Stanozolol, a synthetic derivative of testosterone, is one of the common doping drugs among athletes and bodybuilders. It is metabolized to a large extent and metabolites are detected in urine for a ...longer duration than the parent compound. In this study, a novel dummy molecularly imprinted polymer (DMIP) is developed as a sorbent for solid-phase extraction of stanozolol metabolites from spiked human urine samples. The optimized DMIP is composed of stanozolol as the dummy template, methacrylic acid as the functional monomer, and ethylene glycol dimethacrylate as the cross-linker in a ratio of 1:10:80. The extracted analytes were quantitively determined using a newly developed and validated ultrahigh-performance liquid chromatography tandem mass spectrometry method, where the limits of detection and quantitation were 0.91 and 1.81 ng mL
−1
, respectively, fulfilling the minimum required performance limit decided on by the World Anti-Doping Agency. The mean percentage extraction recoveries for 3’-hydroxystanozolol, 4β-hydroxystanozolol, and 16β-hydroxystanozolol are 97.80% ± 13.80, 83.16% ± 7.50, and 69.98% ± 2.02, respectively. As such, the developed DMISPE can serve as an efficient cost-effective tool for doping and regulatory agencies for simultaneous clean-up of the stanozolol metabolites prior to their quantification.
Graphical abstract
Introduction
The aim of this study was to investigate the characteristics and outcome of systemic lupus erythematosus (SLE) among elderly-onset patients.
Methods
This study included 575 SLE patients ...managed at Cairo, Alexandria, and Helwan universities from August 2014 to 2018: of whom 49 (8.5%), 420 (73%), and 106 (18.4%) were elderly- (> 50 years), adult- (17–50 years), and juvenile- (≤ 16 years) onset patients, respectively. Cumulative characteristics were recorded. Disease activity at the last visit was investigated through the Systemic Lupus Erythematosus Disease Activity Index-2K (SLEDAI-2K), whereby lupus low disease activity (LLDA) was defined as a SLEDAI-2K score ≤ 4. The disease outcome was assessed through investigating disease damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)) and the prevalence of mortality. Quantitative and categorical data were compared using Kruskal–Wallis and Mann–Whitney tests, and chi-square (
χ
2
) test, respectively.
Results
Late-onset SLE (LSLE) patients demonstrated the lowest prevalence of constitutional and mucocutaneous manifestations (
p
< 0.001), serositis (
p
= 0.006), nephritis (
p
< 0.001), neuropsychiatric involvement (
p
< 0.001), and hypocomplementinemia (
p
< 0.001), but showed the highest prevalence of comorbidities and multimorbidity (comorbidities ≥ 2) (
p
< 0.001), and positive anti-ds DNA antibodies (
p
< 0.001). Elderly-onset patients demonstrated the lowest SLEDAI-2K and SDI scores, achieved LLDA the most (
p
< 0.001), and developed any damage (SDI ≥ 1) the least (
p
< 0.001). The prevalence of mortality was comparable across the three age groups (
p
= 0.6).
Conclusions
Late-onset SLE patients (8.5%) showed the lowest prevalence of major organ involvement and the highest prevalence of comorbidities, and demonstrated more favorable disease activity and damage indices.
Key Points
• The disease characteristics and outcome among LSLE patients are characterized by being controversial, with studies from the Middle East being limited. Our cohort constituted of 8.5% elderly-onset SLE patients—who were characterized by the lowest prevalence of major organ involvement and the lowest activity and damage indices—making the disease pattern more favorable in this age group, despite being characterized by the highest prevalence of comorbidities.
To assess the impact of cognitive therapy with the rehacom visual-motor module on the hand function in hemiplegic cerebral palsy children.
The randomised case-control study was conducted at ...Kafrelsheikh University, Egypt, from September 2021 to February 2022, and comprised children aged 6-8 years with spastic hemiplegic cerebral palsy. They were randomised into control group A and intervention group B. Subjects in group A received designed physical therapy and hand function training, while those in group B additionally received visual-motor coordination training with the help of rehacom system. The groups were evaluated for both visual-motor coordination and fine motor skills at baseline and after 6-month training. SPSS version 26 was used to analyse the raw data of the current study.
Of the 40 subjects, 20(50%) were in each of the two groups. There were 13(65%) boys and 7(35%) girls with mean age 66±4.01 monthsin group A, and 9(45%) boys and 11(55%) girls with mean age 67±4.06 monthsin group B (p>0.05). Both groups showed improvement related to grasping, visual-motor integration and fine motor quotient post-intervention, but improvement in group B was significantly higher on each count(p<0.05).
The addition of visual-motor integration programme by rehacom system wasfound to be more effective than the effect of routine physiotherapy training alone.
Introduction
Disease features and laboratory abnormalities differ among adult-onset and childhood-onset systemic lupus erythematosus (aSLE and cSLE). Socioeconomic status both independent of, and in ...combination with, ethnicity influences the disease phenotype and outcome.
Objective
To compare the various disease features among patients with cSLE and aSLE in a limited monetary income Egyptian cohort attending a large free-of-charge university hospital. Patients and methods: Retrospective analysis of the medical records of 714 SLE patients attending Cairo University Hospitals from January 2000 to December 2019. Of them 602 (400 with aSLE and 202 with cSLE) were enrolled in the study.
Results
The mean age of disease onset was 28.27 ± 10.55 among aSLE patients compared to 12.88 ± 4.26 years among cSLE patients. Disease duration was 12.03 ± 5.05 and 4.14 ± 3.18 years in aSLE and cSLE, respectively. Female to male ratio was 15:1 among patients with aSLE, as compared to 2.67:1 among cSLE (<0.001). Arthritis (69%), oral ulcers (48.5%), neuropsychiatric (18.3%) and thrombotic manifestations of antiphospholipid syndrome (12%) were significantly more frequent in aSLE. On the other hand, renal (67.8%), serositis (49.6%), fever (49%), lymphopenia (40.6%), hemolytic anemia (38.6%), and discoid lupus (13.4%) were significantly more frequent in cSLE. Weight loss, malar rash, photosensitivity, thrombocytopenia, leucopenia and lymphadenopathy were not significantly different between the two groups. Hypocomplementemia, proteinuria, urinary sediments, hematuria were significantly more frequent in cSLE. For those patients with renal involvement, who underwent renal biopsy (58.3% in aSLE and 63.5% in cSLE), there was no significant difference with regard to the different histopathological classes. Anti-Smith, anti-cardiolipin antibodies and rheumatoid factor were significantly more frequent among aSLE patients, while anti-La antibodies were more frequent among cSLE patients.
Conclusion
Arthritis was the most common clinical manifestation over time in aSLE compared to renal involvement in cSLE. Renal disease tends to be more active in cSLE. The differences in disease manifestations between this cohort and other studies can be attributed to the ethnic and socioeconomic disparities.
Background
Familial Mediterranean fever (FMF) is an autosomal recessive disorder affecting people in the region of the Mediterranean Sea. It is usually associated with mutation in Mediterranean fever ...(
MEFV
) gene that encodes the pyrin protein, which affects the innate inflammatory response. Toll-like receptors (TLR) are a family of pattern recognition receptors that recognize pathogenic microbes and activate antimicrobial defense mechanisms. Toll-like receptor 4 (TLR-4) is concerned with recognition of gram-negative organisms. There is growing clinical evidence suggesting a role for expression of TLRs in the immune pathogenesis of FMF. Thus, the aim of the current study was to evaluate the presence of
TLR-4
(p.Asp299Gly) and
TLR-4
(p.Thr399Ile) gene variants in association with Egyptian children having FMF, furthermore, its effect on disease course and severity.
Results
Seventy Egyptian children diagnosed as having FMF, together with 50 age and gender-matched controls were enrolled in the study. The
TLR-4
(p.Asp299Gly) and (Thr399Ile) gene variants were determined by PCR-RFLP analysis for all studied patients and controls.
TLR-4
p.Asp299Gly gene variant was detected in 1 (1.4%) of the patients and p.Thr399Ile gene variant was detected in 2 (2%). None of the controls had any of the two tested gene variants. All found variations were heterozygous. We could not find a statistically significant association with disease severity in cases with or without
TLR-4
gene variants (
P
= 0.568). Patients with M694V gene mutation showed a higher disease severity (
P
= 0.035).
Conclusion
TLR-4 (p.Asp299Gly) and (p.Thr399Ile) gene variants were not found to have a link with the occurrence, the clinical picture of FMF, its severity, and response to colchicine treatment in Egyptian children. M694V gene mutation seems to be associated with higher disease severity. Further larger studies are needed to verify these results.
Familial Mediterranean fever (FMF) is suggested to be associated with increased risk of atherosclerosis. Epicardial adipose tissue (EAT) thickness is used in prediction of atherosclerotic risk. The ...aim of our study was to evaluate EAT thickness in FMF patients for early detection of risk of atherosclerosis and to be compared with its level in healthy controls.
Thirty 6- to 18-year-old children with FMF and 30 age- and sex-matched children (control group) were included in the study. Disease characteristics, disease severity and Mediterranean fever gene mutations were recorded. EAT thicknesses was measured by echocardiography.
EAT in patients' group was significantly greater than that of controls (5.21 ± 2.3 vs. 2.81 ± 2.96 mm, p = 0.001) and was correlated with cholesterol level and platelets count (p = 0.047 and 0.018, respectively).
This study concluded that EAT thickness was statistically increased in FMF patients than controls with a positive correlation with cholesterol level and platelet count. This finding suggests a higher risk for atherosclerosis in these patients. Follow-up study is needed to verify the effect of treatment of FMF on the EAT thickness. Further studies with larger number of patients following-up EAT are needed to verify this finding.
Familial Mediterranean fever (FMF) is an autoinflammatory disease that can have conduction disturbances and cardiac rhythm disorders as manifestations of cardiac involvement. The aim of the study is ...to assess the susceptibility of children with FMF to cardiac repolarization abnormalities and therefore arrhythmia in children with FMF.
A cross sectional study conducted on 60 children had FMF and 40 age and sex matched healthy controls. Cardiac repolarization markers, cardiac dimensions and functions were assessed by electrocardiogram (ECG) and conventional echocardiography in patients and controls.
The mean ± SD age of the patients was 10.43 ± 3.472 years, corrected QT (QTc) and the ratio of peak to end T wave (Tpe) over QTc interval (Tpe /QTc) increased significantly in FMF patients more than healthy control (p value 0.023 and 0.022 respectively). P wave dispersion (Pd) was significantly higher in FMF patients with amyloidosis (p value 0.030). No significant difference was found in cardiac dimensions and functions between the two groups. We found a statistically negative correlation between Pd and age of patients at time of study, age of disease onset and age at diagnosis. On the other hand, we found a statistically significant positive correlation between Pd with number of attacks per year and disease severity score. Furthermore, Tpe/QTc ratio correlated with FMF 50 score, QTc correlated with 24 hours proteinuria. QT, JT intervals correlated with fibrinogen.
FMF Patients may have increased risk of arrhythmia and should be monitored on regular basis. Compliance to colchicine therapy and better disease control might play a role in decreasing this risk.
Objective
To investigate the characteristics, evolution, and visual outcome of non-infectious uveitis.
Methodology
Records of 201 patients with non-infectious uveitis (136 (67.7%) males and 84 ...(41.8%) juvenile-onset (≤ 16 years)) were retrospectively reviewed. Data were analyzed through Kruskal–Wallis and Mann–Whitney, chi-square (
χ
2
) tests, and logistic regression.
Results
The median disease and follow-up durations were 36 (interquartile range (IQR) 24–70) and 24 (IQR 10–36) months, respectively. Fifty-eight (28.9%) patients had persistently idiopathic uveitis, and 143 (71.1%) were associated with rheumatic diseases, of whom uveitis heralded, coincided with, and succeeded the rheumatic manifestation(s) in 62/143 (43.4%), 37/143 (25.9%), and 44/143 (30.7%) patients, respectively. Established rheumatic diseases were Behçet’s disease (103/201 (51.2%)), juvenile idiopathic arthritis (13/201 (6.5%)), sarcoidosis (8/201 (4%)), seronegative spondyloarthropathy (7/201 (3.5%)), and Vogt-Koyanagi-Harada (7/201 (3.5%)), and other diagnoses were present in 5/201 (2.5%) patients. Patients with idiopathic uveitis were characterized by a juvenile-onset (
p
< 0.001), lower male predominance (
p
= 0.01), prevalent granulomatous (
p
< 0.001), and anterior (
p
= 0.001) uveitis. The median visual acuity at last visit was 0.3 (IQR 0.05–0.6). Visual loss was present in 45/201 (22.3%) patients (36/201 (17.9%) unilateral and 9/201 (4.4%) bilateral). Apart from a longer disease duration (
p
= 0.002), lower educational level (
p
= 0.03), and prevalent panuveitis (
p
< 0.001), visual loss was not associated with any other studied ocular or extra-ocular characteristics.
Conclusion
Behçet’s disease (51.2%) and idiopathic uveitis (28.9%) were the most prevalent causes of non-infectious uveitis in our study. Visual loss (22.3%) was associated with a longer disease duration, lower education level, and prevalent panuveitis.
Key Points
• Most common causes of uveitis referred to rheumatologists were Behçet’s disease and idiopathic uveitis.
• Several rheumatic diseases initially presented only with uveitis, more commonly in adult and male patients.
• Panuveitis was more frequent among patients with an established rheumatic disease, whereas granulomatous uveitis was uncommon.
• Longer disease duration and presence of panuveitis were independently associated with visual loss.
IgA vasculitis (IgAV), formerly known as Henoch-Schönlein purpura, is the most common cause of systemic vasculitis in childhood. Given its potential life-threatening systemic complications, early and ...accurate diagnosis as well as management of IgAV represent a major challenge for health care professionals. This study was carried out to attain an evidence-based expert consensus on a treat-to-target management approach for IgAV using Delphi technique. The preliminary scientific committee identified a total of 16 key clinical questions according to the patient, intervention, comparison, and outcomes (PICO) approach. An evidence-based, systematic, literature review was conducted to compile evidence for the IgAV management. The core leadership team identified researchers and clinicians with expertise in IgAV management in Egypt upon which experts were gathered from different governorates and health centers across Egypt. Delphi process was implemented (two rounds) to reach a consensus. An online questionnaire was sent to expert panel (n = 26) who participated in the two rounds. After completing round 2, a total of 20 recommendation items, categorized into two sections were obtained. Agreement with the recommendations (rank 7–9) ranged from 91.7–100%. Consensus was reached (i.e. ⩾75% of respondents strongly agreed or agreed) on the wording of all the 20 clinical standards identified by the scientific committee. Algorithms for the diagnosis and management have been suggested. This was an expert, consensus recommendations for the diagnosis and treatment of IgAV and IgA vasculitic nephritis, based on best available evidence and expert opinion. The guideline presented a strategy of care with a pathway to achieve a state of remission as early as possible.
Plain Language Summary
Given its potential life-threatening systemic complications, early and accurate diagnosis of immunoglobulin A vasculitis represents a major challenge for health care professionals. This work provided cornerstone principles for the management of the condition. Adopting PICO approach and implementing Delphi process a consensus was reached on evidence-based treat-to-target treatment recommendations. This will endorse enhancement and consistency of care of this cohort of patients in standard practice.
Background
Familial Mediterranean fever (FMF) is an autosomal recessive auto-inflammatory disease. Arthritis in early-onset FMF is a common finding. The aim of this study was to assess frequency of ...arthritis in 200 Egyptian children with FMF and also to detect its clinical characteristics, response to colchicine treatment, its effect on disease severity, and the most common MEFV gene mutations in patients with arthritis.
Results
We studied 200 children with FMF. We analyzed joint involvement in FMF attacks regarding its clinical characteristics, its effect on the disease severity, and response to colchicine treatment. We found arthritis in 20.5% of the studied population. Most of the children with arthritis had mono-articularjoint involvement during the FMF attack (73.1%), followed by oligo-articularjoint (22%). The knees and ankles were the most commonly affected joints. Arthritis was the presenting symptom in only 4%. We observed redness of the affected joints in 70.7%, and persistence of swelling after the attacks only in 17.1%. The majority of patients (85.4%) had a 75–100% decrease in the frequency of arthritic attacks after colchicine treatment. We did not find any joint disability in all studied patients, and arthritis was only present during attacks. The most frequent MEFV gene mutations in arthritic patients wereV726A and E148Q, each occurring in 28.6%. We observed an earlier age of disease onset and a more disease severity in patients with arthritis (
p
= 0.031 and
p
≤ 0.001, respectively). We also observed that chest pain, erysipelas-like-erythema, and testicular affection were more observed in patients with arthritis (
p
values 0.001, 0.001, and 0.006, respectively).
Conclusion
This study showed that around 20% of Egyptian children with FMF can develop arthritis during the attacks, which usually runs a benign course. The presence of arthritis can denote a more severe disease course.
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