Tumori mozga i epilepsija

Brain tumors are a common cause of epilepsy. Tumor type and location are determining factors that significantly influence seizure frequency. The aim of this study was to analyze clinical data of patients diagnosed with brain tumors and epilepsy. Data for this study were obtained from patient medical records over a 6-year period (2000-2005). Patient history and findings obtained by diagnostic methods such as electroencephalography, computerized tomography and magnetic resonance were analyzed. Data were analyzed by appropriate statistical methods and the structure, prevalence, mean and standard deviation were calculated. The significance of results was tested by use of t-test and χ2-test. A total of 15 933 patient charts were analyzed. Out of 15 933 patients, 10.8% were diagnosed with epilepsy and 175 (1.09%) patients had brain tumor, 75 (42.86%) of which were significantly associated with epilepsy (P>0.05). Almost forty-three percent (42.86%) of tumors were epileptogenic, with no significant sex difference (confidence level of 95%). Fifty-seven (32.5%) brain tumor patients were aged 51-60. The mean age of all patients with brain tumors was 41.6 years. Focal sensorimotor seizures were dominant in 40 (53.3%) cases. Among epilepsy cases with known etiology, 75 (6.8%) patients had epileptogenic tumors. Types of seizures in patients with epilepsy were different from seizures provoked by brain tumors. The most common tumor site was temporal region (43.4%). There was no significant difference according to epileptogenesis. Focal sensorimotor seizures were common in patients with frontal and parietal region tumors.Tumori mozga su čest uzrok epilepsije. Vrst tumora i lokalizacija su odlučujući čimbenici koji značajno utječu na učestalost konvulzija. Cilj ove studije bio je analizirati kliničke podatke bolesnika s dijagnosticiranim tumorom mozga i epilepsijom. Podaci za studiju prikupljeni su iz medicinske dokumentacije bolesnika kroz 6-godišnje razdoblje, od 2000.do 2005. godine. Analizirani su anamnestički podaci i nalazi dobiveni dijagnostičkim metodama poput elektroencefalografije, kompjutorizirane tomografije i magnetske rezonancije. U analizi su se primijenile odgovarajuće statističke metode, te je izračunata struktura, učestalost te srednja vrijednost i standardna devijacija. Značajnost rezultata ispitana je pomoću t-testa i χ2-testa. Analiza je obuhvatila 15933 bolesničkih kartona. Od 15933 bolesnika epilepsija je bila dijagnosticirana u 10,8%; 175 (1,09%) bolesnika je imalo tumor mozga, od kojih je 75 (42,86%) bilo značajno udruženo s epilepsijom (P>0,05). Gotovo je 43% (točnije, 42,86%) tumora bilo epileptogeno, bez značajne razlike prema spolu, na razini pouzdanosti od 95%. Utvrđeno je 57 (32,5%) slučajeva tumora mozga među bolesnicima u dobi od 51 do 60 godina. Srednja dob svih bolesnika s tumorom mozga bila je 41,6 godina. Žarišni senzomotorni napadaji prevladavali su u 40 (53,3%) bolesnika. Među bolesnicima s epilepsijom poznate etiologije 75 (6,8%) ih je imalo epileptogene tumore. Vrste napadaja u bolesnika s epilepsijom razlikovale su se od napadaja izazvanih tumorom mozga. Najčešće mjesto tumora bilo je temporalno područje (43,4%) i nije bilo značajne razlike u odnosu na epileptogenezu. Žarišni senzomotorni napadaji bili su česti u bolesnika s tumorima frontalnog i parietalnog područja

Self-assessment of essential public health operations in Kosovo

Aim: The National Institute of Public Health of Kosovo (NIPHK) considered the challenge of assessing the availability and performance of critical public health services in Kosovo. To this end, support was requested from the World Health Organization (WHO) European Regional Office, through the WHO office in Pristina, for an action-oriented process. The systematic process of the self-assessment of public health operations aimed to generate sufficient empirical evidence to identify the strengths and weaknesses of the country’s health services and functions to provide recommendations for future public health actions in Kosovo.Methods: The NIPHK team followed the systematic self-assessment methodology of the Essential Public Health Operations (EPHO) model that the WHO’s regional office for Europe developed. The appraisal was conducted throughout 2018 and the first quarter of 2019 and involved a broad spectrum of public health actors. It also followed a participatory, interdisciplinary, and inter-sectoral approach. It was developed in three phases: preparation and collection of information, analysis and interpretation of the data, and critical recommendations for the Kosovo health authorities’ consideration. Results: The assessment resulted in an overall score of 48% sufficiency for the set of public health operations (core and enablers). The most in need of development were EPHO 6, which is related to governance (only 20% of what is needed in this dimension as a whole), followed by EPHO 3, which considers vital aspects of health protection (35%), and EPHO 10, which is related to research capacities (40%). Based on the EPHO assessment results, the specialized teams developed a set of priority recommendations to strengthen the implementation of the EPHOs in Kosovo.Conclusion: The self-assessment revealed that, despite ongoing initiatives and measures to strengthen public health, the application of EPHOs has much room for improvement. We believe that decision-makers can use this method and the findings that it reveals to implement the most effective interventions to protect and promote the population’s health. In addition, the methodology and experience can be used for educational and training purposes

Tularemia Outbreak Investigation in Kosovo: Case Control and Environmental Studies

A large outbreak of tularemia occurred in Kosovo in the early postwar period, 1999-2000. Epidemiologic and environmental investigations were conducted to identify sources of infection, modes of transmission, and household risk factors. Case and control status was verified by enzyme-linked immunosorbent assay, Western blot, and microagglutination assay. A total of 327 serologically confirmed cases of tularemia pharyngitis and cervical lymphadenitis were identified in 21 of 29 Kosovo municipalities. Matched analysis of 46 case households and 76 control households suggested that infection was transmitted through contaminated food or water and that the source of infection was rodents. Environmental circumstances in war-torn Kosovo led to epizootic rodent tularemia and its spread to resettled rural populations living under circumstances of substandard housing, hygiene, and sanitation

Biosafety standards for working with Crimean-Congo haemorrhagic fever virus

In countries from which Crimean-Congo haemorrhagic fever (CCHF) is absent, the causative virus CCHF virus (CCHFV) is classified as a hazard group 4 agent and handled in containment level 4. In contrast, most endemic countries out of necessity have had to perform diagnostic tests under biosafety level (BSL) -2 or -3 conditions. In particular, Turkey and several of the Balkan countries have safely processed more than 100000 samples over many years in BSL-2 laboratories. It is therefore advocated that biosafety requirements for CCHF diagnostic procedures should be revised, to allow the required tests to be performed under enhanced BSL-2 conditions with appropriate biosafety laboratory equipment and personal protective equipment used according to standardized protocols in the affected countries. Downgrading of CCHFV research work from Cl-4, BSL-4 to Cl-3, BSL-3 should also be considered.Additional co-authors: Gülay Korukluoglu, Pieter Lyssen, Ali Mirazimi, Johan Neyts, Matthias Niedrig, Aykut Ozkul, Anna Papa, Janusz Paweska, Amadou A Sall, Connie S Schmaljohn, Robert Swanepoel, Yavuz Uyar, Friedemann Weber, Herve Zelle

Molecular epidemiology of Crimean-Congo hemorrhagic fever virus in Kosovo.

Crimean-Congo hemorrhagic fever virus (CCHFV) is a zoonotic agent that causes severe, life-threatening disease, with a case fatality rate of 10-50%. It is the most widespread tick-borne virus in the world, with cases reported in Africa, Asia and Eastern Europe. CCHFV is a genetically diverse virus. Its genetic diversity is often correlated to its geographical origin. Genetic variability of CCHFV was determined within few endemic areas, however limited data is available for Kosovo. Furthermore, there is little information about the spatiotemporal genetic changes of CCHFV in endemic areas. Kosovo is an important endemic area for CCHFV. Cases were reported each year and the case-fatality rate is significantly higher compared to nearby regions. In this study, we wanted to examine the genetic variability of CCHFV obtained directly from CCHF-confirmed patients, hospitalized in Kosovo from 1991 to 2013. We sequenced partial S segment CCHFV nucleotide sequences from 89 patients. Our results show that several viral variants are present in Kosovo and that the genetic diversity is high in relation to the studied area. We also show that variants are mostly uniformly distributed throughout Kosovo and that limited evolutionary changes have occurred in 22 years. Our results also suggest the presence of a new distinct lineage within the European CCHF phylogenetic clade. Our study provide the largest number of CCHFV nucleotide sequences from patients in 22 year span in one endemic area

Self-assessment of essential public health operations in Kosovo

Aim: The National Institute of Public Health of Kosovo (NIPHK) considered the challenge of assessing the availability and performance of critical public health services in Kosovo. To this end, support was requested from the World Health Organization (WHO) European Regional Office, through the WHO office in Pristina, for an action-oriented process. The systematic process of the self-assessment of public health operations aimed to generate sufficient empirical evidence to identify the strengths and weaknesses of the country’s health services and functions to provide recommendations for future public health actions in Kosovo. Methods: The NIPHK team followed the systematic self-assessment methodology of the Essential Public Health Operations (EPHO) model that the WHO’s regional office for Europe developed. The appraisal was conducted throughout 2018 and the first quarter of 2019 and involved a broad spectrum of public health actors. It also followed a participatory, interdisciplinary, and inter-sectoral approach. It was developed in three phases: preparation and collection of information, analysis and interpretation of the data, and critical recommendations for the Kosovo health authorities’ consideration. Results: The assessment resulted in an overall score of 48% sufficiency for the set of public health operations (core and enablers). The most in need of development were EPHO 6, which is related to governance (only 20% of what is needed in this dimension as a whole), followed by EPHO 3, which considers vital aspects of health protection (35%), and EPHO 10, which is related to research capacities (40%). Based on the EPHO assessment results, the specialized teams developed a set of priority recommendations to strengthen the implementation of the EPHOs in Kosovo. Conclusion: The self-assessment revealed that, despite ongoing initiatives and measures to strengthen public health, the application of EPHOs has much room for improvement. We believe that decision-makers can use this method and the findings that it reveals to implement the most effective interventions to protect and promote the population’s health. In addition, the methodology and experience can be used for educational and training purposes. Acknowledgments: We acknowledge the work of the national working group, participating experts, and institutions in the EPHO assessment process, without which the self-assessment exercise would not have been possible. We thank the members of the WHO’s regional office for Europe and the WHO’s office in Pristina for assisting in the work of the national working group by providing expertise and logistical support. We also thank Professor Laura E. Cruz for her contribution to the English editing of this paper. Sources of funding: Work regarding the self-assessment was funded by the WHO’s regional office for Europe, the WHO’s office in Pristina, the National Institute of Public Health, and the Ministry of Health of Kosovo.Conflicts of interest: The authors of this article were part of the national working group for the self-assessment process. The first author (MB) received a consultancy fee from the WHO for coordinating, collecting, and analyzing the data required for the assessment reported in this article. The co-author (MM) received a consultancy fee through a professional assignment from WHO. The last author (JMM) also played a consulting role through a professional assignment from WHO. Disclaimer: The authors alone are responsible for the views expressed in this publication, and they do not necessarily represent the decisions or policies of the WHO

Prevalence of Crimean-Congo hemorrhagic fever virus in healthy population, livestock and ticks in Kosovo.

Crimean-Congo hemorrhagic fever (CCHF) is an acute, tick borne disease often associated with hemorrhagic presentations and high case fatality rate. Kosovo is a highly endemic area for CCHF, with a significant case fatality rate. The aim of our study was to determine the prevalence of CCHF in Kosovo. We tested 1105 serum samples from healthy population in both endemic and non-endemic areas in the country. Our results revealed a seroprevalence of 4.0% (range 0-9.3%) which is comparable to the seroprevalence in other countries. We show that seroprevalence is correlated to the disease incidence in each studied municipality. We also tested 401 animal sera (353 cow, 30 sheep, 10 goat and 8 chicken) in four endemic municipalities in Kosovo. We detected specific antibodies in all animals except in chicken. Seroprevalence in cows is comparable to other endemic areas and correlates to the seroprevalence in humans. No CCHF RNA could be detected in 105 tick samples obtained in 2012 and 2013. Sequencing of CCHFV positive ticks from 2001 revealed that the virus is most closely related to viral strains that were detected in CCHF patients from Kosovo. Results suggest that mild CCHF cases are most probably underdiagnosed and consequently that the burden of disease is higher than reported. Our study provides key information for CCHF surveillance and raises awareness for possible imported cases in CCHF non-endemic countries

Correlation of geographical and phylogenetic clustering of CCHFV sequences in Kosovo.

<p>Sequence abundances were plotted on the map of Kosovo. The numbers represent the number of obtained sequences. Designations A1–A5 represent the assigned phylogenetic clusters. RS = Republic of Serbia, ME = Montenegro, AL = Albania, FYROM = Former Yugoslav Republic of Macedonia.</p

Bayesian phylogenetic analysis of the A. 1019 bp fragment of the CCHFV S segment, B. 389 bp fragment of the CCHFV S segment, C. partial M segment sequences.

<p>Sequences from patients in Kosovo are designated with KS, followed by patients' ID and year of hospitalization. GenBank accession numbers of reference sequences are shown alongside CCHFV strain origin. Branch labels represent posterior probabilities. Designations A1–A5 represent the assigned phylogenetic clusters based on the analysis of the 389 bp fragment. Samples in black type in the M segment analysis did not have a representing S segment sequence.</p