Inflammatory Arthritis Post Covid-19 Infection.

Presentation A 63-year-old man developed polyarthritis two months post recovery from COVID-19 infection. Diagnosis We concluded that the diagnosis was rheumatoid arthritis based upon raised inflammatory markers, positive rheumatoid factor and anti-cyclic citrullinated peptide antibodies. Treatment His symptoms improved with naproxen, corticosteroids, and methotrexate. Discussion We describe a patient with late onset rheumatoid arthritis possibly triggered or unmasked by COVID-19.

Shrinking lung syndrome in systemic lupus erythematosus: a single-centre experience.

Introduction Shrinking lung syndrome (SLS) is a rare manifestation of systemic lupus erythematosus (SLE), characterized by decreased lung volumes and extra-pulmonary restriction. The aim of this study was to describe the characteristics of SLS in our lupus cohort with emphasis on prevalence, presentation, treatment and outcomes. Patients and methods Patients attending the Toronto Lupus Clinic since 1980 ( n = 1439) and who had pulmonary function tests (PFTs) performed during follow-up were enrolled ( n = 278). PFT records were reviewed to characterize the pattern of pulmonary disease. SLS definition was based on a restrictive ventilatory defect with normal or slightly reduced corrected diffusing lung capacity for carbon monoxide (DLCO) in the presence of suggestive clinical (dyspnea, chest pain) and radiological (elevated diaphragm) manifestations. Data on clinical symptoms, functional abnormalities, imaging, treatment and outcomes were extracted in a dedicated data retrieval form. Results Twenty-two patients (20 females) were identified with SLS for a prevalence of 1.53%. Their mean age was 29.5 ± 13.3 years at SLE and 35.7 ± 14.6 years at SLS diagnosis. Main clinical manifestations included dyspnea (21/22, 95.5%) and pleuritic chest pain (20/22, 90.9%). PFTs were available in 20 patients; 16 (80%) had decreased maximal inspiratory (MIP) and/or expiratory pressure (MEP). Elevated hemidiaphragm was demonstrated in 12 patients (60%). Treatment with prednisone and/or immunosuppressives led to clinical improvement in 19/20 cases (95%), while spirometrical improvement was observed in 14/16 patients and was mostly partial. Conclusions SLS prevalence in SLE was 1.53%. Treatment with glucocorticosteroids and immunosuppressives was generally effective. However, a chronic restrictive ventilatory defect usually persisted.

Antimalarial-induced cardiomyopathy: a systematic review of the literature.

Background Antimalarials (AMs) are widely used in the treatment of connective tissue diseases. Their main side effect is retinal damage, while heart disease has been described in isolated cases. The aim of this study is to systematically review the existing literature on AM-induced cardiomyopathy (AMIC). Methods The PubMed database was searched for heart biopsy-confirmed AMIC cases. Information on demographics, clinical presentation, concomitant AM-related toxicity, cardiological investigations, treatment and outcome were collected. Descriptive statistics were used. Results Forty-seven cases (42 females) were identified with a mean age at diagnosis 56.4 ± 12.6 and mean AM treatment duration 12.7 ± 8.2 years. Systemic lupus erythematosus ( n = 19) and rheumatoid arthritis ( n = 18) were the most common primary diseases. Clinical presentation was that of congestive heart failure in 77%, while eight patients presented with syncope (17%). Complete atrioventricular block was reported in 17 patients; 24 received a permanent pacemaker (51%). Impaired systolic function was detected in 52.8%, bi-ventricular hypertrophy in 51.4% and restrictive filling pattern of the left ventricle in 18 patients. Cardiac magnetic resonance showed late gadolinium enhancement in seven cases, with a non-vascular pattern in the interventricular septum. Cardiomyocyte vacuolation was reported in all cases; intravacuolar lamellar and curvilinear bodies were observed in 46 (98%) and 42 (89.4%) respectively. Mortality rate was 45% (18/40). Conclusion AMIC is a rare, probably under-recognized, complication of prolonged AM treatment. It presents as a hypertrophic, restrictive cardiomyopathy with or without conduction abnormalities. Early recognition and drug withdrawal are critical with a survival rate of almost 55%.

Acute Treatment of Migraine: Expert Consensus Statements from the United Arab Emirates (UAE).

INTRODUCTION: Migraine, characterized by recurrent headaches and often accompanied by other symptoms like nausea, vomiting, and sensitivity to light and sound, significantly impacts patients' quality of life (QoL) and daily functioning. The global burden of migraines is reflected not only in terms of reduced QoL but also in the form of increased healthcare costs and missed work or school days. While UAE (United Arab Emirates)-specific consensus-based recommendations for the effective use of preventive calcitonin gene-related peptide (CGRP)-based migraine therapies have been published previously, an absence of such regional guidance on the management of acute migraine represents a gap that needs to be urgently addressed. METHODS: A task force of eight neurologists from the UAE with expertise in migraine management conducted a comprehensive literature search and developed a set of expert statements on the management of acute migraine that were specific to the UAE context. To ensure diverse perspectives are considered, a Delphi panel comprising 16 neurologists plus the task force members was set up. Consensus was achieved using a modified Delphi survey method. Consensus was predefined as a median rating of 7 or higher without discordance (if > 25% of the Delphi panelists rate an expert statement as 3 or lower on the Likert scale). Expert statements achieving consensus were adopted. RESULTS: The Modified Delphi method was used successfully to achieve consensus on all nine expert statements drafted by the task force. These consensus statements aim to provide a comprehensive guide for UAE healthcare professionals in treating acute migraine. The statements cover all aspects of acute migraine treatment, including what goals to set, the timing of treatment, treatment strategy to use in case of inadequate response to triptans, safety aspects of combining gepants for acute attacks with preventive CGRP-based therapies, special population (pregnant and pediatric patients) considerations, and the management of the most bothersome symptoms (MBS). CONCLUSIONS: Adopting these consensus statements on the treatment of acute migraine can help enhance patient care, improve outcomes, and standardize treatment practices in the UAE. The collaborative effort of experts with diverse experiences in developing these consensus statements will strengthen the credibility and applicability of these statements to various healthcare settings in the country.

Structural, radiation shielding, thermal and dynamic mechanical analysis for waste rubber/EPDM rubber composite loaded with Fe2O3 for green environment.

Increasing waste rubber recycling produces a specious range of products for many valuable applications. Waste Rubber/EPDM composite with different concentrations was prepared. Infrared spectroscopy (FTIR) is used to identify the chemical composition. A water absorption test, Dynamic mechanical analysis (DMA), and Thermal Gravimetric Analysis (TGA) were performed. The (75/25) WR/EPDM rubber composite exhibited the best behavior with the highest mechanical performance. Fe2O3 was added to (75/25) WR/EPDM rubber composite. Water absorption, FTIR, TGA, and DMA were investigated. The composite performance was improved with increasing Fe2O3 content. The linear attenuation coefficients (µ) were also measured as a function of the concentrations of Fe2O3 for γ-ray energy 662 keV by using 137Cs point source; the radiation shielding can be denoted by numbers of parameters like mass attenuation coefficient (µm), half value layer (HVL), Tenth value layer TVL and radiation protection efficiency (RPE%), radiation protection efficiency increased as Fe2O3 increased.

Consensus-Based Recommendations on the Use of CGRP-Based Therapies for Migraine Prevention in the UAE.

INTRODUCTION: Migraine is a common debilitating neurological disorder affecting a large proportion of the general population. Calcitonin gene-related peptide (CGRP), a 37-amino acid neuropeptide, plays a key role in the pathophysiology of migraine, and the development of therapies targeting the anti-CGRP pathway has revolutionized the field of migraine treatment. METHODS: An expert task force of neurologists in the United Arab Emirates (UAE) developed and critically assessed recommendations on the use of CGRP-based therapies in migraine treatment and management in the UAE, based on available published literature. A consensus was reached for each statement by means of an open-voting process, based on a predefined agreement level of at least 60%. RESULTS: The consensus recommendations advocate the need for guidelines for the appropriate use of CGRP-based therapies by defining patient cohorts and appropriate monitoring of therapeutic response as well as standardizing the initiation, assessment, and cessation of treatment. The consensus recommendations were primarily formulated on the basis of international studies, because of the limited availability of regional and local data. As such, they may also act as guidelines for global healthcare providers. CONCLUSIONS: These are the first consensus recommendations for the UAE that address the use of CGRP-based therapies in the treatment and management of migraine, integrating both clinical evidence and medical expertise to enhance clinical judgment and decision-making.

The protective effect of xanthenone against LPS-induced COVID-19 acute respiratory distress syndrome (ARDS) by modulating the ACE2/Ang-1-7 signaling pathway.

OBJECTIVE: Acute respiratory distress syndrome (ARDS) is an inflammatory lung disease that has a high rate of morbidity and mortality. It's an acute diffusive lung injury caused by the release of pro-inflammatory cytokines into the lungs. Specific microRNAs have been identified to play a crucial role in the renin-angiotensin system signaling pathways the main pathophysiological pathway responsible for ARDS. Since the ARDS life-threatening complication associated with COVID-19 is an ongoing challenge, this current study aimed to investigate the potential efficacy of xanthenone in the treatment of ARDS induced with LPS in mice through ACE2 activation and modulation of miR-200 and ACE2/Ang 1-7 pathways. MATERIALS AND METHODS: Mice were categorized into three groups randomly. The first set of mice served as the normal control group. The ARDS group was injected with LPS (15 mg/kg; i.p.). The last group was treated with xanthenone (2 mg/kg/day; p.o.) for one week before the LPS injection. RESULTS: Xanthenone treatment resulted in a significant down-regulation of miRNA-200 expression, leading to the activation of ACE2 accompanied with marked inhibition of Angiotensin II as well as increases the levels of Ang 1-7 and SP-A. CONCLUSIONS: Xanthenone has the potential to be a promising therapeutic drug for the treatment of ARDS COVID-19 complication through activation of ACE2/Ang 1-7 pathways.https://www.europeanreview.org/wp/wp-content/uploads/Graphical_abstract.tif.

Technical quality of root fillings performed by undergraduate students in Saudi Arabia.

AIM: To evaluate the technical quality of root fillings performed in the undergraduate clinic of the Dental College, King Saud University, Saudi Arabia and to compare the technical quality of root canal treatment between the 4th- and 5th-year students. METHODOLOGY: A random sample of 710 records of patients who had received dental treatment by undergraduate students at the College of Dentistry (Malaz University Campus), between the years of 2005-2008, was investigated. The final sample consisted of 550 root filled teeth in 459 patients. For each root filled tooth, at least three periapical radiographs were examined: preoperative, working length determination and postoperative. The length, density and taper of root fillings, as well as the presence of procedural errors, were recorded. 'Acceptable' filling quality was defined as having adequate length, density and taper with the absence of any procedural error. Results were evaluated statistically using chi-square test. RESULTS: One hundred and twenty-five of 550 root filled teeth (23%) had a root filling that was classified as 'acceptable'. There was no statistical significant association between the 4th- and 5th-year students in terms of length (P = 0.134), density (P = 0.081) and taper (P = 0.590). Seventy-five (14%) treated teeth had ledges, 40 (7%) had apical transportation and 37 (7%) had apical root perforation. Ledges had significant association with the level of student (P < 0.0001) and were greater in the cases of 4th-year students (18%) compared to the 5th-year students (8%), whilst root perforations had also significant association with level of students (P = 0.016) and were more in the 5th-year cases (3%) compared to the 4th-year cases (0.3%). CONCLUSIONS: The technical quality of root fillings placed by undergraduate dental students was classified as 'acceptable' in 23% of cases. There was little difference between 4th- and 5th-year students in the overall quality of root fillings.

Low calcium and vitamin D intake in healthy children and adolescents and their correlates.

BACKGROUND: Optimal dietary calcium and possibly vitamin D intake throughout childhood and adolescence may enhance bone mineral accrual. Little data on the intake of these nutrients in Mediterranean countries exist, and predictors of their suboptimal intake are not well defined. OBJECTIVE: To evaluate systematically the effect of gender, lifestyle factors, and socioeconomic status on mean calcium and vitamin D intake in healthy school children and adolescents from Lebanon. DESIGN: A total of 385 students aged 10-16 y were selected from four public and four private schools between Fall 1999 and Spring 2000. Information on calcium and vitamin D intake, through a semiquantitative food frequency questionnaire that was validated against a 7-day daily record, and on socioeconomic and lifestyle factors were obtained. RESULTS: Only 12% of the students met the adequate intake (AI) recommendation of 1300 mg of calcium/day, and only 16% met the AI recommendation of 200 IU of vitamin D/day. Boys had a significantly higher mean daily calcium intake than girls. Socioeconomic status as assessed by children's pocket money was a predictor of higher calcium and vitamin D intake. Eating breakfast and physical activity were other correlates of daily calcium and vitamin D intake. CONCLUSIONS: Only a minority of students in our study met the AI for calcium and vitamin D. Gender, lifestyle factors, and socioeconomic status were significant predictors of calcium and vitamin D intake. Our findings have important implications regarding the institution of dietary public health strategies to promote skeletal health in Mediterranean countries during a critical time for bone mass accrual.

Sodium-potassium, magnesium, and calcium ATPase activities in erythrocyte membranes from manic-depressive patients responding to lithium.

Erythrocyte membrane Na+-K+ adenosine triphosphatase (ATPase), Mg2+ ATPase, and Ca2+ ATPase activities were compared among 23 euthymic manic-depressive patients responding to lithium therapy and 24 healthy controls. The two groups were similar in age, sex composition, body mass index, and community background. No significant differences were noted in mean ATPase activities between the two groups. However, plasma lithium concentration correlated positively with Na+-K+ ATPase and Mg2+ ATPase activities within the patient group, and six patients with plasma lithium levels in the range of 0.85-1.2 mM had Na+-K+ ATPase activities 62% greater than the control group mean. Possible biochemical mechanisms for the effects of lithium therapy on erythrocyte membrane functions are discussed.

Odontoonychodermal dysplasia: a previously apparently undescribed ectodermal dysplasia.

Seven affected individuals in a total of 24 belonging to three inbred Lebanese sibships are presented as having a previously apparently undescribed pure ectodermal dysplasia. For this condition, probably owing to the homozygous state of an autosomal recessive gene, we suggest the name trichoodontodermal dysplasia.

Clinical and biochemical characteristics of prolidase deficiency in siblings.

Two brothers with recurrent skin ulcers of the lower limbs, subnormal intelligence, developmental abnormalities, and poliosis were found to excrete large quantities of several imidodipeptides in their urine. Glycylproline was the most prominent imidodipeptide excreted and was also detected in their blood. Prolidase activity was markedly deficient in red blood cells from both patients (4.1% and 3.7% of control mean) and skin fibroblasts from the one brother so examined (3.7% of control mean). A total of 20 patients with prolidase deficiency, including the two in this report, have been described in the literature. Their manifestations and various attempts at treatment are reviewed.

Brief clinical report and review: the Marden-Walker syndrome.

We have studied a sibship with one confirmed and three probable cases of the Marden-Walker syndrome (MWS). Our patient had the major manifestations of blepharophimosis and squint; narrowly arched palate with micrognathia; small mouth and mouth-breathing; facial deformities and distortions; congenital muscle weakness with resulting scoliosis; mild pectus excavatum; camptodactylies and hip and finger joints subluxation. In addition, he had small, apparently low-set and slightly malformed auricles with a unilateral preauricular tag. However, he had no apparent renal or cardiovascular involvement. Results of CPK, EMG, and of histochemical, light microscopic, and ultrastructural studies of muscle biopsy do not suggest a primary myopathy but rather CNS related weakness/hypotonia with small muscle mass and hypoactive DTRs. This pathogenetic hypothesis is confirmed by the presence of severe mental retardation and minor brain changes suggesting cortical atrophy. In five previously reported cases there has been microcephaly. Phenotype analysis does not convince that the MWS is a true malformation syndrome, but rather hints at the possibility of a congenital metabolic dysplasia. Genetic analysis demonstrated autosomal-recessive inheritance in this and two other instances; primarily sporadic occurrence leaves open the possibility of genetic heterogeneity.

Familial spinocerebellar degeneration with corneal dystrophy.

We report on two sisters born to normal but consanguineous parents, with the unusual combination of spinocerebellar degeneration and corneal dystrophy. Their manifestations include mental subnormality, bilateral corneal opacification starting in the second year of life and leading to severe visual impairment, and slowly progressive cerebellar abnormalities with variable dorsal column and upper motor neuron involvement. A third sister had only minor spinocerebellar signs but no eye findings, and three other sibs were completely normal. Both affected sisters underwent penetrating keratoplasty and their vision improved. Histologic examination showed findings of corneal dystrophy including corneal edema, thickening of Descemet membrane, and degenerative pannus. High-resolution light and electron microscopy of muscle and sural nerve performed on both patients was abnormal. It is suggested that, in this family, the corneal dystrophy and spinocerebellar degeneration are pleiotropic manifestations of an autosomal-recessive disorder.

Recurrence of sarcoidosis following bilateral allogeneic lung transplantation.

We report the first case of recurrent sarcoidosis manifested by clinical symptoms, radiographic abnormalities, and pathologic changes in a patient following sequential double allogeneic lung transplantation. A 40-year-old male patient underwent bilateral allogeneic lung transplantation for end-stage pulmonary sarcoidosis. Thirteen months posttransplantation, he developed fatigue, shortness of breath, and bilateral upper lobe pulmonary infiltrates. Transbronchial biopsy specimens revealed noncaseating granulomata. The patient's symptoms and radiographic abnormalities resolved with an increased dose of oral prednisone.

Child survival in Beirut during wartime: time trends and socio-religious differentials.

BACKGROUND: Child mortality estimates in Beirut are presented for the late 1970s and the mid 1980s, and changes in socio-religious differentials of mortality across time are investigated. METHODS: Baseline information was obtained from maternity registries in Beirut in 1984 and 1991. Age of mother, number of children ever born and number of children alive, hospitalization class (1, 2 or 3 within each hospital, depending on the room rate, the services and the doctor's fees), and religion of newborn was recorded. Brass and Macrae's technique was used to convert the proportion dead among children ever born to mothers in age group 30-34 into 5q0 estimates for the reference periods 1978 (1984 data) and 1985 (1991 data). Using hospitalization class as a proxy for social class, religious differentials in child mortality were explored by logistic regression analysis within each period. RESULTS: Overall, 5q0 is estimated at 46 per 1000 in the late 1970s, and at 36 per 1000 in the mid 1980s. The religious differentials in 5q0 mortality estimates were quite large in the former period, with a risk for Muslims relative to Christians of 1.53, which declined to 1.35 in the latter period. The regression analysis of the proportion dead among children ever born; (1) confirmed the magnitude of the religious differentials in child mortality, and their reduction over time; (2) demonstrated the existence of an interaction between religion and social class, as the religious differentials in child mortality were found to be highly prevalent in the lower social classes, and almost insignificant in the middle and upper ones; (3) highlighted the decisive role of differential fertility in generating differential child mortality, with higher fertility and higher child mortality in Muslims, and with the disappearance of religious differentials in child mortality after adjustment for fertility. CONCLUSION: The findings confirm the hypothesis of a reduction over time of religious-based child mortality differences in the capital city of Lebanon, in agreement with the pattern found for religious-based fertility differences. Comparisons with other countries in the region indicate that the war in Lebanon has slowed down the decline in child mortality, causing the country to loose its priviledged position among Arab countries.

PIP: The authors investigated changes in socioreligious differentials of mortality over time using baseline information from maternity registries in Beirut in 1984 and 1991. Mother's age, number of children ever born, number of children alive, hospitalization class, and religion of newborn were recorded. Brass and Macrae's technique was used to convert the proportion dead among children ever born to mothers in age group 30-34 years into mortality estimates for 1978 and 1985. Using hospitalization class as a proxy for social class, religious differentials in child mortality were explored by logistic regression analysis within each period. A reduction over time of religious-based child mortality differences was observed in Beirut, in agreement with the pattern found for religious-based fertility differences. Relative to other countries in the region, the war in Lebanon has slowed down the decline in child mortality.

Expanded indications for transcervical thymectomy in the management of anterior mediastinal masses.

BACKGROUND: Transcervical thymectomy (TCT) is an accepted though controversial approach for thymectomy in myasthenia gravis (MG). The suggestion of thymoma on computed tomography (CT) has been considered a contraindication to TCT. We sought to determine whether the indications for TCT could be safely expanded to include selected patients with thymomas as well as other types of anterior mediastinal masses. METHODS: Between January 1992 and September 1999, we performed 121 TCTs: 98 in patients with MG and 23 in patients without MG. The patients' records were retrospectively reviewed. RESULTS: Among the 98 MG patients, 28 had CT scans suspicious for thymoma. Of these, 14 had a thymoma pathologically. These were classified as stage I (5), stage II (8), and stage III (1). Five patients required extension of the incision for completion of the procedure. There have been no thymoma recurrences to date with a mean follow-up of 48 months (range 3 to 96 months). In the 23 patients without MG, 12 had new anterior mediastinal masses, 4 had a history of treated lymphoma, 1 had a history of treated germ cell tumor, and 6 had suspected mediastinal parathyroid adenoma. Diagnostic tissue was obtained in all patients undergoing the procedure for diagnosis, and in 4 of 6 patients, a parathyroid adenoma was successfully resected. CONCLUSIONS: Transcervical exploration and thymectomy offers a less invasive approach to the diagnosis and/or definitive treatment of selected anterior mediastinal masses. We suggest that it is appropriate to expand its use to several clinical scenarios beyond the typical indication of thymectomy in MG patients without thymoma.

Bronchial anastomotic stricutre caused by ossification of an intercostal muscle flap.

We report a case of heterotopic ossification of a pedicled intercostal muscle flap that had been wrapped circumferentially around a bronchial sleeve anastomosis. This ossification caused severe bronchial stenosis and recurrent pneumonias. Stent insertion failed, and the patient ultimately required completion pneumonectomy. We recommended that caution be used when wrapping intercostal muscle around any important lumen.

Lobectomy with tangential pulmonary artery resection without regard to pulmonary function.

BACKGROUND: Non-small cell carcinoma of the lung invading the pulmonary artery (PA) has traditionally been treated by pneumonectomy. Although PA resection and reconstruction (PAR) has begun to gain acceptance, previous series of PAR by the simplest technique of tangential excision and primary repair have been unfavorable. We have maintained a policy of performing PAR preferentially whenever anatomically feasible, and usually this has been possible by tangential excision and primary repair. This study sought to determine if this approach is sound. METHODS: Retrospective clinical and pathologic review. RESULTS: Thirty-three PARs were performed from 1992 to 1999. The patients, followed 6 to 65 months (mean 25), were aged 36 to 80 years (mean 61), and their tumors were pathologic stage IB (n = 7), IIB (n = 13), IIIA (n = 9), and IIIB (n = 4). The mean preoperative forced expiratory volume in 1 second was 70% predicted. The procedures included 14 bronchial sleeve lobectomies with PAR and 19 simple lobectomies with PAR. The PARs were performed without heparinization and included 19 tangential excisions with primary closure, 11 larger tangential excisions with pericardial patch closure, and 3 sleeve resections. There were no operative deaths and 2 (6.1%) early major complications, all unrelated to the PAR. Thirteen patients (39%) had early minor complications. Four-year Kaplan-Meier survival was 48.3% for stages I/II and 45% for stage III. Ipsilateral, central, intrathoracic recurrence occurred in 3 patients (9.1%). CONCLUSIONS: These data are not dramatically different from those reported for standard resections. Although the numbers are small, the results suggest that lobectomy with PAR by tangential excision is an acceptable alternative to pneumonectomy whenever anatomically possible.

Measures of social class based on education for use in health studies in developing countries.

In this paper we consider the appropriateness of education, compared to occupation and income, as a measure of social class for use in health-related studies in developing societies in transition. Three evaluation criteria were used, namely, the feasibility of constructing the measure, its sensitivity in reflecting relevant social class life conditions, and its ability to produce a family-level measure of social class. We used two data sets from community health surveys in areas of Amman city, Jordan, and in Beirut city, Lebanon, to define a family-based average educational score. We then proceeded, using the Beirut data, to test the score's ability to discriminate social class effects on family health, compared to a more standard representation based on the educational level of the head of the family. It was found that the performance of the average educational score was often better than, but not consistently superior to, the educational level of the head of the family.