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Abstract

Background. Sjogren’s syndrome (SS) is among the most frequent autoimmune diseases and one of its most severe extraglandular manifestations is peripheral neuropathy. There is no consensus about peripheral neuropathy treatment in SS. Our aim is to identify studies proving the efficiency of immunosuppressive treatment on peripheral neuropathies in SS.

Methods. The search was conducted on the PubMed (MEDLINE) database. Studies with patients diagnosed with SS and peripheral neuropathy were included. Treatment with one of the following was among inclusion criteria: glucocorticoids (GC), rituximab (RTX), azathioprine (AZA), mycophenolic acid (MMF), cyclophosphamide (CP), methotrexate (MTX), plasmapheresis or iv immunoglobulins (IV IG).

Results. A total of 116 results were found and abstracts were examined. 103 papers were excluded, and the remaining 13 papers were analyzed. They were 3 case series and 10 case reports, retrospective, totalizing 62 patients of which 22 (35.5%) received IV IG, 8 (13%) received RTX, 7 (11%) CP, and 5 (8%) received only GC. Drug associations containing corticosteroids were frequent. Of those 22 treated with IV IG, 18 patients improved (82%), and 4 stabilized (18%).

IV IG was useful in sensory, motor and sensorimotor neuropathies. CP had good results in mononeuritis multiplex, while autonomic neuropathies responded well to GC or RTX. AZA, RTX, MTX, MMF or plasmapheresis were not used alone. Follow-up periods were heterogenous and the evaluation of the neuropathy was not systematic.

Conclusion. There is only low level evidence (retrospective case reports and case series). In most cases, IV IG treatment in patients with peripheral neuropathies and SS resulted in clinical improvement, while other therapies, such as RTX, corticosteroids and CP proved to be useful in a handful of cases.

Abstract

Deoxynivalenol (DON, vomitoxin) is a type B-trichothecene, naturally occurring contaminants of animal feed, being implicated in several mycotoxicoses in farm livestock. This mycotoxin occurs predominantly in grains such as wheat, barley, oats, rye, and maize, and less often in rice, sorghum, and triticale. Deoxynivalenol is potent nefrotoxic, hepatotoxic and immunosuppressant. High doses of trichothecenes promote rapid onset of leukocyte apoptosis (programmed cell death), which is manifested as immunosuppression. The study aimed to prove the immunosuppressant action of deoxynivalenol in chickens experimentally treated each day, from the 7th day of life, using 5,4 mg/kg b.w in E group for 28 days (since 35 days of life). Histopathology studies of thymus were made on 7th, 14th, 21st and 28th days of experiment. In E group small lesions of thymus were observed even after 7th day of poisoning but intense lesions, hydropic degeneration, necrotic foci and moderate lymphoid depletion was observed after the 14th and 21st day of poisoning. After 28th day a marked proliferation of stromal cells in the reticulum network, in medulla zone, presence of mucous cells, small mucous cysts and haemorages were observed.

Abstract

Renal transplantation is surely the best treatment for Chronic Kidney Disease (CKD) patients in both developed and developing countries. Due to the tragic events in former Yugoslavia at the beginning of the nineties, it was not possible to develop a really good clinical practice in the field of transplantation. Facing the lack of Deceased Donor Donation Transplantation and any organ-sharing among the Balkan countries, we introduced a large and very ambitious living donor transplant programme including what were called expanded criteria living donors. In the period of the past 20 years elderly (above 65 years), unrelated (emotionally related), marginal and ABO incompatible living donors were accepted. Due to the skilled surgical team, powerful immunosupression and HLA compatibility testing, the results were promising and the number of complications very low. The authors concluded that use of an expanded criteria living donor is fully acceptable, especially in developing countries, and could ameliorate the severe organ shortage in the region.

Abstract

Introduction: In childhood, thrombocytopenia caused by transient antibody-mediated thrombocyte destruction is most frequently diagnosed as immune thrombocytopenic purpura (ITP). We report the case of a girl with ITP associated with autoimmune thyroiditis.

Case presentation: A 11-year-old female patient with Hashimoto’s thyroiditis presented with clinical signs of petechiae and ecchymoses on the extremities. Laboratory tests showed remarkable thrombocytopenia with a platelet count of 44,500/μL, hence she was referred to a hematologic consultation. The peripheral blood smear showed normal size platelets in very low range. The bone marrow examination exposed hyperplasia of the megakaryocyte series with outwardly morphologic abnormalities. The patient was diagnosed with ITP, and her first-line treatment was pulsed steroid and immunoglobulin therapy. The thrombocytopenia was refractory to these first-line medications. After 6 months of corticotherapy and a period of severe menorrhagia, azathioprine immunosupression was initiated as a second-line treatment. Her platelet count rapidly increased, and the evolution was good, without bleeding complications.

Conclusion: In case of a medical history of autoimmune diseases and treatment-resistant ITP, attention must be focused on detecting coexisting autoimmune diseases and adjusting the treatment in accordance with the chronic evolution of the disease.

Abstract

Introduction. Assessment of renal function is a crucial component of donor evaluation. The higher measured donor GFR is independently associated with a better allograft outcomes in living donor kidney transplantation (LDKT). Monitoring graft function and estimation of GFR is a recommended method for patients’ follow-up in posttransplantation period. The aim of our study was to investigate the correlation of directly measured GFR of donated kidney with estimated GFR through creatininebased formulas and to detect impact factors on the graft function at 12 months posttransplantation. Methods. Fifty LDKT patients (related and nonrelated donors) with stable renal function in a period of 12 months after transplantation were included in our study. The mean recipient age was 30.7±9.6 years, and donor age 55.45±9.41 years. The mean directly measured donated kidney GFR was 47.61±5.72 ml/min. Graft function was estimated at 3, 6 and 12 months by 3 formulas: Cockcroft- Gault (C-G), MDRD 6 variables and Nankivell. Direct correlation of estimated with measured radiolabeled 99mTc DTPA GFR was performed. Various impact factors such as donor age, dialysis vintage and different calcineurin inhibitors as a part of immunosupression were evaluated. Results. Estimated GFR at 12 months with MDRD, Cockroft Gault, and Nankivell formulas was 72.65±22.6, 94.25±36.42, and 81.78±17.89 ml/min, respectively. The highest estimated GFR was obtained with C-G formula at all three time points. The estimated allograft GFR did not correlate with directly measured GFR of donated kidney. Donor age well correlated with the graft function at 12 months. Allografts from standard criteria donors-SCD (<60 years) had better function than allografts form expanded criteria donors-ECD (>60 years). The highest GFR was estimated with C-G equation (106.08±39.26 ml/min), while GFR estimated with Nankivell was 86.86±15.30 ml/min, and with MDRD 79.67±20.28 ml/min, presenting patients in stage 2 of chronic kidney disease. Duration of hemodialysis treatment under 24 months showed better graft function estimated by C-G at 12 months (102.23±38.86 ml/min), compared to that above 24 months of HD (77.84±18.11 ml/ min). Different type of calcineurin inhibitors did not influence on the graft function at any time point. Conclusion. Creatinine-based formulas for estimation of the graft function did not correlate with directly measured function of the donated kidney with radiolabeled isotopes, nor between each other. Hence, the monitoring of the graft function should be done by a single formula in the posttransplantation period. Expectedly, a better graft function was observed in young donors (standard criteria) and in patients with shorter hemodialysis treatment.

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(Treg) cells express CD4+CD25 high and are crucial in the tolerance to self-antigens. Since tumor antigens are derived from self-antigens, Treg cells may decrease the antimyeloma effect. Treg cells directly inhibit NK cell effector function and Treg depletion exacerbates NK cell proliferation and cytotoxicity in in-vitro essays. 16 , 17 In MM the induction of immunosupression by Treg cells is believed to be associated with myelomagenesis and the progression of MM. 18 , 19 The effect of cyclophosphamide on Treg cells depends on the dose of cyclophosphamide and the

characterized by an accumulation of long-lived, functionally inactive, mature-appearing neoplastic B-lymphocytes. It is associated with severe immunodeficiency. Chemotherapy or immunotherapy generally makes the immunodeficiency worse. JC virus (John Cunningham virus; JCV) is a type of human polyomavirus that causes the progressive multifocal leucoencephalopathy (PML). JCV is found in 70 to 90 percent of population. The virus remains in gastrointestinal tract or tubular cell of kidneys and may infect oligodendrocytes and astrocytes. Immunodeficiency or immunosupression