RESUMEN
Hepatitis E has become an emerging infection in many European countries. We analysed the prevalence of hepatitis E virus (HEV) infection in selected population groups in Croatia. Overall HEV IgG seropositivity was 5.6%, while 1.9% participants showed IgM antibodies suggestive of recent infection. No IgM-positive sample was positive for HEV RNA. HEV IgG antibodies were most prevalent in alcohol abusers (8.9%) and war veterans (8.6%), compared with 6.1% among injecting drug users and 2.7% in healthcare professionals. No individual with high-risk sexual behaviour tested HEV seropositive. HEV IgG positivity increased significantly with age from 1.8% to 2.3% in individuals younger than 40 years to 11.3% in individuals older than 50 years (P = 0.023). The mean age of HEV-positive participants was significantly higher than that of HEV-negative participants (50.9 ± 11.8 years versus 41.2 ± 11.8 years, P = 0.008). Seroprevalence rates were significantly higher in residents of suburban and rural areas compared with residents of urban areas (14.5% versus 2.5%, P = 0.003). Additionally, an increasing prevalence of HEV IgG antibodies was observed from 1.8% in participants living in families with two household members to 12.1% in those living with more than four members (P = 0.046). Gender, marital status, educational level, sexual orientation, source of drinking water, history of blood transfusions, surgical procedures, tattooing and travelling were not associated with HEV seroprevalence. Logistic regression showed that living in suburban/rural areas was the main risk factor for HEV seropositivity (OR = 6.67; 95%CI = 1.89-25.0; AOR = 7.14, 95%CI = 1.89-25.0).
Asunto(s)
Hepatitis E/epidemiología , Estudios Seroepidemiológicos , Adolescente , Adulto , Anciano , Anticuerpos Antivirales , Croacia/epidemiología , Femenino , Hepatitis E/sangre , Virus de la Hepatitis E/inmunología , Humanos , Inmunoglobulina G/sangre , Masculino , Persona de Mediana Edad , Proyectos Piloto , Adulto JovenRESUMEN
Hair of young subjects (N = 36) suspected for drug abuse was analysed for morphine, codeine, heroin, 6-acetylmorphine, cocaine, methadone, amphetamine, methamphetamine, 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxymethamphetamine (MDMA), and 3,4-methylenedioxyethylamphetamine (MDEA). The analysis of morphine, codeine, heroin, 6-acetylmorphine, cocaine, and methadone in hair included incubation in methanol, solid-phase extraction, derivatisation by the mixture of propionic acid anhydride and pyridine, and gas chromatography/mass spectrometry (GC/MS). For amphetamine, methamphetamine, MDA, MDMA, and MDEA analysis, hair samples were incubated in 1M sodium hydroxide, extracted with ethyl acetate, derivatised with heptafluorobutyric acid anhydride (HFBA), and assayed by GC/MS. The methods were reproducible (R.S.D. = 5.0-16.1%), accurate (85.1-100.6%), and sensitive (LoD = 0.05-0.30ng/mg). The applied methods confirmed consumption of heroin in 18 subjects based on positive 6-acetylmorphine. Among these 18 heroin consumers, methadone was found in four, MDMA in two, and cocaine in two subjects. Cocaine only was present in two, methadone only in two, methamphetamine only in two, and MDMA only in seven of the 36 subjects. In two out of nine coloured and bleached hair samples, no drug was found. Despite the small number of subjects, this study has been able to indicate the trend in drug abuse among young people in Croatia.
Asunto(s)
Anfetaminas/análisis , Codeína/análisis , Cromatografía de Gases y Espectrometría de Masas/métodos , Cabello/química , Narcóticos/análisis , Adolescente , Adulto , Femenino , Medicina Legal , Humanos , MasculinoRESUMEN
This paper presents guidelines for the diagnosis and treatment of schizophrenia. Diagnostic guidelines are based on ICD-10 criteria for diagnosis of schizophrenia. Treatment guidelines represent a synthesis of some recently published international algorithms and our own experiences. The guidelines were presented at the seminar organized by the Croatian Association for Clinical Psychiatry and represent professional recommendations of the Association for Diagnostics and Treatment of Schizophrenia. The treatment guidelines include psychopharmacological recommendations for the selection and dosage of antipsychostics, guidelines for psychosocial interventions and psychotherapy. The treatment of the first episode, exarcerbation, relapse of illness, as well as maintenance therapy, treatment resistance and side effects are included.
Asunto(s)
Esquizofrenia/diagnóstico , Esquizofrenia/terapia , Antipsicóticos/efectos adversos , Antipsicóticos/uso terapéutico , Terapia Electroconvulsiva , Humanos , PsicoterapiaRESUMEN
AIM: To investigate the prevalence rate of post-traumatic stress disorder (PTSD) comorbid psychiatric disorders and to explore psychotic symptoms in patients with combat-related current PTSD. METHOD: The sample included Croatian war veterans (N=41) who were hospitalized at the University Department of Psychiatry of the Vrapèe Psychiatric Hospital during the 1995-1996 period and fulfilled the DSM-IV criteria for the current and chronic PTSD. The Schedule for Affective Disorder and Schizophrenia (SADS-L) was applied for the assessment of current and lifetime psychiatric disorders. Only three subjects had a prewar Axis I psychiatric disorder. One third of the patients met the criteria for personality disorder. RESULTS: After severe combat trauma, the majority of PTSD patients (33/41) had at least one comorbid psychiatric diagnosis on Axis I. In those with personality disorders the most frequent was alcohol dependence, whereas in those without personality disorders it was major depressive disorder. Psychotic symptoms occurred in 8 out of 41 PTSD patients. None of them had a primary psychotic disorder or a personality disorder. In all the patients, psychotic symptoms were different from flashbacks. They were symbolically related to the trauma and resistant to antipsychotic treatment. Psychotic symptoms were associated with depression in 5 out of 8 patients with psychotic symptoms. CONCLUSION: Severe and prolonged combat trauma may be followed by the co-occurrence of PTSD and psychotic symptoms, forming the atypical clinical picture of PTSD.