Major depression and disease activity among systemic lupus erythematosus Egyptian females

AbstractAim of the workThe aim of this study was to identify the relationship between disease activity in SLE Egyptian females and the presence, severity and pattern of major depression in these patients.Patients and methodsThe study sample included 100 female patients; fifty SLE patients and fifty healthy adults with matching age serving as control. Patients were assessed using Beck Inventory Score for the presence of major depression, SLEDAI to determine disease activity, SLICC/ACR damage index and HAQ score for functional disability.ResultsThe majority of patients had symptoms of major depression 32/50 (64%) based on Beck Inventory Score while in controls only 16/50 (36%) had major depression. The most common depressive symptoms in SLE patients were: Guilty feeling (92%), Self-dislike (91.6%), Self-criticalness (90.4%), Crying spells (87.5%), Loss of pleasure (83.3%), Change in appetite (83.3%), Agitation (82.8%) and Pessimism (82%). Patients with major depression presented a trend toward having greater severity of SLE disease activity compared with those without major depression (p=0.04). The presence of major depression was significantly associated with functional disability measured by HAQ score (p=0.01). The patients with major depression did not differ significantly from patients without major depression regarding their steroid dosage (p=0.55), SLICC/ACR damage score (p=0.16) and disease duration (p=0.69) but differed significantly as regards Beck Hopelessness Scale (p<0.0001) and suicidal ideation score (p=0.009).ConclusionMajor depression was highly presented in Egyptian SLE patients (64%); its severity was associated with disease activity, but not with steroid administration, cumulative damage or disease duration

Major depression and disease activity among systemic lupus erythematosus Egyptian females

AbstractAim of the workThe aim of this study was to identify the relationship between disease activity in SLE Egyptian females and the presence, severity and pattern of major depression in these patients.Patients and methodsThe study sample included 100 female patients; fifty SLE patients and fifty healthy adults with matching age serving as control. Patients were assessed using Beck Inventory Score for the presence of major depression, SLEDAI to determine disease activity, SLICC/ACR damage index and HAQ score for functional disability.ResultsThe majority of patients had symptoms of major depression 32/50 (64%) based on Beck Inventory Score while in controls only 16/50 (36%) had major depression. The most common depressive symptoms in SLE patients were: Guilty feeling (92%), Self-dislike (91.6%), Self-criticalness (90.4%), Crying spells (87.5%), Loss of pleasure (83.3%), Change in appetite (83.3%), Agitation (82.8%) and Pessimism (82%). Patients with major depression presented a trend toward having greater severity of SLE disease activity compared with those without major depression (p=0.04). The presence of major depression was significantly associated with functional disability measured by HAQ score (p=0.01). The patients with major depression did not differ significantly from patients without major depression regarding their steroid dosage (p=0.55), SLICC/ACR damage score (p=0.16) and disease duration (p=0.69) but differed significantly as regards Beck Hopelessness Scale (p<0.0001) and suicidal ideation score (p=0.009).ConclusionMajor depression was highly presented in Egyptian SLE patients (64%); its severity was associated with disease activity, but not with steroid administration, cumulative damage or disease duration

The Effectiveness of Intraocular Methotrexate in the Treatment of Posterior Uveitis in Behçet’s Disease Patients Compared to Retrobulbar Steroids Injection

Aim of Work. To evaluate the efficacy of intravitreal methotrexate (MTX) compared to retrobulbar triamcinolone acetonide (TAA), in controlling posterior segment involvement and inducing remissions among Behçet’s disease (BD) patients. Study Design. This is a cross-sectional nonrandomized comparative study. Patients and Methods. 31 adult BD male patients with a mean disease duration of 5.45 years who presented with bilateral posterior segment involvement were included. Each patient received intravitreal injection of 400 μg/0.1 mL (MTX) for the right eye (Group A) and 1 mL of retrobulbar 40 mg/mL TAA for the left eye (Group B). Results. 90% of eyes showed complete improvement of anterior chamber reaction, whereas an improvement in vitreous activity in 77% with no significant differences between both groups (p≤0.1). BCVA improved in 77.4% eyes (Group A) compared to 87.1% (Group B) (p≤0.4). Relapses were noted in 11 eyes (35.5%), in group A, with the mean duration of remission being 19.1 weeks ± 2.13 compared to 7.35±2.8 in 20 eyes (64.5%) in group B (p≤0.1). Conclusion. No statistical differences were found between both treatment modalities; however, based on clinical observations, intravitreal MTX may ensure better control of inflammatory reaction and may encourage longer remission as compared to retrobulbar TAA in BD patients

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Utero-placental and cerebrovascular indices in pregnant women with systemic lupus erythematosus: Relation to disease activity and pregnancy outcome

Aim of the work: To assess maternal and fetal vascular indices in SLE patients during pregnancy, and the impact of disease activity on these vascular indices. Patients and methods: 30 pregnant SLE patients and 30 age -matched healthy females with uncomplicated pregnancies were assessed during the third trimester using ultrasonography (US) and Doppler study to detect fetal biometry, the uterine, umbilical (UA) and fetal middle cerebral (MCA) arterial resistance (RI) and pulsatility (PI) indices, as well as cerebro-placental ratio (CPR). Disease activity was determined using the SLE Disease Activity Index (SLEDAI). Results: The mean uterine artery PI, RI and the UA-PI in SLE group were significantly higher than controls (p value  0.05). Conclusion: Pregnancies in SLE are associated with abnormal maternal and fetal vascular indices. Doppler US can identify at-risk pregnancies and optimize the time of delivery; confirming a good pregnancy outcome

The Effectiveness of Pre- and Postoperative Infliximab in Controlling Behçet’s Disease Posterior Uveitis in Patients Undergoing Vitrectomy: A Preliminary Study

Purpose. To evaluate the short-term effectiveness of infliximab in controlling ocular manifestations in Behçet’s Disease (BD) patients candidate for pars plana vitrectomy, if given in a regimen before and after the planned procedure. Patients and Methods. 30 eyes of 27 adult male BD patients with a mean age of 35.56 yrs presented with refractory posterior uveitis not responding to immunosuppressive drugs and candidate for vitrectomy were included. Infliximab was given in a dose of 5 mg/kg intravenous infusion once every two weeks for 3 treatment sessions before the intended vitrectomy followed by 3 treatment sessions at two-week intervals, after vitrectomy. Results. Improvement of ocular manifestations was noted in all eyes, with complete resolution in 26 eyes (87%). Visual acuity improved from 0.23 ± 0.11 to 0.38 ± 0.17 (p≤0.2), ESR decreased from 65.92 mm/hr ± 17.32 SD to 24.93 mm/hr ± 5.28 SD at the last treatment cycle (p≤0.1). The mean daily dose of systemic corticosteroids was tapered from 44.54 mg/d ± 2.89 to 8.48 mg/d ± 6.38 (p≤0.2), and no relapses were noted during the follow-up period. Conclusion. Infliximab may be safe and effective in controlling posterior uveitis and inducing remissions if given in a regimen before and after vitrecomy in BD patients