Prevalence of Helicobacter pylori infection among Slovenian children and adolescents: A prospective cohort study.

BACKGROUND: Helicobacter pylori (H. pylori) infection is primarily acquired in childhood and is notably influenced by socioeconomic variances across different geographical regions. The aim of this study is to assess the prevalence of H. pylori infection in Slovenian children and to identify potential risk factors that facilitate the infection. MATERIALS AND METHODS: Between 2019 and 2022, we conducted a multi-center prospective cross-sectional study among healthy children residing in three different administrative regions in Slovenia. H. pylori infection status was determined using a monoclonal antibody-based stool antigen test (SAT). A standardized questionnaire was designed to evaluate the influence of various H. pylori-associated risk factors, including demographics and socioeconomic, housing and sanitation conditions. RESULTS: During the 3-year period, we recruited a total of 421 children and adolescents (age range 2-18 years, mean age 10.29 ± 4.95 years). Overall, 46 (10.9%) were diagnosed with H. pylori infection. No associations were found between H. pylori prevalence rates and increasing age, sex, parental education level, country of birth of the child or their parents, number of household members, household income, having a dishwasher, owning a pet, duration of breastfeeding, fruit intake frequency, drinking tap water, and handwashing practices. The only parameters associated with an increased risk of infection were the location of the school (p < 0.001) and living in an urban area (p = 0.036). The odds of infection were approximately 4.77 times higher if the child attended school in the Central Slovenian compared to other regions (OR = 4.77; 95% CI 0.87-2.34). CONCLUSIONS: This is the first study providing information on the prevalence of H. pylori infection among Slovenian children and adolescents. Using SAT, we have shown that the burden of H. pylori infection in our pediatric population is low; however, it seems to depend on regional rather than socioeconomic factors.

Diagnostic challenge of Strongyloides stercoralis hyperinfection syndrome: a case report.

Strongyloides stercoralis causes chronic, mostly asymptomatic infections but hyperinfection syndrome may occur in immunosuppressed patients, especially in those receiving corticosteroids. We report a case of S. stercoralis hyperinfection syndrome in a solid organ transplant recipient that occurred approximately 2.5 months after heart transplantation. The patient presented to the intensive care unit with acute respiratory distress, bacteremia, and petechial rash on abdomen and toe. Microbiology testing of respiratory samples excluded infection with Pneumocystis jirovecii, respiratory viruses, pathogenic bacteria and fungi. No eosinophilia was found. Histopathological examination of the skin biopsy of the petechial rash provided the first indication of the diagnosis, revealing the presence of isolated filariform S. stercoralis larvae in the dermis. Subsequent microbiology testing confirmed the diagnosis. This case highlights the role of histopathological examination of a skin rash in diagnosing patients with atypical clinical presentation of Strongyloides hyperinfection syndrome.

Role and perception of clinical microbiology and infectious diseases trainees during the COVID-19 crisis.

Aim: To evaluate the role and perceptions of trainees during the COVID-19 pandemic. Method: An online survey was designed to provide an insight into the significance of the COVID-19 pandemic on working conditions of infectious diseases and clinical microbiology trainees. Results: The main roles of trainees included management of patients hospitalized for COVID-19 (55%), research (53%) and diagnostic procedures (43%). The majority (82%) of trainees felt useful in managing the crisis. However, more than two-thirds felt more stressed and more tired compared with other rotations. Only 39% of the participants had access to psychological support. Conclusion: Due to the significant impact of the pandemic on infectious diseases and clinical microbiology trainees, further research should focus on their health and welfare in the post-pandemic period.

Usefulness of rapid antigen testing for SARS-CoV-2 screening of healthcare workers: a pilot study.

BACKGROUND: Identification of infected healthcare workers (HCWs) is an important step in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) transmission control. Rapid antigen tests (RATs) are considered an important addition to molecular tests in diagnosing coronavirus disease 2019 (COVID-19), mainly because of their fast turnaround time, easier analytical procedure and lower price. However, real-life studies on the usefulness of such testing for screening of HCWs are limited. METHODS: Physicians, nurses and hospital attendants currently working at the University Clinic of Respiratory and Allergic Diseases Golnik were invited to participate in the pilot study. Nasopharyngeal swabs were obtained three times per week for two consecutive weeks and tested with a point-of-care RAT and reverse transcription polymerase chain reaction (RT-PCR). Serum samples were obtained at the beginning of the study and 2 weeks after the last swab was collected to evaluate the serological status. RESULTS: A total of 191 nasopharyngeal swabs from 36 HCWs were obtained. None of the samples tested was positive for the presence of SARS-CoV-2 antigen, whereas two HCWs tested positive on RT-PCR. Of these, one HCW had a newly identified SARS-CoV-2 infection, whereas RT-PCR probably detected a previous but recent infection in the other HCW. CONCLUSION: Based on the results of this pilot study, it is unlikely that RAT will reliably detect novel SARS-CoV-2 infections among asymptomatic HCWs despite serial sampling. Although RT-PCR-based screening of HCWs may not be feasible due to high sample volume, molecular methods may identify SARS-CoV-2-infected HCWs already during the presymptomatic stage. Trial registration number NCT04716088, 19.1.2021, retrospectively registered.

Obtaining an impact factor: mission impossible for Acta Dermatovenerologica Alpina, Pannonica et Adriatica.

Next spring, we will celebrate 30 years since the first issue of Acta Dermatovenerologica Alpina, Pannonica et Adriatica (Acta Dermatovenerol APA) was published and, to our astonishment and disappointment, it seems that the goal we have long awaited (and worked hard for)-obtaining an official impact factor (IF)-is nowhere in sight. Every application for an IF has been met with various reasons why our journal does not fulfill the criteria for inclusion in the Science Citation Index Expanded (SCIE). Given the highly non-transparent evaluation process, we conclude that there probably really is no room for small and independent journals in the world of publishing giants and commercial interests. Although disheartened, we will continue our long-established tradition of providing open-access and quality content in dermatology and sexually transmitted infections for researchers and clinicians in the region and worldwide because science should be open and committed to teamwork.

A retrospective analysis of clinical characteristics and management of perianal streptococcal dermatitis in children and adults.

INTRODUCTION: Due to the paucity of recent literature on perianal streptococcal disease (PSD), we performed a comprehensive analysis of clinical characteristics of PSD and its management. METHODS: We conducted a retrospective search in the laboratory information system of the Institute of Microbiology and Immunology, Ljubljana, Slovenia, between January 2006 and December 2016 and identified patients with suspected PSD. We reviewed patients' medical records and obtained data on patient age and sex, concomitant illnesses, duration of complaints, signs and symptoms of PSD, epidemiological history, date of diagnosis, microbiological characteristics of beta-hemolytic streptococcal isolates, additional laboratory findings, duration and type of systemic and/or topical therapy, and recurrence of PSD. RESULTS: We identified 64 pediatric and eight adult PSD cases in total. The most common signs and symptoms were perianal erythema (67/72; 93.1%), anal fissures (28/72; 38.8%), itching (22/72; 30.6%), and blood-streaked stools (19/72; 26.4%). The duration of symptoms varied from < 1 week to > 1 year, with 58.3% of patients experiencing symptoms between 1 week and 6 months. The majority of patients received systemic (63/72; 87.5%) and topical (56/72; 77.8%) treatment. CONCLUSIONS: Although the signs and symptoms of PSD are non-specific, clinicians should be highly suspicious of the disease in adults and especially in preschool children with perianal complaints. Despite being a common disease, there is still considerable delay in correct diagnosis and treatment, prolonging the discomfort of PSD patients.

Future developments in training.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has demonstrated the value of highly skilled and extensively trained specialists in clinical microbiology (CM) and infectious diseases (ID). Training curricula in CM and ID must constantly evolve to prepare trainees for future pandemics and to allow trainees to reach their full clinical and academic potential. OBJECTIVES: In this narrative review, we aim to outline necessary future adaptations in CM and ID training curricula and identify current structural barriers in training with the aim of discussing possibilities to address these shortcomings. SOURCES: We reviewed literature from PubMed and included selected books and online publications as appropriate. There was no time constraint on the included publications. CONTENT: Drawing from the lessons learnt during the pandemic, we summarize novel digital technologies relevant to CM and ID trainees and highlight interdisciplinary teamwork and networking skills as important competencies. We centre CM and ID training within the One Health framework and discuss gender inequalities and structural racism as barriers in both CM and ID training and patient care. IMPLICATIONS: CM and ID trainees should receive training and support developing skills in novel digital technologies, leadership, interdisciplinary teamwork and networking. Equally important is the need for equity of opportunity, with firm commitments to end gender inequality and structural racism in CM and ID. Policy-makers and CM and ID societies should ensure that trainees are better equipped to achieve their professional goals and are better prepared for the challenges awaiting in their fields.

Usefulness of COVID-19 screen-and-test approach in pregnant women: an experience from a country with low COVID-19 burden.

OBJECTIVES: Information on the usefulness of screen-and-test strategies of pregnant women for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is lacking. METHODS: We retrospectively reviewed the Ljubljana Maternity Hospital database and searched for pregnant women, who were admitted to the hospital between March 15 and May 16, 2020, for a planned procedure or hospitalization. Their medical records were examined and SARS-CoV-2 test results were retrieved. RESULTS: During the two-month period analyzed, there were a total of 265 scheduled admissions of pregnant women to our hospital. Two hundred two (76.2%) were tested for SARS-CoV-2 1 day prior to admission. All tested negative for SARS-CoV-2 RNA, regardless of having coronavirus disease 2019 (COVID-19)-compatible signs or symptoms (n=28) or not (n=174). CONCLUSIONS: In a population with a low SARS-CoV-2 burden, usefulness of universal testing of pregnant women before admission to the hospital is limited. We recommend that obstetric units in regions with low SARS-CoV-2 burden enforce rational use of personal protective equipment and diligent screening protocols using targeted questionnaires, whereas SARS-CoV-2 laboratory testing should be performed only in screen-positives: those with high clinical suspicion of COVID-19 and/or suspected epidemiological history.

Prevalence of the Helicobacter pylori babA2 Gene in Children Mainly Depends on the PCR Primer Set Used.

Various polymerase chain reaction- (PCR-) based methods with varying positivity rates were designed to detect the Helicobacter pylori babA2 gene. To compare different primer sets, babA2 prevalence was determined in 279 H. pylori-positive pediatric samples using the 832 bp, 139 bp, and 271 bp PCR primer sets, resulting in 34.0%, 51.3%, and 79.6% prevalence of the babA2 gene, respectively. The babA2 status determined using the 832 bp and 139 bp PCR primer sets significantly correlated with bacterial density and activity of inflammation, whereas no such correlations were found using the 271 bp PCR primer set. The 139 and 832 bp PCR primer sets concordantly detected the babA2 gene in 93 cases; however, in comparison to the 832 bp PCR primer set, the 139 bp PCR primer set detected additional 50 babA2 cases, whereas only two 832 bp positive cases were missed. The 271 bp PCR primer set missed 32 babA2 cases that were 832 bp and/or 139 bp PCR positive, but tested solely positive in 109 cases. Interestingly, cloning of a subset of 271 bp PCR positive samples revealed amplification of the babA/B gene chimera. Hence, in our opinion, the 271 bp PCR protocol is not a reliable diagnostic tool for detecting the babA2 gene in children. Our results reaffirm previous observations that the use of certain babA2 PCR primer sets can significantly impact estimation of the prevalence and clinical relevance of the H. pylori babA2 gene in children, suggesting babA2 detection methods should be carefully selected.

A descriptive, historical, and thematic analysis of Acta Dermatovenerologica Alpina, Pannonica et Adriatica.

INTRODUCTION: Journal bibliometric indicators are useful tools in assessing the characteristics, development history, and future trending of a particular medical journal. Moreover, they can help potential authors when deciding which journal to submit their work to in order to achieve the highest visibility. METHODS: A single journal study of the medical journal Acta Dermatovenerologica Alpina, Pannonica et Adriatica (ADAPA) from January 1994 to July 2019 was performed. The corpus was harvested from the bibliographical database Scopus (Elsevier, Netherlands) for the period between 1994 and 2019 (inclusive), and the bibliometric analysis was performed using Scopus built-in services and MS Excel (Microsoft, USA). The historical, cooperation, and hot topic analysis was performed on scientific landscapes induced by VOSviewer software (Leiden University, Netherlands). RESULTS: From 1994 to 2019, a total of 759 publications were published in ADAPA. The trend in the number of publications has varied; it increased somewhat until 2009, then decreased until 2015, when the number of articles began to rise again, reaching a peak in 2018 (46 articles annually). A small decline in source normalized impact per paper (SNIP) was observed from 1.2 in 2010 to 0.46 in 2018. Slovenia ranked first (n = 210) in the number of publications among 55 countries. Authors from 44 out of 55 countries published their articles through co-authorships. CONCLUSIONS: Whereas it was initially considered a primarily regional journal, ADAPA's influence has gradually broadened and the journal has become truly international. The number of articles published increased significantly during the last few years, with ADAPA strongly supporting international collaboration, resulting in a high proportion of international co-authorships.

An update on prophylactic human papillomavirus (HPV) vaccines: a review of key literature published between September 2018 and September 2019.

Prophylactic human papillomavirus (HPV) vaccines have revolutionarily modified our understanding of and efforts in preventing communicable diseases. Undeniably, all three prophylactic HPV vaccines currently available have excellent safety and have substantially contributed to the control of HPV infections and HPV-related diseases during the past decade in the setting where high vaccine coverage has been achieved. This review summarizes and discusses the most influential peer-reviewed literature on HPV vaccines published between September 2018 and September 2019. The review focuses on the current status of HPV vaccination implementation, results from recent clinical trials, updates to recommendations and guidelines, long-term immunogenicity, and evaluations of various dosing schemes and HPV vaccination of alternative populations. In addition, we briefly summarize studies on the real-life effectiveness of prophylactic HPV vaccines from countries with successful HPV vaccination programs, present an update on safety data, and discuss progress and the development of novel prophylactic HPV vaccines, as well as potential future applications and challenges.

Alinity m HR HPV Assay Fulfills Criteria for Human Papillomavirus Test Requirements in Cervical Cancer Screening Settings.

The Alinity m HR HPV assay (Alinity) is a novel human papillomavirus (HPV) assay that individually identifies genotypes HPV16, HPV18, and HPV45 while reporting on 11 other high-risk HPV (hrHPV) genotypes in two aggregates: HPV31/33/52/58 and HPV35/39/51/56/59/66/68. The clinical performance of Alinity for screening for cervical cancer was evaluated in population-based settings. For women aged ≥30 years, the clinical sensitivity (n = 68) and specificity (n = 3,077) for the detection of cervical intraepithelial neoplasia grade 2+ (CIN2+) of Alinity were 100.0% and 92.4%, respectively, and were not inferior to those of the Qiagen Digene Hybrid Capture 2 high-risk HPV DNA assay (hc2) (P = 0.0006 and P < 0.0001, respectively). The intralaboratory reproducibility and interlaboratory agreement of Alinity were 96.7% (kappa, 0.92) and 98.7% (kappa, 0.97), respectively. In the group ≥30 years of age, women who were baseline hrHPV negative had a lower risk for CIN2+ at 3 years using Alinity (0.04%) than those with a normal baseline cytology (0.65%) and had a risk comparable to that determined by the Abbott RealTime High Risk HPV assay (0.04%), hc2 (0.08%), or the Roche Cobas 4800 HPV assay (0.04%). High-risk HPV16/18 infection was associated with a significantly higher baseline and 3-year CIN2+ and CIN3+ risk than the absence of HPV16/18 or the presence of hrHPVs at the baseline (all P values were <0.05). The baseline CIN2+ risk was 8.8% for those with HPV31/33/52/58 infection and 2.5% for those with HPV35/39/51/56/59/66/68 infection, while the 3-year CIN2+ risk was 17.0% and 4.9%, respectively (relative risk, 3.4 [P = 0.03] and 3.5 [P = 0.003], respectively), suggesting that extended genotyping by Alinity may be valuable in improving patient risk stratification. Alinity fulfills international consensus guideline criteria for primary cervical cancer screening and can be considered clinically validated, demonstrating safety comparable to that of other clinically validated HPV tests.

Helicobacter pylori virulence genes.

Helicobacter pylori (H. pylori) is one of the most important human pathogens, infecting approximately half of the global population. Despite its high prevalence, only a subset of H. pylori infected individuals develop serious gastroduodenal pathology. The pathogenesis of H. pylori infection and disease outcome is thus thought to be mediated by an intricate interplay between host, environmental and bacterial virulence factors. H. pylori has adapted to the harsh milieu of the human stomach through possession of various virulence genes that enable survival of the bacteria in the acidic environment, movement towards the gastric epithelium, and attachment to gastric epithelial cells. These virulence factors enable successful colonization of the gastric mucosa and sustain persistent H. pylori infection, causing chronic inflammation and tissue damage, which may eventually lead to the development of peptic ulcers and gastric cancer. Numerous studies have focused on the prevalence and role of putative H. pylori virulence genes in disease pathogenesis. While several virulence factors with various functions have been identified, disease associations appear to be less evident, especially among different study populations. This review presents key findings on the most important H. pylori virulence genes, including several bacterial adhesins and toxins, in children and adults, and focuses on their prevalence, clinical significance and potential relationships.

Municipally sponsored human papillomavirus (HPV) vaccination of boys in Slovenia: the first 4 years.

INTRODUCTION: Human papillomavirus (HPV) vaccination was included in the national vaccination program in Slovenia in the 2009/2010 school year. It is recommended for girls attending the sixth grade of primary school only and is fully state funded. Based on the initiative of school medicine specialists, Idrija and Cerkno were the first two municipalities to offer municipally sponsored HPV vaccination to boys in the 2014/2015 school year, showing promising results. METHODS: Our aim was to evaluate HPV vaccination coverage among boys attending the sixth grade who received the municipally sponsored HPV vaccine. Data were collected from corresponding physicians from different municipalities. Boys who received less than two doses of HPV vaccine or were HPV vaccinated against payment were excluded from this analysis. RESULTS: The number of municipalities that offer sponsored HPV vaccination of boys increased from two in 2014/2015 to 10 in the 2017/2018 school year. Although the proportion of vaccinated boys was initially relatively low, most municipalities attained at least 50% vaccination coverage rates, which is similar to the current HPV vaccination coverage of girls in Slovenia. CONCLUSIONS: Our data show that the outstanding local initiative by several pediatricians and school medicine specialists can result in HPV vaccine coverage rates of boys that are comparable to or even higher than those in the national vaccination program for girls. Because acceptance of HPV vaccination among boys in Slovenia is adequate, we believe that the inclusion of boys in the national vaccination program, predicted to occur in the 2020/2021 school year, will yield significant results.

Recent advances in prophylactic human papillomavirus (HPV) vaccination: a review of key literature published between September 2017 and September 2018.

Prophylactic human papillomavirus (HPV) vaccines represent a revolutionary approach in preventing and potentially eliminating HPV-related cancers. Overwhelming real-life data are confirming the high efficacy and exceptional safety profile of all three prophylactic HPV vaccines currently available, which was previously shown in pivotal clinical trials. In this review, we summarized and discussed in our opinion the most influential peer-reviewed literature published between September 2017 and September 2018; that is, during the 2017/2018 school year in Slovenia. We mainly focus on publications on progress and the development of novel prophylactic HPV vaccines, efficacy clinical trials evaluating various dosing schemes and HPV vaccination of alternative populations, and studies contributing to the mounting evidence for the real-life effectiveness of prophylactic HPV vaccines from several countries with successfully implemented HPV vaccination programs. In addition, we present the most important safety data from large population-based cohorts evaluating potential adverse events, briefly describe the most notable HPV vaccine-related crises, and provide insight into various responses by healthcare authorities that have resulted in markedly different outcomes in the vaccination perception of the general population and, consequently, HPV vaccine uptake. Finally, global disparities in access to HPV vaccines reveal substantial gender and socioeconomic inequity that must be overcome to achieve a large population impact of HPV vaccines worldwide.

Prevalence of the Helicobacter pylori homA and homB genes and their correlation with histological parameters in children.

The significance of Helicobacter pylori (H. pylori) virulence genes such as cagA and vacA has been extensively studied in children; however, data regarding the significance of homA and homB genes are scarce. The aim of our study was to evaluate the prevalence and clinical relevance of these genes in Slovenian children. All children diagnosed with H. pylori infection between 1993 and 2013 were included in the study (n = 343). DNA was extracted from biopsy specimens previously used for the rapid urease test. Five histological parameters were evaluated and the presence of the vacA, cagA, iceA, babA2, and homA and homB genes was determined by PCR amplification. The homA and homB genes were detected in 174/285 (61.1%) and 116/285 (40.7%) strains, respectively. The presence of the homA gene was significantly associated with the absence of the homB gene (P < 0.001); however, no associations were found between the presence of either the homA or homB genes and any of the other investigated virulence genes. Similarly, there were no correlations between the presence of the homA and homB genes and any of the histological parameters. In contrast, genotype profiles vacA s1m1/cagA+/babA2+/homB+, vacA s1m2/cagA+/babA2+/homA+, vacA s1m1/cagA+/babA2+/homA+, vacA s1m1/cagA+/babA2-/homA+, vacA s1m2/cagA-/babA2-/homA+, and vacA s2m2/cagA-/babA2-/homB+ were associated with a higher degree of gastric mucosal damage. Thus, although the homA and homB genes did not represent important individual virulence markers in this population, they may act synergistically with other H. pylori virulence genes, causing severe gastritis in children.

Human papillomavirus (HPV) infection and vaccination: knowledge and attitudes among healthcare professionals and the general public in Slovenia.

INTRODUCTION: This study evaluates knowledge of and attitudes toward human papillomavirus (HPV) infection and vaccination among healthcare professionals and the general public in Slovenia. METHODS: Five statements were designed to evaluate participants' opinions regarding age at HPV vaccine administration and potential delay in vaccination, associations of HPV vaccination with riskier sexual behavior, HPV vaccine safety, the importance of the internet as a source of information, and the significance of HPV vaccination in boys. Participants were asked to express agreement or disagreement with each statement. RESULTS: A total of 605 surveys were completed by medical students (n = 259), parents of sixth-graders in 2016 (n = 103) and 2017 (n = 103), pediatricians and school medicine specialists (n = 21), gynecologists (n = 34), and women visiting gynecology outpatient clinics (n = 85). The highest level of knowledge and belief in the HPV vaccine and its safety was observed among pediatricians and school medicine specialists. Medical students tend to have a very positive attitude toward HPV vaccination, although they need additional education about HPV vaccine safety. Some healthcare professionals showed signs of HPV vaccine hesitancy, and their beliefs were somewhat similar to those of the general public. CONCLUSIONS: Although the overall attitude towards HPV vaccination is generally positive, additional education must be provided to both healthcare professionals and the general public in order to achieve higher HPV vaccination coverage rates in Slovenia.

Prevention of human papillomavirus (HPV)-related tumors in people living with human immunodeficiency virus (HIV).

INTRODUCTION: In comparison to their HIV-negative counterparts, people living with HIV (PLWH) have a higher prevalence of human papillomavirus (HPV) infection in various anatomical sites coupled with increased HPV persistence, higher risk of HPV-related tumors, and faster disease progression. Areas covered: Gender-neutral prevention strategies for HPV-related cancers in PLWH discussed: ABC approach, HPV vaccination, antiretroviral treatment (ART), anal cancer screening, and smoking cessation. Gender specific strategies: cervical cancer screening reduces the incidence and mortality of cervical cancer and circumcision might reduce the risk of HPV infections in men. Expert commentary: HPV-related cancer incidence has not declined (e.g. cervical cancer) and has even increased (e.g. anal cancer) in the ART era, demanding an effective HPV prevention strategy. HPV vaccination should be introduced into national prevention programs worldwide immediately because current prophylactic vaccines are safe, tolerable, and immunogenic in PLWH. HPV vaccine efficacy trials in PLWH are essential to determine the most appropriate immunization schedule. The population most at risk of anal cancer is HIV-positive men who have sex with men, who are not protected by herd immunity if only the female population is vaccinated. Unvaccinated PLWH need enhanced surveillance for early detection of HPV-related cancers and their precursors.