Differences in SLE disease activity between patients of Caucasian and South‐East Asian/Chinese background in an Australian hospital

Aim: We performed a semiprospective and retrospective review of all admissions to a single institution of systemic lupus erythematosus (SLE) patients, admitted due to active disease. The aim was to describe differences in disease activity as a cause of hospital admissions between patients originating from South‐East Asia/China (SAC) and Caucasians. Method: There were 210 patients admitted for active disease, with a total of 567 admissions for active SLE over a 16‐year period. Allowing for patients who had left our database, there was a total of 3415 patient years of observation. Results: Patients from SAC with a flare requiring admission presented earlier in their disease course and with more active disease than did Caucasians (median SLE Disease Activity Index 13 vs. 8, P= 0.002). They had longer inpatient stays (7 vs. 5 days P = 0.03). There was a trend to higher rates of re‐presentation to hospital for flare (59% in SAC patients vs. 41% in Caucasians, P = 0.09) with more subsequent admissions (3 vs. 2 P = 0.06) despite a shorter period of observation. Conclusions: South‐East Asian/Chinese were more likely to be diagnosed with class III/IV glomerulonephritis and require cyclophosphamide both at presentation and subsequent admissions. More patients from SAC were readmitted to hospital for severe central nervous system disease after their first hospital admission. In this population, lupus patients had more severe flares and more frequently required admission for these than Caucasians.     

Evaluating projects funded by the Western Australian Health Promotion Foundation: first results

The paper describes output measures of performance of the WesternAustralian Health Promotion Foundation (Healthway), using asystem known as graduated project evaluation (GPE). Resultsare reported at the basic and process levels of evaluation on588 health and sponsorship projects, and at the impact levelbased on surveys of 5710 spectators and participants at 53 sport,arts and racing events sponsored by Healthway funds. At thebasic and process levels the average Healthway project reached7449 people directly and generated media coverage of healthmessages on 27.3 occasions. It secured, on average, 0.99 healthystructural reforms in recreational or cultural venues, involvedthe participation of local community members in project administrationin 38% of instances, and provided 1596 person-hours of healtheducation. Non-smoking, safe drinking, nutrition, exercise,sun protection, safe sex and injury prevention health messageswere promoted using 24 different types of sponsor benefits.Of the 5710 respondents surveyed post-event, 67% were awareof the promoted health message and 82% of these understood whatthe message meant. Four per cent of all respondents intendedto take action ranging from seeking information to adoptingthe health behaviour. A comparison of the cost-effectivenessof small and large sponsorship projects is given to illustratethe use of GPE to inform funding decisions. Smaller projectsoutperformed larger projects on all available indicators. Wediscuss the peculiar features of the health promotion foundationconcept, methods to improve its performance and implicationsfor future research.     

LOCAL RADIOTHERAPY FOR PEDAL MANIFESTATIONS OF HLA-B27-RELATED ARTHROPATHY

Four males with characteristic foot manifestations of HLA-B27-relatedarthropathy are reported. The severity of this problem and itsrecalcitrance to standard therapies led to the use of localradiotherapy. The beneficial outcome and minimal short-termside effects of this treatment are discussed in relation toprevious experience with radiotherapy in ankylosing spondylitis. KEY WORDS: HLA-B27, Radiotherapy, Spondyloarthropathy, Enthesopathy     

NEUROPSYCHIATRIC MANIFESTATIONS OF SYSTEMIC LUPUS ERYTHEMATOSUS

Forty-six episodes of major neuropsychiatric manifestations of systemic lupus erythematosus occurring in 35 patients over a ten-year period were reviewed. The frequency of central nervous system SLF was lower than that reported from overseas referral centres. Glucocorticosteroid treatment did not precipitate psychiatric problems in this group. Whilst neuropsychiatric recovery was the rule, such features indicated a subgroup of SLE with high short-term mortality.     

BRUCELLOSIS COMPLICATED BY AORTIC VALVE ENDOCARDITIS

A 30 year old veterinary surgeon developed a febrile illness with serological evidence of Brucellosis. He was known to have aortic valve disease and during the course of the illness, the clinical features of endocarditis became evident, with a vegetation visible echocardiographically on the aortic valve. Because of persisting fever despite appropriate antibiotic therapy, aortic valve replacement with a viable cryopreserved allograft aortic valve was undertaken. Organisms consistent with Brucella species were demonstrated in the excised vegetation. The patient received a six week course of antibiotics and his post-operative course was uneventful.     

Left Septal Atrial Tachycardias: Electrocardiographic and Electrophysiologic Characterization of a Paraseptal Focus

Left Septal Atrial Tachycardias. Objective: The objective was to characterize the electrocardiographic and electrophysiological features of focal atrial tachycardia (FAT) originating from the left septum (LS). Background: FAT is recognized to occur at predefined anatomic locations rather than randomly throughout the atria. We describe the ECG and EP features of ATs originating from the LS as an important site for apparent perinodal tachycardias. Methods: Nine patients presenting with LS FAT from a consecutive series of 384 underwent EP/RFA for symptomatic FAT. Results: The mean age was 56 ± 12 years; 7 female with symptoms for 36 ± 28 months. P wave morphology (PWM) was negative/positive in lead V1 and across the precordial leads and negative or negative/positive in inferior leads in all patients. Tachycardia was incessant in 6 out of 9 patients with a mean tachycardia cycle length 421 ± 56 milliseconds. His A was ahead of P wave in all patients (mean ?15 ± 5 milliseconds) and earlier than CS proximal (mean 4 ± 9 milliseconds). Successful acute focal ablation achieved at a mean of 31 ± 12 milliseconds ahead of P wave with no recurrences at a mean follow‐up of 30 ± 28 months. Conclusion: Although the left septum is an uncommon site for focal AT an awareness of this location for harboring foci is particularly important when mapping apparently right‐sided septal tachycardias. (J Cardiovasc Electrophysiol, Vol. 24, pp. 413‐418, April 2013)     

Moderating drinking by correspondence: an evaluation of a new method of intervention

Recognizing the need to offer alternative methods of brief interventions, this study developed correspondence treatments for low-dependent problem drinkers and evaluated their impact. One hundred and twenty-one problem drinkers were recruited by media advertisements and were randomly allocated to a full cognitive-behavioural treatment programme (CBT) or to a minimal intervention condition (MI) that gave information regarding alcohol misuse and instructions to record drinking. As predicted, CBT was more effective than MI in reducing alcohol consumption over the 4-month controlled trial period. CBT produced a 50% fall in consumption, bringing the average intake of subjects within recommended maximum levels. Treatment gains at 6 months were well maintained to 12 months. High levels of consumer satisfaction, a high representation of women and a substantial participation from isolated rural areas attested to the feasibility of the correspondence programme as an alternative treatment. However, some drinking occasions still involved high intake for a significant subgroup of subjects, and this issue will be addressed in future programmes. The results supported the use of correspondence delivery as a means of promoting early engagement and equity of access between city and country areas.     

Retrieval of Right Heart Fragments from Implanted Venous Access Catheters in Patients with Malignancy

Chronically implanted venous access catheters are frequently used in patients with malignancy. Fracture and embolization of these catheters may occur during placement, chronic use, or removal. We report four consecutive cases of percutaneous retrieval of catheter fragments from the right heart circulation. A snare formed from an exchange length angioplasty guidewire inserted through a guiding catheter was used successfully in all four patients without complications. Resolution of arrhythmias, chest discomfort, and infection followed the retrieval of the fragments. As larger numbers of patients receive chronically implanted venous catheters, the invasive cardiologist must be familiar with methods of removal. (J Interven Cardiol 1989:2:4)