Relapsing polychondritis associated with hepatitis C virus infection

This article is aimed to review of relapsing polychondritis (RP) and its association to hepatitis C virus (HCV) infection. A case of RP associated with HCV infection in a 59-year-old male is reported. The English medical literature was reviewed for RP and its association with HCV infection. RP is a rare autoimmune and multisystem disorder of unknown etiology in which the cartilaginous and related tissues are the primary targets of inflammation. HCV infection is a more common systemic illness with known hepatic and extra-hepatic manifestations. Although RP is associated with other diseases in about 35% of cases, only one case of RP, HCV, and mixed cryoglobulinemia has been reported. We report a case of RP associated with HCV infection. Treatment with pegylated interferon and ribavirin resulted in sustained virologic response and remission of treatment-resistant RP with azathioprine. We report a case of RP and associated HCV infection. Although treatment of HCV infection resulted in remission of RP, it is unknown if there is a causal relationship between HCV infection and RP.     

Virtual rheumatology appointments during the COVID-19 pandemic: an international survey of perspectives of patients with rheumatic diseases

Clinical Rheumatology -     

Group visits for rheumatoid arthritis patients: a pilot study

This pilot study explored the feasibility of a group visit model for patients with rheumatoid arthritis (RA) and for medical staff at a private practice. RA patients were invited to attend six 3.5-h-long group visit sessions held once per month at a wellness center. Each included group discussion, individual patient examinations, interactive question, and answer periods, and topic-specific presentations from various health professionals. Nineteen of the 24 RA patients invited to the group visits agreed to attend, and 13 to 15 were present at any given session. Participants expressed a high level of satisfaction in evaluation forms completed at the end of the last session. Group visits allowed the rheumatologist to spend more time providing advice for various health issues and eliminated the need to repeat advice about common issues. This group visit model is feasible for motivated RA patients who can meet the time commitment involved.     

Isolated liver nodules.

Thirteen examples of isolated liver nodules were examined in 7 persons, 4 with single nodules and 3 with multiple nodules. Pathologically they present a spectrum from a solid structure that resembles liver parenchyma with varying degrees of disorganization and fibrosis to soft and fatty enough to superficially resemble a lipoma. Abnormal blood vessels were commonly found in and around the nodules, and the nodules were all ischemic compared to surrounding normal liver. The association of abnormal blood vessels and ischemia may be a cause and effect relationship. Studies by angiography might prove two things: (1) that the presence of abnormal blood vessels is constant in the lesions; (2) that the vessels, although relatively large, fail to provide adequate blood supply to the area, either by lack of branches or by some type of shunting mechanism. Review of cases of "lipoma of the liver" reported in the literature suggest that the lesions described are, in fact, the fatty type of isolated liver nodules.     

Adverse events detected by clinical surveillance on an obstetric service

OBJECTIVE: Adverse events are adverse patient outcomes resulting from medical care. We performed this study to estimate the rate of adverse events and potential adverse events-errors that have a high likelihood of causing patient harm-occurring during obstetric care. METHODS: This was a prospective cohort study of an obstetric unit in a teaching hospital. We included patients admitted consecutively to the hospital. A trained observer monitored patients for 72 triggers, which were predefined occurrences deemed likely to indicate an actual or potential adverse event. When a trigger occurred, the observer captured information describing it. A five-person multidisciplinary team, including the observer, three physicians, and a hospital risk manager, judged whether the trigger represented an adverse event or potential adverse event. Adverse events were further characterized as preventable. RESULTS: The cohort included 425 patients; 47% were in active labor. We identified 110 triggers. Nine were considered adverse events (risk 2%, 95% confidence interval [CI] 1-4%, rate 0.8 events per 100 patient days), and six were preventable (risk 1%, 95% CI 0-3%, rate 0.5 events per 100 patient days). The remaining triggers included 14 potential adverse events (risk 3%, 95% CI 2-5%, rate 1.3 events per 100 patient days). No adverse event resulted in permanent disability or death. Adverse events and potential adverse events were most commonly "system" problems, such as unavailable staff or operating rooms, or poor fetal outcomes, such as trauma to the newborn. CONCLUSION: Serious adverse events occur infrequently on an obstetric service. However, important quality problems are common and should be targeted for improvement. LEVEL OF EVIDENCE: II-2.