Search

Despite the abundance of data on the COVID-19 vaccine-induced immune activation, the impact of natural autoantibodies (nAAbs) on these processes is less well defined. Therefore, we investigated potential connections between vaccine efficacy and nAAb levels. We were also interested in the impact of immunomodulatory therapies on vaccine efficacy. Clinical residual samples were used for the assessment of the COVID-19 vaccine-elicited immune response (IR) (n=255), as well as for the investigation of the immunization-associated expansion of the nAAb pool (n=185). In order to study the potential interaction between immunomodulatory therapies and the vaccine-induced IR, untreated, healthy individuals and patients receiving anti-TNFα or anti-IL-17 therapies were compared (n total =45). In-house ELISAs (anticitrate synthase, anti-HSP60 and-70) and commercial ELISAs (anti-SARS-CoV-2 ELISAs IgG, IgA, NeutraLISA and IFN-γ release assay ‘IGRA’) were applied. We found significant differences in the IR given to different vaccines. Moreover, nAAb levels showed plasticity in response to anti-COVID-19 immunization. We conclude that our findings may support the theorem about the non-specific beneficial ‘side effects’ of vaccination, including the broadening of the nAAb repertoire. Considering immunomodulation, we suggest that anti-TNFα and anti-IL17 treatments may interfere negatively with MALT-associated IR, manifested as decreased IgA titers; however, the modest sample numbers of the herein presented model might be a limiting factor of reaching a more comprehensive conclusion.

Bullous pemphigoid is the most common autoimmune subepidermal blistering disease in elderly people. The disease typically manifests on the skin and the mucosa with tense bullae or erosions with surrounding erythema, but in up to 20% of afected patients, bullae may be completely absent. The localized or generalized skin lesions usually present with itch. The author presents the rare, atypical forms of the disease, the most common triggering and predisposing factors, and the new therapeutic recommendations according to the European guidelines.

Dermatomyositis (DM) is an idiopathic inflammatory myopathy with muscle weakness and specific cutaneous findings. The proximal weakness of the limb muscles is present in the majority of the patients, in a proportion of them however the muscle inflammation is preceded by the skin symptoms with several months, and in 40%, skin symptoms are the only manifestations of the disease. While, there may have many difficulties in differential diagnosis of DM without myositis, dermatologists have a major role in the early recognition of the disorder and in the initiation of the proper therapy

Background Numerous generic, skin- and disease-specific health-related quality of life (HRQoL) measures are available for patients with hidradenitis suppurativa (HS). Yet, robust psychometric evidence is lacking in many aspects of these outcome measures. Objectives We sought to determine convergent and known-groups validity of multiple generic and skin-specific HRQoL measures and to identify predictors of impaired HRQoL in patients with HS. Methods Between 2017 and 2019, a multicentre cross-sectional study was carried out involving 200 consecutive HS patients. HRQoL outcomes included the EQ-5D-5L, EQ visual analogue scale (EQ VAS), Skindex-16, Dermatology Life Quality Index (DLQI) and DLQI-Relevant (DLQI-R). Disease severity was graded by HS-Physician's Global Assessment (HS-PGA) scale and the Modified Sartorius scale (MSS). Results Overall, 77%, 56%, 51%, 46% and 28% reported problems in the pain/discomfort, usual activities, anxiety/depression, mobility and self-care dimensions of EQ-5D-5L. Mean ± SD EQ VAS, DLQI and DLQI-R scores were 64.29 ± 22.68, 11.75 ± 8.11 and 12.19 ± 8.33, respectively. Skindex-16 responses indicated that the emotional burden of HS (64.55 ± 29.28) far exceeded those of functioning (49.40 ± 34.70) and physical symptoms (46.74 ± 29.36). EQ-5D-5L, EQ VAS, DLQI, DLQI-R and Skindex-16 total scores had moderate or strong correlations with each other (range: |0.487| to |0.993|), weak or moderate correlations with HS-PGA (|0.350| to |0.433|) and weak correlations with MSS (|0.324| to |0.389|). DLQI-R slightly outperformed DLQI both in terms of convergent and known-groups validity. Being female, lower education level, more severe disease and genital involvement were associated with worse HRQoL (P Conclusion This study provides high-quality evidence that among skin-specific outcomes, the DLQI, DLQI-R and Skindex-16, and among generic instruments, the EQ-5D-5L are suitable to be used in HS patients. In future research, we recommend the use of existing well-validated HRQoL tools instead of developing new measures for each study. The development of composite measures that combine physician- and patient-reported outcomes is not supported by evidence in HS. [Correction added on 25 July 2020, after first online publication: in the Abstract section, the ± signs were missing and have been added to this version.].

A gyermekkorban kialakuló kötődési kapcsolatok lényegesen meghatározzák az egyén későbbi szociális viselkedését. A gyermek szociális kapcsolatainak alakulásában nagy változásokat eredményez az iskolába járás megkezdése (Vajda, 1997). A gyermekek alapvető biztonságszükségletére vonatkozóan Brent (2010) a szülői támogatás mellett a pedagógus támogatásának jelentőségét hangsúlyozza. Az utóbbi évtizedben számos kutatás központi témájává vált a diák-pedagógus kapcsolatának vizsgálata, amelynek mérésére gyakran a Student-Teacher Relationship Scale (STRS, Pianta, 2001) kérdőívet alkalmazzák. Európa több, esetenként igen jelentős szociális, kulturális és oktatási különbségekkel rendelkező országában megvizsgálták már a mérőeszköz alkalmazhatóságát (például Görögországban, Hollandiában). Jelen tanulmány az STRS-kérdőív magyar nyelvű változatának megbízhatóságát, érvényességét és alkalmazhatóságát mutatja be. A kutatás során 183 tanulóra vonatkozóan 14, magyarországi és vajdasági általános iskola alsó tagozatain tanító pedagógus töltötte ki az STRS kérdőívet. A feltáró faktorelemzések kimutatták, hogy megfelelő és elfogadható faktorstruktúra a mérőeszköz öt tételének elhagyásával érhető el. Öt kérdőívtétel mellőzésével a mérőeszköz reliabilitása (α=0,82) megfelelőnek bizonyul, és az elméleti modellben azonosított három alskála mindegyike (konfliktus, közelség és függőség) megbízható. Eredményeink alapján az STRS magyar oktatási környezetben is megfelelő eszköznek bizonyul a tanuló-pedagógus kapcsolatának vizsgálatában.

Az elméleti jellegű szakirodalmi tanulmány betekintést nyújt a tanító és a diákok közötti pedagógiai kapcsolat sajátosságaiba és mélyebb megismerésének lehetőségeibe. Jelen tanulmányban a pedagógusok és a kisiskolás diákok kapcsolatának értelmezéséhez a kötődés nyújtja az általános elméleti kereteket. A tanulmány célja, hogy górcső alá vegye azokat a lehetséges tényezőket és színtereket, amelyek a kisiskolás tanulók pedagógushoz fűződő kapcsolatát befolyásolhatják. A témával foglalkozó irodalom a pedagógus-tanuló kapcsolatát egy komplex rendszerben helyezi el, melynek befolyásoló tényezői között meghatározó szerepet töltenek be az intézményes és intézményen kívüli nevelés színterei is. A tanulmány foglalkozik a kötődés szerepével, a magatartási és a tanulási problémákkal, valamint a szülő-gyermek kapcsolat pedagógus-gyermek kapcsolatára gyakorolt hatásával. A munka kitér azokra a nemzetközi fejlesztő programokra, amelyek alkalmasak lehetnek a tanító-tanuló közötti kapcsolat pozitív irányú változtatására. Bemutatja azt a mérőeszközt, amely a pedagógus szemszögéből teszi lehetővé a tanító-tanuló kapcsolatának feltárását (Student-Teacher Relationship Scale, STRS, Pianta, 2001), ugyanakkor felvázol olyan mérési lehetőségeket is, amelyeknél a diákok nézőpontjából történik a pedagógiai kapcsolat megítélése.

This study’s primary aim is to validate a research instrument in Iraqi Kurdistan middle and secondary schools to explore learners’ perspectives concerning social constructivist learning environments and e-learning outcomes. The research instrument was updated and devised based on Aldridge, Fraser, Taylor, and Chen's (Aldridge et al., International Journal of Science Education 22:37–55, 2000) Constructivist Learning Environment (CLES) Survey. Additionally, it also contains two newly developed rating scales that have been taken from Luckay and Laugksch (Luckay and Laugksch, Research in Science Education 45:1–22, 2015), and a perceived e-learning outcomes scale adopted from Sultan, Woods, and Koo (Sultan et al., Educational Technology and Society 14:149–163, 2011). The instrument included seven prominent social constructivist learning dimensions and plus perceived e-learning outcomes, namely: Respect for Difference, Learner Investigation, Critical Voice, Learner Negotiation, Individual Relevance, Shared Control, Uncertainty and Perceived e-Learning Outcomes. For this study, empirical data were gathered from 1289 upper primary and secondary school students in the Iraqi Kurdistan Region. The research instrument possessed factor structure, discriminant validity, and internal consistency reliability based on the results of data analysis. Consequently, the validity and reliability of Arabic language and Kurdish language versions of the survey were verified. Hence, the principal data are sufficient for additional empirical research involving path model evaluation in order to discern any correlations between the variables included in the research model.

Psoriasis is a systemic inflammatory skin disorder that can be associated with sleep disturbance and negatively influence the daily rhythm. The link between the pathomechanism of psoriasis and the circadian rhythm has been suggested by several previous studies. However, there are insufficient data on altered clock mechanisms in psoriasis to prove these theories. Therefore, we investigated the expression of the core clock genes in human psoriatic lesional and non-lesional skin and in human adult low calcium temperature (HaCaT) keratinocytes after stimulation with pro-inflammatory cytokines. Furthermore, we examined the clock proteins in skin biopsies from psoriatic patients by immunohistochemistry. We found that the clock gene transcripts were elevated in psoriatic lesions, especially in non-lesional psoriatic areas, except for rev-erbα, which was consistently downregulated in the psoriatic samples. In addition, the REV-ERBα protein showed a different epidermal distribution in non-lesional skin than in healthy skin. In cytokine-treated HaCaT cells, changes in the amplitude of the bmal1, cry1, rev-erbα and per1 mRNA oscillation were observed, especially after TNFα stimulation. In conclusion, in our study a perturbation of clock gene transcripts was observed in uninvolved and lesional psoriatic areas compared to healthy skin. These alterations may serve as therapeutic targets and facilitate the development of chronotherapeutic strategies in the future.

Introduction: Cost-of-illness studies are widely used for healthcare decision-making; however, no such study is available in pemphigus from the societal perspective. The purpose of this analysis wa...

BACKGROUND The Dermatology Life Quality Index (DLQI) rates 'not relevant' responses (NRRs) as the item on the questionnaire having no impact on the patients' lives at all. The DLQI-Relevant (DLQI-R) is a recently developed scoring that adjusts the total score of the questionnaire for the number of NRRs indicated by a patient. OBJECTIVES To compare the discriminatory power of the original and DLQI-R scoring approaches in terms of absolute and relative informativity. METHODS Cross-sectional data from 637 patients with morphea, pemphigus and psoriasis were used for the analyses. To assess absolute and relative informativity, Shannon's index and Shannon's evenness index were calculated for the 10 items on the questionnaire and for DLQI and DLQI-R total scores. RESULTS Mean DLQI and DLQI-R scores of patients were 6·13 vs. 6·91. In the subset of patients with NRRs (n = 261, 41%), absolute informativity was higher with the DLQI-R scoring for all eight items with NRR options in all three conditions. The DLQI-R exhibited a better relative informativity in 8, 8 and 6 items in pemphigus, morphea and psoriasis, respectively. The DLQI-R led to an improvement in average item-level informativity in all DLQI score bands up to 20 points. Regarding total scores, the DLQI-R produced both a higher absolute and relative informativity in all three conditions. CONCLUSIONS In patients with morphea, pemphigus and psoriasis, DLQI-R scoring improves the discriminatory power of the questionnaire by benefiting from the additional information in NRRs. DLQI-R scoring may be useful both in clinical practice and research. A scoring chart has been developed to aid physicians with scoring. What's already known about this topic? The original scoring of the Dermatology Life Quality Index (DLQI) rates 'not relevant' responses as the item of the questionnaire having no impact on the patients' lives at all. DLQI-Relevant (DLQI-R) is a new scoring developed in 2018 that adjusts the total score of the questionnaire for the number of 'not relevant' responses indicated by patients. The discriminatory power of the DLQI-R compared with the DLQI has not yet been investigated. What does this study add? In patients with psoriasis, pemphigus and morphea, DLQI-R scoring improves the discriminatory power of the questionnaire by benefiting from the additional information in 'not relevant' responses. What are the clinical implications of this work? DLQI-R scoring may help to more accurately quantify patients' health-related quality of life both in clinical practice and research. A scoring chart has been developed to aid physicians with scoring.

Contains fulltext : 215493.pdf (Publisher’s version ) (Open Access) BACKGROUND: The assessment of health-related quality of life (HRQoL) in patients with pemphigus is now of increasing interest due to the availability of highly effective new therapies. Preference-based HRQoL values or health utilities required for medical and financial decision-making are not yet available directly from pemphigus patients. OBJECTIVE: To obtain health utility values for current health and hypothetical health states from the perspective of pemphigus patients. METHODS: A cross-sectional questionnaire survey was carried out with pemphigus patients. Disease severity was rated by Autoimmune Bullous Skin Disorder Intensity Score (ABSIS). Patients were asked to evaluate their current health as well as three common hypothetical pemphigus health states [uncontrolled pemphigus vulgaris (PV), uncontrolled pemphigus foliaceus (PF) and controlled PV/PF] by using composite time trade-off (cTTO). Multiple regression was applied to explore determinants of utility values. RESULTS: Responses of 108 patients (64.8% women, mean age 57.4 years) were analysed. Mean ABSIS score was 11.6. The mean utility values for the hypothetical uncontrolled PV, uncontrolled PF and controlled PV/PF health states were 0.41, 0.52 and 0.66 with cTTO. The mean cTTO scores for current health were higher compared with the hypothetical health states (0.76; P < 0.001). Patients with higher ABSIS, worse pain intensity scores and those having a caregiver reported lower utility values for current health (P < 0.05). CONCLUSIONS: In pemphigus, HRQoL impairment expressed in utility values seems to be considerable, especially in comparison with other chronic dermatological conditions (e.g. psoriasis, atopic eczema, chronic hand eczema). These health utilities inform physicians, policymakers and funders about the overall extent of health loss in pemphigus and provide evidence to guide medical decisions and cost-effectiveness analyses of treatment strategies. Future research is needed to evaluate the caregiver burden in pemphigus.

Hidradenitis suppurativa (HS) is a, chronic skin disease affecting up to 1% of the population in Europe. This study aims to assess the cost-of-illness of HS from a societal perspective in Hungary and to analyze the predictors of costs.A multicentre, cross-sectional cost-of-illness study was performed among 200 adult HS patients. We evaluated direct medical (physician consultations, inpatient admissions, medical, and surgeries), direct non-medical (transportation and caregiving), and indirect costs (productivity loss).The mean annual cost-of-illness of HS was €6,791 per patient. The main cost components were productivity loss (53.3%), biological treatment (21.5%), and informal care (9.2%). Patients missed, on average, 26 and 63 days from work annually due to absenteeism and presenteeism, respectively. Male sex, more severe disease, gluteal involvement, and coexisting inflammatory bowel disease were associated with higher direct medical costs, while lower education level and worse quality-of-life outcomes predicted higher indirect costs.This is the first study to assess both direct and indirect costs in HS patients. HS imposes a substantial burden on patients and society, predominantly arising from productivity loss and biological therapy. Resource utilization data and cost-of-illness estimates provide valuable inputs into cost-effectiveness analyses of health interventions in HS.

Introduction Dermatitis herpetiformis (DH) is a chronic, pruritic, gluten-induced skin disorder characterized by subepidermal granular IgA deposition and a variable degree of enteropathy identical to that seen in coeliac disease. So far, there has been no European consensus about the management of DH. Methods The guidelines were created by small subgroups of a guideline committee consisting of 26 specialists from various medical fields and one patients' representative. The members of the committee then discussed the guidelines and voted for the final version at two consensus meetings. The guidelines were developed under the support of the European Academy of Dermatology and Venereology (EADV) and in collaboration with the European Dermatology Forum (EDF). Results The guidelines summarize evidence-based and expert-based recommendations (S2 level) for the management of DH (see Appendix). Conclusion These guidelines will improve the quality of management of DH and support dermatologists in their diagnostic and therapeutic decisions.

Purpose Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that affects up to 1% of the population in Europe. The EQ-5D is the most commonly used generic instrument for measuring health-related quality of life among HS patients. This study aims to compare the measurement properties of the two adult versions of EQ-5D (EQ-5D-3L and EQ-5D-5L) in patients with HS. Methods We recruited 200 consecutive patients with HS (mean age 37 years, 38% severe or very severe HS) to participate in a multicentre cross-sectional survey. Patients completed the EQ-5D-3L, EQ-5D-5L, Dermatology Life Quality Index (DLQI) and Skindex-16 questionnaires. Results More than twice as many different health state profiles occurred in the EQ-5D-5L compared to the EQ-5D-3L (101 vs. 43). A significant reduction in ceiling effect was found for the mobility, self-care and usual activities dimensions. A good agreement was established between the EQ-5D-3L and EQ-5D-5L with an intraclass correlation coefficient of 0.872 (95% CI 0.830–0.903; p < 0.001) that was confirmed by a Bland-Altman plot. EQ-5D-5L improved both the absolute and relative informativity in all dimensions except for anxiety/depression. EQ-5D-3L and EQ-5D-5L demonstrated similar convergent validity with DLQI and Skindex-16. EQ-5D-5L was able to better discriminate between known groups of patients based on the number of comorbidities and disease severity (HS-Physician's Global Assessment). Conclusion In patients with HS, the EQ-5D-5L outperformed the EQ-5D-3L in feasibility, ceiling effects, informativity and known-groups validity for many important clinical characteristics. We recommend using the EQ-5D-5L in HS patients across various settings, including clinical care, research and economic evaluations.

A fogalom – amelyet más terminusokkal társadalmi, vagy humán univerzálénak, illetve egyetemes társadalmi-kulturális jelenségeknek is neveznek – a kulturális antropológiából szivárgott át a neveléstudomány területére, és az emberiség számára nélkülözhetetlen társadalmi jelenségek megnevezésére szolgál (Brown, 2013), amelyek kulturális különbségektől függetlenül szükségszerűen megjelentek és megjelennek minden jelenkori, múlt- és jövőbeni társadalomban, kultúrában, emberi közösségben. Az univerzálék számos formában és absztrakciós szinten megnyilvánulhatnak. Jelen lehetnek a mindennapi életben, az emberi viselkedésben, a gondolkodásban és az érzelmekben, az intézményi struktúrákban és a tárgyi kultúra bizonyos formáiban is (pl. étkezés, öltözködés, lakáskörülmények, családstruktúrák, kormányzat, kommunikáció, szállítás, pénz vagy a gazdasági csere egyéb formái, vallás, hivatás, kikapcsolódás stb.).

BACKGROUND No studies to date have employed the EuroQoL EQ-5D questionnaire to assess health-related quality of life (HRQoL) in patients with pemphigus. OBJECTIVES To evaluate the HRQoL of patients with pemphigus by the EQ-5D and to analyse the convergent and known-groups validity of the EQ-5D in this patient population. METHODS Between 2014 and 2017, a multicentre cross-sectional study was carried out. Outcome measures included the five-level EQ-5D (EQ-5D-5L), Dermatology Life Quality Index (DLQI), Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and an average pain intensity visual analogue scale (VAS) for the past 3 months. RESULTS In total, 109 consecutive patients with pemphigus participated in the study (mean age 57 years; 64% women). Among the EQ-5D dimensions, the most problems were reported regarding pain/discomfort (50%), mobility (43%) and anxiety/depression (43%). No significant difference was found in mean EQ-5D index scores between patients with pemphigus vulgaris and those with pemphigus foliaceus (0·81 vs. 0·86, P = 0·14). The mean EQ-5D index scores of patients with limited, moderate, significant and extreme pemphigus were 0·88, 0·82, 0·72 and 0·67, respectively (P = 0·001). The number of comorbidities was associated with greater impairment in EQ-5D index scores (P < 0·001). DLQI (rs = -0·62, P < 0·001) and the average pain intensity VAS (rs = -0·59, P < 0·001) more strongly correlated with the EQ-5D index scores than did ABSIS (rs = -0·40, P < 0·001). CONCLUSIONS This is the first study employing the EQ-5D questionnaire in pemphigus. The EQ-5D is a valid measure of HRQoL in patients with pemphigus that can be useful both in clinical practice and in economic evaluations to assess the health gains associated with new effective treatments.