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.

Relationship between acetylator phenotype and intensity of the hypoglycaemic effect of a suplhonamide preparation in children with insulin-dependent diabetes.

The distribution of acetylator phenotypes was determined in 95 healthy children (4-15 y) and in 48 children with Type I diabetes (5-15) using the sulphadimidine test for the determination of acetylation capacity. The frequency of slow acetylators within the diabetic group (60.4%) closely resembled that in the healthy population (59.0%). There was no significant sex difference within either group. Subgrouping according to age showed a more marked preponderance of slow acetylators (65.0%) among children under six years of age on the control group but not in the diabetics (60.0%). Despite a relatively low dose of sulphadimidine used for acetylator phenotyping (20 mg/kg orally), a marked hypoglycaemic effect was observed in diabetics with slow but not with fast acetylator phenotype. The result appears to be coherent with the marked difference in the plasma concentrations of non-metabolized sulphadimidine which 6 h after the dose was 3.5-fold higher in slow acetylators than in fast ones. (Tab. 2, Fig. 1, Ref. 53.)

[Experiences in CSR with rapid diagnostic tests in diagnosis of bacterial meningitis]. / Erfahrungen in der CSR mit schnelldiagnostischen Tests bei der Diagnose bakterieller Meningitiden.

On the basis of examinations of 229 children with rapid diagnostic method--latex agglutination of cerebrospinal fluid, serum and urine--this method is to compare with classic culture and it is evaluated as advantageous in the clinical practice. The etiologic agents was found out in 199 cases with the help of latex agglutination.

The Slidex-meningite-Kit (Bio-Merieux) tested for exoantigen detection in spinal fluids from purulent meningitis cases.

The Slidex-méningite-Kit allows the used of the rather highly sensitive and specific latex-agglutination method for the detection of N. meningitis group A and C and H. influenzae b exoantigens within a few minutes. In model experiments positive results persisted at unchanged intensity for prolonged periods of time regardless of storage temperature. However, in practical trials performed in a set of 60 spinal fluids from purulent meningitis patients etiological agent identification by the slidex-méningite-Kit failed at least as frequently as by cultivation; in the case of meningococci the kit even failed more often than cultivation. Hence the Slidex-méningite-Kit should be regarded as an auxiliary tool in the diagnosis of purulent meningitis and one that cannot replace the classical methods of cultivation and preparation staining. In the case of positive results, advantages of the Slides-méingite-Kit are rapidity in etiological agent identification and prolonged persistence of positivity in the spinal fluid samples.

T and B lymphocytes in peripheral blood of children with infectious mononucleosis and tonsillitis.

The occurrence of T and B lymphocytes was investigated in children with infectious mononucleosis. It was shown that T and B lymphocytes participate in the increase in the number of lymphocytes during the acute phase of infectious mononucleosis. The increase in the absolute number of T lymphocytes was statistically significant (p < 0.001) as compared with control healthy children, and non-significant as compared with the absolute number of T lymphocytes in children with tonsillitis. The increased absolute number of B lymphocytes with infectious mononucleosis was statistically significant (p < 0.001) as compared with both control groups. Two of the children had a high percentage of atypical lymphocytes and positive titres of EBV-VAC antibodies, mostly comprising nil type lymphocytes. The findings suggest that infectious mononucleosis has probably a more varied immunological picture in children than in adults.