Evaluation of microalbuminuria in patients with systemic sclerosis as an indicator of early renal damage and increased morbidity

IntroductionRenal involvement and systemic vascular damage have been shown to be significantly affecting prognosis in systemic sclerosis.Aim of workMicroalbuminuria detection in SSc patients as an indicator of early renal involvement and its correlation with various SSc clinical, laboratory parameters and severity of organ systems’ damage assessed by Scleroderma Assessment Questionnaire.Patients and methodsForty SSc patients (33 females and 7 males) with mean age of 27.48 ± 12.56 years and mean disease duration of 6.2 ± 4.14 years were included. Twenty-four (60%) had lSSc; 13 (32.5%) had dSSc and 3 (7.5%) patients had SSc sine scleroderma.ResultsEight (20%) had microalbuminuria and 9 (22.5%) patients had decreased creatinine clearance. Albumin/creatinine ratio was significantly higher among dSSc patients compared to those with lSSc and SSc sine scleroderma (X² = 9.077; p = 0.01). Albumin/creatinine ratio showed significant positive correlations with telangiectasia (r = 0.322; p = 0.04) and mRodnan’s skin score (r = 0.352; p = 0.026) and negative correlations with inter-incisor distance (r = ?0.525; p = 0.001) and pleurisy (r = ?0.446; p = 0.004). Albumin/creatinine ratio correlated significantly and positively with IMSS and IDS indices of SAQ (r = 0.378, 0.32; p = 0.016, 0.044, respectively). SSc patients with microalbuminuria showed significantly higher mean IDS than those without (1.058 vs. 0.631, p = 0.04). No statistically significant correlations were found between creatinine clearance and the different demographic, clinical features and the indices of SAQ.ConclusionMicroalbuminuria compared to creatinine clearance may be a more sensitive indicator of early renal affection and predictor of increased morbidity.     

Insulin resistance as a risk factor for subclinical atherosclerosis in rheumatoid arthritis

BackgroundInsulin resistance (IR) is strongly associated with systemic inflammation. Insulin resistance is known to be increased in patients with rheumatoid arthritis (RA) and has been shown to be a risk factor for both clinical cardiovascular disease and subclinical atherosclerosis.Aim of the workTo study the relationship between insulin resistance, disease activity and subclinical atherosclerosis in RA patients.Patients and methodsForty RA patients and twenty age and sex matched healthy individuals as controls were included. Patients with diabetes mellitus, obesity and hypertension were excluded. Fasting plasma sugar and serum insulin were done, RA disease activity was assessed using the disease activity score (DAS28) and IR was evaluated by the homeostasis model assessment (HOMA2). Carotid artery intima media thickness (IMT) was evaluated using ultrasound.ResultsRA patients had significantly higher erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) positivity, fasting plasma sugar and fasting serum insulin, HOMA2-IR levels than the controls. IR was present in 33 (82.5%) RA patients while it was present in only one (10%) of the controls (p = 0.001). RA patients with IR had significantly longer disease duration (p = 0.003), higher disease activity (p = 0.000), greater carotid IMT (p = 0.000), and more carotid plaques (p = 0.043) than those without insulin resistance. RA patients with increased IMT had significantly longer disease duration (p = 0.002), higher DAS28 score (p = 0.000) and higher HOMA2-IR (p = 0.000) than those with normal IMT.ConclusionsIn RA patients, IR significantly correlated with both disease activity and disease duration. Our study pointed out a significant association between IR and subclinical atherosclerosis in RA.     

Regional variations in the use of complementary and alternative medicines (CAM) for inflammatory bowel disease patients in Italy: An IG-IBD study

Background and aimComplementary and alternative medicines (CAM) are being used increasingly by patients with Crohn's disease (CD) and ulcerative colitis (UC). We aimed to assess the prevalence and usage of CAM in different geographical areas of Italy and possible predictors of their use.Methods and materialsA structured questionnaire, administered to outpatients, attending 8 general hospitals and 9 tertiary referral centres, was completed by 2011 patients (909 CD, 1087 UC and 15 indeterminate colitis). 583 patients lived in the North, 659 in Central Italy and 769 in the South.ResultsCAM users were 475 (23.6%) with no regional differences in their distribution. Usage correlated significantly with female gender (p = 0.030), higher education (p = 0.021), hospitalization rates (p = 0.000), extra-intestinal complications (p = 0.000), non-adherence to conventional treatments (p = 0.054), adverse reactions to conventional treatments (p = 0.000), and active disease (p = 0.007); 5-ASA usage was associated with a more limited use of CAM (p = 0.005). Dietary changes or supplements and prayer were significantly more frequently reported in South, while Northern Italian patients more frequently used homeopathy, herbal medicines and physical exercises. Patients in Central Italy adopted an intermediate behavior. CAM use ameliorated the patient's general well-being according to two thirds of the users. Costs were higher for Northern patients than in Central or Southern Italy.ConclusionOne in four IBD patients in Italy use CAM. More money is spent on CAM in Northern Italy. Regional differences emerged as regards the type of CAM but not in terms of disease features, frequency of and reasons for CAM use, or perceived effects.     

Prevalence of renal artery stenosis in flash pulmonary oedema: Determination using gadolinium-enhanced MRA

PurposeThe primary purpose was to determine the prevalence of renal artery stenosis (RAS) in patients presenting with acute (“flash”) pulmonary oedema (FPE), without identifiable cause using contrast-enhanced magnetic resonance angiography (CE-MRA) of renal arteries. A secondary goal was to correlate clinical parameters at presentation with the presence or absence of RAS.Materials and methodsPatients presenting with acute pulmonary oedema without identifiable cause prospectively underwent CE-MRA. > 50% renal artery stenosis was considered significant. Clinical parameters (blood pressure, serum creatinine, history of hypertension/hyperlipidaemia) were compared in patients with and without RAS using an unpaired t-test. Results expressed; mean (+/?SD).Results20 patients (4 male, 16 female, age 78.5+/?11 years) underwent CE-MRA. 9 patients (45%) had significant RAS (6 (30%) bilateral, 3 (15%) unilateral). Systolic BP was higher in patients with RAS (192+/?38 mm Hg) than those without (134+/?30 mm Hg) (p < .005). Diastolic BP was higher in patients with RAS (102+/?23 mm Hg) than those without (76+/?17 mm Hg) (p < .01). All patients with RAS and 6/11(55%) patients without RAS had a history of hypertension. No significant difference in creatinine or hyperlipidaemia history was observed.ConclusionThe prevalence of RAS in patients presenting with FPE is 45%. The diagnosis should be considered in patients presenting with unexplained acute pulmonary oedema, particularly if hypertensive at presentation.     

Sleep disturbance in female patients with systemic lupus erythematosus and its relation to disease parameters

Aim of the workTo assess the prevalence of sleep disturbance in female patients with systemic lupus erythematosus (SLE) and to evaluate the correlation between sleep disturbance and some disease parameters.Patients and MethodsThe Pittsburgh Sleep Quality Index (PSQI) was used to investigate the sleeping habits of 30 female patients with SLE and of 30 healthy age and sex-matched controls. Depressed mood was assessed using the Center for Epidemiological Studies Depression scale (CES-D), functional disability was assessed with the Health Assessment Questionnaire (HAQ) and pain severity was assessed using the visual analogue scale (VAS). Disease activity was measured using the SLE disease activity index (SLEDAI). Disease severity and cumulative damage were measured using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage (SLICC/ACR DI).ResultsThe mean global scores for the PSQI were significantly different between cases and controls (8.47 ± 3.53 versus 5.10 ± 3.66, p = 0.000) indicating poor sleep quality for these patients compared to healthy controls, and 76.7% (23 patients) were poor sleepers. Sleep disturbances were correlated with disease duration (p = 0.001), functional disability (p = 0.001), SLEDAI (p = 0.000), pain severity (p = 0.002), organ damage (p = 0.000) and depressed mood (p = 0.000). However, with multivariate linear regression analysis SLEDAI and SLICC/ACR were the only significant predictors associated with higher level of PSQI.ConclusionSleep disturbances are prevalent among female SLE patients, with multiple factors contributing to it, but disease activity and cumulative disease damage were the only predictors of sleep quality. Assessment and management of sleep disturbances should be part of the routine care of SLE patients.     

Efecto negativo del bloqueo del sistema renina-angiotensina sobre la progresión de la enfermedad renal crónica avanzada: ¿una cuestión de ajuste de dosis?

IntroductionThe renoprotective effect of renin-angiotensin (RAS) blockers (angiotensin converting enzyme inhibitors and angiotensin receptor blockers) has been questioned in patients with advanced chronic kidney disease (CKD). Moreover, combination therapy (dual RAS blockade) can further accelerate renal function decline in some populations at risk. However, it is unknown whether this adverse outcome is due to a dose-dependent effect or if it can be attributed more specifically to a drug interaction.Aim This study aims to investigate if the rate of renal function decline in advanced CKD patients is associated to the doses of RAS blockers, and if dual RAS blockade worsens renal function independently of major confounding factors.Material and methodsRetrospective, observational study in an incident cohort of adult patients with CKD stage 4 or 5 not on dialysis, treated with RAS blockers for at least 3 months prior to the study inclusion. Inclusion criteria were: having at least three consecutive measurements of estimated glomerular filtration rate (eGFR) in a follow-up period > 3 months. Decline in renal function was estimated as the slope of the individual linear regression line of eGFR over follow-up time. Equipotent doses of RAS blockers were normalised for a body weight of 70 kg or a body surface area of 1.73 m² (END-RASI). Associations of END-RASI or dual RAS blockade with the rate of renal function decline were analysed by uni- or multivariate linear regression models, accounting for major confounding variables.ResultsThe study group consisted of 813 patients (mean age 64 ± 14 years, 430 males) with a mean eGFR 14.9 ± 4.2 ml/min/1.73 m²; 729 patients were on RAS blockade monotherapy and 84 on dual RAS blockade. Median END-RASI in the whole group was 0.91 (I.Q. ranges: 0.69-1.20). Patients on dual RAS blockade had significantly higher END-RASI than the rest of study patients (1.52 ± 0.49 vs. 0.93 ± 0.44; p < 0.0001). In univariate linear regression, END-RASI were significantly correlated with eGFR decline (R = −0.149; p < 0.0001). Patients on dual RAS blockade showed a significantly faster decline of renal function than the rest of the study patients (−6.19 ± 5.57 vs. −3.04 ± 5.37 ml/min/1.73 m²/year, p < 0.0001). By multivariate linear regression, while dual RAS blockade remained independent and significantly associated with faster renal function decline (beta = −0.094; p = 0.005), END-RASI (normalised either for body weight or surface area) did not reach statistical significance.ConclusionEND-RASI are significantly associated with the rate of renal function decline in advanced CKD patients. However, the detrimental effect of dual RAS blockade on CKD progression seems to be independent of END-RASI and other major confounding factors.     

Obstructive sleep apnoea syndrome and the metabolic syndrome in an internal medicine setting

BackgroundObstructive sleep apnoea syndrome (OSAS) is widely accepted as a cardiovascular risk factor. Lately it has been considered in turn as both a component and one of the causes of the metabolic syndrome (MS).MethodsWe studied 281 heavy snorers of both sexes consecutively attending a metabolic clinic. Aim was to evaluate the association of OSAS and MS in a large series of patients within an internal medicine setting. Patients underwent a clinical and biochemical work up and performed unattended polysomnography.ResultsOf 226 non-diabetic snorers, 48 had primary snoring; 54 mild, 51 moderate, and 73 severe OSAS. A positive association was found between OSAS severity, central obesity indices and the mean metabolic score (p = 0.016). Prevalence of hypertension increased with OSA severity (p = 0.010). Polysomnographic indices were correlated with the metabolic score, insulin levels and central obesity indices.At regression analysis, male sex (t = 3.92; p = 0.000) and waist circumference (t = 3.93; p = 0.000) were independently associated with AHI (apnoea/hypopnoea index), while ODI (oxygen desaturation index) and waist circumference were the independent predictors (t = 2.16; p = 0.033 and t = 3.74; p = 0.000 respectively) of the metabolic score.Prevalence of OSA was 83% in 55 patients with diabetes and 34% had severe OSA. Almost all diabetics with OSA had MS. The metabolic score was higher in diabetic OSA as compared to non-diabetic OSAS (p = 0.000).ConclusionsOur findings show a high prevalence of OSAS among patients referred to a metabolic outpatient clinic because of suspected metabolic disorders and heavy snoring and suggest a strong bidirectional association between OSAS and MS.     

Prediction of cardiovascular events in pre-dialysis chronic kidney disease patients with normal SPECT myocardial perfusion imaging

PurposePatients with normal stress myocardial perfusion imaging (MPI) results generally have an excellent prognosis with <1% cardiovascular events/year. Chronic kidney disease (CKD) is an established risk factor for cardiovascular events. However, the estimated glomerular filtration rate (eGFR) varies considerably among patients with CKD. We evaluated the prognostic value of eGFR for patients with CKD who did not undergo hemodialysis and had no evidence of coronary artery disease (CAD).Methods and subjectsPatients with CKD (n = 108; 58 males; mean age: 74 years) with no CAD [no previous CAD and normal stress MPI results; summed stress score (SSS) <4] and with no history of hemodialysis were followed-up (mean duration: 24 months). CKD was defined by eGFR of <60 ml/min/1.73 m² and/or persistent proteinuria. Cardiovascular events included cardiac death, non-fatal myocardial infarction, and unstable angina.ResultsCardiovascular events were observed in 8 patients with CKD (7%). The following were determined as significant predictors of these events: age (hazard ratio = 1.14; p = 0.019), hemoglobin levels (hazard ratio = 0.69; p = 0.021), eGFR (hazard ratio = 0.94; p = 0.008), SSS (hazard ratio = 2.31; p = 0.012), and summed difference score (hazard ratio = 2.33; p = 0.014).ConclusionsPatients with CKD and with no previous CAD and normal stress MPI results (SSS < 4) may not exhibit an excellent cardiovascular prognosis. Further, a lower eGFR and stress MPI results may be the predictors of cardiovascular events. Thus, patients with a lower eGFR and/or normal stress MPI results (SSS < 4) may require continuous follow-up.     

Plasma and synovial fluid osteopontin levels in patients with knee osteoarthritis: Relation to radiological grade

Aim of workTo investigate osteopontin (OPN) levels in both plasma and synovial fluid of patients with primary knee osteoarthritis (OA) and their relationship with radiological grade.Patient and methodsSixty patients had knee OA and 30 control subjects were included. Anteroposterior knee radiographs were taken to determine the disease severity of the affected knee. The radiographic grading of OA in the knee was performed by using the Kellgren–Lawrence grading. Osteopontin levels in the plasma and synovial fluid were measured using enzyme-linked immunosorbent assay and compared.ResultsOA patients had higher plasma osteopontin concentrations compared to healthy controls (p < 0.000). Osteopontin levels in synovial fluid were significantly higher with respect to plasma sample (r = 0.694, p < 0.000). The mean plasma levels of osteopontin in KL grade 4 were greater than those in KL grade 3, and the difference was statistically significant (p < 0.01). The plasma osteopontin levels significantly correlated with the severity of disease (r = 0.870, p < 0.000). The synovial fluid levels of osteopontin also correlated with disease severity as regarding the radiological grade (r = 0.817, p < 0.000).ConclusionOsteopontin in plasma and synovial fluid is related to progressive joint damage in knee OA. Osteopontin may serve as a biochemical marker for determining disease severity as regarding radiological grade.     

The effect of linagliptin on renal progression in type-2 diabetes mellitus patients with chronic kidney disease: A prospective randomized controlled study

BackgroundLinagliptin does not require dose adjustment in diabetes mellitus patients with chronic kidney disease (CKD). But, renal effects of linagliptin are not clear. Our aim was to examine the effect of linagliptin on renal disease progression in only insulin dependent type 2 diabetes mellitus (DM) patients with CKD.MethodsStage 3–4 CKD patients were randomized into 2 groups in this prospective randomized controlled study. In the first group, linagliptin 5 mg was added in addition to the background insulin therapy. In the second group, patients continued their insulin therapy. Patients were followed up at 3-month intervals for one year.ResultsThe study population consisted of 164 patients (90 patients in linagliptin group, 74 patients in other group) with a mean age of 67.5 ± 8.8 years. eGFR significantly increased in linagliptin group (p = 0.033), but decreased in other group (p = 0.003). No significant change was observed in total insulin dose in linagliptin group (p = 0.111), but in other group, total insulin dose significantly increased (p < 0.001). Proteinuria levels decreased in both groups, but there was no significant change. In the multiple logistic regression analysis, male gender and proteinuria emerged as variables that showed significant association with increased risk and the use of linagliptin emerged as variable that showed significant association with decreased risk for CKD progression.ConclusionLinagliptin in DM patients with CKD was able to improve renal progression without significant effect on proteinuria and glucose control. With regard to treating diabetic nephropathy, linagliptin may offer a new therapeutic approach.     

Desnervação renal em doentes com hipertensão arterial resistente: resultados aos seis meses de seguimento

IntroductionIncreased activation of the sympathetic nervous system plays a central role in the pathophysiology of hypertension (HTN). Catheter‐based renal denervation (RDN) was recently developed for the treatment of resistant HTN.AimTo assess the safety and efficacy of RDN for blood pressure (BP) reduction at six months in patients with resistant HTN.MethodsIn this prospective registry of patients with essential resistant HTN who underwent RDN between July 2011 and May 2013, the efficacy of RDN was defined as ≥10 mmHg reduction in office systolic blood pressure (SBP) six months after the intervention.ResultsIn a resistant HTN outpatient clinic, 177 consecutive patients were evaluated, of whom 34 underwent RDN (age 62.7 ± 7.6 years; 50.0% male). There were no vascular complications, either at the access site or in the renal arteries. Of the 22 patients with complete six‐month follow‐up, the response rate was 81.8% (n = 18). The mean office SBP reduction was 22 mmHg (174 ± 23 vs. 152 ± 22 mmHg; p < 0.001) and 9 mmHg in diastolic BP (89 ± 16 vs. 80 ± 11 mmHg; p = 0.006). The number of antihypertensive drugs (5.5 ± 1.0 vs. 4.6 ± 1.1; p = 0.010) and pharmacological classes (5.4 ± 0.7 vs. 4.6 ± 1.1; p = 0.009) also decreased significantly. Of the 24‐hour ambulatory BP monitoring and echocardiographic parameters analyzed, there were significant reductions in diastolic load (45 ± 29 vs. 27 ± 26%; p = 0.049) and in left ventricular mass index (174 ± 56 vs. 158 ± 60 g/m²; p = 0.014).ConclusionIn this cohort of patients with resistant HTN, RDN was safe and effective, with a significant BP reduction at six‐month follow‐up.     

The role of polysaccharide peptide of Ganoderma lucidum as a potent antioxidant against atherosclerosis in high risk and stable angina patients

ObjectivesAntioxidants can reduce oxidative radicals that affect the early phase of atherogenesis, that is endothelial dysfunction. Polysaccharide Peptide (PsP) derived from Ganoderma lucidum has an active substance in the form of β-glucan. Previous studies have proven the PsP of Ganoderma lucidum as an effective antioxidant in atherosclerotic rats and shows no toxicity in animal model. This study aims to prove the effect of PsP as potent antioxidant in high risk and stable angina patients.MethodThis is a clinical trial conducted to 37 high risk and 34 stable angina patients, which were determined based on ESC Stable CAD Guidelines and Framingham risk score, with pre and post test design without control group. The parameters are superoxide dimustase (SOD) and malondialdehyde (MDA) concentration, circulating endothelial cell (CEC) and endothelial progenitor cell (EPC) counts. The patients were given PsP 750 mg/day in 3 divided dose for 90 days. Paired t-test was performed for normally distributed data, and Wilcoxon test for not normally distributed data, and significant level of p ≤ 0,05.ResultsSOD level in high risk patients slightly increased but not statistically significant with p = 0,22. Level of SOD in stable angina group significantly increased with p = 0,001. MDA concentration significantly reduced in high risk and stable angina patients with p = 0.000. CEC significantly reduced both in high risk and stable angina patients, with p = 0.000 in both groups. EPC count significantly reduced in high risk and stable angina with p = 0.000.ConclusionPsP of Ganoderma lucidum is a potent antioxidant against pathogenesis of atherosclerosis in stable angina and high risk patients     

Illness perceptions and quality of life in families with child with atopic dermatitis

ObjectiveTo assess the Quality of Life (QoL) of children with Atopic Dermatitis (AD) and their families and the impact of the mothers’ illness perceptions on the family QoL.Materials and methodsSeventy-five children with AD (54 infants and 21 children) and their mothers participated in the study. The following questionnaires were administrated: 1. Brief Illness Perception Questionnaire (Brief IPQ); 2. Infant's Dermatitis Quality of Life Index (IDQOL); 3. Children's Dermatology Life Quality Index (CDLQI); 4. Dermatitis Family Impact Questionnaire (DFIQ) and 5. The Severity Scoring of Atopic Dermatitis (SCORAD).ResultsAtopic dermatitis had a moderate impact on the QoL of the infants (6.67 ± 5.30), children (7.86 ± 7.19) and their families (9.42 ± 7.03). The DFIQ was associated with certain dimensions of the Brief IPQ, specifically, with Illness Identity (greater symptom burden) (r = 0.615, p = 0.000), beliefs about the Consequences of the illness (r = 0.542, p = 0.000), the Concerns (r = 0.421, p = 0.000) and the Emotional Representations (r = 0.510, p = 0.000). Correlation was demonstrated between IDQOL and DFIQ (r = 0.662, p = 0.000) and between CDLQI and DFIQ (r = 0.832, p = 0.000), and a weaker correlation between SCORAD and DFIQ (r = 0.255, p = 0.035). The chronicity of the AD showed negative association with DFIQ (p < 0.001).ConclusionsThe QoL of families with a child with AD is associated with the mother's illness perceptions about AD, the children's QoL and with both the severity and the chronicity of the disease. Therefore, clinicians should pay attention not only to the clinical characteristics of the children, but also to the parents’ beliefs and emotions, to improve the family QoL.     

Volumen renal total y función renal en pacientes nefrectomizados por neoplasias renales

IntroductionThe reduction of renal mass after radical nephrectomy (RN) for renal neoplasm, could be associated with compensatory hypertrophy of the contralateral kidney. The capacity of compensation will determine the renal function (RF) evolution. Measuring of total renal volume (TRV) of the remaining kidney pre and post RN can help assess the RF evolution.ObjectivesTo determine the correlation between TRV pre and post nephrectomy (a year of follow-up) with RF.Materials and methodsA retrospective cohort study was carried out in 47 patients who had undergone RN from 2014 to 2018, due to renal cell carcinoma (confirmed by histopathology).The TRV was calculated, pre and post (a year of follow-up) RN, using ellipsoid formula equation, which were compared with clinical and analytical data. The results were analyzed by multivariate linear logistic models.ResultsThe median age at the time of RN was 70 years old (range, 40-88 years). Most of them were men, 66%. The estimated glomerular filtration rate (eGFR) pre and post nephrectomy was 78 (40-100) and 53.3 ml/min/ m² (30-90) respectively (P = .01). The TRV pre and post-nephrectomy was 168.2 ml (100.4-257.2) and 187.8 ml (115.5-273.1) respectively (P = .001).The pre-nephrectomy eGFR (β = 0.62; P = .034) and the TRV (β = 1.08; P < .0001) were positively correlated with the post-nephrectomy TRV, while the eGFR at year of follow-up was correlated negatively (β = –1.18; P = .047)ConclusionsThe measurement of pre and post nephrectomy TRV can help to predict renal function evolution at a year of follow-up.     

Anatomical variation of pulmonary venous ostium and its relationship with atrial arrhythmia in the Saudi population

PurposeTo assess the anatomical variation of the ostial pattern of pulmonary veins observed on coronary computed tomography (CT) angiogram and to estimate the relationship of atrial arrhythmia with similar ostial variants in the Saudi population.Materials and methodsThin-section (0.625 mm) contrast enhanced CT scans of 151 consecutive patients obtained over a span of a two-year period (January 2009–January 2011) for the diagnosis of ischemic heart disease, aortic regurgitation, infective endocarditis, aortic aneurysm, fibrosing mediastinitis, and pericardial defect. The retrospective study was focused on the identification of the number of venous ostia on either side of the left atrium and the drainage patterns of pulmonary veins. The frequency of each pattern was tabulated, and significance of their relationship with atrial arrhythmias was assessed with the X² and Fisher’s exact tests.ResultsOut of 151 patients analyzed, 26 patients (17.2%) had anatomical variation of the pulmonary venous ostia. Atrial arrhythmia was recorded in 16 of 26(61.5%) patients (p = 0.000). The association of higher anatomical variation of pulmonary venous ostia was recorded as higher (p = 0.034) in the female group (n = 15, 57.7%).ConclusionThe association between anatomically varied venous ostia and atrial arrhythmia was significant (p = 0.000) with a significantly higher anatomical variation of pulmonary venous ostia in the female Saudi population (p = 0.034).     

Influence of adipocytokines and IL-6 on ankylosing spondylitis disease activity and functional status

Aim of the workThis study aimed to assess serum levels of some adipocytokines (leptin, adiponectin and resistin) and IL-6 in patients with ankylosing spondylitis (AS) to evaluate their relationship to disease activity and functional capacity.Patient and methodTwenty-five AS patients were enrolled. Body mass index (BMI), Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI) and acute phase reactants, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, were assessed. Serum leptin, adiponectin, resistin and interleukin (IL)-6 levels were determined using enzyme-linked immunosorbent assay (ELISA).ResultsThe mean levels of leptin (9.1 ± 3.9 ng/ml), resistin (2.27 ± 1.15 ng/ml) and IL-6 (9.2 ± 5.8 pg/ml); were significantly elevated in patients with AS compared to the controls (p = 0.000, p = 0.0028 and p = 0.000, respectively). Only serum leptin levels correlated significantly with IL-6 (p = 0.004), and both serum leptin and IL-6 levels correlated significantly with BASDAI (p = 0.02 and p = 0.005, respectively), ESR (p = 0.04) and CRP (p = 0.01 and p = 0.006, respectively) in AS patients. Serum resistin did not correlate with any of the AS disease parameters, whereas, serum adiponectin neither significantly elevated nor correlated with any of these parameters.ConclusionThe associations of significantly increased levels of serum leptin and IL-6 with AS disease activity parameters give clues to their role in the inflammatory process of the disease. Failure to find any correlation between high serum resistin levels and AS disease activity parameters is suggestive of its role in the pathogenesis rather than disease activity.     

Predictors of outcome in a Spanish cohort of patients with Fabry disease on enzyme replacement therapy

Fabry disease may be treated by enzyme replacement therapy (ERT), but the impact of chronic kidney disease (CKD) on the response to therapy remains unclear. The aim of the present study was to analyse the incidence and predictors of clinical events in patients on ERT.Study designMulticentre retrospective observational analysis of patients diagnosed and treated with ERT for Fabry disease. The primary outcome was the first renal, neurological or cardiological events or death during a follow-up of 60 months (24–120).ResultsIn 69 patients (42 males, 27 females, mean age 44.6 ± 13.7 years), at the end of follow-up, eGFR and the left ventricular septum thickness remained stable and the urinary albumin: creatinine ratio tended to decrease, but this decrease only approached significance in patients on agalsidase-beta (242–128 mg/g (p = 0.05). At the end of follow-up, 21 (30%) patients had suffered an incident clinical event: 6 renal, 2 neurological and 13 cardiological (including 3 deaths). Events were more frequent in patients with baseline eGFR ≤ 60 ml/min/1.73 m² (log Rank 12.423, p = 0.001), and this remained significant even after excluding incident renal events (log Rank 4.086, p = 0.043) and in males and in females. Lower baseline eGFR was associated with a 3- to 7-fold increase the risk of clinical events in different Cox models.ConclusionsGFR at the initiation of ERT is the main predictor of clinical events, both in males and in females, suggesting that start of ERT prior to the development of CKD is associated with better outcomes.     

Serum interleukin-18 levels in patients with systemic lupus erythematosus: Relation with disease activity and lupus nephritis

Aim of the workTo further investigate the possible role of IL-18 in the pathogenesis of systemic lupus erythematosus (SLE) and development of lupus nephritis (LN), and to explore its relationship with pathological classes of LN, degree of acute renal activity and chronic damage.Patients and methodsForty-one SLE patients with LN, thirty-one lupus non-nephritis patients and fifteen age and sex matched healthy controls were enrolled in this study. SLE patients were subjected to disease activity assessment by SLEDAI, renal disease activity assessment by the Systemic Lupus International Collaborating Clinics (SLICC) Renal Activity Score, laboratory investigations including measurement of serum interleukin-18 using Enzyme Linked Immunosorbent Assay. Renal biopsy was obtained from LN patients and pathological classification was made according to World Health Organization (WHO) criteria. Analysis of activity and chronicity indices was done on these biopsy specimens.ResultsSerum levels of IL-18 were significantly higher in patients with LN than lupus non-nephritis patients and healthy controls (p < 0.001). There were significant correlations between IL-18 and SLEDAI (p = 0.002), proteinuria (p = 0.027), renal activity score (p = 0.003) and activity index (p = 0.039) in patients with LN. There was no significant difference in the serum levels of IL-18 between WHO classes of LN.ConclusionIL-18 appears to have a pathogenic role in the development of SLE and plays a crucial role in triggering inflammation in LN. Serum IL-18 levels could be a useful biomarker to assess the activity of renal disease in SLE.     

Staining of antinuclear antibodies and antibodies against removable nuclear antigens in connective tissue diseases

Introduction and objectivesConnective tissue diseases are inflammatory, autoimmune diseases and threaten quality of life. To determine the relationship between staining patterns of antinuclear antibodies and antibodies against extractable nuclear antigens in patients with connective tissue disease.Materials and methodsObservational, basic, analytical and transversal study. Study conducted in the Immunology Service of the Arzobispo Loayza National Hospital between January 2017 and June 2017. We analyzed 291 samples of patients with CTD and for the detection of anti-nuclear antibody staining patterns, the immunological kit and observation with microscope of at 40X Immunofluorescence and for the detection of the antibodies against extractable nuclear antigens. The Immunoblot method was employed. Statistical analyses were carried out with the statistical package SPSS version 21 for Windows. We used the Pearson Chi-square test for the categorical variables, a value of p < 0.05 was considered significant.ResultsThere was a significant relationship p < 0.05 of the homogeneous pattern, the mottled pattern with Anti-histones (p = 0.000), Anti-nucleosomes (p = 0.000), Anti-Ro 52 (p = 0.000), Anti-SSA (p = 0.001), Anti-SSB (p = 0.003), Anti-dsDNA (p = 0.000) with the Pearson Chi-square test. There was a significant relationship of p < 0.05 of the centromeric pattern with Anti-Cenp B (p = 0.000) with Fisher⿿s exact statistic.ConclusionsThere was a significant relationship between the anti-nuclear antibody staining patterns and the antibodies to the core extractable antigens in patients with systemic lupus erythematosus, Sjögren⿿s syndrome, Calcinosis, Raynaud⿿s phenomenon, esophageal Dysmotility, sclerodactyly and Telangiectasia (CREST), Scleroderma and Polymyositis.