The effect of different housing systems on the welfare and the parasitological conditions of laying hens

In Serbia, by 2020, conventional cages will no longer be permitted and hens will be housed in furnished cages. The study was conducted during the winter season on four rearing systems of Lohman Brown hens. For welfare assessment were used indicators from the Welfare quality assessment protocol for poultry. All fecal samples for parasites were qualitatively and quantitatively examined. The results showed that each housing system had positive and negative aspects but overall, hens in cage systems had the highest prevalence of poor plumage condition (47 % and 39%). Hens in conventional cages had more skin lesions (27%) than birds in other systems. Keel bone deformation was the most present in the aviary system (56%) while comb pecking wound in a conventional cage (33%) and free-range system (50%). Hens in the non cage had the highest prevalence of foot pad disorders (32% and 40%). In furnished cages, problems occurred in hens are the lowest. Parasitological examination diagnosed four groups of endoparasites: Coccidia, Trichostrongylidae and Heterakis spp, and Capillaria spp, with a total prevalence of 64% (64/100) only in free-range system. Laying hens in cage systems have a higher expression of negative emotions in relation to the aviary and free-range system. Evidence of negative hens’ emotional condition in cage systems and negative physical condition across all housing systems, suggests that the welfare of modern hens in Serbia is impaired.

Incidence of Type 1 Diabetes Mellitus and Characteristics of Diabetic Ketoacidosis in Children and Adolescents during the First Two Years of the COVID-19 Pandemic in Vojvodina

Background and Objectives: The COVID-19 pandemic has led to significant changes globally, which has also affected patients with type 1 diabetes mellitus (T1DM). This study aimed to determine the incidence of T1DM and the characteristics of diabetic ketoacidosis (DKA) during the pandemic comparing it to pre-pandemic period. Materials and Methods: Data from patients <19 years with newly diagnosed T1DM between 1st January 2017 and 31st December 2021 from four regional centers in Vojvodina were retrospectively collected and analyzed. Results: In 2021, the highest incidence of T1DM in the last five years was recorded, 17.3/100,000. During the pandemic period (2020−2021), there were 99 new-onset T1DM, of which 42.4% presented in DKA, which is significantly higher than in the pre-pandemic period (34.1%). During the pandemic, symptom duration of T1DM lasted significantly longer than before the COVID-19 period. At the age of 10−14 years, the highest incidence of T1DM and COVID-19, the highest frequency rate of DKA, and severe DKA were observed. Conclusions: The pandemic is associated with a high incidence rate of T1DM, longer duration of symptoms of T1DM, a high frequency of DKA, and a severe DKA at diagnosis. Patients aged 10−14 years are a risk group for the occurrence of T1DM with severe clinical presentation. Additional studies are needed with a longer study period and in a wider geographical area, with data on exposure to COVID-19 infection, the permanence of new-onset T1DM, and the psychosocial impact of the pandemic.

An unusual case of takayasu arteritis presenting as acute myocardial infarction and ischaemic stroke

Introduction

Takayasu's arteritis (TA) is well-known yet rare disorder, defined as a chronic large vessel vasculitis mainly involving the aorta and its major branches. We present a complex case of a 51-year-old female patient who first presented with acute myocardial infarction as an initial manifestation of Takayasu arteritis, and later with an acute onset of ischemic stroke.

Case report

We present a case of 51-year-old female patient who was admitted at the Clinic of Nephrology and Clinical Immunology. During hospitalization, a sudden onset of intense chest pain occurred, followed by a development of heart failure to the level of cardiogenic shock. Electrocardiography showed signs of ST-elevated myocardial infarction (STEMI) of the anterior wall, and an increase in cardiospecific enzymes. CT angiography indicated an occlusion of the left common carotid artery (ACC), subclavian and axillary arteries as well as a penetrating aortic ulcer localized infrarenal. In the further course of treatment, left-sided weakness of the body was registered. Head CT scan showed an acute ischemic lesion high parietal on the right, as well as a chronic ischemic lesion on the front right. Doppler ultrasonography of carotid and vertebral arteries registered left occlusion, right ACC/external carotid artery (ACE) stenosis with suspected "macaroni sign". Final diagnosis of Takayasu arteritis was established and corticosteroids were included in the therapy (primarily in pulse doses) with the first pulse of cyclophosphamide of 1000mg.

Conclusion

This disease should be considered in female patients who present with chronic inflammation and acute coronary syndrome.

Improving agricultural production of domestic rabbits in Serbia by follow-up study of their parasitic infections

A study was made on the prevalence of some parasitic infections appearing in domestic rabbits obtained from individual breeders in Serbia in order to improve the agricultural production of these animals. Aside from economic reasons (meat production and reproduction) rabbits are bred for the research purposes, and races are kept as household pets. For these reasons, among others, it is important to gain knowledge of medical culprits including causes of parasitic diseases that compromise their health, well-being and cause economic losses. This parasitological research was conducted in the period from 2010 to 2015 in 8 epidemiological regions of Serbia, on 433 rabbits as representative samples of different races (154 individuals up to 1 years of age and 279 individuals older than 5). Out of the total number of examined rabbits parasitic infections were established in 82.68% of animals. We detected 3 species of endoparasites (Eimeria spp., Trichostrongylus spp., and Passalurus ambiguus) and 3 species of ectoparasites (Scabies from genera Sarcoptes, Psoroptes and Notoedres). In "kits" (small rabbits) coccidiosis was the most prevalent disease (50.65%), while in older animals trichostrongilidosis was common (39.07%). The most represented scabies infection was with the species Psoroptes cuniculi (12.01%). Aiming at better control on the health of rabbits, there is a growing need for continual monitoring of parasitic infections including appropriate diagnosis, application efficient therapeutic protocols and control measures.

[Etanercept therapy in rheumatoid arthritis: efficacy and safety]

INTRODUCTION

Etanercept, tumor necrosis factor (TNF-alpha) antagonist, lowers the disease activity level in patients with rheumatoid arthritis (RA), reduces joint destruction saving physical functions and improving life quality.

OBJECTIVE

The aim of this study was to establish efficacy and safety of etanercept in combination with disease modifying antirheumatic drugs (DMARDs) in the treatment of RA.

METHODS

To patients with active RA, who were on therapy with DMARD, etanercept was introduced in weekly doses of 50 mg, with continuation of DMARD. Efficacy of this form of treatment was evaluated in the 12th week. Maintenance of the effect of treatment was also evaluated during 24, 48 and 96 weeks. Long-term evaluation of etanercept safety was assessed by registering all unwanted events during a two-year period.

RESULTS

After 12 weeks of treatment with etanercept, 80% of patients had ACR20 response, while 85% showed clinically significant decrease of DAS28 index. We achieved remission in five patients (12.5%) and low activity of RA in 17 patients (42.5%). During a 96-week of follow-up period, achieved therapy effects were maintained. In four patients (10%) etanercept therapy was interrupted after 24 weeks because of inadequate response. In one of them (2.5%) we recorded a cardiovascular incident. Acute infections were registered in 47 cases. Four of those were severe infections. Neither cases of malignancy development were noted, nor were there any lethal disease outcomes.

CONCLUSION

Etanercept in combination with DMARD shows a high level of efficacy in the treatment of RA. The safety profile of the drug is satisfactory.

Aortic dissection or renal infarction--multislice computed tomographic angiography can tell

INTRODUCTION

Acute renal infarction as a consequence of renal artery occlusion often goes unrecognized, mostly due to the non-specific clinical features. A quick diagnosis, ideally within three hours of presentation, is a key to renal function recovery.

CASE OUTLINE

A 62-year-old male patient was admitted with a sudden abdominal pain, right flank pain and nausea. He had a diastolic hypertension at admission and his previous medical history showed atrial fibrillation. Initial clinical diagnosis was aortic dissection. Laboratory findings included elevated lactate dehydrogenase (LDH) and serum creatinine levels. There were no signs of aortic dissection or aneurismatic lesions registered during a multislice computed tomographic (MSCT) angiography. However, MSCT angiography demonstrated left "upper" renal artery thrombosis and renal infarction--avascular area of the upper two thirds of the left kidney sharply demarcated from the surrounding parenchyma. Both kidneys excreted the contrast. Anticoagulant therapy was initiated, along with antiarrythmic and antihypertensive medications. The follow-up by computed tomography was performed after nine weeks, and it showed a partial revascularization of the previously affected area.

CONCLUSION

Concomitant presence of flank/abdominal pain, an increased risk for thromboembolism and an elevated LDH suggested a possibility of renal infarction. MSCT angiography is a non-invasive and accurate method in the diagnosis of renal artery occlusion and the resulting renal infarction.

[Therapy of lupus nephritis with mycophenolate mofetil]

INTRODUCTION

Mycophenolate mofetil is an immunosupressive agent used in transplantation and subsequently in a variety of autoimmune conditions. It inhibits both B and T lymphocyte proliferation, and also has nonimmune effects on the kidney. The major experience in systemic lupus erythematosus has focused on proliferative lupus nephritis.

MATERIALS AND METHODS

In our study we treated 8 female patients with proliferative lupus nefritis with combination therapy of prednisone (1 mg/kg body weight) and mycophenolate mofetil (2 g per day). Complete remission was defined as a value for urinary protein excretion that was less than 0.5 g per 24 hours, with normal urinary sediment, a normal serum albumin concentration and improved or stable serum creatinine. Partial remission was defined as a daily proteinuria below 2 g in a previously nephrotic patient or minimum 30% from starting values, with normal urinary sediment, serum albumin of minimum 30 g/L and stable serum creatinine.

RESULTS

Two patients had a complete remission after 7 and 2 months respectively. Five patients had a partial remission after 5.2+/-4.3 months of therapy. One patient did not react on therapy. There were no side effects during the course of therapy.

DISCUSSION

Considering the fact that 7/8 patients have had nephrotic range proteinuria and that 50% of patients were refractory on standard induction therapy, results of this study are good indicator of value of mycophenolate mofetil in the terapy of proliferative forms of lupus nephritis.

CONCLUSION

Mycophenolate mofetil gives satisfactory results in the treatment of proliferative forms of lupus nephritis with minimal side effects.

[Correlation between sera levels of sICAM-1 and sVCAM-1 and severity of kidney lesions in patients with lupus nephritis]

INTRODUCTION

Adhesion molecules are essential for cellular interactions and are important in the activation and adhesion of cells. Studies have shown that elevated levels of solubile ICAM and VCAM are related to disease activity in patients with various acute and chronic inflammatory diseases. Our aim was to investigate the correlation between the levels of sICAM-1 anti sVCAM-1 and the degree of disease activity and severity of lupus nephritis.

MATERIAL AND METHODS

Using the ELISA procedure, we determined the sera levels of sVCAM-1 and sICAM-1 in 80 patients with SLE and in group of 27 healthy volunteers.

RESULTS

Patients with SLE had significantly higher sera levels of adhesion molecules comparing to the controls (p<0.001). There was a high positive correlation between the sera levels of sVCAM-1 and concentration of anti-ds DNA antibodies in patients with SLE (p<0.001), and there was also a negative correlation between the sera levels of sVCAM-1 and concentration of C3 and C4 component of complement (r=-0.64, r=-0.58). In the group of patients with lupus nephritis, significantly higher sera concentrations of sVCAM-1 were detected compared patients without nephritis. Patients with class III and IV kidney changes had significantly higher levels of sVCAM-1 compared to the patients with class II kidney changes. In the group of patients with activity index of kidney changes (AI) over 4 sVCAM-1 the sera levels were significantly higher compared to the group with AI <4.

CONCLUSION

The sera level of sVCAM-1 is a reliable parameter to evaluate the autoreactivity degree in SLE. In the same time, sVCAM-1 sera level can be used as a reliable marker to evaluate the renal lesion extensivity in SLE.

[Evaluation of effects of the intravenous cyclophosphamide treatment of primary glomerulonephritis and the estimation of complications]

INTRODUCTION

Primary glomerulonephritis can be treated by the intravenous use of cyclophosphamide. The aim of our study is to evaluate the effect of the drug in the treatment of mentioned diseases and the follow-up of complications.

MATERIAL AND METHODS

There are 30 patients included in this study, mean-age of 46.83 years. Renal biopsy was performed in 25 patients. Membranoproliferative glomerulonephritis was diagnosed in 36.67% of patients, mesangioproliferative in 16.67%, rapidly progressive in 13,33%, membranous in 10%, chronic in 10%, primary focal segmental glomerulosclerosis in 3,33% and 10% of patients were unclassified They have been treated with cyclophosphamide in intermittent "pulse" doses: once a month fbr the first 6 months and once in 3 months, for 18 months or longer, after that.

RESULTS AND DISCUSSION

The drug was given in the recommended dose of 0.5-lg/m of body-surface area, in the combination with a low-dose corticosteroides. Hematological and renal fimnctional tests were checked before every "pulse" dose. Concerning the development of the renal ailure the fivorable effect occurred in 50% of patients. Proteinuria was found in all patients (80% >3.5 gr/24 h). The favorable effect occurred in 80% patients. At the end, serum proteins were normal in 76.67% patients. 30% of patients normalized the erythrocyte sedimentation level. Remission has not been achieved in 23.33% of patients, 10% of patients developed relapse. 20% of patients died infections were the most common complication and they occurred in 30% of patients. Sepsis, leucopenia, Herpes Zoster infection and hemorrhagic cystitis have not occurred in any patient. Malignant tumor was found in 6.67% of patients.

[Goodpasture's syndrome--case report]

INTRODUCTION

Goodpasture's syndrome is a rare, autoimmune disease characterized by pulmonary hemorrhage, glomerulonephritis and production of anti-GBM (glomerular basement membrane) antibodies. The etiology of this syndrome is still unknown. Goodpasture's syndrome usually starts with pulmonary hemorrhage, which is followed by symptoms of kidney disease. Laboratory findings often include: anemia, microhematuria, proteinuria, increased levels of urea and creatinine and anti-GBM antibodies. Diagnosis of this syndrome can be established by presence of pulmonary hemorrhage, pulmonary radiography, kidney biopsy and positive result of circulating anti-GBM antibodies. Treatment of this syndrome should be initiated as soon as possible using a combination of corticosteroids, cytostatics and plasmapheresis.

CASE REPORT

The first symptoms in a nineteen-year-old female patient were caused by anemia. Two months later she reported symptoms of pulmonary hemorrhage. At that point of time she already had renal insufficiency and was immediately hospitalized. The same day we started therapy with corticosteroids, endoxan and plasmapheresis was initiated Recovery of pulmonary function was obtained, but kidney function was lost.

DISCUSSION AND CONCLUSIONS

The most important thing in regard to Goodpasture's syndrome is quick diagnosis. Because of that, if patients report any kind of pulmonary hemorrhage, this syndrome must be considered At that point of time, kidney function is usually not irreversibly damaged. The second important thing in Goodpasture's syndrome is that treatment must be very aggressive using a combination of immunosuppressives and plasmapheresis. This is the only chance for these patients to avoid hemodialysis or death.

[Major characteristics of immunoglobulin A nephropathy]

INTRODUCTION

Immunoglobulin A nephropathy (IgAN) is one of the most common forms of primary glomerulonephritis in many countries. Most clinical features of IgAN point to a renal problem, such as recurrent macroscopic hematuria or asymptomatic microscopic hematuria and proteinuria. Pathologic features of IgAN present with different types and different degrees of glomerular, tubulointerstitial and vascular lesions. The aim of this study was detailed analysis of clinical and laboratory findings, as well as findings of immunofluorescence and light microscopy. We also investigated associations between these factors.

MATERIAL AND METHODS

We investigated 60 patients who underwent renal biopsy. The study was partly retrospective and partly prospective.

RESULTS

The average age of patients was 34.19 years. Male female ratio was 2.33:1. IgAN was most frequently asymptomatic (83.33%) as microhematuria and proteinuria, while gross hematuria was found in 16.667%. Renal biopsy material was analyzed by light microscopy revealing changes in all glomerular structures. Immunofluorescence microscopy demonstrated dominant IgA deposits. This study established association of glomerulosclerosis with clinical features of disease.

DISCUSSION AND CONCLUSIONS

IgAN frequently develops in the 4th decade of life, mostly in males and presents as asymptomatic (83.33%). Pathohistological changes include all glomerular structures. There is no specific serological test for IgAN, but pathological changes affect clinical features of the disease, as proteinuria and increase of creatinine concentration.

Tubulointerstitial dysfunction in early post-transplant period

Dysfunction of a transplanted kidney may develop at any time in the post-transplant period. The aim of this study was to differentiate levels of early dysfunction of a transplanted kidney. The study included 45 examinees undergoing kidney transplantation. They were divided into four groups, in regard to length of hospitalization and post-transplant complications: group I (up to 15 days, complication-free); group II (up to 15 days, with complications); group III (up to 30 days); group IV (up to 60 days). The control group included patients undergoing abdominal surgery, without uropoetic system disorders. The following parameters were examined on a daily basis a month after transplantation on average: creatinine clearance, creatinine and urea. Statistical analysis of these parameters revealed the following levels of renal dysfunction: control group--circulatory tubular dysfunction without azotemia; group I--polyuric acute tubular necrosis; group II and group III--severe or moderately severe polyuric acute tubular necrosis and group IV--polyuric acute tubular necrosis.

[Immunoglobulin A nephropathy and disease prognostic factors]

INTRODUCTION

Immunoglobilin A nephropathy (IgAN) is a clinicopathological entity characterized by diffuse glomerular mesangial deposition of IgA as the predominant immunoglobulin. Renal biopsy reveals a spectrum of changes in glomerula, tubulointerstitium and blood vessels. 20-50% of all patients develop end-stage renal failure 20 years after onset of disease. The aim of this study was to investigate the incidence of IgAN and to analyze clinicopathological changes and prognosis of IgAN.

MATERIAL AND METHODS

The study included 60 patients with biopsy-proved IgAN without some other systemic diseases or Henoch-Schonlein purpura. We analyzed clinical features of the disease, laboratory findings, findings of immunofluorescence and light microscopy and prognosis of IgAN. The study is partly retrospective and partly prospective.

RESULTS AND DISCUSSION

Incidence of the disease in the period 1981-1997 was 9.78%. At the moment of renal biopsy 63.16% of patients had normal renal function, 31.58% had stage I and 5.25% had stage II chronic renal failure. At the end of study 21.05% of investigated patients were included into the worse stage of renal failure in regard to the initial stage. Progression of renal damage correlated with special tubulointerstitial damage and heavy proteinuria.

CONCLUSIONS

In this study we found severe histopathological changes in the group with already impaired renal function and these changes correlated with laboratory findings, clinical features and prognosis. Normal renal function at the moment of renal biopsy pointed to risk for further damage. Changes in the tubulointerstitium and mesangium, heavy proteinuria and hypertension affect the disease prognosis. Evolution to the higher stage of renal failure was 1.24% per year and this requires long-term follow-up of patients with IgAN.

[Long term survival of patients with lupus nephritis]

Lupus nephritis is a clinical manifestation of Systemic Lupus Erythematosus with most prominent influence on the course of the disease. The most predictive parameters for development of renal failure are: type of hystological changes, degree of interstitial inflammation, serum creatinine concentration at the time of diagnosis and therapeutical protocols used in the treatment. Single center experience in a group of 220 lupus patients is presented in this paper. In 130 patients (59%) lupus nephritis was diagnosed by clinical and laboratory tests, while 74 kidney biopsies were performed. Proliferative type of lupus nephritis (class IV in 54% of cases and class III in 18.9%) was more frequent than the other histological types. During a long term follow up (range 1-17 years, mean 7.6 years) renal failure developed in 17 patients (24%), while 11% of patients developed uremia and required dialysis. Development of renal failure was influenced by histological changes with predominance of class IV lupus nephropathy, disseminated disease with more ARA criteria for systemic lupus erythematosus classification present at the time of kidney biopsy, more frequent lupus flares, persistence of low complement levels during the first year of follow-up and even earlier.

[Radioconstrast nephropathy]

INTRODUCTION

Hospital-acquired acute renal failure increased in the last years from about 5 to 6.4%, while mortality remained high and according to newest investigations it is about 60% on average. Radiocontrast-induced nephropathy is the third cause of death in hospital-acquired acute renal failure. RISK FACTORS FOR RADIOCONTRAST-INDUCED NEPHROPATHY: Risk factors for radiocontrast-induced nephropathy include: the existing kidney disease, diabetes, dehydratation, multiple myeloma, older age and earlier kidney damage by contrast substances. COURSE OF RADIOCONTRAST-INDUCED NEPHROPATHY: The clinical course of radiocontrast-induced nephropathy may manifest from asymptomatic picture to development of oliguric form of acute renal failure. PREVENTION AND TREATMENT MODALITIES OF RADIOCONTRAST-INDUCED NEPHROPATHY: Modalities of prevention and treatment of radiocontrast-induced nephropathy are as follows: adequate hydration of patients, appropriate application of diuretics, calcium channel blockers nonionizing radiocontrast and preventive haemodialysis. EXPERIMENTAL STUDIES IN PREVENTION AND TREATMENT OF RADIOCONTRAST-INDUCED NEPHROPATHY: Experimental studies indicate application of atrial natriuretic peptide, endothelin, prostaglandin.

CASE REVIEW

Two patients treated at the Clinic for Nephrology and Clinical Immunology in Novi Sad, presented with radiocontrast-induced nephropathy. In one patient it appeared after panaortography and in the second after computerized tomography of the abdomen. In both cases aggravation occurred due to already existing renal failure caused by radiocontrast substances.

CONCLUSION

The problem is particularly important because there is a large number of patients in whom there is a risk of radiocontrast-induced nephropathy and it is necessary to carry out adequate prophylaxis and accurate assessment of kidney function before application of radiocontrast substances.

[The Churg-Strauss syndrome]

Churg-Strauss syndrome (CSS) is medium blood vessels vasculitis with predilection for lungs in patients with bronchial asthma, chronic eosinophilic pneumonia and positive ANCA in the sera in 55-67%. This is a case report of a 60 years old female patient with bronchial asthma, peripherial pulmonary infiltrations, blood eosinophilia, xerophtalmia, tachycardia, chronic rhinosinustis, polyneuropathia and negative imunological tests: CIC (PEG), CRYO, ANA (IIF), RF (aglutination) and ANCA (IFF: pANCA and cANCA; ELISA: proteinase 3, lactoferrin, myeloperoxidase. elastase, cathepsin G). Eosinophilic infiltrates in the tissues tested by skin and salivery gland biopsies were not found. The patient had fulfilled five clinical diagnostic criteria and responded well to imunosuppressive therapy, so this case could be classified as the ANCA negative angiitis and granulomatosis of CSS type.

[Anti-U1RNP antibodies and lupus nephritis]

INTRODUCTION

Systemic Lupus Erythematosus is characterized by production of numerous autoantibodies as an abnormal immune response. The most important antibodies are those aimed at constitutive elements of cell nucleus.

METHODS

After antigen typing of antinuclear antibodies in 30 patients with Systemic Lupus Erythematosus we analyzed the correlation between anti-Sm antibodies and anti-U1RNP antibodies and the degree of disease activity, such as correlation of these two antibodies with some clinical manifestations of this disease. This study included patients who fulfilled all revised American Rheumatism Association criteria to diagnose systemic lupus. To determine the degree of disease activity we used Systemic Lupus Erythematosus Disease Activity Index after Bombardier. To detect antinuclear antibodies technique of indirect immunofluorescence and ELISA procedure for antigen typing of these antibodies were used.

RESULTS

We registered antinuclear antibodies (ANA) in 100% of our patients, with domination of homogenous pattern of immunofluorescence (70%). Speakled pattern was registered in 16.66% and margin type in 6.66%. Using ELISA procedure of antigen typing of ANA we registered anti-U1RNP antibodies in 26.7% patients, while anti-Sm antibodies were registered in 20%.

CONCLUSION

Anti-U1RNP antibodies finding is associated with mild forms of disease and rare appearance of lupus nephritis, while anti-Sm antibodies finding is characteristic for very active forms of disease and often lupus nephritis.

[Gabapentin as adjuvant therapy in the treatment of refractory partial epilepsy]

With the aim to evaluate the clinical efficacy and tolerability of gabapentin as an adjuvant therapy in patients with refractory partial epilepsy we conducted an open-randomized study, with 12-weeks follow-up period. The study included 18 epilepsy patients with unsatisfactorily controlled seizures, in spite of the treatment with 1 or 2 first line antiepileptic drug. Gabapentin was administered in a total daily dose between 900-1200 mg. Our results showed seizure frequency reduction by more than 50% in 72.2% patients, while the most frequent adverse effects were vertigo (16.67%) and ataxia (11.11%).

[Magnetic resonance findings and cerebrospinal fluid parameters in the evaluation of blood-brain barrier status and multiple sclerosis activity]

The diagnosis of disseminated demyelinating disease of central nervous system (DDD CNS) was established on clinical criteria, cerebrospinal fluid (CSF) analyses, electrophysiological and neuro-radiological examinations. The aim of this investigation was to perform an analysis of the state of blood-brain barrier and activity of demyelinating process in the patients, by the comparison of CSF findings and results of magnetic resonance (MR) examinations using paramagnetic contrast. Investigations were performed in 30 patients with DDD CNS in the phase of clinical impairment, without immunosuppressive/immunomodulatory therapy in the last 3 months. The results revealed the absence of correlation between CSF and MR findings, as in connection with the damage of blood-brain barrier, so in relation to immunologic activity of the disease. In the study are discussed the causes of these disparities that are the probable sequela of heterogenicity of physiopathologic events and disease forms inside DDD CNS.

Oxidative stress and Parkinson's disease

The aim of this study was to determine the baseline state of oxidative stress indices in drug-naive patients with Parkinson's disease (PD). Cerebrospinal fluid (CSF) and peripheral blood samples of 31 subjects, in disease stages I-III, according to Hoehn & Yahr scale, were analyzed and compared with the control group. Highly significant increase of malondialdehyde content in CSF (p < 0.001) was found, as well as significant differences in peripheral blood parameters: malondialdehyde content was increased in patients with PD (p < 0.05), and also the activities of antioxidative defense enzymes, gluthathion reductase, Cu, Zn-superoxide-dismutase (p < 0.05), and the production of highly reactive oxygen species-superoxide radical (p < 0.05). Those findings indicated the important role of oxidative stress in Parkinson's disease evolution and progress. The findings of increased amount of reactive oxidative species (malondialdehyde content and superoxide radical production) in peripheral blood, and excessive activity of protective enzymatic systems (gluthathion reductase Cu, Zn-superoxid-dismutase) suggested the additional systemic reaction related to chronic oxidative stress state in the brain.

Cerebral infarction vs. intracranial hemorrhage--validity of clinical diagnosis

In aim to improve the validity of clinical diagnosis of acute supratentorial ischemic cerebral infarction vs. intracranial hemorrhage, two different scoring systems were analyzed, each separately and combined, on one hundred eighty-eight patients sample. Results suggested higher sensitivity and positive predictive value for Guy's Hospital score, giving it higher importance in detection of hemorrhage, while combined application of both systems, in cases with identical findings, provided sensitivity 0.95 and 0.92 negative predictive value, in certain diagnosis category. A review of complete results disclosed that application of both systems separately didn't provide satisfactory diagnostic gain in differential diagnosis of that syndrome on our sample, while combined application provided high level of accuracy, eliminating simultaneously a significant proportion of patients (43.62%), as a category of uncertain diagnosis.

[Clinical and morphologic features in patients with acute nephritis syndrome]

Acute glomerulonephritis is a distinct clinical entity, more frequently found in younger age. We report 69 patients with AcGN (25 female and 44 male) mean age 26 years (range 15-58). The disease is clinically characterized with hypertension (57%), edema (59%) and oliguria (35%). Urine analysis showed microhaematuria/proteinuria (36%) and micro/macrohaematuria alone in 89%, while azothaemia was observed in 16% pts, and decreased serum complement levels in one third of patients, more often decrease of C3 (33%) than C4 (15%). Initial infection of the upper respiratory tract was seen in 65%, pneumonia in 8%. In 25% of pts. there were no data of previous infection. Cultures of pharyngeal smear revealed. Streptococcus only in 2 pts. Elevated AST titer was found in 32% pts. Eleven kidney biopsies were made, and histological examination showed 2 normal findings, 6 mesangioproliferative GH, 2 endocapillary GN and 1 membranoproliferative GN. Follow ups have showed urinary abnormalities in 25% of pts., without developing renal failure.

[Urinary infections in patients with transplanted kidneys]

The aim of this study was to evaluate urinary infection frequency in kidney transplanted patients. Infection frequency was assessed in 116 patients (81 males and 35 females; mean age 36.2 years) after renal transplantation. During four year follow-up 41% patients suffered one or more episodes of infection. Bacterial infection caused by Escherichia coli were most frequent. The control group consisted of healthy medical staff and the investigations showed significantly over frequency of infection.

[Methylprednisolone pulse therapy in the early phases of lupus nephritis]

Renal involvement i.e. lupus nephritis (LN) in systemic lupus erythematosus (SLE) mainly determines course and outcome of the disease. Recognition of early manifestations of LN makes adequate therapy possible, with very good therapeutic results. We report 7 patients from a group of 150 SLE patients under our permanent control, 4 female and 3 male, mean age 21 years. All of them had signs of LN: proteinuria 7/7 haematuria 4/7 without azotaemia. Renal biopsy was performed in 6 pts, and histological finding was: class II 1 pt, class IV 3 pts and class V in 2 pts. In 4 pts tubulointerstitial changes were noted, while all showed immunofluorescent deposits of immunoglobulins and complement. Methylprednisolone "pulse" therapy (1000 mg, i.v., 3 days) followed by tapering of the steroid dose was given. Reduction of proteinuria and disappearance of haematuria were observed in all patients. During follow up, kidney function remained normal.

[Treatment of acute migraine attacks]

Considering that migraine patients ask for the physician's help in outpatient clinics and hospitals due to the acute attacks dominated by headaches, the latest research in pathophysiology and pharmacotherapy of migraine, directed the aim of this research to investigate the efficiency of dihydroergotamine in the treatment of the acute attacks of migraine headaches and to define a treatment program of the acute migraine headaches for the out patient and in patient conditions. The investigations were performed in 34 patients of the middle age and younger, of both sexes, with the established clinical diagnosis of a common migraine, with no history of coronary disease, ischemic brain disease, kidney and hepatic deficiency, and who were not for different reasons, Under the prophylactic therapy. Patients were randomly divided into two equal groups. The first group was treated i.m. with dihydroergotamine (1 mg) in combination with metoclopramide (10 mg). In case of insufficient effect the dose was repeated after one and eight hours after the first dose. The second group was treated with diclofenac (75 mg) and metoclopramide (10 mg), using the same pattern. The results investigation showed the significantly better effect of dihydroergotamine regarding the onset and the intensity of the positive effect. It was concluded that in case of acute attacks of migraine headaches in younger patients with no history of coronary disease, ischemic brain disease, kidney and hepatic deficiency, dihydroergotamine with metoclopramide administered i.m. could be used as a therapy of choice in all treatment conditions.

[Sensitivity of atherosclerosis indices in patients with ischemic brain disease]

Epidemiological studies suggest that dyslipoproteinemias and hyperlipoproteinemias present one of the most important risk factors in the development of atherosclerosis and its complications. The aim of this study was to find out which of the lipid status disorders in patients with ischemic brain disease was the most important risk factor in the development of cerebral atherosclerosis. Patients with ischemic brain disease were examined in the acute and subacute phase. Total blood cholesterol, low density lipoproteins (LDL) and high density lipoproteins (HDL) as well as of apolipoproteins A1 and B were determined. Correlations (atherogenic indices) of some lipid components with the severity of clinical course and echo-angiographic finding were determined. It was concluded that the highest correlation with the cerebral atherosclerosis severity degree existed with the level of apoA1 and apoB apolipoproteins, followed by correlation of LDL and HDL cholesterol, and the lowest correlation was found between HDL and the total cholesterol. Accordingly, apolipoproteins, i.e., apoA1/apoB indices are the most sensitive markers of the risk for atherogenesis.

[Sensitivity of electrophysiologic tests in the diagnosis of carpal tunnel syndrome]

According to anatomic characteristics of median nerve branches and pathophysiological basis of the carpal tunnel syndrome (CTS), significant difference in sensitivity of some electrophysiological parameters in the diagnosis of this syndrome was presumed. The aim of this study was to analyze characteristics of some abnormalities of electrophysiological parameters and to determine their frequency in the carpal tunnel syndrome. Investigation was performed on 34 patients with the carpal tunnel syndrome and 30 neurologically healthy subjects. EMGs of the tenar muscles, terminal latency parameters for the median nerve and sensory conductivity of the median nerve branches including cutaneous palmar branch and ulnar nerve branches of the ring finger were examined and analyzed. Results have shown that abnormalities were most frequently found in sensory conductivity parameters for median nerve branch of the ring finger. Significant difference between sensory conductivity parameters for cutaneous palmar branch and median nerve branch of the thumb was also found. These results were discussed in terms of current knowledge about anatomic characteristics of the hand innervation and pathophysiology of the carpal tunnel syndrome. It was concluded that the most frequent physiological findings could be used as a highly sensitive test for reliable and early diagnosis of CTS.