Journal articles on the topic 'Flares History'
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Volvach, A. E., L. N. Volvach, M. G. Larionov, G. C. MacLeod, S. P. van den Heever, and K. Sugiyama. "Monitoring a methanol maser flare associated with the massive star-forming region G358.93–0.03." Monthly Notices of the Royal Astronomical Society: Letters 494, no. 1 (February 21, 2020): L59—L63. http://dx.doi.org/10.1093/mnrasl/slaa036.
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ABSTRACT We report the earliest detection of the 19.967-GHz [transition 21–30E (t = 0)] methanol maser associated with the massive star-forming region G358.93–0.03. The flare was detectable from 2019 January 23 to March 5, for only 44 d. It turned out to be the most powerful 19.967-GHz maser in the Galaxy in the entire history of observations, taking into account the 104-Jy flux from it on the Earth’s surface and the distance to the source, 6.75 kpc. The 19.967-GHz maser flared contemporaneously with the first of two flares detected in associated 20.971-GHz methanol masers. We estimated that the ratio of flux densities between these two transitions is F20.971/F19.967 = 14 ± 4, increasing to >520 in the second flare. We discuss the differences between the two flares in the 20.971-GHz methanol masers and the consequence thereof.
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Rudwaleit, M., E. Rødevand, P. Holck, J. Vanhoof, M. Kron, S. Kary, and H. Kupper. "Adalimumab effectively reduces the rate of anterior uveitis flares in patients with active ankylosing spondylitis: results of a prospective open-label study." Annals of the Rheumatic Diseases 68, no. 5 (July 28, 2008): 696–701. http://dx.doi.org/10.1136/ard.2008.092585.
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Objective:To evaluate the effect of adalimumab on the frequency of anterior uveitis (AU) flares in patients with active ankylosing spondylitis (AS).Methods:We determined the history of ophthalmologist-diagnosed AU in 1250 patients with active AS who were enrolled in a multinational, open-label, uncontrolled clinical study of treatment with adalimumab, 40 mg every other week for up to 20 weeks. All AU flares were documented throughout the adalimumab treatment period plus 70 days. We compared the rates of AU flares per 100 patient years (PYs) reported during the year before adalimumab treatment with rates during adalimumab treatment, in total and by patient subgroups.Results:The AU flare rates before adalimumab treatment were 15/100 PYs in all patients (n = 1250), 68.4/100 PYs in 274 patients with a history of AU flares, 176.9/100 PYs in 106 patients with a recent history of AU flares, 192.9/100 PYs in 28 patients with symptomatic AU at baseline and 129.1/100 PYs in 43 patients with a history of chronic uveitis. During adalimumab treatment, the rate of AU flares was reduced by 51% in all patients, by 58% in 274 patients with a history of AU, by 68% in 106 patients with a recent history of AU, by 50% in 28 patients with symptomatic AU at baseline and by 45% in 43 patients with chronic uveitis. AU flares during adalimumab treatment were predominantly mild. Two patients with periods of high AS disease activity had new-onset AU during the treatment period.Conclusions:Results of this prospective open-label study suggest that adalimumab had a substantial preventive effect on AU flares in patients with active AS, including patients with a recent history of AU flares.Clinical trials:ClinicalTrials.gov Identifier: NCT00478660.
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Chen, Kuan-Jung, Yen-Chun Huang, Yu-Cheng Yao, Wei Hsiung, Po-Hsin Chou, Shih-Tien Wang, Ming-Chau Chang, and Hsi-Hsien Lin. "Risk Factors for Postsurgical Gout Flares after Thoracolumbar Spine Surgeries." Journal of Clinical Medicine 11, no. 13 (June 28, 2022): 3749. http://dx.doi.org/10.3390/jcm11133749.
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Gouty arthritis is the most common form of inflammatory arthritis and flares frequently after surgeries. Such flares impede early patient mobilization and lengthen hospital stays; however, little has been reported on gout flares after spinal procedures. This study reviewed a database of 6439 adult patients who underwent thoracolumbar spine surgery between January 2009 and June 2021, and 128 patients who had a history of gouty arthritis were included. Baseline characteristics and operative details were compared between the flare-up and no-flare groups. Multivariate logistic regression was used to analyze predictors and construct a predictive model of postoperative flares. This model was validated using a receiver operating characteristic (ROC) curve analysis. Fifty-six patients (43.8%) had postsurgical gout flares. Multivariate analysis identified gout medication use (odds ratio [OR], 0.32; 95% confidence interval [CI], 0.14–0.75; p = 0.009), smoking (OR, 3.23; 95% CI, 1.34–7.80; p = 0.009), preoperative hemoglobin level (OR, 0.68; 95% CI, 0.53–0.87; p = 0.002), and hemoglobin drop (OR, 1.93; 95% CI, 1.25–2.96; p = 0.003) as predictors for postsurgical flare. The area under the ROC curve was 0.801 (95% CI, 0.717–0.877; p < 0.001). The optimal cut-off point of probability greater than 0.453 predicted gout flare with a sensitivity of 76.8% and specificity of 73.2%. The prediction model may help identify patients at an increased risk of gout flare.
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Cliver, Edward W. "History of research on solar energetic particle (SEP) events: the evolving paradigm." Proceedings of the International Astronomical Union 4, S257 (September 2008): 401–12. http://dx.doi.org/10.1017/s1743921309029639.
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AbstractForbush initiated research on solar energetic particle (SEP) events in 1946 when he reported ionization chamber observations of the first three ground level events (GLEs). The next key development was the neutron monitor observation of the GLE of 23 February 1956. Meyer, Parker and Simpson attributed this high-energy SEP event to a short time-scale process associated with a solar flare and ascribed the much longer duration of the particle event to scattering in the interplanetary medium. Thus “flare particle” acceleration became the initial paradigm for SEP acceleration at the Sun. A more fully-developed picture was presented by the Australian radio astronomers Wild, Smerd, and Weiss in 1963. They identified two distinct SEP acceleration processes in flares: (1) the first phase accelerated primarily ~100 keV electrons that gave rise to fast-drift type III emission as they streamed outward through the solar atmosphere; (2) the second phase was produced by an outward moving (~1000 km s−1) magnetohydrodynamic shock, occurring in certain (generally larger) flares. The second phase, manifested by slow-drift metric type II emission, appeared to be required for substantial acceleration of protons and higher-energy electrons. This two-stage (or two-class) picture gained acceptance during the 1980s as composition and charge state measurements strengthened the evidence for two distinct types of particle events which were termed impulsive (attributed to flare-resident acceleration process(es)) and gradual (shock-associated). Reames championed the two-class picture and it is the commonly accepted paradigm today. A key error made in the establishment of this paradigm was revealed in the late 1990s by observations of SEP composition and charge states at higher energies (>10 MeV) than previously available. Specifically, some large and therefore presumably “gradual” SEP events looked “impulsive” at these energies. One group of researchers attributes these unusual events to acceleration of high-energy SEPs by flares and another school favors acceleration of flare seed particles by quasi-perpendicular shocks. A revised SEP classification scheme is proposed to accommodate the new observations and to include ideas on geometry and seed particle composition recently incorporated into models of shock acceleration of SEPs.
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Armagan, B., E. Atalar, B. Özdemir, Ö. Karakaş, E. Kayacan Erdogan, S. C. Güven, I. Dogan, O. Küçükşahin, and A. Erden. "AB1175 EFFECTS OF THE COVID-19 DISEASE ON AXIAL SPONDYLOARTHRITIS DISEASE FLARE." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 1702.2–1703. http://dx.doi.org/10.1136/annrheumdis-2022-eular.4769.
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BackgroundRheumatological disease flares may be seen after many infections. However, our knowledge for the post-COVID axial spondyloarthritis (SpA) flares and its related factors is limited.ObjectivesWe aimed to evaluate disease activity and factors that may be associated with disease activity in axial SpA patients in post-COVID period.MethodsWe retrospectively assessed the axial SpA patients who have had COVID-19 disease confirmed by a positive SARS-CoV-2 polymerized chain reaction (PCR) test result. Demographics, comorbid diseases, active medical treatments for SpA and information regarding COVID-19 clinical courses were collected from medical records. PCR positive patients were reached via telephone and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scored for pre- and post-COVID SpA symptoms. An increase of ≥2 points in the BASDAI score was defined as flare, and SpA groups with and without flare were compared. Factors predicting SpA flare were also analyzed by the logistic regression analysis.ResultsA total of 48 axial SpA patients were included in our study, 65% of them male and the mean±SD age was 42.3±8.6 years. Post-COVID SpA flare was seen in 38% patients. Demographic, clinical, medical features of the SpA patients and COVID-19 disease severity were similar between Flare and No flare groups. In comparison of the COVID-19 symptoms, although most of the COVID-19 related symptoms were similar between two groups, the frequency of the back pain and diarrhea were higher in the Flare group than No flare group. But in multivariate analysis, only history of the inflammatory bowel disease had an increased risk for post-COVID SpA flare (Table 1).Table 1.Results from adjusted logistic regression model of the spondyloarthritis flareVariablesEnter MethodBackward:Conditional MethodOR95% CIpOR95% CIpSmoking0.1250.013-1.2330.075Multimorbidity0.2440.047-1.2560.091Inflammatory bowel disease33.2211.236-892.7200.03734.3821.571-752.4620.025Fever1.5820.334-7.4860.563Arthralgia3.4380.233-50.6300.368Back pain1.0540.080-13.8950.968OR: Odds ratio, CI: Confidence IntervalConclusionThe presence of inflammatory bowel disease statistically significant related post-COVID SpA flares. In addition, diarrhea and back pain symptoms in COVID-19 disease may be stimulating factors for SpA flares but we found no effect of rheumatological therapies.Disclosure of InterestsNone declared
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Waggoner, Abygail R., and L. Ilsedore Cleeves. "Classification of X-Ray Flare-driven Chemical Variability in Protoplanetary Disks." Astrophysical Journal 928, no. 1 (March 1, 2022): 46. http://dx.doi.org/10.3847/1538-4357/ac549f.
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Abstract Young stars are highly variable in the X-ray regime. In particular, bright X-ray flares can substantially enhance ionization in the surrounding protoplanetary disk. Since disk chemical evolution is impacted by ionization, X-ray flares have the potential to fundamentally alter the chemistry of planet-forming regions. We present two-dimensional disk chemical models that incorporate a stochastic X-ray flaring module, named XGEN, and examine the flares’ overall chemical impact compared to models that assume a constant X-ray flux. We examine the impact of 500 yr of flaring events and find global chemical changes on both short timescales (days) in response to discrete flaring events and long timescales (centuries) in response to the cumulative impact of many flares. Individual X-ray flares most strongly affect small gas-phase cations, where a single flare can temporarily enhance the abundance of species such as H 3 + , HCO+, CH3 +, and C+. We find that flares can also drive chemistry out of “steady state” over longer time periods, where the disk-integrated abundance of some species, such as O and O2, changes by a few percent over the 500 yr model. We also explore whether the specific history of X-ray flaring events (randomly drawn but from the same energy distribution) impacts the chemical evolution and find that it does not. Finally, we examine the impact of X-ray flares on the electron fraction. While most molecules modeled are not highly sensitive to flares, certain species, including observable molecules, are very reactive to the dynamic environment of a young star.
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Fasano, Serena, Melania Alessia Coscia, Luciana Pierro, and Francesco Ciccia. "Which patients with systemic lupus erythematosus in remission can withdraw low dose steroids? Results from a single inception cohort study." Lupus 30, no. 6 (March 12, 2021): 991–97. http://dx.doi.org/10.1177/09612033211002269.
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Background A progressive tapering until withdrawal of glucocorticoids (GC) is considered one of the main goals of Systemic Lupus Erythematosus (SLE) management. However, which patient may be a candidate for safe GC withdrawal has not been determined yet. This study aimed to evaluate the rate of low-dose GC withdrawal in SLE patients in remission and to identify predictors of flares. Methods Eligible patients were SLE patients in prolonged clinical remission defined by a cSLEDAI = 0 for at least 2 years and on a stable SLE treatment (including daily 5 mg prednisone). Flares were defined by SELENA-SLEDAI Flare Index. Predictors of flares after GC withdrawal were analyzed by Cox regression. Results We selected 56 patients in whom a GC withdrawal was attempted. 98 patients were in the prednisone maintenance group. The proportion of patients experiencing a flare was not significantly lower in the maintenance group than in the withdrawal group (p = 0.81). However, among the withdrawal group, the rate of flares was significantly higher in serologically active clinically quiescent (SACQ) patients (p < 0,0001). At Cox regression analysis, duration of hydroxychloroquine (HCQ) therapy and ≥5 year remission at withdrawal were protective factors, while a SACQ disease and history of lupus nephritis increased the risk of disease flare. Conclusion GC withdrawal is an achievable target in SLE and may be attempted in patients in complete remission.However, it might underline a caution in patients with SACQ disease who may be at greater risk forflare when GCare discontinued. HCQ therapy and durable remission can significantly reduce the risk.
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Hussain, Imad. "Study of the duration of the solar flare of the 23 and 24 solar cycles." MOMENTO, no. 66 (January 2, 2023): 41–58. http://dx.doi.org/10.15446/mo.n66.104439.
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Studying solar flares and their characteristics is significant for understanding the dynamics of the sun. In this work, a new view for studying the duration time of solar flares is presented. Regarding the analysis of the duration time, one of the solar flares parameters is introduced for the solar cycles 23 and 24. This is done by ordering the duration time of solar flares into five groups of minutes (<30, 30-60, 60 90, 90-120, >120) and calculating the total annual duration time of solar flares for each group. The total annual duration time is also calculated for each class of solar flare classification (B, C, M, X). Their relationship with both F10.7 and Kp-index are also studied. We found that approximately 41% of solar flares occur within 6-12 minutes for both solar cycles. Additionally, the total average of their duration time is 19.1 and 19.6 minutes, respectively.Also, the average duration time of the ascending phase is less than the descending phase of both solar cycles for all classes of solar flares, except for B-class, which is vice versa. The relationship between the duration time of solar flares with F10.7 is strong. In contrast, the relationship with the Earth’s magnetic field is weak.
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van der Horst-Bruinsma, Irene, Rianne van Bentum, Frank D. Verbraak, Thomas Rath, James T. Rosenbaum, Maria Misterska-Skora, Bengt Hoepken, et al. "The impact of certolizumab pegol treatment on the incidence of anterior uveitis flares in patients with axial spondyloarthritis: 48-week interim results from C-VIEW." RMD Open 6, no. 1 (April 2020): e001161. http://dx.doi.org/10.1136/rmdopen-2019-001161.
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BackgroundAcute anterior uveitis (AAU) is the most common extra-articular manifestation in patients with axial spondyloarthritis (axSpA). C-VIEW investigates the impact of the Fc-free TNF inhibitor certolizumab pegol (CZP) on AAU flares in patients with active axSpA at high risk of recurrent AAU.MethodsC-VIEW (NCT03020992) is a 96-week ongoing, multicentre, open-label, phase 4 study. Included patients had an axSpA diagnosis, a history of recurrent AAU (≥2 AAU flares, ≥1 flare in the year prior to study entry), HLA-B27 positivity, active disease, and failure of ≥2 non-steroidal anti-inflammatory drugs. Patients received CZP 400 mg at Weeks 0/2/4, then 200 mg every 2 weeks up to 96 weeks. This 48-week pre-planned interim analysis compares AAU flare incidence in the 48 weeks before and after initiation of CZP treatment, using Poisson regression to account for possible within-patient correlations.ResultsIn total, 89 patients were included (male: 63%; radiographic/non-radiographic axSpA: 85%/15%; mean axSpA disease duration: 8.6 years). During 48 weeks’ CZP treatment, 13 (15%) patients experienced 15 AAU flares, representing an 87% reduction in AAU incidence rate (146.6 per 100 patient-years (PY) in the 48 weeks pre-baseline to 18.7 per 100 PY during CZP treatment). Poisson regression analysis showed that the incidence rate of AAU per patient reduced from 1.5 to 0.2 (p<0.001). No new safety signals were identified.ConclusionsThere was a significant reduction in the AAU flare rate during 48 weeks of CZP treatment, indicating that CZP is a suitable treatment option for patients with active axSpA and a history of recurrent AAU.
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Kurtanidze, Omar M. "CCD Monitoring of Flare Stars in Stellar Aggregates." International Astronomical Union Colloquium 151 (1995): 117–18. http://dx.doi.org/10.1017/s0252921100034801.
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After Haro’s fundamental discovery of flare stars in stellar associations and young clusters, their importance was fully recognized. The flare star system provides one of the most important records of the stellar aggregate’s history. This record can be used to establish the chronology of these systems and to test theories of star and aggregate formation.Unfortunately, the observational material contains an unavoidable strong selection with respect to the statistics and the physical characteristics of flare stars in aggregates. This explains the difficulties which arise when one tries to compare physical and statistical characteristics of flare stars in aggregates and in the solar neighborhood, since the latter objects are studied almost exclusively by photoelectric methods. The flare frequency in aggregates is more than one order of magnitude smaller than that of flare stars in the solar neighbourhood. This is probably a selection effect, since the photographic observations in aggregates have been carried out with exposure times 5-10 min. Small amplitude flares cannot be recorded at all. Flare stars in aggregates are usually objects whose recorded flares have amplitudes > 0m.6 − 0m.7, and which last for at least 5 min. The long exposure masks the true amplitude of the flare.
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Crisafulli, F., R. Reggia, M. Filippini, M. Fredi, M. C. Gerardi, R. Gorla, M. G. Lazzaroni, et al. "POS0760 MONITORING C3 AND C4 VARIATIONS IN SYSTEMIC LUPUS ERYTHEMATOSUS PREGNANCIES IS USEFUL TO RECOGNIZE COMPLICATIONS. DATA FROM 2 ITALIAN CENTERS." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 633. http://dx.doi.org/10.1136/annrheumdis-2021-eular.3056.
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Background:In SLE pregnancies adverse pregnancy outcomes (APO) are more frequent than in general obstetric population (GOP). In clinical practice, low C3 and C4 levels are associated with active disease and, during pregnancy, complement activation products are shown to be associated with APO.Objectives:To analyse complement variations during SLE pregnancies, focusing on disease flares and APO.Methods:Data on SLE pregnancies prospectively-followed by multidisciplinary team in 2 Italian Centers from 1987 to 2018 were retrospectively analysed. C3 and C4 normal levels were calculated in general obstetric population (GOP) as previously described1, and related to maternal and fetal outcome. Non categorical variables were compared using Mann-Whitney test or Wilcoxon test when appropriate.Results:Two hundred forty-six pregnancies in 172 SLE patients were analysed (mean age at conception 31.3 ±4.9 years; mean disease duration 8.3 ±7.1). Anti-Ro antibodies were positive in 64 patients (37%) and anti-phospholipid antibodies (aPL) were positive in 84 (48%), with single positivity in 54%, double in 24% and triple in 21%; 9 patients (5%) had also a diagnosis of obstetric-antiphospholipid syndrome (APS) and 8 (4%) had thrombotic-APS. Seventy-one patients (41%) had history of Lupus Nephritis.Thirty-five flares were recorded in 30 pregnancies (12%). APO occurred in 47 pregnancies (19%) and were: 27 fetal loss (20 early miscarriage <10th week and 7 intrauterine fetal death), 11 severe preterm birth (<34th week) and 15 hypertensive disorder (11 pre-eclampsia and 5 pre-eclampsia+HELLP syndrome).In GOP, C3 progressively increased throughout pregnancy and C4 increase from the 1st trimester to the 2nd trimester, as well as in SLE pregnancies without flares and without APO, from preconception (Fig 1). In the other SLE groups, C3 and C4 showed a different trend: in pregnancies with flares, they did not increase from preconception to the 1st trimester; in fetal losses and severe pre-term births, they remained stable throughout pregnancy; in hypertensive disorders they increased only between preconception and the 1st trimester.C3 and C4 levels were higher in GOP than in all SLE pregnancies groups (including those without flares and without APO) in each trimester. SLE pregnancies without flares showed higher C3 and C4 levels than pregnancies with flares, at preconception and in each trimester. SLE pregnancies without APO had higher C3 and C4 levels than pregnancies with fetal death at 2nd trimester, higher C3 levels than severe pre-term births in each trimester and higher C4 at 3rd trimester (Fig.1).At preconception, pregnancies with flares showed a higher frequency of low C3 and of low C4 than in pregnancies without flares (76% vs 42%, p=0.01; 76% vs 26%, p<0.001, respectively). Using the normality range previously calculated in GOP, SLE pregnancies with flares had higher frequency of low C4 in every trimester as compared with pregnancies without flares (1st: 82% vs 48%, p=0.003; 2nd: 82% vs 64%, p=0.01; 3rd: 64% vs 30%, p=0.002). At multivariate analysis, low C4 at preconception was associated with flare (OR [95% CI]: 10.34 [2.52-42.39]; p=0.001).Figure 1.Variations of C3 and C4 median levels (mg/dL) throughout pregnancy in GOP1 and in SLE pregnancies without and with flare (a) and without and with APO (b).* p <0.05^as compared with SLE groups: p<0.05; § as compared with SLE pregnancies without flare: p<0.05; + as compared with SLE pregnancies without APO: p<0.05Conclusion:In SLE pregnancies, monitoring of C3 and C4 is important: its failure to increase can be useful to recognize potential risk situations which deserve particular monitoring.References:[1]Reggia R. et al. Rheumatology 2012;51:2186-2190.Disclosure of Interests:None declared
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Skedros, John G., James S. Smith, Marshall K. Henrie, Ethan D. Finlinson, and Joel D. Trachtenberg. "Upper Extremity Compartment Syndrome in a Patient with Acute Gout Attack but without Trauma or Other Typical Causes." Case Reports in Orthopedics 2018 (2018): 1–6. http://dx.doi.org/10.1155/2018/3204714.
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We report the case of a 30-year-old Polynesian male with a severe gout flare of multiple joints and simultaneous acute compartment syndrome (ACS) of his right forearm and hand without trauma or other typical causes. He had a long history of gout flares, but none were known to be associated with compartment syndrome. He also had concurrent infections in his right elbow joint and olecranon bursa. A few days prior to this episode of ACS, high pain and swelling occurred in his right upper extremity after a minimal workout with light weights. A similar episode occurred seven months prior and was attributed to a gout flare. Unlike past flares that resolved with colchicine and/or anti-inflammatory medications, his current upper extremity pain/swelling worsened and became severe. Hand and forearm fasciotomies were performed. Workup included general medicine, rheumatology and infectious disease consultations, myriad blood tests, and imaging studies including Doppler ultrasound and CT angiography. Additional clinical history suggested that he had previously unrecognized recurrent exertional compartment syndrome that led to the episode of ACS reported here. Chronic exertional compartment syndrome (CECS) presents a difficult diagnosis when presented with multiple symptoms concurrently. This case provides an example of one such diagnosis.
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Loganathan, Aravinthan, Arupam Raman, Natalia Berlinski, and John Riordan. "Representation Rate and Management of Gout for Patients Discharged From Emergency Departments in Illawarra Shoalhaven Local Health District." Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders 15 (January 2022): 117954412210973. http://dx.doi.org/10.1177/11795441221097351.
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Introduction: The estimated prevalence of gout in Western societies is 2.7% to 6.7%. In Australia, there have been increasing rates of hospitalisations for gout flares. Urate-lowering therapy (ULT) is effective in reducing urate burden, which can prevent gout flares and destructive arthropathy. This study assessed the representation rate of patients presenting to the Emergency Department (ED) with crystal arthropathy and the utilisation of ULT in the community for patients with a pre-existing history of gout. Methods: A retrospective review of electronic records of patients presenting to the ED from the Illawarra Shoalhaven Local Health District was performed. Patients included were coded as per the 10th revision of the International Classification of Diseases coding for crystal arthropathy Results: In all, 18.8% of all crystal arthropathy encounters to the ED were repeat presentations. Of the 70% of patients with a history of gout, only 30.8% were on ULT. Discussion: Despite evidence-based recommendations for a ‘treat-to-target’ approach, most patients with a previous history of gout were not on ULT. One in five encounters were re-presentations for crystal arthropathy. Effective adherence to treatment guidelines may reduce the number of repeat encounters for gout flare in the ED.
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Wheatland, Michael S. "Initial Test of a Bayesian Approach to Solar Flare Prediction." Publications of the Astronomical Society of Australia 22, no. 2 (2005): 153–56. http://dx.doi.org/10.1071/as04062.
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AbstractA test of a new Bayesian approach to solar flare prediction is presented. The approach uses the past history of flaring together with phenomenological rules of flare statistics to make a prediction for the probability of occurrence of a large flare within an interval of time, or to refine an initial prediction (which may incorporate other information). The test of the method is based on data from the Geostationary Observational Environmental Satellites, and involves whole-Sun prediction of soft X-ray flares for 1976–2003. The results show that the method somewhat over-predicts the probability of all events above a moderate size, but performs well in predicting large events.
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Akopian, A. A. "Review on the astronomical estimators of number of flare stars." Communications of the Byurakan Astrophysical Observatory 2, no. 1 (2018): 65–79. http://dx.doi.org/10.52526/25792776-2018.2.1-65.
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Review is devoted to estimators introduced in astronomy by Ambartsumian and his followers that are used to estimating the unknown number of flare stars and other randomly flashing objects (stars with X-ray flares, solar type stars with superflares). Some important astronomical applications of them are presented. The development of these methods in astronomy have proceeded regardless of development of analogous methods of mathematical statistics. Brief history of this development and parallels with similar statistical methods is presented.
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Polizzotto, Mark N., Thomas S. Uldrick, Victoria Wang, Karen Aleman, Kathleen M. Wyvill, Vickie Marshall, Stefania Pittaluga, et al. "Distinct Human and Viral Interleukin-6 Profiles and Other Viral and Immunologic Abnormalities In KSHV-Associated Multicentric Castleman Disease: Relationship with Disease Activity and Individual Disease Manifestations." Blood 118, no. 21 (November 18, 2011): 1573. http://dx.doi.org/10.1182/blood.v118.21.1573.1573.
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Abstract Abstract 1573 Background: Multicentric Castleman disease (MCD) is a polyclonal B-cell lymphoproliferative disorder characterized by flares of severe inflammatory symptoms, including fever and cachexia, with cytopenias and biochemical abnormalities. In the idiopathic form, its pathogenesis is linked to overproduction of interleukin (IL)-6. A distinct form of MCD is caused by Kaposi sarcoma-associated herpesvirus (KSHV, also called human herpesvirus [HHV]-8). KSHV encodes a viral homolog of IL-6, vIL-6, and this has been hypothesized to be central to KSHV-MCD pathogenesis. However, viral and human cytokines have not been examined together in KSHV-MCD, and their contribution to disease activity and symptoms is not known. Methods: Patients with pathologically-proven KSHV-MCD were enrolled on a prospective natural history study incorporating pilot evaluation of novel therapies (NCT00099073). Factors potentially important in pathogenesis were assayed at flare and complete clinical and laboratory remission: KSHV viral load (VL) in peripheral blood mononuclear cells, vIL-6, IL-1β, IL-5, human IL-6 (hIL-6), IL-8, IL-10, IL-12p70, IFN-γ and TNF-α. Paired analyses were performed for each patient comparing initial flare and remission. Associations between cytokines and individual disease manifestations were explored across all flares. Results: 21 patients had at least one flare for analysis (19 [90%] male; med age 44 [range 29–52]). 34 flares were observed (range 1–3 per patient) and followed to remission (20 patients) or death (1). All were HIV infected: CD4 med 252cells/μL (range 24–1319), HIV VL med <48 copies/mL (<48–64,100), 94% receiving antiretrovirals. Clinical symptoms included fever (present in 62%, med 38°C [range 36.1–40.5]); fatigue (91%, med CTC grade 2 [0–3]), gastrointestinal (GI) symptoms (68%, med grade 1 [0–3]) and respiratory symptoms (61%, med grade 1 [0–2]). Laboratory findings included anemia (97%, 9.9g/L [6.8–14.4]), thrombocytopenia (68%, 100×103cells/μL [6–567]), hypoalbuminemia (97%, 2.7g/L [1.2–3.9]) hyponatremia (68%, 133mEg/L [127–143]) and C-reactive protein (CRP) elevation (100%, 87.3g/L [6.3–339.5]). Factors elevated during initial flares were: KSHV VL (med 14,700/106 PBMCs [range 0–3,913,000] P <0.0001 compared with remission); vIL-6 (detected in 48%, <1560pg/mL [<1560-20,500] P= 0.0039); hIL-6 (15.9pg/mL [1.4-171.5] P= 0.0006); IL-10 (449pg/mL [2.8-85,900] P= 0.0007); TNF-α (29.0 pg/ml [7.9–90.8] P= 0.0083) and IL-1β (1.2 pg/ml [0.1–5.7] P= 0.0027). IL-5 was decreased compared with remission (0.6 [0.1–15.4] P= 0.016). Differences were most marked for vIL-6 (undetectable in all remissions), hIL-6 (med increase from remission 520%) and IL-10 (med increase from remission 5000%). KSHV VL was correlated with hIL-6 (R = 0.68, P= 0.001) and IL-10 (R=0.82, P= 0.001) across all flares and remissions; other correlations were weaker. There was also a strong association between KSHV VL and vIL-6 (P= 0.001 by Jonckheere-Terpstra). For hIL-6 and vIL-6 only, we observed distinct profiles across flares: vIL-6 elevation only (2 flares, 6%), hIL-6 only (17 flares, 50%), and hIL-6 with vIL-6 (13 flares, 38%). In 2 flares (6%), neither vIL-6 nor hIL-6 were detected at onset, but in both hIL-6 alone soon became elevated. In contrast, KSHV VL, IL-10, TNF-α and IL-1β were consistently elevated during flares. Compared with hIL-6-only flares, hIL-6 with vIL-6 flares exhibited significantly higher CRP (P =0.0009); worse hyponatremia (P =0.02); higher KSHV VL (P =0.016) and IL-10 (P= 0.012); and lower IL-5 (P= 0.009). In linear/logistic regression models of disease manifestations with cytokines, best predictors were: GI symptoms, respiratory symptoms, temperature, platelet count: hIL-6 alone; hemoglobin: hIL-6 and vIL-6; sodium: hIL-6, vIL-6 and IL-10; albumin: IL-1β and vIL-6. Conclusions: This prospective analysis shows for the first time that vIL-6 and hIL-6 can independently or together lead to flares of KSHV-MCD. It shows novel associations of KSHV-MCD flares with IL-1β and TNF-α elevation and IL-5 depression while confirming associations with KSHV VL and IL-10. It further suggests that vIL-6 and hIL-6 may jointly contribute to the severity of some symptoms during flares. As vIL-6 can signal independently of the ligand-binding IL-6 receptor-a, these findings have implications for the development of novel KSHV-MCD therapies targeting IL-6 and its downstream signaling. Disclosures: No relevant conflicts of interest to declare.
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Cipolletta, E., G. Nakafero, M. Mamas, A. Avery, L. Tata, and A. Abhishek. "POS1172 RISK OF VENOUS THROMBOEMBOLISM AFTER GOUT FLARES." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 914–15. http://dx.doi.org/10.1136/annrheumdis-2022-eular.4633.
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BackgroundSeveral population-based cohort studies have reported an increased risk of venous thromboembolism (VTE) in gout patients. However, none of these studies has investigated the temporal relationship between gout flares and VTE.ObjectivesTo explore whether gout flares increase the risk of VTE in the short-term using the self-controlled case series (SCCS) method.MethodsWe identified participants with incident gout from the Clinical Practice Research Datalink (CPRD). Participants having less than one year of registration in CPRD and patients with a history of VTE or anticoagulant prescription more than one year before the first gout consultation were excluded.Participants with at least one gout flare and a diagnosis of VTE were selected. VTEs and gout flares were ascertained using primary care data, hospitalisation and mortality records, using previously validated algorithms (positive predictive value of 94% for VTE [1] and 68-95% for gout flares [2,3]).SCCS method involves fitting a Poisson model conditioned on the number of VTEs, and it calculates the adjusted incidence risk ratio (aIRR) and its 95% confidence interval (95%CI) for each stratum of the “at-risk” period as compared with the “baseline” period (Figure 1). The analysis was adjusted for age and calendar season.Figure 1.Schematic description of the observation period (“at-risk” and baseline periods).The “at-risk” period (in red) was defined as the period following the exposure (the gout flare), and it was subdivided as follows: days 0-30, 31-60 and 61-120 after each gout flare. The baseline period (in green) consisted of a pre-exposure and a post-exposure period of 365 days each.The length of each period varied according to the occurrence of the next flare and its timing. Panel A and panel B provide a schematic representation of patients with a single observation period and with multiple “non-overlapping” observation periods, respectively. In such cases, the length of the “at risk” period was 120 days, while the length of the pre-exposure and post-exposure period was 365 days each.ResultsAmong the 104,962 patients with an incident diagnosis of gout in CPRD between 1997 and 2020, we identified 2,678 VTE (4.0 events/1,000 person-years).There were 53 VTE (13.3 events/month) during the “at-risk” period and 143 (6.0 events/month) during the “baseline” period (crude incidence rate ratio, 1.75; 95%CI: 1.27-2.42). The rates were highest in the first month after gout flares and then fell progressively (Table 1). Sensitivity analyses were consistent with the main analysis (Table 1).Table 1.Gout flareNumber of events per monthaIRR (95%CI)ptrendMain analysis0-30 days17.02.11 (1.27-3.50)0.0131-60 days14.01.86 (1.07-3.24)61-90 days11.01.50 (0.95-2.37)Baseline period6.0ReferenceSensitivity analysis (excluding participants with risk factors for VTE) [4]0-30 days14.03.13 (1.77-5.53)0.0131-60 days7.01.66 (0.76-3.61)61-90 days8.01.75 (0.94-3.37)Baseline period3.4ReferenceConclusionA transitory increase in the risk of VTE was observed after gout flares.References[1]Huerta C, et al. Risk factors and short-term mortality of venous thromboembolism diagnosed in the primary care setting in the United Kingdom. Arch Intern Med. 2007;167:935-43.[2]Zheng C, et al. Using natural language processing and machine learning to identify gout flares from electronic clinical notes. Arthritis Care Res (Hoboken). 2014;66:1740-8.[3]MacFarlane LA, Liu et al. Validation of claims-based algorithms for gout flares. Pharmacoepidemiol Drug Saf. 2016;25:820-6.[4]Konstantinides SV, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41:543-603.Disclosure of InterestsNone declared
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Nossent, Johannes, Warren Raymond, Helen Keen, Charles Inderjeeth, and David Preen. "Pregnancy outcomes in women with a history of immunoglobulin A vasculitis." Rheumatology 58, no. 5 (December 24, 2018): 884–88. http://dx.doi.org/10.1093/rheumatology/key408.
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Abstract Objectives Case series suggest an increased risk of pregnancy complications in women with a history of IgA vasculitis (IgAV); however, no large quantitative studies have examined this possible association to date. We compared pregnancy rates and outcomes between female IgAV patients and controls and assessed flare risk of IgAV during pregnancy. Methods Using state-wide hospital morbidity data we compared rates for live birth, preterm birth, abortive outcome and gestational complications between female IgAV patients (International Classification of Diseases-9-Clinical Modification 287.0; International Classification of Diseases-10-Australian Modification D69.0) (n = 121) and non-exposed age-matched controls (n = 284) in Western Australia. Results presented are means compared by Kruskal–Wallis test and proportions with odds ratios (ORs) (95% CI) compared by χ2 testing. Results There were 247 pregnancies in IgAV patients during which no disease flares were recorded and 556 pregnancies in controls. IgAV patients were younger at first pregnancy (24.7 vs 27.0 years, P < 0.01) and had 43 unsuccessful pregnancies (17.4%) and 204 live births with 17 preterm deliveries (8.3%). Women with IgAV had increased odds of spontaneous abortion (OR 1.9, 95% CI 1.1, 3.1, P = 0.04), preterm delivery (OR 2.0, 95% CI 1.1, 3.9, P = 0.02) and gestational hypertension (OR 4.7, 95% CI 2.3, 9.8). While gravidity did not differ (mean pregnancy number 2.4 vs 2.3, P = 0.36), IgAV patients had over a two-fold greater number of obstetric visits than controls (5.1 vs 2.5, P < 0.01). Conclusions Hospitalization for IgAV has little impact on fertility and IgAV rarely flares during pregnancy. However, a history of IgAV associates with increased odds of spontaneous abortions, gestational hypertension and preterm delivery.
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Kim, Sang T., Xerxes Pundole, Ramona Dadu, Olivier Lambotte, Manuel Ramos-Casals, and Maria E. Suarez-Almazor. "Use of immune checkpoint inhibitors in cancer patients with pre-existing sarcoidosis." Immunotherapy 13, no. 6 (April 2021): 465–75. http://dx.doi.org/10.2217/imt-2020-0272.
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Aim: To evaluate adverse events in cancer patients with pre-existing sarcoidosis receiving immune checkpoint inhibitors (ICIs). Patients & methods: We retrospectively reviewed cancer patients with sarcoidosis who underwent treatment with ICI to determine frequency of sarcoidosis flares. Results: 32 patients with sarcoidosis received ICIs The median time to ICI initiation was 7 years (range: 1 month to 51 years). One patient (3%) with a 20-year remote history of sarcoidosis developed a clinically symptomatic exacerbation after three doses of atezolizumab, with hilar lymphadenopathy, subcutaneous nodules, arthritis and uveitis. Atezolizumab was discontinued and prednisone initiated. She had a fluctuating course with two additional flares. Conclusion: Frequency of flares in patients with a remote history of sarcoidosis who receive ICIs is low.
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van der Horst-Bruinsma, Irene E., Rianne E. van Bentum, Frank D. Verbraak, Atul Deodhar, Thomas Rath, Bengt Hoepken, Oscar Irvin-Sellers, Karen Thomas, Lars Bauer, and Martin Rudwaleit. "Reduction of anterior uveitis flares in patients with axial spondyloarthritis on certolizumab pegol treatment: final 2-year results from the multicenter phase IV C-VIEW study." Therapeutic Advances in Musculoskeletal Disease 13 (January 2021): 1759720X2110038. http://dx.doi.org/10.1177/1759720x211003803.
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Introduction: Acute anterior uveitis (AAU), affecting up to 40% of patients with axial spondyloarthritis (axSpA), risks permanent visual deficits if not adequately treated. We report 2-year results from C-VIEW, the first study to prospectively investigate certolizumab pegol (CZP) on AAU in patients with active axSpA at high risk of recurrent AAU. Patients and methods: C-VIEW (NCT03020992) was a 104-week (96 weeks plus 8-week safety follow-up), open-label, multicenter study. Eligible patients had active axSpA, human leukocyte antigen-B27 (HLA-B27) positivity and a history of recurrent AAU (⩾2 AAU flares in total; ⩾1 in the year prior to baseline). Patients received CZP 400 mg at weeks 0, 2 and 4, then 200 mg every 2 weeks to week 96. The primary efficacy endpoint was the AAU flare event rate during 96 weeks’ CZP versus 2 years pre-baseline. Results: Of 115 enrolled patients, 89 initiated CZP (male: 63%; radiographic/non-radiographic axSpA: 85%/15%; mean disease duration: 9.1 years); 83 completed week 96. There was a significant 82% reduction in AAU flare event rate during CZP versus pre-baseline [rate ratio (95% confidence interval): 0.18 (0.12–0.28), p < 0.001]. One hundred percent and 59.6% of patients experienced ⩾1 and ⩾2 AAU flares pre-baseline, respectively, compared to 20.2% and 11.2% during treatment. Age, sex and axSpA population subgroup analyses were consistent with the primary analysis. There were substantial improvements in axSpA disease activity with no new safety signal identified. Conclusion: CZP treatment significantly reduced AAU flare event rate in patients with axSpA and a history of AAU, indicating CZP is a suitable treatment option for patients at risk of recurrent AAU. Trial Registration ClinicalTrials.gov: NCT03020992, URL: https://clinicaltrials.gov/ct2/show/NCT03020992 [Media: see text]
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Chakravarty, E., T. Utset, D. L. Kamen, G. Contreras, W. J. Mccune, K. C. Kalunian, C. Aranow, et al. "OP0167 SUCCESSFUL WITHDRAWAL OF MYCOPHENOLATE MOFETIL IN QUIESCENT SLE: RESULTS FROM A RANDOMIZED TRIAL." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 105–6. http://dx.doi.org/10.1136/annrheumdis-2020-eular.5110.
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Background:Trials and clinical observations have demonstrated the efficacy of mycophenolate mofetil (MMF) for SLE treatment. Long-term use of MMF is associated with adverse events, pregnancy risks, drug monitoring, and increased cost. Current management continues therapy indefinitely. Whether immunosuppression may be safely withdrawn or whether risks of withdrawal outweigh the benefits of continuation is unknown.Objectives:To compare rates of clinically significant disease reactivation (CSDR), major flares, and all flares in patients with quiescent SLE on stable MMF randomized to maintain or withdraw MMF. The goal is to provide guidance for clinicians and patients on the risks of MMF withdrawal.Methods:Adults with quiescent SLE (SELENA-SLEDAI without serologies <4) receiving MMF for ≥2 years for nephritis or ≥ 1 year for non-nephritis were randomized 1:1 to unblinded MMF (maintenance arm, MA) or to a 12-week taper off MMF (withdrawal arm, WA) and followed through 60 weeks. Subjects were on stable hydroxychloroquine; steroids limited to ≤ 10 mg. CSDR, defined as a SLEDAI flare requiring immunosuppression, BILAG flares and adverse events were assessed. Event rates and time to flare were compared using Kaplan-Meier.Results:102 subjects were randomized (50 MA, 52 WA); 1 subject in each arm was ineligible and 10 terminated early (7 MA, 3 WA). Mean disease duration was 13 years; 76% had a history of nephritis; mean baseline SLEDAI was 2.2. 5 MA subjects (10%) had CSDR, compared to 9 WA (17%). Median time to CDSR was 38 weeks in both arms. BILAG A flares occurred in 1MA subject (pancreatitis) vs. 4 WA (cranial neuropathy, panniculitis, 2 nephritis). Kaplan-Meier curves overlapped for CDSR, BILAG A flares, and all SLEDAI flares (Figure). Based on these data, we are 86% confident that the increased risk of CDSR with MMF withdrawal is less than 15% over 60 weeks. AEs were similar between groups; infections occurred more commonly in MA (63 vs. 49).Conclusion:In this cohort of subjects with quiescent SLE on long term MMF serious flares occurred infrequently in subjects continuing or withdrawing MMF without differences in time to flare. MMF withdrawal may be considered in subjects with prolonged quiescent disease.Table 1.Baseline and Demographic CharacteristicsMaintenance armWithdrawal armTotalRandomized5052102Female, n (%)39 (78)47 (90)86 (84)White, n (%)25 (50)19 (37)44 (43)Black, n (%)19 (38)22 (42)41 (40)Hispanic/Latino, n (%)10 (20)12 (23)22 (22)Age, Years, mean (SD)42.4 (12.9)41.6 (12.5)42.0 (12.6)Disease Duration, Years, mean (SD)13.6 (8.2)12.2 (7.9)12.9 (8.0)H/O Lupus Nephritis, n (%)40 (80)38 (73)78 (76.5)On Baseline Steroids, n (%)18 (36)23 (44)41 (40)Prednisone Dose, mg, mean (SD)4.8 (2.7)3.3 (1.7)4.0 (2.3)MMF Duration, Years, mean (SD)6.8 (4.3)6.4 (4.3)6.6 (4.3)Baseline MMF Dose, mg, mean1,6121,6681,640SELENA-SLEDAI*, mean (SD)2.4 (1.76)1.9 (1.76)2.2 (1.77)Positive DsDNA, n (%)35 (70)27 (52)62 (61)Low C31, n (%)14 (28)9 (17)23 (23)Low C41, n (%)6 (12)5 (10)11 (11)Figure.Kaplan-Meier Estimates of Flare EndpointsDisclosure of Interests:Eliza Chakravarty: None declared, Tammy Utset: None declared, Diane L Kamen Consultant of: Consulted on SLE survey development for Lilly and consulted on SLE trial protocol development for EMD Serono in 2019, Gabriel Contreras Grant/research support from: Genentech, Merck, Consultant of: Genentech, Merck, William Joseph McCune: None declared, Kenneth C Kalunian: None declared, Cynthia Aranow: None declared, Megan Clowse Grant/research support from: GSK, Pfizer, Consultant of: UCB, Astra-Zeneca, Speakers bureau: UCB, Ellen Goldmuntz: None declared, Jessica Springer: None declared, Lynette Keyes-Elstein: None declared, Bill Barry: None declared, Ashley Pinckney: None declared, Judith James: None declared
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Jeria Navarro, S., H. Park, M. A. Pou, E. Calvo-Aranda, and C. Diaz-Torne. "AB0643 IL-1 BLOCKAGE WITH ANAKINRA IN GOUT PATIENTS. SCOPING REVIEW OF THE PUBLISHED LITERATUR." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 1354.3–1355. http://dx.doi.org/10.1136/annrheumdis-2021-eular.3455.
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Background:Gout is the most common inflammatory arthritis in adults. It is caused by the chronic deposition of monosodium urate crystals in joints. Hypertension, diabetes mellitus, chronic kidney disease (CKD) and cardiovascular disease are highly prevalent in gout patients.Nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids or colchicine are the first line therapeutic agents for flares. These drugs can be contraindicated in a large group of gout patients. Off label prescription of IL-1 receptor blockage with anakinra can be an alternative for this complex patients.Objectives:The main objective of this study is to perform a scoping review about patient characteristics, comorbidity, effectivity and safety profile of patients with gout treated with anakinra.Methods:A total of 1119 citations were screened. The reviewers performed a two-stage screening by title/abstract and full-text screening. Thirty six articles that finally met selection criteria, were included for data extraction and synthesis. Treatment duration of ≥12 weeks was considered chronic.Results:Four hundred forty three patients were included in the study. 20 patients (4,5%) received chronic treatment and 423 (95,5%) flare treatment. Outcomes from 496 flares were finally analyzed.The mean age of the patients was 63.6 years and 84% were men. The clinical presentation was polyarticular in 47.9% and tophaceous gout in 66.5%. Some of these patients presented atypical forms of the disease such as spinal gout, autoinflammatory syndromes or sternoclavicular joint arthritis.Most of the patients presented comorbidities, the most prevalent being arterial hypertension in 127 (70.5%) and chronic kidney disease (≥ 3 stage) in 220 (51.8%). History of transplant in 37 (14.6%) with stem cell, kidney, heart, and liver transplant. More than half of patients had more than one associated comorbidity. Demographic and clinical characteristics of gouty arthritis patients are presented in Table 1. Flare was present in admitted patients in 260 (57.5%). Anakinra was administered in 52 patients with an active infection.Different treatment regimens were described. Daily administration was used in 98% of the patients. 92.8% of the flares were treated seven days or less, being the three days regimen the most prevalent. In the chronic group the longest treatment reported was 5 years.Efficacy of treatment with anakinra was evidenced, in flare 426 patients (93%) and chronic 19 patients (91%). Overall, anakinra was well tolerated. In the case of flares, thirty-three (7.9%) adverse effects related to anakinra administration were registered: seven (1.6%) site injection reactions, five (1.1%) reversible hematological alterations and five acute infections (H1N1, herpes zoster, severe cold, pulmonary abscess and nosocomial pyelonephritis). In chronic treated patients, adverse infectious events were more prevalent, seven (32%) infections (Staphylococcus aureus tophus (2), Staphylococcus aureus lung abscess, erysipela of the leg, Streptococcus B urinary tract infection, Staphylococcus aureus knee arthritis and tuberculous cervical lymphadenitis).Conclusion:Anakinra has been shown to be effective and safe in treatment for flares in gout complex or resistant patients. It has been shown in multiples scenarios like active infections, dialysis, transplants, chronic kidney disease, tophi and polyarticular disease refractory to standard treatment. It has also shown its effectiveness as chronic treatment, but there are more concerns about its safety. These findings need to be confirmed with controlled clinical trials for anakinra inclusion in treatment recommendations in special situations of flares in complex or resistant gout patients.Disclosure of Interests:None declared.
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Volvach, Larisa, Alexandr Volvach, and Michail Larionov. "Super-Powerful Flare Phenomenon of the Water Maser in the Protostellar System IRAS 16293-2422." Infocommunications and Radio Technologies 5, no. 2 (October 7, 2022): 153–68. http://dx.doi.org/10.29039/2587-9936.2022.05.2.11.
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Based on long-term monitoring of the water vapor maser at 22.2 GHz from early 2019 to March 2021, the most powerful flare event in the entire history of observations was recorded in the protostellar system IRAS 16293-2422 at a velocity of about –1.5 km s–1, lasting of about two years. The maser emission came from the largest structure of maser spots, the high density of which created their partial overlap in time. The total number of individual flares of the water maser reached ten. Due to the high detail of the data obtained, recorded at intervals of 1–2 days, new unique results were obtained. The existence of such a complex configuration of emitting maser spots with very similar radial velocities located on the observer’s line of sight was confirmed for the first time. It was possible to establish that the masers of powerful flares were in an un-saturated state due to the cascade pumping of several masers on the observer’s line of sight. New important parameters of water masers have been obtained, and an assumption has been made about their localization in the gas-dust structure IRAS 16293-2422.
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Tio, Maria Sarce, and Arundina Sanyoto. "Systemic Lupus Erythematosus Flare Triggered by COVID-19 Infection: A Case-Based Review." Bali Medical Journal 11, no. 3 (October 27, 2022): 1448–55. http://dx.doi.org/10.15562/bmj.v11i3.3719.
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Introduction: The coronavirus disease 19 (COVID-19) and autoimmune disease has been associated bidirectionally, several reports has shown COVID-19 precipitate an exacerbation of an autoimmune disease that has already stable. Recognize and treatment of flare in SLE condition with COVID-19 is challenging in this pandemic era. This review aims to report a case SLE patient who experienced severe flares after being infected with COVID-19 and review of the literature. Case report: We presented a 27-year-old female with a history of Systemic Lupus Erythematosus (SLE) who experienced severe flares after being infected with COVID-19 and a review. Methods and Results: A total of 72 potentially relevant citations were identified. After removing the duplicate citations, the title, and abstracts of 61 articles were evaluated and 11 relevant articles were reviewed in detail. A total of 72 potentially relevant citations were identified. After removing the duplicate citations, the title, and abstracts of 61 articles were evaluated and 11 relevant articles were included. Conclusion: The COVID-19 pandemic is a devastating situation all over the world. SLE patient has already been in a susceptible condition as the disease progressed and continued having immunosuppressant therapy also one of the risk factors. A Flare condition can be happened during the COVID-19 Infection or after the infection is resolved. In SLE patient having COVI-19, close monitoring, high adherence to the therapy, and the health protocol are needed.
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Naoki, Isobe. "Longterm X-ray observations of blazars with MAXI." Proceedings of the International Astronomical Union 6, S275 (September 2010): 186–87. http://dx.doi.org/10.1017/s1743921310015978.
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AbstractLongterm continuous X-ray observations of blazars with MAXI are reported. Thanks to its unprecedentedly high sensitivity as an all sky X-ray monitor, MAXI is an ideal observatory to investigate variability of blazars, which should give a clue to particle acceleration in their jet, as well as the jet dynamics. Actually, since it started its operation in the summer of 2009, MAXI has successfully alerted two strong X-ray flares from the BL Lac object Mrk 421. Especially, in one of these flares, the X-ray flux of the object was found to become the highest in history. By closely examining the MAXI data, the physical quantities associated with the flares were estimated. These results clearly demonstrate the potential of MAXI for the variability of blazars.
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Van der Horst-Bruinsma, I., R. Van Bentum, F. Verbraak, T. Rath, J. Rosenbaum, M. Misterska-Skora, B. Hoepken, et al. "THU0379 REDUCTION OF ANTERIOR UVEITIS FLARES IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS FOLLOWING ONE YEAR OF TREATMENT WITH CERTOLIZUMAB PEGOL: 48-WEEK INTERIM RESULTS FROM A 96-WEEK OPEN-LABEL STUDY." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 423.1–423. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3747.
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Background:Acute anterior uveitis (AAU), inflammation of the anterior uveal tract, is reported in up to 40% of patients (pts) with axial spondyloarthritis (axSpA).1AAU is associated with significant clinical burden; symptoms include blurred vision, photophobia and pain.2Previous studies have shown that TNF inhibitors (TNFi) can reduce AAU flare incidence in pts with radiographic axSpA,3-5but few have focused on pts across the full axSpA spectrum.Objectives:To analyse the impact of certolizumab pegol (CZP) treatment on AAU in pts with active radiographic and non-radiographic axSpA and a recent history of AAU.Methods:C-VIEW (NCT03020992) is an ongoing multicentre, open-label, phase 4 study. Pts had active axSpA according to the ASAS classification, a history of recurrent AAU (≥2 AAU flares in total and ≥1 AAU flare in the year prior to study entry), were HLA-B27 positive, and were eligible for TNFi treatment (previous failure of ≥2 NSAIDs, biologic naïve or had failed ≤1 TNFi). Pts received CZP 400 mg at Weeks (Wks) 0/2/4, then 200 mg every two wks (Q2W) to Wk 96. The primary variable was incidence of AAU flares compared to historic rates. A pre-specified interim analysis compared AAU incidence in the 48 wks prior to CZP treatment with the 48 wks of treatment, using Poisson regression adjusted for possible within-pt correlations, with period (pre- and post-baseline) and axSpA disease duration as covariates. Incidence rates (IR) were calculated based on the number of cases/pts at risk over 48 wks. Observed data are reported.Results:Of 115 enrolled pts, 89 initiated CZP treatment; 85 completed Wk 48. Baseline characteristics are shown in the Table. The 48-wk interim analysis revealed significantly fewer AAU flares/pt during CZP treatment vs before treatment (Figure; Poisson-adjusted IR: 0.2 vs 1.5, p<0.001). The number of pts experiencing 1 and ≥2 AAU flares (64.0% and 31.5% respectively) substantially reduced during CZP treatment (12.4% and 2.2%). After 48 wks CZP treatment, disease activity improved substantially (mean ± SD Ankylosing Spondylitis Disease Activity Score [ASDAS]: 2.0 ± 0.9; Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]: 3.3 ± 2.1), with 31.4% pts achieving ASAS partial remission and 29.1% ASDAS major improvement. No new safety signals were identified.Table.Baseline characteristicsCZP 200 mg Q2W (N=89)Age (years), mean ± SD46.5 ± 11.2Male, n (%)56 (62.9)Racial group, n (%) Caucasian87 (97.8) Other2 (2.2)Diagnosis, n (%) Radiographic axSpA76 (85.4) Non-radiographic axSpA13 (14.6)Duration of axSpA (years), mean ± SD8.6 ± 8.4Time since onset of first uveitis flare (years), mean ± SD9.9 ± 9.0ASDAS, mean ± SD3.5 ± 0.9BASDAI, mean ± SD6.5 ± 1.5Conclusion:In this open-label study, AAU flare rate significantly reduced in axSpA pts with a history of recurrent AAU during the first 48 wks of CZP. Pts also experienced substantial improvements in axSpA disease activity.References:[1]Martin TM. Curr Opin Rheumatol 2002;14:337–41[2]Bacchiega ABS. Rheumatology (Oxford) 2017;56:2060–7[3]van der Heijde D. Rheumatology (Oxford) 2017;56:1498–509[4]van Bentum RE. J Rheumatol 2019;46:153–9[5]van Denderen JC. J Rheumatol 2014;41:1843–8Acknowledgments:This study was funded by UCB Pharma. Editorial services were provided by Costello Medical.Disclosure of Interests:Irene van der Horst-Bruinsma Grant/research support from: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Consultant of: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Rianne van Bentum: None declared, Frank Verbraak Grant/research support from: Bayer, Novartis, IDxDR, UCB Pharma, Consultant of: Bayer, Novartis, IDxDR, UCB Pharma, Thomas Rath Grant/research support from: AbbVie, Bristol-Myers Squibb, Chugai, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB Pharma, James Rosenbaum Consultant of: AbbVie, Corvus, Eyevensys, Gilead, Novartis, Janssen, Roche, UCB Pharma; royalties from UpToDate, Maria Misterska-Skora: None declared, Bengt Hoepken Employee of: UCB Pharma, Oscar Irvin-Sellers Employee of: UCB Pharma, Brenda VanLunen Employee of: UCB Pharma, Lars Bauer Employee of: UCB Pharma, Martin Rudwaleit Consultant of: AbbVie, BMS, Celgene, Janssen, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB Pharma
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Park, Jihye, Hyuk Yoon, Cheol Min Shin, Young Soo Park, Nayoung Kim, and Dong Ho Lee. "Clinical factors to predict flare-up in patients with inflammatory bowel disease during international air travel: A prospective study." PLOS ONE 17, no. 1 (January 21, 2022): e0262571. http://dx.doi.org/10.1371/journal.pone.0262571.
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Backgrounds and aims Inflammatory bowel disease (IBD) patients often experience disease flare-ups during international air travel. We aimed to identify risk factors associated with IBD flare-up during international air travel. Methods Patients with scheduled international air travel were enrolled in the study from the Seoul National University Bundang Hospital IBD clinic. Flight information and clinical data were collected via questionnaires and personal interviews, and risk factors associated with IBD flares were determined. Results Between May 2018 and February 2020, 94 patients were prospectively enrolled in the study (mean age, 33.0 years; males, 53.2%; mean disease duration, 56.7 months), including 56 (59.6%) with ulcerative colitis and 38 (40.4%) with Crohn’s disease. Of the 94 patients enrolled, 15 (16.0%) experienced an IBD flare-up and 79 (84.0%) remained in remission throughout travel. Logistic regression analysis revealed that high fecal calprotectin levels before travel (odds ratio [OR]: 1.001, 95% confidence interval [CI]: 1.000–1.001, p = 0.016), the presence of a comorbidity (OR: 6.334, 95% CI: 1.129–35.526, p = 0.036), and history of emergency room visit (OR: 5.283, 95% CI: 1.085–25.724, p = 0.039) were positively associated with disease flare-up. The previous and current use of immunomodulators and biologics, time of flight, altitude, number countries visited, travel duration, objective of visit, and previous medical consultations were not associated with disease flare-up. Conclusions Elevated fecal calprotectin levels, history of emergency room visits, and the presence of a comorbidity predicted IBD flare-up during international air travel.
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Nishizuka, Naoto, Komei Sugiura, Yuki Kubo, Mitsue Den, Shin-ichi Watari, and Mamoru Ishii. "Solar Flare Prediction Using Machine Learning with Multiwavelength Observations." Proceedings of the International Astronomical Union 13, S335 (July 2017): 310–13. http://dx.doi.org/10.1017/s1743921317007293.
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AbstractWe developed a flare prediction model based on the supervised machine learning of solar observation data for 2010-2015. We used vector magnetograms, lower chromospheric brightening, and soft-X-ray data taken by Solar Dynamics Observatory and Geostationary Operational Environmental Satellite. We detected active regions and extracted 60 solar features such as magnetic neutral lines, current helicity, chromospheric brightening, and flare history. We fully shuffled the database and randomly divided it into two for training and testing. To predict the maximum size of flares occurring in the following 24 hours, we used three machine-learning algorithms independently: the support vector machine, the k nearest neighbors (kNN), and the extremely randomized trees. We achieved a skill score (TSS) of greater than 0.9 for kNN. Furthermore, we compared the prediction results in a more operational setting by shuffling and dividing the database with a week unit. It was found that the prediction score depends on the way the database is prepared.
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Attia, D. H., A. Mokbel, H. M. Haggag, and N. Naeem. "Pregnancy outcome in women with active and inactive lupus nephritis: A prospective cohort study." Lupus 28, no. 7 (May 13, 2019): 806–17. http://dx.doi.org/10.1177/0961203319846650.
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Several studies have emphasized poor pregnancy outcomes associated with active lupus nephritis at the onset of conception. A few controversial studies have compared pregnancy outcome in patients with inactive lupus nephritis at conception and those without a history of lupus nephritis. This study aimed to find out if quiescent lupus nephritis at the onset of conception carries an increased risk of pregnancy complications compared to pregnancies without a history of lupus nephritis. This is a prospective cohort study carried out at the Rheumatology/Obstetrics Conjoint Clinic of Kasr Al-Ainy Hospital between January 2006 and December 2017. A total of 119 pregnancies were included: 72 pregnancies in group I (with a history of lupus nephritis) and 47 pregnancies in group II (non-renal systemic lupus erythematosus). They were subjected to full history taking, monthly clinical examination and laboratory investigations. In total, 16 (22.2%) renal pregnancies had renal flares at the onset of conception. Maternal complications, specifically renal flares, were reported in 36 (50%) pregnancies in group I and 13 (27.7) pregnancies in group II, with a significant difference ( p = 0.015). No significant differences were found concerning the frequency of pregnancy-related maternal and fetal complications between the two groups. When data were re-analyzed after excluding patients experiencing renal flares during the 6 months preceding pregnancy, there were no significant differences regarding the frequency of maternal and fetal complications between renal and non-renal pregnancies. In conclusion, lupus nephritis, per se, is not a risk factor for poor pregnancy outcome; rather, it is the lupus nephritis activity at the onset of pregnancy.
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Fasano, S., L. Pierro, M. A. Coscia, L. Bucci, S. Scriffignano, A. Riccardi, and F. Ciccia. "SAT0162 WITHDRAWAL OF LOW-DOSE STEROIDS IN SYSTEMIC LUPUS ERYTHEMATOSUS IN REMISSION: PREDICTORS OF FLARES AND DIFFERENCE IN OUTCOMES IN SEROLOGICALLY ACTIVE CLINICALLY QUIESCENT PATIENTS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1021.1–1022. http://dx.doi.org/10.1136/annrheumdis-2020-eular.1691.
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Background:According to the recent recommendations for Systemic Lupus Erythematosus (SLE), a progressive tapering until withdrawal of glucocorticoids (GC) is considered one of the main goals of SLE management (1). However, which patient may be a candidate for safe GC withdrawal has not been determined yet and a proportion of patients are kept on long-term low-dose prednisone despite clinical remission.Objectives:to evaluate the rate of low-dose GC withdrawal in SLE patients in remission and to identify predictors of flares.Methods:Eligible patients were SLE patients according to the ACR criteria (2) who were in prolonged clinical remission defined by a cSLEDAI=0 for at least 2 years and on a stable SLE treatment (immunosuppressive drugs and/or hydroxychloroquine (HCQ) and daily 5 mg prednisone). A SACQ period was defined as at least 1-year period with persistent serologic activity without clinical manifestations. Flares were defined by SELENA-SLEDAI Flare Index (3). Damage was assessed by SLICC damage index (SDI). Data were compared by the unpaired student’s t test or chi-squared test as appropriate. Predictors of flares after GC withdrawal were analyzed by Cox regression.Results:Out of 246 SLE patients registered in the Naples Lupus Clinic database, 132 eligible patients were identified. Among them, we selected 57 (43%) patients in whom a GC withdrawal was attempted. 75 (57%) patients were in the prednisone maintenance group.There were no significant differences between the two treatment groups (table 1). The proportion of patients experiencing a flare was not significantly lower in the maintenance group than in the withdrawal group (15/75 vs 16/57; p=0.28). Moreover, the proportion of patients who had an increase in the SDI at the end of follow up was similar between the two groups (14/75 vs 8/57; p=0.48). However, among the withdrawal group, the rate of flares was significantly higher in SACQ patients (10/22 vs 6/35; p=0.02), while the majority of serologically inactive patients (82%) successfully stopped GCs without subsequent flares. At Cox regression analysis (Table 2), duration of HCQ therapy and >4 year remission at withdrawal were protective factors, while a SACQ disease and history of lupus nephritis (LN) increased the risk of disease flare.Table 1.Baseline characteristics of 132 patients at study entryCharacteristicsWithdrawal group (n=57)Maintenance group (n=75)p-valueFemale, no. (%)54 (94)70 (93)0.73Age, years26.7±10.128.5±11.70.37Disease duration, years8.5±2.99.1±12.90.73History of lupus nephritis, no. (%)13(22)22(29)SDI score0.40±0.70.57±0.80.26Immunosuppressive drugs, no. (%)31 (54)33(44)0.16HCQ, no. (%)52 (91)66 (88)0.06Low C3, no. (%)28 (49)41(54)0.52Increased dsDNA Ab, no. (%)11 (19)19 (25)0.41Table 2.Factors predicting lupus flares during follow-up at Cox regression analysisVariablesHR95% CIp valueSACQ2.991.08 – 8.250.03Age0.970.93 – 1.020.29Disease duration0.990.94 – 1.040.84History of LN3.381.22-9.330.01SDI score1.130.63 – 2.010.66Immunosuppressive drugs2.390.86 – 6.620.09HCQ, ever2.920.43 – 35.20.95Duration of HCQ0.840.72 – 0.980.035years remission0.120.04 – 0.390.0003Conclusion:GC withdrawal is an achievable target in SLE and may be attempted in patients in complete remission. In SACQ patients, maintenance of 5mg prednisone is superior to its withdrawal in order to prevent flares. Long-term HCQ therapy and prolonged remission can significantly reduce the risk of disease relapse after GC withdrawal.References:[1]Fanouriakis A, et al. Ann Rheum Dis. 2019;78(6):736–45.[2]Tan EM, et al. Arthritis Rheum. 1982;25(11):1271–7.[3]Petri M, et al. Lupus. 1999;8(8):685–91.Disclosure of Interests:Serena Fasano: None declared, Luciana Pierro: None declared, Melania Alessia Coscia: None declared, laura Bucci: None declared, silvia scriffignano: None declared, Antonella Riccardi: None declared, francesco ciccia Grant/research support from: pfizer, novartis, roche, Consultant of: pfizer, novartis, lilly, abbvie, Speakers bureau: pfizer, novartis, lilly, abbvie
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Jeong, S., and I. Tan. "THU0444 INCIDENCE OF ACUTE GOUT FLARE IN PATIENTS INITIATED ON INTRAVENOUS BUMETANIDE FOR ACUTE CONGESTIVE HEART FAILURE EXACERBATION." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 459.1–459. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3309.
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Background:Heart failure is a prevalent and ever-increasing public health concern associated with significant morbidity, mortality, and financial burden. Therefore, identifying any factors that worsen the outcome of patients with heart failure is crucial to the nation’s medical and financial health.One of the major comorbidities associated with heart failure is gout. Gout is a clinical syndrome of joint inflammation resulting from the deposition of monosodium urate crystals, causing painful and swollen arthritis. Acute gout flares in the context of acute heart failure (AHF) exacerbations result in longer lengths of stay and form an independent risk factor for increased readmissions or death1. The use of loop diuretics in treating patients with AHF exacerbations may cause new onset of gouty arthritis or recurrence of established gout by increasing serum uric acid levels. Uric acid alone is implicated as an independent predictor of mortality in patients with chronic heart failure2.Objectives:In this study, we aim to better characterize the incidence of acute gout flares in patients being treated with intravenous bumetanide for AHF exacerbations.Methods:This single-center retrospective cohort study included adult patients within an urban tertiary-care center hospital between 5 August 2016 and 30 June 2018. Chart review was performed to identify 130 patients who were hospitalized for AHF exacerbations, received intravenous (IV) bumetanide, and developed an acute gout flare for a total of 176 cases (Figure 1).Figure 1Patient SelectionPatients were identified as having an acute gout flare if the primary treating physician(s) documented a clinical picture congruous with acute gout (e.g., onset of a painful, swollen, or erythematous joint) and administered conventional treatment for acute gout including non-steroidal anti-inflammatory agents (NSAIDs), steroids, colchicine, urate-lowering therapies, and/or intra-articular joint injection with symptomatic improvement.Results:The annualized incidence of acute gout while receiving IV bumetanide for a heart failure exacerbation is 7.17%.There was no statistical difference in age, gender, race, or BMI among patients who developed acute gout compared with those who did not develop acute gout while receiving IV bumetanide.An acute gout flare that occurred during treatment of AHF with IV bumetanide increased hospital length of stay (LOS) by 3 days (mean LOS 15.2 days in those who had acute gout, mean LOS 11.6 days in those who did not [p-value 0.277]).Patients who received allopurinol during their hospitalization for AHF exacerbation had lower 30-day readmission rates for any cause (p-value 0.017, Table 4). There was no reduction in the 30-day readmission rate in patients who received colchicine without allopurinol during their hospitalization for AHF exacerbation. Those with a history of gout had higher readmission rates than those without a history of gout (p-value 0.007).Conclusion:Gout is known to be a weighty contributor to patients’ morbidity and mortality in heart failure, and the occurrence of acute gout flare in AHF exacerbations may be precipitated by the use of loop diuretics. We show that the use of IV bumetanide in patients hospitalized for AHF exacerbations is associated with a 7.17% yearly incidence of acute gout flares. Furthermore, patients with a history of gout were found to have higher readmission rates, and those who received allopurinol during their hospitalization had lower readmission rates.References:[1]Thanassoulis G, Brophy JM, Richard H, Pilote L. Gout, Allopurinol Use, and Heart Failure Outcomes.Arch Intern Med. 2019;170(15):1358-1364.[2]Struthers AD, Donnan PT, Lindsay P, Mcnaughton D, Broomhall J, Macdonald TM. Effect of allopurinol on mortality and hospitalisations in chronic heart failure: a retrospective cohort study.Heart. 2002;87(3):229-234.Disclosure of Interests: :None declared
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Barnadas, Maria A., and Montserrat M. Díaz Encarnación. "Refractory Cutaneous IgA Vasculitis Treated with Omega-3 Fatty Acids." Case Reports in Dermatology 8, no. 3 (November 29, 2016): 333–40. http://dx.doi.org/10.1159/000452320.
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Background: Omega-3 fatty acids (O3FA) have been used to treat IgA nephropathy (IgAN) but not cutaneous IgA vasculitis (IgAV). Case Report: A 47-year-old female was referred for cutaneous vasculitis. She had a 24-year history of flares of palpable purpura, arthralgia associated with hematuria, and proteinuria. We diagnosed cutaneous IgAV associated with IgAN. We administered prednisone at doses ranging from 10 to 45 mg/day to control the flares. To reduce prednisone exposure, different therapeutic strategies (colchicine, diphenhydramine, hydroxyzine, azathioprine, benzathine penicillin, and mycophenolate mofetil) were applied without success. After 11 years, therapy with O3FA capsules containing 460 mg eicosapentaenoic acid and 380 mg of docosahexaenoic acid t.i.d. was introduced, allowing the prednisone to be stopped 2 years later. When the dose of O3FA was decreased to 1 capsule on alternate days, the cutaneous flares reappeared, but they were again controlled when the patient took 1 O3FA capsule daily. Conclusions: O3FA can be useful to control cutaneous IgAV.
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Touma, Z., B. Hoskin, C. Atkinson, D. Bell, O. Massey, J. H. Lofland, P. Berry, C. Karyekar, and K. Costenbader. "SAT0213 IMPACT OF FLARES ON HEALTHCARE RESOURCE USAGE AND PROS IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1049.2–1050. http://dx.doi.org/10.1136/annrheumdis-2020-eular.6010.
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Background:The effect of flares on healthcare resource usage and patient-reported outcome scores in SLE patients is not well quantified.Objectives:To understand how flares impact healthcare resource utilization (HCRU) and patient-reported outcomes amongst an international real-world dataset of SLE patients.Methods:The Adelphi Real World 2015 Lupus Disease Specific Programme (DSP) is a cross-sectional study of 263 rheumatologists in the US and EU5. Rheumatologists were asked to complete patient record forms (PRFs) for the next 5 prospectively consulting SLE patients; the same patients were asked to complete patient self-completion (PSC) forms describing how SLE affected them. PRFs collected data pertaining to the patient’s diagnosis, disease history, current clinical outcomes, treatment and management history. PSCs collected similar data and included patient-reported outcome measures (PROs) to assess humanistic burden. Propensity score matching was used to assess differences in HCRU and health status between SLE patients who had flared (physician defined) in the last 12 months and those who had not. Matching variables were patient ethnicity, time since diagnosis, and severity at diagnosis. Data were extracted from 1278 PRFs, and 591 PSCs. Propensity score matching was carried out on two matched groups of 408 patients.Results:Demographic data are reported in Table 1. Propensity score matching showed patients who flared in the last 12 months experienced significantly greater hospitalizations, visits to the ER, and total HCP consults in the last 12 months. Significantly greater drug burden lower physician and patient satisfaction, lower EQ-5D score (worse health status), lower FACIT Fatigue score (greater fatigue), and greater overall work impairment (Table 2) were also observed.Table 1.Demographic dataVariableFlared in last 12 monthsNot flared in the last 12 monthsMean age (years)41.842.4% Female86.087.0% White/Caucasian66.276.3Mean years diagnosed5.95.4Table 2.Propensity score matching resultsOutcome variableFlared meanNot flared meanCoefficient95% CIp-valueHospitalisations in last 12 months24.267.630.17[0.12 – 0.21]<0.001Emergency department visits in last 12 months20.834.190.17[0.12 – 0.21]<0.001Number of tests in last 12 months46.4938.907.59[3.74 – 11.44]<0.001Number of current medications2.762.190.57[0.43 – 0.72]<0.001Physician satisfied64.4686.63-0.22[-0.28 – -0.17]<0.001Patient satisfied69.2985.09-0.16[-0.24 – -0.08]<0.001EQ-5D-3L0.720.83-0.11[-0.15 – -0.07]<0.001FACIT Fatigue30.0636.48-6.42[-8.5 – -4.3]<0.001WPAI overall percentage work impairment42.7430.2312.5[7.51 – 17.50]<0.001Conclusion:The analysis of international real-world data confirmed that SLE patients who flared in the last year represent a greater burden on healthcare resource and demonstrate significantly worse health status, greater fatigue, lower patient and physician satisfaction and greater overall work impairment compared with non-flaring patients. There is a need for more effective treatments in this patient population to reduce patient and healthcare burden.Study funded by Johnson and Johnson.Disclosure of Interests:Zahi Touma Consultant of: Consultant for Janssen, Ben Hoskin Consultant of: Consultant for Janssen, Christian Atkinson Consultant of: Consultant for Janssen, David Bell Consultant of: Janssen, Olivia Massey Consultant of: Janssen, Jennifer H. Lofland Employee of: Janssen, Pamela Berry Employee of: Janssen, Chetan Karyekar Shareholder of: Johnson & Johnson, Consultant of: Janssen, Employee of: Janssen Global Services, LLC. Previously, Novartis, Bristol-Myers Squibb, and Abbott Labs., Karen Costenbader Grant/research support from: Merck, Consultant of: Astra-Zeneca
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Rutter-Locher, Zoe, Bruce Kirkham, and David P. D'Cruz. "ANCA-associated vasculitis can present with episodic attacks of joint pain consistent with palindromic rheumatism." BMJ Case Reports 14, no. 4 (April 2021): e240913. http://dx.doi.org/10.1136/bcr-2020-240913.
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A 64-year-old man with a 2-year history of palindromic rheumatoid arthritis, presented with recurrent flares of arthritis, weight loss, new onset Raynaud’s phenomenon and one previous episode of small-volume haemoptysis. Investigations, including renal biopsy, revealed antineutrophil cytoplasmic antibodies-mediated vasculitis. This case highlights the need to consider vasculitis in patients in whom there is an atypical history of arthritis.
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Pundole, X., O. Lambotte, M. Ramos-Casals, and M. Suarez-Almazor. "SAT0536 IMMUNE CHECKPOINT INHIBITOR THERAPY IN PATIENTS WITH PREEXISTING SARCOIDOSIS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1225.2–1226. http://dx.doi.org/10.1136/annrheumdis-2020-eular.5839.
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Background:Immune checkpoint inhibitors (ICI) have changed the treatment landscape of many cancer types, but are also associated with development of immune-related adverse events, includingde novosarcoid like reactions. However, little is known about the use of ICI therapy in patients with preexisting sarcoidosis as patients with preexisting autoimmune diseases have been systematically excluded from clinical trials of ICI therapy due to concerns of heightened toxicities. Emerging research suggests that ICI therapy can be considered in some patients with autoimmune diseases.1Objectives:To determine the risk of sarcoidosis exacerbation or flare in patients with preexisting sarcoidosis receiving ICI therapy.Methods:We conducted a retrospective cohort study of patients seen at The University of Texas MD Anderson Cancer Center between 2016-2019. Patients were included in the cohort if they received one of 7 ICI therapies (ipilimumab, nivolumab, pembrolizumab, durvalumab, avelumab, atezolizumab, or cemiplimab) and had an International Classification of Disease version 10 code of sarcoidosis (D86.*), prior to the ICI initiation, with diagnosis confirmed in medical record by treating physicians. A sarcoidosis diagnosis was considered “possible” if the medical record documented a history of sarcoidosis, “probable” if a history of biopsy proven sarcoidosis was mentioned, and “definitive” if histological evidence was available. Frequency of flares and outcomes of patients after receiving ICI were collected.Results:During the study timeframe a total of 32 patients with preexisting sarcoidosis received ICI therapy. Nine patients (28%) had a definitive diagnosis of sarcoidosis, 12 (37%) had a probable diagnosis and 11 (35%) had a possible diagnosis of sarcoidosis. The mean time between diagnosis of sarcoidosis and initiation of ICI therapy was 13 years (range: <1 to 51 years). Twenty-seven patients (84%) received monotherapy and five patients (16%) received combination or sequential ICI therapy. Of the 32 patients, one patient with a 20-year remote history of sarcoidosis, never treated, developed a clinically symptomatic exacerbation of sarcoidosis one month after the initial dose of atezolizumab, with increased hilar nodules on imaging, skin nodules, arthritis and uveitis. Biopsy of a lymph node showed non-necrotizing granulomas, and biopsy of the skin panniculitis. The patient also developed colitis thought to be an immune-related adverse event. Atezolizumab was discontinued after 3 doses. Patient was treated with prednisone and azathioprine.Conclusion:Patients with a remote history of stable sarcoidosis at the time of ICI therapy infrequently develop a flare of their sarcoidosis. The risk of flares in patients with active sarcoidosis requiring immunosuppression at the time of ICI initiation is unknown.References:[1]Kennedy LC, Bhatia S, Thompson JA, Grivas P. Preexisting autoimmune disease: implications for immune checkpoint inhibitor therapy in solid tumors. Journal of the National Comprehensive Cancer Network. 2019 Jun 1;17(6):750-7.Acknowledgments:NoneDisclosure of Interests:Xerxes Pundole: None declared, Olivier Lambotte Consultant of: BMS France, MSD, Astra Zeneca, Incyte, Manuel Ramos-Casals: None declared, Maria Suarez-Almazor: None declared
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Van der Horst-Bruinsma, I., R. Van Bentum, F. Verbraak, T. Rath, B. Hoepken, O. Irvin-Sellers, T. Kumke, L. Bauer, and M. Rudwaleit. "POS0897 REDUCTION OF ANTERIOR UVEITIS FLARES IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS DURING CERTOLIZUMAB PEGOL TREATMENT: 96-WEEK RESULTS FROM THE C-VIEW STUDY." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 705–6. http://dx.doi.org/10.1136/annrheumdis-2021-eular.115.
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Background:Acute anterior uveitis (AAU) is the most common extra-articular manifestation in axial spondyloarthritis (axSpA), affecting up to 40% of patients and causing significant burden.1 Previous studies have shown that tumour necrosis factor inhibitors (TNFi) can reduce the incidence of AAU flares in patients with radiographic axSpA (ankylosing spondylitis),2-4 but few have focused on patients across the full axSpA spectrum.1Objectives:To report 2-year outcomes from the phase 4, open-label C-VIEW study (NCT03020992), which investigated the impact of certolizumab pegol (CZP) treatment on AAU in patients with active axSpA and a recent history of AAU.Methods:C-VIEW prospectively investigated patients with active axSpA who were HLA-B27 positive and had recurrent AAU, with a history of ≥1 AAU flare in the year prior to baseline (additional study criteria and study design are described elsewhere5). The primary efficacy variable was the incidence of AAU flares during 96 weeks of CZP treatment versus the 2-year pre-baseline period. AAU incidence was evaluated using Poisson regression adjusted for duration of time in each period, with period (pre- and post-baseline) and axSpA disease duration as covariates. Secondary efficacy variables were Assessment of SpondyloArthritis international Society 20%/40% (ASAS20/40) response rates, as well as mean Ankylosing Spondylitis Disease Activity Score (ASDAS) and mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) to Week 96.Results:Of 115 enrolled patients, 89 initiated CZP treatment; 83 completed Week 96. The primary analysis revealed an 82% reduction in the incidence of AAU flares during CZP treatment compared with pre-baseline (Figure 1A; rate ratio [95% CI]: 0.18 [0.12, 0.28], p<0.001). The percentage of patients experiencing ≥1 and ≥2 AAU flares reduced from 100% and 59.6% pre-baseline to 20.2% and 11.2% during treatment (Figure 1B). There were also improvements in axSpA disease activity (Table 1): by Week 96, 75.6% and 58.5% of patients had achieved ASAS20 and ASAS40 responses, respectively. ASDAS and BASDAI also improved substantially over the 96-week treatment period. No new safety signal was identified, compared to previous reports.5Conclusion:These data support the use of CZP for the treatment of patients with axSpA and a history of recurrent AAU. During 96 weeks’ CZP treatment, there was a significant reduction of 82% in the AAU flare rate compared to pre-baseline. There were also substantial improvements in patients’ axSpA disease activity.References:[1]Martin TM. Curr Opin Rheumatol 2002;14:337–41.[2]van der Heijde D. Rheumatology (Oxford) 2017;56:1498–509.[3]van Bentum RE. J Rheumatol 2019;46:153–9.[4]van Denderen JC. J Rheumatol 2014;41:1843–8.[5]van der Horst-Bruinsma I. RMD Open 2020;6:e001161.Table 1.Changes in axSpA disease activity to Week 96Disease activity measureWeek 0(n=89)Week 48(n=86)Week 96(n=82)ASAS responder rates, n (%)ASAS20N/A65 (75.6)62 (75.6)ASAS40N/A46 (53.5)48 (58.5)ASDAS, mean (SD)3.5 (1.0)2.0 (0.9)1.9 (1.0)BASDAI, mean (SD)6.5 (1.5)3.3 (2.1)3.0 (2.1)Observed data are shown. Patients received CZP 400 mg at Weeks 0/2/4, then 200 mg Q2W through 96 weeks. ASAS20/40: Assessment of SpondyloArthritis international Society 20%/40%; ASDAS: Ankylosing Spondylitis Disease Activity Score; axSpA: axial spondyloarthritis; BASDAI: Bath Ankylosing Spondylitis Disease Activity Index; CZP: certolizumab pegol; Q2W: every 2 weeks; SD: standard deviation.Acknowledgements:This study was funded by UCB Pharma. Editorial services were provided by Costello Medical.Disclosure of Interests:Irene van der Horst-Bruinsma Speakers bureau: AbbVie, BMS, MSD, Pfizer, UCB Pharma, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, UCB Pharma, Grant/research support from: AbbVie, MSD, Pfizer, Rianne van Bentum: None declared, Frank Verbraak Speakers bureau: Bayer, IDxDR, Novartis, UMC, Consultant of: Bayer, Novartis, Grant/research support from: Bayer, Thomas Rath Speakers bureau: AbbVie, BMS, Chugai, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB Pharma, Consultant of: AbbVie, BMS, Chugai, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB Pharma, Bengt Hoepken Shareholder of: UBC Pharma, Employee of: UCB Pharma, Oscar Irvin-Sellers Shareholder of: UCB Pharma, Employee of: UCB Pharma, Thomas Kumke Shareholder of: UCB Pharma, Employee of: UCB Pharma, Lars Bauer Shareholder of: UCB Pharma, Employee of: UCB Pharma, Martin Rudwaleit Speakers bureau: AbbVie, Eli Lilly, Novartis, UCB Pharma, Consultant of: AbbVie, Celgene, Eli Lilly, Janssen, Novartis, UCB Pharma
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Björk, Ulf Jonas. "Race War Flares Up: Chicago’s Swedish Press, the Great Migration, and the 1919 Riots." American Studies in Scandinavia 51, no. 1 (March 2, 2019): 3–22. http://dx.doi.org/10.22439/asca.v51i1.5788.
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This study of the three large Swedish-language weeklies in Chicago examines how they covered the city’s African-American community during the latter half of the 1910s, a time when blacks migrated to the North in huge numbers. In Chicago, the result was that the African-American population almost tripled between 1910 and 1920. Little of that was visible in the columns of the weeklies, however, with only a handful of items telling readers that blacks were arriving in record numbers. What news there was about African-Americans, moreover, tended to portray them as criminals. Consequently, the riots that shook Chicago in late July 1919 seemed to take the editors of the weeklies by surprise. A major explanation for the Swedish weeklies’ coverage was that they relied almost exclusively on the city’s English-language dailies for news that did not concern their own ethnic group and thus mirrored the negative way the dailies portrayed African-Americans.
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Liu, Chieh, Yi-Fen Shih, and Chun-Jen Liu. "Immunopathogenesis of Acute Flare of Chronic Hepatitis B: With Emphasis on the Role of Cytokines and Chemokines." International Journal of Molecular Sciences 23, no. 3 (January 26, 2022): 1407. http://dx.doi.org/10.3390/ijms23031407.
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Acute flares (AFs) of chronic hepatitis B usually occur during the immune-active stage (both immune clearance phase and immune reactivation phase), as the host immune system tries to control the virus. Successful host immune control over viral replication is usually presented as hepatitis B surface antigen seroclearance; however, 20–30% individuals with chronic hepatitis B may encounter repeated AFs with accumulative liver injuries, finally leading to the development of cirrhosis and hepatocellular carcinoma. AF can also develop in other clinical situations such as organ transplantation, cancer chemotherapy, and under treatment for chronic hepatitis B or treatment for chronic hepatitis C in patients with co-infected hepatitis B/hepatitis C. Understanding the natural history and immunopathogenesis of AF would help develop effective strategies to eradicate the virus and improve the clinical outcomes of patients with chronic hepatitis B. In this review article, the immunopathogenesis of AF, and the involvement of innate and adaptive immune responses on the development of hepatitis B flare will be briefly reviewed, with the emphasis on the role of cytokines and chemokines.
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Marsman, D., T. Bolhuis, N. Den Broeder, F. Van den Hoogen, A. Den Broeder, and A. Van der Maas. "FRI0209 EFFECTS OF ADD-ON METHOTREXATE IN POLYMYALGIA RHEUMATICA PATIENTS: A RETROSPECTIVE STUDY." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 688.2–688. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2986.
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Background:Guidelines on polymyalgia rheumatica (PMR) recommend early introduction of methotrexate (MTX), especially in patients with worse prognosis such as flare or glucocorticoid (GC)-related adverse events (AE).1GC-AE are reported in up to 65% of PMR patients,2and 50% of secondary care patients are unable to discontinue GCs, emphasizing the need for GC-sparing agents.3However, evidence regarding MTX efficacy in PMR remains limited.2Objectives:To assess the efficacy of add-on MTX in preventing subsequent flares and GC- sparing in PMR patients.Methods:In a retrospective cohort of newly diagnosed PMR patients visiting our hospital from April 2008 - January 2018, patients starting methotrexate (index event) were compared to first-time flaring PMR patients in whom MTX was not started (control group). Concomitant inflammatory rheumatic diseases were excluded. Data on patient, disease and treatment characteristics were compared. Main outcomes were difference in number of subsequent flares per year between groups (multivariable Poisson regression) and mean GC-use (total GC-dose/total follow-up; multivariable linear regression). In the MTX group only, also incidence rate ratio of flare before vs. after starting MTX was assessed.Results:Of 454 PMR patients, 262 were selected; 42 receiving MTX and 220 in the control group. Reasons for prescribing MTX were GC ineffectiveness and/or GC-related AE and MTX starting dose was 10, 15 and 25 mg/week in 11 %, 82% and 2% respectively. Adjusted for covariates, mean GC-use was 1.21 higher in the MTX group compared to the control group (p = 0.155). The yearly incidence rate of flares in the MTX group did not differ from the control group: incidence rate ratio (IRR) 0.93, (95% CI 0.53-1.63). The yearly flare rate was 1.19 before and 0.42 after MTX initiation, resulting in an IRR of 0.36 (95% CI 0.24-0.53).Conclusion:MTX is infrequently prescribed in daily clinical practice, despite guideline recommendations. No difference in GC use or flare incidence was seen between MTX treated patients and controls, although within MTX treated patients, flare rates were lower after MTX start. Confounding by indication may explain the lack of difference in the outcomes between groups. The optimal timing and dosage of MTX in PMR remains unclear, justifying a clinical trial.References:[1]Dejaco C.e.al.2015. Recommendations. management.of.polymyalgia.rheumatica:a.European.League.Against Rheumatism/American.College.of.Rheumatology.collaborative.initiative.ARD.2015;74:1799-1807.[2]L.Couvaras.etal.Prevalence.of.long-term.steroid.therapy:French data.AB1141 (2017)[3]González-Gay MA et al. Polymyalgia. rheumatica. Lancet. 2017 Oct 7;390(10103):1700-1712Table 1.Patients characteristics methotrexate versus controlsMTXN = 42ControlsN = 220P-valueDifference (95% CI) Time of PMR diagnosisFemale(%)22(52)127(58)0.611-5.3 (-11.0; 21.7)Age,years*(SD)62(7)67(10)0.002-5.0 (-8.2;- 1.8)Previous history PMR*(%)7(17)13(6)0.02510.8 (2.0; 19.5)PMR symptoms,weeks(IQR)9(6-16)5(5-16)0.639Bilateral shoulderpain(%)42(100)209(95)0.2215.0 (-1.6; 11.6)Morning stiffness>45 minutes(%;n=33 versus 159)32(76)177(80)0.533-4.3 (-17.5; 9.0)Elevated ESR/CRP*, (%;n=41 versus 218)40(96)185(84)0.02312.7 (1.4; 24.0) At index eventPMR duration, weeks*,**(IQR)87(41-116)53(33-80)0.001GC-dose index event39(93)Oral10(5-15)210(95) Mg(IQR)*3(7)5(0-8)0.000Intramuscular(%)120(100-10(5) Mg(IQR)120)100(80-120)0.355Mean GC-dose until index event, mg, (IQR; n=33 versus 170)*7.1 (5.9-9.0)5.7 (3.8-7.4)0.000During follow-upFlares, n(%)21 (50)100 (45)0.6164.5 (-21.0; 11.9)Weeks to first flare (IQR)36 (24-51)39 (22-66)0.517Mean GC-dose, mg (IQR)6.2 (4.6-9.7)4.7 (2.9-6.9)0.004Daily GC-dose year1,mg (IQR; n=32 versus 153)*5 (2.5-7.9)2.5 (0-5)0.03* Significant alpha level < 0.05**Before diagnosis until index eventDisclosure of Interests:None declared
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SUSANTI, Elys, Muhammad Ilyas, Nurlaily Idris, Andi Alfian Zainuddin, Bachtiar Murtala, and Faridin HP. "Correlation between Ultrasound Findings of Uric Acid Precipitate in MTP I and Acute Gout Flare in Gouty Arthritis." Jurnal Kedokteran Brawijaya 31, no. 1 (February 29, 2020): 33. http://dx.doi.org/10.21776/ub.jkb.2020.031.01.7.
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<p>Acute gout flare is the most common manifestation of gouty arthritis that intermittently occurs with severe pain in the joints due to interactions between monosodium urate crystals (MSU) and the surrounding tissues. The most common predilection is the metatarsophalangeal joint (the 1st MTP). Ultrasound examination is a modality that can be used to visualize MSU crystal precipitates in and around joints. This study aimed to determine the correlation between the findings of the MSU crystal precipitate on the 1st MTP using ultrasound with the occurrence of acute gout flare in gout patients. This study was an analytical observational study with a cross-sectional method. The samples were 41 patients with a history of previous acute flares and in the intercritical phase when participating in the study. Examinations of ultrasound on the 1st MTP and random serum uric acid level were performed. Evaluations were carried out on both of the 1st MTPs to assess the shape of the MSU crystalline precipitate, namely Double Contour Sign (DCS), aggregate, and tophus. Each sample was evaluated within five days to assess the presence or absence of an acute flare. The diagnostic tests used were the Chi-Square Test and the Fischer Exact Test with a significance value of p <0.05. The results showed the images of DCS were seen in 20 samples with 9 (45%) samples experiencing acute flare (p <0.05), while in 21 samples where no DCS were found, all did not experience any flare. Findings of aggregate and tophus were rarely found, 7.3% and 4.9%, respectively. In this study, the finding of DCS precipitates using ultrasound has a significant correlation to the emergence of acute flare and is a significant form of precipitate findings in this study, whereas aggregate and tophus precipitates are difficult to determine.</p>
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Mu, Hui-Jun, Da-Bin Lin, Shao-Qiang Xi, Ting-Ting Lin, Yuan-Zhu Wang, Yun-Feng Liang, Lian-Zhong Lü, Jin Zhang, and En-Wei Liang. "THE HISTORY OF GRB OUTFLOWS: EJECTION LORENTZ FACTOR AND RADIATION LOCATION OF X-RAY FLARES." Astrophysical Journal 831, no. 1 (October 31, 2016): 111. http://dx.doi.org/10.3847/0004-637x/831/1/111.
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Carpenter, Anna, David J. Levinthal, David G. Binion, and Trent Emerick. "Improvement of Cyclic Vomiting Syndrome with Outpatient Ketamine Infusions." Case Reports in Gastroenterology 15, no. 1 (January 18, 2021): 9–16. http://dx.doi.org/10.1159/000510933.
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Cyclic vomiting syndrome (CVS) is a disorder characterized by recurrent flares of nausea and vomiting, often with significant abdominal pain, of several days duration. Although traditional prophylactic and abortive treatments for CVS are often successful, a subset of CVS patients with chronic abdominal pain may not respond as well to standard therapies. This report is the first, to our knowledge, to describe the use of outpatient ketamine infusions as therapy for refractory CVS. We describe a 63-year-old woman with history of CVS who presented with abdominal pain and recurrent episodes of nausea and vomiting. She first received ketamine during an inpatient admission for a CVS flare, with the aim of treating the abdominal pain. Given her improvement, she was offered a series of outpatient ketamine infusions, which led to a significant reduction in her symptoms. Thus, ketamine may be useful as both an abortive and prophylactic therapy in CVS. Prior reports have noted the anti-emetic effects of ketamine in the perioperative setting, and there is emerging evidence for the use of ketamine infusions for the treatment of chronic pain. However, this report is the first to describe ketamine as a potential prophylactic treatment for CVS.
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Lin, Haibo, Jianpeng Guo, Kei Masunaga, Kanako Seki, Christian Mazelle, Dan Zhao, Hui Huang, Juan Zhao, Yong Wei, and Libo Liu. "In Situ Observation of Solar-flare-induced Proton Cyclotron Waves Upstream from Mars." Astrophysical Journal 934, no. 2 (August 1, 2022): 183. http://dx.doi.org/10.3847/1538-4357/ac7d4f.
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Abstract Proton cyclotron waves (PCWs) upstream from Mars are usually interpreted as waves generated by ion/ion instabilities due to the interaction between the solar wind plasma and the pickup protons, originating from the extended hydrogen (H) exosphere of Mars. Their generation mainly depends on the solar wind properties and the relative density of the newborn protons with respect to the background solar wind. Under stable solar wind conditions, a higher solar irradiance leads to both increased exospheric H density and ionization rate of H atoms, and therefore a higher relative density, which tends to increase the linear wave growth rate. Here we show that the solar irradiance is likely to contribute significantly to PCW generation. Specifically, we present observations from the Mars Atmosphere and Volatile EvolutioN (MAVEN) spacecraft indicating that, around the peak of the X8.2 flare on 2017 September 10, the increased solar irradiance gave rise to higher pickup H+ fluxes, which in turn excited PCWs. This result has implications for inferring the loss of hydrogen to space in early Martian history with more intense and frequent X-class flares as well as their contributions to the total loss.
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Andronov, I. L., L. S. Kudashkina, and G. M. Rudnitskij. "History of the Light Curves and Molecular Maser Emission of the Miras U Ori and R Leo." Symposium - International Astronomical Union 155 (1993): 323. http://dx.doi.org/10.1017/s0074180900171128.
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We have collected all the available data on light curves, OH, H2O and SiO maser observations for a sample of Mira-type variables. We consider in detail the data on two stars, U Ori and R Leo. There is a net correlation between optical and radio line variations for all the three molecular species in these stars. More pronounced maser flares seem to follow brighter-than-average visual maxima of the stars. We discuss also the drastic changes in the type of the OH maser radio emission which happened in these stars some years ago. Implications for the mechanisms of maser pumping and the evolutionary status of these stars (probably undergoing the helium flash) are discussed.
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Fayed, F., and E. Abdelkarim. "POS1179 POST COVID ARTHRITIS; REACTIVE ARTHRITIS OR RHEUMATIC DISEASE FLARE OR BOTH." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 871.1–871. http://dx.doi.org/10.1136/annrheumdis-2021-eular.1148.
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Background:Reactive arthritis (ReA) is an emerging arthritis after viral infection especially respiratory and gastrointestinal related viruses. In 2020, SARS-COV2 virus is sweeping worldwide with diverse symptoms and prolonged post-Covid manifestations in which are arthralgia and myalgia are frequently present for days and even months. Interestedly, arthritis in covid era is a part of ReA or a flare of autoimmune disease, it is challenging.(1)Objectives:Our objective was to determine the frequency of musculoskeletal symptoms with SARS-COV2 virus and after recovery as well as its relation to autoimmune diseases flares.Methods:A Prospective study was done on 241 patients who admitted to the Rheumatology clinic from March 2020 to January 2021, complaining from new onset of musculoskeletal symptoms. Detailed history, Examination of systems including Musculoskeletal, laboratory investigation, past history of existing rheumatic disease, and history of infection with covid 19.Results:Among 241 patients with median age 34.4, 36.92% had an existing Rheumatic disease while 63.08% are not. Moreover, 39% of patients had a post history with covid 19 within weeks. The most frequent Musculoskeletal symptoms are myalgia (74.56%), arthralgia (69.36%), and arthritis (10.78%). Furthermore, ReA (Post covid arthritis) accounted (2.07%) especially monoarthritis of Ankle (68.75%) while rheumatic diseases flares (24.48%) as well as new onset rheumatic diseases (39.68%). (p ≤0.001) patients of ReA improved on NSAID and intrarticular injection of glucocorticosteroid.Conclusion:Covid 19 is one of environmental triggers for development of rheumatic disease as well as reactive arthritis post viral infections. ReA is commonly affected the Ankle joint mainly monoarthritis and had improved on oral NSAID and intrarticular injection of Glucocorticosteroid.References:[1]Schett, G., Manger, B., Simon, D. et al. COVID-19 revisiting inflammatory pathways of arthritis. Nat Rev Rheumatol16, 465–470 (2020).Disclosure of Interests:None declared.
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LOPEZ, JOSE JAVIER, and PEDRO M. THOMAS. "The Geography of Law Enforcement Malpractice: National Patterns of Official Misconduct in the United States, 1989–1999." Journal of American Studies 38, no. 3 (December 2004): 371–90. http://dx.doi.org/10.1017/s0021875804009168.
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One of the darkest aspects of U.S. history and culture is encapsulated in crime perpetrated by law enforcement officials. In fact, police abuse of power has long been a footnote in analyses of governments' monopoly on legitimated violence. The history of modern policing itself indicates long-standing concern with excessive, sometimes brutal, control over citizens by law enforcement agents. Such concerns have been articulated variously over time by the public, academics, the press, and within law enforcement ranks. Much of this concern turns on perception, for police malfeasance is notoriously shrouded behind a “blue wall,” well-meaning law enforcement officials are genuinely interested in public perceptions of their services, and news of police malpractice flares selectively and variously across time.
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Khandalavala, Birgit N. "A Disease-Modifying Approach for Advanced Hidradenitis Suppurativa (Regimen with Metformin, Liraglutide, Dapsone, and Finasteride): A Case Report." Case Reports in Dermatology 9, no. 2 (July 13, 2017): 70–78. http://dx.doi.org/10.1159/000473873.
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Hidradenitis suppurativa (HS) is a challenging skin disease with limited therapeutic options. Obesity and metabolic syndrome are being increasingly implicated and associated with younger ages and greater metabolic severity. A 19-year-old female with an 8-year history of progressively debilitating cicatricial HS disease presented with obesity, profound anemia, leukocytosis, increased platelet count, hypoalbuminemia, and elevated liver enzymes. A combination of metformin, liraglutide, levonorgestrel-ethinyl estradiol, dapsone, and finasteride was initiated. Acute antibiotic use for recurrences and flares could be slowly discontinued. Over the course of 3 years on this regimen, the liver enzymes normalized in 1 year, followed in2 years by complete resolution of the majority of the hematological and metabolic abnormalities. The sedimentation rate reduced from over 120 to 34 mm/h. She required 1 surgical intervention for perianal disease after 9 months on the regimen. Flares greatly diminished in intensity and duration, with none in the past 6 months. Right axillary lesions have completely healed with residual disease greatly reduced. Chiefly abdominal lesions are persistent. She was able to complete high school from home, start a job, and resume a normal life. Initial weight loss of 40 pounds was not maintained. The current regimen is being well tolerated and continued.
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Perrillo, Robert P. "Acute flares in chronic hepatitis B: The natural and unnatural history of an immunologically mediated liver disease." Gastroenterology 120, no. 4 (March 2001): 1009–22. http://dx.doi.org/10.1053/gast.2001.22461.
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Takano, T., S. Enome, H. Nakajima, K. Shibasaki, M. Nishio, Y. Hanaoka, C. Torii, et al. "The Next Plan of the Nobeyama Radioheliograph." International Astronomical Union Colloquium 140 (1994): 430–31. http://dx.doi.org/10.1017/s0252921100020182.
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A high time- and spatial-resolution radio interferometer for solar observations has been constructed at Nobeyama (Figure I.; Nakajima et al. 1994). The Nobeyama Radioheliograph consists of 84 antennas, 0.8m in diameter, arranged on a T-shape lines of 500m in the EW and 220m in the NS directions. The time resolution is 50 ms and the spatial resolution is 10”. The field of view is 40’ at the observing frequency 17GHz, which enables us to watch the whole sun. The radioheliograph has observed hundreds of flares during the few months since the beginning of regular observations in July ‘92, and such powerful performance has never before been demonstrated in the history of solar radio observations.
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Bilici Salman, R., A. Avanoğlu Güler, H. Satiş, H. Karadeniz, H. Babaoglu, N. Atas, S. Haznedaroglu, M. A. Ozturk, B. Goker, and A. Tufan. "AB1065 VISIT COMPLIANCE IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER: RESULTS FROM A GAZI UNIVERSITY FMF COHORT." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1822.1–1822. http://dx.doi.org/10.1136/annrheumdis-2020-eular.4675.
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Background:Follow-up in all rheumatologic patients is critical, particularly Familial Mediterranean Fever (FMF). Current recommendations for all experts by the EULAR state that patients with FMF should be evaluated 6-monthly intervals to monitore the character and frequency of the attacks and the acute phase response. Disease-related complications such as amyloidosis can beasymptomaticand need only a careful follow-up.Objectives:to quantify this phenomenon and to find predictive factors of visit compliance in patients with FMF.Methods:The study included 474 adult patients with a diagnosis of FMF who followed at the outpatient rheumatology clinic of tertiary university hospital, from January 2018 to December 2018. . Demographic, socioeconomic data, familiy history, comorbid disease, medication history, characteristics, the International Severity Score for FMF (ISSF),autoinflammatory disease damage index (ADDI) were recorded. Visit compliance was defined as the presence of two visits in the outpatient rheumatology clinic for FMF last one year for the purposes set out in EULAR suggestion.Those who had fewer than two visits in the last one year were considered noncompliant.Results:230 (48.5%) were compliant while 244 (51.5 %) patients were noncompliant with their rheumatology visit. Both compliant and noncompliant patients had similar median age and disease duration. Female sex and being married was increased the visit compliance.The results of the logistic regression model exploring factors associated with compliance indicated that presence of family history in parents, absence of family history in sibling, treatment with biologic agents, other drug using,presence of more than 2 attacks except fever and adequate medical care were important predictors of visit compliance.Conclusion:In conclusion, if FMF patients visit compliance increase, their functionality, medication adherence and quality of life will increase and flares and complication of disease can decrease. Thus, we highlight some recommendations for FMF specialist, patients and health care providers to improve outcomes.Table 2.Multivariate logistic regression analysis for predictive factors of visit compliance of the patients with FMF, n=430Adj. OR%95 CI**pFamily history in parents(positive history vs negative)1,81,0-3,10.03Family history in sibling(negative history vs positive)1,91,2-3,10.004Comorbid disease status1,30,7-2,50.32Treatment(anakinra&canakinumab vs colchicine)3,71,7-8,20.001Drug using(other drugs vs FMF drugs)2,21,1-4,40.01More than 2 attacks except fever2,31,2-4,00.004Chronic peripheral arthritis2,30,8-6,60.10Proteinuria2,20,7-6,70.14Adequate medical care1,91,2-3,10.003Number of index flare within last 12-month0,90,9-1,00.38ISSF severity score0,80,7-1,10,30Disclosure of Interests:None declared