429 HEADACHE IN SYSTEMIC LUPUS AND SYSTEMIC LUPUS ERYTHEMATOSUS DISEASE ACTIVITY
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This study examines collectible automobiles as an investable alternative asset class. The author discusses the literature related to alternative asset classes, and how collectible automobiles fit into this context. Based on a sample dataset covering the period 2007–2016, the research also presents empirical results on collectible automobiles as an asset class based on risk, returns, and portfolio benefits. The findings indicate that, during the sample period, collectible automobiles exhibited holding period returns superior to traditional equity, bond, and gold investments. The author also finds that the asset class offers risk-adjusted returns that compare favorably with other investments. Finally, he shows that collectible automobiles offer potential portfolio diversification benefits. TOPICS:Real assets/alternative investments/private equity, portfolio constructionKeywords:
Systemic lupus
Periodontal disease is one of the most important disease that is harmful to masticatory organs of human beings, and it has high prevalence in the crowd. Periodontal disease is the main factor that causes adults loosing and even losing teeth. The medical researches and clinical observation Show that periodontal disease is not only a disease associated with oral cavity tissues, but also closely associated with many systemic diseases. Some systemic diseases play promoting roles in the pathogenesis and aggravating of periodontal disease, and some diseases have genetic factors, others are accompanied with reducing host's defense capabilities; and periodontal disease can be complications and sources of some diseases. So this article discusses about the relationship between periodontal disease and some systemic diseases, and it will help to explore the prevention and cure of periodontal disease and some systemic diseases.
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The psychiatric and neurological symptoms of systemic lupus erythematosus (SLE) are referred to as lupus cerebritis. The wide range of symptoms associated with SLE can pose a diagnostic challenge. We present a case of lupus cerebritis in a 31-year-old female presenting with psychosis. We present this case to increase awareness of the psychiatric manifestations of SLE that can be mistaken for more common etiologies of psychosis.
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Objective: The aim of the present study was to determine neurocognitive profile in Children with Systemic (SLE) and Neuropsychiatric Lupus (NPSLE) describing differences in the seven cognitive areas proposed by the ACR (attention, memory, visuospatial processing, language, problem solving, processing speed, and executive function) between children with SLE and those with NPSLE and to understand the level of cognitive deterioration in children afflicted by SLE with and without neuropsychiatric changes. Method: Children with SLE and with NPSLE were evaluated using the Wechsler Intelligence Scale for Children (WISC-IV) and some selected subtests of the Neuropsychological Assessment for Children (NAC), which allowed us to measure the 7 cognitive areas proposed by the ACR. Both, SLE and NPSLE children performances were compared to scores obtained by children without any affection. Results: The area’s most affected in the NPSLE group were attention, working memory, processing speed, memory, and visuospatial ability; in the SLE group, the area’s most affected were processing speed, visuospatial ability, planning, and auditory memory. Conclusion: Based on our findings, it is concluded that frequently in both groups cognitive decline is present since early stages of illness, being more important in the NPSLE group. These deficiencies are heterogenous and with a multi-domain pattern.
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In an update on systemic lupus erythematous, this article provides an overview of the classification and available treatments for variants of cutaneous lupus erythematous. Also discussed are the induction and maintenance therapy for lupus nephritis, as well as other treatments to induce and maintain improvement and prevent further damage for lupus patients.
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Though pleuritis and pleural effusion are common in lupus patients they are distinctly rare as the initial manifestation of lupus. Diagnosis of lupus pleuritis is also a difficult task and often costly and lengthy immunological panels are employed to diagnose it. We report one case of systemic lupus erythematosus (SLE) presenting with lupus pleuritis as the first manifestation. We propose that demonstration LE cells have a very prominent role in differentiating lupus pleuritis from other causes of pleural effusions in SLE patients. We believe that our case is the first report from India which shows pleuritis may be a first manifestation of lupus.
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Measurement of disease activity in systemic lupus erythematosus (SLE) is central to evaluating outcomes, differences among SLE patient groups, responses to a new drug proposed, and also for assessing disease longitudinally for observational and clinical trials. Several validated and updated instruments have been available since the early 1980s, but more recent studies gauging reliability and validity for classifying and monitoring groups of patients in the research setting are now available.
Two cardinal features of SLE have challenged investigators refining these tools: first, the complex multisystem nature of this disease with fluctuating levels of disease activity, which may vary between patients and within the same patient over time; second, the absence of a “gold standard” for determining the psychometric properties of each proposed scale limits comparisons to expert opinion using a physician’s visual analog scale or by comparing one scale against other to assess performance across proposed instruments. However, these strategies do not eliminate bias based on personal experience, nor do they differentiate between different opinions on the relative importance of disease manifestations in different systems.
Therefore, an experience-based evaluation may be subject to greater interrater variability than the use of the disease activity instrument itself. Furthermore, psychometric properties should be influenced by the length of the scale (number of items and scoring scale), number of patients included, or disease severity of patients under study.
Two main types of activity measures in SLE have been developed: global score systems (for example, the European Consensus Lupus Activity Measurements, Systemic Lupus Activity Measure [SLAM], and Systemic Lupus Erythematosus Disease Activity Index [SLEDAI]), which provide an overall measure of activity, and individual organ/system assessment scales that assess disease activity in single organs (such as the British Isles Lupus Assessment Group Index [BILAG]). The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index score is a measure for chronic damage; it has been included due to its prognostic value in clinical and research basis.
The SLEDAI, SLAM, and BILAG have performed in effective and reliable manners in studies; furthermore, they correlate with one another (1-3). The SLEDAI, Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA)–SLEDAI, SLEDAI 2000 (4-7), and BILAG (8-10) have been successfully used in observational trials and case studies, although baseline disease activity index (DAI) scores were not always predictors of subsequent damage or other outcomes (11,12). These DAIs were validated in the context of long-term observational trials studies and not in randomized clinical trials (RCTs) (1,9,10,13-15). The few RCTs conducted have shown that improvement in DAI scores correlates with response rates, disease remission, and flare prevention; however, a threshold of clinically meaningful change has not been established (1,13,16,17). Current work has focused on developing a responder index developed in collaboration with the Food and Drug Administration–defined response as improvement and/or no deterioration in patient- and physician-reported outcomes. The SLE responder index, which utilizes the SELENA–SLEDAI score to determine global improvement, BILAG domain scores to ensure no significant worsening in heretofore unaffected organ systems, and physician’s global assessment to ensure that improvements in disease activity are not achieved at the expense of the patient’s overall condition, which may have been missed by either DAI, is one example used in a recent clinical trial (18). Ongoing work to refine or develop responder indices will enhance our ability to measure meaningful outcomes in future RCTs.
For purpose of this review, we selected those indices that have shown the strongest evidence of validity when used by investigators from different countries in large studies of patients with SLE. The exact choice of instrument should be governed by the purpose for which it is required in clinicalpractice or research.
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