Vascular endothelial function assessed by a noninvasive ultrasound method and serum asymmetric dimethylarginine concentrations in mild-to-moderate plaque-type psoriatic patients

Objectives: Our aim was to evaluate vascular endothelial function assessed by serum asymmetric dimethylarginine (ADMA) concentrations and noninvasive ultrasonographic parameters such as flow-mediated dilatation (FMD) and nitroglycerin-induced dilatation (NID) in mild-to-moderate plaque-type psoriatic patients, as rated by the Psoriasis Area and Severity Index. Design and methods: Plaque-type psoriatic patients (n = 29) diagnosed with clinical and/or histopathological findings and control subjects (n = 25) without skin and systemic metabolic diseases were included in the study. Results: There was no statistically significant difference between patients and control subjects in respect to FMD (p = 0.441), NID (p = 0.557), or serum ADMA concentrations (p = 0.225). Also, among the acute-phase reactants, serum C-reactive protein and plasma fibrinogen levels were moderately higher in patients when compared to control subjects (p = 0.008 and p = 0.011, respectively). Conclusions: Mild-to-moderate plaque-type psoriatic patients with low-to-medium grade systemic inflammation did not have evidence of vascular endothelial function. (C) 2011 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved

The results of streptokinase therapy in acute pulmonary embolism with intermediate and high risk [Orta ve yüksek riskli pulmoner embolizm olgularında streptokinaz tedavisi sonuçları]

Objective: Pulmonary embolism (PE) is a life threatening but potentially reversible cardiovascular emergency situation which is caused by the blockage of a pulmonary arterial vessel. In our study we aimed to evaluate the symptoms, clinical and demographical characteristics, response to treatment, mortality during hospitalization and 30 days-after-discharge in patients who were diagnosed with high risk and intermediate risk PE and who were treated with streptokinase as a thrombolytic agent. Material and Method: The study included a total of 31 patients with acute PE who were diagnosed in the coronary intensive care department of our hospital from December 2006 to December 2009. Twenty six of these patients were treated with streptokinase as the thrombolytic agent. The five patients were treated with standard heparin. Results: PE is identified with evaluation of clinical laboratory qualifications, spiral angio computerized tomography (BT) and ventilation-perfusion scintigraphy methods. In 29 patients a thrombus in a pulmonary vascular vessel was shown with spiral angio BT. In 26 of the cases, streptokinase was emöployed as a thrombolytic agent In four of our patients, streptokinase associated bleeding complication occured. Further in four patients, exitus caused by respiratory and circulatory deficiency during hospitalization occured. Conclusion: Especially in patients at high risk, treatment with thrombolytics is life saving. Nowadays alteplase is suggested as a thrombolytic by FDA and ESC. In our study; streptokinase was applied due to reasons such as capability of our hospital, low socioeconomic degree of the patients and the lack of social security of patients. Mortality was similar in comparison to the studies conducted with alteplase and major bleeding rates were lower. As in many other studies, our study has shown that alteplase and streptokinase are equal in terms of efficacy and safety. Therefore, in developing countries such as ours, streptokinase is very important both in treatment efficiency and decreasing the treatment costs

Limited reliability of radiographic assessment of spinal progression in ankylosing spondylitis

Objectives. Conventional radiography is key to assessing AS-related spinal involvement and has become increasingly important given that spinal fusion may continue under biologic therapy. We aimed to compare the reliability of radiographic scoring of the spine by using different approaches to understand how different readers agree on overall scores and on individual findings. Method. Six investigators scored 68 plain radiographs of the cervical and lumbar spine of 34 patients with a 2-year interval, for erosions, sclerosis, squaring, syndesmophytes and ankyloses using the Spondyloarthritis Radiography (SPAR) module. The intraclass correlation coefficients were calculated compared with two gold standards. The reproducibility of each finding in 1632 vertebral corners and new syndesmophytes in each corner was calculated by kappa analysis and positive agreement rates. Results. The intraclass correlation coefficients mostly revealed good to excellent agreement with the gold standards (0.69-0.95). The kappa analysis showed worse agreement, being relatively higher for syndesmophytes (0.163-0.559) and ankylosis (0.48-0.95). Positive agreement rates showed that erosions were never detected at the same vertebral corner by two readers (positive agreement rate: 0%). The mean (range) positive agreement rates were 10.1% (0-27.7%) for sclerosis and 19.2% (0-59.7%) for squaring, and were higher for syndesmophytes [38.8% (21.4-62.5%)] and ankylosis [77.3% (64-95.3%)]. Conclusion. Our results show that there is a poor agreement on the presence of grade 1 lesions included in the Modified Stoke Ankylosing Spondylitis Spine Score-mostly for erosions and sclerosis-which may increase the measurement error. The currently used definitions of reliability have a risk of overestimating reproducibility

Criteria sets for primary Sjogren's syndrome are not adequate for those presenting with extraglandular organ involvements as their dominant clinical features

Patients with primary Sjogren's syndrome (pSS) may go undiagnosed or be misclassified due to the insidious nature and wide spectrum of the disease. The available several classification criteria emphasize glandular findings. We aimed to analyze the efficiency of various classification criteria sets in patients diagnosed on the clinical basis by expert opinion and to compare those pSS patients who fulfilled these criteria with those who did not. This is a multicenter study in which 834 patients from 22 university-based rheumatology clinics are included. Diagnosis of pSS was made on the clinical basis by the expert opinion. In this study, we only interviewed patients once and collected available data from the medical records. The European criteria, American-European Consensus Group (AECG) and American College of Rheumatology (ACR) Sjogren's criteria were applied. Majority of the patients were women (F/M was 20/1). The median duration from the first pSS-related symptom to diagnosis was significantly shorter in men (2.5 +/- 2.3 vs 4.3 +/- 5.9 years) (p = 0 < 0.016). When the European, AECG and ACR Sjogren's criteria were applied, 666 patients (79.9%) satisfied at least one of them. In total, 539 patients (64.4%) satisfied the European, 439 (52.6%) satisfied the AECG, and 359 (43%) satisfied the ACR criteria. Among the entire group, 250 patients (29.9%) satisfied all and 168 (20.1%) met none of the criteria. The rates of extraglandular organ involvements were not different between patients who met at least one of the criteria sets and those who met none. There is an urgent need for the modification of the pSS criteria sets to prevent exclusion of patients with extraglandular involvements as the dominant clinical features