Impact of tapering targeted therapies (bDMARDs or JAKis) on the risk of serious infections and adverse events of special interest in patients with rheumatoid arthritis or spondyloarthritis: a systematic analysis of the literature and meta-analysis

OBJECTIVES

To systematically review the impact of tapering targeted therapies (bDMARDs or JAKis) on the risk of serious infections and severe adverse events (SAEs) in patients with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA) in remission or low disease activity (LDA) state.

MATERIALS AND METHODS

A meta-analysis based on a systematic review of PubMed, Embase, Cochrane, until August 2019, as well as relevant databases of international conferences, was used to evaluate the risk difference (RD) at 95% confidence interval (95% CI) of incidence density of serious infections, SAEs, malignancies, cardiovascular adverse events (CV AEs), or deaths after tapering (dose reduction or spacing) compared to continuation of targeted therapies.

RESULTS

Of the 1957 studies initially identified, 13 controlled trials (9 RA and 4 SpA trials) were included in the meta-analysis. 1174 patient-years were studied in the tapering group (TG) versus 1086 in the usual care group (UC). There were 1.7/100 patient-year (p-y) serious infections in TG versus 2.6/100 p-y in UC (RD (95% CI) 0.01 (0.00 to 0.02), p = 0.13) and 7.4/100 p-y SAEs in TG versus 6.7/100 p-y in UC (RD 0.00 (- 0.02 to 0.02), p = 0.82). The risk of malignancies, CV AEs, or deaths did not differ between the tapering and the usual care groups. Subgroup analysis (RA and SpA) detected no significant differences between the two groups.

CONCLUSION

We could not show significant impact of tapering bDMARD or JAKi over continuation concerning the risk of serious infections, SAEs, malignancies, CV AEs, or deaths in RA and SpA patients in remission or LDA state.

What drives intentional overdose with non-prescription drugs? A cross-sectional study

BACKGROUND

Use of overdosage of Non-Prescription Drugs (NPD) among university students is a serious public health issue. However, there are no extensive studies that measured the prevalence of taking more than the recommended dose of NPD and/or identified the risk associated with this behavior among university students.

OBJECTIVES

This study was undertaken to assess the prevalence and associated risks of self-overdosage with NPDs in university students in United Arab Emirates (UAE).

METHODS

A cross-sectional survey-based study was conducted from January to April 2014, among 2875 students in three randomly selected universities. A structured and validated questionnaire was used to collect the responses of the students. SPSS version 20 was used to analyze the data.

RESULTS

Out of 2875 students, only 2355 surveys were fully answered, returned back and included in the present study. Of 2355, more than half (1348; 57.2%) the participants reported using Oral NPD (ONPD) in the past 90 days before conducting the study and were asked to complete the survey. Only 290 (22%) of a total 1348 participants reported taking more than the recommended dose of ONPD in the previous three months before conducting the study. Analgesic/antipyretic (223, 16.5%) and anti-allergic (67, 4.9%) drugs were more than other classes of the ONPD, reported to be taken in a dose, more than the recommended dosage. The most common justifications for taking more than the recommended dose of ONPD among respondents were severe symptoms (6%), the belief that the recommended dose would not be sufficient to relieve the symptom (5%), the belief that a stronger dose would relieve the symptoms faster (11%), and previous experience (4%). Our results identified three risk factors for taking more than the recommended dose of NPD. High frequently drug-users of daily use (OR=3.494, 95% CI: 1.677-7.279) (P<0.001), and students from non-medical colleges had higher odds of taking more than the recommended dosage as compared to students from medical colleges (OR=1.486, 95% CI: 1.060-2.085, P-value<0.05). Furthermore\re, participants with a poly-pharmacy behavior had higher odds of taking overdosage of ONPD than single NPD users (OR=1.918, 95% CI: 1.440-2.555) (P<0.001).

CONCLUSION

There are a sizable proportion of university students that use overdosage of NPD, but it is more serious issue when it comes to non-medical student. There is a need for educational programs designed to increase awareness among all university students and to motivate them not to use overdosage of NPD. Further studies are also required to investigate additional explanatory variables that could influence the practice of overdosage with NPD.

Dissociation of lexical syntax and semantics: evidence from focal cortical degeneration

The question of whether information relevant to meaning (semantics) and structure (syntax) relies on a common language processor or on separate subsystems has proved difficult to address definitively because of the confounds involved in comparing the two types of information. At the sentence level syntactic and semantic judgments make different cognitive demands, while at the single word level, the most commonly used syntactic distinction (between nouns and verbs) is confounded with a fundamental semantic difference (between objects and actions). The present study employs a different syntactic contrast (between count nouns and mass nouns), which is crossed with a semantic difference (between naturally occurring and man-made substances) applying to words within a circumscribed semantic field (foodstuffs). We show, first, that grammaticality judgments of a patient with semantic dementia are indistinguishable from those of a group of age-matched controls, and are similar regardless of the status of his semantic knowledge about the item. In a second experiment we use the triadic task in a group of age-matched controls to show that similarity judgments are influenced not only by meaning (natural vs. manmade), but also implicitly by syntactic information (count vs. mass). Using the same task in a patient with semantic dementia we show that the semantic influences on the syntactic dimension are unlikely to account for this pattern in normals. These data are discussed in relation to modular vs. nonmodular models of language processing, and in particular to the semantic-syntactic distinction.

Elevated mercury concentrations in soils, sediments, water, and fish of the Madeira River basin, Brazilian Amazon: a function of natural enrichments?

Previous site-specific investigations have found that mercury concentrations in water, sediments, and biota of the Brazilian Amazon are elevated above global averages, and that these concentrations are a direct result of widespread mercury amalgamation mining operations conducted by non-organized prospectors. In order to assess the regional impacts of Hg contamination from these non-organized gold mining activities, water, sediments, and fish were systematically collected in 1997 along a 900-km reach of the Madeira River. The sampling program extended from the Amazon River upstream to Porto Velho, the site of historic and ongoing mercury amalgamation mining. Mercury concentrations were found to be elevated above global averages in all sampled media. However, the geochemical data suggest that the high mercury levels are due largely to natural sources and natural biogeochemical processes, and that the impacts of anthropogenically released mercury from mine sites is relatively localized.

Erythropoietin stimulates G-protein-coupled phospholipase D in haematopoietic target cells

A murine haematopoietic stem-cell line, B6SUt.EP, responsive to erythropoietin (EPO), has been found to exhibit both early and late changes in diacylglycerol (DAG) and phosphatidic acid (PA) as measured by HPLC and TLC. DAG levels peaked at 5 s with a 28.1% increase compared with control levels (from 17.3 to 22.2 pmol/10(6) cells) with a later peak at 30 min (84.2% increase from 17.3 to 31.9 pmol). These changes were concentration-dependent from 0.025 to 10 units/ml EPO (5 s, EC50=0.82 unit/ml; 30 min, EC50 = 0.10 unit/ml). In addition, PA levels increased 752.3% compared with control levels (from 8.6 to 64.7 micrograms/10(6) cells) with an early peak at 20 s, as measured by both HPLC and TLC (5 s, EC(50)=0.07 unit/ml). G-protein regulation was investigated by studying the effects of the non-hydrolysable GTP analogue guanosine 5'-[gamma-thio]triphosphate (GTP[S]) on PA synthesis. The addition of GTP[S] (10 microM) in permeabilized cells increased PA content from 6.3 micrograms to 48.6 micrograms per 10(6) cells. In the presence of EPO and GTP[S], PA levels increased to 64.8 micrograms. An antagonist of G-proteins, guanosine 5'[beta-thio]diphosphate (GDP[S]), had no effect on control levels of PA (5.9 micrograms/10(6) cells) but blocked the effect of EPO on PA (30.6 micrograms/10(6) cells). Thus, EPO stimulated both lipid second messengers, DAG and PA. Our results demonstrate DAG kinetics to be biphasic, as observed with a high concentration of EPO, or monophasic, as observed with low concentrations of EPO. The PA accumulation preceding that of DAG in the slower and sustaining phase suggests that PA was not derived from DAG. This was confirmed by the stimulation of PA (without ATP) by GTP[S], effectively excluding phosphorylation of DAG by DAG kinase in the formation of PA. In addition, phospholipase D (PLD) activation was demonstrated with a maximal increase in phosphatidylethanol at 5 min, suggesting the EPO increases PA via a guanine nucleotide-binding protein coupled to PLD. The temporal relationship of the evolution of PA and DAG is further strengthened by experiments with ethanol and propranolol as inhibitors of the DAG/PA phosphohydrolase reaction and R59022 as an inhibitor of the DAG kinase reaction.

Relationship of hyperglycemia and severity of illness to neurologic outcome in head injury patients

Hyperglycemia upon hospital admission has been associated with poorer neurologic outcomes in patients with brain injury, but this relationship has not been well defined. To evaluate the relationship of hyperglycemia and severity of illness to neurologic outcome, the authors examined Surgical Intensive Care Unit (SICU) records for a 6 month period at a Level I trauma center. Of 276 trauma admissions, 97 patients had intracranial injuries. The peak glucose determination on the first day of admission was correlated with the Glasgow Coma Scale (GCS) score upon admission and discharge from the SICU and with severity of illness as measured by the Simplified Acute Physiology Score (SAPS). The mean admission GCS was 10.6 (+/- 0.49 S.E.M.), the mean glucose on the first SICU day was 146 (+/- 7.7 S.E.M.), and the mean peak glucose was 176 (+/- 8.2 S.E.M.). The peak glucose was inversely related to both GCS on admission and GCS at discharge (P < 0.001). However, stepwise multiple regression analysis revealed that the best single predictor of GCS at discharge was the GCS on admission. The next best predictor was the SAPS on the first SICU day. Peak glucose did not add to the power of admission GCS and SAPS to predict neurologic outcome. Peak glucose levels in brain-injured patients may simply reflect severity of illness and injury that is better represented by SAPS.

Qualitative and quantitative distribution of plasminogen activators in organs from healthy adult mice

Twenty organs from healthy adult mice were tested for plasminogen activator activity. All were positive although specific activities varied 200-fold. Tissues with high activity were lung, uterus, brain and kidney. Endocrine glands were moderately rich in activator activity, and lymphoid tissues were poor. Molecular mass characterization was carried out. Two enzymatic forms were observed in all twenty organs: a 70 kDa form similar to human tissue plasminogen activator and a 48 kDa form analogous to mouse urokinase.

Differentiation of thymocytes during chicken ontogeny: occurrence of a specific DNA ligase in relationship to cell size and surface antigens

The activities of two forms (8.2 and 6.2 S) of DNA ligase have been studied in chicken thymocytes at different stages of development (16 and 18 days of incubation, hatching and one month after birth). Thymocytes have been sorted out on the basis of size and T antigenicity (immunofluorescence) with the activated cell sorter. Three kinds of cells can be distinguished: (a) large, antigenically negative cells of 16 days of incubation, expressing only the "heavy" (8.2 S) form of enzyme. The activity of this form decreases during development and is very low after birth; (b) large, antigenically positive cells without DNA ligase activity and (c) small, antigenically positive cells, expressing the "light" (6.2 S) enzyme. This form of enzyme appears only from 18 days of incubation onwards. These results allow us to consider the 6.2 S DNA ligase activity as an additional marker (with cell reduction and T antigenicity) for thymocyte maturation.

Evidence for a DNA ligase change related to early cleavage in axolotl egg

A definite change in the forms of DNA ligase appears when the axolotl egg enters cleavage. Sucrose gradient and phosphocellulose chromatography show that the a 6S form of DNA ligase exists before division, i.e. in unfertilised and fertilised egg, and a 8.2S form is present at the first division. N-ethylmaleimide sensitivity and heat stability are different for the two forms. The possible significance of this early change is discussed.