Excess Mortality Stratified by Age and Sex for Croatia and Croatian Counties during the 2020-2021 COVID-19 Pandemic.

Excess mortality is often used to estimate the effect of a certain crisis on the population. It is defined as the number of deaths during a crisis exceeding the expected number based on historical trends. Here, we calculated excess mortality due to the COVID-19 pandemic for Croatia in the 2020-2021 period. The excess was calculated on the national and county level for different age and sex categories. In addition to the absolute number, the excess mortality was also expressed as a ratio of excess deaths to the predicted baseline and excess mortality rate. We showed that using both measures is necessary to avoid incorrect conclusions. The estimated excess mortality on the national level was 14,963, corresponding to an excess percentage of 14.3%. With respect to sex, there was a higher excess mortality rate for men compared to women. An exponential relationship was observed between age and the excess mortality rate.These trends wee representative of most counties as well, with large variations in the magnitude of the effect. However, there were also exceptions to the general rule. The reasons for these deviations were discussed in terms of between-county differences in demographic structure, population density and special events that took place during the pandemic.

Vancomycin-resistant Enterococcus faecium COLONIZATION and Clostridium difficile infection in a HEMATOLOGIC patient.

Vancomycin-resistant enterococci (VRE), especially Enterococcus faecium, have emerged as significant nosocomial pathogens and patients with impaired host defenses are at a particular risk of VRE infection. The most common occurrence is asymptomatic colonization of the gastrointestinal tract that can persist for a long time and serve as a reservoir for transmission of VRE to other patients. We present a case of a patient who was diagnosed with acute myelogenous leukemia and suffered from bone marrow aplasia following induction therapy. The patient received prolonged broad-spectrum antimicrobial therapy. During hospital stay, the patient developed Clostridium difficile infection (CDI) and was found to be colonized with a strain of Enterococcus faecium resistant to vancomycin during therapy for CDI. This case also highlights the role of risk factors that could contribute to development of resistance, particularly CDI. Early detection of VRE colonization or infection is a crucial component in hospital program designed to prevent transmission of nosocomial infections. Surveillance cultures of such patients should be mandatory.

Interactions of resveratrol with other phenolics and activity against food-borne pathogens.

The aim of this study was to investigate the antibacterial activity of individual phenolics and their binary mixtures with resveratrol against selected food-borne pathogens. The antibacterial activity was quantified using the broth microdilution method by the determination of minimal inhibitory concentrations (MICs). Interactions between compounds in the binary phenolic mixtures were determined by calculating the fractional inhibitory concentration index (FICI). The influence of the number of OH groups in the phenols' structure on their antibacterial activity was assessed by principal component analysis (PCA). The most effective compounds were flavone luteolin and flavonol rutin, while the weakest antimicrobial activity was observed for phenolic acid and flavan-3-ols (catechin and epicatechin). The synergistic effect (FICI ≤0.5) of equimolar mixture of resveratrol with kaempferol was confirmed against Staphylococcus aureus, Bacillus cereus, and Escherichia coli, while the mixture of rutin with resveratrol proved synergistic only against S. aureus. The increasing concentrations of resveratrol in the mixtures with kaempferol and rutin resulted in a loss of synergism which indicates that only selected phenolic mixtures, with optimal concentrations of their individual components, result in synergistic antibacterial activity. We did not find an association between total number of OH groups and antibacterial activity of either individual phenolics or their mixtures.

A six-year epidemiological surveillance study in Split-Dalmatia County, Croatia: urban versus rural differences in human campylobacteriosis incidence.

Data from population-based laboratory surveillance were used to examine the epidemiological pattern of campylobacteriosis in a sentinel site, Split-Dalmatia County (SDC),Croatia, from 2007 to 2012, and to evaluate the association between disease incidence and demographic, geographical, climatic, agricultural, and microbiological factors. A total of 2658 laboratory-confirmed Campylobacter infections were recorded. Overall mean incidence was 96/100,000, ranging from 61/100,000 in rural to 131/100,000 in urban areas; rates were highest in the age group 0-4 years. Overall mean and age- and sex-specific incidences were significantly higher in urban versus rural areas (p < 0.01). The number of infections peaked in early summer, and was correlated with higher average monthly temperature (r = 0.58) and lower humidity (r = - 0.27), but not with precipitation. Incidence was not associated with agricultural activities. A distinct campylobacteriosis pattern with consistently higher urban versus rural incidence was observed, which may help formulate further preventive measures.

Perinatal risk factors in newborns with gastrointestinal perforation.

AIM: To investigate correlation of perinatal risk factors in newborns with gastrointestinal perforation (GIP). METHODS: Single-center retrospective cohort study was conducted between January 1990 and December 2012. Medical records on all newborns with GIP were reviewed (n = 35). Surgical records and histopathologic examination of all perforated intestine samples were also reviewed. RESULTS: The most common cause of GIP was necrotizing enterocolitis (51.4%). The most common site of perforation was large intestine. Mortality rate was 31%. Infants with GIP more frequently had very low birth weight (< 1500 g), especially birth weight below 10th percentile according to gestational age. Ponderal index was not differing between infants with GIP and control subjects. In infants with GIP anemia was more frequently found than in control group. CONCLUSION: GIP in newborns is mostly disease of infants with birth weight below 10th percentile according to gestational age. GIP occurs more often in infants with anemia.

Surgical scientific publication and the 1991-1995 war in Croatia.

The aim of this study was to evaluate surgical scientific publication in relation to the 1991-1995 war in Croatia, based on the articles indexed in Medline database that were published in 1980-2005 period. The number of articles was extracted from PubMed and analysed with trend analysis, which is preferred analytic approach over calculation of crude publication rates. The results indicate sporadic pre-war output, which was almost completely reduced by the onset of war. During wartime, a significant increasing trend in the number of published surgical articles that were related to warfare was detected (p = 0.003). During the post-war period a gradual shift towards surgical articles that were not related to warfare was detected, also marked by the significant increasing trend (p = 0.027). Both trends were significantly steeper than the overall Croatian biomedical output, suggesting that surgical scientific articles were being published more dynamically than in other biomedical areas in Croatia. The results suggest that war in Croatia has had a strong modifying effect on the surgical scientific output.

Thermally treated wine retains vasodilatory activity in rat and guinea pig aorta.

In contrast to the intact wine, cardiovascular effects of the thermally treated wine have not been studied, despite widespread habits of cooking with wine and consumption of mulled wine. Vasodilatory effects of the red wine heated at 75 and 125°C were examined in the isolated rat and guinea pig aorta and compared with the intact and wine dealcoholized without thermal stress. Samples were analyzed for their phenolic content, antioxidant capacity, resveratrol and ethanol contents. Heating-induced degradation of individual phenolic fraction was observed only in the samples treated at 125°C, although total phenolic concentration and related antioxidant activity increased in the thermally treated samples due to the reduction in their volume. All wine samples regardless of treatment caused similar maximal relaxation in both species, but the response was stronger in aortas from guinea pigs. At the lowest concentrations up to 1‰, dealcoholized wine produced vasodilation greater than that produced by intact wine and wines treated at 75 and 125°C, which showed similar vasodilating activity at all concentrations. Our results indicate that wine thermally treated under heating conditions applicable to the preparation of a mulled wine and cooking with wine largely retains vasodilatory activity in vitro despite significant heat-induced changes in its composition.

Antimicrobial effects of wine: separating the role of polyphenols, pH, ethanol, and other wine components.

While the antimicrobial effectiveness of wine is well documented, relative contributions of the wine components to its antimicrobial activity is controversial. To separate the role of wine phenolics, ethanol, and pH from other wine constituents, the antimicrobial effects of intact wine were compared to that of phenols-stripped wine, dealcoholized wine, ethanol, and low pH applied separately and in combination, against 2 common foodborne pathogens, Salmonella enterica serovar Enteritidis and Escherichia coli. All samples were biochemically characterized with respect to their total phenolics and resveratrol content, antioxidant capacity, ethanol content, and pH. Antioxidative activity of the samples corresponded to their total phenolics content. Except for respective controls, pH and ethanol content were similar in all samples. The order of antibacterial activity of the samples was: intact wine > phenols-stripped wine > dealcoholized wine > combination of ethanol and low pH > low pH > ethanol. Separate application of ethanol or low pH showed negligible antibacterial activity while their combination showed synergistic effect. Antibacterial activity of the samples could not be related to their total phenolics and resveratrol content, antioxidant capacity, ethanol content, or pH. Our study indicates that antimicrobial activity of complex solutions such as intact wine cannot be exclusively attributed to its phenolic or nonphenolic constituents, nor can the antimicrobial activity of wine be predicted on the basis of its particular components.