Duška Tješić-Drinković

Expression of chemokine receptor CX3CR1 in infants with respiratory syncytial virus bronchiolitis

Respiratory syncytial virus (RSV) glycoprotein G mimics fractalkine, a CX3C chemokine, which mediates chemotaxis of leukocytes expressing its receptor, CX3CR1. The aim of this study was to examine the relationship between RSV infection and expression of perforin and IFN‐γ in CX3CR1‐expressing peripheral blood CD8+ T cells. Samples were collected from infants with RSV bronchiolitis, both in the acute and convalescence phase (n = 12), and from their age‐ and sex‐matched healthy controls (n = 15). Perforin expression and IFN‐γ secretion in CX3CR1+ CD8+ T cells were assessed by four‐color flow cytometry. The NF‐κB p50 and p65 subunit levels were also determined as markers of RSV‐induced inflammation. Study results showed perforin and CX3CR1 expression to be significantly lower in the convalescent phase of infected infants than in healthy controls. There was no significant difference in IFN‐γ secretion and NF‐κB binding activity between two time‐points in RSV‐infected infants, or when compared with healthy controls. Infants with prolonged wheezing had lower acute‐phase CX3CR1 levels in peripheral blood. These data indicate existence of an event persisting after acute RSV infection that is able to modulate effector functions of cytotoxic T cells, and also link disease severity with CX3CR1 expression.

Detecting Undernutrition on Hospital Admission - Screening Tool Versus WHO Criteria

To prevent the development of malnutrition in hospitalized children, it is important to develope an early identification of nutritional depletion, ideally at the time of admission to the hospital. In 2009 Hulst et al. proposed new guidelines for assessing the nutritional status of hospitalized children called STRONGkids questionnaire (Screening Tool Risk on Nutritional Status and Growth). This study was designed to describe the current prevalence of malnutrition on admission to a pediatric gastroenterology hospital unit and to compare the value and feasibility of STRONGkids scoring system versus anthropometric World Health Organization (WHO) criteria in identifying children at risk of developing malnutrition during hospital stay. The prospective observational study involved 124 children hospitalized at the Department of Pediatrics, University Hospital Center Zagreb. Nutritional status and risk for malnutrition were estimated by STRONGkids questionnaire and anthropometric measurements of subjects. Statistical analysis was performed using the computer program STATISTICS 10, StatSoft. Inc. 1984-2011; using descriptive statistics, Fishers exact (FE) test and non-parametric Kruskal-Wallis (KW) test. Total malnutrition was observed in 18.5% of patients. Larger number of children at risk for malnutrition were identified by STRONGkids questionnaire than by anthropometric measurements (STRONGkids questionnaire: 75.8%; anthropometric measures: 40.3%). Patients that lost weight during hospitalization (33.1%) were further analyzed: 8/41 were not detected to be at risk by either method, 11/41 were identified by STRONGkids and anthropometry, and 22/41 were detected only by STRONGkids (Fishers exact test p=0,08). This study justifies the inclusion of the STRONGkids questionnaire in the initial evaluation of children on admission to the hospital, in order to recognize those who need special nutritional support and thus prevent the development of malnutrition during hospitalization.

Lung transplantation in cystic fi brosis

Transplantacija pluća je sve češća terapijska mogućnost u završnom stadiju plućne bolesti. Jedna od najčešćih indikacija za transplantaciju danas je cistična fi broza, i to kako kod odraslih tako i u djece. Cistična fi broza nije samo bolest pluća nego je multisistemska bolest koja ima svoje posebnosti, o kojima treba voditi računa u izboru kandidata za transplantaciju. Transplantacija pluća danas je opcija za sve bolesnike s cističnom fi brozom i uznapredovanom plućnom bolešću koji ispunjavaju danas prihvatljive kriterije.

Neishranjenost u cističnoj fi brozi – više od insufi cijencije gušterače

Neishranjenost u cističnoj fi brozi posljedica je nerazmjera između povećanih potreba za energijom, povećanih gubitaka, manjeg iskorištavanja hranjivih tvari s jedne strane i nedostatnog unosa hrane s druge. Vodeći uzrok maldigestije i malapsorpcije je insufi cijencija pankreasa, no ni optimalna nadoknada enzima ne može ispraviti neishranjenost, jer ne djeluje na niz drugih čimbenika koji pridonose energetsko-prehrambenoj neravnoteži i trijadi infekcije, upale i opstrukcije u probavnom sustavu. Oni uključuju promijenjene karakteristike crijevnih sokova, disbiozu, nedostatak žučnih soli i neadekvatnu lipolizu, promjenu motiliteta, jetrenu bolest i drugo. Energetske potrebe veće su nego u zdravih osoba, zbog kronične infekcije i upale te dodatno rastu s propadanjem plućne funkcije. Dostatan unos hrane sprječavaju gastrointestinalne komplikacije, narušen tek, a često i psihosocijalni čimbenici. Važan je anticipirajući i aktivan stav liječnika i nutriciologa prema problemu uhranjenosti, čak i prije nego je ona narušena.