Clinical Centre of Serbia

Left ventricular non-compaction (LVNC) remains one of the most debated phenotypes within the spectrum of cardiomyopathy. Increasing recognition of left ventricular hypertrabeculation (LVHT) in healthy individuals and in physiological adaptive states challenges the concept of LVNC as a distinct morphological entity. In patients with heart failure (HF), distinguishing adaptive trabeculation from true cardiomyopathic LVNC is clinically critical, as misclassification may lead to unnecessary interventions or failure to identify high-risk patients. This review summarizes current evidence on the pathophysiology, imaging features, genetic background, and clinical implications of LVHT and LVNC from an HF-centred perspective. We propose a pragmatic diagnostic approach integrating echocardiography, cardiac magnetic resonance, and selective genetic testing to improve clinical interpretation, risk stratification and management. Importantly, prognosis appears to be determined primarily by ventricular function, myocardial substrate, and arrhythmic burden rather than by the extent of trabeculation itself.

BACKGROUND:Atrial fibrillation (AF) is the most frequent arrhythmia worldwide and a major cause of ischemic stroke. Screening tools are becoming increasingly popular to detect AF for stroke prevention, yet data from randomized trials are lacking. OBJECTIVE:The purpose of this study was to analyze AF detection rates using a smartphone application with early intervention (intervention group) compared with no intervention (sham group). METHODS:This is an international, multicenter, prospective, randomized, sham-controlled, double-blinded trial conducted between October 2019 and May 2024. Patients with no prior AF were randomized 1:1 to an intervention group or a sham group. The study application used the smartphone camera to generate photoplethysmography signals. If an arrhythmia was detected, patients in the intervention group received a notification and a 7-day patch electrocardiogram to confirm AF. RESULTS:A total of 1021 patients from 8 centers were randomized. The mean CHA2DS2-VASc score was 3.4 ± 0.92 in the intervention group and 3.5 ± 1.02 in the sham group. Arrhythmia was detected in 32 (3.1%) cases: 20 (3.9%) in the intervention group and 12 (2.4%) in the sham group. AF was diagnosed in 13 (1.3%) patients. AF detection rates were numerically higher in the intervention group (10 [1.9%] vs 3 [0.5%]; P = .094), especially in cases of asymptomatic AF (4 [0.8%] vs 0 [0%]; P = .13). There was no difference in the rate of stroke, transient ischemic attack, or systemic embolism after 6 months. CONCLUSION:In this multicenter trial, application usage in combination with early intervention did not significantly increase overall AF detection rates. However, asymptomatic AF detection was numerically higher in the intervention group, aligning with current guidelines that recommend photoplethysmography-based devices for AF screening.

BACKGROUND:Lung cancer is the leading cause of cancer deaths worldwide, with non-small cell lung cancer (NSCLC) being most common. This study examines how patient and tumor characteristics influences NSCLC treatment in Romania, Bulgaria, and Serbia, highlighting regional disparities and aiming to improve outcomes. METHODS:This retrospective cohort study of stage IV NSCLC patients in Romania, Bulgaria, and Serbia analyzed the impact of patient and tumor characteristics on treatment choices, timelines for diagnosis, biomarker testing, and imaging, using regression analyses. RESULTS:The study included 840 stage IV NSCLC patients (mean age 64.2 years) across Romania, Bulgaria, and Serbia, with 280 patients per country. Overall, chemo-immunotherapy (CIT) was most common (38.1 %), followed by immunotherapy (31.2 %). Bulgaria and Romania favored CIT, while Serbia's options were limited by reimbursement. Factors influencing treatment included programmed death-ligand 1 (PD-L1) status and gene mutation profile in Bulgaria, weight loss and appetite in Romania, and smoking status and symptoms in Serbia. Testing and treatment initiation times varied, with Serbia showing the shortest times. PD-L1 status and Eastern Cooperative Oncology Group performance were crucial across all countries. Common symptoms included chest pain, cough, shortness of breath, and general pain, with varying frequencies across countries. CONCLUSION:This retrospective three-country real-world cohort shows marked regional differences in first-line treatment and timing for stage IV NSCLC. Beyond clinical factors, health-system elements, reimbursement, biomarker-testing availability/turnaround, and access to chemo-immunotherapy, shape care. Addressing these offers policy-level opportunities to improve equitable, guideline-concordant treatment. Initiated after the most heated phase of the COVID-19 pandemic and conducted without contingency measures, thus study highlights the need for personalized medicine and improved healthcare infrastructure to address disparities in treatment and testing times. MICROABSTRACT:Non-small cell lung cancer (NSCLC) is the most common type of lung cancer worldwide. In this retrospective cohort study we examined how patient and tumor characteristics influences NSCLC treatment in Romania, Bulgaria, and Serbia, and revealed significant regional differences in baseline characteristics, treatment preferences, and influencing factors for stage IV NSCLC in these countries.

BACKGROUND:Most studies show that individuals who abuse psychoactive substances (PAS) have an increased risk of aggressive behavior and the degree of increased risk varies depending on the type of PAS. This study aimed to determine the risk and level of risk for committing violence among individuals dependent on alcohol and other PAS. METHODS:A cross-sectional study was carried out, including a sample of N = 100 respondents with alcohol dependence and other PAS dependence. The Historical-Clinical-Risk Management-20, Version 3 (HCR-20V3) was used to assess the risk of committing violence. RESULTS:This study found no significant difference in the overall scores of the HCR-20V3 scale between the examined groups regarding the risk of committing violence [the historical section - presence (p = 0.253) and relevance (p = 0.379); the clinical section - presence (p = 0.549) and relevance (p = 0.191); the risk management section - presence (p = 0.506) and relevance (p = 0.788)]. The results obtained for certain elements of the HCR-20V3 (violence, violent behavior, and violent ideation) showed statistical significance between the examined groups: the presence of violence risk (p = 0.042), violent ideation (p < 0.001) and violent behavior (p = 0.016) and relevance of violence risk (p = 0.009) and violent ideation (p < 0.001) was more pronounced in the alcohol dependent group. CONCLUSION:Our data confirm that respondents with alcohol dependence exhibit a higher risk of committing violence compared to respondents with other PAS dependence. Findings show that conducting risk assessment for committing violence among respondents with alcohol dependence and respondents with other PAS dependence is crucial, as both the healthcare system and outpatient services should focus on maintaining established abstinence and preventing relapse in terms of potential repeated violence-related behaviors.

Objective To examine opinions about incentives for vaccination against COVID-19. Methods A qualitative study was conducted in spring 2022. The study population consisted of pairs of university students and their parents throughout Serbia. The qualitative content analysis was applied. Results A total of 18 participants (9 student-parent pairs) were included. The following themes were identified: 1) Attitudes about financial incentives for vaccination, 2) Non-financial incentives for vaccination, and 3) Suggestions to enhance vaccination coverage. Theme 1 comprised several subthemes: General response to money, Dissatisfaction with financial incentives, Satisfaction with financial incentives and Amount of money to change people’s opinion. Most parents and some students expressed a clear dissatisfaction and disapproval of the concept of financial incentives for compliance with vaccination. Financial offers would not make our participants change their position on whether to receive the vaccine, as no major differences in attitude towards vaccinations between the vaccinated and the non-vaccinated study participants was observed. Non-financial incentives were more acceptable compared to financial ones, but they were also seen as beneficial for some and not others. Conclusions Financial incentive programs’ potential for inefficiency and public mistrust make other methods to boost vaccine uptake better public health choices for now.