An Epidemic Outbreak of Salmonella Typhimurium in a Romany Ethnic Community - A Clinical-Epidemiological Survey

Opisuje se epidemija koja je izbila u listopadu 2005. godine u romskoj zajednici, a bila je povezana s uzimanjem kosanog mesa podrijetlom s manjeg gospodarstva bez sanitarnog nadzora. Salmonella (S.) typhimurium je potvrđena kao etiološki uzročnik epidemije. Cilj studije bio je ispitati kliničke i epidemiološke nalaze kod ove epidemije. Ispitana je skupina od 40 Roma u dobi od 2 do 77 godina, 15 muških i 25 ženskih osoba. Provedene su kliničke, laboratorijske, mikrobiološke i epidemiološke pretrage. Klinički manifestna malaksalost, groznica i proljev zabilježeni su u 22 (55%) bolesnika. Šestoro bolesnika je imalo blagi oblik, devetoro umjeren oblik, a sedmoro težak oblik salmoneloze, dok je 18 (45%) bilo asimptomatično. Većina bolesnika je imala tipične kliničke manifestacije, pri čem je prevladavao umjeren i teži oblik zaraze. Uzimanje namirnica bez sanitarnog nadzora nije neuobičajeno u romskoj zajednici zbog loših uvjeta života i niske razine zdravstvenog obrazovanja.An epidemic outbreak in October 2005 in a Romany community associated with consumption of minced meat, produced and sold by a private manufacturer without any sanitary surveillance is reported. Salmonella typhimurium was confirmed as an etiologic agent. The aim was to study the clinical and epidemiological findings in this outbreak. The study group included 40 Romanies, 15 male and 25 female, aged 2 to 77 years. Clinical, laboratory, microbiological and epidemiological investigations were performed. Twenty two (55%) patients had clinical manifestations such as prostration, fever and diarrhea. A mild clinical form was observed in 6, moderate form in 9 and severe form in 7 patients. Eighteen (45%) patients were asymptomatic. Most patients had typical clinical presentation, whereby moderate and severe forms prevailed. Using foodstuffs beyond sanitary control is quite possible in a Romany community because of poor living conditions and low health education

Построение системы качества в медицинских организациях: международный и Российский опыт

The scientific report presents the results of a study of various approaches to the construction of modern quality management systems in medical organizations. Trends in the development of healthcare systems in the world and in the Russian Federation are analyzed, it is shown what role, on the one hand, the development of the infrastructure of medical care for the population, the staff of medical organizations, and on the other hand, the satisfaction of patients with the quality of the services provided to them by the medical organization, plays

Infections With the Tick-Borne Bacterium "Candidatus Neoehrlichia mikurensis” Mimic Noninfectious Conditions in Patients With B Cell Malignancies or Autoimmune Diseases

We present a comprehensive study of a new infectious disease in immune compromised patients, neoehrlichiosis. The clinical picture of the disease can be misleading because the symptoms may be misinterpreted to be a worsening of the underlying diseas

PECULIARITIES AT CLINICAL COURSE AND PROGNOSTIC FACTORS OF THE MOST COMMON VIRAL INFECTIONS OF THE CENTRAL NERVOUS SYSTEM

Viral infections of the central nervous system (CNS) are highly varied and in many cases difficult for diagnostics. Recently they have become more frequent in the practice of the specialists in infectious diseases and general medicine. Sometimes they had a motley clinical spectrum in other cases they were so similar that their appearance was a big challenge for clinicians. The aim of this presentation was to clarify the peculiarities in clinical course and prognostic factors of some of the most widespread viral CNS infections. In Bulgaria, 400 cases of viral infections of the CNS were registered per annum. The most prevalent of them were caused by Enteroviruses. Encephalitis, caused by Herpes simplex virus type 1 (HSV1) was associated with high mortality and severe residual complications in survivors. VZV provoked benign encephalitis with cerebellitis. Lymphocytic choriomeningitis virus meningitis was characterized with long-lasting meningeal signs and combined with some psychological deviations and focal neurological disorders. Influenza virus rare but serious affected CNS with convulsions, psychotic expressions, stupor and coma. Prognosis for the severity of viral infections of the CNS was dependent on age, immune status, neurological predisposition and virulence of the etiological agent. Some peculiarities at laboratorial findings, as well as the delaying of specific etiological therapy were important prognostic factors for bad outcome

Building a Quality System in Medical Organizations: International and Russian Experience

The scientific report presents the results of a study of various approaches to the construction of modern quality management systems in medical organizations. Trends in the development of healthcare systems in the world and in the Russian Federation are analyzed, it is shown what role, on the one hand, the development of the infrastructure of medical care for the population, the staff of medical organizations, and on the other hand, the satisfaction of patients with the quality of the services provided to them by the medical organization, plays

Merle phenotypes in dogs - SILV SINE insertions from Mc to Mh.

It has been recognized that the Merle coat pattern in dogs is not only a visually interesting feature, but it also exerts an important biological role, in terms of hearing and vision impairments. In 2006, the Merle (M) locus was mapped to the SILV gene (aka PMEL) with a SINE element in it, and the inserted retroelement was proven causative to the Merle phenotype. Mapping of the M locus was a genetic breakthrough and many breeders started implementing SILV SINE testing in their breeding programs. Unfortunately, the situation turned out complicated as genotypes of Merle tested individuals did not always correspond to expected phenotypes, sometimes with undesired health consequences in the offspring. Two variants of SILV SINE, allelic to the wild type sequence, have been described so far-Mc and M. Here we report a significantly larger portfolio of existing Merle alleles (Mc, Mc+, Ma, Ma+, M, Mh) in Merle dogs, which are associated with unique coat color features and stratified health impairment risk. The refinement of allelic identification was made possible by systematic, detailed observation of Merle phenotypes in a cohort of 181 dogs from known Merle breeds, by many breeders worldwide, and the use of advanced molecular technology enabling the discrimination of individual Merle alleles with significantly higher precision than previously available. We also show that mosaicism of Merle alleles is an unexpectedly frequent phenomenon, which was identified in 30 out of 181 (16.6%) dogs in our study group. Importantly, not only major alleles, but also minor Merle alleles can be inherited by the offspring. Thus, mosaic findings cannot be neglected and must be reported to the breeder in their whole extent. Most importantly, sperm cells seem to be a significant source of germline Merle allelic variants which can be passed to the offspring on Mendelian basis and explain unusual genotype / phenotype findings in the offspring. In light of negative health consequences that may be attributed to certain Merle breeding strategies, we strongly advocate implementation of the refined Merle allele testing for all dogs of Merle breeds to help the breeders in selection of suitable mating partners and production of healthy offspring

Severe clinical forms of Mediterranean spotted fever: A case series from an endemic area in Bulgaria

Background/Aim. Mediterranean spotted fever (MSF) belongs to Rickettsioses, the Spotted fever group (SFG). The causal agent is Rickettsia conorii conorii and the transmission to humans occurs through dog tick Rhipicephalus sanguineus bites. The aim of this study was to describe clinical and laboratory characteristics in patients with severe form of Mediterranean spotted fever admitted to Bulgarian university hospital in endemic region. Methods. A retrospective study was conducted at Stara Zagora University Hospital (Southeastern Bulgaria) between April 2015 and August 2016. During the analyzed period, 58 cases had clinical and laboratory data for MSF. Serological tests were applied for the etiological diagnosis. MSF-specific immunoglobulin (IgM) and IgG antibodies were detected in serum by indirect immunoenzyme assay (ELISA IgG/IgM, Vircell, Spain) – R. conorii ELISA IgG sensitivity 85%, specificity 100% and R. conorii ELISA IgM sensitivity 94%, specificity 95%. Statistical analysis was made by MS Excel 2007 and SPSS Statistics, version 19.0. Results. Eighteen patients presented as severe forms. The predominant gender of them were males (78%) and 22% were females. The median age of the analyzed group was 55 years (range: 14– 78 years). Ten patients developed hepatic disorder while 4 had neurological signs. Laboratory data showed thrombocytopenia in 15 patients, mean value of platelet (PLT) count for the whole group was 108.6 ± 53.8 × 109/L. Liver enzymes were elevated with mean value of aspartate aminotransferase (AST) 161.4 ± 90.1 IU/L and alanine aminotransferase (ALT) 163.9 ± 81.5 IU/L. Acute phase reactant as C-reactive protein (CRP) had mean value of 140.3 mg/L (range: 9–230 mg/L). Kidney function was impaired in some cases; the mean value of creatinine for the studied group was 134.7 μmol/L (range: 78–313 μmol/L) and mean value of urea was 9.6 mmol/L (range: 4.2–27.4 mmol/L). Conclusion. Bulgaria is an endemic area for tick-borne diseases. Cases of MSF are reported annually. Severe forms of MSF are not rare. Typical clinical and laboratory markers for severity should be actively searched for. Early diagnosis and proper treatment is the key to avoid complications and enable patient recovery