Frequency and Pattern of Rheumatoid Arthritis in a Tertiary Hospital in Maiduguri, North-Eastern Nigeria.

BACKGROUND: Rheumatoid arthritis (RA) is considered rare and mild in Africa, its exact burden is unknown. OBJECTIVES: To determine the pattern of RA and medications used in its management at University of Maiduguri Teaching Hospital (UMTH), Nigeria. METHODS: A retrospective cross-sectional study of RA patients, aged >18 years, satisfying the American college of rheumatology (ACR)/European alliance of associations for rheumatology (EULAR) 2010 and/or ACR 1987 classification criteria seen over six years (January 2015 to December 2020) at UMTH. Ethical approval was granted by the hospital's Ethics committee. Excluded, were other Rheumatic and musculoskeletal diseases (RMDs) and those with incomplete data. Sociodemographic, clinical features, laboratory results, medications used, and clinical disease activity index (CDAI) were recorded. Data were analyzed using SPSS version 23.0. A p-value of < 0.05 was considered significant. RESULTS: Of the 1,315 RMDs seen, 162 (12.3%) had RA of which 32 were excluded due to incomplete data. Their median [IQR] age was 40.9 [29.6-54.0] years and 78.5% were females. The median [IQR] disease duration before presentation was 3 [2-5] years. The wrist joint was the most affected (88.5%), while the hip was the least (15.4%). Sicca symptoms was reported by 42.3% while, 41.1% had subcutaneous nodules. The median [IQR] erythrocyte sedimentation rate (ESR) was 66.2 [45-72.3] mm in the 1st hour, 65.7% had positive Rheumatoid factor (RF). The mean(±SD) CDAI score was 33.0(±9.5) and 86.2% of patients had high disease activity. All patients were treated with steroids, 70.0% had methotrexate (MTX) while none received biologics. CONCLUSION: In Maiduguri, RA patients present late with high disease activity and poor access to biologics. There is a need to improve early diagnosis and prompt referral to a rheumatologist.

BACKGROUND: La polyarthrite rhumatoïde (PR) est considérée comme rare et bénigne en Afrique, son poids exact est inconnu. OBJECTIFS: Déterminer le profil de la PR et les médicaments utilisés pour sa prise en charge à l'hôpital universitaire de Maiduguri (UMTH), au Nigeria. MÉTHODES: Étude rétrospective transversale des patients atteints de PR, âgés de plus de 18 ans, répondant aux critères de classification 2010 de l'American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) et/ou ACR 1987, examinés sur une période de six ans (de janvier 2015 à décembre 2020) à l'UMTH. L'approbation éthique a été accordée par le comité d'éthique de l'hôpital. Ont été exclues, les autres maladies rhumatismales et musculosquelettiques (RMD) et celles dont les données étaient incomplètes. Les caractéristiques sociodémographiques et cliniques, les résultats de laboratoire, les médicaments utilisés et l'indice d'activité clinique de la maladie (CDAI) ont été enregistrés. Les données ont été analysées à l'aide de SPSS version 23.0. Une valeur p de < 0,05 a été considérée comme significative. RÉSULTATS: Sur les 1 315 DMR examinés, 162 (12,3 %) étaient atteints de PR, dont 32 ont été exclus en raison de données incomplètes. Leur âge médian [IQR] était de 40,9 [29,6-54,0] ans et 78,5% étaient des femmes. La durée médiane [IQR] de la maladie avant la présentation était de 3 [2-5] ans. L'articulation du poignet était la plus touchée (88,5 %), tandis que la hanche était la moins touchée (15,4 %). Des symptômes de siccité ont été signalés par 42,3 % des patients, tandis que 41,1 % présentaient des nodules sous-cutanés. Le taux de sédimentation érythrocytaire médian [IQR] était de 66,5 %. La vitesse de sédimentation des érythrocytes (VS) médiane [IQR] était de 66,2 [45-72,3] mm au cours de la première heure, 65,7 % avaient un facteur rhumatoïde (FR) positif. Le score CDAI moyen (±SD) était de 33,0 (±9,5) et 86,2% des patients présentaient une forte activité de la maladie. Tous les patients ont été traités par stéroïdes, 70,0 % par méthotrexate (MTX) et aucun n'a reçu de produits biologiques. CONCLUSION: A Maiduguri, les patients atteints de PR se présentent tardivement avec une forte activité de la maladie et un faible accès aux produits biologiques. Il est nécessaire d'améliorer le diagnostic précoce et l'orientation rapide vers un rhumatologue. Mots clés: Polyarthrite rhumatoïde, Nord-Est du Nigeria, Investigations, Disease Activity Management.

Multivariate computational analysis of biosensor's data for improved CD64 quantification for sepsis diagnosis.

Sepsis, as a leading cause of death worldwide, relies on systemic inflammatory response syndrome (SIRS) criteria for its diagnosis. SIRS is highly non-specific as it relies on monitoring of patients' vitals for sepsis diagnosis, which are known to change with many confounding factors. Changes in leukocyte counts and CD64 expression levels are known specific biomarkers of pro-inflammatory host response at the onset of sepsis. Recently, we have developed a biosensor chip that can enumerate the leukocyte counts and quantify the neutrophil CD64 expression levels from a drop of blood. We were able to show improved sepsis diagnosis and prognosis in clinical studies by measuring these parameters during different times of the patients' stay in hospital. In this paper, we investigated the rate of cell capture with CD64 expression levels and used this in a multivariate computational model using artificial neural networks (ANNs) and showed improved accuracy of quantifying CD64 expression levels from the biosensor (n = 106 whole blood experiments). We found a high coefficient of determination and low error between biosensor- and flow cytometry-based neutrophil CD64 expression levels using multiple ANN training methods in comparison to those of univariate regression commonly employed. This approach can find many applications in biosensor data analytics by utilizing multiple features of the biosensor's data for output determination.

Point-of-care sensors for the management of sepsis.

Point-of-care sensors that enable the fast collection of information relevant to a patient's health state can facilitate improved health access, reduce healthcare costs and improve the quality of healthcare delivery. In the diagnosis of sepsis - defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection, and the leading cause of in-patient death and of hospital readmission in the United States - predicting which infections will lead to life-threatening organ dysfunction and developing specific anti-sepsis treatments remain challenging because of the significant heterogeneity of the host response. Yet the use of point-of-care devices could reduce the time from the onset of a patient's infection to the administration of appropriate therapeutics. In this Perspective, we describe the current state of point-of-care sensors for the diagnosis and monitoring of sepsis, and outline opportunities in the use of these devices to dramatically improve patient care.

A point-of-care microfluidic biochip for quantification of CD64 expression from whole blood for sepsis stratification.

Sepsis, a potentially life-threatening complication of an infection, has the highest burden of death and medical expenses in hospitals worldwide. Leukocyte count and CD64 expression on neutrophils (nCD64) are known to correlate strongly with improved sensitivity and specificity of sepsis diagnosis at its onset. A major challenge is the lack of a rapid and accurate point-of-care (PoC) device that can perform these measurements from a minute blood sample. Here, we report a PoC microfluidic biochip to enumerate leukocytes and quantify nCD64 levels from 10 µl of whole blood without any manual processing. Biochip measurements have shown excellent correlation with the results from flow cytometer. In clinical studies, we have used PoC biochip to monitor leukocyte counts and nCD64 levels from patients' blood at different times of their stay in the hospital. Furthermore, we have shown the biochip's utility for improved sepsis diagnosis by combining these measurements with electronic medical record (EMR).

Feline bartonellosis associated with some clinicopathological conditions in a veterinary hospital in Selangor, Malaysia.

A cross-sectional study was conducted to determine the prevalence of feline bartonellosis and the associated clinicopathological findings in cats presented to the University Veterinary Hospital, Selangor, Malaysia from 2013-2014. Out of 284 cats examined, Bartonella DNA was detected in 48 (16.9%) cats using a specific polymerase chain reaction (PCR) assay targeting the internal transcribed spacer of Bartonella species. Bartonella henselae strain Houston was identified through BLAST analyses of randomly selected amplicons. Univariable analysis showed significant association of feline bartonellosis with cats < 2 years of age (OR 1.37, 95% CI 0.982-1.927, p = 0.036) and those presenting with ocular discharge (OR 3.211, 95% CI 1.422-7.248, p = 0.003). Significant associations of neutrophilia (OR 2.244, 95% CI 1.131-4.452, p = 0.019) and monocytosis (OR 2.476, 95% CI 1.154-5.312, p = 0.017) with bartonella infection in cats were observed. This study reports for the first time the prevalence (approximately 17%) of feline bartonellosis in Malaysia and highlights several clinicopathological factors associated with the disease.

Feline bartonellosis associated with some clinico- pathological conditions in a veterinary hospital in Selangor, Malaysia

A cross-sectional study was conducted to determine the prevalence of feline bartonellosis and the associated clinicopathological findings in cats presented to the University Veterinary Hospital, Selangor, Malaysia from 2013–2014. Out of 284 cats examined, Bartonella DNA was detected in 48 (16.9%) cats using a specific polymerase chain reaction (PCR) assay targeting the internal transcribed spacer of Bartonella species. Bartonella henselae strain Houston was identified through BLAST analyses of randomly selected amplicons. Univariable analysis showed significant association of feline bartonellosis with cats < 2 years of age (OR 1.37, 95% CI 0.982–1.927, p = 0.036) and those presenting with ocular discharge (OR 3.211, 95% CI 1.422–7.248, p = 0.003). Significant associations of neutrophilia (OR 2.244, 95% CI 1.131–4.452, p = 0.019) and monocytosis (OR 2.476, 95% CI 1.154–5.312, p = 0.017) with bartonella infection in cats were observed. This study reports for the first time the prevalence (approximately 17%) of feline bartonellosis in Malaysia and highlights several clinicopathological factors associated with the disease.

Bowel perforation due to break and distal passage of the safety ring of an adjustable intra-gastric balloon: A potentially life threatening situation.

A 45-year-old man of Middle Eastern origin, morbid obese, with a body mass index of 39 had an intra-gastric balloon, filled with 500 mL of saline/methylene blue and intended as definite therapy, inserted some 8 wk previously. He was admitted to the emergency department with abdominal cramps. An ultrasound of the abdomen was performed in ER which confirmed the balloon to be in place without any abnormality. He was discharged home on symptomatic medication. Patient remains symptomatic therefore he reported back to ER 2 d later. Computed tomography scan was performed this time for further evaluation which revealed a metallic ring present in the small bowel while the intra-gastric balloon was in its proper position. There was no clinical or radiological sign of intestinal obstruction. Patient was hospitalized for observation and conservative management. The following night, patient experienced sudden and severe abdominal pain, therefore an X-ray of the abdomen in erect position was done, which showed free air under the right dome of diaphragm. Patient was transferred to O.R for emergency laparotomy. There were two small perforations identified at the site of the metallic ring entrapment. The ring was removed and the perforations were repaired. Due to increasing prevalence of obesity and advances in modalities for its management, physicians should be aware of treatment options, their benefits, complications and clinical presentation of the known complications. Physicians need to be updated to approach these complications within time, to avoid life-threatening situations caused by these appliances.

A microfluidic biochip for complete blood cell counts at the point-of-care.

Complete blood cell counts (CBCs) are one of the most commonly ordered and informative blood tests in hospitals. The results from a CBC, which typically include white blood cell (WBC) counts with differentials, red blood cell (RBC) counts, platelet counts and hemoglobin measurements, can have implications for the diagnosis and screening of hundreds of diseases and treatments. Bulky and expensive hematology analyzers are currently used as a gold standard for acquiring CBCs. For nearly all CBCs performed today, the patient must travel to either a hospital with a large laboratory or to a centralized lab testing facility. There is a tremendous need for an automated, portable point-of-care blood cell counter that could yield results in a matter of minutes from a drop of blood without any trained professionals to operate the instrument. We have developed microfluidic biochips capable of a partial CBC using only a drop of whole blood. Total leukocyte and their 3-part differential count are obtained from 10 µL of blood after on-chip lysing of the RBCs and counting of the leukocytes electrically using microfabricated platinum electrodes. For RBCs and platelets, 1 µL of whole blood is diluted with PBS on-chip and the cells are counted electrically. The total time for measurement is under 20 minutes. We demonstrate a high correlation of blood cell counts compared to results acquired with a commercial hematology analyzer. This technology could potentially have tremendous applications in hospitals at the bedside, private clinics, retail clinics and the developing world.

Coincidence detection of heterogeneous cell populations from whole blood with coplanar electrodes in a microfluidic impedance cytometer.

Particle counting finds many industrial applications especially in medical healthcare. In particular, cell counting from whole blood is used pervasively for disease diagnostics. Microfluidic impedance cytometry is fast, requires a small volume of blood, can be used at point of care and can perform absolute enumeration of different cell types in the sample. Coincidence detection is very essential for accurate counting results and becomes more significant while counting specific target cells, e.g. CD4(+) or CD8(+) T cell count in HIV/AIDS patient blood samples. In heterogeneous samples, e.g. blood, cell differentiation for all coincidence occurrences is essential in addition to the coincidence detection for accurate cell enumeration. In this paper, we have characterized the coincidence detection with cell differentiation using a microfluidic impedance biochip. The pure population of leukocytes is obtained after all erythrocytes are lysed on-chip from whole blood. Leukocytes were counted electrically as they pass over coplanar microfabricated electrodes bonded to the 15 µm × 15 µm cross section counting channel while generating a bipolar pulse for each cell passage. We have developed a mathematical model to simulate the electrical cell pulse and its coincidences. We show that coincidence detection can be characterized into three main types based on the range of time delay at which the coincidence occurs. We have also characterized cell differentiation for all the three coincidence types and show that multiple coincidences of different types can also occur. We used healthy and HIV-infected patient blood samples and used our coincidence detection technique to count CD4(+) and CD8(+) T cells and show the improvement in accuracy of cell counts compared to that without coincidence detection. We have also shown the improvement in the erythrocyte counting with coincidence detection in diluted whole blood samples.

Flow metering characterization within an electrical cell counting microfluidic device.

Microfluidic devices based on the Coulter principle require a small aperture for cell counting. For applications using such cell counting devices, the volume of the sample also needs to be metered to determine the absolute cell count in a specific volume. Hence, integrated methods to characterize and meter the volume of a fluid are required in these microfluidic devices. Here, we present fluid flow characterization and electrically-based sample metering results of blood through a measurement channel with a cross-section of 15 µm × 15 µm (i.e. the Coulter aperture). Red blood cells in whole blood are lysed and the remaining fluid, consisting of leukocytes, erythrocyte cell lysate and various reagents, is flown at different flow rates through the measurement aperture. The change in impedance across the electrodes embedded in the counting channel shows a linear relationship with the increase in the fluid flow rate. We also show that the fluid volume can be determined by measuring the decrease in pulse width, and increase in number of cells as they pass through the counting channel per unit time.

Glass ionomer cements: effect of strontium substitution on esthetics, radiopacity and fluoride release.

OBJECTIVE: SrO and SrF2 are widely used to replace CaO and CaF2 in ionomer glasses to produce radiopaque glass ionomer cements (GIC). The purpose of this study was to evaluate the effects of this substitution on release of ions from GIC as well as its effect on esthetics (translucency) and radiopacity. MATERIALS AND METHODS: Cements were produced from ionomer glasses with varying content of Sr, Ca and F. The cements were stored in dilute acetic acid (pH 4.0) for up to 7 days at 37°C. Thereafter, the cements were removed and the solution was tested for F(-), Sr(2+), Ca(2+), and Al(3+) release. Radiopacity and translucency were measured according to BS EN ISO 9917-1:2003. RESULTS: Ion release was linear to t(1/2) suggesting that this is a diffusion controlled mechanism rather than dissolution. The fluoride release from the cements is enhanced where some or all calcium is replaced by strontium. Radiopacity shows a strong linear correlation with Sr content. All cements were more opaque than the C0.70 0.55 standard but less opaque than the C0.70 0.90 standard which is the limit for the ISO requirement for acceptance. SIGNIFICANCE: This study shows that the replacement of calcium by strontium in a glass ionomer glass produces the expected increase in radiopacity of the cement without adverse effects on visual properties of the cement. The fluoride release from the cements is enhanced where some or all calcium is replaced by strontium.

Electrical flow metering of blood for point-of-care diagnostics.

We have developed a microfabricated chip that creates a purified white blood cell (WBC) population from whole blood samples and then electrically analyzes the WBCs at the same time as measuring sample volume flown. The flow metering is based on the measurement of the electrical admittance between microelectrodes inside a microfluidic channel. We found that the admittance related to the flow rate linearly. WBC counts which correlated with the flow rate shows how this technique is a viable method in metering and analyzing blood and other biological samples in a point-of-care environment.

SPlitSSI-SVM: an algorithm to reduce the misleading and increase the strength of domain signal.

Protein domains contain information about the prediction of protein structure, function, evolution and design since the protein sequence may contain several domains with different or the same copies of the protein domain. In this study, we proposed an algorithm named SplitSSI-SVM that works with the following steps. First, the training and testing datasets are generated to test the SplitSSI-SVM. Second, the protein sequence is split into subsequence based on order and disorder regions. The protein sequence that is more than 600 residues is split into subsequences to investigate the effectiveness of the protein domain prediction based on subsequence. Third, multiple sequence alignment is performed to predict the secondary structure using bidirectional recurrent neural networks (BRNN) where BRNN considers the interaction between amino acids. The information of about protein secondary structure is used to increase the protein domain boundaries signal. Lastly, support vector machines (SVM) are used to classify the protein domain into single-domain, two-domain and multiple-domain. The SplitSSI-SVM is developed to reduce misleading signal, lower protein domain signal caused by primary structure of protein sequence and to provide accurate classification of the protein domain. The performance of SplitSSI-SVM is evaluated using sensitivity and specificity on single-domain, two-domain and multiple-domain. The evaluation shows that the SplitSSI-SVM achieved better results compared with other protein domain predictors such as DOMpro, GlobPlot, Dompred-DPS, Mateo, Biozon, Armadillo, KemaDom, SBASE, HMMPfam and HMMSMART especially in two-domain and multiple-domain.