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Objective - to determine the presence of antinuclear antibodies (ANAs) in children with juvenile idiopathic arthritis (JIA) and arthritis related to infection (ARI). Methods - Retrospective-prospective study at the Clinic for Children's Diseases Tuzla, from January 2014 to January 2020. Results - 81 children were included in the study: 26 boys and 16 girls with JIA (median age 9.9 years) and 22 boys and 17 girls with ARI (median age 9.6 years). The most common form of JIA was oligoarticular (64.2%), while reactive arthritis (ReA) was the most common form of ARI (64.1%). ANAs were positive in 7/42 (16.6%) children with JIA: 5/27 (18.5%) children with the oligoarticular and 2/10 (20%) children with polyarticular rheuma factor negatve form. Considering ARI, ANAs were positive in 12/39 (30.7%) children: 9 children with ReA (23.1%) and 3 children with postinfectious arthritis (7.6%). We did not find a significant difference in ANAs positivity between the examined groups of children (χ2=1.523; P=0.21). One child with JIA and 25.6% of children with ARI had a positive ANA profile; a statistically significant difference (P=0.002) was found. Conclusion - ANAs tests have little diagnostic utility in clarifying the diagnosis of JIA, and should not be used as a screening tool if JIA is the diagnosis under consideration. The persistence of ANAs was not associated with the type of arthritis, juvenile or ARI. [ABSTRACT FROM AUTHOR]

Objective -- To assess diagnostic criteria, laboratory findings and response to therapy among children with multisystem inflammatory syndrome (MIS-C) associated with SARS-CoV-2 infection. Patients and Methods -- retrospective study at the Clinic for Children's Diseases Tuzla in the period November 2020-April 2021. Results -- 13 children fulfilled diagnostic criteria, median age 7.2 years, 5 were treated at the intensive care unit; one with lethal outcome. The most common symptoms and signs were: unremitting fever (100%), skin rash (84.6%), gastrointestinal symptoms (76.9%), pneumonia (92.3%); one girl required invasive mechanical support. Cardiac manifestations were present in 76.9%, one of three children with acute kidney injury required hemoperfusion. Altered mental status was present in 69.2%. Inflammatory markers were elevated and we found strong correlation between IL-6 and procalcitonin (rs=0.85), CRP and IL-6 (rs=0.70), and medium correlation between ferritin and procalcitonin (rs=0.53), ferritin and IL-6 (rs=0.52) values. Clinical improvement and a drop in inflammatory markers were seen within the first 48 to 72 hours of initiating IVIG and corticosteroid therapy (7/13 children), but it was also evident with corticosteroids alone (6/13 children). Conclusion -- MIS-C is a potentially fatal condition with very different presentations and strong inflammatory response. The key for a positive outcome is early recognition of MIS-C and adequate and prompt treatment. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Saliniana is the property of Jzu Univerzitetski Klinickui Centar Tuzla and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Medica Saliniana is the property of Jzu Univerzitetski Klinickui Centar Tuzla and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Transplantation of kidneys (TK) is the best way of curing patients with terminal kidney disease. Unfortunately, right after the operation, different kinds of complications are possible and might happen to transplant. The worst and the most often complication is acute rejection (AR)., Purpose: The aim of work is to find the most often clinical signs and symptoms of AR. The aim of research is to value the influence of AO on function of graft and to find the influence of AR on surviving patients and graft., Methods: This study has been done on 91 patients, 62 male and 29 female patients in the age of 38.58 +/- 11.4. Patient are divide in two groups: experimental group which includes 29 patients that have had one or more episodes of acute rejection. We used serum concentration of creatinine defined by Cocroft-Gault curve to measure function of transplant. Time of patients and graft survival is estimated by Caplan-Meier curve., Results: In a group of patients with acute rejection we registered 42 episodes of dysfunction of graft which are treated as AR. The average creatinine in a group of patients with acute rejection was 183.42 +/- 65.39 micromol/L. Clearance of creatinine of group patient without AR is much bigger (p < 0.0001) than average clearance of creatinine of patients with acute rejection. Average serum creatinine in this group of patients is 147.59 +/- 62.57 and it is quite smaller (p < 0.002) than average creatinine at patients with acute rejection. Survival of all patients after five years is 91%, survival of patients without acute rejection is 96%, and with acute rejection is 80% (p < 0.014). Five year survival of graft is 78%, at the patients without acute rejection is 96% and at the patients with acute rejection is 64% (p < 0.0001), which is quite shorter., Discussion: Clinical image of acute rejection is unspecific. There is not arranged values of serum creatinine although in some research those values are 130-170 micromol/L. This values includes patients which did not have an acute rejection. Five year survival patients and graft in our patients that did not have an acute rejection is same as in the results of relevant centers. But survival of patients and grafts in patients that had an acute rejection is little bit lower than it is in the results in relevant centers., Conclusion: There is no clinical picture than can help you to recognize an acute rejection because many other dysfuncion look the same. Acute rejection reduces function of transplant. Survival of patients and graft is mutch longer in the patients without acute rejection.

Celiac disease is intolerance to gluten that classically produces chronic diarrhea with a picture of malabsorption and a total villous atrophy. These elements regress completely in a sequential way under a prolonged gluten-free diet. We describe a case of a 35-year-old woman affected by celiac disease who presented atypically, with features including hypoproteinaemia (38g/L) with dominant hypoalbuminaemia (12g/L), weight loss, strong psychoneurotic component and amenorrhoea. These manifestations for the first time were diagnosed as irritable bowel disease and after immunology diagnostic as celiac disease. Current research on celiac disease has pointed out the biologically significant role of antigliadin antibodies IgG and IgA and antibodies to tissue transglutaminase (tTg).

Aim of the Study: To establish the presence of pericarditis and exudative pleuritis in patients with systemic lupus erythematosus (SLE) prior to and after glicocorticoid and cytotoxic therapy., Patients and Methods: In 43 patients, 39 women and 4 men, with SLE (disease was diagnosed according to revised American College of Rheumatology ACR criterias, 1997), aged between 20 and 61 and averaged disease duration of 5.54 +/- 5.74 years, heart/lung radiology and heart echosonography were performed in order to discover possible serositis (pericarditis and exudative pleuritis) prior to and after cytotoxic and glucocorticoid therapy., Results: The presence of pericarditis and exudative pleuritis was established in 20 patients (47%) before the therapy. After the therapy pericarditis was present in 2 patients, average volume of 150 ml, and exudative pleuritis was also present in phrenicocostal sinus, but its volume was minimal. This table is showing the results of our study on patients with SLE and serositis. The results were compared with the results of European and Belgrade group in year 2000. [table: see text], Conclusion: Higher frequency of serositis (pericarditis and exudative pleuritis) in our study is probably a result of more active disease, and the effects of cytotoxic and glucocorticoid therapy were satisfing exept in two patients who were resistant on therapy. That is the reason why we had to consider plasmapheresis.

Unlabelled: Bosnia and Herzegovina has been known as a highly endemic region for Hantavirus infections for more than 50 years. Previous studies have shown that at least two different hantaviruses, the murine Dobrava (DOB) and avricoline Puumala (PUU) viruses, each carried by a different rodent species, have been circulating in the area. However, there is little information on rodent population density fluctuations in Bosnia over the past years as well as on the ratio of Puumala to Dobrava infection in humans., The Aims of Our Study Were: to identify the rodent species which may serve as hantavirus reservoirs in the north-east and central Bosnia; to assess the geographical distribution, density and population dynamics of rodent species in the area; to assess the influence of climatic conditions on the size of rodent population; and to determine the ratio of Puumala to Dobrava infection in humans., Methods: The epidemiologic and epizootic study in the north-east and central Bosnia was conducted during the 8-year period (1995-2003). The average yearly and monthly temperatures, air humidity and precipitation during the study period were analyzed. A total of 381 small rodents were caught during the epidemic years (1995 and 2002), and in-between the epidemic periods (1999 and 2000). The animals were caught by live-traps and identified by morphometric methods. The density of animals was estimated by counting the number of holes per 1000 m2. Sera of 311 patients with clinical signs and symptoms of hemorrhagic fever with renal syndrome (HFRS) were tested for the presence of antibodies reactive to the Dobrava, Puumala and Seoul viruses by using indirect immunofluorescence test (IIF), and IgG and IgM ELIS. Sera of 84 patients were tested using only IIF, and 227 sera were tested by IIF and -capture IgM ELIS tests., Results: During the epidemic years, the average monthly temperatures in February were by 4.3 times higher than the average temperatures during the nonepidemic years, which may have influenced the early reproduction of rodents and development of "mouse years". The rodents were identified as: Apodemus flavicollis (n = 139), Apodemus sylvaticus (n = 89), Apodemus agrarius (n = 4), Clethrionomys glareolus (n = 117), Sorex araneus (n = 5), Pytimus subterraneus (n = 23), Mus musculus (n = 1), Mycrotus arvalis (n = 1) and Rattus norvegicus (n = 2). Clethrionomys glareolus was predominant in the regions with the altitude higher than 1160 meters and Apodemus species in the regions with the altitude lower than 670 meters. The rodent population density changes seasonally and cyclically. During the epidemic years, the rodent population density was marked as very high, whereas during the nonepidemic years it was designated from low to moderate. Well-known natural hosts of Hantaviruses (A. flavicolis and C. glareolus) are most widely spread species of small rodents, and the increase in their population is closely related with outbreaks of epidemics of HVBS-a. Puumala virus caused HVBS-a in 49.84% (155/311); Dobrava virus in 23.15% (72/311) of cases, whereas Hantaviruses serotype was not identified in 27.00% (84/311) of cases. Infections caused by Puumala virus were more frequent than the infections caused by Dobrava virus during both epidemic and nonepidemic periods. The proportion of humans infected with Puumala and Dobrava viruses correlated with the number of natural hosts of Hantaviruses in the areas of HVBS outbreaks. The study of the prevalence of hantavirus antibodies in the populations of rodents and humans, which had been under way, should elucidate these relationships.