Viral gastroenteritis

Virusi čine 30-40% poznatih uzročnika akutnih infekcijskih proljeva. Među njima najčešći su uzročnici rotavirusi i crijevni adenovirusi, koji uzrokuju proljev u djece od 6-24 mjeseca života. Ponekad se mogu zaraziti i neimuni odrasli u njihovoj okolini. U ostalih uzročnici virusnih proljeva su Norwalk-virus i njemu slični, astrovirusi, kalicivirusi i vjerojatno još neki drugi. Među virusnim gastroenteritisima slični su klinički simptomi. Svi se oni prenose fekalno-oralnim putem i vrlo su kontagiozni, jer zaražene osobe izlučuju veliki broj virusa stolicom (zaraženi s rotavirusom izlučuju 1010 virusa u gramu izmeta), a infekcijska doza je vrlo mala - samo nekoliko virusnih čestica može uzrokovati proljeve. U dijagnostici se koriste imunološke metode koje dokazuju virusne čestice u stolici blesnika. Sada se u Klinici za infektivne bolesti "Dr. Fran Mihaljević" može dokazati imunološkim metodama (latex-aglutinacija, imunokromatografski test) u stolici samo virusne čestice rotavirusa i adenovirusa, što je jedan od razloga za etiološki nedokazane akutne infekcijske proljeve u odrasloj populaciji.Viruses make up 30–40 % of known agents causing acute infectious diarrhoea. The most common among them are rotaviruses and intestinal adenoviruses, that cause diarrhoea in children aged 6–24 months. Sometimes nonimmune adults in their surroundings can become infected as well. In others, causative pathogens of viral diarrhoea are Norwalk and Norwalk-like viruses, astroviruses, caliciviruses, etc. Viral gastroenteritises have similar clinical symptoms. They are all transmitted by faecal-oral-route and are highly contagious, because infected persons excrete a large number of viruses by stool (persons with rotavirus infection excrete 1010 viruses in one gram of stool), and infectious dose is very small – only a few viral particles can cause diarrhoea. Immunological methods are used to detect viral particles in the stool of infected patients. Immunological methods currently used at the University Hospital for Infectious Diseases »Dr. Fran Mihaljević« (latex-agglutination, immunochromatography test) can detect only viral particles of rotavirus and adenovirus in stool, which is one of the reasons for etiologically unclear cases of acute infectious diarrhoea among adults

Viral gastroenteritis

Virusi čine 30-40% poznatih uzročnika akutnih infekcijskih proljeva. Među njima najčešći su uzročnici rotavirusi i crijevni adenovirusi, koji uzrokuju proljev u djece od 6-24 mjeseca života. Ponekad se mogu zaraziti i neimuni odrasli u njihovoj okolini. U ostalih uzročnici virusnih proljeva su Norwalk-virus i njemu slični, astrovirusi, kalicivirusi i vjerojatno još neki drugi. Među virusnim gastroenteritisima slični su klinički simptomi. Svi se oni prenose fekalno-oralnim putem i vrlo su kontagiozni, jer zaražene osobe izlučuju veliki broj virusa stolicom (zaraženi s rotavirusom izlučuju 1010 virusa u gramu izmeta), a infekcijska doza je vrlo mala - samo nekoliko virusnih čestica može uzrokovati proljeve. U dijagnostici se koriste imunološke metode koje dokazuju virusne čestice u stolici blesnika. Sada se u Klinici za infektivne bolesti "Dr. Fran Mihaljević" može dokazati imunološkim metodama (latex-aglutinacija, imunokromatografski test) u stolici samo virusne čestice rotavirusa i adenovirusa, što je jedan od razloga za etiološki nedokazane akutne infekcijske proljeve u odrasloj populaciji.Viruses make up 30–40 % of known agents causing acute infectious diarrhoea. The most common among them are rotaviruses and intestinal adenoviruses, that cause diarrhoea in children aged 6–24 months. Sometimes nonimmune adults in their surroundings can become infected as well. In others, causative pathogens of viral diarrhoea are Norwalk and Norwalk-like viruses, astroviruses, caliciviruses, etc. Viral gastroenteritises have similar clinical symptoms. They are all transmitted by faecal-oral-route and are highly contagious, because infected persons excrete a large number of viruses by stool (persons with rotavirus infection excrete 1010 viruses in one gram of stool), and infectious dose is very small – only a few viral particles can cause diarrhoea. Immunological methods are used to detect viral particles in the stool of infected patients. Immunological methods currently used at the University Hospital for Infectious Diseases »Dr. Fran Mihaljević« (latex-agglutination, immunochromatography test) can detect only viral particles of rotavirus and adenovirus in stool, which is one of the reasons for etiologically unclear cases of acute infectious diarrhoea among adults

Leptospirosis: indications of changes in clinical presentation in Croatia

Leptospiroza ponovno postaje zanimljiva bolest diljem svijeta zbog promjene epidemiološkog oblika bolesti – epidemijskog pojavljivanja u urbanoj populaciji, u športaša, rekreativaca, vojnika i putnika na međunarodnim destinacijama, te zbog promjena kliničke slike bolesti, u smislu sve češće pojave teške plućne hemoragije kao najsmrtonosnije kliničke manifestacije leptospiroze. U Republici Hrvatskoj je prema službenim podacima Službe za epidemiologiju zaraznih bolesti Hrvatskog zavoda za javno zdravstvo od 1990.–2004. godine prijavljeno 1251 (raspon: 12–154 godišnje) oboljelih od leptospiroze, od toga je 18 bolesnika umrlo. U promatranom razdoblju bolest se uglavnom pojavljivala sporadično. U navedenom razdoblju u našoj je Klinici liječeno 410 (raspon: 12–52 godišnje) bolesnika od leptospiroze, od kojih je sedmero umrlo. Povećani broj oboljelih bilježi se svakih 2–5 godina. U Republici Hrvatskoj za sada ne primjećujemo promjenu epidemiološkog obrasca bolesti, ali postoje neke naznake da i u nas, unatoč napretku intenzivnog liječenja, bolest u posljednje vrijeme ima veću smrtnost.Leptospirosis has again became an interesting disease around the World because of changes in epidemiological pattern of disease – with appearance of epidemics among urban population, military personnel, athlets, people who participate in recreational activities and international route travellers, and because of changes in clinical patterns of the disease, with severe pulmonary haemorrhage as clinical manifestation of leptospirosis with highest mortality becoming more frequent. According to official data from the Department for Infectious Diseases Epidemiology, Croatian National Institute of Public Health, 1251 (range 12–154 per year) persons with leptospirosis were recorded in Croatia in the period 1990–2004, 18 of whom died. In the observed period, the disease appeared mostly sporadic. Altogether 410 (range: 12–52 per year) patients with leptospirosis were treated in our Clinic, seven of whom died. An increased number of patients is recorded every 2–5 years. Changes in the epidemiological pattern of the disease in the Republic of Croatia are currently not observed, but there are some data which suggest that despite of intensive care medicine developments, the disease shows a tendency of higher mortality

Enterocytozoon bieneusi as a cause of acute enteritis in an immunocompromised patient

43-godišnji bolesnik pod imunosupresivnom terapijom radi prije dvije godine presađenog srca, hospitaliziran je s kliničkom slikom akutnog enteritisa. Rutinskim mikrobiološkim analizama stolica nije dokazan uzročnik. Modificiranim Ziehl-Nielsenovim bojanjem kao i trikromnim bojanjem na mikrosporidije dokazane su spore mikrosporidija koje morfološki odgovaraju Enterocytozoon bieneusi. Na simptomatsku terapiju je bolesnik ozdravio.43-year-old patient receiving immunosuppressive therapy for two years after heart transplantation was admitted because of acute enteritis. Routine stool examinations did not reveal causative agent. Modified Ziehl-Nielsen stain and trichrome stain revealed microsporidia spores shaped as Enterocytozoon bieneusi. Patient recovered completely after symptomatic treatment

Look, the World is Watching How We Treat Migrants! The Making of the Anti-Trafficking Legislation during the Ma Administration

Employing the spiral model, this research analyses how anti-human trafficking legislation was promulgated during the Ma Ying-jeou (Ma Yingjiu) presidency. This research found that the government of Taiwan was just as accountable for the violation of migrants’ human rights as the exploitive placement agencies and abusive employers. This research argues that, given its reliance on the United States for political and security support, Taiwan has made great efforts to improve its human rights records and meet US standards for protecting human rights. The reform was a result of multilevel inputs, including US pressure and collaboration between transnational and domestic advocacy groups. A major contribution of this research is to challenge the belief that human rights protection is intrinsic to democracy. In the same light, this research also cautions against Tai-wan’s subscription to US norms since the reform was achieved at the cost of stereotyping trafficking victimhood, legitimising state surveillance, and further marginalising sex workers

Clinical characteristic of campylobacteriosis in hospitalised patients

Bolest izazavana gram-negativnim bakterijama iz roda Campylobacter u ljudi najčešće prolazi kao akutna proljevna bolest u trajanju do tjedan dana. Komplikacije bolesti su rijetke, a najznačajnije su među njima sepsa, bakterijemija s vancrijevnim žarištima zaraze, septički pobačaj, te imunološki uvjetovan Guillain-Barréov sindrom. Među 1632 bolesnika s kampilobakteriozom hospitalizirana od 1994.–2002. godine analizom pojedinih kliničkih parametara logističkom regresijom uočeno je značajno duže trajanje proljeva u bolesnika zaraženih s C. jejuni (p = 0,014, OR 1,06, 95 % CI 1,01–1,11). Komplikacije bolesti su zabilježene u 4,6 % bolesnika, a smrtni ishod ili naknadna hospitalizacija zbog Guillain-Barréovog sindroma u klinikama zagrebačkog područja nisu u njih zabilježeni. S učestalošću od 7,2 % komplikacije su bile značajno češće u dobnoj skupini mlađih od tri godine (p = 0,010). Odgovarajućim antimikrobnim lijekom je liječeno 78,7 %, neodgovarajućim antimikrobnim lijekom 6,7 %, a simptomatski 14,6 % bolesnika. Kliničke osobine u naših bolesnika s kampilobakteriozom ne odudaraju znatnije od onih opisanih u populacijama razvijenih zemalja. Kao osobitost bilježi se česta primjena antimikrobnog liječenja, a azitromicin, kojeg je dobijalo 46,4 % bolesnika liječenih odgovarajućim antimikrobnim lijekom, je najčešće primjenjivani lijek.Diseases caused by gram-negative bacteria from genus Campylobacter in humans are most often presented as an acute diarrhoeal illness, which lasts up to seven days. Complications are rare, and among them the most important are: sepsis, bacteremia with extraintestinal sites of infection, septic abortion, and immunologically triggered Guillain-Barré syndrome. Among 1632 hospitally treated patients in the period from 1994–2002, the analysis of a particular clinical parameters using logistic regression showed significantly longer duration of diarrhoea among patients with C. jejuni infection (p = 0.014, OR 1.06, 95 % CI 1.01–1.11). Disease complications were observed in 4.6 % patients, and no fatalities or hospitalisations of observed patients due to Guillain-Barré syndrome in any of the hospitals from Zagreb region were recorded. Complications were significantly more frequent (7.2 %) in the age group younger than three years (p = 0.010). Adequate antimicrobial treatment received 78.7 % of patients, unadequate antimicrobial treatment 6.7 %, and 14.6 % of patients were treated symptomaticaly. Clinical characteristics in our patients with campylobacteriosis do not differ significantly from those described in populations of developed countries. As a peculiarity, a common use of antimicrobial therapy is recorded, and azithromycin, used in 46.4 % of patients treated with adequate antimicrobial treatment, was the most frequently used drug

Epidemiologic characteristics of campylobacteriosis in hospitalized patients

Među 1632 bolesnika s kampilobakteriozom hospitalizirana od 1994.–2002. godine, nije utvrđen porast udjela kampilobakterioza u odnosu na sve druge uzročnike proljeva (p=0,333), niti u odnosu na salmoneloze (p=0,751), te je utvrđen porast bolesnika s C. jejuni (71,7%) u odnosu na one s C. coli (28,3%) infekcijom (p<0,001). Najviše je bolesnika u dobnoj skupini mlađih od tri godine (38,5 %), zatim u skupini 18–29 g. (9,9 %). Mu{karci prevladavaju u svim dobnim skupinama, osim u najstarijoj (≥60 g.) (p<0,001). Značajno najveći broj bolesnika je hospitaliziran u toplijim mjesecima godine; 14,3% bolesnika s C. jejuni tijekom lipnja, a po 11,5 % bolesnika s C. coli u lipnju i kolovozu (p<0,001). U skupinama seoskog, prigradskog i gradskog stanovništva je omjer bolesnika s C. jejuni i C. coli infekcijom podjednak (p=0,289). Bolest se u 83,9% bolesnika javila sporadično, a u 13,1% bolesnika nakon putovanja. Pohađanje kolektiva se pokazalo značajnim u odnosu na epidemijski oblik pojavnosti bolesti (p<0,001).Among 1632 patients with campylobacteriosis hospitalized in the period from 1994–2002, we did not record an increase in the ratio of campylobacteriosis compared to all other causative agents of diarrhoeal diseases (p=0.333), nor in comparison to salmonelloses (p=0.751), but a significant increase in the number of C. jejuni (71.7%) compared to C. coli infections (28.3 %) was noticed (p<0.001). The majority of patients belonged to age group of three years and younger (38.5 %), and to 18 –29 years group (9.9 %), respectively. Males predominated in all age groups, except in the oldest one (≥60 years) (p<0.001). Significantly highest number of patients was hospitalized during warm months of the year; 14.3% patients with C. jejuni infection during June, and 11.5 % of patients with C. coli infection in both June and August (p<0.001). In the groups of rural and urban population, the difference in the ratio between C. jejuni and C. coli infections was not recorded (p=0.289). The disease appeared in 83.9% of patients sporadically, and in 13.1% after travelling. Community setting was a significant factor in epidemic pattern of the disease (p<0.001)

Ceramic implants:the state of art

A multitude of biomaterials have been used for the production of implants through the years. Titanium or titanium alloy have been regarded as the 'gold standard' for years. However, potential risks and disadvantages regarding biocompatibility and aesthetics have also been reported for the use of titanium in dental implantology. As such, there is need for an alternative material. Zirconia may be regarded as a possible alternative. It is a ceramic with high fracture toughness and other positive qualities, such as beings metal-free, biocompatible, and white, which is aesthetically desirable. Short-term study results of contemporary zirconia implants are promising and comparable to titanium implants. Nevertheless, the material is relatively brittle and susceptible to surface defects. However, no long-term clinical results exists and possible complications are unknown. Long-term clinical research is needed before zirconia implants routine use may be endorsed.</p