Sleep-related disorders in Latin-American children with atopic dermatitis: A case control study

BackgroundAtopic dermatitis (AD) has been associated with impairment of sleep. The aim of this study was to evaluate sleep disorders in AD Latin-American children (4–10 years) from nine countries, and in normal controls (C).MethodsParents from 454 C and 340 AD children from referral clinics answered the Children Sleep Habits Questionnaire (CSHQ), a one-week retrospective 33 questions survey under seven items (bedtime resistance, sleep duration, sleep anxiety, night awakening, parasomnias, sleep-disordered breathing and daytime sleepiness). Total CSHQ score and items were analysed in both C and AD groups. Spearman's correlation coefficient between SCORAD (Scoring atopic dermatitis), all subscales and total CSHQ were also obtained.ResultsC and AD groups were similar regarding age, however, significantly higher values for total CSHQ (62.2 ± 16.1 vs 53.3 ± 12.7, respectively) and items were observed among AD children in comparison to C, and they were higher among those with moderate (54.8%) or severe (4.3%) AD. Except for sleep duration (r = −0.02, p = 0.698), there was a significant Spearman's correlation index for bedtime resistance (0.24, p < 0.0001), sleep anxiety (0.29, p < 0.0001), night awakening (0.36, p < 0.0001), parasomnias (0.54, p < 0.0001), sleep-disordered breathing (0.42, p < 0.0001), daytime sleepiness (0.26, p < 0.0001) and total CSHQ (0.46, p < 0.0001). AD patients had significantly higher elevated body mass index.ConclusionLatin-American children with AD have sleep disorders despite treatment, and those with moderate to severe forms had marked changes in CSHQ.     

Abnormal Axon Reflex-Mediated Sweating Correlates with High State of Anxiety in Atopic Dermatitis

BackgroundSweating plays a key role in skin homeostasis, including antimicrobial and moisturizing effects, and regulation of skin surface pH. Impaired axon reflex-mediated (AXR) sweating has been observed in patients with atopic dermatitis (AD). However, the mechanism of such abnormal sudomotor axon reflex remains to be revealed.MethodsTo investigate this mechanism, sudomotor function was analyzed using a quantitative sudomotor axon reflex test (acetylcholine iontophoresis) in patients with AD (n = 26) and healthy volunteers (n = 12). Correlation between sudomotor function and certain background factors, including Spielberger State Trait Anxiety Inventory score, Severity Scoring of Atopic Dermatitis (SCORAD) score, number of circulating eosinophils, and serum concentrations of thymus and activation-regulated chemokine and immunoglobulin E radioimmunosorbent test, was validated.ResultsLatency time was significantly prolonged in AD (p = 0.0352), and AXR sweating volume (mg/0-5 min) was significantly lower in AD patients than in healthy controls (p = 0.0441). Direct sweating volume (mg/0-5 min) was comparable in AD patients and healthy controls. A significant correlation between the evaluation results of quantitative sudomotor axon reflex tests and certain background factors was not observed. The latency time in non-lesioned and lesioned areas for AD patients versus continuous anxiety value in the Spielberger State Trait Anxiety Inventory and the AXR versus SCORAD showed significant correlations (p = 0.0424, p = 0.0169, and p = 0.0523, respectively).ConclusionsAlthough the number of study subjects was little, abnormal AXR sweating in patients with AD was observed. Correlative analysis suggests possible involvement of continuous anxiety and the immune system in such abnormal sudomotor function.     

Anaemia,but not iron deficiency,is associated with clinical symptoms and quality of life in patients with severe heart failure and palliative home care: A substudy of the PREFER trial

BackgroundTo explore the relationships between anaemia or iron deficiency (ID) and symptoms, quality of life (QoL), morbidity, and mortality.MethodsA post-hoc, non-prespecified, explorative substudy of the prospective randomized PREFER trial. One centre study of outpatients with severe HF and palliative need managed with advanced home care. Associations between anaemia, ID, and the Edmonton Symptom Assessment Scale (ESAS), Euro QoL (EQ-5D), Kansas City Cardiomyopathy Questions (KCCQ) were examined only at baseline but at 6 months for morbidity and mortality.ResultsSeventy-two patients (51 males, 21 females), aged 79.2 ± 9.1 years. Thirty-nine patients (54%) had anaemia and 34 had ID (47%). Anaemia was correlated to depression (r = 0.37; p = 0.001), anxiety (r = 0.25; p = 0.04), and reduced well-being (r = 0.26; p = 0.03) in the ESAS; mobility (r = 0.33; p = 0.005), pain/discomfort (r = 0.27; p = 0.02), and visual analogue scale of health state (r = − 0.28; p = 0.02) in the EQ-5D; and physical limitation (r = − 0.27; p = 0.02), symptom stability; (r = − 0.43; p < 0.001); (r = − 0.25; p = 0.033), social limitation;(r = − 0.26; p = 0.03), overall summary score; (r = − 0.24, p = 0.046) and clinical summary score; (r = − 0.27; p = 0.02) in the KCCQ. ID did not correlate to any assessment item. Anaemia was univariably associated with any hospitalization (OR: 3.0; CI: 1.05–8.50, p = 0.04), but not to mortality. ID was not significantly associated with any hospitalization or mortality.ConclusionAnaemia, but not ID, was associated although weakly with symptoms and QoL in patients with advanced HF and palliative home care.     

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.     

Significance of platelets to lymphocytes and platelets to haemoglobin ratios in patients with systemic sclerosis

BackgroundSystemic sclerosis (SSc) is a progressive autoimmune connective tissue disease. Platelets to lymphocytes (PLR) and platelets to haemoglobin ratios (PHR) are emerging biomarkers used in the assessment of activity and severity of various autoimmune diseases. This study was designed to clarify the association of PLR and PHR with SSc disease activity and its different manifestations.MethodA cross-sectional study involved sixty SSc patients. Demographic, clinical data and investigations were done.ResultsPLR and PHR were correlated positively with ESR (r = 0.351, p = 0.003*), (r = 0.620, p = 0.000**), CRP (r = 0.417, p = 0.001*), (r = 0.305, p = 0.018**) and SSc activity index (r = 0.292, p = 0.024*), (r = 0.359, p = 0.005*). PLR and PHR were highly significantly related to digital ulcerations, musckeloskeletal, and pulmonary manifestations. Also, they had a significant relation to ground glass abnormalities on HRCT, mild restriction in pulmonary function tests and anti-scleroderma-70 antibodies. The cutoff value for PLR was 107.8 with high sensitivity 97.9% and specifity 92.3%, area under the curve (AUC = 0.723, P 0.015) on receiver operating characteristic curve (ROC). PHR AUC (0.799, P .001), cut value was 23.5 at 95.7% sensitivity and 84.6% specifity.ConclusionPLR and PHR were significantly related to digital ulcerations, musculoskeletal, and pulmonary manifestations and can be considered as predictive biomarkers for the assessment of SSc disease activity and severity.     

Cough affects Quality of Life in asthmatic children aged 8-14 more than other asthma symptoms

BackgroundAsthma may influence children's health-related quality of life (QoL) differently by various symptoms, at different severity. The primary aim of this study was to evaluate the QoL in children with asthma and describe the impact of each asthma symptom on the child's well-being at different severity levels.Material and MethodsTwo hundred randomly selected children and one of their parents who consulted an outpatient asthma clinic, participated in the study. Qol was assessed with DISABKIDS-Smiley measure for children aged 4-7 years and with DISABKIDS DCGM-37 and Asthma Module for children 8-14 year old.ResultsMost of the children suffered from mild or moderate persistent asthma. Children with uncontrolled asthma stated lower QoL compared to partly controlled or controlled in both age groups (p < 0.05 in all domains). Cough appeared to affect QoL of 8-14 year olds more than other symptoms, especially in girls. In younger children, sex (boys, p = 0.039), age (p = 0.045), proxy sex (father, p = 0.048), frequency of doctor visits (4-6 months, p = 0.001), use of beta-2 agonists (p = 0.007) and father's smoking habits (p = 0.015) were associated with the QoL of coughing children but no correlation between cough and QoL was detected. In the 8-14 year age group coughers reported lower QoL compared to their counterparts; moreover, cough was found to affect QoL more than other symptoms (p < 0.05 in all domains).ConclusionsCough has a direct effect on asthmatic children's QoL but there is still an obvious need for research to reveal all the determinats of this effect.     

Correlation between nasal eosinophils and nasal airflows in children with asthma and/or rhinitis monosensitised to house dust mites

BackgroundAllergic rhinitis and asthma due to mite sensitisation are diseases which are frequently associated and characterised by persistent inflammation. In the present study, we aimed to investigate the relationship between nasal airflows and nasal eosinophils in patients with asthma and/or rhinitis due to house dust mite sensitisation.MethodsTwenty-four children with both rhinitis and asthma (R + A), 13 children with rhinitis and no asthma (R) and 10 non-allergic healthy children were evaluated prospectively. The patients belonging to the first two groups had moderate–severe grade of nasal obstruction. Total nasal symptom scores, peak nasal inspiratory flows (PNIFs) obtained by anterior rhinomanometry, skin prick tests, nasal eosinophils and FEV1 values were all assessed.ResultsPercentages of nasal eosinophils and PNIFs in patients with R + A and R (r = −0.415, p = 0.04) were found to be statistically significant and to have an inverse correlation. Skin prick tests were also significantly correlated with nasal eosinophils and PNIFs (r = 0.372, p = 0.01 and r = −0.306, p = 0.04, respectively). Both PNIFs and nasal eosinophils of patients with R + A were significantly correlated with FEV1 values (r = −0.641, p = 0.001 and r = 0.548, p = 0.007, respectively).ConclusionIn this study, a close relationship was demonstrated between eosinophil infiltration and nasal airflows in children having asthma and/or rhinitis monosensitised to mites. Additionally, the significant association found between FEV1 values and nasal eosinophils or PNIFs supported the close link of upper and lower airways.     

Prevalence of mental disorder and impact on quality of life in inflammatory bowel disease

IntroductionDifferent studies have described psychiatric comorbidities in inflammatory bowel disease (IBD) patients, but most of them focus mainly on depression and anxiety. Even though major mental disorders are considered one of the main factors that decrease quality of life (QoL), its role in IBD patients remains unclear. We sought to identify the prevalence of different mental disorders as well as its relationship with QoL.Patients and methodsSubjects were recruited from the IBD Clinic. IBD Questionnaire 32 and structured clinical interview (SCID) for DMS-IV Text Revision were applied. Demographic and clinical data were collected via self-report questionnaires and medical records. The correlation between mental disorders and QoL (IBDQ-32 score) was evaluated using the Spearman correlation test.ResultsIn all, 104 patients were recruited, 12 with Crohn's disease, and 92 with ulcerative colitis. The prevalence of any major mental disorder was 56.7%: anxiety (44.2%), mood (27.9%), substance use (12.2%), and other psychiatric diagnoses (17.3%), and 29.8% of the patients presented three or more comorbid diagnoses. Mental Disorder (p = 0.005), mood disorder (p = 0.004), anxiety disorder (p = 0.009), were found to be significantly associated with lower QoL. Substance use disorder was associated with lower Digestive QoL (p = 0.01). Major depressive disorder (p = 0.004), social phobia (p = 0.03), PTSD (p = 0.02), and Generalized Anxiety Disorder (p < 0.001), were found to be significantly associated with lower QoL.ConclusionsIBD patients had important psychiatric comorbidity that significantly affects their QoL. These results warrant a systematic evaluation of psychiatric conditions in IBD patients.     

Study the Relationship of MDCT Staging in Disease Extent with the Systemic Sclerosis Disease Parameters

Background and objectivesThe highest incidence of death in systemic sclerosis due to pulmonary disease raises the need for early detection and treatment. The study aim is the assessment of interstitial pulmonary disease by Multi Detector High Resolution CT (MDCT) and finds its relationship with the other disease parameters and the Pulmonary Function tests (PFT).Patients and methodsA prospective cross-sectional study was performed in Assiut University Hospitals from May 2018 to January 2020 and included 62 consecutive SSc female patients. Demographic, clinical, Laboratory, PFT and MDCT assessment were conducted for all participants.ResultsThe coarseness of fibrosis was 8.32 (range 0.0–17), the average proportion of ground-glass opacification was 28.3% (range, 0.0%–75%). Honey-comb pattern was seen in (52.5%). Mean Extent of disease was 46.25 ± 3.7 (range 5–81). Restrictive deficit found in 42 patients. Significant relation was found between the extent of disease and the percentage predicted FVC (r = 0.373, p 0.018) and FEV1/FVC (r = 0.593, p 0.000) and coarseness of fibrosis and proportion of ground glass opacification correlated inversely with VC (r = ?0.385, p = 0.014, r = ?0.376, p = 0.017 respectively), Rayanud's phenomena, modified Rodnan Skin Score and Medsger's general are positively correlated with MDCT disease extent.ConclusionScoring of systemic sclerosis (SSc) related interstitial lung disease (SSc-ILD) could be applicable as one of the important tools for disease assessment.     

Non-acid gastro-oesophageal reflux in children with suspected pulmonary aspiration

Background & aimsIn a group of children with suspected pulmonary aspiration, we aimed to describe the type and physical characteristics of gastro-oesophageal reflux (GOR) episodes, and to determine their correlation with the lipid-laden macrophage (LLM) content in bronchoalveolar lavage (BAL).Patients and methodsTwenty-one children with a diagnosis of bronchial asthma, recurrent lung consolidations and recurrent laryngotracheitis underwent 24-h multichannel intraluminal impedance and pH (MII-pH) monitoring, fibreoptic bronchoscopy and BAL. The following parameters were evaluated: total number of reflux episodes, number of acid reflux [AR; pH < 4] and non-acid reflux [NAR] episodes [pH > 4], height of reflux episodes, LLM content and percentage of neutrophils in the BAL.ResultsThe number of NAR episodes and the number of those reaching the proximal oesophagus were significantly higher in patients with recurrent lung consolidations than in those with bronchial asthma and laryngotracheitis (p < 0.01 and p < 0.01). BAL studies showed a significantly higher LLM content in children with recurrent lung consolidations than in those with bronchial asthma and laryngotracheitis (p < 0.01). The LLM content correlated significantly with the total number of reflux episodes (r = 0.73; p < 0.001) and with those reaching the proximal oesophagus (r = 0.67; p < 0.001). Finally, the LLM content correlated with the number of NAR episodes (r = 0.61; p < 0.01), with those reaching the proximal oesophagus (r = 0.64; p < 0.01) and with the percentage of BAL neutrophils (r = 0.7; p < 0.01).ConclusionNAR episodes reaching the proximal oesophagus correlate with diagnostic marker for pulmonary micro-aspiration. MII-pH monitoring increases the yield in identifying types and proximal extension of reflux episodes, that discriminate between patients with and without pulmonary aspiration.     

Comparative study of kidney affection in SLE patients with and without antiphospholipid syndrome

Aim of the workTo evaluate the incidence, clinical associations and outcome of APS nephropathy in SLE patients with 2ry APS.Patients and methodsWe studied 64 female SLE patients with nephritis; 32 of them had 2ry APS (group 1) and the rest without 2ry APS (group 2). Demographic, clinical and serological data were prospectively evaluated. Systemic lupus erythematosus disease activity index (SLEDAI) and Systemic Lupus International Collaboration Clinics/ACR damage index (SLICC) were assessed. Renal duplex, renal ^99mTc-dimercaptosuccinic) scan (DMSA scan) and renal magnetic resonance angiography (MRA) were all used to detect renal vascular affection.ResultsThere were statistically significant differences between the two examined groups regarding damage index (p = 0.000), hypertension (p = 0.02), thrombocytopenia (p = 0.000), ↓LDL (p = 0.008), ↓C3 (p = 0.01) and TMA (p = 0.04). In group 1: MR angiography detected 7 patients with RAS: 5 patients with renal artery thrombosis that showed a significant association with TMA and proteinuria (p = 0.002, p = 0.004: p < 0.001, p = 0.02, respectively). Patients with RAS had ↑DBP, ↑s.creatinine and ↑TGs (p = 0.004, p = 0.005 and p = 0.0003, respectively). Renal DMSA detected 6 patients with cortical scar which showed a significant association with TMA, proteinuria, livedoreticularis and arthritis (p = 0.001, p = 0.01, p = 0.04 and p = 0.03, respectively) those patients had ↑DBP and ↑RI (p = 0.000 and p = 0.006, respectively).ConclusionaPL testing should become a routine investigation in patients evaluated for RAS or renal infarctions especially with hypertension and unexplainable deteriorating renal function. To confirm our results we propose that larger scale, multicentre studies with longer evaluation periods.     

Homocysteine is related to peripheral arterial disease only in male elderly with type 2 diabetes mellitus

PurposeTo find out a novel risk factor for peripheral arterial disease (PAD) in the elderly with Type 2 diabetes mellitus (T2DM).MethodsA cross-sectional study involving 70 out of 146 elderly (≥60 years) with T2DM whose ankle–brachial index (ABI) was measured at the Geriatric Out-patient Clinic, Sanglah Hospital.ResultsThe overall prevalence of PAD was 30.8% (45 out of 146); in males, it was 25.88% (22 out of 85) and in females, 37.70% (23 out of 61). Only 70 out of 146 subjects who had complete data were further analyzed. By bivariate correlation test, it was found that age (right ABI: r = ?0.396, p < 0.001; left ABI, r = ?0.509, p < 0.001); lying systolic blood pressure (right ABI: r = ?0.268, p = 0.012; left ABI: r = ?0.267, p = 0.013); and concentration of 2-hours post-prandial (2-hpp) plasma glucose (right ABI: r = ?0.252, p = 0.018) had inverse correlation with ABI, whereas waist circumference, body mass index, sitting and standing systolic and diastolic blood pressures, lying diastolic blood pressure, levels of total cholesterol, low-density-lipoprotein (LDL) cholesterol, high-density-lipoprotein (HDL) cholesterol, triglyceride, fasting plasma glucose, haemoglobin A1C (A1C), and duration of diabetes, had no correlation with ABI. The ages of subjects who had PAD were greater than those without PAD (71.5 years vs. 65.2 years, p < 0.001). Homocysteine tended to be correlated only with left ABI (r = ?0.198; p = 0.050), but after assessment on sex factor, it showed that homocysteine had inverse correlation with ABI in males (right ABI: r = ?0.371, p < 0.026; left ABI: r = ?0.358, p = 0.032). Homocysteine also had a positive correlation with age (r = 0.315, p = 0.004). By multiple regression test, age, LDL cholesterol, and 2-hpp plasma glucose had a role in the PAD event.ConclusionsSome traditional risk factors (age, lying systolic blood pressure, LDL cholesterol, and 2-hpp plasma glucose) were related with PAD in the elderly with T2DM. Homocysteine as a novel risk factor had a correlation with ABI only in the male subjects. Age was the most important risk factor for PAD, either directly or indirectly through homocysteine (only in males).     

Plasma adiponectin levels are related to obesity,inflammation, blood lipids and insulin in type 2 diabetic and non-diabetic Trinidadians

AimsTo determine the relationship between plasma adiponectin levels and obesity, inflammation, blood lipids and insulin resistance in type 2 diabetics (T2DM) and non-diabetics in a patient population in Trinidad.MethodsA cohort study of a total of 126 type 2 diabetic (42 males and 84 females) and 140 (43 males and 97 females) non-diabetic public clinic attendees were assessed between December 2008 and July 2009. Along with clinical history and anthropometry, adiponectin, TNF-α, IL-6, CRP, lipid profile, glucose, and insulin were measured in fasting blood samples and insulin resistance (HOMA-IR) was calculated.ResultsDiabetics had higher (p < 0.05) glucose, insulin, HOMA-IR, triglycerides (TG), VLDL and systolic blood pressure than non-diabetics, but lower (p < 0.05) HDL and adiponectin levels. Adiponectin levels were lower (p < 0.05) in obese than in non-obese individuals regardless of diabetic status. There were significant gender differences in HDL, LDL and TG. Among non-obese persons, adiponectin correlated negatively with triglycerides (r = ?0.280; adiponectin), IL-6 (r = ?0.216; p < 0.005), HOMA-IR (r = ?0.373; p = 000) and positively correlated with HDL (r = 0.355; p = 0.000). Diabetic status (p = 0.025), TNF-α (p = 0.048) and BMI (p = 0.027) were identified as useful predictors of adiponectin by multiple linear regression methods. In addition binary logistic regression analysis found glucose (p = 0.001) and adiponectin (p = 0.047) to be useful indicators of type 2 diabetes.ConclusionsAdiponectin decreases with increasing adiposity and insulin resistance. Adiponectin and TNF-α appear to be related to differences in the insulin mediated glucose turnover.     

Predictors of atopic dermatitis phenotypes and severity: Roles of serum immunoglobulins and filaggrin gene mutation R501X

BackgroundAtopic dermatitis (AD), the most common chronic relapsing skin condition of infancy and childhood, is a complex multifactorial disease, which arises from the interaction between strong genetic and environmental factors.ObjectiveTo investigate the roles of several factors on the severity of AD including FLG R501X gene mutation, serum immunoglobulin (Ig) levels, atopy and accompanying allergic disorders.MethodChildren were genotyped for the mutation in FLG R501X gene. Serum levels of major Ig isotypes, atopy and accompanying allergic disorders were assessed.ResultsStudy group consisted of 49 patients (M: 26, F: 23) with a mean age of 4.9 ± 3.6 years and control group consisted of 50 children (M: 30, F: 20) with a mean age of 3.8 ± 2.8 years. Genotyping of R501X mutation revealed risk alleles in none of the children in study group or control group. IgG z-scores were significantly higher in patients with AD compared to controls (?0.97 ± 1.13 vs 1.48 ± 1.02, p = 0.026). There was a positive trend in IgG z-scores and a negative trend in IgA z-scores across the severity of AD. History of recurrent infections was significantly associated with asthma and/or AR (47.8% in patients with asthma/AR vs 3.8% in those without). Children with low IgG or IgA levels presented at an earlier age with lower rates of atopy and mild type AD.ConclusionIn a sample of Turkish children, FLG R501X genotyping revealed no risk alleles in variable severities of AD or healthy controls. Our data suggest that IgG and IgA levels might have a role in phenotypic features of AD in terms of severity and atopic sensitisation.     

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.     

Effect of neighborhood factors on diabetes self-care behaviors in adults with type 2 diabetes

ObjectiveThe objective of this study was to identify latent variables for neighborhood factors and diabetes self-care and examine the effect of neighborhood factors on diabetes self-care in adults with type 2 diabetes.Research design and methods615 subjects were recruited from an academic medical center and a Veterans affairs medical center in the southeastern United States. Validated scales were used to assess neighborhood factors and diabetes-related self-care. Confirmatory factor analysis (CFA) was used to determine the latent constructs. Structural equation modeling (SEM) was then used to assess the relationship between neighborhood factors and diabetes self-care.ResultsBased on a theoretical framework, CFA yielded four latent variables for neighborhood factors (neighborhood violence, access to healthy food, social support, and neighborhood esthetics) and one latent variable diabetes self-care (including diet, exercise, foot care, blood sugar testing and medication adherence). SEM showed that social support (r = 0.28, p < 0.001) and access to healthy foods (r = −0.16, p = 0.003) were significantly associated with self-care behaviors, while neighborhood violence (r = −0.06, p < 0.001) and esthetics (r = −0.07, p = 0.278) were not χ² (180, N = 611) = 192, p = 0.26, RMSEA = 0.01, CFI = 0.999). In the final trimmed model, social support (r = 0.31, p < 0.001) and access to healthy foods (r = −0.20, p < 0.001) remained significantly associated with self-care behaviors χ² (76, N = 611) = 60, p = 0.91, RMSEA = 0.00, CFI = 1.0).ConclusionThis study developed latent factors for neighborhood characteristics and diabetes self-care and found that social support and access to healthy foods were significantly associated with diabetes self-care and should be considered as targets for future interventions.     

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.     

Gut microbiota interactions with the immunomodulatory role of vitamin D in normal individuals

BackgroundDue to immunomodulatory properties, vitamin D status has been implicated in several diseases beyond the skeletal disorders. There is evidence that its deficiency deteriorates the gut barrier favoring translocation of endotoxins into the circulation and systemic inflammation. Few studies investigated whether the relationship between vitamin D status and metabolic disorders would be mediated by the gut microbiota composition.ObjectiveWe examined the association between vitamin D intake and circulating levels of 25(OH)D with gut microbiota composition, inflammatory markers and biochemical profile in healthy individuals.MethodsIn this cross-sectional analysis, 150 young healthy adults were stratified into tertiles of intake and concentrations of vitamin D and their clinical and inflammatory profiles were compared. The DESeq2 was used for comparisons of microbiota composition and the log2 fold changes (log2FC) represented the comparison against the reference level. The association between 25(OH)D and fecal microbiota (16S rRNA sequencing, V4 region) was tested by multiple linear regression.ResultsVitamin D intake was associated with its concentration (r = 0.220, p = 0.008). There were no significant differences in clinical and inflammatory variables across tertiles of intake. However, lipopolysaccharides increased with the reduction of 25(OH)D (p-trend < 0.05). Prevotella was more abundant (log2FC 1.67, p < 0.01), while Haemophilus and Veillonella were less abundant (log2FC − 2.92 and − 1.46, p < 0.01, respectively) in the subset with the highest vitamin D intake (reference) than that observed in the other subset (first plus second tertiles). PCR (r = − 0.170, p = 0.039), E-selectin (r = − 0.220, p = 0.007) and abundances of Coprococcus (r = − 0.215, p = 0.008) and Bifdobacterium (r = − 0.269, p = 0.001) were inversely correlated with 25(OH)D. After adjusting for age, sex, season and BMI, 25(OH)D maintained inversely associated with Coprococcus (β = − 9.414, p = 0.045) and Bifdobacterium (β = − 1.881, p = 0.051), but significance disappeared following the addition of inflammatory markers in the regression models.ConclusionThe role of vitamin D in the maintenance of immune homeostasis seems to occur in part by interacting with the gut microbiota. The attenuation of association of bacterial genera by inflammatory markers suggests that inflammation participate in part in the relationship between the gut microbiota and vitamin D concentration. Studies with appropriate design are necessary to address hypothesis raised in the current study.     

Increased maximum p wave duration in smoking patients with ST-elevation acute myocardial infarction and its relationship with inflammatory markers

IntroductionElectrocardiographic markers for atrial fibrillation and the relationship with inflammatory markers have not been evaluated in smoker patients with acute myocardial infarction.Material and methodsThis is a cross-sectional study developed between January 2012 and July 2014 at Hospital Universitario Celestino Hernández Robau from Santa Clara, Cuba. One hundred fifteen patients were included finally. The sample was divided into two groups (smokers and non-smokers). We obtained clinical and laboratory data and compared electrocardiographic markers for atrial fibrillation in both groups and with inflammatory markers.ResultsMaximum p wave duration was significantly higher in smoker than non-smoker patients (102 ± 12 vs. 97 ± 9; p = 0,020). Minimum p wave duration and p wave dispersion also are higher in smoker patients but not significantly (61 ± 10 vs. 60 ± 7; p = 0,476 and 41 ± 10 vs. 37 ± 9; p = 0,050). There is a positive and significant linear correlation between neutrophils count and maximum p wave duration in smokers (r = 0,45; p = 0,004), but not in non-smokers patients (r = 0,09; p = 0,49). There is a negative correlation between lymphocyte count and maximum p wave duration in smokers (r = -0,44; p = 0,004) and in non-smoker patients (r = -0,07; p = 0,62).ConclusionMaximum p wave duration is higher in smoker patients than non-smoker patients during ST-elevation acute myocardial infarction. Neutrophil count is positively associated with maximum p wave duration in smoker patients. Lymphocyte count has a negative association with maximum p wave duration.