Põletikulise soolehaiguse soolevälised ilmingud

Kuni 40%-l haavandilise koliidi ja Crohni tõve patsientidest kaasuvad haigusega soolevälised ilmingud, mida võib jagada kolme suurde rühma: soolehaiguse aktiivsusega seotud (nt perifeerne artriit, episkleriit, iriit, aftoosne stomatiit), soolehaiguse tüsistusena tekkinud (nt neerukivitõbi, urotrakti infektsioonid, malabsorptsiooni sündroom, sapikivitõbi) ning soolehaiguse aktiivsusest sõltumatu kuluga (nt anküloseeriv spondüliit, sakroiliit). Oma kaebustest tulenevalt võivad patsiendid pöörduda väga erinevate erialade arstide poole, mistõttu on oluline sooleväliste haigusnähtude äratundmine ning nende diagnostika- ja ravivõimaluste rakendamine. Eesti Arst 2007; 86 (6): 411–41

Inflammatory bowel disease: an immunogenetic study

http://www.ester.ee/record=b4332630~S58*es

Gastroenteroloogia

Eesti Arst 2010; 89(10):651−65

Maksakahjustus alfa1-antitrüpsiini vaeguse korral

Alfa1-antitrüpsiini (AAT) vaegus on maksas produtseeritava proteaasi inhibiitori alfa1-antitrüpsiini pärilik defitsiit, mis loob eelsoodumuse kopsu-, naha- ja maksakahjustuse tekkeks. AAT-vaegus pärandub autosoom-kodominantselt. Maksakahjustus ilmneb homosügootidel PiZZ alleeli olemasolu korral, kui alfa1-antitrüpsiini süntees hepatotsüütide endoplasmaati lises retiikulumis on häirunud. Erinevalt alfa1-antitrüpsiini vaegusest põhjustatud kopsukahjustuse tekkemehhanismist ei ole plasmaproteaaside pärssimine maksakahjustuse patogeneesis oluline. Hepatotsüütide endoplasmaatilisse retiikulumi ladestunud AAT põhjustab väga varieeruva maksakahjustuse hepatiidist tsirroosini. Neil, kel otsitakse aminotransferaaside aktiivsuse tõusu põhjust, on skriiningtestiks alfa1-antitrüpsiini määramine vereseerumis. Kui alfa1-antitrüpsiini tase on vähenenud, siis on näidustatud täiendavad geeniuuringud Z- ja S-alleeli olemasolu hindamiseks. Artiklis on analüüsitud alfa1-antitrüpsiini vaegusest põhjustatud maksakahjustusega patsiendi haigusjuhtu. Eesti Arst 2010; 89(2):133−13

Täiskasvanute sõeluuringud Eestis 2023. aasta seisuga

Eesti Arst 2023; 102(8):418–42

Mycobacterium microti: not just a coincidental pathogen for cats

Public interest in animal tuberculosis is mainly focused on prevention and eradication of bovine tuberculosis in cattle and wildlife. In cattle, immunodiagnostic tests such as the tuberculin skin test or the interferon gamma (IFN-γ) assay have been established and are commercially available. Feline tuberculosis is rather unknown, and the available diagnostic tools are limited. However, infections with Mycobacterium tuberculosis complex members need to be considered an aetiological differential diagnosis in cats with granulomatous lymphadenopathy or skin nodules and, due to the zoonotic potential, a time-efficient and accurate diagnostic approach is required. The present study describes 11 independent cases of Mycobacterium microti infection in domestic cats in Switzerland. For three cases, clinical presentation, diagnostic imaging, bacteriological results, immunodiagnostic testing, and pathological features are reported. An adapted feline IFN-γ release assay was successfully applied in two cases and appears to be a promising tool for the ante mortem diagnosis of tuberculosis in cats. Direct contact with M. microti reservoir hosts was suspected to be the origin of infection in all three cases. However, there was no evidence of M. microti infection in 346 trapped wild mice from a presumptive endemic region. Therefore, the source and modalities of infection in cats in Switzerland remain to be further elucidated

Comorbidity of eczema, rhinitis, and asthma in IgE-sensitised and non-IgE-sensitised children in MeDALL: a population-based cohort study

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A randomized trial of a transglutaminase 2 inhibitor for celiac disease

BACKGROUND In celiac disease, small intestinal transglutaminase 2 causes deamidation of glutamine residues in gluten peptides, which enhances stimulation of T cells and leads to mucosal injury. Inhibition of transglutaminase 2 is a potential treatment for celiac disease. METHODS In a proof-of-concept trial, we assessed the efficacy and safety of a 6-week treatment with ZED1227, a selective oral transglutaminase 2 inhibitor, at three dose levels as compared with placebo, in adults with well-controlled celiac disease who underwent a daily gluten challenge. The primary end point was the attenuation of gluten-induced mucosal damage, as measured by the ratio of villus height to crypt depth. Secondary end points included intraepithelial lymphocyte density, the Celiac Symptom Index score, and the Celiac Disease Questionnaire score (for assessment of health-related quality of life). RESULTS Of the 41 patients assigned to the 10-mg ZED1227 group, the 41 assigned to the 50-mg group, the 41 assigned to the 100-mg group, and the 40 assigned to the placebo group, 35, 39, 38, and 30 patients, respectively, had adequate duodenal-biopsy samples for the assessment of the primary end point. Treatment with ZED1227 at all three dose levels attenuated gluten-induced duodenal mucosal injury. The estimated difference from placebo in the change in the mean ratio of villus height to crypt depth from baseline to week 6 was 0.44 (95% confidence interval [CI], 0.15 to 0.73) in the 10-mg group (P=0.001), 0.49 (95% CI, 0.20 to 0.77) in the 50-mg group (P<0.001), and 0.48 (95% CI, 0.20 to 0.77) in the 100-mg group (P<0.001). The estimated differences from placebo in the change in intraepithelial lymphocyte density were -2.7 cells per 100 epithelial cells (95% CI, -7.6 to 2.2) in the 10-mg group, -4.2 cells per 100 epithelial cells (95% CI, -8.9 to 0.6) in the 50-mg group, and -9.6 cells per 100 epithelial cells (95% CI, -14.4 to -4.8) in the 100-mg group. Use of the 100-mg dose may have improved symptom and quality-of-life scores. The most common adverse events, the incidences of which were similar across all groups, were headache, nausea, diarrhea, vomiting, and abdominal pain. Rash developed in 3 of 40 patients (8%) in the 100-mg group. CONCLUSIONS In this preliminary trial, treatment with ZED1227 attenuated gluten-induced duodenal mucosal damage in patients with celiac disease.publishedVersionPeer reviewe

ARIA 2016 : Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA-disseminated and implemented in over 70 countries globally-is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.Peer reviewe