Long Non-coding RNA Genes Polymorphisms H19 (rs2251375) and MALAT1 (rs3200401) Association with Rheumatoid Arthritis and Their Correlation with Disease Activity in a Cohort of Egyptian Patients: A Pilot Study.

Rheumatoid arthritis (RA) is a chronic, progressive, inflammatory, autoimmune disease that could be disabling throughout its course. It affects people in their most reproductive years with relatively high morbidity and mortality. Long non-coding RNAs became one of the epigenetic mechanisms to prove a link to RA pathogenesis and development, including H19 and MALAT1 genes. These two genes' expressions had proved to increase in multiple diseases, attracting attention to their polymorphisms and their possible risk role. Assess the association between H19 SNP (rs2251375) and MALAT1 SNP (rs3200401) and the susceptibility of RA and its disease activity. In this pilot study, 200 hundred subjects (100 RA patients and 100 healthy controls) were investigated for a possible link between the polymorphisms H19 SNP (rs2251375) and MALAT1 SNP (3200401) and RA susceptibility and disease activity. RA-related investigations and clinical assessment were done. Real-time PCR genotyping of both SNPs was done using TaqMan® MGB probes. There was no association between the SNPs and risk of developing RA. However, both SNPs had a significant association with high disease activity. H19 SNP (rs2251375) heterozygous genotype CA had an association with elevated levels of ESR (p = 0.04) and higher DAS28-ESR score (p = 0.03). MALAT1 (rs3200401) C allele had an association with elevated ESR (p = 0.001), DAS28-ESR (p = 0.03), and DAS28-CRP (p = 0.007), while CC genotype had an association with DAS28-CRP (p = 0.015). Linkage disequilibrium and haplotyping of the alleles of both SNPs were analyzed as both genes are present on chromosome 11, but no significant association was found between any of the combinations of the alleles (p > 0.05), denoting that (rs2251375) and (rs3200401) are not in linkage disequilibrium. There is no association between H19 SNP (rs2251375) and MALAT1 SNP (rs3200401) and the susceptibility of RA. However, there is an association between H19 SNP (rs2251375) genotype CA and MALAT1 SNP (rs3200401) genotype CC with RA high disease activity.

Practice makes the model: A critical review of stormwater green infrastructure modelling practice.

Green infrastructures (GIs) have in recent decades emerged as sustainable technologies for urban stormwater management, and numerous studies have been conducted to develop and improve hydrological models for GIs. This review aims to assess current practice in GI hydrological modelling, encompassing the selection of model structure, equations, model parametrization and testing, uncertainty analysis, sensitivity analysis, the selection of objective functions for model calibration, and the interpretation of modelling results. During a quantitative and qualitative analysis, based on a paper analysis methodology applied across a sample of 270 published studies, we found that the authors of GI modelling studies generally fail to justify their modelling choices and their alignments between modelling objectives and methods. Some practices, such as uncertainty analysis, were also found to be limited, despite their necessity being widely acknowledged by the scientific community and their application in other fields. In order to improve current GI modelling practice, the authors suggest the following: i) a framework, called STAMP, designed to promote the standardisation of the documentation of GI modelling studies, and ii) improvements in modelling tools for facilitating good practices, iii) the sharing of data for better model testing, iv) the evaluation of the suitability of hydrological equations for GI application, v) the publication of clear statements regarding model limitations and negative results.

On the use of multi-objective optimization for multi-site calibration of extensive green roofs.

Conceptual hydrological models are practical tools for estimating the performance of green roofs. Such models require calibration to obtain parameter values, which limits their use when measured data are not available. One approach that has been thought to be useful is to transfer parameters from a gauged roof calibrated locally (single-site calibration) to a similar ungauged roof in a different location. This study tested this approach by transferring calibrated parameters of a conceptual hydrological model between sixteen extensive green roofs located in four Norwegian cities. The approach was compared with a multi-site calibration scheme that explores trade-offs of model performances between the sites. The results showed that single site calibration could yield optimal parameters for one site and perform poorly in other sites. In contrast, obtaining a common parameter set that yields satisfactory results (Kling Gupta Efficiency >0.5) for different sites, and roof properties could be achieved by multi-site calibration.

Performance of 2016 revised fibromyalgia diagnostic criteria in patients with rheumatoid arthritis.

Fibromyalgia (FM) is a common comorbidity in rheumatoid arthritis (RA). Recently, there were several updates for the American College of Rheumatology (ACR) FM criteria. To assess the performance of the 2016 revised ACR FM criteria in patients with RA in comparison to 1990 criteria and to study the relation to composite disease measures. This study included 130 adult RA patients fulfilling the 2010 ACR/EULAR classification criteria for RA. Patients were evaluated according to 2016 and 1990 ACR criteria for FM. Kappa agreement between the two criteria was determined. Spearman's correlation between the polysymptomatic distress scale (PSD) and selected variables including disease activity score-28 with erythrocyte sedimentation rate (DAS-28 ESR), clinical disease activity index (CDAI), patient global assessment (PGA), and visual analogue scale (VAS) for pain was evaluated. Of the 130 RA patients, 52 patients (40%) satisfied the 2016 criteria and 40 (31.5%) the 1990 criteria. The Kappa agreement between the two criteria was 0.733. RA patients with FM had higher DAS28-ESR, CDAI, PGA, and VAS compared with those without FM. A significant positive correlation was found between the polysymptomatic Distress scale (PSD) and DAS28-ESR, CDAI, and PGA (rs 0.481, 0.516, 0.511, respectively, P < 0.001). FM coexists in a substantial number of RA patients according to the 2016 revised criteria and associated with high composite disease activity measures. Therefore, assessment of FM should be considered in RA patients with persistently high disease activity.

Diagnosis of spontaneous bacterial peritonitis in children using leukocyte esterase reagent strips and granulocyte elastase immunoassay.

AIM OF THE STUDY: We aimed to assess the utility and rapidity of granulocyte elastase (GE) latex immunoassay and leukocyte esterase (LE) reagent strips for the diagnosis of spontaneous bacterial peritonitis (SBP) in hepatic children with ascites. MATERIAL AND METHODS: This study included 80 ascitic fluid (AF) samples from 45 patients with chronic liver diseases. They were divided into 2 groups (SBP and non-SBP groups). White blood cells > 500 cell/mm3 or polymorphonuclear leukocytes > 250 cell/mm3 were considered as a positive result for the diagnosis of SBP. The AF obtained at bedside was immediately tested with an LE enzyme reagent strip, and another sample was aliquoted for measurement of serum GE. RESULTS: On doing LE dipstick strips, all the non-SBP group gave no coloration with LE strips while 62% of the SBP group gave coloration. LE strips had accuracy of 86.25% in differentiating SBP and non-SBP at a cut-off value of 1 (color grade 1). The diagnostic performance of GE in differentiating SBP and non-SBP was assessed and showed accuracy of 70% for a cutoff value of 123.5 ng/ml. CONCLUSIONS: Application of LE reagent strips is a bedside, rapid, easy-to-use, and inexpensive method for diagnosis of SBP. It has an accuracy of 86.25% in differentiating SBP and non-SBP, which is higher than more complicated and delayed methods such as GE latex immunoassay, which has an accuracy of 70%.

Urinary urobilinogen in biliary atresia: A missed, simple and cheap diagnostic test.

AIM: Early diagnosis of biliary atresia (BA) is of utmost importance for good outcome; however, it is sometimes difficult due to the overlapping diagnostic test results with other causes of neonatal cholestasis. Moreover, many diagnostic tests are costly, invasive and not available in all centers, especially in developing countries. So, we aimed to investigate the diagnostic performance of urinary urobilinogen; an easy, cheap test that was not tested before in BA. METHODS: Seventy-five infants divided into three age- and sex-matched groups (BA, non-BA cholestasis and healthy control group) were recruited for the study. Each group comprised 25 infants. Urinary urobilinogen was measured for all infants using the modified Ehrlich's method. RESULTS: Urinary urobilinogen was significantly lower in the BA group (0.31 ± 0.25 mg/dL) than both of the non-BA cholestasis (2.08 ± 3.48 mg/dL) and healthy control (0.53 ± 0.64 mg/dL) groups at P < 0.0001 and P < 0.001, respectively. Urinary urobilinogen at a cut-off value of 0.32 mg/dL or less can differentiate BA from other non-BA cholestasis with a sensitivity of 88% and a specificity of 72%. When this cut-off value was combined with γ-glutamyltransferase (γ-GT) at a cut-off value of 363 U/L or more, BA could be differentiated from other cholestatic disorders with a sensitivity of 80% and specificity of 100%. On the other hand, dipstick test could not differentiate between BA and non-BA cholestasis (P = 0.396). CONCLUSION: Urinary urobilinogen is a simple, non-invasive, cheap, sensitive and specific marker, especially if combined with γ-GT, which can be used in diagnosis of BA, especially in developing countries.

Trends in the Aggressiveness of End-of-Life Cancer Care in the State of Qatar.

PURPOSE: Quality of end-of-life (EOL) care is a key component of excellence in cancer care, and monitoring indicators for quality of EOL cancer care is crucial to providing excellent care. The aim of the current study is to describe the relative aggressiveness of EOL cancer care in the state of Qatar and to compare it with international figures. METHODS: We analyzed all deaths from cancer in Qatar between January 1, 2009 and December 31, 2013. A total of 784 eligible patients were studied to assess aggressiveness of cancer care at EOL. RESULTS: The average number of intensive care unit admissions per person decreased from 0.44 to 0.22 (P < .001) over the period of study. In addition, patients spent fewer days in the intensive care unit (2.79 to 1.82 days; P = .006) and made fewer visits to the emergency department (1.00 to 0.52 visits; P < .001) in the last 30 days of life. Fewer patients had at least one aggressive treatment measure at EOL during the 5-year period (82.3% to 71.0%; P = .038). The mean composite score for aggressiveness of EOL care decreased from 2.24 to 1.92 (P < .01). CONCLUSION: The aggressiveness of EOL cancer care has significantly decreased over time in Qatar; however, despite this decrease, the rate is still higher than that reported internationally. The integration of community palliative care services in Qatar may further decrease the aggressiveness of cancer care at EOL.

Patterns in place of cancer death in the State of Qatar: a population-based study.

BACKGROUND: International studies show that most people prefer to die at home; however, hospitals remain the most common place of death (PoD). This study aims to investigate the patterns in PoD and the associated factors, which are crucial for end-of-life cancer care enhancement. METHOD: This retrospective, population-based study analyzed all registered cancer deaths in Qatar between January 1, 2006 and December 31, 2012 (n = 1,224). The main outcome measures were patient characteristics: age, gender, nationality, cancer diagnosis, year of death, and PoD. Time trends for age-standardized proportions of death in individual PoDs were evaluated using chi-square analysis. Odds ratio (OR) were determined for variables associated with the most preferred (acute palliative care unit [APCU] and hematology/oncology ward) versus least preferred (ICU and general medicine ward) PoDs in Qatar, stratified by nationality. RESULTS: The hematology/oncology ward was the most common PoD (32.4%; 95% CI 26.7-35.3%) followed by ICU (31.4%; 95% CI 28.7-34.3%), APCU (26.9%; 95% CI 24.3-29.6%), and general medicine ward (9.2%; 95% CI 7.6-11.1%). APCU trended upward (+0.057/year; p<0.001), while the hematology/oncology ward trended downward (-0.055/year; p<0.001). No statistically significant changes occurred in the other PoDs; home deaths remained low (0.4%; 95% Cl 0.38-0.42). Qataris who died from liver cancer (OR 0.23) and aged 65 or older (OR 0.64) were less likely to die in the APCU or hematology/oncology ward (p<0.05). Non-Qataris who died from pancreatic cancer (OR 3.12) and female (OR 2.05) were more likely to die in the APCU or hematology/oncology ward (p<0.05). Both Qataris and non-Qataris who died from hematologic malignancy (OR 0.18 and 0.41, respectively) were more likely to die in the ICU or general medicine ward (p<0.05). CONCLUSION: A high percentage of cancer deaths in Qatar occur in hospital. As home was the preferred PoD for most people, effective home care and hospice programs are needed to improve end-of-life cancer care.

Acute disseminated encephalomyelitis following infectious mononucleosis in a toddler.

Symptomatic Epstein-Barr virus (EBV) infection complicated by acute disseminated encephalomyelitis (ADEM) in a toddler is rare. Our patient is a 14 month-old boy who presented with listlessness and reduced eye movements nearly 10 days after a prodromal upper respiratory illness that was accompanied by an amoxicillin rash. On examination, the boy appeared drowsy, had a congested throat and a resolving lower extremity rash, but otherwise had a normal neurological examination. Investigation revealed lymphocytosis, mildly elevated liver enzyme and a positive EBV IgM serology. Cerebrospinal fluid analysis showed pleocytosis. Subsequent brain and spine MRI showed demyelinating disease extending from the cerebral peduncles, across the brain stem and down to the mid-thoracic spinal cord. The patient was treated as a case of ADEM and given intravenous methylprednisolone. On outpatient follow-up his symptoms resolved completely in 6 weeks.

Acute effects of dokha smoking on the cardiovascular and respiratory systems among UAE male university students.

BACKGROUND: In the United Arab Emirates (UAE) tobacco use is rampant. A less reported, yet widely used form of smoking native to UAE is midwakh or dhokha. The aim of the study is to assess the acute effects of smoking dokha (Arabian pipe) on the cardiovascular and respiratory systems among male university students in the UAE. METHOD: A quasi-experimental study was conducted among 97 male volunteers aged more than 17 years. Blood pressure, heart rate and respiratory rate of each participant, were measured before and immediately after smoking. A self administered questionnaire was used to collect personal details and data about smoking pattern. RESULTS: Mean increases in systolic blood pressures (12±1 mmHg), heart rates (20±2 bpm) and respiratory rates (4±1 breaths/min) were observed (p<0.001). A mean decrease in diastolic blood pressures (1±1 mmHg) was observed (p=0.483). CONCLUSION: Smoking dokha has a significant acute effect on systolic blood pressure, heart rate and respiratory rate. Anti smoking campaigns must address the ill effects of this form of smoking. Results from the study warrant further research into this method of smoking which is becoming more popular.