Diagnosis and treatment of chronic viral hepatitis B and C: doctrinary approach.

Association of Gastroenterologists and Hepatologists of Bosnia and Herzegovina based on the experiences of domestic and foreign centers operating in the field of hepatology and accepted guidelines of the European and the U.S. Association for Liver Diseases adopted the consensus for the diagnosis and treatment of chronic viral hepatitis B and C. The guidelines are intended for specialists in gastroenterology and hepatology, and infectious diseases physicians working in primary health care and family medicine, but also other physicians who are confronted with this disease in their practice, with the aim of facilitating and shortening the diagnostic and treatment protocols of patients with chronic viral hepatitis B and C. This ensures faster, more efficient, more rational and cost-effective care of patients with hepatitis, with an emphasis on stopping the deterioration of liver disease to liver cirrhosis and eventually hepatocellular carcinoma. Key words: Chronic hepatitis B and

Hepatitis C infection in risk groups.

Hepatitis C infection is important global health problem with wide spectrum of health, social and economic consequences. The goal of this research was to estimate prevalence of hepatitis C virus infection in risk groups, and to determine association hepatitis C virus (HCV) infection and risk factors. Research included 4627 subjects divided in two groups. Test group included 2627 subjects divided in 4 subgroups with risk for HCV infection: those who received blood transfusion without screening on HCV (it was introduced in 1995) (700); intravenous drug users (60); patients on hemodialysis (168) and health care workers (1699). Control group included 2000 healthy volunteer blood donors. In all subjects anti-HCV antibodies were tested with third generation ELISA test. Positive serum samples were tested for presence of HCVRNA, using reaction of reverse transcription and polymerase chain reaction. In all anti-HCV positive subjects further epidemiological and clinical workup was performed. Prevalence of HCV infection in risk groups was: 4.6% in subjects who have received blood transfusions without HCV blood screening, 35% in intravenous drug users, 58.9% in patients on chronic dialysis, and 0.4% in health care workers. In control group prevalence was low (0.2%). In the group of 158 anti-HCV positive subjects, 73.4% had HCVRNA. The largest number of subjects with HCV infection was in the age group of 30-49 years (45.8%). This study showed that multiple blood transfusions before introducing the blood screening for HCV, longer duration of intravenous drug abuse, longer duration of hemodialysis treatment, larger number of accidental injuries in health care workers are independent and statistically significant risk factors for those groups examined. Results of this study confirm that general screening for HCV infection is recommended in risk groups for HCV infection in order to identify to prevent and to treat it.

Prevalence of chronic hepatitis B and hepatitis C among first time blood donors in Northeast Bosnia and Herzegovina: an estimate of prevalence in general population.

BACKGROUND: Data on the epidemiology of hepatitis B and C in Bosnia and Herzegovina (B&H) are lacking. OBJECTIVES: To assess the prevalence of hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (anti-HCV) in blood samples of first time blood donors in a well-defined region of B&H. Our secondary goal was to estimate the prevalence of HBsAg and anti-HCV in the general population of the same region. PATIENTS AND METHODS: We evaluated 8196 blood samples for the presence of HBsAg and/or anti-HCV, adjusted for differences in gender, and used the ratio estimation method to determine the prevalence in the general population. RESULTS: We analyzed 1263 (15.4%) female and 6933 (84.6%) male blood donors (male-to-female ratio: 5.49 to 1). The adjusted prevalence of HBsAg among blood donors was 0.787% (95% CI = 0.535-1.038), while the prevalence of anti-HCV was 0.267% (95% CI = 0.016-0.519). There was no difference in the prevalence of HBsAg or anti-HCV between men and women. We estimate that the prevalence of HBsAg and anti-HCV in the general population is 1.057% to 1.535% and 0.29% to 0.89%, respectively. CONCLUSIONS: The prevalence of HBsAg and anti-HCV among blood donors suggests that our region has low endemicity for both hepatitis B and hepatitis C.

[Hepatitis C virus infection in hemodialysis patients in General Hospital Gracanica]. / Hepatitis C virusna infekcija u hemodijaliziranih bolesnika Opce bolnice Gracanica.

PURPOSE: It is estimated that 10-20 % patients on hemodialysis therapy have hepatitis C virus infection with big geographic and individual variability in HCV prevalence between different hemodialysis centers. OBJECTIVES: To determine prevalence of HCV infection among hemodialysis patients in Hemodialysis Unit of General Hospital Gracanica and to make epidemiological, clinical, biochemical and virusological analysis in anti-HCV positive patients. WORK METHODS: 58 patients that were hemodialyse during 2000 year in Hemodialysis Unit Gracanica were included in this study. All patients were tested on anti-HCV antibody and further planed analyses were done. WORK RESULTS: Prevalence HCV infection in Dialysis Unit Gracanica was 46.5 %. The most number of HCV positive patients were in age of 40-49 years 40.7 % or (11/27 patients). The more often HCV positive patients were male 59.3 % or (16/27 patients). In group of anti-HCV positive patients, in 85 % (23/27) have detected HCV RNA. It means that 39.60 % patients in Hemodialysis Unit Gracanica have chronic HCV infection, but 6.80 % patients had past infection. Receiving of blood transfusion, as risk factor, for HCV infection were more often found in group anti HCV + patients (81.5 %) than in group anti-HCV negative patients (51.6 % patients). The length of dialysis therapy were longer in group anti HCV + patients and it was 6.8 years than in group of anti-HCV negative patients that was 1.6 years. HCV infection was not associated with significant biochemical parameters of liver lesion or with manifested clinical symptoms in the time of this study. CONCLUSION: The observed Unit for Hemodialysis can be concerned as unit with high prevalence of HCV infection. It is courage fact that there was no new registered HCV seroconversion since beginning of work this unit until time of this study. Implementation of general and specific measures for prevention of HCV infection and introduction of regular control can decrease risks for HCV infection inside hemodialysis unit.

[Retrospective analyzes of patients with meningococcal sepsis and meningitis during the period of ten years (1995-2004)]. / Retrospektivna analiza bolesnika s meningokoknom sepsom i meningitisom u desetogodisnjem razdoblju (1995.-2004.).

Meningococcal disease is the most significant cause of morbidity and mortality even in the most developed socio-economic surroundings. Meningococcal sepsis and meningitis are caused by Neisseria meningitidis (NM), which is surrounded by polysaharide capsule, which is the main factor of virulence. THE GOAL OF THE WORK: was to confirm the frequency and characteristics of meningococcal disease as well as the justification of introducing vaccination. Through retrospective analysis of the history of the disease, a total of 87 patients with meningococcal sepsis hospitalized at the hospital for infectious in Tuzla in the period 1995 to 2004. diseases were included. Out of 87 hospitalized patients, 34 patients (39%) had meningococcal sepsis, meningococcal sepsis and meningitis had 50 patients (57.6%), and only 3 patients (3.4%) had only meningitis. The diseases most frequently appears in males, 54 patients (62.0%), and in females, 33 patients (38.0%). The largest number of diseased is in the period 0-12 months, 39 patients (44.8%), and then in the period from 13-24 months, 19 diseased (21.8%), from 3-6 years of age 12 patients (13.8%), after sixth year of age meningococcal disease appears in a smaller percent. The youngest patient was 3 and a half months old, and the oldest was 23 years old. Diagnosis was established based on the history of the disease, clinical examination, lab researches, biochemical and bacteriological search of liquid. Etiological cause was proved through liquor culture in 24 cases (27.5%), hemoculture in two cases (2.29%). Death was the result in eight cases (9.1%), one patient (1.1%) resulted in the amputation of a finger, and the rest of 78 patient (89.6%) are cured without sequel. Patients are treated with the Penicillin G, Ampicillin, and in a case of the resistance, were treated with cephalospores of third generation. CONCLUSION: the meningococcal disease, and especially its form of Waterhause-Friderichsen syndrome represents a hard disease which in 50% of cases has a death as the result.

Acute infectious diarrhea in children.

INTRODUCTION: Acute infectious diarrhea is a global health problem especially in infants and children, and is a leading cause of morbidity and mortality. The ethiology of acute infectious diarrhea and also biochemical, epidemiological and clinical characteristics of children dying with infectious diarrhea are investigated in this study. METHODS: 201 children, aged from 6 months to 14 years, with acute infectious diarrhea admitted to the Infectious Diseases Clinic in Tuzla in the period from 21st December 1999 to 21st December 2000 were included in the study. RESULTS: Enteropathogens were identified in stool samples in 103 (51.3%) of 201 examined children. Viruses were identified in 51 (25.4%) cases, bacteria in 44 (21.9%), fungi in 3 (1.5%), and parasites in 2 (1%). Rotavirus, a frequent pathogen, was detected in 48 cases (23.9%), followed by Salmonella species in 20 (10%), EPEC in 10 (4.9%), and Shigella species in 9 (4.5%) cases. In this study the authors noticed that the highest morbidity was recorded in children in the first 2 years of life (70.5%), and among rural community (68.4%). The detection of rotavirus decreased with increasing age of cases and peaked in winter and autumn. Blood in stool was most common in children with shigellosis (22.2%). CONCLUSIONS: High percentage of infants and children dying with acute infectious diarrhea presents a serious socio-economic and medical problem in Tuzla region of Bosnia and Herzegovina. Rotavirus is the single most common pathogen in children with infectious diarrhea.

[Immune response to Engerix-B vaccine in employees at the Clinic for Infectious Diseases in Tuzla]. / Imuni odgovor na Engerix-B vakcinu uposlenika Klinike za infektivne bolesti u Tuzli.

The adults died more frequents from the diseases that could be prevented by vaccinae. To data from WHO HBV infection numbers the nineth place on the list for causes of death. The paper from 1980 proved that chronic HBV carriers have 5-100 folds higher risk for liver carcinoma than noninfected persons lived in the same areas and had the same occupations. In the group of higher risks for HBV infection the medical employees are on the first place. The aim of our paper was to show the high risk of HBV diseased at the Clinic of infectious Diseases and to point HBV vaccina in relation to prevention of HBV infection and HBV chronical carriers. During 2002 we've tested on markers of HBV et HCV all employees of the Clinical Center and among them 84 persons of the Clinic of Infectious Diseases in Tuzla. Tests were done by ELISA in the Department of Transfusiology in University Clinical Center in Tuzla. From total 84 persons 41 (56.9%) were vaccinated before and at 17 (23.6%) the seroconversion weren't done. They most receive 1 booster-dosis. The others with negative markers of HBV were 30 (35.7%) vaccinated by "Engerix B" vaccina (GlaxoSmithKline), that we're had in the beginning of our project. 27 persons (32.0%) have been in contact with HBV virus during the long term duty in the Clinic. They've had HBs antibodies. At 3 (4.1%) members of medical employees that were recovered from severe HBV diseases after accidental injury by winkles the seroconversion HBsAg to HBs antibodies were happened. Among the to have been in contact with HBV virus proved the true of high risk of diseased from hepatitis in the Clinic of Infectious Diseases.