Left ventricular systolic dysfunction in rheumatoid disease: an unrecognized burden?

OBJECTIVES: This study sought to ascertain whether left ventricular systolic dysfunction (LVSD) is more common among clinic patients with rheumatoid disease (RD) compared with the general population, and to assess the diagnostic utility of brain natriuretic peptide (BNP). BACKGROUND: Patients with RD are at increased risk of ischemic heart disease. However, there are few large echocardiographic studies identifying cardiac dysfunction in RD. We hypothesized that LVSD would be more prevalent in RD patients than in the general population. METHODS: A total of 226 hospital out-patients with RD (65% women) underwent clinical evaluation, electrocardiography (ECG), echocardiography, and plasma BNP assay (218 patients). Prevalence of LVSD was compared with local population estimates. RESULTS: Definite LVSD (left ventricular ejection fraction <40%) occurred in 5.3% of the RD group: standardized prevalence ratio, 3.20; 95% confidence interval, 1.65 to 5.59. Median BNP values were higher in patients with LVSD compared with those without: 16.6 pmol/l versus 8.5 pmol/l, p < 0.005, although values between the two groups overlapped. One in nine patients with an abnormal ECG had definite LVSD. CONCLUSIONS: Definite LVSD was three times more common in RD patients than in the general population. Given the prognostic benefits of treating LVSD, echocardiographic screening of RD patients with an abnormal ECG may be worthwhile.     

Accessibility to biologics and its impact on disease activity and quality of life in patients with rheumatoid arthritis in Kuwait

Clinical Rheumatology - Biologics are indicated in rheumatoid arthritis (RA) in case of persistent high disease activity despite conventional disease-modifying anti-rheumatic drugs (cDMARDs) or...     

Basketing a basket: A novel emergency rescue technique

Fracture of the central lead wire of an impacted basket during a mechanical lithotripsy for large common bile duct(CBD) stones poses a special challenge.Different maneuvers have been described to resolve this problem.Most techniques require equipment or facilities which may not be readily available in small community hospitals.We present here a similar situation in a patient with a large stone at the level of the cystic duct.Through the duodenoscope,a smaller Dormia basket was introduced into the CBD along the side of the impacted broken basket.The tip of the impacted basket was grasped and,by pulling downwards,the basket was disengaged from the stone.The two baskets were then removed successfully.We suggest this simple technique should be tried initially,before resorting to more advanced procedures.     

Comparison of Sprint Fidelis and Riata defibrillator lead failure rates

Background/objectives

Sprint Fidelis and Riata defibrillator leads are prone to early failure. Few data exist on the comparative failure rates and mortality related to lead failure. The aims of this study were to determine the failure rate of Sprint Fidelis and Riata leads, and to compare failure rates and mortality rates in both groups.

Methods

Patients implanted with Sprint Fidelis leads and Riata leads at a single centre were identified and in July 2012, records were reviewed to ascertain lead failures, deaths, and relationship to device/lead problems.

Results

113 patients had Sprint Fidelis leads implanted between June 2005 and September 2007; Riata leads were implanted in 106 patients between January 2003 and February 2008. During 53.0 ± 22.3 months of follow-up there were 13 Sprint Fidelis lead failures (11.5%, 2.60% per year) and 25 deaths. Mean time to failure was 45.1 ± 15.5 months. In the Riata lead cohort there were 32 deaths, and 13 lead failures (11.3%, 2.71% per year) over 54.8 ± 26.3 months follow-up with a mean time to failure of 53.5 ± 24.5 months. There were no significant differences in the lead failure-free Kaplan–Meier survival curve (p = 0.77), deaths overall (p = 0.17), or deaths categorised as sudden/cause unknown (p = 0.54).

Conclusions

Sprint Fidelis and Riata leads have a significant but comparable failure rate at 2.60% per year and 2.71% per year of follow-up respectively. The number of deaths in both groups is similar and no deaths have been identified as being related to lead failure in either cohort.     

Dubin-Johnson syndrome with systemic lupus erythematosus: a case report

Introduction Dubin-Johnson syndrome (DJS) is a rare recessively inherited conjugated hyperbilirubi- nemia caused by deficiency of the canalicular multi-drug resistance/multi-specific organic anionic transporter protein (MDR2/cMOAT). Thus bilirubin is conjugated but inefficiently secreted into bile, which results in accumulation of conjugated and, to some extent, unconjugated bilirubin in blood, leading to hyperbilirubinemia and bilirubinuria. But, the results of liver function tests are no…     

Free radical scavenging (DPPH) potential in nine Mentha species

Mentha species are used in every day life in various food items. These species produce valuable secondary metabolites that scavenge toxic free radicals. Toxic free radicals can cause different diseases in the human body. In the present study free radical scavenging potential (1,1-diphenyl-2-picrylhydrazyl scavenging activity) in nine Mentha species were investigated to evaluate and explore new potential sources for natural antioxidants. The activity was performed after different time intervals with incubation period of 30 minutes. The methanolic extracts revealed that significantly higher activity (82%) was observed in Mentha suaveolens, followed by Mentha longifolia (79%), Mentha officinalis (76%) and Mentha piperita, Mentha pulegium, Mentha royleana (75%), respectively. Significantly same activity was observed in Mentha arvensis and Mentha spicata. Lower activity was observed in Mentha citrata (64%). The present study revealed that these species can be used as natural antioxidants.