Vaccination against COVID-19 and pregnancy

Cjepivo je najučinkovitija medicinska preventivna mjera kojom se smanjuje rizik od razvoja teških oblika bolesti COVID-19. U trudnica je prepoznata sklonost za razvoj težeg oblika bolesti nakon 28. tjedna trudnoće s posljedičnim negativnim zdravstvenim ishodima ploda (uglavnom zbog prijevremenog porođaja), pa trudnice zahtijevaju povećanu preventivnu skrb tijekom pandemije bolesti COVID-19. Cijepljene trudnice imaju niži rizik za razvoj težeg oblika bolesti, smrtnog ishoda, prijevremenog poroda i mrtvorođenja u usporedbi s necijepljenima pa međunarodna stručna društva gotovo jednoglasno preporučuju cijepljenje trudnica i žena oko trudnoće glasničkim cjepivima (gRNK). Sigurnosni profil cijepljenja gRNK cjepivom trudnica u bilo kojoj fazi trudnoće, žena oko trudnoće i opće populacije jest jednak. Trudnicama, bez obzira na trajanje trudnoće, dojiljama i ženama koje planiraju trudnoću ili liječe neplodnost preporučuje se cijepljenje protiv COVID-19 bez odgađanja. Ne preporučuje se odgađanje cijepljenja trudnicama koje se oklijevaju cijepiti tijekom organogeneze. Trudnicama i babinjačama treba preporučiti docjepljivanje šest mjeseci nakon cijepljenja. Odluku o cijepljenju treba donijeti žena osobno, a nakon što ju medicinski djelatnik informira o stručno i znanstveno argumentiranoj dobrobiti i potencijalnim rizicima cijepljenja.Vaccine is the most effective preventive health measure that reduces the risk of developing a severe form of COVID-19 disease. Since it was determined that pregnant women were prone to develop more severe forms of the disease after being pregnant for 28 weeks with the consequent adverse pregnancy outcome (mainly due to the premature delivery), increased preventive care is required in pregnancy during the pandemic of COVID- 19. Vaccinated pregnant women are at a lower risk for severe forms of disease, lethal outcome, preterm labour and stillbirth compared with their unvaccinated counterparts, thus the vaccination during pregnancy with mRNA vaccine is recommended by the majority of International Societies for Obstetrics and Gynaecology. The mRNA vaccine safety is equal in pregnant women at any stage of pregnancy, both in women becoming pregnant and the general population as well. It is recommended that pregnant women, regardless of the duration of their pregnancy, along with breastfeeding women, women who are planning a pregnancy or treating infertility should be immediately vaccinated against COVID-19. Vaccination postponement due to organogenesis is not recommended. Both pregnant and puerperal women should be advised to get a booster six months after vaccination. Any pregnant woman should decide for herself whether to get vaccinated, after being informed by a medical professional of vaccine risks and benefits based on professional and scientific arguments

Prevalencija humanog papiloma virusa kod karcinoma larinksa, orofarinksa i usne šupljine u Zadarskoj županiji

We present a retrospective research of HPV testing of tissue samples, by the polymerase chain reaction method (PCR), in patients that underwent surgery due to squamous cell carcinoma of the oral cavity, oropharynx or larynx in Zadar General Hospital in the period from 2007 to 2016. Out of 99 patients included in this study, 89 (89,9%) were men with median age of 62.3 years and ten (10,1 %) were women with median age of 66 years. According to the cancer site, the percentage of HPV positive carcinoma tissue samples of larynx carcinoma, oral cavity carcinoma and oropharyngeal carcinoma were 25.8%, 26.9% and 18,2 %, respectively. According to the HPV genotype, among all cancer sites, in 60% (n=15) HPV 16 were detected, and in 40% mixed HPV infection, that is, in 32% (n=8) HPV 16, 26, 34, 53 and in 8% (n=2) HPV 16, 18, 26, 34, 53. The presented research results support the need for stronger public health promotion of vaccines against HPV, and the selection of the best strategy for the implementation of vaccination to prevent cancer of the larynx, oropharynx and oral cavity among men.Radi se o retrospektivnom istraživanju HPV testiranja metodom lančane reakcije polimeraze (PCR) uzoraka tkiva pacijenata operiranih zbog karcinoma skvamoznih stanica usne šupljine, orofarinksa ili grkljana u Općoj bolnici Zadar u razdoblju od 2007. do 2016. godine. Od 99 pacijenata uključenih u ovu studiju, 89 (89,9%) bili su muškarci s medijanom dobi od 62,3 godine i 10 (10,1%) su bile žene s medijanom dobi od 66 godina. Ukupno je u 25 (25,3%) uzoraka tkiva bolesnika otkrivena prisutnost HPV DNA. Prema mjestu raka, postotak uzoraka HPV pozitivnih karcinoma tkiva, karcinoma grkljana, karcinoma usne šupljine i karcinoma orofaringeusa bio je 25,8%, 26,9% odnosno 18,2%. Prema genotipu HPV-a, od svih sijela karcinoma, u 60% (n=15) otkriven je HPV 16, a u 40% mješovite HPV infekcije, i to u 32% (n=8) HPV 16, 26, 34, 53 te u 8% (n=2) HPV 16, 18, 26, 34, 53. Predstavljeni rezultati istraživanja podupiru potrebu jače javnozdravstvene promocije cjepiva protiv HPV-a, te odabir najbolje strategije za provedbu cijepljenja za prevenciju raka grkljana, orofarinksa i usne šupljine kod muškaraca

Stavovi studenata sestrinstva o Covid-19 i cijepljenju protiv Covid-19 bolesti

Tijekom trajanja pandemije stavovi o cijepljenju protiv COVID-19 su se mijenjali, a ta je podjela bila izraženija što je tijek pandemije dulje trajao. Imali smo priliku čuti razna mišljenja i stavove o cijepljenju. Sudjelovali smo u mnogim raspravama koje su rezultirale iznošenjem i pozitivnih i negativnih stavova o cijepljenju protiv koronavirusa. Cilj ovoga istraživanja bio je utvrditi postoje li razlike u stavovima o bolesti COVID-19 između studenata sestrinstva koji su cijepljeni i onih koji nisu, te procijeniti kakvo je povjerenje prema odlukama Nacionalnog stožera. Istraživanje je provedeno od 4. travnja do 4. svibnja 2022. godine. Kako bi se odgovorilo na postavljena pitanja, u istraživanju je korišten modificirani mjerni instrument stvoren na temelju modela zdravstvenog vjerovanja (eng. Health Beliefs model -HBM) tvrtke Wang et al. (2021.). U istraživanju je sudjelovao 271 ispitanik, studenti Preddiplomskog i Diplomskog studija sestrinstva u Republici Hrvatskoj iz Varaždina, Osijeka, Zagreba, Rijeke, Pule, Splita i Zadra, od čega je bilo 231 (85,2%) studentica i 40 (14,8%) studenata. Rezultati istraživanja pokazuju da studenti koji su se cijepili, situaciju s COVID-om procjenjuju ozbiljnijom. Za njih je dobrobit cijepljenja veća, manje je zapreka za cijepljenje i manje odbijaju cijepljenje od studenata koji se nisu cijepili. Nadalje, studentice izražavaju više zabrinutosti i prepreka u odnosu na studente, ali razlike u pogledu razine obrazovanja nisu dobivene. Studenti koji su se cijepili drže da bi obitelj, prijatelji, struka, Vlada i mediji trebali zagovarati i preporučiti cijepljenje, u odnosu na studente koji se nisu cijepili. Važno pitanje odnosilo se na ispitivanje povjerenja prema Nacionalnom stožeru. Ispitanici su pokazali relativno nisku razinu povjerenja, a oni studenti koji su cijepljeni imali su više povjerenja u zdravstvene stručnjake, medije i članove Vlade. Drukčiji pristup osobama kod kojih postoji zabrinutost u pogledu učinkovitosti i sigurnosti cjepiva i mogućih nuspojava, trebalo bi biti jedna od aktivnosti usmjerenih prema toj populaciji, kako bi oni mogli donijeti odluke na temelju objektivno stečenog znanja i informacija koje donosi znanost

Strategies to eliminate hepatitis C in Croatia, a modelling study

Since a 2016 analysis on the epidemiology and disease burden of HCV in Croatia, the HCV treatment paradigm has shifted substantially. Fibrosis restrictions were removed, and the number of patients treated tripled. With these encouraging changes to policy and practice, an updated analysis was completed to guide resource allocation and a national strategic plan for HCV elimination in Croatia. A comprehensive literature review and discussions with in-country experts were used to identify epidemiological factors defining HCV disease burden in Croatia. An HCV disease burden model, seeded with this data, was used to assess the impact of increasing screening rates and delineate the steps needed to reach the World Health Organization’s (WHO) Global Health and Sector Strategy hepatitis C elimination targets. Achieving WHO elimination targets would reduce the number of viremic cases of HCV from 21,000 in 2015 to 4,000 by 2030 while averting 500 liver-related deaths, and 680 cases of hepatocellular carcinoma and decompensated cirrhosis from 2015 to 2030, relative to the projections under the current standard of care. Screening practices will need to ramp up to testing about 250,000 Croatians annually so that about 1,500 patients can be diagnosed and treated each year. Elimination requires a coordinated effort between country and industry leaders including government authorities, policymakers and healthcare and insurance providers. Improved screening mechanisms will be needed for the scale-up required to achieve goals

Vaccine effectiveness against COVID-19 hospitalisation in adults (≥ 20 years) during Alpha- and Delta-dominant circulation: I-MOVE-COVID-19 and VEBIS SARI VE networks, Europe, 2021

Members of the I-MOVE-COVID-19 and VEBIS hospital study teams (in addition to the named authors): Svjetlana Karabuva, Petra Tomaš Petrić, Marija Marković, Sandra Ljubičić, Bojana Mahmutović, Irena Tabain, Petra Smoljo, Iva Pem Novosel, Tanya Melillo, John Paul Cauchi, Benédicte Lissoir, Xavier Holemans, Marc Hainaut, Nicolas Dauby, Benedicte Delaere, Marc Bourgeois, Evelyn Petit, Marijke Reynders, Door Jouck, Koen Magerman, Marieke Bleyen, Melissa Vermeulen, Sébastien Fierens, François Dufrasne, Siel Daelemans, Ala’a Al Kerwi, Francoise Berthet, Guy Fagherazzi, Myriam Alexandre, Charlene Bennett, Jim Christle, Jeff Connell, Peter Doran, Laura Feeney, Binita Maharjan, Sinead McDermott, Rosa McNamara, Nadra Nurdin, Salif Mamadou Cissé, Anne-Sophie L'Honneur, Xavier Duval, Yolande Costa, Fidouh Nadhira, Florence Galtier, Laura Crantelle, Vincent Foulongne, Phillipe Vanhems, Sélilah Amour, Bruno Lina, Fabrice Lainé, Laetitia Gallais, Gisèle Lagathu, Anna Maisa, Yacine Saidi, Christine Durier, Rebecca Bauer, Ana Paula Rodrigues, Adriana Silva, Raquel Guiomar, Margarida Tavares, Débora Pereira, Maria José Manata, Heidi Gruner, André Almeida, Paula Pinto, Cristina Bárbara, Itziar Casado, Ana Miqueleiz, Ana Navascués, Camino Trobajo-Sanmartín, Miguel Fernández-Huerta, María Eugenia Portillo, Carmen Ezpeleta, Nerea Egüés, Manuel García Cenoz, Eva Ardanaz, Marcela Guevara, Conchi Moreno-Iribas, Hana Orlíková, Carmen Mihaela Dorobat, Carmen Manciuc, Simin Aysel Florescu, Alexandru Marin, Sorin Dinu, Catalina Pascu, Alina Ivanciuc, Iulia Bistriceanu, Mihaela Oprea, Maria Elena Mihai, Silke Buda, Ute Preuss, Marianne Wedde, Auksė Mickienė, Giedrė Gefenaitė, Alain Moren, Anthony NardoneIntroduction: Two large multicentre European hospital networks have estimated vaccine effectiveness (VE) against COVID-19 since 2021. Aim: We aimed to measure VE against PCR-confirmed SARS-CoV-2 in hospitalised severe acute respiratory illness (SARI) patients ≥ 20 years, combining data from these networks during Alpha (March–June)- and Delta (June–December)-dominant periods, 2021. Methods: Forty-six participating hospitals across 14 countries follow a similar generic protocol using the test-negative case–control design. We defined complete primary series vaccination (PSV) as two doses of a two-dose or one of a single-dose vaccine ≥ 14 days before onset. Results: We included 1,087 cases (538 controls) and 1,669 cases (1,442 controls) in the Alpha- and Delta-dominant periods, respectively. During the Alpha period, VE against hospitalisation with SARS-CoV2 for complete Comirnaty PSV was 85% (95% CI: 69–92) overall and 75% (95% CI: 42–90) in those aged ≥ 80 years. During the Delta period, among SARI patients ≥ 20 years with symptom onset ≥ 150 days from last PSV dose, VE for complete Comirnaty PSV was 54% (95% CI: 18–74). Among those receiving Comirnaty PSV and mRNA booster (any product) ≥ 150 days after last PSV dose, VE was 91% (95% CI: 57–98). In time-since-vaccination analysis, complete all-product PSV VE was > 90% in those with their last dose < 90 days before onset; ≥ 70% in those 90–179 days before onset. Conclusions: Our results from this EU multi-country hospital setting showed that VE for complete PSV alone was higher in the Alpha- than the Delta-dominant period, and addition of a first booster dose during the latter period increased VE to over 90%.Key public health message: - What did you want to address in this study? To understand how well the COVID-19 vaccine was performing in Europe against hospitalisation during SARS-CoV-2 Alpha and Delta variant periods, we present vaccine effectiveness results from a multi-country study of complete and booster dose COVID-19 vaccination among adults (aged 20 years and over). - What have we learnt from this study? Between March and June 2021 (Alpha period), vaccine effectiveness against hospitalisation with laboratory-confirmed SARS-CoV-2 was 43% for partial vaccination and 86% for complete vaccination. For June to December 2021 (Delta period), vaccine effectiveness for complete vaccination was lower (52%) but with addition of an mRNA booster dose, effectiveness reached 91%, and remained > 90% up to 119 days after the booster dose. - What are the implications of your findings for public health? In Europe in 2021, COVID-19 vaccine effectiveness results for the Alpha period indicated an excellent benefit for preventing hospitalisation after complete vaccination. During Delta variant circulation, however, a booster dose was required to achieve this level of effectiveness, and this was maintained for up to 4 months post booster.info:eu-repo/semantics/publishedVersio

Vaccine effectiveness against COVID-19 hospitalisation in adults (≥ 20 years) during Omicron-dominant circulation: I-MOVE-COVID-19 and VEBIS SARI VE networks, Europe, 2021 to 2022

Introduction: The I-MOVE-COVID-19 and VEBIS hospital networks have been measuring COVID-19 vaccine effectiveness (VE) in participating European countries since early 2021. Aim: We aimed to measure VE against PCR-confirmed SARS-CoV-2 in patients ≥ 20 years hospitalised with severe acute respiratory infection (SARI) from December 2021 to July 2022 (Omicron-dominant period). Methods: In both networks, 46 hospitals (13 countries) follow a similar test-negative case-control protocol. We defined complete primary series vaccination (PSV) and first booster dose vaccination as last dose of either vaccine received ≥ 14 days before symptom onset (stratifying first booster into received < 150 and ≥ 150 days after last PSV dose). We measured VE overall, by vaccine category/product, age group and time since first mRNA booster dose, adjusting by site as a fixed effect, and by swab date, age, sex, and presence/absence of at least one commonly collected chronic condition. Results: We included 2,779 cases and 2,362 controls. The VE of all vaccine products combined against hospitalisation for laboratory-confirmed SARS-CoV-2 was 43% (95% CI: 29-54) for complete PSV (with last dose received ≥ 150 days before onset), while it was 59% (95% CI: 51-66) after addition of one booster dose. The VE was 85% (95% CI: 78-89), 70% (95% CI: 61-77) and 36% (95% CI: 17-51) for those with onset 14-59 days, 60-119 days and 120-179 days after booster vaccination, respectively. Conclusions: Our results suggest that, during the Omicron period, observed VE against SARI hospitalisation improved with first mRNA booster dose, particularly for those having symptom onset < 120 days after first booster dose.Key public health message: 1. What did you want to address in this study? In order to understand how well the COVID-19 vaccine is performing in Europe against hospitalisation during the period when the SARS-CoV-2 Omicron variant was circulating, we investigated vaccine effectiveness using data from a multi-country study of complete and booster-dose COVID-19 vaccination among adults aged 20 years and over. 2. What have we learnt from this study? Between December 2021 and July 2022, vaccine effectiveness against hospitalisation with laboratory-confirmed SARS-CoV-2 was 43% for complete vaccination. With addition of an mRNA booster dose, effectiveness was 59% overall. It was higher when onset of illness was close to the date of the last vaccination, at 85% when last booster dose was 14–59 days before onset, at 70% for 60–119 days, and falling below 40% for 120–179 days. 3. What are the implications of your findings for public health? In European hospital settings in 2022, during the Omicron period, COVID-19 mRNA booster vaccine provided an improved benefit for preventing hospitalisation, particularly if disease onset was within 4 months of receiving the booster dose.info:eu-repo/semantics/publishedVersio

Prevalence of chronic HCV infection in EU/EEA countries in 2019 using multiparameter evidence synthesis

Publisher Copyright: © 2023 The Author(s)Background: Epidemiological data are crucial to monitoring progress towards the 2030 Hepatitis C Virus (HCV) elimination targets. Our aim was to estimate the prevalence of chronic HCV infection (cHCV) in the European Union (EU)/European Economic Area (EEA) countries in 2019. Methods: Multi-parameter evidence synthesis (MPES) was used to produce national estimates of cHCV defined as: π = πrecρrec + πexρex + πnonρnon; πrec, πex, and πnon represent cHCV prevalence among recent people who inject drugs (PWID), ex-PWID, and non-PWID, respectively, while ρrec, ρex, and ρnon represent the proportions of these groups in the population. Information sources included the European Centre for Disease Prevention and Control (ECDC) national operational contact points (NCPs) and prevalence database, the European Monitoring Centre for Drugs and Drug Addiction databases, and the published literature. Findings: The cHCV prevalence in 29 of 30 EU/EEA countries in 2019 was 0.50% [95% Credible Interval (CrI): 0.46%, 0.55%]. The highest cHCV prevalence was observed in the eastern EU/EEA (0.88%; 95% CrI: 0.81%, 0.94%). At least 35.76% (95% CrI: 33.07%, 38.60%) of the overall cHCV prevalence in EU/EEA countries was associated with injecting drugs. Interpretation: Using MPES and collaborating with ECDC NCPs, we estimated the prevalence of cHCV in the EU/EEA to be low. Some areas experience higher cHCV prevalence while a third of prevalent cHCV infections was attributed to PWID. Further efforts are needed to scale up prevention measures and the diagnosis and treatment of infected individuals, especially in the east of the EU/EEA and among PWID. Funding: ECDC.Peer reviewe

Risk factors and seroprevalence of anisakiasis in the professionay exposed population

Ovo je prva studija koja sistematski i sveobuhvatno evaluira rizik od senzibilizacije na Anisakis spp. i potencijalne genetske prijemčivosti za anisakijazu. Radi procjene seroprevalencije anisakijaze i mogućih čimbenika rizika uključeno je u studiju 600 zaposlenika tvornica za preradu morske ribe i glavonožaca u Hrvatskoj, kao i 466 zdravih kontrolnih ispitanika koje su činili dobrovoljni darivatelji krvi. Izuzeti uzorci krvi svih osoba uključenih u istraživanje testirani su različitim laboratorijskim testovima: indirektnim ELISA testom koji sadrži rekombinantne Ani s 1 and Ani s 7 alergene, drugim testom koji je baziran na Anisakis sirovom pripravku, te komercijalnim ImmunoCAP testom. Svi su anketirani putem pripremljenog upitnika, a genetska prijemčivost je ispitana metodom genotipizacije humanih leukocitnih alela (HLA sustav). Zaključno, opažena anti-Anisakis seroprevalencija utvrđena indirektnim ELISA testom bila je značajno viša u radnika riboprerađivačke industrije (1,8%; 95% CI 0,9-3,3%) u odnosu na kontrolne ispitanike (0,0%; 95% CI 0,0-0,8%). Svi seropozitivni radnici (11) su nakon provedenog istraživanja telefonom obaviješteni o rezultatima testa uz upit o pojavi tegoba nakon ribljeg obroka u prošlosti te je većina (8) radnika povezala konzumaciju ribe i probavne ili alergijske smetnje. Sedam od 11 prethodno pozitivnih radnika na Trisakis 170 testu (Ani s 1 i Ani s 7 antigeni) imalo je pozitivne rezultate ImmunoCAP testa (alergeni cijelog parazita), a nitko od 65 odabranih, prethodno negativnih radnika (na Trisakis 170 testu) nije imao pozitivan rezultat. Rezultati testa u kojem je korišten prethodno pripremljeni sadržaj sirove nematode detektirao je seropozitivnost u 3,9% radnika, od kojih je troje (14%) ujedno pokazalo IgE reaktivnost na proteine mlijeka. Najviši rizik povezan sa senzibilizacijom na parazit bio je hobi ribolov kao oblik aktivnosti tijekom slobodnog vremena, u odnosu na bilo koji čimbenik povezan sa svakodnevnim poslom u tvornici za preradu ribe. Iako nije opažena povezanost između seropozitivnosti radnika i nošenja zaštite maske ili rukavica, većina radnika je tijekom posla (92%) nosila rukavice te je time smanjila mogućnost senzibilizacije na nametnika preko kože, tijekom procesuiranja ribe. Šest HLA alela na DRB1 genu pokazalo je značajnu povezanost sa seropozitivnošću, bilo na dominantnom ili recesivnom modelu. Istraživanjem su obuhvaćeni gotovo svi zaposlenici u riboprerađivačkom sektoru Hrvatske, koji su inače izloženi utjecaju različitih alergena na radnom mjestu, pa rezultati pokazuju trenutno stanje seroprevalencije anisakijaze u radnika ove grane industrije.We undertook the first study systematically evaluating the risk of Anisakis-sensitization in Croatian fish-processing workers and potential genetic susceptibility to anisakiasis. Anti Anisakis IgE seroprevalence and risk factors for 600 employees of Croatian fish processing facilities and 466 blood donor controls, were assessed by indirect ELISA targeted with: recombinant Ani s 1 and Ani s 7 allergens, an Anisakis Crude Extract, the commercial ImmunoCAP kit, and questionnaires. Genetic susceptibility to anisakiasis was evaluated by genotypization of human leukocytes alleles (HLA). Overall, the observed anti-Anisakis seroprevalence inferred by indirect ELISA was significantly higher in fish processing workers (1.8%; 95% CI 0.9-3.3%) compared to the controls (0.0%; 95% CI 0.0-0.8%). All seropositive workers (11) were contacted by telephone and notified about results of the test, and also asked about any occurance of discomfort after a fish meal they had in the past. Majority of the workers (8) combined fish consumption with digestive or allergic problems. Seven out of 11 Ani s 1 and Ani s 7 - positives and none of selected 65 negative sera, tested positive on whole-Anisakis extract (ImmunoCAP), whereas Anisakis Crude Extract ELISA detected 3.9% seropositives in fish processing workers, three (14%) of which showed IgE reactivity to milk proteins. The highest risk associated with Anisakis sensitization among workers was fishing in the free time, rather than any of attributes related to the occupational exposure. Although no association was observed between anti Anisakis seropositivity and wearing gloves or protective goggles, the majority of workers (92%) wore protective gloves, minimizing the risk for Anisakis sensitization via skin contact. Six HLA alleles within DRB1 gene were significantly associated with seropositivity under dominant, allelic or recessive models. The study exhaustively covered almost all marine fish processing workers in Croatia, reflecting real-time Anisakis seropositivity status within the industry, already under the influence of wide array of allergen

Clinical and epidemiological features of acute coronary syndrome in women hospitalized in KBC Split

Istraživanje je provedeno u cilju utvrđivanja kliničko-epidemioloških značajki AKS-a u žena iz Splitsko-dalmatinske županije, hospitaliziranih od AKS-a u KBC-u Split u dvogodišnjem razdoblju 2007.-2008. godine. Žene su činile približno trećinu hospitaliziranih od AKS-a tijekom promatranog razdoblja. Među ženama s AKS-om u približno 4/5 utvrđen je AIM, a kod svake pete NAP, pri čemu je NSTEMI utvrđen u 28, 7% slučajeva, STEMI u 25, 2% te NAP u 21, 6%, dok je AIM ostao neklasificiran kod četvrtine ispitanica. Prema udjelu žene su prevladavale samo u najstarijoj dobnoj skupini, a broj oboljelih žena je rastao proporcionalno starenju. Umrle su bile starije od onih koje su preživjele (za STEMI starije 2, 39 godina, za NSTEMI 11, 72 godina, a za neklasificirani AIM 5, 70 godina). Žene su bile značajno starije od muškaraca (za 6, 3 godina kod umrlih, a za 7, 62 godina kod preživjelih). Među svim hospitaliziranima od AKS-a umrlo je više žena (11, 8%) nego muškaraca (6, 0%). U istraživanju je dokazano da su muški ispitanici s AKS-om značajno više preživljavali, te da ženski spol povećava rizik umiranja za 2, 1 put, a svaka godina života više u žena povećava rizik umiranja od AKS za 1, 07 puta. Ove bolesnice su kasnile s hospitalizacijom. Naime, 12, 0% žena je stiglo u bolnicu u roku 2 sata od početka boli, 21, 7% u vremenu 2-6 sati, 16, 0% u vremenu 6-12 sati, 18, 6% u vremenu 12-24 sata, te 31, 7% u vremenu duljem od 24 sata. Približno 1/3 svih zabilježenih komplikacija utvrđena je u žena, a muškaraca bez komplikacija je bilo značajno više. Komplikacija zatajivanje srca je bila vezana uz ženski spol. U preživjelih žena su također značajno češće kao čimbenici rizika nađeni hipertenzija, šećerna bolest i nestabilna angina pektoris, a kod muškaraca aktivno ili bivše pušenje. Umrle žene značajno su imale hipertenziju i šećernu bolest tip 2, a umrli muškarci aktivno pušenje. U ovom radu se pokazalo da su neinvazivni dijagnostički postupci ehokardiografije i ergometrije značajno češće obavljani u muškaraca nego u žena. Nije utvrđena rodna razlika u provođenju trombolize. Invazivni kardiološki postupci su značajno češće vršeni u muškaraca (koronarografija i PCI). Ispitanice s AKS-om su značajno više koristile ACE inhibitore, dok su ispitanici češće koristili statine prije hospitalizacije. Dokazano je da su prilikom bolničkog otpusta muškarcima značajno češće propisivali statini, a ženama ACE inhibitori. Ovo je istraživanje utvrdilo postojanje spolnih razlika u kliničko-epidemiološkim značajkama AKS-a kod stanovnika naše županije, te je uglavnom potvrdilo dosadašnje 55 rezultate provedenih istraživanja u svijetu. Međutim, donijelo je i nove spoznaje specifične za našu sredinu, koje je nužno dalje istraživati. Pozornost treba posvetiti edukaciji svih segmenata zajednice, te boljoj organizaciji zdravstvene zaštite.The study was carried out in order to determine the clinical and epidemiological aspects of the ACS in women in the Split-Dalmatia County, hospitalised therewith in the Clinical Hospital Centre Split during the period of two years, 2007 and 2008. Women formed about one third of all persons hospitalised with the ACS during the period in question. Among the women with ACS, four fifths of them were diagnosed with the AIM and every fifth with the UAP, where the NSTEMI was diagnosed in 28.7% of cases, STEMI in 25.2% and UAP in 21.6%, whereas the AIM remained unclassified in one fourth of cases. Women prevailed only in the oldest group of patients and the number of women grew proportionally with age. It was shown that women with the ACS who died were older than those who survived (for STEMI older by 2.39 years, for NSTEMI by 11.72 years and for the unclassified AIM by 5.70 years). Women were significantly older than men (by 6.3 years for those who died and by 7.62 for those who survived). Among all the hospitalised with ACS, more women (11.8%) died than men (6.0%). More men survived than women, and the female sex increased the risk of dying by 2.1 times, whereas with each year of life the risk of dying of the ACS for women increased by 1.07 times. The women hospitalised with the ACS had a delayed arrival to the hospital. Namely, 12.0% of women arrived within 2 hours since the pain had started; 21.7% after 2-6 hours; 16.0% after 6-12 hours; 18.6% after 12-24 hours; and 31.7% after more than 24 hours. Approximately 1/3 of all the recorded complications were diagnosed in the hospitalised women, and there were also more men with the ACS without complications in comparison to women. Among the hospitalised women with complications, there were significantly more of those with heart failure. Hypertension, diabetes mellitus type 1, diabetes mellitus type 2 and unstable angina pectoris were found as risk factors more frequently in women, and active or past smoking in men. In women who were hospitalised and then died of the ACS, hypertension and diabetes mellitus type 2 were found more frequently, and in men active smoking. This study has shown that the non-invasive diagnostic procedures of echocardiography and ergometry were performed more frequently on men than on women. A significant difference in the performance of thrombolysis on men and on women was not determined. The study has determined that the invasive cardiologic procedures (such as coronarography and PCI) were significantly more frequently 57 performed on men than on women. Women with the ACS used the ACE inhibitors significantly more frequently, whereas men more often used the statins in the ACS treatment before hospitalisation. Men received statins at the discharge from the hospital significantly more frequently whereas women were given more ACE inhibitors. This study has established the existence of differences between women and men when it comes to the ACS clinical and epidemiological aspects among citizens of the Split-Dalmatia County, and has mostly confirmed the past results of studies carried out throughout the world. However, the study has also brought new perceptions specific for our region which should be further examined. Attention should be paid to educating all segments of the community and better organisation of the health care

Risk factors and seroprevalence of anisakiasis in the professionay exposed population

Ovo je prva studija koja sistematski i sveobuhvatno evaluira rizik od senzibilizacije na Anisakis spp. i potencijalne genetske prijemčivosti za anisakijazu. Radi procjene seroprevalencije anisakijaze i mogućih čimbenika rizika uključeno je u studiju 600 zaposlenika tvornica za preradu morske ribe i glavonožaca u Hrvatskoj, kao i 466 zdravih kontrolnih ispitanika koje su činili dobrovoljni darivatelji krvi. Izuzeti uzorci krvi svih osoba uključenih u istraživanje testirani su različitim laboratorijskim testovima: indirektnim ELISA testom koji sadrži rekombinantne Ani s 1 and Ani s 7 alergene, drugim testom koji je baziran na Anisakis sirovom pripravku, te komercijalnim ImmunoCAP testom. Svi su anketirani putem pripremljenog upitnika, a genetska prijemčivost je ispitana metodom genotipizacije humanih leukocitnih alela (HLA sustav). Zaključno, opažena anti-Anisakis seroprevalencija utvrđena indirektnim ELISA testom bila je značajno viša u radnika riboprerađivačke industrije (1,8%; 95% CI 0,9-3,3%) u odnosu na kontrolne ispitanike (0,0%; 95% CI 0,0-0,8%). Svi seropozitivni radnici (11) su nakon provedenog istraživanja telefonom obaviješteni o rezultatima testa uz upit o pojavi tegoba nakon ribljeg obroka u prošlosti te je većina (8) radnika povezala konzumaciju ribe i probavne ili alergijske smetnje. Sedam od 11 prethodno pozitivnih radnika na Trisakis 170 testu (Ani s 1 i Ani s 7 antigeni) imalo je pozitivne rezultate ImmunoCAP testa (alergeni cijelog parazita), a nitko od 65 odabranih, prethodno negativnih radnika (na Trisakis 170 testu) nije imao pozitivan rezultat. Rezultati testa u kojem je korišten prethodno pripremljeni sadržaj sirove nematode detektirao je seropozitivnost u 3,9% radnika, od kojih je troje (14%) ujedno pokazalo IgE reaktivnost na proteine mlijeka. Najviši rizik povezan sa senzibilizacijom na parazit bio je hobi ribolov kao oblik aktivnosti tijekom slobodnog vremena, u odnosu na bilo koji čimbenik povezan sa svakodnevnim poslom u tvornici za preradu ribe. Iako nije opažena povezanost između seropozitivnosti radnika i nošenja zaštite maske ili rukavica, većina radnika je tijekom posla (92%) nosila rukavice te je time smanjila mogućnost senzibilizacije na nametnika preko kože, tijekom procesuiranja ribe. Šest HLA alela na DRB1 genu pokazalo je značajnu povezanost sa seropozitivnošću, bilo na dominantnom ili recesivnom modelu. Istraživanjem su obuhvaćeni gotovo svi zaposlenici u riboprerađivačkom sektoru Hrvatske, koji su inače izloženi utjecaju različitih alergena na radnom mjestu, pa rezultati pokazuju trenutno stanje seroprevalencije anisakijaze u radnika ove grane industrije.We undertook the first study systematically evaluating the risk of Anisakis-sensitization in Croatian fish-processing workers and potential genetic susceptibility to anisakiasis. Anti Anisakis IgE seroprevalence and risk factors for 600 employees of Croatian fish processing facilities and 466 blood donor controls, were assessed by indirect ELISA targeted with: recombinant Ani s 1 and Ani s 7 allergens, an Anisakis Crude Extract, the commercial ImmunoCAP kit, and questionnaires. Genetic susceptibility to anisakiasis was evaluated by genotypization of human leukocytes alleles (HLA). Overall, the observed anti-Anisakis seroprevalence inferred by indirect ELISA was significantly higher in fish processing workers (1.8%; 95% CI 0.9-3.3%) compared to the controls (0.0%; 95% CI 0.0-0.8%). All seropositive workers (11) were contacted by telephone and notified about results of the test, and also asked about any occurance of discomfort after a fish meal they had in the past. Majority of the workers (8) combined fish consumption with digestive or allergic problems. Seven out of 11 Ani s 1 and Ani s 7 - positives and none of selected 65 negative sera, tested positive on whole-Anisakis extract (ImmunoCAP), whereas Anisakis Crude Extract ELISA detected 3.9% seropositives in fish processing workers, three (14%) of which showed IgE reactivity to milk proteins. The highest risk associated with Anisakis sensitization among workers was fishing in the free time, rather than any of attributes related to the occupational exposure. Although no association was observed between anti Anisakis seropositivity and wearing gloves or protective goggles, the majority of workers (92%) wore protective gloves, minimizing the risk for Anisakis sensitization via skin contact. Six HLA alleles within DRB1 gene were significantly associated with seropositivity under dominant, allelic or recessive models. The study exhaustively covered almost all marine fish processing workers in Croatia, reflecting real-time Anisakis seropositivity status within the industry, already under the influence of wide array of allergen