Antibody predictors of mortality and lung function trends in myositis spectrum interstitial lung disease.

OBJECTIVES: The impact of autoantibody profiles on prognosis of idiopathic inflammatory myositis associated interstitial lung disease (IIM-ILD) and myositis spectrum ILD with Myositis Specific Antibodies (MSA) remains unclear. This retrospective cohort study examines whether serological profiles are associated with mortality and longitudinal lung function change. METHODS: Baseline clinical/demographic characteristics and follow-up lung function of consecutive adult patients with IIM-ILD or Interstitial Pneumonia with Autoimmune Features (IPAF) positive for MSAs were extracted from three hospitals. Univariate and multi-variate Cox-Proportional Hazards analyses were used to compare mortality between autoantibodies. Regression models were used to analyse lung function trends. RESULTS: Of 430 included patients, 81% met IIM criteria, 19% were IPAF-MSA. On univariate analysis, risk factors associated with mortality included higher age, Charlson Co-morbidity Index and CRP; and lower BMI, baseline TLCO% and FEV1%. Compared to anti-MDA5-negativity, anti-MDA5-positivity (MDA5+) was associated with high mortality in the first 3 months (HR 65.2. 95%CI 14.1, 302.0), while no significant difference was seen thereafter (HR 0.55, 95%CI 0.14, 2.28). On multi-variate analysis, combined anti-synthetase antibodies carried a reduced risk of mortality (HR 0.63), although individually, mortality was reduced in anti-Jo1 + (HR 0.61, 95%CI 0.4-0.87) and increased in anti-PL7+ patients (HR 2.07, 95%CI 1.44-2.99). Anti-MDA5+ was associated with slow improvement in %FVC over the first 3 years, while anti-PL7+ was linked with a slow decline from 12 months onwards. CONCLUSIONS: Among autoantibody profiles in myositis spectrum disorders, anti-MDA5+ and anti-PL7+ confer higher mortality risks. Survivors of an early peak of mortality in anti-MDA5+ disease appear to have a favourable prognosis.

Skeletal muscles and Covid-19: a systematic review of rhabdomyolysis and myositis in SARS-CoV-2 infection.

OBJECTIVES: Myalgia is a widely publicised feature of Covid-19, but severe muscle injury can occur. This systematic review summarises relevant evidence for skeletal muscle involvement in Covid-19. METHODS: A systematic search of OVID and Medline databases was conducted on 16/3/2021 and updated on 28/10/2021 to identify case reports or observational studies relating to skeletal muscle manifestations of Covid-19 (PROSPERO: CRD42020198637). Data from rhabdomyolysis case reports were combined and summary descriptive statistics calculated. Data relating to other manifestations were analysed for narrative review. RESULTS: 1920 articles were identified. From these, 61 case reports/series met inclusion criteria, covering 86 rhabdomyolysis cases. Median age of rhabdomyolysis patients was 50 years, (range 6-89). 49% had either hypertension, diabetes mellitus or obesity. 77% were male. Symptoms included myalgia (74%), fever (69%), cough (59%), dyspnoea (68%). Median peak CK was 15,783U/L. 28% required intravenous haemofiltration and 36% underwent mechanical ventilation. 62% recovered to discharge and 30% died. Dyspnoea, elevated CRP and need for intravenous haemofiltration increased risk of fatal outcome. Additional articles relating to skeletal muscular pathologies include 6 possible concomitant diagnoses or relapses of idiopathic inflammatory myopathies and 10 reports of viral-induced muscle injuries without rhabdomyolysis. Localised myositis and rhabdomyolysis with SARS-CoV-2 vaccination have been reported. CONCLUSIONS: Rhabdomyolysis is an infrequent but important complication of Covid-19. Increased mortality was associated with a high CRP, renal replacement therapy and dyspnoea. The idiopathic inflammatory myopathies (IIM) may have viral environmental triggers. However, to date the limited number of case reports do not confirm an association with Covid-19.

Psychiatric Providers' Willingness to Participate in Shared Decision Making When Prescribing Psychotropics.

Background: Patients with mental health disorders experience difficulty in selecting treatments. With a paternalistic approach, patients are not offered an opportunity to provide input. Shared decision making (SDM) occurs when providers and patients collaborate on informed treatment decisions. Research on psychiatric providers' perceptions toward SDM is limited. Objective: This pilot study aimed to determine psychiatric providers' willingness to engage in SDM and factors that influence willingness. Methods: This cross-sectional, self-report study measured willingness, attitude, experiences, and barriers related to SDM as well as demographic/practice characteristics. A survey was e-mailed to psychiatric providers at 3 psychiatric institutions. Results: Out of 80 providers e-mailed, 29 (36.3%) responded. Providers had a favorable attitude toward SDM (3.26 ± 0.24, range = 1-4) and a high willingness to use SDM (3.43 ± 0.50, range = 1-4). The most common SDM methods were discussions (96.6%) and written material (89.7%). Common perceived barriers included limited patient capacity (86.2%) and limited time with patient (62.1%). Current SDM users (3.46 ± 0.51) had a higher willingness to engage in SDM than noncurrent users (3.00 ± 0.00), t = 4.63, df = 25.0, P < .001. Attitude and willingness were positively related (r = .62, P < .001). Attitude did not vary based on demographic/practice characteristics. Conclusions: Willingness to use SDM was positively related to a favorable attitude toward SDM. Larger, geographically diverse, randomized controlled trials need to be conducted to evaluate the willingness of psychiatric providers to conduct SDM.

Variceal bleeding caused by oesophageal varices: A manifestation of hepatocellular carcinoma in a 17-year-old girl.

The authors present the rare case of a 17-year-old girl referred to the medical assessment unit following a large upper gastrointestinal haemorrhage. On further evaluation, she was found to have a primary hepatocellular carcinoma with extensive metastases. In our patient, the tumour was deemed incurable by resection, liver transplantation or percutaneous treatment. She underwent palliative chemotherapy and passed away 11 months following presentation.

Synthesis and characterization of new chromium, molybdenum and tungsten complexes of 2-[2-(methylaminoethyl)] pyridine.

A green chemistry route of synthesis using direct sunlight irradiation for the reactions of [M(CO)(6)] M=Cr, Mo or W with 2-[2-(methylaminoethyl)] pyridine (maepy) in THF. The reactions resulted in the formation of the oxo complex [Cr(2)(O)(4)(maepy)(2)] (1) and the tetracarbonyl complexes [Mo(CO)(4)(maepy)] (2) and [W(CO)(4)(maepy)] (3). The prepared complexes were characterized by elemental analysis, IR, NMR, mass spectrometry and magnetic measurement. The complexes (1-3) were further investigated by thermogravimetric technique (TG). The biological activity of maepy and complexes as antibacterial and antifungal reagents have been investigated.

Synthesis, characterization and biological activities of some new chromium molybdenum and tungsten complexes with 2,6-diaminopyridine.

The reactions of [M(CO)6], M=Cr, Mo, W with 2,6-diaminopyridine (dap) in ethanol was carried out under sun light and microwave irradiation routes of synthesis and compared with the traditional thermal reflux method. All routes resulted in the formation of the binuclear oxo complexes with the general formulas [M2(O)4(dap)2]. The prepared complexes were characterized using elemental analysis, IR, 1HNMR, mass spectrometry and magnetic measurement. The biological activity of dap and its complexes as antibacterial and antifungal reagents have been screened.

Spectral and thermal studies of some chromium and molybdenum complexes with ONO donor Schiff bases.

Reactions of M(CO)(6), where M=Cr and Mo with Schiff bases prepared by the condensation of ethanolamine with either acetylacetone or benzoylacetone were investigated. The reactions of Cr(CO)(6) in benzene resulted in the formation of the tricarbonyl drivatives [Cr(CO)(3)(HL)], HL=acaceaH or baceaH. The HL proved to act as a tridentate ligand. The corresponding reactions with Mo(CO)(6) in dioxane gave the oxo complexes [Mo(2)O(6)(HL)(2)] with HL was a bidentate. All prepared complexes were investigated using elemental analysis, IR, mass spectrometry, UV-vis absorption spectra and magnetic measurement. Thermal behaviors of the complexes were studied using by thermogravimetry (TG). Schemes for the thermal decomposition were proposed along with their mass fragmentation patterns.

Spectroscopic and thermal studies of chromium(III), molybdenum(VI) and ruthenium(0) complexes of maleic hydrazide.

Interaction of maleic hydrazide (LH(2)) with [Cr(CO)(6)] in air at atmospheric pressure resulted in the formation of the complex [(LH)Cr(mu-O)(2)Cr(LH)] (1). Reaction of LH(2) with [Mo(CO)(6)] in air also gave the complex [(LH(2))O(2)Mo(mu-O)(2)MoO(2)(LH(2))] (2). Under the same conditions, the reaction of LH(2) with [Ru(3)(CO)(12)] resulted in the formation of the tricarbonyl complex [Ru(CO)(3)(LH(2))] (3). The complexes were characterized by elemental analysis, IR, and (1)H NMR spectroscopy. The thermal properties of the complexes were investigated by thermogravimetry technique.

Transduction of multiple cell types using improved conditions for gene delivery and expression of SV40 pseudovirions packaged in vitro.

This comprehensive study demonstrates highly efficient transduction of a wide variety of human, murine, and monkey cell lines, using a procedure for in vitro packaging of plasmid DNA in recombinant simian virus 40 (SV40) capsid proteins to form pseudovirions. The pseudovirions are encapsidated by the VP1 major capsid protein, with no SV40 sequence requirement, and are able to carry up to 17.7 kb of supercoiled plasmid DNA. We developed a procedure to scale-up production of SV40 pseudovirions, as well as an efficient protocol to concentrate the virions with no loss of activity. We also developed a method that allows transduction of 10 times more cells than the original protocol. This protocol was tested using supercoiled in vitro-packaged plasmid carrying the human multidrug-resistance gene (MDR1 encoding P-glycoprotein; P-gp), or the enhanced green fluorescent protein reporter gene (EGFP) in .45 human lymphoblastoid cells and in K562 human erythroleukemia cells. Multiple transductions at 24-h intervals were shown to increase expression using the EGFP reporter gene. The protocols developed in this study establish in vitro-packaged SV40 pseudovirions as one of the most efficient gene delivery systems.