RESUMO
OBJECTIVES: This study aimed to determine the prevalence of gout in a general Turkish population, according to the American College of Rheumatology (Wallace) criteria proposed for gout classification. METHODS: This study was conducted in two districts of Izmir Province in Turkey, and involved 2835 subjects of ≥ 20 years of age. In the first stage, face-to-face interviews were performed at the subjects' registered households. In the second stage, subjects who gave positive answers in the screening questionnaire were invited to the hospital for a full examination, which included a detailed medical history, medication use and blood tests. RESULTS: A total of 2887 subjects were contacted, and complete interviews were obtained for 2835 (1551 women, 1284 men). A total of 312 subjects (227 women, 85 men) reported experiencing a short period of joint pain accompanied by swelling, redness or reduced range of movement, and 247 (79%) of these patients underwent a detailed clinical examination in the hospital. Gout was diagnosed in 11 patients (8 men, 3 women). We found minimum age- and sex-adjusted prevalence rates of gout of 0.31% (95% CI: 0.16-0.61) in subjects of ≥ 20 years of age, and 0.72% (95% CI: 0.37-1.24) in subjects of ≥ 40 years of age. CONCLUSIONS: Our data suggest that the estimated prevalence of gout (0.31%) is lower than the previously published estimated prevalence of rheumatoid arthritis (0.36%) in the same study population (14 definite rheumatoid arthritis cases among the 2835 subjects).
Assuntos
Gota/epidemiologia , População Urbana/estatística & dados numéricos , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Turquia/epidemiologiaRESUMO
OBJECTIVE: To evaluate new classification criteria for peripheral spondyloarthritis (SpA) in patients with SpA with peripheral manifestations only. METHODS: In this Assessment of SpondyloArthritis international Society (ASAS) study, two prespecified sets of criteria were compared against the European Spondylarthropathy Study Group (ESSG) and Amor criteria in newly referred consecutive patients with undiagnosed peripheral arthritis, and/or enthesitis, and/or dactylitis that usually began before 45 years of age. The clinical diagnosis (SpA vs no SpA) made by the ASAS rheumatologist served as reference standard. RESULTS: In all, 24 ASAS centres included 266 patients, with a final diagnosis of SpA being made in 66.2%. After adjustments a final set of criteria showed the best balance between sensitivity (77.8%) and specificity (82.9%): arthritis and/or enthesitis and/or dactylitis plus (A) one or more of the following parameters: psoriasis, inflammatory bowel disease, preceding infection, human leucocyte antigen B27, uveitis, sacroiliitis on imaging, or (B) two or more other parameters: arthritis, enthesitis, dactylitis, inflammatory back pain in the past, family history of SpA. The new criteria performed better than modified versions of the ESSG (sensitivity 62.5%, specificity 81.1%) and the Amor criteria (sensitivity 39.8%, specificity 97.8%), particularly regarding sensitivity. In the entire ASAS population of 975 patients the combined use of ASAS criteria for axial SpA and ASAS criteria for peripheral SpA also had a better balance (sensitivity 79.5%, specificity 83.3%) than the modified ESSG (sensitivity 79.1%, specificity 68.8%) and Amor criteria (sensitivity 67.5%, specificity 86.7%), respectively. CONCLUSIONS: The new ASAS classification criteria for peripheral SpA performed well in patients presenting with peripheral arthritis, enthesitis and/or dactylitis.
Assuntos
Espondilartrite/classificação , Adulto , Artrite Reativa/classificação , Artrite Reativa/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Doenças Inflamatórias Intestinais/complicações , Cooperação Internacional , Masculino , Pessoa de Meia-Idade , Psoríase/complicações , Sacroileíte/complicações , Sensibilidade e Especificidade , Espondilartrite/complicações , Espondilartrite/diagnóstico , Espondilite Anquilosante/classificação , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico , Uveíte/complicações , Adulto JovemRESUMO
OBJECTIVE: To validate and refine two sets of candidate criteria for the classification/diagnosis of axial spondyloarthritis (SpA). METHODS: All Assessment of SpondyloArthritis international Society (ASAS) members were invited to include consecutively new patients with chronic (> or =3 months) back pain of unknown origin that began before 45 years of age. The candidate criteria were first tested in the entire cohort of 649 patients from 25 centres, and then refined in a random selection of 40% of cases and thereafter validated in the remaining 60%. RESULTS: Upon diagnostic work-up, axial SpA was diagnosed in 60.2% of the cohort. Of these, 70% did not fulfil modified New York criteria and, therefore, were classified as having "non-radiographic" axial SpA. Refinement of the candidate criteria resulted in new ASAS classification criteria that are defined as: the presence of sacroiliitis by radiography or by magnetic resonance imaging (MRI) plus at least one SpA feature ("imaging arm") or the presence of HLA-B27 plus at least two SpA features ("clinical arm"). The sensitivity and specificity of the entire set of the new criteria were 82.9% and 84.4%, and for the imaging arm alone 66.2% and 97.3%, respectively. The specificity of the new criteria was much better than that of the European Spondylarthropathy Study Group criteria modified for MRI (sensitivity 85.1%, specificity 65.1%) and slightly better than that of the modified Amor criteria (sensitivity 82.9, specificity 77.5%). CONCLUSION: The new ASAS classification criteria for axial SpA can reliably classify patients for clinical studies and may help rheumatologists in clinical practice in diagnosing axial SpA in those with chronic back pain. TRIAL REGISTRATION NUMBER: NCT00328068.
Assuntos
Algoritmos , Articulação Sacroilíaca/patologia , Espondilartrite/classificação , Espondilite Anquilosante/classificação , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Reprodutibilidade dos Testes , Espondilartrite/diagnóstico , Espondilite Anquilosante/diagnósticoAssuntos
Espondilite Anquilosante/classificação , Humanos , Imageamento por Ressonância Magnética , Articulação Sacroilíaca , Espondilartrite/classificação , Espondilartrite/diagnóstico , Espondilartrite/epidemiologia , Espondiloartropatias/classificação , Espondiloartropatias/diagnóstico , Espondiloartropatias/epidemiologia , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/epidemiologiaRESUMO
OBJECTIVE: Takayasu's arteritis (TA) is a chronic, inflammatory vasculitis affecting the aorta and its major branches. Although it is more prevalent in Far-East Asia, the distribution of the disease is worldwide with different vascular involvement patterns and clinical manifestations. The objective of this study was to evaluate the demographic, clinical, angiographic and prognostic features of TA patients in Turkey. METHODS: Clinical and angiographic findings of 248 TA patients (228 female, 27 male) followed at 15 Rheumatology Centers were prospectively evaluated according to a predefined protocol. RESULTS: The mean age was 40.1 years (30.2 years at the clinical onset). Clinical manifestations included constitutional symptoms in 66%, absent or diminished pulses in 88%, bruits in 77%, extremity pain in 69%, claudication in 48%, hypertension in 43% and cerebrovascular accidents (CVA) in 18% of the patients. Renal artery stenosis, aortic regurgitation and pulmonary hypertension were present in 26%, 33% and 12%, respectively. According to the new angiographic classification, type V (50.8%) and Type I (32%) were the most frequent types of involvement. Corticosteroids were the main treatment in 93% of the patients alone (9%) or in combination with immunosuppressive agents (84%). Most frequently preferred immunosuppressive agents were methotrexate (63%), azathioprine (22%) and cyclophosphamide (13%). Remission was observed at least once in 94% of the patients and sustained remission in 71% during follow-up. CONCLUSION: The demographical, clinical and angiographic findings of TA patients in our series were similar to those reported from Japan, Brazil and Colombia. Combination therapies with immunosuppressive agents were the preferred choice of treatment in Turkey.
Assuntos
Glucocorticoides/uso terapêutico , Imunossupressores/uso terapêutico , Arterite de Takayasu , Adolescente , Adulto , Idade de Início , Idoso , Angiografia , Criança , Comorbidade , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Indução de Remissão , Arterite de Takayasu/diagnóstico , Arterite de Takayasu/tratamento farmacológico , Arterite de Takayasu/epidemiologia , Arterite de Takayasu/fisiopatologia , Turquia/epidemiologia , Adulto JovemRESUMO
OBJECTIVES: The aim of this study was to determine the prevalence of primary Sjogren's syndrome (pSS) in a general Turkish population according to the latest proposed American-European Consensus Group (AECG) criteria and European-1 (EU-1) criteria. METHODS: The study was conducted in two districts of Izmir and involved 2835 subjects 20 years of age and older. In the first stage, face-to-face interviews were performed at the registered households. In the second stage, subjects reporting symptoms of both dry eye and dry mouth were invited to the hospital for a full examination, which included Schirmer-1, sialometry and serologic tests. In the third stage, a minor salivary gland biopsy was performed as required. RESULTS: A total of 2887 subjects were contacted and a complete interview was obtained for 2835 (1551 female, 1284 male) subjects. A total of 159 subjects (126 female, 33 male) confirmed oral and ocular dryness, and 86 of these patients (54.1%) underwent a detailed clinical examination in the hospital. pSS was diagnosed in 10 patients (nine females) according to the EU-1 criteria, and in six patients (six females) according to the AECG criteria. We found a minimum crude prevalence of 0.21% [95% confidence interval (CI): 0.03-0.29] in the sample population and an age-sex adjusted prevalence of 0.16% (95% CI: 0.06-0.35), according to AECG criteria. According to EU-1 criteria, these prevalence rates were found to be 0.35% (95% CI: 0.10-0.45) and 0.28% (95% CI: 0.13-0.51) respectively. CONCLUSION: The pSS prevalence rates found in the Turkish population in this study were lower than the estimated prevalence rate in a general population.
Assuntos
Síndrome de Sjogren/epidemiologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Turquia/epidemiologia , Adulto JovemRESUMO
Nisin production of three bioengineered strains, (LAC338, LAC339 and LAC340) with immunity (nisFEG) and/or regulation (nisRK) genes of nisin biosynthesis on plasmids in the Lactococcus lactis LL27 nisin producer, was evaluated under pH-controlled and pH-uncontrolled batch fermentations. Optimization studies showed that fructose and yeast extract yielded the highest nisin activity. The strains LAC338, LAC339, and LAC340 produced 24, 45, and 44% more nisin, respectively, than wild-type L. lactis LL27 after 12-h incubation. However, sharp decreases in the yield of nisin were observed at the late phase of fermentation with LAC339 and LL27 in contrast to LAC340 and LAC338 strains for which the high level of nisin could be maintained longer. Obviously, increasing the copy number of the regulation genes together with immunity genes in the nisin producers retarded the loss of nisin in the late phase of the fermentation.
Assuntos
Engenharia Genética , Lactococcus lactis/crescimento & desenvolvimento , Lactococcus lactis/metabolismo , Nisina/biossíntese , Meios de Cultura/metabolismo , Técnicas de Cultura , Fermentação , Dosagem de Genes , Regulação Bacteriana da Expressão Gênica , Lactococcus lactis/genética , Plasmídeos/genéticaRESUMO
Nisin production in continuous cultures of bioengineered Lactococcus lactis strains that incorporate additional immunity and regulation genes was studied. Highest nisin activities were observed at 0.2 h(-1) dilution rate and 12.5 g l(-1) fructose concentration for all strains. Recombinant strains were able to produce greater amounts of nisin at dilution rates below 0.3 h(-1) compared to the control strain. However, this significant difference disappeared at dilution rates of 0.4 and 0.5 h(-1). For the strains LL27, LAC338, LAC339, and LAC340, optimum conditions for nisin production were determined to be at 0.29, 0.26, 0.27, and 0.27 h(-1) dilution rates and 11.95, 12.01, 11.63, and 12.50 g l(-1) fructose concentrations, respectively. The highest nisin productivity, 496 IU ml(-1) h(-1), was achieved with LAC339. The results of this study suggest that low dilution rates stabilize the high specific nisin productivity of the bioengineered strains in continuous fermentation. Moreover, response surface methodology analysis showed that regulation genes yielded high nisin productivity at wide ranges of dilution rates and fructose concentrations.
Assuntos
Engenharia Genética , Lactococcus lactis/genética , Lactococcus lactis/metabolismo , Nisina/metabolismo , Meios de Cultura/metabolismo , Fermentação , Cinética , Lactococcus lactis/química , Nisina/químicaRESUMO
OBJECTIVES: To investigate the role of shared epitope (SE) alleles in the short-term clinical response to leflunomide for the treatment of active RA. METHODS: In an open-label, multi-centre study of 16-weeks duration, 93 patients (82% female) fulfilling ARA 1987 RA criteria were treated with leflunomide (100 mg loading dose for 3 days, then 20 mg/day as the maintenance dose). The primary efficacy criterion was the response status according to the European League Against Rheumatism (EULAR) response criteria using Disease Activity Score-28 (DAS28) activity measure. SE determinations have been undertaken by polymerase chain reaction and sequence-specific oligonucleotide genotyping methods. RESULTS: The mean (s.d.) Disease Activity Score-28 (DAS28) was 5.1 (1.3) before the treatment, which was significantly decreased after 16 weeks [3.0 (1.1), P < 0.001]. According to the EULAR response criteria, 55 patients (59.1%) were classified as good responders. SE was positive in 51 (54.8%) of the patients, with 13 (13.9%) having SE homozygosity or carrying any two SE alleles. Among SE-positive patients, 68.6% (35/51) were good responders, compared with 47.6% (20/42) in SE negatives (P = 0.04). No difference was present according to SE hetero- or homozygosity (68.4 vs 69.2%). RF was also present significantly more frequently in the SE-positive group compared with negatives (78.4 vs 57.1%, P = 0.03). However, no significant difference was observed in the prevalence of RF positivity in patients with a good clinical response (72.7 vs 63.2%, P = 0.32). CONCLUSIONS: The results suggest that HLA-DRB1 SE presence may favourably affect the outcome of leflunomide monotherapy in an unselected group of RA patients with an active disease and naive to leflunomide.
Assuntos
Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/genética , Antígenos HLA-DR/genética , Isoxazóis/administração & dosagem , Adulto , Alelos , Artrite Reumatoide/imunologia , Biomarcadores/análise , Relação Dose-Resposta a Droga , Esquema de Medicação , Epitopos , Feminino , Seguimentos , Antígenos HLA-DR/análise , Cadeias HLA-DRB1 , Humanos , Leflunomida , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Musculoskeletal symptoms such as myalgia are well-known features in the course of trichinellosis; however, the characteristics of musculoskeletal findings have been described in detail in only 1 study. The present study was aimed to determine the joint and muscle symptoms in subjects diagnosed with acute trichinellosis at our rheumatology unit during a Trichinella britovi outbreak that occurred in Izmir, Turkey, in 2004. In total, 98 patients (55 females, 43 males; mean age 32.3 +/- 10.9 yr) were included in the study. A detailed history and full musculoskeletal examination were obtained in each patient. A self-administered questionnaire developed for recording the musculoskeletal symptoms was completed monthly until all the symptoms were resolved. Pain at the joints, restriction of movements (in shoulders, elbows, wrists, knees, ankles, and temporomandibular joints), myalgia, and muscle weakness (neck and shoulder girdle, muscles of the upper and forearm, back, thigh, and calf muscles) were assessed in every patient. Eosinophil counts, serum levels of creatine kinase, and lactate dehydrogenase also were analyzed. The most frequent musculoskeletal symptoms were muscle pain (86 cases [87.8%]), joint pain (83 [84.7%]), subjective muscle weakness (75 [76.5%]), and restriction of joint movements (63 [64.3%]). Calves, upper arm, neck and shoulder girdle, and forearms were the most affected muscle groups. Muscle pain was reported more frequently in the upper than in the lower extremities and during activity. The most frequent painful joints were shoulders, knees, wrists, and ankles. Upper extremity joints were affected more frequently than the lower extremity joints (77.6 vs. 70.4%). Joint pain occurred more frequently at rest. Both muscle weakness and restriction of joint movements were reported in and around the most frequently affected regions. No evidence of arthritis and objective muscle weakness was noted on physical examination in any patient. Musculoskeletal symptoms in the course of T. britovi infection are frequent but with an excellent prognosis. Joint pain in people suffering from acute trichinellosis may occur more frequently than reported previously.
Assuntos
Surtos de Doenças , Trichinella/classificação , Triquinelose/epidemiologia , Adulto , Animais , Antinematódeos/uso terapêutico , Artralgia , Biópsia , Bovinos , Extremidades , Feminino , Parasitologia de Alimentos , Humanos , Masculino , Produtos da Carne/parasitologia , Mebendazol/uso terapêutico , Debilidade Muscular , Músculo Esquelético/parasitologia , Músculos , Dor , Amplitude de Movimento Articular , Inquéritos e Questionários , Suínos , Trichinella/isolamento & purificação , Trichinella/patogenicidade , Triquinelose/tratamento farmacológico , Triquinelose/fisiopatologia , Turquia/epidemiologiaRESUMO
Takayasu's arteritis (TA) is a chronic arterial inflammation of unknown etiology involving mainly the aorta and its major branches. Genetic polymorphisms of cytokines are screened as susceptibility factors for TA in Turkey. A total of 94 patients with TA were investigated for the genetic polymorphisms of the interleukin genes IL12, IL2,and IL6 and were compared with 108 healthy control subjects using polymerase chain reaction-sequence-specific primer method. The frequencies of IL12B 1188 C allele (p = 0.03, OR = 1.7) and CC genotype (p = 0.007, OR = 3.7) were both higher in TA patients than in control subjects. TT genotype at IL2-330 (p = 0.006, OR = 2.4) and GG genotype at IL6-174 (p = 0.04, OR = 1.9) were more frequent in TA patients. Lower prevalence of GT genotype at IL2-330 (p = 0.005, OR = 0.4), CG genotype at IL6-174 (p = 0.001, OR = 0.4), and AG genotypes at IL6-598 (p = 0.01, OR = 0.4) were also detected. The polymorphism of IL-12 as well as IL-6 and IL-2 genes may contribute to susceptibility and pathogenesis of TA by altering cytokine production and inducing inflammation.
Assuntos
Predisposição Genética para Doença , Interleucina-12/genética , Interleucina-2/genética , Interleucina-6/genética , Arterite de Takayasu/genética , Adulto , Feminino , Humanos , Masculino , Reação em Cadeia da Polimerase , Polimorfismo Genético , TurquiaRESUMO
Applying absorption-elution techniques with homozygous typing cells and flow cytometry, a number of alloantibodies that recognized HLA-B62 but not B46 were identified. B62 and B46 are identical except in amino acids 66-76, which are probably recognized by the B62-specific antibodies. The patients who made these antibodies, however, had HLA antigens sharing amino acids 66-76 with B62, indicating that residues that are identical to the patient's own contribute to the antigenic determinants of foreign HLA molecules. Fine specificity analysis of most of these antibodies revealed that they recognized residues in the 66-76 segment in addition to other residues which were located in close proximity to this segment. We conclude that mismatched amino acid residues located in one part of the HLA molecule can interact with residues that are not different from those in the patient's own HLA molecules to form epitopes recognizable by alloantibodies. These findings should be helpful in improving our understanding of how to use current knowledge at the molecular level for the purpose of matching transplant donors and recipients.
Assuntos
Reações Antígeno-Anticorpo/imunologia , Epitopos/imunologia , Antígenos HLA-B/imunologia , Imunofenotipagem/métodos , Isoanticorpos/imunologia , Especificidade de Anticorpos , Reações Cruzadas , Citometria de Fluxo , Humanos , Transplante de Rim/imunologia , Linfócitos T/imunologiaRESUMO
Recent descriptions of epitopes within HLA class I antigens recognized by mouse monoclonal antibodies are providing an antigenic map of such molecules. However, for transplantation purposes, it is crucial to understand the epitope specificity of alloantibodies. To investigate this issue, we performed sequential absorption/elution studies with serum from a broadly sensitized patient and homozygous typing cells (HTCs) which shared one HLA-A,B antigen with the patient. Antibody reactivity in the different eluates was measured by flow cytometry in a panel of 20 HTCs. These studies revealed two major findings: (a) There were multiple antibodies recognizing one HLA antigen. For example, there were 8 anti-B62 antibodies, 8 anti-B51, 5 anti-B57, 5 anti-B46, and 4 anti-B35. (b) The reactivity of most antibodies correlated highly with the presence of specific amino acids at a given position in the target HLA molecule. Such residues were absent in most HLA antigens not recognized by the antibody. Most of the target residues were located in the accessible alpha helices or connecting loops, but at least one antibody reactivity appeared to be influenced by residues located in the beta sheets. The HLA antigens evaluated in this study were those of the B5, B15, B17 cross-reactive group which have multiple epitopic sites. However, further studies are necessary to determine if alloantibodies directed to other HLA molecules will have a similar or more restricted degree of complexity.
Assuntos
Especificidade de Anticorpos , Antígenos HLA/imunologia , Isoanticorpos/imunologia , Sequência de Aminoácidos , HumanosRESUMO
BACKGROUND: Gemcitabine (GEM) is an alternative chemotherapeutic agent for patients with metastatic bladder cancer. It is believed to be a well-balanced agent, having acceptable toxicity and enhanced antitumor activity. The integration of GEM into the initial chemotherapy plan for these patients is still being developed. CASE REPORT: The patient, male, aged 56 years, was suffering from a transitional cell carcinoma of the bladder. Due to frequent local superficial recurrences, radical cystectomy with pelvic lymphadenectomy and continent ileal diversion was performed. Four years after the operation a left inguinal lymphadenopathy was noted and metastatic bladder carcinoma was confirmed on biopsy. Cytotoxic therapy combining GEM and cisplatin and local external irradiation therapy was initiated. The patient developed extensive necrotising vasculitis with muscle damage after the second course of therapy. Chemotherapy was stopped immediately but this was not enough to relieve the symptoms of severe myalgia and swelling, and additional treatment consisting of cyclophosphamide and prednisolone was initiated. CONCLUSION: Although GEM seems to be relatively safe, some unexpected complications may occur during treatment. This case is not common, but it reinforces the need for careful attention to any new symptoms that seem to be unassociated with the primary disease. Prompt evaluation of such symptoms should be carried out in patients receiving GEM therapy.
Assuntos
Antimetabólitos Antineoplásicos/efeitos adversos , Carcinoma de Células de Transição/tratamento farmacológico , Desoxicitidina/análogos & derivados , Desoxicitidina/efeitos adversos , Recidiva Local de Neoplasia/tratamento farmacológico , Neoplasias da Bexiga Urinária/tratamento farmacológico , Vasculite/induzido quimicamente , Antimetabólitos Antineoplásicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células de Transição/radioterapia , Carcinoma de Células de Transição/secundário , Carcinoma de Células de Transição/cirurgia , Cistectomia , Desoxicitidina/administração & dosagem , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/radioterapia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária , GencitabinaRESUMO
OBJECTIVE: To estimate the prevalence of rheumatoid arthritis (RA) in an urban area in Izmir, Turkey. METHODS: The study was conducted in the Balcova and Narlidere districts of Izmir and a total of 2,887 people aged 20 years or older were contacted with a 98.2% acceptance rate. Nine medical doctors administered an RA questionnaire by face-to-face interview. Subjects reporting a history of swelling in at least 2 joints lasting more than 4 continuous weeks or a history of a diagnosis of rheumatoid arthritis, inflammatory joint rheumatism or joint rheumatism were considered as screening positive and they were invited to come in for an examination. RA cases were defined by the 1987 American College of Rheumatology (ACR) criteria modifiedfor use in population studies. RESULTS: A total of 301 subjects (243 women, 58 men), or 10.6% of those who received the questionnaire were screening positive. 240 (79.7%) of these agreed to undergo a clinical examination either in the clinic or at home. Among these, 14 (12 female, 2 male) patients fulfilled the ACR criteria for RA. The prevalence of RA was 0.49% (95% CI 0.27-0.83) in the total population interviewed, 0.77% (95% CI 0.40-1.35) in women and 0.15% (95%CI 0.02-0.60) in men. The age- and sex-adjusted prevalence for the general population was estimated as 0.36%. Five of the 14 RA (36%) cases had not been diagnosed previously CONCLUSION: These data are consistent with the results of other Mediterranean countries. A significant proportion of RA cases remain undiagnosed in the community.
Assuntos
Artrite Reumatoide/epidemiologia , Saúde da População Urbana , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários , Turquia/epidemiologiaRESUMO
Behçet's disease is a chronic multisystem vasculitis of unknown aetiology. This case report describes a patient who applied to the hospital because of dyspnoea, ascites, oedema of lower extremities and recurrent episodes of haemoptysis. For the last 12 yr, he had superior vena cava syndrome (SVCS) and cardiac and pulmonary involvement of Behçet's disease, and biochemical examination of ascite fluid yielded a chylous effusion containing triglyceride 421 mg dl-1 and cholesterol 49 mg dl-1. Chyloptysis was also detected by Sudan III stain. The patient died from cardiac tamponade in spite of cardiac fenestration. To the authors' knowledge, this is the first reported case of Behçet's disease with chylous ascites and chyloptysis in the English literature.
Assuntos
Síndrome de Behçet/complicações , Ascite Quilosa/complicações , Pneumopatias/complicações , Síndrome da Veia Cava Superior/complicações , Adulto , Humanos , Masculino , Derrame Pericárdico/complicaçõesRESUMO
The hemostatic activity of blood shows a circadian variation with a higher frequency of acute coronary events in the morning. The thrombotic tendency of blood is influenced by many factors, including platelets. Diurnal changes of in vivo platelet activation were investigated by whole blood flow cytometry in 10 young healthy male volunteers using anti-GMP-140 (anti-alpha-granule membrane protein 140 kD) monoclonal antibody at 3h intervals from 06:00 to 24:00. We also studied circulating platelet aggregates to investigate whether there exists a similarity between the results of these methods. Results of flow cytometric analysis indicate that there is an increase in platelet activation during the period from 06:00 to 09:00. Platelet activation then decreases gradually during the period from noon to midnight. These changes are accompanied by a similar trend in circulating platelet aggregates. This suggests that GMP-140 expression on platelets is synchronized with or followed by platelet aggregate formation in vivo, and increased platelet activation may predispose individuals to thrombosis at this time.
Assuntos
Anticorpos Monoclonais , Ritmo Circadiano/fisiologia , Selectina-P/imunologia , Ativação Plaquetária , Adulto , Citometria de Fluxo/métodos , Humanos , Masculino , Agregação Plaquetária , Complexo Glicoproteico GPIb-IX de Plaquetas/imunologiaRESUMO
Familial Mediterranean fever (FMF) is prevalent among Arabic, Turkish, Armenian, and Jewish people and it must always be considered in the differential diagnosis of patients from these ethnic groups presenting with recurrent abdominal pain with fever. In cases of fever and recurrent abdominal pain, acute pancreatitis is an important clinical condition, which should be considered in the differential diagnosis. Serum amylase concentration in acute pancreatitis is usually more than three times the upper limit of normal. However, in recurrent pancreatitis secondary to hypertriglyceridemia, serum amylase levels, for reasons that are not well understood, may be normal or mildly elevated. Recurrent pancreatitis secondary to hypertriglyceridemia may thus pose a problem in the differential diagnosis and may lead to an erroneous diagnosis of FMF. Measurement of serum triglyceride along with amylase levels should be required for a suspected diagnosis. Computerized examination of the abdomen may need to be undertaken to exclude acute pancreatitis in the presence of hypertriglyceridemia since serum amylase levels may be normal or slightly elevated.