First Isolation, Antifungal Susceptibility, and Molecular Characterization of Cryptococcus neoformans from the Environment in Croatia

The purpose of this study was to investigate the presence of Cryptococcus neoformans species complex isolates from environmental sources in Croatia and to determine their molecular types and antifungal susceptibility. Swab samples of tree hollows and bird excreta in the soil beneath trees were collected. Samples included 472 (92.73%) samples obtained from tree hollows and 37 (7.27%) samples from bird excreta. Four C. neoformans species complex isolates were recovered from tree hollow swabs along the Mediterranean coast, while there were no isolates recovered from bird excreta or from the continental area. Three isolates were identified as molecular types VNI and one as VNIV. All tested antifungals showed high in vitro activity against the four isolates. This is the first report proving the presence of C. neoformans species complex in the environment of Croatia. The results of the study suggest a major risk of exposure for inhabitants living along the Croatian coast and that both VNI and VNIV molecular types can be expected in clinical cases of cryptococcosis. Susceptibility to antifungals confirmed that no resistance should be expected in patients with cryptococcosis at the present time

Health warnings on wine labels: a discrete choice analysis of Italian and French Generation Y consumers

This paper aims to analyse Generation Y consumers' preferences for, interest in and attitudes towards different formats of health warnings on wine labels in two countries with different legal approaches: France and Italy. A Discrete Choice Experiment was realized on a sample of 500 wine consumers. Three warning options were applied: the long-term effect of drinking (brain damage); a short-term effect (car crash) and no warning option. Four attributes composed the choice set: alcohol content; framing of warning statement; warning size and position. Findings reveal that both the general degree of attention to the label and the level of visibility of the warnings are low, as are their effectiveness in changing consumption. Generation Y tend to prefer the ''no logo option'', short-term effects warnings and a small logo posted on the back label with neutrally framed messages. Results also show some significant differences among preferences in France and Italy, providing inputs to the ongoing debate in the EU on mandatory labelling. Although findings are subject to limitations related to the use of self-reported questionnaire and prone to social-desirability bias, practical implications are clear for private companies interested in implementing marketing strategies focused on enhancing the efficacy and readability of labels. Keywords: Health warning, Wine labelling, Discrete Choice Experimen

Amendments and updates to the ISKRACroatian national guidelines for the treatment and prophylaxis of urinary tract infections in adults

Kod odabira lijeka za infekcije mokraćnog sustava (IMS) gledamo njegov spektar djelovanja, in vitro djelotvornost, farmakokinetiku, farmakodinamiku, nuspojave, interakcije s drugim lijekovima, kontraindikacije za primjenu, mjesto liječenja, cijenu, jednostavnost primjene, individualne osobine pojedinačnog bolesnika i pojedinačne infekcije, poziciju na listi HZZO. Kod određivanja empirijske antimikrobne terapije za IMS moramo imati uvid u lokalna istraživanja uzročnika pojedinih kliničkih sindroma i njihovu osjetljivost na antimikrobna sredstva. Prema ISKRAhrvatskim nacionalnim smjernicama i nihovim dopunama i promjenama s obzirom na preporuke EUCAST-a za liječenje IMS, preporuča se sljedeće: – za akutne nekomplicirane IMS donjeg urotrakta žena kao prvi izbor nitrofurantoin u dozi 2×100 mg po. kroz 7 dana, ili fosfomicin 1×3,0 g po. jednokratno, kao alternativna terapija koamoksiklav 2×1,0 g po. kroz 7 dana, cefaleksin 2×1,0 g po. kroz 7 dana, cefuroksim aksetil, ili cefiksim, zatim norfloksacin 2×400 mg po. kroz 3 dana, – za akutni nekomplicirani pijelonefritis prvi izbor je koamoksiklav 2×1,0 g po. kroz 10–14 dana, a alternativna terapija su cefalosporini II ili III generacije kroz 10–14 dana, te ciprofloksacin 2×500 mg po. kroz 7–10 dana, – za komplicirane IMS žena lijek prvog izbora je koamoksiklav 2×1,0 g po. kroz 10–14 dana, a alternativna terapija je ceftibuten, odnosno ciprofloksacin 2×500 mg po. kroz 7–10 dana, – za akutne IMS mu{karaca koji imaju i sustavne simptome, lijek prvog izbora je ciprofloksacin 2×500 mg po. kroz 2 tjedna, a alternativna terapija je koamoksiklav 2×1,0 g po. kroz 14 dana, odnosno ceftibuten 14 dana, – za IMS muškaraca koji imaju tegobe koje odgovaraju bakterijskom prostatitisu lijek prvog izbora je ciprofloksacin 2×500 mg po. kroz 4 tjedna, a alternativna terapija su trimetoprim/sulfametoksazol ili ceftibuten, – za IMS trudnica, prema kliničkom sindromu, trajanju trudnoće i antibiogramu uzročnika, preporuča se terapija 7–14 dana: ceftibuten, koamoksiklav, nitrofurantoin, amoksicilin ili fosfomicin.When selecting appropriate antimicrobial treatment for urinary tract infections (UTIs), the following drug characteristics should be taken into account: spectrum of activity, in vitro efficacy, pharmacokinetics, pharmacodynamics, side effects, drug interactions, contraindications, the location of treatment, cost, ease of administration, individual characteristics of particular patient and infection, the position of the drug on the Croatian Health Insurance Fund medicine list. In determining the empirical antimicrobial therapy for UTIs, one has to consider the results of local research on causative pathogens for particular clinical syndromes and their susceptibility to antimicrobial agents. According to ISKRA Croatian National Guidelines and their amendments and updates, with regards to EUCAST recommendations for UTI treatmet, the following is recommended: – for acute uncomplicated lower UTIs in women, the drug of choice is nitrofurantoin (2×100 mg po. for 7 days), or fosfomycin (1×3.0 g po. once), and as alternative therapy co-amoxiclav (2×1.0 g po. for 7 days), cephalexin (2×1.0 g po. for 7 days), cefuroxime axetil or cefixime or, followed by norfloxacin (2×400 mg. po. for 3 days); – for acute uncomplicated pyelonephritis the drug of choice is coamoxiclav (2×1.0 g po. for 10–14 days), and as alternative therapy the 2nd or 3rd generation cephalosporins for 10–14 days, and ciprofloxacin (2×500 mg po. for 7–10 days), – for complicated UTIs in women the drug of choice is coamoxiclav (2×1.0 g po. for 10–14 days) and the alternative therapy is ceftibuten, that is ciprofloxacin (2×500 mg po. for 7–10 days); – for acute UTIs in men who have systemic symptoms, the drug of choice is ciprofloxacin (2×500 mg po. for 2 weeks), and alternative therapy is co-amoxiclav (2×1.0 g po. for 14 days) or ceftriaxone for 14 days; – for UTIs in men with complaints that correspond to chronic bacterial prostatitis the drug of choice is ciprofloxacin (2×500 mg po. for 4 weeks), and alternative therapies are trimethoprim / sulfamethoxazole or ceftibuten; – for UTIs in pregnant women, according to clinical syndromes, duration of pregnancy and antibiogram of the causative pathogen, the following 7–14 day therapy is recommended: ceftibuten, co-amoxiclav, nitrofurantoin, amoxicillin or fosfomycin

Immunoprophylaxis of recurrent urinary tract infections with lyophilized bacterial lysate of Escherichiae coli

Preko 40 godina se pokušava imunostimulirajućim ljekovima prevenirati rekurentne infekcije mokraćnog sustava (IMS) u žena. U postupku ispitivanja su vakcine za oralnu, injekcionu i vaginalnu primjenu koje se sastoje od različitih kombinacija ekstrahiranih imunostimulirajućih frakcija toplinom inaktiviranih uropatogenih bakterija. U kliničkoj primjeni je preparat OM-89 (Uro-Vaxom®, OM Laboratories, Ženeva, Švicarska) koji sadrži ekstrahirane imunostimulirajuće frakcije 18 različitih serotipova E.coli koji su najčešći uzročnici IMS stečenih izvan bolnice. U pet prospektivnih randomiziranih kliničkih studija i dvije meta-analize s preko 1 000 ispitanika dokazano je da je OM-89 djelotvoran i siguran lijek te da značajno smanjuje učestalost rekurentnih epizoda IMS, incidenciju bakteriurije i leukociturije te potrošnju antimikrobnih ljekova. Preventivna djelotvornost OM-89 traje još najmanje tri mjeseca nakon prestanka uzimanja. Prednost je OM-89 što se može primijeniti kroz duže vrijeme bez bojazni za poticaj nastanka bakterijske antimikrobne rezistencije i drugih nuspojava koje prate dugotrajnu antimikrobnu terapiju.Immunostimulating drugs have been used for over 40 years in trying to prevent recurrent urinary tract infections (UTI) in women. Vaccines for oral, intramuscular injection, and vaginal administration are in the process of testing, consisting of various combinations of extracted immunostimulating fractions of heathinactivated uropathogenic bacteria. The bacterial extract OM-89 (OM Laboratories, Geneve, Switzerland) has been used in clinical practice. It contains extracted immunostimulating fractions derived from 18 E. coli strains that are most frequently responsible for community acquired UTIs. In five prospective randomized clinical trials and two meta-analyses with more than 1 000 examinees OM-89 proved as effective and safe drug that significantly reduces the incidence of recurrent UTI episodes, incidence of bacteriuria and leukocyturia and antimicrobial consumption. Preventive effectiveness of OM-89 lasts for at least three months after cessation. The advantage of OM-89 is that it can be used over a longer period without concern for development of bacterial antimicrobial resistance and other side effects that accompany long-term antimicrobial therapy

Organisational structure and activities of the Reference Centre for Urinary Tract Infections of the Ministry of Health and Social Welfare from 2005 to 2010

Referentni centar Ministarstva zdravstva i socijalne skrbi RH za infekcije mokraćnog sustava djeluje u Klinici za infektivne bolesti "Dr. Fran Mihaljević" u Zagrebu od siječnja 2005. godine. Referentni centar ispunjava sva zadana, zakonom propisana mjerila, te kao centar stručnosti i izvrsnosti, obavlja najsloženije oblike zdravstvene zaštite iz infekcija mokraćnog sustava (IMS) bolesnika. Mjerila stručnosti se odnose na postignute znanstvene i stručne rezultate u praćenju, proučavanju i unaprjeđenju prevencije, dijagnostike i terapije, a u skladu sa svjetskim standardima. Centar ima visoko - stručne kadrove i suvremene prostorne uvjete. Aktivnosti centra odvijaju se u sklopu bolničko-stacionarne i specijalističko - konzilijarne službe, uz potporu gotovo svih kliničkih laboratorija i zavoda Klinike. Veći dio bolesnika obrađivan je i liječen u Zavodu za urogenitalne infekcije, Klinike za infektivne bolesti "Dr. Fran Mihaljević" i u Ambulanti za urogenitalne infekcije. Na Klinici se za liječenje bolesnika s IMS primjenjuju najnoviji dijagnostički i terapijski postupci. Preporuke dijagnostike i liječenja IMS-a u suradnji sa stručnim društvima HLZ-a i srodnim Referentnim centrima MZSS RH donešene su 2004., 2006. i 2009. godine (9,10,11).The Reference Centre for Urinary Tract Infections of the Croatian Ministry of Health and Social Welfare has been active at the University Hospital for Infectious Diseases "Dr Fran Mihaljevic" in Zagreb since January 2005. The Reference Centre fulfills all mandatory, statutory requirements, and as the centre of professionalism and expertise provides the most complex tasks of patient health care in the field of urinary tract infections. The criteria of expertise refer to achieved scientific and professional results in monitoring, analysis and improvement of prevention, diagnostics and therapy of urinary tract infections in accordance with international standards. The reference centre has highly qualified and modern infrastructural conditions. The activities of the centre are performed at the inpatient, hospital and outpatient specialist departments, in collaboration with all clinical laboratories and departments of the hospital. The majority of the patients are treated at the Department for Urogenital Infections and the Outpatient Clinic for Urogenital Infections of the University Hospital for Infectious Diseases "Dr Fran Mihaljevic", Zagreb. Latest diagnostic and therapeutic procedures for the treatment of patients with urinary tract infections are in use at the hospital. Recommendations for diagnostics and treatment of urinary tract infections in collaboration with professional societies of the Croatian Medical Association and related reference centers have been published in 2004, 2006 and 2009. (9,10,11)

Oglej v slovenskem zgodovinskem pripovedništvu

Razprava obravnava podobo Ogleja in oglejskega patriarhata v tistih besedilih slovenske književnosti, ki jim je literarna zgodovina dala oznako "zgodovinska povest" ali "zgodovinski roman". Na splošno velja, da je tema bolj privlačila katoliško usmerjene pisce in bila celo v ospredju prvega slovenskega katoliškega romana A. Carlija. Za pisatelje, ki so se posvečali Ogleju, je bila - tako v pozitivnem kot negativnem smislu - bistvena njegova povezava s papeškim Rimom. Kljub pozitivnim poudarkom, ki jih je ta povezava za Slovence prinašala s seboj, celo pri kataloških avtorjih podoba Ogleja ni zgolj pozitivna, predvsem zaradi posvetnih podvigov njegovih patriarhov