Leprosy epidemics during history increased protective allele frequency of PARK2/PACRG genes in the population of the Mljet Island, Croatia.

INTRODUCTION: Two regulatory polymorphisms (rs1040079 and rs9356058) shared by PARK2 and PACRG genes were identified as major risk variants for leprosy susceptibility. The aim of this study was to investigate if allele frequencies of these polymorphisms in the isolated population of the island of Mljet, which served as a quarantine for leprosy patients during past centuries, were different to allele frequencies in two control populations with no history of leprosy. SUBJECTS AND METHODS: This study included 88 unrelated Caucasian individuals from the island of Mljet while two control groups included 93 individuals from the island of Rab and 160 individuals from the region of Split. Genotyping for rs1040079 and rs9356058 was performed by "real-time" PCR analysis. We also compared the allele frequency of the rs9356058 polymorphism from the population of Mljet with allele frequencies derived from the existing genome wide association scans in two additional island populations, Vis (924 subjects) and Korcula (909 subjects). RESULTS: We found a significant increase in the frequency of rs9356058 allele C in the population of Mljet when compared to both control groups. We also observed a significant increase in the frequency of rs1040079 allele A in the population of Mljet when compared with the population of Rab, however this increase was not significant when compared with the population of Split. Allele frequencies of both examined polymorphisms did not differ between the two control populations. Protective haplotype rs9356058-rs1040079 CA was also more frequent in the population of Mljet compared with the Rab and Split populations. In addition, an increase of frequency of rs9356058 allele C was also observed in the population of Mljet when compared with the frequency in the Korcula population. CONCLUSION: The results of our study show the association of polymorphisms rs9356058 and rs1040079 in gene PARK2/PACRG with leprosy. The results of our study indicate that exposure to leprosy and mortality in the population caused by leprosy on Mljet resulted in the selection of rs9356058 "protective" C allele in the PARK2 gene, while this was not observed in the two control groups. This is the first study to assess the genetic susceptibility to leprosy in a European population.

[Use of antimicrobial drug prescriptions in children with a common cold or diarrhea]. / Ucestalost propisivanja antimikrobnih lijekova kod djece oboljele od prehlade i/ili proljeva.

There are justified reasons to assume that antibicrobial drugs are too frequently prescribed in routine pediatric practice. The main aim of the study was to prove the frequency of antimicrobial administration to children. A total of 209 children of either sex and under 18 years of age with common colds and 95 children with diarrhea who were examined at the Primary Health Care Department of Hospital Konjic, Bosnia and Herzegovina for the period of Jan 1999-Apr 2000 were investigated for antimicrobial therapy. Antimicrobials were prescribed to 175 (83.73 per cent) patients with common cold and 78 (82.11 per cent) patients with diarrhea. Taking into consideration that the aetiology of these conditions was predominantly viral, the outcome of this study provides the evidence of irrational administration of antimicrobials and states the possible ones: diagnostic difficulties in routine pediatric practice, low educational level of physicians, lack of consulting skills, overworked primary health care physicians, influence of inpatient parents about prescribing antibiotics and influence of pharmaceutical industry. It is widely known that the negative effects of such superflous administration could leave numerous consequences to the patients health condition. Besides that, irrational use of the above mentioned drugs financially charges health system funds. It is therefore necessary to enhance consulting skills, to improve research and evidence based guidelines and monitoring strategies as well in order to support rational antimicrobial administration to children. The observation that irrational use of antibiotics was detected frequently with both common cold and diarrea suggests the need for continous monitoring and analyses of antibiotic administration to children from our region.

[Malaria in Croatia: in the past, today and tomorrow]. / Malarija u Hrvatskoj: nekad, danas i sutra.

Until 1964, when officially declared eradicated, malaria had been a major public health problem in Croatia. No autochthonous infections have been noted since 1958. Within ten year period after the eradication three cases were transmitted by transfusion. Until 1998, all other cases, a total of 308, were imported. Within last 10 years 119 cases were noted. The most of infections were caused by P. falciparum (n = 71, 59.66%), than by P. vivax (n = 31, 26.05%), and P. ovale, respectively (n = 1, 0.84%). Mixed infections were noted in 8 cases (6.73%), and the cause remained undetermined in 6 (1.68%). Seamen make the most of those who acquire primary malaria. There are some 30,000 seamen in Croatia. Some 10,000 are on foreign ships, therefore many data are definitely not available or incomplete. An average of 8 Croatian seamen get infected annually, but this number is supposed to be much greater. Mosquitos which are vectors for malaria exist in Croatia even today. Sporadic cases of autochthonous malaria in the neighboring countries, in which malaria was officially eradicated, are a warning that cases of autochthonous malaria might appear in Croatia, too. Due to the increased resistance to known antimalaria drugs including mefloquine, chemoprophylaxis when indicated, campaign against mosquitos, and control of persons who come from the malaria regions are determinants of control of malaria in Croatia, as in accordance with World Health Organization recommendations. Besides, further research of medically interesting insects, including the genus Anopheles, would be useful, at least in the coastal area of Croatia.

Hepatitis B in the family.

During a 3-year period (1992-1995), 239 index cases of hepatitis B virus (HBV) infection and 459 members of their households from the Osijek-Baranja county were examined. The aim of the study was to determine the spread of HBV infection in the families with a member verified as a virus carrier, and to identify the family members with the highest risk of infection according to kinship degrees. The retrospective and prospective methods were used in the study. The probable route of infection was assessed by the use of an epidemiologic questionnaire, and the serologic status of the study subjects concerning infection with HBV was determined by enzyme immunoassays (HBsAg, anti-HBs, anti-HBe and anti-HBc). The first member of a family identified as a virus carrier was considered an index case. HBV infection was demonstrated in 334 (47.85%) out of a total of 698 subjects. Only 21 (6.28%) of the 334 subjects with verified HBV infection developed the clinical picture of acute hepatitis B. The ratio of clinically manifest vs inapparent infection was 1:16. Serologic traces of infection were detected in 95 of the 459 family members of the index cases, yielding a mean rate of the infection among the virus carrier family members of 20.70%.

[Lyme borreliosis in Croatia from 1987 to 1998--epidemiologic aspects]. / Lajmska borelioza u Hrvatskoj od 1987. do 1998.--epidemioloski aspekt.

Lyme borreliosis is one of the most common diseases originating from natural foci in the Republic of Croatia. Some 200 cases are reported every year to the Epidemiological Department of Croatian National Institute of Public Health, but data from hospital treatment and individual limited research show that the number of infected is certainly higher. Officially reported cases have been used and analysed in this article. Although, aware of the limits of such a source, the results gained with this analysis point to certain epidemiological characteristics of Lyme borreliosis in Croatia, which can be useful. Clinical manifestations might vary, depending on the part of the world, i.e. type of Borrelia involved. In Croatia, skin manifestations are predominant--erythema (chronicum) migrans. The disease generally does not occur in Southern Croatia; it has been only sporadically reported in the area south of Zadar. Although the tick, the vector of this disease, can be found everywhere in Croatia, data about vector species and their presence in the coastal area are not complete or they are missing. Therefore, additional entomological, epidemiological, and clinical research are necessary to clarify the absence of Lyme borreliosis in Southern Croatia.