Serum serotonin in rheumatoid arthritis patients: Relation to rheumatoid factor positivity, clinical manifestations and fibromyalgia

Aim of the work: To estimate serum level of serotonin in rheumatoid arthritis (RA) patients and study its relation with various clinical data, radiographic scores and fibromyalgia. Patients and methods: This study involved eighty RA patients divided equally according to rheumatoid factor (RF) positivity. Modified Health Assessment Questionnaire, disease activity score in 28-joints (DAS 28), visual analogue scale of pain, Short Form Health Survey for mental and physical health, fibromyalgia questionnaire, RA Articular Damage score and radiological joint damage by van der Heijde modification were assessed. Serum level for serotonin was measured for all patients. Results: The mean age of seronegative patients was 41.7 ± 10.7 years; 36 females and 4 males and of seropositive (44.9 ± 12.9 years and were 34 females and 6 males). Serum serotonin level was high in RA patients compared to control (129.8 ± 99.1 ng/ml vs 79.6 ± 54.5 ng/ml respectively, p = 0.001). Serum serotonin was higher in seropositive than seronegative (155.9 ± 93.2 vs 101.5 ± 99.4 ng/ml respectively, p = 0.007). Fibromyalgia syndrome (FMS) was associated with a significant lower serotonin level in both groups (p < 0.005). High serotonin level was associated with combined disease modifying antirheumatic drugs (p = 0.04) in seronegative patients. A lower serotonin level was associated with corticosteroids administration and dry eye (p = 0.03, p = 0.004 respectively) in seropositive cases. A significant correlation was present between serotonin level with erythrocyte sedimentation rate, vitality energy and mental health (r = 0.4, p < 0.05) in seropositive patients. Conclusion: Serum serotonin level was high in RA, especially in seropositive patients. It demonstrated central antidepressant and peripheral pro-inflammatory role. The SSRI could be of benefit only in RA with FMS. Keywords: Rheumatoid arthritis, Serotonin, Rheumatoid factor positivity, Fibromyalgi

Atherosclerosis biomarkers in female systemic lupus erythematosus patients with and without cardiovascular diseases

Background: Cardiovascular diseases (CVD) and atherosclerosis are over presented in patients with systemic lupus erythematosus (SLE). Aim of the work: The aim of this study is to determine the frequency of some atherosclerosis biomarkers in SLE patients with and without CVD compared with controls. Patients and methods: 28 female SLE patients with a mean age of 30.1 ± 7.2 years and a history of CVD (SLE cases) were compared with 25 age matched SLE female patients but without a history of CVD (SLE controls) and 25 age matched population based control women (population controls). Intima, media thickness (IMT) was measured by B-mode ultrasound as a potential measure of atherosclerosis. Nontraditional biomarkers of atherosclerosis such as leptin, oxidized LDL (oxLDL) and homocysteine were also investigated. Results: SLE cases had significantly increased IMT compared with SLE controls and population controls (p < 0.001), whereas IMT of SLE controls did not differ from population controls. Compared to SLE controls, SLE cases had raised circulating levels of leptin (p < 0.001), homocysteine, dyslipidemia with raised triglycerides (p < 0.001), decreased HDL-cholesterol concentration, (p < 0.001), lupus anticoagulants (p = 0.01), and higher cumulative prednisone dose (p = 0.4). Disease duration was comparable between the two SLE groups and the blood pressure and body mass index (BMI) were similar among the 3 groups. Conclusion: A set of distinct CVD risk factors (biomarkers of atherosclerosis) separate SLE cases from SLE controls and normal population controls. If confirmed in a prospective study, they could be used to identify SLE patients at high risk of CVD in order to optimize treatment

Adipose Tissue-Derived Mesenchymal Stem Cell Modulates the Immune Response of Allergic Rhinitis in a Rat Model

This study was designed to investigate the potential effects and underlying mechanism of adipose tissue-derived mesenchymal stem cells (MSCs) on allergic inflammation compared to Montelukast as an antileukotriene drug in a rat model of allergic rhinitis (AR). The effect of MSCs was evaluated in albino rats that were randomly divided into four (control, AR, AR + Montelukast, and AR + MSCs) groups. Rats of AR group were sensitized by ovalbumin (OVA) and then challenged with daily nasal drops of OVA diluted in sterile physiological saline (50 &#956;L/nostril, 100 mg/mL, 10% OVA) from day 15 to day 21 of treatment with/without Montelukast (1 h before each challenge) or MSCs I/P injection (1 &#215; 106 MCSs; weekly for three constitutive weeks). Both Montelukast and MSCs treatment started from day 15 of the experiment. At the end of the 5th week, blood samples were collected from all rats for immunological assays, histological, and molecular biology examinations. Both oral Montelukast and intraperitoneal injection of MSCs significantly reduced allergic symptoms and OVA-specific immunoglobulin E (IgE), IgG1, IgG2a and histamine as well as increasing prostaglandin E2 (PGE2). Further analysis revealed that induction of nasal innate cytokines, such as interleukin (IL)-4 and TNF-&#945;; and chemokines, such as CCL11 and vascular cell adhesion molecule-1 (VCAM-1), were suppressed; and transforming growth factor-&#946; (TGF-&#946;) was up-regulated in Montelukast and MSCs-treated groups with superior effect to MSCs, which explained their underlying mechanism. In addition, the adipose tissue-derived MSCs-treated group had more restoring effects on nasal mucosa structure demonstrated by electron microscopical examination

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research