Naravna povijest bruceloze u endemskom području kroz različita vremenska razdoblja

The aim of the study was to determine the evolution and outcome of human brucellosis in an endemic region in relation to time interval. Retrospective analysis was employed to compare demographic, epidemiological, clinical, laboratory features and the outcome of patients with brucellosis, treated at University Department of Infectious Diseases in Skopje during two different periods of time. A series of 159 patients were studied in the first (1990-1991) and 138 in the second (2003-2005) study period. Patients treated in the second period were older (34.6±20.9 vs. 30.0±17.7 years; P=0.041) and acquired brucellosis less frequently on ingestion of incriminated food (34.8% vs. 47.2%; P=0.031). Focal forms were more evident in the second period (66.7% vs. 50.3%; P=0.004), mainly due to osteoarticular localization. Post-treatment follow up was more efficient in the second group (76.1% vs. 61%; P=0.005). There was no difference according to disease outcome in spite of different therapeutic trials during the two study periods. In conclusion, the established differences showed an improvement in the understanding of the disease by the general population as well as upgrading of some aspects considering medical activities. Nevertheless, this endemic region still lacks the most important measure, i.e. development and implementation of an appropriate national program for efficient control of the disease.Cilj studije bio je utvrditi razvoj i ishod bruceloze kod ljudi u jednom endemskom području u odnosu na vremenski pomak. Demografski, epidemiološki, klinički i laboratorijski podaci te ishodi u bolesnika s brucelozom liječenih na Klinici za infektivne bolesti u Skopju kroz dva vremenska razdoblja uspoređeni su retrospektivnom analizom. U prvom razdoblju (1990.-1991.) ispitano je 159 bolesnika, a u drugom razdoblju (2003.-2005.) 138 bolesnika. Bolesnici iz drugog razdoblja bili su stariji (34,6±20,9 prema 30,0±17,7 godina; P=0,041) i rjeđe su obolijevali od bruceloze zbog unosa određene hrane (34,8% prema 47,2%; P=0,031). Žarišni oblici bili su očitiji u drugom razdoblju (66,7% prema 50,3%; P=0,004), uglavnom zbog koštano¬zglobne lokalizacije. Praćenje nakon liječenja bilo je bolje u drugoj skupini (76,1% prema 61,0%; P=0,005). Usprkos različitim terapijskim pristupima tijekom ispitivanih razdoblja nije zabilježena nikakva razlika u ishodu bolesti. Dakle, utvrđene razlike pokazale su napredak u vidu boljeg razumijevanja bolesti u općoj populaciji, kao i poboljšanja u nekim vidovima medicinskih postupaka. Ipak, u ovom endemskom području jo. uvijek nedostaje najvažnija mjera, a to je stvaranje i provedba boljeg nacionalnog programa za kontrolu ove bolesti

Characteristics of an Outpatient Cohort with HBeAg-Negative Chronic Hepatitis B

Introduction: Patients with hepatitis Be antigen negative chronic hepatitis B (HBeAg-negative CHB) and patients inactive carriers (IC) have similar laboratory and serologic characteristics and are not always easy to distinguish. Aim: To characterize hepatitis Be antigen (HBeAg) negative chronic hepatitis B cohort based on their laboratory and virology evaluations at one point of time. Material and Methods:  A prospective non-randomized study was conducted on 109 patients with HBeAg negative chronic hepatitis B treated as outpatients at the Clinic for infectious disease and febrile conditions.   All patients underwent laboratory and serology testing, quantification of HBV DNA and HBs antigen (qHBsAg). Results: 56 patients were inactive carriers (IC) and 53 patients had HBeAg-negative CHB (AH). The mean values of ALT, HBV DNA and qHBsAg in IC were 29,13 U/L; 727,95 IU/ml and 2753,73 IU/ml respectively. In the AH group the mean values of ALT, HBV DNA and quantitative HBsAg were 50,45 U/L; 7237363,98 IU/ml and 12556,06 IU/ml respectively. The serum value of ALT was more influenced by qHBsAg than HBV DNA in both IC and AH groups (R=0.22 vs R=0.15) (p>0.05). Conclusion:  patients with inactive and active HBeAg-negative CHB have similar laboratory and serology profile. It is necessary to combine analysis of ALT, HBV DNA and qHBsAg for better discrimination between patients IC and patient swith HBeAg- negative CHB. Key words: chronic hepatitis B, inactive carriers, ALT, HBeAg, HBV DNA, quantitative HBsAg BACKGROUND: Patients with hepatitis Be antigen-negative chronic hepatitis B (HBeAg-negative CHB), and patients' inactive carriers (IC) have similar laboratory and serologic characteristics and are not always easy to distinguish. AIM: To characterise hepatitis Be antigen (HBeAg) negative chronic hepatitis B cohort based on their laboratory and virology evaluations at one point of time. METHODS: A prospective non-randomized study was conducted on 109 patients with HBeAg negative chronic hepatitis B treated as outpatients at the Clinic for Infectious Diseases and Febrile Conditions. All patients underwent laboratory and serology testing, quantification of HBV DNA and HBs antigen (qHBsAg). RESULTS: A group of 56 patients were inactive carriers (IC), and 53 patients had HBeAg-negative CHB (AH). The mean values of ALT, HBV DNA and qHBsAg in IC were 29.13 U/L; 727.95 IU/ml and 2753.73 IU/ml respectively. In the AH group, the mean values of ALT, HBV DNA and quantitative HBsAg were 50.45 U/L; 7237363.98 IU/ml and 12556.06 IU/ml respectively. The serum value of ALT was more influenced by qHBsAg than HBV DNA in both IC and AH groups (R = 0.22 vs R = 0.15) (p > 0.05). CONCLUSION: patients with inactive and active HBeAg-negative CHB have similar laboratory and serology profile. It is necessary to combine analysis of ALT, HBV DNA and qHBsAg for better discrimination between patient's IC and patient with HBeAg-negative CHB

The changing pattern of fever of unknown origin in the Republic of North Macedonia

Introduction. The study aimed to compare the etiologic spectrum of diseases causing fever of unknown origin (FUO) and methods for definitive diagnosis in a tertiary care hospital in the Republic of North Macedonia during two different time periods

Human Brucellosis in Macedonia – 10 Years of Clinical Experience in Endemic Region

Aim To present our 10-year clinical experience with brucellosis patients at the University Clinic for Infectious Diseases and Febrile Conditions in Skopje, Republic of Macedonia. Methods A total of 550 patients with brucellosis treated between 1998 and 2007 were retrospectively assessed for their demographic, epidemiological, and clinical characteristics and outcomes. Results Of the 550 patients, 395 (72%) were male. The median age was 34.5 years (range, 1-82). Direct contact with infected animals was recorded in 333 (61%) patients and positive family history in 310 (56%). The most frequently seen symptoms were arthralgia (438, 80%), fever (419, 76%), and sweating (394, 72%). The most common signs were fever and hepatomegaly, which were verified in 357 (65%) and 273 (50%) patients, respectively. Focal brucellosis was found in 362 patients (66%) and osteoarticular in 299 (54%). Therapeutic failures were registered in 37 (6.7%) patients. Of the 453 (82%) patients who completed a follow- up period of at least 6 months, relapses occurred in 60 (13%). Conclusion Due to non-specific clinical manifestation and laboratory parameters, brucellosis should be considered one of the differential diagnoses of any patient suffering from obscure involvement of various organs in a brucellosis- endemic region. High percentage of relapses and therapeutic failures in spite of the use of currently recommended therapeutic regimens indicates the seriousness of this zoonosis and the need to control it

Prevalence of Gastrointestinal Symptoms in Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Results of the Prospective Controlled Multinational GI-COVID-19 Study

INTRODUCTION: Gastrointestinal (GI) symptoms in coronavirus-19 disease (COVID-19) have been reported with great variability and without standardization. In hospitalized patients, we aimed to evaluate the prevalence of GI symptoms, factors associated with their occurrence, and variation at 1 month. METHODS: TheGI-COVID-19 is a prospective,multicenter, controlled study. Patientswith and without COVID-19 diagnosis were recruited at hospital admission and asked for GI symptoms at admission and after 1 month, using the validated Gastrointestinal Symptom Rating Scale questionnaire. RESULTS: The study included 2036 hospitalized patients. A total of 871 patients (575 COVID1and 296 COVID2) were included for the primary analysis. GI symptoms occurred more frequently in patients with COVID-19 (59.7%; 343/575 patients) than in the control group (43.2%; 128/296 patients) (P < 0.001). Patients with COVID-19 complained of higher presence or intensity of nausea, diarrhea, loose stools, and urgency as compared with controls. At a 1-month follow-up, a reduction in the presence or intensity of GI symptoms was found in COVID-19 patients with GI symptoms at hospital admission. Nausea remained increased over controls. Factors significantly associated with nausea persistence in COVID-19 were female sex, high body mass index, the presence of dyspnea, and increased C-reactive protein levels. DISCUSSION: The prevalence of GI symptoms in hospitalized patients with COVID-19 is higher than previously reported. Systemic and respiratory symptoms are often associated with GI complaints. Nausea may persist after the resolution of COVID-19 infection