Rising incidence of thyroid cancer in Serbia.

BACKGROUND: In the past decade, the incidence of thyroid cancer (TC) has shown a stable increase, for both sexes, in many parts of the world at a rate faster than for any other type of malignancy. The aim of our study was to analyze and report changes in TC incidence in Serbia, as well as to evaluate potential reasons for these changes. So far, the incidence of TC in Serbia has not been reported. MATERIAL AND METHODS: This is a retrospective descriptive epidemiological study of TC data from the Cancer Register for Serbia for a ten year period, from 1999 to 2008. Crude rates (CR), age-specific rates (ASR), age-adjusted rates (AAR), linear trends and average annual percentage changes (AAPC) were calculated and analyzed. RESULTS: TC incidence increased substantially for both genders with the highest increase in 2007 for the age group 50-59 (females 14.2, males 10.3). TC was three times more common in females (CR 4.7:1.5). The AAR for females ranged 1.9-4.8 (3.3, 95% CI 2.6-4.0), for males 1.0-2.6 (1.0, 95% CI 0.8-1.2) and for both sexes combined 1.4-3.2 (2.2, 95% CI 1.7-2.6). The incidence trend for males showed an increase (y =0.05x + 0.70, p =0.058). It was highly statistically significant for females (y =0.31x + 1.61, p <0.001) and both genders combined (y =0.18x + 1.18, p <0.001). AAPC was highest for ages 20-29 and 30-39, for females (+25.2%) and males (+17.3%), respectively. CONCLUSIONS: We found a substantial increase in TC incidence in Serbia for both genders. The highest increase in TC incidence was found in females aged 20 to 29 years while the highest incidence was found in the age group 50 to 59.

Survival and prognostic factors of anaplastic thyroid carcinoma.

BACKGROUND: Anaplastic thyroid carcinoma (ATC) is relatively rare and represents one of the most aggressive tumours with poor prognosis, despite therapy. The aim of the study was to analyse demographic and clinical characteristics of ATC patients, and to identify survival rates and prognostic factors. METHODS: In a retrospective study (1995-2005) ATC was found in 150 patients treated at our institution. Survival was calculated by Kaplan-Meier curve and log-rank test. Potential prognostic factors affecting survival were compared by Cox univariate and multivariate analyses. RESULTS: Mean survival time was 56 weeks; median survival time was 16 weeks and 1 and 5-year survival were 17% and 8%. More than 10% died during the first month and 50% died up to the fourth month. Multivariate analysis showed that age, goitre and surgery were independent prognostic factors of survival in all ATC patients. Among operated patients, the extent of tumour resection, distant metastasis and multicentricity were independent prognostic risk factors of survival. Postoperative radiotherapy was a protective factor. CONCLUSIONS: There is still no successful treatment of ATC that can guarantee long term survival. Younger patients with pre-existing goitre, who undergo complete resection of unilocular early stage ATC without distant metastasis and with postoperative external radiotherapy, stand a better chance of long-term survival.

Survival and Prognostic Factors of Anaplastic Thyroid Carcinoma.

BACKGROUND: Anaplastic thyroid carcinoma (ATC) is relatively rare and represents one of the most aggressive tumours with poor prognosis, despite therapy. The aim of the study was to analyse demographic and clinical characteristics of ATC patients, and to identify survival rates and prognostic factors. METHODS: In a retrospective study (1995-2005) ATC was found in 150 patients treated at our institution. Survival was calculated by Kaplan-Meier curve and log-rank test. Potential prognostic factors affecting survival were compared by Cox univariate and multivariate analyses. RESULTS: Mean survival time was 56 weeks; median survival time was 16 weeks and 1 and 5-year survival were 17% and 8%. More than 10% died during the first month and 50% died up to the fourth month. Multivariate analysis showed that age, goitre and surgery were independent prognostic factors of survival in all ATC patients. Among operated patients, the extent of tumour resection, distant metastasis and multicentricity were independent prognostic risk factors of survival. Postoperative radiotherapy was a protective factor. CONCLUSIONS: There is still no successful treatment of ATC that can guarantee long term survival. Younger patients with pre-existing goitre, who undergo complete resection of unilocular early stage ATC without distant metastasis and with postoperative external radiotherapy, stand a better chance of long-term survival.

Long-term prognostic significance of living alone and other risk factors in patients with acute myocardial infarction.

BACKGROUND: Living alone has been associated with higher risk of acute coronary syndrome in general population, but there are no consistent findings about its effect on prognosis after acute myocardial infarction (AMI). AIM: To analyse the relationships between living alone and other risk factors at baseline and long-term survival after AMI. METHODS: One hundred and thirty-five patients with confirmed myocardial infarction (MI) admitted to the coronary care unit of the Institute of Cardiovascular Diseases, Clinical Centre of Serbia in Belgrade, between June 2002 and April 2006, were followed up until September 2011. Survival time was estimated using the Kaplan-Meier method and Cox regression analysis. RESULTS: Patients with MI were followed up for a median of 77 months. The mean age of participants was 57.82 years (SD ± 10.8), and one quarter of them were women. According to the multivariate Cox regression analysis stratified on marital status, the model in which were included living alone, age, gender, education, obesity, smoking, hyperlipidaemia, hypertension, diabetes mellitus, previous cardiovascular and other disease, thrombolytic therapy and localisation of MI, the following variables were found to be independent predictors of death after AMI: living alone, with a hazard ratio (HR) of 7.60 [95 % confidence interval (CI) 1.99-29.08], diabetes mellitus (HR 3.31; 95 % CI 1.33-8.23), current smoking (HR 2.82; 95 % CI 1.03-7.71) and, older age (HR 1.13; 95 % CI 1.06-1.19). CONCLUSION: The results of this study support hypothesis that patients who live alone have higher long-term all-cause mortality following AMI.

Prognostic parameters after surgery for adrenal metastases: a single institution experience.

BACKGROUND: Clinically isolated adrenal metastases are rare and therefore present a therapeutic challenge. We report our experience with surgery of adrenal metastases and analyze factors that may influence postoperative survival. METHODS: A consecutive series of 31 patients (16 male, 15 female) underwent adrenal surgery for metastases at a single institution over 10-year period (1999-2008). The Kaplan-Meier method and log-rank test were used to determine overall survival. Potential prognostic factors were identified by univariate and multivariate Cox regression analysis. RESULTS: The primary tumor diagnoses were non-small-cell lung carcinoma (NSCLC) 20, colorectal carcinoma 5, renal cell carcinoma (RCC) 2, malignant melanoma and breast carcinoma, one each. The median survival was 12 months, with one year and five year survival of 21% and 3.4% respectively. According to multivariate analysis independent prognostic factors of favorable survival were disease free interval (DFI) longer than 12 months (Hazard ratio (HR) = 0.28, 95% CI = 0.09-0.90), potentially curative resection (Hazard ratio (HR) = 0.35, 95% CI = 0.12-1.00) and postoperative radiotherapy of adrenal bed (Hazard ratio (HR) = 0.33, 95% CI = 0.12-0.91). CONCLUSIONS: Overall survival after surgery for adrenal metastases is poor. In multivariate analyses, survival is influenced by DFI, curative resection, and postoperative radiotherapy.

Stressful life events and type 2 diabetes.

OBJECTIVES: The purpose of this study is to compare cases with type 2 diabetes and their controls for the frequency of stressful life events and social support before the occurrence of the disease. METHODS: The study of cases and their controls was undertaken in Belgrade. A case group comprised 179 subjects in whom type 2 diabetes was for the first time diagnosed in the 'Savski Venac' Medical Center during the period 2005-2007 year. The diagnosis was made by a specialist of internal medicine according to criteria of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. For each case two controls were chosen among patients with trauma (fracture, reposition, internal/external fixation) who were treated at the 'Banjica' Institute for Orthopedic-Surgical Diseases during the same period. Cases and controls were matched by sex, age (±2 years) and place of residence (Belgrade). Data were collected on demographic characteristics, habits, personal history, stressful life events, social support and family medical history. RESULTS: According to multivariate analysis low social support in personal history, such as relatives/friends help and financial assistance in solving problems, and bad management of monthly income were significantly positively related to type 2 diabetes. However, significantly more controls than cases had no financial insurance in case of urgent need CONCLUSION: Examine psychosocial factors play a role in the development of type 2 diabetes.

Risk factors for anaplastic thyroid cancer.

Background. Anaplastic thyroid cancer (ATC) is a form of thyroid cancer with very poor prognosis, but is fortunately quite rare. Its aetiology is unknown and not well researched. Aim. The aim of this study was to identify potential risk factors for ATC. Material and Method. Case-control study of 126 ATC patients (77 females and 49 males) and 252 controls individually matched by gender, age, and place of abode. In statistical analysis we used a Cox regression model. Results. Univariate logistic regression showed that the risk factors for ATC are low education level, type B blood group, goitre, other nonthyroid malignancies, diabetes, late menarche, and an early first pregnancy. Multivariate logistic regression analysis showed that independent risk factors for ATC are low education level (OR = 1.42, 95% CI = 1.09-1.86), type B blood group (OR = 2.41, 95% CI = 1.03-5.66), and goitre (OR = 25-33, 95% CI = 5.66-126.65). Conclusion. Independent risk factors for ATC are: low education level, type B blood group, and goitre.

Rising incidence of type 1 diabetes in Belgrade children aged 0-14 years in the period from 1982 to 2005.

BACKGROUND: Type 1 diabetes (T1DM) is an autoimmune disease in which both genetic and environmental factors play a role in the etiology. AIM: The aim of this study was to analyze the incidence of T1DM. METHODS: A retrospective technique was used to register all newly diagnosed cases of T1DM in Belgrade (Serbia) children at the age of 0- 14 yr between 1982 and 2005. The incidence was adjusted directly by age using the Segi's world population as the standard. A total of 702 cases was identified from the two sources: patients' records from two pediatric hospitals in Belgrade referent for the disease, and from the population based register. RESULTS: The average annual age adjusted incidence rate of T1DM for Belgrade was 10.4/100,000 [95% confidence interval (95% CI)=3.8-15.4]. It was slightly higher in boys than in girls. The age-specific annual incidence rates (per 100,000) for the age groups 0-4, 5-9, and 10-14 were 5.5 (95% CI=4.5-6.7), 11.9 (95% CI=10.5-13.5), and 15.4 (95% CI=13.8-17.1), respectively. Over the 24 yr incidence rates significantly increased by 8.5% for boys and 3.0% for girls. The highest increase of incidence rate was in the 5-9 age group. DISCUSSION: The results obtained are in line with data from other studies showing that the incidence of T1DM has been increasing in almost all populations worldwide.

Comparison of the Adult Comorbidity Evaluation 27 and the Charlson Comorbidity indices in patients with laryngeal squamous cell carcinoma.

OBJECTIVE: This study aimed to compare the prognostic impact of comorbidity grading by the Adult Comorbidity Evaluation 27 index and the Charlson Comorbidity Index on the five-year overall and disease-specific survival in patients undergoing surgery for laryngeal squamous cell carcinoma. METHODS: The impact of comorbidity and other factors on survival was examined retrospectively in a group of 177 patients with previously untreated tumour stage one to four laryngeal squamous cell carcinoma surgically treated at the Clinic of Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, between 2000 and 2003. The Cox proportional hazard model was used to identify independent prognostic factors. RESULTS: On univariate analysis, comorbidity had an impact on prognosis regardless of which index was used. On multivariate analysis, the significant predictors of patients' five-year overall and disease-specific survival were tumour-node-metastasis stage and comorbidity as graded by the Adult Comorbidity Evaluation 27 index. CONCLUSION: The Adult Comorbidity Evaluation 27 index is a more reliable predictor of survival than the Charlson Comorbidity Index in patients with laryngeal squamous cell carcinoma.

Changing trends in mortality of thyroid cancer in Belgrade population.

PURPOSE: Thyroid cancer patients have favorable prognosis. The aim of this study was to analyze changing trends in mortality of thyroid cancer in Belgrade, during the period between 1987 and 2006. METHODS: Mortality data were obtained from the Belgrade Office of Statistics. Mortality rates per 100,000 inhabitants were standardized according to the Segi's world population. Regression analysis was used to estimate the thyroid cancer mortality trend for the period 1987-2006. RESULTS: The average percent of deaths due to thyroid cancer among all deaths was almost 2-fold higher in females (0.11%) than in males (0.6%), as well as among deaths due to all malignancies (females 0.54% and males 0.27%). During this 20-year period, the average standardized mortality rate was 1.5 times higher in females (0.74 per 100.000) than in males (0.51 per 100.000). In the observed period, the mortality rates for thyroid cancer were increased (+0.40%) in women and decreased (-0.42%) in men. In particular, in the 60-69 years age group in males, a significant trend for mortality decrease of 3.5%/year was detected. CONCLUSION: Belgrade is classified in the regions with low risk of dying due to thyroid malignancies. The increasing trend of thyroid cancer mortality in females during the examined period calls for improvement of methods for early detection of disease and differential diagnosis of thyroid nodules, so that surgical treatment of thyroid cancer could be performed at a stage when it is not life threatening.

Risk factors for genital lichen sclerosus in men.

BACKGROUND: Lichen sclerosus (LS) is an inflammatory disease of the skin and mucous membranes. Its aetiology is still unknown. OBJECTIVES: To determine risk factors for genital LS in men. METHODS: In a case-control study, 73 patients with LS, consecutively diagnosed at the City Dispensary for Skin and Venereal Diseases in Belgrade, were compared with 219 male patients visiting the same institution because of tinea cruris. Univariate and multivariate logistic regression analyses were used for analysis of data collected. RESULTS: According to multivariate logistic regression analysis, risk factors for male LS were as follows: a personal history of genital injury [odds ratio (OR) 28·1, 95% confidence interval (CI) 5·2-150·8], vitiligo (OR 23·1, 95% CI 2·2-240·2), alopecia areata (OR 8·8, 95% CI 1·1-68·5) and hypercholesterolaemia (OR 3·1, 95% CI 1·1-8·2), and a family history of alopecia areata (OR 24·3, 95% CI 2·1-280·7), diseases of the thyroid gland (OR 9·1, 95% CI 2·3-36·2) and other autoimmune diseases (OR 8·6, 95% CI 1·3-58·6). CONCLUSIONS: The results of the present study are in line with the hypothesis that trauma of the penis is a possible trigger of symptoms in genetically predisposed individuals and that personal and family histories of autoimmune disorders are risk factors for male LS.

Birthweight and the risk of childhood-onset type 1 diabetes: a meta-analysis of observational studies using individual patient data.

AIMS/HYPOTHESIS: We investigated whether children who are heavier at birth have an increased risk of type 1 diabetes. METHODS: Relevant studies published before February 2009 were identified from literature searches using MEDLINE, Web of Science and EMBASE. Authors of all studies containing relevant data were contacted and asked to provide individual patient data or conduct pre-specified analyses. Risk estimates of type 1 diabetes by category of birthweight were calculated for each study, before and after adjustment for potential confounders.Meta-analysis techniques were then used to derive combined ORs and investigate heterogeneity between studies. RESULTS: Data were available for 29 predominantly European studies (five cohort, 24 case-control studies), including 12,807 cases of type 1 diabetes. Overall, studies consistently demonstrated that children with birthweight from 3.5 to 4 kg had an increased risk of diabetes of 6% (OR 1.06 [95% CI 1.01-1.11]; p=0.02) and children with birthweight over 4 kg had an increased risk of 10% (OR 1.10 [95% CI 1.04-1.19]; p=0.003), compared with children weighing 3.0 to 3.5 kg at birth. This corresponded to a linear increase in diabetes risk of 3% per 500 g increase in birthweight (OR 1.03 [95% CI 1.00-1.06]; p=0.03). Adjustments for potential confounders such as gestational age, maternal age, birth order, Caesarean section, breastfeeding and maternal diabetes had little effect on these findings. CONCLUSIONS/INTERPRETATION: Children who are heavier at birth have a significant and consistent, but relatively small increase in risk of type 1 diabetes.

Nutrition and prostate cancer.

PURPOSE: since an association between prostate cancer and some foods or food groups like meat, milk and dairy products, tomato foods, and allium vegetables, has been suggested, we analyzed the possibility that some food items or some food groups could be related to prostate cancer in some other way and not only through their nutrients. The purpose of this study was to test some hypotheses about diet as risk factor for prostate cancer. METHODS: this case-control study comprised 101 cases of prostate cancer and 202 hospital controls individually matched for age (± 2 years), hospital admission and place of residence. Dietary information of 150 food items was obtained by a quantitative history approach. RESULTS: multivariate logistic regression analysis indicated as risk factors for prostate cancer high intake of fruit, processed meat, fish (most frequently canned) and butter. High intake of chicken, potato and rice exhibited a protective effect. CONCLUSION: these results support the hypothesis that consumption of meat and fat play a role in the development of prostate cancer. The findings that consumption of processed meat only (not fresh) and fish increased the risk of prostate cancer, as well as the protective effect of chicken, potato and rice consumption should be corroborated by other investigators.

Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies.

AIMS/HYPOTHESIS: The aim of this study was to investigate the evidence of an increased risk of childhood-onset type 1 diabetes in children born by Caesarean section by systematically reviewing the published literature and performing a meta-analysis with adjustment for recognised confounders. METHODS: After MEDLINE, Web of Science and EMBASE searches, crude ORs and 95% CIs for type 1 diabetes in children born by Caesarean section were calculated from the data reported in each study. Authors were contacted to facilitate adjustments for potential confounders, either by supplying raw data or calculating adjusted estimates. Meta-analysis techniques were then used to derive combined ORs and to investigate heterogeneity between studies. RESULTS: Twenty studies were identified. Overall, there was a significant increase in the risk of type 1 diabetes in children born by Caesarean section (OR 1.23, 95% CI 1.15-1.32, p < 0.001). There was little evidence of heterogeneity between studies (p = 0.54). Seventeen authors provided raw data or adjusted estimates to facilitate adjustments for potential confounders. In these studies, there was evidence of an increase in diabetes risk with greater birthweight, shorter gestation and greater maternal age. The increased risk of type 1 diabetes after Caesarean section was little altered after adjustment for gestational age, birth weight, maternal age, birth order, breast-feeding and maternal diabetes (adjusted OR 1.19, 95% CI 1.04-1.36, p = 0.01). CONCLUSIONS/INTERPRETATION: This analysis demonstrates a 20% increase in the risk of childhood-onset type 1 diabetes after Caesarean section delivery that cannot be explained by known confounders.

Outbreak of early syphilis in an institution for the care of adults with mental disorders.

This paper describes the features of an outbreak of early syphilis in an institution for the care of adults with mental disorders. A case-note review was performed. In the period June to November 2001, 87 cases of syphilis were diagnosed [25 primary, 21 secondary and 41 early latent syphilis in 983 inmates (crude attack rate 8.9%)]. Among them 82 were heterosexual, four were homosexual or bisexual, and for one case sexual preference was not established. About half the cases were known to be promiscuous. The initial case was not identified. Penicillin therapy was administered to all cases and all known or suspected sexual contacts. Sporadic cases of syphilis have, however, continued to emerge from time to time. Institutions for patients with mental disorders are vulnerable to sexually transmitted diseases, and special strategies should be devised for their control.

Blood pressure levels in 7 to 14-year-old Belgrade children.

The objective of the work was to study blood pressure and some anthropometric characteristics in children. The study design included the prevalence study at Belgrade, Serbia and Montenegro. The study comprised 1651 subjects (809 boys and 842 girls) aged 7-14 years, that is, 2.6% of all relevant population. The average levels of systolic and diastolic blood pressures (SBP and DBP) were 113.4/70.3 mmHg in boys and 114.6/71.1 mmHg in girls. High SBP was present in 4.7% of boys and in 5.3% of girls. High DBP was found in 5.6% of boys and in 4.8% of girls. According to multivariate regression analysis, in boys SBP and DBP were significantly associated with age, body mass index (BMI) and subscapular skinfold, SBP was also associated with body weight, and DBP with triceps skinfold. In girls, SBP was significantly related to BMI, suprailiac skinfold and body height, and DBP was significantly associated with BMI, suprailiac and subscapular skinfolds. The results of the present study support the opinion that BMI is a significant predictor of blood pressure in children and point out to suprailiac skinfold in girls as a possible predictor of blood pressure.

Family history and risk of type 1 diabetes mellitus.

The aim of the study was to evaluate association of type 1 diabetes in children and adolescents with positive family history of type 1 diabetes, type 2 diabetes, and thyroid, adrenal, rheumatic, allergic, celiac and some other diseases. A case-control study was conducted in Belgrade. The case group comprised 105 subjects < or = 16 years old who were for the first time hospitalized because of type 1 diabetes during the period 1994-1997. For each case, two controls were chosen among children and adolescents treated for skin diseases. Cases and controls were individually matched by age (+/- one year), sex and place of residence (all were from Belgrade). In the statistical analyses we used chi(2)-test, Fisher's exact test and univariate and multivariate logistic regressions. According to multivariate logistic regression analysis, risk of type 1 diabetes was significantly associated with a positive family history for type 1 diabetes (OR = 4.04; 95% CI, 2.31-7.07), allergic diseases (OR = 3.32; 95% CI, 1.63-6.76), celiac and Crohn's diseases (OR = 11.02; 95% CI, 1.14-106.89) and other diseases (thrombocytopenia, alopecia areata, psoriasis, chronic uveitis and pernicious anemia; OR = 3.63; 95% CI, 1.05-12.48).

Prevalence of menstrually related migraine and nonmigraine primary headache in female students of Belgrade University.

OBJECTIVES: To determine prevalence and characteristics of menstrually related migraine and nonmigraine headache in female students of Belgrade University. METHODS: A questionnaire was administered to female students during randomly selected classes of the Schools of Medicine and Pharmacy. Diagnoses were assigned according to the criteria of the International Headache Society and MacGregor's stricter definition of "menstrual" migraine. RESULTS: Of 1943 female students (18 to 28 years old), 1298 (66.8%) had primary headaches. Among 1298 students with headache, 245 (12.6%) had migraine and 1053 (54.2%) had nonmigraine headache. The prevalence rates of migraine versus nonmigraine headache in relation to the menstrual cycle were: premenstrual, 0.9% versus 4.4%; menstrual, 1.5% versus 1.5%; menstrually associated, 6.1% versus 10.1%; menstrually unchanged, 2.7% versus 19.2%; and menstrually unrelated, 1.4% versus 18.9%. Female students with migraine had menstrually related attacks more frequently than students with nonmigraine headache (67.7% versus 29.5%). This difference was most prominent among students with menstrual migraine compared with students with menstrual nonmigraine headache (12.2% versus 2.7%). Exacerbation of migraine during menstruation was slightly more severe and more complex than exacerbation of nonmigraine headache. Female students with migraine versus nonmigraine headache did not differ significantly in age, age at onset of menarche, or age at onset of headache. Female students with migraine were significantly more likely to report a positive family history for migraine and menstrual migraine, severe attacks, reduced work activity, and aura. CONCLUSION: The results obtained are in accord with the prevailing opinion that there is a relationship between migraine and female sex hormones, and suggest that women with nonmigraine headache are also susceptible to hormonal fluctuations.