173 research outputs found
Accelerated infusion rates of rituximab are well tolerated and safe in rheumatology practice: a single-centre experience
No full textDue to the possible risk of infusion reactions of rituximab (RTX), a slow infusion rate (total infusion time, 255 min) is suggested for rheumatological use. However, especially in oncology field, accelerated infusion of RTX is reported to be well tolerated and safe. The aim of our study was to evaluate whether accelerated infusion rates of RTX would similarly be safe and tolerable in rheumatoid arthritis (RA) patients and other off-label rheumatological indications. All patients treated with RTX for RA and other autoimmune diseases between May 2011 and January 2012 were recruited to the study. Each treatment course consisted of two RTX 1,000 mg infusions, 2 weeks apart. Total time of the infusion for the first cycle was 255 min. Second and subsequent infusions were administered over 120 min as follows: 0-30 min, 100 mg; 30-60 min, 200 mg; 60-90 min, 300 mg; and 90-120 min, 400 mg. The Clinical Trials Classification of Adverse Events (CTCAE) version 4.3 was used to categorise side effects. The study population comprised 68 patients [F/M, 59:9; mean age, 52.4 (10.6) years]: 60 with RA, 4 with systemic lupus erythematosus (SLE), 1 with non-Hodgkin's lymphoma with SLE and 3 with vasculitis. A total of 77 fast infusions were administered. Eleven patients (16.2 %) had taken a fast infusion at the first course. A total of nine patients experienced at least one AE. Seven patients had a reaction on the first infusion (infusion-related reaction (IRR)), two patients on the second infusion and one patient on both infusions. When graded from 1 to 5 according to CTCAE v. 4.3, grade 1 IRRs were observed in a total of seven patients and grade 2 IRR in three patients. In this study of fast infusions, adverse events after RTX were mostly mild and seem to be well tolerated. Faster rituximab infusion times seem to be safe and might be incorporated into routine practice
Does illness perception associate with disease symptoms in Behcet's disease?
No full textThis study aims to assess the relationship between illness perception and disease course and symptoms in Behcet disease (BD). One hundred ten consecutive BD patients (F/M 50/60, mean age 38.5 +/- 9.88years) and 57 patients with Psoriasis as a disease control group (F/M 28/29, mean age 48.12 +/- 15.52) are included in this cross-sectional study. Illness perception is evaluated using a revised version of the Illness Perception Questionnaire (IPQ-R). In IPQ-R, the identity score reflecting the number of symptoms is higher in BD patients with musculoskeletal involvement than the others (6.77 +/- 2.91 vs. 5.08 +/- 3.3, respectively, p=0.007). The consequences score for musculoskeletal involvement (19.52 +/- 7.03) and timeline (acute/chronic) score for eye involvement (26.67 +/- 4.32) are also higher compared to patients without them (16.37 +/- 5.82 and 22.09 +/- 8.68) (p=0.011 and p=0.038), reflecting negative beliefs about the illness. The score of psychological attribution is higher in patients with psoriasis than BD (p=0.039), whereas the other subgroup scores are lower in patients with psoriasis compared to those of BD (p<0.05). This study provides a patient's perspective in the disease management process of BD using the IPQ-R questionnaire. A patient's own personal beliefs and emotional responses to their symptoms might affect the outcome measures, especially with musculoskeletal symptoms and eye involvement in BD. However, psychological attribution is found to be a prominent issue in psoriasis
Behavior of Soil Reinforcements in Slopes
No full textAbstractIn geotechnical and transportation engineering, especially road constructions in cuts and deep excavation problems are solved by using different supporting excavation methods. Soil reinforcements are chosen due to easy and economic application. In this study, behavior of supported slopes with geotextiles and geogrids were analyzed by performing experiments on slope models in the laboratory. In the experiments, a static loading was applied to find failure surface and deformations for each case. Additionally, slopes were designed by using Plaxis program. At the end of the study, experimental and analytic models were compared and also behavior of models were presented
Oral ulcer activity in Behcet's disease: Poor medication adherence is an underestimated risk factor
No full textObjective: The aim of this study was to evaluate the relationship between oral ulcer activity and medication adherence according to gender in Behcet's disease (BD) patients. Material and Methods: The study group included 330 BD patients (F/M: 167/163, mean age: 38.5 +/- 10.5 years). Oral ulcer activity and medication adherence were evaluated in the previous month. Medication adherence was evaluated using the 8-item Morisky Medication Adherence Scale (MMAS-8) having a score range of 0 to 8 with high scores indicating better adherence. Low adherence was defined as < 6 points on MMAS-8. Results: Over half of the group had active oral ulcers (n= 219, 66.4%) within the month preceding the visit. The number of oral ulcers was significantly higher in female patients with low medication adherence (2.39 +/- 3.24) than in the rest of the female group (1.28 +/- 2.05; p= 0.023). Although a similar trend was also observed in male patients (2.14 +/- 3.3 vs. 1.81 +/- 2.31), a significant relationship was not observed (p= 0.89). The frequency of medication intake per day was lower in patients with high medication adherence than in the rest of the study group (p= 0.04). Conclusion: Low medication adherence is a hidden risk factor in the management of BD. Poor adherence was associated with oral ulcer activity in female BD patients
The assessment of contributing factors to oral ulcer presence in Behcet's disease: Dietary and non-dietary factors
No full textObjective: The aim of this study was to assess the contributing factors for oral ulcer activity in Behcet's disease (BD). Methods: Ninety-two patients with BD (F/M: 42/50, mean age: 38.7 +/- 10.02 years) participated in this cross-sectional study. Data regarding disease-related factors, smoking patterns, and self-reported dietary/non-dietary triggering factors for oral ulcer activity were collected by a questionnaire. Treatment protocol was categorized as mild and intensive groups associated with organ involvements. Results: A mild treatment protocol was more common in females (52.4% vs 20%) than in males (p=0.002). During the last three months, the number of oral ulcers in female patients was higher in the mild treatment group (6.4 +/- 6.5) than in the intensive treatment group (3.3 +/- 4.9) (p=0.045). In patients with active oral ulcers (n=63), rate of being a non-smoker was also higher in females (86.7% vs 63.6%) than in males. Daily frequency of tooth brushing was 1.2 +/- 0.8 in patients with BD, and was higher in females (1.5 +/- 0.9 vs 0.9 +/- 0.6) (p=0.001). Stress and fatigue (78.3%) were reported as the most frequent triggering factors for oral ulcer presence in patients with BD. A total of 148 different dietary factors associated with oral ulcer presence were reported in the study. Conclusion: A mild treatment protocol and being a non-smoker were found to be the contributing factors associated with oral ulcer activity in patients with BD. Being motivated for oral hygiene and being non-smokers were positive health behaviors observed in females. Irrespective of gender, stress and fatigue were defined as the most common self-reported triggering factors for oral ulcer presence in BD. In addition, the roles of some dietary factors were also reported
Oral health is a mediator for disease severity in patients with Behcet's disease: A multiple mediation analysis study
No full textObjectivesThe aim of the study was to examine whether oral health as an infection focus could mediate disease course in patients with Behcet's disease (BD). MethodsIn the study, oral health of 194 BD patients was examined at baseline and follow-up periods. The reasons for last dental visits were recorded as tooth extraction or regular control visits/planned treatments at the end of follow-up period. The Behcet's disease severity score was calculated with higher scores indicating a more severe course. Mediation analysis was carried out to assess the effects of oral health on disease severity score at follow-up period in the study. ResultsDental and periodontal indices were found to be higher at follow-up visit compared to those of baseline (P<0.05). Disease severity score was found to be higher in males (5.32.4) compared to females (4.4 +/- 2.5) in the whole group (P=0.005). Moreover, patients having tooth extraction at their last dental visit and patients with dental caries had a more severe disease course (5.4 +/- 2.4; 5.5 +/- 2.5) compared to others (4.2 +/- 2.3; 4.4 +/- 2.4; P<0.0001). In multiple mediation analysis, disease severity score was a dependent variable and was directly mediated by male gender (B=-0.8822, P=0.0145) and indirectly mediated through the presence of dental caries (B=0.9509 P=0.0110) and need of tooth extraction (B=0.8758, P=0.0128). ConclusionBoth presence of dental caries and need of tooth extraction were observed to be effective mediators for a more severe disease course in BD. Therefore, better oral health should be aimed to eliminate microbial factors, which are a part of pathogenic processes
DC/DC Converters for Multiterminal HVDC Systems: Based on Modular Multilevel Converter
No full textThe increase in the energy demand has resulted in searching for new energy sources. Due to the increased prices of fossil fuels and the environmental issues, renewable energy sources has become popular in Europe. Renewable energy generation such as wind, solar and wave has point-to-point connections with the main grid. In order to minimize the disadvantages of renewable energy sources like energy fluctuations, multi-terminal systems are favoured interconnecting energy generation stations among them with the main grid. The long distance interconnection especially for offshore wind farms and intercontinental connections is not possible with traditional alternating current (AC) technology because of the limited power transfer. Therefore, high voltage direct current (HVDC) technology is considered as the main element for the future multi-terminal grid. The conversion between AC and DC is preferred via voltage source converters (VSC) as they offer more flexible power control compared to traditional current source converters in other words line commutated converters (LCC). HVDC power transmission schemes have been constructed depending on the technology of the time, which means that there is no standardization in voltage levels and configurations of the HVDC schemes. Therefore, the connection of such systems operating at different voltage levels and/or in different schemes such as monopole and bipolar systems for the future multi-terminal DC grids requires DC/DC converters. Although the voltage level and the configurations are the same for both DC systems, DC/DC converter may be required for the power flow control in multi-terminal DC grid. The modular multilevel converter (MMC) seems as the most suitable converter in this application due to its advantages such as low switching losses, high scalability and modularity. MMC control structures are introduced and front-to-front connection of two MMC forming a DC/AC/DC converter is modelled and simulated for different applications such as interconnecting systems with same voltage levels, different voltage levels or different configurations in this study. The passive element sizes of MMC submodules are also compared for different AC side frequency as the component sizes can be decreased thanks to the increase in the AC frequency which has a disadvantage of higher switching losses. Moreover, the designed converters are tested in multi-terminal DC grids to check their performance and functionality.Electrical Engineering, Mathematics and Computer ScienceElectrical Sustainable EnergyErasmus Mundus, European Wind Energy Master (EWEM), Electric Power System Trac
The assessment of work productivity and activity impairment in Behcet's disease
No full textBackground/aim: The aim of this study was to assess the relationships between the course of Behcet's disease (BD), disease-specific fears, and work productivity and activity impairment. Materials and methods: In this cross-sectional study, 110 consecutive BD patients were included. The Work Productivity and Activity Impairment questionnaire was used. Results: In the group of employed patients, 30.41% had missed work during the previous week. The mean percentages of daily activity impairment were higher in patients with musculoskeletal involvement (39.81 +/- 33.61%) compared to those without (23.48 +/- 32.45%) (P = 0.008). A greater decrease in working hours was observed in patients with eye involvement (45.52 +/- 15.29 h) compared to those without (54.15 +/- 15.29 h) (P = 0.007). More of the male patients (67.8%) were afraid of losing their jobs compared to females (30%) (P = 0.000). Conclusion: The highest levels of lost productivity and the most severe effects on daily life are consequences of eye and musculoskeletal involvement in the study population. More effective therapeutic approaches are required to improve the working lives of patients with BD. Moreover, male patients had a higher fear of losing their jobs, suggesting a match between the expected clinical course and the predictions of BD patients
Unmet need in Behcet's disease: most patients in routine follow-up continue to have oral ulcers
No full textThe clinical course of Behcet's disease (BD) as a multisystemic disorder with a remitting-relapsing nature is insufficiently explored. As complete remission should be aimed in all inflammatory diseases, we investigated the frequency of complete remission in patients with BD followed in long-term, routine practice. In this retrospective study, 258 patients with BD who were regularly followed in outpatient clinics were assessed. The demographic and clinical data for active organ manifestations and treatment protocols were evaluated, and complete remission for this study was defined as no sign of any disease manifestation in the current visit and the preceding month. Two hundred fifty-eight patients with BD (F/M 130/128, mean age 41.1 +/- 11.5 years) were included to the study. Mucocutaneous disease was present in 48.4 % (n = 125). Mean visit number was 6.8 +/- 2.7, and mean follow-up duration was 45.8 +/- 36.5 months. Patients were clinically active in 67.2 % (n = 1,182) of the total visits (n = 1,757), which increased to 75.6 % (68.1-90.3) when the month preceding the visit was also included. The most common active manifestation was oral ulcers (39.4-63.2 %) followed by other mucocutaneous manifestations and musculoskeletal involvement. When multivariate analysis was performed, oral ulcers, which are the main cause of the clinical activity, negatively correlated with immunosuppressive treatments (beta = -0.356, p < 0.000) and age (beta = -0.183, p = 0.04). It is fairly difficult to achieve complete remission in BD with current therapeutic regimens. The reluctance of the clinician to be aggressive for some BD manifestations with low morbidity, such as mucocutaneous lesions and arthritis, might be influencing the continuous, low-disease activity state, especially due to oral ulcers, in BD patients
Assessment of Patients with Takayasu Arteritis in Routine Practice with Indian Takayasu Clinical Activity Score
No full textObjective. To assess the Indian Takayasu Clinical Activity Score (ITAS2010) in followup of Takayasu arteritis (TA). Methods. ITAS2010 forms were filled in prospectively (n = 144). Clinical activity was assessed with physician's global assessment (PGA) and criteria defined by Kerr, et al. Results. ITAS2010 was significantly higher in patients with active disease. Total agreement between ITAS2010 and PGA was 66.4%, and between ITAS2010 and Kerr, et al was 82.8%. During followup, 14 of 15 patients showing vascular progression with imaging were categorized as having inactive disease according to ITAS2010. Conclusion. ITAS2010 was discriminatory for activity during the followup, but the agreement between PGA and ITAS2010 was moderate. Future work should include the incorporation of advanced vascular imaging and demonstration of ITAS2010 as a scalable measure and not simply a dichotomous measure of activity/flare versus remission
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