The prevalence and clinical spectrum of post-Covid syndrome in patients with rheumatic diseases: a single-center experience.

Post-coronavirus disease (COVID) syndrome (PCS) is a term used to describe the clinical condition of patients who have recovered from COVID-19 but are still experiencing prolonged effects of infection or persistent symptoms for longer than expected. Although PCS has been previously studied in the general population, it has not been investigated in a specific population of patients with inflammatory rheumatic disease (IRD). This study aims to evaluate the presence and frequency of PCS among our rheumatology outpatients. This is a cross-sectional study of patients with IRD whose symptoms persisted for 12 weeks after the detection of COVID-19 infection. The patients were assessed with a survey form during their routine clinic follow-up or by contacting them by phone. Patients' demographics, diagnosis, medication, comorbidities, outcome of COVID-19, and symptoms related to PCS were collected. Fifty-three patients with IRD and COVID (mean age: 48.5 13.99 years, 71.7% women) were included. PCS was observed in 36 (67.9%) patients. Twenty-two (41.5%) of them had three or more symptoms; 14 (26.4%) had one or two symptoms. Although more than 30 symptoms were detected, the most frequent were fatigue and weakness. No significant relationship was detected between the development of PCS and gender, age, disease duration, presence of COVID-related complications, and the need for oxygen support, except for smoking which showed a protective effect (p=0.008). PCS was detected in more than half of the patients. There was no independent risk factor for the development of PCS, except smoking.

Microwave-dried or air-dried? Consumers' stated preferences and attitudes for organic dried strawberries. A multi-country investigation in Europe.

Non-thermal food processing technologies are becoming more important in the organic food sector because, beyond preserving the organic feature, they could offer organic products with additional benefits in terms of enhanced nutritional content and healthiness as well as better sensory properties that could satisfy the more complex demands of organic consumers. Berries have a well-known health benefits and show increasing market shares in European markets while dehydration can increase the food convenience in terms of extended shelf-life. This study investigates for the first time organic consumers' stated preferences, attitudes and individual differences for a non-thermal organic processing technology. Specifically, we investigated consumers' preferences for organic dried strawberries varying in drying technology used, such as the most conventional (i.e. thermal) air drying and the most innovative (i.e. non-thermal) microwave drying, origin, price levels, and nutrient contents in three European countries: Norway, Romania and Turkey. Data from a total of 614 consumers were collected through an online choice experiment. Results show that on average consumers prefer organic dried strawberries produced with air drying technology that have national origin, with natural nutrient content and at low price, but country and individual differences are identified. Consumers who showed least rejection for microwave dried products are young, mostly from Norway and have higher positive attitudes towards new food technologies. Consumers who showed most rejection for microwave dried products are older, mostly from Turkey and have higher positive attitudes for organic, natural and ecological products. Organic producers who adopt microwave drying might better inform consumers about the characteristics, the process and highlight the nutritional benefits of such technology. Finally, this research informs policy makers about the need to define and regulate more clearly microwave drying as an organic technology, as well as to regulate labelling to ensure that consumers are not misled and correctly informed about the new technology.

Processing of a novel powdered herbal coffee (Pistacia Terebinthus L. Fruits Coffee) and its sensorial properties.

In this study, the effects of roasting method, grinding and reduction in oil content on the characteristics of Pistacia terebinthus fruit coffee were investigated. Pistacia terebinthus fruit was roasted by microwave, pan and combined (microwave and convection) methods. The degree of roasting was determined by L*, a*, b* color values. The roasting times were 1,500, 1,900 and 1,620 s for microwave, pan and combined roasting methods, respectively. Cold press was used to reduce the oil content both prior to roasting and after the roasting. The oil content was reduced to around 21.5 % in all roasting methods to approach to that of coffee beans. Powdered Pistacia terebinthus fruit coffee brews were compared with each other and Turkish coffee in terms of aroma, flavor, acidity aftertaste, and overall acceptability. Sensorial analysis results showed that coffee brews prepared by pressing after the roasting process were better than those pressing prior to roasting.

Perioperative anesthetic and surgical complications of the Nuss procedure.

OBJECTIVE: The Nuss procedure is a chest wall remodeling surgery performed in patients with pectus excavatum. This study was performed to analyze perioperative surgical and anesthetic complications with the Nuss procedures. DESIGN: A retrospective analysis. SETTING: An academic hospital. PARTICIPANTS: Two hundred fourteen patients (children, adolescents, and adults) undergoing the Nuss procedure over 6 years. INTERVENTIONS: Patient age and sex, premorbid diseases, indications for surgery, patient position during the procedure, the length of surgery, time to hospital discharge, postoperative analgesia method, and the presence of perioperative complications were recorded. MEASUREMENTS: No mortality was observed. The overall complication rate was 18.7%, but the overall event rate was 42.6% (91 events in 40 patients). Intraoperative hypotension, tachycardia, and hypercapnia were the most common complications (4.7%), followed by postoperative ileus (3.2%), pneumothorax (right, left, or bilateral; 4.2%), lung parenchymal laceration (2.3%), and postoperative nausea and vomiting (2.3%). Two patients had an ulnar nerve palsy and 1 patient had a brachial nerve palsy as a result of surgical position. CONCLUSION: Although the Nuss procedure is reported to be minimally invasive, some serious complications concerning both surgery and anesthesia should not be overlooked.

Determination of volatile nitrosamines in grilled lamb and vegetables using comprehensive gas chromatography - nitrogen chemiluminescence detection.

The grilling of meat may generate dangerous levels of mutagenic and carcinogenic nitrosamines (NAs). Meat and vegetable samples underwent a two-step solid-phase extraction before analysis by comprehensive gas chromatography with a nitrogen chemiluminescence detection system (GCxGC-NCD). The GCxGC-NCD method showed high selectivity, sensitivity and equimolarity in its response to six specific NAs. NA contamination of charcoal-grilled lamb at various stages of cooking and with various fat contents and also charcoal-grilled vegetables were investigated. The grilling of lamb on unready charcoal resulted in the formation of considerable quantities of NAs. Grilling lamb on properly prepared, ready charcoal resulted in an increase in total concentrations of six NAs from 0 to 4.51 µg kg(-1) over a period of 16 min. Increasing the fat content of the grilled lamb from 5% to 20% caused a modest increase in total concentrations of the six investigated NAs from 4.51 to 5.30 µg kg(-1).

Finalisation and validation of the rheumatoid arthritis impact of disease score, a patient-derived composite measure of impact of rheumatoid arthritis: a EULAR initiative.

OBJECTIVE: A patient-derived composite measure of the impact of rheumatoid arthritis (RA), the rheumatoid arthritis impact of disease (RAID) score, takes into account pain, functional capacity, fatigue, physical and emotional wellbeing, quality of sleep and coping. The objectives were to finalise the RAID and examine its psychometric properties. METHODS: An international multicentre cross-sectional and longitudinal study of consecutive RA patients from 12 European countries was conducted to examine the psychometric properties of the different combinations of instruments that might be included within the RAID combinations scale (numeric rating scales (NRS) or various questionnaires). Construct validity was assessed cross-sectionally by Spearman correlation, reliability by intraclass correlation coefficient (ICC) in 50 stable patients, and sensitivity to change by standardised response means (SRM) in 88 patients whose treatment was intensified. RESULTS: 570 patients (79% women, mean ± SD age 56 ± 13 years, disease duration 12.5 ± 10.3 years, disease activity score (DAS28) 4.1 ± 1.6) participated in the validation study. NRS questions performed as well as longer combinations of questionnaires: the final RAID score is composed of seven NRS questions. The final RAID correlated strongly with patient global (R=0.76) and significantly also with other outcomes (DAS28 R=0.69, short form 36 physical -0.59 and mental -0.55, p<0.0001 for all). Reliability was high (ICC 0.90; 95% CI 0.84 to 0.94) and sensitivity to change was good (SRM 0.98 (0.96 to 1.00) compared with DAS28 SRM 1.06 (1.01 to 1.11)). CONCLUSION: The RAID score is a patient-derived composite score assessing the seven most important domains of impact of RA. This score is now validated; sensitivity to change should be further examined in larger studies.

Analysis of roasted and unroasted Pistacia terebinthus volatiles using direct thermal desorption-GCxGC-TOF/MS.

The objective of this study was to determine the effects of roasting time on volatile components of Pistacia terebinthus L., a fruit growing wild in Turkey. The whole fruit samples were pan roasted for 0, 5, 10, 15, 20 and 25min at 200°C. Volatile compounds were isolated and identified using the direct thermal desorption (DTD) method coupled with comprehensive gas chromatography - time of flight mass spectrometry (GCxGC-TOF/MS). The major components of the fresh hull of P. terebinthus were α-pinene (10.37%), limonene (8.93%), ß-pinene (5.53%), 2-carene (4.47%) and γ-muurolene (4.29%). Eighty-three constituents were characterised from the volatiles of fresh whole P. terebinthus fruits obtained by direct thermal desorption with α-pinene (9.62%), limonene (5.54%), γ-cadinane (5.48%), ß-pinene (5.46%), ß-caryophyllene (5.24%) being the major constituents. The type and the number of constituents characterised were observed to change with differing roasting times. Limonene (5.56%), α-pinene (4.84%), 5-methylfurfural (4.78%), 5-hydroxymethylfurfural (5-HMF, 3.89%), dimethylmetoxyfuranone (3.67%) and 3-methyl-2(5H)furanone (3.12%) were identified as the major components among the 104 compounds characterised in the volatiles of P. terebinthus, roasted for 25min. In addition, volatiles of fully roasted P. terebinthus fruits contained furans and furanones (15.42%), pyridines (4.45%) and benzene derivatives (3.81%) as the major groups.

Histopathological effects on epidural tissue of bolus or continuous infusions through an epidural catheter in ewes.

This study was performed to evaluate the histopathological effects of epidural drug injection given either by intermittent bolus or continuous infusion through a catheter on epidural tissue. Fourteen ewes received intermittent bolus injections of morphine with bupivacaine, or a bolus of the same drugs followed by continuous infusion for 5 days. After 5 days, histopathological examination of the epidural space revealed mild to moderate inflammatory changes, and focal fibrosis surrounding the catheter in all ewes. The similarity of the inflammatory reaction in the control and drug treated groups seems to indicate that neither intermittent bolus or continuous infusion after a bolus dose caused histopathological changes in the epidural space beyond that caused by the catheter itself.

Smokers and non smokers with rheumatoid arthritis have similar clinical status: data from the multinational QUEST-RA database.

OBJECTIVES: To analyse clinical severity/activity of rheumatoid arthritis (RA) according to smoking status. METHODS: The QUEST-RA multinational database reviews patients for Core Data Set measures including 28 swollen and tender joint count, physician global estimate, erythrocyte sedimentation rate (ESR), HAQ-function, pain, and patient global estimate, as well as DAS28, rheumatoid factor (RF), nodules, erosions and number of DMARDs were recorded. Smoking status was assessed by self-report as 'never smoked', 'currently smoking' and 'former smokers'. Patient groups with different smoking status were compared for demographic and RA measures. RESULTS: Among the 7,307 patients with smoking data available, status as 'never smoked,' 'current smoker' and 'former smoker' were reported by 65%, 15% and 20%. Ever smokers were more likely to be RF-positive (OR 1.32;1.17-1.48, p<0.001). Rheumatoid nodules were more frequent in ever smokers (OR 1.41;1.24-1.59, p<0.001). The percentage of patients with erosive arthritis and extra-articular disease was similar in all smoking categories. Mean DAS28 was 4.4 (SD 1.6) in non-smokers vs. 4.0 (SD 1.6) in those who had ever smoked. However, when adjusted by age, sex, disease duration, and country gross domestic product, only ESR remained significantly different among Core Data Set measures (mean 31.7mm in non-smokers vs. 26.8mm in ever smoked category). CONCLUSIONS: RA patients who had ever smoked were more likely to have RF and nodules, but values for other clinical status measures were similar in all smoking categories (never smoked, current smokers and former smokers).

Disparities in rheumatoid arthritis disease activity according to gross domestic product in 25 countries in the QUEST-RA database.

OBJECTIVE: To analyse associations between the clinical status of patients with rheumatoid arthritis (RA) and the gross domestic product (GDP) of their resident country. METHODS: The Quantitative Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST-RA) cohort includes clinical and questionnaire data from 6004 patients who were seen in usual care at 70 rheumatology clinics in 25 countries as of April 2008, including 18 European countries. Demographic variables, clinical characteristics, RA disease activity measures, including the disease activity score in 28 joints (DAS28), and treatment-related variables were analysed according to GDP per capita, including 14 "high GDP" countries with GDP per capita greater than US$24,000 and 11 "low GDP" countries with GDP per capita less than US$11,000. RESULTS: Disease activity DAS28 ranged between 3.1 and 6.0 among the 25 countries and was significantly associated with GDP (r = -0.78, 95% CI -0.56 to -0.90, r(2) = 61%). Disease activity levels differed substantially between "high GDP" and "low GDP" countries at much greater levels than according to whether patients were currently taking or not taking methotrexate, prednisone and/or biological agents. CONCLUSIONS: The clinical status of patients with RA was correlated significantly with GDP among 25 mostly European countries according to all disease measures, associated only modestly with the current use of antirheumatic medications. The burden of arthritis appears substantially greater in "low GDP" than in "high GDP" countries. These findings may alert healthcare professionals and designers of health policy towards improving the clinical status of patients with RA in all countries.

Does bilateral superficial cervical plexus block decrease analgesic requirement after thyroid surgery?

In this randomized, double-blind and controlled study we evaluated and compared the analgesic efficacy of bilateral superficial cervical plexus block and local anesthetic wound infiltration after thyroid surgery. Forty-five patients were assigned to 3 groups. After general anesthesia induction, bilateral superficial cervical plexus block with 0.25% bupivacaine 15 mL in each side was performed in Group I, and local anesthetic wound infiltration with 0.25% bupivacaine 20 mL was performed in Group II. In Group III (control) no regional block was administered. Intravenous patient-controlled analgesia was used to evaluate postoperative analgesic requirement. Neither visual analog scale scores nor total patient-controlled analgesia doses were different among groups. We concluded that bilateral superficial cervical plexus block or local anesthetic wound infiltration with 0.25% bupivacaine did not decrease analgesic requirement after thyroid surgery.

Effects of multiple pulmonary aspirations of enteral solutions on lung tissue damage.

BACKGROUND & AIM: The aim of this study was to compare the pulmonary histopathologic effects of enteral solutions with various lipid content, after multiple aspirations in rats. METHODS: Thirty Wistar albino rats were randomly assigned to one of three groups (n = 10). Saline solution (0.9%) (group C, control), Impact (lipid content, 28 g/l; group I), Pulmocare (lipid content, 93.3g/l; group P) were injected into the lung through the trachea, in a volume of 0.8 ml/kg. The aspiration procedure was performed three times in total, in every 2 days. After seven days from the first aspiration, rats were killed, and lungs were examined for histopathologic examination. RESULTS: Alveolar histiocytes were statistically higher in left lungs of the group I than the left ones of the control group (P < 0.05). Lipid-laden alveolar macrophages were significantly higher in left lungs of groups I and, P than left lungs of the control group (P<0.05). CONCLUSION: Lung tissue damage occurring after multiple pulmonary aspirations of Impact and Pulmocare, is histopathologically similar to each other, and is in the form of lipoid pneumonia. In cases of multiple pulmonary aspirations, volume of the aspirate and chronicity of the aspiration look like major impact factors rather than the amount of the lipid.

A double-blind trial of depot corticosteroids in Behçet's syndrome.

OBJECTIVES: Corticosteroids are widely used in Behçet's syndrome despite the absence of controlled studies. We assessed the effect of depot corticosteroids primarily for genital ulcers and secondarily for the other mucocutaneous manifestations of Behçet's syndrome. METHODS: We randomized 86 patients who had active disease with genital ulcers to receive either intramuscular corticosteroid injections (40 mg methylprednisolone acetate) or placebo every 3 weeks for 27 weeks. RESULTS: Seventy-six patients (88%) completed the treatment. There were no significant differences in the mean number of genital and oral ulcers, or folliculitis between groups. The mean number of erythema nodosum lesions was less in the corticosteroid group as a whole (P = 0.0046); subgroup analyses revealed that this was significant for females (P = 0.0148) but not for males (P = 0.1). CONCLUSION: Low-dose depot corticosteroids did not have any beneficial effect on genital ulcers. However, it was useful in controlling erythema nodosum lesions, especially among the females.

Oxidative burst response to monosodium urate crystals in patients with Behçet's syndrome.

OBJECTIVE: An erythematous response to intradermal injection of monosodium urate crystals (MSU) has been demonstrated in Behçet's syndrome (BS). To further elucidate the pathogenesis of this response, the effects of MSU on in vitro oxidative burst reaction of neutrophils and monocytes were investigated. METHODS: Peripheral blood mononuclear cells from patients with Behçet's syndrome (BS), rheumatoid arthritis (RA), familial Mediterranean fever (FMF) and healthy controls (HC) were incubated with 100 ng/ml phorbol myristate acetate (PMA) and MSU at different dosages (25-500 microg/ml). Oxidative burst reaction was evaluated in neutrophils and monocytes by flow cytometry. RESULTS: In patients with BS, oxidative burst of neutrophils was significantly increased compared to HC at 125 microg/ml and 250 microg/ml dosages of MSU (p < or = 0.001 and 0.004 respectively). In patients with FMF; there was also an increased oxidative burst reaction at 75 microg/ml, 250 g/ml and 500 microg/ml (p < or = 0.007; 0.001 and 0.004 respectively). In patients with BS, oxidative burst of monocytes was increased only at 125 g/ml dosage of MSU (p < or = 0.002). However, in patients with FMF monocyte burst response was increased at 25 microg/ml, 75 microg/ml and 125 g/ml (p < or = 0.004; < 0.0001; < 0.0001 and 0.002 respectively). In RA group, stimulation with PMA resulted in a higher oxidative burst reaction than FMF and BS (p < or = 0.000 and p < or = 0.008). No correlation was observed between oxidative burst of neutrophils or monocytes and intradermal responses to MSU crystals. CONCLUSION: Oxidative burst reaction with MSU is augmented in neutrophils and monocytes of BS. However, the response is not specific and is unassociated with skin dermal test which has a high specificity for BS.

CARD15 polymorphisms in Behçet's disease.

BACKGROUND: Behçet's disease (BD) is a chronic multi-system inflammatory disorder of unknown aetiology, which shares many features of the inflammatory bowel diseases (IBDs). CARD15 has recently been identified as the first susceptibility gene in Crohn's disease (CD). OBJECTIVE: Given certain clinical and pathological similarities between CD and BD, and recent evidence of linkage of BD to the CARD15 genomic region, the aim of this study was to investigate the role of CARD15 variants in determining susceptibility to BD. METHODS: We studied 374 BD patients from three ethnically homogeneous cohorts (white English, Turkish, and Middle Eastern Arabs of Palestinian and Jordanian descent). Mutation detection of CARD15 was performed by direct sequencing in a subset of patients from each group and the identified variants were genotyped in the complete cohorts. Case-control analyses were carried out with additional stratification by the BD-associated allele, HLA-B*51. RESULTS: Mutation detection identified six previously described CARD15 polymorphisms at a frequency of > 3%. Additionally, two of the three CD-associated polymorphisms were present, but at low frequency. The frequency of haplotypes, constructed from nine genotyped polymorphisms, demonstrated significant variation between different ethnic groups. However, case-control analyses demonstrated no association between the CARD15 polymorphisms and susceptibility to BD, irrespective of HLA-B*51 status. CONCLUSION: CARD15 variant alleles are not associated with susceptibility to BD. Other shared loci, currently under investigation, may determine susceptibility to both CD and BD.

Inclusion criteria as widely used for rheumatoid arthritis clinical trials: patient eligibility in a Turkish cohort.

OBJECTIVE: To identify the proportion of patients fulfilling the inclusion criteria widely used in most clinical trials for rheumatoid arthritis (RA)--including the recent clinical trials of anti-Tumor Necrosis Factor alpha (TNFalpha) agents--in a Turkish cohort. METHODS: 186 consecutive RA patients attending a routine tertiary rheumatology clinic were evaluated in 2 groups: Early RA group (group E): 31 patients with a disease duration of < or = 3 years (mean: 1.9 +/- 0.9 years); late RA group (group L): 155 patients with a disease duration of > 3 years (mean: 13.3 +/- 8.6 years). Patients were evaluated according to 2 different sets of inclusion criteria: (i) The widely used common inclusion criteria for RA clinical studies, as outlined by Sokka and Pincus; (ii) the criteria of two major anti-TNF clinical studies, ERA and ATTRACT. RESULTS: No patients in group E, and 9 (6%) patients in group L fulfilled the common criteria used in clinical studies for RA. In group E, 28 patients had already been started on methotrexate; 2 patients were on sulphasalazine and one patient was on leflunomide. Nevertheless, even if the criterion for previous use of methotrexate was not applied patients did not fulfill the rest of the criteria of ERA study. In group L, 9 out of 155 patients (6%) met the criteria for the ATTRACT study. CONCLUSION: Only few patients met the widely used inclusion criteria for most RA clinical trials and the recent clinical trials of TNFalpha agents in this Turkish cohort. This may be explained by the milder disease activity in this geographical region, which further emphasizes the need to consider development of new criteria for inclusion in clinical trials.

The art of alleviating pain in greek mythology.

We reviewed many of the essential Greek myths to identify the methods used at that time to relieve the pain of both illness and surgery, and we discovered many pioneering methods. Both gods and demigods implemented these methods to ease pain, to conduct surgery, and, on occasion, to kill mythological beings. The myths describe the three most common components of anesthesia: hypnosis, amnesia, and (an)algesia. Drugs and music-aided hypnosis were two of the most common methods use to treat emotional and surgical pain. This article identifies highlights in the development of concepts to treat pain in Greek mythology. The examples found in the Greek myths remind us of the historical significance of pain treatment.

The pustular skin lesions in Behcet's syndrome are not sterile.

BACKGROUND: The pustular skin lesions of Behcet's syndrome (BS) are clinically and histopathologically similar to ordinary acne, but BS patients get lesions at sites not commonly involved in acne, such as the legs and arms. The microbiology of these lesions has not been studied adequately. OBJECTIVE: To make a detailed study of the microbiology of BS lesions. METHODS: Subjects were patients with BS and acne vulgaris. Material was extracted from pustular lesions and directly plated to aerobic and anaerobic media by sterile swab. Anaerobic bacteria were identified using a commercial kit (API 20A). Aerobic bacteria were defined by standard procedures. RESULTS: 58 BS patients and 37 acne patients were studied. Pustules were cultured from the following sites: BS patients (70 pustules): face (17), back (30), chest (2), arm (4), leg (17); acne patients (37 pustules): face (27), back (6), chest (1), arm (2), leg (1). At least one type of microorganism was grown from each pustule. Staphylococcus aureus (41/70, 58.6%, p = 0.008) and Prevotella spp (17/70, 24.3%, p = 0.002) were significantly more common in pustules from BS patients, and coagulase negative staphylococci (17/37, 45.9%, p = 0.007) in pustules from acne patients. CONCLUSIONS: The pustular lesions of BS are not usually sterile. The microbiology of these lesions is different from ordinary acne. It remains to be determined whether the infection is secondary or has any pathogenic implications.

The analgesic and anti-inflammatory effects of subcutaneous bupivacaine, morphine and tramadol in rats.

The analgesic and anti-inflammatory effects of subcutaneously administered bupivacaine, morphine and tramadol on formalin-induced inflammation were compared. 0.25 % bupivacaine in Group B, 20 mg/kg tramadol in Group T, 1 mg/kg morphine in Group M and 0.9 % NaCl in Group S in a volume of 200 micro l were injected into the right hind paw of the rats (n: 40) 15 minutes before injection of 50 micro l 5 % formalin. Sedation and pain behaviour scores, number of flinches and licking-time were recorded. The degree of dermal edema, intraneural edema, vasodilation, erythrodiapedesis, infiltration of polymorphonuclear leukocyte/lymphocyte and mast cell counts were analyzed histopathologically. In Group T and B, circumferential changes were lower than in Group M and S. The pain behaviour scores were significantly lower in Group T and B. The number of flinches in Group T was lower than Group B and S. The vasodilation was significant only in Group M. The dermal edema was limited to deep dermis only in Group T. Preinflammational subcutaneous tramadol infiltration can provide effective analgesia and may have anti-inflammatory effects.