Measles in Czech population with varying vaccination rates in 2018-2019: clinical and laboratory differences between vaccinated and unvaccinated individuals and their relevance to clinical practice

BACKGROUND AND OBJECTIVES

In a highly vaccinated population, an increasing number of previously vaccinated measles cases can be expected. The aim of this study was to assess the effect of vaccination on the clinical course and immune response in relation to the current measles case definition.

METHODS

The presence of fever, catarrhal symptoms, exanthema and complications, and specific IgM and IgG positivity were assessed in all 230 patients and compared in 193 patients with known vaccination status, divided into measles-containing vaccine (MCV) groups: MCV0 (85 patients), MCV1 (25 patients) and MCV2 (83 patients).

RESULTS

Statistically significant differences between groups were found for catarrhal symptoms.Conjunctivitis and rhinitis were significantly less frequent in the MCV2 group (47% and 54%) compared to MCV0 (80% and 80%), p < 0.001 and p = 0.002 respectively. Typical exanthema was present in 74 (87%) MCV0 and 56 (67%) MCV2 patients, p = 0.005. Complications were most common in the MCV0 group (29%). ECDC clinical case criteria were met in 81 (95%) MCV0, 18 (72%) MCV1 and 59 (71%) MCV2 patients, p < 0.001. IgM were positive in 64 (83%) MCV0, 14 (74%) MCV1 and 36 (67%) MCV2 patients, differences were not statistically significant. There were highly significant differences in IgG between MCV0 and both vaccinated groups (p < 0.001).

CONCLUSIONS

A redefinition of the clinical case classification is essential to better capture modified measles and to raise awareness among healthcare workers of the differences in measles in vaccinated patients.

Major ions in Central European precipitation - Insight into changes in NO3-/SO42-, NH4+/NO3- and NH4+/SO42- ratios over the last four decades

Knowledge of precipitation composition is important, among other things, to reveal changes in atmospheric chemistry. Here we present the long-term time trends in ratios of major ions in precipitation, namely nitrate to sulphate (NO3-/SO42-), ammonium to sulphate (NH4+/SO42-) and ammonium to nitrate (NH4+/NO3-). For this we explore the long-term time series recorded by the Czech Hydrometeorological Institute at eight monitoring sites situated in urban, rural and mountain regions of the Czech Republic between 1980 and 2020. To that end, we use innovative Bayesian inference with the Integrated Nested Laplace Approximation (INLA) computational method appropriate for investigating complicated large-scale data. Our results indicated: (i) increasing NO3-/SO42- ratio in precipitation over time and distinct seasonal behaviour with higher values in winter and lower values in summer, (ii) increasing NH4+/SO42- ratio in precipitation and distinct seasonal behaviour with higher values in summer and lower values in winter and (iii) relatively stable NH4+/NO3- ratio in precipitation with a mild recent increase and distinct seasonal behaviour with higher values in summer and lower values in winter. This behaviour pattern holds true for all the sites analysed, irrespective of their geographical position, altitude or environment. Though explored in detail rarely, the ion ratios are important to study as they reflect changes in atmospheric chemistry, mirroring changes in emissions and meteorology and suggesting changing impacts on ecosystems and the environment.

Stigmatization and discrimination of people living with HIV in the Czech Republic: a pilot study

OBJECTIVES

HIV positivity diagnosis is often accompanied by stigmatization and discrimination, even in developed societies. The aim of the study was to obtain current information on the quality of life of people living with HIV in the Czech Republic, to assess the level and perception of stigmatization and discrimination, and to identify existing problems of people living with HIV concerning health services, family and the public.

METHODS

Data for the pilot study were collected by convenience sampling between 2021 and 2022. Respondents were recruited from residents of Czech nationality and foreigners living with HIV in the Czech Republic who participated in an ECDC online questionnaire study or attended a convalescent stay for people living with HIV. Likert scales were used to capture key opinions, attitudes and beliefs of respondents. Data were processed using descriptive analysis.

RESULTS

The study involved 42 people living with HIV. A total of 77% of the respondents reported that they had learned to live with their HIV-positive status, but 21% admitted to having low self-esteem due to their status. A total of 81% of the respondents had disclosed their HIV-positive status to someone outside of the healthcare setting, however, 40% of the respondents found it difficult to do so. Assault or threats from a sexual partner were reported by 17% of the respondents. A total of 27% of the respondents admitted having been denied or suspended health care, 44% reported inappropriate comments from healthcare workers, and 32% of the respondents avoided visiting the healthcare facility. Alarmingly, 41% of the respondents had been refused dental care at some point in the past because of their HIV-positive status.

CONCLUSIONS

Although the study presents only limited findings due to the small number of respondents, it is clear that stigmatization and discrimination of people living with HIV exists in the Czech society. It brings the risk of loss of motivation and involvement of people living with HIV in working together with healthcare providers on their treatment. There is a clear need for a larger study to identify the causes of stigmatization and to find ways to prevent it.

Ambient ozone at a rural Central European site and its vertical concentration gradient close to the ground

The representativeness of ambient air quality of an in situ measurement is key in the use and correct interpretation of the measured concentration values. Though the horizontal representativeness aspect is generally not neglected in air pollution studies, a detailed, high-resolution vertical distribution of ambient air pollutant concentrations is rarely addressed. The aim of this study is twofold: (i) to explore the vertical distribution of ground-level ozone (O3) concentrations measured at four heights above the ground-namely at 2, 8, 50, and 230 m-and (ii) to examine in detail the vertical O3 concentration gradient in air columns between 2 and 8, 8 and 50, and 50 and 230 m above the ground. We use the daily mean O3 concentrations measured continuously at the Košetice station, representing the rural Central European background ambient air quality observed during 2015-2021. We use the semiparametric GAM (generalised additive model) approach (with complexity or roughness-penalised splines implementation) to analyse the data with sufficient flexibility. Our models for both O3 concentrations and O3 gradients use (additive) decomposition into annual trend and seasonality (plus an overall intercept). The seasonal and year-to-year patterns of the modelled O3 concentrations look very similar at first glance. Nevertheless, a more detailed look through O3 gradients shows that they differ substantially with respect to their seasonal and long-term dynamics. The vertical O3 concentration gradient in 2-230 m is not uniform but changes substantially with increasing height and shows by far the highest dynamics near the ground between 2 and 8 m, differing in both the seasonal and annual aspects for all the air columns inspected. We speculate that non-linear changes of both seasonal and annual components of vertical O3 gradients are due to atmospheric-terrestrial interactions and to meteorological factors, which we will explore in a future study.

The Safety Assessment of Cosmetic Perfumes by Using In Chemico and In Vitro Methods in Combination with GC-MS/MS Analysis

Animal testing has been prohibited for the safety assessment of cosmetic ingredients or finished products. Thus, alternative non-animal methods, followed by confirmatory clinical studies on human volunteers, should be used as the sole legally acceptable approach within the EU. The safety assessment of cosmetic products requires the involvement of multiple scientific disciplines, including analytical chemistry and biomedicine, as well as in chemico, in vitro and in silico toxicology. Recent data suggest that fragrance components may exert multiple adverse biological effects, e.g. cytotoxicity, skin sensitisation, (photo)genotoxicity, mutagenicity, reprotoxicity and endocrine disruption. Therefore, a pilot study was conducted with selected samples of fragrance-based products, such as deodorant, eau de toilette and eau de parfum, with the aim of integrating results from a number of alternative non-animal methods suitable for the detection of the following toxicological endpoints: cytotoxicity (with 3T3 Balb/c fibroblasts); skin sensitisation potential (in chemico method, DPRA); skin sensitisation potential (LuSens in vitro method, based on human keratinocytes); genotoxicity potential (in vitro Comet assay with 3T3 Balb/c cells); and endocrine disruption (in vitro YES/YAS assay). The presence of twenty-four specific known allergens in the products was determined by using GC-MS/MS. The strategies for estimation of the NOAEL of a mixture of allergens, which were proposed by the Scientific Committee on Consumer Products in their 'Opinion on Tea tree oil' document and by the Norwegian Food Safety Authority in their 'Risk Profile of Tea tree oil' report, were used as models for the NOAEL estimation of the mixtures of allergens that were identified in the individual samples tested in this study.

Vaccination against influenza in pregnant women in a maternity hospital in the Czech Republic in the season 2020-2021

OBJECTIVES

Pregnant women are among the priority groups to receive influenza vaccines in the Czech Republic since 2011, data on vaccination coverage are not yet available. The aim of the study was to determine the influenza vaccination coverage (IVC) and provide source data for further activities.

METHODS

A prospective observational study was performed in a large maternity hospital in Prague. The self-completed questionnaire was distributed to 5,475 pregnant women between September 1, 2020 and August 31, 2021. Questions included maternal sociodemographic characteristics, influenza vaccination status and sources of maternal vaccination recommendations during pregnancy.

RESULTS

A total of 4,617 completed questionnaires have been analysed. The median age of study participants (N = 4,592) was 33 years (range: 18-51 years). The majority (69.7%) of women had completed their university education, most women were childless (58.5%) or had one child (32.5%) before the start of the study. Less than 2% of women reported being vaccinated against influenza during their pregnancy (1.5%; 95% CI, 1.1-1.9%). Only 21% of women knew that it's possible to get vaccinated against influenza during pregnancy. Participants considered influenza vaccination in pregnancy as important (3.3%), useful (41.1%) and useless (44.4%). Out of 959 pregnant women who had information about influenza vaccination during pregnancy, only 6.9% were vaccinated, while among those who did not have this information, 0.1% were vaccinated during pregnancy (p < 0.001). The most frequent source of information was Internet, then media and a general practitioner.

CONCLUSIONS

The IVC during pregnancy in our study was extremely low. In order to improve IVC among pregnant women, it is necessary to increase awareness of recommendations and vaccination options among the public and professionals and incorporating vaccination recommendation in routine antenatal practice.

Changes in cognitive function after thoracoscopic and catheter ablation for atrial fibrillation

BACKGROUND

Comparative data regarding the effect of percutaneous and thoracoscopic ablation of atrial fibrillation (AF) on cognitive function are very limited. The aim of the study was to determine and compare the effect of both types of ablations on patient cognitive functions in the mid-term.

METHODS

Patients with AF indicated for ablation procedure were included. Forty-six patients underwent thoracoscopic, off-pump ablation using the COBRA Fusion radiofrequency system, followed by a catheter ablation three months afterward (Hybrid group). A comparative cohort of 53 AF patients underwent pulmonary vein isolation only (PVI group). Neuropsychological examinations were done before and nine months after the surgical or catheter ablation procedure. Neuropsychological testing comprised 13 subtests of seven domains, and the results were expressed as post-operative cognitive dysfunction (POCD) nine months after the procedure.

RESULTS

Patients in both groups were similar with respect to the baseline clinical characteristics; only non-paroxysmal AF was more common in the hybrid group (98% vs. 34%). Major POCD was present in eight (17.4%) of hybrid patients versus three (5.7%) of PVI patients (p = 0.11), combined (major/minor) worsened cognitive decline was present in 10 (21.7%) hybrid patients versus three (5.6%) PVI patients (p = 0.034). On the other hand, combined (major/minor) improvement was present in 15 (32.6%) hybrid patients versus nine (16.9%) patients in the PVI group (p = 0.099).

CONCLUSION

Hybrid ablation, a combination of thoracoscopic and percutaneous ablation, is associated with a higher risk of cognitive decline compared to sole percutaneous ablation.

The influence of meteorological factors on the risk of tick-borne encephalitis infection

OBJECTIVES

The aim of this work was to analyze the relationship between new cases of clinical tick-borne encephalitis (TBE) and various meteorological and seasonal predictors.

MATERIAL AND METHODS

The modelling is based on national data from the Czech Republic for the period 2001-2016 in daily resolution, namely on average temperatures, average relative air humidity and the number of TBE cases classified according to the date of the first symptoms. Four variants of a negative binomial model from the generalized additive model class are used. The basic model relates the occurrence of TBE to the lagged ambient daily average temperature and daily average relative air humidity and their interaction with the lag reflecting the incubation period and other factors. The lag value was estimated via the optimization procedure based on Akaike information criterion. The model also includes the effect of the season and the effect of the day of the week. To increase the biological plausibility, the basic model has been expanded to account for possible time-varying effects of meteorological variables and to incorporate multiple lags.

RESULTS

The most statistically significant effect is the within-year seasonality and then the interaction of the temperature and relative air humidity. The relationship of both meteorological factors and their interactions vary throughout the activities season of the hostquesting Ixodes ricinus. This also changes the conditions of occurrence of the new clinical cases of TBE. The time-varying effect of meteorological factors on the incidence of TBE shows non-trivial changes within a year. In the period before the middle of the calendar year (around the week 22) the effect decreases, then it is followed by an increase until the week 35.

CONCLUSION

Flexible models were developed with quantitatively characterized effects of temperature, air humidity and their interaction, with the delay of the effect estimated through the optimization process. Performance of the model with multiple lags was checked using independent data to verify the possibility of using the results to improve the prediction of the risk of clinical cases of TBE uprise.

Detection of persistent low IgG avidity-an interpretative problem in the diagnosis of acute toxoplasmosis

OBJECTIVES

For the proper diagnosis of toxoplasmosis it is essential to determine the stage of the infection, for which the most preferred method is IgG avidity test. The avidity index (AI) should initially be low (AI≤0.3) in the acute phase and increase during the infection. However, persistent low avidity can occur in patients with latent toxoplasmosis, which can complicate the interpretation of the results. The aim of the study is to explain the causes of this phenomenon.

METHODOLOGY

A retrospective study was carried out with 717 serum samples collected from 442 patients from the categories of pregnant and non-pregnant women, men, and newborns + infants (age < 0.5 year). The trends of AI kinetics were evaluated in repeatedly examined patients. The frequency of cases with low avidity was compared in individual categories of patients and in groups of people with acute and non-acute toxoplasmosis.

RESULTS

The proportion of patients with initially low avidity was 42.1% in the acute toxoplasmosis group while it was 13.0% in the non-acute groups. In uninfected newborns with anti-Toxoplasma antibodies transmitted from the mother, a decrease in IgG avidity levels over time was observed, resulting in 29.2% of samples showing low (improper) avidity. While the dynamics of IgG avidity and the frequency of cases of improperly low avidity were similar in men and pregnant and non-pregnant women, the category of newborns and infants differed substantially for these indicators.

CONCLUSIONS

Due to acceptable specificity and negative predictive value, high avidity can rule out acute toxoplasmosis, but moderate sensitivity complicates the possibility of its confirmation. The results of the avidity test must be interpreted in the context of the results of other methods.

Adaptive Synthesis of Functional Amphiphilic Dendrons as a Novel Approach to Artificial Supramolecular Objects

Supramolecular structures, such as micelles, liposomes, polymerosomes or dendrimerosomes, are widely studied and used as drug delivery systems. The behavior of amphiphilic building blocks strongly depends on their spatial distribution and shape of polar and nonpolar component. This report is focused on the development of new versatile synthetic protocols for amphiphilic carbosilane dendrons (amp-CS-DDNs) capable of self-assembly to regular micelles and other supramolecular objects. The presented strategy enables the fine modification of amphiphilic structure in several ways and also enables the facile connection of a desired functionality. DLS experiments demonstrated correlations between structural parameters of amp-CS-DDNs and the size of formed nanoparticles. For detailed information about the organization and spatial distribution of amp-CS-DDNs assemblies, computer simulation models were studied by using molecular dynamics in explicit water.

Local fresh- and sea-water effects on fog occurrence

Fog is an important atmospheric phenomenon highly relevant to ecosystems and/or the environment. Two essential prerequisites of fog formation are the presence of fog condensation nuclei and water in the atmosphere. The aim of our study was to examine in detail how fog occurrence is influenced by water areas in the immediate vicinity of the fog observation site. We have used as input data long-term observations on fog occurrence measured at 56 professional meteorological stations in Romania in 1981-2017 and GIS-derived information on water areas and on two topographical indices, TWI and TPI, in the neighbourhood of these stations. We formulated three alternative models of different complexity based on a semiparametric generalised additive logistic model for the probability of fog occurrence with potentially nonlinear, smooth effects modelled via penalised splines. A radius of 9 km appeared to be the most influential when considering the water area in a circle around the fog observation station. Based on our results, we concluded that (i) the water area in the vicinity of the station is a factor influencing fog occurrence, (ii) the water's effect differs according to water type (freshwater or seawater proximity), and (iii) GIS-derived topographical indices are informative for the explanation of fog occurrence and their inclusion enhanced the fit of the models substantially. Our findings, based on a reliable long-term data set of fog occurrence and recent GIS-derived data, explored by a relevant statistical approach will enhance further considerations related to fog formation and its environmental consequences.

Carbosilane Glycodendrimers for Anticancer Drug Delivery: Synthetic Route, Characterization, and Biological Effect of Glycodendrimer-Doxorubicin Complexes

The complexity of drug delivery mechanisms calls for the development of new transport system designs. Here, we report a robust synthetic procedure toward stable glycodendrimer (glyco-DDM) series bearing glucose, galactose, and oligo(ethylene glycol)-modified galactose peripheral units. In vitro cytotoxicity assays showed exceptional biocompatibility of the glyco-DDMs. To demonstrate applicability in drug delivery, the anticancer agent doxorubicin (DOX) was encapsulated in the glyco-DDM structure. The anticancer activity of the resulting glyco-DDM/DOX complexes was evaluated on the noncancerous (BJ) and cancerous (MCF-7 and A2780) cell lines, revealing their promising generation- and concentration-dependent effect. The glyco-DDM/DOX complexes show gradual and pH-dependent DOX release profiles. Fluorescence spectra elucidated the encapsulation process. Confocal fluorescence microscopy demonstrated preferential cancer cell internalization of the glyco-DDM/DOX complexes. The conclusions were supported by computer modeling. Overall, our results are consistent with the assumption that novel glyco-DDMs and their drug complexes are very promising in drug delivery and related applications.

Characteristics of homeless persons hospitalized in health care facilities in the Czech Republic in 2006-2015

AIM

Homelessness is a social, societal, economic, and health problem. The aim of the study was to describe the characteristics of hospitalized homeless persons in the Czech Republic in relation to their health status and to propose targeted measures for improvement.

MATERIAL AND METHODS

The study used anonymous data from the National Registry of Hospitalized Patients from 2006-2015, including the primary diagnosis at hospital admission and up to five additional diagnoses according to the 10th revision of the International Classification of Diseases (ICD-10). The basic statistical unit is the completed case of hospitalization of a homeless person in an inpatient health care facility such as hospital or nursing home.

RESULTS

Over the 10-year study period (2006-2015), 3387 homeless persons, 77.5% of them male, were admitted to inpatient health care facilities in the Czech Republic. The length of hospital stay tended to decrease over the years, with a median of six days. The majority of hospitalized homeless persons were aged between 40 and 69 years. Their distribution by type of health care facility: 2,710 (80.0%) were admitted to hospitals, 468 (13.8%) to psychiatric hospitals, 180 (5.3%) to long-term care facilities, and 29 (0.9%) to tuberculosis and respiratory disease hospitals. According to the mode of termination of hospitalization, 2189 (64.6%) homeless persons were discharged to their original environment, 280 (8.3%) were transferred to an after-care facility, 277 (8.2%) were transferred to an acute care facility, 222 (6.6%) left against medical advice, 180 (5.3%) were transferred to another ward, and 80 (2.4%) were transferred to a social care facility. A total of 159 (4.7%) in-hospital deaths occurred. The underlying causes of hospitalization according to ICD-10 were mostly those under Chapter V - Mental and behavioural disorders (19.9%) and Chapter XIX - Injury, poisoning and certain other consequences of external causes (18.1%). Among the 175 cases with a primary diagnosis from Chapter I - Certain infectious and parasitic diseases, the most common conditions were scabies, pediculosis, mycosis, bacterial infections, and tuberculosis.

CONCLUSION

Data on hospital admissions is one of the important tools for monitoring the health of homeless people. They illustrate the seriousness of the situation of homeless people and point to the need to obtain more information on this issue in order to improve the availability of specific health care and social care for sick homeless people. Prevention programs, residential services, and specific outreach health and social activities can contribute to reducing the negative impacts.

Incidence of tuberculosis among HIV-positive persons in the Czech Republic between 2000 and 2020

AIM

The aim is to characterize in more detail the group of HIV-positive persons in the Czech Republic diagnosed with tuberculosis (TB) in 2000-2020.

MATERIAL AND METHODS

Data sources were mainly the national online TB register (RTBC), which is part of the information system of the Public Health Service, and the national electronic register of HIV-positive persons (RHIV) maintained by the National Reference Laboratory for HIV/AIDS of the National Institute of Public Health.

RESULTS

Of 3,763 TB cases reported to the RHIV since 1985 and 16,212 TB cases reported to the RTBC since 2000, 91 occurred in 88 HIV-positive persons (69 males and 22 females) between 2000 and 2020. Sixty-five (74%) of the 88 HIV-positive persons were foreign born. Twenty-six per cent of TB cases were screened for HIV. The mean age of patients with TB/HIV coinfection was 35 years. The largest number of coinfected persons (35 cases) were from the capital city of Prague. Pulmonary TB was detected in 84 cases. Ninety-two per cent of the TB cases were bacteriologically confirmed, and 10 cases were multidrug-resistant TB. At the time of TB diagnosis, the median CD4+ lymphocyte count was 91.5 cells per mm3 of blood. TB was the most common reason for HIV testing in the analysed cohort (23 cases). The most common mode of HIV transmission was sexual intercourse (heterosexual in 39 cases and homosexual in 13 cases). Treatment success at 12-month follow-up was only recorded in 32% of cases of culture-positive pulmonary TB in HIV-positive patients.

CONCLUSIONS

TB/HIV co-infection remains a serious health concern, especially in the foreign-born residents of the Czech Republic. Of foreign-born persons with TB, 42% were tested for HIV over the 21-year study period, with their percentage increasing over the years. Almost 6% of them tested HIV positive. The most relevant finding is that treatment success was only recorded for less than one third of HIV-positive persons with culture-positive pulmonary TB and that every fourth patient with TB/HIV died before or during TB treatment.

What risk factors affect hospitalisation for confirmed pertussis cases among infants in the Czech Republic?

BACKGROUND

We estimated what risk factors affect hospitalisation for confirmed pertussis cases among infants (child up to 1 year) in the Czech Republic based on data from the questionnaire-based enhanced surveillance system (ESS) in years 2015, 2017 and 2019.

METHODS

Retrospective cohort study was conducted in which we assessed demographic, clinical data, vaccination status and risk/protective factors. Vaccination status was extracted from the electronic nationwide notification system (NNS). We performed descriptive, univariable and multivariable analysis using risk ratio (RR) and logistic regression with odds ratio (OR).

RESULTS

A total of 104 confirmed cases (27, 13, 64) were reported in the ESS during 2015, 2017 and 2019. Most cases were in age group 1 month (24), more males (57). Fifteen cases were vaccinated and 89 unvaccinated. Of 88 hospitalised cases, 31 cases reported stay in Intensive Care Unit (ICU). The median length of hospitalisation was 8 days. Although the variable vaccinated in infants was statistically significant in a univariable analysis for outcome hospitalisation, RR 0.76 (95% CI 0.53-1.10), it was not in multivariable. Hospitalisation was strongly associated with the younger age group of 0-3 months adjusted by a smoking family member in a household (OR = 9.72; 95% CI: 2.97-31.81). Stay in ICU was strongly correlated with the younger age group of 0-3 months (OR = 5.07; 95% CI: 1.44-17.87) and with a contact with confirmed or probable pertussis (OR = 7.05; 95% CI: 1.36-36.52).

CONCLUSIONS

Our study demonstrated younger age and contact with other pertussis case as risk factors for hospitalisation of infants with pertussis. It is necessary to consider adolescent and adult boosters, including vaccination during pregnancy. We suggest integrating the variables from the enhanced surveillance system into the nationwide notification system, in order to simplify the data reporting and evaluation. Further studies are needed to evaluate the ESS and to monitor the vaccination of pregnant women against pertussis.

Transport of Anions across the Dialytic Membrane Induced by Complexation toward Dendritic Receptors

A novel approach to inducing anion transport over the dialytic membrane was proposed and successfully tested using the dihydrogen phosphate anion. The anion receptor based on isophthalamide was anchored on a dendritic skeleton, resulting in a macromolecular structure with a limited possibility to cross the dialytic membrane. The dendritic receptor was placed in a compartment separated from a mother anion solution by a membrane. The resulting anion complexation reduced the actual concentration of the anion and induced the anion transfer across the membrane. The anion concentration in mother solution decreased, while it was found to be increased in the compartment with the dendritic receptor. This phenomenon was observed using dendritic receptors with four and eight complexation sites. A detailed analysis of a series of dialytic experiments by ¹H NMR spectroscopy enabled an assessment of the complexation behavior of both receptors and an evaluation of the dendritic effect on the anion complexation.

Terrain and its effects on fog occurrence

Fog is a very complex phenomenon, relevant to both atmospheric physics and chemistry, contributing to the atmospheric inputs of both nutrients and pollutants to the environment. Fog occurrence is affected by numerous factors. The aim of this study is to examine the effects of terrain on fog occurrence. Namely, we studied in detail how altitude, slope and landform influence the probability of fog occurrence using the generalized additive model. In particular, we investigated how different explanatory variables might modify (deform) the trend and the seasonal component of the probability of fog occurrence. We used long-term records of daily fog occurrence measured in 1981-2017 at 56 professional meteorological stations in Romania, reflecting different environments and geographical areas. The altitude of the sites under review ranged between 13 and 2504 m above sea level, the coverage of localities at different altitudes being highly uneven. Out of the terrain variables considered, the most decisive influence was found to be altitude. We have included information on slope and landform, which refined and bettered the basic model. Our model results indicated a significant decrease in the probability of fog occurrence over the examined period. The behaviour of fog differed according to the altitude, the most profound effects being observed for ground-level fog and fog above flat terrain. The probability of fog occurrence at different altitudes varied mostly in summer and autumn, whereas it was very similar in winter.

Influence of air temperature and implemented veterinary measures on the incidence of human salmonellosis in the Czech Republic during 1998-2017

Background

The aim of our study was to analyse the influence of air temperature and implemented veterinary measures on salmonellosis incidence in the Czech Republic (CZ).

Methods

We conducted a descriptive analysis of salmonellosis as reported to the Czech national surveillance system during 1998–2017 and evaluated the influence of applied veterinary measures (started in January 2008) on salmonellosis incidence by comparing two 9-year periods (1998–2006, 2009–2017). Using a generalized additive model, we analysed association between monthly mean air temperature and log-transformed salmonellosis incidence over the entire twenty-year period.

Results

A total of 410,533 salmonellosis cases were reported during the study period in the CZ. Annual mean incidences of salmonellosis were 313.0/100,000 inhabitants before and 99.0/100,000 inhabitants after implementation of the veterinary measures. The time course of incidence was non-linear, with a sharp decline during 2006–2010. Significant association was found between disease incidence and air temperature. On average, the data indicated that within a common temperature range every 1 °C rise in air temperature contributed to a significant 6.2% increase in salmonellosis cases.

Conclusions

Significant non-linear effects of annual trend, within-year seasonality, and air temperature on the incidence of salmonellosis during 1998–2017 were found. Our study also demonstrates significant direct effect of preventive veterinary measures taken in poultry in reducing incidence of human salmonellosis in the CZ. The annual mean number of salmonellosis cases in the period after introducing the veterinary measures was only 32.5% of what it had been in the previous period.

COVID-19 reinfections

Reports of SARS-CoV-2 reinfections are on the rise. This study focused on reinfections in patients with confirmed COVID-19 in the Czech Republic. Between 1 March 2020 and 9 November 2020, 362 084 cases with the onset of symptoms before 31 October 2020 were reported. Overall, 28 cases of symptomatic SARS-CoV-2 reinfections were identified, 11 in males and 17 in females, age range 25-80 years, median age 46 years. The interval between the first and second episodes of the disease ranged from 101 to 231 days, and the median interval was 201.5 days. During both symptomatic episodes, all patients have been tested by RT-PCR. Altogether 26 patients (92.9%) have been tested negative after recovery from the first episode of COVID-19. Symptomatic reinfections occurred in nearly 0.2% of all patients at risk. Most patients with reinfection had mild symptoms in both episodes, and only three episodes were moderate to severe. Thus, reinfections may have been underdiagnosed. In summary, COVID-19 reinfections are possible and not exceptional.

Monitoring the dynamics of clinical and laboratory markers of chronic heart failure during 12 months of sacubitril/valsartan treatment

AIM

Treatment with sacubitril/valsartan (S/V) significantly improves cardiovascular morbidity, mortality, quality of life and prolongs the survival of chronic heart failure patients with reduced ejection fraction. The aim of the study was to evaluate changes in ejection fraction, NT-proBNP and glomerular filtration after 12 months of sacubitril/valsartan treatment.

METHODS

30 patients (28 men) with chronic heart failure with reduced ejection fraction, functional classes NYHA II-III, EF LK &lt; 40%, NT-proBNP (&gt; 450 ng/l), with glomerular filtration &gt; 0.5 ml/s/1.73 m2, with a potassium &lt; 5.4 mmol/l were classified in the study. S/V treatment was started at systolic blood pressure &gt; 100 mmHg. Ejection fraction, glomerular filtration rate and NT-proBNP values were compared before treatment and after 12 months of S/V treatment. The number of hospitalizations and deaths was also monitored.

RESULTS

During 12 months of S/V treatment there was a significant improvement in left ventricular ejection fraction (median initial 26.3%, after treatment 36.3%, difference 7.5%, p.

Trends in ambient O3 concentrations at twelve sites in the Czech Republic over the past three decades: Close inspection of development

Ambient or ground-level ozone (O₃), a key player in atmospheric chemistry, has been studied extensively throughout the world in recent decades due to its harmful effects on human health and the environment. The aim of this study is to examine in detail the time patterns of O₃ in the Czech Republic, a Central European country with a long-term history of ambient air pollution. We have examined the interplay between annual trends and within-a-year seasonality in daily O₃ concentrations at twelve stations representing different environments, geographical regions and altitudes in the Czech Republic in 1993-2018. We base our analysis on a generalised additive model (GAM) framework as a modern regression approach suitable for addressing non-linear trend shapes in a formalised and unified way. In particular, we use penalised splines. The inconsistent behaviour of the stations prior to 1998, two local maxima around 2003 and 2006 and a steady increase in O₃ at all sites from 2014 to the present are the main features of our study. A seasonality O₃ pattern with a clear maximum in May-June is similar for all stations. In parallel with the O₃ concentration changes over the years, the deformation of seasonality profiles over a long period of time occurs, resulting in a shift of the peak O₃ concentrations towards later days in the year. Our statistical modelling offers a detailed view of both long-term trend and seasonality components separately. Additionally, in a model with trend*seasonality interaction, we are able to study the gradual deformation of the seasonality profile over the years. Capsule: Our analysis of daily mean O₃ concentrations at twelve Czech sites in 1993-2018 revealed a steady increase in O₃ from 2014 and deformation of the seasonality O₃ profiles over the year.

Biomonitoring of PFOA, PFOS and PFNA in human milk from Czech Republic, time trends and estimation of infant's daily intake

BACKGROUND

Perfluoralkylated substances (PFASs) are persistent and bioaccumulative environmental contaminants. They are included on the list of emergent compounds monitored in the frame of HBM4EU project.

OBJECTIVES

To analyze PFASs levels in human milk samples collected in the period 2006 through 2017, to follow their time trends, to assess the PFASs exposure in breastfed infants, to calculate the daily intake of PFASs and to compare it with the tolerable daily/weekly) intakes and to quantify risk from exposure using the hazard quotient and hazard index approach.

MATERIAL AND METHODS

A broad spectrum of PFASs were analyzed by means of UHPLC-MS/MS in primipara human milk samples collected in four consecutive time periods 2006, 2010/11, 2014, and 2017; N = 46, 183, 164 and 232, respectively. Mothers living in urban and suburban residences were recruited after their delivery at maternity hospitals, and milk samples were taken within 2 and 8 weeks after delivery. The questionnaire was focused on possible sources of exposure, dietary habits and lifestyle.

RESULTS

Only perfluorooctane sulfonate (PFOS) and perfluorooctanoid acid PFOA (in 2017, also perfluorononanoic acid (PFNA)) were quantified in more than 90% of analyzed human milk samples. In all sampling periods, the levels of PFOA were higher than those of PFOS (p < 0.05). A significant downward temporal trend (p < 0.001) was observed for both PFOA and PFOS levels. The median concentrations in sampling years 2006, 2010/11, 2014, and 2017 were 0.075, 0.059, 0.035, and 0.023 ng/mL for PFOA and 0.045, 0.031, 0.029, and 0.020 ng/mL for PFOS, respectively. In 2017, PFNA was also quantified in 99% of samples with the median concentration of 0.007 ng/mL. The levels of PFASs correlated with maternal sea fish consumption. No maternal age-related relationship was observed. Using the tolerably daily intake (TDI) values for PFOS and PFOA set by the European Food Safety Authority (EFSA) in 2008, the calculated daily intakes from breastfeeding were clearly below these limits. Using the new, more conservative EFSA Provisional Tolerably Weekly Intake (PTWI) values set in 2018, we demonstrated a considerable exceedance of PTWI, with a hazard index above 1.

CONCLUSION

Significant time-related decreasing trends in the PFOS and PFOA levels in human milk were observed. Nevertheless, the body burden of infants from breastfeeding might pose an enhanced health risk to infants when the current PTWI values are applied. These findings strongly support the present EU efforts to phase out PFOA, its salts and PFOA related compounds. Since PFOS exposure there has still been widely detected despite PFOS usage reduction measures, the major exposure routes should be further monitored and, if possible, eliminated.

Long-term trends in fog occurrence in the Czech Republic, Central Europe

Fog is a very important and complex atmospheric phenomenon of the utmost importance for the environment and for human society. For practical reasons, fog occurrence is observed regularly at meteorological stations worldwide. Decreasing trends in fog frequency reported from numerous regions have been often associated with either decreasing pollution or climate change, including increasing temperature and changes in atmospheric circulation. We have examined the data on fog occurrence from twelve Czech sites representing different environments (urban, rural, mountain), geographical areas, and altitudes across the country. For our analysis we used long-term records from the time period of 1961-2018, covering both the ambient air's heavily polluted periods of the 1970s and 1980s and the cleaner period, following the adoption of new, more stringent legislation and effective countermeasures after the 1990s. We applied a generalised additive model (GAM) framework as a flexible, semiparametric regression approach to address nonlinear trend shapes in a formalised and unified way. In particular, we employed a penalised spline approach with cross-validated penalty coefficient estimation. Our study confirmed non-linear behaviour for both year-to-year trends and annual seasonality. Our results showed further that over the analysed, almost sixty-year period, fog occurrence has decreased significantly at all the examined sites, though the pattern of the long-term change differed among individual sites. Moreover, we have found significant seasonality in fog occurrence, though it is different at individual sites. Furthermore, apart from the overall annual fog probability change over the years, at some sites the fog's seasonal profile has also deformed substantially over the long term.

Cross-sectional study on vaccination coverage in newly diagnosed HIV-infected persons in the Czech Republic

OBJECTIVES

Individuals with HIV infection are at an increased risk for a number of infectious diseases, some of which are preventable by vaccination. Unfortunately, little is known about the attitudes of this population group to vaccination, therefore, we decided to find out vaccination coverage against 5 infections among newly diagnosed HIV-infected patients in the Czech Republic.

METHODS

This cross-sectional study was conducted on newly diagnosed patients who started their follow-up care at the HIV Clinic of Na Bulovce Hospital during the two following years. Vaccination history data and results of serological tests were collected from all participants.

RESULTS

Enrolled were 269 HIV-positive subjects (94.1% males) with a mean age of 34.4 years, 64 subjects (23.8%) had tertiary education, 229 (85.1%) were men having sex with men, 32 (11.9%) were heterosexual, and 8 (3.0%) were injection drug users. The mean CD4+ T-lymphocyte count was 556.2/µL, with 149 persons (55.4%) who had a CD4+ T-lymphocyte count &gt; 500/µL, and 68 (25.3%) individuals were late presenters with CD4+ T-lymphocyte count &lt; 350/µL. A vaccination against tetanus was reported by 262 subjects (97.4%), against influenza by 18 subjects (6.7%), against tick-borne encephalitis by 18 subjects (6.7%), against viral hepatitis A by 78 persons (29.0%), and against hepatitis B by 104 subjects (38.7%). For influenza, tick-borne encephalitis and hepatitis A, a significant positive impact of tertiary education was found (p-values &lt; 0.001-0.044). Vaccination coverage against both types of hepatitis was significantly lower in late presenters (p = 0.044 and p = 0.004, respectively).

CONCLUSIONS

Vaccination rates found in our cohort were except tetanus and hepatitis B in young people low, especially for influenza and tick-borne encephalitis. Higher level of education and less advanced HIV infection were associated with higher vaccination rates. To improve this unsatisfactory situation, more attention should be paid to vaccination.

High serological response to Cryptosporidium-specific antigens in the Czech Republic and its association with water supply

A survey was conducted in the Czech Republic to determine whether serological responses to the 15/17-kDa and 27-kDa Cryptosporidium antigens had changed since the end of the communist era and if these responses were associated with drinking water sources. Sera from 301 blood donors residing in six areas served by various sources of drinking water were analysed by Western Blot (mini-immunoblots) to measure the IgG response. The intensity of response and percentage of persons with a strong response to the 27-kDa, but not the 15/17-kDa, antigen were higher than found 20 years earlier. A strong response to both the 15/17- and 27-kDa-antigens was higher than reported in other countries, and the probability of persons having a strong response was greater in areas with surface water sources than river-bank infiltration. Few cases of cryptosporidiosis were reported in spite of these high responses to Cryptosporidium antigens. These responses suggest a chronic low-level exposure from several sources that may be affording protection against symptoms and illness. Although strong serological responses were associated with surface water sources, drinking water is not likely to be the most important exposure for Cryptosporidium in the Czech Republic.

Carbosilane Dendron-Peptide Nanoconjugates as Antimicrobial Agents

Over the last decades, multidrug-resistant bacteria have emerged and spread, increasing the number of bacteria, against which commonly used antibiotics are no longer effective. It has become a serious public health problem whose solution requires medical research in order to explore novel effective antimicrobial molecules. On the one hand, antimicrobial peptides (AMPs) are regarded as good alternatives because of their generally broad-spectrum activities, but sometimes they can be easily degraded by the organism or be toxic to animal cells. On the other hand, cationic carbosilane dendrons, whose focal point can be functionalized in many different ways, have also shown good antimicrobial activity. In this work, we synthetized first- and second-generation cationic carbosilane dendrons with a maleimide molecule on their focal point, enabling their functionalization with three different AMPs. After different microbiology studies, we found an additive effect between first-generation dendron and AMP3 whose study reveals three interesting effects: (i) bacteria aggregation due to AMP3, which could facilitate bacteria detection or even contribute to antibacterial activity by preventing host cell attack, (ii) bacteria disaggregation capability of second-generation cationic dendrons, and (iii) a higher AMP3 aggregation ability when dendrons were added previously to peptide treatment. These compounds and their different effects observed over bacteria constitute an interesting system for further mechanism studies.

Childhood respiratory allergies and symptoms in highly polluted area of Central Europe

The study investigated the associations between the prevalence of the childhood respiratory diseases and the long-term exposure to air pollution in the burdened area of Moravian-Silesian Region in the Czech Republic. The health data were collected during 2014 in 7,239 children 5, 9, 13 and 17 years of age. Exposure to PM₁₀ and NO₂ in the residence addresses was based on dispersion models and GIS based traffic-related indicators. PM₁₀ levels were positively associated with both lifetime (OR 1.35; 95%CI 1.09-1.67) and current (OR 1.32; 95%CI 1.05-1.67) allergic rhinitis; current asthma was associated negatively. The associations between traffic indicator and respiratory health were not found. On the other hand, marked positive associations were found between the respiratory diseases and symptom severity structured into ordinal variables, and PM₁₀ and NO₂. Modelled long-term exposure to air pollution was associated with childhood allergic rhinitis and deterioration of the respiratory symptoms.

A novel PSMA/GCPII-deficient mouse model shows enlarged seminal vesicles upon aging

BACKGROUND

Prostate-specific membrane antigen (PSMA), also known as glutamate carboxypeptidase II (GCPII), is an important diagnostic and therapeutic target in prostate cancer. PSMA/GCPII is also expressed in many healthy tissues, but its function has only been established in the brain and small intestine. Several research groups have attempted to produce PSMA/GCPII-deficient mice to study the physiological role of PSMA/GCPII in detail. The outcomes of these studies differ dramatically, ranging from embryonic lethality to production of viable PSMA/GCPII-deficient mice without any obvious phenotype.

METHODS

We produced PSMA/GCPII-deficient mice (hereafter also referred as Folh1^-/- mice) by TALEN-mediated mutagenesis on a C57BL/6NCrl background. Using Western blot and an enzyme activity assay, we confirmed the absence of PSMA/GCPII in our Folh1^-/- mice. We performed anatomical and histopathological examination of selected tissues with a focus on urogenital system. We also examined the PSMA/GCPII expression profile within the mouse urogenital system using an enzyme activity assay and confirmed the presence of PSMA/GCPII in selected tissues by immunohistochemistry.

RESULTS

Our Folh1^-/- mice are viable, breed normally, and do not show any obvious phenotype. Nevertheless, aged Folh1^-/- mice of 69-72 weeks exhibit seminal vesicle dilation, which is caused by accumulation of luminal fluid. This phenotype was also observed in Folh1^+/- mice; the overall difference between our three cohorts (Folh1^-/- , Folh1^+/- , and Folh1^+/+ ) was highly significant (P < 0.002). Of all studied tissues of the mouse urogenital system, only the epididymis appeared to have a physiologically relevant level of PSMA/GCPII expression. Additional experiments demonstrated that PSMA/GCPII is also present in the human epididymis.

CONCLUSIONS

In this study, we provide the first evidence characterizing the reproductive tissue phenotype of PSMA/GCPII-deficient mice. These findings will help lay the groundwork for future studies to reveal PSMA/GCPII function in human reproduction.

Prevalence and the role of CCR5Δ32 heterozygosity in disease progression in HIV positive patients in the Czech Republic

BACKGROUND

Entry of human immunodeficiency virus type 1 (HIV-1) in target cells is enabled by CD4 receptor and one of two co-receptors, CXCR4 or CCR5. Deletion of 32 bp in CCR5 gene (CCR5Δ32) in both alleles provides strong but not absolute resistance to HIV-1 infection and deletion in one allele slows disease progression to AIDS. Here, we analyzed the prevalence and the role of CCR5Δ32 heterozygosity on the disease progression in HIV positive patients in the Czech Republic.

PATIENTS AND METHODS

A total of 92 HIV-1 seropositive subjects that included 80 Czech individuals from the AIDS center in the Hospital Na Bulovce in Prague were enrolled in CCR5 genotyping as a part of a study of the role of HIV fitness on disease progression. DNA was extracted from patient’s peripheral blood mononuclear cells and subjected to real-time PCR with specific probes detecting wild-type and 32 bp-deleted CCR5 variants. A subgroup of 74 antiretroviral therapy-naive patients with more than one year of follow-up was used to determine the role of the CCR5Δ32 heterozygous phenotype in disease progression.

RESULTS

CCR5Δ32 was found heterozygous in 23.8% of 80 Czech HIV-1 seropositive individuals which is very similar to 21% and 24% prevalence reported in HIV negative Czech population. Homozygous mutant variant was not detected. In CCR5Δ32 heterozygous group we observed slightly higher mean CD4+ T-cell count and lower mean plasma viremia levels.

CONCLUSIONS

Overall, our study indicates no obvious benefit of CCR5Δ32 heterozygosity on HIV transmission and only small benefit on disease progression in the Czech HIV-1 cohort.

Congenital anomalies in children born in the Czech Republic in 1994-2015

ÚVOD Populace je v sou&#269;asné vystavena r&#367;zným zevním vliv&#367;m, ze kterých mohou vyplývat i r&#367;zná zdravotní rizika. Jedním z mo&#382;ných je i riziko vzniku vrozené vady (VV). Z hlediska studia zdravotního stavu populace je d&#367;le&#382;itá znalost nejen pr&#367;m&#283;rných celkových incidencí VV, ale i p&#345;ípadných zm&#283;n t&#283;chto incidencí v pr&#367;b&#283;hu &#269;asu. Incidence VV je pova&#382;ována za jeden ze základních kvalitativních ukazatel&#367; popula&#269;ních i medicínských (1). Nelze opomenout ani hledání potenciálních rizik vedoucích ke zvý&#353;ené pravd&#283;podobnosti výskytu VV. T&#283;mito riziky mohou být ne&#382;ádoucí vlivy zevního prost&#345;edí nebo faktory biologicko-sociální (v&#283;k &#382;en, jejich onemocn&#283;ní aj). Podíl jednotlivých typ&#367; VV u narozených d&#283;tí se v &#269;ase m&#283;ní, obdobn&#283; jako struktura p&#345;í&#269;in úmrtí. Z hlediska epidemiologického je nutné hodnotit incidence VV a jejich zm&#283;ny p&#345;edev&#353;ím z pohledu jednotlivých diagnóz. B&#283;hem posledních let se intenzita VV v &#268;esku m&#283;nila. U n&#283;kterých typ&#367; se &#269;etnost v novorozenecké populaci sni&#382;uje díky úsp&#283;&#353;né prenatální diagnostice, u jiných diagnóz naopak &#269;etnost u narozených d&#283;tí stoupá (2). Krom&#283; prenatální diagnostiky se v&#353;ak na výsledné &#269;etnosti VV v populaci mohou uplat&#328;ovat i dal&#353;í vlivy. Jedním z nich m&#367;&#382;e být i zlep&#353;ení, zrychlení a zkvalitn&#283;ní postnatálních diagnostických mo&#382;ností - p&#345;edev&#353;ím zavedení a rozvoj ultrazvukové diagnostiky (3). Úsp&#283;&#353;nost prenatální diagnostiky a &#269;etnost VV u narozených jsou rovn&#283;&#382; významným ukazatelem prenatální a perinatální pé&#269;e, p&#345;e&#382;ívání d&#283;tí narozených s VV pak ukazatelem pé&#269;e postnatální (p&#345;edev&#353;ím neonatální a chirurgické). Registrace vrozených vad má v &#268;eské republice dlouhou tradici - Národní registr vrozených vad zahájil svou &#269;innost ji&#382; p&#345;ed více ne&#382; p&#367;lstoletím, v roce 1964 (4).   METODIKA Retrospektivní epidemiologická studie vyu&#382;ívá oficiální data z Národního registru vrozených vad vedeného v rámci Registru reproduk&#269;ního zdraví v Ústavu zdravotnických informací a statistiky &#268;R (ÚZIS). Analyzovány byly incidence jednotlivých diagnóz vrozených vad (kódy Q00-Q99) u narozených d&#283;tí z celého území &#268;eské republiky za &#269;asové období 1994-2015. Incidence VV byly analyzovány pro ob&#283; pohlaví, a to jak celkov&#283; (pro celou skupinu diagnóz VV), tak i dle základních diagnostických skupin Mezinárodní klasifikace nemocí (MKN).   VÝSLEDKY V období 1994-2015 se dle údaj&#367; ÚZIS &#268;R narodilo v &#268;eské republice celkem 87 359 d&#283;tí s vrozenou vadou zji&#353;t&#283;nou do 1 roku &#382;ivota. Z tohoto celkového po&#269;tu bylo 51 315 chlapc&#367; a 36 030 dívek. U 14 p&#345;ípad&#367; nebylo pohlaví známé / zji&#353;t&#283;no. Vývoj po&#269;tu diagnostikovaných p&#345;ípad&#367; ukazují p&#345;ehledn&#283; první t&#345;i grafy (obr. 1-3), zvlá&#353;&#357; pro chlapce, dívky a celkov&#283;. V relativních po&#269;tech to bylo za celé sledované období pr&#367;m&#283;rn&#283; 385,4 na 10 000 &#382;iv&#283; narozených d&#283;tí: nejmén&#283; 242,5 v roce 1994, nejvíce pak 448,3 v roce 2011. V p&#345;ípad&#283; &#382;iv&#283; narozených chlapc&#367; to bylo nejmén&#283; 263,6 v roce 1994, nejvíce pak 533,3 v roce 2011; pr&#367;m&#283;rná hodnota &#269;inila 440,6 na 10 000. U &#382;iv&#283; narozených dívek byla pr&#367;m&#283;rná hodnota za sledované období 327,1 na 10 000 ; nejni&#382;&#353;í hodnota 220,1 byla zaznamenána op&#283;t v roce 1994, nejvy&#353;&#353;í hodnota 380,9 v roce 2003. Grafy na obr. 4-6 ukazují relativní po&#269;ty na 10 000 &#382;iv&#283; narozených v pr&#367;b&#283;hu sledovaného období, op&#283;t zvlá&#353;&#357; pro chlapce, dívky a celkov&#283;. Dal&#353;í &#269;ást na&#353;í analýzy se v&#283;novala zm&#283;nám v pr&#367;b&#283;hu sledovaného období pro jednotlivé skupiny diagnóz dle rozd&#283;lení v Mezinárodní klasifikaci nemocí, 10. verze (tab. 1). various types of congenital anomalies are changing during the time according to different factors. Three main factors are methodical changes of the registration process, improvement of prenatal diagnostics and the real changes of incidences of selected diagnoses. While in the previous time period (till 1993) the registry included only selected diagnoses of congenital anomalies, in the new period (starting 1994) the registry includes all diagnoses of congenital anomalies from the ICD-10 classification. We can also see the difference in the incidences from 1994-1999 and 2000-2015 time period. The reason for this difference is the methodical change of registration, the Registry of congenital anomalies also receives the notifications about possible anomalies from the report of newborn (even when the report of congenital anomaly was not sent). As for the prenatal diagnostics - we may analyse possible changes of incidences - if the specific defect can be diagnosed prenatally.

Revisiting fog as an important constituent of the atmosphere

We examined observation-based fog occurrence at three Czech monitoring sites: Praha 4 - Libuš, Košetice and Churáňov, representing different environments - urban, rural and mountain - over a time span of 27 years (1989-2015). We searched for a simple model describing fog occurrence fitting the observed air pollution and meteorological data. For our analysis we used a generalized additive model, GAM, with (penalized) spline components to capture possible nonlinear and a priori unknown functional relationships. In order to cope with the binary nature of the data (indicators of fog presence on individual days), we employed a logistic regression GAM model fitted by a maximizing penalized likelihood (where the penalty coefficients were estimated via cross-validation). After testing several physically motivated models, being guided by AIC and physical interpretation of the components, we arrived at a model which uses the following explanatory variables: relative humidity, ambient SO₂ concentrations, ambient NO_x concentrations, air temperature and seasonality. All associations between the response and the analysed explanatory variables were highly significant. According to our results, the most important explanatory variables modelling the fog probability were relative humidity and air pollutants. Interestingly, we observed an increasing trend in fog occurrence at all three sites under review starting around the mid 2000s.

CAPSULE

The most important explanatory variables modelling the fog probability at three Central European sites were humidity, SO₂ and NO_x. An increasing trend in fog occurrence has been observed since the mid 2000s.

Cross-sectional study on sensitization to mite and cockroach allergen components in allergy patients in the Central European region

Background

The major sources of allergens in the indoor air include house dust mites, dander derived from domestic animals and rodents, cockroach, and several fungi. Mites are the main cause of allergies in some countries with a warmer climate, but the epidemiological significance of mite and cockroach allergens in Central Europe has not been established yet.

Methods

We assessed sensitization profiles of allergy patients in a Central European region in regard to sensitization to mites and cockroach. We used molecular diagnosis by means of the microarray ISAC, and we investigated 1766 patients with clinical suspicion to an allergic disorder. 1255 of them were positive to at least one allergen component, and this group was subjected to statistical analysis.

Results

The sensitization to at least one mite-specific molecule (Der p 1, 2, Der f 1, 2) was observed relatively frequently in 32.7% of patients. Specific IgE to mite group 2 molecules is almost fully cross-reactive. Group 1 allergens are also cross-reactive, but in some patients, a species-specific response was observed. Relatively high rate of sensitization both to group 1 and 2 allergens in our patients indicates the greater role of co-sensitizations. Isolated sensitizations to molecules derived from glyciphagid mites Lep d 2 and/or Blo t 5 without sensitization to other mite-derived molecules were observed only exceptionally (in 0.6% of cases). True sensitization to at least one cockroach-specific molecule (Bla g 1, 2, 5) was very rare (in 0.6% of cases), and nearly all of them were co-sensitizations with other noncockroach-derived molecules. Sensitization to an inhaled tropomyosin was observed rarely in 2.2% of patients (Der p 10 in 1.9% and Bla g 7 in 1.5%). Co-sensitization of inhaled tropomyosins with the respective mite- or cockroach-specific molecules was observed only in the minority of patients suggesting the different route of sensitization being more frequent.

Conclusions

The majority of patients are co-sensitized to several molecules of the respective allergen source. The knowledge of this molecular spectrum of sensitization is important for optimal diagnosis and treatment in respect to allergen content in mite extracts used for diagnostic and therapeutic purposes. In regard to the sensitization patterns of Central European patients, it is necessary to point out the importance of quantifying at least three major mite components Der f 1, Der p 1 and Der f 2 (or Der p 2).

A serological study of antibodies to Anaplasma phagocytophilum and Borrelia burgdorferi sensu lato in the sera of healthy individuals collected two decades apart

Sera collected from healthy individuals from the general population in the Czech Republic during repeated cross-sectional surveys were analyzed. Samples collected in the same six districts in two time periods, 1978-1989 and 2001, were compared. The study subjects were divided into six age categories between 10 and 59 years. Overall, 434 samples from 1978-1989 and 270 samples from 2001 were screened for Anaplasma phagocytophilum (AP) and Borrelia burgdorferi sensu lato (BB). The anti-AP positivity rates were 13.1% and 11.5% in the first and second period, respectively, and did not differ significantly between the periods (P = 0.559). The anti-BB antibodies were detected in 33.9% and 14.8% of study subjects, respectively. The positivity rates were significantly lower in the second period (P<0.001). No considerable changes were observed in the sex distribution of positive findings between the two periods. The highest positivity rates of anti-AP antibodies were found in the 10-14 year age group: 16.0% in 1978-1989 and 16.7% in 2001. The age distribution of the anti-AP antibody positivity rates did not change substantially (P = 0.872). In 1978-1989, the lowest anti-BB antibody positivity rate (26.7%) was found in the 10-14 year age group, with a gradual increase with age to 41.1% in 50-59 year-olds. In 2001, the positivity rate in the 10-14 year age group was 26.2% and was not significantly different from that in the first period (P = 0.955). However, the positivity rates in the older age groups 15-59 years decreased significantly (P<0.001) and varied between 8.3% and 15.1%.

Increased Relative Risk of Tick-Borne Encephalitis in Warmer Weather

Tick-borne encephalitis (TBE) is a serious acute neuroinfection of humans caused by a tick-borne flavivirus. The disease is typically seasonal, linked to the host-seeking activity of Ixodes ricinus (predominantly nymphs), the principal European tick vector species. To address the need for accurate risk predictions of contracting TBE, data on 4,044 TBE cases reported in the Czech Republic during 2001-2006 were compared with questing activity of I. ricinus nymphs monitored weekly at a defined location for the same 6-year period. A time shift of 21 days between infected tick bite and recorded disease onset provided the optimal model for comparing the number of cases of TBE with numbers of questing nymphs. Mean annual distribution of TBE cases and tick counts showed a similar bimodal distribution. Significantly, the ratio of TBE cases to questing nymphs was highest in the summer-autumn period even though the number of questing nymphs peaked in the spring-summer period. However, this pattern changed during a period of extreme meteorological events of flooding and abnormally high temperatures, indicating that changes in climate affect the incidence of TBE. Previous studies failed to link human behavior with changes in incidence of TBE but showed extrinsic temperature impacts arbovirus replication. Hence, we hypothesize the apparent discrepancy between peak nymphal tick activity and greatest risk of contracting TBE is due to the effect of temperature on virus replication in the tick vector. Relative proportions of questing nymphs and the numbers of weeks in which they were found were greater in summer-autumn compared with spring-summer at near-ground temperatures >5°C and at standard day and weekly average temperatures of >15°C. Thus, during the summer-autumn period, the virus dose in infected tick bites is likely greater owing to increased virus replication at higher microclimatic temperatures, consequently increasing the relative risk of contracting TBE per summer-autumn tick bite. The data support the use of weather-based forecasts of tick attack risk (based on daytime ambient temperature) supplemented with weekly average temperature (as a proxy for virus replication) to provide much-needed real-time forecasts of TBE risk.

Generic versus Disease-specific Instruments in Quality-of-life Assessment of Chronic Obstructive Pulmonary Disease

Objectives: Chronic respiratory diseases may alter a patient’s social life and well-being. Measures of health-related quality of life have been proven to bring complementary information to functional assessments. The aim of the study was to describe the questionnaires that are most frequently used to measure this subjective construct in patients with chronic obstructive pulmonary disease (COPD) and to compare the responses obtained via administering one generic (SF-36) and one disease-specific questionnaire (St. George’s Respiratory Questionnaire; SGRQ) to patients with COPD.

Methods: One group of patients (46 individuals) was used to evaluate the questionnaire’s performance in repeated administrations under unchanged conditions (reproducibility) and to study the correlations of corresponding domains of respective questionnaires. Responsiveness of both questionnaires was tested on another group of 129 patients measured before and after the therapeutic stay at the spa. Methods of cor-relational analysis (Spearman, intraclass, and canonical correlation coefficients) as well as the Wilcoxon rank test were used for statistical analysis.

Results: Both questionnaires seem to be comprehensive outcome measures for patients with COPD, but some particular areas may not be covered with the same intensity (e.g. emotional problems). Reproducibility of both questionnaires was good and only small non-significant shifts were seen, particularly in physical and social functioning domains. In repeated measurement, the SGRQ seemed to be slightly more responsive to change than the SF-36.

Conclusions: The idea of using generic and disease-specific questionnaires together probably represents the best approach to this topic. It may improve our knowledge and explain better the relationship between disease-specific changes in patient status and both disease-specific treatment and general functional status.

Comparison of the epidemiological patterns of Lyme borreliosis and tick-borne encephalitis in the Czech Republic in 2007-2016

BACKGROUND

Lyme borreliosis (LB) and tick-borne encephalitis (TBE) are two vector-borne diseases transmitted by ticks. Both diseases are endemic and have been reported in all regions of the Czech Republic including urban agglomerations, but in varying proportions. Because of the natural conditions in the border areas, the risk of infection is also high for travelers from the neighboring countries such as Austria, Germany, Poland, and Slovakia.

MATERIALS AND METHODS

To gain more information on the epidemiology of LB and TBE in the last decade, we analyzed national surveillance data from 2007 to 2016.

RESULTS

Incidence of LB in the Czech Republic was 37.3/100,000 population and year (27.6 - 46.1/100,000). Incidence of TBE incidence was 5.7/100,000 (3.4-8.2/100,000) and declined although the trend was not significant (p = 0.155). Difference between the incidences of LB and TBE was increasing in time. Overall male-to-female ratio was 0.84 and 1.51 for LB and TBE, respectively. The age-specific incidences of both infections have a typical two-peak shape, with the first peak in the age group 5-9 years for LB and 15-19 years for TBE. The second peak for both LB and TBE is in the age group 55-64 years. TBE poses a considerable risk to children < 15 years. Among 39,074 cases of LB, the most common clinical manifestations were erythema migrants 62.1% and Lyme neuroborreliosis 25.1%. All 5969 TBE cases manifested itself by affecting nervous system, namely meningo-encephalitis 47.9%, meningoencephalomyelitis 21.8% and meningitis 19.8%.

CONCLUSIONS

The data evidence the high chance risk of infection with LB and TBE in the Czech Republic. The incidence of both infections shows a bimodal distribution during the year. LB cases are five to six times as frequent as TBE cases. Over the last years, the incidence of LB has remained roughly stable while TBE has shown a downward trend. The present study is unique in allowing the comparison of the incidence rates of LB and TBE over time and space.

Urinary Cadmium and Cotinine Levels and Hair Mercury Levels in Czech Children and Their Mothers Within the Framework of the COPHES/DEMOCOPHES Projects

The COPHES/DEMOCOPHES twin project was performed in 2011-2012 in 17 European countries to harmonize all steps of the human biomonitoring survey. Urinary cadmium, cotinine, phthalate metabolites, and hair mercury were measured in children (N = 120, 6-11 years) and their mothers of reproductive age, living in urban or rural areas. Cadmium in mothers' and children's urine was detected at a geometric mean (GM) concentration 0.227 and 0.109 μg/L, respectively; 95th percentile (P95) was 0.655 and 0.280 μg/L in mothers and children, respectively. No age-related, education-related, or urban versus rural differences were observed within the frame of each population group. Cadmium urinary level in mothers was about twofold compared with children. Higher levels were obtained in all smoking mothers but not in occasionally smoking or mothers and children exposed to environmental tobacco smoke (ETS). Mercury values in mothers were significantly higher in urban than in rural populations but not in children. GM and P95 for mercury in children's hair were 0.098 and 0.439 μg/g and in mothers' hair were 0.155 and 0.570 μg/g. Concentrations for mercury in the Czech samples were lower than European average. Hair mercury increased significantly with consumption of fish or seafood and with number of amalgam tooth fillings (in children). A positive association was found with family educational level. No influence of age was observed. Urinary cadmium and hair mercury levels were lower than health-based guidelines with one exception. High levels of urinary cotinine were found in the 12 smoking mothers (GM approximately 500 μg/L); lower levels in occasionally smoking mothers, N = 11 (34.5 μg/L). The mean cotinine levels in nonsmoking mothers who reported daily exposure to ETS was 10.7 μg/L. A similar mean value (10.8 μg/L) was obtained in six children who had daily exposure to ETS. In children without exposure to ETS, the mean cotinine level was 1.39 μg/L urine. Cotinine in the urine of children demonstrates limited protection of the Czech children against exposure to ETS.

Urine Levels of Phthalate Metabolites and Bisphenol A in Relation to Main Metabolic Syndrome Components: Dyslipidemia, Hypertension and Type 2 Diabetes. A Pilot Study

AIM

Human exposure to organic pollutants (some of them also called endocrine disruptors) can be associated with adverse metabolic health outcomes including type 2 diabetes. The goal of this study was to compare the urine levels of bisphenol A and phthalate metabolites in subgroups of patients with metabolic syndrome composed of patients with and without three important components of metabolic syndrome (hypertension, dyslipidemia and diabetes).

METHODS

We have investigated 24 hr urine samples of 168 patients with metabolic syndrome from the Metabolic Outpatient Department of General University Hospital in Prague. Using standard metabolic syndrome criteria, we classified patients as dyslipidemic (n=87), hypertensive (n=96), and type 2 diabetic (n=58). Bisphenol A and 15 metabolites of phthalates were evaluated in relation to creatinine excretion. Samples were analysed with enzymatic cleavage of glucuronide using ultra-high-performance liquid chromatography-electrospray ionization tandem mass spectrometry in one laboratory with external quality control.

RESULTS

Four metabolites, mono-n-butyl phthalate, mono-(2-ethyl-5-hydroxyhexyl) phthalate, mono-(2-ethyl-5-oxohexyl) phthalate, and mono-(2-ethyl-5-carboxypentyl) phthalate showed significantly higher levels in diabetic compared to non-diabetic patients (p<0.001, p=0.002, p=0.002, and p=0.005, respectively). The differences remained significant after adjustment to hypertension, dyslipidemia, age, and BMI. No difference was found between either the hypertensive and non-hypertensive or dyslipidemic and non-dyslipidemic patients. There was no significant relation of bisphenol A level to diabetes, hypertension, dyslipidemia, age, and BMI.

CONCLUSIONS

Urine levels of four phthalate metabolites were significantly higher in type 2 diabetics independently on specified predictors. Phthalate levels can be in relation to beta cell dysfunction in type 2 diabetic patients but this study is not able to show if the relation is causal.

Detection of Borrelia burgdorferi sensu lato and Anaplasma phagocytophilum in questing ticks Ixodes ricinus from the Czech Republic

The aim of the present study is to compare the prevalence of Borrelia burgdorferi sensu lato (s.l.) and Anaplasma phagocytophilum in questing ticks by using molecular methods from spring to autumn 2007. A total of 526 Ixodes ricinus ticks were collected from vegetation in three different sampling sites, representing an urban area (city park), a suburban area (village) and a natural montane habitat. The prevalence of B. burgdorferi s.l. was 17.3% (7.5% in males, 18.7% in females and 20.2% in nymphs), while 4.4% of ticks (13.1% of males, 3.7% of females and 1.6% of nymphs) tested positive for A. phagocytophilum. We found higher rates of Anaplasma infection in ticks from the urban area (8.6%) than from the suburban (0.8%) and natural (1.6%) habitats in the spring months. The prevalence of Borrelia infection in the urban park increased significantly from spring (14% in March) to autumn (50% in October). The Anaplasma positivity in the urban area in the autumn months (2.2%) was significantly lower than in the spring and summer months (9.6%). The prevalence of A. phagocytophilum was significantly higher in male ticks than in females and nymphs. For B. burgdorferi s.l., the inverse was true. We conclude that infection risks associated with the presence of Anaplasma and Borrelia in ticks in cities may be comparable to those in natural ecosystems or may be even higher. Our results indicate the need for the surveillance of tick-borne pathogens in urban areas.

[The prevalence of antibodies against Hepatitis E Virus in the Czech Republic: serological survey]

AIM

To determine the prevalence of antibodies against hepatitis E virus in the general population of the Czech Republic of age 15 to 64, to analyse the age and sex distribution of these antibodies, and to evaluate the benefit of the immunoblot test for the confirmation of the specificity of the enzyme immunoassay (EIA) screening test.

MATERIAL AND METHODS

Sera from the last available multipurpose serological survey conducted in 2001 were tested. Anti-HEV IgG was detected by the RecomWell HEV IgG EIA test (Mikrogen Diagnostik, Germany). The immunoblot assay RecomLine HEV IgG/IgM (Mikrogen Diagnostik, Germany) was used for confirmation.

RESULTS

Using the RecomWell IgG EIA test, anti-HEV IgG reactivity was found in 115 (6.7%) of 1715 sera. No significant difference in the anti-HEV IgG reactivity was found between men 58 (6.9%) and women 57 (6.6%). The prevalence of anti-HEV IgG increased with age from 3.5% in the age group 15-24 years to 16.8% in 55-64-year-olds.

CONCLUSIONS

The prevalence of hepatitis E IgG antibodies determined in the serological survey in the age group 15-64 years was 6.7%. Recalculated for the general population of the Czech Republic, the prevalence was 8.6%. The prevalence of anti-HEV antibodies increased with age, reaching a peak of 16.8% in the age group 55-64 years. The prevalence was not significantly different between men and women. Using the immunoblot RecomLine IgG test for the confirmation of the specificity of the screening test in the seroprevalence study was not of clear benefit.

Phosphonium carbosilane dendrimers for biomedical applications – synthesis, characterization and cytotoxicity evaluation

Phosphonium carbosilane dendrimers could represent an alternative to ammonium ones in gene therapy applications with high potential of mitochondrial targeting.

Neuroborreliosis in patients hospitalised for Lyme borreliosis in the Czech Republic in 2003 - 2013

STUDY OBJECTIVE

The objective was to analyse and evaluate a cohort of Lyme borreliosis (LB) patients with neuroborreliosis (LNB) hospitalised in the Czech Republic in 2003-2013.

MATERIAL AND METHODS

Data analysed in this study were obtained from the National Register of Hospitalised Patients, which is a nationwide population register maintained at the Institute of Health Information and Statistics of the Czech Republic. Data collection from all departments of bed care establishments are regularly processed every year. Registration of basic hospitalisation diagnoses is performed in accordance with the 10th revision of the International Classification of Diseases (ICD-10). The study cohort consisted of 23,631 patients with clinically and laboratory confirmed LB hospitalised between 2003 and 2013.

RESULTS

Nervous system involvement, i. e. LNB (ICD-10 codes G00-G99) was recorded in 27.1% (6,392) of LB patients. Hospital admissions for LB exhibited a slight downward trend with year-on-year fluctuations over the study period. In contrast, LNB showed an upward trend with slight year-on-year fluctuations (345-779 cases) (p = 0.003). Overall, 6,392 persons, 3,220 males and 3,172 females, were diagnosed with LNB over the 11-year study period. Some patients presented with multiple concomitant neurological symptoms. Overall, 6,392 hospitalised patients were diagnosed with 8,168 diseases of the nervous system. The most common diagnoses were facial nerve disorders (21.1%), meningitis (18.3%), polyneuropathies (13.6%), encephalitis, myelitis, and encephalomyelitis (11.3%), and nerve root and plexus disorders (4.9%). The average age of male and female patients hospitalised with LNB was 44.4 and 44.7 years, respectively. It varied significantly between the ICD-10 code groups (p < 0.001) from 38.0 to 63.0 years. The relative incidence of LB by five-year age group showed the first peak at the age of 5-9, followed by a considerable drop at the age of 20-24 and then by another higher peak at the age of 55-59 (the hospitalisation rate ratio comparing the peaks in the adults and children was 1.78). For LNB, the second peak shifted to the age of 65 to 74 years and was similar to the peak in children age groups (hospitalisation rate ratio of 0.95). The distribution of hospital admissions for LNB by month of admission showed the highest numbers of admissions in July and September and the lowest numbers of admissions in December and April. The length of hospital stay was significantly higher (mean of 12.4 days and median of 13 days) in LNB patients (p < 0.001) than in other LB patients (mean of 10.3 days and median of 10 days).

CONCLUSION

The basic prerequisite for reliable diagnosis of LNB is a multidisciplinary collaboration of highly experienced neurologists, infection disease specialists, and microbiologists. The cohort of 6,392 patients hospitalised for LNB was analysed by gender, length of hospital stay, and month of hospital admission. The study found LNB cases to occur in all age groups. LNB diagnosis performed in accordance with the ICD-10 enables valid comparison between neurological outcomes of LB patients at both the national and international levels.

Exposure and risk assessment of the Czech population to chlorinated pesticides and polychlorinated biphenyls using archived serum samples from the period 1970 to 1990

The serum samples from the years 1970-1990 archived at the temperature of -20°C in the biobank primarily intended for serological survey performed in the CR since 1960 were pooled and analyzed for DDT, its metabolites, HCB, HCHs, and indicator PCB congeners using up-to-date GC/MS/MS methods to retrospectively assess health risks according to current health guidelines. Samples were pooled based on the decade of sampling, age, gender, and three geographical areas; in adults, one pooled samples consisted of ten and in children of twenty individual samples. Altogether 233 pooled samples were analyzed. For all organochlorine pesticides (OCPs), significant downward trends were observed in the period 1970-1990 (p<0.001). The levels of HCB exceeded the Biomonitoring Equivalent (BE) value. The hazard quotient (HQ) in Prague and Ostrava during the 1970s and 1980s was about 40 and in the 1990s it had dropped to about five. In Uherské Hradiště, the HQ in 1975 was one order of magnitude higher (about 170), and had decreased to approximately 12 by 1987. For both HCB and the DDT sum, the BE-related carcinogenic risk of actual concentrations in the past exceeded significantly the individually accepted cancer risk level of 10(-4). The levels of the main PCB congeners in the 1970s through 1990s revealed an upward time trend in all analyzed strata. The highest concentrations were found in the serum of residents from the hot-spot area Uherské Hradiště. Critical PCB sum concentration levels (700ng/g lipid for vulnerable population groups and 1800ng/g lipid for other population groups) were substantially exceeded with an increasing time trend. PCB sum had exceeded HBM II values of 7μg/L of serum since 1980 in all age strata. In conclusion, the body burden of the Czech general population relative to persistent organic pollutants (POPs) in the period 1970 through 1990 significantly exceeded currently existing health based limit values. The past exposure might adversely affect the health status of the Czech population.