B. Zouari

Fecal calprotectin is a predictive marker of relapse in Crohn's disease involving the colon: a prospective study

Objectives Fecal calprotectin seems to have a diagnostic precision in predicting relapse in quiescent ulcerative colitis patients. However, the data remain controversial in Crohns disease. The aim of this study was to prospectively evaluate the role of fecal calprotectin as a predictive marker for 1-year follow-up in patients with asymptomatic Crohns disease. Methods Fifty-three Crohns disease patients in clinical remission were consecutively included providing at the beginning of the study a single stool sample as well as a blood sample and regularly followed-up for 12 months. Fecal calprotectin level was measured using a commercially available enzyme-linked immunoassay. Results Among 53 patients, 10 (18.9%) developed clinical relapse during the 12-month follow-up period. Median fecal calprotectin level was significantly higher in relapse group patients compared with that in nonrelapse group (380.5 vs. 155u2009μg/g, P<0.001). With a cutoff value of 340u2009μg/g fecal calprotectin gave sensitivity of 80% and specificity of 90.7% in predicting clinical relapse. Fecal calprotectin level greater that 340u2009μg/g gave an 18-fold higher risk to develop relapse (log rank P<0.001) and was found to be an independent predictive factor of relapse (P=0.02). Conclusion Fecal calprotectin seems to be a reliable marker of relapse in quiescent Crohns disease patients.

HLA-B, DR and DQ antigens polymorphism in Tunisian patients with ankylosing spondylitis (a case–control study)

The objective of the study is to assess the distribution of HLA-B genes, HLA-B27 subtypes, HLA-DRB1 and HLA-DQB1 alleles in patients with ankylosing spondylitis (AS) and in control subjects in the Tunisian population and to compare their distribution with that found in other countries. This is a case–control study that included 100 consecutive patients (85 males/15 females) with AS according to the modified New York criteria and 100 control individuals. HLA-B, B27 subtypes and class II (DR and DQ) typing of all subjects was performed by polymerase chain reaction amplification with sequence-specific primers (PCR-SSP). HLA-B27 was found in 62% of patients against 3% in controls (Pxa0=xa00.0000, ORxa0=xa052.6, 15.6xa0<xa0CIxa0<xa0166.7). On the other hand, B*07 and B*51 were significantly decreased in comparison with controls (Pxa0=xa00.01, ORxa0=xa00.3, 0.1xa0<xa0CIxa0<xa00.8 and Pxa0=xa00.0000, ORxa0=xa00.2, 0.1xa0<xa0CIxa0<xa00.4, respectively). Eight B*27 subtypes were identified in the AS group, but the most frequent ones were B*2702 (32%) and B*2705 (24%). Among HLA-DRB1 alleles, a significant increase in DRB1*11 was found in comparison with controls (Pxa0=xa00.01, ORxa0=xa02.2, 1.2xa0<xa0CIxa0<xa04.5). However, DRB1*13 had a negative association with AS (Pxa0=xa00.01, ORxa0=xa00.4, 0.2xa0<xa0CIxa0<xa00.8). For HLA-DQB1 alleles, a significant positive association with DQB1*03 was observed in AS group (Pxa0=xa00.03, ORxa0=xa01.8, 1.0xa0<xa0CIxa0<xa03.4). Multivariate analysis by logistic regression revealed that DRB1*11 and DQB1*03 had no direct links with the disease, but were dependent on the presence of HLA-B27. Moreover, B*07 and B*51 seemed to have independently a negative correlation with AS, but DRB1*13 seemed to depend on B*51. Haplotypes carrying B27 were significantly associated with AS and those carrying B*07 or B*51 were negatively correlated with the disease. In conclusion, our study confirms that B27 predisposes to AS while B*07 and B*51 are negatively correlated with the disease.

Metabolic syndrome is associated with gastroesophageal reflux disease based on a 24-hour ambulatory pH monitoring

Several studies have focused on the relationship between metabolic syndrome and gastroesophageal reflux disease (GERD). They were based on GERD complications, whereas little is known about the association between metabolic syndrome and objectively measured esophageal acid exposure. The aim of our study was to assess the relationship between metabolic syndrome and GERD based on a 24-hour pH testing. It was a cross-sectional study including 100 consecutive patients who underwent a 24-hour pH-metry monitoring and were assessed for the five metabolic syndrome components as well as for body mass index (BMI). Among the 100 patients, 54 had a pathological acid GERD. The 46 GERD-free patients represented control group. Sex distribution was comparable between both groups but GERD patients were older than controls (44.59 vs. 37.63 years, P= 0.006) and more often obese or with overweight (83.3 vs. 60.9%, P= 0.01). Frequency of metabolic syndrome as a whole entity was higher among patients with GERD than those without GERD (50 vs. 19.56%; P= 0.002) with a crude odds ratio of 4.11 (95% confidence interval: 1.66-10.14). Multivariate regression analysis showed that metabolic syndrome as well as an age ≥ 30 years were independent factors associated to GERD but not BMI and sex. Abnormal waist circumference and fasting glucose level ≥ 100 mg/L were the only independent factors among the five components of metabolic syndrome. Metabolic syndrome but not BMI was an independent factor associated to GERD. These results confirm the hypothesis that central obesity is associated to GERD.

Association of ACE I/D polymorphism in Tunisian patients with dilated cardiomyopathy

Primary cardiomyopathies are multifactorial diseases. Genetic factors other than the causal mutations in the modified genes affect the phenotypic expression of dilated cardiomyopathy. The aim of this study was to determine the association of angiotensin-converting enzyme I/D polymorphism with the risk of dilated cardiomyopathy in a Tunisian population. A total of 76 patients with dilated cardiomyopathy was compared to 151 ethnically, age- and gender-matched controls. The frequencies of the DD genotype and D allele were significantly higher in patients as compared with controls, and were associated with increased risk of dilated cardiomyopathy (ACE DD versus ID and II: OR = 3.05 (95% CI, 1.58—5.87; p = 0.001)); D versus I: OR = 2 (95% CI: 1.35—2.97; p = 0.001)). No association was found between the combined genotypes (DD+ID) or D allele and left ventricular end diastolic diameter in dilated cardiomyopathy patients with severe and moderate clinical phenotypes. DD genotype and D allele of angiotensin-converting enzyme I/D gene polymorphism are associated with increased risk of dilated cardiomyopathy in a Tunisian population but do not influence the cardiac phenotype severity.

Risk factors for perinatal mortality in a Tunisian population

Age 20–24 8 (26.7) 25–29 9 (30.0) 30–34 9 (30.0) 35–39 3 (10.0) N39 1 (3.3) Parity 0 9 (30.0) 1 7 (23.3) 2–4 9 (30.0) 5 and above 5 (16.7) Financial independence Yes 19 (63.3) No 11 (36.7) HIV discordance Yes 18 (60.0) No 12 (40.0) Unwanted pregnancy Yes 8 (26.7) No 22 (73.3) Educational level At least primary education 8 (26.7) Secondary education and above 22 (73.3) Type of marriage Polygamy 2 (6.7) Monogamy 28 (93.3) Place of residence Urban 20 (66.7) Rural 10 (33.3)

Health-related Quality of Life Assessment on 100 Tunisian Patients with Ankylosing Spondylitis using the SF-36 Survey

OBJECTIVESnThe main objective of the study was to examine the self reported health status in patients with ankylosing spondylitis (AS) compared with the general population and the secondary objective (in the AS group) was to study the association between health status, demographic parameters, and specific disease instruments in AS.nnnMETHODSnA cross sectional study of 100 AS patients recruited between 2006 and 2009 at the Department of Rheumatology. Health status was assessed by using the SF-36 health questionnaire in patients with AS. Demographic characteristics and disease-specific instruments were also examined by the questionnaire. A sample of 112 healthy individuals was also surveyed using the SF-36 health questionnaire.nnnRESULTSnThis study showed a great impairment in the quality of life of patients with AS involving all scales. All male patients with AS reported significantly impaired health-related quality of life on all items of the SF-36 compared with the general population whereas female patients reported poorer health on three items only, namely physical functioning, general health and bodily pain. Mental health was mostly affected than physical role. The physical role was significantly higher in patients with high education level than in patients with low education level (p=0.01). Physical functioning was better in employed patients. All scales of SF-36 were correlated with BASFI, BASDAI and BAS-G. Only physical functioning and general health were correlated with BASMI.nnnCONCLUSIONnImpairment in the quality of life can be significant when suffering from AS, affecting mental health more than physical health. Among disease parameters, functional impairment, disease activity, mobility limitation, and spinal pain were the most associated factors resulting to the deterioration of quality of life.

A cross sectional study of bone and cartilage biomarkers: correlation with structural damage in rheumatoid arthritis

ABSTRACT The aim of our study was to assess the relationship between bone and cartilage remodeling biomarkers and joint damage in Rheumatoid Arthritis (RA), and to detect whether they have the capacity to predict the progression of joint disease assessment by computed tomography (CT) erosion score. We analyzed 65 female patients with established RA in our Rheumatology Department. Serum levels of bone and cartilage markers were measured: osteocalcin (OC), N-propeptide of type I collagen (PINP), collagen type I and II, C-telopeptide (CTX I, CTX-II) and cartilage oligomeric matrix protein (COMP). Radiography of both wrist and MCP joints were available. Two expert-readers independently scored articular damage and progression using the High-resolution low dose CT scan in a blinded fashion. 65 female patients with established RA with a median age of 44 years were included. The median disease-duration was two years and the median (Disease activity score) DAS 28 score at 4.46 [2.65–7.36]. The percentage of patient with low disease activity was 13.8%, while 55.4 and 30.8% for those with moderate and high disease activity respectively. The resorption bone markers were high in active versus non-active RA. Wrist and MCP erosion scores were also associated with RA activity. Our study shows that biomarkers of bone and cartilage collagen breakdown were related to specific joint erosion in RA and could predict subsequent radiographic damage in RA. Further larger scale longitudinal studies maybe needed to confirm our data.

Filgrastim following HLA-identical allogeneic bone marrow transplantation: long-term outcomes of a randomized trial

Human recombinant granulocyte colony stimulating factor reduces the duration of neutropenia following HLA-identical allogeneic bone marrow transplantation. However, its use remains controversial due to the risk of increasing the incidence of acute graft-versus-host disease (GVHD) and slower platelet recovery. To clarify these risks, we conducted a prospective randomized placebo-controlled trial of filgrastim 5 µg/kg/day i.v. from dayxa07 post-transplant until neutrophil recovery in 145xa0consecutive adults undergoing HLA-identical allogeneic bone marrow transplantation, with cyclosporine and methotrexate as GVHD prophylaxis. The primary endpoint was the incidence of acute GVHD; hematological recovery, nonrelapse mortality, and post-transplant complications were secondary endpoints. Filgrastim had no significant effect on the incidence of acute GVHD, platelet recovery, platelet transfusion requirements, chronic GVHD, or survival. Filgrastim accelerated granulocyte recovery significantly (with absolute neutrophil counts >.5u202f×u202f109/L achieved after a median of 16 days versus 23 days for placebo; P < .0001), and reduced both early nonrelapse mortality (2.9% versus 10.5%; P = .042) and the duration of i.v. antibiotic therapy (18 days versus 26 days; P = .001) and hospitalization (27 versus 34xa0days; P = .017). In conclusion, in this setting, filgrastim reduced significantly the duration of neutropenia, i.v. antibiotic therapy, hospitalization, and early nonrelapse mortality, without increasing the risk of acute and chronic GVHD or relapse, or delaying platelet recovery.

Late mitral restenosis after percutaneous commissurotomy: Predictive value of inflammation and extracellular matrix remodeling biomarkers

Background The role of chronic inflammation in mitral restenosis after percutaneous mitral commissurotomy (PMC) is still controversial. Aims We sought to assess the predictive value of inflammation and extracellular matrix (ECM) remodeling biomarkers in late mitral restenosis after PMC. Methods We prospectively enrolled 155 patients (mean age 46.2±11 years) with at least 5 year follow up after primary PMC. Serum levels of high sensitive C‐Reactive Protein (hs‐CRP), matrix metalloproteinases MMPs, tissue‐specific inhibitors of matrix metalloproteinases TIMPs, and tumor necrosis factor &agr; (TNF&agr;)] were measured. Results Late mitral restenosis occurred in 55 patients (35.5%). The independent predictors of late mitral stenosis were: age> 55 years [HR10.51 (95%CI 1.12–95.9); p=0.037]; no long acting penicillin therapy [HR 18.1 (95% CI 2.6–122.9); p=0.003]; TNF&agr; > 80 ng/ml [HR 5.85 (95% CI 1.1–31.42); p=0.039]; and TIMP‐2 > 289 ng/ml [HR 0.52 (95% CI 0.22–0.95); p=0.045]. Conclusion Chronic inflammation and ECM remodeling are involved in late mitral restenosis after PMC.

029 Prognostic value of cortisol, insulin and thyroid hormones levels in ST elevation acute myocardial infarction

Thyroid hormones, cortisol and insulin affect the metabolism of myocardial cells. Their secretion can be altered in case of ST elevation acute myocardial infarction (STEMI) and their prognostic value is not well established. The aim of this study was evaluate the hormonal profile and its correlation with patients outcome in STEMI. Methods and results 186 consecutive patients (162 males, 87%) with STEMI were prospectively enrolled. Blood sampling for insulin, cortisol, thyreostimulin (TSH), free thyroxin (FT4), triiodothyronin (T3) and free triiodothyronin (FT3) level measurements were performed in the 24 hours after admission. Patients who died within the first 24 hours were excluded. Mean follow-up period was 17,2 [12-28.8] months. We distinguished 2 groups, with (MACE1+) and without (MACE1-) in-hospital complications (Death and/or shock and/or left ventricular insufficiency and/or myocardial infarction and/or revascularization) and 2 groups, with (MACE2+) or without (MACE2-) late complications (Death and/or cardiac insufficiency and/or myocardial infarction and/or revascularization). The mean age of patients was 58.4xa0±xa012.6 years. 77.9% were smokers, 35.4% were diabetics, 37% were hypertensive, 18.8% had a dyslipemia, 17.2% had a history of familial coronary disease and 4.3% of patients had a renal insufficiency. Hormonal levels were as follows: insulin=12.6±20.5 mU/l, cortisol=250.4±37 ng/ml, TSH=2.3±8.3μU/l, FT4=10.2±3 ng/l, T3=0.83±0.23 pg/l, FT3=2.04±3ng/l. Differences in hormonal levels between MACE1+ and MACE1- groups were significant for cortisol (289.5±304.9 vs 217.5±110.2 ng/l, p=0.033) and T3 (0.83±0.23 vs 0.77±0.2 pg/l, p=0.001). Threshold values determined by ROC curves were 380 ng/l for the cortisol and 0.95 pg/l for T3. In a multivariate model, only T3 was independently correlated with in-hospital outcome (OR=3.9, IC [1.6-9.8]). There was no correlation between hormonal levels and late outcome. In Conclusion: T3 affect short but not long term STEMI prognosis. The usefulness of routine hormonal measurement and the therapeutic implications are still to determine.