Background/Objectives: Congenital heart disease (CHD), affecting approximately 1% of live births, has transitioned to a chronic condition due to advances in diagnostics and surgery, resulting in an increasing adult congenital heart disease (ACHD) population. This study characterizes the clinical and demographic profiles of ACHD patients in Serbia, focusing on congenital anomalies, mortality rates, and key clinical factors to identify opportunities for improving care and outcomes. Methods: This observational single-center study was conducted at the Cardiovascular Institute “Dedinje” in Belgrade, Serbia, involving patients diagnosed or treated for CHD between 2006 and 2022. Results: A total of 1532 patients were included in the study, with common diagnoses including atrial septal defects (ASD) (47.65%) and ventricular septal defects (VSD) (13.19%). The mean patient age was 48.31 years, with a slight predominance of females (57.21%). The complexity of CHD was categorized as mild (54.6%), moderate (36.5%), and severe (6.3%). The mortality rate was 4.2%, with higher rates observed in conditions like Ebstein anomaly (17.78%) and congenital aortic stenosis (11.76%). Conclusions: This study provides a comprehensive overview of the current state of ACHD management in Serbia, highlighting the high prevalence of ASD and VSD among patients, the challenges associated with moderate and severe CHD, and the notable mortality rates for certain conditions. The findings underscore the importance of improving early detection, individualized treatment plans, and multidisciplinary care to enhance patient outcomes in this growing population.

BACKGROUND Arboviruses have expanded into new regions in Europe, yet data indicate gaps in disease notifications and a risk of further spread. We aimed to report on prevalence, clinical management, and outcomes of endemic arbovirus infections in southeast Europe. METHODS In this prospective observational study (MERMAIDS-ARBO), we enrolled adults (age ≥18 years) hospitalised with an arbovirus-compatible disease syndrome within 21 days of symptom onset across 21 hospitals in seven countries in southeast Europe over four arbovirus seasons (May 1-Oct 31, during 2016-19). We obtained data from case report forms completed by site investigators on admission and discharge. Participants were excluded if they had non-infectious CNS disorders, symptoms of another confirmed cause, an identified focal source of infection, or symptoms caused by recurrence of a pre-existing condition. The primary outcome was the proportion of participants with confirmed or probable acute infections with West Nile virus (WNV), tick-borne encephalitis virus (TBEV), Crimean-Congo haemorrhagic fever virus (CCHFV), or Toscana virus (TOSV), per reference laboratory criteria. Secondary outcomes were the proportions of patients treated with antivirals, antibiotics, or corticosteroids; the proportion of patients requiring intensive care; hospital length of stay; and mortality. FINDINGS Of 2896 adults screened for eligibility, 929 were recruited and 913 met protocol-defined eligibility criteria (median age 43·1 years [IQR 29·5-59·7]; 550 [60%] men, 361 [40%] women, and two [<1%] with missing data). 530 (58%) participants presented with suspected meningitis, encephalitis, or both, and 318 (35%) with fever plus myalgia, fever plus arthralgia, or both. 820 (90%) reported no international travel within 21 days before symptom onset. 727 (80%) were administered antibiotics, 379 (42%) corticosteroids, and 222 (24%) antivirals. The median length of hospital stay was 9 days (IQR 6-14), and 113 (12%) required intensive care. Of 847 participants with a reference laboratory sample who met full eligibility criteria for analysis, 110 (13%) were diagnosed with 114 confirmed or probable acute arbovirus infections (four had coinfections or cross-reactivity): one (<1%) with CCHFV, 16 (2%) with TBEV, 44 (5%) with TOSV, and 53 (6%) with WNV. There was one death (<1%) of an individual with WNV. Of the 110 participants, 49 (45%) had a local clinician-attributed arbovirus discharge diagnosis. INTERPRETATION Our data highlight the need to strengthen arbovirus surveillance systems for the early detection of emerging and re-emerging outbreaks, including investments to increase awareness of arbovirus infections among clinicians, to improve access to specialist diagnostics, and to develop effective and accessible vaccines and treatments to protect populations and health systems in southeast Europe. FUNDING European Commission and Versatile Emerging infectious disease Observatory. TRANSLATIONS For the Greek, Albanian, Romanian, Bosnian, Serbian, and Croatian translation of the summary see Supplementary Materials section.

Background/Objectives: This cross-sectional study aimed to produce an adapted Croatian version of the Negative Behaviors in Health Care Questionnaire and to validate it. Methods: The process comprised the translation, cultural adaptation, and psychometric evaluation of the questionnaire. Clinical specialists and qualified bilingual speakers participated in both forward and backward translation. Face validity was tested. The survey’s original developer approved the final version. The reliability of the questionnaire was assessed using the test–retest method and Cronbach’s alpha coefficient. Exploratory and confirmatory factor analyses and assessments of divergent and convergent validity were conducted. The collected data were analyzed using SPSS 21.0 and R, program version 3.5.2., for Windows. Results: A five-factor structure was obtained and confirmed via CFA, although not all fit coefficients were satisfactory. The internal consistency reliability was 0.86 for the contributing factors and the seriousness of aggression, 0.79 for the use of aggression, 0.95 for the fear of retaliation, and 0.83 for the frequency of aggression; in total, α = 0.88. Test–retest reliability was moderate. All correlations were statistically significant, and the correlation was the highest for seriousness (0.754) and frequency of aggression (0.725) and the lowest for contributing factors (0.528). Test–retest reliability was satisfactory. Statistically significant differences were found when comparing respondents by gender, age, work experience, education, and hierarchical position. Conclusions: The adapted, translated, and validated survey provides a valuable tool for assessing lateral and vertical aggression between and towards nurses in terms of contributing factors, frequency, severity, uses of aggression, and fear of retaliation.

OBJECTIVE This study aimed to assess the prevalence and analyze characteristics and symptoms of non-infectious sore-throat in teachers. STUDY DESIGN AND METHODS Adult persons employed as teachers were screened for non-infectious sore throat. A cross-sectional study was performed in patients with non-infectious sore throat confirmed based on clinical examination. RESULTS Out of 1008 teachers who participated in the screening, non-infectious sore throat was found in 70 respondents (6.9%). Most of the participants with non-infectious sore throat were women with a mean age of 45.5 years and a mean length of service 18.1 years. A small number of participants (n = 7, 10%) often visited a medical doctor because of throat problems. Over 80% of participants commonly used throat therapeutic agents. The most common symptoms were dry throat, tickling, and scratching in the throat. The oropharyngeal mucosa in most subjects was slightly red to red, the tonsils were normal, and there was no oropharyngeal enanthema. The median subjective assessments using the visual analog scale from zero to ten were four (interquartile range (IQR) 0-5) for pain, four (IQR 1-5) for difficulty in swallowing, and two (IQR 0-4) for swelling of the pharynx back wall. Of the analyzed risk factors, the highest percentages of participants were using air conditioning and consuming chilled and carbonated drinks, 21.4% were smokers and 10% of participants had a confirmed respiratory allergy. CONCLUSIONS The prevalence of non-infectious sore throat was 6.9% with the most common symptoms being dry throat, tickling, and scratching in the throat. While a small percentage of participants often visited a medical doctor because of throat problems, the majority of them used throat therapeutic agents. Additional multicentric prospective studies are needed to increase our knowledge about symptoms and therapeutic strategies for non-infectious sore throat and voice disorders in general.

Summary Background Deaths from suicide are a tragic yet preventable cause of mortality. Quantifying the burden of suicide to understand its geographical distribution, temporal trends, and variation by age and sex is an essential step in suicide prevention. We aimed to present a comprehensive set of global, regional, and national estimates of suicide burden. Methods We produced estimates of the number of deaths and age-standardised mortality rates of suicide globally, regionally, and for 204 countries and territories from 1990 to 2021, and disaggregated these results by age and sex. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 estimates of deaths attributable to suicide were broken down into two comprehensive categories: those by firearms and those by other specified means. For this analysis, we also produced estimates of mean age at the time of death from suicide, incidence of suicide attempts compared with deaths, and age-standardised rates of suicide by firearm. We acquired data from vital registration, verbal autopsy, and mortality surveillance that included 23 782 study-location-years of data from GBD 2021. Point estimates were calculated from the average of 1000 randomly selected possible values of deaths from suicide by age, sex, and geographical location. 95% uncertainty intervals (UIs) were derived from the 2·5th and 97·5th percentiles from a 1000-draw distribution. Findings Globally, 746 000 deaths (95% UI 692 000–800 000) from suicide occurred in 2021, including 519 000 deaths (485 000–556 000) among males and 227 000 (200 000–255 000) among females. The age-standardised mortality rate has declined over time, from 14·9 deaths (12·8–15·7) per 100 000 population in 1990 to 9·0 (8·3–9·6) per 100 000 in 2021. Regionally, mortality rates due to suicide were highest in eastern Europe (19·2 [17·5–20·8] per 100 000), southern sub-Saharan Africa (16·1 [14·0–18·3] per 100 000), and central sub-Saharan Africa (14·4 [11·0–19·1] per 100 000). The mean age at which individuals died from suicide progressively increased during the study period. For males, the mean age at death by suicide in 1990 was 43·0 years (38·0–45·8), increasing to 47·0 years (43·5–50·6) in 2021. For females, it was 41·9 years (30·9–46·7) in 1990 and 46·9 years (41·2–52·8) in 2021. The incidence of suicide attempts requiring medical care was consistently higher at the regional level for females than for males. The number of deaths by suicide using firearms was higher for males than for females, and substantially varied by country and region. The countries with the highest age-standardised rate of suicides attributable to firearms in 2021 were the USA, Uruguay, and Venezuela. Interpretation Deaths from suicide remain variable by age and sex and across geographical locations, although population mortality rates have continued to improve globally since the 1990s. This study presents, for the first time in GBD, a quantification of the mean age at the time of suicide death, alongside comprehensive estimates of the burden of suicide throughout the world. These analyses will help guide future approaches to reduce suicide mortality that consider a public health framework for prevention. Funding Bill & Melinda Gates Foundation.

The aim of this study was to examine the gender-specific criterion validity of the Physical Activity Questionnaire for Children (PAQ-C) in a sample of urban Croatian early school-age children. The participants were 80 children (aged 9-11 years; 36 girls, 44 boys) from southern Croatia. The PAQ-C was used to indirectly measure physical activity (PA), whereas the GENEActiv accelerometers were used to obtain data on PA directly. Spearman’s correlations between variables, and forward multiple regressions were calculated separately for boys and girls. The differences in the studied variables between genders were established via a t-test for independent samples. Boys reported higher PAQ-C scores (t test = 3.6, p<0.05), had more vigorous PA (t test =3.87, p<0.05), and performed more steps than girls did (t test =3.44, p<0.05). The correlations between the PAQ-C and accelerometer-derived data were similar in magnitude across genders. Vigorous PA was determinant of the PAQ-C in boys (Beta =0.44, p<0.05), and moderate PA was found to be a determinant of the PAQ-C in girls (Beta =0.51, p<0.05). While the criterion validity of the PAQ-C is similar for both boys and girls, by acknowledging and addressing potential gender differences in activity patterns associated with questionnaire-based scores, we can develop more effective strategies to encourage PA in children.

Background: Three-dimensional printing is used in veterinary medicine to produce precise physical models for education, research, and training. As simulation-based approaches in veterinary education continually improve, we are exploring the applicability of three dimensional (3D) printing technology for this purpose. Aim: The aim of this study was to evaluate the level of student satisfaction, motivation, and confidence with the introduction of 3D-printed models in veterinary clinical training. Methods: A total of 57 students from the University of Sarajevo–Veterinary Faculty were included in the study. The groups were created according to the previous clinical training: third-year students with dominant observational and little active participation, fourth-year students with modest active participation, and fifth-year students with high prominent active participation in the clinical work. The students attended the theoretical review and practical presentation prior to their work on 3D printing models. Upon completion of the activity, students were given a survey that included questions divided into four categories: general satisfaction, comparison with traditional teaching methods, interactivity and practical application, and technical characteristics. Results: Students exhibited a positive attitude toward the use of the three dimensional printing (3DP) models as clinical simulators. This innovative approach could reduce stress when transitioning to work with live animals while enhancing interest in clinical work. Conclusion: The significant benefits of the 3DP include enhanced durability, low production costs, and a significant reduction in the number of cadavers needed for educational purposes.

Background: Acute intracranial stenting for the treatment of patients with large vessel occlusion in case of failed reperfusion or severe stenosis is a growing practice. Our aim was to explore the clinical and radiological outcome in a large multicenter and international registry. Methods: The RESISTANT registry is a multicenter and international retrospective registry of patients with large vessel occlusion stroke that underwent intracranial stenting due an acute stroke from 2016 to 2023. Primary endpoints was clinical outcome at 90 days. Secondary efficacy endpoints were final reperfusion (mTICI 2b-3), and stent patency at 24 hours. Safety outcomes included procedural complications, symptomatic intracranial hemorrhage and in-hospital mortality. Results: Among 890 patients enrolled, 862 fulfilled inclusion criteria. Median age was 67.0 years (IQR 59.0-77.0), 558 (64.7%) were males and median NIHSS was 12 (IQR 7.0-19.0). Occlusion location was proximal in 758 (87.9%) patients and anterior circulation was affected in 613 (71.1%) patients (390 M1-MCA, 142 terminal ICA). The indication for intracranial stenting was failed reperfusion (mTICI 0-2a) in 456 patients (52.9%). After intracranial stenting, successful recanalization was achieved in 764 (88.6%) with a reocclusion rate during admission of 11.9% and missing controls of 17.7%. The rate of symptomatic intracranial hemorrhage was 8.1%. At 90 days, the median mRS was 3 (IQR 1-6). Successful recanalization and regular flow after stenting were predictors of functional outcome at 90 days. No variables were independently associated with early reocclusion or symptomatic intracranial hemorrhage. Conclusion: Acute intracranial stenting was an effective therapy for patients with failed reperfusion or severe stenosis. Successful reperfusion and regular flow after stenting predicted functional outcome. Prospective studies are warranted to confirm efficacy and safety.

Background: Intracranial stenting is increasingly performed after thrombectomy failure. Stent selection and procedural strategies are heterogenous between centers. Our aim is to evaluate the clinical and radiological impact of stent design among these patients. Methods: The RESISTANT registry is a multicenter, international, retrospective study of patients with acute ischemic stroke who underwent intracranial stenting from 2016 to 2023. This analysis compares outcomes based on stent type and evaluates the role of pre- and post-stenting angioplasty. The primary endpoint was 90-day good clinical outcome defined as modified Rankin Scale 0 to 2. Secondary outcomes included final reperfusion, and early stent patency (within 48 hours). Safety outcomes included procedural complications, symptomatic intracranial hemorrhage, and in-hospital mortality. Results: Among 859 patients in the RESISTANT registry, 176 underwent intracranial stenting with balloon-mounted stent (BMS) and 683 with self-expandable stent (SES). The Vertebrobasilar location was more frequent in patients who received BMS (46.6% vs 24.0%, p<0.001); other baseline variables were similar between groups. Angioplasty was performed more frequently before (SES: 54.0% vs BMS: 39.2%, p<0.001) and after SES (SES: 21.1% vs BMS: 9.2%, p<0.001). Successful reperfusion (mTICI 2b-3) was similar between groups (BMS: 91.2% vs SES: 89.1%) and the rate of residual intracranial stenosis was higher in SES patients (57.1% vs 35.6%, p<0.001). Reocclusion, procedural complications and symptomatic intracranial hemorrhage rates were similar between groups. At 90 days, the rate of good clinical outcome was higher among those patients treated with SES (44.7% vs 29.5%, aOR 1.74 (95%ICI 1.07-2.82)). Conclusions: Among patients who underwent rescue intracranial stenting, patients treated with self-expandable stents had a better outcome than patients treated with balloon-mounted stent at 90 days despite similar rates of symptomatic intracranial hemorrhage, successful recanalization and early reocclusion.