Ventricular arrhythmia predicts poor outcome in polymyositis/dermatomyositis with myocardial involvement

Rheumatology ◽  
2020 ◽  
Author(s):  
Yongfa Huang ◽  
Huazhen Liu ◽  
Chanyuan Wu ◽  
Ligang Fang ◽  
Quan Fang ◽  
...  

Abstract Objective Myocardial involvement (MCI) is known to increase morbidity and mortality in polymyositis (PM) and dermatomyositis (DM). This study aims to investigate whether complicating with ventricular arrhythmia (VA) predicts poor outcomes in patients with PM/DM-related myocardial involvement (PM/DM-MCI). Methods We reviewed all PM/DM-MCI patients admitted in Peking Union Medical College Hospital from October 1997 to April 2019. VA and the other possible risk factors for the composite end point, including death from any cause and rehospitalization for cardiac causes, were analysed. Results A total of 75 PM/DM-MCI patients (44 PM and 31 DM) were enrolled, of which 27 (36%) met the composite end point during a median follow-up of 24 months. Independent prognostic factors for the composite end point includes VA (HR 4.215, 95% CI [1.737, 10.230]), NT-proBNP > 3415 pg/ml (HR 2.606, 95% CI [1.203, 5.646]), interstitial lung disease (HR 2.688, 95% CI [1.209, 5.978]), and anti-cardiac remodelling therapy (HR 0.302, 95% CI [0.115, 0.792]). The 3-year event-free survival rate of patients without VA was significantly higher than that of patients with VA (63.3% vs 40.7%, p = 0.034). Skin lesions (OR 0.163, 95% CI [0.051, 0.523]) and positive antimitochondrial antibody (OR 3.484, 95% CI [1.192, 10.183]) were independent predictors of VA. Conclusion VA provides prognostic insights for PM/DM-MCI patients and predicts poor outcome. Polymyositis and positive antimitochondrial antibody are closely associated with the presence of VA in PM/DM-MCI.

2020 ◽  
Vol 20 (2) ◽  
pp. 61-64
Author(s):  
Mohammad Mahfuzur Rahman Chowdhury ◽  
Rifat Zaman ◽  
Md Amanur Rasul ◽  
Akm Shahadat Hossain ◽  
Shafiqul Alam Chowdhury ◽  
...  

Introduction and objectives: Congenital ureteropelvic junction obstruction (UPJO) is the most common cause of hydronephrosis. Management protocols are based on the presence of symptoms and when the patient is asymptomatic the function of the affected kidney determines the line of treatment. Percutaneous nephrostomy (PCN) became a widely accepted procedure in children in the 1990s. The aim of the study was to evaluate the results of performing percutaneous nephrostomy (PCN) in all patients with UPJO and split renal function (SRF) of less than 10% in the affected kidney, because the management of such cases is still under debate. Methods:This prospective clinical trial was carried out at Dhaka Medical College Hospital from January 2014 to December 2016. Eighteen consecutive patients who underwent PCN for the treatment of unilateral UPJO were evaluated prospectively. In these children, ultrasonography was used for puncture and catheter insertion. Local anesthesia with sedation or general anesthesia was used for puncture. Pig tail catheters were employed. The PCN remained in situ for at least 4 weeks, during which patients received low-dose cephalosporin prophylaxis. Repeat renography was done after 4 weeks. When there was no significant improvement in split renal function (10% or greater) and PCN drainage (greater than 200 ml per day) then nephrectomies were performed otherwise pyeloplasties were performed. The patients were followed up after pyeloplasty with renograms at 3 months and 6 months post operatively. Results: All the patients had severe hydronephrosis during diagnosis and 14 patients with unilateral UPJO were improved after PCN drainage and underwent pyeloplasty. The rest four patients that did not show improvement in the SRF and total volume of urine output underwent nephrectomy. In the patients with unilateral UPJO who improved after PCN drainage, the SRF was increased to 26.4% ±8.6% (mean± SD) after four weeks and pyeloplasty was performed. At three and six months follow-up, SRF value was 29.2% ±8.5% and 30.8.2% ±8.8% respectively. Conclusion: Before planning of nephrectomy in poorly functioning kidneys (SRF < 10%) due to congenital UPJO, PCN drainage should be done to asses improvement of renal function. Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.61-64


2020 ◽  
Vol 22 (2) ◽  
pp. 89-94
Author(s):  
Nasir Uddin Mahmud ◽  
ABM Khurshid Alam ◽  
Mohammad Altaf Hossain Chawdhury ◽  
Mohammad Abul Khair

Background : Pilonidal sinus was first described by Dr. A.W. Anderson in 1847 and is often seen in the intergluteal region. It is a disease of mainly younger male and rarely affects after 40. Main causes for the formation of this sinus are hirsutism, sweating in the area, repeated maceration due to trauma, leading to breakage of the skin barrier, attracting hair inside which initiates a foreign body reaction leading to infection with abscess or sinus formation. Most common embarrassing situation is discharging sinus. The diagnosis is mainly on clinical ground. Though there are a lot of modalities of treatment but recurrence is still a challenge. We have adopted Limberg flap technique since 2012 with a least recurrent chance. Objectives : To prove that this procedure will be end up with lower morbidity & least chance of recurrence Methods : This prospective study was done jointly by the Department of Surgery of Central Medical College and Comilla Medical College Hospital. In this series 50 patients were selected from July 2012 to June 2017. Results : Out of 50 patients operated by Limberg flap technique 42(84%) were males and 8(16%) were females. Mean age was 27.3 years (range 18–37years). Of them,12(24%) were driver, 6(12%) police, 6(12%) teacher, 6(12%) student, 5(10%) worker, 4(8%) millitary army, 4(8%) housewife, 4 (8%)service holder, 2(4%) computer operator, 1(2%) doctor and 1(2%) were barber. In our study most common mode of presentation were chronic discharging sinuses 15(30%), beside this 12(24%) had multiple sinuses, 10(20%) had multiple pits,7(14%) had acute abscess and 6(12%) had unpleasant smell. Associated hirsutism were present in 30(60%) and absent in 20(40%) patients. One (2%) male patient had wound gap & discharge and six(12%) patients had flap edema. We have found no recurrence in follow up period. Conclusion : Pilonidal sinus is a notoriously recurrent disease, so treatment by this flap technique is the only hope of cure with lower morbidity. Journal of Surgical Sciences (2018) Vol. 22 (2) : 89-94


2020 ◽  
Vol 26 (3) ◽  
pp. 275-282
Author(s):  
Michael M. McDowell ◽  
Nitin Agarwal ◽  
Gordon Mao ◽  
Stephen Johnson ◽  
Hideyuki Kano ◽  
...  

OBJECTIVEThe study of pediatric arteriovenous malformations (pAVMs) is complicated by the rarity of the entity. Treatment choice has often been affected by the availability of different modalities and the experience of the providers present. The University of Pittsburgh experience of multimodality treatment of pAVMs is presented.METHODSThe authors conducted a retrospective cohort study examining 212 patients with pAVM presenting to the University of Pittsburgh between 1988 and 2018, during which patients had access to surgical, endovascular, and radiosurgical options. Univariate analysis was performed comparing good and poor outcomes. A poor outcome was defined as a modified Rankin Scale (mRS) score of ≥ 3. Multivariate analysis via logistic regression was performed on appropriate variables with a p value of ≤ 0.2. Seventy-five percent of the cohort had at least 3 years of follow-up.RESULTSFive patients (2.4%) did not receive any intervention, 131 (61.8%) had GKRS alone, 14 (6.6%) had craniotomies alone, and 2 (0.9%) had embolization alone. Twenty-two (10.4%) had embolization and Gamma Knife radiosurgery (GKRS); 20 (9.4%) had craniotomies and GKRS; 8 (3.8%) had embolization and craniotomies; and 10 (4.7%) had embolization, craniotomies, and GKRS. Thirty-one patients (14.6%) were found to have poor outcome on follow-up. The multivariate analysis performed in patients with poor outcomes was notable for associations with no treatment (OR 18.9, p = 0.02), hemorrhage requiring craniotomy for decompression alone (OR 6, p = 0.03), preoperative mRS score (OR 2.1, p = 0.004), and Spetzler-Martin score (OR 1.8, p = 0.0005). The mean follow-up was 79.7 ± 62.1 months. The confirmed radiographic obliteration rate was 79.4% and there were 5 recurrences found on average 9.5 years after treatment.CONCLUSIONSHigh rates of long-term functional independence (mRS score of ≤ 2) can be achieved with comprehensive multimodality treatment of pAVMs. At this center there was no difference in outcome based on treatment choice when accounting for factors such as Spetzler-Martin grade and presenting morbidity. Recurrences are rare but frequently occur years after treatment, emphasizing the need for long-term screening after obliteration.


2021 ◽  
pp. 1-5
Author(s):  
Joshua S. Catapano ◽  
Mohamed A. Labib ◽  
Fabio A. Frisoli ◽  
Megan S. Cadigan ◽  
Jacob F. Baranoski ◽  
...  

OBJECTIVEThe SAFIRE grading scale is a novel, computable scale that predicts the outcome of aneurysmal subarachnoid hemorrhage (aSAH) patients in acute follow-up. However, this scale also may have prognostic significance in long-term follow-up and help guide further management.METHODSThe records of all patients enrolled in the Barrow Ruptured Aneurysm Trial (BRAT) were retrospectively reviewed, and the patients were assigned SAFIRE grades. Outcomes at 1 year and 6 years post-aSAH were analyzed for each SAFIRE grade level, with a poor outcome defined as a modified Rankin Scale score > 2. Univariate analysis was performed for patients with a high SAFIRE grade (IV or V) for odds of poor outcome at the 1- and 6-year follow-ups.RESULTSA total of 405 patients with confirmed aSAH enrolled in the BRAT were analyzed; 357 patients had 1-year follow-up, and 333 patients had 6-year follow-up data available. Generally, as the SAFIRE grade increased, so did the proportion of patients with poor outcomes. At the 1-year follow-up, 18% (17/93) of grade I patients, 22% (20/92) of grade II patients, 32% (26/80) of grade III patients, 43% (38/88) of grade IV patients, and 75% (3/4) of grade V patients were found to have poor outcomes. At the 6-year follow-up, 29% (23/79) of grade I patients, 24% (21/89) of grade II patients, 38% (29/77) of grade III patients, 60% (50/84) of grade IV patients, and 100% (4/4) of grade V patients were found to have poor outcomes. Univariate analysis showed that a SAFIRE grade of IV or V was associated with a significantly increased risk of a poor outcome at both the 1-year (OR 2.5, 95% CI 1.5–4.2; p < 0.001) and 6-year (OR 3.7, 95% CI 2.2–6.2; p < 0.001) follow-ups.CONCLUSIONSHigh SAFIRE grades are associated with an increased risk of a poor recovery at late follow-up.


2019 ◽  
Vol 6 (2) ◽  
pp. 73-76
Author(s):  
Mohammad Ibrahim Khalil ◽  
Md Ashiqur Rahman ◽  
Adnan Ahmed ◽  
Samia Shihab Uddin ◽  
Mohammad Alauddin ◽  
...  

Background: Haemorroid stapler becomes easier and safe to deal multiple and prolapsed haemorrhoid at a time. Objectives: The purpose of the present study was to evaluate the outcome of suture haemorrhoidopexy for secondary position haemorrhoids in addition to haemorrhoidectomy for primary haemorrhoids (multiple). Methodology: This prospective interventional study was performed in Dhaka Medical College Hospital, Dhaka, Bangladesh and in a private hospital in Gazipur, Bangladesh for over five (05) years from January 2012 to December 2016. Patients who were presented with secondary position haemorrhoids in addition to primary position haemorrhoids (multiple haemorrhoids) were included in this study. Open haemorrhoidectomy (Milligan-Morgan) followed by suture haemorrhoidopexy was done. All patients were followed up after 1, 2, 4, 8 weeks, 6 months and 1 yearly. Result: Total 18 patients were operated. Among those immediate complications were encountered in patients in the form of per rectal bleeding 1(5.55%), pain 3(visual pain scale 4)16.66%, mucosal oedema 6(33.33%), no patient developed early postoperative prolapse. No patient developed bowel incontinence. Late complications experienced as prolapse at 1 year follow up which was treated by conservative measures. No patient developed anal stenosis. Mean operating time was 25 minutes and duration of hospital stay was 1 day. Conclusion: Stapled haemorrhoidopexy is a safe procedure for circumferential excision of mucosa and submucosa dealing all haemorrhoids and prolapse simultaneously. Journal of Current and Advance Medical Research 2019;6(2): 73-76


2020 ◽  
Vol 7 (3) ◽  
pp. e705 ◽  
Author(s):  
Shengde Li ◽  
Haitao Ren ◽  
Yan Xu ◽  
Tao Xu ◽  
Yao Zhang ◽  
...  

ObjectiveTo investigate whether the use of mycophenolate mofetil (MMF) could reduce the relapse risk in patients with myelin oligodendrocyte glycoprotein (MOG)-immunoglobulin G (IgG)-associated disorders (MOGADs).MethodsThis prospective observational cohort study included patients with MOGAD at Peking Union Medical College Hospital between January 1, 2017, and April 30, 2019. The patients were divided into 2 groups: those with (MMF+) or without (MMF−) MMF therapy. The primary outcome was relapse at follow-up. We used Cox proportional hazards models to calculate hazard ratios (HRs) for relapse.ResultsSeventy-nine patients were included in our MOG cohort. Fifty (63.3%) were adults at index date, and 47 (59.5%) were women. Fifty-four (68.4%) were in the MMF+ group, and 25 (31.6%) were in the MMF− group. Clinical and demographic factors, MOG-IgG titer, and follow-up time (median, 472.5 days for MMF+, 261.0 days for MMF−) were comparable between the groups. Relapse rates were 7.4% (4/54) in the MMF+ group and 44.0% (11/25) in the MMF− group. Of all potential confounders, only the use of MMF was associated with reduced risk of relapse. The HR for relapse among patients in the MMF+ group was 0.14 (95% CI, 0.05–0.45) and was 0.08 (95% CI, 0.02–0.28) in a model adjusted for age, sex, disease course, and MOG-IgG titer. MMF therapy also remained associated with a reduced relapse risk in sensitivity analyses. Only one patient (1.9%) discontinued MMF therapy because of adverse effect.ConclusionsThese findings provide a clinical evidence that MMF immunosuppression therapy may prevent relapse in patients with MOGAD.Classification of evidenceThis study provides class IV evidence that for patients with MOGAD, MMF reduces relapse risk.


2018 ◽  
Vol 42 (2) ◽  
pp. 62-66
Author(s):  
MA Rouf ◽  
Md Khairuzzaman ◽  
Nur E Nazni Ferdous ◽  
Md Golam Mowla

Background: Phototherapy is crucially an important aspect for the management of most neonatal jaundice. Neonates are prone to develop bilirubin encephalopathy (kernicterus). LED phototherapy is a new option of managing neonatal jaundice. The objective of this study is to compare the efficacy and safety of LEDs with fluorescent phototherapy in the treatment of indirect hyperbilirubinemia.Method: The study was Experimental research design, prospective study. The Study was conducted at Neonatal unit of Shaheed Suhrawardy Medical College Hospital, Dhaka. Total sample size of the study was one hundred neonates. Fifty for conventional phototherapy and fifty for LED phototherapy. Purposive sampling method was used for the study. The data collection tool of the study was pretested structured questionnaire. The modes of presentation, the clinical examination and investigation findings at admission and during daily follow up were recorded for individual patient.Result: The rate of fall of S. bilirubin was more in those neonates who have had LED phototherapy. As a result, duration of phototherapy as well as hospital stay was less in LED group. Furthermore, higher number of neonates developed rashes in LED group than in conventional group with statistically significant difference. Of course, variables regarding other adverse events did not show any statistically significant difference between two groups.Conclusion: Management of neonatal jaundice may be more effective in LED phototherapy than conventional phototherapy. LED device require shorter duration of phototherapy, thus, shorter hospital stay.Bangladesh J Child Health 2018; VOL 42 (2) :62-66


Author(s):  
Mohankumar Vedhanayagam ◽  
Rajesh Rajagopalan ◽  
Srinivasahan Karatupalyam Govindan ◽  
Balamurgan Bhavani Rajendran

Background: Ever since the early reports of human immuno deficiency infection, it presented as wide range of infectious and non-infectious dermatoses which correlate with the degree of immunodeficiency. Skin assessment remains a vital tool in the diagnosis and management of HIV infection due to relative easiness of examination. Most of skin diseases are amenable to diagnosis by inspection and biopsy. In this descriptive study, we have enumerated in detail the dermatological manifestations of Link ART centre clients.Methods: To analyze the dermatological manifestations in people living with HIV, we undertook a prospective observational study of all PLHIV on ART visiting IRT Perundurai Medical College Hospital link anti- retroviral therapy centre (LAC) during July 2015 to August 2016 with focus to skin manifestations.Results: Among the 140 clients, 22 in 2010, 12 in 2011, 6 in 2012, 51 in 2013, 36 in 2014, and 9 in 2015, 3 up to June 2016 enrolled for follow up. 31 were transferred to nearby ART, Link ART centres during this period as per their request, 4 lost for follow up and 6 deceased after enrolment, finally ninety-nine (39 male; 60 female) were utilizing our centre during the study period. Majority of participants were on ZLN (zidovudine, lamivudine, and nevirapine) regimen, hailing from rural zones, belonged to low or low middle income group, were undertaking farming, cattle rearing. CD4 counts of the asymptomatic clients in the ZLN group noted increase and decrease in the ZLE (zidovudine, lamivudine, and efavirenz), TLN (tenofovir, lamivudine, and nevirapine) group.  In the symptomatic clients, decline in the individual and the mean counts except in female ZLN subset. 70% were clinically asymptomatic and 30 % were having some dermatological manifestations. Multiple manifestations were seen in 5 clients during the study period. Dermatological manifestations observed commonly were fungal and viral infections, xerosis/ichthyoses, adverse drug reactions like lipodystrophy, and discoloration of nails.Conclusions: Skin manifestations observed in this study were due to aging and long term cosmetic side effects of highly active antiretroviral therapy  (HAART). Lipodystrophy posed significant aesthetic distress in HAART clients. Hence, early management would decrease the most offending cosmetolgical side effects of the disease and drugs. Therapy yields the declining trend in the inflammatory, infectious dermatoses.


2021 ◽  
Vol 11 (2) ◽  
pp. 173-176
Author(s):  
P.K Purushothaman ◽  
Dhanyan Harshidan ◽  
Priyangha Elangovan

Bell's palsy is the most common facial nerve disorder. The clinical symptoms of Bell's palsy include facial muscle paralysis, difficulty in eating, drinking and talking. Bell's palsy management is still controversial. Many patients recover spontaneously; some require medicines like corticosteroids, antiviral drugs and other managements.To study the effectiveness of Bell's palsy management that has been followed in our institution.This analysis had carried out from June 2016 to June 2019at SRM Medical College Hospital and Research Institute, Chennai. Total of 30 patients with Bell's palsy who had admitted in the Department of Otorhinolaryngology had enrolled in this study. All the patients underwent thorough clinical examination and laboratory investigation, and the results were statistically analyzed and discussed.Out of 30 patients, 16(53%) patients were males, and 14(47%) patients were females. 53.3% of patients had onset of symptoms after 48 hours. There was a statistical significant improvement in House-Brackman scale on 6 months follow-up.The therapeutic measures for Bell's palsy if initiated within 72 hours of onset aids in bringing better outcome and improves the quality of life in patients.


KYAMC Journal ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 179-183
Author(s):  
Hafiz Al Asad ◽  
Nahid Rahman Zico ◽  
AKM Shahadat Hossain ◽  
Zulfia Zinat Chowhury ◽  
Md Mostafizur Rahman ◽  
...  

Background: Dhaka Medical College Hospital is the highest referral center for PFUI. As anstomotic urethroplasty is a challenging surgery and most of the surgeons refer these type of injuries to our center, we performed this study to evaluate the outcome of our cases. Objective: This study aims to find the outcome and complications of perineal end to end anastomotic urethroplasty in the management of posterior urethral injury resulting from pelvic fracture. Materials and Methods: We performed 147 perineal bulbo-prostatic anastomotic urethroplasty for PFUIs from January, 2013 to May, 2019. Mean age was 37 years with majority between 21 to 50 years (>85%). Nine patients had history of failed anastomotic urethroplasty. After surgical intervention patients were discharged with a supra-pubic catheter (SPC) and per urethral catheter in situ. On 22nd POD urethral catheter was removed and SPC on the next day if patient can void normally. 1st and 2nd follow up done on of 3rd and 6th month respectively following surgery. If patient voided well and Qmax>15ml/ sec; repair was defined as successful. Results: Success rate of anastomotic urethroplasty for PFUI was 93.87%. Total 9 procedures were failed including 2 urethro-cutaneous fistula and needed re-do anastomosis. Erectile dysfunction (ED) was present in 18 patients before operation and after surgery 12 more patients developed ED and total number was 30 during first follow up, which reduced to 24 during second follow-up. Two patient developed incontinence which improved in subsequent follow-up. Conclusion: Anastomotic urethroplasty remains the gold standard in the management of PFUI. Erectile dysfunction is the main issue to be concerned and need special attention. KYAMC Journal Vol. 10, No.-4, January 2020, Page 179-183


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