Sustained seroprevalence of SARS-CoV-2 antibodies one year after infection: one of the first COVID-19 cluster cases in Bosnia and Herzegovina

SARS-CoV-2 (severe acute respiratory syndrome coronavirus type 2) is a novel virus that has been identified as a causal agent of COVID-19,  an emergent infectious disease which brought about a new pandemic in the twenty-first century. The immune responses and clinical features of individuals infected with SARS-CoV-2 have not yet been fully described. Thus, in this study, we compare the seroprevalence and define the correlation between symptoms and serological results in the first COVID-19 cluster in the city of Konjic, Bosnia and Herzegovina. Of the total number, 93% of RT-PCR positive participants had positive IgG serology and 75% of them developed symptoms of COVID-19. We found that there was no significant alteration in specific IgG (p = 0.504) antibody levels during the 1-year period after COVID-19. Our results indicate that symptomatic COVID-19 patients have a higher rate of seroconversion (p < 0.01). The IgG seroconversion was correlated with high fever (p = 0.002) and headache (p = 0.007), suggesting that these symptoms could be considered as indicators of a better immune response. This study has demonstrated persistence of sustained levels of specific SARS-CoV-2 antibodies after recovering from COVID-19 infection. However, in order to gain a better insight into the immune response to SARS-CoV-2, further systematic studies should be focused on quality and longevity analyses

Excretion of SARS-CoV-2 RNA in feces has no prognostic benefit in the outcome of COVID-19: A clinical and immunological study

This study explores the correlation between immunological and clinical characteristics in coronavirus disease 2019 (COVID-19) patients with detectable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in feces, analyzing data from 251 patients admitted to Mostar University Clinical Hospital (UCH) from December 2021 to January 2022. Methods involved reverse transcription quantitative polymerase chain reaction (RT-qPCR) from nasopharyngeal (NP) swabs and feces, alongside serological tests for anti-SARS-CoV-2 spike IgGs. Demographic and clinical data were collected through questionnaires and medical records. The data analyses were performed using SPSS statistical software. Death occurred in 53 patients (21.1%, P < 0.001), mostly in the elderly (47/53, 88.7%, P = 0.001) and immunocompromised (19/53, 35.8%, P = 0.05), particularly those developing acute respiratory insufficiency (ARI) (46/53, 86.8%, P = 0.004), and severe/critical disease (46/53, 86.8%, P = 0.002). Among the patients with positive anti-SARS-CoV-2 IgG antibodies (86/251, 34.3%, P < 0.001), 41 (47.7%) were vaccinated and 45 (52.3%) unvaccinated (P = 0.666), showing no significant differences in clinical outcomes or mortality. Unvaccinated patients with a negative antibody titer had a higher incidence of ARI (96/123, 78%, P = 0.029) and intensive care unit (ICU) admission (22/123, 17.9%, P = 0.026), than those with a positive antibody titer. Forty-seven (62.7%) patients, out of the 75 hospitalized who provided a feces sample, were positive for SARS-CoV-2 RNA (P = 0.028), without statistical differences between fecal SARS-CoV-2 positive and negative groups regarding vaccination status (15/47, 31.9%, P = 0.493), antibody status (18/47, 38.3%, P = 0.628), or death outcome (5/47, 10.6%, P = 0.706). In conclusion, unvaccinated hospitalized patients with a severe COVID-19 presentation and a negative anti-spike SARS-CoV-2 IgG titer had adverse outcomes more frequently. This suggests cautious consideration for the diagnostic use of fecal samples compared to NP swabs

DIAGNOSIS AND TREATMENT OF HELLP SYNDROME

HELLP sindrom (H – hemolysis, EL – elevated liver enyzmes, LP – low platetet) teška je komplikacija trudnoće s potencijalno smrtnonosnim ishodom za majku i dijete. Etiologija i patogeneza još nisu razjašnjene u cijelosti, ali se temeljem bolesti smatra abnormalna placentacija. Zbog poremećaja prokrvljenosti posteljice, pokreće se patofiziološka kaskada koja uključuje prejaku aktivaciju imunološkog sustava, trombocita i endotela što rezultira ishemijskim oštećenjem ciljnog organa, jetre. Oštećenjem jetre, tipično između 27. i 37. tjedna gestacije, započinje klinička prezentacija sindroma, koja uključuje bol u trbuhu (epigastrična ili pod desnim rebrenim lukom), mučninu, povraćanje, malaksalost i glavobolju sa ili bez vizualnih fenomena. Dijagnoza se postavlja temeljem kliničke slike i dokazivanja laboratorijskih abnormalnosti u imenu sindroma. Na temelju broja trombocita, HELLP sindrom se može subklasificirati u tri kategorije koje govore o težini stanja. Okosnicu liječenja čini porođaj, koji se prije 24. i nakon 34. tjedna gestacije učini hitno, a između 24. i 34. tjedna s odgodom od 48 sati kako bi se primjenom kortikosteroida povećala zrelost fetalnih pluća. Terapija uključuje i primjenu magnezijevog sulfata za prevenciju konvulzija i fetalnu neuroprotekciju, antihipertenzive za kontrolu tlaka te transfuziju trombocita u slučaju teške trombocitopenije. Maternalni i peritnatalni ishod je lošiji nego u fiziološke trudnoće, s brojnim komplikacijama i povišenim stopama mortaliteta. Trudnica s HELLP sindromom u osobnoj anamnezi ima u sljedećoj trudnoći povišen rizik za razvoj svih gestacijskih hipertenzivnih poremećaja, uključujući HELLP sindrom, te za intrauterini zastoj rasta, abrupciju posteljice i prijevremeni porođaj.HELLP syndrome (H – hemolysis, EL – elevated liver enzymes, LP – low platelet) is a severe complication of pregnancy, with potentially lethal outcomes for both the mother and neonate. The etiology and pathogenesis are still being investigated, but the root cause is considered to be abnormal placentation. Due to the disruption of the placental circulation, the stressed placenta emits various products which results in an enhanced inflammatory response, as well as endothelial and platelet activation, causing ischemia in the liver. The gestational age at onset is typically between 27 and 37 weeks, and women usually present with pain in the upper abdomen (epigastric or in the right upper quadrant), nausea, vomiting, malaise and headache with or without neurological involvement. The diagnosis of HELLP is based on both the clinical presentation and laboratory abnormalities that the name of the acronym is comprised of. HELLP syndrome can then be categorized into three classes according to platelet count. Delivery is the basis of treatment. Before 24 and after 34 weeks of gestation the mother should be delivered immediately, while the delivery between 24 and 34 weeks' gestation can be briefly delayed in order to administer corticosteroids for fetal lung maturity. The treatment also includes administering magnesium sulphate for seizure prophylaxis and fetal neuroprotection, antihypertensive therapy for blood pressure control and platelet transfusion in case of very low platelet count. The HELLP syndrome is associated with poor maternal and perinatal outcomes, including increased rates of serious morbidity and mortality. The risk of recurrence is high, as are the risks for developing other gestational hypertensive disorders, intrauterine growth retardation, placental abruption and preterm delivery

DIAGNOSIS AND TREATMENT OF HELLP SYNDROME

HELLP sindrom (H – hemolysis, EL – elevated liver enyzmes, LP – low platetet) teška je komplikacija trudnoće s potencijalno smrtnonosnim ishodom za majku i dijete. Etiologija i patogeneza još nisu razjašnjene u cijelosti, ali se temeljem bolesti smatra abnormalna placentacija. Zbog poremećaja prokrvljenosti posteljice, pokreće se patofiziološka kaskada koja uključuje prejaku aktivaciju imunološkog sustava, trombocita i endotela što rezultira ishemijskim oštećenjem ciljnog organa, jetre. Oštećenjem jetre, tipično između 27. i 37. tjedna gestacije, započinje klinička prezentacija sindroma, koja uključuje bol u trbuhu (epigastrična ili pod desnim rebrenim lukom), mučninu, povraćanje, malaksalost i glavobolju sa ili bez vizualnih fenomena. Dijagnoza se postavlja temeljem kliničke slike i dokazivanja laboratorijskih abnormalnosti u imenu sindroma. Na temelju broja trombocita, HELLP sindrom se može subklasificirati u tri kategorije koje govore o težini stanja. Okosnicu liječenja čini porođaj, koji se prije 24. i nakon 34. tjedna gestacije učini hitno, a između 24. i 34. tjedna s odgodom od 48 sati kako bi se primjenom kortikosteroida povećala zrelost fetalnih pluća. Terapija uključuje i primjenu magnezijevog sulfata za prevenciju konvulzija i fetalnu neuroprotekciju, antihipertenzive za kontrolu tlaka te transfuziju trombocita u slučaju teške trombocitopenije. Maternalni i peritnatalni ishod je lošiji nego u fiziološke trudnoće, s brojnim komplikacijama i povišenim stopama mortaliteta. Trudnica s HELLP sindromom u osobnoj anamnezi ima u sljedećoj trudnoći povišen rizik za razvoj svih gestacijskih hipertenzivnih poremećaja, uključujući HELLP sindrom, te za intrauterini zastoj rasta, abrupciju posteljice i prijevremeni porođaj.HELLP syndrome (H – hemolysis, EL – elevated liver enzymes, LP – low platelet) is a severe complication of pregnancy, with potentially lethal outcomes for both the mother and neonate. The etiology and pathogenesis are still being investigated, but the root cause is considered to be abnormal placentation. Due to the disruption of the placental circulation, the stressed placenta emits various products which results in an enhanced inflammatory response, as well as endothelial and platelet activation, causing ischemia in the liver. The gestational age at onset is typically between 27 and 37 weeks, and women usually present with pain in the upper abdomen (epigastric or in the right upper quadrant), nausea, vomiting, malaise and headache with or without neurological involvement. The diagnosis of HELLP is based on both the clinical presentation and laboratory abnormalities that the name of the acronym is comprised of. HELLP syndrome can then be categorized into three classes according to platelet count. Delivery is the basis of treatment. Before 24 and after 34 weeks of gestation the mother should be delivered immediately, while the delivery between 24 and 34 weeks' gestation can be briefly delayed in order to administer corticosteroids for fetal lung maturity. The treatment also includes administering magnesium sulphate for seizure prophylaxis and fetal neuroprotection, antihypertensive therapy for blood pressure control and platelet transfusion in case of very low platelet count. The HELLP syndrome is associated with poor maternal and perinatal outcomes, including increased rates of serious morbidity and mortality. The risk of recurrence is high, as are the risks for developing other gestational hypertensive disorders, intrauterine growth retardation, placental abruption and preterm delivery

DIAGNOSIS AND TREATMENT OF HELLP SYNDROME

HELLP sindrom (H – hemolysis, EL – elevated liver enyzmes, LP – low platetet) teška je komplikacija trudnoće s potencijalno smrtnonosnim ishodom za majku i dijete. Etiologija i patogeneza još nisu razjašnjene u cijelosti, ali se temeljem bolesti smatra abnormalna placentacija. Zbog poremećaja prokrvljenosti posteljice, pokreće se patofiziološka kaskada koja uključuje prejaku aktivaciju imunološkog sustava, trombocita i endotela što rezultira ishemijskim oštećenjem ciljnog organa, jetre. Oštećenjem jetre, tipično između 27. i 37. tjedna gestacije, započinje klinička prezentacija sindroma, koja uključuje bol u trbuhu (epigastrična ili pod desnim rebrenim lukom), mučninu, povraćanje, malaksalost i glavobolju sa ili bez vizualnih fenomena. Dijagnoza se postavlja temeljem kliničke slike i dokazivanja laboratorijskih abnormalnosti u imenu sindroma. Na temelju broja trombocita, HELLP sindrom se može subklasificirati u tri kategorije koje govore o težini stanja. Okosnicu liječenja čini porođaj, koji se prije 24. i nakon 34. tjedna gestacije učini hitno, a između 24. i 34. tjedna s odgodom od 48 sati kako bi se primjenom kortikosteroida povećala zrelost fetalnih pluća. Terapija uključuje i primjenu magnezijevog sulfata za prevenciju konvulzija i fetalnu neuroprotekciju, antihipertenzive za kontrolu tlaka te transfuziju trombocita u slučaju teške trombocitopenije. Maternalni i peritnatalni ishod je lošiji nego u fiziološke trudnoće, s brojnim komplikacijama i povišenim stopama mortaliteta. Trudnica s HELLP sindromom u osobnoj anamnezi ima u sljedećoj trudnoći povišen rizik za razvoj svih gestacijskih hipertenzivnih poremećaja, uključujući HELLP sindrom, te za intrauterini zastoj rasta, abrupciju posteljice i prijevremeni porođaj.HELLP syndrome (H – hemolysis, EL – elevated liver enzymes, LP – low platelet) is a severe complication of pregnancy, with potentially lethal outcomes for both the mother and neonate. The etiology and pathogenesis are still being investigated, but the root cause is considered to be abnormal placentation. Due to the disruption of the placental circulation, the stressed placenta emits various products which results in an enhanced inflammatory response, as well as endothelial and platelet activation, causing ischemia in the liver. The gestational age at onset is typically between 27 and 37 weeks, and women usually present with pain in the upper abdomen (epigastric or in the right upper quadrant), nausea, vomiting, malaise and headache with or without neurological involvement. The diagnosis of HELLP is based on both the clinical presentation and laboratory abnormalities that the name of the acronym is comprised of. HELLP syndrome can then be categorized into three classes according to platelet count. Delivery is the basis of treatment. Before 24 and after 34 weeks of gestation the mother should be delivered immediately, while the delivery between 24 and 34 weeks' gestation can be briefly delayed in order to administer corticosteroids for fetal lung maturity. The treatment also includes administering magnesium sulphate for seizure prophylaxis and fetal neuroprotection, antihypertensive therapy for blood pressure control and platelet transfusion in case of very low platelet count. The HELLP syndrome is associated with poor maternal and perinatal outcomes, including increased rates of serious morbidity and mortality. The risk of recurrence is high, as are the risks for developing other gestational hypertensive disorders, intrauterine growth retardation, placental abruption and preterm delivery

SARS-CoV-2 viral load in feces does not have a prognostic benefit in outcome of COVID-19: Clinical and immunological study

This study explores the correlation between immunological and clinical characteristics in coronavirus disease 2019 (COVID-19) patients with detectable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in feces, analyzing data from 251 patients admitted to Mostar University Clinical Hospital from December 2021 to January 2022. Methods involved reverse transcription quantitative polymerase chain reaction RT-qPCR from nasopharyngeal swabs and feces, alongside serological tests for anti-SARS-CoV-2 spike IgGs. Demographic and clinical data were collected through questionnaires and medical records. The data analyses were performed using SPSS statistical software. Death occurred in 53 patients (21.1%, P < 0.001), mostly in the elderly (47/53, 88.7%, P = 0.001) and immunocompromised (19/53, 35.8%, P = 0.05), particulary those developing acute respiratory insufficiency (ARI) (46/53, 86.8%, P = 0.004), and severe/critical disease (46/53, 86.8%, P = 0.002). Among the patients with positive anti-SARS-CoV-2 IgG antibodies (86/251, 34.3%, P < 0.001), 41 (47.7%) were vaccinated and 45 (52.3%) unvaccinated (P = 0.666), showing no significant differences in clinical outcomes or mortality. Unvaccinated patients with a negative antibody titer had a higher incidence of ARI (96/123, 78%, P = 0.029) and intensive care unit admission (22/123, 17.9%, P = 0.026), than those with a positive antibody titer. Forty-seven (62.7%) patients, out of the 75 hospitalized who provided a feces sample, were positive for SARS-CoV-2 RNA (P = 0.028), without statistical differences between fecal SARS-CoV-2 positive and negative groups regarding vaccination status (15/47, 31.9%, P = 0.493), antibody status (18/47, 38.3%, P = 0.628) or death outcome (5/47, 10.6%, P = 0.706). In conclusion, unvaccinated hospitalized patients with a severe COVID-19 presentation and a negative anti-spike SARS-CoV-2 IgG titer have more frequent adverse outcomes. This suggests cautious consideration for the diagnostic use of fecal samples compared to nasopharyngeal swabs

Non-alcoholic fatty liver disease and transient elastography

Nonalcoholic fatty liver disease (NAFLD) is a serious condition that can lead to fibrosis, cirrhosis, and hepatocellular carcinoma. NAFLD is associated with metabolic syndrome (MetS) and all of its components. According to data, around 25-30% of population has NAFLD. Giving the growing incidence of MetS, obesity and diabetes mellitus type 2, NAFLD related terminal-stage liver disease is becoming prevailing indication for liver transplantation. In order to prevent terminal stage of this disease, it is crucial to determine those that are in risk group, to modify their risk factors and monitor their potential progression. In the absence of other causes of chronic liver disease, the prime diagnosis of NAFLD in daily clinical practice includes anamnesis, laboratory results (increased levels of aminotransferases and gammaglutamil transferases) and imaging methods. The biggest challenge with NAFLD patients is to differentiate simple steatosis from nonalcoholic steatohepatitis, and detection of fibrosis, that is the main driver in NAFLD progression. The gold standard for NAFLD diagnosis still remains the liver biopsy (LB). However, in recent years many noninvasive methods were invented, such as transient elastography (TE). TE (FibroScan®, Echosens, Paris, France) is used for diagnosis of pathological differences of liver stiffness measurement (LSM) and controlled attenuation parameter (CAP). Investigations in the last years have confirmed that elastographic parameters of steatsis (CAP) and fibrosis (LSM) are reliable biomarkers to non-invasively assess liver steatosis and fibrosis respectively in NAFLD patients. A quick, straightforward and non-invasive method for NAFLD screening in patients with MetS components is TE-CAP. Once diagnosed, the next step is to determine the presence of fibrosis by LSM which should point out high risk patients. Those patients should be referred to hepatologists. LB may be avoided in a substantial number of patients if TE with CAP is used for screening

Slagalica nasljeđa : priručnik za opismenjavanje iz medicinske genetike

"Slagalica nasljeđa" - priručnik za opismenjavanje iz medicinske genetike ima tri namjene. Prije svega, on je edukativna slikovnica za studente, liječnike i pacijente, ali i druge zainteresirane pojedince jer su u njoj kroz ilustracije objašnjene osnove genetike čovjeka, kao i osnove medicinske genetike. Od toga kako prepoznati osobu s genetičkim poremećajem, kako nastaju i koje vrste genetičkih poremećaja postoje pa sve do toga na koji ih način možemo dijagnosticirati. Nadalje, nakon svake ilustracije na pojedinoj stranici nalaze se definicije 79 pojmova iz medicinske genetike koje čine tezaurus za studente, liječnike i pacijente koji se na bilo koji način susreću s genetičkim poremećajima. Naposljetku, ova knjiga sadrži i primjere rečenica u koje su ubačeni stručni pojmovi iz medicinske genetike, a koji su namijenjeni studentima prilikom savladavanja komunikacijskih vještina na kolegiju Medicinska genetika, ali i liječnicima prilikom informiranja svojih pacijenata o (mogućem) genetičkom poremećaju. Uz kreatoricu ideje i urednicu izdanja, doc. dr. sc. Ninu Perezu, autori izdanja su studenti šeste godine Integriranog preddiplomskog i diplomskog sveučilišnog studija Medicina i prof. dr. sc. Saša Ostojić

Slagalica nasljeđa : priručnik za opismenjavanje iz medicinske genetike

"Slagalica nasljeđa" - priručnik za opismenjavanje iz medicinske genetike ima tri namjene. Prije svega, on je edukativna slikovnica za studente, liječnike i pacijente, ali i druge zainteresirane pojedince jer su u njoj kroz ilustracije objašnjene osnove genetike čovjeka, kao i osnove medicinske genetike. Od toga kako prepoznati osobu s genetičkim poremećajem, kako nastaju i koje vrste genetičkih poremećaja postoje pa sve do toga na koji ih način možemo dijagnosticirati. Nadalje, nakon svake ilustracije na pojedinoj stranici nalaze se definicije 79 pojmova iz medicinske genetike koje čine tezaurus za studente, liječnike i pacijente koji se na bilo koji način susreću s genetičkim poremećajima. Naposljetku, ova knjiga sadrži i primjere rečenica u koje su ubačeni stručni pojmovi iz medicinske genetike, a koji su namijenjeni studentima prilikom savladavanja komunikacijskih vještina na kolegiju Medicinska genetika, ali i liječnicima prilikom informiranja svojih pacijenata o (mogućem) genetičkom poremećaju. Uz kreatoricu ideje i urednicu izdanja, doc. dr. sc. Ninu Perezu, autori izdanja su studenti šeste godine Integriranog preddiplomskog i diplomskog sveučilišnog studija Medicina i prof. dr. sc. Saša Ostojić