Pattern of cesarean deliveries among women in an urban and rural district in Egypt

Aim: to compare patterns of delivery at an urban and a rural district in Egypt over 3 years. Methods: This retrospective study included 500 women and 50 obstetricians from each district from January, 2013 till December, 2015. Women answered a questionnaire about their deliveries. Obstetricians answered a questionnaire about their practiceof CS. Results: CS rate in the rural district was 57.2% compared to 54.8% in the urban district in 2013. In 2014 and 2015, CS rates increased to 65.3% and 69%, respectively in the rural district compared to 56% and 57.7%, respectively in the urban district. 66% of obstetricians in the rural district performed CS for more than 50% of their patients compared to 76% of obstetricians in the urban district. 52% and 4% of obstetricians in the rural and urban districts, respectively, performed CS upon maternal request. 70.3% of women in the rural district who delivered by CS preferred to deliver vaginally. 51.4% of urban women who delivered by CS preferred to deliver vaginally. Level of education was the only factor showing statistical significance. Conclusion: CS rates increased over time with higher rates in the rural area. Level of women's education was the only factor affecting delivery choice. Keywords: Cesarean sections; CS rate; urban area; rural area; Egypt; obstetricians

Defining criteria for disease activity states in systemic juvenile idiopathic arthritis based on the systemic Juvenile Arthritis Disease Activity Score

Objective To develop and validate cutoff values in the systemic Juvenile Arthritis Disease Activity Score 10 (sJADAS10) that distinguish the states of inactive disease (ID), minimal disease activity (MiDA), moderate disease activity (MoDA), and high disease activity (HDA) in children with systemic juvenile idiopathic arthritis (sJIA), based on subjective disease state assessment by the treating pediatric rheumatologist. Methods The cutoffs definition cohort was composed of 400 patients enrolled at 30 pediatric rheumatology centers in 11 countries. Using the subjective physician rating as an external criterion, 6 methods were applied to identify the cutoffs: mapping, calculation of percentiles of cumulative score distribution, Youden index, 90% specificity, maximum agreement, and ROC curve analysis. Sixty percent of the patients were assigned to the definition cohort and 40% to the validation cohort. Cutoff validation was conducted by assessing discriminative ability. Results The sJADAS10 cutoffs that separated ID from MiDA, MiDA from MoDA, and MoDA from HDA were ≤ 2.9, ≤ 10, and > 20.6. The cutoffs discriminated strongly among different levels of pain, between patients with or without morning stiffness, and between patients whose parents judged their disease status as remission or persistent activity/flare or were satisfied or not satisfied with current illness outcome. Conclusion The sJADAS cutoffs revealed good metrologic properties in both definition and validation cohorts, and are therefore suitable for use in clinical trials and routine practice

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

Serum IL17 and IL4R RS1805010 genotypes: relationship with rheumatoid arthritis disease activity in Egyptian patients

Rheumatoid arthritis(RA) is characterized by the presence of a relative state of imbalance between pro- and anti-inflammatory cytokines such as Interleukin(IL)17 and IL4, respectively. IL4 is supposed to regulate production of IL17 from T-helper (Th)17 cells. However, this regulatory function might be affected by singlenucleotide polymorphism (SNP) of IL4 receptor (IL4R) gene, rs1805010. The current study aimed to assess serum IL17 level in Egyptian patients with RA according toIL4Rrs1805010 genotypes,and to detect possibleassociations betweenIL17/ IL4R genotypesand clinical status, disease activity as well as effect of treatment. Serum IL17 was assessed by ELISA, and qPCR was used to determine the genotypes of IL4R SNP rs1805010. Serum IL17 was significantly increased in patients’ samples as compared to controls. According to IL4R genotypes, patients with AG and GG genotypes showed significantly higher IL17 levels than control subjects with corresponding genotypes. Within RA group, significantly higher IL17 were found in GG carriers compared to those with AA genotype. The G allele was significantly associated with higherythrocyte sedimentation rate(ESR), increased disease activity score in 28 joints (DAS28), highLarsen score and seropositive rheumatoid factor (RF) as well as C-reactive protein (CRP).Patients with AG and GG genotypes demonstrated significant positive correlations between serum IL17 and DAS28.Meanwhile, serum IL17 levels and Larsen score had significant positive correlation only in GG patients.The use of different treatment regimens did not affect serum IL17 levels significantly in various genotypes. In conclusion, IL17 may be implicated in the pathogenesis of RA, being associated with a higher disease activity parameters, however, its action may be potentiated due to loss of the functional IL4RA allele (rs1805010), particularly in carriers ofthe GG genotype. Furthermore, determining the genetic variants of IL4R rs1805010 may be promising for identification of patients at risk worse prognosis. Key words:Autoimmune disease; pro-inflammatory cytokines;IL4Rgenotypes

Consensus evidence-based recommendations for transition of care for adolescents with juvenile idiopathic arthritis: meeting patients’, parents’, and rheumatologists’ perspectives

Abstract Background Transition of care means the process of educating and empowering adolescents and young adults to take an active role in their own healthcare, develop decision-making skills, and eventually transition from paediatric to adult healthcare providers. Most people do not switch doctors until they are young adults, but it can be beneficial to start preparing children earlier. We aimed to develop a specific toolkit tailored to paediatric and adult rheumatologists to assist them in transitioning of care of young people with juvenile onset rheumatic musculoskeletal diseases from the paediatric to adult rheumatology care. Results The expert panel was confined to an online survey (n = 18), all the experts completed the two rounds. At the conclusion of round 2, a total of 10 points were gathered. The range of respondents (ranks 7–9) who agreed with the recommendations was 88.9 to 100%. All 10 clinical standards identified by the scientific committee were written in the same way. Based on the answers to the structured key questions and the literature review, a structured template was developed presenting transition of care integrated pathway. Conclusion The developed rheumatology-specific guideline offers adolescents and young adults a focussed, multidisciplinary transition of care approach with equity of access, quality of care and flexibility and set up standards for transitional care for young adults with juvenile rheumatological diseases

Defining Criteria for Disease Activity States in Systemic Juvenile Idiopathic Arthritis Based on the Systemic Juvenile Arthritis Disease Activity Score

Objective. Our objective was to develop and validate cutoff values in the systemic Juvenile Arthritis Disease Activity Score 10 (sJADAS10) that distinguish the states of inactive disease (ID), minimal disease activity (MDA), moderate disease activity (MoDA), and high disease activity (HDA) in children with systemic juvenile idiopathic arthritis, based on subjective disease state assessment by the treating pediatric rheumatologist. Methods. The cutoff definition cohort was composed of 400 patients enrolled at 30 pediatric rheumatology centers in 11 countries. Using the subjective physician rating as an external criterion, six methods were applied to identify the cutoffs: mapping, calculation of percentiles of cumulative score distribution, the Youden index, 90% specificity, maximum agreement, and receiver operating characteristic curve analysis. Sixty percent of the patients were assigned to the definition cohort, and 40% were assigned to the validation cohort. Cutoff validation was conducted by assessing discriminative ability. Results. The sJADAS10 cutoffs that separated ID from MDA, MDA from MoDA, and MoDA from HDA were &lt;= 2.9, &lt;= 10, and &gt;20.6, respectively. The cutoffs discriminated strongly among different levels of pain, between patients with and without morning stiffness, and among patients whose parents judged their disease status as remission or persistent activity or flare or were satisfied or not satisfied with current illness outcome. Conclusion. The sJADAS cutoffs revealed good metrologic properties in both definition and validation cohorts and are therefore suitable for use in clinical trials and routine practice