Biljana Mijović

Toxicology of microcystins with reference to cases of human intoxications and epidemiological investigations of exposures to cyanobacteria and cyanotoxins

Blooms of cyanobacteria have been documented throughout history, all over the world. Mass populations of these organisms typically present hazards to human health and are known for the production of a wide range of highly toxic metabolites—cyanotoxins, of which among the most common and most investigated are the microcystins. The toxicity of the family of microcystin congeners to animal and cell models has received much attention; however, less is known about their negative effects on human health, whether via acute or chronic exposure. Useful information may be acquired through epidemiological studies since they can contribute to knowledge of the relationships between cyanotoxins and human health in environmental settings. The aim of this review is to compile and evaluate the available published reports and epidemiological investigations of human health incidents associated with exposure to mass populations of cyanobacteria from throughout the world and to identify the occurrence and likely role of microcystins in these events. After an initial screening of 134 publications, 42 publications (25 on the chronic and 17 on the acute effects of cyanotoxins) describing 33 cases of poisonings by cyanobacterial toxins in 11 countries were reviewed. The countries were Australia, China, Sri Lanka, Namibia, Serbia, Sweden, UK, Portugal, Brazil, USA, and Canada. At least 36 publications link cyanobacteria/cyanotoxins including microcystins to adverse human health effects. The studies were published between 1960 and 2016. Although the scattered epidemiological evidence does not provide a definitive conclusion, it can serve as additional information for the medical assessment of the role of microcystins in cancer development and other human health problems. This paper discusses the major cases of cyanotoxin poisonings as well as the strengths, weaknesses, and importance of the performed epidemiological research. This study also proposes some recommendations for future epidemiological work.

Risk factors for Clostridium difficile infection in surgical patients hospitalized in a tertiary hospital in Belgrade, Serbia: a case–control study

BackgroundThe objective of this study was to investigate independent risk factors (RFs) connected with healthcare-associated (HA) Clostridium difficile infection (CDI) in surgical patients, its frequency per surgical wards and in-hospital-mortality at a single hospital.MethodsRisk factors for the infection were prospectively assessed among surgical patients with laboratory confirmed HA CDI and compared with a control group without HA CDI.ResultsThe overall incidence rate of HA CDI was 2.6 per 10000 patient-days. Significant independent RFs for HA CDI were the use of carbapenems (P = 0.007, OR: 10.62, 95% CI: 1.93–58.4), the admission to intensive care unit (P = 0.004, OR:3.00, 95% CI:1.41–6.40), and the administration of 3rd generation cephalosporins (P = 0.014, OR:2.27, 95% CI:1.18–4.39). Patients with HA CDI had significantly higher in–hospital mortality compared to controls (P: 0.007; OR: 8.95; 95% CI: 1.84–43.43).ConclusionsCDI is an important HA infection in population of surgical patients and this study emphasizes the importance of the wise use of antibiotics, and other infection control strategies in order to prevent HA CDI, and to decrease the incidence and in-hospital mortality rate.

Health-related quality of life in outpatients with chronic heart failure associated with sideropenic anemia

AimsThe aim of this study was to assess the impact of anemia and iron deficiency on health-related quality of life (HRQoL) in outpatients with chronic congestive heart failure.MethodsThe data were collected from patients with chronic congestive heart failure admitted to a university hospital outpatient clinic who agreed to be involved in the cross-sectional study. According to the World Health Organization’s cutoffs to define anemia, the patients were further divided into two groups, with and without anemia. HrQoL was assessed using two questionnaires: a disease-specific instrument, the chronic heart failure questionnaire (CHFQ), and a generic instrument, the Sickness Impact Profile (SIP). The standardized questionnaire was used to collect data regarding patients’ gender, age, marital status, place of living, education, occupation, and duration of diseases and comorbidities. To assess the iron status, ferritin, serum iron, the total iron binding capacity/TIBC and transferrin were measured.ResultsIn total, 200 outpatients with congestive heart failure were included in the study, 100 with and 100 without anemia. Patients with anemia were mainly female, had longer duration of disease (p = 0.001) and more hospitalizations (p = 0.001). Independent associations were found between the HrQoL and hemoglobin level (p = 0.049), HrQoL and hematocrit value (p = 0.006) and HrQoL and NYHA functional class (p = 0.004). Iron deficiency was not associated with impaired HrQoL.ConclusionAnemia has a significant impact on self-perceived health. Anemic patients are more likely to have worse heart failure as indicated by a higher NYHA class, thus being at higher risk for a decline of HrQoL compared with non-anemic patients.

Compassion fatigue and compassion satisfaction among family physicians in the Republic of Srpska, Bosnia and Herzegovina

Aims. The aim of this study was to examine self-perceived compassion fatigue and compassion satisfaction among family physicians in Bosnia and Herzegovina and describe potential contributing factors. Methods. The cross-sectional study enrolled 120 family physicians. Professional quality of life compassion satisfaction and fatigue version 5 (ProQOL5) was used to assess compassion satisfaction and two components of compassion fatigue, secondary traumatic stress and burnout. The symptoms of chronic fatigue were evaluated using the Chalder fatigue scale. Results. The majority of family physicians had moderate levels of compassion satisfaction (70%), burnout (75%) and secondary traumatic stress (55.8%). Family physicians with higher levels of secondary traumatic stress reported chronic fatigue (p = 0.001), longer length of service (p = 0.024) and residency training (p = 0.041). Chronic fatigue (p = 0.001), living in a rural environment (p = 0.033), larger size of practice (p = 0.006) and high number of patients with chronic disease (p = 0.001) were associated with a higher risk of burnout. Conclusion. Family physicians with large practices, long years of experience, a high number of chronically ill patients and experiencing chronic fatigue are at risk of developing compassion fatigue. A systematic exploration of compassion fatigue in relation to working conditions might provide an appropriate starting point for the development of preventive interventions.

Efekat benzodiazepina na kontrakciju preparisane traheje zamorca izazvane histaminom

Uvod. Disajni putevi su bioloske strukture koje se sire i skupljaju mijenjajucivolumen pluca i tonus bronha. Gama-amino butericna kiselina (GABA) jeneurotransmiter koji je znacajan inhibitor u centralnom nervnom sistemusisara. Benzodiazepini su lijekovi koji imaju direktan bronhodilatatorni efekatna glatku muskulaturu disajnih puteva. Oni ucestvuju u kolicini otpustenogacetilholina i odgovora misica na nadražaj. Cilj istraživanja je bio da se utvrdida li benzodiazepini redukuju kontrakciju izolovane traheje zamorca koja jeindukovana histaminom.Metode. Mjerena je tenzija glatke muskulature traheje zamorca cija je kontrakcijaindukovana histaminom. Korisceno je 10 zamoraca oba pola, prosjecnetežine od 610 g. Pripremljeni preparat traheje zamorca tretiran je rastucimkoncentracijama histamina od 0,01, 0,1 i 1,0 mg/mL pri cemu je konstriktorniodgovor registrovan fiziografom firme Godart “Fersttransducer” na visekanalnompisacu “Watanable”. Preparat je ispiran Krebsovim rastvorom, a poslijeponovne stabilizacije postupak se ponavljao uz dodavanje benzodiazepinau rastucim koncentracijama.Rezultati. Prethodna inkubacija trahealnih prstenova zamorca benzodiazepinomu koncentraciji od 0,014 mg/mL smanjila je kontraktilnu sposobnosttraheje indukovanu sa 0,01 mg/mL histamina za 82,3%. Koriscenje benzodiazepinau koncentraciji od 0,028 mg/mL smanjilo je kontrakciju za 85,2%, akoncentracija benzodiazepina od 0,042 mg/mL dovela je do najveceg padakontraktilnosti za 88,2%.Zakljucak. Dobijeni rezultati ukazuju da vece koncentracije benzodiazepinasmanjuju kontraktilnu sposobnost traheje izazvane histaminom.

Ispitivanje znanja studenata medicine o bolničkim infekcijama

Uvod. Bolnicka infekcija je svaka infekcija koja je nastala kod bolesnika,osoblja, ucenika ili studenata u bolnici ili u nekoj drugoj zdravstvenoj ustanovi,a koja nije bila prisutna, niti je bolesnik bio u inkubaciji na prijemu. Bolnickainfekcija se može manifestovati u toku hospitalizacije, ili po njenom prestanku.Cilj rada je bio da se ispita znanje studenata Medicinskog fakulteta u Foci uodnosu na bolnicke infekcije.Metode. Studija je izvedena među 52 studenta IV i 48 studenata VI godineMedicinskog fakulteta u Foci, koji su anketirani u periodu septembar - oktobar2008. godine putem anonimnog epidemioloskog upitnika.Rezultati. Svi ispitani studenti su znali da je bolnicka infekcija ona koja jepostala evidentna nakon 48 casova ili kasnije poslije prijema bolesnika ubolnicu, a koja nije bila prisutna, niti je bolesnik bio u inkubaciji pri prijemu.Najveci broj studenata (83%) je znalo da 5-10% bolesnika dobije bolnickuinfekciju tokom boravka u bolnici. Cak 82% studenata je znalo da su bakterijenajcesci prouzrokovaci bolnickih infekcija.Zakljucak. Nasi rezultati ukazuju da je znanje studenata medicine o bolnickiminfekcijama na visokom nivou.