Publishing frequency: twice a year. Editor-in-Chief: Prof. Dušica Pahor, MD, PhD The Acta Medico-Biotehnica is the official journal of the Faculty of Medicine, University of Maribor in Slovenia. The scientific-professional journal contains material of interest to a wider readership covering the medical and biotechnical fields. The Papers are peer reviewed by an international Editorial Board. Indexing: EBSCO, DKUM, COBISS, dLib, Ulrich's Periodical Directory Licence: CC BY
Address of the UM Rector Full Professor Zdravko Kačič 35th Conference Medicine, Law and Society, March 26, 2026, University of Maribor
Health is one of the most profound and one of the most universal values of humanity. When health is jeopardised, the differences between countries, cultures or social systems become unimportant. What remains is only common human experience of vulnerability and the need for solidarity. This is exactly why issues of health always surpass the frames of medicine and are also becoming issues of law, ethics, society and global responsibility.
Copyright (c) 2026 Zdravko Kačič (Author) https://creativecommons.org/licenses/by/4.0
Balancing the Benefits and Risks of SGLT2 Inhibitors
Cardiovascular, renal, and metabolic diseases frequently coexist and are leading contributors to global morbidity and mortality. Sodium–glucose cotransporter 2 inhibitors (SGLT2is), originally developed for the treatment of type 2 diabetes mellitus, have demonstrated substantial benefits extending beyond glycemic control. This review synthesizes current evidence on the renal, cardiovascular, and metabolic effects of SGLT2is and highlights key clinical outcome trials supporting use. SGLT2is restore tubuloglomerular feedback, reduce intraglomerular pressure, and attenuate glomerular hyperfiltration by inhibiting sodium–glucose reabsorption in the proximal renal tubule, thereby slowing the progression of chronic kidney disease. Large randomized controlled trials have consistently demonstrated reductions in kidney disease progression, hospitalization for heart failure, and cardiovascular mortality in populations with and without diabetes. In addition, SGLT2is exert systemic effects, including modest reductions in body weight and blood pressure, improved metabolic efficiency, and modulation of inflammatory and oxidative stress pathways. Adverse effects, including genitourinary infections, volume depletion, transient declines in renal function, and rare events, such as diabetic ketoacidosis and Fournier’s gangrene, are also discussed. In summary, SGLT2is represent a transformative therapeutic strategy with broad, multi-system benefits across cardiovascular, renal, and metabolic diseases.
Copyright (c) 2026 Alex Forštnarič, Ana Stajan, Nejc Piko (Author) https://creativecommons.org/licenses/by/4.0
Treatment effects of dentofacial orthopedics followed by a multibracket appliance for Class II division 1 malocclusion
Purpose: The aim of this study was to evaluate the effects of a two-phase orthodontic treatment for Class II division 1 malocclusion and to compare the outcomes with the natural growth observed in untreated Class II subjects. Methods: The study group consisted of 27 patients (17 males and 10 females). Lateral cephalograms were evaluated before treatment (T0), after treatment with a functional orthodontic appliance during puberty (T1), and after treatment with a fixed appliance to achieve proper occlusion (T3). The mean age of patients before functional appliance therapy was 11.7 years (±0.7; Cervical Vertebral Maturation Stage (CVMS) 2–4). The effect of growth was assessed by comparing the results to untreated Class II cases in the control group. Results: Compared to untreated individuals, first-phase treatment with functional appliances significantly increased the effective mandibular length, reduced maxillo-mandibular sagittal skeletal discrepancy, improved the facial profile, and decreased overjet through the protrusion and proclination of maxillary incisors and the retrusion and retroclination of mandibular incisors (p ≤ 0.022). Dentofacial orthopedics did not significantly affect the vertical facial dimension. In the second phase, treatment with fixed appliances reduced the vertical facial dimension and reduced overjet, primarily through proclination and protrusion of the mandibular incisors (p ≤ 0.046). Conclusions: The first phase of Class II division 1 treatment produced greater effects than the second phase. In both phases, changes were predominantly dentoalveolar rather than skeletal.
Copyright (c) 2026 Anita Fekonja, Stjepan Špalj (Author) https://creativecommons.org/licenses/by/4.0
Legal framework for artificial intelligence
Artificial intelligence is becoming a reality in today’s world, and is becoming increasingly integrated into our lives. The development of new technologies based on artificial intelligence is unprecedented, bringing numerous benefits and raising many legal questions. Its use can no longer be avoided; we must familiarize ourselves with it, take advantage of its benefits, and at the same time, be aware of the challenges it brings. The impact of artificial intelligence can be felt in all areas of the economy from manufacturing, public administration, transport, science, and education. It is also strongly present in some areas of healthcare. For its proper and safe use, it is necessary to define an appropriate legal framework that will lay the foundation for its proper functioning and resolve legal issues that arise in in the field of artificial intelligence.
Copyright (c) 2025 Mojca Tancer Verboten (Author) https://creativecommons.org/licenses/by/4.0
Two siblings with late infantile form of Metachromatic leukodystrophy – a case report
Metachromatic leukodystrophy is an autosomal recessive neurodegenerative disease. The underlying mechanism of disease is the lack of arylsulphatase A, which leads to the accumulation of sulphated glycosphingolipids. Three forms of disease are recognized based on clinical onset, including infantile, juvenile, and adult forms. Until recently, metachromatic leukodystrophy was untreatable. In this article, we present the cases of a sister and brother with the late infantile form. The female was diagnosed when the disease was at an advanced stage, and thus, was treated palliatively. Her younger brother was diagnosed at the pre-symptomatic stage and experimental genetic treatment was conducted, which markedly Improved the course of disease.
Copyright (c) 2025 Bernarda Vogrin (Author) https://creativecommons.org/licenses/by/4.0
The Development of Pharmacy Education at the Faculty of Medicine, University of Maribor: A Chronological Review Leading to the 2025 Accreditation
Background: Establishment of the Integrated Master’s Programme in Pharmacy at the Faculty of Medicine, University of Maribor (MF UM [Maribor, Slovenia]) was driven by national pharmacist shortages, expansion of the pharmaceutical industry, increasing clinical pharmacy needs, and harmonisation under EU Directives 2013/55/EU and 2024/782/EU. These factors underscored the necessity of a second accredited pharmacy programme in Slovenia. This review summarises the development that led to accreditation in December 2024. Methods: A chronologic document-based review was performed using institutional archives, three accreditation applications, reports from the Slovenian Quality Assurance Agency for Higher Education (NAKVIS), internal strategic analyses, collaboration agreements, and national statistical data. These materials were integrated with the scientific literature on pharmacy education and EU regulatory frameworks to identify structural, pedagogic, and contextual elements shaping the final programme. Results: Development of the Integrated Master’s Programme in Pharmacy progressed through three phases: early conceptualisation (2006–2016); two accreditation attempts (2017–2020), which clarified curricular, staffing, and competency gaps; and a comprehensive redesign (2021–2024) involving interdisciplinary collaboration among the MF UM, Faculty of Chemistry and Chemical Engineering, University of Maribor (FKKT UM), clinical institutions, and pharmaceutical industry partners. The final curriculum was aligned with EU competence requirements and integrated biomedical, technological, analytical, and enhanced clinical sciences. Strong inter-faculty collaboration and robust clinical and industrial components were formalised through extensive partnerships. Conclusions: The programme represents a significant advance for Slovenian pharmacy education, addressing national workforce needs, strengthening regional development, and complementing existing educational capacities. Establishment of the Integrated Master’s Programme in Pharmacy at the MF UM highlights the value of strategic planning and cross-sector collaboration in contemporary pharmacy education.
Copyright (c) 2025 Uroš Maver, Ivan Krajnc, Iztok Takač, Tina Maver (Author) https://creativecommons.org/licenses/by/4.0
Anatomical Considerations Regarding Catheter Ablation of Atrial Fibrillation in Cor Triatriatum Sinister: A Case Report and Review of the Literature
Introduction: Cor triatriatum sinister (CTS) is a rare congenital cardiac defect. Catheter ablation of atrial fibrillation (AF) in patients with CTS has important anatomical considerations. Case presentation: A 49-year old female patient with a known CTS was referred to our institution for catheter ablation of symptomatic paroxysmal AF. Echocardiography revealed a dilated left atrium, which was split into two separate compartments by a thin fibromuscular membrane. A second membranous structure, in front of the left pulmonary vein (PV) ostia, was noted on the preprocedural magnetic resonance scan. The procedure was guided by intracardiac echocardiography and fluoroscopy. A 3D-electroanatomic map was created and the right PVs were isolated. The left PVs could not be mapped and isolated. The patient was discharged the following day without complications, and has remained entirely asymptomatic for over one year. Discussion: Catheter ablation in patients with AF and a CTS appears to be a feasible rhythm control treatment modality. Most published literature details preprocedural and intraprocedural CTS assessment with different imaging modalities, as well as different ablation strategies based on the arrhythmia type. To the best of our knowledge, an additional membranous structure in front of the left PVs has not been reported.
Copyright (c) 2026 Žiga Mrak, Jan Alatič, Franjo Naji (Author) https://creativecommons.org/licenses/by/4.0
Endocrine activity assessment approaches: From mechanistic bioassays to adverse pathway outcomes
Purpose: To provide an integrated overview of current approaches for detecting and characterizing endo­crine activity in chemicals by em­phasizing the relationship between mechanistic in vitro assays, in vivo models, and regulatory frameworks. Methods: Recent developments in high-throughput screening (HTS) platforms, validated Organisation for Economic Co-operation and De­velopment (OECD) test guidelines, and effect-based bioassays were crit­ically compared. The review covers representative assays for estrogen­ic, androgenic, thyroid, and ste­roidogenic pathways and evaluates the complementarity within adverse outcome pathway (AOP) frame­works. Attention was given to data integration, bioavailability consid­erations, and regulatory adoption under the European Union Regis­tration, Evaluation, Authorization, and Restriction of Chemicals (REACH) and the US En­vironmental Protection Agency (EPA) Endocrine Dis­ruptor Screening Program. Results: Mechanistic assays, such as YES, E-Screen, HeLa-9903, and H295R, provide rapid, sensitive, and cost-effective screening for receptor-mediated and ste­roidogenic effects. In contrast, in vivo systems, including vitellogenin induction, Daphnia reproduction, amphib­ian metamorphosis, and zebrafish assays, yield organ­ism-level confirmation. Integrating both tiers within AOP and quantitative in vitro-to-in vivo extrapolation (QIVIVE) frameworks increases predictive reliability. Despite advances in standardization, challenges remain concerning metabolic competence, inter-laboratory variability, and harmonized effect thresholds. Conclusion: Endocrine testing science is transitioning toward mechanistically anchored, animal-reduced strat­egies that combine HTS, computational modeling, and effect-based monitoring. Harmonized validation cri­teria and performance standards will further enhance regulatory acceptance and facilitate the efficient identi­fication of substances with endocrine activity across both human health and environmental contexts.
Copyright (c) 2025 Andrej Grobin (Author) https://creativecommons.org/licenses/by/4.0
The Need for a Pacemaker after TAVI can be Influenced by Careful Planning and Predicted by Higher Troponin Values after Implantation Study
Aim: Conduction abnormalities that require the implantation of a permanent pacemaker (PM) are known to accompany transcatheter aortic valve implantation (TAVI). Specific patient-dependent and pro­cedure-related features are known to correlate with higher pacemaker implantation rates. Methods: We analysed retrospec­tive data from a single centre with 150 TAVI cases in 2023. Fourteen cases had a PM already implant­ed and two were excluded due to a change to surgery and repeated TAVI in the same month. Results: Two types of transcatheter heart valves (THVs) were implanted and chosen based on computer to­mography scans. Nineteen patients (14%) required PM after TAVI and all underwent implantation in the same hospital. There was no difference in the type of THV implant­ed. Patients that required PM had preexisting right bundle branch block more frequently (20% vs. 9%, p = 0.355), but this was not significantly different. They had however, have significantly higher values of tro­ponin (p = 0.012) and required longer hospitalisations (p = 0.007). On first outpatient control, patients with PM implants had an average of 95% of ventricular pacing, no difference in ejection fraction, and no dif­ference in three month survival compared to patients without a PM implanted. Conclusions: The need for a PM after TAVI can be predicted and avoided to some point. Every TAVI pro­cedure should be carefully planned. Well implanted PMs carry no risks for short term survival.
Copyright (c) 2026 Nina Glavnik Poznič, Vojko Kanič (Author) https://creativecommons.org/licenses/by/4.0
Fournier’s gangrene in a female patient: a case report
Purpose: Fournier’s gangrene is a rare life-threatening form of necrotizing fasciitis that affects the genital, perineal and perianal regions. A significantly higher mortality rate occurs in females due to anatomic differences and greater susceptibility to peritonitis and retroperitonitis. Common risk factors for Fournier’s gangrene include diabetes melitus, substance abuse, liver failure, and immunosuppression. Case presentation: A 73-year-old woman collapsed and was transported to the emergency room tachycardic and in atrial fibrillation. Earlier that day she had an appointment with her gynecologist for evaluation of an inflamed, erythematous, painful left labia, which the gynecologist treated with antibiotics.
Copyright (c) 2026 Nadja Novak Skodič, Tomislav Magdalenič, Gregor Petrun, Timea Hebar, Iztok Takač (Author) https://creativecommons.org/licenses/by/4.0
Fitz-Hugh–Curtis Syndrome in an Adolescent Athlete: MRI Diagnosis of an Atypical Presentation
Purpose: To emphasize the diagnostic role of magnetic resonance imaging (MRI) in identifying Fitz-Hugh–Curtis syndrome (FHCS) in an adolescent patient with a subtle clinical presentation. Methods: A 17-year-old female presented with acute onset right upper quadrant and right shoulder pain. The initial diagnostic workup, including ultrasound (US), computed tomography (CT), and laboratory testing was inconclusive. Due to persistent symptoms and elevated inflammatory markers, MRI of the abdomen and pelvis was subsequently performed. Results: MRI demonstrated a bilateral pyosalpinx with restricted diffusion, free fluid in the pelvis and subhepatic region, and linear adhesions between the hepatic capsule and peritoneum, which was consistent with pelvic inflammatory disease (PID) complicated by FHCS. Microbiologic analysis confirmed a Chlamydia trachomatis infection. The patient received targeted antibiotic therapy with clinical improvement. Conclusion: FHCS represents a rare but important complication of PID that may present with non-specific or extra-pelvic symptoms. MRI is the modality of choice for confirming PID-related complications and perihepatic inflammation, offering high sensitivity and the advantage of radiation-free imaging, which is especially relevant in the adolescent population.
Copyright (c) 2025 Eva Čokolič, Lucijan Lučič Šrajer, Ivana Kodrič, Sarah Dobnik, Matija Žerdin, Irmina Sefić Pašič (Author) https://creativecommons.org/licenses/by/4.0
Diagnostics and Treatment of Dementia in Radovljica Health Center - A Retrospective Study
Aim: The aim of this study was to determine whether patients with newly diagnosed dementia underwent an assessment of cognitive status and which assessment tool was used. We also examined whether patients underwent laboratory and imaging diagnostics and investigated whether they were prescribed anti-dementia medication by their family physician or referred to a clinical specialist (neurologist or psychiatrist). Methods: A retrospective quantitative study was conducted at the Radovljica Health Center, based on an analysis of patients’ medical records from January 1, 2014, to December 31, 2018. Results: The study included 98 patients, 28.6% males (n = 28) and 71.4% females (n = 70), aged 75 to 96 years. Patients had average of 3.7 chronic non-communicable diseases, most commonly arterial hypertension (81.6%, n = 80) and hyperlipidemia (41.8%, n = 41). Patients were prescribed an average of 4.2 regular medications. Cognitive status was assessed in 19.4% (n = 19) of patients; the Mini-Mental State Examination (MMSE) was used most frequently (89.5%, n = 17), followed by the Clock Drawing Test (CDT) and the Montreal Cognitive Assessment (MoCA) in 5.3% (n = 1) of cases each. In the year of diagnosis, laboratory tests were performed in 88.8% (n = 87) of patients, of whom basic laboratory tests were conducted in 65.3% (n = 64). A total of 25.5% (n = 25) of patients were referred for imaging diagnostics, while 79.6% (n = 78) of patients were referred to clinical specialists: 28.6% (n = 28) to psychiatrists and 51.0% (n = 50) to neurologists. Anti-dementia medication was initiated by family medicine physicians in 9.8% (n = 10) of cases at the time of diagnosis. Conclusions: This study found that there is room for improvement in the diagnosis and treatment of dementia at the primary care level (cognitive assessment, laboratory tests, and imaging diagnostics). In particular, progress is needed in the independent initiation of anti-dementia medications by family medicine physicians.
Copyright (c) 2026 Vojislav Ivetić, Julija Šter, Zala Peterka (Author) https://creativecommons.org/licenses/by/4.0
Irritable Bowel Syndrome: Is an Effective Solution Still Elusive?
Irritable bowel syndrome (IBS) is classified as a disorder of the gutbrain interaction. IBS presents an ongoing challenge for patients and healthcare professionals due to the complexity of the underlying pathophysiology. It is important to approach the patient with IBS in a stepwise manner, beginning with the exclusion of alarming symptoms and other conditions, such as inflammatory bowel disease, colorectal cancer, celiac disease, diverticulitis, carbohydrate malabsorption or maldigestion, chronic pancreatitis, neuroendocrine tumours, hyperthyroidism, small intestinal bacterial overgrowth, bile acid malabsorption or idiopathic bile acid diarrhoea, and gastrointestinal infections, which often have more straightforward or effective treatment. When the diagnosis of IBS is established, the focus is on therapy aimed at alleviating symptoms, such as pain, bloating, and altered bowel habits. Management of IBS includes a strong patient-physician relationship, lifestyle modifications (physical activity and dietary changes), analysing the gut microbiota, using probiotics, pharmacologic therapy, and psychological support, including psychotherapy and stress modulation.
Copyright (c) 2025 Ana Globočnik, Andreja Ocepek (Author) https://creativecommons.org/licenses/by/4.0
Management of a venous leg ulcer in a resident receiving long-term care: a case study
Purpose: Venous leg ulcers are chronic wounds that are associated with chronic venous insufficiency, which significantly reduces the quality of life in elderly residents and increases the risk of infection and the need for prolonged care. Case Report: We present a case involving an 82-year-old female resident of a long-term care facility with a venous leg ulcer on the left leg. Treatment was administered from April to December 2024 and included wound management according to modern care principles (tissue care, infection/inflammation control, moisture management, and epithelialisation support [TIME]), nursing care planning based on activities of daily living, and multidisciplinary collaboration. Complete wound healing with full granulation and epithelialisation was achieved through individualised local care of the chronic wound, effective exudate management, inflammation and exudate control, nutritional support, appropriate analgesia, and gradual mobilisation as part of physical therapy. At the conclusion of treatment, the pain had resolved, sleep had improved, the fear of limb amputation had decreased, and her psychological well-being had improved. Conclusion: Comprehensive, continuous, and interdisciplinary care of an elderly resident with a venous leg ulcer in an institutional setting can lead to successful healing with appropriate dressing selection, compression therapy, inflammation control, and support with activities of daily living. Key factors for a favourable outcome include realistic goal setting, regular evaluation of treatment progress, and empowerment of the resident and the family.
Copyright (c) 2026 Sabina Medjedović (Author) https://creativecommons.org/licenses/by/4.0
Use of Botulinum Toxin for the Treatment of Headache and Facial Pain
Botulinum toxin (BT) is widely used in cosmetics and clinical practice. This literature review explores the applications of BT for the man­agement of headaches and facial pain. The most widespread, well-re­ported, and ALIMS and EMA approved application for BT is in preventing chronic migraine at dos­es between 165–196 IU. After an incidental discovery, BT was vali­dated through several RCTs, includ­ing most notably, the PREEMPT study. Following validation, BT was approved for use in treating chron­ic migraines. According to current guidelines, BT is used for the pre­vention of chronic migraines in patients who are resistant to other forms of therapy, such as triptans or NSAIDs. The most widely used BT injection protocol was established in the PREEMPT study and recommends 31–39 injection sites. In other primary headaches, such as tension-type headaches, there is little and confounded evidence of the efficacy of BT. However, some small-scale studies report­ed that BT outperformed placebo and improved pain in trigeminal autonomic headaches. BT is also used to treat chronic facial pain, most notably trigeminal neuralgias, with encouraging results in RCTs. While the primary mechanism of action of BT is the inhibition of acetyl­choline release from terminal cholinergic nerves, more specific mechanisms of pain relief are yet to be eluci­dated, especially for migraine headaches. Our review of relevant published literature indicates that BT therapy is safe, generally well-tolerated and efficacious, and is a viable option for the management of certain primary headaches and chronic facial conditions.
Copyright (c) 2025 Milena Šibalić, Danka Mostić Stanišić, Dragana Milivojević (Author) https://creativecommons.org/licenses/by/4.0
Address of Rector Prof. dr. Zdravko Kačič on Rector’s Day at University of Maribor
Revered Guest Rectors and Vice-Rectors of Slovenian universities, Revered Academic Community of the University of Maribor: Prize Winners, Vice Rectors, Deans of Faculties, Emeritus Professors and Retired Professors, Teachers, Researchers and Associate Experts, Students, Ladies and Gentlemen! This year is a special Jubilee year for the University of Maribor. Fifty years ago, on September 18, 1975, “a second Slovenian university was solemnly proclaimed upon the sound of a fanfare in an assembly of distinguished guests and locals.” With today’s ceremony, we begin a year-long celebration to mark the 50th anniversary of the founding of the University of Maribor.
Copyright (c) 2025 Zdravko Kačič (Author) https://creativecommons.org/licenses/by/4.0
Comparative evaluation of fresh and freeze-dried 3D-printed wound dressings with Plantago major extract
Aim: In this study, we prepared an extract of Plantago major L. (PM) herb and assessed its safety and impact on fibroblast metabolic activity (MA) across a broad concentration range. Additionally, we examined the effects of dry and fresh three dimensionally (3D)-printed wound dressings (abbreviated: dressing) on fibroblasts and evaluated their influence on cell migration and proliferation by a scratch assay. Methods: We prepared a methanolic PM extract and investigated its effect on fibroblast MA across various concentrations. Using 3D printing, we fabricated dressings composed of methylcellulose, alginate, and nanofibrillated cellulose, incorporating the extract. Subsequently, we assessed the effects of dry and fresh dressings on fibroblast MA as well as on migration/proliferation by a scratch assay. Results: T he e xtract h ad n o c ytotoxic e ffects a t c oncentrations of 1–1,000 μg/mL, but became cytotoxic at 10,000 μg/mL. Fibroblast MA increased up to a concentration of 1,000 μg/mL, after which it began to decline, indicating a hormetic effect. The dry dressing enhanced fibroblast MA 1.2-fold more than the control (normalized to 1.0) and the fresh dressing (0.99-fold). The scratch assay confirmed that both dressings supported fibroblast migration/proliferation equally. Conclusions: Our in vitro results support the traditional use of PM in wound healing and can serve as a basis for future investigation of this plant in clinical trials.
Copyright (c) 2025 Laura Činč Ćurić, Uroš Maver, Tina Maver (Author) https://creativecommons.org/licenses/by/4.0
The application of computednanotomography in biomedical sciencesand medicine
Background: Computed nanotomography (nano-CT) is a cutting-edge imaging technology that provides ultra-high-resolution three-dimensional (3D) visualization at the cellular and subcellular levels, significantly surpassing conventional computed tomography (CT) and other imaging modalities. In this review, we describe the technological development of nano-CT along with its current capabilities and potential for integration into clinical medicine. Methods: We reviewed the existing literature relating to nano-CT technology, emphasizing biomedical research applications and evaluating potential for future clinical integration. Results: Nano-CT has demonstrated exceptional utility across various biomedical disciplines, including cardiology, vascular medicine, neurology, pulmonology, oncology and dentistry. This imaging technique provides unprecedented insights into tissue architecture, cellular details and pathological processes, providing significant enhancement in our understanding of diseases and supporting advancements in diagnosis, treatment planning, and therapeutic strategies. Conclusions: Despite remarkable potential for biomedical research, the clinical adoption of nano-CT faces several challenges, including limitations in imaging speed, soft tissue contrast, radiation dose and sample size. Continued technological innovations, clinical validation, and the development of multimodal imaging approaches are essential for the successful transition of nano-CT into routine medical diagnostics and personalized medicine.
Copyright (c) 2025 Jernej Vajda, Marko Milojević, Uroš Maver, Boštjan Vihar (Author) https://creativecommons.org/licenses/by/4.0
Management and treatment of children with chronic kidney disease
Chronic kidney disease (CKD) is defined as a disorder of kidney function or structure that is present for more than 3 months and has a significant impact on health with the risk of progressive loss of kidney function. New recommendations for the management of patients with CKD have recently been published. The basic management of children with CKD includes promoting a healthy lifestyle, preventing the progression of CKD, treating associated complications, and preparing the patient and their family for renal replacement therapy if needed. Maintaining a healthy lifestyle includes close monitoring of kidney function and potential complications, monitoring growth, nutrition, neurological development, and blood pressure. In the context of preventing the progression of CKD, it is important to treat the underlying disease, if possible, and prevent further acute kidney injury. Well-controlled blood pressure as well as proteinuria have been shown to slow the progression of kidney disease in children, and are therefore vital. CKD significantly affects the quality of life of a child and his family. Comprehensive treatment of a child includes treatment by a multidisciplinary team that works proactively.
Copyright (c) 2025 Mirjam Močnik, Nataša Marčun Varda (Author) https://creativecommons.org/licenses/by/4.0
Early postoperative outcomes in a retrospective comparison between Lichtenstein repair method and Rutkow-Robbins repair method for inguinal hernia repair
Purpose: The purpose of this retro­spective study was to determine the difference in postoperative outcomes in inguinal hernia patients treated with a Lichtenstein or Rutkow-Rob­bins hernioplasty. Methods: Ninety male patients who underwent a Lichtenstein or Rutkow-Robbins hernioplasty were retrospectively analysed. The ob­served variables were postoperative outcomes, specifically urinary re­tention, early and late postoperative bleeding, pain and analgesic usage, wound and implant infection, scro­tal hematoma and testicular atro­phy, patient mobilization time, and hernia recurrence. Results: No statistically significant differences in the incidence of post­operative outcomes were detected between the Lichtenstein and Rut­kow-Robbins hernioplasty groups (P > 0.005). Conclusion: No statistically significant differences in postoperative outcomes were detected between patients undergoing Lichtenstein and the Rutkow-Robbins her­nioplasty repairs.
Copyright (c) 2025 Nuhi Arslani (Author) https://creativecommons.org/licenses/by/4.0
Management of newborns with congenital heart defects in Northeast Slovenia: a single-center retrospective study
Purpuse: To compare the epidemiological and clinical characteristics between critical and noncritical congenital heart defects (CHD), and the detection rate of CHD, time of intervention, and outcomes in Slovenia and globally. Methods: We performed a retrospective observational study of 353 neonates with CHD who were born in the maternity ward at the University Medical Center Maribor between 2018 and 2022. Data were collected from the database at the University Medical Center Maribor and from personal patient files. We compared maternal and infant characteristics between critical and noncritical CHD. The detection rate of CHD, time of intervention, treatment options, and outcomes were also compared among infants with CHD. Results: The overall incidence of critical CHD was 1.75/1,000 live births, while the incidence of major CHD was 4.4/1,000 live births. Genetic abnormalities were found in 21.4% (n = 3) of children with critical CHD. Critical CHD was identified prior to the patient being released from the maternity ward in 85.7% (n = 12) and after discharge in 14.3% (n = 2). All critical CHD cases were identified based on clinical condition and confirmed by echocardiography. The absence of a heart defect was detected by newborn pulse oximetry screening. A total of 27.5% (n = 97) of pregnancies were affected by gestational diabetes (GDM). Conclusions: The management of newborns with CHD requires a trained multidisciplinary medical team, as early recognition improves morbidity and prevents mortality. Most CHDs are detected based on clinical conditions, with the diagnosis being confirmed by echocardiography. While the detection of CHD was satisfactory, some newborns with critical CHD were undiagnosed and discharged from the maternity ward. The proportion of undetected infants with CHD may increase in the future if the trend toward earlier discharge continues.
Copyright (c) 2025 Teja Senekovič Kojc, Tjaša Barbič, Mirjana Miksić✝ (Author) https://creativecommons.org/licenses/by/4.0
Validation of the Slovenian version of the Patient-Practitioner Orientation Scale – PPOS
Purpose: Recent decades have seen the emergence of a healthcare framework that places the patient at the core, giving rise to a novel approach termed patient-centered care (PCC) which emphasizes the importance of understanding and respecting the individual needs, values, and preferences of patients, while promoting active collaboration between patients and healthcare providers at all levels. This approach also addresses the psychological, social, and spiritual needs of patients. Several questionnaires have been developed to measure PCC, among which Krupat’s *Patient-Practitioner Orientation Scale* (PPOS) is frequently used. Methods: Validation of the PPOS questionnaire was conducted in several phases. The translation followed the recommendations of the World Health Organization and the ISPOR guidelines. The process included: translation of the questionnaire into Slovenian by two independent translators, review and harmonization of the translations by experts in the field of family medicine, back-translation of the questionnaire into English, and cultural validation of the questionnaire’s appropriateness. The questionnaire was distributed via email to participating family medicine physicians. This was followed by exploratory factor analysis of the data and an assessment of the scale’s internal consistency. Results: The questionnaire was completed by 112 family physicians of various ages, working in different environments and practice sizes. Only items 9 and 13 in the questionnaire met the criterion of being “patient-oriented.” “Moderate patient orientation” was observed in item 17. All other items met the criterion of being “practitioner-oriented.” Exploratory factor analysis identified four factors within the scale. The reliability of each of the four factors was assessed. The calculation of Cronbach’s alpha showed acceptable internal consistency for the entire questionnaire (0.724), as well as for factor 1 (0.709) and factor 2 (0.688). For the other two factors, however, low internal consistency was observed (factor 3 = 0.437, factor 4 = 0.437). Conclusion: The analysis of the results revealed a predominant orientation toward the practitioner. The validation process showed that the Slovenian translation of the questionnaire in its current form is not yet suitable for use. Further adjustments and additional validation are needed to ensure that the questionnaire becomes an appropriate tool for assessing PCC in the Slovenian context.
Copyright (c) 2025 Ksenija Tušek Bunc (Author) https://creativecommons.org/licenses/by/4.0
Catheter-directed thrombolytic therapy for lowerextremity deep vein thrombosis: a case report
Patients with lower-extremity deep vein thrombosis commonly present to emergency departments. However, the propagation of deep vein thrombosis to phlegmasia cerulea dolens is rarely seen. Catheter-directed thrombolytic therapy is widely accepted as an appropriate treatment for severe forms of lower-limb deep vein thrombosis such as phlegmasia cerulea dolens. It is usually available only in a few selective hospitals. This study aimed to present a case of the first such procedure performed in the University Medical Centre Maribor.
Copyright (c) 2022 Aja Pajnik Snoj, Andrej Markota https://creativecommons.org/licenses/by/4.0
Modern technologies enable treatment planning and the fabrication of clear aligners for the correction of misaligned teeth
Purpose: This article reports the realignment of teeth with clear aligners (CA) made using a modern technique manufactured entirely in Slovenia. Case report: A 34-year-old man visited the Orthodontic Department of our healthcare centre because of misaligned teeth in the mandibular arch. The goal of treatment was to align the mandibular anterior teeth using a Slovenian-made CA. The procedure began with an impression for the working cast that was scanned and a 3D image of the patient's dental arches and occlusion were created in the computer. A software package was used to create a 3D virtual model,and the teeth were virtually placed in the positions that would be achieved during treatment with the CA. The CA were made of an elastic thermoplastic material (polyurethane). The patient was instructed to wear the appropriate aligner for 22 hours daily and change it every two weeks. Dental crowding was corrected in six months and at the end of treatment a lingual fixed retainer was bonded to prevent relapse. The patient was very satisfied with the result. After two years of retention, the results remain stable. Results: Comparable to a conventional fixed appliance, a CA is a removable device that offers better aesthetics, more comfort and better oral hygiene.
Copyright (c) 2022 Anita Fekonja, Nejc Rošer, Igor Drstvenšek https://creativecommons.org/licenses/by/4.0
Hemorrhagic stroke in children: A case report
Purpose: The purpose of this report is to present a case of hemorrhagic stroke in a child. Case report: We present a 13-year-old child with a hemorrhagic stroke, which resulted from spontaneous bleeding of congenital arteriovenous malformations in the brain. Conclusion: Although a brain stroke in children is rare, it is an important cause of disability and mortality. Clinical, neurologic, and radiologic examinations are key for the detection and treatment of arteriovenous malformations, which are the most important cause of hemorrhagic stroke in children and may threaten a child's health and life.
Copyright (c) 2022 Tanja Dukić Vuković, Mirjana Miksić, Tomaž Šeruga, Janez Ravnik https://creativecommons.org/licenses/by/4.0
Systemic risk factors in patients younger than 50 years with retinal vein occlusionsl
Purpose: To identify the etiological factors of patients with retinal vein occlusion (RVO) younger than 50 years. Methods: The clinical records of patients with RVO under the age of 50 years seen between January 2015 and December 2020 were analyzed retrospectively. Past medical history, drug use, thrombophilic features, hyperviscosity syndromes, and pathologies that may have caused vasculitis were noted. All patients underwent ocular and systemic examinations, as well as complete screening for thrombophilic risk factors. Results: A total of 20 patients (22 eyes) were recruited in the study, 14 (70%) of whom were male and seven (30%) were female. The mean age was 42 years. The diagnosis was central retinal vein occlusion (CRVO) in 12 eyes (60%) and branch retinal vein occlusion (BRVO) in 10 eyes (40%). Two patients had bilateral BRVO. Hypertension was determined in eight (38%) patients, diabetes mellitus in two (9.5%) patients, and dyslipidemia in 11 (52%) patients. Mutation of factor V Leiden was found in one (5%) patient. An ocular risk factor was pigmentary glaucoma in two (10%) patients. Other diseases that were also noted included Behcet's (5%) and Eale's disease (5%). Multiple etiological factors were detected in 10 (48%) patients. No risk factors were found in only four (19%) patients. Conclusion: Dyslipidemia was the most prevalent risk factor for RVO. Work-up for the etiology of RVO in younger patients may reveal nontraditional risk factors for retinal vein occlusion. It was particularly interesting that thrombophilic disorder was found in only one female CRVO patient. Etiological factors that might result in RVO in young individuals should therefore be investigated in detail.
Copyright (c) 2022 Katja Kuhta, Katarina Petelin, Matejka Masten, Nina Košič Knez, Dušica Pahor https://creativecommons.org/licenses/by/4.0
Achievements in surgical treatment for colorectal liver metastases from 2000 until 2020
Purpose: Colorectal cancer represents the third most frequently occurring malignant disease worldwide that most often disseminates into the liver. The present report describes the treatment possibilities and results of a surgical approach to treat colorectal liver metastases (CLM). Methods: A retrospective review of a prospectively maintained database of patients who underwent surgical treatment for CLM at the Clinical Department of Abdominal and General Surgery of University Medical Centre Maribor in Slovenia was performed. The study was based on the intention-to-treat principle. All procedures, redo procedures, morbidity, and survival were analyzed. Results: The study covered the period between January 2000 and December 2020, during which 631 surgical liver procedures were performed. A total of 352 (74.4%) patients underwent a single procedure, and 121 (25.6%) patients had more than one procedure. The largest portion of surgeries consisted of 541 (85.7%) liver resections (389 minor and 152 major). Radiofrequency ablation was performed in 61 (9.7%) cases and exploration in 29 (4.6%) cases. There were 138 (21.9%) redo procedures. A major morbidity (Clavien-Dindo grade ≥ 3a) was present in 84 (13.3%) cases. The 90-day mortality was 3.8%. In cases with a clinical risk score of 0, the median survival time was 69 months and 5- and 10-year overall survival was 57% and 38%, respectively. Conclusion: The complete surgical removal of metastases accompanied by favorable prognostic factors offers long-term survival in CLM patients.
Copyright (c) 2022 Irena Plahuta, Tomislav Magdalenić, Špela Turk, Stojan Potrč, Arpad Ivanecz https://creativecommons.org/licenses/by/4.0
Effects of differential time and difficulty weighting on the improvement of OSCE quality metrics
Purpose: Objective structured clinical examination (OSCE) has become a leading method for assessing clinical skills. A common problem observed in OSCE is the discrepancy between checklist scores and global scale scores. To reduce this discrepancy, checklists have been unsuccessfully weighted. However, differential weighting based on a combination of time and difficulty weighting had not been investigated. The goals of our study were to: (a) develop new formulas for time and difficulty weights, (b) design an experimental checklist considering the calculated weights, and (c) evaluate the effectiveness of the method in improving OSCE quality metrics. Methods: First, we created formulas for time and difficulty weights for each checklist item. Second, we formulated an experimental checklist considering the calculated weights of each item. Simultaneously, a control checklist was independently weighted by OSCE board members. Third, we compared the experimental and control checklists during the OSCE, wherein students (n=55) were graded by ten assessors using both checklists and the holistic global rating form. Finally, we performed statistical analysis with paired samples t-test, simple linear regression, and scale reliability statistics. Results: A higher correlation coefficient between the checklist and the holistic scoring form (r=0.622, p<0.001 vs. r=0.496, p<0.001), and significantly lower checklist scores (p<0.001), were obtained with the experimental checklist than the control checklist. Conclusion: Assigning time and difficulty differential weights to checklist items improved OSCE quality metrics and reduced the discrepancy between global and checklist scores.
Copyright (c) 2022 Matic Mihevc, Klara Masnik, Tadej Petreski, Nejc Pulko, Sebastjan Bevc https://creativecommons.org/licenses/by/4.0
Clinical manifestaions of renal disease in patients with tuberous sclerosis complex at University Medical Centre Maribor
Purpose: Tuberous sclerosis is an autosomal dominant neurocutaneous syndrome that affects approximately 1/6000–10,000 people. The clinical presentation varies and is dependent on patient age. Renal manifestations, most often angiomyolipomas, cystic renal disease, and renal carcinoma, are present in 48%–80% of patients with tuberous sclerosis. The aim of our study was to determine the clinical characteristics and extent of renal impairment in patients with tuberous sclerosis who were followed at the University Medical Centre Maribor. Methods: We reviewed the medical records of patients with tuberous sclerosis (ICD Q85.1) who received care at the University Medical Centre Maribor. The medical history, clinical characteristics, laboratory results, imaging studies, and current treatment were highlighted. In addition, the results of genetic analysis were reviewed. Results: Our cohort consisted of 13 patients with tuberous sclerosis (age range, 7–71 years; median age, 16 years; average age, 25.2 [14.6-35.9] years). Cutaneous pathology was noted in 12 (92%) patients. Renal manifestations were present in 6 (60%) of the patients; 46% had angiomyolipomas and 23% had renal cysts. No significant renal function impairment was demonstrated. Two patients were treated with systemic everolimus and two patients were treated with topical everolimus for skin lesions. Genetic analysis was performed in seven patients, five of whom were positive and two of whom were negative. Conclusion: In agreement with literature reports, our results confirmed that renal impairment frequently occurs in tuberous sclerosis patients; however, because most of our patients were children, renal function was stable and treatment was rarely needed. Regular screening and follow-up evaluations in the multidisciplinary team are essential for good long-term outcomes.
Copyright (c) 2022 Sonja Golob Jančič, Peter Gradišnik, Andreja Osterc Koprivšek, Albin Gačnik, Nataša Marčun Varda https://creativecommons.org/licenses/by/4.0
Risk factors for surgical site infection following craniotomy: a 10-year retrospective cohort study
Purpose: A craniotomy is a common surgical procedure with complications, including a surgical site infection after craniotomy (SSI-CRAN), for which risk factors are ill-defined. Therefore, we determined the risk factors for developing an SSI-CRAN in adult patients at a university hospital in Maribor. Methods: A retrospective cohort study was conducted to compare patients with an SSI-CRAN (n=66) against a control group (n=70) from January 2009 to August 2019. We collected data from patients in who elective craniotomy had been performed and required surgical treatment for an infection. Results: A total of 1192 patients underwent a craniotomy, of whom 66 (5.5%) developed an SSI-CRAN. The most common infections were osteomyelitis (66.7%) and epidural abscesses (63.6%). The most frequent causative organism was Propionibacterium acnes (54.5%). Based on Fisher’s exact test, the factors associated with an SSI-CRAN compared to the control group were use of Surgicel® (89.4% vs. 67.1%, p=0.0019), use of dural substitutes (53% vs. 27.1%, p=0.0028), use of adhesive dura (13.9% vs. 2.9%, p=0.0274), sutures used for skin closure (69.7% vs. 34.3%, p=0.0001), a frontal craniotomy (28.8% vs. 12.9%, p=0.0328), and postoperative administration of glucocorticosteroids (73.7% vs. 54.4%, p=0.04). Conclusion: We identified risk factors associated with SSIs-CRAN, for which alternatives exist that could reduce the incidence of SSIs-CRAN.
Copyright (c) 2022 Hojka Rowbottom, Borut Hribernik, Janez Ravnik https://creativecommons.org/licenses/by/4.0