How much of the increased incidence of heart failure in rheumatoid arthritis is attributable to traditional cardiovascular risk factors and ischemic heart disease?

Objective

To compare the proportion of the risk for the development of heart failure (HF) that is attributable to traditional cardiovascular (CV) risk factors, ischemic heart disease (IHD), and alcohol abuse between subjects with and subjects without rheumatoid arthritis (RA).

Methods

A population‐based inception cohort of RA patients was assembled along with a similar cohort of subjects without RA. All individuals were followed up through their complete medical records, until HF incidence, death, migration, or January 1, 2001. The attributable risk of HF was estimated as the difference between the observed cumulative incidence of HF in each cohort (estimated from multivariable Cox models and adjusted for the competing risk of death) and the predicted cumulative incidence of HF in the absence of risk factors, with results expressed as a percentage of the observed cumulative incidence.

Results

A total of 575 RA subjects and 583 non‐RA subjects (mean age 57 years, 73% women) without HF at incidence/index date had a mean followup of 15.1 and 17.0 years, respectively. During that period, 165 RA and 115 non‐RA subjects had a first episode of HF, with a cumulative incidence of 36.3% and 20.4%, respectively, at age 80 years. Among non‐RA subjects, 77% of the HF at age 80 years was attributable to CV risk factors, IHD, and alcohol abuse combined, whereas among RA subjects, only 54% of the HF at age 80 years was attributable to these factors (P < 0.01).

Conclusion

The excess risk of HF among RA patients is not explained by an increased frequency or effect of CV risk factors and IHD.

     

Livedo racemosa associated with central venous catheter use in a newborn

Livedo racemosa (LRac) refers to violaceous, red, or blue netlike mottling of the skin in an irregular pattern caused by circulatory abnormalities. Central venous catheters (CVC) are widely used in neonates who require intensive care to offer steady intravenous access. CVCs are covered with a hydrophilic polymer gel that reduces friction between the sheath and the vessel wall, thereby minimizing vascular spasm, irritation, and aneurysm formation. However, the introduction of foreign material into the vein carries a risk of embolization. Recently, LRac was reported as a cutaneous manifestation of hydrophilic polymer gel embolization (HPE) in adults. We present a case of LRac in a newborn that developed following CVC insertion and resolved spontaneously after the catheter was removed.     

Quality of life and self-esteem in women living with urinary incontinence in Turkey

This study was conducted to determine the quality of life and self-esteem levels of women with urinary incontinence (UI). A total of 180 women participated in this cross-sectional study. This study was conducted in two stages. First, the international consultation on incontinence questionnaire-UI short form (ICIQ-SF) was implemented, and then other measures were applied to the women who scored 8 or more as the most appropriate cut-off point for ‘irritating’ UI. More specifically, a personal information form, the Rosenberg self-esteem scale (RBSS), the urogenital distress inventory-6 (UDI-6), and the incontinence impact questionnaire-7 (IIQ-7) were applied. It was observed that the mean self-esteem score of women with UI was generally sufficient. In line with the data obtained, it was observed that as the UI levels of women increased, their quality of life decreased. Similarly, a decrease was observed in the self-esteem levels of women whose quality of life decreased. As a woman's UI worsens, levels of urogenital distress increase and quality of life decreases, which leads to decreased self-esteem. Urinary incontinence is often kept secret, ignored, considered private, and seen as an unavoidable consequence of ageing.     

Atypical and uncommon presentation of sarcoidosis with long segment involvement of the pharynx and larynx: Case report and review of literature

Pharynx/Larynx is an uncommon site of involvement of sarcoidosis. Isolated pharyngo-laryngeal sarcoidosis is extremely rare as most of the cases are part from multiorgan and systemic sarcoidosis. Pharyngo-laryngeal sarcoidosis is usually asymptomatic which could be attributed to its rare incidence as many cases pass unnoticed. Symptomatic cases usually present with hoarseness of voice. As the disease progress, the patient can present with progressive dysphagia to solid and liquid with globus sensation. We described an atypical involvement of almost the whole length of the pharynx with extension into the larynx in a 51-year-old woman who presented with progressive dysphagia. To the best of our knowledge, this is the first report to describe the imaging features of sarcoidosis involvement of the pharynx and larynx.