Search

BackgroundRheumatoid arthritis (RA) is an inflammatory, systemic autoimmune disease affecting the synovial membrane of small joints.1 Wagan A. et al demonstrated that the frequency of fatigue in rheumatoid arthritis is 62%,2 Hammam et al described a higher rate of fatigue associated with higher disease activity. Fatigue is as a feeling of exhaustion, also as a reduction in physical and mental capacity,3,4 it can be measured with the scale FACIT-F (Functional Assessment of Chronic Illness Therapy-Fatigue), which evaluates the last 7 days, with a score of 0-52. For the severity analysis, 4 grades are used: no or mild fatigue (40-52), moderate (27-39), severe (14-26) and extreme fatigue (0-13).2,5ObjectivesTo evaluate the frequency and degree of fatigue in rheumatoid arthritis.MethodsProspective, observational, cross-sectional study of a cohort of patients of the Rheumatology Service of the Hospital Docente Padre Billini. Patients were interviewed in July 2021. Inclusion criteria: ≥ 18 years, diagnosis of RA according to the ACR/EULAR 2010 classification criteria. Exclusion criteria: previous diagnosis of fibromyalgia, depression or anxiety, treatment with antidepressants, antihistamines, beta-blockers. Scales measured: FACIT-F, DAS28, CDAI, and HAQ-DI. Statistical analysis was performed with the Pearson correlation (rp). Data were analyzed in IBM-SPSS v23.Results597 patients met inclusion criteria. 93% female, mean age 58.5±12.4 years, mean disease duration 7.5 years. HT 73.9% (441), DM 14.2% (85), dyslipidemia 21.3% (127), obesity 17.9% (107), smoking 9.9% (59), high ESR 60.0% (358), high CRP 49.7% (297), scDMARD8 2.7% (494), bDMARDS 36.8% (218), tsDMARDS 18.1 (108). Frequency of fatigue 19.9% (119): moderate 12.9% (77), severe 7.0% (42). Correlation of FACIT-F with DAS28, CDAI and HAQ-DI: No fatigue FACIT-F 80.1% (478): DAS28 remission or low activity 84.9% (406), CDAI remission or low activity 93.5% (447), moderate 4.0% (19), high activity 2.5% (12), HAQ-DI mild 75.9% (363), moderate 16.5% (79), severe 7.5% (36). Moderate FACIT-F 12.9% (77): DAS28 remission or low activity 19.5% (15), moderate 80.5% (62), CDAI moderate 48.1% (37), high activity 51.9% (40), HAQ-DI mild 24.7% (19), moderate 63.6% (49), severe 11.7% (9). Severe FACIT-F 7.0% (42): DAS28 remission or low activity 4.8% (2), high activity 95.2% (40), CDAI low activity or remission 35.7% (15), high activity 64.3% (27), HAQ-DI mild 7.1% (3), moderate 23.8% (10), severe 69.0% (29). Correlation between FACIT-F/DAS28 (rp= .673, p< .001) and FACIT-F/CDAI (rp= .701, p < .001) were strong.ConclusionThe study showed a low frequency of fatigue; the degree of fatigue most found was moderate. The group of patients with fatigue had a statistically significant linear association with disease activity and degree of functional limitation. There were no patients with extreme fatigue.References[1]Gomero García, D., 2018. Rheumatoid arthritis, epidemiology, pathophysiology, diagnostic criteria and treatment. Journal of Medicine and Research Universidad Autónoma del Estado de México, 6(2).[2]Wagan AA, Raheem A, Bhatti A, Zafar T. Fatigue assessment by FACIT-F scale in Pakistani cohort with Rheumatoid Arthritis (FAF-RA) study. Pak J Med Sci. 2021;37(4).[3]Hammam N, Gamal RM, Rashed AM, Elfetoh NA, Mosad E, Khedr EM. Fatigue in Rheumatoid Arthritis Patients: Association With Sleep Quality, Mood Status, and Disease Activity. Rheumatol Clin (Engl Ed). 2020 Sep-Oct;16(5 Pt 1):339-344.[4]James K, Al-Ali S, Tarn J, Cockell SJ, Gillespie CS, Hindmarsh V, et al. (2015) A Transcriptional Signature of Fatigue Derived from Patients with Primary Sjögren’s Syndrome. PLoS ONE.[5]Cella D. The Functional Assessment of Cancer Therapy-Anemia (FACT-An) Scale: a new tool for the assessment of outcomes in cancer anemia and fatigue. Semin Hematol. 1997 Jul;34(3 Suppl 2):13-9.Disclosure of InterestsNone declared

BackgroundAxial spondyloarthritis (SpAa) is a chronic inflammatory disease of unknown etiology that affects the axial skeleton, affecting peripheral joints, entheses and extra-articular structures, with a prevalence of 0.5-1% associated with HLA-B27+.1 The impact of Chronic disease is often multifactorial that affects physical, hormonal and psychological alterations, leading to problems of sexuality.2 The CSFQ-14 (Changes in Sexual Functioning Questionnaire), evaluates changes in sexual functioning due to disease and/or or treatment in 5 domains with a score range of 14-70; cut-off point indicating sexual dysfunction 3,4ObjectivesTo evaluate the frequency and degree of sexual dysfunction in patients with axial spondyloarthritis.MethodsProspective, observational, cross-sectional study. of the SpAa cohort of the Hospital Docente Padre Billini rheumatology service Patients were interviewed in July 2021. Inclusion criteria: > 18 years, diagnosis of SpAa according to the ASAS 2009 classification criteria, at least 1 sexual. Exclusion criteria: previous diagnosis of another autoimmune disease, depression, diabetes mellitus (DM), treatment with antidepressants, antiepileptics, narcotics. Measurement of: CSFQ-14, BASDAI. Statistical analysis was performed with the Pearson correlation (rP) with p>0.05. The data was analyzed by SPSS V23.ResultsOf the SpAa cohort, 87 met the inclusion criteria. Male 67.8% (59), female 32.2% (28), mean age 45.7±8 years, mean diagnosis 7, married 67.8%(59), single 24.1%(21), widowed 8%(7), HLA-B27 + 51.1 %, hypertension 8% (7), diabetes 6.8% (6), dyslipidemia 10.3%(9), smokers 4.5%(4), 100% (87) bDMARD´s, 13.6% (12) combined with csDMARD´s, Frequency of sexual dysfunction 24.1%(21). Sexual dysfunction in women 6.9% (6) and men 17.2% (15) by CSFQ-14. Global domains: Desire/Interest 2.3% (2), Desire/Frequency 2.3% (2), Pleasure 5.7% (5), Arousal 2.3% (2), Orgasm/Completion 2.3% (2). Female: Desire/interest 6.8% (4), desire/Frequency 3.4% (2), pleasure 8.5% (5). Male: Desire/interest 3.4% (2), desire/Frequency 3.4% (2), pleasure 8.5% (5), arousal 6.8% (4), orgasm/completion 3.4% (2). Correlation CSFQ-14 domains with BASDAI: rp =. -0.088 p>0.05: Desire/interest dysfunction: inactive BASDAI 71.4% (15). Desire/frequency: inactive BASDAI 90.5% (20). Pleasure: inactive BASDAI 23.8% (5), active 23.8% (5). Excitation: inactive BASDAI 14.3% (3). Orgasm/completion> inactive BASDAI 90.5% (20)ConclusionThe study showed a low frequency of sexual dysfunction, being more frequent in males. The greatest dysfunction was found in the pleasure domain in both sexes. A statistically significant inverse linear association was found between sexual dysfunction and disease activity.References[1]Gunaydin, R., Karatepe, AG, Cesmeli, N. & Kaya, T. Fatiga en pacientes con espondilitis anquilosante: relaciones con variables específicas de la enfermedad, depresión y trastornos del sueño. Reumatología clínica 28, 1045-1051 (2009).[2]Helland, Y. et al. Enfermedades reumáticas y sexualidad: impacto de la enfermedad y estrategias de autocuidado. Arthritis Care Res. (Hoboken)63, 743–750 (2011).[3]Badley EM (2008) Enhancing the conceptual clarity of the activity and participation components of the International Classification of Functioning, Disability and Health. Soc Sci Med 66: 2335–2345[4]Clayton AH, McGarvey EL, Clavet GJ. The Changes in Sexual Functioning Questionnaire (CSFQ): development, reliability, and validity. Psychopharmacol Bull. 1997;33(4):731-45. PMID: 9493486.Disclosure of InterestsNone declared

BackgroundSystemic sclerosis (SSc) is a systemic autoimmune disease.1 Sexual function has been associated with a high prevalence of dissatisfaction.2,3,4 Various factors have been implicated as causes of impaired sexual function.5 CSFQ-14 (Changes in Sexual Functioning Questionnaire) assesses changes in sexual functioning due to disease and/or treatment in 5 domains with a score range of 14-70; cut-off point indicating sexual dysfunction < 41 men and < 47 women.6ObjectivesTo evaluate the frequency and degree of sexual dysfunction in patients with systemic sclerosis.MethodsProspective, observational, cross-sectional study of the cohort of the Rheumatology service at Hospital Docente Padre Billini. Patients were interviewed in November 2021. Inclusion criteria: > 18 years, diagnosis of SSc by ACR/EULAR 2013 classification criteria, at least 1 sexual relationship. Exclusion criteria: previous diagnosis of another autoimmune disease, depression, diabetes, treatment with antidepressants, antiepileptics, narcotics. Measurement of CSFQ-14, mRSS. Statistical analysis was performed with the Pearson correlation (rp) with p=>0.05. The data was analyzed by SPSS V23.ResultsOf 63 patients, 54 met the inclusion criteria. 100% female, mean age 53 + 15.07 years, mean duration 11.3 years, lSSc 24.1% (13), dSSc 75.9% (41), single 50% (27), married 44.4% (24), widowed 5.6% (3). Frequency of sexual dysfunction 81.5% (44). Domains: pleasure 79.6% (43), desire/interest 37% (20), frequency desire 81.5% (44), arousal 46.3% (25), orgasm/completion 75.9% (41). Correlation CSFQ-14 with mRSS: Pleasure dysfunction: normal mRSS 2.3% (1), mild 23.3% (10), moderate 20.9% (9), severe 32.6% (14), terminal 20.9% (9). Desire/interest dysfunction: mild mRSS 35% (7), moderate 20% (4), severe 35% (7), terminal 10% (2). Frequency desire dysfunction: normal mRSS 2.3% (1), mild 25% (11), moderate 15.7% (12), severe 36.4% (16), terminal 20.5% (9). Arousal dysfunction: normal mRSS 4% (1), mild 16% (4), moderate 16% (4), severe 36% (9), terminal 28% (7). Orgasm/completion dysfunction: normal mRSS 2.4% (1), mild 22% (9), moderate 22% (9), severe 26.8% (11), terminal 26.8% (11). rp=. 065 p> 0.05.ConclusionThe study demonstrated a high frequency of sexual dysfunction in most of the population studied. The desire/frequency dysfunction domain turned out to be the one with the highest presentation, followed by the orgasm/completion domain. A statistically significant linear association between sexual dysfunction and cutaneous activity of the disease was evidenced.References[1]Basta F, Afeltra A, Margiotta DPE. Fatigue in systemic sclerosis: a systematic review. Clin Exp Rheumatol. 2018[2]Heřmánková, B., 2019. Sexual Dysfunction in Patients with Systemic Sclerosis. New Insights into Systemic Sclerosis[3]Gao, R., Qing, P., Sun, X., Zeng, X., Hu, X., Zhang, S., Yang, Y. and Qin, L., 2021. Prevalence of Sexual Dysfunction in People With Systemic Sclerosis and the Associated Risk Factors: A Systematic Review. Sexual Medicine, 9(4), p.100392.[4]Frikha, F., Masmoudi, J., Saidi, N. and Bahloul, Z., 2014. Sexual dysfunction in married women with systemic sclerosis. Pan African Medical Journal, 17.[5]Levis B, Burri A, Hudson M, Baron M, Thombs BD, et al. (2012) Sexual Activity and Impairment in Women with Systemic Sclerosis Compared to Women from a General Population Sample. PLoS ONE 7(12): e52129.[6]Clayton AH, McGarvey EL, Clavet GJ. The Changes in Sexual Functioning Questionnaire (CSFQ): development, reliability, and validity. Psychopharmacol Bull. 1997;33(4):731-45.Disclosure of InterestsNone declared

BackgroundPsoriatic arthritis (PsA) is an inflammatory joint disease that cause structural damage, disability, and an impairment of quality of life.1Sexual function is a neglected area of quality of life in patients with PsA, with a high prevalence of dissatisfaction.2 It has been described that there is no relationship between the activity of the disease and the degree of joint dysfunction.3 In 1 out of 5 patients consider that the disease negatively impacts their sexuality.4 CSFQ-14 (Changes in Sexual Functioning Questionnaire), evaluates changes in sexual functioning due to an illness or treatment in 5 domains with a score range 14-70; cut-off point indicating sexual dysfunction -41 men and -47 women.5ObjectivesTo evaluate the frequency and degree of sexual dysfunction in patients with psoriatic arthritis.MethodsProspective, observational, cross-sectional study. The patients of the outpatient clinic of the rheumatology service of the Padre Billini teaching hospital were interviewed during November 2021. Inclusion criteria: ≥18 years, PsA diagnosis according to CASPAR classification criteria 2006. Exclusion criteria: diagnosis of another autoimmune disease, depression, treatment with antidepressants. We analyzed the data in SPSS23 and used the Pearson correlation coefficient with a statistical significance p=Results58 met inclusion criteria. 63.8% (37) female, male 36.2% (21), mean age 54.8 + 11.75 y, mean diagnosis 7.9 y, married 55.2% (32), unmarried 39.7% (23), widowed 5.2% (3). Frequency of sexual dysfunction 39.7% (23), CSFQ-14 indicative of dysfunction in women 35.1% (23), men 47.6% (10). Female Domains: Pleasure dysfunction 35.1% (13), desire/interest 32.4% (12), desire/frequency 32.4% (12), arousal 24.3% (9), orgasm/completion 43.2% (16). Male Domains: Pleasure dysfunction 38.1% (8), desire/interest 47.6% (10), desire/frequency 33.3% (7), arousal 23.8% (5), orgasm/completion 42.9% (9). Correlation CSFQ-14/DAPSA28 domains: Pleasure dysfunction: DAPSA remission 19.2% (5), low 32.1% (9), moderate 50% (2). Desire/interest: DAPSA remission 34.6% (9), low 32.1% (9), moderate 100% (4). Desire/frequency: DAPSA remission 30.8% (8), low 37.5% (10), moderate 25% (1). Excitation: DAPSA remission 30.8% (8), low 17.9% (5), moderate 25% (1). Orgasm/completion: DAPSA remission 50% (13), low 37.5% (10), moderate 50% (2). rp=. 042 pConclusionThe study showed a modest frequency of global sexual dysfunction. In men it was superior. The orgasm/completion domain proved to be the most dysfunctional in both sexes. A statistically significant linear association of sexual dysfunction and disease activity was evident.References[1]Reygaerts T. Effect of Biologics on Fatigue in Psoriatic Arthritis: A Systematic Literature Review with Metaanalysis, Joint Bone Spine (2018).[2]Esteve E et al. Preliminary development of a questionnaire assessing the impact of psoriasis and psoriatic arthritis on patient’s perception of sexuality. Medicine (Baltimore). 2018[3]Aguiar R, Ambrósio C. Sexuality in spondyloarthritis-the impact of the disease. Acta Reumatol Port. 2014 Apr-Jun;39(2):152-7. PMID: 25254264.[4]G Haugeberg, (2020): Perceived influence of health status on sexual activity in patients with psoriatic arthritis, Scandinavian Journal of Rheumatology.[5]Clayton AH, McGarvey EL. The Changes in Sexual Functioning Questionnaire (CSFQ): development, reliability, and validity. Psychopharmacol Bull. 1997;33(4):731-45.Disclosure of InterestsNone declared

BackgroundRheumatoid arthritis (RA) is an inflammatory, autoimmune systemic disease that affects the synovial membrane of small joints.1 Kamissoko et al found the frequency of sexual dysfunction in RA to be 69.2%.2 Pain is considered to have a fundamental role associated with the decrease in the frequency of sexual intercourse.3 The CSFQ-14 (Changes in Sexual Functioning Questionnaire), evaluates the changes in sexual functioning due to a disease and/or treatment in 5 domains with a score range of 14-70; cut-off point indicating sexual dysfunction 4ObjectivesTo evaluate the frequency and degree of sexual dysfunction in patients with rheumatoid arthritis.MethodsProspective, observational, cross-sectional study of a cohort of patients of the Rheumatology Service at Hospital Docente Padre Billini. Patients were interviewed in July 2021. Inclusion criteria: > 18 years, diagnosis of RA according to the ACR/EULAR 2010 classification criteria, at least 1 sexual intercourse. Exclusion criteria: previous diagnosis of another autoimmune disease, depression, diabetes, treatment with antidepressants, antiepileptics, narcotics. Scales measured: CSFQ-14, DAS28. Statistical analysis was performed with the Pearson correlation (rp) with p>0.05. Data were analyzed in IBM-SPSS v23.ResultsOf the RA cohort, 483 met inclusion criteria. 93.4% (451) female, mean age 58±12.6 years, mean duration of diagnosis 8 years, married 53.8% (260), single 27.7% (134), widowed 16.6% (80), hypertension 73.9% (357), dyslipidemia 21.5% (104), obesity 18.0% (87), smoking 9.9% (48). Frequency of sexual dysfunction 61.3% (296). Sexual dysfunction in women 93.9% (278) and men 6.1% (18). Global domains: desire/interest 55.7% (165), desire/frequency 56.4% (167), pleasure 58.1% (172), arousal/excitement 67.2% (199), orgasm/completion 50.0% (148). Female: desire/interest 94.5% (156), desire/frequency 93.4% (156), pleasure 93.6% (161), arousal/excitement 93.0% (185), orgasm/completion 93.9% (139). Male: desire/interest 5.5% (9), desire/frequency 11.6% (11), pleasure 6.4% (11), arousal/excitement 7.0% (14), orgasm/completion 6.1% (9). Desire/interest dysfunction: DAS28 remission or low activity 28.5% (47), moderate 53.3% (88), high activity 4.8% (8). Desire/frequency: DAS28 remission or low activity 35.3% (59), moderate 47.3% (79), high activity 3.6% (6). Pleasure: DAS28 remission or low activity 30.2% (52), moderate 50.0% (86), high activity 2.9% (5). Arousal/excitement: DAS28 remission or low activity 25.1% (50), moderate 55.8% (111), high activity 6.0% (12). Orgasm/completion: DAS28 remission or low activity 43.2% (64), moderate 38.5% (57), high activity 6.1% (9).ConclusionThe study showed a high frequency of sexual dysfunction, observing greater dysfunction in females. In the population, the most affected global domain was arousal/excitement, and it was the most frequent in female and male.References[1]Gomero García, D., 2018. Artritis reumatoide, epidemiología, fisiopatología, criterios diagnósticos y tratamiento. Revista de Medicina e Investigación Universidad Autónoma del Estado de México, 6(2).[2]Kamissoko, A.B., Edikou, T.N.R., Barry, A., Sanda, M., Fofana, K., Irie, L.N.E., Diallo, M.L. and Oniankitan, O. (2021) Sexuality of Women with Rheumatoid Arthritis in a West African Hospital. Open Journal of Rheumatology and Autoimmune Diseases, 11, 152-159[3]Bay, L. et al. Sexual Health and Dysfunction in Patients With Rheumatoid Arthritis: A Cross-sectional Single-Center Study. Sexual Medicine, 8(4), pp.615-630.[4]Clayton AH, McGarvey EL, Clavet GJ. The Changes in Sexual Functioning Questionnaire (CSFQ): development, reliability, and validity. Psychopharmacol Bull. 1997;33(4):731-45. PMID: 9493486.Disclosure of InterestsNone declared

BackgroundSystemic sclerosis (SSc) is a systemic autoimmune disease.1 Fatigue has been reported in 75% of SSc patients, and is the most problematic symptom due to impact on quality of life. Despite its high prevalence, origin is unknown.2 Some studies associate it with the degree of disease activity and decreased quality of life. Fatigue is defined as a feeling of exhaustion, also as a reduction in physical and mental capacity,3 scales such as FACIT-F (Functional Assessment of Chronic Illness Therapy-Fatigue) are used, which evaluates the last 7 days, with a score of 0-52. For the severity analysis, 4 grades are used: no or mild fatigue (40-52), moderate (27-39), severe (14-26) and extreme (0-13).4,5ObjectivesTo evaluate the frequency and degree of fatigue in systemic sclerosis.MethodsProspective, longitudinal, observational study of the cohort of patients of the Rheumatology service of the Hospital Docente Padre Billini. Patients were interviewed in November 2021. Inclusion criteria: ≥18 years, diagnosis of SSc according ACR/EULAR 2013 classification criteria. Exclusion criteria: previous diagnosis of fibromyalgia, depression or anxiety, treatment with antidepressants, antihistamines, beta-blockers. Measurement of FACIT-F, HAQ-DI, mRSS scales. Statistical analysis was performed with the Pearson correlation (rp) with p=>0.05. The data was analyzed by SPSS V23.Results54 met inclusion criteria. 100% female, mean age 53.3±15.1 years, mean disease duration 11.3 years, SScd 75.9% (41), SScl 24.1% (13), interstitial pneumonia 33.3% (18), gastrointestinal reflux disease 27.8% (15), HAP 20.37% (11). Frequency of fatigue 100% (54): moderate FACIT-F: 29.6% (16), severe FACIT-F 38.8% (21), extreme 31.5% (17). Correlation FACIT-F with mRSS and HAQ-DI: Moderate FACIT-F: mRSS mild 43.8% (7), moderate 12.5% (2), severe 18.8% (3), terminal 25% (4), HAQ-DI mild 25% (4), moderate 37.5% (6), severe 18.8% (3). Severe FACIT-F: mRSS normal 4.8% (1), mild 19% (4), moderate 91% (4), severe 33.3 % (7), terminal 23.8% (5), HAQ-DI mild 4.8% (1), moderate 19% (4), severe 47.6% (10). FACIT-F extreme: mRSS mild 7.61% (3), moderate 29.4% (5), severe 35.3% (6), terminal 17.6% (3), HAQ-DI moderate 11.8% (2), severe 52.9% (9). rp=. 246 p>0.05ConclusionThe study demonstrated a high frequency of fatigue. The most frequent degree was severe. A statistically significant linear association was observed between skin involvement and the degree of functional limitation.References[1]Basta F, Afeltra A, Margiotta DPE. Fatigue in systemic sclerosis: a systematic review. Clin Exp Rheumatol. 2018.[2]Chernis, J., Buni, M., Kazzaz, S., Ying, J., Lyons, M., Assassi, S. and Mayes, M., 2021. Predictors of Perceived Functional Status in Early Systemic Sclerosis: A Prospective Longitudinal Study of the GENISOS Cohort. Arthritis Care & Research.[3]Stamm, T., Mosor, E., Omara, M., Ritschl, V., & Murphy, S. L. (2020). How can fatigue be addressed in individuals with systemic sclerosis? The Lancet Rheumatology, 2(3), e128-e129.[4]Nakayama, A., Tunnicliffe, D., Thakkar, V., Singh-Grewal, D., O’Neill, S., Craig, J. and Tong, A., 2016. Patients’ Perspectives and Experiences Living with Systemic Sclerosis: A Systematic Review and Thematic Synthesis of Qualitative Studies. The Journal of Rheumatology, 43(7), pp.1363-1375.[5]Acaster, S., Dickerhoof, R., DeBusk, K., Bernard, K., Strauss, W. and Allen, L., 2015. Qualitative and quantitative validation of the FACIT-fatigue scale in iron deficiency anemia. Health and Quality of Life Outcomes, 13(1).Disclosure of InterestsNone declared

Changes in phytoplankton community composition potentially affect the entire marine food web. Because of seasonal cycles and inter-annual variations in species composition, long-term monitoring, co...

Chikungunya infection is a febrile illness, which currently is afflicting the Caribbean islands including the Dominican Republic. We would like to report our experience with Chikungunya-related musculoskeletal manifestations in our arthritis clinics in the Dominican Republic. A total of 514 patients presented for the first time to our arthritis clinic exhibiting musculoskeletal manifestations, 473/514 (92 %) exhibiting symmetric polyarthralgias, 344/514 (67 %) arthritis, and 385 (75 %) skin rash. The great majority 457.46 (89 %) exhibited very good clinical response to nonsteroidal anti-inflammatory drugs (NSAIDs), 370 (72 %) require low-dose steroids, and only 5 patients (0.97 %) required methotrexate therapy. In addition, of a total of 328 patients with rheumatoid arthritis on biological treatment, 53 exhibited Chikungunya-related musculoskeletal manifestations; 51/53 (96.2 %) exhibited symmetric polyarthralgias, 25/53 (47.1 %) arthritis, and 13/53 (24.5 %) tendinopathy. Of most patients, 51/53 responded to NSAIDs, of which, 23 patients only responded partially, and in total 25 (47.1 %) required low-dose steroids. Disease-modifying antirheumatic drug (DMARD) therapy including biologics remained unchanged in this population.

The potential impact of seawater acidification on the concentrations of dimethylsulfide (DMS) and dimethylsulfoniopropionate (DMSP), and the activity of the enzyme DMSP-lyase was investigated during a pelagic ecosystem CO2 enrichment experiment (PeECE III) in spring 2005. Natural phytoplankton blooms were studied for 24 days under present, double and triple partial pressures of CO2 (pCO2; pH=8.3, 8.0, 7.8) in triplicate 25 m3 enclosures. The results indicate similar DMSP concentrations and DMSP-lyase activity (DLA) patterns for all treatments. Hence, DMSP and DLA do not seem to have been affected by the CO2 treatment. In contrast, DMS concentrations showed small but statistically significant differences in the temporal development of the low versus the high CO2 treatments. The low pCO2 enclosures had higher DMS concentrations during the first 10 days, after which the levels decreased earlier and more rapidly than in the other treatments. Integrated over the whole study period, DMS concentrations were not significantly different from those of the double and triple pCO2 treatments. Pigment and flow-cytometric data indicate that phytoplanktonic populations were generally similar between the treatments, suggesting a certain resilience of the marine ecosystem under study to the induced pH changes, which is reflected in DMSP and DLA. However, there were significant differences in bacterial community structure and the abundance of one group of viruses infecting nanoeukaryotic algae. The amount of DMS accumulated per total DMSP or chlorophyll-a differed significantly between the present and future scenarios, suggesting that the pathways for DMS production or bacterial DMS consumption were affected by seawater pH. A comparison with previous work (PeECE II) suggests that DMS concentrations do not respond consistently to pelagic ecosystem CO2 enrichment experiments.

We now know that the abundance of free viruses in most marine environments is high. There is still, however, a lack of understanding of their occurrence and distribution and of in situ relationships between viral and host communities in natural environments. This may be partly due to methodological limitations. Our main aim was therefore to perform a case study in which a variety of methods were applied in order to give an improved, high-resolution description of the microbial communities in a natural environment, In order to do this we combined light microscopy (LM), transmission electron microscopy (TEM), flow cytometry (FCM), PCR denaturing gradient gel electrophoresis (PCR-DGGE) and pulsed-field gel electrophoresis (PFGE) and studied the diversity and succession of algae, bacteria and viruses in a nutrient enriched seawater enclosure. In the enclosure we experienced a situation where the development of the dominating algal population, which consisted of several flagellate species, was followed by proliferation of several different size-classes of viruses. The total bacterial number decreased markedly during the flagellate bloom but the community composition was maintained and the diversity remained high. Our results indicate a close linkage between various algal, bacterial and viral populations and show that virioplankton do not necessarily terminate algal and bacterial blooms but that they keep the host populations at non-blooming levels. [KEYWORDS: bacteria, DGGE, diversity, flow cytometry, light microscopy, PFGE, phytoplankton, virus]

This paper describes the development of a method for quantitative measurement of the elemental composition of particulate matter (PM) in seawater. This method is based on use of wavelength dispersive X-ray fluorescence (WDXRF) analysing PM harvested on various filter types. As the amount of material is less than a monolayer of cells on the filters we reduced the need for absorption correction. Given the appropriate combination of filters and elements the detection limits are low: 90–750 µgC,23–116 µgN and7–30 µgP, depending on the filters applied. Calibration constants for the elements included in this study were obtained from analysis of known quantities of chemical compounds on filters or silver plates. For carbon and nitrogen we also used comparative measurements ofSynechococcussp. cultures by CHN analyser and WDXRF. We harvested PM from 150 ml to 2000 ml on each filter in three replicates, obtaining less than 5% analytical variability between the replicates. One of the challenges using WDXRF as proposed here is the absorption of X-ray signals by the filter and variability of cell/particle sizes, and, consequentlyly, the variability of harvested PM on various filters. We find that an anodisc filter is best suited for C and N, while polycarbonate filters are best for heavier elements. Here we present analytical details and some data from field experiments related to C, N, P, Si, Ca and Fe in particles from seawater.

Increasing atmospheric mixing ratios of CO2 have already lowered surface ocean pH by 0.1 units compared to preindustrial values and pH is expected to decrease an additional 0.3 units by the end of this century. Pronounced physiological changes in some phytoplankton have been observed during previous CO2 perturbation experiments. Marine microorganisms are known to consume and produce climate-relevant organic gases. Concentrations of (CH3)2S (DMS) and CH2ClI were quantified during the Third Pelagic Ecosystem CO2 Enrichment Study. Positive feedbacks were observed between control mesocosms and those simulating future CO2. Dimethyl sulfide was 26% (±10%) greater than the controls in the 2x ambient CO2 treatments, and 18% (±10%) higher in the 3xCO2 mesocosms. For CH2ClI the 2xCO2 treatments were 46% (±4%) greater than the controls and the 3xCO2 mesocosms were 131% (±11%) higher. These processes may help contribute to the homeostasis of the planet.

Background Rheumatoid Arthritis (RA) is a systemic, inflammatory, chronic, autoimmune disease that predominantly affects the joints.1 In the last decade new drugs have been introduced, including biological drugs that act on different targets implicated in the pathogenesis of the disease.2 Within this group of drugs is tocilizumab (TCZ), a humanized monoclonal antibody anti IL-6r, key cytokine involved in the pathogenesis of RA and the disease activity.3 TCZ use has been associated with abnormalities in transaminases (AST, ALT).2 Objectives To determine the frequency of transaminases abnormalities in patients with RA treated with TCZ in Santo Domingo, Dominican Republic. Methods We performed a longitudinal, observational, prospective study. The records of patients diagnosed with RA who fulfilled the 1987 ACR criteria and ACR/EULAR 2010, which use biological therapy with TCZ in HDPB and HFMP in July 2013 until August 2014 were reviewed. All patients signed informed consent. We reviewed a total of 56 records from which we selected patients who had at least 2 follow-up visits after the start of treatment (40 patients) taking into account the transaminases baseline values to compare changes. Visits were conducted every three months, mild and moderate levels were considered between (>1xUI/L, >2xUI/L) and severe (>3xUI/L) over the normal value. The patients whose records were found incomplete during the first 3 visits were excluded. The frequency of continuous variables was analyzed using the SPSS statistical program (V20.x86). Results Of 40 patients who met the inclusion criteria, 45% (18) elevated transaminases levels. For AST elevations 33.3% (6) elevated from mild to moderate, only 5.6% (1) severely and 61.1% (11) did not alter the levels. As for ALT, 50% (9) presented increased mild to moderate, 5.6% (1) course with severe elevation and the remaining 44.4% (8) did not alter the normal parameters. On the third visit 50% (9) presented elevated AST from mild to moderate, not severe elevations were reported and 50% (9) remained within normal parameters. Elevations of ALT were higher during the third visit in 72.2% (13) of mild to moderate, only 5.6% (1) course with severe elevation and 22.2% (4) was found within normal values. Of the 18 patients who were enrolled with alterations, 83.33% (15) were using simultaneously therapy with sDMARD. Conclusions The results of monitoring of a population of Dominican Republic showed that treatment with TCZ was associated with increased levels of transaminases. References Ann Rheum Dis 2014; 73:1607-1615. Ann Rheum Dis 2010; 69:88-96. Reumatol Clin.2011, 6 (S3). S29-S32. Disclosure of Interest None declared

Drug related problems (DRPs) are perceived to occur frequently when patients are discharged from the hospital. Community pharmacists' interventions to detect, prevent and solve DRPs in this population are scarcely studied.To examine the nature and frequency of DRPs in community pharmacies among patients discharged from hospitals in several countries, and to examine several variables related to these drug related problems.The study was performed in 112 community pharmacies in Europe: Austria, Denmark, Germany, The Netherlands, Portugal and Spain. Community pharmacists asked patients with a prescription after discharge from hospital between February and April 2001 to participate in the study. A patient questionnaire was used to identify drug related problems. Pharmacists documented drug related problems, pharmacy interventions, type of prescriber and patient and pharmacy variables.435 patients were included in the study. Drug related problems were identified in 277 patients (63.7%). Uncertainty or lack of knowledge about the aim or function of the drug (133; 29.5%) and side effects (105; 23.3%) were the most common DRPs. Practical problems were reported 56 times (12.4%) by patients. Pharmacists revealed 108 problems (24.0%) concerning dosage, drug duplication, drug interactions and prescribing errors. Patients with more changes in their drug regimens (drugs being stopped, new drugs started or dosage modifications) and using more drugs were more likely to develop DRPs. Community pharmacists recorded 305 interventions in 205 patients with DRPs. Pharmacists intervened mostly by patient medication counselling (39.0%) and practical instruction to the patient (17.7%). In 26.2% the intervention was directed towards the prescriber. In 28 cases (9.2%) the pharmacists' intervention led to a change of the drug regimen.This study shows that a systematic intervention by community pharmacists in discharged patients, or their proxies, is able to reveal a high number of DRPs that might be relevant for patient health outcomes. There should be more initiatives to insure continuity of care, since DRPs after discharge from hospital seem to be very common.