Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study

Introduction

We analyzed the prevalence of cardiovascular (CV) disease in patients with rheumatoid arthritis (RA) and its association with traditional CV risk factors, clinical features of RA, and the use of disease-modifying antirheumatic drugs (DMARDs) in a multinational cross-sectional cohort of nonselected consecutive outpatients with RA (The Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis Program, or QUEST-RA) who were receiving regular clinical care.

Methods

The study involved a clinical assessment by a rheumatologist and a self-report questionnaire by patients. The clinical assessment included a review of clinical features of RA and exposure to DMARDs over the course of RA. Comorbidities were recorded; CV morbidity included myocardial infarction, angina, coronary disease, coronary bypass surgery, and stroke. Traditional risk factors recorded were hypertension, hyperlipidemia, diabetes mellitus, smoking, physical inactivity, and body mass index. Unadjusted and adjusted hazard ratios (HRs) (95% confidence interval [CI]) for CV morbidity were calculated using Cox proportional hazard regression models.

Results

Between January 2005 and October 2006, the QUEST-RA project included 4,363 patients from 48 sites in 15 countries; 78% were female, more than 90% were Caucasian, and the mean age was 57 years. The prevalence for lifetime CV events in the entire sample was 3.2% for myocardial infarction, 1.9% for stroke, and 9.3% for any CV event. The prevalence for CV risk factors was 32% for hypertension, 14% for hyperlipidemia, 8% for diabetes, 43% for ever-smoking, 73% for physical inactivity, and 18% for obesity. Traditional risk factors except obesity and physical inactivity were significantly associated with CV morbidity. There was an association between any CV event and age and male gender and between extra-articular disease and myocardial infarction. Prolonged exposure to methotrexate (HR 0.85; 95% CI 0.81 to 0.89), leflunomide (HR 0.59; 95% CI 0.43 to 0.79), sulfasalazine (HR 0.92; 95% CI 0.87 to 0.98), glucocorticoids (HR 0.95; 95% CI 0.92 to 0.98), and biologic agents (HR 0.42; 95% CI 0.21 to 0.81; P < 0.05) was associated with a reduction of the risk of CV morbidity; analyses were adjusted for traditional risk factors and countries.

Conclusion

In conclusion, prolonged use of treatments such as methotrexate, sulfasalazine, leflunomide, glucocorticoids, and tumor necrosis factor-alpha blockers appears to be associated with a reduced risk of CV disease. In addition to traditional risk factors, extra-articular disease was associated with the occurrence of myocardial infarction in patients with RA.     

Alternative housing for Xenopus laevis

At the authors' facility, housing arrangements for Xenopus laevis were cumbersome and labor-intensive, requiring technicians to wash frog tanks by hand several times a week. The authors describe an alternative housing solution they implemented by modifying a rack system that was originally used to maintain zebrafish. The rack's self-contained water circulation and filtration system saved technicians time and labor, and a commercial chiller attached to the mechanism efficiently controlled frogs' environmental temperature.     

Plasma metabolites and migration physiology of semipalmated sandpipers: refueling performance at five latitudes

Long-distance bird migration is fueled by energy gathered at stopover sites along the migration route. The refueling rate at stopover sites is a determinant of time spent at stopovers and impacts the overall speed of migration. Refueling rate during spring migration may influence the fitness of individuals via changes in the probability of successful migration and reproduction during the subsequent breeding season. We evaluated four plasma lipid metabolites (triglycerides, phospholipids, β-OH-butyrate, and glycerol) as measures of refueling rate in free-living semipalmated sandpipers (Calidris pusilla) captured at non-breeding areas. We described the spatial and temporal variation in metabolite concentrations among one winter site in the Dominican Republic and four stopover sites in the South Atlantic and Mid-Atlantic Coastal Plain regions of North America. Triglycerides and β-OH-butyrate clearly identified spatial variation in refueling rate and stopover habitat quality. Metabolite profiles indicated that birds had higher refueling rates at one site in the Mid-Atlantic Coastal Plain than at three sites on the South Atlantic Coastal Plain and one site in the Dominican Republic. Temporal variation in lipid metabolites during the migration season suggested that male semipalmated sandpipers gained more weight at stopovers on the South Atlantic Coastal Plain than did females, evidence of differential migration strategies for the sexes. Plasma lipid metabolites provide information on migration physiology that may help determine stopover habitat quality and reveal how migratory populations use stopover sites to refuel and successfully complete long-distance migrations.     

Isolation and characterization of microsatellite markers in Oligoryzomys longicaudatus (Muridae, Sigmodontinae, Oryzomini), the natural reservoir of genotype Andes hantavirus

The rodent Oligoryzomys longicaudatus or long-tailed pygmy rice rat is the reservoir of the aetiological agent of the hantavirus pulmonary syndrome in southern Argentina and Chile. We characterize 11 polymorphic microsatellite loci which would be useful for studies on microgeographical population structure in the species. Amplification of these loci in 42 individuals from four natural populations revealed four to 21 alleles per locus, and values of observed heterozygosities ranging from 0.371 to 0.896. Cross-species amplifications showed that some of the primers designed may be useful for other species of the genus Oligoryzomys.     

Management of extensively drug-resistant tuberculosis in Peru: cure is possible

Aim

To describe the incidence of extensive drug-resistant tuberculosis (XDR-TB) reported in the Peruvian National multidrug-resistant tuberculosis (MDR-TB) registry over a period of more than ten years and present the treatment outcomes for a cohort of these patients.

Methods

From the Peruvian MDR-TB registry we extracted all entries that were approved for second-line anti-TB treatment between January 1997 and June of 2007 and that had Drug Susceptibility Test (DST) results indicating resistance to both rifampicin and isoniazid (i.e. MDR-TB) in addition to results for at least one fluoroquinolone and one second-line injectable (amikacin, capreomycin and kanamycin).

Results

Of 1,989 confirmed MDR-TB cases with second-line DSTs, 119(6.0%) XDR-TB cases were detected between January 1997 and June of 2007. Lima and its metropolitan area account for 91% of cases, a distribution statistically similar to that of MDR-TB. A total of 43 XDR-TB cases were included in the cohort analysis, 37 of them received ITR. Of these, 17(46%) were cured, 8(22%) died and 11(30%) either failed or defaulted treatment. Of the 14 XDR-TB patients diagnosed as such before ITR treatment initiation, 10 (71%) were cured and the median conversion time was 2 months.

Conclusion

In the Peruvian context, with long experience in treating MDR-TB and low HIV burden, although the overall cure rate was poor, a large proportion of XDR-TB patients can be cured if DST to second-line drugs is performed early and treatment is delivered according to the WHO Guidelines.     

Tracking the introduction history of <Emphasis Type="Italic">Ichthyosaura alpestris</Emphasis> in a protected area of Central Spain

One of the main goals of protected areas, especially National Parks, is biodiversity conservation. Taking into account the multiple negative impacts that allochthonous animals can cause in an ecosystem, it is important to know and track the introductions in order to take efficient management measures to enhance biodiversity conservation. We study the origin of an Ichthyosaura alpestris population in Peñalara Massif within the Guadarrama National Park, Central Spain. To accomplish this goal, we used nine microsatellite markers and sequences from 16S and ND4 genes. Both mitochondrial DNA and microsatellite analyses showed the close relationship between Peñalara and Asturian populations, despite their geographical distance, confirming the allochthonous origin of this population. Interestingly, more than one introduction event seems to have occurred with individuals from Lago Ercina and Pozos de Lloroza populations participating in the founding of the Peñalara population. Due to predation, competition and transmission of diseases enhanced by its ongoing expansion, I. alpestris population might be considered a threat to Peñalara biodiversity. We advise an efficient population control to conserve the biodiversity within the Guadarrama National Park and an update of the position of this population in the Spanish indexes and list of species.     

Early exposure to <Emphasis Type="Italic">Batrachochytrium dendrobatidis</Emphasis> causes profound immunosuppression in amphibians

Fungal pathogens have evolved a broad suite of strategies aiming at evading the host immune response. Amphibians are globally infected by the panzootic chytrid fungus Batrachochytrium dendrobatidis (Bd) and, while robust innate immune defences have been characterised, there is little evidence for the existence of effective adaptive immunity. We determine the immune response of the common midwife toad following challenge by Bd as larvae. Immune function was described for both the cell-mediated and antibody-mediated immune responses following infectious challenge as larval amphibians. While there were no significant differences in the ratio of neutrophils/lymphocytes between infected and uninfected individuals, early exposure of tadpoles to Bd significantly dampened the levels of circulating immunoglobulins (IgM and IgY) in the serum of juveniles after metamorphosis. Our results show that Bd immunosuppresses amphibians when infection occurs as larvae with potentially broad effects on the remodelling of immunity during metamorphosis.     

Molecular Characterization of <Emphasis Type="Italic">Cyclamen</Emphasis> Species Collected from Different Parts of Turkey by RAPD and SRAP Markers

The genus Cyclamen (family Myrsinaceae) contains about 20 species, most of which occur in the Mediterranean region. Turkey has critically important Cyclamen genetic resources. Molecular characterization of plant materials collected from different regions of Turkey in which Cyclamen species grow naturally, namely Adana, Antalya, Ayd?n, Mu?la, ?zmir, Denizli, Kahramanmara?, Osmaniye, Eski?ehir, Trabzon, and Rize provinces, was performed using RAPD and SRAP markers. DNA was successfully amplified by 30 RAPD primers and 14 SRAP primer pairs. Among the 470 bands generated by the RAPD primers, 467 were polymorphic. The number of bands detected by a single primer set ranged from 11 to 22 (average of 15.6). The percentage polymorphism was 99.3 % based on the RAPD data. In the SRAP analysis, a total of 216 bands were generated, showing 100 % polymorphism. The number of bands detected by a single primer set ranged from 9 to 22 (average of 15.4). All data were scored and UPGMA dendrograms were constructed with similar results in both marker systems, i.e., different species from nine provinces of Turkey were separated from each other in the dendrograms with the same species being clustered together.