A National Cross-Sectional Study from the Republic of Kosovo on Lot Quality Assurance Sampling (LQAS) to Evaluate the Vaccination Status of Children Between 12 and 24 Months of Age During 2018 to 2020.

BACKGROUND In the Republic of Kosovo, full vaccination status in children under age 2 years includes: 1 dose of Bacillus Calmette-Guerin (BCG) hepatitis B virus (HBV) vaccine; 3 doses of diphtheria, tetanus, pertussis, hepatitis B, polio, and Haemophilus influenzae type b (DTaP-HB-IPV-Hib) vaccine; 3 doses of inactivated polio vaccine (IPV); and 1 dose of measles, mumps, and rubella (MMR) vaccine. Lot quality assurance sampling (LQAS) is a method used to assess the performance of health quality indicators. MATERIAL AND METHODS A national cross-sectional study with children aged between 12 and 24 months from Kosovo was performed between 2018 and 2020. The vaccination status of children was assessed with lot quality assurance sampling (LQAS) using randomized samples. RESULTS Among 430 children, more than 90% had completed the full immunization schedule. Delays in children's immunizations were observed. Most vaccinations showed short delays of less than 1 month, followed by delays of up to 3 months. The main reason for vaccination delay was the COVID-19 pandemic, following by child's illness at the scheduled time of vaccination or the parents were too busy to take the child to the vaccination site. Meanwhile, child age was the only parameter that showed difference among non-vaccinated and fully vaccinated (P<0.001). CONCLUSIONS LQAS analysis showed that between 2018 and 2020 lack of full immunization was due to delay caused by the parent not taking the child to the vaccination site, which may be prevented by improving information given to parents and the use of vaccination reminders.

Exploring instruments used to evaluate potentially inappropriate medication use in hospitalised elderly patients in Kosovo.

OBJECTIVES: A number of instruments are used to identify potentially inappropriate medications (PIMs) in the elderly. In this study we identify PIMs in elderly patients and aim to compare three different instruments used to assess PIMs. METHODS: In this prospective cohort study, we compared medications of elderly patients against three commonly used instruments: Beers' list, PRISCUS and STOPP/START, at the point of hospital admission and discharge in the nephrology clinic of Kosovo's largest hospital. Readmission risk was evaluated using the LACE Index and correlations with the number of PIMs and PIMs criteria were analysed. RESULTS: Of 184 patients admitted to the nephrology clinic, 84 met study inclusion criteria. Patients had a median of three drugs at admission and four at discharge. Hospital readmission risk was high with median LACE Index being 11 (63% of patients). A higher number of PIMs was associated at the point of discharge compared with admission for all three tools (Beers' list: 29% vs 38 %, P=0.04; STOPP/STRART: 20% vs 23%, P<0.001; PRISCUS list: 12% vs 21%, P<0.001). The number of drugs at admission predicted the number of PIMs at discharge only when using Beers' criteria (P=0.006). At discharge, each increase in medication was associated with an increase in PIMs based on Beers' [0.134; (P=0.007)] and STOPP/START criteria [0.130; (P=0.005)]. Nitrofurantoin was the main PIM identified with Beers' and PRISCUS list in comparison to proton- pump-inhibitors being the most prevalent agents identified with STOPP/START criteria. CONCLUSIONS: There are differences when using Beers' criteria, STOPP/START criteria and PRISCUS list during identification of PIMs in elderly patients with high readmission risk. These differences should be considered when identifying PIMs in hospital settings.

Infections from temporary catheters in hemodialysis patients in Kosovo.

The objective of this study is to evaluate the frequency of infections from central venous temporary catheters and the type of a microorganism caused, from January 2017 up to December 2019. This study was performed on patients who were on hemodialysis (HD) through the central temporary venous catheter, right and left femoral vein, right jugular vein, and right subclavian vein.The patients in the HD center in Pristina, Kosovo, were used as a clinical sample. In this study, 1902 patients with temporarily central venous catheters (CVCs) were involved, while the control group consisted of 642 patients. Both groups were matched for age and gender. In all patients and the subjects of the control group, following data were obtained: Anamnesis, medical examination, as well as biochemical and hematological laboratory tests, CVC swab and antibiogram and hemoculture. Data analysis was performed using the descriptive statistical methods and the Chi-square test comparing the laboratory results of a HD patients treated through the central temporary venous catheter. Based on the results of this research, higher incidence of infections occurred with femoral vein access, compared to other CVCs accesses. The most common microorganisms responsible were Staphylococus epidermidis, while the 2019 had the highest incidence of infection.

Phylogenetic analysis confirms hepatitis C virus transmission among hemodialysis patients in Kosovo.

INTRODUCTION: It has recently been demonstrated that there is a very high prevalence of hepatitis C virus (HCV) infection among hemodialysis patients in Kosovo with HCV subtype 1 being the most prevalent subtype. In this study, we further detail the molecular epidemiology of HCV outbreaks occurring in seven dialysis centers in Kosovo. METHODOLOGY: In total, 273 samples obtained from HCV RNA positive patients undergoing hemodialysis at one of the seven centers in Kosovo were selected for this study: 171 subtype 1a samples, 91 subtype 4d samples, and 11 subtype 1b samples. A partial HCV NS5B region was amplified and sequenced. Subtype-specific phylogenetic analyses were performed with the inclusion of control sequences and transmission clusters were identified. RESULTS: NS5B sequences were successfully obtained in 257/273 (94.1%) of samples; 162 subtype 1a, 84 subtype 4d, and 11 subtype 1b sequences. Phylogenetic analyses showed a high degree of phylogenetic clustering of HCV sequences subtyped 1a (99.4%), 1b (63.6%), and 4d (76.2%). Distinct phylogenetic clusters of sequences obtained from hemodialysis patients were observed for all three subtypes studied. In addition, several smaller clusters within the large clusters were identified, mainly from a single dialysis center. CONCLUSIONS: Phylogenetic analyses confirmed nosocomial transmission during dialysis as a major factor in the spread of HCV at the seven dialysis centers in Kosovo.

A very high prevalence of hepatitis C virus infection among patients undergoing hemodialysis in Kosovo: a nationwide study.

BACKGROUND: Patients on hemodialysis are at high risk for hepatitis C virus (HCV) infection if measures for effective control of HCV infection in the hemodialysis environment are not implemented. Whereas in developed countries isolated small-scale outbreaks of HCV in hemodialysis units are occasionally reported, HCV transmission in the hemodialysis environment still represents a substantial problem in low-resource countries. This study systematically assessed the prevalence of HCV infection among all patients at all hemodialysis centers in Kosovo, determined the HCV genotype distribution, and reviewed the main risk factors associated with HCV infection in this group of patients. METHODS: From January to March 2013, blood samples from all patients undergoing hemodialysis at all seven hemodialysis centers in Kosovo were collected. The samples were screened for the presence of anti-HCV antibodies, and seropositive samples were also tested for HCV RNA. Genotyping was performed by sequencing the core region of the HCV genome. Subsequently, face-to-face interviews were conducted with consented patients attending hemodialysis in December 2015 and with the management of all hemodialysis centers in Kosovo. RESULTS: The overall seroprevalence of HCV infection among hemodialysis patients in Kosovo was 53.0% (354/668), ranging from 22.3 to 91.1% at different centers. HCV RNA was detected in 323/354 (91.2%) seropositive patients. The most frequent HCV genotype was genotype 1a (62.2%), followed by genotypes 4d (33.1%), 1b (4.0%), and 2c (0.7%). The duration of hemodialysis and receiving dialysis at more than one center were identified as independent significant predictors of anti-HCV positivity. Shortage of staff, lack of resources, and inconsistent use of hygienic precautions and/or isolation strategies were observed. CONCLUSIONS: The prevalence of HCV infection among hemodialysis patients in Kosovo is extremely high. The relatively low prevalence of HCV infection in the general population, predominance of two otherwise rare HCV genotypes among hemodialysis patients, and longer history of hemodialysis as a predictor of HCV infection all indicate nosocomial transmission due to inappropriate infection control practices as the main transmission route.

Left and right ventricular diastolic function in hemodialysis patients.

The aim of this prospective study was the assessment of left ventricular and right ventricular diastolic function in patients on hemodialysis (HD) and the correlation of this function with the duration of HD. The study included 42 patients (22 females and 20 males) with chronic renal failure (CRF), treated with HD, and 40 healthy subjects (24 females and 16 males) with no history of cardiovascular disease and with normal renal function, who constituted the control group. The groups were matched for age and sex. All study patients and control subjects underwent detailed history taking and physical examination. They also underwent electrocardiogram, echocardiography and biochemical and hematological blood analyses. Significant differences were noted between the two groups in the two-dimensional and M-mode echocardiography findings concerning aortic root dimension, transverse diameter of the left atrium, thickness of the interventricular septum, thickness of the left ventricular posterior wall, left ventricular diastolic diameter, left ventricular systolic diameter, shortening fraction, ejection fraction as well as findings from the pulse Doppler study, including E wave, A wave, E/A ratio, deceleration time of E wave (DT-E), acceleration time of E wave (AT-E), tricuspid E and A waves (E tr and A tr ) and E tr /A tr , ratio. There were significant changes in HD patients without arterial hypertension as well in the control group subjects. Our study suggests that the left ventricular and left atrial dimensions as well as the left ventricular wall thickness are augmented in patients with CRF treated with HD compared with the control group. Additionally, the left and right ventricular diastolic function is also reduced in these patients. These differences were also noted in patients with CRF without arterial hypertension. Left ventricular diastolic dysfunction had no correlation with the duration of HD.

Hemorrhagic fever with acute renal failure: a report from Kosova.

Acute renal failure (ARF) is a well-known complication of hemorrhagic fever (HF). We studied patients with HF and ARF who were treated in our department for two years between March 2005 and the end of December 2006. The age of the patients ranged from 17 to 71 years. The incidence of complications in the study patients was acceptable and similar to that reported in the literature of Balkan region. Our study shows that the efficacy of the overall results in the treatment of these patients in our center is comparable to the published data in the country from the Balkan region.