A retrospective record review of tuberculous infections in rheumatoid arthritis patients on biologics in Malaysia.

INTRODUCTION: The aim of this study was to analyse the clinical characteristics of patients with rheumatoid arthritis receiving biologics therapy and investigate the association between types of biologics and tuberculosis (TB) infections in 13 tertiary hospitals in Malaysia. MATERIALS AND METHODS: This was a retrospective study that included all RA patients receiving biologics therapy in 13 tertiary hospitals in Malaysia from January 2008 to December 2018. RESULTS: We had 735 RA patients who received biologics therapy. Twenty-one of the 735 patients were diagnosed with TB infection after treatment with biologics. The calculated prevalence of TB infection in RA patients treated with biologics was 2.9% (29 per 1000 patients). Four groups of biologics were used in our patient cohort: monoclonal TNF inhibitors, etanercept, tocilizumab, and rituximab, with monoclonal TNF inhibitors being the most commonly used biologic. The median duration of biologics therapy before the diagnosis of TB was 8 months. 75% of patients had at least one co-morbidity and all patients had at least one ongoing cDMARD therapy at the time of TB diagnosis. More than half of the patients were on steroid therapy with an average prednisolone dose of 5 mg daily. CONCLUSION: Although the study population and data were limited, this study illustrates the spectrum of TB infections in RA patients receiving biologics and potential risk factors associated with biologics therapy in Malaysia.

Growth of 1D TiO2nanostructures on Ti substrates incorporated with residual stress through humid oxidation and their characterizations.

Different Ti substrates, such as particles (as-received and ball milled), plate and TEM grid were oxidized for the growth of one dimensional (1D) TiO2nanostructures. The Ti substrates were oxidized for 4 h at temperatures of 700 °C-750 °C in humid and dry Ar containing 5 ppm of O2. The effects of residual stress on the growth of 1D TiO2nanostructures were investigated. The residual stress inside the Ti particles was measured by XRD-sin2ψtechnique. The oxidized Ti substrates were characterized using field emission scanning electron microscope equipped with energy dispersive x-ray spectroscope, transmission electron microscope, x-ray diffractometer and x-ray photoelectron spectroscope. Results revealed that humid environment enhances the growth of 1D TiO2nanostructures. Four different types of 1D morphologies obtained during humid oxidation, e.g. stacked, ribbon, plateau and lamp-post shaped nanostructures. The presence of residual stress significantly enhances the density and coverage of 1D nanostructures. The as-grown TiO2nanostructures possess tetragonal rutile structure having length up to 10µm along the 〈1 0 1〉 directions. During initial stage of oxidation, a TiO2layer is formed on Ti substrate. Lower valence oxides (Ti3O5, Ti2O3and TiO) then form underneath the TiO2layer and induce stress at the interface of oxide layers. The induced stress plays significant role on the growth of 1D TiO2nanostructures. The induced stress is relaxed by creating new surfaces in the form of 1D TiO2nanostructures. A diffusion based model is proposed to explain the mechanism of 1D TiO2growth during humid oxidation of Ti. The 1D TiO2nanostructures and TiO2layer is formed by the interstitial diffusion of Ti4+ions to the surface and reacts with the surface adsorbed hydroxide ions (OH-). Lower valence oxides are formed at the metal-oxide interface by the reaction between diffused oxygen ions and Ti ions.

Genitourinary trauma: a pictorial essay.

Genitourinary trauma is often overlooked in the setting of acute trauma. Usually other more life-threatening injuries take precedence for immediate management. When the patient is stabilized, radiologic imaging often plays a key role in diagnosing insults to the upper and lower genitourinary tract in the setting of trauma. Our aim is to provide a pictorial assay of imaging findings in upper and lower tract genitourinary trauma from a variety of mechanisms including blunt trauma, penetrating trauma, and iatrogenic trauma. A patient archiving and communication system will be used to review imaging studies of patients at our institution with genitourinary tract trauma. Cases of renal, ureteral, bladder, urethral, penile, and scrotal trauma will be considered for inclusion in our study. Multimodality imaging techniques will be reviewed. The imaging and pertinent findings that occur in various types of genitourinary trauma are outlined. Genitourinary trauma is often missed in the frenzy of acute trauma. It is important to have a high suspicion for injury especially in severe trauma, and in particular clinical settings. Although often not life threatening, recognizing the diagnostic imaging findings quickly is the realm of the astute radiologist so appropriate urologic management can be made.

Human erythrocyte CAI and CAII isoenzymes in hypoxemic and anemic fetuses.

OBJECTIVES: The aims of the present study are (1) to determine the erythrocyte CAI and CAII concentrations in SGA and anemic fetuses and to compare them with normal levels, and (2) to examine whether there is any correlation between fetal hypoxia or anemia and isoenzyme concentrations. METHODS: Human erythrocyte CAI and CAII concentrations were measured in SGA (n = 25) and anemic (n = 32) fetuses (20-36 weeks' gestation), using enzyme-linked immunosorbent assays (ELISA). The blood gases and pH were measured with an ABL-2c blood gas analyzer. RESULTS AND CONCLUSION: In the group of SGA fetuses, there was a tendency for CAI and CAII to be higher than for normal fetuses. The CAI/CAII ratio was also significantly higher than the normal ratio. There were significant correlations between blood Delta pH and Delta CAI, Delta CAII, or Delta CAI/CAII ratio in this group of fetuses. The levels of CAI, CAII, and CAI/CAII ratio were the same as for normal fetuses in the group of anemic fetuses from red cell isoimmunized pregnancies before their first intrauterine blood transfusion. However, in the group of anemic fetuses after their first blood transfusion, the levels of both isoenzymes were significantly higher than the normal blood levels. Within the latter group there was a significant negative correlation between the Delta CAI and the percentage of fetal erythrocytes in the circulation.