Papers by Tina Plankar Srovin
The Central European Journal of Paediatrics, Dec 20, 2023
Objective − We present the imaging characteristics of an unusual case of Fitz-Hugh-Curtis syndrom... more Objective − We present the imaging characteristics of an unusual case of Fitz-Hugh-Curtis syndrome (FHCS), a late complication of pelvic inflammatory disease in an adolescent girl with left upper abdominal pain due to perisplenitis seen on contrast-enhanced ultrasound and magnetic resonance imaging. Case Report − A 16-year-old girl presented with acute abdominal pain in the left upper quadrant, vomiting, diarrhoea, and vaginal odour with yellow discharge. She was recently diagnosed with infectious mononucleosis. Abdominal ultrasound showed perisplenic fluid collection that did not enhance post-contrast application, but it did show a mild enhancement of perisplenic tissue. MRI findings indicated perisplenitis. The results of the positive vaginal swab for Chlamydia trachomatis and Ureaplasma parvum and the imaging findings favoured a final diagnosis of FHCS with perisplenitis. Conclusion − Imaging findings, and clinical and laboratory data, including positive vaginal swabs, are crucial to confirm the unusual presentation of FHCS in an adolescent with left upper abdominal pain.
Slovenska pediatrija, revija pediatrov Slovenije in specialistov šolske ter visokošolske medicine Slovenije
Zapletene akutne okužbe sečil pri otrocih Acute complicated urinary tract infections in children ... more Zapletene akutne okužbe sečil pri otrocih Acute complicated urinary tract infections in children Izvleček Ker v literaturi ni enotne definicije zapletenih okužb sečil pri otrocih, v prispevku kot zapletene okužbe sečil pri otrocih obravnavamo tiste okužbe, ki potekajo s hujšo in invazivno (sistemsko ali lokalno) klinično sliko ali se pojavijo ob dejav nikih tveganja. Predstavljamo torej žariščni nefritis, ledvični absces, pionefros, perirenalni absces, emfizematozni pie lonefritis, ksantogranulomatozni pielonefritis, okužbe sečil ob ledvičnih kamnih in okužbe sečil ob vstavljenih umetnih pripomočkih. Omenjena stanja se pogosto razvijejo ob prid ruženih dejavnikih tveganja, kot so funkcionalne in anatom ske nepravilnosti sečil, vstavljeni umetni pripomočki (npr. urinski kateter, perkutana drenažna cevka), nedavni poseg na sečilih, okužbe z večkratno odpornimi mikroorganizmi, bolnišnične okužbe in imunosupresivno zdravljenje. Opisuje mo tudi diagnostične možnosti in pristop k zdravljenju zaple tenih okužb sečil, ki lahko vključuje tudi kirurško zdravljenje.
Slovenska pediatrija, 2020
Pri otrocih koronavirusi obiËajno povzroËajo blage okužbe dihal. V zadnjih dveh desetletjih so se... more Pri otrocih koronavirusi obiËajno povzroËajo blage okužbe dihal. V zadnjih dveh desetletjih so se iz živalskih rezervoarjev na Ëloveka razširile tri vrste koronavirusov, ki so pri ljudeh povzroËile resne bolezni s pomembno stopnjo umrljivosti. Decembra 2019 je na Kitajskem izbruhnila nova koronavirusna bolezen covid-19, ki jo povzroËa virus SARS-CoV-2, in se je v treh mesecih razširila po vsem svetu. Glavna naËina prenosa sta kapljiËni in kontaktni. PovpreËna inkubacijska doba je 4−6 dni. Bolezen se pri otrocih veËinoma kaže z nespecifiËnimi simptomi in znaki akutne virusne okužbe dihal, v manjšem deležu pa so pridruženi tudi gastrointestinalni simptomi. Najpogostejša kliniËna znaka sta vroËina in kašelj. Bolezen je samoomejujoËa in jo veËina otrok brez posledic preboli v 1−2 tednih po nastopu bolezni. Pri delu otrok bolezen poteka brez simptomov, medtem ko do 6 % otrok s potrjeno okužbo s SARS-CoV-2 prizadene težka in kritiËna oblika bolezni. Konec aprila so se v povezavi s prebolelo boleznijo covid-19 zaËeli pojavljati opisi otrok s prekrivajoËo se kliniËno sliko Kawasakijeve bolezni in sindroma toksiËnega šoka. NatanËna patogeneza še ni znana, morda gre za superantigensko povzroËeno aktivacijo imunskega sistema. SpecifiËnega zdravljenja za covid-19 trenutno nimamo. Pripravljajo cepiva, ki naj ne bi pripomogla le k obvladovanju oz. omejitvi trenutne epidemije, ampak tudi k prepreËevanju podobne epidemije v prihodnje.
Slovenska pediatrija, revija pediatrov Slovenije in specialistov šolske ter visokošolske medicine Slovenije
Zapletene akutne okužbe sečil pri otrocih Acute complicated urinary tract infections in children ... more Zapletene akutne okužbe sečil pri otrocih Acute complicated urinary tract infections in children Izvleček Ker v literaturi ni enotne definicije zapletenih okužb sečil pri otrocih, v prispevku kot zapletene okužbe sečil pri otrocih obravnavamo tiste okužbe, ki potekajo s hujšo in invazivno (sistemsko ali lokalno) klinično sliko ali se pojavijo ob dejav nikih tveganja. Predstavljamo torej žariščni nefritis, ledvični absces, pionefros, perirenalni absces, emfizematozni pie lonefritis, ksantogranulomatozni pielonefritis, okužbe sečil ob ledvičnih kamnih in okužbe sečil ob vstavljenih umetnih pripomočkih. Omenjena stanja se pogosto razvijejo ob prid ruženih dejavnikih tveganja, kot so funkcionalne in anatom ske nepravilnosti sečil, vstavljeni umetni pripomočki (npr. urinski kateter, perkutana drenažna cevka), nedavni poseg na sečilih, okužbe z večkratno odpornimi mikroorganizmi, bolnišnične okužbe in imunosupresivno zdravljenje. Opisuje mo tudi diagnostične možnosti in pristop k zdravljenju zaple tenih okužb sečil, ki lahko vključuje tudi kirurško zdravljenje.
European Journal of Pediatrics
Children constitute 6–10% of all patients attending the emergency department (ED) by emergency me... more Children constitute 6–10% of all patients attending the emergency department (ED) by emergency medical services (EMS). However, discordant EMS use in children occurs in 37–61% with fever as an important risk factor. We aimed to describe EMS utilisation among febrile children attending European EDs. This study is part of an observational multicentre study assessing management and outcome in febrile children up to 18 years (MOFICHE) attending twelve EDs in eight European countries. Discordant EMS use was defined as the absence of markers of urgency including intermediate/high triage urgency, advanced diagnostics, treatment, and admission in children transferred by EMS. Multivariable logistic regression analyses were performed for the association between (1) EMS use and markers of urgency, and (2) patient characteristics and discordant EMS use after adjusting all analyses for the covariates age, gender, visiting hours, presenting symptoms, and ED setting. A total of 5464 (15%, range 0....
JAMA Network Open
ImportanceCardiac dysfunction and myocarditis have emerged as serious complications of multisyste... more ImportanceCardiac dysfunction and myocarditis have emerged as serious complications of multisystem inflammatory syndrome in children (MIS-C) and vaccines against SARS-CoV-2. Understanding the role of autoantibodies in these conditions is essential for guiding MIS-C management and vaccination strategies in children.ObjectiveTo investigate the presence of anticardiac autoantibodies in MIS-C or COVID-19 vaccine-induced myocarditis.Design, Setting, and ParticipantsThis diagnostic study included children with acute MIS-C or acute vaccine myocarditis, adults with myocarditis or inflammatory cardiomyopathy, healthy children prior to the COVID-19 pandemic, and healthy COVID-19 vaccinated adults. Participants were recruited into research studies in the US, United Kingdom, and Austria starting January 2021. Immunoglobulin G (IgG), IgM, and IgA anticardiac autoantibodies were identified with immunofluorescence staining of left ventricular myocardial tissue from 2 human donors treated with sera...
Nature
Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis ... more Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic ...
European Journal of Pediatrics
Pediatric Infectious Disease Journal, 2020
This study evaluated the application of a wireless sensor network (WSN) on a web-based vital sign... more This study evaluated the application of a wireless sensor network (WSN) on a web-based vital signs monitoring system to nursing homes in Taiwan. The applicability assessment focused on the timely provision of information, information accuracy, system usability, and system accessibility of healthcare systems using a wireless sensor network. Experiments were performed under Internet-based network conditions to verify the timely information provision, especially for a web-based system, including Ajax technology. The accuracy of the information was verified from statistical analyses of the residents' daily vital sign measurements. A comparison was performed between having and not having a healthcare monitoring system in nursing homes for system usability, system accessibility, and system efficacy. The results indicate that the successful application of a WSN healthcare monitoring system is feasible for use in nursing homes in Taiwan.
European Journal of Pediatrics
Febrile children below 3 months have a higher risk of serious bacterial infections, which often l... more Febrile children below 3 months have a higher risk of serious bacterial infections, which often leads to extensive diagnostics and treatment. There is practice variation in management due to differences in guidelines and their usage and adherence. We aimed to assess whether management in febrile children below 3 months attending European Emergency Departments (EDs) was according to the guidelines for fever. This study is part of the MOFICHE study, which is an observational multicenter study including routine data of febrile children (0–18 years) attending twelve EDs in eight European countries. In febrile children below 3 months (excluding bronchiolitis), we analyzed actual management compared to the guidelines for fever. Ten EDs applied the (adapted) NICE guideline, and two EDs applied local guidelines. Management included diagnostic tests, antibiotic treatment, and admission. We included 913 children with a median age of 1.7 months (IQR 1.0–2.3). Management per ED varied as follow...
Clinical and Experimental Rheumatology
Paediatric rheumatology High incidence of multisystem inflammatory syndrome and other autoimmune ... more Paediatric rheumatology High incidence of multisystem inflammatory syndrome and other autoimmune diseases after SARS-CoV-2 infection compared to COVID-19 vaccination in children and adolescents in south central Europe
Slovenska pediatrija, revija pediatrov Slovenije in specialistov šolske ter visokošolske medicine Slovenije, 2020
Pri otrocih koronavirusi obiËajno povzroËajo blage okužbe dihal. V zadnjih dveh desetletjih so se... more Pri otrocih koronavirusi obiËajno povzroËajo blage okužbe dihal. V zadnjih dveh desetletjih so se iz živalskih rezervoarjev na Ëloveka razširile tri vrste koronavirusov, ki so pri ljudeh povzroËile resne bolezni s pomembno stopnjo umrljivosti. Decembra 2019 je na Kitajskem izbruhnila nova koronavirusna bolezen covid-19, ki jo povzroËa virus SARS-CoV-2, in se je v treh mesecih razširila po vsem svetu. Glavna naËina prenosa sta kapljiËni in kontaktni. PovpreËna inkubacijska doba je 4−6 dni. Bolezen se pri otrocih veËinoma kaže z nespecifiËnimi simptomi in znaki akutne virusne okužbe dihal, v manjšem deležu pa so pridruženi tudi gastrointestinalni simptomi. Najpogostejša kliniËna znaka sta vroËina in kašelj. Bolezen je samoomejujoËa in jo veËina otrok brez posledic preboli v 1−2 tednih po nastopu bolezni. Pri delu otrok bolezen poteka brez simptomov, medtem ko do 6 % otrok s potrjeno okužbo s SARS-CoV-2 prizadene težka in kritiËna oblika bolezni. Konec aprila so se v povezavi s prebolelo boleznijo covid-19 zaËeli pojavljati opisi otrok s prekrivajoËo se kliniËno sliko Kawasakijeve bolezni in sindroma toksiËnega šoka. NatanËna patogeneza še ni znana, morda gre za superantigensko povzroËeno aktivacijo imunskega sistema. SpecifiËnega zdravljenja za covid-19 trenutno nimamo. Pripravljajo cepiva, ki naj ne bi pripomogla le k obvladovanju oz. omejitvi trenutne epidemije, ampak tudi k prepreËevanju podobne epidemije v prihodnje.
Slovenian Medical Journal, 2017
Background: Antibiotics are among the most common drugs prescribed in outpatient settings. It is ... more Background: Antibiotics are among the most common drugs prescribed in outpatient settings. It is estimated that up to 50 % are prescribed unnecessarily or inappropriately. To plan the actions for optimizing the use of antibiotics, we conducted a national antibiotic consumption study in children aged 0–18 years in the period between 2003 and 2015. Methods: In this national retrospective research we analyzed outpatient antibiotic consumption using ATC/DDD classification. The use of antibiotics was recorded in relation to the pattern of prescription, age, gender and health region. Results: The total consumption of antibiotics decreased by 35 % from 979 to 636 prescriptions per 1000 children/year (PTY) during the whole study period. Te use of all antibiotic classes decreased (except for quinolones and nitrofuran derivatives) by 12.5 %–81 %. In all those years we recorded the highest consumption in children aged 1 to 4 years (2184–1160 PTY). Amoxicillin was the most commonly prescribed a...
Journal of Global Antimicrobial Resistance, 2015
In the last decade, Slovenia introduced restrictive measures for some antibiotic classes in ambul... more In the last decade, Slovenia introduced restrictive measures for some antibiotic classes in ambulatory care as well as regulatory interventions to reduce costs. The aim of this study was to analyse the effects of these interventions on consumption and costs of antibiotics in ambulatory care. Consumption data were expressed in defined daily doses/1000 inhabitants per day (DID), number of packages/1000 inhabitants per day and number of prescriptions/1000 inhabitants per year. In 2000, Slovenia introduced restrictive measures for prescription of amoxicillin/clavulanic acid (AMC) and fluoroquinolones, in 2005 for oral third-generation cephalosporins and in 2009 for macrolides. Segmented regression analysis of interrupted time series was used to estimate the effects of restrictive interventions on antibiotic consumption. Total outpatient consumption of antibacterial drugs decreased by 29.65% from 20.27 DID in 1999 to 14.26 DID in 2012. Three years after the introduction of restrictions, consumption of AMC, fluoroquinolones and macrolides decreased by 29.3%, 23.8% and 28.8%, respectively, compared with the year before the intervention, and of non-restricted antibiotics by 3.3% (in 2003). Twelve years after the introduction of restrictive interventions, use of AMC and fluoroquinolones decreased by 28.1% and 28.5%, respectively, and use of non-restricted antibiotics by 18.8% (in 2012). In the same time period, the costs of AMC and fluoroquinolones were reduced by 63.3% and 52.4%, respectively, and of non-restricted antibiotics by 46.9%. Restrictive interventions in ambulatory care are effective in reducing antibiotic consumption and costs. Restrictive interventions had a significantly greater impact on consumption 3 years post-intervention than after 12 years.
Journal of Chemotherapy, 2013
The aim of our prospective cohort study was to determine the incidence, genetic relatedness and r... more The aim of our prospective cohort study was to determine the incidence, genetic relatedness and risk factors for colonization with ampicillin and high-level aminoglycoside-resistant enterococci (ARHLARE) among patients hospitalized in the intensive care unit. During 15-month period, we included 105 patients. The only independent risk factor for ARHLARE colonization was days of cefotaxime/ceftriaxone therapy [odds ratio (OR): 1.13; 95% confidence interval (CI) 1.10-1.27; P = 0.045]. Patients with higher total use of antibiotics, patients on prolonged mechanical ventilation, and patients with urinary tract infection (UTI), were also found to be at increased risk to become colonized with ARHLARE. Pulsed-field gel electrophoresis suggested multifocal origin of the majority of the colonizing strains. Our results show that an increase in total antibiotic consumption for 10 defined daily doses (DDD)/patient increased the odds of colonization with ARHLARE for 36%. Further efforts to optimize antimicrobial use in high risk patients are proposed.
Slovenian Medical Journal, Jun 28, 2017
Izhodišča: Antibiotiki so med najpogostejšimi zdravili, ki jih predpisujejo zdravniki ambulantno.... more Izhodišča: Antibiotiki so med najpogostejšimi zdravili, ki jih predpisujejo zdravniki ambulantno. V svetu ocenjujejo, da jih v do 50 % bolniki prejemajo brez razloga ali nepravilno. Za namen načrtovanja aktivnosti za izboljšanje predpisovanja smo opravili nacionalno raziskavo o ambulantni porabi antibiotikov pri otrocih od 0 do 18 let v obdobju 2003-2015. Metode: Raziskava je bila nacionalna in retrospektivna. Analizirali smo porabo antibiotikov za sistemsko rabo po metodologiji DDD/ATC. Porabo antibiotikov smo beležili glede na strukturo predpisovanja, starost, spol in zdravstveno regijo. Rezultati: V preiskovanem obdobju se je celotna poraba znižala za 35 % od 979 na 636 receptov na 1000 otrok na leto (RTL). Poraba različnih antibiotičnih razredov (razen kinolonov in nitrofuranskih derivatov) se je znižala od 12,5 % do 81 %. V vseh letih je bila poraba najvišja v starostni skupini otrok, starih od 1 do 4 let (2184-1160 RTL), Amoksicilin je bil najpogosteje predpisan otrokom, starim od 0-4 let, penicillin V otrokom od 5-14 let, mladostnikom, starim od 15-19 let pa amoksicilin s klavulansko kislino. V zdravstvenih regijah severovzhodne Slovenije se je predpisalo bistveno več antibiotikov kot v drugih regijah. V letu 2015 so pediatri in specialisti šolske medicine predpisali 65 % antibiotikov, 16 % so jih predpisali zdravniki brez naziva specialist, 14 % splošni oz. družinski zdravniki in 5 % ostali specialisti. Zaključki: Kljub znižanju ambulantne porabe antibiotikov pri otrocih ter mladostnikih, je v Sloveniji še vedno previsoka celotna raba in še posebej raba antibiotikov širokega spektra (amoksicilin s klavulansko kislino, azitromicin in cefalosporini druge ter tretje generacije). Potrebno je okrepiti dejavnosti za znižanje predpisovanja, zlasti pri okužbah (zgornjih) dihal.
Antibiotics are commonly prescribed in community and hospital care. Overuse and misuse favors eme... more Antibiotics are commonly prescribed in community and hospital care. Overuse and misuse favors emergence and spread of resistant bacteria. The ATC/DDD methodology is commonly used for presenting the drug utilization data. In primary care, the consumption is usually expressed in DDD per 1,000 inhabitants per day, in hospital, preferably in DDD per 100 bed days and DDD per 100 admissions. The alternative metric is days of therapy (DOT), which needs IT support. Antibiotics have ecological adverse effects at individual and population level. Antibiotics select resistant bacteria among pathogens and normal flora. Broad-spectrum antibiotics, low dosage and prolonged antibiotic therapy favor the development of resistance. Although total use of antibiotics in hospital is much less than in the community, the intensity of use magnified by cross infection ensures a multitude of resistant bacteria in today’s hospitals. Reversal of resistance is complex and might persist for many years despite the...
Journal of Antimicrobial Chemotherapy, 2018
To evaluate the impact of European Antibiotic Awareness Day (EAAD) on antibiotic consumption, imp... more To evaluate the impact of European Antibiotic Awareness Day (EAAD) on antibiotic consumption, improvements in general public awareness and antibiotic resistance in Slovenia. Methods: Outpatient data for the period from 2002 to 2016 and hospital antibiotic consumption data for 2004-16 were collected using the Anatomical Therapeutic Chemical (ATC) classification/DDDs. Outpatient antibiotic consumption data were expressed in DDDs/1000 inhabitants/day (DIDs), number of packages/1000 inhabitant-days and number of prescriptions/1000 inhabitants/year. Hospital consumption data were expressed in DIDs, number of DDDs/100 bed-days and number of DDDs/100 admissions. Segmented regression analysis of interrupted time series was used to estimate the effects of these interventions on antibiotic consumption. Results: During the 8 year period since establishing EAAD, a 9%-17% decrease in outpatient antibiotic consumption has been observed, depending on the measurement unit, which was a little more than in the 6 years prior to EAAD (7%-12%). The trend change in hospital consumption after EAAD was established remained small, with a highly non-significant P value. Eurobarometer data did not show an increase in knowledge on antibiotic use. Resistance of Streptococcus pneumoniae to penicillin and macrolides decreased during EAAD activities. Conclusions: EAAD activities were associated with a decreasing trend in community consumption. Owing to many other national activities on the prudent use of antimicrobials in outpatients and inpatients it is difficult to analyse the direct effect of EAAD.
Journal of Antimicrobial Chemotherapy, 2005
Compared with European countries, the use of antibiotics in Slovenia is moderate. In the period 1... more Compared with European countries, the use of antibiotics in Slovenia is moderate. In the period 1999-2002 an 18.67% decrease in outpatient antibiotic consumption was noted. The aim of the present study was to analyse this decrease and its consequences.
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Papers by Tina Plankar Srovin