SEROLOGICAL DIAGNOSIS OF HEPATITIS C VIRAL INFECTION - SITUATION IN PRIMORSKO-GORANSKA COUNTY

SAŽETAK Hepatitis C jedan je od najvažnijih javnozdravstvenih problema u svijetu. Najveći problem infekcije hepatitis C virusom, jest čest razvoj kroničnih oblika bolesti koji traje desetljećima i pojavljuje se u više od 80% inficiranih osoba. U visokoj proporciji oboljelih osoba, kronični hepatitis dovodi do razvoja ozbiljnih komplikacija poput ciroze i hepatocelularnoga karcinoma. Prevalencija hepatitisa C različita je u pojedinim područjima u svijetu. Dok podaci za Republiku Hrvatsku pokazuju prevalenciju od približno 1%, za Primorsko-goransku županiju o prevalenciji nema raspoloživih podataka. U radu retrospektivno su analizirani laboratorijski nalazi seroloških testiranja na hepatitis C virus (HCV), provedenih u Laboratoriju za serodijagnostiku Nastavnoga zavoda za javno zdravstvo (NZZJZ) Primorsko-goranske županije tijekom godine 2006., i u prvih pet mjeseci godine 2007. Pretraženo je ukupno 4785 uzoraka seruma bolesnika s područja Primorsko-goranske županije. Ukupno su evidentirane 174 anti-HCV pozitivne osobe. Među pozitivnim osobama podjednako su bila zastupljena oba spola. Analiza dobne raspodjele pokazala je da je od svih anti-HCV pozitivnih bolesnika, najzastupljenija bila dobna skupina između 21 godine i 30 godina, i to s 44%, te dobna skupina između 31 godine i 40 godina s 19%.ABSTRACT Hepatitis C is today one of the most important public health problems in the world. The major problem connected with hepatitis C virus infection is the fact that more than 80% of infected persons will develop chronic infection lasting for decades. The prevalence of hepatitis C virus infections varies in different parts of the world. A great proportion of chronic infections will result with the development serious complications such as cirrhosis and hepatocellular carcinoma. The prevalence of hepatitis C is different in differant parts of the world. The estimated prevalence for Croatia is about 1% and there are no available data regarding prevalence for Primorsko-Goranska County. Presented paper represents the results of retrospective analysis of serological tests for hepatitis C virus (HCV) performed in the Laboratory for Serodiagnosis of Teaching Institute of Public Health of Primorsko-Goranska County during 2006 and first five months of 2007. Overall 4785 sera of patients from Primorsko-Goranska County were analysed with positive anti-HCV results found in sera from 174 patients. Positive anti-HCV results were distributed almost equaly among female and male patients. Analysis of age distribution revealed that most of positive anti-HCV patients belong to the age group between 21 and 30 years (44%), followed by the age group between 31 and 40 years with 19% of all anti-HCV positive patients

THE RESISTANCE OF OUTPATIENT’S URINARY TRACT ISOLATES FROM FAMILY ENTEROBACTERIACEAE ON ANTIBACTERIAL AGENTS - SITUATION IN PRIMORSKO-GORANSKA COUNTY

SAŽETAK Infekcije mokraćnoga sustava ubrajaju se među najčešće bakterijske infekcije, i jedan su od najučestalijih razloga primjene antibakterijskih lijekova. Iako bi bilo optimalno zasnivati liječenje na nalazima laboratorijskoga testiranja osjetljivosti, to u praksi često puta nije moguće. Stoga se liječenje najčešće započinje empirijski, na osnovi poznavanja osjetljivosti, odnosno otpornosti najvažnijih uzročnika infekcija prema antibakterijskim lijekovima na određenu području. Godine 2004. u Republici Hrvatskoj dogovorene su smjernice antimikrobnoga liječenja i profilakse infekcija mokraćnoga sustava. U ovome su radu prikazani rezultati ispitivanja osjetljivosti najvažnijih uzročnika mokraćnih infekcija – bakterija iz porodice Enterobacteriaceae – provedenih u Nastavnome zavodu za javno zdravstvo Primorsko- -goranske županije. Cilj je rada bio analiza stanja otpornosti najučestalijih izolata iz te porodice u trogodišnjem razdoblju (2004. – 2006.), usporedba dobivenih rezultata s preporukama danim u sklopu Smjernica antimikrobnoga liječenja nakon njihova objavljivanja, te usporedba s podacima iz drugih dijelova Hrvatske. Analizom je obuhvaćeno ukupno 15.076 izolata. Prema dobivenim rezultatima, udio otpornih izolata bakterija najniži je prema ceftibutenu (3%), potom slijede koamoksiklav (5%), cefuroksim i gentamicin (6%), te ciprofloksacin i norfloksacin (7% i 8%). Dok su na osnovi naših rezultata cefazolin i nitrofurantoin bili nedjelotvorni prema 13% obuhvaćenih sojeva, stupanj otpornosti bio je najviši prema ko-trimoksazolu (26%) i amoksicilinu (44%).ABSTRACT Urinary tract infections are very frequent and often caused by bacterial agents. Therefore, they are one of the most common reasons for antbacterial agents prescribing. In everyday’s practise the introduction of empiric antibiotic therapy is almost inevitable. The empiric therapy should be based on data regarding susceptibility/resistance of the most common causal bacterial agents against antibacterial drugs on certain area. During 2004, Recommendations for antimicrobial therapy and prophylaxis of urinary tract infections in Croatia were published. Present paper presents the results of antimicrobial susceptibility testing of the most important bacterial agents of urinary tract infections belonging to the family Enterobacteriaceae performed in Teaching Public Health Institute of Primorsko-Goranska County. The main goal of this paper was to determine the resistance rates against selected antimicrobials during the three year period (2004 – 2006) and comparison of these results with previously mentioned Recommendations after their publishing and results from the rest of Croatia. The total number of 15.076 isolates were analysed. The ratio of resistant isolates was lowest against ceftibuten (3%), followed by co-amoxiclav (5%), cephuroxim, gentamycin (6%), ciprofloxacin and norfloxacin (7% and 8% respectively). Cephasoline and nitrofurantoin were not active against 13% of analysed strains while the highest ratios of resistant strains were recorded against co-trimoxasole (26%) and amoxicillin (44%)

Colorectal cancer, prevention and early detection program in Primorsko-goranska County

Cilj: Prikazati “Program ranog otkrivanja raka debeloga crijeva u Primorsko-goranskoj županiji”. Ispitanici i metode: U razdoblju od 2006. do 2008. godine 7.482 ispitanika u dobi od 50 do 69 godina pozvano je kako bi obavili hemokult analizu stolice. Hemokult test je obavilo 3.978 (53%) pozvanih osoba. Rezultati: Pozitivne hemokult testove imalo je 490 osoba (12,3%) koje su liječnici obiteljske medicine uputili na daljnju obradu gastroenterologu. Rasprava: Rak debeloga crijeva nalazi se među tri najčešća sijela raka kod pripadnika oba spola u Republici Hrvatskoj, pa tako i u Primorsko-goranskoj županiji. U Hrvatskoj je 2005. godine otkriveno 2.843 novooboljelih. U našoj se županiji, kao i u Republici Hrvatskoj, do sada nije provodio ovakav program, te je stoga Primorsko-goranska županija 2006. godine organizirala “Program ranog otkrivanja raka debeloga crijeva” čiji je nositelj Nastavni zavod za javno zdravstvo. Zaključak: “Program ranog otkrivanja raka debeloga crijeva u Primorsko-goranskoj županiji” primjenom hemokult testa jeftina je i učinkovita metoda rane detekcije koja dugoročno dovodi do smanjenja pobola i umiranja od raka debeloga crijeva.Aim: To present the “Program of early detection of colon cancer” in Primorsko-goranska county. Subjects and methods: In the period of the years 2006-2008, 7.483 patients ages 50 to 69 years were summoned for the analysis of hemoccult test. Hemoccult test was done on 3.978 patients (53%). Results: 490 (12,3%) patients had positive hemoccult tests and were sent to gastroenterologist. Discussion: Colorectal cancer is one of three most frequent cancer sites in both sexes in Croatia, and also in Primorsko-goranska county. In the year 2005 there were 2.843 new cases in Croatia. Until now the approach to early detection of colorectal carcinoma was not systematic and hemoccult stool test was not a rutine test. In the year 2006 Primorsko-goranska county initiated the “Program for early detection of colon cancer”. The Teaching Institute for public health is the host of the program. Conclusions: Program of early detection of colorectal cancer using hemoccult testing should become a rutine test because the method is cost-effective, and brings lower morbidity and mortality from colorectal carcinoma

ANTIMICROBIAL SUSCEPTIBILITY OF NASOPHARYNGEAL STREPTOCOCCUS PNEUMONIAE STRAINS TO BETA-LACTAMS

SAŽETAK Asimptomatsko nazofaringealno kliconoštvo vrste Streptococcus pneumoniae (S. pneumoniae), rašireno poglavito među malenom djecom, pridonosi širenju bakterije u populaciji, te razvoju bolesti. Utvrđivanje prevalencije kliconoštva i osjetljivosti sojeva koji kolaju u populaciji kao mogućih izvora infekcije, pridonosi unapređenju liječenja i preventivnih mjera1,2. U radu je u prvome redu analizirana incidencija pneumokoka otpornih na antibiotike u izvanbolničkoj populaciji. S. pneumoniae izoliran je iz 2464/33.139 (7,4%) uzoraka. U razdoblju od 1. siječnja 2003. do 31. prosinca 2006., disk-difuzijskim postupkom ispitana je osjetljivost 2464 izolata na eritromicin, azitromicin, klaritromicin, klindamicin, tetraciklin i trimetoprim sa sulfometoksazolom. Za 493 (20%) izolata sa smanjenom osjetljivošću na penicilin, što je ustanovljeno oksacilinskim diskom, E-testom (AB Biodisk) određene su minimalne inhibitorne koncentracije (MIK) penicilina. Od 2464 izolata, na penicilin je bio osjetljiv 1971 izolat (80%), a umjereno osjetljiva bila su 493 izolata (20%). Minimalne inhibitorne koncentracije sojeva smanjene osjetljivosti na penicilin, kretale su se od 0,125 do 1,5 μg/ml. Na eritromicin, azitromicin i klaritromicin ustanovljena je otpornost u 418 (18%) ispitanih sojeva, 370 (16%) izolata bilo je otporno na klindamicin, 297 (11%) na tetraciklin, a 543 (22%) izolata bila su otporna na trimetoprim sa sulfometoksazolom.ABSTRACT The asymptomatic nasopharyngeal carriage of Streptococcus pneumoniae (S. pneumoniae) is widely prevalent in children and has been related to the development of disease and the spread of the pathogen.The bacteria carried in the nasopharynx of healthy children reflect the infection- causing strains currently circulating in the community, and so studies of the prevalence of different pathogens and their resistance patterns can provide useful indications for more rational therapeutic and preventive strategies1,2. Present studies have been focused mainly on the incidence of antibiotic-resistant pneumococci among out-patients. S. pneumoniae was isolated from 2464/33.139 (7.4%) specimens. From 01. 01. 2003. till 31. 12. 2006. the susceptibility of 2464 Streptococcus pneumoniae strains to erythromycin, azithromycin, clindamycin, tetracycline, and trimethoprim-sulfamethoxazole was tested using the disk diffusion method. In (86) isolates with reduced sensitivity to penicillin (as determined with oxacillin disk method), minimal inhibitory concentrations (MIC) of penicillin and ceftriaxone was tested by the E-test (AB Biodisk) method. Sensitivity to penicillin was found in 1971 (80%) of the 2464 Streptococcus pneumoniae while 493 (20%) of the isolates demonstrated decreased susceptibility. Isolates with reduced sensitivity to penicillin had MICs from 0.125 to 1.5 μg/ml. 418 (18%) isolates were resistant to erythromycin, azithromycin and clarythromicin, 370 (16%) to clindamycin, 297 (11%) to tetracycline, and 543 (22%) to trimethoprim-sulfamethoxazole

First report on PVL-positive methicillin-resistant Staphylococcus aureus of SCCmec type V, spa type t441 in Croatia

Purpose The aim of the study was to investigate the molecular epidemiology of community- associated MRSA in Primorsko-Goranska County of Croatia during a six-year period(2001-2007). Methods In period from 2001 and 2007, 46 MRSA isolates were collected in Rijeka, strains were subjected to susceptibility testing according to CLSI guidelines, mecA gene detection and SCCmec typing as well as detection of PVL. Strains were typed by Pulse Field Gel Electrophoresis (PFGE) and spa typing. Results All isolates were susceptible to vancomycin, linezolid, mupirocin, nitrofurantoin, only one strain was resistant to fusidic acid and co-trimoxazole. Results of SCCmec typing showed the presence of SCCmec type IV in 26 MRSA strains, SCCmec type V in three strains, and 13 strains comprised SCCmec I. SCCmec type II and III were not observed. Four MRSA strains were non-typeable by applied SCCmec typing methods. PVL was detected in 4 strains, two SCCmec IV and two SCCmec V. PFGE analysis, grouped MRSA strains into six similarity groups and 18 singletons. Dominating spa types in this collection of strains were t015, with 15 strains, followed by t041(N=7), t051,(N=2 ), t2850(N=2), t008(N=2)and single isolates t441, t002, t448, t018, t019, t355, t390, t026, t449, t148. We also detected two new spa types, t3510 and t3509, respectively. Conclusions This is the first report on SCCmec type V in Croatia, and, to our knowledge, first report of PVL-positive mehicillin-resistant Staphylococcus aureus SCCmec type V and t441(ST59-MRSA-V) in this part of Europe

Epidemiologic Characteristics of Human Campylobacteriosis in the County Primorsko-goranska (Croatia), 2003–2007

The aim of the study was to investigate campylobacteriosis incidence in the County Primorsko-goranska (Croatia) between 2003 and 2007 and to find out possible connection with environmental factors (the average monthly temperature and total monthly precipitation). The data (number of stool samples examined, age and sex distribution of patients, monthly distribution of isolates and distribution of isolates according to the species) from the Laboratory for Diagnostics of Enteric Infections of the Teaching Institute of Public Health of the County Primorsko-goranska (Croatia) were analyzed retrospectively. During the observed period 30,164 stool samples were examined for Campylobacter spp. Campylobacters were identified in 1,242 (4.12%) samples. The overall annual campylobacter incidence rate was 81.3±21.9/100,000 population. Campylobacter jejuni was found in 1,093 (88%) and C. coli in 149 (12%) patients. Our findings showed age distribution of patients typical for developed countries. The patients were mostly children under 5 years (484.4±129.1/ 100,000, p<0.001) and between 5 and 9 years of age (226.5±60.5/100,000, p<0.05). Male consistently experienced higher rates, but the difference between genders was significant in the age groups from birth till late twentieth (p<0.001). Campylobacter rates were significantly associated with monthly average temperatures (p<0.05), but not with precipitation. Further investigations into the incidence of campylobacteriosis on the national level are necessary. The causes of the noticed monthly distribution, sources of infection and connection with the routes of transmission in humans need to be elucidated as well

The use of an interferon gamma release assay (IGRA) in the immunodiagnosis of tuberculosis

Cilj: Otkrivanje latentne tuberkuloze sukladno nacionalnim smjernicama uključuje procjenu rizika, radiografsku pretragu, izvođenje tuberkulinskog kožnog / PPD testa (PPD – purificirani proteinski derivat) i/ili novijeg ex vivo testa otpuštanja interferona gama (engl. Interferon Gamma Release Assay – IGRA). U radu je analizirana dinamika izvođenja i rezultati dobiveni dijagnostičkom primjenom imunoenzimske IGRA pretrage na M. tuberculosis. Metode: Izvršena je retrospektivna analiza rezultata Quantiferon-TB Gold In-Tube (QFT-GIT) testiranja provedenih u Laboratoriju za dijagnostiku tuberkuloze Nastavnog zavoda za javno zdravstvo Primorsko-goranske županije (Hrvatska). Rezultati: U sedmogodišnjem razdoblju (2007. – 2013.) u Laboratoriju za dijagnostiku tuberkuloze primjenom QFT-GIT testa analizirano je 2.110 uzoraka krvi pacijenata koji su pripadali različitim dobnim skupinama (od dobi od mjesec dana do 95 godina; x̄ = 41,9 godina; SD = 29,1; mod 56 godina). Rezultati analize su bili pozitivni u 585 (27,7 %), negativni u 1.498 (71 %) uzoraka, a u 27 (1,3 %) izvršenih pretraga su bili neodredivi. Pozitivni nalazi podjednako su zastupljeni u pretragama izvršenim za muškarce (29 % od 1.058 pretraga) i žene (26 % od 1.052 pretrage). Veća zastupljenost pozitivnih nalaza zabilježena je u osoba starijih od 56 godina, napose u dobnoj skupini od 81 do 85 godina (61 % od 44 pretrage). Prema uputnoj dijagnozi pozitivni nalazi su zastupljeniji kod hiperreaktora (40,5 % od 84 analize), TB kontakata (35,1 % od 464 analize) i zdravstvenih radnika (34,9 % od 43 analize). Rasprava i zaključci: Primjena in vitro IGRA QFT-GIT testa u kombinaciji s konvencionalnim metodama danas je prepoznata kao dijagnostički postupak koji ima značajnu ulogu u otkrivanju LTB-a, što predstavlja važan korak u prevenciji tuberkuloze, posebice kod rizičnih skupina.Aim: Tuberculosis (TB) remains a major global public health problem. Screening for latent tuberculosis infection (LTB) usually involves risk assessment, chest X-ray, the tuberculin skin/PPD (Purified Protein Derivate) test, and/or interferon-gamma release assay (IGRA), according to country-specific guidelines. This paper describes the frequency of application and the results obtained by enzyme-linked immunosorbent IGRA assay for M. tuberculosis. Methods: We conducted a retrospective analysis of the results obtained using Quantiferon-TB Gold In-Tube (QFT-GIT) analysis at the Laboratory for the diagnosis of tuberculosis – Teaching Institute of Public Health County Primorsko-goranska (Croatia). Results: In the seven-year period (2007–2013) QFT-GIT analysis were processed in 2110 blood samples of patients from different age groups (aged 1 month-95 years; x̄ = 41.9 years; SD = 29.1; mode 56 years). Results were positive in 585 (27.7 %) samples, whereas negative results were found in 1498 (71 %) cases, and in 27 (1.3 %) samples the results were indeterminate. Positive results were distributed equally among males (29 % of 1058 samples) and females (26 % of 1052 samples). Higher incidence of positive results was observed in people over the age of 56, especially in the age group between 81-85 years (61 % of 44 tests). Positive results were most common in the group of hyperreactors (40.5 % of 84 tests) then in TB contacts (35.1 % of 464 tests), as well as health workers (34.9 % of 43 tests). Discussion and Conclusions: Applying in vitro IGRA QFT-GIT test in combination with conventional methods is recognized as a diagnostic method that plays an important role in uncovering LTB and as such represents an important step in prevention of tuberculosis, especially in high-risk groups

Voice restoration using tracheoesophageal voice prostheses following total laryngectomy

Cilj: Totalna laringektomija opsežan je operativni zahvat koji se može izvesti sa ili bez resekcije vrata. Tijekom ovog postupka u potpunosti se odstranjuje grkljan, a traheja se mobilizira te pričvrsti za kožu u obliku trajnog otvora za disanje – traheostome. Najsloženiji problem u vezi s rekonstrukcijom funkcije larinksa, kojemu je posvećen najveći broj istraživanja, ponovno je uspostavljanje govora. Osnovne mogućnosti govorne rehabilitacije nakon totalne laringektomije jesu razvijanje vještine ezofagealnog govora, korištenje elektrolarinksa i traheoezofagealna punkcija s uporabom govorne proteze. Traheoezofagealna punkcija s govornom protezom je kirurška metoda izbora za govornu rehabilitaciju bolesnika. Punkcija može biti izvedena primarno, istovremeno s laringektomijom, i sekundarno, tjednima ili godinama nakon izvršene laringektomije. Materijali i metode: U razdoblju od 1. 1. 2004. do 31.12. 2008. godine na Klinici za otorinolaringologiju KBC-a u Rijeci liječeno je 125 laringektomiranih bolesnika. Indikacija za izvođenje totalne laringektomije bio je T3 ili T4 karcinom larinksa u 58 (46%) bolesnika, a u 67 (54%) bolesnika izvršena je parcijalna laringektomija. Rezultati: Metode govorne rehabilitacije bile su uspostava traheoezofagealnog (91%) i ezofagealnog (6%) govora i uporaba elektrolarinksa (3%). Govorne proteze postavljene su u 49 bolesnika primarnom punkcijom, a u 36 bolesnika sekundarnom punkcijom. Srednje vrijeme trajanja proteza iznosilo je 7,9 mjeseci. 10% proteza zamijenjeno je nakon manje od 3 mjeseca korištenja, 46% nakon 3 do 6 mjeseci, a 44% proteza korišteno je dulje od 6 mjeseci. Zaključak: Učinkovita rehabilitacija glasa bitna je i omogućava bolesniku povratak normalnim životnim funkcijama. Traheoezofagealni govor postao je metoda izbora za govornu rehabilitaciju nakon izvršene laringektomije.Aim: Total laryngectomy is an expansive operation and can be performed with or without neck dissection. During this procedure the entire larynx is removed, the windpipe is brought out to the skin and secured there in the form of a permanent tracheostome. The most difficult aspect of laryngeal function to reconstruct, and the one to which most research is dedicated to is the reattainment of speech. The main options for voice restoration after total laryngectomy are esophageal speech, electrolarynx speech, and tracheoesophageal speech. Tracheoesophageal puncture with prosthesis is currently the surgical method of choice for vocal restoration after total laryngectomy. This puncture tract can be created primarily, at the time of total laryngectomy, or secondarily, weeks or years following the laryngectomy. Patients and Methods: Between the period of 01.01.2004. and 31.12.2008., 125 laryngectomized patients have been rehabilitated at the Otorhynolaryngology Department of the Clinical Hospital Center Rijeka. The indication for total laryngectomy was T3 or T4 laryngeal carcinoma in 58 (46%) patients, and 67 (54%) patients underwent a partial laryngectomy. Results: The methods of voice rehabilitation were tracheoesophageal speech (91%), esophageal speech (6%) and artificial larynx (3%). A voice prosthesis could be inserted in 49 patients by primary puncture, in 36 patients by secondary puncture. The median device lifetime was 7,9 months. 10 % of the prostheses were replaced with a lifetime of less than 3 months, 46% from 3 to 6 months, and 44% devices longer than 6 months. Conclusion: Effective restoration of voice is critical to enabling the patient to return to normal functioning in their life. Tracheoesophageal speech has become the method of choice for postlaryngectomy voice restoration

Voice restoration using tracheoesophageal voice prostheses following total laryngectomy

Cilj: Totalna laringektomija opsežan je operativni zahvat koji se može izvesti sa ili bez resekcije vrata. Tijekom ovog postupka u potpunosti se odstranjuje grkljan, a traheja se mobilizira te pričvrsti za kožu u obliku trajnog otvora za disanje – traheostome. Najsloženiji problem u vezi s rekonstrukcijom funkcije larinksa, kojemu je posvećen najveći broj istraživanja, ponovno je uspostavljanje govora. Osnovne mogućnosti govorne rehabilitacije nakon totalne laringektomije jesu razvijanje vještine ezofagealnog govora, korištenje elektrolarinksa i traheoezofagealna punkcija s uporabom govorne proteze. Traheoezofagealna punkcija s govornom protezom je kirurška metoda izbora za govornu rehabilitaciju bolesnika. Punkcija može biti izvedena primarno, istovremeno s laringektomijom, i sekundarno, tjednima ili godinama nakon izvršene laringektomije. Materijali i metode: U razdoblju od 1. 1. 2004. do 31.12. 2008. godine na Klinici za otorinolaringologiju KBC-a u Rijeci liječeno je 125 laringektomiranih bolesnika. Indikacija za izvođenje totalne laringektomije bio je T3 ili T4 karcinom larinksa u 58 (46%) bolesnika, a u 67 (54%) bolesnika izvršena je parcijalna laringektomija. Rezultati: Metode govorne rehabilitacije bile su uspostava traheoezofagealnog (91%) i ezofagealnog (6%) govora i uporaba elektrolarinksa (3%). Govorne proteze postavljene su u 49 bolesnika primarnom punkcijom, a u 36 bolesnika sekundarnom punkcijom. Srednje vrijeme trajanja proteza iznosilo je 7,9 mjeseci. 10% proteza zamijenjeno je nakon manje od 3 mjeseca korištenja, 46% nakon 3 do 6 mjeseci, a 44% proteza korišteno je dulje od 6 mjeseci. Zaključak: Učinkovita rehabilitacija glasa bitna je i omogućava bolesniku povratak normalnim životnim funkcijama. Traheoezofagealni govor postao je metoda izbora za govornu rehabilitaciju nakon izvršene laringektomije.Aim: Total laryngectomy is an expansive operation and can be performed with or without neck dissection. During this procedure the entire larynx is removed, the windpipe is brought out to the skin and secured there in the form of a permanent tracheostome. The most difficult aspect of laryngeal function to reconstruct, and the one to which most research is dedicated to is the reattainment of speech. The main options for voice restoration after total laryngectomy are esophageal speech, electrolarynx speech, and tracheoesophageal speech. Tracheoesophageal puncture with prosthesis is currently the surgical method of choice for vocal restoration after total laryngectomy. This puncture tract can be created primarily, at the time of total laryngectomy, or secondarily, weeks or years following the laryngectomy. Patients and Methods: Between the period of 01.01.2004. and 31.12.2008., 125 laryngectomized patients have been rehabilitated at the Otorhynolaryngology Department of the Clinical Hospital Center Rijeka. The indication for total laryngectomy was T3 or T4 laryngeal carcinoma in 58 (46%) patients, and 67 (54%) patients underwent a partial laryngectomy. Results: The methods of voice rehabilitation were tracheoesophageal speech (91%), esophageal speech (6%) and artificial larynx (3%). A voice prosthesis could be inserted in 49 patients by primary puncture, in 36 patients by secondary puncture. The median device lifetime was 7,9 months. 10 % of the prostheses were replaced with a lifetime of less than 3 months, 46% from 3 to 6 months, and 44% devices longer than 6 months. Conclusion: Effective restoration of voice is critical to enabling the patient to return to normal functioning in their life. Tracheoesophageal speech has become the method of choice for postlaryngectomy voice restoration

CAMPYLOBACTERS AS THE CAUSE OF ACUTE DIARRHEAL DISEASE IN THE COUNTY PRIMORSKOGORANSKA IN THE YEAR 2006

SAŽETAK Bakterije roda Campylobacter jesu gram-negativne, zavinute, mikroaerofilne i termofilne bakterije. U humanoj patologiji najčešće su zastupljeni Campylobacter jejuni (C. jejuni) i Campylobacter coli (C. coli), i to kao uzročnici akutne dijareične bolesti nastale najčešće nakon konzumiranja nedovoljno termički obrađenoga kontaminiranoga mesa peradi ili svinja. Cilj je ovoga rada prikazati zastupljenost kampilobaktera u stolicama bolesnika s proljevom, na području Primorsko-goranske županije. Analizirani su retrospektivno podaci Laboratorija za dijagnostiku crijevnih infekcija Nastavnoga zavoda za javno zdravstvo Primorsko-goranske županije za godinu 2006. Tijekom te godine, na kampilobakter pretraženo je 6416 stolica bolesnika s akutnim proljevom. Od toga su broja iz 407 (6,34%) uzoraka izolirani kampilobakteri. Primoizolata (bolesnika) bilo je 239 (3,73%), a ostali izolati bili su ponovljene izolacije tijekom kontrole bolesnika. Među primoizolatima, C. jejuni bio je zastupljen u 187 (78,24%) slučajeva, a C. coli u 50 slučajeva (20,92%), dva izolata (0,84%) bila su identificirana jedino na razini roda kao Campylobacter spp. Najčešći bolesnici bili su mala djeca u dobi do četvrte godine, te mlađe odrasle osobe (20 – 29 godina). Najviše primoizolata bilo je tijekom mjeseca siječnja i rujna, vjerojatno zbog blage zime i toplijega kraja ljeta.ABSTRACT Campylobacter spp. are gram negative, curved, microaerophilic and thermophilic bacteria. The most important role in human pathology play Campylobacter jejuni (C. jejuni) and Campylobacter coli (C. coli) as the causative agents of acute diarrheal disease developed after consumption of contaminated meat (poultry or pork). The aim of the study was to present the quantity of campylobacters isolated from stools of the patients with diarrhea in the County Primorsko-Goranska. The data from the Laboratory for diagnostics of enteric infections of the Teaching institute of public health of the County Primorsko-Goranska for the year 2006 were analysed retrospectively. During that year 6416 stool samples were examined for Campylobacter spp. Campylobacters were found in 407 samples (6.34%) but primoisolates were identified in 239 (3.73%) patients and the other isolates were from control stools obtained from the same patients. Among primoisolates C. jejuni was found in 187 (78.24%) patients, C. coli in 50 (20.92%) patients and for two isolates (0.84%) species determination was not possible. The patients were mostly children under four years of age and young adults and the largest numbers of isolation were seen in January and September