Efficacy and Safety of Rituximab Therapy for Lupus Nephritis Among SLE Female Patients; a Retrospective Hospital-Based Study.

Background: Renal affection in systemic lupus erythematosus (SLE) is a high-risk manifestation in which novel treatment strategies are required, particularly in patients who show lower response to conventional therapy. Rituximab has been used as an off-label treatment for lupus nephritis (LN) for the last ten years. This study aims to assess the outcome of the use of rituximab to treat LN patients. Methods: A retrospective cross-sectional study included 40 LN patients on Rituximab therapy who attended the Rheumatology clinic at Omdurman Military Hospital, Khartoum, Sudan. Between January to July 2020. Data were collected from the hospital records and included demographic, duration of disease and Rituximab doses. Renal biopsy, renal function parameters, albumin-creatinine ratio, hematological parameters and inflammatory markers. Assessment of the outcomes was conducted by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI score). Data were analyzed by using Statistical Package for Social Studies Program (SPSS, V. 21.0. IBM; Chicago). Chi-square test was used as significance test, the P. value was considered as significant at level 0.05 and akk continues variables had a normal distribution with Kolmogorov-Smirnov test. Results: Renal function test showed significant improvement after 6 months of treatment with Rituximab. In addition, the mean of the SLE Activity Index 2000 (SLEDAI 2K) was significantly decreased with remarkable improvement in the histological degree of LN. The histology of renal biopsy of the patients commonly was diffuse proliferative nephritis followed by minimal mesangial glomerulonephritis, mesangial proliferative LN then membranous nephritis respectively. Improvement was common among the patients aged 20-39 years, those with disease duration less than 5 years, who received 4 doses and rituximab as the initial modality. Conclusion: Rituximab therapy is effectively managing patients with lupus nephritis, after 6 months of follow-up, Patients showed remarkable clinical and laboratory improvement.

Comparison between D-dimer levels in diabetic and non-diabetic positive COVID-19 adult patients: A hospital-based study.

BACKGROUND: Diabetes is one of the most common associated comorbidity with severe acute respiratory syndrome coronavirus (SARS-CoV-2) pneumonia patients. Coagulation disorders with D-dimer levels are increased in both diseases. This study aimed to compare the levels of D-dimer in DM and non-DM patients with coronavirus disease (COVID-19) and correlate it with the disease severity. METHODS: This is a cross-sectional hospital-based study. It was conducted at royal care hospital, isolation COVID-19 Centre in 2021. The study included 130 patients with COVID-19 who fulfilled the inclusion criteria. Data were collected through a structured datasheet. The disease was diagnosed by a nasal swab polymerase chain reaction (PCR) Participants were divided into diabetics and non-diabetics depending on the history from the datasheet. The data were analysed with Statistical Package of Social Science (SPSS) version 23. RESULTS: The study showed that 73.1% of the participants were males and 26.9% were females. The most frequent age group was >65 years. The percentages of diabetics and non-diabetics, among the study participants, were found to be 41.5% and 58.5%, respectively. Moreover, 52.3% were admitted to the intensive care unit (ICU). This study revealed that D-dimer was higher compared with diabetes mellitus. The diabetics were associated with higher levels of D-dimer compared to non-diabetics. Regarding the correlation between the level of D-dimer and severity of COVID-19, it was found that there is a significant association, as the ICU patients were associated with higher levels of D-dimer in comparison with non-ICU patients. CONCLUSION: This study concluded that there is a significant association between the high D-dimer level and severity of COVID-19 among diabetic patients.

Neutrophilic dermatoses in a seronegative rheumatoid arthritis patient: A case report.

Rheumatoid arthritis (RA) is a chronic inflammatory disease, characterized by symmetric and destructive polyarthritis with a broad-spectrum clinical manifestation of various organs. RND is an unusual distinctive manifestation of RA and typically develops in severe RA. This report aims to present an unusual and a rare neutrophilic skin condition, in a seronegative RA Sudanese patient. A 51-year-old woman was diagnosed with RA three years ago and a history of bilateral polyarthritis, presented with a skin rash involving her extremities and abdomen. Clinical examination of her skin revealed the presence of maculopapular lesions affecting the extensor surfaces of the lower extremities and the lower part of the abdomen with hyperpigmentation. Hand X-ray demonstrated periarticular osteopenia, and laboratory and immunological studies that include C-reactive protein, erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), anticitrullinated peptide antibodies (ACPAs), and antinuclear factor in addition to skin biopsy were all suggested a diagnosis of neutrophilic dermatosis. The patient received steroids for the skin lesion still no significant improvement was seen, and then, cyclosporin 100 mg was administrated twice/ day with close monitoring, and two weeks later marked improvement was shown.

Incidence and Clinical Pattern of Mixed Connective Tissue Disease in Sudanese Patients at Omdurman Military Hospital: Hospital-Based Study.

BACKGROUND: Mixed connective tissue disease (MCTD) is a rare autoimmune disease, characterized by the production of specific autoantibody anti-RNP, which presents with varied overlapping symptoms of different connective tissue disorders. The aim of this study is to identify the frequency and patterns of MCTD. METHODS: This is a descriptive cross-sectional hospital-based study conducted at the rheumatology clinic at Omdurman Military Hospital between February 2019 and July 2019. The study included 30 patients and data were collected using a designated questionnaire. RESULTS: The study showed that the majority of patients (96.7%) were females and only 3.3% was male. About 30% of the patients aged between 30 and 39 years were the most affected. As a first diagnosis, 10% of the patients had a MCTD fulfilling the Alarcon-Segovia criteria. The remaining 90% of the patients were diagnosed with other diseases before evolving into MCTD. The most common clinical presentation was arthralgia in 100% of the patients, 90% were symmetrically followed by myositis in 70% of the patients, arthritis in 63.3% of the patients, puffy fingers in 63.3% of the patients, and hand swelling in 60% as major musculoskeletal symptoms. Regarding the initial results in immunological profile, the most common positive autoantibodies among the patients were anti-RNP titer in 96.7% of the patients, ANA in 90%, anti-Sm in 50%, RF in 50%, anti-Ds DNA in 46.7%, and anti-Ro in 43.3%. CONCLUSION: This study showed that MCTD is more common in females, only 10% of patients presented with a fulfilling criteria of the disease at diagnosis, and the rest of the patients presented with other rheumatologic diseases before evolving into MCTD.

Analysis of Serum Immune Markers in Seropositive and Seronegative Rheumatoid Arthritis Among Sudanese Patients and the Relation Between the Serotype and Joint Involvement: A Cohort Study.

INTRODUCTION: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation of the synovial membrane. RA is classified as seropositive or seronegative, according to the absence or presence of primarily IgM RF, RF, and/or ACPA. The aim of this study is to identify the relationship between the serotype of rheumatoid arthritis and the level of ESR. METHODS AND MATERIALS: This is a descriptive, cross-sectional study done in Omdurman military hospital, Khartoum, Sudan. Conducted with 60 patients with RA, data were collected through a designated questionnaire which included demographic, age, gender, duration of the disease, laboratory finding. All the patients in the study were treated with conventional DMARDs and diagnosed according to the 2010 ACR/EULAR criteria; their disease activity status was assessed by DAS28/ESR. Data were analyzed using SPSS version 23. RESULTS: The study found that 91.7% of the patients were females, patients of age group between 36 and 50 years had the highest percentage at 38.3% followed by those between 51 and 70 years and the least age group between 20 and 35 years, 36.7% and 15%, respectively. Of all the patients 61.7% were found to be SPRA, while the remaining 38.3% were seronegative (SNRA). Altogether 55% of the patients had moderate disease activity, followed by 16.7% who had a remission, 15% had high disease activity and the remaining 13.3% had low disease activity. The metacarpophalangeal (MCP) joint was found to be the only joint that was significantly associated with DAS28 and its involvement was greater among seropositive patients. The most affected joints were found to be shoulders, knees, wrist, MCP, PIP and elbow, in that order. CONCLUSION: Females, middle-age group and shoulder joint were the most affected. Most RA was found to be SPRA, and the seropositive group was found to be more associated with high disease activity, while the seronegative group was associated with remission and low disease activity.

A Rare Association of Thrombotic Thrombocytopenic Purpura with Systemic Lupus Erythematosus in a Sudanese Woman: Case Report.

Thrombotic thrombocytopenic purpura (TTP) is an uncommon life-threatening condition characterized by hemolytic disorders. The coexistence of systemic lupus erythematosus (SLE) with TTP is extremely rare, although Africans are at increased risk due to inherited risk factors. This report describes a rare clinical manifestation of TTP associated with SLE in a Sudanese patient. A 41-year-old Sudanese woman presented to the emergency department with symptoms and features that were suggestive of malaria, for which she had been treated accordingly. However, a few days later she complained of fever, and was found to have a body temperature of 39.5°C, jaundice, anemia, and thrombocytopenia. Soon after admission, she developed confusion and unrecordable blood pressure. After the patient had stabilized, clinical assessment, immune-system investigation (antinuclear antibody profile, complements, blood panel), and imaging revealed a diagnosis of TTP associated with SLE. The patient received imipenem 500 mg, five sessions of plasmapheresis (60 mL/kg), methylprednisolone 1 g pulse for 3 days, and rituximab 375 mg/week. Three weeks later, the patient was discharged after her condition had improved, and she is now on regular follow-up.

Vesiculobullous disease with Cutaneous Systemic Lupus Erythematosus Treated by Rituximab: A case report.

Vesiculobullous lesions in systemic lupus erythematosus (SLE) are a rare cutaneous manifestation of cutaneous and/or systemic LE with variable presentation. The diagnosis of SLE-associated vesiculobullous diseases remains challenging, due to the poorly defined similarities and nosology in immunohistopathological and clinical and features.

Systemic lupus erythematous as an unusual cause of intussusception in Sudanese woman: A case report.

Abdominal pain does have a wide differential diagnosis, however, gastrointestinal involvement is not unusual in SLE, and this report is to describe an unusual case of intussusception due to SLE in a Sudanese woman.

A multiple peptides vaccine against COVID-19 designed from the nucleocapsid phosphoprotein (N) and Spike Glycoprotein (S) via the immunoinformatics approach.

Due to the current Coronavirus (COVID-19) pandemic, the rapid discovery of a safe and effective vaccine is an essential issue. Consequently, this study aims to predict a potential COVID-19 peptide-based vaccine utilizing the Nucleocapsid phosphoprotein (N) and Spike Glycoprotein (S) via the Immunoinformatics approach. To achieve this goal, several Immune Epitope Database (IEDB) tools, molecular docking, and safety prediction servers were used. According to the results, The Spike peptide SQCVNLTTRTQLPPAYTNSFTRGVY is predicted to have the highest binding affinity to the B-Cells. The Spike peptide FTISVTTEI has the highest binding affinity to the Major Histocompatibility Complex class 1 (MHC I) Human Leukocyte Allele HLA-B*1503 (according to the MDockPeP and HPEPDOCK servers, docking scores were -153.9 and -229.356, respectively). The Nucleocapsid peptides KTFPPTEPK and RWYFYYLGTGPEAGL have the highest binding affinity to the MHC I HLA-A0202 allele and the three the Major Histocompatibility Complex class 2 (MHC II) Human Leukocyte Allele HLA-DPA1*01:03/DPB1*02:01, HLA-DQA1*01:02/DQB1-*06:02, HLA-DRB1, respectively. Docking scores of peptide KTFPPTEPK were -153.9 and -220.876. In contrast, docking scores of peptide RWYFYYLGTGPEAGL were ranged from 218 to 318. Furthermore, those peptides were predicted as non-toxic and non-allergen. Therefore, the combination of those peptides is predicted to stimulate better immunological responses with respectable safety.

Recurrent Stevens-Johnson syndrome in a patient with systemic lupus erythematosus: a case report.

Systemic lupus erythematosus (SLE) is a systemic disease that affects many organs. A few patients with SLE develop Stevens-Johnson syndrome (SJS), a life-threatening disease characterized by the appearance of a partial-thickness burn in the skin and mucous membranes. This report aims to increase awareness among clinicians about the relationship between SLE and SJS. An 18-year-old man was admitted to the rheumatology department of Omdurman Military Hospital with a skin rash that was preceded by symptoms of a short febrile illness. He had a maculopapular rash on his palms, soles, trunk, and mucous membranes. The patient had been diagnosed with SLE at 10 years of age and had had SJS three times since the diagnosis of SLE. Investigations to exclude other diagnoses were conducted, and a skin biopsy showed features consistent with early SJS. The patient received intravenous hydrocortisone, oral prednisolone, and oral acyclovir. The lesions resolved 3 weeks after treatment with acyclovir and he was discharged in good condition. A young patient with SLE and recurrent SJS with no immunodeficiency responded very well to the conventional SJS therapy after 3 weeks of treatment.