[Alteration in the expression of platelet microRNAs in diseases with abnormal platelet activation]. / Vérlemezke-mikro-RNS-ek expressziójának változása thrombocytaaktivációval járó betegségekben.

MicroRNAs (miRNA) are short, non-coding RNAs consisting of 18-25 nucleotides that regulate posttranscriptionally the gene expression involved in the regulation of physiological processes of the cells. Their key role is to modulate the translation of target mRNAs via binding to complementary sequences within the 3' UTRs of mRNAs resulting in altered protein synthesis or even the degradation of mRNAs. miRNAs are carried not only by cells with nucleus, but also in platelets, red blood cells, and they are present in the circulation, in urine and in other body fluids as well. The fact about functional miRNAs in platelets without nucleus having a half-life of 8-12 days was questioned for a long time, thus it was also obscure whether platelets are able to produce proteins de novo when being exposed to different challenges. In the last few years, several publications have described the expression and function of certain platelet mRNAs with their regulatory miRNAs in terms of regulation of cell activation, especially in diseases in which platelet activation status is elevated, such as in type 2 diabetes mellitus or in sepsis. Apart from their pathophysiological role, miRNAs may be applied as potential new biomarkers in the investigation or differential diagnosis of these clinical conditions. This review article sought to summarize the recent findings about platelet miRNAs focusing on their altered expression in diabetes and sepsis. Orv Hetil. 2018; 159(47): 1962-1970.

[Bacterial infection after orthotopic liver transplantation]. / Bakteriális infekciók májátültetés után.

INTRODUCTION: The authors reviewed the prevalence of postoperative infections, the results of bacterium cultures, and the incidence of multidrug resistance in their liver transplanted patients during a period between 2003 and 2012. AIM: The aim of this study was to analyse risk factors and colonisations of bacterial infections. METHOD: The files of 408 patients (281 bacterium cultures) were reviewed. RESULTS: Of the 408 patients 70 had a postoperative infection (17%); 58 patients (14.2%) had positive and 12 patients (2.9%) negative bacterial culture results. Cholangitis was found in 7 cases (12.1%), abdominal infection in 17 cases (29.3%), and pulmonary infection in 28 cases (48.3%). Postoperative infection was more frequent in patients with initial poor graft function, acute renal insufficiency, biliary complication, and in those with intraabdominal bleeding. The 1-, 3- and 5-year cumulative survival of patients who had infection was 70%, 56% and 56%, respectively, whereas the cumulative survival data of patients without infection was 94%, 87% and 85%, respectively (p<0.001). Multidrug resistance was found in 56% of the positive cultures, however, the one-year survival was not different in patients who had multidrug resistance positive and negative bacterial infection (both 70.2%). CONCLUSIONS: Infection control must target the management of multidrug resistance microbes through encouraging prevention, hygienic, and isolation rules, improving the operative, transfusion, and antimicrobial policy in a teamwork setting.

[Bacterial translocation: gap in the shield]. / Bakteriális transzlokáció: rés a pajzson.

The gastrointestinal tract is not only regarded as a system where nutrient absorption takes place, but also as a vital barrier against intraluminal pathogens entering the circulation and the maintenance of immune homeostasis. Bacterial translocation is defined as the penetration of viable bacteria or bacterial compounds from the gastrointestinal tract to extraintestinal sites. This disorder has been described in several clinical conditions. The main promoting factors for bacterial translocation have been proposed to be changes in the intestinal microflora, mucosal barrier failure and defects in host immunity. The presence of bacterial translocation has been associated with higher complications and mortality rates; therefore it should be taken into account in the therapeutic strategies of patients with predisposing factors.

[Prevention of neonatal group B streptococcal sepsis in Hungary in 2012. Preliminary data of a nation-wide survey]. / A korai kezdetu újszülöttkori B csoportú Streptococcus-szepszis megelozésének helyzete Magyarországon 2012-ben. Egy országos felmérés adatai.

INTRODUCTION: At present, there is no obligatory guideline for the prevention of early-onset neonatal group B streptococcal disease in Hungary. AIM: The aim of the present study was to gain insight into the spontaneously developed preventive strategy of the domestic obstetric divisions and departments in Hungary. METHOD: Standardized questionnaire was sent out to each of the 71 obstetric divisions and departments in Hungary. RESULTS: Overall, 20 (27.4%) of the chairpersons replied, and thus, 39.9% of the total number of live births in Hungary were included in the study. Despite missing public health guidelines, each of the divisions and departments developed their own strategy to prevent neonatal group B streptococcal disease. In 95% of cases, bacterial culture of the lower vagina was the method of identifying pregnant women at risk. In 5% of the cases intrapartum antibiotic prophylaxis was based on risk assessment only. Of the departments using culture-based prophylaxis, 58% departments sampled women after completion of 36th gestational weeks. Antibiotic of choice was penicillin or ampicillin in 100% of cases. Of the study participants, 80% reported on multiple administration of colonized pregnant women after onset of labor or rupture of the membranes. CONCLUSIONS: The authors concluded that the rate of participation in the study was low. However, prevention of early-onset neonatal group B streptococcal infection is a priority of obstetric care in Hungary. Lack of a nation-wide public health policy did not prevent obstetric institutions in this country to develop their own prevention strategy. In the majority of cases and institutions, the policy is consistent with the widely accepted international standards.

[Obstetrical aspects of perioperative medicine]. / A perioperatív medicina szülészeti aspektusai.

Recently the most frequently applied surgical procedure worldwide has been Cesarean section. It is essential to perform the operation without any complication. In addition, a fast postoperative recovery must be provided, because all mothers must have the chance for being together with their newborn infant even on the first day. The maternal mortality rates of Cesarean section significantly decreased in the last decades due to the planned team work as well as the widely applied regional (spinal and epidural) anesthetic procedures. Apart from the obstetrician and neonatologist the anesthesiologist is the member of the perinatal team, too, who is responsible for the patient's perioperative care. To prevent complications and have an early successful treatment the anesthesiologist should be informed by the pregnant woman' s health status in time in order to be able to plan the perioperative management. The high-risk groups of pregnant women, the most common causes of maternal death and possibilities of prevention and treatment are discussed.

[Significance of selenium in the pathogenesis and therapy of cardiovascular diseases and those requiring intensive care]. / A szelén szerepe a cardiovascularis és intenzív kezelést igénylo betegségek létrejöttében és kezelésében.

Selenium deficiency results in profound changes in cellular defence mechanisms against oxidative stress, which plays an important role in the development of cardiovascular disease and the associated risk factors. Increased formation and decreased elimination of reactive oxygen radicals contribute to the complicated mechanisms of sepsis and related disorders. Use of selenium in prevention and treatment of the above mentioned conditions is not a new idea, but controversial data were published in relation to both fields recently. The aim of the present review is to summarize the most important results related to this area.

Use of antibiotics in suspected early-onset neonatal sepsis / Antibiotikumhasználat korai szepszis gyanúja esetén újszülöttkorban.

Összefoglaló. Bevezetés: Az újszülöttkori szepszis ritka, de magas mortalitással járó állapot. Az Egészségügyi Szakmai Kollégium Neonatológiai Tagozata 2017-ben bevezette a korai szepszisrol szóló állásfoglalást, meghatározva a kezelés indikációját a túlzott mértéku antibiotikumadás elkerülése céljából. Célkituzés: Retrospektív analízissel vizsgáltuk az állásfoglalás elotti és utáni idoszak antibiotikumhasználatát klinikánk beteganyagán. Módszer: Az intézményünkben 2014. 01. 01. és 2018. 12. 31. között született, a 34. gestatiós hetet betöltött újszülöttek adatait vizsgáltuk a következo kimenetelekre koncentrálva: szepszisre utaló klinikai tünetek jelenléte, az antibiotikummal kezelt újszülöttek száma, koraiszepszis-incidencia, mortalitás. A statisztikai analízis az RStudio programmal történt (szignifikancia: p<0,05). Eredmények: A vizsgált 5 évben összesen 12 347 újszülött jött a világra, közülük antibiotikumot kapott 1502 (12,16%); évekre lebontva: 2014-ben 517 (21,10%), 2015-ben 401 (16,63%), 2016-ban 459 (17,96%), 2017-ben 61 (2,39%), 2018-ban 64 (2,69%). Az antibiotikumterápiában részesültek (n = 1502) közül 239 (15,91%) újszülöttnek volt fertozésre utaló tünete. A klinikai tüneteket mutató újszülöttek száma nem növekedett szignifikánsan (p = 0,285); 2014-ben 52 (2,12%), 2015-ben 42 (1,74%), 2016-ban 42 (1,64%), 2017-ben 46 (1,80%), 2018-ban 57 (2,40%). Hemokultúra-pozitív szepszis összesen: 4; koraiszepszis-incidencia: 0,324/1000. Szepszishez kötheto haláleset nem volt. Megbeszélés: A protokollváltást megelozoen az újszülöttek csupán rizikófaktorok alapján is részesültek antibiotikumterápiában, 2017 óta azonban elsosorban a fertozés klinikai tüneteit mutató újszülötteket kezeljük, ami az antibiotikumhasználat szignifikáns csökkenéséhez vezetett. A korábbi, rizikófaktorok alapján adott antibiotikumterápia megszüntetését követoen nem emelkedett a tünetet mutató szeptikus újszülöttek száma, sem a korai szepszis okozta mortalitás. Következtetés: A 34. gestatiós hetet betöltött újszülötteknél a korai szepszis gyanúja miatti antibiotikumhasználat biztonsággal csökkentheto volt, ezzel megelozve a felesleges antibiotikumkezelés rövid és hosszú távú mellékhatásait. Orv Hetil. 2022; 163(11): 431-437. INTRODUCTION: Early-onset neonatal sepsis is a rare, but life-threatening condition. In 2017, the Hungarian Neonatal Society issued a national guideline to rationalize the use of antibiotic use in neonatal sepsis. OBJECTIVE: To retrospectively determine the frequency of prescribed antibiotics before and after the introduction of national guidance. METHOD: Data of neonates (>34. gestational weeks) delivered in our hospital between 1st January 2014 and 31st December 2018 were analysed with focusing on signs of sepsis, number of neonates treated with antibiotics, incidence of early-onset neonatal sepsis, sepsis-related mortality. Statistical analysis was performed with RStudio software (significance: p<0.05). RESULTS: During the analysed time period, 12 347 neonates were born, 1502 (12.16%) neonates were given antibiotics, showing a significant decrease after 2017: 517 (21.10%) in 2014, 401 (16.63%) in 2015, 459 (17.96%) in 2016, 61 (2.39%) in 2017, 64 (2.69%) in 2018, respectively. Out of the group of neonates treated with antibiotics (n = 1502), only 239 (15.91%) neonates showed the clinical signs of sepsis. No significant change was observed in the number of symptomatic newborns during the study period: 52 (2.12%) in 2014, 42 (1.74%) in 2015, 42 (1.64%) in 2016, 46 (1.80%) in 2017, 57 (2.40%) in 2018, p = 0.285. Blood culture confirmed neonatal sepsis was observed in 4 babies, incidence of early-onset neonatal sepsis was 0.324/1000, sepsis-related mortality was zero. DISCUSSION: Before the introduction of the national guideline, most of the neonates were prescribed antibiotics based on risk factors. Since 2017, antibiotics have been mainly preserved for newborns with clinical signs of sepsis. Despite cessation of antiobiotic treatment indicated by risk factors, the number of symptomatic babies and sepsis-related mortality have not increased. CONCLUSION: The use of antibiotics for neonates >34th gestational week can be safely reduced, entailing a decrease in short- and long-term complications of early antibiotic use. Orv Hetil. 2022; 163(11): 431-437.

Kinetics of serum C-reactive protein and procalcitonin levels and their connection to outcomes in community-acquired sepsis / A C-reaktívprotein- és -prokalcitoninszintek szérumkinetikája és a klinikai kimenetellel való kapcsolata közösségben szerzett szepszisben

Introduction and objective: Community-acquired sepsis is a life-threatening systemic reaction to infection starting 72 hours within hospital admittance. Data concerning kinetics of serum C-reactive protein (CRP) and procalcitonin (PCT) levels during disease progression are sparse. Our aim was to analyze kinetics of CRP and PCT among adults with community-acquired sepsis. Methods: We analyzed data of consecutive patients hospitalized with community-acquired sepsis at our centre during 2016. Sepsis was defined according to ACCP/SCCM criteria, community-acquisition was ascertained by a priori exclusion criteria. CRP and PCT values of days 1­14 were collected. Primary outcomes were in-hospital all-cause mortality, intensive care unit admission, secondary outcomes were septic source and the causative microorganism. Absolute (ΔabsCRP, ΔabsPCT) and relative (Δ%CRP, Δ%PCT) differences were calculated between values at the time of diagnosis and control values within 24 hours of empirical antimicrobial therapy initiation. Results: 193 patients were included. In-hospital all-cause mortality was 13.9%, intensive care unit admittance was 25.9%. Patients who died had significantly smaller median Δ%PCT decrements (­7.7 ± 127.9% vs. ­45.7 ± 88.8%, p = 0.01), compared to survivors. During hospital stay, daily absolute values of PCT on days 2­14, while those of CRP on days 5­14 were significantly higher among patients who died. Patients admitted to the intensive care unit also had smaller median Δ%PCT decrements (­19.6 ± 72.5% vs. ­49.8 ± 100.8%, p = 0.01), compared to non-admitted patients. Calculated parameters did not show significant correlations with septic focus or causative microorganisms. Discussion, conclusion: Our findings suggest that specific fluctuations of CRP and PCT are observable, and Δ%PCT might be a favourable parameter for outcome prediction among adults with community-acquired sepsis.

SARS-CoV-2-associated inflammatory multisystem disease in a 15-year-old boy / SARS-CoV-2-fertozéshez társuló többszervi megbetegedés 15 éves fiúban.

Összefoglaló. Újabb megfigyelések szerint a SARS-CoV-2-fertozést követoen gyermekekben a paediatric inflammatory multisystem syndrome (PIMS) elnevezésu, sokkállapottal szövodött Kawasaki-megbetegedéshez hasonlító, többszervi elégtelenségnek megfelelo tünetegyüttes alakulhat ki. A gyermekek többségében ilyenkor a direkt víruskimutatás már sikertelen, azonban a SARS-CoV-2 ellen képzodött antitest igazolhatja a diagnózist. Dolgozatunk célja az egyik elso hazai eset ismertetése. Egy 15 éves fiú került gyermek intenzív osztályos felvételre több napon át észlelt magas láz, kesztyu-, zokniszeru exanthema, conjunctivitis, többszervi elégtelenség, szeptikus sokk tüneteivel, akut gyulladásra utaló laboratóriumi eltérésekkel és diffúz hasi panaszokkal. Felvételét megelozoen néhány héttel SARS-CoV-2-fertozésen esett át. Felvételekor a direkt víruskimutatás sikertelen volt, ám a SARS-CoV-2 elleni antitest vizsgálata pozitív lett. Komplex intenzív terápia mellett állapota stabilizálódott. Az irodalmi ajánlásoknak megfeleloen immunglobulin-, acetilszalicilsav- és szteroidkezelésben részesítettük, melynek hatására állapota maradványtünetek nélkül rendezodött. A növekvo esetszámú gyermekkori SARS-CoV-2-fertozés mellett egyre gyakrabban várható a SARS-CoV-2-fertozést követo, a Kawasaki-betegség tüneteire emlékezteto PIMS kialakulása. Gyermekekben súlyos szeptikus állapot és többszervi elégtelenség esetén gondolni kell a PIMS lehetoségére, mely esetenként intenzív osztályos ellátást és célzott terápiát igényel. Legjobb tudomásunk szerint a leírásra került beteg a Magyarországon diagnosztizált egyik legkorábbi eset. Orv Hetil. 2021; 162(16): 602-607. Summary. Recently following SARS-CoV-2 infection, a new, multisystem disease (paediatric inflammatory multisystem syndrome, PIMS) with fever was recognized in children with shock and multiorgan failure. On of the first Hungarian cases will be described. A 15-year-old boy was admitted to the Paediatric Intensive Care Unit with persistent high fever, diffuse abdominal pain, septic shock, multiple organ failure, gloves- and socks-shaped cutan exanthema, conjunctivitis and laboratory signs of inflammation. Some weeks preceding his admission, symptoms of mild SARS-CoV-2 infection were revealed. At admission, the SARS-CoV-2 PCR and antigen tests were negative, however, the presence of IgG antibody was shown. Following complex supportive intensive care along with internationally recommended immunoglobulin, aspirin and steroid treatment, the patient was completely cured without any sequalae. In children after SARS-CoV-2 infection, PIMS could occur mimicking Kawasaki syndrome. At this time, in children virus PCR or antigen tests are usually negative already, but the presence of SARS-CoV-2 antibody could prove the preceding disease. Due to the increasing number of SARS-CoV-2 infections, the occurrence of post-SARS-CoV-2 PIMS in childhood is expected to increase. For paediatric patients, in case of severe septic state and multiple organ failure, PIMS should be also considered, which may require intensive care and targeted therapy. As far as we know, the described case is one of the earliest cases of PIMS in Hungary. Orv Hetil. 2021; 162(16): 602-607.

[The clinical significance of severe human parechovirus infections in newborns and infants in Hungary]. / A humán parechovírusok klinikai jelentosége súlyos újszülött- és csecsemokori fertozésekben hazánkban.

INTRODUCTION: Most human parechovirus (HPeV, family Picornaviridae) infections are asymptomatic but may cause gastroenteritis in children. New reports show that HPeVs can be associated with severe central nervous system symptoms and sepsis-like syndromes in infants. The clinical significance of HPeVs in Hungary has not been investigated before. AIM: The aim of this study was to detect genotype HPeV in faecal samples of children and analysis of the clinical symptoms. METHOD: For the detection and genotyping of HPeV strains, reverse transcription-polymerase chain reaction and sequencing methods were used from faecal samples of children with gastroenteritis divided into three groups: group A) hospitalised children younger than 10 years (n = 75); group B) 0-12 months infants (n = 237) and group C) children less than 18 years of age with sepsis-like/neurological symptoms (n = 105) were tested. RESULTS: Three HPeV positive samples (3/75, 4%) were found in group A, two of them belong to the HPeV type 1, the third was non-typeable. All positive samples were from infants of 7 to 11 months of age. In group B, HPeV was detected in 6.8% (16/237) of the samples. Five were HPeV1, six were HPeV3 and five were non-typeable. While most of the infants with HPeV1 (4/5) did not require hospitalisation, 83% of the HPeV3 infected infants (5/6) did. Five (4.8%) HPeV strains detected from children less than 18 years of age with sepsis-like/neurological symptoms (group C) belonged to HPeV1 (three) and HPeV3 (two). All positive samples were from hospitalised infants less than 2 months of age. CONCLUSION: HPeV1 infections are less severe in infants than HPeV3 infections. The leading symptom of HPeV1 was diarrhoea, although in infants less than 1-2 months neurological symptoms (somnolence, lassitude) were also present. HPeV3 infections were more common among newborns. The main symptoms of severe HPeV3 infection are: gastroenteritis (7/8), fever ≥38 °C (6/7), loss of appetite (6/7), rash (4/7), somnolence/lassitude (3/7), sepsis-like syndrome (3/7) and respiratory symptoms (2/7). Orv Hetil. 2019; 160(10): 386-395.