A successful outcome of pregnancy in a patient with congenital antithrombin deficiency

Uvod. Prisustvo urođene trombofilije predstavlja dodatni faktor rizika od nastanka venskog tromboembolizma u trudnoći, ali i komplikacija same trudnoće kao što su ponavljani gubitak trudnoće, abrupcija placente, intrauterino zaostajanje u rastu i razvoju, te rana preeklampsija. Trudnice sa trombofilijom, a posebno one sa nedostatkom antitrombina, u riziku su od nastanka obe vrste komplikacija u trudnoći. Prikaz bolesnice. U radu je prikazana trudnica sa urođenim nedostatkom antitrombina u toku njene prve trudnoće, čija majka je četiri puta imala duboke venske tromboze, tokom trudnoće i puerperijuma. Uz redovno laboratorijsko praćenje hemostaznih parametara i redovne akušerske kontrole sa praćenjem važnog parametra placentne vaskularizacije, čitava trudnoća protekla je bez komplikacija. Profilaktička terapija niskomolekularnim heparinom uvedena je od 20. nedelje trudnoće, a supstituciona terapija primenom koncentrata antitrombina, neposredno pre porođaja. Porođaj je protekao bez komplikacija i u 37. nedelji rođena je zdrava muška beba telesne težine 3,6 kg i dužine 52 cm, sa Abgar skorom 9/10. Zaključak. Pravovremeno postavljena dijagnoza trombofilije, redovne akušerske kontrole i praćenje hemostaznih parametara u toku trudnoće, kao i primena adekvatne profilaktičke i supstitucione terapije, doprinele su prevenciji mogućih maternalnih ili komplikacija same trudnoće kod bolesnice sa urođenim nedostatkom antitrombina.Background. Presence of inherited thrombophilia is an additional risk factor for maternal thromboembolism and certain adverse pregnancy outcomes, including recurrent fetal loss, placental abruption, intrauterine growth restriction and earlyonset severe preeclampsia. Pregnant women with thrombophilia, especially those with antithrombin (AT) deficiency, are at high risk of both kinds of complications. Case report. We presented a pregnant women with congenital antithrombin deficiency in the first pregnancy, whose mother had had four times pregnancy-related deep vein thrombosis, and antithrombin deficiency. With the regular laboratory monitoring of hemostatic parameters and gynaecology surveillance including the follow-up of placental vascular flow, the whole pregnancy proceeded without complications. The prophylactic therapy with low molecular weight heparin was introduced from the 20th week of gestation and one dose of substitution therapy with antithrombin concentrate was administrated before delivery. Pregnancy and labour were terminated without complications at the 37th week of gestation, resulting in the delivery of a healthy male newborn of 3.6 kg body weight, 52 cm long, and with the Apgar scores of 9/10. Conclusion. A timely made diagnosis of thrombophilia, accompanied with regular obstetrics check-ups and follow-ups of hemostatic parameters during pregnancy, as well as the use of adequate prophylactic and substitution therapy, are the successful tools for the prevention of possible maternal complications and pregnancy itself in our patient with congenital AT deficiency

Epidemiology of Toxoplasmosis in SERBIA: A Cross-Sectional Study on Blood Donors

Toxoplasmosis is a globally distributed parasitic zoonosis, affecting approximately one third of the human population. Epidemiological studies on toxoplasmosis conducted in Serbia so far have been focused on women of childbearing age, without a clear insight into the prevalence in the general population. We conducted a cross-sectional study in a representative sample of the healthy adult population consisting of 1095 blood donors of both genders to establish the prevalence and risk factors for Toxoplasma gondii infection. Data on the demographic and clinical characteristics of all study participants, as well as on their lifestyle habits, were collected by means of a questionnaire. The overall prevalence of infection was 20.5% (224/1095) and the avidity of the specific IgG antibodies detected was high in a vast majority of the seropositive donors (98.2%). Interestingly, the remaining 1.8% of the specific IgG positive samples were of borderline avidity (4/224), in complete absence of specific IgM. The multivariate logistic regression analysis showed that independent risk factors included age (from OR (95% CI) 1.9 (1.13–3.28) in the 30–39 age group, to 6.8 (3.27–14.24) in the age group of >60 years), suburban living (OR (95% CI) 2.2 (1.43–3.34)) and contact with soil (OR (95% CI) 1.4 (1.01–1.94)). This first large-scale study on toxoplasmosis in the general population in Serbia shows the lowest prevalence ever reported in this country. Moreover, the novel perspective on risk factors provides an updated basis for future prevention programs

Factors Associated with Toxoplasma gondii Seroprevalence in Pregnant Women: A Cross-Sectional Study in Belgrade, Serbia

Toxoplasmosis, caused by the cosmopolitan protozoan Toxoplasma gondii, has particular implications during pregnancy due to the possible transmission of infection to the fetus. Very few studies have assessed seroprevalence and the risk factors for toxoplasmosis in healthy pregnant women. The aim of this study was to examine the seroprevalence of T. gondii infection in healthy pregnant women and to identify the associated risk factors for toxoplasmosis. The cross-sectional study involved 300 healthy pregnant women who came to the Institute for Blood Transfusion in Belgrade between November 2018 and February 2019 for routine blood group and Rh factor testing before delivery, who were also tested using serological screening for the presence of specific antibodies. Positives were further examined using enzyme immunoassay. Of the total sera of participants analyzed, 38 were positive for specific IgG, resulting in a seroprevalence rate of 12.7% (95% Confidence Interval (CI) 9.1–17.0%). All pregnant women presented negative anti-T. gondii IgM antibodies. The multivariate logistic regression analysis revealed that living in a house with a garden was independently associated with the risk of T. gondii infections, while eating chicken meat was connected with a lower risk compared to eating other types of meat with an odds ratio (OR) of 2.5 (95% CI 1.21–5.02) and an OR of 0.3 (95% CI 0.09–0.83), respectively. Although the prevalence of anti-T. gondii IgG antibodies is relatively low, it is essential to maintain and adapt evidence-based preventive measures for toxoplasmosis continually

Importance of TLR9-IL23-1L17 axis in inflammatory bowel disease development: Gene expression profiling study

Background and aims: Mucosal gene expression have not been fully enlightened in inflammatory bowel disease (IBD). Aim of this study was to define IL23A, IL17A, IL17F and TLR9 expression in different IBD phenotypes. Methods: Evaluation of mRNA levels was performed in paired non-inflamed and inflamed mucosal biopsies of newly diagnosed 50 Crohn's disease (CD) and 54 ulcerative colitis (UC) patients by quantitative real-time PCR analysis. Results: IL17A and IL17F expression levels were significantly increased in inflamed IBD mucosa. Inflamed CD ileal and UC mucosa showed increased IL23A, while only inflamed CD ileal samples showed increased TLR9 mRNA level. Correlation between analysed mRNAs levels and endoscopic and clinical disease activity were found in UC, but only with clinical activity in CD. Conclusion: Both CD and UC presented expression of Th17-associated genes. Nevertheless, expression profiles between different disease forms varies which should be taken into account for future research and therapeutics strategies.This is the peer reviewed version of the paper: Dragasevic, S., Stankovic, B., Sokic-Milutinovic, A., Milosavljevic, T., Milovanovic, T., Lukic, S., Drazilov, S. S., Klaassen, K., Kotur, N., Pavlovic, S., & Popovic, D. (2018). Importance of TLR9-IL23-IL17 axis in inflammatory bowel disease development: Gene expression profiling study. Clinical Immunology, 197, 86–95. [https://doi.org/10.1016/j.clim.2018.09.001

The development of the program of voluntary blood donation promotion in students population of the University of Belgrade

Background/Aim. Given that in each country students represent the most progressive population group, as of 2001, the Blood Transfusion Institute of Serbia (BTIS) has been carrying the program of voluntary blood donation promotion and education of volunteers at the University of Belgrade (UB). In 2011, the BTIS intensified all activities at the UB. The aim of this study was to present activities performed from 2001 at the Blood Donors` Motivation Department (DMD) of the BTIS related with increasing the level of awareness on voluntary blood donation in the Belgrade students` population, enhancing their motivation to become voluntary blood donors (VBDs), increasing the number of blood donations at faculties of the UB, and increasing the number of blood donations in the UB students population compared with the total number of blood units collected by BTIS in Belgrade, with the emphasis on the year 2013. Methods. Initially, the applied methodology was based on encouraging students to donate blood through discussions and preparatory lectures, followed by organized blood drives. Appropriate selection of volunteers at each faculty was crucial. Besides their recognisable identity, they had to have remarkable communication skills and ability to positivly affect persons in their environment. The applied principle was based on retention of volunteers all through the final academic year, with the inclusion of new volunteers each year and 1,000 preparatory lectures on the annual basis. The activities were realized using two Facebook profiles, SMS messages and continuous notification of the public through the media. Results. There was an increase in the average number of students in blood drives at the faculties from 2011, when the average number of the students per blood drive was 39, followed by 43 in 2012 and 46 in 2013. The number of students who donated blood in 2013 increased by 21.3% compared with 2012 data. Conclusion. The applied concept highly contributed to generation and retention of future VBDs willing to regularly donate blood in the coming years, with a minimum risk of transmission of transfusion transmissible diseases markers

Urban greenery’s effects on Public Health and Wellbeing of Citizens and how to assess it – preliminary euPOLIS findings

Many studies report on the ability of natural environments and accessible green and blue spaces in the cities to diminish climate change impacts and lower the possibility of disasters. However, that is not the full extent of their effects. Among others, these urban spaces enhanced with nature-based solutions (NBS) can support active recreation and allow places for relaxation and consolidation from daily stress. There is some evidence that NBS with their extensive greenery can give the positive impact on numerous psychological and physiological outcomes. Urban areas rich in greenery and biodiversity provide great opportunity for humans to come closer to nature and improve their health and well-being through interaction with a variety of flora and fauna species. Specifically, there is evidence that mental health (anxiety, stress levels) and psychological wellbeing may benefit from plant species richness (Fuller et al., 2007), animal species richness (Dallimer et al., 2012) and soil biodiversity (Wall et al., 2015). Furthermore, it has been shown that soil organisms, through their roles in controlling soil-borne pathogens and pests (soil vitality) lessen the prevalence of allergic diseases (Wall et al. 2015). Replacing or restoring the soil, regulation of water conditions, enabling plant species diversity - especially native ones, can substantially increase soil biodiversity leading to recovery of the natural soil food web, so the pathogen risk would be minimized with respect to communicable and non-communicable diseases (Crump et al., 2021). However, urban green spaces can also be linked to negative health outcomes, such as allergic reactions, or vectorborne diseases, as the result of increased exposure to allergenic pollen or increased amount of disease vectors in urban green environments (Calaza‐Martinez and Iglesias‐Díaz, 2016). These potential harmful effects may be addressed through the adequate design, maintenance and management of urban green spaces and selection of species. Although different studies show some positive (or negative) effects of NBS on public health and wellbeing (PH&WB), still it is a challenge to actually quantify the extent of the effects, and also attribute the quantity to particular characteristics of an NBS. This is why EC has established a call topic SC5-14-2019 - Visionary and integrated solutions to improve well-being and health in cities, to fund projects that will implement different types of solutions that are capable of enhancing PH&WB in cities and assess their impacts. Once demonstration sites are developed and assessed, key findings and indicators will be included in the already available EC Handbook of indicators - Evaluating the impact of nature-based solutions: A handbook for practitioners. This paper presents preliminary findings in the endeavour to quantify urban greenery’s and biodiversity’s effects on PH&WB, by integrating subjective, objective, physiological, and psychological monitoring approaches and producing a multifaceted understanding that is essential for policymakers, urban planners, and public health professionals to design sustainable and nature-inclusive cities that promote the wellbeing of their inhabitants

Neonatal hyperbilirubinemia caused by anti-Jra antibodies - the first case report in Serbia

Introduction. Jra is a high-frequency antigen belonging to the JR blood group system. Population studies have established that the Jr (a-) phenotype is rare. The clinical significance of anti-Jra antibodies is controversial. This case report describes a newborn with prolonged jaundice due to alloimmunization against Jra antigen. Case Outline. A female Roma infant, 27 days of age, was admitted to hospital due to prolonged jaundice and failure to thrive. Immunohematological testing determined a blood group type A, D+ C+ E+ c+ e+, K-, and the presence of an antibody direct against a high-prevalence red blood cell antigens. On admission, total bilirubin was 199.6 μmol/l, direct bilirubin 10.3 μmol/l, hemoglobin concentration 132 g/l, hematocrit 41.1%, reticulocytes 1.08%. The newborn was the third child from a third routinely monitored pregnancy. Maternal sensitization to Jra antigen was detected during the second pregnancy. The titer of anti-Jra reached the highest value of 1,024 at the 28th week of gestation. Conclusion. This is the first description of neonatal hyperbilirubinemia caused by anti-Jra antibody in the Republic of Serbia. This case report provides new data about the clinical significance of anti-Jra in pregnancy and the newborn

A successful outcome of pregnancy in a patient with congenital antithrombin deficiency

Background. Presence of inherited thrombophilia is an additional risk factor for maternal thromboembolism and certain adverse pregnancy outcomes, including recurrent fetal loss, placental abruption, intrauterine growth restriction and earlyonset severe preeclampsia. Pregnant women with thrombophilia, especially those with antithrombin (AT) deficiency, are at high risk of both kinds of complications. Case report. We presented a pregnant women with congenital antithrombin deficiency in the first pregnancy, whose mother had had four times pregnancy-related deep vein thrombosis, and antithrombin deficiency. With the regular laboratory monitoring of hemostatic parameters and gynaecology surveillance including the follow-up of placental vascular flow, the whole pregnancy proceeded without complications. The prophylactic therapy with low molecular weight heparin was introduced from the 20th week of gestation and one dose of substitution therapy with antithrombin concentrate was administrated before delivery. Pregnancy and labour were terminated without complications at the 37th week of gestation, resulting in the delivery of a healthy male newborn of 3.6 kg body weight, 52 cm long, and with the Apgar scores of 9/10. Conclusion. A timely made diagnosis of thrombophilia, accompanied with regular obstetrics check-ups and follow-ups of hemostatic parameters during pregnancy, as well as the use of adequate prophylactic and substitution therapy, are the successful tools for the prevention of possible maternal complications and pregnancy itself in our patient with congenital AT deficiency

A successful outcome of pregnancy in a patient with congenital antithrombin deficiency

Uvod. Prisustvo urođene trombofilije predstavlja dodatni faktor rizika od nastanka venskog tromboembolizma u trudnoći, ali i komplikacija same trudnoće kao što su ponavljani gubitak trudnoće, abrupcija placente, intrauterino zaostajanje u rastu i razvoju, te rana preeklampsija. Trudnice sa trombofilijom, a posebno one sa nedostatkom antitrombina, u riziku su od nastanka obe vrste komplikacija u trudnoći. Prikaz bolesnice. U radu je prikazana trudnica sa urođenim nedostatkom antitrombina u toku njene prve trudnoće, čija majka je četiri puta imala duboke venske tromboze, tokom trudnoće i puerperijuma. Uz redovno laboratorijsko praćenje hemostaznih parametara i redovne akušerske kontrole sa praćenjem važnog parametra placentne vaskularizacije, čitava trudnoća protekla je bez komplikacija. Profilaktička terapija niskomolekularnim heparinom uvedena je od 20. nedelje trudnoće, a supstituciona terapija primenom koncentrata antitrombina, neposredno pre porođaja. Porođaj je protekao bez komplikacija i u 37. nedelji rođena je zdrava muška beba telesne težine 3,6 kg i dužine 52 cm, sa Abgar skorom 9/10. Zaključak. Pravovremeno postavljena dijagnoza trombofilije, redovne akušerske kontrole i praćenje hemostaznih parametara u toku trudnoće, kao i primena adekvatne profilaktičke i supstitucione terapije, doprinele su prevenciji mogućih maternalnih ili komplikacija same trudnoće kod bolesnice sa urođenim nedostatkom antitrombina.Background. Presence of inherited thrombophilia is an additional risk factor for maternal thromboembolism and certain adverse pregnancy outcomes, including recurrent fetal loss, placental abruption, intrauterine growth restriction and earlyonset severe preeclampsia. Pregnant women with thrombophilia, especially those with antithrombin (AT) deficiency, are at high risk of both kinds of complications. Case report. We presented a pregnant women with congenital antithrombin deficiency in the first pregnancy, whose mother had had four times pregnancy-related deep vein thrombosis, and antithrombin deficiency. With the regular laboratory monitoring of hemostatic parameters and gynaecology surveillance including the follow-up of placental vascular flow, the whole pregnancy proceeded without complications. The prophylactic therapy with low molecular weight heparin was introduced from the 20th week of gestation and one dose of substitution therapy with antithrombin concentrate was administrated before delivery. Pregnancy and labour were terminated without complications at the 37th week of gestation, resulting in the delivery of a healthy male newborn of 3.6 kg body weight, 52 cm long, and with the Apgar scores of 9/10. Conclusion. A timely made diagnosis of thrombophilia, accompanied with regular obstetrics check-ups and follow-ups of hemostatic parameters during pregnancy, as well as the use of adequate prophylactic and substitution therapy, are the successful tools for the prevention of possible maternal complications and pregnancy itself in our patient with congenital AT deficiency

The use of D-dimer with new cutoff can be useful in diagnosis of venous thromboembolism in pregnancy

Objective: D-dimer testing has an important role in the exclusion of acute venous thromboembolism (VTE) in the nonpregnant population. Establishing D-dimers role in the diagnosis of VTE in pregnancy is hampered because of the substantial increase of D-dimer throughout gestational age. Study design: In a prospective study we followed 89 healthy pregnant women to establish the reference range of D-dimer for each trimester. D-dimer testing was also performed in 12 women with clinical suspicion of VTE and their results were compared with the established new reference range of D-dimer, and with the recorded ultrasound findings. Results: In the first trimester, 84% women from reference group had normal D-dimer, in the second 33%, and by the third trimester only 1%, which suggests that D-dimer has no practical diagnostic use in ruling out VTE if the threshold of 230 ng/mL for abnormal is used. All pregnant women with thrombosis who had positive ultrasound findings also had statistically significant elevation of the D-dimer level, considering the established reference range of the corresponding trimester. We found 100% sensitivity of D-dimer test. A women developed thrombosis in the first trimester had 6.7-7.6 time higher level of D-dimer than the mean value in the reference group, and in the third trimester thrombotic women had 2.0-3.8 time higher level of D-dimer, p lt 0.0001. Conclusion: D-dimer test with the new threshold for: the first of 286, the second of 457 and the third trimester of 644 ng/mL can be useful in diagnosis of pregnancy related VTE