Increasing trend in enterococcal bacteraemia and vancomycin resistance in a tertiary care hospital in Croatia, 2017-2021.

BACKGROUND: The epidemiology of enterococcal bacteraemia has changed worldwide and vancomycin-resistant enterococci increasingly cause healthcare-associated infections) with limited treatment options. Studies show heterogeneity among countries, regions and individual hospitals. METHODS: We retrospectively analysed enterococcal bacteraemia with Enterococcus faecalis and E. faecium at the largest hospital in Croatia, University Hospital Centre Zagreb from January 2017 to December 2021. RESULTS: A total of 432 cases of enterococcal bacteraemia were identified with 256 (59.3%) due to E. faecalis and 176 (40.7%) to E. faecium. Enterococcal bacteraemia occurred more frequently in men (n = 270; 62.5%) and the median age of all patients was 62 years (IQR: 0-92). We found statistically significant increase in the incidence trend of bacteraemic episodes with an annual percent change of 20.9% (95% confidence interval 14.3 to 27.8; p = .002) predominantly due to an increase of E. faecalis bacteraemia. The majority of patients (362/432; 83.8%) had healthcare-associated infections and 38.0% (165/432) of patients were in the intensive care unit. The proportion of vancomycin-resistant enterococcal bacteraemia increased from 12.7% (n = 8/63) in 2017 to 25.7% (n = 29/113) in 2021, statistically significant increasing trend (p = .0455), mainly due to an increased proportion of vancomycin-resistant E. faecium (p = .0169). CONCLUSIONS: This is the first study describing the trends in enterococcal bacteraemia and vancomycin-resistance in enterococci in Croatia. We found a rising trend in enterococcal bacteraemia and in the proportion of vancomycin resistance and identified the most vulnerable patient groups, notably intensive care unit patients.

In vitro susceptibility of carbapenem-resistant Enterobacterales to eravacycline - the first report from Croatia.

The main obstacle in treatment of infections caused by carbapenem-resistant Enterobacterales (CRE) are limited treatment options. The novel antimicrobial agents other than ß-lactams with activity not being dependent on ß-lactamase class are especially important. Eravacycline (ERV) is the first fully synthetic fluorocycline indicated for the treatment of complicated intra-abdominal infections in adults. Eighty CRE isolates at the University Hospital Centre Zagreb, Croatia were examined for susceptibility to ERV by disc diffusion method and minimal inhibitory concentration (MIC). Total of 54 (54/80; 67.5%) isolates were susceptible to ERV with MIC50 of ≤0.5 µg/mL and MIC90 of 4 µg/mL. Susceptibility of OXA-48 positive isolates was not significantly higher in comparison with NDM positive (P = 0.539) and VIM positive (P = 0.7805) isolates. ERV is possible alternative to novel ß-lactamase inhibitor combinations for treatment of CRE infections with antimicrobial susceptibility testing of CRE isolate to ERV in particular patient as condicio sine qua non before administration.

Maternity Blues among Croatian Mothers - A Single-Center Study.

BACKGROUND: Maternity blues is a transient change of mood that occurs within the first few days after delivery. Some of the most common symptoms include mood swings, tearfulness, irritability, loss of appetite, fatigue. The aim of the study was to investigate the relationship between maternity blues, psychological, demographic and obstetrics risk factors. SUBJECTS AND METHODS: A cross-sectional study was conducted between October 2019 and February 2020 at the University Hospital Center Zagreb, Croatia. Final analysis included 227 mothers. Participants were assessed with Stein's Maternity Blues Scale, Connor-Davidson Resilience Scale (CD-RISC), Multidimensional Scale of Perceived Support (MSPSS) and Brennan's Experiences in Close Relationship Scale, as well as demographic and obstetric data. RESULTS: The prevalence of maternity blues in our study was 19.9%. Higher result on Stein's Maternity Blues Scale was associated with anxious attachment style (r=0.425, p<0.01), oxytocin (r=0.308, p<0.01), lower birth weight (r=-0.242), lower resilience (r=-0.252) and less perceived social support from family and significant other (p<.01). CONCLUSIONS: This report presents the very first study assessing maternity blues occurence among Croatian mothers and in Croatian cultural environment. We believe that our report will address importance of employing adequate screening methods in preventing and timely recognizing maternity blues and subsequent postpartum depression in Croatian population.

Endometriosis, Pain and Mental Health.

BACKGROUND: Endometriosis is a chronic and progressive disease which can significantly affect a woman's personal, as well as intimate and professional aspects of life. The aim of this study was to asses health-related quality of life and mental health status in patients with endometriosis, investigating also their relationship with endometriosis-related comorbid symptoms and conditions, such as pain and infertility. SUBJECTS AND METHODS: An observational cross-sectional study involved 79 women with endometriosis. All patients filled the Endometriosis Health Profile (EHP-5), the Depression Anxiety Stress Scales (DASS-21) and the Visual Analogue Scale (VAS). Their medical data were retrieved from medical records. Data was analyzed using the SPSS 23.0 (IBM Corp., Armonk, NY). RESULTS: Of all the patients evaluated in our study, 44.3% presented depressive symptoms and 25.3% presented anxiety, while 31.7% reported stress symptoms. Moderate correlations were found between results on EHP-5 and depression (r=0.515), stress (r=0.558) and VAS score (r=0.565). Furthermore, weak positive relationship was observed between EHP-5 and anxiety (r=0.295) and infertility (r=0.267). Additionally, moderate correlation was found between depression and infertility (r=0.519), while there was weak association between VAS score and stress (r=0.236). CONCLUSIONS: This study showed complex relationships between symptoms and conditions manifesting in patients with endometriosis. Due to diversity of symptoms, potentially including mental health issues, it is important to emphasize the need for combined personalized treatment for these patients, taking into account both physical and psychological aspect of the disease.

Diagnostic accuracy of modified Hadlock formula for fetal macrosomia in women with gestational diabetes and pregnancy weight gain above recommended.

OBJECTIVES: Women with gestational diabetes (GDM) and weight gain during pregnancy above recommended more often give birth to macrosomic children. The goal of this study was to evaluate the diagnostic accuracy of the modified formula for ultrasound assessment of fetal weight created in a pilot study using a similar specimen in comparison to the Hadlock-2 formula. METHODS: This is a prospective, cohort, applicative, observational, quantitative, and analytical study, which included 213 pregnant women with a singleton pregnancy, GDM, and pregnancy weight gain above recommended. Participants were consecutively followed in the time period between July 1st, 2016, and August 31st, 2020. Ultrasound estimations were made within three days before the delivery. Fetal weights estimated using both formulas were compared to the newborns' weights. RESULTS: A total of 133 fetal weight estimations were made. In comparison to the newborns' weight modified formula had significantly smaller deviation in weight estimation compared to the Hadlock-2 formula, higher frequency of deviation within 5% of newborns weights (78.2% [95% CI=0.74-0.83] vs. 60.2%), smaller frequency of deviations from 5 to 10% (19.5 vs. 33.8%) and above 10%, which was even more significant among macrosomic children. There were 36/50 (72%) correctly diagnosed cases of macrosomia by modified and 33/50 (66%) by Hadlock-2 formula. Area under the curve (AUC) for the modified formula was 0.854 (95% CI=0.776-0.932), and for the Hadlock-2 formula 0.824 (95% CI=0.740-0.908). The positive predictive value of the modified formula was 81.81%, the negative 97.91%. CONCLUSIONS: In cases of greater fetal weights, the modified formula showed greater precision.

Management of Wolffian duct tumor recurrence without chemotherapy.

BACKGROUND: A female adnexal tumor of probable Wolffian origin (FATWO) is a rare neoplasm which is considered to have a low malignant potential. CASE: In 2006, a 60-year-old patient was admitted to hospital with solid tumor on the vaginal cuff confirmed by abdominal/pelvic CT, 6 years after her first FATWO was diagnosed and hysterectomy, bilateral adnexectomy, and omentectomia were done. No chemotherapy was administrated after her first surgery. Pelvic washings, lysis of adhesions, and excision of tumor mass were performed. Pathologic examination revealed malignant epithelial neoplasm of Wolffian origin with morphologic features similar to those of the patient's prior tumor. Immunohistochemical staining was positive for vimentin and partially low positive for cytokeratin 19. No chemotherapy was administrated. Two years after second surgery, the patient was asymptomatic and her clinical, laboratory, CT, and chest X-ray findings were unremarkable. CONCLUSION: Surgical debulking with hysterectomy and bilateral adnexectomy appears as the most successful initial treatment for FATWOs.

Afect of botulinum toxin-A injection on intraocular pressure and proptosis in thyroid associated orbitopathy.

The aim of this study was to evaluate the effects of extraocular muscle injection of botulinum toxin-A (BTX-A) on intraocular pressure (IOP) and proptosis in patients with ocular motility disturbances in thyroid associated orbitopathy (TAO). In 17 patients (20 eyes) with restrictive strabismus and diplopia, BTX-A injections were applied. Intraocular pressure was measured with a Goldmann applanation tonometer in primary gaze position before and 2-4 weeks after BTX-A injection. Extraorbital prominention of the eyeball was measured before and after BTX-A injection using a Hertel instrument. Before the injection, the mean IOP in primary position of gaze was 18.6 +/- 2.8 mmHg and 2-4 weeks after BTX-A injection was 16.9 +/- 3.3 mmH; (p = 0.001). There was no statistically significant difference in Hertel egzophthalmometer readings before and after BTX-A injection, 21.5 +/- 2.7 mm vs. 22.0 +/- 2.6 mm; (p = 0.678). In conclusion, BTX-A injection has a secondary lowering effect on IOP in TAO due to relaxation of extraocular muscles, but with no influence on proptosis.

[Screening for Down syndrome using triple marker testing in the second trimester of pregnancy]. / Probir Downova sindroma trostrukim testom u drugom tromjesecju trudnoce.

The aim of this study was to check the validity of the biochemical screening of pregnancies with Down's syndrome during the second trimester of pregnancy, in order to reduce the incidence of invasive diagnostic procedures. We used the optimal balance between sensitivity and specificity to determine the "cut off" values to estimate the results of the biochemical screening. Between January 1995 and December 2000, 2000 pregnancies were checked by double (determining hCG and AFP serum levels) and triple test, (determining hCG, AFP and uE3 serum levels). Competitive radioimmunochemical procedures (2nd trimester Amerlax-M, Ortho Clinical Diagnostics, USA) were used. The risk of Down's syndrome was calculated by Prenata program (Ortho Clinical Diagnostics, USA). The "cut off" median MoM values in pregnancies with Down's syndrome were 0.73 (AFP); 2.02 (hCG) and 0.74 (nE3). The calculated risk was compared with possibility 1:300 to estimate the results of biochemical screening. Our results were checked in the cytogenetic laboratory where samples of amniotic fluid, that we also took, were sent. We observed lower AFP levels (0.96 +/- 0.09 MoM), uE3 levels (0.65 +/- 0.1 MoM) and higher levels of hCG (1.57 +/- 0.27 MoM) in pregnancies with Down's syndrome, in comparison with euploid pregnancies of the corresponding gestational age. With 1:200 risk, the sensitivity of triple test is 80%, with acceptable number of false-positive results. This cut-off value showed to be acceptable for separating positive from negative results. Invasive procedures should be performed in pregnancies with positive screening result, with the aim of getting the tissue sample of the fetus for further cytogenetic analysis.

Second trimester total human chorionic gonadotropin, alpha-fetoprotein and unconjugated estriol in predicting pregnancy complications other than fetal aneuploidy.

OBJECTIVE: To assess the value of alpha-fetoprotein (AFP), total human chorionic gonadotropin (ThCG) and unconjugated estriol in predicting certain complications of pregnancy other than fetal aneuploidy. STUDY DESIGN: Among 2384 women that underwent biochemical screening between 15 and 22 weeks of gestation, pregnancy outcome was evaluated in 677 women under 35 years of age according to serum marker levels by using cut-off points discriminative for Down syndrome or neural tube defect (NTD). RESULTS: High alpha-fetoprotein levels (MoM>/=2.0) were found to be significantly more frequent (P<0.05) in cases of fetal growth restriction (odds ratio=2.7), miscarriage (odds ratio=4.4) and intrauterine fetal death (odds ratio=5.8). High chorionic gonadotropin levels (MoM>/=2.02) were associated with intrauterine growth restriction (odds ratio=2.1; P<0.05), miscarriage (odds ratio=4; P<0.01), preterm birth (odds ratio=2.5; P<0.05), and intrauterine fetal death (odds ratio=4.2; P<0.01). Among pregnancies with intrauterine growth restriction and threatening preterm delivery, low unconjugated estriol levels (MoM