Diagnostic Challenges and Management Update in Rheumatoid Arthritis

Rheumatoid arthritis is a chronic, systemic inflammatory disease, with certain evidence of multiple factors involved, but also with the strong autoimmune component, leading to a high potential for disability, through synovial inflammation and joint destruction. Diagnostic methods and management possibilities have recently improved, thus leading to a better outcome, based on the treat to target recommendation. Although biologic agents represent efficient therapeutic agents, in the last few years, the advances in understanding the mediators involved in rheumatoid arthritis pathogenesis have provided new targeted therapies, represented by small molecule inhibitors against the Janus kinases that contribute in the signaling pathways of various cytokine receptors

Racial differences in systemic sclerosis disease presentation: a European Scleroderma Trials and Research group study

Objectives. Racial factors play a significant role in SSc. We evaluated differences in SSc presentations between white patients (WP), Asian patients (AP) and black patients (BP) and analysed the effects of geographical locations.Methods. SSc characteristics of patients from the EUSTAR cohort were cross-sectionally compared across racial groups using survival and multiple logistic regression analyses.Results. The study included 9162 WP, 341 AP and 181 BP. AP developed the first non-RP feature faster than WP but slower than BP. AP were less frequently anti-centromere (ACA; odds ratio (OR) = 0.4, P < 0.001) and more frequently anti-topoisomerase-I autoantibodies (ATA) positive (OR = 1.2, P = 0.068), while BP were less likely to be ACA and ATA positive than were WP [OR(ACA) = 0.3, P < 0.001; OR(ATA) = 0.5, P = 0.020]. AP had less often (OR = 0.7, P = 0.06) and BP more often (OR = 2.7, P < 0.001) diffuse skin involvement than had WP.AP and BP were more likely to have pulmonary hypertension [OR(AP) = 2.6, P < 0.001; OR(BP) = 2.7, P = 0.03 vs WP] and a reduced forced vital capacity [OR(AP) = 2.5, P < 0.001; OR(BP) = 2.4, P < 0.004] than were WP. AP more often had an impaired diffusing capacity of the lung than had BP and WP [OR(AP vs BP) = 1.9, P = 0.038; OR(AP vs WP) = 2.4, P < 0.001]. After RP onset, AP and BP had a higher hazard to die than had WP [hazard ratio (HR) (AP) = 1.6, P = 0.011; HR(BP) = 2.1, P < 0.001].Conclusion. Compared with WP, and mostly independent of geographical location, AP have a faster and earlier disease onset with high prevalences of ATA, pulmonary hypertension and forced vital capacity impairment and higher mortality. BP had the fastest disease onset, a high prevalence of diffuse skin involvement and nominally the highest mortality

Detection and Classification of Postural Transitions in Real-World Conditions

This study proposes a new robust classifier for sit-to-stand (SiSt) and stand-to-sit (StSt) detection in daily activity. The monitoring system consists of a single inertial sensor placed on the trunk. By using dynamic time warping, the trunk acceleration patterns of SiSt and StSi are classified based on their similarity with specific templates. The classification algorithm is validated with actual data obtained in a real-world environment (five healthy subjects and five chronic pain patients); the best accuracy is obtained through using a custom template defined for each subject (>95% for healthy subjects and 89% for chronic pain). Real-world examinations are found to be preferable because after validating results collected in both real-world and laboratory conditions, the controlled conditions' predictions are too optimistic. Finally, the potential of the new method in clinical evaluation is studied in both healthy and frail elderly subjects. Frail elderly participants show a significantly lower rate of postural transitions, longer SiSt duration, and lower SiSt trunk tilt and acceleration compared to healthy elderly subjects. We conclude that the proposed wearable system provides a simple method to detect and characterize postural transitions in healthy, chronic pain, and frail elderly subjects

MOLECULAR FACTORS WITH PREDICTIVE VALUE FOR THE SURVIVAL RATE IN PANCREATIC CANCER: FOCUSING ON CA 19-9

The incidence of pancreatic neoplasm has increased exponentially over the last decades in many parts of the world, and moreover it has become the fifth or even sixth cause of death by cancer in the Western countries. Still, little is known about this disease, since the main disadvantage encountered in pancreatic cancer is the fact that the diagnosis is established too late despite the development of new technologies, while also most of the studies carried out have not been able to identify the significant risk factors for pancreatic. In this way, in the present mini-review we want it to make a short description for the main molecular factors with predictive value for the survival rate in pancreatic cancer and by focusing especially on the CA 19-9. Thus, it seems that CA 19-9 should enter in the arsenal of methods for monitoring the condition of the operated patients and also be a tool for the prognostic evaluations. Also, some of the results we describe here are suggesting that tumor-metastatic involvement of LN 8a can be a strong predictive factor of aggressive tumor biology and, therefore, of the early existence of metastatic disease

THE RELEVANCE OF SOME TUMORAL MARKERS IN PATIENTS WITH PANCREATIC CANCER

The pancreatic cancer is a disease with exponentially increased incidence, especially over the last decades, being the sixth or even fifth cause of death by cancer in most of the modern societies. Moreover, it is estimated that almost 95% of the patients with this disease are presenting to the doctor in the advanced and unresectable stages. Thus, the only way of establishing a diagnosis in the early stage, potentially curable, would be a rigorous anamnesis that would reveal the early symptoms to 'send' the patient to the doctor in the early stage. In this way, all hopes are turning to early diagnosis and/or the discovery of an effective therapeutic agent. Thus, in the present report we will be interested in presenting the relevance for the serum determination of some tumoral markers, such as CA19-9 (carbohydrate antigen 19- 9) and CEA (carcinoembryonic antigen) in our selected patients with pancreatic cancer. In this way, our results are showing the relevance in determining these specific tumoral markers, especially as predictors for recurrences after pancreatic neoplasm surgery, since the determination of the serum level of CA 19-9 seem to be relevant in the cases when the antigen level drops immediately after the surgery, then increases progressively, highlighting the emergence of recurrence

Uncommon Association of Mckittrick-Wheelock Syndrome and <i>Clostridioides difficile</i> Infection in Acute Renal Failure

We present the case of a 71-year-old male who suffered an episode of acute renal failure caused by the uncommon association of two different diseases (Clostridioides difficile infection and McKittrick-Wheelock syndrome). He presented with hypovolemic shock, severe hypokalemia, hyponatremia, metabolic acidosis and acute renal failure; consequences of secretory diarrhea caused by a giant rectal tumor revealed from colonoscopy. The biopsy results revealed tubulo-villous adenoma with low/high grade dysplasia. After correction of electrolyte imbalances and azotemia, the patient underwent surgical resection with full subsequent recovery. In the literature review, including papers published from which January 1945 to April 2021, we found only one case-report of acute renal failure associated with Clostridioides difficile infection and McKittrick-Wheelock syndrome

Uncommon Association of Mckittrick-Wheelock Syndrome and Clostridioides difficile Infection in Acute Renal Failure

We present the case of a 71-year-old male who suffered an episode of acute renal failure caused by the uncommon association of two different diseases (Clostridioides difficile infection and McKittrick-Wheelock syndrome). He presented with hypovolemic shock, severe hypokalemia, hyponatremia, metabolic acidosis and acute renal failure; consequences of secretory diarrhea caused by a giant rectal tumor revealed from colonoscopy. The biopsy results revealed tubulo-villous adenoma with low/high grade dysplasia. After correction of electrolyte imbalances and azotemia, the patient underwent surgical resection with full subsequent recovery. In the literature review, including papers published from which January 1945 to April 2021, we found only one case-report of acute renal failure associated with Clostridioides difficile infection and McKittrick-Wheelock syndrome

Pethidine efficacy in achieving the ultrasound-guided oblique subcostal transversus abdominis plane block in laparoscopic cholecystectomy: A prospective study

Pethidine is a synthetic opioid with local anesthetic properties. Our goal was to evaluate the analgesic efficacy of pethidine for achieving the ultrasound-guided oblique subcostal transversus abdominis plane (OSTAP) block in laparoscopic cholecystectomy. This prospective, double-blind study included 79 patients of physical status I and II according to American Society of Anesthesiologists, scheduled for elective laparoscopic cholecystectomy. The patients were randomly allocated into three groups, depending on the drug used to achieve preoperative bilateral OSTAP block: 1) OSTAP-Placebo (treated with normal saline); 2) OSTAP-Bupivacaine (treated with 0.25% bupivacaine); and 3) OSTAP-Pethidine (treated with 1% pethidine). The efficacy of pethidine in achieving the OSTAP block was analyzed using visual analog scale (VAS), intraoperative opioid dose, opioid consumption in post anesthesia care unit, and opioid consumption in the first 24 postoperative hours. The pain scores assessed by VAS at 0, 2, 4, 6, 12, and 24 hours were significantly lower in OSTAP-Pethidine than in OSTAP-Placebo group (p < 0.001). The mean intraoperative opioid consumption was significantly lower in OSTAP-Pethidine compared to OSTAP-Placebo group (150 versus 400 mg, p < 0.001), as well as the mean opioid consumption in the first 24 hours (20.4 versus 78 mg, p < 0.001). Comparing VAS assessment between OSTAP-Bupivacaine and OSTAP-Pethidine groups, statistically significant differences were observed only for the immediate postoperative pain assessment (0 hours), where lower values were observed in OSTAP-Pethidine group (p = 0.004). There were no statistically significant differences in the incidence of postoperative nausea and vomiting (p = 0.131) between the groups. The use of 1% pethidine can be an alternative to 0.25% bupivacaine in achieving OSTAP block for laparoscopic cholecystectomy