Development of additional autoimmune diseases in a multiethnic cohort of patients with systemic lupus erythematosus with reference to damage and mortality

OBJECTIVES

To determine the prevalence of other autoimmune diseases (AID) in black, Caucasian and South Asian patients with systemic lupus erythematosus (SLE) compared with the prevalence of these AID in the UK population, and to assess the impact of these additional AID on damage scores and mortality.

METHODS

The prevalence and chronology of development of additional AID in SLE patients was determined by case note review. Comparisons were made with prevalence data for AID in the general UK population. The impact of additional AID on mortality and damage scores at up to 10 years was determined in the index cases (patients who developed another AID either in the same year or within 5 years of onset of SLE) compared with controls matched for sex, age, ethnicity and year of onset of SLE.

RESULTS

There was no significant difference in the total number of AID that developed in patients from each ethnic group but differences in the frequency of some AID were noted. Mortality and damage scores were worse at 5 years in the study cases than the controls, particularly in the peripheral vascular category.

CONCLUSION

Patients with SLE might develop other AID that could complicate management of SLE by having an adverse impact on damage scores and mortality.

Comparative study of coronary collaterals in diabetic and nondiabetic patients by angiography

Myocardial ischaemia is known to be significantly related to the development of coronary collaterals, but there are considerable variations in their formation. The nature of this variability is not well understood. Likewise it remains unclear whether diabetes mellitus. DM has any effect on coronary collaterals. The aim of this study was to evaluate the effect of diabetes mellitus on coronary collaterals. This prospective case- control study was done from January to December 2000 in patients undergoing coronary angiography in National Institute of Cardiovascular Diseases (NICVD), Dhaka, who fulfilled the inclusion criteria of having < or = 75% stenosis in at least one coronary artery. The patients with diabetes having CAD without other modifiable major risk factors (hypertension, smoking, dyslipidaemia) were constituted case study group (n=36) and nondiabetic patients having CAD with those risk factors were constituted control group (n=50). Coronary collaterals were graded according to Rentrope scoring system and the collateral score was calculated by summing the Rentrope number of every patient. There was no statistical difference between patients with and without diabetes in clinical characteristics. The mean number of diseased vessel in DM group 2.6+/-0.6 was higher than that in nondiabetic patients (2.1+/-0.8, P>.05). The mean collateral score was 0.5+/-0.6 in DM group and 1.2+/-1.0 in nondiabetic group. These findings suggest that coronary collateral development is significantly poorer in diabetic than on diabetic patients.

Maternal depression increases infant risk of diarrhoeal illness: --a cohort study

AIMS

To examine the associations between postnatal depression in mothers and diarrhoeal illness in their infants in the first year of life in a low-income country.

METHODS

Using a prospective cohort design, 265 infants (n = 130 of mothers having a depressive episode according to the International Classification of Diseases, 10th revision, at 3 months postnatal and n = 135 of psychologically well mothers) living in rural Rawalpindi, Pakistan, were followed up for 1 year. Frequency of diarrhoeal episodes was measured fortnightly by health workers using a standard questionnaire.

RESULTS

Infants of depressed mothers had significantly more diarrhoeal episodes per year than those of controls (mean 5.5 v 4.0; 95% confidence interval (CI) 0.9 to 2.0). The relative risk of having > or =5 diarrhoeal episodes per year in infants of depressed mothers was 2.3 (95% CI 1.6 to 3.1). The association remained significant after adjustment for other risk factors by multivariate analysis.

CONCLUSIONS

Maternal depression is associated with infant diarrhoeal morbidity in a low-income community setting. It is independent of the effects of known factors such as undernutrition, socioeconomic status and parental education. Preventive child health programmes targeting mothers must consider their mental health.

Dietary factors and cognitive impairment in community-dwelling elderly

BACKGROUND

Diet may play a role in cognitive impairment.

OBJECTIVE

To examine the relationship between dietary factors and cognitive impairment.

DESIGN AND METHODS

All subjects (n=1056) were participants in the State-wide Survey of Alabama's Elderly (1986-87). Basic demographic information, Mental Status Questionnaire (MSQ) score, and dietary intake frequency of meat (pork, beef, lamb), fish, chicken or turkey, vegetables, fruit, milk, cheese, desserts, bread or cereal, and dried beans and peas were ascertained during an inhome interview.

RESULTS

Most participants were female (67%) and white (73%) with a mean age of 69 years (SD 8.9, min 55 max 94) and mean years of education of 10.7 (SD 3.8, min 1 max 18). Intake of cheese was found to be inversely associated with cognitive impairment in a simple logistic regression analysis, (OR = 0.59; 95% CI: 0.42, 0.84; p=0.003) and in a multiple logistic regression analysis (OR=0.68; 95% CI: 0.47, 0.99; p=0.04), after adjusting for basic socio-demographic factors and for other dietary factors. Increased frequency of cheese intake was associated with decreased cognitive impairment (p=0.0034). In the multiple logistic regression analysis bread or cereal (OR= 0.37, 95% CI: 0.14, 0.97; p=0.044) was inversely associated with, and dessert intake (OR= 1.70, 95% CI: 1.12, 2.59; p=0.013) positively associated with cognitive impairment.

CONCLUSION

Dietary intake of cheese is associated with a lower prevalence of cognitive impairment, with a dose-response effect, while intake of dessert is associated with a higher prevalence of cognitive impairment. Possible reasons for a potential protective effect of cheese ingestion are discussed.

Drowning--a major but neglected child health problem in rural Bangladesh: implications for low income countries

This study was intended to estimate the magnitude and explore the determinants of childhood drowning in rural Bangladesh. A cross-sectional survey as well as a population-based case - control study was conducted. By multistage cluster sampling 51 147 children aged 1 - 4 years were identified from 108 827 rural households. All drownings in children aged 1 - 4 years in the preceding 5 years were identified and recruited as cases and two living children of the same age group were selected from the same localities as controls. Socio-economic, demographic, environmental and other related information was collected from mothers of both cases and controls by face-to-face interview with the help of structured questionnaires. The incidence of drowning among children aged 1 - 4 years old was 156.4 per 100 000 children-year. The highest rate (328.1 per 100 000; 95% CI 254.8 - 421.7) was observed in 1 year old male children. The proportional mortality due to drowning in the children was 27.9%. Mothers' age and literacy and family income were identified as risk factors. Drowning is one of the major causes of 1 - 4 years childhood mortality in Bangladesh. One-year-old male children from poor families were at great risk of drowning in rural Bangladesh.

Mortality in systemic lupus erythematosus

OBJECTIVE

To examine mortality rates in the largest systemic lupus erythematosus (SLE) cohort ever assembled.

METHODS

Our sample was a multisite international SLE cohort (23 centers, 9,547 patients). Deaths were ascertained by vital statistics registry linkage. Standardized mortality ratio (SMR; ratio of deaths observed to deaths expected) estimates were calculated for all deaths and by cause. The effects of sex, age, SLE duration, race, and calendar-year periods were determined.

RESULTS

The overall SMR was 2.4 (95% confidence interval 2.3-2.5). Particularly high mortality was seen for circulatory disease, infections, renal disease, non-Hodgkin's lymphoma, and lung cancer. The highest SMR estimates were seen in patient groups characterized by female sex, younger age, SLE duration <1 year, or black/African American race. There was a dramatic decrease in total SMR estimates across calendar-year periods, which was demonstrable for specific causes including death due to infections and death due to renal disorders. However, the SMR due to circulatory diseases tended to increase slightly from the 1970s to the year 2001.

CONCLUSION

Our data from a very large multicenter international cohort emphasize what has been demonstrated previously in smaller samples. These results highlight the increased mortality rate in SLE patients compared with the general population, and they suggest particular risk associated with female sex, younger age, shorter SLE duration, and black/African American race. The risk for certain types of deaths, primarily related to lupus activity (such as renal disease), has decreased over time, while the risk for deaths due to circulatory disease does not appear to have diminished.

Mesotrione a new herbicide for weed control in maize

Six field trials were conducted over three growing seasons to evaluate both preand postemergence applications of the recently developed herbicide mesotrione for weed control in maize As a preemergence treatment it provided excellent control of broadleaf weeds (>99 reduction in dry matter) but was poor on grass weeds (ca 80 reduction) However its combination with atrazine smetolachlor or acetochlor provided gt;93 reduction in grass and broadleaf weed dry matter Applications of mesotrione postemergence were very effective on broadleaf weeds (>94) but less so on grass weeds (ca 85) although several adjuvant combinations improved the efficacy against annual grass weeds A number of herbicide combinations were demonstrated to be effective for postemergence weed control Mesotrione did not cause any apparent damage to maize crops in any trial and grain yields were not significantly different from the standard treatments Recommended rates for postemergence use of mesotrione will be 7296 g/ha depending on soil type

Prevalence and social correlates of postnatal depression in a low income country

BACKGROUND

Postnatal depression is an important public health problem worldwide. Recent evidence suggests that rates may be relatively higher in developing countries. We aimed to explore the prevalence of postnatal depression and its association with social support and other risk factors in a sample of Pakistani women.

METHODS

Population-based survey of 149 women at 12 weeks postnatal using the Edinburgh Postnatal Depression Scale (EPDS), Multidimensional Scale of Perceived Social Support (MSPSS) and Personal Information Questionnaire (PIQ).

RESULTS

Thirty six percent women scored > or =12 on EPDS. High depression score was associated with lower social support, increased stressful life events in the preceding year and higher levels of psychological distress in the antenatal period.

CONCLUSIONS

There is a high prevalence of postnatal depression in Pakistani women. Early interventions should be developed that target the antenatal period and strengthen social support networks in women at risk.

Radiological recanalization of an occluded anterior resection anastomosis

We present a case of occluded colorectal anastomosis following surgery for rectal tumor. Contrast enema and antegrade ileography confirmed occlusion by a thin membrane. This was thought amenable to needle puncture and placement of a temporary stent under fluoroscopy guidance, avoiding surgery and its associated morbidity. This provides a minimally invasive alternative to surgery and has only been reported once before.

A randomized trial of intravenous iloprost (a stable prostacyclin analogue) versus lumbar sympathectomy in the management of Buerger's disease

AIM

The aim of this study was to compare the effects of iloprost and lumbar sympathectomy (LS) in the treatment of Buerger's disease.

METHODS

Two hundred patients with rest pain and/or ischemic ulcers were randomized to undergo LS or 28-day intravenous treatment of iloprost. The primary endpoint was complete healing without pain or major amputation at 4 and 24 weeks. The secondary endpoints were analgesic requirement, reduction in the ulcer size, 50% reduction of the ulcer, and shift in the modified SVS/ISCVS clinical status grading scale.

RESULTS

The comparison was carried out in 162 patients (iloprost: n=84; LS: n=78). Complete healing rate was 61.9% in the iloprost group, but 41% in the LS group at the 4th week (P=0.012); respective values for the 24th week were 85.3%, 52.3%, P<0.001. Analgesic requirement was lower in the iloprost group at the 4th and 24th weeks (P=0.01, and P=0.098, respectively). The size of the ulcers decreased more in the iloprost group than the LS group (P=0.044 and P=0.035 at 4th and 24th weeks); 50% reduction in the ulcer size in the iloprost group was greater than in the LS group (P=0.001 and P=0.009 at 4th and 24th weeks). SVS/ISCVS grading scale demonstrated a better clinical benefit in patients treated with iloprost (P<0.001 at 4th week, and P<0.001 and at 24th week).

CONCLUSIONS

The results of this independent study indicate that using iloprost relieves ischemic symptoms better than LS. In the era of stable prostacyclin analogues, there is no reliable evidence to support the use of LS in Buerger's disease.

Long term outcome of birth asphyxiated infants

Fifty eight neonates who survived birth asphyxia were prospectively studied in the department of Paediatrics, Dhaka Medical College Hospital, to see the incidence of long term neurodevelopmental sequelae among them and also to identify possible risk factors. All of them had been admitted in the Neonatal Unit of this hospital and were born between July 1997 & December 1999. After discharge from the hospital, the study infants were followed up at the Child Neurology Clinic of this hospital. They were seen at 6 weeks. at 3 months & then every 3 months upto 2 years of age for evaluation of growth and development (age corrected for prematurity for preterm babies) 69% of them were boys and 31% were girls. 74% of the babies were inborn in the same hospital & the rest were out born. Prolonged labour (24%) and PET (18.96%) were the most common obstetric factors & respiratory distress (38%) and neonatal convulsion (35%) were the important neonatal complications. Of the 58 enlisted study cases, 30 (51.7%) responded to complete 2 years follow up and the rest were lost. Normal growth and developments were observed in 12 (40%) cases, 7 (23.33%) had mild handicap, 6 (20%) moderate & 5 (16.6%) were left with severe neurodevelopmental handicaps at 2 years of age. 61% of the handicapped children had suffered from neonatal seizure for varying periods. It may be concluded that the response to follow up unsatisfactory, the number of severe handicap was alarmingly high and post asphyxiated seizure was associated with poor outcome. So prevention of perinatal asphyxia should be targeted. Further long term follow up study is required.

Bioefficacy of some plant derivatives that protect grain against the pulse beetle, Callosobruchus maculatus

Experiments were conducted to study the bioefficacies of different plant/weed derivatives that affect the development of the pulse beetle, Callosobruchus maculates F. (Coleoptera: Bruchidae) fed on black gram, Vigna mungo, seeds. Plant extracts, powder, ash and oil from nishinda (Vitex negundo L.), eucalyptus (Eucalyptus globules Labill.), bankalmi (Ipomoea sepiaria K.), neem (Azadirachta indica L.), safflower (Carthamus tinctorius L.), sesame (Sesamum indicum L.) and bablah (Acacia arabica L.) were evaluated for their oviposition inhibition, surface protectant, residual toxicity and direct toxicity effects on C. maculates. The results showed that plant oils were effective in checking insect infestation. The least number of F(1) adults emerged from black gram seeds treated with neem oil. The nishinda oil extract was the most toxic of three extracts tested (nishinda, eucalyptus and bankalmi). Bablah ash was the most effective compared to the powdered leaves of nishinda, eucalyptus and bankalmi. The powdered leaves and extracts of nishinda, eucalyptus and bankalmi, at a 3% mixture, provided good protection for black gram seeds by reducing insect oviposition, F(1) adult emergence, and grain infestation rates. The oil treatment did not show adverse effects on germination capability of seeds, even after three months of treatment.

[Diabetic eye in children]

Diabetes mellitus is a new morbidity in children and adolescents. For pediatric patients, it announces the earlier onset of cardiovascular disease, retinopathy, nephropathy, and neuropathy, with the risk of impaired quality of life and premature death. The emergence of diabetes mellitus in young people is believed to be associated with changes in the level of physical activity and nutrition that are ubiquitous in modern society. The authors present a prospective study of 26 children with diabetes mellitus. The average age was 9.1 +/- 2.8 for boys and 12.6 +/- 3.7 for girls. The ophthalmologic disorders founded were: lens modifications in 7.7%, refractive errors in 34.6% and diabetic retinopathy in 11.5%. The study estimated the necessity of ophthalmologic screening for children with diabetes mellitus.

B cell depletion therapy in systemic lupus erythematosus: Effect on autoantibody and antimicrobial antibody profiles

OBJECTIVE

Autoantibody production in patients with systemic lupus erythematosus (SLE) is associated with abnormalities of B cell function and phenotype. Clinical responses to B cell depletion therapy (BCDT), based on rituximab, are encouraging. Therefore, we undertook this study to investigate the effect of BCDT on antibody profiles.

METHODS

Serial sera from 16 patients with active, refractory SLE were assayed for antinucleosome antibodies, anti-double-stranded DNA (anti-dsDNA), anti-extractable nuclear antigen, anti-tetanus toxoid, and antibodies to pneumococcal capsular polysaccharide for at least 1 year following BCDT. Anti-dsDNA antibodies derived from the V(H)4.34 immunoglobulin germ line gene (9G4+) were also measured.

RESULTS

All patients achieved peripheral B cell depletion and improved clinically for at least 3 months. Antinucleosome and anti-dsDNA antibodies decreased to a mean +/- SD of 64 +/- 37% and 38 +/- 33% of baseline values, respectively, by 6-8 months post-BCDT. Levels of other autoantibodies and antimicrobial antibodies were generally unchanged. In the 9 of 16 patients who were still well at 1 year, anti-dsDNA antibodies fell to 42 +/- 36% of baseline values at 6-8 months and to 37 +/- 33% at 10-14 months. In patients who had disease flares within 1 year of BCDT, levels of these antibodies decreased to 60 +/- 40% and 83 +/- 93% of baseline values at 6-8 months and at 10-14 months, respectively. Circulating anti-dsDNA antibodies were positive for 9G4 expression in 4 of 6 patients tested, and flares in 2 of these patients were accompanied by rises in 9G4+ anti-dsDNA antibodies.

CONCLUSION

These observations suggest that B cell clones committed to producing antinucleosome and anti-dsDNA antibodies, including the V(H)4.34 subpopulation of anti-dsDNA antibodies, have a relatively rapid turnover compared with B cell clones producing other antibodies. There was also a trend toward a greater and more sustained decrease in anti-dsDNA antibodies in patients with clinical benefit lasting >1 year.

Association of antinucleosome antibodies with disease flare in serologically active clinically quiescent patients with systemic lupus erythematosus

OBJECTIVE

To identify the prevalence of serologically active clinically quiescent (SACQ) patients in a cohort of 290 patients with systemic lupus erythematosus (SLE). We investigated if the presence of anti-double-stranded DNA (anti-dsDNA) or antinucleosome (anti-NCS) antibodies during the SACQ period was associated with future flares.

METHODS

SACQ patients defined as clinically inactive for 6 months (global British Isles Lupus Activity Group index [BILAG] scores <6) and serologically active (anti-dsDNA antibodies >50 units/ml on at least 2 occasions by enzyme-linked immunosorbent assay [ELISA]) were identified. Patient sera collected during the defined SACQ period were also tested for anti-NCS antibodies (ELISA). We retrospectively reviewed patient clinical details and episodes of flare using the BILAG activity index.

RESULTS

Twenty-seven (9%) patients were SACQ. Seventeen (81%) patients experienced a flare (total of 91 flares, up to 12 flares per person) in the next 5 years. Median duration to first flare was 15 months (range 2-46). Time to first flare after SACQ period was significantly correlated with the presence of anti-NCS (P = 0.0012), high anti-NCS antibody titers (P = 0.0006), and anti-dsDNA titers 5 times above the normal limit (P = 0.02). Patients with higher absolute anti-NCS antibody titers showed a significant correlation with the number of flares (r = 0.57, P = 0.007).

CONCLUSION

A minority of patients with SLE are SACQ. The majority of these patients experience a flare in the next 5 years and close followup is recommended. Anti-NCS antibodies may be a better predictor than anti-dsDNA antibodies for future flares.

A longitudinal study of the incidence of major endemic and epidemic diseases affecting semi-scavenging chickens reared under the Participatory Livestock Development Project areas in Bangladesh

A 17-month (from January 2002 to May 2003) longitudinal study was undertaken to elucidate the epidemiology of important endemic and epidemic diseases affecting semi-scavenging chickens reared in the Participatory Livestock Development Project area in Bangladesh. This project was implemented in 17 northern and north-central districts of Bangladesh, under which 361 839 rural poor people were assisted to undertake poultry-rearing activity as a tool of poverty reduction. Of the total beneficiaries 93% were "key rearers". A key rearer is defined as a beneficiary who generally rears 10 to 13 hens in a semi-scavenging system with little additional feed supply. Households of 650 key rearers and some chick rearers were observed. During the study period 1227 birds, which belonged to different age, breed and sex categories, were found dead as a result of disease occurrence. From every dead bird organ samples such as the liver, heart, spleen, brain lung, trachea and bursa of Fabricius were collected. The incidence rate of mortality was 0.01976 per bird-months at risk. Of the total deaths 58.44% had single or mixed type of infections. Newcastle disease had the highest proportional mortality rate (15.81%). The proportional mortality caused by fowlpox, fowl cholera, salmonellosis, colibacillosis, aspergillosis, infectious bursal disease, mixed infections and undiagnosed cases were 8.96%, 6.76%, 7.09%, 6.93%, 0.33%, 2.04%, 10.51% and 41.56%, respectively. Newcastle disease affected a significant higher proportion (18.81%) of birds older than 60 days of age (P=0.00). Younger birds (age < or = 60 days) had a higher proportional mortality due to fowlpox and infectious bursal disease than older birds (P=0.00). Sonali (male Rhode Island Red x female Fayoumi) birds reared under the semi-scavenging system had a higher infection rate with Newcastle disease virus compared with indigenous and Fayoumi birds (P=0.00). Fowlpox was more prevalent in Fayoumi birds compared with Sonali. Surprisingly, Newcastle disease was more common in the vaccinated birds rather than the unvaccinated birds.

Raised levels of interleukin 6 in systemic lupus erythematosus correlate with anaemia

OBJECTIVES

Raised levels of the cytokines interleukin (IL) 6 and IL10 have been reported in patients with systemic lupus erythematosus (SLE).

OBJECTIVE

To determine if levels of IL6 and IL10 correlate with organ/system-specific disease activity in SLE, using the British Isles Lupus Assessment Group (BILAG) Disease Activity Index.

METHODS

Levels of IL6 and IL10 in serum samples from 171 patients with SLE and 50 normal controls were determined by enzyme linked immunosorbent assay (ELISA). Levels of cytokines in individual patients with SLE were compared with the presence or absence of active disease in eight organ/systems using the BILAG index.

RESULTS

Levels of IL6 were significantly higher (p = 0.005) in patients with active compared with inactive haematological disease, as scored by the BILAG index. Further analysis showed that this association was dependent on an inverse correlation (p = 0.002, r = -0.26) between IL6 levels and haemoglobin levels in patients with SLE. In contrast, IL10 levels did not correlate with individual organ/system disease activity.

CONCLUSIONS

Raised levels of IL6 in SLE may influence the development of anaemia in this disease. These findings are in agreement with an increasing number of studies, which support physiological links between IL6 and anaemia. Importantly, with the exception of the haematological system, our studies do not provide evidence of any individual organ/system which would respond to therapeutic manipulation of either IL6 or IL10 levels.

An international cohort study of cancer in systemic lupus erythematosus

OBJECTIVE

There is increasing evidence in support of an association between systemic lupus erythematosus (SLE) and malignancy, but in earlier studies the association could not be quantified precisely. The present study was undertaken to ascertain the incidence of cancer in SLE patients, compared with that in the general population.

METHODS

We assembled a multisite (23 centers) international cohort of patients diagnosed as having SLE. Patients at each center were linked to regional tumor registries to determine cancer occurrence. Standardized incidence ratios (SIRs) were calculated as the ratio of observed to expected cancers. Cancers expected were determined by multiplying person-years in the cohort by the geographically matched age, sex, and calendar year-specific cancer rates, and summing over all person-years.

RESULTS

The 9,547 patients from 23 centers were observed for a total of 76,948 patient-years, with an average followup of 8 years. Within the observation interval, 431 cancers occurred. The data confirmed an increased risk of cancer among patients with SLE. For all cancers combined, the SIR estimate was 1.15 (95% confidence interval [95% CI] 1.05-1.27), for all hematologic malignancies, it was 2.75 (95% CI 2.13-3.49), and for non-Hodgkin's lymphoma, it was 3.64 (95% CI 2.63-4.93). The data also suggested an increased risk of lung cancer (SIR 1.37; 95% CI 1.05-1.76), and hepatobiliary cancer (SIR 2.60; 95% CI 1.25, 4.78).

CONCLUSION

These results support the notion of an association between SLE and cancer and more precisely define the risk of non-Hodgkin's lymphoma in SLE. It is not yet known whether this association is mediated by genetic factors or exogenous exposures.

PP2B isolated from human brain preferentially dephosphorylates Ser-262 and Ser-396 of the Alzheimer disease abnormally hyperphosphorylated tau

PP2B is one of the major serine/threonine phosphatases in the brain. We quantitated the dephosphorylation of various sites of Alzheimer disease abnormally hyperphosphorylated tau by PP2B purified from six (three Alzheimer and three control) autopsied human brains. The purified PP2B was essentially homogenous holoenzyme as determined by SDS-PAGE, Western blot analyses and biochemical characterization. Purified PP2B from all six brains efficiently dephosphorylated (32)P-tau with specific activities ranging from 684-1286 pmol (32)Pi/mg/min. Estimated by dot-blot analyses, the purified PP2B (on average from six brains) dephosphorylated Alzheimer tau at pS199, pT217, pS262, pS396 and pS422 by 38%, 32%, 63%, 78%, and 32%, respectively. Dephosphorylation of tau at pT181, pS202, pT205, pT212, pS214, and pS404 by PP2B was undetectable. The preferential dephosphorylation of Ser262 and Ser396 by PP2B suggests a possible involvement of this phosphatase in Alzheimer neurofibrillary degeneration.