Indication criteria for monoclonal antibody treatment for COVID-19 in the era of vaccination: is an update needed?

This study describes a cohort of 223 patients who received anti-S protein monoclonal antibody (mAb) treatment for COVID-19 after having met the indication criteria set by the national guidelines in the Czech Republic at the time. The authors compare the vaccinated and unvaccinated subpopulations of this cohort. The results show that most of the patients (73.5%) already had significant circulating levels of anti-S antibodies detectable at the time of treatment. The authors confirm a positive correlation between number of vaccine doses and S-protein antibody levels. The data show, that vaccinated patients are overall less likely to be hospitalized than unvaccinated ones. The authors recommend a change in the national guidelines for mAb treatment in the Czech Republic.

The duration of SARS-CoV-2 shedding in patients recovering from COVID-19

The knowledge of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) shedding is highly relevant to the diagnosis, treatment and follow-up of patients with COVID-19 (coronavirus disease 2019). Deep nasopharyngeal swabs repeatedly collected from a cohort of one hundred patients with COVID-19 were tested for SARS-CoV-2 RNA using RT-PCR (real-time polymerase chain reaction). The median period of viral genome detectability was 15 days. Furthermore, the authors tested the hypothesis on the relationship between the severity of COVID-19 and the period in which the viral genome is detectable. They did not find any statistically significant difference in the duration of viral clearance between patients with asymptomatic to mild disease or severe disease.

Streptococcal toxic shock syndrome - a life-threatening condition caused by various streptococcal species

Streptococcal toxic shock syndrome (STSS) is an acute, life-threatening condition which presents as a rapid onset shock and multiorgan failure (multiorgan dysfunction syndrome, MODS). This communication summarizes the existing body of evidence and presents three case reports. In two patients, STSS was caused by the bacterium Streptococcus pyogenes and in one patient, Streptococcus dysgalactiae was identified as the causative agent. STSS cases caused by other streptococcal species have been reported less often in the literature. A number of articles and manuals (including the CDC definition from 2010) even continue to state that STSS can only be caused by group A streptococci (S. pyogenes) [1]. To our knowledge, the case report presented of STSS caused by another streptococcal species is the first report in the Czech literature.

Orally administered whey proteins have comparable effect on C-peptide secretion in healthy subjects as standard C-peptide stimulation tests

Our study compared total C-peptide secretion after administration of whey proteins and whey proteins in combination with glucose with results of classical tests assessing beta cell function in the pancreas of healthy individuals. Eight young, healthy (7 males, 1 female; aged 20-26 years), non-obese (BMI: 17-25.9 kg/m²) participants with normal glucose tolerance underwent six C-peptide secretion tests. Three secretion tests measured C-peptide response to orally administered substances: whey proteins only (OWT), whey proteins with glucose (OWGT) and glucose only (OGTT); while three secretion tests measured C-peptide response to intravenously administered substances: arginine (AST), glucagon (GST) and glucose (IVGTT). OWT stimulated a greater (93 %, p<0.05) C-peptide response than AST and a 64 % smaller response (p<0.05) than OGTT. OWT also showed lower variability (p<0.05) in C-peptide responses compared to OWGT and OGTT. The greatest total C-peptide response was induced by OWGT (36 % higher than glucose). OWT consistently increased C-peptide concentrations with lower individual variability, while insignificantly increasing glucose levels. Results of this study suggest that both dietology and beta-cells capacity testing could take advantage of the unique property of whey proteins to induce C-peptide secretion.

[Chronic mild inflammation links obesity, metabolic syndrome, atherosclerosis and diabetes]

Chronic low grade inflammation is relatively new concept in metabolic medicine. This concept describes the relations between the inflammation and adipose tissue, insulin resistence, atherosclerosis and type 2 diabetes mellitus. Macrophages and lymphocytes deposed in adipose tissue produce proinflammatory cytokines which directly or through the CRP liver secretion are targeting endothelial cells, hepatocytes and beta cells of Langerhans islets of pancreas. The dysfunction of these cells follows often further disturbances and in case of beta cells - the cell death. The connection between the adipose tissue insulin resistence, atherosclerosis and type 2 diabetes was earlier described with endocrine and metabolic descriptors. The concept of chronic low grade inflammation creates also another description of multilateral connections in metabolic syndome. The salicylates and the drugs related to them seem to have some glucose lowering properties. The recent development in the field ofchronic low grade inflammation represents also certain therapeutic hope for antiinflammatory intervention in type 2 diabetes.

Short-term dietary intake of C18:1 trans fatty acids decreases the function of cellular immunity in healthy young men

AIM

In this study, we tested the impact of short-term intake of increased amounts of C18:1 trans fatty acids (TFAs) on parameters of cellular and humoral immunity in healthy young men.

METHODS

Twenty-seven healthy young men were subsequently exposed to a standard diet for 7 days and an experimental TFA-enriched diet for 4 days. The mean energy content of these diets was 2,453 and 2,455 kcal/day, with 10, 35 and 55% of energy from proteins, fats and carbohydrates, respectively. Standard diet contained about 0.8 g and experimental diet 10.4 g TFAs. Plasma levels of C18:1 TFAs and immunological parameters were measured.

RESULTS

The 4-day increased consumption of C18:1 TFAs led to a significant decrease in mitogen-induced CD69 expression on CD8+ T cells as well as decreased phagocytic activity on neutrophils. After returning to the participants' habitual diet (1 week after the end of the experimental diet), we observed a significant decrease in the mean level of circulating immune complexes. Concentrations of plasma immunoglobulins remained unchanged throughout the study.

CONCLUSIONS

Acute impact of higher dietary C18:1 TFA intake on phagocytosis and cell-mediated immunity seems to be suppressive. This finding differs from results describing proinflammatory effects associated with long-term exposure to TFAs.

[Listeriosis - four case reports]

The authors described four cases of listeria infection. The patients were hospitalized in the Department of Infectious Diseases of the Masaryk Hospital in Ustí nad Labem during the epidemic outbreak of this infection around the turn of 2006/2007. The disease in three of the four patients was manifested as purulent meningitis and in the remaining one as a sepsis. All of the patients were above the age of 55 years; moreover, two of them were assumed to be immunocompromised. In three of the patients, whose laboratory findings revealed purulent meningitis, direct microscopy of cerebrospinal fluid (CSF), specific latex agglutination test and PCR were negative. Final diagnosis was determined on the basis of the CSF and blood cultures reported 3-4 days after collection. None of the patients suffered from diarrhoea. In the epidemiological anamnesis, only two of them admitted consumption of food that could become source of infection. The patients were successfully treated with either ampicillin and chloramphenicol.

[Listeriosis a review of current knowledge]

The study includes a recent review of the epidemiology, pathogenesis and clinical picture of listeriosis and new data concerning its treatment.

Iodine Saturation of Roma Neonates in Prague Is Not at an Optimum Level

AIM

The purpose of our study was to determine urinary iodine as an indicator of iodine supplementation in Roma (Gypsy) neonates compared to majority population neonates.

METHODS

The groups studied were formed by 30 full-term Roma neonates and 151 majority population neonates. Iodine was determined from samples of urine collected on the 4th day after delivery, after alkaline ashing, using the Sandell-Kolthoff method.

RESULTS

The median of urinary iodine in Roma neonates was 92.15 microg/l urine and in neonates from majority population mothers it was 109.20 microg/l urine. The mean of urinary iodine in Roma neonates was 114.55 microg/l urine (SD 71.68 microg/l) and in neonates from majority population mothers it was 141.86 microg/l urine (SD 87.42 microg/l). The difference was not statistically significant. Majority population mothers more frequently consumed nutrition supplements containing iodine as well as fish.

CONCLUSIONS

Compared to older data, supplementation of neonates with iodine is higher. However, it does not reach optimum levels. The urinary iodine median in Roma neonates lies in the mild iodine deficiency band.

[Diabetic diet and reduction diet are worthy of a basic discussion of their paradigms]

Present knowledge of etiopathogenesis of various types of diabetes postulate substantial differences between type I and type II diabetes. Whereas type I diabetes results from autoimmune destruction of pancreatic B-cells and subsequent absolute lack of insulin, type II diabetes is connected with insulin resistance and frequently with rather relative lack of sometimes absolutely elevated plasmatic insulin. From the viewpoint of the diet therapy an access to both types of diabetes fairly differs. Whilst in type I diabetes it is necessary to find out relationship among preprandial insulin dose, received carbohydrates, and expected physical activity soon after meal, treatment of type II diabetes is based in an effort to influence insulin resistance and the whole metabolic syndrome. Therefore, on one side carbohydrates with low glycemic index and plenty of fibers are administered in a diet and on the other side monoenic and polyenic fatty acids are preferred to saturated fatty acids and trans fatty acids are continuously reduced in a diet. Of course, diets for patients with overweight and for obese patients are low energy. From the viewpoint of the current structure of the diabetic diets it is suitable to differentiate diets for patients with type I and type II diabetes. Instead of the use of a fix proportion of nutrients we have to discuss diets with regard to a qualitative composition of fatty acids in fats, glycemic index of saccharides, and an amount of fibers in the diet.

Higher content of 18:1 trans fatty acids in subcutaneous fat of persons with coronarographically documented atherosclerosis of the coronary arteries

AIM

To identify the total content of trans fatty acid (TFA) isomers and C18:1 trans isomers in subcutaneous fat samples from persons with atherosclerosis of the coronary arteries, as an indicator of dietary exposure.

METHODS

Using capillary gas chromatography, the authors determined total content of TFA isomers and C18:1 trans isomers in the subcutaneous fat of 34 patients with ischemic heart disease who had undergone aortocoronary bypass surgery and in 46 patients with no sign of coronary disease.

RESULTS

On average, the total TFAs in cardiac patients were 2.88 +/- 1.19% of all fatty acids, in noncardiac patients 2.56 +/- 0.89%. However, the difference is not statistically significant. The average concentration of C18:1 trans in cardiac patients (2.31 +/- 1.09%) was statistically significantly higher (p = 0.05) than in the noncardiac group (1.95 +/- 0.77%).

CONCLUSIONS

The results obtained indicate a lower TFA load in comparison with previous studies in other countries. A higher concentration of 18:1 TFAs in the subcutaneous fat of patients with coronary disease might be an impulse to correct the dietary habits of this very high-risk population.

[Infectious and inflammatory factors in the etiology and pathogenesis of atherosclerosis]

Although the metabolic syndrome together with insulin resistance and their consequences are probably basic factors in pathogenesis of atherosclerosis, inflammatory and infectious aspects of this process are unquestionable only in some of the patients. Endothelial dysfunction was identified both in the experiment and in patients after herpes virus simplex 1 infection, cytomegaloviral infection, Chlamydia pneumoniae infection, or Helicobacter pylori infection. However, it is not clear whether it is always caused by direct specific activity of a given pathogen or whether it is a result of inflammatory cytokines activity, heat shock protein activity, or CRP activity. In recent years secondary antibiotic prevention in patients after myocardial infarction has been discussed. Lower mortality rate from acute myocardial infarction and cerebral vascular accidents were found in several observations of patients vaccinated against influenza. In patients with non-stable angina pectoris we have found significantly more frequent occurrence of IgG antibodies against Chlamydia pneumoniae. This occurrence was more frequent in diabetics compared to non-diabetics. Endothelia exposed to cyto-megaloviral infection exprimed adhesive molecules on their surfaces. After an increase of the concentration of glucose in medium to 11.0 mmol/l and 16.5 mmol/l the expression of adhesive molecules after cyto-megaloviral infection increased. Relationship of infection, inflammation, and atherosclerosis has been a subject of intensive investigation in recent years. Discussion of possible consequences of these findings, especially from viewpoint of atherosclerosis prevention and its organ complications, is of the same intensity. Hypothesis about participation of infection and inflammation in pathogenesis of atherosclerosis seems to be very attractive. In spite of the fact that findings supporting this hypothesis cumulate final conclusion can't be made yet.

Administration of antibiotics before admission in patients with meningococcal disease

PURPOSE

To determine whether parenteral or oral antibiotics given before admission to a regional hospital with a special intensive care unit (ICU) reduce the case fatality rate in patients with meningococcal disease.

DESIGN

Prospective analysis of 164 consecutive patients with meningococcal disease admitted to 5 regional hospitals in the Czech Republic between August 1996 and October 2001. Main outcome measure was number of deaths from meningococcal disease. Fisher's exact test was used for statistical analysis.

MAIN FINDINGS

Nine out of 116 patients (8%) given antibiotics before admission died, compared with five deaths in 48 patients (10%) admitted without such a treatment (p = 0.55). None of 19 patients given oral or combined oral and parenteral pre-admission antibiotics died.

CONCLUSION

Parenteral and probably also oral antibiotics given before admission to a regional hospital and an adequate treatment of shock can reduce the case fatality rate from meningococcal disease.

[Fatty acid composition of domestic dietary fats]

Trans fatty acids (TFA) were analyzed by capillary gas chromatography in four groups of edible fats available on the Prague market. In animal fats, 1.9-2.5%, 2.8-5.5% and 11.3-13.5% TFA were found in the lard, butter, and butter enriched by vegetable fat, respectively. In shortenings, TFA content varied between 0.5 and 38%, in margarines from 0.6 to 13% and in table fats from 1.4 to 27%.

[Trans-fatty acids in the diet and their possible health risks]

Trans fatty acids are unsaturated fatty acids which have at least one double bond in the trans configuration. Their dietary source are some foods of animal origin, but in particular hardened fats and products which contain them. Increased attention is paid to these substances in particular because they are suspected to act as risk factors for ischaemic heart disease. The authors discuss in the submitted review the chemistry, dietary sources, estimated intake and effects of trans fatty acids in the organism.

[Candida sepsis. I. Risk factors, pathogenesis and the clinical picture]

Candida sepsis is a serious and ever increasing complication in patients with a reduced defense capacity. At the intensive care unit of the infectious department in 1978-1990 from a total of 430 patients with the diagnosis of sepsis 20 (4.7%) had a Candida aetiology. Candida sepsis is suspected in particular in leukaemic patients with neutropenia, in organ transplantations and in patients given intensive care on account of a serious primary disease, bacterial infection or after surgery. The risk of deep candidosis is increased by venous catheters, hyperalimentation, antibiotic treatment, invasive operations. Diagnosis is supported by endophthalmitis and skin lesions; signs of affection of the liver, lungs, kidneys and cardiac valves are sought. Analysis of risk factors, pathogenesis and the clinical picture of invasive Candida infections is based on ample data in the literature.

[Candida sepsis. II. Laboratory methods and their clinical importance]

The authors present experience assembled at the septic station of the infectious department and mycological laboratory as regards interpretation of results of laboratory examinations in invasive Candida infections and they summarize the most important data from the literature on the correct collection of material, evaluation of microscopic and cultivation findings, the importance of examinations and haemocultures, venous catheters, urine, faeces and sputum. They analyze problems of serological examination and direct detection of antigen, they recommend mycological monitoring of patients at risk. In the conclusion they summarize the most frequent mistakes as regards the evaluation of laboratory results and indications of treatment.

[Takayasu's disease. Detection of the early systemic stage of the disease in a pregnant woman]

The authors describe the case of Takayasu's disease detected in the non-obliterating systemic stage. The disease developed in a 24-year-old woman in the 8th month of gestation and was associated with severe pain of the back and upper extremities, subfebrile temperatures, later fever and tachycardia. The authors describe the difficult diagnosis of the disease and discuss the relationship of the case with so-called fever of unknown aetiology and the development of the disease during pregnancy.