Demographic and socioeconomic factors associated with cervical cancer screening among women in Serbia

ObjectivesEffective reduction of cervical cancer incidence and mortality requires strategic measures encompassing the implementation of a cost-effective screening technology. Serbia has made significant strides, introducing organized cervical cancer screening in 2012. However, various impediments to screening implementation persist. The aim of the study was to estimate the socioeconomic factors associated with cervical cancer screening among women in Serbia.MethodsData from 2019 National Health Survey of the population of Serbia were used in this study. The study is cross sectional survey on a representative sample of the population of Serbia. Present total number of participants analyzed in survey 6,747.ResultsIn Serbia, 67.2% of women have done a Pap test at any time during their lives, of which 46.1% of women have undergone cervical cancer screening in the past 3 years. About a quarter of women have never undergone a Pap test in their life (24.3%). The probability of never having a Pap test have: the youngest age group (15–24 years) is 1.3 times more likely than the oldest age group (OR = 1.31), unmarried women 0.3 times more often than married women (OR = 0.37), respondents with basic education 0.9 times more often than married women (OR = 0.98), the women of lower socioeconomic status 0.5 times more often than respondents of high socioeconomic status (OR = 0.56).ConclusionEnhancement of the existing CCS would be the appropriate public health approach to decrease the incidence and mortality of cervical cancer in the Republic of Serbia

Mental Health Assessment of Cancer Patients: Prevalence and Predictive Factors of Depression and Anxiety

Background: Patients with oncological diseases often have mental disorders in the form of comorbidity. The aim of this study was to research the association of cancer with the presence of symptoms of depression and anxiety in primary health care patients.Methods: This prospective observational study done in 2020 included adult users of health care at the Health Center Trstenik, Central Serbia, aged 19 and over, both sexes, with a diagnosis of oncological disease. A research instrument to assess depressive symptoms is used PHQ-9 (The Patient Health Questionnaire) questionnaire, derived from PRIME MD- and (The Primary Care Evaluation of Mental Disorders), and the Beck Anxiety Scale (BAI) to register the presence of certain anxiety symptoms.Results: The largest percentage of patients had symptoms of mild (27.2%) or moderate depression (22%), while 18% reported symptoms of major depression. The level of depression was higher in older subjects, in the presence of chronic diseases with greater limitations of activity and the presence of difficulties in performing daily activities, with a more pronounced effect of pain on activity, the presence of stress. All subjects were characterized as persons with severe anxiety (score 26-63). The level of anxiety was higher in older respondents, in the presence of long-term illness, with greater limitations of activities and difficulties in performing daily activities, with a more pronounced influence of pain on performing activities and the influence of the media.Conclusion: Caring for the mental health of cancer patients must occupy a significant part of each country's national health policy

Redox Parameters in Blood of Thyroid Cancer Patients After the Radioiodine Ablation

The radioactive iodine (I-131) ablation is a well-accepted treatment modality for differentiated thyroid cancer patients. Unfortunately, the radiation induces the oxidative stress and damages cells and tissues, simultaneously activating the mechanisms of antioxidative defense. Since the mechanisms of those processes are not completely known, we wanted to examine the changes in the most important reactive oxygen species and antioxidative components, as well as their correlation and significance for lipid peroxidation. Our results showed that the level of thiobarbituric acid reactive substances was increased during the first 30 days after the radiotherapy. Among antioxidant components, superoxide dismutase was increased in the 3rd and 30th day; catalase in 7th and reduced glutathione in 3rd and 7th day after the radiotherapy. As regards the prooxidants, the reduction of hydrogen peroxide (H2O2) was recorded in 7th and 30th day, and superoxide anion radical (O-2(center dot-)) was unchanged after the exposure to I-131. These results indicate that differentiated thyroid cancer patients are under constant oxidative stress despite the observed increase in antioxidative and reduction in prooxidative parameters. The understanding of these early processes is important since their progress determines the latter effects of I-131 therapy

Socioeconomic inequalities in the use of dental health care among the adult population in Serbia

ObjectivesThe aim of this paper is to assess the association of demografic and socioeconomic determinants with utilization of dental services among Serbian adults.Materials and methodsThe study is a part of the population health research of Serbia, conducted in the period from October to December 2019 by the Institute of Statistics of the Republic of Serbia in cooperation with the Institute of Public Health of Serbia “Dr. Milan JovanovićBatut” and the Ministry of Health of the Republic of Serbia. The research was conducted as a descriptive, cross-sectional analytical study on a representative sample of the population of Serbia. For the purposes of this study, data on the adult population aged 20 years and older were used.ResultsMen were approximately 1.8 times more likely than women to not utilize dental healthcare services (OR = 1.81). The likelihood of not utilizing dental healthcare protection rises with increasing age, reaching its peak within the 65–74 age range (OR = 0.441), after which it declines. Individuals who have experienced marital dissolution due to divorce or the death of a spouse exhibit a higher probability of not utilizing health protection (OR = 1.868). As the level of education and wealth diminishes, the probability of abstaining from health protection increases by 5.8 times among respondents with an elementary school education (OR = 5.852) and 1.7 times among the most economically disadvantaged respondents (OR = 1.745). Regarding inactivity, respondents who are not employed have a 2.6-fold higher likelihood of not utilizing oral health care compared to employed respondents (OR = 2.610).ConclusionThe results suggest that individual sociodemographic factors influence utilization of dental services by Serbian adults and confirmed the existence of socioeconomic disparities

Effects of Divalent Cations on Outward Potassium Currents in Leech Retzius Nerve Cells

The present study examines the effects of divalent metals, cadmium (Cd2+) and manganese (Mn2+), on the outward potassium currents of Retzius cells in the hirudinid leeches Haemopis sanguisuga using conventional two-microelectrode voltageclamp techniques. The outward potassium current is activated by depolarization and plays an important role in determining both the neuronal excitability and action potential duration. A strong inhibition of the fast current and a clear reduction in the late currents of the outward current with 1 mM Cd2+ were obtained, which indicated that both components are sensitive to this metal. Complete blockage of the fast and partial reduction of the slow outward currents was observed after adding 1 mM Mn2+ to the extracellular fluid. These data show that the outward K+ current in leech Retzius nerve cells comprises at least two components: a voltage-dependent K+ current and a Ca2+- activated K+ current. These observations also indicate that Cd2+ is more eff ective than Mn2+ in blocking ion fl ow through these channels and that suppressing Ca2+-activated K+ outward currents can prolong the action potential in nerve cells

Effects of divalent cations on outward potassium currents in leech retzius nerve cells

© 2016, University of Kragujevac, Faculty of Science. All rights reserved. e present study examines the effects of divalent metals, cadmium (Cd2+) and manganese (Mn2+), on the outward potassium currents of Retzius cells in the hirudinid leeches Haemopis sanguisuga using conventional two-microelectrode voltageclamp techniques. e outward potassium current is activated by depolarization and plays an important role in determining both the neuronal excitability and action potential duration. A strong inhibition of the fast current and a clear reduction in the late currents of the outward current with 1 mM Cd2+ were obtained, which indicated that both components are sensitive to this metal. Complete blockage of the fast and partial reduction of the slow outward currents was observed after adding 1 mM Mn2+ to the extracellular fluid. ese data show that the outward K+ current in leech Retzius nerve cells comprises at least two components: a voltage-dependent K+ current and a Ca2+- activated K+ current. ese observations also indicate that Cd2+ is more effective than Mn2+ in blocking ion flow through these channels and that suppressing Ca2+-activated K+ outward currents can prolong the action potential in nerve cells

Fatigue in Patients with Autoimmune Thyroid Diseases

Fatigue is a common feature in a wide variety of chronic inflammatory and autoimmune diseases, but fatigue in autoimmune thyroid disease (AITD) has not been investigated so far. The aim of this study was to examine fatigue in patients with AITD and to analyse the correlation between fatigue and the serum concentrations of thyroid antibodies, thyroid function and depression. This cross-sectional clinical study included 62 patients with increased concentrations of thyroperoxidase antibodies (TPOAbs) as confirmation of AITD and 52 healthy individuals who were negative for thyroid antibodies; all controls were euthyroid. Thyroid antibodies, free thyroxine and thyroid-stimulating hormone were measured in the sera of all subjects. The Fatigue Severity Scale was used to measure the severity of fatigue; the level of depression was measured by the Beck Depression Inventory. Eight (12.9%) patients had evident fatigue, 7 (11.3%) patients had fatigue limit values, and 47 (75.8%) patients had no fatigue. The frequency of fatigue was highly significant and almost three times higher in the AITD patients compared to the control group, in which only 2 (3.8%) patients had evident fatigue. The majority of patients with fatigue had normal thyroid function, and only one (1.6%) patient had overt hypothyroidism. Seven (11.3%) patients had both fatigue and depression, whereas one (1.6%) patient had fatigue without depression. We did not find significant correlations between fatigue and the concentrations of thyroid antibodies, but we found statistically significant correlations between fatigue and depression in AITD patients

Protein and Lipid Concentrations in Patients with Differentiated Thyroid Cancer Treated with Radioactive Iodine-131 / Koncentracija Proteina I Lipida Kod Pacijenata Sa Diferentovanim Karcinomom Štitaste Žlezde Koji Su Lečeni Radioaktivnim Jodom-131

Prolazna, manifestna hipotireoza koja se javlja kod pacijenata sa diferentovanim karcinomom štitaste žlezde (DTC) pre terapije radioaktivnim jodom (131-I) može biti udružena sa brojnim metaboličkim promenama, uključujući i promene u metabolizmu proteina i lipida. Koncentracija proteina i njihov odnos sa lipidima u serumu pacijenata sa DTC nakon terapije 131-I nedovoljno su ispitani. Cilj našeg istraživanja bio je da se ispita serumska koncentracija proteina i lipida kod pacijenata sa DTC pre, kao i tri i sedam dana posle terapije 131-I. Studijom je obuhvaćeno 24 DTC pacijenata i 20 zdravih ispitanika. Pokazano je značajno, progresivno smanjenje koncentracije proteina (78.71±6.71 g/L vs. 87.16±6.04 g/L; p=0.003) i holesterola (8.12±2.13 mmol/L vs. 8.84±2.09 mmol/L; p=0.001) tri dana nakon terapije 131-I, uz statistički značajno povećanje koncentracije triglicerida tri dana nakon terapije (2.44±1.07 mmol/L vs. 2.26±1.08 mmol/L; p=0.041) i povratkom na preterapijske vrednosti 7 dana posle terapije. Pri tom, indirektna korelacija između koncentracije proteina i triglicerida tri dana posle 131-I pokazana je u grupi pacijenata starijih od 50 godina (Spearman r=- 0.583, p=0.048), što nije bio slučaj sa ispitanicima mlađim od 50 godina (Pearson r=- 0.277, p=0.384). U zaključku, terapija radioaktivnim jodom prouzrokuje smanjenje koncentracije serumskih proteina i holesterola, koje je udruženo sa povećanjem koncentracije triglicerida i posebno je izraženo kod starijih pacijenata sa metastazama

Cytokine profile in patients with differentiated thyroid cancer

291-299Multiple cytokines released in tumor microenvironment can promote anticancer effects, or carcinogenesis and tumor growth. Although cytokines mainly act locally, the changes in their circulating levels may reflect the interactions between tumor and inflammatory cells during the disease course. The aim of this study was to analyze the serum cytokine profile in patients with differentiated thyroid cancer (DTC) and to identify cytokines those could be associated with tumor progression/metastasis. Serum concentrations of thirteen cytokines were measured in control subjects and DTC patients before, three and seven days after radioactive iodine therapy, using multiplex cytokine detection systems for Th1/Th2/Th9/Th17/Th22 cell-related cytokines Most cytokines were not detected in serum samples from control subjects, while detectable levels of the cytokines were measured in some, but not all DTC patients. The serum levels of the following cytokines: interleukin IL-17A, IL-10 and IL-13 were significantly increased in DTC patients with metastasis. At the same time, the concentrations of several cytokines (IL-12p70, IL-17A, IL-5, IL-1β and tumor necrosis factor (TNF-α) were positively correlated with thyroglobulin (Tg) levels. The histological type of tumor, hypothyroidism, and intensity of oxidative stress were not associated with cytokine levels in patients’ sera. Radioactive 131-I therapy reduced serum levels of the majority of examined cytokines, but these differences did not reach statistical significance. In conclusion, the study indicates that the increase of the levels of several Th2/Th17 cells and proinflammatory cytokines in the serum of patients with DTC is associated with tumor progression/metastasis. Thus, the increase in this specific cytokine constellation might be an indicator of the malignant disease progression

Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study.

BACKGROUND Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours. METHODS In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186. FINDINGS Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039). INTERPRETATION Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation. FUNDING None