Background: The newly synthesized palladium(II) complex [Pd(L1)Cl]Cl (where L1 = N2,N6-bis(5-methylhthiazol-2-yl)pyridine-2,6-dicarboxamide) has demonstrated significant in vitro antitumor activity. In this study, the effects of this complex on the immune response and its antimicrobial potential were evaluated. Methods: Splenocytes isolated from mice were treated with lipopolysaccharide (LPS)/Concanavalin A (ConA) along with the Pd(II) complex. The concentrations of IFN-γ, IL-17, IL-4, TNF-α, IL-1β, and IL-10 were measured using commercial ELISA kits. The antimicrobial effect was tested against reference strains of Gram-positive and Gram-negative bacteria, as well as yeast. The Minimal Inhibitory Concentration (MIC) was determined via the broth microdilution method, followed by the determination of Minimal Bactericidal/Fungicidal concentrations (MBC/MFC). Results: The Pd(II) complex induced an increase in the concentration of all tested cytokines compared to untreated cells. Co-treatment with Pd(II) complex and LPS significantly increased the levels of IFN-γ, IL-1β, and IL-17 compared to the LPS-only-stimulated group. Co-treatment with ConA and the Pd(II) complex resulted in a significant increase in TNF-α and IL-17 levels, whereas a significant decrease was observed in the concentrations of IL-10, IL-4, and IFN-γ compared to the ConA-only-stimulated group. The tested complex showed weak to moderate antimicrobial activity, Gram-positive bacteria showed better susceptibility to the examined complex compared to Gram-negative. Conclusions: Results of the study indicate that the Pd(II) complex exhibits a significant immunomodulatory effect on splenocytes, alongside weak to moderate antimicrobial activity.

Background/Objectives: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for postpartum pain management. However, previous studies have indicated that NSAIDs may increase systolic blood pressure, particularly in patients receiving antihypertensive therapy. The aim of the present study was to assess whether postpartum ibuprofen administration is associated with a higher risk of severe postpartum hypertension and increased mean arterial pressure (MAP) compared with acetaminophen. Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science to identify relevant studies. Only randomized controlled trials were considered eligible for inclusion. For dichotomous outcomes, effect sizes were expressed as risk ratios (RRs) with corresponding 95% confidence intervals (CIs). For continuous outcomes, mean differences (MDs) with 95% CIs were calculated. Statistical heterogeneity among studies was assessed using the I2 statistic. A fixed-effects model was applied in cases of low heterogeneity (I2 < 20%). Results: No significant difference was observed in the prevalence of severe postpartum hypertension between the ibuprofen and acetaminophen groups (RR 1.07, 95% CI 0.84 to 1.35; p = 0.59; I2 = 0%). Similarly, MAP did not differ significantly between groups (MD −0.05 mmHg, 95% CI −1.53 to 1.42; p = 0.94; I2 = 0%). Conclusions: No increased risk of postpartum hypertension or difference in mean arterial pressure was observed between the ibuprofen and acetaminophen groups, supporting the safety of ibuprofen for postpartum analgesia in women with hypertensive disorders of pregnancy.

Background The concept of flipped classrooms (FCs) is gaining attention in medical education as it aligns with the digital age’s demand for more interactive and accessible learning experiences. By shifting the delivery of instructional content outside of the classroom, an FC allows students to engage with materials at their own pace, thereby maximizing in-class time for discussions, problem-solving, and other active learning activities. Objective This study aimed to conduct a comprehensive meta-analysis to appraise the comparative effectiveness of FC instruction in contrast to traditional pedagogical modalities, with a particular focus on postepidemic analyses within specific subfields of medical education. Methods The PubMed, Web of Science, and Scopus databases were systematically searched for studies comparing academic outcomes between the FC and traditional learning approaches in medical education. The primary outcome measures were knowledge assessment and students’ satisfaction. The standardized mean difference (SMD) was used as a measure of the overall effect, and subgroup analysis was performed according to the study design (randomized controlled trial [RCT] vs observational). The Cochran Q test and Baujat plots were used to estimate heterogeneity, coupled with I2. Highly influential studies were identified; sensitivity analyses and metaregression were performed. Results In total, 141 studies were included in the systematic review; 127 (90.1%) studies with 21,171 participants were included in the meta-analysis of students’ knowledge assessment, of which 37 (29.1%) were RCTs. FCs had significantly better outcomes than the traditional method in knowledge test scores in both observational studies and RCTs (SMD 0.90, 95% CI 0.59-1.20, P<.001 and SMD 0.93, 95% CI 0.65-1.22, P<.001, respectively). There was substantial heterogeneity among included studies (I2=95.2%, τ2=1.614; P<.001). The funnel plot showed high asymmetry with significant small study effects (P<.001). However, the effect estimate remained robust to the exclusion of highly influential studies in the sensitivity analysis. In total, 27 (21.3%) studies with a total of 5842 participants reported students’ satisfaction. Higher student satisfaction scores for FCs were demonstrated in contrast to control groups (SMD 0.82, 95% CI 0.45-1.19; P<.001). There was substantial heterogeneity among the included studies (I2=97.8%, τ2=0.913; P<.001) but no evidence for publication bias, and no studies were found to be influential. Conclusions The FC method is associated with better knowledge achievement and greater student satisfaction than the traditional approach in medical education, paving the way for its broader integration into medical school curricula. However, it is essential to consider various factors, such as the availability of resources, faculty readiness, and student preferences when implementing any new educational approach. This study holds promise for advancing medical education by exploring innovative teaching methodologies that leverage technology to enhance learning outcomes.

Purpose Diabetic kidney disease (DKD) significantly affects health and healthcare costs due to chronic kidney disease complications. Given asprosin’s potential as a biomarker for disease progression, we conducted the first systematic review and meta-analysis on its relationship with DKD in adults with type 2 diabetes mellitus (T2DM). Methods PubMed, Embase, Cochrane, and Web of Science were systematically searched. Standard mean differences (SMD) with 95% confidence intervals (CI) and Fisher’s Z transformation were used to examine the relationship between asprosin and DKD. The risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS) and its version for cross-sectional studies. Heterogeneity (I² > 50%) was analyzed with a random-effects model. Results Six studies (n = 1340) were included. Meta-analysis results indicated that T2DM patients with DKD (micro/macroalbuminuria) had significantly higher circulating asprosin levels than normoalbuminuric T2DM patients (SMD: 1.5, 95% CI: 0.69–2.32, p = 0.0003). Meta-analysis of correlation revealed a positive association of asprosin with urinary albumin excretion ratio (UACR) (Fisher’s Z = 0.4; 95% CI: 0.240–0.554, p < 0.001) and body mass index (BMI) (Fisher’s Z = 0.17; 95% CI: 0.036–0.301, p = 0.013), and a negative association with estimated glomerular filtration rate (eGFR) (Fisher’s Z = −0.35; 95% CI: −0.471 to −0.239, p < 0.001). Conclusion Asprosin is elevated in T2DM patients with pre-DKD (early stage DKD) and DKD and correlates with key markers of disease severity. Additional research is required to better understand the pathophysiological mechanisms of asprosin and its role in DKD.

Background/Objectives: Composite hemangioendothelioma (CHE) is a rare vascular endothelial tumor with borderline malignancy. This study presents a case of CHE and an updated systematic review of previously reported cases, providing insights into recurrence patterns and survival outcomes. Methods: A comprehensive electronic search was conducted across PubMed, Scopus, the Cochrane Library, and Web of Science up to 31 December 2024, to identify eligible case reports. Kaplan–Meier curves were used to estimate event-free survival. Results: We report a 61-year-old man with a splenic lesion associated with weight loss and abdominal pain persisting for 1 year. Intraoperative findings revealed an enlarged spleen and multiple hepatic deposits. Splenectomy and liver biopsy revealed a well-demarcated, nodular tumor measuring 160 × 145 × 100 mm, with histological and immunohistochemical findings consistent with CHE, complicated by hepatic metastasis. Of 405 potentially eligible studies, 59 were included in the review, covering cases from 2000 to 2024, with a peak in 2020 and 2023. The median age of patients was 42 years, with the most common tumor sites being the lower extremities (30.48%), followed by the face, head, and neck (20.95%), and upper extremities (18.1%). Surgical intervention was the most common treatment (60.95%). Recurrence-free survival was observed in 42.86% of cases, while 15.24% experienced recurrence with or without metastasis. Two patients (1.90%) died from the disease. The median recurrence-free survival was 48 months (95% CI: 7.3–88.7). Conclusions: CHE exhibits significant morphological variation and can mimic other vascular tumors. Accurate diagnosis is crucial for proper prognosis and avoiding overtreatment due to misdiagnosis as more aggressive neoplasms. Patients with high-risk CHE should undergo closer surveillance to ensure timely detection of progression.

Introduction This study explored the complex relationship between anxiety, depression, compassion fatigue, and satisfaction among long-term care (LTC) workers following the COVID-19 pandemic. In addition, the study assessed psychometric properties of the Professional Quality of Life (ProQOL) scale, to ensure a reliable and valid instrument for identifying compassion fatigue and satisfaction in the Serbian healthcare system. Methods A cross-sectional study was conducted across LTC facilities in the Republic of Serbia. A ProQOL was administered to physicians, nurses, and aids, to measure compassion fatigue (including burnout and secondary traumatic stress) and compassion satisfaction. The following standardized instruments were also distributed: Secondary Traumatic Stress Scale (STSS), Depression Anxiety and Stress Scale 21 (DASS-21) and 12-Item Short-Form Health 36 Survey (SF-12). Results A total of 300 LTC workers participated, mostly women (86.3%), with an average age of 45.4 ± 10.5 years and a median work experience of 15 years (range: 1 to 42 years). The study reported a significant presence of anxiety and depression symptoms (53.3% and 43.3%, respectively), with LTC workers experiencing moderate levels of compassion fatigue, as indicated by burnout (58.3%) and stress (57.3%) subscales, and moderate or high levels of compassion satisfaction (49.0% and 50.0%, respectively). The study demonstrated that anxiety impacts depression both directly and indirectly (p<0.05). Specifically, burnout and compassion satisfaction mediated the positive effect of anxiety on depression, indicating that increased anxiety led to higher burnout and lower compassion satisfaction, which resulted in greater depression (p<0.05). The three-factor structure of the ProQOL was validated (IFI, TLI, and CFI were above the cut-off of ≥0.95, and the RMSEA was below the suggested value of ≤ 0.06). The Cronbach α of the three subscales was above 0.8, indicating good scale reliability. Conclusion This study contributes to the broader literature on LTC workers wellbeing by examining the complex interplay between professional quality of life, anxiety, and depression. The findings should guide decision-makers in developing targeted interventions and policies that promote the psychological resilience and well-being of LTC workers, thereby enhancing both individual and organizational outcomes in the healthcare sector.

Background: The purpose of this meta-analysis was to examine the prevalence of hypertensive disorders of pregnancy (HDPs), particularly preeclampsia (PE), in peripartum cardiomyopathy (PPCM)-affected pregnancies, and to evaluate whether a HDP significantly alters the prognosis of PPCM, with specific reference to the recovery of left ventricular function (LVEF) and mortality. Methods: A total of 5468 potentially eligible studies were identified, and 104 were included in the meta-analysis. For pooling proportions, the inverse variance methods with logit transformation were used. Complete recovery of LVEF (>50%) and mortality were expressed by odds ratios (ORs), with 95% confidence intervals (CIs). The Peto OR (POR) was used in cases of rare events. Baseline LV function and baseline LV end-diastolic diameter (LVEDD) were summarized by the mean difference (MD) and 95% confidence interval (CI). Results: The summary estimate of the prevalence of HDPs and PE in women with PPCM was 36% and 25%, respectively. Patients with HDPs and, more specifically, PE with PPCM had a higher chance of complete recovery (OR = 1.87; 95%CI = 1.64 to 2.13; p < 0.001 and OR = 1.98; 95%CI 1.69 to 2.32; p < 0.001, respectively), a higher baseline LVEF (MD, 1.42; 95% CI 0.16 to 2.67; p = 0.03 and MD, 1.69; 95% CI 0.21 to 3.18; p = 0.03, respectively), and a smaller baseline LVEDD (MD, −1.31; 95% CI −2.50 to −0.13; p = 0.03 and MD, −2.63; 95% CI −3.75 to −1.51; p < 0.001, respectively). These results, however, did not translate into a significant difference in 12-month mortality (POR = 0.80; 95% CI = 0.57 to 1.13; p = 0.21 and POR = 1.56; 95% CI 0.90 to 2.73; p = 0.12, respectively). Conclusions: The findings of this study may contribute to evidence that can be utilized to aid in the risk stratification of patients with PPCM regarding their long-term prognoses.

Background/Aim. Postoperative cognitive dysfunction (POCD) occurs very often in operated patients. This increasingly frequent complication compromises the recovery of operated patients, impairs the quality of life of patients and their families, prolongs the length of hospital stay, and increases the cost of treatment. The aim of the study was to examine the association between the apolipoprotein E (APOE) ?4 allele and sociodemographic and clinical characteristics with the occurrence of POCD seven days and three months after colon cancer surgery (CCS) under general anesthesia (GA). Methods. A total of 113 patients aged 18 to 87 years who underwent CCS under GA in the period from 2021 to 2023 participated in the study. Preoperative preparation, anesthesia, and postoperative treatment were uniform and standardized for all patients. The assessment of cognitive status was conducted using the Mini Mental State Examination psychometric test on the day before surgery, on the seventh postoperative day, and three months after surgery. Results. Seven days after surgery, a statistically significant impairment of cognitive functions was found in patients with the APOE ?4 allele in their genotype (p = 0.007). Patients 65 years old or above were more likely to have POCD three months after surgery compared to younger patients (80.0% vs. 52.9%; p = 0.003). Conclusion. The presence of the APOE ?4 allele is a potential predictor of the occurrence of POCD seven days after surgery, and age is a significant sociodemographic factor for the occurrence of POCD three months after CCS is performed under GA.

Research involves the systematic collection and analysis of data to enhance understanding of a particular phenomenon. Participation in medical research is crucial for advancing healthcare practices. However, there has been limited focus on understanding the factors that motivate medical students to engage in research. Additionally, in the era of e-learning, the easy accessibility of online resources has contributed to a widespread ‘copy-paste culture’ among digital-native students, which is recognized in academia as plagiarism. Existing studies suggest that a contributing factor to the increasing prevalence of plagiarism is students’ limited understanding of this act. The purpose of this study was to assess medical students’ attitudes toward research and plagiarism, and to evaluate the psychometric properties of the Attitudes Toward Research (ATR) and Attitudes Toward Plagiarism (ATP) questionnaires. This was a multicenter study conducted among medical undergraduate and postgraduate students attending the three medical universities who were involved in research. Students’ attitudes toward research and plagiarism were assessed using the ATR and ATP questionnaires. The research instruments underwent translation and cultural adaptation in accordance with internationally accepted methodology. The psychometric properties of the ATR and ATP, including validity and reliability, were assessed. Confirmatory factor analysis was used to test the model’s fit to the data. The ATR and ATP questionnaires were completed by 793 medical students who were involved in research (647 undergraduates and 146 PhD students). Cronbach’s alpha coefficients of 0.917 and 0.822 indicated excellent and good scale reliability for the ATR and ATP questionnaires, respectively. The five-and three- factor structures of ATR and ATP have been validated with maximum likelihood confirmatory analysis, and the results demonstrated an adequate level of model fit (TLI = 0.930, CFI = 0.942 and TLI = 0.924, CFI = 0.943, respectively). Medical students showed a high degree of positive attitudes toward research and favorable scores across all three domains of attitudes toward plagiarism. In multivariate regression models, age was found to be positively associated with favorable attitudes of research usefulness, positive attitudes, relevance to life subscales and total ATR scale (p < 0.001), while PhD study level was related to research anxiety (p < 0.001) and favorable attitudes across all three ATP domains (p < 0.001). Medical students who were involved in research showed a high degree of favorable attitudes toward research and plagiarism. Adjusting medical school curricula to include research courses would broaden the students’ interest in scientific research and maximize their impact on the full preservation of research ethics and integrity.

Background/Objectives: The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is a widely employed self-report tool for assessing upper extremity function. The aim of this study was to assess the psychometric properties of the Serbian version of the DASH by determining its criterion and construct validity, as well as internal consistency. Methods: This cross-sectional study was conducted among patients with hand and wrist disabilities at the Institute for Orthopedics “Banjica”, Serbia. The psychometric properties of the Serbian version of the DASH were analyzed through an examination of its factorial structure and internal consistency. The DASH consists of 30 items, 24 of which assess function, 21 of which focus on physical function and three on social/role function. The remaining six items evaluate symptoms related to pain, tingling/numbness, weakness, and stiffness. Results: A total of 297 patients were included in the study. The mean age was 47.4 ± 16.8 years, with 50.5% males. Three models were assessed to determine the reliability and validity of the questionnaire across different domains. Model 1 examined a single-factor structure. In Model 2, the items were divided into two domains: Physical Function and Psychosocial/Symptoms. In Model 3, items were subdivided into three domains: Physical Function, Symptoms, and Psychosocial. All models demonstrated an excellent internal consistency with a Cronbach’s alpha > 0.9 for most domains. The values for the fit indices Tucker–Lewis index (TLI) and Comparative-Fit Index (CFI) were above their cut-off criteria of 0.9, while the Root Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Square Residual (SRMR) were below the suggested value of 0.06, indicating an excellent level of models fit. Standardized factor loadings were statistically significant (p < 0.05). Conclusions: The present study provided the evidence for the appropriate metric properties of the Serbian version of the DASH. Results support both the unidimensional and multidimensional structures of the DASH.