bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Early Diagnosis in Patients with Axial Spondyloarthritis on Arterial Stiffness Progression
Authors: Lau Sze-Lok , Meng Huan , Cheng Isaac Tsz Ho , Yan Bryan Ping Yen , Lee Alex Pui Wai , So Ho , Tam Lai-Shan
Published: November 2024

Background:

In patients with axial spondyloarthritis (AxSpA), we have reported that higher inflammatory burden as reflected by a longer disease duration, delay in diagnosis and higher erythrocyte sedimentation rate (ESR) levels were predictors associated with incident hypertension after adjusting for traditional cardiovascular (CV) risk factors (1). Whether this is due to accelerated arterial stiffness progression is worth exploring.

Methods:

One hundred patients with axSpA who fulfilled the ASAS classification criteria and with active disease (ASDAS [Formula: see text]2.1) were recruited from the out-patient clinic of 6 regional hospitals. All participants will receive a 2-year protocolized treatment aiming to achieve ASDAS low disease activity (LDA) in order to address the effects of treating-to-target (T2T) and vascular outcomes (The Hong Kong AxSpA T2T vascular study). Medical history, medication used, disease activity, serum levels of inflammatory markers, cholesterol and fasting glucose were measured/recorded every 6 months. Brachial-ankle pulse wave velocity (baPWV) and carotid ultrasound were assessed at baseline and yearly. In this interim-analysis, we will focus on baPWV.

Results:

Ninety-two patients completed the month 12 follow-up. The patients were stratified into two groups based on the duration from symptom onset to diagnosis: less than 2 years (early axSpA group) and 2 years or more (non-early axSpA group). Table 1 summarized the demographic and clinical characteristics of both groups. The baseline baPWV values were comparable between the two groups (1412.4 ± 230.45 and 1325.19 ± 174.75, p > 0.05). However, at Month 12, there was a significant difference in baPWV between the groups (1470.77 ± 233.70 and 1302.09 ± 198.52, p= 0.001) (Figure 2). The early axSpA group showed a decrease of 23.09 cm/s, while the non-early axSpA group exhibited an increase of 59.85 cm/s (p=0.033). A multivariate linear regression analysis was conducted to predict the change in baPWV based on age, gender, early axSpA, use of csDMARDs, and glucocorticoids at baseline. Early axSpA remained the only significant predictor and was associated with a positive effect in reducing baPWV ([Formula: see text]= -82.939; p= 0.033).

Conclusion:

Early diagnosis may be able to prevent progression of arterial stiffness in patients with axial SpA by lowering the cumulative inflammatory burden before effective suppression of inflammation could be given to the patients.
A Review of the Awareness of Herpes Zoster Infection in Patients with Rheumatic Diseases Taking JAK Inhibitors
Authors: Leung Chung Lai , Ma Hoi Yin , Lee Pik Fan , Yim Cheuk Wan
Published: November 2024

Background

Herpes zoster (HZ), commonly known as shingles, is caused by the reactivation of the Varicella-zoster virus (VZV), the same virus that causes chickenpox. Approximately one-third of the population experiences shingles at least once in their lifetime. While age is the primary risk factor, immunocompromised individuals, such as patients with rheumatic diseases are particularly susceptible, especially those treated with Janus kinase inhibitors (JAKi). Real-world data from the Hong Kong Biologics Registry 2023 reported a herpes zoster infection rate of 3.49 per 100 patient-years among rheumatoid arthritis patients. This study aims to determine the rate of HZ infection among these patients and in particular, to assess their self-management strategies for HZ infection in a regional hospital.

Methods

This retrospective study involved patients diagnosed with rheumatoid arthritis, Spondyloarthritis and Psoriatic Arthritis, who were receiving JAKi treatments (Tofacitinib, Baricitinib and Upadacitinib). Participants were interviewed at the Rheumatology nurse clinic or by phone. A questionnaire gathered data on patient age, HZ vaccination status, history of HZ post JAKi initiation, and self-management plans for HZ infections.

Results

As of July 2024, a total number of 52 patients were interviewed. 33 (63.5%) had received the HZ vaccine prior to starting of JAKi, while 19 (36.5%) had not. 4 (7.7%) of them developed HZ after initiating treatment, with ages ranging from 46-84. 19 (36.5%) of them would seek medical advice if they have HZ infection, 7 (13.5%) would consult a doctor and consider withholding JAKi treatment. 3 (5.8%) would only stop the medication, 23 (44.2%) of them were uncertain about their actions.

Conclusion

This study demonstrates an increased risk of HZ infection among these patients and most importantly, highlights a critical gap in patient knowledge about HZ prevention and management. There is a clear need to enhance patient education regarding raising awareness of HZ risks, promoting vaccination, and providing effective self-management strategies.
Recurrent Palpitation in a Young Man with Systemic Lupus Erythematosus Undergoing Belimumab with Resolution After Switching to Telitacicept
Authors: Mai Yanfen , Pai Pearl , Li Tao , Guan Jing , Zhang Lijun , Huang Jinxian
Published: November 2024

Background

Cardiovascular disease is a significant complication of SLE patients, leading to high risk of morbidity and mortality. Atherosclerosis is a major contributor. Belimumab can reduce disease relapses and indicated to be atheroprotective. As a new biologic agent telitacicept targets both BLys and APRIL and inhibits both B cells and plasma cells. It may become a better option.

Methods

This case report describes a male patient with SLE combined with refractory lupus nephritis. Belimumab was given on the basis of corticosteroids and MMF. His condition was partially improved but recurrent palpitation occurred. Coronary artery atherosclerosis was confirmed. After switching from belimumab to telitacicept, palpitation disappeared and the patient’s condition gradually improved.

Results

A 40-year-old man presented recurrent fatigue for 8 years. He is a non-smoker, BMI 24.07kg/m2, without family history of CAD. In October 2015, pancytopenia was found, with ANA, anti-dsDNA and U1-nRNP/Sm antibody positive. C3 decreased obviously. Coombs test was positive. 24h proteinuria was 11895 mg. SLE complicated with lupus nephritis was diagose and he was treated with pulse steroid, IVIG and CTX. Condition was improved, and he maitained steroid, MMF and hydroxychloroquine.

In May 2023, he stopped MMF himself for fear of COVID-19 infection. Soon lower limbs edema developed. C3 0.37g/L, C4 0.02g/L, dsDNA 675.3 IU/ml, 24h-P 8444 mg was documented. SLEDAI score was 12. Renal pathology indicated ISN/RPS 2003 Class IV-G(A)+V Lupus Nephritis. He received pulse steroid (MP 500 mg per day) for 3 days, belimumab 720mg once and with MMF 750mg twice per day. Belimumab was regularly given after disease was controlled. Proteinuria decreased and remained about 3g.

In August,2023, the patient began to feel palpitation repeatedly. LDH, HBDH and LDL increased. Holter showed sinus rhythm, accidental supraventricular premature beat, but no ST-T change. Coronary CTA showed non-calcified plaques in local section of RCA and the proximal section of branch of LAD, with slight stenosis. Rosuvastatin was prescribed. But palpitation reoccured after belimumab was given. Belimumab was stopped and changed to telitacicept 160mg every 4 weeks from 12 November, 2023. Till now, palpitation doesn’t occure. Prednisolone was tapered down to 7.5mg per day and MMF maintained 750mg twice a day. Complements rised. Proteinuria decreased to 1164.34mg.

Conclusion

Telitacicept is supposed to be a choice for refractory active SLE patient with atherosclerosis who has poor response to conventional therapy.
Systemic Sclerosis Sine Scleroderma Presenting as Pulmonary Arterial Hypertension - A Case Report
Authors: Karar Ali
Published: November 2024

A 60-year-old married male farmer with a significant medical history, including STElevation Myocardial Infarction (STEMI), coronary artery bypass grafting (CABG), and Raynaud’s disease, presented to the emergency department with sudden-onset syncope and progressive shortness of breath on exertion. The syncope episode involved an abrupt loss of consciousness, with spontaneous recovery and no associated symptoms like jerky movements or tongue biting. The shortness of breath had been gradually worsening over several weeks, becoming noticeable even during minimal exertion.

On examination, the patient appeared chronically ill but had stable vital signs cardiovascular examination revealed bilateral pedal edema, while respiratory assessment and Neurological evaluation were normal. Blood tests indicated normal full blood count (FBC) and urea and electrolytes (U+E), but slight elevations in CRP 29 mg/L and ESR 20 mm/hr. Troponin levels remained stable, but brain natriuretic peptide (BNP) was markedly elevated at 2061 pg/mL. The electrocardiogram (ECG) showed right axis deviation and incomplete right bundle branch block (RBBB). A CT scan of the brain ruled out any acute pathology, such as stroke or hemorrhage. A previous echocardiogram (ECHO) had shown a left ventricular ejection fraction (LVEF) of 50-55%, indicating good left ventricular function. Given the findings, the patient was started on Furosemide 40 mg daily and advised to follow a fluid restriction regimen to prevent worsening of overload symptoms.

A repeat echocardiogram revealed deterioration in right ventricular (RV) function with a significantly (RVSP) of 80 mmHg, suggesting severe pulmonary hypertension (PHTN). A D-dimer test was negative for pulmonary embolism (PE). Cardiology consultation raised concerns about possible chronic thromboembolic disease, leading to further testing, including a computed tomography pulmonary angiogram (CTPA) and an autoimmune screen, along with potential right heart catheterization (RHC). The CTPA was negative for PE, but the autoimmune screen returned positive results for antinuclear antibodies (ANA >1200) and anticentromere antibodies. Right heart catheterization confirmed pre-capillary pulmonary hypertension (PAH) with pulmonary artery pressure exceeding 44 mmHg and no nitrate response. A rheumatology review, in light of the patient’s history of Raynaud’s disease, positive ANA, and confirmed PAH, led to the diagnosis of Systemic Sclerosis Sine Scleroderma–a form of systemic sclerosis without skin involvement. The patient was initiated on Tadalafil, (PDE-5) for PAH management and prescribed home oxygen therapy, particularly during exertion. He was discharged with a plan for multidisciplinary followup involving rheumatology, cardiology, and pulmonology to manage his complex condition.

Conclusion: Multidisciplinary is essential for optimizing outcomes in SSc and PAH.
Efficacy and Safety of Rituximab in Lupus Nephritis from a Tertiary Care Rheumatology Clinic in India
Authors: Gopal Manikandan , Mathew Ashish J , Mathew John
Published: November 2024

Background:

LUNAR trial failed in lupus nephritis. However case series across the globe have shown good outcome with rituximab in lupus nephritis. So we evaluated the efficacy and safety of rituximab in lupus nephritis in Indian patients

Methods:

This was single centre, retrospective study done in patients of lupus nephritis receiving rituximab between 2013 to 2022. All patients fulfilled the SLICC criteria. Rituximab was given if there was a flare with background immunosuppression or upfront for early steroid tapering. Patients were followed up at 3, 6 and 12 months. Complete kidney Response (CR) is defined as return of serum creatinine(Scr) to previous level with a decline in 24 hour urine protein to <500 mg at 12 months. (1) Partial kidney response (PR) was defined as an improvement of Scr, but not to the standardized normal, with at least 50% decline in the 24 hour urine protein achieved preferably by 6 months and no later than 12 months following treatment initiation.

Results:

Out of 125 patients who were included for analysis, CR and PR were achieved in 79(63%) and 18(14%) patients respectively at 12 months. Mean steroid dose in prednisolone equivalent was less than 10 mg at 6 months in all patients. Improvement in parameters like dsDNA, c3, c4 were observed. In follow up 14 patients (11%) developed Chronic kidney disease (CKD), 6 patients (4.8%) required dialysis and 8 patients (6.4%) expired. Subgroup analysis between patients who received rituximab upfront and those after treatment failure or relapse didn’t show statistical difference in results including CR,PR,CKD, dialysis requirement or death.

Conclusions:

These results indicate the possible efficacy and safety of rituximab based regimen with its potential to reduce the steroid requirement as well as achieving remission in treatment naïve and in patients who are refractory or relapse with standard agents in Indian Subcontinent.
Sleep Quality in Systemic Lupus Erythematosus
Authors: Aggarwal Anushka , Handa Rohini , Upadhyaya Sundeep , Gupta S J
Published: November 2024

Background: SLE is a chronic heterogenous systemic autoimmune disease associated with significant morbidity and poor health related quality of life. Chronic sleep disturbances have been found to have detrimental effects on health and functioning. In this study we aim to evaluate and compare the sleep quality in SLE patients vs. healthy controls using validated sleep questionnaires in the Indian population.

Methods: We assessed sleep quality in enrolled SLE patients and age-sex matched controls using Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness score. Data on demographics, quality of life (QoL) and functional disability was collected using the WHO QoL Brief version and Health assessment Questionnaire (HAQ)-CRD version. Disease severity i.e. activity and damage scores were recorded during clinical examination.

Results: 90 cases and 90 controls were enrolled in this study. In cases, the mean age was 37.11 ± 13.01 years with 90% females, average disease duration of 7.12 ± 6.65 years, SLEDAI-2k of 4.01± 3.72 (i.e. mild disease) and SLICC-DI of 0.40± 0.76 (Table 1). 72.2% cases had Musculo-skeletal involvement, 50% has mucocutaneous, 30% had nephritis and 25.6% had hematological abnormalities as primary complaints. Few cases had serositis (5.6%), gangrene (2.2%), anti-phospholipid syndrome (3.3%) and pulmonary involvement (3.3%). Cases demonstrated worse sleep quality than controls with a mean PSQI of 7.59± 3.33 vs 4.52± 2.90 respectively (p[Formula: see text]0.001). 82.2% (n=74) cases had PSQI score [Formula: see text]4. Cases also had poorer PSQI component scores i.e. quality, latency, disturbances, medication use and daytime dysfunction (p[Formula: see text]0.001). Epworth sleepiness score was significantly higher in the SLE group (4.68± 3.31 vs 2.19± 2.55) (Table 2). Poor sleep quality was associated with lower WHO QoL domain scores and higher HAQ scores (p[Formula: see text]0.001). Significant association was found between disease activity (SLEDAI-2K) and PSQI total score (p=0.027), but no such correlation was found with organ involvement or total damage.

Conclusion: Sleep quality was significantly worse in SLE patients than controls. This was associated with overall poor quality of life and physical function. Given that sleep is multifactorial; symptoms such as fatigue, myalgia, joint pains and rashes significantly affect sleep but maybe missed on standard disease indices. Poor sleep translates into poor general health which the patient may experience despite controlled disease.
Ultrasound and Power Doppler Evaluation of the Distal Interphalangeal Joints in Patients with Psoriatic Arthritis
Authors: Vu Minh
Published: November 2024

Objective:

1. To evaluate the frequency of the various lesions in distal interphalangeal joints of patients with psoriatic arthritis by clinical and ultrasound assessment. 2. To determine the correlation between grayscale and Power Doppler ultrasonography score with disease activity score. Methods: This cross-sectional study was performed on 41 patients, who were diagnosed with psoriatic arthritis by CASPAR 2006 criteria. Results: Ultrasound detected more joint lesions than clinical examination. The proportion of patients with clinical distal interphalangeal arthritis was 12,2%. 100% of patients had at least one distal interphalangeal arthritis by ultrasound, and 27,6% of patients had periarticular soft tissue lesions. The frequency of various ultrasound abnormalities was as follows: Synovial hypertrophy was seen in 55,9%, Power Doppler abnormality suggesting hypervascularity in 52,5%. The periarticular lesion frequency: extensor tendonitis in 6,1%; loss of normal fibrillary architecture of extensor tendon erosions was seen in 14,4%; flexor tenositis in 7,1%; and other lesions were seen in 32,8% of patients. Significant correlation was found between DAPSA score and grayscale joint count (GSJC) (Spearman’s R=0,55; p[Formula: see text]0,001), grayscale joint score (GSJS) (R=0,62; P<0,001), Power Doppler joint count (PDJC) (R=0.68; p[Formula: see text]0,001), and Power Doppler joint score (PDJS) (R=78; p[Formula: see text]0,001). Conclusion: Ultrasound can detect more joint lesions than clinical assessment. The severity of lesions on ultrasound correlates with the disease activity score.
Impact on Work Productivity Among Patients with Axial Spondyloarthritis in a Rheumatology Specialized Care Centre in Sri Lanka
Authors: Kulasinghe Udari , Abeysinghe Duminda
Published: November 2024

Background: Axial Spondyloarthritis (AxSpA) is a chronic inflammatory condition which impacts various aspects of patients’ lives, including work productivity. This study aims to identify the impact of AxSpA on key work outcomes including sick leave rate, disease related unemployment rate, work productivity loss and its association with disease activity.

Methods:

62 Adult patients aged ¿20 years who met the Assessment in Spondyloarthritis International Society (ASAS) 2009 criteria for AxSpA were enrolled. Work productivity was assessed by the Work Productivity and Activity Impairment scale (WPAI:SpA). The validated Sinhala version of WPAI questionnaire was used to obtain data and calculate absenteeism, presenteeism and work productivity loss (WPL). Higher scores for presenteeism, absenteeism, or WPL indicate greater work impairment due to illness. Disease activity was assessed by Ankylosing Spondylitis Disease Activity Score (ASDAS). Multivariate linear regression was utilized to assess the association between work productivity and disease activity.

Results:

Among 62 patients who were on paid employment, permanent loss of employment rate due to disease was 20.9% and disease related sick leave rate for [Formula: see text] 2 months was 58.06%. Out of them 48% engaged in heavy labor jobs and 65% had high or very high disease activity. (Figure 1) Among employed patients, mean Absenteeism, Presenteeism and WPL were 22%, 51.04% and 56% respectively. A decrease in work productivity was related to an increase in disease activity. Disease activity was strongly correlated with absenteeism (p [Formula: see text] 0.01), presenteeism (p [Formula: see text] 0.01) and work productivity loss (p [Formula: see text] 0.001). (Figure 2)

Conclusion:

The impact of AxSpA on work outcomes is substantial and necessitates effective intervention, like controlling disease activity. The significantly elevated levels of presenteeism, absenteeism, and WPL when compared to global data may be linked to suboptimal disease management due to limited availability of biological treatments as well as labor-intensive jobs among the population.
Primary Apla Syndrome Presenting as Stroke in Young Male: A Case Report
Authors: Islam Asif , Haider Umer , Khurshid Fatima , Shahid Kinza , Khalood Memoona
Published: November 2024

Background:

Antiphospholipid syndrome (APLA) is an autoimmune disease with autoantibodies and hypercoagulability. APLA commonly presents vascular thrombosis and obstetrical complications. Stroke in young adults is rare, and unusual causes must be considered.

Case Report:

Here we present a case of 26 year-old male patient with sudden onset of hemiparesis marked on right side without evidence of atherothrombosis or other vascular pathology. However extensive workup revealed primary Antiphospholipid Antibody Syndrome (APLA) as the underlying cause. MRI brain showing acute infarcts involving both cerebellar hemispheres more on left side, bilateral periventricular and deep white matter infarcts involving bilateral frontal and parietal lobes, Periventricular T2WI hyperintensities likely suggestive of Fazekas II change. Prompt treatment with anticoagulation led to significant neurological recovery.

Conclusion:

This case highlights the importance of considering APLA in the differential diagnosis of stroke in young adults, and the need for early recognition and treatment to improve outcomes.
Anti-Synthetase Syndrome: A Rare and Challenging Diagnosis for Interstitial Lung Disease (ILD): A Case Report
Authors: Islam Asif , Shahid Kinza , Khurshid Fatima , Haider Umer , Khalood Memoona
Published: November 2024

Background:

ASA syndrome is a rare and complex immune-mediated entity with heterogeneously diverse presentations diagnosed by the presence of antibodies directed against aminoacyl tRNA synthetase (most common anti-JO-1). The clinical manifestations range from myositis, interstitial lung disease (NSIP PATTERN), non-erosive arthritis, unexplained recurrent fever, Raynaud’s phenomenon, mechanics hands involving mainly skin, respiratory and musculoskeletal systems.

Case Report:

We report a case of 37-year-old female who had multiple admissions for polyarthritis which was symmetrical, progressive, involving large and small joints associated with morning stiffness, relieved by medication temporarily, with subsequent development of respiratory symptoms like cough, fever off and on, shortness of breath, exertional dyspnea, along with cracks on fingers of hands (mechanics hands). Symptoms worsened gradually with time, affecting her daily routine activities like combing hair, changing clothes, exertional dyspnea on taking few steps, debilitating her quality of life. Extensive and detailed workup was done, Anti-Jo-1 antibodies and Anti-SSA/Ro were positive, CPK level raised, serum aldolase raised, HRCT chest showed interstitial lung disease most likely NSIP, ANA negative, ACE levels normal, Bronchial biopsy showed benign respiratory mucosa, no evidence of malignancy was found. Patient was diagnosed with anti-synthetase antibody syndrome and started on pulse therapy with methylprednisolone.

Conclusion:

This article explores the clinical manifestations, diagnostic criteria, treatment, progression and prognosis of the disease course.
Efficacy of Mycophenolate in Interstitial Lung Disease Associated with Rheumatoid Arthritis
Authors: Rajendran Sindhuja , Mathew Ashish Jacob , Mathew John , Goel Ruchika
Published: November 2024

Background:

Interstitial lung disease (ILD) is a significant cause of mortality in patients with Rheumatoid Arthritis (RA). Existing studies on the efficacy of Mycophenolate (MPA) for RA-associated ILD are limited, with the largest study including only 26 patients. This study aims to evaluate the efficacy of MPA in stabilizing or improving lung function in a larger cohort of RA-ILD patients over an extended follow-up period.

Methods:

Patients diagnosed with RA-ILD and treated with MPA for [Formula: see text] 1year, attending our clinics between 2017 and 2023 were included. Data regarding demography, spirometry, HRCT and treatment were noted retrospectively at the diagnosis of ILD (baseline) and 6 monthly visits thereafter till last follow up. Data were collected on patient demographics, spirometry, high-resolution CT (HRCT) scans, and treatment regimens. The primary outcome was the change in predicted forced vital capacity (FVC) over the follow-up period, with a [Formula: see text] 10% decline considered as progression. Clinical improvements in cough, dyspnea, and HRCT findings were recorded as binary outcomes.

Results:

Of the 73 patients (58 females), 70% showed stability or improvement in FVC, while 18% experienced a decline. Clinically, 86% of patients improved or remained stable, while 12% worsened. HRCT results showed stable or improved disease in 34% of patients, 30% had worsening of fibrosis, while 36% did not undergo follow-up HRCT due to clinical stability. Physiologically - 52(70%) met the primary outcome of stability/ improvement in % FVC while 18% had worsening in % FVC. Use of rituximab was not associated with better outcomes. None of the baseline clinical parameters predicted better outcomes in univariate. The most common adverse events were dyspepsia and serious infections, occurring in 12% of patients

Conclusion:

MPA is an effective and relatively safe treatment option for RA-ILD, with 70% of patients achieving stabilization or improvement in lung function.
Cardiovascular and Cerebrovascular Outcomes in Anti-neutrophil Cytoplasmic Antibody-Associated Vasculitis
Authors: Xiao Shiyu , Xie Wenhui
Published: November 2024

Background:

Cardiovascular and cerebrovascular outcomes in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) remain elusive, especially for some specific cardiovascular and cerebrovascular disease (CCVD). We aimed to quantify the magnitude of the risk of total and type-specific CCVD in AAV population.

Method:

Electronic database searches of PubMed, EMBASE and Cochrane Library plus a hand search of conference proceedings were performed. Observational studies reporting data on CCVD in AAV patients were eligible. Pooled risk ratios (RR) with 95% confidence intervals were calculated. The primary outcome was the risk of CCVD, CAD and CVA in AAV population. The secondary outcomes were the risk of cause-specific CCVD, including myocardial infraction, angina pectoris, heart failure, stroke, ischemic stroke.

Results:

Fourteen studies met the inclusion criteria, comprising 20,096 AAV patients (over 46,495 person-years) with 5,757 CCVD events. Compared with non-vasculitis population, AAV patients showed an 83% increased risk of incident CCVD (1.83 [1.37-2.45]; n=10), 48% for coronary artery disease (1.48 [1.26-1.75]; n=9), and 56% for cerebrovascular accident (1.56 [1.22-1.99]; n=9). For type-specific CCVD, the risks of myocardial infarction, stroke, heart failure were increased by 67% (1.67 [1.29-2.15]; n=6), 97% (1.97 [1.19-3.25]; n=8) and 72% (1.72 [1.28-2.32]; n=4), whereas there was only a trend toward a higher risk of angina pectoris (1.46 [0.90-2.39]; n=2), and ischemic stroke (1.88 [0.86-4.12]; n=4). Subgroup analyses by AAV type found significantly increased CCVD risk in both granulomatosis with polyangiitis (1.87 [1.29-2.73]; n=7) and microscopic polyangiitis (2.93 [1.58-5.43]; n=3). In three studies reporting impact of follow-up period after AAV diagnosis, the CCVD risk was significantly higher in the first two years after diagnosis than the subsequent follow-up (2.23 [2.00-2.48] vs. 1.48 [1.40-1.56]; p < 0.01). Significant heterogeneity existed in the main analyses.

Conclusions:

This meta-analysis demonstrates that AAV is associated with increased risks of overall and type-specific CCVD, especially within two years after AAV diagnosis.
Association Between Triglyceride-glucose Index and Carotid Atherosclerosis in Patients with Systemic Lupus Erythematosus: A Cohort-based Study
Authors: Xie Wenhui , Zhang Zhuoli
Published: November 2024

Background:

Individuals with systemic lupus erythematosus (SLE) patients confer substantial increased risks of cardiovascular complications that have become the primary cause of premature mortality worldwide. We aimed to investigate the association between triglyceride-glucose (TyG) index and carotid atherosclerosis in patients with systemic lupus erythematosus (SLE).

Methods:

This cross-sectional study in a tertiary hospital included 333 consecutive SLE patients receiving carotid ultrasonography with integrated TyG index, calculated as ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. The subjects were categorized into three groups according to the TyG index tertiles. Logistic regression models were used to assess the association of TyG index with carotid atherosclerosis and carotid artery plaque. Fully adjusted model included age, gender, body mass index, comorbidities, low-density lipoprotein cholesterol and SLE-related variables.

Results:

There were 10.5% (35/333) of participants identified as having carotid atherosclerosis. Patients with carotid atherosclerosis had significantly higher TyG index as compared with those without (8.77 ± 0.45 vs. 8.45 ± 0.49, p [Formula: see text] 0.001). The frequency of carotid atherosclerosis was increased with increases in TyG index tertiles (3.6% for tertile 1, 10.0% for tertile 2, 17.7% for tertile 3; p = 0.003). Multivariate logistic analyses showed that each 1-unit increase in TyG index was significantly associated with prevalent carotid atherosclerosis (unadjusted OR 4.07 (1.87-8.87); fully-adjusted OR 4.88 (1.74-13.69)). The unadjusted and fully-adjusted OR for occurrence of carotid atherosclerosis were 5.70 (1.88-17.28) and 5.88 (1.66-20.74) in patients with tertile 3 compared to patients with tertile 1 of TyG index (P for trend 0.006 and 0.019, respectively). Similar findings were noticeable for the outcome of carotid artery plaque.

Conclusions:

The present study suggested that an elevated TyG index was associated with a higher risk of carotid atherosclerosis, independent of traditional cardiovascular risk factors and SLE-related factors. TyG index may be a promising and accessible atherosclerotic indictor for SLE population.
Current Practice, Trends and Attitudes of Rheumatologists Towards Glucocorticoids Use for Rheumatoid Arthritis (GURANTEE): A National Cross-sectional Survey Across China
Authors: Xiao Shiyu , Xie Wenhui
Published: November 2024

Background:

There were mixed practices and attitude towards glucocorticoids (GC) use for rheumatoid arthritis (RA). We aimed to investigate current practices, changes, and perceptions of rheumatologists regarding GC use in RA patients.

Methods:

A cross-sectional survey was conducted using a structured questionnaire between April and August 2023. Rheumatologists from 31 province-level regions of Mainland China were invited to participate. Chi-squared tests were adopted to investigate the differences by sociodemographic characteristics.

Results:

1,717 rheumatologists from 598 hospitals completed the survey with a response rate of 92%. Up to 60% of participants expressed currently infrequent initiation of GC co-therapy with csDMARDs (hardly ever 7.0%; occasionally 24.6%; sometimes 29.1%), accompanied by a decline of frequency over time reported in 64.2%. Regarding attitudes towards bridging therapy with GC, 604 (35.2%) participants supported this approach, 468 (27.3%) opposed it, and 645 (37.6%) remained inconclusive. Time to GC discontinuation in context of csDMARDs was commonly reported within 6 months in current practice which has been narrowed over time. Reasons for chronic GC use were mostly reported due to suboptimal disease control, followed by the need of RA complications, and pre-existing comorbidities. After failure of GC cessation, majority of respondents (84.4%) would escalate RA therapy (commonly by addition of JAK inhibitors, TNF inhibitors), which usually or often facilitated the GC cessation. The most frequently reported advantages and weaknesses of GC were rapid and strong efficacy, adverse events, respectively. Regarding long-term low-dose GC use for RA, the percentage of respondents who supported, opposed, or depended on the situation were 15.9%, 17.2%, and 66.9%, respectively.

Conclusion:

The current data demonstrate that GC initiation for RA treatment is not as frequent as before and the awareness of GC discontinuation is growing in current practice. Attitudes towards GC co-therapy with csDMARDs vary considerably and long-term low-dose GC use remain situation dependent.
Analytical Performance of a Novel, Fully Automated Multiplexed Microarray Immunoassay Prototype for the Simultaneous Detection of Fifteen Autoantibodies Associated with Connective Tissue Diseases
Authors: Gomez Gerber , Bijlsma Daphne , Lukasik Ewa , Hausmann Michael , Fischer Christian , Ghillani-Dalbin Pascale , Miyara Makoto , Moreau Emmanuel
Published: November 2024

Background:

There is currently a limited offer of automated multi-analyte tests for autoantibody testing in autoimmune connective tissue diseases (CTD). We assessed the analytical performance of a novel, single-use, multiplexed microarray immunoassay prototype (MosaiQ AiPlex CTDplus), used with the fully automated MosaiQⓇ system, for the simultaneous detection of fifteen autoantibodies associated with CTD, compared with selected CE-marked devices.

Methods:

Banked human serum samples, characterized as reactive to ≥ 1 autoantibody or non-reactive were included. Reactive samples were characterized with FIDIS™ Connective Profile (Theradiag) for CENP B, Jo-1, Ribosomal P, Scl-70, Sm, Sm/RNP, SS-A 60, TRIM21 (SS-A 52), SS-B and U1RNP; EliA CCP (Phadia) for CCP2, QUANTA LiteⓇ Chromatin (Werfen) for Chromatin, QUANTA FlashⓇ DFS70* (Werfen) for DFS70, Anti-dsDNA-IgG-ELISA (DRG) for dsDNA, and Immunodot (Euroimmun) for RNA polymerase III (RNAP III). For CCP2, only reactive samples were included. For the remaining analytes, non-reactive samples were characterized using immunofluorescence (ANA-Ro IgG FLUORESCENT HEp-2000Ⓡ; Immuno Concepts, Germany) and ANAscreen ELISA (ORGENTEC-Diagnostika-GmbH, Germany). Each individual non-reactive sample was tested with the investigational device once; reactive samples were tested in duplicates. Positive percentage agreement (PPA) and negative percentage agreement (NPA) for individual analytes were calculated. For CCP2 only PPA is presented as no negative samples were included.

Results:

Compared with relevant devices, the investigational prototype showed PPA ranging from 75% for chromatin to 99% for SS-A 60 and TRIM21. NPA ranged from 95% for chromatin, RNAP III, Scl-70 and Sm to 100% for DFS70, SS-A 60 and TRIM21. Performance details are shown in the Table.

Conclusions:

The investigational prototype demonstrated substantial agreement with the compared CE-marked devices. Further studies will allow for expanded performance assessment of the investigational device. This fully-automated multiplexed platform has the potential to contribute to optimizing CTD evaluation by simplifying complex testing pathways and analyzing large number of samples per day.
Detecting Invasive Alien Plant Species Using Remote Sensing, Machine Learning and Deep Learning
Authors: Rakgoale Perry B. , Ngetar Silas Njoya
Published: November 2024

Invasive alien plants (IAPs) are nonnative species that pose significant threats to the environment by outcompeting native vegetation and disrupting ecosystem functions. Efforts to monitor and eradicate IAPs have been limited due to the challenges in accurately identifying these plants using traditional remote sensing (RS) methods. This paper reviews the literature to identify the most accurate and reliable plant detection methods for IAPs. Advanced searches were conducted on ScienceDirect, Scopus and Institute of Electrical and Electronics Engineers (IEEE) Xplore databases using keywords such as ‘Remote Sensing (RS)’, ‘Machine Learning (ML)’, ‘Deep Learning (DL)’, ‘Invasive Alien Plant (IAP)’ and ‘detection’. The search yielded 1689 articles: 1129 focused on the RS methodologies, 303 on ML, 142 on DL and 115 combining all three approaches. The review found that the RF and support vector machine (SVM) algorithms are the most effective for detecting IAPs. This suggests that future research should prioritize the application of ML and DL techniques, particularly RF and SVM, due to their high potential for improving IAP identification and aiding in their eradication. These advancements align with Sustainable Development Goal (SDG) 15, which emphasizes the protection, restoration and sustainable use of terrestrial ecosystems, and SDG 8, which promotes sustained, inclusive and sustainable economic growth. Effective IAP management not only preserves biodiversity but also creates economic opportunities by improving land value and usability. This review underscores the importance of integrating advanced technological methods in environmental management to support both ecological and economic objectives.
Supplementary Figure S1 from Region-Based Analyses of Existing Genome-Wide Association Studies Identifies Novel Potential Genetic Susceptibility Regions for Glioma
Authors: Alpen Karen , Maclnnis Robert J. , Vajdic Claire M. , Lai John , Dowty James G. , Koh Eng-Siew , Hovey Elizabeth , Harrup Rosemary , Nguyen Tuong L. , Li Shuai , Joseph David , Benke Geza , Dugué Pierre-Antoine , Southey Melissa C. , Giles Graham G. , Nowak Anna K. , Drummond Katharine J. , Schmidt Daniel F. , Hopper John L. , Kapuscinski Miroslaw K. , Makalic Enes
Published: November 2024

Supplementary Figure S1 is a stylised illustration of DEPTH’s use of sliding windows to identify genomic susceptibility regions.
Figure 3 from Region-Based Analyses of Existing Genome-Wide Association Studies Identifies Novel Potential Genetic Susceptibility Regions for Glioma
Authors: Alpen Karen , Maclnnis Robert J. , Vajdic Claire M. , Lai John , Dowty James G. , Koh Eng-Siew , Hovey Elizabeth , Harrup Rosemary , Nguyen Tuong L. , Li Shuai , Joseph David , Benke Geza , Dugué Pierre-Antoine , Southey Melissa C. , Giles Graham G. , Nowak Anna K. , Drummond Katharine J. , Schmidt Daniel F. , Hopper John L. , Kapuscinski Miroslaw K. , Makalic Enes
Published: November 2024

DEPTH results for the 1p36.21 region. DEPTH PLO score for GICC (blue), AGOG (orange), and GliomaScan (green) for the 1p36.21 PRDM2 gene region for all-glioma male from the UCSC genome browser (https://genome.ucsc.edu/). The PLO score is on the y-axis.
Data from Region-Based Analyses of Existing Genome-Wide Association Studies Identifies Novel Potential Genetic Susceptibility Regions for Glioma
Authors: Alpen Karen , Maclnnis Robert J. , Vajdic Claire M. , Lai John , Dowty James G. , Koh Eng-Siew , Hovey Elizabeth , Harrup Rosemary , Nguyen Tuong L. , Li Shuai , Joseph David , Benke Geza , Dugué Pierre-Antoine , Southey Melissa C. , Giles Graham G. , Nowak Anna K. , Drummond Katharine J. , Schmidt Daniel F. , Hopper John L. , Kapuscinski Miroslaw K. , Makalic Enes
Published: November 2024

Abstract
Glioma is a rare and debilitating brain cancer with one of the lowest cancer survival rates. Genome-wide association studies have identified 34 genetic susceptibility regions. We sought to discover novel susceptibility regions using approaches that test groups of contiguous genetic markers simultaneously. We analyzed data from three independent glioma studies of European ancestry, GliomaScan (1,316 cases/1,293 controls), Australian Genomics and Clinical Outcomes of Glioma Consortium (560 cases/2,237 controls), and Glioma International Case-Control Study (4,000 cases/2,411 controls), using the machine learning algorithm DEPendency of association on the number of Top Hits and a region-based regression method based on the generalized Berk–Jones (GBJ) statistic, to assess the association of glioma with genomic regions by glioma type and sex. Summary statistics from the UCSF/Mayo Clinic study were used for independent validation. We conducted a meta-analysis using GliomaScan, Australian Genomics and Clinical Outcomes of Glioma Consortium, Glioma International Case-Control Study, and UCSF/Mayo. We identified 11 novel candidate genomic regions for glioma risk common to multiple studies. Two of the 11 regions, 16p13.3 containing RBFOX1 and 1p36.21 containing PRDM2, were significantly associated with female and male glioma risk respectively, based on the results of the meta-analysis. Both regions have been previously linked to glioma tumor progression. Three of the 11 regions contain neurotransmitter receptor genes (7q31.33 GRM8, 5q35.2 DRD1, and 15q13.3 CHRNA7). Our region-based approach identified 11 genomic regions that suggest an association with glioma risk of which two regions, 16p13.3 and 1p36.21, warrant further investigation as genetic susceptibility regions for female and male risk, respectively. Our analyses suggest that genetic susceptibility to glioma may differ by sex and highlight the possibility that synapse-related genes play a role in glioma susceptibility.
Significance:
Further investigation of the potential susceptibility regions identified in our study may lead to a better understanding of glioma genetic risk and the underlying biological etiology of glioma. Our study suggests sex may play a role in genetic susceptibility and highlights the importance of sex-specific analysis in future glioma research.
Labor Transformation in the Agricultural Sector in Riau Province
Authors: Khairunas  , Syapsan  , Tambupolon Dahlan
Published: November 2024

One of the efforts to increase economic added value is through economic structure transformation. The impact of the transformation of the economic structure is the transformation of workforce. Economic transformation that is not accompanied by labor transformation can result in lower incomes for workers in the agricultural sector and a scarcity of labor in the non-agricultural sectors. The goal of this research is to analyze the transformation of the workforce structure in Riau Province and to build a model that can explain the transformation of the workforce structure in Riau Province during 2018-2023. Using panel regression analysis, this research found that the GRDP ratio and average years of schooling had a linear positive effect on the transformation of labor structure. Thus, it can be said that these two variables can encourage workforce transformation in Riau Province. Regarding the various results obtained, there are several policy suggestions and recommendations that can be given to related parties.
Ética e política do instante: um tributo a Maurício Lissovsky
Authors: Yamamoto Eduardo Yuji
Published: November 2024

In 2010, Maurício Lissovsky taught a graduate course called “The redemption method.” Based on notes and readings in this course, it inquires about the possibility of thinking about ethics and politics of the “instant” – a term frequently used in classes to refer to the messianic apprehension of a singular temporality: the now saturated with tensions. To bring the problem to light, the method of individuation of the philosophical element (Entwicklungsfähigkeit) was used on the discursive set that made up the course above. This study concludes with the questioning about the value of Lissovsky’s propositions in light of the requirement for ethics and politics in current times.
As fotografias de Lissovsky: o que farão enquanto não estivermos olhando para elas?
Authors: Sanz Claudia Linhares
Published: November 2024

Feito originalmente para homenagear Mauricio Lissovsky, o texto se dedica a dois temas intricados. Primeiro, trata do último livro do autor, A fotografia e seus duplos; e, em seguida, discute como a ontogênese por ele proposta se constitui como um estudo histórico das formas fotográficas na perspectiva de seu devir. Trata-se, aqui, de homenagear o autor e, simultaneamente, destacar sua relevância como pensador original, fundamental nos estudos acerca da fotografia, no Brasil e no mundo.
On the assessment of the ability of measurements, nowcasts, and forecasts to track changes
Authors: Rieger Jonas , Liu Bolin , Saugel Bernd , Grothe Oliver
Published: November 2024

Background

Measurements, nowcasts, or forecasts ideally should correctly reflect changes in the values of interest. In this article, we focus on how to assess the ability of measurements, nowcasts, or forecasts to correctly predict the direction of changes in values - which we refer to as the ability to track changes (ATC).

Methods

We review and develop visual techniques and quantitative measures to assess ATC. Extensions for noisy data and estimation uncertainty are implemented using bootstrap confidence intervals and exclusion areas.

Results

We exemplarily illustrate the proposed methods to assess the ability to track changes for nowcasting during the COVID-19 pandemic, patient admissions to an emergency department, and non-invasive blood pressure measurements. The proposed methods effectively evaluate ATC across different applications.

Conclusions

The developed ATC assessment methods offer a comprehensive toolkit for evaluating the ATC of measurements, nowcasts, and forecasts. These techniques provide valuable insights into model performance, complementing traditional accuracy measures and enabling more informed decision-making in various fields, including public health, healthcare management, and medical diagnostics.
Sirolimus-induced pulmonary toxicity without recurrence more than 8 years after everolimus replacement in a renal transplant patient with recurrent skin SCC: a case report
Authors: Ghasemi Golsa , Shahidi Shahrzad
Published: November 2024

Background

Interstitial Pneumonitis (IP) is one of the pulmonary complications associated with mammalian Target of Rapamycin-Inhibitors (mTOR-Is). Sirolimus and everolimus belong to mTOR-Is. According to studies, IP is caused by both.

Case presentation

This is a case report in a kidney transplant recipient. We want to present a case of IP after 50 months of sirolimus consumption. Sirolimus was discontinued, and cyclosporine was started. Thirty-seven months later, everolimus was prescribed as an alternative to cyclosporine due to the recurrence of skin Squamous Cell Carcinoma (SCC). Fortunately, no respiratory manifestations were seen after more than 8 years of everolimus consumption.

Conclusions

In conclusion, in cases with sirolimus-induced IP, discontinuation of sirolimus and replacement with everolimus are recommended after resolving clinical symptoms and pulmonary lesions.
Perspective on patient-centered communication: a focus group study investigating the experiences and needs of nursing professionals
Authors: Mielke Kendra , Frerichs Wiebke , Cöllen Katja , Lindig Anja , Härter Martin , Scholl Isabelle
Published: November 2024

Background

Delivering high quality care tailored to patients’ needs necessitate patient-centered communication. High physical and mental workload, as well as organizational barriers, contribute to challenges nurses face in patient-centered communication. Participation in a communication skills training can help nurses to improve their patient-centered communication skills. Thus, the aim of this study was to investigate the experiences of nursing professionals in patient-centered communication and delineate the requisite content for a communication skills training.

Methods

We conducted focus group interviews with nursing professionals working at an academic medical center in Germany. The focus group interviews were audio-recorded and transcribed verbatim. Data analysis was performed using Kuckartz’s qualitative content analysis.

Results

31 nursing professionals from diverse medical disciplines (e.g., pediatrics, obstetrics, cardiology, neurology, oncology) participated in the study, unveiling a spectrum of communication experiences, including organizational and system-related challenges, constraints induced by the COVID-19 pandemic, management of personal emotions, and communication challenges with patients and relatives. They also identified aspects they experienced as beneficial for patient-centered communication (e.g., allocating sufficient time, being authentic, providing clear information). Furthermore, participants identified specific aspects, which should be included in a patient-centered communication skills training.

Conclusion

The findings suggests that not only nurses from oncology and intensive care, but also from other medical disciplines, experience significant communication challenges with patients and relatives. Applying patient-centered aspects of communication was considered beneficial for effective communication. The needs identified through participants’ experiences (e.g., core communication skills and strategies, handling escalating situations, and discussing serious illness, death and dying) informed the development of a patient-centered communication skills training specifically tailored for nursing professionals across diverse medical disinclines in Germany.