Assessment of blood clot formation and platelet receptor function ex vivo in patients with primary Sjogren's syndrome

OBJECTIVES

Primary Sjögren's syndrome (pSS) shares clinical features and pathogenetic mechanisms with systemic lupus erythematosus (SLE). SLE is associated with an increased thromboembolic risk; however, it is unclear whether pSS patients are susceptible to thromboembolic diseases. In this study, we examined ex vivo blood clot formation (clot strength, rates of clot formation and lysis) in pSS using thromboelastography (TEG) and platelet aggregation to common agonists using multiple electrode aggregometry (MEA). We also investigated the relationship between TEG/MEA parameters and clinical/laboratory features of pSS.

DESIGN

Case control.

SETTING

Secondary care, single centre.

PARTICIPANTS

34 pSS patients, 11 SLE patients and 13 healthy volunteers (all women) entered and completed the study.

PRIMARY OUTCOMES

TEG and MEA parameters between three subject groups.

SECONDARY OUTCOMES

The relationships between TEG/MEA and clinical/laboratory parameters analysed using bivariate correlation analysis with corrections for multiple testing.

RESULTS

All TEG and MEA parameters were similar for the three subject groups. After corrections for multiple testing, interleukin (IL)-1α and Macrophage inflammatory proteins (MIP)-1α remain correlated inversely with clot strength (r=-0.686, p=0.024 and r=-0.730, p=0.012, respectively) and overall coagulability (r=-0.640, p=0.048 and r=-0.648, p=0.048). Stepwise regression analysis revealed that several cytokines such as MIP-1α, IL-17a, IL-1α and Interferon (IFN)-γ may be key predictors of clot strength and overall coagulability in pSS.

CONCLUSIONS

Clot kinetics and platelet receptor function are normal in pSS. Several cytokines correlate with clot strength and overall coagulability in pSS.

Hyptis verticillata Jacq: a review of its traditional uses, phytochemistry, pharmacology and toxicology

ETHNOPHARMACOLOGICAL RELEVANCE

Hyptis verticillata Jacq. (Lamiaceae) (John Charles) is an important medicinal plant with a long history of traditional use, originating in Central America and now extending from Florida to Colombia and across the Caribbean. Records of its earliest use date back to the ancient Mayan and Aztec cultures of Mesoamerica. There is no indication that this plant is being used outside of the Americas.

AIM OF THE REVIEW

This review aims to provide a comprehensive overview of the traditional use, phytochemistry, pharmacological activity and toxicology of Hyptis verticillata and to highlight the opportunities for greater development of the plant's medicinal properties at a local and international level.

MATERIALS AND METHODS

An extensive and systematic review of the literature was undertaken and all relevant abstracts and full-text articles analysed and included in the review.

KEY FINDINGS

A wide range of traditional uses are cited in the literature, from internal uses for conditions affecting the respiratory system, digestive tract and gynaecological system to external uses for conditions affecting the skin and musculoskeletal system. Pharmacological studies to date have demonstrated significant activity which support the traditional use of the plant as an antiinflammatory, antimicrobial, antisecretory agent and hormone modulator. In addition studies have identified anti-cancer, acaricidal, insecticidal and molluscicidal activity. No clinical trials had been completed at the time of this review. A number of key phytochemicals have been isolated, identified and published to date including: 17 lignans; 4 triterpenes; 11 diterpenes, 3 sesquiterpenes, 3 monoterpenes, 2 flavonoids, 1 polyphenol and 1 alkaloid. Nine of these phytochemicals are novel to Hyptis verticillata. Plant extracts and isolated phytochemicals exhibit a broad range of activities that include: antimitotic; antiproliferative; cytotoxic; antioxidant; antiinflammatory; antibacterial; antifungal; antiviral; anti-HIV; antisecretory; hepatoprotective; insecticidal and acaricidal.

CONCLUSIONS

Hyptis verticillata is a medicinal plant with current widespread traditional use in the Americas that warrants further research, clinical trials and product development to fully exploit its medicinal value.

Medical student appraisal: searching on smartphones

BACKGROUND

The rapidly growing industry for mobile medical applications provides numerous smartphone resources designed for healthcare professionals. However, not all applications are equally useful in addressing the questions of early medical trainees.

METHODS

Three popular, free, mobile healthcare applications were evaluated along with a Google(TM) web search on both Apple(TM) and Android(TM) devices. Six medical students at a large academic hospital evaluated each application for a one-week period while on various clinical rotations.

RESULTS

Google(TM) was the most frequently used search method and presented multimedia resources but was inefficient for obtaining clinical management information. Epocrates(TM) Pill ID feature was praised for its clinical utility. Medscape(TM) had the highest satisfaction of search and excelled through interactive educational features. Micromedex(TM) offered both FDA and off-label dosing for drugs.

DISCUSSION

Google(TM) was the preferred search method for questions related to basic disease processes and multimedia resources, but was inadequate for clinical management. Caution should also be exercised when using Google(TM) in front of patients. Medscape(TM) was the most appealing application due to a broad scope of content and educational features relevant to medical trainees. Students should also be cognizant of how mobile technology may be perceived by their evaluators to avoid false impressions.

Primary Sjogrens syndrome is associated with impaired autonomic response to orthostasis and sympathetic failure

BACKGROUND

Symptoms in keeping with autonomic dysfunction are commonly described by primary Sjögrens syndrome patients (pSS); whether objective abnormalities of autonomic function occur is unclear. This study set out to explore dynamic cardiovascular autonomic responses in pSS and their relationship with symptoms and quality of life.

METHODS

Twenty-one people from the UK pSS registry, 21 community controls and 21 patients with the autoimmune liver disease primary biliary cirrhosis (PBC) (matched case-wise for age and sex) attended for assessment of autonomic responses to orthostasis and Valsalva manoeuvre (VM). pSS patients also completed EULAR Sjögrens Syndrome patient-reported index (ESSPRI), EULAR Sjögren's syndrome disease activity index (ESSDAI), fatigue impact scale and EURO-QOL 5-dimension (EQ-5D).

RESULTS

Compared with controls, pSS patients had significantly lower baseline systolic blood pressure (SBP) (114 ± 13 vs. 127 ± 20; P = 0.02), which dropped to a significantly lower value (98 ± 22 vs. 119 ± 24, P = 0.009). When area under the curve (AUC) was calculated for when the SBP was below baseline this was significantly greater in pSS compared to both control groups (pSS vs. control vs. PBC: 153 ± 236 vs. 92 ± 85 vs. 1.2 ± 0.3, P = 0.005). Peak phase IV SBP during the VM was significantly lower in pSS (P = 0.007) indicating early sympathetic failure. Increased heart rate associated with fatigue (P = 0.02; r(2) = 0.2) and EQ-5D. A shift in sympathetic-vagal balance associated with overall symptom burden (ESSPRI) (P = 0.04, r(2) = 0.3) and EULAR sicca score (P = 0.016; r(2) = 0.3), the latter also correlated with baroreceptor effectiveness (P = 0.03; r(2) = 0.2) and diastolic blood pressure variability (P = 0.003; r(2) = 0.4).

CONCLUSION

pSS patients have impaired blood pressure response to standing. Dysautonomia correlates with PSS-associated symptoms and quality of life.

The Colour Test for drug susceptibility testing of Mycobacterium tuberculosis strains

SETTING

Tartu, Estonia.

OBJECTIVE

To assess the performance and feasibility of the introduction of the thin-layer agar MDR/XDR-TB Colour Test (Colour Test) as a non-commercial method of drug susceptibility testing (DST).

DESIGN

The Colour Test combines the thin-layer agar technique with a simple colour-coded quadrant format, selective medium to reduce contamination and colorimetric indication of bacterial growth to simplify interpretation. DST patterns for isoniazid (INH), rifampicin (RMP) and ciprofloxacin (CFX) were determined using the Colour Test for 201 archived Mycobacterium tuberculosis isolates. Susceptibilities were compared to blinded DST results obtained routinely using the BACTEC™ Mycobacteria Growth Indicator Tube™ (MGIT) 960 to assess performance characteristics.

RESULTS

In all, 98% of the isolates produced interpretable results. The average time to positivity was 13 days, and all results were interpretable. The Colour Test detected drug resistance with 98% sensitivity for INH, RMP and CFX and 99% for multidrug-resistant tuberculosis. Specificities were respectively 100% (95%CI 82-100), 88% (95%CI 69-97) and 91% (95%CI 83-96) and 90% (95%CI 74-98). Agreement between the Colour Test and BACTEC MGIT 960 were respectively 98%, 96%, 94% and 97%.

CONCLUSION

The Colour Test could be an economical, accurate and simple technique for testing tuberculosis strains for drug resistance. As it requires little specialist equipment, it may be particularly useful in resource-constrained settings with growing drug resistance rates.