The role of selenium and zinc in allergic hypersensitization in children

The prevalence of allergy has increased rapidly over recent years, especially among pediatric patients and it is detected approximately in 2–3% of the world population. Worldwide, respiratory allergic diseases affect nearly 700 million subjects. The pathogenesis of allergy is still poorly understood and is a matter of worldwide concern. It is thought that it results from the interactions between genetic predisposition and excessive and inappropriate immune responses to a large spectrum of environmental risk factors. Recent clinical observations and epidemiological studies have identified associations between nutritional elements (e.g., zinc, and selenium) and allergy prevalence. It is suggested that micronutrients influence the immune system and may play a major role in the development of asthma and in the progression of other allergic diseases. This link is based on the hypothesized benefits of antioxidant functions of certain micronutrients, which may modulate the amount of oxidants in the body. As a result, decrease in oxidative stress may be an important factor in the etiology of childhood asthma. Our aim was to analyze the current literature and to assess whether trace elements level is a risk factor for allergic symptoms in childhood. In this review article, we aimed to describe the properties and biological importance and to define the possible relationship between atopic sensitization and serum levels of zinc and selenium in children

Atipičan slučaj bolesti ruku, nogu i usta (Enterovirusni egzantem) iz kliničke prakse

A clinical case of atypical hand-foot-and-mouth disease in a previously healthy girl was presented. The disease had atypical course with vesiculobullous lesions located mainly on the buttocks, dorsal surfaces of the feet, shins, knees, and less pronounced on the elbows and dorsal surfaces of the hands; purpuric lesions on the feet, palms and soles; minimal oral lesions; and streptococcal co-infection. Timely hospitalization and appropriate treatment of the patient led to her fast and complete recovery and showed effectiveness of therapy prescribed.Prikazujemo atipičan slučaj bolesti ruku, nogu i usta u prethodno zdrave djevojčice. Bolest je imala atipičan tijek s vezikulobuloznim lezijama smještenima uglavnom na stražnjici, dorzalnim površinama stopala, goljenica, koljena, manje izražene na laktovima i dorzalnim područjima šaka; purpurnim lezijama stopala, dlanova i tabana; minimalnim oralnim lezijama; i streptokoknom infekcijom. Pravodobna hospitalizacija i odgovarajuće liječenje bolesnice rezultirali su njezinim brzim i potpunim oporavkom te pokazali djelotvornost primijenjene terapije

Tetanus u djeteta kao rezultat nepoštivanja kalendara cijepljenja – prikaz slučaja

A clinical case of generalized tetanus in a preschooler with vaccination schedule noncompliance was analyzed. Clinical signs of generalized severe tetanus are presented. Modern approaches to the treatment of such patients, effectiveness and promises of therapy are shown.Analiziran je klinički slučaj generaliziranog tetanusa u predškolskog djeteta kod kojega se nije poštivao kalendar cijepljenja. Opisanisu klinički znakovi teškog generaliziranog tetanusa. Prikazani su suvremeni pristupi liječenju ovakovih bolesnika, učinkovitost i očekivanadobrobit terapije

The relationship between neonatal stress in preterm infants and developmental outcomes at the corrected age of 24–30 months

AimThe aim of research was to study the relationship between the stress experienced by preterm infants in the neonatal intensive care unit (NICU) and developmental status in the follow up, and to establish factors, associated with their neurodevelopment.MethodsThe first stage of research involved measuring stress markers (cortisol, melatonin) in infants (n = 56) during their NICU stay; the second phase assessed the developmental status at the corrected age of 24–30 months.ResultsThe total ASQ-3 score, communication, problem solving, and personal-social skills scores at the corrected age of 24–30 months were positively correlated with melatonin level determined in the neonatal period (r = 0.31, p = 0.026; r = 0.36, p = 0.009; r = 0.30, p = 0.033, and r = 0.32; p = 0.022 respectively). In the same time, ASQ-3 communication and personal-social scores were negatively correlated with cortisol level (r = −0.31, p = 0.043; r = −0.35, p = 0.022). The ROC-curve analysis revealed that a decrease of melatonin below 3.44 ng/mL and 3.71 ng/mL during the neonatal period could predict communication and problem-solving delay, respectively. An increase in cortisol above 0.64 mcg/dl is predictive in personal-social delay. Negative correlation was identified between the NICU and total hospital stay duration and ASQ-3 communication scores in the follow-up (r = −0.27; p = 0.049 and r = −0.41; p = 0.002, respectively). The duration of mechanical ventilation was negatively correlated with gross motor scores (r = −0.46; p = 0.043). Apgar score was positively correlated with ASQ-3 communication (r = 0.29; p = 0.032) and personal-social scores (r = 0.28; p = 0.034); maternal age—with ASQ-3 total (r = 0.29; p = 0.034), communication (r = 0.37; p = 0.006), and personal-social scores (r = 0.29; p = 0.041). Positive correlations were observed between gestational age and communication scores (r = 0.28; p = 0.033). Infants who suffered neonatal sepsis had significantly often delay of communication (p = 0.014) and gross motor skills (p = 0.016). Children who required mechanical ventilation were more likely to have communication delay (p = 0.034).ConclusionDevelopmental outcomes in preterm infants at the corrected age of 24–30 months were associated with neonatal stress. Correlations between the communication, problem-solving and personal-social development in the follow up and cortisol and melatonin levels determined in the neonatal period supported this evidence. Factors as low gestational age, duration of hospital and NICU stay, mechanical ventilation, and sepsis were associated with more frequent delays in communication, gross motor and problems-solving skills

Diagnostic value of markers of oxidative stress and metabolic disorders in preterm infants in the early neonatal period

Cilj istraživanja bio je procijeniti biljege oksidativnog stresa i metaboličkih poremećaja kod nedonoščadi te ispitati njihovu udruženost s kratkoročnim ishodima u ranom neonatalnom razdoblju kako bi se utvrdili prediktori nepovoljnih ishoda. Istraživanje je obuhvatilo 46 nedonoščadi gestacijske dobi ≤32 tjedna u ranom neonatalnom razdoblju: 1. skupina od 12 nedonoščadi sa smrtnim ishodom i 2. skupina od 34 nedonoščadi s povoljnim ishodom. Biljezi metaboličkih poremećaja, oksidativnog stresa i antioksidantnog sustava analizirani su u pupčanoj krvi i mokraći prvog i drugog dana života. Procjena parametara oksidativnog (8-izoprostan) i antioksi- dantnog sustava (aktivnost katalaze i superoksid dismutaze (SOD)) te metaboličkog stresa (laktat, piruvat, omjer laktata i piruvata (LPR), NAD+/NADH) potvrdila je energetsku neravnotežu i prisutnost tkivne hipoksije kod novorođenčadi s lošim ishodom. Utvrđeni su sljedeći rizični čimbenici nepovoljne prognoze kod novorođenčadi u ranom neonatalnom razdoblju: asfiksija (p=0,038), rana sepsa (p=0,003), intraventrikulsko krvarenje (p=0,029), hiperlaktatemija (p=0,013), povišena razina piruvata (p=0,002), povišen LPR (p=0,008), snižena aktivnost katalaze (p=0,003) i SOD (p=0,001). Logistička regresija pokazala je da je stopa smrtnosti pozitivno pove- zana s asfijksijom, ranom sepsom i razinom laktata te negativno povezana s aktivnošću SOD. U zaključku, intenzivan oksidativni i metabolički stres kod nedonoščadi udružen je s nepovoljnim ishodima u ranom neonatalnom razdoblju. Kombinacija asfiksije i rane sepse zajedno s visokom razinom laktata i sniženom aktivnošću SOD predviđa nepovoljan ishod u ranom neonatalnom razdoblju.The aim of the study was to evaluate the markers of oxidative stress and metabolic disorders in preterm infants and to examine their association with short-term outcomes in the early neonatal period to identify the predictors of unfavourable outcome. The study included 46 preterm infants, gestational age ≤32 weeks, in the early neonatal period, i.e. group 1 of 12 infants with lethal outcome and group 2 of 34 preterm infants with favourable outcome. Markers of metabolic disorders, oxidative stress and antioxidant system were analysed in cord blood and urine on the first/second day of life. Evaluation of oxidative (8-isoprostane) and antioxidant system (catalase and superoxide dismutase (SOD) activity) and metabolic (lactate, pyruvate, lactate to pyruvate ratio (LPR), NAD+/NADH) stress parameters confirmed energy imbalance and presence of tissue hypoxia in preterm newborns with adverse outcomes. The following risk factors of unfavourable prognosis in preterm infants in the early neonatal period were identified: asphyxia (p=0.038), early-onset sepsis (p=0.003), intraventricular haemorrhage (p=0.029), hyperlactatemia (p=0.013), increased pyruvate level (p=0.002), increased LPR (p=0.008), decreased catalase (p=0.003) and SOD (p=0.001) activity. Logistic regression indicated that mortality rate was positively related to asphyxia, early-onset sepsis and lactate level, and negatively related to SOD activity. In conclusion, intensive oxidative and metabolic stress in preterm infants is associated with adverse outcomes in the early neonatal period. A combination of asphyxia and early-onset sepsis together with high lactate level and decreased SOD activity is a predictor of unfavourable out- come in the early neonatal period

Peculiarities of the prevalence and risk factors for vitamin D deficiency in overweight and obese adolescents in Ukraine

Introduction. Lipid metabolism disorder is recognized as one of the risk factors for vitamin D deficiency, and the amount of adipose tissue is crucial in its metabolism and biological role. Childhood obesity is an important public health problem in Ukraine, especially among adolescents. The objective of the study was to determine peculiarities of the prevalence and risk factors for vitamin D deficiency in overweight and obese adolescents in Ukraine. Material and methods. 146 children, aged 12 to 17 years, with excessive weight and obesity, and 63 healthy children with normal body weight were examined. The vitamin D status was determined by the level of 25(OH) D in blood serum. The multiple logistic regression analysis was used to determine the risk factor affecting the development of vitamin D deficiency. Results. The study has established that the average level of 25(OH) D in adolescents with normal body weight was 19.76±4.28 ng/mL, in adolescents with excess body weight 15.24±3.47 ng/mL, and in obese children 13.87±2.71 ng/mL. The prevalence of vitamin D deficiency in overweight adolescents was 70.62%, and in adolescents with obesity 77.19%. Conclusions. The study has established the main risk factors and prevalence features for vitamin D deficiency in overweight and obese adolescents

A Case of Pediatric Multisystem Inflammatory Syndrome Temporally Associated with SARS-CoV-2

Uvod. COVID-19 u djece je relativno blaga bolest. Međutim, ozbiljnije stanje koje karakterizira upalni sindrom u obliku Kawasakijeve bolesti nazvane multisistemski upalni sindrom kod djece a koja je vremenski povezana s infekcijom SARS-CoV-2 je ponešto rjeđa patologija. Izvješće o slučaju. Prikazan je klinički slučaj multisistemskog upalnog sindroma kod djeteta koji je vremenski povezan s infekcijom SARS-CoV-2 u prethodno zdrave djevojčice predškolske dobi. Bolest je imala nepotpuni oblik sličan Kawasakijevoj bolesti koji je odgovarao kriterijima SZO-a i CDC-a za ovaj sindrom u djece i adolescenata. Zaključak. Ovaj klinički slučaj skreće pažnju liječnika opće prakse i pedijatara na osobitosti dijagnosticiranja i liječenja ovog sindroma.Introducion. COVID-19 in children is a relatively mild disease. Though a more serious condition characterized by systemic inflamma- tion does occur in children in a Kawasaki disease-like form named multisystem inflammatory syndrome (MIS-C). MIS-C in children is a less common pathology. Case Report. A clinical case of multisystem inflammatory syndrome in children (MIS-C) temporally associated with SARS-CoV-2 in- fection in a previously healthy preschool-age girl is presented. The disease had an incomplete Kawasaki disease-like form corre- sponding to this syndrome in children and adolescents as defined by WHO and CDC criteria. Conclusion. This clinical case draws the attention of general practitioners and pediatricians to the peculiarities of this type of syn- drome diagnosis and management

Parents’ perception of health-related quality of life in healthy children and adolescents

Cilj ovoga istraživanja bio je utvrditi kako roditelji procjenjuju sadašnju kvalitetu života povezanu sa zdravljem svoje zdrave djece i adolescenata. Ukupno je 278 roditelja zdrave djece (srednja dob 10,79±1,03 godina) i adolescenata (srednja dob 14,15±1,01 godina) pozvano da sudjeluju u istraživanju. Svi sudionici izabrani su iz dvije javne škole u gradu Ternopilu, Ukrajina. Naknadno je 148 sudionika isključeno iz studije zbog nepotpunih podataka u upitniku Child Health Questionnaire Parent Form-50 (CHQ-PF50). Tako je istraživanje obuhvatilo 130 roditelja zdrave djece (n=55) i zdravih adolescenata (n=75). Rezultati studije pokazali su kako nema razlike u sumarnom zbiru za fizičko zdravlje i sumarnom zbiru za psihosocijalno zdravlje između djece i adolescenata, dok je usporedba ovih sumarnih rezultata pokazala značajno lošije psihosocijalno zdravlje u odnosu na fizičko zdravlje u svim skupinama pedijatrijskih ispitanika (t=9,19; p=0,000000). Također smo utvrdili izravnu korelaciju sumarnog zbira za fizičko zdravlje i sumarnog zbira za psihosocijalno zdravlje (r=0,45; p=0,000000). Roditelji zdravih adolescenata pridali su niži zbir na upitniku CHQ-PF50 za domene globalnog ponašanja i emocionalnog utjecaja na roditelje. Kvaliteta života kod zdravih djevojčica bila je udružena sa smanjenom domenom globalnog zdravlja u usporedbi sa zdravim dječacima. Za razliku od djevojčica, dječaci su bili obilježeni nižim zbirom na upitniku CHQ-PF50 za domene ponašanja, ograničenja u obiteljskim aktivnostima i obiteljske kohezije. Prema izvješćima roditelja sumarni zbir za fizičko zdravlje i sumarni zbir za psihosocijalno zdravlje nisu se razlikovali između djece i adolescenata. Psihosocijalno zdravlje djece i adolescenata bilo je lošije od njihova fizičkog zdravlja.The purpose of the study was to evaluate current health-related quality of life of healthy children and adolescents by parent proxy assessment. A total of 278 parents of healthy children (mean age 10.79±1.03 years) and adolescents (mean age 14.15±1.01 years) were invited to participate in the survey. All participants were recruited from two public schools of Ternopil city, Ukraine. Subsequently, 148 participants were excluded from the study due to incomplete data on the Child Health Questionnaire Parent Form-50 (CHQ-PF50). Therefore, the study included 130 parents of healthy children (n=55) and adolescents (n=75). Study results revealed that there were no differences in summary score of physical health and summary score of psychosocial health between children and adolescents, while comparing these summaries showed significantly worse psychosocial health than physical health in all groups of paediatric subjects (t=9.19; p=0.000000). We also identified direct correlation between summary score of physical health and summary score of psychosocial health (r=0.45; p=0.000000). Parents of healthy adolescents attributed lower scores of the CHQ-PF50 to the domains of global behaviour and emotional impact on the parent. Quality of life in healthy girls was associated with decreased global health domain when compared with healthy boys. In contrast to girls, boys were characterised by lower scores on the CHQ-PF50 for the domains of behaviour, limitations in family activities, and family cohesion. According to the parents’ reports, the summary score of physical health and summary score of psychosocial health did not differ between children and adolescents. Psychosocial health of both children and adolescents was worse than their physical health

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants.

BACKGROUND: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING: WHO