Hungarian Immunology

[Waiting for DROP]

SZEKANECZ Zoltán

OCTOBER 20, 2007

Hungarian Immunology - 2007;6(05)

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Hungarian Immunology

[Scientific program]

Hungarian Immunology

[The role of endothelial cells]

CERVENAK László

[The role of endothelial cells is much beyond the well known barrier function between blood and tissues. Several different stimuli converge in the endothelial cells, which in turn regulate a number of vital processes in the organisms. Among these processes one of the most important is the immune response. Endothelial cells modulate the homing of leukocytes by the production of adhesion molecules and cytokines depending on activation state, anatomic location and vessel type. Endothelial cells express MHC and costimulatory molecules, which enables them to present antigens to T cells. Antigen presentation may lead to activation or tolerance of T cells depending on the phenotype of endothelial cells. They also express complement regulatory molecules and produce several complement cascade proteins. Endothelial cells take part in the catabolism of immunoglobulins as well as in the removal of circulating immune complexes. Finally, endothelial cells regulate inflammation at different levels by several mechanisms, which may substantially determinate the progression of the immune response.]

Hungarian Immunology

[Examination of leukocyte-endothel interactions in inflammatory animal models]

GONDA Andrea, MIKECZ Katalin, HUNYADI János

[Leukocyte influx into tissues is one of the hallmarks of physiological reactions to inflammatory stimuli, which is followed by a multistep process, resulting in leukocyte extravasation from the postcapillary venules. The different kinds of adhesion molecules, that play role in the rolling and firm adhesion of the leukocytes, have been investigated very intensively. By the help of animal models of inflammation, numerous individuals, being in the same stage of the disease, can be examined. The requirement for the adhesion molecules for inflammatory responses could be investigated with antibodies or, nowadays more often, gene knock out (KO) or transgenic mice. Beside evaluating the morphological and cytokine profile differences, using intravital microscopy is of great importance in the inflammatory experiments, while it allows observing interactions of virtually any blood cell types with the endothelial wall in vivo. The results are sometimes conflicting, indicating that the process of leukocyte-endothel interactions depends on different kind of other factors than the adhesion molecules, and still not fully understood.]

Hungarian Immunology

[Altered rate and absolute count of Th1/Th2 and Tc1/Tc2 lymphocytes in whole blood of patients with psoriasis]

ANTAL-SZALMÁS Péter, ALEKSZA Magdolna, GONDA Andrea, HERÉDI Emese, SIPKA Sándor, HUNYADI János, SZEGEDI Andrea

[BACKGROUND - Psoriasis is a chronic inflammatory skin disorder characterised by an altered rate of interferon (IFN)-γ and interleukin (IL)-4 producing lesional and peripheral blood CD4+ and CD8+ T cells. To further characterise the imbalance of these cells and cytokines the rate and as a novel approach the absolute cell count (ACC) of IFN-γ+, IL-4+ and IL-10+ Thelper and Tcytotoxic cells was determined in the peripheral blood of psoriatic individuals. MATERIALS AND METHODS - Cell-associated cytokine expression was determined using intracellular cytokine staining and flow cytometry, serum cytokine levels were measured by enzyme linked immunosorbent assays (ELISAs) in the samples of 35 psoriatic patients and 15 controls. RESULTS - Significantly elevated rate (p<0.008) and ACC (p<0.009) of CD4+/IFN-γ+ cells was observed in the patients (28.3±8.8% and 237,216±134,154 cells/ml) compared to the healthy controls (21.0+ 6.8% and 135,772±50,212 cells/ml). In contrast the rate and the ACC of CD4+/IL-4+ cells decreased significantly in psoriasis (0.45±0.67% vs. 1.01± 0.48%, p<0.0001; 3,229±3,724 vs. 5,117±4,171 cells/ml, p<0.05). In the case of CD8+ T cells only the rate and the ACC of CD8+/IL-10+ cells increased significantly in patients compared to controls (5.49±5.42% vs. 1.59±0.78%, p<0.003 and 19,799±17,412 vs. 5,564±2,794 cells/ml, p<0.03). Though higher IFN-γ and lower IL-4 and IL-10 serum concentrations were detected in psoriasis these differences between patients and controls were not significant. Comparing the different cytokine parameters the serum cytokine levels showed some correlation only with the ACC and not with the rate of cytokine positive cells. CONCLUSIONS - These results further prove the presence of an altered balance in cytokine regulation towards the Thelper 1 cytokines in psoriasis, besides indicate that application of the ACC of cytokine positive helper and cytotoxic T cells as a novel parameter can help in the characterisation of these changes in different disorders.]

Hungarian Immunology

[Alpha calcidol treatment in patients with psoriatic arthropathy: clinical and immunological effects]

GAÁL János, LAKOS Gabriella, ALEKSZA Magdolna, KISS Judit, HORVÁTH Irén, HORKAY Edit, NAGY Georgina, SZEGEDI Andrea

[OBJECTIVE - Our objective was to describe the functional changes of the immune system also to evaluate the clinical parameters during systemic alphacalcidol (1αOH vitamin D3) treatment in patients with psoriatic arthropathy. PATIENTS AND METHOD - Nineteen patients with peripheral polyarticular form of psoriatic arthropathy were investigated. Ten patients were treated with daily 2×25 mcg alphacalcidol per os for 6 months and the other 9 patients served as controls. Three visits (at start, 3 and 6 months later) were carried out during the study, changes in the laboratory and clinical parameters were examined and analysed statistically in the treated and control groups. RESULTS - In the peripheral blood of the treated group a statistically significant decrease in the percentage of CD3/CD69 positive activated and CD8 positive IFNγ producing T cells was observed and the serum level of IFNγ also showed a significant decrease during the first 3 months. Another three months later no change in the above mentioned variables could be detected. Additionally, there was a significant decrease in the clinical activity of the disease using DAS28 score during the whole 6 months follow up period. In the control group no significant changes were observed. CONCLUSION - Our results show that systemic alphacalcidol treatment has a notable immune modulatory effect on patients with psoriatic arthropathy. This effect is manifested in short-term temporary decrease of type 1 immune responses and continuous decrease in the disease activity.]

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[Operational Efficiency Investigation from APN Perioperative Perspective]

MADARÁSZ Ildikó, VÁRADYNÉ HORVÁTH Ágnes, PUSZTAI Dorina, ROZMANN Nóra, BERTA Gábor, HARANGOZÓ Csilla, KOZMANN Krisztina

[In the healthcare system operating theatres have to put great emphasis on quality work, patient safety and efficiency as well, and to achieve this, optimal utilization of theatres is extremely important. The results of researches in this topic in Hungarian and international literature draw attention to a lot of aspects. The study of perioperative periods, and the evaluation of the analysed processes show that theatres could be operated more effectively. As a result of this, more operations could be carried out and waiting time would also reduce. In order to increase the efficiency of the processes, APNs can play a prominent role at several points. According to the experience, the number of people using health care and the number of people waiting for surgery is increasing, which is further increased by the development of the ongoing SARS-CoV-2 (COVID-19) epidemic. Thereby, patients are not satisfied with the service. The work of APNs would also help increasing the contentment of patients during the operation procedures. Taking advantage of the multifunctional role of the nurse due to her knowledge and training, she actively participates in the operation, in the smooth running of the scheduled daily surgical program and contributes to the reduction of the number of missed, planned surgeries.]

Clinical Neuroscience

[Neurological aspects of the COVID-19 pandemic caused by the SARS-CoV-2 coronavirus]

BERECZKI Dániel, STANG Rita, BÖJTI Péter, KOVÁCS Tibor

[By the spring of 2020 the COVID-19 outbreak caused by the new SARS-CoV-2 coronavirus has become a pandemic, requiring fast and efficient reaction from societies and health care systems all over the world. Fever, coughing and dyspnea are considered the major signs of COVID-19. In addition to the involvement of the respiratory system, the infection may result in other symptoms and signs as well. Based on reports to date, neurological signs or symptoms appear in 30-50% of hospitalized COVID-19 patients, with higher incidence in those with more severe disease. Classical acute neurological syndromes have also been reported to associate with COVID-19. A drop in the volume of services for other acute diseases has been described in countries with healthcare systems focusing on COVID-19. During the COVID-19 epidemic it is also important to provide appropriate continuous care for those with chronic neurological disorders. It will be the task of the future to estimate the collateral damage caused by the COVID-19 epidemic on the outcome of other neurological disorders, and to screen for the possible late neurological complications of the SARS-CoV-2 coronavirus infection.]

Clinical Neuroscience

Acute bilateral drop foot as a complication of prolonged squatting due to haemorrhoid

KOKSAL Ayhan, DOGAN Burcu Vasfiye

Drop foot is defined as difficulty of dorsiflexion of the foot and ankle due to weak anterior tibial, extensor hallucis longus and extensor digitorum longus muscles. Cauda equina syndrome, local peroneal nerve damage due to trauma, nerve entrapment, compartment syndrome and tumors are common etiologies. A 32-year-old male patient was applied with difficulty in dorsiflexion of both of his toes, feet and ankles after he had squatted in toilette for 6-7 hours (because of his haemorrhoid) after intense alcohol intake 2 weeks before. Acute, partial, demyelinating lesion in head of fibula segment of peroneal nerves was diagnosed by electromyography. This case was reported since prolonged squatting is an extremely rare cause of acute bilateral peroneal neuropathy. This type of neuropathy is mostly demyelination and has good prognosis with physical therapy and mechanical devices, but surgical intervention may be required due to axonal damage. People such as workers and farmers working in the squatting position for long hours should be advised to change their position as soon as the compression symptoms (numbness, tingling) appear.

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Delirium due to the use of topical cyclopentolate hydrochloride

MAHMUT Atum, ERKAN Çelik, GÜRSOY Alagöz

Introduction - Our aim is to present a rare case where a child had delirium manifestation after instillation of cyclopentolate. Case presentation - A 7-year old patient was seen in our outpatient clinic, and cyclopentolate was dropped three times at 10 minutes intervals in both eyes. The patient suddenly developed behavioral disorders along with gait disturbance, and complained of visual hallucinations 20-25 minutes after the last drop. The patient was transferred to intensive care unit and 0.02 mg/kg IV. physostigmine was administered. The patient improved after minutes of onset of physostigmine, and was discharged with total recovery after 30 minutes. Conclusion - Delirium is a rare systemic side effect of cyclopentolate. The specific antidote is physostigmine, which can be used in severely agitated patients who are not responding to other therapies.

Hypertension and nephrology

[Data on blood pressure over two years in resistant hypertensive patients with lett brain stem microvascular decompression]

FEJES Imola, VÖRÖS Erika, BARZÓ Pál, ÁBRAHÁM György, LÉGRÁDY Péter

[In the background of resistant hypertension (RHT) the neurovascular pulsatile compression (NVPC) of the left rostral ventrolateral medulla may play a role. In these cases a microvascular decompression (MVD) may decrease the blood pressure (BP). The aim of this work was to investigate how the BP has changed after the MVD in the operated patients recorded at the farthest time from the MVD up to maximum 31 December 2016. We have retrospectively collected data from 9 patients whose follow-up data fór 2 years has already been published earlier. Data collection was carried out from the patient register program of the University of Szeged Albert-Szent Györgyi Clinical Centre. The MVDs were performed between 2000 and 2004. The mean follow-up time was 11.1±4.6 years. Both the systolic and the diastolic BPs were significantly lower at the time of last record compared to the BPs at the time of MVD (systolic BP 211±40 vs. 135±20 mmHg, p=0.003; diastolic BP 116±17 vs. 81±14 mmHg, p=0.007). Last recorded BPs compared to the 24-month data alsó were lower bút nőt signffi- cantly (systolic BP 148±32 vs. 135±20 mmHg, p=0.25; diastolic BP 96 vs. 85 mmHg, p=0.11). The mean number of antihypertensives at the last Office visít was nőt sig- nificantly higher compared to MVD (5.9±1.4 vs. 6.3±1.5; p=0.5) bút signfficantly increased compared to MVD +1 month data (4.7±0.9vs. 6.3±1.5; p=0.03). These results confirmed our previous opinion that in severe RHT nőt respond- ing to conventional therapy an MVD of the left side NVPC could be a therapeutic option and may guarantee a long-lasting BP reduction. Evén if the number of antihypertensives increased in the meantime, as they still responded better to therapy. ]