OBJECTIVES: We prospectively compared the postvaccination immunity to messenger ribonucleic acid BNT162b2 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine of our pediatric patients over 12 years old with inflammatory bowel disease (IBD) to that of healthy controls and looked for predictors of its robustness. METHODS: Anti-receptor binding domain, anti-spike S2, and anti-nucleocapsid immunoglobin-G (IgG) and immunoglobin-A levels were measured in 139 pediatric patients with IBD [65 fully vaccinated (2 doses), median age 16.3, interquartile range (IQR) 15.2-17.8 years, median time from vaccination (IQR) 61.0 (42.0-80.0) days] and 1744 controls (46, 37-57 years) using microblot array. RESULTS: All IBD and control patients developed positive anti-receptor binding domain IgG antibodies at comparable titers. The proportion of observations with positive anti-spike S2 IgG was higher in patients with IBD than in controls [63% vs 21%, odds ratio 2.99 (1.51-5.90)], as was its titer [median (IQR) 485 (92-922) vs 79 [33-180] IU/mL]. Anti-receptor binding domain and anti-spike S2 IgG levels were associated with IBD status. We found an association between anti-spike S2 IgG levels and time since vaccination (β -4.85, 95% CI -7.14 to 2.71, P = 0.0001), history of SARS-CoV-2 polymerase chain reaction positivity (206.76, 95% CI 39.93-374.05, P = 0.0213), and anti-tumor necrosis factor treatment (-239.68, 95% CI -396.44-83.55, P = 0.0047). Forty-three percent of patients reported vaccination side effects (mostly mild). Forty-six percent of observations with positive anti-nucleocapsid IgG had a history of SARS-CoV-2 infection. CONCLUSIONS: Patients with IBD produced higher levels of postvaccination anti-spike S2 antibodies than controls. Previous SARS-CoV-2 infection is associated with higher production of postvaccination antibodies and anti-tumor necrosis factor treatment with lower production.

• MeSH
• COVID-19 * prevence a kontrola   MeSH
• dospělí MeSH
• idiopatické střevní záněty * MeSH
• imunoglobulin G MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• nekróza MeSH
• protilátky virové MeSH
• SARS-CoV-2 MeSH
• TNF-alfa MeSH
• vakcína BNT162 MeSH
• vakcinace MeSH
• vakcíny proti COVID-19 MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

AIM OF STUDY: Duodenum-preserving resection of the pancreatic head (DPRPH) with Roux-en-Y pancreatojejunostomy is a procedure used to remove focal pathological lesions of the pancreatic head. Although predominantly used in adult patients, it is both safe and effective in children. The aim of this study was to review our experience with this procedure, with focus on its indications, complications and long-term outcomes. METHODS: A retrospective analysis of pediatric patients who underwent DPRPH between 1994 and 2015 was performed. Patient files were reviewed for demographic, diagnostic, operative and histological details, postoperative complications. Patients were contacted telephonically and sent questionnaires to determine long-term outcomes. RESULTS: The study cohort consists of 21 patients, 14 girls and 7 boys, with an average age of 11.72 years (range 3 months to 18.6 years), who underwent DPRPH with end-to-end anastomosis of the jejunum to the pancreatic body (Roux-en-Y anastomosis). In four cases the head and also part of the body of the pancreas was resected. In the remaining 17 cases, only the head of the pancreas was resected. Indications for DPRPH were solid pseudopapillary tumor of the pancreas (n = 10), trauma (n = 8), pancreas divisum (n = 1), focal congenital hyperinsulinism (n = 1) and pancreatic cyst (n = 1). The length of follow-up ranged from 1 to 22 years (average 9.66). One patient developed a biliary fistula, which closed spontaneously within 2 weeks after stent insertion. A recurrence of abdominal pain was reported in two patients, occurring at 7 months after the operation in one patient and at 1 year in the other. Pancreatic endocrine insufficiency did not occur in any of the 21 patients. Seven patients currently require a low fat diet, five of which need pancreatic enzyme supplementation. An additional two patients need enzyme supplementation without dietary restriction. CONCLUSION: DPRPH is a safe and effective procedure for the treatment of large focal pathological lesions of the pancreatic head in children. As a less invasive procedure than pancreatoduodenectomy, it is more appropriate for the developing child.

• MeSH
• časové faktory MeSH
• dítě MeSH
• duodenum chirurgie   MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• nádory slinivky břišní chirurgie   MeSH
• následné studie MeSH
• pankreas chirurgie   MeSH
• pankreatektomie metody   MeSH
• pankreatikojejunostomie metody   MeSH
• pooperační komplikace prevence a kontrola   MeSH
• předškolní dítě MeSH
• retrospektivní studie MeSH
• Rouxova Y-anastomóza metody   MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION:  Standard coagulation tests (activated partial thromboplastin time [aPTT] and prothrombin time [PT]) are used for the assessment of coagulation profile in critically ill pediatric patients undergoing invasive interventions such as insertion of central venous catheter, tonsillectomy, laparotomy, etc. However, these tests do not reflect the profile of whole blood coagulation. Rotational thromboelastometry (ROTEM) as a point of care (POC) viscoelastic test may serve as an alternative method. Due to its ability to assess coagulation profile of the whole blood, it might yield normal results despite prolonged aPTT/PT results. The aim of this study was to find out if there was any severe bleeding during or after invasive procedures if ROTEM test was normal despite prolonged values of aPTT/PT in pediatric patients. MATERIALS AND METHODS:  We retrospectively analyzed data for the years 2015 to 2017 for pediatric patients with prolonged values of aPTT or PT and normal ROTEM tests-internal thromboelastometry (INTEM) (assessing internal pathway of coagulation) and external thromboelastometry (EXTEM) (assessing external pathway of coagulation)-and we looked for severe bleeding during or after invasive procedures. RESULTS:  In 26 pediatric patients (children from 2 months to 17 years old), we found that INTEM and EXTEM tests showed normal coagulation despite prolonged values of aPTT ratio with a median of 1.47 (minimum 1.04 and maximum 2.05), international normalized ratio with a median of 1.4 (minimum 0.99 and maximum 2.10), and PT ratio with a median of 1.30 (minimum 0.89 and maximum 2.11). In these patients, no severe bleeding was observed during interventions or postoperatively. CONCLUSION:  Our data support using thromboelastometry method as an alternative coagulation test for the assessment of coagulation profile in pediatric patients undergoing surgical or other invasive procedures, especially using it as a POC test. All invasive procedures in our study were performed without severe bleeding despite prolonged values of PT/aPTT with normal ROTEM results. It seems that ROTEM assessment of coagulation may lead to decreased administration of fresh frozen plasma and shorten time of patient preparation for intervention.

• MeSH
• dítě MeSH
• koagulopatie komplikace   diagnóza   MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• pilotní projekty MeSH
• pooperační krvácení etiologie   prevence a kontrola   MeSH
• předškolní dítě MeSH
• retrospektivní studie MeSH
• tromboelastografie metody   MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

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.

• MeSH
• adalimumab aplikace a dávkování   MeSH
• dítě MeSH
• gastrointestinální látky aplikace a dávkování   MeSH
• idiopatické střevní záněty farmakoterapie   imunologie   MeSH
• infliximab aplikace a dávkování   MeSH
• kohortové studie MeSH
• kojenec MeSH
• komplikace těhotenství diagnóza   farmakoterapie   imunologie   MeSH
• lidé MeSH
• matky MeSH
• následné studie MeSH
• předškolní dítě MeSH
• prognóza MeSH
• studie případů a kontrol MeSH
• těhotenství MeSH
• TNF-alfa antagonisté a inhibitory   MeSH
• zpožděný efekt prenatální expozice farmakoterapie   imunologie   MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

Súhrn: V zdravej detskej populácii je počas ultrasonografického vyšetrenia (USG) celková echogenita pečeňového parenchýmu porovnateľná s echogenitou kôry obličiek či sleziny. Pri obezite, ako najrizikovejšom faktore vzniku nealkoholovej steatózy pečene (NAFLD – non-alcoholic fatty liver disease), môže vzrastať celková echogenita pečene v závislosti od závažnosti steatózy. V súčasnosti sa dostáva do popredia USG kvantifikácia steatózy pečene na základe hodnoty hepatorenálneho indexu (HRI). Hodnota HRI je definovaná pomerom histogramov medzi mediánom echogenity pečene a mediánom echogenity pravej obličky a je priamo úmerná stupňu steatózy pečene, zatiaľ čo celková elasticita pečeňového tkaniva sa môže v prípade rozvinutých štádií steatózy znižovať. V našej práci sme posudzovali význam a možné uplatnenie USG neinvazívnych vyšetrovacích metód na hodnotenie prítomnosti a stupňa steatózy pečene u pediatrických pacientov s exogénnou obezitou. V skupine obéznych detských pacientov bola zaznamenaná vyššia výsledná priemerná hodnota HRI v porovnaní so zdravou kontrolnou skupinou (1,43 ± 0,19 vs. 1,12 ± 0,07; p < 0,0001) a nižšia elasticita tkaniva v porovnaní s kontrolnou skupinou (index fibrózy pečene = 1,64 ± 0,43 vs. 1,02 ± 0,27; p < 0,0001). Výsledky našej práce tiež poukazujú na skutočnosť, že pacienti s vyššími hodnotami body mass indexu a obvodu pása majú USG vyšší stupeň steatózy a nižší stupeň elasticity pečene. U obéznych pacientov so zvýšenými hodnotami LDL cholesterolu a triacylglycerolov klesá elasticita pečene a taktiež sa elasticita pečene znižuje so znižujúcou sa sérovou koncentráciou vitamínu D. Na základe prezentovaných dát možno konštatovať, že obezita predstavuje významný rizikový faktor vzniku a rozvoja NAFLD, a že neinvazívne USG hodnotiace metódy majú svoje uplatnenie v diagnostike a kontrole obéznych pacientov s rizikom rozvoja NAFLD.

Summary: In healthy children, tissue echogenicity of the liver parenchyma is comparable to that of the kidneys or spleen. With obesity, the most prominent risk factor for non-alcoholic fatty liver disease (NAFLD), overall liver tissue echogenicity increases with the severity of steatosis. Currently, ultrasonographic quantification of liver steatosis using the hepatorenal index (HRI) is coming to the forefront. The HRI value is defined as a histogram ratio between tissue echogenicities of the liver and those of the right kidney, and its increase is proportional to the severity of steatosis, while overall liver tissue elasticity tends to decrease in more advanced stages of steatosis. In this study, we evaluated the significance and possible use of noninvasive ultrasonography for the assessment of the presence and stages of liver steatosis in paediatric patients with exogenous obesity. The obese children cohort showed higher HRI values than the healthy patient group (HRI = 1.43 ± 0.19 vs. 1.12 ± 0.07; p < 0,0001), and lower tissue elasticity than the control group (liver fi brosis index (LFI) = 1.64 ± 0.43 vs. 1.02 ± 0.27). The ultrasonograms also revealed that patients with higher body mass indexes and waist circumferences had more steatosis and lower liver elasticity. Liver elasticity was lower in obese patients with increased serum LDL and triglyceride levels, and the decrease also tended to be proportional to the decrease in serum vitamin D concentration. Based on these results, we conclude that obesity is a significant risk factor for the onset and development of NAFLD, and that noninvasive ultrasonographic methods can be used to diagnose and monitor obese patients with a high risk of NAFLD.

• MeSH
• biologická terapie metody   MeSH
• dítě MeSH
• idiopatické střevní záněty * farmakoterapie   MeSH
• imunitní systém * MeSH
• infekce MeSH
• klinická studie jako téma MeSH
• kojenec MeSH
• komplikace těhotenství * farmakoterapie   MeSH
• lidé MeSH
• nežádoucí účinky léčiv MeSH
• předškolní dítě MeSH
• průzkumy a dotazníky MeSH
• těhotenství MeSH
• TNF-alfa * MeSH
• vakcinace MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• předškolní dítě MeSH
• těhotenství MeSH
• ženské pohlaví MeSH

• Klíčová slova
• vedolizumab,
• MeSH
• adalimumab terapeutické užití   MeSH
• antibakteriální látky terapeutické užití   MeSH
• biosimilární léčivé přípravky MeSH
• diferenciální diagnóza MeSH
• dítě MeSH
• genetická predispozice k nemoci MeSH
• humanizované monoklonální protilátky terapeutické užití   MeSH
• idiopatické střevní záněty * diagnóza   farmakoterapie   MeSH
• imunosupresiva škodlivé účinky   terapeutické užití   MeSH
• indukční chemoterapie MeSH
• infliximab terapeutické užití   MeSH
• kojenec MeSH
• kontraceptiva orální hormonální škodlivé účinky   terapeutické užití   MeSH
• léková rezistence MeSH
• lidé MeSH
• mladiství MeSH
• oportunní infekce prevence a kontrola   MeSH
• předškolní dítě MeSH
• sklerozující cholangitida diagnóza   farmakoterapie   komplikace   MeSH
• udržovací chemoterapie MeSH
• vakcinace MeSH
• žilní trombóza komplikace   prevence a kontrola   MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• předškolní dítě MeSH
• Publikační typ
• směrnice pro lékařskou praxi MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH

BACKGROUND: Young age and thiopurine therapy are risk factors for lymphoproliferative disease among patients with inflammatory bowel disease (IBD). AIMS: The aims of this study were to evaluate the prevalence of seropositivity for the Epstein-Barr virus (EBV) and human cytomegalovirus (CMV) among children and adolescents with IBD, to assess the viral load of EBV, CMV, and BK and JC polyomaviruses (BKV, JCV) in these patients, and to assess the influence of different therapeutic regimens on seroprevalence and viral load. METHODS: Children who had been followed in our center were tested for EBV, CMV, BKV, and JCV in a cross-sectional study. One hundred and six children were included who had Crohn's disease (68%), ulcerative colitis (29%), and unclassified IBD (3%). RESULTS: We found that 64% of patients were EBV seropositive. The proportion of EBV seropositive patients increased during childhood. Azathioprine therapy (p = 0.003) was associated with EBV seropositivity in a multiple logistic regression model, after adjusting for gender, age, and disease activity at determination. We found a significant association between the number of polymerase chain reaction copies and infliximab dose (p = 0.023). We did not find any significant association between CMV serology and CMV, BKV, or JCV viral load, or any other therapeutic regimen or clinical characteristics. CONCLUSIONS: Treatment with azathioprine appears to be a risk factor for early EBV seropositivity in children with IBD, and the infliximab dose was associated with a higher EBV viral load.

• MeSH
• azathioprin škodlivé účinky   MeSH
• Crohnova nemoc diagnóza   farmakoterapie   epidemiologie   imunologie   MeSH
• cytomegalovirové infekce diagnóza   epidemiologie   imunologie   virologie   MeSH
• dítě MeSH
• hostitel s imunodeficiencí MeSH
• imunosupresiva škodlivé účinky   MeSH
• infekce virem Epsteina-Barrové diagnóza   epidemiologie   imunologie   virologie   MeSH
• infliximab škodlivé účinky   MeSH
• lidé MeSH
• logistické modely MeSH
• mladiství MeSH
• multivariační analýza MeSH
• odds ratio MeSH
• oportunní infekce diagnóza   epidemiologie   imunologie   virologie   MeSH
• polyomavirové infekce diagnóza   epidemiologie   imunologie   virologie   MeSH
• předškolní dítě MeSH
• prevalence MeSH
• průřezové studie MeSH
• rizikové faktory MeSH
• séroepidemiologické studie MeSH
• sérologické testy MeSH
• ulcerózní kolitida diagnóza   farmakoterapie   epidemiologie   imunologie   MeSH
• věkové faktory MeSH
• virová nálož MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH