Frequency of latent tuberculosis in patients receiving Anti-TNF-Alpha therapy

Setting-Objective: In this study, it was aimed to reveal the incidence of tuberculosis development in patients receiving tumor necrosis factor-alpha (TNF-α) blocker therapy, despite tuberculosis chemoprophylaxis. Design: 520 patients who were receiving anti TNF-α treatment in the last 3 years were evaluated retrospectively. Radiological imaging tuberculin skin test (TST), history of tuberculosis, BCG vaccine, chemoprophylaxis administration, used anti TNF-α drugs were recorded. Results: There were 265(51.0%) of the patients with ankylosing spondylitis (AS), 175(33.7%) with rheumatoid arthritis, 35(6.7%) with Crohn's, 10(1.9%) with ulcerative colitis (UC), 21(4.0%) with psoriatic arthritis, 14(2.7%) with psoriasis vulgaris. In total, 455 (79.6%) patients were given INH prophylaxis. Active tuberculosis development was observed in five patients (4: pulmonary,1: extrapulmonary; 3: UC, 2:AS) who all received anti TNF-α treatment (0.96%), infliximab. Three patients had tuberculosis disease in the 6th month, and the other 2 patients in the 5th and 24th month of their anti TNF-α treatments, and two had 9-month, and 1 had 6-month chemoprophylaxis history. Conclusion: The incidence of tuberculosis development in patients treated with anti TNF-α was found to be higher than the general population. In our country, where tuberculosis is still prevalent, patients receiving Anti TNF-α treatment (especially in-fliximab) should be carefully questioned and examined about tuberculosis

The prevalence of sicca symptoms and sjogren's syndrome in patients with systemic sclerosis and expression of ?lfa-smooth muscle actin in salivary gland biopsy specimens.

Giriş ve Amaç: Sistemik Skleroz (SSc), kollajen ve matrix proteinlerinin konnektif dokuda masif birikimi ile karakterli heterojen bir sistemik hastalıktır. Sikka semptomları SSc'da sıklıkla görülür ancak tükürük bezi hipofonksiyonunun sıklığı ve patogenezi tam olarak aydınlatılamamıştır. Çalışmamızın amacıæ SSc'lu hastalarda sikka semptomları ve Sjögren sendromu (SjS) sıklığı ile buna katkıda bulunan faktörlerin saptanması ve ayrıca miyofibroblastik transformasyonun göstergesi olan ?-smooth muscle actin (?-SMA) ekpresyonunun tükürük bezi biyopsilerinde değerlendirilmesidir. Hastalar ve yöntem: Çalışmaya romatoloji polikliniğinde takip edilen ardışık 102 SSc hastası [91 kadın (89%), ortalama yaş 52,5 ± 12 yıl] ardışık olarak dahil edildi. İlk aşamada klinik değerlendirmede, tüm hastalarda Amerika-Avrupa SjS sınıflama kriterlerinde tanımlanan spesifik soruları içeren, subjektif ağız, göz kuruluğu semptomlarının varlığı araştırıldı ve birlikte Schirmer 1 ve uyarılmamış tükürük akım testi uygulandı. İlk aşamada yapılan klinik değerlendirmesi pozitif olan hastalara tükürük bezi biyopsisi yapıldı. Tükürük bezi biyopsilerinde fokal lenfositik siyaloadenit (fokus skoru ?1) ve glandular fibrosis varlığı araştırıldı. Tükürük bezi biyopsilerinde ?-SMA ekspresyonunun tespitinde immunohistokimyasal yöntem kullanıldı. Sonuçlar: Çalışmaya alınan 102 hastanın 85'i (83%) sınırlı SSc (limitedæ lSSc), 12'si (%12) diffüz SSc (dSSc) ve 5'i (5%) sine sklerodermaya sahipti. Yüz iki hastanın 76'sında (%75) sikka sendromu (65'inde [%64] kserostomi, 49'unda [%48] kseroftalmi) vardı. Yüz iki hastanın 65'inde (%64) schirmer 1 testi, 36'sında (%35) uyaransız total tükürük akımı testi (siyalometri) pozitifti. Çalışma protokolüne göre 90 hastaya minör tükürük bezi biyopsisi endikasyonu konuldu, bunlardan 6'sı biyopsiyi reddetti ve toplamda 84 (%82) hastaya biyopsi yapıldı. Biyopsi örneklerinin histopatolojik değerlendirmesinde 67 (%80) hastada fibrotik lezyon gözlenirken, 38 (%45) hastada fokus skoru ? 1 idi. Amerika-Avrupa kriterlerine göre 36 (%35,3) hasta sekonder SjS olarak sınıflandırıldı. SjS'lu hastalardan 34'ü lSSc, 2'si sine sklerodermaydı. Sekonder SjS'u yaş, semptom başlangıç yaşı ve SS-A pozitifliği ile ilişkili bulundu. Multivariate analizde SS-A pozitifliği ve yaş sekonder SjS gelişiminde istatistik anlamlı belirleyicilerdi (p=0.015, p=0,038). İmmunohistokimyasal incelemede yalnızca 7 örnek ?-SMA ile zayıf boyandı. Tartışma: Sikka semptomlarının temel nedeni fibrosis gibi görünmesine rağmen bizim çalışmamız, SSc'li hastalarda SjS prevalansının en yüksek olarak gösterildiği çalışmalardan biridir. Bu sonuçlar SSc'nin limitli kutanöz subtipinin SjS açısından daha riskli olduğunu düşündürmektedir. Miyofibroblastik transformasyon minör tükürük bezinde fibrozis gelişiminde tek faktör olmayabilir. Objective: Systemic sclerosis (SSc) is a heterogeneous systemic disorder characterized by massive deposition of collagen and other matrix substances in connective tissue. Although sicca symptoms are thought to be a frequent complaint associated with SSc, pathogenesis of salivary hypofonction is not defined clearly and little is known about how often they occur. The aim of this study was to determine the prevalence and contributing factors of sicca symptoms and Sjogren's syndrome (SjS) in patients with SSc, and also to evaluate to expression of the ?-smooth muscle actin (?-SMA), a myofibroblast marker, in salivary gland specimens. Method: Consecutive 102 SSc patients [91 female (89%), mean age 52,5 ± 12 years] followed by an outpatient rheumatology clinic were included in the study. The systematic first-line clinical evaluation included a questionnaire specific for the subjective presence of xerophthalmia and xerostomia based on the revised American-European Consensus Group criteria for SS, together with the Schirmer I test and unstimulated whole salivary flow. If the findings of the first-line clinical evaluation were positive a labial salivary gland biopsy was performed. Salivary glandular tissue sections were evaluated for the presence of focal lymphocytic sialadenitis (a focus score?1), and glandular fibrosis. Immunohistochemistry was used for the expression of ?-SMA. Results: Of 102 patients, 85 (83%) had limited SSc (lSSc), 12 (%12) diffuse SSc (dSSc) and 5 (5%) had sine scleroderma. Seventy-six patients (75%) had sicca syndrome (65 [64%] had xerostomia, and 49 [48%] had xerophthalmia). Sixty-five of the 102 patients (64%) had positive findings on the Schirmer test and 36 (35%) patients had positive salivary flow test. A total salivary gland biopsy was indicated in 90 patients according to our protocol. Six patients refused the procedure therefore biopsy were performed in eighty-four (82%) patients. On histopathologic examination of biopsy samplesæ fibrotic lesion were observed in 67 out of 84 (80%) and in 38 (45%) sample focus score was ?1. Thirty-six patients (35,3%) fulfilled American European Consensus Group criteria for secondary SjS. Thirty-four patients who diagnosed secondary SjS had lcSSc and two of them had sine scleroderma. Secondary SjS were associated with age, age at onset of disease and the presence of SS-A antibody. Multivariate analysis revealed that SS-A antibody positivity, age were significant predictor for SjS (p=0,015, p=0,038). In immunohistochemistry examination only 7 sample were stained poorly for ?-SMA. Conclusion: Despite fibrosis seems to be the main cause of sicca symptoms, our study revealed one of the highest prevalence of SjS in patients with SSc. These results suggest that limited cutaneous subtype of SSc carries a greater risk for SjS. Our study also suggested that myofibroblastic transformation may not be the only factor for fibrosis seen on minor salivary glandular tissue

The Recent Topics in Genetic Polymorphisms

Recent advances in genome technology revealed various single nucleotide polymorphisms (SNPs), the most common form of DNA sequence variation between alleles, in several plant species. The discovery and application of SNPs increased our knowledge about genetic diversity and a better understanding on crop improvement. Natural breeding process which takes an agelong time during collecting, cultivating, and domestication has been accelerated by detecting dozens of SNPs on various species using advanced biotechnological techniques such as next-generation sequencing. This will result in the improvement of economically important traits. Therefore, we would like to focus on the discovery, current technologies, and applications of SNPs in breeding. The chapter covers the following topics: (1) introduction, (2) application of SNPs, (3) techniques to detect SNPs, (4) importance of SNPs for crop improvement, and (5) conclusion