[DEVELOPMENT OF ZAGREB HEALTH CARE IN THE LAST DECADES OF 19th CENTURY]

The article describes health and health care development in Zagreb in the 19th century, with special attention to the last period of the century, using articles from Liječnički vjesnik for analysis. The development of the hospital and public health system is being considered, as well as the modernisation of other areas - pharmacy and dentistry. In addition, the paper presents basic health enlightenment thoughts as well as their authors. In the end, a brief analysis of treatment success is made on several separate examples.

[THE MATERNITY WARD AT THE REBRO HOSPITAL FROM 1942 TO 1946]

The maternity ward at the Rebro Hospital in Zagreb was established in the newly opened new hospital on 12 May 1942. It operated discontinuously at the gynaecology and obstetrics department during three periods between 1942 and 1946, when it was closed. It was located on the second floor of the eastern part of the hospital with 24 beds. During the activity of the maternity ward from 13 May 1942 to 16 December 1942, 24 May 1944 to 28 August 1945, and from 6 February 1946 to 28 July 1946, there were 1,337 births. They were registered as live births, stillbirths and aborted children weighing 450 grams or more, so perinatal mortality was therefore significantly higher (38.89 ‰) because, in addition to physiological, a significant number of pathological births were performed in the hospital. The head of the newly established ward was Assoc. prim. Dr Filip Dražančić, who worked alongsideward doctors and midwives. Most of the women who gave birth were from Zagreb, with a smaller number of women from other parts of Croatia, primary housewives aged 20-30. In the mentioned period, three mothers died. All obstetric procedures, episiotomies, caesarean section, assistance during breech delivery, rotating of a baby, forceps, and treatment of perineallacerations were performed under local infiltration, spinal (lumbar) or general inhalation anaesthesia using ether. Along with a significant number of home midwifery deliveries and the already established hospital maternity wards in the Petrova and Merkur sanatoriums, the maternity ward at the Rebro hospital, until now only sporadically mentioned as an institution, had an important place in the development of hospital obstetrics in Zagreb and Croatia.

[IVO HORVAT, BOTANIST (1897 - 1963), WORK AT THE DEPARTMENT OF BOTANY OF THE FACULTY OF VETERINARY MEDICINE AT THE UNIVERSITY OF ZAGREB]

Professor Ivo Horvat, a world-renowned Croatian scientist, botanist, and university teacher, was born in Čazma on October 7, 1897. After finishing the Classical Gymnasium in Zagreb in 1916, he graduated from the University of Zagreb, Faculty of Philosophy in 1920 and obtained his Ph.D. in botany on July 31, 1920. From his invaluable scientific and educational heritage, we have selected out for this occasion only a small part dedicated to the period from June 11, 1947 to April 23, 1963, in which Prof. Horvat worked at the Faculty of Veterinary Medicine, University of Zagreb. He worked in a wide range of both natural and biomedical veterinary sciences: from systematic botany, ecology, and environmental protection to the study of phylogeny, floristic, and vegetation research, including vegetation mapping and scientific-organizational work. Following the bibliographic and archival sources of the original documents, the given data represent a brief overview of Prof. Horvat’s contribution to phytocoenological work and an overview of scientific and educational heritage with an emphasis on the years spent at the Faculty of Veterinary Medicine, University of Zagreb.

Disinfection by-products in Croatian drinking water supplies with special emphasis on the water supply network in the city of Zagreb

The occurrence of disinfection by-products (DBPs) was investigated in 48 drinking water systems across Croatia. Eleven DBPs were studied: chlorite (ClO₂^-), chlorate (ClO₃^-), four trihalomethanes (THMs), and five haloacetic acids (HAAs). Furthermore, an intensive sampling program was conducted in the distribution system in the city of Zagreb where, aside from DBP analyses, natural organic matter (NOM) was characterized using fluorescence spectroscopy. In the drinking waters examined across Croatia, DBP values were found in the range from 0.7 μg/L to 32.8 μg/L for THMs, below LOQ to 17.2 μg/L for HAAs (primarily di- and trichloroacetic acids), below LOQ to 720 μg/L for ClO₂^- and below LOQ to 431 μg/L for ClO₃^-. The results obtained showed higher chlorite concentrations in the systems treated with hypochlorite compared to systems treated with chlorine dioxide. DBPs in the Zagreb distribution network were generally low (the average values were below 6 μg/L and 2 μg/L for total THM and total HAA respectively). In contrast to our observations throughout Croatia, dibromoacetic acid (DBAA) was found to be the predominant HAA within Zagreb, most likely due to the degradation of chlorinated carboxylates (di-/tri-chloroacetic) in the network. Characterization of NOM by Parallel Factor Analysis (PARAFAC) fluorescence spectroscopy across the Zagreb network showed distinct temporal variations arising from groundwater inputs, as evident from variable humic-, tyrosine-, and tryptophan-like peaks. Statistical correlations between fluorescence data and DBPs highlight its potential for monitoring the presence of DBPs in distribution networks.

Long-term monitoring of drug consumption patterns in a large-sized European city using wastewater-based epidemiology: Comparison of two sampling schemes for the assessment of multiannual trends

A comprehensive study aimed at monitoring of temporal variability of illicit drugs (heroin, cocaine, amphetamine, MDMA, methamphetamine and cannabis) and therapeutic opiate methadone in a large-sized European city using wastewater-based epidemiology (WBE) was conducted in the city of Zagreb, Croatia, during an 8-year period (2009-2016). The study addressed the impact of different sampling schemes on the assessment of temporal drug consumption patterns, in particular multiannual consumption trends and documented the possible errors associated with the one-week sampling scheme. The highest drug consumption prevalence was determined for cannabis (from 59 ± 18 to 156 ± 37 doses/day/1000 inhabitants 15-64 years), followed by heroin (from 11 ± 10 to 71 ± 19 doses/day/1000 inhabitants 15-64 years), cocaine (from 8.3 ± 0.9 to 23 ± 4.0 doses/day/1000 inhabitants 15-64 years) and amphetamine (from 1.3 ± 0.9 to 21 ± 6.1 doses/day/1000 inhabitants 15-64 years) whereas the consumption of MDMA was comparatively lower (from 0.18 ± 0.08 to 2.7 doses ±0.7 doses/day/1000 inhabitants 15-64 years). The drug consumption patterns were characterized by clearly enhanced weekend and Christmas season consumption of stimulating drugs (cocaine, MDMA and amphetamine) and somewhat lower summer consumption of almost all drugs. Pronounced multiannual consumption trends were determined for most of the illicit drugs. The investigated 8-year period was characterized by a marked increase of the consumption of pure cocaine (1.6-fold), THC (2.7-fold), amphetamine (16-fold) and MDMA (15-fold) and a concomitant decrease (2.3-fold) of the consumption of pure heroin. The heroin consumption decrease was associated with an increase of methadone consumption (1.4-fold), which can be linked to its use in the heroin substitution therapy. The estimated number of average methadone doses consumed in the city of Zagreb was in a good agreement with the prescription data on treated opioid addicts in Croatia.

Comparative study on the immunogenicity and safety of a purified chick embryo cell rabies vaccine (PCECV) administered according to two different simulated post exposure intramuscular regimens (Zagreb versus Essen)

Despite availability of effective rabies vaccines, India has the highest global mortality rate for rabies. Low socio-economic communities are most affected due to lack of awareness of the disease and poor compliance to post-exposure prophylactic regimens. Currently, the only approved intramuscular regimen for post-exposure prophylaxis (PEP) against rabies in India is the Essen regimen, which consists of 5 injections administered over 5 separate days in a period of one month. The high number of doses and clinical visits, however, are major reasons for non-compliance, and thus a shorter regimen would be beneficial. In a simulated PEP trial in healthy, adult subjects, this study evaluated whether purified chick embryo cell vaccine (PCECV), administered according to the WHO-recommended 4-dose/3 visit Zagreb vaccination regimen is of equal immunogenicity and safety as the standard Essen regimen in Indian subjects. Two hundred and 50 healthy adults were enrolled and randomized into a Zagreb or Essen group, each receiving PCECV according to their respective regimen. Blood samples were collected on Days 0, 7, 14 and 42 and analyzed using the rapid fluorescent focus inhibition test (RFFIT). By Day 14, all subjects across both groups attained rabies virus neutralizing antibody (RVNA) concentrations of ≥ 0.5IU/ml. The Zagreb regimen was then demonstrated to be immunologically non-inferior to the Essen regimen by Day 14, which was the primary endpoint of the study. No safety issues were noted and the occurrence of adverse events was similar in both groups (17% and 15%, respectively). NCT01365494. CTRI No.: CTRI/2011/07/001857.