Viktor Brusnjai

Introduction. Immune checkpoint inhibitors have improved outcomes in triple-negative breast cancer but may trigger immunerelated adverse events involving multiple organs. Pancreatic toxicity is uncommon but clinically important, and its recognition is challenging because of broad differential diagnoses. Case Report. We report the case of a 44-year-old woman with a first relapse of triple-negative breast cancer after seven years of disease-free follow-up. Germline testing revealed a mutation in the breast cancer susceptibility gene 1. First-line systemic therapy with pembrolizumab combined with weekly paclitaxel was initiated, resulting in a radiologically confirmed partial response. During the fifth treatment cycle, the patient developed upper abdominal discomfort, and endoscopy identified fibrin-covered “kissing” duodenal bulb ulcers, suggestive of possible immune-mediated duodenitis. Symptoms improved with proton pump inhibitors and supportive care. After reintroduction of therapy, the patient subsequently presented with recurrent symptoms. Laboratory evaluation revealed markedly elevated pancreatic enzymes, while imaging confirmed acute pancreatitis. Alternative aetiologies were excluded. Pembrolizumab was permanently discontinued, and corticosteroid therapy was initiated, resulting in gradual clinical and biochemical recovery. Maintenance therapy with a poly adenosine diphosphate-ribose polymerase inhibitor was introduced. At 10 months of follow-up, the patient remained asymptomatic, with preserved pancreatic function and sustained partial response. Conclusion. This case highlights an uncommon presentation of pembrolizumab-associated pancreatic and duodenal toxicity in a patient with triple-negative breast cancer. Awareness of rare irAEs is crucial to ensure timely diagnosis and effective management. Multidisciplinary collaboration and individualised therapeutic planning enabled both toxicity resolution and continued oncological disease control in this patient.

Introduction. Randomised clinical trials have demonstrated the indispensable role of implantable cardioverter defibrillators in reducing mortality among patients at high risk of sudden cardiac death. This study aimed to assess the incidence and predictors of cardiac arrest recurrence in such patients. Material and Methods. This retrospective study included 240 patients who underwent defibrillator implantation for secondary prevention at the Institute for Cardiovascular Diseases of Vojvodina between 2008 and 2020. The cumulative incidence of recurrence was determined using Kaplan-Meier curves, while Cox regression was used to identify predictors of sudden cardiac arrest recurrence. Results. The median follow-up was 4.46 years, and recurrence of sudden cardiac arrest occurred in 60% (n=144) of patients. Sustained ventricular tachycardia as the indication for implantation was shown to be an independent predictor of recurrence. These patients also had a significantly higher number of hospitalisations during follow-up. Patients diagnosed with channelopathy or arrhythmogenic right ventricular dysplasia had a significantly higher number of hospitalisations than those diagnosed with ischaemic or non-ischaemic cardiomyopathy. Conclusion. The incidence of sudden cardiac arrest recurrence following defibrillator implantation is high across all patient groups, regardless of aetiology. Sustained ventricular tachycardia as the indication for device implantation predicts a higher incidence of cardiac arrest recurrence.

Introduction. Flexibility and joint mobility are fundamental determinants of efficient and safe movement execution. They play an important role in injury prevention during daily activities, training, and competitive performance, and substantially influence athletic outcomes. Between the ages of 20 and 49, flexibility declines by approximately 10% per decade. Stretching is one of the primary interventions used to restore, maintain, and enhance flexibility. Evidence suggests that regular and structured stretching programs can preserve joint range of motion and improve mobility. Stretching has also been proposed to enhance physical performance, facilitate post-exercise recovery, and reduce injury risk. Discussion. Stretching constitutes an essential component of both athletic training and rehabilitation; therefore, identifying the optimal timing, volume, and intensity of stretching within motor learning and re-education programs is of considerable importance. However, despite widespread application, the scientific literature has not yet reached a clear consensus regarding its effects, as evidence remains inconsistent or insufficient for several commonly cited benefits. The aim of this narrative review is to summarize current evidence on the effects of dynamic and static stretching on injury prevention and physical performance. Conclusion. It remains difficult to definitively determine whether stretching exerts predominantly beneficial or adverse effects. Given the heterogeneity and often contradictory findings in the existing literature, stretching protocols should be individualized, with careful consideration of the type, volume, and intensity of stretching in relation to the specific goals of rehabilitation or athletic training.

Introduction. Osteoarthritis is the most prevalent joint disease worldwide, with knee osteoarthritis representing its most common form. Pain in knee osteoarthritis is known to have neuropathic components; however, the mechanisms leading to central sensitization remain incompletely understood. It is also unclear whether surgical pain relief achieved through total knee arthroplasty results in modulation of central sensitization and neuropathic pain. Quantitative sensory testing in the prediction of postoperative pain after total knee arthroplasty. Sensory profiling using quantitative sensory testing modalities - particularly temporal summation and conditioned pain modulation - has emerged as a valuable approach for identifying patients with osteoarthritis who are at risk of acute and chronic postsurgical pain. These modalities, when combined with other parameters, may facilitate individualized pain management strategies. Preoperative hyperalgesia and neuropathic pain features, detected through temporal summation testing and Pain- DETECT questionnaires, have demonstrated predictive value for the development of chronic postsurgical pain after total knee arthroplasty. Patients exhibiting centrally mediated pain mechanisms and established central sensitization tend to experience less postoperative pain relief following total knee arthroplasty. Female sex has been associated with higher magnitude of conditioned pain modulation and an increased prevalence of severe acute and chronic postsurgical pain, identifying it as a potential risk factor for pain chronification. Conclusion. Quantitative sensory testing modalities - particularly temporal summation, conditioned pain modulation, and pressure pain threshold - appear to be the most promising tools for predicting postoperative pain outcomes using quantitative sensory testing. Patients with evidence of central sensitization show reduced pain relief after total knee arthroplasty.

Introduction. Chronic obstructive pulmonary disease is the fourth leading cause of death worldwide. Acute exacerbations often require hospitalization, and are associated with high mortality. Identifying risk factors associated with mortality may improve medical treatment and reduce mortality. This study aimed to analyze outcomes of patients with acute exacerbations of chronic obstructive pulmonary disease treated in the intensive care unit, and to identify factors associated with mortality. Material and Methods. This retrospective study was conducted at the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia, between April 2015 and January 2019. Inclusion criteria were a diagnosis of acute exacerbation of chronic obstructive pulmonary disease, intensive care unit admission, and treatment with invasive mechanical ventilation. Results. A total of 127 patients were included, of whom 79 (62.2%) were male, with mean age (X - ? SD) of 66.96 ? 8.57 years. Intensive care unit mortality was 33/127 (26%), with a mean length of stay of 3.5 days (interquartile range 2.0-8.0). Overall in-hospital mortality was 56/127 (44%), with a median hospital stay of 15.0 days (interquartile range 7.0-24.0). Multivariate analysis identified the PaO2/FiO2 ratio (odds ratio 0.99; 95% confidence interval 0.98- 0.99; p=0.013), Glasgow Coma Score (odds ratio 0.82; 95% confidence interval 0.69-0.96; p=0.014), and presence of septic shock (odds ratio 50.9; 95% confidence interval 8.58-549.52; p < 0.001) as predictors of intensive care unit mortality. Conclusion. Mortality among patients with acute exacerbations of chronic obstructive pulmonary disease treated in the intensive care unit remains high. Reduced PaO2/FiO2 ratio, lower Glasgow Coma Score, and septic shock are independent predictors of mortality.

Introduction. Single-chamber and dual-chamber pacemakers are used for the treatment of bradycardia. Dual-chamber pacemakers more closely replicate physiological cardiac function by preserving atrioventricular synchrony, whereas single-chamber pacemakers are less complex, more cost-effective, and easier to implant. Clinical trials comparing these two pacing modalities have reported inconsistent results, largely depending on the studied population and study design. The AQUAREL questionnaire is a disease-specific instrument designed to assess life quality of life in patients with pacemakers. The aim of this study was to compare the quality of life of patients with single-chamber and dual-chamber pacemakers using the AQUAREL questionnaire. Material and Methods. After providing informed consent, 80 patients treated at the Institute for Cardiovascular Diseases of Vojvodina completed the AQUAREL questionnaire. Inclusion criteria were age ?60 years and implantation of either a single or dual-chamber pacemaker. These criteria were met by 69 patients, including 33 with single-chamber and 36 with dual-chamber pacemakers. Data were obtained from the Institute?s digital medical record. Statistical analysis was performed using standard methods. Results. The mean age of the patients was 76 years; 42 participants (63.77%) were male, and 92.75% had at least one comorbidity. Analysis of AQUAREL questionnaire scores revealed no statistically significant differences in overall quality of life between patients with single-chamber and dual-chamber pacemakers. Conclusion. Although patients with dual-chamber pacemakers reported fewer severe symptoms compared with those with single-chamber pacemakers, the difference was not statistically significant. Overall, no significant difference in quality of life was observed between patients according to pacemaker type.