Clinical Manifestations Of Disease Research Articles

Biomarkers and subclinical left ventricular dysfunction in patients with type 2 diabetes without clinical manifestations of cardiovascular diseases

Aim. To study the relationship between the structural and functional left ventricular (LV) parameters and N-terminal pro-brain natriuretic peptide (NT-proBNP) and inflammatory markers in patients with type 2 diabetes (T2D) without clinical manifestations of cardiovascular diseases, as well as to evaluate the possibility of their use for early diagnosis of subclinical LV dysfunction.Material and methods. Data from 120 patients of both sexes aged 45-75 years (57,11±7,9 years) were analyzed. They were divided into three following groups: 1st — with T2D (n=47), 2nd — with prediabetes (n=20), 3rd — control (n=53). All participants underwent transthoracic echocardiography with assessment of the linear and volumetric heart dimensions, systolic and diastolic LV function. Speckle tracking echocardiography was analyzed with calculation of LV global longitudinal strain (GLS). The blood levels of NT-proBNP and inflammatory markers were determined (high-sensitivity C-reactive protein (hsCRP), fibrinogen, interleukin-6).Results. According to echocardiography, patients with carbohydrate metabolism disorders revealed significantly higher LV mass values, LV posterior wall thickness, and relative wall thickness in comparison with the control group. Transmitral flow parameters, as well as tissue Doppler sonography, in the T2D and prediabetes groups were significantly different from those in the control group. GLS in the groups of patients with carbohydrate metabolism disorders was lower than in the control group (p=0,001). The level of NT-proBNP was significantly higher in the T2D and prediabetes groups compared to the control group, while in all three groups it did not exceed normal values (p<0,001). A higher level of NT-proBNP was associated with hypertension — odds ratio (OR) 3,64 [1,02-13,04] (p=0,005), a decrease in LV ejection fraction — OR 1,25 [1,06-1 ,47] (p=0,007), concentric hypertrophy — OR 4,84 [1,43-16,41] (p=0,011) and decreased GLS — OR 1,85 [1,62-2,06] (p=0,005), an increase in the ratio of early and late diastolic transmitral flow (E/A) — OR 0,01 [0,008-0,416] (p=0,024) and isovolumic relaxation time (IVRT) — OR 1,08 [1,03-1,14] (p=0,03). The sensitivity and specificity of NT-proBNP as a test for predicting GLS reduction <-18% were 86 and 27%, respectively. The hsCRP level, within the reference values, was significantly higher in the T2D and prediabetes groups compared to the control group (p<0,001) and demonstrated a direct linear relationship with E/A, IVRT, early diastolic deceleration time (p<0,05). A higher level of hsCRP was significantly associated with diastolic dysfunction — OR 1,16 [1,02-1,32] (p=0,023), as well as with a GLS decrease <-18% — OR 1,58 [1,12-4,65] (p=0,03).Conclusion. In patients with T2D without clinical manifestations of cardiovascular disease, the presence of concentric LV myocardial hypertrophy, LV diastolic dysfunction and decreased GLS (<-18%) is associated with higher blood levels of NT-proBNP and hsCRP. However, in all cases, the levels of biomarkers do not exceed the reference values, which does not allow their use in the early diagnosis of subclinical LV dysfunction in T2D.

Tuberculosis and diabetes mellitus comorbidity in an adult Ugandan population

BackgroundDiabetes mellitus (DM) has a direct impact on the clinical manifestation and prognosis of active tuberculosis disease (TB) and is known to increase the chance of developing the condition. We sought to determine the prevalence of DM in adult Ugandan patients with recently diagnosed TB and the associated sociodemographic, anthropometric, and metabolic characteristics of TB-DM comorbidity.MethodsIn this cross-sectional study conducted at the adult TB treatment centres of three tertiary healthcare facilities in Uganda, we screened adult participants with recently diagnosed TB (diagnosed in < 2 months) for DM. All participants were screened with five tests; initially with a random blood glucose (RBG) test, and then later with fasting blood glucose (FBG), laboratory-based glycated hemoglobin (HbA1c), point-of-care (POC) HbA1c, and oral glucose tolerance test (OGTT) if the RBG was ≥ 6.1 mmol/l. The WHO guidelines for diagnosing and managing DM were used to support the DM diagnosis. To identify the factors associated with DM-TB comorbidity, logistic regression was used.ResultsA total of 232 participants with recently diagnosed TB were screened for DM. Of these, 160 (69%) were female. The median (IQR) age, body mass index, and RBG of all study participants was 35 (27–42) years, 19.2 (17.6–21.3) kg/m2, and 6.1 (5.5–7.2) mmol/l, respectively. About half of the participants (n = 117, 50.4%) had RBG level ≥ 6.1 mmol/l. Of these, 75 (64.1%) participants returned for re-testing. Diabetes mellitus was diagnosed in 32 participants, corresponding to a prevalence of 13.8% (95% CI 9.9–18.9). A new diagnosis of DM was noted in 29 (90.6%) participants. On logistic regression, age ≥ 40 years was associated with increased odds of TB and DM comorbidity (AOR 3.12, 95% CI 1.35–7.23, p = 0.008) while HIV coinfection was protective (AOR 0.27, 95% CI 0.10–0.74, p = 0.01).ConclusionTB and DM comorbidity was relatively common in this study population. Routine screening for DM in adult Ugandan patients with recently diagnosed TB especially among those aged ≥ 40 years and HIV-negative patients should be encouraged in clinical practice.

Poor virus-specific T-cell responses early after tick-borne encephalitis virus infection correlate with disease severity

ABSTRACT Tick-borne encephalitis virus (TBEV) infection may cause acute central nervous system inflammation varying in clinical manifestations and severity. A possible correlation of TBEV-specific antibody and cell-mediated immune responses, shortly after infection, with clinical manifestations, severity and long-term outcome has been poorly investigated. In a cohort of thirty early tick-borne encephalitis (TBE) patients, we assessed the magnitude, specificity and functional properties of TBEV-specific T-cell and antibody responses. These responses early during disease were assessed in view of clinical manifestations, severity and long-term outcome. TBEV-specific T-cell responses to C, E, NS1, and NS5 proteins were significantly lower in patients with severe acute illness than in patients with mild TBE. Lower T-cell responses to E, NS1, and NS5 proteins also correlated with the development of meningoencephalomyelitis. Virus-specific antibody titres early after infection did not correlate with disease severity, clinical manifestations, or long-term outcome in this study, possibly due to the small number of patients of which matching serum and peripheral blood mononuclear cells were available. The findings suggest that virus-specific T cells afford a certain degree of protection against the development of severe TBEV-induced disease.

The unique monoclonal antibodies and immunochemical assay for comprehensive determination of the cell-bound and soluble HER2 in different biological samples

The expression of the HER2 (human epidermal growth factor receptor 2) protein in cancer cells is a well-established cancer marker used for diagnostic and therapeutic purposes in modern treatment protocols, especially in breast cancer. The gold-standard immunohistochemical diagnostic methods with the specific anti-HER2 antibodies are utilized in the clinic to measure expression level of the membrane-bound receptor. However, a soluble extracellular domain (ECD) of HER2 is released to the extracellular matrix, thus the blood assays for HER2 measurements present an attractive way for HER2 level determination. There is a need for accurate and validated assays that can be used to correlate the concentration of the circulating HER2 protein with disease clinical manifestations. Here we describe two monoclonal antibodies binding HER2 with a unique sequence of the complementarity-determining regions that recognize HER2 ECD. Development and validation of the sandwich enzyme-linked immunosorbent assay (ELISA) for quantification of the soluble HER2 in a variety of biological samples is also presented. The assay provides HER2 quantitation within a concentrations range from 1.56 to 100 ng/ml with sensitivity at the level of 0.5 ng/ml that meets the expectations for measurements of HER2 in the blood and tumor tissue samples. The method presents satisfactory intra- and inter-assay precision and accuracy for immunochemical quantification of biomarkers in biological samples. The utility of the generated monoclonal anti-HER2 antibodies has been confirmed for use in the precise measurement of HER2 (both cell-bound and soluble) in several types of biological material, including serum, solid tumor tissue, and cell culture medium. Additionally, the developed immunochemical tools have a potential for HER2 detection, not only in a wide range of sample types but also independently of the sample storage/pre-processing, allowing for comprehensive HER2 analysis in tissue (IHC), cultured cells (immunofluorescence) and blood (ELISA).

Add-on sirolimus for the treatment of mild or moderate systemic lupus erythematosus via T lymphocyte subsets balance

ObjectiveThe efficacy of sirolimus in treating severe or refractory systemic lupus erythematosus (SLE) has been confirmed by small-scale clinical trials. However, few studies focused on mild or moderate SLE. Therefore,...

Community-based Descriptive Cross-sectional Study on Prevalence, Clinical Manifestation, Beliefs and Management Approach of Gastroesophageal Reflux Disease (GERD) Among Young Bangladeshi Population

Despite being a common public health problem, there are few population-based research available to learn about the epidemiology and management of gastrointestinal reflux disease (GERD) in Bangladesh. The tenacity of this study was to investigate the prevalence, potential predisposing factors, clinical representation, therapeutic management of GERD among the young Bangladeshi population along with their beliefs regarding the disease. A descriptive cross-sectional study was conducted during 13th June 2022 to 10th December 2022 among 925 individuals (16-35 years of age) from various parts of Bangladesh. A standardized online questionnaire in both English and the local language (Bengali) was utilized to collect all the desired data that were analyzed using either Microsoft Excel 2019 or, IBM SPSS Statistics, v26.0. The prevalence of GERD was 55.7% which was not significantly associated with different sociodemographic parameters. However, family history (Odds ratio (OR) = 2.512), irregular meal (OR = 1.527) and spicy/junk food (OR = 1.495) were significantly associated with GERD prevalence in binary logistic regression analysis. Heart burn (94.0%) and regurgitation (83.3%) were the major symptoms observed and the average number of symptoms was higher in patients with relevant family history (p &lt; 0.0005). Omeprazole (42.5%) was the most used medication to treat GERD followed by other proton pump inhibitors and H2 blockers. Self-medication was practiced by 52.6% of the patients which was associated with duration of treatment (p &lt; 0.0005). The study has found a high prevalence of GERD in Bangladesh. Family history, irregular meal and spicy/junk foods have been identified as potential risk factors and only half the participants had the right belief regarding the effectiveness of lifestyle modification against GERD. Further cohort studies are advised to solidify the findings of this study. Bangladesh Pharmaceutical Journal 27(1): 19-36, 2024 (January)

Herbal Components for the Treatment of Various Kidney Disorders

Abstract:: Acute kidney injury is described as a loss of renal excretory function that occurs suddenly. AKI is one of several ailments grouped together as acute kidney diseases and disorders (AKD), in which progressive degradation of kidney function or persistent renal dysfunction is associated with irreversible loss of kidney cells and nephrons, potentially leading to chronic kidney disease (CKD). The prevalence and incidence of KDs are assessed in light of population disparities in the prevalence of risk factors such as diabetes, hypertension, and obesity. However, the presence of these associated illnesses does not fully explain the increased rate of progression of chronic renal disease in high-risk patients (CKD). The development of renal disease is accompanied by a decline in renal function, which eventually leads to renal failure. The current status of diagnostic testing does not allow for accurate early disease diagnosis, prognosis, or therapy efficacy monitoring. Despite significant advances in care and understanding of the causes of acute renal failure (ARF), many aspects of ARF remain controversial, confusing, and uncertain. Accurate information on the disease's prevalence, genesis, and clinical manifestations is required to successfully advocate for enough funding and resources to manage the disease. Herbal components for the treatment of a variety of kidney disorders, and the page includes a list of plants that are good for kidney treatment. This review focuses on several herbal products used to treat renal problems. It is clear from this study that medicinal plants play an important role in the fight against many different diseases. Several different plants and plant extracts have been shown to have beneficial effects in treating renal disease. These medications have great promise for use in treating kidney damage because of their nephroprotective, cytoprotective, immunomodulatory, antioxidant, anti-inflammatory, and reducing effects on oxidative stress, renal hypertension, and blood toxins such as urea, creatinine, and others. Therefore, India's traditional medicine offers a wide variety of medications that can be utilized in renal illnesses due to their effectiveness in both treating the ailment and restoring normal kidney function. Therefore, it is suggested that additional research be conducted to learn many aspects and mechanisms of medications.

Epidemiology and clinical characteristics of biopsy-confirmed adult-onset IgA vasculitis in southern Sweden

ObjectiveImmunoglobulin A vasculitis (IgAV) is the most prevalent primary childhood vasculitis in Sweden, but is considerably rarer in adults. This study aims to describe the epidemiology, clinical characteristics and renal...

Effectiveness and safety of Jiejing Runmu decoction in treatment of dry eye disease

ObjectiveTo investigate the effectiveness and safety of Jiejing Runmu decoction in relieving the clinical manifestations of dry eye disease (DED). Design and interventionsThis single-arm prospective intervention study was conducted at the Peking University Third Hospital and People's Hospital of Yongqing. Of the 211 patients recruited, 200 completing the follow-up were included in the analysis. Patients received Jiejing Runmu decoction once a day for 4 weeks continuously, without any change in eye care habits. Individuals were evaluated at four time points: pretreatment (baseline), 2 weeks, 1 month, and 3 months (2 months after completion of treatment), using the Ocular Surface Disease Index (OSDI), tear film breakup time (TBUT), corneal fluorescein staining, Schirmer test I and meibomian gland assessments. Adverse effects were evaluated at each follow-up visit and systematic examinations were performed during the first and last visits. ResultsOSDI, TBUT, corneal fluorescein staining, Schirmer test I, meibomian gland expressibility, and quality of secretions improved at 2 weeks, 1 month and 3 months compared to baseline (P < 0.0001). No significant differences were found between the sexes. Patients above 45 years showed worse subjective symptoms and objective signs, and greater improvements in corneal fluorescein staining, meibomian gland expressibility, and quality of secretions were observed in this group. No obvious adverse effects were detected during any follow-up visit. ConclusionJiejing Runmu decoction significantly improved both the subjective symptoms and objective signs of DED, with favorable tolerance.

Positive relation between dopamine neuron degeneration and metabolic connectivity disruption in the MPTP plus probenecid mouse model of Parkinson's disease

The clinical manifestation of Parkinson's disease (PD) appears when neurodegeneration is already advanced, compromising the efficacy of disease-modifying treatment approaches. Biomarkers to identify the early stages of PD are therefore of paramount importance for the advancement of the therapy of PD. In the present study, by using a mouse model of PD obtained by subchronic treatment with the neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) and the clearance inhibitor probenecid (MPTPp), we identified prodromal markers of PD by combining in vivo positron emission tomography (PET) imaging and ex vivo immunohistochemistry. Longitudinal PET imaging of the dopamine transporter (DAT) by [18F]-N-(3-fluoropropyl)-2β-carboxymethoxy-3β-(4-iodophenyl) nortropane ([18F]-FP-CIT), and brain glucose metabolism by 2-deoxy-2-[18F]-fluoroglucose ([18F]-FDG) were performed before MPTPp treatment and after 1, 3, and 10 MPTPp administrations, in order to assess relation between dopamine neuron integrity and brain connectivity. The results show that in vivo [18F]-FP-CIT in the dorsal striatum was not modified after the first administration of MPTPp, tended to decrease after 3 administrations, and significantly decreased after 10 MPTPp administrations. Post-mortem immunohistochemical analyses of DAT and tyrosine hydroxylase (TH) in the striatum showed a positive correlation with [18F]-FP-CIT, confirming the validity of repeated MPTPp-treated mice as a model that can reproduce the progressive pathological changes in the early phases of PD. Analysis of [18F]-FDG uptake in several brain areas connected to the striatum showed that metabolic connectivity was progressively disrupted, starting from the first MPTPp administration, and that significant connections between cortical and subcortical regions were lost after 10 MPTPp administrations, suggesting an association between dopamine neuron degeneration and connectivity disruption in this PD model. The results of this study provide a relevant model, where new drugs that can alleviate neurodegeneration in PD could be evaluated preclinically.

Clinical and radiological efficacy of a new conservative treatment for fibrocystic disease

Background. Long-lasting dyshormonal breast diseases in women represent a risk factor for breast cancer, especially in patients with atypia. Clinical manifestations of fibrocystic breast disease (FBD) and mastopathy, including high-intensity pain cause psychoemotional discomfort and reduce the quality of life of women. The search for effective management strategies for mastopathy with an antiproliferative effect is highly relevant.Aim. To assess clinical and radiological efficacy of a new conservative treatment for FBD, “Evening primrose oil” administered orally for 6 months in women with symptomatic FBD.Materials and methods. This randomized, blind, placebo-controlled trial included 144 patients with clinical FBD manifestations (pain and tension in the breast). Patients were randomly assigned to one of the two treatment groups. Women in group I received “Evening primrose oil”, whereas women in group II received placebo (ascorbic acid) for 6 months. We measured the dynamics of radiological findings (at mammography and ultrasound examination) in the breast before and after treatment, as well as pain intensity using the visual-analog scale.Results. Patients in group I with all types of FBD (diffuse mastopathy, nodular, and mixed forms) demonstrated positive dynamics and BI-RADS category downgrading within 6 months. In the placebo group, the examination after 6 months demonstrated no significant changes in the breast and no BI-RADS category downgrading among women with diffuse mastopathy. Some patients with nodular and mixed FBD receiving placebo had negative dynamics after 6 months (as demonstrated by mammography and ultrasound examination; BI-RADS category upgraded from II to III, p&lt;0.01). Patients receiving “Evening primrose oil” also showed positive dynamics in their clinical manifestations, including decreased breast pain (from 7.8 to 1.8 on the visual analog scale). By contrast, patients receiving placebo had no changes in their breast pain intensity after 6 months (from 7.3 to 7.1 on the visual analog scale), which resulted in poorer psychoemotional state in 55.6 % of women.Conclusion. Our new treatment strategy for FBD patients with clinical and radiological manifestations in the breast demonstrated high efficiency and can be implemented into routine clinical practice.

The nature and origin of immunosuppressive disorders

This publication reflects modern ideas about the main aspects of etiology, pathogenesis and the latest achievements of clinical practice in the field of the most common primary and secondary immunodeficiency. The features of laboratory diagnostics of congenital immunodeficiency, risk factors and early clinical guidelines that allow the patient to suspect an immunosuppressive state are considered. Special attention is paid to the problem of secondary immunodeficiency, their prevalence and polyetiology. When covering immunopathogenesis, infection caused by the human immunodeficiency virus (HIV), attention is paid to the multimorbidity of clinical manifestations of HIV-associated immunosuppression and concomitant diseases, the importance of timely administration of antiretroviral therapy (ART) and its role in the development of immune reconstitution syndrome (IRS). The criteria for the diagnosis of SVI based on their own experience and the opinion of foreign colleagues, the tactics of patient management are presented in detail.

Recovery after Prolonged Disturbance of Consciousness and Repeated Cerebral Perfusion Changes in Neuronal Intranuclear Inclusion Disease.

Encephalitic episodes are a clinical manifestation of neuronal intranuclear inclusion disease (NIID) and often show transient disturbance of consciousness. We herein report a genetically confirmed patient with NIID who initially presented progressive dementia and showed prolonged disturbance of consciousness preceded by an acute-onset headache. During that time, we performed N-isopropyl-p-[123I] iodoamphetamine single-photon-emission computed tomography twice and found that the blood flow increased in different regions. Prolonged disturbance of consciousness following an encephalitic episode may be associated with repeated hyperperfusion in various regions resulting from mitochondrial dysfunction. NIID patients presenting with encephalitic episodes can recover gradually and spontaneously even after prolonged disturbances of consciousness.

Pathophysiological Relationships of Neuroendocrine Immune Systems in Thyroid Diseases

Pathophysiological relationships of neuroendocrine immune systems in diseases of the thyroid gland. Signs of damage to the nervous system occupy a prominent place in the clinical manifestations of thyroid diseases. Sometimes they come to the fore, significantly complicating the diagnosis of the disease. They especially often experience asthenic syndrome, which consists of mental and physical asthenia, autonomic disorders, and sleep disturbances. Sometimes somatovegetative disorders predominate in these patients: palpitations, heart pain, shortness of breath, sweating, chills. It is well known that depression negatively affects general and somatic status. A syndrome of secondary immunological deficiency is formed. The pathogenetic basis for the mutual conditionality of these conditions are the mechanisms of neuroendocrine-immune interaction, which form a functional system consisting of a physiological and pathological basis. Clinical signs of the disease, the content of thyroid hormones, immune status, determination of autonomic tone, autonomic reactivity and autonomic support of activity were used. 75 patients were examined, and it was found that the disturbance of the neuroendocrine immune system depended on the functional activity of the thyroid gland.

Hereditary Amino Acid Metabolism Disorders and Urea Cycle Disorders: to Practicing Physician

Hereditary amino acid metabolism disorders (aminoacidopathies) are clinically and genetically heterogeneous group of hereditary metabolic diseases caused by enzymes deficiency involved in amino acid metabolism, that finally leads to progressive damage of central nervous system, liver, kidneys, and other organs and systems. Hereditary urea cycle disorders occur because of enzyme deficiency leading to impaired urea synthesis and hyperammoniemia in patients. The age of disease onset and clinical manifestations severity range from milder, intermittent forms to severe, manifesting in the first hours of life. Expanded neonatal screening (implemented in Russian Federation at 01.01.2023) allows to diagnose diseases from these groups in the first days of life, to prescribe timely pathogenetic therapy. Altogether it helps to prevent the development of disease severe complications. Raising awareness about hereditary aminoacidopathies and urea cycle disorders among pediatricians, neonatologists, neurologists, gastroenterologists, ophthalmologists is a topical issue of modern pediatrics.

Autoimmune pancreatitis - role of intestinal microbiota in pathogenesis. Review of the literature

Introduction: Autoimmune pancreatitis is a type of chronic autoimmune inflammation that can be divided into two types. Type 1 is a clinical manifestation of IgG4-mediated disease, while type 2 may coexist with inflammatory bowel diseases. Objective: The aim of the study is to review the literature on the role of the intestinal microbiota in the pathogenesis of autoimmune pancreatitis. Methods: A literature review was conducted on databases such as PubMed and Google Scholar using the terms: ”autoimmune pancreatits”, “intestinal dysbiosis”, “intestinal microbiome”, and “pathogenesis”. Conclusions: The intestinal microbiota has an impact on the development of autoimmune pancreatitis, but it is not the main pathogenic factor, but rather a risk factor.

Distinct fibroblast functions associated with fibrotic and immune-mediated inflammatory diseases and their implications for therapeutic development.

Fibroblasts are ubiquitous cells that can adopt many functional states. As tissue-resident sentinels, they respond to acute damage signals and shape the earliest events in fibrotic and immune-mediated inflammatory diseases. Upon sensing an insult, fibroblasts produce chemokines and growth factors to organize and support the response. Depending on the size and composition of the resulting infiltrate, these activated fibroblasts may also begin to contract or relax thus changing local stiffness within the tissue. These early events likely contribute to the divergent clinical manifestations of fibrotic and immune-mediated inflammatory diseases. Further, distinct changes to the cellular composition and signaling dialogue in these diseases drive progressive fibroblasts specialization. In fibrotic diseases, fibroblasts support the survival, activation and differentiation of myeloid cells, granulocytes and innate lymphocytes, and produce most of the pathogenic extracellular matrix proteins. Whereas, in immune-mediated inflammatory diseases, sequential accumulation of dendritic cells, T cells and B cells programs fibroblasts to support local, destructive adaptive immune responses. Fibroblast specialization has clear implications for the development of effective induction and maintenance therapies for patients with these clinically distinct diseases.

Herpesviruses and SARS-CoV-2: Viral Association with Oral Inflammatory Diseases.

The oral cavity is a niche for diverse microbes, including viruses. Members of the Herpesviridae family, comprised of dsDNA viruses, as well as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an ssRNA virus, are among the most prevalent viruses infecting the oral cavity, and they exhibit clinical manifestations unique to oral tissues. Viral infection of oral mucosal epithelia triggers an immune response that results in prolonged inflammation. The clinical and systemic disease manifestations of HHV have been researched extensively, and several recent studies have illuminated the relationship between HHV and oral inflammatory diseases. Burgeoning evidence suggests the oral manifestation of SARS-CoV-2 infection includes xerostomia, dysgeusia, periodontal disease, mucositis, and opportunistic viral and bacterial infections, collectively described as oral post-acute sequelae of COVID-19 (PASC). These diverse sequelae could be a result of intensified immune responses initially due to the copious production of proinflammatory cytokines: the so-called "cytokine storm syndrome", facilitating widespread oral and non-oral tissue damage. This review explores the interplay between HHV, SARS-CoV-2, and oral inflammatory diseases such as periodontitis, endodontic disease, and peri-implantitis. Additionally, the review discusses proper diagnostic techniques for identifying viral infection and how viral diagnostics can lead to improved overall patient health.

Vitamin D as a predictor of severe course of inflammatory bowel diseases in children

Background. Inflammatory bowel diseases (IBD) develop in childhood more often, last throughout life, and their frequency is rapidly increasing in industrialized countries. Most researchers identify vitamin D (VD) as a key regulator of gastrointestinal homeostasis, an innate immune response and a biomarker for the activity and severity of IBD. The purpose was to determine the frequency of vitamin D deficiency and its relationship with the course of inflammatory bowel diseases in children. Materials and methods. The study included 36 patients: 13 with IBD (main group) and 23 children of the comparison group with irritable bowel syndrome and functional abdominal pain. The average age of children was 13.09 ± 2.28 years, with a median of 14.5 years; 63.6 % were boys. Patients with IBD were evaluated for clinical disease manifestations, disease localization (Paris Classification) and disease activity (PCDAI/PUCAI). Irritable bowel syndrome and functional abdominal pain were diagnosed based on the Rome IV Criteria. Serum 25-hydroxyvitamin D (25(OH)D) was assessed by the electrochemiluminescence method (Elecsys Vitamin D total, Cobas). Results. Severe IBD prevailed among the examined children (61.5 %). There was no significant difference in overall body weight and height between the groups, which may be due to the short duration of IBD. However, children with IBD showed a tendency to lower physical development indicators. Significant differences in hemoglobin, erythrocyte sedimentation rate, C-reactive protein, number of platelets, fecal calprotectin were observed among the studied groups (p &lt; 0.05). The concentration of VD in the blood of the examined children ranged from 39.9 to 10.8 ng/ml, with an average of 21.8 ± 5.8 ng/ml. In 76.9 % of patients with IBD, blood concentration of VD reduced, while only 21.7 % children in the comparison group had its level below the norm. Children with IBD were characterized by significantly lower levels of VD in the blood (average of 16.7 ng/ml). Lower levels of VD were associated with female sex, Chron’s disease (CD) and ulcerative colitis (UC), as well as disease duration of more than 3 years and disease severity. There was an inverse correlation between VD and the degree of IBD activity (CD: r = –0.33; p = 0.01; UC: r = –0.38; p = 0.01) and the severity of the course (CD: r = –0.35; p = 0.01; UC: r = –0.36; p = 0.01), the levels of C-reactive protein (CD: r = –0.39; p = 0.01; UC: r = –0.37; p = 0.01) and fecal calprotectin (CD: r = –0.42; p = 0.01; UC: r = –0.46; p = 0.01). Conclusions. In most children (76.9 %) with inflammatory bowel diseases, the concentration of VD in the blood is significantly lower than in those with functional gastrointestinal disorders. Lower vitamin D levels were associated with female sex, Crohn’s disease, and ulcerative colitis, as well as disease duration of more than 3 years, activity level, and severity, supporting the role of vitamin D as a possible predictor of severity of these diseases in childhood.

An overview of anthrax: a neglected zoonosis of the tropical region

Anthrax is a neglected bacterial zoonosis that can be highly contagious and potentially lethal. The disease, which mainly affects herbivorous ungulate animals, is caused by Bacillus anthracis, a rod-shaped, gram-positive bacterium. The pathogenicity depends on the production of toxins by Bacillus anthracis and the sensitivity of the host. The infection is transmitted to humans when they come in to contact with infected animals or their products. It is an important occupational risk to the abattoir workers. Clinical manifestations of disease in humans include different forms, including cutaneous, pulmonary and intestinal. The disease is widespread in African and Asian countries with frequent reports of cases. Lack of appropriate and effective control programs in these countries has led to increase in the number of human cases. Bacillus anthracis spores are extremely resistant to environmental conditions, and can persist for several decades in nature and, thus making the control or eradication of the disease difficult. Disease control involves managing contaminated animal products, avoiding contact with infected animals, livestock vaccination in endemic regions and routine surveillance of animals. The most effective and dependable way to control zoonotic diseases like anthrax is through collaborative monitoring programs including the "One Health" approach.