Beyond the symptoms: Personalizing giant cell arteritis care through multidimensional patient reported outcome measure

BACKGROUND

Giant Cell Arteritis (GCA) is the commonest form of systemic vasculitis in people over the age of 50. Published research highlighted the lack of a disease-specific patient reported outcomes (PROMs) for GCA.

OBJECTIVES

To assess the validity, reliability and responsiveness to change of a devised disease specific patient self-reported outcome measures questionnaire for Giant Cell Arteritis (GCA).

METHODS

The GCA-PROMs was conceptualized based on frameworks outlined in the OMERACT developed core set of Outcome Measures for Large-Vessel Vasculitis and the guiding principles of the FDA guidance. Initially, cognitive interviews were conducted to identify item pool of questions. Item selection and reduction was achieved based on patients as well as an interdisciplinary group of specialists. Rasch and internal consistency reliability analyses were implemented.

RESULTS

A total of 54 GCA patients completed the questionnaire. The GCA-PROMs questionnaire was reliable as demonstrated by a high standardized alpha (0.878-0.983). Content construct assessment of the GCA-PROMs functional disability and QoL revealed significant correlation (p< 0.01) with both HAQ and EQ-5D. Changes in functional disability, QoL showed significant (p< 0.01) variation with diseases activity status in response to therapy.

CONCLUSIONS

The developed GCA-PROMs questionnaire is a reliable and valid instrument for assessment of GCA patients. A stratified treatment regimen depending on the individual patient's risk factors as well as preferences and associated comorbidities is the best approach to tailored patient management.

POS1288 TREAT TO TARGET MANAGEMENT OF FIBROMYALGIA: EVIDENCE-BASED CONSENSUS ON CLINICAL PRACTICE GUIDELINES

Background

Because of the subjective character of symptoms, absence of a diagnostic test, modest response to treatments, and at times, patient reports of important functional disability, fibromyalgia remains a challenge for the treating health care professionals in the standard clinical practice.

Objectives

To develop an up to date consensus, evidence-based clinical practice guidelines for treat to target management of fibromyalgia.

Methods

15 key clinical questions were identified by a scientific committee according to the Patient/ Population, Intervention, Comparison, and Outcomes (PICO) approach. A literature review team performed a systematic review to summarize evidence advocating the benefits and harms of available pharmacologic and nonpharmacologic therapies for fibromyalgia. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A 3-round Delphi process was conducted with 16 experts. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations.

Results

An online questionnaire were sent to expert panel who participated in the three rounds (response rate 100%). At the end of round 3, a total of fifteen recommendation items, categorized into 10 sections to address the main fibromyalgia categories, were obtained. Agreement with the recommendations (rank 7-9) ranged from 85-100%. Consensus was reached (i.e.≥80%of respondents strongly agreed or agreed) on the wording of all the 15 clinical standards identified by the scientific committee. Algorithm for the management of fibromyalgia have been suggested.

Conclusion

These recommendations provide an updated consensus on both the non-pharmacological as well as the pharmacological treatment of fibromyalgia. The provide strategies to reach optimal treat to target outcomes in common clinical scenarios, based on a combination of evidence and expert opinion. Best treatment decisions should be tailored to each individual patient situation.

Disclosure of Interests

None declared

AB0908 Treating to target of psoriasis: An evidence-based consensus on clinical practice recommendations

Background

The Tight Control of psoriatic arthritis (TICOPA) trial revealed a treat to target (T2T) strategy has led to improved clinical outcomes in psoriatic arthritis (PsA). The heterogeneity of the disease, the feasibility of therapy and the associated comorbidities made the implementation of such strategy in routine care a real challenge. There is a high need for establish real world recommendations for the T2T approach in PsA tailored to the disease activity status, the Psoriasis manifestations as well as the individual patient’s requirements.

Objectives

to provide up-to-date, evidence-based and consensus-based recommendations for Treat-to-Target management of psoriatic arthritis (PsA) and its associated clinical manifestations.

Methods

14 key clinical questions were identified by scientific committee according to the Patient/ Population, Intervention, Comparison, Outcomes and Timing (PICOT) approach. Literature Review team performed a systematic review to summarize evidence advocating the benefits and harms of available pharmacologic and nonpharmacologic therapies for PsA. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A 3-round Delphi process was conducted with 19 experts. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations.

Results

An online questionnaire were sent to expert panel who participated in the three rounds (response rate 100%). At the end of round 3, a total of fifty-one recommendation items, categorized into 6 sections to address the main 6 PsA categories, were obtained. Agreement with the recommendations (rank 7-9) ranged from 89.5-100%. Consensus was reached (i.e.≥75%of respondents strongly agreed or agreed) on the wording of all the 51 clinical standards identified by the scientific committee. Algorithms for the management of PsA have been suggested.

Conclusion

These recommendations provide an updated consensus on the pharmacological treatment of PsA and strategies to reach optimal treat to target outcomes in in common clinical scenarios, based on a combination of evidence and expert opinion. Best treatment decisions should be tailored to each individual patient situation.

Disclosure of Interests

None declared

POS1168 TREAT TO TARGET OF GOUT: AN EVIDENCE-BASED CONSENSUS ON CLINICAL PRACTICE GUIDELINES

Background

New therapies, management approaches and evidence regarding the management of gout have become available over the past years. This triggered the need for updated recommendations for the management of gout.

Objectives

to develop an up-to-date consensus evidence-based clinical practice guideline for the management of gout including recommendations for management of acute gout flares, optimum usage of urate lowering therapy for chronic gout as well as patient education and lifestyle guidance.

Methods

An extensive systematic literature review was performed, and evidence-based recommendations were extrapolated, based on 16-key questions identified according to population, intervention, comparator, and outcomes (PICO) approach. For each item, the level of evidence was determined using the Oxford Centre for Evidence-based Medicine (CEBM) system. These were evaluated by a panel of 17-experts via online surveys over a 2-round Delphi process.

Results

At the end of round 2, a total of 30-recommendation items, categorized into 10 domains to were obtained. Agreement with the recommendations (rank 7-9) ranged from 90-100%. Consensus was reached (i.e.≥75%of respondents strongly agreed or agreed) on the wording, the grade of recommendation and level of evidence of all the 30 clinical standards identified by the scientific committee. The guideline emphasized that all gouty patients should be screened for comorbidities. Based on this, an algorithm for treat to target management approach tailored to the individual patient’s needs and associated comorbidities has been outlined.

Conclusion

This work provides updated evidence-based recommendations for the prevention and treatment of acute as well as chronic gouty arthritis. It provides an approach for physicians and patients making decisions on the management of gout. It will also facilitate improvement and uniformity of care.

Disclosure of Interests

None declared

Effects of Solanum lycopersicum L. (tomato) against isoniazid and rifampicin induced hepatotoxicity in wistar albino rats

Anti-tuberculosis drugs are reported to cause hepatotoxicity, which varies from asymptomatic rise of the hepatic enzymes. Hepatoprotective plants plays important role to protect liver. This study investigated the hepatoprotective potential of the Solanum lycopersicum in rats intoxicated with Isoniazid and Rifampicin (INH+RIF) to induce hepatotoxicity. Thirty wistar albino rats were divided into five groups of six animals each. Group 1 rats were kept control while groups II, III, IV and V were administered with INH+RIF (75+150 mg/kg) orally, for seven consecutive days. For treatment, rats in group III received silymarin while animals in group IV and V were provided with 40 mg/kg and 80 mg/kg of Solanum lycopersicum extract, respectively. On day 0 and 8th blood samples were collected for the analysis of hepatic biomarkers. The data were subjected to one-way ANOVA and Bonferroni's post hoc test for statistical analysis. Hepatotoxicity induced by INH+RIF resulted in significant elevation of serum hepatic enzymes including Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Alkaline phosphatase (ALP), and total bilirubin while decreased the albumin level. The Solanum lycopersicum at dose of 80 mg/kg significantly reduced the hepatic enzymes AST, ALT, ALP and bilirubin while the albumin level was significantly increased. The treatment had non-significant effect on body and liver weight. Drug induced hepatotoxicity can be effectively treated with Solanum lycopersicum at 80 mg/kg dose.

Evaluation of methanolic crude extract of Linum usitatissimum for the removal of biofilm in diabetic foot isolates

Linum usitatissimum L is a widely used traditionally for multiple ailments. The present research was carried out to explore the antimicrobial, and anti-biofilm activity of crude extract of Linum usitatissimum L (Lu. Cr). Phytochemical and proximate analyses were performed. The bandages of diabetic foot patients were collected from the various hospitals. The bandages were cultured to isolate the bacterial strains present on it. The disc diffusion method was used to identify the antimicrobial potential whereas the minimum inhibitory concentration of the Lu.Cr were also determined. Proximate analysis confirms moisture content 8.33%, ash content 4.33%, crude protein 21.20%, crude fat 49.2% and crude fiber 5.63%. It was revealed that Gram-positive bacteria are most prevalent among all study groups. Lu.Cr possess significant bactericidal potential against S. aureus among all other microbes. Owing to this potential, linseed coated bandages can be used alternatively for the treatment of diabetic foot.

POS1104 THE DEVELOPMENT AND VALIDATION OF A RISK STRATIFICATION QUESTIONNAIRE TO SCREEN FOR MEDICATION RELATED OSTEONECROSIS OF THE JAW RISK IN OSTEOPOROTIC PATIENTS

Background:

Given the gaps in knowledge that exist in relation to risk stratification for osteonecrosis of the jaw (ONJ) amongst patients treated with anti-resorptive agents, there is a high need for an evidence-based measure which would facilitate the identification of those patients at higher risk of ONJ development; particularly, most of the available advice is empirically based.

Objectives:

to develop a valid self-administered questionnaire to facilitate risk stratification and risk minimisation of medication related ONJ in osteoporotic patients treated with anti-resorptive agents.

Methods:

Development of ONJ risk assessment questionnaire (ONRAQ) followed 5 stages: 1. Review of the literature to Identify the risk factors associated with medication related ONJ. 2. Item pool development: a list of the main risk factors was compiled. Rare or uncommon factors were excluded. 3. A questionnaire was developed. This was based on the idea that the questions should be straight forward and as clear as possible. 4. Pre-testing of the questionnaire. 5. Validation of the questionnaire by comparing the patients answers with their medical records. Patients at risk were advised to seek dental assessment and the dental report was evaluated. The last prescription was reviewed to verify the current medications. 157 patients were invited to participate and were prospectively monitored for 5-years to assess for the incidence of medication related ONJ. Advice was given regarding how to maintain good dental hygiene to prevent dental disease and to ensure that any dental interventions that are considered necessary are carried out as conservative and preservative as possible. Comprehensibility of the model sections was also assessed.

Results:

Stages 1 and 2 identified the risk factors chosen for the questionnaire. These risk factors were stratified into 4 sections: Personal, Dental and oral health, current medications and associated comorbidities. Stage 3 led to the development of the 27 items questionnaire. Personal: 3 risk factors (age, elevated BMI and smoking), Dental and oral health (11 risk factors), current medications (3 risk factors) and associated comorbidities (10 risk factors). Analysis of the answers provided by 126 patients, who completed the study, age range 58-82 years revealed that the mean time to answer the questionnaire was 1.9 + 0.153 minutes. The ONRAQ has shown a strong validity when compared to the patients’ data record (range 0.89-0.97). All patients rated the questionnaire as easily comprehensible. Comprehensibility of the various questionnaire sections ranged between 96.1% and 98.2% denoting that all the questions were well understood by the great majority of patients. 11/126 (8.7%) had a dental procedure in the past 6-months, 13/126 (10.3%) were advised to stop smoking. Whereas 20/126 (20.6%) had associated comorbidities. Risk stratification led to the advice to start oral bisphosphonates/ denosumab rather than IV zoledronate for patients at moderate risk (comorbidities, personal, medication). Treatment was postponed till complete healing for those with recent history of invasive dental procedure (high risk). No ONJ was identified after 5-years of follow up.

Conclusion:

Results of this questionnaire revealed that the ONRAQ is valid screening questionnaire. It can be implemented, as a risk minimisation measure, in standard practice. The questionnaire was able to identify patients at risk of developing medication related osteonecrosis of the jaw and facilitate the prospective risk management of ONJ.

Disclosure of Interests:

None declared.

Reversibility of heart block after congenital heart surgeries in pediatrics, is it predictable?

Funding Acknowledgements

Type of funding sources: None.

Background

 

AV block is a serious complication of congenital heart diseases(CHD) repair surgeries.it is associated with an increased mortality and morbidity.

Purpose : 

Identifying the incidence of Complete Heart Block (CHB) after heart surgeries for CHD, analyzing the patients` specifications and procedural data to evaluate the potential correlations that contribute the HB postoperatively.

Patients and methods : 

We enrolled all patients who underwent CHD surgeries from September 2014 till February 2020 and identified the patients who developed postoperative CHB, those patients  were divided into two groups, (a group who developed transient  CHB  and those who developed permanent CHB which required implantation  of permanent pacemaker (PPM).

We defined the transient HB as the recovery from  an advanced second or third degree HB after the surgery within 10days .  

And the presence of advanced second or third degree HB persisting for more than 10 days after cardiac surgery is considered a permanent HB and indicated  for PPM implantation according to current guidelines .

Results :  

Our cohort includes 2377 CHD surgeries, 46 % female patients, median weight was 12.06 kg at the time of the operation, median height was 85 cm. 

Mean age at the time of the operation was 2.7 years in the cohort with transient HB while it was 2.6 years  in the cohort who received PPM.

Incidence of HB following those surgeries was 3 %(72) patients, 1.8 %of the patients (43)  had transient HB  and 1.2% of the patients (21 ) received a PPM. 

Recovery from HB was within 7days in 35 patients (82%),Two out of the 43 patients who had transient HB ended up with late onset CHB requiring pacing representing 4.6 % of that cohort, one after one month of recovery and the other one after 11 years from the surgery despite they restored their sinus rhythm within 6 days and 10 days respectively. 

We found the highest incidence of postoperative HB associated with VSDs surgeries either isolated or with other complex CHD diseases followed by TOF with no significant difference between transient and permanent groups according to the type of surgery. 

The duration of preoperative PR interval suggested the incidence of permanent  CHB postoperatively with a P value of 0.005

We found that gender, age, weight and height didn`t affect the outcome, preoperative heart rate and preoperative medications didn`t alter the prognosis, the duration of CBP time and the clamping time were of no statistical significance between the 2 groups with P value of ( 0.38 and 0.33 ). 

Conclusion : 

Incidence of CHB post CHD surgeries in our center is 3 %, only 1.2 % required PPM. 

Various clinical data , ECG criteria , procedural time and duration of the HB except for the preoperative PR interval  failed to prove a significant correlation with the incidence of CHB necessitating further investigation to identify the specific risk factors for such complication. Abstract Figure. Incidence of CHB with various surgeries

774 Primary vs Deferred Ureteroscopies In Stone Management-Quality and Cost Evaluation

Introduction

To investigate quality and cost benefits of primary ureteroscopies (URS) compared to deferred URS after initial ureteric stenting in patients presenting with urolithiasis.

Method

This was one-year, retrospective study, carried out to evaluate quality and cost benefits of primary URS in comparison to deferred URS after initial stenting. 85 patients underwent emergency stenting while as 148 patients underwent elective URS (Including both primary as well as deferred URS). The quality assessment was based on patient factors -including number of procedures, days spent at hospital, days off work and expertise of person operating. Cost analysis included hospital stay expenses and income loss due to off work.

Results

Study revealed the average stay of patients who had a stent inserted on index admission was 2.54 days compared to 1.35 in patients who underwent primary URS during index admission. Overall, additional expenditure in patients who did not undergo primary URS was in the range of £ 1800 for hospital alone, excluding loss of work for patients, who needed to return for multiple procedures.

Conclusions

We conclude approach of primary URS and management of stone in index admission in stone management is very effective in both improving quality of patients as well as bringing down cost.

Seroprevalence of Toxoplasma gondii and associated hematological alterations in small ruminants of D.G. Khan district of Southern Punjab, Pakistan

ABSTRACT The present study was carried out to evaluate the prevalence and hematological effects of Toxoplasma gondii in sheep and goat in district Dera Ghazi Khan. Blood samples (n=204) were collected comprise goats (n=101) and sheep (n=103) alongwith age, gender and breeds of animals. Samples were collected randomly from 25 flocks of 7 different union council Viz. Vehova, Tibbi Qaisrani, Lakhani, Kohar, Tuman Qaisrani, Nutkani and Kot Qaisrani of Tehsil Taunsa Sharif at least 4 animals from each flock. All ruminants divide into three groups based on age, breed and gender. The prevalence was detected through two different kits Viz. LAT and ELISA kit. The overall prevalence suspected in goats through LAT and ELISA kit was (35.64%), (32.67%) and in sheep was (25.24%), (23.30%) respectively. The Toxoplasma gondii had a significant effect on goats in age groups and non-significant all other groups of goats and sheep. Toxoplasma gondii had a significant effect on all hematological parameters like Hemoglobin, total leukocyte cells, granulocytes, lymphocytes, platelets, and red blood cells, except monocytes. In conclusion of the current study, toxoplasmosis is prevalent among ruminants, reveals the possibility of transmission to humans on the use of host animals as protein source.

OP0313 THERAPEUTIC APPROACHES TO OSTEOSARCOPENIA: DENOSUMAB EFFECT ON FALLS RISK, PHYSICAL PERFORMANCE AND WALKING SPEED

Background:

There is a strong association between osteoporosis and skeletal muscle dysfunction. Heparan-sulfate proteoglycans are abundant in skeletal muscles and may represent a target for RANKL inhibitor. It was noted that patients who completed their planned denosumab therapy course (5-years) started to sustain falls.

Objectives:

To assess the effect of Denosumab on falls risk, physical performance, grip strength and gait speed and whether there is a relation with bone mineral density.

Methods:

127 osteoporotic patients treated with denosumab were assessed prior to starting denosumab therapy for: baseline BMD using DXA scan, blood test for osteoporosis bone profile, self-reported falls risk using (FRAS score [1]), fracture risk using FRAX, handgrip strength using a calibrated dynamometer (the best of three trials of the dynamometer testing was recorded), the patient’s physical performance assessed by testing for: Short Physical Performance Battery (SPPB), Timed Up and Go (TUG), and the 4 Meter Walk Gait Speed. Same measures were assessed again after completing 5-years of denosumab therapy. Comparison groups included 112 patients diagnosed to have osteoporosis and treated with zoledronate (Zol), once yearly IV injection, for 3-years; and 134 patients treated with once weekly oral alendronate (Aln) 70mg for 5-years. The patients were assessed for the same parameters as in the denosumab therapy. All the measures were reassessed 1-year after stopping the osteoporosis therapy.

Results:

No differences were seen on comparing the baseline parameters of the 3 groups. In comparison to the baseline, there was significant increase in the BMD in the 3 groups, Denosumab /Zol/Aln at both spine and hip (P = 0.02) at 5-, 3- and 5-years of treatment respectively. In the denosumab group, at 5-years of therapy, there was significant decrease in falls risk score (-1.4, 95% CI = −2.8 to −0.7; P = .01), significant improvements in the grip strength (+4.2Kg, P = 0.01), SPPB score (1.2 points; 95% CI = −0.07 to 2.2; P = .02), TUG (1.7 seconds; 95% CI = −2.2 to 0.1; P = .031) and gait speed (0.1 m/s; 95% CI = 0.03-0.2; P = .01). Zol and Aln improved significantly SPPB score (0.9 and 0.8 points; P = .04), TUG (1.4 and 1.3 seconds; P = .05) and gait speed (0.2 and 0.3 m/s; P = .02) respectively, however, there was no significant change in the falls risk (p = 0.06 and 0.07 respectively). 1-year after stopping Denosumab, there was significant worsening of the falls risk score, grip strength, SPPB score, TUG and gait speed (P = 0.1). There was no difference in all the measures 1-year after stopping Zol and Aln. There was no relation to the increase in BMD gained.

Conclusion:

Denosumab displayed positive impact and significant improvements in physical performance, grip strength and gait speed. Also, Denosumab, enhanced multidirectional agility as depicted by TUG. Collectively, this would explain the reduction of falls risk which got worse on stopping the medication.

Osteoporosis and sarcopenia share similar risk factors, highlighting muscle-bone interactions, which may result in debilitating consequences, such as falls and fractures. RANK/RANKL/OPG pathway, a key regulator of bone homeostasis, may contribute also to the regulation of skeletal muscle integrity and function.

References:

[1]El Miedany et al. Falls Risk Assessment Score (FRAS). J Clin Gerontology and Geriatrics 2011; 21-26.

Acknowledgments:

Ali El Miedany for his help in data entry

Disclosure of Interests:

None declared

Isolation and Molecular Identification of Microsporidian Pathogen Causing Nosemosis in Muga Silkworm, Antheraea assamensis Helfer (Lepidoptera: Saturniidae)

Microsporidia are intracellular fungal parasites and they are the most common pathogens for sericulture. Microsporidian sp. can cause pebrine, a dreadful disease and lead to destructive disorder in Muga silkworm, Antheraea assamensis Helfer by vertical and horizontal transmission. This disease is the key factor obstructing the developmental progress of Muga culture in India. Nevertheless, molecular identification and characterization of pathogen associated with pebrine disease in A. assamensis is not yet established. Insect bioassay studies revealed that microsporidian infection in Muga silkworm, A. assamensis Helfer significantly reduced (P < 0.005) cocoon weight, pupal weight, shell weight and silk ratios. A new set of PCR primers suitable for amplification of small subunit ribosomal RNA (SSU-rRNA) of microsporidia infecting A. assamensis have been designed. The amplicon was cloned, sequenced and analysed. Microsporidia pathogen of wild silk moth A. assamensis has been identified at genus level as Nosema sp. AA1. Phylogeny of Nosema sp. AA1 was constructed on the basis of SSU-rRNA sequence and it has a close evolutionary relationship with microsporidian pathogens of other wild silkmoths. The arrangement and organization of the rRNA genes inferred that Nosema sp. AA1 belongs to true Nosema group and not to members of the Nosema/Vairimorpha group.

The Duality of Kupffer Cell Responses in Liver Metabolic States

Kupffer cells (KCs) are vital innate immune system cells in the liver that participate in various metabolic states. Although several studies have directly evaluated the role of KCs in different metabolic situations in the liver, the definite characteristics of KCs remain unknown. KC depletion techniques are used to determine the functions of KCs under metabolic challenges; however, there is debate about their precise role even after successful ablation. While some KC ablation studies showed improvement in insulin resistance, fatty liver and metabolic parameters, other reports, under the similar conditions, have not. Some studies have rationalized the KCs dual actions in liver metabolic states by arguing their M1 and M2 biases. Activated M1 KCs secrete pro-inflammatory cytokines, growth factors and other mediators to create inflammatory stress which initiates inflammatory signalling in hepatocytes to disrupt the metabolic scenario. In contrast, M2 KCs generate anti-inflammatory cytokines and mediators which improve glucose and lipid metabolic states within the liver. Unfortunately, the M1/M2 bias does not provide reliable explanation as KCs depletion shows strikingly different results. Despite many investigational studies on this topic, a comprehensive review of these studies is lacking. This review attempts to address the issues related with the dichotomy of KCs effects in lipid metabolism. This review not only warns the future studies to carefully analyze the results that are drawn from KCs effects on lipid metabolism but also suggest to evaluate animal models and KCs depletion techniques as an equally important cofactor.

The potential toxicological insights about the anti-HIV drug azidothymidine-derived monoselenides in human leukocytes: Toxicological insights of new selenium-azidothymidine analogs

Acquired immunodeficiency syndrome (AIDS) is a worldwide disease characterized by impairments of immune function. AIDS can be associated with oxidative stress (OS) that can be linked to selenium (Se) deficiency. Se is fundamental for the synthesis of selenoproteins, such as glutathione peroxidase and thioredoxin reductase. These enzymes catalyze the decomposition of reactive oxygen species and contribute to maintain equilibrium in cell redox status. Literature data indicate that organoselenium compounds, such as ebselen and diphenyl diselenide, have antioxidant properties in vitro and in vivo models associated with OS. Nevertheless, selenocompounds can also react and oxidize thiols groups, inducing toxicity in mammals. Here, we tested the potential cytotoxic and genotoxic properties of six analogs of the prototypal anti-HIV drug azidothymidine (AZT) containing Se (5′-Se-(phenyl)zidovudine; 5′-Se-(1,3,5-trimethylphenyl)zidovudine; 5′-Se-(1-naphtyl)zidovudine; 5′-Se-(4-chlorophenyl)zidovudine) (C4); 5′-Se-(4-methylphenyl)zidovudine (C5); and 5′-(4-methylbenzoselenoate)zidovudine). C5 increased the rate of dithiothreitol oxidation (thiol oxidase activity) and C2-C4 and C6 (at 100 µM) increased DNA damage index (DI) in human leukocytes. Moreover, C5 (200 µM) decreased human leukocyte viability to about 50%. Taken together, these results indicated the low in vitro toxicity in human leukocytes of some Se-containing analogs of AZT.

Different Designs of Dual-Focus Perforated Transmitarray Antenna in Near/Far-Field Region

Designs of the single-focus and multi-focused transmitarray antennas for the near-field (NF) or/and far-field (FF) applications have been introduced. Perforated dielectric single sheet is used for transmitarray design for simple configuration. Single-focus transmitarray for the far-field and the near-field are obtained. The radiation characteristics of 13×13 unit-cells transmitarray in the near-field and the far-field region have been investigated. A single structure multi-focus transmitarray is designed using the chess-board arrangement of the unit-cells elements. Multi-focus transmitarray for FF/FF, FF/NF, and NF/NF have been designed and investigated. The phase distribution and the corresponding holes radii for the first quadrant of the multi-focus transmitarray are presented. The radiation characteristics of different array configuration have been investigated and analyzed using full-wave simulator CST Microwave Studio.

CT findings of pulmonary artery dissection

Pulmonary artery dissection is a serious fatal complication of chronic pulmonary arterial hypertension, always occurring at the site of maximal dilatation of the artery. Diagnosis is made mainly at autopsy as many of these patients experience sudden death when the main pulmonary artery dissects into the pericardium, causing acute cardiac tamponade. To our knowledge, five reported cases have described CT imaging findings of acute pulmonary artery dissection in the literature.

Dysphagia lusoria caused by aberrant right subclavian artery, Kommerell's diverticulum, legamentum ring, right descending aorta, and absent left pulmonary artery: a report of a unique vascular congenital disease undetected until adulthood and a review of the literature

An active otherwise healthy and middle-aged woman presented with left supraclavicular pulsation, right upper extremity claudication, and mild dysphagia. Evaluation revealed an aberrant right subclavian artery, Kommerell's diverticulum with aneurysmal degeneration, legamentum arteriosum completing vascular ring, and absent left pulmonary artery with multiple collateral supply to the left lung. She underwent successful surgical repair via right thoracotomy, including division of the vascular ring, resection of the diverticulum and aneurysm, and finally reimplantation of the right subclavian artery to the aortic arch. Her symptoms resolved completely, and she was able to resume normal activities.

Independent contributions of GR-1+ leukocytes and Fas/FasL interactions to induce apoptosis following interleukin-12 gene therapy in a metastatic model of prostate cancer

In a mouse model of prostate cancer, adenovirus-mediated interleukin-12 (Ad.mIL-12) gene therapy resulted in significant growth inhibition of both the injected primary tumor and synchronous metastases. Within 2 days of vector injection, two distinct patterns of apoptosis were detected within the primary tumor, the inhibition of which with a caspase inhibitor substantially negated growth suppression. The dominant pattern displayed localized sheets of apoptotic cells in close association with necrosis containing polymorphic neutrophils (PMNs). Depletion of PMNs resulted in the loss of this pattern of apoptosis and reduced growth suppression. A second major wave of growth suppression within the primary tumor was mediated by an immune response. Natural killer (NK) cell activity was detected within tumor-infiltrating lymphocytes (TIL) by the eighth day post-vector injection, the depletion of which resulted in a significant loss of survival enhancement. A more modest role for T cells was identified, which in the absence of documented cytotoxic T lymphocyte (CTL) activity may be related to a significant reduction in interferon-gamma (IFN-gamma) levels found in mice depleted of T cells, thereby reducing the secondary influences of IFN-gamma. However, depletion of NK cells or T cells had no discernible negative effect on IL-12-mediated anti-metastatic activity. Attention focused on the role of IFN-gamma, observed following Ad.mIL-12 therapy, to mediate the diffuse pattern of apoptosis seen in the primary and metastatic lesions. In vitro studies noted the ability of IFN-gamma to up-regulate tumor cell expression of Fas and FasL to mediate apoptosis, whereas in vivo blockage of Fas/FasL interactions with soluble Fas resulted in a modest reduction in primary tumor growth suppression but complete abrogation within metastatic lesions.

Prospects for herpes-simplex-virus thymidine-kinase and cytokine gene transduction as immunomodulatory gene therapy for prostate cancer

In completed and ongoing clinical trials, adenovirus-mediated (Ad.) expression of herpes-simplex-virus thymidine-kinase (HSV-tk) gene transduction followed by ganciclovir (GCV) therapy has produced limited toxicity and evidence of antitumor activity following injection of the prostate. Furthermore, this system has been shown to direct systemic antitumor activity in several experimental cancer models, including that of prostate cancer, which may serve as the basis for in-situ immunomodulatory gene therapy. In a mouse model of prostate cancer, natural killer (NK) cells have been identified as the mediator of antimetastatic activity following Ad.HSV-tk + GCV, resulting in the combination of Ad.HSV-tk and adenovirus-mediated expression of interleukin 12 (Ad.IL-12) to exploit this cytokine's ability to enhance NK proliferation and cytotoxicity. Combination therapy demonstrated superior local and systemic growth suppression over that obtained with either therapy alone. Importantly, when the metastatic tumor burden was increased to an extent that negated the growth-suppressive activity directed by Ad.HSV-tk + GCV or Ad.IL-12 alone, combination therapy continued to demonstrate significant growth suppression. Examination of tumor-infiltrating lymphocytes documented enhanced NK lytic activity following combination therapy. Therefore, it appears that the combination of Ad.HSV-tk and Ad.IL-12 should be validated in a clinical trial for the treatment of prostate cancer.

The role of the anti-sperm autoantibodies in the management of patients with primary infertility

The role of antibody mediated infertility in patients with primary/secondary unexplained infertility is the subject of current interest worldwide. A prospective study was conducted to study the role of anti sperm antibodies in Pakistani patients with infertility. Patients reporting in the outpatient clinic of a local gynaecology department with problem of infertility were subjected to a detailed scrutiny by history and clinical examination including post-coital test and hysterosalpingography. Hormonal profile consisting of serum FSH, LH, Prolactin and Progesterone was assessed. Most of the ladies also underwent a pelviscopic examination. A total of 117 patients were selected where post-coital test was abnormal, semen analysis was not satisfactory or who had unexplained infertility. Tests were performed on the serum specimen from the husbands, wives and in some cases on the seminal plasma as well, for the measurement of the anti sperm agglutinating and anti-sperm immobilizing antibodies by the microagglutination technique. Fifteen of these patients were found positive for these antibodies, 7 were positive for the agglutinating antibody, 6 for the immobilizing antibody and two for both types. These results indicate that immunomodulation may be responsible for some cases of infertility in our population.

Immune deficiency in Hodgkin and non-Hodgkin lymphoma

Forty-three previously untreated Egyptian patients with Hodgkin's disease and thirty-five patients with non-Hodgkin lymphoma were studied with several readily available tests of immune function, number of peripheral blood lymphocytes, delayed hypersensitivity to two recall antigens, in vitro blastoid transformation by PHA, the capacity of E-rosette formation and surface marker criteria. The results were correlated to the histology, stage of disease and to the presence of general symptoms and signs.

Properties of the double substituted hemoglobin C Ziguinchor alpha2A beta 2 6 Glu replaced by Val 58 Pro replaced by Arg

We have previously described the structural identification of the sickle hemoglobin variant Hb C Ziguinchor (alpha2A beta2 6 Glu replaced by Val, 58 Pro replaced by Arg). This hemoglobin was found in two generations (three members) of an African family. In two family members, the clinical picture resembled that typical of a sickle cell trait, while the third member showed a more extreme clinical condition due to complication by an iron deficiency anemia. The functional properties of Hb C Zig. in red blood cells or in dilute solutions were identical to those of Hb S. The gelling behaviour of deoxy Hb C Zig. was also indistinguishable from that of Hb S. These findings suggest that, in contrast to the case of Hb C Harlem, the second substitution in position beta58 in Hb C Zig. does not interfere with the intermolecular interactions determined by the sickle substitution.

Inhibition of erythrocyte sickling by cystamine, a thiol reagent

Incubation of sickle cells with cystamine, a thiol reagnet, resulted in the formation of an intracellular S-ethylamine derivative. The rate of the reaction was dependent upon the cystamine concentration, the temperature, and the duration of the incubation. The cystamine-treated cells demonstrated a marked inhibition of sickling under hypoxic conditions, a decrease in their mean corpuscular hemoglobin concentration, and a significant increase in their oxygen affinity. The oxygen affinity of these cells was less dependent on their mean corpuscular hemoglobin concentration than that of untreated sickle cells. The minimum gelling concentration of S-ethylamine doxyhemoglobin S was slightly increased. Cystamine did not affect the intracellular pH nor the 2,3-diphosphoglycerate level. The exact contribution of the interrelated factors in cystamine inhibition of sickling (changes in oxygen affinity, mean corpuscular hemoglobin concentration, and minimum gelling concentration) has yet to be determined.

Hemoglobin J Cairo: beta 65 (E9) Lys leads to Gln, A new hemoglobin variant discovered in an Egyptian family

The present report describes clinical, hematological and biochemical studies of a 27-year old Egyptian woman in whom a fast moving Hb variant was found. The abnormal Hb constituted 48% of the total erythrocyte Hb of the propositus and her father. Structural studies demonstrated that in the abnormal Hb lysine beta 65 is replaced by glutamine. The new Hb mutant is designated hemoglobin J Cairo beta 65 (E9) Lys leads to Gln. This substitution results in only a moderate decrease in cooperativity. No evidence of Hb instability was found. A slight anemic state has been observed in the propositus since she reached adolescence.