Low prevalence of nodules in rheumatoid arthritis patients in Kuwait: a description and a comparison of patients from the Kuwait registry for rheumatic diseases

Objectives: To describe the prevalence of rheumatoid nodules [RN] in patients with rheumatoid arthritis [RA] and to compare their features with those of patients without RN

Subjects and Methods: Adult RA patients [n = 952] in the Kuwait Registry for Rheumatic Diseases from February 2013 to December 2015 were evaluated for RN. Demographic and serological features and disease activity and severity were obtained from the registry

Results: Of the 952 RA patients, 22 [2.3%] had RN and 930 [97.7%] did not. Age, sex, disease duration, smoking, and family history of an autoimmune rheumatic disease were similar. Obesity was more prevalent in the RN group, i.e. 11 [50%] vs. 326 [35.1%], p = 0.016. There was no difference in rheumatoid factor [RF] or anti-cyclic citrullinated peptide antibody positivity. Patients with RN had more sicca symptoms, i.e. 8 [36.4%] vs. 152 [16.3%], p = 0.025, a higher mean score on the visual analogue scale pain [3 +/- 2.9 vs. 2 +/- 2.7, p < 0.001], more tender joints [6.4 +/- 8.8 vs. 4.2 +/- 7.2, p = 0.001], a higher patient global assessment of disease activity [3.3 +/- 2.7 vs. 2.3 +/- 2.7, p < 0.001], and more deformities, i.e. 3 [13.6%] vs. 74 [8%], p = 0.034. The mean health assessment questionnaire score in RN patients was 1.1 versus 0.9 in patients without RN [p = 0.08]. Patients with RN had a low disease activity [means: disease activity score [DAS-28], 3.02; clinical disease activity index, 7.7; and simple disease activity index, 10.4], similar to the other group. While the rates of methotrexate treatment were comparable, biologic therapy was administered more in patients with RN [i.e. 15 [68.2%] vs. 478 [51.4%], p < 0.001]

Conclusion: In Kuwait, the prevalence of RN is low among RA patients. Patients with and without RN are similar in terms of demographics and serologic features, except for more obesity. However, patients with RN have more sicca symptoms, joint deformities, and painful and tender joints. Disease activity scores are low with more frequent biologic therapy

Effect of auricular acupuncture on weight reduction in a sample of obese children

Introduction: Growing evidence that obese children are at greater risk for several metabolic disturbances, including glucose intolerance, insulin resistance, hyperlipidemia, the metabolic syndrome, and diabetes mellitus, as well as for cardiovascular disease and nonalcoholic fatty liver disease. There are numerous therapies for obesity, including pharmacotherapy, acupuncture therapy, dietary therapy, exercise therapy, and surgical therapy. The auricular acupuncture therapy is one of the regional acupuncture therapies which have treated various diseases through a needle insertion on the auricle. Its effects can be explained by a relationship between the original functions of nerves distributed on the auricle and internal organs. Recent studies have indicated that acupuncture can reduce body weight in patients with simple obesity, as well as lower their Body Mass Index [BMI] and waist-to-hip ratio

Objective: The objective of this study is to study the effect of auricular acupuncture on weight reduction, BMI, BMIP, lipid profile, fasting insulin and lepin levels, in a sample of obese children

Sample: The study was conducted on 34 obese children [6-12] years attending the outpatient-s clinics of the National Research Center, these subjects were divided randomly into 2 groups Group A, were subjected to auricular acupuncture, balanced low caloric diet. Group B, were subjected to sham auricular acupuncture, balanced low caloric diet. In both groups, acupuncture and sham acupuncture were given twice weekly over the course of 12 weeks

Results: There were significant reductions in weight, BMI, HC, WC, Cholesterol, triglycerides, LDL and insulin resistance in group A after treatment and they were more than reduction in group B [p value < 0.001]. There were significant reduction in insulin and leptin in group A after treatment and they were more than reduction in group B [p value 0.005], [p value 0.09] respectively. So acupuncture therapy in combination with diet restriction was found to be effective for weight loss and also reduction of the obesity- associated risks factors, such as dyslipidemia

Effect of parathyroidectomy on patients with tertiary hyperparathyroidism [retrospective study]

The aim of this work was to study the effect of parathyroidectomy on patients with tertiary hyperparathyroidism. A total number of 10 patients with tertiary hyperparathyroidism manifestations underwent parathyroidctomy, where the patients with adenoma of parathyroid gland underwent excision of adenoma or multiple adenoma, and patients with hyperplasia of parathyroid gland underwent total parathyroidectomy and implantation of a part of one parathyroid gland into the sternomastoid muscle. There were significant changes in clinical and labortatory values between pre- and post-operative measures in both types of patients [adenoma and hyperplasia] where there were significant decrease in serum cacium, serum alkaline phosphatase and parathyroid hormone [P.T.H] and great changes in preoperative manifestations. From this study we can concluded that the optimal treatment of tertiay hyperparathyroidism is surgical excision of edenoma or adenomas, or total parathyroidectomy and transplantation of a part of one gland into the sternomastoid muscle in case of hyperplasia of parathyroid gland

Prognostic value of sentinel lymph node and local thyroid lymphocyte infiltration in differentiated thyroid carcinoma

The aim of this work is to investigate the prevalence, significance and prognostic value of lymphocytic infiltration and SLN associated to differentiated thyroid carcinoma. Our study included 50 patients with preoperative diagnosis of differentiated thyroid carcinoma by FNAC and Trucut needle biopsy, there age ranged from 17 to 55 years with mean age [36 year]. They were 35 females and 15 males. Absence of clinically palpable draining cervical lymph node was the main exclusion criterion in selection of our patients.Our patients were subjected to peroperative injection of patent blue dye intra tumoral, detection and resection of SLN and stained lymphatic channels, resection of samples from jugular lymph nodes [non stained] as NSLNs. Then total thyroidectomy was done. In our study, SLNs staining occurred in 37/50 patients with DTC [74%], 28 of which in patients with PTC 28/33 [84.8%], 5 in patients with FTC 5/13 [38.4%] and 4 in patients with follicular variants of PTC 4/4 [100%] mapping failure occurred in 13/50 patients [26%].22 patients revealed the SLN biopsy from which 18 patients show -ve NSLN and 4 patients with +ve NSLNs [false +ve]. 15 patients revealed -ve SLN biopsy from them 10 patients show -ve NSLNs and 5 patients show +ve NSLN [false -ve SLNI. The accuracy of SLN biopsy needs further investigation before it can be recommended in the routine management of the thyroid neoplasia. The onus must fall on the endocrine surgeon to define clearly the direct therapeutic relevance of occult nodal disease if SLN biopsy is to become a standard of care in thyroid cancer

Correlation between subclinical common carotid artery atherosclerosis and plasma homocysteine level in rheumatoid arthritis

Objective: To detect subclinical morphologic atherosclerotic changes of common carotid artery in rheumatoid arthritis patients and to correlate it with plasma level of homocysteine, C-reactive protein and disease severity

Methodology: The study included twenty five rheumatoid arthritis females as a patient group, their age ranged from 42 to 66 years. Their disease duration was more than 5 years. Nine apparently healthy females served as a control group, their age ranged from 42 to 65 years. All patients and controls were chosen with exclusion criteria including: presence of hypertension, diabetes mellitus, renal insufficiency, history of any cardiovascular or cerebrovascular events, hyperlipidemia, using lipid lowering agents, smoking and intake of contraceptive pills. Patients were subjected to full history taking, thorough clinical examination, disease severity assessment using disease severity index, disease activity assessment using the modified disease activity score [DAS], physical activity assessment using Stanford Health Assessment Questionnaire [HAQ], laboratory investigations especially C-reactive protein and serum homocysteine level. Intima media thickness of the right common carotid artery and plaques were detected with B-mode ultrasound

Results: Seventeen patients [68%] out of 25 had increased intima media thickness of right common carotid artery [subclinical atherosclerosis]. Among them 6 showed atherosclerotic plaques and I 1 without atherosclerotic plaques. Intima media thickness and homocysteine level were significantly higher in patients as compared to controls. Age, disease duration, severity index, C-reactive protein, homocysteine level and intima media thickness were significantly increased in patients with sabclinical atherosclerosis as compared to those without atherosclerosis. Intima media thickness showed a significant positive correlation with age, disease duration, severity index, C-reactive protein and level of homocysteine

Conclusion: Our results suggest the presence of subclinical atherosclerosis in rheumatoid arthritis patients as indicated by increased intima media thickness of common carotid artery. Chronic inflammation may play an important role in development of this atherosclerosis. We also suggest that increased homocysteine level may be a non traditional risk factor for atherosclerosis in rheumatoid arthritis. B-mode ultrasound can be considered a useful tool for detection of early morphologic atheroscleroric changes in carotid artery despite absence of clinical manifestations for this atherosclerosis