Diagnostic and prognostic values of antikeratin antibodies (AKA) and collagen III propeptides (PIIINP) in juvenile rheumatoid arthritis

Background: The need for specific and sensitive diagnostic as well as prognostic markers for juvenile rheumatoid arthritis (JRA) has urged  scientific research toward this field.Objective: We sought to assess the diagnostic and prognostic values of serum and synovial fluid collagen III propeptides (PIIINP) and antikeratin antibodies(AKA) in JRA.Methods :Thirty-one JRA patients with a mean age of 10.6±4.2 years were enrolled in the study. They were compared to 10 SLE patients with arthritis and 15 age and sex matched healthy children as control groups. All  patients were subjected at enrollment to laboratory evaluation by CBC,  ESR, CRP, serum PIIINP and AKA. Patients with knee effusion were  subjected to AKA and PIIINP analysis in their synovial fluid samples. Clinical evaluation was done by examination of joint swelling, tenderness and limitation of movement scores. Also, radiological evaluation by plain X-ray films for hands, knees and feet using modified Larsen score (MLS) was performed. Laboratory, clinical and radiological evaluation methods were re-performed after 3 months of proper treatment. A third radiological evaluation was done one year after the first evaluation.Results: Serum PIIINP was significantly elevated in JRA patients  (12.8±8.7) ìg/L in comparison to healthy controls (7.0±1.9 ìg/L, p<0.05). However, no significant difference was observed when compared to SLE patients. Reduction of serum PIIINP was observed after 3 months of treatment with no significant difference between JRA patients (10.5±8.8 ìg/L) and the healthy controls. Synovial fluid PIIINP (56.4±6.6 ìg/L) was significantly higher than that of the serum (p<0.05). Neither serum nor synovial fluid PIIINP correlated with any of the laboratory, clinical or radiological parameters. The serum AKA positivity rate was significantly higher in JRA patients (77% at the study onset and 90% after three months) as compared to the control group (7%, p<0.001). Serum AKA values recorded a sensitivity, specificity and diagnostic efficiency in JRA patients of 77%, 93% and 83% at the study onset. These values increased after 3 months to 90%, 93% and 91% respectively. Synovial AKA levels displayed no significant difference in comparison to that of the serum.Conclusion :AKA is a specific and sensitive diagnostic marker for JRA. Meanwhile, PIIINP was significantly elevated during JRA disease activity particularly in the synovial fluid. Neither AKA nor PIIINP proved to have prognostic values in JRA.Key words: juvenile rheumatoid, arthritis, antikeratin antibodies, collagen III propeptides, SLE

Lemierre's syndrome due to Klebsiella pneumoniae in a 63-year-old man with diabetes: a case report

<p>Abstract</p> <p>Introduction</p> <p>Lemierre's syndrome was originally documented to be caused by <it>Fusobacterium necrophorum</it>. It is a very rare condition with a prevalence of one to 14.4 instances per million. Its presentation is varied, not only in composition but also in the infecting organism. Treatment with anticoagulants has been controversial and applied only on a case-by-case basis.</p> <p>Case presentation</p> <p>A 63-year-old Saudi man who had had uncontrolled diabetes mellitus for 47 years presented to our facility with a five-day history of swelling on the right side of his neck and fever. The swelling progressively increased in size and was associated with pain, dysphagia, odynophagia, change of voice ('hot potato voice'), and reduced appetite. Abscess content culture and sensitivity testing revealed <it>Klebsiella pneumoniae</it>. However, blood culture results were repeatedly negative. The abscess was incised and drained without any complication. Our patient was treated with clindamycin and cefuroxime. Warfarin was also administered concurrently for six weeks, for an isolated internal jugular vein thrombosis (IJV), with complete resolution of the thrombus. Normoglycemia was achieved and our patient was discharged after complete wound healing and the return of his biochemical parameters to normal.</p> <p>Conclusions</p> <p>Only two cases of Lemierre's syndrome in patients with diabetes due to <it>K. pneumoniae </it>have been reported previously. A review of the literature suggested that an association exists between deep neck infections due to <it>K. pneumoniae </it>and diabetes mellitus. The reasons for this association are still not clear. This poses a question as to whether diabetes mellitus specifically predisposes these patients to infection with this organism. It is suggested that clinicians should consider infectious agents other than <it>F. necrophorum </it>in the causation of Lemierre's syndrome, especially in patients with diabetes.</p

Quality of Type 2 Diabetes Management in the States of The Co-Operation Council for the Arab States of the Gulf: A Systematic Review

Type 2 diabetes mellitus is a growing, worldwide public health concern. Recent growth has been particularly dramatic in the states of The Co-operation Council for the Arab States of the Gulf (GCC), and these and other developing economies are at particular risk. We aimed to systematically review the quality of control of type 2 diabetes in the GCC, and the nature and efficacy of interventions. We identified 27 published studies for review. Studies were identified by systematic database searches. Medline and Embase were searched separately (via Dialog and Ovid, respectively; 1950 to July 2010 (Medline), and 1947 to July 2010 (Embase)) on 15/07/2009. The search was updated on 08/07/2010. Terms such as diabetes mellitus, non-insulin-dependent, hyperglycemia, hypertension, hyperlipidemia and Gulf States were used. Our search also included scanning reference lists, contacting experts and hand-searching key journals. Studies were judged against pre-determined inclusion/exclusion criteria, and where suitable for inclusion, data extraction/quality assessment was achieved using a specifically-designed tool. All studies wherein glycaemic-, blood pressure- and/or lipid- control were investigated (clinical and/or process outcomes) were eligible for inclusion. No limitations on publication type, publication status, study design or language of publication were imposed. We found the extent of control to be sub-optimal and relatively poor. Assessment of the efficacy of interventions was difficult due to lack of data, but suggestive that more widespread and controlled trial of secondary prevention strategies may have beneficial outcomes. We found no record of audited implementation of primary preventative strategies and anticipate that controlled trial of such strategies would also be useful

The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview

Aziz Sheikh and colleagues report the findings of their systematic overview that assessed the impact of eHealth solutions on the quality and safety of health care

Selected Predictors Of Apoptosis In Retinitis Pigmentosa

The genetics of non syndromic retinitis pigmentosa (RP) is complex with numerous gene mutations. An attempt to overcome each individual mutation provides an overwhelming challenge. However targeting apoptosis which represents a final common pathway to photoreceptor cell death may provide a more practical approach. This study focused on some predictors of apoptosis in RP and their potential usefulness for patients\' management and relatives\' early diagnosis. Forty nine RP patients with thirty controls were evaluated genetically and ophthalmologicaly with assessment of plasma total nitrite and nitrate (as an index for nitric oxide), Plasma sFas as an index of apoptosis and plasma fatty acids levels. Autosomal recessive RP was the most common type of inheritance and the levels of plasma sFas and nitric oxide (NO) were significantly higher in retinitis pigmentosa compared to controls. Retinitis pigmentosa patients had significantly lower percentage of plasma omega3 fatty acids especially docosahexaenoic acid (DHA) relative to controls. sFas, NO, and DHA could differentiate between RP patients and control subjects with 100%, 100%, 97% sensitivity and 90%, 90%, 100% specificity respectively. sFas and nitric oxide levels were higher in cases of autosomal recessive (AR) type followed by X-linked, autosomal dominant, then simplex cases relative to the control group this may explain why AR and X-Linked forms are clinically more severe. In conclusion; diagnosis and treatment of RP could be aided by systemic markers or predictors of retinal degeneration. The consistent decrease in the plasma omega 3 fatty acids especially DHA, and increase sFas and nitric oxide levels may draw the attention upon the use of these markers as laboratory tests for relatives of affected patients who are at high risk for having retinitis pigmentosa. Also, omega 3 fatty acids in the form of DHA were recommended as possible supplements for the patients and their relatives. Keywords: Retinitis pigmentosa, Apoptosis, Plasma sFas, Docosahexaenoic acid (DHA). Egyptian Journal of Biochemistry and Molecular Biology Vol. 26 (2) 2008: pp. 119-13

First evidence of avian metapneumovirus subtype A infection in turkeys in Egypt.

Although avian metapneumovirus (aMPV) infection has been reported in most regions of the world, to date, only subtype B has been detected in Egypt. At the end of November 2013, dry oropharyngeal swabs were collected during an outbreak of respiratory diseases in a free-range, multi-age turkey dealer farm in Northern Upper Egypt. The clinical signs that appeared when turkeys were 3 weeks-old were characterized by ocular and nasal discharge and swelling of sinuses. aMPV of subtype A was detected by real-time reverse transcription-polymerase chain reaction. In order to confirm the results and obtain more information on the molecular characteristics of the virus, F and G protein genes were partially sequenced and compared with previously published sequences deposited in GenBank by using BLAST. Subtype of the strain was confirmed by sequencing of partial F and G protein genes. The highest percentages of identity were observed when G sequence of the Egyptian strain was compared with the sequence of an aMPV-A isolated in Nigeria (96.4 %) and when the F sequence was compared with strains isolated respectively in Italy and in UK (97.1 %). Moreover, the alignment of the sequences with commercial subtype A vaccine or vaccine-derived strains showed differences in the Egyptian strain that indicate its probable field origin. The detection of aMPV in the investigated turkey flock highlights some relevant epidemiological issues regarding the role that multi-age farms and dealers may play in perpetuating aMPV infection within and among farms. To our knowledge, this is the first report of aMPV subtype A in Egypt