Autoimmune encephalitides

Autoimuni encefalitisi skupina su poremećaja koji se prezentiraju različitim kliničkim slikama – epileptičnim napadajima, psihijatrijskim poremećajima i poremećajima ponašanja, pokreta i autonomnog živčanog sustava. Ovisno o protutijelima nađenim u bolesnikovu nalazu cerebrospinalnog likvora, autoimune encefalitise možemo podijeliti u 3 grupe: encefalitisi uzrokovani protutijelima na površinske antigene membrane, encefalitisi uzrokovani protutijelima na antigene sinapse i encefalitisi uzrokovani protutijelima na intracelularne antigene. Za ispravnu dijagnozu encefalitisa potrebno je provesti detaljnu dijagnostičku obradu uključujući testiranje na protutijela, MR mozga, EEG i lumbalnu punkciju. Veliki postotak autoimunih encefalitisa paraneoplastične je etiologije i iz tog razloga neophodno je sve pacijente dijagnostički obraditi u svrhu traženja moguće neoplazme. Što ranije uvođenje imunoterapije (kortikosteroidi, intravenski imunoglobulini, plazmafereza, rituksimab i ciklofosfamid) i liječenje maligne tvorbe, ukoliko ona postoji, povećavaju vjerojatnost boljeg ishoda pacijenta. Uspješnost liječenja različita je i ovisi o tipu autoimunog encefalitisa od kojeg pacijent boluje. Relapsi bolesti se pojavljuju u određenom broju bolesnika i tada se u liječenje uvode rituksimab i ciklofosfamid.Autoimmune encephalitides (AIE) are disorders characterized by various clinical manifestations – seizures, psychiatric and behavioral symptoms, movement disorders and autonomic disturbances. Depending on which type of antibodies are detected in the patient's cerebrospinal fluid (CSF), AEI are divided into three groups: those with antibodies to the cell surface proteins, those with antibodies to synaptic proteins and those with antibodies to intracellular antigens. Autoantibody testing, brain magnetic resonance imaging (MRI) , electroencephalography (EEG) and lumbar puncture are very important for the proper diagnosis of AIE. Many forms of AIE are paraneoplastic, therefore, all patients should be screened for tumors. Early immunotherapy (corticosteroids, intravenous immunoglobulin, plasma exchange, rituximab and cyclophosphamide) improves patient outcome, as well as the treatment of the underlying malignancy. Rates of treatment success vary among different types of AEI. Some patients tend to relapse and then they are usually treated with second-line therapy

COVID-19 in children – a single center experience

Cilj studije: Cilj studije bio je ispitati kliničke karakteristike, liječenje i ishod djece hospitalizirane zbog COVID-19. Ispitanici i metode: Proveli smo retrospektivnu studiju djece mlađe od 18 godina hospitalizirane zbog COVID-19 u Klinici za infektivne bolesti „Dr Fran Mihaljević“ u Zagrebu u periodu od 01.07.2020. do 01.01.2022. Prikupili smo i statistički obradili demografske podatke, podatke o kliničkoj slici i tijeku bolesti te modalitetima liječenja. Rezultati: U promatranome periodu bolnički je liječeno 136 djece, od toga polovica mlađa od godinu dana. Dječaka je bilo malo više nego djevojčica. Većina djece (71%) imala je blagu bolest. Najčešći simptomi bili su vrućica i respiratorni simptomi (kašalj, začepljenost nosa, tahi/dispneja). Gastrointestinalne simptome imalo je manje od 20%, a neurološke manje od 10% djece. Oko četvrtine bolesnika trebalo je oksigenoterapiju, a 4% mehaničku ventilaciju. Ishod bolesti bio je povoljan – nije bilo smrtnog ishoda, a sva su djeca otpuštena izliječena ili poboljšanoga stanja. Zaključci: COVID-19 je blaga bolest u djece. Vrućica i kašalj su najčešći simptomi COVID-19 u hospitalizirane djece.Objective: Explore clinical characteristics, treatment and outcome of pediatric COVID-19. Methods: Retrospective analysis of children under 18 admitted for COVID-19 to University Hospital for Infectious Diseases „Dr Fran Mihaljević“, Zagreb between July 1st 2020. and January 1st 2022. We analyzed demographic data as well as data on clinical characteristics, treatment and outcome. Findings: 136 children were included, half of them being infants. There was a slight male predominance. Disease severity was mild in most cases (71%). Fever and respiratory symptoms (cough, rhinorrhea, tachi/dyspnea) were the most common. Gastrointestinal symptoms and neurologic involvement occurred in less than 20% and 10% of children, respectively. Oxygen supplementation was applied in a quarter of cases, and mechanical ventilation in 4%. Outcome was good overall – none of the children died and all were discharged cured or recovered. Conclusion: COVID-19 is generally a mild disease in children. Fever and cough were the most common symptoms in hospitalized children

Does assisted reproductive technology increase adverse perinatal outcome in preterm twins ? A hospital based comparative study at a single tertiary center in Croatia

Objective: The aim of this study is to investigate the association of assisted reproductive technology (ART) as an independent risk factor for obstetric complications and perinatal outcome in preterm twin pregnancies in 5 years period at a single tertiary center. Methods: We collected the data (from maternal and neonatal medical records) from 88 preterm twin pregnancies conceived after ART and 147 preterm twin pregnancies conceived naturally in a 5-year period. Results: Pregnancy complications in ART mainly included preterm premature rupture of membranes, gestational hypertension and gestational diabetes. More than 85% of ART twins were born by caesarean section, significantly higher than non-ART twins (p = 0.005). Neonatal complications in both groups mainly included low Apgar score in 1st minute, perinatal infections, respiratory distress syndrome (RDS) and hyperbilirubinemia and the incidences of these complications were comparable between the groups. According to Weinberg’s differential rule, there were 32 monozygotic ART twins and 119 monozygotic non-ART twins. This represents a monozygotic twin rate of 4.7% for ART births and 0.6% for non-ART births. Conclusion: Our results indicated that ART procedures were not associated with adverse perinatal outcome and that ART is not associated with increased obstetric complications in preterm twins followed and born in a single tertiary center

Autoimmune encephalitides

Autoimuni encefalitisi skupina su poremećaja koji se prezentiraju različitim kliničkim slikama – epileptičnim napadajima, psihijatrijskim poremećajima i poremećajima ponašanja, pokreta i autonomnog živčanog sustava. Ovisno o protutijelima nađenim u bolesnikovu nalazu cerebrospinalnog likvora, autoimune encefalitise možemo podijeliti u 3 grupe: encefalitisi uzrokovani protutijelima na površinske antigene membrane, encefalitisi uzrokovani protutijelima na antigene sinapse i encefalitisi uzrokovani protutijelima na intracelularne antigene. Za ispravnu dijagnozu encefalitisa potrebno je provesti detaljnu dijagnostičku obradu uključujući testiranje na protutijela, MR mozga, EEG i lumbalnu punkciju. Veliki postotak autoimunih encefalitisa paraneoplastične je etiologije i iz tog razloga neophodno je sve pacijente dijagnostički obraditi u svrhu traženja moguće neoplazme. Što ranije uvođenje imunoterapije (kortikosteroidi, intravenski imunoglobulini, plazmafereza, rituksimab i ciklofosfamid) i liječenje maligne tvorbe, ukoliko ona postoji, povećavaju vjerojatnost boljeg ishoda pacijenta. Uspješnost liječenja različita je i ovisi o tipu autoimunog encefalitisa od kojeg pacijent boluje. Relapsi bolesti se pojavljuju u određenom broju bolesnika i tada se u liječenje uvode rituksimab i ciklofosfamid.Autoimmune encephalitides (AIE) are disorders characterized by various clinical manifestations – seizures, psychiatric and behavioral symptoms, movement disorders and autonomic disturbances. Depending on which type of antibodies are detected in the patient's cerebrospinal fluid (CSF), AEI are divided into three groups: those with antibodies to the cell surface proteins, those with antibodies to synaptic proteins and those with antibodies to intracellular antigens. Autoantibody testing, brain magnetic resonance imaging (MRI) , electroencephalography (EEG) and lumbar puncture are very important for the proper diagnosis of AIE. Many forms of AIE are paraneoplastic, therefore, all patients should be screened for tumors. Early immunotherapy (corticosteroids, intravenous immunoglobulin, plasma exchange, rituximab and cyclophosphamide) improves patient outcome, as well as the treatment of the underlying malignancy. Rates of treatment success vary among different types of AEI. Some patients tend to relapse and then they are usually treated with second-line therapy

Autoimmune encephalitides

Autoimuni encefalitisi skupina su poremećaja koji se prezentiraju različitim kliničkim slikama – epileptičnim napadajima, psihijatrijskim poremećajima i poremećajima ponašanja, pokreta i autonomnog živčanog sustava. Ovisno o protutijelima nađenim u bolesnikovu nalazu cerebrospinalnog likvora, autoimune encefalitise možemo podijeliti u 3 grupe: encefalitisi uzrokovani protutijelima na površinske antigene membrane, encefalitisi uzrokovani protutijelima na antigene sinapse i encefalitisi uzrokovani protutijelima na intracelularne antigene. Za ispravnu dijagnozu encefalitisa potrebno je provesti detaljnu dijagnostičku obradu uključujući testiranje na protutijela, MR mozga, EEG i lumbalnu punkciju. Veliki postotak autoimunih encefalitisa paraneoplastične je etiologije i iz tog razloga neophodno je sve pacijente dijagnostički obraditi u svrhu traženja moguće neoplazme. Što ranije uvođenje imunoterapije (kortikosteroidi, intravenski imunoglobulini, plazmafereza, rituksimab i ciklofosfamid) i liječenje maligne tvorbe, ukoliko ona postoji, povećavaju vjerojatnost boljeg ishoda pacijenta. Uspješnost liječenja različita je i ovisi o tipu autoimunog encefalitisa od kojeg pacijent boluje. Relapsi bolesti se pojavljuju u određenom broju bolesnika i tada se u liječenje uvode rituksimab i ciklofosfamid.Autoimmune encephalitides (AIE) are disorders characterized by various clinical manifestations – seizures, psychiatric and behavioral symptoms, movement disorders and autonomic disturbances. Depending on which type of antibodies are detected in the patient's cerebrospinal fluid (CSF), AEI are divided into three groups: those with antibodies to the cell surface proteins, those with antibodies to synaptic proteins and those with antibodies to intracellular antigens. Autoantibody testing, brain magnetic resonance imaging (MRI) , electroencephalography (EEG) and lumbar puncture are very important for the proper diagnosis of AIE. Many forms of AIE are paraneoplastic, therefore, all patients should be screened for tumors. Early immunotherapy (corticosteroids, intravenous immunoglobulin, plasma exchange, rituximab and cyclophosphamide) improves patient outcome, as well as the treatment of the underlying malignancy. Rates of treatment success vary among different types of AEI. Some patients tend to relapse and then they are usually treated with second-line therapy

Parents' attitudes toward childhood COVID-19 immunization in Croatia: a multicenter cross-sectional study

Aim: To assess parents' attitudes toward childhood COVID-19 immunization in Croatia. Methods: In this multicenter cross-sectional study, we collected data from four tertiary care facilities in Zagreb, Split, and Osijek between December 2021 and February 2022. During the visit to the Pediatric Emergency Departments, parents were asked to fill out a highly-structured questionnaire about their attitudes toward COVID-19 immunization in children. Results: The sample consisted of 872 respondents. A total of 46.3% of respondents were hesitant about vaccinating their child against COVID-19, 35.2% definitely did not intend to vaccinate their child, and 18.5% definitely intended to vaccinate their child. Parents who were themselves vaccinated against COVID-19 were more likely than unvaccinated parents (29.2% and 3.2%, P<0.001) to vaccinate their children. Parents agreeing with the epidemiological guidelines were more inclined to vaccinate their children, as were parents of older children and parents of children vaccinated according to the national program schedule. Child comorbidities and respondents' history of COVID-19 were not associated with childhood vaccination intention. Ordinal logistic regression revealed that the most important predictors for a positive parents' attitude toward vaccinating their child were parents' vaccination status and regular vaccination of their child according to the national immunization program schedule. Conclusion: Our results demonstrate Croatian parents' mostly hesitant and negative attitudes toward childhood COVID-19 immunization. Future vaccination campaigns should target unvaccinated parents, parents with younger children, and parents of children with chronic diseases