Trends in tuberculosis notification and mortality and factors associated with treatment outcomes in Serbia, 2005 to 2015.

BackgroundPreviously a country with medium tuberculosis (TB) burden, Serbia almost reached a low TB burden during the period 2005 to 2015.AimThe aim of this study was to analyse the trends in notification rates and treatment success rates as well as to identify predictors of treatment outcomes.MethodsWe performed a trend analysis and logistic regression analysis of 17,441 TB cases registered from 2005 to 2015 in all health facilities in Serbia, to identify predictors of treatment success, loss to follow-up and mortality.ResultsFrom 2005 to 2015, TB notification rate and mortality in Serbia decreased but treatment success remained below the global target. Loss to follow-up was associated with retreatment (odds ratio (OR) = 2.38; 95% confidence interval (CI): 2.08-2.77), male sex (OR = 1.57; 95% CI: 1.39-1.79), age younger than 65 years (OR = 1.37; 95% CI: 1.20-1.51), lower education level (OR = 2.57; 95% CI: 1.74-3.80) and pulmonary TB (OR = 1.28; 95% CI: 1.06-1.56). Deaths were more frequent in retreatment cases (OR = 1.39; 95% CI: 1.12-1.61), male patients (OR = 1.34; 95% CI: 1.19-1.52), those 65 years and older (OR = 4.34; 95% CI: 4.00-5.00), those with lower education level (OR = 1.63; 95% CI: 1.14-2.33) and pulmonary TB (OR = 2.24; 95% CI: 1.78-2.83).ConclusionsSpecial interventions should be implemented to address groups at risk of poor treatment outcome.

HIV prevalence, knowledge and self-perceived risk of HIV infection among tuberculosis patients in Serbia.

OBJECTIVE: The aim of the study was to estimate the seroprevalence of HIV infection among TB patients, knowledge, self-perceived risks and testing practices related to HIV. METHODS: We performed cross-sectional study from 10 May to 15 July 2011. Cluster sampling method was used to select 27 hospitals where 289 TB patients were consecutively recruited. Descriptive statistics and multivariable logistic regression methods were used to identify the factors associated with correct comprehensive knowledge of HIV/AIDS. RESULTS: HIV prevalence among TB patients was 0.3%. Only 25.2% of the respondents presented comprehensive correct knowledge of HIV/AIDS. The percentage of correct answers to all questions related to knowledge about HIV/AIDS increases with educational status (χ2 = 5.42; p < 0.05) and decreases with the age of respondents (χ2 = 8.53; p > 0.05). The independent predictors of correct comprehensive knowledge were living without partner (OR = 4.45; CI = 1.59-12.95) and self-awareness of HIV risk (OR = 4.43; CI = 1.20-16.52). CONCLUSION: HIV prevalence among TB patients is higher than among general population in Serbia. The level of comprehensive correct knowledge of HIV/AIDS is low. There is a need for continuous implementation of public health strategy to successfully manage HIV and HIV/TB co-infection in Serbia.

Risk factors for multidrug-resistant tuberculosis among tuberculosis patients in Serbia: a case-control study.

BACKGROUND: Multidrug resistant (MDR) tuberculosis (TB) represents TB which is simultaneous resistant to at least rifampicin (R) and isoniazid (H). Identifying inadequate therapy as the main cause of this form of the disease and explaining the factors leading to its occurrence, numerous social determinants that affect the risk of developing resistance are highlighted. The objectives of the study was to identify independent factors of MDR-TB among tuberculosis patients. METHODS: Case-control study was conducted from 1st September 2009 to 1st June 2014 in 31 healthcare institutions in Serbia where MDR-TB and TB patients were treated. TB patients infected with MDR- M. tuberculosis and non MDR- M. tuberculosis strain were considered as cases and controls, respectively. Cases and controls were matched by the date of hospitalization. The data was collected using structured questionnaire with face to face interview. Bivariate and multivariable logistic regression analysis (MLRA) were used to identify determinants associated with MDR-TB. RESULTS: A total of 124 respondents, 31 cases and 93 controls were participated in the study. MLRA identified six significant independent risk factors for the occurrence of MDR-TB as follows: monthly income of the family (Odds ratio (OR) = 3.71; 95% Confidence Interval (CI) = 1.22-11.28), defaulting from treatment (OR = 3.33; 95% CI = 1.14-9.09), stigma associated with TB (OR = 2.97; 95% CI = 1.18-7.45), subjective feeling of sadness (OR = 4.05; 95% CI = 1.69-9.70), use of sedatives (OR = 2.79; 95% CI = 1.02-7.65) and chronic obstructive pulmonary disease (OR = 4.51; 95% CI = 1.07-18.96). CONCLUSION: In order to reduce burden of drug resistance, strategies of controlling MDR-TB in Serbia should emphasize multi-sectorial actions, addressing health care and social needs of TB patients.

Smart Anklet Use to Measure Vascular Health Benefits of Preventive Intervention in a Nature-Based Environment-A Pilot Study.

The present study aimed to investigate the associations between nature-based intervention and peripheral pulse characteristics of patients with PAOD using new smart technology specifically designed for this purpose. A longitudinal panel study performed between 1 January 2022 and 31 December 2022 included 32 patients diagnosed with peripheral arterial occlusive disease (PAOD) who were treated in the vascular surgeons' hospital "Dobb" in Valjevo. These patients were exposed for six months to moderate-intensity physical activity (MPA) in a nature-based environment. They practiced 150 to 300 min of walking 6 km/h and cycling activities (16-20 km/h) weekly as recommended for patients with chronic conditions and those living with disability. Univariate logistic regression analysis was used to identify factors associated with major improvements in peripheral pulse characteristics of patients with PAOD. After six months of MPA, half of the patients (50%, 16/32) achieved minor, and half of them major improvements in peripheral pulse characteristics. The major improvements were associated with current smoking (OR = 9.53; 95%CI = 1.85-49.20), diabetes (OR = 4.84; 95%CI = 1.09-21.58) and cardiac failure, and concurrent pulmonary disease and diabetes (OR = 2.03; 95%CI = 1.01-4.11). Our pilot study showed that patients with PAOD along with other chronic conditions and risk factors benefited more from continuous physical activity in a nature-based environment.

Factors associated with COVID-19 among hospitalized patients with severe acute respiratory infections in Serbia, 2022-2023: A test negative case-control study.

Severe acute respiratory infections (SARI) are estimated to be the cause of death in about 19% of all children younger than 5 years globally. The outbreak of coronaviral disease (COVID-19) caused by SARS-CoV-2, increased considerably the burden of SARI worldwide. We used data from a vaccine effectiveness study to identify the factors associated with SARS CoV-2 infection among hospitalized SARI patients. We recruited SARI patients at 3 hospitals in Serbia from 7 April 2022-1 May 2023. We collected demographic and clinical data from patients using a structured questionnaire, and all SARI patients were tested for SARS-CoV-2 by RT-PCR. We conducted an unmatched test negative case-control study. SARS-CoV-2 infected SARI patients were considered cases, while SARS CoV-2 negative SARI patients were controls. We conducted bivariate and multivariable logistic regression analysis in order to identify variables associated with SARS-CoV-2 infection. We included 110 SARI patients: 74 were cases and 36 controls. We identified 5 factors associated with SARS-CoV-2 positivity, age (OR = 1.04; 95% CI = 1.01-1.07), having received primary COVID-19 vaccine series (OR = 0.28; 95% CI = 0.09-0.88), current smoking (OR = 8.64; 95% CI = 2.43-30.72), previous SARS CoV-2 infection (OR = 3.48; 95% CI = 1.50-8.11) and number of days before seeking medical help (OR = 0.81; 95% CI = 0.64-1.02). In Serbia during a period of Omicron circulation, we found that older age, unvaccinated, hospitalized SARI patients, previously infected with SARS CoV-2 virus and those who smoked, were more likely to be SARS-CoV-2-positive; these patient populations should be prioritized for COVID vaccination.

Tuberculosis and COVID-19 co-infection in Serbia: Pandemic challenge in a low-burden country.

Introduction: COVID-19 and tuberculosis (TB) represent global threats to the public health system. The impact of COVID-19 on TB results in a reduction in the number of notified TB cases, delayed diagnosis and treatment, and increased case fatality and mortality rates. The aim of the study was to analyze the TB/COVID-19 co-infected cohort in Serbia as a low-burden country and compare it to the global TB/COVID-19 cohort. Methods: A retrospective analysis was done on 53 TB and COVID-19 co-infected patients treated in COVID hospital "Batajnica" in Belgrade and Special Hospital for Pulmonary Diseases "Ozren" Sokobanja in the period from 6 March 2020 to 1 April 2022. A comparative analysis with the global cohort published recently was also performed. Results: TB/COVID-19 cohort in Serbia included significantly fewer migrants and diabetes cases, but more cases with chronic respiratory diseases compared to the global. Descriptive analysis of TB cases in the Serbian TB/COVID-19 cohort showed fewer cases diagnosed with sputum smear and Gene Xpert/HAIN, fewer EPTB and mono-resistant cases, and more cases diagnosed with solid culture, unilateral pulmonary infiltrate (with bilateral cavity lesions), and bilateral pulmonary infiltrate (no cavities) compared to TB/COVID-19 cases worldwide. Nasal congestion and fever were more common COVID-19 symptoms in the global cohort. Radiology was more commonly used for the diagnosis of COVID-19 in Serbia. Typical bilateral ground opacities were less common among Serbian patients. Serbian patients spent fewer days in the hospital and achieved a higher PCR conversion rate and TB treatment success rate. Conclusion: The Serbian TB/COVID-19 cohort achieved a higher treatment success rate compared to the global cohort. Encouraging vaccination against SARS-CoV-2 for people with a current or past TB disease, as well as rapid diagnosis and targeted treatment of TB in highly specialized pulmonology institutions, presents key points to avoid excessive morbidity and mortality.

Immunogenicity and Reactogenicity of the Booster Dose of COVID-19 Vaccines and Related Factors: A Panel Study from the General Population in Serbia.

The Republic of Serbia applied the booster dose of the following COVID-19 vaccines: BNT162b2 mRNA (Pfizer-BioNTech), Sinopharm BBIBP-CorV (Vero Cell®), Gam-COVID-Vac (Sputnik V) and ChAdOk1 nCoV-19 (AstraZeneca). We aimed to examine the immunogenicity and reactogenicity of the booster dose and identify factors related to immune response and adverse events. Panel study, conducted during August and September 2021, included 300 persons receiving the booster dose at the Institute of Public Health of Serbia. Blood samples were taken on the day of receiving the booster dose, and after 7 and 28 days. When applying homologous regimen, the average increase in anti-spike immunoglobulin G was 8782.2 (after 7 days), 1213.9 after 28 days, while 9179.5 (after 7 days) and 16,728.1 after 28 days of heterologous regimen. Sinopharm BBIBP-CorV (p < 0.001) and Sputnik V (p < 0.001), age 65 and over (p = 0.001) and currently smoking (p < 0.001) were independently associated with lower levels of anti-spike immunoglobulin G. Female sex (OR = 1.77; 95%CI = 1.01−3.12), previous COVID-19 infection (OR = 3.62; 95%CI = 1.13−11.63) and adverse events after the second dose (OR = 2.66; 95%CI = 1.33−5.32) were independently associated with intense systemic adverse events 7 days after. Booster dose significantly increased antibodies titers, especially 28 days after heterologous regimen, without a significant increase in reactogenicity.

Influence of the COVID-19 pandemic on the incidence of tuberculosis and influenza.

We examined whether the COVID-19 pandemic has affected the incidence of tuberculosis (TB) and influenza in Serbia, a Southeast European country with a low TB incidence rate and a mandatory BCG vaccination at birth. The first case of COVID-19 was registered on March 6, 2020. Despite the need for a sudden adaptation of the health care system, routines of mycobacterial laboratories have never stopped. In 2020, the number of newly diagnosed TB patients was significantly lower than expected (p = 0.04), but the number of patients with influenza increased when compared to 2019. Although many patients with influenza A H1N1 were observed before the beginning of the COVID-19 pandemic, the increment of cases could also be a consequence of cases of influenza with COVID-like symptoms detected thereafter. It may also be attributed to misclassification of clinical cases that were negative for SARS-CoV-2 and reported as influenza. Difficulties to seek medical attention because of the COVID-19 pandemic and possible underreporting are considered as reasons for the decline in the incidence rate of TB. On the other hand, individual and social measures to prevent the spread of SARS-CoV-2 such as wearing face masks, social distancing, lockdown, which were strictly applied to COVID-19 patients, health care staffs and most of the population, could have hindered TB infections more than the two viral diseases, which appear to be more contagious. The increased motivation of the population to protect their health during the COVID-19 pandemic provided an opportunity for their effective education. This is crucial in further combating TB as a preventable disease.

Tuberculosis and associated risk factors among children and adolescent population in Serbia: 12 year's retrospective study.

INTRODUCTION: Recognition and epidemiological control of childhood and adolescent tuberculosis (TB) is essential to achieve effective control of TB in general as it presents high risk for transmission in the community. The aim of the study is to provide a descriptive and analytic overview of the trends in childhood and adolescent TB notifications and treatment outcomes and to identify factors associated with treatment success in a twelve-year period in Serbia. METHODOLOGY: We performed a retrospective trend analysis and analysis of treatment outcomes of 596 child and adolescent TB cases notified in Serbia in the period 2005-2016 from all health facilities, as well as logistic regression analysis to identify predictors of treatment success. RESULTS: Factors independently associated with treatment success were: new TB (OR=2.60; 95% CI: 1.45-3.74), male sex (OR=2.55; 95% CI: 2.09-3.00), pulmonary TB (OR=3.34; 95% CI: 2.34-4.34), comorbidities (OR=2.58; 95% CI: 2.24-2.91), age below 5 years (OR=0.37; 95% CI: 0.32-0.43), and social vulnerability (OR=0.40; 95% CI: 0.34-0.46). CONCLUSIONS: In order to improve TB treatment outcomes among children and adolescent population in Serbia, it is important to focus on female, age group 5-18, EPTB, retreatment cases and socially vulnerable groups.

Impact of the bronchopulmonary sequestration on endobronchial tuberculosis: the case report and the review of literature.

INTRODUCTION: We describe the rare case of endobronchial tuberculosis (EBTB) and chronic pulmonary atelectasis with mediastinal distortion. Finding of the concomitant venous anomaly of inferior vena cava revealed the diagnosis of bronchopulmonary sequestration. CASE REPORT: A 22-year-old Caucasian woman presented with a history of chronic cough, initially treated as bronchial asthma for a year. Chest X-ray showed fibrocaseous cavernous tuberculosis on the right lung. Acid Fast Bacilli (AFB) were found in sputum samples. Patient was treated for 6 months with usual antituberculous regiment. Control chest X-ray showed subatelectasis of the upper right lobe. Six months later the first thorax computed tomography (CT) showed complete atelectasis of the right lung. Patient was admitted to the hospital again after 6 years due to the persistent fever and cough. Endoscopic finding and histopathological analysis confirmed EBTB. Thoracic CT scan revealed duplication of inferior vena cava which led to profound vascular analysis and aberrant arterial vascularization of aortic origin that contributed to the diagnosis of bronchopulmonary sequestrations. Antituberculous treatment was initiated (streptomycin, isoniazid, rifampicin, ethambutol and pyrazinamide) and lasted for 8 months. After 8 months a follow-up fiberoptic bronchoscopy showed the progression of endoscopic finding with 60-70% tracheal stenosis. Histopathological finding of the mid-trachea showed non-specific granulations. During 7 years of follow-up repeated bronchoscopy and thoracic CT scans were unchanged and patient was well-shaped. CONCLUSIONS: The clinician should consider bronchopulmonary sequestration in the cases of recurrent EBTB.

Tuberculosis outbreak among high school students in Novi Pazar, Serbia 2016: a retrospective-cohort study.

INTRODUCTION: Between February and November 2016, 17 tuberculosis (TB) cases were identified among high school students in Novi Pazar, Serbia. The objectives of our study were to describe the outbreak, to identify potential risk factors and to evaluate the applied control measures. METHODOLOGY: The outbreak was described by time, person and place. A retrospective cohort study was conducted. Attack rates, unadjusted relative risks (RR) and 95% confidence intervals (CI) were calculated. Multiple log-binomial regression analysis was performed to calculate adjusted RR. RESULTS: Sixteen of the total 17 cases occurred among grade 3 students, AR 5.5%. Previous TB family history, (RR = 5.29; 95% CI = 1.63-17.12), spending time with a known TB case at school (RR = 5.38; 95% CI = 1.48-19.55) and exposure to secondhand smoke (RR = 3.37; 95% CI = 1.11-10.29) were all significantly and independently associated with the occurrence of TB. CONCLUSIONS: Delayed diagnosis and reporting resulted in delayed initiation of the contact investigation and non-identification of latent TB cases probably favored the occurrence of this outbreak in a low incidence country. Public health authorities should consider revising the existing guidelines, promoting inter-sectorial collaboration and increasing awareness of public health professionals.

ASSESSMENT OF THE ROLE OF PRIMARY HEALTH CARE IN TUBERCULOSIS CONTROL IN SERBIA.

INTRODUCTION: At the onset of the 21st century, tuberculosis is still a public health problem. Due to the implementation of tuberculosis control program in Serbia, there is no fear of an epidemic. Within the reform of the health care system, the service for pulmonary diseases is being restructured, calling for strengthening the role of primary health care. This study was aimed at analyzing the current role of primary health care in tuberculosis control. MATERIAL AND METHODS: A cross-sectional study was conducted between the 12th and 30th September, 2010. For evaluating the current role of primary health care in tuberculosis control, four questionnaires were designed based on the "Performance assessment questionnaire regarding TB control for use in PHC", Journal Brasileiro de Pneumologia, print version ISSN 1806-3713 (vol. 35, no 6, Sao Paulo, June 2009). The following methods were used to analyze the results: descriptive statistical analysis, Student's T-test, Fisher's analysis of variance. The reliability of the results was tested with Cronbach's alpha and factor analysis. The level of significance in all the methods bordered 0.05. RESULTS: Primary health care does not participate in tuberculosis control in line with the possibilities of the existing legal framework. Although the paper proves that tuberculosis notification rate is higher in the areas less covered by the pneumophysiological service, the role of primary health care does not differ from the areas fully covered. CONCLUSION: There is a need for strategic empowerment of the primary health care system to be actively involved in the diagnostics. treatment and follow up of tuberculosis in Serbia.

Index of orthodontic treatment need in children from the Nis region.

BACKGROUND/AIM: The Index of Orthodontic Treatment Need (IOTN) is a scoring system for malocclusion that con- sists of the two independent components: Denal Health Component (DHC) and Aesthetic-Component (AC). IOTNs are usually used in the countries with dental healthcare financed by the government through the national healthcare system or healthcare insurance. The aim of the study was to determine IOTN in primary school children from the town of Nis and to asses percent of children with any kind of orthodontic treatment. METHODS: The study involved 301 school children, 11-14 (12.4 ± 1.1) years old. The IOTN was used by the two examiners in order to evaluate the treatment need. RESULTS: The results of the study showed that 111 (37%) out of 301 examined children had orthodonic treat- ment (33.33% boys and 66.67% girls) and they were excluded from the study. Out of final sample of 190 school children, considering DHC of the IOTN, 27.4% of the children showed great (grades 4-5), 41.0% moderate (grade 3) and 31.6% slight or no treatment need (grade 1-2). Considering IOTN AC, 15.3% of the children showed great (grade 8-10), 24.3 % moderate (grade 5-7) and 60.4% slight or no treatment need (grade 1-4). CONCLUSION: The need for ortho- dontic treatment in school children in the town of Nis, Serbia, is similar to the need in most European countries, despite the fact that the number of children orthodontically treated is much higher compared to most of European countries.

[Analysis of interjaw ratios in relation to permanent tooth size in subjects with class I malocclusion].

INTRODUCTION: A certain ratio of maxillary to mandibular tooth size is very important for the proper occlusion formation. In regular occlusion, the teeth must be proportional to size. A discrepancy in tooth size between the mandibular and maxillary arch is usually the cause of disharmonious occlusion ratios. One of the most widespread methods in determining of discrepancy in tooth size between the upper and lower jaw is the Bolton analysis of mesiodistal width of permanent teeth. MATERIAL AND METHODS: The subjects of both sexes with the permanent dentition and occlusive ratio of Angle Class I classification had had the precise impressions taken on the basis of which the study models were obtained. 60 patients were selected for this investigation (30 males and 30 females) according to the following criteria: the presence of completely erupted teeth of permanent dentition from the first molar on one side to the first molar on the other side of the dental string; good quality of the study models; the absence of mesiodistal and occlusive abrasion, caries lesions, Class II fillings; the absence of prosthetic or composite restoration;the absence of anomalies in regard to shapes, structures and tooth development. We measured the mesiodistal width of each tooth from the first molar on one side to the first molar on the other side, from the mesial contact point to the distal contact point with the greatest interproximal distance. RESULTS: The obtained results for mesiodistal tooth width of the right and left side do not show statistically significant differences. The mean values of the Bolton anterior ratio showed neither the sexual dimorphism nor did the mean values of the Bolton total ratio show any differences in sexes. The mean values of the Bolton anterior ratio in our examinees of both sexes are significantly higher compared to the values of Bolton norms. The mean values of the Bolton total ratios in our examinees of both sexes were not statistically different compared to the values of Bolton norms. CONCLUSION: Determining of intermaxillary ratios is an important diagnostic and prognostic value in orthodontics since it offers a possibility to predict the outcome of orthodontic therapy applied on persons with tooth size discrepancy related to the upper and lower jaw.

[Effect of soft tissue thickness on profile appearance in persons with class III malocclusion].

The aim of the research was to determine the characteristics of soft tissue in persons with class III malocclusion, through the analysis of profile X-rays. The research was carried out on fifty profile X-rays of people with class III malocclusion (eighteen males and thirty two females, from the age of fifteen to twenty five). Linear and angular parameters were analyzed by Burston's and Steiners method. The increased soft tissue thickness in subspinal region in both genders had a partial compensatory effect. The reduced upper and lower lip thickness in females created more harmonious profile in relation to males, in whom lip thickness shows great individual variations. The increased soft tissue thickness in supramental region in males emphasized the abnormality in relation to females.