Morphea is a form of localized scleroderma characterized from the presence of sclerotic plates localized in the skin. It may be in the form of plaque morphea or generalized. Usually morphea does not associate with systemic involvement, however anti-nuclear antibody (ANA), ds-DNA, etc, are measured in peripherial blood.
Objectives
Idenification of pulmonary involvement in morphea.
Methods
We studied 18 patients diagnosed with morphea. All patient were tested for auto-antibodies: ANA, ENA, Scl-70, anti RNP, ANCAp/c, anti-Sm, anticentrome antibudies. The patient underwent chest x-ray, pulmonary function test, HRCT of the lung.
Results
12 from 18 patient that we studied resulted with plaque morphea (PM) and the other 6 patients with generalized morphea (GM). We found the presence of ANA the titer ≥1/320 in 8 patient (5 patient with GM and 3 patient with PM). The laboratory results for ds-DNA, ANCAp/c, Scl-70, anti-Sm, anticentromer antibody were negative in all patients. The chest x-ray resulted with interstitial involvement of the lungs of the reticular pattern in 7 patient (5 patient with GM and positive ANA and 2 patient with PM). HRCT in this patients showed the presence of interstitial infiltrate, while pulmonary function test resulted with mild to moderate restrictive syndrome.
Conclusions
Pulmonary involvement is found more frequently in the generalized form of morphea. The patient that resulted positive for ANA have a higher risk for developing pulmonary involvement. Anyway the pulmonary involvement in morphea is moderate.
Objective: Based on the flow cytometry multiparametric immunophenotyping methodology we studied some useful cell marker criteria needed for the practical differentiation of the chronic lymphocytic leukemia from other chronic limphoproliferative diseases with a leukemic component.Materials and Methods: The applied methodology is a four color flow cytometry multiparametric immunophenotyping technique using EDTA blood samples taken from 84 consecutive patients diagnosed with CLL through a preliminary clinical and white blood cell examination. The following fluorescent stained monoclonal antibodies were used: CD3, CD4, CD5, CD8, CD11c, CD19, CD20, CD23, CD25, FMC7 and kappa/lambda light chains.Results: From the 84 individuals tested, 2 out of them (2.4%) resulted with a abnormal T-cell population while 82 (97.6%) showed a pathological B cell line. 58 (69.1%) patients resulted with typical CLL markers (CD19+CD5+CD23+) while 5 (5.9%) of them presented a non typical chronic lymphocytic leukemia profile (CD19+CD5+CD23-). 19 (22.6%) out of patients displayed an abnormal CD19+CD5- B cell population. A statistically significant correlation was found between the clinical stage of CLL and the positivity for the CD38 marker (p=0.04).Conclusion: Flow cytometry immunophenotyping is a fundamental examination for the final diagnosis of chronic lymphocytic leukemia. The expression of CD38+ in CLL patients stands for a more advanced clinical stage.
BACKGROUND: Autoimmune hepatitis (AIH) is an unknown chronic disease characterized by hepatocellular inflammation with a tendency to progress to cirrhosis. AIH can present with symptoms of acute hepatitis with symptoms of chronic liver disease. AIH occurs globally; it is more commonly found in females. Autoantibodies such as antinuclear, smooth muscle, liver kidney microsome, and soluble liver antigen are used to aid in the diagnosis of AIH, which presents with a variety of symptoms that also contribute to the classification of AIH. AIM: Evaluation of anti-nuclear antibodies (ANA) and anti-smooth muscle antibodies (SMA) positivity in hepatic diseases, gastrointestinal diseases, viral hepatitis, and extra-hepatic diseases, providing better markers for the early diagnosis of AIH-type 1. MATERIALS AND METHODS: The study included 207 individuals. 62.4% of them were female. Regarding the diagnoses, we grouped them into 4 groups: hepatic diseases (n = 73), viral hepatitis B and C (n = 54), gastrointestinal diseases (n = 34), and extra-hepatic diseases (n = 46). Serum levels of ANA and anti-SMA were measured using an indirect immunofluorescence method following the manufacturer’s instructions (Aesku Diagnostics, Germany). Fluorescence intensity was interpreted semi-quantitatively based on negative control (0) and positive control (+4). RESULTS: The positivity of ANA and anti-SMA resulted as follows: In hepatic diseases 34.2% and 48%, in viral hepatitis B and C, ANA positivity was 14.8% and SMA positivity was 22.2%; in gastrointestinal diseases, ANA and SMA positivity were, respectively, 11.8% and 20.6%; and in extrahepatic diseases, positivity of ANA resulted in 32.6% and SMA in 26%. When compared to the viral hepatitis patient group, the ANA specificity for hemagglutination inhibition (HAI) was 85.2% and that of anti-SMA was 77.8%. The analysis of 46 extrahepatic patient groups provided an ANA specificity of 67.4% and an anti-SMA specificity of 74% for HAI. The comparison to gastrointestinal disease showed that ANA specificity for HAI was 88.2% and anti-SMA specificity was 79.4%. CONCLUSION: Diagnosing AIH is difficult because the clinical spectrum ranges from an asymptomatic presentation to an acute and severe disease. So in all cases, AIH must be suspected. Both males and females can develop AIH, but the disease is more common in females. Based on our diagnostic parameters, we can say that ANA and anti-SMA provide moderate sensitivity for AIH, but they are more specific to AIH type 1.
Objective: The aim of this study was to determine the diagnostic role of anti-cyclic citrullinated peptide antibodies, rheumatoid factor including RF isotypes and antinuclear antibodies in patients with rheumatoid arthritis.
Methods: This prospective study, conducted during the time interval from November 2010 to November 2012, included 126 consecutive patients sent from the Rheumatology Clinic of the University Hospital Center of Tirana. In all the RA patients, ACPA, RF screen, RF IgA, IgM, IgG isotypes and ANA were tested using respectively ELISA and indirect immunofluorescence methods. Results: The age of RA patients ranged from 17 to 78 years and 84% of them were females. The prevalence rates of ACPA, RF and ANA were 54.4 %, 44.4 % and 39.7% respectively. 35% of patients resulted positive for both specific serological markers (ACPA and RF). Positive results with two or three RF isotypes detected together were observed in 38.8% of patients. The RF isotype pattern IgM +/ IgA+ was found in 13.5% of patients, whereas RF isotype patterns IgA+/ IgG+ and IgM+/IgG+ have been detected at a rate of 1.6% respectively. The most frequent pattern (IgA+/IgM+/IgG+) RF was in 22.2% of RF screen positive patients.
Conclusion: The RF and ACPA positivity rates in the RA Albanian patients were found lower compared to the results reported in other populations. The ACPA positivity resulted higher compared to RF. An IgA RF positivity, combined with IgM RF positivity, are more frequently found than other RF isotypes. The specific RA markers studied, provide an important support for the diagnosis of RA.
Objective- To evaluate the efficiency of recombinant growth hormone for increasing adult height in children treated for idiopathic growth hormone deficiency and to evaluate the prognostic factor for height at the end of treatment. Design- Observational follow up study. Setting- Population based registry. Participants- All Albanian children diagnosed with idiopathic growth hormone deficiency who had attained final height. Their treatment started between 2001 and 2011. Main outcome measures- Annual changes in height, and change in height between the start of treatment and adulthood; the importance of the factors that influence on final height. Results- Adult height was obtained for 83 (55%) patients. The mean dose of growth hormone at start of treatment was 0.21 IU/kg/week for 29 patients and 0.24 IU/week for 54 patients. Height gain was 2.41±1.19 z-scores, resulting in an adult height of -1.98±1.12 z-score (girls, -2.05±1.27 z-score; boys, -1.95±1.20 z-score). Patients who completed the treatment gained 2.40±1.13 z-score of height in 4.0±2.0 years. Most of the variation in height gain was explained by regression towards the mean, patients' characteristics, and delay in starting puberty. Conclusion- Nearly all our patients with idiopathic growth hormone deficiency treated with growth hormone were able to achieve their genetic height potential. Despite starting treatment late, they managed to gain 2.40±1.13 HAZ score in height and the final height for majority of them (61.5%) was within the target height range. It was found that the final height had good correlation with the prediction height, HAZ score at beginning of treatment, change of HAZ score during the puberty, duration of treatment with GH, and pubertal stage at the start of therapy.
Objective : Biphosphonates are well known drugs for their efficacy in reducing fracture incidence, increasing bone density and improving bone micro architecture. The aim of this study is to evaluate the effectiveness of ibandronate and alendronate used in the treatment of osteoporosis in post-menopausal women over the age of 50 y at a specialized clinic in Tirana and to calculate the annual cost of osteoporosis treatment and perform a cost-effectiveness analysis. Methods : Study design: Retrospective study The patients included were all female, in menopause or post-menopause with T-score-1 to-6, treated with alendronate or ibandronate. The effectiveness of the treatment was calculated as the average percentage of change in bone mineral density (av. % of change in BMD) between 2011 and 2010 (baseline). The annual cost of the osteoporosis treatment according to the protocols and the cost of the DXA (dual x-ray absorptiometry) scan were calculated and the comparison of cost-effectiveness was performed. Results: Patients with osteoporosis treated with ibandronate (n=24) had a statistically significant higher average change from baseline compared to patients treated with alendronate (n=46) (Mann Whitney U = 66.0, p<0.01). The annual cost of treatment with ibandronate was 1.3 times higher than that of alendronate. The cost/efficacy ratio was 13.434 units for ibandronate and 31.677 units for alendronate type A1. Conclusion: Ibandronate is more effective and cost-effective than alendronate in the treatment of osteoporosis.
This study aims to assess the changes in COVID-19 seroprevalence among the adult urban population of Albania between July and December 2020, when the Wuhan strain of SARS-CoV-2 virus was still prevalent in the country.
