The effects of parental smoking on anthropometric parameters, peak expiratory flow rate and physical condition in school children.

Passive smoking in children is a considerable health problem, mainly arising from parental smoking. The objectives of the present cross-sectional study were to assess the impact of passive smoking on 1) anthropometric parameters; 2) peak expiratory flow rate (PEFR); and 3) physical condition in school children. The target population included 177 children attending elementary school 5th to 8th grade. Study subjects were divided into two groups according to parental smoking habits. Body weight and height were determined using a digital weighing scale and digital stadiometer; PEFR was measured between 8 a.m. and 10 a.m. using a Peak Flow Meter; and physical condition was assessed by the 6-minute run test. Sixty-six percent of study children were exposed to passive smoking. The children of smoking parents had higher BMI [18.79 (17.50-21.13) kg/m2] than children of nonsmoking parents [17.90 (16.00-20.00) kg/m2; p = 0.036]. There was no statistically significant difference in body height and weight. The children of smoking parents had statistically lower values of PEFR [M(IQR) = 84 (78-88)%, M(IQR) = 94 (89-101)%, respectively; p < 0.0001] and 6-minute run test than children of nonsmoking parents [M(IQR) = 2(1-3), M(IQR) = 4(3-5); respectively; p < 0.0001]. The results of the present study showed that exposure of school children to passive smoking by their parents resulted in an increase of BMI, impairment of lung function, and impairment of physical condition, especially in children of both smoking parents.

Antiphospholipid antibodies in patients with antiphospholipid syndrome.

Antiphospholipid syndrome (APS) is a rare systemic autoimmune disease characterized by recurrent pregnancy morbidity or thrombosis in combination with the persistent presence of antiphospholipid antibodies (aPLs) in plasma/serum. Antiphospholipid antibodies are a heterogeneous, overlapping group of autoantibodies, of which anti-ß2-glycoprotein I (aß2GPI), anticardiolipin (aCL) antibodies and antibodies that prolong plasma clotting time in tests in vitro known as lupus anticoagulant (LAC) are included in the laboratory criteria for the diagnosis of APS. The presence of LAC antibodies in plasma is indirectly determined by measuring the length of coagulation in two tests - activated partial thromboplastin time (aPTT) and diluted Russell's viper venom time (dRVVT). The concentration of aß2GPI and aCL (immunglobulin G (IgG) and immunoglobulin M (IgM) isotypes) in serum is directly determined by solid-phase immunoassays, either by enzyme-linked immunosorbent assay (ELISA), fluoroimmunoassay (FIA), immunochemiluminescence (CLIA) or multiplex flow immunoassay (MFIA). For patient safety, it is extremely important to control all three phases of laboratory testing, i.e. preanalytical, analytical and postanalytical phase. Specialists in laboratory medicine must be aware of interferences in all three phases of laboratory testing, in order to minimize these interferences. The aim of this review was to show the current pathophysiological aspects of APS, the importance of determining aPLs-a in plasma/serum, with an emphasis on possible interferences that should be taken into account when interpreting laboratory findings.

Divergent Trends in the Prevalence of Children's Asthma, Rhinitis and Atopic Dermatitis and Environmental Influences in the Urban Setting of Zagreb, Croatia.

BACKGROUND: Previous studies have reported that the allergy epidemic in developed countries has reached its plateau, while a rise is expected in developing ones. Our aim was to compare the prevalence of allergic diseases among schoolchildren from the city of Zagreb, Croatia after sixteen years. METHODS: Symptoms of asthma, allergic rhinitis (AR) and atopic dermatitis (AD) and risk factors were assessed using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. An allergic profile was determined by a skin prick test. RESULTS: The prevalence of current, ever-in-a-lifetime and diagnosed AR of 35.7%, 42.5% and 14.9% and AD of 18.1%, 37.1% and 31.1% demonstrated a significant increase. The asthma prevalence has remained unchanged. The allergen sensitivity rate has remained similar, but pollens have become dominant. Mould and dog exposure are risks for asthma (OR 14.505, OR 2.033). Exposure to cat allergens is protective in AR (OR 0.277). Parental history of allergies is a risk factor in all conditions. CONCLUSION: Over sixteen years, the prevalence of AR and AD, but not of asthma, have increased. The proportion of atopy has remained high. The AR/AD symptom rise is probably a consequence of increased pollen sensitisation united with high particulate matter concentrations. The stable asthma trend could be a result of decreasing exposures to indoor allergens.

Inflammatory markers in childhood asthma.

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.

High prevalence of metabolic syndrome in an elderly Croatian population - a multicentre study.

OBJECTIVE: To investigate the prevalence and characteristics of metabolic syndrome (MetS) in a healthy elderly Croatian population. DESIGN: Cross-sectional study consisting of a health check including anthropometric measures and food questionnaires as well as analysis of biochemical parameters related to MetS. The diagnostic criteria of the International Diabetes Federation (IDF) were used for diagnosis of MetS. SETTING: Four centres in continental (Virovitica and Zagreb) and Adriatic coast (Split and Omis) regions of Croatia. SUBJECTS: Free-living elderly persons aged 70-90 years (n 320). RESULTS: Significantly lower MetS prevalence was found among participants from small urban centres compared with those from large urban centres (59·1 % v. 69·6 %; P = 0·051). Participants without MetS consumed wine more frequently (P = 0·05) than those with MetS. Compared with their peers with HDL cholesterol (HDL-C) <1·03 mmol/l, more male participants with HDL-C ≥1·03 mmol/l consumed wine (P = 0·04) or pelagic fish (P = 0·03). The prevalence of participants with TAG ≥1·7 mmol/l was higher in wine non-consumers (P = 0·05) than in wine consumers. Multivariate analysis with age and gender as covariates showed a significant inverse association of wine consumption with total cholesterol (P < 0·001), a positive association with HDL-C (P < 0·001) and a marginally inverse association with TAG (P = 0·06). In the male population, alkaline phosphatase and γ-glutamyl transferase activities were higher in participants with MetS (P < 0·05). CONCLUSIONS: High MetS prevalence was observed in an elderly Croatian population. Data showed that moderate consumption of wine and/or pelagic fish has a protective role against MetS in the population studied.

The influence of mother's active smoking during pregnancy on body mass index of newborns.

Many investigations have noted bad influence of smoking during pregnancy. In the present article, the influence of mothers smoking during pregnancy on the body mass index (BMI), birth weight and birth length are examined. This retrospective research included 219 children: Group I: 109 children from rural area of east Slavonia (born in General Hospital-Vinkovci) and group II: 110 children from industrial area (born in Zagreb). The questioned subjects were divided into two groups depending on mothers smoking during pregnancy: newborns of mothers who didn't smoke during pregnancy (subgroup A) and newborns of mother who did smoke 10 or more cigarettes per day during pregnancy (subgroup B). Anthropometric parameters (BMI, birth length and birth weight) in newborns of non-smoking mothers were statistically higher (p < 0.05) than in newborns of smoking mothers. Moderate correlation between birth length and birth weight in newborns of non-smoking and smoking mothers from rural area and from non-smoking mothers in urban area was statistically significant, but correlation in the group in newborns of smoking mothers from Zagreb was not statistically significant. Results of this research show that smoking during pregnancy significantly influences the birth weight and birth length. Further investigation is needed, to investigate the lack of correlation between the birth length and birth weight in newborns of smoking mothers from industrial city.

Current status of the lateral flow immunoassay for the detection of SARS-CoV-2 in nasopharyngeal swabs.

Early detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and diagnosis of coronavirus disease 2019 (COVID-19) are priorities during the pandemic. Symptomatic and suspected asymptomatic individuals should be tested for COVID-19 to confirm infection and to be excluded from social interactions. As molecular testing capacity is overloaded during the pandemic, rapid antigen tests, such as lateral flow immunoassays (LFIAs), can be a useful tool as they allow greater test availability and obtain results in a very short time. This short review aims to present the analytical properties of LFIAs in the detection of SARS-CoV-2 in nasopharyngeal swabs. Lateral flow immunoassay is a method that combines thin-layer chromatography and indirect immunochemical sandwich method and allows the detection of a specific SARS-CoV-2 antigen in nasopharyngeal swabs. Swab specimens should be adequately collected and tested as soon as possible. Users should pay attention to quality control and possible interferences. Antigen tests for SARS-CoV-2 show high sensitivity and specificity in cases with high viral loads, and should be used up to five days after the onset of the first symptoms of COVID-19. False positive results may be obtained when screening large populations with a low prevalence of COVID-19 infection, while false negative results may happen due to improper specimen collection or insufficient amount of antigen in the specimen. So as to achieve reliable results, a diagnostic accuracy study of a specific rapid antigen test should be performed.

Ferroptosis: regulated cell death.

Ferroptosis is a recently identified form of regulated cell death that differs from other known forms of cell death morphologically, biochemically, and genetically. The main properties of ferroptosis are free redox-active iron and consequent iron-dependent peroxidation of polyunsaturated fatty acids in cell membrane phospholipids, which results in the accumulation of lipid-based reactive oxygen species due to loss of glutathione peroxidase 4 activity. Ferroptosis has increasingly been associated with neurodegenerative diseases, carcinogenesis, stroke, intracerebral haemorrhage, traumatic brain injury, and ischemia-reperfusion injury. It has also shown a significant therapeutic potential in the treatment of cancer and other diseases. This review summarises current knowledge about and the mechanisms that regulate ferroptosis.

SARS-CoV-2 - a new challenge for laboratory medicine.

The new corona virus SARS-CoV-2 (Severe Acute Respiratory Syndrome Corona Virus 2) causes a disease called COVID-19 (coronavirus disease 2019), that develops mostly in subjects with already impaired immune system function, primarily in the elderly and in individuals with some chronic disease or condition. The reasons for this should be sought in the processes of aging and chronic latent inflammation, i.e. immunosenescence and inflammaging. Laboratory medicine specialists are currently focused on proving the presence of the virus and defining biomarkers that would enable the prediction of disease progression. For now, it has been shown that useful biomarkers can include general biomarkers of inflammation (parameters of complete blood count, C-reactive protein, interleukin-6, procalcitonin), biomarkers of myocardial damage (high sensitivity troponin I/T, B-type natriuretic peptide, and N-terminal B type natriuretic peptide), and vascular biomarkers (D-dimer, prothrombin time, fibrinogen). Their actual diagnostic specificity, sensitivity and predictive value need to be tested on a larger number of subjects. In addition, it is important to find and evaluate specific biomarkers of immunosenescence.

Magnesium and calcium in exhaled breath condensate of children with asthma and gastroesophageal reflux disease.

BACKGROUND: Magnesium and calcium physiologic functions are closely related. Magnesium is primarily an intracellular cation, the action of which also involves maintenance of cellular ionic balance, while influencing calcium homeostasis by blocking calcium channels. The aim of this study was to compare the concentrations of magnesium and calcium in exhaled breath condensate (EBC) of children with asthma and gastroesophageal reflux disease (GERD). SUBJECTS AND METHODS: EBC was collected from 66 children aged 7-14 years (23 children with acute asthma, 17 children with GERD, and 26 healthy children). Determination of magnesium and calcium concentrations was preceded by optimization and validation for low concentrations. RESULTS: No difference was recorded for either magnesium or calcium concentration between study groups. However, the magnesium to calcium ratio was statistically significantly lower in both GERD and asthma children as compared with control group. CONCLUSION: Study results showed the magnesium to calcium ratio to be a statistically significantly better indicator of certain pathologic changes than absolute concentration of either ion.

Malonaldehyde and erythrocyte antioxidant status in children with controlled asthma.

In the pathogenesis of asthma, oxidative stress appears to play an important role and existence of an oxidant/antioxidant imbalance is evident. In this study the key markers of oxidative stress and lipid peroxidation in the pathogenesis of asthma in childhood in comparison to healthy subjects were investigated. Plasma marker of the lipid peroxidation: malondialdehyde (MDA), the erythrocytes antioxidative enzymes: glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), glutathione reductase (GR) and cysteine-containing tripeptide glutathione (GSH) were evaluated by spectrophotometric methods using blood samples collected from 37 healthy children and 44 asthmatic patients. The GSH-Px activity was significantly lower in asthmatic children (3.99 +/- 1.0 IU/g Hb) than in healthy controls (4.61 +/- 1.3 IU/g Hb; p < 0.034). Significant difference in activity of the SOD, GR, and concentration of cysteine-containing tripeptide GSH was not confirmed (p > 0.05). Lower GSH-Px activity in children with controlled asthma showed deficient erythrocyte antioxidant defence and evidence of association between oxidative stress and asthma in childhood. Preserved activity of GR and SOD, together with concentration of GSH and MDA, still seems to be crucial in controlling antioxidant/oxidant balance of the disease.

Hallmarks of senescence and aging.

The complex process of biological aging, as an intrinsic feature of living beings, is the result of genetic and, to a greater extent, environmental factors and time. For many of the changes taking place in the body during aging, three factors are important: inflammation, immune aging and senescence (cellular aging, biological aging). Senescence is an irreversible form of long-term cell-cycle arrest, caused by excessive intracellular or extracellular stress or damage. The purpose of this cell-cycles arrest is to limit the proliferation of damaged cells, to eliminate accumulated harmful factors and to disable potential malignant cell transformation. As the biological age does not have to be in accordance with the chronological age, it is important to find specific hallmarks and biomarkers that could objectively determine the rate of age of a person. These biomarkers might be a valuable measure of physiological, i.e. biological age. Biomarkers should meet several criteria. For example, they have to predict the rate of aging, monitor a basic process that underlies the aging process, be able to be tested repeatedly without harming the person. In addition, biomarkers have to be indicators of biological processes, pathogenic processes or pharmacological responses to therapeutic intervention. It is considered that the telomere length is the weak biomarker (with poor predictive accuracy), and there is currently no reliable biomarker that meets all the necessary criteria.

Filaggrin and atopic march.

There is an increasing number of experimental, genetic and clinical evidence of atopic dermatitis expression as a pre-condition for later development of other atopic diseases such as asthma, food allergy and allergic rhinitis. Atopic dermatitis is a heterogeneous, recurrent childhood disease, also present in the adult age. It is increasingly attributed to systemic features and is characterized by immunological and skin barrier integrity and function dysregulation. To maintain the protective function of the skin barrier, in particular the maintenance of pH, hydration and antimicrobial functions, the filaggrin, among others, plays a significant role. Filaggrin is a multifunctional, histidine-rich, insoluble protein. The lack of filaggrin is associated with various cutaneous (e.g. ichthyosis vulgaris, allergic contact dermatitis) and non-cutaneous (e.g. diabetes, inflammatory conditions of the gastrointestinal tract) diseases and may be a result of genetic, immunological factors combined with environmental factors. In this review we summarised (emphasized) recent findings in understanding the role of filaggrin in atopic dermatitis and other diseases, participants in the atopic march.

Transient hyperphosphatasemia in an infant with bronchiolitis and pneumonia.

We present a case of benign transient hyperphosphatasemia in a 4-month-old infant with acute bronchiolitis and pneumonia. During hospitalization the infant had an increased catalytic activity of alkaline phosphatase (ALP): day 2, 5074 U/L; day 3, 5622-U/L; and day 8, 3129 U/L. The x-ray, leukocytosis, and C-reactive protein findings pointed to bacterial etiology of the respiratory disorder. Electrophoretic separation revealed an atypical isoenzyme profile: fast anodal, near-cathodal and bone fractions. ALP levels normalized within 54 days, and control electrophoresis indicated normal liver, placental/placental-like, intestinal and bone isoenzymes. The appearance of atypical fast anodal and near-cathodal fractions of ALP in this infant during the course of acute lower respiratory tract infection and rapid return to the reference intervals pointed to benign transient hyperphosphatasemia.

Chronic autoimmune urticaria in children.

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 with treatment that included antihistamines, low salicylate-low preservative diet in all, and high dose intravenous immunoglobulin in 3 children.

Corrigendum to: The potential of component-resolved diagnosis in laboratory diagnostics of allergy.

[This corrects the article DOI: 10.11613/BM.2018.020501.].

The potential of component-resolved diagnosis in laboratory diagnostics of allergy.

The initial laboratory approach in the diagnosis of allergies is to detect the type of allergic reaction, i.e. whether the patient's allergy is mediated by immunoglobulin E (IgE) or not. For this purpose, the concentration of total serum IgE (tIgE) and specific IgE (sIgE) are determined. Progress in laboratory diagnostics is the use of component-resolved diagnosis (CRD) which implies determination of sIgE against purified native and recombinant allergenic molecules. Component-resolved diagnosis is used in laboratory practice as singleplex and multiplex assays. The choice of allergen for singleplex assay is based on anamnesis, clinical findings of a patient and on skin prick test results. Multiplex-microarray assays simultaneously determine multiple sIgE's against numerous allergens. The goal of CRD is to distinguish the true allergens from the cross-reactive allergen molecules. Component-resolved diagnosis allows predicting the risk of severe symptoms, as well as anticipating the development of allergies. Thus, determination of sIgE against allergenic components may significantly improve current diagnostics of allergy. Since this method is applied in laboratory practice just a few years, it is necessary to acquire new knowledge and experience, to establish good co-operation between specialist in medical biochemistry and laboratory medicine and the specialist allergologist, so that the method can be applied in a rational manner. Component-resolved diagnosis will significantly improve the diagnostics of IgE-mediated allergy in the future. The aim of this article is to present potentials of CRD in the laboratory diagnostics of allergy mediated by IgE.

Correlation between asthma severity and serum IgE in asthmatic children sensitized to Dermatophagoides pteronyssinus.

BACKGROUND: We undertook this study to test the possible correlation between serum concentration of total and specific IgE antibodies and asthma severity in asthmatic children sensitized to the house dust mite Dermatophagoides pteronyssinus. METHODS: The study included 157 asthmatic children aged 5-15 years (8 +/- 3 years). Clinical diagnosis was based on personal and family history, physical examination, pulmonary function testing and skin tests. Asthma severity was determined according to GINA guidelines. In vitro tests included serum concentration of total and specific IgE. RESULTS: All asthmatic children had elevated serum concentration of total IgE. The children with elevated serum concentration of total IgE also showed an increased serum concentration of specific IgE. Asthma of higher higher severity was present in patients with total IgE concentration >288.0 kIU/L (AUC = 0.736) and specific IgE to Dermatophagoides pteronyssinus >44.1 kIUA/L (AUC = 0.843). Intermittent asthma was present in 76.9% of children with specific IgE concentration <44.1 kIUA/L. The positive predictive value suggested with 79.2% probability that a child with a concentration of specific IgE to Dermatophagoides pteronyssinus >44.1 kIUA/L would have a more severe form of asthma. CONCLUSIONS: Asthmatic children with higher asthma severity have a higher serum concentration of both total IgE (>288.0 kIU/L) and specific IgE to Dermatophagoides pteronyssinus (>44.1 kIUA/L), respectively.

Gamma-glutamyltransferase activity and total antioxidant status in serum and platelets of patients with community-acquired pneumonia.

BACKGROUND: We undertook this study to analyze serum and platelet gamma-glutamyltransferase (GGT) activity and total antioxidant status (TAS) concentration during the course of pneumonia and to compare them between patients with normal platelet count and those who developed reactive thrombocytosis. METHODS: Platelet count, GGT activity and TAS concentration in serum (S) and platelet (Plt) isolates were measured in 60 patients with community-acquired pneumonia (CAP) on admission and at discharge. RESULTS: At the end of treatment, platelet count increased significantly from the value recorded on admission. By the end of treatment, 42% of patients developed reactive thrombocytosis. Serum and platelet GGT activity was higher, whereas (S)TAS was significantly lower in CAP patients than in control subjects. On admission, (Plt)TAS was significantly higher in CAP patients as compared with control subjects; at discharge, (Plt)TAS was lower in comparison with either patient admission and control subjects. GGT activity and TAS concentration in serum and platelet isolate on admission did not differ significantly between patients with and without thrombocytosis. At discharge, (S)GGT activity showed no significant changes, whereas (Plt)GGT decreased significantly in patients with thrombocytosis as compared with those without thrombocytosis. In patients with thrombocytosis, (S)TAS concentration showed no significant difference, whereas (Plt)TAS concentration measured at discharge was significantly lower in patients with thrombocytosis as compared to those with normal platelet count. CONCLUSIONS: The pattern of changes in (Plt)GGT catalytic activity and TAS concentration might be indicative of a certain role of thrombocytosis during treatment in patients with CAP. Further investigations are necessary to clarify these changes.

Enzyme catalytic activities in chronic obstructive pulmonary disease.

BACKGROUND: Altered muscle amino acid metabolism resulting in skeletal muscle dysfunction is one of the systemic effects of chronic obstructive pulmonary disease (COPD) associated with systemic oxidative stress and inflammation. The aim of the study was to investigate the existence and extent of changes in the activities of the enzymes catalyzing transamination reactions (aminotransferases), the enzyme involved in bone rearrangement (alkaline phosphatase), and the enzyme reflecting hypoxia that is characteristic of these patients (lactate dehydrogenase). In addition, the effect of cigarette smoking on these enzyme activities was also assessed. METHODS: Enzyme activities such as alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyltransferase and lactate dehydrogenase were determined by standard analysis in sera of 29 COPD patients (FEV(1) = 46.6 +/- 12.1%) and 58 healthy subjects (21 nonsmokers, 17 ex-smokers and 20 smokers). RESULTS: The activity of aspartate aminotransferase and alanine aminotransferase was significantly decreased, and the activity of lactate dehydrogenase increased in sera of COPD patients as compared with the group of healthy nonsmokers. According to centile values, the activity of alkaline phosphatase, gamma-glutamyltransferase and lactate dehydrogenase was increased in 50, 5, and 50% of COPD patients, respectively. CONCLUSIONS: Study results revealed significant changes in the activities of transamination enzymes in patient sera, thus supporting the reports on altered amino acid metabolism in skeletal muscle in COPD. The elevated activity of alkaline phosphatase provides additional evidence for altered bone rearrangement in these patients. Smoking was not found to have any major effect on these enzyme activities in the present study.