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PubMed2006

Depleted uranium and cancer in Danish Balkan veterans deployed 1992-2001.

In a population based retrospective cohort study we studied cancer risk in Danish soldiers deployed to the war in the Balkans. In particular, leukaemia, earlier linked to ammunition enforced with depleted uranium (DU) in other deployed soldiers, was a concern. Military personnel, 13,552 men and 460 women, without known cancer at first deployment to the Balkans, January 1, 1992 to December 31, 2001 were followed through December 2002. We found 96cases of cancer, 84 among men (standardised incidence ratio (SIR) 0.9) and 12 among women (SIR 1.7). Only four male bone cancers (SIR 6.0), with three during the first year of follow-up, exceeded expectations. Earlier reports on increased risk of leukaemia and testis cancer among deployed military personnel to the Balkans are not corroborated by our study. Quick and open communication about potential risks, a health check, a telephone counselling line and careful monitoring, and diminished anxiety all helped contain the 'Balkan syndrome' in Denmark.

Adult↗

PubMed2005

Phylogenetic relationships and biogeography of Podarcis species from the Balkan Peninsula, by bayesian and maximum likelihood analyses of mitochondrial DNA sequences.

Wall lizards of the genus Podarcis (Sauria, Lacertidae) comprise 17 currently recognized species in southern Europe, where they are the predominant nonavian reptile group. The taxonomy of Podarcis is complex and unstable. Based on DNA sequence data, the species of Podarcis falls into four main groups that have substantial geographic coherence (Western island group, southwestern group, Italian group, and Balkan Peninsula group). The Balkan Peninsula species are divided into two subgroups: the subgroup of P. taurica (P. taurica, P. milensis, P. gaigeae, and perhaps P. melisellensis), and the subgroup of P. erhardii (P. erhardii and P. peloponnesiaca). In the present study, the question of phylogenetic relationships among the species of Podarcis encountered in the Balkan Peninsula was addressed using partial mtDNA sequences for cytochrome b (cyt b) and 16S rRNA (16S). The data support the monophyly of Podarcis and suggest that there are three phylogenetic clades: the clade A (P. taurica, P. gaigeae, P. milensis, and P. melisellensis); the clade B (P. erhardii and P. peloponnesiaca), and the clade C (P. muralis and P. sicula). By examining intraspecific relationships it was found that extant populations of P. erhardii are paraphyletic. Furthermore, subspecies previously defined on the basis of morphological characteristics do not correspond to different molecular phylogenetic clades, suggesting that their status should be reconsidered. The distinct geographic distribution of the major clades of the phylogenetic tree and its topology suggest a spatial and temporal sequence of phylogenetic separations that coincide with some major paleogeographic separations during the geological history of the Aegean Sea. The results stress the need for a reconsideration of the evolutionary history of Balkan Podarcis species and help overcome difficulties that classical taxonomy has encountered at both the species and subspecies level.

Albania↗

PubMed2006

Vicariance, colonisation, and fast local speciation in Asia Minor and the Balkans as revealed from the phylogeny of spined loaches (Osteichthyes; Cobitidae).

We reconstruct the phylogeny of the morphologically diagnosable subgenera Bicanestrinia, Beysehiria, and Cobitis sensu stricto of the genus Cobitis from Asia Minor and the Balkans. We used the complete cytochrome b gene of 65 specimens in order to infer their evolutionary history in this zoogeographically interesting area. Our phylogeographic analysis did not evidence the previously suggested monophyly of the Bicanestrinia subgenus but revealed five monophyletic lineages in the area: the lineages Bicanestrinia I-IV including all species of Bicanestrinia plus the lineage Cobitis s. str. The monotypic subgenus Beysehiria from Lake Beysehir in Anatolia was closely related to the syntopic population of C. turcica and nested inside the lineage Bicanestrinia III. The strictly allopatric distribution of the four lineages of Bicanestrinia suggests that vicariance has played a major role in the diversification of Bicanestrinia. All analysed species of Cobitis s. str. from Asia Minor and Balkans were closely related to Cobitis s. str. from Central Europe, the Danube basin and the Caucasus, indicating at least two colonisation events into Asia Minor and the Balkans. A third, recent colonisation event led to the presence of C. strumicae, generally restricted to the Aegean Sea drainage, in the Danube basin. Besides the evidences of vicariance and colonisation events in the phylogenetic history of the genus Cobitis in Asia Minor and the Balkans, our analysis suggested also a rapid morphological evolution of C. bilseli in a lacustrine environment. Application of Cobitis mitochondrial cytochrome b clocks of 0.68% sequence divergence per million years (MY) suggest that the split between the five major lineages happened approximately 12.4-17.6 MYA, and according to the lack of basal resolution of this monophyletic group probably the split of all lineages happened within a narrow time window.

Animals↗

PubMed2003

Population ageing in the Balkan countries.

INTRODUCTION: As we enter the third millennium, we are witnessing an unprecedented rapid expansion of the population of older persons in both the developed and developing world. The total worldwide aged population (aged 60 and older) is projected to rise from 605 million in 2000 to 1.2 billion in 2025 and to nearly 2 billion in 2050. AIM: To study the process of population ageing in Bulgaria and Balkan countries and to reveal its main characteristics, similarities and differences as compared to other European countries. MATERIAL AND METHODS: Primary information was obtained from the European Database "Health for all", the European Public Health Information Network for Eastern Europe and the US Census Bureau International Database. Total, male and female old and youth dependency ratios and ratio of people over 65 to 0-14 years were calculated and trends were followed for 30 years. Countries were ranked and compared with Europe and East European countries. RESULTS: From 1970 to 1999 the old dependency ratio increased dramatically in Bulgaria (14.2-23.6%), Greece (17.2-24.7%), Romania and Slovenia. The ratio of old to young people surpassed 100% in Greece (107.3%, for female 122.6%) and in Bulgaria (99.7% and 116.8%, respectively). Albanian and Turkish populations differ substantially from the other Balkan countries. DISCUSSION: Population ageing creates great socio-economic and health problems--slower economic growth, lack of young labour force, higher tax charges on working-age population, etc. The process in Balkan countries is aggravated by the rise of inflation, unemployment and other socio-economic factors. CONCLUSION: All Balkan countries face multiple challenges posed by population ageing. Most of them experience the same demographic tendencies as for market economy countries even though their economic development is far worse. This is especially true for Bulgaria.

Adolescent↗

PubMed2026

Cryptic serpentine divergence and substrate adaptation of Cardamine glauca in the Balkan Peninsula.

BACKGROUND AND AIMS: Serpentine soils represent one of the most challenging substrates for plant life due to skewed ratios of essential nutrients and toxic concentrations of metals. Plant adaptation to such conditions may lead to locally adapted edaphic ecotypes or, when reproductive barriers evolve, to distinct serpentine endemics. However, a third scenario may occur: cryptic edaphic divergence, where phenotypically similar lineages adapted to contrasting substrates exhibit deep genetic divergence. Here, we tested whether substrate-associated divergence reflects repeated serpentine adaptation or cryptic edaphic lineage divergence in Cardamine glauca (Brassicaceae) in Balkan peninsula - a hotspot of serpentine endemism in Europe. METHODS: We sampled and sequenced genomes of 43 individuals of C. glauca together with four individuals representing closely related taxa, C. plumieri and C. pancicii, from variable substrates across the Balkans. We combined phylogenomics, population genomic analyses of selection and a reciprocal transplant experiment to infer the most likely evolutionary scenario. KEY RESULTS: Phylogenomic analysis of 941 loci confirmed monophyly of C. glauca, including the local endemic C. pancicii, but revealed deep splits (∼2.2-3.2 Mya) between co-occurring serpentine and non-serpentine lineages. Population genomic analyses of replicated geographically proximate serpentine-non-serpentine population pairs demonstrated strong genome-wide differentiation and limited gene flow between edaphic types. Window-based analyses of local genomic divergence and tests for positive selection revealed candidate genes involved in ion transport, membrane transporter activity and metal homeostasis, consistent with the hypothesis of substrate-driven ecological adaptation. This was further supported by a significant substrate-of-origin fitness advantage in a reciprocal transplant experiment. CONCLUSIONS: Altogether, our results demonstrate that edaphic preferences may correspond with deep genetic divergence between similar-looking yet differently adapted lineages. The presence of cryptic edaphic lineages suggests that plant diversity may still be underestimated in genomically underexplored but edaphically diverse hotspots such as the Balkans.

Cardamine glauca↗

PubMed1985

Tamm-Horsfall protein in Balkan endemic nephropathy.

It is suggested that Tamm-Horsfall protein, a specific renal glycoprotein, may be involved in the pathogenesis of some renal diseases. In cadmium nephropathy and Fanconi syndrome (primary tubular diseases of the kidney) an increased excretion rate of Tamm-Horsfall protein has been observed. Balkan endemic nephropathy is a chronic tubulointerstitial disease of unknown etiology, most probably a primary disease of the kidney tubules with secondary reaction of the interstitial tissue. Investigation of Tamm-Horsfall proteinuria in Balkan endemic nephropathy has shown that subjects living in the area where this condition is prevalent have a significantly higher Tamm-Horsfall protein /creatinine ratio than those living in the control area where the condition has not been observed. Differences in this ratio among diseased, suspect and subjects "at risk" were not observed, despite differences in their glomerular filtration rates. But excretion of Tamm-Horsfall protein per litre of glomerular filtrate was significantly different among diseased, suspect and subjects "at risk" and significantly higher compared to control subjects. a relatively significant correlation was obtained between Tamm-Horsfall protein excretion rate and glomerular filtration rate as measured by creatinine clearance in both control and subjects living in the area of Balkan endemic nephropathy. Determination of Tamm-Horsfall protein in urine together with determination of proteinuria by electrophoresis on cellulose acetate membranes as a screening procedure, and by SDS -electrophoresis in polyacrylamide gell may be useful laboratory tests in detecting this nephropathy.

Adolescent↗

PubMed1992

Animal studies related to Balkan endemic nephropathy.

Basic field studies related to the animal population were performed in the region of Slavonski Brod, Republic of Croatia, where Balkan endemic nephropathy is an endemic disease. Pathological changes in several animal species from the locality were examined. The pig population in the area is numerous. Morphologically and physiologically pigs make an excellent animal model for studies of human diseases. Their use in studies should be encouraged, especially because there is a possibility that pigs and humans suffer from the same type of intoxication with a specific xenobiotic of natural origin. According to the mycotoxin theory about the aetiology of Balkan endemic nephropathy, pork meat might be one of the possible hazards for humans. Experiments on laboratory animals provide an excellent possibility to monitor several aspects of pathogenesis and all stages of pathomorphological changes which might then be correlated with Balkan endemic nephropathy. However, the experimental species should be critically chosen because some spontaneous, species-specific lesions of the kidneys are easily mistaken for changes induced experimentally.

Animals↗

PubMed1991

Environmental renal disease: lead, cadmium and Balkan endemic nephropathy.

The similarity of lead and cadmium nephropathy to Balkan endemic nephropathy warrants careful reevaluation of the possibility that these nephrotoxic metals contribute to the production of the endemic renal disease. Low-level environmental exposure may result in a relationship between the concentration of the metals in tissue storage sites and biological fluids that differs from that encountered after occupational exposure. Urine and blood concentrations may therefore be inadequate measures of exposure. Lead is accumulated in the skeleton and cadmium in the liver and kidneys with biological half lives approximating a decade. Non-invasive in vivo x-ray fluorescence or neutron activation analysis can therefore be used to measure cumulative tissue stores. Multiple regression analysis of epidemiologic data could reveal the relative contribution of causal factors, including lead and cadmium, and help to distinguish Balkan endemic nephropathy from other renal diseases using rigorous diagnostic criteria. As long as Balkan endemic nephropathy remains a diagnosis of exclusion, the accuracy of the diagnosis of other renal disease determines the reliability of identification of the endemic disease.

Balkan Nephropathy↗

PubMed1991

Epidemiological characteristics of Balkan endemic nephropathy in eastern regions of Yugoslavia.

Foci of Balkan endemic nephropathy have been found scattered along several rivers in many parts of Serbia, as well as in north-eastern Bosnia. There is no indication that the medical geography of the disease changes over time. As for the intensity of the endemic process, both the poor quality of the routinely collected data and an inconsistent methodological approach obscure the real epidemiological situation. The incidence of deaths, the most reliable measure of outcome, has been stable over the last few decades, slightly exceeding 3 per 1000 person-years of observation in the most heavily affected endemic villages. The point prevalence rate of hyper-beta-2-microglobulinuria, an indicator of tubular damage, also remained unchanged over that period, at a value as high as 20-25%. Over time, however, the course of the disease became more protracted and its onset moved towards older ages. These two facts may indicate a less intense contact with the agent(s) and, consequently, suggest a decreased burden of Balkan endemic nephropathy in the near future. The natural history of Balkan endemic nephropathy is still not well understood, however. The disease seems to have had an endemo-epidemic pattern in the past, and the possibility of another epidemic wave in the future cannot be completely ruled out.

Adolescent↗

PubMed1991

Epidemiological aspects of Balkan endemic nephropathy in a typical focus in Yugoslavia.

Balkan endemic nephropathy is a noninflammatory bilateral kidney lesion that affects rural populations in several circumscribed areas of the Balkans. Its etiology is still not understood, but recently it has been associated with exposure to nephrotoxic mycotoxins. It has been known to be present since the mid-1950s in 14 villages in an endemic area of Croatia, where approximately 10,000 people are at risk. Its prevalence fluctuates between 0.4 and 8.3%, showing a slight decline in recent years, but it has not disappeared from any of the endemic villages. The occurrence of the disease in several ethnic groups contradicts the hypothesis of a primary hereditary basis for Balkan endemic nephropathy. Recently, evidence has been found of an extremely high incidence of urinary tract tumours in the endemic area, and particularly of urothelial tumours of the pelvis and ureter. There may therefore be a common causative agent for these two rare diseases.

Adolescent↗

PubMed1985

[Balkan nephropathy and transitional cell carcinoma. Pathogenetic problems and the early phase of cancerogenesis].

Balkan Nephropathy belongs to the group of primary chronic interstitial nephropathy with tubular functional abnormalities at early clinical stage. This disease may occur at any age and may affect all members of the same family including the children existing in them in latent form. The coincidental occurrence of Balkan Nephropathy and urothelial carcinoma has been very often observed. The actual problems of early Balkan Nephropathy pathogenesis and carcinogenesis are considered.

Adult↗

PubMed1983

[Clinical and morphologic stages in Balkan endemic nephropathy].

The first clinical classification of Balkan endemic nephropathy was elaborated by A. Puhlev et al in 1960, according to which two stages could be established in the course of the disease-compensated and decompensated. Gradually, many new data accumulated as regards the various aspects of the disease, that cannot be put into the frames of the first clinical classification. On the base of the author's own long-term complex clinical-laboratory, functional, instrumental and nephrobiopsic studies, he admits the existence of four stahes in the clinical and morphological course of the Balkan endemic nephropathy. 1. Initial stage, reflecting the onset of the morbid process. The disease, at that stage, could be diagnosed via some provoking methods or renal biopsy. Morphologically, light alterations in some glomerules were established as well as more severe ones in the cells of the proximal tubules. 2. Subclinical stage - decreet and inconstant manifestations of the disease were established with completely preserved renal function. The size of the kidneys is slightly reduced - bilaterally. The morphological alterations are localized in the glomerules, proximal tubules, small vessels and interstitium. 3. Compensated stage - with manifested renal symptomatics and considerable morphological alterations in renal parenchyma, but still preserved excretory function. 4. Decompensated stage - where the known four stages of the chronic renal insufficiency are included. The classification proposed reflects the dynamics of the advancement of the morbid process. In this way, the most adequate treatment is enabled as well as the prophylaxis and assessment of working capacity and disability of the patients with Balkan endemic nephropathy.

Adolescent↗

PubMed2006

Phylogeny of the cave shrimp Troglocaris: Evidence of a young connection between Balkans and Caucasus.

The remarkably discontinuous distribution of the cave shrimp genus Troglocaris in South France, West Balkans, and West Caucasus has long been considered a biogeographic enigma. To solve it, its phylogeny was reconstructed by analyzing sequences from two mitochondrial (cytochrome oxidase I and 16S rRNA) and one nuclear gene (28S rRNA) using maximum likelihood, parsimony and Bayesian inference. The genus was found to be polyphyletic because the French taxon T. inermis had no direct common ancestry with other Troglocaris taxa but was sister to the epigean freshwater atyid Dugastella valentina. All other Troglocaris species constituted a well-supported monophylum, the second cave shrimp genus Spelaeocaris nested within. The monophylum had a well-defined structure: (1) a clade restricted to the Dinaric area of the Western Balkans containing the type species T. anophthalmus along with some unnamed species, and (2) a geographically mixed clade split between the Caucasian T. kutaissiana species complex on one, and T. hercegovinensis, S. pretneri, plus an unnamed taxon on the other side. It was surprising to find the dichotomy between the Caucasian and one of the West-Balkan lineages so low in the phylogenetic hierarchy of the genus. Taking into account molecular rates of other decapods, we tentatively dated this split at 6-11 Myr. This time is in agreement with the brackish and freshwater phase of the Paratethys thus allowing for a freshwater common ancestor of Caucasian and Dinaric cave shrimps. This would weaken the marine relicts hypothesis that has often been invoked to explain the distribution of freshwater cave species with close marine relatives.

Animals↗

PubMed1977

Balkan (endemic) nephropathy and a toxin-producing strain of Penicillium verrucosum var cyclopium: An experimental model in rats.

Cultures of an isolate of Penicillium verrucosum var. cyclopium, obtained from stored maize in an area of Balkan (endemic) nephropathy--Vratza, Bulgaria--has consistently induced renal tubular lesions when force-fed to rats for 20 days. The lesions, confined to the lower reaches of the proximal convoluted tublues (pars recta and junctional zone), closely resemble the tubular changes in patients with Balkan nephropathy. Preliminary evidence suggests that this nephrotoxin-producing strain of P. verrucosum var. cyclopium may be implicated in the aetiology of Balkan nephropathy.

Animals↗

PubMed2001

Undergraduate oncology nursing education in the Balkans and the Middle East.

BACKGROUND: The levels of undergraduate oncology nursing education in the Balkans and the Middle East had not been determined. METHODS: The authors used a questionnaire to survey representatives of nine Balkan and Middle East countries about the oncology nursing education available in undergraduate nursing programs in their countries. Admission criteria, the educational requirements for teachers providing the education, and the levels of nursing credentials in the country were investigated. RESULTS: Years of schooling needed for admission ranged from eight to 12. Requirements for teachers varied widely, from none to academic degrees and experience, as did levels of nurses in the countries. Israel, Slovenia, and Greece had fairly substantial oncology nursing education programs, while some countries, especially in the Balkans, offered none at all. CONCLUSIONS: There is a need for routine inclusion of required oncology training in the nursing programs of these countries.

Education, Nursing, Baccalaureate↗

PubMed2006

Paternal and maternal lineages in the Balkans show a homogeneous landscape over linguistic barriers, except for the isolated Aromuns.

The Balkan Peninsula is a complex cultural mosaic comprising populations speaking languages from several branches of the Indo-European family and Altaic, as well as culturally-defined minorities such as the Aromuns who speak a Romance language. The current cultural and linguistic landscape is a palimpsest in which different peoples have contributed their cultures in a historical succession. We have sought to find any evidence of genetic stratification related to those cultural layers by typing both mtDNA and Y chromosomes, in Albanians, Romanians, Macedonians, Greeks, and five Aromun populations. We have paid special attention to the Aromuns, and sought to test genetically various hypotheses on their origins. MtDNA and Y-chromosome haplogroup frequencies in the Balkans were found to be similar to those elsewhere in Europe. MtDNA sequences and Y-chromosome STR haplotypes revealed decreased variation in some Aromun populations. Variation within Aromun populations was the primary source of genetic differentiation. Y-chromosome haplotypes tended to be shared across Aromuns, but not across non-Aromun populations. These results point to a possible common origin of the Aromuns, with drift acting to differentiate the separate Aromun communities. The homogeneity of Balkan populations prevented testing for the origin of the Aromuns, although a significant Roman contribution can be ruled out.

Chromosomes, Human, Y↗

PubMed1977

Balkan (endemic) nephropathy and foodborn ochratoxin A: preliminary results of a survey of foodstuffs.

Ochratoxin A is a nephrotoxic fungal metabolite (mycotoxin) occurring in foodstuffs. The compound is causally associated with mycotoxic porcine nephropathy, a disease comparable with a human kidney disease, Balkan endemic nephropathy. A preliminary survey of home-produced foodstuffs in areas of Yugoslavia revealed that contamination with ochratoxin A is more frequent in an area where Balkan endemic nephropathy is prevalent (endemic area) than in area where this disease is absent. This indicates higher exposure to foodborn ochratoxin A in the endemic area. Thus further evidence is provided supporting the hypothesis that ochratoxin A is a disease determinant of Balkan endemic nephropathyk0

Food Analysis↗

PubMed1979

Ochratoxin A contamination of foodstuffs in an area with Balkan (endemic) nephropathy.

Ochratoxin A is a nephrotoxic fungal metabolite (mycotoxin) occurring in foodstuffs. The compound is causally associated with mycotoxic porcine nephropathy, a disease comparable with a human kidney disease, Balkan (endemic) nephropathy. A survey of 768 samples of foodstuffs (cereals and bread), locally produced in an area of Yugoslavia where Balkan (endemic) nephropathy is prevalent, has revealed that ochratoxin A is constantly present in parts of foodstuffs. The mean frequency of ochratoxin A contamination of cereals in the study period was 8.7 per cent, but a pronounced annual variation was encountered, with frequencies of contamination up to 43 per cent. These contamination frequencies are higher than those reported elsewhere for foodstuffs for human consumption. Thus further evidence is provided to support the hypothesis that ochratoxin A might by a disease determinant of Balkan (endemic) nephropathy.

Adult↗