Preventive Paediatrics

HISTAMINE - DIFFERENT POINT OF VIEW

Jasmina Jocić Stojanović, Zorica Živković, Andreja Prijić — Sat, 18 Apr 2026 00:00:00 +0200

Although the first association with histamine is an allergic reaction, events in the body mediated by this biogenic amine do not always have to be related to allergy. The accumulation of exogenously introduced histamine in the body, which exceeds the possibilities of its elimination, can be the cause of symptoms such as: rhinitis, headache, gastrointestinal symptoms, palpitations, urticaria and itching. This condition is known as histamine intolerance and is most often triggered by histamine-rich foods, alcoholic beverages, and medications that release histamine and/or block diamine oxidase, the main enzyme involved in the metabolism of ingested histamine. This state of disturbed balance between ingested histamine and the possibility of its elimination may be associated with reduced diamine oxidase activity. Due to the intertwining of symptoms with other clinical entities, primarily allergy, and the absence of a specific diagnostic test that confirms this condition, the diagnosis of histamine intolerance requires a multidisciplinary approach that will first rule out other possible causes, and then by implementing a low-histamine diet, using antihistamines, supplementing diamine oxidase, minerals and vitamins lead to symptom control and improvement in the quality of life of patients.

DELIRIUM IN THE PEDIATRIC POPULATION – A HIDDEN CHALLENGE OF INTENSIVE CARE MEDICINE

Jelena Obrenović Stanković, Vesna Veković, Aleksandra Sekulić — Sat, 18 Apr 2026 00:00:00 +0200

Introduction: Delirium is an acute syndrome of impaired attention, awareness, and cognition, often underrecognized in pediatric intensive care (PICU) due to nonspecific manifestations.

Objective: The aim of this paper is to highlight the significance, epidemiology, diagnosis, prevention, and therapy of delirium in critically ill children.

Methodology: This is a narrative review based on the analysis of relevant contemporary literature.

Results: The prevalence of delirium in the PICU ranges from 10% to 44%. It is associated with prolonged hospitalization, increased morbidity, and mortality. The key to diagnosis is the routine use of validated screening tools, such as the Cornell Assessment of Pediatric Delirium (CAPD) for children of all ages and the Pediatric Confusion Assessment Method for the ICU (pCAM-ICU) for children over 5 years. Multidisciplinary prevention includes preserving the circadian rhythm, reorientation, early mobilization, and rational sedation.

Conclusion: Delirium is a serious but often overlooked problem in pediatric intensive care. Its timely detection through validated tools and the implementation of preventive measures are crucial for improving treatment outcomes.

CLINICAL APPROACH TO SKELETAL DYSPLASIAS PATIENTS INTENDED FOR PEDIATRICIANS

Sat, 18 Apr 2026 00:00:00 +0200

Introduction: Skeletal dysplasias comprise a heterogeneous group of disorders associated with abnormalities of the skeletal system. Most skeletal dysplasias are genetically determined. A comprehensive classification of skeletal dysplasias is subject to periodic revision. The phenotype of skeletal dysplasias is highly variable, depending on the involved genes and the mechanisms underlying their dysfunction. Establishing a diagnosis is often challenging because many skeletal dysplasias may have similar or overlapping phenotypes.

The objective of this study is to define practical guidelines for clinical work with children affected by skeletal dysplasia. We want to familiarize pediatricians with the physiology of skeletal development and the classification of skeletal dysplasias, followed by a practical approach to the diagnosis, treatment, and follow-up of children with skeletal dysplasias.

Methods: This is a review, based on data obtained from a literature search and the results of our retrospective cohort study that included 168 patients with suspected skeletal dysplasia.

Results: Establishing a diagnosis of skeletal dysplasia requires a detailed clinical evaluation, often radiological, and sometimes laboratory assessment. Genetic testing based on next generation sequencing, i.e., genotyping, represents a confirmatory tool for establishing a precise diagnosis in many cases. Many skeletal dysplasias require personalized treatment through a multidisciplinary approach and assessment of associated complications. The role of pediatricians at all levels of health care is crucial, from the early identification of suspected skeletal dysplasia, through referral for appropriate diagnostic evaluation, to the follow-up of these children with attention to their specific needs. The ultimate goal is to ensure the best possible quality of life for affected individuals.

Conclusion: Practical guidelines intended for pediatricians who encounter children with skeletal dysplasias in their clinical practice can significantly facilitate their work by enabling an individualized approach to these patients.

CONTEMPORARY APPROACH TO NOCTURNAL ENURESIS: PRACTICAL GUIDELINES FOR PEDIATRICIANS

Saša Milivojević, Đorđe Topalović, Tijana Jovanović, Slađana Mihajlović — Sat, 18 Apr 2026 00:00:00 +0200

Nocturnal enuresis is defined as intermittent urinary incontinence during sleep in children older than five years and represents a common condition with relevant medical and psychosocial impact. Its prevalence decreases with age, yet without treatment it may persist into adolescence. The etiology is multifactorial, involving genetic predisposition, imbalance between nocturnal urine production and bladder capacity, reduced nocturnal vasopressin secretion, and functional bladder disorders. Psychological factors are not primary causes but often arise as consequences of the condition. Diagnosis relies on careful history taking, physical examination, voiding diaries, and selective laboratory testing, with clear differentiation between monosymptomatic and non-monosymptomatic enuresis, which guides management. Treatment includes education, lifestyle and fluid-intake modifications, enuresis alarm therapy, and desmopressin as first-line options, while resistant cases may require combination therapy and specialist evaluation. Treatment success largely depends on adherence, family motivation, and management of comorbidities, and relapses can be effectively managed with repeated therapy.

AmbTrack: A CLINICALLY RELEVANT BRIDGE BETWEEN RURAL POLLEN SOURCES AND URBAN ALLERGY CHALLENGES

Sat, 18 Apr 2026 00:00:00 +0200

Ragweed (Ambrosia artemisiifolia) is a highly potent aeroallergen whose season in Europe typically overlaps with the period of the most significant burden of allergic rhinitis and acute asthma exacerbations. In clinical practice, a paradox is often observed whereby patients living in urban environments report more severe symptoms than rural populations, although the primary ragweed source areas are most often located outside cities. This review focuses on the clinical implications of the rural–urban exposure gradient. It presents the AmbTrack project (Real-Time Monitoring and Molecular Characterisation of Ambrosia Pollen Exposure through Citizen Tracking) as a conceptual and operational framework that integrates aerobiological monitoring, meteorological conditions, air pollution, remote sensing, and symptom reporting via mobile tools, together with ragweed location data and the individual's current health status as affected by ragweed allergy. The key message for clinical practice is that pollen in urban settings does not behave as a "neutral" biological particle, as interactions with air pollution (particulate matter - PM, NO₂, O₃), urban heat islands, and the micro-aerodynamics of streets may increase clinical burden and prolong exposure duration. Conceptually, AmbTrack enables timely alerts and supports a shift from reactive to preventive therapy, with the potential to improve patient management, promote more rational medication use, and reduce socio-economic consequences.

SELECTIVE IgA DEFICIENCY IN CHILDREN

Đurđa Palić, Stefan Kotlajić, Tijana Đerić, Gordana Petrović, Srđan Pašić — Sat, 18 Apr 2026 00:00:00 +0200

Selective IgA deficiency is the most common primary immunodeficiency, and is defined as a serum IgA level lower than 0.07 g/L with a lack of secretory IgA, in girls or boys under 4 years of age. These children have normal IgG and IgM levels with an adequate antibody response to vaccination. IgA deficiency in children increases susceptibility to respiratory and gastrointestinal infections, which may be prolonged or recurrent. Many studies indicate a clear association between allergic diseases and IgA deficiency. Common autoimmune diseases associated with selective IgA deficiency are: idiopathic thrombocytopenic purpura, autoimmune hemolytic anemia, type 1 diabetes mellitus, vitiligo, Graves' disease, thyroiditis, rheumatoid arthritis, systemic lupus erythematosus, and celiac disease. The occurrence of malignancy in these patients is sporadic, and the most common are gastric adenocarcinoma and B-cell lymphoma. Also, selective IgA deficiency can be associated with other primary immunodeficiencies, such as IgG2 and IgG3 subclass deficiencies. There are no clear recommendations for specific treatment of patients with selective IgA deficiency. These patients require clinical and laboratory monitoring for prolonged and/or recurrent infections, treatment of associated allergic and autoimmune manifestations, need for use of a polyvalent pneumococcal vaccine, and substitution by intravenous or subcutaneous immunoglobulins.

IRON DEFICIENCY AND ANAEMIA IN ADOLESCENTS: DIAGNOSTIC CRITERIA AND THE PATIENT BLOOD MANAGEMENT PATHWAY

Katarina Pavlović, Nataša Đorić, Katarina Smiljanić — Sat, 18 Apr 2026 00:00:00 +0200

Introduction: Adolescence (10–19 years) is a period of rapid growth and pubertal maturation during which haemoglobin values differ by sex and iron requirements increase, particularly after menarche. Because iron deficiency often develops before haemoglobin falls below diagnostic thresholds, a haemoglobin-only approach may underestimate depleted haematological reserves.

Aim: To present practical criteria for anaemia and iron deficiency in adolescence and translate them into a feasible patient blood management (PBM) clinical pathway for routine practice.

Methods: A narrative review of key international guidelines and selected recent publications, focusing on three interpretive domains: iron stores, iron availability for erythropoiesis, and the confounding effect of inflammation.

Results: Clinically significant iron deficiency frequently exists without overt anaemia, especially in adolescent girls. Therefore, the minimum laboratory work-up should extend beyond the complete blood count to include serum ferritin and transferrin saturation, with C-reactive protein when inflammation is suspected, to avoid falsely elevated ferritin. Heavy menstrual bleeding is the most practical trigger for early evaluation and treatment; additional high-risk situations include chronic inflammatory diseases and malabsorption.

Conclusion: PBM in adolescence is most effective when implemented through early risk recognition, confirmation of iron deficiency and its cause, timely initiation of iron therapy, and documentation of response until iron stores are replenished. Red blood cell transfusion should be reserved for clearly indicated acute conditions and should not substitute for delayed aetiological management.

RISK FACTORS FOR EXCESSIVE SCREEN EXPOSURE IN CHILDREN

Tanja Rožek Mitrović — Sat, 18 Apr 2026 00:00:00 +0200

Digital technological advancements and changes in the surrounding environment are significantly transforming the lifestyle of today’s children. With the rapid development of digital technology and the widespread use of electronic devices, children’s screen exposure has gradually become a global public health concern. This paper provides a literature review of the factors influencing children’s screen exposure and outlines perspectives for future research. The determinants of screen exposure are not universal; rather, they depend on numerous interrelated factors, including child characteristics, family routines and parental attitudes, the socioeconomic status of the family and the broader community, as well as the wider social and technological environment.

HYDRONEPHROSIS IN CHILDREN: FROM PERINATAL DIAGNOSIS TO TREATMENT

Đorđe Topalović, Slađana Mihajlović, Tijana Jovanović, Saša Milivojević — Sat, 18 Apr 2026 00:00:00 +0200

Hydronephrosis is defined as dilation of the renal pelvicalyceal system and represents the most common prenatally detected urological anomaly. Although its incidence is approximately 1 in 100 pregnancies, clinically significant obstructive uropathy is considerably less frequent. The primary objective of evaluation is to identify obstructive dilation associated with increased intrapelvic pressure and risk of progressive renal damage. Ureteropelvic junction (UPJ) obstruction is the leading cause of pediatric hydronephrosis. Obstruction may result from intrinsic anatomical narrowing, disordered ureteral peristalsis (functional obstruction), or extrinsic compression, most commonly by aberrant renal vessels. Several anatomical variants exist, and UPJ obstruction may coexist with vesicoureteral reflux or other congenital anomalies. Ultrasound is the cornerstone of both prenatal and postnatal assessment, with grading based on anteroposterior pelvic diameter and SFU classification. Further diagnostic workup includes voiding cystourethrography, diuretic renography, and magnetic resonance urography in selected complex cases. The risk of renal impairment is estimated indirectly through the degree of dilation, split renal function, and drainage patterns. Management strategies include observation or surgical intervention. Pyeloplasty, most commonly the Anderson–Hynes technique, is indicated in patients with proven obstruction and declining renal function. In asymptomatic patients with preserved renal function, careful observation combined with antibiotic prophylaxis is often appropriate. Hydronephrosis requires an individualized and structured approach. Accurate interpretation of imaging findings and timely decision-making regarding intervention are essential to preserve renal function and achieve favorable long-term outcomes.

VACCINATION IN PREGNANCY - CHALLENGES AND NOVELTIES

Bojana Ivić, Ivana Filipović, Slađana Mihajlović — Sat, 18 Apr 2026 00:00:00 +0200

Vaccines are the most effective way to prevent infectious diseases. Immunization is a key compo-nent of primary healthcare. Maternal immunization before and/or during the pregnancy proves to significantly reduce maternal and infant morbidity and mortality associated with the diseases caused by pathogens that are relevant to the perinatal period and early life, and for which there are currently no other effective alternative preventive measures. Women can be vaccinated before or during the pregnancy to protect themselves and pass immunity directly to their babies.The mother's immune system in pregnancy plays a key role in the development of child’s immunity. Therefore it is important to explore this area that presents a challenge for deci-sion-making regarding how, when, and why vaccinate women in a reproductive period.

PARATESTICULAR RHABDOMYOSARCOMA IN THE PEDIATRIC POPULATION – CASE REPORT

Saša Milivojević, Đorđe Topalović — Sat, 18 Apr 2026 00:00:00 +0200

Introduction: Paratesticular rhabdomyosarcoma is a rare and aggressive intrascrotal tumor. Its superficial localization allows for early detection, an adequate diagnostic approach, and timely therapy, all of which are associated with a favorable outcome.

Case outline: We present the case of a 13-year-and-2-month-old boy with a painless tumor mass in the left hemiscrotum, present for approximately two months prior to admission. He had no symptoms until 2–3 days before admission, when pain in the left hemiscrotum occurred during physical activity. No other complaints were reported. Initial evaluation included a scrotal ultrasound, which showed heteroechoic paratesticular tumor change of the left testis. MRI of the scrotum and pelvis, performed both natively and post-contrast, revealed a spherical, expansive extratesticular lesion located between the testis, which it displaced cranially, and part of the epididymal tail, which it displaced caudally. The lesion measured 35 mm × 36 mm × 37 mm. Laboratory findings, including tumor markers (beta-hCG, alpha-fetoprotein and LDH), were within physiological limits. Additionally, abdominal ultrasound, chest X-ray and the chest CT showed no pathological changes. Following the decision of the oncology board, a radical orchiectomy with complete excision of the paratesticular tumor mass was performed. Histopathology with immunohistochemistry confirmed a high-grade primary malignant mesenchymal tumor with rhabdomyoblastic differentiation, consistent with rhabdomyosarcoma. Accordingly, chemotherapy was initiated following the standard IVA regimen used in Europe (Ifosfamide, Vincristine, Actinomycin).

During the 2-year follow-up period from the end of treatment, the patient showed no signs of recurrence of the underlying disease.

Conclusion: Paratesticular rhabdomyosarcoma most commonly presents similarly to other intrascrotal tumors. Due to its aggressiveness and tendency for rapid spread, early diagnosis and treatment are essential. Multimodal therapy—including surgery, chemotherapy, and occasionally radiotherapy—improves survival prospects and contributes to a more favorable outcome.

A RARE CAUSE OF FUNGAL SEPSIS IN PRETERM NEONATE: A CASE REPORT AND LITERATURE REVIEW

Ilija Palić, Sonja Gojić — Sat, 18 Apr 2026 00:00:00 +0200

Introduction: Fungal sepsis is a serious bloodstream infection and an important cause of morbidity and mortality in preterm neonates. Meyerozyma guilliermondii (anamorph Candida guilliermondii) is an ascomycetes fungus, a saprophyte detected on human skin, gastrointestinal and genitourinary mucosa. This fungus is a rare cause of invasive infection, occurring in less than 5% of cases.

Case presentation: The preterm male neonate was delivered by emergency cesarean section at 28^6/7 weeks of gestation with birth weight of 1590 g. On the 12^th days of life, the neonate developed signs of sepsis, associated with mild thrombocytopenia and increased concentration of C-reactive protein. Meyerozyma guilliermondii was proven in blood culture, while cerebrospinal fluid and urine were sterile. Respiratory and hemodynamic stability was maintained during infection. Fungal sepsis was treated with fluconazole, with a favorable outcome.

Conclusion: The importance of monitoring the clinical picture and laboratory parameters in neonates with fungal sepsis is emphasized when making a decision about the use of antifungal drug. In accordance with the current recommendations, the use of fluconazole prophylaxis reduces the risk of invasive fungal infection, especially in extremely preterm neonates with extremely low birth weight.

EXTRAOSSEOUS EWING’S SARCOMA OF THE PELVIC REGION IN THE PEDIATRIC POPULATION – A CASE REPORT

Saša Milivojević, Đorđe Topalović — Sat, 18 Apr 2026 00:00:00 +0200

Introduction: Primary extraosseous Ewing sarcoma is a rare malignant soft tissue tumor, accounting for a small proportion of the Ewing sarcoma family. Pelvic localization in the pediatric population is exceptionally uncommon. Treatment requires a multimodal approach including chemotherapy, surgery, and radiotherapy when indicated, while prognosis depends on patient age, tumor size, and the possibility of complete resection.

Case outline: We present the case of a 13-year-old boy admitted with acute urinary retention, accompanied by impaired urination, constipation, and lumbar pain lasting one month. Ultrasound and MRI revealed a large solid–cystic pelvic mass associated with bilateral grade II hydronephrosis. Tumor biopsy followed by histopathological, immunohistochemical, and FISH analyses confirmed the diagnosis of extraosseous Ewing sarcoma, with diffuse FLI-1 and NKX2.2 positivity.

Treatment was initiated according to the Euro-Ewing 2012 protocol. After six VIDE chemotherapy cycles, a significant reduction in tumor size was achieved. Therapy was continued with the VAI protocol with the aim of further tumor reduction and potential surgical resection. However, despite the initial favorable response, rapid disease progression occurred, leading to abandonment of surgical treatment and initiation of radiotherapy. Due to aggressive local tumor growth, infiltration of surrounding structures, and distant metastatic dissemination, a fatal outcome ensued.

Conclusion: Extraosseous Ewing sarcoma of the pelvic region is an extremely rare and aggressive malignancy in children. Definitive diagnosis relies on histopathological and immunohistochemical evaluation. Although multimodal treatment is essential, pelvic localization is associated with limited therapeutic options and an unfavorable prognosis.

POLYCYTHEMIA IN A NEWBORN: FROM PLETHORA TO SEPSIS – A CASE REPORT

Mirjana Makevic Djuric, Milivoje Djuric, Mirjana Lukic, Marija Vujkovic — Sat, 18 Apr 2026 00:00:00 +0200

Introduction: Neonatal polycythemia is a hematological condition characterized by an abnormally elevated number of circulating erythrocytes. It is defined by hemoglobin levels exceeding 22 g/dL and hematocrit values of 65% or higher, which represent standardized diagnostic criteria in newborns. This condition poses a significant clinical challenge due to the risk of metabolic disturbances, hyperbilirubinemia, and potential complications affecting vital organs.

Case outline: This paper describes a male infant, born at 38-week of gestation by spontaneous vaginal delivery, initially presenting with plethora and laboratory-confirmed polycythemia (hemoglobin 23.4 g/dL, hematocrit 70%). During the first days of life, intravenous rehydration was administered as a conservative treatment for polycythemia, along with phototherapy for hyperbilirubinemia. On the third day of life, hemoglobin and hematocrit values further increased (Hgb 24.6 g/dL, Hct 74%), accompanied by total bilirubin levels of 281.9 µmol/L. Partial exchange transfusion was considered but withheld due to clinical stability. In the following days, laboratory findings demonstrated gradual correction (Hgb 19.4 g/dL, Hct 65%, total bilirubin 215 µmol/L). On the sixth day of life, the infant developed clinical deterioration with fever, respiratory insufficiency, and septic appearance. Endotracheal intubation, mechanical ventilation, and dual broad-spectrum antimicrobial therapy were initiated. Blood culture revealed Klebsiella pneumoniae, while tracheal aspirate culture identified Enterobacter hormaechei, indicating a nosocomial infection. Therapy was adjusted according to the antibiogram and protocol for late-onset neonatal sepsis. After five days in the neonatal intensive care unit, the infant was transferred to standard care, gradually recovered, and was discharged home on the twentieth day of life.

Conclusion: This case highlights the complex course of neonatal polycythemia, evolving from initial plethora and hyperbilirubinemia to late-onset neonatal sepsis with respiratory insufficiency, classified as a nosocomial infection. Timely monitoring, conservative management, and appropriate treatment of complications contributed to a favorable outcome.

MYCOPLASMA PNEUMONIAE PNEUMONIA – A CASE SERIES REPORT

Sat, 18 Apr 2026 00:00:00 +0200

Introduction: Mycoplasma pneumoniae is one of the main causes of community-acquired pneumonia in children. In recent years, there has been a global increase in severe cases that often do not respond to the standard beta-lactam antibiotics usually initially used for treatment of community-aquired pneumonia. The pathogenesis of these forms is caused by the citotoxic effect of the CARDS toxin and a dysregulated immune response, which leads to serious lung and extrapulmonary complications. Early recognition of atypical clinical presentations and starting the right therapy on time is key to preventing permanent lung damage.

Case Series: We presented three pediatric cases treated in 2025 at the Hospital for Pediatric Lung Diseases and Tuberculosis. Case 1, an 18 years old adolescent, shows an atypical presentation with pneumonia and suspected MIRM syndrome (Mycoplasma-induced rash and mucositis), with dry cracked lips, a buccal aphthous lesion, and a morbilliform rash later in the treatment. Case 2, a 9 years old girl, shows M. pneumoniae as a trigger for asthma exacerbation and the development of pleural effusion during treatment, after initial improvement. Case 3, a 11 years old girl, highlights the importance of lung ultrasound in detecting bilateral pleural effusion in previously healthy children. In all cases, initial oral therapy with amoxicillin+clavulanic acid and cefixime was not effective. Rapid improvement and regression of complications were achieved by introducing macrolides combined with parenteral cephalosporins and systemic corticosteroids, along with supportive and symptomatic therapy.

Discussion: The analysis of this case series shows that M. pneumoniae is no longer just a cause of mild infections; it can manifest with severe lung complications like pleural effusion and also with strong immune responses outside the lungs.

Conclusion: The current epidemiological wave requires a high level of suspicion for atypical etiology in children with a persistent cough, long-lasting fever, or sudden respiratory worsening. Prompt radiological evaluation, detection of the pathogen, and a more aggressive therapeutic approach are key steps for successful treatment and the prevention of sequelae.

OVERLOOKED FOREIGN BODY ASPIRATION IN AN ADOLESCENT WITH AUTISM SPECTRUM DISORDER

Sat, 18 Apr 2026 00:00:00 +0200

Introduction: Foreign body aspiration is an emergency and potentially life threatening condition, most commonly observed in children under the age of three. In older children and adolescents, it occurs less frequently and is often overlooked due to nonspecific clinical manifestations and the absence of reliable anamnestic information. Individuals with autism spectrum disorder and other neurodevelopmental conditions are at particularly increased risk, as behavioral characteristics and impaired communication constitute significant factors both for aspiration and for delayed recognition and diagnosis.

Case Report: We present the case of a fifteen year old adolescent with autism spectrum disorder who was hospitalized for persistent cough and fever lasting one month, unresponsive to prior antibiotic therapy. Difficulties in obtaining a reliable medical history and the absence of witnesses to the aspiration event contributed to a delayed diagnosis. Upon admission chest radiography demonstrated atelectasis and consolidation of the basal segments of the right lung. Flexible bronchoscopy revealed complete obstruction of the right intermediate bronchus by a foreign body (a figurine from a board game), which was successfully extracted using rigid bronchoscopy. Following removal of the foreign body, the patient experienced rapid clinical improvement and complete radiological resolution of pathological findings.

Conclusion: Foreign body aspiration should be considered in older children and adolescents with autism spectrum disorder who present with prolonged, nonspecific respiratory symptoms. In the presence of a high index of clinical suspicion, bronchoscopy serves as an indispensable diagnostic and therapeutic modality and should be performed in order to prevent serious respiratory complications.

PARATESTICULAR PSEUDOTUMOR IN AN ADOLESCENT PATIENT – A CASE REPORT

Đorđe Komadina, Magdalena Savatijević, Saša Milivojević — Sat, 18 Apr 2026 00:00:00 +0200

Introduction: Paratesticular inflammatory and fibrous pseudotumors are rare benign lesions with unclear etiopathogenesis. They are considered to represent a reactive process associated with factors such as trauma and inflammatory conditions. Preoperative clinical and radiological differentiation of these benign paratesticular lesions from malignant tumors of this region remains extremely challenging. As a result, despite their benign nature, most of these lesions are treated by radical orchiectomy rather than testis-sparing surgery.

Case outline: We report the case of a 15-year-and-6-month-old adolescent hospitalized for diagnostic evaluation and treatment of a painful right scrotal mass measuring 5 × 4 cm. Laboratory findings revealed leukocytosis with neutrophilia, elevated inflammatory markers, and mildly increased neuron-specific enolase levels. Scrotal ultrasonography demonstrated a heterogeneous, highly vascularized paratesticular soft-tissue mass measuring 33 × 26 × 20 mm in the right hemiscrotum. Additional radiological evaluation failed to reliably exclude malignancy; therefore, a multidisciplinary decision was made to proceed with surgical treatment, and a right radical orchiectomy was performed. The definitive diagnosis was established by histopathological examination and corresponded to epididymitis subacuta partim abscedens.

Conclusion: Paratesticular pseudotumors represent a significant diagnostic challenge, particularly in the pediatric and adolescent population, primarily due to their rarity and clinical and radiological resemblance to malignant tumors of this region. The case highlights the importance of considering these benign entities in the differential diagnosis of paratesticular masses in order to avoid unnecessary radical surgical procedures whenever possible.

SELF-INSERTED FOREIGN BODY IN THE URINARY BLADDER IN AN ADOLESCENT: A CASE REPORT

Đorđe Komadina, Magdalena Savatijević, Saša Milivojević — Sat, 18 Apr 2026 00:00:00 +0200

Introduction: Foreign bodies in the urinary bladder are an uncommon urological emergency. Most cases of foreign bodies in the urethra or bladder are self-inserted, with a wide variety of objects being described. Foreign bodies in the urinary bladder are most commonly managed with cystoscopic extraction due to its safety and low complication rates. Surgical exploration is reserved for cases in which endoscopic removal is unsuccessful or carries a high risk of injury.

Case outline: We present the case of a 17-year-old adolescent who reported self-inserting foreign body like a “rubber lace” into the bladder several hours before admission. Radiography of the urogenital tract revealed no signs of a foreign body in the bladder. Ultrasonography demonstrated a well-defined intraluminal structure measuring approximately 9 mm in diameter. The patient underwent explorative cystoscopy which revealed a foreign body resembling a rubber lace, measuring 25 cm in length and more than 1 cm in thickness. Attempted endoscopic extraction was unsuccessful, therefore open cystostomy was performed. During hospitalization, the patient underwent a psychological evaluation.

Conclusion: Foreign bodies in the urinary bladder require an individualized diagnostic and therapeutic approach. While cystoscopic extraction remains the preferred first-line treatment, cystostomy represents a safe and effective alternative when endoscopic removal is not possible. Psychological evaluation is essential in identifying underlying causes and preventing recurrence.

THE INFLUENCE OF SOCIODEMOGRAPHIC FACTORS ON EXCLUSIVE BREASTFEEDING

Sat, 18 Apr 2026 00:00:00 +0200

Introduction: Breastfeeding has multiple positive benefits for the health of children and mothers, the environment and the economy. Breastfeeding success and breastfeeding duration are influenced by biological, sociodemographic, cultural and psychological factors. Accordingly, the support that the mother receives from her environment, health workers, society and the state can significantly contribute to the success and increase of the breastfeeding rate.

Aim: The aim of the research was to examine the frequency of breastfeeding and identify sociodemographic factors associated with the success of exclusive breastfeeding among women who gave birth in 2025 in the territory of the municipality of Doljevac.

Material and methods: An observational cross-sectional study was conducted among 95 women who became mothers during 2025. The following factors were analyzed: parity, maternal age, level of education, mode of delivery, support of parner and immediate family, as well as ethnicity. Data were analyzed using descriptive statistics and the chi-square test, while odds ratios (OR) with 95% confidence intervals (CI) were calculated for statistically significant factors. Statistical significance was set at p < 0.05.

Results: Out of 95 participants, 56 women (58.9%) exclusively breastfed their infants during the first six months. A statistically significant association with successful breastfeeding was found for parity, family support, and ethnic background. Multiparous women were significantly more likely to breastfeed compared to primiparous women (OR = 4.13; 95% CI: 1.16–14.7). All women who reported family support breastfed their infants, whereas none of the women without support did so (OR ≈ 0; p < 0.001). Women of Roma ethnic background had a significantly lower breastfeeding rate compared to non-Roma women (OR = 0.09; 95% CI: 0.03–0.30). Maternal age, level of education, and mode of delivery were not significantly associated with breastfeeding success.

Conclusion: The findings indicate that family support, previous maternal experience, and ethnicity are key determinants of successful breastfeeding. These results highlight the need for targeted education and strengthened support systems, particularly for first-time mothers and women from socially vulnerable groups, in order to improve exclusive breastfeeding rates.

ASSESSMENT OF INDOOR AIR QUALITY IN SCHOOLS - SIGNIFICANCE FOR HEALTHCARE PROFESSIONALS IN SERBIA

Maja Nikolić, Aleksandra Stanković, Biljana Kocić, Jovana Simonović, Nadežda — Sat, 18 Apr 2026 00:00:00 +0200

Introduction: Children are particularly vulnerable to indoor air pollution due to their physiological characteristics and the substantial amount of time spent in school environments. In Serbia, data on indoor air quality (IAQ) in schools remain limited. Healthcare professionals must rely on international data that may not fully reflect regional building characteristics and climatic conditions.

Objective: The aim of this study was to assess indoor air quality in two primary schools in Niš, Serbia, located in areas with different levels of air pollution - one situated in the central urban zone characterized by higher traffic density and elevated pollution levels, and the other in a suburban spa area with lower levels of ambient air pollution.

Materials and methods: Target air quality parameters investigated in this study were sulfur dioxide (SO₂) and black smoke (BS), nitrogen oxides, formaldehyde, carbon monoxide, and biological agents. The pollutants were measured daily, during the heating season. Gas samples were collected using the aspiration method with an Air Sampling Pump in corridors, sport halls/gymnasiums and two classrooms. Microflora was examined using classical microbiological techniques, by aspiration sampling, in which air was drawn through liquid dextrose broth, as well as by sedimentation on blood agar. Sabouraud dextrose agar was used for the identification of fungi.

Results: Concentrations of SO₂, black smoke and NOₓ were consistently higher in the primary school located in the more air polluted area compared to the other school, yet all remained below the relevant national guideline values. Carbon monoxide levels were also higher in school in city center, while being negligible in school in Niška Banja (spa), whereas formaldehyde was detected exclusively in city center school at concentrations exceeding the guideline value. Microbiological analysis showed distinct contamination patterns between the two schools and the presence of coagulase-negative staphylococci, Enterococcus faecium, enteric bacteria and Candida at one school, while the other school showed predominance of Bacillus species with sporadic pathogenic bacteria and saprophytic molds.

Conclusion: This study provides new indoor air quality data from two primary school buildings in the city of Niš, highlighting the need for reduced formaldehyde concentrations and improved risk assessment approaches to support the development of national IAQ action plans in Serbia.

PREVALENCE OF LIPID PROFILE DISORDERS IN CHILDREN – A RETROSPECTIVE CROSS-SECTIONAL STUDY IN PRIMARY HEALTH CARE

Milica Jovanović, Miloš Bogoslović, Milan Tošić — Sat, 18 Apr 2026 00:00:00 +0200

Introduction: Dyslipidemia is a clinically asymptomatic condition characterized by an altered lipid profile in the blood and an increased risk of premature development of cardiovascular diseases, diabetes, and atherosclerosis. Timely screening, detection, and treatment of dyslipidemia may slow the progression of atherosclerosis and reduce the risk of cardiovascular diseases in adulthood.

Aim: To examine the prevalence of lipid profile disorders in children and to assess potential differences according to sex at the pediatric department of the Primary Health Care Center Doljevac during the year 2025.

Methodology: The study included 56 children aged 5 to 18 years (mean ± SD: 11.5 ± 3.75 years), including 27 boys (48.2%) and 29 girls (51.8%). The sample size was calculated based on an expected prevalence of dyslipidemia of 20% according to the literature, with a significance level of α = 0.05 and a study power of 80%. Participants were analyzed at the Pediatric Department of the Primary Health Care Center Doljevac during 2025. The analyzed lipid profile parameters included total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides. Differences between sexes were assessed using Fisher’s exact test, while the strength of association was expressed as odds ratios (OR) with 95% confidence intervals.

Results: During 2025, a total of 1,000 laboratory analyses were performed in children. Total cholesterol was analyzed in 56 cases (5.6%), triglycerides in 55 cases (5.5%), LDL cholesterol in 15 cases (1.5%), and HDL cholesterol in 15 cases (1.5%). Elevated total cholesterol was detected in 12.5% of participants, more frequently in girls than in boys. Elevated HDL cholesterol was observed in a higher proportion of participants in whom this parameter was analyzed, with no significant sex-related differences. Elevated LDL cholesterol and triglyceride levels were rare. The observed trends did not reach statistical significance.

Conclusion: Lipid profile disorders in the studied pediatric population were relatively uncommon. Although no statistically significant sex-related differences were identified, a trend toward a higher prevalence of elevated total cholesterol and triglycerides was observed among female participants, highlighting the importance of early screening and preventive monitoring of lipid status in childhood.

CONGENITAL DIAPHRAGMATIC HERNIA - A SINGLE CENTRE TEN-YEAR-EXPERIENCE AND MORTALITY PREVENTION LITERATURE REVIEW

Sat, 18 Apr 2026 00:00:00 +0200

Introduction:Congenital diaphragmatic hernia (CDH) is a severe congenital anomaly characterized by herniation of abdominal viscera into the thoracic cavity through a diaphragmatic defect. Although the etiology of CDH is multifactorial and not fully elucidated, the condition remains associated with substantial mortality despite advances in prenatal diagnosis, neonatal intensive care, and surgical management. Clinical outcomes are influenced by multiple factors, including prenatal detection, severity of pulmonary hypoplasia, associated anomalies, and the timing of surgical repair.

Objective: To present a ten-year single-center experience in the management of congenital diaphragmatic hernia and to review contemporary evidence regarding factors associated with mortality reduction.

Materials and Methods: A retrospective cohort study was conducted, including patients with CDH treated at the Clinic for Pediatric Surgery, Orthopedics and Traumatology, University Clinical Center Niš, between 2016 and 2025. Demographic and perinatal characteristics, prenatal diagnosis, anatomical characteristics of the defect, need for respiratory support, timing of surgical repair, and clinical outcomes were analyzed.

Results: The study included 17 patients, 76.5% of whom were male. Left-sided CDH was registered in 82.4% of patients. In four patients (23.5%), CDH manifested itself later, in the period from the fifth month of life to the tenth year. Prenatal diagnosis was established in 11.8% of cases. Immediately after birth, eight patients (61.5%) required mechanical ventilation support, while five patients (38.5%) were initially administered oxygen therapy exclusively. Surgical intervention is usually performed after 48 hours, at the latest on the 7^th day of life. A fatal outcome was recorded in 23.5% of patients.

Conclusion: Congenital diaphragmatic hernia remains a major therapeutic challenge with persistently high mortality. Prenatal diagnosis, structured postnatal stabilization, normalization of pressure in the pulmonary artery system, and individualized timing of surgical intervention are critical determinants of outcome. Further prospective, multicenter studies are warranted to refine management strategies and improve survival in this high-risk neonatal population.

THE IMPACT OF THE BROADER SOCIAL COMMUNITY ON THE PREVENTION OF SEVERE TRAUMATIC DEFORMITIES IN CHILDREN – A CASE SERIES

Sat, 18 Apr 2026 00:00:00 +0200

Introduction: The use of pyrotechnic devices among children and adolescents, particularly during holiday seasons, is highly prevalent worldwide as a form of entertainment. Improper handling of these explosive devices frequently results in severe injuries, including blast wounds and burns. Despite appropriate medical treatment, such injuries often lead to significant deformities and long-term disability. The fingers and hands are most commonly affected, representing crucial anatomical structures for the performance of manual activities, although injuries to the eyes, face, and chest are also observed. The aim of this study is to emphasize the seriousness of the consequences of improper handling of pyrotechnic devices, as well as to highlight the importance of prevention and the mitigation of trauma-related outcomes.

Case Series: We present 10 patients injured by pyrotechnic devices during the New Year holiday periods from 2024 to 2026 (December and January), who were treated at the Clinic for Pediatric Surgery, Pediatric Orthopedics and Traumatology, University Clinical Center Nis. The injuries consisted predominantly of complex hand trauma, but also affecting other body regions such as the face, neck, and chest.

Conclusion: Given that injuries caused by pyrotechnic devices result not only in severe physical deformities but also have a profound impact on mental health and overall quality of life in children and adolescents, the role of prevention is unequivocal. Preventive efforts should reflect shared societal responsibility, implemented through public media outreach, school-based initiatives, and education of both parents and children.

PROBIOTICS IN TREATMENT OF ATOPIC DERMATITIS - KNOWLEDGE AND ATTITUDE AMONG SERBIAN PHYSICIANS

Sat, 18 Apr 2026 00:00:00 +0200

Introduction: Since the 1970s, AD incidence has increased 2- to 3-fold in industrialized nations, impacting approximately 15% to 20% of children, 5% to 20% of adolescents.

Materials and methods: This was 6 months (January to June 2024) retrospective study collecting data through a web-based questionnaire designed to measure knowledge and attitude of Serbian physicians towards AD diagnosis, treatment and prevention strategies. The participants were healthcare professionals, specialists who are treating patients with AD. Surveys can reveal gaps in knowledge, concerns about safety or effectiveness, and the need for further training or support. This insight can help improve clinical guidelines, promote evidence-based practices, and ensure patients receive comprehensive and up-to-date care.

Results: Patients with Atopic Dermatitis in Serbia were mostly treated by physicians specialized in pediatrics and dermatology (210 dermatologist and 218 pediatricians were included). Virtually all participants agreed that discovering and avoiding triggering factors are crucial to keep AD under control. Among our participants diagnosing and staging of AD are mostly based on clinical criteria including assessment of itching intensity and sleep disturbance using visual analogue scales and overall quality of life.

Discussion: Results of our survey has the potential to identify current knowledge gaps and attitudes of physicians who are treating patients with atopic dermatitis. Physicians who experience less difficulties while treating AD have more positive practice attitudes and treatment satisfaction rates.

Conclusion: Continuous medical education, open-mindedness to evolving evidence, and a genuine commitment to understanding the patient’s lived experience are essential for elevating care quality in this challenging and burdensome condition.

IMPACT OF PREMATURITY ON NEUROMOTOR, COGNITIVE, SPEECH-LANGUAGE DEVELOPMENT, ASSESSED BY BAYLEY III SCALE

Gordana Sekulović, Danijela Vukićević — Sat, 18 Apr 2026 00:00:00 +0200

Preterm-born children represent a significant public health issue due to the increased risk of growth disorders as well as neurological and psychomotor developmental impairments. Preterm birth is defined as delivery before 37 completed weeks of gestation. According to data from the World Health Organization in 2020, approximately 13.4 million children are born preterm each year worldwide, with prevalence rates ranging from 4% to 16% across different countries, meaning that nearly one in ten newborns is born prematurely. The etiology of preterm birth is multifactorial and includes maternal and placental risk factors. Maternal risk factors include physiological and social stress, systemic inflammation, pregnancy-related complications such as thyroid disorders and eclampsia, nutritional deficiencies (zinc, iron, folate), short interpregnancy intervals, vaginal bleeding, cervical insufficiency, previous surgical interventions, multiple pregnancies, unfavorable body mass index, as well as the use of alcohol and psychoactive substances. Placental causes include placenta previa, placental abruption, chorioamnionitis, umbilical cord complications, and premature rupture of membranes. Due to the increased risk of short- and long-term complications, continuous and systematic monitoring of the growth and development of preterm-born children plays a crucial role in the early detection of deviations and the implementation of appropriate preventive and therapeutic interventions, thereby improving the quality of life and long-term prognosis of this population.