Wirus zapalenia wątroby typu C jako stymulator autoprzeciwciał we wczesnym okresie życia dzieci zakażonych wertykalnie

Zakażenie wirusem zapalenia wątroby typu C (HCV) wykazuje związek ze stymulacją procesów autoimmunologicznych. Oceniano częstość występowania niespecyficznych narządowo autoprzeciwciał (NOSA) u 19 dzieci zakażonych wertykalnie HCV, dotychczas nieleczonych. Autoprzeciwciała wykryto u 10 spośród 19 dzieci (52,6%); przeciwciała przeciw mięśniom gładkim (SMA) — u 3; przeciwciała przeciwjądrowe (ANA) — u 3; przeciwciała przeciw mikrosomom wątroby i nerki (LKM-1) — u 4. Średnia aktywność aminotransferazy alaninowej (ALT) u pacjentów z NOSA(+) — 77,17 jm./l, u pacjentów NOSA(–) — 51,72 jm./l. Stężenie g-globulin w obu grupach było prawidłowe. Badanie histopatologiczne bioptatu wątroby wykonano u 2 dzieci z NOSA(+), u 1 z NOSA(–). Nie stwierdzono cech histologicznych procesu autoimmunizacyjnego w wątrobie. Dzieci zakażone wertykalnie HCV będą leczone interferonem α i rybawiryną. Interferon α może indukować procesy autoimmunizacyjne. Pacjenci, szczególnie z NOSA(+), powinni podczas terapii podlegać ścisłemu nadzorowi i częstym badaniom kontrolnym, które pozwolą jak najszybciej wyodrębnić pacjentów uaktywniających proces autoimmunizacyjny. Forum Medycyny Rodzinnej 2011, tom 5, nr 6, 485–49

Testing for HIV Increases the Odds of Correct Fetal Ultrasound Result

Introduction: Infectious diseases during pregnancy may pose a threat to both mother and the developing fetus. It also creates an opportunity to screen for diseases being widely underdiagnosed among women in Poland, such as human immunodeficiency virus (HIV) or sexually transmitted infections (STI). Therefore, we aimed to assess the number of pregnant women that had not been tested for HIV despite the recommendations. In addition, a comparison of clinical evaluation between HIV-tested and non-tested pregnant women was also performed. Material and methods: Medical records of all consecutive pregnant women, referred to our Infectious Diseases Hospital between September 2019 and March 2020 were retrospectively analyzed. Implementation of recommended screening testing towards infectious diseases during pregnancy including human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), cytomegalovirus (CMV), syphilis, and rubella, were also analyzed. Results: Medical records of 273 women were included in the analysis. The median age was 32 years (interquartile range: 26–33 years). In total 243/273 (89.0%) had been tested for HIV as recommended, and the remaining 30/273 (11.0%) had not been tested. HIV infection was not confirmed in any of the participants. Only one woman within the HIV non-tested group had been correctly tested towards other infections during her pregnancy. The recommended full testing was more likely to be correctly implemented in women who had also been tested for HIV (171/243, 70.4% vs. 1/30, 3.3%, OR 68.9; 95% CI 9.2–515.3, p < 0.00001). Moreover, the correct fetal ultrasound result was more likely to be obtained in women who had been tested for HIV as recommended (234/243, 96.3% vs. 11/30, 36.7%, OR 44.9; 95% CI 16.6–121.8, p < 0.00001). Conclusions: Despite the law regulations, 11% of pregnant women referred to consultations to the infectious diseases center had not been tested for HIV. At the same time, correct fetal ultrasound results are more likely to occur in women tested for HIV according to recommendations. This suggests that a holistic approach to screening, both for communicable and non-communicable diseases, among pregnant women may translate to better pregnancy outcomes

Novel serum biomarkers modified by the body mass index z-score for the detection of liver fibrosis and steatosis in children with chronic hepatitis C

Abstract Background There is a need for validation of noninvasive alternatives to liver biopsy for the evaluation of fibrosis in children with chronic hepatitis C (CHC). The aim of this study was to evaluate the diagnostic performance of serum biomarkers modified by the body mass index z-score (BMI z-score) for the detection of fibrosis and steatosis in children with CHC. Methods Thirty children aged 9.4 ± 3.7 years (14 males, 16 females) with CHC underwent liver biopsy. Fibrosis was scored using a 5-point METAVIR scale (≥2 = significant fibrosis). For all the children, the following noninvasive markers were calculated: The aspartate transaminase (AST)-to-platelets ratio index (APRI), the modified APRI (M-APRI: BMI z-score × APRI), the Fibrosis-4 index (FIB-4), the modified FIB-4 (M-FIB-4: BMI z-score × FIB-4), and a novel marker, B-AST (BMI z-score × AST). The area under the receiver operator characteristic curve (AUROC) was calculated to detect significant fibrosis and steatosis. Results In the histopathological evaluation, 22/30 (73%) patients presented with fibrosis, and 8/30 (27%) presented with steatosis. For the detection of significant fibrosis, the AUROCs for M-APRI, M-FIB-4 and B-AST were 0.842, 0.823, and 0.848, respectively. For significant steatosis, the AUROCs were more than 0.9 for all markers that included the BMI z-score. B-AST, with a cut-off of 92.8, showed 71% sensitivity and 95% specificity for detecting significant fibrosis. For predicting severe steatosis, B-AST had 100% sensitivity and 92% specificity. Negative values of all three markers that included BMI z-scores excluded all patients with both significant fibrosis and significant steatosis. Conclusions Including the BMI z-score in serum biomarker formulas enhances their diagnostic ability to detect significant fibrosis and steatosis. B-AST may thus act as an effective alternative to liver biopsy

Analysis of Preventable Risk Factors for Toxoplasma gondii Infection in Pregnant Women: Case-Control Study

Background: Toxoplasma gondii (TG) is a parasitic protozoon that may cause miscarriages or birth defects if the infection occurs during pregnancy. The study’s aim was to evaluate the risk factors associated with TG infection in pregnant women. Materials: Medical charts for all 273 pregnant women with suspected TG infection consecutively admitted to the Hospital of Warsaw between 2019 and 2020 were retrospectively analyzed. The presumptive TG diagnosis was verified by a serologic assessment of IgM and IgG titers, and IgG affinity tests. Results: The median age was 32 years (range: 19–42 years). The diagnosis of primary TG infection was confirmed in 74/273 (27.1%) women. In 114/273 (41.8%) there was evidence of past infection. In 71/273 (26%) women, an infection was excluded. In 172/273 (62%) women the recommended testing for other infectious diseases putting fetus development at risk was performed correctly. Logistic regression model analysis revealed that living in rural areas and eating raw meat were independent factors associated with increased risk of TG infection during pregnancy (OR 2.89, 95% CI: 1.42–5.9, p = 0.004; and OR 2.07, 95% CI: 1.03–4.18, p = 0.04, respectively). Conclusions: The independent risk factors for TG infection during pregnancy include living in rural areas and eating raw meat. The physician’s educational role here is crucial for the efficient prevention of congenital toxoplasmosis