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AFMN Biomedicine is an international, peer-reviewed, open-access journal dedicated to publishing high-quality original research and review articles in basic, translational, and clinical biomedicine, emphasizing discoveries of broad significance for the health sciences.

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Vol. 43, No. 1 (2026):

Published: 15.03.2026.

AFMN BIOMEDICINE

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SGLT-2 inhibitors have been associated with increases in hemoglobin and hematocrit levels; however, the independence of this effect from confounding factors remains unclear in real-world settings. This study aimed to determine whether hemoglobin and hematocrit levels differed between patients with type 2 diabetes mellitus using SGLT-2 inhibitors and the control group and to investigate whether this effect was independent of factors such as age, sex, ferritin level, glycemic control, and renal function. Data were retrospectively collected from 205 adult patients at the Internal Medicine Clinic of Düziçi State Hospital. Patients were divided into two groups: those using an SGLT-2 inhibitor for at least three months (n = 103) and the control group (n = 102). Hemoglobin, hematocrit, ferritin, HbA1c, and eGFR levels were compared. Subgroup analyses and propensity score matching (PSM) were performed. Median hemoglobin (14.90 (12.6–18.2) vs. 13.00 (12.0–16.06) g/dL, p < 0.001) and hematocrit (45.20 (37.6–54.1) vs. 40.00 (32.2–49.6)%, p < 0.001) were significantly higher in the SGLT-2 group. This increase remained significant across all subgroups (sex, age, ferritin, HbA1c) and persisted after PSM (p < 0.001). Higher hematological parameters were observed with a treatment duration of ≥12 months. SGLT-2 inhibitors are associated with significantly higher hemoglobin and hematocrit levels in patients with type 2 diabetes, independent of iron stores and glycemic control. The underlying mechanism likely involves increased erythropoiesis beyond hemoconcentration. Periodic hematological monitoring is recommended. 

Original article Online first
RISK FACTORS FOR SPINAL ANESTHESIA – INDUCED HYPOTENSION DURING THE ELECTIVE CESAREAN SECTION

By Selena Djurić, Arsen Uvelin, Nikola Gvozdanović

Spinal anesthesia is widely considered the “gold standard” for elective cesarean sections due to its rapid onset and lower risk of complications compared to general anesthesia. However, hypotension is a common adverse effect, influenced by maternal and procedural factors. Despite various preventive measures, predicting hypotension based on patient characteristics remains challenging. This study investigated the relationship between hypotension and variables such as age, BMI, height, preoperative fasting, and hypertension during pregnancy. A retrospective analysis was conducted on 123 patients who underwent elective cesarean section under spinal anesthesia between April and August 2023 at the Clinic of Gynecology and Obstetrics, Novi Sad. Demographic data, anesthetic dose, timing of surgery, and blood pressure trends were collected. Patients were categorized according to delivery time, height, occurrence of hypotension, and history of hypertension. Statistical analyses included Student’s t-test, Mann–Whitney U, Shapiro–Wilk, chi-square tests, ANOVA, and correlation analysis. Hypotension occurred in 45.5% of patients. Older age was significantly associated with a higher incidence of hypotension (p = 0.031), whereas hypertension during pregnancy correlated with a lower incidence (p = 0.032). Height, BMI, and surgery timing had no significant impact on hypotension risk. Taller patients received a larger volume of anesthetic (p = 0.005), with a moderate correlation between height and dose (rs = 0.427, p < 0.001); however, anesthetic dose was not predictive of hypotension. Most hypotensive events occurred within 10 minutes following spinal anesthesia. In conclusion, hypotension was associated with older age, while hypertension during pregnancy appeared to have a protective effect. No significant associations were found with height, BMI, or fasting duration. These findings highlight the need for individualized monitoring and larger-scale studies to optimize spinal anesthesia management in cesarean delivery.

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