BILATERAL ACUTE MACULAR NEURORETINOPATHY IN ACUTE COVID-19 INFECTION: A CASE STUDY.

AIM: The aim of the present paper is to describe the case study of a female patient with bilateral AMN, suffering from active acute infection with COVID-19. METHODS: A 32-year-old female patient with impaired vision bilaterally persisting for 2 days reported to the emergency Department of Ophthalmology at the Central Military Hospital in Ruzomberok, Slovakia. The patient manifested symptoms of COVID-19 infection persisting for 3 days before the onset of visual complaints. RESULTS: At the primary examination, initial best corrected central visual acuity was 20/40 bilaterally, paracentral scotomas were present more in the right eye. Upon examination of the ocular fundus, the edges of the optic nerve disc were out of focus more in the left eye; brownish red petaloid lesions were present around the fovea, the periphery was without pathological findings. OCT and OCTA were performed, with a conclusion of bilateral AMN upon a background of COVID-19 infection. Low molecular weight heparin (LMWH) was administered in a preventive dose. CONCLUSION: The number of documented ocular complications of COVID-19 infection, including microvascular events, is currently increasing.

Links between alcohol and external causes of deaths in males: an autopsy study.

OBJECTIVES: This study aimed to analyse deaths due to external causes in males in northwest Slovakia. STUDY DESIGN: This was a cross-sectional autopsy study. METHODS: The autopsy registry provided information on fatalities in males in northwest Slovakia due to external causes in 2015. Data were analysed by age, cause of death and blood alcohol concentration (BAC), and the contribution to overall mortality was calculated. RESULTS: From a total of 305 fatalities, the dominant cause of death was unintentional (other than traffic; 56.7%), followed by intentional (26.6%) and traffic (16.7%). A BAC of ≥0.5 g/kg was found in 43.9% of deaths. Lower levels of BACs (0.5-1.9 g/kg) were observed in relatively high proportions among the younger (aged ≤34 years) and older (aged ≥65 years) males (17.9% and 14.0%, respectively), as well as in the traffic and intentional injury cause of death categories (23.5% and 19.8%, respectively). Male deaths due to external causes had a 6.2% contribution to overall mortality in northwest Slovakia. CONCLUSIONS: Alcohol intoxication frequently co-occurs with fatalities from external causes, including at lower BACs, indicating the harmful role of alcohol at all concentrations.

Initial attachment of Borrelia burgdorferi spirochetes to Vero cells.

BACKGROUND: Adhesion is the initial process in the establishment of any infection and can contribute to bacterial pathogenesis. Without the ability to adhere to host cell surface, there is no invasion, dissemination, or persistence and host colonization by many bacterial pathogens, including B. burgdorferi. During the infection, B. burgdorferi cells interact with cells of various origins. We are having limited information and knowledge regarding the borrelial invasion, intracellular existence and the host cell damage and the pathological effects to the host. We have investigated by electron microscope the adherence of motile Borrelia burgdorferi s.l. to Vero cells derived from the kidney of an African green monkey by electronmicroscopy. These cells have been shown as an interesting model for study of the toxic potential of many bacterial pathogens. METHODS: Adherence of the long-term in vitro passaged Borrelia burgdorferi sensu lato strains to a 24-hour monolayer of primate kidney epithelial Vero cells was studied using transmission electronmicroscopy. The reaction was read after incubation at 1-hour intervals. RESULTS: A vertical contact between borreliae and Vero cells was confirmed already after one hour of in vitro incubation. A cytotoxic effect of borreliae could be observed when the time of incubation was extended to 4 hour. The extent of attachment varied between the two borrelia strains tested. CONCLUSION: The optimal time for spirochetal adhesion in our model was 1 h postinoculation. Our results suggest that borrelia attaches to the tested cells by length and by the tip. The data showed that the extent of attachment varied between the two borrelia strains tested (Tab. 1, Fig. 4, Ref. 21).

The impact of sound exposure on heart rate variability in adolescent students.

Previous studies of physiological responses to music and noise showed the effect on the autonomic nervous system. The heart rate variability (HRV) has been used to assess the activation of the sympathetic and the parasympathetic nervous systems. The present study was aimed to examine HRV with exposure to four sine-wave pure tones (20 Hz, 50 Hz, 2 kHz and 15 kHz) in an environment where the sound intensity exceeded level 65 dB (A-weighted). The participants (20 adolescent girls) were lying in supine position during exposure protocol divided into 6 periods, the first time with generated sounds and the second time without sounds. In the protocol without sound exposure, the low frequency band of the HRV spectrum was increased compared to the basal state before examination (period_1: 6.05+/-0.29 ms(2) compared to period_5: 6.56+/-0.20 ms(2), p<0.05). The significant increase of root Mean Square of the Successive Differences (rMSSD, period_1: 4.09+/-0.16 s compared to period_6: 4.33+/-0.12 s, p<0.05) and prolongation of R to R peak (RR) interval (period_1: 889+/-30 ms compared to period_5: 973+/-30 ms, p<0.001) were observed in the protocol without sound exposure comparing to the protocol with sound exposure where only bradycardia was observed. Contrary to rather polemical data in literature our pilot study suggests that sounds (under given frequencies) have no impact on the heart rate variability and cardiac autonomic regulation.

[Validation of a new tool for identification of barriers to cervical cancer prevention in Slovakia]. / Validácia nového nástroja pre indentifikáciu bariér v prevencii rakoviny krcka maternice na Slovensku.

OBJECTIVE: The aim of the work was to validate the Slovak version of the CPC-28 questionnaire (Beliefs about Papanicolaou and Cervical Cancer). DESIGN: Original study. SETTING: Department of Public Health, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, in co-operation with gynaecological centers in University Hospital Martin and district Martin, Slovakia. METHODS: The original English version of the CPC-28 questionnaire was translated into Slovak language. The questionnaire consists of 28 statements divided into six domains. Cronbach´s alpha coefficient was used to analyse the internal consistency of the questionnaire. Construction validity was evaluated by using Pearsons correlation coefficient. The results were processed in the statistical programs Epi Info 7.1.5. and Statistica 13, p-values < 0.05 were considered statistically significant. RESULTS: The Slovak version of the questionnaire was provided to 27 women. The women were given two questionnaires, and one of them was filled in immediately (test). After 14 days they filled in and returned second questionnaire (retest). The value of Cronbachs alpha was > 0.8 in all six domains which demonstrates the high internal consistency of the questionnaire. Pearsons coefficient was > 0.7 in all six domains and p-values < 0.001. CONCLUSION: The validated CPC-28 questionnaire in the Slovak language can be administered to women to collect data for identification of barriers to cervical cancer screening among women.

Biotechnological conversion of spent coffee grounds into lactic acid.

This work investigates the potential bioconversion of spent coffee grounds (SCG) into lactic acid (LA). SCG were hydrolysed by a combination of dilute acid treatment and subsequent application of cellulase. The SCG hydrolysate contained a considerable amount of reducing sugars (9·02 ± 0·03 g l-1 , glucose; 26·49 ± 0·10 g l-1 galactose and 2·81 ± 0·07 g l-1 arabinose) and it was used as a substrate for culturing several lactic acid bacteria (LAB) and LA-producing Bacillus coagulans. Among the screened micro-organisms, Lactobacillus rhamnosus CCM 1825 was identified as the most promising producer of LA on a SCG hydrolysate. Despite the inhibitory effect exerted by furfural and phenolic compounds in the medium, reasonably high LA concentrations (25·69 ± 1·45 g l-1 ) and yields (98%) were gained. Therefore, it could be demonstrated that SCG is a promising raw material for the production of LA and could serve as a feedstock for the sustainable large-scale production of LA. SIGNIFICANCE AND IMPACT OF THE STUDY: Spent coffee grounds (SCG) represent solid waste generated in millions of tonnes by coffee-processing industries. Their disposal represents a serious environmental problem; however, SCG could be valorized within a biorefinery concept yielding various valuable products. Herein, we suggest that SCG can be used as a complex carbon source for the lactic acid production.

Trends in standardized mortality rates for select groups of cardiovascular diseases in Slovakia between 1980 and 2010.

OBJECTIVES: Reducing mortality due to cardiovascular diseases especially in people less than 65 years is one of the main targets of WHO preventive programs. This work aimed to analyse recent trends in cardiovascular mortality rates in Slovakia. STUDY DESIGN: A descriptive study was implemented with a Joinpoint analysis. METHODS: Analysis was of annual all circulatory, acute myocardial infarction mortality, and cerebrovascular disease mortality rates, between 1980 and 2010 for Slovakia. Data were stratified by sex and 10-year age group (age 25-85 years). The annual percentage change (APC) and significant changes in the trend were identified using joinpoint Poisson regression. RESULTS: The standardized mortality rate for all cardiovascular diseases declined in Slovakia between 1980 and 2010 by 25.7% and 30.5% for men and women, respectively. Joinpoint analysis of all cardiovascular disease mortality rates demonstrated statistically significant changes in trends of APC decline for both genders. For men, acceleration in the rate of decline between 2001 and 2010 was observed APC -2.2 (95% CI = -3.5, -1.2) following a slowing of the rate of decline between 1980 and 2001, when the APC reached -0.5 (95% CI = -0.8, -0.3). For women the trend was similar. Between 2003 and 2010 acceleration in the decline was demonstrated APC -2.8 (95% CI = -4.3, -1.4). CONCLUSION: The results of our analysis demonstrate the need to constantly address issues of cardiovascular diseases, as mortality rates in Slovakia are among the highest within the European Union countries in the long term.

[Knowledge about cervical cancer among respondents in Slovakia and the Czech Republic - Aurora Project]. / Vedomosti respondentov na Slovensku a v Cechách o karcinóme cervixu - projekt Aurora.

OBJECTIVE: The Aurora Project, aimed at promotion of cervical cancer prevention, was realised with the support of the European Commission. The project included 14 partners from 11 EU countries. The objective of this contribution was to analyse the level of knowledge on cervical cancer among respondents in the project partner countries and to compare the situations in Slovakia and the Czech Republic. Data were obtained within one of the project outputs: Work Package 2 (WP2) Dissemination of Aurora Project Objectives and Results. METHODS: The questionnaire used included 10 questions (available at the project website www.aurora-project.eu) and has been translated into 11 languages of the project partners. In total, 2111 questionnaires were analysed (91.7% response rate), among them 246 were from Slovakia and 305 from the Czech Republic. Descriptive statistical methods and the χ2 test were used to analyse data. RESULTS: The level of knowledge in Slovak and Czech respondents was comparable in answers to seven questions. Statistically significant differences were observed in answers to questions about anatomy and cervical cancer therapy. Answers to the question, 'What are the symptoms of cervical cancer in the early stages?', should be considered as crucial to understand attitudes of the lay population towards prevention. There were 7% of women in the Czech Republic and 16% in Slovakia with the opinion that there is some clinical manifestation of such a condition. This means that women with such an opinion have no reason to visit a gynaecologist while no signs of a disease are present. The period during which they do not attend a preventive check-up is sufficient for the development of precancerous lesions or even cancer. CONCLUSION: Recommendations of doctors play a key role in primary and secondary prevention of the disease. An important part of interventions includes information campaigns and educational programmes. The internet is another important source of information, especially for younger generations. Together, these can contribute to increased participation in preventive check-ups by education of the general public. Thus, the disease can be detected early and the development of cervical cancer prevented.

[Occupational tuberculosis in Slovakia and in the Czech Republic]. / Profesionálna TBC na Slovensku a v Ceskej republike.

STUDY OBJECTIVE: To conduct a retrospective 15-year study to monitor trends in the number of employees at risk for occupational tuberculosis (TB) (levels III and IV) in the Slovak Republic, and in particular in the sector of economic activities Q (health care and social assistance). Furthermore, to analyze reported cases of occupational TB and to compare the incidence and sex-specific and age-specific prevalence with the data reported in the Czech Republic. MATERIAL AND METHODS: Data on the number of employees at risk of exposure to occupational TB were derived from the Automated Risk Classification System of the Slovak Republic. Data on cases of occupational TB were taken from health statistics (Institute of Health Information and Statistics/National Health Information Center in the Slovak Republic and the National Institute of Public Health in the Czech Republic). A retrospective analysis was conducted (for 1998-2012) of reported cases of occupational TB, selected from Article 24 of the List of occupational diseases (infectious and parasitic diseases except tropical infectious and parasitic diseases and diseases transmissible from animals to humans). The selection criterion was a TB diagnosis according to ICD-10. In the Czech Republic, the data were derived from Article 5.1.02 (tuberculosis), Chapter V. of the List of Occupational Diseases. The data obtained were analyzed by methods of descriptive statistics. RESULTS: The numbers of employees with a level III risk of exposure to occupational TB in the Slovak Republic declined by 30% over the 15 years of study and by 40% in category Q. In 2012, 2027 employees were classified in category III and 1442 of them belonged to group Q. Females accounted for 81-84% of employees at risk of exposure to occupational TB. Eighty-six and 181 cases of occupational TB were reported in the Slovak Republic and in the Czech Republic, respectively, in 1998-2012, with the incidence showing a downward trend in both countries. TB of the respiratory tract was reported most often (83.7% of the total of reported cases of occupational TB). As expected, more cases occurred in females than in males (1.9 times as many cases in females as in males in the Slovak Republic and three times as many cases in females as in males in the Czech Republic). The incidence of occupational TB was the highest in sector Q, with the highest absolute numbers reported in nurses. In 2012, the incidence rates of occupational TB were 0.22 cases per 100,000 sick benefit policy holders in the Slovak Republic and 0.13 cases per 100,000 sick benefit policy holders in the Czech Republic. CONCLUSION: The incidence of occupational TB has a downward trend in both countries, similarly to TB incidence in the general population. A negative aspect in both countries is the incidence of occupational TB at the middle productive age, in contrast to the population occupationally non-exposed to TB. Slovakia is surrounded by higher prevalence countries, with the exception of the Czech Republic. It cannot be ruled out that, in addition to the known factors influencing the prevalence of TB, including occupational TB, migration from eastern countries, including job search migration, can also play a role in increase in TB cases. It is vital to continue epidemiological surveillance and to reduce the risk of TB as much as possible also in healthcare settings by adhering to barrier nursing practices. Cases of active TB need early and adequately long, controlled treatment in order to reduce, among others, the incidence of multi-drug resistant TB.

[A point prevalence survey of healthcare-associated infections in the Slovak Republic - a part of the EU project]. / Bodové prevalencné sledovanie nozokomiálnych nákaz na Slovensku - súcast projektu Európskej únie.

AIM: The aim of this survey was to estimate the prevalence of healthcare-associated infections (HAI) in the Slovak Republic (SR), distribution of causative pathogens, and risk factors. METHODS: The point prevalence survey (PPS) of HAI in the SR was carried out in 40 acute care hospitals, according to a standardized methodology developed by the European Centre for Disease Prevention and Control (ECDC). Data were collected according to the standard protocol at the country, hospital, and patient levels. RESULTS: Of 8 397 patients included in the survey in the SR, 298 (3.5%) had HAI. The highest prevalence of HAI (12.4%) was found in the intensive care units (ICU) and Anaesthesiology and Intensive Care Medicine Units (AICMU). Nevertheless, intensive care medicine patients only represented 6.5% of all patients. The following six most common types of HAI accounted for 87.3% of all HAI: urinary tract infection (26.2%), pneumonia and other lower respiratory tract infections (22.0%), surgical site infection (15.7%), bloodstream infection (9.9%), infection of the eye, ear, and upper respiratory tract (8.3%), and skin and soft tissue infection (5.2%). The most often isolated pathogens were Escherichia coli (15.0%), Klebsiella spp. (12.5%), and Pseudomonas aeruginosa (10.8%). Of 8 397 surveyed patients, 60.5% had a medical device inserted: central vascular catheter (CVC)(3.4%), peripheral vascular catheter (PVC)(40.8%), urinary catheter (14.1%), or endotracheal tube (2.1%). The prevalence of HAI was higher in patients with than without a medical device inserted. CONCLUSION: By participating in the PPS, the SR has collected the most recent data on HAI and antimicrobial use in acute care hospitals. The adherence to the standard methods, standard definitions of HAI, and PPS protocol allows to repeat the survey, to analyse the HAI prevalence trend, and to take effective interventions.

Acrylamide in biological materials and methods of the analytical determination.

Acrylamide is a toxic water-soluble highly-reactive substance of anthropogenic origin. It is formed in foodstuffs containing asparagine and reducing carbohydrates during their thermal processing at high temperatures. The presence of acrylamide has been proven in numerous kinds of food; fried potatoes and cereal based products contained significant levels. Approximately one third of human daily energy intake is food with a higher content of acrylamide, which gives rise to high loading. It effects as neurotoxin in human organism and is suspected to be genotoxic and carcinogenic to humans. In a relatively short time since the detection of acrylamide in human nutriment, many of scientific studies focused on contaminated food. Many indefinite findings resulted from all the data about its toxicity, negative effects and occurrence in biological materials. Based on former monitoring intent on the quantitative determination of acrylamide in food chain, we would like to emphasize the importance of additional studies on its occurrence in human milk and other biological fluids. Upon the strength of results of acrylamide research up till now, the European Union has discussed setting of maximum levels for acrylamide in particular types of food (Ref. 21).

[Exotic pets as a potential source of Salmonella]. / Exotickí domáci milácikovia ako potenciálny zdroj salmonel.

STUDY AIM: To clarify the source of infection with the exotic serovar Salmonella Urbana and the route of transmission in a 2-year-old child. MATERIAL AND METHODS: To identify the source of infection and the route of transmission, we used epidemiological investigation of the case of salmonellosis and microbiological methods for the detection of Salmonella from biological specimens, epidemiologically suspected food, turtle tank water and feed, and serotyping of isolated strains of Salmonella. RESULTS: Salmonella Urbana was confirmed in a rectal swab of the infected child and in a sample of turtle tank water. Laboratory analyses of farm eggs eaten by the investigated family, of rectal swabs of the other family members and of a turtle feed sample did not reveal the presence of salmonellae. CONCLUSION: The confirmed source of Salmonella infection caused by the exotic serovar Salmonella Urbana in a two-year-old child were pet water turtles. In the case of the isolation of exotic serovars of Salmonella, the epidemiological and laboratory investigation needs to be aimed at the contact with pet animals, especially reptiles. It is desirable to raise the awareness of both the public and health professionals of this issue.

Results of the first studies of occurence of ochratoxin A in human milk in Slovakia.

Authors bring the work the purpose of which is to offer information about quality of human milk from the viewpoint of possible contamination with mycotoxin Ochratoxin A from the fist analyses in Slovakia. One of its main toxic effect is nephrotoxicity, immunotoxicity, neurotoxicity, teratogenity and carcinogenity. MATERIAL AND PROCEDURE: 76 samples of human milk from locality Martin and the corresponding zone were analysed by technique of High Performance Liquid Chromatography (HPLC) in conditions as mentioned below. RESULTS: Ochratoxin A was proved in 23 samples, 9 samples of the number with values from 2.3 +/- 0.99 ng/l to 60.3 +/- 25.93 ng/l, its occurence was at the level of quantification limit in the other 14 samples and it was undetectable in 55 samples of human milk. CONCLUSION: Up to now findings of our study have pointed out that Ochratoxin A can occur in human milk also in our conditions and determined values range between limits like those in Germany and Switzerland (Tab. 3, Fig. 1, Ref. 15).

Cost effectiveness and cost benefit of viral hepatitis B vaccination in the Slovak Republic.

In our work we tried to evaluate the cost effectiveness (CEA) and cost benefit (CBA) of the vaccination strategy of viral hepatitis B (VHB) vaccination in Slovakia. Retrospectively we analysed the incidence of VHB before and after the vaccination against VHB. From the calculated yearly cost (direct and indirect)--treatment costs and vaccination costs--we tried to calculate the estimated financial costs of vaccination strategy in 2000 (89.4 mil. SK), the saved costs (92 mil. SK), cost effectiveness (201 642 SK) and cost benefit (2.70 SK). First a decrease of the incidence (after introduction of measures to prevent nosocomial transmission) had been achieved by vaccination of selected risk groups of the population. A significant positive impact on the incidence of VHB is expected from mass preventive vaccination of infants, introduced in Slovakia in 1998.

[Intestinal parasites in children from the Turiec region in long-term monitoring. How should we proceed with further preventive parasitologic examinations?]. / Crevné parazity u detí regiónu Turiec v dlhodobom priereze. Ako d'alej s preventívnymi parazitologickými vysetreniami?

The results of preventive parasitological examinations for intestinal parasites in preschool and school children of the Turiec Region (Central Slovakia) in 1970-1999 are submitted. The study is divided into three cross-sections in the following decades (1970-1979; 1980-1989; 1990-1999). An acute decrease in geohelminths virtually to zero values has been found, as well as a significant decrease in intestinal protozoans. The occurrence of Enterobius vermicularis, despite its significant decrease in the recent decade, remains on a relatively high level. In the conclusion the authors discuss continuation of parasitological field examinations, and, on the basis of their 30-year experience, they submit their recommendations for the simplest and most effective way of such examinations.

[Health and economic benefits of mandatory regular vaccination in Slovakia. IV. Measles, rubella and mumps]. / Zdravotná a ekonomická návratnost' povinného pravidelného ockovania v Slovenskej republike. IV. Morbilli, rubeola a parotitis.

The epidemiological situation as regards measles, rubella and mumps in Slovakia before vaccination and after its introduction in 1996, is analysed. On the basis of model costs of treatment of these diseases before vaccination and costs of treatment in 1996 including costs of vaccination, the authors calculated the total saved costs (549.7 mil. Sk), cost-effectiveness (10,680 Sk), as well as the cost-benefit.

Epidemiological features and economic evaluation of a potential chickenpox vaccination strategy in Slovak Republic.

Cost effectiveness and cost benefit of a potential chickenpox vaccination strategy in Slovakia have been evaluated. As a base for comparison with potential vaccination strategy, direct and indirect costs of chickenpox incidence in Slovakia in 1996 were evaluated, using the EPIS data (Epidemiological Information System in Slovak Republic), and official annual analyse of epidemiological situation in Slovakia. According to their estimates, the authors consider the potential chickenpox vaccination as highly cost effective. The results of their analysis show that as the saved costs mostly indirect costs participate. With respect to the prevailing social impact of chickenpox also the funding of the future chickenpox vaccination is supposed to be shared by social insurance system.

[Analysis of bacterial meningitis in the Slovak Republic 1991-1998]. / Analýza bakteriálnych meningitíd v Slovenskej republike za roky 1991-1998.

The authors present the results of analyses of cases of notified bacterial meningitis in Slovakia in 1991-1998, focused on haemophilic meningitis. They demonstrate the ratio of different sources of infection on the development of disease--Haemophilus influenzae 214 cases (13.6%), Streptococcus pneumoniae 183 (11.6%), Neisseria meningitidis 343 (21.8%), other infectious agents 182 (11.5%) and negative cultivations 652 (41.4%). In children aged 0-5 years 668 cases were notified, i.e. 42.4% of the total number (1,574), in other age groups 906 cases, i.e. 57.6%. The mean notified morbidity of haemophil meningitis in 1991-1998 was 0.5/100,000 population. The highest age specific morbidity was in the group of children aged 0-5 years and varied from 2.5/100,000 in 1991 to 7.7/100,000 in 1998.

[Health and economic benefits of mandatory regular vaccination in the Slovak Republic. II. Poliomyelitis]. / Zdravotná a ekonomická návratnost' povinného pravidelného ockovania v Slovenskej republike. II. Detská obrna.

The authors compared intervention strategy (vaccination) and non-intervention strategy (no vaccination). For the evaluation of health and financial effectiveness of regular polio vaccination the authors used the modelling of treatment of polio cases in 1957, and vaccination costs in 1996--the most recent year with available statistical data from the Slovak Republic. From these model years they calculated: the cost saving (11,919,106 Sk), cost-effectiveness ratio (79,944 Sk) and the net cost of vaccination (3,047,786 Sk). Simultaneously, they present a breakdown of cost-benefit analysis.