Comparability of patients with ANCA-associated vasculitis enrolled in clinical trials or in observational cohorts.

OBJECTIVES: To analyse the differences between patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) entered into randomised clinical trials (RCTs) and those followed in large observational cohorts. METHODS: The main characteristics and outcomes of patients with generalised and/or severe GPA or MPA with a five-factor score ≥ 1 enrolled in the French Vasculitis Study Group (FVSG) or the US-Canadian-based Vasculitis Clinical Research Consortium cohorts were compared to those enrolled in one of 2 FVSG clinical RCTs (WEG91, WEGENT) or 3 European Vasculitis Society clinical trials (CYCLOPS, CYCAZAREM, IMPROVE). RESULTS: 657 patients (65.3% with GPA) in RCTs were compared to 437 in cohorts (90.6% with GPA). RCT patients were older at diagnosis than the cohort patients (56.6 ± 13.9 vs. 46.8 ± 17.3 years), had higher Birmingham vasculitis activity score (19.5 ± 9.1 vs. 16.9 ± 7.4), and more frequent kidney disease (84.0% vs. 54.9%) but fewer ear, nose, and throat symptoms (56.8% vs. 72.2%). At 56 months post-diagnosis, mortality and relapse rates, adjusted for age and renal function, were higher for patients with GPA in RCTs vs. cohorts (10.7% vs. 2.5% [p=0.001] and 22.5% vs. 15.6% [p=0.03], respectively) but similar for patients with MPA (6.2% vs. 6.6% [p=0.92] and 16.6% vs. 10.1% [p=0.39], respectively). CONCLUSIONS: Patients with GPA or MPA in RCTs and those in observational cohorts show important differences that should be remembered when interpreting results based on these study populations.

Sensorineural hearing loss in systemic lupus erythematosus: case report and literature review.

OBJECTIVES: We present a case of systemic lupus erythematosus with symptomatic sensorineural hearing loss which was successfully treated with azathioprine, as assessed both clinically and radiologically. We also present a review of the relevant literature. CASE REPORT: A woman with systemic lupus erythematosus presented with sensorineural hearing loss, initially on the right and subsequently developing on the left over several months. An audiogram revealed profound neurosensory hearing loss bilaterally. The patient was treated with prednisone 60 mg daily and azathioprine 200 mg daily. An improvement on the left was noted on follow-up audiography as well as on magnetic resonance imaging of the internal auditory canals and surrounding structures. CONCLUSION: Sensorineural hearing loss has been described in autoimmune disorders but is rare. Aural symptoms have been described, with varying incidences (0-57.5 per cent), in systemic lupus erythematosus. However, symptomatic sensorineural hearing loss is rare in systemic lupus erythematosus. Prednisone appears essential when an immunological or vasculitic cause is found. The use of azathioprine should be considered, as well as follow-up with magnetic resonance imaging to detect improvement.

Afghanistan: demographic consequences of war, 1978-1987.

"In this paper, I attempt to analyse the effects of war on the size and age-sex structure of the Afghan population, and to estimate the size of the Afghan population in Afghanistan by age and sex for the years 1978-1987. In doing so, I try to estimate the number of persons killed during the war and examine the validity of the available estimates." The analysis is based on data from the 1979 census, a 1987 survey, and other sources.

Regional variations in the distribution of population and levels of urbanization in the Democratic Republic of Afghanistan 1979-80.

PIP: The Preliminary 1979-80 Population Census Data of Afghanistan were used to examine the following: the regional variations in the spatial distribution and density of population; the incidence of concentration of population; the regional variations in the degree and levels of urbanization; the regional variations in the concentration of urban population according to size class of urban centers; and the growth of urban population during 1972-73 to 1979-80. The extraordinary natural conditions of Afghanistan divide the country into 4 different geographical zones or regions and causes many essential natural, socioeconomic, and cultural differentials among the regions. The total population in 1979-80 was 15,540,030. Of this, 2,488,642 persons were Nomadics, 16% of the total population. Of the total settled population in Afghanistan nearly 85% was living in rural areas at the time of the census. Afghanistan is a sparsely populated country with a density of 20 persons/sq km. This low population density is because of the hazardous geographical conditions. Most of the country is either mountainous or suffers with desert conditions and temperature extremes. Only about 1/8 of the country's area is arable. Despite low arithmetical density, the physiological density (population arable land) and agricultural (rural population/arable land), densities for the country as a whole were substantially high, 165/sq ha and 138 persons/sq ha. The pattern of the distribution of the rural population followed the pattern of total population with the Northern Plains having the largest number of the country's rural population (34.3%), followed by Eastern Southern, Central, and Southern Western regions, but the pattern of distribution of the country's urban population was totally different. The Eastern Southern region possessed 50.3% of the total urban population. The Central region had only 3.7% of the urban population. Only 15% of the population lives in urban areas. In 1979 there were 63 urban centers. Only 1 primary city, Kabul, had a population above 500,000. 3 cities had populations above 100,000 but below 500,000. Over a period of 7 years, the urban population increased by 30.3% but only 2 new places were added to urban class, and they had a population of less than 5000. The growth of urban poulation was primariliy due to the increase in the population of the urban centers themselves rather than by the addition of new centers.^ieng