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Background and Objectives : Patients undergoing chronic hemodialysis (HD) are predisposed to both thrombotic and bleeding complications due to the complex interplay of end-stage renal disease (ESRD), cardiovascular comorbidities, and the routine use of anticoagulant and antiplatelet therapies. This study aimed to investigate the incidence of bleeding and thrombotic events in chronic HD patients receiving anticoagulant and antiplatelet therapy, with a specific focus on those with atrial fibrillation (AF). Materials and Methods : A total of 224 patients, with 43 (19%) of them diagnosed with AF, were included in this single-center, observational cohort study conducted over 24 months. The cohort was divided into three groups: patients without anticoagulation, those on warfarin monotherapy, and those on combined warfarin and aspirin therapy. Bleeding events were classified as major, clinically relevant non-major bleeding (CRNMB), or minor bleeding, while thrombotic events included ischemic stroke, myocardial infarction, pulmonary embolism, and arteriovenous fistula thrombosis. Results : Overall, 35.7% of patients experienced a bleeding event, with major bleeding occurring in 9.4%. Patients with AF had significantly higher rates of major bleeding (18.6%) compared to those without AF (7.18%; p = 0.043), especially in the combined therapy group. Mortality due to bleeding was also higher in AF patients (14%). In contrast, thrombotic events occurred in 26.8% of patients, with AF patients experiencing significantly more events (48.8%) compared to non-AF patients (21.5%; p = 0.0006). The hazard ratio (HR) for major bleeding in patients on combined warfarin and aspirin therapy was 2.56 ( p = 0.016), while the HR for thrombotic events was 2.34 ( p = 0.0202). Conclusions : These findings highlight the increased risks of both bleeding and thrombosis in chronic HD patients with AF, particularly those on combined anticoagulation and antiplatelet therapy.

Background: A significant reduction in bacterial growth on stethoscope membranes has been noticed after performing daily disinfection. Nevertheless, disinfection is rarely performed. We aimed to assess self-reported stethoscope disinfection practices among medical doctors, detect bacterial contamination on personal stethoscopes, and estimate the effectiveness of 70% ethanol as a stethoscope disinfecting agent., Methods: To determine stethoscope disinfection practices, participants filled out a questionnaire (N = 47), followed by providing stethoscopes for bacterial analysis. Differences in bacterial contamination were observed through the self-reported frequency and method of stethoscope disinfection. The effect of disinfecting with 70% ethanol was evaluated by comparing the presence of bacterial growth before and after disinfection., Results: The presence of bacterial growth was found in 78.7% of the stethoscope samples, with the median (interquartile range) number of colony-forming units at 25 (10-105). The frequency of disinfection greatly impacted the number of colony-forming units, and the method affected the presence of bacterial growth. Disinfection of stethoscope membranes using 70% ethanol resulted in a compelling 97.3% reduction of bacterial growth., Conclusions: Adequate stethoscope disinfection is highly efficient in reducing bacterial contamination and as such should be considered a critical step in hygienic practices., (Copyright © 2023 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Bosnia and Herzegovina (BiH) and Serbia are countries in the Western Balkans that share parts of their social and political legacy from the former Yugoslavia, such as their health care system and the fact that they are not members of European Union. There are very scarce data on COVID - 19 pandemic from this region when compared to other parts of the world and even less is known about its impact on the provision of renal care or differences between countries in the Western Balkans., Materials and Methods: This observational prospective study was conducted in two regional renal centres in BiH and Serbia, during the COVID - 19 pandemic. We obtained demographic and epidemiological data, clinical course and outcomes of dialysis and transplant patients with COVID - 19 in both units. Data were collected a via questionnaire for two consecutive time periods: February - June 2020 with a total number of 767 dialysis and transplant patients in the two centres, and July - December 2020 with a total number of 749 studied patients, corresponding to two of the largest waves of the pandemic in our region. Departmental policies and infection control measures in both units were also recorded and compared., Results: For a period of 11 months, from February to December 2020, 82 patients on in-centre haemodialysis (ICHD), 11 peritoneal dialysis patients and 25 transplant patients who tested positive for COVID-19. In the first study period, the incidence of COVID - 19 positive in Tuzla was 1.3% among ICHD patients, and there were no positive peritoneal dialysis patients, or any transplant patients who tested positive. The incidence of COVID-19 was significantly higher in both centres in the second time period, which corresponds to the incidence in general population. Total deaths of COVID-19 positive patients was 0% in Tuzla and 45.5% in Niš during first, and 16.7% in Tuzla and 23.4% in Niš during the second period. There were notable differences in the national and local/departmental approach to the pandemic between the two centres., Conclusion: There was poor survival overall when compared to other regions of Europe. We suggest that this reflects the lack of preparedness of both of our medical systems for such situations. In addition, we describe important differences in outcome between the two centres. We emphasize the importance of preventative measures and infection control and highlight the importance of preparedness., (© 2023. The Author(s).)

Many adolescents worldwide have the problem of meeting recommended nightly sleep hours. The causes of sleep disturbance are multifactorial, but interest in food's effect on sleep has dramatically increased lately. In this study, we investigated the association between regular energy drink (ED) intake (weekly or more frequent) and sufficient sleep (SS) (≥8 h) in adolescents. Additional objectives were to examine the relationship between health-related behaviors and SS, stratified by gender. A population-based cross-sectional study was conducted during the 2019/2020 school year from 12 schools in Belgrade. There were 1287 students aged 15 to 19 who participated (37.4% male). We used a modified version of the food frequency questionnaire adapted for Serbian adolescents. Logistic regression revealed that regular ED consumption was an independent risk factor negatively related to SS in both sexes. Additionally, daily vegetable and water intake (≥2 L) showed a positive correlation with SS in boys, while in girls, the odds of realizing SS decreased with statements of sedative use. In conclusion, we show that ED intake is negatively associated with SS in both sexes; daily vegetable and water intake (≥2 L) may raise the odds of SS in boys, while sedative use may decrease the chances of SS in girls.

Objectives: Adults aged 65 years and older comprise one fifth of the Serbian population. Many of them have multiple, often diet-related comorbidities. We aimed to investigate their dietary habits by comparing them with younger adults' and to determine the relation of the differing ones to demographic, socioeconomic and health factors. Methods: We performed a secondary analysis of 2013 Serbian National Health Survey data on 14,082 adults. Binary logistic regression was used to determine dietary habits associated with older age (≥65 years) compared to younger age (18-64 years) and to assess their independent predictors in older adults. Results: Older adults more often reported everyday breakfast (OR = 2.085, 95%CI = 1.622-2.680) and brown/wholegrain bread consumption (OR = 1.681, 95% CI = 1.537-1.839), while using margarine (OR = 0.578, 95%CI = 0.397-0.839), discretionary salt (sometimes: OR = 0.648, 95%CI = 0.596-0.705, almost always: OR = 0.522, 95%CI = 0.445-0.614) and consuming fish (two or more times a week: OR = 0.465, 95%CI = 0.383-0.566) less frequently than younger adults. This was mainly positively related to urban environment, affluence, higher education and poor health. Conclusion: Using nationally representative data, we found that older adults reported healthier dietary habits compared to younger adults, which requires timely public health action., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Stosovic, Vasiljevic, Jovanovic, Cirkovic, Paunovic and Davidovic.)

This systematic review assesses the quality of the evidence across studies on the effect of environmental noise (road traffic noise, aircraft noise, railway noise, wind-turbine noise) on quality of life, wellbeing and mental health. Quantitative studies of noise effects on children and adults published from January 2005 up to October 2015 were reviewed. A total of 29 papers were identified. 90% of the papers were of cross-sectional design, with fewer studies of longitudinal or intervention design. Outcomes included depression and anxiety, medication use and childhood emotional problems. The quality of the evidence across the studies for each individual noise source was assessed using an adaptation of the GRADE methodology. Overall, given the predominance of cross-sectional studies, most evidence was rated as very low quality, with evidence of effects only being observed for some noise sources and outcomes. These ratings reflect inconsistent findings across studies, the small number of studies and a lack of methodological robustness within some domains. Overall, there are few studies of clinically significant mental health outcomes; few studies of railway noise exposure; and studies of large samples are needed. The lack of evidence for noise effects across studies for many of the quality of life, wellbeing and mental health domains examined does not necessarily mean that there are no effects: rather, that they have not yet been studied robustly for different noise sources.

This systematic review assesses the quality of the evidence across individual studies on the effect of environmental noise (road traffic, aircraft, and train and railway noise) on cognition. Quantitative non-experimental studies of the association between environmental noise exposure on child and adult cognitive performance published up to June 2015 were reviewed: no limit was placed on the start date for the search. A total of 34 papers were identified, all of which were of child populations. 82% of the papers were of cross-sectional design, with fewer studies of longitudinal or intervention design. A range of cognitive outcomes were examined. The quality of the evidence across the studies for each individual noise source and cognitive outcome was assessed using an adaptation of GRADE methodology. This review found, given the predominance of cross-sectional studies, that the quality of the evidence across studies ranged from being of moderate quality for an effect for some outcomes, e.g., aircraft noise effects on reading comprehension and on long-term memory, to no effect for other outcomes such as attention and executive function and for some noise sources such as road traffic noise and railway noise. The GRADE evaluation of low quality evidence across studies for some cognitive domains and for some noise sources does not necessarily mean that there are no effects: rather, that more robust and a greater number of studies are required., Competing Interests: The authors declare no conflict of interest. The design of the study was undertaken by the World Health Organization Europe.

The aim of this pilot study was to calculate the disability-adjusted life years (DALY) as a quantification of the burden of myocardial infarction (MI) attributable to road-traffic noise in Belgrade, Serbia. Exposure to road-traffic noise was estimated on a sample of almost 6000 adult inhabitants living in the central municipality Stari Grad in Belgrade, Serbia. Each participant was assigned to daytime noise levels for 16 h exposure measured on the street of current residence. Population-attributable fraction of MI due to road-traffic noise was calculated based on the distribution of the population in different noise exposure categories and the respective relative risk of MI compared to the reference level. DALYs due to noise-related MI were calculated as the sum of years of life lost and years with disability. The contribution of road traffic noise to the occurrence of MI for the population of the municipality Stari Grad in Belgrade equals 2.518%. Total DALY for MI due to road-traffic noise results in 176 years, that is, 115 years for men and 61 years for women. When adjusted for the present size of the population in Belgrade, total DALY due to road-traffic noise equals 107 years/million inhabitants that is, 70/million inhabitants for men and 37/million inhabitants for women. The burden of disease due to road-traffic noise in Belgrade is relatively small but noteworthy from the public health point of view.

The aim of the study was to investigate the relationship between noise levels, traffic density and the presence of public transport and children's blood pressure. Another aim was to assess the applicability of public transport as a proxy indicator of noise exposure. A cross-sectional study involved 1113 children aged 7-11 years from a central municipality in Belgrade. Equivalent noise levels were measured in front of all schools and in the middle of all streets. Traffic density was defined as number of light and heavy vehicles per hour. The number of public transport vehicles was calculated from official timetables. Children's addresses were matched with noise levels and transport maps. A physician measured blood pressure with the sphygmomanometer. Children attending schools with public transport running nearby had by 1.3 mmHg higher systolic pressure than did children from schools without public transport. This relationship was independent from children's age, gender, and body mass index, family history of hypertension, some dwelling characteristics, and lifestyle habits. The association between diastolic pressure and public transport was statistically insignificant. The study indicated a possible positive association between the presence of public transport in the vicinity of schools with systolic blood pressure in 7-11 year-old schoolchildren. The presence of public transport may serve as an auxiliary indicator of noise exposure in undeveloped countries with limited capacities for noise measurement or modeling.

Arsenic in drinking water presents a serious public health problem in Serbia, but its relationship with diabetes has not been studied previously. The aim of this study was to explore the association between exposure to arsenic in drinking water and the occurrence of type 2 diabetes in Middle Banat region, Serbia. This cross-sectional study comprised two populations. Exposed population in Middle Banat region consumes drinking water with arsenic (mean = 56 μg/L); unexposed population from six regions in Central Serbia consumes arsenic below detection limit (2 μg/L). Newly diagnosed cases of type 2 diabetes were obtained from the National Registry of Diabetes in 2008. The Registry included age, gender, family history of diabetes, presence of overweight, central obesity, cholesterol and triglyceride levels. In addition, the number of cases of diabetes reported in years 2006, 2007 and 2009 was used to calculate standardized incidence rates for both populations. Two populations were comparable by age, family history of diabetes and prevalence of overweight persons. Unexposed population was more likely to have central obesity, and high total cholesterol and triglycerides. Standardized incidence rates of type 2 diabetes were higher in exposed population. Odds ratios for type 2 diabetes were significantly higher for the exposed population, both men and women, in the period from 2006 to 2009, when compared with the unexposed population. The population from Middle Banat region, consuming drinking water with low levels of arsenic, was at higher risk for the occurrence of type 2 diabetes in comparison to the unexposed population in Central Serbia., (Copyright © 2012 Elsevier GmbH. All rights reserved.)

Many reviews have documented the adverse effects of noise on children's health, but the international scientific community was previously unfamiliar with noise research in Central and Eastern Europe (CEE), South-East Europe (SEE), and Newly Independent States (NIS). The aim of this review was to present studies on the effects of noise on children's health, conducted in aforementioned countries in the second half of the 20 th century, interpret their findings, and criticize their methodology and results wherever possible. This review focused on 30 papers published in national journals in the period from 1965 to 2000. By design, 22 studies were observational and cross-sectional, and eight studies were experimental. The outcomes under the study included auditory changes, stress reactions, sleep disturbances, school performance, upright posture, and vegetative functions. Researchers from CEE, SEE, and NIS were the pioneers in the assessment of noise-induced changes of vegetative functions and blood pressure of children in urban areas, as well as of infants exposed to noise in incubators. Future research should focus on intervention studies and follow-up of children's health in relation to noise exposure.

The systems of public complaints on environmental noise were reviewed in seven countries of Central and Eastern Europe (CEE), South-East Europe (SEE), and Newly Independent States (NIS). Public complaints remain an important issue due to differences in public sensitivity to noise and due to several cases where a measurement of noise intensity does not give a satisfying solution to the problem. The unresolved problem remaining in the residential neighborhoods is the noise from pubs and restaurants that are open until late in the night. In our review, we compiled information on the institutions responsible for the implementation of environmental noise legislation and organizations that are responsible for dealing with public complaints. Information on activities for increasing public awareness on hazards rising from environmental noise and the role of civil initiative was explored. In seven countries, and among them, Slovenia, Lithuania, Latvia, Slovakia, The Former Yugoslav Republic of Macedonia, Serbia, and Poland, the responsibilities and duties are shared among different institutions at national and regional levels, depending on the noise source. The problem of gathering information on complaints and using it for improving the wellbeing and health of citizens remains often difficult and unsolved.

Unlabelled: Assessment of liver fibrosis is important for making treatment decisions, as well as for predicting prognosis and therapeutic outcome in patients on chronic hemodialysis (HD) treatment and infected with hepatitis C virus (HCV). The aim of the present investigation was to evaluate changes in standard laboratory tests (AST, ALT, yGT, cholesterol and platelet count) and indirect serum fibrosis markers: AST-to-platelet ratio index (APRI), FIB-4 and Forns index, in chronically HCV-infected patients on maintenance HD with and without antiviral treatment., Patients and Methods: A total of 38 patients on chronic HD program more than 3 months and with chronic hepatitis C, were included in the study. According to local legislature 14 patients receive antiviral therapy (24 or 48 weeks, according to HCV genotype) adjusted for patients on HD: eight of them achieved sustained virological response (SVR) and six did not., Results: All treated patients were HCV genotype 1. Baseline blood samples for standard laboratory tests and indirect serum fibrosis markers were collected on the day of antiviral treatment initiation, as well as at the end of follow-up treatment, 36 month later. At the beginning of antiviral treatment there were no significant differences in APRI, FIB-4, Forns and its components between patients who will achieve SVR and those who did not. A significant decrease of AST, ALT, yGT and APRI, and moderate decrease FIB-4 and Forns index was found at the end of follow-up in patients with SVR. In non-sustained responders group those three indexes and its components remained unchanged. Using cut-of values for APRI and FIB-4 (APRI < 0.5 and FIB-4 < 1.45) it was registered that raised percentage of patients with "no fibrosis" at the end of follow-up in those who achieved SVR. Absence of fibrosis measured by Forns index remained unchanged in all groups of patients., Conclusion: Simple indexes as APRI and FIB-4, successfully decrease after antiviral treatment of chronic hepatitis C in hemodialysis patients. These parameters seems to be useful in monitoring for liver fibrosis rate after antiviral treatment in patients on maintenance HD infected by HCV and can be used for estimation liver fibrosis progression in candidates for cadaveric renal transplantation.

Research on the cardiovascular effects of noise in Serbia started in the year 2002, including experimental studies on humans and epidemiological studies on the adult and children population of Belgrade and Pancevo. Experimental exposure to noise [L eq = 89 dB (A)] had a hypodynamic effect, significantly lowering the cardiac index, cardiac work, and pump performance (P < 0.01). The vasoconstrictive effect of noise was shown through the significant elevation of after-load (P < 0.01). In a cross-sectional population study that was carried out on 2874 residents [1243 males and 1631 females] in Pancevo City, a significant odds ratio (adjusted for age, body mass index (BMI), and smoking habits) was found for self-reported hypertension (OR = 1.8, 95% CI = 1.0 - 2.4, P < 0.01) in men with a high level of noise annoyance compared to those with a low level of noise annoyance. In another study on 2503 residents (995 men and 1508 women) residents of Belgrade, the proportions of men with hypertension in the noisy [(L night , 8h > 45 dB (A)] and quiet areas [(L night , 8h ≤ 45 dB (A)] were 23.6% and 17.5%, respectively. The adjusted odds ratio (OR) for hypertension of the exposed group was 1.58 (95% CI = 1.03 - 2.42, P = 0.038), where men living in quiet streets were taken as a reference category. Associations between road traffic noise and blood pressure were also investigated in 328 preschool children in Belgrade. The systolic blood pressure was significantly higher among children from noisy residences and kindergartens, compared to children from both quiet environments (97.30 ± 8.15 and 92.33 ± 8.64 mmHg, respectively, P < 0.01). As a continuation of the study on preschool children, investigations were also carried out on 856 school children, aged between seven and eleven years, in Belgrade. It was found that systolic pressure was significantly higher among children from noisy schools and quiet residences, compared to children from both quiet environments (102.1 ± 9,3 and 100.4 ± 10.4 mmHg, respectively, P < 0.01).

Noise annoyance is influenced by sound-related factors: type of noise, noise level and frequency, and person-related factors-physiological, psychological, and social factors. Prior to implementation of the Directive 2002/49/EC of the European Parliament and of the Council in Serbia, there was a need for the first comprehensive study on noise annoyance in Serbian urban population. The aim of this study was to determine principal factors for high noise annoyance in an adult urban population and to assess their predictive value. A cross-sectional study was performed on 3097 adult residents of a downtown municipality in Belgrade (1217 men and 1880 women), aged 18-96 years. Equivalent noise levels [Leq (dBA)] were measured during day, evening and night in all streets of the municipality. Noise annoyance was estimated using self-reported annoyance scale. Noise annoyance showed strong correlation with noise levels, personal characteristics and some housing conditions. Dose-response relationship was found between the percentage of highly annoyed residents and Lden. Logistic regression model identified increased risk for a high level of noise annoyance with regard to: orientation of living room/bedroom toward the street (Odds Ratio=2.60; 95% Confidence Interval=2.04-3.31), duration of stay at apartment during the day [OR=1.04, 95%CI=1.02-1.06 (per hour)], noise sensitivity [OR=1.04, 95%CI=1.03-1.04 (per scale unit)], and nighttime road-traffic noise level [OR=1.03, 95%CI=1.02-1.04 (per decibel)].

Background: Left ventricular hypertrophy (LVH) is an independent risk factor for morbidity/mortality in patients with end stage renal disease (ESRD). Our study aimed to identify prevalence as well as independent risk factors that contribute to the development of LV geometric remodeling in our HD patients., Methods: The left ventricles of 116 HD patients were classified echocardiographically into four different geometric patterns on the basis of LV mass and relative wall thickness. Furthermore, we measured inferior vena cava (IVC) diameter and its collapsibility index (CI) by echocardiography. Finally, we modeled a stepwise multiple regression analysis to determine the predictors of LV geometry., Results: Our study provides evidence that HD patients had a prevalence of abnormal LV geometry in 92% and LVH in 81%. We found all four geometric models of LV. Most dominant were eccentric LVH. Concentric LVH was observed in 37, normal geometry (NG) in 9, and concentric remodeling (CR) in 13 of HD patients. Mean arterial blood pressure was significantly higher in the cLVH group (95 +/- 10 mmHg) than in the NG and CR groups (81.6 +/- 12.3 and 80 +/- 11.8, respectively, p < 0.001). The cLVH and eCLVH groups had significantly lower mean hemoglobin (10.3 +/- 1.4 g/dL and 10.6 +/- 1g/dL, respectively) compared with the NG group (11.9 +/- 1.4 g/dL), p < 0.001. Furthermore, interdialytic weight gain (kg) was significantly higher in eCLVH group (3.13 +/- 0.8) than in NG group (2.3 +/- 1.1), p < 0.001. Mean IVC index of the eLVH group (10.83 +/- 2.07 mm/m(2)) was significantly higher than corresponding indexes of NG (10.83 +/- 2.07 mm/m(2)), CR (8.31 +/- 1.32 mm/m(2)) and cLVH (8.12 +/- 2.06 mm/m(2)) groups (p < 0.001 for each comparisons)., Conclusion: Mean arterial pressure, hemoglobin, IVC index, and interdialytic weight gain were found to be independent predictors of LV geometry (R(2) = 0.147; p < 0.001) in HD patients.

Night time noise exposure has very rarely been used in previous studies on the relationship between community noise and children's blood pressure, although children spend a larger part of their night time sleeping at home than adults. For this reason, we focused on night time noise exposure at children's residences and daytime noise at kindergartens. The aim of this study was to investigate the effects of urban road-traffic noise on children's blood pressure and heart rate. A cross-sectional study was performed on 328 preschool children (174 boys and 154 girls) aged 3-7 years, who attended 10 public kindergartens in Belgrade. Equivalent noise levels (Leq) were measured during night in front of children's residences and during day in front of kindergartens. A residence was regarded noisy if Leq exceeded 45 dB (A) during night and quiet if the Leq was < or =45 dB (A). Noisy and quiet kindergartens were those with daily Leq>60 dB (A) and < or =60 dB (A), respectively. Children's blood pressure was measured with mercury sphygmomanometer. Heart rate was counted by radial artery palpitation for 1 min. The prevalence of children with hypertensive values of blood pressure was 3.96% (13 children, including 8 boys and 5 girls) with higher prevalence in children from noisy residences (5.70%), compared to children from quiet residences (1.48%). The difference was borderline significant (p=0.054). Systolic pressure was significantly higher (5 mm Hg on average) among children from noisy residences and kindergartens, compared to children from both quiet environments (p<0.01). Heart rate was significantly higher (2 beats/min on average) in children from noisy residences, compared to children from quiet residences (p<0.05). Multiple regression, after allowing for possible confounders, showed a significant correlation between noise exposure and children's systolic pressure (B=1.056; p=0.009).

Glassblowers are exposed to numerous physical and chemical noxious factors at their workplace. Mucosal layer of upper aerodigestive tract (nose, oral cavity, pharynx and larynx) is particularly vulnerable to the influence of these factors. Inhalation of hot gases, dust particles, and oral contact with glassblower's pipe are the most important factors that can cause chronic inflammation of the upper respiratory tract. The aim of this study was to examine the prevalence of chronic laryngitis in the group of glassblowers and control group of workers and to examine whether the observed differences depend on the membership in these two groups, on the duration of exposure, or on both factors. The results of the study show significantly higher prevalence of chronic laryngitis among glassblowers than among control group of workers employed in the same plant. On the other hand, the duration of exposure was not statistically significant factor for chronic laryngitis. The exposure to risk factors on the working place represents an independent risk factor for the occurrence of chronic laryngitis among glassblowers, when adjusted for other possible confounders, such as age, years of service, smoking habits and alcohol consumption.