical phenotype of cognitive impairment in chronic kidney disease. It also discusses the molecular and cellular mechanisms of uremic neurotoxicity and examines new biomarkers of the kidney–brain axis, including neurofilament light chain, glial fibrillary acidic protein, brain-derived neurotrophic factor, tight junction proteins, and uremic toxins. However, these biomarkers remain insufficiently validated for routine clinical use, as their interpretation is complicated by reduced renal clearance, systemic inflammation, comorbid vascular disease, methodological heterogeneity, and the lack of longitudinal studies linking biomarker changes to cognitive outcomes. Therapeutic strategies targeting uremic toxins remain compelling from a mechanistic standpoint, but they are not yet fully developed in clinical practice. Subsequent research ought to amalgamate toxin profiling, cognitive phenotyping, neuroimaging, endothelial and inflammatory biomarkers, alongside patient-centered outcomes. Integrating cognitive assessment into nephrology care may enhance risk stratification, collaborative decision-making, and personalised management for patients with chronic kidney disease.

A BSTRACT Heart failure (HF) patients are frequently exposed to polypharmacy, placing them at increased risk for drug–drug interactions (DDIs), especially in an outpatient setting where monitoring may be limited. The aim was to assess the prevalence and predictors of clinically relevant DDIs in HF patients and identify patterns associated with higher interaction risk. This cross-sectional observational study included 670 HF patients, treated at a single outpatient cardiology practice. Clinical and pharmacologic data were extracted from medical records. DDIs were identified using the Epocrates interaction checker and classified by severity. Logistic regression and generalized linear models were used to evaluate predictors of avoidable and monitor-required interactions. No contraindicated DDIs were found, but 72.7% of patients had at least one avoidable interaction, and 100% had at least one requiring monitoring. Anticoagulants, mineralocorticoid receptor antagonists, proton pump inhibitor (PPI) use, older age, and HFmrEF and HFpEF phenotypes were significantly associated with increased risk of clinically relevant DDIs. Polypharmacy strongly influenced interaction burden, particularly when ramipril, metformin, atorvastatin, SGLT2 inhibitors, or PPIs were prescribed. Beta-blockers were mildly protective. Clinically significant DDIs are common in HF patients in outpatient care. Risk is highest in older patients, patients with comorbidities requiring multiple pharmacological agents, regimens, and patients with HFmrEF and HFpEF. Structured medication review and attention to high-risk drug combinations are essential to improve safety in HF pharmacotherapy.

This study aimed to identify distinct motivational profiles in mathematics based on students’ confidence and liking of mathematics and to examine their association with mathematics achievement. A person-centered approach was employed using latent profile analysis (LPA) on TIMSS 2023 data from Bosnia and Herzegovina. The sample comprised 2,795 fourth-grade students (1,449 girls; 1,346 boys). The analysis identified four distinct profiles characterized by different combinations of confidence and liking of mathematics. These profiles ranged from generally low levels on both constructs to profiles with high levels of confidence and liking, as well as mixed patterns reflecting discrepancies between the two. Students in the profile characterized by high confidence and high liking of mathematics significantly outperformed all other profiles, whereas no statistically significant differences were observed among the remaining profiles. Gender differences in profile membership were statistically significant but small in magnitude. No interaction effect between gender and profile membership on mathematics achievement was found, although boys demonstrated higher achievement overall. The findings highlight the importance of considering combined motivational patterns rather than isolated constructs, and fostering both confidence and positive attitudes toward mathematics may contribute to improved student achievement.

This study aimed to determine the nutritional status and dietary habits of younger school age children and to assess the accuracy of parental perception regarding their children’s eating behaviours. A total of 300 children aged 7–11 years from northwestern Bosnia and Herzegovina participated in this cross sectional study. Nutritional status was evaluated using anthropometric measurements and age and sex specific body mass index (BMI) percentile curves. Dietary habits were assessed using an anonymous, adapted, structured questionnaire consisting of 24 questions, incorporating a 24-hour dietary recall and a food frequency questionnaire (FFQ). The questionnaires were independently completed by both children and their parents to assess self-reported dietary intake and eating behaviours. Overall, 60.6% of children were classified as having normal body weight, while 8.7% were underweight, 17.0% were overweight, and 13.7% were obese. According to dietary habits evaluated relative to the USDA MyPlate guidelines (USDA, 2019), 81.3% of children consumed breakfast daily, 69.8% had three meals per day, 52.9% consumed two or more servings of fruit, and 83.7% reported water as their primary beverage. However, 52.9% consumed only one serving of vegetables daily, 51.0% consumed less than 250 mL of milk per day, 69.3% had insufficient meat intake, and 46.7% consumed sweets and snacks daily. Statistically significant differences between children’s and parents’ responses were identified in 79% of the assessed items. These findings indicate a substantial discrepancy between parental perceptions and children’s self-reported dietary intake, emphasizing the need for targeted nutritioneducation programmes for both children and parents to support healthier eating habits.

The aim of this study was to assess the frequency of patient complaints, and dentists’ perceptions of legal protection in Bosnia and Herzegovina. A total of 171 dentists participated, employed in both the public (21.5%) and private sector (78.5%), with varying years of professional experience. Data were collected using an anonymous structured questionnaire addressing record-keeping practices, the use of informed consent, experiences with complaints and lawsuits, and perceptions of legal security and exposure to violence. Results show that 80.4% of dentists report maintaining proper documentation, while only 16.8% routinely obtain written informed consent. Negative experiences with patient complaints were reported by 60.7% of respondents, yet only 7.5% had been involved in legal proceedings. Most conflicts (61.7%) were resolved informally through settlement. The highest proportion of complaints concerned prosthodontics (71%), followed by restorative dentistry (15%) and oral surgery (9.3%). More than half of dentists (56.1%) do not feel adequately protected by law, and 69.2% do not know which institution to contact in the event of a patient lawsuit. Verbal violence was reported by 66.4% and physical violence by 1.9% of respondents. Multivariate analysis showed that dentists exposed to violence were significantly less likely to feel legally protected (OR = 9.62, p = 0.031), independent of gender and years of experience. Dentists in the private sector were more likely to resolve complaints through settlement (OR = 1.65, p < 0.001), while prosthodontists experienced the highest number of complaints and exhibited the strongest preference for settlements (OR = 2.63, p = 0.03).

<p>Estmating the risk to pulic health from heavy metals can help solve the basic questions about the potential dangers of exposure to them. This is the first study&nbsp; aimed to assess the health risk for the residents of the municipality of Zenica, on the land closest to the steel industry by examining the heavy metals Zn, Ni, Pb, Cd, Cr and Cu in the soil and plant cultivars corn and chard that could be used for the potential remediation of such soil. With the calculated data for HQ and HI, the non-carcinogenic and carcinogenic risk for adults and children were estimated, based on heavy metals in the selected topsoil and plants, which are usually grown in the area of interest, through different ways of their intake. The results showed that there is an unacceptable risk for children and adults due to long-term consumption of investigated plant cultivars from soil contaminated with heavy metals. Constant monitoring and measures to reducing the heavy metal pollution, primarily Cd, Pb and Cr, are necessary in the lands of ​​the municipality of Zenica. Special caution is required for residents who intend to grow plant cultivars near steel industry</p>

<p>The aim of this work was to examine the possibility of stabilizing red mud with a natural mineral, namely pyrophyllite shale, to the extent that it is not harmful to the environment, as well as the use of such a stabilized composite for the production of building materials such as bricks, in order to ultimately achieve a complete circular economy, where on the one hand there would be the utilization of waste material, the preservation of the environment and natural resources, and on the other hand, the production of products of the same quality.</p> <p>Based on the set goal, the results for the composition of red mud and pyrophyllite shale as well as the stabilized composite before and after thermal treatment at 900 &deg;C are presented in the work, and they show that there is a decrease in the proportion of all oxides present in the mixture except silicon, because it is over 63% in pyrophyllite shale. Based on the stabilized composite, building block samples were formed. After the firing process, the samples cracked, and as such they could not be analyzed further. Based on this, it could be concluded that only stabilized composite cannot be used to make bricks.</p>