Efficacy of selenium supplementation on autoantibody titers in Graves' ophthalmopathy

BACKGROUND: Selenium (Se) shows potential benefit in Graves' disease (GD) especially those with active Graves' ophthalmopathy(GO).   OBJECTIVES: To evaluate the efficacy of Se supplementation among patients with GD and GO. METHODOLOGY: We performed a meta-analysis of trials evaluating the efficacy of Se supplementation among adult patients with GD and active GO, versus either placebo or an alternative drug, and on top of standard therapy. Results were presented as mean differences, standard errors, and 95% confidence intervals,and graphically presented as forest plots.Estimates were calculated using the inverse variance method for continuous variables and pooled using the fixed effects model. I2 and Chi2 tests were used to assess heterogeneity.RESULTS: Only  two  trials  were  ultimately  included  in  the  analysis. Both studies totaled 197 participants with GD and non-severe  GO  on  standard  therapy,  and  compared  Se  supplementation to placebo. The only common outcomes of  interest  were  changes  in  TSH  receptor  antibody  (TRAB)  and thyroid peroxidase antibody (TPOAB) titers. We found no statistically significant difference in either TRAB (95% CI,-1.38  [-3.19,  0.44],  p=0.14)  or  TPOAB  (95%  CI,  36.66  [-32.56, 105.88], p=0.30) titers between Se and placebo groups on follow  up.However,our analysis was limited by the small number of included studies, a small sample size, and lack of other synthesizable outcomes.CONCLUSION: This is the  first  meta-analysis  summarizing  the available data on Se supplementation in patients with GD and  non-severe  GO.We found no statistically significant differences in both TRAB and TPOAB titers between Se and placebo groups. We recommend larger studies to validate these findings. 

Disease characteristics of Filipino ankylosing spondylitis patients in Metro Manila rheumatology clinics

OBJECTIVES: The study aims to describe the disease characteristics of Filipino patients diagnosed with ankylosing spondylitis (AS) in different rheumatology clinics in Metro Manila, Philippines. METHODS: The study retrospectively reviewed the records of all Filipino AS patients aged 18 years old and above,diagnosed by the Rome Criteria and seen from January 2000 to May 2012 at the rheumatology outpatient clinic of the Philippine General Hospital and in different rheumatology clinics in Metro Manila. Demographics, joint manifestations, radiographic findings, and medications were described and tabulated. Descriptive statistics included mean and standard deviation for quantitative variables and frequency and percentage for qualitative variables. . RESULTS: Forty-seven Filipino AS patients were included in the study. The male to female ratio was 46:1. The mean age at diagnosis was 33.2 +/- 10.93 years while the mean disease duration was 7.04 +/- 4.28 years. Seven (14.8%) patients had a family history of AS while twelve (70.6%) tested positive for HLA-B27. The lumbar spine was the most commonly affected site in the majority (80.9%) of subjects. A significant number of participants (70.2%) also had peripheral joint involvement,with the knee being the most common peripheral joint involved (72.7%). In terms of imaging, sacroiliitis was found in the majority (87.5%) of patients. All patients received standard rehabilitation exercises and almost all (97.9%) were on NSAIDs. Nine (19.1%) patients each received opioids and DMARD therapy, while eight (17%) received anti-TNF therapy. CONCLUSION: Filipino patients with AS are mostly young males presenting with chronic lumbar pain and HLA-B27 positivity.The data gathered in this study may help local physicians identify AS early in affected patients, giving them access to early intervention and thereby preventing progressive structural and functional deterioration.

Efficacy of tiotropium as add-on therapy for adults with uncontrolled asthma

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> The study aimed to evaluate efficacy of tiotropium as add-on therapy on top of standard regimens for uncontrolled asthma, specifically in terms of FEV1, morning and evening PEF, reduction in exacerbations, rescue medication use, and quality of life improvement.<br /><strong>METHODS:</strong> A search was done for eligible trials after which validity screen and data extraction was performed. Results were presented as mean differences, standard errors, and 95% confidence intervals, and graphically as forest plots. Estimates were pooled using the random effects model with I2 and Chi2 tests used to assess heterogeneity. Adverse events were reported as dichotomous variables.<br /><strong>RESULTS:</strong> Four studies were included totaling 1617 participants. The tiotropium group had statistically significant improvement in FEV1 (95% Cl, 0.14 [0.09, 0.19], p<0.00001), morning (95% Cl, 20.03 [11.71, 28.35], p<0.00001) with trend towards benefit in reduction of rescue medications (95% Cl, 0.12 [-0.17,0.4],p=0.42) and quality of life improvements (95% Cl, 0.1 [-0.05,0.25], p=0.20). Homogeneity (I2= 0%, Chi2= 0.47-3.22) was found across studies.<br /><strong>CONCLUSION:</strong> Tiotropium is associated with significant improvement in pulmonary function among patients with uncontrolled asthma, with possible benefit in reduction of rescue medications and quality of life improvement.</p>

Histomorphologic effects of Bacillus clausii spores in enteropathogenic E. coli O127:H21-infected mice: A pilot study

OBJECTIVE: The study aimed to determine the basic histomorphologic effects of Bacillus clausii (B. clausii) spores in enteropathogenic Escherichia coli (E. coli) O127:H21-infected mice by evaluating the spleen, mesenteric lymph nodes, and intestinal mucosa. METHODS: The study involved 46 apparently healthy Balb/c mice (Mus musculus) which were acclimatized for 19 days prior to any intervention. Sixteen mice were used to determine the sublethal dose of E. coli, which was performed by administering serially-diluted solutions and subsequent generation of a standard curve. From the remaining 30 mice, ten served as normal controls while the remaining 20 were randomized to receive either B. clausii or placebo of sterile water for a week. All mice were then challenged with E. coli for another week and euthanized, and the spleen, mesenteric lymph nodes, and small intestine harvested and examined microscopically. All study personnel were blinded of the treatment assignments. RESULTS: Histologic evaluation of the small intestine in E. coli only-fed mice exhibited prominent attachment effacement lesions, with severely denuded mucosa, lymphocytic infiltration, and debris in the intestinal lumen. However, mice given B. clausii prior to E. coli infection displayed only minimal mucosal damage with less sloughing of villus tips, plus increased mucus-secreting goblet cells. In the spleen, E. coli only-fed mice showed moderate to severe lymphoid hyperplasia with blurred boundaries between red and white pulp. In contrast, mice which received B. clausii prior to E. coli infection had only mild degrees of lymphoid hyperplasia. Similar findings were seen in the mesenteric lymph nodes where E. coli only-fed mice showed moderate to severe lymphoid hyperplasia while those given B. clausii prior to E. coli infection merely had mild lymphoid hyperplasia. CONCLUSION: B. clausii exerts a potential protective and immunomodulatory action in E. coli O127:H21-infected mice based on histomorphologic effects. However, additional studies are needed to fully characterize these mechanisms.mice based on histomorphologic effects. 

Correlation between disease activity, functional capacity, and health-related quality of life of Filipinos with ankylosing spondylitis

OBJECTIVE: The study aimed to evaluate the relationships between disease activity, functional capacity,  and  health-related  quality  of  life   (HRQoL) in   Filipino   patients   with   ankylosing   spondylitis (AS).METHODS: Filipino AS patients gathered from the Rheumatology Clinic of the Philippine General Hospital (PGH) and from selected tertiary hospitals  in Metro Manila who have been  diagnosed  via  the  Revised New  York  Criteria  were  included.  Disease   activity  was measured using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), while functional capacity and HRQoL were measured using the Bath Ankylosing Spondylitis Functional  Index  (BASFI)  and Short Form (SF)-36, respectively.  Pearson's  correlation  was used to analyze  the  relationship  between  BASDAI and   BASFI,   and   between   BASDAI   and  SF-36.RESULTS: Twenty-four patients entered the study.  Mean age was 38.75 ± 12.7  years  and  mean  age  at  diagnosis  was  31 ±  12.29  years.   Symptoms  occurred for  a   mean  of   9.0  ±   6.97  years  with  mean      duration of symptom onset to  diagnosis  of  3.38  ±  5.14  years.  Study subjects had mild to moderate disease activity. Functional  capacity  was most   impaired  in   performing a full day's activities at home or at work.  HRQoL  was highest in vitality and lowest in emotional role,  with  mental health components generally showing higher scores than physical health components. Pearson's correlation showed moderate positive correlation between BASDAI and BASFI (r=0.6016, p=0.0012) and moderate negative correlation between BASDAI  and  the  physical  health  domain  (r=  -0.6916,  p=0.0001)  and mental health domain (r= -0.3575, p=0.0863)  of SF-36. However, only the first two correlations were statistically  significant.CONCLUSION: Filipino AS patients with higher disease activity have more functional disability and poorer physical  HRQoL.