Clinical characteristics of children with MIS-C fulfilling classification criteria for macrophage activation syndrome.

Background: Macrophage activation syndrome (MAS) is a potentially life-threatening complication of various inflammatory disorders, including multisystem inflammatory syndrome in children (MIS-C). MIS-C refractory to treatment should raise suspicion of MAS, which can be fatal if a definitive diagnosis is delayed. Unfortunately, there is a lack of data on MAS in children with MIS-C. Objective: Our study aims to analyze the risk factors for the development of MAS in MIS-C, its clinical course and response to treatment, and identify predictive factors for pediatric intensive care. Material and methods: We analyzed data from the Polish MIS-C registry of the MultiOrgan Inflammatory Syndromes COVID-19 Related Study. Patients were diagnosed according to the WHO MIS-C definition and treated according to national guidelines (Polish Pediatric Society) based on international consensus. MAS definition was based on 2016 Classification Criteria for Macrophage Activation Syndrome Complicating Systemic Juvenile Idiopathic Arthritis. Results: Two-hundred and seventy four children met the study inclusion criteria. Fifty-nine patients fulfilled MAS classification criteria, nine of which required admission to the pediatric intensive care unit (PICU). MIS-C patients with MAS were significantly older than patients without MAS (median 11.2 vs. 8.1 years). Multivariable analysis showed that age, symptoms characteristic of atypical Kawasaki disease, and skin erosions were significant factors associated with MAS in MIS-C patients. Analysis of laboratory parameters showed that on admission, MIS-C patients with MAS had significantly lower median lymphocyte and platelet counts, albumin and sodium levels, and higher median levels of C-reactive protein, procalcitonin, ferritin, D-dimers, triglycerides, serum creatinine, urea, and γ-glutamyl transpeptidase, and neutrophil count. Multivariate analysis showed that higher procalcitonin, ferritin, and fibrinogen levels at admission were predictive of MAS. Only elevated troponin level was a factor indicating a requirement of PICU hospitalization for children with MAS. MIS-C patients fulfilling MAS criteria were treated more often with intravenous immunoglobulins and steroids than children without MAS. Children with MAS more often required mechanical ventilation. None of the patients required biological agents. Conclusions: The clinical course of MAS in MIS-C seems milder, treatment less aggressive, and the prognosis better than expected based on the current knowledge on MAS complicating other rheumatological diseases.

Influenza and Other Prophylactic Vaccination Coverage in Polish Adult Patients Undergoing Allergen Immunotherapy-A Survey Study among Patients and Physicians.

Vaccines against infectious diseases may raise safety concerns in patients undergoing allergen immunotherapy (AIT). The objective of our study was to investigate influenza vaccine and other selected prophylactic vaccines coverage in patients treated with AIT and the attitude of physicians towards vaccinations in this group of patients. We conducted a questionnaire-based study among patients undergoing AIT and physicians. The patients' survey evaluated influenza and other prophylactic vaccines coverage. The physicians' survey assessed their experience and opinions on prophylactic vaccinations during AIT. In total, 176 patients (aged 18−79 years) and 120 doctors filled the questionnaires. Patients were assigned to two groups­inhaled allergens group (n = 101) and insect venoms group (n = 68). The number of patients who received any dose (36% and 45%, p = 0.26), as well as two or more doses (17% and 22%, p = 0.43) of influenza vaccine was comparable between two groups. However, in both groups there was a significant (p < 0.0001) decrease in influenza vaccine uptake after the beginning of AIT. Patients from the inhaled allergens group declared a higher tetanus vaccine rate (41% vs. 19%, p = 0.004). The groups did not differ in the pneumococcal and tick-borne encephalitis vaccination coverage. A majority of doctors believe that prophylactic vaccinations in patients undergoing AIT are safe and effective (96% and 94%, respectively); however, as many as 87% of them identify with the need to create clear recommendations regarding vaccinating patients undergoing AIT. Prophylactic vaccine coverage is not satisfactory among Polish adult patients undergoing AIT. Polish doctors are convinced of the validity of prophylactic vaccinations during AIT.

Simultaneous Influenza Vaccination and Hymenoptera Venom Immunotherapy Is Safe.

Allergen immunotherapy (AIT) is a standard treatment for venom allergy. Our purpose was to determine if the administration of both allergen and protective vaccines during one visit is safe and if such a procedure does not deteriorate the tolerance of both vaccines. As current guidelines are based on theoretical assumptions, our aim was to establish the safety and tolerance of shortening the recommended interval between vaccinations. During two influenza seasons, 44 adult patients, with a history of systemic allergic reactions after a Hymenoptera sting, underwent 58 simultaneous allergen and seasonal influenza vaccinations (study group) while in the maintenance phase of venom immunotherapy (VIT). The control group consisted of 57 healthy adults who were vaccinated against influenza only. The conditions of the patients were monitored during hospital visits, and via telecommunication methods to evaluate the safety and tolerance of the procedure. Within the study group, there were no immediate or delayed allergic reactions after vaccinations. The presence of common, adverse influenza vaccine reactions among study group patients (29%) and control group patients (32%) did not differ significantly (p = 0.841). We did not observe a difference in the frequency of various adverse reactions in either group or a dependence of previous vaccinations against influenza on the occurrence of adverse reactions. The most frequent occurrences were local adverse reactions. All adverse reactions were resolved without treatment. These findings demonstrate the safety and tolerance of an influenza vaccination and Hymenoptera venom immunotherapy administration during one visit.

Porous Coatings Containing Copper and Phosphorus Obtained by Plasma Electrolytic Oxidation of Titanium.

To fabricate porous copper coatings on titanium, we used the process of plasma electrolytic oxidation (PEO) with voltage control. For all experiments, the three-phase step-up transformer with six-diode Graetz bridge was used. The voltage and the amount of salt used in the electrolyte were determined so as to obtain porous coatings. Within the framework of this study, the PEO process was carried out at a voltage of 450 VRMS in four electrolytes containing the salt as copper(II) nitrate(V) trihydrate. Moreover, we showed that the content of salt in the electrolyte needed to obtain a porous PEO coating was in the range 300-600 g/dm3. After exceeding this amount of salts in the electrolyte, some inclusions on the sample surface were observed. It is worth noting that this limitation of the amount of salts in the electrolyte was not connected with the maximum solubility of copper(II) nitrate(V) trihydrate in the concentrated (85%) orthophosphoric acid. To characterize the obtained coatings, numerous techniques were used. In this work, we used scanning electron microscopy (SEM) coupled with electron-dispersive X-ray spectroscopy (EDS), conducted surface analysis using confocal laser scanning microscopy (CLSM), and studied the surface layer chemical composition of the obtained coatings by X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD), glow discharge of optical emission spectroscopy (GDOES), and biological tests. It was found that the higher the concentration of Cu(NO3)2∙3H2O in the electrolyte, the higher the roughness of the coatings, which may be described by 3D roughness parameters, such as Sa (1.17-1.90 µm) and Sp (7.62-13.91 µm). The thicknesses of PEO coatings obtained in the electrolyte with 300-600 g/dm3 Cu(NO3) 2∙3H2O were in the range 7.8 to 10 µm. The Cu/P ratio of the whole volume of coating measured by EDS was in the range 0.05-0.12, while the range for the top layer (measured using XPS) was 0.17-0.24. The atomic concentration of copper (0.54-0.72 at%) resulted in antibacterial and fungicidal properties in the fabricated coatings, which can be dedicated to biocompatible applications.

Modification of Growth, Yield, and the Nutraceutical and Antioxidative Potential of Soybean Through the Use of Synthetic Biostimulants.

Improvement of crop cultivation technologies is focused on increasing crop productivity and improving yield quality, and at the same time on minimizing risks posed to the natural environment. The use of biostimulants contributes to the increase in the productivity of plants, especially under their exposure to stress induced by negative environmental stimuli. A field experiment was conducted in three growing seasons (2014-2016). Seeds of soybean of the Atlanta cultivar were sown in the third decade of April. Two synthetic biostimulants were used in the growing period in the form of single (stage BBCH 13-15) or double (stage BBCH 13-15, BBCH 61) spraying: Atonik (in concentrations of 0.1 and 0.2%) and Tytanit (in concentrations of 0.07 and 0.13%). Atonik, the first tested biostimulant, contained three phenolic compounds: sodium p-nitrophenolate, sodium o-nitrophenolate, and sodium 5-nitroguaiacolate. The Tytanit preparation contained a titanium complex, magnesium oxide, and sulfur (VI) oxide. This work presents a complex study addressing the action of the biostimulants Atonik and Tytanit and demonstrates their effect on the physiological traits, plant productivity, and seed yield quality of Glycine max L. The conducted experiment proved that the biostimulant type, as well as the number of its applications and its concentration, modified the biometric traits, crop productivity, as well as yield quality and the nutraceutical and antioxidative potential of soybean seeds. It was also found that by positively affecting plant growth and seed yield, the Atonik and Tytanit also resulted biostimulants decreased the protein and lipid contents in seeds. A double application of these preparations in their higher concentrations had a more positive impact on soybean seed number and soybean seed yield. The use of both Atonik and Tytanit resulted also in an increased antioxidative activity of soybean seeds. The greatest increase in this activity was observed after the application of the Tytanit preparation. Dietary fiber fraction analysis demonstrated an increase in the acid-detergent fiber, lignin, and cellulose contents in soybean seeds as a result of biostimulant application; however, the increase was greater upon the use of Tytanit. In contrast, the neutral-detergent fiber, cellulose, and hemicellulose contents were observed to decrease in all analyzed combinations of crops treated with the tested preparations.

Modeling Biometric Traits, Yield and Nutritional and Antioxidant Properties of Seeds of Three Soybean Cultivars Through the Application of Biostimulant Containing Seaweed and Amino Acids.

In recent years, attempts have been made to use preparations that allow obtaining high and good quality yields, while reducing the application of pesticides and mineral fertilizers. These include biostimulants that are safe for the natural environment and contribute to the improvement of yield size and quality, especially after the occurrence of stressors. Their use is advisable in the case of crops sensitive to such biotic stress factors like low temperatures or drought. One of these is soybean which is a very important plant from the economic viewpoint. Field experiments were established in the years 2014-2016 in a random block design in four replicates on experimental plots of 10 m2. Three soybean cultivars: Annushka, Mavka, and Atlanta were planted in the third decade of April. Fylloton biostimulant was used at 0.7% or 1% concentrations as single spraying (BBCH 13-15) or double spraying (BBCH 13-15, BBCH 61) in the vegetation period. The number of seeds per 1 m2, seed yield, thousand seed weight, number of pods per plant, number of nodes in the main shoot, height of plants, and protein and fat contents in seeds were determined. The content of phenolic compounds, antioxidant capacity and antioxidant effect of soybean seeds were assayed as well. Foliar treatment of soybean with Fylloton stimulated the growth and yield of plants without compromising their nutritional and nutraceutical properties. The double application of the higher concentration of Fylloton was favorable for the plant height, seed number and soybean yield. Moreover, the highest number of pods was obtained after single treatment of plants with the lower biostimulant concentration. There was also a positive effect of using this biostimulant on the content and activity of some bioactive compounds, such as phenolics and flavonoids, and on the reducing power.

Concurrent peritonsillar abscess and poststreptococcal reactive arthritis complicating acute streptococcal tonsillitis in a young healthy adult: a case report.

BACKGROUND: Streptococcus pyogenes is responsible for 5-15% and 20-30% of acute pharyngitis/tonsillitis in adults and children, respectively. It not only causes acute illness but also can give rise to local suppurative complications such as peritonsillar abscess as well as trigger the postinfectious syndromes of glomerulonephritis, acute rheumatic fever and poststreptococcal reactive arthritis. Here, we report a case of a young healthy adult in whom both peritonsillar abscess and poststreptococcal reactive arthritis developed as a complication of acute streptococcal tonsillitis. To the best of our knowledge, such a coincidence of poststreptococcal sequelae has not been reported previously. CASE PRESENTATION: A 32-year-old previously healthy woman was diagnosed with acute tonsillitis by her family doctor and treated empirically with amoxicillin/clavulanic acid (875/125 mg) twice daily for 5 days. Four days after completing antibiotic therapy, peritonsillar abscess of left tonsil developed. Needle aspiration followed by incision and drainage were performed by otolaryngologist at the Emergency Department. Next, the patient was discharged home on a 10-day course of cefuroxime and metronidazole. The symptoms of peritonsillar abscess were subsiding during treatment, however on the last day of antibiotic therapy, swelling and pain of the left ankle appeared. Five days later the patient was consulted by rheumatologist. Cultures of throat swabs and abscess aspirate collected 2 weeks before revealed the presence of Streptococcus pyogenes. Antistreptolysin O (ASO) titer was evaluated and proved to be 412 IU/ml (normal 0-200 IU/ml). The level of C-reactive protein was 13,0 mg/L (normal <5,0 mg/L). There was no known cardiac involvement. Poststreptococcal reactive arthritis was diagnosed. Left ankle arthralgia persisted for about 5-6 weeks. Six months after the presentation at the Emergency Department, the patient was well, with ASO titer reaching 262 IU/ml. CONCLUSIONS: Clinicians should be aware that appropriate choice of antibiotic, proper dose as well as duration of therapy of acute GAS pharyngitis/tonsillitis are crucial to prevent poststreptococcal sequelae.

[Influence of weight reduction on leptin concentration and bone mineral density in patients with morbid obesity before and 6 months after bariatric surgery]. / Wplyw zmniejszenia masy ciala na stezenie leptyny i gestosc mineralu kostnego u osób z otyloscia olbrzymia przed i 6 miesiecy po operacji bariatrycznej.

INTRODUCTION: Leptin is considered to exert dual effect on bone metabolism: anabolic (through peripheral pathways) and antiosteogenic (through central nervous system). The total leptin's effect on bone is not known. The aim of the study was to examine bone metabolism and leptin concentration in patients with morbid obesity before and after bariatric surgery (BS). MATERIAL AND METHODS: Forty one patients with morbid obesity selected for BS were included in the prospective study. Body mass index (BMI), serum leptin, parathyroid hormone (PTH), 25-hydroxy vitamin D (25(OH)D) concentrations and bone mineral density (BMD) in the lumbar spine (LS) and proximal femur (PF) were examined before and 6 months after BS. RESULTS: Before operation (mean BMI 44.0 kg/m(2)) mean leptin and PTH concentration was increased (accordingly 37.1 ng/ml and 82.7 pg/ml), mean 25OHD concentration was decreased to 4.3 ng/ml. Mean BMD was within the upper limit of the population reference range. Leptin concentration was positively correlated with BMI. There was no correlation of leptin with BMD (in LS and PF), PTH and 25(OH)D. Following the operation (mean BMI 31.8 kg/m(2)) mean leptin concentration decreased by 30.6 ng/ml (p < 0.001), PTH decreased by 38.9 pg/ml (p < 0.001), 25(OH)D increased by 2.1 ng/ml (NS). Mean BMD in LS increased by 0.067 g/cm(2) (p < 0.005), in PF decreased by 0.044 g/cm(2) (p < 0.02). Leptin was positively correlated with BMI but not with BMD (in both sites), PTH, 25(OH)D. CONCLUSIONS: Weight loss in patients with morbid obesity after BS leads to decrease in serum leptin, increase in BMD in LS and decrease in PF. These changes are accompanied by regression of hyperparathyroidism, which is probably secondary to vitamin D deficiency.

[The influence of bariatric surgery on calcium homeostasis and biochemical markers of bone turnover in patients with morbid obesity]. / Wplyw operacji bariatrycznej na homeostaze wapnia i biochemiczne markery obrotu kostnego u osób z otyloscia olbrzymia.

INTRODUCTION: Obese patients may have abnormal calcium homeostasis because of unbalanced diet and decreased sun exposure. Bariatric surgery itself may lead to disturbances in calcium homeostasis (and in consequence changes in bone mass) or increase preexisting metabolic derangements. The aim of the study was: 1. To assess calcium homeostasis and biochemical markers of bone turnover in patients with morbid obesity. 2. To determine the impact of bariatric surgery on parameters mentioned above. 3. To establish recommendations for supplementation with calcium and vitamin D in morbidly obese patients after bariatric surgery. MATERIAL AND METHODS: Serum calcium, parathormone (PTH), vitamin D (25(OH)D), biochemical markers of bone turnover (beta-CrossLaps as a marker of bone resorption and osteocalcin as a marker of bone formation) and urine calcium as well as fat mass, lean mass and bone mineral content (by DXA) were measured before bariatric surgery of the stomach (VBG or GBP) in 57 morbidly obese patients (48 women, 9 men; mean age 35.9 y). The same procedures were repeated six months after operation in 28 of them (24 women, 4 men). Daily calcium intake was also determined based on food questionnaire. RESULTS: Biochemical findings in the group of patients before bariatric surgery were as follows: serum calcium, beta-CrossLaps and urine calcium were within normal range, PTH concentration was increased to 81.0 pg/ml and 25(OH)D as well as osteocalcin concentration decreased (4.9 ng/ml and 13.6 ng/ml, respectively). Six months after bariatric surgery there was no change in serum and urine calcium, PTH concentration decreased to normal level (46.8 pg/ml), 25(OH)D concentration increased to 6.5 ng/ml (not significant) and still remained below normal range. Markers of bone turnover--both resorption and formation--increased (beta-CrossLaps over normal range to 0.594 ng/ml, osteocalcin to normal range 26.8 ng/ml). Daily calcium intake was below RDA before and after bariatric procedure. CONCLUSIONS: 1. Patients with morbid obesity have secondary hyperparathyroidism and deficiency of vitamin D. 2. Abrupt weight loss after bariatric surgery is accompanied by the regression of secondary hyperparathyroidism, decrease of the deficiency of vitamin D and increase in bone turnover. 3. Supplementation with vitamin D and calcium is recommended for patients with morbid obesity after bariatric surgery.