Darko Richter
University Hospital Center Zagreb, Pediatrics, Faculty Member
- Pediatric allergist and clinical immunologist. Interested in asthma, food allergy, drug allergy, immunotherapy, immunization and primary immunodeficiencies.edit
Allergic rhinitis is the most prevalent form of chronic rhinitis in children. It is driven by allergic inflammation and is commonly associated with other atopic diseases such as asthma and atopic eczema. The main allergens are primarily... more
Allergic rhinitis is the most prevalent form of chronic rhinitis in children. It is driven by allergic inflammation and is commonly associated with other atopic diseases such as asthma and atopic eczema. The main allergens are primarily aeroallergens: house dust mite, and tree, grass and weed pollen. It is, however, not exceptional to experience symptoms of allergic rhinoconjunctivitis in conjunction with food allergy and oral food allergy syndrome, especially in infants and toddlers. Allergic rhinitis is often associated with allergic asthma, either preceding it, or developing later and making it more difficult to treat. The mainstay of treatment is exposure prophylaxis, antihistamines, leukotriene antagonists and intranasal corticosteroids. Allergic rhinitis is one of the prime indications for specific allergen immunotherapy, which may have a preventive effect on the development of asthma. Allergic rhinitis associated with intermittent or mild persistent asthma may be a good indic...
Results of determination of circulating histamine releasing autoantibodies using histamine release urticaria test in 12 children (aged 3 to 18 years, mean age 8.5 years; 7 female and 5 male) with chronic urticaria are presented. Standard... more
Results of determination of circulating histamine releasing autoantibodies using histamine release urticaria test in 12 children (aged 3 to 18 years, mean age 8.5 years; 7 female and 5 male) with chronic urticaria are presented. Standard work-up including detailed history, allergy testing and routine laboratory findings did not disclose any plausible cause of chronic/recurrent urticarial eruption in these children. All children underwent serum-induced basophil histamine release urticaria test. At serum dilution of 12.5%, the mean percent of histamine liberation was 40.8% (range 18%-77%; normal <16.5%), which indicated the presence of autoantibodies to Fc epsilon RI and/or to the IgE-Fc epsilon RI complex. The percent of histamine release did not correlate with patient age or duration and severity of symptoms. Thus the autoimmune basis of chronic urticaria was established. Associated antithyroid autoantibodies were found in two patients. Complete or partial remission was obtained ...
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SUMmARY An 8 year old girl with primary pulmonary hypertension and signs of heart failure was given 17*5 mg of verapamil injected into the pulmonary artery over 25 minutes to test for the reversibility of pulmonary arteriolar obstruction.... more
SUMmARY An 8 year old girl with primary pulmonary hypertension and signs of heart failure was given 17*5 mg of verapamil injected into the pulmonary artery over 25 minutes to test for the reversibility of pulmonary arteriolar obstruction. Pulmonary artery pressure fell from 70/50 to 35/25 mm Hg. Treatment with 40 mg verapamil by mouth four times daily was started, and she was discharged. She gradually became asymptomatic and resumed the activities of a normal child of school age. On recatheterisation seven months later her pulmonary artery pressure was 30/ 10 mm Hg. She was still doing well 12 months after the start of treatment. Primary pulmonary hypertension has a poor prog-nosis and is a frustrating problem for the managing physician. Calcium antagonists have smooth muscle relaxing properties ' and well known systemic vaso-dilator and antihypertensive effects.2 McMurtry et al showed on a rat lung model that calcium antagonists were capable of inhibiting the hypoxic pulmonary...
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U radu prikazane su smjernice za lijecenje anafilaksije i anafilaktickog soka u djece koje je donijela radna skupina Hrvatskog drustva za alergologiju i klinicku imunologiju.
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Temporal association of an adverse event to immunization should not automatically be considered to constitute a causal relation If the events are not causally related, the continuation of immunization is advised Atopy and autoimmunity are... more
Temporal association of an adverse event to immunization should not automatically be considered to constitute a causal relation If the events are not causally related, the continuation of immunization is advised Atopy and autoimmunity are not associated with history of immunization Comorbid disorders like multiple sclerosis, Guillain-Barre syndrome and thrombocytopenia may constitute relative or absolute contraindications to specific vaccines
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Analiza izdahnutoga kondenziranog zraka zadnjih se godina opisuje kao moguca nova metoda u dijagnostici i longitudinalnom pracenju plucnih bolesti. Uzorak izdahnutoga kondenzata dobije se vrlo jednostavno: izdisanjem zraka u rashlađeni... more
Analiza izdahnutoga kondenziranog zraka zadnjih se godina opisuje kao moguca nova metoda u dijagnostici i longitudinalnom pracenju plucnih bolesti. Uzorak izdahnutoga kondenzata dobije se vrlo jednostavno: izdisanjem zraka u rashlađeni spremnik. Metoda dobivanja uzorka je neinvazivna, lako se izvodi, može se ponavljati, te je prikladna za djecju dob. Analiza izdahnutoga kondenzata omogucuje mjerenje koncentracije razlicitih plucnih sastojaka: kako nehlapljivih(oksidativni produkti, medijatori, proteini) tako i hlapljivih molekula (dusikov oksid, ugljicni monoksid, ugljicni dioksid). Ocekuje se da ce analiza izdahnutog kondenzata pomoci u diferencijalnoj dijagnozi razlicitih plucnih bolesti, kao sto su astma, kronicna opstruktivna plucna bolest, cisticna fibroza, broniektazije, intersticijska plucna bolest. U tu se svrhu u mnogim laboratorijima danas provode istraživanja dijagnosticke važnosti određivanja koncentracije interferona gama, leukotrijena, prostaglandina, interleukina. Osi...
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Results of determination of circulating histamine releasing autoantibodies using histamine release urticaria test in 12 children (aged 3 to 18 years, mean age 8.5 years ; 7 female and 5 male) with chronic urticaria are presented. Standard... more
Results of determination of circulating histamine releasing autoantibodies using histamine release urticaria test in 12 children (aged 3 to 18 years, mean age 8.5 years ; 7 female and 5 male) with chronic urticaria are presented. Standard work-up including detailed history, allergy testing and routine laboratory findings did not disclose any plausible cause of chronic/recurrent urticarial eruption in these children. All children underwent serum-induced basophil histamine release urticaria test. At serum dilution of 12.5%, the mean percent of histamine liberation was 40.8% (range 18%-77% ; normal <16.5%), which indicated the presence of autoantibodies to FcepsilonRI and/or to the IgE-FcepsilonRI complex. The percent of histamine release did not correlate with patient age or duration and severity of symptoms. Thus the autoimmune basis of chronic urticaria was established. Associated antithyroid autoantibodies were found in two patients. Complete or partial remission was obtained wi...
Anaphylaxis to vaccines is rare; approximately once in one million doses Anaphylaxis usually occurs within the first 30 min after exposure, but sometimes it can take up to 4 h or longer Symptoms of anaphylaxis are polymorphic, but well... more
Anaphylaxis to vaccines is rare; approximately once in one million doses Anaphylaxis usually occurs within the first 30 min after exposure, but sometimes it can take up to 4 h or longer Symptoms of anaphylaxis are polymorphic, but well systematized and should be readily recognized and carefully appreciated Anaphylaxis should be acutely treated with adrenaline, systemic corticosteroids, volume replacement, and antihistamines Twenty-four-hour hospital observation is indicated because a biphasic course is possible in anaphylaxis Diagnosis relies on skin testing with the culprit vaccine and its components, and where available, in vitro tests for the specific IgE to vaccine additives Anaphylaxis contraindicates further immunization with the culprit vaccine; in exceptional vital situations, a desensitization-immunization graded dose protocol may be attempted in an intensive care setting
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Patients with successful autologous or allogeneic hematopoietic stem-cell therapy should get booster courses of previous vaccinations Additionally, the patient should get inactivated Inf, PCV and Men vaccine Inactivated vaccines can... more
Patients with successful autologous or allogeneic hematopoietic stem-cell therapy should get booster courses of previous vaccinations Additionally, the patient should get inactivated Inf, PCV and Men vaccine Inactivated vaccines can generally be started at 6 months post HSCT, provided the child has no immunosuppression for the past 3 months, a lymphocyte count >1200/μL, and endogenous IgG > 500 mg/dL Live vaccines are strictly contraindicated. Only MMR and Var can be considered in select well engrafted cases, no sooner than 24 months after HSCT. Requirement is CD4+ count >700/mL, endogenous IgG >500 mg/dL, and adequate serological response to inactivated vaccines, no immunosuppression and no GVHD Passive immunoglobulin prophylaxis is established for measles by IVIG and for chickenpox by VZIG Chemoprophylaxis with valacyclovir is available for chickenpox, in intramuscular and subcutaneous forms The 16% HNIG concentrate can provide passive protection for measles, and to some extent hepatitis A and chickenpox
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Mycotoxicoses are acute and chronic poisonings caused by mould toxins called mycotoxins. Although acute mycotoxicoses, caused by high mycotoxin levels in food are rare nowadays, they need to be described in order to inform physicians and... more
Mycotoxicoses are acute and chronic poisonings caused by mould toxins called mycotoxins. Although acute mycotoxicoses, caused by high mycotoxin levels in food are rare nowadays, they need to be described in order to inform physicians and other health care workers about their symptoms. Children are more sensitive to mycotoxins because of their lower body mass, higher metabolic rate, and underdeveloped organ functions and detoxication mechanisms. Some mycotoxicoses appear only in children, and some are more pronounced in children than in adults. Acute mycotoxicoses in children are reported poorly, mostly because they occur in the tropical regions with poor healthcare coverage. In developed countries healthcare authorities are more concerned about child exposure to low levels of mycotoxins with immunotoxic, genotoxic or carcinogenic properties
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ABSTRACT Wraz z postępującym starzeniem się populacji europejskiej prawdopodobnie będzie następował stały wzrost zachorowalności i zwiększenie nakładów finansowych na leczenie w populacji osób dorosłych. Tendencje te czynią zasadne... more
ABSTRACT Wraz z postępującym starzeniem się populacji europejskiej prawdopodobnie będzie następował stały wzrost zachorowalności i zwiększenie nakładów finansowych na leczenie w populacji osób dorosłych. Tendencje te czynią zasadne przeprowadzenie przeglądu i rewizji możliwych strategii profilaktycznych, jakimi są szczepienia. Z uwagi na niedobór skoordynowanych programów szczepień u dorosłych istotny problem stanowi wdrażanie tej formy immunizacji w populacji dorosłych. W krajach Europy Zachodniej zaczęto uwzględniać konieczność rozszerzenia szczepień w tej grupie demograficznej. Problem ten w Europie Środkowej pozostaje słabo poznany i wciąż niedostatecznie opisany. W niniejszym artykule podsumowano dostępne dane, których analiza wskazuje na konieczność rozszerzenia kalendarza szczepień dorosłych w grupie krajów Europy Środkowej, należących do Stowarzyszenia Świadomej Postawy wobec Szczepień CEVAG (Central European Vaccination Awareness Group) (Bułgaria, Chorwacja, Czechy, Estonia, Węgry, Łotwa, Litwa, Rumunia, Słowacja, Słowenia i Turcja). Grupa CEVAG zaleca wdrożenie kalendarza szczepień dorosłych, który powinien obejmować szczepienia przeciwko chorobom o największej śmiertelności i zachorowalności w tej populacji. Kalendarz ten powinien być indywidualizowany w stosunku do indywidualnych potrzeb i priorytetów krajowych.As Europe&#39;s population ages, disease morbidity and treatment costs in the adult population are likely to rise substantially, making this a pertinent time to review and revise preventive strategies such as vaccination. Vaccine uptake remains a problem for adults and there is a lack of coordinated programmes for vaccination of adults. Countries in Western Europe have begun to identify the need to increase adult vaccination, but the situation in Central European countries remains poorly identified and inadequately described. This paper summarises the evidence to support the development of an adult vaccination calendar in the Central European Vaccination Awareness Group (CEVAG) member countries (Bulgaria, Croatia, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Romania, Slovakia, Slovenia and Turkey). CEVAG recommends the introduction of an adult vaccination calendar, which should include vaccination against diseases that represent a large burden in adults in terms of mortality and morbidity. This calendar could be modified to meet the priorities of individual countries.
Research Interests: Medicine and Vaccination
Interleukin-12 receptor β1 (IL-12Rβ1) deficiency is the most common form of Mendelian susceptibility to mycobacterial disease (MSMD). We undertook an international survey of 141 patients from 102 kindreds in 30 countries. Among 102... more
Interleukin-12 receptor β1 (IL-12Rβ1) deficiency is the most common form of Mendelian susceptibility to mycobacterial disease (MSMD). We undertook an international survey of 141 patients from 102 kindreds in 30 countries. Among 102 probands, the first infection occurred at a mean age of 2.4 years. In 78 patients, this infection was caused by Bacille Calmette-Guérin (BCG; n = 65), environmental mycobacteria (EM; also known as atypical or nontuberculous mycobacteria) (n = 9) or Mycobacterium tuberculosis (n = 4). Twenty-two of the remaining 24 probands initially presented with nontyphoidal, extraintestinal salmonellosis. Twenty of the 29 genetically affected sibs displayed clinical signs (69%); however 8 remained asymptomatic (27%). Nine nongenotyped sibs with symptoms died. Recurrent BCG infection was diagnosed in 15 cases, recurrent EM in 3 cases, recurrent salmonellosis in 22 patients. Ninety of the 132 symptomatic patients had infections with a single microorganism. Multiple infec...
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Streptococcus pneumoniae causes considerable global paediatric morbidity and mortality, despite the availability of safe and effective pneumococcal conjugate vaccines (PCVs). To justify the introduction of PCVs, accurate information on... more
Streptococcus pneumoniae causes considerable global paediatric morbidity and mortality, despite the availability of safe and effective pneumococcal conjugate vaccines (PCVs). To justify the introduction of PCVs, accurate information on the burden of disease is required. Here, we present an appraisal of the pneumococcal epidemiological situation in 11 Central European countries. The data are based on study findings presented at the 12th Central European Vaccine Advisory Group (CEVAG) meeting, held on 21-22 May 2010 in Sofia, Bulgaria, and a literature review of the PubMed database using the search terms &amp;amp;amp;#x27;pneumococcal&amp;amp;amp;#x27; or &amp;amp;amp;#x27;Streptococcus pneumoniae&amp;amp;amp;#x27;, in combination with &amp;amp;amp;#x27;otitis media&amp;amp;amp;#x27;, &amp;amp;amp;#x27;pneumonia&amp;amp;amp;#x27;, &amp;amp;amp;#x27;meningitis&amp;amp;amp;#x27; or &amp;amp;amp;#x27;bacteraemia/sepsis&amp;amp;amp;#x27;, and &amp;amp;amp;#x27;[Central European country name]&amp;amp;amp;#x27;. The incidence of pneumococcal disease appears to be lower in Central Europe than previously reported for Europe as a whole, with the highest risk in infants aged 0-2 years. The fatality rates in the under fives from invasive infections are up to 40%. A paucity of comprehensive country-specific data on pneumococcal disease burden arises from the lack of homogenous surveillance programmes. Standardised, active surveillance systems are required for the accurate evaluation of the pneumococcal disease burden in the region. Only then can the need for vaccination be addressed.
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Research Interests: Eastern Europe, Evidence Based Medicine, Turkey, Health Policy, Medicine, and 15 moreCentral and Eastern Europe, Humans, Gastroenteritis, Infant, Incidence, Vaccination, Prevalence, Rotavirus, Cost Benefit Analysis, World Health Organization, Cost of Illness, Health Care Costs, Child preschool, Mass vaccination, and Medical and Health Sciences
Alergijski rinitis najčešći je oblik kroničkog rinitisa u dječjoj dobi. Pokreće ga alergijska upala i obično je udružen s drugim atopijskim bolestima: astmom i atopijskim ekcemom. Glavni su alergeni aeroalergeni: grinja iz kućne prašine,... more
Alergijski rinitis najčešći je oblik kroničkog rinitisa u dječjoj dobi. Pokreće ga alergijska upala i obično je udružen s drugim atopijskim bolestima: astmom i atopijskim ekcemom. Glavni su alergeni aeroalergeni: grinja iz kućne prašine, te peludi stabala, trava i korova. Međutim, nije sasvim rijetko da se simptomi alergijskog rinokonjunktivitisa pojave u svezi s nutritivnom alergijom i oralnim alergijskim sindromom, osobito u dojenčadi i male djece. Alergijski je rinitis često udružen s alergijskom astmom, bilo da joj prethodi, ili da nastane naknadno, a u svakom slučaju otežava njezino liječenje. Oslonac liječenja je ekspozicijska profilaksa, antihistaminici, antagonisti leukotriena i intranazalni kortikosteroidi. Alergijski je rinokonjunktivitis jedna od glavnih indikacija za specifičnu alergensku imunoterapiju koja može imati i preventivni učinak na razvoj astme. Alergijski rinitis udružen s povremenom ili blagom trajnom astmom može biti dobrom indikacijom, ne samo za imunoterap...
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X-linked hyper IgM syndrome (XHIGM) is a primary immunodeficiency with high morbidity and mortality compared to normal individuals. Hematopoietic cell transplant (HCT) has been considered a curative therapy, but the procedure has inherent... more
X-linked hyper IgM syndrome (XHIGM) is a primary immunodeficiency with high morbidity and mortality compared to normal individuals. Hematopoietic cell transplant (HCT) has been considered a curative therapy, but the procedure has inherent complications, and may not be available for all patients. We sought to collect data on the clinical presentation, treatment, and follow-up of a large sample of patients with XHIGM in order to (1) compare long-term overall survival and general well-being of patients treated with or without HCT along with clinical factors associated with mortality, and (2) summarize clinical practice and risk factors in the subgroup of patients treated with HCT. Physicians caring for patients with primary immunodeficiency diseases were identified through the Jeffrey Modell Foundation, United States Immunodeficiency Network, Latin American Society for Immunodeficiency, and the Primary Immune Deficiency Treatment Consortium. Data was collected using a REDCap web applic...
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Research Interests: Eastern Europe, Central and Eastern Europe, Biological Sciences, Humans, Rubella Virus, and 13 moreVaccine, Vaccination, Heart Disease, European regions, Pregnant Women, Monitoring System, Laboratory Tests, Clinical Diagnosis, Immunization Programs, Congenital Rubella Syndrome, Immunization Schedule, Medical and Health Sciences, and Viral Disease
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The pharmacology, efficacy, dosage, adverse effects, and economics of anti IgE (omalizumab) are discussed. Omalizumab is the generic name for the human/murine chimeric (recombinant humanized) monoclonal IgG antibody. Anti-IgE prevents IgE... more
The pharmacology, efficacy, dosage, adverse effects, and economics of anti IgE (omalizumab) are discussed. Omalizumab is the generic name for the human/murine chimeric (recombinant humanized) monoclonal IgG antibody. Anti-IgE prevents IgE from attaching to effector cells, and thereby blunts IgE-mediated inflammatory responses. After subcutaneous administration its absorption is slow, reaching peak concentration in serum after an average of 7-8 days. At recommended doses, serum free IgE levels decrease within 1 hour following the first dose and maintained between doses. Dose and dosing frequency are adjusted according to body mass and serum total IgE concentration before the start of treatment. Omalizumab administered subcutaneously is an effective treatment for add-on therapy in patients with poorly controlled, moderate-to-severe allergic asthma and allergic rhinitis (adults and adolescents >12 years). It reduces the requirement for inhaled corticosteroids while protecting agains...
Vaccination is the most important medical success of the 20th century, having resulted in saving more lives than any other medical intervention. The contraindications for vaccination are discussed in children with neurological disorders... more
Vaccination is the most important medical success of the 20th century, having resulted in saving more lives than any other medical intervention. The contraindications for vaccination are discussed in children with neurological disorders and diseases which were present before or occurred after vaccination. General contraindications for vaccination in these children do not differ from contraindications in the general pediatric population. Special contraindications refer to particular vaccines. Non-progressive encephalopathies caused by early perinatal brain damage (cerebral palsy), well controlled epilepsies, congenital neuromuscular diseases and the majority of metabolic diseases as well as developmental pervasive disorders, acute encephalomyelitis and transverse myelitis, multiple sclerosis and Guillian Bareov syndrome in later childhood – are not contraindications for vaccination. Vaccination is often hampered by „pseudo-contraindications“ such as mild febrile illness, antibiotic t...
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Transplantacija jetre u djece jedan je od najboljih primjera kako moderna medicina uspješno liječi inače fatalne bolesti djece. Isto tako, transplantacija jetre jedan je od najboljih primjera potrebe za multidisciplinarnim i timskim radom... more
Transplantacija jetre u djece jedan je od najboljih primjera kako moderna medicina uspješno liječi inače fatalne bolesti djece. Isto tako, transplantacija jetre jedan je od najboljih primjera potrebe za multidisciplinarnim i timskim radom u modernoj medicini.
Allergic rhinitis is the most prevalent form of chronic rhinitis in children. It is driven by allergic inflammation and is commonly associated with other atopic diseases such as asthma and atopic eczema. The main allergens are primarily... more
Allergic rhinitis is the most prevalent form of chronic rhinitis in children. It is driven by allergic inflammation and is commonly associated with other atopic diseases such as asthma and atopic eczema. The main allergens are primarily aeroallergens: house dust mite, and tree, grass and weed pollen. It is, however, not exceptional to experience symptoms of allergic rhinoconjunctivitis in conjunction with food allergy and oral food allergy syndrome, especially in infants and toddlers. Allergic rhinitis is often associated with allergic asthma, either preceding it, or developing later and making it more difficult to treat. The mainstay of treatment is exposure prophylaxis, antihistamines, leukotriene antagonists and intranasal corticosteroids. Allergic rhinitis is one of the prime indications for specific allergen immunotherapy, which may have a preventive effect on the development of asthma. Allergic rhinitis associated with intermittent or mild persistent asthma may be a good indic...
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The pharmacology, efficacy, dosage, adverse effects, and economics of anti IgE (omalizumab) are discussed. Omalizumab is the generic name for the human/murine chimeric (recombinant humanized) monoclonal IgG antibody. Anti-IgE prevents IgE... more
The pharmacology, efficacy, dosage, adverse effects, and economics of anti IgE (omalizumab) are discussed. Omalizumab is the generic name for the human/murine chimeric (recombinant humanized) monoclonal IgG antibody. Anti-IgE prevents IgE from attaching to effector cells, and thereby blunts IgE-mediated inflammatory responses. After subcutaneous administration its absorption is slow, reaching peak concentration in serum after an average of 7-8 days. At recommended doses, serum free IgE levels decrease within 1 hour following the first dose and are maintained between doses. Dose and dosing frequency are adjusted according to body mass and serum total IgE concentration before the start of treatment. Omalizumab administered subcutaneously is an effective treatment for add-on therapy in patients with poorly controlled, moderate-to-severe allergic asthma and allergic rhinitis (adults and adolescents > 12 years). It reduces the requirement for inhaled corticosteroids while protecting a...
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The allergic rhinitis (AR) is an important risk factor for the development of asthma. In significant number of patients with AR, the non-specific bronchial hyperresponsiveness (BHR) could be demonstrated. It has been anticipated that... more
The allergic rhinitis (AR) is an important risk factor for the development of asthma. In significant number of patients with AR, the non-specific bronchial hyperresponsiveness (BHR) could be demonstrated. It has been anticipated that these patients were at the greater risk for asthma. This study was aimed to determine the frequency and intensity of BHR in patients with seasonal AR (SAR) due to Wall pellitory allergy. The patients who were sensitized solely to Parietaria officinalis (Wall pellitory) pollen allergen were recruited in the study, namely patients with SAR (n = 26), SAR with seasonal asthma (n = 23) as well as healthy volunteers (n = 10). In all subjects the clinical check-up, spirometry and bronchial challenge test with metacholine were performed before, during the peak, and after the peak of pollination of pellitory. Comparing to initial findings (23%), in patients with SAR the prevalence of BHR significantly increased during the peak of pollination (50%, p = 0.0039), a...
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The aim of the study was to compare physician/patient differences in the perception of asthma. The data were obtained by questionnaires from 156 physicians and 148 asthmatics in four urban regions in Croatia. On a "bad day", 62%... more
The aim of the study was to compare physician/patient differences in the perception of asthma. The data were obtained by questionnaires from 156 physicians and 148 asthmatics in four urban regions in Croatia. On a "bad day", 62% of physicians and 16% of patients perceived respiratory symptoms with statistically significant difference. The patients described asthma impact in terms of reduced daily activities and experienced emotional problems. Asthma was estimated as controlled in 28% of adults and 49% of children, nevertheless, 45% of adults and 22% of children reported respiratory symptoms. The patients seem to be satisfied with asthma control that does not correspond to suppression of symptoms, whereas physicians neglect patients' emotional problems and asthma impact on everyday life. The differences in the perception of asthma may reflect differences in beliefs about health. Physicians see health as an absence of symptoms, whereas patients regard being healthy as &q...
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A 14-year old boy was admitted for signs of heart failure and scapuloperoneal muscle weakness. He fulfilled the clinical, functional and diagnostic criteria for dilated cardiomyopathy. There was also a moderate increase in pulmonary... more
A 14-year old boy was admitted for signs of heart failure and scapuloperoneal muscle weakness. He fulfilled the clinical, functional and diagnostic criteria for dilated cardiomyopathy. There was also a moderate increase in pulmonary vascular resistance. The immunohistochemical examination of the heart muscle revealed a slightly positive phytohemagglutinin reaction and minimal IgM deposits without complement. The electron microscopy examination disclosed increased numbers of abnormal mitochondria disrupting the usual cell structure; the mitochondria were of various sizes with irregular and abnormal structure of the cristae. The scapuloperoneal spinal muscular atrophy was mild and diagnosed according to clinical and electromyographic findings. Light microscope examination of the skeletal muscle revealed hypotrophic fibers. This patient is presumed to have postinflammatory mitochondriopathy and is currently being managed on low-dose digitalis, diuretics and captopril.
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ABSTRACT Allergic rhinitis is the most prevalent form of chronic rhinitis in children. It is driven by allergic inflammation and is commonly associated with other atopic diseases such as asthma and atopic eczema. The main allergens are... more
ABSTRACT Allergic rhinitis is the most prevalent form of chronic rhinitis in children. It is driven by allergic inflammation and is commonly associated with other atopic diseases such as asthma and atopic eczema. The main allergens are primarily aeroallergens: house dust mite, and tree, grass and weed pollen. It is, however, not exceptional to experience symptoms of allergic rhinoconjunctivitis in conjunction with food allergy and oral food allergy syndrome, especially in infants and toddlers. Allergic rhinitis is often associated with allergic asthma, either preceding it, or developing later and making it more difficult to treat. The mainstay of treatment is exposure prophylaxis, antihistamines, leukotriene antagonists and intranasal corticosteroids. Allergic rhinitis is one of the prime indications for specific allergen immunotherapy, which may have a preventive effect on the development of asthma. Allergic rhinitis associated with intermittent or mild persistent asthma may be a good indication for concomitant combination treatment with antihistamines and leukotriene antagonists. Intranasal corticosteroids should not be withheld in more severe forms. Shortterm (up to 3 months) use of intranasal corticosteroids has not been associated with any significant local or systemic side effects.
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... A great deal of time and effort was spent working with many organizations to bring about veryfew international transfers of patients. It is possible that efforts to support the Edited by Drummond Rennie, MD, Deputy Editor (West), and... more
... A great deal of time and effort was spent working with many organizations to bring about veryfew international transfers of patients. It is possible that efforts to support the Edited by Drummond Rennie, MD, Deputy Editor (West), and Margaret A. Winker, MD, SeniorEditor. ...
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The major characteristic of asthma is persistent airway inflammation that fails to resolve spontaneously. Dysregulation of pro- and anti-inflammatory mechanisms is responsible for the development of chronic inflammation. The inflammatory... more
The major characteristic of asthma is persistent airway inflammation that fails to resolve spontaneously. Dysregulation of pro- and anti-inflammatory mechanisms is responsible for the development of chronic inflammation. The inflammatory reaction is mediated by numerous cells and their mediators. Detection and quantification of airway inflammation in children are subject to many requirements, e.g., use of biologic samples obtained in a non-invasive way; use of standardized analytical methods to determine biomarkers that can identify inflammation processes (inflammation itself, oxidative stress, apoptosis and remodelling); determining the role of systemic inflammation; assessment of correlation of various biomarkers of inflammation with clinical parameters and their diagnostic efficacy; providing a tool(s) to monitor diseases, and to evaluate adequacy of therapy; and predicting the clinical course of inflammation and prognosis of asthma. Using standardized analyses, it is now possible to determine direct markers of local inflammation, i.e., fractional nitric oxide (marker of oxidative stress) in exhaled breath, pH (marker of acid stress) in breath condensate, and indirect markers in blood/serum, i.e., eosinophil granulocytes (indicating migration), eosinophil cationic protein (marker of activated eosinophil granulocytes) and C-reactive protein (marker of systemic inflammation). However, none of these biomarkers are specific for asthma. Further standardization of the known pulmonary biomarkers of local inflammation and identification of new ones will allow for longitudinal follow-up of inflammation in children with asthma.
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The major characteristic of asthma is persistent airway inflammation that fails to resolve spontaneously. Dysregulation of pro- and anti-inflammatory mechanisms is responsible for the development of chronic inflammation. The inflammatory... more
The major characteristic of asthma is persistent airway inflammation that fails to resolve spontaneously. Dysregulation of pro- and anti-inflammatory mechanisms is responsible for the development of chronic inflammation. The inflammatory reaction is mediated by numerous cells and their mediators. Detection and quantification of airway inflammation in children are subject to many requirements, e.g., use of biologic samples obtained in a non-invasive way; use of standardized analytical methods to determine biomarkers that can identify inflammation processes (inflammation itself, oxidative stress, apoptosis and remodelling); determining the role of systemic inflammation; assessment of correlation of various biomarkers of inflammation with clinical parameters and their diagnostic efficacy; providing a tool(s) to monitor diseases, and to evaluate adequacy of therapy; and predicting the clinical course of inflammation and prognosis of asthma. Using standardized analyses, it is now possible to determine direct markers of local inflammation, i.e., fractional nitric oxide (marker of oxidative stress) in exhaled breath, pH (marker of acid stress) in breath condensate, and indirect markers in blood/serum, i.e., eosinophil granulocytes (indicating migration), eosinophil cationic protein (marker of activated eosinophil granulocytes) and C-reactive protein (marker of systemic inflammation). However, none of these biomarkers are specific for asthma. Further standardization of the known pulmonary biomarkers of local inflammation and identification of new ones will allow for longitudinal follow-up of inflammation in children with asthma.