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Effect of dexpanthenol on cyclophosphamide-induced ovarian toxicity: a histological and molecular study in rats. Reprod Biomed Online 2024; 48:103778. [PMID: 38492417 DOI: 10.1016/j.rbmo.2023.103778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/28/2023] [Accepted: 12/19/2023] [Indexed: 03/18/2024]
Abstract
RESEARCH QUESTION Does dexpanthenol work as an effective therapeutic agent against cyclophosphamide (CYC)-induced premature ovarian failure (POF) in rats? DESIGN A total of 28 female Wistar Albino rats were randomly divided into four groups (n = 7 per group). The POF and POF plus dexpanthenol groups were intraperitoneally administered CYC at an initial dose of 50 mg/kg, followed by 8 mg/kg for 14 days. The dexpanthenol and POF plus dexpanthenol groups were both intraperitoneally administered dexpanthenol at a dose of 500 mg/kg/day for 15 days. RESULTS In the group administered CYC, the following was observed: a decrease in the ovarian index; a decrease in the numbers of primordial, primary, secondary and antral follicles; an increase in the number of corpus luteum and atretic follicles; a decrease in proliferation cell nuclear antigen immunoreactivity; a significant reduction in anti-Müllerian hormone and oestradiol levels; and an increase in serum FSH levels compared with controls. Dexpanthenol, on the other hand, reversed these effects. Quantitative reverse transcription polymerase chain reaction analyses showed that dexpanthenol increased Bcl-2, Akt1, mTOR, Nrf2 and HO-1 in CYC-induced ovarian tissues, but decreased Bax, Cas3, Hsp27, Hsp70, and Hsp90. Dexpanthenol treatment has a potential for inhibiting the intrinsic apoptotic pathway and oxidative stress levels in ovarian tissues via the downregulation of the mRNA expression of heat shock proteins and the activation of Nrf2/HO-1 pathways. CONCLUSIONS Our findings demonstrated that dexpanthenol is an effective agent against POF caused by CYC; however, further experimental and clinical data are needed to use it effectively.
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A bibliometric perspective with research trends and global productivity on the modernization of andrology from the founder of modern clinical andrology Edward Martin to the present. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2023; 27:11947-11960. [PMID: 38164858 DOI: 10.26355/eurrev_202312_34794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVE The number of studies in the field of andrology is increasing day by day, but a bibliometric study covering the entire literature on andrology has not yet been conducted. This bibliometric study aims to shed light on the question of where we came from and where we are going in andrology from past to present. It also aimed to summarize the intellectual structure of andrology to reveal global productivity and identify and map the latest trends of scientific articles published in the field of andrology. MATERIALS AND METHODS 16,659 articles published between 1980 and 2022 were extracted from the Web of Science and analyzed using various statistical methods. Bibliometric network visualization maps revealed trending topics, global productivity, the most influential studies, and international collaborations. Spearman's correlation analysis was used for determining correlations. RESULTS The top three productive countries were United States of America (3,452; 20.7%), China (2,300; 13.8%), and Germany (1,069; 6.4%). The top two most productive authors were Agarwal A. (n=130) and Nieschlag E. (n=130). The most productive institution was the Egyptian Knowledge Bank (n=422). From past to present, the most studied subjects were testis, male infertility, spermatozoa, testosterone, infertility, erectile dysfunction, spermatogenesis, sperm, prostate cancer (PCA)/neoplasms, oxidative stress, fertility/fertilization, semen, rat(s), apoptosis, azoospermia, sperm motility, human and varicocele. CONCLUSIONS The trend topics that have been researched more in recent years include erectile dysfunction, oxidative stress, prostate cancer, sperm quality, sperm parameters, infertility, premature ejaculation, diabetes mellitus, obesity, prognosis, sperm DNA fragmentation/damage, antioxidant, asthenozoospermia, varicocelectomy, COVID-19, inflammation, prostatectomy, metabolic syndrome, hypogonadism, benign prostatic hyperplasia, lower urinary tract symptoms, meta-analysis, sexual dysfunction, peyronie's disease, and proliferation. We identified the research leadership of China, Japan, Turkey and India, in addition to Western countries, such as the USA and European countries.
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The influence of sex and age on bone turnover markers in the adult to geriatric Kangal shepherd dogs. Vet Clin Pathol 2023; 52:353-359. [PMID: 36740233 DOI: 10.1111/vcp.13199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 08/23/2022] [Accepted: 09/19/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The objective of this research was to learn more about bone metabolism in intact female and male Kangal shepherd dogs during the aging process following skeletal maturity. It also evaluated the potential application of biochemical bone indicators in veterinary clinical practice. METHODS Bone markers were determined as bone alkaline phosphatase (BALP), osteocalcin (OC), C-terminal telopeptide of type I collagen (CTX), and cross-linked C-telopeptide of type I collagen (ICTP) in this study. Kangal shepherd dogs of different age (adult, senior, and geriatric) and sex (male and female) groups were split into six groups of equal numbers (n = 8/group). RESULTS In this study, the effect of age was observed on serum BALP, OC, CTX, and ICTP concentrations. Specifically, BALP was highest in geriatric female Kangal shepherd dogs, while serum OC, CTX, and ICTP concentrations were highest in geriatric male Kangal shepherd dogs. However, no effects of sex and age-sex interactions were identified. Moreover, the effects of age, sex, and age-sex interactions had no significant effect on serum creatinine, CK, LDH, Mg, and P concentrations or ALT activities. However, only sex was found to affect serum AST activities and gradually decreased with age in females. The effect of age and age-sex interactions on serum Ca concentrations was significant (the lowest serum Ca concentrations were in geriatric females), but the effect of sex was not. CONCLUSIONS These results show the effect of age and sex on bone turnover in Kangal shepherd dogs and provide information about bone biomarkers.
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CT features of pulmonary embolism in patients with COVID-19 pneumonia. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2023; 27:4085-4097. [PMID: 37203834 DOI: 10.26355/eurrev_202305_32316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVE The aim of this study was to describe the Computed Tomography (CT) features of pulmonary embolism in patients hospitalized for acute COVID-19 pneumonia and to evaluate the prognostic significance of these features. PATIENTS AND METHODS This retrospective study included 110 consecutive patients who were hospitalized for acute COVID-19 pneumonia and underwent pulmonary computed tomography angiography (BTPA) on the basis of clinical suspicion. The diagnosis of COVID-19 infection was determined by CT findings typical of COVID-19 pneumonia and/or a positive result of a reverse transcriptase-polymerase chain reaction test. RESULTS Of the 110 patients, 30 (27.3%) had acute pulmonary embolism and 71 (64.5%) had CT features of chronic pulmonary embolism. Of the 14 (12.7%) patients who died despite receiving therapeutic doses of heparin, 13 (92.9%) had CT features of chronic pulmonary embolism and 1 (7.1%) of acute pulmonary embolism. CT features of chronic pulmonary embolism were more common in deceased patients than in surviving patients (92.9% vs. 60.4%, p=0.01, respectively). Low oxygen saturation and high urine microalbumin creatinine ratio at admission in COVID-19 patients are important determinants of mortality after adjusting for sex and age in logistic procedures. CONCLUSIONS CT features of chronic pulmonary embolism are common in COVID-19 patients undergoing Computed Tomography Pulmonary Angiography (CTPA) in the hospital. The coexistence of albuminuria, low oxygen saturation and CT features of chronic pulmonary embolism at admission in COVID-19 patients may herald fatal outcomes.
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Lipid-lowering, anti-inflammatory, and hepatoprotective effects of isorhamnetin on acetaminophen-induced hepatotoxicity in mice. Drug Chem Toxicol 2023; 46:566-574. [PMID: 35502492 DOI: 10.1080/01480545.2022.2069256] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Isorhamnetin is a hepatoprotective flavonoid molecule derived from the leaves and fruits of Hippophae rhamnoides L. However, the protective effect of isorhamnetin on acetaminophen (APAP) induced hepatotoxicity is still unknown. Thus, we aimed to investigate the lipid-lowering, anti-inflammatory, and hepatoprotective effects of isorhamnetin on APAP-induced hepatotoxicity in mice. Hepatotoxicity was induced by a single injection of APAP (300 mg/kg, intraperitoneally). Isorhamnetin (50 or 100 mg/kg, orally) and N-acetylcysteine (NAC) (200 mg/kg, orally), or vehicle control, were administered 1 h before the administration of APAP. Total antioxidant status (TAS) and total oxidative status (TOS) of liver tissue and levels of inflammatory factors (TNF-α, IL-1β, and IL-6) were analyzed by ELISA. Lipid profiles and liver function parameters were measured using an autoanalyzer. In addition, liver tissue was examined histopathologically. Isorhamnetin treatment significantly reduced the APAP-induced increase in the liver weight and liver index; it also reduced the APAP-induced increase in serum liver parameters (ALT, AST, ALP, and LDH) (p < 0.05). Isorhamnetin significantly reduced APAP-induced oxidative stress and inflammation by increasing TAS levels and decreasing TOS, TNF-α, IL-1β, and IL-6 levels (p < 0.05). Moreover, isorhamnetin treatment significantly regulated lipid profiles (TG, T-C, LDL-C, and HDL-C levels) that changed in response to APAP administration (p < 0.05). In histopathological examination, liver degeneration observed in the APAP group was significantly reduced in the NAC and isorhamnetin-treated groups (p < 0.05). This study suggests that isorhamnetin has a significant protective effect on APAP-induced hepatotoxicity in mice through its lipid-lowering, antioxidant, and anti-inflammatory effects.
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Protective effect of Allium scorodoprasum L. ethanolic extract in cyclophosphamide-induced hepatotoxicity model in rats. J Pharm Pharmacol 2023; 75:625-634. [PMID: 36805251 DOI: 10.1093/jpp/rgad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/05/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVES Cyclophosphamide is a chemotherapeutic agent and immunosuppressant drug; however, it damages the liver. This study investigates the protective effect of ethanolic extract of Allium scorodoprasum (ASE) on cyclophosphamide-induced liver injury. METHODS Twenty-eight Wistar albino rats were randomly divided into four groups (n = 7 per group): healthy rats, cyclophosphamide (200 mg/kg), cyclophosphamide (200 mg/kg) + ASE (100 mg/kg) and cyclophosphamide (200 mg/kg) + ASE (200 mg/kg). ASE was administered for 14 days, and the rats were euthanized 24 h after cyclophosphamide administration. KEY FINDINGS Cyclophosphamide treatment leads to an increase in serum levels of alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, total cholesterol, triglycerides, low-density lipoprotein and very low-density lipoprotein, as well as an increase in the liver levels of malondialdehyde, tumour necrosis factor, interleukin (IL)-1β and IL-6, while high-density lipoprotein levels decrease. Treatment with cyclophosphamide caused liver necrosis and postnecrotic cell infiltration; however, pathological changes were prevented by ASE. 8-Hydroxy-2'-deoxyguanosine, anti-4-hydroxynenal antibody and anti-dityrosine levels increased in rats treated with cyclophosphamide and decreased in the groups treated with ASE. These changes were dose dependent in the ASE-treated groups. CONCLUSIONS Treatment with cyclophosphamide caused liver damage due to oxidative stress and inflammation. ASE regulated the damage at high doses because it has potent antioxidant and anti-inflammatory ingredients. In future studies, it may be beneficial to administer ASE in higher doses or for longer periods of time.
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Effects of anterior cruciate ligament rupture and reconstruction on sexual activity of male patients. Jt Dis Relat Surg 2022; 34:138-143. [PMID: 36700275 PMCID: PMC9903125 DOI: 10.52312/jdrs.2023.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/14/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES This study aims to investigate the impact of anterior cruciate ligament (ACL) injury and its reconstruction on men's sexual functions. PATIENTS AND METHODS Between February 2016 and November 2019, a total of 27 sexually active male patients (mean age: 33.7±4.3 years; range, 26 to 40 years) who were operated for ACL injury at least six months after trauma were retrospectively analyzed. Erectile function was assessed using the International Index of Erectile Function questionnaire (IIEF) and knee function was evaluated by using the International Knee Documentation Committee (IKDC) Scoring System, Lysholm Knee Scoring Scale, and Tegner Activity Score. Sexual and functional questionnaires were applied to evaluate three different periods retrospectively. These periods were as follows: the period before an ACL injury (Period I); the period in which the patient suffered from an ACL injury, but not operated (Period II), and the period after the ACL reconstruction (Period III). RESULTS There was a statistically significant difference in the comparison of knee function scores according to three different periods. Sexual function scores were significantly different between Periods I and II, and between Periods I and III. However, although the IIEF value was higher in Period III than in Period II, no statistically significant difference was observed. A moderate correlation was found between the sexual functional scores of IIEF and IKDC scores. CONCLUSION Our study results suggest that ACL injury affects sexual functions adversely. The change in sexual functions after ACL surgery depends on the success of surgery. While deciding on the treatment of ACL injury, the patient's sexual life should be questioned along with his expectations.
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AB0278 IN RHEUMATOID ARTHRITIS PATIENTS RECEIVING bDMARDs, THE CHARLSON COMORBIDITY INDEX IS MORE PRONOUNCED THAN PSORIATIC ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAccording to international recommendations, co-morbidities must be taken into account in the management of patients with inflammatory arthritis.ObjectivesTo evaluate the distribution of pre-treatment comorbidities in the bDMARD cohort including patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA).MethodsThe Hacettepe University biological database (HUR-BIO) was established in 2005, 581(75.4% female) patients with RA and 520 (69.4%female) patients with PsA enrolled up to 2021 were analyzed. Diagnosis of RA and PsA were based on the clinical evaluation of the rheumatologist who followed the patients. Comorbidities of the patients were reviewed retrospectively from the biological database, hospital electronic records, ICD-10 diagnostic codes and prescriptions of patients. Diabetes mellitus (DM), Hypertension (HT), Dyslipidemia (DL), Coronary artery disease (CAD), Body mass index (BMI) and smoking were recorded. DL was grouped in terms of lipid values according to the classification of the Turkish Society of Endocrinology and Metabolism Dyslipidemia Guide(1). Detection of coronary artery disease before the age of 55 in men and of 65 in women was classified as premature - CAD. Data on Chronic Kidney Disease, obstructive pulmonary disease, Cerebro-vascular disease, Thyroid Diseases were also recorded. The Charlson comorbidity index (CCI) was calculated by summing the comorbidities in the patients’ medical history before the bDMARDs.ResultsThe distribution of comorbidities in patients with RA and PsA prior to initiation of bDMARDs was given in Table 1. Patients with RA were older and smoking was more common. HT(28.5% for RA, 21.9% for PsA) and thyroid diseases (22.7% for RA, 14.7% for PsA) were the most comorbidities in both groups. Compared to PsA, patients with RA had higher rate of comorbidities (64.8% vs. 40.4%, p<0.001). Multimorbidity was detected in 231/581 (39.7%) of patients with RA, and it is significantly more common than the patients with PsA (21.8%) (p<0.001). There was no difference between the groups in terms of cardiovascular comorbidities such as BMI, DM, and dyslipidemia. When adjusted for age, the comorbidity burden according to CCI was 3.96 (2.57-6.13, p<0.001) times higher in patients with RA than in patients with PsA.Table 1.Comorbidities in RA and PsA patientsFeaturesRA n=581PsA n=520pGender, female n (%)438 (75.4)361 (69.4)0.027Age at PsA diagnosis, mean (SD) years46.7 (13.7)39.3 (12.0)<0.001Age at bDMARD start, mean (SD) years49.5 (13.8)42.2 (12.3)<0.001CCI-No comorbidity205/581 (35.2)290/486 (59.6)<0.001-1 comorbidity145/581 (24.9)90/486 (18.5)-≥ 2 comorbidity231/581 (39.7)106/486 (21.8)CCI mean, (SD)1.56 (1.77)0.78 (1.18)<0.001Smoking (ever), n292/581282/506<0.001BMI, mean (SD)29.3 (6.7)29.6 (5.9)0.50BMI ≥ 30 n261/577221/4980.77Diabetes Mellitus, n68/58149/4020.30Hypertension, n166/581110/5020.012Dyslipidemia* n-High TC47/27032/1610.30-High TG62/24245/1590.79-High LDL -C53/289(43/1750.38-Low HDL-C88/26757/1570.48Uric acid (>6 mg/dl), n150/554136/4370.16CAD n59/52432/4860.010Premature CAD, n39/58118/4860.030CKD, nG1 (GFR > 90)437/5230<0.001G2 (GFR 60-90)68/5230G3a (GFR 45-60)11/5230G3b (GFR 30-45)5/52328/370G4 (GFR 15-30)2/523342/370Lung disease, n-COPD15/5193/4850.007-Asthma66/52019/485<0.001Thyroid disease, n132/58165/440<0.001*TC > 240, TG 150-499, LDL-C> 160, HDL-C erkek < 40, kadin < 50CCI: Charlson comorbidity index, CAD: Coronary artery disease, CKD: Chronic Kidney Disease, COPD: Chronic Obstructive pulmonary diseaseConclusionThe burden of comorbidities in patients with RA before bDMARDs is more pronounced than in patients with PsA. Although, cardiovascular risk factors were similar, with the exception of hypertension and smoking, the age-adjusted CCI was 3.96 times higher in patients with RA than in patients with PsA.References[1]TEMD Obesity Guideline, L.M., Hypertension Working Group, TEMD Dyslipidemia Diagnosis and Treatment Guideline. 9th ed. 2021Disclosure of InterestsNone declared
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AB0353 bDMARD CHOICES FOR INFLAMMATORY ARTHRITIS WITH CHRONIC KIDNEY DISEASE; HUR-BIO REAL-LIFE REGISTRY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundRheumatic disesases may involve multiple systems and chronic kidney disease (CKD) can be seen during the course of diseases. Accompanying CKD affects the the choice of treatments in patients with rheumatic disease. There is limited data on the use of biological DMARDs in rheumatic patients with chronic kidney disease.ObjectivesTo determine the preferred first and second bDMARDs in patients in the CKD in the bDMARD cohort.MethodsThe Hacettepe University biological database (HUR-BIO), was established in 2005. A total of 2160 RA patients, 3744 SPA patients, were registered in HUR-BIO until November 2021. The CKD was confirmed and classified according to 2012 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. . Patients were evaluated for the presence of CKB before the initiation of bDmard and during follow-up under bDMARDs. Age and sex matched RA patients without CKD were selected for the control group.Results142/5904 (2.4%) patients have CKD. 102(%71.8) patients had CKD prior to initiation of bDMARD and 40 (28.1%) patients had developed during follow-up. The median time to CKD development after starting bDMARD was 4.13 years(±4.05). Of the patients with CKD, 98 (69.0%) had RA and 44 (31.0%) had SpA. RA patients followed for CKD were older than SpA (66.0 (±11.1) vs 59.1 (±13.0) years, p=0.001), female gender was more common (73.5% vs 36.4%, p<0.001), disease duration was similar (19.3 (±13.8) vs 17.1 (±10.5) years, p=0.40). The first bDMARD choices of patients with and without CKD in RA and SpA patients were shown in Table 1. There was no difference between the SPA patients with or without CKD regarding TNF-i preferences. In patients with rheumatoid arthritis there was no difference in terms of TNFi and non-TNF-i preferences, but tocilizumab was more prefered in CKD group.Table 1.Relationship between remission according to bDMARD and CKDRheumatoid arthritispSpondyloarthritispw CKD n=98wo CKD n=91w CKD n=44(%)wo CKD n=80(%)p<0,05Etanercept, n(%)34 (34.6)30 (33.0)0.4617 (38.6)22 (27.5)P=0.14Adalimumab, n(%)17(17.3)17 (18.7)0,4810 (22.7)22 (27.5)P=0.36Infliximab,n(%)3 (3)8 (8.8)0.8514(31.8)32 (40.0)p=0.24Golimumab, n(%)4 (4)3 (3.3)0,541 (2.2)3 (3.8)p=0.55Certolizumab, n(%)0 (0)3 (3.3)0,111 (2.2)1 (1.3)p=0.58Anti-TNF therapy, n(%)58 (59.2)61 (67.0)0,6143800.352Non-TNF biologics, n(%)40 (40,8)30 (33.0)0,13100.355Rituximab, n(%)14 (14.3)12 (13.2)0,57Abatacept, n(%)14(14.3)12 (13.2)0,49Tocilizumab, n(%)6 (6.1)10.0411(2.2)p=0.35Jak-kinase inhibitors, n(%)6(6.1)5 (5.5)0.55ConclusionIn our biologic cohort, 2% of patients with RA and SpA had accompanying CKD. In one-third of the patients with CKD, it was developed during the follow-up after bDMARDs. In patients with RA, there was no difference in terms of TNFi and non-TNF-i preferences. It should be kept in mind that CKD may develop during the follow-up of patients using bDMARDs.References[1]Ye W, Zhuang J, Yu Yet all Gender and chronic kidney disease in ankylosing spondylitis: a single-center retrospectively study. BMC Nephrol. 2019 Dec 9;20[2]Chebotareva NV, Guliaev SVet al. [Chronic kidney disease in rheumatoid arthritis patients: prevalence, risks factors, histopathological variants]. Ter Arkh. 2019 May 15;91(5)Disclosure of InterestsNone declared
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POS1440 HEMATOLOGICAL MALIGNANCIES AND ANTI-TNF IN INFLAMMATORY ARTHRITIS: THE REAL LIFE DATA FROM THE HUR-BIO REGISTRY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundTNF inhibitors (TNFi) is highly effective in inflammatory arthritis (IA) treatment. However, concerns are raised about the possible association between TNFi and hematologic malignancies (HMs).ObjectivesTo assess the incidence of HMs among IA patients receiving TNFi compared with the general Turkish population.MethodsHUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (bDMARD) registry since 2005. Patients with IA including rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA) patients who had at least 1 visit after the TNFi usage were screened from 2005 to November 2021. HM diagnosis was determined from the each patient files according to the hematologists’ decision and/or bone marrow/lymph node biopsy. Demografic data, disease characteristics, and death status were recorded. Standardized incidence rates (SIR) were calculated after adjustment for age and gender and compared with age- and gender-specific SIR values abstracted from the 2017 Turkish National Cancer Registry (TNCR).ResultsOf the 6139 patients registered in the HUR-BIO database, 5355 [3116 female (58.2%)] used any TNFi at least once. Median follow-up duration was 2.6 years for all patients receiving TNFi. 13 patients [8 (61.5%) female] had HM on follow-up. In these patients, median age at the IA onset was 38 (range 26 to 67) and the number of patients with SpA, RA, and PsA was 7, 4, and 2, respectively. The median duration of IA was 17.7 years (range 1 to 33). The median age at the HM onset was 55.5 (range 38 to 76) and the type of HM as follow: 8 lymphoma, 2 multiple myeloma, 1 large granular lymphocytic leukemia, 1 plasma cell dyscrasia, and 1 myelodysplastic syndrome. The median duration of the TNFi usage onset to HM was 36 (range 4-112) months. The TNFi was as follows: etanercept (n=8), adalimumab (n=6), infliximab (n=4), golimumab (n=1), and certolizumab (n=1). 5 patients used more than one TNFi. Patients using TNFi had an increased incidence for HMs (SIR 4.23, 95% CI 2.35-7.05). These results were also valid for both gender. 10 patients with HMs were under the age of 65. In this group, there was a higher incidence of HMs in both men (SIR 5.15, 95% CI 1.88-11.43) and women (SIR 4.76, 95% CI 1.74-10.55). 5 patients deceased on follow-up.ConclusionThe risk of HMs in inflammatory arthritis patients receiving TNFi being four times higher in comparison with the general Turkish population. There is a plethora of information that discusses the association between HMs and rheumatic disease. To determine whether the increased risk is from rheumatic disease or from TNFi usage, it would be ideal to compare patients receiving TNFi with bDMARD naive IA patients.Table 1.SIR for diferent age cut-ofs in both sexes for patients with hematologic malignanciesGenderAgeObserved/expected casesSIR%95 confidence intervalTotalAll ages*13/3.074.232.35-7.05Male20-64 years (n=2059)5/0.975.151.88-11.43≥ 65 years (n=180)0/0.39NA-Overall (n=2239)5/1.363.671.34-8.14Female20-64 years (n=2667)5/1.054.761.74-10.55≥ 65 years (n=449)3/0.664.541.15-12.37Overall (n=3116)8/1.714.672.17-8.88*: Includes patients ≥18 years.NA: Not applicable, SIR: standardized incidence ratesFigure 1.Cumulative number of hematologic malignancies in function of time from start of first anti-TNF therapyDisclosure of InterestsNone declared
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POS1184 EPIDEMIOLOGICAL CHARACTERISTICS OF VIRAL HEPATITIS IN PATIENTS WITH RHEUMATIC DISEASES – IMPLICATIONS FROM TREASURE DATABASE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundRecent epidemiological data on HBV and HCV in Turkey revealed that the seroprevalence rates of hepatitis B surface antigen and antibody against HCV were 4% and 1%, respectively, and seropositivity rates for hepatitis B surface antibody and hepatitis B core antibody were 31.9% and 30.6%, respectively. A previous multicenter nationwide study conducted in Turkey reported that the HBsAg positivity was determined in 2.3% of patients with rheumatoid arthritis (RA) and 3% of patients with ankylosing spondylitis (AS), and the anti-HCV positivity was detected in 1.1% of patients in each group. Given these rates, viral hepatitis is still considered a potential threat to patients with rheumatic diseases, specifically for the treatment-related viral reactivation.ObjectivesThis study aimed to evaluate the serologic HBV and HCV frequency and clinical characteristics among our patients with RA or SpA and receive biological treatments based on this background.MethodsThe prospective TReasure database, which observationally collects data of patients with rheumatic diseases from fifteen centers across Turkey, was analyzed for viral hepatitis, patient characteristics, and treatments used. TReasure registry study protocol, and the data collection was started on December 2017. At the time of the analysis for this study was performed, the registry database included 3147 patients with RA and 6071 patients with SpA. For hepatitis B; Hepatitis B surface antigen (HBsAg), anti-HBV core antibody (anti-HBc) and anti-HBV surface antibody (Anti-HBs) tests were evaluated. HBV-DNA was studied in HBsAg positive patients. Anti-HCV antibody has been studied for HCV. The clinical and serological HBV reactivation in the follow-up of the patients was evaluated by looking at the HBV-DNA viral loads.ResultsA total of 9218 patients (3147 RA and 6071 patients with SpA) were included in the analyses. The screening rate for HBV was 97% in RA and 94.2% in SpA groups. HBsAg positivity rates were 2.6% and 2%, anti-HBs positivity rates were 32.3% and 34%, anti-HBc positivity rates were 20.3% and 12.5%, HBV DNA positivity rates were 3.5% and 12.5%, and anti-HCV positivity rates were 0.8% and 0.3% in these groups, respectively (Table 1).Table 1.Serological analyses in the study groupRASpApNn (%)Nn (%)Hepatitis testing28962809 (97.0)54445130 (94.2)<0.001HBsAg positivity275071 (2.6)501799 (2)0.080Anti-HBs positivity2708876 (32.3)48931663 (34)0.147Anti-HBc positivity2362480 (20.3)4194524 (12.5)<0.001HBV-DNA positivity45416 (3.5)63735 (5.5)0.129Anti-HCV positivity260222 (0.8)462716 (0.3)0.005The HBsAg (+) patients were older and had higher comorbidities, including hypertension, diabetes, and coronary artery disease. In addition, RF positivity was more in HBsAg(+) cases. The most frequently prescribed bDMARDS were adalimumab (28.5%), etanercept (27%), tofacitinib (23.4%), and tocilizumab (21.5%) in the RA group, whereas adalimumab (48.1%), etanercept (31.4%), infliximab (22.6%), and certolizumab (21.1%) in the SpA group. HBV reactivation was observed in one patient with during RA treatment, who received rituximab and prophylaxis with tenofovir.Figure 1.Prescription proportions of medications in the rheumatoid arthritis (RA) and spondyloarthritis (SpA) groupsConclusionThe epidemiological characteristics of patients with rheumatic diseases and viral hepatitis are essential for effective patient management. This study provided the most recent epidemiological characteristics from the prospective TReasure database, one of the most comprehensive registries in rheumatology practice. According to the results of our study; It can be thought that there is no risk in the choice of treatment by the rheumatologist in patients who receive appropriate prophylaxis.Disclosure of InterestsNone declared
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POS0602 PULMONARY RHEUMATOID NODULES: DOES SEROLOGIC STATUS MATTER? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe frequency of pulmonary rheumatoid nodules closely relates to the diagnostic modality and changes from <0.4% to 32%. Also, it is known that seropositive RA patients tend to have more extra-articular disease.ObjectivesWe aimed to compare the disease and pulmonary rheumatoid nodule characteristics of seropositive and seronegative RA patients.MethodsIn this study, all RA patients - according to ICD-10 code - and had at least one chest computerized tomography (CT) were examined and revealed 4117 individual patients. First, RA diagnosis was confirmed according the patients’ history, physical examination, radiography and laboratory assessment. Then, chest CTs were examined by an experienced radiologist. To classify pulmonary nodules as ‘’pulmonary rheumatoid nodule’’, following inclusion and exclusion criteria were used; For inclusion: 1) nodules with changing dimension on follow-up, 2) At least two nodules with different dimensions, 3) Cavitary nodule at any chest CT. For exclusion: 1) Solitary nodules OR all nodules ≤ 5mm and without follow-up OR no change on follow-up. Biggest nodule was named as dominant nodule. Then, patients were grouped according to rheumatoid factor and anti-CCP status as seropositive (RF ± anti-CCP) and seronegative. Demographics, comorbidities, RA-spesific treatments and nodule characteristics were compared.ResultsOf 680 RA patients who had pulmonary nodule in chest CT, 208 (30.6%) patients were classified as having pulmonary rheumatoid nodule. 167 (80.3%) patients were seropositive. Demographic and comorbidity characteristics were similar among seronegative and seropositive patients (Table 1). Regarding RA-spesific treatments, methotrexate, leflunomide and rituximab were prescribed more frequently in seropositive patients. For nodule characteristics, seropositive patients had higher number of nodules (5 [1-48] vs 3 [1-27]; p=0.004), bigger dominant nodule (8 [3-95] vs 6 [3-45] mm; p=0.011), and higher percentage of cavitary nodule (28.7% vs 12.2%; p=0.03). Localization of the nodule was compareble.Table 1.Comparison of demographic, disease and nodule characteristics of seropositive and seronegative patients (n=208)Seropositive (n=167, 80.3%)Seronegative (n=41, 19.7%)P valueFemale, n(%)113 (67.7)28 (68.3)0.94Age at the time of CT (median, min-max)61 (24-83)59.7 (20-83)0.28Smoking (n=73)26 (43.3)4 (30.8)0.40- Never smoked34 (56.7)9 (69.2)- Ever smokedComorbidity (n=188)127 (84.7)30 (78.9)0.40- Hypertension72 (55.0)18 (58.1)0.91- Diabetes (n=166)25 (18.5)7 (22.6)0.79- CAD (n=165)30 (22.6)7 (21.9)0.93- Heart Failure (n=164)15 (11.4)6 (18.8)0.41- COPD (n=163)20 (15.2)1 (3.2)0.13- Asthma (n=160)15 (11.6)5 (16.1)0.54- CKD (n=169)20 (14.5)8 (25.8)0.22- ILD (n=202)54 (33.1)10 (25.6)0.37RA-spesific treatments (ever)90 (72.6)16 (55.2)0.07- Methotrexate (n=153)105 (64.0)12 (30.8)0.001- Leflunomide (n=208)117 (70.5)25 (61.0)0.06- Hydroxchloroquine (n=169)65 (47.4)11 (36.7)0.28- Sulfasalazine (n=167)39 (39.0)6 (27.3)0.30- TNFi (n=122)41 (39.8)2 (9.5)0.008- Rituximab (n=124)11 (9.9)2 (8.0)0.77- Tofacitinib (n=136)12 (11.9)2 (10.5)0.86- Abatacept (n=120)9 (8.5)2 (8.7)0.98- Tocilizumab (n=129)Number of nodules at baseline CT (median, min-max)5 (1-48)3 (1-27)0.004Diameter of dominant nodule (median, min-max) (mm)8 (3-95)6 (3-45)0.011Localization of dominant nodul64 (38.3)15 (36.6)0.84- Left or right?64 (38.3)12 (29.3)0.48◦ Left51 (30.5)16 (39.0)0.28- Upper, middle or lower?52 (31.1)13 (31.7)◦ Upper69 (41.3)21 (51.2)◦ Middle22 (13.2)7 (17.1)◦ Lower76 (45.5)13 (31.7)-Peripheral, central or subpleural◦ Peripheral◦ Central◦ SubpleuralCavitation48 (28.7)5 (12.2)0.03Calcification54 (32.5)12 (29.3)0.69CAD: Coronary artery disease, CKD: Chronic kidney disease,; ILD: Interstitial Lung Disaese,ConclusionAutoantibodies seem to have impact on the characteristics of pulmonary rheumatoid nodules. As there were different prescription patterns were seen in our study, effects of these treatment differences need to be determined.ReferencesDisclosure of InterestsNone declared
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POS0991 PREDICTORS OF DEVELOPMENT OF ADVANCED SPINAL ANKYLOSIS/BAMBOO SPINE IN AXIAL SPONDYLOARTHRITIS: RESULTS FROM REAL-LIFE DATA. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundIn axial spondyloarthritis (axSpA), intervertebral ossification bridges of consecutive vertebrae may progress to advanced spinal ankylosis and bamboo spine over the years [1].ObjectivesTo identify demographic, clinical, disease activity and treatment factors associated with development of bamboo spine / advanced spinal ankylosis and bamboo spine-only in the Hacettepe University Rheumatology Biologic Registry (HUR-BIO) cohort.MethodsHUR-BIO is a prospective, single center database of biological disease-modifying antirheumatic drug (bDMARD) treatments. 770 patients on bDMARDs treatment had both lumbar and cervical lateral radiographies at the time of the data collection, and were included in the study. Bamboo spine was defined Bath Ankylosing Spondylitis Radiologic Index (BASRI)-spine grade 4 with a complete fusion of lumbar and cervical spines. Advanced spinal ankylosis was defined as the presence of at least two intervertebral adjacent bridges and/or fusion at the lumbar and/or cervical spine without bamboo spine. We analyzed the ensemble of variables by multivariable logistic regression to identify predictors associated with bamboo spine / advanced spinal disease, and bamboo spine-only.ResultsIn the study, there were 99 patients with advanced spinal ankylosis and 78 patients with bamboo spine. Older age (OR 1.12, 95% CI 1.07-1.17), male gender (OR 4.26, 95% CI 1.75-10.41), delay diagnosis ≥ 24 months (OR 2.7, 95% CI 1.27-5.74), obesity (OR 4.03, 95% CI 1.53-10.64), hip involvement (OR 4.94, 95% CI 1.94-12.6), smoking ≥ 10 package/year (OR 2.28, 95% CI 1.003-5.2) were significantly associated factors with bamboo spine / advanced spinal ankylosis. Similarly, older age (OR 1.17, 95% CI 1.09-1.3), male gender (OR 8.31, 95% CI 2.09-33.1), obesity (OR 5.15, 95% CI 1.25-21.27), hip involvement (OR 4.74, 95% CI 1.32-16.96) and smoking ≥ 10 package/year (OR 3.19, 95% CI 1.03-9.89) were showed statistical significance with bamboo spine (Table 1).Table 1.Predictors of Bamboo Spine and Advanced Spinal Ankyloses, and Bamboo Spine-onlyMultivariable ModelCovariatesBamboo Spine and Advanced Spinal AnkylosisBamboo SpineOR (95% CI)p-valueOR (95% CI)p-valueAge1.12 (1.07-1.17)<0.001*1.17 (1.09-1.3)<0.001*Male (vs female)4.26 (1.75-10.41)0.001*8.31 (2.09-33.1)0.003*Delay Diagnosis (≥ 24 months vs <24 months)2.7 (1.27-5.74)0.01*2.39 (0.85-6.71)0.09BMI0.019*0.074- 25 to < 30 (vs <25)2.05 (0.77-5.46)0.153.37 (0.84-13.6)0.087- ≥ 30 (vs <25)4.03 (1.53-10.64)0.005*5.15 (1.25-21.27)0.024*Hip involvement (present vs absent)4.94 (1.94-12.6)0.001*4.74 (1.32-16.96)0.017Smoking (≥ 10 package/year vs <10 package/year)2.28 (1.003-5.2)0.049*3.19 (1.03-9.89)0.044*Family History of SpA (First-degree; present vs absent)1.67 (0.61-4.57)0.322.82 (0.79-10.06)0.11Uveitis History (present vs absent)1.04 (0.39-2.74)0.941.19 (0.33-4.29)0.79Use SSZ (present vs absent)0.6 (0.17-2.07)0.422.09 (0.39-11.28)0.39Use Corticosteroids (present vs absent)0.69 (0.27-1.75)0.430.73 (0.18-2.97)0.66*p <0.05BMI: Body mass index; SpA: Spondyloarthritis; SSZ: SulfasalazineConclusionData on the predictors of development of advanced spinal ankylosis and bamboo spine are scarce. In this study, we showed that older age, male gender, delay in diagnosis, obesity, hip involvement and smoking are factors that predict the development of advanced spinal involvement in axSpA.References[1]Ostergaard M, Lambert RG. Imaging in ankylosing spondylitis. Ther Adv Musculoskelet Dis. 2012;4(4):301-11.Disclosure of InterestsNone declared
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POS1085 FREQUENCY OF DYSLIPIDEMIA AND COMPLIANCE WITH THE TREATMENT IN PsA PATIENTS USING bDMARDs. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundDyslipidemia is the leading treatable-modifiable factor among comorbidities in Psoriatic arthritis (PsA) patients. International treatment recommendations have left the management of dyslipidemia to national guidelines and especially to the rheumatologists.ObjectivesIn this study, we aimed to determine the frequency of dyslipidemia and the rates of initiation of treatment within the indication in PsA patients using bDMARDs.MethodsThe Hacettepe University biological database (HUR-BIO), was established in 2005 and data of 520 PsA patients included until 2021 were analyzed. In all included patients, the diagnosis of PsA was made by therheumatologist. Lipid profiles of PsA patients were evaluated at diagnosis, during the first bDMARD initiation, and at the last visit. Total cholesterol (TC), Triglyserides (TG), HDL-C and LDL-C values were grouped as optimal, borderline, high and severely high according to the Turkish Endocrine and Metabolism society criteria (1).ResultsLipid profile values of PsA patients were known at diagnosis (n=159, 30.6%), in the initial bDMARD baseline (n=161, 30.9%), and at the last visit (n=203, 39.0%). The time to diagnosis of PsA and first bDMARD use was 2.8 years, and the time between the start of bDMARD and the last visit was 3.7 years. Accordingly, the rates of high TC, borderline TG, and high LDL increased over time. Rates at the time of PsA diagnosis, first bDMARD onset and at the last visit are as follows; high TC (14.3%, 17.1% and 28.0%), borderline TG (20.4%, 27.7% and 40.5%) and high LDL (17.0, 24.0% and 27.9%). On the other hand, low HDL-C slightly improved in men (33.3%, 29.4% and 23.1%), but did not show a significant change in women. While LDL-C level was >160 in 24.0% of patients who were started on bDMARD, anti-hyperlipidemic drug was started in only 6.2% of them. A similar situation persisted at the last visit (27.9% had LDL-C levels >160, but 10.8% received anti-hyperlipidemic therapy) (Table 1).Table 1.Lipid levels and changes over timeLipid levelsAt the time of diagnosis n= 159At the time of bDMARD initiation n=161bDMARD last visit n= 203Total Cholesterol (TC) mean (SD)195 (42)201 (43)214 (47)- TC < 200 (optimal) (%)56.552.845.3- TC 200-239 (borderline) (%)27.230.125.7-- TC > 240 (high) (%)14.317.128.0Triglyceride (TG) mean (SD)115 (52)132 (90)158 (103)- TG < 150 (optimal) (%)79.671.758.0- TG 150-499 (borderline) (%)20.427.740.5- TG 500-880 (high) (%)001.0-- TG ≥ 880 (severely high) (%)00.60.5HDL-C mean (SD)51.8 (13.1)50.6 (13.0)53.2 (12.5)- ≥60 (optimal) (%)20.620.425.6- 40-59 (borderline) in men (%)54.660.852.3- 50-59 (borderline) in women (%)32.324.530.3- Male < 40 (low) (%)33.329.423.1-- Women < 50 (low) (%)32.339.633.8LDL-C mean (SD)126 (33)132 (37)139 (36)- LDL-C < 100 (optimal) (%)21.421.114.2- LDL 130-159 (borderline) (%)22.525.127.0- LDL 160-190 (high) (%)17.024.027.9-- LDL > 190 (very high) (%)4.46.38.4Anti-hyperlipidemic drug n (%)5 (3.1)10 (6.2)22 (10.8)ConclusionAmong the modifiable risk factors for cardiovascular comorbidities in PsA patients, the leading risk factor is dyslipidemia. On the other hand, dyslipidemic drug use rates in daily practice are significantly lower. Although attention is paid to the management of comorbidities in all recommendations, there is still work to be done in real life.References[1]TEMD Obezite, L.M., Hipertansiyon Çalişma Grubu, TEMD DİSLİPİDEMİ TANI VE TEDAVİ KILAVUZU. 9 ed, ed. 2021, Ankara: Türkiye Endokrinoloji ve Metabolizma Derneği. 159.Disclosure of InterestsNone declared
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POS1087 THE RELATIONSHIP BETWEEN CHANGES IN PSORIATIC ARTHRITIS DISEASE ACTIVITY AND COMORBIDITIES IN PATIENTS TREATED WITH bDMARDs. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundComorbidities are common in psoriatic disease, needed to be recognized and managed to effectively when treating psoriatic arthritis (PsA) patients. However, the data on the impact of particular comorbidities on the disease activity in patients requiring bDMARDs are very small.ObjectivesOur aim was to understand the relationship between the disease activity and comorbidities in PsA patients under bDMARDs.MethodsThe Hacettepe University biological database (HUR-BIO), was established in 2005 and data of 520 PsA patients included until 2021 were analyzed. In all included patients, the diagnosis of PsA was made by the rheumatologist. DAS-28 score (at the last visit) and all comorbidities were documented after bDMARD initiation. Multivariate analysis was performed to understand comorbidities that have impact on DAS-28 remission.ResultsThere were 469 patients with a known DAS-28 score median (IQR) 28 (61) months after bDMARD initiation. It was detected in 214/469 (45.6%) patients with a DAS-28 score below 2.6. Patients in remission of DAS-28 were younger, remission was less frequent in women, and comorbidities, mainly BMI, Diabetes Mellitus (DM) and hypertension, were also found less frequent (Table 1). In the multivariate analysis, no determining factor was found in male gender. On the other hand, in females, smoking, presence of comorbidity, Body mass index (BMI) at the start of bDMARDs, age at onset of bDMARDs, DM at the start of bDMARDs, HT at the start of bDMARDs, coronary artery disease, and cardiovascular risk factors were included in the analysis and revealed, bDMARD baseline BMI [OR 1.06 (95% CI 1.02-1.11), p= 0.004] and presence of bDMARD baseline DM [OR 3.08 (95% CI 1.14-8.30), p=0.026] had significant impact on DAS-28 remission.Table 1.Relationship between remission according to DAS-28 score and comorbiditiesParametersDAS-28 ≤ 2.6 (n=214)DAS-28 > 2.6 (n=255)pAge, mean (SD), years43.8 (11.7)47.5 (12.5)0.001Age at PsA diagnosis, mean (SD), years36.8 (11.5)41.6 (11.7)<0.001Gender, female, n(%)115 (53.7)211 (82.7)<0.001Comorbidity count1.54 (0.98)1.98 (1.31)<0.001Comorbidity (yes/no)67 (31.9)118 (47.6)0.001Comorbidity distribution0.001-No143 (68.1)130 (52.4)-1 Comorbidity38 (18.1)47 (19.0)-≥ 2 Comorbidity17 (8.1)36 (14.5)-≥ 3 Comorbidity12 (5.7)35 (14.1)Body Mass Index (BMI)28.1 (5.4)30.3 (5.9)<0.001BMI > 30, n(%)70 (32.9)123 (48.4)0.001Diabetes Mellitus, n(%)10 (4.7)35 (13.7)0.001Hypertension, n(%)29 (13.6)71 (27.8)<0.001Total cholesterol > 240, n(%)8 (10.5)22 (28.6)0.019Thyroid Disease20 (9,8)43 (17,3)0,02ConclusionPrevious data showed that obesity, hypertension and at least 1 point from charlson comorbidity index are poor prognositc factors for treatment outcomes (1). Our data showed that BMI and presence of DM were determined as factors affecting bDMARD treatment response in female PsA patients.References[1]Ballegaard C, et al. Comorbidities, pain and fatigue in psoriatic arthritis, psoriasis and healthy controls: a clinical cohort study. Rheumatology (Oxford). 2021 Jul 1;60(7):3289-3300.Disclosure of InterestsNone declared
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AB0912 Swollen and tender joints improvement in the randomized controlled trials of psoriatic arthritis. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe ACR response is used to evaluate peripheral joints in psoriatic arthritis. However the main component in ACR treatment response is swollen (SJ) and tender joints (TJ), therewithal patient and physician global assessment, acute phase response, pain and function are included in this treatment response. Therefore, it can be thought that peripheral arthritis can best evaluated over SJ and TJ. Although ACR treatment responses are generally found to be similar between anti-TNF and anti-IL17/anti-IL23 in PsA, there is a general opinion that anti-TNF treatments may be more effective on the peripheral joint. (1).ObjectivesIn this study, it was aimed to evaluate the efficacy on SJ and TJ in RCTs performed in PsA.MethodsWe was searched with the keywords ‘psoriatric arthritis’ and ‘randomized controlled trial’ in Pubmed. All studies between 1975 and 31.10.2021 were screened for TJ count (SD) and SJ count (SD) values at treatment initiation and primary endpoint. The 2 studies with anti-TNFs and the SPIRIT-1 study comparing ixekizumab with placebo and adalimumab showed the number of SJ and TJ at baseline and primary endpoint. Effect size calculated separately according to Morris and Klauer formula. (2,3) We can interpret the effect size according to Cohen as follows: 0-0,1 no effect; 0,2-0,4 small effect; 0,5-0,7 intermediate effect; 0,8-≥1 large effect. (4)ResultsCertolizumab study, ES was found at a good level in the number of TJ and SJ at 200 and 400 mg doses. (ES 0.84 for SJ). The study comparing ixekizumab with adalimumab and placebo, it was observed that administration of ixekizumab every 4 weeks was minimally more effective in the number of TJ (ES 0.16) and SJ (ES 0.13) than adalimumab. The effect of ixekizumab over placebo is also slightly better than that of Adalimumab over placebo. (0.51 vs 0.36 in TJ, 0.38 vs 0.29 in SJ)Table 1.Effect size analysis of studiesTender Joint CountReferenceWeek (w)InterventionControlBaseline (Intervention vs Control)ES (Morris)ES (Klauer)Spirit-112Ixekizumab 4 w (n=107)Adalimumab (n=101)20,5 (13,7) vs 19,3 (13,0)0.160.9112Ixekizumab 2 w (n=103)Adalimumab (n=101)21,5 (14,1) vs 19,3 (13,0)0.120.2912Ixekizumab 4 w (n=107)Plasebo (n=106)20,5 (13,7) vs 19,2 (13,0)0.515.112Ixekizumab 2 w (n=103)Plasebo (n=106)21,5 (14,1) vs 19,2 (13,0)0.473.912Adalimumab (n=101)Plasebo (n=106)19,3 (13,0) vs 19,2 (13,0)0.364.1GENOVESE, Mark C., et al. M02-570 Study Group12Adalimumab (n=51)Plasebo (n=49)25,3 (18,3) vs 29,3 (18,1)0.190.30RAPID-PsA24Certolizumab 200 mg (n=138)Plasebo (n=136)21,5 (15,3) vs 19,9 (14,7)0.670.7524Certolizumab 400 mg (n=135)Plasebo (n=136)19,6 (14,8) vs 19,9 (14,7)0.490.61Swollen Joint CountSpirit-112Ixekizumab 4 w (n=107)Adalimumab (n=101)11.4 (8.2) vs 9.9 (6.5)0.130.6312Ixekizumab 2 w (n=103)Adalimumab (n=101)12,1 (7,2) vs 9,9 (4,7)0.191.1812Ixekizumab 4 w (n=107)Plasebo (n=106)11,4 (8,2) vs 10,6 (7,3)0.383.812Ixekizumab 2 w (n=103)Plasebo (n=106)12,1 (7,2) vs 10,6 (7,3)0.453.212Adalimumab (n=101)Plasebo (n=106)9.9 (6.5) vs 10.6 (7.3)0.294.4GENOVESE, Mark C., et al. M02-570 Study Group12Adalimumab (n=51)Plasebo (n=49)18.2 (10.9) vs 18.4 (12.1)0.330.29RAPID-PsA24Certolizumab 200 mg (n=138)Plasebo (n=136)11.0 (8.8) vs 11.0 (8.8)0.840.8324Certolizumab 400 mg (n=135)Plasebo (n=136)10.5 (7.5) vs 11.0 (8.8)0.840.87ConclusionChanges in the number of SJ and TJ that directly assess the peripheral joint have not been reported enough in RCTs in PsA patients. According to a limited number of reports, Anti-TNFs (eg, certolizumab) cause significant improvement in the number of SJ and TJ in the primary endpoint. On the other hand, Ixekizumab has as much effect on SJ and TJ as Adalimumab. The effect of anti-IL 17 treatments on the peripheral joint is not less than that of anti-TNFs, as thought.References[1]Noviani M et at. Ther Adv Musculoskelet Dis. 2020[2]Klauer, K. J. Handbuch kognitives Training[3]Morris, S. B. Estimating Effect Sizes From Pretest-Posttest-Control Group Designs.[4]Cohen, J. Statistical power analysis for the behavioral sciences (2. Auflage)Disclosure of InterestsNone declared
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AB0275 THE FREQUENCY, PREVALENCE OF CORONARY ARTERY DISEASE AND PRE-MATURE CAD IN PsA AND RA PATIENTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAn increased incidence of coronary artery disease (CAD) is known in inflammatory arthritis patients compared to the normal population. In the Veterans With Premature Atherosclerosis (VITAL) registry, the frequency of premature CAD (CAD < 55 in men, < 65 years in women) in autoimmune rheumatic diseases was 1.72 (95% CI 1.63-1.81) in Rheumatoid arthritis (RA) compared to the healthy population in approximately 135,000 patients, while a similar situation was not observed in Psoriatic arthritis (PsA) patients 1.09 (95%CI 0.98-1.21) (1).ObjectivesIn this study, we aimed to compare the frequency of CAD and premature CAD in RA and PsA patients using bDMARDs.MethodsThe Hacettepe University biological database (HUR-BIO), database was established in 2005 and prospective follow-up of patients using bDMARDs is being carried out. The frequency of CAD was recorded in 486 PsA and 524 RA patients using bDMARDs. CAD was determined according to the angiography reports or Coronary Computed-Tomography results. Premature CAD is defined as a history of CAD before the age of 55 in men and before the age of 65 in women. Demographic characteristics and other comorbid conditions of the patients were also noted. Disease activity (DAS-28) and functional status (HAQ-DI) of the patients before the first DMARD initiation were recorded.Results581 (75.4% female) RA and 520 (69.4% female) PsA patients were evaluated. The ages of the patients and the duration of the disease are as follows; RA, mean (SD) years of age 52.1 (13.9), disease duration 5.3 (2.1) years, PsA mean (SD) years of age 48.7 (12.5), disease duration 9.2 (6.4). At the time of first bDMARD initiation, 43/581 (7.4%) patients with RA and 12/486 (2.4%) patients with PsA had CAD (p<<0.001). After a median (IQR) follow-up of 32 (23) months in RA patients and 49 (88.5) months in PsA patients, CAD was detected in 59 (11.2%) patients, 32 (6.6%) in PsA patients, p=0.01. While 39/59 (66.1%) of RA patients had premature CAD, 18/32 (56.3%) PsA patients had premature CAD (Table 1).Table 1.Characteristics of RA and PsA patients with/without premature CADRAPsAPremature CADn=38Non-prematureCADn=21pPremature CADn=18Non-prematureCAD(n=14)pGender, n (%)29 (76.3)9 (42.8)0.0110 (55.5)10 (71.4)0.36Age, mean (SD), years56.6 (8.9)72.7 (7.1)<0.00159.9 (8.2)69.1 (6.3)0.002PsA duration, mean (SD), years5.5 (2.1)6.0 (1.7)0.3413.3 (8.9)12.6 (9.5)0.83Smoking (ever), n(%)22 (57.9)11 (52.4)0.8016 (88.9)5 (35.7)0.002BMI > 30, n(%)19 (52.3)7 (35.0)0.208 (44.4)11 (78.5)0.051HT (ever), n(%)23 (63.9)14 (66.7)0.8911 (61.1)13 (92.8)0.040DM (ever), n(%)20 (57.1)9 (52.9)0.774 (22.2)6 (42.8)0.45LDL > 130 (ever), n(%)29120.1311 (61.1)5 (35.7)0.14DAS-284.7 (1.1)4.2 (1.2)0.114.7 (1.4)4.5 (1.5)0.72HAQ (0-3)1.41 (0.7)1.05 (0.8)0.0790.7 (0.6)1. 3 (0.7)0.13RA: Rheumatoid arthritis, PsA: Psoriatic arthritis, CAD; Coronary artery disease, BMI; Body-mass index, HT: Hypertension, DM: Diabetes mellitusConclusionWhile the frequency of premature CAD is 10% in the normal population, CAD has a premature character in two-thirds of RA patients and 55% of PsA patients (2). In a large community-based study, the frequency of premature CAD was found to be increased in RA patients compared to the normal population, but no similar difference was observed in PsA patients (1). In real-life data in which we examined a large group of patients using bDMARDs, it is seen that the subtype of CAD is of pre-mature character in both RA patients and PsA patients.References[1]Mahtta D et al. Am J Med. 2020 Dec;133(12):1424-1432[2]Cole JH, et al. Curr Atheroscler Rep. 2004 Mar;6(2):121-5.Disclosure of InterestsNone declared
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AB1076 IS THERE AN ADDITIONAL IMPACT OF STIMULATING CD8+ LYMPHOCYTES TO DETECT LATENT TUBERCULOSIS IN PATIENTS WITH RHEUMATIC DISEASES? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPurified protein derivative skin test (PPD) or interferon gamma release assays (IGRAs) are used as diagnostic tools to detect latent tuberculosis. QuantiFERON-TB Gold Plus (QFT-Plus) is a new test that detects latent tuberculosis. Antigens of Mycobacterium tuberculosis (ESAT-6 and CFP-10) are used. The test contains two tubes: TB1 and TB2. TB1 tube contains peptides of these antigens that induce CD4+T cell response while TB2 tube contains peptides designed to stimulate both CD4+ and CD8+ T cells. The amount of interferon gamma releases from those cells are determined by ELISA method. In patients with recent exposure to tuberculosis, there is an increased amount of CD8+ expression in comparison to patients with past exposure to tuberculosis.ObjectivesTo investigate the additional impact of stimulating CD8+ lymphocytes with QFT-Plus test in order to detect latent tuberculosis in patients with inflammatory rheumatic diseases.MethodsHacettepe University Rheumatology Biologic Registry Database (HURBIO) database was used in this study. QFT-Plus test of patients with rheumatoid arthritis (RA) and spondyloarthritis (SPA) between January 2018 and March 2021 during work up before biologic/targeted therapy were analysed, retrospectively. Positivity of any of tubes has been reported as QFT (+). The impact of each tube on QFT positivity is analysed.Results1480 patients (946 (64%) SPA, 534 (36%) RA) were enrolled. 957 patients were women. The median age was 45 (min-max:18-82). Totally 12.2% of patients had been reported as QFT(+). In 6% of QFT (+) patients only TB2 tube is positive (Table 1).Table 1.The impact of each tube on QFT-Plus positivityQFT-Plus test (n=1480)Negative86.2%Indeterminate1.5%PositiveOnly TB1 tube positivity8% of positively reported patients12.2% of all patientsOnly TB2 tube positivity6% of positively reported patientsTB1 and TB2 positivity86% of positively reported patientsConclusionDisease inflammatory cascades along with ongoing usage of immunosuppressive agents could affect results of QFT-plus assay in rheumatic diseases. TB2 tubes stimulating CD8(+) T lymphocytes have additional impact in detecting latent TB infection in patients with RA and SpA.Disclosure of InterestsNone declared
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AB0277 DYSLIPIDEMIA TREATMENT IN RHEUMATOID ARTHRITIS PATIENTS USING bDMARDs IS BETTER THAN PsA, BUT THERE IS STILL A WAY TO GO. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPatients with inflammatory arthritis have an increased risk of cardiovascular disease. Dyslipidemia is one of the primary modifiable risk factors.ObjectivesComparasion of the frequency of dyslipidemia and the use of anti-hyperlipidemic agents in patients with Rheumatoid Arthritis (RA) and Psoriatic arthritis (PsA) receiving bDMARDs.MethodsThe Hacettepe University biological database (HUR-BIO), was established in 2005 and 581 (75.4% female) patients with RA and 520 (69.4% female) patients with PsA enrolled up to 2021 were analyzed. Dyslipidemia was defined according to the Turkish Endocrine and Metabolism society criteria (TC > 240, Triglycerides (Tg) > 150, LDL-C > 160, HDL-C (< 40 in men, < 50 in women) (1). The anti-hyperlipidemic (anti-HL) agents used by the patients during follow-up and at their last visit were recorded.ResultsThe mean (SD) age of the patients and diseases duration were as follows; RA vs. PsA [age: 52.1 (13.9) vs. 48.7 (12.5) years; disease duration: 5.3 (2.1) vs. 9.2 (6.4) years]. Lipid profiles were known in 289 (49.7%) patients with RA and in 175 (33.6%) patients with PsA at the initiaiton of bDMARD. Lipid profiles were evaluated in 356 (61.2%) patients with RA and 226 (43.4%) patients with PsA during follow-up and at the last visit. Lipid profiles were similar in patients with RA and PsA at the initiation of bDMARDs (Table 1). At the initiation of bDMARD, 29 (5.0%) of RA patients and 10 (3.2%) of PsA patients were receiving anti-HL agents. During the entire follow-up, 65 (12.6%) patients with RA and 22 (4.8%) patients with PsA have used anti-HL agents (p<0.001).Table 1.Lipid values in patients with RA and PsA at the initiation of bDMARD and at the last visitRheumatoid arthritis, n (%)Psoriatic arthritis, n (%)p1*p2**Lipid valuesbDMARD initiationLast visitbDMARD initiationLast visitTotal Cholesterol> 24047/270(17.4)98/339 (28.9)32/161(19.8)57/203 (28.1)0.300.13Triglyseride> 15062/242 (25.6)108/320 (33.7)45/159 (28.3)80/193 (41.4)0.790.20HDL-C< 40 (males),< 50 (females)88/267 (32.9)70/343 (20.4)57/157 (36.3)20/207 (9.6)0.480.001LDL-C > 16053/289 (18.3)91/356 (25.6)43/175 (24.5)65/226 (28.7)0.380.55*p1, bDMARD initiation visit comparison**p2, last visit comparisonConclusionIn real-life cohort, lipid profile was not assesed in half of the patients during entire follow-up. Although, LDL-C levels are high in about a quarter of the patients in both groups, use of anti-hyperlipidemic drug was inadequate. This is even more evident in PsA patients. Despite the significant emphasis on comorbidities in treatment guidelines, there is still a long way to go in real life.References[1]TEMD Obesity Guideline, L.M., Hypertension Working Group, TEMD Dyslipidemia Diagnosis and Treatment Guideline. 9th ed. 2021,Disclosure of InterestsNone declared
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AB0416 CARDIOVASCULAR EVENT, VENOUS THROMBOEMBOLIZM, AND INFECTION RISK WITH TOFACITINIB IN RHEUMATOID ARTHRITIS PATIENTS AGED ≥ 60 YEARS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundTofacitinib is a targeted synthetic DMARD that selectively inhibits Janus kinase (JAK) and is approved for the treatment of RA by the FDA in 2012. In recent years, an important safety concern related to incidence of adverse events after treatment with tofacitinib has emerged.ObjectivesTo evaluate the risk of major adverse cardiovascular events (MACE), venous thromboembolism (pulmonary embolism or deep vein thrombosis), serious infections requiring hospitalization, and herpes zoster with tofacitinib in RA patients aged ≥ 60 years.MethodsHUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological and targeted synthetic DMARD registry since 2005. We analyzed RA patients aged ≥ 60 years receiving tofacitinib who had at least 1 control visit registered in the HURBIO database. Phone calls were made with these patients for the current health status information until the end of January 2022. The data of the patients who lost the follow-up in our clinic were obtained from the personal health record system of the Republic of Turkey Ministry of Health by patients’ permission. The coprimary end points were adjudicated MACE, VTE, serious infections, and herpes zoster. These events were identified using patients’ medical records. Crude incidence rates were expressed in patients with first events per 100 patient-years, with two-sided 95% confidence intervals.ResultsA total of 132 RA patients (109, 82.6% female) aged ≥ 60 years received tofacitinib at a dose of 5 mg twice daily. The median (25–75% percentiles) age was 67 (63-73) years and median duration under tofacitinib was 18 (5-33) months. Approximately 70% of patients were biologically naive. During a median follow-up of 1.5 years, the incidences of serious infection requiring hospitalization and herpes zoster were higher (5.5% [95%CI 3.12-9.86] and 3.4% [1.67-7.17], respectively) while there was no increase in the incidences of MACE and VTE. The causes for hospitalization were as follows: COVID-19 (n=4), pneumonia (n=3), soft-tissue infection (n=3), and GIS infection (n=1). Two of these patients deceased.ConclusionOlder patients with RA are at increased infection risk because of age and comorbid conditions. Although adverse events are reported with 10 mg tofacitinib twice daily, clinicians should be careful against the risk of infection at a dose of 5 mg twice daily, especially in elderly patients.References[1]Ytterberg SR, Bhatt DL, Mikuls TR, et al. Cardiovascular and Cancer Risk with Tofacitinib in Rheumatoid Arthritis. N Engl J Med. 2022;386(4):316-326.Table 1.Clinical characteristics of the patients and incidence rates for adverse eventsCharacteristic*Tofacitinib, 5 mg Twice Daily (N=132)Age, years67 (63-73)Female/male109 (82.6)/23 (17.4)Smoking status-Never smoked78 (59.1)-Ever smoked54 (40.9)History of hypertension82 (62.1)History of diabetes mellitus40 (30.2)History of coronary heart disease14 (10.8)History of congestive heart failure3 (2.3)History of chronic kidney disease11 (8.3)Family history of coronary heart disease8 (6.2)RA disease duration, years10 (7-18)Biologic naïve/experienced92 (69.7)/40 (30.3)Duration under tofacitinib, months18 (5-33)No. of Patients with First EventIncidence Rate per 100 Patient-Yr (95% CI)MACE, n=10.49 (0.07-3.44)VTE, n=41.96 (0.74-5.17)Infection-Requiring hospitalization, n=115.55 (3.12-9.86)-Herpes zoster, n=73.46 (1.67-7.17)* n (%), if otherwise specified; median (IQR) for numeric values.CI: Confidence Interval, MACE: Major adverse cardiovascular events, VTE: Venous thromboembolism (pulmonary embolism or deep vein thrombosis)Disclosure of InterestsNone declared
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AB0940 Is psoriatic arthritis really seronegative? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPsoriatic Arthritis (PsA) is a heterogeneous disease classified as a seronegative group of inflammatory arthritis.ObjectivesOur aim was to understand the real-life seropositivity rates for commonly used autoantibodies in rheumatology practice in a cohort of PsA patients treated with biologic agents.MethodsPsA patients from the Hacettepe University biological database (HUR-BIO) were assessed for the anti-nuclear antibody (ANA), rheumatoid factor (RF), and anti-cyclic citrullinated peptide (CCP) before and after the initiation of biologic agents. Demographic characteristics, the interval between the test and biologic initiation, and the rates of seropositivity for individual tests, autoantibody titers, and subtypes for ANA were determined.ResultsFrom 520 PsA patients registered, results of 419 patients with at least one autoantibody tested either before or after biologic treatment is presented in Table 1. From the patients tested, 69% of them had at least one autoantibody positive and 30.8 % of them were triple negative before the biologic treatment. The rates reached to 78.7% of seropositivity for at least one autoantibody and 21.2 %triple negativity after treatment. ANA showed the highest rates of seropositivity among autoantibodies with a rate of 40% before and 55.3 % after biologic treatment. Concomitant seropositivity for RF and CCP autoantibodies showed rates of 2.8% and 6.3% before and after treatment, respectively. The most common subtype was AC4-5 before and AC1-4-5 after biologic agent treatment. ANA was tested in 31 patients both before and after biologic treatment showing 6 negative patients became positive after treatment and from 12 positive patients at the baseline 6 of them became negative (p=0.452). The most common biologic agents used in patients with ANA tested after treatment, were adalimumab (ADA) (42.4%), etanercept (ETN) (18.9%), and infliximab (IFX) (18.9%). The only difference was observed in IFX treated patients (n=25) with significantly higher rates of IFX usage in ANA-positive patients (p=0.001).Table 1.Demographics and ANA, RF, Anti-CCP test results of patients before and after biologic treatmentANARFAnti-CCPbDMARDs initiationBeforeAfterBeforeAfterBeforeAfterNumber of patients10413231027814497Age43.5 (12.7)46.7 (11.6)43.3 (12.5)47.9 (11.9)44.3 (12)48.6 (12.1)Female sex, n (%)84 (80.7)97 (73.5)225 (72.5)211 (75.8)110 (76.3)75 (77.3)Time interval between test and bDMARD initiation, months, median (IQR)7.4 (0.84-17.83)32.6 (14.93-72.33)4.1 (0.35-16.75)31.63 (13.10-64.08)3.23 (0.30-11.5)35.13 (12.40-75.43)Positivity, n (%)42 (40.4)73 (55.3)30 (9.6)32 (11.5)12 (8.3)11 (11.3)Titer IU/ml, median (IQR)NANA28.7 (22.35-98.5)28.9 (21.9-110)139.1 (20.38-250)67.5 (16.77-139)Titer, n (%) *28 (66.6)38 (52)N/AN/AN/AN/A1/1007 (16.7)14 (19.1)1/1607 (16.7)20 (27.3)≥1/320bDMARD: Biologic Disease Modifying Anti-Rheumatic Drugs, ANA: Anti-nuclear antibody, RF: Rheumatoid factor, Anti-CCP: Anti- Cyclic citrullinated peptide, F:Female, M:Male, IQR: Interquartile range, IU/ml: International units per milliliter, N/A: Not available*Subtype is not given for one patient in patients with positive ANA after biologic treatmentConclusionSynovial lymphoid neogenesis rates in PsA are similar to the frequency seen in rheumatoid arthritis (1). Nevertheless, PsA is classified under the group of “seronegative diseases”. On the other hand, current reports have started to define specific autoantibodies particularly in psoriasis patients (2). The real-life experience in serology results of PsA patients showed that only 20-30 % of the patients were seronegative for all three tests commonly used in practice.References[1]Celis R, et al. Synovial cytokine expression in psoriatic arthritis and associations with lymphoid neogenesis and clinical features. Arthritis Res Ther. 2012 Apr 27;14(2):R93.[2]Yuan Y, et al. Identification of Novel Autoantibodies Associated With Psoriatic Arthritis. Arthritis Rheumatol. 2019 Jun;71(6):941-951.Disclosure of InterestsNone declared
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POS1187 DO IMMUNOSUPPRESSIVE AGENTS AFFECT IGRA TESTS IN PATIENTS WITH RHEUMATOID ARTHRITIS? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundTuberculin skin test (PPD) or interferon gamma release assays (IGRAs) are used to detect latent tuberculosis infection. Induration of 15 mm or more is considered positive in any person whereas this cut-off is ≥5 mm for immunosuppressed individuals such as Rheumatoid arthritis. Since IGRAs are dependent on normal T-cell function, it may result in false-negatives for among RA patients due to disease itself and immunosuppressive drugs.ObjectivesWe aimed to compare IGRA results of RA patients using high dose DMARDS vs. not using any of them.MethodsTotally 534 RA patients among Hacettepe University Rheumatology Biologic Registry Database (HURBIO) database was enrolled into this study. QFT-Plus test of patients with rheumatoid arthritis (RA) between January 2018 and March 2021 during work up before biologic/targeted therapy were analysed, retrospectively. The patient group was divided into two according to the drugs have been using at the time of IGRA test. Patients using methotrexate ≥ 10 mg or leflunomide (any dose) or steroids (≥7.5 mg prednisolone) or any combination thereof were classified as the “High Dose” group. The other group consisted of patients who did not take these drug doses. Demographic characteristics, comorbidities, drugs and doses used, and hemogram, sedimentation, and CRP values of the patients were recorded. QuantiFERON test was recorded as positive, negative, indeterminate.Results353(66.1%) RA patients were in the high dose patient group and also 287(81.3%) of these patients were female, the median age was 55 years (min:19- max:82). The high dose group was older than the other group. When the two groups were compared, no statistically significant difference was found between comorbidity, and smoking (Table 1). While QFT positivity was detected in 37 (10.5%) patients in the high-dose group, it was found to be positive in 37 (20.4%) patients in the other group (p<0.001). However, there was no significant difference regarding acute phase reactants, hemogram including lymphocyte counts and IFN-gamma levels in the tubes between these two groups.Table 1.Comparison of RA patients’ groups using high-dose immunosuppressives and not using any of themHigh Dose Methotrexate or Leflunomide or Steroid (+), (%)66.1High Dose Methotrexate or Leflunomide or Steroid (-), (%)33.9P ValueFemale81.375.10.09Age, med (min-max)55 (19-82)52 (19-81)0.01Diabetes Mellitus1110.50.84Hypertension30.624.90.16Chronic Renal Failure0.300.66Chronic Obstructive Pulmonary Disease4.23.30.59Coronary Artery Disease3.76.10.20History of malignancy0.81.70.40SmokingNever4952.50.19Ever24.127.6Quit26.318.8Leukocyte,*103/mlMedian (min-max)7.6 (2.8-28.8)7.9 (3.5 – 20.8)0.26Neutrophil,*103/ml4.8 (0.2-23.0)5.0 (1.5-19.1)0.18Lymphocyte,*103/ml1.9 (0.4-5.9)1.8 (0.5-5.3)0.67Thrombocyte,*103/ml285 (117-669)285.5 (60-724)0.79Hemoglobine,g/dL12.8 (7.7-17.9)12.8 (9.3-16.6)0.41Sedimentation,mm/saat30 (2-294)28 (2-104)0.27C Reactive Protein,mg/dl1.1 (0.1-62.8)1.1 (0-20.7)0.96QuantiFERON-TB Gold-Plus (QFT-Plus)10.520.40.00Nil med (min-max)0.07 (0-2.7)0.05 (0-0.85)0.48QFT-Plus TB-1 med (min-max)1 (0->10)0.99 (0->10)0.25QFT-Plus TB-2 med (min-max)1 (0->10)1.1 (0->10)0.42Mitogen med (min-max)10 (0->10)9.5 (0->10)0.27MethotrexateNot Taking31.433.7Less than 10 mg44.266.310 mg and more24.40LeflunomideNot Taking25.8100Taking74.20HydroxychloroquineNot Taking25.240.9Taking74.859.1SulfasalazineNot Taking62.661.9Taking37.438.1SteroidsNot Taking4.219.9Less than 7.5 mg66.380.17.5 mg and more29.50ConclusionOur results confirmed a significantly lower QFT-Plus positivity in patients with RA taking methotrexate ≥ 10 mg or leflunomide (any dose) or steroids (≥7.5 mg prednisolone). Physicians should be careful in interpretation of QFT-Plus in patients with rheumatoid arthritis. Further analysis including flow cytometry analysis is required to better identifying cut-offs for immunosuppressive individuals and patients with inflammatory rheumatic diseases.Disclosure of InterestsNone declared
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AB0843 OSTEOPOROSIS IN PATIENTS WITH SPONDYLOARTHRITIS: DO WE NEED TO DO MORE? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundData regarding the prevalence and especially incidence of osteoporosis in Spondylarthritis (SPA) is scarce and very divergent among studies from different patient populations (1).ObjectivesIn this study, we aimed to compare demographic, disease and laboratory characteristics of SpA patients regarding their bone mineral densitometry (BMD) categories and find out incidence of osteoporosis in the follow-up BMD of patients who were not found to have osteoporosis at baseline.MethodsBetween 2010-2021, patients with a SPA diagnosis in the HUR-BIO database were searched. HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (DMARD) registry since 2010. Patients with BMD measurement were included in the study. Follow-up BMD scores were also documented. The patients were divided into 3 groups as normal, osteopenia and osteoporosis in accordance with the WHO criteria (2). Demographic characteristics, comorbidities, laboratory data and drugs in each group were documented.Results3245 patients were reviewed. BMD was measured at least once in 118 patients out of 3245 (3.6%) patients. When the groups classified, 34 patients (28.8%) were included in the normal, 49 (41.5%) osteopenia and 35 (29.7%) osteoporosis groups. Patients with normal BMD was younger than both groups. Diabetes and hypertension were more prevalent in patients with osteopenia. The BMI was significantly lower in the osteoporosis group. 25 patients with normal and osteopenia in baseline BMD measurement had at least 1 follow-up BMD measurement. During the total follow-up of 91 patient-years, 3 patients had osteoporosis, revealing a the incidence of 3.3% in 100 patient-years.ConclusionIn our study, the incidence of OP development in SPA patients was found to be 3.3%. Frequency of osteoporosis was 29.7% among SpA patients with BMD measurement (118/3245; 3.6%), however; only 40% of them had appropriate treatment. Osteoporosis seems as an overlooked and undertreated comorbidity of SpA.Table 1.Comparison of spondyloarthritis patients according to BMD scores (normal, osteopenia and osteoporosis) according to baseline BMD assessmentNORMAL Number, (%)OSTEOPENIA Number, (%)OSTEOPOROSIS Number, (%)P VALUENumber of Patients34 (28.8)49 (41.5)35(29.7)Age47,5 (27-70)63 (45-79)58 (20-75)0.00*Gender (Female)24 (70.6)34 (69.4)23 (65.7)Diabetes Mellitus3 (8.8)14 (29.2)1 (2.9)0.00*Hypertension11 (32.4)28 (58.3)5 (14.3)0.00*Chronic Renal Failure2 (6.9)1 (2.7)1 (5.3)0.81Chronic Ostructive Pulmonary Disease4 (13.8)4 (10.8)1 (5.3)0.30Coronary Artery Disease0 (0)5 (12.5)3 (15)0.27Malignancy1 (3.6)1 (2.9)1 (4.2)1.0Smoking21 (61.8)23 (47.9)21 (63.6)0.379 (26.5)13 (27.1)5 (15.2)4 (11.8)12 (25)7 (21.2)Calcium mg/dl9.4 (8.2-10.2)9.5 (8.7-10.4)9.7 (8.1-10.4)0.49Phosphorus mg/dl3.5 (3-4.4)3.4 (2.6-5)3.8 (2.9-4.9)0.25Vitamin D ng/ml16 (7.4-64.4)21.2 (5-69.6)15.8 (5.8-49.1)0.66ALP IU/ml89.5 (54-137)89.5(53-169)80 (50-239)0.43Albumin g/dl4.2 (1.7-4.7)4.2 (3.3-8.4)4.2 (2-4.8)0.43TSH mU/ml1.5 (0.8-4.1)2.3 (0.1-9.7)2 (0.7-3.3)0.71Body Mass Index (BMI) kg/m229 (17-41.2)28.3 (20-44.6)25.1(15.8-43.2)0,06*Steroids4 (11.8)8 (16.3)2 (5.7)0.33Anti-TNF25 (73.5)35 (71.4)26 (74.3)0,95D Vitamin7 (20.6)14 (28.6)10 (28.6)0.67Calcium4 (11.8)5 (10.2)6 (17.1)0.63Bisphosphonate0 (0)4 (8.2)14 (40)0,00*Data was represented as median (minimum-maximum) or n(%)References[1]Hu LY, Chen PM, Shen CC, et all. Should clinicians pay more attention to the potential underdiagnosis of osteoporosis in patients with ankylosing spondylitis? A national population-based study in Taiwan. PoleS one 2019:6;14[2]Kanis JA on behalf of the World Health Organization Scientific Group (2007) Assessment of osteoporosis at the primary health-care level. Technical Report. World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK. 2007: Printed by the University of Sheffield.Disclosure of InterestsNone declared
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POS0944 PREDICTORS OF SUSTAINED REMISSION IN PEOPLE WITH AXIAL SPONDYLOARTHRITIS TREATED WITH BIOLOGIC DRUGS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe ultimate goal of treatment in axial spondyloarthritis (axSpA) is sustained remission. Data on predictors of sustained remission are scarce in axSpA.ObjectivesTo determine predictors of sustained remission in people with axSpA after treatment with their first biological disease-modifying anti-rheumatic drug (bDMARD).MethodsHacettepe University Rheumatology Biologic Registry (HUR-BIO) is a prospective, single center registry of rheumatic disease patients treated with bDMARDs. Patients with axSpA were selected and sustained remission defined as attainment of Assessment of SpondyloArthritis International Society partial remission (ASAS-PR) and/or Ankylosing Spondylitis (AS) Disease Activity Score C-reactive protein Inactive Disease (ASDAS-ID) for two or more consecutive visits spanning ≥6 months during follow-up. Patients achieving and not achieving sustained remission were compared using the independent t-test. Multivariable logistic regression analysis was performed to determine independent factors predictive of sustained remission. Variables with a p-value<0.1 were re-tested in multivariable models. Forward selection was performed until the best-fit model was obtained, taking possible confounders into account. Two separate multivariable models were built, one with and one without the covariate “achievement of remission at 3-6 months”, to assess consistency of findings and to account for missing information regarding remission status between 3 and 6 months.ResultsData on 990 patients with sustained remission data were available. Of these, 299 (30%) were in sustained remission, while 691 (70%) were not. Patients in sustained remission were younger, had earlier disease onset, were more frequently male, had lower BMI and were more frequently HLA-B27 positive, compared to patients not in sustained remission. Furthermore, at the start of bDMARD treatment, Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), and patient global assessment (PGA, 0-10 scale) were lower, while acute phase reactants (ESR and CRP) were higher, in the sustained remission group. In multivariable analysis, male gender (OR 2.2, 95% CI 1.21-3.95), concomitant conventional synthetic DMARD (csDMARD) use (OR 3.63, 95% CI 1.29-10.19), PGA (OR 0.96, 95% CI 0.95-0.98), and early achievement (between 3-6 months) of remission (OR 13.1, 95% CI 7.13-24.02) were independently associated with sustained remission (Table 1, model 1). In the model without the variable early achievement of remission (Table 1, model 2), similar and a few additional associations were described: age at diagnosis (OR 0.97, 95% CI 0.96-0.99), male gender (OR 2.31, 95% CI 1.60-3.35), concomitant csDMARD use (OR 1.88 95% CI 1.23-2.86), PGA (OR 0.98, 95% CI 0.97-0.99), BASDAI (OR 0.87, 95% CI 0.78-0.96), and baseline symptom duration (OR 0.97, 95% CI 0.94-0.99).Table 1.Multivariable analysis (best-fit model) of predictors of sustained remissionModel 1Model 2CovariatesMultivariable Analysis (n= 541)Multivariable Analysis (n=739)OR (95% CI)p-valueOR (95% CI)p-valueAge at diagnosisNSNS0.97 (0.96-0.99)0.006Male sex2.84 (1.71-4.70)<0.0012.31 (1.60-3.35)<0.001Concomitant csDMARD use (at baseline or follow-up)2.94 (1.57-5.51)0.0011.88 (1.23-2.86)0.003Baseline PGA0.97 (0.96-0.98)<0.0010.98 (0.97-0.99)0.002Baseline BASDAINSNS0.87 (0.78-0.96)0.009Baseline symptom durationNSNS0.97 (0.94-0.99)0.021Achievement of remission at 3-6 months after baseline11.70 (7.11-19.23)<0.001NANANA: not applicable; NS: not selected (not contributing to the model). Baseline refers to start of bDMARD treatment.ConclusionThis study demonstrates that patients in sustained remission after starting bDMARD treatment have distinctive characteristics compared to patients not in sustained remission. These data can be used to aid clinical and personalized management of axSpA, and to facilitate better communicate between health care professionals and patients regarding the course and prognosis of their condition.Disclosure of InterestsBayram Farisogullari: None declared, Gözde Kübra Yardimci: None declared, Emre Bilgin: None declared, Ertugrul Cagri Bolek: None declared, Emine Duran: None declared, Gizem Ayan: None declared, Zehra Özsoy: None declared, Gullu Sandal Uzun: None declared, Mustafa Ekici: None declared, Erdinc Unaldi: None declared, Levent Kiliç: None declared, Ali Akdoğan: None declared, Omer Karadag: None declared, Şule Apraş Bilgen: None declared, Sedat Kiraz: None declared, Ali İhsan Ertenli: None declared, Umut Kalyoncu: None declared, Pedro M Machado Speakers bureau: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, Consultant of: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB
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Pulmonary embolism in patients with dyspnea after COVID-19 infection. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2022; 26:3751-3759. [PMID: 35647858 DOI: 10.26355/eurrev_202205_28872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Pulmonary embolism as a potential complication that may occur late in the course of COVID-19 cases. The aim of our study is to evaluate the frequency of pulmonary embolism in patients with new or ongoing dyspnea after a COVID-19 infection. PATIENTS AND METHODS This is a single-center, prospective observational study to evaluate the clinical and radiological outcomes of consecutive patients presenting outpatient clinic diseases to the chest and a new or ongoing dyspnea after a COVID-19 infection. Demographic, clinical and laboratory data were collected. Dyspnea was evaluated according to the New York Heart Association (NYHA) classification. RESULTS Pulmonary embolism was detected in 23.8% (25/105) of patients with new or ongoing dyspnea after a COVID-19 infection. Proportion of pulmonary embolism in patients with NYHA classes I, II, III and IV were respectively 8.7%, 20.0%, 30.0% and 35.3% (p for trend=0.02). Compared to NYHA class I and II patients with dyspnea, those in NYHA classes III and IV showed a higher rate of pulmonary embolism [31.6% vs. 14.6%, OR: 2.7 (1.0 to 7.1), p=0.04, respectively]. In Logistic Procedures, NYHA classes of dyspnea (OR: 4.3, 95% CI: 1.2 to 16.6, p=0.03) (NYHA class III and IV vs. NYHA class I and II) determine the likelihood of pulmonary embolism after COVID-19 infection. CONCLUSIONS Pulmonary embolism is common in patients with new or ongoing shortness of breath after a COVID-19 infection. Pulmonary embolism is more likely to develop in patients with higher NYHA classes.
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Reply to Letter to the Editor: “Can ARNI Prevent Doxorubicin-Induced Cardiotoxicity?”. Anatol J Cardiol 2022; 26:344. [PMID: 35435851 PMCID: PMC9366426 DOI: 10.5152/anatoljcardiol.2021.1371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Stationary optical solitons with complex Ginzburg-Landau equation having nonlinear chromatic dispersion. OPTICAL AND QUANTUM ELECTRONICS 2022; 54:167. [PMID: 35194297 PMCID: PMC8853289 DOI: 10.1007/s11082-022-03557-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/22/2022] [Indexed: 05/14/2023]
Abstract
The current work is on the retrieval of stationary soliton solutions to the complex Ginzburg-Landau equation that is studied with nonlinear chromatic dispersion having a plethora of nonlinear refractive index structures. The Jacobi's elliptic function approach is employed to recover doubly periodic waves which leads to soliton solutions when the limiting value of the modulus of ellipticity is reached.
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Optical solitons in fiber Bragg gratings with quadratic-cubic law of nonlinear refractive index and cubic-quartic dispersive reflectivity. PROCEEDINGS OF THE ESTONIAN ACADEMY OF SCIENCES 2022. [DOI: 10.3176/proc.2022.2.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Angiotensin receptor-neprilysin inhibition by sacubitril/valsartan attenuates doxorubicin-induced cardiotoxicity in a pretreatment mice model by interfering with oxidative stress, inflammation, and Caspase 3 apoptotic pathway. Anatol J Cardiol 2021; 25:821-828. [PMID: 34734816 DOI: 10.5152/anatoljcardiol.2021.356] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Doxorubicin (DOX) is a well-known cardiotoxic agent, whereas sacubitril/valsartan (Sac/Val) is an effective treatment option in heart failure. In this study, we aimed to evaluate the effect of Sac/Val on DOX-induced cardiotoxicity in pretreatment mice model. METHODS A total of 24 mice were equally classified into 4 groups; control group, DOX (20 mg/kg; fifth day), Sac/Val (80 mg/kg), and Sac/Val+DOX (Sac/Val was given from day one of the study before doxorubicin administration). Electrocardiography parameters, including durations of QRS, ST, QT, PP segment, and QT/PQ index were measured. Total antioxidant status (TAS), total oxidant status (TOS), tumor necrosis factor-α (TNF-α), interleukin 1β (IL-1β), IL-6, NT-proBNP concentrations, and Caspase 3 activity were evaluated. RESULTS At the end of the 9-day study duration, QRS, ST, QT intervals, QT/PQ index and TAS, TOS, TNF-α, IL-1β, IL-6 levels were significantly higher in the DOX group than in the control group (p<0.001). Moreover, there were significant differences only in the PP interval when comparing the Sac/Val+DOX and control groups (p<0.001). QRS, ST, QT intervals, and QT/PQ index, TAS, TOS, TNF-α, IL-1β, IL-6 levels were significantly lower in the Sac/Val+ DOX group compared with the DOX group (p<0.001). Furthermore, NT-proBNP levels were lower in the Sac/Val+DOX group compared with the DOX group along with less Caspase 3 apoptosis. CONCLUSION Sac/Val seems to be cardioprotective against DOX-induced cardiotoxicity in pretreatment mice model. These findings can be attributed to the antiarrhythmic, anti-inflammatory, antioxidant, and antiapoptotic effects of Sac/Val as shown in this study.
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Relationship Between Neutrophil/Albumin Ratio and Early Mortality After Major Lower Extremity Amputation. Cureus 2021; 13:e17733. [PMID: 34659947 PMCID: PMC8491629 DOI: 10.7759/cureus.17733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Diabetic foot infection is a condition that affects the patient's life, may cause limb loss, and has a high mortality. Too many parameters were used for predicting early mortality but the gold standard method wasn't described. Neutrophil lymphocyte ratio (NLR) is universally accepted as a predictive value for amputation-free survival and mortality. NLR increases due to inflammation-induced neutrophilia and lymphopenia related to cortisol-induced stress. Increasing in the neutrophil albumin ratio is expected due to decreasing albumin levels because albumin is a negative acute-phase reactant. The aim of this study is to investigate the sensitivity and value of the neutrophil albumin ratio (NAR) for early mortality after major lower extremity amputation (LEA). Methods Following the approval of the ethics committee, 87 patients who underwent major LEA between May 2018 and May 2020 were analyzed for the study. White blood cell (WBC), neutrophil, lymphocyte, C-reactive protein (CRP), creatinine, albumin, platelet, and hemoglobin values on the day prior to surgery were recorded. NLR was calculated as the ratio of neutrophil count to lymphocyte count, NAR as the ratio of neutrophil count to albumin value, CRP/albumin ratio (CAR) as the ratio of CRP value to albumin value, and platelet lymphocyte ratio (PLR) as the ratio of platelet count to lymphocyte count. Each parameter was also recorded in the postoperative second week. Results Of the patients included in the study, 52 were men (59.8%) and 35 were women (40.2%). It was determined that 29 of 87 patients (33.3%) died within the first year. The relationship between post-operative NAR value and early mortality is examined. The area under the curve was calculated as 0.873. When the cut-off value was applied as 0.265, the sensitivity was found as 88% and specificity as 76%. Conclusions Higher neutrophil/albumin ratio after lower extremity amputation was associated with early mortality after extremity amputation. This parameter can help predict mortality. The cut-off value was determined as 0.265, the sensitivity was found as 88%, and specificity as 76%.
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Solitions in magneto-optic waveguides with anti-cubic nonlinearity. OPTIK 2020; 222:165313. [PMID: 32836402 PMCID: PMC7413843 DOI: 10.1016/j.ijleo.2020.165313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 06/11/2023]
Abstract
Optical soliton solutions are recovered for magneto-optic waveguides that maintains anti-cubic form of nonlinear refractive index. The analytical scheme is Jacobi's elliptic function approach. Once the solutions to the governing model are obtained in terms of Jacobi's elliptic functions, the limiting value to it's modulus of ellipticity reveals the complete spectrum of soliton solutions.
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Pulmonary embolism in obesity-hypoventilation syndrome. CLINICAL RESPIRATORY JOURNAL 2020; 14:1099-1104. [PMID: 32745286 DOI: 10.1111/crj.13241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 07/14/2020] [Accepted: 07/27/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Obesity-hypoventilation syndrome occurs with alveolar hypoventilation during sleeping and daytime. Obesity may be a risk factor for venous thromboembolism. However, the venous thromboembolism in the obesity-hypoventilation syndrome is not well characterized. OBJECTIVE This case series aimed to investigate the presence and clinical features of venous thromboembolism in patients with the obesity-hypoventilation syndrome. METHODS Data of eight case reports were collected. Ages ranged from 36 to 73 years. RESULTS All patients had mosaic perfusion and enlarged main pulmonary artery, two had signs of infarction and mostly segmental and subsegmental filling defects. On the basis of this information some conclusions can be drawn carefully. CONCLUSION Present cases indicate that pulmonary embolism are also very common in patients with obesity-hypoventilation syndrome, anticoagulant therapy is at least as important as the treatment of the current disease. Clinicians will frequently be faced with patients with obesity-hypoventilation syndrome suspected of PE.
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AB0195 FACTORS RELATED TO RADIOGRAPHIC PROGRESSION IN PATIENTS WITH RHEUMATOID ARTHRITIS-RELATED INTERSTITIAL LUNG DISEASE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Interstitial lung disease is an important cause of mortality and morbidity for RA. Lung computerized tomography (CT) is a valid method for the detection of interstitial lung disease (ILD) in rheumatoid arthritis (RA) patients. Besides, CT may have a role in the detection of progression in RA-ILD.Objectives:To compare the clinical and radiological features of RA-ILD patients with and without radiographic progression according to lung CT.Methods:From the hospital database, all patients recorded as having RA according to ICD-10 code and had a lung CT examination were recruited. RA was confirmed in 822 of 2305 (35.6%) records. Three radiologists re-evaluated lung CTs and 156/822 (18.9%) patients with had RA-ILD. Of these 156 patients, 101 (64.7%) had at least 1 follow-up long CT and these patients were included to analysis. Demographic and clinical data of the patients were recorded. ILD was divided into 3 main groups by radiologists: Usual interstitial pneumonia (UIP), non-specific interstitial pneumonia (NSIP) and airway disease (AD) (bronchiectasis and/or bronchiolitis without parenchymal involvement). Avila et al reported a grading system to assess the severity of ILD using HRCT (1). In our study we utilized a similar method using interlobular septal thickening, ground glass opacities, reticulations, traction bronchiectasis and honeycomb appearance as elementary findings to evaluate the RA associated ILD. Septal thickening, reticulations and ground glass opacities were considered as relatively mild features whereas traction bronchiectasis and honey comb appearance were considered as severe findings as those frequently result from advanced fibrosis. The lungs were divided into upper, middle and lower zones each with equal number of slices. Progression was defined as involvement of more zones in vertical extent by the same elementary findings or emergence of more severe findings (i.e traction bronchiectasis or honey comb appearance) in the same zones compared to previous exam. For the multivariate analysis, the possible factors identified with univariate analyses were further entered into the logistic regression analysis to determine independent predictors of radiographic progression.Results:In this study, 101 patients with 215 lung CT were included to analysis. 67 (66.3%) patients had 3 CTs, 30 (29.9%) patients 4 CTs and 17 (16.9%) patients had 5 CTs. Mean duration between first and last CT was 47.7±38.8 months. Of 101 patients, radiographic progression was seen in 42 (41.6%) patients. Univariate comparison of demographic, clinical and radiographic features of patients with or without radiographic progression were given in Table. In multivariate analysis (adjusted for ILD disease duration)having ground-glass opacity(aOR 8.6; CI: 1.65-44.9; p=0.011),male gender(aOR 2.9; CI: 1.13-7.4; p=0.026) were found as independent risk factors radiographic progression, whiletaking methotrexate (ever) (aOR 0.21; CI: 0.07-0.6; p=0.04) was found as an independent protector factor for radiographic progression.Conclusion:The prediction of ILD progression in RA patients were a challenge for clinicians. According to lung CT, baseline ground-glass opacities looks like prominent factor for ILD progression, particularly at male RA patients. Using methotrexate in ILD patients is a dilemma in routine practice, our results demonstrate that methotrexate (not other cs or bDMARDs) is protective drugs for ILD progression, however these results should be confirmed in the further studies.References:[1]Avila NA. AJR Am J Roentgenol. 2002;179(4): 887-892Disclosure of Interests:Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB, Mustafa Ekici: None declared, Emre Bilgin: None declared, Alper Sari: None declared, Yusuf Baytar: None declared, Ertugrul Cagri Bolek: None declared, Berkan Armagan: None declared, Bayram Farisoğullari: None declared, Omer Karadag: None declared, Ali İhsan Ertenli: None declared, Sedat Kiraz: None declared, Levent Kiliç: None declared, Şule Apraş Bilgen: None declared, Gamze Durhan: None declared, Ali Akdoğan: None declared, Macit Ariyürek: None declared
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Troublesome cough as the sole manifestation of pulmonary embolism. Respir Med Case Rep 2019; 28:100861. [PMID: 31194180 PMCID: PMC6554364 DOI: 10.1016/j.rmcr.2019.100861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 11/30/2022] Open
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Effects of Topical Thymoquinone in an Experimental Dry Eye Model. Turk J Ophthalmol 2018; 48:281-287. [PMID: 30605933 PMCID: PMC6330663 DOI: 10.4274/tjo.50146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 05/11/2018] [Indexed: 12/01/2022] Open
Abstract
Objectives To comparatively evaluate the effects of thymoquinone (TQ), the biologically active main component of volatile oil derived from Nigella sativa seeds, in an experimental dry eye model. Materials and Methods A total of 36 BALB/c mice 10 weeks of age were used in the study. The mice were divided into 6 groups of 6 mice. Two groups were negative and positive controls, and the other 4 groups were treated with balanced salt solution, fluorometholone (FML), TQ, or vehicle (Tween80). After 1 week of treatment, the mice were killed and the eyes removed for histopathologic examination and cytokine analysis. Interleukin (IL)-1α tumor necrosis factor-α, interferon-γ, IL-2, IL-6, IL-10, and lactoferrin levels in the conjunctival tissue were measured by multiplex immunobead assay. The presence of inflammatory cells in ocular tissue samples were investigated by hematoxylin-eosin and periodic acid-Schiff staining. Inflammatory T cells containing CXT receptor in the conjunctiva were determined by flow cytometry. Results FLML and TQ groups had less inflammatory cell density and more goblet cells compared to the other groups. High levels of IL-1α and IL-2 were found in the TQ group. Conclusion TQ treatment was associated with reduced inflammation in pathological examination, but did not significant lower cytokine levels.
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The effects of exhaustive swimming and probiotic administration in trained rats: Oxidative balance of selected organs, colon morphology, and contractility. Physiol Int 2018; 105:309-324. [PMID: 30565473 DOI: 10.1556/2060.105.2018.4.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The duration and intensity of exercise are significant factors in oxidative, morphological, and functional changes of the gastrointestinal tract. This study aimed to investigate the effects of both exhaustive swimming and probiotic VSL#3 on rats that had been previously trained with moderate swimming. The rats were divided into four groups labeled: control (C), probiotic (P), exercise (E), and probiotic-exercise (PE). Groups P and PE were fed with probiotic mixture VSL#3. Groups E and PE had a 5-week moderate swimming program (1 h/day for 5 days/week), followed by a 1-week exhaustive swimming program (trained like in moderate program but 3 times with 150 min resting sessions, for 5 days/week). At the end of the program, the rats were euthanized. Malondialdehyde, superoxide dismutase, catalase, and reduced glutathione levels were measured in tissue samples from the gastrocnemius muscle, heart, liver, kidney, and colon. In vitro contractile activity and histomorphology of the colon were also determined. Exercise and/or probiotic decreased the oxidative stress and also increased the level of one or more of the antioxidant enzymes in some of the organs. Probiotics had more pronounced effects on colon morphology than exercise but unexpectedly this effect was non-trophic. In the colon, the thickness of the tunica muscularis and the number of goblet cells were not affected; however, probiotic administration decreased the crypt depth and tunica mucosa thickness. Exercise increased the Emax value of acetylcholine (ACh), while decreased its sensitivity. These findings suggest that exhaustive swimming does not cause oxidative stress and that probiotic consumption improves oxidative balance in trained rats. The probiotic intake does not alter the effect of exercise on the contractile activity of the colon. Colon mucosal changes induced by probiotics are independent of exercise.
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Determination of radiation shielding parameters of 304L stainless steel specimens from welding area for photons of various gamma ray sources. PROGRESS IN NUCLEAR ENERGY 2017. [DOI: 10.1016/j.pnucene.2017.06.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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On the Solutions of the Space and Time Fractional Benjamin–Bona–Mahony Equation. IRANIAN JOURNAL OF SCIENCE AND TECHNOLOGY, TRANSACTIONS A: SCIENCE 2016. [DOI: 10.1007/s40995-016-0121-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Psychological characteristics of patients with asthma. CLINICAL RESPIRATORY JOURNAL 2016; 12:113-118. [PMID: 27149073 DOI: 10.1111/crj.12494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 12/14/2015] [Accepted: 04/19/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Psychological distress of patients with asthma may be reduced when they learned to live with their illness. Asthma can change the psychological and personality characteristics. We aim to investigate the psychological and personality characteristics of patients with asthma using MMPI (Minnesota Multiphasic Personality Inventory). METHODS Thirty-three adult patients with asthma (23 female and 10 male) and 20 healthy controls (14 females and 6 males) were enrolled in this study. Psychometric evaluation was made with the Turkish version of the MMPI. The patients were separated into two groups according to the duration of symptoms (recent-onset asthma < 10 years, long-standing asthma ≥10 years). RESULTS Patients with asthma compared with control group had significantly higher the rate of clinical elevation on depression, hysteria, psychasthenia and social introversion. Patients with recent-onset asthma compared with long-standing asthma have significantly higher the rate of clinical elevation on depression, hysteria, psychopathic deviate, psychasthenia and social introversion. MMPI mean t score in patients with recent-onset asthma was higher than patients with long-standing asthma. MMPI mean t score in patients with asthma was negatively associated with the symptom duration in multivariate model. CONCLUSIONS Patients with asthma have relatively more inactivity, anergia, guilt, pessimism, nonspecific physical complaints, irrational fears and introvert. Patients with long-standing asthma have less psychological distress, suggesting that learned to cope with his illness.
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Quality of Life and Bronchial Hyper-Responsiveness in Subjects With Bronchiectasis: Validation of the Seattle Obstructive Lung Disease Questionnaire in Bronchiectasis. Respir Care 2015. [PMID: 26199452 DOI: 10.4187/respcare.03906] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Bronchiectasis can adversely affect quality of life. However, the tests examining quality of life in bronchiectasis are not sufficient. We examined the validity of a measure designed for COPD, the Seattle Obstructive Lung Disease Questionnaire (SOLQ), in bronchiectasis. In addition, we aimed to compare the quality of life of subjects with bronchiectasis and bronchial hyper-responsiveness with that of those without to identify the effective factors. METHODS We studied 78 subjects with clinically stable bronchiectasis and 41 healthy controls matched for age and sex. Subjects were assessed by the SOLQ. A detailed history, physical examination, the Medical Outcomes Study 36-Item Short Form questionnaire, the Hospital Anxiety and Depression Scale, and spirometric measurements were obtained. RESULTS Cronbach α coefficients, which reflected internal consistency, were >0.70 for all SOLQ components except for treatment satisfaction. SOLQ component scores correlated with all of the component scores of the Medical Outcomes Study 36-Item Short Form questionnaire and the Hospital Anxiety and Depression Scale, confirming their concurrent validity. All SOLQ scores correlated positively with percent-of-predicted FEV1, whereas the physical function, treatment satisfaction, and emotional function correlated negatively with the exacerbation frequency in Pearson analysis. Emotional and physical functions were positively associated with percent-of-predicted FEV1 in linear regression analysis. Compared with subjects without bronchial hyper-responsiveness, those with bronchial hyper-responsiveness had lower FEV1/FVC and more exacerbations/y. Compared with bronchiectasis subjects without bronchial hyper-responsiveness, those with bronchial hyper-responsiveness had significantly lower SOLQ, physical function, and coping skills scores but not emotional function and treatment satisfaction. CONCLUSIONS The SOLQ is a valid instrument for determining quality of life in subjects with bronchiectasis. Subjects with bronchiectasis and bronchial hyper-responsiveness had a poorer quality of life, lower baseline spirometric values, and more frequent exacerbations, suggesting more severe disease.
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Abstract
AbstractObjective: This study aimed to determine the relationship between MPV and thyroid malignancy by comparing patients who underwent surgery for benign or malignant thyroid diseases. BACKGROUND Mean platelet volume (MPV) is a useful early indicator of platelet activation. Platelets differ in terms of functional activity and size. Large platelets are relatively new, more reactive and produce more thrombogenic factors. Therefore, in conditions that involve increased platelet activation, an increase in the proportion of young platelets and MPV is expected. PATIENTS AND METHODS This study involved 146 patients who underwent total thyroidectomy because of benign (99 patients) or malignant (47 patients) diseases of the thyroid. Data on age, sex, MPV, white blood cell (WBC) count, hemoglobin level and platelet count were collected retrospectively. RESULTS MPV was significantly higher in patients with malignant thyroid diseases than in those with benign thyroid diseases. Age, sex, hemoglobin level, WBC count and platelet count did not significantly differ between the two groups. CONCLUSION MPV was significantly higher in patients with thyroid malignancies than in patients with benign thyroid diseases. We propose that MPV might be an important predictive factor for thyroid malignancies. Further prospective studies with a larger number of patients in high-volume endocrine surgery centers are required to confirm our findings.
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Abstract
BACKGROUND The purpose of this study was to assess the impact of bronchiectasis, anxiety and depression, and parameters of disease severity on health-related quality of life (HRQOL) in subjects with COPD. METHODS Sixty-two subjects with stable COPD were selected for the study. The presence of bronchiectasis in all subjects with COPD was investigated by high-resolution computed tomography. Pulmonary function tests were performed. Dyspnea was assessed using the Modified Medical Research Council (MMRC) dyspnea scale. Psychological disorders were investigated using the Hospital Anxiety and Depression Scale (HADS), and the HRQOL was examined using the St George Respiratory Questionnaire (SGRQ). RESULTS High-resolution computed tomography revealed that 44 of 62 (70.9%) subjects with COPD had bronchiectasis. There were no differences in pulmonary function tests, symptoms, activities, impact, SGRQ total scores, and HADS scores between COPD subjects with and without bronchiectasis. Pearson correlation analyses showed that there was no significant association between the presence of bronchiectasis, bronchial wall thickness, or severity of bronchial dilatation and all subscales of the SGRQ or HADS scores. Additionally, HADS scores showed significant positive association with all subscales of the SGRQ in all subjects. In linear regression analysis, a statistically significant relationship was found between the SGRQ total score and percent-of-predicted FEV1, percent-of-predicted diffusing capacity of the lung for carbon monoxide, MMRC score, and anxiety score, but the SGRQ total score was not associated with age, body mass index, total number of hospitalizations, PaO2 , or depression score. CONCLUSIONS The presence of bronchiectasis in subjects with COPD does not impact HRQOL and psychological disorders. However, disease severity, dyspnea levels, and anxiety scores predict poor HRQOL.
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Type 2 Respiratory Insufficiency, Pulmonary Hypertension, and Obstructive Sleep Apnea Syndrome that Developed in Morquio Syndrome. EURASIAN JOURNAL OF PULMONOLOGY 2015. [DOI: 10.5152/ejp.2014.85579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Case of round pneumonia: pulmonary infarct and a rare situation that is similar with the lung cancer. CLINICAL RESPIRATORY JOURNAL 2014; 9:512-5. [PMID: 24725533 DOI: 10.1111/crj.12137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 03/05/2014] [Accepted: 04/04/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Round pneumonia (RP) is a rare radiological presentation of a subtype of lobar pneumonia that arises because of a developmental defect in connective tissues (pores of Köhn and channels of Lambert). The round appearance on chest X-ray (CXR) is thought to occur from an infectious process that spreads from small peripheral alveoli centrifugally through interalveolar channels via the pores of Kohn and the canals of Lambert. This explains the nonsegmental distribution and shape of RP. The pathogenesis of RP is unknown. An alternative theory holds that RP in children occurs because of underdeveloped pores of Kohn and the absence of canals of Lambert, limiting the spread of the organism and resulting in a focal, round mass seen on radiographs. As a result of this developmental defect, dissemination of infection remains in a limited area. While this is a well-known entity in childhood, it has been described infrequently in adults. Lesions of RP are not necessarily round; oval lesions can also be seen. It is a radiological subtype of the pneumonia subtype and presents as a solitary nodule or a mass lesion in CXR. METHODS We presented two cases of RP. One mimicked and was mistaken for pulmonary infarction because of triangular pleural-based density and the other mimicked pulmonary malignancy because of a homogeneous triangular opacity based on the pleura on the posteroanterior radiography and computed tomography. CONCLUSION These cases were presented because of RP's importance, and RP should be considered a part of differential diagnosis of pulmonary infarct and lung tumor.
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Assessment of patients' preferences regarding the characteristics associated with the treatment of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2014; 9:363-8. [PMID: 24790426 PMCID: PMC3998864 DOI: 10.2147/copd.s56229] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective Patient preferences regarding characteristics associated with the treatment of chronic obstructive pulmonary disease (COPD) must be determined to increase the compatibility between the patients and the treatments, but as yet no studies have been performed regarding these characteristics. Here, we evaluate the preferred characteristics associated with the treatment of patients with COPD. Method The expectations of patients receiving COPD therapy were assessed in six categories: time allocated by the physician to listen to patients’ complaints, treatment to be applied, estimated adverse effect frequency concerning the therapy, ability of patients to visit the same physician each time, integral approach of the physician to the treatment of the patient, and therapy cost. These groups were divided into categories of therapy indicating 25 alternative treatment methods, using conjoint analysis. Patients were sorted to the 25 types of treatment with regard to their preferences. Results The major expectation of conjoint analysis associated with the treatment of COPD patients is for the therapy to allow the patients to completely recover from their complaints. The order preferred by patients of other treatment expectations is from sufficient time to be allowed by the physician to listen to the patient, to no cost for the treatment, to minimum adverse effects resulting from the treatment, to each follow-up to be performed by the same physician, and to the physician performing an assessment of the patient’s well-being, rather than examining only the areas of complaint. Conclusion The major expectation of COPD patients regarding treatment was to completely recover with the help of the therapy. Considering the expectations of the patient may help improve the compatibility of the patient with the treatment.
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Abstract
BACKGROUND Microalbuminuria is an important risk factor for cardiovascular diseases. Microalbuminuria may be seen due to hypoxemia in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVES In this study, we investigated prevalence and relationship of microalbuminuria with clinical and physiological parameters in patients with COPD. METHOD During the research, 66 consecutive patients with COPD and 40 cases smokers with normal spirometry were included. The urinary albumin creatinin ratio (UACR) was calculated according to previously described formula. The presence of microalbuminuria was defined as UACR being ≥20 in men and ≥30 in women. The severity index of chronic diseases was evaluated by using MCIRS. RESULTS The rate of presence of microalbuminuria and UACR were higher in patients with COPD than smokers with normal spirometry. Pearson correlation analysis showed a significant inverse relationship between UACR and PaO2, FEV1%, FVC%. On the other hand, there was a positive relationship between UACR and BODE index. There was a significant relationship between the presence of microalbuminuria with PaO2 and BODE index. In the linear regression model, there was a negative relationship between UARC and PaO2 yet there was a significantly positive relationship between UARC and MCIRS score, BODE index. In the logistic regression model, the presence of microalbuminuria showed significant associations with PaO2, BODE index. CONCLUSION Microalbuminuria may be seen in patients with COPD, depending on the severity of disease and hypoxemia. Microalbuminuria in patients with severe COPD should be examined in regular periods for risk of cardiovascular morbidity or mortality.
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