Ioan Gherghina

Latest posts by Ioan Gherghina (see all)

Selective IgA deficiency and allergic diseases - 31/07/2015
DEFICITUL SELECTIV DE IgA SI BOLILE ALERGICE - 31/07/2015
Macrophage activation syndrome - 31/07/2015

Articole semnate de acelasi autor in Revista Romana de Pediatrie:

Selective IgA deficiency and allergic diseases

Revista Romana de PEDIATRIE | Volumul LX, Nr. 4, An 2011

ISSN 1454-0398 | e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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Promoting Global Health

The published medical research literature is a global public good. Medical journal editors have a social responsibility to promote global health by publishing, whenever possible, research that furthers health worldwide.

Alexis-Virgil Cochino, Florin-Dan Popescu and Ioan Gherghina

ABSTRACT

Objectives. Review of literature data on the association of DSIgA with allergic diseases.

Materials and methods. We studied PubMed medical database, and from a total of 99 articles published between 1973-2011 20 articles were selected as being significant for the association.

Results. The first studies on this association goes back over 35 years. Studies published during this time cite association with asthma, atopic dermatitis, allergic rhinitis/conjunctivitis, urticaria, drug and food allergies and transfusion anaphylaxis. Sometimes, the relationship between allergic diseases and DSIgA can be bidirectional, as in allergic rhinitis or atopic dermatitis. Sometimes DSIgA can even represent an aggravating factor in allergic disease.

Conclusions. Although the literature offers few data on the association of these diseases, respiratory allergies and atopic dermatitis appear to be more common in patients with DSIgA. Some studies even claim DSIgA aggravating effect in these diseases. Association with celiac disease and transfusion anaphylaxis should not be neglected. Allergic manifestations may be those that determine the patient to the doctor, so a significant percentage of DSIgA is detected during allergology appointments.

Key words: immunodeficiency, selective IgA deficiency, allergy, asthma, atopic dermatitis

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Alexis-Virgil Cochino

DEFICITUL SELECTIV DE IgA SI BOLILE ALERGICE

ISSN 1454-0398 | e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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Promoting Global Health

Alexis-Virgil Cochino, Florin-Dan Popescu and Ioan Gherghina

REZUMAT

Obiective. Revizuirea datelor din literatura de specialitate privind asocierea DSIgA cu boli alergice.

Material şi metodă. S-a cercetat baza de date medicale PubMed şi, dintr-un număr total de 99 de articole publicate în intervalul 1973-2011, au fost selectate 20 de articole semnificative pentru asocierea studiată.

Rezultate. Primele studii privind această asociere datează de peste 35 de ani. Studiile publicate în acest interval citează asocieri cu astmul, dermatita atopică, rinita/conjunctivita alergică, urticaria, alergiile medicamentoase şi alimentare şi anafilaxia posttransfuzională. Uneori, relaţia dintre DSIgA şi bolile alergice poate fi bidirecţională, cum este cazul rinitei alergice sau a dermatitei atopice. Alteori, DSIgA poate chiar să reprezinte un factor agravant al bolii alergice.

Concluzii. Deşi în literatura de specialitate există puţine date privind asocierea acestor afecţiuni, alergiile respiratorii şi dermatita atopică par a fi mai frecvente la pacienţii cu DSIgA. Unele studii susţin chiar un efect agravant al DSIgA în aceste boli. Nu trebuie neglijată asocierea DSIgA cu boala celiacă şi reacţiile anafilactice posttransfuzionale. Manifestările alergice pot fi cele care determină pacientul să se prezinte la medic, de aceea un procent important din DSIgA este depistat cu ocazia consulturilor alergologice.

Cuvinte cheie: imunodeficienţe, deficit selectiv de IgA, alergie, astm, dermatită atopică

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Alexis-Virgil Cochino

Macrophage activation syndrome

Revista Romana de PEDIATRIE | Volumul LXI, Nr. 1, An 2012

ISSN 1454-0398 | e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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Promoting Global Health

Ioan Gherghina, Dumitru Matei, Constantin Pascu, Mirela Covăcescu, Alexis Cochino and Georgiana Nache

REZUMAT

Methods. Short case presentation of a possible macrophage activation syndrome (MAS) secondary to acute viral infections and presentation of a literature review on this subject.

Results. Seven year old boy hospitalized for high fever, chills, and alteration of general state, hepatosplenomegaly, peripheral and central adenomegaly, sudden onset of anemia and thrombocytopenia. Lab results also showed elevated triglycerides and ferritin, moderately high ESR, high CRP, presence of infl uenza B virus in faryngian swab (PCR). Acute myeloid leukemia was excluded on the base of bone marrow biopsy. Treatment was started with 400 mg/kg intravenous immunoglobulin and resulted in normalization of clinical and biological picture, including mesenteric adenopathy remission. MAS secondary to infl uenza B was a diagnosis consistent with the picture of the clinic, biologic and evolution pattern. As described in the literature, MAS represent the macrophage tissue expansion (or of the hystiocites), which is often triggered by infection (EBV, CMV) or changes in drug therapy of chronic rheumatic diseases (Still’s disease, SLE, vasculitic syndromes). Pathogenic mechanism of MAS is characterized by proliferation of macrophages, correlated with decreased cytotoxic function of NK cells and cytotoxic lymphocytes – often determined by mutations in the gene that encodes perforina, PRF1, or mutations in MUNC 13-4, another gene that is involved in the release of perforine into the immune synapse with a target cell.

Conclusions. The occurrence of MAS complicating an underlying disease (vasculitis, SLE) or acute infection is a vital element of aggravation and imminent danger that should be immediately diagnosed and vigorously treated.

Key words: macrophage activation, child

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Ioan Gherghina

SINDROMUL DE ACTIVARE MACROFAGICA

ISSN 1454-0398 | e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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Promoting Global Health

Ioan Gherghina, Dumitru Matei, Constantin Pascu, Mirela Covăcescu, Alexis Cochino and Georgiana Nache

REZUMAT

Metodă. Scurtă prezentare de caz a unui sindrom de activare macrofagică (MAS) secundar unei infecţii virale acute şi prezentare a unei revizuiri a literaturii de specialitate pe această temă.

Rezultate. Pacient în vârstă de 7 ani spitalizat pentru febră ridicată, frisoane, alterarea stării generale, hepatosplenomegalie, adenopatii periferice şi centrale, anemie şi trombocitopenie cu debut brusc. Rezultatele de laborator au arătat, de asemenea, trigliceride şi feritină crescute, VSH moderat crescut, CRP crescută, prezenţa virusului gripei B în exsudatul faringian (PCR). Leucemia acută mieloidă a fost exclusă pe baza biopsiei de măduvă osoasă. Tratamentul cu imunoglobuline intravenoase a fost început cu 400 mg/kg şi a dus la normalizarea tabloului clinic şi biologic, inclusiv la remiterea adenopatiei mezenterice. MAS secundar infecţiei cu virusul gripal B a fost un diagnostic în concordanţă cu aspectul clinic, biologic şi evolutiv al cazului. După cum este descris în literatura de specialitate, MAS reprezintă expansiunea ţesutului macrofagic (sau a histiocitelor), care este adesea declanşată de infecţie (EBV, CMV) sau de modificări în terapia unor boli reumatice cronice (boala Still, LES, sindroame vasculitice). Mecanismul patogenic al MAS este caracterizat prin proliferarea macrofagelor, corelată cu scăderea funcţiei citotoxice a celulelor NK şi a limfocitelor citotoxice – adesea determinate de mutaţii ale genei care codifică perforina, PRF1, sau mutaţii in MUNC 13-4, o altă genă care este implicată în eliberarea perforinei în sinapsa imunitară cu o celulă ţintă.

Concluzii. Apariţia MAS ca o complicaţie a unei boli subiacente (vasculită, LES) sau infecţii acute este un element de agravare şi de pericol iminent care ar trebui să fie imediat diagnosticat şi viguros tratat.

Cuvinte cheie: activare macrofagă, copil

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Ioan Gherghina

Bruton disease – case presentation and relevant studies comments

Revista Romana de PEDIATRIE | Volumul LXII, Nr. 3, An 2013

ISSN 1454-0398 | e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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Costin Nuţă and Ioan Gherghina

ABSTRACT

Bruton disease is a primary immunodeficiency consisting in severe hypogammaglobulinemia with a serious decrease of B cells by mutations at the level of Btk gene, causing severe recurrent infections that may result in death. Objectives. Presentation of a suggestive case of severe hypogammaglobulinemia with invalidating infectious complications up to the date when the Bruton disease diagnosis was set and the substitution treatment was initiated. Methods. From all cases treated by us as part of the Primary Immunodeficiency Program conducted within “Alfred Rusescu” IOMC, a Bruton disease case was selected; such case displayed specific clinical symptoms, diagnosis methods, treatment and evolution while it was under examination. Results. The selected case was characterized by an early onset of lung infectious complications that resulted in right basal bronchiectasis and osteo-articular infections. The Bruton disease diagnosis was set at the age of 15, when the substitution treatment was initiated. Such treatment improved the prognosis. Conclusions. The presence of frequent and severe infectious episodes in children requires the physician to analyze the possibility of a congenital immunodeficiency. In Bruton disease, the immunoglobulin substitution treatment is the first line treatment.

Key words: Bruton disease, XLA, X linked agammaglobulinemia, hypogammaglobulinemia

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Costin Nuţă

BOALA BRUTON – PREZENTARE DE CAZ SI COMENTARII DIN LITERATURA

ISSN 1454-0398 | e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

ICMJE- Recommendations

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Costin Nuţă and Ioan Gherghina

REZUMAT

Boala Bruton reprezintă o imunodeficienţă primară caracterizată prin hipogamaglobulinemie severă, cu scăderea drastică a limfocitelor B prin mutaţii la nivelul genei Btk, având drept consecinţă infecţii recurente severe ce pot evolua până la deces.

Obiective. Prezentarea unui caz sugestiv pentru o hipogamaglobulinemie severă cu complicaţii infecţioase invalidante până la momentul precizării diagnosticului de boală Bruton şi introducerii tratamentului substitutiv.

Metode. Din cazuistica noastră, parte a Programului de Imunodeficienţe Primare din cadrul IOMC „Alfred Rusescu“, a fost selectat un caz de boală Bruton, fiind prezentate manifestările clinice caracteristice, metodele de diagnostic, tratamentul şi evoluţia pe durata monitorizării.

Rezultate. Cazul selectat s-a caracterizat prin debut precoce al complicaţiilor infecţioase pulmonare care s-au soldat cu bronşiectazie bazală dreaptă şi infecţii osteoarticulare. Diagnosticul de boală Bruton a fost precizat la vârsta de 15 ani, când s-a introdus tratament substitutiv care a ameliorat prognosticul.

Concluzii. Prezenţa unor episoade infecţioase frecvente şi severe la copil impune explorarea unei imunodeficienţe congenitale. În boala Bruton tratamentul substitutiv imunoglobulinic este de primă linie.

Cuvinte cheie: boala Bruton, XLA, agamaglobulinemie X linkată, hipogamaglobulinemie

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Costin Nuţă

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Ioan Gherghina

Latest posts by Ioan Gherghina (see all)

Articole semnate de acelasi autor in Revista Romana de Pediatrie:

Selective IgA deficiency and allergic diseases

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