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Biomedical subjects

Margit Zeher

Publications and source records attributed to Margit Zeher.

25 records · Page 2Linked to original sources

[Lipid profile in patients with systemic lupus erythematosus, with special focus on lipoprotein(a) in lupus nephritis].

Systemic lupus erythematosus (SLE) is a multifactorial polysystemic autoimmune disorder. Although life expectance in SLE has been improved by adequate immune suppressive therapy, the importance of chronic renal failure has not been reduced. Among late complications of the disease accelerated atherosclerosis attempts increasing attention. Dyslipoproteinemia and increased concentration of lipoproteins are important risk factors of atherosclerotic cardiovascular complication in SLE. Serum lipid parameters of 50 patients with lupus were examined in the present work. Thirty patients had histologically proven lupus nephritis (LN+), while the other group did not have renal involvement (LN-). Serum triglyceride, total cholesterol, LDL-C and apolipoprotein B (apoB) concentrations were significantly higher in the lupus nephritis (LN+) group. On the other hand, HDL-C and apoAI levels were also elevated in patients with LN. As a consequence of that, LDL-C/HDL-C and the apoB/apoAI ratios did not differ between patients with or without kidney involvement. This concluded the authors to measure the concentration of lipoprotein (a) in SLE patients, as Lp(a) is known to be an independent risk factor of atherosclerosis. Results indicated a significantly increased Lp(a) concentration in patients with lupus nephritis as compared to the LN- group. All but 2 patients without kidney involvement had lower than 100 mg/L Lp(a) concentration, while 27% of patients with lupus nephritis has an Lp(a) level between 100-300 mg/L. Further more, Lp(a) concentration was higher than 300 mg/L in 13% of the LN+ group. In a good correlation of these observations patients with nephritis suffered more frequently from deep venous thrombosis and ischaemic heart disease. The frequencies of hypertension and non-insulin dependent diabetes mellitus were slightly elevated in patients with nephritis. Present results suggest the importance of elevated lipoprotein (a) concentration in patients with lupus nephritis, further increasing the risk of athero-thrombotic cardiovascular complications.

Adult↗

[Combined therapy in pregnancy with primary antiphospholipid syndrome].

Patients with antiphospholipid syndrome have a high frequency of mid-pregnancy intrauterine growth retardation or fetal death. The authors report the case of a 28 year old pregnant woman with antiphospholipid syndrome with severe obstetrical complications (spontaneous abortion, missed abortion) in the past history. By means of the administration of combined immunomudulant (intravenous immunoglobulin, steroid), anticoagulant and antiplatelet therapy we could prevent a subsequent pregnancy loss of the patient. Apropos of this case the authors give an overview on the monitoring of the disease and the therapeutical recommendations of the literature.

Adult↗

Coeliac disease in Sjögren's syndrome--a study of 111 Hungarian patients.

Recent studies report that in patients with Sjögren's syndrome (SS), concomitant coeliac disease (CD) is more frequent than in the average healthy population, with dominance of the latent/silent form. We further investigated this to characterise the clinical and immunolaboratory features of SS patients with CD. One hundred and eleven patients with SS were involved in the study. After detailed history, blood samples were taken for antibodies to gliadin, endomysium, and tissue transglutaminase. Of them, six had positive serology for CD and underwent jejunoscopy and small bowel biopsy to confirm the diagnosis of CD. In five patients, the diagnosis was established histologically. The frequency of CD in the SS population was significantly higher than in the non-SS European population (4.5:100 vs 4.5-5.5:1,000). Laboratory findings in these patients showed significantly higher erythrocyte sedimentation rates and IgG, IgA, and IgM levels. On the basis of these findings, we recommend screening, follow-up, and regular gastrointestinal care of SS patients to identify CD cases and help them to avoid severe malnutrition and intestinal malignancies.

Adult↗

[Reactive macrophage activation syndrome].

Reactive macrophage activation syndrome or haemophagocytic lymphohistiocytosis is a life-threatening immunoregulatory disorder characterized by the activation of the mononuclear phagocytic system with prominent haemophagocytosis particularly involving the bone marrow, reticuloendothelial system and central nervous system. It frequently occurs in children as a familial autosomal recessive disorder and it has been reportedly associated with infections, underlying hematopoetic malignancies or autoimmune disorders. It has been suggested that central to the pathogenesis of this disorder is uncontrolled T-cell activation which results in the excessive secretion of cytokines. The clinical and laboratory findings are dramatic, at presentation with persistent fever, hepatosplenomegaly, profound depression of three blood cell lines, elevated serum liver enzyme values, coagulopathy and abundant haemophagocytosis can be visualized in bone marrow. Most of the described clinical findings could be explained by the oversecretion of proinflammatory cytokines and the presence of histiocytic infiltrates. In general, immunosuppressive therapy, cytotoxic chemotherapy with immunomodulatory agents will induce remissions in a substantial percentage of patients, whereas others require allogenic bone marrow transplantation.

Diagnosis, Differential↗

Malignant lymphoma-associated autoimmune diseases--a descriptive epidemiological study.

Lymphoproliferative disorders and autoimmune diseases have some common aspects in their clinical appearance. We reviewed 940 patient charts with malignant lymphomas to assess the rate of associated autoimmune diseases. Of 421 non-Hodgkin's lymphoma (NHL) patients (230 males, 191 females), 32 (7.6%) had an autoimmune disease (26 females, six males, mean age 48.3 years). The most common diagnosis was Sjögren's syndrome. The other cases were autoimmune skin diseases (5), thyroiditis (3), polymyositis (2), scleroderma (2), other musculoskeletal disorders (2), rheumatoid arthritis (1), vasculitis (1), undifferentiated collagenosis (1), colitis ulcerosa (1), autoimmune hepatitis (1), Addison's disease (1), and autoimmune hemolytic anemia (1). Of 519 Hodgkin's lymphoma patients (308 males, 211 females), an associated autoimmune disease occurred in 45 (8.6%) (25 females, 20 males, mean age 39.2 years). In 31 cases, we found autoimmune thyroid disorders, then came glomerulonephritis (3), immune thrombocytopenia (3), insulin-dependent diabetes mellitus (2), autoimmune hemolytic anemia (1), seronegative spondylarthritis (1), systemic lupus erythematosus (1), mixed connective tissue disease (1), scleroderma (1), and vasculitis (1). We also analyzed histology, choice of treatment, and sequence of appearance of the disease types. We found a difference between NHL and Hodgkin's lymphoma patients, since in NHL autoimmunity - mostly from Sjögren's syndrome - preceded the lymphoma diagnosis (70%), but in Hodgkin's the autoimmunity developed mainly after the treatment of malignancy. The relatively high prevalence of autoimmune diseases in malignant lymphomas has several explanations. Clinicians have to consider autoimmunity when treating lymphoproliferative disorders.

Adolescent↗