Agnieszka Kieltyka

Prenatal Exposure to Airborne Polycyclic Aromatic Hydrocarbons and Children's Intelligence at 5 Years of Age in a Prospective Cohort Study in Poland

Background In this prospective cohort study of Caucasian mothers and children in Krakow, Poland, we evaluated the role of prenatal exposure to urban air pollutants in the pathogenesis of neurobehavioral disorders. Objectives The objective of this study was to investigate the relationship between prenatal polycyclic aromatic hydrocarbon (PAH) exposure and child intelligence at 5 years of age, controlling for potential confounders suspected to play a role in neurodevelopment. Methods A cohort of pregnant, healthy, nonsmoking women was enrolled in Krakow, Poland, between 2001 and 2006. During pregnancy, participants were invited to complete a questionnaire and undergo 48-hr personal air monitoring to estimate their babies’ exposure, and to provide a blood sample and/or a cord blood sample at the time of delivery. Two hundred fourteen children were followed through 5 years of age, when their nonverbal reasoning ability was assessed using the Raven Coloured Progressive Matrices (RCPM). Results We found that higher (above the median of 17.96 ng/m3) prenatal exposure to airborne PAHs (range, 1.8–272.2 ng/m3) was associated with decreased RCPM scores at 5 years of age, after adjusting for potential confounding variables (n = 214). Further adjusting for maternal intelligence, lead, or dietary PAHs did not alter this association. The reduction in RCPM score associated with high airborne PAH exposure corresponded to an estimated average decrease of 3.8 IQ points. Conclusions These results suggest that prenatal exposure to airborne PAHs adversely affects children’s cognitive development by 5 years of age, with potential implications for school performance. They are consistent with a recent finding in a parallel cohort in New York City.

Lack of association between measles-mumps-rubella vaccination and autism in children: a case-control study.

Objective: The first objective of the study was to determine whether there is a relationship between the measles-mumps-rubella (MMR) vaccination and autism in children. The second objective was to examine whether the risk of autism differs between use of MMR and the single measles vaccine. Design: Case-control study. Study Population: The 96 cases with childhood or atypical autism, aged 2 to 15, were included into the study group. Controls consisted of 192 children individually matched to cases by year of birth, sex, and general practitioners. Methods: Data on autism diagnosis and vaccination history were from physicians. Data on the other probable autism risk factors were collected from mothers. Logistic conditional regression was used to assess the risk of autism resulting from vaccination. Assessment was made for children vaccinated (1) Before diagnosis of autism, and (2) Before first symptoms of autism onset. Odds ratios were adjusted to mothers age, medication during pregnancy, gestation time, perinatal injury and Apgar score. Results: For children vaccinated before diagnosis, autism risk was lower in children vaccinated with MMR than in the nonvaccinated (OR: 0.17, 95% CI: 0.06–0.52) as well as to vaccinated with single measles vaccine (OR: 0.44, 95% CI: 0.22–0.91). The risk for vaccinated versus nonvaccinated (independent of vaccine type) was 0.28 (95% CI: 0.10–0.76). The risk connected with being vaccinated before onset of first symptoms was significantly lower only for MMR versus single vaccine (OR: 0.47, 95% CI: 0.22–0.99). Conclusions: The study provides evidence against the association of autism with either MMR or a single measles vaccine.

Serum interleukin-6 predicts cortisol release in acute stroke patients

Altered hypothalamo-pituitary-adrenal axis was reported in stroke patients; however, mechanisms responsible for this phenomenon are barely understood. Acute cerebral ischemia triggers interleukin-6 (IL-6) release into blood. Circulating IL-6 can stimulate hypothalamo-pituitary-adrenal axis. The goal of our study was to assess a relationship between serum IL-6 and cortisol in acute ischemic stroke. Twenty two patients with ischemic stroke and 17 controls were included. Serum samples were collected on the 2nd day of stroke at 6:00, 10:00 18:00, 22:00 h and at the same time points in control group. Cytokines and cortisol levels were measured using ELISA method. Serum IL-6 and cortisol levels were higher in stroke patients than in controls. Cortisol displayed diurnal variations in both stroke patients and controls. In contrast with control subjects, serum IL-6 levels did not display diurnal variations in stroke patients. In stroke patients, but not in controls, IL-6 level correlated significantly with cortisol level and morning serum IL-6 level independently predicted evening/night cortisol level. In conclusion, brain ischemia could stimulate IL-6 release in blood and in this way modulate hypothalamo-pituitary-adrenal axis.

Reduced prefrontal N-acetylaspartate in stroke patients with apathy

BACKGROUND Although substantial numbers of stroke patients suffer from apathy, its causes are still poorly understood. Previous studies suggest that dysfunction of the frontal lobes is implicated in the pathophysiology of motivation. Our aim was to investigate the association between proton magnetic resonance spectroscopy (H1-MRS) measurements in unaffected frontal lobes and apathy in a group of first-time stroke patients. METHODS 31 patients with a first-time ischemic stroke located outside the frontal lobes and 20 healthy subjects were included in the study. The authors performed single voxel H1-MRS in order to measure the N-acetylaspartate/creatine (NAA)/Cr, glutamate+glutamine (Glx)/Cr, choline (Cho)/Cr and myo-inositol (mI)/Cr ratios in the frontal lobes. Patients were assessed between days 7 and 12 post stroke. Diagnosis of apathy was made on the basis of clinical observation, interview and Apathy Scale. RESULTS 13 out of 31 patients (42%) demonstrated apathy. Patients with apathy had lower NAA/Cr ratios in the right frontal lobe than non-apathetic subjects. The patient group was divided into two subgroups: Those with left hemisphere strokes, and those with right hemisphere strokes. Of these subjects, significantly lowered NAA/Cr ratios were found in the right hemispheres of apathetic patients in the subgroup with left-sided brain lesions. CONCLUSIONS These findings point to the association between apathy and frontal lobe integrity, suggest different reactions of the hemispheres and indicate that changes in the NAA/Cr ratio are related to the apathy.

Prenatal polycyclic aromatic hydrocarbon (PAH) exposure, antioxidant levels and behavioral development of children ages 6–9 ☆

PURPOSE Prenatal polycyclic aromatic hydrocarbon (PAH) exposure has been shown to increase DNA adduct levels and to affect neurodevelopment. Micronutrients may modify the adverse effect of PAH on neurodevelopment. Thus, we examined if micronutrient concentrations modified the association between PAH exposure and neurodevelopmental outcomes. METHODS 151 children from a birth cohort who had micronutrient concentrations measured in cord blood and completed the Child Behavioral Checklist (CBCL), between the ages of 6 and 9 years, were evaluated. Prenatal airborne PAH exposure was measured by personal air monitoring. The betas and 95% CI for the associations of antioxidant concentrations and PAH exposure with each of the outcomes of CBCL raw score and dichotomized standardized T-score (based on clinical cutpoints) were estimated, respectively, by multivariable poisson and logistic models. RESULTS Children below the median for alpha-tocopherol and gamma-tocopherol concentrations, compared to those above, were more likely to have thought problems, aggressive behavior and externalizing problems (p<0.05). Lower carotenoid concentration was associated with more thought problems (MVβ=0.60, p<0.001) and externalizing problems (MVβ=0.13, p<0.05) for the same contrast. No statistically significant associations were observed between retinol concentrations and neurodevelopmental symptoms. Overall, no consistent patterns were observed when we examined the interaction between antioxidants (e.g., alpha-tocopherol) and PAH in relation to CBCL symptoms (e.g., internalizing and externalizing problems, p<0.05). CONCLUSIONS Lower alpha-tocopherol, gamma-tocopherol and carotenoid levels may adversely affect healthy neurodevelopment, even after accounting for PAH exposure. Future research to confirm these findings are warranted given the importance of identifying modifiable factors for reducing harmful PAH effects.

The effectiveness of rotavirus vaccine in preventing acute gastroenteritis during rotavirus seasons among Polish children

Introduction Rotavirus is the main etiological cause of intestinal infections in children. Voluntary rotavirus vaccines were included in the Polish vaccination schedule in 2007. The aim of this study was to assess the effectiveness of a completed rotavirus vaccination course in preventing acute gastroenteritis in Polish infants during their first five years of life. Material and methods This was a retrospective cohort study conducted in Lesser Poland (Malopolska Province). The sample population included a group of 303 children who received the completed rotavirus vaccination course and 303 children not vaccinated against rotavirus. The date of the childs acute gastroenteritis diagnosis and his or her vaccination history were extracted from the physicians’ records. Each kind of diagnosed acute gastroenteritis during winter-spring rotavirus seasons was treated as the endpoint. The relative risk of having gastrointestinal infection was assessed using the hazard ratio from the Cox proportional hazards regression model. Results In the examined group, 96 (15.8%) children had winter-spring gastrointestinal infections. In the non-vaccinated children, the cumulative incidence of these infections in the first 5 years of life was 20.8%, whereas in the children vaccinated with Rotarix it was only 10.9%. Those who were vaccinated with Rotarix had a 44% reduction in the risk of a winter-spring acute gastroenteritis infection compared to those not vaccinated with Rotarix (p = 0.005). Birth weight less than 2500 g increased the risk of the infection twofold and also reached statistical significance (p = 0.044). Conclusions The results showed that Rotarix is effective in preventing acute gastroenteritis in Polish children during rotavirus seasons.

Whole-cell pertussis vaccine (DTwP) has no influence on allergic diseases and atopic sensitization in children

Introduction Vaccine opponents indicate that the infant’s immune system is inadequately developed to handle multiple vaccines which may overwhelm the immune system, leading to allergic diseases. Aim To verify the association between the vaccine antigen overload derived from DTwP and the development of atopic sensitization and allergic diseases. Material and methods Data from an earlier established birth cohort in Krakow, followed up to the 6th year of life were used. Allergic diseases such as eczema, hay fever and asthma were diagnosed by a physician and reported every half a year from the 1st to 6th year of life by the child’s parent. Skin prick tests (SPT) were performed in children at 5 years of age. The data on infants’ vaccination were extracted from the physician’s records. The status of vaccine antigen exposure was based on different types of vaccines against pertussis (DTwP or DTaP) in a primary course. Results were determined by multiple logistic regression, adjusted to potential confounders. Results The analyzed population consisted of 234 children: 53.4% – boys and 46.6% – girls. Infants up to the age of 8 months were vaccinated with the primary course against pertussis, with DTwP – 60.7%, DTaP – 32.9% and further 6.4% with a mixed course (DTwP + DTaP). There were no significant relationships between any of vaccination groups and allergic disease and allergen sensitivity in the multiple logistic regression model with adjustment to potential confounders. Conclusions The exposure to a large number of vaccine antigens derived from DTwP has no influence on the development of allergic diseases and atopic sensitization in children.

Incomplete oral sanation as a risk factor for elevated leucocytosis and postoperative infection

BACKGROUND Patients after cardiac surgery are particularly at risk of infections. The oral cavity is a potential source of bacteria. AIM To assess of influence of incomplete oral sanation on the probability of occurrence of infection in the postoperative period. METHODS The study subjects (n = 240) were patients undergoing cardiac surgery, with (n = 185) and without (n = 55) complete oral sanation. Complete oral sanation - patients had treated and eradicated all potential inflammatory foci in the oral cavity. Dental treatment: conservative dental treatment (70%), endodontic treatment (30%), and surgical dental treatment (85%), depending on treatment needs. RESULTS Patients with incomplete oral cavity sanation had more infections (7.27% vs. 1.62%, p = 0.062) in the postoperative period. The risk of infection was six times higher compared to the patients with complete sanation (p = 0.042), which correlated with higher level of leucocytosis in the early postoperative period (10.11 vs. 10.96 × 103/μL, p = 0.059). CONCLUSIONS Incomplete oral sanation is associated with higher levels of leucocytosis and greater risk of infection in the early postoperative period.