ISSN 2224-4980 International Journal of ...

ISSN 2224-4980

International Journal of Ecosystems and Ecology Science (IJEES)

Essays on Ecosystems and Environmental Research Volume 5/1, 2015

February, 2015 https://sites.google.com/site/injournalofecosystems/template

International Journal of Ecosystems and Ecology Science (IJEES)

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International Journal of Ecosystems and Ecology Science (IJEES), ISSN: 2224-4980 Volume 5, Issue 1, February, 2015, (Serial Number 17)

Editor - in - Chief: Hysen Mankolli, Professor, Ecologist, Plainfield, Illinois, USA;Health and Environment Association, Tirana Albania; Earth System Science Interdisciplinary Center (ESSIC), University of Maryland College Park, USA, Consultant Scientist; Co-Editor - in - Chief: Sukru Dursun, Professor, Selcuk University, Engineering and Architecture Faculty, Environmental Engineering Dep., Konya-Turkey; Massimo Zuchetti, Professor, MIT, Massachusetts Institute of Technology, Cambridge MA, USA; Editorial Board: Sukru Dursun, Professor, Selcuk University, Engineering and Architecture Faculty, Environmental Engineering Dep., Konya-Turkey; Massimo Zuchetti, Professor, MIT, Massachusetts Institute of Technology, Cambridge MA, USA; Veselin Alexandrov, Professor, National Institute of Meteorology and Hydrology, Bulgaria; Nicola Senesi, Professor, University of Bari, Bari, Italy; Wander Michelle M, Professor, University of Illinois at Urbana-Champaign,Urbana,Urbana, IL 61801,USA; Vladimir Pesic, Professor, University of Montenegro, Department of Biology, Podgorica Montenegro; Ibraim Dincer, Professor, University of Ontario, Faculty of Engineering and Applied Science, Ontario, Canada; Ali Berktay, Professor, Selcuk University, Dept of Environmental Eng, 42031 Konya Turkey; Mariana Golumbeanu, PhD, National Institute for Marine Research and Development "Grigore Antipa", Constanta, Romania; Antonis K. Kokkinakis, Professor, Aristotle University of Thessaloniki, Faculty of Forestry and Natural Environment, Thessaloniki, Greece; Olivia Cioboiu, PhD, The Oltenia Museum Craiova, Popa Şapcă str. No 8, Rumania; Nasser Modirshahla, Professor, Islamic Azad University, Department of Applied Chemistry, Iran; Nina Liogchii, Professor, Institut of Ecology and Geografy, Republic of Moldova; Trajce Talevski, Professor, Hydrobiological Institute, Naum Ohidski 50, 6000 Ohrid - R.Macedonia; Alexander V. Derunkov, Professor, Department of Entomology, National Museum of Natural History, MRC-168 Washington, DC, USA; Can Ozgur Colpan, PhD, Ryerson University, Canada; Muhammad Ashraf, Professor, University of Agriculture, Faculty of Sciences, Faisalabad 38040, Pakistan.; Roberto Mancinelli, Professor, University of Tuscia,Viterbo, Italy; Bahrive Gulgun, Professor, Ege University, Izmir, Turkey; Shukri Fetahu, Professor, Pristine University, Kosovo; Insaf Mekki, PhD, National Research Institute for Rural Engineering, Water, and Forestry (I.N.R.G.R.E.F), Ariana, Tunisia; Hany Gaber El Shaer, PhD, IUCN Centre for Mediterranean Cooperation / Global Marine, Egypt; Ertugrul Esmeray, Ph.D, Karabuk University, Engineering Faculty, Environmental Engineering Department Turkey; Violeta Vidaček-Hainš, PhD, Ass. Professor, University of Zagreb, Croatia; Cezar Kongoli, PhD, Research Scientist at Earth System Science Interdisciplinary Center (ESSIC), University of Maryland College Park, USA; Justas Kažys, PhD, Ass. Professor, Vilnius University, Department of Hydrology and Climatology, Vilnius –Lithuania; Selim Dogan, PhD, Selcuk University, Environmental Engineering Department, Konya Turkey; Hisham Mostafa Alidrisi, PhD, Ass. Professor, Department of Industrial Engineering, Engineering College, King Abdulaziz University, Jeddah Saudi, Arabia; Khalid A. A. Al-Ghamdi, PhD, Ass. Professor, Department of Industrial Engineering, Engineering College, King Abdulaziz University, Jeddah Saudi, Arabia; Osman Taylan, PhD, Ass. Professor, Department of Industrial Engineering, Engineering College, King Abdulaziz University, Jeddah Saudi, Arabia; Robert J. Kuligowski, National Oceanic and Atmospheric Administration (NOAA), National Environmental Satellite Data and Information Service (NESDIS), NOAA Center for Weather and Climate Prediction (NCWCP), College Park, MD, USA; Narayan Ramappa Birasal, Associate Professor, Zoology Department, KLE Society’s G H College, HAVERI – 581 110, Karnataka state, India; Rana P. Singh, Professor, Department of Environmental Science, Babasaheb Bhimrao Ambedkar University, Lucknow-226025, U.P., India;

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Publication Information: International journal of ecosystems and ecology science (IJEES), ISSN 2224-4980, publishing original articles, reviews and short communications of high scientific standard on ecosystems and science ecology. By: Hysen Mankolli, Professor, Ecologist, Plainfield, Illinois, USA; Health and Environment Association, Tirana, Albania; ISSN International Centre, Bibliographic Data Section, PARIS, FRANCE Bib - ID 68337 ; ISO standard 3297 Key title: International journal of ecosystems and ecology science Abbreviated key title: Int. j. ecosyst. ecol. sci. ISSN 2224-4980, Frequency: three times a year. IJEES Electronic Journal Publication: 24354 Leski Ln. Plainfield, Illinois, USA This journal has the status of an international journal.

Aims and Scope: The goals of the International journal of ecosystems and ecology science (IJEES), ISSN 2224-4980, are to bring together researchers and scientists with interests in the quality of the ecosystems research results, theories, technologies, systems, tools, applications, the work in progress and experiences on ecosystems used. The main topics of interest are:                           

Ecosystems Agro ecosystems Forest ecosystems Ecology Lakes and Rivers ecosystems Applied Biology Applied Chemistry Biodiversity Energy Geology Bioaccumulation Desalination Water Soil Air pollution Climate Change Ecosystem restoration Environment toxicology Environment protection Environmental radioactivity; Environmental legislation; Environmental management; Environmental education. Green technology Socioeconomic aspects in ecosystems Agro tourism and National Park Health Care

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Manuscripts and correspondence are invited for publication. Dear Professors, PhD, researchers and scholars of the field of ecosystems and related areas to, such as environmental engineering, agriculture, bio-chemistry (soil, water, air),pollution, geology, forestry, urban ecology, resource economics, etc., at the moment, I declare the sending of scientific journal articles to International Journal of Ecosystems and Ecology Science (IJEES) is open. Sending of items can only be done electronically, to the following address: E-mail: [email protected]; [email protected]; The confirmation of receiving these items will be announced within the period of three weeks after sending. Weather the article is accepted or not, will be announced within a period of six weeks. Only original articles will be accepted, validated, and not to have or be published in other journals. Publication lasts from three to six months. Submission guidelines and Web Submission system are available at: https://sites.google.com/site/injournalofecosystems/template/guide-for-authors.

Editorial Office: IJEES Electronic Journal Publication: 24354 Leski Ln. Plainfield, Illinois, USA; E-mail: [email protected]; Health and Environment Association, Tirana, Albania; E-mail: [email protected];

© IJEES copyright. All rights reserved. Health and Environment Association, Tirana, Albania Publisher; hold the exclusive copyright of all the contents of this journal. In accordance with the international convention, no part of this journal may be reproduced or transmitted by any media or publishing organs (including various websites) without the written permission of the copyright holder. Otherwise, any conduct would be considered as the violation of the copyright. The contents of this journal are available for any citation. However, all the citations should be clearly indicated with the title of this journal, serial number and the name of the author. Price per article published online Regular: $140 or euro 100 and article published out of order in a short time: $280 or euro 200; To send online full journal: $560 or euro 400; *Subscription for online access to a single article by non-authors has a price of $140 or euro 100; Health and Environment Association, Tirana, Albania; Tel: 0035542258730; Fax:03554258730;E-mail:[email protected]; Electronic Journal Publication:24354 Leski Ln., Plainfield, Illinois, US; Tel:1-815-267-3458. Fax:1-815-267-3458; E-mail:[email protected];

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International Journal of Ecosystems and Ecology Science (IJEES) Volume 5/1, 2015 Table of contents: Olivia Cioboiu, Gheorghe Brezeanu, THE DANUBE – CONTROLLING FACTOR OF THE ECOLOGY OF THE DANUBE DELTA AND THE BLACK SEA , page 1-6; Ionelia Claudia Goga, Constanţa Tîmburescu, THE PRESENCE OF THE PARASITE MYXOBOLUS SP. (MYXOZOA: MYXOBOLIDAE) AT THE SPECIES CARASSIUS AURATUS GIBELIO FROM THE SHALLOW RESERVOIRS WITHIN THE LOWER HYDROGRAPHIC BASIN OF THE JIU RIVER (DOLJ – ROMANIA), page 7-10; Ala Donica, Adam Begu, Nina Liogchii, HABITATS DIVERSITY OF ADONIS VERNALIS SPECIES OF THE REPUBLIC OF MOLDOVA, page 11-16; Bahriye Gülgün1, Mediha Abdioğlu1, Kübra Yazici, Şükrü Dursun3, ALTERNATIVES OF THE GREEN TISSUE IN THE CITY CENTRES, page 17-22; Azeta Tartaraj, PRIVATE HOSPITAL MARKETING IN HEALTH SYSTEM OF ALBANIA, page 23-28; Teuta Bare1, Anila Mitre1, Ervis Vata1, Endrin Shkurti1, Odeta Hoxhaj1, Nikita Manoku1, BIOMARKERS AND CERVICAL LENGTH TO PREDICT SPONTANEOUS PRETERM BIRTH IN HIGH-RISK WOMEN, page 29-34; Edlira Tako1, Altin Mele2, Valbona Plaku (Hoxha)1, Krenaida Taraj2, ADSORPTION OF LEAD IONS ON NATURAL AND ACID ACTIVATED PRRENJAS MONTMORILLONITE CLAY, page 35-42; Adela Vasili1, Agim Shehi1, Silvia Bino1, SYNDROMIC SURVEILLANCE OF SEXUALLY TRANSMITTED INFECTIONS IN ALBANIA, page 43-46; Begu Adam, THREATENED PLANT SPECIES AND HABITATS FROM THE PRUT RIVER BASIN, REPUBLIC OF MOLDOVA, page 47-54; Sead Noćajević1 Midhat Jasić2 Alma Mićijević1 Sabina Begić2, CONTRIBUTION TO THE STUDY OF WILD CHERRY SEEDLING FEDERATION OF BOSNIA AND HERZEGOVINA, page 55-60; Eugena Tomini1, Mimoza Basho1, Shpëtim Qyra1, Eleni Anastas2, Artan Simaku1, Imelda Zeqo3, Jonilda Sulo1, Silva Bino1, BIOLOGICAL SURVEILLANCE OF INFECTIOUS AGENTS AMONG MULTITRANSFUSED PATIENTS IN ALBANIA, page 61-66; Eda Bezhani, TRADE EXCHANGE FROM CEFTA COUNTRIES: CASE OF ALBANIA, page 67-72; Armand Shehu1, Migena Kika2, Afërdita Tako1, Sonila Tomorri1, Robert Rado3, Aida Bushati1, Valentina Tashko4, EPILEPSY IN CHILDREN WITH AUTISM SPECTRUM DISORDERS, paper 73-76; Lulezim Lekaj1, Ardian Dajti1, Ardian Ymeri1, Gezim Galiqi1, Shpetim Ymeri1, Bledar Shega1, Edmond Çeliku2, SURGICAL MANAGEMENT OF THYROID NODULES, page 77-82;

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Edi Smajlaj1, Sabit Brokaj2, EVALUATION OF RISK FACTORS IN ACUTE MYOCARDIAL INFARCTION PATIENTS ADMITTED TO THE CORONARY CARE UNIT, page 83-86; Agim Dokaj1, Tahir Hysa2, MAMMOGRAPHIC SCREENING MICROCALCIFICATIONS AND EARLY BREAST CANCER, page 87-90;

IN

THE

DETECTION

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Belshaku, M1*, Xhemaj, E2, Beqiraj, I3, MONITORING OF SULPHUR CONTENT IN DIESEL IMPORTED IN ALBANIA AND ENVIRONMENTAL IMPACT, DURING THE PERIOD 2007 – 2012, page 91-96; Klodeta Muçaj1, Irida Pano1, Orgeta Dervishi1, Migena Gega1, HYPERTENSIVE CRISIS IN EMERGENCY ROOM, page 97-100; Orgeta Dervishi1, Klodeta Muçaj1, Migena Gega1, Vilma Mema2, DIABETIC RETINOPATHY IN A TERTIARY HOSPITAL, page 101-106; Rrahim Sejdiu1*, Arben Bejtja2, Agron Bajraktari1, CALCULATION OF COST DURING TIMBER KILN DRYING IN KOSOVO, page 107-110; Arla Juma1, Blerta Kika2, SURVEY FOR ANTIBODIES TO COXIELLA BURNETII IN SELECTED POPULATIONS OF DOMESTIC ANIMALS IN ALBANIA, page 119-122; Damiana Osmalli1, Artan Simaku1, PREVALENCE AND ANTIMICROBIAL PROFILE OF METHICILLINRESISTANT STAPHYLOCOCCUS AUREU, page 123-128; Desantila Tahiraj1, Ermira Vasili2, THE COMMON ALLERGENS OF CONTACT DERMATITIS, page 129134; Floreta Korumi1, Gjeorgjina Kuli-Lito1, Raida Petrela1, Hamide Hoxha1, Eli Kallfa1, THE PATTERN OF PAEDIATRIC EMERGENCY VISITS FOR INFECTIOUS DISEASES, page 135-138; Dijana Blažeković Dimovska1, Aleksandar Cvetković2, Stojmir Stojanovski3, COMMON CARP (CYPRINUS CARPIO L.) PRODUCTION IN CYPRINID FISH BREEDING FACILITIES IN PELAGONIA (BITOLA, MACEDONIA), page 139-144; Arsen Hoxha1, Tahir Hysa2, EPIDEMIOLOGY OF SOFT TISSUE TRAUMAS IN DISTRICT OF SHKODRA, page 145-152;

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International Journal of Ecosystems and Ecology Sciences (IJEES) Vol. 5 (1): 1-6 (2015) _____________________________________________________________________________________________

THE DANUBE – CONTROLLING FACTOR OF THE ECOLOGY OF THE DANUBE DELTA AND THE BLACK SEA Olivia Cioboiu, Gheorghe Brezeanu The Oltenia Museum, Craiova, Romania; The Biology Institute of the Romanian Academy, Bucharest, Romania; Email: [email protected]; [email protected];

Received August, 2014; Accepted December, 2014

ABSTRACT

The Danube represents the essential factor that influences the main ecological characteristics of the Danube Delta and, mostly, of the Black Sea. The hydrological, physical-chemical, and hydro-biological quantitative and qualitative variations bring to the modifications of the biotic and abiotic structures of the Danube Delta and the Black Sea in a rhythm and concordancxe with the dynamics of the physical-chemical and biological parameters specific to the Danube. Starting from this point, it can be noticed the controlling character of the ecology of the Danube Delta and the Black Sea. This fact appears more obvious in the conditions of the last 50 years, when the large pollution of the river led to radical ecological modifications within the Danube Delta and the Black Sea, during a very short historical period. The main factor, which determined fundamental modifications in the structure and functionality of the aquatic ecosystems is due the intensification of the man-induced eutrophication process. Phytoplankton increased, but submerged macrophytes disappeared at the same time with certain populations of invertebrates and species of fish that populated the associations of macrophytes. Key words: the Danube Delta, the Black Sea, control factor, phytoplankton.

INTRODUCTION

The Danube, the Danube Delta, and the Black Sea are geographical units, which form an assembly, where the component parts are linked through multiple relations: physical-chemical, hydrological, biological. These relations determine the dynamics of their evolution. Thus, their reciprocal influence determines the evolution of each part. Within this assembly, which belongs to the hydrographical basin of the Black Sea, the Danube represents the main factor in the formation and evolution of the Delta and the Sea. The Paleo-Danube is the one that led to the appearance of the sea and the Delta forme don a limnic golf through the interaction of the sea an driver. When the Danube Delta and the Black Sea appeared as distinct geographical entities, within the hydrographical basin of the Black Sea, the Danube became the main factor of their ecological evolution (Fig. 1). Grigore Antipa (1910) was the first who deciphered the natural mechanisms, which brought to the consolidation of the Delta, to the formation and diversification of the ecosystems types, underlining the role of the ecological factors in this process. At the same time, the history of the ecological evolution of the Black Sea emphasize the major part played by the Danube in determining and functioning of the sea biocoenosis structures (Antipa 1915; Brezeanu et al. 1999, 2011).

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Olivia Cioboiu, Gheorghe Brezeanu ______________________________________________________________________________________________________________________________________________

Figure 1. The Danube (Km 2826 – 0) (after ICPDR, Vienna).

RESULTS

The impact of the physical-chemical factors. In order to emphasize the role of the Danube in controlling the ecology of the Delta and the Black Sea, is has to be known those quantitative and qualitative factors through which the river influence and act upon the Delta and the Black Sea. The surface of the Danube basin is of 817.000 Km2. Within this area, the river receives 120 main tributary rivers (Fig. 1). Through the amount of water carried by its tributary rivers, the average discharge of the Danube is of 6.283 m3/sec. The maximum discharge reaches 13.000 m3/sec, while the minimum discharge is of about 3.000 m3/sec. The Danube lets to the Delta a discharge of 620 m3/sec (approximately 0.5 % of the total discharge). The variation of the Danube discharge represents a factor that controls the entire hydrological mechanism of the Delta. During the period of maximum discharges, the water of the river floods the higher areas of the Delta, pushes the older water from channels and lakes, and replaces it with fresh water from the river. In the present stage, the quantity of alluvia carried by the river is of 1.737 Kg/sec, respectively, 55 million t/year (average values). From this quantity, 1.430.600 t/year of alluvia are deposited within the Delta, while the rest of the quantity is carried to the sea. This i sone of the main causes of the colmatation of the lakes, bringing to their ageing and transforming into swamps. During the present stage, which includes the last 50 – 60 years, the quantity of alluvia (especially sand) carried by the Danube into the Black Sea decreased with about 25 – 30 % due to the fact that alluvia were deposited within the basins built both along the Danube and its tributary rivers. This is the cause, which brought to the diminution of the quantity of sand deposited on beaches; thus the sea advanced towards the land and the shore erosion intensified. The mineral salts brought by the river play a major part in the controlling of the structures and functioning of the biocoenosis, of the populations of plants and animals. As a direct consequence of the increase of the pollution

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International Journal of Ecosystems and Ecology Sciences (IJEES) Vol. 5 (1): 1-6 (2015) _____________________________________________________________________________________________ degree, the quantity of mineral salts continuously enlarged, especially during the last 50 – 60 years. Thus, from 210 mg/l registered in the , 20s, during the last two decades, the concentration reached 426 mg/l. In this context, the quantities of nitrogen and phosphorus, main constituents of the biological production of the aquatic ecosystems, increased: phosphorous – from 150.000 t/year registered in 1990 to 500.000 tones/year in 1996, nitrogen – from 5.000 tones/year to 20.000 t/year. Besides the above-mentioned physical-chemical factors, it has to noticed the biological ones, as well; the species of plants and animals characteristic to the river and its tributary rivers, which come into the Delta and the sea and contribute to the diversification of the flora and fauna of the aquatic ecosystems (Brezeanu et al. 1999, 2001, 2011; Cioboiu 2005). The evolution of the ecological factors. The quatitative and qualitative physical-chemical and hydro-biological variations of the river brings to the modifications of the biotic and abiotic structures of the Danube Delta and the Black Sea in a rhythm and concordance with the dynamics of the physical-chemical and biological parameters specific to the Danube. Starting from this point, it can be noticed the controlling character of the ecology of the Danube Delta and the Black Sea. This fact appears more obvious in the conditions of the last 50 - 60 years, when the large pollution of the river brought to radical ecological modifications within the Danube Delta and the Black Sea, during a very short historical period. The dynamics of aquatic biocoenosis structures from the Danube Delta. The researches from the last decades demonstrated that the main factor, which determined fundamental modifications in the structure and functionality of the aquatic ecosystems is due the intensification of the man-induced eutrophication process. This process intensified as the quantities of nutrients brought by the river water increased (Zinevici & Teodorescu 1992; Zinevici & Parpală 2007). Within the Delta aquatic ecosystems, the impact induced by eutrophication affected, in the beginning, the trophic level of phytoplankton primary producers. Their number increased a lot bringing to the appearance of a phenomen called algal bloom for long periods. In these conditions, the numerical density increased from 80.000 – 900.000 samples of algae/l registered in 1975 to 35 million samples/l in 1983. Besides the numerical density, the phytoplankton biomass registered a similar evolution during the same period: it increased from 20 – 30 Kg/ha to 500 – 600 Kg/l. The increase of the numerical density, as well as of the biomass and the algal bloom phenomen appeared base don a relatively law number of species. Thus, from 600 – 700 species of algae identified in the ,60s and ,70s, in 1992, the number decreased to 90 – 100 species. The eutrophication process induced by the larger and larger quantities of nutrients, minerals, and organic substances, brought by river, led to the modification of the natural tendency of evolution of all biocoenosis structures. Phytoplankton increased, but submerged macrophytes disappeared at the same time with certain populations of invertebrates and species of fish that populated the associations of macrophytes (Bodeanu 1985, 1992). As a consequence of the accumulation of some huge quantities of organic mas sat the level of the benthos, as well as of the process of anaerobic bacterial degradation, the populations of benthic invertebrates reduced from 15 – 17 groups to 2 – 3 groups (mainly Oligochaeta worms and Chironomida larvae) adapted to the conditions of anaerobiosis. The structure of ichthyofauna modifies the species of fish sensible to pollution (zander, pike, perch, carp, and sheat fish) are more rare, while the crucian carp proved to be an opportunist species, becoming dominant. In the last 4 – 5 years, the most recent researches, developed within the Danube as controlling factor of the ecology of the Danube Delta and the Black Sea, proved that quantities of nutrients from the river water decreased, mainly duet to the reduction of the quantities of mineral fertilizers (nitrogen, phosphorous) in the agriculture of the former communist countries. In these conditions, the pressure of the eutrophication process reduced. Thus, there can be noticed significant modifications in the structure and functioning of the aquatic ecosystems (Fig. 2). Within the Delta, at the same time with the reduction of the phytoplankton production, it can be noticed the appearance of an equilibrium state among all the components of the trophic links, a coming back to the characteristics of the biocoenosis structures from the ‚50s – ‚60s (Brezeanu 1991; Brezeanu & Popa 1994; Brezeanu & Cioboiu 2005; Brezeanu et al. 2011; Niculescu & Oltean 1984; Panin 1984).

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Figure 2. The Danube Delta (after Brezeanu et al., 1999). Present particularities of the biocoenosis from the shelf of the Black Sea along the Romanian seacost. The Danube represents the most important factor that influences the Black Sea. The influence of the river is mainly felt along the nortwestern shelf (Fig. 3). From the average discharge of the Danube of 6.283 m3/sec, 620 m3/sec remain in the Delta (approximately 0.5 % of the total discharge), the rast of the amount is directly receivad by the sea through the three branches: 62.5 % through the Chilia branch, 16.9 % through the Sulina branch, and 20.6 % through the Sf. Gheorghe branch.

Figure 3. The Black Sea (after Brezeanu et al., 1999).

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The average alluvia runoff (54.8 million t/year) is almost entirely directed towards the sea; only 1.430.600 t/year remain within the Delta. The quantities of salt present a great importance. The quantities directed to the sea are similar with the water discharge. Their concentration increased from 210 mg/l to 426 mg/l in the last 2 – 3 decades. Mineral salts, especially the nutrients (nitrogen, phosphorous), and alluvia are the most important factors that intervene in controlling the structures of the sea biotope and biocoenosis (Nicolaev et al. 2004). The larger and larger quantity of nutrients during the last 20 – 30 years brought, as it happened in the Delta, to the rapid intensification of the eutrophication process. The consequences are similar to the ones in the Delta: the excessive increase of the plankton algae with frequent phenomena of algal bloom. The diversity of algae species reduce dat the same time with the increase of the number of samples of some opportunist species (numerical densities of more than 1.000.000 samples/l), which brings to the algal blooming. The zooplankton registers an increase of the numerical density of the species that tolerate the new conditions, as wel (Acartia clausi, Pleopsis polyphemaides, Noctiluca miliaris, Aurelia aurita). It can be notice the decline of certain populations that play a major trophic part in insuring the food for the populations of planctophagous fish. The structure of the zoobenthos fundamentally modifies due to the accelerated process of main-induced eutrophication. The accumulation of some large quantities of organic mass resulted from the death of the plankton algae led to the disappearance of a great number of psamophyle invertebrates (for example, Pontogammarus maeoticus, Crangon crangon, Euridice sp., the molluscs Donacilla cornea, Corbula mediterranea). At the same time, it can be noticed that the number of some opportunist species, recently introduced in the Black Sea, increases (Mnemiopsis leidyi, Mya arenaria, Scapharca inaequivalis) (Gomoiu & Skolka 1996; Skolka & Gomoiu 2004). An ecological aspect, significant for the evolution of the benthic structures, is the reduction of the perennial macrophytes (Phylophora, Cystoseira, Zoostera), which covered large surfaces on the sea bottom. This meant the dissappearance of the population of fish and invertebrates that used to be found among these associations of plants (Gomoiu 1985; Petran & Moldoveanu 1992; Şerbănescu 1992, 1998).

CONCLUSION As a conclusion, the researches developed during many decades, but especially the researches made in the last 20 – 30 years, emphasize the role of the Danube as a controlling factor of the ecology of the Danube Delta and the Black Sea (Brezeanu et al. 2011). In order to ensure a well-balanced evolution of the Delta and the Black Sea, it is necessary to eliminate pollution along certain sectors of the river. Only in this way – due to its controlling role – the Danube Delta and the Black Sea will regain their natural characteristics.

REFERENCES Antipa, Gr. (1915). Wissenchafllich und Wertchaftliche Probleme des Donaudeltas. Annales Inst. Rom. Bucharest. 1: 105 – 108; Bodeanu, N. (1985). Caracteristique du development quantitatif et de la structure du phytoplancton des eaux du litoral roumain pendant la periode 1983 - 1985. Cercetări marine INCDM Grigore Antipa, Constanţa. 18: 117 – 137; Bodeanu, N. (1992). Algal blooms and development of the main phytoplanktonic species at the Romanian Black Sea littoral in condition of intensification eutrophication process. Science of the Total Environment. Suppl. Eisevier Science publ. Amsterdam: 891 – 906; Brezeanu, Gh. (1991). Der Einfluss der Eotrophisieruny auf du Entwiklung der aquatschien Okosisteme im Donaudelta und im Schwazen Mur. Internat. Donau Aktuell, Simnal Bericht. Stuttgart: 27 – 32; Brezeanu, Gh. & Popa, R. (1994). Die Struktur der Fischfauna in Gebieten besonderer Traphizitet in der Seen des Donau Delta. Limnological Bericht. Stuttgart: 110 – 115; Brezeanu, Gh. & Cioboiu, Olivia (2005). Impactul eutrofizării antropice asupra ecosistemelor acvatice din Delta Dunării. Edit. Univ. de Vest Vasile Goldiş. Arad: 22 – 26; Brezeanu, Gh., Pleniceanu, V., Cioboiu, Olivia (1999). Starea ecologica actuală a ecosistemelor acvatice ale Deltei Dunării şi a celor marine din dreptul litoralului românesc al Mării Negre. Analele Universităţii Craiova, Seria Geografie. Craiova: 108 – 120;

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Brezeanu, Gh., Pleniceanu, V., Cioboiu, Olivia (2001). Ecologia şi protecţia mediului în România - Fundamente programatice. Revista Geoforum a Academiei Române. Bucureşti: 15 – 22; Brezeanu, Gh., Cioboiu, Olivia, Ardelean, A. (2011). Aquatic Ecology. Vasile Goldiş University Press. Arad. 406 pp. (in Romanian); Cioboiu, C. Olivia (2005). Ecologia şi protecţia mediului. Edit. Sitech, Craiova. 195 pp; Gomoiu, M. T. (1985). On the Productive Potential of the benthos from the Romanian Shelf of the Black Sea. Cercetări marine INCDM Grigore Antipa, Constanţa. 18: 265 – 271; Gomoiu, M. T. & Skolka M. (1996). Changements recents dans la biodiversité de la Mer Noire dus aux immigrants. In: Danube Delta – Black Sea System Under Global Changes Impact. Bucharest: 49 – 65; Niculescu, N. & Oltean, M. (1984). Daten betreffend das Phytoplankton am Donaudelta in der Yahren 1981 – 1983. Lymnological Reports IAD. Budapesta: 109 – 125; Nicolaev, S., Papadopol, N. C., Bologa, Al., Cocieşu, Adriana, Dumitrescu, Elena, Zaharia, Tania, Pătraşcu, V. (2004). Needs for sustainable development of the Romanian Black Sea costal waters. Cercetări marine INCDM Constanţa. 36: 7 – 25; Panin, N. (1984). Evoluţia Deltei Dunării în timpul Holocenului, Studii de geologie contemporană. Inst. Geol. Geofiz. Bucureşti: 28 – 35; Petran, A. & Moldoveanu, M. (1992). Remmarques sur le development quantitatif du zooplancton de la Mer Noire en face du delta du Danube. Rapp. Comm. int. Mer Medit. Bucharest. 33: 265 – 267; Şerbănescu, Elena (1992). Variaţia compoziţiei ihtiofaunei de la litoralul românesc al Mării Negre şi unele cauze determinante. Conferinţa de Ecologie Cluj – Napoca: 98 – 112; Şerbănescu, Elena (1998). Modificările ihtiofaunei de la litoralul românesc al Mării Negre sub influenţa factorilor antropici. Teză de doctorat. Bucureşti. 358 pp; Skolka, M. & Gomoiu, M. T. (2004). Specii invazive în Marea Neagră. Ovidius Universty Press. Constanţa. 180 pp; Zinevici, V. & Teodorescu, Laura (1992). Evolution of the Zooplankton Biodiversity of Lacustrian Ecosystem in the Danube Delta under the Impact of Eutrophication and its Reflection in an Ecological Succession, Analele Şt. Inst. Delta Dunării. Tulcea: 122 – 128; Zinevici, V. & Parpală, Laura (2007). Zoopalnctonul din Delta Dunării şi Avandeltă. Edit. ARS Docendi. 378 pp;

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THE PRESENCE OF THE PARASITE MYXOBOLUS SP. (MYXOZOA: MYXOBOLIDAE) AT THE SPECIES CARASSIUS AURATUS GIBELIO FROM THE SHALLOW RESERVOIRS WITHIN THE LOWER HYDROGRAPHIC BASIN OF THE JIU RIVER (DOLJ – ROMANIA) Ionelia Claudia Goga, Constanţa Tîmburescu The Oltenia Museum, Nature Sciences, Craiova, Romania; The Sanitary Veterinary Direction Dolj, Romania; Email: [email protected]; [email protected]

Received November, 2014; Accepted December, 2014

ABSTRACT

The protozoan Myxobolus sp. belongs to the phylum Myxozoa, a phylum that groups animals characterized by an insufficiently elucidated biological cycle, involving a single host. It parasitizes a wide range of fish hosts, causing them the disease known as myxoboliosis, manifested by difficulty in swimming and slow growth rate. Myxosporidia passes through two stages of development in their biological cycle: vegetative and spore. The spore stage represents both a form of resistance and reproduction. In the fall of 2013, there were performed two sampling sessions in the nine small reservoirs located along the Preajba Valley river. By means of monofilament nets, there were caught 31 specimens of fish belonging to the species: Carassius gibelio, Perca fluviatilis, Abramis brama, Lepomis gibbosus and Alburnus alburnus. They were transported in a plastic container in the laboratory of the Sanitary Veterinary Directorate Dolj. There were prepared and examined native preparations obtained from brachial scrapings and squash preparations obtained by crushing and pulverization of the cartilages of the gill arches, in a short span. Microscopically, the spores are present only in one species, namely Carassius gibelio. In order to establish the etiologic agent and highlight the spores, there were used May Grunwald - Giemsa staining method, as well as malachite green method. The parasitosis evolved subclinically, the parasitized fish not emphasizing obvious evidence of disease. Key words: Preajba Valley river, Carassius gibelio, Myxobolus sp, parasitosis.

INTRODUCTION

The protozoan Myxobolus sp. belongs to the phylum Myxozoa, a phylum grouping animals characterized by a developed but insufficiently elucidated life cycle, involving a single host, alternative or even intermediate hosts. There have not been elucidated yet the migration paths through the fish body of the vegetative stage to the place of attachment. It parasitizes a wide range of fish hosts, causing them the disease known as myxoboliosis, manifested by slow growth rate and difficulty in swimming, which make fish become an easy prey for ichthyophagous birds. Myxosporidia passes through two stages of development in their biological cycle: vegetative and spore. The spore stage represents both a form of resistance and reproduction. There are over 700 species of myxosporidia that parasitize fish (BOGATU & MUNTEANU, 2008), some of them causing serious diseases due to the lack of effective therapeutic means but also due to the resistance of spores. The most numerous are the myxosporidia belonging to the Myxosporidae family (genus Myxobolus) represented by spherical, oval or elongated spores, with two polar capsules and an ameboid germ with iodophilic vacuole, considered a taxonomic criterion in the past.

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Ionelia Claudia Goga, Constanţa Tîmburescu ______________________________________________________________________________________________________________________________________________

In 1952, BOROVIŢKAIA signals the parasitosis caused by Myxobolus at rudd, tench, silver bream and carp in the Danube Delta. The same author indicates the presence of the parasite Myxobolus carassi in the Danube Delta (Mile 23) for the first time in Romania, in the wall of the intestine and on the gills of perch, but also as small white cysts in various organs in the crucian carp body cavity. V. A. ZAHVATKIN reports M. elipsoides and M. exigus in the Danube basin in 1951 at freshwater nase and BOROVIŢKAIA signals the parasitosis at the common bream in 1952. In 1947, RĂDULESCU indicates the presence of the parasite at the bream caught in Mosiştea. M. macrocapsularis was found at Călăraşi on the gills of barbel as pyriform spores and by BOROVIŢKAIA in the Danube Delta at the freshwater bream. In 1937, M. pfeifferi was reported by DUMITRU on the skin and gills of the barbel as oval shaped spores at Călăraşi and Olteniţa (ROMAN, 1955).

MATERIAL AND METHOD

In the fall of 2013, there were made two sampling sessions in the 9 small reservoirs located on the Preajba Valley river (GOGA, 2009; GOGA & TÎMBURESCU, 2011; GOGA & CODREANU BĂLCESCU, 2011; GOGA, 2012; GOGA & TÎMBURESCU, 2012; GOGA & CODREANU BĂLCESCU, 2013; GOGA & TÎMBURESCU, 2013). By means of monofilament nets (a length of 100 m and a mesh size between 4.5 and 6 cm), there were caught 31 specimens of fish (Prussian carp, perch, bream, pumpkinseed, bleak), which were carried in a plastic container with water to the parasitology laboratory of the Sanitary Veterinary Directorate Dolj.

Figure 1. The Preajba Valley There were prepared and examined native preparations obtained from brachial scrapings and squash preparations obtained by crushing and pulverization of the cartilages of the gill arches; cysts were microscopically identified in only one species, namely the Prussian carp. In order to establish the etiologic agent and highlight the spores, there were used May Grunwald - Giemsa staining method, as well as malachite green method.

Figure 2. Achievement of the native preparation for visualization at the microscope Olympus BX43.

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Figure 3. Staining the slides by means of May Grunwald - Giemsa staining method. The slides were examined under Olympus BX43 optical microscope with the 20x, 40x objectives and the two stainings emphasized the oval spores with two equal capsules located in the anterior pole and the ameboid germ with a less obvious iodophilic vacuole.

Figure 4. Highlighting the spores in the May Grunwald - Giemsa colorant preparation.

Figure 5. Highlighting the spores in a slide-slide native preparation

RESULTS

The determination of species by morphological characteristics was not possible due to the unclear visualization of the iodophilic vacuole. The specialized literature indicates that, in stagnant waters with clogged organic substances in excess, there is not noticed an increase in the incidence of these parasites, as intermediate or alternative hosts do not survive in waters with a fast clogging process. It can be considered that the incidence of these parasites can be also induced by the feed regime of the parasitic fish as they have a diverse trophic regime (OŢEL & CONSTANTIN, 1989).

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Ionelia Claudia Goga, Constanţa Tîmburescu ______________________________________________________________________________________________________________________________________________

CONCLUSIONS

The parasitosis evolved subclinically, the parasitized fish displaying no obvious signs of the disease. The diagnosis was established after the microscopic examination of the native and stained preparations, which highlighted the oval spores. The prophylactic and therapeutic measures are not well known; the specialized literature mentions that the parasitosis may recur even in the pools treated with chloride of lime. The only way to control the appearance of pests is to prevent the introduction of infested fish in the lakes.

REFERENCES GOGA IONELIA CLAUDIA. 2009. Boli parazitare semnalate la peştii dulcicoli din bazinul hidrografic Valea Preajba. “Diversitatea, valorificarea raţională şi protecţia lumii animale”. Chişinău. Edit. Ştiinţa. Moldova: 256260; GOGA IONELIA CLAUDIA & CONSTANŢA TIMBURESCU. 2011. Ichthyophthirius multifiliis infection at Carassius gibelio from the small reservoirs within the Preajba Valley. Oltenia. Studii şi Comunicări. Ştiinţele Naturii. Muzeul Olteniei Craiova. 27(2): 129 – 132; GOGA IONELIA CLAUDIA & CODREANU - BĂLCESCU DOINA. 2011. The trematode Clinostomum complanatum (Platyhelminthes: Digenea) identified at the perch from the small reservoirs along the Preajba river. Oltenia. Studii şi Comunicări. Ştiinţele Naturii. Muzeul Olteniei Craiova. 27(1 ): 115 -118; GOGA IONELIA CLAUDIA. 2012. INFESTATION OF THE Carassius auratus auratus (variety vailtail goldfish) BY THE COPEPOD Lernaea cyprinacea(CRUSTACEA). International Journal of Ecosystems and Ecology Sciences. ISSN 2224-4980, Volume 2, issue 4. Agriculture University of Tirana, Albania: 337340; GOGA IONELIA CLAUDIA, CONSTANŢA TIMBURESCU. 2012. Infestation of gibel carp Carassius auratus gibelio (CYPRINIDAE) with Piscicola geometra (HIRUDINEA, RHYNCHOBDELLIDA). Oltenia. Studii şi Comunicări. Ştiinţele Naturii. 28(2): 109-113; GOGA IONELIA CLAUDIA, CONSTANŢA TIMBURESCU. 2013. Research on the infection of the carp Cyprinus carpio (CYPRINIDAE) with the acanthocephalus Pomphorhynchus laevis (ACANTHOCEPHALA, PALAEACANTHOCEPHALA). International Journal of Ecosystems and Ecology Sciences. ISSN 2224-4980, Volume 2, issue 4. Agriculture University of Tirana, Albania: 147-152; GOGA IONELIA CLAUDIA, CODREANU - BĂLCESCU DOİNA. 2013. Preliminary records on the presence of the nematode Eustrongylides excisus at the fish species Silurus glanis and Perca fluviatilis from VICTORIA LAKE (BRATOVOIEŞTI – DOLJ). Oltenia. Studii şi Comunicări. Ştiinţele Naturii. Muzeul Olteniei Craiova. 29(2): 184-190; MUNTEANU GABRIELA & BOGATU D. 2008. Tratat de ihtiopatologie. Edit. Excelsior Art. Timisoara: 317-321; OŢEL V. & CONSTANTIN GH. 1989. Ghid ihtiopatologic pentru piscicultura din Delta Dunării. Bucureştii Noi. Bucureşti: 64-70; ROMAN ELENA. 1955. Cercetări asupra parazitofaunei peştilor din Dunăre. Edit. Academiei Republicii Populare Române. Bucureşti: 14-20; VULPE V. 2007. Paraziţi şi parazitoze ale peştilor dulcicoli. Edit. Stef. Iaşi: 169-171; Fauna Europaea, 2013. Myxobolus sp. Taxonomic hierarchy. http://www.faunaeur.org/full-results.php. id=391549; 24 May 2013. Foodborne illness and contaminants. Causes of foodborne illness: Bad Bug Book. U.S. Food and drug administration, 2013. (Accessed: March 18, 2014); www.fda.gov/FoodborneIllnessContaminants/CausesOfIllness/ucm070800.htm/3/22/2013. (Accessed: March 8, 2014);

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HABITATS DIVERSITY OF ADONIS VERNALIS SPECIES OF THE REPUBLIC OF MOLDOVA Ala Donica, Adam Begu, Nina Liogchii Academiei street, Institute of Ecology and Geography, Chisinau,Moldova; Email: [email protected]

Received June, 2014; Accepted December, 2014

ABSTRACT Have been identified and studied habitats of rare and threatened species – Adonis vernalis L., (Ranunculaceae), the chorology, discussing physical and geographical peculiarities of habitats, plant-communities where species is found, possible threats and dangers that lead to species extinction. Was indicated the occurrence of the species in 43 habitats of Moldova territory and studied a new area of Adonis vernalis distribution, which was proposed to be included in the protected areas of the Republic of Moldova, as the mixed nature monument – “Adonis”. Key words: Adonis vernalis, protected threatened plant, habitats.

INTRODUCTION

Taxonomic, False hellebore (Adonis vernalis L. 1753), is a plant from Class Magnoliatae, Order Ranunculales, Family Ranunculaceae, with other synonyms: Adonis apennina L.; Adonis davurica RCHB.; Adonis helleborus CRANTZ; Adonanthe vernalis (L.) SPACH (Гейдеман, 1975). Adonis vernalis, known variously as pheasant's eye, spring pheasant's eye, yellow pheasant's eye and false hellebore. It is named after the Phoenician and Assyrian god of the resurrection of nature, Adon. There is another, more romantic Greek legend about a handsome lad with whom the goddess of love Aphrodite was in love. Once, while they were hunting, a wild boar hurt Adonis. He died and Aphrodita’s tears made a beautiful flower grow at that place (http://www. homeovision.org). Adonis vernalis, is a rare and protected plant (mentioned in the Convention on International Trade Endangered Species of Wild Flora and Fauna (Washington, 1973), relict of the steppe flora, which occurs in the xerothermic grasslands. Also has introduced in list of rare, vulnerable or endangered species of majority European Union countries and that from Eastern Europe (Ukraine, Moldova, Russia etc). This species is an element of different primary or secondary subcontinental to continental grassland communities (dominated by slow-growing, perennial, herbaceous plants and semishrubs). A. vernalis is also capable of growing in open stands of wood, light woods as well as in pine and steppe-forests. It prefers summer-warm, sunny places or at most semi-shaded ones, where the soil can warm up easily enabling the plant to emerge early in spring. According to Melnik (1998), A. vernalis stands are normally found on well-drained but sufficiently moistured soils, on loose loam soils, loess soils or black-earth soils. Adonis vernalis is a highly valuable medicinal plant with a cardiotropic effect. It also has a sedative action; the herb is cardiotonic, diuretic, sedative and vasoconstrictor (Neta Gostin, 2011).

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Ala Donica, Adam Begu, Nina Liogchii ______________________________________________________________________________________________________________________________________________

MATERIALS AND METHODS

Adonis vernalis had been observed in the natural protected area from Republic of Moldova for a period of over 10 years. All other potential habitats where the species could be expected to occur were included in the study. The physico-geographical peculiarities of studied habitats were described according (Атлас Молдавской ССР, 1978 Mihailescu et al., 2006), the peculiarities of vegetation (Postolache, 1995), the national and international status of species (Negru, 2002, Red Book of Moldova, 2002, CITES Convention, 1973) and the spread area of Adonis vernalis (map of CITES Convention, 1973).

RESULTS

In order to identify the physico-geographic pecularities of existing habitats with this species and the discovery of new habitats, within the Institute of Ecology and Geography were studied all state protected areas (and related areas) in the Danube river basin and the Dniester Basin, taking into account and the results of bibliographical studies. According the classifier of the International Union for Conservation of Nature (IUCN) and the Law on State Protected Natural Areas (2002) in the studied area, included items belonging to the following categories: 1. Monuments of nature: a. Geology and Paleontology Monument of Nature (GPMN) - GPMN tectonic rift near village Naslavcea, GPMN Ravene Bechirov Iar, GPMN Ravene Musaitu; b. Botanical Natural Monument (BNM) – BNM Călineştii Mici; 2. Natural Reserves: a. Natural Forest Reservations (NFR) - NFR Şaptebani, NFR Selişte Leu, NFR Sărata Galbenă, NFR Liceul Bolgrad, NFR Ciobalaccia, NFR Hîrtopul Moisei, NFR Copanca, NFR Leuntea, NFR Baurci, NFR Flămînda, NFR Vadul lui Isac; b. Natural Reservation of Medicinal Plants (NRMP) – NRPM Cahul 3. Landscape Reservations (LR) –LR Feteşti, LR Suta de Movile, LR Holoșnița, LR Rudi-Arionesti, LR Cosauti, LR Tipova, LR La Castel, LR Geology and paleontology complex of the Lopatnic river basin, LR Poiana Curatura, LR Tiganesti, LR Climautii de Jos, LR Hirbovat Forest, LR Telita, LR Carbuna, LR Codrii Tigheci, LR Chioselia. 4. Multifunctional Management Areas (MMA) - MMA sector of steppe in southern Bugeac (Ciumai), MMA sector of steppe in northern Bugeac, MMA Balti sector of steppe. 5. Other areas: ravine with steppe Popeasca, Cricova, Dubăsari, the sector Jura-Mihailovca, Beloci, Cervona Gora, Calahur-Stroenți, Nicolscoe-steppe, Chizlar-steppe (Andreev et al., 2012). According to the Geobotanical Districts of Bessarabia (Negru et al., 2002), Adonis vernalis is a vulnerable species, spreads in steppe slopes, degraded slopes or forest-steppe, in almost all the territory. Same data about the widespread of species Adonis vernalis we find in other source (Гейдеман, 1975), indicating the boundaries of the distribution from the West of Moldova along the Prut River; in the central part of Moldova – in Codrii Plateau; in the South - Tigheci plateau, plain Bugeac; to the East - plateau Nistru, on both banks of the Dniester River. Adonis vernalis preferences face habitat varies from North to South of Moldova. Thus, North of Moldova is referred to the region of plateaus and plains of forest steppe, with forests of oak with cherry and hornbeam, with well-drained, but sufficiently moistured soils (gray-wooded soils or clay illuviated, leached and typical chernozem), with or under chalk-stone rocks surface, with more than 200 meters altitude. The North of Moldova are characterized by mild winters, long, hot summers, with average annual temperature 8-90 C and average annual precipitation between 600-640 mm.

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International Journal of Ecosystems and Ecology Sciences (IJEES) Vol. 5 (1): 11-16 (2015) _____________________________________________________________________________________________ Here we distinguish, habitats of Adonis vernalis in: a. the calcareous slopes with a rock vegetation. In this region are spread The Toltrels of Prut (Cliffs of Prut) - a chain of calcareous reef formations, of tropical Tortonian and Sarmatian seas, 10-20 million years ago, spread along the Middle Prut, Republic of Moldova, starting from the northern border country and continues over 200 km further to south. They are declared natural monuments and protected by law. The steppe communities meet rare species from Red Book of Moldova (2002), as Aurinia saxatilis, Schivereckia podolica, Sempervivum ruthenicum, Paronychia cephalotes, Poa podolica, on calcareous slopes of rivers Prut, Dniester and Raut. Adonis vernalis grows here in plant communities dominated by perennial, herbaceous plants and semishrubs on open slopes, limestone slopes, steppe sectors. As xerophile element, in this region, it prefers summer-warm, sunny places, with East, South –West exposition or, at most, semi-shaded ones (Northeast exposition), where the soil can warm up easily enabling the plant to emerge early in spring. The habitats in this part of Moldova, where the species was identified, included following Natural Areas: BNM Călineştii Mici, NFR Şaptebani, LR Feteşti, LR La Castel, LR Geology and paleontology complex of the Lopatnic river basin. Unfavorable factors affecting this region are the extraction of stone for construction, recreational activities, and intensive grazing on steppe sectors. Special interest shows habitat LR Suta de movile (Hundred Mounds), located in the middle valley of the River Prut, at 130-270 m altitude. On the entire territory, meeting multiple fragments of slidings and mounds, alternating with depressions where water accumulates from rain and springs, forming lakes and marshes. Steppe formations present here, in combination with other rare, endangered hygro- and mesophilic species, also includes Adonis vernalis. These formations, unfortunately, are destroyed because of intense pasturage and the agricultural utilization of land, liquidation of thickets of shrubs and plant agglomerations. Also, steppe ecosystems are highly degraded because a part of the territory is illegally privatized and plowed. b. Oak forests of Quercus robur and Q. petraea on rock slopes and gravel alluvia and petrophite steppes of Nistru Plateau on limestone slopes. Specific forests of Quercus robur and Q. petraea (rock forests) grow on stony slopes (with predominance of Sarmatian limestone rocks), on loamy soils, dark gray forest soils and carbonate chernozems, in arid and subarid environmental conditions. Are located on loam steep stony of Medial Dniester (and tributaries) in the sector from Naslavcea (North East of Moldova) to Centre of Moldova, and on toltres string, with exit on the surface of rocks, big stones and alluvia gravel. Rocky steppe are formed on steep slopes with limestone rocks from the tertiary period, which are characteristic of Dniester banks, its tributaries and small streams in north-western districts of Moldova. Natural habitats of Adonis vernalis from this region is GPMN tectonic rift near village Naslavcea, GPMN Ravene Bechirov Iar, LR Holosnita, LR Cosauti, LR Rudi-Arionesti, LR Climautii de Jos, LR Poiana Curatura, LR Tipova, placed in the middle of the Dniester basin, with fragmented landscape, caves, ravines, on portion adjacent terraces. Some sections of the forest and some arid rocky surfaces, limestone slopes, wiht Northeast, Northweast and Southeast exposition, containing elements of the rare steppe vegetation, including Adonis vernalis. Because some sectors are at a greater distance from villages and are located on the slopes, the human impact is less, except for portions arranged for recreation. As a protective measure also serves here that the border passes and access to it is under special permits. Dangers and unfavorable factors affecting the species are related to overgrazing of the slopes, cleaning of forest from bushes and felling old secular forest sectors, destruction plant communities and illegal deforestation of trees, extracting of limestone and recreational activities. c. Northern steppes from the forest – steppe of Moldova Plateau, Northern Moldova Plain, Medial Dniester, were formed on typical and leachates chernozem soils, with meadow steppes predominate (Stipeto-Festucetum herbosum), mezoxerophyle species (Stipa pennata, S. pulcherrima, S. tirsa), Poa versicolor communities and the participation of a large number of herbaceous species. Most of the steppe is plowing, but on steep, eroded slopes were, isolated, kept fragments of semi-natural communities (like in the MMA Balti sector of steppe, Sector JuraMihailovca, Beloci, Cervona Gora, Calahur-Stroenți areas). These areas include forest and grassy territories, on the rocky slopes, steppe areas affected by intensive grazing and recreational activities. The habitats of Adonis vernalis from Center of Moldova distributed on forest plateaus region of central Moldova, with forests of oak, beech, lime, ash, with gray and brown forest soils. The rocky substrate of Central Moldavian

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Plateau, the average annual temperature is 9-100 C and average annual precipitation between 550-600 mm, favored the growth of given species in habitats: a. Oak forest and oak-hornbeam Central European forest specific for Codrii Plateau. Natural habitats of Adonis vernalis identified in NFR Selişte Leu, NFR Sărata Galbenă, LR Tiganesti on slopes with Northeast, Northwest, Southeast, Southeast exposition, at more 200 m altitude. The preferable places of growth are the open spaces, meadows, inclined, heavily fragmented slopes from forest region (with sessile oak, pedunculate oak, pubescent oak, hornbeam, ash and linden, on dark gray forest soils). b. areas at the border of two landscape zones - the forest- steppe and steppe (plains region steppe of the Lower Dniester and terraced plateau Codrii), with the sectors of oak forests, mainly with leachates or ordinary chernozem on loess clays. Here is the contact area of central European forests with the sub – Mediterranean type. Alternation of these forests depending on the slopes exhibition and altitude. Higher places and northeastern slopes are occupied by sessile oak with linden and ash. The Southern, Southeast, Southwest slopes characterize steppe communities, with calcareous slopes and presence of various species of rare plants. Protection of species taken under state protection is related to the maintenance and limitations of forest management sectors (illegal cut) and the steppe (location of illegal dumps, illegal extraction of construction rocks, overgrazed). Adonis vernalis habitats are located in LR Carbuna and area with steppe vegetation Cricova. The south of Moldova is characterized by mild winters and long, hot, summers, with average annual temperature of 100 C. Region is located at the interference of forest steppe district with pubescent oak predomination, from South of Moldova with the district of Bugeac Steppe, on typical, low humus and carbonate chernozems (Ursu et al., 2011). Natural habitats of Adonis vernalis in the South of Moldova were grouped into more areas: a. Xeromorphe oak forest habitats on the Tigheci Plateau (LR Codrii Tigheci, LR Chioselia, NFR Liceul Bolgrad, NFR Ciobalaccia, NFR Baurci). Are located in the southwest of the Republic of Moldova, with the highest elevations (200-300 m) of the plain South Moldavian Plain, with annual average rainfall of 450-500 mm, on a hilly relief, broken by valleys with wide spread, sometimes, of ravines, the erosion and landslides. These conditions allowed the growth of forest communities represented by xenomorphic forest on the slopes of the southern districts of Moldova (between forests of Codrii Plateau and Bugeac steppes), with predominance of Quercus pubescens on places with higher relief and very arid slopes (southern exposition), on xerophytes forest chernozem and sometimes on clay soils. These forests represent northeast outpost of Mediterranean origin vegetation and in Moldova is highlighted in a special geobotany forest-steppe region with pubescent oak. Today these forests are mostly destroyed, representing young plantations. In connection with the extreme conditions of vegetation on border areas, multiannual cutting and cattle grazing, these forests are represented by low bushes, alternation of clearings with steppe vegetation, and grassy carpet rich in xerothermal species, arid plant communities or communities at the edge of forests. Fragmented steppe vegetation was preserved only in some places, ravines and land subject to landslides. b. steppe habitats of lower Dniester Plain (LR Hirbovat Forest, LR Telita). Are located on the steppe -terraced plains of the Lower Dniester with carbonate chernozems, small fragments of specific light downy oak forests and meadows and grassy steppe carpet. Many species of plants are from Balkan - Mediterranean area. The slopes of the upper terraces of the river covered with forest-steppe ecosystems with specific Quercus pubescent, Quercus robur and Cotinus coggygria, alternate with areas of steppe. Although they are partially replaced by plantations of Robinia pseudoacacia and agricultural land, within reserves were preserved valuable areas of forest and steppe. In communities that grow on the tops of hills and on southwest exhibition slopes, is found Adonis vernalis species. Negative factors affecting habitats are the overgrazing and shrub cleaning of forest edge, destruction caused by recreation activities. c. steppe habitats disposed in the South Moldavian Plain (NFR Flămînda, NFR Hîrtopul Moisei, MMA sector of steppe in southern Bugeac (Ciumai), MMA sector of steppe in northern Bugeac, ravine with steppe Popeasca, Nicolscoe-steppe, Chizlar-steppe, NFR Vadul lui Isac, NRPM Cahul, NFR Copanca, NFR Leuntea, GPMN Ravene Musaitu). This plain has a nearly flat relief, with 150-200 m prevailing altitudes. Climate of this region is the warmest and driest in the country, with mild, unstable, small duration winters, and hot, dry and long duration summers. Small amount of annual precipitation (370-440 mm) cause the growth of steppe vegetation, characterized by the dominance of xerophytes plants, on ordinary carbonate chernozem. In some parts, are encountered natural areas of downy oak (Quercus pubescens). The sector is located on the territory of Geobotanical region - Bugeac

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International Journal of Ecosystems and Ecology Sciences (IJEES) Vol. 5 (1): 11-16 (2015) _____________________________________________________________________________________________ steppes, that goes into Pontic province. Characteristic of this area are genuine steppes with a mixture of herbs, with dominance in grassy carpet of euxerophile species Stipa ucrainica P.Smirn. and Stipa lessingiana Trin. et Rupr. In mesophilic conditions of habitation, are common fragments of meadow steppe community with participation of mezoxerophyle species (Stipa dasyphylla, S. pennata, S. pulcherrima, S. tirsa). Often, sectors represents a steppe area, are intercalate with anti-erosion Robinia pseudoacacia plantations. Unfavorable factors affecting Adonis vernalis species in this region are uncontrolled fires that break out after accumulating plant remains, on isolated steppe sectors, overgrazing, destruction shrubs thickets, unregulated mowing etc (Andreev et al., 2012) Adonis vernalis must be included in Red Data Book of Moldova, with protection of all native habitats as botanical reserves. We proposed to organize national reserves and monuments to nature for the protection of Adonis vernalis in natural habitats. For this purpose was indentified and studied a new habitat with a great floristic diversity: the forest around the village Saptebani, district Riscani, which was proposed to the Ministry of Environment of the Republic of Moldova to be introduced in the categories of protected areas, as a mixed monument of nature Adonis (in 2010 year). Value of this reserve was estimated based on the tree vegetation consists of linden stands (90%) and oak (10%), the limestone relief units at an altitude of 110 - 120 m. Sector stands out in the grassy carpet well developed, composed of common species and many rare species, including Adonis vernalis, which occupy large areas (Begu et al., 2011). Therefore, this is community where Adonis vernalis have to be protected actively in situ, which requires special individual protection plans and financial resources.

CONCLUSIONS

Adonis vernalis is widespread in Republic of Moldova (about 44 habitats). The localities of the species are associated with xerothermic habitats with East, West, Southeast, Southwest exposures, on chernozems soils, rich in humus and calcium. Our studies have identified that in Moldova, Adonis vernalis grows in good drained places at the altitude of 50-250 m above sea level. In lower and bad drained places, Adonis vernalis no was found. The species reaches the optimum development in xerothermic communities of grasslands, slopes with steppe herbs, open areas of mezoxerophyle forests, calcareous areas. The main reason of habitat reduction and isolation of populations is plowing of virgin and fallow lands, where earlier was situated the largest part of native habitats of Adonis vernalis. Pasture of cattle on slopes, artificial forestation of some steppe regions and wrong management of natural habitats, negatively influenced the condition of Adonis vernalis populations.

REFERENCES Andreev, A., Bezman-Moseiko, О,. Bondarenco A. et al. (2012). Directory of the identified core areas of the National Ecological Network of the Republic of Moldova. Chisinau, Biotica, p.356; Begu, A., David A., Liogchii N. et al. (2012). Starea mediului și patrimoniul natural al bazinului Dunării (în limitele Republicii Moldova). Chișinău, p.300; Cheklist of CITIES species and Annotated CITIES appendices and reservations (1979). Washington, p.417; http://www.homeovision.org, accessed 26.01.2014; Legea privind fondul ariilor naturale protejate de stat (2002). Chişinău, p.102; Melnik, V.J. (1998). Trade survey of Adonis vernalis in Ukraine. Kiev (unpubl. report for D. Lange), p.15; Mihăilescu, C., Boboc, N., et all. (2006). Mediul geografic al Republicii Moldova: caracterizare de ansamblu. Vol.I. Mediul geografic al Republicii Moldova. Chişinău, Ştiinţa, p.10-26; Negru, A., Şabanov, G., Cantemir, V., Gînju, Gh., Ghendov, V., Bacalov, V.(2002). Plante rare din flora spontană a Republicii Moldova. Chişinău, p.198; Neta Gostin, I. (2011). Anatomical and micromorphological peculiarities of Adonis vernalis L. (Ranunculaceae). Pak. J. Bot., 43(2), 811-820; Postolache, Gh., (1995). Vegetaţia Republicii Moldova. Chişinău, Ştiinţa, p.340; The Red Book of the Republic of Moldova (2002). Second edition. Chişinău, Ştiinţa, p. 287;

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Ursu, A., Overcenco, A. (2011). Soil map of the Republic of Moldova. Chisinau, Ingeocad; Атлас Молдавской ССР (1978). АНМССР. Отдел Географии. Москва, p.131; 14. Гейдеман, Т. С. (1975). Определитель высших растений Молдавской ССР. Кишинев, Штиинца, p. 636;

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ALTERNATIVES OF THE GREEN TISSUE IN THE CITY CENTRES Bahriye Gülgün1, Mediha Abdioğlu1, Kübra Yazici, Şükrü Dursun3 1

Ege University, Agriculture Faculty, Landscape Architecture Department, Bornova, İzmir,Turkey; 2 Gazıosmanpasa Un., Agriculture Faculty, Horticulture Department, Taşlıçiftlik, Tokat, Turkey; 3 Selcuk University, Engineering and Architecture Faculty, Environmental Engineering,Konya, Turkey; Email: [email protected], [email protected], [email protected];

Received June, 2014; Accepted December, 2014

ABSTRACT

In rapidly developing countries in the world, the number of urban population and urban growth by further increasing the value of land and leads to high density the construction of the structure. This loss can change the green space in cities and is seen as the root cause of many environmental problems in these areas. Living in those urban built environment can need to get breathe under the pressure of parks, gardens and so on. Dwindling green spaces around buildings, streets and sidewalks of the urban, daily life continued moving away from nature day by day. Give more space to green space in urban areas in search of nature at every opportunity with the integration of assessment and conservation of natural resources are important issues on the world agenda, environmental issues in global scale such as climate change, the built environment, increase the "green" awareness and cities with the natural environment, and creating conditions future use of natural resources gives direction to work on building new habitats. Thus today's rapidly devolving urbanization destructive effects everyday minimize the life and to built environment is under pressure to sustain the people who have green space/area/front/surface alternatives to provide recently produced an ecological and aesthetic green tissue alternatives that we are need. Keywords: Green Tissue, City Centres, developing, urban population

INTRODUCTİON

Quality of an urban is a result of balanced distribution between life buildings, roads and green areas [12]. Morever different types of green areas in the city, the functions of green space and in urban service areas reveal the impact of quality life. However, as a result of big cities and urban growth, urban population leads intensively and highly to buildings [10]. These results lead to reduction of green areas. It is emerged that idle spaces can be used for different functions in major cities in buildings, also the multi-purpose approaches provide a huge potential in the green area of the roof or terrace. People have used both ecologic and roof gardens for aesthetic purposes since centuries. In particular, throughout history, both aesthetic and indoor air in order to control, the building walls and balconies have been used which information is provided by various sources how about plants can be grown ( Figure 1).

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Bahriye Gülgün1, Mediha Abdioğlu1, Kübra Yazici, Şükrü Dursun3 ______________________________________________________________________________________________________________________________________________

Figure 1: A Picture about French Green Building [14] Pompei artisans who grew on their balconies with the vines which were graced with the Roman mausoleum. Furthermore, Vikings covered with grass both the walls and the roof. At home of India and Spanish, in the 16th and 17th century in Mexico, Russia and other countries that were former Soviet Union of part, also in France, the 18th century examples of vertical gardens were sought [2]. Today, on the world agenda is important issues such as to give more space to green space in urban areas, to search of nature and exposed opportunity with the integration of assessment and conservation of natural resources. Issues such as use of natural resources in future, environmental issues, global issues, climate change, increase the awareness about green bulding" in environment and these issues gives direction how work to create the natural environment in cities [1]. In this study, we investigated the evaluations to minimize the destructive effects of urbanization. We aimed to submit alternative for people who have to under the pressure of everyday life of the built environment. Furhermore, our aim was to address produced alternatives -such ecological and aesthetic green tissue and to offer an alternatives to in green space / area / front / surface . VERTICAL GARDEN STRUCTURE Vertical garden structure is garden design which consists of vegetations placed on the wall surface. Vertical garden structure can improve the air quality of building and can save energy. Vertical garden structure was invented by French botanist Patrick Blanc. To build vertical gardens were started in Paris, London, Tokyo and New York since 1988 (Figure 2, Figure 3).

2

3

Figure 2-3 Examples about Vertical garden structure [15],[16] Aesthetic and functional advantages of vertical gardens Vertical garden structure; It helps to conceal bad fronts. It ensures indoor of buildings (cold in the summer, warm in winter).

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International Journal of Ecosystems and Ecology Sciences (IJEES) Vol. 5 (1): 17-22 (2015) _____________________________________________________________________________________________ If there is no green space areas created the garden of building, the vertical garden may made on the walls of buildings. Especially, impermeable hard surfaces such as concrete and asphalt which are rapidly growing problems in urban areas, vertical gardens contribute to effect of heat island. Soil and plant materials which are used in a vertical gardens have the ability to sound absorption therefore they are undertook noise reduction function One of the major problems of urban air pollution is the contribution to the solution. Because plants can effect the increase of the density of oxygen and carbon dioxide consumption, plants play an influential role in the regeneration of the city atmosphere. For example; the one wall of 50 houses is covered with plants on the any street, this is the equivalent with planting 50 trees on the street. Vertical plants are used to cut wind speed in gardens, they can be created damp environment by way of stem or leaf in the region also they can keep dust particles. In ecological design, precautions such as effectively to use renewable energy sources and environmentally to use of local materials, to prevent pollution and to protect environment and public health should be taken into account. In the uses of plants which constitute surface of structure, they contribute to the economy by providing the energy conservation [4]. GREEN ROOF The “Roof Garden“ - green roof system- is a multifunctional green roof build-up with high water storage. It is suitable for lawns, perennials, and with deeper system substrate, for shrubs and trees. Integration with hard landscapes, for example, walkways, terraces, driveways or play areas, etc. is also possible [21]. Roof and terrace gardens cannot take the place of active and passive green space in the city. However; they can provide living areas in city, at the same time they consist of habitats for birds and butterflies [3];[8]. it is not correct to accept that roof gardens are only planted areas. To building from the city, in all of city, roof and terrace gardens are common spaces provided social communication in the urban environment [11]. 1. Aesthetic and Functional Benefits of Green Roofs 1- The amount of waste water can be reduced. Green roof design selected according to the characteristics of the system need to be taken from the roof of the amount of water and it is possible to save up to 90%. 2- Environment's climate change and wettest summers, more livable environments can be occured moderate climate. 3- Less dusty environments can be created. Especially, as nitrates present in the air or rain water and environmentally damaging substances are transmitted into the soil suction. 4-Roof insulation increases if green roofs insulate heat. Polystyrene reinforced with some type of green roof, is possible even up to 50% and roof thermal insulation to provide an increase in capacity with polystyrene. 5-Environmental noise can be reduced and transferred into the roof structure up to 8 dB 6- Waterproofing is guaranteed by green roof to be longer lasting. 7- New use areas of its can be obtained. Instead of gravel terrace on the roof, it is combined with plant and livable spaces (Outdoor) can be obtained. 8- It means that the natural environment is beauty. It is clearly felt that in today's urban, common green space is insufficient -the lack of the natural environment- However the greening of roofs considerably may decrease insufficient[5];[4]. 2. Types of Roof Garden Roof gardens are divided into two groups in terms of features and benefit functions with different forms of maintenance, including intensive and extensive [6]. 1. Intensive Green Roof Green spaces which consist of more labor intensive production inputs and plant spicies, plants as inanimate material are used in a variety of studies that are utilized flat roofs arrangements applied by ornimental plants as the grass, bushes, shrubs and trees. Usually, in intensive plantings can require deep soil. Morever to filter for insulation, drainage and irrigation systems are perfect for intensive gren garden. [9]. These case can lead to very costly in intensive roof plantings. However; intensive green roof is appropriate to roam and to do various recreational activities [8]`;[3].

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Figure 4: Intensive roof garden[17] Intensive roof arrangements needs to taking regularly care measures as watering, fertilizing, spraying, pruning, weed shows [7]. 2.Extentive green roof Extentive roof plantings are planting that labor and production, maintenance costs to a minimum in a very wide area without at least or no maintenance on shallow soils created on flat or curved roof plantings. These vegetation types are used dwarf shrubs, mosses, annual and perennial weeds (grass) and some cover crops which have succulent structure. Rockery Type Plants“ allow for an extensive green roof with sophi- sticated design and individual character. The “Rockery Type Plants“ substrate is applied with a minimum of 70 mm in depth. “Rockery Type Plants“ vegetation consists of a wide variety of species which results in a long blooming period and allows for different accents throughout the vegetation period. Sedum species and other perennials are primarily used as a ground cover [22]. The extensive roof gardens are not suitable both for recreational activities and for walking [7]; [6].

Figure 5: Extentive roof plantings [18] 2. System Build-up “Roof Garden” 1-Vegetation:Plants are used by the aesthetic and functional properties. 2- System Substrate “Roof Garden” or System Substrate “Lawn : Zincolit and Zinco created with special materials such as earth-system sub-structures are used. 3- The fitler sheet and drainage layer: Rain water filtered by the filter layer, a hand must be stored for days without rain. But, ıf the deposition is over, the decay of plants in order to prevent may be drained. Floradra and Floratec used as materials.

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International Journal of Ecosystems and Ecology Sciences (IJEES) Vol. 5 (1): 17-22 (2015) _____________________________________________________________________________________________ 4-Protection layer against mechanical impact: Zinco protective layer has a compressive strength of norms as required. 5- Root Barrier: Waterproofing should not harm plant roots. For this purpose, special root holder layers or waterproofing protecting are used against roots. 6-Waterproofing and roof construction: The most important condition for green roofing is that waterproofing and good carrier are the presence of a sound roof structures

Figure 6: Examples about Roof Layer Material

[19] Figure 7: Basics Layers of Roof Garden [20].

CONCLUSIONS

Nowadays, the number of population are dramatically increasing. Thus the need to green tissue is going up in areas of many cities. Green tissues are summarized with their many alternatives in our study. Especially, it is important that the plants which are thev main material in roof garden are to choose when plants were considered as aesthetic and functional. Because plants can be basically used aesthetic and functional aims, the plant physiognomy and morphological properties of plant are important to consider. Plant species Carefully selected provide important contribution to green tissues both function and aesthetic aspects. Whereas the section of plant species that are the lack of excessive water resistantbin extensive gren roof is important,plant species that are strong and aesthetic charateristics and need maintance in intensive gren roof were used.Defoliations that seem in plants are not a desired situation in a vertical garden. Therefore, selected every green plants may be preferred in green tissue or in vertical garden for the some aims that are thermal insulation applications In summary, the application of green tissue can be thought in low-rise buildings that are not too high, green tissues should be applied ın the vertical garden. In addition, building walls that can be applied plantings should be checked whether to handle the project or not. planting, the surface of a vertical garden or roof garden. The process should be checked by experts before you start. Suitable areas should be preferred for hipodronik system. Plant selection should be appropriate according to the climate and conditions.

REFERENCE Yücel, G., Elgin, Ü., “Garden Wall: Vertical Garden / gren wall”, Journal of Blue Buildings l, Year:1, Sayı:2, November-December 2010, s: 51-53; Bass, B.,Baskaran B., “Evaluating Roof topand Vertical Gardens as an Adaptation Strategyfor Urban Areas”, IRC (InstitudeforResearch of Construction), NRCC(NationalResearchCouncilCanada) -46737, http://irc.nrccnrc.gc.ca/ircpubs; Barış, M.E. Yazgan, M.E, Erdoğan, E. Roof gardens, potted ornamental plants Publications.Ankara, 67p. 2003;

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Kemaloğlu, A. Yılmaz, Greening Front the Contribution to Urban Ecology. Journal of Landscape Architecture, volume 2, Number 30, 52-54, 1991; Özdemir, A. Yılmaz, O. A Study on planting. of Surface Structure the Journal of Agricultural Sciences, Volume 7, Number 2, 13-18, 2001; Krupka,1983-thommen,1987); Liesecke, 1983, Ekstansif Çatı Bitkilendirmesi; Berger,1988 Entansif Çatı Bitkilendirmesi; Koç, N., Güneş, G., 1998, Ornamental planting Regulatory Principles in the roof garden, Pamukkale University, Faculty of Engineering, Journal of Engineering Sciences, Volume: 4, Number: 1-2, p.625-633; Todd, N. J, Todd, J., From Eco-Cities to Living Machines: Principles of Ecological Design, Nort Atlantic Books Berkeley, california, 1993, s.75; S. Edgar David, “How Does Your Rooftop Grow?, Temple University Ambler, The Philadelphia Inquirer, March 8, 2002, Features Magazine, Edition: City-D, Page E01; Aksoy Y., İçmek S., 2010. Çatı Bahçelerinden Kent Yaşamındaki yeri ve önemi:İstanbul Örnekleri 5. National Roof & Front Symposium u 15 -16 April 2010Dokuz Eylül University, Faculty of Architecture, Tınaztepe yerleskesi Bucaİzmir; http://www.cativecephe.com/?pid=22806, accessed / 22.04.2014; Figure1:http://img374.imageshack.us/img374/4070/denhaag0409200542822477vy8.jpg, accessed / 22.04.2014; Figure 2: http://images04.olx-st.com/ui/16/28/66/1385637457_571072266_9, accessed / 22.04.2014; Figure 3: http://www.mirzayapi.com/FileUpload/bs537805/File/isiyalitim-enrgy.jpeg, accessed / 22.04.2014; Figure 4: http://evdekora.com/resim/2012/10/cati-bahceleri-5.jpg, accessed / 22.04.2014; Figure 5: http://v1.raf.com.tr/images/Image/product/2012/39/11_02.jpg, accessed / 22.04.2014; Figure 6 http://www.dsmimarlik.com/dscape/wp-content/uploads/2009/10/cati.jpg, accessed / 22.04.2014; Figure 7 http://www.ftrctlb.com/sites/default/files/green_2.jpg?1307430480 accessed / 22.04.2014; System Solutions for Intensive Green Roofs: http://www.zinco-greenroof.com/EN/downloads/pdfs/ZinCo_Intensive_Green_Roofs.pdf accessed /24.04.2014; http://www.zinco-greenroof.com/EN/downloads/pdfs/ZinCo_Extensive_Green_Roofs.pdf, accessed /24.04.2014;

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PRIVATE HOSPITAL MARKETING IN HEALTH SYSTEM OF ALBANIA Azeta Tartaraj Universiteti “Aleksandër Moisiu” Durrës, Albania; E-mail: [email protected]

Received November, 2014; Accepted November, 2014

ABSTRACT

The last decade private hospitals play a significant role in health system in Albania. Access to private hospital services however, is still very limited largely because they cost significantly more than services in the public sector. Despite the country’s low economic level, private hospitals have experienced substantial growth with the total number of beds increasing and they are located mainly in capital city Tirana. The high standards of quality of care, services, medical equipments and facility premises are far better as compared to public hospitals. Health care marketers use advertising in its many forms to sell their products and services. Promotional campaigns, television spots, brochures and leaflets are the main marketing tools utilized to convey their message to general public. The private hospital industry consistently attracts the attention of health care funders and regulatory authorities attempting to include some of their services into public scheme of reimbursement. Patients frequenting private hospitals act more like "consumers" of health care. Like consumers in most other industries, health care consumers are required to choose from an array of products and services offered to them. The study focuses on the distribution of private hospitals in Tirana and the types of services provided by those hospitals and hospital marketing techniques. Key words: private hospital, marketing technique

INTRODUCTION

Healthcare industry is a wide and intensive form of services which are related to well being of human beings. Health care is the social sector and it is provided at state level with the help of central government. Health care industry covers hospitals, health insurances, medical software, health equipments and pharmacy in it. Healthcare industry is booming all over the world. A World Bank Report points at the emergence of large-scale, investor-owned hospitals in the country as a "dramatic" development (1,2). The corporate hospitals will play a positive role in the healthcare sector by taking the load off government hospitals, whose performance hasn’t been up to the mark. The healthcare industry is on the threshold of a major growth spiral which shall assimilate all new technologies to provide cost effective healthcare. It shall not only employ the largest chunk of all available capital but shall also employ a large proportion of the skilled work force (3,4). The healthcare industry is poised to become the biggest employer in all countries. It shall also be the biggest consumer of all new technologies. Specifically, in the next decade, it is anticipate that the healthcare industry shall grow at an accelerated pace in most developing countries. As a result, most of the countries in the world shall add more hospital beds (5). This accelerated growth will require a large body of skilled healthcare providers. As a result, the medical education sector, including medical and all para-medical staff, shall also witness a faster growth. It is anticipated that the numbers of skilled healthcare

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Azeta Tartaraj ______________________________________________________________________________________________________________________________________________

providers shall double in next decade. The addition of hospital beds shall catalyse a growth in hospital equipment industry. It shall also fuel the growth of pharmaceutical industry (6). In the next decade, the earth's population shall reach a peak number. This, coupled with availability of better Healthcare shall lead to a higher expectancy of life at birth. The average age of earth's population shall increase. This will require a far superior understanding of multiple organ syndromes and there treatments. There shall be a shift in focus of providing healthcare (7). The hospitals shall tend to be the providers of acute & intensive healthcare, while new cost effective modalities shall provide intermediate care or nursing only care (8). The Albanian healthcare system is predominately public, centralized and rigidly structured. The state is the major provider of health services, health promotion, prevention, diagnosis and treatments for the citizens. The system often has difficulties in meeting the healthcare needs and requirements of patients. New technologies and developments in medicine are often not available to medical professionals and staff in Albania, especially for those outside the capital. University Hospital Center “Mother Theresa” is the largest university medical center in the country. There are 1400 beds in this center, more than 2500 employees (9). This is the only tertiary medical service in Albania. The provision o f other health care is still dominated by public providers, but the importance o f the private sector i s growing in the areas o f diagnostics and outpatient services. While public sector physicians and nurses are not allowed to operate in private practice, with the exception of university professors, evidence suggests that the incidence of private care provided by publicly employed physicians may be growing. As the economy grows and the health system develops, private providers will invariably become more important players. The Government’s Health Sector Strategy foresees that much of primary care would, in the medium to long term, be provided through independent primary care physicians or groups of independent physicians (9, 10). Over the past decade and a half, Albania has undergone major political, economic, and social changes that have affected almost all aspects of the population's life, including health outcomes and health care services. Although the private sector is still relatively small, its importance in providing outpatient services is growing. Dental care and the pharmaceutical sector are largely privatized. In Tirana, medical care at private hospitals and clinics has certainly improved in recent years, however, medical facilities outside Tirana have very limited capabilities, often providing inadequate standards of care due to a lack of medical specialists, diagnostic aids, medical supplies, and prescription drugs (11). The private sector is still developing and covers most of the pharmaceutical and dental services as well as some clinics for specialized diagnosis, again mainly being located in Tirana. Private hospitals have experienced rapid growth, since 1990 with a remarkable increase the last decade demonstrating their significant role in health system in Albania. Despite the country’s low economic level, private hospitals have experienced substantial growth with the total number of beds increasing and they are located mainly in capital city Tirana. The high standards of quality of care, services, medical equipments and facility premises are far better as compared to public hospitals. Although the private hospital industry is making a significant contribution to the overall health system access their services however, is still very limited largely because they cost significantly more than services in the public sector. In general, far more resources are being spent by private hospital services to acquire advanced and contemporary medical equipment (9,12). During the same period, attempts were made from the National Institute of health Insurance to include in the scheme the collaboration with private insurance companies to cover a part of the expenses for the services delivered at private hospitals. Recognition as an industry and as a new field for investing by businessmen coupled with reduced importing by government of medical equipment’s and technology is one of the main factors attracting the private healthcare thus opening up the sector. As the country changes and the new health problems arise that cannot be dealt with by state health sector on comprehensive healthcare. The socio-economic changes, the high emigration rate and the contact with the developed world, the higher levels of income and increasing awareness through deep penetration of media channels, contributed to greater attention being paid to health (9, 13). More individuals and families care for regular health check-ups increasing the health expenses of the family. Also, some pharmaceutical companies have ventured into this sector as it is a direct extension to their line of business. A majority of private hospitals are expensive for a normal middle class family. The opening up of the insurance sector to private investors is expected to enhance the private healthcare industry (9, 14). Health insurance will make the private healthcare affordable to a large number of people.

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MATERIAL AND METHODS

Distribution of private hospitals The majority of private hospitals can be classified as short-stay hospitals, where most patients are admitted for less than 30 days (17-21). The average size of a private hospital is small with an average number of beds below 200. Table 1 presents the name and distribution of private hospitals in Albania

Table 1. Name and location of private hospitals Hospital name

Location

HYGEIA Hospital

Tirana

Universal Hospital

Tirana

American Hospital Albania

Tirana/Fier/Durrës

SALUS Hospital

Tirana

German Hospital Tirana,

Tirana

Amavita Hospital Tirana

Tirana

Private hospital services

All hospitals offer a wide range of comprehensive health care services including various surgical interventions. The growth in number of private hospital beds occurred at a time when the public sector was reducing the number of beds in every district. Internet plays an essential role in daily life in the vast majority of households in Albania and thus an essential role in the health field as well, since this is one of the cornerstones of society. Perception of patients’ was another important consideration for hospitals, as they felt that the patients would take them as profit oriented organization rather than service oriented organization. The development of hospital websites was one of the first marketing techniques used by the hospitals to take advantage of the unique characteristics of the internet as a communications medium (13). Patients are becoming autonomous decision makers in their own right. They want more information, clearer explanations of methods of treatment, and details of both costs and alternatives so it is natural for them to behave more like customers. They question and compare the medical services offered to them and base their decisions on a wide variety of criteria.

25

Azeta Tartaraj ______________________________________________________________________________________________________________________________________________

Marketing Techniques Human resources, Public speech and Relations, Media interview on Hospital and healthcare Advertisement of the hospital equipments and doctor’s profile (22). Physicians Physicians play a central role in ensuring the success of a hospital. Decisions that determine the content of hospital care are made by doctors, making them indirect sellers of hospital services. However, doctors are also dependent on the hospital to supply a complete service to patients, thus making the relationship between private hospitals and doctors one that is mutual (23). Nurses Hospitals are highly dependent on nursing staff for the success of their operations and in the private sector the priority is given to hire nurses who have studied abroad rather than in Albania (24). As hospitals spend much in technology and infrastructure, it becomes necessary, that they attract patients and generate funds. Hospitals follow various marketing and brand building exercises (25). Hospitals have eminent personalities from the industry in their board of directors. This indirectly leads to increase in, inflow of patients, because the presence of eminent personalities creates a sense of confidence in the minds of people. Private hospitals attract patients by offering discounts. The success rate of crucial operations and surgeries, reflect the knowledge and technological advantage of the hospital over the public sector. Such successes are discussed in health magazines and newspapers, brochures, poster, pamphlets, television and radio emissions, which become a natural advantage for the hospital.

RESULTS

Private hospitals have a significant function in the health system. They reduce the geographical distance to the nearest health facility for many in the population and they alleviate pressure from a substantially overburdened public hospital infrastructure. Private hospital services however, generally cost more than services at public hospitals and are therefore accessible to wealthy households and those with private health insurance. Private hospitals comprise the single largest component of expenditure by medical schemes followed closely by expenditure on medical specialists, which is not unusual due to the nature and intensity of services offered in these settings. Of concern, however, are the sharp increases in expenditure on private hospitals and the number of medical specialists during the last few years (9,15,16). The study focuses on the distribution of private hospitals in Tirana, the types of services provided by those hospitals and hospital marketing techniques. Hospitals hold seminars and conferences relating to specific diseases, where they invite the doctors from all round the country, for detailed discussion. This makes the hospital well known amongst the doctors, who could in future refer complicated cases to the hospital. Public speech and relations consisting of the doctor’s team that explain the various updates.They conduct visitor hospital tour and evaluate the patient satisfaction.

26


CONCLUSION

Albania healthcare system is bowing more and more to the principles of the market. This means hospital managers must cope with new challenges. As competition for patients and cases becomes fiercer, hospitals come up with competitive and distinctive and actively market them. Patients are becoming more willing to pay for services that are not covered by public sector. In addition, the private sector in general is prepared to become more involved in healthcare. This development opens up new potential to optimize the healthcare sector.

REFERENCES

The World Bank Group, 2010. WorldDevelopment Indicators. Website: http://data.worldbank.org/indicator. [Assessed13 July 2010]; Miller, W.J., Sumner, A.T. and Deane, R.H.2009. “Assessment of Quality Management Practices within the Healthcare Industry”,American Journal of Economics and Business Administration, Vol.1 No.2, pp. 105-113; Zuckerman, A., 2006. “Advancing the State of the Art in Healthcare Strategic Planning.” Frontiers of Health Services Management, American College of Healthcare Executives (ACHE), Winter; Ballou, B, Heitger, DL & Tabor, R 2003, 'Nonfinancial Performance Measures in the Healthcare Industry', Management Accounting Quarterly, vol. 5, no. 1, pp. 11-6; E. Abraham Mathew. Hospitals can leverage Programs as a content marketing opportunity print..http://hospitalmanagementasia.com/branding-strategies-you-can-do-for-your-healthcare-facility/ August 25, 2014; Bart, CK & Hupfer, M 2004, 'Mission Statements in Canadian Hospitals', Journal of Health Organization and Management, vol. 18, no. 2, pp. 92-110; World Hosp Health Serv. 2010;46(4):30-3.Hospital marketing: characterization of marketing actions in private hospitals in the city of São Paulo - Brazil. Leiderman EB, Padovan JL, Zucchi P.; Hariharan, S, Dey, PK, Moseley, HSL, Kumar, AY & Gora, J 2004, 'A New Tool for Measurement of ProcessBased Performance of Multispecialty Tertiary Care Hospitals', International Journal of Health Care Quality Assurance, vol. 17, no. 6, pp. 302-12; Document of the World Bank report no.: 88074 Project performance assessment report republic of Albania. Health system modernization project and social sector reform development policy loan june 24, 2014; Hopper, TM, Ogunmokun, G & McClymont, H 2005, 'The Effect of Strategic Marketing Planning Practices on Performance: A Study of Australian Private Hospitals', paper presented to Australiasian Business and Behavioural Sciences Association, Cairns, QLD, Australia; Stewart Gandolf. Methods of Marketing on March 4, 2010 in MEDICAL MARKETING http://www.healthcaresuccess.com/blog/medical-marketing; Lober WB and Flowers JL. Consumer empowerment in healthcare amid the Internet and social media. Semin Oncol Nurs2011; 27(3): 169–182; Thielst CB. Using social media to engage patients: many tools exist to connect, communicate, and build loyalty. Healthcare Exec 2011; 26(3): 66, 68–70; Squazzo JD. Best practices for applying social media in healthcare. Healthcare Exec 2010; 25(3): 34–36, 38–39; Huang E and Chang C. Case studies of implementation of interactive e-health tools on hospital Web sites. In: Paper presented at the Medicine X Conference, Stanford, CA, 27–30September 2012; Bennett E. Hospital social network list: U.S. hospitals that use social networking tools, http://ebennett.org/hsnl/ (2012, accessed 23 August 2012); http://www.hygeia.al

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Azeta Tartaraj ______________________________________________________________________________________________________________________________________________

www.salus.al/ www.spitaligjerman.com/ www.aksoygroup.net/Universal-Hospital-Albania www.spitaliamerikan.com www.spitaliamavita.com Croni J.J, Taylor S.A,2010. Measuring Service Quality, Journal of Marketing; Youssef et al., Journal of Service Marketing, Sep. 2010; Michal R.Bowers, 2011. “Journal of Health Care Marketing,- June,2011;

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BIOMARKERS AND CERVICAL LENGTH TO PREDICT SPONTANEOUS PRETERM BIRTH IN HIGH-RISK WOMEN Teuta Bare1, Anila Mitre1, Ervis Vata1, Endrin Shkurti1, Odeta Hoxhaj1, Nikita Manoku1 1

Obstetric Gynecologic Hospital “Queen Geraldine” Tirana, Albania; Email: [email protected]

Received December, 2014; Accepted December, 2014

ABSTRACT

Preterm birth still remains a major cause of perinatal morbidity and mortality, and its rate has not declined over the last two decades despite the improvement in perinatal management. The aim of the study is to assess the use of fetal fibronectin (fFN) testing and cervical length (CL) measurement to predict preterm delivery. This is a prospective study of patients admitted between November 2009 and June 2011 to the University Obstetric Gynecologic Hospital “Mbreteresha Geraldine”, in Tirana, with the diagnosis of increased preterm uterine contractility and intact membranes between 22 and 34 weeks of gestation. Among the 249 women with complete outcome, four were excluded from the final analysis as two had assessment for fFN but no CL measurement, and another two had CL measured but no screening for fFN. Among 245 women with complete results, the mean gestational age at recruitment was 29.4 ± 2.5 weeks. Six women (9.6%) delivered within two weeks of assessment, and 14 (22.5%) delivered before 34 weeks. A positive fFN test resulted in a sensitivity of 83%, a specificity of 84%, a positive predictive value of 36%, and a negative predictive value of 98% for delivery within two weeks; for CL < 25 mm, these figures were 50%, 52%, 10%, and 91%, respectively. In this study, fFN screening provided the best predictive capacity. Cervical ultrasound after fFN triage is an acceptable option, depending on the resources available. Key words: fetal fibronectin, preterm delivery, ultrasonography, cervical length,

INTRODUCTION

Preterm birth remains a major cause of perinatal morbidity and mortality, (1) and its rate has not declined over the last two decades despite the improvement in perinatal management (2). Assessing the probability of preterm delivery is still a clinical challenge and is important to reduce the clinical interventions (tocolysis, corticosteroid administration, and transfer to a tertiary care facility) which are risky and expensive. Several studies have shown that a diagnosis of preterm labour based on digital examination was not as reliable as the diagnosis based on tests, such as detection of fetal fibronectin in cervicovaginal secretions and ultrasound measurement of cervical length (3). Fetal fibronectin, an extracellular matrix glycoprotein localized at the maternal–fetal interface of the amniotic membranes between the chorion and the decidua, is found at very low levels in cervicovaginal secretions under normal conditions. Levels ≥ 50 ng/mL at or after 22 weeks’ gestation have been associated with an increased risk of spontaneous preterm birth (3–6). A recent meta-analysis has shown that birth before 37 weeks was significantly decreased in patients whose management was based on knowledge of fFN results compared with controls whose fFN results were not known (7) Transvaginal CL measurement is the other validated test to predict preterm birth in women with threatened preterm labour as well as in asymptomatic high-risk and low-risk women.(3,8–14). A CL measurement of 25 mm or less is generally considered an excellent indicator of an increased risk of preterm delivery, particularly among women with preterm labour. Several studies have reported that fFN screening and CL measurement provided similar results in

29

Teuta Bare1, Anila Mitre1, Ervis Vata1, Endrin Shkurti1, Odeta Hoxhaj1, Nikita Manoku1 ______________________________________________________________________________________________________________________________________________

predicting the risk of preterm delivery (15–20). However, whether combined fFN and CL measurement improves the prediction of preterm delivery and how the tests should be combined remain unclear.3 Availability of one of the two tests may be an issue in some facilities because the ultrasound expertise for CL measurement may not be always available in small centres. On the other hand, the additional cost of fFN testing may be difficult to justify in centres where CL measurement is readily available. Therefore, the use of CL or fFN as the first-line test might be a more rational option, limiting the use of a second test to selected cases in a contingent approach. The aim of the present study was to determine the performance of FN testing and ultrasound CL measurement for the prediction of preterm delivery in patients with preterm lab our.


This is a prospective cohort study of patients admitted between November 2009 and June 2011 to the Obstetric Gynecologic University Hospital “Mbretëresha Geraldine”, in Tirana, with the diagnosis of increased preterm uterine contractility and intact membranes between 24 and 34 weeks. Preterm labour was defined by the presence of regular uterine contractions, lasting at least 30 seconds and occurring at least four times per 30 minutes, and significant cervical changes on digital examination. Women were excluded if they had confirmed or suspected rupture of membranes, cervical dilatation > 3 cm, cervical cerclage, vaginal bleeding, placenta previa, placental abruption, severe intrauterine growth restriction, preeclampsia, or medically indicated preterm delivery before 34 weeks. The study investigations were carried out either on admission or within 24 hours of admission if a digital examination had been performed in the 24 hours before the patient’s inclusion in the study. Each subject was first examined with a vaginal speculum. A Dacron swab was rotated in the posterior fornix of the vagina and sent to the laboratory. The presence or absence of fFN was measured by a qualitative test (Fibronectin collection kit, Adeza Biomedical), and results were expressed as positive or negative. A concentration of 50 ng/mL in the vaginal fluid was indicative of a positive test. The outcome of the pregnancy was recorded in a database with other relevant information. The outcomes of interest were delivery within two weeks of admission to the study and delivery before 34 weeks. Predictive values and likelihood ratios with their 95% confidence interval were first calculated for each test considered separately, then for different combinations of both markers. Predictive values were compared using the McNemar chi-square test. All analyses were performed with SPSS 16.0 software.

RESULTS

Two hundred fifty four women were included in the study. The outcome of pregnancy could not be determined for five women who had been discharged and delivered in another centre. Among the 249 remaining women, two had a fFN assessment but no CL measurement, and another two had CL measured but no evaluation of fFN. These cases were excluded from further analysis. Two hundred forty five women were included in the final analysis, including seven twin pregnancies, and 147 (60%) women were initially transferred from another centre because of preterm labour. Twenty four (9.6%) delivered within two weeks, and 55 women (22.5%) delivered before 34 weeks. General characteristics and pregnancy outcome in study subjects are summarized in Table 1. Table 1. General characteristics, pregnancy outcome, and test results Characteristics Maternal age in years, mean ± SD Nulliparous, n (%) Maternal transfer, n (%) Gestational age at inclusion in weeks, mean ± SD Gestational age at delivery in weeks, mean ± SD Received tocolytics, n (%) Delivery within 2 weeks, n (%) Delivery before 34 weeks, n (%) Delivery before 37 weeks, n (%)

30

N = 245 27.6 ± 6.2 115 (46.8) 146 (59.7) 29.4 ± 2.5 36.5 ± 3.2 174 (71.0) 24(9.7) 55 (22.6) 91 (37.1)

International Journal of Ecosystems and Ecology Sciences (IJEES) Vol. 5 (1): 29-34 (2015) _____________________________________________________________________________________________ Admission to delivery interval in days, mean ± SD Median cervical length in mm (range) Cervical length < 15 mm Cervical length < 25 mm Cervical length _ 30 mm Positive fFN, n (%)

49.9 ± 22.8 26.5 (0–51) 12 (28.8) 20 (48.4) 16 (38.7) 10 (22.6)

The values of the different tests in predicting delivery within two weeks and before 34 weeks are shown in Table 2.

Table 2 .Predictive values for preterm birth of cervical length, fFN Sensitivity % ( 95% CI)

Specificity % ( 95% CI )

LR + % ( 95% CI )

LR – % ( 95% CI )

PPV % ( 95% CI )

NPV % ( 95% CI )

83(36 – 100) 50(12-88)

84(72-92)

5.2(2.6-10.4)

0.2(0.0-1.2)

36(13-65)

98(89-100)

52(38-65)

1.0(0.4-2.4 )

1.0(0.4-2.2)

10(2 -26)

91(75 -98 )

fFN +

50(23-77)

85(72-94)

3.4(1.4-8.1)

0.6(0.3-1.0)

50(23-77)

85(72-94)

CL < 25 mm

71(42-92)

58(43-72)

1.7(1.1-2.7)

0.5(0.2-1.2)

33(17-53)

87(71-96)

fFN +

48(35-60)

92(86-99)

6.2(1.9-20.0)

0.5(0.4-0.8)

79(68-89)

75(64-86)

CL < 25 mm

74(52-90)

67(50-81)

2.2(1.3-3.7)

0.4(0.2-0.8)

57(37-74)

81(64-93)

Delivery

Within 2 weeks (prev 9.7 % ) fFN + CL < 25 mm < 34 weeks (prev 22.6 % )

< 34 weeks (prev 37.1 % )

Fetal fibronectine was the best single test for the prediction of delivery within two weeks (sensitivity 83% and specificity 84%), whereas CL measurement had a slightly better sensitivity than fFN (71 vs. 50%, respectively) for predicting delivery before 34 weeks. The specificity of fFN was significantly better than CL measurement (p < 0.001). Overall, no significant difference was found between the sensitivity of fFN testing, CL measurement, and their combinations. The results of this study confirm that both cervicovaginal fFN testing and endovaginal CL measurement provide good prediction of delivery within two weeks or before 34 weeks in women with threatened preterm labour. In addition, we have tested two different strategies combining both tests, with the aim of improving the predictive value while decreasing the need for additional resources. For the prediction of delivery within two weeks, the best performance was provided by fFN testing alone. However, the sensitivities did not differ significantly between the various combinations; this means that, depending on local resources, a choice can be made among these options.

31

Teuta Bare1, Anila Mitre1, Ervis Vata1, Endrin Shkurti1, Odeta Hoxhaj1, Nikita Manoku1 ______________________________________________________________________________________________________________________________________________

Figure.1. Receiver-operator characteristic curve analysis of cervical length and fetal fibronectine for preterm delivery risk. Receiver-operator characteristic curve analysis of cervical length showed that a cutoff point of 25mm best minimized both the false-positive and the false-negative results. Areas under the cervical length (0.792) and fetal fibronectin (0.708) curves did not differ significantly, p = 0.6 (Fig. 1). When cervical length was ≤25mm, the mean gestational age at delivery was significantly lower than when cervical length exceeded 25mm (35.2 ± 2.9 weeks vs 38.2 ± 2.1 weeks, p 0.97) for all clays indicate good agreement between experimental and predicted data using the Langmuir equation. All the RL values for the adsorption of Pb2+ ions onto natural and acid activated montmorillonite clay shows that the adsorption process is favorable. The results of this study showed that the Prrenjas montmorillonite clay powder can be efficiently used as a low-cost adsorbent for the removal of Pb2+, from aqueous solution without nedded to activate with sulphuric acid. Keywords: Adsorption, Langmuir isotherm, Acid activation, Clay, Lead removal INTRODUCTİON

Heavy metals were extensively known of difficulty to eliminate. The biological treatment could not be applied to treat effluent water with metal contaminants due to their inhibitory ability on bacteria in the system [LipczynskaKochany E, Kochany J. 2000] The physical and chemical treatment has been used in metal effluent removal. The adsorption method with different types of adsorbent has been used to treat these metals from wastewater [Sprynskyy M, Buszewski B, Terzyk AP, Namiesnik (2008); Zhao X, Jia Q, Zhou W (2009)]. Many types of clay have been reported of their high capability in adsorption [Sdiri A, Higashi T, Hatta T, Jamoussi F, Tase N 2011]. Montmorillonite clay is alumina-silicate clay mineral, which has been used, in metal absorption because of its

35

Edlira Tako1, Altin Mele2, Valbona Plaku (Hoxha)1, Krenaida Taraj2 ______________________________________________________________________________________________________________________________________________

physicochemical properties i.e. large specific area, high cation exchange capacity and strong absorptive affinity with organic and inorganic substances, low cost and low permeability. Many research works have used natural bentonite clay as an adsorbent to eliminate metals from water. The chemical activation, such as NaCl and KCl, has been used to improve specific surface area of natural bentonite. However, no much work has utilised H 2SO4 to activate natural montmorillonite. There are many studies on the adsorption of Pb 2+, Cd2+ and Cu2+. For example, [Zou W, Han R, Chen Z, Jinghua Z, Shi J (2006)], studied the adsorption of Pb2+ and Cu2+ from aqueous solutions using manganese oxide coated zeolite. [Goyal M, Rattan VK, Aggarwal D, Bansal RC (2001), and Chen JP, Wu S (2004)] investigated the adsorption of Cu2+ using activated carbon . However, the use of these adsorbents is restricted due to high costs. Therefore, it is relevance to find suitable low cost adsorbent. Acid-activated clays are the most common bleaching agents for vegetal oils. A series of features including the available surface area and acidity of the clay sheets, along with the exchangeable cations exert influence upon the adsorption capacity of a given clay [Güler and Tunç, 1992; Liew KY, Tan SH, Morsingh F, Khoo LE. 1982; Taylor and Jenkins, 1988]. Clay features are strongly dependent on the activation procedure. Acid treatment is expected to improve the specific surface area and porosity, unless the clay framework collapses, more particularly under severe activation conditions. Nonetheless, the decay in adsorption effectiveness cannot be explained in terms of clay structure collapsing only, as reported by some authors [Kheok and Lim, 1982], since in our view, high specific surface area and porosity do not necessarily give rise to high adsorption activity in the clay. Indeed, even in the absence of framework destruction, the acidic activation of montmorillonite must involve partial delumination, inducing an increase in the silica/alumina ratio. As a result, there will be an increase in the number of weak acidic Si–OH groups and subsequently in the global acidity of the clay’s surface, though only up to a certain level. Nevertheless, this may occur at the expense of not only [Si–O–Al]H groups in the tetrahedral layers of the clay lamellae, if traces of beidellite are present, but also most of [Al–O–Metal2+]H groups, in the case of an extensive acid attack on the octahedral layer in montmorillonite. These removed groups are well known for displaying stronger acidities than terminal silanols [Azzouz A, Nistor D, Miron DN, Ursu AV, Sajin T, Monette F, Niquette P, Hausler R. 2006] and are presumably involved in absorption sites [Taylor DR, Jenkins DB, Ungermann CB. 1989]. Consequently, both the acidity strength and negative charge of the clay surface will rather decrease, in contrast with results reported by these authors (Kheok and Lim, 1982). Furthermore, high pore volume seems to play a predominant role within the total volume pore. Therefore, any variation of the activation parameters has a great impact upon the distribution of the acid strength and of the pore volume of the clay material. This is why full control of the adsorption capacity of a given clay material requires a thorough understanding of the role of activation parameters for a hierarchical ranking of their influences. This can lead to an accurate compromise between highly accessible surface areas with a high number of sites that interact with the adsorbate. Thus, the objective of this work is to understand the adsorption capacity of natural and acidic Prrenjas montmorillonite clay with Pb2+ ions. Equilibrium adsorptions isotherms help provide important information on the adsorption mechanisms, the surface properties and affinities of the adsorbent. The Langmuir and Freundlich isotherm equations were applied in this study. MATERİALS AND METHODS

1. Clay Sampling Montmorillonite clay was collected from Prrenjas region in Albania. The structural formula of the Prrenjas montmorillonite is given as: (Na 0.42K 0.09Mg 0.034Ca 0.009), (Fe3+1.26Al 0.45Mg 0.24Fe2+0.006) (Si 3.69 Al 0.30) O10(OH)2. (Jozja, 2003). Quartering technique was used to get a representative sample of natural clay. Before using, the natyral clay became richer evacuating the roughly sedimentson clear water to conserve their natural forms. The clay was then crushed ground and sieved. 2. Adsorbate solutions Chemicals used were of analytical/laboratory grade procured from Merck. Salt of lead nitrate was used as a source of heavy metal ions. Bidistilled water was used for all experimental investigations. pH adjustments were carried on using 0.1N hydrochloric acid (HCl) and 0.1N sodium hydroxide (NaOH). 3. Acid activation The equipment shown below is used for acid activation of clay with sulphuric acid.

36


Figure 1: Equipment scheme for clay acid activation. A fine montmoillonite suspension in water was put in contact with pure H 2SO4 at various concentration of acid (10 – 35%). The temperature of acid activation was 900C and the contact time was 3 hours. After activation, the solid residue was filtered, repeatedly washed with distilled water until reaching a neutral pH, and then at 100 °C for 6h or overnight at 40 °C. Then the dried montmorillonite was crushed to a particle size that would pass through a 75 μm sieve (200 mesh ASTM). In the table below is shown the acid concentration related to dry clay and the quantity of sulphuric acid and bidistillated water. Table 1: The mixing of clay + H2SO4 + H2O 10%

22%

35%

20

20

20

1.21

3.07

5.86

H2O ml

157.77

154.36

149.3

Molar. Conc

0.143

0.371

0.734

Clay (g) H2SO4 ml

4. Adsorption experiments The batch adsorption experiments were carried out in 100 ml Erlenmeyer flasks by mixing clay and 50 ml aqueous solution of metal ions and agitating the mixture in a constant temperature water bath thermostat for a desired time interval and the mixture was centrifuged. The experiments were repeated with different clay amounts, adsorbate concentration, and pH of the medium, interaction time and temperature. The pH was monitored both before and after adsorption. All samples were done in duplicates. The initial and the equilibrium metal ion concentration (mg/L) in solution were carried out using atomic absorption with air-acetylene oxidizing flame. The amount of adsorbed ions is calculated by difference. The results are represented as metal uptake per unit weight of adsorbent (qe) by using the following formula:

37


qe = [(C0–Ce) /m]× V Where: C0: is the initial metal ion concentration (mg/L), Ce: is the equilibrium concentration of metal ion (mg/L), m: is the mass of clay (g), V: is the volume of sample in (ml).

RESULTS

1. Equilibrium studies The equilibrium adsorption isotherm is of importance in the design of adsorption systems. Figure 2 show the plot of amounts adsorbed versus equilibrium concentrations for the adsorption isotherms of Pb 2+ on the natural and acid activated montmorillonite clay. It can be seen that the adsorption capacity of these clays is in proportion with metal concentrations. The adsorption ability of Pb2+ was in the following order: acid activated clay 35% > acid activated clay 22% > acid activated clay 10% > natural clay.

Figure 2. Adsorption isotherm of Pb2+ on the natural and acid activated montmorillonite clay at room temperature (initial concentration 10-50 mg/L) Furthermore, the results clearly shown that acid activation clay has not a higher sorption capacity than that of natural clay. 2. Isotherm study Isotherms models were studied for characterization of the adsorption process such as Langmuir and Freundlich isotherm which provide information on the capacity of sorbent. These isotherms relate metal uptake per unit weight, qe to the equilibrium metal ion concentration in the bulk fluid phase Ce. The Langmuir model been empirically most

38

International Journal of Ecosystems and Ecology Sciences (IJEES) Vol. 5 (1): 35-42 (2015) _____________________________________________________________________________________________ often used, contained the two parameters qm and b, which reflect the two important characteristics of the sorption systems. Langmuir adsorption model was applied to the data:

Ce C 1   e qe qm  b qm

(1)

Where: qm and b are the coefficients qm is the maximum amount of adsorption with complete monolayer coverage on the adsorbent surface (mg/g) and b is the Langmuir constant (L/g), qe is the weight adsorbed per unit weight of adsorbent (mg/g), and Ce is the metal concentration in bulk solution at equilibrium (mg/L),. Equilibrium concentration Ce and equilibrium capacity qe were calculated for each metal concentration. Ce was plotted against Ce/qe and a straight line was fitted in the data. Correlation factor R2 for Pb2+ indicates that sorption followed Langmuir model. Values of Langmuir constants qm and b were calculated from slope and intercept of line. The adsorption isotherms for Pb2+ removal were studied using initial concentrations of metal ions between 10 and 50 mg/L at clay mass of 2 g/L at 303K. The adsorption isotherms plotted in Figure 2 were fitted to the Langmuir equation: (1) The values of the Langmuir equation’s parameters are given in Table 2. High values of R2 (> 0.97) for all clays indicate good agreement between experimental and predicted data using the Langmuir equation.

Figure 3. Linearized Langmuir isotherm models for Pb2+ adsorption by the natural and acid activated clay (10, 22 and 35% H2SO4) The essential characteristics of Langmuir equation can be expressed in term of a dimensionless separation factor RL, which is defined as: RL=1/(1+bCo) (2) Where Co is the initial metal concentration (mg/L) and RL values indicate the shape of the isotherm. The nature of the adsorption process to be either unfavorable (RL> 1), linear (RL = 1), favorable (0 0.97) for all clays indicate good agreement between experimental and predicted data using the Langmuir equation. All the RL values for the adsorption of Pb2+ ions onto natural and acid activated montmorillonite clay shows that the adsorption process is favorable. The results of this study showed that Prrenjas montmorillonite clay can be used as a low-cost adsorbent for the removal of Pb2+ ions from aqueous solution without needed to activate with sulfuric acid.

REFERENCES

Assaad E, Azzouz A, Nistor D, Ursu AV, Sajin T, Miron DN, Monette F, Niquette P, Hausler R. 2007. Metals removal through synergic coagulation-flocculation using an optimized chitosan-montmorillonite system. Appl. Clay Sci. 37, 258–274. Azzouz A, Nistor D, Miron DN, Ursu AV, Sajin T, Monette F, Niquette P, Hausler R. 2006. Assessment of the acid–base strength distribution of ion-exchanged montmorillonites through NH3 and CO2–TPD measurements. Thermochimica Acta 449, 27–34 (8) Bergouzini JC, Duby C. 1995. Analyse et planification des expériences–les dispositifs en bloc. Masson, Paris, France. Bodo R, Ahmanache K, Hausler R, Azzouz A. 2004. Optimized extraction of total proteic mass from water hyacinth dry leaves. J. Environ. Sci. Eng. 3, 529–536. Chen JP, Wu S. Simultaneous adsorption of copper ions and humic acid onto an activated carbon. J. Colloid Interface Sci. 2004; 208: 334-42. Didi MA, Makhoukhi B, Azzouz A, Villemin D. 2009. Colza oil bleaching through optimized acid activation of bentonite; A comparative study. Appl. Clay Sci. 42, 336–344. Goyal M, Rattan VK, Aggarwal D, Bansal RC. Removal of copper from aqueous solutions by adsorption on activated carbon. Colloids and Surface A: Physicochemical and Engineering Aspects 2001; 229-38. Güler C, Tunç F. 1992. Chlorophyll adsorption on acidactivated clay. J. Amer. Oil Chem. Soc. 69, 948–950. Kheok SC, Lim EE. 1982. Mechanism of palm oilbleaching by montmorillonite clay activated at various acid concentrations. J. Amer. Oil Chem. Soc. 59, 129–131. Kirali EG, Laçin O. 2006. Statistical modelling of acid activation on cotton oil bleaching by Turkish bentonite. J. Food Eng. 75, 137–141. Liew KY, Tan SH, Morsingh F, Khoo LE. 1982. Adsorption of beta-carotene: II. On cation exchanged bleaching clays. J. Amer. Oil Chem. Soc. 59, 480–484. Lipczynska-Kochany E, Kochany J. Effect of humate on biological treatment of wastewater containing heavy metals. Chemosphere 2009; 77: 279-84. Liu Zr, Zhou Lm, Wei P, Zeng K., Wen Cx, Lan Hh. Competitive adsorption of heavy metal ions on peat. Journal of China University of Mining and Technology 2008; 18: 255-60. Official and Tentative Methods of the American Oil Chemists’ Society (AOCS). 1979. Bleaching Test, Official Method Cc 8b-52. Makhoukhi B, Didi MA, Villemin D. 2008. Modification of bentonite with diphosphonium salts: Synthesis and characterisation. Mater. Lett. 62, 2493–2496. Sdiri A, Higashi T, Hatta T, Jamoussi F, Tase N. Evaluating the adsorptive capacity of montmorillonitic and calcareous clays on the removal of several heavy metals in aqueous systems. Chemical Engineering Journal 2011; 172: 37-46. Sprynskyy M, Buszewski B, Terzyk AP, Namiesnik J. Study of the selection mechanism of heavy metal (Pb2+, Cu2+, Ni2+, and Cd2+) adsorption on clinoptilolite. J. Colloid Interface Sci. 2008; 304: 21-8. Taylor DR, Jenkins DB. 1988. Acid activated clays. Soc. Min. Eng. AIME Trans 282, 1901–1910.

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Taylor DR, Jenkins DB, Ungermann CB. 1989. Bleaching with alterative layered minerals: a comparison with acid activated montmorillonite for bleaching soybean oil. J. Amer. Oil Chem. Soc. 66, 334–341. Zhao X, Jia Q, Zhou W. Adsorption of zinc (II), cadmium (II), and copper (II) with PTFE Selective resin containing primary amine N1923 and Cyanex925. Korean J. Chem. Eng. 2009; 26: 1729-32. Zou W, Han R, Chen Z, Jinghua Z, Shi J. Kinetic study of adsorption of Cu(II) and Pb(II) from aqueous solutions using manganese oxide coated zeolite in batch mode. Colloids and Surface A: Physicochemical and Engineering Aspects 2006; 238-46.

42


SYNDROMIC SURVEILLANCE OF SEXUALLY TRANSMITTED INFECTIONS IN ALBANIA Adela Vasili1, Agim Shehi1, Silvia Bino1 Institute of Public Health, Tirana, Albania; Email: [email protected]

Received December, 2014; Accepted January, 2015

ABSTRACT

The availability of baseline information on the epidemiology of sexually transmitted infections (STIs) and other associated risk behaviors is essential for designing, implementing, and monitoring successful targeted interventions. The aim of the present study was to document the pattern of common STIs and to evaluate the performance of syndromic case management against their laboratory diagnoses. The study included all cases of sexually transmitted infections reported to the Public Health Institute during the period September 2007 - December 2012 with one or more of the complaints as enunciated by WHO in its syndromic approach for the diagnosis of STIs. Detailed history, demographic data, and clinical features were recorded and screened for STIs. A total of 5344 cases were notified in the public health sector. The mean age of patients was 30 (±8.4) years with a range14 to 84 years. 2.2% were men and 97.8% were women. 43.5% belonged to agegroup 20-30 years old. The syndrome most frequent syndrome were vaginal discharge in 91.6% of cases, while 36.0% of cases reported for lower abdominal pain. A routine surveillance system gives an incomplete picture of the epidemiological situation. Furthermore, there is general evidence that many cases of STI are not accounted for because of the high frequency of asymptomatic infections, and the frequent tendency for STI patients to seek care outside the public health services. Key words: epidemiology, management, laboratory diagnoses, public health

INTRODUCTION

Sexually transmitted infections (STIs) are of major public health importance as they predominantly affect young adults, carry stigma, facilitate transmission and acquisition of the human immunodeficiency virus (HIV) infection and have complications which constitute a great socio-economic burden (1,2). Complications resulting from failure to diagnose and treat infections include pelvic inflammatory disease (PID), infertility, ectopic pregnancy, chronic pelvic pain, cervical cancer and urethral stricture. The impact on foetuses and newborns can be devastating, as manifested by miscarriages, stillbirths, neonatal deaths, mental retardation, neonatal conjunctivitis and pneumonia (3,4). The World Bank estimates that for those aged 15–44 years, STIs excluding HIV are the second most important cause of healthy life lost in women after maternal mortality and morbidity. In spite of this burden, STIs have been accorded low priority in many developing countries. Most countries lack an effective STI control programme. Fortunately, interest in STIs has been boosted by evidence from recent studies confirming that control of STIs could contribute considerably to reducing the incidence of HIV (5,6). Control of sexually transmitted diseases (STIs) is a public health priority. The main aims of STD control are to interrupt their transmission, development and consequences. Besides primary prevention, measures to accomplish these aims include detecting and curing disease by providing adequate diagnostic and treatment facilities as well as limiting the complications of infection by providing early and effective treatment for both symptomatic and asymptomatic patients and their contacts. Syndromic case management is one approach for the secondary prevention

43

Adela Vasili1, Agim Shehi1, Silvia Bino1 ______________________________________________________________________________________________________________________________________________

of STIs (7.8). In Albania, the STI control programme was set up in 2007. Management of STIs carried out by doctors, nurses or midwives, is based on a syndromic approach, with no requirement for laboratory tests at the peripheral health care level. The syndromic approach provides a useful mechanism for STD services to be integrated into the primary health care (PHC) system (9,10). High STI prevalence rates, lack of specialized staff and limited laboratory services in many developing countries warrant the use of such an approach. Most of the STIs, both ulcerative and no ulcerative, are prevalent in Albania and constitute one of the major public health problems. The department of control disease in Institute of Public Health (IPH) supervises monthly the epidemiological surveillance. The STI programme led to inclusion of 8 STI syndromes in this surveillance during a 5 year: genital vesicular ulcers, genital No vesicular ulcer Urethral discharge, vaginal discharge, Lower abdominal pain, scrotal swelling, inguinal bubo, warts. The objective of this surveillance was to assess the extent of STI syndromes in health care services and to detect changes in trends or distribution in order to initiate investigative or control measures.


The Institute of Public Health (IPH) collects information from 12 prefectures from the public clinics and hospitals. For all patients, reasons for consultation are reported in registers by each health care provider. The study included all cases of sexually transmitted infections reported to the Public Health Institute during the period September 2007 - December 2012. The study cohort is homogeneous and ineligible. Because the study included all patients with sexually transmitted infections for the aforesaid period, the cohort has not-in selection bias. Data Collection Data from this study were obtained from individual forms of patients with sexually transmitted infections over the period September 2007 - December 2012. This forms are filled in by doctors. Detailed history, demographical data, and clinical features were recorded from all the patients. All patients were managed on the basis of algorithms of the syndromic approach at the peripheral health center level recommended by national AIDS control organization, after carrying out risk assessment. In this descriptive study, we determine the relevance of the information from a pragmatic point of view. The absolute number of case was related to the number of consultations to evaluate the relative role of STIs in health care service, and to the population as a whole to estimate STI incidence.

RESULTS

The age of patients ranged from 14 to 84 years, the mean age being 30 years, and 43,5% of them were in the age group of 20–30 years. 2,2 percent of the patients were male. Majority of the patients (99, 9%) were educated. The most cases are secondary and elementary education respectively in 2125 (39.8%) and 1951 (36.5%) followed by higher education in 1042 (19,n5%) of the total. 87, 6 percent of the patients were married at the time of presentation. Only 2, 3% of them reported regular use of condom. Most of patients (39%) had one sexual partner (husband in 90% of them), 0, 9% had two sexual partners in 6 months and 0, 3% had multiple sexual partners in the past 6 months. Table 1 shows the absolute number of STI cases reported nation-wide for each of 8 syndromes during the 5 year period. A total of 5344 cases were notified in the public health sector. The overall number of STI cases reported was steady in men 120 (2,2%), but increased by 97.8% in women. Noted that the syndrome is the most common vaginal discharge syndrome with 4895 (91.6%) cases, while 1924 (36.0%) of cases reported for Lower abdominal pain. 139 (2.6%) cases reported for warts, 93 (1.7%) cases of urethral discharge report, 42 (0.8%) cases reported vesicular genital ulcer, 14 (0.3%) cases reported scrotal swelling, 23 (0.4%) cases reported of genital No vesicular ulcer, 2 (0.1%) cases reported to the inguinal bubo. 35,5% of the patients had multiple syndrome.

44

International Journal of Ecosystems and Ecology Sciences (IJEES) Vol. 5 (1): 43-46 (2015) _____________________________________________________________________________________________ Table 1 syndrome presented by sexually transmitted infections Syndrome

Frequency

Percentage

Genital Vesicular Ulcers

42

0,8

Genital Non Vesicular Ulcer

23

0,4

Urethral Discharge

93

1,7

Vaginal Discharge

4895

91,6

Lower Abdominal Pain

1924

36

Scrotal Swelling

14

0,3

Inguinal Bubo

2

0,1

139

2,6

Warts

Figure 1. Distribution of cases according to the laboratory reference

It is observed that 4061 (76%) of the cases were referred to the laboratory, while 1,283 (24%) are not referred to the lab with a statistically significant difference between them p 12 hours.

84


Figure 2. Signs and symptoms of the patients Laboratory investigation: All of the patients included in the study had abnormal ECG and elevated levels of CK and LDH. Cardiovascular disease continues to be one of the major causes of morbidity and mortality among women as well as men in many countries (6). Cardiovascular disease is much less frequent in premenopausal women than in agematched men (7). This essentially shifts the incidence curves for women by 5–10 years compared with men. Acute MI below the fourth decade is predominantly a disease of men. In the present study, more than three-quarter of patients included were male. This is similar to the results from communities in some industrialized countries (8). In the present study, the ratio of the number of patients > 60 years of age to those ≤ 60 years was 1.0:1 in male patients and 3.3:1 in female patients Diabetes is a major independent predictor of morbidity and mortality in acute MI, probably through its associations with pre-existing left ventricular dysfunction and diffuse and rapidly progressive coronary atherosclerosis (9). The study findings indicated that 51% of all patients hospitalized at Shkodra regional hospital for MI had diabetes. This is higher than the 10.5% to 30.0% reported in the other studies conducted in countries (10). This reflects the high burden of diabetes in our population, and suggests that more aggressive strategies need to be directed towards primary prevention among this vulnerable group. Hypertension, another wellestablished cardiovascular risk factor, was present in 36% of patients. Hypertensive individuals more frequently have symptoms preceding acute MI, probably due to ventricular hypertrophy associated with high blood pressure. Women with acute ischaemic syndromes have higher rates of associated diabetes and hypertension because the protective effects of the premenopausal state can probably be overcome by these two potent causes of atherosclerosis (11). The effect of cigarette smoking on the risk of MI has long been investigated and the results of one recent study suggested that cigarette smoking played the most important role in MI in individuals under the age of 36 years (12). Smoking increases the risk of an initial cardiac event and doubles the rate of subsequent infarction and death. The association between cigarette smoking and a high cholesterol level is well established (13). This may reflect the higher intake of dietary fat and cholesterol among smokers or the metabolic effects of cigarette smoke metabolites (3). As the number of cigarettes smoked per day increases so the cholesterol level rises in both males and females (14). Our results showed that smoking was an important risk factor among male patients. Of the total patients in the present study group for whom smoking history was available, 15% were ex-smokers and 53% were current smokers. This is comparable with the range of current smoking history among males with acute MI found in some other studies (14). On the other hand, in industrialized countries the range of smoking in females can be high and approach the male range (15). However, this is quite different from the female smoking habits in our sample. Few women smoke in our study. Our study showed that only 2% of female patients were current smokers.

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Edi Smajlaj1, Sabit Brokaj2 ______________________________________________________________________________________________________________________________________________

CONCLUSION

In view of the high inpatient mortality risk among acute MI patients in the present investigation public health planners and clinicians should be aware of the importance of early diagnosis of MI and the ensuing burden of various cardiovascular risk factors so that appropriate primary and secondary prevention strategies can be implemented.

REFERENCES

Mackay J, Mensah G. Atlas of Heart Disease and Stroke Geneva: WHO, 2004; Cardiovascular disease in Albania (Source: INSTAT/MoH) 2013; Khot UN et al. Prevalence of conventional risk factors in patients with coronary heart disease. Journal of the American Medical Association, 2003, 290:898–904; Manfroi WC et al. Acute myocardial infarction. The first manifestation of ischemic heart disease and relation to risk factors. Arquivos Brasileiros de Cardiologia, 2002, 78:392–395; Mehta RH, Eagle KA. Secondary prevention in acute myocardial infarction. British Medical Journal, 1998, 316:838–842; Ribeiro DG et al. Acute myocardial infarction: predictors of mortality at a public hospital in the city of Fortaleza, Ceará state. Arquivos Brasileiros de Cardiologia, 2003, 80:614–620; Wilson PW, Kannel WB. Hypertension as a risk factor for cardiac events-epidemiologic results of long-term studies. Journal of Cardiovascular Pharmacology, 1993, 21:S27–S37; Grundy SM et al. Assessment of cardiovascular risk by use of multiple risk factor assessment equations. Circulation, 1999, 100:1481–1492; Eagles CJ, Gulati R, Martin U. Non-pharmacological modification of cardiac risk factors: part 1. Journal of Clinical Pharmacy and Therapeutics, 1996, 21:289–296; Mendelsohn ME, Karas RH. The protective effects of estrogen on the cardiovascular system. New England Journal of Medicine, 1999, 340:1801–1811; Borzak S, Weaver WD. Sex and outcome after myocardial infarction: a case of sexual politics? Circulation, 2000, 102:2458– 2459; Keith A, Website. Stress hyperglycemia and enhanced sensitivity to MI. 2008;10:78-84; Tunstall-Pedoe H et al. Sex differences in myocardial infarction and coronary deaths in the Scottish MONICA population of Glasgow 1985 to 1991: presentation, diagnosis, treatment, and 28-day case fatality of 3991 events in men and 1551 events in women. Circulation, 1996, 93:1981–1992; Panagiotakos D et al. Cigarette smoking and myocardial infarction in young men and women: a case–control study. International Journal of Cardiology, 2007, 116:371–375; Hebert JR, Kabat GC. Difference in dietary intake associated with smoking status. European Journal of Clinical Nutrition, 1990, 44:185–193;

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MAMMOGRAPHIC SCREENING IN THE DETECTION OF MICROCALCIFICATIONS AND EARLY BREAST CANCER Agim Dokaj1, Tahir Hysa2 1

Regional Hospital of Shkodra, Albania; University Hospital Centre "Mother Theresa", Tirana, Albania;

2

E-mail: [email protected]

Received January, 2015; Accepted January, 2015

ABSTRACT

Micro calcifications can occur in benign and malignant diseases. Scattered bilateral micro calcifications are usually present in benign breast diseases, but irregular shape and development of new calcifications among diffusely scattered bilateral calcifications, on follow up study, should also raise suspicion for being malignant. The aim of this study was to determine the frequency of micro calcifications and malignancy in women included in a screening program. This is a prospective study: 750 women were included in a screening program at regional hospital in Shkodra over the period 2012 -2013. Clustered and scattered micro calcifications were included in the study. Age women included in this study ranged from 30-80 years (mean 52 years). Micro calcifications were detected in 113 (15%) of screened women. Ninety seven (86%) had clustered micro calcifications and 16 (14%) had scattered micro calcifications. In 35(31%) of calcifications was detected a cancer. 53(47%) women had 20 micro calcifications/cm2. Irregularity in size of micro calcifications was found in 55 (48.7%) of patients, while mean density of micro calcifications was found in 57 patients. The study highlights the effectiveness of the screening program in diagnosing micro calcification and malignancy in women. Key words: breast, micro calcifications, cancer, screening

INTRODUCTION

The breast develops from mammary ridges. After menarche, the young virgin breast contains more dense connective tissue. With progression in age the dense breast becomes mixed glandular pattern tissue, and with further progression in age, breast begins to involute into fatty tissue (1,3). Any aberration in this process leads to the susceptibility to a spectrum of localised pathologies like, hyperplastic and neoplastic changes. Of the various pathologies that affl ict the breast, cancers are most often encountered and are the most dreaded (2). Despite the gloomy prognosis, increased morbidity and reduced survival time, it can be controlled if detection and diagnosis are made in the earliest stages i.e., in the pre-invasive and clinically nonpalpable stage. Detection of breast cancer in its earliest possible stage is the ultimate goal in imaging the breast, and the role of the radiologist is therefore vital. Radiology chiefly includes MG (mammography) and USG (ultrasonography) followed by biopsy (3). The incidence of breast cancer deaths can be reduced by 30% by the routine screening of healthy women with MG (4,5). This is because breast changes like asymmetry, neodensity, distortion of fibroglandular architecture and microcalcifi cations are picked up earlier than lesions that become clinically palpable, or are sometimes detected by self-examination. Primary breast carcinoma is one of the commonest causes of cancer deaths among females1-2 and with many advances mortality rate for breast cancer remains challenging. Mammography using high resolution and low dose film screen is the established method for early detection of breast cancers.3-5 Approximately 25-43% of non-

87

Agim Dokaj1, Tahir Hysa2 ______________________________________________________________________________________________________________________________________________

palpable cancers are detected on mammography as a result of calcifications (6,7). The presence of multiple fine, clustered, pleomorphic calcifications increases the suspicion of malignancy whereas large, solitary, round or ring like calcifications are unlikely to be associated with malignancy. The aim of this study was to determine the frequency of microcalcifications and malignancy in women included in a screening program.


This is a prospective study. 750 women were included in a screening program at regional hospital in Shkodra over the period 2012 -2013. Clustered and scattered microcalcifications were included in the study. Among clustered microcalcifications, the eight analytic mammographic criteria have been chosen for determining the diagnostic value of isolated clustered microcalcifications. These included the number of calcifications per square centimeter which are described as 20. The total number of microcalcifications per square centimeter was determined by moving a sheet of 1cm square hole in it over the mammogram. The count was made where number of microcalcifications was greatest. Total number of microcalcifications in the cluster are grouped as 30. The Irregularity of microcalcifications' density and size in the same cluster is evaluated by the experts (yes or no). The morphologic aspect of each cluster was evaluated. Observations were recorded as linear, branched or vermicular disposition, mean density of microcalcifications (high or low) and opinion of experts on the possible malignancy of the lesions. Results of the study were correlated with the histopathological analysis.

RESULTS

Age of 750 patients included in this study ranged from 30-80 years (mean 52 years). Microcalcifications were detected in 113 (15%) of screened women. Ninety seven (86%) had clustered microcalcifications and 16 (14%) had scattered microcalcifications (fig. 1). In 35 (31%) of calcifications was detected a cancer (fig. 2).

Figure 1. Distribution of microcalcifications

Figure 2. Frequency of malignant calcifications

The number and characteristics of microcalcifications are presented in table 1, 53 (47%) women had 20 microcalcifications/cm2. In 64 (56.5%) patients microcalcifications were found in upper outer quadrant, in 33 (29.2%) patients in upper inner quadrant, in 14 (12.4%) patients in lower outer quadrant and in 9 (7.8%) patients in lower inner quadrant. Table 1. Characteristics of microcalcifications Calcification Characteristic No. of microcalcifications/cm2 20 Location

88

N

%

53 26 12

47 22 10

International Journal of Ecosystems and Ecology Sciences (IJEES) Vol. 5 (1): 87-90 (2015) _____________________________________________________________________________________________ Upper outer quadrant Upper inner quadrant Lower outer quadrant Lower inner quadrant Morphology Linear Segmental Regional Diffuse Irregularity in density of microcalcifications Irregularity of size of microcalcifications Mean density of microcalcifications

64 33 14 9

56.5 29.2 12.4 7.8

3 6 8 2 59 55 57

2.5 5.3 6.7 1.8 52.1 48.7 50.3

Regarding the morfology 3 (2.5%) of microcalcifications were linear, 6 (5.3%) were segmental, 8 (6.7%) were regional and 2 (1.8%) were diffuse. Linear, branched or vermicular shape is one of important criteria in diagnosing a malignant cluster. Out of 35 patients with malignant disease, 3 had linear, branched or vermicular calcifications Irregularity in density and size of microcalcification in a cluster is one of the reliable criteria to diagnose breast cancer. Out of 59 patients with irregular density, 21 were proven to have breast cancer. Irregularity in size of microcalcifications was found in 55 (48.7%) of patients, while mean density of microcalcifications was founfd in 57 patients. Expert Radiologists' opinion on the necessity for biopsy of breast with microcalcifictions. These criteria are reliable enough for an expert radiologist to diagnose malignant calcifications. Among 113 patients with microcalcifications biopsy was advised for 47 patients by radiologist. Of these 23 patients were proven to have breast cancer by histopathology. Hence, yield of biopsy after expert radiologist opinion was 42% which is similar with the results described in literature, where the biopsy yield advised by radiologist is approximately 35%. Breast cancer is one of the commonest cause of cancer death among females (8,9). Mammography is the only investigation proven to be effective for the detection of early occult (T0) breast cancers. In this study 97 out of 113 (86%) had clustered microcalcifications while 16 patients (14%) had scattered microcalcifications. Clustered microcalcification can occur in benign as well as malignant conditions (10-13). In this study clustered microcalcifications were present in 70% of benign and 30% of malignant conditions. Certain criteria have been established to determine malignant clustered microcalcification. Cancer was detected in 35 (31%) patients with calcifications. Linear, branched or vermicular shape is one of important criteria in diagnosing a malignant cluster (14-16). Out of 35 patients with malignant disease, 3 had linear, branched or vermicular calcifications Irregularity in density and size of microcalcification in a cluster is one of the reliable criteria to diagnose breast cancer. Out of 59 patients with irregular density, 21 were proven to have breast cancer. Irregularity in size of microcalcifications was found in 55 (48.7%) of patients, while mean density of microcalcifications was founfd in 57 patients. Diffusely and randomly distributed microcalcifications in a large volume of breast are usually associated with benign breast disease. Morphologically, a central area of lucency in a calcium deposit is virtually always associated with benign processes (17,18). Certain patterns, however should arouse concern, for example, extensive comedocarcinoma is associated with large areas of mammographically visible calcium deposits. Their mammographic pattern was characterized by a strikingly wild, chaotic appearance with profuse deposition of calcium, Many deposits may have typically benign morphology (19,20). Shape of microcalcifications is again important in such cases. The radiological suspicion should be raised, when these calcifications are interspersed with more irregular appearances resulting in overall heterogeneity (21). When such patterns occur, diffuse breast cancer should be suspected and follow up or biopsy of that area should be considered.

CONCLUSION

Clustered microcalcifications may be the only detectable manifestation of early breast cancer. Mammographic assessment of calcifications is an essential part of assessment of potentially abnormal screening mammograms. The incidence of malignancy associated with a mammographic abnormality of microcalcification in our study is

89

Agim Dokaj1, Tahir Hysa2 ______________________________________________________________________________________________________________________________________________

comparable to results shown by other investigators. The study highlights the effectiveness of the screening program in diagnosing microcalcification and malignancy in women.

REFERENCES

Clarke D, Sudhakaran N, Gateley CA. Replace fi ne needle aspiration cytology with automated core biopsy in the triple assessment of breast cancer. Ann R Coll Surg Engl 2001; 83:110–2; Schoonjans JM, Brem RF. Fourteen-gauge ultrasonographically guided large-core needle biopsy of breast masses. J Ultrasound Med 2001; 20:967–72; Morris KT, Vetto JT, Petty JK, Lum SS, Schmidt WA, Toth-Fejel S, et al. A new score for the evaluation of palpable breast masses in women under age 40. Am J Surg 2002; 184:346–7; Kerlikowske K, Smith-Bindman R, Ljung BM, Grady D. Ann Intern Med. 2003 Aug 19; 139(4): 274–84. Evaluation of abnormal mammography results and palpable breast abnormalities. Ann Intern Med. 2003 Aug 19; 139(4): 274– 84; Chakraborti KL, Bahl P, Sahoo M, Ganguly SK, Oberoi C.Magentic resonance imaging of breast masses: Comparison withmammography. Indian J Radiol Imaging 2005; 15:381–387; Pande AR, Lohani B, Sayami P, Pradhan S.Predictive value of ultrasonography in the diagnosis of palpable breast lump. Kathmandu Univ Med J (KUMJ). 2003 Apr-Jun; 1(2): 78–84; Fajardo LL. Screening mammography, sonography of dense fibrocystic breast tissue. AJR Am J Roentgenol. 2003 Dec; 181(6):1715; Dennis MA, Parker SH, Klaus AJ, Stavros AT, Kaske TI, Clark SB. Breast biopsy avoidance: the value of normal mammograms and normal sonograms in the setting of a palpable lump. Radiology 2001; 219:186 -191; Weinstein SP, Conant EF, Orel SG, Zuckerman JA, Czerniecki B, Lawton TJ. Retrospective review of palpable breast lesions after negative mammography and sonography. J Women's Imaging 2000; 2:15–18; Kerlikowske K, Smith-Bindman R, Ljung BM, Grady D. Evaluation of abnormal mammography results and palpable breast abnormalities. Ann Intern Med 2003; 139:274–84; Shetty MK, Shah YP, Sharman RS. Prospective evaluation of the value of combined mammographic and sonographic assessment in patients with palpable abnormalities of the breast. J Ultrasound Med 2003; 22:263–8; Kumle M, Weiderpass E, Braaten T, Persson I, Adami HO, Lund E. Use of oral contraceptives and breast cancer risk: the Norwegian-Swedish Women's Lifestyle and Health Cohort Study. CancerEpidemiol Biomarkers Prev 2002; 11:1375–81; Budai B, Szamel I, Sulyok Z, Nemet M, Bak M, Otto S, et al. Characteristics of cystic breast disease with special regard to breast cancer development. Anticancer Res 2001; 21:749–52; Osuch JR, Reeves MJ, Pathak DR, Kinchelow T. BREASTAID: clinical results from early development of a clinical decision rule for palpable solid breast masses. Ann Surg 2003; 238:728–37; Berg WA, Campassi CI, Ioff e OB. Cystic lesions of the breast: sonographic-pathologic correlation. Radiology 2003; 227:183–91; Kolb TM, Lichy J, Newhouse JH. Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that infl uence them: an analysis of 27,825 patient evaluations. Radiology 2002; 225:165–75; Barlow WE, Lehman CD, Zheng Y, Ballard-Barbash R, Yankaskas BC, Cutter GR, et al. Performance of diagnostic mammography for women with signs or symptoms of breast cancer. J Natl Cancer Inst 2002; 94:1151–9; Leichter I, Buchbinder S, Bamberger P, Novak B, Fields S, Lederman R. Quantitative characterization of mass lesions on digitized mammograms for computer-assisted diagnosis. Invest Radiol 2000; 35:366–72; Obenauer S, Luftner-Nagel S, von Heyden D, Munzel U, Baum F, Grabbe E. Screen fi lm vs full-fi eld digital mammography: image quality, detectability and characterization of lesions [published correction appears in Eur Radiol 2002; 12:2388]. Eur Radiol 2002;12:1697–702; Lewin JM, Hendrick RE, D'Orsi CJ, Isaacs PK, Moss LJ, Karellas A, et al. Comparison of full-fi eld digital mammography with screenfilm mammography for cancer detection: results of 4,945 pairedexaminations. Radiology 2001; 218:873–80; Westenend PJ, Sever AR, Beekman-De Volder HJ, Liem SJ. A comparison of aspiration cytology and core needle biopsy in the evaluation of breast lesions. Cancer 2001; 93:146–50;

90


MONITORING OF SULPHUR CONTENT IN DIESEL IMPORTED IN ALBANIA AND ENVIRONMENTAL IMPACT, DURING THE PERIOD 2007 – 2012 Belshaku, M1*, Xhemaj, E2, Beqiraj, I3 1

General Directorate of Albanian Customs, Albania; Central Laboratory of the Armed Forces, Tirana, Albania; 3 Department of Industrial and Environmental Chemistry, Faculty of Natural Sciences, University of Tirana, Tirana, Albania; 2

Email: [email protected]; [email protected];

Received April, 2013; Accepted June, 2013

ABSTRACT

Development of road transport over the last decade has been accompanied by a growing trend to derivative fuel imports, gasoline and diesel, at 70 - 75%. This development among others, is associated with negative impacts on environmental pollution especially in urban areas at the rate of 25 -75% of the total pollution.Sulphur oxide (SOx) emissions from diesel vehicles are one of the main pollutants of urban air. The sulfur level in diesel fuel ranges from below 10 ppm to above 10,000 ppm. The diesel imported during this period is 2 244 thousand tons. In these conditions, continuous monitoring of sulfur content in diesel takes a special significance to improve its quality standards.In developing countries improvements to standards on the control of sulphur content in diesel fuel actually is in focus. In our country, a significant improvement of laws mark the adoption of Decision 147, dated 21.03.2007, in which the Sulphur content to imported diesel was limited at 350 mg/kg for the period from 1 January 2009 and 10 mg/kg for the period from 1 January 2011.The aim of this study is monitoring of the sulfur content in diesel import during the period 2007-2012, the environmental effects in urban areas and the impact of legal restrictions undertaken in the country to reduce the sulphur level to transportation fuels. Keywords: Diesel, environnemental impact, sulphur content, standard, pollution.

INTRODUCTION

After 1990 transport sector in Albania has shown an increasing trend. Compared with 1995, when the number of means of transport has been close to 130 933 vehicles, around the end of 2010 this number has reached to 420 thousand vehicles. Increasing trend in the number of vehicles in the transport sector is directly reflected in the development of hydrocarbon which as its main source of supply from import supply [1]. Thus, 85% of vehicles use diesel fuel and over 75% of diesel needs are met by hydrocarbon import market. Health and environmental impacts of sulphur One of the biggest problems faced in developing countries and countries in transition is air pollution, especially in urban areas. The World Health Organization (WHO) has estimated that almost 800,000 people a year die prematurely due to air pollution in urban spaces, and most of these deaths occur in developing countries [2]. Pollution from vehicle emissions is one of the main factors of pollution in urban spaces. In terms of health impact, four are especially problematic pollutants, particulate matter (PM), ozone (O3), carbon monoxide (CO), sulfur dioxide (SOx) [3].

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Belshaku, M1*, Xhemaj, E2, Beqiraj, I3 ______________________________________________________________________________________________________________________________________________

Sulfur is a natural component of raw oils and is found in both gasoline and diesel. Nearly, 100% of fuel sulfur is emitted as SO2. SO2 causes negative impacts on the environment and the health. People with asthma, children, the elderly and they with heart or lung disease are particularly sensitive are to these adverse effects. This impact includes: • (Dysponea)- a breathing difficulty especially for people with asthma • Respiratory illness and aggravates existing heart diseases • SO2 reacts with other chemicals in the air to form tiny sulfate particles which, when inhaled, accumulate in lungs leading to respiratory disorders • Premature death. Sulfate particles provide a relatively large surface area onto which HC condense resulting in particle growth and increasing particle matter toxicity. Sulfate particles are the major cause of reduced visibility. These have carcinogenic and toxic effects [3]. Legal measures for reducing the sulphur content in diesel fuels For above reasons and the other reason are taken a number of legislative measures to reduce the amount of sulfur in fuel especially, in diesel. Thus, Council Directive 98/70/EC of 13 October 1998 put limits to reduce the sulfur content in diesel fuels that marketed within their territory, as follows: • No later than 1 January 2000 the max. of permitted S content must be 350 mg / kg (EN 590:1999); • Not later than 1 January 2005 the maximum of permitted S content must be 50 mg / kg or 10 mg / kg; • From 1 January 2010 the maximum of permitted S content must be ≤ 10 mg / kg. Our country to become part of the EU, inter alia, has taken a number of legislative measures in terms of environmental protection. So, at 2007 by Decision no. 147 of date 21.03.2007 "On the quality of fuels, gasoline and diesel," was decided to allow the trading of diesel fuel for engines with permitted S content measured by Standard Method of Albanian S SHEN 590: • From 1 January 2009, the maximum of permitted S content must be 350 mg / kg; • From 1 January 2011, the maximum of permitted S content must be 10 mg / kg.

MATERIAL AND METHODS Table 1 shows the quantities of diesel that are imported for the period 2007 to 2012 [4]. These quantities are shown divided into subgroups according to sulfur content declared to customs in accordance with the Combined Nomenclature of Goods 2007 - 2012 [6]. Table 1. Quantities of diesel (in thousand ton) for the period 2007 – 2012 S content in weight%/ Year

2007

2008

< 0,05

120.18

149.17

0.05 ÷0.2

216.91

204.30

> 0.2

0.38

0.12

2009

2010

2011

2012

÷0.001

368.95

283.45

>0.001

73.9

65.45

442.87

348.9

÷0.035

286.91

368.45

>0.035

48.2

57.5

335.11

425.96

Total

337.47

353.59

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International Journal of Ecosystems and Ecology Sciences (IJEES) Vol. 5 (1): 91-96 (2015) _____________________________________________________________________________________________ Figure 1: Graphic of imported diesel during the period 2007 - 2012

Note: The quantities of diesel containing S> 0.035 or S> 0.001 (period 2009 – 2011), have destinations differently from uses in vehicles. Their destinations are: for use in generators, fishing boats, etc.; for use in crude oil extraction wells. Monitoring quality of imported diesel during the period 2007 - 2012 was conducted in the Laboratory of General Directorate of Customs. In table below are given monitoring customs parameters and Methods.

Table 2: The parameters of Customs monitoring

Features

Results

Limits allowed

Methods

Clear Liquid, yellow to green 0.82-0.86

Visual ASTM D 1298

First point of the distillation (0C) Distilate at 2500C (%vol) Temperature at 50% vol. (0C)

Min 170 Max 65 Max300

ASTM D 86-97 ASTM D 86-97 ASTM D 86-97

Distilate at 350 0C (%vol) Distilate at 370 0C (% vol.) End of distilation (0C/%vol.) Viscosity at 400C (cSt) Content of S (% weight)

Min 85 Min 95 2-4 S

ASTM D 86-97 ASTM D 86-97 ASTM D 86-97 ASTM D 445-97 Multi EA 3100

Appearance Density at 150C (kg/l)

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Determination of the amount of Sulfur performed by apparatus EA 3100 which at the same time makes the determination of the content of nitrogen and chlorine in petroleum product services. Pyrolys is used for the breakdown of the substances in the Multi EA 3100. The apparatus can be operated in vertical or horizontal mode. The vertical mode is used for pyrolysis of samples in liquid or gaseous phase whereas the horizontal mode for samples in solid or liquid phase. The process passes two stages: • The first stage – pyrolysis of sample components in the stream of argon; • The second stage - burning of the pyrolysis products in the stream of oxygen according to the reactions: R + O2 → CO2 +H2O R-N + O2 → NOx + CO2 + H2O R-S + O2 → S O2 + C O2 + H2O R-X + O2 → HX* + CO2 +H2O R → substance containing carbon *→ X = F-, Cl-, Br-, I-

(1) (2) (3) (4)

RESULT

For the study are taken into consideration 355 samples analyzed in the Customs Laboratory, during the period 2007 to 2012 [5]. The quantity of average of sulfur is calculated for each subgroup of imported diesel from the analytical laboratory results. Considering the quantities of imported diesel and the average of sulfur content is making the calculation of the amount of sulfur in diesel imported for this period. These data are presented in the table below.

Table 3. Number of analyses, the average S content (% weight), the total sulphur (ton)

Year

2007

2008

2009

2010

2011

2012 Total

Amount of diesel/thousand ton

Amount of S in ton

description

Nr/analyses

%S, average

0,2

3

0.21067

0.38

0.08

0,2

2

0.23000

0.12

0.03

÷0.035

24

0.00223

286.91

0.64

>0.035

2

0.07800

48.20

3.76

÷0.035%

124

0.00079

368.44

0.29

>0.035

1

0.07500

57.46

4.31

÷0.001%

61

0.00054

368.95

0.20

> 0.001

9

0.04410

73.92

3.26

÷ 0,001 %

28

0.00069

283.45

0.20

> 0.001

3

0.05100

65.45

3.34

2243.84

91.01

355

94


In column 3 is given the number of analyzes that are done in Custom Laboratory. In column 4 is given the average of sulfur content for each group of imported diesel and; In column 6 are given the quantities of sulfur that are calculated considering the amount of diesel imported. The data in this table shows that: During the period of study are cleared a total of 2243.84 thousand tons diesel; The estimated amount of sulfur in diesel is 91.01 tons; From laboratory tests conclude that: 64% and 57% of the cleared quantity of diesel for 2007 and 2008 have the average content of S respectively 0.18039% and 0.12427%; 86% of the cleared quantity of diesel for 2009 and 2010 have the average content of S respectively 0.00223% and 0.00079%; 83% and 81% of the cleared quantity of diesel for 2011 and 2012 have the average content of S respectively 0.00054% and 0.00069%. Ratio of quantities of diesel cleared during 2007 - 2012: During the period 2007-2008 is cleared 31% of total; during the period 2009-2010 is cleared 34% of total; during the period 2011-2012 is cleared 35% of total. Ratio of quantities of sulfur in diesel import during 2007 - 2012: During the period 2007-2008 the sulfur content is 83% of total; during the period 2009 to 2010 the sulfur content is 10% of total; during the period 2011-2012 the sulfur content is 7% of total.

CONCLUSIONS

The study results conclude that: From the consumption of import diesel during the period 2007 - 2012 is emitted into the environment a considerable amount of sulfur, about 91.01 tons; The sulfur pollution emitted into the environment is great, especially in urban areas with heavy traffic vehicles; The highest amount of sulfur emitted into the environment of diesel cleared in 2007-2008 (83%) regardless of the amount cleared in this period is smaller (31%); Significant reduction in the rate of sulfur content in diesel has come as a result of legal restrictions on sulfur content reduction in the rate: up to 350 mg / kg for the period 2009-2010 and to 10 mg / kg from 1 January 2011. So compared with the period 2007-2008, the amount of sulphur during the period 2009-2010 was reduced 9 times, while for the period 2011 to 2012 has decreased 11 times.

REFERENCE Beqiraj I, et al. (2012): “Evolution on the diesel fuels national Standards during last decade and its environmental impact”, Koferenca Nderkombetare e Shkodres “Towards future sustainable development", 2012; Opening the door to Cleaner Vehicles in Developing and Transition Countries: The role of Lower Sulphur Fuels, Report of Sulphur Working Group of the partnership for Clean Fuels and Vehicles (PCFV) 2007, (6);

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Low Sulphur Fuels and Clean Vehicles ‘Towards a Clean and Healthy Environment’: Report of the National Environment Management Authority (NEMA) & Motor Vehicle Inspection Unit (MVIU), 2009 (7); Anonim: Statistical Data for diesel imported during 2007 -2012, General Directorate of Customs of Albania; Anonim: the data of sulfur content in imported diesel during 2007 – 2012, taken from Customs Laboratory; Combined Nomenclature of Goods, 2007 – 2012;

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HYPERTENSIVE CRISIS IN EMERGENCY ROOM Klodeta Muçaj1, Irida Pano1, Orgeta Dervishi1, Migena Gega1 1

Faculty of Medical Technical Sciences, Tirana, Albania; E-mail: [email protected]


ABSTRACT

Hypertension is the most widespread disease nowadays and one of the most common causes of visits and emergencies with significant acute and chronic morbidity. The aim of the study is to describe the clinical signs/symptoms, and the frequency of urgency and emergency hypertension. This is a prospective study including 164 patients who presented with hypertensive crisis in the emergency room of University Hospital Center "Mother Teresa" Tirana during the year 2013. All patients over 18 years of age who presented to the emergency department with a hypertensive crisis were included in the study. The mean age of patients was 59.6 (±14.8) years. 102 (62%) of patients were males and 62 (38%) females. 94 (57.3%) patients met the criteria for medical emergency while 70 (43%) patients for urgency. Dyspnea (41.1%), chest pain (37.2%) and neurological deficit (27.2%) were more common signs/symptoms in patients with emergency while headache (42.0%), chest pain (41.2%) and dyspnea (34.3%) in those with urgency. Among the forms of emergency most frequent were acute pulmonary edema (30%), myocardial infarction/unstable angina (25%), ischemic (22%) and hemorrhagic stroke (14%). 75% of the patients were diagnosed with hypertension and were on medication. Hypertensive crisis is a clinical entity associated with high morbidity in the emergency room. Adequate control of blood pressure is crucial to prevent permanent damage to organs. Key words: crisis, hypertension, emergency, complication

INTRODUCTION

Hypertension is one of the most common chronic medical conditions in the world, affecting close to 30% of the population above 20 years old (1). While chronic hypertension is an established risk factor for cardiovascular, cerebrovascular, and renal disease, acute elevations in blood pressure (BP) can result in acute end-organ damage with significant morbidity. Hypertensive emergencies and hypertensive urgencies are commonly encountered by a wide variety of clinicians. Prompt recognition, evaluation, and appropriate treatment of these conditions are crucial to prevent permanent end-organ damage. Severe elevations in BP were classified end-organ damage, or as hypertensive urgencies in the absence of acute target-organ involvement (2). Distinguishing hypertensive urgencies from emergencies is important in formulating a therapeutic plan. Patients with hypertensive urgency should have their BP reduced within 24 to 48 h, whereas patients with hypertensive emergency should have their BP lowered immediately, although not to “normal” levels. Currently, it is estimated that 1 to 2% of patients with hypertension will have a hypertensive emergency at some time in their life (3,4). Hypertensive emergencies continue to be quite common, and the epidemiology of this disorder parallels the distribution of essential hypertension, being higher among men more frequently than women (5). Despite the development of increasingly effective antihypertensive treatments over the past 4 decades, the incidence of hypertensive emergencies has increased (6). The vast majority of patients presenting with a hypertensive emergency to an emergency department have a previous diagnosis of hypertension and have been prescribed antihypertensive agents (7). However, in many of these patients BP control

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Klodeta Muçaj1, Irida Pano1, Orgeta Dervishi1, Migena Gega1 ______________________________________________________________________________________________________________________________________________ prior to presentation was inadequate.13 The lack of a primary care physician, as well as the failure to adhere to prescribed antihypertensive regimens have been associated with the development of a hypertensive emergency (8). In some studies, 50% of patients presenting to an emergency department with a hypertensive emergency were not adherent with their antihypertensive medication regimen in the preceding week (9). Acute severe hypertension can develop de novo or can complicate underlying essential or secondary hypertension. The factors leading to the severe and rapid elevation of BP in patients with hypertensive crises are poorly understood. The rapidity of onset suggests a triggering factor superimposed on preexisting hypertension. Hypertensive crisis is thought to be initiated by an abrupt increase in systemic vascular resistance likely related to humoral vasoconstrictors. The subsequent increase in BP generates mechanical stress and endothelial injury leading to increased permeability, activation of the coagulation cascade and platelets, and deposition of fibrin. With severe elevations of BP, endothelial injury and fibrinoid necrosis of the arterioles ensue. This process results in ischemia and the release of additional vasoactive mediators generating a vicious cycle of ongoing injury. The renin-angiotensin system is often activated, leading to further vasoconstriction and the production of proinflammatory cytokines such as interleukin (10). The volume depletion that results from pressure natriuresis further simulates the release of vasoconstrictor substances from the kidney. These collective mechanisms can culminate in end-organ hypoperfusion, ischemia and dysfunction that manifests as a hypertensive emergency. The aim of the study is to describe the clinical signs/symptoms, and the frequency of urgency and emergency hypertension.


This is a prospective study including 164 patients who presented with hypertensive crisis in the emergency room of University Hospital Center "Mother Teresa" Tirana during the year 2013. All patients over 18 years of age who presented to the emergency department with a hypertensive crisis were included in the study. The criteria used to define hypertensive crisis were diastolic blood pressure ≥120 mm Hg. Both patients previously recognized to be hypertensive (those with known hypertension) and those who were not previously known to have hypertension (those with unknown hypertension) were considered. We classified as hypertensive emergencies all cases in which the increase in blood pressure was associated with one or more of the following types of acute or ongoing end-organ damage: hypertensive encephalopathy; stroke (cerebral infarction or intracerebral or subarachnoid hemorrhage); acute pulmonary edema, congestive heart failure, left ventricular failure, or aortic dissection; acute myocardial infarction or unstable angina pectoris; progressive renal insufficiency; and eclampsia. All these conditions were diagnosed clinically and by diagnostic tests (blood and urine chemistry, eye fundus examination, ECG, roentgenogram, computed tomography, and ultrasound imaging) as appropriate; computed tomographic scanning in particular was performed in all patients with neurological symptoms. In the absence of end-organ damage all other hypertensive crises were considered by exclusion to be hypertensive urgencies. Each patient underwent a complete history, physical examination, and routine blood and urine chemical analyses. We included in medical urgenciesemergencies any critically ill patient; that is, any patient with an illness or injury that by its nature and/or severity is a direct threat to life or places the patient at high risk of life-threatening complications. All results were expressed as mean±SD. Statistical analysis was performed by Student’s t and χ2 tests.

RESULTS

The mean age of patients was 59.6 (±14.8) years. 102 (62%) of patients were males and 62 (38%) females. 94 (57.3%) patients met the criteria for medical emergency while 70 (43%) patients for urgency (fig. 1).

Figure 1. Hypertensive Urgencies and Emergencies

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International Journal of Ecosystems and Ecology Sciences (IJEES) Vol. 5 (1): 97-100 (2015) _____________________________________________________________________________________________ Patients with emergency were older (p lower layer > middle layer. Furthermore, dead wood carbon stock was high in Ilunde forest where there are high extent fires than in Kitwe forest. On the contrary, higher carbon stock of the litter was recorded in Kitwe forest than in Ilunde forest. The Extent of Fire Figure 4 summarizes the extent of fire in terms of percentage of the burnt area of the forest and percentage of vegetated area in the studied forests. In Ilunde forest, the extent of fire was high in that the scorched land increased with time, while the vegetated land decreased with time. In Kitwe forest, the opposite trend was observed whereby the scorched land and vegetated areas decreased and increased with time respectively.

Figure 4. The extent of fire at approximately ten years interval in the study area Table 1. Organic carbon in the 0-30 cm soil depth, dead wood and litter at the study area Soil depth (cm) 0 – 10 10 – 20 20 – 30 Total Dead wood Litter

Kitwe (t ha-) 7.6 ± 0.59 4.8 ± 0.5 5.45 ± 0.43 17.9 ± 0.9 0.46 ± 0.18 12.6 ± 1.03

Ilunde (t ha-) 4.28 ± 0.27 2.47 ± 0.19 2.54 ± 0.21 9.2 ± 0.3 0.67 ± 0.1 2.57 ± 0.35

A = 1990 B = 2000 C = 2011 Discussion. In the studied miombo woodlands, the higher value of soil organic carbon of 17.9 ± 0.9 t ha - was recorded in Kitwe forest, with the lowest recorded in Ilunde forest (9.2 ± 0.3 t ha -). Low fire extent in Kitwe forest in the studied years contributed to increased plant growth and productivity in that there was very high accumulation of leaf litter which plays a positive role in sequestering carbon to the soil. Most studies had reported that the quantity of soil organic carbon following disturbance starts to increase after five years later on (Aweto, 1981; Szott et al., 1999). On the contrary, soil recovery following previous disturbance is possibly interrupted by repeated fires spreading over large forestland which decompose organic matter that exceed the microbial decomposition of organic

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Nyatwere D. Mganga1, Herbert V. Lyaruu2. Feetham F. Banyikwa2 ______________________________________________________________________________________________________________________________________________

matter. It is likely that Ilunde forest was converted into source of carbon dioxide rather than sink for carbon. The large part of Ilunde forest is changing to a bare land and ultimately limiting organic matter accumulation. This observation was also reported by Trapnell et al. (1976) and Schlesinger (1999). According to Certini (2005), the most sensitive change in soil during burning is loss of organic matter, and hence organic carbon due to litter reduction. The effect of fire on soil organic carbon is highly variable from total destruction of soil organic matter to partially scorching depending on fire severity, dryness of the surface organic matter and fire type (Gonza´lez-Pe´rez et al., 2004). This implies that areas with different levels of fire extent experience different regeneration potential subsequently different productivity and different soil organic carbon stock. This could be the reason for varied levels in soil organic carbon in the studied forests. During fires specifically ground level-fires, the leaf litter and grasses that contribute much to the soil organic carbon become utilized as fuels. The soils will finally be depleted of organic carbon. In Kitwe forest the higher value of soil organic carbon could be associated with enormous accumulation of leaf litter and consequently increased soil organic carbon stock. On the contrary, in Ilunde the lower soil organic carbon stock could be associated to high fire extent, which may contribute to the increase in soil erosion and therefore to soil organic carbon mobilization. This could be accompanied with increased easiness to soil erosion due to temporal removal of the herbaceous layer, resulting into loss of topsoil layers hence lower soil organic carbon. According to Novara et al. (2010), soil organic matter redistribution by water erosion is accelerated after forest fires, and contributes to degradation of soils. The amount of litter biomass mainly depends on the vegetation cover type which will in turn reflect the severity of fire. In the present study, it was observed that Ilunde forest which had high fire extent had small amount of litter and ultimately low soil organic carbon compared to Kitwe forest where leaf litter and debris accumulation on the forest floor was very high (Figure 5).

Figure 5. Litter accumulation in Kitwe forest floor In both forests the relatively higher levels of soil organic carbon were detected in the 0 – 10 cm layer, followed by the 20 – 30 cm one and the lowest was between 10 and 20 cm depth. This trend could be caused by the surface accumulation of organic matter exceeding the decomposition of organic matter, also, leaching of humus into the lower layers and shedding of roots into the lower depths in the three woodlands. In the forest with high fire extent it is likely that after fires, there is resprouting of species which adds litter above the ground during the dry season that will eventually add some quantities of soil organic carbon to the soil pool. The accumulated surface organic carbon in this forest is likely to be leached after wildfire episodes hence increasing the stock of organic carbon in the deeper layer of soils. According to Ketterings and Bigham (2000), after fire episode, a trend to coarser soil textures is observed due to some heat induced formation of stable aggregates of clay and silt fractions with easy seepage. Accumulation of organic carbon on the surface of the forest with high fire extent suggests that the surface layers of soils apart from having some leaf litter were dominated by charcoal formed by incomplete combustion of plant materials which could be responsible for elevating the surface organic carbon stock. According to Vargas et al. (2008), soils that are frequently burned contain high concentrations of black carbon. Presence of more soil organic

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International Journal of Ecosystems and Ecology Sciences (IJEES) Vol. 5 (1): 107-114 (2015) _____________________________________________________________________________________________ carbon on the surface layers of soils was also reported by Jobbagy and Jackson (2000). Also, a similar trend in accumulation of organic carbon was reported by Mabuza (2011). These results on effect of fire extent on sequestration of soil organic carbon are in agreement to that of Walker and Desanker (2004) who reported that shifting agriculture reduced soil organic carbon by an average of 14%. Similarly, Schlesinger (1986) estimated 30% loss of carbon over 20 to 50 years period after forest clearance.

CONCLUSION Within 30 cm soil depth a significantly higher soil organic carbon stock of 17.9 ± 0.9 t ha- was recorded in a forest with a small scorched land between 1990 and 2011. On the contrary, lower soil organic carbon of 9.2 ± 0.3 t ha - was observed in a forest with a large scorched land. An increase in fire extent with years implies that almost all the forestland becomes touched by fire, ultimately lowering the sequestration of soil organic carbon. On the other hand, low fire extent results into patchy and negligible reduction in soil organic carbon sequestration. Acknowledgements. The first author would like to express her sincere gratitude to Mkwawa University College of Education under the World Bank Project for provision of funds which made this study possible. Mr. Almas Manumbu of the Botany Department of the University of Dar es Salaam is very much thanked for assistance in laboratory analysis.

REFERENCES

Aweto AO, (1981) Secondary succession and soil fertility restoration in south-western Nigeria. II. Soil fertility restoration. Journal of Ecology, 69, 609-614; Blake GR, Hartage KH, (1986) Bulky density. (2nd ed.). Madison. ASA and SSSA, WI. pp 363-382; Bloesch U, (1999) Fire as a tool in the management of a savanna/dry forest reserve in Madagascar. Applied Vegetation Science, 2, 117-124; Broos K , Baldock J, (2008) Building soil carbon for productivity and implications for carbon accounting. South Australian GRDC Grains Research Update; Certini G, (2005) Effect of fire on properties of soil - A review. Oecologia, 143, 1-10; Garten CT, Ashwood TL, (2002) Landscape level differences in soil carbon and nitrogen: implication for soil carbon sequestration. Global Biogeochemical Cycles, 16, 1114; Gonza´lez-Pe´rez JA, Francisco JG, Gonzalo A and Heike K 2004 The effect of fire on soil organic matter-a review. Environmental International, 30, 855– 870; Huete AR, Didan K, Miura T, Rodriguez EP, Gao X, Ferreira LG, (2002) Overview of the radiometric and biophysical performance of the MODIS Vegetation Indices. Remote Sensing of Environment, 83, 195–213; Jobbágy EG and Jackson RB 2000 The vertical distribution of soil organic carbon and its relation to climate and vegetation. Ecological Applications, 10, 423-436; Ketterings QM and Bigham JM 2000 Soil Color as an Indicator of Slash-and-Burn Fire Severity and Soil Fertility in Sumatra, Indonesia. Soil Science Society of America Journal, 64, 1826-1833; Lal R, (2004) Soil carbon sequestration impacts on global climate change and food security. Science, 304, 162311627; Lutz JA, Key CH, Kolden CA, Kane JT, van Wagtendonk JW, (2011) Fire frequency, area burned, and severity: a quantitative approach to defining a normal fire year. Fire Ecology, 7, 51-65; Mabuza TV, (2011) Evaluating Long Term Effects of Fire Frequency on Soil Seed Bank Composition and Species Diversity in a Semi-Arid, South African Savanna. Unpublished Master of Science in Agriculture Dissertation. University of Fort Hare, South Africa; Medina E, (1987) Nutrients requirements, conservation and cycles of nutrients in the herbaceous layer. In: Walker BH (ed) Determinants of tropical savannas. IUBS, Paris. pp 39–66; National Aeronautics and Space Administration (NASA), (2010) Active fires from FAO’s global fire information management system http://rapidfire.sci.gsfc.nasa.gov/ Retrieved on Tuesday 1st February, 2011; Nhantumbo A, Katterer T, Ledin S, Du Preez CC, (2009) Carbon loss from Brachystegia spiciformis leaf litter in the sandy soils of southern Mozambique. Nutrient Cycling in Agroecosystems, 83, 13-26;

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Nyatwere D. Mganga1, Herbert V. Lyaruu2. Feetham F. Banyikwa2 ______________________________________________________________________________________________________________________________________________

Novara A, Gristina L, Bodì MB, Cerdà A, (2011) The impact of fire on redistribution of soil organic matter on a Mediterranean hillslope under maquia vegetation type. Land Degradation and Development, 22, 530–536; Ojima D, Schimel DS, Parton WJ, Owensby CE, (1994) Long and short-term effects of fire on nitrogen cycling in tallgrass Prairie. Biogeochemistry, 24, 67–84; Pereira MC, Chuvieco E, Beaudoin A, Desbois N, (1997) Remote Sensing of Burned Areas. A Review of Remote Sensing Methods for the Study of Large Wildland Fires. pp 127– 183; Richards A, (2009) The effect of fire frequency on carbon stocks in Australian tropical savannas. 7 th Annual Savanna Science Network Meeting. CSIRO Sustainable Ecosystems, Darwin, Australia. pp 13; Rossi J, Govaerts A, De Vos B, Verbist B, Vervoort A, Poesen J, Muys B, Deckers J, (2009) Spatial structures of soil organic carbon in tropical forests-A case study of Southeastern Tanzania. Catena, 77, 19-27; Saatchi S, Houghton RA, dos Santos Alvalá RC, Soares JV, Yu Y, (2007) Distribution of aboveground live biomass in the Amazon Basin. Global Change Biology, 13, 816-837; Schlesinger WH, (1986) Changes in soil carbon storage and associated properties with disturbance and recovery. In Trabalka JR and Reichle DE (ed) The changing carbon cycle: A global analysis. Springer Verlag, New York, New York, USA. pp. 175-193; Schlesinger WH, (1999) Carbon sequestration in soils. Nature, 284, 2095-2096; Sugihara NG, van Wagtendonk JW, Fites-Kaufman J, (2006) Fire as an ecological process. In: Sugihara NG, van Wagtendonk JW, Shaffer KE, Fites-Kaufman J and Thode AE (ed) Fire in California’s ecosystem. Berkeley and Los Angeles, California: University of California Press; Szott LT, Palm CA, Buresh RJ, (1999) Ecosystem fertility and fallow function in the humid and sub-humid tropics. Agroforestry Systems, 47, 163-196; Tieszen LL, (2000) Carbon sequestration in semi-arid and sub-humid Africa. U.S. Geological Survey, EROS Data Center, Sioux Falls, South Dakota; Trapnell CG, Friend MT, Chamberlain GT, Birch HF, (1976) The effect of fire and termites on a Zambian woodland soil. Journal of Ecology, 64, 577-588; Vargas R, Allen MF, Allen EB, (2008) Biomass and carbon accumulation in a fire chronosequence of a seasonally dry tropical forest. Global Change Biology, 14, 109-124; Vesa L, Malimbwi RE, Tomppo E, Zahabu E, Maliondo S, Chamuya N, Nssoko E, Otieno J, Miceli C, Daisgaard S, (2010) National Forestry Resources Monitoring and Assessment of Tanzania. FAO-Finland Forestry Program, Forestry Department, FAO; Walker SM, Desanker PV, (2004) The impact of land use on soil carbon in Miombo Woodlands of Malawi. Forest Ecology and Management, 203, 345-360; Walkley A, Black IA, (1934) An examination of the Degtjareff method for determining organic carbon in soils: Effect of variations in digestion conditions and of inorganic soil constituents. Soil Science, 63, 251-263; Williams M, Ryan CM, Rees RM, Sambane E, Fernando J, Grace J, (2008) Carbon sequestration and biodiversity of re-growing miombo woodlands in Mozambique. Forest Ecology and Management, 254, 145-155; www.intergraph.com Intergraph 2013 Geospatial Products, January, 2013;

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CALCULATION OF COST DURING TIMBER KILN DRYING IN KOSOVO Rrahim Sejdiu1*, Arben Bejtja2, Agron Bajraktari1 1

University of Prishtina, Department of Wood Design and Technology, Ferizaj-Kosovo; Agricultural University of Tirana and, Department of Wood Processing, Ferizaj-Kosovo;

2



ABSTRACT

The drying process of timber in Kosovo mainly is done by conventional kiln (almost 90% around the world are using the same), because of easy kiln characteristics and lower price. The cost of kiln drying loads the selling price of wooden material. In the study is selected timber of beech (Fagus Sylvatica L. 28mm thickness), with initial moisture content 60% and final moisture content ≈ 10%. A case study is chosen conventional kilns in Kosovo. Results from measurements give the costs/m3: The capital cost 4,37€/m3; The maintenance cost 0.65€/m3; The electricity cost 4.26€/m3; The labor cost 4,11€/m3; the heat energy cost 3.61€/m3; the cost of drying quality 8.74€/m3, and the tax cost 3,37. Based on the calculations, to dry 1m3 (28mm thickness) of the beech wood with initial moisture content 60% and final moisture content ≈ 10%, dried in conventional kiln drying in Kosovo are spent 29,5 €/m.3 Objectives: This paper is attempted to find out the cost of timber drying, based on literature data and our practical part. The material can be useful for all drying subjects in Republic of Kosovo. Keywords: beech, conventional drying, moisture content, cost of drying.

INTRODUCTON

Kiln drying of wood is very costly (approximately 10% of the wood value), because, to realize the wood drying are needed some costs that charges the costs of timber in markets. The total cost of wood drying depends mainly from energy consumption, investments, drying quality, defects, labors (workers), type of wood, wood thickness, initial and final moisture content of the wood, the amount of kiln etc. Drying costs of wood increases if the drying process is poor, so poor drying may exceed all other costs, especially with conventional drying of thicken boards of beech timber (Fagus sylvatica L.). From the literature it is found that, the cost of construction and dryer equipment for their operating time (about 10 years) are equal to 1-2% of the drying wood.


The material used in the study is beech timber (Fagus Sylvatica L.), thickness of the boards 28mm, which is grown in the territory of Kosovo. The studies are done in conventional kiln chamber with total volume of 123m3, where are dried 35m3 in a shift, or in percentage 28.5% of the total volume of the chamber (other spaces of the chamber are caught with stick and other spaces for free movement of air). Dimension of stick were 25*32mm, made from beech wood. Initial moisture content 60% and drying moisture content 9.94% ≈ 10%.

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Rrahim Sejdiu1*, Arben Bejtja2, Agron Bajraktari1 ______________________________________________________________________________________________________________________________________________

There are two groups of costs: Fixed costs Variable costs. Fixed costs: capital costs (investment and interest costs); Variable costs: maintenance, heat energy, workers (labor), electricity, drying quality, taxes. Capital costs - Investments for the construction of the drying chamber were 25.000€. The investment cost for the production of dried timber is based on the time of the return on investment for 10 years with overall growth of 10.07% interest, the amount of interest 14.761€. Total capital investment costs are = 25.000+14.000=39.761€. Table 1. Capital investment and interest cost in m3 0,92€/m3 11,0€/m3 331,3€/m3 4,73€/m3

Costs/hour Costs/day Costs/month Cost/m3

Cost of Maintenance– Maintenance cost includes all works that deal with the maintenance of the chamber, such: avoiding failures that occur during labor and the cost price of the employees working in avoiding breakdowns. According to the data of the factories for the last 5 years, average maintenance cost ranges approximately 550€/year. Calculations for maintenance costs: 0.064€/h; 1.53€/day; 45.8€/month; € 0.65/m3. Cost of electricity - Electricity consumed for a month is calculated from the spending that makes: fans, water pumps and other equipment within the dryer. This cost is calculated to be: Emonthly=4291kW/h. Based on calculations the costs of electricity is: 0,414€/hour; 9,939€/day; 298,22€/month; and 4,26€/m3. Cost of heat energy - Specific heat consumption of 2400-3700kJ assimilate 3700kJ ≈ 1kWh, is calculated to evaporate a kilogram of water in conventional drying, including requirements for all other energies used in heating of the chamber and drying of sawn timber in it. The price for a kilogram of wood used for heating energy is calculated from the weight of beech wood in natural dry condition 15€/480kg=1m3 ≈0,031€/kg. Low thermal capacity for dried timber is calculated to be 14700-16700kJ/kg adopted 14700kJ/kg or 3.97kW/kg. If 1kg of wood =0.031€/kg then 1kW of heat energy will be 0.031/3.97= 0.0076€/kW. The average amount of energy required to evaporate 1kg/moisture, is 3700kJ1kW/h. Average of moisture that need to be removed from wood chamber is taking to calculate the cost of heat energy (drying of 70m 3 is calculated 33264kg water must be removed). Thus 123076800kJ or 33264kW of heat energy is required to evapurate 33264kg of water. Table 2. The cost of heat energy Cost/hour

5,96 kW

0,0076kW/€

0,35€/hour

Cost/day

1109 kW

0,0076kW/€

8,42€/day

Cost/month

33264 kW

0,0076kW/€

253€/month

61,3 kW

0,0076kW/€

3,61€/m3

Cost/m3

The cost of workers in wood drying depends on the number of workers employed in the wood drying factory. Based on the number of labors that working in permanent job and those with temporary job take the following values: 1,2€/hour; 9,6€/day; 288€/month; 4,11€/m3. The cost of kiln drying quality is determined from the literature with a loss of 2-3%. In the study it is used 3,24%. Price per 1m3/wood of beech (dried) is calculated based on the Kosovo markets price 270€/m3. Total drying of wood amount for a month is 70m3. The total amount for a month (expressed in €/m3) is 70*270€=18900€/month.

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International Journal of Ecosystems and Ecology Sciences (IJEES) Vol. 5 (1): 115-118 (2015) _____________________________________________________________________________________________ Table 3. The cost of wood drying defects 0,85€/hour 20,4€/day 612€/month 8,74€/m3

Cost/hour Cost/day Cost/month Cost/m3

The tax is calculated 16% of the total amount of drying/m3. If the drying cost of 1m3 is 26,1€/m3, the tax cost is =26,1×0,16= 3,37€/m3; 236,3€/month; 7,87€/day; 0,33€/hour.

RESULTS

Table 4. The cost of unit (not considered the cost of drying quality and taxes) Cost type Capital Electricity Labor Heat energy Maintenance Total

€/month 331,3 298,2 288,0 253,0 45,8

€/day 11,0 9,9 9,6 8,4 1,5

€/m3 4,73 4,26 4,11 3,61 0,65 17,36

€/hour 0,46 0,4 1,2 0,3 0,06

% 27,2% 24,5% 23,7% 20,8% 3,7% 100%

Often subjects who dry timber don’t calculate the losses from drying quality and taxes, if we take into consideration the quality of drying, it increase total cost drying 1m3, as shown in table. 5. Table 5. Total cost drying/cubic meter Costs type Drying quality Capital Electricity Labor Heat energy cost Maintenance cost Taxes Total

€/month 609€ 331,3€ 298,2€ 288,0€ 253,0€ 45,8€ 263,3€

€/day 20,3€ 11,0€ 9,9€ 9,6€ 8,4€ 1,5€ 7,873€

€/hour 0,85€ 0,46€ 0,4€ 1,2€ 0,3€ 0,06€ 0,33€

€/m3 8,74€/m3 4,73€/m3 4,26€/m3 4,11€/m3 3,61€/m3 0,65€/m3 3,37€/m3 29,5€/m3

% 29,6% 16,1% 14,5% 13,9% 12,2% 2,2% 11,5% 100%

Table 6. Comparison of costs for some European countries and Kosovo

Cost type Labor €/h Electricity Thermal capacity Price of fuel Interest rate Selling price

STATES Belgium 19,8€/h 0,1€kW/h 37420kJ/kg (oil) 0,26€/kg 5% 500€/m3 oak 150€/m3 spruce

Kosovo 1,2€/h 0,0695kW/h 14700kJ/kg (wood) 0,031€/kg 10,07% 270€/m3 beech 350€/m3 oak

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Poland 2,33€/h 0,067kW/h 15900kJ/kg (wood) 0,07€/kg 5% 335€/m3 oak 200€/m3 spruce

Rrahim Sejdiu1*, Arben Bejtja2, Agron Bajraktari1 ______________________________________________________________________________________________________________________________________________

Table 7. Drying costs in Republic of Kosovo and Serbia Type of cost Cost type Drying quality Capital cost Electricity and energy Labor Maintenance Taxes Total

Kosovo €/m3 % 3 8,74€/m 29,6% 4,73€/m3 16,2% 7,87€/m3 26,8% 3 4,11€/m 13,9% 0,65€/m3 2,2% 3 3,37€/m 11,5% 29,5€/m3 100,0%

Serbia €/m3 3,5€/m3 10,0€/m3 20,5€/m3 6,48€/m3 1,88€/m3 46,11€/m3

% 8,3% 23,6% 48,4% 15,3% 4,4% 100%

CONCLUSION The drying cost of 1m3/beech wood in conventional kiln (thickness 28mm) including and drying defects is 29,5€/m3; Without taking into consideration the cost of quality drying, the cost of drying and taxes is: 17,36€/m3 The amount of fixed costs in percentile are 16,2%, and the amount of variable costs in percentile are 83,8%. In calculation are not considered some other costs (the amount of land and security of kiln). Spending units: (taking into account the cost of quality drying) cost of defects 8.74€/m3 (29,6%); the capital cost 4.73€/m3 (16,3%); electricity cost 4.26€/m3 (14,5%); labor cost 4,11€/m3 (13,9%); the heat energy cost 3.61€/m3 (12,2%), the cost of maintenance 0,65€/m3 (2,2%) and the cost of taxes 3,37 (11,5%). Drying quality defects for 1%, increase the costs of drying 2.88€/m3.

REFERENCES

Bajraktari A, Sejdiu R; Thaci B, Nunes L. Pereira H., 2012: Evaluation of beech wood defects due to different drying sheme, IUFRO Wood Drying Conference, Para, Belem, Brazil pg. 30. http://www.ipef.br/publicacoes/stecnica/nr36/st036.pdf. ; Bergman R. Drying and Control of Moisture Content and Dimensional Changes, Research Forest Products Technologist. General Technical Report FPL–GTR–190. Chapter 13. http://www.woodbodger.com/wpcontent/uploads/2012/02/Wood-Handbook-Chapter-13-Drying-and-Control-of-Moisture-Content1.pdf; Bytyqi B. Osmani H. Qehaja N 2000: Materialet e Makinerisë, Ministria e Arsimit, Shkencës dhe Teknologjisë. Pg 184; Denig J. Wengert E. Simpson W: 2000. Drying Hardwood Lumber, U.S. Department of Agriculture, Forest Service, Forest Products Laboratory. http://arconlab.com/shop/howto/Drying%20Hardwoods.pdf ; Guzenda R., Olek W., Gołębiewska M., 2004: Computer-aided prediction of timber air pre-drying times and costs, FOLIAFORESTA LIAPOLONICA, Seria B, Zeszyt 35, 73-83, http://ffp.matlibhax.com/pdf/35/Folia%20Forestalia%20Pol%2035-7%20Guzenda%20et%20al.pdf; Hukka A., 2010: Calculation of Drying Costs, Fall Meeting of the NEKDA, Shelburne, New Hampshire, 8-16. http://www.esf.edu/nekda/documents/nekda_2010_yfslides.pdf ; Kerpan J: 1965: Sušenje i Parenje Drva, Šumarski Fakultet, Sveućilišta u Zagrebu; Kržalić B. Milić G. i Kolin B., 2010: Cena veštačkog sušenja rezane građe, Prerada drveta, 8 (29). 21-26 http://scindeks.ceon.rs/article.aspx?query=ISSID%26and%268625&page=2&sort=8&stype=0&backurl=%2Fissue.a spx%3Fissue%3D8625; Sejdiu Rr. Bajraktari Ȧ, Bejtja Ȧ. and Loku F, 2013: Shrinkage of Beech Wood Depending of the Geographical Location of the samples in the Tree (Case study, timer of beech (Fagus Sylvatica L) , that is growing up in the territory of Kosovo), International Journal of Current Engineering and Technology. 3, (5). 653-654. http://inpressco.com/shrinkage-of-beech-wood-depending-on-the-geographical-location-of-the-samples-in-the-tree/ ; Yaghubian A., Hodgson T. & Joines J., 2007: Dry-or-buy decision support for dry kiln scheduling in furniture production, 33 (2): 131-136. DOI: http://dx.doi.org/10.1080/07408170108936814;

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SURVEY FOR ANTIBODIES TO COXIELLA BURNETII IN SELECTED POPULATIONS OF DOMESTIC ANIMALS IN ALBANIA Arla Juma1, Blerta Kika2 1

Animal Health Diagnosis Department, Institute of Food Safety and Veterinary, Tirana, Albania; 2 Institute of Public Health, Tirana, Albania; E-mail: [email protected]


ABSTRACT

Coxiella burnetii, as the etiology agent of Q Fever, is a zoonotic pathogen, which can cause abortion in animals. The objective of this work has been to investigate the serological response against Coxiella burnetii in aborted cattle, sheep, goats and pigs. The knowledge of the epidemiology and prevalence of zoonotic diseases, like Q Fever in Albania is limited. Therefore sera from aborted animals were used for this investigation where 60 cattle, 32 sheep, 44 goats, 10 pigs were involved in the study. The serological examination was carried out using CFT (Complement Fixation Test). It was found the presence of Coxiella burnetii in 28 (47%) cattle, the maximal titer was 1:160 in 4 sheep, the maximal titer was 1:20 and in 25 (57%) goats, the maximal titer was 1:80. Antibodies against Coxiella burnetii was not found in blood taken from aborted pigs. Data show that coxiella could be involved as cause of abortion in ruminants. Identification of coxiella from organs of infected animals or aborted fetuses, isolation in chicken embryos and cell lines could clear the diagnosis. Key words: serological examination, Coxiella burnetii, aborted ruminants, aborted pigs, Complement Fixation Test

INTRODUCTION

Zoonoses is any disease or infection that is naturally transmissible from vertebrate animals to humans. Animals play an essential role in maintaining zoonotic infections in nature. Zoonoses still represent significant public health threats, but many of them are neglected, like Q Fever. Q Fever is a zoonotic disease with acute and chronic stages. Q Fever belongs to a group of rickettsial infection caused by Coxiella burnetii as the etiological agent. (1,2) Cattle, sheep and goats are primary reservoirs of Coxiella burnetti. Microorganisms are excreted in milk, urine, and feces of infected animals (3). Infection of humans usually occurs by inhalation of these organisms from air. Other modes of transmition including tick bites and unpasteurized milk are too rare (3,4,6). Q fever, in human, in its acute stage is a potentially severe disease characterized by pneumonitis, hepatitis and neurological complications. Persistent Coxiella burnetti infections in humans may lead to a chronic disease in the form of endocarditis. There are no significant clinical signs in animals. Abortion in animals is the only clinical manifestation who is debatable because there are other microorganisms who causes abortion in animals (5). The objective of this work has been to investigate the serological response against Coxiella burnetii in aborted cattle, sheep, goats and pigs. Therefore in this study we use the Complement Fixation Test, one of the most applied methods of laboratory diagnostics of the Q Fever (3,7). It has been preferred to use a phase I antigen. Phase I antibodies are present at higher titers only during the chronic form of the illness; phase II antibodies are largely predominant in primary acute Q fever (4). The sera were taken from aborted animals from different species. The sera which showed fixation of complement at Titer ≥1:10 were considered positive.

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Arla Juma1, Blerta Kika2 ______________________________________________________________________________________________________________________________________________


A total of 146 blood samples from cattle, sheep, goats and pigs were tested using Complement Fixation Test, CFT. Samples originated from aborted animals from different parts in of Albania between February 2013 and November of 2013. Blood samples initially were tested for Brucellosis. Sera from samples that resulted negative for brucellosis were stored for a further evaluation and after that they were used to study the presence of Coxiella burnetii. Sera were extracted by centrifugation at 3000g for 10 minutes, and stored at -20°C until further processing. The serological examination was carried out using CFT (Complement Fixation Test). A standard micro plate method with modifications described by Stamp et al. (1952) was employed. I Phase antigen, hemolytic amboceptor and guinea pig complement were obtained from Virion Institute, Germany. Sheep erythrocytes obtained from our ram raised in Institute of Food Safety and Veterinary were washed three times in saline and diluted in a final concentration of 2.5%. Sera diluted from 1:5 to 1: 5220 were used. The end-point titers were scored as wells exhibiting approximately 50% lysis. A titer over 1:10 was considered positive. Test Principle: In the test antigen and sera are mixed together in the presence of complement and allowed to react. Any complex formed will fix the complement with the effect that after an incubation period, there will be no complement remaining in the system. The addition of an indicator system (hemolytic system = sheep erythrocytes coated with antibodies) demonstrate the presence or absence of a specific reaction. When added to a system containing complement, the indicator system will be attached by now activate complement and the erythrocytes lyses. If the complement has been used by antigen – antibody complexes in the serum, the erythrocytes will stay intact and a button of blood cells is seen on the bottom of the microtest plate. The test was performed according to the Standard Operation Procedures after Office International of Epizooties guidelines. The normalization of the results was based on the Titer. Sera with titer ≥ 10 were considered as positive and sera with Titer fewer than 10 were considered as negative. Statistical analysis Data analysis was conducted using SPSS 16.0 programme. Chi-square test was used to compare the positivity rate of CFT between animals. A p value ≤0.05 was considered statistically significant.

RESULTS

There are studies in Albania devoted to the presence of Coxiella in the domestic animals which have shown a presence of infection respectively 9.8 % in goats and 7.9 % in cattle. (3) We set ourselves the task of studying the dynamics of the 1st – phase CFT – antibodies in aborted cattle, sheep, goats and pigs. The serological examination was carried out using CFT (Complement Fixation Test). Complement is an enzymatic component of blood which is activated or fixed by the presence of antigen and antibody complexes. These properties are used in CFT to demonstrate the presence of specific antibodies. In testing the phase I antibodies, the number of positive serum samples was different in selected population. The numbers of positive samples determined by CFT represent the half or less of the number of aborted ruminants, but antibodies were not found in blood taken from aborted pigs. (Table1) Table 1. Results of CFT CFT Positive ≥ 10

Cattle (n,%)

Sheep (n,%)

Goats (n,%)

Pigs (n,%)

28 (47)

13 (41)

25 (57)

0

32 (53)

19 (59)

19 (43)

10 (100)

60

32

44

10

Negative < 10 Total

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The antibody reactivity against Coxiella burnetii Antibody reactivity against C.burnetti in cattle

Antibody reactivity against C.burnetti in sheep

180

25

160

20

140

15

Titer

Titer

120 100 80

10

60 40

5

20

0

0 1

3

5

7

9

11

13

15

17

1

19

2

3

4

5

6

7

8

9

10

Sera

Sera

Figure 1. Antibody reactivity in cattle

Figure 2. Antibody reactivity in sheep

Antibody reactivity against C.burnetti in goats 90 80 70 Titer

60 50 40 30 20 10 0 1

2

3

4

5

6

7

8

9

10

11

12

13

14

Sera

Figure 3. Antibody reactivity in goats The antibody reactivity is presented in graphics to show the dynamics and to evaluate the maximum of the titers in selected populations. There is a statistically significant difference among ani,als regarding the CFT seropositivity rate (x2 =10.9 p=0.01) The antibody reactivity in goats is higher than in sheep and the highest antibody reactivity is observed in cattle. (160) The maximal antibody reactivity in sheep is 20 while in goats maximal antibody reactivity is 80. In terms of the number of sera included in the study it is notable that 28 (47%) sera were positive from 60 aborted cattle, 13 (41%) sheep were positive from 32 aborted sheep and 25 (57%) goats were positive from 44 aborted goats. Antibodies against Coxiella burnetii was not found by us in blood taken from aborted pigs. The present report provides information on Coxiella burnetii on selected population, aborted animals, revealing that Coxiella burnetii is present, approximately the half of the tested aborted animals were positive, and could be the cause of abortion in animals. Due to a limited number of sera the data presented should be considered with caution. Should be noted also that in cases of positive reaction it is not always considered that this is the center of active rickettsial infection and the cause of abortion (5,9). C. burnetti is extremely hardy and resistant to heat, drying and many common disinfectants which enable the bacteria to survive in the environment.(2,3,8) However considering C.burnetti as unusual because of its survives characteristics in serological positive cases it is important to isolate aborted animals until discharges unset and restrict access by a animals and people (10). In presented report also there are no false positive results due to vaccination because there is no vaccination program against C. burnetti in Albania.

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Arla Juma1, Blerta Kika2 ______________________________________________________________________________________________________________________________________________

CONCLUSIONS

With this study we aimed to fill the information gap and provide reliable data for C. burnetti infection in aborted in animals in Albania, as the knowledge of the presence is important to prevent animals becoming infected and reduce human health risk. Further studies are expected to evaluate the clinical damages and economical losses caused by C. burnetti and the public health relevance of this agent.

REFERENCES

Berxholi K. (2007): Ethja Q, Zoonozat, 2007, 249- 266; Cabeli P. Rendi Riketsiales dhe Chlamydiales, Bakteriologjia Mykologjia Veterinare (2003): 420-434; Cekani Mirela, Anna Papa, Majlinda Kota, Enkeleida Velo, Kristaq Berxholi (2008): Report of a serological study of Coxiella burnetii in domestic animals in Albania The Veterinary Journal. 175(2), 276-8; Hatckete T., Campbell N., Whitney H.(2002): Seroprevalence of coxiella in Newfoundland. Canadian Veterinary Journal, 363-364; Lika (Çekani) M, Berxholi K. (2007): Sistemi i komplementit, Imunologjia,114-118; Marrie TJ., Faurnier PE. Diagnosis of Q.Fever. (2001): J.Clin.Mikrobiology 36, 1823-1824; Martinov SP, Pandurov S.(2005): Serological study of experimental and natural Q Fever in cattle and sheep Biotechnol & Biotechnol 19, 39-42; Quinn P.J.,Carter M.E., Markey B., Carter G.R (1998): Clinical Veterinary Microbiology, 316- 320; Slaba K., Skuttely L.,Toma R. (2005): Efficency of various serological techniques for diagnosing Coxiella burnetii infections, Acta Virologjia 49, 123-127; Sung Guk Kim, Eun Hee Kim, Caroline Jcaffeerly (2005): Coxiella burnetii in bulk tank milk samples USA, Emerging Infection diseases Voll 11, 36-39; OIE Manual of Diagnostic Tests and Vaccines for Terrestrial Animals 2012,Part 1., Section 2.1., Chapter Q.Fever, http://www.oie ;

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PREVALENCE AND ANTIMICROBIAL PROFILE OF METHICILLINRESISTANT STAPHYLOCOCCUS AUREUS Damiana Osmalli1, Artan Simaku1 1

Institute of Public Health, Tirana, Albania E-mail: [email protected]


ABSTRACT

Staphylococcus aureus is a hospital and community-acquired pathogen that causes a broad spectrum of diseases, ranging from skin and soft tissue infections to endocarditis and fatal pneumonia. This study was carried at Institute of Public Health in Tirana, Albania from June 2011 to 2014. A total of 756 isolates of S. aureus were included in the study. These strains were obtained from various clinical samples like pus, sputum, urine, blood, and body fluids from the inpatients and outpatients at University Hospital Center “Mother Theresa” in Tirana, Albania. A total of 756 isolates of S. aureus were obtained from different clinical samples from inpatients (66.3%) and outpatients (33.7%) of the hospital. Pus (39.6%), sputum (15.1%) and nasal secretions (11.1%) accounted for the majority of isolates), followed by blood and body fluids. Methicillin resistance was documented in 187 (24.7%) of 756 isolates (fig. 1). 94 (50%) of MRSA isolates were collected from outpatients whereas 93 (50%) were collected from inpatients. The prevalence rate of MRSA was found to be 24.7% (12). The majority of MRSA strains were isolated in pus (55.1%), blood (14.4%), sputum (10.7%), body fluids (10.2%), nasal secretions (5.9%), urine (2.1%) and bronchial lavage (1.6%). The most effective way to prevent MRSA infections is by doing continuous surveillance of antibiotic resistance profiles of local S. aureus isolates to formulate antibiotic policies and effective infection control practices. Key words: strain, resistance, staphylococcus aureus, clindamycin

INTRODUCTION

Staphylococcus aureus is a hospital and community-acquired pathogen that causes a broad spectrum of diseases, ranging from skin and soft tissue infections to endocarditis and fatal pneumonia. This pathogenicity is associated with different enzymes and toxins such as enterotoxins, exfoliative toxin, toxic shock syndrome toxin, and PantonValentine leucocidin (PVL) (1,2). This bacterium has the remarkable ability to adapt to different antibiotics and now with the emergence of multi-drug resistant (MDR) bacteria, S. aureus is a warning for public health (1,3). Methicillin-resistant S. aureus (MRSA) strains are able to grow in the presence of methicillin, oxacillin and nafcillin (4). After the emergence of MRSA as a nosocomial pathogen in the early 1960s, there have been an increasing number of outbreaks of MRSA infections in hospitals reported from many countries. Life-threatening sepsis, endocarditis, and osteomyelitis caused by MRSA have also been reported (5). Since resistance to multiple antibiotics among MRSA isolates is very common, there is a possibility of extensive outbreaks, which may be difficult to control. MRSA is now one of the commonest nosocomial pathogens, and asymptomatically colonized healthcare workers are the major sources of MRSA in the hospital environment. The emergence of novel community-acquired MRSA (CA-MRSA) strains has complicated the control and prevention of infections caused by MRSA isolates. The genetic and phenotypic properties of these CA-MRSA isolates are completely different from hospital acquired MRSA (HA-MRSA) isolates (6,7). These differences in the structure of CA and HA-MRSA strains results in

123

Damiana Osmalli1, Artan Simaku1 ______________________________________________________________________________________________________________________________________________

antibiotic resistance patterns differences of isolates influencing the hospital and community environments (8). Increasing rate of CA-MRSA isolates recovered from patients in different parts of the world, suggests that these strains are displacing among nosocomial MRSA strains and might behave similar to traditional nosocomial MRSA strains with respect to mortality and other various clinical outcomes (9). Early detection of MRSA and formulation of effective antibiotic policy in tertiary care hospitals is of paramount importance from the epidemiological point. The present study has been carried out in our medical college hospital with an aim to know the prevalence and antibiotic sensitivity pattern of Staphylococcus aureus isolates, in order to utilize the information obtained and formulate antibiotic policy and appropriate control measures.


This study was carried at Institute of Public Health in Tirana, Albania from June 2011 to 2014. A total of 756 isolates of S. aureus were included in the study. These strains were obtained from various clinical samples like pus, sputum, urine, blood, and body fluids from the inpatients and outpatients at University Hospital Center “Mother Theresa” in Tirana, Albania. The specimens were cultured on blood agar and MacConkey agar plates and incubated aerobically at 37°C for 48 hours. The isolates were identified using standard tests like catalase, slide and tube coagulase, and growth on Mannitol salt agar.The antimicrobial susceptibility profiles of the MRSA strains to the main classes of antibiotics were determined by using the Kirby-Bauer method, according to CLSI guidelines (10). The MRSA isolates were tested against a panel antimicrobial agents as follows: ciprofloxacin (5 μgm), chloramphenicol (30 μgm), trimethoprim-sulfamethoxazole (1.2/23.7µg) clindamycin (2 μgm), gentamicin (10 μgm), erythromycin (15 μmg), penicillin (10 units), rifampicin (5 μgm), and vancomycin (30 μmg). The erythromycin (15 μgm) disc was placed at a distance of 15 mm (edge-to-edge) from clindamycin (2 μgm) disc on a Mueller–Hinton agar plate previously inoculated with 0.5 McFarland bacterial suspension. Following overnight incubation at 37°C, flattening of zone (D-shaped) around clindamycin in the area between the two discs, indicated inducible clindamycin resistance. Test for methicillin resistance was performed by Kirby–Bauer disc diffusion method using oxacillin (1 μgm) disc on Mueller–Hinton agar with 24 hours incubation at 35°C. Results were interpreted according to the criteria of CLSI. Methicillin resistance was confirmed by agar screen test using Mueller–Hinton agar plate supplemented with 4% NaCl and oxacillin (6 μgm/ml).

RESULTS

A total of 756 isolates of S. aureus were obtained from different clinical samples from inpatients (66.3%) and outpatients (33.7%) of the hospital. Pus (39.6%), sputum (15.1%) and nasal secretions (11.1%) accounted for the majority of isolates), followed by blood and body fluids. Methicillin resistance was documented in 187 (24.7%) of 756 isolates (fig. 1). 94 (50%) of MRSA isolates were collected from outpatients whereas 93 (50%) were collected from inpatients (fig. 2).

Figure 1. The frequency of MRSA isolates

124


Figure 2. Distribution of MRSA isolates

The distribution of 187 MRSA isolates in relation to various specimens is provided in table 1.

Table 1. The distribution of 187 MRSA isolates

Specimens Blood Bronchial lavage Pus Nasal secretions Sputum Urine Body fluids Total

N 27 3 103 11 20 4 19 187

% 14.4 1.6 55.1 5.9 10.7 2.1 10.2 100.0

The sensitivity data of MRSA is shown in table 2. All strains of MRSA were found to be resistant to penicillin and oxacillin.

Table 2. Frequency in percentage of resistance strains of MRSA Antibiotics

N

%

Penicillin

187

100

Oxacillin

187

100

Cefoxitin

152

81.5

Tetracycllin

87

46.7

Trimethoprim-sulfamethoxazole

47

25.4

125


Ciprofloxacin

94

50

Rifampicin

60

32.2

Erythromycin

108

57.6

Clindamycin

25

13.6

Gentamicin

125

67

Chloramphenicol

21

11

Vancomycin

0

0

MRSA is a major nosocomial pathogen causing significant morbidity and mortality (11). The important reservoirs of MRSA in hospitals/institutions are infected or colonized patients and transient hand carriage on the hands of health care workers is the predominant mode for patient-to-patient transmission (). MRSA are capable of causing a range of infections other than bacteraemia, including skin and soft tissue infections (SSTIs), pneumonia and deep-seated infections such as endocarditis and osteomyelitis. In a recent Europe-wide survey of clinical experience of MRSA the most common infections reported were SSTIs (79%), while for patients with MRSA bacteraemia, the most common underlying foci were intravenous lines (48%) and SSTIs. In another study of SSTIs in European medical centres, S. aureus was the most common pathogen (71% of cases), with 22.5% of the isolates being methicillin resistant. The proportion of S. aureus resistant to methicillin varied among countries, ranging from 0.4% in Sweden to 50% in Belgium. In our study, the prevalence and antibiotic susceptibility patterns of various MRSA isolates obtained from different clinical and carrier subjects were determined. We isolated 187 MRSA strains from 756 clinical specimens. The prevalence rate of MRSA was found to be 24.7% (12). The majority of MRSA strains were isolated in pus (55.1%), blood (14.4%), sputum (10.7%), body fluids (10.2%), nasal secretions (5.9%), urine (2.1%) and bronchial lavage (1.6%). MRSA are often multidrug-resistant. Currently, the majority of S. aureus strains in communities are beta-lactamase producers, but resistant to penicillin and oxacillin. Our study also showed a total resistance to penicillin and oxacillin 100% respectively and a high degree of resistance to cefoxitin (81.5%), erythromycin (57.6%), gentamicin (67%), ciprofloxacin (50%), tetracycllin (46.7%), rifampicin (32.2%). All MRSA strains were sensitive to vancomycin in the present study. This is in accordance with other studies (13). The present study reports that antibiotics other than vancomycin, for instance, clindamycin and ciprofloxacin can be promising if a susceptibility testing is done, reserving vancomycin for life-threatening infections. Similar findings have been reported from other studies as well (14). Multidrug resistance among MRSA strains was higher than those that were sensitive to methicillin. The model of antibiotic resistance of MRSA in this study is typical of these strains. All strains tested were resistant to oxacillin and Cefoxitin, which indicates the resistance of these strains to antibiotics of β-lactam class. But they represent different values of resistance to other classes of antibiotics. Resistance to erythromycin is characteristic of community strains of MRSA. As in other studies of MRSA, most of the strains were susceptible to Clindamycin, however there is the possibility of Clindamycin induced resistance during treatment with this antibiotic. For this reason the performance of D test for the detection of this resistance is of great importance. In our study iMLSb was 46.15%, cMLSb was 15:38% and MS was 38.46% (14,15).Resistance to gentamicin was also high (67%). Also in studies that were previously performed in our laboratory thr resistance to gentamycin was relatively high compared to other studies abroad. It is assume that these values may be due to more extensive use of this antibiotic (16-18). Ciprofloxacin was proposed to be an alternate therapy for MRSA infection (19). Although rapidly developing resistance to ciprofloxacin has been reported, the antibiotic was found working on S. aureus (50%) in our patients. This is perhaps due to the differential clonal expansion and drug pressure in the community. In the light of the restricted range of antibiotics available for the treatment of methicillin-resistant staphylococcal infections and the known limitations of vancomycin, clindamycin should be considered for the management of serious soft-tissue infections with methicillin-resistant staphylococci that are sensitive to clindamycin. Therefore, regular surveillance of hospital-associated infections including antimicrobial susceptibility pattern of MRSA and formulation of a definite antibiotic policy may be helpful in reducing the burden of MRSA infections in the hospital.

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CONCLUSION

The regular surveillance of hospital-acquired infections of MRSA may be helpful in formulating and monitoring the antibiotic policy. This may also help in preserving antibiotics like vancomycin, only for life-threatening staphylococcal diseases. The routine testing of methicillin-resistance, should preferably be done by using cefoxitin disc. The most effective way to prevent MRSA infections is by doing continuous surveillance of antibiotic resistance profiles of local S. aureus isolates to formulate antibiotic policies and effective infection control practices.

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THE COMMON ALLERGENS OF CONTACT DERMATITIS Desantila Tahiraj1, Ermira Vasili2 1

Regional Hospital of Elbasan, Albania; University Hospital Center “Mother Theresa” Tirana, Albania;

2



ABSTRACT

Allergic contact dermatitis is a common inflammatory skin disease, caused by exposure to specific allergens. Patch testing is a unique tool for diagnosing allergic contact dermatitis. The aim to identify the most common allergens found on the patch testing that was applied to the patients that have been suspected with allergic contact dermatitis diagnosed in our policlinic at Elbasani district. A total of 204 consecutive patients presenting with signs/symptoms of suspected allergic contact dermatitis were patch tested January 2010 to December 2012. The patients were tested with the 23-allergen European standard series. Patch-tests were performed and read in accordance with the guidelines of the ICDRG. A total of 157 (77%) 95%CI 70.7 – 82.2 patients showed positivity to one or more allergens. 64 (40.8%) of these hundred and fifty seven patients were male whereas 59.2% were females with a significant difference between them, p