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

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

Interacting Roles of Immune Mechanisms and Viral Load in the Pathogenesis of Crimean-Congo Hemorrhagic Fever ▿

Until now, the pathogenesis of Crimean-Congo hemorrhagic fever (CCHF) has not been well described. However, it has been hypothesized that it could be a result of the direct injury of virus-infected tissues in combination with the indirect effects of host immune responses, including cytokines. To shed more light on the role of viral load and cytokines, differential influences of CCHF virus (CCHFV) RNA load, antibody response, and cytokine production on severity and outcome of the disease were studied in sera of 46 patients with confirmed acute CCHF from Kosovo. In this study, viral load proved to be strongly related to the severity and outcome of the disease, with higher viral loads detected in patients with fatal outcomes than in surviving patients. Also, patients with fatal outcome had on average a weaker antibody response, if one was present at all. High levels of interleukin-10 (IL-10), gamma interferon (IFN-γ), and tumor necrosis factor alpha (TNF-α) were associated with poor outcome, since detected concentrations were highest in patients with fatal outcome and lowest in patients with moderate disease course. Additionally, a positive linear dependence between viral load and these cytokines was observed. Interestingly, reduced levels of IL-12 were detected in all CCHF patients. Our study favors the hypothesis that CCHF could be a result of a delayed and downregulated immune response caused by IL-10, which leads to an increased replication and spread of CCHFV throughout the body. This consequently triggers increased production of IFN-γ and TNF-α, cytokines mediating vascular dysfunction, disseminated intravascular coagulation, organ failure, and shock

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

Practice forum Denial, Media and Endurance in Infection Control in Kosova

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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

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

Prevalence of CCHF in Kosovo A. Cumulative incidence (per 100,000) of CCHF (from 1995 to 2013) in each municipality of Kosovo.

<p>Asterisk (*) represents a single reported CCHF case. <b>B.</b> Seroprevalence of CCHF in healthy human population in the studied municipalities of Kosovo and the number of tested sera in each municipality (in brackets), <b>C.</b> CCHF seroprevalence in cows in the studied municipalities of Kosovo, <b>D.</b> maximum likelihood phylogenetic analysis (with 1000 bootstrap) of partial (260 bp) CCHFV S segment nucleotide sequences. The map shows the municipalities where ticks were collected (green and red) and the municipality (red) of the positive ticks that were included in the study for CCHFV sequencing. Designations A1 and A3 represent Kosovo CCHFV sub-lineages described by Fajs et al. <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0110982#pone.0110982-Fajs1" target="_blank">[27]</a>.</p