C-reactive protein in children with asthma and allergic rhinitis

Uvod: Jedno od glavnih obilježja astme i alergijskog rinitisa je kronična upala dišnih putova. Cilj ovoga istraživanja bio je ispitati može li se određivanje koncentracije C-reaktivnog proteina (CRP) primijeniti kao biljeg upale u djece s astmom odnosno alergijskim rinitisom. Materijali i metode: Ispitano je 42 zdrave djece prosječne dobi 9±5 godina i 70 bolesnika s respiracijskim alergijskim bolestima u tijeku redovite kontrole: s astmom (n=47) i rinitisom (n=23) prosječne dobi 7±4 godina. Koncentracija visoko osjetljivog CRP (hsCRP) određivana je imunoturbidimetrijskom metodom na lateks česticama. Koncentracije C3 i C4te alfa-1-antitripsina određivane su imunoturbidimetrijskom metodom na biokemijskom analizatoru Olympus AU 400, a broj leukocita i trombocita na hematološkom brojaču SysmexXT-1800i. Rezultati: Koncentracija hsCRP bila je statistički značajno veća u bolesnika s astmom i rinitisom nego u zdrave djece. Bolesnici su također imali statistički značajno veće vrijednosti C3, C4, A1-AT i broja leukocita nego zdrava djeca. Broj trombocita bio je značajno veći u bolesnika s astmom (ali ne i u bolesnika s rinitisom) nego u zdravih ispitanika. Zaključak: Rezultati ovoga istraživanja pokazali su da djeca s alergijskim bolestima dišnih putova imaju veću koncentraciju hsCRP u serumu nego klinički zdrava djeca.Introduction: Chronic inflammation of airways is one of the major characteristics of asthma and allergic rhinitis. The aim of the study was to estimate whether determination of C-reactive protein (CRP) concentration could be used as an inflammation marker in children with asthma and allergic rhinitis. Matherials and methods: The study included 42 healthy children (mean age 9±5 years) and 70 pediatric patients during regular control of respiratory allergic diseases, asthma (n=47) and rhinitis (n=23), mean age 7±4 years. High sensitive CRP (hsCRP) concentration was determined by immunoturbidimetric method on latex particles. The concentrations of C3, C4 and alpha1-an-titrypsin were determined by immunoturbidimetric method on an Olympus AU 400 biochemistry analyzer, whereas leukocyte and platelet counts were determined on a SysmexXT-1800i counter. Results: The concentration of hsCRP was statistically significantly higher in patients with asthma and allergic rhinitis than in healthy children. These patients also had statistically significantly higher levels of C3, C4, alpha1-anti-trypsin and leukocyte count as compared with healthy subjects. Platelet count was significantly greater in asthma (but not rhinitis) patients as compared with the group of healthy children. Conclusion: Study results demonstrated that children with respiratory allergic diseases had greater concentrations of hsCRP in serum compared with healthy children

Association of Latent Tuberculosis Infection in Health Care Workers with Allergy and Allergic Sensitization to Common Aeroallergens

Health care workers (HCW) are at increased risk of a latent tuberculosis infection (LTBI) due to occupational exposure to Mycobacterium tuberculosis. In order to investigate the mutual influence of a TH1 type immune response caused by LTBI and T helper 2 (TH2) type immune response caused by allergy, we conducted a study examining the prevalence of common inhaled allergen sensitization in the HCW population with different levels of exposure to tuberculosis (high and low). HCW with possible exposure to tuberculosis (TB) were tested with QuantiFERON-TB Gold (QFT-G) and tuberculin skin test (TST), while skin prick test (SPT) was performed for inhaled allergens. The antigen (Ag) response at QFT-G was inversely correlated with participants` allergy anamnesis (p= 0.039). Sensitization to inhaled allergens (positive SPT and number of positive allergens at SPT) was more prominent in the low exposure group (p= 0.006 and p= 0.0065, respectively). Ag response at QFT-G test was significantly higher in participants with no medical history of allergy (p= 0.048). Our results demonstrate that exposure to TB and LTBI are associated with inhaled allergen sensitization in HCW, possibly inhibiting allergic sensitization by mediating the T-helper type 1 (Th1) immune response

THE PREVALENCE OF SYMPTOMS OF ALLERGIC DISEASES AMONG YOUNGER SCHOOL CHILDREN IN MEĐIMURJE COUNTY (ISAAC PHASE I)

Cilj rada: procjena učestalosti simptoma astme, alergijskog rinitisa/rinokonjunktivitisa i atopijskog dermatitisa na području Međimurske županije u Sjeverozapadnoj Hrvatskoj. Metode i ispitanici: ispitivanje je provedeno od siječnja do travnja 2005. godine među djecom mlađe školske dobi u 27 osnovnih škola izabranih metodom slučajnog odabira. Podaci su prikupljeni standardiziranim pisanim upitnikom ISAAC faze I. Rezultati: u ispitivanje je uključeno 3106-ero djece mlađe dobne skupine (7 – 9 godina), s odazivom od 96,94%. 712-ero (22,9%) djece imalo je do tada simptome alergijskih bolesti. Učestalost simptoma tijekom života iznosila je: piskanje 14,91%, simptomi alergijskog rinitisa 8,88% i simptomi atopijskog dermatitisa 10,66%. Učestalost simptoma unatrag 12 mjeseci iznosila je: piskanje 6,92%, simptomi alergijskog rinitisa 8,40%, simptomi alergijskog rinokonjunktivitisa 4,67%, simptomi atopijskog dermatitisa 5,76%. Zaključak: rezultati pokazuju da je Međimurska županija područje s umjerenim stupnjem prevalencije simptoma alergijskih bolesti među djecom mlađe školske dobi.Objective: To estimate the prevalence of symptoms of asthma, allergic rhinitis/rhinoconjuctivitis and atopic eczema symptoms in the Međimurje County in Northwest Croatia. Subjects and methods: The study was undertaken between January and April 2005 among school children in 27 randomly selected elementary schools. Data were collected using standardized ISAAC written questionnaire Phase I. Results: A total of 3106 children participated in the study (7–9 yrs) with response rate 96.94%. 712 (22.9%) children had symptoms of allergic diseases at some time in their life. Estimated lifetime (ever) prevalence rates of symptoms were: wheezing 14.91%, allergic rhinitis symptoms 8.88% and atopic dermatitis symptoms 10.66%. Estimated 12-month prevalence rates were: wheezing 6.92%, allergic rhinitis symptoms 8.40%, allergic rhinoconjunctivitis 4.67%, and atopic dermatitis symptoms 5.76%. Conclusions: The results of this study show that Međimurje County is an area with moderate prevalence of atopic disease symptoms among the pediatric population

Racionalno liječenje infekcija mokraćnog sustava kod djece u Hrvatskoj

Resistance to chemotherapeutics used in the treatment of urinary tract infection is increasing throughout the world. Taking into account clinical experiences, as well as current bacterial resistance in Croatia and neighboring countries, the selection of antibiotic should be the optimal one. Treatment of urinary tract infection in children is particularly demanding due to their age and inclination to severe systemic reaction and renal scarring. If parenteral antibiotics are administered initially, it should be switched to oral medication as soon as possible. Financial aspects of antimicrobial therapy are also very important with the main goal to seek the optimal cost/benefit ratio. Financial orientation must appreciate the basic primum non nocere as a conditio sine qua non postulate as well.Otpornost na antibiotike u liječenju infekcija mokraćnog sustava sve se više povećava. Optimalan izbor antibiotika postiže se objedinjavanjem kliničkog iskustva s poznavanjem otpornosti na uobičajene bakterijske uzročnike mokraćnih infekcija kako u Republici Hrvatskoj tako i u državama njenog okruženja. Liječenje mokraćnih infekcija u djece je naročito zahtjevno zbog njihove dobi i sklonosti prema sistemskoj reakciji i ožiljčenju bubrega. Ako je primijenjena, parenteralnu primjenu antibiotika potrebno je što prije zamijeniti oralnim antibiotikom. Također nije uputno zanemariti niti financijski aspekt liječenja kojega je cilj postizanje optimalnog učinka uz minimalnu cijenu liječenja. Pritom se nikako ne smije zanemariti osnovni medicinski postulat primum non nocere kao conditio sine qua non

Fenotip spavanja u djece s Downovim sindromom – izmijenjena arhitektura spavanja i poremećeno disanje u snu

The aim of the study was to assess sleep architecture and breathing in sleep in children with Down syndrome. The study was conducted by using overnight video-polysomnography (V-PSG) in children with Down syndrome and age-matched children from the general population. Analysis of polysomnographic parameters revealed that compared to the norms of healthy age- and maturitymatched children from the general population, children with Down syndrome had significantly shorter sleep latency (p=0.007), shorter total sleep time (p=0.004), lower sleep efficiency (p=0.010), less NREM1 sleep phase (p=0.0002), less NREM3 sleep phase (p=0.034), less REM sleep (p=0.034) in favour of more NREM2 phase but not significantly (p=0.069), and spent more time awake after sleep onset (p=0.0002). Children with Down syndrome had significantly more obstructive sleep apnoeas and hypopnoeas per hour (higher obstructive sleep apnoeas and hypopnoeas index) (p=0.008), but less central sleep apnoea per hour (lower central apnoeas index) (p=0.041), which led to the nonsignificantly lower total apnoea-hypopnoea index (p=0.762) in children with Down syndrome. The mean and longest apnoea duration did not differ significantly between these two groups. Children with Down syndrome had a significantly lower mean and nadir oxygen saturation (p=0.008 and p=0.001, respectively). In conclusion, the majority of respiratory complications in children with Down syndrome can be prevented by raising awareness of sleep disturbances in children with Down syndrome among their parents and health care providers and by introducing early routine V-PSG in the follow up of these children.Cilj: Istražiti arhitektoniku spavanja i disanja tijekom sna u djece s Downovim sindromom. Metode: Cjelonoćna videopolisomnografija (V-PSG) u skupini djece s Downovim sindromom i u onoj iz opće populacije odgovarajuće dobi i zrelosti. Rezultat: Analiza polisomnografskih parametara pokazala je da djeca s Downovim sindromom, u usporedbi s normativima u zdrave djece u općoj populaciji, odgovarajuće dobi i zrelosti, imaju značajno kraću latenciju spavanja (SL) p=0,007, kraće ukupno vrijeme spavanja (TST) p=0,004, nižu efikasnost spavanja (SE) p=0,010, manje NREM1 faze spavanja p=0,0002, manje NREM3 faze spavanja p=0,034, manje REM spavanja p= 0,034 (na račun više površnog NREM2 spavanja, ali ne statistički značajno, p=0,069) i da provode više vremena budni nakon započimanja spavanja (p=0,0002). Djeca s Downovim sindromom imaju značajno više opstruktivnih apneja i hipopneja po satu spavanja (viši OAHI) p=0,008, ali imaju manje centralnih apneja po satu spavanja (niži CAI) p=0,041, što pridonosi statistički neznačajno nižem ukupnom AHI-u (p=0,762) u djece s Downovim sindromom. Prosječno i najdulje trajanje apneja nije se značajno razlikovalo između dviju skupina. Djeca s Downovim sindromom su imala značajno niže i prosječne i nadir saturacije kisika (p=0,008 i p=0,001). Zaključak: Možemo prevenirati većinu respiratornih komplikacija u djece s Downovim sindromom podizanjem svjesnosti njihovih roditelja o poremećajima spavanja u te djece, ali i zdravstvenih djelatnika, te uključivanjem rutinske cjelonoćne videopolisomnografije u njihovo praćenje

Fenotip spavanja u djece s Downovim sindromom – izmijenjena arhitektura spavanja i poremećeno disanje u snu

The aim of the study was to assess sleep architecture and breathing in sleep in children with Down syndrome. The study was conducted by using overnight video-polysomnography (V-PSG) in children with Down syndrome and age-matched children from the general population. Analysis of polysomnographic parameters revealed that compared to the norms of healthy age- and maturitymatched children from the general population, children with Down syndrome had significantly shorter sleep latency (p=0.007), shorter total sleep time (p=0.004), lower sleep efficiency (p=0.010), less NREM1 sleep phase (p=0.0002), less NREM3 sleep phase (p=0.034), less REM sleep (p=0.034) in favour of more NREM2 phase but not significantly (p=0.069), and spent more time awake after sleep onset (p=0.0002). Children with Down syndrome had significantly more obstructive sleep apnoeas and hypopnoeas per hour (higher obstructive sleep apnoeas and hypopnoeas index) (p=0.008), but less central sleep apnoea per hour (lower central apnoeas index) (p=0.041), which led to the nonsignificantly lower total apnoea-hypopnoea index (p=0.762) in children with Down syndrome. The mean and longest apnoea duration did not differ significantly between these two groups. Children with Down syndrome had a significantly lower mean and nadir oxygen saturation (p=0.008 and p=0.001, respectively). In conclusion, the majority of respiratory complications in children with Down syndrome can be prevented by raising awareness of sleep disturbances in children with Down syndrome among their parents and health care providers and by introducing early routine V-PSG in the follow up of these children.Cilj: Istražiti arhitektoniku spavanja i disanja tijekom sna u djece s Downovim sindromom. Metode: Cjelonoćna videopolisomnografija (V-PSG) u skupini djece s Downovim sindromom i u onoj iz opće populacije odgovarajuće dobi i zrelosti. Rezultat: Analiza polisomnografskih parametara pokazala je da djeca s Downovim sindromom, u usporedbi s normativima u zdrave djece u općoj populaciji, odgovarajuće dobi i zrelosti, imaju značajno kraću latenciju spavanja (SL) p=0,007, kraće ukupno vrijeme spavanja (TST) p=0,004, nižu efikasnost spavanja (SE) p=0,010, manje NREM1 faze spavanja p=0,0002, manje NREM3 faze spavanja p=0,034, manje REM spavanja p= 0,034 (na račun više površnog NREM2 spavanja, ali ne statistički značajno, p=0,069) i da provode više vremena budni nakon započimanja spavanja (p=0,0002). Djeca s Downovim sindromom imaju značajno više opstruktivnih apneja i hipopneja po satu spavanja (viši OAHI) p=0,008, ali imaju manje centralnih apneja po satu spavanja (niži CAI) p=0,041, što pridonosi statistički neznačajno nižem ukupnom AHI-u (p=0,762) u djece s Downovim sindromom. Prosječno i najdulje trajanje apneja nije se značajno razlikovalo između dviju skupina. Djeca s Downovim sindromom su imala značajno niže i prosječne i nadir saturacije kisika (p=0,008 i p=0,001). Zaključak: Možemo prevenirati većinu respiratornih komplikacija u djece s Downovim sindromom podizanjem svjesnosti njihovih roditelja o poremećajima spavanja u te djece, ali i zdravstvenih djelatnika, te uključivanjem rutinske cjelonoćne videopolisomnografije u njihovo praćenje

C-reactive protein and complement components\u27 C3 and C4 in children with latent tuberculosis infection

Cilj: U posljednje se vrijeme hsCRP (engl. high sensitive CRP) primjenjuje kao prognostički biljeg kronične upale. Cilj ovoga rada bio je ispitati dolazi li do promjene serumske koncentracije hsCRP, C3 i C4 u djece s latentnom tuberkuloznom infekcijom nakon dva mjeseca profilakse izonijazidom. Ispitanici i metode: Ukupno je ispitano 79-ero djece podijeljene u tri skupine: 1) ispitanici s latentnom tuberkuloznom infekcijom (LTBI); 2) ispitanici s tuberkulozom pluća; 3) klinički zdravi ispitanici upućeni na sistematski pregled, s biokemijsko-hematološkim pokazateljima unutar referentnih vrijednosti za dob - kontrolna skupina. Krv je uzorkovana dvaput: prije započinjanja terapije i poslije dvomjesečne terapije tijekom koje su lijekovi primjenjivani svakodnevno. Imunokemijskim metodama određena je koncentracija hsCRP, C3 i C4. Rezultati: Koncentracija hsCRP, C3 i C4 u ispitanika s LTBI prije profilakse izonijazidom bila je statistički značajno veća nego u kontrolnoj skupini. Nakon profilakse izonijazidom u osoba s LTBI koncentracija hsCRP bila je statistički značajno manja nego prije primjene izonijazida. Specifičnost je za sve odabrane analite bila veća nego osjetljivost. Granične vrijednosti za hsCRP imale su bolju dijagnostičku učinkovitost nego granične vrijednosti za C3 odnosno C4. Zaključak: Koncentracija hsCRP može se primijeniti za praćenje bolesnika s LTBI u svrhu procjene odgovora na profilaksu izonijazidom i stupnja aktivnosti bolesti.Aim: Recently, hsCRP (high sensitive CRP) concentration has been used as a prognostic marker of chronic inflammation. The aim of the study was to determine whether two-month isoniazid prophylaxis induced changes in serum concentrations of hsCRP, C3 and C4 in children with latent tuberculosis infection (LTBI). Subjects and methods: The study included 79 children divided into three groups: 1) subjects with LTBI; 2) subjects with lung tuberculosis; and 3) control group of clinically healthy subjects, referred for systematic examination, with biochemistry-hematology parameters within reference range for age. Blood sampling was performed twice: before drug administration and after a two-month period during which drugs were administered on a daily basis; hsCRP, C3 and C4 were determined by use of immunoassays. Results: Before prophylactic isoniazid therapy induction, the concentrations of hsCRP, C3 and C4 were significantly higher in LTBI group as compared with control group. After prophylactic therapy, the concentration of hsCRP in LTBI was lower than before isoniazid administration. The specificity was greater than sensitivity for all study analytes. The cut-off value of hsCRP showed higher optimum diagnostic efficiency than the cut-off values of C3 and C4. Conclusion: The concentration of hsCRP can be used in the follow up of LTBI patients to evaluate response to isoniazid prophylaxis and the level of disease activity

C-reactive protein and complement components\u27 C3 and C4 in children with latent tuberculosis infection

Cilj: U posljednje se vrijeme hsCRP (engl. high sensitive CRP) primjenjuje kao prognostički biljeg kronične upale. Cilj ovoga rada bio je ispitati dolazi li do promjene serumske koncentracije hsCRP, C3 i C4 u djece s latentnom tuberkuloznom infekcijom nakon dva mjeseca profilakse izonijazidom. Ispitanici i metode: Ukupno je ispitano 79-ero djece podijeljene u tri skupine: 1) ispitanici s latentnom tuberkuloznom infekcijom (LTBI); 2) ispitanici s tuberkulozom pluća; 3) klinički zdravi ispitanici upućeni na sistematski pregled, s biokemijsko-hematološkim pokazateljima unutar referentnih vrijednosti za dob - kontrolna skupina. Krv je uzorkovana dvaput: prije započinjanja terapije i poslije dvomjesečne terapije tijekom koje su lijekovi primjenjivani svakodnevno. Imunokemijskim metodama određena je koncentracija hsCRP, C3 i C4. Rezultati: Koncentracija hsCRP, C3 i C4 u ispitanika s LTBI prije profilakse izonijazidom bila je statistički značajno veća nego u kontrolnoj skupini. Nakon profilakse izonijazidom u osoba s LTBI koncentracija hsCRP bila je statistički značajno manja nego prije primjene izonijazida. Specifičnost je za sve odabrane analite bila veća nego osjetljivost. Granične vrijednosti za hsCRP imale su bolju dijagnostičku učinkovitost nego granične vrijednosti za C3 odnosno C4. Zaključak: Koncentracija hsCRP može se primijeniti za praćenje bolesnika s LTBI u svrhu procjene odgovora na profilaksu izonijazidom i stupnja aktivnosti bolesti.Aim: Recently, hsCRP (high sensitive CRP) concentration has been used as a prognostic marker of chronic inflammation. The aim of the study was to determine whether two-month isoniazid prophylaxis induced changes in serum concentrations of hsCRP, C3 and C4 in children with latent tuberculosis infection (LTBI). Subjects and methods: The study included 79 children divided into three groups: 1) subjects with LTBI; 2) subjects with lung tuberculosis; and 3) control group of clinically healthy subjects, referred for systematic examination, with biochemistry-hematology parameters within reference range for age. Blood sampling was performed twice: before drug administration and after a two-month period during which drugs were administered on a daily basis; hsCRP, C3 and C4 were determined by use of immunoassays. Results: Before prophylactic isoniazid therapy induction, the concentrations of hsCRP, C3 and C4 were significantly higher in LTBI group as compared with control group. After prophylactic therapy, the concentration of hsCRP in LTBI was lower than before isoniazid administration. The specificity was greater than sensitivity for all study analytes. The cut-off value of hsCRP showed higher optimum diagnostic efficiency than the cut-off values of C3 and C4. Conclusion: The concentration of hsCRP can be used in the follow up of LTBI patients to evaluate response to isoniazid prophylaxis and the level of disease activity