Hüper-IgE-sündroom – primaarse immuunpuudulikkuse haruldane vorm

Hüperimmunoglobuliin-E-sündroom (HIES) on primaarse immuunpuudulikkuse haruldane vorm, millele on iseloomulik klassikaline sümptomitriaad: nahalööve, korduv raske pneumoonia ning seerumi üld-IgE-sisalduse suurenemine. Nelja-aastasel tüdrukul, kes põdes raskeid hingamisteede infektsioone, kandidoosi ja kelle vereseerumi üld-IgE-sisaldus oli suurenenud, diagnoositi HIES, kuigi tal tüüpilist löövet ei olnud. Tegemist on Eestis esimest korda geneetiliselt kinnitatud hüperimmunoglobuliin- E-sündroomiga.Eesti Arst 2014; 93(9):521–52

Maternal breast milk microbiota and immune markers in relation to subsequent development of celiac disease in offspring

The potential impact of the composition of maternal breast milk is poorly known in children who develop celiac disease (CD). The aim of our study was to compare the microbiota composition and the concentrations of immune markers in breast milk from mothers whose offspring carried the genetic predisposition to CD, and whether they did or did not develop CD during follow-up for the first 3 years of life. Maternal breast milk samples [CD children (n = 6) and healthy children (n = 18)] were collected 3 months after delivery. Enzyme-linked immunosorbent assays were used to measure TGF-beta 1, TGF-beta 2, sIgA, MFG-E8 and sCD14. For microbiota analysis, next generation (Illumina) sequencing, real-time PCR and denaturing gradient gel electrophoresis were used. Phylotype abundance and the Shannon 'H' diversity index were significantly higher in breast milk samples in the CD group. There was higher prevalence of the phyla Bacteroidetes and Fusobacteria, the classes Clostridia and Fusobacteriia, and the genera Leptotrichia, Anaerococcus, Sphingomonas, Actynomyces and Akkermansia in the CD group. The immunological markers were differently associated with some Gram-negative bacterial genera and species (Chryseobacterium, Sphingobium) as well as Gram-positive species (Lactobacillusreuteri, Bifidobacteriumanimalis). In conclusion, the microbiota in breast milk from mothers of genetically predisposed offspring who presented CD showed a higher bacterial phylotype abundance and diversity, as well as a different bacterial composition, as compared with the mothers of unaffected offspring. These immune markers showed some associations with bacterial composition and may influence the risk for development of CD beyond early childhood.Peer reviewe

Nööppatarei neelamine lapseeas – haigusjuhud ja kirjanduse ülevaade

Nööppatarei neelamisega võivad lastel kaasneda rasked tüsistused ja isegi surm. Kõige suuremat ohtu kujutab söögitorru peetunud patarei, söögitoru raske kahjustus võib tekkida kahe tunni jooksul. Esmases diagnostikas on oluline koht kahes vaates tehtud röntgenipiltidel. Hilisemate tüsistuste ennetamiseks on kõige olulisem patarei kiire endoskoopiline eemaldamine. Eemaldamise järel tuleb jälgida patsienti võimalike tüsistuste suhtes, millest ohtlikem, fistul suurte veresoontega, võib lõppeda surmaga. Ülevaate eesmärk on iseloomustada kolme näite põhjal nööppatareide neelamise raskema kuluga juhtumeid, analüüsida ajakohast praktikat ja pakkuda tegevuse algoritmi selliste juhtumite käsitluseks