Emerging infections

U radu su prikazane neke nadolazeće infekcije: Humani herpes virus tip 6 (HHV-6) je prvi put izoliran 1986., a 1988. je otkriveno daje uzročnik rozeole infantum. HHV-6 se povezuje sa encefalitisom, febrilnom bolešću sličnoj infekcijskoj mononukleozi, kao uzročnik mijelopatije, a spominje se i u patogenezi multiple skleroze. Prvi slučaj humane erlihioze u SAD-u je registriran 1987. g. Erlihije su male, gram negativne, obligatno intracelulame bakterije. Humanu monocitnu erlihiozu (HME) uzrokuje Ehrlichia chafeensis, a humanu granulocitnu erlihiozu (HGE) Ehrlichia phagocitophyla. Obje bolesti se stječu ubodom krpelja. Bolest mačjeg ogreba je prvi put spomenuta 1950. g. ali je uzročnik bolesti otkriven tek 1983. g. Očituje se benignom limfadenopatijom u djece i mladeži. Bacilama angiomatoza je prvi put opisana 1983. Obično se javlja u ljudi oboljelih od AIDS-a.The present paper describes some emerging infections. Human herpes virus-6 (HHV-6) was first isolated in 1986. In 1988, HHV-6 was identified as a causative agent of roseola infantum. HHV-6 has been associated with encephalitis, a mononucleosis-like febrile illnes, as a causative agent of myelophaty, and in the pathogenesis of multiple sclerosis. The first case of human ehrlichiosis in the United States was reported in 1987. Ehrlichiae are small, obligate intracellular bacteria with a gram-negative type cell wall. The causative agent of human monocytic ehrlichiosis (HME) is Ehrlichia chaffeensis, and the causative agent of human granulocytic ehrlichiosis (HGE) is Ehrlichia phagocythophila. Both HME and HGE are acquired by tick bite. Cat scratch disease was first reported in 1950, but causative organism has not been identified until 1983. Cat scratch disease is the most common cause of benign lymphadenopathy in children and young adults. Bacillary angiomatosis was originally described in 1983. It occurs most commonly in patients with AIDS

Emerging infections

U radu su prikazane neke nadolazeće infekcije: Humani herpes virus tip 6 (HHV-6) je prvi put izoliran 1986., a 1988. je otkriveno daje uzročnik rozeole infantum. HHV-6 se povezuje sa encefalitisom, febrilnom bolešću sličnoj infekcijskoj mononukleozi, kao uzročnik mijelopatije, a spominje se i u patogenezi multiple skleroze. Prvi slučaj humane erlihioze u SAD-u je registriran 1987. g. Erlihije su male, gram negativne, obligatno intracelulame bakterije. Humanu monocitnu erlihiozu (HME) uzrokuje Ehrlichia chafeensis, a humanu granulocitnu erlihiozu (HGE) Ehrlichia phagocitophyla. Obje bolesti se stječu ubodom krpelja. Bolest mačjeg ogreba je prvi put spomenuta 1950. g. ali je uzročnik bolesti otkriven tek 1983. g. Očituje se benignom limfadenopatijom u djece i mladeži. Bacilama angiomatoza je prvi put opisana 1983. Obično se javlja u ljudi oboljelih od AIDS-a.The present paper describes some emerging infections. Human herpes virus-6 (HHV-6) was first isolated in 1986. In 1988, HHV-6 was identified as a causative agent of roseola infantum. HHV-6 has been associated with encephalitis, a mononucleosis-like febrile illnes, as a causative agent of myelophaty, and in the pathogenesis of multiple sclerosis. The first case of human ehrlichiosis in the United States was reported in 1987. Ehrlichiae are small, obligate intracellular bacteria with a gram-negative type cell wall. The causative agent of human monocytic ehrlichiosis (HME) is Ehrlichia chaffeensis, and the causative agent of human granulocytic ehrlichiosis (HGE) is Ehrlichia phagocythophila. Both HME and HGE are acquired by tick bite. Cat scratch disease was first reported in 1950, but causative organism has not been identified until 1983. Cat scratch disease is the most common cause of benign lymphadenopathy in children and young adults. Bacillary angiomatosis was originally described in 1983. It occurs most commonly in patients with AIDS

Ureterorenoscopic treatment of ureteral stones: influence of operator’s experience and skill on the procedure outcome

Aim To observe the influence of operating urologist’s education and adopted skills on the outcome of ureterorenoscopy treatment of ureteral stones. Methods The study included 422 patients (234 men, 55.4%) who underwent ureterorenoscopy to treat ureteral stones at the Urology Department of Clinical Hospital Center Split, Croatia, between 2001 and 2009. All interventions were carried out with a semi-rigid Wolf ureteroscope and an electropneumatic generator used for lithotripsy. The operating specialists were divided into two groups. The first group included 4 urologists who had started learning and performing endoscopic procedures at the beginning of their specialization and the second group included 4 urologists who had started performing endoscopic procedures later in their careers, on average more than 5 years after specialization. Results Radiology tests confirmed that 87% (208/238) of stones were completely removed from the distal ureter, 54% (66/123) from the middle ureter, and 46% (28/61) from the proximal ureter. The first group of urologists completed significantly more procedures successfully, especially for the stones in the distal (95% vs 74%; P = 0.001) and middle ureter (66% vs 38%; P = 0.002), and their patients spent less time in the hospital postoperatively. Conclusion Urologists who started learning and performing endoscopic procedures at the beginning of their specialization are more successful in performing ureteroscopy. It is important that young specialists receive timely and systematic education and cooperate with more experienced colleagues

Ureterorenoscopic treatment of ureteral stones – influence of operator’s experience and skill on the procedure outcome

Aim To observe the influence of operating urologist’s education and adopted skills on the outcome of ureterorenoscopy treatment of ureteral stones. Methods The study included 422 patients (234 men, 55.4%) who underwent ureterorenoscopy to treat ureteral stones at the Urology Department of Clinical Hospital Center Split, Croatia, between 2001 and 2009. All interventions were carried out with a semi-rigid Wolf ureteroscope and an electropneumatic generator used for lithotripsy. The operating specialists were divided into two groups. The first group included 4 urologists who had started learning and performing endoscopic procedures at the beginning of their specialization and the second group included 4 urologists who had started performing endoscopic procedures later in their careers, on average more than 5 years after specialization. Results Radiology tests confirmed that 87% (208/238) of stones were completely removed from the distal ureter, 54% (66/123) from the middle ureter, and 46% (28/61) from the proximal ureter. The first group of urologists completed significantly more procedures successfully, especially for the stones in the distal (95% vs 74%; P = 0.001) and middle ureter (66% vs 38%; P = 0.002), and their patients spent less time in the hospital postoperatively. Conclusion Urologists who started learning and performing endoscopic procedures at the beginning of their specialization are more successful in performing ureteroscopy. It is important that young specialists receive timely and systematic education and cooperate with more experienced colleagues

Tipizacija izolata Brucella melitensis izdvojenih u Republici Hrvatskoj analizom broja uzastopnih ponavljanja na više lokusa (MLVA).

In the period from 2009 to 2013, bacteriological testing was conducted on 336 sheep, goat and cattle samples. Using classical bacteriological and molecular procedures, B. melitensis was confirmed in 14 (4.2 %) samples. Brucella was isolated in the Karlovac, Lika-Senj and Split-Dalmatia Counties. Brucella isolates were genotyped using the MLVA method and compared with isolates from neighbouring Bosnia and Herzegovina (BH). A total of 14 isolates (strains) originating from Croatia and 25 from BH were analysed. Complete matches between Croatian and BH isolates were found in two genotype groups. Overall, the MLVA analysis indicated that the Croatian and BH genotypes of B. melitensis from animals were highly homogenous. The Hunter Gaston diversity index (HGDI) showed that diversity was found among the 16 tested loci for 5 loci of panel 2B (Bruce 04, 07, 09, 16, 30). The discriminating loci are optimal for the use in epidemiological investigation of B. melitensis infections in these two countries.U razdoblju od 2009. do 2013. u Hrvatskoj je izvršena bakteriološka pretraga uzoraka ukupno 336 ovaca, koza i goveda. Klasičnim bakteriološkim i molekularnim postupcima B. melitensis je potvrđena u 14 (4,2%) izolata. Brucele su izdvojene u Karlovačkoj, Ličko-senjskoj i Splitsko-dalmatinskoj županiji. Analiza broja uzastopnih ponavljanja na više lokusa (engl. multiple locus variable number of tandem repeat analysis, MLVA) primijenjena je radi genotipizacije i usporedbe s izolatima iz susjedne Bosne i Hercegovine. Ukupno je analizirano 14 izolata podrijetlom iz Hrvatske i 25 iz susjedne Bosne i Hercegovine. U dva slučaja genotipovi izolata iz Hrvatske u potpunosti su se poklapali s genotipovima u Bosni i Hercegovini. Korištenjem metode MLVA utvrđen je visok stupanj homogenosti izolata u ove dvije zemlje. Od korištenih 16 MLVA lokusa raznolikost je utvrđena samo na 5 lokusa panela 2B (Bruce 04, 07, 09, 16, 30) što je potvrđeno računanjem HGDI indeksa. Korištenje ovih 5 razlikovnih lokusa optimalno je za provođenje epidemioloških istraživanja u Hrvatskoj i Bosni i Hercegovini

Clinical Characteristics and Predictors Affecting the Probability of Complications and Negative Outcome in Hospitalized Patients with Influenza

Cilj: Istraživanju je glavni cilj ispitati kliničke karakteristike u odnosu na dob i komplikacije te pronaći prediktore koji utječu na vjerojatnost pojave komplikacija i negativnog ishoda u hospitaliziranih bolesnika s influencom. Ispitanici i metode: Istraživanjem su obuhvaćeni svi hospitalizirani bolesnici s klinički i/ili laboratorijski dokazanom gripom u Klinici za infektologiju Kliničkog bolničkog centra Osijek u razdoblju od prosinca 2018. do travnja 2019. godine. Istraživanje je provedeno nad 128 ispitanika. Iz povijesti bolesti prikupljeni su i analizirani klinički, demografski, mikrobiološki, radiološki, biokemijski i hematološki podatci. Rezultati: Istraživanjem koje je provedeno, pokazano je kako je starija životna dob povezana s težim oblikom kliničke slike gripe i kompliciranim tijekom bolesti. Kao prediktor negativnog ishoda korisnom se pokazala urea s vrijednosti većom od 9,2 mmol/L te dob veća od 78 godina, a kao prediktori prisutnosti pneumonije ženski spol i CRP uz točku razlučivanja veću od 128,9 mg/L. Komplikacije su općenito češće u bolesnika s duljim kliničkim tijekom bolesti i višim vrijednostima upalnih pokazatelja pri prijamu na bolničko liječenje. Zaključak: Rezultati provedenog istraživanja upućuju na nedvojbenu težinu kliničke slike, razinu laboratorijskih poremećaja, pojavu komplikacija te utjecaj dobi i komorbiditeta u bolesnika s gripom. Za konačno definiranje specifičnih ranih prediktora težine kliničke slike, u svrhu pravovremenog i učinkovitog liječenja te povoljnijeg ishoda bolesti, potrebno je daljnje sustavno praćenje bolesnika i prospektivne studije.Aim: The main objective of the study is to examine clinical characteristics in relation to age and complications, and to find predictors that affect the likelihood of complications and the negative outcome in hospitalized patients with influenza. Respondents and methods: The study included all hospitalized patients with clinically and/or laboratory-proven influenza at the Clinic for Infectious Diseases of the Clinical Hospital Center Osijek in the period from December 2018 to April 2019. The survey was conducted on 128 respondents. Clinical, demographic, microbiological, radiological, biochemical, and hematological data were collected and analyzed from the History of the disease. Results: Research has shown that higher age is associated with a more severe form of the clinical picture of influenza and a complicated course of the disease. Urea with a value of more than 9.2 mmol / L and an age higher than 78 years proved to be useful as predictors of the negative outcome, and female sex and CRP with a resolution point of more than 128.9 mg / L as predictors of the presence of pneumonia. Complications are generally more common in patients with a longer clinical course of the disease and higher values of inflammatory parameters when admitted to the hospital. Conclusion: The results of the study indicate the undisputed severity of the clinical picture, the level of laboratory disorders, the occurrence of complications, and the impact of age and comorbidity in patients with influenza. Further systematic monitoring of patients and prospective studies are needed to finally define specific early predictors of the severity of the clinical picture, for the purpose of timely and effective treatment and a more favorable disease outcome

Ureterorenoscopic treatment of ureteral stones: influence of operator’s experience and skill on the procedure outcome

Aim To observe the influence of operating urologist’s education and adopted skills on the outcome of ureterorenoscopy treatment of ureteral stones. Methods The study included 422 patients (234 men, 55.4%) who underwent ureterorenoscopy to treat ureteral stones at the Urology Department of Clinical Hospital Center Split, Croatia, between 2001 and 2009. All interventions were carried out with a semi-rigid Wolf ureteroscope and an electropneumatic generator used for lithotripsy. The operating specialists were divided into two groups. The first group included 4 urologists who had started learning and performing endoscopic procedures at the beginning of their specialization and the second group included 4 urologists who had started performing endoscopic procedures later in their careers, on average more than 5 years after specialization. Results Radiology tests confirmed that 87% (208/238) of stones were completely removed from the distal ureter, 54% (66/123) from the middle ureter, and 46% (28/61) from the proximal ureter. The first group of urologists completed significantly more procedures successfully, especially for the stones in the distal (95% vs 74%; P = 0.001) and middle ureter (66% vs 38%; P = 0.002), and their patients spent less time in the hospital postoperatively. Conclusion Urologists who started learning and performing endoscopic procedures at the beginning of their specialization are more successful in performing ureteroscopy. It is important that young specialists receive timely and systematic education and cooperate with more experienced colleagues

Identifikacija i MLVA genotipizacija vrste Chlamydia abortus iz slučajeva pobačaja malih preživača u Hrvatskoj

In addition to zoonotic potential, Chlamydia (C.) abortus is a very important bacterium causing serious disease in small ruminants. The main outcome of the disease is abortion in the late stages of pregnancy and the economic impact for farms is significant. During a three-year period (2015–2017), 191 vaginal swabs, 24 placentas, 210 foetal organs and 2 milk samples from small ruminant abortion cases were tested for C. abortus by real-time PCR. Positive samples were detected on eight sheep farms and two goat farms, with 8.4% of total samples testing positive samples. These samples were characterised using the MLVA method, and a single MLVA genotype (genotype [2]) was identified from sheep and goat samples, suggesting highly conserved C. abortus strains among the national flock. This study is the first description of C. abortus as a causative agent of abortion in goats in Croatia. More detailed study is required to recognize the epidemiological relevance of the abortion chlamydiosis. An open register of farms with defined health status should be established for each farm at the national level for better disease(s) control.Osim zoonotskog potencijala, vrsta Chlamydia (C.) abortus je vrlo važna bakterija koja može prouzročiti tešku bolest malih preživača. Dominantni klinički znak bolesti je pobačaj u kasnom stadiju graviditeta sa znatnim ekonomskim učinkom za farme. Tijekom trogodišnjeg razdoblja (2015.-2017.) metodom Real time (RT) PCR na C. abortus testiran je 191 vaginalni obrisak, 24 placente, 210 organa fetusa i 2 uzorka mlijeka iz slučajeva pobačaja malih preživača. Pozitivni uzorci ustvrđeni su u 8 farmi ovaca i 2 farme koza, što ukupno predstavlja 8,4 % pozitivnih uzoraka. Ovi uzorci su tipizirani metodom MLVA i identificiran je jedinstveni genotip MLVA (genotip [2]). Dobiveni rezultat ukazuje na visok stupanj podudarnosti sojeva C. abortus u nacionalnom stadu ovaca i koza. Ovo istraživanje prvi je opis vrste C. abortus kao uzročnika pobačaja u koza u Hrvatskoj. Temeljem ustvrđenog rezultata bilo bi uputno provesti daljnja, detaljnija istraživanja da bi se prepoznalo epidemiološko i ekonomsko značenje infekcija vrstom C. abortus. Radi kvalitetnijeg nadzora bolesti potrebno je uspostaviti otvoreni registar gospodarstava s definiranim zdravstvenim statusom za svaku pojedinu farmu

The Evaluation of γ-Zein Reduction Using Mass Spectrometry—The Influence of Proteolysis Type in Relation to Starch Degradability in Silages

The starch availability and nutritional value of corn (Zea mays L.) are affected by zein proteins. The aim of the study was to see whether the proposed reduction of γ-zeins during the fermentation of silages is a result of either the enzymatic proteolytic activity or of the acidic environment, and how this reduction affects starch availability and degradability in high-moisture corn. A mass spectrometry (MS) technique was used to quantify the 16- and 27-kDa γ-zeins. Briefly, two-dimensional gel electrophoresis (2-DE) was used for γ-zein separation, followed by densitometry for protein quantification and matrix-assisted laser desorption ionization time-of-flight MS (MALDI-TOF/TOF) for protein identification. The results show that the reduction in γ-zeins induced by the ensiling led to a more pronounced starch availability and in vitro degradation, and this reduction was dependent on the type of proteolysis. More specifically, the results indicate that the reduction of γ-zeins in the ensiled corn was primarily driven by the enzymatic proteolysis. Furthermore, we demonstrated that 2-DE followed by densitometric quantification and the mass spectrometry analysis for protein identification can be used as a state-of-the-art method for γ-zein evaluation both in fresh and fermented/ensiled corn samples

Encephalitis or Encephalopathy During an Influenza-A Epidemic

Six female patients with encephalitis, mean age 36.5 (17–60) years, were admitted to the hospital during the 2000–2001 influenza A (H1N1) epidemic in the Osijek – Baranja County. In three (50.0%) patients, the manifestation of encephalitis occurred on day 4 or 5, and in two (33.3%) patients within 24–48 hours of the onset of influenza symptoms. The disease manifestations included headache, elevated body temperature, generalized fatigue, and consciousness disturbance through coma. Three (50.0%) patients had grand mal seizures. Pathologic electroencephalography findings were recorded in all six (100%) patients, whereas computed tomography showed cerebral edema in three (50.0%) patients. Elevated levels of hepatic enzymes and peripheral blood leukopenia were found in two (33.3%) patients in whom encephalitis developed early upon the onset of influenza. One (16.6%) of these patients died, whereas permanent sequels remained in the other two (33.3%) patients