Urban Air Pollution Associated with the Incidence of Autoimmune Thyroid Diseases.

Background: Endocrine disrupting air pollutants such as sulphur dioxide (SO2), carbon monoxide (CO), nitrogen dioxide (NO2), fine particle matter (PM2.5), and ozone (O3) can affect thyroid gland function on the level of synthesis, metabolism, and the action of its hormones. Objective: The aim of this study was to establish whether increased air pollution could contribute to an increased incidence of autoimmune thyroid diseases (AITD). Methods: A retrospective analysis was conducted of the medical records of 82000 patients at the University Clinical Centre in Tuzla, Bosnia and Herzegovina. The target group of this study comprised a total of 174 patients from the Lukavac area. Daily data on concentrations of air pollutants were collected from the air quality monitoring station located in Lukavac. The study covered the period from 2015 to 2020. Results: The results of the monitoring confirmed the presence of air pollutants in concentrations above the permitted limits throughout the entire observed period. Concentrations of PM2.5, SO2, NO2, CO, and O3 were in the range of 1.90-431.40 µg/m3, 3.60-620.50 µg/m3, 3.40-66.20 µg/m3, 48.00-7002.00 µg/m3, and 0.70-89.40 µg/m3, with means of 64.08 µg/m3, 77.48 µg/m3, 22.57 µg/m3, 1657.15 µg/m3, and 31.49 µg/m3, respectively. During the six-year period, 174 cases of AITD were registered, of which 150 (86.21%) were women and 24 (13.79%) men. Hashimoto's thyroiditis was found in 33 patients (18.97%), whilst 141 patients (81.03%) were diagnosed with atrophic thyroiditis. The highest total incidence of autoimmune thyroiditis was recorded in 2017, when it reached 99.49, 95% CI. Conclusion: The effects of chronic exposure to a mixture of air pollutants on the function of the thyroid gland are still not sufficiently well-known, but the numerical tendency towards a higher incidence of AITD in this study, albeit without statistical significance (p>0.05), still underlines the need for additional research.

Cognitive Functionality of Patients with Delirium after Stroke.

BACKGROUND: Delirium is a syndrome that occurs in all age groups and in many clinical departments, and is most common in intensive care units. It is an emergency, in the overlapping fields of somatic medicine, neurology and psychiatry. Delirium occurs suddenly, dramatically, and requires a quick reaction, recognition and treatment. There are only a small number of studies that have reported delirium after a stroke. In our study, the goal was to determine the cognitive functionality of patients with delirium after a stroke. SUBJECTS AND METHODS: This is a prospective study in which a group of 100 delirium patients in the acute phase of a stroke were evaluated for cognitive function. The control group consisted of the same number of patients with acute stroke who were not diagnosed with delirium. Neurological, neuropsychiatric and neuropsychological tests were performed in all patients at five different time periods. In these time periods, all patients were evaluated: Glasgow Coma Scale; Delirium Assessment Scale; The American National Institutes of Health Scale Assessment; Information-Memory-Concentration test; Dementia Score; Mini-Mental Test. The findings of computed tomography of the brain and magnetic resonance imaging of the brain were interpreted by a radiologist who was not familiar with the goals of this study. RESULTS: Cognitive functioning of delirious patients is statistically significantly worse after three and six months, and one year from stroke compared to those without delirium. There is no statistically significant difference in cognitive functioning between delirious patients in relation to gender, age, location and type of stroke and patients without delirium throughout one year from stroke. There is no significant difference in cognitive functioning between delirious patients during one year from stroke in relation to severity and type of delirium, and statistically significantly higher degree of cognitive dysfunction has those older than ≥65 years. CONCLUSIONS: Delirium significantly reduces the cognitive functioning of patients after a stroke.

Others Are to Blame (Displacement in patients with drug-resistant epilepsy).

OBJECTIVE: To evaluate the defense mechanisms (DM) in patients with drug-resistant epilepsy and, to determine whether displacement is associated with seizures. SUBJECTS AND METHODS: Following an examination, 50 patients were diagnosed in accordance with the 2005 proposal of the International League Against Epilepsy and the definition of drug-resistant epilepsy from 2010. The neuropsychological examination used the Defense Style Questionnaire (DSQ-40). We measured the intensity of individual DMs. Mature DMs: sublimation, humor, suppression and anticipation; neurotic DMs: undoing, pseudo-altruism, idealization and reactive formation; and immature DMs: projections, passive aggression, acting out, isolation, devaluation, autistic fantasies, denial, displacement, dissociation, splitting, rationalization and somatization. The values were compared with 50 subjects without epilepsy. RESULTS: Patients with drug-resistant epilepsy use immature defensive styles significantly more (p=0.0010). Displacement have a positive correlation with frequency of seizure (p=0.0412). CONCLUSION: Blaming others is a characteristic of the behavior of patients with drug-resistant epilepsy, especially if they have seizures. As such, they may be less adaptable in a micro social environment.

The Epidemiological Characteristics of Autoimmune Thyroiditis in the Tuzla Canton in the Period from 2015 to 2020.

BACKGROUND: Bosnia and Herzegovina (B&H) is one of the countries of Southeast Europe with the lack of data about chronic autoimmune thyroid diseases (CAITD) epidemiology. OBJECTIVE: This research aimed to assess incidence of CAITD in the Tuzla Canton of B&H during a 6-year period (2015-2020). METHODS: We retrospectively evaluated 82,000 hospital records of inpatients and outpatients with possible thyroid symptoms residing in Tuzla Canton of B&H (total of 445,028 inhabitants). The study included patients with laboratory and clinical proof of autoimmune thyroid diseases (AITD). Incidence rates were calculated with age standardisation using European standard population. Trends in incidence were evaluated as moving three-year averages. RESULTS: During the observed period, 1875 patients satisfied the diagnostic criteria for CAITD with male to female ratio of 1: 8.01. Median age of all cases was 46 years (interquartile range: 31 to 61) and women and men were on average the same age at the time of diagnosis. The overall standardized incidence was found to be 71.25 per 105 (%95 CI=63.36-79.15). The overall standardized incidence in men was 16.25 per 105 and 123.74 per 105 in women. In the end of the observed period, AITD prevalence was 427.52 per 105 (% 95 CI=408.17-446.87). CONCLUSION: There was a slight decline of incidence in our region during the observed period. This decrease might be the result of combination of various factors, mainly the Corona epidemics outbreak and emigration. On the basis of the lower incidence rate in the Tuzla Canton, one can assume that iodine prophylaxis carried out in order to eradicate goitre had satisfied expectations because there had not been any enormous increase in patients with AITD.

Knowledge, attitude and stigma towards HIV patients: a survey among medical students in Tuzla, Bosnia and Herzegovina.

INTRODUCTION: This survey aims to assess knowledge, attitude and stigma towards HIV patients, among medical students in Tuzla, Bosnia and Herzegovina. We also aimed to assess potential risk factors for HIV infection among fourth year medical students. METHODOLOGY: Data were collected from specific questionnaire that was completed by 171 students of the Faculty of Medicine, University of Tuzla. A multivariable logistic regression was performed. RESULTS: Majority of students (79%) had a good knowledge of HIV, (median value of correct answers was 9 (95%) with at least 6 correct responses). Also, majority of students (73.6%) had a positive attitude towards HIV patients and the median positive value was 6 (95% CI: 6-7). More than a third of students considered that all hospitalized patients should be tested for HIV. Total of 81% of students considered that they should inform the sexual partner of HIV positive patient, although she/he disagrees. 61.4% of students had a discriminatory attitude towards HIV, with the median values of 3 (95% CI: 3-3). Multivariate regression analysis identified positive attitude towards HIV patients as an independent predictor for a non-discriminatory attitude. Moreover, an overall attitude towards HIV patients defines student`s determination to work with AIDS population. Male gender, and older age, were identified as predictors of risky behavior. CONCLUSIONS: Preventive measures, including better HIV education, are crucial. Knowledge can increase awareness of HIV infection, decrease the incidence and reduce stigma towards HIV patients.

Post-Stroke Depression.

INTRODUCTION: The depression is a common mental disorder, especially after a stroke, which further aggravates the recovery. AIM: To analyze depression within 48 hours and fifteen days after ischemic stroke in relation to gender and location (brain hemisphere and brain circulation). METHODS: We analyzed 40 patients (65.3±10.3 years), half of them were women. Mean age of women was 66.35±7.31 years and men 64.2±12.68 years (p= 0.5). Ischemic stroke was verified by computed tomography. Levels of depression were measured with self-estimated Zung's scale. On the tests, score of 50 and higher verified depression. Criteria made by Domasio were used to determine location of the IS. RESULTS: Mean value on depression scale in acute phase of ischemic stroke was 46.85 ± 8.6 and in subacute phase 43.4 ± 8 (p =0.06). In 19 (47.5%) patients (55% of women, 40% of men; p=0.3) depression was found during the first and in 10 (25%) patients (35% of women, 15 % of men; p=0.06) during the second evaluation (p<0.019). Mean value on depression in acute phase of illness in women was 49.1 ± 7.38, as well as in men 44.6 ± 9.22 (p=0.088) and in subacute phase in women 45.25 ± 8.04, as well as in men 41.5 ± 7.75 (p=0.16). Concerning location of ischemic stroke, there were no significant differences in levels of depression. CONCLUSION: Number of patients with post-stroke depression is significantly lower in subacute phase of ischemic stroke. Although the number of depressive women and their depression scores are higher, gender differences are not statistically significant. There is no correlation between post-stroke depression and location of lesion in acute and subacute phase of illness.

Epidemiological Characteristics of the Accidental Exposures to Blood-Borne Pathogens Among Workers in the Hospital.

INTRODUCTION: The main route of acquiring infectious blood and body fluids in hospital conditions is accidental exposure to stinging incidents. AIM: The aim of this study was to determine the epidemiological characteristics of accidental exposures to blood-borne pathogens among different professional groups of health care workers (HCWs). MATERIALS AND METHODS: A cross-sectional study was conducted using the "Questionnaire on the HCWs exposure to blood and blood transmitted infections" at the University Clinical Centre Tuzla, Bosnia and Herzegovina, from the 1st of March to the 31st of December 2014. Study sample consisted of 1031 participants (65% of total employees) stratified into three occupational groups: doctors, nurses and support staff. RESULTS AND DISCUSSION: Exposure incident was recorded in 1231 participants (54.8%) at least once in the last 12 months. An average number of exposure incidents per HCWs in total years of service was 7.07± 8.041. Out of total sample, 70% reported at least one type of exposure incident. Nurses had a higher frequency of multiple contacts compared to doctors and support staff (χ2=37.73; df=4; p<0.001). The frequency of reported incidents among nurses at the surgical departments was almost two times higher (1.7). 75.5% (778/1031) of the participants, reported not having been exposed to these incident. Doctors were significantly less likely to report exposure incidents than nurses and support staff. There were significant differences in reporting rate (χ2=32,66; df=4; p<0.001). CONCLUSION: HCWs in hospitals have a high prevalence of occupational exposure to blood-borne infections. Seventy percent of the HCWs is periodically or constantly exposed to or contact related to blood. Nurses are most frequently exposed occupational group among HCWs, while the lowest reporting rate on an exposure incident is among doctors.

The predictive value of the clinical sign of limited hip abduction for developmental dysplasia of the hip (DDH).

Aim To assess the relationship between the clinical sign of limited hip abduction and developmental dysplasia of the hip (DDH). Methods A research was conducted on 450 newborns at the Neonatal Unit at the Clinic of Gynaecology and Obstetrics and the Orthopaedics and Traumatology Clinic of the University Clinical Centre, Tuzla, between 30th August 2011 and 30th April 2012. Clinical (degree of hip abduction) and ultrasound examination of all newborns' hips were performed using the Graf method on their first day of life. Results Clinical sign of limited hip abduction showed significant predictive value for DDH. There were 67 (14.7%) newborns with the clinical sign of limited hip abduction, of which 26 (5.7%) were on the left hip, 11 (2.4%) on the right hip and 30 (6.6%) on both hips. Limited hip abduction had a positive predictive value (PPV) of 40.3% and a negative predictive value (NPV) of 80.4% for DDH. Conclusion Limited hip abduction, especially unilateral, is a useful and important clinical sign of DDH. Doctors, who perform the first examination of the child after birth, would have to pay attention to this clinical sign. Newborns with this clinical sign would have to go to an ultrasound examination of the hips for further diagnosis.

Clinical and Epidemiological Characteristics of HIV Infection/AIDS in Hospitalized Patients.

INTRODUCTION: More than three decades after recognition of acquired immunodeficiency syndrome (AIDS) in the United States, the pandemic of human immunodeficiency virus (HIV) infection has dramatically changed the global burden of disease. AIM: The main goal of this research is retrospective analysis of epidemiological and clinical characteristics of 28 HIV infected patients, who were diagnosed and treated at the Clinic for Infectious Diseases in University Clinical Center Tuzla in the period from 1996 until the end of 2013. SUBJECTS AND METHODS: Retrospective analysis was performed using the medical records of 28 HIV-infected persons. Two rapid tests were used for HIV testing: OraQuick Advance test, Vikia HIV1/2, Elisa combo test, HIV RNA test. AIDS disease was determined by using the criteria from WHO. RESULTS: Among a total of 28 HIV-infected persons, 23 (82.14%) were males and 5 (17.86%) were females, with the male: female ratio of 4,6:1. In terms of the transmission route, a large proportion of cases were infected through heterosexual contact 19 (67.86%). At the time of the first visit, 16 (57.15%) patients showed asymptomatic HIV infection, 4 (14.28%) HIV infection with symptoms other than the AIDS defining diseases, and 8 (28.57) had AIDS. At the time of first hospital visit, the CD4 + cells count ranged from 40 to 1795/µl (conducted in 19 patients), and mean value of CD4 + cells was 365,31/µl, and mean HIV RNA titer was 287 118 copies/ml³. Of 28 HIV-infected persons 39 cases of opportunistic diseases developed in 12 patients (42.9%). In terms of the frequency of opportunistic diseases, tuberculosis (12 cases, 42.9%). Among a total of 28 HIV-infected patients, 6 (21.4%) of them died. CONCLUSION: This study characterizes the epidemiological and clinical patterns of HIV-infected patients in Tuzla region of Bosnia and Herzegovina to accurately understand HIV infection/AIDS in our region, in the hope to contribute in the establishment of effective HIV guidelines in the Tuzla region of B&H in the future.

Epidemiological surveillance of bacterial nosocomial infections in the surgical intensive care unit.

INTRODUCTION: Intensive care units (ICUs) are associated with a greater risk of developing nosocomial infections (NIs) than other departments. AIM: The aim of this study was to determine the rate, the site and causative organisms of NIs in the surgical ICU at University Clinical Center Tuzla. METHODS: All patients admitted to the surgical ICU were followed prospectively, for the development of NIs (January-December 2010). Determination of NIs was performed using standardized the Centers for Disease Control and Prevention (CDC) criteria. RESULTS: 94 out of 834 patients (11.27%) developed NIs. Respiratory tract infections were seen in 56 (60%), urinary tract infections in 15 (16%) and gastrointestinal tract infections in 8 (9%) patients. Other infections identified were surgical site, bloodstream and skin infections. Gram-negative organisms were reported in approximately 75% of cases (78.7% extended-spectrum beta-lactamase (ESBL)-producers). Klebsiella pneumoniae was the commonest (51.0%), followed by Proteus mirabilis (21.3%) and Pseudomonas aeruginosa (10.6%). Methicillin-resistant Staphylococcus aureus (MRSA) (16%), and Clostridium difficile (9.6%) were the commonest among gram-positive bacteria. CONCLUSION: Respiratory and urinary tract infections made up the great majority of NIs. ICU patients are more susceptible to NIs, emphasizing the importance of continuous surveillance and enforcement of specific infection control measures.

Epidemiological monitoring of nosocomial infections caused by acinetobacter baumannii.

INTRODUCTION: Acinetobacter baumannii is a frequent cause of infections in hospitals around the world, which is very difficult to control and treat. It is particularly prevalent in intensive care wards. AIM: The main objective of the research was to establish the application of epidemiological monitoring of nosocomial infections (NIs) caused by A. baumannii in order to determine: the type and distribution of NIs, and to investigate antimicrobial drug resistance of A. baumannii. MATERIAL AND METHODS: 855 patients treated at the Clinic of Anesthesiology and Reanimation, University Clinical Center Tuzla during 2013 were followed prospectively for the development of NIs. Infections caused by A. baumannii were characterized by the anatomical site and antibiotics resistance profile. RESULTS: NIs were registered in 105 patients (12.3%; 855/105). The predominant cause of infection was A. baumannii with an incidence of 51.4% (54/105), followed by ESBL-producing Klebsiella pneumoniae with 15.2% (16/105) of cases, methicillin-resistant Staphylococcus aureus with 8.6% (9/105), and ESBL-producing Proteus mirabilis with 7.6% (8/105). According to the anatomical site, and type of NIs caused by A. baumannii, the most frequent were respiratory infections (74.1%; 40/54). Infections of surgical sites were registered in 11.1% (6/54) of cases, while bloodstream infections in 9.2% (5/54). A. baumannii isolates tested resistant against most antibiotics examined, but showed a high degree of susceptibility to tobramycin (87%; 47/54) and colistin (100%; 54/54). CONCLUSION: The increasing incidence of multi- and extensively drug-resistant Acinetobacter spp. emphasizes the importance of administration of an adequate antibiotic strategy and the implementation of strict monitoring of the measures for controlling nosocomial infections.

Clostridium difficile infection in hospitalized patients at university clinical center tuzla, bosnia and herzegovina: a 4 year experience.

INTRODUCTION: Clostridium difficile (C. difficile) is currently the leading cause of healthcare-associated diarrhea, but almost nothing is known about the extent of C. difficile infection (CDI) in Bosnia and Herzegovina. GOAL: We aimed to retrospectively analyze CDI in hospitalized patients at University Clinical Center (UCC) Tuzla, Bosnia and Herzegovina from January 2009 through June 2012. METHODS: We analyzed all patients (except children ages 0-2), diagnosed with CDI based on anamnestic and epidemiological, clinical picture and microbiological tests (proof of toxins in the stool by enzyme-linked immunosorbent assay). RESULTS: From a total of 989 patients tested for C. difficile toxin (60.2 per 10,000 inpatient days) 347 (35.08%) were positives. The mean incidence rate of CDI was 2.23 per 10,000 inpatient days (range 1.32-2.87). Annual rates of hospitalization were 15.68 per 10,000 admissions (range 8.99-20.35). Most patients had a previously identified risk profile of old age, comorbidity and recent use of antibiotics. 41/276 (14.86%) patients had died, and 11/41 (26.82%) were CDI-associated deaths. Complicated CDI were registered in 53/276 (19.21%) patients, and recurrent infections in 65/276 (23.55%). CONCLUSION: Our data suggest that CDI is largely present in our setting which represents a serious problem and points to the importance of international surveillance, detection and control of CDI.

Human brucellosis in Tuzla Canton.

INTRODUCTION: The prevalence of human brucellosis in Bosnia and Herzegovina and the Tuzla Canton reached its peak in 2008, with a reported total of 994 cases within country, and with 104 cases within the Tuzla Canton. AIM: to analyze the clinical and epidemiological features of human brucellosis in patients hospitalized at the University Clinical Center Tuzla during the period from 01/01/2000 till the 31/12/2010. METHODS: We retrospectively analyzed the clinical symptoms, the laboratory and X-ray findings, the treatments, and the course and outcome of the disease. The diagnosis of brucellosis was based on anamnesis, clinical presentation, in correlation with a positive blood-culture, and/or serological tests. RESULTS: The majority of patients (93.18%) were from rural regions. There were more males (79.54%) than females. Most of the patients were aged between 30 to 39 years (21% cases). Contact with infected animals was registered for 83.40% of the patients. The main symptoms and signs were fever, joint-pains, night sweating, anorexia, headaches, and hepatosplenomegaly. The important laboratory findings were increased erythrocyte sedimentation rates, increased values of C-reactive protein, and anemia. Adult patients were treated with a combination of gentamicin or streptomycin with doxycycline, and the children with a combination of gentamicin, and trimethoprim-sulfametaxasol, over at least 6 weeks. Complications were documented in 20.45% of the patients. Relapses were observed in 14.20%, and a chronic form of brucellosis in 5.11% of patients. There were no cases with lethal outcomes. CONCLUSION: Brucellosis is a growing public health problem, not only within the Tuzla Canton, but throughout Bosnia and Herzegovina.

Epidemiological and microbiological control of hospital infections in surgical patients.

INTRODUCTION: Intrahospital infections in surgical wards pose a significant problem, particularly in patients with impaired natural defense potential. They significantly complicate and increase the cost of basic treatment of the patient and sometimes leave permanent damage. Active control of their appearance is of paramount importance in their prevention. GOAL: By this study we try to determine the frequency of individual agents, their anatomical and gender distribution at the Clinic of Surgery, University Clinical Centre Tuzla in 2005.v. RESULTS: Our study showed that gram negative bacteria were more common trigger of IHI (76.37%), and especially the urinary and respiratory tract and surgical wounds infections. We also showed that men from older age groups are more likely to have IHI. CONCLUSION: Active surveillance and tracing for agents, especially in high-risk groups of patients is the best method of prevention of IHI occurrence.

Surveillance of intrahospital infections at the clinic for gynaecology and obstetrics.

Intrahospital infections (IHI) and antibiotics resistance are the problems which exist in virtually all hospitals in the world. The main aim of the present research is establishing of epidemiological surveillance over occurrence of IHI at the Clinic for Gynaecology and Obstetrics at the University Clinical Center Tuzla and thus identifies: types of bacteria which cause IHI, types of infection according to anatomical localization and research resistance organisms causing of IHI on antimicrobial drugs. A study was implemented on all patients admitted to Clinic for Gynaecology and Obstetrics during the period of one year and who subsequently developed infection. Determination of intrahospital infections was done according to criteria defined by the Centres for Disease Control and Prevention from the United States. The results of our work have shown that both urinary tract infections and surgical site infections are the most frequent. As IHI causers the most found are gram-negative organisms (73,7%), such as Escherichia coli (29,8%), right after that Klebsiella pneumoniae (24,6%), Pseudomonas aeruginosa (14%) and Proteus mirabilis (5,3%) (p<0,05). Gram-positive organisms as causers of IHI are registered in 26,3% cases. Out of that Streptococcus species are isolated in 10,5% cases, Staphylococcus aureus (8,8%) and coagulasa negative staphylococci (7%) (p>0,05). High percent resistance of bacteria was evident to beta-lactams, aminoglycosids and cephalosporin's of third generation. Gram-positive organisms were 100% sensitive to vancomycin, while gram-negative organisms manifested the high percent of sensibility to imipenem and cefepime.

[Intrahospital infections and antimicrobial resistance at University Clinical Center Tuzla]. / Intrahospitalne infekcije i antimikrobna rezistencija u Univerzitetskom klinickom centru Tuzla.

The aim of presented research was to determine microorganisms which cause intrahospital infections (IHI) with specific anatomical localization and to determine the antimicrobial resistance of these organisms in a group of 5106 patients hospitalized at Surgery Department of the University Clinical Center Tuzla in the period between 1 January to 31 December 2004. The research was conducted in accordance with the National Nosocomial Infections Surveillance (NNIS) methodology. The results show that in 73.82% of cases the gram-negative organisms (p < 0.001) have been isolated and identified as the IHI pathogens, while the gram-positive organisms (p < 0.05) have been isolated and identified as the IHI pathogens in remaining 26.18% of cases. Urinary tract infections, surgical site infections, respiratory tract infections and bloodstream infections have been mostly caused by gram-negative organisms, while the other infections have been more often caused by gram-positive organisms. Gram-positive organisms were found to be resistant to beta-lactam antibiotics and sensitive to the vancomycin. Gram-negative organisms have shown resistance to beta-lactams, aminoglycoside and cephalosporins of third generation. They were well sensitive to cinolones and carbapenems.

[Epidemiology of bacterial intrahospital infections in newborns]. / Epidemiologija bakterijskih intrahospitalnih infekcija kod novorodencadi.

Nosocomial infections are important problem for the modern medicine. Especially sensitive category, susceptible to nosocomial infections, are the infants. The aim of the research was to establish an active monitoring over the breaking out of the nosocomial infections in the Neonatology Department of the Gynecology and Obstetrics Clinic of the University Clinical Center Tuzla (UKC) and to determine the kind of bacteria that causes the nosocomial infections as well as the type of infection according to anatomical localization. The research encompassed 8000 of newborn infants at the Neonatology Department of the UKC Tuzla in the years 2005 and 2006. The determining of the nosocomial infections was done by using the standard CDC criteria. The results show that in two researching years the leading nosocomial infections were bacteriemia, followed by other infections, respiratory tract infections and urinary tract infections. The mostly identified carrier of the nosocomial infections in 2005 were gram-positive bacteria (65,5%): coagulase-negative staphylococci was isolated in 54,6%, Staphylococcus aureus in 5,5% and Streptococcus species in 5,5% of cases (p<0,001). The isolated gram-negative bacteria, carriers of nosocomial infections in 2005 were Klebisiella pneumoniae (21,8%), Escherichia coli (5,5%), Pseudomanas aeruginosa (3,6%) and Morganella morganii (3,6%) (p<0,05). In 2006 the mostly identified and isolated carriers of nosocomial infections were gram positive bacteria (64,2%): coagulase-negative Staphylococci (43,3%), Streptococcus species (13,4%) and Staphylococcus aureus (7,5%) (p<0,001). Gram negative bacteria, carriers of nosocomial infections in 2006 were Klebsiella pneumoniae (19,4%), Escherichia coli (10,5%), Acinetobacter species (3%), Pseudomonas aeruginosa (1,5%) and Proteus mirabilis (1,5%) (p<0,05). The bacteriemia was mostly caused by coagulase-negative staphylococcus. Infections of the urinary tract were caused by gram-negative bacteria Klebsiella pneumoniae and Escherichia coli. Other infections were caused by coagulase-negative Staphylococci, Staphylococcus aureus, Klebsiella pneumoniae and Escherichia coli. Infections of the respiratory tract were caused by Streptococcus species, Klebsiella pneumoniae, coagulase-negative Staphylococci, Staphylococcus aureus and Pseudomonas aeruginosa. The most frequent carriers of the nosocomial infections at the Neonatology Department of the UKC Tuzla in 2005 and 2006 was gram-positive bacteria-coagulase-negative Staphylococci.

[Prevention of food poisioning in hospitals]. / Prevencija trovanja hranom u bolnicama.

Epidemic food poisioning caused by food contaminated by microorganisms, its toxins or chemical toxic substances, emerge in the hospitals as specific kind of intrahospital infections. An occurrence of food poisoning in hospitals is facilitated by several facts as: centralized food preparation, kinds of food, staff carriers, an unfavourable hygienic regime in the kitchens and at the places where food is shared, crossing of clean and unclean paths in a kitchen, carelessness, non-education etc. Danger that contaminated food brought to hospitals is more serious since it is about consumers with disrupted health. Main goal of work was to show conditions in the central kitchen and restaurants in University clinical center Tuzla in regard to sanitary care of the staff hands, which are in direct and indirect contact with food, cutlery and working surfaces, that are in direct contact with food.