Knowledge and Attitudes of Sexually Transmitted Infections Among High School Students in Sarajevo.

OBJECTIVE: The aim of the study was to evaluate knowledge and behavioural risks related to sexually transmitted infection (STIs) among high school students. METHODS: The cross sectional study was conducted among students aged 15-18 years old from two high schools in the Sarajevo Canton in the period from October 2017 to March 2018. An anonymous self-administered questionnaire was used. The survey investigated their socio-demographic characteristics, sexual habits and level of knowledge about STIs. The data were analysed using SPSS version 25 and MS Excel 2016. RESULTS: In total 278 high school students participated in the study, with a mean age of 17.79±1.026 years, of which 89 (32%) were male, and 189 (68%) were female. There was no significant difference in age in relation to sex distribution (P=0.074). Regarding the number of participants, 234 (84.2%) were from the dental school, while 44 (15.8%) were from a gimnazija (grammar high school). There was no significant difference in gender-based distribution by school (P=0.080). Students from the grammar high school had significantly better knowledge about the impact of STI on the foetus (P=0.025) and infected individuals (P=0.001), also about the impact of STI on sterility (P=0.005). CONCLUSION: Our study confirmed the need for implementation of sexual education programs in the final grades of elementary school or in first grades of high school, aimed at improving knowledge of sexually transmitted infections and improving sexual and reproductive health.

Panton-Valentine leukocidin and staphylococcal cassette chromosome mec characterization of community acquired methicillin-resistant Staphylococcus aureus.

OBJECTIVES: Staphylococcus aureus (SA) represents one of the most important microorganism that is part of the normal microflora of humans, but in certain conditions can cause very serious infections. Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for a wide spectrum of nosocomial and community associated infections worldwide. The aim of this study was to determine community acquired MRSA (CA-MRSA), as well as the frequency of Panton-Valentine leukocidin (PVL) genes and staphylococcal cassette chromosome mec (SCCmec) types in isolates obtained from outpatients in the region of 700,000 people (Canton Sarajevo, Bosnia and Herzegovina) Methods: Our investigation included phenotypic and genotypic markers such as antimicrobial resistance, pulsed-field gel electrophoresis (PFGE), SCC typing, and PVL detection. RESULTS: Antimicrobial susceptibility: all MRSA isolates were resistant to the ß-lactam antibiotics tested, and all isolates were susceptible to trimethoprim sulphamethoxazole, rifampicin, fusidic acid, linezolid, and vancomycin. After the PFGE analysis, the isolates were grouped into five similarity groups: A-E. The largest number of isolates belonged to one of two groups: C - 60% and D - 27%. In both groups C and D, SCCmec type IV was predominant (60% and 88.8%, respectively). A total of 24% of the isolates had positive expression of PVL genes, while 76% showed a statistically significantly greater negative expression of PVL genes. CONCLUSIONS: Using combination techniques, we were able to investigate the origin and genetic background of the strains. PFGE analysis revealed two large, genetically related groups of strains consisting of 87 isolates. Our results suggest failure to apply the screening policy, and a lack of knowledge about multiresistant MRSA strains. This study showed the local epidemiological situation which should be the basis of antimicrobial empiric therapy for non-hospitalized patients.

The Importance of Acinetobacter Species in the Hospital Environment.

INTRODUCTION: Acinetobacter species is associated with health care associated infections especially in patients on respiratory therapy equipment and indwelling catheters. They are becoming increasingly drug resistant. The knowledge of the prevalence and pattern of antimicrobial susceptibility pattern of Acinetobacter spp. is important. AIMS: The study is undertaken to estimate the prevalence rate, risk factors and antimicrobial resistance pattern of isolates. in Acinetobacter spp. from various clinical samples. MATERIAL AND METHODS: The isolates of Acinetobacter species obtained from various clinical specimen. Specimens were processed by standard microbiological techniques. Antimicrobial sensitivity tests of the Acinetobacter isolates were done by modified Kirby-Bauer disc diffusion method. RESULTS: Out of 622 isolates, 399 isolates were from inpatients (62,18%) and 223 were from outpatients (37,82%). More than 90% of isolates displayed resistance to ampicillin, amoxicillin-clavulanic acid, ceftazidime, caftriaxon and amikacin. Resistance to gentamicin, co-trimoxazole and ciprofloxacin were also common. Least resistance was seen to piperacillin-tazobactam and imipenem. A total of 125 Acinetobacter isolates were analyzed, out of which 78.4 % were multi-drug resistant (MDR). Of these MDR isolates, 17.24% were pan-resistant. A. baumannii was the most common species responsible for wound infection (84,8%), pneumonia(96,15%), abscess (72.7%), urinary tract infection (85,7%) and septicemia(89,5%). CONCLUSION: Multi-drug resistant Acinetobacter has emerged as an important nosocomial pathogen. Antibiotic susceptibility testing is critical in the treatment of infections caused by Acinetobacter. Continued surveillance of prevalent organisms in ICUs, combined with preventive measures remains absolutely essential in efforts to prevent or limit the spread of Acinetobacter infection.

The Most Frequent Isolates from Outpatients with Urinary Tract Infection.

OBJECTIVES: The main objective of the study was to identify the most frequent isolates from female outpatients with urinary tract infection. MATERIAL AND METHODS: The retrospective study was performed at the Department of Microbiology, Parasitology and Virology Faculty of Medicine, University of Sarajevo in period of 2015. The most frequent isolates were determined in 405 first urine samples from female outpatients of Hrasno community in Sarajevo, B&H. Identification of isolates was performed by the standard microbiological testing and the standard methods of descriptive statistics as well. RESULTS: E. coli was identified with the frequency of (67.21%), followed by Proteus spp. (9.83%), Enterococcus faecalis (7.37%) and Enterobacter (5.73%). Pseudomonas aeruginosa and Pseudomonas spp. were found in (2.45%), while the frequency of Klebsiella spp., Streptococcus spp. and Acinetobacter spp. was lower (1.63%). CONCLUSIONS: The isolated strains of E. coli pointed the highest frequency among female outpatients of Hrasno community.

Typing of Methicillin Resistant Staphylococcus Aureus Using DNA Fingerprints by Pulsed-field Gel Electrophoresis.

BACKGROUND: Methicillin resistant Staphylococcus aureus (MRSA) is responsible for a wide spectrum of nosocomial and community associated infections worldwide. The aim of this study was to analyze MRSA strains from the general population in Canton Sarajevo, B&H. METHODS: Our investigation including either phenotypic and genotypic markers such as antimicrobial resistance, pulsed-field gel electrophoresis (PFGE), SCC typing, and Panton-Valentine leukocidin (PVL) detection. RESULTS: Antimicrobial susceptibility: all MRSA isolates were resistant to the ß-lactam antibiotics tested, and all isolates were susceptible trimethoprim sulphamethoxazole, rifampicin, fusidic acid, linezolid and vancomycin. Sixty-eight per cent of the MRSA isolates were resistant to erythromycin, 5% to clindamycin, 5% to gentamicin and 4% to ciprofloxacin. After the PFGE analysis, the isolates were grouped into five similarity groups: A-E. The largest number of isolates belonged to one of two groups: C: 60 (60%) and D: 27 (27%). In both groups C and D, SCCmec type IV was predominant (60% and 88, 8%, respectively). A total of 24% of the isolates had positive expression of PVL genes, while 76% showed a statistically significantly greater negative expression of PVL genes. CONCLUSION: SCCmec type IV, together with the susceptibility profile and PFGE grouping, is considered to be typical of CA-MRSA.

THE FREQUENCY OF COMMUNITY-ACQUIRED METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (CA-MRSA) AMONG SAMPLES IN INSTITUTE FOR PUBLIC HEALTH IN CANTON SARAJEVO.

BACKGROUND: The increase in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections lacking risk factors for exposure to the health care system has been associated with the recognition of new MRSA clones known as community-associated MRSA (CA-MRSA). These strains have been distinguished from health care-associated MRSA (HA-MRSA) strains by epidemiological, molecular and genetic means as well as by antibiotic susceptibility profile, tissue tropism and virulence traits. OBJECTIVE: To assess prevalence and antibiotic susceptibility profile of CA-MRSA in Canton Sarajevo, Bosnia and Herzegovina. RESULTS: Out of 1.905 positive Staphylococcus aureus isolates from various samples of outpatients collected during six months, 279 (14,64%) were MRSA isolates. Out of 279 MRSA samples, 133 (47,67%) were found in nasal swabs, from which 48 (36,09%) were in the age group <1 year and 39 (29,32 %) are in the age 1-5 year. Rate of the positive skin swabs was highest among the subject of age group <1 year (46 or 54,12 %) and 1-5 year (18 or 21,18 %). Predominantly antibiotic types among MRSA strains are resistant to penicillin and cefoxitin (36,90 %) and to penicillin, cefoxitin and erythromycin (61,35 %). CONCLUSION: Continued monitoring of epidemiology and emerging drug resistance data is critical for the effective management of these infections.

Antibiotic Resistance in Urinary Isolates of Escherichia coli.

OBJECTIVES: The aim of this study was to examine the presence of antimicrobial resistance / susceptibility strains of Escherichia coli in inpatients and outpatients. MATERIALS AND METHODS: It is a retrospective study carried out at the Department of Microbiology, Parasitology and Virology Faculty of Medicine, University of Sarajevo. In cooperation with the Microbiological laboratory of the Cantonal Hospital Zenica and the Microbiological laboratory of the General Hospital Tesanj, 3863 urine samples were processed in the period from March 1st to March 31st 2016. RESULTS: Our study showed that E. coli had the highest antimicrobial resistance to trimethoprim / sulfamethoxazole (38.61%), followed by amoxicillin / clavulanic acid (19.62%), ciprofloxacin (9.49%), gentamicin (8.86%), cephalexin (8.23%), nitrofurantoin (8.23%), cefuroxime (7.52%), ceftazidime (6.33%), cefuroxime (89.87%), amikacin (4.43%). CONCLUSIONS: The isolated strains of E. coli showed the highest resistance to trimethoprim / sulfamethoxazole and amoxicillin / clavulanic acid. The isolated strains of E. coli showed the greatest susceptibility to amikacin and ceftazidime. Gender distribution of positive E. coli isolates showed statistically significant differences in favor of females.

Representation of Streptococcus Pneumoniae in Outpatient Population of Sarajevo Canton.

INTRODUCTION: Streptococcus pneumoniae in asymptomatic manner colonize the mucous membranes of the nasopharynx of children and adults, but can cause serious illness in the media which are naturally sterile. In 5-40% of healthy population this bacteria colonize the nasopharyngeal mucosa thanks to the surface adhesin protein, which allow the bacteria to attach to the epithelial cells. The normal nasopharyngeal microflora retains pneumococcus in a small number and does not allow it to express its pathogenic potential and cause disease. If this dominance of the normal microflora is violated, after adherence and local duplication, pneumococcus can spread to the middle ear, sinuses or lungs. Colonization is more common in children than in adults. GOAL: The goal of this study was to determine the prevalence of the carrier state and susceptibility of pneumococcal strains that circulate in the outpatient population of Sarajevo Canton as a potential source of infection. MATERIAL AND METHODS: In the microbiological laboratory of the Institute of Public Health of Canton Sarajevo in the period from July 1, 2013 until April 15, 2014 were analyzed swabs of the nose and nasopharynx, eye and ear from a total of 4109 outpatients. Swabs were inoculated on blood agar nutrient medium. Then was performed catalase test, preparation by Gram and susceptibility test on Optochin. Isolates positive for S. pneumoniae were subjected to in vitro assays to investigate the antimicrobial susceptibility/resistance. RESULTS: Out of 4109 analyzed swabs the pneumococcus positive was 180 (4.38%). Of these, 137 (76.11%) nasal and nasopharyngeal swabs, 33 (18.33%) of the eyes and 10 (5.56%) ear. The highest number of positive swabs were isolated in children aged 6 years and less, a total of 168 (93.33%), in children aged 7-13 years were positive 7 (3.89%), while among respondents aged 14-20 years only 5 (2.78%). CONCLUSIONS: The most common site for isolation of pneumococci is the nose and throat, and the most common carriers of these bacteria are children under 6 years of age. Determining the prevalence of the carrier state contributes to the improvement of preventive measures to reduce the risk of infection and possible sequels.

Antimicrobial Susceptibility/Resistance of Streptococcus Pneumoniae.

INTRODUCTION: Pneumococcal infections are a major cause of morbidity and mortality worldwide, whose treatment is threatened with an increase in the number of strains resistant to antibiotic therapy. GOAL: The main goal of this research was to investigate the presence of antimicrobial susceptibility/resistance of S. pneumoniae. MATERIAL AND METHODS: Taken are swabs of the nose and nasopharynx, eye and ear. In vitro tests that were made in order to study the antimicrobial resistance of pneumococci are: disk diffusion method and E-test. RESULTS: The resistance to inhibitors of cell wall synthesis was recorded at 39.17%, protein synthesis inhibitors 19.67%, folate antagonists 47.78% and quinolone in 1.11%. S. pneumoniae has shown drug resistance to erythromycin in 45%, clindamycin in 45%, chloramphenicol-0.56%, rifampicin-6.11%, tetracycline-4.67%, penicillin-G in 4.44%, oxacillin in 73.89%, ciprofloxacin in 1.11% and trimethoprim-sulfamethoxazole in 5.34% of cases. CONCLUSION: The highest resistance pneumococcus showed to erythromycin, clindamycin and trimethoprim-sulfamethoxazole and these should be avoided in the treatment. The least resistance pneumococcus showed to tetracycline, rifampicin, chloramphenicol, penicillin-G and ciprofloxacin.

Rat bone marrow stem cells isolation and culture as a bone formative experimental system.

Bone marrow mesenchymal cells have been identified as a source of pluripotent stem cells with multipotential potential and differentiation in to the different cells types such as are osteoblast, chondroblast, adipoblast. In this research we describe pioneering experiment of tissue engineering in Bosnia and Herzegovina, of the isolation and differentiation rat bone marrow stromal cells in to the osteoblast cells lineages. Rat bone marrow stromal cells were isolated by method described by Maniatopulos using their plastic adherence capatibility. The cells obtained by plastic adherence were cultured and serially passaged in the osteoinductive medium to differentiate into the osteocytes. Bone marrow samples from rats long bones used for isolation of stromal cells (BMSCs). Under determinate culture conditions BMSCs were differentiated in osteogenic cell lines detected by Alizarin red staining three weeks after isolation. BMSCs as autologue cells model showed high osteogenetic potential and calcification capatibility in vitro. In future should be used as alternative method for bone transplantation in Regenerative Medicine.

In vivo osteoinductive effect and in vitro isolation and cultivation bone marrow mesenchymal stem cells.

Bone marrow contains cell type termed mesenchymal stem cells (MSC), first recognized in bone marrow by a German pathologist, Julius Cohnheim in 1867. That MSCs have potential to differentiate in vitro in to the various cells lines as osteoblast, chondroblast, myoblast and adipoblast cells lines. Aims of our study were to show in vivo capacity of bone marrow MSC to produce bone in surgically created non critical size mandible defects New Zeland Rabbits, and then in second part of study to isolate in vitro MSC from bone marrow, as potential cell transplantation model in bone regeneration. In vivo study showed new bone detected on 3D CT reconstruction day 30, on all 3 animals non critical size defects, treated with bone marrow MSC exposed to the human Bone Morphogenetic Protein 7 (rhBMP-7). Average values of bone mineral density (BMD), was 530 mg/cm3, on MSC treated animals, and 553 mg/cm3 on control group of 3 animals where non critical size defects were treated with iliac crest autologue bone graft. Activity of the Alkaline Phosphatase enzyme were measurement on 0.5, 14, 21, 30 day and increased activity were detected day 14 on animals treated with bone marrow MSCs compared with day 30 on iliac crest treated animals. That results indicates strong osteoinduction activity of the experimental bone marrow MSCs models exposed to the rhBMP-7 factor Comparing ALP activity, that model showed superiorly results than control group. That result initiates us in opinion that MSCs alone should be alternative for the autolologue bone transplantation and in vitro study we isolated singles MSCs from the bone marrow of rat's tibia and femora and cultivated according to the method of Maniatopoulos et all. The small initial colonies of fibroblast like cells were photo-documented after 2 days of primary culture. Such isolated and cultivated MSCs in future studies will be exposed to the growth factors to differentiate in osteoblast and indicate their clinically potential as alternative for conventional medicine and autologue bone transplantation. That new horizons have potential to minimize surgery and patient donor morbidity, with more success treatment in bone regenerative and metabolism diseases.

[Agglutination as screening test in routine diagnostic of listeriosis]. / Aglutinacija kao skrining test u rutinskoj dijagnostici Listerioze.

INTRODUCTION: The persons with weakened immunity, newborn infants and pregnant women are very much sensitive on infection with bacteria Listeria monocytogenes. Listeria can readily invade the placenta and precipitate premature labor and fetal death. To confirm diagnosis is very difficult because listeriosis is disease very similar to the others acute diseases. Serum threshold values above 1: 320 confirm think about listeriosis when the relevant clinical symptoms are present. Of greater diagnostic relevance is the detection of a rise in titer. Therefore, it is always desirable to test a second sample (collected 2 to 3 weeks later) together with the first sample (stored in the deep-freeze). AIM: The aim of the study is to confirm the advance agglutination as a screening test in routine diagnostic Listeriae monocytogenes. MATERIAL AND METHODS: In testing were included 60 women in the reproductive age to divide in experimental group and control group. By agglutination serologic methods we researched if there is any antibody on Listeria monocytogenes with Listeria antigen. RESULTS AND DISCUSSION: From a total of 60 patients positive samples were 18 (60.00%) in experimental group (30) and 8 (26.70%) in control group (30). CONCLUSION: due to simple way of performing screening test of agglutination the same one are giving adequate antibiotic therapy in a case of positive serological response.

Serotesting of human brucellosis on wider area of Bosnia and Herzegovina.

The study involved 286 individuals from different regions of Bosnia and Herzegovina, whose sera were tested in the Laboratory for specific diagnosis of human brucellosis in Microbiology Department of Medical Faculty of University in Sarajevo, during the period from 2000. to 2003. Sera were tested using Brucelloslide Test, qualitative agglutination test Rose Bengal. Using the agglutination test, we serologically confirmed a diagnosis of human brucellosis in 59 (20.62%) seropositive individuals, whereof 38 (64.40%) men and 21 (35.60%) women. Individuals with human brucellosis were the most present in the age group of 31-40 (22.03%) and 41-50 (22.03%). One serologically confirmed death case was registered. The most seropositive individuals were from Zenica-Doboj Canton (32.20%), Sarajevo Canton (28.82%), Herzegovina-Neretva Canton (23.73%), Central Bosnia Canton (13.55%) and Una-Sana Canton (1.70%). During our four-year study, it was serologically confirmed that human brucellosis is present in Bosnia and Herzegovina and, through seropositive testing, we revealed the level of general exposition to Brucella spp. on wider area of Bosnia and Herzegovina.

Listeria monocytogenes as the possible cause of the spontanous abortion in female of the fertile age.

Listeria monocytogenes is a Gram-positive, weakly pathogenic bacterium able to grow also at the temperature of 40 degrees C. A man most often gets affected by consuming contaminated food and water. Animals can carry bacteria although they have not to appear ill, then their meat and milk products are the source of infection of human being. The disease most often attacks with the weak immune system, newborns and pregnant women. That what is significant, listeria penetrates through the placenta and can lead to the fatal infection, which is characteristic by disseminated granulomatosis lesions of a newborn and micro abscess on the placenta. In a newborn can provoke the sepsis with the mortality of 50%. By the examination are encircled two groups of the reproductive age-totally 60. From these 30 had one or more spontaneous abortion, and 30 had no spontaneous abortion. By the serologic reaction the agglutination is discovered the presence of the antibodies in serum of the. The positive serologic answer was found in the first group in 18 (60%) and in that another group in 8 participants (26, 70%).

[Listeria monocytogenes in women of reproductive age]. / Zastupljenost Listerie monocytogenes kod zena fertilne dobi.

OBJECTIVE: Listeria monocytogenes (LM) is gram-positive bacteria linear shaped which grows good also at refrigerator temperature (4 degrees C). The bacteria is resistant on high and low temperatures. This bacteria can be found in the dirt, rotted vegetation, vegetables and fruit, milk and dairy products, and also in the meat and processed meat. This bacteria cause disease called Listeriosis. This bacteria attacks at first people with weak immune system like infants, pregnant women, people with chronic diseases, people with HIV and people who are 60 and over. Pregnant women can transfer Listeria through the placenta, from mother to child and that can cause premature delivery, premature birth, early rupture of placenta or still born. GOAL: Find out if there is serological respond by female patients in the reproductive age who had spontaneous abortion and female patients in the reproductive age who never had the spontaneous abortion. By agglutination serologic method it had been researched if there is any antibody on Listeria monocytogenes. RESULTS: Two groups were included in testing: experimental and control group with a total of 60 patients. In experimental group there were 18 (60%) positive samples. In control group there were 8 (26.70%) positive samples. CONCLUSION: The results investigations have shown that there is serological respond to Listeria monocytogenes in the women of reproductive age. The number of positive patients was greater in women who had spontaneous abortion compared to women who never had the spontaneous abortion.

[Coxiella burnetii infections as the public-health problem]. / Coxiella burnetii infekcije kao javnozdravstveni problem.

THE AIM OF WORK: To evaluate the incidence of human Q-fever in individual regions of Bosnia and Herzegovina, to determine the prevalence and areas at risk of Q-fever incidence, to assess Q-fever seroprevalence and to demonstrate seroprevalence ratings in regard to relevant criteria (sex, age, location of residence). METHODS: The research has involved 708 individuals from different cantons, whose sera were tested in Laboratory for Specific Diagnosis of Human Q-fever on the Microbiology Desk of Medical Faculty of University in Sarajevo, during the period from July 2000-December 2003. Sera were tested by Indirect Immunofluorescence Assay (IFA), using commercial test kit, reagents for Q-fever IFA IgM and IFA IgG for in vitro diagnostic use (Focus technologies). THE RESULTS: Specific anti-C. burnetii antibodies were detected in 249 (35.2%) individuals, whereof 75 (30.12%) female individuals, and 174 (69.9%) male individuals. Individuals suffering from Q-fever were mostly included in 31-40 aged group (26.8%). Most seropositive individuals were from Zenica-Doboj Canton (35.4%), then from Herzegovinian-Neretvian Canton (22.9%), from Sarajevo Canton (14.5%), from Una-Sana Canton (11.6%), and from Middle-Bosnian Canton (11.6%). CONCLUSIONS: In our four-year study, it is serologically demonstrated that Q-fever is imminent in Bosnia and Herzegovina and that it is going to be the actual concern of public health. The number and distribution of seropositive individuals suggest that Q-fever is endemic phenomenon in Bosnia and Herzegovina.

Demonstration of different endocervical staining methods and their usefulness in the diagnosis of the chlamydial infection in exfoliated cells advantages and disadvantages.

Microscopic demonstration of chlamydial inclusions within cells offered the first laboratory procedure supporting the clinical diagnosis of chlamydial infection. Our aim is to evaluate the usefulness of different endocervical staining methods in diagnosis of Chlamydia trachomatis (CT) infection within exfoliated cells of the endocervix. The cytological test for the detection of chlamydial inclusions in genital tract infection, though not as sensitive and specific as isolation in the cell culture monolayers, is still of the diagnostic value. The present study discusses the collection of clinical smears for microscopic examination, their preparation; fixation and staining of slides by a variety of staining methods that have been used to detect Chlamydia in clinical smears and biopsies. Most of these methods such as Giemsa stain, Papanicolaou, iodine, and immunofluorescence (IF) using monoclonal antibodies, are based on the combination of dyes designed to obtain optimum differentiation of the various structures. The utilization of different endocervical smear stains together with the clinical information can be used to identify women at high risk for CT infection.