No abstract

Purpose Retinopathy of prematurity (ROP) is a leading cause of worldwide childhood blindness with increasing incidence in low and middle income countries (LMICs) due to advances in neonatal care. There are insufficient numbers of healthcare professionals specialized in ROP management and few local training opportunities in LMICs. Social media platforms provide a promising solution to enable interactive medical education across geographic and logistic barriers. As an adjunct to an ROP training program for ophthalmologists in Armenia, we implemented a Facebook Virtual Examination Room (VER) for case discussion with a global community of collaborators and preceptors. To evaluate training through VER, we operationalized engagement as a multilayer meta-construct that includes cognitive, behavioral, and social-emotional domains. Methods A concurrent mixed methods approach was taken to collect and analyze data from comments and activities within VER. Quantitative data was analyzed for descriptive statistics on group utilization, participant activity, and clinical metrics. Qualitative data was analyzed by conducting thematic analysis involving initial and pattern coding. Results Ten participants (7 trainees and 3 preceptors) interacted in the Facebook group across 153 unique cases, with 218 threads, 414 comments, and 216 likes. Of the 120 unique cases eligible for consensus evaluation, treatment was mentioned most frequently (87), followed by location (68), staging (65), and plus disease (31), with agreement ranging from 67% to 97%. Based on the qualitative analysis, the most common themes of discussion were clinical management, dilemma resolution, knowledge growth, and gratitude. Conclusion A closed Facebook group for case-based discussions can be a useful adjunct to an existing ROP training program by engaging learners across social-emotional, behavioral, and cognitive domains. For international training partnerships, the financial and logistical advantages can be significant, though focus should remain on the primary curriculum and training modality.

BackgroundArthritis is one of the most common causes of people's disability in the world. Recent years investigations were done to find biomarkers which can help in differentiating the type of arthritis, to evaluate the correlation between marker and disease severity. A purine nucleoside adenosine possesses anti-inflammatory activity via decreasing the level of pro-inflammatory cytokines, increasing the level of anti-inflammatory cytokines and represents one of the potent regulators of the inflammatory response. Adenosine deaminase (ADA) metabolizes adenosine to inosine, decreasing its anti-inflammatory activity. The significant elevation of ADA activity in rheumatoid arthritis (RA) and other inflammatory joint disorders has been observed. In our earlier study we have shown that the ADA activity can be used as a biomarker suitable for RA and osteoarthritis differentiation (1). The cutoff value of the enzyme activity in synovial fluid (SF) for differentiating these diseases in Armenian population has been evaluated. We observed the increasing of small-molecular (SADA, catalytic unit) to large-molecular (LADA, a complex of the catalytic unit with ADA-binding protein) isoforms ratio in RA SFs at increasing of the total activity of enzyme. The linear correlation between the initial activity and the SM/LM ratio of ADA isoforms has been shown (correlation coefficient r =0.97, P=0.0017).ObjectivesThe aim of the present investigation was to analyze the levels of ADA activity in SFs of patients with different arthritis and their probable correlation with the SADA/LADA ratios in various cases.MethodsThe SFs of RA, reactive arthritis, ankylosing spondylitis and gout patients were studied. The activity of ADA was assayed, evaluating the amount of ammonia, liberated in the reaction of adenosine deamination. To compare the levels of SADA and LADA isoforms, the SFs were subjected to gel-filtration on the column with G-200 Sephadex. The elution diagrams regarding the ADA activity in the obtained fractions were constructed.ResultsThe values of ADA activity in SFs of different arthritis mainly scatter in the higher region of the enzyme activities in SFs of RA. The elution diagrams after G-200 Sephadex gel-filtration of SFs of various arthritis manifested the absence or very low levels of SADA isoform even at high total initial activity of the enzyme. That excluded any correlation between the total activities of the enzyme and the ratios of its isoforms.ConclusionsThe earlier observed and proved in this study significant correlation between total activity of ADA and its isoforms ratio at RA might be in account of the SADA release from the damaged synoviocytes. This phenomenon appeared specific for RA and was not observed in the other arthritis types. We can conclude that the mechanism of joint inflammation at RA has some peculiarities, which may be a subject of special future study.ReferencesA.A. Antonyan et al. Adenosine deaminase activity in synovial fluid at arthritis. Proceedings of the YSU, Chemistry and biology, 2013, N3, p. 2...

No abstract

Background During last years, the great attention is paid to the identification of biomarkers which can help in differentiating the type of arthritis. The recent studies have shown Adenosine deaminase (ADA) can be useful in this regards [1]. ADA, an enzyme of purine metabolism, catalyses the irreversible deamination of (deoxy)adenosine to (deoxy)inosine. It plays a significant role in the immune system [2]. The enzyme is released into synovial fluid followed by significant elevation of its activity during inflammatory joint disorders such as rheumatoid arthritis (RA). Endogenous adenosine, a substrate of ADA, is provided with tissue protective property against damages. It’s anti-inflammatory effect is conditioned by decreasing the level of pro-inflammatory cytokines, increasing the level of anti-inflammatory cytokines, cytokine modulation of macrophage and monocytes and regulation of endothelial cell inflammatory functions. Therefore, ADA can help in understanding some pathologic aspects of diseases, in relieving the triggering factors of inflammation and promoting a new diagnostic approach. Objectives The goals of this work were to compare the levels of ADA activity in synovial fluid of patients with RA and osteoarthritis (OA), to determine the proper cut-off level for ADA in differentiating of RA and OA, to calculate the sensitivity and specificity of ADA-test. Methods The study involved 40 patients (23 - with RA and 17- with OA). They were diagnosed according to the accepted classification criteria of diseases. Synovial fluid samples obtained from patients and stored at -20°C, were refrozen, centrifuged, diluted three times and the aliquots were taken for the enzyme assay. The ADA activity was assayed by evaluation of ammonia amount, liberated in the reaction of adenosine deamination, using a phenol-hypochlorite colorimetric method. Statistical analyses were performed with GraphPad software, version 3, for Windows (USA). Unpaired two-tailed t-test with Welch correction was applied. Results The obtained mean values of ADA activity were 33.9 ± 22.4 (mean ± SD) IU/L (maximum – 99.6, minimum – 10.5) in RA patients and 4.6 ± 3.99 (mean ± SD) IU/L (maximum - 12.7, minimum - 0.3) in OA patients. They evidence statistically significant difference (p < 0.0001) between ADA levels in joint synovial fluid in RA and OA patients. The optimal cut-off value of ADA activity for differentiating these diseases was evaluated using ROC curve method as 12 IU/l. Based on this value, for ADA test, the sensitivity (the ratio of positive diagnoses - 22, to the sum of this number and the number of false negative diagnoses - 1), was 96%, the specificity (the ratio of negative diagnoses - 15, to the sum of this number and the number of the false positive diagnoses - 2), was 88%. Conclusions In spite of limited number of studied samples, the obtained data on ADA activity are statistically significant and evidence the high specificity and sensitivity of the test. However, it requires further study on a larger number of patients with inf...