The future of damage assessment in vasculitis

Damage denotes the aspects of chronic disease that do not reverse with therapy. This concept is particularly important for the primary systemic vasculitides, since the careful differentiation between activity and damage may help avoid unnecessary exposure to cytotoxic medications. Damage significantly influences both longterm prognosis and quality of life. Because the primary systemic vasculitides have diverse manifestations, the use of a damage assessment instrument is crucial to ensure reproducibility. The Vasculitis Damage Index (VDI) is the only validated measure for damage assessment in vasculitis. Use of the VDI in recent clinical trials has shown that it may not adequately determine the full spectrum of damage experienced by patients with vasculitis of small- and medium-size vessels. We propose reexamining the way in which damage is assessed, focusing on vasculitides of small- and medium-size vessels, and outline an initiative to create a substantially revised and improved damage assessment instrument using data-driven approaches. This initiative is part of a larger international effort to create a unified approach to disease assessment for the primary systemic vasculitides.     

Tracking survival of institutional births for neonatal period-feasibility at district hospitals

We assessed the feasibility of involving routine district health system personnel in tracking survival of institutional births for neonatal period in two district hospitals (Nagaur in Rajasthan and Chhatarpur in Madhya Pradesh) for the month of March 2010. A centralized district level tracking system was used in Nagaur, whereas in Chattarpur, block-wise tracking of births was performed. A total of 607 live births were tracked with 17 identified neonatal deaths. Prematurity and infections were commonest causes of deaths with majority occurring within first week of life. The block-wise approach resulted in identifying extra neonatal deaths.     

Cherry consumption and decreased risk of recurrent gout attacks

Objective

To study the relationship between cherry intake and the risk of recurrent gout attacks among individuals with gout.

Methods

We conducted a case–crossover study to examine the associations of a set of putative risk factors with recurrent gout attacks. Individuals with gout were prospectively recruited and followed up online for 1 year. Participants were asked to provide the following information regarding gout attacks: the onset date of the gout attack, symptoms and signs, medications (including antigout medications), and exposure to potential risk factors (including daily intake of cherries and cherry extract) during the 2‐day period prior to the gout attack. We assessed the same exposure information over 2‐day control periods. We estimated the risk of recurrent gout attacks related to cherry intake using conditional logistic regression. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated.

Results

Our study included 633 individuals with gout. Cherry intake over a 2‐day period was associated with a 35% lower risk of gout attacks compared with no intake (multivariate OR 0.65 [95% CI 0.50–0.85]). Cherry extract intake showed a similar inverse association (multivariate OR 0.55 [95% CI 0.30–0.98]). The effect of cherry intake persisted across subgroups stratified by sex, obesity status, purine intake, alcohol use, diuretic use, and use of antigout medications. When cherry intake was combined with allopurinol use, the risk of gout attacks was 75% lower than during periods without either exposure (OR 0.25 [95% CI 0.15–0.42]).

Conclusion

These findings suggest that cherry intake is associated with a lower risk of gout attacks.

     

Anti-dsDNA antibody testing by Farr and ELISA techniques is not equivalent

OBJECTIVE: To determine the degree of correlation between Farr and ELISA methods of detecting anti-dsDNA antibodies in patients with systemic lupus erythematosus (SLE), and their association with measures of disease activity. METHODS: Anti-dsDNA antibodies were assayed using the Farr and ELISA methods in patients followed between January 1, 2000, and December 31, 2002. Statistical correlations between Farr and ELISA were determined. Relationships between the 2 assays and measures of disease activity [SLE Disease Activity Index 2000 (SLEDAI-2K-DNA), renal, central nervous system (CNS), and vasculitis] were determined for the same clinic visit. RESULTS: 550 patients with 2940 clinic visits met the inclusion criteria. Correlation between Farr and ELISA levels was 0.46 using the first visit for each patient. When the Farr was abnormal, the ELISA was equally likely to be normal or abnormal. Abnormal Farr results were associated with higher SLEDAI-2K scores than normal Farr results (6.2 vs 4.3, respectively; p < 0.0001). There was less of a distinction with ELISA results (5.9 vs 4.8; p = 0.04). Farr levels were significantly associated with the presence of renal disease and vasculitis, while ELISA levels were not. Neither Farr nor ELISA results correlated with the presence of active CNS involvement. CONCLUSION: Farr and ELISA techniques for the detection of anti-dsDNA antibodies in patients with SLE are poorly correlated. The Farr is superior to the ELISA in correlating with measures of global disease activity, as well as renal and vasculitis involvement. The Farr technique should continue to be used in clinical practice. The ELISA adds no additional information.     

An ELISA for the detection of localized adherent classic enteropathogenic Escherichia coli serogroups

An ELISA for the detection of classic enteropathogenic Escherichia coli (EPEC) serogroups was developed. It detected EPEC positive for localized adherence (LA) by HeLa cell assay and EPEC positive for EPEC adherence factor (EAF) by DNA probe assay. A specific antiserum was raised with LA+ EPEC strain E2348/69 (serotype O127:H6) by immunizing rabbits and then absorbing the antiserum with its LA- derivative, MAR20. The absorbed antiserum reacted specifically with all 90 strains of E. coli belonging to eight different EPEC serogroups that were LA+ by HeLa cell assay and EAF+ by DNA probe assay. All E. coli strains including EPEC serogroups that were LA- by HeLa cell assay and EAF- by DNA probe assay were also negative by ELISA. Thus the ELISA is 100% sensitive and specific in detecting LA+ classic EPEC serogroups.     

Changes in Pain Sensitization After Bariatric Surgery

Objective

To evaluate changes in pain (at the knee and elsewhere) and pain sensitization in obese subjects with knee pain who were having bariatric surgery compared with similarly obese individuals who were undergoing medical management.

Methods

This study included a cohort of subjects who were having bariatric surgery and those undergoing medical management. Knee pain severity of the more painful knee (index knee) was assessed at baseline and at 12 months using the Western Ontario and McMaster Universities Osteoarthritis Index. The pressure pain threshold (PPT) was evaluated at the index patella and the right wrist. Low patella PPT may reflect peripheral and/or central sensitization, and low wrist PPT may reflect central sensitization. The mean change in measures of pain and pain sensitization was analyzed in the surgery and medical management groups separately.

Results

A total of 45 subjects in the surgery group and 22 in the medical management group completed baseline and follow‐up visits. The mean weight loss was 32.7 kg (29.0%) and 4.6 kg (4.1%) in the surgery and medical management groups, respectively. Knee pain decreased only in the surgery group, in which the PPT at the patella improved by 38.5% (P = 0.0007) and at the wrist by 30.9% (P = 0.005). There was no significant change in PPT in the medical management group.

Conclusion

Persons who underwent bariatric surgery experienced an improvement in pain sensitization, reflected by improvements in PPT. This improvement was observed not only at the patella, but also at the wrist, suggesting that central sensitization improved after bariatric surgery.

     

Correction: Quantum curcumin mediated inhibition of gingipains and mixed-biofilm of Porphyromonas gingivalis causing chronic periodontitis

Correction for ‘Quantum curcumin mediated inhibition of gingipains and mixed-biofilm of Porphyromonas gingivalis causing chronic periodontitis’ by Ashish Kumar Singh et al., RSC Adv., 2018, 8, 40426–40445.

The authors regret the incorrect naming of the bacterial species Actinomycetemcomitans viscosus in the published article. It should be correctly shown as Actinomyces viscosus throughout, on pages 40427 (fifth line of last paragraph), 40436 (sixth line of “Individual isolates & mixed” section), 40437 (Table 2) and 40440 (Table 3).Also, the ATCC number of A. viscosus was incorrectly given as 29522 throughout the published article and should be correctly shown as 15987 in the following places: p. 40429 (“Bacterial strains and culture conditions” section and “Minimum inhibitory concentration determination” section), p. 40430 (“Determination of antibiofilm activity using tissue culture plate assay (TCP)” section), p. 40434 (“Antimicrobial assay of quantum curcumin against clinical isolates of Porphyromonas gingivalis and select reference strains” section and “Determination of minimum inhibitory concentration” section), p. 40435 (“Growth rate analysis” section), p. 40437 (Table 2), and on p. 40438 (caption to Fig. 7 (twice), caption to Fig. 8, and sixth line of “Discussion” section).An error was also present in the published article in the co-author name spelling for K. Sharma. The correct spelling of the author names is as shown here.The Royal Society of Chemistry apologises for these errors and any consequent inconvenience to authors and readers.