Ejection experience in Serbian Air Force, 1990-2010.

BACKGROUND/AIM: Ejection injuries are the problem for air forces. The present risk for injuries is still too high, approximately 30-50%. The aim of this study was to determine factors responsible for and contributing to injuries in the Serbian Air Force (SAF) in the last two decades. METHODS: All ejection cases in the SAF between 1990 and 2010 were analyzed. The collected data were: aircraft type, ejection seat generation, pilots" age and experience, causes of ejection, aeronautical parameters, the condition of aircraft control and types of injuries. For ease of comparison the US Air Force Safety Regulations were used to define major injuries: hospitalization for 5 days or more, loss of consciousness for over 5 min, bone fracture, joint dislocation, injury to any internal organ, any third-degree burn, or second-degree burn over 5% of the body surface area. RESULTS: There were 52 ejections (51 pilots and 1 mechanic) on 44 airplanes. The ejected persons were from 22 to 46 years, average 32 years. Major injuries were present in 25.49% cases. Of all the ejected pilots 9.61% had fractures of the thoracic spine, 11.53% fractures of the legs, 3.48% fractures of the arms. Of all major injuries, fractures of the thoracic spine were 38.46%. None of the pilots had experienced ejection previously. CONCLUSION: Our results suggest that taking preventive measures is obligatory. Namely, magnetic resonance imaging (MRL) scan must be included in the standard pilot selection procedure and procedure after ejection, physical conditioning of pilots has to be improved, training on ejection trainer has to be accomplished, too.

Evidence of recombination in Tula virus strains from Serbia.

Tula hantavirus (TULV) belongs to Bunyaviridae family, with negative sense RNA genome. Segmented nature of hantaviral genome allows for genetic reassortment, but the evidence of homologous recombination also exists. In this study we analyzed TULV sequences isolated in Serbia on different occasions and from different rodent hosts: 1987 strain from Microtus subterraneus and 2007 strain from Microtus arvalis. Phylogenetic analysis of both L and S segment sequences is suggestive of geographically related clustering, as previously shown for majority of hantaviruses. Reconstruction of phylogenetic tree for TULV S segment showed that both sequences from Serbia clustered together with sequences from East Slovakia, which had previously been shown to be recombinants (Kosice strain). Exploratory recombination analysis, supported by phylogenetic and amino acid pattern analysis, revealed the presence of recombination in the S segment sequences from Serbia, resulting in mosaic-like structure of TULV S segment similar to the one of Kosice strain. Although recombination is considered a rare event in molecular evolution of negative strand RNA viruses, obtained molecular data in this study support evidence of recombination in TULV, in geographically distant regions of Europe.

Pandemic influenza H1N1 outbreak in the military school.

BACKGROUND/AIM: The first cases of the pandemic pH1N1 influenza virus infection was observed in the Unated States and Mexico in April 2009 and the first laboratory confirmed case in Serbia was registered in June 2009. The aim of this paper was to report on the investigation of the first confirmed outbreak of the 2009 pandemic H1N1 influenza in Serbia and to describe the clinical and epidemiologic findings from this investigation. METHODS: Descriptive and analytical epidemiological methods were used. Data were collected from medical records of the Military School students and epidemiological questionnaire. Pandemic H1N1 infection was initially confirmed by the RT-PCR assay in nasopharyngeal and oropharyngeal swabs and subsequently by the complement fixation test in serum samples. RESULTS: The attack rate of acute respiratory illness was 70.8% (204/288). Pandemic H1N1 virus infection was confirmed in 44 of 82 tested cases of acute respiratory illness (53.7%) The most common clinical manifestations of pandemic influenza H1N1 were fever (88.6%/), cough (61.4%/o), malaise (38.6%/), runny nose (36.4%), headache (29.60/%), sore throat (20.50/%) and muscle pain (15.9%). CONCLUSION: The findings from this investigation suggest that pandemic H1N1 influenza in a high military school was widespread but did not cause severe illness.

Clinical manifestations, therapy and outcome of pandemic influenza A (H1N1) 2009 in hospitalized patients.

BACKGROUND/AIM: Increasing number of epidemiological and clinical studies to date showed that the pandemic influenza A (H1N1) 2009, by its characteristics, significantly differs from infection caused by seasonal influenza. Therefore, the information about clinical spectrum of manifestations, risk factors for severe form of the disease, treatment and outcome in patients with novel flu are still collected. METHODS; A total of 98 patients (mean age 32 +/- 15 years, range 14-88 years) with the signs and symptoms of novel influenza were treated in the Clinic for Infectious and Tropical Diseases, Military Medical Academy. There were 74 (75.5%) patients with suspected influenza A (H1N1) 2009, 10 (10.2%) with the likelihood and 14 (14.3%) with the confirmed influenza. In all the patients we registered the basic demographic data, risk factors for severe disease, symptoms and signs of influenza, laboratory tests and chest radiography. We analyzed antiviral therapy use and disease outcome (survived, died). RESULTS: The average time from the beginning of influenza A (H1N1) to the admission in hospital was 3 days (0-16 days) and from the moment of hospitalization to the Intensive Care Unit (ICU) admission was 2 days (0-5 days). There were 49 (50.0) patients, 20-29 years of age and 5 (5.1) patients older than 65. A total of 21 (21.4%) patients were with underlying disease, 18 (18.4%) were obese, 19 (19.4) were cigarette smokers. All of the patients had fever, 81 (82.6%) cough, while dyspnea and diarrhea were registered in 4 of the patients. In more than 75% of the patients laboratory tests were within normal limits. The real-time polymerase chain reaction (PCR) test for identification of influenza A (H1N1) 2009 was positive in 14 (77.8%), while pneumonia was verified in 30 (30.7%) of the patients. Six (6.1%) patients, mean age of 45 +/- 14 years (31-59 years) were admitted to the ICU, of whom five (5.1%) had Adult Respiratory Distress Syndrome (ARDS). Risk factors were registered more frequently in the patients with acute respiratory failure (14.2% vs 4.9%, p < 0.05). A total of 67 (68.4%) patients received oseltamivir, 89 (90.1%) was applied to antibiotics and 64 (65.3%) were treated with a combined therapy. Antiviral therapy was applied to 43 (43.3%) patients in the first 48 hours from the onset of the disease, of whom only one (3.4) developed ARDS. Fatal outcome was noted in 2.0% of the patients (2 of 98 patients) and in 33.3% of the patients treated in the ICU. CONCLUSION: Novel influenza A (H1N1) is most commonly manifested as a mild acute respiratory disease, which usually affects young healthy adults. A small number of the patients develop severe illness with acute respiratory failure and death. Patients seem to have benefit from antiviral therapy especially in first 48 hours.

Epidemiological characteristics of brucellosis in Serbia, 1980-2008.

AIM: To analyze the epidemiological characteristics of human brucellosis in Serbia from 1980 to 2008 and the most important factors affecting its emergence and spread. METHODS: Public sources of data on brucellosis were used, including official reports of infectious diseases and epidemics, as well as monthly and annual reports of the Serbia and Vojvodina Institutes of Public Health. RESULTS: From 1980 through 2008, there were 1521 human brucellosis cases in Serbia. The annual number ranged from 2 in 2000 to 324 in 1991. Infections occurred more often in men (67% of cases) than in women (odds ratio, 2.17; 95% confidence interval, 1.57-3.00; chi2=24.52, P<0.001). The largest number of patients over the entire study period (1184) was recorded in Kosovo and Metohija, which accounted for 78% of the total number of patients. The maximum incidence rate in Kosovo and Metohija was 12 per 100,000 in 1991. In Vojvodina, the first autochthonous human cases of brucellosis were recorded in 1999, and 101 affected persons were registered by the end of 2008. During the period 1994-2008, the largest number of patients in Serbia was recorded from June to September (310 of 623 cases, 50%). The disease was most prevalent among people aged 30-49 years, accounting for 81 of 177 (46%) of the cases in Serbia from 1999 to 2008. CONCLUSION: Brucellosis has been a significant public health concern in Serbia. This problem may be solved by joint efforts of all relevant factors, first of all human and veterinary medical services.

[Risk of Lyme disease development after a tick bite].

BACKGROUND/AIM: Despite numerous research of Lyme disease (LD), there are still many concerns about environmental of infectious agent of LD, as well as its prophylaxis, diagnosis and treatment. The aim of this work was to determine the risk of LD in relation to the way of removing ticks and duration of tick attachment. METHODS: In the period from 2000 to 2007 a prospective study was conducted including persons with tick bite referred to the Institute of Epidemiology, Military Medical Academy, and followed for the occurrence of early Lyme disease up to six months after a tick bite. Epidemiological questionnaire was used to collect relevant information about the place and time of tick bites, the way of a removing tick, duration of tick attachment, remnants of a tick left in the skin (parts of the mouth device) and the signs of clinical manifestations of LD. Duration of tick attachment was determined on the basis of size of engorged tick and epidemiological data. Removed ticks were determined by the key of Pomerancev. Professional removing of attached tick was considered to be removing of tick with mechanical means by healthcare personnel. Fisher's exact test, Chi squares test and calculation of the relative risk (RR) were used for data analysis. RESULTS: Of 3 126 patients with tick bite, clinical manifestations of LD were demonstrated in 19 (0.61%). In the group of subjects (n = 829) in which a tick was not removed professionally there were 17 (2.05%) cases with LD, while in the group of respondents (n = 2 297) in who a tick was removed professionally there were 2 (0.09%) cases with LD after tick bite (RR, 23.55; p < 0.0001). The disease was most frequent in the group of respondents with incompletely and unprofessionally removed ticks (2.46%). In the groups of patients with unprofessionally but completely removed ticks LD occurred in 0.89%, while in the group of subjects with a tick removed by an expert, but incompletely in 0.78% cases. The disease occurred rarely in the group with a tick removed completely and professionally (0.05%). There was no case of LD in the group of patients with a tick removed within 24 hours. The longer time of exposure after 24 hours, the higher absolute risk of disease was reported. CONCLUSION: In prevention of Lyme disease it is important to urgent remove a tick, to use a correct procedure of removing and to remove the whole tick without any remnants.

Prevalence of Borrelia burgdorferi in Ixodes ricinus ticks in Belgrade area.

OBJECTIVE: Lyme borreliosis is vector-borne zoonosis. The causative agent of Lyme borreliosis is a spirochete of Borrelia burgdorferi (Bb) sensu lato complex, which is transmitted by ticks of the Ixodes ricinus complex. The aim of our paper is to estimate the prevalence of I. ricinus ticks, the level of their infectivity by Bb, and the prevalence of certain genospecies of Bb sensu lato in ixodide ticks inhabiting Belgrade. MATERIALS AND METHODS: An estimate of the tick population density was expressed by the value of flag/hour. For isolation and cultivation of Borrelia, selective Barbour-Stonner-Kelly II media was used. Typization of Borrelia was made by applying the species-specific polymerase chain reaction (PCR) and polymerase chain reaction-restriction fragment length polymorphism analysis. In statistical analysis, Chi(2) test was used. RESULTS: Values of flag/hour have varied in relation to year observed and type of habitat: The lowest values were recorded in the city parks (17.9). The values were higher in parks-woods (19.7 and 33.4, respectively). The highest values were detected in localities similar to wooded areas (48.0). The estimated average infestation of ticks with Bb was 21.9%, excluding statistically significant differences by years of investigation. We found the dominance of Borrelia afzelii (75%). Bb sensu stricto (22.2%) as well as Borrelia garinii (2.8%) was much less present. Statistically significant difference was established in the prevalence of the above-mentioned genospecies in relation to the examined localities. CONCLUSIONS: We have established the prevalence of all three genospecies in the city of Belgrade. Bb sensu lato was found, with the dominance of B. afzelii.

[An outbreak of trichinellosis in a military unit].

BACKGROUND/AIM: In December 2001, an outbreak of trichinellosis spreaded in a military unit. The aim of this paper was to show possibilities and consequences of trichinellosis infestations in military units during peace time, as well as to improve knowledge and awareness of medical corps personnel, commanders and soldiers about this disease. METHODS: A descriptive and analytical epidemiological models were used to find out a source of outbreak and to identify the ways of its transmission. RESULTS: This outbreak was caused by the contaminated raw smoked sausage which had not undergone health inspection and brought from civilians to a military unit. Thirty-eight persons were exposed, twenty-one affected and hospitalized. The most frequent symptoms reported were fever (76.2%), myalgia (76.2%), palpebral edema (42.8%), face edema (19.0%) and diarrhea (14.3%). Test for indirect immunofluorescence was positive in 14.3% and ELISA test was positive in 28.6% of the patients. Eosinophilia was present in 85.7% of the affected. IgE values were increased in 28.6% and CPK values were increased in 61.9% of the diseased. All of the 17 exposed undiseased had negative laboratory analyses for trichinellosis. CONCLUSION: We propose intensifying health education and continuing the implementation of duly supervised and evaluated self-check programs. A well-tuned, fast-reacting epidemiological monitoring system has to be obligatory.

Molecular characterization of Borrelia burgdorferi sensu lato strains isolated in the area of Belgrade, Serbia

This is the first report of the molecular characterization and identification of Borrelia burgdorferi sensu lato strains isolated in Serbia. Isolates A1, A2 and M1, from Ixodes ricinus, belong to Borrelia burgdorferi sensu stricto, while isolate K1 from Apodemus flavicollis is a mixture of Borrelia afzelii and B. burgdorferi s.s.

Trata-se do primeiro relato de identificação e caracterização molecular de cepas de Borrelia burgdorferi sensu lato isoladas na região de Belgrado, Sérvia. As cepas A1, A2 e M1, isoladas de Ixodes ricinus, pertencem à Borrelia burgdorferi sensu stricto, enquanto a cepa K1, isolada de Apodemus flavocollis é uma mistura de Borrelia afzelii e B. burgdorferi s.s.

[Foodborne disease outbreak among soldiers in Nis garrison associated with the consumption of coleslaw].

AIM/BACKGROUND: Large outbreaks of foodborne diseases are always focused by the general public who expect experts to rapidly explain both the causes of the disease and its growth. This article presents the results of the investigation of an outbreak of foodborne disease that has attracted much of the electronic and written media attention. METHODS: The data on food items consumed by intoxicated and healthy soldiers were obtained by the adapted questionnaire during a field investigation performed on November 3-4, 2005. On the same occasion other relevant data were also collected. For microbiological investigations stool samples from the ill persons were collected, as well as food specimen and swabs from the working surfaces and utensils in the kichen where the food had been prepared. RESULTS: In the outbreak of foodborne disease, which started on November 2, 2005, and terminated on the next day, 103 ill soldiers were registered in 7 units scattered over 4 locations in the garrison of Nis. The attack rate varied in the affected units from 33 to 338 per thousand, with the mean value of 109.7 per thousand. The clinical course of the disease was predominantly light including vomiting, diarrhea and fever as the most frequent signs of illness. All the affected soldiers were hospitalized, treated with symptomatic therapy, and discharged fully recovered. By comparing dishes that had been consumed by the ill and the healthy persons before the beginning of the outbreak, the greatest statistical significance (p < 0.0001), and the only significant relative risk (RR = 3.43) were related to the consumption of the coleslaw served for lunch on November 1, 2005. In addition, two control groups with the total of 151 persons who had not consumed the coleslaws were identified no one of them was affected. An microbiological investigation did not reveal any bacterial enteropathogens. CONCLUSION: In the described foodborne disease outbreak a causative agent was not identified although coleslaw was the way of transmission probably secondarily contaminated by the improper hygiene practice during its processing.

[An epidemic of Q fever in a unit of the Yugoslav Army during war conditions]. / Epidemija Q groznice u jednoj jedinici Vojske Jugoslavije u ratnim uslovima.

In an outbreak of Q-fever in an Army unit lasting 9 days, 20 (13.4%) soldiers had contracted a disease. The outbreak occurred due to the entry of the unit into the focus originated by lambing and pasture of infected sheep. The source of the infection was the contaminated dust from the grassland where the soldiers were training, and they were infected by aerogenic way. In 11 (55%) patients, the disease was manifested as pneumonia that was radiologically confirmed in 7 (35%) patients, while the rest were with the symptoms of influenza and upper airways infection. As soon as tetracycline was administered, health state of the patients was significantly improved and all were released as cured after the treatment. Finding of the antibodies to Coxiella burneti in 66.6% of the patients confirmed the etiology of the disease in this outbreak.