Prevalence of HEV RNA in Croatian blood donors

OBJECTIVES

HEV infection is asymptomatic for immunocompetent blood donors (BD). Transfused HEV-infected blood products may cause potentially hazardous HEV infection in immunocompromised patients. Evaluation of the need for routine BD HEV RNA screening primarily demands the establishment of HEV infection prevalence in Croatian BD.

MATERIALS AND METHODS

We tested BD samples in ID-NAT with the Procleix UltrioPlex E screening test for simultaneous detection of HBV DNA, HCV RNA, HIV-1,2 RNA, and HEV RNA (Grifols, Spain). HEV infection was confirmed with HEV RNA quantitative test (Altona Diagnostics, Germany) and HEV IgM and HEV IgG antibody test (DIA.PRO Diagnostic Bioprobes, Italy). We analysed the HEV RNA sequence and performed a phylogenetic analysis. We recorded BD's anamnestic data and dietary habits. BDs gave follow-up samples after two months and did not donate blood for six months.

RESULTS

Between December 2021 and March 2022, we tested 8,631 donations and found four HEV RNA-positive donations, which equals to one in 2,158 donations (0.046 %, 95 % confidence interval, 0.018 %-0.119 %). Confirmatory HEV RNA testing gave results from negative to 4.73E + 3 IU/ml HEV RNA. Three donations were in the serological window period. We have genotyped HEV RNA of two infected BD as genotype HEV-3c. Blood donors didn't report any health problems and their diet included pork. Testing on follow-up samples presented seroconversion and no HEV RNA could be detected.

CONCLUSION

The incidence of HEV RNA infection in BD in Croatia corresponds with other European data. The decision on implementation of HEV NAT screening in Croatia needs an expert team evaluation of the possible risk of TT-HEV infection.

Prenatal RHD genotyping in Croatia: preliminary results

OBJECTIVES

Croatian Institute of Transfusion Medicine (CITM) implemented non-invasive fetal RHD genotyping as a request for targeted antenatal anti-D prophylaxis. The diagnostic performance of in-house RT-PCR method for fetal RHD genotyping and preliminary results are analyzed.

MATERIALS AND METHODS

Evaluation included results of RHD genotyping for 205 RhD negative pregnant women, 12-36th week of gestation, whose samples were received in period between 2015 and 2020. QIAsymphony SP DSP Virus Midi Kit was used for cffDNA extraction on QIAsymphony SP platform (Qiagen, Germany). Fragments of RHD exons 7 and 10 and later exon 5 were RT-PCR amplified. As internal controls, amplification of SRY gene or RASSF1A fragment and β-actin genes digested with BsTUI were used.

RESULTS

We identified 70.72% (145/205) positive and 28.78% (59/205) negative fetal RHD genotypes. We had one inconclusive result (0.50%) due to the interference of maternal DNA with variant genotype RHD*09.02.00/01/*01N.01. When compared to newborns RhD phenotypes, no false negative and three false positive results (3/199, 1.50%) were observed. The test yielded 100% sensitivity and 95.08% specificity, while diagnostic accuracy was 98.48%. We were able to determine one case of fetal variant genotype RHD*04.04/*01N.01 inherited from the father. The negative and positive predictive test values were 100% and 97.86%, respectively.

CONCLUSION

Automated cffDNA extraction and RT-PCR amplification of fetal RHD exons 5,7,10 and fragments of SRY, RASSF1A genes represents highly reliable system for determining fetal RHD status which enables targeted antenatal anti-D prophylaxis. To obtain high specificity of cffDNA extraction, strict and thoroughly cleaning procedures are required.

Combined multichannel intraluminal impedance-pH monitoring should be used to diagnose reflux-related otitis media with effusion in children

AIM

This study investigated the diagnostic usefulness of combined multichannel intraluminal impedance-pH monitoring (MII-pH) in children with suspected reflux-related otitis media with effusion (OME) as existing data were scarce.

METHODS

This was a prospective study that included children up to seven years of age who underwent MII-pH due to OME lasting more than three months. The study was conducted in the Children's Hospital Zagreb, Croatia, from January 2014 to August 2016.

RESULTS

The study comprised 63 children (63% male) with a mean age of 4.7 years. Gastroesophageal reflux (GER) disease was detected by impedance in 22 (35%) of the children and by pH-metry in nine (14%). In children with OME, MII-pH found a median number of 24 proximal GER episodes, of which a median of nine was acidic and a median of 11 was weakly acidic. There was a significant positive correlation between the number of GER episodes and the presence of eosinophils in nasal swabs.

CONCLUSION

Both acidic and weakly acidic refluxes seemed to play a significant role in the pathogenesis of OME. Localised nasal eosinophilia may serve as a marker of extraoesophageal reflux in children with suspected reflux-related OME.

Therapeutic efficacy of azithromycin and acetylcysteine in chronic otitis media with effusion

Otitis media with effusion (OME) is a common disease in childhood. There is no consensus on the optimal therapeutic option for OME. Considering the known efficacy of acetylcysteine (AC) and azithromycin (AZ) in the treatment of middle ear mucosa, the aim of the study was to assess their efficacy in the management of chronic OME. The study included 90 children with OME, both ears. They are divided into three groups of 30 children. Group 1 (AC) patients were treated with acetylcysteine per os, 3 × 100 mg, for 3 weeks; group 2 (AZ) with body weight adjusted dose of azithromycin for 3 days; and group 3 (AC + AZ) with a combination of acetylcysteine and azithromycin at doses described above. Three measurements were performed. On second measurement, tympanogram improvement was recorded in 45% of 60 ears in group I, 53.3% of 60 ears in group II, and 61.7% of 60 ears in group III. The percentage of improvement was highest in group III. Although between-group differences did not reach statistical significance, the results obtained appear to be clinically relevant. In conclusion, conservative therapy for chronic OME is reasonable. Although study results don't have a strong statistical differences and may not refer clinical improvement results suggest that this combination of drugs (antibiotics, bronchosecretolytics) can be useful in the treatment of OME.

The importance of combined 24-hour multichannel intraluminal impedance-pH monitoring in the evaluation of children with suspected laryngopharyngeal reflux

OBJECTIVE

The aim of this study was to investigate the diagnostic usefulness of combined multichannel intraluminal impedance-pH (MII-pH) monitoring in children with suspected laryngopharyngeal reflux (LPR).

DESIGN, SETTING AND PARTICIPANTS

A prospective study including children in whom, due to LPR suggestive symptoms, MII-pH monitoring was performed at tertiary medical centre from February 2012 to July 2015.

INTERVENTIONS

All included children underwent same diagnostic protocol which included examination by single pulmonologist and ENT specialist and underwent 24-hour MII-pH monitoring.

MAIN OUTCOMES

Primary outcome was to determine MII-pH characteristics of the children in whom LPR was suspected based on symptoms and ENT examination.

RESULTS

One hundred and four patients (mean age 8.9 years; range 0.4-17.9 years; male/female 57/47) participated in the study. In children with signs and symptoms suggestive of LPR, MII-pH monitoring found the median incidence of proximal gastro-oesophageal reflux (GER) of 15 (range 0-129), proximal acidic GER of 6.5 (range 0-66) and weakly acidic GER of 5 (range 0-102). There were significant positive correlations between the number of GER (proximal total, acidic and weakly acid) with Reflux Finding Score, Reflux Symptom Index and presence of eosinophils in nasal swabs. The only endoscopy ENT finding which significantly correlated with total proximal GER, acid proximal GER and weakly acidic proximal GER was arytenoid hyperaemia.

CONCLUSION

Both acid and non-acid reflux seem to have a significant role in the pathogenesis of LPR.

Application of the procedural consolidation concept to surgical treatment of children with epidermolysis bullosa: a retrospective analysis

Aim

To assess the efficacy of the procedural consolidation concept (PCC) at reducing the number of sessions of general anesthesia necessary for treating children with epidermolysis bullosa (EB).

Methods

We examined the records of children treated at Children's Hospital of Zagreb between April 1999 and December 2007. Children treated before the introduction of PCC in January 2005 (n = 39) and after (n = 48) were analyzed in order to determine the effect of PCC on the occurrence of complications, days of hospitalization, and number of hospitalizations.

Results

During the study period, 53 patients underwent 220 sessions of general anesthesia for a total of 743 surgical interventions per session. Before the introduction of PCC (n = 39 patients, 83 sessions), the median number of interventions per session was 2 (range 1-5), and after the introduction of PCC (n = 48 patients, 137 sessions) it was 4 (range 3-7, P < 0.001). After the introduction of PCC, the median number of complications per anesthesia session increased from 2 (range 0-10) to 3 (range 0-10) (P = 0.027), but the median number of complications per surgical procedure decreased from 1 (range 0-10) to 0.6 (range 0-2.5) (P < 0.001). PCC lengthened each anesthesia session from a median of 65 minutes (range 35-655) to 95 minutes (range 50-405), (P < 0.001). Total length of hospitalization was similar before (median 1, range 1-4) and after (median 1, range 1-3) introduction of PCC (P = 0.169). The number of hospitalization days per procedure was 3 times lower after the introduction of PCC (median 0.3, range 0.2-3) than before (median 1, range 0.75-1.7) (P < 0.001).

Conclusion

PCC should be considered an option in the surgical treatment of children with EB.

Identification and characterization of potential autochthonous starter cultures from a Croatian "brand" product "Slavonski kulen"

The microbial population of a traditional Croatian fermented sausage "Slavonski kulen" was isolated, identified and subjected to technological and functional characterization in order to select potential autochthonous functional starter cultures. Dominant microflora were lactic acid bacteria (LAB), followed by staphylococci. Identification of isolated lactobacilli showed domination of Leuconostoc mesenteroides and Lactobacillus acidophilus while Staphylococcus xylosus and Staphylococcus warneri outnumbered the staphylococcal microbiota. Most of the isolated LAB and Staphylococcus species displayed good growth in the presence of 5% of NaCl and at 12, 18 and 22°C. All LAB and most of the staphylococci possess proteolytic activity and only Staphylococcus xylosus had lipolytic activity. All lactobacilli and staphylococci isolates produced significant concentrations of lactic acid (as determined by HPLC) and showed antimicrobial activity against pathogenic test microorganisms. Dominant LAB and Staphylococcus species displayed growth in the presence of 1% bile. Most of the staphylococci and all of lactobacilli showed sensitivity to all antibiotics tested.

Inherited epidermolysis bullosa - the spectrum of complications

Epidermolysis bullosa is a group of inherited diseases that are characterized by skin and mucosal fragility and blister formation. A wide variety of extracutaneous manifestations can develop as well as various complications of the disease such as severe anemia, growth retardation, esophageal stenosis, mutilating deformities of hands and feet, glomerulonephritis leading to chronic renal failure, and many others. One of the most important and often occurring complications is the development of cutaneous squamous cell carcinomas that grow and metastasize quickly. The objective of this paper is to give dermatologists a review of major complications encountered in patients with epidermolysis bullosa. Since these complications occur so often and can be considered to be part of the clinical picture, it is mandatory to develop a multidisciplinary well-educated team involved in follow-up and treatment of these patients.

Respiratory tract involvement in a child with epidermolysis bullosa simplex with plectin deficiency: a case report

We report a rare case of a child with epidermolysis bullosa simplex (EBS) with plectin deficiency but without muscular dystrophy, with severe lesions of the oral cavity, oropharyngeal, hypopharyngeal, laryngeal, tracheal and bronchial mucosa. Case report and a review of the world literature are used. The literature review revealed only five similar patients with EBS without muscular dystrophy complicated by respiratory involvement. This paper highlights the potentially serious complications of the EB in the form of breathing, swallowing and speech difficulties and describes the specific problems encountered in the treatment of this patient. Epidermolysis bullosa (EB) is a group of severe hereditary diseases, primarily of the skin, but which can also involve the respiratory and gastrointestinal tract mucosa. Respiratory tract involvement is usually only found in certain types of EB. The oral cavity and oropharynx are involved more frequently than the hypopharynx, larynx and trachea. Involvement of laryngeal and tracheal mucosa is generally associated with an increased morbidity and mortality, numerous complications and therapeutic difficulties, and is more common in junctional EB and dystrophic EB than in EBS. We present a rare case of a child with EBS and plectin deficiency with pronounced lesions of respiratory tract mucosa from the oral cavity to the bronchi and even extending into the trachea. Deciding on tracheotomy requires thorough consideration and should not be taken lightly.

Severe psychomotor retardation in a boy with a small supernumerary marker chromosome 19p

We describe the clinical case of a nine-year-old boy with psychomotor retardation and a small supernumerary marker chromosome (sSMC) present in mosaic form. Fluorescence in situ hybridization (FISH) using centromere cross-hybridizing probes D1/5/19Z (pZ5.1), the whole chromosome paint probe 19, pool YACs19p (839B1, 872G3, 728C8), and pool YACs19q (767C4, 761C1, 786G6) demonstrated that the sSMC was derived from chromosome 19p. Based on GTG-banding and FISH analyses, the patient's karyotype was interpreted as: 47,XY,+mar.ish der(19) (:p13.3-->p11:)(839B1+, 872G3+,728C8+, D1/5/19Z+) de novo[52]/46,XY[48]. To our knowledge, only two other similar cases have been reported. This case helps to better delineate karyotype-phenotype correlations between sSMC 19p and associated clinical phenomena.

Clinical validation of bronchial hyperresponsiveness, allergy tests and lung function in the diagnosis of asthma in persons with dyspnea

The aim of the study was to determine the most useful tests for decision making in the diagnosis of asthma in patients with dyspnea assessed by commonly used terms: sensitivity, specificity, positive and negative predictive values and diagnostic accuracy. In a group of 195 patients with dyspnea data were analyzed with respect to case histories and different diagnostic procedures: bronchial hyperresponsiveness (BHR), skin prick tests (SPT), total IgE, spirometry (FEV1), sputum eosinophils (SE) and blood eosinophilia (BE). Asthma was diagnosed in 141 subjects. The control group comprised 18 subjects. Sensitivity for BHR in asthma in subjects with dyspnea amounted to 97%, for SPT to 62%, while all other diagnostics were lower than 50%. Specificity was highest for SE (94%), and BHR (85%). Positive predictive value (PPV) in asthma was for BHR 94%, for SE 86%, for SPT 81%, for decreased FEV1 79%, total IgE 72% and BE 64%. The highest negative predictive value (NPV) was found for BHR (92%). Diagnostic accuracy was highest for BHR 93% and for SPT 62%, while all other tests were comparable or lower than 50%. It is not possible to conclude whether or not a person has asthma merely on the basis of data on skin sensitization to aeroallergens, total IgE, eosinophils or lung function tests. Bronchial hyperresponsiveness showed the highest values for sensitivity (97%), PPV (94%), NPV (92%) and accuracy (93%). The second most efficient test is the skin prick test, with PPV 81% and diagnostic accuracy 62%.

[Correlation of the size of the residual volume measured by whole body plethysmography and the single breath helium dilution method]

The value of residual volume, intrathoracic gas volume, functional residual capacity and total lung capacity obtained by the method of body plethysmography and helium dilution method was correlated by single-breath diffusing capacity. These parameters were correlated in 22 patients who had had complete functional diagnostics of the lung: spirometry, flow volume curve, body plethysmography and single-breath diffusing capacity. All findings were within normal limits, which was a condition for selection of patients for our group. Statistically significant differences (p = 0.01) of t-test were established between residual volumes by the plethysmographic and helium dilution method of single-breath diffusing capacity. The residual volume obtained by body plethysmography showed higher values for 526 ml, or 30%. The intrathoracic gas volume showed higher values for 682 ml, or 17%. Inspite of the fact that values of RV obtained by two methods had statistically significant differences, they were still within normal limits, if presented as percent of the predicted value.

[The frequency of bacteriuria in pregnancy]

The authors present the results of a bacteriological urine analysis of 1774 pregnant women controlled in the Gynecological Dispensary Pesćenica in Zagreb. In 2824 examined urine specimens sterile urinocultures were found in 67.6% and bacteriuria in 32.4%. Significant findings of bacteriuria were recorded in 10.5% and insignificant ones in 21.9% of the specimens. The most common bacteria were E. coli (45.24%), then Staphylococcus albus epidermidis (17.4%), Staphylococcus pyogenes aureus (14.64%), Proteus mirabilis (9.39%), and Enterococcus (5.24%). Urine specimens were taken by the dip slide method. A rather high percentage of significant asymptomatic bacteriurias (10.5%) suggests the early detection and therapy in urinary infections as the best prevention of pyelonephritis gravidarum and gestosis. A routine bacteriological urine analysis in pregnant women should be one of the factors included in prenatal care.