Changing trends in injury patterns of undocumented migrants along the Hungarian-Serbian border from 2018 to 2022.

OBJECTIVE: The Traumatology Clinic of the University of Szeged is a level one Trauma center situated near the Hungarian - Serbian border, where a 4 m tall fence constructed in 2018 serves as a barricade leading to numerous trauma cases. The objective of this study is to characterize the epidemiology of injuries, challenges, and recent trends whilst treating these undocumented migrants in Hungary. MATERIALS AND METHODS: A national retrospective mono-centrical study was performed, examining 982 patients who were admitted to the emergency trauma center in the University of Szeged between January 2018 and December 2022, using data from our electronic administrative system (eMedSol). Factors such as basic epidemiology, country of origin, fractures- according to the AO classification- and its respective treatments, mechanism of injury, duration of stay, and costs were assessed to set as a basis for prediction using a regression model. RESULTS: A total of 982 patients from 2018 to 2022 were included in the study. Patterns of injury included calcaneal fractures in 2018 and 2019 whereas in 2021 and 2022 along with the exponential increase in patient number, bilateral calcaneal fractures, open and multi-fragmentary tibial fractures were also observed. Additionally, seasonal variations, favoring the months of September through November were observed. Treatment cost ratios, especially surgeries, have also been consistent with the pattern of proximalizing injuries; more proximal surgeries indicate higher surgical costs which is evidently visible in the significantly higher cost ratio dedicated to surgery in 2022. CONCLUSION: While migration seems to be a global problem affecting governments and citizens alike, rarely do we understand the direct consequences of illegal migration affecting healthcare services. Hungary in particular created a 4 m tall wall between Serbia in 2019 with means of preventing illegal migration, which in turn led to gradual and later an exponential increase in the number of injured patients particularly in the years 2021 and 2022. Undocumented migrant cases have increased exponentially between 2018 and 2022, with certain patterns seen not only in the injury types but also in seasonal variations and cost expectations. Injuries have been showing a trend of proximalization and have been of more serious quality, including bilateral and/or open injuries. Revisions after surgery were virtually impossible due to the discharging of patients back to border control after their definitive treatment. The need for adequate quality surgical care, manpower and financial aid should be considered.

Impact of the COVID-19 Pandemic on Measles Vaccination Coverage and Estimated Catch-up Efforts for Serbia.

BACKGROUND: Measles is highly infectious, requiring ≥95% vaccine coverage rate (VCR) to prevent outbreaks. This study aimed to understand the impact of the COVID-19 pandemic on routine measles-containing vaccine (MCV) VCRs in Serbia and estimate national and regional catch-up vaccination required to prevent outbreaks. METHODS: A multiplier model was used to calculate annual MCV dose 1 (MCV1) and MCV dose 2 (MCV2) VCRs for children 1-6 and 6-12 years of age, respectively, for 2011-2022. Postpandemic (2023-2024) VCRs were modeled. The numbers of administered doses were compared to prepandemic and postpandemic, and monthly catch-up rates were calculated for 12-, 18- and 24-month campaigns. RESULTS: Between prepandemic and pandemic periods, national MCV1 VCR decreased from 88% to 81%, while MCV2 VCR decreased from 92% to 89%, corresponding to 20,856 missed MCV1 and 8760 missed MCV2 doses. Assuming national VCRs returned to prepandemic levels post-2022, 18% of children 1-6 years of age and 11% of children 6-12 years of age would have missed their MCV1 and MCV2 doses, respectively, by 2024. To catch up missed doses under this scenario, most regions would require monthly catch-up rates of 25%, 16% or 12% for MCV1 and 14%, 9% or 7% for MCV2, considering 12-, 18- or 24-month campaigns, respectively. CONCLUSIONS: The pandemic negatively impacted MCV VCRs in Serbia, leaving a sizeable proportion of children with missed doses. Significant catch-up efforts are required to recover VCRs to prepandemic levels and avoid future measles outbreaks, with increased monthly administration rates versus those in prepandemic periods.

Depressive Symptoms during Pregnancy and the Postpartum Period: A Tertiary Hospital Experience.

Background and Objectives: The prevalence of depressive symptoms during pregnancy is about 20%, and 10-15% in the postpartum period. Suicide is a worrying cause of death among women in these periods. Although ICD-10 lacks specific definitions for perinatal depression (it is planned in ICD-11), the DSM-5 defines it. Various etiological factors and treatment options are being investigated. This study aimed to examine potential etiological factors in order to contribute to potential preventive and therapeutic approaches. Material and Methods: A prospective study at the Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, from October 2023 to January 2024 was conducted. Two hundred and five healthy women were surveyed before giving birth (37+ gestational weeks) and 2 weeks and 2 months after childbirth. The following factors were examined: sociodemographic, psychological, and obstetric (using a specially designed questionnaire); relationship quality (DAS-32); and depression, anxiety, and stress symptoms (EPDS; DASS-21). Results: Depression frequency was 26.3% before childbirth, 20% in the second week, and 21.9% in the second month after delivery. DASS-21 test results showed a statistically significant correlation before delivery and two weeks postpartum (p = 0.02). Factors that are significantly associated with the presence of depressive symptoms include the following: before childbirth-miscarriages (p < 0.01); in the second week after childbirth-personal experiences of a difficult birth (p < 0.01), cesarean delivery instead of planned vaginal delivery (p = 0.03), and application of epidural anesthesia (p = 0.04); and in the second month after childbirth-satisfaction with financial status (p = 0.035). Relationship quality is significantly correlated with DASS-21 test results before childbirth, in the second week, and in the second month after childbirth (p < 0.01), and it is significantly different in women with and without depressive symptoms (before childbirth, in the second week, and in the second month after childbirth, p < 0.01). Conclusions: There are risk factors that can be addressed preventively and therapeutically during pregnancy and in labor. This could be achieved through psychotherapy, partner support, and appropriate management of labor.

Epidemic in the time of the COVID-19 pandemic: News media framing of the MMR vaccination controversy in Serbia.

Rising vaccine hesitancy is often related to negative vaccination media coverage. It is generally accepted that the media played a great role in spreading the MMR (measles, mumps, and rubella) childhood vaccination scare first in the UK and then worldwide. During the COVID-19 pandemic, the MMR vaccination rate dropped further in some countries. This paper examines the Serbian news media framing of the MMR vaccination controversy in the period 2019-2023 (periods of declining MMR vaccination rate, rising COVID-19 vaccine hesitancy and the 2023 measles outbreaks). Furthermore, the paper questions whether the COVID-19 pandemic influenced the MMR vaccine narrative in the newspapers. For this reason, quality content analysis of the press in combination with framing approaches (diagnostic-prognostic-motivational framing tasks and responsibility framing) were used. In total, 122 articles dealing with the MMR vaccine and measles epidemics were analysed. According to the press, the most significant cause of the declining MMR rate is anti-vaccination campaigns and conspiracy theories by the "anti-vax lobby" (diagnostic frames). The pandemic was the other significant cause for the intake drop. Achieving herd immunity through vaccine uptake is offered as the best solution (prognostic frames). Finally, MMR vaccination campaigns and penalties for non-compliant parents and vaccine refusers are proposed as calls to action (motivational frames). During this period, the press did not publish any "sensational anti-vax stories". Considering the low MMR vaccine numbers in Serbia in this period, positive media messages did not have a significant influence on improving the vaccination rate. Thus, I suggest that Serbian parents distrust vaccination information presented by the dominant news, including the advice of health experts.

Impact of Vitamin D Status and Nutrition on the Occurrence of Long Bone Fractures Due to Falls in Elderly Subjects in the Vojvodina Region of Serbia.

Bone fractures are a significant public health issue among elderly subjects. This study examines the impact of diet and vitamin D status on the risk of long bone fractures due to falls in elderly subjects in Vojvodina, Serbia. Conducted at the University Clinical Center of Vojvodina in autumn/winter 2022-2023, the study included 210 subjects >65 years: 105 (F: 80/M: 15) with long bone fractures due to falls and 105 (F: 80/M: 15) controls. Groups were similar regarding age and BMI. Dietary intakes (by two 24-h recalls) and serum vitamin D levels were analyzed. The fracture group had a significantly lower median daily vitamin D intake (1.4 µg/day vs. 5.8 µg/day), intake of calcium, energy, proteins, fats, fibers, dairy products, eggs, fish, edible fats/oils, and a higher intake of sweets (p < 0.001 for all). Serum vitamin D levels were significantly lower in the fracture group (40.0 nmol/L vs. 76.0 nmol/L, p < 0.001). Logistic regression identified serum vitamin D as the most important protective factor against fractures, and ROC curve analysis indicated that serum vitamin D levels > 50.5 nmol/L decreased fracture risk. Nutritional improvements (increased intake of vitamin D and protein sources such as fish, eggs, and dairy), increased sun exposure, and routine vitamin D supplementation during winter are advised.

Comorbidity in primary care - causal or casual? A longitudinal observational study in family medicine.

BACKGROUND: Comorbidity is increasingly important in the medical literature, with ever-increasing implications for diagnosis, treatment, prognosis, management and health care. The objective of this study is to measure casual versus causal comorbidity in primary care in three family practice populations. METHODS: This is a longitudinal observational study using the Transition Project datasets. Transition Project family doctors in the Netherlands, Malta and Serbia recorded details of all patient contacts in an episode of care structure using electronic medical records and the International Classification of Primary Care, collecting data on all elements of the doctor-patient encounter, including diagnoses (1,178,178 in the Netherlands, 93,606 in Malta, 405,150 in Serbia), observing 158,370 patient years in the Netherlands, 43,577 in Malta, 72,673 in Serbia. Comorbidity was measured using the odds ratio of both conditions being incident or rest-prevalent in the same patient in one-year dataframes, as against not, corrected for the prior probability of such co-occurrence, between the 41 joint most prevalent (joint top 20) episode titles in the three populations. Specific associations were explored in different age groups to observe the changes in odds ratios with increasing age as a surrogate for a temporal or biological gradient. RESULTS: The high frequency of observed comorbidity with low consistency in both clinically and statistically significant odds ratios across populations indicates more casual than causal associations. A causal relationship would be expected to be manifest more consistently across populations. Even in the minority of cases where odds ratios were consistent between countries and numerically larger, those associations were observed to weaken with increasing patient age. CONCLUSION: After applying accepted criteria for testing the causality of associations, most observed primary care comorbidity is due to chance, likely as a result of increasing illness diversity. TRIAL REGISTRATION: This study was performed on electronic patient record datasets made publicly available by the University of Amsterdam Department of General Practice, and did not involve any patient intervention.

Prevalence and antimicrobial resistance trends among vaginal bacteria isolates from pregnant bitches.

Many of the reproductive tract infections in the bitches are caused by bacteria that can normally be present on the vaginal mucosa. These bacteria also might have an important role as the cause responsible for pregnancy loss and fetal deaths. The choice of antibiotic therapy for the pregnant animal is narrow and represents a severe problem in veterinary practice, especially due to increased antimicrobial resistance. Due to incorrect antimicrobials use in breeding kennels, the aim of the present study was to assess the occurrence of the bacterial flora isolated from the pregnant bitches and their antibiotic sensitivity. The study was carried out at the private Veterinary clinic in Novi Sad, Serbia. The vaginal swabs were taken from 60 bitches diagnosed with pregnancy and were sent to be laboratory tested. Based on the results, the most common isolated pathogens were Staphylococcus pseudintermedius (20%) and beta-hemolytic streptococci (18.33%). Furthermore, significant resistance to antibiotics from beta-lactams group was detected. It is of particular importance that antimicrobial treatment be evidence based in order to reduce the overuse of antimicrobials due to increased concern regarding antimicrobial resistance.

Drivers and epidemiological patterns of West Nile virus in Serbia.

Background: West Nile virus (WNV) is an emerging mosquito-borne pathogen in Serbia, where it has been detected as a cause of infection in humans since 2012. We analyzed and modelled WNV transmission patterns in the country between 2012 and 2023. Methods: We applied a previously developed modelling approach to quantify epidemiological parameters of interest and to identify the most important environmental drivers of the force of infection (FOI) by means of statistical analysis in the human population in the country. Results: During the study period, 1,387 human cases were recorded, with substantial heterogeneity across years. We found that spring temperature is of paramount importance for WNV transmission, as FOI magnitude and peak timing are positively associated with it. Furthermore, FOI is also estimated to be greater in regions with a larger fraction of older adult people, who are at higher risk to develop severe infections. Conclusion: Our results highlight that temperature plays a key role in shaping WNV outbreak magnitude in Serbia, confirming the association between spring climatic conditions and WNV human transmission risk and thus pointing out the importance of this factor as a potential early warning predictor for timely application of preventive and control measures.

First case of ichthyophonosis in farmed rainbow trout Oncorhynchus mykiss in Serbia.

Ichthyophonosis is a disease caused by the mesomycetozoean parasite Ichthyophonus hoferi that affects a variety of fish species, including rainbow trout Oncorhynchus mykiss Walbaum. This disease is characterized by granulomatous lesions and necrosis in various organs, which can have severe impacts on the health and welfare of the fish. Ichthyophonosis has been found in several parts of the world, including Europe, and is a significant concern in the aquaculture industry and for populations of wild marine fishes. The rainbow trout is a widely cultured salmonid species in many countries, including Serbia. Although the presence of I. hoferi in rainbow trout has been reported in several countries, it has never been documented in Serbia. In this article, we report the first case of ichthyophonosis in rainbow trout in Serbia.

Academic burnout syndrome among medical students in Serbia: prevalence of high risk and determinants.

BACKGROUND: Although burnout syndrome has been described in numerous research studies, the data on burnout syndrome among medical students in developing countries is scanty. This study aimed to determine the prevalence of high-risk for burnout syndrome and its associated factors among university undergraduate medical students in Serbia. METHODS: An observational, analytical, cross-sectional study was conducted using the Maslach Burnout Inventory-Student Survey and a survey on associated factors. The research was carried out from February to March 2014. Multivariate logistic regression was used to determine the adjusted odds ratio (Odds Ratio, OR) with 95% Confidence Interval (95%CI) in order to identify independent correlates of high risk of burnout syndrome. RESULTS: A high risk for burnout syndrome was noted in 15.0% of respondents; that is, 114/760 medical students suffered from high emotional exhaustion, high cynicism, and low academic efficiency. According to the results of multivariate logistic regression, the main significant independent correlates of high risk for burnout syndrome in medical students were: age of students (for aged 22-24: adjusted OR = 5.64, 95%CI = 2.58-12.34, p < 0.001 for aged ≥ 25: adjusted OR = 5.65, 95%CI = 2.08-15.39, p = 0.001) with p for trend < 0.001, higher frequency of alcohol consumption (for habit 1-2 times a week: adjusted OR = 2.01, 95%CI = 1.01-4.03, p = 0.048) with p for trend = 0.025, and use of sedatives (adjusted OR = 3.44, 95%CI = 1.31-9.04; p = 0.012). CONCLUSION: The present study identified several factors associated with burnout syndrome in Serbian medical students. Some factors associated with the high risk of burnout syndrome in medical students are modifiable. It is important to carry out similar research on burnout syndrome in the future, especially using longitudinal studies, in order to evaluate the associations found in this cross-sectional study.

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.

Burnout syndrome among preschool teachers in Serbia.

Pedagogical work, especially with preschool children, is one of the most stressful professions, and the incidence of stress-related illnesses among preschool teachers is higher than in the general population. The aim of this cross-sectional study, conducted between October 2018 and April 2019, was to examine the prevalence of the burnout syndrome in a representative sample of 482 preschool teachers in Serbia and the factors associated with it. For this purpose, the participants completed a questionnaire composed of six sections: the socio-demographic and socio-economic characteristics, health and lifestyle characteristics, workplace and employment characteristics; Copenhagen Burnout Inventory (CBI); Beck Depression Inventory (BDI), and the Zung Self-Rating Anxiety Scale (SAS). The frequency of the total burnout was 27.1 %. The frequency of burnout on the CBI was 25.4 % for personal burnout, 27.0 % for work-related burnout, and 23.4 % for client-related burnout. Multivariate logistic regression analysis with total burnout as an outcome variable showed that being single (OR: 0.18; 95 % CI: 0.05-0.58), having poor (OR: 6.05; 95 % CI: 1.05-34.91), or average (OR: 3.60; 95 % CI: 1.57-8.25) self-rated health, not having didactic/play tools (OR: 2.71; 95 % CI: 1.21-6.04), having a higher score on the BDI (OR: 1.19; 95 % CI: 1.09-1.29) or SAS (OR: 1.10; 95 % CI: 1.03-1.18) was significantly associated with the total burnout among our participants. Our study shows the worryingly high prevalence of the burnout syndrome among preschool teachers in Serbia and points to its association with mental health issues, depression, and anxiety.

The trend of the quality of cause-of-death data and its association with socio-economic indicators in Serbia in the period 2005-19.

This study aims to evaluate the temporal trend in the quality of cause-of-death data and garbage code profiles and to determine its association with socio-economic status in Serbia. A longitudinal study was assessed using data from mortality registers from 2005 to 2019. Computer application Analysis of Causes of National Deaths for Action (ANACONDA) calculates the distribution of garbage codes by severity and composite quality indicator: Vital Statistics Performance Index for Quality (VSPI(Q)). A relationship between VSPI(Q) and country development was estimated by analysing two socio-economic indicators: the Socio-demographic Index and the Human Development Index (HDI). Serbia indicates progress in strengthening cause-of-death statistics. The steady upward trend of the VSPI(Q) index has risen from 55.6 (medium quality) to 70.2 (high quality) over the examined years. Significant reduction of 'Insufficiently specified causes with limited impact' (Level 4) and an increase in the trend of 'High-impact garbage codes' (Levels 1 to 3) were evident. Decreased deaths of no policy value (annual percentage change of -1.41%) have manifested since 2014. A strong positive association between VSPI(Q) and socio-economic indicators was assessed, where the HDI has shown a stronger association with VSPI(Q). Improved socio-economic conditions on the national level are followed by enhanced cause-of-death data quality. Upcoming actions to improve quality should be directed at high-impact garbage codes. The study underlines the need to prioritise the education and training of physicians with a crucial role in death certification to overcome many cause-of-death quality issues identified in this assessment.

Analysis of antipsychotic drugs prescribing in incarcerated persons in a Serbian correctional facility.

PURPOSE: Prison settings have limited resources, and it is of particular interest to analyze which antipsychotics are commonly prescribed in these conditions and to determine the prevalence of the adverse effects. DESIGN/METHODOLOGY/APPROACH: A cross-sectional, epidemiological survey was used to measure the prevalence of antipsychotic prescribing among adult prisoners in Sremska Mitrovica Prison in 2020. FINDINGS: The prevalence of antipsychotic use was 7.58%. The most commonly prescribed antipsychotic was clozapine (45.36%), but also olanzapine, haloperidol and risperidone were prescribed. The incidence of extrapyramidal adverse effects was nonexistent and the metabolic parameters did not differ between participants using metabolic syndrome-inducing antipsychotics and those who were prescribed metabolically inert medications. The prescribed doses were lower compared with the recommended. RESEARCH LIMITATIONS/IMPLICATIONS: This research includes certain points that should be cautiously considered. First, the data were cross-sectional and the findings did not provide causal interpretations. Second, the data are from a single penitentiary institution, albeit the largest in the country; however, that may affect the generalizability of the findings. Third, because the included subjects were not hospitalized, some laboratory analyses were not available, according to the local regulations, and thus the prevalence of metabolic syndrome could not be precisely determined. PRACTICAL IMPLICATIONS: The prevalence of the antipsychotic use in prison environment is significantly higher than in general population. The most frequently prescribed antipsychotics are clozapine and olanzapine. The prevalence of adverse effects is rare, however, that is possibly due to low doses of the prescribed antipsychotics. The list of therapeutic options available to the incarcerated persons in this facility is also limited. The list of available antipsychotics does not include some atypical antipsychotics with more favorable safety and tolerability profile, such as aripiprazole or cariprazine. Long-acting antipsychotic injectables were also not available to these patients. Laboratory analyses are not regularly conducted and do not include some essential parameters such as lipid status or differential blood count. Low-dose antipsychotics for behavioral symptoms appears to be well tolerated under prison conditions where adherence is assured. It is effective during the prison stay but long-term effects, especially after release from prison, had not been studied. SOCIAL IMPLICATIONS: This paper advocates for better quality of health care in this correctional facility: more therapeutic options and better laboratory monitoring. The authors justify the use of clozapine in this settings due its benefits in reducing violence and aggression; however, further research would be necessary to clarify does the use of clozapine in incarcerated persons cause behavioral improvements that could result in shorter incarcerations, less recidivism and better quality of life. ORIGINALITY/VALUE: To the best of the authors' knowledge, this is the first insight of the antipsychotic prescribing practice in Serbia. There is very limited data on prisoners' health care, especially mental health care, in Balkan countries. The antipsychotic prescribing pattern in this sample is characterized with higher than expected clozapine use, but without expected adverse effects.

Predictors of Intrahospital Mortality in Aneurysmal Subarachnoid Hemorrhage after Endovascular Embolization.

Background and Objectives: Aneurysmal subarachnoid hemorrhage (ASAH) is defined as bleeding in the subarachnoid space caused by the rupture of a cerebral aneurysm. About 11% of people who develop ASAH die before receiving medical treatment, and 40% of patients die within four weeks of being admitted to hospital. There are limited data on single-center experiences analyzing intrahospital mortality in ASAH patients treated with an endovascular approach. Given that, we wanted to share our experience and explore the risk factors that influence intrahospital mortality in patients with ruptured intracranial aneurysms treated with endovascular coil embolization. Materials and Methods: Our study was designed as a clinical, observational, retrospective cross-sectional study. It was performed at the Department for Radiology, University Clinical Center Kragujevac in Kragujevac, Serbia. The study inclusion criteria were ≥18 years, admitted within 24 h of symptoms onset, acute SAH diagnosed on CT, aneurysm on DSA, and treated by endovascular coil embolization from January 2014 to December 2018 at our institution. Results: A total of 66 patients were included in the study-48 (72.7%) women and 18 (27.3%) men, and 19.7% of the patients died during hospitalization. After adjustment, the following factors were associated with in-hospital mortality: a delayed ischemic neurological deficit, the presence of blood in the fourth cerebral ventricle, and an elevated urea value after endovascular intervention, increasing the chances of mortality by 16.3, 12, and 12.6 times. Conclusions: Delayed cerebral ischemia and intraventricular hemorrhage on initial head CT scan are strong predictors of intrahospital mortality in ASAH patients. Also, it is important to monitor kidney function and urea levels in ASAH patients, considering that elevated urea values after endovascular aneurysm embolization have been shown to be a significant risk factor for intrahospital mortality.

Prevalence of Carcinogenic Genotypes of HPV-Infected Women in a Ten-Year Period (2014-2023) in Vojvodina, Serbia.

Background and Objectives: Human papillomavirus (HPV) infection and its etiological role in the development of cervical cancer are well established. The cervical cancer mortality rate in Serbia is one of the highest among European countries, and this cancer is the second-leading cause of death in Serbian women aged from 15 to 44. Materials and Methods: This retrospective study was conducted at the Institute of Public Health of Vojvodina. A total of 10,062 cervical specimens from Serbian women were collected and HPV tested in ten years. The study patients were divided into five age groups. HPV genotype testing was performed using a commercial kit to detect 14 high-risk (HR) HPV genotypes. Additionally, cervix cytology data have been available for patients tested in 2022 and 2023. Results: An overall positive rate was found in 43.3% of patients (4356/10,062). A single HPV infection (62.1%) was the main infection pattern. The most frequent HR HPV genotypes were HPV 16, 31, 52, 56, 39, and 51, comprising 62.3% of the detected genotypes, including multiple infections. A significant difference was noted in the HPV prevalence across the different age groups, with a bimodal distribution of HPV infection. The highest prevalence was recorded in the age group ≤ 30 and those after 61 years. Women diagnosed with high-grade squamous intraepithelial lesions (HSIL) were significantly older compared to others. HR HPV is the most prevalent in patients with HSIL cytological findings (76.5%). The most common type, according to age-specific distribution and cytological findings, was HR HPV 16. Conclusions: This study provides comprehensive data on HR HPV distribution among Serbian women, which can serve as a basis for subsequent monitoring of genotypic distribution. It is particularly significant considering they are missing in the updated ICO/IARC Report for Serbia, and the cervical cancer mortality rate in Serbia is one of the highest among European countries.

Molnupiravir's real-world effectiveness in COVID-19 outpatients at high risk of severe disease: a single-center study.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic started in March 2020. Since then, there has been an urgent need for effective therapeutic methods to manage the disease. We aimed to assess the effectiveness of molnupiravir in reducing the need for hospitalization in at-risk, non-hospitalized COVID-19 patients. METHODOLOGY: This was a single-center, non-randomized, observational retrospective study of non-hospitalized patients with confirmed COVID-19, treated at the Clinic for Infectious and Tropical Diseases, University Clinical Center in Belgrade, Serbia. RESULTS: The study was conducted between 15 December 2021 and 15 February 2022 and included 320 patients. Of these, 165 (51.6%) received treatment with molnupiravir. The study and control groups were similar in gender and age distribution. The study group had a higher proportion of vaccination (75.2% vs. 51%, p < 0.001). There was no statistically significant difference in presence of comorbidity within the groups. Majority of the patients who received molnupiravir did not require hospitalization; and this was statistically significant in comparison to control group (92.7 vs. 24.5%, p < 0.001). Oxygen supplementation was less frequently required in the study group compared to the control group (0.6% vs. 31%, p < 0.001). During the follow-up period of 12.12 ± 3.5 days, significantly less patients from the study group were admitted to the intensive care unit (p < 0.001). Molnupiravir significantly reduced the risk of hospitalization by 97.9% (HR 0.021; 95% CI 0.005-0.089; p < 0.001). CONCLUSIONS: Molnupiravir is an effective therapy in preventing the development of severe forms of COVID-19 and hospitalization.

Frequency of C9orf72, GRN, and MAPT pathogenic variants in patients recruited at the Belgrade Memory Center.

Most of the heritability in frontotemporal dementia (FTD) is accounted for by autosomal dominant hexanucleotide expansion in the chromosome 9 open reading frame 72 (C9orf72), pathogenic/likely pathogenic variants in progranulin (GRN), and microtubule-associated protein tau (MAPT) genes. Until now, there has been no systematic analysis of these genes in the Serbian population. Herein, we assessed the frequency of the C9orf72 expansion, pathogenic/likely pathogenic variants in GRN and MAPT in a well-characterized group of 472 subjects (FTD, Alzheimer's disease - AD, mild cognitive impairment - MCI, and unspecified dementia - UnD), recruited in the Memory Center, Neurology Clinic, University Clinical Center of Serbia. The C9orf72 repeat expansion was detected in 6.98% of FTD cases (13.46% familial; 2.6% sporadic). In the UnD subgroup, C9orf72 repeat expansions were detected in 4.08% (8% familial) individuals. Pathogenic variants in the GRN were found in 2.85% of familial FTD cases. Interestingly, no MAPT pathogenic/likely pathogenic variants were detected, suggesting possible geographical specificity. Our findings highlight the importance of wider implementation of genetic testing in neurological and psychiatric practice managing patients with cognitive-behavioral and motor symptoms.

Geographic variation of mutagenic exposures in kidney cancer genomes.

International differences in the incidence of many cancer types indicate the existence of carcinogen exposures that have not yet been identified by conventional epidemiology make a substantial contribution to cancer burden1. In clear cell renal cell carcinoma, obesity, hypertension and tobacco smoking are risk factors, but they do not explain the geographical variation in its incidence2. Underlying causes can be inferred by sequencing the genomes of cancers from populations with different incidence rates and detecting differences in patterns of somatic mutations. Here we sequenced 962 clear cell renal cell carcinomas from 11 countries with varying incidence. The somatic mutation profiles differed between countries. In Romania, Serbia and Thailand, mutational signatures characteristic of aristolochic acid compounds were present in most cases, but these were rare elsewhere. In Japan, a mutational signature of unknown cause was found in more than 70% of cases but in less than 2% elsewhere. A further mutational signature of unknown cause was ubiquitous but exhibited higher mutation loads in countries with higher incidence rates of kidney cancer. Known signatures of tobacco smoking correlated with tobacco consumption, but no signature was associated with obesity or hypertension, suggesting that non-mutagenic mechanisms of action underlie these risk factors. The results of this study indicate the existence of multiple, geographically variable, mutagenic exposures that potentially affect tens of millions of people and illustrate the opportunities for new insights into cancer causation through large-scale global cancer genomics.

High risk of burnout syndrome and associated factors in medical students: A cross-sectional analytical study.

INTRODUCTION: Although research on burnout syndrome in medical students has increased in recent years, results are inconsistent about which factors are associated with a high risk for burnout syndrome. The aim of this study was to assess the prevalence of high risk of burnout syndrome and to identify factors associated with burnout in medical students in preclinical and clinical training. METHOD: A cross-sectional study was conducted at the University of Kragujevac, Serbia. The Maslach Burnout Inventory Student Survey and an epidemiological questionnaire on basic socio-demographic and academic characteristics were used. Statistical evaluation was performed through logistic regression analysis, using Odds Ratio (OR) and 95% Confidence Interval (CI). RESULTS: Among medical students, no statistically significant differences were found in the prevalence of high risk of burnout syndrome in preclinical (14.8%) and clinical grade (15.1%), p > 0.05. High risk for burnout syndrome in preclinical study years was independently associated with the female sex (adjusted OR = 0.41, 95%CI = 0.19-0.91, p = 0.028), and cigarette smoking (adjusted OR = 2.47, 95%CI = 1.05-5.78, p = 0.038). The high risk of burnout syndrome was associated with sedatives use (adjusted OR = 4.03, 95%CI = 1.27-12.73; p = 0.018) only in clinical years medical students. The frequency of alcohol consumption was correlated with the high risk of burnout syndrome in medical students in both preclinical and clinical training, but without statistical significance (both p for trend < 0.1). CONCLUSION: There was a significant prevalence of burnout among medical students, with some modifiable associated factors revealed.