Prevalence and associated factors of overweight and obesity among medical students from the Western Balkans (South-East Europe Region).

Being overweight and obese is associated with an elevated risk of developing noncommunicable diseases, which are the leading causes of mortality worldwide. It is a warning that global prevalence of overweight among university students ranges from 20 to 40%, which presents a significant public health problem. To date, there was no research conducted on medical students regarding the prevalence and associated factors of overweight and obesity in the countries of the Western Balkans (Slovenia, Croatia, Bosnia and Herzegovina, North Macedonia, and Serbia). The aim of this study was to determine the prevalence and potential demographic, socioeconomic, and health-related behavioral factors associated with overweight and obesity of medical students from Western Balkans. A cross-sectional study was conducted, surveying 2452 students from 14 medical faculties from 5 countries in the region. The prevalence of overweight was 12% and obesity was 2.3% among medical students from Western Balkans. Male gender and smoking status are significant positive predictors of overweight and obesity. Daily level of physical activity up to 1 h per day, going to preventive check-ups once a year or as a part of annual dormitory check-ups are associated with lower odds of being overweight and obese. By creating adequate public health educational programs, students can be influenced to acquire proper health-related lifestyle habits, which would lead to reducing the prevalence of overweight and obesity among the student population, as well as risk of developing noncommunicable diseases and improving the overall health of the population.

Carbapenem-resistant Klebsiella pneumoniae in the Balkans: Clonal distribution and associated resistance determinants.

Carbapenems are considered to be among the last line antibiotics against extended-spectrum ß-lactamase producing Enterobacterales. Carbapenem-resistant Klebsiella pneumoniae (CRKP) has been frequently reported and its spread in Europe is indisputable and poses an enormous threat to hospitalized patients which is of growing concern. This review aims to record prevalence of CRKP in the Balkan region and to review the current knowledge about this life-threatening pathogen. In this review, we summarize data about clinical isolates of carbapenem-resistant K. pneumoniae from Greece, Croatia, Romania, Bulgaria, Serbia, Slovenia, Montenegro, Bosnia-Herzegovina and Albania from published reports between 2000 and 2023. Among Balkan countries, Greece and Romania are the ones with the most reports about CRKP. Since 2007, KPCs are the dominant carbapenemases in both countries. KPC-2 and NDM-1-producing K. pneumoniae strains have been identified as the most frequent CRKP in Croatia, Bulgaria, Serbia, and Slovenia. OXA-48 enzyme has been identified in most Balkan countries. In addition, since 2018, CRKP sequence type 11 (ST11) seems to have replaced ST258 in Balkan Peninsula, while ST15 continues to thrive throughout the years. Not only efficacy of colistin against CRKP has decreased dramatically during the last ten years but colistin resistance mechanism is based on alterations of chromosomal mgrB gene, rather than the already known mcr genes.Moreover, ceftazidime-avibactam-resistant CRKP were detected mostly in Greece. Emergence of CRKP poses a severe threat to the Balkan countries. Due to the narrow therapeutic window, it is essential to prevent the spread of multiresistant K. pneumoniae strains.

Genomic insights into NDM-1-producing Pseudomonas aeruginosa: Current status in a Bulgarian tertiary hospital and on the Balkans.

The present study aimed to explore the genomic characteristics of eight New Delhi metallo-ß-lactamase-1 (NDM-1)-producing carbapenem-resistant Pseudomonas aeruginosa (CRPA) isolates from a Bulgarian tertiary hospital (2021-2023) in comparison to blaNDM-1-positive strains originating from the Balkans. Antimicrobial susceptibility testing, phenotypic assays for carbapenemase activity, PCR screening, whole-genome sequencing (WGS), and phylogenomic analysis were performed. Seven of the CRPA isolates investigated (Minimum inhibitory concentration values of imipenem and meropenem >32 mg L-1) were also resistant to piperacillin-tazobactam, ceftazidime, ceftazidime-avibactam, cefepime, ceftolozane-tazobactam, amikacin, tobramycin, ciprofloxacin, and levofloxacin, but were susceptible to colistin (0.5-2 mg L-1) and cefiderocol (0.25-1 mg L-1). The P. aeruginosa Pae57 isolate (designated Pae57) remained susceptible to aminoglycosides as well. WGS uncovered the co-existence of blaNDM-1 and blaGES-1. The isolates belonged to the ST654 high-risk clone, except for Pae57 (ST611). Alignment against reference sequences revealed the presence of a Tn21 transposon harboring bleMBL-blaNDM-1-ISAba125. It was similar to that found in the P. aeruginosa ST654 NDM1_1 strain (GCA_020404785.1) from Serbia. Phylogenomic analysis of our isolates indicated that seven of them (ST654) differed from each other in no more than 44 single-nucleotide polymorphisms (SNPs). Pae57 (ST611) was strikingly different (>21,700 SNPs) compared to all Balkan strains. In conclusion, to our knowledge this is the first report of blaNDM-1-positive P. aeruginosa ST611 isolation, which indicates the transmission dynamics of this determinant between high-risk and potentially high-risk P. aeruginosa clones. Obtained results unveil the dissemination of clonally related NDM-1-producing P. aeruginosa strains in the monitored hospital for approximately a 2-year period.

Evaluation of Risk Factors for the Occurrence of Limb Fractures in Children Due to Unintentional Injury in Podgorica, Montenegro, Mediterranean.

Background and Objectives: Limb injuries in childhood are very common, with most of them being unintentional and often accompanied by soft tissue injuries. The aim of our study was to determine the risk factors that contribute to the occurrence of limb fractures as the most common type of accidental injury to children in our conditions. Materials and Methods: This study was designed as a prospective clinical analysis of predictive factors with a "nested" case-control study. It included all patients under the age of 18 who were diagnosed with unintentional limb injury and limb fracture due to accidental injury, at the Clinical Center of Montenegro, Podgorica, in the period of 7 January 2020-30 June 2021. Results: The gender of the child and the occurrence of the fracture are not related, and a statistically significant relationship was found between the occurrence of the fracture and the place of residence, the child's age, body mass index (BMI), the affected limb, the method of injury, and the mental state of the parents of the injured child, as well as their economic status. It was proved that the older the child was, the lower the chance of injury, while multivariate analysis proved that BMI could be a predictor of accidental fracture. The most common method of accidental limb fractures in children was a fall from a height. Conclusions: The analysis of factors that influence the occurrence of children's injuries is of great importance for public health. Such and similar research can enable a better understanding of the factors that influence accidental injuries, and therefore influence the prevention of these injuries by organizing various educational materials at the primary healthcare level or at the school level, for both children and parents.

Energy poverty in the Energy Community region: Interrogating policy formulation and coverage.

The capacity of the state to develop and implement policy at the complex nexus of energy infrastructure, social inequality and housing is indicative of the political priorities of governing structures and, by extension, the nature of statecraft more generally. We compare and contrast the energy poverty amelioration policies of two former Yugoslav and two post-Soviet states located outside the European Union, but seeking to join its regulatory sphere - Serbia, Montenegro, Ukraine and Georgia - against the background of deep and persistent patterns of domestic energy hardship. We are particularly interested in uncovering the time horizons, socio-technical systems and target constituencies of different policy measures, as well as energy sector-specific responses to the COVID-19 pandemic. We find that most states in the region have done little to address some of the more substantive challenges around improving housing quality, energy efficiency and gender inequality. However, energy poverty is present in the policy lexicon of all case study countries, and Ukraine, in particular, has advanced a number of more sophisticated approaches and programmes.

Atlas Florae Europaeae notes, 35. Further critical notes on Cytisussect.Tubocytisus (Fabaceae) in Europe.

A few species names in Cytisussect.Tubocytisus are re-assessed and taxonomically evaluated. Diagnostic characters are discussed and the species status of C.absinthioides Janka, C.eriocarpus Boiss., C.frivaldszkyanus Degen, C.jankae Velen. and C.smyrnaeus Boiss. is confirmed. The holotype of Cytisustriflorus Lam. was found to belong to C.hirsutus L. rather than to the C.ratisbonensis group as currently treated. Cytisuslasiosemius Boiss. is not the correct name for C.frivaldszkyanus Degen, but another synonym of C.hirsutus. Cytisuslitwinowii V.I.Krecz., which was known solely from the holotype, is a synonym of C.austriacus L. s.str. Chamaecytisuspseudojankae Pifkó & Barina, reported from a small area shared between Albania, Greece and North Macedonia, is treated as a subalpine variant of C.austriacus. Cytisustmoleus Boiss. is removed from the synonymy of C.eriocarpus and added to the synonymy of C.pygmaeus Willd. Cytisusfalcatussubsp.albanicus Degen & Dörfl. and C.pubescens Gilib. are synonymised with C.hirsutus. Cytisusmicrophyllus Boiss. is moved from C.austriacus s.l. to the synonymy of C.frivaldszkyanus, and C.pindicola (Degen) Halácsy to the synonymy of C.jankae. Chamaecytisuscalcareus (Velen.) Kuzmanov is accepted as Cytisuscalcareus (Velen.) Sennikov & Val.N.Tikhom., comb. nov., and its distribution is circumscribed. Cytisushirsutusvar.ciliatus (Wahlenb.) Hazsl. and C.polytrichusvar.subglabratus Val.N.Tikhom. & Sennikov, var. nov. are recognised as glabrous variants of the corresponding species. Lectotypes of C.ciliatus, C.hirsutissimus K.Koch, C.jankae, C.lasiosemius, C.pubescens, C.rhodopeus J.Wagner ex Bornm. and C.thirkeanus K.Koch are designated. Cytisuspolytrichus is reported from the Western Caucasus in place of C.wulffii auct.

Twenty-five-year mapping species of the superfamily Cercopoidea (Hemiptera, Auchenorrhyncha) in Bulgaria.

Background: In Bulgaria, the superfamily Cercopoidea consists of 18 species in two families - Aphrophoridae and Cercopidae. Of these, 13 species of Aphrophoridae belong to the genera Philaenus, Neophilaenus, Aphrophora and Lepyronia and five species of Cercopidae are in Cercopis and Haematoloma. Over a period of 25 years of extensive research on the species of the superfamily in the country, a large amount of geo-referenced data has been collected on 17 of the species, which has significantly increased knowledge of their biogeography. New information: The paper presents a dataset of the materials of the superfamily Cercopoidea deposited in the Zoological Collection of the University of Sofia (BFUS). The specimens were collected from 888 localities in Bulgaria over a period of 25 years (1997 to 2022). The Cercopoidea collection comprises 8722 specimens grouped into 6670 collection objects.The text provides data for each species, including a distribution map, regional literature taxon names and identifiers from eight taxonomic infrastructures (GBIF, BOLD, OpenBiodiv, BHL, COL, Plazi, EOL and TaxonWorks). It also includes data from literature and new records, phenology and altitudinal distribution in Bulgaria, as well as known host plants. Live photographs are provided for all species. A nanopublication presents the establishment of a new host plant, Asphodelinelutea (L.) Rchb., for the species Philaenussignatus Melichar, 1896.

Mapping the path to excellence: Evaluation of the diagnostic and treatment tools for invasive fungal infections in the balkans.

BACKGROUND: In the Balkans, rising concerns about invasive fungal infections over the past decade stem from various factors. Primarily, there has been a notable uptick in immunocompromised individuals, including those with chronic illnesses like immunological and hematological diseases. Thus, it is essential to assess the region's laboratory capabilities and the availability of antifungals. This evaluation is vital for gauging the preparedness to diagnose and treat fungal infections effectively, thus minimizing their public health impact. METHODS: Data were collected via an online questionnaire targeting healthcare professionals specializing in relevant fields across diverse healthcare settings in Balkan countries. The survey covered various aspects, including diagnostic methods, imaging techniques, and available antifungal armamentarium. RESULTS: Responses were obtained from 50 institutions across the Balkans. While conventional diagnostic methods like microscopy (96 %) and culture (100 %) diagnostics were widely available, access to newer diagnostic tools such as molecular assays (61 %) were limited, often relying on outsourced services. Imaging modalities like ultrasound (100 %) and CT scans (93 %) were universally accessible. A variety of antifungal drugs were available, including amphotericin B formulations (80 %), echinocandins (79 %), and triazoles (100 %). However, access to newer agents like posaconazole (62 %) and isavuconazole (45 %) was inconsistent. Therapeutic drug monitoring (53 %) services were also limited. CONCLUSION: The study underscores the need for equitable access to diagnostic facilities and antifungal treatments across healthcare settings in the Balkan geographic region. Improving access to molecular diagnostic tools and essential antifungal drugs, as well as implementing therapeutic drug monitoring, would optimize the management of fungal infections in the region.

At a crossroads: Genetic lineages and dispersal routes of Morimusasper (Sulzer, 1776) s.l. (Coleoptera, Cerambycidae) in Bulgaria.

The present study fills a knowledge gap in the distribution and genetic variation of Morimus populations in the Balkans, by studiyng the representatives of the genus in Bulgaria - M.asperfunereus Mulsant, 1862, M.verecundusbulgaricus Danilevsky, 2016 and M.orientalis Reitter, 1894. Additional information is provided for Albania and northern Greece. The mitochondrial cytochrome C oxidase subunit I (COI) marker and the nuclear internal transcribed spacer 2 (ITS2) were used for the genetic analyses. Three of the previously-defined mitochondrial lineages (Lb/HgA, L2 and L3) were detected in Bulgaria, as well as a new lineage (Str) from the Strandzha Mountains (south-eastern Bulgaria). A total of 24 distinct haplotypes, 20 of them in Bulgaria, were found. Bulgarian populations of Morimus demonstrated relatively high nucleotide diversity. The L3 COI lineage was confirmed as the most diverse and frequent in the Balkans. The L3 lineage is dominant in most of Bulgaria, but was not identified in the easternmost parts near the Black Sea coast, where the L2 and Str lineages were found. New data highlighted two dispersal routes of the L2 mitochondrial lineage on the Balkan Peninsula: 1) northwards along the Black Sea coast and 2) westwards, across the Balkans where only disjunct populations remain. North-western Bulgaria seems to be the eastern limit of the basal lineage Lb/HgA distribution. Our results show high levels of genetic exchange between most of the mitochondrially defined lineages, yet some of the easternmost populations probably remained isolated for comparatively longer periods.

Ixodid ticks and zoonotic tick-borne pathogens of the Western Balkans.

Ixodid ticks are distributed across all countries of the Western Balkans, with a high diversity of species. Many of these species serve as vectors of pathogens of veterinary and medical importance. Given the scattered data from Western Balkan countries, we have conducted a comprehensive review of available literature, including some historical data, with the aim to compile information about all recorded tick species and associated zoonotic pathogens in this region. Based on the collected data, the tick fauna of the Western Balkans encompasses 32 tick species belonging to five genera: Ixodes, Haemaphysalis, Dermacentor, Rhipicephalus and Hyalomma. A range of pathogens responsible for human diseases has also been documented, including viruses, bacteria and parasites. In this review, we emphasize the necessity for integrated surveillance and reporting, urging authorities to foster research by providing financial support. Additionally, international and interdisciplinary collaborations should be encouraged that include the exchange of expertise, experiences and resources. The present collaborative effort can effectively address gaps in our knowledge of ticks and tick-borne diseases.

Potamophylaxkosovaensis sp. nov. (Trichoptera, Limnephilidae), a new species of the Potamophylaxwinneguthi species cluster from the Ibër River Basin in Kosovo.

Background: The Potamophylaxwinneguthi species cluster comprises species with limited distribution, currently documented from Kosovo, Serbia, Bosnia and Herzegovina and Bulgaria. New information: In this paper, we describe a new species, Potamophylaxkosovaensis sp. nov., discovered in two tributaries of the Ibër River Basin, within the Kopaonik Mountains of the Republic of Kosovo. Morphologically, males of this species closely resemble those of P.idliri Ibrahimi, Bilalli & Kucinic, 2022 from Serbia's Jastrebac Mountain and P.humoinsapiens Ibrahimi & Bilalli, 2023 from the Sharr Mountains in the Republic of Kosovo. However, the new species can be distinguished by its smaller aedeagus, thicker and differently-shaped parameres, as well as distinctive patterns and elongated spines on the parameres. Notably, this species is restricted to spring areas, indicating sensitivity to water pollution and habitat degradation. Additionally, we provide a list of caddisfly species found in sympatry with the new species.Potamophylaxkosovaensis sp. nov. is the third known species within the Potamophylaxwinneguthi species cluster, identified in the Republic of Kosovo.

Albanian Health Promotion Model: a health perspective for Western Balkan countries.

This article proposes a mixed-blended model adapted for Western Balkan countries, advancing the connections between the Icelandic Model of Health Promotion and the assets models for health improvement through the whole school approach and non-formal education methodology. The need to reshape health promotion interventions in Western Balkan countries is urgent, and requires explicit synergies so that a more coherent approach can be taken in their utilization. To this end, we propose a new Albanian Health Promotion Model that integrates key concepts that are associated with the involvement of schoolchildren; parents/caregivers, grandparents, communities, and religious leaders; teachers and school staff; involvement of central and local governments; engagement of the private sector; involvement of non-governmental and civil society organizations; and, importantly, enables the development of supportive environments. The proposed model aims to contribute to a more in-depth theoretical understanding of health and development through integration of the key elements of various models, methods, approaches, and tools employed in health promotion practice. Making the theory of the Icelandic model more feasible for non-Nordic cultures could better contextualize the ideas in public health policy and practice. The Albanian Health Promotion Model may also support interventions to maximize their results in vulnerable communities that have specific requirements and, as a result, could be extrapolated to similar countries in the region and beyond.

Advancing HER2-low breast cancer management: enhancing diagnosis and treatment strategies.

BACKGROUND: Recent evidence brought by novel anti-human epidermal growth factor receptor 2 (HER2) antibody-drug conjugates is leading to significant changes in HER2-negative breast cancer (BC) best practices. A new targetable category termed 'HER2-low' has been identified in tumors previously classified as 'HER2-negative'. Daily practice in pathology and medical oncology is expected to align to current recommendations, but patient access to novel anticancer drugs across geographies might be impeded due to local challenges. MATERIALS AND METHODS: An expert meeting involving ten regional pathology and oncology opinion leaders experienced in BC management in four Central and Eastern Europe (CEE) countries (Bulgaria, Croatia, Serbia, Slovenia) was held. Herein we summarized the current situation of HER2-low metastatic BC (mBC), local challenges, and action plans to prevent delays in patient access to testing and treatment based on expert opinion. RESULTS: Gaps and differences at multiple levels were identified across the four countries. These included variability in the local HER2-low epidemiology data, certification of pathology laboratories and quality control, and reimbursement conditions of testing and anticancer drugs for HER2-negative mBC. While clinical decisions were aligned to international guidelines in use, optimal access to testing and innovative treatment was restricted due to significant delays in reimbursement or limitative reimbursement conditions. CONCLUSIONS: Preventing delays in HER2-low mBC patient access to diagnosis and novel treatments is crucial to optimize outcomes. Multidisciplinary joint efforts and pro-active discussions between clinicians and decision makers are needed to improve care of HER2-low mBC patients in CEE countries.

Tick-borne diseases at the crossroads of the Middle East and central Europe.

OBJECTIVES: The Balkan Peninsula, acting as a crossroad between central Europe and the Middle East, presents diverse ecosystems supporting various tick species capable of transmitting TBDs. This study focuses on Serbia and North Macedonia, both endemic for TBDs, aiming to investigate human-biting ticks' prevalence, TBD prevalence, and major TBPs in blood samples. PATIENTS AND METHODS: This prospective observational study was conducted in 2022 at two medical centers, involving 45 patients from Novi Sad, Serbia, and 17 patients from Skopje, North Macedonia. All participants had either a tick still attached or had had one removed within the preceding 48 h. The study consisted in clinical evaluations of patients and testing of patient samples and ticks for tick-borne pathogens using a High-Throughput pathogen detection system based on microfluidic real-time PCR. In addition, the study assessed the genetic diversity of the identified pathogens. RESULTS: Ixodes ricinus was the most prevalent tick species, with varying infestation rates across various body parts. Tick species and feeding times differed between Novi Sad and Skopje. TBPs were prevalent, with Rickettsia spp. dominant in Skopje and a mix including Rickettsia aeschlimannii, Rickettsia monacensis, Anaplasma phagocytophilum, and Borrelia afzelii in Novi Sad. Subclinical bacteremia occurred in 8.06% of cases, mostly involving Anaplasma spp. Clinical manifestations, primarily local hypersensitivity reactions, were observed in six patients. Phylogenetic analysis confirmed R. aeschlimannii and R. monacensis identity, highlighting genetic differences in gltA gene sequences. CONCLUSIONS: This study sheds light on the prevalence and diversity of TBPs in tick-infested individuals from Serbia and North Macedonia, contributing valuable insights into the epidemiology of TBDs in the Balkan region.

The genetic characterization of grapevines prospected in old Serbian vineyards reveals multiple relationships between traditional varieties of the Balkans.

Serbia preserves a high number of local grape varieties, which have been cultivated across the country for centuries. Now, these ancient varieties are in the spotlight, and there is a global trend towards their recovery and characterization because they can revitalize regional, national and international grape and wine sectors. In addition, their genetic study can be useful to find new pedigree relationships to reveal how local varietal assortment evolved over time. Here, the genetic characterization of 138 grapevines from old Serbian vineyards revealed 59 different genetic profiles, 49 of which were identified as grapevine varieties whose origin in the country could be linked to some major Serbian historical periods. Most of the genetic profiles found in this work arranged in a complex pedigree network that integrates numerous grapevine varieties from diverse Balkan countries, agreeing with an intense exchange of plant material among Balkan regions for centuries. This analysis identified some varieties as important founders of Balkan genetic resources, like 'Alba Imputotato', 'Braghina Rosie', 'Coarna Alba', and 'Vulpea'. After deepening into their genealogy, these major direct founders might have ultimately derived from 'Visparola', an ancient variety of likely Balkan origin with a major founding role in some European regions. Our results also indicated the genetic singularity of the grapevine resources from the Balkans when compared to those from other relevant winemaking regions, supporting the interest of their detailed study to evaluate their oenological potential and for the eventual identification of useful traits to counteract current viticulture challenges.

Long Time No Hear, Magnificent Wohlfahrtia! Morphological and Molecular Evidence of Almost Forgotten Flesh Fly in Serbia and Western Balkans.

The "beautiful viviparous fly", Wohlfahrtia magnifica, may have a magnificent appearance due to its striking morphology; however, it is a potentially deadly agent of obligate traumatic myiasis in humans and animals, with a serious impact on welfare and economics. The fly is found across the Palearctic realm, including the Western Balkan region, with reports from former Yugoslavian countries from the first half of the 20th century. In this paper, a recent case of wohlfahrtiosis recorded in Northern Serbia is evidenced using morphological and molecular techniques. Larvae were collected from two adult sheep with severe hoof myiasis and two young sheep with genital and interdigital myiasis. Morphological identification was performed for adults bred from the infested vulva and third-stage larvae (L3) collected from the hoof wounds, supported with barcoding sequences of the COI gene obtained from larval pairs from the hoof wounds of older and the genitalia of younger sheep. W. magnifica was identified according to the appearance of male fly terminalia and the morphology of L3, which was confirmed after the comparison of representative sequences of the COI gene (deposited in GenBank™ under accession numbers MT027108-MT027114) to those available in GenBank™. This finding represents the first reported case of wohlfahrtiosis in the Western Balkans in 80 years, highlighting the need to re-inform relevant stakeholders to achieve adequate disease control.

Clinopodium L. Taxa from the Balkans-Are There Unique Leaf Micromorphological and Phytochemical Patterns?

The concept of the genus Clinopodium L. has changed considerably since its first description. Most of the currently accepted species of the genus have traditionally been treated as separate genera in the group Satureja sensu lato: Clinopodium L., Calamintha sensu Miller or Moench, and Acinos sensu Miller or Moench. This study aimed to gain a better insight into the species diversity of Clinopodium L. from the Balkans by analyzing the taxa that have traditionally been placed in separate genera. The alkane profile and the micromorphological characteristics of the leaves are analyzed. The leaves are visualized using scanning electron microscopy, and alkanes are isolated using n-hexane as a solvent and analyzed using gas chromatography/mass spectrometry. The alkane profile showed the differentiation of the Acinos-group from the other taxa based on the dominant n-C31, while most of the other taxa contained n-C33 as the dominant alkane. The micromorphological features also showed clear differences between the previously recognized genera, especially in the capitate trichomes. The results showed that micromorphological patterns are highly variable in certain groups of the genus Clinopodium.