Rapid diagnosis of parasitic diseases: current scenario and future needs

Background

Parasitic diseases are one of the world's most devastating and prevalent infections, causing millions of morbidities and mortalities annually. In the past, many of these infections have been linked predominantly to tropical or subtropical areas. Nowadays, however, climatic and vector ecology changes, a significant increase in international travel, armed conflicts, and migration of humans and animals have influenced the transmission of some parasitic diseases from ‘book pages’ to reality in developed countries. It has also been noted that many patients who have never travelled to endemic areas suffer from blood-borne infections caused by protozoa. In the light of existing knowledge, this new trend can be explained by the fact that in the process of migration a large number of asymptomatic carriers become a part of the blood bank donor and transplant donor populations. Accurate and rapid diagnosis represents the crucial weapon in the fight against parasitic infections.

ICPC-2--international classification of primary health care and its application in Croatian health care

A consensus reached by the medical profession, Croatian Institute of Health Insurance, Croatian Institute of Public Health, and Ministry of Health constitutes a solution to the problem of a data standard required in building an information system for primary health care. This consists of accepting ICPC-2 as a data standard for our Family Medicine, Pediatrics and Women's Health. The classification structure of the International Classification of Primary Care allows, recommends and urges that special codes be established by individual states or local authorities when registering patients' reasons for seeking medical aid or medical procedures. Namely, it urges the authorities to set the codes for such reasons about which a state or local agreement or determination has been made. This is the first public presentation of the proposal Croatia's Additions to the International Classification of Primary Care. They are essential to its implementation in our health insurance, health statistics and medical informatics.     

National public health information system

Information production and its communication being a key public health activity, developing modern information systems is a precondition for its fulfilling these assignments. A national public health information system (NPHIS) is a set of human resources combined with computing and communication technologies. It enables data linkage and data coverage as well as undertaking information production and dissemination in an effective, standardized and safe way. The Croatian Institute of Public Health LAN/WAN modules are under development. Health Safety System, Health Workers Registry, and Digital Library are among the Institute's developmental priorities. Communication between NPHIS participants would unfold over the Internet by using every relevant data protection method. Web technology-based applications would be run on special servers. Between individual applications, use would be made of the transaction module of communication through an exchange of the HL7 standard-based xml messages. In the conditions of transition, the health system must make an optimal use of the resources, which is not feasible without applying modern information and communication technologies.     

Systemic fungal infections in immunocompromised patients

Opportunistic fungal infections are becoming more frequent complications during cancer therapy, after organ transplantation and in AIDS infections, especially after better control of bacterial infections in immunocompromised patients. Periods of prolonged neutropenia with neutrophil count less than 0.5 x 10(9)/L longer than 7 days, are the most important risk factors for the development of systemic fungal infections. Especially susceptible are the patients during treatment of acute leukemia, or after bone marrow transplantation. The most frequent causing agents of systemic fungal infections are Candida and Aspergillus species, than Cryptococcus neoformans and Mucor. Some other unusual species such Fusarium, Trichosporon, non-albicans Candida species of Candida are becoming more frequent, and is frequently resistant to conventional therapy. The difficulties in early and precise diagnosis of fungal infections, and the lack of adequate and efficient drugs are responsible for the high mortality of immunocompromised patients, even in potentially curable diseases. The recognition of risk factors, introduction of prophylactic measures, application of empirical antifungal therapy, are the procedures for the reduction of morbidity and mortality of invasive fungal infections. Fluconazole administration in prevention of systemic fungal infections, has become the standard approach, especially after bone marrow transplantation, while the oral itraconazole solution, has even more extended activity. Fluconazole appears successful also in the treatment of systemic Candidiasis. Conventional amphotericin-B is still the "gold standard" in the treatment of fungal infections. The new lipid formulations of amphotericin-B, intravenous itraconazole, has an identical efficacy, but are less toxic than conventional amphotericin-B. Several new promising agents are in the stage of clinical investigation like voriconazole, caspofungin, mycafungin and some other.     

脐血CD34+细胞体外定向诱导分化为T淋巴细胞的实验研究

目的：建立利用人造血干／祖细胞体外定向诱导分化为T淋巴细胞的方法，为研究T细胞生物学特性及细胞免疫提供技术平台。方法：MACS方法分离人脐带CD34^ 细胞接种到人胎儿胸腺基质单层细胞上，IMDM液体培养基含20％人AB血清并加入FL、IL-12、IL-7和IL-2细胞因子组合，于培养7、14、21、28、35、42天取非贴壁细胞利用流式细胞仪对细胞表型进行检测，并进行细胞形态学分析。结果：2周后，CD4^ CD8^ 非成熟T淋巴细胞占细胞总数的0．3％-13．3％，4-5周CD4^ CD8^ T淋巴细胞达到高峰占16．6％-26．5％，且CD3^ CD4^ CD8^ 和CD3^ CD4^-CD8^ T淋巴细胞逐渐增多，6周后达26．5％～64．9％和11．6％-38．9％。培养成熟的T淋巴细胞经PHA IL-2刺激后瑞氏染色鉴定可见大原始淋巴细胞存在。结论：利用人脐血CD34^ 在体外人胎儿胸腺基质单层细胞上加FL、IL-12、IL-7和IL-2细胞因子组合条件下，可诱导分化出T淋巴细胞，并且培养的T细胞对有丝分裂素刺激有增殖反应。     

Left Bochdalek hernia with delayed presentation: report of two cases

Left Bochdalek hernia is a serious and complex condition with high mortality. In most cases, it presents in the neonatal period and is seldom found later in life when symptomatology, usually after an asymptomatic period, is quite different and the prognosis excellent. The embryological development of left Bochdalek hernia suggests the presence of abdominal content in the left pleural cavity before birth. The type of clinical presentation and the prognosis depend on the time of visceral herniation. This study presents two cases of left Bochdalek hernia with delayed presentation. In both cases, after surgical reposition of the hernia, a small congenital diaphragmatic defect was found hidden between the rims of diaphragm. This indicates the possibility for the abdominal content to enter the left pleural cavity at the time of presentation.