14 research outputs found
Usporedba kliniÄke djelotvornosti probiotika Lactobacillusa reuteri i enteroadsorbenta polimetilsiloksana u lijeÄenju rotavirusnog gastroenteritisa u djece u dobi od 6 do 36 mjeseci [Comparison of clinical efficacy of probiotic Lactobacillus reuteri versus enteroadsorbent polymethylsiloxane (EnterosgelĀ®) in the treatment of rotaviral gastroenteritis in children 6-36 months old]
Rotavirus gastroenteritis is the most common cause of acute infectious diarrhea in infants and young children. It is a very frequent cause of childhood hospitalisation due to its sudden onset of symptoms - vomiting, diarrhea and fever. There is still no causative therapy against rotavirus. However, there are many adjunctive therapies available to alleviate the symptoms of infection. Once very popular enterosorbent, medicinal activated charcoal, was replaced by some new agents, namely probiotics. Amongst many probiotic preparations only a few showed some advantages over placebo. In the last few years a new enterosorbent, polymethylsiloxane (Enterosgel) has emerged on the Croatian market and we wanted to compare it to the stardard therapy, probiotic L. reuteri (BioGaia). We chose L. reuteri because it was the first probiotic preparation registered for safe use in infants. We also wanted to compare two gastroenteritis clinical severity assessment scales and describe some clinical characteristics of rotavirus infection in our region.
The efficacy of the investigated therapies was tested on three levels - duration of symptoms, duration of hospital stay and the total number of liquid stools. We have found no significant differences between the therapies according to any of the tested parameters. We have noticed no significant side-effects of the tested therapies. Probiotic preparation seemed to have better palatability, however this might be attributed to a smaller single dose volume (BioGaia cca 1 mL; Enterosgel cca 20-30 mL).
Although very similar, the standard clinical severity scores for the evaluation of acute gastroenteritis, Vesikari's and Clark's, are not comparable. If there is a need for comparing different treatments or preventive measures (vaccinations) the same clinical score must be used. We also cannot use these scores for predicting the duration of symptoms of rotavirus disease. It would be beneficial if a single scale would be set as the standard on the international level, thus enabling easier comparison of future clinical trials.
The clinical and epidemiological characteristics of the rotavirus infection in our examinees did not significantly differ to the ones described in the standard textbooks. However, the expected slightly higher number of cases in the late autumn was not recorded, due to the limited duration of the trial or it could be just a reflection of the usual seasonal variability. We did not find a significant number of rare manifestations of rotavirus infection such as urticaria, reactive arthritis, hepatitis, encephalitis, nor did we notice any complications such as severe dehydration, encephalopathy, etc. One of the reasons for that can be prompt admission of patients with more severe rotavirus infection to the intensive care unit. Due to the nature of the trial, these patients were not recruitable or suitable for inclusion as we could not obtain the parents' consent.
Subsequently, the patients with the most severe and those with the most benign symptoms were not included in our trial. On the positive note, our study population was very homogeneous as all the patients had similar clinical characteristics thus making the comparison of treatment effectiveness more reliable.
In conclusion, with the statistical power of 80 %, we can claim that there is no difference in the efficacy between the new enterosorbent polymethylsiloxane and probiotic L. reuteri in the treatment of rotavirus gastroenteritis in children
Bronchiolitis caused by respiratory syncytial virus in the period from 2003 to 2009
Respiratorni sincicijski virus (RSV) uzrokuje akutne respiratorne infekcije u osoba svih dobnih skupina. Donji diÅ”ni putovi ÄeÅ”Äe su zahvaÄeni u dojenÄadi i male djece s primoinfekcijom te u starijih i imunokompromitiranih, dok su u ostalih obiÄno zahvaÄeni samo gornji diÅ”ni putovi. VeÄina djece preboli primoinfekciju do druge godine života, dok su reinfekcije uobiÄajene tijekom života. RSV je najvažniji uzroÄnik infekcija donjega respiratornog trakta, a pogotovo
bronhiolitisa, u dojenÄadi. KarakteristiÄna je sezonska pojavnost od kasne jeseni do ranoga proljeÄa s vrhuncem tijekom sijeÄnja i veljaÄe. RSV uzrokuje febrilni respiratorni katar, otitis, traheobronhitis, bronhiolitis i pneumoniju. Virus se može dokazati izolacijom iz respiratornih sekreta, a danas se rutinski koriste brzi testovi visoke osjetljivosti i specifiÄnosti kojima se dokazuje antigen.
LijeÄenje je simptomatsko (adekvatna hidracija, antipireza, kisik, dekongestija nosne sluznice). U lijeÄenju bronhiolitisa koriste se inhalacijski bronhodilatatori (albuterol, salbutamol, racemiÄni epinefrin) i kortikosteroidi iako kliniÄke studije nisu dokazale njihovu djelotvornost. Ribavirin u obliku aerosola preporuÄuje se u djece kod koje oÄekujemo težu bolest. U dijela bolesnika nakon preboljele RSV infekcije zaostaje pojaÄana reaktivnost diÅ”nih putova. Primjena palivizumaba, monoklonskog antitijela protiv RSV-a, indicirana je
kao profilaksa kod djece s rizikom za teÅ”ku RSV infekciju. U naÅ”oj Klinici tijekom razdoblja od Å”est godina lijeÄeno je 422 djece zbog bronhiolitisa uzrokovanog RSV-om. Dobna, spolna i sezonska raspodjela odgovaraju oÄekivanima. U 17 djece (4% hospitaliziranih) provoÄena je mehaniÄka ventilacija, dok je jedno dijete umrlo (smrtnost 0,24%). ViÅ”e od polovice mehaniÄki ventiliranih imalo je neki Äimbenik rizika za težu bolest. Na varijacije u udjelu mehaniÄki
ventiliranih meÄu hospitaliziranima vjerojatno utjeÄe virulencija tipa virusa koji kruži u populaciji.Respiratory syncytial virus (RSV) causes acute respiratory tract illness in persons of all ages. Lower respiratory tract infection is usually the result of primary infection of infants and small children as well as secondary infection of older adults and immunodeficient persons. Healthy older children and adults typically have symptoms restricted to the upper respiratory tract. Almost all children acquire primary RSV infection during the first two years of life and reinfections occur throughout lifetime. RSV is the most important cause of lower respiratory tract infections, especially of bronchiolitis, in infants. Seasonal outbreaks are typically seen from late autumn to early spring peaking in January and February. RSV infection manifests as upper respiratory tract infection, acute otitis media, tracheobronchitis, bronchiolitis or pneumonia. The laboratory diagnosis of RSV infection is made by analysis of respiratory secretions with rapid assays utilizing antigen capture technology. Their sensitivity and specificity exceed 90 percent. Supportive care is the mainstay of therapy and sometimes includes oxygenotherapy. Bronchodilators and corticosteroids are widely used, although no convincing data exist for their efficacy. Nebulized ribavirin is reserved for severe infections. In some patients RSV infection is correlated with recurrent wheezing. Immunoprophylaxis with palivizumab, a humanized monoclonal antibody against the RSV F glycoprotein, is indicated for children at high risk for serious infection. During the period of six years 422 children with RSV bronchiolitis were treated at our hospital. We found expected age, sex and seasonal distribution of our patients. Seventeen children (4 %) required mechanical ventilation and one child died (mortality 0.24 %). More than half of the patients requiring mechanical ventilation had at least one risk factor for severe infection. Seasonal variations in the number of mechanically ventilated patients are probably the result of virulence of circulating strain of virus
Etiology of Chronic Prostatitis Syndrome in Patients Treated at the University Hospital for Infectious Diseases Ā»Dr. Fran Mihaljevi}Ā« from 2003 to 2005
A total of 835 patients with symptoms of chronic prostatitis syndrome and no evidence of structural or functional
lower genitourinary tract abnormalities were examined in a three year period at the Outpatient Department for Urogenital
Infections, University Hospital for Infectious Diseases Ā»Dr Fran Mihaljevi}Ā« Zagreb, Croatia. Disease etiology was
determined in 482 (57.72%) patients. Chlamydia trachomatis was proved to be the causative pathogen in 161 patients,
Trichomonas vaginalis in 85, Escherichia coli in 68, Enterococcus in 51, Proteus mirabilis in 20, Klebsiella pneumoniae
in 9, Streptococcus agalactiae in 15, Ureaplasma urealyticum in 49 patients with chronic prostatitis. Other patients had
mixed infection. In 257 (53.32%) of 482 patients, the inflammatory finding (>10 WBCs/hpf) was found in EPS or VB3.
Normal WBCs/hpf (<10) was found in 103 (63.98%) of 161 patients with symptoms of chronic prostatitis in whom C.
trachomatis was detected in EPS or VB3, in 50 (58.82%) of 85 patients in whom Trichomonas vaginalis was isolated, and
in 23 (46.94%) of 49 patients in whom Ureaplasma urealyticum was isolated
Comparison of clinical efficacy of probiotic Lactobacillus reuteri versus enteroadsorbent polymethylsiloxane (EnterosgelĀ®) in the treatment of rotaviral gastroenteritis in children 6-36 months old
Rotavirusni gastroenteritis je najÄeÅ”Äi uzrok akutnog infektivnog proljeva u populaciji dojenÄadi i predÅ”kolske djece. Zbog naglog nastupa simptoma, povraÄanja, proljeva i vruÄice, Äest je razlog hospitalizacije u djece. Do danas nema uzroÄnog lijeka koji djeluje na rotavirus. Postoje mnoga pomoÄna ljekovita sredstva koja služe ublažavanju simptoma. Nekada popularni enteroadsorbens medicinski ugljen zamijenila su neka novija sredstva, danas su to prije svih probiotici. MeÄu brojnim preparatima samo neki imaju blagu prednost pred placebom. U zadnjih nekoliko godina na hrvatskom tržiÅ”tu se pojavio novi enteroadsorbens polimetilsiloksan (Enterosgel) koji smo htjeli testirati usporeÄujuÄi ga sa standarnim sredstvom, probiotikom L. reuteri (BioGaia) koji je prvi probiotik licenciran u nas za upotrebu u dojenaÄkoj dobi. Osim toga, željeli smo ispitati dvije kliniÄke ljestvice za ocjenu težine rotavirusne infekcije i opisati neke kliniÄke osobitosti rotavirusne infekcije u naÅ”em podneblju.
Djelotvornost ispitivanih lijekova ispitivali smo na tri razine - duljini trajanja bolesti, duljini bolniÄkog lijeÄenja i ukupnom broju stolica u toku bolesti. Niti po jednom parametru nije bilo znaÄajnih razlika izmeÄu dva ispitivana lijeka. Nismo zamijetili niti jednu znaÄajniju nuspojavu meÄu naÅ”im ispitanicima. Dojam je neÅ”to bolje palatabilnosti probiotika, ali to može biti i odraz manje koliÄine pojedinaÄne doze (BioGaia oko 1 mL; Enterosgel 20-30 mL).
Standardne kliniÄke ljestvice za ocjenu težine rotavirusne bolesti, Vesikarijeva i Clarkova, premda vrlo sliÄne, nisu meÄusobno usporedive. U sluÄaju ispitivanja terapijskih tretmana ili preventivnih mjera (cijepljenje) potrebno je koristiti istu skalu. Ljestvice takoÄer ne možemo koristiti u svrhu predviÄanja duljine bolesti. Bilo bi dobro da se na meÄunarodnoj razini odluÄi za jednu skalu radi lakÅ”e usporedbe kliniÄkih istraživanja u buduÄnosti.
KliniÄke i epidemioloÅ”ke znaÄajke rotavirusne infekcije u naÅ”ih ispitanika ne razlikuju se znaÄajno od onih opisanih u standardnim udžbenicima. OÄekivali smo neÅ”to veÄi broj oboljelih u kasnu jesen, ali izostanak veÄeg broja oboljelih u tom razdoblju može biti samo odraz sezonske varijabilnosti. Nismo naÅ”li znaÄajniji udio rijetkih pojavnosti rotavirusne infekcije kao Å”to su urtikarija, reaktivni artritis, hepatitis, encefalitis, niti komplikacija kao Å”to su teÅ”ka dehidracija, encefalopatija i sl. Jedan od razloga za to može biti prijem težih bolesnika u jedinicu intenzivnog lijeÄenja. Teže oboljeloj djeci nismo bili u moguÄnosti davati ispitivana ljekovita sredstva niti smo mogli pridobiti roditelje za sudjelovanje u naÅ”em istraživanju.
Ipak, izostanak najtežih i najlakÅ”ih bolesnika iz naÅ”e studije ima i nekih prednosti - Äini skupinu ispitanika vrlo homogenom jer su sva djeca sliÄnih kliniÄkih karakteristika i prema tome usporedbu djelotvornosti Äini toÄnijom.
U zakljuÄku možemo reÄi da sa statistiÄkom snagom od 80 % možemo tvrditi da nema razlike u djelotvornosti izmeÄu enteroadsorbensa polimetilsiloksana i probiotika L. reuteri u lijeÄenju rotavirusnog gastroenteritisa.Rotavirus gastroenteritis is the most common cause of acute infectious diarrhea in infants and young children. It is a very frequent cause of childhood hospitalisation due to its sudden onset of symptoms - vomiting, diarrhea and fever. There is still no causative therapy against rotavirus. However, there are many adjunctive therapies available to alleviate the symptoms of infection. Once very popular enterosorbent, medicinal activated charcoal, was replaced by some new agents, namely probiotics. Amongst many probiotic preparations only a few showed some advantages over placebo. In the last few years a new enterosorbent, polymethylsiloxane (Enterosgel) has emerged on the Croatian market and we wanted to compare it to the stardard therapy, probiotic L. reuteri (BioGaia). We chose L. reuteri because it was the first probiotic preparation registered for safe use in infants. We also wanted to compare two gastroenteritis clinical severity assessment scales and describe some clinical characteristics of rotavirus infection in our region.
The efficacy of the investigated therapies was tested on three levels - duration of symptoms, duration of hospital stay and the total number of liquid stools. We have found no significant differences between the therapies according to any of the tested parameters. We have noticed no significant side-effects of the tested therapies. Probiotic preparation seemed to have better palatability, however this might be attributed to a smaller single dose volume (BioGaia cca 1 mL; Enterosgel cca 20-30 mL).
Although very similar, the standard clinical severity scores for the evaluation of acute gastroenteritis, Vesikari's and Clark's, are not comparable. If there is a need for comparing different treatments or preventive measures (vaccinations) the same clinical score must be used. We also cannot use these scores for predicting the duration of symptoms of rotavirus disease. It would be beneficial if a single scale would be set as the standard on the international level, thus enabling easier comparison of future clinical trials.
The clinical and epidemiological characteristics of the rotavirus infection in our examinees did not significantly differ to the ones described in the standard textbooks. However, the expected slightly higher number of cases in the late autumn was not recorded, due to the limited duration of the trial or it could be just a reflection of the usual seasonal variability. We did not find a significant number of rare manifestations of rotavirus infection such as urticaria, reactive arthritis, hepatitis, encephalitis, nor did we notice any complications such as severe dehydration, encephalopathy, etc. One of the reasons for that can be prompt admission of patients with more severe rotavirus infection to the intensive care unit. Due to the nature of the trial, these patients were not recruitable or suitable for inclusion as we could not obtain the parents' consent.
Subsequently, the patients with the most severe and those with the most benign symptoms were not included in our trial. On the positive note, our study population was very homogeneous as all the patients had similar clinical characteristics thus making the comparison of treatment effectiveness more reliable.
In conclusion, with the statistical power of 80 %, we can claim that there is no difference in the efficacy between the new enterosorbent polymethylsiloxane and probiotic L. reuteri in the treatment of rotavirus gastroenteritis in children
Comparison of clinical efficacy of probiotic Lactobacillus reuteri versus enteroadsorbent polymethylsiloxane (EnterosgelĀ®) in the treatment of rotaviral gastroenteritis in children 6-36 months old
Rotavirusni gastroenteritis je najÄeÅ”Äi uzrok akutnog infektivnog proljeva u populaciji dojenÄadi i predÅ”kolske djece. Zbog naglog nastupa simptoma, povraÄanja, proljeva i vruÄice, Äest je razlog hospitalizacije u djece. Do danas nema uzroÄnog lijeka koji djeluje na rotavirus. Postoje mnoga pomoÄna ljekovita sredstva koja služe ublažavanju simptoma. Nekada popularni enteroadsorbens medicinski ugljen zamijenila su neka novija sredstva, danas su to prije svih probiotici. MeÄu brojnim preparatima samo neki imaju blagu prednost pred placebom. U zadnjih nekoliko godina na hrvatskom tržiÅ”tu se pojavio novi enteroadsorbens polimetilsiloksan (Enterosgel) koji smo htjeli testirati usporeÄujuÄi ga sa standarnim sredstvom, probiotikom L. reuteri (BioGaia) koji je prvi probiotik licenciran u nas za upotrebu u dojenaÄkoj dobi. Osim toga, željeli smo ispitati dvije kliniÄke ljestvice za ocjenu težine rotavirusne infekcije i opisati neke kliniÄke osobitosti rotavirusne infekcije u naÅ”em podneblju.
Djelotvornost ispitivanih lijekova ispitivali smo na tri razine - duljini trajanja bolesti, duljini bolniÄkog lijeÄenja i ukupnom broju stolica u toku bolesti. Niti po jednom parametru nije bilo znaÄajnih razlika izmeÄu dva ispitivana lijeka. Nismo zamijetili niti jednu znaÄajniju nuspojavu meÄu naÅ”im ispitanicima. Dojam je neÅ”to bolje palatabilnosti probiotika, ali to može biti i odraz manje koliÄine pojedinaÄne doze (BioGaia oko 1 mL; Enterosgel 20-30 mL).
Standardne kliniÄke ljestvice za ocjenu težine rotavirusne bolesti, Vesikarijeva i Clarkova, premda vrlo sliÄne, nisu meÄusobno usporedive. U sluÄaju ispitivanja terapijskih tretmana ili preventivnih mjera (cijepljenje) potrebno je koristiti istu skalu. Ljestvice takoÄer ne možemo koristiti u svrhu predviÄanja duljine bolesti. Bilo bi dobro da se na meÄunarodnoj razini odluÄi za jednu skalu radi lakÅ”e usporedbe kliniÄkih istraživanja u buduÄnosti.
KliniÄke i epidemioloÅ”ke znaÄajke rotavirusne infekcije u naÅ”ih ispitanika ne razlikuju se znaÄajno od onih opisanih u standardnim udžbenicima. OÄekivali smo neÅ”to veÄi broj oboljelih u kasnu jesen, ali izostanak veÄeg broja oboljelih u tom razdoblju može biti samo odraz sezonske varijabilnosti. Nismo naÅ”li znaÄajniji udio rijetkih pojavnosti rotavirusne infekcije kao Å”to su urtikarija, reaktivni artritis, hepatitis, encefalitis, niti komplikacija kao Å”to su teÅ”ka dehidracija, encefalopatija i sl. Jedan od razloga za to može biti prijem težih bolesnika u jedinicu intenzivnog lijeÄenja. Teže oboljeloj djeci nismo bili u moguÄnosti davati ispitivana ljekovita sredstva niti smo mogli pridobiti roditelje za sudjelovanje u naÅ”em istraživanju.
Ipak, izostanak najtežih i najlakÅ”ih bolesnika iz naÅ”e studije ima i nekih prednosti - Äini skupinu ispitanika vrlo homogenom jer su sva djeca sliÄnih kliniÄkih karakteristika i prema tome usporedbu djelotvornosti Äini toÄnijom.
U zakljuÄku možemo reÄi da sa statistiÄkom snagom od 80 % možemo tvrditi da nema razlike u djelotvornosti izmeÄu enteroadsorbensa polimetilsiloksana i probiotika L. reuteri u lijeÄenju rotavirusnog gastroenteritisa.Rotavirus gastroenteritis is the most common cause of acute infectious diarrhea in infants and young children. It is a very frequent cause of childhood hospitalisation due to its sudden onset of symptoms - vomiting, diarrhea and fever. There is still no causative therapy against rotavirus. However, there are many adjunctive therapies available to alleviate the symptoms of infection. Once very popular enterosorbent, medicinal activated charcoal, was replaced by some new agents, namely probiotics. Amongst many probiotic preparations only a few showed some advantages over placebo. In the last few years a new enterosorbent, polymethylsiloxane (Enterosgel) has emerged on the Croatian market and we wanted to compare it to the stardard therapy, probiotic L. reuteri (BioGaia). We chose L. reuteri because it was the first probiotic preparation registered for safe use in infants. We also wanted to compare two gastroenteritis clinical severity assessment scales and describe some clinical characteristics of rotavirus infection in our region.
The efficacy of the investigated therapies was tested on three levels - duration of symptoms, duration of hospital stay and the total number of liquid stools. We have found no significant differences between the therapies according to any of the tested parameters. We have noticed no significant side-effects of the tested therapies. Probiotic preparation seemed to have better palatability, however this might be attributed to a smaller single dose volume (BioGaia cca 1 mL; Enterosgel cca 20-30 mL).
Although very similar, the standard clinical severity scores for the evaluation of acute gastroenteritis, Vesikari's and Clark's, are not comparable. If there is a need for comparing different treatments or preventive measures (vaccinations) the same clinical score must be used. We also cannot use these scores for predicting the duration of symptoms of rotavirus disease. It would be beneficial if a single scale would be set as the standard on the international level, thus enabling easier comparison of future clinical trials.
The clinical and epidemiological characteristics of the rotavirus infection in our examinees did not significantly differ to the ones described in the standard textbooks. However, the expected slightly higher number of cases in the late autumn was not recorded, due to the limited duration of the trial or it could be just a reflection of the usual seasonal variability. We did not find a significant number of rare manifestations of rotavirus infection such as urticaria, reactive arthritis, hepatitis, encephalitis, nor did we notice any complications such as severe dehydration, encephalopathy, etc. One of the reasons for that can be prompt admission of patients with more severe rotavirus infection to the intensive care unit. Due to the nature of the trial, these patients were not recruitable or suitable for inclusion as we could not obtain the parents' consent.
Subsequently, the patients with the most severe and those with the most benign symptoms were not included in our trial. On the positive note, our study population was very homogeneous as all the patients had similar clinical characteristics thus making the comparison of treatment effectiveness more reliable.
In conclusion, with the statistical power of 80 %, we can claim that there is no difference in the efficacy between the new enterosorbent polymethylsiloxane and probiotic L. reuteri in the treatment of rotavirus gastroenteritis in children
Comparison of clinical efficacy of probiotic Lactobacillus reuteri versus enteroadsorbent polymethylsiloxane (EnterosgelĀ®) in the treatment of rotaviral gastroenteritis in children 6-36 months old
Rotavirusni gastroenteritis je najÄeÅ”Äi uzrok akutnog infektivnog proljeva u populaciji dojenÄadi i predÅ”kolske djece. Zbog naglog nastupa simptoma, povraÄanja, proljeva i vruÄice, Äest je razlog hospitalizacije u djece. Do danas nema uzroÄnog lijeka koji djeluje na rotavirus. Postoje mnoga pomoÄna ljekovita sredstva koja služe ublažavanju simptoma. Nekada popularni enteroadsorbens medicinski ugljen zamijenila su neka novija sredstva, danas su to prije svih probiotici. MeÄu brojnim preparatima samo neki imaju blagu prednost pred placebom. U zadnjih nekoliko godina na hrvatskom tržiÅ”tu se pojavio novi enteroadsorbens polimetilsiloksan (Enterosgel) koji smo htjeli testirati usporeÄujuÄi ga sa standarnim sredstvom, probiotikom L. reuteri (BioGaia) koji je prvi probiotik licenciran u nas za upotrebu u dojenaÄkoj dobi. Osim toga, željeli smo ispitati dvije kliniÄke ljestvice za ocjenu težine rotavirusne infekcije i opisati neke kliniÄke osobitosti rotavirusne infekcije u naÅ”em podneblju.
Djelotvornost ispitivanih lijekova ispitivali smo na tri razine - duljini trajanja bolesti, duljini bolniÄkog lijeÄenja i ukupnom broju stolica u toku bolesti. Niti po jednom parametru nije bilo znaÄajnih razlika izmeÄu dva ispitivana lijeka. Nismo zamijetili niti jednu znaÄajniju nuspojavu meÄu naÅ”im ispitanicima. Dojam je neÅ”to bolje palatabilnosti probiotika, ali to može biti i odraz manje koliÄine pojedinaÄne doze (BioGaia oko 1 mL; Enterosgel 20-30 mL).
Standardne kliniÄke ljestvice za ocjenu težine rotavirusne bolesti, Vesikarijeva i Clarkova, premda vrlo sliÄne, nisu meÄusobno usporedive. U sluÄaju ispitivanja terapijskih tretmana ili preventivnih mjera (cijepljenje) potrebno je koristiti istu skalu. Ljestvice takoÄer ne možemo koristiti u svrhu predviÄanja duljine bolesti. Bilo bi dobro da se na meÄunarodnoj razini odluÄi za jednu skalu radi lakÅ”e usporedbe kliniÄkih istraživanja u buduÄnosti.
KliniÄke i epidemioloÅ”ke znaÄajke rotavirusne infekcije u naÅ”ih ispitanika ne razlikuju se znaÄajno od onih opisanih u standardnim udžbenicima. OÄekivali smo neÅ”to veÄi broj oboljelih u kasnu jesen, ali izostanak veÄeg broja oboljelih u tom razdoblju može biti samo odraz sezonske varijabilnosti. Nismo naÅ”li znaÄajniji udio rijetkih pojavnosti rotavirusne infekcije kao Å”to su urtikarija, reaktivni artritis, hepatitis, encefalitis, niti komplikacija kao Å”to su teÅ”ka dehidracija, encefalopatija i sl. Jedan od razloga za to može biti prijem težih bolesnika u jedinicu intenzivnog lijeÄenja. Teže oboljeloj djeci nismo bili u moguÄnosti davati ispitivana ljekovita sredstva niti smo mogli pridobiti roditelje za sudjelovanje u naÅ”em istraživanju.
Ipak, izostanak najtežih i najlakÅ”ih bolesnika iz naÅ”e studije ima i nekih prednosti - Äini skupinu ispitanika vrlo homogenom jer su sva djeca sliÄnih kliniÄkih karakteristika i prema tome usporedbu djelotvornosti Äini toÄnijom.
U zakljuÄku možemo reÄi da sa statistiÄkom snagom od 80 % možemo tvrditi da nema razlike u djelotvornosti izmeÄu enteroadsorbensa polimetilsiloksana i probiotika L. reuteri u lijeÄenju rotavirusnog gastroenteritisa.Rotavirus gastroenteritis is the most common cause of acute infectious diarrhea in infants and young children. It is a very frequent cause of childhood hospitalisation due to its sudden onset of symptoms - vomiting, diarrhea and fever. There is still no causative therapy against rotavirus. However, there are many adjunctive therapies available to alleviate the symptoms of infection. Once very popular enterosorbent, medicinal activated charcoal, was replaced by some new agents, namely probiotics. Amongst many probiotic preparations only a few showed some advantages over placebo. In the last few years a new enterosorbent, polymethylsiloxane (Enterosgel) has emerged on the Croatian market and we wanted to compare it to the stardard therapy, probiotic L. reuteri (BioGaia). We chose L. reuteri because it was the first probiotic preparation registered for safe use in infants. We also wanted to compare two gastroenteritis clinical severity assessment scales and describe some clinical characteristics of rotavirus infection in our region.
The efficacy of the investigated therapies was tested on three levels - duration of symptoms, duration of hospital stay and the total number of liquid stools. We have found no significant differences between the therapies according to any of the tested parameters. We have noticed no significant side-effects of the tested therapies. Probiotic preparation seemed to have better palatability, however this might be attributed to a smaller single dose volume (BioGaia cca 1 mL; Enterosgel cca 20-30 mL).
Although very similar, the standard clinical severity scores for the evaluation of acute gastroenteritis, Vesikari's and Clark's, are not comparable. If there is a need for comparing different treatments or preventive measures (vaccinations) the same clinical score must be used. We also cannot use these scores for predicting the duration of symptoms of rotavirus disease. It would be beneficial if a single scale would be set as the standard on the international level, thus enabling easier comparison of future clinical trials.
The clinical and epidemiological characteristics of the rotavirus infection in our examinees did not significantly differ to the ones described in the standard textbooks. However, the expected slightly higher number of cases in the late autumn was not recorded, due to the limited duration of the trial or it could be just a reflection of the usual seasonal variability. We did not find a significant number of rare manifestations of rotavirus infection such as urticaria, reactive arthritis, hepatitis, encephalitis, nor did we notice any complications such as severe dehydration, encephalopathy, etc. One of the reasons for that can be prompt admission of patients with more severe rotavirus infection to the intensive care unit. Due to the nature of the trial, these patients were not recruitable or suitable for inclusion as we could not obtain the parents' consent.
Subsequently, the patients with the most severe and those with the most benign symptoms were not included in our trial. On the positive note, our study population was very homogeneous as all the patients had similar clinical characteristics thus making the comparison of treatment effectiveness more reliable.
In conclusion, with the statistical power of 80 %, we can claim that there is no difference in the efficacy between the new enterosorbent polymethylsiloxane and probiotic L. reuteri in the treatment of rotavirus gastroenteritis in children
Etiology of chronic prostatitis syndrome in patients treated at the university hospital for infectious diseases "Dr. Fran MihaljeviÄ" from 2003 to 2005
A total of 835 patients with symptoms of chronic prostatitis syndrome and no evidence of structural or functional lower genitourinary tract abnormalities were examined in a three year period at the Outpatient Department for Urogenital Infections, University Hospital for Infectious Diseases "Dr. Fran Mihaljevic" Zagreb, Croatia. Disease etiology was determined in 482 (57.72%) patients. Chlamydia trachomatis was proved to be the causative pathogen in 161 patients, Trichomonas vaginalis in 85, Escherichia coli in 68, Enterococcus in 51, Proteus mirabilis in 20, Klebsiella pneumoniae in 9, Streptococcus agalactiae in 15, Ureaplasma urealyticum in 49 patients with chronic prostatitis. Other patients had mixed infection. In 257 (53.32%) of 482 patients, the inflammatory finding (>10 WBCs/hpf) was found in EPS or VB3. Normal WBCs/hpf (<10) was found in 103 (63.98%) of 161 patients with symptoms of chronic prostatitis in whom C. trachomatis was detected in EPS or VB3, in 50 (58.82%) of 85 patients in whom Trichomonas vaginalis was isolated, and in 23 (46.94%) of 49 patients in whom Ureaplasma urealyticum was isolated
Comparison of Clinical and Bacteriological Efficacy of Antimicrobial Treatment in Patients with Chronic Prostatitis Caused by Chlamydia trachomatis
Ispitali smo ukupno 194 bolesnika starija od 18 godina s kroniÄnim prostatitisom, od Äega 38 bolesnika s kroniÄnim prostatitisom uzrokovanim klamidijom trahomatis. Za svakog bolesnika prikupljeni su sljedeÄi podaci: anamneza i težina simptoma kroniÄnog prostatitisa bodovan prema hrvatskom prijevodu upitnika o simptomima kroniÄnog prostatitisa (NIH-CPSI), kliniÄki status ukljuÄujuÄi digitorektalni pregled prostate, uzorci obriska uretre, selektivni uzorci urina i eksprimata prostate testom Äetiri ÄaÅ”e (metoda po Mearesu i Stameyu). Chlamydia trachomatis dokazivana je metodom DNK-RNK hibridizacije u obrisku uretre i eksprimatu prostate. Bolesnici s kroniÄnim bakterijskim prostatitisom lijeÄeni su azitromicinom peroralno u ukupnoj dozi od 4,5 g kroz tri tjedna. KliniÄko izljeÄenje podudaralo se s bakterioloÅ”kom eradikacijom (kappa >0,20.2<0.5)
Comparison of Clinical and Bacteriological Efficacy of Antimicrobial Treatment in Patients with Chronic Prostatitis Caused by Chlamydia trachomatis
Ispitali smo ukupno 194 bolesnika starija od 18 godina s kroniÄnim prostatitisom, od Äega 38 bolesnika s kroniÄnim prostatitisom uzrokovanim klamidijom trahomatis. Za svakog bolesnika prikupljeni su sljedeÄi podaci: anamneza i težina simptoma kroniÄnog prostatitisa bodovan prema hrvatskom prijevodu upitnika o simptomima kroniÄnog prostatitisa (NIH-CPSI), kliniÄki status ukljuÄujuÄi digitorektalni pregled prostate, uzorci obriska uretre, selektivni uzorci urina i eksprimata prostate testom Äetiri ÄaÅ”e (metoda po Mearesu i Stameyu). Chlamydia trachomatis dokazivana je metodom DNK-RNK hibridizacije u obrisku uretre i eksprimatu prostate. Bolesnici s kroniÄnim bakterijskim prostatitisom lijeÄeni su azitromicinom peroralno u ukupnoj dozi od 4,5 g kroz tri tjedna. KliniÄko izljeÄenje podudaralo se s bakterioloÅ”kom eradikacijom (kappa >0,20.2<0.5)