Safety of Anti-TNF-Alpha Therapy During Pregnancy on Long-term Outcome of Exposed Children: A Controlled, Multicenter Observation.

BACKGROUND: Evidence of the impact of in utero exposure to anti-tumor necrosis factor (TNF)-alpha on long-term childhood development is limited. The aim was to assess the impact of in utero exposure to anti-TNF-alpha due to mothers' inflammatory bowel disease (IBD) on long-term postnatal development of exposed children. METHODS: We included consecutive children (≥12 months of age) born to mothers with IBD (2007-2016) treated with anti-TNF-alpha during pregnancy in 3 centers in the Czech Republic. A control group was comprised of unexposed children of non-IBD mothers undergoing mandatory check-ups at general pediatricians' offices. Data on perinatal period, psychomotor development, vaccination, infections, antibiotics, and allergy were collected by treating pediatricians using a predefined questionnaire. RESULTS: Seventy-two exposed and 69 unexposed children were included (median age, 35 and 50 months, respectively). Exposed children had growth and psychomotor development similar to controls. There was no significant difference in infectious complications within the first year of life (23.9% vs 17.4%; P = 0.36) or during the whole follow-up between exposed infants and controls (P = 0.32). Concomitant immunosuppressants during pregnancy and anti-TNF-alpha levels in cord blood were not associated with elevated infection rate within the first year of life (P > 0.05). Over 95% of exposed children had adequate serologic response to vaccination, except for haemophilus and mumps vaccines. Clinically manifested allergy was similar between the groups (P = 0.98). CONCLUSIONS: Anti-TNF-alpha exposure in utero does not seem to have a negative impact on postnatal development of children with regard to infectious complications, allergy, growth, or psychomotor development when compared with unexposed children of non-IBD women.

[A study of antibiotic treatment of upper respiratory infections in primary care]. / Studie antibiotické lécby infekcí horních cest dýchacích v primární péci.

OBJECTIVE: To assess the antibiotic therapy of and approach to treating pharyngitis/tonsillopharyngitis in primary care physicians, including the trends and rationality. METHODS: In April 2005, a multicentre study was carried out as a sequel to a similar study performed in 1998. The two studies monitored how primary care physicians treated patients subsequently hospitalized in Czech departments of infectious diseases with the diagnosis of acute upper respiratory infection. Patients' data were provided by physicians from the departments of infectious diseases in standard questionnaires and processed by employees of a Prague department of infectious diseases. RESULTS: In 1998, 14 departments of infectious diseases participated in the study and 241 valid questionnaires were obtained from them. The 2005 study comprised 21 departments and 324 valid questionnaires. According to their final diagnosis, patients were divided into four groups: infectious mononucleosis, viral infection, bacterial infection and infectious mononucleosis with bacterial superinfection. The study included only patients initially treated and/or examined by primary care physicians and later referred to a hospital; patients directly referred to a hospital were not enrolled. The numbers of assessable cases were 188 in 1998 and 199 in 2005. Primary care physicians' approach was evaluated according to defined criteria. Respiratory infections were treated correctly in 63 cases (34 %) in 1998 and in 84 cases (42 %) in 2005. Incorrect treatment was found in 66 cases (35 %) in 1998 and in 60 cases (30 %) in 2005. The most common forms of incorrect approach were as follows: antibiotics prescribed for viral infections, aminopenicillin prescribed for infectious mononucleosis and unwarranted administration of protected aminopenicillins in upper respiratory infections. In all three categories, improvements in prescription were noted in 2005 as compared with 1998, yet the differences were not statistically significant. In 2005, outpatient CRP tests for evaluating the aetiology of pharyngitis/tonsillopharyngitis were significantly more frequent. CONCLUSIONS: When comparing results of the 1998 and 2005 studies, certain improvements in prescription of antibiotics for treating respiratory infections in primary care were noted. Also positive is the outpatient use of CRP tests. On the other hand, there still are numerous cases when antibiotics are prescribed irrationally, without prior examination, and their choice is not in accordance with guidelines. This study provides an option for close monitoring of prescription by primary care physicians. Specialists are capable of objective evaluation of primary care physicians' work and specification of errors. These may be focused on and dealt with when education programmes for primary care physicians are developing.

Adiponectin, adipocyte fatty acid binding protein, and epidermal fatty acid binding protein: proteins newly identified in human breast milk.

BACKGROUND: Breastfeeding may protect children from developing metabolic syndrome and other diseases later in life. We investigated novel proteins in human breast milk that might play a role in this process. METHODS: We used ELISA to measure adiponectin, adipocyte and epidermal fatty acid binding proteins (AFABP, EFABP), and leptin concentrations in human breast milk obtained from 59 mothers 48 h after initiation of lactation. Using a questionnaire and medical records, we collected information about the mothers and newborns. RESULTS: Mean (SE) adiponectin concentrations in breast milk were 13.7 (0.8), range 3.9-30.4 microg/L; AFABP concentrations 26.7 (4.4), range 1.2-137.0 microg/L; EFABP concentrations 18.1 (1.4), range 0.8-47.0 microg/L; and leptin concentrations 0.50 (0.05), range 0-1.37 microg/L. We found a significant correlation between AFABP and EFABP concentrations (r = 0.593, P <0.0001). Maternal EFABP concentrations were significantly higher in mothers who delivered boys than in those who delivered girls [21.7 (2.3) vs 15.4 (1.7) microg/L, P = 0.028] and correlated with newborn birth weight (r = 0.266, P = 0.045). Maternal leptin correlated with body weight before pregnancy (r = 0.272, P = 0.043) and at delivery (r = 0.370, P = 0.005), body mass index before pregnancy (r = 0.397, P = 0.003) and at delivery (r = 0.498, P <0.0001), body weight gain during pregnancy (r = 0.267, P = 0.047), and newborn gestational age (r = 0.266, P = 0.048). Leptin was significantly lower in mothers who delivered preterm vs term babies [0.30 (0.09) vs 0.60 (0.05) ug/L, P = 0.026]. CONCLUSIONS: Concentrations of adiponectin, AFABP, and EFABP in human breast milk are related to nutritional variables of mothers and newborns and thus may play a role in the protective effects of breastfeeding.

[Diagnostics of invasive meningococcal, haemophilus and pneumococcal disease by PCR assay].

OBJECTIVES: Development of extended polymerase chain reaction (PCR) for non-culture detection of Nesseria meningitidis, Haemophilus influenzae and Streptococcus pneumonie from invasive infections. MATERIALS AND METHODS: A method of PCR was optimalised on strains of Nesseria meningitidis, Haemophilus influenzae b and Streptococcus pneumonie. Detection of pathogens was evaluated on 230 samples from patiens with invasive infection. RESULTS: Positive results of PCR were found in 103 samples of 230 (44.7 %). The percentage of positivity was higher in CSF samples (57.0 %) than in serum (33.8 %) or blood (33.3 %) samples. CONCLUSION: PCR method enables etiological diagnostics in cases, where antibiotic treatment was started. PCR results are available earlier than the results of cultivation. Multilocus sequence typing (MLST) of PCR products enables clonal analysis of etiological agents even in cases with negative results of cultivation.