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Lacustrine strata record long-term variations in climatic and tectonic perturbations during orogen evolution. Here we use the sedimentological record of the early to middle Miocene intramontane lacustrine Pranjani Basin (Serbia) to study tectonic and climatic variations during the evolution of the Dinaridic orogen. Our study focuses on a Mg-clay-bearing succession that belongs to the second depositional cycle. A detailed sedimentological, mineralogical and geochemical study shows that the investigated Mg-clays bearing succession consists of an alternation of smectite- (± analcime or sepiolite), dolomite-sepiolite and sepiolite layers. We interpret this high-order cyclicity to have been driven by variable water availability, i.e. by the interplay between runoff, groundwater influx and evaporation. Furthermore, we relate these pulses in water variability to wet and dry intervals under semi-arid to arid climatic conditions. Dry intervals produced a negative water balance promoting the deposition of sepiolite - and dolomite - dominated facies. Wet intervals and a positive water balance stimulated higher terrestrial input and thus favored the deposition of smectite-dominated facies. Our new data combined with a review of previous studies reveal longer-term basin-wide lake level and chemistry fluctuations, which we relate to closed and open lake phases. We suggest that these phases can be explained by alternating humid and arid phases superimposed on tectonically induced uplift and subsidence. The arid phases led to lake shrinking and deposition of an evaporite-bearing succession. During the intervening humid phase, the lake expanded. In contrast to the lakes formed in the external part of the Dinarides, the lakes that existed in its internal part contain evaporite-bearing successions, indicating that this arid phase was regionally extensive and possibly orographically controlled. • Mg-clay bearing succession reveals changing lake level and chemistry over time. • Lake cycles can be linked to wet and dry palaeoclimate cycles. • Deposition took place in saline-alkaline conditions under semi-arid to arid climate. • During Miocene evaporite-bearing successions were spread across the Internal Dinarides. • The distribution of the evaporite-bearing successions in the Dinarides is possibly controlled by orographic rainshadow effect. [ABSTRACT FROM AUTHOR]

In the first review of potentially toxic elements (PTEs) in fish in water ecosystems in Serbia, 40 studies related to fish contamination with PTEs were identified and evaluated. Studies of concentrations of PTEs in fish tissues covered 28 ecosystems (108 localities). The main studied river ecosystems were the Danube and the Sava, and the Međuvršje reservoir was the most studied standing water ecosystem. Among the most studied fish species were catfish (Silurus glanis), followed by pikeperch (Sander lucioperca), bream (Abramis brama), carp (Cyprinus carpio), and barbel (Barbus barbus). There were 48 "hot spot" sampling sites where concentrations of Hg, Cd, Pb, As, Ni, Fe, and/or Cu exceeded the maximum permitted concentrations (MPCs) prescribed by legislation. Elevated concentrations of these elements were the most detected in fish species sampled in the Danube, Sava, and rivers belonging to the Velika Morava basin. Hg concentrations were the most common above MPC in muscle tissue of species sampled from the Danube and Sava rivers. On the other hand, we can single out the species Vimba bream (Vimba vimba), sampled in Danube River in Zemun near Belgrade, as the safest species for human consumption due to the largest number of elements in fish meat below detection limits. Finally, having in mind all the criteria prescribed by U.S. EPA (2000), we identify and recommend two predatory fish species pikeperch (S. lucioperca) and catfish (S. glanis), and bottom-feeding fish species barbel (B. barbus) as bioindicators of PTEs contamination in Serbian waters., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Many countries around the world have recognized the need for using an electronic health record (EHR) system. However, there is limited literature that could serve as a guide during a lengthy and challenging process of planning, development, and implementation of the e-Health system. Since the EHR system was recently introduced in Serbia, the purpose of this communication is to describe our experience and lessons learned along the way., Methods: The key personnel involved in the implementation of the EHR system in Serbia that began in 2015 conducted in 2019 a retrospective narrative review of the process and early outcomes., Results: An incremental approach in the planning, development, and implementation of the nationwide EHR system was taken. The process was split into phases with the gradual introduction of different regions of the country. The gradual shift from the existing to a new workflow for the prospective users was also implemented. The significant milestones were the achievement of quick legislative changes, the hiring of a professional team of experts in the field, the provision of timely and appropriate information and training to prospective users, the close collaboration between the implementation team and the Ministry of Health and mutual understanding of the aims and expectations, and the flexibility in accepting the evolving nature of the process, goals, and the system model., Conclusions: A successful implementation of the nationwide EHR system is feasible providing careful planning, the assembly of a multi-disciplinary team, the use of a stepwise approach, the early and continued involvement of the intended users, and the willingness to make adjustments along the way. The end-result sets the stage for the reform of the health care system itself., Competing Interests: Conflict of Interest The authors declare that they have no conflicts of interest in the research.

Introduction : Clostridioides difficile ( C. difficile ) infection (CDI) is one of the most common healthcare-associated (HA) infections in contemporary medicine. The risk factors (RFs) for HA CDI in medical and surgical patients are poorly investigated in countries with a limited resource healthcare system. Therefore, the aim of the study was to investigate differences in patients' characteristics, factors related to healthcare and outcomes associated with HA CDI in surgical and medical patients in tertiary healthcare centre in Serbia. Materials and Methods : A prospective cohort study was conducted including adult patients diagnosed with initial episode of HA CDI, first recurrence of disease, readmission to hospital, while deaths within 30 days of CDI diagnosis and in-hospital mortality were also recorded. Patients hospitalized for any non-surgical illness, who developed initial HA CDI were assigned to medical group, whereas those who developed initial HA CDI after surgical procedures were in surgical group. The data on patients' characteristics and factors related to healthcare were collected, too. Results : During 7-year period, from 553 patients undergoing in-hospital treatment and diagnosed with CDI, 268 (48.5%) and 285 (51.5%) were surgical and medical patients, respectively. Age ≥ 65 years, use of proton pump inhibitors, chemotherapy and fluoroquinolones were positively associated with being in medical group, whereas admission to intensive care unit and use of second- and third-generation cephalosporins were positively associated with being in surgical group. Conclusions : Based on obtained results, including significant differences in 30-day mortality and in-hospital mortality, it can be concluded that medical patient were more endangered with HA CDI than surgical ones.

Introduction: Healthcare-associated infections (HAIs) and irrational use of antibiotics in healthcare settings are major global public health concerns. Surveillance of HAIs in intensive care units (ICU), surgical-site infections (SSIs), and Clostridium difficile infections (CDIs), together with implementation of antibiotic stewardship, are cornerstones of hospital infection prevention programs. The aim of this study was to evaluate antibiotic consumption, especially of broad spectrum antibiotics, in relation to HAI incidence density (ID)., Methodology: The study was conducted from 2011 to 2016 in a tertiary hospital, the Military Medical Academy (MMA), in Belgrade, Serbia. Through regular hospital surveillance we identified all patients with a new HAI. Data on consumption of antibacterials for systemic use were expressed as defined daily dose per 100 bed days (DDD/100 BD)., Results: The highest incidence density (ID) of HAI was observed among patients in surgical ICUs (47.2 per 1000 patient-days), while the highest incidence rate among SSI was 3.7%. Moreover, the highest ID of CDI in medical patients was 6.2 per 10,000 patient-days, while in surgical patients it was 4.3 per 10,000 patient-days. The most frequently used antibiotics were cephalosporins, aminoglycosides and carbapenems (16.0 ± 2.3, 4.8 ± 0.7, 4.3 ± 0.7 DDD/100 BD, respectively). There was no significant correlation between consumption of any groups of antibiotics and ID of CDI in medical and surgical patients., Conclusion: The multidisciplinary healthcare team would have crucial importance in the implementation of the antibiotic stewardship program in order to decrease unnecessary exposures of patients treated in healthcare settings., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2018 Aneta Perić, Viktorija Dragojević-Simić, Bojana Milenković, Sandra Vezmar Kovačević, Vesna Šuljagić.)

Background/aim: Cancer, one of the leading causes of mortality in the world, imposes a substantial economic burden on each society, including Serbia. The aim of this study was to evaluate the major cancer cost drivers in Serbia., Methods: A retrospective, in-depth, bottom-up analysis of two combined databases was performed in order to quantify relevant costs. End-of-life data were obtained from patients with cancer, who deceased within the first year of the established diagnose, including basic demographics, diagnosis, tumour histology, medical resource use and related costs, time and cause of death. All costs were allocated to one of the three categories of cancer health care services: primary care (included home care), hospital outpatient and hospital inpatient care., Results: Exactly 114 patients were analyzed, out of whom a high percent (48.25%) had distant metastases at the moment of establishing the diagnosis. Malignant neoplasms of respiratory and intrathoracic organs were leading causes of morbidity. The average costs per patient were significantly different according to the diagnosis, with the highest (13,114.10 EUR) and the lowest (4.00 EUR) ones observed in the breast cancer and melanoma, respectively. The greatest impact on total costs was observed concerning pharmaceuticals, with 42% of share (monoclonal antibodies amounted to 34% of all medicines and 14% of total costs), followed by oncology medical care (21%), radiation therapy and interventional radiology (11%), surgery (90%), imaging diagnostics (9%) and laboratory costs (8%). CONCLUSION. Cancer treatment incurs high costs, especially for end-of-life pharmaceutical expenses, ensued from medical personnel tendency to improve such patients' quality of life in spite of nearing the end of life. Reimbursement policy on monoclonal antibodies, in particular at end-stage disease, should rely on cost-effectiveness evidence as well as documented clinical efficiency.

The concentrations of iron, lead, cadmium, copper, manganese, mercury and arsenic were measured in water, sediment, five macrophytes (Typha angustifolia, Iris pseudacorus, Polygonum amphybium, Myriophyllum spicatum and Lemna gibba) and five fish species (Sander lucioperca, Abramis brama, Carassius gibelio, Silurus glanis and Arystichtys nobilis) in the Gruža Reservoir, used for water supply and recreational fishing. The concentrations of all examined elements were higher in sediment than in water. The values of the ratio between element concentrations in the sediment and those in the water were the highest for Fe and As. Among the five plant species, the highest concentrations of Pb and Mn were observed in T. angustifolia, while the highest concentrations of Fe, Cu and Hg were in L. gibba. I. pseudacorus and P. amphybium had the highest concentrations of Cd and As, respectively. Among the fish species, C. gibelio showed the highest tendency of element accumulation (Fe, Cd, Cu), followed by S. lucioperca (Pb, Hg), A. brama (Mn) and A. nobilis (As). The average concentrations of elements in fish muscle, except for As in A. nobilis (2.635 ± 0.241 mg kg(-1) ww), were below the limits that are considered safe for human consumption in accordance with the European Commission Regulation and Official Gazette of Serbia.