The connection between endourological procedures and occurrence of urinary infections.

INTRODUCTION: Endoscopic surgery and endourological procedures imply the use of special instruments that are introduced into the urinary system through the urethra and percutaneous techniques that allow ante grade access to the urinary tract. The risk of urinary tract infection after endourological procedures and the use of antibiotic prophylaxis for these procedures is a question about which there is no unique opinion. GOAL: The objective of this study was to determine the connection between endourological procedures and occurrence of urinary infections and to analyze the risk factors of urinary infection for patients who were hospitalized at the Urology Clinic of the Clinical Center University of Sarajevo (CCUS). MATERIAL AND METHODS: The research was conducted as a prospective study on a sample of 208 patients of both genders, who were hospitalized at the Urology Clinic of the CCUS and to whom one of endourological procedures was indicated either for diagnostic or therapeutic purposes. All patients were clinically examined prior to endoscopic procedures and after the treatment attention was focused on the symptoms of urinary tract infections. RESULTS: Analysis of the presence of postoperative bacteriuria shows that it has been more common in men or in 48 cases (28.1%) compared to women with 8 cases (21.6%) (p>0.05). Preoperative catheterization was statistically significantly more present in patients who have had a postoperative bacteriuria (16 or 28.6%) compared to those without bacteriuria (8 or 5.3%) (p<0.05). Analysis of the average duration of postoperative catheterization shows that patients with postoperative bacteriuria had longer duration of postoperative cauterization of 1.97±0.14 days (range 1-20 days) compared to those without postoperative bacteriuria with 1.4±0.4 days (range 0-5 days) and with a statistically significant difference (p<0.05). Antibiotic prophylaxis in relation to the occurrence of postoperative bacteriuria did not show a statistically significant difference (p> 0.05). Analysis of the correlation coefficient indicates that a statistically significant effect on the occurrence of postoperative bacteriuria have preoperative bacteriuria, duration of postoperative catheterization and duration of hospital stay, as well as the total duration of hospitalization before and after endourological treatment (p<0.05). CONCLUSION: It is important to emphasize that the endourological procedures are safe procedures in terms of urinary tract infections. This study should lay pathway to establishment of guidelines for the application of antibiotic prophylaxis in endourological procedures. This would standardize the perioperative use of antibiotics, taking into account the local prevalence of pathogens and antibiotic resistance, but keeping the individual approach to each patient, considering all risk factors for the development of urinary infection after endourological procedures..

Antimicrobial susceptibility of bacteria isolated from inpatients and outpatients urine samples.

Antibacterial resistance is generally regarded as a public health problem, not only in local terms, but also worldwide. The objective of this research work would be to analyze inpatient's and outpatient's antimicrobial resistance to a set of various agents. The patients have been medically treated in the region of Ze-do canton since 2005 until today. Total number of 164 patients was included in our research. Regarding the place of medical treatment, our patients were divided into two groups: a total number of 111 inpatients and a total number of 53 outpatients. 56 of them were males, rest females. Apart from the sex affiliation, the exeminees were divided into two groups, depending on the presence of the Foley's catheter (inpatients only). We were obliged to determine the antimicrobial sensitivity of the isolated bacteria to certain representatives of antimicrobials. During the conducted testing, it has been proved that the phenomenon of polymicrobic infection found while testing inpatients is in immediate correlation to the catheterization. The inpatients urine tract infections are duo to the most commonest agent--E. coli that is in terms of percentage 38.5%, followed closely by Proteus spp.--19.3%, Pseudomonas spp.--13.6%, Klebsiella pneumoniae, 12.5%, et cetera. The outpatients urine tract infections are due to the most common agent E. coli percentage is 81%, as well as to Klebsiella pneumoniae, 19.0%. During the testing of the antimicrobial sensitivity of the isolated bacteria, it has been determined that the urine tract infection agents (starting with E. coli and Klebsiella pneumoniae) isolated from the inpatients urine specimens are proved to have higher resistance to tested antimicrobials compared to the same agents isolated from the outpatient's urine specimens. The differences refferring to resistance rates are ranging from 0.2% (trimetoprim-sulphametoksazol) to 25.9% (cephazolin) for E. coli, since the difference refferring resistance to Klebsiella pneumoniae is more noticeable and ranging from 0.8% (amoxicillin- clavulonic acid) to 65.0% (gentamicin).

Genetic characterisation of rabies virus isolates in Bosnia and Herzegovina.

Serotyping of five rabies virus isolates with monoclonal anti-nucleoprotein antibodies for classical rabies virus and rabies-related viruses and phylogenetic relationships among sequences indicate that viruses circulating in population of animals in Bosnia and Herzegovina belong to the sero-genotype 1 of classical rabies virus. Phylogenetic relationships among sequences of our viruses have shown the presence of two phylogenetic lines, one which is present in the northwestern part and other which is present in the northeastern part of the country. Our viruses are closely related to Westeuropean isolates of rabies virus.

[Epidemiological variation of Q-fever in Zenica Doboj Canton during period 2000-2005]. / Epidemioloske varijacije Q groznice u Ze-Do Kantonu u periodu od 2000. do 2005. godine.

After the war in Bosnia and Herzegovina there is a sudden increase in number of infected with the Q-fever, which becomes huge public health and economic problem. Although this disease occurred in very different geographic areas of Bosnia and Herzegovina the Zenica-Doboj Canton was among the most affected. Infections of Q-fever at the Zenica-Doboj Canton represent very complex epidemiology problem, because it is in highest incidence rates not only for Bosnia and Herzegovina, but also for Europe. The total number of population affected by Q-fever in Zenica-Doboj Canton since the beginning of 1998 until the end of 2005 was 193, with the average morbidity rate of 48.30 %000. In Zenica-Doboj canton affected by Q-fever was the inhabitants of both genders, all ages and on wide territory, which in majority of cases did not have the contact with domestic animals. Incubation period varies from 14 to 27 days. Actual incidence rate due to asymptomatic occurrence of this disease is for sure higher. Researches of spreading manner for the Q-fever among humans showed that this disease can be spread in epidemic and sporadic manner in Zenica-Doboj Canton, and that there are many risk factors which influence its occurrence.

Epidemiology of the viral hepatitis A at the Zenica municipality ara in period from 1987 until 2003.

Viral hepatitis A is an endemic disease with periodic epidemics, or sporadic cases within endemic areas. It is present in a majority of world countries, more often in undeveloped ones. In our country it occurs occasionally, so it still cannot be considered as solved problem. This is because Bosnia and Herzegovina until 1990 was in the group of countries with the largest hepatitis A morbidity in Europe, and municipality Zenica within B&H with the largest morbidity in the period from 1987 until 1996. By studying the occurrence of the viral hepatitis A according to age groups, we can notice that the largest number of patients is at the age between 7 and 18 years (school children and youth) with 68.86% of baseline, than follows patients up to 6 years of age with 15.34%. In analysis of occurrence season, it is noticed that disease have a season features with the peak occurrence during November and December. Regarding the area of living, it is noticed that the disease occurs significantly less frequently among urban than rural and suburban population (78%). Among total number of patients within the period of epidemic we have registered 82.0% of patients, and only 18.0% was occasional cases. In majority of cases virus spreads by contact, which is the consequence of poor hygiene and sanitation that was, or still are present in the rural areas, because of inadequate infrastructure and lack of sufficient quantity of clean drinking water, or to say low level of health knowledge among rural population.

[Role of rotavirus non-structural protein 4 in causing of acute gastroenteritis]. / Uloga nestrukturnog rotavirusnog proteina 4 u uzrokovanju akutnog gastroenteritisa.

Rotaviruses belong to the family Reoviridae, genus Rotavirus with several types that are important for human and animal medicine. Rotavirus genome is consisted of 11 segments of double-stranded RNA, which code the synthesis of structural (VP) and non-structural proteins (NSP). The virus genome is enclosed in the three-layer capsid. Protein of the middle layer (VP6) is responsible for group specificity, and two proteins of the external capsid layer (VP7 and VP4) are responsible for belonging of rotaviruses group A to different sero/genotypes, in further text G and P. These two important antigen proteins stimulate an organism to produce specific neutralizing antibodies. Today, there are overall 15 G and 23 P serotypes of rotaviruses known and discovered so far. It infects humans, with 10 G and 11 P serotypes of rotaviruses discovered, with the most frequent presence of group A of serotypes G1 to G4, and serotypes P4 and P8, respectively. The most frequently found serotype among them is G1. According to recent reports, rotaviruses are still one of the most important causes of acute gastroenteritis in the population of young children, with endemic distribution in all geographic regions. Annually, around 50,000 of rotavirus-infected individuals are hospitalized in USA and around 80,000 in Europe. Compared to other pathogens, rotaviruses are present in causing of acute diarrheas in children in 30-40 % of cases. In children younger than 5, around 136 millions of gastroenteritis cases with rotavirus etiology are registered annually. Out of this number, 111 millions are treated at homes, 25 millions ask for medical consultations, 2 millions are hospitalized, and around 440,000 die.

Brucella melitensis: review of the human infection case.

During the last several years, brucellosis has become an important public-health problem on a large territory part of Bosnia and Herzegovina. The disease belongs to the zoonosis group, and can be caused by several bacterium species from Brucella genus. For human and veterinarian medicine, B. abortus, B. melitensis, B. suis and B. canis from Brucella genus are important, while other brucella species are found only in animals. The results of laboratory process of isolating Brucella melitensis, as well as of detection of specific antibacterial antibodies, are presented in this work. Namely, B. melitensis was isolated from blood samples (chemo-culture), as a causal agent of disease in one sixty years-old patient, treated during 2001. In pair serum samples of the patient, the presence of specific anti-brucella antibodies was confirmed qualitatively and quantitatively. In the serum I, ELISA test confirmed the presence of specific IgM antibodies of 25,7 U/ml, and IgG antibodies of 252 U/ml. In the serum II, IgM antibodies of 24,9 U/ml, and IgG antibodies of 311 U/ml were found. These results suggest and confirm established work diagnosis, and etiology causality of the disease with isolated bacterium.

Eradication of typhus exanthematicus in Bosnia and Herzegovina.

Typhus exanthematicus in Bosnia and Herzegovina held in endemic areas from which especially quickly began spread after 1945. That year, in 1945, one hundred epidemics of typhus fever appeared, with the highest incidence rate in Europe of 215.04 per 1,000. Directions of unique program in the world were to eradicate lice of the body, but also establish monitoring of the recidivism, Brill-Zinsser disease. Since 1971, typhus exanthematicus (classical typhus) hasn't appeared in Bosnia and Herzegovina, so epidemic typhus can considered as an eradicated communicable disease.

[Agglutination as screening test in routine diagnostic of listeriosis]. / Aglutinacija kao skrining test u rutinskoj dijagnostici Listerioze.

INTRODUCTION: The persons with weakened immunity, newborn infants and pregnant women are very much sensitive on infection with bacteria Listeria monocytogenes. Listeria can readily invade the placenta and precipitate premature labor and fetal death. To confirm diagnosis is very difficult because listeriosis is disease very similar to the others acute diseases. Serum threshold values above 1: 320 confirm think about listeriosis when the relevant clinical symptoms are present. Of greater diagnostic relevance is the detection of a rise in titer. Therefore, it is always desirable to test a second sample (collected 2 to 3 weeks later) together with the first sample (stored in the deep-freeze). AIM: The aim of the study is to confirm the advance agglutination as a screening test in routine diagnostic Listeriae monocytogenes. MATERIAL AND METHODS: In testing were included 60 women in the reproductive age to divide in experimental group and control group. By agglutination serologic methods we researched if there is any antibody on Listeria monocytogenes with Listeria antigen. RESULTS AND DISCUSSION: From a total of 60 patients positive samples were 18 (60.00%) in experimental group (30) and 8 (26.70%) in control group (30). CONCLUSION: due to simple way of performing screening test of agglutination the same one are giving adequate antibiotic therapy in a case of positive serological response.

Serotesting of human brucellosis on wider area of Bosnia and Herzegovina.

The study involved 286 individuals from different regions of Bosnia and Herzegovina, whose sera were tested in the Laboratory for specific diagnosis of human brucellosis in Microbiology Department of Medical Faculty of University in Sarajevo, during the period from 2000. to 2003. Sera were tested using Brucelloslide Test, qualitative agglutination test Rose Bengal. Using the agglutination test, we serologically confirmed a diagnosis of human brucellosis in 59 (20.62%) seropositive individuals, whereof 38 (64.40%) men and 21 (35.60%) women. Individuals with human brucellosis were the most present in the age group of 31-40 (22.03%) and 41-50 (22.03%). One serologically confirmed death case was registered. The most seropositive individuals were from Zenica-Doboj Canton (32.20%), Sarajevo Canton (28.82%), Herzegovina-Neretva Canton (23.73%), Central Bosnia Canton (13.55%) and Una-Sana Canton (1.70%). During our four-year study, it was serologically confirmed that human brucellosis is present in Bosnia and Herzegovina and, through seropositive testing, we revealed the level of general exposition to Brucella spp. on wider area of Bosnia and Herzegovina.

Listeria monocytogenes as the possible cause of the spontanous abortion in female of the fertile age.

Listeria monocytogenes is a Gram-positive, weakly pathogenic bacterium able to grow also at the temperature of 40 degrees C. A man most often gets affected by consuming contaminated food and water. Animals can carry bacteria although they have not to appear ill, then their meat and milk products are the source of infection of human being. The disease most often attacks with the weak immune system, newborns and pregnant women. That what is significant, listeria penetrates through the placenta and can lead to the fatal infection, which is characteristic by disseminated granulomatosis lesions of a newborn and micro abscess on the placenta. In a newborn can provoke the sepsis with the mortality of 50%. By the examination are encircled two groups of the reproductive age-totally 60. From these 30 had one or more spontaneous abortion, and 30 had no spontaneous abortion. By the serologic reaction the agglutination is discovered the presence of the antibodies in serum of the. The positive serologic answer was found in the first group in 18 (60%) and in that another group in 8 participants (26, 70%).

[Viruses in water]. / Virusi u vodi.

The article elaborates the significance of water, which is necessary for the maintenance of an organism and specifies its daily needs in human beings. Reference data on the early isolations of viruses from sewage water and modern understanding on the occurring virus species are listed. The article considers virus survival in sewage and flowing water and other fresh and marine water systems as well as marine silt or fruit. Finally, we give here an overview of basic features of individual virus kinds that are potential water contaminants.

[Listeria monocytogenes in women of reproductive age]. / Zastupljenost Listerie monocytogenes kod zena fertilne dobi.

OBJECTIVE: Listeria monocytogenes (LM) is gram-positive bacteria linear shaped which grows good also at refrigerator temperature (4 degrees C). The bacteria is resistant on high and low temperatures. This bacteria can be found in the dirt, rotted vegetation, vegetables and fruit, milk and dairy products, and also in the meat and processed meat. This bacteria cause disease called Listeriosis. This bacteria attacks at first people with weak immune system like infants, pregnant women, people with chronic diseases, people with HIV and people who are 60 and over. Pregnant women can transfer Listeria through the placenta, from mother to child and that can cause premature delivery, premature birth, early rupture of placenta or still born. GOAL: Find out if there is serological respond by female patients in the reproductive age who had spontaneous abortion and female patients in the reproductive age who never had the spontaneous abortion. By agglutination serologic method it had been researched if there is any antibody on Listeria monocytogenes. RESULTS: Two groups were included in testing: experimental and control group with a total of 60 patients. In experimental group there were 18 (60%) positive samples. In control group there were 8 (26.70%) positive samples. CONCLUSION: The results investigations have shown that there is serological respond to Listeria monocytogenes in the women of reproductive age. The number of positive patients was greater in women who had spontaneous abortion compared to women who never had the spontaneous abortion.

[Enfuvirtide, mechanism of action and pharmacological properties]. / Enfuvirtid, mehanizam djelovanja i farmakoloske osobine.

Enfuvirtide is a new class of antiviral drug, fusion inhibitors, which interferate with penetration of HIV-1 in the cells. Enfuvirtide exhibits potent and selective inhibition of membrane of viral and cells. It specifically inhibits the function of the gp41 transmembrane glycoprotein of HIV-1. Enfurvitide showed significantly efficacy in the combination with other antiviral drugs in early stadium of HIV infection and in patients with antiretroviral resistention. Local injection site reactions are the most common adverse events associated with enfurvitide. However, the need for subcutaneous application of enfurvitide is a distinct disadvantage, especially in patients who are already burdened by complex oral therapy.

[Epidemiological investigations transmisssion of Q fever among humans in Bosnia and Herzegovina]. / Epidemioloska istrazivanja prenosenja Q groznice kod ljudi u Bosni i Hercegovini.

Appearance of an acute disease by Coxiella burnetii in humans in Bosnia and Herzegovina is very big epidemiological problem because incidence rate is among the highest incidence rates in Europe. Incidence rate of Q fever in Federation Bosnia and Herzegovina was very high during 1998. year 5.68% and the highest in 2000, with 115 diseases with acute clinical form of the disease and incidence rate of 6.95%. The incubation period varied from 9 to 28 days. Real incidence rate because of asymptomatic appearance of the disease is very much higher, at least 40-50 times higher. Chronic infection with Coxiella burnetii has been the most common developed as infectious endocarditis, which is the hardest complication. The researches of mode of transmission Q fever in humans showed that this disease spreads in epidemic and sporadic form in Bosnia and Herzegovina. In the period 1998-2003 year, there were 373 cases of Q fever, among them 265 or 71,05% cases epidemic transmission, and 108 or 28,95% cases sporadic. The research of outbreaks of Q fever showed that appearance of Q fever is statistical significant with risk factors at 266 cases of disease. The mode of transmission in 107 cases was the most probably across inhalation of infected aerosols.

Causal factors of acute gastroenteritis in infants and young children.

Respiratory, gastrointestinal and skin diseases represent the most common diseases in infants and young children. Causal factors of these diseases are important infectious agents and causes of pathological conditions in children, but they are also very important for their parents, as well as for people in their close environment. Greater incidence of infections in infants and young children can be explained in different ways. A cause can be insufficient maturity of their immune system, but also their exposure to infections within collective accommodations (cribs, nurseries, pre-school institutions), where they are, at the same time, exposed to a number of unknown agents. Today, a great emphasis is devoted to the ways and kinds of children's nutrition. The problem of relation between infected young organism and infectious agent itself, is also reflected in a long resistance and excretion of microorganisms in their exterior environment. It is well-known that microorganisms resist and excrete much longer in younger organisms, compared to adults, where their resistance and excretion is much shorter or very rare. Actually, adults have already formed protective immunity against particular infectious agents. It doesn't prevent infections in adults, colonization of pathogens, nor eventual development of disease. Established immunity can shorten the time necessary for excretion of microorganisms in their exterior environment and, if disease gets developed, it is of shorter duration and slower progress.

[Electron microscopy study and clinical characteristics of rotavirus disease]. / Elektronskomikroskopsko ispitivanje i klinicke karakteristike rotavirusne bolesti.

In this paper it is been described method of electronic microscopy applied for discovering characteristic morphology of rotaviruses in samples of stools of infected and hospitalized patients. To have electronic microscopy as standard method it is necessary to know morphology or structure of the researched microorganism. In the second part of the paper we have made clinical epidemiological analysis of the rotavirus infection on the examined samples, and made comparison with result of other researches. Out of 78 patients with diarrhea, in 15 or 19.2% have been proofed presents of rotaviruses in the stool samples. All hospitalized patients had diarrhea (100%), vomiting was present in 90.9%, high temperature to 39C in 63.6% and over 39C in 36.4% patients. Stomachache was registered in 36.3% and blood in stool has not been found. Majority of the hospitalized had some respiratory syndromes. Time of hospitalization was between 6 to 13 days with average of 9.5 days. Death of hospitalized was not registered.

[Prevention strategy of viral hepatitis B and C]. / Strategija prevencije virusnih hepatitisa B i C.

Infections by Hepatitis B and Hepatitis C viruses, as well as infections caused by microorganisms transmitted through blood, blood products or in any other way, are now reality for all medical workers. This danger is stilll becoming increased for those medial workers who are more exposed in their everyday work to contaminated human blood or other biological materials. Therefore, the health institutions must introduce prevention measures against possible infection, but also the protection procedures to be applied immediately before and after incidental exposition to infectious material. They are especially essential at the occasion of incidental injuries of the persons by medical instruments which had been in the contact with blood. That is why it is obligatory for the employees of the health care institutions to be vaccinated against possible infection by Hepatitis B.

Clinical characteristics of rotaviruses disease.

Rotaviruses are the major causes of viral gastroenteritis in infant and the young children. There are a wide spectrum of clinical signs and symptoms of rotavirosis. Rotavirus infection is fecal-oral infection. Rotaviruses prove with Latex agglutination test and electron microscopy. In a four year period 943 stool samples out of 527 hospitalized patients had been analyzed. A presence of rotavirus is proved with a LA and EM tests at 170 (32,2%) patients age 0-7 years, in their stool samples. Analyzing age groups of these patients, it was found that the rotaviruses infection the most frequently occurred at age group from 7-24 months. From 170 positive patients, 122 or 71,8% were in this age group. At all patients was found diarrhea, vomiting in a 90,5% cases. Mild fever had 65,5% patients, signs of a respiratory infection appeared at 60,7% patients, abdominal pain at 13,3% patients. Severe dehydration had 49,9% patients and metabolic acidosis had 79,2% cases. Macroscopically blood in stool had 6,4% patients, slime in a stool 46,0% patients was found, and aholic stool had 8,4% patients. In all hospitalized patients disease lasted in average 12,6 days, and the hospitalization in average 10,2 days. None of the patient had any kind of complication, all of them very successfully cured. These results confirm that rotaviruses are important health problem among infant and the young children in Bosnia and Herzegovina.

[Serologic diagnosis of hemorrhagic fever with renal syndrome in Bosnia and Herzegovina in 2002]. / Seroloska dijagnostika hemoragijske vrucice s bubreznim sindromom u Bosni i Hercegovini 2002. godine.

AIM: Results of the serologic confirmation of hemorrhagic fever with renal syndrome (HFRS) in patients with clinical picture and overt symptoms of the disease from particular areas in Bosnia and Herzegovina during 2002 are presented. METHODS: A total of 146 sera from 100 clinically suspected patients were tested. The sera were tested for the presence of specific IgM antibodies to Hantaan and Puumala antigens by Elisa IgM "capture" test, and for the presence of specific antibodies to Hantaan, Puumala and Dobrava antigens by Elisa IgG test. DISCUSSION: Most of the positive IgM reactions were recorded as cross reactions to Hantaan and Puumala antigens, and most of the positive IgG reactions as cross reactions to Hantaan and Dobrava antigens. The finding of antibodies in the sera of patients from Europe that react with Hantaan antigen are not associated with the infection with Hantaan, but with the infection with viruses that are genetically related with Hantaan. To date, HFRS caused by Puumala and Dobrava viruses has been verified in Bosnia and Herzegovina. CONCLUSION: Using Elisa IgM "capture" test, acute hantavirus infection was serologically confirmed in 38% of clinically suspected patients with manifested symptoms from different areas of Bosnia and Herzegovina in 2002. The distribution of human hantavirus infection in Bosnia and Herzegovina was confirmed by the presence of specific hantavirus antibodies in patient sera.