Zoltan Barth er doktorgradsstudent fra Universitetet i Oslo (UiO) og University of Pécs i Ungarn. Hans doktorgradsoppgave er et samarbeid mellom Bjørknes Høyskole og de to nevnte universitetene, samt Oslo Universitetssykehus (OUS). Zoltan ble uteksaminert som Medical Doctor (MD) i 2013 ved University of Pécs, et ungarsk universitet Bjørknes Høyskole har samarbeidet med i mange år. Han startet sine doktogradsstudier i september 2013 da han kom til Oslo for første gang for å delta i et klinisk prosjekt med revmatiske pasienter. 

Zoltan, please tell us about your PhD Project!

The basis of my international PhD work has been established by the fruitful cooperation between Bjorknes University College and the Medical School of University of Pécs.

My supervisors met on diverse occasions in the course of this collaboration, and proposed a scientific cooperation besides educational, to promote this successful partnership. I came to Oslo in September 2013 as the initiative of this proposed collaboration. I am involved in an ongoing clinical study investigating patients with juvenile dermatomyositis. This cross-sectional cohort study was established in 2005, to investigate outcomes, predisposing factors and early predictors of unfavorable disease course in juvenile dermatomyositis. All the patients and controls were included in the study by my Norwegian supervisors, Helga Sanner at OUS-Rikshospitalet, and Ivar Sjaastad, OUS-Ullevål.

Juvenile dermatomyositis is the childhood onset type of dermatomyositis; a rare, autoimmune disease with unknown origin. The disease primarily affects the skin and muscles, meaning that most of the patients have skin rashes, muscle weakness and/or muscle pain, because of a sterile/autoimmune inflammatory process affecting these tissues. Some decades ago, there was no treatment available and most of the patients died or became physically disabled due to the disease. Nowadays, we have effective drugs (corticosteroids and other immunosuppressive drugs) and the long-term outcomes are relative good. However, due to the chronic disease course (there is no curative therapy), patients may develop damage in different organ systems, such as in the respiratory-, gastrointestinal- or cardiovascular systems.

Previously the research group I’m a part of has published interesting results in these patient cohort regarding the activity of the disease, levels of inflammatory markers and other laboratory parameters, pulmonary and cardiac function, among others. Continuing this work, I evaluate (1) long term ECG recordings and (2) microscopic pictures from the participants’ nailfold-capillaries, in order to assess arrhythmias, heart rate variability, autonomic nervous system function, and microvascular damage.

Our aim is to assess arrhythmias, autonomic function, and microvascular damage, furthermore, to correlate these findings to different disease outcomes. This work may help the better understanding of the disease mechanism in juvenile dermatomyositis. This work also aims to find predictors for specific and/or overall organ damages, which may be helpful to diagnose patients with high risk for complications, and to treat them as early as possible.

 

What does a day look like for a PhD-student?

PhD work is very heterogeneous, depending on many factors (e.g. scientific field, study design, etc.), and on the actual state of the project. My schedule is especially busy because of the cooperation with the Medical School in Pécs, where I have obligations at the Heart Clinic (Department of Interventional Cardiology).

In Oslo, I work at the Institute for Experimental Medical Research in Ullevål. The institute’s main profile is heart failure research: both on molecular and cellular levels, also performing animal and human studies. My project does not relate closely to heart failure research; however, I believe that this working environment with expertise in cardiac research and the different types of projects ensure a fascinating and effective scientific milieu for all PhD students and Postdocs at the institute.

But returning to my PhD project, it started with literature search and research strategy set up – which is quite typical. At the beginning, you have to get the relevant background data and knowledge of the field of your interest. I started to read articles about long term ECG analysis, about the relevance of arrhythmias and heart rate variability, both in general, and in diseases which are similar to juvenile dermatomyositis. I also consulted with cardiologist experts and nurses regarding data processing, data preparation and analysis. In health and biological sciences, it is extremely important to network and discuss with experts, who can answer your questions and tell their experiences. Meanwhile, I started the work with the preparation of the recordings. This has been really time-consuming, as you can imagine, without any experience in this field – if you consider the length of 118 ECG recordings, each containing 24 hours of data about heart function. Finally, the analysis has been done by using software. After all of this work, we had an excessive amount of data, which had to be interpreted, correlated to previous findings and put in the clinical context, in order to find the final message of the study, and to publish it.

We have found interesting results, and the article was just recently published in Revmatology. (In Juvenile Dermatomyositis, heart rate variability is reduced, and associated with both cardiac dysfunction and markers of inflammation.)

 

You mentioned that you had two projects??

Yes, now I am working on the “Capillaroscopy project”. Capillaroscopy means that we take microscopic pictures from the fingers’ nailfolds, in order to analyze the capillaries based on their density, shape and size. This method is one of the clinical routine examinations in the differential diagnosis of certain connective tissue diseases (rheumatic diseases), among others. We hypothesize that there is connection between capillaroscopic pattern and cardiac function in juvenile dermatomyositis.

I participated at the ‘Course and Conference on Capillaroscopy in Rheumatic Diseases’. It was held in Genova, organized by the experts of this field. It was really useful, especially because there is limited scientific experience with this method in Oslo. However, there are experts in clinical capillaroscopy, such as my main supervisor, Helga Sanner (which also is an associate professor at Bjørknes College in addition to her main position at OUS-Rikshospitalet.

We had more than 2000 capillaroscopic pictures in the study. I made a specific evaluation form for this project, used it for the analysis. I have now recently published the second study on these data.

 

What other obligations do you have as a PhD student?

There are different obligations beyond the scientific work, e.g. PhD courses. I have done a couple of the courses offered both by University of Oslo and University of Pécs. Some of them are mandatory, others are electives. For example, the statistics course was an elective course, but really useful, so I am happy that I was able to participate in that course.

Otherwise, there are conferences and meetings, where we can learn from each other, asking and discussing our questions. PhD students have to present their data; this requires thorough preparation and training, which is part of the PhD education.

Important to note, that the PhD programs are not only aiming for scientific results, but also has to ‘produce’ excellent, highly qualified academic individuals.

I believe that this part is just as important as research itself. PhD does not only mean that someone is able to perform scientific work, but also able to understand and interpret others’ scientific work and able to present data properly; as well as to teach/educate both scientific and «common people”.

Read more about Zoltan´s publications