Two trichinellosis outbreaks in Serbia - challenging diagnosis due to a potential co-infection with Toxocara spp.

In Serbia, in most cases, small family outbreaks of trichinellosis occur due to the consumption of untested infected meat from domestic pigs that are raised and slaughtered in the backyards of small individual farms. The aim of this study is to present data regarding 24 patients involved in two outbreaks that occurred in two neighbouring districts in Serbia during a closely related period of time in August 2014. The source of infection in the first outbreak was undercooked pork, while raw pork sausages caused the second outbreak. Meat samples and sausages were Trichinella spp. positive by artificial digestion. With the aim to obtain a second opinion and validate the serological findings discovered at the Public Health Institute Nis, all samples were sent to the National Reference Laboratory for Trichinellosis, INEP. Serodiagnosis showed that 21 persons were positive (87.5%) and three (12.5%) were negative for anti-Trichinella antibodies, while 15 patients fulfilled the trichinellosis case definition. Western blot analysis (using an epitope unique for the muscle larvae stage of the Trichinella genus) confirmed the diagnosis of trichinellosis in five patients. Six patients also had specific antibodies against Toxocara canis (T. canis). Due to the fact that in endemic foci in Serbia there is the presence of Trichinella spiralis and T. canis and that these two infections could be asymptomatic, we consider that trichinellosis cases were irrefutably proven. The dilemma about the existence of co-infection with T. canis remained open due to the lack of clinical findings.

Human Encounter with a Horsehair Worm (Nematomorpha): Is There a Reason To Worry?

We report here a specimen of the horsehair worm (Gordiida, Nematomorpha) Spinochordodes bacescui (Capuse, 1965) found in a patient´s urine. This is the first record of this species from Serbia and the sixth gordiid species known in Serbia. It is discussed that there is no evidence that gordiids are parasites of humans. Instead, gordiids parasitize terrestrial insects, which release their mature gordiid parasite into water and may thereby also use containers in human surroundings. Pseudoparasites, such as Spinochordodes bacescui, do not pose a threat to human health nor are they a serious public health issue.

Soil and Sand Contamination with Canine Intestinal Parasite Eggs as a Risk Factor for Human Health in Public Parks in Nis (Serbia).

Regarding geographical distribution and clinical relevance, the most common canine geohelminths are Toxocara canis, ancylostomatids, and Trichuris vulpis. Canine intestinal parasites from the soil and sand present an important potential serious human health hazard, especially for the children preschool and school - age. This paper aimed to establish the degree of contamination of soil and sand with zoonotic parasites from the canine feces and the degree of risk they could pose for human health in public places and playgrounds in the city of Nis. Our parasitological study involved 200 soil samples and 50 sand samples from the public parks in the city of Nis in southeastern Serbia (43°19'15″N, 21°53'45″ E). From several locations, about 100 g of soil and sand was collected based on the bioclimatic indices. Parasitological diagnosis was performed using conventional qualitative and quantitative coprological methods, abiding by the recommendations about the diagnosis of parasitic diseases. In 38 - 46 % of soil samples and 40 % of sand samples seven species of endoparasites were diagnosed. In the samples of soil, a medium and high degree of contamination with the ascarid T. canis (14 - 22 %) was detected, as well as a low and medium degree of contamination with ancylostomatids (4 - 12 %), and in the samples of sand, a variable degree of contamination with the helminths T. canis (26 %) and A. alata (16 %) was found. A statistically significant difference was found in the contamination with A. alata eggs between the samples of sand and samples of soil. The studied public surfaces represent the reservoir of zoonotic parasites, which is a public health problem requiring a synergistic action of several factors to be successfully resolved, i.e. the implementation of prevention, surveillance, and control measures.

A competitive enzyme-linked immunosorbent assay for rapid detection of antibodies against Trichinella spiralis and T. britovi - one test for humans and swine.

Infection with parasites from the Trichinella genus occurs in many vertebrates but disease only occurs in humans (trichinellosis). Humans are infected after the consumption of raw or undercooked meat from infected wild or domestic animals (usually swine or horses). Using the monoclonal antibody (mAb) 7C2C5, specific for an epitope unique to the muscle larvae of the genus Trichinella, we have developed a competitive enzyme-linked immunosorbent assay (c-ELISA) that enables the rapid detection of Trichinella-specific antibodies in sera originating from two different host species (human, swine) infected with either Trichinella spiralis or Trichinella britovi. This novel c-ELISA exhibited 100% specificity and sensitivity, as confirmed by a Western blot test. The assay is easy to use (one incubation step), and the time required for the procedure (45 min) is shorter than in any other ELISA format. This test could be useful for both the detection and surveillance of Trichinella infections.

Comparison of short-term and medium-term swimming training on cardiodynamics and coronary flow in high salt-induced hypertensive and normotensive rats.

The aim of present study was to evaluate the effects of 3- and 6-week swimming exercise on cardiodynamics and coronary flow in high salt-induced hypertensive and normotensive rats. 80 male Wistar albino rats (6 weeks old) were divided into 8 groups: hypertensive animals that swam for 3 weeks; hypertensive animals that swam for 6 weeks and their respective sedentary controls; normotensive animals that swam for 3 weeks; normotensive animals that swam for 6 weeks and their respective sedentary controls. Hypertensive animals were on high sodium (8% NaCl solution) diet for 4 weeks, and these animals did not drink tap water during the experimental protocol. After sacrificing, hearts were isolated and perfused according to Langendorff technique at gradually increased coronary perfusion pressure (40-120 cmH2O). The following parameters of cardiac function were continuously recorded: maximum and minimum rate of pressure development in LV, systolic, and diastolic left ventricular pressure, and heart rate. Coronary flow was measured flowmetrically. Findings of the present study may help in better understanding of short- to medium-term exercise-induced direct effects on cardiac function and perfusion. Generally viewed, swimming of both durations did not change myocardial function and perfusion in hypertensive and normotensive conditions.

Subcutaneous dirofilariosis in South-East Serbia--case report.

Human dirofilariosis is a relatively rare infection caused by filarial worms of the genus Dirofilaria. We herein report the first case of human subcutaneous dirofilariosis in the southeastern part of Serbia. A complete alive nematode was removed from a nodule in the periorbital region of a 50-year-old woman. The nematode was morphologically identified as a D. repens-like immature female. The diagnosis was confirmed with molecular methods. The patient was probably infected in the South-East Serbia as she had not travelled abroad, nor in other parts of Serbia such as Vojvodina, recently identified as a hyperendemic area for D. repens infection of dogs.

Treatment of visceral artery aneurysms: retrospective study of 35 cases.

BACKGROUND: Visceral artery aneurysms (VAA) represent a rare clinical entity with possible life-threatening complications. The presentation, diagnosis and management vary accordingly to the artery involved and the underlying pathology. PATIENTS AND METHODS: During a 25-year period (1980-2005), 35 patients (25 males + 10 females, age range 36-73 years-median 59.2 years) with VAA were treated at two tertiary vascular surgery centers in Belgrade. All data were retrospectively collected from the patient's records. RESULTS: On presentation, 19/35 patients were symptomatic, and 3/35 had ruptured VAA. Surgery was performed in 28 cases; most commonly involved arteries were splenic (11), hepatic (5), celiac trunk (5), superior mesenteric (3), inferior mesenteric (3) and gastroduodenal (1). Fatal rupture occurred in two patients. In 5 patients abdominal aortic aneurysm was associated with VAA, and in 4 patients multiple aneurysms of the involved artery were noted. Successful embolization was performed in 3 patients. Overall, four patients were treated medically. In the surgically treated patients, perioperative mortality and morbidity were 11% (3/28) and 40% (10/25) respectively. Of 25 patients included in the long-term follow up, six died. CONCLUSION: Since VAA have considerable tendency to rupture, an active approach is necessary. Based on our experience, surgical treatment could be recommended for any VAA patient with symptoms. In addition, we believe that the choice of the therapeutic procedure should be made on an individual basis.

Head-to-head comparison of indices of left ventricular contractile reserve assessed by high-dose dobutamine stress echocardiography in idiopathic dilated cardiomyopathy: five-year follow up.

OBJECTIVE: To compare head to head the indices of left ventricular contractile reserve assessed by high-dose dobutamine in the five-year prognosis of patients with idiopathic dilated cardiomyopathy. DESIGN AND SETTING: Prospective study in a tertiary care centre. PATIENTS: 63 consecutive patients with idiopathic dilated cardiomyopathy. INTERVENTIONS: High-dose dobutamine stress echocardiography was performed in progressive stages lasting 5 min each. Wall motion score index, ejection fraction, cardiac power output and end systolic pressure to volume ratio were evaluated as indices of left ventricular contractility. MAIN OUTCOME MEASURE: Five-year cardiac mortality. RESULTS: During the follow up of 59 patients, 27 (45.8%) died of cardiac causes. According to Kaplan-Meier and receiver operating characteristic analyses all indices of contractile reserve differentiated patients with respect to cardiac death. Wall motion score index achieved the best separation (log rank 21.75, p < 0.0001, area under the curve 0.84), followed by change in ejection fraction (log rank 11.25, p = 0.0008, area under the curve 0.79), end systolic pressure to volume ratio (log rank 14.32, p = 0.0002, area under the curve 0.75) and cardiac power output (log rank 9.84, p = 0.0017, area under the curve 0.71). Cox's regression model identified wall motion score index as the only independent predictor of cardiac death. CONCLUSIONS: These data show that all examined indices of left ventricular contractile reserve are predictive of five-year prognosis, but change in wall motion score index may have the greatest prognostic potential.

[The effect of gender on vasomotor function of the vascular endothelium and cardiovascular remodelling during aging]. / Uticaj pola na vazomotornu funkciju endotela krvnih sudova i kardiovaskularno remodelovanje tokom starenja.

INTRODUCTION: Aging is correlated with decreased endothelial vasomotor influence, increased carotid intima-media thickness and stiffness, increased left ventricular mass index and increased blood pressure [1-3]. However, these changes are not expressed in the same way in both genders [4, 5]. It seems that females are more protected from cardiovascular changes during aging compared to males [1, 6]. AIM OF THE STUDY: The aim of the study was to evaluate the influence of gender on brachial vasomotor responses (reactive hyperemia test) as well as the correlation with vascular and cardiac remodelling in healthy volunteers of different ages. MATERIAL AND METHODS: The study was carried out on healthy subjects (n = 66; 37 males, 29 females) of different ages (20-82 years) with no history of cardiovascular diseases and diabetes mellitus. All subjects were normotensive, non-smokers with normal blood lipid and glucose values, were not taking any medication at the time of investigation and were asked to refrain from eating and drinking alcohol, coffee or tea 12 hours before the examination. Subjects were divided in two groups (male and female) and 5 age-related groups according to appropriate decade (20-29, 30-39, 40-49, 50-59, and above 60 years). All subjects underwent regular cardiologic examination, ECG recording and cardiac ultrasound in order to exclude valvular diseases, decreased myocardial contractility and ejection fraction. During the study blood pressure and ECG were recorded continuously. Carotid artery intima-media thickness and brachial artery diastolic internal diameter (mm) and blood flow (ml/min) values were measured continuously using high-resolution ultrasound. Brachial artery parameters were measured in baseline condition, during ischaemia and reactive hyperemia (endothelium-dependent relaxation) and after nitroglycerin administration (endothelium independent relaxation, 2 x 400 micrograms, sublingual) [7, 8]. Brachial ischaemia was induced by inflation of a pneumatic tourniquet placed at the forearm to a pressure of 300 mmHg followed by deflation after 3 min. We analyzed changes in peripheral arteries (changes in brachial artery diastolic diameter and flow during 90 sec after cuff deflation), structural changes of carotid artery, functional and structural changes of the left ventricle (19-11). We used cardiac ultrasound (Hewlett Packard Sonos 2500) with a 2.0-2.5 MHz imaging transducer and a 7.0-MHz linear array transducer for vascular measurements. Demographic and clinical characteristics of subjects are presented in Table 1. All results are expressed as mean and S.E.M. Data analysis was done by linear regression analyses, multivariate test (LSD procedure) and Student's T-test. P values less than 0.05 were considered to be significant. RESULTS: Relative changes in brachial artery diastolic diameter in reactive hyperemia in comparison to aging (with gender distribution) are shown in Graphs 1 and 2. Our study showed decrease in brachial vasodilator response to reactive hyperemia during aging (male p < 0.05, female p < 0.001). Data analysis showed a significant difference between age-related groups above 40 years and groups below 30 years of age (p < 0.001). The analysis of carotid intima-media thickness showed increased values during aging in both genders but without statistical significance (Graph 2). Analysis of relationship between carotid intima-media thickness and aging (by gender) showed a good correlation of these parameters expressed by the following formula: intima-media thickness (cm) = 0.0009 x years of age + 0.0139. ANOVA test for age-related groups showed significant correlation (p < 0.01) between all age-related groups except 30-40 vs. 40-50 year group. Student's T-test showed no significant correlation between genders. The relationship between the left ventricular mass index (LVMI) and aging (with gender distribution) is shown in Graphs 3 and 4. The left ventricular mass index was increased during aging

[The effect of cilazapril and prazosin on insulin sensitivity in patients with essential hypertension]. / Uticaj cilazaprila i prazosina na insulinsku senzitivnost u bolesnika s esencijalnom hipertenzijom.

Two groups of drugs are actual for improving effects of insulin in vivo: alpha-1-adrenergic blockers and angiotensin-converting-enzyme-inhibitors. The objective of this study was to examine short-term effects of cilazapril and prazosin therapy on insulin sensitivity assessed by a 15' test of insulin tolerance of obese hypertensive persons. In groups of 8 patients insulin tolerance was tested prior to and 7 days after therapy by cilazapril dosed to 2.5 mg a day and prazosin 3 mean 1-2 mg a day. In this way satisfactory control of arterial tension was achieved. No significant changes of coefficient which enable assessment of insulin effects in vivo were established. However, in the group treated with cilazapril there were 6 out of 8 patients in whom coefficient increase was registered, so that among groups there was a significant difference in coefficient change in regard to therapy with better cilazapril effects.