Clinical and Morphologic Differences between Class IV-S and Class IV-G Lupus Nephritis

Introduction. The new ISN/RPS classification of lupus nephritis (LN) divides diffuse proliferative LN into two subcategories with predominantly segmental proliferative lesions (class IV-S) and with predominantly global proliferative lesions (class IV-G). This paper explores the validity of this distinction and possible differences between the two types of lesions. Patients and Methods. A retrospective analysis of biopsy-proven cohort of 231 patients with LN was performed. Clinical and laboratory data were available on all patients selected. Results. The prevalence of Class IV was 27,27% (41 patients had class IV-S, 22-class IV-G). The serum creatinine levels, proteinuria, and diastolic blood pressure were significantly greater in the IV-G class, but haemoglobin was significantly lower. Histologically combined lesions with segmental endocapillary proliferation and fibrinoid necrosis were more frequent in the class IV-S. No significant difference was detected in outcomes in the two groups after followups of 145,2 ± 76,87 months. Conclusions. There are definite clinical and morphologic differences between class IV-S and IV-G lesions. Data suggest that class IV-G lesions behave as an immune complex disease; however, in class IV-S lesions, the presence of proportionally greater glomerular fibrinoid necroses suggests that these lesions may have a different pathogenesis.

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Acute Kidney Injury, Recurrent Seizures, and Thrombocytopenia in a Young Patient with Lupus Nephritis: A Diagnostic Dilemma

Case Reports in Nephrology ◽

10.1155/2016/7104098 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8

Author(s):

Hector Alvarado Verduzco ◽

Anjali Acharya

Keyword(s):

Blood Pressure ◽

Acute Kidney Injury ◽

Lupus Nephritis ◽

Kidney Biopsy ◽

Brain Mri ◽

Kidney Injury ◽

Uncontrolled Hypertension ◽

Cerebral White Matter ◽

Mri Findings ◽

Class Iv

Introduction. Posterior reversible encephalopathy syndrome (PRES) is a constellation of clinical and radiologic findings. Fluctuations in blood pressure, seizures, and reversible brain MRI findings mainly in posterior cerebral white matter are the main manifestations. PRES has been associated with multiple conditions such as autoimmune disorders, pregnancy, organ transplant, and thrombotic microangiopathy (TMA). Case Presentation. A 22-year-old woman with history of Systemic Lupus Erythematous complicated with chronic kidney disease secondary to lupus nephritis class IV presented with recurrent seizures and uncontrolled hypertension. She was found to have acute kidney injury and thrombocytopenia. Repeat kidney biopsy showed diffuse endocapillary and extracapillary proliferative and membranous lupus nephritis (ISN-RPS class IV-G+V) and endothelial swelling secondary to severe hypertension but no evidence of TMA. Brain MRI showed reversible left frontal and parietal lesions that resolved after controlling the blood pressure, making PRES the diagnosis. Conclusion. PRES is an important entity that must be recognized and treated early due to the potential reversibility in the early stages. Physicians must have high suspicion for these unusual presentations. We present a case where performing kidney biopsy clinched the diagnosis in our patient with multiple confounding factors.

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Characteristics and Histological Types of Lupus Nephritis in a Jordanian Tertiary Medical Center

BioMed Research International ◽

10.1155/2019/7087461 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Randa I. Farah ◽

Ebtesam Dannoun ◽

Nisreen Abu Shahin ◽

Saif Aldeen AlRyalat

Keyword(s):

Lupus Nephritis ◽

Clinical Laboratory ◽

Medical Center ◽

Class Iii ◽

Laboratory Findings ◽

Histological Types ◽

Nephritic Syndrome ◽

Significant Difference ◽

Stage Renal Disease ◽

Class Iv

Objectives. Few reports of lupus nephritis (LN) from Jordan and the Middle East exist. This study assessed the demographic, clinical, and basic laboratory characteristics of Jordanian patients with LN and correlations with the histological class of LN. Methods. This was a retrospective study of all patients who underwent kidney biopsy between 2007 and 2018 at a tertiary medical center in Jordan. Patients’ demographic, clinical, laboratory, and pathological data were reviewed. Results. In total, 79 patients were included in this study [mean age, 29.95 ± 12.16 years; 11 men (13.9%), 68 women (86.1%)]. Asymptomatic proteinuria and hematuria were the most common presentations in LN patients at biopsy (59.5%). The study revealed a significant difference in frequency of nephritic syndrome (p= 0.01) between sexes (10.3% female vs. 45.5% male). Class IV was the most common pathological class of LN [37 (46.8%)], followed by class V [15 (19%)] and class III [10 (12.7%)]. Post hoc analysis of the associations between laboratory values and histopathological patterns revealed a significant correlation between class IV lupus and renal failure (p= 0.018) and class IV lupus and anti-DNA antibodies p= 0.030). End-stage renal disease (ESRD) occurred in 25% of lupus nephritis cases. There was an increased likelihood of ESRD among men than women (45% vs. 22%). Overall mortality was 10%. Conclusion. Although some clinical and laboratory findings correlate with histological types of LN, clinical and laboratory parameters of Jordanian patients with LN are not predictive of the histological type, although differences with regional studies were noted.

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Outcomes of the Re-classification of WHO Class IV Lupus Nephritis Using the ISN/RPS Classification: a Single Center Retrospective Observational Study from the JUDE Study

Juntendo Medical Journal ◽

10.14789/jmj.63.362 ◽

2017 ◽

Vol 63 (5) ◽

pp. 362-369

Author(s):

TOMOKO MIYASHITA ◽

SHINJI MORIMOTO ◽

DAISUKE HONDA ◽

SOUICHIRO NAKANO ◽

HIROFUMI AMANO ◽

...

Keyword(s):

Lupus Nephritis ◽

Observational Study ◽

Retrospective Observational Study ◽

Single Center ◽

Class Iv

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OP0313 PRELIMINARY CRITERIA FOR MACROPHAGE ACTIVATION SYNDROME ASSOCIATED WITH CORONAVIRUS DISEASE-19

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3113 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 191.1-192

Author(s):

S. Amikishiyev ◽

M. G. Gunver ◽

M. Bektas ◽

S. Aghamuradov ◽

B. Ince ◽

...

Keyword(s):

Macrophage Activation Syndrome ◽

Macrophage Activation ◽

Laboratory Data ◽

Disease Onset ◽

Dynamic Changes ◽

Ferritin Concentration ◽

Neutrophil Lymphocyte Ratio ◽

Significant Difference ◽

D Dimer ◽

Activation Syndrome

Background:COVID-19 runs a severe disease associated with acute respiratory distress syndrome in a subset of patients, and a hyperinflammatory response developing in the second week contributes to the worse outcome. Inflammatory features are mostly compatible with macrophage activation syndrome (MAS) observed in other viral infections despite resulting in milder changes. Early detection and treatment of MAS may be associated with a better outcome. However, available criteria for MAS associated with other causes have not been helpful.Objectives:To identify distinct features of MAS associated with COVID-19 using a large database enabling to assess of dynamic changes.Methods:PCR-confirmed hospitalized COVID-19 patients followed between March and September 2020 constituted the discovery set. Patients considered to have findings of MAS by experienced physicians and given anakinra or tocilizumab were classified as the MAS group and the remaining patients as the non-MAS group. The MAS group was then re-grouped as the cases with exact-MAS and borderline-MAS cases by the study group. Clinical and laboratory data including the Ct values of the PCR test were obtained from the database, and dynamic changes were evaluated especially for the first 14 days of the hospitalization. The second set of 162 patients followed between September-December 2020 were used as the replication group to test the preliminary criteria. In the second set, hospitalization rules were changed, and all patients required oxygen support and received dexamethasone 6mg/day or equivalent glucocorticoids. Daily changes were calculated for the laboratory items in MAS, borderline, and non-MAS groups to see the days differentiating the groups, and ROC curves and lower and upper limits (10-90%) of the selected parameters were calculated to determine the cutoff values.Results:A total of 769 PCR-confirmed hospitalized patients were analysed, and 77 of them were classified as MAS and 83 as borderline MAS patients. There was no statistically significant difference in the baseline viral loads of MAS patients compared to the non-MAS group according to the Ct values. Daily dynamic changes in the MAS group differed from the non-MAS group especially around the 6th day of hospitalization, and more than a twofold increase in ferritin and a 1.5-fold increase in D-dimer levels compared to the baseline values help to define the MAS group. Twelve items selected for the criteria are given in Table 1 below. The total score of 45 provided 79.6% sensitivity for the MAS (including borderline cases) and 81.3% specificity around days 5 and 6 in the discovery set, and a score of 60 increased the specificity to 94.9% despite a decrease in sensitivity to 40.8%. The same set provided a similar sensitivity (80.3%) in the replication, but a lower specificity (47.4-66% on days 6 to 9) due to a group of control patients with findings of MAS possibly masked by glucocorticoids.Table 1.Preliminary Criteria for Macrophage Activation Syndrome Associated with Coronavirus Disease-191.Fever (>37.0 °C)2.Ferritin concentration > 550 ng/mL3.More than 2 times increase of ferritin concentration within 7 days of disease onset4.Neutrophil count > 6000 cell/mm35.Lymphopenia < 1000 cell/mm36.Neutrophil/lymphocyte ratio > 67.D-dimer concentration > 1000 ng/ml8.More than 50% increase of D-dimer concentration within 7 days of disease onset9.CRP concetration > 50 mg/L10.LDH concentration > 300 U/L11.ALT or AST concentration > 50 U/L12.Procalcitonin concentration < 1.21 point for each positive item assessed on Days 5-7Score calculation: Total points / 12 x 100Possible MAS ≥45 and Definite MAS ≥60Conclusion:This study defined a set of preliminary criteria using the most relevant items of MAS according to the dynamic changes in the parameters in a group of COVID-19 patients. A score of 45 would be helpful to define a possible MAS group with reasonable sensitivity and specificity to start necessary treatments as early as possible.Disclosure of Interests:None declared.

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AB0566 NAILFOLD EXTENT OF REDUCED CAPILLARY DENSITY IS ASSOCIATED WITH DIGITAL ULCERS AND WITH AN INCREASED RISK OF DIGITAL ULCERS IN SYSTEMIC SCLEROSIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4173 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1580.2-1580

Author(s):

R. De Angelis ◽

F. Salaffi

Keyword(s):

Systemic Sclerosis ◽

Laboratory Data ◽

Quantitative Measure ◽

Capillary Density ◽

Optical Probe ◽

Typical Feature ◽

Slight Reduction ◽

Digital Ulcers ◽

Increased Risk ◽

Significant Difference

Background:A growing evidence supports the role of microvasculopathy as a primary pathogenic event in systemic sclerosis (SSc). The most commonly used imaging technique to identify microangiopathy in SSc is high magnification videocapillaroscopy (NVC), and reduced capillary density and/or capillary loss, which is a typical feature of “scleroderma microangiopathy”, easily identified by NVC, has been associated with digital ulcers (DUs). Different approaches have been proposed to measure capillary density or capillary loss. Some of these were qualitative methods, others semi-quantitative, others only concerned a limited nailfold area, without ever evaluating the overall density, which is more suitable for quantitative estimate.Objectives:To assess the association between the extent of different values of nailfold capillary density and the presence of DUs and to identify the risk of developing DUs, based on quantitative parameters.Methods:The study involved 54 SSc selected patients (47 women and 7 men, mean age 59.5 years, 50 with limited and 4 with diffuse). The study population came from an ongoing database, that includes clinical and laboratory data of patients with definite SSc. A videocapillaroscope (VideoCap® 3.0, DS Medica, Milan, Italy) with a 200x optical probe was used. During examination, eight fingers (fingers 2–5 of each hand), 4 fields per finger, according to the standard literature were assessed. For each patient, a total of 32 images were collected, then classified as having either “normal”, “non-specific” or the “scleroderma pattern” (SP). Capillary density was defined as the number of capillaries/mm in the distal row, regardless of its shape and morphology. Avascular areas were defined by the absence of loops within a width/area extending over more than 500 microns. For each patient, the SP images were further graded with no/slight reduction of the capillary density (7-9 loops/mm) (NOR), with a well-defined reduction of capillary density (6-4 loops/mm) (RED) and with loss of capillaries (<4) plus avascular areas (AA). Then, the overall percentages were calculated (the number with SP, the number with NOR, with RED and with AA, respect to 32), thus obtaining the quantitative measures. All data were analysed using the MedCalc® version 18.6; 64-bit (MedCalc Software, Mariakerke, Belgium).Results:A total of 1728 images were analyzed. Patients with DUs were 16/54 (29.6%). All patients had a SP, but only five patients showed a SP along the entire nailfold. A comparison between patients with or without DUs showed a significant difference both for the overall extent of AA (p=0.032), and particularly for the overall extent of RED (p<0.001). No significant difference was found regarding the overall extent of the SP (p=0.085). Factor significantly associated with DUs in multivariate analysis was the overall extent of RED (p=0.0286). The ROC curve was very effective at discriminating the capillary feature able to distinguish patients with DUs from patients without DUs. The discriminatory power of the overall extent of RED was very good, with an AUC of 0.948 (95 % CI 0.852 ± 0.990). Then, we calculated the cut-off values of the overall extent of RED for presence/absence of DUs with the highest combination of sensitivity and specificity. The resulting cut-off value (Yourden index of 0.825) was >68.7 (sensitivity 92.31 %; specificity 90.24 %) with a LR+ of 9.46.Conclusion:Our data strongly support that the capillary density between 4 and 6 loops/mm is the best capillaroscopic quantitative measure associated with DUs and able to discriminate the probability of having DUs. If all SSc-specific antibodies and/or other laboratory/clinical parameters are not yet available, the overall capillary density can allow physicians to assess SSc patients easily, regarding DUs and risk for developing DUs.Disclosure of Interests:None declared

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AB0655 RHEUMATOID ARTHRITIS ACTIVITY BEFORE AND AFTER COVID-19 LOCKDOWN PERIOD

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.576 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1360.1-1360

Author(s):

M. Jordhani ◽

D. Ruci ◽

F. Skana ◽

E. Memlika

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Musculoskeletal Diseases ◽

Statistical Tests ◽

Laboratory Data ◽

World Population ◽

Chronic Patients ◽

Das 28 ◽

Significant Difference ◽

Before And After

Background:The COVID-19 global pandemic has had a great impact on world population due to morbidity, mortality and restriction measures in order to stop the progression of COVID-19.Patients with rheumatic and musculoskeletic diseases, and especially rheumatoid arthritis (RA) patients, being one of the vulnerable classes of chronic patients, were recommended to follow the government’s rules1.Objectives:The aim of this study was to evaluate DAS-28-ESR in patients with rheumatoid arthritis before and after lockdown period.Methods:This is a multi-center observational study including 85 patients which were evaluated before and after lockdown for their disease activity score according to DAS-28-ESR score. They had been diagnosed with rheumatoid arthritis more than 5 years ago. A thorough physical examination was performed before and after the lockdown period. It included examination of tender and swollen joints and patient’s global health. They were completed with all required laboratory data, including erythrosedimentation rate. For a more accurate calculation, DAS-28-ESR was used in an electronic version. Patients with other inflammatory or infective diseases were excluded from the study. All data were statistically evaluated using statistical tests such as t-student test.Results:The first group (the one before lockdown) had an average DAS-28-ESR of 4.7 while after the lockdown period, the average DAS-28-ESR was 5.16.After statistically evaluating all data, it was found that there exists a significant difference between DAS-28-ESR score before and after COVID-19 lockdown (p=0.0011).Conclusion:Our study showed that lockdown period due to COVID-19 pandemic, has aggravated disease activity in patients with Rheumatoid Arthritis. This may be consequence of various causes such as physical inactivity and difficulty to follow-up or to take the medication properly.References:[1]Landewé RB, Machado PM, Kroon F, et al, EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2, Annals of the Rheumatic Diseases 2020;79:851-858.Disclosure of Interests:None declared.

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387. Markers for Mortality in COVID-19 Patients with Atrial Fibrillation or Flutter

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.582 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S262-S262

Author(s):

Kok Hoe Chan ◽

Bhavik Patel ◽

Iyad Farouji ◽

Addi Suleiman ◽

Jihad Slim

Keyword(s):

Atrial Fibrillation ◽

Logistic Regression ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Prognostic Markers ◽

Univariate Analysis ◽

Laboratory Data ◽

Significant Difference ◽

New Onset

Abstract Background Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection can lead to many different cardiovascular complications, we were interested in studying prognostic markers in patients with atrial fibrillation/flutter (A. Fib/Flutter). Methods A retrospective cohort study of patients with confirmed COVID-19 and either with existing or new onset A. Fib/Flutter who were admitted to our hospital between March 15 and May 20, 2020. Demographic, outcome and laboratory data were extracted from the electronic medical record and compared between survivors and non-survivors. Univariate and multivariate logistic regression were employed to identify the prognostic markers associated with mortality in patients with A. Fib/Flutter Results The total number of confirmed COVID-19 patients during the study period was 350; 37 of them had existing or new onset A. Fib/Flutter. Twenty one (57%) expired, and 16 (43%) were discharged alive. The median age was 72 years old, ranged from 19 to 100 years old. Comorbidities were present in 33 (89%) patients, with hypertension (82%) being the most common, followed by diabetes (46%) and coronary artery disease (30%). New onset of atrial fibrillation was identified in 23 patients (70%), of whom 13 (57%) expired; 29 patients (78%) presented with atrial fibrillation with rapid ventricular response, and 2 patients (5%) with atrial flutter. Mechanical ventilation was required for 8 patients, of whom 6 expired. In univariate analysis, we found a significant difference in baseline ferritin (p=0.04), LDH (p=0.02), neutrophil-lymphocyte ratio (NLR) (p=0.05), neutrophil-monocyte ratio (NMR) (p=0.03) and platelet (p=0.015) between survivors and non-survivors. With multivariable logistic regression analysis, the only value that had an odds of survival was a low NLR (odds ratio 0.74; 95% confidence interval 0.53–0.93). Conclusion This retrospective cohort study of hospitalized patients with COVID-19 demonstrated an association of increase NLR as risk factors for death in COVID-19 patients with A. Fib/Flutter. A high NLR has been associated with increased incidence, severity and risk for stroke in atrial fibrillation patients but to our knowledge, we are first to demonstrate the utilization in mortality predictions in COVID-19 patients with A. Fib/Flutter. Disclosures Jihad Slim, MD, Abbvie (Speaker’s Bureau)Gilead (Speaker’s Bureau)Jansen (Speaker’s Bureau)Merck (Speaker’s Bureau)ViiV (Speaker’s Bureau)

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Implementation of a deep learning model for automated classification of Aedes aegypti (Linnaeus) and Aedes albopictus (Skuse) in real time

Scientific Reports ◽

10.1038/s41598-021-89365-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Song-Quan Ong ◽

Hamdan Ahmad ◽

Gomesh Nair ◽

Pradeep Isawasan ◽

Abdul Hafiz Ab Majid

Keyword(s):

Deep Learning ◽

Aedes Aegypti ◽

Real Time ◽

Aedes Albopictus ◽

Automated Classification ◽

Expert Performance ◽

Deep Convolutional Neural Networks ◽

Significant Difference ◽

Set Up

AbstractClassification of Aedes aegypti (Linnaeus) and Aedes albopictus (Skuse) by humans remains challenging. We proposed a highly accessible method to develop a deep learning (DL) model and implement the model for mosquito image classification by using hardware that could regulate the development process. In particular, we constructed a dataset with 4120 images of Aedes mosquitoes that were older than 12 days old and had common morphological features that disappeared, and we illustrated how to set up supervised deep convolutional neural networks (DCNNs) with hyperparameter adjustment. The model application was first conducted by deploying the model externally in real time on three different generations of mosquitoes, and the accuracy was compared with human expert performance. Our results showed that both the learning rate and epochs significantly affected the accuracy, and the best-performing hyperparameters achieved an accuracy of more than 98% at classifying mosquitoes, which showed no significant difference from human-level performance. We demonstrated the feasibility of the method to construct a model with the DCNN when deployed externally on mosquitoes in real time.

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Quantification and Classification of Diclofenac Sodium Content in Dispersed Commercially Available Tablets by Attenuated Total Reflection Infrared Spectroscopy and Multivariate Data Analysis

Pharmaceuticals ◽

10.3390/ph14050440 ◽

2021 ◽

Vol 14 (5) ◽

pp. 440

Author(s):

Eirini Siozou ◽

Vasilios Sakkas ◽

Nikolaos Kourkoumelis

Keyword(s):

Infrared Spectroscopy ◽

Low Cost ◽

Diclofenac Sodium ◽

Reference Method ◽

Sodium Content ◽

Attenuated Total Reflection ◽

Accuracy And Precision ◽

Significant Difference ◽

Ft Ir

A new methodology, based on Fourier transform infrared spectroscopy equipped with an attenuated total reflectance accessory (ATR FT-IR), was developed for the determination of diclofenac sodium (DS) in dispersed commercially available tablets using chemometric tools such as partial least squares (PLS) coupled with discriminant analysis (PLS-DA). The results of PLS-DA depicted a perfect classification of the tablets into three different groups based on their DS concentrations, while the developed model with PLS had a sufficiently low root mean square error (RMSE) for the prediction of the samples’ concentration (~5%) and therefore can be practically used for any tablet with an unknown concentration of DS. Comparison with ultraviolet/visible (UV/Vis) spectrophotometry as the reference method revealed no significant difference between the two methods. The proposed methodology exhibited satisfactory results in terms of both accuracy and precision while being rapid, simple and of low cost.

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Telomere Length as a Biomarker for Race-Related Health Disparities

Genes ◽

10.3390/genes12010078 ◽

2021 ◽

Vol 12 (1) ◽

pp. 78

Author(s):

Vaithinathan Selvaraju ◽

Megan Phillips ◽

Anna Fouty ◽

Jeganathan Ramesh Babu ◽

Thangiah Geetha

Keyword(s):

Blood Pressure ◽

Telomere Length ◽

Diastolic Pressure ◽

Systolic Pressure ◽

Single Copy ◽

Normal Weight ◽

Length Ratio ◽

Hierarchical Regression ◽

Significant Difference ◽

The Usa

Disparities between the races have been well documented in health and disease in the USA. Recent studies show that telomere length, a marker of aging, is associated with obesity and obesity-related diseases, such as heart disease and diabetes. The current study aimed to evaluate the connection between telomere length ratio, blood pressure, and childhood obesity. The telomere length ratio was measured in 127 children from both European American (EA) and African American (AA) children, aged 6–10 years old. AA children had a significantly high relative telomere to the single copy gene (T/S) ratio compared to EA children. There was no significant difference in the T/S ratio between normal weight (NW) and overweight/obese (OW/OB) groups of either race. Blood pressure was significantly elevated in AA children with respect to EA children. Hierarchical regression analysis adjusted for race, gender, and age expressed a significant relationship between the T/S ratio and diastolic pressure. Low T/S ratio participants showed a significant increase in systolic pressure, while a high T/S ratio group showed an increase in diastolic pressure and heart rate of AA children. In conclusion, our findings show that AA children have high T/S ratio compared to EA children. The high T/S ratio is negatively associated with diastolic pressure.

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