Cases of Crimean-Congo haemorrhagic fever in North Macedonia, July to August 2023.

The last report of Crimean-Congo haemorrhagic fever (CCHF) in North Macedonia was more than 50 years ago in the northwest. We report on a fatal CCHF case following a Hyalomma tick bite in the east of the country in July 2023. Tracing of 67 contacts identified CCHF in one healthcare worker (HCW) providing care for the patient. Monitoring of contacts is concluded (including further 11 HCW contacts), thus far 28 days after the death of the case no additional cases were identified.

No social distancing from food: How the COVID-19 pandemic shaped student food-related activities in the Western Balkans.

BACKGROUND: The COVID-19 pandemic has influenced food preparation and consumption habits, as well as food wastage. The pandemic also affected the lives of university students worldwide; their learning and living environments changed, influencing their eating habits. AIM: The purpose of this study was to evaluate the repercussions of the COVID-19 pandemic on students' food-related activities in four countries in the Western Balkans: Bosnia and Herzegovina, Serbia, North Macedonia, and Montenegro. METHODS: The research draws upon an online survey gathered through the SurveyMonkey platform in four Balkan countries-viz. Bosnia and Herzegovina, Serbia, North Macedonia, and Montenegro-and used a structured questionnaire. The information was collected during the second wave of COVID-19 in October-November 2020. A total of 1658 valid responses were received. Descriptive statistics and nonparametric tests were used to analyze the survey findings. RESULTS: The research results suggest that the pandemic influenced students' food purchase habits, diets, and food-related behaviors and practices such as food preparation, cooking, and food waste management at the household level. In particular, students have been eating healthier and shopping less frequently during the pandemic. Meanwhile, the pandemic improved their attitude toward food wastage. CONCLUSION: This study is the first to examine how students in the Balkan region perceive the impact of the COVID-19 pandemic on their eating habits, laying the groundwork for future studies into the disease's consequences. This and other studies will assist in preparing students and education institutions for future calamities and pandemics. The findings will also help develop evidence-based postpandemic recovery options targeting youth and students in the Western Balkans.

Accumulation and distribution of heavy metals in soil and food crops in the Pb-Zn mine environ. Case study: Region of Probistip, North Macedonia.

The aim of the study was to investigate the exploration and distribution of various chemical elements in soils and vegetables from gardens in the region of Probistip, North Macedonia. This region was exposed to heavy metals pollution from Pb-Zn mining and flotation tailings landfill near the town of Probistip for 70 years. A total of 38 samples of various crops and vegetable products from 19 gardens were analyzed. The analyzes were carried out by ICP-AES (Al, Ba, Ca, Cr, Cu, Fe, K, Li, Mg, Mn, Na, Ni, P, Pb, Sr, V, and Zn) and by ICP-MS (As, Cd, Co, Cr, and Pb). It was found that the content of some potentially toxic elements (As, Cd, Cu, Pb, and Zn) in the soil samples from the gardens, exceeded the target values. From these results, it is clear that the contamination of the soils in this area is due to mining activities and the distribution of flotation wastes from the nearby flotation dump. It was also found that the contaminated soils lead to elevated levels of these elements in some vegetables from the gardens, especially those near the Zletovska River and the flotation waste landfill, exceeding the nationally permissible food content.

Regional air quality study by assessing trace metal atmospheric deposition.

This study addresses the atmospheric deposition of trace elements investigated in Albania, Croatia and Macedonia in 2010 as part of the European Moss Study. This study provides data on the concentration of ten metals (Cd, Cr, Cu, Ni, Pb, V, Zn, Fe, Al, and Li) in naturally growing mosses. In general, all concentration data follow a lognormal distribution. Cd, Cr, Ni, and Zn show strong fluctuations in the moss samples from Albania and Macedonia, and Pb, Fe, and Al in the mosses from Croatia. The concentrations of Cd, Cu, and Zn were higher in the samples from Croatia than in those from Albania and Macedonia; the concentrations of Cr, Ni, V, Fe, Al, and Li were higher in the samples from Albania than in those from Croatia and Macedonia; and a higher concentration of Pb was found in the samples from Macedonia. The observed relationship between the concentration of lithogenic elements (Al, Fe, and V) and the air quality index (AQI) confirms that moss species have a high capacity to retain atmospheric deposition particles. The anthropogenic emission sources of these elements from local and long-range transport were considered to be the most important factors affecting air quality in the studied areas.

Mediterranean spotted fever-like illness caused by Rickettsia sibirica mongolitimonae, North Macedonia, June 2022.

Mediterranean spotted fever-like illness (MSF-like illness) is a tick-borne disease caused by Rickettsia sibirica mongolitimonae first reported in France more than 25 years ago. Until today, more than 50 cases of MSF-like illness have been reported in different regions of Europe and Africa, highlighting variable clinical manifestation. Here we report a case of MSF-like illness following a bite from a Hyalomma tick in the Skopje region of North Macedonia.

Moss biomonitoring of air pollution with potentially toxic elements in the Kumanovo Region, North Macedonia.

A study was carried out to investigate air deposition and to explore the natural distribution and contamination with potentially toxic elements (PTEs) in the Kumanovo Region, North Macedonia, by using moss samples as biomonitors for air pollution. The distribution of 51 elements was detected in 42 moss samples collected from this area. Moss samples were analyzed following microwave digestion by inductively coupled plasma-atomic emission spectrometry (ICP-AES) and inductively coupled plasma-mass spectrometry (ICP-MS). It was found that the atmospheric deposition for some PTEs in the moss samples in specific parts of the study area is influenced by anthropogenic and urban activities. R-mode factor analysis was used to identify and characterize element associations, and six associations of elements were determined. Four factors were separated from the group of macroelements determined by ICP-AES: Factor 1 (Al, Cr, Fe, Li, Ni, V, and Zn), F2 (K, Mg, and P), F3 (Ba and Sr), and F4 (Cd, Pb, and Zn); and two associations were separated from the group of trace elements determined by ICP-MS: Factor 1 (As, Co, Cs, Ga, Ge, Sc, Ti, Y, Zr, and rare earth elements-REEs) and Factor 2 (Bi, Br, Hg, I, Sb, Sn, and W).

Surveillance Metrics of SARS-CoV-2 Transmission in Central Asia: Longitudinal Trend Analysis.

BACKGROUND: SARS-CoV-2, the virus that caused the global COVID-19 pandemic, has severely impacted Central Asia; in spring 2020, high numbers of cases and deaths were reported in this region. The second wave of the COVID-19 pandemic is currently breaching the borders of Central Asia. Public health surveillance is necessary to inform policy and guide leaders; however, existing surveillance explains past transmissions while obscuring shifts in the pandemic, increases in infection rates, and the persistence of the transmission of COVID-19. OBJECTIVE: The goal of this study is to provide enhanced surveillance metrics for SARS-CoV-2 transmission that account for weekly shifts in the pandemic, including speed, acceleration, jerk, and persistence, to better understand the risk of explosive growth in each country and which countries are managing the pandemic successfully. METHODS: Using a longitudinal trend analysis study design, we extracted 60 days of COVID-19-related data from public health registries. We used an empirical difference equation to measure the daily number of cases in the Central Asia region as a function of the prior number of cases, level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. RESULTS: COVID-19 transmission rates were tracked for the weeks of September 30 to October 6 and October 7-13, 2020, in Central Asia. The region averaged 11,730 new cases per day for the first week and 14,514 for the second week. Infection rates increased across the region from 4.74 per 100,000 persons to 5.66. Russia and Turkey had the highest 7-day moving averages in the region, with 9836 and 1469, respectively, for the week of October 6 and 12,501 and 1603, respectively, for the week of October 13. Russia has the fourth highest speed in the region and continues to have positive acceleration, driving the negative trend for the entire region as the largest country by population. Armenia is experiencing explosive growth of COVID-19; its infection rate of 13.73 for the week of October 6 quickly jumped to 25.19, the highest in the region, the following week. The region overall is experiencing increases in its 7-day moving average of new cases, infection, rate, and speed, with continued positive acceleration and no sign of a reversal in sight. CONCLUSIONS: The rapidly evolving COVID-19 pandemic requires novel dynamic surveillance metrics in addition to static metrics to effectively analyze the pandemic trajectory and control spread. Policy makers need to know the magnitude of transmission rates, how quickly they are accelerating, and how previous cases are impacting current caseload due to a lag effect. These metrics applied to Central Asia suggest that the region is trending negatively, primarily due to minimal restrictions in Russia.

Schoolchildren thyroid volume in North Macedonia: data from a national survey in an iodine-sufficient country.

PURPOSE: North Macedonia is historically iodine deficient, but due to the longstanding and effective preventive measures, it has been considered iodine replete since 2003. The aim of the recent national survey was to re-evaluate iodine status and to measure thyroid volume (TVol) by ultrasound in schoolchildren as a representative of the general population. METHODS: A stratified probability proportionate to size cluster sampling was used to obtain a representative national sample of school children aged 7-10 years between the 28th of March and 4th of October 2016. Thyroid volume (TVol) was measured using ultrasonography in 1188 children. All TVol measurements were done by a single operator and their medians were compared with an international reference standard. RESULTS: Significant positive correlation was found between Tvol and age, height, weight, body surface area (BSA), body mass index (BMI) in both girls and boys (p < 0.001), but not between TVol and urinary ioidine concentration (UIC). The most important predictors for Tvol in all children were age, height, weight, BMI, and BSA ( all p < 0.001). In multivariate regression, independent predictors for TVol were only BSA (p < 0.001) and age (p = 0.004) after being adjusted for sex, BMI, and UIC (R2 = 0.291). The 97th percentile of Tvol in our survey was generally higher than in the reference study and goiter prevalence of 18.3% in boys and 15.6% in girls was found compared to the international standard. CONCLUSION: In our survey, Tvol of schoolchildren was larger than in the international reference study, although iodine nutritional status of the country has been considered sufficient for many years. In countries and regions with long and effective, well-documented iodine prophylaxis, the optimal way to have realistic normative TVol would be to create their TVol reference limits. Therefore, the provided data for TVol measured in our survey could be proposed as the national reference TVol for schoolchildren aged 7-10 years.

Study of nitrogen pollution in the Republic of North Macedonia by moss biomonitoring and Kjeldahl method.

In the summer of 2005 and 2010, moss samples were collected from 72 sampling sites evenly distributed all over the territory of Republic of North Macedonia. Kjeldahl method was used to determine the nitrogen content in the samples. Descriptive statistics and distribution maps were prepared. Data obtained from these two surveys were compared, and additional comparison was done with data obtained from similar studies in the South-Eastern European countries and Finland as a clean area. The median value of N content in the samples collected in 2005 is 1.21%, varies from 0.70% to 1.54%, while the content of N in samples collected in 2010 ranges between 0.68% and 1.75% with the median value of 1.06%. High contents of N were found in the Northern and Central parts of the country mainly as a result of agricultural activities, industry and traffic.

Dangerous sadness: nervoza among first and second generation Macedonian immigrants to Australia.

OBJECTIVE: Nervoza is a commonly-used illness category among Macedonian Australians. Although nervoza belongs broadly to the category of 'nerve illnesses' little is known of its meaning among Macedonian immigrants, and whether there is intergenerational attrition in its meaning and use. We aimed to explore how nervoza and its treatment are perceived by members of the Macedonian community in Australia. DESIGN: In-depth interviews in Macedonian with 18 participants from the Macedonian community in Melbourne, Australia. RESULTS: Nervoza is a layered concept relating shame, emotional experience and nerves, used as an idiom of distress and sadness in the presence of acute and chronic stressors. Nervoza develops in both the social world (through poverty, grief or the loss of war), and in the psyche of distressed and isolated people. It is viewed as dangerous on many levels: to physical health, as a 'gateway condition' to long-term psychological illnesses such as depression and schizophrenia, and to the person's social well-being. The normalised treatment for nervoza in Macedonia - benzodiazepines - is the subject of significant medical control in Australia. CONCLUSION: For sufferers of nervoza, the social self is both medicalized and stigmatised. Health services in Australia are often considered marginal in the management of nervoza. Second generation Macedonians viewed the concept as unhelpful, and possibly increasing the stigmatisation of mental illnesses. The lack of knowledge about, and underutilisation of, mental health services and support groups in the Macedonian Australian community should be the focus of community-based inter-generational health literacy initiatives.

Geochemical characteristics of soil of the city of Skopje, Republic of Macedonia.

This study represents the first systematic investigation of the spatial distribution of different chemical elements in the soil of the city of Skopje, Republic of Macedonia. For this purpose, surface soil samples from 234 locations were analyzed to determine the content of 20 major and trace elements (Ag, Al, As, Ba, Ca, Cd, Cr, Cu, Fe, K, Li, Mg, Mn, Na, Ni, P, Pb, Sr, V and Zn) to assess the size of the areas eventually affected by heavy metal pollution. All samples were analyzed by atomic emission spectroscopy with inductively coupled plasma (ICP-AES). Cluster and factor analysis (R-mode) were applied in order to show the associations of chemical elements. Four factors were obtained: Factor 1 (K, Na, Ba and Al), Factor 2 (Cr, Ni, Mg and Fe), Factor 3 (Zn, Cd and Cu) and Factor 4 (Sr and Ca). It was established that the distribution of the associations of F1, F2 and F4 are mostly as a result of the complex geology and lithology of the region while the association of F3 represents an anthropogenic association.

Spatial distribution and pollution assessment of heavy metals in soil from the Republic of North Macedonia.

The purpose of the study was to determine the spatial distribution and pollution assessment of 39 chemical elements in soil from the Republic of North Macedonia. From the whole territory of the country top soil samples (0-30 cm) were collected from 995 locations with a grid of 5 × 5 km distance between the sampling locations. Two analytical techniques were used for the analysis of soil samples: inductively coupled plasma-atomic emission spectrometry and inductively coupled plasma-mass spectrometry. Based on a comparison of statistical parameters, spatial distribution of particular elements and results of cluster and factor analysis, four mаin geochemical associations were identified: (1) association connected with the Neogene and Quaternary volcanism (Ba, Be, Ce, Hf, K, La, Rb, Th, Tl, U and Zr); (2) association of siderophile elements (Co, Cu, Fe, Mn, Sc, Ti and V); (3) association connected with ophiolites and Mesozoic ultrabasic magmatic rocks of Vardar zone (Cr and Ni) and (4) chalcophile (sulphide) elements (As, Bi, Cd, Pb, Sb, Sn and Zn). The regional distribution was prepared according to the eight statistical regions in Macedonia, distribution according to 15 most common geological formation and distribution according to 13 pedological units.

The lameness of King Philip II and Royal Tomb I at Vergina, Macedonia.

King Philip II was the father of Alexander the Great. He suffered a notorious penetrating wound by a lance through his leg that was nearly fatal and left him lame in 339 B.C.E. (i.e., 3 y before his assassination in 336 B.C.E.). In 1977 and 1978 two male skeletons were excavated in the Royal Tombs II and I of Vergina, Greece, respectively. Tomb I also contained another adult (likely a female) and a newborn skeleton. The current view is that Philip II was buried in Tomb II. However, the male skeleton of Tomb II bears no lesions to his legs that would indicate lameness. We investigated the skeletal material of Tomb I with modern forensic techniques. The male individual in Tomb I displays a conspicuous case of knee ankylosis that is conclusive evidence of lameness. Right through the overgrowth of the knee, there is a hole. There are no obvious signs that are characteristic of infection and osteomyelitis. This evidence indicates that the injury was likely caused by a severe penetrating wound to the knee, which resulted in an active inflammatory process that stopped years before death. Standard anthropological age-estimation techniques based on dry bone, epiphyseal lines, and tooth analysis gave very wide age ranges for the male, centered around 45 y. The female would be around 18-y-old and the infant would be a newborn. It is concluded that King Philip II, his wife Cleopatra, and their newborn child are the occupants of Tomb I.

Geochemical properties of topsoil around the coal mine and thermoelectric power plant.

The results of the systematic study of the spatial distribution of trace metals in surface soil over the Bitola region, Republic of Macedonia, known for its coal mine and thermo-electrical power plant activities are reported. The investigated region (3200 km2) is covered by a sparse sampling grid of 5 × 5 km, but in the urban zone and around the thermoelectric power plant the sampling grid is denser (1 × 1 km). In total, 229 soil samples from 149 locations were collected including top-soil (0-5 cm) and bottom-soil samples (20-30 cm and 0-30 cm). Inductively coupled plasma - atomic emission spectrometry (ICP-AES) was applied for the determinations of 21 elements (Al, As, B, Ba, Ca, Cd, Co, Cr, Cu, Fe, K, Li, Mg, Mn, Na, Ni, P, Pb, Sr, V and Zn). Based on the results of factor analyses, three geogenic associations of elements have been defined: F1 (Fe, Ni, V, Co, Cr, Mn and Li), F2 (Zn, B, Cu, Cd, Na and K) and F3 (Ca, Sr, Mg, Ba and Al). Even typical trace metals such as As, Cd, Cu, Ni, P, Pb and Zn are not isolated into anthropogenic geochemical associations by multivariate statistical methods still show some trends of local anthropogenic enrichment. The distribution maps for each analyzed element is showing the higher content of these elements in soil samples collected around the thermoelectric power plants than their average content for the soil samples collected from the whole Bitola Region. It was found that this enrichment is a result of the pollution by fly ash from coal burning which deposited near the plant having a high content of these elements.

Distribution of trace elements in sediment and soil from river Vardar Basin, Macedonia/Greece.

A systematic study was carried out to investigate the distribution of 59 elements in the sediment and soil samples collected from the river Vardar (Republic of Macedonia and Greece) and its major tributaries. The samples were collected from 28 sampling sites. Analyses were performed by inductively coupled plasma-mass spectrometry. R-mode factor analysis (FA) was used to identify and characterise element associations. Seven associations of elements were determined by the method of multivariate statistics. Every factor (Factors 1-3 and 6 and 7 as geogenic and Factors 4 and 5 as anthropogenic associations of elements) are examined and explained separately. The distribution of various elements showed that there is a presence of anthropogenic elements (Ag, Cd, Cu, Ge, Pb, Sn and Zn) introduced in the river sediments and soils from the mining, metallurgical, industrial and agricultural activities in Vardar River Basin, which covers most of the Republic of Macedonia and Central-northern part of Greece.

Classification of non-Hodgkin lymphoma in South-eastern Europe: review of 632 cases from the international non-Hodgkin lymphoma classification project.

The distribution of non-Hodgkin lymphoma (NHL) subtypes varies around the world, but a systematic study of South-eastern Europe (SEEU) has never been done. Therefore, we evaluated the relative frequencies of NHL subtypes in three SEEU countries--Croatia, Romania and Macedonia. Five expert haematopathologists reviewed 632 consecutive cases of newly diagnosed NHL from the three SEEU countries using the World Health Organization classification. The results were compared to 399 cases from North America (NA) and 580 cases from Western Europe (WEU). The proportions of B- and T-cell NHL and the sex distribution in SEEU were similar to WEU and NA. However, the median ages of patients with low- and high-grade B-NHL in SEEU (60 and 59 years, respectively) were significantly lower than in NA (64 and 68 years, respectively; P < 0·05). SEEU had a significantly lower proportion of low-grade B-NHL (46·6%) and higher proportion of high-grade B-NHL (44·5%) compared to both WEU (54·5% and 36·4%, respectively) and NA (56·1% and 34·3%, respectively). There were no significant differences in the relative frequencies of T-NHL subtypes. This study provides new insights into differences in the relative frequencies of NHL subtypes in different geographic regions. Epidemiological studies are needed to better characterize and explain these differences.

Molecular Characterization of Glucose-6-phosphate Dehydrogenase Deficiency in Families from the Republic of Macedonia and Genotype-phenotype Correlation.

INTRODUCTION: Glucose-6-phospahte dehydrogenase deficiency (G6PD) is one of the most common inherited disorders affecting around 400 million people worldwide. Molecular analysis of the G6PD gene identified more than 140 distinct mutations, the majority being single base missense mutations. G6PD Mediterranean is the most common variant found in populations of the Mediterranean area. AIM: The aim of our study was to perform molecular characterization of G6PD deficiency in families from the Republic of Macedonia and correlate the findings to disease phenotype. PATIENTS AND METHODS: Six patients and seven other family members were selected for genetic characterization, the selection procedure involved clinical evaluation and G6PD quantitative testing. All patients were first screened for the Mediterranean mutation, and subsequently for the Seattle mutation. Mutations were detected using PCR amplification and appropriate restriction endonuclease cleavage. RESULTS: Four hemizygote and 3 heterozygous carriers for G6PD Mediterranean were detected. All G6PD deficient patients from this group showed clinical picture of hemolysis, and in 66.6% neonatal jaundice was confirmed based on history data. To our knowledge, this is the first study concerned with molecular aspects of the G6PD deficiency in R. Macedonia. CONCLUSION: This study represents a step towards a more comprehensive genetic evaluation in our population and better understanding of the health issues involved.

First records of Dirofilaria repens in wild canids from the region of Central Balkan.

Dirofilaria repens causes an emerging zoonotic disease in Europe, particularly in its southern part, the Mediterranean region. Many reports on human dirofilariosis have been published recently, but little is known about the wildlife hosts and reservoirs of this parasite in nature. This paper presents the first records of adult D. repens specimens from free-ranging carnivores in Central Balkan countries (Serbia and Macedonia). During the period 2009-2013, a total of 145 regularly shot canids were examined for the presence of D. repens adults. In order to investigate their role as hosts and potential wild reservoirs of this zoonosis, 71 wolves (Canis lupus), 48 foxes (Vulpes vulpes) and 26 jackals (Canis aureus) were examined. Under the skin of two wolves (one from Serbia and one from Macedonia) and of a red fox from Serbia D. repens adults were found. In all three cases only one parasite was present. Further research on wild canids is needed, particularly on species widening their range (such as jackals) and those living near human settlements (foxes and jackals), which facilitates the transmission of the parasites to dogs and humans.

Distribution of the most Common Genetic Variants Associated with a Variable Drug Response in the Population of the Republic of Macedonia.

Genetic variation in the regulation, expression and activity of genes coding for Phase I, Phase II drug metabolizing enzymes (DMEs) and drug targets, can be defining factors for the variability in both the effectiveness and occurrence of drug therapy side effects. Information regarding the geographic structure and multi-ethnic distribution of clinically relevant genetic variations is becoming increasingly useful for improving drug therapy and explaining inter-individual and inter-ethnic differences in drug response. This study summarizes our current knowledge about the frequency distribution of the most common allelic variants in three broad gene categories: the Phase I oxidation-cytochrome P450 (CYP450) family (CYP2C9, CYP2C19, CYP3A5, CYP2D6); the Phase II conjugation (GSTT1, SULT1A1; UGT1A1) and drug target (TYMS-TSER, MTHFR and VKORC1) in the population of the Republic of Macedonia and compares the information obtained with data published for other indigenous European populations. Our findings define the population of the Republic of Macedonia as an ethnic group with a highly polymorphic genetic profile. These results add to the evidence regarding the distribution of clinically important variant alleles in DME and drug target genes in populations of European ancestry.

How older adults experience the age-friendliness of Skopje: Results of the validation of the AFCCQ for use in North Macedonia and a representative survey.

Hundreds of cities and communities in the world have joined the WHO's Global Network for Age-Friendly Cities and Communities since 2010. In order to do quantitative assessments of the age-friendliness of cities, the Age-Friendly Cities and Communities Questionnaire (AFCCQ) was developed for the Dutch municipality of The Hague. The purpose of this study was first to translate and test the validity and reliability of the AFCCQ for use in North Macedonia and second to explore perceptions on age-friendliness of the bicultural and bilingual City of Skopje. The AFCCQ proved valid for use in North Macedonia. Overall, older adults in Skopje experience the age-friendliness of the city as neutral (in seven out of nine domains). The best score ("slightly satisfied") was found in the domain of Housing domain, which was rated positive in all ten municipalities. The lowest total score ("slightly dissatisfied") was found in the domain of Outdoor spaces and buildings scoring, which received negative scores in eight out ten municipalities. In five out of nine domains differences were observed between the Albanian and Macedonian communities. The Albanian sample has slightly higher scores in two domains: 1) Housing and 2) Civic Participation and Employment, while the Macedonian sample scored higher in three domains: 1) Communication and Information; 2) Outdoor Spaces and Buildings and 3) Transportation. A hierarchical cluster analysis further revealed the presence of six distinct age-friendly typologies that can be used for a better understanding of subpopulations in the city and draft policies and action programs on the city level.