Perceptions of Dutch general practitioners towards eHealth for patients with type-2 diabetes: a qualitative study.

BACKGROUND: eHealth provides a viable option to facilitate type-2 diabetes mellitus self-management and adherence. To this end, a web-based computer-tailored eHealth programme, My Diabetes Profile (MDP), was developed and implemented in Dutch diabetes care. To fully utilize the potential of eHealth, the reach of effective programmes like MDP should be maximized. Therefore, it is vital to explore perceptions of general practitioners (GPs) regarding eHealth and factors that influence GPs' decision to adopt eHealth programmes. OBJECTIVE: To shed light on Dutch GPs' perceptions towards eHealth in general and specifically, the adoption of MDP. METHODS: Interviews were conducted among a heterogeneous sample of 16 Dutch GPs. The interview guide, based on the Diffusion of Innovations Theory, addressed perceptions about eHealth in general, characteristics of MDP, organizational characteristics, and external influences on adoption. Audio-recordings were transcribed and analysed using deductive coding in NVivo. RESULTS: Nearly all GPs used some form of eHealth and listed many benefits and few drawbacks about eHealth. Sometimes, GPs were unaware of what eHealth encompassed; programmes resembling MDP were not mentioned. COVID-19 immensely increased eHealth uptake, especially for remote communication. Regarding MDP, the organizational and external influences on adoption were limited, while characteristics of the innovation were deemed more important. GPs expressed benefits of MDP (e.g. uncomplex, user-friendly, tailored) other than attributed to eHealth in general and fewer drawbacks. CONCLUSION: While GPs' opinions about eHealth and MDP were positive, the concept of MDP was relatively unfamiliar. Future research should focus on targeting GPs' awareness of eHealth possibilities.

Serum level of APRIL/BLyS in Behçet's disease patients: clinical significance in uveitis and disease activity.

OBJECTIVE: The aim of the study reported here was to assess the serum concentration of B-cell activating factors, B lymphocyte stimulators (BLyS), and a proliferation-inducing ligand (APRIL) in Behçet disease (BD) patients in order to evaluate their role and study their relation to uveitis subtype and disease activity. METHODS: The study included 58 consecutively recruited BD patients with a mean age of 35.54 ± 8.85 years and disease duration of 8.33 ± 5.84 years and 30 age- and sex-matched controls. Disease activity was assessed using the BD current activity form score. Patients were subclassified according to the presence and type of uveitis. Serum BLyS and APRIL were measured by enzyme-linked immunosorbent assay. RESULTS: Recurrent uveitis was present in 42 (72.41 %) patients, of whom 19 had the anterior form, 13 had the posterior form, and ten had a combined anterior with posterior form; 16 had no eye involvement. Serum APRIL (60.29 ± 57.99 ng/ml) and BLyS (2.31 ± 1.97 ng/ml) levels were significantly higher in the BD patients than in the controls (4.14 ± 4.31 and 0.49 ± 0.39 ng/ml, respectively; P < 0.0001). The levels were clearly higher in those with combined uveitis. The BLyS level significantly correlated with disease activity. CONCLUSIONS: The overexpression of BLyS and APRIL in BD patients supports the notion of a critical role for B cell activation factors in BD, particularly in terms of uveitis and disease activity. This provides an interesting prospect for the use of anti-BLyS/APRIL antibodies against future therapeutic targets.

Cartilage Oligomeric Matrix Protein (COMP) in systemic sclerosis (SSc): role in disease severity and subclinical rheumatoid arthritis overlap.

OBJECTIVE: The aim of the present study was to compare the serum level of COMP in both subsets of Systemic sclerosis (SSc) as a marker of arthritis and reveal an associated subclinical RA overlap and a relation to clinical, laboratory and radiological findings in SSc. METHODS: Forty adult SSc patients were included in the study and grouped into the two subsets diffuse (dSSc) and limited (lSSc) SSc. Their mean age was 40 ± 9 years. Thorough history taking and clinical examination were performed to all patients. Skin thickness was scored according to the modified Rodnan skin score method (MRSS). The disease activity was assessed by measuring the Medsger severity score. The joints were extensively examined and the tenderness counted according to the Ritchie articular index (RAI). Relevant laboratory and radiological investigations were carried out. The serum COMP level was determined by ELISA. RESULTS: The serum COMP was significantly higher in the SSc patients compared to the control and obviously higher in the dSSc compared to the lSSc patients. The level of COMP was higher in the females and significantly higher in the SSc patients with arthritis (56.5 ± 6.8 ug/ml) compared to those without (34 ± 8.3 ug/ml) (P 0.000). CONCLUSION: The COMP level may become a nonspecific but useful marker for joint involvement in SSc patients to identify patients at risk of joint damage and developing SSc-RA overlap syndrome even with mild arthritis.

Subclinical renal involvement in essential cryoglobulinemic vasculitis and classic polyarteritis nodosa.

OBJECTIVE: Renal vasculitis is usually associated with anti-neutrophil cytoplasmic antibodies (ANCAs). However, non-ANCA patients constitute a rarely studied variant of renal vasculitis. The aim of the present study was to demonstrate the features of renal involvement in patients with primary systemic non-ANCA associated vasculitis (NAAV) and compare essential cryoglobulinemic vasculitis (ECV) with classic polyarteritis nodosa (PAN). METHODS: The study included 30 patients with primary systemic non-ANCA associated vasculitis (NAAV). Fifteen with ECV and another 15 patients with classic PAN. The patients were recruited from the Rheumatology and Internal medicine departments and outpatient clinics of Cairo University Hospitals. The patients had no or mild renal involvement at entry and the ANCA was negative as tested by immunoflourescence and ELISA. Renal biopsy was performed for all the patients and histopathologically studied. RESULTS: Renal biopsy abnormalities were seen in six females. One patient with PAN showed renal vasculitis and membranoproliferative glomerulonephritis (MPGN) and was HBV and ANA positive. The patient had negative HCV and cryoglobulins. Five patients with ECV-associated HCV had findings; one had chronic interstitial nephritis and was HBV positive. The other four were HBV negative with MPGN in two, focal proliferative and crescentic GN in one patient each. CONCLUSIONS: Increased understanding of the manifestations of systemic vasculitis is likely to provide the basis for the use of more selective immunomodulatory therapies in the future. It is our hope that this study will raise awareness of the non ANCA-associated vasculitic renal involvement.

Insulin resistance and metabolic syndrome in primary gout: relation to punched-out erosions.

OBJECTIVES: To verify the relation of gout to insulin resistance (IR) and metabolic syndrome (MetS) and find any association of metatarsophalangeal (MTP) joint erosions to the features of MetS and IR. METHODS: Forty-six primary gout male patients with a mean age of 41.96 ± 5.77 years were grouped according to the presence of MetS. Twenty-seven age and sex matched healthy volunteers served as controls. Insulin sensitivity was estimated using the homeostatic model assessment index (HOMA-B) for beta cell function and HOMA-IR for peripheral tissue IR. RESULTS: Gout patients had significantly higher HOMA-IR and HOMA-B compared to controls. Those with MetS (n = 27) had significantly higher serum uric acid (SUA) than those without (n = 19; 11.51 ± 3.72 mg/dL vs. 9.15 ± 2.34 mg/dL; P = 0.012). Gout patients with MTP erosions had notable higher insulin levels and more IR as shown by the higher levels of HOMA-IR and HOMA-B compared to those without. HOMA-IR and HOMA-B significantly correlated with the presence of erosions. Moreover, the presence of erosions significantly correlated with SUA (r = 0.64, P < 0.0001). CONCLUSIONS: The level of SUA is closely related to IR in patients with and without MetS. There is an association of the severity of gout and presence of MTP erosions to IR. Metabolic syndrome forms an important marker for those who develop more punched-out erosions.

Elevated BAFF (BLyS) and APRIL in Juvenile idiopathic arthritis patients: relation to clinical manifestations and disease activity.

OBJECTIVE: To assess the level of B-cell activating factor belonging to the tumor necrosis factor family (BAFF) also known as B-lymphocyte stimulator (BLyS) and A proliferation-inducing ligand (APRIL) in the serum of Juvenile idiopathic arthritis (JIA) patients and to detect their relation to the clinical manifestations and disease activity in the different subtypes of the disease. METHODS: Seventy-four consecutively recruited JIA patients were clinically examined, the Juvenile arthritis disease activity score in 27 joints (JADAS-27) calculated and Childhood Health Assessment Questionnaire (CHAQ) used to measure the functional status. Thirty-four healthy matched children served as controls. Routine laboratory examinations were recorded and serum BAFF and April were determined. RESULTS: The JIA patients were 20 systemic-onset, 31 oligoarticular and 23 polyarticular. Serum BAFF and APRIL were elevated in JIA patients being higher in systemic onset and both significantly correlated. APRIL significantly correlated with both JADAS-27 and CHAQ scores while BAFF correlated only with JADAS-27. The APRIL serum levels were significantly associated with the presence of RF and ANA. The BAFF serum levels were significantly higher in oligoarticular onset JIA patients with uveitis compared to those without. CONCLUSION: Our results suggest increased BAFF and APRIL serum levels in JIA patients denoting their possible role in the disease and calling for additional research to elucidate the intrinsic mechanisms explaining APRIL and BAFF over expression.

Role of some viral infections in neonatal cholestasis.

Viral infection is one of the postulated causes of neonatal cholestasis. In addition to earlier reports on the association of viral infection and intrahepatic cholestasis (IH), recent studies have suggested a similar link to extra hepatic biliary atresia (EHBA). The aim of this work was to evaluate the role of some viral infections in neonates presenting with cholestasis to the Neonatology Ward of Zagazig University Hospitals. Sixty-two neonates were included in the study (44 cholestatic neonates and 18 apparently healthy neonates as the control group). All neonates were subjected to full history taking and complete physical examination. Laboratory investigations included CBC, liver function tests, bleeding profile, blood cultures, abdominal ultrasound and detection of HBsAg and serum IgM antibodies against certain viruses (CMV, Reovirus III, HSV I, HSV II, Rubella virus) using ELISA. Radionuclide cholescintigraphy was performed for patients only. The study revealed that cholestatic neonates were significantly associated with dark urine, pale stool and hepatomegaly compared with the control (P<0.004, P<0.001, P<0.008, respectively). Quantitation of IgM antibody titre using ELISA revealed significantly higher levels of serum anti-CMV IgM and anti-Reovirus III IgM in cholestatic than in the control groups. No significant differences were found in levels of anti-HSV I, anti-HSV II or anti-rubella antibodies between cholestatic and control groups. HBsAg was negative for all neonates; cholestatic and control. Lastly, no significant differences were found between neonates with EHBA (7 cases) and Intrahepatic cholestasis (37 cases) regarding anti -CMV IgM or anti -Reo III IgM. It can be concluded that CMV and Reovirus type 3 infections of the neonates are associated with the development of cholestatic disorder, not only due to IH cholestasis but also due to the production of EHBA.