The clinical characteristics of systemic lupus erythematosus patients in Indonesia: a cohort registry from an Indonesia-based tertiary referral hospital

Introduction

To date, no national epidemiological data of systemic lupus erythematosus are available in Indonesia.

Objective

We aimed to demonstrate clinical characteristics of systemic lupus erythematosus patients of the Dr Hasan Sadikin General Hospital, one of Indonesia's top tertiary-referral hospitals.

Method

We reviewed retrospective cohort data from the Hasan Sadikin Lupus Registry, which was created in January 2016. Initial retrospective data were collected from the medical records of systemic lupus erythematosus patients from 2008 to 2015 and enhanced the cohort data from January 2016 to December 2017. The records were analysed for age, sex, clinical manifestations, comorbidity, treatment and outcome.

Results

Of 813 patients, 95.6% were females. Mean age at diagnosis was 27.7 ± 9.4 years, with a mean disease duration of 76.5 ± 53.1 months. Major clinical manifestations were arthritis (75.5%) and malar rash (68.3%). The majority of patients received steroid treatment, beside chloroquine and azathioprine. In total, 93 patients (11.4%) developed tuberculosis, 522 patients (64.2%) had routine follow-up and 66 patients (8.1%) died. Infection was the most common cause of death (36.4%).

Conclusion

Arthritis and malar rash were the most commonly encountered clinical manifestations in the Hasan Sadikin Lupus Registry. Tuberculosis incidence in systemic lupus erythematosus patients was high, as was the mortality rate of lupus.

Homozygous variants in the gene SCAPER cause syndromic intellectual disability

The S-Phase Cyclin A Associated Protein In The ER (SCAPER) gene is a ubiquitously expressed gene with unknown function in the brain. Recently, biallelic SCAPER variants were described in four patients from three families with retinitis pigmentosa (RP) and intellectual disability (ID). Here, we expand the spectrum of pathogenic variants in SCAPER and report on 10 further patients from four families with ID, RP, and additional dysmorphic features carrying homozygous variants in SCAPER. The variants found comprise frameshift, nonsense, and missense variants as well as an intragenic homozygous deletion, which spans SCAPER exons 15 and 16 and introduces a frameshift and a premature stop codon. Analyses of SCAPER expression in human and mouse brain revealed an upregulation of SCAPER expression during cortical development and a higher expression of SCAPER in neurons compared to neural progenitors. In the adult brain SCAPER is expressed in several regions including the cerebral cortex where it shows a layer-specific expression with an expression peak in lower layer glutamatergic neurons. Our study supports the role of SCAPER variants in the pathogenesis of ID and RP, expands the variant spectrum and highlights the need for functional studies concerning the role of SCAPER during brain development and function.

Rbfox1 Is Expressed in the Mouse Brain in the Form of Multiple Transcript Variants and Contains Functional E Boxes in Its Alternative Promoters

The RNA-binding protein RBFOX1 is an important regulator of neuron development and neuronal excitability. Rbfox1 is a dosage-sensitive gene and in both mice and humans, decreased expression of Rbfox1 has been linked to neurodevelopmental disorders. Alternative promoters drive expression of Rbfox1 transcript isoforms that encode an identical protein. The tissue- and developmental stage-specific expression of these isoforms, as well as the underlying regulatory mechanisms, are, however, unclear. Here, we set out to capture all of the Rbfox1 transcript isoforms and identify transcriptional mechanisms that regulate brain-specific Rbfox1 expression. Isoform sequencing identified multiple alternative Rbfox1 transcript variants in the mouse cerebral cortex, including transcripts with novel first exons, alternatively spliced exons and 3′-truncations. Quantitative RT-PCR determined the expression of the alternative first exons in the developing cerebral cortex and different subregions of the juvenile brain. Alternative first exons were found to be highly stage- and subregion specific in their expression patterns suggesting that they fulfill specific functions during cortex development and in different brain regions. Using reporter assays we found that the promoter regions of the two first exons E1B and E1C/E1C.1 contain several functional E-boxes. Together, we provide an extensive picture of Rbfox1 isoform expression. We further identified important regulatory mechanisms that drive neuron-specific Rbfox1 expression. Thus, our study forms the basis for further research into the mechanisms that ensure physiological Rbfox1 expression in the brain. It also helps to understand why, in patients with neurodevelopmental disorders deletion of individual RBFOX1 transcript isoforms could affect brain function.

Tolerability and pharmacokinetic profile of a novel benzene-poly-carboxylic acids complex with cis-diammineplatinum (II) dichloride in dogs with malignant mammary tumours

The pharmacokinetic profile, tolerability and efficacy of benzene-poly-carboxylic acids complex with cis-diammineplatinum (II) dichloride (BP-C1) were studied in dogs with mammary cancer. A three-level response surface pathway designed trial was performed on seven dogs. At each level BP-C1 was administered subcutaneously daily for 7 days followed by a 7-day rest period in a dose escalating manner. Adverse events according to VCOG-CTCAE, performance status and tumour progression were recorded. The pharmacokinetic profile followed a two-compartment model with rapid absorption, short distribution, and a slow elimination phase. The overall elimination half-life was 125 h. The maximum tolerated dose of BP-C1 was estimated to be above 0.46 mg kg^-1 . A significant reduction in VCOG-CTCAE toxicity which correlated negatively with increasing dose was found. The dogs' general performance status remained unchanged. No decrease in total tumour burden was found, although temporary tumour reduction was seen in some target tumours.

Efficacy of methotrexate in reducing the risk of bone erosion in patients with rheumatoid arthritis: a systematic review of randomized controlled trials

Even though new drugs for the treatment of rheumatoid arthritis (RA) have been developed, methotrexate (MTX) remains a commonly used drug for RA management. In addition to monitoring disease activity during RA treatment, bone erosion should be closely assessed throughout long-term RA management. In this review article, we present a systematic review of MTX effectiveness in reducing the risk of bone erosion. We reviewed randomized controlled trial studies that involved MTX monotherapy or MTX in combination with placebo. Evaluation of the progression of bone erosion was examined by radiographic assessment such as total Sharp score (TSS) or van der Heijde score (SvdH or vdH TSS), joint space narrowing (JSN), erosion score (ERO), and proportion of radiographic nonprogressors. Several key factors were found to influence the response to MTX treatment, such as gene polymorphism. The exact mechanism of the prevention of bone erosion by MTX remains unclear, which warrants future investigations. The variability of RA disease activity in study subjects resulted in variations in the results reported by individual studies. Collective analysis suggests that MTX could slow down the progression of bone erosion based on a radiographic score of less than 0.5-1/year.

The Effect of Perception Stimulation Group Activity Therapy on Controlling Ability of Hallucinations in Patients with Schizophrenia

Schizophrenia is a personality that is divided between thoughts, feelings, and behavior. One of the most common symptoms of schizophrenia is hallucinations. The highest number of schizophrenic patients with hallucinations was 83 people in the Merpati Room of Prof. HB Sa'anin Hospital in Padang. Therapy is usually given in the management of overcoming hallucinations, one of which is Group Activity Therapy (GAT). The purpose of this study is to determine the effect of Perception Stimulation Group Activity Therapy on the Ability to Control Hallucinations in Schizophrenia Patients at Prof Sa'anin Hospital Padang in 2019. This study uses a Quasi Experiment research design using one group pre-post-test. The population is schizophrenia patients with hallucinations in Prof Sa'anin Hospital in Padang, about 206 persons. Sampling is done by Samples taken were 50 persons, with purposive sampling. The analysis is t-dependent. The results showed a significant difference between the ability of patients between before and after Perception Stimulation Group Activity Therapy with a P-value = 0.000 or α <0.05. It is expected that Prof. Sa'anin Padang's nurses will be more optimal in the implementation of GAT, and improve the implementation of quality GAT according to the grouping of nursing diagnoses so that the ability of schizophrenic patients with hallucinations can be achieved   Keywords: schizophrenia, hallucinations, group activity therapy