Novel nomogram-based integrated gonadotropin therapy individualization in in vitro fertilization/intracytoplasmic sperm injection: A modeling approach / 대한생식의학회지

Objective@#This study aimed to characterize a validated model for predicting oocyte retrieval in controlled ovarian stimulation (COS) and to construct model-based nomograms for assistance in clinical decision-making regarding the gonadotropin protocol and dose. @*Methods@#This observational, retrospective, cohort study included 636 women with primary unexplained infertility and a normal menstrual cycle who were attempting assisted reproductive therapy for the first time. The enrolled women were split into an index group (n=497) for model building and a validation group (n=139). The primary outcome was absolute oocyte count. The dose-response relationship was tested using modified Poisson, negative binomial, hybrid Poisson-Emax, and linear models. The validation group was similarly analyzed, and its results were compared to that of the index group. @*Results@#The Poisson model with the log-link function demonstrated superior predictive performance and precision (Akaike information criterion, 2,704; λ=8.27; relative standard error (λ)=2.02%). The covariate analysis included women’s age (p<0.001), antral follicle count (p<0.001), basal follicle-stimulating hormone level (p<0.001), gonadotropin dose (p=0.042), and protocol type (p=0.002 and p<0.001 for short and antagonist protocols, respectively). The estimates from 500 bootstrap samples were close to those of the original model. The validation group (n=139) showed model assessment metrics comparable to the index model. Based on the fitted model, a static nomogram was built to improve visualization. In addition, a dynamic electronic tool was created for convenience of use. @*Conclusion@#Based on our validated model, nomograms were constructed to help clinicians individualize the stimulation protocol and gonadotropin doses in COS cycles.

Effect of Patient Empowerment Model on Smoking Cessation: Randomized Controlled Trial / 가정의학회지

Background@#Smoking is a preventable cause of chronic morbidity. Patient empowerment is a process through which people establish greater control over their health-related decisions and actions. To assess the effect of patient empowerment versus health education on the nicotine dependence score and progress of patients under different stages of smoking cessation. @*Methods@#This was a single-blinded randomized controlled clinical trial that included 76 smokers attending family medicine clinics. Participants were divided into two groups: empowerment and health education groups. Their nicotine-dependence score and smoking cessation stage were identified. All study participants were subjected to five health education sessions with a 3-month follow-up period. @*Results@#The mean nicotine-dependence score decreased significantly in both groups after the intervention. This decrease was slightly higher in the empowerment group; however, the difference was not statistically significant. After the intervention, 16.7% of the health education and 30.0% of the empowerment group transitioned from stage 1 to stages 2–4 of smoking cessation, with the change being statistically significant only in the empowerment group. There was no statistically significant difference in the number of study participants who stopped smoking between the health education and empowerment groups. @*Conclusion@#Both the empowerment model and traditional health education have similar positive effects on decreasing the nicotine-dependence level. There was a significant improvement in the stage of change for patients under the empowerment model, although there was no statistically significant difference between the groups regarding the number of participants who stopped smoking.

Novel nomogram-based integrated gonadotropin therapy individualization in in vitro fertilization/intracytoplasmic sperm injection: A modeling approach / 대한생식의학회지

Objective@#This study aimed to characterize a validated model for predicting oocyte retrieval in controlled ovarian stimulation (COS) and to construct model-based nomograms for assistance in clinical decision-making regarding the gonadotropin protocol and dose. @*Methods@#This observational, retrospective, cohort study included 636 women with primary unexplained infertility and a normal menstrual cycle who were attempting assisted reproductive therapy for the first time. The enrolled women were split into an index group (n=497) for model building and a validation group (n=139). The primary outcome was absolute oocyte count. The dose-response relationship was tested using modified Poisson, negative binomial, hybrid Poisson-Emax, and linear models. The validation group was similarly analyzed, and its results were compared to that of the index group. @*Results@#The Poisson model with the log-link function demonstrated superior predictive performance and precision (Akaike information criterion, 2,704; λ=8.27; relative standard error (λ)=2.02%). The covariate analysis included women’s age (p<0.001), antral follicle count (p<0.001), basal follicle-stimulating hormone level (p<0.001), gonadotropin dose (p=0.042), and protocol type (p=0.002 and p<0.001 for short and antagonist protocols, respectively). The estimates from 500 bootstrap samples were close to those of the original model. The validation group (n=139) showed model assessment metrics comparable to the index model. Based on the fitted model, a static nomogram was built to improve visualization. In addition, a dynamic electronic tool was created for convenience of use. @*Conclusion@#Based on our validated model, nomograms were constructed to help clinicians individualize the stimulation protocol and gonadotropin doses in COS cycles.

Effect of Patient Empowerment Model on Smoking Cessation: Randomized Controlled Trial / 가정의학회지

Background@#Smoking is a preventable cause of chronic morbidity. Patient empowerment is a process through which people establish greater control over their health-related decisions and actions. To assess the effect of patient empowerment versus health education on the nicotine dependence score and progress of patients under different stages of smoking cessation. @*Methods@#This was a single-blinded randomized controlled clinical trial that included 76 smokers attending family medicine clinics. Participants were divided into two groups: empowerment and health education groups. Their nicotine-dependence score and smoking cessation stage were identified. All study participants were subjected to five health education sessions with a 3-month follow-up period. @*Results@#The mean nicotine-dependence score decreased significantly in both groups after the intervention. This decrease was slightly higher in the empowerment group; however, the difference was not statistically significant. After the intervention, 16.7% of the health education and 30.0% of the empowerment group transitioned from stage 1 to stages 2–4 of smoking cessation, with the change being statistically significant only in the empowerment group. There was no statistically significant difference in the number of study participants who stopped smoking between the health education and empowerment groups. @*Conclusion@#Both the empowerment model and traditional health education have similar positive effects on decreasing the nicotine-dependence level. There was a significant improvement in the stage of change for patients under the empowerment model, although there was no statistically significant difference between the groups regarding the number of participants who stopped smoking.

Peritoneal cancer index as a predictor of survival in advanced stage serous epithelial ovarian cancer: a prospective study / 부인종양

OBJECTIVE: A numerical score, the peritoneal cancer index (PCI), was developed to reflect the extent of tumor growth in gastric and colorectal cancers and to tailor treatment. This study aimed to examine the value of the PCI score in advanced epithelial ovarian cancer (EOC) regarding completeness of surgical cytoreduction and survival. METHODS: This was a prospective observational cohort study. Patients with primary serous EOC at International Federation of Gynecology and Obstetrics (FIGO) stages IIIB or higher were included. Patients with FIGO stage IVB as well as those assigned to receive neoadjuvant treatment were excluded from the study. The PCI was obtained and registered intraoperatively. RESULTS: In the study period we recruited 96 patients with serous EOC stage IIIB–IVA. A PCI score cut-off value of 13 was calculated using a receiver operator characteristic (ROC) curve, above which worse survival is expected (area under the curve [AUC]=0.641; 95% confidence interval [CI]=0.517–0.765; sensitivity and specificity 80.6%, 45.0%, respectively; p=0.050). A multivariate analysis determined that suboptimal surgical cytoreduction was the only independent predictive factor for recurrence (odds ratio [OR]=7.548; 95% CI=1.473–38.675; p=0.015). A multivariate analysis determined that only suboptimal surgical cytoreduction (hazard ratio [HR]=2.33; 95% CI=0.616–8.795; p=0.005), but not PCI score >13 (HR=1.289; 95% CI=0.329–5.046; p=0.716), was an independent predictive factor for death. CONCLUSION: We conclude from this study that the PCI score is a reliable tool helping to assess the extent of disease in advanced serous EOC patients and may help predicting complete surgical cytoreduction but cannot qualify as a predictor of survival.

Portal hypertension treatment with candesartan plus propranolol for nine months restores normal portal circulation hemodynamic pattern

Post HCV liver cirrhosis is one of the most prominent etiologies behind the abnormal portal circulation hemodynamics. It occurs as a result of distorted balance between portal venous flow [PVF] and intrahepatic resistances [IHR]. PVF is partially controlled by using both specific and non-specific beta blockers [NSBBs] that have insignificant effects on IHR. Angiotensin receptor blockers [ARBs] inhibit the activated hepatic stellate cell [HSC] contraction and thought to reduce the dynamic portion of MR. The study aimed to slow down the venous blood flow and to reduce the IHR of portal vein vasculature to control sequelae of the enhanced post cirrhosis portal venous turbulence. We evaluated the effects of Candesartan plus propranolol compared to each of them individually in management of portal hypertension [PH]. Three groups of 25 patients each, presented with chronic HCV infection and grade II- III esophageal varices [OV], were randomly assigned to one of three treatment regimens: Propranolol or Candesartan or both. Subjects were screened every three month by Doppler Ultrasound for a total of nine months. Damping Index [DI], pulse Pulsatility index [PT], Portal Venous Flow [PVF] Volume, Portal Venous Peak Velocity [PVPV], and Portal Vein Diameter [PVD] were evaluated once every third month. Our study concluded that combined therapy [Propranolol + Candesartan] induced highly significant improvements that led to restoration of normal values of DI, PI, PVF volume and PVPV overtime compared to monotherapy regimens [P>0.001]. Data strongly recommended using Propranolol plus Candesartan in overtime management of portal hypertension

finite element study on stress distribution of two different attachment designs under implant supported overdenture

Objective: This study aimed to evaluate stress patterns generated within implantsupported mandibular overdentures retained by two different attachment types: ball and socket and locator attachments

Materials and methods: Commercial CAD/CAM and finite element analysis software packages were utilized to construct two 3D finite element models for the two attachment types. Unilateral masticatory compressive loads of 50, 100, and 150 N were applied vertically to the overdentures, parallel to the longitudinal axes of the implants. Loads were directed toward the central fossa in the molar region of each overdenture, that linear static analysis was carried out to find the generated stresses and deformation on each part of the studied model

Results: According to FEA results the ball attachment neck is highly stressed in comparison to the locator one. On the other hand mucosa and cortical bone received less stresses under ball and socket attachment

Conclusions: Locator and ball and socket attachments induce equivalent stresses on bone surrounding implants. Locator attachment performance was superior to that of the ball and socket attachment in the implants, nylon caps, and overdenture. Locator attachments are highly recommended and can increase the interval between successive maintenance sessions

[Effect of Islet Cell Autoantibodies on clinical course of children with newly diagnosed type 1 diabetes mellitus: a one year follow up]

Background: Type 1 diabetes mellitus [T1DM] is an autoimmune disease identified by the presence of several autoantibodies to islet and/ or /beta-cell antigens, among which is islet cell autoantibodies [ICA]. The positivity of ICA in newly diagnosed patients with T1DM, may predict the course of the disease

Objectives: The purpose of this study was to identify the ICA positive patients with newly diagnosed T1DM and to verify how the ICA positivitycould influence the course of disease during one year follow up as regard clinical improvement[frequency of diabetic ketoacidosis [DKA] and insulin dose requirement] and glycemic ocontrol[glycosylated hemoglobin[HbAlc]level]

Methods: A prospective study was conducted over a period of twoyears at Assiut University Children Hospital; including 34 newly diagnosed T1DM children; 20 females and 14 males; the mean age was 9.14 +/- 3.52 yr. Work up for the patients included complete clinical assessment, CBC, liver andkidney function tests,lipid profile, ICA andHbAlclevels at first presentation. We followed up patients for one year with assessment of episodes of DKA, HbAlclevels quarterly, and the mean of insulin doses were calculated and assessed at the end of the study

Results: Out of 34 newly diagnosed T1DM children; 22 [64.7%] wereICA positive. The mean insulin requirement at the end offollow up was significantly greater in ICA positive group [P<0.04]. Out of 34patients, 13 [38.2%] presented by DKA as a first manifestation of T1DM, whileduring the follow up period there was no significant difference [P>0.05] between both ICA positive andnegative groups. The HbA lc levels were significantly greater in ICA positive group than those with negative results throughout the follow up period [P<0.02].Atthe time of presentation 27.3% and 63.6% of ICA positive cases had total cholesterol andLDL-Cholesterol levels which were significantly greater than IC Anegative cases [P<0.03 and P<0.001] respectively

Conclusion: Follow up of newly diagnosed children with T1DM with positive ICA had poor glycemic control [greater HbAlclevel], during the course of follow up, and higher insulin requirement at the end of follow up

Quantiferon vs. tuberculin testing in detection of latent tuberculous infection among chronic renal failure patients

Latent tuberculous infection [LTBI] lacks a solid gold standard in its diagnosis and many clinicians rely upon tuberculin testing, however there has been an increasing interest in depending on Interferon Gamma Release Assays especially Quantiferon-Gold [QFT-G]. Since chronic renal failure [CRF] poses an important health problem in Egypt and taking into consideration the immuno compromisation caused by this condition, LTBI detection emerged as an important health concern in those patients. In this study, the aim was to find which tool was better in the detection of LTBI in CRF patients. Forty patients with chronic renal failure and on hemodialysis, with exclusion of active tuberculosis and other immuno compromisation conditions were tested for LTBI by tuberculin skin test [TST] and QFT-G. 25% of the tested showed LTBI. It was found that although both tests gave comparable results, yet there was a discrepancy between both. TST + /QFT + group was 10%, TST + /QFT- group was 5%, TST-/QFT+ was 10% and TST-/QFT- group was 75%.In Chronic renal failure and probably any immuno compromisation setting, it would be better to perform both tuberculin and Quantiferon tests to detect latent tuberculous infection

CCl[4] ilnduced hepatotoxicity: protective effects of carnosine on peroxisome proliferator-activated receptor gamma gene expression, genotoxicity and oxidant/antioxidant status in rats

Effect of carnosine as an antioxidant in protection against carbon tetrachloride CCI[4] induced oxidative stress and hepatotoxicity in rats was investigated. Liver toxicity was induced in rat model at which four experimental groups of 20 rats each were constructed: group [1] the control group in which rats were not administrated CCI[4] or carnosine; group [II] CCI[4] group in which rats were subcutaneously injected with CCI[4] in a dose of 2 ml /Kg body weight twice weekly for 4 weeks; group[III] CCI[4] and carnosine group in which rats were also subcutaneously injected with CCI[4] and co-treated with daily intraperitoneal [i.p.] carnosine at a dose of 10 mg / kg body weight and group [IV] received also i.p. repeated daily dose of carnosine. Hepatotoxicity was assessed by measurement of serum aspartate aminotransferase [AST] and alanine aminotransferase [ALT] activities. Hepatic peroxisome proliferator-activated receptor gamma [PPARgammay] mRNA expression, glutathione-S-transferase [GST] activity, paraoxonase 1 [PON1] activity, xantheine oxidase [XO] activity and total anti-oxidant capacity [TAC] level as well as DNA damage in blood were evaluated. The results were confirmed by histopathological examination. Carnosine treatment significantly prevented the CCI[4] induced hepatotoxicity, oxidative stress and DNA damage. In conclusion, our results suggested that carnosine might be a therapeutic antifibrotic/antigenotoxic agent for the treatment of CCI[4-] induced hepatotoxicity due to its antioxidant properties

Isolation of stem cells from the mid gut epithelium of culex pipiens mosquitoes [diptera: culicidae]

Stem cells are undifferentiated cells that remarkable ability to self-renew and produce differentiated cells that support normal development and tissue homeostasis. The authors isolated spherical stem cells from the midgut epithelium of the late third larval instars of Culex pipiens mosquitoes. In vitro, cultivated epithelial stem cells were able to proliferate and differentiate in fresh culture for 48 hr in absence of 20- hydroxyecdysone [20-E]. The stem cells were the most common cells in the initial culture. One hundred of epithelial stem cells had been cultured. After 24 hr became 132 cells, 78% was undifferentiated stem cells and 8.3% and 13.7% was enterocytes and goblet cells respectively. This ratio slightly decreased after de 48 hr to be 74% undifferentiated stem cells, 4.5% enterocytes and 5.6% goblet cells. After 72 hr the undifferentiated stem cells were not able to proliferate .The most differentiated goblet and enterocytes survived few days then died

Distinguishing the two forms of egyptian aedes [ochlerotatus] caspius palias species [diptera: culicidae] by ultra structure micrographs of eggs

Ultrastructure of the two forms autogenous and anautogenous eggs of Aedes [Ochlerotatus] caspius of Egypt are described using Scanning Electron Microscope [SEM]. The eggs of the two forms are slightly boat shape with quite difference in width. Chorionic cells of the ventral surface are ultimately different in both forms in shape, width of reticulum, number and size of tubercles. The chorionic cells of the autogenous form's egg are elongate, narrow and almost curved with unusually wide, outer reticulum contain 2 - 13 large tubercles along with a few number in small size. However, the anautogenous form's egg, the chorionic cells of the ventral surface fairly distinct, very regular in outline with thin reticulum and usually hexagonal, each cell contain one or two large tubercles with many small scattered peripheral tubercles. Fine structure micrographic work of eggs of the Egyptian Ae. caspius provides new morphological evidence that both autogenous and unautogenous forms are certainly different and suggests that those forms are two distinct species

Correlation between the level of vitamin D and Bone mass index in primary osteoporotic patients in Taif, KSA

Osteoporosis [OP] is considered as one of the commonest metabolic bone diseases in orthopedics, characterized by a reduction in bone mass density and micro-architectural deterioration of bone tissue leading to diminished material properties with an increase in bone fragility and susceptibility to minor trauma fractures. The aim of this cross sectional study was to detect the level of vitamin D in patients suffering from primary osteoporosis and to correlate their levels with bone mass index. This work was performed - at the Orthopedic Outpatient Clinic of King Abdul Aziz specialist Hospital, Taif, [KSA] - on 115 patients [77 females and 38 males] fulfilling WHO revised criteria of 1994 for osteoporosis. The mean age of patients was 67.5 +/- 8.2. A medical history was taken and bony pains, fragility fractures, and loss of height, were elicited, with Inclusion criteria in the form of a T-score

Histopathological changes in liver of mice after experimental envenomation with androctonus amoreuxi scorpion venom

A total of 78 adult male Albino mice were divided into thirteen groups [6 mice in each]. One served as a control group and the other twelve groups were venom treated groups. The mice of treated groups were injected with 0.1 ml saline solution in which a particular amount of scorpion venom. The first 6 groups were subcutaneously injected with 1/2 LD50 [0.05 microg/g body weight], while the other 6 groups were injected with 1/4 LD 50 [0.025 microg/g body weight] by the same route. The animals from each group were anesthetized with ethyl ether and sacrificed at different time intervals [3, 6, 9, 12 hrs, 4 and 7days post toxin administration]. The microscopic examination of liver tissue obtained from envenomed animals showed variable histopathological changes being severely increased with the time interval of envenoming. The most obvious changes in the liver were acute cellular swelling, hydropic degeneration, congestion of central veins and portal blood vessels. Besides, extramedullary hematopoiesis and invaginations in nuclei of hepatic cells, with formation of intranuclear cytoplasmic inclusions were observed

impact of morus alba leaves extract on neurotransmitters and apoptosis experimental diabetic rats

Diabetes mellitus is one of the most common endocrine diseases. Researchers all over the world are exploring herbal supplements to control diabetes and its complications. This study evaluated the antidiabetic action of Morns alba leaves extract through its effect on hyperglycaemia, DNA damage and apoptosis of brain cells due to oxidative stress in diabetes. Moreover, evaluate the effect of diabetes on neurotransmitters levels of streptozotocin-induced diabetic rats. Application of crude water extract of Mous alba resulted in amelioration of the alterations of serum glucose as well as neurotransmitters including acetylcholine, nor-adrenaline. serotonin, histamine, dopamine. and gamma amino butyric acid. Furthermore, Morus alba leaves leaf extract display hypoglycemic effect, diminish DNA damage and apoptosis of brain cells of diabetic rats. In conclusion ,our results suggest that The protective effect of Morus alba leaves extract could be attributed to the hypoglycaemic, and antioxidative potential of flavonoids. the major components of the plant extract

Serum interleukin 27: a possible biomarker of pediatric systemic lupus erythematosus

Systemic lupus erythematosus [SLE] is a complex autoimmune disease; different cytokines play a role in the immunopathogenesis of SLE. IL-27 has both immunosuppressive and pro-inflammatory roles and its role is unclear in SLE. To measure serum interleukin [IL]-27 among a group of patients with pediatric SLE [pSLE] and whether it varies with SLE clinical and laboratory features or with therapy. Fifty patients with pSLE and 25 healthy subjects were included. Routine laboratory and immunological markers of SLE were done. Serum IL-27 was measured by enzyme linked immunosorbent assay for both patients and healthy subjects. Serum IL-27 was significantly lower in patients when compared to healthy subjects [p< 0.001]; 17 patients [34%] had low serum IL-27 [serum IL-27 < 160 pg/ml]. Patients in lupus flare and those in remission had comparable levels [p> 0.05]. Serum IL-27 did not vary significantly between patients with lupus nephritis [LN] and those without evident LN, moreover, it was comparable among different histological classes of LN [p> 0.05]. The disease status in terms of SLE disease activity index was comparable among lupus patients with normal serum IL-27 and those with decreased serum IL-27 [p> 0.05]. Serum IL-27 was not affected significantly with the cumulative doses and the types of the immunosuppressive drugs used [p> 0.05]. Decreased serum IL-27 in SLE might support its involvement in the immune alteration underlying SLE but its exact role remains unclear

Image analysis assessment of fibrosis from liver biopsy of chronic hepatitis patients

Liver fibrosis results from chronic inflammation of the hepatic parenchyma. Progressive accumulation of fibrous tissue eventually leads to cirrhosis and its complications. The severity of liver fibrosis defines the stage of chronic hepatitis and carries with it important clinical implications. Histological scoring systems such as Ishak provide descriptive evaluation of the liver tissue mainly in terms of architectural changes without measuring the amount of fibrosis. This study aimed to assess the theoretical advantage of image analysis morphometry for providing truly quantitative data with respect to the amount of fibrous tissue. A Lieca Qwin 500 image analyzer with a damaged area morphometry software was used applying the interactive method to measure the fibrous tissue area on the basis of different colors of hepatocytes and fibers following staining with Masson's trichrome stain. Forty-three patients [38 men and five women] were recruited into the study with a mean age of 45.5 years [range 15-58 years]. Of them, 40 had chronic viral hepatitis and three had chronic nonviral hepatitis. Morphometric measurements of fibrosis obtained with the image analyzer were highly correlated with results obtained using the Ishak method. The correlation was found to be statistically significant using the chi2-test [P<0.0001]. Quantitative image analysis for estimation of the percentage area of liver fibrosis is a simple and accurate method for evaluating fibrous tissue in patients with chronic hepatitis, aiding therapeutic approaches

Fluoride levels of mothers' breast milk in Egypt

Fluoride exists naturally in water sources and is derived from fluorine. It is well known that fluoride helps, prevent and even reverse the early stages of tooth decay. The aim of the present study was to determine the fluoride levels in plasma and breast milk of lactating mothers in Egypt [Cairo and Giza Governorate]. Two hundred healthy lactating mothers aged between 20-40 years old were asked to give plasma and milk samples voluntary. Breast milk samples were directly refrigerated until measurements. The fluoride concentrations of plasma, milk and drinking tap water were assessed using an ion-selective fluoride electrode combined with an ion analyzer. The fluoride levels of plasma, breast milk and drinking tap water samples were 0.0207+/-0.012, 0.0111+/-0.0044 ppm, and 0.482+/-0.117 ppm, respectively. A significant direct correlation between fluoride content in breast milk and drinking tap water was found [r=0.858, p< 0.01]

Formulation and in-vivo study of ketoprofen tablets prepared using chitos an interpol ymer complexes

The application of interpolymer complexes [IPCs] for oral controlled drug delivery systems was tested between chitosan and various anionic polymers viz sodium alginate, sodium carboxymethylcellulose and pectin. The prepared IPCs were investigated using Fourier transform infra-red spectroscopy and differential scanning calorimetry, Ketoprofen tablets were prepared using the polymers alone, physical mixtures of chitosan with sodium alginate, sodium carboxymethylcellulose or pectin in different ratios; 1:3, 1:1 and 3:1, and the corresponding IPCs. In-vitro release studies were carried out in two dissolution media; 0.1 N HCl ofpH 1.2 and phosphate buffer ofpH 7. 4. It was found that, chitosan - sod. carboxymethylcellulose 1PC tablets showed more controlled drug release compared to that containing chitosan - sodium alginate and chitosan -pectin IPCs. The dissolution rate from tablets prepared using physical mixtures of polymers were found to be dependant on the interaction between chitosan and each of the anionic polymers in the physical mixtures, their ratios and pH of the dissolution medium. Tablets prepared using chitosan - sod. carboxymethylcellulose physical mixture 1:1 and chitosan - sod. carboxymethylcellulose IPC were selected for the in-vivo study using albino rabbits. The results showed a lower peak plasma concentration and marked controlled release effect of drug in tablets containing the physical mixture compared to that of the IPC and the control tablets

Alveolar hemorrhage in systemic lupus erythematosus: an overview

Alveolar hemorrhage [AH] is a rare, but serious manifestation of SLE. It may occur early or late in disease evolution. Extrapulmonary disease may be minimal and may be masked in patients who are already receiving immunosuppressants for other symptoms of SLE. The capacity of AH to occur and recur despite ongoing immunosuppressive therapy is emphasized. Reporting our experience with alveolar hemorrhage in patients with systemic lupus erythematosus. Records of SLE patients admitted between years 2000 and 2008 were reviewed. Seven patients with SLE admitted with nine episodes of AH were found. For all study subjects, the pertinent demographic, clinical, laboratory, histologic, therapeutic and outcome data were abstracted and chest X-ray reviewed. The disease activity was assessed using SLEDAI. The seven patients were females. Their age ranged from 17 to 35 years and disease duration ranged from 4 to 48 months. AH occurred within 4 months of SLE onset in two patients. All patients presented with hemoptysis, new pulmonary infiltrates and hemoglobin drop. Glomerulonephritis was the most common extrapulmonary SLE manifestation [85%]. Initial treatment included IV methylprednisolone in all cases [100%], with cyclophosphamide in four episodes. Plasmapheresis [one session] was done in only one episode. Survival rate was 14%.Alveolar hemorrhage is a rare but lethal complication of SLE and represents a remarkable challenge. It should be diagnosed promptly with falling red cell indices and new infiltrates on chest radiograph. It occurs in vicinity of active disease. Lupus nephritis is most associated manifestation. Alveolar hemorrhages frequently recur despite ongoing immunosuppressant therapy. Early treatment with intra venous [IV] pulse methylprednisolone and IV cyclophosphamide should be instituted for a better outcome