Az ovarialis hiperstimulációs szindróma kórélettana és korszerű klinikuma = Pathophysiology and current clinical approach of ovarian hyperstimulation syndrome

Absztrakt: Az asszisztált reprodukciós kezelések során a petefészkek szabályozott stimulációja történik. Az ovarialis hiperstimulációs szindróma a meddőségi kezelés során a petefészek túlzott válaszreakciójának következménye. Ritkán egyéb ok, például a folliculusstimulálóhormon-receptor mutációjának következménye is lehet. A betegség következményeként az intravascularis folyadék a harmadik (extracelluláris) folyadéktérbe, főként a hasüregbe vándorol. Túlstimulálódás esetén a klinikai jelek a hasfeszüléstől, a megnövekedett petefészkeken és az ascitesen keresztül a vénás vagy artériás thromboemboliás szövődményekig mutatkozhatnak. A betegség súlyos formájában életveszélyes állapotot is okozhat, ha ischaemiás stroke vagy végtagkeringési elégtelenség alakul ki. Az elmúlt években számos új módszer került bevezetésre a tünetegyüttes kialakulásának megelőzésére. Az ovarialis hiperstimulációs szindróma iatrogén, súlyos formájában életveszélyes állapot, mely fiatal, a meddőségtől eltekintve egyébként egészséges embereket érint. A betegség gazdasági hatása számottevő. A munkakiesés, a kórházi bennfekvés és súlyos esetekben az intenzív ellátás költségei tetemesek. Továbbra is a szupportív kezelés, az antikoaguláns profilaxis, valamint a szoros megfigyelés a szindróma bázisterápiája. Súlyos, illetve kritikus állapotú betegeknél azonban a kórházi felvétel, illetve beavatkozás nem késlekedhet. Orv Hetil. 2018; 159(34): 1390–1398. | Abstract: During assisted reproduction technologies, controlled hyperstimulation of the ovaries occurs. Ovarian hyperstimulation syndrome is an excessive overreaction of the ovaries complicating pharmacological ovulation induction. Rarely other causes, such as the mutation of the follicle-stimulating hormone receptor may also be in the background. Ovarian hyperstimulation syndrome is clinically characterized by a massive ovarian enlargement associated with an acute third-space fluid shift responsible for the development of ascites, and sometimes pleural or pericardial effusion. Associated arterial or venous thromboembolic symptoms are also common. Ovarian hyperstimulation syndrome is an iatrogenic and potentially life-threatening condition in the form of ischemic stroke or circulatory insufficiency of the limbs. Recently some new methods have been developed for the prevention of the disease. The syndrome affects young, healthy patients. It also has an important economic burden due to the absence from work, bed rest, or hospitalization and intensive medical management of more severe cases. Supportive therapy, anticoagulant prophylaxis and close monitoring are the main approach for the syndrome. However, hospitalization or intervention should not be delayed for patients with severe or critical conditions. Orv Hetil. 2018; 159(34): 1390–1398

Small Paraquat Resistance Proteins Modulate Paraquat and ABA Responses and Confer Drought Tolerance to Overexpressing Arabidopsis Plants

Adaptation of higher plants to extreme environmental conditions is under complex regulation. Several small peptides have recently been described to modulate responses to stress conditions. The Small Paraquat resistance protein (SPQ) of Lepidium crassifolium has previously been identified due to its capacity to confer paraquat resistance to overexpressing transgenic Arabidopsis plants. Here, we show that overexpression of the closely related Arabidopsis SPQ can also enhance resistance to paraquat, while the Arabidopsis spq1 mutant is slightly hypersensitive to this herbicide. Besides being implicated in paraquat response, overexpression of SPQs enhanced sensitivity to abscisic acid (ABA), and the knockout spq1 mutant was less sensitive to ABA. Both Lepidium‐ and Arabidopsis‐derived SPQs could improve drought tolerance by reducing water loss, stabilizing photosynthetic electron transport and enhancing plant viability and survival in a water‐limited environment. Enhanced drought tolerance of SPQ‐overexpressing plants could be confirmed by characterizing various parameters of growth, morphology and photosynthesis using an automatic plant phenotyping platform with RGB and chlorophyll fluorescence imaging. Our results suggest that SPQs can be regulatory small proteins connecting ROS and ABA regulation and through that influence responses to certain stresses

Circulating Clusterin and Osteopontin Levels in Asthma and Asthmatic Pregnancy

Asthma in pregnancy poses a risk of adverse outcomes. Osteopontin and clusterin emerged as asthma biomarkers; however, their circulating levels during pregnancy are unknown yet. This cross-sectional study investigated peripheral osteopontin and clusterin levels and their relationship to disease control in 26 asthmatic pregnant (AP), 22 asthmatic nonpregnant (ANP), and 25 healthy pregnant (HP) women and 12 healthy controls (HNP). Osteopontin levels of ANP and HNP were similar (2.142 [1.483-2.701] versus 2.075 [1.680-2.331] ng/mL, p = 0.7331). Pregnancy caused a marked elevation in both healthy (HP: 3.037 [2.439-4.015] ng/ml, p = 0.003 versus HNP) and asthmatic (AP: 2.693 [1.581-3.620] ng/ml) patients; thus the pregnant groups did not differ (p = 0.3541). Circulating clusterin levels were comparable in ANP and HNP (109.2 [95.59-116.3] versus 108.8 [97.94-115.3] mu g/mL, p = 0.8730) and the level was lower in HP (98.80 [84.26-105.5] mu g/mL, p = 0.0344 versus HNP). In contrast, the level was higher in AP (111.7 [98.84-125.6] mu g/mL, p = 0.0091 versus HP). In ANP, a positive correlation of PEF (r = 0.3405; p = 0.0221) and a negative correlation of R-aw (r = -0.3723; p = 0.0128) to clusterin level were detected. Circulating osteopontin level increases in pregnancy regardless of concomitant well-controlled asthma, indicating its gestational role. Clusterin level decreases in healthy but not in asthmatic pregnancy and correlates directly with lung function

Significance of Mycobacterium avium subspecies avium, ‘hominissuis’#, and silvaticum, and data on their occurrence in Hungary

SUMMARY The authors report on the occurrence of Mycobacterium avium ssp. avium, ‘Mycobacterium avium ssp. hominissuis’, and Mycobacterium avium ssp. silvaticum in Hungary. Similar to Mycobacterium avium ssp. paratuberculosis, these subspecies are also capable of provoking immunological cross-reactivity in tuberculin skin test, thus hampering the in vivo diagnosis of bovine tuberculosis. Between 2006 and 2015 the authors isolated 301 Mycobacterium avium strains which were other than M. avium ssp. paratuberculosis. Molecular biological identification methods were applied on 290 isolates, and 140 M. avium ssp. avium, 87 ‘M. avium ssp. hominissuis’ and 63 M. avium ssp. silvaticum strains were detected. From avian hosts the authors almost exclusively identified M. avium ssp. avium. In red deer and cattle ‘M. avium ssp. hominissuis’ was dominant while from swine, wild boars and red foxes M. avium ssp. avium was isolated more often. The high number of M. avium ssp. silvaticum isolates indicates the importance of this subspecies. It can be stated that beside M. avium ssp. paratuberculosis M. avium ssp. avium, ‘M. avium ssp. hominissuis’, and M. avium ssp. silvaticum are also consequently isolated from the whole geographic region of Hungary equally from domestic and wild mammals and birds. The dog and monitor lizard cases highlight the possibility of zoonotic infections, while the wild animals serve as reservoirs in maintaining and spreading these pathogens

Detection of a novel bat gammaherpesvirus in Hungary

This paper describes the detection of a novel herpesvirus in a Serotine bat ( Eptesicus serotinus ) in Hungary. The rescued animal showed signs of icterus and anorexia and died within a day, in spite of immediate supportive therapy. Autopsy confirmed the clinical picture by the major lesions observed in the liver. Histopathology revealed vacuolar degeneration in the hepatocytes and leukocytosis in the sinusoidal lumina. By electron microscopy, hydropic degeneration and apoptotic cells with a pycnotic nucleus were found in the liver. Bacteriological examinations gave negative results. As part of a routine screening project, detection of adeno-and herpesviruses from homogenised samples of the liver, lungs and small intestines was attempted by nested polymerase chain reaction (PCR) assays. The adenovirus PCR ended with negative results. The herpesvirus PCR resulted in an amplification product of specific size. The nucleotide sequence of the amplicon was determined and analysed by homology search and phylogenetic analysis. A novel herpesvirus was identified, which seemed to be most closely related to members of the genus Rhadinovirus within the subfamily Gammaherpesvirinae . The causative role of the detected rhadinovirus in the fatal condition of the Serotine bat could not be proven, but it is most likely that reactivation from a latent infection allowed the detection of the virus by PCR

Molecular analysis of the VP7 gene of pheasant rotaviruses identifies a new genotype, designated G23

Rotavirus-associated enteritis has been reported in pheasants, but there is no information on the genetic/ antigenic features of pheasant rotaviruses. In this study, we sequenced the VP7-encoding genome segment of three pheasant rotavirus strains detected during 2008 in Hungary. The full-length genome segment was 1,070 bp long, while the open reading frame was predicted to encode a 330-aalong protein. The nucleotide sequence identities among the three pheasant rotavirus strains were high (C94%), whereas the range of nucleotide sequence identities to other avian and mammalian rotavirus VP7 genes fell between 68 and 73% and between 60 and 66%, respectively. Our findings indicate that these Hungarian pheasant rotaviruses need to be considered representatives of a new VP7 genotype specificity, designated G23

Clinical microbiology of neonatal candidiasis in Hungary

The occurrence of Candida spp. was investigated during a three-year period in two neonatal intensive care units, Budapest, Hungary. The species distribution among the 41 analysed cases was the following: C. albicans (30/41, 73%), C. parapsilosis (10/41, 24%) and C. glabrata (1/41, 3%). All of the isolates were susceptible to the tested drugs. There was a significant difference in the birth weight, the gestational age 1500 g birth weight groups, significant difference was found in the parenteral nutrition, the gestation weeks 1500 g group. The mortality rate for C. parapsilosis was higher than for C. albicans

Tissue tropism of highly pathogenic avian influenza virus subtype H5N1 in naturally infected mute swans ( Cygnus Olor ), domestic geese ( Anser Anser var. domestica ), pekin ducks ( Anas platyrhynchos ) and mulard ducks ( Cairina moschata × anas platyrhynchos )

The 2006 epidemic due to highly pathogenic avian influenza virus (HPAIV) subtype H5N1 in Hungary caused the most severe losses in waterfowl which were, according to the literature at the time, supposed to be the most resistant to this pathogen. The presence of pathological lesions and the amount of viral antigen were quantified by gross pathology, histopathology and immunohistochemistry (IHC) in the organs of four waterfowl species [mute swans (n = 10), domestic geese (n = 6), mulard ducks (n = 6) and Pekin ducks (n = 5)] collected during the epidemic. H5N1 subtype HPAIV was isolated from all birds examined. Quantitative real-time reverse transcriptase-polymerase chain reaction (qRRT-PCR) was also applied on a subset of samples [domestic geese (n = 3), mulard (n = 4) and Pekin duck (n = 4)] in order to compare its sensitivity with IHC. Viral antigen was detected by IHC in all cases. However, the overall presence of viral antigen in tissue samples was quite variable: virus antigen was present in 56/81 (69%) swan, 22/38 (58%) goose, 28/46 (61%) mulard duck and 5/43 (12%) Pekin duck tissue samples. HPAIV subtype H5N1 was detected by qRRT-PCR in all birds examined, in 19/19 (100%) goose, 7/28 (25%) mulard duck and 12/28 (43%) Pekin duck tissue samples. As compared to qRRTPCR, the IHC was less sensitive in geese and Pekin ducks but more sensitive in mulard ducks. The IHC was consistently positive above 4.31 log10 copies/reaction but it gave very variable results below that level. Neurotropism of the isolated virus strains was demonstrated by finding the largest amount of viral antigen and the highest average RNA load in the brain in all four waterfowl species examined