Preclinical coronary endothelial dysfunction in Egyptian Behçet’s disease patients; Tc-99m sestamibi pharmacological Gated-SPECT,is it a useful screening tool?

IntroductionBehçet’s disease (BD) is an idiopathic multisystem disorder. Cardiac involvement[cardio-BD] occurs in 7–60% of BD patients. Technetium 99m-Methoxyisobutyl isonitrile (Tc-99m sestamibi) is a myocardial perfusion imaging agent that is used for evaluation of the coronary flow.Aim of the workTo evaluate the usefulness of Dipyridamole pharmacological stress test in conjunction with Tc-99m sestamibi cardiac gated single photon emission computed tomography (GSPECT) to investigate the prevalence of subclinical coronary endothelial dysfunction[SCED] in asymptomatic Egyptian BD patients; also to assess possibly associated clinical predictive variables.Patients and MethodsTwenty-five BD patients without overt cardiac involvement and fifteen healthy controls matched for age, BMI and sex were included. Database included full history, clinical examination, relevant laboratory tests, and Tc-99m sestamibi myocardial GSPECT with coronary angiography[CAG] in GSPECT positive cases. Disease activity was assessed using Behçet’s Disease Current Activity Form (BDCAF).ResultsSCED detected by reduced flow or left ventricular dysfunction (LVD) or both was found in 13/25[52%] of BD-patients[12 males and 1 female] vs. 1/15[6.7%] of controls[P < 0.0001] with normal CAG. Subjects with positive GSPECT had significantly older age[P = 0.01] and longer disease duration (P = 0.02) and were more frequently males (P < 0.0001) than those with negative GSPECT. No statistically significant differences between cases with negative and positive GSPECT were found regarding other clinical or laboratory parameters.ConclusionTc-99m sestamibi GSPECT could be a useful screening tool for detection of SCED in BD patients, so early prophylactic measures and therapy modifications could be considered.     

Bypassing proximal health care facilities for acute care: a survey of patients in a Ghanaian Accident and Emergency Centre

Objective To characterise the population that presents to the Accident and Emergency Centre (AEC) at Komfo Anokye Teaching Hospital (KATH) and to identify risk factors associated with bypassing proximal care facilities. Methods A structured questionnaire was verbally administered to patients presenting to the AEC over 2 weeks. The questionnaire focused on the use of health care resources and characteristics of current illness or injury. Measures recorded include demographics, socioeconomic status, chief complaint, transportation and mobility, reasons for choosing KATH and health care service utilisation and cost. Results The total rate of bypassing proximal care was 33.9%. On multivariate analysis, factors positively associated with bypassing included age older than 38 years (OR: 2.18, P 0.04) and prior visits to facility (OR 2.88, P 0.01). Bypassers were less likely to be insured (OR 0.31, P 0.01), to be seeking care due to injury (OR 0.42, P 0.03) and to have previously sought care for the problem (OR 0.10, P < 0.001). Conclusions Patients who bypass facilities near them to seek care at an urban AEC in Ghana do so for a combination of reasons including familiarity with the facility, chief complaint and insurance status. Understanding bypassing behaviour is important for guiding health care utilisation policy decisions and streamlining cost‐effective, appropriate access to care for all patients.     

中西医结合治疗新生儿呕吐51例

目的:观察中西医结合治疗新生儿呕吐的临床疗效。方法:选择2012年4月—2014年4月本院收治的102例患儿,随机分为观察组与对照组,每组各51例。对照组行西医常规治疗,观察组在对照组的基础上服用生大黄水,比较两组患儿的临床疗效。结果:观察组有效率为90.20%,对照组有效率为60.78%,两组有效率比较,差异具有统计学意义(P0.05)。观察组患儿呕吐停止时间与鼻饲停止时间分别为(51.67±30.02)h、(63.32±31.30)h,均显著优于对照组患儿的(74.35±30.22)h、(85.32±31.28)h,差异均有统计学意义(P0.05)。结论:中西医结合治疗新生儿呕吐可明显提高临床疗效,缩短疗程。     

Case for diagnosis

Idiopathic Atrophoderma of Pasini and Pierini (IAPP) is a rare, exclusively cutaneous disease. It is more frequent in females, with incidence peak in the second and third decades of life. The etiopathogenesis remains unknown. IAPP most commonly affects the back, abdomen and proximal regions of the limbs. Lesions may be rounded, oval or circular; single or multiple. The evolution is variable and the course is initially progressive. Collagen changes such as atrophy, thinning, condensation and sclerosis may be observed in the papillary dermis. This paper describes a case of Idiopathic Atrophoderma of Pasini and Pierini with histopathologic findings.