The usefulness of the basophil activation test in monitoring specific immunotherapy with house dust mite allergens

Introduction: In clinical practice, reliable tools for monitoring specific immunotherapy (SIT) are of utmost importance. Aim: To assess the usefulness of the basophil activation test (BAT) in monitoring SIT in paediatric patients with allergy to house dust mites (HDM). Material and methods: Thirty-one children qualified for SIT with HD,, of whom 21 completed the SIT during the observation period. The BAT was carried out prior to commencing the SIT (time point BAT1) and upon finishing the initial pack of allergy vaccine (cumulative dose of allergen 12487.5 PNU, BAT2), as well as after the second vaccine pack (cumulative dose of allergen 23750.0 PNU; BAT3). Peripheral blood of the patients was stimulated with allergen solutions in five concentrations from 0.00225 ng/ml to 22.5 ng/ml. Basophil activation was measured by CD63 expression in flow cytometry. Results: For the allergen concentration of 0.225 ng/ml, a statistically significant decrease in median basophil activation was observed, from 51.29% at BAT1 to 8.48% at BAT2 (\rho = 0.004) and 4.21% at BAT3 (\rho < 0.001). For the allergen concentration of 0.0225 ng/ml, a statistically significant decrease was seen between BAT1 (1.72%) and BAT3 (0.21%, \rho = 0.01). Median CD-sens index decreased significantly from 1099.02 at BAT1 to 179.31 at BAT2 (\rho < 0.002) and 168.04 at BAT3 (\rho < 0.001). Conclusions: There is a significant decrease in BAT results in the course of specific immunotherapy with HDM allergens in children, with the optimum allergen concentration for monitoring basophil response at 0.225 ng/ml. The CD-sens index seems to be a better monitoring parameter than the plain percentage of CD63-expressing basophils

Analysis of complications during pregnancy in women with serological features of acute toxoplasmosis or acute parvovirosis

Abstract Objectives: Toxoplasma gondii and parvovirus B19 (PVB19) infections in a healthy adult are usually asymptomatic. Congenital toxoplasmosis is the cause of hydrocephalus, chorioretinitis and intracranial calcifications. Hydrops remains the most common complication during the fetal PVB infection. The aim of the study was to analyze the complications during pregnancy in women with serological features of acute toxoplasmosis or acute parvovirosis. Material and methods: In our study, we have included 1800 pregnant women, hospitalized in Department of Fetal-Maternal Medicine and Gynecology Research Institute, Polish Mother's Memorial Hospital (RIPMMH) in Lodz, (Poland) between 2000-2007. Anti-T.gondii antibodies were tested by ELISA Vidas Toxo IgG, ELISA Vidas IgM (BioMerieux) and Platelia Toxo-A Anti-PVB19 antibodies were detected by NovaLisa Parvovirus B19 Recombinant IgG-ELISA and IgM-ELISA (NOVATEC). Results: Prevalence of IgG anti-PVB19 among pregnant women was 35% (n=633). IgG anti-T.gondii was noticed in 55.5% (n=910) of women. Serological features of acute parvovirosis were demonstrated in 13.5% (n=243) of the patients and 14.2% (n=256) of women suffered from acute toxoplasmosis. Fetal hydrocephalus or ventriculomegaly was diagnosed in 19.5% (n=64) of the pregnancies with IgM anti-PVB19 and in 7.3% (n=19) women with serological features of acute toxoplasmosis. In 8.5% (n=28) of the patients with IgM anti-PVB19 and 9% (n=5) of the pregnant women with IgM and/or IgA anti-T.gondii, fetal hydrops was detected. Intrauterine death was diagnosed in 4.5% (n=15) of the cases with acute PVB19 infection and in 2.3% (n=6) of the patients with acute toxoplasmosis. Amniotic fluid disorders were noticed more often in women with acute parvovirosis (polihydramnion 15.5%, n=51; oligohydramnion 8.5%, n=28; ahydramnion 6.3%, n=21) than in those with active toxoplasmosis (polihydramnion 3.4%, n=9; oligohydramnion 3.4%, n=9; ahydramnion 0%). We have examined also the influence of T.gondii and PVB19 infections on an intrauterine growth restriction, preterm delivery and spontaneous abortions. Conclusions: In conclusion, infections of T.gondii and PVB19 are a very common cause of complications in pregnancy. Due to high prevalence rate of IgG antibodies in Poland, it is necessary to consider routine serological testing in pregnancy

Analysis of complications during pregnancy in women with serological features of acute toxoplasmosis or acute parvovirosis

Abstract Objectives: Toxoplasma gondii and parvovirus B19 (PVB19) infections in a healthy adult are usually asymptomatic. Congenital toxoplasmosis is the cause of hydrocephalus, chorioretinitis and intracranial calcifications. Hydrops remains the most common complication during the fetal PVB infection. The aim of the study was to analyze the complications during pregnancy in women with serological features of acute toxoplasmosis or acute parvovirosis. Material and methods: In our study, we have included 1800 pregnant women, hospitalized in Department of Fetal-Maternal Medicine and Gynecology Research Institute, Polish Mother's Memorial Hospital (RIPMMH) in Lodz, (Poland) between 2000-2007. Anti-T.gondii antibodies were tested by ELISA Vidas Toxo IgG, ELISA Vidas IgM (BioMerieux) and Platelia Toxo-A Anti-PVB19 antibodies were detected by NovaLisa Parvovirus B19 Recombinant IgG-ELISA and IgM-ELISA (NOVATEC). Results: Prevalence of IgG anti-PVB19 among pregnant women was 35% (n=633). IgG anti-T.gondii was noticed in 55.5% (n=910) of women. Serological features of acute parvovirosis were demonstrated in 13.5% (n=243) of the patients and 14.2% (n=256) of women suffered from acute toxoplasmosis. Fetal hydrocephalus or ventriculomegaly was diagnosed in 19.5% (n=64) of the pregnancies with IgM anti-PVB19 and in 7.3% (n=19) women with serological features of acute toxoplasmosis. In 8.5% (n=28) of the patients with IgM anti-PVB19 and 9% (n=5) of the pregnant women with IgM and/or IgA anti-T.gondii, fetal hydrops was detected. Intrauterine death was diagnosed in 4.5% (n=15) of the cases with acute PVB19 infection and in 2.3% (n=6) of the patients with acute toxoplasmosis. Amniotic fluid disorders were noticed more often in women with acute parvovirosis (polihydramnion 15.5%, n=51; oligohydramnion 8.5%, n=28; ahydramnion 6.3%, n=21) than in those with active toxoplasmosis (polihydramnion 3.4%, n=9; oligohydramnion 3.4%, n=9; ahydramnion 0%). We have examined also the influence of T.gondii and PVB19 infections on an intrauterine growth restriction, preterm delivery and spontaneous abortions. Conclusions: In conclusion, infections of T.gondii and PVB19 are a very common cause of complications in pregnancy. Due to high prevalence rate of IgG antibodies in Poland, it is necessary to consider routine serological testing in pregnancy

Influence of percutaneous pulmonary valve implantation on exercise capacity: Which group of patients benefits most from the intervention?

Background: The aim of the study was to evaluate the role of cardiopulmonary exercise testing (CPET) parameters in assessing exercise capacity improvement after percutaneous pulmonary valve implantation (PPVI). Additionally, it aimed to determine if there are any baseline characteristics influencing that change. Methods and results: The study comprised 32 patients (mean age 26 ± 9); 53% males; diagnosis: tetralogy of Fallot (n = 18), pulmonary atresia (n = 6), Ross procedure (n = 4), other (transposition of great arteries, pulmonary stenosis, double outlet right ventricle, common arterial trunk type II — n = 4) who underwent successful PPVI due to right ventricular out­flow tract dysfunction (predominant pulmonary regurgitation — n = 17, predominant pulmo­nary stenosis — n = 15). Treadmill CPET was performed before and a year after PPVI along with clinical evaluation, cardiac magnetic resonance and transthoracic echocardiography. Twelve months post successful PPVI (pulmonary valve competence restoration and pulmonary gradient reduction from 58.8 ± 47.1 to 26.6 ± 10.8 mm Hg) there was a significant decrease in the ventilatory equivalent for CO2 at peak exercise (EQCO2) (25.3 ± 3.3 to 24.3 ± 3.0, p = 0.04) and oxygen consumption at peak exercise (pVO2) (20.4 ± 5.0 to 22.6 ± 5.3 mL/kg/min, p = 0.04). Improved EQCO2 correlated with an increase in right and left ventricular ejection fraction (respectively R = –0.57, p = 0.002; R = –0.56, p = 0.002). In this study, no baseline factors that might affect improvement in exercise function were found. Conclusions: Successful PPVI leads to an improvement in exercise capacity and hemodynamic response to exercise. The correlation between the improvement in EQCO2 or peak VO2 and baseline characteristics was too weak to reliably identify the group of patients that will benefit from the procedur

Rodzina w zdrowiu i w chorobie. Uwarunkowania środowiskowe zdrowia

Praca recenzowana / peer-reviewed pape

Vestibular Disorders in Children

Celem pracy jest próba znalezienia zależności pomiędzy uszkodzeniami narządu przedsionkowego u dzieci, a występowaniem objawów w postaci: zawrotów głowy i zaburzeń równowagi. Zachowanie równowagi wymaga sprawnych odruchów: przedsionkowo –ocznego i przedsionkowo-rdzeniowego. W wieku rozwojowym symptomatologia uszkodzeń błędnika będzie zależała od tego na jakim etapie rozwoju do takiego uszkodzenia dojdzie. Pacjenci z wrodzoną wadą przedsionka z reguły nie uskarżają się na zawroty głowy. Dominującym objawem u nich jest opóźnienie rozwoju sprawności motorycznych, co zazwyczaj nie jest wiązane przez lekarzy z dysfunkcją błędnika. Oczopląs samoistny jako objaw ostrego uszkodzenia przedsionka pojawia się u niemowląt i małych dzieci rzadziej niż u pacjentów starszych. Oczopląs u młodszych dzieci ma w większości przypadków charakter ukryty. Natomiast częstość występowania zawrotów głowy i zaburzeń równowagi u dzieci i młodzieży, w zależności od przyjętych definicji tych objawów, szacuje się na poziomie od 0,4% do 5,7% badanej populacji. Główną przyczyną napadowych zawrotów głowy u dzieci jest migrena i zespoły z nią związane. Sprawność błędnika można szacować próbami: fotela obrotowego, dwukaloryczną, VHIT oraz VEMP. Wszystkie testy przedsionkowe, za wyjątkiem obrotowej, wymagają minimum współpracy ze strony pacjenta. Wniosek: Niezmiernie rzadko udaje się potwierdzić, że objaw określany przez dziecko jako zawrót głowy jest spowodowany trwałym uszkodzeniem błędnika.The aim of the article is an attempt to find a parallel relationship between injuries of the congenital inner ear (vestibular) disorder in children and the occurrence of symptoms in the form of dizziness and vertigo. Balance requires efficient reflexes: vestibule- ocular reflex and vestibule-spinal reflex. At developmental age the symptomatology of vestibular damage depends on the stage of development at which such damage occurs. Patients with congenital vestibular disorder usually do not report any dizziness. Their dominant symptom is manifested in delayed motor skills development which is usually not associated by the doctors with vestibular disorder. Spontaneous nystagmus as a symptom of acute vestibular damage occurs less frequently in infants and young children than in older patients. Nystagmus in younger children, in most cases, is latent. However, the incidence of dizziness and vertigo in children and adolescents, depending on the adopted definitions of these symptoms, is estimated at 0.4% to 5.7% of the studied population. The main cause of paroxysmal dizziness and vertigo in children is migraine associated symptoms (MAS). The vestibule’s functional efficiency can be estimated with the following tests: Damped rotational chair test, Caloric nystagmus test, VHIT- Video Head Impulse Test, and VEMP – Vestibular Evoked Myogenic Potentials test. All the vestibular tests, with the exception of rotational test, require minimum cooperation from the patient. In extremely rare cases it is possible to confirm that the symptom described by the child as dizziness is caused by permanent vestibular disorder