63 research outputs found

    THE ROLE OF INFORMATION FOR GLOBAL MARKETING - EDUCATIONAL AND PRACTICAL ASPECTS

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    The selection of company strategy for international market appearance is an essential part of implementation the global marketing. Given the fact that this process is influenced by a diverse range of factors, it is necessary to research and report frequently about the dynamics. The research of market environment is one of the most essential company activities. Information is the base of the market assessment as an opportunity to company entry, as well as for establishing a balance between the marketing-mix tactics in accordance with specific conditions set out by the local markets. Some of the huge problems in the transition economies are closely connected with education and practice connected to the global marketing issues. It is very significant to understand that marketing is not only a theory, but also an amount of knowledge created and carried through the experience in the business practice. The low level of theoretical and practical knowledge of this problematic is a serious flaw in global assessment process, especially in relation to local countries and regions, including the specific marketing functions of the company. The initial step should be implementation of theoretical and practical knowledge in the process of the company’s information needs definition, and then to carry out further implementation of other phases of the process. The transition of economic and political system in Macedonia created favorable circumstances on education that sought to understand and employ the market system logic. The fundamental goals have been to achieve reflective, practical and analytical skills for those involved in management or marketing and for those who want a better understanding of the nature and process of management and marketing within broader contexts.Information; Management; Marketing; Education; Institution; Globalization.

    THE ROLE OF MARKETING IN SME’S DEVELOPMENT IN REPUBLIC MACEDONIA

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    The SME's currently need to upgrade their knowledge and skills to respond the complex market needs, in order to make their position and competitiveness on the market. There is a very close connection among marketing orientation and the level of development of small business. Among other macro and institutional factors, marketing has become one of the most important for SME's development. To be competitive means to create optimal marketing mix by using the four marketing instruments: product, place, promotion and price (4P). The situation of SME's in the Republic of Macedonia is characterized by disturbances in their development through the period of transition. The reasons for such situation are focused mainly on the highest (macro) level, but there are still some opinions that firms are not very innovative or creative in implementing the real marketing concept in practice. The owners or managers in this SME's are not aware or educated in the sphere of marketing and the possibilities for implementation of business activities. Responding to the consumer needs should be a base for creating the whole strategy and the process of consumer satisfaction has to be an indicator for the development small business. This should be a base for creating the contemporary relationship management concept in order to make a real business strategy for positioning the SME’s in order to increase the completeness on the market.Marketing orientation; SME’s development; Marketing concept; Promotion; Integrated communication

    Level of Education and Health Status of the Different Social Groups: Case Study Macedonia

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    The educational level is an important indicator within the socioeconomical status for health evaluation and a powerful instrument in promotion of population’s health. In 2000 a study conducted in R. Macedonia, in 15 municipalities with different gross national product per capita, encompassing 1129 examinees older than 18 years. The results of the conducted research showed statistically significant association of the educational level with the morbidity. Higher morbidity emerges in persons that are illiterate (78,57%) and in those who have completed only 1-3 elementary school grades (77,08%). There is also an interaction between the mortality and the educational level. Persons with lower educational level have higher mortality rate. What kind of interaction is there between the educational level and the positive health? People with lower educational level are more susceptible to diseases; they are less informed which leads to a poor health. Morbidity and mortality rates are lower in people with higher educational level, who also have high level of self-informing that augments their health awareness and culture, leading towards positive health. According to many research studies, the mechanisms that link education to positive health are the employment and self-satisfaction with the job, healthy lifestyle, psycho-social resources etc. There is a mutual negative effect between poverty and lack of education that provides skills and information needed for managing the stress situations life brings with itself. Education, employment and incomes increase the capacity of self-control, and that condition strengthen the health in relation to the environment The social support, which is most frequent in persons with higher educational level, promotes health and decreases mortality through physiological mechanisms of the environment. People with higher educational level most likely will look for preventive health care (yearly check-ups for health control, immunization and other preventive examinations) and will probably not abuse alcohol and drugs. Preparation of various programs for applying the health education will contribute in the process of directing the individual to correct behavior that leads towards positive health, opposite the hostile influences of the social environment, which leads to bad quality in health (based on the education)

    Discovering Strategic Behaviour of Multi-Agent Systems in Adversary Settings

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    Can specific behaviour strategies be induced from low-level observations of two adversary groups of agents with limited domain knowledge? This paper presents a domain-independent Multi-Agent Strategy Discovering Algorithm (MASDA), which discovers strategic behaviour patterns of a group of agents under the described conditions. The algorithm represents the observed multi-agent activity as a graph, where graph connections correspond to performed actions and graph nodes correspond to environment states at action starts. Based on such data representation, the algorithm applies hierarchical clustering and rule induction to extract and describe strategic behaviour. The discovered strategic behaviour is represented visually as graph paths and symbolically as rules. MASDA was evaluated on RoboCup. Both soccer experts and quantitative evaluation confirmed the relevance of the discovered behaviour patterns

    ΠœΠ•Π’ΠΠ€ΠžΠ ΠΠ’Π Π’Πž ΠˆΠΠ—Π˜Π§ΠΠΠ’Π ΠšΠžΠΠ¦Π•ΠŸΠ’Π£ΠΠ›Π˜Π—ΠΠ¦Π˜ΠˆΠ НА Π•ΠœΠžΠ¦Π˜Π˜Π’Π• (БО ΠŸΠžΠ‘Π•Π‘Π•Π ΠžΠ‘Π’Π Π’ НА Π€Π ΠΠ—Π•ΠœΠ˜Π’Π• БО Π—ΠΠΠ§Π•ΠŠΠ• БВРАВ Π’Πž ΠœΠΠšΠ•Π”ΠžΠΠ‘ΠšΠ˜ΠžΠ’ И Π’Πž РУБКИОВ ΠˆΠΠ—Π˜Πš)

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    This article illustrates how important role metaphor plays in understanding a phenomenon as complex as the nature of emotion and how the human body influences the conceptualization of emotion. A lot of emotion metaphors are biologically rooted and based on physiologically conditioned responses to various stimuli. Well-known example of such biologically-based linguistic metaphor is fear is cold. The purpose of this article is to make a comparison of the metaphorical models applied on idioms denotiong fear in Macedonin and Russian language following the similar studies made for other Slavic languages

    ΠΠ°Ρ˜Ρ‡Π΅ΡΡ‚ΠΈ бактСриски ΠΈΠ·ΠΎΠ»Π°Ρ‚ΠΈ ΠΎΠ΄ ΠΏΡ€ΠΈΠΌΠ΅Ρ€ΠΎΡ†ΠΈ ΠΎΠ΄ Ρ€Π°Π½ΠΈ – Ρ‚Ρ€ΠΈΠ³ΠΎΠ΄ΠΈΡˆΠ½Π° ΡΡ‚ΡƒΠ΄ΠΈΡ˜Π°

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    Aim: The aim of our study was to determine the most common bacteria isolated from wound samples and tΠΎ compare the frequency of the resistant bacteria isolated over a 3-year period. Material and methods: During a three years period (2017-2019) a total of 11 863 wound samples (wound swabs, punctuates, exudates, tissue, etc.) were obtained from the hospitalized patients in the University Clinics of the ,,Mother Theresa” campus, the City hospital ,,8th September” and the University Clinic for surgical diseases ,,St. Naum Ohridski” in Skopje. All samples were processed at the Institute of Microbiology and Parasitology, Faculty of Medicine, Skopje. They were examined by standard microbiology techniques. Identification and susceptibility of microorganisms were done by both standard methods and automatized Vitek 2 system. Results: Out of a total number of samples, which was 3 463 in 2017, 4 127 in 2018 and 4 273 in 2019, positive were 2 068 (60%), 2 302 (55.8%) and 2 387 (55.9%), respectively. From the total of aerobes/facultative anaerobes (2 758, 2 949 and 3 279 in three consecutive years, 2017, 2018 and 2019, respectively), Staphylococcus aureus was the most predominant isolate (19.5%, 16.6%, 16.9%) followed by Enterococcus spp (16%, 16%, 16.7%), Pseudomonas aeruginosa (12%, 13%, 12.7%) and E. coli (10%, 10.4%, 10.7%). Considering anaerobic bacteria, the percentage of Gram positive anaerobes (Peptostreptococcus) has decreased from 33% to 18% out of a total number of anaerobes, unlike Gram negative anaerobes in which the increasing percentage was mostly observed in bacteria of the genus Bacteroides (from 39% to 45%). The percentage of the resistant strains of MRSA, CNS-MR and VRE was almost the same in that period. In Gram-negatives the percentage of ESBL-positive isolates of E. coli and Enterobacter spp. increased consecutively from 2017 to 2019. The increase in the percentage of resistant strains was more noticeable in ESBL-positive isolates of Klebsiella pneumonia between 2017 and 2018, but in 2019 a percentage decrease can be observed. Considering carbapenem-resistant (CR) Enterobacterales, an increase in the resistance was noticeable in K. pneumonia. The increase in the percentage of resistant strains in Enterobacter spp. between 2017 and 2018, as well as the decrease between 2018 and 2019 was statistically significant. The percentage of CR-isolates of Pseudomonas aeruginosa was from 30% to 38% and for Acinetobacter spp. this percentage was from 81% to 85%. Conclusion: The knowledge of the most commonly isolated bacterial pathogens, especially the presence of resistant bacteria, is crucial and should be continuously monitored in order to understand, construct and update effective treatment algorithms and guidelines.Π¦Π΅Π»: Π¦Π΅Π» Π½Π° ΡΡ‚ΡƒΠ΄ΠΈΡ˜Π°Ρ‚Π° Π΅ Π΄Π° сС Π΄Π΅Ρ‚Π΅ΠΊΡ‚ΠΈΡ€Π°Π°Ρ‚ Π½Π°Ρ˜Ρ‡Π΅ΡΡ‚ΠΈΡ‚Π΅ Π±Π°ΠΊΡ‚Π΅Ρ€ΠΈΠΈ ΠΈΠ·ΠΎΠ»ΠΈΡ€Π°Π½ΠΈ ΠΎΠ΄ ΠΏΡ€ΠΈΠΌΠ΅Ρ€ΠΎΡ†ΠΈ ΠΎΠ΄ Ρ€Π°Π½ΠΈ ΠΈ Π΄Π° сС спорСди ΠΏΡ€ΠΎΡ†Π΅Π½Ρ‚ΠΎΡ‚ Π½Π° рСзистСнтни Π±Π°ΠΊΡ‚Π΅Ρ€ΠΈΠΈ Π²ΠΎ Ρ‚Ρ€ΠΈΠ³ΠΎΠ΄ΠΈΡˆΠ½ΠΈΠΎΡ‚ ΠΏΠ΅Ρ€ΠΈΠΎΠ΄. ΠœΠ°Ρ‚Π΅Ρ€ΠΈΡ˜Π°Π» ΠΈ ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΈ: Π’ΠΎ ΠΏΠ΅Ρ€ΠΈΠΎΠ΄ ΠΎΠ΄ Ρ‚Ρ€ΠΈ Π³ΠΎΠ΄ΠΈΠ½ΠΈ (2017-2019) Π±Π΅Π° Π·Π΅ΠΌΠ΅Π½ΠΈ Π²ΠΊΡƒΠΏΠ½ΠΎ  11 863 ΠΏΡ€ΠΈΠΌΠ΅Ρ€ΠΎΡ†ΠΈ ΠΎΠ΄ Ρ€Π°Π½ΠΈ (брисСви, ΠΏΡƒΠ½ΠΊΡ‚Π°Ρ‚ΠΈ, Сксудати, Ρ‚ΠΊΠΈΠ²ΠΎ ΠΈ Π΄Ρ€.) ΠΎΠ΄ ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΈ хоспитализирани Π²ΠΎ УнивСрзитСтскитС ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΈ Π²ΠΎ кампусот ,,Мајка ВСрСза”, Градската Π±ΠΎΠ»Π½ΠΈΡ†Π° ,,8. БСптСмври” УнивСрзитСтската ΠΊΠ»ΠΈΠ½ΠΈΠΊΠ° Π·Π° Ρ…ΠΈΡ€ΡƒΡ€ΡˆΠΊΠΈ болСсти ,,Π‘Π². Наум ΠžΡ…Ρ€ΠΈΠ΄ΡΠΊΠΈβ€ Π²ΠΎ БкопјС. Π‘ΠΈΡ‚Π΅ ΠΏΡ€ΠΈΠΌΠ΅Ρ€ΠΎΡ†ΠΈ Π±Π΅Π° ΠΎΠ±Ρ€Π°Π±ΠΎΡ‚Π΅Π½ΠΈ Π½Π° Π˜Π½ΡΡ‚ΠΈΡ‚ΡƒΡ‚ΠΎΡ‚ Π·Π° ΠΌΠΈΠΊΡ€ΠΎΠ±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡ˜Π° ΠΈ ΠΏΠ°Ρ€Π°Π·ΠΈΡ‚ΠΎΠ»ΠΎΠ³ΠΈΡ˜Π°, ΠœΠ΅Π΄ΠΈΡ†ΠΈΠ½ΡΠΊΠΈ Ρ„Π°ΠΊΡƒΠ»Ρ‚Π΅Ρ‚, БкопјС. Π—Π° ΠΎΠ±Ρ€Π°Π±ΠΎΡ‚ΠΊΠ° Π±Π΅Π° користСни стандардни ΠΌΠΈΠΊΡ€ΠΎΠ±ΠΈΠΎΠ»ΠΎΡˆΠΊΠΈ Ρ‚Π΅Ρ…Π½ΠΈΠΊΠΈ. Π˜Π΄Π΅Π½Ρ‚ΠΈΡ„ΠΈΠΊΠ°Ρ†ΠΈΡ˜Π°Ρ‚Π° Π½Π° Π±Π°ΠΊΡ‚Π΅Ρ€ΠΈΠΈΡ‚Π΅, ΠΊΠ°ΠΊΠΎ ΠΈ ΠΎΠ΄Ρ€Π΅Π΄ΡƒΠ²Π°ΡšΠ΅ Π½Π° Π½ΠΈΠ²Π½Π°Ρ‚Π° осСтливост ΠΊΠΎΠ½ Π°Π½Ρ‚ΠΈΠΌΠΈΠΊΡ€ΠΎΠ±Π½ΠΈ срСдства бСшС Π½Π°ΠΏΡ€Π°Π²Π΅Π½Π° со стандардни ΠΈ Π°Π²Ρ‚ΠΎΠΌΠ°Ρ‚ΠΈΠ·ΠΈΡ€Π°Π½ΠΈ ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΈ (Vitek 2- систСм).  Π Π΅Π·ΡƒΠ»Ρ‚Π°Ρ‚ΠΈ: Од Π²ΠΊΡƒΠΏΠ½ΠΈΠΎΡ‚ Π±Ρ€ΠΎΡ˜ Π½Π° ΠΏΡ€ΠΈΠΌΠ΅Ρ€ΠΎΡ†ΠΈ кој ΠΈΠ·Π½Π΅ΡΡƒΠ²Π°ΡˆΠ΅  3 463 Π²ΠΎ  2017, 4 127 Π²ΠΎ 2018 ΠΈ 4 273 Π²ΠΎ 2019 Π³ΠΎΠ΄., ΠΏΠΎΠ·ΠΈΡ‚ΠΈΠ²Π½ΠΈ Π±Π΅Π° 2 068 (60%), 2 302 (55,8%) ΠΈ 2 387 (55,9%), послСдоватСлно. Од Π²ΠΊΡƒΠΏΠ½ΠΈΠΎΡ‚ Π±Ρ€ΠΎΡ˜ Π°Π΅Ρ€ΠΎΠ±ΠΈ/Ρ„Π°ΠΊΡƒΠ»Ρ‚Π°Ρ‚ΠΈΠ²Π½ΠΎ Π°Π½Π°Π΅Ρ€ΠΎΠ±ΠΈ (2 758, 2 949 ΠΈ 3 279 Π²ΠΎ Ρ‚Ρ€ΠΈ послСдоватСлни Π³ΠΎΠ΄ΠΈΠ½ΠΈ, 2017, 2018 ΠΈ 2019 Π³ΠΎΠ΄.), Π½Π°Ρ˜Ρ‡Π΅ΡΡ‚ΠΎ ΠΈΠ·ΠΎΠ»ΠΈΡ€Π°Π½Π° бСшС Π±Π°ΠΊΡ‚Π΅Ρ€ΠΈΡ˜Π°Ρ‚Π° Staphylococcus aureus (19,5%, 16,6% ΠΈ 16,9%), ΠΏΠΎΡ‚ΠΎΠ° Enterococcus spp (16%, 16% ΠΈ 16,7%), Pseudomonas aeruginosa (12%, 13% ΠΈ  12,7%) ΠΈ E. coli (10%, 10,4% ΠΈ 10,7%). Од Π°Π½Π°Π΅Ρ€ΠΎΠ±Π½ΠΈΡ‚Π΅ Π±Π°ΠΊΡ‚Π΅Ρ€ΠΈΠΈ, бСшС Π΄Π΅Ρ‚Π΅ΠΊΡ‚ΠΈΡ€Π°Π½ΠΎ Π½Π°ΠΌΠ°Π»ΡƒΠ²Π°ΡšΠ΅ Π½Π° ΠΏΡ€ΠΎΡ†Π΅Π½Ρ‚ΠΎΡ‚ Π½Π° Π“Ρ€Π°ΠΌ-ΠΏΠΎΠ·ΠΈΡ‚ΠΈΠ²Π½ΠΈΡ‚Π΅ Π°Π½Π°Π΅Ρ€ΠΎΠ±ΠΈ (Peptostreptococcus) ΠΎΠ΄ 33% Π½Π° 18%, ΠΎΠ΄ Π²ΠΊΡƒΠΏΠΈΠΎΡ‚ Π±Ρ€ΠΎΡ˜ Π½Π° Π°Π½Π°Π΅Ρ€ΠΎΠ±ΠΈ, Π·Π° Ρ€Π°Π·Π»ΠΈΠΊΠ° ΠΎΠ΄ Π“Ρ€Π°ΠΌ-Π½Π΅Π³Π°Ρ‚ΠΈΠ²Π½ΠΈΡ‚Π΅ Π°Π½Π°Π΅Ρ€ΠΎΠ±ΠΈ ΠΊΠ°Π΄Π΅ бСшС Π΄Π΅Ρ‚Π΅ΠΊΡ‚ΠΈΡ€Π°Π½ΠΎ Π·Π³ΠΎΠ»Π΅ΠΌΡƒΠ²Π°ΡšΠ΅ Π½Π° Ρ‚ΠΎΡ˜ ΠΏΡ€ΠΎΡ†Π΅Π½Ρ‚, особСно кај Π±Π°ΠΊΡ‚Π΅Ρ€ΠΈΠΈΡ‚Π΅ ΠΎΠ΄ Ρ€ΠΎΠ΄ΠΎΡ‚ Bacteroides (ΠΎΠ΄ 39% Π½Π° 45%). ΠŸΡ€ΠΎΡ†Π΅Π½Ρ‚ΠΎΡ‚ Π½Π° рСзистСнтни соСви (MRSA, CNS-MR ΠΈ VRE) бСшС рСчиси ΠΈΠ΄Π΅Π½Ρ‚ΠΈΡ‡Π΅Π½ Π²ΠΎ испитуваниот ΠΏΠ΅Ρ€ΠΈΠΎΠ΄. Кај Π“Ρ€Π°ΠΌ-Π½Π΅Π³Π°Ρ‚ΠΈΠ²Π½ΠΈΡ‚Π΅ Π±Π°ΠΊΡ‚Π΅Ρ€ΠΈΠΈ, бСшС Π΄Π΅Ρ‚Π΅ΠΊΡ‚ΠΈΡ€Π°Π½ΠΎ Π·Π³ΠΎΠ»Π΅ΠΌΡƒΠ²Π°ΡšΠ΅ Π½Π° ΠΏΡ€ΠΎΡ†Π΅Π½Ρ‚ΠΎΡ‚ Π½Π° ESBL-ΠΏΠΎΠ·ΠΈΡ‚ΠΈΠ²Π½ΠΈ ΠΈΠ·ΠΎΠ»Π°Ρ‚ΠΈ Π½Π° E. coli ΠΈ Enterobacter spp. Π²ΠΎ ΠΏΠ΅Ρ€ΠΈΠΎΠ΄ΠΎΡ‚ ΠΎΠ΄ 2017 Π΄ΠΎ 2019, Π° кај  Klebsiella pneumoniaΠ΅ Π²ΠΎ ΠΏΠ΅Ρ€ΠΈΠΎΠ΄ΠΎΡ‚ ΠΎΠ΄ 2017 ΠΈ 2018 имашС Π·Π³ΠΎΠ»Π΅ΠΌΡƒΠ²Π°ΡšΠ΅, Π° Π²ΠΎ 2019 Π½Π°ΠΌΠ°Π»ΡƒΠ²Π°ΡšΠ΅ Π½Π° Ρ‚ΠΎΡ˜ ΠΏΡ€ΠΎΡ†Π΅Π½Ρ‚. Π’ΠΎ однос Π½Π° ΠΊΠ°Ρ€Π±Π°ΠΏΠ΅Π½Π΅ΠΌ-рСзистСнтнитС (CR) Π΅Π½Ρ‚Π΅Ρ€ΠΎΠ±Π°ΠΊΡ‚Π΅Ρ€ΠΈΠΈ, кај К. pneumoniae бСшС Π΄Π΅Ρ‚Π΅ΠΊΡ‚ΠΈΡ€Π°Π½ΠΎ Π·Π³ΠΎΠ»Π΅ΠΌΡƒΠ²Π°ΡšΠ΅ Π½Π° ΠΏΡ€ΠΎΡ†Π΅Π½Ρ‚ΠΎΡ‚ Π½Π° рСзистСнтни ΠΈΠ·ΠΎΠ»Π°Ρ‚ΠΈ Π²ΠΎ ситС Ρ‚Ρ€ΠΈ Π³ΠΎΠ΄ΠΈΠ½ΠΈ, Π΄ΠΎΠ΄Π΅ΠΊΠ°, ΠΏΠ°ΠΊ, кај Enterobacter spp. Ρ‚ΠΎΡ˜ ΠΏΡ€ΠΎΡ†Π΅Π½Ρ‚ΠΎΡ‚ бСшС повисок ΠΌΠ΅Ρ“Ρƒ 2017 ΠΈ 2018, Π° Π²ΠΎ 2019 Π³ΠΎΠ΄. статистички Π·Π½Π°Ρ‡Π°Ρ˜Π½ΠΎ ΠΏΠΎΠ½ΠΈΠ·ΠΎΠΊ. ΠŸΡ€ΠΎΡ†Π΅Π½Ρ‚ΠΎΡ‚ Π½Π° CR- ΠΈΠ·ΠΎΠ»Π°Ρ‚ΠΈ Π½Π° Pseudomonas aeruginosa бСшС ΠΏΠΎΠΌΠ΅Ρ“Ρƒ 30% ΠΈ 38%, Π° Π·Π° Acinetobacter spp. овој ΠΏΡ€ΠΎΡ†Π΅Π½Ρ‚ бСшС ΠΌΠ΅Ρ“Ρƒ 81% ΠΈ 85%. Π—Π°ΠΊΠ»ΡƒΡ‡ΠΎΠΊ: ΠŸΠΎΡ‚Ρ€Π΅Π±Π½ΠΎ Π΅ ΠΊΠΎΠ½Ρ‚ΠΈΠ½ΡƒΠΈΡ€Π°Π½ΠΎ ΠΌΠΎΠ½ΠΈΡ‚ΠΎΡ€ΠΈΡ€Π°ΡšΠ΅ Π½Π° Π½Π°Ρ˜Ρ‡Π΅ΡΡ‚ΠΎ ΠΈΠ·ΠΎΠ»ΠΈΡ€Π°Π½ΠΈΡ‚Π΅ Π±Π°ΠΊΡ‚Π΅Ρ€ΠΈΠΈ ΠΎΠ΄ ΠΏΡ€ΠΈΠΌΠ΅Ρ€ΠΎΡ†ΠΈΡ‚Π΅ ΠΎΠ΄ Ρ€Π°Π½ΠΈ, особСно присуството Π½Π° рСзистСнтни Π±Π°ΠΊΡ‚Π΅Ρ€ΠΈΠΈ, со Ρ†Π΅Π» ΠΏΡ€ΠΈΠΌΠ΅Π½Π° Π½Π° соодвСтни Π°Π»Π³ΠΎΡ€ΠΈΡ‚ΠΌΠΈ ΠΈ Π²ΠΎΠ΄ΠΈΡ‡ΠΈ Π·Π° Π΅Ρ„Π΅ΠΊΡ‚ΠΈΠ²Π΅Π½ Ρ‚Ρ€Π΅Ρ‚ΠΌΠ°Π½ Π½Π° ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΈΡ‚Π΅ Π½Π° Ρ€Π°Π½ΠΈ. &nbsp

    Π•Π²Π°Π»ΡƒΠ°Ρ†ΠΈΡ˜Π° Π½Π° (1,3)--d-Π³Π»ΠΈΠΊΠ°Π½ СсСј Π²ΠΎ дијагноза Π½Π° ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΈ ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΈ со Аspergillus

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    Invasive fungal infections caused by Aspergillus are a significant problem in immunocompromised and critically ill patients and associated with increased morbidity and mortality. Early diagnosis of invasive aspergillosis is still a big clinical and diagnostic challenge. Conventional methods are not sensitive enough, and therefore, there is a need for rapid, more sensitive methods for early diagnosis of invasive fungal infections with Aspergillus. The aim of this study was to evaluate the diagnostic performance, sensitivity and specificity of serological panfungal (1,3)-b-D-glucan marker compared to conventional method for diagnosis of invasive fungal infections with Aspergillus. Material and methods: Specimens of 125 patients divided into 4 groups (group I - immune deficiency, group II - prolonged ICU stay, group III - chronic aspergillosis, group IV - cystic fibrosis), classified according to clinical diagnosis and EORTC/MSG criteria, were analyzed at the Institute of Microbiology and Parasitology, with conventional and serological methods, during a period of two years. Results: A total of 71 isolates of Aspergillus were confirmed in this study. Four isolates were recovered from bloodculture of patients with primary immune deficiency. With BAL culture, Aspergillus was detected in the group of chronic aspergillosis (63.33%), followed by the groups of cystic fibrosis (56.67%), primary immune deficiency (51.43%), and the group with prolonged ICU stay (43.33%). Sensitivity and specificity of BAL culture were: 64.29% and 100%, 59.09% and 100%, 54.55% and 12.5%, 100% and 54.17%, in I, II, III and IV group, respectively. In 79.1% (53/67) from positive BAL cultures in all groups, A. fumigatus was confirmed, of which, 32.1% (17/53) in group III, followed by group I – 26.42% (14/53) and group IV – 26.42% (14/53), and 15.1% (8/53) in group II. Other species confirmed in BAL were A. flavus 16.42% (11/67) and A.terreus 4.48% (3/67). Sensitivity and specificity of the serological panfungal (1,3)-b-D-glucan (BDG) marker were: 64.71% and 85.71%, 50% and 87.5%, 36.36% and 50%, in groups I, II and III, respectively. No positive findings of the panfungal (1,3)-b-D-glucan (BDG) marker were found in the group with cystic fibrosis. Conclusion: The results obtained in this study have demonstrated that a positive (1,3)-b-D-glucan assay highlights the value of this test as a diagnostic adjunct in the serodiagnosis of invasive fungal infections with Aspergillus, and along with the results from conventional mycological investigation, helped in reaching a timely antifungal treatment with a favorable clinical outcome. Β Π˜Π½Π²Π°Π·ΠΈΠ²Π½ΠΈΡ‚Π΅ Ρ„ΡƒΠ½Π³Π°Π»Π½ΠΈ ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΈ со Aspergillus прСтставуваат сСриозСн ΠΏΡ€ΠΎΠ±Π»Π΅ΠΌ кај ΠΈΠΌΡƒΠ½ΠΎΠΊΠΎΠΌΠΏΡ€ΠΎΠΌΠΈΡ‚ΠΈΡ€Π°Π½ΠΈΡ‚Π΅ Π»ΠΈΡ†Π° ΠΈ ΠΊΡ€ΠΈΡ‚ΠΈΡ‡Π½ΠΎ Π±ΠΎΠ»Π½ΠΈΡ‚Π΅ Π»ΠΈΡ†Π°, ΠΈ сС асоцирани со Π·Π³ΠΎΠ»Π΅ΠΌΠ΅Π½ ΠΌΠΎΡ€Π±ΠΈΠ΄ΠΈΡ‚Π΅Ρ‚ ΠΈ ΠΌΠΎΡ€Ρ‚Π°Π»ΠΈΡ‚Π΅Ρ‚. Π Π°Π½Π° дијагноза Π½Π° ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½Π°Ρ‚Π° аспСргилоза Π΅ сѐ ΡƒΡˆΡ‚Π΅ Π³ΠΎΠ»Π΅ΠΌ ΠΊΠ»ΠΈΠ½ΠΈΡ‡ΠΊΠΈ ΠΈ Π΄ΠΈΡ˜Π°Π³Π½ΠΎΡΡ‚ΠΈΡ‡ΠΊΠΈ ΠΏΡ€Π΅Π΄ΠΈΠ·Π²ΠΈΠΊ. ΠšΠΎΠ½Π²Π΅Π½Ρ†ΠΈΠΎΠ½Π°Π»Π½ΠΈΡ‚Π΅ ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΈ Π½Π΅ сС Π΄ΠΎΠ²ΠΎΠ»Π½ΠΎ сСнзитивни, ΠΈ Π·Π°Ρ€Π°Π΄ΠΈ Ρ‚ΠΎΠ°, сС Π½Π°ΠΌΠ΅Ρ‚Π½ΡƒΠ²Π° ΠΏΠΎΡ‚Ρ€Π΅Π±Π° Π·Π° Π±Ρ€Π·ΠΈ ΠΈ посСнзитивни ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΈ Π·Π° Ρ€Π°Π½Π° дијагноза Π½Π° ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΈ Ρ„ΡƒΠ½Π³Π°Π»Π½ΠΈ ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΈ со Aspergillus. Π¦Π΅Π»Ρ‚Π° Π½Π° ΠΎΠ²Π°Π° ΡΡ‚ΡƒΠ΄ΠΈΡ˜Π° бСшС Π΄Π° сС Π΅Π²Π°Π»ΡƒΠΈΡ€Π° Π΄ΠΈΡ˜Π°Π³Π½ΠΎΡΡ‚ΠΈΡ‡ΠΊΠΈΠΎΡ‚ пСрформанс, сСнзитивноста ΠΈ спСцифичноста Π½Π° ΡΠ΅Ρ€ΠΎΠ»ΠΎΡˆΠΊΠΈΠΎΡ‚ ΠΏΠ°Π½Ρ„ΡƒΠ½Π³Π°Π»Π΅Π½ ΠΌΠ°Ρ€ΠΊΠ΅Ρ€ (1,3)-b-D-Π³Π»ΠΈΠΊΠ°Π½ спорСдСно со ΠΊΠΎΠ½Π²Π΅Π½Ρ†ΠΈΠΎΠ½Π°Π»Π½ΠΈΠΎΡ‚ ΠΌΠ΅Ρ‚ΠΎΠ΄ Π·Π° дијагноза Π½Π° ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΈΡ‚Π΅ Ρ„ΡƒΠ½Π³Π°Π»Π½ΠΈ ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΈ со Aspergillus. ΠœΠ°Ρ‚Π΅Ρ€ΠΈΡ˜Π°Π» ΠΈ ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΈ: ΠŸΡ€ΠΈΠΌΠ΅Ρ€ΠΎΡ†ΠΈ ΠΎΠ΄ 125 ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΈ, ΠΏΠΎΠ΄Π΅Π»Π΅Π½ΠΈ Π²ΠΎ 4 Π³Ρ€ΡƒΠΏΠΈ (Π³Ρ€ΡƒΠΏΠ° I - ΠΈΠΌΡƒΠ½ Π΄Π΅Ρ„ΠΈΡ†ΠΈΡ‚, Π³Ρ€ΡƒΠΏΠ° II - ΠΏΡ€ΠΎΠ»ΠΎΠ½Π³ΠΈΡ€Π°Π½ ΠΏΡ€Π΅ΡΡ‚ΠΎΡ˜ Π²ΠΎ Π•Π˜Π›, Π³Ρ€ΡƒΠΏΠ° III - Ρ…Ρ€ΠΎΠ½ΠΈΡ‡Π½Π° аспСргилоза, Π³Ρ€ΡƒΠΏΠ° IV - цистична Ρ„ΠΈΠ±Ρ€ΠΎΠ·Π°), ΠΈ класифицирани спорСд ΠΊΠ»ΠΈΠ½ΠΈΡ‡ΠΊΠ°Ρ‚Π° дијагноза ΠΈ EORTC/MSG ΠΊΡ€ΠΈΡ‚Π΅Ρ€ΠΈΡƒΠΌΠΈΡ‚Π΅, Π±Π΅Π° Π°Π½Π°Π»ΠΈΠ·ΠΈΡ€Π°Π½ΠΈ Π½Π° Π˜Π½ΡΡ‚ΠΈΡ‚ΡƒΡ‚ΠΎΡ‚ Π·Π° ΠΌΠΈΠΊΡ€ΠΎΠ±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡ˜Π° ΠΈ ΠΏΠ°Ρ€Π°Π·ΠΈΡ‚ΠΎΠ»ΠΎΠ³ΠΈΡ˜Π°, со ΠΊΠΎΠ½Π²Π΅Π½Ρ†ΠΈΠΎΠ½Π°Π»Π½ΠΈ ΠΈ ΡΠ΅Ρ€ΠΎΠ»ΠΎΡˆΠΊΠΈ ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΈ, Π²ΠΎ Ρ‚Π΅ΠΊ Π½Π° Π΄Π²Π΅-годишСн ΠΏΠ΅Ρ€ΠΈΠΎΠ΄. Π Π΅Π·ΡƒΠ»Ρ‚Π°Ρ‚ΠΈ: Π’ΠΊΡƒΠΏΠ½ΠΎ 71 ΠΈΠ·ΠΎΠ»Π°Ρ‚ Π½Π° Aspergillus Π±Π΅Π° ΠΏΠΎΡ‚Π²Ρ€Π΄Π΅Π½ΠΈ Π²ΠΎ ΠΎΠ²Π°Π° ΡΡ‚ΡƒΠ΄ΠΈΡ˜Π°. Π§Π΅Ρ‚ΠΈΡ€ΠΈ ΠΈΠ·ΠΎΠ»Π°Ρ‚ΠΈ Π±Π΅Π° Π΄ΠΎΠΊΠ°ΠΆΠ°Π½ΠΈ Π²ΠΎ Ρ…Π΅ΠΌΠΎΠΊΡƒΠ»Ρ‚ΡƒΡ€Π°, кај ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΈ со ΠΏΡ€ΠΈΠΌΠ°Ρ€Π΅Π½ ΠΈΠΌΡƒΠ½ Π΄Π΅Ρ„ΠΈΡ†ΠΈΡ‚. Π‘ΠΎ ΠΊΡƒΠ»Ρ‚ΡƒΡ€Π° Π½Π° БАЛ, Aspergillus Π½Π°Ρ˜Ρ‡Π΅ΡΡ‚ΠΎ бСшС Π΄Π΅Ρ‚Π΅ΠΊΡ‚ΠΈΡ€Π°Π½ Π²ΠΎ Π³Ρ€ΡƒΠΏΠ°Ρ‚Π° Π½Π° Ρ…Ρ€ΠΎΠ½ΠΈΡ‡Π½Π° аспСргилоза (63,33%), ΠΏΠΎ ΡˆΡ‚ΠΎ слСдуваа Π³Ρ€ΡƒΠΏΠΈΡ‚Π΅ со цистична Ρ„ΠΈΠ±Ρ€ΠΎΠ·Π° (56,67%), ΠΏΡ€ΠΈΠΌΠ°Ρ€Π΅Π½ ΠΈΠΌΡƒΠ½ Π΄Π΅Ρ„ΠΈΡ†ΠΈΡ‚ (51,43%), ΠΈ Π³Ρ€ΡƒΠΏΠ°Ρ‚Π° Π»ΠΈΡ†Π° со ΠΏΡ€ΠΎΠ»ΠΎΠ½Π³ΠΈΡ€Π°Π½ ΠΏΡ€Π΅ΡΡ‚ΠΎΡ˜ Π²ΠΎ Π΅Π΄ΠΈΠ½ΠΈΡ†ΠΈΡ‚Π΅ Π·Π° ΠΈΠ½Ρ‚Π΅Π½Π·ΠΈΠ²Π½ΠΎ Π»Π΅ΠΊΡƒΠ²Π°ΡšΠ΅ (43,33%). БСнзитивноста ΠΈ спСцифичноста Π½Π° ΠΊΡƒΠ»Ρ‚ΡƒΡ€ΠΈΡ‚Π΅ Π½Π° БАЛ Π±Π΅Π°: 64,29% ΠΈ 100%, 59,09% ΠΈ 100%, 54,55% ΠΈ 12,5%, 100% ΠΈ 54,17%, Π²ΠΎ I, II, III ΠΈ IV Π³Ρ€ΡƒΠΏΠ°, соодвСтно. Π’ΠΎ 79,1% (53/67) ΠΎΠ΄ ΠΏΠΎΠ·ΠΈΡ‚ΠΈΠ²Π½ΠΈΡ‚Π΅ ΠΊΡƒΠ»Ρ‚ΡƒΡ€ΠΈ Π½Π° БАЛ Π²ΠΎ ситС Π³Ρ€ΡƒΠΏΠΈ, бСшС Π΄ΠΎΠΊΠ°ΠΆΠ°Π½ A.fumigatus, ΠΎΠ΄ ΠΊΠΎΠΈ, 32,1% (17/53) ΠΎΠ΄ Π³Ρ€ΡƒΠΏΠ° III, ΠΏΠΎΡ‚ΠΎΠ° 26,42 % (14/53) ΠΎΠ΄ Π³Ρ€ΡƒΠΏΠ° I ΠΈ 26,42% (14/53) ΠΎΠ΄ Π³Ρ€ΡƒΠΏΠ° IV, ΠΊΠ°ΠΊΠΎ ΠΈ 15,1% (8/53) ΠΎΠ΄ Π³Ρ€ΡƒΠΏΠ° II. Π”Ρ€ΡƒΠ³ΠΈ спСциСси ΠΏΠΎΡ‚Π²Ρ€Π΄Π΅Π½ΠΈ Π²ΠΎ БАЛ Π±Π΅Π° A.flavus 16,42% (11/67) ΠΈ A.terreus 4,48% (3/67). БСнзитивноста ΠΈ спСцифичноста Π½Π° ΡΠ΅Ρ€ΠΎΠ»ΠΎΡˆΠΊΠΈΠΎΡ‚ ΠΏΠ°Π½Ρ„ΡƒΠ½Π³Π°Π»Π΅Π½ (1,3)-b-D-Π³Π»ΠΈΠΊΠ°Π½ (BDG) ΠΌΠ°Ρ€ΠΊΠ΅Ρ€ Π±Π΅Π°: 64,71% ΠΈ 85,71%, 50% ΠΈ 87,5%, 36,36% ΠΈ 50%, Π²ΠΎ Π³Ρ€ΡƒΠΏΠΈΡ‚Π΅ I, II ΠΈ III, соодвСтно. НС Π±Π΅Π° Π΄Π΅Ρ‚Π΅ΠΊΡ‚ΠΈΡ€Π°Π½ΠΈ ΠΏΠΎΠ·ΠΈΡ‚ΠΈΠ²Π½ΠΈ Π½Π°ΠΎΠ΄ΠΈ ΠΎΠ΄ ΠΏΠ°Π½Ρ„ΡƒΠ½Π³Π°Π»Π½ΠΈΠΎΡ‚ (1,3)-b-D-Π³Π»ΠΈΠΊΠ°Π½ (BDG) ΠΌΠ°Ρ€ΠΊΠ΅Ρ€ Π²ΠΎ Π³Ρ€ΡƒΠΏΠ°Ρ‚Π° со цистична Ρ„ΠΈΠ±Ρ€ΠΎΠ·Π°. Π—Π°ΠΊΠ»ΡƒΡ‡ΠΎΠΊ: Π Π΅Π·ΡƒΠ»Ρ‚Π°Ρ‚ΠΈΡ‚Π΅ ΠΎΠ΄ ΠΎΠ²Π°Π° ΡΡ‚ΡƒΠ΄ΠΈΡ˜Π° ΠΏΠΎΠΊΠ°ΠΆΠ°Π° Π΄Π΅ΠΊΠ° ΠΏΠΎΠ·ΠΈΡ‚ΠΈΠ²Π΅Π½ Π½Π°ΠΎΠ΄ Π½Π° (1,3)-b-D-Π³Π»ΠΈΠΊΠ°Π½ ја истакнува врСдноста Π½Π° овој тСст ΠΊΠ°ΠΊΠΎ Π΄ΠΈΡ˜Π°Π³Π½ΠΎΡΡ‚ΠΈΡ‡ΠΊΠΎ Π½Π°Π΄ΠΎΠΏΠΎΠ»Π½ΡƒΠ²Π°ΡšΠ΅ Π²ΠΎ ΡΠ΅Ρ€ΠΎΠ΄ΠΈΡ˜Π°Π³Π½ΠΎΠ·Π°Ρ‚Π° Π½Π° ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΈΡ‚Π΅ Ρ„ΡƒΠ½Π³Π°Π»Π½ΠΈ ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΈ со Aspergillus, ΠΈ Π·Π°Π΅Π΄Π½ΠΎ со Ρ€Π΅Π·ΡƒΠ»Ρ‚Π°Ρ‚ΠΈΡ‚Π΅ ΠΎΠ΄ ΠΊΠΎΠ½Π²Π΅Π½Ρ†ΠΈΠΎΠ½Π°Π»Π½ΠΈΡ‚Π΅ миколошки ΠΈΡΠΏΠΈΡ‚ΡƒΠ²Π°ΡšΠ°, ΠΏΠΎΠΌΠ°Π³Π°Π°Ρ‚ Π²ΠΎ Π½Π°Π²Ρ€Π΅ΠΌΠ΅Π½Π° ΠΏΡ€ΠΈΠΌΠ΅Π½Π° Π½Π° Π°Π½Ρ‚ΠΈΡ„ΡƒΠ½Π³Π°Π»Π½Π° Ρ‚Π΅Ρ€Π°ΠΏΠΈΡ˜Π°, ΠΈ ΠΏΠΎΡΡ‚ΠΈΠ³Π½ΡƒΠ²Π°ΡšΠ΅ ΠΏΠΎΠ²ΠΎΠ»Π΅Π½ ΠΊΠ»ΠΈΠ½ΠΈΡ‡ΠΊΠΈ исход.
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