Cystatin C Concentration During the First Three Postnatal Days in Healthy Term Newborns.

OBJECTIVE: Cystatin C (Cys-C) concentration has not been examined sufficiently among healthy newborn population, particularly in terms of reference values. This study aimed to establish gender-, postnatal age- and birth weight-specific Cys-C concentration for healthy term newborns. Its objective was also to examine if there were any differences between our measured concentration and the reference interval established by the CALIPER study. METHODS: Serum samples from a total of 90 healthy term newborns were used to determine Cys-C concentration. Cys-C was measured within first three days of birth using particle-enhanced turbidimetric immunoassay (PETIA) on the Architect plus ci8200 analyzer. RESULTS: Median concentration of the Cys-C was 2.05 mg/L. There were no statistically significant differences in Cys-C concentration regarding gender (p=0.779), birth weight (p=0.505), postnatal age (p=0.512) or Apgar score (p=0.799). The value of the 2.5th and 97.5th percentile for Cys-C concentrations for girls was 0.93-3.15 mg/L and for boys it was 1.5-3.36 mg/L. CONCLUSION: Cys-C concentration in healthy term newborns does not depend on gender, birth weight, postnatal age, or Apgar score. Our measured concentration range of CyS-C in healthy newborns turned out to be slightly wider than the interval determined in the CALIPER study.

Excretion of SARS-CoV-2 RNA in feces has no prognostic benefit in the outcome of COVID-19: A clinical and immunological study

This study explores the correlation between immunological and clinical characteristics in coronavirus disease 2019 (COVID-19) patients with detectable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in feces, analyzing data from 251 patients admitted to Mostar University Clinical Hospital from December 2021 to January 2022. Methods involved reverse transcription quantitative polymerase chain reaction (RT-qPCR) from nasopharyngeal swabs and feces, alongside serological tests for anti-SARS-CoV-2 spike IgGs. Demographic and clinical data were collected through questionnaires and medical records. The data analyses were performed using SPSS statistical software. Death occurred in 53 patients (21.1%, P < 0.001), mostly in the elderly (47/53, 88.7%, P = 0.001) and immunocompromised (19/53, 35.8%, P = 0.05), particularly those developing acute respiratory insufficiency (ARI) (46/53, 86.8%, P = 0.004), and severe/critical disease (46/53, 86.8%, P = 0.002). Among the patients with positive anti-SARS-CoV-2 IgG antibodies (86/251, 34.3%, P < 0.001), 41 (47.7%) were vaccinated and 45 (52.3%) unvaccinated (P = 0.666), showing no significant differences in clinical outcomes or mortality. Unvaccinated patients with a negative antibody titer had a higher incidence of ARI (96/123, 78%, P = 0.029) and intensive care unit admission (22/123, 17.9%, P = 0.026), than those with a positive antibody titer. Forty-seven (62.7%) patients, out of the 75 hospitalized who provided a feces sample, were positive for SARS-CoV-2 RNA (P = 0.028), without statistical differences between fecal SARS-CoV-2 positive and negative groups regarding vaccination status (15/47, 31.9%, P = 0.493), antibody status (18/47, 38.3%, P = 0.628) or death outcome (5/47, 10.6%, P = 0.706). In conclusion, unvaccinated hospitalized patients with a severe COVID-19 presentation and a negative anti-spike SARS-CoV-2 IgG titer had adverse outcomes more frequently. This suggests cautious consideration for the diagnostic use of fecal samples compared to nasopharyngeal swabs.

A case report of biclonal immunoglobulin D lambda/lambda multiple myeloma in patient with liver echinococcosis.

Less than 2% of all symptomatic multiple myeloma (MM) has immunoglobulin D (IgD) as monoclonal protein. Biclonal gammopathy is much rarer. At the time of diagnosis, disease is often in advanced stage, including renal failure, anemia, hypercalcemia and lytic bone lesions. Due to the rarity of myeloma itself, but also due to the fact that anti-IgD antisera is not used in routine practice, there are only a few reports of IgD MM described in the literature. This case report describes a patient with IgD lambda MM with anemia and renal failure. Anemia, renal failure, and > 80 percent plasma cells in bone biopsy in our patient with IgD lambda MM meets International Myeloma Working Group criteria for diagnosis of MM. The patient clinical course was similar to other patients with IgD MM. The final result of serum protein immunofixation (s-IFE) showed IgD lambda and free lambda monoclonal bands. To prevent misdiagnosis, it is necessary to use anti-IgD and anti-IgE antisera whenever the serum protein immunofixation with IgA, IgM, IgG, kappa and lambda antiserums shows a kappa or lambda monoclonal band without monoclonal band in heavy chain.

Sustained seroprevalence of SARS-CoV-2 antibodies one year after infection: one of the first COVID-19 cluster cases in Bosnia and Herzegovina.

SARS-CoV-2 (severe acute respiratory syndrome coronavirus type 2) is a novel virus that has been identified as a causal agent of COVID-19,  an emergent infectious disease which brought about a new pandemic in the twenty-first century. The immune responses and clinical features of individuals infected with SARS-CoV-2 have not yet been fully described. Thus, in this study, we compare the seroprevalence and define the correlation between symptoms and serological results in the first COVID-19 cluster in the city of Konjic, Bosnia and Herzegovina. Of the total number, 93% of RT-PCR positive participants had positive IgG serology and 75% of them developed symptoms of COVID-19. We found that there was no significant alteration in specific IgG (p = 0.504) antibody levels during the 1-year period after COVID-19. Our results indicate that symptomatic COVID-19 patients have a higher rate of seroconversion (p < 0.01). The IgG seroconversion was correlated with high fever (p = 0.002) and headache (p = 0.007), suggesting that these symptoms could be considered as indicators of a better immune response. This study has demonstrated persistence of sustained levels of specific SARS-CoV-2 antibodies after recovering from COVID-19 infection. However, in order to gain a better insight into the immune response to SARS-CoV-2, further systematic studies should be focused on quality and longevity analyses.

Effects of midazolam co-induction to general anesthesia: A randomized clinical trial.

BACKGROUND: This study aimed to determine the potential advantages of midazolam co-induction with general anesthesia (GA) over the use of propofol alone. METHODS: We conducted a randomized, placebo-controlled, single-blinded clinical trial of 102 patients, aged 18 to 65, American Society of Anesthesiologists II and III, who underwent elective laparoscopic gallbladder surgery. Patients were randomly divided into 3 groups: the placebo group (C) received 1 mL of 0.9% saline intravenously and the test groups received intravenous midazolam at doses of 0.03 mg/kg (M1) or 0.06 mg/kg (M2) before induction of GA. We assessed effects of midazolam co-induction on arterial pressure and heart rate (HR) in the early stage of GA prior to surgical incision and effects on perioperative and postoperative glycemia and cortisol levels. Systolic/mean/diastolic (SAP/MAP/DAP) arterial pressure and HR were measured 4 times (preoperative, on the third, sixth and ninth minute after atracurium administration). Cortisol was measured on 3 occasions (preoperatively, 60 minutes after surgical incision, and the following morning) and glucose on 4 occasions (preoperatively, 15 and 60 minutes after incision, and the following morning). We also assessed the incidence of postoperative anxiety, postoperative nausea and vomiting (PONV), and propofol requirement for induction. RESULTS: SAP/MAP/DAP were significantly higher in M2 immediately after induction compared to the other study groups (P = .002/.004/.013). Midazolam co-induction led to a significant reduction in postoperative anxiety (P = .03), reduced cortisol concentration 60 minutes after surgical incision (P < .001) and propofol requirements (P < .001). CONCLUSION SUBSECTIONS: Midazolam co-induction prevented a marked decline in SAP/MAP/DAP immediately after induction of GA, led to reduced postoperative anxiety and cortisol response to surgery, and reduced propofol requirements for induction.

Urine neutrophil gelatinase-associated lipocalin concentration in healthy newborns during the first three postnatal days.

INTRODUCTION: Urine neutrophil gelatinase-associated lipocalin (uNGAL) is a biochemical marker significant for early prediction of acute kidney injury in adults. However, it has not been examined sufficiently among the infant population, particularly newborns in terms of reference values. The aim of our study was to determine the concentration of uNGAL in healthy term newborns and to determine if there was a difference in uNGAL concentration according to gender, postnatal age and birth weight. MATERIALS AND METHODS: Our study involved 81 healthy term newborns birth (≥ 37 weeks, Apgar score ≥ 8 in the first minute after birth, CRP < 5 mg/L). Urine NGAL was measured using chemiluminescent microparticle immunoassay (CMIA) within 72 hours after birth, on Architect plus ci8200 analyser (Abbott, Chicago, USA). Data were analysed using Statistica software. RESULTS: The median concentration of uNGAL in the whole study group of healthy term newborns was 27.1 ng/mL (16.5-56.0 ng/mL) (newborn girls, 27.1 ng/mL (15.8-47.9 ng/mL); newborn boys, 27.9 ng/mL (16.5-61.0 ng/mL), P = 0.941). Median uNGAL concentration according to postnatal age expressed in days was 28.2 ng/mL (11.7-57.2 ng/mL) 1st day, 28.9 ng/mL (16.5-64.2 ng/mL) 2nd day and 23.9 ng/mL (20.2-46.6) 3rd day, P = 0.863. Regarding birth weight for newborns < 3500 g, median concentration was 25.0 ng/mL (16.5-45.4 ng/mL) and for weight ≥ 3500 g 30.6 ng/mL (16.5-64.2 ng/mL), P = 0.455. CONCLUSIONS: There were no significant difference in uNGAL concentration in relation to gender, postnatal age and birth weight.