Vojnosanitetski pregled

Influenza surveillance in the Autonomous Province of Vojvodina, Serbia, over ten consecutive seasons (2015/16–2024/25): epidemiological trends, fatal case characteristics, and vaccination

Mioljub Ristić — 2025-12-26

Background/Aim. Influenza represents a significant public health concern. The aim of this study was to analyze indicators of influenza activity over ten consecutive seasons in the Autonomous Province of Vojvodina (APV), Serbia, including age-specific and weekly distribution, and characteristics of influenza-related mortality. In addition, influenza vaccination trends in APV over the past ten seasons were assessed. Methods. A retrospective study was conducted using data from sentinel surveillance of influenza-like illness (ILI) and acute respiratory infections (ARI) among outpatients, as well as severe acute respiratory infection (SARI) and acute respiratory distress syndrome (ARDS) among hospitalized patients with fatal outcomes, along with data on the number of individuals vaccinated against influenza in APV. Laboratory confirmation of influenza-related deaths was performed at the Virology Center, Institute of Public Health of Vojvodina, Novi Sad, Serbia. Results. ILI and ARI incidence varied seasonally, peaking typically between surveillance weeks 5 and 10. The 2020/21 season showed markedly low influenza virus activity, while the 2021/22–2024/25 seasons displayed patterns typical of influenza seasons. Throughout the surveillance period, children aged 0–4 and 5–14 exhibited the highest incidence rates. Over the ten seasons, 202 laboratory-confirmed influenza-associated deaths were recorded, predominantly among men aged 24–64 years, occurring mainly during winter months. None of the patients had been vaccinated. The most common influenza A subtype was A (H1N1)pdm09 (59.4%). Fatal cases were almost evenly distributed between SARI (49.0%) and ARDS (51.0%), with ARDS being more common in adults aged 24–64 years. No statistically significant difference in the distribution of fatal outcomes was observed between the pre- and post-coronavirus disease 2019 periods (p = 0.6870). Influenza vaccination coverage among high-risk populations remained low, peaking at 17.5% among individuals ≥ 65 years in the 2020/21 season. Among healthcare workers, coverage reached over 40.0% in 2020/21 but declined to 20.0–25.0% in the subsequent seasons. Conclusion. Integrated sentinel and hospital-based surveillance encompasses monitoring of outpatient, severe, and fatal influenza cases. A significant increase in influenza vaccination coverage among high-risk groups could reduce hospitalization rates, the frequency of complications, and influenza-related deaths.

Validity and reliability of the A-test in assessing the functional capacity of patients with heart failure

Dejan Ilić — 2025-12-26

Background/Aim. Before initiating early rehabilitation, it is essential to assess the functional status of patients with heart failure (HF). Although the Barthel Index (BI) is well-established, the A-test, originally developed for traumatology and orthopedic patients, has recently been introduced into broader clinical practice. The aim of this study was to evaluate the validity and reliability of the A-test in assessing functional status in patients with HF. Methods. The study included patients of both sexes with HF, regardless of age or left ventricular ejection fraction, classified according to the New York Heart Association (NYHA) I–IV class, with Mini-Mental State Examination (MMSE) scores ≥ 24, who were tested daily at the same time. Two experienced senior physiotherapists performed the testing, and they completed the A-test and BI separately. Results. A total of 77 patients were enrolled, two-thirds of whom were male, with a mean age of 72 years and a mean ejection fraction of 41.83% [standard deviation (SD) = 11.46]. The average NYHA class at admission, 2.75 (SD = 1.05), and discharge, 2.42 (SD = 1.12), showed a statistically significant improvement (Z = -4.914, p < 0.001). Content validity was supported by low floor (minimal score = 2.0%) and ceiling (maximal score = 10.8%) effects, a wide range of scores (0–50), and appropriate score distribution. Concurrent validity was confirmed by a strong correlation between the A-test and BI (ρ = 0.991, p < 0.001). Predictive validity was demonstrated, as the A-test score on the first day significantly predicted BI at discharge (β = 0.880, p < 0.001, 95% confidence interval: 1.087–1.562). Construct validity was confirmed through four hypotheses. Patients in NYHA class I–II, with higher MMSE scores and higher left ventricular ejection fractions, scored significantly better on the A-test. Age had a significant effect on the results. The A-test demonstrated excellent internal consistency (α = 0.971) and high inter-rater reliability (κ = 0.842). Conclusion. The A-test is a valid and reliable instrument for evaluating the functional capacity of patients with HF.

Inhibition of colorectal cancer cell proliferation, invasion, and migration, and induction of epithelial-mesenchymal transition via TFF1 silencing

Jing Zhao — 2025-12-26

Background/Aim. The identification of aberrant genes associated with colorectal cancer (CRC) and understanding their pathogenic mechanisms are important for early diagnosis and the determination of appropriate therapy. The aim of this study was to examine the impact of trefoil factor 1 (TFF1) on the proliferation, invasion, and migration of CRC cells. Methods. The expression of TFF1 in 40 CRC tissue samples was assessed using immunohistochemistry. Additionally, the expression of TFF1 in CRC cell lines HCT116 and Caco-2 was determined using real-time quantitative polymerase chain reaction (qPCR) and Western blot analysis. Then the Caco-2 cell line was transfected with a lentivirus-packaged small interfering ribonucleic acid to silence TFF1 expression. The cell counting kit-8 assay and cell colony formation assay were used to assess cell proliferation and colony formation capacity, while the Transwell assay and wound healing assay were used to assess cell invasion and migratory ability. Subsequently, the expression levels of E-cadherin and vimentin were assessed using qPCR and Western blotting to study the relationship between TFF1 expression and epithelial-mesenchymal transition. Results. The positive rate of TFF1 expression in CRC tissues was 35% (14/40). The HCT116 cell line demonstrated modest levels of TFF1 expression, while the Caco-2 cell line exhibited significant levels. Caco-2 cells expressed less TFF1 messenger ribonucleic acid and protein after TFF1 silencing. The proliferative and colony-forming powers of Caco-2 cells, as well as their invasion and migratory capabilities, were subsequently seen to decrease. Furthermore, silencing TFF1 expression led to an increase in E-cadherin expression and a decrease in vimentin expression. Conclusion. Caco-2 CRC cells can be inhibited from proliferating, migrating, and invading by silencing TFF1 expression. TFF1 may play a significant role in the initiation, development, and metastasis of CRC by promoting epithelial-mesenchymal transition.

Nerve-sparing vs. non-nerve-sparing open radical prostatectomy: correlations between International Index of Erectile Function and corpus cavernosum electromyography

Saša Vojinov — 2025-12-26

Background/Aim. Erectile dysfunction (ED) increases with age, and the importance of sexual health has become more widespread in therapeutic practice. The aim of this study was to evaluate the correlation between subjective and objective measures of ED in patients undergoing nerve-sparing vs. non-nerve-sparing open radical prostatectomy for localized prostate cancer. Methods. This prospective controlled study included 50 patients with diagnosed prostate cancer and normal preoperative erectile function (EF). Patients were divided into nerve-sparing (n = 25) and non-nerve-sparing (n = 25) groups. EF was assessed preoperatively and at six months using the International Index of Erectile Function (IIEF) questionnaire, while corpus cavernosum electromyography recorded spontaneous smooth muscle activity. Statistical analysis included paired t-tests and Spearman’s correlations. Results. Postoperative IIEF scores declined significantly in both groups (nerve-sparing: 22.04 ± 2.10 to 17.87 ± 3.83, p < 0.001; non-nerve-sparing: 21.67 ± 2.64 to 6.42 ± 1.51, p < 0.001). Bilateral nerve-sparing preserved superior EF compared to unilateral preservation (19.87 ± 2.80 vs. 14.13 ± 2.42, p < 0.001). No significant correlation was found between corpus cavernosum electromyography parameters (amplitude, mean wave, phase reversals) and IIEF scores (p > 0.05). Conclusion. Nerve-sparing open radical prostatectomy, particularly bilateral techniques, significantly reduces ED severity. However, corpus cavernosum electromyography did not correlate with patient-reported outcomes, suggesting its limited standalone utility in postoperative ED assessment.

Development of a personalized sound therapy system and its therapeutic effect on subjective tinnitus patients

Tao Wu — 2025-12-26

Background/Aim. Tinnitus is a prevalent auditory condition that significantly affects the quality of life. Despite the variety of treatments available, their effectiveness is inconsistent. The aim of this study was to evaluate the impact of a newly developed sound therapy system on tinnitus patients, specifically in terms of changes in audiology, tinnitus-related tests, and tinnitus psychoacoustic characteristics. Methods. A total of 100 patients with tinnitus were included in the study. They were divided into two groups: the control group (CG) (n = 48) and the treatment group (TG) (n = 52). Various demographic characteristics of the patients were recorded. All patients had a thorough audiological assessment, which included pure tone audiometry and acoustic immittance testing, as well as tinnitus-specific evaluations, such as tinnitus frequency matching, tinnitus loudness matching, minimum masked level (MML), and residual inhibition (RI) examinations. In addition, psychoacoustic characteristics of tinnitus were assessed, including Tinnitus Handicap Inventory (THI), Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI), and Visual Analog Scale (VAS) scores. Results. There were no significant differences in various demographic characteristics between CG and TG before acoustic therapy. Additionally, there were no significant differences between the groups in audiometric assessments, tinnitus-related tests, psychological acoustic characteristics before treatment, or in the distribution of tinnitus frequencies. The hearing threshold level in TG was notably lower than in CG (p = 0.0238). Tinnitus loudness was significantly reduced in TG (p = 0.0256). MML in TG tended to improve (p = 0.0532), although this difference did not reach statistical significance and showed a positive trend. Among the subscales of THI, TG demonstrated significant improvements. PSQI scores also indicated they were significantly lower in TG than in CG (p = 0.0238). The total score on HADS (16.58 ± 2.89 vs. 16.67 ± 2.76; p = 0.8730) and the total score on VAS (4.19 ± 1.48 vs. 4.22 ± 1.37; p = 0.9160) did not show a significant difference. Conclusion. Acoustic therapy significantly improves patients’ hearing, reduces tinnitus loudness, and improves sleep quality. Our acoustic therapy system is an effective strategy for alleviating chronic subjective tinnitus.

Correlation between clinically and histopathologically measured tumor width in basal cell carcinoma

Branislava Gajić — 2025-12-26

Introduction/Aim. Basal cell carcinoma (BCC) is the most common malignant skin tumor in fair-skinned populations. Although it has low metastatic potential, it can be highly locally invasive and, in addition to impairing function, may even pose a threat to life itself. The majority of BCCs can be successfully reated by classical surgical excision with appropriate safety margins. The aim of this study was to evaluate the correlation between clinical and histopathological tumor width in excised BCCs. Methods. A prospective clinical and histopathological study included 45 subjects consecutively examined at the Department of Dermatologic Surgery and Skin Tumors, University Clinical Center of Vojvodina, Novi Sad, Serbia, with a total of 60 primary BCC specimens obtained by classical surgical excision. Medical history was recorded, and dermatological examination was performed. Prior to the excisional biopsy, an incision was made along the edge of the clinically visible tumor to the level of the papillary dermis, and the standard recommended safety margin was added. Histopathological assessment involved microscopic analysis at various magnifications. The histopathological tumor width was measured using a millimeter ocular. The total clinically estimated tumor width was determined as the distance between the two stated skin incisions, and the distance from the incision to the histopathological tumor margin was also recorded. Results. A statistically significant correlation was found between clinically determined and microscopically measured total tumor width (p < 0.05). The mean clinically estimated width was 9.55 ± 5.13 mm, while the histopathological width was 7.98 ± 4.75 mm. The statistically determined difference between the clinically marked and microscopically measured tumor width was less than 2.0 mm in 96.7% of cases, i.e., in 88.4% of cases, this difference in assessment was 1.0 mm or less. Conclusion. There is a positive correlation between the clinically assessed and histopathologically verified width of the BCC.