[Curriculum "Tracheostomy management in dysphagia therapy"]. / Curriculum "Trachealkanülenmanagement in der Dysphagietherapie".

The number of tracheotomized patients with dysphagia and their need for treatment are continuously increasing in clinical and community settings. The revised version of the directive on home care and community-based intensive care of the Federal Joint Committee (G-BA) requires that tracheotomized patients are regularly evaluated with the aim of identifying and promoting the therapeutic potential after hospital discharge. Dysphagia treatment plays a crucial role as without improvement of severe dysphagia there is practically no possibility for decannulation. Tracheotomized patients with dysphagia are treated by speech and language therapists (SLT); however, the contents of tracheostomy management (TM) are not obligatory in the speech and language therapeutic training curricula, so that there is a need for further education and treatment standards must be secured. Therefore, the German Interdisciplinary Society for Dysphagia (DGD) in cooperation with the participating German medical and therapeutic societies developed a postgraduate curriculum for TM. This should serve as the basis for contents in TM and qualification of therapists within the framework of the delegation of medical services. The goals of the TM curriculum are the definition of theoretical and practical contents of TM, the qualification to perform TM according to current standards of care and quality assurance. The curriculum defines two qualification levels (user and trainer), entry requirements, curricular contents, examination and qualification criteria as well as transitional regulations for SLTs already experienced in TM.

[Curriculum "Tracheostomy management in dysphagia therapy"]. / Curriculum "Trachealkanülenmanagement in der Dysphagietherapie".

The number of tracheotomized patients with dysphagia and their need for treatment are continuously increasing in clinical and community settings. The revised version of the directive on home care and community-based intensive care of the Federal Joint Committee (G-BA) requires that tracheotomized patients are regularly evaluated with the aim of identifying and promoting the therapeutic potential after hospital discharge. Dysphagia treatment plays a crucial role as without improvement of severe dysphagia there is practically no possibility for decannulation. Tracheotomized patients with dysphagia are treated by speech and language therapists (SLT); however, the contents of tracheostomy management (TM) are not obligatory in the speech and language therapeutic training curricula, so that there is a need for further education and treatment standards must be secured. Therefore, the German Interdisciplinary Society for Dysphagia (DGD) in cooperation with the participating German medical and therapeutic societies developed a postgraduate curriculum for TM. This should serve as the basis for contents in TM and qualification of therapists within the framework of the delegation of medical services. The goals of the TM curriculum are the definition of theoretical and practical contents of TM, the qualification to perform TM according to current standards of care and quality assurance. The curriculum defines two qualification levels (user and trainer), entry requirements, curricular contents, examination and qualification criteria as well as transitional regulations for SLTs already experienced in TM.

Transesophageal Echocardiography - Dysphagia Risk in Acute Stroke (TEDRAS): a prospective, blind, randomized and controlled clinical trial.

BACKGROUND AND PURPOSE: Dysphagia is common in acute stroke and leads to worse overall outcome. Transesophageal echocardiography (TEE) is used in the diagnostic evaluation of stroke with regard to its etiology and is a known cause of postoperative dysphagia in cardiac surgery. The prevalence of dysphagia in acute stroke patients undergoing TEE remains unknown. The aim of the Transesophageal Echocardiography - Dysphagia Risk in Acute Stroke (TEDRAS) study was to assess the influence of TEE on swallowing among patients who have experienced acute stroke. METHODS: The TEDRAS study was a prospective, blind, randomized, controlled trial that included two groups of patients with acute stroke. Simple unrestricted randomization was performed, and examiners were blinded to each other's results. Swallowing was tested using flexible endoscopic evaluation of swallowing (FEES) at three different time points in the intervention group (24 h before, immediately after and 24 h after TEE) and in the control group (FEES on three consecutive days and TEE earliest after the third FEES). Validated scales were used to assess dysphagia severity for all time points as primary outcome measures. RESULTS: A total of 34 patients were randomized: 19 to the intervention group and 15 to the control group. The key findings of the repeated-measures between-group comparisons were significant increases in the intervention group for the following dysphagia measures: (1) secretion severity score (immediately after TEE: P < 0.001; 24 h after TEE: P < 0.001) and (2) Penetration-Aspiration Scale score for saliva (immediately after TEE: P < 0.001; 24 h after TEE: P = 0.007), for small (immediately after TEE: P = 0.009) and large liquid boli (immediately after TEE: P = 0.009; 24 h after TEE: P = 0.025). CONCLUSION: The results indicate a negative influence of TEE on swallowing in acute stroke patients for at least 24 hours.

First record and spreading of the invasive mosquito Aedes japonicus japonicus (Theobald, 1901) in Croatia.

Aedes (Hulecoeteomyia) japonicus japonicus (Theobald, 1901) has recently established across North America and Central Europe. A 3-year survey was conducted in northwestern Croatian regions from 2013 to 2015 using mosquito ovitraps at possible points of entry and house yards, occasionally complemented by larval collections from cemetery vases. In the first year, the survey investigated the county bordering Slovenia, where the first detection of Ae. j. japonicus had taken place on 28 August 2013. During the next 2 years, Ae. j. japonicus was detected in this area from early May until late October. In 2015, several counties further to the east were included in the survey, leading to the detection of Ae. j. japonicus approximately 100 km eastward from the initially surveyed region. Given a moderate continental climate and homogeneous climatic conditions in this part of Europe, the eastward spread of Ae. j. japonicus can be expected to continue.

Novel Genetic Variants in Carboxylesterase 1 Predict Severe Early-Onset Capecitabine-Related Toxicity.

An important concern with the anticancer drug capecitabine (Cp), an oral prodrug of 5-fluorouracil, are dose-limiting adverse effects, in particular hand-foot syndrome (HFS) and diarrhea. Here we evaluated the association of genetic variability in all enzymes of the Cp-activation pathway to 5-fluorouracil with Cp-related early-onset toxicity in 144 patients receiving Cp. We identified a haplotype encompassing five variants in the carboxylesterase 1 (CES1) gene region including an expression quantitative trait locus associated with early-onset Cp-toxicity (Haplotype A3: ORadditive = 2.2, 95% CI 1.2-4.0, Padjusted = 0.012; ORrecessive = 10.3, 95% CI 2.1-49.4, Padjusted = 0.0038). Furthermore, the association of two linked cytidine deaminase (CDA) promoter variants (c.1-451C>T: ORdominant = 4.3, 95% CI 1.3-14.2, Padjusted = 0.017; and c.1-92A>G: ORdominant = 4.4, 95% CI 1.3-14.5, Padjusted = 0.015) with Cp-related diarrhea was replicated. This first study identifying an association of genetic variation in CES1 with Cp-related toxicity provides further evidence for the existence of a functional noncoding CES1-variant with a possible regulatory impact.

The impact of ABCC11 polymorphisms on the risk of early-onset fluoropyrimidine toxicity.

A missense variant (c.1637C>T, T546M) in ABCC11 encoding the MRP8 (multidrug resistance protein 8), a transporter of 5-fluorodeoxyuridine monophosphate, has been associated with an increased risk of 5-fluorouracil-related severe leukopenia. To validate this association, we investigated the impact of the ABCC11 variants c.1637C>T, c.538G>A and c.395+1087C>T on the risk of early-onset fluoropyrimidine-related toxicity in 514 cancer patients. The ABCC11 variant c.1637C>T was strongly associated with severe leukopenia in patients carrying risk variants in DPYD, encoding the key fluoropyrimidine-metabolizing enzyme dihydropyrimidine dehydrogenase (odds ratio (OR): 71.0; 95% confidence interval (CI): 2.5-2004.8; Pc.1637C>T*DPYD=0.013). In contrast, in patients without DPYD risk variants, no association with leukopenia (OR: 0.95; 95% CI: 0.34-2.6) or overall fluoropyrimidine-related toxicity (OR: 1.02; 95% CI: 0.5-2.1) was observed. Our study thus suggests that c.1637C>T affects fluoropyrimidine toxicity to leukocytes particularly in patients with high drug exposure, for example, because of reduced fluoropyrimidine catabolism.

Serotesting of human Q fever distribution in Bosnia and Herzegovina.

Q fever is a zoonotic disease with worldwide distribution. It occurs in different geographic regions and climate zones. From 1990 till the end of 1997, only three infected individuals were registered in Bosnia and Herzegovina, during the year 1991, with the incidence of 0.05% 000. From 1996 onward, there was a sudden aggravation of epizoological and epidemiological situation in particular regions of Bosnia and Herzegovina. We performed serotesting during the 4-year period from 2000 to 2003. We tested serum samples from 708 individuals from different regions of Bosnia and Herzegovina. Q fever was serologically diagnosed in 249 individuals. The overall seroprevalence was 35.2%. The acute disease form was confirmed in 79.9% of the whole seropositive sample. Most of the Q seropositive individuals were from Kakanj (17.3%), Mostar (15.3%), Sarajevo (12.5%), Bihac (9.6%), Zenica (9.2%), Gornji Vakuf (8.9%), Tesanj (4.4%), Visoko (2.8%), and Travnik (2.4%). The number and distribution of seropositive individuals suggests that Q fever is endemic in Bosnia and Herzegovina.

Public health problem of zoonoses with emphasis on Q fever.

Zoonoses are animal and human diseases. Q fever is primarily a zoonosis-an animal disease that can be transmitted to humans under certain conditions. Recent epidemiological studies suggest that Q fever should be considered as a public health problem in many countries where it is present, but unrecognizable due to inadequate disease controls. Through specific serological diagnosis of clinically suspected human Q fever cases, we are trying to determine a level of general Coxiella burnetii (C. burnetii) exposition among populations in different regions of Bosnia and Herzegovina. This would be a contribution in controlling the present and the future disease outbreaks, as well as its prevention, which is one of the prime objectives of public health. During the period from January to June 2004, in the Laboratory of the Department for Microbiology in the Medical Faculty of the University of Sarajevo, of 58 tested sera from 48 clinically suspected individuals, we confirmed the presence of specific anti-C. burnetii antibodies in 30 sera (51.7%), from 25 seropositive individuals (52.0%), by means of indirect immunofluorescent antibody (IFA) testing. Urgent steps must be taken in public education to help decrease the risk of C. burnetii infection among at-risk populations in regions of Bosnia and Herzegovina.

Significance of Q fever serologic diagnosis in clinically suspect patients.

Q fever is caused by C. burnetii, an intracellular obligate bacterium. For clinical confirmation of Q fever, diagnosis of interstitial pneumonia is of significance. The acute disease varies in severity from minor to fatal, with the possibility of serious complications. Chronic endocarditis is a well-known outcome. Symptoms of Q fever can vary; fixing diagnosis is done by serology with the phase I and the phase II antibody. We tested 44 sera of 31 clinically suspect patients. From these, 22 patients were taken to the infection clinic, 8 to the pulmonary clinic, and one to the general hospital. From the 31 patients, 21 patients had one serum, 7 patients, 2 sera, and 3 patients, 3 sera. Blood samples were collected by vein puncture, and serum samples were kept at -20 degrees C until testing. All sera were processed by indirect immunofluorescent assay (IFA) Q fever IgM and IgG. Of 44 processed sera, 21 were seropositive. Specific IgM antibody was found in sera of 6 patients (19.4%), and specific IgG antibody in sera of 16 patients (51.2%). In sera of 15 clinically suspect patients (48.3%), no specific anticoxiella antibody was found. From these results we can confirm the importance of serology in laboratory diagnosis and clinical affirmation of suspect Q fever. Indirect immunofluorescent assay (IFA) is reliable and appropriate for daily, routine diagnosis of human Q fever.

[Serologic verification of epidemic hemorrhagic fever during the lifting of the blockade in Sarajevo]. / Seroloska potvrda epidemije hemoragicne groznice u toku deblokade Sarajeva.

OBJECTIVES: After four years of Sarajevo siege, the deblocade started on July 1995. Many soldiers involved in the deblocade developed a clinical symptoms of hemorrhagic fever indicating a possible epidemic. METHODS: Suspected patients were treated in the war hospital Igman-Fojnica. Blood samples of all the patients were processed on IgM and IgG antibodies with ELISA test, using "the double sandwich" technique. RESULTS: IgM and IgG were performed on Puumala (PVV), Hantaan (HTN) and Dobrava antigens. 38 out of 45 treated serums had high antibody titres. Sera of 28 patients had high titres of specific IgM antibodies on Hantaan antigen (12,800). A ten patients had a same titre level for specific antibodies of Puumala antigen. A 20 patients had specific IgG antibodies on Dobrava antigen with the titre 400. Our results confirmed the epidemic for which were responsible two serotypes of HFRS-PVV and HTN. They also proved the existence of a new serotypes appearing for the first time in Sarajevo region. This epidemic confirms that BiH especially Sarajevo region are among the biggest epidemic areas of HFRS in Europa.