Корелација на серумското ниво на витамин Д со вкупниот серумски ИгЕ кај деца со астма

Asthma is a chronical disease of the airways characterized by reversible obstruction of the bronchi and airway inflammation. In recent decades, the scientific interest of the vitamin D system and its role in development of asthma and other alergic diseases has been increased. Aims of this study are to mesure and compare the serum level of 25 OHD in asthmatic and healthy children and corelate the level of 25OHD and total IgE in asthmatic children. This prospective study includes 70 children at age 2 to 14, of which 32 are children with diagnosed asthma and 38 healthy children. In both  of the groups the serum level of 25 OHD was measured  and by the results 18 % of the healthy children (C) and 28% of the asthma children (E) had 25OHD  deficiency, 45%  of C and 50% of E were insufficient and 37 % of C / 22% of E were with normal 25 OHD serum level. The mean level of 25OHD in C was 27,83 +/- 10,24 and in E 20,9 ng/ml +/- 10,72. The mean levels in both groups had statistic significant difference with p-value < 0,05. According to age no statistic significant difference was found in both of the groups. There was a statisticaly significant decreased serum level of 25 OHD in asthmatic females.In the examined group (children with asthma) there was a negative linear correlation (association) of the level of 25OHD and total IgE serum level with r=- 0,55  Vitamin D serum level measurements in asthma patients gives the possibility for discovering the connection between its deficiency and development of asthma symptoms.Астмата е хронична болест на дишните патишта која се карактеризира со реверзибилна бронхоопструкција, клеточна инфилтрација и инфламација на дишното стебло. Последните неколку децении се бележи зголемен интерес на медицинската наука за значењето на витаминот Д во развојот на астмата и другите алергиски заболувања. Цели на овој труд беа: споредба на вредноста на серумското ниво на витамин Д кај децата со астма и здрави деца и одредување на корелацијата на нивото на витамин Д во серум со нивото на серумското вкупно ИгЕ. Материјал и методи: Оваа проспективна студија вклучи испитувана група од 32 (23 машки и 9 женски) пациенти на возраст од 2 до 14 години и контролна група од 38 пациенти (23 машки и 15 женски), здрави деца (пациенти без астма) на иста возраст. Во двете групи беше одредено нивото на серумскиот витамин Д, а кај испитуваната група и вредностите на серумско ИгЕ. Резултати: Во испитуваната група со витамин Д со дефицит беа 28%, инсуфициентни 50% и со нормални вредности 22% од децата. 18% од пациентите во контролната група беа со дефицитни (<20 ng/ml), 45% со инсуфициентни (20-30 ng/ml) и 37% со нормални вредности (>30 ng/ml) на витамин Д. Средната вредност на нивото на серумскиот витамин Д во контролната група изнесуваше 27,83 ng/ml +/- 10,24, а во испитуваната 20,9 +/- 10,72, со статистички сигнификантна разлика помеѓу двете групи  (p< 0,05). Средните вредности во подгрупите од двете групи според возраст (2-5 год и над 5 год), не покажаа статистички сигнификантна разлика додека статистички сигнификантно намалена средна вредност се доби кај женските деца од испитуваната група. Во испитуваната група деца беше анализирана и корелацијата на нивото на серумските вредности на 25OHD и вкупниот ИгЕ како еден од најважните параметри во дијагностичкиот протокол за астма, при што беше добиена негативна корелација на испитуваните параметри (r= -0,55). Заклучок: Со одредувањето на серумското ниво на витамин Д кај пациенти со астма се покажува директната зависност на развојот на симптомите на болеста од степенот на неговиот дефицит

Severe Encephalitis in Infant with COVID-19: A Case Report

BACKGROUND: Encephalitis is a serious condition that contains neurological dysfunction cause by inflammation of the brain tissue. Etiological factors for the occurrence of this condition include infectious and non-infectious causes. CASE REPORT: We are presented 9-month-old infant referred to our clinic in convulsive status, fever, and disturbed consciousness. From anamnestic information, the infant has been febrile for 2 days with profuse vomiting initiating just before admission at the clinic. At the moment of admission in the clinic, the infant looked intoxicated with generalized tonic-clonic seizures, with shortness of breath and fever with a weakened reaction to painful stimuli. It was admitted in the Isolation Unit by the protocol of the clinic. Laboratory investigations were done. Due to the persistence of convulsive status, a computed tomography scan of the brain was performed with the finding of enlargement of the lateral ventricles, with intraventricular masses and pronounced internal hydrocephalus. The results of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) from the infant were positive as well as the grandmother. The infant was intubated immediately and put on mechanical ventilation SIPPV. CONCLUSION: Our case report could suggest that SARS-CoV-2 infection may cause severe clinical symptoms, neurological manifestations, and encephalitis in infants

Need for Developmental Assessment

Introduction: When we start our work as medical professionals the most important was improving and understanding physical growth and nutrition. Today we know that as much important as good knowledge in physical examination is adequate assessment of personality and social development which is crucial for appropriate developmental assessment. In this context early identification of developmental delay is not just responsibility but either obligation of all health care professionals, especially pediatricians. Aim of the Study: The aim of this study is to analyze developmental monitoring based on parents informations in our hospital in order to find out which percentage of referred children has to be followed further and has to start with early intervention. Our ap�proach to developmental monitoring is: we start the pediatric assessment by taking very careful history of child. Second step is very careful examination in order to find if the child has same kind of organ dysfunction. In second step crucial is neurological examination especially if we know that children with developmental disabilities have very high rate of seizure disorder, structural MRI abnormali�ties - especially frontal atrophy… Pediatrician has to be aware that observation of the parent-child interaction also, may be an aid in identifying children with delayed development. Methodology and Sample: The developmental monitoring in 465 children at the age of 12 - 60 months, referred as children with developmental delay according to primary care pediatricians, special educators or family members in the period of 4 years (from January 2016 until the end of 2019) was implemented. The assessment of the evaluated sample is done using CDC developmental milestone checklist (Centers for Disease Control and Prevention) for specific ages -12 and 18 months and 2,3,4 and 5 years. To assess behavioral and emotional problems, physicians need information from family and people who see children in their everyday contexts. Results: The results were presented for each group separately. Conclusion: Research indicates that the first five years of a child’s life are critical to brain development, academic achievement and later life outcomes. The right developmental and behavioral assessment can change the trajectory of a child’s life forever

Anxiety, Stress and Coping Patterns in Children in Dental Settings

BACKGROUND: Fear of the dentist and dental treatment is a common problem. It can cause treatment difficulties for the practitioner, as well as severe consequences for the patient. As is known, the level of stress can be evaluated thought electrodermal activity, cortisol measure in saliva, or indirectly by psychometric tests.AIM: The present study examined the psychological influence of dental interventions on the child as well as coping patterns used for stress diminution.METHODS: We examined two matched groups of patients: a) children with orthodontic problems (anomalies in shape, position and function of dentomaxillofacial structures) (N = 31, mean age 10.3 ± 2.02) years; and b) children with ordinary dental problems (N = 31, mean age 10.3 ± 2.4 years). As psychometric instruments, we used: 45 items Sarason’s scale for anxiety, 20 items simple Stress - test adapted for children, as well as A - cope test for evaluation coping patterns.RESULTS: Obtained scores confirmed the presence of moderate anxiety in both groups as well as moderate stress level. For Sarason’s test obtained scores for the group with dental problems are 20.63 ± 8.37 (from max 45); and for Stress test 7.63 ± 3.45 (from max 20); for the orthodontic group obtained scores are 18.66 ± 6.85 for Sarason’s test, while for the Stress test were 7.76 ± 3.78. One way ANOVA confirmed a significant difference in values of obtained scores related to the age and gender. Calculated Student t - test shows non-significant differences in obtained test results for both groups of examinees. Coping mechanisms evaluated by A - cope test shows that in both groups the most important patterns used for stress relief are: developing self-reliance and optimism; avoiding problems and engaging in demanding activity.CONCLUSION: This study confirmed that moderate stress level and anxiety are present in both groups of patients (orthodontic and dental). Obtained scores are depending on gender and age. As more used coping patterns in both groups are developing self-reliance and optimism; avoiding problems and engaging in demanding activity. Some strategies for managing this problem are discussed

Oдносот помеѓу нивото на серумскиот прокалцитонин и ц-реактивен протеин кај новороденчиња со сепса при различни видови на респираторна поддршка во единицата за интензивна нега и терапија

Sepsis in newborns with RDSy and asphyxia is essential; it is a life-threatening condition and still represents an important cause of mortality and morbidity. The aim of this study was to evaluate the predictive values of procalcitonin (PCT) as an early diagnostic and prognostic biochemical marker for sepsis in newborns with RDS and asphyxia. Material and methods: The study was designed as prospective and we examined 110 newborns with proven sepsis admitted in the Intensive  Care Unit at the University Clinic of Pediatrics – Skopje in the period between December 2018 and Јanuary 2021. Procalcitonin levels were measured by using the immunoassay system Vidas based on the ELFA principles. The newborns with proven sepsis were divided into two groups. The first group comprised 55 newborns with RDS and proven sepsis and the second group included 55 newborns with asphyxia and proven sepsis. The statistical analysis confirmed significantly different values ​​of PCT in the analyzed time period in first group of newborns with RDS and proven sepsis, p<0.001. The highest average values (40.37±53.79) ​​were measured on admission with a high level of peak compared to the second group of newborns with asphyxia and proven sepsis. The statistical analysis confirmed significantly different values ​​of PCT in the analyzed time period in the first group of newborns with RDS and proven sepsis with mechanical ventilation (MV) and bubble continuous positive airway pressure (BCPAP) compared to the second group of newborns with asphyxia  and proven sepsis,  p<0.001. PCT is a promising sepsis marker in newborns with RDSy, capable of complementing clinical signs and routine laboratory parameters suggestive of severe infection at the time of ICU admission.  Сепсата кај новороденчиња со респираторен дистрес синдром (РДС) и асфиксија е животозагрозувачка состојба и сè уште претставува важна причина за морталитет и морбидитет. Целта на оваа студија беше да се проценат предвидувачките вредности на прокалцитонинот (ПЦТ) како ран дијагностички и прогностички биохемиски маркер за сепса кај новороденчиња со РДС и асфиксија. Студијата беше дизајнирана како проспективна и испитавме 110 новороденчиња со докажана сепса, хоспитализирани во Единицата за интензивна нега и терапија (ЕИНТ), при Универзитетската клиника за детски болести - Скопје, во периодот од декември 2018 до јануари 2021 година. Нивото на прокалцитонин беше мерено со користење на имуноанализирачкиот систем Видас базиран на ЕЛФА методот. Новороденчињата со докажана сепса беа поделени во две групи. Во првата група беа анализирани 55 новороденчиња со РДС и докажана сепса, а во втората група 55 новороденчиња со асфиксија и докажана сепса. Статистичката анализа потврди значително различни вредности на ПЦТ во анализираниот период во првата група новороденчиња со РДС и докажана сепса, p<0,001. Највисоките просечни вредности (40,37±53,79) беа измерени за време на приемот со висок пик во споредба со втората група новороденчиња со асфиксија и докажана сепса. Статистичката анализа потврди сигнификантно различни вредности на ПЦТ во анализираниот временски период кај првата група новороденчиња со РДС и докажана сепса со механичка вентилација (МВ) и bubble континуиран позитивен притисок на дишните патишта (БЦПАП), споредено со втората група новороденчиња со асфиксија и докажана сепса,  p<0,001.  ПЦТ е ветувачки маркер за сепса кај новороденчиња со РДС, кој ја надополнува клиничката презентација и рутинските лабораториски параметри кои укажуваат на тешка инфекција за време на хоспитализацијата во ЕИНТ

Phenotypic and genetic heterogeneity of adult patients with hereditary spastic paraplegia from Serbia

Hereditary spastic paraplegia (HSP) is among the most genetically diverse of all monogenic diseases. The aim was to analyze the genetic causes of HSP among adult Serbian patients. The study comprised 74 patients from 65 families clinically diagnosed with HSP during a nine-year prospective period. A panel of thirteen genes was analyzed: L1CAM (SPG1), PLP1 (SPG2), ATL1 (SPG3A), SPAST (SPG4), CYP7B1 (SPG5A), SPG7 (SPG7), KIF5A (SPG10), SPG11 (SPG11), ZYFVE26 (SPG15), REEP1 (SPG31), ATP13A2 (SPG78), DYNC1H1, and BICD2 using a next generation sequencing-based technique. A copy number variation (CNV) test for SPAST, SPG7, and SPG11 was also performed. Twenty-three patients from 19 families (29.2%) had conclusive genetic findings, including 75.0% of families with autosomal dominant and 25.0% with autosomal recessive inheritance, and 15.7% of sporadic cases. Twelve families had mutations in the SPAST gene, usually with a pure HSP phenotype. Three sporadic patients had conclusive findings in the SPG11 gene. Two unrelated patients carried a homozygous pathogenic mutation c.233T>A (p.L78*) in SPG7 that is a founder Roma mutation. One patient had a heterozygous de novo variant in the KIF5A gene, and one had a compound heterozygous mutation in the ZYFVE26 gene. The combined genetic yield of our gene panel and CNV analysis for HSP was around 30%. Our findings broaden the knowledge on the genetic epidemiology of HSP, with implications for molecular diagnostics in this region