Fetal alcohol syndrome (FAS) is a congenital syndrome caused by maternal alcohol consumption during pregnancy and is entirely preventable by abstinence from alcohol drinking during this time. Little ...is known about the prevalence of FAS and maternal alcohol consumption during pregnancy in Western countries. We present the results of FAS/partial fetal alcohol syndrome (PFAS) prevalence study and maternal characteristics in a sample of schoolchildren from a rural province of Croatia. This study involved seven elementary schools with 1,110 enrolled children attending 1st to 4th grade and their mothers. We used an active case ascertainment method with passive parental consent and Clarified IOM criteria. The investigation protocol involved maternal data collection and clinical examination of children. Out of 1,110 mothers, 917 (82.6%) answered the questionnaire. Alcohol exposure during pregnancy was admitted by 11.5%, regular drinking by 4.0% and binge drinking by 1.4% of questioned mothers. Clinical examination involved 824 (74.2%) schoolchildren and disclosed 14 (1.7%) with clinical signs of FAS and 41 (5.0%) of PFAS. The observed FAS prevalence, based on 74.2% participation rate, was 16.9, PFAS 49.7 and combined prevalence was 66.7/1,000 examined schoolchildren. This is the first FAS prevalence study based on active ascertainment among schoolchildren and pregnancy alcohol drinking analysis performed in a rural community of Croatia and Europe. High prevalence of FAS/PFAS and pregnancy alcohol consumption observed in this study revealed that FAS is serious health problem in rural regions as well as a need to develop future studies and preventive measures for pregnancy alcohol drinking and FASD.
Background
Lung function testing in small children is cumbersome. However, reduced variability of tidal breathing recorded using impedance pneumography (IP) during sleep was recently found to be a ...potential objective marker of wheeze in children aged 1‐5 years. We aimed to investigate how an acute bronchial obstruction (BO) and its severity, and recovery thereof reflect in expiratory variability index (EVI).
Methods
EVI was measured using a wearable IP system (Ventica®) during sleep in 40 healthy controls (aged 1.5‐5.9 years) and 30 patients hospitalized due to acute BO (aged 1.3‐5.3 years). In healthy controls, EVI was measured for 1‐3 nights at their homes. Patients were measured for several nights during hospitalization, as practically feasible, and at home 2 and 4 weeks post‐discharge.
Results
We received 79 EVI results from 39 controls and 139 from 30 patients. 90% had previous BO episodes, 30% used asthma controller medication before and 100% after hospitalization. Compared to controls, EVI was significantly lower during hospitalization (P < .0001) having significant correlation with number of days to discharge (r = −.38, P = .004). At 2 or 4 weeks post‐discharge, EVI was not significantly different from the controls (P = .14, P = .49, respectively). EVI was significantly associated with chest auscultation findings (P = .0001) being 17.5 (4.9) (median, IQR) with normal auscultation, 15.6 (7.4) in those with prolonged expiration and 11.4 (6.8) in those with wheeze and/or rales and crackles.
Conclusions
EVI was found to be a sensitive, objective marker of acute BO, showing strong association with changes in clinical status in wheezy children aged 1‐5 years.
Mjerenje plućne funkcije kod predškolske djece predstavlja jedno od najdinamičnijih i najizazovnijih područja istraživanja fiziologije dišnog sustava te integralnu komponentu kliničkog praćenja i ...liječenja. Cilj ovoga preglednog članka jest pružiti uvid o metodi i primjeni najčešćih testova plućne funkcije u djece predškolske dobi koji su nam dostupni (spirometrija, impulsna oscilometrija, tjelesna pletizmografija), kao i potencijalne probleme ispitivanja plućne funkcije u toj dobi. Spirometrija je najčešće primjenjivani test plućne funkcije koji se izvodi u pedijatrijskoj populaciji na standardiziran način kao i kod odraslih. U predškolskoj dobi primjena spirometrije ima nekoliko izazova poput dobi ispitanika, osiguravanja maksimalnog napora kod izvođenja, duljine izdisaja tijekom spirometrijskog manevra, pouzdanosti dobivenih parametra. Mjerenje specifičnog otpora dišnih putova putem tjelesne pletizmografije kao i impulsna oscilometrija također daju uvid u plućnu funkciju, a glavna im je prednost što se izvode tijekom mirnog disanja te zahtijevaju samo minimalnu suradnju. Kod odabira metode procjene plućne funkcije važno je odrediti moguću kliničku dijagnozu, a ne da se izbor pretrage temelji na dostupnoj opremi. Važno je i primijeniti odgovarajuće dostupne referentne intervale za pojedine pretrage. Potrebna su dodatna istraživanja koja će odrediti ulogu pojedinih testova, standardizirati postupak i odrediti prikladne referentne vrijednosti što bi olakšalo praćenje bolesnika, ali i omogućilo uspoređivanje različitih metoda u cilju dobivanja kompletnije kliničke slike.
We present the results of active case ascertainment of fetal alcohol syndrome (FAS). This study included a sample of urban schoolchildren attending 1st to 4th grade elementary school and their ...mothers. Out of 912 mothers, 575 (63.04%) participated in the interview. Prenatal alcohol consumption was admitted by 15.47% and binge drinking by 3.13% of interviewed mothers. We evaluated 466 (51.09%) schoolchildren for signs of FAS or partial fetal alcohol syndrome (PFAS) using revised Institute of Medicine (IOM) diagnostic criteria. Nineteen students had features consistent with FAS or PFAS. The observed prevalence of FAS is 3 children and of PFAS is 16 children among 466 students, based on 51% participation rate. The estimated prevalence of FAS is 6.44/1000, of PFAS 34.33/1000 and overall prevalence of FAS/PFAS 40.77/1000. This is the first study of FAS prevalence in Croatia and as far as we are aware the second study in Europe.
Pandemija COVID-19 uzrokovala je pad kvalitete medicinske skrbi oboljelih od tuberkuloze. Iako se broj prijavljenih novooboljelih slučajeva tijekom pandemije smanjio, povisio se broj umrlih od ...tuberkuloze uz pretpostavku povećanja broja novooboljelih. Tuberkuloza pluća u djece stoga je ostala izazov u zbrinjavanju pacijenata te važan javnozdravstveni problem. Osnova dijagnoze tuberkuloze u djece predstavlja dobro uzimanje anamnestičkih podataka koji se odnose na karakteristike izvornoga indeksnog pacijenta, karakteristike i vrstu kontakta te karakteristike djeteta, prvenstveno njegove dobi te imunološkog stanja. Karakteristični simptomi bolesti prisutni su u starije djece, dok mlađa djeca mogu biti i asimptomatska. Također, radiološki nalaz postaje specifičan u adolescentnoj dobi, dok u manje djece može pokazivati nekarakteristične promjene. Za dokaz infekcije s Mycobacterium tuberculosis koristi se interferon gamma releasing assay, brza i sigurna pretraga iz krvi kojom se dokazuje imunološka reakcija na Mycobacterium tuberculosis. Mikrobiološka obrada sputuma i želučanih lavata mikroskopski i uzgojem kultura neizostavan je stupanj obrade, no u mlađe djece također je smanjene osjetljivosti. Terapija u djece odnosi se na profilaktičku terapiju tuberkulozne infekcije kojoj je svrha spriječiti razvoj aktivnih oblika bolesti i punu intenzivnu antituberkulotsku terapiju kod aktivne tuberkuloze pluća. Praćenje i obrada djece sa suspektnom ili dokazanom tuberkulozom u domeni je dječjeg pulmologa u suradnji s primarnim pedijatrom i nadležnom epidemiološkom službom, a u svrhu pravodobne dijagnostike bilo latentne ili aktivne tuberkuloze te adekvatnog liječenja i suzbijanja bolesti.
Cilj je ispitati serumske koncentracije ukupnog IgE-a (uIgE), specifi čnog IgE-a (sIgE) prema alergenu ambrozije Ambrosia artemisiifolia,
Amb a, te vrijednost indeksa koncentracije sIgE-a prema Amb a ...(I-sIgE) u sezoni cvjetanja ambrozije, u djece preosjetljive na
alergen peludi ambrozije. Ispitana su djeca s astmom i/ili rinitisom (N=121), preosjetljiva na alergen ambrozije, Amb a. Standardiziranom
fl uoroimunikemijskom metodom UniCAP u sezoni cvjetanja ambrozije (tijekom rujna i listopada), određena je serumska
koncentracija uIgE-a, sIgE-a prema Amb a, te izračunat I-sIgE. Ispitanici su svrstani u dvije podskupine: podskupina 1a (N = 70), djeca
s koncentracijom sIgE-a prema Amb a < 100 kIUA
/L; Podskupina 1b (N = 51), djeca s vrijednostima sIgE-a prema Amb a ≥ 100 kIUA
/L.
ROC krivuljom je određena razlikovna granična koncentracija za I-sIgE za ispitivane podskupine. Koncentracija uIgE-a bila je u rasponu
od 41,5 do 5730 kIU/L, a koncentracija sIgE-a u rasponu 2,5 - 991 kIUA
/L. Raspon I-sIgE-a bio je u 0,01 - 0,53 M (IQR) = 0,14
(0,08-0,26. Vrijednosti I-sIgE-a bile su statistički značajno veće (p < 0,0001) u podskupini 1b - M (IQR) = 0,28 (0,20-0,35 - u odnosu
na podskupinu 1a - M (IQR) = 0,09 (0,07-0,13. Granična vrijednost I-sIgE-a između podskupine 1b i podskupine 1a bila je >0,15
(osjetljivost 87,3%; specifi čnost 88%). I-sIgE se može primijeniti kao koristan dodatan biomarker stupnja senzitizacije bolesnika
prema alergenu Amb a.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Cilj je ispitati sezonske razlike u koncentraciji ukupnog IgE-a (uIgE-a), specifi čnog IgE-a (sIgE) prema alergenu breze, Betula verrucosa
- Bet v, te indeks sIgE-a (I-sIgE) u djece preosjetljive na ...alergen breze, Bet v. Ispitana su djeca s astmom i/ili rinitisom (N=19), preosjetljiva
na alergen Bet v. Standardiziranom fl uoroimunikemijskom metodom UniCAP određena je koncentracija uIgE-a, sIgE-a prema Bet v,
te izračunat I-sIgE. Odabrani biomarkeri određivani su u sezoni peludacije breze (od ožujka do lipnja) i izvan nje (tijekom listopada).
Koncentracija sIgE-a prema alergenu Bet v u sezoni peludacije breze iznosila je M(IQR) = 33,9 (7,2-130,3) kIUA
/L, a izvan nje M(IQR)
= 5 (2,3-32,7) kIUA
/L, sa statistički značajnom razlikom, p = 0,005. Vrijednosti uIgE-a i I-sIgE-a nisu se statistički značajno razlikovale.
U sezoni peludacije breze najveću koncetraciju uIgE-a (1378 kIU/L) i sIgE-a (942 kIUA
/L) imao je bolesnik s dijagnozom astme i rinitisa,
ujedno preosjetljiv i na alergene trava, ambrozije i lijeske; I-sIgE bio je 0,68. Izvan sezone peludacije uIgE je iznosio 146 kIU/L, sIgE
prema Bet v 46 kIUA/L, a I-sIgE 0,31. Za precizniju interpretaciju nalaza uIgE-a te sIgE-a i I-sIgE-a prema Bet v krv za analizu treba
uzorkovati u sezoni peludacije.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Fetal alcohol syndrome (FAS) is a congenital syndrome caused by maternal alcohol consumption during pregnancy and is entirely preventable by abstinence from alcohol drinking during this time. Little ...is known about the prevalence of FAS and maternal alcohol consumption during pregnancy in Western countries. We present the results of FAS/partial fetal alcohol syndrome (PFAS) prevalence study and maternal characteristics in a sample of schoolchildren from a rural province of Croatia. This study involved seven elementary schools with 1,110 enrolled children attending 1st to 4th grade and their mothers. We used an active case ascertainment method with passive parental consent and Clarified IOM criteria. The investigation protocol involved maternal data collection and clinical examination of children. Out of 1,110 mothers, 917 (82.6%) answered the questionnaire. Alcohol exposure during pregnancy was admitted by 11.5%, regular drinking by 4.0% and binge drinking by 1.4% of questioned mothers. Clinical examination involved 824 (74.2%) schoolchildren and disclosed 14 (1.7%) with clinical signs of FAS and 41 (5.0%) of PFAS. The observed FAS prevalence, based on 74.2% participation rate, was 16.9, PFAS 49.7 and combined prevalence was 66.7/1,000 examined schoolchildren. This is the first FAS prevalence study based on active ascertainment among schoolchildren and pregnancy alcohol drinking analysis performed in a rural community of Croatia and Europe. High prevalence of FAS/PFAS and pregnancy alcohol consumption observed in this study revealed that FAS is serious health problem in rural regions as well as a need to develop future studies and preventive measures for pregnancy alcohol drinking and FASD.
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