The prevalence of West Nile virus (WNV) is increasing across Europe, with cases emerging in previously unaffected countries. Kosovo is situated in a WNV-endemic region where the seroepidemiological data on WNV in humans remains absent. To address this issue, we have conducted a seroepidemiological investigation of 453 randomly selected sera from a hospital in Kosovo, revealing a 1.55% anti-WNV IgG seroprevalence. Comparative and phylogeographic analyses of the WNV genomes obtained by sequencing archived samples from patients with West Nile fever indicate at least two recent and distinct introductions of WNV lineage 2 into Kosovo from neighboring countries. These findings confirm the eco-epidemiological status of WNV in southeast Europe, where long- and short-range dispersion of lineage 2 strains contributes to a wider circulation via central Europe. Our results suggest an increasing risk for WNV spreading in Kosovo, underscoring the need for an integrated national surveillance program targeting vectors and avian populations for early epidemic detection, as well as the screening of blood donors to gauge the impact of virus circulation on the human population.

The available monitoring data from Kosovo Environmental Protection Agency show concerning levels of the air pollution in Prishtina - the capital city of Kosovo and the most populated city in the country. Due to the air pollutants emitted mostly from the heavy traffic and the coal-fired power plants located in the vicinity, the residents of urban area in Prishtina are exposed to unhealthy air. It is reported that the situation worsens during the autumn and winter months due to more frequent smog episodes. Based on the concerns raised, the aim of the study was to assess the eventual genotoxic effects of air pollution among residents of Prishtina during the autumn and winter months. For this purpose, 29 healthy female non-smoker students (aged 20-26) were involved in this preliminary study. The first sampling of buccal cells took place beginning of November 2019 whereas the second sampling took place by the end of January 2020. Buccal cell samples were analyzed for the frequency of micronuclei and the obtained data demonstrate increased genotoxicity in a sample population as an effect of the exposure to increased air pollution levels in Prishtina urban area during the autumn and winter period. On the other hand, these preliminary data clearly indicate the need for continuing with bio-monitoring studies by extending the timeframe and increasing the number of seasons under investigation.

Introduction:Baló's concentric sclerosis (BCS) is a rare subtype of multiple sclerosis characterized by inflammatory demyelination within the central nervous system.Case Presentation:This case report presents a challenging diagnostic scenario involving a 26-year-old woman diagnosed with BCS. Despite treatment, her condition did not ameliorate, and magnetic resonance imaging (MRI) findings remained unchanged. A subsequent stereotactic biopsy revealed tumefactive Balo disease, highlighting the intricate diagnostic and therapeutic issues surrounding BCS.Conclusion:The juxtacortical location of the BCS lesion, as observed in our case, suggests an unfavourable prognosis due to treatment-resistant seizures.

Background:Early diagnosis of sepsis is essential for a favorable disease outcome. The aim of this study was to evaluate the association of initial and subsequent presepsin concentrations with sepsis outcomes.Methods:One hundred sepsis patients were enrolled in the study from two different university centers. Four times during study, concentrations of presepsin, procalcitonin (PCT), and C-reactive protein (CRP) were measured, and Sequential Organ Failure Assessment (SOFA) score and Acute Physiology and Chronic Health Evaluation (APACHE II) score were calculated. Patients were grouped into survivors and nonsurvivors. A sandwich ELISA kit was used to measure presepsin concentrations. To test the changes in biomarkers concentrations and SOFA score and APACHE II score during the disease course and to estimate the differences between outcome groups, generalized linear mixed effects model was used. Receiver operating characteristic curve analysis was performed to determine the prognostic value of presepsin concentrations.Results:Initial values of presepsin, SOFA score, and APACHE II score were significantly higher in nonsurvivors compared to survivors. Concentrations of PCT and CRP did not differ significantly between outcome groups. ROC curve analyses show a greater predictive ability of initial presepsin concentrations for predicting mortality compared to subsequent measurements of presepsin concentrations.Conclusions:Presepsin has a good ability to predict mortality. Initial presepsin concentrations better reflects poor disease outcome compared to presepsin concentrations 24 and 72 hours after admission.

Objectives: Prompt identification and appropriate treatment of sepsis is crucial for better disease outcome. Different sepsis biomarkers are widely used for rapid diagnosis of sepsis. The diagnostic accuracy of presepsin, procalcitonin (PCT), and C-reactive protein (CRP) in discriminating sepsis severity and their relationship with the Sepsis-related Organ Failure Assessment (SOFA) score were investigated in this study. Methods: During two time periods, 100 septic patients from two university clinical centres were enrolled in the study. Sepsis stratification was done using new Sepsis-3 definitions. During the illness, biomarkers and the SOFA score were assessed four times. The presepsin was measured using a sandwich ELISA kit. To evaluate the changes in biomarker concentrations and SOFA score values during the illness and to estimate the differences between severity groups, a generalised linear mixed effects model was utilised. The correlation of biomarkers with SOFA score was investigated using multivariate analysis. Results: Patients with septic shock (n=34) had significantly higher presepsin concentrations on admission compared to patients with sepsis (n=66), mean ±SD: 128.5±47.6 ng/mL vs. 88.6±65.6 ng/mL, respectively (p<0.001). Concentrations of PCT and CRP did not differ significantly between sepsis severity groups. A strong correlation of presepsin with SOFA score was also found (p<0.0001). Conclusions: In the research groups, presepsin demonstrated an excellent diagnostic ability to distinguish septic shock from sepsis. PCT and CRP were unable to distinguish the severity of sepsis.

According to several studies, children represent only about 2% of the patients affected by the current SARS-CoV-2, and most often, they are asymptomatic. However, there is a concern about a vascular inflammatory disease which is similar to Kawasaki disease observed in children and adolescents weeks after infection. We report a case of Kawasaki disease presented with ischemic stroke in a 14-year-old male patient following SARS-Cov-2 infection.

Objectives: Biomarkers are widely used for rapid diagnosis of sepsis. This study evaluated the diagnostic accuracy of presepsin, procalcitonin (PCT), and C-reactive protein (CRP) in differentiating sepsis severity as well as their association with Sepsis-related Organ Failure Assessment (SOFA) score. Methods: One hundred septic patients from two university clinical centers were enrolled in the study during two time periods. New Sepsis-3 definitions were used for sepsis stratification. Biomarkers and SOFA score were evaluated four times during the illness. A sandwich ELISA kit was used for presepsin measurement. Generalized linear mixed effects model was used to test the changes in biomarkers concentrations and SOFA score values during the illness and to estimate the differences between severity groups. Multivariate analysis was used to test the association of biomarkers with SOFA score. Results: Presepsin concentrations were significantly higher on admission in patients with septic shock (n = 34) compared to patients with sepsis (n = 66), mean +/- SD: 128.5 +/- 47.6 ng/mL vs. 88.6 +/- 65.6 ng/mL, respectively (p < 0.001). The same was not observed for PCT and CRP; their concentrations did not differ significantly between severity groups. A strong correlation of presepsin with SOFA score was also found (p < 0.0001). Conclusions: Presepsin had a good diagnostic ability to differentiate septic shock from sepsis in the study groups. PCT and CRP failed in differentiating sepsis severity. (C) 2020 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

Background: This study aimed to analyze the outcome of neurobrucellosis according to treatment. Material/Methods: A cross-sectional epidemiologic survey was carried out in 648 patients with brucellosis hospitalized in Infectious Diseases Clinic, UCC of Kosova. Among them 82 patients fulfill criteria for neurobrucellosis and were analyzed regarding medication and outcome. Results: The mean age of patients with neurobrucellosis was 31.46 years, with age distribution 12-71 years. In this retrograde study the most often presentation of neurobrucellosis was affection of PNS in 34 (41, 46%), meningitis 28 (34.14%), and cranial nerve damages in 20 (24.39%). Radiculopathies of legs (41.46%) was leading finding followed by neck rigidity (46.34%). Clinically in admission patient present agitation (25,6%), behavioral disorders (18.3%) and disorientation (19.5%). Cranial nerves were involved in (24.4%). Five patients (6.1%) leave hospital with severe consequences, three patients with peripheral facial paresis, two with sensori-neural hearing loss and one with left hemiparesis. Leading complains for hospitalization improved in most patients after 6 weeks of treatment, which demonstrated a favorable efficacy. Cross-sectional epidemiologic survey suggested that sex and regional distribution were not related to nervous system damage (P>0.05), whereas duration of disease, prior to treatment, were related factor. From a totally 82 patients with neurobrucellosis, 43 patients are treated for 12 weeks, 34 for 24 weeks and 5 for 36 weeks. The shorter duration of treatment without relapses was 24 week. Conclusions: In endemic areas for brucellosis patients complaining in radiculopathies, persistent headache, facial palsy, hearing loss or presenting stroke without risk factors, should be considered for screening for neurobrucellosis. Based on our data, according to treatment and clinical follow-up, 24 weeks of antibiotic therapy in neurobrucellosis seems adequate. Duration of disease is risk factors for neurobrucellosis.

IntroductionPurulent meningitis is a severe infection of the central nervous system caused by different bacteria and very often causes severe complications and high lethality. Since the disease still has unclear pathogenesis and high mortality, researchers and clinicians are focused on the influence of damage of the blood-brain barrier (BBB) and its subsequent impact on the outcome of purulent meningitis. The aim of this study was to investigate the albumin concentration and the albumin coefficient as the best parameters of BBB damage, and their influence on the outcome of patients with purulent meningitis.Material and methodsThe study was carried out by examining the hospitalized patients in the Clinic of Infective Diseases in Prishtina, Kosovo. Blood-brain barrier damage is evaluated by analyzing the dynamics of values of proteins, glucose and albumins, as well as by determining the BBB coefficient of damage.ResultsThe data consistent with BBB damage in patients with purulent meningitis corresponded with disease outcome. Consequently, 56.97% of the patients who developed complications or died had very severe BBB damage. Patients with the mean value of albumin coefficient X = 46.5 ±27.23 g/l were at higher risk of developing complications (relative risk (RR) = 2.63; p < 0.0001) or having a lethal outcome (RR = 5.20; p < 0.0001). Patients with longer duration of pathological mean values of albumin coefficient were at higher risk of developing complications (RR = 3.11; p < 0.0001).ConclusionsOur data suggest that BBB damage in patients with purulent meningitis correspond with disease outcome. The best predictors for outcome were albumin coefficient and albumin concentration in cerebrospinal fluid.

INTRODUCTION:Migraine is ranked as the seventh leading cause of disability worldwide, and it is characterized by a manifestation of combined neurological, gastrointestinal, and autonomic symptoms linked with different provoking factors. AIM OF THE STUDY:This study investigates the association between migraine and PTSD, depression and anxiety in the Kosovo population during the post-war period. MATERIAL AND METHODS:273 war survivors with headache were enrolled in the study and were divided into two groups: 153 individuals with confirmed migraine (the study group) and 120 individuals with non-migraine headaches (control group). All individuals were evaluated using the ICHD-II 2004 diagnostic criteria for migraine, as well as the mini-test for PTSD, MMPI (Minnesota Multiphasic Personality Inventory) for psychological evaluation, PAI (Personality Assessment Inventory) and Hamilton Scale for Depression. RESULTS:Among migraine patients, depressive disorders were present in 27.5% of patients, anxiety was found in 60.8%, and PTSD was present in 39.2%. While the prominence of depression was not different between groups, anxiety was significantly more common (p<0.05) in women from the control group. PTSD was significantly more common (p<0.001) in migraine patients overall, whereas the difference in PTSD prevalence between women from the migraine and control groups came close to significance (p=0.05). Females in the migraine group had higher incidences of aura (50% vs. 25.5%), whereas the incidence of aura in males in each group was approximately equal (9.8% vs. 7.84%). CONCLUSION:Based on our data, we can confirm an association between PTSD and migraine in a sample of patients from Kosovo.

Among hantaviruses (HTNV), 22 are known as pathogenic for humans. HTNV can cause two clinical entities: hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome or hantavirus cardiopulmonary syndrome (HCPS). In most countries of Eastern Europe as well as in Kosovo, HTNV infection is presented mainly as HFRS. Here, we report a 20-year-old man with HFRS and HCPS caused by Dobrava hantavirus strain, successfully treated in Intensive Care Unit of Infectious Diseases Clinic, University Clinical Center of Kosovo. In HFRS endemic areas, patients with acute respiratory distress syndrome need to be evaluated for Dobrava hantavirus strain as a possible causative agent.

Background: The aim of this study was to investigate the immunohistochemical expression of ribosomal protein (RP) S6-pS240 in non-special type invasive breast cancer in relation to other prognostic markers and gain new insights to facilitate more individualized treatment. Methods: The following clinical and histopathological parameters of 120 patients were determined: S6-pS240 expression, age, menopausal status, tumor size and grade, TNM stage, Nottingham Prognostic Index (NPI), lymph node stage, estrogen and progesterone receptor (ER/PR) expression, HER2/neu amplification, lymphovascular invasion, and proliferative index as measured by Ki-67. Treatment protocol and disease-free survival were evaluated accordingly. Results: Significant positive correlations were seen between S6-pS240 expression and Ki-67 values (rho = 0.530, p < 0.001), and NPI (rho = 0.370, p < 0.001) and HER2/neu amplification (rho = 0.368, p < 0.001). A negative correlation was found between S6-pS240 and ER/PR expression (rho = 0.362, p < 0.001). Patients with negative RP S6-pS240 expression had significantly longer disease-free survival (log-rank test, p = 0.005). Conclusion: Immunohistochemical analysis of RP S6-pS240 is a valuable additional prognostic marker in patients with invasive breast cancer. Routine use of S6-pS240 immunohistochemistry is recommended.

Substantial public engagement in and support for climate action is needed to prevent the worst impacts of climate change from occurring. Efforts to boost such engagement can be collectively referred to as “social mobilization” initiatives, which can take a number of forms, from government-led planning processes to neighbourhood-scale grassroots initiatives. Such programs hold significant promise in their ability to lower perceptual barriers about climate change and increase motivation for action through various forms of engagement, learning and hands-on involvement. However, evaluations of the necessary components for the success of such programs remain scarce. To address this gap, we evaluate eight research projects that focused on developing and/or evaluating novel social mobilization initiatives on energy and climate change mitigation in the province of British Columbia, Canada. We identify the components of successful social mobilization projects and explore transferable lessons to future initiatives or programs designed to engage and mobilize citizens on climate change. Our findings indicate that social mobilization on climate change can be effectively fostered via multiple pathways. However, several barriers and limitations to effective community engagement on climate change are also identified, along with implications for other regions and researchers attempting to scale up societal responses to climate change.

BACKGROUND:Tuberculous meningitis is globally highly prevalent and is commoner in resource-limited countries and in patients with immunosuppression. Central nervous system tuberculosis is one of the severest forms of extrapulmonary tuberculosis during pregnancy and associated brain tuberculomas have been rarely reported. With the availability of neuroimaging at our hospital center, we present the first case of tuberculous meningoencephalitis associated with brain tuberculomas during pregnancy.CASE PRESENTATION:In this case report we present a 25-year-old, Albanian, pregnant woman living in an urban area in Kosovo, who at 24 weeks of twin pregnancy manifested signs and symptoms of meningoencephalitis with decreased level of consciousness, hemiparesis, and generalized recurrent seizures. Based on medical history, origin from a region of high prevalence of tuberculosis, clinical presentation, especially neurological examination, cytobiochemical changes in cerebrospinal fluid (mild mononuclear pleocytosis with decreased level of glucose and elevated proteins), and elevated level of interferon-gamma release assay in cerebrospinal fluid, antituberculous therapy was initiated on the fourth day of admission. After 3 weeks of treatment, at 27 weeks of pregnancy, she had a preterm delivery and both twins, with low birthweight, died after 24 and 72 hours. Although findings on chest radiography were normal, brain magnetic resonance imaging showed signs of meningoencephalitis and multiple intracerebral tuberculomas, while Koch's bacillus was isolated from urine cultures. On long-term follow-up after delivery, she was cured with no sequelae and became pregnant again without any additional complications.CONCLUSIONS:In countries with a high prevalence of tuberculosis, screening for central nervous system tuberculosis should be considered in the differential diagnosis of meningitis in pregnancy. Cerebral imaging is essential to establish the diagnosis of brain tuberculomas in such a case of suspected tuberculous meningoencephalitis during pregnancy.

Background: Host genetic factors may impact susceptibility to infection. A small number of studies have investigated the association between factors such as ABO blood groups and selected phenotypes on the incidence and severity of H1N1 infections with inconclusive results.Methods: Using data from the Clinic of Infectious Diseases - University Clinical Centre Prishtina and based on the examination of 125 patients hospitalized with H1N1 in the period 2009-2014, the frequency of blood groups from ABO and Rhesus (Rh) systems as phenotypical markers were evaluated. In addition, other phenotypes such as ear lobe free/ear lobe attached, normal chin/cleft chin, tongue roller/non roller, hand clasping right thumb over/hand clasping left thumb over, right-handed/left-handed, dark eyes/light eyes were also analyzed. The data obtained from the 125 hospitalized patients were compared with the data from the Kosovar population (n - 2000) as a reference group.Results: A total of 303 patients with H1N1 were hospitalized in the period 2009-2015. Blood group and phenotype data available from 125 hospitalized H1N1 patients showed significant differences in the frequencies of the blood groups from Rh system as well as in two (out of six) phenotypes of the selected morphological traits compared to reference groups.Conclusions: The findings from this preliminary study indicate that these Rh system and phenotype differences may be linked to H1N1 susceptibility and may guide identification of risk groups and populations. (C) 2017 Elsevier Ltd. All rights reserved.

Crimean-Congo hemorrhagic fever (CCHF) is the most widespread tick-borne viral infection of humans, occurring across western China through southern Asia, Middle East, and Southeastern Europe (SEE) and in the most of African countries. CCHF virus is maintained through vertical and horizontal transmission in several genera of ticks, mainly in Hyalomma, which spreads the virus to a variety of wild and domestic mammals, which develop a transient viremia without signs of illness. Human infections occur through tick bite or exposure to the blood or other body fluids of an infected animal or of a CCHF patient.

Abstract:In order to assess DNA damage associated with exposure to environmental pollution in two polluted sites and one control site in Kosovo, whole blood samples were collected from volunteers in two polluted areas (Kastriot/ Obiliq - lignite-based power plants and lignite mines - and Drenas/Gllogovc - Ferronikeli smelting plant) as well as from Peja, representing an unpolluted area. White blood cells were isolated, and DNA damage was analyzed by the alkaline comet assay. Significantly higher levels of DNA damage (strand breaks) were found in white blood cells from subjects living in the polluted areas compared with residents of the unpolluted city, indicating a potential threat to human health.