Pediatrics
The Effect of Probiotics on Phototherapy for Bilirubin Reduction in Term Neonates: A Randomized Controlled Trial
This interventional study aimed to assess the impact of combining probiotics with phototherapy compared to using phototherapy alone on bilirubin reduction in term neonates hospitalized in neonatal wards in a pediatric hospital in western Iran.
This clinical trial study included 150 term neonates with a gestational age of 37 to 42 weeks birth weight of more than 2500 g and diagnosed with neonatal jaundice. Patients were equally assigned to two groups of phototherapy (wavelength 420-450 nm) with oral probiotics (PediLact drop 10 drops daily) and phototherapy alone through a simple random sampling method. Serum bilirubin levels (SBL) at the time of intervention and 24 48 and 72 hours later duration of phototherapy duration of hospitalization and the need for blood transfusion were compared in the two groups. We used t-test and repeated analysis of variance to compare continuous variables. SPSS24 software was used to analyze the data. The significance level was set as 0.05.
There was no statistically significant difference found between the two groups regarding basic variables gender birth weight gestational age maternal age and neonatal age at hospitalization time. On the first day of hospitalization the mean serum bilirubin level (SBL) in the combinatory therapy group was 15.6 ± 1.7 mg/dl while in the monotherapy group it was 15.8 ± 1.6 mg/dl (p = 0.584). On the second day the mean SBL in the combinatory therapy group was 11.2 ± 2.2 whereas in the monotherapy group it was 12.4 ± 2.1. By the third day these levels were 7.2 ± 0.9 and 7.8 ± 0.7 respectively with a statistically significant difference between the two groups. Repeated analysis of variance testing confirmed a statistically significant decrease in serum bilirubin levels in both groups. The average length of hospital stay for the combinatory therapy group was 2.4 ± 0.5 days compared to 2.8 ± 0.6 days in the phototherapy group (p = 0.001). In terms of phototherapy duration the combinatory therapy group received treatment for 26.2 ± 9.9 hours while the phototherapy group received it for 31.4 ± 10.3 hours (p = 0.001).
The findings of the present study indicate that incorporating oral probiotics into phototherapy for neonatal jaundice (icterus) treatment is associated with a reduction in phototherapy duration and hospital stay.
IRCT20120215009014N306
Group A β-hemolytic Streptococcal Pharyngitis: An Updated Review
Group A β-hemolytic Streptococcus (GABHS) is the leading bacterial cause of acute pharyngitis in children and adolescents worldwide.
This article aims to familiarize clinicians with the clinical manifestations evaluation diagnosis and management of GABHS pharyngitis.
A search was conducted in December 2022 in PubMed Clinical Queries using the key term “group A β-hemolytic streptococcal pharyngitis”. This review covers mainly literature published in the previous ten years.
Children with GABHS pharyngitis typically present with an abrupt onset of fever intense pain in the throat pain on swallowing an inflamed pharynx enlarged and erythematous tonsils a red and swollen uvula enlarged tender anterior cervical lymph nodes. As clinical manifestations may not be specific even experienced clinicians may have difficulties diagnosing GABHS pharyngitis solely based on epidemiologic or clinical grounds alone. Patients suspected of having GABHS pharyngitis should be confirmed by microbiologic testing (e.g. culture rapid antigen detection test molecular point-of-care test) of a throat swab specimen prior to the initiation of antimicrobial therapy. Microbiologic testing is generally unnecessary in patients with pharyngitis whose clinical and epidemiologic findings do not suggest GABHS. Clinical score systems such as the Centor score and McIssac score have been developed to help clinicians decide which patients should undergo diagnostic testing and reduce the unnecessary use of antimicrobials. Antimicrobial therapy should be initiated without delay once the diagnosis is confirmed. Oral penicillin V and amoxicillin remain the drugs of choice. For patients who have a non-anaphylactic allergy to penicillin oral cephalosporin is an acceptable alternative. For patients with a history of immediate anaphylactic-type hypersensitivity to penicillin oral clindamycin clarithromycin and azithromycin are acceptable alternatives.
Early diagnosis and antimicrobial treatment are recommended to prevent suppurative complications (e.g. cervical lymphadenitis peritonsillar abscess) and non-suppurative complications (particularly rheumatic fever) as well as to reduce the severity of symptoms to shorten the duration of the illness and to reduce disease transmission.
Diagnosis and Management of Riga-fede Disease in a Healthy 7-month old Child: A Case Report
Riga-Fede disease (RFD) presents as oral mucosal ulceration in anatomical juxtaposition to sharp dental surfaces.
A 7-month-old healthy male presented to the pediatric dentist for an emergency appointment. His mother was concerned about episodic recurrent and excessive bleeding from his mouth for three weeks. She reported that her son would often wake up in “a pool of blood”. The pediatrician assessed the patient when oral bleeding first started and prescribed magic mouthwash. This did not resolve the problem. The mother then took the child to an urgent care clinic where she was referred to a pediatric dentist. The pediatric dentist noted a sublingual traumatic granulomatous ulcer on the ventral surface of the tongue extending up to the tip of the tongue. The mandibular primary central incisors had recently erupted. The pediatric dentist established a clinical diagnosis of RFD. Incisal edges were smoothened with dental polishing tips on a slow-speed handpiece and topical fluoride varnish was applied to the teeth. The size of the ulceration decreased over two weeks. However in three weeks there was another bleeding episode. The pediatric dentist smoothened the incisal edges again followed by a fluoride varnish application. Eight weeks after the initial dental intervention the lesion resolved completely without further bleeding.
The details of this case report highlight the maternal concerns interprofessional educational touchpoints scope for interprofessional collaborative care and noninvasive management of Riga-Fede disease.
In neurotypical patients conservative dental management by smoothening sharp dental surfaces can resolve RFD. RFD should be differentiated from viral illnesses which present with oral ulcerations.
The Evaluation of the Impact of Antibiotic De-escalation among Paediatric Patients Admitted to Tertiary Care Hospital in Ajman, UAE: A Cross-sectional Retrospective Observational Study
Antibiotic de-escalation therapy plays a vital role in reducing the risk of bacterial resistance across the globe. This study elucidates the significance determinants and outcomes pertaining to Antibiotic De-escalation (ADE). The ADE is acknowledged as a crucial component within Antimicrobial Stewardship Programs (ASPs). The proliferation of antimicrobial-resistant bacteria arises as an anticipated outcome of the extensive utilization of antibiotics heightening researchers' apprehensions regarding this global challenge.
The primary objective of the study was to evaluate the usage of antibiotics in terms of clinical outcomes (re-admission within 30 days and therapy outcomes upon discharge) adverse events duration of de-escalation and duration of hospitalizations among pediatric patients admitted to a tertiary care hospital due to various infectious diseases.
A retrospective study was conducted during a four-month period from January 2022 to April 2023 at a tertiary care facility in Ajman United Arab Emirates. Participants included in this study were based on specific inclusion and exclusion criteria.
A total of 200 pediatric records were screened. The majority of participants accounting for 66.0% were female and 54.0% were classified as Arabs in terms of race. The mean age was 7.5 years (± 2.8). The most prevalent symptoms reported were fever (98%) cough (75%) and sore throat (73%). Male participants were more inclined to present with bacterial infections (88.2%) compared to viral infections (3.8%) bacterial and viral co-illnesses (2.5%) or parasitic infections (1.3%) at the time of admission. Regarding clinical outcomes 27% of patients were readmitted with the same infection type while 52% did not experience readmission. The analysis also included information on the number of patients within each antibiotic therapy duration category alongside the mean duration of antibiotic de-escalation in hours with standard deviation (± SD). The statistical significance of these associations was assessed using P-values revealing a significant relationship (P < 0.0001) between the duration of antibiotic therapy and the time required for antibiotic de-escalation.
The study's analysis revealed that individuals readmitted to the hospital irrespective of whether they presented with the same or a different infection type exhibited prolonged durations of antibiotic de-escalation. This observation underscores the potential influence of the patient's clinical trajectory and the necessity for adjunctive therapeutic interventions on the duration of antibiotic de-escalation.
Submaximal Field Walking Tests Applied in the Cardiopulmonary Assessment in Congenital Heart Diseases: A Systematic Review
Submaximal field walking tests are easy to apply and low cost but it is necessary to standardize their application especially in the pediatric population. The feasibility and its use in patients with congenital heart disease have been studied. The goal of this study was to verify which are the submaximal field walking tests applied in the cardiopulmonary assessment of children and adolescents with CHD and to verify if they are being performed as recommended by the standardization protocols/guidelines.
Literature review through a search in six electronic databases structured in PICO format without date restrictions. Looking for studies that used submaximal field walking tests in children and adolescents with congenital heart disease aged 5 to 18 years. Methodological quality effectiveness and safety and risk of bias were assessed.
Five studies met the eligibility criteria with a sample of 160 individuals with congenital heart disease and all used the six-minute walk test. Note that different methodologies and modifications are used. Only the clinical trial showed good methodological quality.Four studies had low risk of bias and one study had moderate risk.
Although the six-minute walk test is the only test used as a field test found in our research there is no standardization in the application of the test making it difficult to compare the results. In this sense reducing the limitations and heterogeneity in the application of the test will enable more concrete outcomes and facilitate their reproduction in clinical practice.
The Effectiveness of Perinatal Omega-3 Supplements in Neurodevelopment and Physical Growth of 9- and 12-month-old Infants: A Follow-up of a Clinical Trial
Omega-3 fatty acids (FAs) are essential long-chain polyunsaturated fatty acids (LCPUFAs) that are essential for optimal health and development.
The present study aimed to evaluate the effectiveness of maternal fish oil (containing omega-3 LCPUFA) intake from 21th week of pregnancy to 30 days postpartum for neurodevelopment and growth of infants at 9 and 12 months.
This was a follow-up study of a triple-blinded clinical trial. The study population was 9- month-old infants. Their mothers were randomly divided into two groups of 75 people with a 1:1 ratio to take one fish oil supplement or a placebo daily. The anthropometric indicators of infants at months 9 and 12 and neurodevelopment at month 12 by the ASQ questionnaire were measured. In the fish oil and placebo groups respectively 73 and 71 infants at nine months as well as 71 and 69 at 12 months were analyzed.
No statistically significant impact was observed following consuming omega-3 capsules on the neurodevelopmental domains growth parameters and the profile of maternal serum FAs (p > 0.05) except DHA. Neurodevelopmental problems were illustrated in one case in the intervention group and two cases in the placebo group.
Perinatal relatively low-dose omega-3 LCPUFAs supplements indicated no statistically significant impacts on the growth and neurodevelopment of 9- and 12-month-old infants in a population with low consumption of marine products. Further studies investigating the effect of higher doses of omega-3 LCPUFAs are suggested.
IRCT2013100914957N1
Sleep Bruxism in Children: A Narrative Review
Sleep bruxism characterized by involuntary grinding or clenching of the teeth and/or by bracing or thrusting of the mandible during sleep is common in children. Sleep bruxism occurs while the patient is asleep. As such diagnosis can be difficult as the affected child is usually unaware of the tooth grinding sounds.
This article aims to familiarize physicians with the diagnosis and management of sleep bruxism in children.
A search was conducted in May 2023 in PubMed Clinical Queries using the key terms “Bruxism” OR “Teeth grinding” AND “sleep”. The search strategy included all observational studies clinical trials and reviews published within the past 10 years. Only papers published in the English literature were included in this review.
According to the International classification of sleep disorders the minimum criteria for the diagnosis of sleep bruxism are (1) the presence of frequent or regular (at least three nights per week for at least three months) tooth grinding sounds during sleep and (2) at least one or more of the following (a) abnormal tooth wear; (b) transient morning jaw muscle fatigue or pain; (c) temporary headache; or (d) jaw locking on awaking. According to the International Consensus on the assessment of bruxism “possible” sleep bruxism can be diagnosed based on self-report or report from family members of tooth-grinding sounds during sleep; “probable” sleep bruxism based on self-report or report from family members of tooth-grinding sounds during sleep plus clinical findings suggestive of bruxism (e.g. abnormal tooth wear hypertrophy and/or tenderness of masseter muscles or tongue/lip indentation); and “definite” sleep bruxism based on the history and clinical findings and confirmation by polysomnography preferably combined with video and audio recording. Although polysomnography is the gold standard for the diagnosis of sleep bruxism because of the high cost lengthy time involvement and the need for high levels of technical competence polysomnography is not available for use in most clinical settings. On the other hand since sleep bruxism occurs while the patient is asleep diagnosis can be difficult as the affected child is usually unaware of the tooth grinding sounds. In clinical practice the diagnosis of sleep bruxism is often based on the history (e.g. reports of grinding noises during sleep) and clinical findings (e.g. tooth wear hypertrophy and/or tenderness of masseter muscles).
In childhood sleep-bruxism is typically self-limited and does not require specific treatment. Causative or triggering factors should be eliminated if possible. The importance of sleep hygiene cannot be over-emphasized. Bedtime should be relaxed and enjoyable. Mental stimulation and physical activity should be limited before going to bed. For adults with frequent and severe sleep bruxism who do not respond to the above measures oral devices can be considered to protect teeth from further damage during bruxism episodes. As the orofacial structures are still developing in the pediatric age group the benefits and risks of using oral devices should be taken into consideration. Pharmacotherapy is not a favorable option and is rarely used in children. Current evidence on the effective interventions for the management of sleep bruxism in children is inconclusive. There is insufficient evidence to make recommendations for specific treatment at this time.
A Case Series of Appendicitis and Pseudo-appendicitis in a Paediatric Intensive Care Unit
Appendicitis is a common childhood condition that can be diagnostically challenging. Severe cases may necessitate support in the critical or intensive care unit. These “critical appendicitis diagnoses” have rarely been described.
We retrospectively reviewed the Paediatric Intensive Care Unit (PICU) database of the Hong Kong Children’s Hospital and identified cases of suspected and confirmed appendicitis. Clinical features radiologic findings and final diagnosis of each case were summarized and reported in this case series. We review six anonymized cases of appendicitis managed in a PICU to illustrate the different age spectrum and clinical manifestations of the condition. Rupture of the inflamed appendix peritonitis and pancreatitis were some of the complications encountered. Crohn’s disease was found in one case as an underlying diagnosis. Also one girl clinically diagnosed with appendicitis was found to be a case of ruptured hepatoblastoma with no appendicitis (i.e. pseudo-appendicitis).
Prompt diagnosis surgical removal of the inflamed appendix and use of appropriate antimicrobials when indicated are essential in reducing mortality and morbidity associated with severe appendicitis. Significant premorbid conditions such as acute myeloid leukemia Mitochondrial Encephalopathy Lactic Acidosis Syndrome (MELAS) inflammatory bowel disease and complications may be present in patients needing intensive care as is illustrated in the present cases. Pseudo-appendicitis is an important differential diagnosis. Imaging is crucial and useful in establishing and confirming the diagnosis of appendicitis and pseudo-appendicitis in these PICU cases.
Use and Efficacy of I-gel in Complicated Intubations in Newborn Infants: A Review of Case Reports in the Literature
Current guidelines for neonatal resuscitation suggest the use of a laryngeal mask when ventilation with both facemask and endotracheal tube has failed in newborns weighing >2000 g or delivered ≥ 34 weeks of gestation age. Paediatric I-gel® is one of the latest supraglottic airway management devices suitable for children and newborns. I-gel® use was effective in guaranteeing adequate ventilation in patients with anatomic abnormalities in case of respiratory impairment or during surgical procedures after the induction of anaesthesia.
The purpose of our review was to evaluate the use and efficacy of I-gel® in case of complicated intubations.
In July 2023 two authors of this paper independently conducted searches of the MEDLINE Web of Science and Scopus databases without imposing any time constraints or other restrictions. Three case reports were included each describing the use of I-gel® device in difficult intubations in newborns with anatomical abnormalities.
No difficulties were reported in the insertion of the device which was placed even by inexperienced clinicians.
The data collected highlighted the possibility of using I-gel® not only as a rescue device after attempted and failed endotracheal placement but also as a first choice in selected patients. Studies on larger cohorts would be needed. Further research involving larger patient cohorts of multicentre NICUs is necessary to confirm the use of laryngeal masks in neonates weighing less than 2000 grams.
Perinatal Exposure to Trace Elements: The Dubious Culprit of Autistic Spectrum Disorder in Children
There is evidence that few trace elements in the environment work as hazardous materials in terms of their exposure in the perinatal period causing autistic spectrum disorder (ASD) in children and avoiding these exposures in the environment can reduce the number of new cases. This perspective study provides preliminary evidence to consider a few trace elements as culprits for ASD. More studies with larger cohorts are needed but meanwhile as per available evidence exposure to these hazardous materials must be warranted during pregnancy and early stages of life.
Assessment of Interleukin 17 in Egyptian Systemic Lupus Erythematosus Patients as a Biomarker in Disease Activity
Introduction: Systemic lupus erythematosus (SLE) is a chronic idiopathic systemic autoimmune disorder with dysregulation of adaptive and innate immune systems. Interleukin (IL)-17 is the prototypical pro-inflammatory cytokine of T helper 17 (Th17) cells. Therefore it contributes to the pathogenesis of human SLE. Aim: The aim of the research paper was the evaluation of IL-17 level as a biomarker in the SLE cohort and its relation to disease activity and analysis of IL-17 concentration in patients with lupus nephritis and non-lupus nephritis. Methods: The research enrolled 45 SLE patients according to Systemic Lupus International Collaborating Clinics Classification Criteria (SLICC) and age and sex-matched. The patients underwent full history clinical examination laboratory investigation and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) calculation. Results: The mean age ± SD of the participants equaled 32 ± 11 years and serum IL-17 in SLE cases was statistically significantly high (p < 0.001). No statistically significant correlations were reported between disease activity according to SLEDAI and IL-17. In addition a statistically significant positive correlation was reported between IL-17 and ESR and a high statistically significant negative correlation was reported between IL-17 and C3 and C4 (P < 0.001). A statistically significant positive correlation was reported between IL-17 and 24-hour urinary proteins with a Pvalue of 0.01. Conclusion: SLE cases demonstrated higher levels of serum IL-17 contributing to SLE pathogenesis. However no statistically significant difference was reported between IL-17 and Lupus nephritis. IL-17 and SLE activity (SLEDAI) did not correlate. A statistically significant positive relation was reported between IL-17 and 24-hour urinary proteins. Additionally a high statistically significant negative correlation was reported between IL-17 and C3 and C4.
Hypoparathyroidism: Musculoskeletal Manifestations Related to Parathormone Deficiency
Background: Hypoparathyroidism is a rare metabolic disorder that can be responsible for musculoskeletal manifestations. Aim: We present a systematic review of musculoskeletal manifestations of adult-onset nonsurgical nongenetic hypoparathyroidism. Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline using the MEDLINE database including manuscripts describing musculoskeletal manifestations of adult-onset nonsurgical nongenetic hypoparathyroidism. Results: Musculoskeletal manifestations included myopathy shoulder disorder immune-negative non-erosive peripheral arthritis axial involvement simulating spondylarthritis and diffuse ligamentous ossifications. An association between hypoparathyroidism and spondyloarthritis or autoimmune diseases is possible. T-cell activation seen in patients with hypoparathyroidism may explain the co-occurrence of hypoparathyroidism with other autoimmune diseases. The treatment of these manifestations is based on calcium and active vitamin D supplementation. Parathyroid hormone may have an anabolic effect on muscle atrophy and muscle weakness. Parathyroid hormone can also promote bone formation and bone resorption by stimulating osteoclast differentiation by increasing RANKL (receptor activator for nuclear factor kappa-B ligand) expression. Therefore hypoparathyroidism can be responsible for an increase in bone mineral density. However the risk of fractures does not appear to be reduced due to changes in bone microarchitecture and the high risk of falls. Treatment with parathyroid hormone has been shown to improve bone microarchitecture. Conclusion: Our review showed that musculoskeletal manifestations are frequent in patients with hypoparathyroidism including muscular axial peripheral articular and entheseal manifestations.
Low Frequency of Upper Gastrointestinal Bleeding Despite Non-Steroidal Anti-Inflammatory Drugs and Corticosteroids in Patients with Rheumatoid Arthritis
Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease. It has been identified that non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids can be essential risk factors for developing complications such as upper gastrointestinal bleeding (UGIB). Objective: This study aimed to describe the safety profile of drugs used to treat RA focused in UGIB. Methods: A cross-sectional study of patients with RA between 2015 and 2021 a description of the population and an evaluation of the relationship with UGIB through bivariate analysis and logistic regression. Results: Of 405 individuals 16 presented UGIB (93.8% women mean age was 65±13.6 years). No statistically significant differences were found regarding UGIB and medication use except for the mean dose of corticosteroids. In the multivariate analysis it was found that the presence of anemia in the last three months had an adjusted OR (AOR) of 16.1 (95% CI 2.74- 24.23) and higher HAQ values during the previous three months had an AOR of 6.17 (95% CI 1.79- 21.24). Conclusion: This study found a low frequency of UGIB in patients with RA. More significant disability and anemia in the previous months were independently associated with UGIB. The low frequency of NSAID use in this population is noteworthy. In general reasonable medication use related to this complication is recommended.
Exploring the Promising Role of Guggulipid in Rheumatoid Arthritis Management: An In-depth Analysis
Background: Guggulipid an oleo-gum resin extracted from the bark of Commiphora wightii of the Burseraceae family holds a significant place in Ayurvedic medicine due to its historical use in treating various disorders including inflammation gout rheumatism obesity and lipid metabolism imbalances. Objective: This comprehensive review aims to elucidate the molecular targets of guggulipids and explore their cellular responses. Furthermore it summarizes the findings from in-vitro in-vivo and clinical investigations related to arthritis and various inflammatory conditions. Methods: A comprehensive survey encompassing in-vitro in-vivo and clinical studies has been conducted to explore the therapeutic capacity of guggulipid in the management of rheumatoid arthritis. Various molecular pathways such as cyclooxygenase-2 (COX-2) vascular endothelial growth factor (VEGF) PI3-kinase/AKT JAK/STAT nitric oxide synthase (iNOS) and NFΚB signaling pathways have been targeted to assess the antiarthritic and anti-inflammatory effects of this compound. Results: The research findings reveal that guggulipid demonstrates notable antiarthritic and anti-inflammatory effects by targeting key molecular pathways involved in inflammatory responses. These pathways include COX-2 VEGF PI3-kinase/AKT JAK/STAT iNOS and NFΚB signaling pathways. in-vitro in-vivo and clinical studies collectively support the therapeutic potential of guggulipid in managing rheumatoid arthritis and related inflammatory conditions. Conclusion: This review provides a deeper understanding of the therapeutic mechanisms and potential of guggulipid in the management of rheumatoid arthritis. The collective evidence strongly supports the promising role of guggulipid as a therapeutic agent encouraging further research and development in guggulipid-based treatments for these conditions.
Reaction Time in Fibromyalgia Patients
Background: Fibromyalgia has unknown aetiology and is associated with reduced information processing speed and therefore prolonged reaction time. However the processes underlying this are unknown. Objectives: First to compare the reaction time in a cohort of fibromyalgia patients and a matched group of normal controls. Second to assess whether detailed symptoms of pain and autonomic function as well as measures of tinnitus fatigue daytime sleepiness and Mycoplasma pneumoniae infection are predictors of reaction time in fibromyalgia. Methods: The between-groups mean serial five-choice reaction time difference was assessed in a cohort of fibromyalgia patients and in a matched group of normal controls in an analytical casecontrolled study. With the mean serial five-choice reaction time as the dependent variable for the fibromyalgia group a mixed stepwise multiple linear regression was performed with inputs relating to pain dysautonomia tinnitus fatigue daytime sleepiness and Mycoplasma pneumoniae infection. Results: The mean (standard error) serial five-choice reaction time for the fibromyalgia group was 448.4 (23.0) ms compared with 386.3 (8.3) ms for the control group (p = 0.007). The final multiple linear regression model (p < 0.001; adjusted R2 = 0.772) contained 13 predictors: eight sensory pain and three affective pain parameters and Mycoplasma pneumoniae IgG and IgA assay results. Conclusion: Certain sensory and affective pain parameters as well as Mycoplasma pneumoniae infection appear to be predictors of reaction time in fibromyalgia. Further research into the pathophysiological mechanisms by which they affect information processing is warranted and may shed light on the aetiology of fibromyalgia.
Severe Acro-osteolysis Mimicking Arthritis Mutilans in a Patient with Primary Hyperparathyroidism: A Case Report
Background: Primary hyperparathyroidism (PHPT) should be considered in the differential diagnosis of a patient with suspected secondary osteoporosis and severe osteoporosis with multiple fractures is frequently the first clinical manifestation of the disease. Case Presentation: Mutilating arthritis (arthritis mutilans) can be part of the clinical presentation of a number of rheumatic diseases most commonly seen in psoriatic arthritis rheumatoid arthritis and juvenile idiopathic arthritis but also in systemic lupus systemic sclerosis and multicentric reticulohistiocytosis. Evidence exists that subperiosteal and subchondral bone resorption seen in PHPT could induce the so-called ‘osteogenic synovitis’ which could eventually lead to the development of a secondary osteoarthritis with bone deformities. Conclusion: Here we present a case report of a patient initially diagnosed with PHPT who presented with mutilating arthritis of the finger joints and discuss whether the severe acro-osteolysis is a manifestation of the endocrinopathy or whether there is a co-existing undiagnosed inflammatory joint disease.
Insight into the Epidemiology of the Adult-onset Systemic Autoimmune Rheumatic Diseases in Egypt: A Descriptive Study of 8690 Patients
Background/Objective: Although systemic autoimmune rheumatic diseases (SARDs) seem to be ubiquitous Africa and the Middle East seem to be a remarkable exception with scarcity of data compared with the developed countries. Furthermore most of the studies addressed a particular disease. This work aimed to shed light on the relative frequency and epidemiology of the different adult-onset SARDs in Egypt. Methods: This is a retrospective hospital-based study including six university hospitals providing free health care services: Cairo Alexandria Tanta Suez Canal Beni-Suef and Assiut University Hospitals. All available files for patients attending the outpatient clinics or admitted to the inpatient departments between January 2000 and December 2021 were retrospectively reviewed. Data about the patient’s diagnosis gender age at disease onset year of disease onset and residence were collected. Results: The study included 8690 patients. Rheumatoid arthritis (RA) systemic lupus erythematosus (SLE) Behçet’s disease (BD) and spondyloarthropathies (SPA) represented the main SARDs in Egypt. They mainly affect young patients below the age of 40 years. RA and SLE mainly affect females; males are mainly affected by axial SPA and BD. There is an increasing incidence of SARDs during the study period. Conclusion: The study revealed the high burden of SARDs in Egypt helping better allocation of economic resources for the management of diseases of the highest prevalence and those affecting the young reproductive age groups. Increased public and medical staff awareness about SARDs is recommended to help early referral of patients to rheumatologists and hence better estimation of their epidemiology.
Study on the Expression and Potential Function of LncRNA in Peripheral Blood of Patients with Ankylosing Spondylitis
Background: Ankylosing spondylitis (AS) is an autoimmune disease that has the characteristics of difficult early diagnosis and a high disability rate. Objective: The objective of this study was to further explore the possible mechanism and potential function of lncRNA in AS. Methods: We used lncRNA microarray technology to detect the expression of lncRNA and mRNA in patients with active AS stable patients and healthy controls (HC). Afterward bioinformatics analysis was conducted on differentially expressed genes. Seven differentially expressed lncRNAs were screened out for real-time fluorescent quantitative PCR (RT-qPCR) combined with various clinical indicators for correlation analysis and the receiver operating characteristic (ROC) curve was used to analyze the potential of lncRNA as a diagnostic marker for AS. Results: The results showed that the expression levels of NR-037662 and ENST00000599316 in the AS subgroups were significantly higher than those in the HC group while the expression levels of ENST00000577914 and ENST00000579003 were lower than those in the HC group. The expression levels of NR-003542 and ENST00000512051 in the ASA group were significantly higher than those in the ASS and HC groups while NR-026756 was just the opposite. Spearman’s correlation analysis showed that the expression level of NR-003542 was positively correlated with Bath Ankylosing Spondylitis Functional Index (BASFI) Erythrocyte Sedimentation Rate (ESR) and high sensitivity C-Reactive Protein (hsCRP). The expression level of NR-026756 was negatively correlated with the Bath Ankylosing Spine Inflammatory Disease Activity Index (BASDAI) BASFI ESR hsCRP and globulin (GLOB). In addition it was also found that the ROC curve analysis of the 4 lncRNAs between the AS group (ASA group and ASS group) and the HC group were statistically significant and the area under the curve (AUC) of NR-037662 ENST00000599316 ENST00000577914 and ENST00000579003 was 0.804 0.812 0.706 and 0.698 respectively. Conclusion: It was found that these differentially expressed lncRNAs of AS may be involved in the occurrence and development of the disease. Among them NR-037662 ENST00000599316 ENST00000577914 and ENST00000579003 might have the potential to become AS diagnostic molecular markers. Moreover NR -003542 ENST00000512051 and NR-026756 might have the potential to be indicators of disease activity.
An Overview of Adalimumab Therapy for Ankylosing Spondylitis
Background: Ankylosing spondylitis (AS) is a chronic inflammatory disease known for causing pain stiffness and reduced mobility in the axial skeleton. Adalimumab a tumor necrosis factor (TNF) inhibitor has emerged as a promising therapeutic option for AS. Methods: This systematic review involved a comprehensive search of randomized controlled trials related to AS treatment conducted in major databases such as MEDLINE Google Scholar and PubMed. The search terms encompassed ankylosing spondylitis adalimumab methotrexate other non-biologic DMARDs glucocorticoids NSAIDs and analgesics. A total of 14 randomized controlled trials with 4500 participants were included in the review. Results: The review's results revealed that adalimumab demonstrated notable superiority when compared to a placebo. It effectively reduced disease activity improved physical function and lowered inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate. Adalimumab demonstrated a favorable safety profile with adverse events comparable to those observed with placebo. Conclusion: Based on the results adalimumab is deemed an effective treatment for AS showcasing its potential as a first-line therapeutic option. Notably no significant increase in adverse events was observed compared to placebo. However the conclusion emphasizes the need for further studies with extended follow-up durations to ascertain the long-term efficacy and safety of adalimumab in AS management. This systematic review provides valuable insights supporting the use of adalimumab in the treatment of AS and underscores the importance of ongoing investigations into its long-term effects to optimize its clinical utilization in AS patients.