Accessibility to biologics and its impact on disease activity and quality of life in patients with rheumatoid arthritis in Kuwait

Clinical Rheumatology - Biologics are indicated in rheumatoid arthritis (RA) in case of persistent high disease activity despite conventional disease-modifying anti-rheumatic drugs (cDMARDs) or...     

Chikungunya infection in Malaysia: Comparison with dengue infection in adults and predictors of persistent arthralgia

BackgroundChikungunya virus (CHIKV) and dengue virus (DENV) co-circulate in areas endemic with the Aedes mosquito vectors. Both viruses cause similar illnesses which may be difficult to distinguish clinically. CHIKV is also associated with persistent arthralgia.ObjectivesTo compare and describe factors which differentiate between DENV and CHIKV infections on presentation; and to describe predictors of persistent arthralgia in CHIKV patients.Study designPatients aged >14 years diagnosed with acute CHIKV and DENV infections in Kuala Lumpur, Malaysia were retrospectively identified. Clinical and laboratory data were obtained from medical records, and compared. CHIKV patients were telephoned 15–24 months later and interviewed about persistent symptoms. Logistic regression analysis was performed.ResultsA total of 53 CHIKV and 113 DENV patients were included. CHIKV patients were older and more likely to be female. CHIKV was independently associated with arthralgia and rash, while DENV was associated with myalgia, raised aspartate transaminase, and leucopaenia. Forty CHIKV patients were followed up, with a median duration of self-reported arthralgia of 3 months (range, 0–24 months). Eighteen (45%) had persistent arthralgia beyond 4 months, for which age >40 years was an independent predictor. At 1 year, 9 (22.5%) patients had arthralgia.ConclusionIn Kuala Lumpur, selected clinical and laboratory predictors help to distinguish between DENV and CHIKV infections. Persistent arthralgia was a frequent sequel of CHIKV infection in this cohort.     

Effects of Al-dopant at Ni or Co sites in LiNi0.6Co0.3Ti0.1O2 on interlayer slabs (Li–O) and intralayer slabs (TM–O) and their influence on the electrochemical performance of cathode materials

In order to satisfy the energy demands of the electromobility market, further improvements in cathode materials are receiving much attention, especially high energy density cathode materials for Li-ion batteries (LIBs). In this work, the self-propagating combustion (SPC) method is use to synthesise undoped LiNi_0.6Co_0.3Ti_0.1O₂ (LNCT), novel nano-sized Al-doped LiNi_0.6Co_0.3−xAl_xTi_0.1O₂ (LCA) and LiNi_0.6−xCo_0.3Al_xTi_0.1O₂ (LNA) (x = 0.01) cathode materials. LNCT, LCA and LNA were annealed at 700 °C for 24 h. Following the synthesis, the phase, chemical structure and purity of the materials were analysed using X-ray diffraction (XRD). Based on the XRD results, all materials exhibit a single-phase structure with rhombohedral layered structure. Based on the HRTEM and EDX results, all samples exhibit polyhedral-like shapes, while the Al-doped samples display smaller crystallite sizes compared to the undoped sample. As for the electrochemical performances, the initially discharged capacity of LCA (238.6 mA h g⁻¹) is higher than that of LNA (214.7 mA h g⁻¹) and LNCT (150.5 mA h g⁻¹). However, LNA has a lower loss of capacity after the 50^th cycle compared to the LCA sample, which makes it a more excellent candidate for electrochemical applications. The main reason for the excellent electrochemical behaviour of LNA is due to lower cation mixing. Furthermore, Rietveld refinements reveal that the LNA sample has a longer atomic distance of Li–O and shorter TM–O in the cathode structure, which makes Li⁺ ion diffusion more efficient, leading to excellent electrochemical performance. These findings further proved the potential of the novel nano cathode material of LiNi_0.6−xCo_0.3Al_xTi_0.1O₂ (LNA) to replace the existing commercialized cathode materials for rechargeable Li-ion batteries.

Al substitute into Ni site increase Li–O and reduce M–O atomic distance lead to excellent cycleability with high energy density.     

High mortality in Nipah encephalitis is associated with presence of virus in cerebrospinal fluid

During the outbreak of Nipah virus encephalitis in Malaysia, stored cerebrospinal fluid (CSF) samples from 84 patients (27 fatal and 57 nonfatal cases) were cultured for the virus. The virus was isolated from 17 fatal cases and 1 nonfatal case. There were significant associations between CSF virus isolation and mortality as well as clinical features associated with poor prognosis. In addition, there was a positive linear correlation of CSF virus isolation with age. There was no significant association between CSF virus isolation and the character of the CSF, presence of Nipah-specific antibody in the serum or CSF, duration of illness before collection of samples, or sex or ethnicity of the patients. This study suggests that high viral replication in the central nervous system may be an important factor for high mortality.     

Tuberculin skin testing among healthcare workers in the University of Malaya Medical Centre, Kuala Lumpur, Malaysia.

OBJECTIVES: To determine the occupational risk of Mycobacterium tuberculosis infection among healthcare workers (HCWs) and to examine the utility of tuberculin skin testing in a developing country with a high prevalence of bacille Calmette-Guerin vaccination. DESIGN: Tuberculin skin test (TST) survey. SETTING: A tertiary-care referral center and a teaching hospital in Kuala Lumpur, Malaysia. PARTICIPANTS: HCWs from medical, surgical, and orthopedic wards. INTERVENTION: Tuberculin purified protein derivative RT-23 (State Serum Institute, Copenhagen, Denmark) was used for the TST (Mantoux method). RESULTS: One hundred thirty-seven (52.1%) and 69 (26.2%) of the HCWs tested had indurations of 10 mm or greater and 15 mm or greater, respectively. Medical ward HCWs were at significantly higher risk of a positive TST reaction than were surgical or orthopedic ward HCWs (odds ratio, 2.18; 95% confidence interval, 1.33 to 3.57; P = .002 for TST positivity at 10 mm or greater) (odds ratio, 2.61; 95% confidence interval, 1.44 to 4.70; P = .002 for TST positivity at 15 mm or greater). A previous TST was a significant risk factor for a positive TST reaction at either 10 mm or greater or 15 mm or greater, but a duration of employment of more than 1 year and being a nurse were only significantly associated with a positive TST reaction at a cut-off point of 15 mm or greater. CONCLUSIONS: HCWs at the University of Malaya Medical Centre had an increased risk for M. tuberculosis infection that was significantly associated with the level of occupational tuberculosis exposure. A TST cut-off point of 15 mm or greater may correlate better with M. tuberculosis infection than a cut-off point of 10 mm or greater in settings with a high prevalence of bacille Calmette-Guerin vaccination.