Mirjana Bogic

Gender differences revealed by the Brief Illness Perception Questionnaire in allergic rhinitis

The increasing prevalence of allergic rhinitis (AR) is reported worldwide. Illness perception (IP) assessment is warranted in current routine clinical practice to assist communication between patients and medical staff, and improve adherence to treatment and disease outcome.

Systemic Lupus Erythematosus and Secondary Antiphospholipid Syndrome after Thymectomy for Myasthenia Gravis - A Case Report

INTRODUCTION: Systemic lupus erythematosus (SLE) and myasthenia gravis (MG) are autoimmune diseases that show some similarities: a higher incidence in young women, relapsing-remitting course and positive anti-nuclear antibodies (ANA). However, they are two different clinical syndromes, which can coexist or precede each other. Thymectomy is a therapeutic option for patients with severe MG or thymoma. There are many cases of SLE after thymectomy described in the literature, so the question arises whether thymectomy predisposes patients to SLE and what are imunopathogenetic mechanisms behind this process. CASE REPORT: We report a case of a patient who was diagnosed with SLE and secondary antiphospholipid syndrome (APS) 28 years after thymectomy for MG. Clinical picture of SLE was characterized by cutaneous and articular manifestations, polyserositis, lupus nephritis and immunological parameters showed positive ANA, anti-ds-DNA, excessive consumption of complement components, positive cryoglobulins. Clinical and laboratory immunological parameters for the diagnosis of secondary APS where also present. The patient was initially treated with glucocorticoids followed by mycophenolate mofetil. During one year follow-up patient was in a stable remission of SLE. CONCLUSION: Thymectomy for MG may predispose SLE development in some patients. Further studies are needed to better understand the connection between these two autoimmune diseases.

Messung der gesundheitsbezogenen Lebens-qualität bei Patienten mit Rhinitis allergica

Introduction: Allergic rhinitis is a chronic respiratory inflammatory disease affecting many aspects of patients daily activities. The aim of the present study was the comparison of quality of life between intermittent and persistent allergic rhinitis patients in pollen season and to test measurement properties of the Serbian version of Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Patients and methods: The investigation comprised 75 outpatients with intermittent and 25 outpatients with persistent allergic rhinitis, recorded from March to November 2002 at the Institute of Allergology and Immunology, Clinical Center Serbia, Belgrade. Medical Outcome Study Short Form Health Survey (SF-36) and RQLQ were used in the study. Results: Postnasal drip (t = 1.977, p = 0.051), itchy eyes (t = 2.756, p = 0.007), sore eye (t = 2.925, p = 0.004) and swollen eyes (t = 2.168, p = 0.033) were significantly more discomfortable to patients with intermittent than with persistent rhinitis, while mopping the floor was more troublesome to patients with persistent rhinitis (t = 3.166, p = 0.002) According to final multivariate logistic regression model, physical functioning (RR = 1.030, p = 0.020, 95% CI = 1.00 - 1.06) and sore eyes (RR = 1.546, p = 0.003, 95% CI = 1.16 - 2.07) were variables by which the patients with persistent and intermittent rhinitis differed significantly. Conclusion: Intermittent rhinitis patients in comparison with persistent rhinitis patients experienced significantly worse quality of life during pollen season. Serbian version of RQLQ has good discriminative properties and high reliability, and the specificity of our RQLQ version has been confirmed.

Sjögren's Syndrome and Silicosis - a Case Report.

Sjögren’s syndrome is an autoimmune disease of unknown etiology where immune response to self-antigens is believed to result from interactions between genetic and environmental factors. We describe the case of a patient who has been diagnosed with Sjögren’s syndrome based on typical clinical and immunological parameters. The clinical picture was dominated by the respiratory symptoms, and radiographic and multislice computed tomography examination of the chest showed certain changes characteristic of pneumoconiosis. Given that the patient has worked in a foundry where he has been exposed to the silica dust, he was subject to examination by occupational health specialists under the suspicion of lung silicosis, who confirmed the silicosis. This case report points to the possible connection between a professional exposure to silica and Sjögren’s syndrome. Occupational exposure to silica is a possible risk factor for the development of autoimmune diseases, and in the evaluation of patients with connective tissue diseases it is important to consider work-related history.

Severe strongyloidiasis and systemic vasculitis: comorbidity, association or both? Case-based review

A possible association between strongyloidiasis and systemic vasculitis is rarely reported in the literature. We report the case of a patient with severe strongyloidiasis and an angiographic finding consistent with polyarteritis nodosa. Diagnosis of strongyloidiasis was made by finding of larvae and adult parasites in samples of the upper gastrointestinal tract mucosa and stool. The patient was treated with albendazole, ivermectin and corticosteroid withdrawal. This therapy led to the resolution of symptoms, with repeated stool samples negative for S. stercoralis. However, the clinical course was complicated with pulmonary tuberculosis. Despite tuberculostatic therapy and supportive measures, a lethal outcome occurred. The report is followed by a focused review of the available literature on the association of strongyloidiasis and systemic vasculitis.

Role of Vitamin D in Systemic Lupus Erythematosus

Vitamin D is a steroid hormone that in addition to its well known role in the metabolism of calcium and phosphorus exerts immunoregulatory properties. Data from animal studies and from prospective clinical trials on patients with rheumatoid arthritis, multiple sclerosis and type 1 diabetes point to the potential role of vitamin D as important environmental factor in the development of autoimmune diseases. Such role of vitamin D in systemic lupus erythematosus (SLE) has not yet been sufficiently studied. This review shows the sources, metabolism and mechanism of action of vitamin D, its effect on the cells of the immune system, prevalence and causes of vitamin D deficiency in patients with SLE, the link between vitamin D status and disease activity as well as recommendations for vitamin D supplementation.

Systemic Lupus Erythematosus and Antiphospholipid Syndrome

Antiphospholipid syndrome is an autoimmune disorder defined as association of vascular thrombosis and/or pregnancy complications with presence of antiphospholipid antibodies (lupus anticoagulant, anticardiolipin and anti-β2 glycoprotein I). It is the most common cause of acquired thrombophilia, and can occur as an independent entity or in relation with other diseases, especially systemic lupus erythematosus. Presence of antiphospholipid syndrome in systemic lupus erythematosus is additional vaso occlusive factor in already present inflammation, bringing further risk for thrombotic events. Clinical and serological manifestations of antiphospholipid syndrome and systemic lupus erythematosus are very similar, so possible connection for these two autoimmune disorders is assumed.

[Importance of dysphagia examination in patient with dermatomyositis--case report].

INTRODUCTION Polymiositis belongs to the group of inflammatory myopathies which are manifested by muscle weakness of the shoulder blade and pelvic region. The presence of typical skin manifestations is suggestive of dermatomyositis. These patients may also develop dysphagia (10-54%) as a result of involvement of the oropharyngeal and upper oesophageal striated muscles. Dermatomyositis may also be associated with another systemic disease or malignancy. CASE REPORT Hereby is presented the case of a 42-year-old female patient hospitalized at the Department of Allergy and Immunology, Clinical Center of Serbia for the shoulder blade and pelvic muscle weakness and pains in the small and large joints, eyelid edema, facial and neckline redness, difficult swallowing and loss of body mass. Based on the presence of proximal muscle weakness, increased enzyme serum levels (lactic acid dehydrogenase, glutamic-oxalacetic transaminase), positive electroneuromyography findings, typical skin changes and positive muscle biopsy, the patient was diagnosed to have dermatomyositis. Both radioscopy and esophagography revealed some disturbances in all phases of swallowing, absence of all primary and secondary peristaltic waves accompanied by contrast medium aspiration. Additionally, esophageal manometry proved the absence of esophageal peristalsis. Additional examinations ruled out the presence of any malignancies. The patient underwent glycocorticoid and azatioprim treatment along with specific dietary regimen, symptomatic and physical therapy, which led to favorable clinical outcome. CONCLUSION Dermatomyositis-associated dysphagia may lead to severe complications such as cachexia and aspiration pneumonia. In addition to the management of underlying disease, the treatment includes special dietary regimen, rehabilitation and even interventional surgical procedures, if necessary.

Atopisches Asthma und dessen Risikofaktoren

Aim: To investigate the factors associated with atopic asthma in the adult Serbian population. Method: A case-control study of 134 atopic asthmatics and 134 non-asthmatics was carried out, during the period from March 2002 June 2003. The cases and controls were matched by sex, age (± 5 years) and place of residence (urban, rural). A detailed questionnaire based on the latest research results in the field was used to obtain information on the known risk factors. Stressful life events were recorded using Paykels Interview for Recent Life Events. Results: According to multivariate conditional logistic regression, the following factors were independently significantly associated with the occurrence of atopic asthma: allergic rhinitis (OR = 30.74, 95% CI = 7.62 - 123.98, p < 0.001), sinusitis (OR = 5.06,95% CI = 1.27 -20.17, p = 0.022), and lower respiratory tract infections in childhood (OR = 5.72, 95% CI = 1.65 - 19.87, p = 0.006). Conclusion: Our study indicates potentially important roles of allergic rhinitis, sinusitis and infections of the lower airways in childhood as factors increasing the risk of atopic asthma. Recognizing of the risk factors is important for the diagnosis and prevention of the disease.

Asthmavorstadium bei Patienten mit Rhinitis allergica

Background: Association between the allergic rhinitis and allergic bronchial asthma has been clinically observed long time ago. The aim of our study was to determine the possible presence of inflammation of the lower airway mucosal tissue in patients with allergic rhinitis who were symptom-free in the lower airways. Methods: A total of 87 patients with allergic rhinitis, 25 patients with allergic bronchial asthma without allergic rhinitis and 25 healthy controls were examined. Based on the results of the non-specific and specific bronchoprovocation tests (NBPT and SBPT), the patients with allergic rhinitis were divided into 4 subgroups: the patients with negative results of both tests (subgroup 1), patients only with positive NBPT results (subgroup 2), patients only with positive SBPT (subgroup 3) and patients with positive results of both tests (subgroup 4). Results: The results of the cytological analysis of the induced sputum from the subgroups of patients with allergic rhinitis were compared to those obtained from the patients with allergic bronchial asthma and healthy controls and confirmed presence of the allergic inflammation in subgroups 3 and 4 of the patients. Conclusions: Absence of lower airway complaints in subgroup 4 patients with allergic rhinitis may be explained by still insufficient degree of the allergic inflammation in comparison to the one in patients with allergic bronchial asthma.