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Celiac disease (CD) is a malabsorptive condition of the small intestine that presents clinically with episodic or nocturnal diarrhea, flatulence and weight loss [1]. It has been increasingly recognized that CD does not always present in the traditional fashion but instead may present with elevated hepatic transaminase level [2] or with iron deficiency anemia, growth retardation, osteoporosis, infertility and menstrual disturbances [3]. CD results from an inappropriate T-cell mediated response against ingested gluten. CD frequently is associated with autoimmune diseases including diabetes mellitus, autoimmune thyroid diseases, Sjögren’s syndrome, autoimmune hepatitis, autoimmune atrophic gastritis and Addison’s disease [4]. The association of CD and hepatitis C is not established presently. We present three cases of CD with hepatitis C as case series.

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Absztrakt:

Bevezetés: A közönséges variábilis immundeficiencia a primer veleszületett immunhiányos állapotok közül a leggyakoribb felnőttkorban manifesztálódó kórkép. A betegséget alacsony immunglobulinszintek, az ellenanyagképzés csökkenése vagy hiánya jellemzi. Klinikai megjelenése változó, visszatérő heveny és krónikus fertőzések dominálnak. Változatos autoimmun betegségek képében is manifesztálódhat, fennállása esetén szolid tumorok és extranodalis B-sejtes lymphomák előfordulása gyakori. A kórkép kezelése rendszeres immunglobulinpótlásból áll. Esetismertetés: A szerzők egy immun thrombocytopenia és autoimmun haemolyticus anaemia miatt évekig gondozott fiatal férfi beteg esetét mutatják be. Osztályos észlelésekor a láz és a thrombocytopenia dominált igen alacsony immunglobulin- és memória-B-sejt- (sejtfelszíni CD27+ antigén jelenléte) szintek mellett. Infekció, malignus betegség nem igazolódott. A közönséges variabilis immundeficiencia diagnózisát a hypogammaglobulinaemia szekunder okainak kizárását követően állították fel. A beteg rendszeres immunglobulinpótlásban részesült. Állapota romlásakor fokozódó hepatosplenomegaliát, pancytopeniát és hemophagocytosis szindróma laboratóriumi jeleit észlelték. Kiterjesztett terápiás erőfeszítése ellenére a beteg elhunyt, a halála előtt megismételt csontvelő-biopsziás minta poszt-mortem igazolta a perifériás T-sejtes lymphoma, tovább nem osztályozható diagnózisát cytotoxikus fenotípussal. A kórboncolás számos szervrendszer súlyos érintettségét írta le. Megbeszélés: A közönséges variábilis immundeficienciához társuló lymphoproliferatív betegségek szinte kivétel nélkül B-sejtes fenotípusúak, T-sejtes lymphoma társulásáról csak elvétve lehet adatot találni az irodalomban.

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anaemia in brown bullhead ( Ameiurus nebulosus ). Comp. Biochem. Physiol. 135 , 165-175. Apparent diffusion limitations on branchial CO 2 transfer are revealed by severe experimental anaemia in brown bullhead ( Ameiurus

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., Schwartz, S., Owen, R. A.: Gastrointestinal blood loss and anemia in runners. Ann. Int. Med. 100 , 843-845 (1984). Gastrointestinal blood loss and anemia in runners. Ann. Int. Med

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Hematológia–Transzfuziológia
Authors: Henrietta Poset, Judit Kárteszi, Tibor Kalmár, Zoltán Maróti, Julianna Fekete, and Miklós Egyed

Összefoglaló. A familiáris mediterrán láz a herediter autoinflammatorikus betegségek közé tartozik. Klinikai tüneteit döntően a savós hártyák akut gyulladása (serositis: peritonitis, pleuritis, synovitis, ritkán pericarditis, meningitis) határozza meg. A betegség hátterében a pyrin fehérjét kódoló MEFV-gén többségében autoszómális recesszív módon öröklődő mutációi állnak. Legfontosabb szövődménye az amyloidosis, amely veseelégtelenséghez vezethet. Kezelésében első vonalbeli terápiaként a colchicin szerepel.

Fiatal nőbetegünket 12 éves kora óta több intézetben vizsgálták intenzív hasi fájdalommal és lázzal járó attakok miatt. A tünettan részeként hányás, hasmenés és mellkasi fájdalom jelentkezett. A gyulladásos epizódok 5–14 napig tartottak, a köztes időszakokban viszont teljesen jól volt. A rohamok alatt készült laboratóriumi vizsgálatok során leukocitózis, valamint emelkedett süllyedés és CRP mutatkozott. Intravazális hemolízisre utalt az anémia, retikulocitózis, magas Sebi, szérum szabad hemoglobin és LDH együttes megjelenése. Az EKG-én inferior és az anteroseptalis elvezetésekben átmenetileg negatív T-hullámok jelentek meg, ami pericarditis lehetőségét vetette fel. Fizikális státuszából kiemelendő a diszkrét, de progrediáló splenomegalia. Kizártuk a porphyriat, glucose-6-phosphat dehydrogenase-hiányt, PNH-t és C1-inhibitorhiányt. Az autoinflammatorikus betegség miatt elvégzett molekuláris genetikai vizsgálat az MEFV-génmutáció homozigóta formáját, a Familiáris mediterrán láz diagnózisát igazolta.

Summary. The familial Mediterranean fever is one of the hereditary autoinflammatory diseases. Its clinical symptoms are mainly determined by acute inflammation of the serous membranes (serositis: peritonitis, pleurisy, synovitis, rarely, pericarditis, meningitis). The background of the disease is mostly represented by autosomal recessively inherited mutations in the MEFV gene encoding the pyrine protein. Its most important complication is amyloidosis, which can lead to renal failure. Colchicine is included in its treatment, as a first-line therapy.

Our young female patient has been examined in several institutions since the age of 12 for attacks of intense abdominal pain and fever. The symptoms included vomiting, diarrhea, and chest pain. The inflammatory episodes lasted 5–14 days, but in the intervening periods she was free of symptoms. Laboratory tests performed during the inflammatory periods showed leukocytosis as well as increased ESR and CRP. Intravascular hemolysis was indicated by anemia, reticulocytosis, co-occurrence of high Sebi, serum free hemoglobin and LDH. On the ECG, transiently negative T waves appeared in the inferior and anteroseptal leads, raising the possibility of pericarditis. Of her clinical status, discrete but progressive splenomegaly should be highlighted. Porphyria, glucose-6-phosphat dehydrogenase deficiency, PNH, and C1 inhibitor deficiency were excluded during our examinations. Molecular genetic testing urged by autoinflammatory disease confirmed a homozygous form of the MEFV gene mutation and established the diagnosis of familial Mediterranean fever.

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Orvosi Hetilap
Authors: Barbara Nagy, Zsuzsanna Nagy-Lőrincz, Márta Bakacs, Éva Illés, Eszter Sarkadi Nagy, Gergő Erdei, and Éva Martos

.] Táplálkozás, Anyagcsere, Diéta. 1995; 1: 31–36. [Hungarian] 10 Breymann C. Iron deficiency anemia in pregnancy. Semin Hematol. 2015; 52: 339–347. 11 Vos T, Flaxman

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Acta Veterinaria Hungarica
Authors: Darko Davitkov, Milos Vucicevic, Jevrosima Stevanovic, Vanja Krstic, Snezana Tomanovic, Uros Glavinic, and Zoran Stanimirovic

Canine babesiosis is a frequent and clinically significant tick-borne disease. Sixty symptomatic dogs with clinical findings compatible with babesiosis were included in this study conducted in Serbia. After clinical examination, blood samples were taken for microscopic examination, complete blood count (CBC), Canine SNAP 4Dx Test, DNA analyses and sequencing. The main clinical signs included apathy, anorexia, fever, brown/red discoloration of urine, pale mucous membranes, icterus, splenomegaly, and vomiting. The main clinicopathological findings in Babesia infections were a slight to severe thrombocytopenia and a mild to very severe normocytic normochromic anaemia. Microscopic evaluation revealed 58 positive samples with the presence of large and small intraerythrocytic piroplasms in 57 and 1 sample(s), respectively. No co-infections were found using SNAP test. Two Babesia species, B. canis (58/60) and B. gibsoni (2/60), were differentiated by polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP). Species identification was further confirmed by sequencing PCR products of B. gibsoni samples and six randomly selected B. canis samples. All dogs were treated with imidocarb dipropionate (6.6 mg/kg of body weight), given intramuscularly twice at an interval of 14 days. This report presents the first molecular evidence of the occurrence of B. gibsoni and B. canis, confirmed by DNA sequencing, in sick dogs from Serbia.

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In order to investigate the effects of exposure to possible environmental pollutants such as Cd, Pb and Hg on haematological and serum biochemistry values, New Zealand White female rabbits were treated orally with distilled water solutions of CdSO4·H2O, Pb(NO3)2 and HgCl2 (n = 4/treatment) in concentrations of 2.3, 4.1, and 30 mg/kg dry matter, respectively, for 28 days. The initial concentrations of Cd, Pb, and Hg in serum were significantly increased by the treatment. Exposure to Pb significantly decreased the red blood cell (RBC) count, haemoglobin (Hgb) concentration and the haematocrit (Hct) value. The Zn-protoporphyrin concentration did not change as a result of Pb exposure. Pb and Hg loading significantly increased the aspartate aminotransferase (AST) activity. Alanine aminotransferase (ALT) activity was also increased by both Hg and Cd exposure. Comparing the treated and the control rabbits, all the trace elements studied significantly reduced the activity of enzymes in the pancreatic tissues. The haematological results indicate that hyperchromic macrocytic anaemia developed in rabbits treated with Pb. The increased activities of both AST and ALT indicate pathophysiological changes of the liver parenchyma, which was verified by focal fatty infiltration seen histopathologically. Cd exposure could exert a toxic effect on the kidneys, although the slight tubulonephrosis developed would not possibly affect the renal function. The reduced activities of amylase, trypsin, protease and lipase induced by Cd, Pb and Hg suggest toxicity to the pancreas.

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Acta Veterinaria Hungarica
Authors: Zoltán Demeter, Elena Palade, Éva Balogh, Csaba Jakab, Róbert Farkas, Balázs Tánczos, and Sándor Hornok

Here we report a case of canine babesiosis with unusual morphology of the causative agent. A male, seven-week-old Labrador retriever puppy, exhibiting severe anaemia and haemoglobinuria, was presented at the Clinic of Internal Medicine in February 2011. The puppy was euthanised. The most relevant pathological changes were icterus, severe splenomegaly, generalised lymphadenopathy and haemoglobin nephrosis. Samples were collected from various organs for histology within one hour post mortem. Impression smears were also prepared from the spleen after overnight storage at 4 °C. Tissue sections and smears showed the presence of multiple, coccoid intraerythrocytic bodies that measured 1–2 μm and resembled small babesiae. No large piroplasms were seen. DNA was extracted from the spleen, and a conventional PCR was performed for the amplification of a 450-bp region of the 18S rRNA gene of piroplasms. The causative agent was identified as Babesia canis canis, with 99% sequence identity to other European isolates. Sequence identity to B. gibsoni was only 91%. This is the first account to verify that the morphology of the large canine piroplasm, B. canis, can be uniformly small babesia-like post mortem or following the storage of tissue samples.

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Acta Veterinaria Hungarica
Authors: Nikitas Prassinos, Katerina Adamama-Moraitou, Haralabos Ververidis, Tilemachos Anagnostou, and Stefanos Kladakis

A 1.5-year-old German Shepherd mixed breed dog was admitted with mild haemorrhage from the vulva and a perineal mass of 24-hour duration, which had been first observed immediately after parturition. Parturition had occurred at low ambient temperature, and only one puppy survived out of the seven oversized fetuses. The dog was in poor body condition, dehydrated, hypothermic, depressed, non-ambulatory and in a state of shock. Intestinal loops, the urinary bladder and the uterine horns and body were protruding from the vulva. A true vaginal prolapse was also observed. The abdominal viscera were flushed with warm sterile saline solution, protected and maintained wet. The laboratory findings included moderate anaemia, leukocytosis, hypoalbuminaemia, azotaemia and elevated liver enzyme activities. Stabilisation of the dog’s general condition was attempted before surgery. Antimicrobial and analgesic drugs were also administered. After exploratory laparotomy the protruding organs, which were in good condition, were reduced. A recent rupture in the vaginal wall, approximately 6 cm long, was observed. Ovariohysterectomy and partial vaginectomy were performed. The preoperative course of therapy was continued, but the bitch died 12 hours later. The probable cause of vaginal rupture and evisceration in this bitch was tenesmus and/or trauma due to the oversized fetuses.

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