Long-term efficacy and safety of interferon α-2a therapy in severe refractory ophthalmic Behcet’s disease

Ophthalmic involvement is the most debilitating complication of Behcet’s disease (BD). The aim of the current study is to report on the efficacy and safety of a long-term use of interferon alpha-2a (IFNα-2a) in the treatment of refractory ophthalmic BD in the Azari population of Iran. We retrospectively analyzed the clinical data of 12 patients with ophthalmic BD who were under IFNα-2a therapy. All these patients had previously been treated unsuccessfully with corticosteroid and at least one conventional immunosuppressive drug. IFNα-2a was administered at a daily dose of 6 million IU (MIU). After controlling the symptoms, a dose of 6 MIU three times per week was applied for 8–12 weeks, and then, a dose of 3 MIU was administered three times per week as a subcutaneous injection. Visual acuity and total inflammatory activity index (TIAI) were used in order to assess the response to the treatment. Response to the treatment and complete eye remission were obtained in 10 (83.3 %) and 7 (58.3 %) patients, irrespectively. Improvement or stabilization of visual acuity was observed in 18 (81.8 %) out of 22 eyes. After a mean period of 29.6 months, the use of IFNa-2a was discontinued in eight (66.7 %) patients. Unaltered vision for 2 years after IFNa-2a discontinuation happened in eight (100 %) patients. IFNa-2a is probably effective and safe in the treatment of refractory sight-threatening ophthalmic BD in the Azari population of Iran.     

Filtration efficiency of surgical sterilization fabric for respiratory protection during COVID-19 pandemic

BackgroundDue to COVID-19 and high demand for respirators, some healthcare professionals have been using the Halyard H600 fabric as an alternative to N95 respirators without testing the filtration efficiency of the fabric with established scientific methods. The purpose of this study was to assess the efficiency of the Halyard H600 as a respirator filtering material as compared to the NIOSH-certified N95 and P100 filters, and determine if H600 is a good alternative for respiratory protection for healthcare professionals during the COVID-19 pandemic.MethodsThree filter types (Halyard H600, N95, and P100) were challenged with salt particles inside an exposure chamber at a flow rate of 43 LPM and relative humidity of 40 ± 2%. N95 and P100 respirator filters were tested initially to establish the validity of the chamber, followed by the Halyard H600 fabric. Particle penetration was measured using an aerosol spectrometer. The filtration efficiency was calculated for different particle sizes by measuring the particle number concentration upstream and downstream of the filter. The pressure drop across the filter materials was measured using a manometer.ResultsThe efficiency of the P100 for particles ≥250 nm was 100%. The N95 efficiency was 97 ± 1% at 275 nm, 99 ± 0% at 324 nm, and 100% for larger particles. The Halyard H600 fabric had a variable efficiency with an average of 62 ± 28% at 275 nm, 89 ± 8% at 324 nm, and 100% efficiency for particles >450 nm. The pressure drop values for P100 and N95 were 32 and 8 mmH₂O, respectively. The Halyard H600 fabric resistance increased dramatically from 30 mmH₂O at the start of the exposure to 65 mmH₂O after 16-minutes of exposure.ConclusionThe high variability in filter efficiency for particles ≤324 nm and the increased fabric breathing resistance demonstrate that the Halyard H600 has an inferior performance and is not a good substitute for N95 and P100. Thus, the use of the Halyard H600 fabric for respiratory protection is not recommended.     

The clinimetric properties of the World Health Organization Disability Assessment Schedule II in early inflammatory arthritis

OBJECTIVE: To assess the clinimetric properties of a new health-related quality of life (HRQOL) instrument, the World Health Organization Disability Assessment Schedule II (WHODAS II), in patients with early inflammatory arthritis. METHODS: Internal consistency as well as criterion, construct, and discriminative validity of the WHODAS II were assessed in 172 patients with early inflammatory arthritis who completed the WHODAS II, the Medical Outcomes Study Short Form 36 (SF-36), and other measures of disease severity, functioning, pain, depression, and resource use. Test-retest reliability of the WHODAS II was assessed by having a subset of 20 patients complete the WHODAS II a second time, 1 week after the first assessment. RESULTS: The WHODAS II had high internal consistency (Cronbach's alpha = 0.96 for patients working or in school and 0.93 for patients not working or in school). Test-retest intraclass correlation coefficients of the WHODAS II total score and subscales ranged from 0.82-0.96. The WHODAS II total score was strongly correlated with the SF-36 physical component score (Kendall's tau-b 0.51, P < 0.001) and moderately correlated with the SF-36 mental component score (tau-b 0.43, P < 0.001). WHODAS II correlations with disease outcomes ranged from Kendall's tau-b 0.15-0.55. The WHODAS II significantly differentiated between every aspect of disease severity assessed with the exception of measures of health resource use. CONCLUSION: The WHODAS II is a valid and reliable measure of HRQOL in cross-sectional studies of patients with early inflammatory arthritis. Research is still required to investigate potential item redundancy and determine its usefulness in longitudinal studies.     

A three-dimensional finite element analysis of the human hip

Abstract

A three-dimensional hip model was created from the MRI scans of one human subject based on constructing the entire pelvis and femur. The ball and socket joint was modelled between the hip’s acetabulum and the femoral head to analyse the multiaxial loads applied in the hip joint. The three key ligaments that reinforce the external surface of the hip to help to stabilise the joint were also modelled which are the iliofemoral, the pubofemoral and ischiofemoral ligaments. Each of these ligaments wraps around the joint connection to form a seal over the synovial membrane, a line of attachment around the head of the femur. This model was tested for different loading and boundary conditions to analyse their sensitivities on the cortical and cancellous tissues of the human hip bones. The outcomes of a one-legged stance finite element analysis revealed that the maximum of 0.056?mm displacement occurred. The stress distribution varied across the model which the majority occurring in the cortical femur and dissipating through the cartilage. The maximum stress value occurring in the joint was 110.1?MPa, which appeared at the free end of the proximal femur. This developed finite element model was validated against the literature data to be used as an asset for further research in investigating new methods of total hip arthroplasty, to minimise the recurrence of dislocations and discomfort in the hip joint, as well as increasing the range of movement available to a patient after surgery.     

Diabetes mellitus following pituitary adenomectomy in euglycemic patients with acromegaly

Insulin resistance, impaired glucose tolerance and diabetes mellitus (DM) secondary to acromegaly generally improve following treatment of the underlying disease. In rare cases, in spite of normoglycaemia in the presence of active acromegaly, patients develop diabetes mellitus following pituitary adenomectomy to the extent of requiring insulin therapy. We report 7 patients who developed diabetes mellitus after pituitary adenomectomy. Regular measuring of blood glucose in post-pituitary surgery patients is recommended as a necessary step even in the previously normoglycaemics.     

Effects of levothyroxine suppressive therapy on bone mineral density in premenopausal women

BACKGROUND: Levothyroxine (L-T4) is widely prescribed for treating thyroid disorders, but its effect on bone mineral density (BMD), is being debated. OBJECTIVES: We studied the effect of supraphysiologic doses of L-T4 on BMD in a group of premenopausal women. PATIENTS AND METHODS: We included 50 women (mean age=36.8 +/- 7.6 years) receiving L-T4 for at least 1 year for treating their benign cold thyroid nodules. Serum T3, T4, thyroid-stimulating hormone (TSH), parathyroid hormone (PTH), calcium, and phosphate and urine calcium and sodium levels of all patients were measured. Bone density at femoral neck and lumbar (L1-L4) regions was measured, using dual energy X-ray absorptiometry (DXA). RESULTS: No significant decrease was detected in the bone density of the subjects treated with L-T4 compared with the control group. CONCLUSION: L-T4 treatment for 1 year is not associated with increased risk of osteoporosis in premenopausal women but other potential adverse effects still need to be monitored in women receiving L-T4 especially long-term.