Rheumatoid arthritis and membranoproliferative glomerulonephritis: an unusual case

SUMMARY: Renal involvement is not uncommon in rheumatoid arthritis (RA). Many RA patients have renal dysfunction either secondary to the drugs used to treat arthritis or because of the chronic inflammation. Renal pathologies have often included amyloidosis, drug-related renal disease and mesangial glomerulonephritis. However, membranoproliferative glomerulonephritis has only been rarely reported. We report a case of rheumatoid arthritis associated with membranoproliferative glomerulonephritis that rapidly progressed to end-stage renal disease.     

Expansion of Patient Education Programming Regarding Live Donor Liver Transplantation via Virtual Group Encounters During the COVID-19 Pandemic

During the coronavirus 2019 pandemic we converted our liver transplant waitlist candidate education and support program to a virtual format and expanded it to include ongoing engagement sessions aimed to educate and empower patients to maximize opportunity for live donor liver transplantation. Over a period of 6 months from April 2020 to Sept 2020 we included 21 patients in this pilot quality improvement program. We collected data regarding patient response and potential donor referral activity. Overall, patient response was positive, and some patients saw progress toward live donor liver transplantation by fostering inquiry of potential live liver donors. Optimization of logistical aspects of the program including program flow, technology access, and utilization is required to enhance patient experience. Long-term follow-up is needed to assess impact on the outcome of transplantation rates. Future data collection and analysis should focus on assessment of any potential disparity that may result from utilization of virtual programming. Herein we provide a framework for this type of virtual program and describe our experience.     

Bahcesehir long-term population-based screening compared to National Breast Cancer Registry Data: effectiveness of screening in an emerging country

PURPOSEWe aimed to show the effects of long-term screening on clinical, pathologic, and survival outcomes in patients with screen-detected breast cancer and compare these findings with breast cancer patients registered in the National Breast Cancer Registry Data (NBCRD).METHODSWomen aged 40–69 years, living in Bahcesehir county, Istanbul, Turkey, were screened every 2 years using bilateral mammography. The Bahcesehir National Breast Cancer Registry Data (BMSP) data were collected during a 10-year screening period (five rounds of screening). BMSP data were compared with the NBCRD regarding age, cancer stage, types of surgery, tumor size, lymph node status, molecular subtypes, and survival rates.RESULTSDuring the 10-year screening period, 8758 women were screened with 22621 mammograms. Breast cancer was detected in 130 patients; 51 (39.2%) were aged 40–49 years. The comparison of breast cancer patients in the two programs revealed that BMSP patients had earlier stages, higher breast-conserving surgery rates, smaller tumor size, more frequent negative axillary nodal status, lower histologic grade, and higher ductal carcinoma in situ rates than NBCRD patients (p = 0.001, for all).CONCLUSIONThese results indicate the feasibility of successful population-based screening in middle-income countries.

Breast cancer is the most frequent cancer and cause of cancer-related deaths among Turkish women, as well as globally (1–5). Although the incidence of breast cancer increases every year, mortality rates are decreasing in developed countries because of nationwide screening programs and modern treatment options (5, 6). An invited mammography screening program for women aged between 40 and 69 years revealed a 60% reduction in cancer-related 10-year mortality in a landmark study (7). A systematic review of Myers et al. (8) showed that breast cancer screening reduced mortality by 20% in average-risk women of all age groups. However, this review did not evaluate the differences between annual and biannual mammographic screening.In 2004, the Cancer Control Department of Turkey recommended biannual mammographic screening for women aged 50–69 years, based on European Guidelines. The population of Turkey is relatively young, and almost half of all breast cancer patients in Turkey are younger than 50 years. According to and National Breast Cancer Registry Data (NBCRD) reports, the starting age for mammography screening was set as 40 years. The Bahcesehir Mammographic Screening Program (BMSP) was the first organized population-based 10-year (2009–2019) mammography screening program in Turkey, a middle-income country.Turkish Federation of Breast Diseases Societies started a voluntary data registry program that was provided by breast surgeons working in secondary or tertiary hospitals. This program aimed to collect detailed information of breast cancer patients and to pool comprehensive country-specific breast cancer data. This registry, namely the NBCRD, was the first specified database on breast cancer in the country and was started in 2005, before the BMSP (9). Data from 36 centers were collected for 10 years. However, the cancer registry is a standard database containing general information as defined by the International Agency for Research on Cancer standards.The aim of this study was to show the feasibility of a population-based breast cancer screening program in an emerging, middle-income country, Turkey. The objective of our study was to evaluate the effectiveness of a population-based breast cancer screening program by comparing it with NBCRD data.     

Is multiple sclerosis a risk factor for atherosclerosis?

BackgroundMultiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. We aimed to discuss possible predisposing factors to atherosclerosis such as carotid intima-media thickness (CIMT) and high-sensitivity C-reactive protein (Hs-CRP) levels in MS.MethodsThirty-five ambulatory patients with relapsing-remitting MS (RRMS) (22 females and 13 males) and 34 healthy controls (21 females and 13 males) with similar demographic variables were included. Blood cell counts, cholesterol levels, vitamin D and B12, Hs-CRP levels, body mass index (BMI), history of smoking, and CIMT of both groups, Expanded Disability Status Scale (EDSS) scores, and disease duration of patients were recorded. Patients with a history of other vascular diseases such as hypertension, diabetes mellitus, peripheral artery disease, and acute relapses were excluded.ResultsSixty-nine participants were included. The mean age of the study population was 35.8 ± 7.1 years. Right CIMT was significantly greater in the patient population (P < 0.001). Spearman's correlation coefficient between age and right CIMT was r = 0.41, P = 0.01. When we compared the Hs-CRP with a cut-off value of ≤ 3, the right, left, and mean CIMT levels were not statistically significant (P = 0.17; P = 0.22; P = 0.15). The mean serum vitamin D levels were higher in the patient group and this was statistically significant (P < 0.001). The statistically significant factors identified with univariate analysis with P < 0.2 were further entered into multivariate modelling.ConclusionCIMT seems to be affected in patients with MS by means of the disease itself and age. Thus, CIMT might reflect the predisposition to subclinical atherosclerosis more than Hs-CRP. Further investigation in a large MS population is still needed.     

Single-Center Study of 72 Patients with Severe Combined Immunodeficiency: Clinical and Laboratory Features and Outcomes

Journal of Clinical Immunology - Severe combined immunodeficiency is an inborn error of immunity characterized by impairments in the numbers and functions of T and B lymphocytes due to various...     

Role of the coronary sinus in maintenance of atrial fibrillation

INTRODUCTION: Bursts of tachycardia arising in the pulmonary veins may play an important role in perpetuating atrial fibrillation (AF). However, the role of the coronary sinus (CS) in the perpetuation of AF has been unclear. The aim of this study was to determine whether the CS plays a role in perpetuation of AF. METHODS AND RESULTS: Pulmonary vein isolation was performed by segmental ostial ablation with radiofrequency energy in 22 consecutive patients with paroxysmal AF. Bipolar and unipolar electrograms recorded in the left atrium and CS were analyzed during atrial pacing from the mitral annulus and during AF. There was a mean of 2.5 +/- 0.5 electrical connections between the CS and the left atrium. The electrical connections between the left atrium and CS were ablated with a mean of 6.2 +/- 2.7 minutes of radiofrequency energy applied along the atrial side of the inferior mitral annulus. During AF, episodes of intermittent tachycardia alternated between the left atrium and the CS. Among the 22 patients, sustained AF was still inducible in 9 after pulmonary vein isolation. After electrical disconnection of the CS from the left atrium, sustained AF was inducible in only 3 of these 9 patients. CONCLUSION: The CS may be a source of rapid repetitive electrical activity during AF. The lower probability of inducible sustained AF after electrical disconnection of the CS from the left atrium suggests that the CS may play a role in perpetuating AF.