Lidija Popovic-Dragonjic

Antioxidant defense and oxidative stress in children with acute hepatitis A.

Background and Objectives: Published data on oxidative stress in children with acute hepatitis A are still very scarce. This study aims to evaluate the oxidant/antioxidant status of these patients. Design and Setting: Prospective, case-control study, over 2.5 years in patients under hospitalized and ambulatory care. Patients and Methods: The levels of a whole-blood antioxidant, reduced glutathione; and plasma antioxidants, β-carotene, retinol, ascorbic acid, α-tocopherol; and the biomarker of oxidative stress, malondialdehyde, were evaluated in 50 pediatric patients (age range, 5-16 years; 29 males and 21 females) with acute hepatitis A and in 50 healthy children as control subjects (age range, 5-16 years; 25 males and 25 females). Results: Plasma levels of reduced glutathione, β-carotene, retinol, α-tocopherol and ascorbic acid were significantly lower, while malondialdehyde plasma levels were significantly increased in the patient group when compared to the controls (P<.0001 for all parameters). Conclusions: Our findings show that pediatric patients with acute hepatitis A were influenced by oxidative stress, resulting in significantly lower levels of plasma antioxidants and increased lipid peroxidation. In the absence of other therapeutic options, antioxidant vitamin supplements could be added to the therapy for these patients to help reestablish the oxidant status balance. Further investigations to confirm this suggestion are recommended.

MONITORING OF IMMUNE RESPONSE IN VIROLOGIC SUCCESSFULLY TREATED HIV-INFECTED PATIENTS IN SOUTHEASTERN SERBIA

The number of CD4 lymphocytes defines the evolutional stage of HIV-infection and is the most important for a reliable estimation of the individual risk of developing AIDS. However, it is difficult to predict the degree of immune reconstitution during antiretroviral therapy, as it varies significantly from one person to another. Further investigations to better understand the limitations of immunological success are necessary to improve the response to treatment and regimen durability. The current study includes HIV-infected patients in Southeastern Serbia with achieved virologic suppression of HIV infection. The CD4 count was determined by flow cytometry, and was correlated with the duration of treatment, initial number of CD4 cells, type of antiretroviral therapy, mode of transmission of infection, age and gender of examinees. The resulting arithmetic mean and standard deviation of CD4 number was 473±259 cells/µl (range, 1130 cells/µl). There was no statistically significant correlation between the values of CD4 count and length of treatment, stage of the infection at which the therapy was started, treatment profile, method of infection, age or gender. The obtained results are comparable with the existing studies that follow immunological response to antiretroviral therapy and primarily point out the issue of substantial individual response variability, which has not yet been fully elucidated.

Our experience in the treatment of botulism

Introduction. Botulism is a neuro -intoxication caused by a toxin secreted by Clostridium botulinum. Due to extremely high toxicity and lethality, this toxin can be used as an agent in a biological warfare. Case report. We presented six patients, mean age 28.8 years, who ate canned food and in whom the diagnosis of disease was made based on the typical clinical picture. Predominant symptoms were blurred vision, double vision (diplopia), dry mouth and constipation which were present in all patients. The patient whose disease was recognized only after 23 days and who did not receive the anti botulinum serum underwent the longest hospital treatment. All the patients received antibiotics and 4 patients received antitoxin. Neostigmine and enemas were used for the treatment of the disorder of intestinal motility and constipation. Conclusion. The diagnosis of botulinum was made based on afebrility, preserved states of consciousness, double vision, dry mouth and history data on consumption of suspicious food. Polyvalent serum anti botulinum should be applied as soon as possible because it reduces the occurrence of complications, length of hospital stay and mortality rate.

Two-Year Complete Remission of Diffuse Large B-Cell Lymphoma in an Immunological Nonresponder HIV-Infected Patient: Case Report

Introduction: HIV-infected patients are affected significantly more frequently by all types of lymphoma, with diffuse large B-cell lymphoma (DLBCL) as the most prevalent histological type. Since the introduction of combination antiretroviral therapy (cART) morbidity and mortality of DLBCL has been markedly reduced, which is primarily interpreted as a result of the drug-mediated immune reconstitution. Case Report: We present a previously healthy, 44-year-old HIV-infected man with DLBCL of the oral cavity, treated with immunochemotherapy and cART. During HIV-directed treatment, despite the successful virologic response, a satisfactory immunological response was not achieved. However, the patient had a 2-year complete remission after first-line treatment of DLBCL. Conclusion: Response to cART strongly predicts outcome in patients with DLBCL. Close monitoring of HIV-directed therapy efficacy, especially as to achievement of successful virologic response, independently associated with prolonged survival, is essential for estimating future DLBCL treatment strategies.