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Pain is a major health issue representing a leading cause of disability. It affects millions of adults worldwide and impose significant burdens on society, healthcare systems, and personal well-being. The management of chronic pain presents a major challenge for healthcare professionals, as there is no single or universally effective treatment. Conventional treatments such as opioids and nonsteroidal anti-inflammatory drugs are first line treatment, but they carry significant risks and limitations, including addiction, tolerance, dependence, adverse effects, especially when used long term. As a result, additional approaches are needed to provide effective and safe chronic pain relief. Non-pharmacological pain management strategies represent a promising domain especialy as a part of complementary tailored to individual needs and integrated to contemporary pain medicine.

Procedural sedation as an anesthesiological method performed in patients who are unable to tolerate the examination. Procedural sedation was defined for clinical situations which require conditions for performing a therapeutic or diagnostic procedure with protected spontaneous breathing, airway reflexes and hemodynamic stability, with absence of anxiety and pain. Endoscopic urological procedures represent a good therapeutic alternative to open surgical methods but with an incomparable advantage in diagnostics. Endoscopy experienced its expansion in the last 20 years as minimally invasive surgery. Cystourethroscopy is one of the most common procedures performed by a urologist. In a patient with an advanced bladder tumor, after examination with a cystoscope, bimanual palpation is performed requiring good muscle relaxation of the anterior abdominal wall. The Clinic for Urology and Nephrology has started with examination under a cystoscope during the sixties years of the last century. Originally without anesthesia condition, cystoscopies were performed under analgosedation conditions since 1980. Due to the length of the examination and the need to perform bimanual palpation examination this anesthetic approach was inadequate. Furthermore, cystoscopies were performed under general anesthesia, with the increasing dose of anxiolytics, followed with depolarizing muscle relaxants and hypnotics. Nowdays, cystoscopies are performed under general anesthesia, with inhalation anesthetic or propofol maintenance, both provided adequate conditions for examination. The changes of the anesthesiological method over time represents one of the testimonies of the evolutionary pharmacologicaly-technologicaly-personnel development of the anesthesiological specialty for the endoscopic procedure, which has not fundamentally and technically changed since the very beginning.

Low back pain occurs in the area of the back between the lower edge of the 12th rib and the lower edge of the gluteus, with or without spreading down the leg. LBP occurs as a result of a combination of the influence of various physical, psychological and social factors, lifestyle habits and style, associated comorbidities, as well as various health factors that can or cannot be influenced. What is common to all guides is the consensus that multidisciplinary rehabilitation is necessary and that removing psychological obstacles has a significant positive impact on recovery. A multidisciplinary approach to treatment must include at least one physical component of treatment and rehabilitation and at least one component from the biopsychosocial model (psychological, social, occupational-work). Almost all guides suggest NSAIDs as the first pharmacological treatment, followed by the addition of paracetamol and weak opioids.

In situ measurements of the chemical identity and quantity of anode gases during electrochemical measurements and rare earth (RE) electrolysis from fluoride-based molten salts composed of different kinds of rare earth oxides (REOs) were performed using FTIR spectrometry. Linear sweep voltammetry (LSV) was carried out to characterize oxidation processes and determine the anodic effect from NdF3 + PrF3 + LiF + REO melt. RE complex formation and subsequent reactions on the GC anode surface were discussed to understand the formation pathways of CO/CO2 and perfluorocarbon gases (PFC), mainly CF4 and C2F6. The LSV shows that increasing the REO content from 1 wt.% up to 4 wt.% in the system, leads to a positive shift in the critical potential for a full anode effect, recorded around 4.50 V vs. W with 4 wt.% REO. The FTIR results from on-line off-gas analysis during LSV measurements indicate that the anode gas products were composed mainly of CO and CO2, whereas CF4 can be detected before the full anode effect and C2F6 at and after this phenomenon. Compositions of off-gases from electrolysis performed using different kinds of REOs were compared. The main off-gas component was found to be CO in RE electrolysis with REOs as raw materials, while in electrolysis with magnet recycling derived oxides (MRDOs), CO2 content was slightly higher compared to CO. PFC emissions during RE electrolysis were generally similar: CF4 was detected periodically, but in negligible concentrations, while C2F6 was not detected. [ABSTRACT FROM AUTHOR]

Background/Aim. Among the other challenges of the 21st century, medical waste (MW) has become an arising problem for both the environment and people because of its increasing amount, variety, and complexity. That is way MW management has become one of the very important ecological imperatives. Serbia with no potential for appropriate disposal of all MW is forced to export MW to countries with MW incineration facilities. Incineration lowers the possible risks of inappropriate disposal and the emission of environmental pollutants, but leads to the need for a “clever” choice of the incinerator facility location which has to meet diverse environmental, economic and technical criteria Methods. The criteria for the choice of optimal locations for a MW incinerator facility were as follows: the amount of MW that needs to be transported, the transport time from other locations, the current pollution of the location, the unemployment rate and the location safety in terms of natural disasters and accidents. By using the obtained results for seven efficient locations gained by Data Envelopment Analysis (DEA), we used a goal programming for the analysis of the most suitable location for a MW incineration facility. Results. In the proposed methodology on the chosen scenario and analysing the criteria relevant for selecting the most suitable location, using the DEA method, seven efficient locations for MW incineration facility were obtained. The optimal location was location 13. Conclusion. Based on the obtained results, we demonstrated that by the use of goal programming it is possible to develop a methodology for selection of optimal MW incineration facility location as one of the necessary activities of MW risk management.

Background/Aim. Diabetic polyneuropathy is a common chronic complication in patients with diabetes mellitus. The aim of this study was to determine the importance of applied physical procedures on the functional status of diabetic polyneuropathy patients compared to the group of respondents treated by alpha-lipoic acid. Methods. Sixty sub-jects were divided into two groups: group A – diabetic polyneuropathy patients treated with physical procedures, and group B – diabetic polyneuropathy patients treated with alpha-lipoic acid. The study has lasted for three diagnostic and therapeutic cycles, each lasting for 16 days with a time between cycles of 6 weeks. Results. Manual muscle test, range of motion, Michigan Neuropathy Screening Instrument, and Berg balance scale values showed statistically significant improvement at the end of testing group A respondents, while no improvement was shown in group B respondents. Conclusion. The application of the combined physical procedures shows clear benefits for the improvement of muscle strength and mobility of the ankle joint in respondents with diabetic polyneuropathy.

The author criticizes the concept of whole life sentence from the aspect of the European standards of protection of the rights of persons deprived of their liberty. The aim of the paper is to contribute scientific critique of new solutions on life imprisonment in Serbian Criminal legislations, because the life imprisonment was introduced in 2019, but the conditions on serving the sentence are not prescribed. Conditional release of convict for certain serious crimes are forbidden. On the contrary, the relevant acts of the Council of Europe and the decisions of the European Court of Human Rights (ECHR) show that the principle of social reintegration of offenders must be ensured in the national enforcement system, otherwise there is a risk of violating Art. 3 of the European Convention. The state has an obligation to include lifelong prisoners in prison rehabilitation programs, as well as establish and use mechanism to reduce sentences. Using examples from Italy and the Netherlands, the author examines the circumstances due to which the standards of ECHR of execution of life imprisonment in those countries have not been reached. In that way, the attention of the legislator in Serbia is drawn to the fact that the principle of effective offender's rehabilitation (also his right of rehabilitation) must not be neglected even when the crime needs to be reacted to the strongest sanctions, with a lifelong imprisonment.

Renal transplantation is the most common procedure in solid organ transplantation. Compered to dialysis, renal transplantation offers better quality of life and overall survival for patients. Due to the improvement of surgical technique, imunosupressive therapy and medical monitor-ing in general, the outcome of treatment has significantly improved today. The importance of the anesthesiologists and the correct performance of all procedures during this treatment has been shown in many studies related to the outcome. In addition to the correct selection of anesthesia drugs, it is very important to pay attention to the position-ing of the patient, adequate monitoring, careful fluid re-placement and the type of fluid intra-and postoperative, as well as adequate pain control after the procedure.

This study explores the electrochemical desulfurization of coal and the recovery of copper (Cu) using dimensionally stable anode (DSA) electrodes. Background: The research addresses the need for effective sulfur removal from coal to reduce emissions. Methods: Electrochemical desulfurization was conducted using DSA and graphite electrodes, evaluating parameters like activation energy, desulfurization rate, and energy consumption. Cyclic voltammetry and linear sweep voltammetry were used to study the electrochemical properties. Results: The DSA electrode demonstrated superior performance with higher desulfurization rates, lower activation energy, and better response to temperature increases compared to the graphite electrode. Optimal desulfurization was achieved at 50 °C with the DSA electrode, balancing efficiency and energy consumption. Copper recovery from the solution post-desulfurization was effective, with an 86.34% recovery rate at −0.15 V vs. (Ag|AgCl). The energy consumption for the Cu recovery was calculated to be 10.56 J, and the total cost for recovering 1 ton of Cu was approximately 781.20 €. Conclusions: The study highlights the advantages of DSA electrodes for efficient sulfur removal and metal recovery, promoting cleaner energy production and environmental sustainability. Future research should focus on optimizing electrochemical conditions and scaling up the process for industrial applications. [ABSTRACT FROM AUTHOR]

Since the beginning of the COVID-19 pandemic, many articles have been published on the subject of organising surgical activity in such conditions. The object of this article is to present the published literature in order to provide key suggestions for dealing with acute surgical problems during the pandemic. A systematic overview is presented of the most relevant articles dealing with COVID-19 and surgery, published between December 30th 2019 and April 30th 2020. The operating room is reserved solely for emergency and oncological procedures. The use of laparoscopy in COVID-19 positive patients should be assessed very carefully and critically because the virus is present in the pneumoperitoneum and its release through aerosol into the operating room can present a risk of contamination for the staff and the immediate environment. The possibility of delaying surgical procedures during the COVID-19 pandemic should be considered, until such time when the patient is no longer considered contagious or is no longer at risk of perioperative complications. If the surgery cannot be delayed, the surgeon in charge must minimize the risk of infection by including the smallest possible number of medical staff into the procedure and shortening the route the patient has to take through the hospital as much as possible. During the pandemic, open procedures take precedence. The purpose of this article is to provide surgeons with advice, so they can make decisions in the best possible interest of the patient and the surgical team, based on risk assessment for the patient (clinical presentation, comorbidity, hospital resources availability). For COVID-19 positive patients, as well as for those who are clinically highly suspected to be COVID-19 positive, nonoperative treatment is preferred if it is available and safe for the patient. If surgical procedures are necessary, personal protective equipment and all safety measures should be applied to protect the patient and the medical team.

Introduction: Chronic postsurgical pain has an estimated mean incidence of 30% and varies according to the type of surgery and patient characteristics. The pain can be severe and result in clinically relevant functional impairment reported by 5-10% of patients. Epidemiological surveys have shown that many patients with neuropathic pain do not receive appropriate treatment. Bio-psycho-social model of chronic pain is highly expressive in neuropathic pain management and requires the adjustment of the therapeutic approach. Case Report: A 37-year-old female complained of numbness, burning, and discomfort of the perineum. In 2016, after the vaginal baby delivery followed by episiotomy, she experienced discomfort and variety of painful sensations in the episiotomy incision region. A year later, after a hemorrhoid surgery followed by episiotomy scar reconstruction symptoms intensified with a strong influence on the patient's psychosocial condition. Consultation of obstetrician, psychiatrist and neurologist took part. Nevertheless, after two years had passed without significant clinical improvement, the patient was referred to a pain specialist. The pain specialist noticed inconsistency in the current treatment and the pain assessment was done only by one specialist. Testing revealed severe symptoms of hyperalgesia and allodynia, impaired psychosocial functioning related to chronic postsurgical pain. Pregabalin and duloxetine were introduced into the therapy and significantly improved pain relief and psychosocial functioning. Conclusion: Chronic postsurgical neuropathic pain is a complex syndrome which is not necessarily related to extensive surgical stimulus. The multidisciplinary therapy approach is crucial. Health providers who understand bio-psycho-social origin of chronic pain should be members of a multidisciplinary team.

Polytrauma is a condition where patients have two or more organ systems or physical regions injuries, with one being life threatening, resulting in cognitive, physical, psychosocial, or psychological functional disability. Polytrauma patients suffer from different types of pains depending on the nature of the traumatic injury they sustain. There are two basic classification of pain: nociceptive and neuropathic pain. Nociceptive pain results from improper functioning of the body's nervous system. Patients suffering from neuropathic pain, (the second type) display characteristics of complete or partial changes in the innervations territories. The viable option for develop a protocol for pain management is to estimate relative safety and efficacy using the number needed to harm (NNH) and the number needed to treat (NNT) approach. There are different forms of therapies for patients suffering from neuropathic pain; various types of therapies that may assist polytraumatic patients to understand the connection of the mind and the body. Anesthesiologic or neurosurgical neurolytic techniques may be effective. Pharmacotherapy and other strategies of pain management depend primarily on the needs and lifestyle of the patient. Studies indicate that patients suffering from neuropathic pain respond positively to a holistic approach.

Sepsis is an innate immunological response of the systemic inflammatory pathway to infection, and is growing problem worldwide inn terms of mortality rates. Rapid molecular based tests have been developed to address this need but are not always accurate in this respect. The most commonly used biomarkers specially the serum markers are reviewed for their current uses and the diagnostic accuracies. Challenges that are faced during biomarker research lied in the lack of uniform protocol and methodology. define sepsis to be a systemic inflammatory response to a bacteria, virus or fungi. In clinical setting several other physiological symptoms must be presented to properly diagnose sepsis. The gold standard of sepsis diagnosis has been traditionally the use of microbial cultures to identify the source of illness. The major limitation of using cultures in the length of the time required to develop cultures to identifiable quantities to detect sepsis. The gold standard of sepsis diagnosis has been traditionally the use of microbial cultures to identify the source of illness. The major limitation of using cultures in the length of the time required to develop cultures to identifiable quantities to detect sepsis. Biomarkers for the Infections caused by Bacteria: C-reactive protein is the general acute phase reactant protein, Procalcitonin is a precursor of the hormone calcitonin and is another potent biomarker for bacterial infections, Serum Amyloid A is an important apolipoprotein, Biomarkers for the Infections caused by Fungi. Mannan and Antimannan antibodies are used to detect the fungal infections due to the presence of mannan in the cell walls of the invasive fungal pathogens. The main disadvantage Mannan and Antimannan antibodies test alone is the high rate of false positives and negatives. Biomarkers for Viral Infections: Interferon Gamma inducible protein 10 (IP-10) IP-10 a proinflammatory chemokine is an important biomarker for diagnosing viral infections. Other Biomarkers on Avenue: IL10, Lipopolysaccharide Binding Protein, Soluble triggering receptor, TLRs, Toll like Receptors 2 (TLR-2) and Neutrophil CD64 receptors, CD163, Micro RNAs, SNP, TNF Alpha, IL-1. Sepsis, as an increasing cause of mortality in the group of multiple injured and critically ill patients in the ICU, requires rapid diagnosis and treatment, and hence the importance of biomarkers is highly important.

This paper aims to investigate the outlook of energy generation by means of transformation within the context of sustainable energy development. An analysis is conducted to assess the stability of energy systems so to implement cutting-edge energy production models at the national level, with a focus on a contemporary approach to energy modeling. Considering the energy transition and the existing constraints within the energy industry, the model assesses the feasibility of the practical advancement of renewable energy sources. The bottom-up energy model was used to determine how the components of energy development sustainability can be applied until the year 2050. To perform comparison testing with the reference state scenario, the LEAP energy model was used. This instrument was selected because of its ability to provide flexible and advanced options for selecting suitable parameters for energy transformation prediction. A progressive reduction in environmental pollution can be achieved by the deployment of current methods of energy generation by transformation until the year 2050 in Serbia, as indicated by the findings. The research highlights the significance of utilizing green energy sources for the continuing development of energy and the gradual reduction in environmental pollution through value co-creation. [ABSTRACT FROM AUTHOR]

The focus of the article is the protection of the rights of crime victims in the Netherlands. The goal of the research is to explain the comprehensiveness of reforms (from 1980) and demonstrate examples of good practice (related to harmonization with the Victims' Rights Directives 2012/29EU). Permanent reforms overcame the passive role of the victim in the criminal procedure where the special rights of victim are guaranteed. The victim becomes the central figure of the criminal justice system. The author points out special solutions in Dutch law, such as victim's right to speak to the court (pointing out to the consequences of victimization etc.), mediation, transactio (diversion in criminal process), compensation order, "advance arrangement" for payment victim's claim by the Central Fine Collection Agency, if it is not paid within the given time. The procedure of compensation from the Criminal Injuries Compensation Fund is described. It is crucial to establish an effective organizational framework for the realization of victim's rights, suited to the needs of a concrete society.

This article discusses worldwide experiences in testing and acceptance of vehicles without drivers, highlights the importance of legal regulation of autonomous vehicles in particular through the analysis of legal regulation in the country that has achieved the most in the development of this technology and its present-day use, it provides a sociological dimension of the use of these vehicles, and then discusses the relationship of the Republic of Serbia towards the vehicles of the future and the advantages and disadvantages that they bring. Legal requirements are only one, but significant obstacle for the vehicles without drivers, though the circumstances in this area are gradually changing.

Background/Aim. Neuropathy represents the most frequent complication in the patients with diabetes mellitus (DM). Symmetric distal sensorimotor polyneuropathy (DSP), which represents the most frequent type of diabetic neuropathy, is present in 30% of hospitalized diabetic patients. The aim of our study was to compare the effects of physical therapy (PT) and alpha-lipoic acid (ALA) supplementation on pain reduction and quality of life improvement in the DSP patients. Methods. The study was performed on 60 adult patients with DM type 2 and DSP. The patients were randomly divided into 2 groups: group A (n = 30) was treated by PT and group B (n = 30) was treated by ALA. The study lasted 6 months during which 3 diagnostictherapeutic cycles were performed. To asses their pain before and after every of 3 cycles, we used visual analog scale (VAS). We also evaluated quality of life before the 1st and after the 3rd cycle with the European Quality of Life Questionnaire (EQ-5D-3L). To analyze results between groups we used mixed between-within subjects ANOVA and statistical significance was set on p < 0.05. Results. Pain intensity showed statistically significant influence of both PT and ALA (λ = 0.028; p < 0.001). A statistically significant difference between the effects of those two therapy modalities was observed (F = 4.78; p < 0.05): PT reduced pain to the greater extent than ALA. A statistically significant improvement was found in the domain of pain/discomfort both in the group A (η = 0.54, p < 0.001) and group B (η = 0.57, p < 0.001), as well as anxiety/depression (group A: η = 0.32, p = 0.008; group B: η = 0.22, p < 0.019) and EQ-VAS (both groups, p < 0.05). Conclusion. Our research showed that physical therapy had a greater influence in pain reduction than alpha-lipoic acid in the patients with DSP.

The term 'disaster' denotes a low-probability but high-impact event that causes a large number of individuals to become ill or injured. Hospitals are required to have an Emergency Operations Plan (EOP) which describes how a facility will respond to and recover from all hazards. It is inclusive of the six critical elements: communications, resources and assets, safety and security, staff responsibilities, utilities, clinical support activities. The 'all hazards' approach allows ability to respond to a range of emergencies varying in scale, duration, and cause. The EOP addresses response procedures, capabilities and procedures when the hospital cannot be supported by the community, recovery strategies, initiating and terminating response and recovery phases, activating authority and identifies alternate sites for care, treatment and services. The initial response to an emergency begins with recognition that an incident may, or has occurred. In cases where the incident is likely to impact or disrupt routine operations, and may require coordination of efforts and response involvement among hospitals, health care coalition partners, EMS, public health, and environmental health. Key management issues involving situational status, incident characteristics and resource capabilities must be quickly determined and communicated amongst response partners in order to establish a common operating picture. The hospital plays maybe a small but crucial role in this larger picture. It is the epicenter of medical care delivered to those who are injured. Each type of threat presents different challenges to hospitals, which must able to respond to each in some capacity. Given finite resources, however, hospitals must attempt to focus their resources on the most likely and potentially serious scenarios.

Introduction Critically ill patients are at risk of GI hemorrhage from acute mucosal lesion or primarily gastric or duodenal ulcers. Increased gastric acidity and a decrease in gastric mucosal barrier is believed to be the cause. The longer the gastric pH remains below 4 the greater the risk of hemorrhage. Patients most at risk include critically ill (sepsis, burn, trauma including neuro-trauma) patients requiring >48 hours of mechanical ventilation, patients with a coagulopathy, prior history of GI hemorrhage, organ dysfunction (renal, hepatic, cardiac), or with hypotension/shock. Zinner et al defined an Illness Severity Index Score for patients in the Intensive Care Unit (ICU). This can help identify a patient at risk for upper gastrointestinal hemorrhage and who may benefit from interventions to reduce that risk. Overall, we know that there is a good relationship between severity of illness (as determined by, for example, Apache II scores, SIRS score) and incidence of ulceration. Moreover, the longer a patient is in ICU, the more likely they are to have a GI bleeding. As many as 20% of patients may develop clinical GI hemorrhage and if surgery is required mortality can approach 80%. The aim of our study was to evaluate the relationship between Zinner score and bleeding from SRMD in severe trauma and critically ill patients. Methodology The series included 954 patients with severe trauma and critical illnesses, 124 among them with acute bleeding stress ulcers of the stomach and duodenum seen at the Intesive care unit of Clinic for Emergency Surgery, Emergency center, Clinical center of Belgrade, during a 10-year period. Results The incidence of bleeding is low and bleeding develops usually after 7 days of Intensive care unit stay. All of patients received prophylaxis. Thirteen patients underwent operation for control of massive bleeding that was unresponsive to intensive medical therapy. All ulcers were superficial and occurred during clinically stressful circumstances. Overall operative mortality was 54%, and this rate seemed to be related to multiple factors acting together. All patients with clinical significant bleeding were in the group of high Zinner score. Conclusion Zinner score appears to be a good predictor of bleeding in patients with severe trauma and criticall illnesses in Intensive care units.

Introduction: Pain is a subjective experience. Perception of the pain intensity is influenced by multiple factors including genetic, socio-economic and psychological factors. Chronic non-cancer pain represents the socioeconomic burden. In adolescent population, osteoid osteoma has an incidence of 10-12% in all symptomatic benign bone tumors. Nonsteroid anti-inflammatory drugs (NSAIDs) are the most frequently used medications for non-cancer pain treatment. Case report: Male, 17 years old, complained about moderate low back pain. Clinical examination was performed and subsequent diagnostic procedures (ultrasound examination of abdomen, nuclear magnetic resonance examination, and radiographic examination of lumbal spine) revealed discopathia and left leg sensory neuropathy. After examination by a pediatrician, physical medicine specialist and an orthopedic surgeon, he started using analgesic (ibuprofen 600 mg), vitamins and physical treatment. Diclofenac 75 mg was added for severe pain management. Haematuria, eosinophylia, decreased creatinine clearance were consequences of NSAIDs toxic nephritis. NSAIDs were stopped and patient reffered to pain specialist - different focuses of pain were suspected. Subspecialist verified pricking and heating sensation in upper leg, severe hip pain without functional deficit and dominating neuropathic pain originating from spinal nerve compression. New radiography reveiled presence of osteoid osteoma of the hip, and after orthopedic consultation, surgery (biopsy of tumor and tumor extirpation) was performed. In the postoperative period, strong pain disappeared, pregabalin was introduced and neuropathic pain was reduced by 20% and low back pain by 30%. Discussion: NSAIDs are the first line treatment of wide range of pain states. NSAIDs can cause numerous serious side effects including acute interstitial nephritis. Conclusion: Multiple causes and types of pain can exist simultaneously, therefore detailed physical examination, followed by other diagnostic Pre primene analgetika, neophodno je izvršiti detaljan klinički pregled i dijagnostičke pretrage, čime bi se smanjila nekritična primena NSAIL.