Sindrom akutnog respiracijskog distresa u četvorogodišnjeg dječaka s dijabetičnom ketoacidozom - prikaz slučaja

Among many disease states as known initiators of acute respiratory distress syndrome (ARDS), diabetic ketoacidosis (DKA) is the rarest one. We present a 4-year-old boy with DKA as the first manifestation of insulin-dependent diabetes mellitus who developed ARDS, required tracheal intubation and mechanical ventilation, and survived without significant sequels. To improve survival of patients with ARDS as a complication of DKA, physicians should be aware of this rare pulmonary complication and its appropriate management.Među poznatim inicijatorima sindroma akutnog respiracijskog distresa (ARDS) dijabetična ketoacidoza (DKA) je najrjeđi. U ovom radu prikazujemo 4-godišnjeg dječaka s DKA kao prvom manifestacijom o inzulinu ovisne šećerne bolesti u kojega se razvio ARDS te je zahtijevao mehaničku ventilaciju i preživio bez značajnijih posljedica. Kako bi se unaprijedilo preživljenje bolesnika s ARDS kao komplikacijom DKA liječnici trebaju biti upoznati s ovom rijetkom plućnom komplikacijom i njezinim pravilnim liječenjem

Adherence Ability of Pseudomonas aeruginosa Strains Isolated from Patients with Cystic Fibrosis to Two Different Epithelial Cell Lines

The ability of 59 wild-type strains of Pseudomonas aeruginosa to adhere to the HeLa and Buffalo Green Monkey Kidney (BGMK) cells was investigated. Twenty strains were isolated from sputa of cystic fibrosis patients, while 19 strains were isolated from tracheal aspirates and 20 from bronchial secretions of patients without cystic fibrosis, and they were used as a control group of strains. The statistically significant difference between adherence ability of strains was observed (p<0.01). While most of the tracheal and bronchial isolates were hyperadhesive (51–110 bacteria per cell) most of the cystic fibrosis isolates adhered poorly to the HeLa and BGMK cells (1–10 bacteria per cell). The bacterial binding to the cells was blocked when bacteria were incubated at 80°C for 20 min before the adherence assay. These results indicate that alginate is not involved in the adherence of P. aeruginosa to the used epithelial cell lines, and, because of that, mucoid strains isolated from persistently colonized cystic fibrosis patients showed poor adherence ability

Nasal polyposis in cystic fibrosis: experience from CF Center, UHC Zagreb

Cystic fibrosis (CF) is a lethal autosomal recessive disease, caused by mutations in the CF transmembrane conductance regulator gene (CFTR). CFTR mutations affect epithelial cells in the lungs, sinuses, pancreas, liver, kidneys, intestine and sweat glands, causing abnormally viscous mucus production, thickening of digestive fluids and salty sweat. The consequences for the respiratory system are mucus buildup, decreased mucociliary clearance and tissue inflammation. A change in microbioma follows, with S. aureus and P. aeruginosa being prevalent in most patients, as they have the capacity of biofilm formation causing chronic colonization. This represents the basis for recurrent infection. At the same time, pancreatic insufficiency leads to malabsorption of fat-soluble vitamins, i.g. vitamin D3, a powerful immunomodulator implicated in both pulmonary and sinus pathophysiology. CF is marked by a high incidence of nasal polyposis, even in the pediatric population and ENT follow-up is mandatory. CF nasal polyposis is a distinctive form of nasal polyposis and its treatment and follow up present many challenges. CF affects one out of every 3000 newborns. The total number of patients with CF in Croatia is 175, and the majority of them now refer to our CF Center of Zagreb University Center where they are approached by a multidisciplinary team: both pediatric and adult pulmologists, gastroenterologists, endocrinologists, rhinologists, microbiologists and nutritionists. We aimed to review our experience with CF patients from a rhinologist point of view and present the prevalence and specifics of nasal polyposis in cystic fibrosis patients from our CF Center

Nasal polyposis in cystic fibrosis: experience from CF Center, UHC Zagreb

Cystic fibrosis (CF) is a lethal autosomal recessive disease, caused by mutations in the CF transmembrane conductance regulator gene (CFTR). CFTR mutations affect epithelial cells in the lungs, sinuses, pancreas, liver, kidneys, intestine and sweat glands, causing abnormally viscous mucus production, thickening of digestive fluids and salty sweat. The consequences for the respiratory system are mucus buildup, decreased mucociliary clearance and tissue inflammation. A change in microbioma follows, with S. aureus and P. aeruginosa being prevalent in most patients, as they have the capacity of biofilm formation causing chronic colonization. This represents the basis for recurrent infection. At the same time, pancreatic insufficiency leads to malabsorption of fat-soluble vitamins, i.g. vitamin D3, a powerful immunomodulator implicated in both pulmonary and sinus pathophysiology. CF is marked by a high incidence of nasal polyposis, even in the pediatric population and ENT follow-up is mandatory. CF nasal polyposis is a distinctive form of nasal polyposis and its treatment and follow up present many challenges. CF affects one out of every 3000 newborns. The total number of patients with CF in Croatia is 175, and the majority of them now refer to our CF Center of Zagreb University Center where they are approached by a multidisciplinary team: both pediatric and adult pulmologists, gastroenterologists, endocrinologists, rhinologists, microbiologists and nutritionists. We aimed to review our experience with CF patients from a rhinologist point of view and present the prevalence and specifics of nasal polyposis in cystic fibrosis patients from our CF Center

Kojim PPD-hiperreaktorima treba dati profilaksu – naša iskustva [Which tuberculin skin test hyperreactive child should be treated with -our experience]

Since persons with latent tuberculosis infection (LTBI) represent a huge reservoir of potential tuberculosis (TB) disease, accurate diagnosis and treatment of LTBI is essential for TB control and eradication. The aim was to assess the diagnostic value of determination of interferon-gamma release assay in school children with hyperreactive tuberculin skin test (TST) reaction. A total of 120 BCG-vaccinated children were investigated due to a hyperreactive TST results. The QuantiFERON-TB Gold In-Tube test (QFT-GIT) was performed. Fifteen children (12.5%) had positive QFT-GIT and 105 (87.5%) children had negative QFT-GIT. There was no statistically significant difference in TST reaction (21.5 mm u QFT+ vs. 20.9 mm u QFT-group, p=0.458). The children with positive QFT-GIT had a statistically higher level of interferon-gamma (IFN-γ) than children with negative QFT-GIT. There were no statistically significant differences in concentrations of IFN-y either basic or upon stimulation with mitogen phytohemagglutinin. After isoniazid prophylaxis QFT-GIT remained positive in two children (p=0.019). In a difficult procedure for diagnosing LTBI in BCG-vaccinated children determination of IFN-γ could be the key factor in making decision whether to use preventive therapy or not

Abdominal ultrasound diagnostics of infectious diseases

Abdominalni ultrazvuk rabi transmisiju i refleksiju ultrazvučnih valova za prikaz unutarnjih organa kroz trbušnu stijenku. Opisali smo klinički značaj i sonografske karakteristike različitih oblika žarišnih i difuznih jetrenih lezija te upalnih stanja žučnog sustava, gušteraće i slezene kao i diferencijalno dijagnostičke mogućnosti. Izuzevši jednostavne ciste i tipične hemangiome, definitivna karakterizacija jetrenih lezija nije uvijek moguća konvencionalnim ultrazvukom. Ovaj pregledni rad također opisuje karakteristike transabdominalnog ultrazvuka tankog i debelog crijeva kod različitih infektivnih bolesti i upalnih stanja.Abdominal ultrasonography uses the transmission and reflection of ultrasound waves to visualise internal organs through the abdominal wall. We describe the clinical significance and sonographic features of various types of liver focal and diffuse infections, biliary, pancreatic and splenic inflammatory conditions and differential diagnosis. With the exception of cysts and typical haemangiomas, a definitive characterisation of liver lesions is often not possible using conventional ultrasound. This review also provides an overview of transabdominal ultrasonography of the small and large bowel, while summarizing its use in a variety of gastrointestinal infectious and inflammatory diseases

Poster 17. - Predstavljaju li IGRA testovi napredak u prevenciji tuberkuloze?

Tuberkuloza je i nadalje jedan od glavnih javnozdravstvenih problema u cijelom svijetu. Nakon kontakta s bacilom tuberkuloze, djeca imaju povećani rizik za razvoj bolesti te je zbog toga važno djecu testirati ukoliko postoji sumnja na infekciju. Do prije nekoliko godina jedini način testiranja kontakata na izloženost bacilu tuberkuloze bio je kožni PPD test koji ima iznimno nisku osjetljivost i specifičnost. Napredak u probiru kontakata učinjen je uvođenjem IGRA (od engl. Interferon gamma release assay) testova, kod kojih je osjetljivost i specifičnost bolja nego kod kožnog testa. Osnovni cilj ovoga rada bio je procijeniti dijagnostičku vrijednost ex vivo određivanja koncentracije IFN-γ u djece s pojačanom reakcijom nakon redovnog PPD testiranja. U istraživanje je uključeno 120 BCG-irane djece koji su prilikom redovitog PPD testiranja bili hiperreaktori. Od ukupnog broja testiranih samo je 15 (12,5%) djece imalo pozitivan IGRA test, dok je čak 105 (87,5%) imalo negativan. Nije bilo statistički značajne razlike u veličini PPD probe između skupina (21,5 mm u IGRA+, 20,9 mm u IGRA- skupini, p=0,458). Postojala je razlika u skupinama u odnosu na koncentraciju IFN-g nakon stimulacije s antigenima specifičnim za M. tuberculosis, dok nije bilo razlike kako u bazičnoj koncentraciji IFN-g tako i u koncentraciji IFN-g nakon stimulacije mitogenom. Prije bi sva djeca PPD hiperreaktori bila uključena u dijagnostički algoritam za dokaz tuberkuloze, te bi velikom broju bila prepisana preventivna terapija izonijazidom kroz više mjeseci. Međutim, dodatnim IGRA testiranjem pokazali smo kako je samo manji broj ove djece zaista i bio u kontaktu s bacilom tuberkuloze. Gotovo 90% djece koja su prije bila podvrgnuta dijagnostičkim i terapijskim postupcima ovim je novim testom isključeno iz daljnje obrade. Zaključno, uključivanje IGRA testiranja u djece kod koje se sumnja na infekciju s bacilom tuberkuloze pridonosi boljem odabiru pacijenata kojima je potrebna obrada i profilaksa

WHICH TUBERCULIN SKIN TEST HYPERREACTIVE CHILD SHOULD BE TREATED WITH – OUR EXPERIENCE

S obzirom na to da su osobe s latentnom tuberkuloznom infekcijom (LTBI) rezervoar budućih bolesnika, na putu prema eradikaciji tuberkuloze (TBC) nije dovoljno samo liječiti bolesnike koji boluju od aktivnog TBC-a, nego je nužno tražiti, dijagnosticirati i liječiti osobe s LTBI. Osnovni cilj bio je procijeniti dijagnostičku vrijednost ex vivo određivanja koncentracije IFN-g u djece s pojačanom reakcijom nakon redovitog PPD-testiranja. U istraživanje je uključeno 120-ero BCG-irane djece. Petnaest-ero (12,5%) djece imalo je pozitivan QFT-GIT, a 105-ero (87,5%) negativan QFT-GIT. Nije bilo statistički značajne razlike u veličini PPD-probe između skupina (21,5 mm u QFT+, 20,9 mm u QFT- skupini, p = 0,458). Postojala je razlika u skupinama u odnosu prema koncentraciji IFN-g nakon stimulacije antigenima specifičnima za M. tuberculosis, dok nije bilo razlike ni u bazičnoj koncentraciji IFN-g, a ni u koncentraciji IFN-g nakon stimulacije mitogenikom fitohemaglutininom. Nakon provedene kemoprofilakse QFT-GIT je ostao pozitivan u dvoje djece (p = 0,019). Zaključno, u složenom postupku dijagnosticiranja LTBI određivanje koncentracije IFN-g može biti ključno u donošenju odluke hoće li se kod određenog djeteta primijeniti preventivna terapija.Since persons with latent tuberculosis infection (LTBI) represent a huge reservoir of potential tuberculosis (TB) disease, accurate diagnosis and treatment of LTBI is essential for TB control and eradication. The aim was to assess the diagnostic value of determination of interferon-gamma release assay in school children with hyperreactive tuberculin skin test (TST) reaction. A total of 120 BCG-vaccinated children were investigated due to a hyperreactive TST results. The QuantiFERON-TB Gold In-Tube test (QFT-GIT) was performed. Fifteen children (12.5%) had positive QFT-GIT and 105 (87.5%) children had negative QFT-GIT. There was no statistically significant difference in TST reaction (21.5 mm u QFT+ vs. 20.9 mm u QFT- group, p=0.458). The children with positive QFT-GIT had a statistically higher level of interferon-gamma (IFN-g) than children with negative QFT-GIT. There were no statistically significant differences in concentrations of IFN-g either basic or upon stimulation with mitogen phytohemagglutinin. After isoniazid prophylaxis QFT-GIT remained positive in two children (p=0.019). In a difficult procedure for diagnosing LTBI in BCG-vaccinated children determination of IFN-g could be the key factor in making decision whether to use preventive therapy or not

WHICH TUBERCULIN SKIN TEST HYPERREACTIVE CHILD SHOULD BE TREATED WITH – OUR EXPERIENCE

S obzirom na to da su osobe s latentnom tuberkuloznom infekcijom (LTBI) rezervoar budućih bolesnika, na putu prema eradikaciji tuberkuloze (TBC) nije dovoljno samo liječiti bolesnike koji boluju od aktivnog TBC-a, nego je nužno tražiti, dijagnosticirati i liječiti osobe s LTBI. Osnovni cilj bio je procijeniti dijagnostičku vrijednost ex vivo određivanja koncentracije IFN-g u djece s pojačanom reakcijom nakon redovitog PPD-testiranja. U istraživanje je uključeno 120-ero BCG-irane djece. Petnaest-ero (12,5%) djece imalo je pozitivan QFT-GIT, a 105-ero (87,5%) negativan QFT-GIT. Nije bilo statistički značajne razlike u veličini PPD-probe između skupina (21,5 mm u QFT+, 20,9 mm u QFT- skupini, p = 0,458). Postojala je razlika u skupinama u odnosu prema koncentraciji IFN-g nakon stimulacije antigenima specifičnima za M. tuberculosis, dok nije bilo razlike ni u bazičnoj koncentraciji IFN-g, a ni u koncentraciji IFN-g nakon stimulacije mitogenikom fitohemaglutininom. Nakon provedene kemoprofilakse QFT-GIT je ostao pozitivan u dvoje djece (p = 0,019). Zaključno, u složenom postupku dijagnosticiranja LTBI određivanje koncentracije IFN-g može biti ključno u donošenju odluke hoće li se kod određenog djeteta primijeniti preventivna terapija.Since persons with latent tuberculosis infection (LTBI) represent a huge reservoir of potential tuberculosis (TB) disease, accurate diagnosis and treatment of LTBI is essential for TB control and eradication. The aim was to assess the diagnostic value of determination of interferon-gamma release assay in school children with hyperreactive tuberculin skin test (TST) reaction. A total of 120 BCG-vaccinated children were investigated due to a hyperreactive TST results. The QuantiFERON-TB Gold In-Tube test (QFT-GIT) was performed. Fifteen children (12.5%) had positive QFT-GIT and 105 (87.5%) children had negative QFT-GIT. There was no statistically significant difference in TST reaction (21.5 mm u QFT+ vs. 20.9 mm u QFT- group, p=0.458). The children with positive QFT-GIT had a statistically higher level of interferon-gamma (IFN-g) than children with negative QFT-GIT. There were no statistically significant differences in concentrations of IFN-g either basic or upon stimulation with mitogen phytohemagglutinin. After isoniazid prophylaxis QFT-GIT remained positive in two children (p=0.019). In a difficult procedure for diagnosing LTBI in BCG-vaccinated children determination of IFN-g could be the key factor in making decision whether to use preventive therapy or not

Poster 17. - Predstavljaju li IGRA testovi napredak u prevenciji tuberkuloze?

Tuberkuloza je i nadalje jedan od glavnih javnozdravstvenih problema u cijelom svijetu. Nakon kontakta s bacilom tuberkuloze, djeca imaju povećani rizik za razvoj bolesti te je zbog toga važno djecu testirati ukoliko postoji sumnja na infekciju. Do prije nekoliko godina jedini način testiranja kontakata na izloženost bacilu tuberkuloze bio je kožni PPD test koji ima iznimno nisku osjetljivost i specifičnost. Napredak u probiru kontakata učinjen je uvođenjem IGRA (od engl. Interferon gamma release assay) testova, kod kojih je osjetljivost i specifičnost bolja nego kod kožnog testa. Osnovni cilj ovoga rada bio je procijeniti dijagnostičku vrijednost ex vivo određivanja koncentracije IFN-γ u djece s pojačanom reakcijom nakon redovnog PPD testiranja. U istraživanje je uključeno 120 BCG-irane djece koji su prilikom redovitog PPD testiranja bili hiperreaktori. Od ukupnog broja testiranih samo je 15 (12,5%) djece imalo pozitivan IGRA test, dok je čak 105 (87,5%) imalo negativan. Nije bilo statistički značajne razlike u veličini PPD probe između skupina (21,5 mm u IGRA+, 20,9 mm u IGRA- skupini, p=0,458). Postojala je razlika u skupinama u odnosu na koncentraciju IFN-g nakon stimulacije s antigenima specifičnim za M. tuberculosis, dok nije bilo razlike kako u bazičnoj koncentraciji IFN-g tako i u koncentraciji IFN-g nakon stimulacije mitogenom. Prije bi sva djeca PPD hiperreaktori bila uključena u dijagnostički algoritam za dokaz tuberkuloze, te bi velikom broju bila prepisana preventivna terapija izonijazidom kroz više mjeseci. Međutim, dodatnim IGRA testiranjem pokazali smo kako je samo manji broj ove djece zaista i bio u kontaktu s bacilom tuberkuloze. Gotovo 90% djece koja su prije bila podvrgnuta dijagnostičkim i terapijskim postupcima ovim je novim testom isključeno iz daljnje obrade. Zaključno, uključivanje IGRA testiranja u djece kod koje se sumnja na infekciju s bacilom tuberkuloze pridonosi boljem odabiru pacijenata kojima je potrebna obrada i profilaksa