Trend of breast cancer mortality in Montenegro, 1990-2018 - Joinpoint regression.

OBJECTIVE: In this study, we analyzed breast cancer mortality data overall and by age groups in women in Montenegro, to determine if there were any changes in trend for period 1990-2018. MATERIALS AND METHODS: The study gathered data on breast cancer mortality in Montenegro obtained from Vital Registration System. Annual data on breast cancer mortality were extracted for period 1990-2018 and analyzed using World Standard Population age-standardized and age-specific rates and Joinpoint regression. RESULTS: In 2018 in Montenegro, breast cancer accounted for 4.64% of all deaths in women and for 19.78% of all cancer deaths in women. In terms of total cancer mortality, it ranked first among women. Age-standardized rates ranged from 11.41/100,000 in 1990 to 20.46/100,000 in 2016. Joinpoint regression showed no one joinpoint for the entire population of all women and age groups. In the observed period, breast cancer mortality rates significantly increased in the women in Montenegro [average annual percentage change (AAPC) = 1.44%; 95% confidence interval (CI): 0.9-2.0]. The most affected age group was 55-64 years. CONCLUSIONS: There is a growing breast cancer mortality trend in Montenegro. It is necessary to create specific programs for urgent action, in order to reduce this undesirable trend. At the same time, support from the competent institutions is needed for increasing screening coverage and better prevention of breast cancer in the target population.

Massive outbreak of viral gastroenteritis associated with consumption of municipal drinking water in a European capital city.

On 24 August 2008, an outbreak alert regarding cases of acute gastroenteritis in Podgorica triggered investigations to guide control measures. From 23 August to 7 September, 1699 cases were reported in Podgorica (population 136 000) and we estimated the total size of the outbreak to be 10 000-15 000 corresponding to an attack rate of approximately 10%. We conducted an age- and neighbourhood-matched case-control study, microbiologically analysed faecal and municipal water samples and assessed the water distribution system. All cases (83/83) and 90% (80/90) [corrected] of controls drank unboiled chlorinated municipal water [matched odds ratio (mOR) 11.2, 95% confidence interval (CI), 1.6-infinity]. Consumption of bottled water was inversely associated with illness (mOR 0.3, 95% CI 0.1-0.8). Analyses of faecal samples identified six norovirus genotypes (21/38 samples) and occasionally other viruses. Multiple defects in the water distribution system were noted. These results suggest that the outbreak was caused by faecally contaminated municipal water. It is unusual to have such a large outbreak in a European city especially when the municipal water supply is chlorinated. Therefore, it is important to establish effective multiple-barrier water-treatment systems whenever possible, but even with an established chlorinated supply, sustained vigilance is central to public health.

[Surgical perspectives in treatment of bleeding peptic ulcers].

Peptic ulcer bleeding has overall incidence of 50 to 150 on 100.000 grown-ups per year and represents cause for over 1% of all urgent hospitalization today. Despite of the evolution of the endoscopic diagnostics and haemostasis, improved intensive care and surgical treatment, overall mortality is still over 10% (operative treatment over 20%), and it almost hasn't changed over past 40 years. For more than 100 years surgery had major role in treatment of peptic bleeding ulcers, whereas nowadays it is limited to treatment of its complications. Adequate surgical treatment demands properly timed operation, safest but appropriate operation and trained surgeon. Early surgery is much better compared to the last minute surgery. At high risk rebleeding ulcer, early delayed surgery appears to be adequate, since the complications and lethal outcome are more frequent in this group.

The epizootiological occurrence of bluetongue in the central Balkans.

In the last five years, bluetongue has been diagnosed in the following areas of the Mediterranean Basin: Algeria, France, Greece, Italy, Spain, Tunisia and Turkey. In the Balkan Peninsula, the disease has been recorded in Bulgaria (since 1999), Macedonia, Serbia and Montenegro, Croatia, Bosnia and Herzegovina and Albania. Bluetongue arrived in the Balkans from Turkey in 1999. In Serbia and Montenegro, the disease was first diagnosed in July 2001 in the Zubin Potok region of Kosovo. In August, the neighbouring regions of Novi Pazar, Tutin, Rozaje and Leposavic were also affected. The disease was simultaneously observed in eastern Serbia in the regions bordering Bulgaria (city regions of Bosilegrad, Pirot and Knjazevac). The occurrence of the disease and clinical signs indicate that the disease was also present in western Serbia in 2001. During 2002, more extensive serological investigations of animals in some regions of Yugoslavia indicated that the disease had spread towards the north of the country. At the same time, serological evidence also revealed the presence of the disease in the east of Bosnia and Herzegovina. The epizootiological data show that the northernmost point of disease spread in Serbia was the River Sava.