Vojnosanitetski pregled

Assessing the impact of nintedanib and pirfenidone on lung function in idiopathic pulmonary fibrosis: a comprehensive meta-analysis

Zhaoji Luan, Amol Muthal, Smeeta Mohod — Thu, 26 Feb 2026 13:50:34 +0100

Background/Aim. The incidence of idiopathic pulmonary fibrosis (IPF) has been increasing each year. Although pirfenidone and nintedanib were approved in 2014, they received only conditional recommendations, and no medication has yet been strongly endorsed for IPF treatment. The aim of the study was to compare the safety and efficacy of pirfenidone and nintedanib. Methods. All randomized and non-randomized clinical trials were identified by searching databases for published studies, including Medline, Embase, Scopus, Google Scholar, and ClinicalTrials.gov. A meta-analysis was conducted to evaluate the impact of pirfenidone and nintedanib on clinical outcomes and safety. Patients treated with pirfenidone were compared with those treated with nintedanib. Results. This study included twelve papers. Both pirfenidone and nintedanib were found to significantly reduce the decline in mean forced vital capacity (FVC) and mean diffusion capacity of the lungs for carbon monoxide (DLco) at 6 and 12 months. No significant difference was observed between pirfenidone and nintedanib in terms of improvement in FVC or DLco. Similarly, both antifibrotic agents had similar safety profiles. However, patients receiving nintedanib experienced significantly fewer instances of diarrhea (p < 0.00001) compared to those receiving pirfenidone, whereas patients receiving pirfenidone experienced significantly fewer instances of skin rash (p < 0.00001) compared with those receiving nintedanib. Conclusion. Potential differences between pirfenidone and nintedanib can be inferred from the effectiveness ranking derived from this meta-analysis. Further direct comparative studies are necessary to explore this issue, which will help us better understand the potential of combinatorial, sequential, or adjunctive treatment regimens in which both antifibrotic agents might play a crucial role for a specific group of IPF patients.

Invasive pneumococcal and Haemophilus influenzae type b disease in the Autonomous Province of Vojvodina, Serbia (2003–2024): trends, vaccination impact, and serotype dynamics

Mioljub Ristić, Vladimir Petrović — Thu, 26 Feb 2026 13:52:37 +0100

Background/Aim. Invasive pneumococcal disease (IPD) and invasive Haemophilus influenzae type b (Hib) disease remain associated with significant morbidity and mortality. The aim of the study was to analyze long-term trends, age-specific and seasonal disease patterns, clinical outcomes, IPD serotype distribution, and the impact of immunization programs on these diseases in the Autonomous Province (AP) of Vojvodina, Serbia, from 2003 to 2024. Methods. A descriptive population-based study was conducted using data from the regional communicable disease surveillance system coordinated by the Institute of Public Health of Vojvodina. All reported cases of IPD and invasive Hib disease were included in the analysis. Results. The Hib immunization program introduced in 2006 led to a sustained reduction in invasive Hib disease, with only sporadic cases reported after 2009. IPD incidence fluctuated over the study period and has increased in recent years despite high coverage (≥ 90%) of the primary pneumococcal conjugate vaccine (PCV) series since 2019. PCV introduction markedly reduced the frequency of serotypes covered by PCV10. Serotype 3 and non-vaccine serotypes persisted, particularly among adults and infants aged < 1 year. Adults aged ≥ 40 years were predominantly affected by IPD, whereas invasive Hib disease mainly occurred in children aged 1–4 years. None of the patients had been previously vaccinated against IPD or invasive Hib disease. Case-fatality rates were significantly higher for IPD (9.6%) than for Hib disease (3.5%) (p = 0.0361). In the overall population, PCV10 serotypes declined sharply after vaccine introduction (from 55% to 22%), while PCV13-non-PCV10 serotypes remained stable (~40%), and non-vaccine serotypes increased (from 11% to 28%), with the additional emergence of PCV20-non-PCV15 serotypes. Conclusion. The Hib immunization program achieved sustained disease control in the AP of Vojvodina, while IPD remains a public health concern due to persistent serotype 3 and emerging non-vaccine serotypes. Continued surveillance and consideration of higher-valency pneumococcal vaccine (minimum PCV13) or adult-targeted vaccination strategies are crucial to further reduce disease burden.

Simultaneous assessment of TNF-α, TIM-1, and TLR4 plasma levels for predicting the severity of allergic rhinitis

Lijun Zhou, Chenke Shi, Feng Yuan — Thu, 26 Feb 2026 13:54:01 +0100

Background/Aim. Allergic rhinitis (AR) is a chronic inflammation of the nasal mucosa caused by allergens. To date, some individual biomarkers, such as total immunoglobulin E (IgE), have been shown to be possible factors for the assessment of the severity of AR. The aim of the study was to determine the value of simultaneously measuring the levels of tumor necrosis factor (TNF)-α, T-cell immunoglobulin and mucin domain 1 (TIM-1), and toll-like receptor 4 (TLR4) as predictors of AR severity. Methods. The study included two groups of respondents: the AR group – ARG (n = 96), which consisted of patients with AR treated between March 2021 and May 2023, and the control group – CG (n = 60), which consisted of healthy individuals undergoing physical examinations during the same period. Levels of TNF-α, TIM-1, and TLR4 were compared between the ARG and CG, and their associations with disease severity were analyzed. Results. Logistic regression analysis revealed that elevated eosinophil counts, IgE, TNF-α, TIM-1, and TLR4 levels were independent risk factors for the occurrence of moderate-to-severe AR (odds ratio > 1, p < 0.05). The areas under the receiver operating characteristic curves for plasma TNF-α, TIM-1, and TLR4 levels in predicting disease severity were 0.889, 0.831, and 0.842, respectively, while the combined predictive value reached 0.932, indicating excellent diagnostic performance. Conclusion. The simultaneous measurement of plasma TNF-α, TIM-1, and TLR4 levels provides a novel and reliable approach for predicting the severity of AR. Their combined assessment demonstrates higher predictive accuracy than that of individual markers, offering potential value for disease stratification and clinical decision-making.

Evaluation of the quality of neurosurgical services using the SERVQUAL method

Thu, 26 Feb 2026 13:55:03 +0100

Background/Aim. In an era of rapid technological innovation and growing patient expectations, healthcare systems worldwide face the need for continuous improvement in service quality. The Service Quality model (SERVQUAL) is a validated instrument for measuring service quality, based on comparing patients’ expectations with their perceptions of the service provided. The difference (gap) between these two measures is assessed using a five-point Likert scale across five dimensions: tangibility, reliability, responsiveness, assurance, and empathy. The aim of this study was to measure and compare expectations and perceptions of patients undergoing neurosurgical services, and to examine whether the size of the gap differs between SERVQUAL dimensions. Methods. The study included a total of 60 patients who underwent surgery for degenerative lumbar and cervical spine diseases at the Clinic for Neurosurgery, University Clinical Center of Vojvodina, Novi Sad, Serbia, between June and September 2024. A modified SERVQUAL questionnaire was used for data collection. Data were collected on admission and before the patients’ discharge. Data were analyzed using descriptive statistics, paired t-tests to compare expectations and perceptions, and analysis of variance to examine differences across sociodemographic groups. Results. Patients had positive perceptions of the provided services. The results indicated the existence of a gap between patients’ expectations and their perceptions of the services received. Mean expectations were high across dimensions (overall 4.85; range 4.79–4.88), as were perceptions (overall 4.90; range 4.85–4.94). All gaps were positive (perceptions > expectations). Dimension-specific gaps were as follows: tangibility 0.06 (p = 0.196), reliability 0.05 (p = 0.132), responsiveness 0.04 (p = 0.249), assurance 0.06 (p = 0.107), empathy 0.06 (p = 0.039). Only the empathy dimension reached statistical significance. No significant differences emerged across sociodemographic subgroups. Conclusion. The SERVQUAL method provided clear insights into patients’ perceptions of the quality of neurosurgical services. The findings from this study can contribute to improving service quality and increasing patient satisfaction, positively influencing clinical outcomes and the healthcare system as a whole.

Impact of the severity of obstructive sleep apnea-hypopnea syndrome on the quality of life and exercise tolerance in hypertensive patients

Thu, 26 Feb 2026 13:55:56 +0100

Background/Aim. Obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with impaired quality of life (QoL) and reduced exercise tolerance. The aim of the study was to determine whether the severity of OSAHS influences the QoL and exercise tolerance in patients with moderate to severe OSAHS and arterial hypertension. Methods. The study included 115 consecutive patients with arterial hypertension and either moderate [40 (34.78%)] or severe [75 (65.22%)] OSAHS. Exercise tolerance was assessed using the exercise stress test, while QoL was evaluated with the Short Form-36 (SF-36) questionnaire. Results. The groups under study did not differ significantly in terms of age (54.80 ± 8.91 vs. 53.55 ± 9.53, p = 0.494) or sex distribution [females: 11 (27.50%) vs. 13 (17.33%), p = 0.201]. A high prevalence of cardiovascular risk factors was observed in the study population. Patients with severe OSAHS had significantly higher body mass index and neck circumference. Obesity was also more frequent among patients with severe OSAHS. In addition, this group demonstrated significantly higher apnea-hypopnea index, desaturation index, and time spent with oxygen saturation below 90%. There were no statistically significant differences in either exercise tolerance or the SF-36 parameters between the groups. Furthermore, no significant correlations were observed between apnea-hypopnea index, exercise tolerance, and QoL parameters. Multivessel coronary artery disease was detected in two asymptomatic patients. Conclusion. Patients with OSAHS overall exhibit multiple cardiovascular risk factors and are characterized by reduced QoL and decreased exercise tolerance. No significant correlation was found between OSAHS severity and exercise tolerance and QoL. The detection of multivessel coronary artery disease in asymptomatic patients in the study underscores the clinical significance of screening for coronary heart disease in patients diagnosed with OSAHS.

Nikolai Sergeyevich Korotkov: 120 years of his arterial blood pressure measurement method

Ankica Jelenković — Thu, 26 Feb 2026 13:56:43 +0100

Nikolai Sergeyevich Korotkov (1874–1920) was a Russian military doctor and surgeon who discovered the technique of non-invasive measurement of arterial blood pressure. Measuring arterial blood pressure is possible based on the tones recorded with a stethoscope, now known as Korotkov sounds, using a sphygmomanometer. The tones disappear when the air pressure in the cuff placed around the upper arm exceeds the systolic pressure. The appearance of the first of a total of five tones occurs after the gradual deflation of the cuff and indicates the systolic pressure. It is several millimeters of mercury higher than that obtained by palpation of the radial artery, as was determined until then. The disappearance of the last, fifth tone, with a further reduction of air pressure in the cuff, indicates the diastolic pressure. Until that moment, measuring diastolic pressure in such a painless and simple manner had not been possible. Exactly 120 years have passed since Korotkov, at only 31 years of age, first announced his discovery in 1905 in Petrograd. The method was recognized by the professional community in 1939. Since then, Korotkov’s sounds have been accepted worldwide for measuring arterial blood pressure. This method has remained unsurpassed to this day.

Corrigendum: Clinical and laboratory status in Parkinson’s disease patients with and without polyneuropathy (vol. 81, no. 10, p. 613-8, 2024, https://doi.org/10.2298/VSP240528061P)

Thu, 26 Feb 2026 14:57:26 +0100