Introduction: Clostridium difficile (C. difficile) is currently the leading cause of healthcare-associated diarrhea, but almost nothing is known about the extent of C. difficile infection (CDI) in Bosnia and Herzegovina. Goal: We aimed to retrospectively analyze CDI in hospitalized patients at University Clinical Center (UCC) Tuzla, Bosnia and Herzegovina from January 2009 through June 2012. Methods: We analyzed all patients (except children ages 0-2), diagnosed with CDI based on anamnestic and epidemiological, clinical picture and microbiological tests (proof of toxins in the stool by enzyme-linked immunosorbent assay). Results: From a total of 989 patients tested for C. difficile toxin (60.2 per 10,000 inpatient days) 347 (35.08%) were positives. The mean incidence rate of CDI was 2.23 per 10,000 inpatient days (range 1.32-2.87). Annual rates of hospitalization were 15.68 per 10,000 admissions (range 8.99-20.35). Most patients had a previously identified risk profile of old age, comorbidity and recent use of antibiotics. 41/276 (14.86%) patients had died, and 11/41 (26.82%) were CDI-associated deaths. Complicated CDI were registered in 53/276 (19.21%) patients, and recurrent infections in 65/276 (23.55%). Conclusion: Our data suggest that CDI is largely present in our setting which represents a serious problem and points to the importance of international surveillance, detection and control of CDI.

Since its foundation in 1992, the Croatian Medical Journal (CMJ) has followed the strict standards of quality in the scientific publishing. However, the Journal has been aware that its specific position demands more than just following the already established rules. From the very beginning, the Journal declared an “author-helpful policy,” stating that “journal editors should have a major role in training authors in science communication, especially in smaller and developing scientific communities. Journal authors usually send scientifically acceptable but poorly prepared articles and it is a pity to lose valid data because of their poor presentation.” (1,2). In brief, the editors and editorial staff of the CMJ have been well aware that the skills of scientific reporting and publishing in our academic community are not developed and that valuable research results and valid data are being lost because of poor presentation. To be perfectly honest, ten years ago this statement looked like a nice promise, one of the many we in academic medicine learnt not to take too seriously.

The problem of the lack of good quality and quantity of water for all purposes has been increasing due to the war damage to water supply plants, the effects of the unique phenomena of subsidence of the area as well as flooding caused by recent heavy rain in the area of Tuzla Canton. The flood has resulted in pollution of the drinking water and, in the light of this emergency we carried out a study to determine drinking water quality by two methods: traditional tests required by law and specific laboratory tests. The aims of the microbiological analysis of water were: to detect evidence of excretal biological pollution as a result of the flooding in the area of Tuzla Canton in 2002; to evaluate the required laboratorial procedures in Bosnia and Herzegovina for the detection of potent pathogens in the drinking water. The study included the examination of 99 samples of water: 48 samples from municipal water supplies; 13 from closed sources and 38 from open sources. Samples of water were tested by routine bacteriological, parasitological and biological methods. Reverse transcription -polymerase chain reaction (RT-PCR) was applied for the detection of viruses. Microorganisms were absent in four (4.04%) of the 99 samples of water. Out of 95 samples of water, 240 micro-organisms were isolated as follows: 114 strains of bacteria, 56 viruses, 52 bacteriophages (19 coliphages and 33 Salmonella enteritidis phage), 2 nematodes, 16 algae. According to traditional tests required by law, water from 35.35% (35/99) sources was found suitable for drinking but using specific laboratory tests, only 10.10% (10/99) of samples were in compliance with the law. There was a significant difference in water quality (p<0.01). These results call for a revision of water quality guidelines based only on indicator organisms without also making reference to the absence of viruses. We have pointed out the importance of all the parameters, which should be applied during emergencies such as the recent flooding. We also suggest that, along with routine examination of drinking water there should be periodically (per month or per year) incorporated into the current protocol extra measures for detection of enteroviruses and bacteriophages.