Aim: To determine the prevalence of irritable bowel syndrome (IBS)-related symptoms and associated factors among medical students in Bosnia and Herzegovina. Methods: This cross-sectional online survey included 176 medical students from the universities of Sarajevo and Zenica between November 2022 and December 2023. IBS-related symptoms were assessed using the Serbian-language Rome III questionnaire, and test anxiety using the Westside Test Anxiety Scale. Categorical variables were compared using Pearson’s χ² test. Results: Eighty-four students (47.7%) met the symptom-based Rome III criteria. The IBS-related symptoms group included 75 females (89.3%) compared with 54 (58.7%) in the comparison group (p<0.001). Sweets consumption at least four times weekly was reported by 53 (63.1%) and 45 (48.9%) students, respectively (p = 0.021). Test-anxiety distributions differed between groups (p < 0.001); extremely high anxiety was reported by 12 (14.3%) students with IBS-related symptoms and one (1.1%) without symptoms. Other sociodemographic and lifestyle characteristics were not associated with IBS-related symptoms. Conclusion: IBS-related symptoms were frequent in this medical-student sample and were associated with female sex, frequent sweets consumption, and test anxiety. The cross-sectional, self-reported design precludes causal interpretation and clinical confirmation of IBS.

The burden of nephrotoxicity and ototoxicity consequences caused by gentamicin warrants preventive therapeutic measures. Our aim was to evaluate combined and potentially synergistic effects of rosuvastatin and curcumin, both possessing anti-inflammatory and antioxidant properties, compared to their monotherapies in a gentamicin-induced model of nephrotoxicity and ototoxicity. In a randomized, controlled study, 36 male Wistar rats were allocated to six groups and treated for 5 days: negative control group received solvent, model group gentamicin (100 mg/kg, intraperitoneally), treatment groups gentamicin and via orogastric tube either standard-dose rosuvastatin (5 mg/day), reduced-dose rosuvastatin (1.25 mg/day), curcumin (100 mg/kg), or combination of reduced-dose rosuvastatin and curcumin. Human rosuvastatin doses were converted to rat doses using the conversion factor of 6.2. Functional outcomes evaluated by Preyer pinna reflex for hearing and a vestibular battery test were complemented by renal and cochlear histology, biochemical biomarkers of injury, inflammation, and oxidative stress. Gentamicin induced proximal tubular necrosis and cochlear and vestibular damage. Compared to monotherapies, combination therapy significantly preserved renal architecture, improved renal biomarkers, reduced early inflammatory biomarkers, preserved cochlear architecture and drove vestibular protection. It also alleviated gentamicin-induced cardiotoxicity. Rosuvastatin provided stronger auditory protection, with reduced-dose rosuvastatin superior to standard-dose in preserving vestibular function. Bliss independence modelling showed that combined therapy synergistically inhibited kidney injury and inflammation. In conclusion, the combination of reduced-dose rosuvastatin and curcumin outperforms both monotherapies in alleviating gentamicin-induced nephrotoxicity, audiotoxicity and vestibulotoxicity, whilst synergistically attenuating nephrotoxicity and early-phase inflammation in rats. These findings highlight promising preventive strategies against aminoglycoside nephrotoxicity and ototoxicity.

The objective of this study was to confirm the effects of curcumin and to investigate the effects of its combination with a reduced dose (RD) of rosuvastatin in an adenine-induced model of chronic kidney disease (CKD) and associated dyslipidemia in rats. Renal function and morphology, as well as lipid status, were assessed using laboratory parameters and histopathological analysis. Male Wistar rats (n ═ 36) randomly divided into six groups, were treated for 24 days: normal control (standard diet), CKD control (adenine diet, 0.75% w/w adenine-supplemented diet), curcumin (100 mg/kg/day + adenine diet), rosuvastatin minimal therapeutic dose (MTD) (5 mg/day + adenine diet), rosuvastatin RD (25% of rosuvastatin MTD + adenine diet), and rosuvastatin RD + curcumin (25% of rosuvastatin MTD + curcumin 100 mg/kg/day + adenine diet) group. While rosuvastatin alone showed only antilipemic action, both curcumin alone and its combination with an RD of rosuvastatin showed better renal protection with lower serum creatinine levels and milder renal morphological alterations, as well as better antilipemic action with lower levels of triglycerides, very low-density lipoprotein, and low-density lipoprotein cholesterols compared with the levels in CKD control rats. Treatment with curcumin alone also resulted in a significantly higher estimated glomerular filtration rate, lower uric acid levels, and higher high-density lipoprotein cholesterol, while the combined therapy additionally resulted in higher serum albumin levels, lower total cholesterol, and both atherogenic and coronary risk indexes compared with CKD control rats. The results of this study confirmed the beneficial effects of curcumin alone and provided new evidence for the beneficial effects of its combination with an RD of rosuvastatin in rats with CKD and associated dyslipidemia.

Drug-induced nephrotoxicity is still a significant obstacle in pharmacotherapy of various diseases and it accounts for around 25 % of serious side-effects reported after drug administration. Furthermore, some groups of drugs such as nonsteroidal anti-inflammatory drugs, antibiotics, antiviral drugs, antifungal drugs, immunosuppressants, and chemotherapeutic drugs have the "preference" for damaging the kidney and are often referred to as the kidney's "silent killer". Clinically, the onset of acute kidney injury associated with drug administration is registered in approximately 20 % of patients and many of them develop chronic kidney disease vulnerability. However, current knowledge about the mechanisms underlying this dangerous phenomenon is still insufficient with many unknowns. Hence, the valuable use of these drugs in clinical practice is significantly limited. The main aim of this study is to draw attention to commonly prescribed nephrotoxic drugs by clinicians or drugs bought over the counter. In addition, the complex relationship between immunological, vascular and inflammatory events that promote kidney damage is discussed. The practical use of this knowledge could be implemented in the engineering of novel biomarkers for early detection of drug-associated kidney damage such as Kidney Injury Molecule (KIM-1), lipocalin associated with neutrophil gelatinase (NGAL) and various microRNAs. In addition, the utilization of artificial intelligence (AI) for the development of computer algorithms that could detect kidney damage at an early stage should be further explored. Therefore, this comprehensive review provides a new outlook on drug nephrotoxicity that opens the door for further clinical research of novel potential drugs or natural products for the prevention of drug-induced nephrotoxicity and accessible education.

Abstract Gut microbiota is known as unique collection of microorganisms (including bacteria, archaea, eukaryotes and viruses) that exist in a complex environment of the gut. Recently, this has become one of the most popular areas of research in medicine because this plays not only an important role in disease development, but gut microbiota also influences drug pharmacokinetics. These alterations in drug pharmacokinetic pathways and drug concentration in plasma and blood often lead to an increase in the incidence of toxicological events in patients. This review aims to present current knowledge of the most commonly used drugs in clinical practice and their dynamic interplay with the host’s gut microbiota as well as the mechanisms underlying these metabolic processes and the consequent effect on their therapeutic efficacy and safety. These new findings set a foundation for the development of personalized treatments specific to each metabolism, maximizing drugs’ therapeutic effects and minimizing the side effects because they are one of the major limiting factors in treating patients.

Purpose Educational interventions have already been shown to positively affect awareness of clinical trials (CTs) among medical students. We aimed to explore basic knowledge and attitudes about CTs among medical students in terms of educational interventions that should be reflected in their further involvement in performing CTs and their role in raising awareness about CTs. Methods This cross-sectional, self-report anonymous online survey involved undergraduate medical students of the Medical Faculty University of Sarajevo enrolled in classes held within the Department of Pharmacology and Toxicology in the academic year 2015–2016. To include all accessible subjects for better representation of the whole population, consecutive sampling was applied. Results Among 142 students who completed questionnaire, 50% of them expressed partial or full agreement with the questionnaire statement that they were satisfied with the available information on CTs. Only 38% said they would participate in a CT, 21% would not, while 41% were not sure. Positive correlations were detected for composite subscale scores of agreement with questionnaire statements conveying the student’s knowledge about ethical and legal aspects of CTs and their perception about reliability/integrity and impact of CTs on medical practice. Conclusion Students have knowledge of the basic design and ethical aspects of CTs. Positive attitudes toward the impact of CTs on medical practice were shown in students of higher years of study, where educational intervention of additional knowledge of CTs was inserted and those students expressed better knowledge of CTs. However, no significant impact was detected between knowledge and willingness to participate in CTs, irrespective of years of study, reflecting the third of students that would participate in CTs. Changes in medical curricula led to the change in students’ knowledge and attitudes regarding CTs as well as their involvement in CTs.