Several new treatment modalities with different mechanisms of action have been studied in patients with Behçet's syndrome (BS). The aim of the current effort was to update the recommendations in the light of these new data under the auspices of the European League Against Rheumatism (EULAR) Standing Committee for Clinical Affairs. A task force was formed that included BS experts from different specialties including internal medicine, rheumatology, ophthalmology, dermatology, neurology, gastroenterology, oral health medicine and vascular surgery, along with a methodologist, a health professional, two patients and two fellows in charge of the systematic literature search. Research questions were determined using a Delphi approach. EULAR standardised operating procedures was used as the framework. Results of the systematic literature review were presented to the task force during a meeting. The former recommendations were modified or new recommendations were formed after thorough discussions followed by voting. The recommendations on the medical management of mucocutaneous, joint, eye, vascular, neurological and gastrointestinal involvement of BS were modified; five overarching principles and a new recommendation about the surgical management of vascular involvement were added. These updated, evidence-based recommendations are intended to help physicians caring for patients with BS. They also attempt to highlight the shortcomings of the available clinical research with the aim of proposing an agenda for further research priorities.

BackgroundPericonceptional use of vitamin supplements containing folic acid reduces the risk of a neural tube defect (NTD). In November 1998, food fortification with folic acid was mandated in Canada, as a public health strategy to increase the folic acid intake of all women of childbearing age. We undertook a comprehensive population based study in Newfoundland to assess the benefits and possible adverse effects of this intervention.MethodsThis study was carried out in women aged 19–44 years and in seniors from November 1997 to March 1998, and from November 2000 to March 2001. The evaluation was comprised of four components: I) Determination of rates of NTDs; II) Dietary assessment; III) Blood analysis; IV) Assessment of knowledge and use of folic acid supplements.ResultsThe annual rates of NTDs in Newfoundland varied greatly between 1976 and 1997, with a mean rate of 3.40 per 1,000 births. There was no significant change in the average rates between 1991–93 and 1994–97 (relative risk [RR] 1.01, 95% confidence interval [CI] 0.76–1.34). The rates of NTDs fell by 78% (95% CI 65%–86%) after the implementation of folic acid fortification, from an average of 4.36 per 1,000 births during 1991–1997 to 0.96 per 1,000 births during 1998–2001 (RR 0.22, 95% CI 0.14–0.35). The average dietary intake of folic acid due to fortification was 70 μg/day in women aged 19–44 years and 74 μg/day in seniors. There were significant increases in serum and RBC folate levels for women and seniors after mandatory fortification. Among seniors, there were no significant changes in indices typical of vitamin B12 deficiencies, and no evidence of improved folate status masking haematological manifestations of vitamin B12 deficiency. The proportion of women aged 19–44 years taking a vitamin supplement containing folic acid increased from 17% to 28%.ConclusionsBased on these findings, mandatory food fortification in Canada should continue at the current levels. Public education regarding folic acid supplement use by women of childbearing age should also continue.

(Accepted 10 February 1999)Relation of Chlamydia pneumoniae serology to mortality and incidence of ischaemic heart disease over 13 years in the Caerphilly prospective heart disease study AbstractObjectives To investigate the effect of Chlamydia pneumoniae infection on future development of ischaemic heart disease and mortality. Design Prospective longitudinal study. Setting Caerphilly, South Wales. Subjects Plasma specimens were collected during 1979-83 from 1773 men aged 45-59 years. These were tested for IgG and IgA antibodies to C pneumoniae (TW183) by microimmunofluorescence. Outcome measures 13 year mortality and incident ischaemic heart disease events were ascertained from death certificates, hospital records, and electrocardiographic changes at follow up every 4 to 5 years.Results 642 men (36.2%) had IgG antibodies at a titre of >1 in 16, of whom 362 (20.4% of all men) also had detectable IgA antibodies. The prevalence of ischaemic heart disease (a history of past or current disease) at entry was similar at all IgG antibody titres but was positively related to IgA antibody titre. IgA antibody titre was positively correlated with plasma viscosity but not with other cardiovascular risk factors.

The seasonal flight activity of both sexes of the eastern hemlock looper, Lambdina fiscellaria fiscellaria Guenée (Lepidoptera: Geometridae) was studied during two consecutive years in Quebec and Newfoundland, using light (L), pheromone (P) and combined light and pheromone (LP) traps. Moth density significantly affected the performance of the different traps, with P traps being more effective at low than high density. However, P trap catches decreased just prior to the onset of female captures, probably as a result of competition between traps and virgin calling females. Nearly all females caught in L and LP traps were already mated and even the first females caught had laid at least half of their egg complement. In Quebec under warm nights, the pattern of male activity occurred at different times, with peak P catches being later in the scotophase than those of L traps, but overall similar numbers of males were caught in both traps. In contrast, under cool nights, males were caught early in the night in both P and L traps, suggesting a strong competition effect between traps, although more males were caught in P than L traps overall. In Newfoundland, the pattern of male captures in L and P traps was similar at both high and low temperatures, so competition between trap types would always be high. Under these conditions P traps were more effective than L traps. Irrespective of the region, year or temperature, significantly more males were captured in LP, with the effect of L and P being additive. In both regions, females responded similarly to L and LP traps with peak activity occurring early in the night. Captures of females were lower than those of males under cool temperatures, suggesting that the temperature threshold for flight is higher for females. The use of L and P traps simultaneously and/or in combination is discussed in relation to integrated pest management programs and ecological considerations.

The majority of studies related to major organ involvement that informed the updated EULAR recommendations for the management of BS were observational studies.

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Our data support the stepwise approach to management of BCS, with very good outcomes from venoplasty combined with stenting when required. TIPSS should only be offered where HV interventions are not feasible or unsuccessful.