6 research outputs found
Immuunivajavuustilat, taudinaiheuttajat ja sukupuolierot ylähengitystiesairauksissa
In the first part of this thesis the association of different forms of sinonasal diseases and plasma concentrations of C3, C4, immunoglobulins, immunoglobulin G subclasses, C4A and C4B gene numbers were studied in 287 adult patients and 150 sex-matched adult controls. Patients were well characterized and stratified into groups using strict clinical criteria and females and males were also studied as separate groups.
Severe primary antibody antibody deficiencies were rare in patients coming to sinonasal operations. Female patients had more recurrent sinusitis and other mucosal infections and males had more nasal polyposis. Upregulation of complement activity was seen in acute rhinosinusitis patients (high levels of plasma C3, C4, and complement classical pathway activity CH50) and male patients coming to sinonasal operations (high levels of plasma C3 and C4). In females, total and partial C4B deficiencies and lower levels of IgG1 and IgG3 were associated with rhinosinusitis leading to sinonasal operations. C4A deficiencies were found to predispose to severe chronic rhinosinusitis in females and males. In female patients with chronic or recurrent rhinosinusitis with nasal polyposis C4B deficiencies seem to predispose to the disease, but in males with a similar disease C4B deficiencies seem to be protective. This suggests a different pathophysiology between sexes in this form of sinonasal disease.
In the second part of this thesis work 213 children coming to elective tonsillectomy were studied and compared with 155 randomly selected school children. An association with recurrent upper respiratory tract infections and hypersensitivity disorders was seen especially in children under 7 years of age. However, this association was not seen in levels of specific IgE to respiratory allergens in the same age group. Both symptomatic respiratory allergy and specific IgE to respiratory allergens became more common in boys than girls over 7 years of age.
We were able to show that although both rhinoviruses and bacterial pathogens were found in the tonsils, no association between their presence and clinical forms of tonsillar disease was seen. The ability of GAS to bind complement regulators FH and C4BP did not differ between strains causing tonsillar diseases or septicemia, suggesting that other virulence mechanisms of the bacteria are more important.Väitöstutkimuksen ensimmäisessä osassa selvitettiin nenän ja sivuonteloiden tulehdusten ja polyyppitaudin yhteyttä komplementin C3- ja C4-tasoihin, vasta-aineiden ja niiden alaluokkien plasmapitoisuuksiin ja C4A- ja C4B geenilukumääriin tutkimalla 287 aikuista potilasta ja 150 aikuista kontrollihenkilöä. Potilaat jaettiin ryhmiin tiukkojen kliinisten kriteerien mukaan tutkien naiset ja miehet myös erillisinä ryhminään.
Vakavat vasta-ainepuutokset olivat harvinaisia sivuonteloleikkauksiin tulevilla potilailla. Naisilla oli yleisemmin toistuvia sivuontelontulehduksia ja muita limakalvotulehduksia ja miehillä nenän polyyppitautia. Komplementin toiminnan lisääntymisen merkkejä oli havaittavissa äkillistä poskiontelontulehdusta sairastavilla potilailla (korkeat plasman C3, C4 ja komplementin klassisen tien aktivaation CH50 tasot) ja sivuonteloleikkaukseen tulevilla miehillä (korkeat plasman C3-, C4-tasot). Naisilla täydelliset ja osittaiset C4B-geenipuutokset ja matalat plasman IgG1- ja IgG2-tasot liittyivät leikkaukseen johtavaan sivuontelotautiin. C4A-geenipuutokset altistivat sekä miehiä että naisia vaikeille sivuontelontulehduksille. Kroonista tai toistuvaa sivuontelontulehdusta ja polyyppitautia samanaikaisesti sairastavilla naispotilailla C4B-puutokset vaikuttivat altistavan sairaudelle, mutta samalla tavalla sairastavilla miespotilailla samalla puutoksella oli suojaava vaikutus. Tämä viittaa siihen, että tämä sivuontelotaudin muoto kehittyy eri tavalla naisilla ja miehillä.
Väitöstutkimuksen toisessa osassa tutkittiin 213 nielurisaleikkaukseen tulevaa lapsipotilasta verraten heitä 155 satunnaisesti valittuun koululaislapseen. Toistuvien ylähengitystieinfektioiden ja yliherkkyysoireiden välillä havaittiin yhteys alle 7-vuotiailla lapsilla. Tätä yhteyttä ei kuitenkaan ollut havaittavissa seerumin allergia-vasta-ainetutkimuksessa. Sekä oireinen hengitystieallergia että spesifisten vasta-aineiden määrä seerumissa lisääntyivät kouluiässä pojilla tyttöjä enemmän.
Tutkimuksessa pystyttiin osoittamaan, että vaikka sekä rinoviruksia että tautia aiheuttavia bakteereja on osoitettavissa nielurisoissa, niiden läsnäololla ei ollut vaikutusta nielurisasairauden laatuun. Nielurisoista ja verenmyrkytyspotilailta eristettyjen A-streptokokkien kyvyllä sitoa komplementin säätelytekijöitä FH ja C4BP ei ollut vaikutusta näiden bakteerien aiheuttamien sairauksien kulkuun viitaten siihen, että muilla bakteerin virulenssiin vaikuttavilla tekijöillä on suurempi merkitys
The Psoriasis Risk Allele HLA-C*06 : 02 Shows Evidence of Association with Chronic or Recurrent Streptococcal Tonsillitis
Pharyngeal tonsillitis is one of the most common upper respiratory tract infections, and group A streptococcus is the most important bacterial pathogen causing it. While most patients experience tonsillitis only rarely, a subset of patients suffers from recurrent or chronic tonsillitis or pharyngitis. The predisposing factors for recurring or chronic forms of this disease are not yet fully understood, but genetic predisposition has been suggested. A genetic association study using Illumina's Immunochip single-nucleotide polymorphism (SNP) array was performed to search for new genetic biomarkers in pharyngeal tonsillitis. More than 100,000 SNPs relevant to immune-mediated diseases were analyzed in a cohort of 95 patients subjected to tonsillectomy due to recurrent/chronic tonsillitis and 504 controls. Genetic association between the cases and controls showed strongest association with two peaks in the HLA locus (odds ratio [OR], 3.7 to 4.7; P = 4.9 x 10(-6) to 5.7 x 10(-6)). Further analysis with imputed classical HLA alleles suggested the known psoriasis risk allele HLA-C*06:02 as a risk factor for tonsillitis (P = 4.8 x 10(-4); OR, 2.3). In addition, the imputed HLA haplotype HLA-C*06:02/HLA-B*57:01, a reported risk haplotype in psoriasis, had the strongest risk for tonsillitis (P = 3.2 x 10(-4); OR, 6.5). These findings further support the previously reported link between streptococcal throat infections and psoriasis.Peer reviewe
Decompression illness (DCI) in Finland 1999-2018 : Special emphasis on technical diving
Introduction: This is the first published study on decompression illness (DCI) and its treatment in Finland. Diving conditions are demanding, as even in the summer the water temperature below 20 meters' sea/fresh water (msw/mfw) is 4-10 degrees C. Technical diving has become more popular over the years, so the emphasis of this study was to describe DCI in technical divers and compare it with non-technical recreational divers. Methods: This study includes by estimation over 95% of all hyperbaric oxygen-treated DCI patients during the years 1999-2018 (n = 571). The cases were divided into technical divers (n = 200) and non-technical divers (n = 371). We focused on the differences between these two groups. Technical diving was defined as the usage of mixed breathing gases, closed circuit rebreather diving or planned decompression diving. Results: The mean annual number of treated DCI cases in Finland was 29 (range 16-38). The number of divers treated possibly indicate a shift towards technical diving. Technical dives were deeper and longer and were mainly performed in cold water or an overhead environment. Technical divers were more likely to utilize first aid 100% oxygen (FAO(2)) and sought medical attention earlier than non-technical divers. Symptom profiles were similar in both groups. Recompression was performed using USN Treatment Table Six in the majority of the cases and resulted in good final outcome. Eighty two percent were asymptomatic on completion of all recompression treatment(s). Conclusion: This 20-year observational study indicates a shift towards technical diving, and hence a more demanding and challenging style of diving among Finnish divers, with a surprisingly constant number of DCI cases over the years. There is still need for improvement in divers' education in use of FAO(2) for DCI symptoms. Fortunately, the outcome after recompression therapy is generally successful.Peer reviewe