Purpose: Diabetic kidney disease (DKD) significantly affects health and healthcare costs due to chronic kidney disease complications. Given asprosin’s potential as a biomarker for disease progression, we conducted the first systematic review and meta-analysis on its relationship with DKD in adults with type 2 diabetes mellitus (T2DM). Methods: PubMed, Embase, Cochrane, and Web of Science were systematically searched. Standard mean differences (SMD) with 95% confidence intervals (CI) and Fisher’s Z transformation were used to examine the relationship between asprosin and DKD. The risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS) and its version for cross-sectional studies. Heterogeneity (I² > 50%) was analyzed with a random-effects model. Results: Six studies (n = 1340) were included. Meta-analysis results indicated that T2DM patients with DKD (micro/macroalbuminuria) had significantly higher circulating asprosin levels than normoalbuminuric T2DM patients (SMD: 1.5, 95% CI: 0.69– 2.32, p = 0.0003). Meta-analysis of correlation revealed a positive association of asprosin with urinary albumin excretion ratio (UACR) (Fisher’s Z = 0.4; 95% CI: 0.240– 0.554, p < 0.001) and body mass index (BMI) (Fisher’s Z = 0.17; 95% CI: 0.036– 0.301, p = 0.013), and a negative association with estimated glomerular filtration rate (eGFR) (Fisher’s Z = − 0.35; 95% CI: − 0.471 to − 0.239, p < 0.001). Conclusion: Asprosin is elevated in T2DM patients with pre-DKD (early stage DKD) and DKD and correlates with key markers of disease severity. Additional research is required to better understand the pathophysiological mechanisms of asprosin and its role in DKD.

Introduction: Cardiac arrest is one of the five leading causes of death in Europe. Timely recognition and application of cardiopulmonary resuscitation (CPR) significantly increase the chances of survival. It is necessary to better understand the reasons for not starting CPR, with the aim that their identification leads to the improvement of guidelines and an increase in survival rates. The Aim: The aim of this study is to analyze the data on the non-initiation of CPR in the context of the etiology of cardiac arrest. Material and Methods: The study included epidemiologic data on out-of-hospital cardiac arrest (OHCA) collected through questionnaires from the EuReCa, European Resuscitation Council (ERC) studies. The criterion for inclusion in the research was a OHCA treated by the emergency medical service (EMS). Pediatric patients were also included in the analysis. The created database consisted of information defined by the unique protocol of the EuReCa ONE study, for the period of October 1, 2014 to December 31, 2023. Results: We found a statistically significant correlation between Utstein and EuReCa etiology of cardiac arrest and the proportion of non-initiation of CPR in recorded cases (p<0.001). The highest percentage of non-initiation of CPR was observed in patients after drowning, where out of 40 recorded cases of submersion, the application of CPR measures was not initiated in any of them, while the lowest percentage of non-initiation of CPR was recorded in electrocution, where out of a total of 15 recorded cases, CPR was not initiated in 5/15 (33.33%) cases. The ratio of starting and not starting CPR in the group of patients with cardiogenic cardiac arrest was almost identical, that is, CPR was not started in 3293/6708 (49.1%) cases. Binary logistic regression analysis indicated the female gender as a significant predictor of non-initiation of CPR (p<0.001, OR 2.037, 95% CI 1.880-2.208). Conclusion: This study provides significant data that can contribute to the improvement of strategies for recognition and intervention in out-of-hospital cardiac arrest in Serbia. Additional research and continuous monitoring are needed to determine the influence of etiology, but also of other factors, on the decision not to start CPR.

Background/Objectives: Insomnia is a prevalent sleep disorder with substantial public health implications, yet epidemiological data from Serbia remain limited. This study aimed to assess the prevalence of clinically significant insomnia symptoms in the adult population of Serbia and to examine associated sociodemographic, comorbidity, psychosocial, and lifestyle factors. Materials and methods: A cross-sectional study was conducted from September 2023 to September 2025, including 2577 adults aged 18–89 years across Serbia. Insomnia symptom severity was measured using the Insomnia Severity Index (ISI), with scores ≥ 15 indicating clinically significant insomnia symptoms. Sociodemographic, comorbidity, psychosocial, and lifestyle factors were assessed via self-reported questionnaires. Multivariable logistic regression with LASSO variable selection was used to identify factors independently associated with clinically significant insomnia symptoms. Results: The prevalence of clinically significant insomnia symptoms (ISI ≥ 15) was 10.9%. Independent factors associated with clinically significant insomnia symptoms included being single (OR = 1.54) or divorced (OR = 1.75), lower educational attainment (OR = 0.71 per level increase), being retired (OR = 1.83) or a student (OR = 1.66), dermatological comorbidities (OR = 2.99), use of anxiolytic medications (OR = 2.44), exposure to stressful life events (OR = 1.88), engagement in late-night activities (OR = 1.37), consumption of coffee/tea (OR = 2.22), energy drink consumption (OR = 1.52), and late-night eating habits (OR = 1.27). Conclusions: Clinically significant insomnia symptoms among adults in Serbia are influenced by a complex interplay of sociodemographic, comorbidity, psychosocial, and lifestyle factors. These findings underscore the need for integrated approaches that address both medical and modifiable behavioral determinants in the prevention and management of insomnia symptoms.

Introduction: EuReCa Serbia study collects data on out-of-hospital cardiac arrest (OHCA) from October 1, 2014, including the period during the coronavirus disease 19 (COVID-19) pandemic. The aim of this paper is to analyze the data on OHCA and its outcomes and compare them between the periods before, during and after the period of the COVID-19 pandemic. Material and Methods: The study included epidemiological data on OHCA collected through the EuReCa study questionnaire from 2014 to 2023. Data on OHCA incidence, frequency of initiation/non-initiation of cardiopulmonary resuscitation (CPR), participation of bystanders in applying CPR, as well as the incidence of shockable initial heart rhythm, return of spontaneous circulation on the scene (any ROSC), and admission to the hospital with spontaneous circulation, were collected and analyzed for their association and trend before, during, and after the COVID-19 pandemic in Serbia. Results: Throughout the COVID-19 pandemic, the annual incidence of documented OHCA cases was 49.23/100,000 inhabitants, compared to 114.78/100,000 before and 105.52/100,000 after the pandemic. The incidence of CPR initiation per 100,000 inhabitants in these periods showed significant variation, with rates of 34.95 before, 48.14 during, and 75.20 after the pandemic. In percentage terms, a decrease in the frequency of bystander CPR was observed during the pandemic period (10.03%), compared to the period preceding it (13.13%), while a significant increase was observed after the pandemic period (19.56%). However, a trend of increasing incidence of bystander CPR per 100,000 inhabitants was observed before, during, and after the pandemic period continuously (4.59; 4.83; and 14.71, respectively). A significantly reduced incidence of ROSC during the COVID-19 pandemic of 15.21% was observed compared to 21.55% and 31.11% before and after the pandemic, respectively. The annual incidence of survival to hospital admission per 100,000 inhabitants among the groups of OHCA cases before, during, and after the pandemic was also significantly different among these time periods (6.12, 6.54, and 16.21, respectively). Conclusion: The EuReCa Serbia registry noted a decrease in the incidence of OHCA during the COVID-19 pandemic, compared to the periods before and after. There was a consistent upward trend in bystander CPR rates before, during, and after the pandemic. The rates of any ROSC, and hospital admissions with spontaneous circulation remained stable before and during the pandemic, with an increase seen in the post-pandemic period.

Aims: This study aimed to identify predictors of prehospital outcomes, specifically initial shockable rhythms and return of spontaneous circulation, in out-of-hospital cardiac arrest cases witnessed by emergency medical services. Materials and Methods: The study utilized epidemiological data collected via EuReCa questionnaires from October 1, 2014, to December 31, 2021. It included patients treated by EMS, covering both pediatric cases and non-cardiac causes of cardiac arrest. Data from 16 municipalities in Serbia, representing 24.13% of the population, were analyzed using SPSS Statistics. Statistical significance was defined as p<0.05. Results: Among 8,349 out-of-hospital cardiac arrest cases analyzed, we found that 12.2% cases were witnessed by emergency medical teams. The likelihood of registering an initially shockable rhythm is 2.08 times greater if the incident occurs in a location with fewer than 100,000 residents compared to an incident in a populated area with more than 100,000 residents (OR: 2.08; 95% CI: 1.296-3.363), 2.85 times greater for individuals younger than 65 compared to older individuals (OR: 2.85; 95% CI: 1.781-4.570) and 16.55 times greater in cases of cardiogenic etiology (OR: 6.55; 95% CI: 4.885-56.060). The probability of the return of spontaneous circulation is 3.03 times greater in cases of incidents occurring outside the place of residence (OR: 3.03; 95% CI: 1.926-4.764) and 4.21 times greater in cases with initially registered shockable rhythm (OR: 4.21; 95% CI: 2.596-6.837). The likelihood of spontaneous circulation return upon hospital admission is 1.87 times greater in cases of incidents outside the place of residence (OR: 1.87; 95% CI: 1.164-2.997), and 3.58 times greater in cases with initially registered shockable rhythm (OR: 3.58; 95% CI: 2.203-5.814). Conclusion: Younger patients with cardiogenic cardiac arrest, an initial shockable rhythm, and incidents outside their place of residence have better chances of spontaneous circulation return. In addition to the mentioned factors, gender and the size of the population where the incident occurred emerged as predictors of initial shockable rhythm. Since survival is better in cases witnessed by emergency medical teams and the number of studies on predictors of desired prehospital outcomes is limited, we emphasize the need for further research to enhance understanding and increase survival rates in out-of-hospital cardiac arrest.

Introduction: Out-of-hospital cardiac arrest (OHCA) is a global health challenge with an average survival rate of 8%. Outcomes depend on factors such as arrest location, time to return of spontaneous circulation (ROSC), patient demographics, and initial rhythm type. Material and methods: EuReCa_Serbia is part of the EuReCa ONE study on OHCA survival in Europe. It included OHCAs managed by EMS, including pediatric and non-cardiogenic cases. Data were collected per the EuReCa ONE protocol from October 1, 2014, to December 31, 2021. Results: We examined predictors of shockable initial rhythms, ROSC, and hospital admission using univariable and multivariable binary logistic regression analysis. OHCAs in areas with over 100,000 inhabitants and at patient residences were significantly less likely to have shockable rhythms (57.4% and 65.4% less likely), while younger age and cardiogenic cause increased the likelihood (1.7 and 8.5 times more likely). Shockable rhythms strongly predicted any ROSC, increasing the likelihood by 3.9 times, and ROSC at hospital admission by 3.3 times. Urban and residential locations reduced the chances of ROSC by 55.8% and 51.1%, respectively. EMS dispatcher assistance improved the likelihood of ROSC at admission by 1.7 times, while a delay of 10 or more minutes from EMS call to defibrillation reduced the likelihood by 86.1%.