AWARENESS OF PRIMARY IMMUNODEFICIENCY DISEASES AMONG MEDICAL STUDENTS.

Primary immunodeficiency diseases (PID) are a group of more than 300 rare, chronic disorders in which a part of the body's immune system is missing or functions improperly. The issue of early diagnosis, timely and effective treatment, prevention of complications and improved prognosis remains extremely relevant. The aim of this study was to assess the awareness of graduating medical university students about the signs of primary immunodeficiency in children and adults. A survey on awareness of primary immunodeficiencies was conducted among sixth year (graduating) students of the Faculty of Medicine of I.Horbachevsky Ternopil State Medical University, Ukraine. Questionnaires were offered to 271 students. The questionnaire consisted of 25 questions. The average percentage of correct answers given by the surveyed students for each question was 59.2% (ranging from 22.5% to 82.3%). The percentage of correct answers to the questions about warning signs of PID in children was 64.4%, and in adults was 54.2% (p=0.0491). The percentage of correct answers to the questions about general signs of PID was 61.6% and about specific signs of PID 51.7% (p=0.0016). The percentages of correct answers among surveyed students ranged from 26 to 88%. 223 (82.3%) medical students gave more than 50% of correct answers to all questions, but only 21 surveyed students (7.7%) gave more than 75% of correct answers. This study has revealed the lack of awareness for PID among medical students. The lowest knowledge was about PID warning signs in adults and the specific signs of PID, especially those concerning verification and management of Nijmegan breakage syndrome and common variable immunodeficiency. This study indicates a significant need to increase knowledge of medical students about primary immunodeficiencies, taking into account low levels of diagnosis of these diseases in Ukraine and the need to raise knowledge and awareness about PID among physicians of all specialties.

Rheumatoid arthritis in a patient with common variable immunodeficiency: difficulty in diagnosis and therapy.

Common variable immunodeficiency (CVID) is the most frequent primary immunodeficiency syndrome in adults with equal sex prevalence. The syndrome typically presents as recurrent infections, with onset in childhood or young adulthood (between 20 and 30 years). CVID patients also have a higher prevalence of autoimmune diseases. A 38-year-old woman presented to the Rheumatology Department with polyarthralgia and fever of 39 degrees C of several months' duration. She had recurrent respiratory and gastrointestinal tract infections and pernicious anemia. Immunological studies showed decreased levels of IgG, IgM, complete IgA deficiency, increased percentage of CD8 lymphocytes, and a reduced CD4:CD8 ratio. HLA-DR typing was performed and we identified HLA-DRB1*01. Adequate intravenous immune globulin substitution as well as antibiotic and anti-inflammatory treatment resulted in the remission of arthritis. Hand radiograms repeated after 12 months showed narrowing of the intra-articular space in the right metacarpophalangeal and radiocarpal joints with multiple bone cysts and erosions. Erosions were found in both humeral heads as well. This prompted the diagnosis of rheumatoid arthritis. Arthritis can be a presenting symptom of primary immunodeficiency in adults, especially when accompanied by recurrent infections or autoimmune diseases. These patients require more advanced diagnostic procedures and therapeutic cooperation of different specialists.

[The ability to produce nitric oxide by leukocytes in whole blood of children with recurrent urinary tract infections]. / Zdolnosc do produkcji tlenku azotu przez leukocyty pelnej krwi u dzieci chorych na nawracajace zakazenia ukladu moczowego.

We examined 20 children in age from 6 till 18 years old with recurrent urinary tract infection (rUTI). The control group were 15 healthy volunteers in age from 19 till 23 years old. In all cases nitrogen oxide concentration was designated in supernatant of 48 hours leukocytes culture with using colorimetric method with Griess reagent described by Ding. The spontaneous and LPS stimulated ability to nitrogen oxide production in full blood was estimated. The nitrogen oxide index was counted from the difference of concentration of inducated and stimulated nitrogen oxide. The defective response of the leukocytes of full blood to LPS-stimulation for nitrogen oxide productionin aggravation also in remission in children with rUTI and with rUTI in age till 5 years old and above 5 years old comparing to healthy ones.

[Level of GM-CSF and IL-4 in serum of children with bronchial asthma]. / Stezenie GM-CSF oraz IL-4 w surowicy dzieci z astma oskrzelowa.

Serum IgE, GM-CSF and IL-4 concentrations were measured in 35 children (3 to 18 years of age) with bronchial asthma in I and II clinical stage. Control group consisted of 10 healthy children (6 to 9 years of age) without any symptoms of inflammatory process. All measurements were performed by ELISA tests. The concentration of serum IL-4 was statistically significantly higher in children with bronchial asthma (0.06 ng/ml) than in the control group (0.01 ng/ml). Serum concentration of GM-CSF was lower in children with bronchial asthma than in control group (4.4 and 8.44 pg/ml respectively).

A randomised, double-blind study on the efficacy of Tolpa Torf Preparation (TTP) in the treatment of recurrent respiratory tract infections.

TTP is a new immunomodulating drug of natural origin, registered in Poland for human use. In the randomised, double blind study to assess the therapeutic efficacy of the Tolpa Torf Preparation (TTP) in the recurrent respiratory tract infectious participated 39 young patients (age 16-22). TTP was administered orally, 5 mg daily for three weeks. During 3 months follow-up period favourable results of treatment were obtained in 14 of 20 TTP treated patients and in 8 of 19 of the placebo patients. The therapeutic effects were seen even after the 6 months follow-up period. The phagocytic activity of granulocytes was significantly stimulated in the TTP--treated patients but not in the placebo-treated patients. The results suggest that TTP is effective drug in the treatment of recurrent respiratory tract infections with undefined infectious etiology. In the period of the treatment as well as during 6 months observation no side effects were noticed.