ABSTRACT
INTRODUCTION: Q fever is a zoonosis which commonly manifests as an acute febrile disease accompanied by pneumonia or hepatitis. The aim of this study was to reveal the reservoirs, sources and routes of infection relevant for the Q fever outbreak that occurred in the border region between Serbia and Montenegro. METHODOLOGY: A prospective study was conducted from 3rd to 23rd March, 2016 in Brodarevo, village near the Serbian-Montenegro border. The EU case definition for Q fever was applied and serological evidence of IgM and/or IgG antibody for phase II antigen Coxiella burnetii used for laboratory confirmation. Animal infection was proven by detection of specific biomarkers for Q fever by ELISA and Real-Time PCR. RESULTS: In total, ten patients were registered with Q fever, giving an attack rate of 0.5% in the village. A severe form of disease with atypical pneumonia ended up with hospitalization of eight patients. Serological surveillance was conducted in 30 herds of the receptive animals in the outbreak area. Overall the anti-Coxiella antibody seroprevalence was 20.6%. Positive molecular findings (68.4%) accompanied with high seroprevalence (63.2%) were identified in a mini-farm of sheep and cattle in the nearby Orasac, these were considered to be active sources of infection. The most probable route of C. burnetii transmission was the inhalation of contaminated aerosols originating from infected animals. CONCLUSION: The main reservoirs for human Q fever at the border region between Serbia and Montenegro are infected cattle and ruminants. Adoption of a comprehensive strategy for disease prevention and control at the intergovernmental level is urgent.
ABSTRACT
INTRODUCTION: Declining of ovarian hormone production can seriously disturb the quality of woman's life, with physical and emotional consequences and to potentiate the development of additional health risks such as cardiovascular diseases and osteoporosis which are already present in women of older age. Benefits of Menopausal Hormone Therapy. Menopausal hormone therapy ameliorates the quality of life by resolving the atrophic symptoms and vasomotor problems, protecting from the osteoporosis, maintaining the skin and connective tissue turgor, as well as by improving libido, mood and depression during the menopausal transition. Forms of Menopausal Hormone Therapy. There are several possibilities to treat menopausal problems: estrogen, combination of estrogen and progestogen, androgens, selective estrogen receptor modulators, tissue selective estrogen complex, tibolon and alternatives. Initiating, Monitoring and Discontinuing Menopausal Hormone Therapy. Menopausal hormone therapy should be started when the problems due to menopausal symptoms appear. It is important to have on mind that the effects of hormones depend on age and actual condition of the woman's organism. The goal is effective treatment at the lowest dose and during the shortest interval needed for symptom control. The therapy must be reevaluated every year and potential risks must be discussed as well. CONCLUSION: Menopausal hormone therapy ameliorates the quality of woman's life in perimenopause. Type, doses and duration of the menopausal hormone therapy should be individualized.
