Dušanka Mičetić-Turk

Autoantibodies pANCA, GAB and PAB in inflammatory bowel disease: prevalence, characteristics and diagnostic value

SummaryBACKGROUND: The diagnosis of inflammatory bowel disease (IBD), particularly the differentiation between ulcerative colitis (UC) and Crohns disease (CD), is difficult and delayed in many cases, despite invasive diagnostic tools. AIMS: To determine the presence and evaluate the diagnostic accuracy of the potential serological diagnostic markers perinuclear antineutrophil cytoplasmic antibodies (pANCA), autoantibodies to intestinal goblet cells (GAB) and autoantibodies to exocrine pancreas (PAB), together with combinations of these, in the diagnosis of IBD and differential diagnosis of UC and CD. METHODS: The presence of pANCA, GAB and PAB was determined in indirect immunofluorescence assay of serum samples from 71 patients with IBD (CD 43, UC 28) and 41 healthy controls. The antigen specificity of ANCA was determined using ELISA. RESULTS: Compared with the control group, we confirmed a statistically significant presence of pANCA (71.4%) and GAB (46.4%) in patients with UC and the presence of PAB only in patients with CD (30.2%) (P < 0.001). In healthy controls, neither PAB nor GAB was detected and pANCA was present in only 4.8%. The sensitivity, specificity and positive and negative predictive values in differentiation of IBD from healthy controls were as follows: pANCA+: 71%, 95%, 91%, 83%; GAB+: 46%, 100%, 100%, 73%; PAB+: 30%, 100%, 100%, 58%; combination of (pANCA+ or GAB+)/PAB–: 82%, 95%, 92%, 87%; and to distinguish UC from CD: pANCA+: 71%, 98%, 95%, 84%; GAB+: 46%, 98%, 93%, 74%; PAB+: 30%, 100%, 100%, 48%; (pANCA+ or GAB+)/PAB–: 82%, 98%, 96%, 89%. CONCLUSIONS: All three autoantibodies may be helpful tools in non-invasive diagnosis and differential diagnosis of UC and CD. Combination of the autoantibodies may be particularly helpful, as the diagnostic sensitivity is considerably improved.

Fecal calprotectin as a marker of the severity of mucosal inflammation in children with inflammatory bowel disease.

SummaryObjectivesInflammatory bowel disease (IBD) in children has a remitting and relapsing course. The aim of our study was to evaluate the value of fecal calprotectin (FC), C-reactive protein (CRP), and clinical scores in predicting endoscopic and histological lesions in children with IBD.MethodsA total of 68 children with IBD (29 with ulcerative colitis (UC), 39 with Crohn’s disease (CD), mean age 14.2 years) were included in the study.We retrospectively reviewed clinical scores (PUCAI, PCDAI), CRP values, endoscopic, and histological data as well as FC values in all included children.ResultsIn children with UC, the correlation between the histological lesions and FC (r = 0.609, p < 0.01), CRP (r = 0.390, n.s.), or PUCAI (r = 0.535, p < 0.05) was higher than for children with CD (FC r =  0.490, n.s.; CRP r =  0.269, n.s.; PCDAI r = 0.257, n.s.). The correlation between endoscopy scores and the same parameters yielded similar findings (UC: FC r = 0.628, p < 0.01; CRP r = 0.387, n.s.; PUCAI r = 0.256, n.s.; CD: FC r = 0.516, p < 0.05; CRP r = 0.238, n.s.; PCDAI r = 0.267, n.s.).The correlation between FC and PUCAI (r = 0.532, p < 0.01) was higher than that between CRP and PUCAI (r = 0.424, p < 0.01). However, the correlation between FC and PCDAI (0.384, p < 0.01) is lower than that between CRP and PCDAI (r = 0.447, p < 0.01).ConclusionFC is a better predictor of the severity of endoscopic and histological lesions than CRP or disease activity scores, especially for UC. FC, as a noninvasive marker, could possibly be used to reduce the number of endoscopic procedures in children with a confirmed diagnosis of IBD.

Diagnosis and management of diaper dermatitis in infants with emphasis on skin microbiota in the diaper area

Diaper dermatitis is the most common inflammatory skin eruption within the diaper area in infants and toddlers. Although it rarely causes problems for prolonged periods of time, it causes considerable distress for both infants and parents. Diapered skin is exposed to friction, excessive hydration, varying pH, and is in constant contact with urine and feces, both of which are highly irritant to the skin. The three most common types of diaper dermatitis include chaffing dermatitis, irritant contact dermatitis, and diaper candidiasis. However, a variety of other skin conditions may manifest in the diaper area. Candida albicans and Staphylococcus aureus are most frequently isolated from the affected area and are thought to have a predominant role in diaper dermatitis. The review includes an overview of the epidemiology, etiology, and common skin microbiota in the diaper area. State‐of‐the‐art strategies for diagnosis, management, and prevention of diaper dermatitis are also included. Appropriate skin care can help in the prevention of diaper dermatitis and can aid the reparation of the skin. This review discusses common causes, skin microbiota within the diapered area, differential diagnosis, and finally possible prevention and treatment recommendations. Recent findings have proven that the key to efficient eradication of irritant diaper dermatitis lies in its prevention.

Time allocation simulation model of clean and dirty pathways in hospital environment

In usual modern hospital architectural design we try to separate the clean and dirty corridor that should facilitate traffic flow of clean and dirty items. However that is not the case in the hospitals with older architectural design, where clean and dirty pathways flow through a single corridor systems. The most common solution which enables separation of clean and dirty pathways in such systems is introduction of time allocation for dirty and clean items transportation. Currently such schedules are fixed and do not allow quick changes in case of specific events. We propose a solution to the problem using multi-agent based system able to quickly adapt the schedule of transports.

Simulation in Medicine and Nursing – First Experiences in Simulation centre at Faculty of Health Sciences University of Maribor

Medical and nursing simulations at the Faculty of Health Sciences University of Maribor provide the skills to nursing and medical students that will improve clinical practice. Simulations is thus becoming an essential tool in improving quality of patient care and safety. Simulations enable teaching, learning, evaluation and clinical research.

Increased augmentation index and central systolic arterial pressure are associated with lower school and motor performance in young adolescents

Objective In adults, improper arterial function has been linked to cognitive impairment. The pulse wave velocity (PWV), augmentation index (AIx) and other vascular parameters are useful indicators of arterial health. In our study, we monitored arterial properties, body constitution, school success, and motor skills in young adolescents. We hypothesize that reduced cognitive and motor abilities have a vascular origin in children. Methods We analysed 81 healthy school children aged 11–16 years. Anthropometry central systolic arterial pressure, body mass index (BMI), standard deviation scores (SDS) BMI, general school performance grade, and eight motor tests were assessed. PWV, AIx, and central systolic arterial pressure (SBPao) were measured. Results AIx and SBPao correlated negatively with school performance grades. Extremely high AIx, PWV and SBPao values were observed in 5% of children and these children had average to low school performance. PWV correlated significantly with weight, height, and waist and hip circumference. AIx, PWV, school success, and BMI correlated strongly with certain motor functions. Conclusions Increased AIx and SBPao are associated with lower school and motor performance in children. PWV is influenced by the body’s constitution.

Modern diagnostic approach to celiac disease

Background: Celiac disease, also known as genetic gluten intolerance is a chronic disease that affects genetically predisposed individuals after the gluten ingestion. It affects about 1 % of population regardless of the age, and can manifest with diverse clinical picture. Diagnosis of celiac disease is based on criteria adopted and later revised by European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). These criteria consider intestinal biopsy as a gold standard. The number of biopsies has decreased after the introduction of serological tests, which are considered in revised criteria. Genetic tests have also proven to be very valuable in diagnostic procedure, especially HLA-DQ2 and HLA-DQ8 determination. Bedside or point-of-care tests, which enable quick determination of anti tissue transglutaminase antibodies in capillary blood, are a promising new tool. Many reports have shown that adverse immunological response to gluten in genetically predisposed individuals is systemic, which can lead to a decreased importance of intestinal biopsy in future. Conclusions: Diagnosis of celiac disease is based on specific serological markes and reversible mucosal changes of small intestine. Lately developed genetic tests and new quick serological tests are also used. Intensive research focused on pathogenesis and manifestations of celiac disease will show whether definite diagnosis could be confirmed without the use of intestinal biopsy in future.