6 research outputs found
Pemphigus vulgaris ehk harilik villtĂ”bi â interdistsiplinaarne haigus
Pemphigus vulgaris on harva esinev raskekujuline autoimmuunne villiline haigus. Haigust pĂ”hjustavad autoantikehad, mis tekivad naha basaalmembraani normaalsete komponentide desmogleiin 1 ja 3 vastu, mistĂ”ttu epidermises katkevad keratinotsĂŒĂŒtidevahelised seosed ning tagajĂ€rjeks on laiaulatuslike villide ja erosioonide teke limaskestadel ja nahal (1). Pemphigus vulgaris vĂ”ib esineda igas vanuses inimestel, kuid sagedamini kesk- ja vanemaealistel patsientidel. Diagnoosi kuldstandardiks on nahabiopsia ning diagnoos kinnitatakse otsese ja/vĂ”i kaudse immunofluorestsentsmeetodiga (2). Ravimata juhtudel on tegemist eluohtliku haigusega, mille suremus on ka tĂ€napĂ€eval umbes 5â15%. Enne glĂŒkokortikosteroidide kasutusele vĂ”tmist 1950. aastatel oli selle haiguse suremus ĂŒle 75% (3). Farmakoteraapia eesmĂ€rgiks on vĂ€hendada pĂ”letikureaktsiooni ning autoantikehade teket. Raviks kasutatakse kortikosteroidhormoone ja immunosupresseerivaid ravimeid. Varane diagnoos ja Ă”ige ravi kiire alustamine parandab prognoosi ning vĂ€hendab suremust. Pikaajalise remissiooni saavutamiseks on vajalik regulaarne jĂ€relkontroll ning adekvaatne sĂ€ilitusravi (4â6).Eesti Arst 2014; 93(2):95â9
Eesti Unemeditsiini Selts PÔhjamaade unemeditsiinikonverentsil
Eesti Arst 2019; 98(7):412â41
Eesti Unemeditsiini Selts PÔhjamaade unemeditsiinikonverentsil
Eesti Arst 2019; 98(7):412â41
Tuberkuloosne spondĂŒliit. Haigusjuhu kirjeldus
64aastane naine haigestus nimmevaluga. Ravi mittesteroidsete pĂ”letikuvastaste ainetega (NSAID) oli ebaefektiivne. Kompuutertomograafilisel (KT) uuringul ilmnesid spodĂŒlodistsiidi nĂ€hud, mida kinnitas ka magnetresonantstomograafiline (MRT) uuring. Haige hospitaliseeriti ja 3 nĂ€dala vĂ€ltel raviti teda tseftasidiimi ja tsefepiimiga. Haige seisund halvenes ja ta viidi ĂŒle ĂŒlikoolihaiglasse. 6 nĂ€dala möödudes haigestumisest tehtud MRT-uuringul ilmnes L5 ja S1 lĂŒli destruktsioon. Tuberkuloosse protsessi kahtluse tĂ”ttu tehtud test, millega mÔÔdetakse gammainterferooni eritumist, osutus positiivseks ja haigel alustati antituberkuloosset ravi. Ordineeriti 4 ravimit: isoniasiid, levofloksatsiin, etambutool ja pĂŒrasiinamiid. Kliiniliselt haige seisund paranes ning MRT-uuring, mis tehti 4 kuud pĂ€rast haigestumist, tĂ”i esile positiivse dĂŒnaamika.Eesti Arst 2015; 94(3):153â15
Apnoeaâhypopnoea index of 5â events·hâ1 as a metabolomic threshold in patients with sleep complaints
Background
The apnoeaâhypopnoea index (AHI) forms the basis for severity of obstructive sleep apnoea (OSA), a condition expected to reprogramme metabolic pathways in humans. We aimed to identify the AHI breakpoint from which the majority of significant changes in the systemic metabolome of patients with sleep complaints occur.
Methods
In a prospective observational study on symptomatic individuals, who underwent polysomnography for the diagnosis of OSA, profiles of 187 metabolites including amino acids, biogenic amines, acylcarnitines, lysophosphatidylcholines, phosphatidylcholines and sphingomyelins were analysed with liquid chromatography mass spectrometry in peripheral blood drawn at three different time points overnight. Comparisons of rank-transformed data using a general linear model for repeated measures after dichotomising the study group at different AHI levels were applied to define the best cut-off based on Cohen's f.
Results
65 subjects were recruited with a median AHI of 15.6â
events·hâ1. The mean Cohen's f over the metabolites was highest (0.161) at an AHI level of 5â
events·hâ1 representing the metabolomic threshold. Of the particular between-group differences, eight phosphatidylcholines, nine acylcarnitines and one amino acid (threonine) had significantly lower concentrations in the individuals with an AHI level equal to or above the metabolomic threshold. The metabolomic changes at AHI levels defining moderate and severe OSA were smaller than at an AHI of 5â
events·hâ1.
Conclusions
The metabolomic threshold for patients with sleep complaints described in this report for the first time coincides with the AHI threshold required to confirm the diagnosis of OSA