POS0854 SEX DIFFERENCES IN SYSTEMIC SCLEROSIS PATIENTS IN A SINGLE CENTER IN EASTERN EUROPE

Background:

The low overall prevalence of systemic sclerosis (SSc) and the low proportion of male patients have resulted in a scarcity of studies assessing sex differences in SSc patients, and contradictory results have often been observed.

Objectives:

The aim of the study was to assess differences in disease manifestations in a cohort of SSc patients according to gender.

Methods:

We performed a retrospective observational study using data extract from the EULAR scleroderma trials and research (EUSTAR) cohort 096.We looked at sex influence on disease characteristics at baseline and then focused on patients with at least 2 years of follow-up to estimate the effects of sex on disease progression and survival.

Results:

173 patients with SSc were available for the baseline analyses. Males were older (52,96 vs 45,88, p=0.009), were more likely to smoke (73% vs 7%, p<0,001), had more frequent diffuse skin involvement (73,1% vs 56,5%,p<0.01), higher modified Rodnan skin score (34,61% vs 17%, p=0.01) and activity score(84,62% vs 46,26%,p<0.001) and were more often associed with positive acute phase reactants (65,38% vs 38,77%, p=0.01). Severe interstitial lung disease was more common in males (59,09% vs 27,53%, p=0.003), also the presence of tendon friction rubs was more frequent in this sex group (23,07% vs 8,84%, p=0.032).

In the longitudinal analysis after a mean follow-up of 3,5(±0,65) years, male sex was associated with a higher risk of scleroderma renal crisis (OR:9.45 (1.49 to 59.69); p=0.004), digital contractures (OR:8,2 (3,1 to 21,9); p<0,001), arrhythmias (OR:3,37 (1.36 to 8,34); p=0.006), pulmonary fibrosis (OR: 3.56, (1.51 to 8.41); p=0.003), pulmonary hypertension (OR: 3.01 (1.19 to 7,59); p=0.016), severe vascular involvement (OR:2,86, (1,22 to 6,73); p=0.013) and low ventricular ejection fraction (OR: 2,84, (1.2 to 6,73); p=0.014). Males had significantly reduced survival time after diagnosis (p=0,004). The most frequent causes of death were scleroderma renal crisis in males and pulmonary hypertension in females.

Conclusion:

Although more common in women, SSc appears as strikingly more severe in men. Our results demonstrate a higher risk of severe organ involvement and poor prognosis in men. These results raise the point of including sex in the management and the decision-making process.

Disclosure of Interests:

None declared

Survival Rates and Complications for Zirconia-Based Fixed Dental Prostheses in a Period up to 10 Years: A Systematic Review

AIMS

The purpose of this study was to methodically review the literature concerning the success and survival rates of zirconia fixed dental prostheses (FDPs).

METHODS

A systematic search was conducted of MEDLINE, Elsevier and the Cochrane Library to identify relevant articles about zirconia FDPs. In order to obtain suitable articles, rigorous criteria were applied. The minimum follow-up period was five years.

RESULTS

From a total of 986 articles identified in the first electronic search, only 10 matched the inclusion criteria. A total of 368 patients with 430 zirconia FDPs were included in this systematic review. The survival rate was 89.43% ± 10.01% and chipping of the veneering ceramic occurred in 16.97% of the cases.

CONCLUSION

Zirconia-based fixed dental prostheses perform reasonably well and can serve as an alternative to metal-ceramic fixed dental prostheses.

THE PREVALENCE AND CLINICAL PROFILE OF MULTIPLE SCLEROSIS IN TIMIS COUNTY, ROMANIA

Introduction. Multiple sclerosis is a neurodegenerative disease for which correct prevalence and incidence data are mandatory to assess the long term health policy in terms of social and economic burden. The present study aims to evaluate the prevalence of MS and the distribution of clinical MS forms in Timis County, a region inhabited by 3.39% of the Romanian stable population according to the 2011 Romanian census, and is meant as a sample of the national situation. There have been no previous attempts to assess the MS prevalence status in Timis County. Material and methods. This study was conducted in a well-defined geographical area (i.e. the Timis County which lies in the Western region of Romania) exploring the prevalence of MS and the patients’ clinical profile. The information regarding MS patients was obtained using hospital records and the files of the patients treated and followed up in the Romanian National MS Program for treatment of MS. Results. The crude calculated prevalence was 53.6 per 100,000 inhabitants. The F:M ratio was 1.7 corresponding to a number of 220 (65.4%) females and 116 (34.5%) males. Discussions. This study is the first attempt to estimate the prevalence of multiple sclerosis in Timis County as part of an ongoing project of the National Romanian Society of Neurology to build up the Romanian MS Registry and our results indicate higher prevalence values than expected, fact due to an increased diagnostic accuracy provided by clear cut diagnosis criteria and MRI standardized magnetic resonance imagery procedures currently available.

MS TREATMENT OPTIMIZATION: FACTORS ASSOCIATED WITH POOR CLINICAL RESPONSE IN NAB POSITIVE PATIENTS

Background and purpose. Interferon beta (IFN beta) belongs to the first line of disease modifying therapy drugs in the treatment of relapsing-remitting multiple sclerosis being widely used in the chronic treatment of this pathology. The serum presence of the neutralizing antibodies (Nabs) has been shown to alter the treatment response, its routine applicability being still debated. In an observational study, we aimed to determine in the Nabs positive patients, correlations with other clinical factors which contribute to IFN beta decreased efficacy. Methods. We measured Nabs in 104 patients who were on IFN beta therapy (29.8% on IFN beta 1a s.c., 27.88% on IFN beta 1a i.m. and 42,3 on IFN beta 1b s.c.) for at least one year in our clinic. Serum was collected at 24 h after treatment injection to avoid transitory antibody peak (12-18 h post administration). We considered positive the patients with a titer higher than 20 TRU. Results. The prevalence of Nabs in our group of patients was 13.43% (42.85% IFN Beta 1b s.c., 50% IFN beta 1a s.c. and 7.14% IFN beta 1 a i.m.). Nabs positivity was associated with an increase in the relapse rate (for IFB beta 1a and 1b s.c. groups) and progression for IFN beta 1 b s.c. patient group. Conclusions. The routine clinical testing for Nabs should impact the clinical decision of switching therapy in multiple sclerosis patients that present with an increased number of relapses, EDSS progression or a higher number of MRI T2 lesions.

THE EPIDEMIOLOGY OF MULTIPLE SCLEROSIS IN ROMANIA AND ACROSS CENTRAL AND SOUTHEASTERN EUROPE – A HISTORICAL REVIEW

Background. Multiple sclerosis (MS) has a variable clinical and pathological course and pace, which eventually turns over years of that progression into a major source of disability especially among young adults. The regional incidence and prevalence data course are of utmost interest (i.e they tend to be higher in Europe within the last decade) mirroring diagnosis improvement, earlier and better treatment choices and an improved physio-pathological insight as shown by most recent studies. (1) The incidence and prevalence data tend to be higher in Europe within the last decade and are explained by diagnosis improvement and earlier and better treatment solutions for the patients mirrored by most recent studies. (1) The objective of the present study is to assess data available concerning the prevalence of multiple sclerosis in Romania and in Central and Southeastern Europe in a regional view. Material and method. A literature search has been performed in PubMed, DIMDI, Web of Science, and Google Scholar to retrieve population based studies in Central and Eastern Europe and epidemiological reviews through years 1960-2015. We searched the term “MS” combined with one of the following: “epidemiology” or “incidence” or “prevalence”. We also did a manual search of reference list of the relevant articles. Results. 38 studies met the inclusion criteria and were analyzed. The epidemiologic data available for Central and Eastern Europe during the period 1960-2015 support the heterogeneity both of this region’s resident population and of the studies design, making any global data assessment difficult, with a questionable reliability, therefore justifying a newer reappraisal.

Space charge distributions in insulating polymers: A new non-contacting way of measurement

A new technique for the determination of space charge profiles in insulating polymers is proposed. Based on the evolution of an existing thermal wave technique called Focused Laser Intensity Modulation Method ((F)LIMM), it allows non-contact measurements on thin films exhibiting an internal charge to be studied. An electrostatic model taking into account the new sample-cell geometry proposed was first developed. It has been shown, in particular, that it was theoretically possible to calculate the internal charge from experimental measurements while allowing an evaluation of the air layer appearing between the sample and the electrode when non-contact measurements are performed. These predictions were confirmed by an experimental implementation for two thin polymer samples (25 μm-polyvinylidenefluoride and 50 μm-polytetrafluoroethylene (PTFE)) used as tests. In these cases, minimum air-layer thickness was determined with an accuracy of 3% and 20%, respectively, depending on the signal-to-noise ratio during the experimental procedure. In order to illustrate the reachable possibilities of this technique, 2D and 3D cartographies of a negative space charge implanted by electron beam within the PTFE test sample were depicted: like in conventional (F)LIMM, a multidimensional representation of a selectively implanted charge remains possible at a few microns depth, but using a non-contacting way of measurement.

[The possibilities for improving the serological diagnosis of active tuberculosis by using new mycobacterial antigens and immunoblot and ELISA technics]

The study concerns 264 cases among which: 119 active lung tb. eliminating and 11 cases not-eliminating M. Tuberculosis; 17 cases of extrarespiratory tb. confirmed by bacteriology and/or by anatomopathology; 18 cases of bone-joint non-tb disease; 38 cases of chronic lung disease other than tb; 61 healthy persons (controls). Sera from these cases were collected before treatment and submitted concomitantly to two different methods: (1) Mycodot test (immunoblot) with lipoarabinomannan (LAM) as antigen, on nitrocellulose discs (Dynagen, Cambridge, MA, USA); (2) ELISA test with antigen 60 (A60) (ANDA-Biologicals, Strasbourg, France) and with antigen I.C. (Cantacuzino Institute, Bucharest). The results were estimated on terms of sensitivity and specificity. As for sensitivity the results show 74-90%. the highest values were reached in ELISA with A60 IgA. The specificity of the Mycodot test was highest: 90-100% in the two successive experiments. The active tb diagnosis discrimination capacity of the studied methods allows the following classification: 1. Mycodot test with LAM antigen 2. ELISA with A60-Ig G complex 3. ELISA with I.C. antigen The Mycodot test is more advantageous being more rapid and more simple to perform.

Advantages of treatment with Reprimun in sarcoidosis

Favourable results were obtained by treatment with Reprimun alone or in association with low doses of Prednisone in 112 patients with sarcoidosis (59% with active sarcoidosis and 33% failures of a previous corticotherapy). Treatments were applied during 3-6 series each one of 6 weeks at intervals of 2 weeks between series. In comparison with the classical corticotherapy, treatment with Reprimun has better results, namely: absence of any major adverse reactions; reduction of the treatment period to 6-12 months (3-6 series); 95% lasting remissions in the sarcoidoses with initial treatment and 78% remissions in the case of failures of a previous corticotherapy.

[Preliminary results of the use of a new derivative of rifamycin SV in the treatment of sarcoidosis]

Seven patients with advanced forms of mediastino-pulmonary sarcoidosis (involvement of the pulmonary parenchyma, and restrictive respiratory syndrome), confirmed by histopathologic investigation, have been treated with a new SV-rifamycin derivative, 1246-EH, or "Reprimum" without any other association. Reprimun was given in daily doses of 10 mg/kg of body weight for a period of two weeks, then, for another 4-5 weeks, the drugs was given intermittently in doses of 15 mg/kg of body weight twice weekly. Between two cycles of therapy a period of 14 days was free of drug administration. In all patients the treatment with the new derivative was well tolerated. The treatment was not followed by adrenal deficiencies, neither was noted obesity, bone decalcification, gastric ulcers, etc., which are commonly associated with prolonged corticoid therapy. The treatment with "Reprimun" efficient for all patients. A clear clinical and X-ray improvement was noted after the first three months of treatment with the new drug. Respiratory function, as well as clinical and radiological signs improved, the serum immunologic parameters, and the biochemical ones were also significantly improved (Ig, C3 total serum proteins and gammaglobulins). All parameters which were tested were finally improved and became normal. In only two of the seven patients the radiological aspects of the lung suggested the presence of sequellae at the end of the treatment. In these two patients there was a persistant reduction in the respiratory volume, as well as a discret hypoxemia. However, both these patients had a more advanced form of the disease, with extensive pulmonary fibrosis, and in these cases prolonged corticoid therapy which had previously been applied had failed. Reprimun had an immunological-modulatory effect in all patients, resulting in normal levels of IgG, IgA, and C3 in the first three months of therapy. There was a direct correlation between the normalization of immunological indicators and the good evolution of the diseases, a fact which suggests once again the existence of some immune mechanisms involved in the maintenance of sarcoidosis.