Alergenska imunoterapija (AIT) još uvijek je jedina dostupna terapija alergijskih bolesti koja djeluje na imunosnu disfunkciju u podlozi alergije te može modificirati tijek i napredovanje bolesti. ...Suvremeno načelo imunoterapije ne razlikuje se znatnije od ideje koju je imao Leonard Noon 1911. godine, kad je prvi puta AIT primijenjena za liječenje alergijskog rinitisa. AIT podrazumijeva ponavljanu primjenu rastućih doza alergena supkutanim injekcijama do doze održavanja koja se primjenjuje tijekom najmanje tri godine, čime se postiže specifična tolerancija na alergen s dugoročnom učinkovitošću i nakon prekida liječenja. U novije vrijeme sublingvalni put primjene, provediv i u kućnim uvjetima, pokazao se učinkovitom i sigurnom alternativom supkutanom putu. Oralna se imunoterapija sve više primjenjuje u liječenju IgE posredovane alergije na hranu i omogućava postizanje učinkovite ograničene desenzitizacije, ali ne i dugotrajne tolerancije. Imunosni mehanizmi pojave tolerancije uključuju povećano stvaranje interleukina 10 (IL-10) i transformirajućeg faktora rasta beta (TGF-β), smanjenje broja alergenski specifičnih T-pomoćničkih stanica tipa 2 (Th2), indukciju alergenski specifičnih regulacijskih limfocita T i B (Tregs i Bregs) i proizvodnju alergenski specifičnih IgG 4 i IgA blokirajućih protutijela. S obzirom na stalan porast prevalencije alergijskih bolesti, od velikog je interesa u liječenju alergija istražiti nove metode za postizanje imunotolerancije sa sigurnijim, učinkovitijim i dugotrajnijim učinkom; to uključuje alternativne putove primjene alergena za imunoterapiju, nove adjuvanse, rekombinantne alergene (uključujući hipoalergene varijante) i kombinaciju alergena s imunološkim modifikatorima ili monoklonskim protutijelima koji potiskuju Th2 stanični put.
IntroductionRare pulmonary diseases in childhood continue to be a significant problem in clinical practice because there is a lack of diagnostic and therapeutic guidelines based on reliable ...scientific evidences. This group of diseases includes idiopathic eosinophilic pneumonias (IEP) that can manifest as acute or chronic or as transient Löffler syndrome. A paediatric case of chronic IEP was reported.Case ReportA 15-year old adolescent was referred to paediatric pulmonologist for suspected asthma. He complained of episodes of shortness of breath and wheezing for a year. Symptoms were more pronounced at night and were also effort induced. The symptoms showed a progressive trend. The boy did not lose weight and had no fever nor night sweats. He denied smoking cigarettes.Lung function was severely impaired (FVC 61% FEV1 47%) with negative reversibility test. Inflammatory reactants were slightly elevated (ESR 28; CRP 11.1). Severe eosinophilia (3.36 x109/L) of peripheral blood was recorded. Chest CT demonstrated extensive bilateral ground-glass opacifications and peripheral airspace consolidations. Bronchoscopy revealed diffuse redness of tracheobronchial mucosa with severe BAL eosinophilia (eos 75%). In spite to high total blood IgE level of 1265 kIU/L, results of allergic and extensive microbiological and parasitological processings were all negative. Bone marrow analysis revealed predominance of mature eosinophils without elements of malignant proliferation. Thus, diagnosis of chronic IEP was made. Oral administration of prednisone (0.7 mg/kg) provided a dramatic clinical improvement in two days. The prednisone dose was gradually reduced at intervals of two weeks and inhaled fluticasone 500 mcg daily was added. After 6 months systemic administration of prednisone was discontinued. However, 7 months later relapse of IEP occured. Again, the boy responded very vell to resumed oral prednisone (0.35 mg/kg) which was tapered again over a next 4 months course. Conclusion: The clinical presentation, the course of the disease, the severe eosinophilia of blood and BAL samples, and the absence of other known causes of pulmonary eosinophilia, all these diagnostic clinical elements suggested the diagnosis of chronic IEP. In spite to favourable long-term prognosis further follow-up of the boy is needed because according to modest published clinical experience relapses are always threatening.
Introduction Nutritional deficiency among the older adult is a widespread concern, significantly affecting their health. The prevalence of malnutrition increases with age, concurrent health ...conditions, and the level of care provided. Hospital stays can affect as 90% of the older adult. Malnutrition can hinder efforts to improve health and regain function in individuals undergoing rehabilitation. This study aims to assess the frequency of malnutrition among geriatric rehabilitation patients. Materials and methods A retrospective quantitative analysis was conducted on 357 patients admitted to the geriatric unit at Lucerne Cantonal Hospital Wolhusen in Switzerland. The patients’ nutritional status was evaluated using the standardized Mini Nutritional Assessment Long Form questionnaire. Results The initial analysis indicated a considerable prevalence of malnutrition among the geriatric population: 31.1% were identified as malnourished (MNA < 17), while an additional 35.8% were at risk of malnutrition (MNA 17–23.5), totaling 66.9% of patients. The Kruskal-Wallis ANOVA test revealed a statistically significant difference in MNA scores among different age groups ( p = 0.035). Statistical analysis also suggested a slightly higher prevalence of malnutrition among female patients. The duration of rehabilitation varied from 20.07 ± 6.93 to 22.20 ± 7.50 days, with longer durations associated with lower MNA scores. A correlation analysis between MNA values and body mass index (BMI) showed a positive correlation coefficient ( r = 0.56), indicating that lower MNA scores were associated with lower BMI and vice versa. Conclusion Malnutrition is prevalent among individuals over 65 years old, highlighting the importance of regular and timely nutritional assessments for geriatric patients to mitigate the complications and enhance prognoses in both acute care and rehabilitation settings. Such assessments can also improve the efficacy of rehabilitation programs and potentially reduce the duration of rehabilitation, thus carrying significant economic implications.
Background and Objectives: There are limited data regarding the incidence and risk factors for hypoglycemia, hyperglycemia, and unstable glycemia in preterm infants. The aim of the present study was ...to determine the incidence and risk factors associated with neonatal hypoglycemia, hyperglycemia, and unstable glycemia in preterm infants during the first seven days of life. Materials and Methods: This prospective study included preterm infants <37 weeks of gestation, admitted to the Neonatal Intensive Care Unit between January 2018 and December 2020. Based on blood glucose levels in the first week of life, infants were divided into the following four groups: normoglycemic, hypoglycemic, hyperglycemic, and unstable. Blood glucose levels were measured from capillary blood at the 1st, 3rd, 6th, and 12th hour of life during the first 24 h, and at least once a day from days 2 to 7, prefeed. Results: Of 445 enrolled infants, 20.7% (92/445) were categorized as hypoglycemic, 9.9% (44/445) as hyperglycemic, and 2.9% (13/445) as unstable, respectively. Hypoglycemia was most commonly observed among infants ≥34 weeks (27.9%), and hyperglycemia was most common among preterm infants <28 weeks (50%). Female gender increased the chances of developing hypoglycemia by three times. The decrease in gestational age by one week increased the chance of developing hyperglycemia by 1.9 times. Sepsis increased the chance of developing hyperglycemia seven times, respiratory distress syndrome five times, and mechanical ventilation three times, respectively. Conclusions: Glucose disturbances in the early neonatal period in preterm infants are common and mostly asymptomatic. Therefore, careful blood glucose level monitoring is required in those infants, especially in late preterm infants, in order to prevent possible neurological complications.
Background: Breast cancer is one of the most common tumours and one of the leading causes of death among women in all parts of the world. The aim of this study is to investigate the influence of ...Nordic walking on the functional capacity of women who have undergone surgery for breast cancer. Methods: The study involved a cohort of women who exercised through Nordic walking for 10 weeks (from March to May 2022). The subjects trained with a licenced instructor (INWA method), with two training sessions per week of 70–80 min each. We collected information on pain, arm mobility, hand grip strength, shoulder joint range of motion bilaterally, circumference of both arms, body mass index, physical activity, aerobic capacity, and endurance. Results: There were 14 women, median age 63. BMI was significantly lower (28.9/28.1; p = 0.013) after training and a difference in shoulder range of motion was better (anteflexion right (142.5/170, p = 0.002), retroflexion right (40/60, p = 0.005), abduction right (135/180, p = 0.005), abduction left (135/180, p = 0.005)). There was no difference in right hand strength, while there was a significant difference in left hand strength (19/20, p = 0.007). A correlation was found between BMI and the six-minute walk test (r = −0.70; p = 0.005). Conclusions: Considering the multidimensionality of the disease itself and the results of this study, we believe that Nordic walking is a favourable and good choice of physical activity for breast cancer patients.
To identify the risk factors of a repeated episode of severe febrile neutropenia (FN) and to build an accurate and easy-to-use predictive model.
This single-center retrospective cohort study ...conducted at the Clinical Hospital Center Children's Hospital Rijeka from January 1, 2008 to December 31, 2016 included pediatric patients with malignant diseases who experienced at least one FN episode. The association of the second severe FN episode appearance with relevant clinical and laboratory data was analyzed by logistic regression.
Out of 45 patients with one FN episode, 25 (56%) had severe FN and 11 (24%) had repeated severe FNs. Significant predictors of a repeated severe FN episode were the first FN episode duration of 9 or more days and red blood cells ≤3.0×1012/L. The predictive model constructed by crossing these two indicators had the accuracy of 87% (95% confidence interval CI 73%-94%), sensitivity of 82% (95% CI 53%-97%), and specificity of 88% (95% CI 79%-93%).
The first FN episode duration and anemia are significantly associated with the risk for severe FN re-occurrence. These factors may be useful in the identification of children with cancer who are at high risk for adverse outcome at any future fever onset and may benefit from early intensive treatment.
Objectives. Thrombosis is an increasingly recognized complication of childhood malignancy and its treatment. The incidence and etiology of pediatric cancer-related thrombosis is still not well ...understood. The aim of this study was to evaluate the preva- lence of common prothrombotic genetic conditions in children with cancer, the frequency of thrombosis, and the role of inher- ited thrombophilia in the development of thrombosis in a pediatric oncology population. Patients and Methods. Forty-seven children (36 treated for hematological malignancies and 11 for solid tumors) with a median age of 8.8. years (range 0.4 – 19.3 years) were included in the study. Genetic polymorphisms of Factor V Leiden (G1691A), prothrombin G20210A, and methy- lenetetrahydrofolate reductase (MTHFR) C677T were determined by real-time polymerase chain reaction-based DNA analysis. Results. Four (8.5%) patients were heterozygous for Factor V Leiden, 3 (6.4%) were heterozygous for prothrombin G20210A mutation, and 3 (6.4%) were homozygous for MTHFR C677T mutation. All patients had implanted central venous catheters. Four (8.5%) children had documented thrombosis, three of which were in the upper venous system. Two of the four patients with thrombosis had Factor V Leiden heterozygosity. Conclusions. Thrombosis is an important complication of childhood cancer. The risk of thrombosis may be increased in patients with Factor V Leiden. In the absence of consensus guidelines, our results support the recommendation for thrombophilia screening in children with cancer.
Glucose transporter type 1 (GLUT1) is the most important energy carrier of the brain across the blood-brain barrier, and a genetic defect of GLUT1 is known as GLUT1 deficiency syndrome (GLUT1DS). It ...is characterized by early infantile seizures, developmental delay, microcephaly, ataxia, and various paroxysmal neurological phenomena. In most cases, GLUT1DS is caused by heterozygous single-nucleotide variants (SNVs) in the
gene that provoke complete or severe impairment of the functionality and/or expression of GLUT1 in the brain. Despite the rarity of these diseases, GLUT1DS is of high clinical interest since a very effective therapy, the ketogenic diet, can improve or reverse symptoms, especially if it is started as early as possible. We present a clinical phenotype, biochemical analysis, electroencephalographic and neuropsychological features of an 11-month-old boy with myoclonic seizures, hypogammaglobulinemia, and mildly impaired gross motor development. Using sequence analysis and deletion/duplication testing, deletion of an entire coding sequence in the
gene was detected. Early introduction of a modified Atkins diet maintained a seizure-free period without antiseizure medications and normal cognitive development in the follow-up period. Our report summarizes the clinical features of GLUT1 syndromes and discusses the importance of early identification and molecular confirmation of GLUT1DS as a treatable metabolic disorder.
Aim To identify the risk factors of a repeated episode of severe
febrile neutropenia (FN) and to build an accurate and
easy-to-use predictive model.
Methods This single-center retrospective cohort ...study
conducted at the Clinical Hospital Center Children’s Hospital
Rijeka from January 1, 2008 to December 31, 2016
included pediatric patients with malignant diseases who
experienced at least one FN episode. The association of
the second severe FN episode appearance with relevant
clinical and laboratory data was analyzed by logistic regression Results Out of 45 patients with one FN episode, 25 (56%)
had severe FN and 11 (24%) had repeated severe FNs. Significant
predictors of a repeated severe FN episode were
the first FN episode duration of 9 or more days and red
blood cells ≤3.0 × 1012/L. The predictive model constructed
by crossing these two indicators had the accuracy of
87% (95% confidence interval CI 73%-94%), sensitivity
of 82% (95% CI 53%-97%), and specificity of 88% (95% CI
79%-93%).
Conclusion The first FN episode duration and anemia are
significantly associated with the risk for severe FN re-occurrence.
These factors may be useful in the identification of
children with cancer who are at high risk for adverse outcome
at any future fever onset and may benefit from early
intensive treatment.
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