Worrying increase in the risk of vertical transmission of syphilis in Croatia, 2020 to 2024.

Four infants potentially exposed to syphilis infection in utero, meeting World Health Organization surveillance criteria of congenital syphilis (CS), were diagnosed in Croatia between September 2020 and January 2024. We conducted a retrospective analysis of epidemiological, clinical and laboratory data of these cases to assess compliance with surveillance case definitions. As only one confirmed CS case has been reported in Croatia in over 2 decades, these reports signal an increased risk of syphilis vertical transmission and warrant strengthening antenatal screening.

The Impact of the COVID-19 Pandemic on Individuals with Down Syndrome: A Croatian Survey.

Background: Severe acute respiratory syndrome coronavirus-2 infection has spread uncontrollably worldwide. Among the most vulnerable groups in society are populations with multiple comorbidities, including individuals with Down syndrome (DS). Aim: Our aim was to conduct an online survey to assess the impact of COVID-19 on DS individuals in Croatia. We also explored the views of their parents and caregivers about the challenges they faced during COVID-19. Methods: The anonymous online survey was launched in March 2022 and remained open until October 2022. Participants were conducted online through closed group on Facebook. The survey included questions about participant characteristics, medical information, clinical presentation of COVID-19, and challenges faced by the parents during COVID-19. Results: A total of 268 surveys were collected and analysed. We found that age and body mass index of DS individuals were significantly and positively correlated with the clinical presentation of COVID-19. Lack of social activities, cancelled therapies, and psychological problems were the most frequently cited challenges during the pandemic. Conclusion: Clinicians and caregivers should primarily be alert to the same COVID-19 signs and symptoms that occur in the general population (fever, cough, shortness of breath). Ongoing therapies, social activities, and psychological support should be cited as indispensable for maintaining physical health and emotional well-being in DS individuals.

Accuracy of second and third molar maturity indices, Olze, Haavikko, and Demirjian methods for 14- and 16-year-old age thresholds assessment in Croatian children and adolescents.

This study explores the reliability of four established legal age threshold estimation approaches in a Croatian sample. We applied Haavikko stages, Demirjian stages, Olze's third molar eruption stages, and second and third molar maturity indices measurement in 593 orthopantomograms of Croatian children and adolescents aged 11.00-20.99 years old. The left mandibular second and third molar were assessed. Logistic regression analysis was conducted to test the significance of predictive variables. Logistic Receiver operating characteristic (ROC) curves were performed to evaluate the classification ability of variables for estimating 14- and 16-year-old thresholds. The areas under the ROC curve (AUC), accuracy (Acc), sensitivity (Se), specificity (Sp), Positive Likelihood Ratio (LR +), Negative Likelihood Ratio (LR-), and Bayes post-test probability (Bayes PTP) were calculated to evaluate classification performance. Results suggest that the combination of I2M&I3M is the best classifier for the 14-year-old threshold (AUC = 0.879); for males alone, I2M is an even better classifier (AUC = 0.881). The highest Acc 80.1% (95%CI, 75.9%-83.9%), Bayes PTP 86.5% (95%CI, 82.8%-89.7%) and Sp 88.9% (95%CI, 83.0%-93.3%) were by I3M < 0.81 & I2M < 0.03 in total samples; the highest Acc 86.1% (80.6%- 90.6%), Bayes PTP 87.2% (95%CI, 81.7%- 91.4%) and Sp 87.8% (95%CI, 78.2%- 94.3%) were by I2M < 0.01 in males, Acc of Haavikko Ac and Demirjian H stage in second molar is very close with slightly lower Bayes PTP and Sp. I3M is a good classifier for 16-year-old threshold (AUC = 0.889). The cut-off value I3M < 0.34 can be used to classify the 16-year-old threshold with Acc of 80.6% (95%CI, 77.2%-83.7%), Sp of 83.4% (95%CI, 79.0%-87.3%), and 81.7% (95%CI, 78.4%-84.8%) Bayes PTP. In conclusion, to classify the 14-year-old threshold, a pair of cut-off values I3M < 0.81 & I2M < 0.03 can be used in Croatian females; I2M < 0.01, Demirjian H stage, Haavikko Ac stage in second molar, and the pair I3M < 0.81 & I2M < 0.03 can all be used in Croatian males. I3M < 0.34 can classify the 16-year-old threshold in Croatian populations.

Spread of Puumala Hantavirus to New Areas in a Large Croatian Outbreak of Hemorrhagic Fever with Renal Syndrome, 2021.

Background: The largest documented outbreak of hemorrhagic fever with renal syndrome occurred in Primorje-Gorski Kotar County, Croatia, in 2021, marking the first-time cases of hantavirus infection recorded outside of the known endemic region in the north of the county. Aim: To identify the factors contributing to the spread of the outbreak and to compare risk factors for acquiring hantavirus infection in the endemic and newly affected regions. Methods and Results: A total of 189 cases were confirmed by positive Puumala IgM/IgG antibodies (93.6%), and 13 probable cases were identified by clinical and epidemiological data (6.4%) using a structured questionnaire. Of the 179 cases with available clinical data, 59 (33.0%) were hospitalized. Three cases received hemodialysis, and no deaths were reported. Among 170 cases with information on exposures, 66 (38.8%) reported occupational risk. Cases in the northern part of county were more likely to have been infected in early spring (OR 27.1, 95% CI 2.93-250.7), to report seeing a rodent (OR 6.5; 95%CI 2.3-18.4), and to know someone with hemorrhagic fever with renal syndrome (HFRS) (OR 3.0; 95%CI 1.2-8.0) than cases from the southern part of the county. Data from Croatian Forests Ltd. suggested that an unusually good production of beech seeds in 2020 may have contributed to an increased rodent population in 2021. However, average temperature, rainfall, and humidity data from 2021 did not illustrate a significant difference from previous years (Kruskal-Wallis p = 0.837, p = 0.999, p = 0.108). Conclusion: The 2021 HFRS outbreak was likely fueled by an abundant rodent population and virus transmission in rodent hosts. Human activity, environmental factors, and the ensuing animal-human interactions have spread hantavirus infection from Croatia's mountainous region to a previously nonendemic coastal area with a Mediterranean climate.

The Relevance of ß-Thalassemia Heterozygosity in Pediatric Clinical Practice: Croatian Experience.

(1) Background: Thalassemia syndromes are common monogenic disorders that represent a significant global health issue. No systematic epidemiological or molecular investigations on thalassemias in the Croatian population have been reported to date. (2) Methods: This prospective study included 70 children with a presumptive diagnosis of thalassemia and their 42 first-degree relatives. Molecular characterization was performed using direct sequencing and gap-PCR methods. (3) Results: We identified 46 (30 children and 16 first-degree relatives) ß-thalassemia heterozygous carriers from 24 unrelated families, carrying eight different mutations and one hemoglobin variant. Five variants account for approximately 85% of all affected ß-globin alleles: Hb Lepore-Boston-Washington (32.6%), HBB:c.93-21G>A (19.6%), HBB:c.315+1G>A (13.1%), HBB:c.92+1G>A (10.9%), and HBB:c.92+6T>C (8.7%) variants. (4) Conclusions: ß-thalassemia carriers need more detailed genetic profiling since genetic modifiers can significantly impact their phenotype. Our study provides important new insights into the relevance of ß-thalassemia heterozygosity in pediatric clinical practice.

Is golden jackal (Canis aureus) the most important indicator species of Trichinella infection in Croatia?

Epidemiologic monitoring of wild animals is always an important step in defining potential zoonoses that can threaten humans. Particular emphasis should be given to those zoonotic agents permanently cycling within wild animal populations and represent a permanent reservoir for other wild or domesticated animals that can be direct sources of disease for humans. In Croatia, there are two European jackal populations: the Dalmatian population (DP) that has been inhabiting the islands and coastal area along the Adriatic Sea since medieval times, and the South East European population (SEEP) that is found in continental Croatia. Research on Trichinella infections in jackal populations in Croatia was conducted from 2008 to 2022. During this 15-year period, we tested 186 jackal samples and confirmed infection in 47 individuals (25.3 %). The dominant species was T. spiralis, identified in 28 samples (60 %), T. britovi was found in 13 samples (28 %), while for six samples (12 %) the PCR test was unsuccessful. In both populations, the Trichinella species of the domestic cycle (T. spiralis) was found, though in varying ratios: in DP the ratio of identified species was 10:6 in favour of T. britovi, as opposed to 22:3 in favour of T. spiralis in SEEP. The frequency of infection with parasites from the genus Trichinella was significantly different in DP (22.9 %) than in SEEP (26.7 %) (p<0.001), while the larval count in analysed tissue did not differ by type of Trichinella species (p=0.1028). Infected jackals were found in nine of ten tested counties. The results were analysed statistically and the origin of tested and positive samples shown on a map of Croatia. Based on these findings, both jackal populations can be considered to represent an exceptionally important indicators of parasites from the genus Trichinella in Croatia, both for the sylvatic and domestic cycles. There is an evident need for epidemiological monitoring for members of both populations.

Screening for TORCH Antibodies in Croatian Childbearing-Aged Women, 2014-2023.

TORCH infections usually result in mild maternal morbidity, but may cause severe congenital abnormalities. Therefore, it is important to detect maternal infections, monitor the fetus after the disease has been recognized, and define the seronegative women who are at risk of primary infection during pregnancy. From 2014 to 2023, serum samples from 1032 childbearing-aged and pregnant women (16-45 years) were tested for IgM/IgG antibodies to the most common TORCH pathogens: Toxoplasma gondii, rubella virus (RUBV), cytomegalovirus (CMV), and herpes simplex viruses (HSV-1 and HSV-2). The overall IgG seroprevalence rates were 20.1% for T. gondii, 91.3% for RUBV, 70.5% for CMV, 66.8% for HSV-1, and 3.5% for HSV-2. Only HSV-2 seroprevalence was age-related, with a significant progressive increase in seropositivity from 0% in those aged less than 26 years to 9.3% in those older than 40 years. The seroprevalence of T. gondii was higher in residents of suburban/rural areas than in residents of urban areas (27.4% vs. 17.1%). In addition, participants from continental regions were more often toxoplasma-seropositive than those from coastal regions (22.2% vs. 15.3%). HSV-1 seroprevalence was also higher in suburban/rural areas (71.7% vs. 64.7%). Obstetric history was not associated with TORCH seropositivity. Univariate and multivariate risk analysis showed that suburban/rural areas of residence and continental geographic regions were significant risk factors for T. gondii seroprevalence. Furthermore, suburban/rural area of residence was a significant risk factor for HSV-1 seroprevalence, while older age was a significant risk factor for HSV-2 seroprevalence. A declining trend in the seroprevalence of all TORCH pathogens was observed compared to previous Croatian studies (2005-2011). Similarly, the proportion of women simultaneously IgG-seropositive to two or three pathogens decreased over time. The maternal serology before pregnancy could potentially reduce the burden of congenital TORCH infections.

Can we see differences between the 14C activities of urban (Zagreb) and rural (Cvetkovic) sites (central Croatia)?

Radiocarbon (Δ14C) was measured for four years (2019-2022) in Zagreb (Croatia) and in Cvetkovic village near Jastrebarsko (Zagreb County, Croatia) to see whether there are differences between the city site and the rural one because of the fossil fuel combustion. The δ13CCO2 was measured as grab samples once in a month in period December 2020-November 2022. The bomb-produced 14C has been globally distributed across the planet, but the combustion of fossil fuels that do not contain 14C causes a local effect of lowering Δ14C. Zagreb is considered to be a location with heavy fossil fuel combustion as compared to the Cvetkovic (rural site). Monthly 14C activity at Zagreb is constantly below the 14C activity at Cvetkovic. Mean 14C activity at Zagreb (Δ14CZagreb = -18.4 ± 2.6 ‰) is lower than that in Cvetkovic (Δ14CCve = -2.9 ± 2.1 ‰) due to fossil fuel combustion in the city of Zagreb. This is especially pronounced during winter when the mean value in Zagreb is Δ14CZagreb = -26.0 ± 4.3 ‰ and in Cvetkovic Δ14CCve = -5.9 ± 3.4 ‰. Natural gas consumption was used as the proxy for fossil fuel combustion, and it shows better correlation with Δ14C in Zagreb than in Cvetkovic. The Δ14C difference, Δ14CCve ‒ Δ14CZagreb, becomes statistically negligible when natural gas consumption is small. No difference is observed on δ13CCO2; in Zagreb mean δ13CCO2 is -11.0 ± 1.3 ‰, and in Cvetkovic -11.4 ± 1.4 ‰. Lower δ13CCO2 values are observed in winter (Zagreb -11.9 ± 1.1 ‰, -12.2 ± 1.5 ‰ Cvetkovic) than in summer (-10.1 ± 0.8 ‰ vs. -10.4 ± 1.0 ‰) at both locations. Together with higher Δ14C in Cvetkovic, it indicates that at the area of Cvetkovic biogenic samples of modern origin (biomass, wood) as energy source for heating is more pronounced.

Y Chromosome Story-Ancient Genetic Data as a Supplementary Tool for the Analysis of Modern Croatian Genetic Pool.

Due to its turbulent demographic history, marked by extensive settlement and gene flow from diverse regions of Eurasia, Southeastern Europe (SEE) has consistently served as a genetic crossroads between East and West and a junction for the migrations that reshaped Europe's population. SEE, including modern Croatian territory, was a crucial passage from the Near East and even more distant regions and human populations in this region, as almost any other European population represents a remarkable genetic mixture. Modern humans have continuously occupied this region since the Upper Paleolithic era, and different (pre)historical events have left a distinctive genetic signature on the historical narrative of this region. Our views of its history have been mostly renewed in the last few decades by extraordinary data obtained from Y-chromosome studies. In recent times, the international research community, bringing together geneticists and archaeologists, has steadily released a growing number of ancient genomes from this region, shedding more light on its complex past population dynamics and shaping the genetic pool in Croatia and this part of Europe.

Home birth in Croatia - a medico-legal perspective today.

In Croatia, the model of obstetrics-midwifery management of childbirth in maternity hospitals is still in effect, and this is how > 99% of Croatian women give birth. However, in my view, midwives are still not sufficiently educated for completely independent work notwithstanding their university education. The Law on Midwifery defined the role of the midwife in home birth without, however, setting out other organisational-communication and professional provisions. Then it began with sporadic midwifery home births of a few per year, which grew quite rapidly, especially with the impact of the Covid-19 virus pandemic, to about 100 out of a total of about 38,000 births that are performed annually in the Republic of Croatia in maternity hospitals. Since the start of planned home births many bad perinatal outcomes have been recorded in hospital maternity wards who have admitted women after such deliveries. These include puerperal sepsis, protracted labour of several days, neglected protracted labour with perinatal asphyxia and aspiration of meconium amniotic fluid and resuscitation of the newborn (who later developed cerebral palsy), severe postpartum haemorrhage with obstetric shock and postpartum hysterectomy, episiotomy infection, and stillbirth at term pregnancy. Therefore, planned home birth in Croatia should now be regarded as an unsafe birth in extraordinary circumstances and the person who takes charge of it must be professionally prepared, educated and have numerous social skills. Most Croatian gynaecologists and obstetricians give support to midwives in their efforts to be professional and independent when at work, including the controlled and legal implementation of the planned home birth. We unreservedly support self-aware midwives to maintain their profession as highly ethical and professional as possible above the wishes of non-professionals who call for autonomy, so that we do not have to discuss such problems of malpractice of Croatian midwifery in the 21st century.