Recommendations for the Management of Uveitis Associated With Juvenile Idiopathic Arthritis: The Czech and Slovak adaptation of SHARE Initiative.

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and uveitis is its most important extra-articular manifestation. Evidence-based recommendations are available only to a limited extent and therefore JIA associated uveitis management is mostly based on physicians experience. Consequently, treatment practices differ widely, both nationally and internationally. Therefore, an effort to optimize and publish recommendations for the care of children and young adults with rheumatic diseases was launched in 2012 as part of the international project SHARE (Single Hub and Access Point for Pediatric Rheumatology in Europe) to facilitate clinical practice for paediatricians and (paediatric) rheumatologists. The aim of this work was to translate published international SHARE recommendations for the diagnosis and treatment of JIA associated uveitis and to adapt them for use in the Czech and Slovak Republics. International recommendations were developed according to the standard methodology of the European League against Rheumatism (EULAR) by a group of nine experienced paediatric rheumatologists and three experts in ophthalmology. It was based on a systematic literature review and evaluated in the form of an online survey and subsequently discussed using a nominal group technique. Recommendations were accepted if > 80% agreement was reached (including all three ophthalmologists). A total of 22 SHARE recommendations were accepted: 3 on diagnosis, 5 on disease activity assessment, 12 on treatment and 2 on future recommendations. Translation of the original text was updated and modified with data specific to the czech and slovak health care systems and supplemented with a proposal for a protocol of ophthalmological dispensarization of paediatric JIA patients and a treatment algorithm for JIA associated uveitis. Conclusion: The aim of the SHARE initiative is to improve and standardize care for paediatric patients with rheumatic diseases across Europe. Therefore, recommendations for the diagnosis and treatment of JIA-associated uveitis have been formulated based on the evidence and agreement of leading European experts in this field.

The Incidence of Pinworm (Enterobius Vermicularis) in Pre-school and School Aged Children in the Eastern Slovakia.

Helminth infections caused by Enterobius vermicularis have a cosmopolitan character and most often affect the paediatric pre-school and school age population. The presented study was conducted to determine the prevalence of E. vermicularis in the analyzed population of children in the Eastern Slovakia. The Graham's scotch tape method was used to investigate the presence of Enterobius vermicularis eggs in 390 specimens. The analyzed set consisted of 218 girls and 172 boys, divided by age into three groups - aged from 5 months to 2 years, aged from 3 to 6 years, and aged from 7 to 15 years. Investigation of perianal scotch tapes of children for the presence of E. vermicularis eggs revealed the prevalence of E. vermicularis was P = 3.59 %. Depending on the incidence of E. vermicularis infection, we detected no statistically significant difference (p> 0.05). The prevalence of E. vermicularis in boys was P = 4.07 %, and in girls P = 3.21 %. The highest prevalence of E. vermicularis was recorded in the group of children aged from 3 to 6 years (P = 5.03 %). Most of the samples were positive at age 4 and 5. The lowest prevalence was in the group of children aged from 5 months to 2 years (P = 0.97 %), and the prevalence of E. vermicularis in the group of children aged from 7 to 15 was P = 3.91 %. The difference in the incidence of E. vermicularis infection among different age groups of children was not statistically significant (p> 0.05). Enterobius vermicularis nematode infection and enterobiasis currently represents a major public health problem in Slovakia. At the present its occurrence is the most frequent in the paediatric population. Therefore it is important to introduce a targeted hygienic-epidemiological measure in children's collectives, what also should include proper and effective diagnostics and frequent recurrent therapy.

[Secondary dyslipidemias]. / Sekundárne dyslipidémie.

Dyslipidemias rank among the most important preventabile factors of atherogenesis and its progression. This topic is increasingly being discussed as e.g. more than 50% of Slovak population die on atherosclerotic complications. According to etiology we distinguish primary dyslipidemias with strictly genetic background and secondary ones with origin in other disease or pathological state. Secondary dyslipidemias accompany various diseases, from common (endocrinopathies, renal diseases etc) to rare ones (thesaurismosis etc.) and represents one of symptoms of these diseases. Apart from particular clinical follow up of diagnosed dysipidemias, basic screening and secondary causes as well as treatment due to updated guidelines is recuired. In this review we present the most frequent dyslipidemias of clinical practice.

Serotonin receptors - from molecular biology to clinical applications.

Serotonin (5-hydroxytryptamine) is an ubiquitary monoamine acting as one of the neurotransmitters at synapses of nerve cells. Serotonin acts through several receptor types and subtypes. The profusion of 5-HT receptors should eventually allow a better understanding of the different and complex processes in which serotonin is involved. Its role is expected in the etiology of several diseases, including depression, schizophrenia, anxiety and panic disorders, migraine, hypertension, pulmonary hypertension, eating disorders, vomiting and irritable bowel syndromes. In the past 20 years, seven distinct families of 5-HT receptors have been identified and various subpopulations have been described for several of them. Increasing number of 5-HT receptors has made it difficult to unravel the role of 5-HT receptor subpopulations due to the lack of suitable selective agents. The present review describes the different populations and nomenclature of recently discovered 5-HT receptors and their pharmacological relevance.

[Thyroid gland in the gravidity]. / Stítna zl'aza v gravidite.

OBJECTIVES: Disorders of the thyroid gland are the most common endocrinopathies in the gravidity. The spectrum of thyroid diseases in the pregnancy is not different from the diseases that affect the thyroid outside this period of life. However, clinical manifestations of thyreopaties can be modified by gravidity. Some thyreopaties are associated with gravidity or post partum period, or become manifest in this periods for the first time. The aim of this study was to assess thyroidal status of healthy pregnant women without history or clinical signs of thyreopathy. TYPE OF THE STUDY: One-time cross-sectional study. SETTING: 3rd internal clinic FNLP, Kosice. METHODS: We examined 76 pregnant women (mean age 34.46 +/- 5.34 years). The protocol included medical history, physical examination and assessment of TSH, fT4 and anti-TPO concentrations. RESULTS: The mean concentration of TSH was 2.78 +/- 1.25 mlU/ml. We found TSH concentration over 5.0 mlU/ml in 5 participants (6.58%), TSH levels in the borderline range between 4.0-5.0 mlU/ml had another 2 pregnants (2.63%). fT4 concentration was 15.02 +/- 3.61 pmol/l. The mean anti-TPO concentration was 43.28 +/- 15.75 IU/ml. 17 pregnant women (22%) had anti-TPO concentration over 25 IU/ml, which is the level that indicates autoimmune thyroiditis. CONCLUSIONS: Thyreopathies are the most common endocrinopathies in the population and there is the evidence that almost one third of European population is affected from diseases of thyroid gland, predominantly women in fertile age. In the clinical praxis it is essential to think of thyroid disorders and in the case of need screening of the thyroid function.

[Thyroid disease in the pregnancy and congenital malformations of newborns]. / Ochorenia stítnej zl'azy matky a vrodené vývojové chyby plodu.

THE AIM: The aim of this study was to compare thyroidal status of mothers who delivered newborns with morphological congenital malformations and mothers with healthy newborns. TYPE OF THE STUDY: One-time cross-sectional study. SETTING: 3rd internal clinic FN LP, Kosice. METHODS: We examined 43 mothers with newborns born with congenital malformation and 76 mothers with healthy newborns. The protocol included anamnesis, basic physical examination, ultrasonography of the thyroid, assessment of the mothers' plasma fT4, TSH and anti-TPO levels, and comparison of the birth weight and birth length of the newborns. The results were statistically processed by PC programs StatsDirect 2.6.2 and MS Excel 2000. RESULTS: The thyroid volume was significantly greater in mothers with newborns with congenital malformation as in the control group (p<0.001). The birth weight and birth length was significantly lower in newborns with malformations (p<0.0001 resp. p<0.001). We found no differences in the plasma levels of fT4, TSH and anti-TPO between these groups. CONCLUSION: Thyroid disease of the mother can contribute to the congenital malformations of the newborn although there was found no direct association between mothers' thyroid autoantibodies and creation of congenital malformations of the child, yet.

[Thyroid disease in the pregnancy and hypotrophy of newborns]. / Ochorenia stítnej zl'azy matky a hypotrofia plodu.

THE AIM: The aim of this study was to compare thyroidal status of mothers who delivered newborns with hypotrophy and mothers with healthy newborns. TYPE OF THE STUDY: One-time cross-sectional study. SETTING: 3rd internal clinic FN LP, Kosice. METHODS: We examined 56 mothers with hypotrophic newborns and 76 mothers with healthy newborns. The protocol included anamnesis, basic physical examination, ultrasonography of the thyroid, assessment of the mother's plasma fT4, TSH and anti-TPO levels, and comparison of the birth weight and birth length of the newborns. The results were statistically processed by PC programs StatsDirect 2.6.2 and MS Excel 2000. RESULTS: The thyroid volume was significantly greater in mothers with hypotrophic newborns as in the control group (p<0.001). The birth weight and birth length was significantly lower in hypotrophic newborns (p<0.0001 resp. p<0.0001). Mothers with hypotrophic newborns had significantly higher TSH levels (p<0.0001) and higher anti-TPO levels (p<0.0001) as mothers in the control group. We found no differences in the fT4 levels in these groups. CONCLUSION: Thyroid disease of the mother can contribute to the hypotrophy of the newborns.

n-3 PUFAs-From dietary supplements to medicines.

Although there has been a great progress in the prevention of cardiovascular diseases, the mortality of patients with acute myocardial infarction (AMI) still remains high. One of the most important underlying causes explaining this phenomenon is the sudden cardiac death. Nearly half of all cardiovascular deaths in the USA each year is attributed to this unpredictable and unexpected complication of AMI. Hence, there is an urgent medical need for a targeted therapy to reduce the incidence of sudden cardiac death. Since 1980 there have been several epidemiological and other studies concerning the benefits of n-3 polyunsaturated fatty acids (n-3 PUFAs) in cardiovascular health and prevention. Results from one of the largest studies, GISSI Prevenzione Trial show that adding the n-3 PUFAs to standard therapy of patients who survived AMI reduces sudden cardiac death (44% risk reduction, p=0.0006). In addition, significant decline in all-cause cardiovascular mortality (21% risk reduction, p=0.0064) further emphasizes the role of n-3 PUFA in cardiovascular prevention. To date, beneficial effects of n-3 PUFA are attributed to their antiarrhythmic, lipid lowering, antithrombotic and anti-inflammatory properties. To conclude, EPA and DHA improve the prognosis of cardiovascular patients in the secondary prevention of sudden cardiac death without any documented side effects.

[Characteristics of the cytokine response in patients with various forms of juvenile idiopathic arthritis]. / Charakteristika cytokínovej odpovede u pacientov s rôznymi formami juvenilnej idiopatickej artritídy.

BACKGROUND: Impairment of the dynamic balance between the first and second type of cytokine response with the prevalence of cytokines of the first type plays and important role in the pathogenesis of several autoimmune diseases, including the juvenile idiopathic arthritis (JIA). The aim of our work was to analyse cytokine profile in lymphocytes in the peripheral blood of patients with JIA, and to evaluate the mutual ration between T lymphocytes producing cytokines of the first and second type in different forms of the disease. METHODS AND RESULTS: We studied a group of 42 children aged 6 to 16 years, 32 of them were patients with JIA, 10 children with non-autoimmune diseases represented the control group. Expression of intracellular cytokines INF-gamma and IL-4 were assayed in activated T lymphocytes using recommended protocol (FastImmune Cytokine system, BD). For the sample analysis, flow cytometer FACScan (BD) was used. No differences in incidence of CD3+INF-gamma + Ly was found between patients with oligoarticular and polyarticular form of JIA (19.3 +/- 8.65 vs. 19.2 +/- 9.7%), and values were equal to that of the control group (19.5 +/- 5.85%). Similarly, no difference was found in incidence of CD3+INF4+ Ly between the JIA patients and controls (2.4 +/- 0.9 vs. 2.8 +/- 0.45%). Patients with polyarticular form of disease had statistically lower incidence of CD3+INF4+ Ly than it was among the control group (1.8 +/- 0.9 vs. 2.8 +/- 0.45%, p < 0.05). CONCLUSIONS: In the studied group of 32 patients with different forms of JIA, lower activity of cytokine response of the type 2 was found in children with polyarticular form of the disease.

The Slovak version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ).

We report herein the results of the cross-cultural adaptation and validation into the Slovak language of the parent's version of two health related quality of life instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with juvenile idiopathic arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children independently from the underlying disease. The Slovak CHAQ CHQ were fully validated with 3 forward and 3 backward translations. A total of 119 subjects were enrolled: 52 patients with JIA (15% systemic onset, 37% polyarticular onset, 10% extended oligoarticular subtype, and 38% persistent oligoarticular subtype) and 67 healthy children. The CHAQ clinically discriminated between healthy subjects and JIA patients, with the systemic, polyarticular and extended oligoarticular subtypes having a higher degree of disability, pain, and a lower overall well-being when compared to their healthy peers. Also the CHQ clinically discriminated between healthy subjects and JIA patients, with the systemic onset, polyarticular onset and extended oligoarticular subtypes having a lower physical and psychosocial well-being when compared to their healthy peers. In conclusion the Slovak version of the CHAQ-CHQ is a reliable, and valid tool for the functional, physical and psychosocial assessment of children with JIA.

[Will administration of omega-3 unsaturated fatty acids reduce the use of nonsteroidal antirheumatic agents in children with chronic juvenile arthritis?]. / Môze podávanie omega-3 nenasýtených mastných kyselín znízit spotrebu nesteroidných antireumatík u detí s juvenilnou chronickou artritídou?

BACKGROUND: An increased intake of omega-3 polyunsaturated fatty acids (PUFA) in the diet of patients with rheumatoid arthritis has a favourable effect on the course of the disease. The objective of the present work was to assess the effect of such a diet on the daily consumption of non-steroid antirheumatic drugs in children with juvenile chronic arthritis. METHODS AND RESULTS: A group of 23 children with the diagnosis of chronic juvenile arthritis was divided by the method of random numbers into two groups. The first group received in addition to ibuprofen treatment a diet with an increased content of omega-3 PUFA. The second group served as control. In the first group (13 patients, mean age 11 years) in the course of five months treatment the original ibuprofen consumption declined by 17.3% (from a mean value of 28.4 mg/kg/day to 23.4 mg/kg/day), while in the control group (10 children, mean age 9.1 years) there was a decline of 6.5% (from a mean value of 23.7 mg/kg/day to 22.7 mg/kg/day). This difference was statistically significant at the level of 0.05 (P = 0.03). CONCLUSIONS: Despite the statistically significant difference in the decline of daily consumption of the non-steroid antirheumatic drug in the investigated groups of patients and the obvious favourable effect of omega-3 PUFA the mean consumption of the drug remained in the first group after five months of treatment higher (23.4 mg/kg/day) than in the control group (22.4 mg/kg/day).

[Toxocara infections in childhood in relation to reactive arthritis]. / Toxokarová infekcia v detskom veku vo vzt'ahu k reaktívnej artritíde.

Reactive arthritis belongs to a group of rheumatoid diseases known as seronegative spondylarthritis or spondarthropathies. Of many reactive arthritis-evoking agents, the authors focused on larval toxocarosis. The authors describe a child with high anti-Toxocara antibody and circulating antigen titres in combination with acute Chlamydia infection, which may have caused reactive arthritis in this immunologically impaired organism. This is evidence of the coincidence of different pathological factors manifested by reactive affection of the knee joint.

[Present possibilities of improving the diagnosis of glomerular erythrocyturia]. / Súcasné moznosti zlepsenia diagnostiky glomerulovej erytrocytúrie.

Examination of glomerular erythrocyturia which proved useful in the differential diagnosis of haematuria faces in practice two serious problems--the necessity to examine fresh urine and differences as regards the interpretation of criteria of glomerular erythrocyturia (from 10 to 80%). The authors examined therefore the morphology of erythrocytes in urine of 65 children with different causes of haematuria, incl. 35 patients with different forms of glomerulonephritis. They found that adding 25 mg thimerasol to 10 ml urine preserves urinary elements, incl. morphologically altered red cells for a period of 72 hours or longer. This makes it possible to examine the red cells under a phase microscope after dealing with ambulatory patients. Among various morphological forms of red cells in urine of 31 patients with glomerulonephritis in urine acanthocytes were found in a concentration above 5%, and in the majority above 20%. Acanthocyturia above 5% was not present only in 4 patients with glomerulonephritis, whereby all four suffered from mild erythrocyturia. The authors consider therefore acanthocyturia above 5% as the most reliable evidence of glomerulonephritis, in case of erythrocyturia above 10 Ery in the visual field. The criteria of acanthocyturia in children are thus lower than in adults.

[Are dietetic and non-immunologic therapies becoming deciding factors in the treatment of autoimmune diseases?]. / Stáva sa diétna a neimunologická liecba rozhodujúcim faktorom v terapii autoimúnnych chorôb?

Authors call attention to non-immunological therapy and its determining role for fate and final prognosis in patients with autoimmune diseases. A stress importance of the timely and rigorous antihypertensive and antiinfectious treatment. From the dietary measures is best known favourable effect of the low protein diet and pharmacological limitation of the phosphorus supply. A new therapeutical aspect is the influence of the lipids on the autoimmune diseases activity and efficiency of the omega-3 unsaturated fatty acids. Non-immunological methods of the treatment are particularly valuable for the general practitioners and pediatricians, because enable them essentially to influence the course of the autoimmune diseases.