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Serum prostate-specific antigen (PSA) testing increases the number of persons who undergo prostate biopsy. However, the best possible strategy for selecting patients for prostate biopsy has not yet been defined. The aim of this study was to develop a classification and regression tree (CART) decision model that can be used to predict significant prostate cancer (PCa) in the course of prostate biopsy for patients with serum PSA levels of 10 ng/ml or less.The following clinicopathological characteristics of patients who had undergone ultrasound-guided transrectal prostate biopsy were collected: age, PSA, digital rectal examination, volume of the prostate, and PSA density (PSAD). CART analysis was carried out by using all predictors. Different aspects of the predictive performances of the prediction model were assessed.In this retrospective study, significant PCa values were detected in 26 (26.8%) of a total of 97 patients. The CART model had three branching levels based on PSAD as the most decisive variable and age. The model sensitivity was 73.1%, the specificity was 80.3% and the accuracy was 78.3%. Our model showed an area under the receiver operating characteristic curve of 82.6%. The model was well calibrated.In conclusion, CART analysis determined that PSAD was the key parameter for the identification of patients with a minimal risk for positive biopsies. The model showed a good discrimination capacity that surpassed individual predictors. However, before recommending its use in clinical practice, an evaluation of a larger and more complete database is necessary for the prediction of significant PCa.

Background and Objectives: Chronic inflammation (CIn) is common among peritoneal dialysis (PD) patients and contributes to adverse outcomes. However, the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and fibrinogen-to-albumin ratio (FAR) in PD remains uncertain. Methodology: In this prospective cohort study, 65 PD patients were followed for 18 months. Baseline demographic, clinical and laboratory data were collected and inflammatory indices were calculated. The composite outcome was all-cause mortality or transfer to hemodialysis (HD). Logistic regression analyses were used to identify independent predictors of outcomes. Results: Over the 18-month follow-up, 23 patients (35.4%) died and 13 (20.0%) transferred to HD. Patients with adverse outcomes had higher baseline FAR, C-reactive protein (CRP) and serum glucose (Glc) levels and lower triglycerides (TG). In multivariate analysis, higher FAR (OR 5.28, 95% CI 1.16–24.12), CRP (OR 1.28, 95% CI 1.02–1.62) and PTH (OR 1.01, 95% CI 1.00–1.01) were independently associated with adverse outcomes, while NLR showed marginal significance. In the mortality-only model, FAR (OR 3.99, 95% CI 1.17–13.61) and PTH remained significant predictors. Conclusions: FAR demonstrated a significant prognostic association with mortality and composite adverse outcomes in PD patients, whereas NLR had limited predictive value. Albumin-based inflammatory indices such as FAR may complement established markers for risk stratification. Larger multicenter studies are warranted to validate these findings.

Background: Chronic kidney disease (CKD) is a progressive, irreversible impairment of kidney function due to various etiologies. Numerous studies have shown that sodium-glucose cotransporter-2 inhibitors (SGLT2i) slow the progression of CKD, due to their pleiotropic effects. Therefore, there has been an increase in interest in their effects not only on kidney function but also on other parameters in patients with CKD. The aim of the study was to examine the effects of SGLT2i on serum lipid values and kidney function in patients with CKD undergoing SGLT2i treatment. Methods: This study was a retrospective data analysis of 75 patients with CKD on SGLT2i treatment. We compared the values of biochemical parameters, renal function outcomes, and blood pressure at two time points: baseline and 24 months after. Results: Total cholesterol (Chol) significantly decreased in all patients, while triglyceride (Tg) and low-density lipoprotein cholesterol (LDLc) levels also decreased in all patients. High-density lipoprotein cholesterol (HDLc) levels increased, but this increase was not significant. Creatinine clearance (Ccr) significantly decreased, and serum urea (Sur) significantly increased in all patients. The proteinuria (Prt) levels did not change significantly. The results showed that the diastolic blood pressure (DBP) significantly decreased in all patients. Conclusions: This study showed that the use of SGLT2i reduced total Chol in all patients with CKD during the 24-month follow-up, regardless of diabetes mellitus (DM) status. No significant differences were observed for the Tg, LDLc, and HDLc values.

Membranous nephropathy (MN) is the most prevalent cause of nephrotic syndrome (NS) in adults, and it can be primary (idiopathic) with an unknown cause or secondary due to a variety of conditions (lupus, infections, malignancies, medications, etc.). It progresses to chronic kidney disease (CKD) in up to 60% of patients, and 10 to 30% develop end-stage kidney disease (ESKD). This retrospective study examines the importance of specific factors, including baseline demographic and clinical data, kidney biopsy PH findings, and selected biochemical parameters, influencing MN outcomes after 10 years of follow-up. The cohort included 94 individuals in whom a diagnosis of MN was established by percutaneous biopsy of the left kidney’s lower pole at the University Clinical Center of Serbia (UCCS) between 2008 and 2013. According to the outcomes, patients were divided into three groups: the recovery (Rec) group, with complete remission, including normal serum creatinine (Scr) and proteinuria (Prt), the group with development of chronic kidney disease (CKD), and the group with development of end-stage kidney disease (ESKD). Nephropathologists graded pathohistological (PH) results from I to III based on the observed PH findings. During the follow-up period, 33 patients were in the Rec group, CKD developed in 53 patients, and ESKD developed in 8 patients. Baseline creatinine clearance levels (Ccr), Scr, and uric acid (urate) were found to be significantly associated with the outcomes (p < 0.001). The lowest values of baseline Scr and urate were observed in the Rec group. The presence of acute kidney injury (AKI) or CKD at the time of kidney biopsy was associated with the more frequent development of ESKD (p = 0.02). Lower Ccr was associated with a higher likelihood of progressing to CKD (B = −0.021, p = 0.014), whereas older age independently predicted progression to ESKD (B = 0.02, p = 0.032). Based on this study, it was concluded that the most important biochemical and clinical factors that are associated with the outcomes of this disease are the values of Scr, Ccr, and urate and the existence of CKD at the time of kidney biopsy. Unlike most previous studies, the presence of HTN had no statistical significance in the outcome of the disease.

: Anemia is a common complication of chronic kidney disease (CKD) and is associated with reduced quality of life, accelerated disease progression, and increased cardiovascular risk. Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have demonstrated significant renal and cardiovascular benefits, and clinical trials have reported improvements in hematologic parameters during treatment. However, real-world evidence regarding their longitudinal effects on hemoglobin (Hb) and iron metabolism in patients with CKD remains limited. : We conducted a pre-post analysis of 118 adult patients with CKD stages 1-4 treated with SGLT2is (empagliflozin or dapagliflozin) at the University Clinical Center of Serbia between January 2024 and June 2025. Patients received either agent at 10 mg once daily for 18 months. Hb, ferritin, C-reactive protein (CRP), albumin (Alb), daily proteinuria (Prt), and estimated glomerular filtration rate (eGFR) were assessed at baseline and at 18 months. Ferritin was adjusted for inflammatory and nutritional status using a residualization model incorporating CRP and Alb. Changes between the two time points were analyzed using repeated-measures general linear models (GLMs). : In unadjusted analyses, mean Hb increased modestly from 136.5 ± 17.9 g/L at baseline to 138.8 ± 18.9 g/L at follow-up ( = 0.028), while median ferritin decreased from 102.2 µg/L to 89.9 µg/L ( = 0.011). After adjustment for CRP and Alb, ferritin levels remained unchanged ( = 0.752). Repeated-measures analyses showed no significant longitudinal effect of time on Hb or ferritin and no significant interaction between time and SGLT2i type. Baseline eGFR, Prt, sex, and baseline ferritin significantly influenced longitudinal hematologic trajectories. : SGLT2i therapy was associated with modest increases in Hb levels over 18 months, while inflammatory status remained stable and no significant reduction in ferritin levels was observed after adjustment for inflammatory and nutritional factors. Longitudinal Hb and ferritin trajectories did not differ significantly between empagliflozin and dapagliflozin, while baseline kidney function, Prt, iron status, and sex significantly influenced hematologic outcomes. Although causal inference is limited by the absence of a control group, these findings suggest a possible favorable effect of SGLT2is on anemia-related parameters in patients with CKD.

The aim of this systematic review was to determine the causal role of Erysipelatoclostridium ramosum in specific invasive infections in humans, and to assess the clinical outcome of antibiotic therapy used to treat them. Several electronic databases were systematically searched for clinical trials, observational studies or individual cases on patients of any age and gender with a systemic inflammatory response syndrome (SIRS) due to E. ramosum isolated from body fluids or tissues in which it is not normally present. Only reports identifying E. ramosum as the only microorganism isolated from a patient with SIRS were included. This systematic review included 15 studies reporting 19 individual cases in which E. ramosum caused invasive infections in various tissues, mainly in immunocompromised patients. E. ramosum was most often isolated by blood cultures and identified by specific biochemical tests. Severe infections caused by E. ramosum were in most cases effectively treated with antibiotics, except in two patients, one of whom died. More than one isolate of E. ramosum exhibited 100% susceptibility to metronidazole, amoxicillin/clavulanate and piperacillin/tazobactam. On the other hand, individual resistance of this bacterium to penicillin, ciprofloxacin, clindamycin, imipenem and ertapenem was reported. This systematic review confirmed the clinical relevance of E. ramosum as a cause of a number of severe infections mainly in immunocompromised inpatients. Metronidazole and meropenem appear to be the antibiotics of choice that should be used in combination or as monotherapy to treat E. ramosum infections, depending on the type and severity of the infection.

Translations of instruments for measuring quality of life developed in certain, mostly more developed, parts of the world usually do not cover regionally specific aspects of health-related quality of life, even after transcultural validation. The aim of this study was to develop and validate a reliable questionnaire in Serbian, Croatian, Bosnian, and Montenegrin languages suitable for measuring health-related quality of life in adults. The study was of a cross-sectional type, assessing the reliability and validity of a newly developed questionnaire for measuring health-related quality of life (HRQoL) in adults residing in western Balkan states (WB-HRQoL). It was conducted on a sample of 489 adults from Serbia, Croatia, Bosnia & Herzegovina, and Montenegro, with a mean age of 52.2±14.4 years and a male/female ratio of 195/294 (39.9%/60.1%). The definitive version of the WB-HRQoL scale with 19 items showed very good reliability, with Cronbach's alpha 0.905. The scale was temporally stable, and satisfactory results were obtained for divergent and convergent validity tests. Exploratory factorial analysis brought to the surface four domains of health-related quality of life, namely the physical, psychical, social, and environmental. The WB-HRQoL scale is a reliable and valid generic instrument for measuring HRQoL that takes into account the cultural specifics of the western Balkan region.

PurposesThe aim of the study was to determine optimal threshold of the Prostate Health Index (Phi) for predicting aggressive prostate cancer (PCa), taking into account misclassification costs, prevalence, and plausible risk factors.MethodsThis prospective cohort study analyzed patients undergoing prostate biopsy and Phi testing. The primary endpoint was aggressive PCa, defined as biopsy Gleason score ≥ 7. The data about age, total prostate-specific antigen (PSA), percentage of free PSA (%fPSA), and digital rectal examination (DRE) were extracted from the patient files. We divided the patients to the low- and high-risk group. The clinical usefulness of the Phi was assessed by the decision curve analysis. The predictive performance was assessed using the area under the receiver operating characteristic curve (AUC), per-class metrics, and the potential reduction in unnecessary biopsies. The uncertain interval of Phi values was also determined.ResultsThere were 200 men included in the study, 35 (17.5%) of them having aggressive PCa. Important predictors of aggressive PCa were %fPSA, DRE, Phi, and belonging to the high-risk group. With optimal threshold of 30.7, about 32% unnecessary biopsies would be avoided. The optimal threshold of Phi was lower in the high-risk group than in the low-risk group. The AUC for detection of aggressive PCa was 0.791. Per-class metrics showed that the Phi has insufficient diagnostic accuracy. The lower and upper limits of the uncertain interval were 41.8 and 51.4, respectively.ConclusionDifferent thresholds of the Phi could be optimal, depending on prevalence, patient characteristics, and misclassification costs. Further studies with a larger patient sample are necessary to confirm our conclusions.

Screening has dramatically changed the distribution of the mean age, stage and grade of prostate cancer (PCa) at diagnosis. However, regional-level data that characterize contemporary PCa patients are limited. The aim of the study was to ascertain main clinical and pathological characteristics of PCa at the present time in the circumstances of opportunistic testing.High-grade PCa according to age, serum prostate specific antigen (PSA), volume prostate, PSA density (PSAD), digital rectal examination (DRE) number of positive cores biopsies and the average percentage of cancer in biopsy at diagnosis has been retrospectively evaluated in 100 men with biopsyproven PCa, at Clinical Centre Kragujevac, from September 2016 until September 2017. PCa were stratified according to Gleason score (GS) into low/intermediate-grade (GS ≤ 7) and high-grade (GS ≥ 8). To identify the determinants associated with high-grade PCa, we performed univariate and multivariate logistic regression.The most prevalent PCa were the low/intermediate-grade (65%), followed by high-grade (35%). The mean age of the patients was 71.5 (range: 56–88) years and median PSA was 14.6 (range: 1.4–935) ng/ml. There were significant differences in age, PSA, PSAD, DRE, number of positive biopsy and average percentage of cancer in biopsy between patients with or without high-grade GS. Logistic analysis demonstrated the PSAD and age have strong prognostic value of high-grade PCa.In conclusion, our study has shown the worrying frequency of high-grade PCa in the circumstances of opportunistic testing. Older men and higher level of PSAD had a much higher probability of high-grade PCa.

Purposes Intermediate-risk prostate cancer (IR PCa) is the most common risk group for localized prostate cancer. This study aimed to develop a machine learning (ML) model that utilizes biopsy predictors to estimate the probability of IR PCa and assess its performance compared to the traditional clinical model. Methods Between January 2017 and December 2022, patients with prostate-specific antigen (PSA) values of ≤ 20 ng/mL underwent transrectal ultrasonography-guided prostate biopsies. Patient's age, PSA, digital rectal exam, prostate volume, PSA density (PSAD), and previous negative biopsy, number of positive cores, Gleason score, and biopsy outcome were recorded. Patients are categorized into no cancer, very low, low-, and intermediate-risk categories. The relationship between the model and IR PCa was investigated using binary generalized linear model (GLM) and assessed its discriminatory ability by calculating the area under the receiver operating characteristic curve (AUC). Results Among 729 patients, PCa was detected in 234 individuals (32.1%), with 120 (16.5%) diagnosed with IR PCa. The AUC for the novel model compared to the clinical model was 0.806 (95% CI: 0.722–0.889) versus 0.669 (95% CI: 0.543–0.790), with a p -value of 0.018. In DCA, the GLM outperformed the clinical model by over 7%, potentially allowing for an additional 44.3% reduction in unnecessary biopsies. The PSAD emerged as the most significant predictor. Conclusion We developed a GLM utilizing pre-biopsy features to predict IR PCa. The model demonstrated good discrimination and clinical applicability, which could assist urologists in determining the necessity of a prostate biopsy.