Sleep disorders and vascular responsiveness in patients with rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is the most common systemic autoimmune disease characterized by chronic systemic inflammation. Half of the deaths of patients with RA are due to cardiovascular diseases (CVD), considered to be 1.5 to -2.0-fold that in the general population. Patients with RA also experience poor sleep, which by itself is associated with endothelial dysfunction, CVD events and sudden death. Our aim was to study the mechanistic pathways and the correlations between sleep efficiency and vascular reactivity of patients with RA. METHODS AND RESULTS: A prospective study that evaluated quality of sleep using ACTi Graphs, vascular inflammation and endothelial function of 18 patients with RA. Inflammation was studied by levels of E-selectin, intercellular adhesion molecule 1 (ICAM-1) and NO in serum. Endothelial function was studied using the brachial artery plethysmography method. Eighteen RA patients (aged 57.56 ± 13.55 years; 16 women) with a long-standing active RA: Eight patients had impaired sleep efficiency and 10 had a good sleep efficiency. Those who had an impaired sleep had larger baseline diameters of the brachial artery (0.39 ± 0.08 cm vs. 0.32 ± 0.04 cm; P = 0.02). Negative correlations were found between baseline brachial artery diameter and sleep efficiency (P = 0.01), and with NO level (P = 0.04). Stepwise regression found that brachial artery diameter at baseline and NO level could predict sleep efficiency (r2  = 0.543, P = 0.01). CONCLUSION: Vascular reactivity could predict quality of sleep in patients with RA. Quality of sleep may serve as an independent CVD risk factor in patients with RA.

Decrease in 14-3-3η protein levels is correlated with improvement in disease activity in patients with rheumatoid arthritis treated with Tofacitinib.

14-3-3η protein is a proinflammatory mediator that may represent a novel diagnostic and prognostic biomarker for rheumatoid arthritis (RA). We assessed the correlation between changes in serum 14-3-3η levels and changes in clinical disease activity measures in RA patients treated with Tofacitinib (TOF). Paired serum samples from 35 patients with RA were obtained at baseline and 5 months after the initiation of treatment with TOF. The levels of 14-3-3η were measured by JOINT stat 14-3-3η ELISA test kits (Augurex Life Sciences Corp.). The cut-off was defined as 0.19 ng/ml. 14-3-3η positivity was found in 57% of the patients at baseline and in 37% of the patients after 5 months of treatment. Mean ± SD baseline 14-3-3η levels [4.92 ± 8.86 ng/ml] were significantly higher (p < 0.005) than 14-3-3η levels following treatment [1.97 ± 4.59 ng/ml]. A statistically significant improvement (p < 0.001) of CDAI, SDAI, DAS4ESR and DAS4CRP was achieved after 5 month of treatment. Decrease in 14-3-3η protein levels was highly correlated with improvement in DAS4ESR (r = 0.50, p < 0.01), DAS4CRP (r = 0.46, p < 0.01) and ESR (r = 0.36, p = 0.03) and moderately correlated with improvement in CDAI (r = 0.32, p = 0.065) and SDAI (r = 0.33, p = 0.051). The correlation between decrease in 14-3-3η levels and improvement in DAS4ESR remained significant in a partial correlation analysis controlling for ESR (r = 0.39, p = 0.02). This study demonstrates that in RA patients who were treated with TOF, decrease in 14-3-3η levels is correlated with improvement in clinical disease activity parameters. The 14-3-3η protein may serve as an objective biomarker for monitoring of TOF therapy response.

Monitoring public interest toward pertussis outbreaks: an extensive Google Trends-based analysis.

OBJECTIVES: Pertussis is a vaccine-preventable disease. Despite this, it remains a major health problem among children in developing countries and in recent years, has re-emerged and has led to considerable outbreaks. Pertussis surveillance is of paramount importance; however, classical monitoring approaches are plagued by some shortcomings, such as considerable time delay and potential underestimation/underreporting of cases. STUDY DESIGN: This study aims at investigating the possibility of using Google Trends (GT) as an instrument for tracking pertussis outbreaks to see if infodemiology and infoveillance approaches could overcome the previously mentioned issues because they are based on real-time monitoring and tracking of web-related activities. METHODS: In the present study, GT was mined from inception (01 January 2004) to 31 December 2015 in the different European countries. Pertussis was searched using the 'search topic' strategy. Pertussis-related GT figures were correlated with the number of pertussis cases and deaths retrieved from the European Centre for Disease prevention and Control database. RESULTS: At the European countries level, correlation between pertussis cases and GT-based search volumes was very large (ranging from 0.94 to 0.97) from 2004 to 2015. When examining each country, however, only a few reached the threshold of statistical significance. CONCLUSIONS: GT could be particularly useful in pertussis surveillance and control, provided that the algorithm is better adjusted and refined at the country level.

Validation of an Arabic version of an instrument to measure waterpipe smoking behavior.

OBJECTIVES: Reliable and valid measures of waterpipe smoking are essential to study its health effects. The purpose of this study was to examine the reliability and validity of an Arabic translation of Maziak questionnaire that assesses various aspects of waterpipe smoking in epidemiological studies. STUDY DESIGN: A cross-sectional study. METHODS: This questionnaire was translated, back translated, and culturally adapted to the local Arabic dialect. Construct and convergent validity were assessed in a sample of 119 daily waterpipe smokers (WPS) and 30 occasional WPS, defined as smoking at least one waterpipe per week but less than daily from Beirut and Doha (mean age = 52.4 years, males = 61.7%). Construct validity was assessed by comparing the smoking behavior of daily and occasional WPS. Convergent validity was assessed by correlating daily smoking intensity ('number of waterpipe smoked per day') with 'number of waterpipe smoked yesterday' and by correlating lifetime smoking exposure (waterpipe-year) calculated by multiplying number of waterpipe smoked per day × duration of waterpipe smoking with alternate measures obtained graphically (graphical waterpipe-year) or adjusted (adjusted waterpipe-year). Criterion validity was assessed by correlating daily smoking intensity and lifetime smoking exposure with serum cotinine level. Test-retest reliability was analyzed by re-administering the questionnaire to 30 daily and 30 occasional WPS after 2 weeks. RESULTS: Smoking intensity, patterns of use, and willingness to quit differed significantly between daily and occasional WPS. Daily smoking intensity correlated strongly with the number of waterpipe smoked yesterday (rs = 0.68, P < 0.001), but not in the occasional WPS (rs = 0.13, P = 0.70). Waterpipe-year correlated very strongly with adjusted waterpipe-year and graphical waterpipe-year (rs = 0.98, P < 0.001 and rs = 0.92, P < 0.001, respectively). Waterpipe-year, daily smoking intensity, and number of waterpipe smoked yesterday, correlated weakly but significantly with serum cotinine levels (rs = 0.243, P = 0.01; rs = 0.359, P < 0.01 and rs = 0.387, P < 0.01, respectively). The type and pattern of waterpipe use items showed high test-retest reliability with near perfect agreement (k > 0.9), the sharing and intention to quit waterpipe items had substantial agreement (k > 0.6), and the intent to quit item showed moderate agreement (k > 0.4). CONCLUSION: The questionnaire showed strong reliability, face validity, construct and convergent validity, and a weak but statistically significant criterion validity. Maziak questionnaire is valid and reliable for assessing waterpipe smoking patterns, intensity, and willingness to quit.

Impact of temperature and residence time on sewage sludge pyrolysis for combined carbon sequestration and energy production.

Environmental challenges related to sewage sludge call for urgent sustainable management of this resource. Sludge pyrolysis might be considered as a sustainable technology and is anticipated to support measures for mitigating climate change through carbon sequestration. The end products of the process have various applications, including the agricultural utilization of biochar, as well as the energy exploitation of bio-oil and syngas. In this research, sewage sludge was pyrolyzed at 500 °C, 600 °C, 750 °C, and 850 °C. At each temperature, pyrolysis was explored at 1hr, 2hrs, and 3hrs residence times. The ratio (H/Corg)at was tapped to imply organic carbon stability and carbon sequestration potential. Optimum operating conditions were achieved at 750 °C and 2hrs residence time. Produced biochar had (H/Corg)at ratio of 0.54, while nutrients' contents based on dry weight were 3.99%, 3.2%, and 0.6% for total nitrogen (TN), total phosphorus (TP), and total potassium (TK), respectively. Electrical conductivity of biochar was lesser than the feed sludge. Heavy metals in biochar aligned with the recommended values of the International Biochar Initiative. Heat content of condensable and non-condensable volatiles was sufficient to maintain the temperature of the furnace provided that PYREG process is considered. However, additional energy source is demanded for sludge drying.

Gender differences in cardiovascular risk of patients with rheumatoid arthritis.

BACKGROUND: Rheumatoid Arthritis (RA) is a chronic inflammatory disease, affecting women more than men, with a more aggressive course in women. DESIGN: A prospective study that recruited 58 patients (46 women aged 56 ± 12 years) with active long-standing RA disease (>12 months). Our goals were to measure their endothelial function, part of the cardiovascular risk assessment. METHODS: The Brachial Artery method measured endothelial function (the flow mediated percent change [FMD percentage] of the brachial artery diameter). A senior Rheumatologist clinically evaluated all subjects. Mann Whitney rank sum test estimated gender differences among the RA patients. RESULTS: Median FMD% change for men was -6.07%, while median FMD% change for women was 0.44% (Z = 2.38, P = 0.01). Baseline Brachial artery diameter was larger in men (Z = 2.52, P = 0.01); however, tender joints count and BMI were greater in women (Z=-2.24, P = 0.01; Z=-3.99, P = 0.001), respectively. CONCLUSIONS: Women with RA have significantly better endothelial function than men with RA. It means that even though RA is 3-fold more prevalent in women, women are more protected from atherosclerotic coronary artery disease and cardiac events.

Psoriatic and psoriatic arthritis patients with and without jet-lag: does it matter for disease severity scores? Insights and implications from a pilot, prospective study.

Background: Jet-lag may affect air-travelers crossing at least two time-zones and has several health-care implications. It occurs when the human biological rhythms are out of synch with respect to the day-night cycle at the country destination. Its effect in psoriasis is missing. We aimed to evaluate the effect of Jet-lag in psoriatic patients' management. Methods: This is a prospective observational study that enrolled psoriatic patients that underwent a flight: patients who experienced jet-lag were compared to patients who did not experience jet-lag. Before the flight, a dermatologist recorded clinical and demographical data with particular attention to Psoriasis Area Severity Index (PASI) and Disease Activity in Psoriatic Arthritis (DAPSA). Patients performed Self-Administered Psoriasis Area Severity Index (SAPASI), the Dermatology Life Quality Index (DLQI) and the pruritus Visual Analog Scale (VAS) scores. After the flight, patients completed the SAPASI, DLQI and pruritus-VAS scores. Results: The sample recruited comprised of 70 psoriatic patients aged 42.4 ± 9.7 years (median 42.5 years). Thirty (42.9%) were males, mean BMI was 25.5 ± 2.2 kg/m2. Average disease duration was 15.2 ± 7.1 years, and 20 (28.6%) subjects had developed PsA. Average hours of flight were 5.4 ± 3.5 (median 3.5 h), with 34 (48.6%) subjects reporting jet-lag. At the multivariate regression analysis, the change in the SAPASI score resulted correlated with jet-lag (regression coefficient 1.63, p = .0092), as well the change in the DLQI score (regression coefficient = 1.73, p = .0009), but no change on the pruritus VAS scale was found. Conclusions: The present study suggests that jet-lag may influence disease severity and DLQI scores, but not itch in psoriatic patients.

Inhibition of endothelial progenitor cells may explain the high cardiovascular event rate in patients with rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) patients may suffer cardiovascular (CV) events much more than the general population, and CV disease is the leading cause of death in patients with RA. Our hypothesis was that impaired function of endothelial progenitor cells may contribute to endothelial dysfunction and the clinical CV events of patients with RA. METHODS: About 27 RA patients (9 males and 18 females) with an active disease and 13 healthy subjects who served as the control group (nine males and four females) were enrolled to this prospective study. The ability to grow in culture colony-forming units of endothelial progenitor cells (CFU-EPCs) was measured, as well as their endothelial function using high-resolution ultrasonography of the brachial artery, and levels of C reactive protein (CRP) in the serum. For statistical analysis, we used the Student's t-test. RESULTS: As a group, patients with RA were older (P < 0.0001), had severe endothelial dysfunction (P<0.0001), with impaired ability to grow CFU-EPCs (P<0.0001), and a higher inflammatory state (P = 0001). No difference was observed in BMI. All RA patients had an active disease (DAS28 3.9 ± 0.9) for 9.2 ± 6.5 years. The same differences were observed in both genders. CONCLUSIONS: Patients with RA had an impaired ability to grow EPCs and severe endothelial dysfunction. Inability to grow colonies of EPCs reflects the impaired regenerative capacity of patients with RA and may explain the endothelial dysfunction and the high CV event rate among patients with RA.

Endothelial function in rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) patients are at higher risk of accelerated atherosclerosis. AIMS: To assess endothelial dysfunction in RA to find a possible mechanistic pathway that will explain the clinical phenomenon. METHODS: A prospective study recruited 44 RA patients with an active long standing (>12 months) disease. All underwent a detailed assessment of disease activity. To estimate the endothelial function the brachial artery method was performed, measuring flow mediated diameter percent (FMD%) change. Clustering analyses (hierarchical and k-means) were performed. Patients were compared to healthy subjects. RESULTS: Forty four RA patients (54.42 ± 11.14 years, females (72.7%)) with co-morbidities (70.5%), not taking tumor necrosis factor-blockers or disease modifying anti rheumatic drugs (63.6%). Only 6 (13.6%) had a normal endothelial function. Hierarchical and k-means clustering techniques showed statistically significant differences among the three clusters concerning disease activity score-28 (DAS-28)- erythrocyte sedimentation rate (ESR) (P = 0.000), DAS-28- C-reactive protein (CRP; P = 0.001), clinical disease activity index (P = 0.002), simplified disease activity index (P = 0.001), ESR (P = 0.000), (CRP) (P = 0.003) and FMD% (P = 0.009). The group with the highest FMD% values exhibited the lowest clinical scores and laboratory parameters. Patients with the lowest FMD% values co-clustered with subjects with positive but low FMD% changes and elevated clinical and laboratory parameters. CONCLUSIONS: Our study confirmed the feasibility of exploiting endothelial function in clinical practice as an early predictor of atherosclerosis in RA patients.

The diagnostic value of 14-3-3η protein levels in patients with rheumatoid arthritis.

14-3-3η may represent a useful diagnostic biomarker for rheumatoid arthritis (RA). We assessed the prevalence and serum levels of 14-3-3η in patients with RA and in patients with other rheumatic diseases. Serum levels of 14-3-3η were measured in 96 patients with RA, in 101 patients with other rheumatic diseases, and in 66 healthy subjects. All of the sera samples were evaluated by JOINT stat 14-3-3η ELISA test kits (Augurex Life Sciences Corp.). Median (IQR) 14-3-3η levels were significantly higher in the early RA group [0.25 ng/ml (0.075-3.11)] and in patients with established RA [0.15 ng/ml (0.08-1.26)] than in healthy subjects [0 ng/ml (0-0)] and disease controls: SLE [0.01 ng/ml (0-0.055)], AS [0.05 ng/ml (0-0.255)], and PsA [0.01 ng/ml (0-0.065)]. The prevalence of 14-3-3η positivity in patients with early RA was 58%, significantly higher than that in disease controls and healthy subjects (p < 0.001). In patients with established RA, this prevalence was 43%, and it was significantly higher than that in patients with other rheumatic diseases and healthy subjects (p < 0.05), excluding the AS group (p = 0.054). In the early RA cohort, the positivity for 14-3-3η, RF, and anti-CCP was 58%, 67%, and 71%, respectively. Eighty-two percent of the patients in this cohort were positive for at least one of these biomarkers. The concentration of 14-3-3η protein may be used to distinguish between patients with early RA and patients with other rheumatic diseases.

Comparative effect of irradiation and heating on the microbiological properties of licorice (Glycyrrhiza glabra L.) root powders.

PURPOSE: To determine the effect of gamma irradiation, steaming and heating on microbial load and chemical composition of licorice root powder. MATERIALS AND METHODS: Powders were exposed to hot air treatment at 60°C for 24 h, steaming at 1.1 bar and about 121°C for 15 min, and irradiation at 10 kGy using a (60)Co source. Microbial load, moisture, ash, and electrical conductivity (EC) values of licorice root powders were evaluated immediately after treatment, and after 12 months of storage. RESULTS: Total aerobic plate count (TAPC) of licorice roots powder (control sample), including coliform, Escherichia coli, and Klebsiella spp. were relatively high. Irradiation reduced the TAPC by 4 logs and total coliform to negative (less than 1 log(10) colony forming units (CFU) g(-1)) Klebsiella spp., E. coli, and Salmonella spp. were not detected (less than 1 log(10) CFU/g) in irradiated sample. Meanwhile, heating and steaming reduced the total count by 1 and 2 logs with slight effect on reducing the total coliforms counts. Also, irradiated samples were free of coliforms. No considerable changes in the moisture and ash were observed in irradiated powders, but the moisture increased due to steaming, and decreased due to dried heating. CONCLUSION: Gamma irradiation at 10 kGy was more effective than heating and steaming treatments in their microbial decontamination effect on the licorice root powders.

Malabsorption in systemic lupus erythematosus.

OBJECTIVE: To screen patients with SLE for malabsorption. METHODS: Twenty-one patients fulfilling the American College of Rheumatology (ACR) criteria for SLE were enrolled in the study. Patients were screened for malabsorption by the D-Xylose test (DXT) and by microscopic examination of the stool for fat droplets. All patients underwent upper GI endoscopy with biopsy from the second portion of the duodenum. The specimen was examined for morphologic abnormalities and for the presence of IgG, IgM, IgA, and kappa and lambda light chains. Ten patients without SLE served as controls. RESULTS: A history of abdominal pain and occasional diarrhea was elicited in 2/21 patients. These patients were found to have an abnormal DXT and excessive fecal fat excretion. In one of these patients, histologic examination revealed flattened and deformed villi with an inflammatory infiltrate. Two other patients showed isolated excessive fecal fat excretion with a normal microscopic appearance of the mucosa. In 20/21 patients the small bowel histology was normal. In all patients, immunoperoxidase staining revealed a normal quantity and distribution of the immunoglobulins and light chains within the intestinal mucosa. No correlation was demonstrated between CH50, C3, C4, anti-dsDNA levels and the malabsorption. CONCLUSION: In this series of SLE patients, the prevalence of malabsorption was 9.5%, and was even higher if isolated fat malabsorption was considered. A search for malabsorption in patients with SLE, and in particular in those with abdominal complaints, is recommended. The pathogenesis is not yet clear and warrants further investigation.

Synergetic effect of gamma irradiation and moisture content on decontamination of sewage sludge.

Samples of concentrated municipal sewage sludge, stored for 2, 4 and 6 months, with moisture contents of 2%, 20%, 40%, 60%, and 80% were exposed to doses of 0, 1, 2, 3, 4 and 5 kilogray (kGy) of gamma irradiation. Immediately after irradiation, total microbial count and bacterial pathogens in sewage sludge were determined. The results indicated that in all tested sewage sludge samples, bacterial pathogens including Enterobacter sp., Klebsiella sp., Salmonella sp., and Escherichia coli were initially detected. All doses of gamma irradiation reduced the total counts of microorganisms. D(10) of total count decreased with increase in the moisture content of the sewage sludge. The lowest lethal dose for tested bacterial pathogens was 5 kGy in air dried sewage sludge. In addition for wet sewage sludge having more than 40% moisture, the lethal dose was 1 kGy, for samples taken at different storage periods 2, 4 and 6 months, and therefore the cost per unit could be decreased to half when wet sewage sludge (about 50% moisture) was used.

Intravenous administration of gentamicin once daily versus thrice daily in adults.

The efficacy and safety of intravenous gentamicin administered once daily versus thrice daily was evaluated in adults. Patients over 16 years of age with a suspected or documented gram-negative infection were randomly divided into two groups: one group received gentamicin intravenously 4.5 mg/kg once daily (n = 48), and the other received 1.5 mg/kg every eight hours (n = 52). Baseline characteristics were comparable in the two groups. The mean peak level of gentamicin in the once daily group was significantly higher than that in the thrice daily group, 8.7 +/- 2.3 mg/l versus 4.6 +/- 1.2 mg/l (p < 0.005), and the trough level lower, 0.7 +/- 0.3 mg/l versus 1.1 +/- 0.9 mg/l (p < 0.005). The clinical cure rate was significantly higher in the once daily group, 42 of 48 (87.5%) versus 36 of 52 (69.2%). The microbiological cure rate was also better in the once daily group than in the thrice daily group (31 of 36 versus 28 of 38 patients evaluated), although this difference was insignificant. Nephrotoxicity was not observed in either group, but ototoxicity was present in three of the patients treated thrice daily. A once daily dosing regimen of gentamicin is more effective and less ototoxic than a thrice daily regimen.

Behçet's disease in Israel: the influence of ethnic origin on disease expression and severity.

OBJECTIVE: To evaluate the relationship between ethnic origin and manifestations of Behçet's disease (BD) in Israel. METHODS: We studied 100 Israeli patients with BD, 66 Jews and 34 Arabs. The 3 largest ethnic groups of Jewish patients originated from Iran/Iraq (n = 21), Turkey (n = 12), and North African countries (n = 21). Patients were evaluated with respect to the entire spectrum of disease manifestations, and a systemic severity score for BD was calculated for each patient. Disease expression was compared between Jewish and Arab patients and among Jewish ethnic groups. RESULTS: There were no statistically significant differences between Jewish and Arab patients with respect to male:female ratio, prevalence of HLA-B5, age of disease onset, or disease duration. Disease expression and severity score were also similar in the 2 groups, but Arab patients had a higher rate of posterior uveitis (20.6 vs 4.6%; p < 0.03). Among the 3 largest Jewish ethnic groups, patients of North African origin had a significantly higher rate of ocular disease (p < 0.01), mainly in the form of anterior uveitis (p < 0.01). These patients also had higher rates of arthritis, overall vascular disease, deep vein thrombosis, and neuro-Behçet without reaching statistical significance. The disease severity score in this group was significantly higher compared to the other Jewish ethnic groups (p < 0.02). CONCLUSION: The expression of BD is similar in Israeli Jewish and Arab patients but the latter have more severe eye disease. The disease in Israeli Jewish patients is most severe in those originating from North African countries.

Thrombophilic factors and their relation to thromboembolic and other clinical manifestations in Behçet's disease.

OBJECTIVE: To evaluate the prevalence of thrombophilic factors known to induce intravascular clotting and to assess their relationship with thromboembolic complications and the other clinical manifestations in Behçet's disease (BD). METHODS: Twenty-five patients with established BD were studied. Twenty patients with rheumatic conditions not known to be associated with venous or arterial thromboembolic phenomena served as controls. Eight of the patients with BD (32%) had either deep vein thrombosis (6 patients), arterial thromboembolic phenomena (2), or both (2). All participants were tested for IgG and IgM anticardiolipin antibody (aCL) levels, the presence of circulating lupus anticoagulant (LAC), protein C, protein S, and antithrombin III activity, activated protein C resistance, and where appropriate factor V Leiden mutation. RESULTS: Elevated levels of IgG aCL were detected in 10 (40%) patients with BD compared to one (5%) in the control group (p = 0.012). No significant differences were noted in the other variables studied between the 2 groups. No statistically significant correlation was found between any variable and the clinical manifestations. CONCLUSION: Patients with BD do not have decreased protein C, protein S, or antithrombin III activity, activated protein C resistance, circulating LAC, or elevated levels of IgM aCL. A significant number of patients have elevated levels of IgG aCL but they are not associated with venous or arterial thrombosis. No correlation was found between any variable and other clinical manifestations of the disease.