ORAL ALLERGY SYNDROME

Oralni alergijski sindrom (OAS) je alergijska reakcija posredovana IgE protutijelima koja se javlja nakon konzumacije svježeg voća i povrća u bolesnika s alergijom na peludi. Simptomi nastaju zbog unakrsne reaktivnosti između peludi i hrane biljnog podrijetla, a koristi se i naziv sindrom alergije na pelud i hranu. Bolesnici su senzibilizirani na alergene peludi i iskazuju alergijsku reakciju na hranu strukturne sličnosti s alergenima peludi. OAS se rijetko viđa u male djece, ali mu učestalost raste s dobi pa je najčešća manifestacija alergije na hranu u adolescenata i odraslih. Simptomi su najčešće lokalizirani u usnoj šupljini, ali se mogu javiti i trbušni simptomi na probavnom sustavu i anafilaksija. Bolesnici u pravilu toleriraju termički obrađenu hranu, iako u onih s atopijskim dermatitisom može doći do pogoršanja ekcema. U slučaju generaliziranih simptoma i anafilaksije savjetuje se strogo izbjegavanje i mjere prve pomoći, uključujući autoinjektor adrenalina.Oral allergy syndrome (OAS) is an IgE antibody-mediated allergic reaction that occurs after consumption of fresh fruits and vegetables in patients with allergy to pollen. Symptoms arise due to cross-reactivity between pollen and plant-derived food and another term used for this syndrome is pollen-food allergy syndrome. The patient is sensitized with pollen and exhibits an allergic reaction to food antigen with structural similarity to the pollen. OAS is rarely seen in young children, but the prevalence increases with age and OAS is the most common manifestation of food allergy in adolescents and adults. Symptoms are usually localized in the oral mucosa, but abdominal symptoms and anaphylaxis may occur as well. Patients generally tolerate thermally processed food, but in those with atopic dermatitis it may lead to worsening of eczema. In the case of generalized symptoms and anaphylaxis, strict avoidance and first aid measures including a self-injectable adrenaline are advised

Allergen immunotherapy in the treatment of asthma

Alergenska imunoterapija (AIT) je jedino uzročno liječenje alergijskih bolesti čija je učinkovitost i sigurnost dokazana u liječenju alergijskog rinitisa i astme u djece i odraslih. Osim smanjenja simptoma bolesti i potrebe za farmakoterapijom, AIT može modificirati tijek bolesti i potaknuti razvoj alergen-specifične imunosne tolerancije. U liječenju alergijske astme AIT se primjenjuje subkutano i sublingvalno. Oba oblika primjene pokazala su sličan mehanizam indukcije tolerancije i podjednaku učinkovitost koja se zadržava još godinama nakon prekida liječenja. Sigurnosni profil je bolji kod sublingvalne AIT zbog manjeg rizika od teških alergijskih reakcija, a zbog jednostavne i bezbolne primjene sublingvalna AIT je metoda izbora za liječenje alergijskih respiratornih bolesti u djece. Randomizirane kliničke studije kao i studije iz stvarnog života pokazuju da AIT ima i preventivni učinak na smanjenje rizika za nastanak senzitizacija na nove alergene te smanjuje rizik za razvoj astme u bolesnika s alergijskim rinitisom. Usprkos brojnim dokazima koji podupiru važnost AIT u liječenju alergijskih bolesti, ovaj oblik liječenja još uvijek se nedovoljno koristi u kliničkoj praksi.Allergen immunotherapy (AIT) is to date the sole etiologic treatment of allergic diseases with proven efficacy and safety in allergic rhinitis and asthma. In addition to reducing the symptoms and the need for medication, AIT can influence the course of the disease and induce allergen-specific immune tolerance. In treatment of allergic asthma AIT is delivered either subcutaneously or sublingually. Both modes of delivery have similar clinical efficacy and capacity to modify the underlying allergic disease, which persist years after AIT discontinuation. Due to its superior safety profile and lower risk of severe allergic adverse reactions, along with simple and painless application, sublingual AIT is the treatment of choice in pediatric allergic respiratory diseases. Randomized clinical trials as well as real-life trials have shown that AIT can prevent new allergen sensitizations and reduce the risk of asthma in patients suffering from allergic rhinitis. Despite numerous clinical trials proving the importance of AIT in the treatment of allergic diseases, it still remains underused in clinical practice

ASTHMA – EPIDEMIOLOGY, RISK FACTORS AND PATHOPHYSIOLOGY

Alergijske bolesti i astma postale su najčešće kronične bolesti dječje dobi u razvijenim zemljama, sa stalnim porastom prevalencije u posljednjih nekoliko desetljeća. Astma kao kronična bolest uvelike ograničava fizički, emocionalni i socijalni aspekt bolesnikova života te utječe na obitelj, školovanje i karijeru. Kronična upala promjenjivog intenziteta u astmi je trajno prisutna i izaziva pojačanu reaktivnost dišnih putova, koja dovodi do ponavljajućih epizoda piskanja, zaduhe, napetosti u prsnom košu i kašlja. Akutna pogoršanja mogu nastati naglo, a prigodno mogu biti i opasna za život. Na pojavu i klinički tijek astme utječu brojni čimbenici vezani za bolesnika i okoliš. Kao posljedica neprepoznate ili neodgovarajuće liječene upale u astmi, dolazi do procesa remodeliranja dišnih putova i ireverzibilnog slabljenja plućne funkcije u većine bolesnika.Allergic diseases and asthma have become the most common chronic diseases of childhood in developed countries, with increasing prevalence in the last few decades. Asthma is a chronic illness with a strong impact on the patient’s physical, emotional and social aspects of life and it affects the child\u27s family, education and career. The chronic inflammation of the airways in asthma is variable but constant and causes increase in airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing. Acute exacerbations of asthma can be rapid in onset, severe and even life threatening in the absence of effective treatment. Risk factors involved in the development of asthma and the clinical expression of the disease may be classified as host factors and environmental factors. Unrecognised or inadequately treated chronic inflammation in asthma leads to airway wall remodelling and progressive irreversible loss of lung function in most patients

Specific Features of Childhood Asthma

Astma u djece najčešće počinje u ranoj dobi i ima varijabilan tijek i različitu kliničku pojavnost. U djece se astma očituje različitim fenotipovima koji se mogu preklapati, ući u remisiju, ali i perzistirati do odrasle dobi. Razlikovanje astme od ponavljanog piskanja povezanog s drugim bolestima u prvim godinama života nije jednostavno. Astma u školske djece i adolescenata značajno je češće povezana s alergijom nego astma u odraslih. Klinička ekspresija bolesti, važnost alergije i nespecifičnih čimbenika u pokretanju simptoma i egzacerbacija astme, dijagnostika, praćenje upalnih zbivanja u bronhima, kao i liječenje, u djece se razlikuju od astme u odraslih. Na temelju ovih spoznaja formirane su internacionalne i nacionalne smjernice usredotočene samo na dječju astmu. U ovom tekstu iznesene su suvremene postavke o posebnostima astme dječje dobi.Asthma in children usually occurs at an early age and has a variable course and a diff erent clinical appearance. In children, asthma exhibits different phenotypes, which may overlap, enter into remission, but also persist into adulthood. It is not easy to diff erentiate asthma from recurrent wheezing associated with other diseases in the first years of life. Asthma in school children and adolescents is significantly more often associated with allergies than asthma in adults. Clinical expression of the disease, the importance of allergy and nonspecific triggers in the initiation of symptoms and asthma exacerbations, diagnostics, monitoring of bronchial inflammation, as well as the treatment itself in children are diff erent from those found in adults. Based on these findings, international and national guidelines have been established, focusing exclusively on paediatric asthma. This paper presents contemporary standpoints on the specific features of asthma in children

Multiculturalism – bridge that connects librareis

Poslanje je Pučke knjižnice i čitaonice Daruvar približiti informacije, znanje i kulturu svim korisnicima bez obzira na njihovu dob, nacionalnu pripadnost, vjersko ili političko opredjeljenje, odgovoriti na zahtjeve korisnika stručno utemeljenim uslugama pomoću suvremene tehnologije. Vezano uz multikulturalnost zajednice u kojoj Knjižnica djeluje, nastojali smo manjinskom stanovništvu približiti jezik i kulturu njihovih matičnih zemalja. Posljednje dvije godine intenzivno razvijamo programe i iskustva sa sestrinskom knjižnicom u Češkom Tešinu (Češka Republika) i Narodnom i univerzitetskom bibliotekom “Derviš Sušić” Tuzla u Bosni i Hercegovini. Cilj djelovanja Knjižnice je nastojati razvijati interkulturalnu komunikaciju kako bismo čitanje i pisanu riječ približili svim skupinama korisnika.The Mission of the Public Library Daruvar is to provide information, knowledge and culture to all its users regardless of their age, nationality, religion or political orientation, and to fulfill users’ requests using modern technology if necessary. Since our local community is multicultural, the Daruvar Public Library has been working on bringing together the minorities and their native languages and cultures. For the past two years, we have developed intensive programs and have shared our experiences with our sister library in Czech Republic and the National and University Library “Derviš Sušić” in Tuzla, Bosnia and Herzegovina. The main goal of the Daruvar Public Library is to continue developing intercultural communication in order to bring reading closer to different groups of library users

The discourse of anti-instrumentalism: exploring a conceptual model through the case study of the We won’t let Belgrade d(r)own initiative

The main focus of our paper is on a specific form of democratic discourse, used in different types of social engagement actions (petitions, speeches, intellectual engagement, ad hoc citizens' protests, social movements etc.), that attempts to politicize a certain issue by challenging the neoliberal principle of instrumentalism which argues that democratic procedures can legitimately be abandoned in the name of the greater efficiency of socioeconomic development. Therefore, we start from identifying the discourse of "neoliberal instrumentalism" and its relative success in delegitimizing the welfare state and mechanisms of democratic decision making and we formulate a conceptual model of a democratic counter-narrative named "anti-instrumentalist discourse". Through empirical analyses of discourse used by We Won't Let Belgrade D(r)own initiative, that mobilized against the Serbian government's urban project Belgrade Waterfront we try to illustrate the applicability and the heuristic value of the proposed model. The data for the analyses were collected through 1) desk analysis of available secondary data on the Belgrade Waterfront project, 2) official statements and proclamations of the We Won't Let Belgrade D(r)own initiative, 3) semi-structured interviews with four core members of the initiative

The Distribution of HLA Alleles among Children with Atopic Asthma in Croatia

Allergic asthma is a multifactorial disease involving well known environmental factors and less identified genetic components. In several studies the HLA genes have been implicated in the development of asthma and atopy, but the importance of these associations remains unclear. The aim of the present study was to analyse the distribution of specificities at HLA class I loci (-A and -B) and HLA class II locus (-DRB1) in a group of 143 Croatian children with atopic asthma, regarding total serum IgE and specific IgE against common inhalant allergens, as well as their connection with different asthmatic phenotypes and to identify HLA genotype which increases the risk for atopy or asthma or which has a protective effect. As controls we used a group of 163 healthy unrelated individuals. HLA class I antigens were determined by serology, while DRB1 specificities were detected by polymerase-chain reaction amplification and hybridisation with sequence specific oligonucleotide probes method (PCR-SSOP). We found no significant correlation between any of the HLA-A antigens and asthma, atopy or associated atopic phenotypes. At HLA-B locus, HLA-B8 antigen was significantly increased among asthmatic patients (p=0.002), patients with high total serum IgE (p=0.002), as well as among patients sensitizated to Dermatophagoides pteronyssinus (Der p) (p=0.014) and among patients sensitizated to Der p + Dactylis glomerata (Dact g) or Ambrosia elatior (Amb a) (p=0.004). Among HLA-DRB1 specificities, HLA-DRB1*01 showed positive correlation with asthma and atopy (p=0.034), while HLA-DRB1*03 specificity was observed with significantly higher frequency among patients with total serum IgE 400 KU/L (p=0.048). HLA-DRB1*16 specificity was observed with significantly lower frequency among patients with asthma only in comparison to healthy controls (p=0.027) and to patients with asthma and allergic rhinitis (p=0.005). In conclusion, our data suggest that HLA specificities play a relevant role in predisposition to asthma, as well as in different clinical forms of atopic diseases. HLA-B8, HLA-DRB1*01 and HLA-DRB1*03 genotype increases the risk for atopic asthma and high serum IgE

Fibromatosis colli – izazov za otorinolaringologe

Fibromatosiscolli,ili fibromatoza vrata, rijetka je benigna infiltrativna proliferacija vezivnog tkiva u sternokleidomastoidnom mišiću, koja se javlja kod 0,4% novorođenčadi. Bolest nastaje dva do četiri tjedna nakon rođenja kao bezbolna oteklina na vratu u projekciji sternokleidomastoidnog mišića. Kontrakcije fibroznog tkiva unutar lezije mogu prouzročiti mišićni tortikolis, što naposlijetku može dovesti do kraniofacijalne asimetrije. Fizikalna terapija glavna je metoda liječenja, a kirurški zahvat nužan je u refraktornim slučajevima i nejasnim situacijama. Diferencijalna dijagnoza otekline na vratu kod novorođenčeta je široka i uključuje upalne i benigne procese, kao i maligne neoplazme. Poseban izazov u diferencijalnoj dijagnozi predstavljaju benigni mezenhimalni tumori, kao što je infantilna fibromatoza koja može biti nepredvidivoga tijeka, a naglim rastom u dojenačkoj dobi može dovesti i do smrtnog ishoda. Autori predstavljaju slučaj muškog novorođenčeta starog dva tjedna koji se prezentirao naglo nastalom oteklinom na desnoj strani vrata. Učinjena je dijagnostička obrada (UZV vrata, MR vrata i aspiracijska biopsija tankom iglom), te je bolesnik prikazan na multidisciplinarnom timu za tumore glave i vrata, uz sudjelovanje dječjeg kirurga i ortopeda. Mogućnosti liječenja svedene su na fizikalnu terapiju, biopsiju lezije ili kompletnu resekciju. Kao optimalni modalitet liječenja izabran je kirurški pristup. Postoperativno se ultrazvučnim pregledima prati oporavak mišića uz zdravo napredovanje djeteta. Zaključno, unatoč dobroćudnoj prirodi bolesti, zdravstvene reperkusije fibromatoze vrata mogu biti značajne u slučaju odgođenog kirurškog liječenja. Jasne smjernice u pogledu zahvaćenosti samog mišića kada je dostatna konzervativna terapija ne postoje, te je na kliničarima teška odluka kada se odlučiti za operativno liječenje koje, kao i u našem slučaju, može imati odličan estetski i funkcionalni rezultat

Fibromatosis colli – izazov za otorinolaringologe

Fibromatosiscolli,ili fibromatoza vrata, rijetka je benigna infiltrativna proliferacija vezivnog tkiva u sternokleidomastoidnom mišiću, koja se javlja kod 0,4% novorođenčadi. Bolest nastaje dva do četiri tjedna nakon rođenja kao bezbolna oteklina na vratu u projekciji sternokleidomastoidnog mišića. Kontrakcije fibroznog tkiva unutar lezije mogu prouzročiti mišićni tortikolis, što naposlijetku može dovesti do kraniofacijalne asimetrije. Fizikalna terapija glavna je metoda liječenja, a kirurški zahvat nužan je u refraktornim slučajevima i nejasnim situacijama. Diferencijalna dijagnoza otekline na vratu kod novorođenčeta je široka i uključuje upalne i benigne procese, kao i maligne neoplazme. Poseban izazov u diferencijalnoj dijagnozi predstavljaju benigni mezenhimalni tumori, kao što je infantilna fibromatoza koja može biti nepredvidivoga tijeka, a naglim rastom u dojenačkoj dobi može dovesti i do smrtnog ishoda. Autori predstavljaju slučaj muškog novorođenčeta starog dva tjedna koji se prezentirao naglo nastalom oteklinom na desnoj strani vrata. Učinjena je dijagnostička obrada (UZV vrata, MR vrata i aspiracijska biopsija tankom iglom), te je bolesnik prikazan na multidisciplinarnom timu za tumore glave i vrata, uz sudjelovanje dječjeg kirurga i ortopeda. Mogućnosti liječenja svedene su na fizikalnu terapiju, biopsiju lezije ili kompletnu resekciju. Kao optimalni modalitet liječenja izabran je kirurški pristup. Postoperativno se ultrazvučnim pregledima prati oporavak mišića uz zdravo napredovanje djeteta. Zaključno, unatoč dobroćudnoj prirodi bolesti, zdravstvene reperkusije fibromatoze vrata mogu biti značajne u slučaju odgođenog kirurškog liječenja. Jasne smjernice u pogledu zahvaćenosti samog mišića kada je dostatna konzervativna terapija ne postoje, te je na kliničarima teška odluka kada se odlučiti za operativno liječenje koje, kao i u našem slučaju, može imati odličan estetski i funkcionalni rezultat

Different levels of epidermal growth factor signaling modifies the differentiation of specific cell types in mouse postnatal retina

Epidermal growth factor (EGF) signaling has been implicated in the regulation of the differentiation and proliferation of retinal progenitors. We assessed how different levels of EGF signaling, achieved either by increasing receptor expression or via addition of the exogenous ligand, or an increase in both, can affect the differentiation of progenitors in the first week of postnatal retinal development in the model system of retinal explants (REs). Proliferating progenitor cells in REs were infected with either the control CLV3/ESR-related peptide family (CLE)-green fluorescent protein (GFP)-or with EGF receptor (EGFR)-GFP-expressing retrovirus, and grown in the control medium or in the presence of exogenous EGF (10 ng/mL). The differentiation of infected cells into Muller glia (Sox9+), rod photoreceptors (rhodopsin+) and horizontal cells (calbindin+) was analyzed. In all the examined conditions, infected cells differentiated into Muller glia and rod photoreceptors that normally develop postnatally. Horizontal cells finished their development during the embryonic stages and progenitors infected with control-GFP virus did not differentiate into GFP+/calbindin-in either control or EGFsupplemented medium, however, cells infected with EGFR-GFP differentiated into horizontal cells (GFP+/calbindin+) in both culture conditions. These results imply that altering the levels of EGFR and/or the amount of the EGF ligand can overcome progenitor competence restriction