Medium-size-vessel vasculitis

Medium-size-artery vasculitides do occur in childhood and manifest, in the main, as polyarteritis nodosa (PAN), cutaneous PAN and Kawasaki disease. Of these, PAN is the most serious, with high morbidity and not inconsequential mortality rates. New classification criteria for PAN have been validated that will have value in epidemiological studies and clinical trials. Renal involvement is common and recent therapeutic advances may result in improved treatment options. Cutaneous PAN is a milder disease characterised by periodic exacerbations and often associated with streptococcal infection. There is controversy as to whether this is a separate entity or part of the systemic PAN spectrum. Kawasaki disease is an acute self-limiting systemic vasculitis, the second commonest vasculitis in childhood and the commonest cause of childhood-acquired heart disease. Renal manifestations occur and include tubulointerstitial nephritis and renal failure. An infectious trigger and a genetic predisposition seem likely. Intravenous immunoglobulin (IV-Ig) and aspirin are effective therapeutically, but in resistant cases, either steroid or infliximab have a role. Greater understanding of the pathogenetic mechanisms involved in these three types of vasculitis and better long-term follow-up data will lead to improved therapy and prediction of prognosis

Takayasu's Arteritis: A Review Article

We selected the medicine research papers in English language published from the year 2005 to the date to determine the clinical significance of Takayasu’s arteritis (TA) and to review the literature available on this condition. TA is a world-wide, chronic inflammatory disease of unknown etiology. It is more prevalent in Asian countries. There are no specific laboratory tests to diagnose TA as it usually presents with non-specific symptoms such as fatigue, fever, arthralgia, weight loss, malaise, weakness and vision changes. Angiographic imaging is considered to be the gold standard investigation in diagnosing TA. Steroids with subsequent tapering doses are the mainstay of medical treatment; however, for addressing the refractory cases additional therapy becomes necessary. Reconstructive vascular surgery is limited to the severe and irreversible stenotic lesions where surgery becomes inevitable

Systemic betamethasone accelerates functional recovery after a crush injury to rat sciatic nerve

Purpose: The aim of the study was to evaluate the effect of perioperatively systemically administered betamethasone on nerve recovery (within or outside a confined space) after induced nerve crush injury. Materials and Methods: The sciatic nerve of 40 adult Wistar rats was crushed. In half of the animals, the injured nerve was entrapped in a silicone tube to simulate the environment of a closed space, and in the other half the nerve was left to heal. Half of the rats in each group were treated with subcutaneous betamethasone (2 mg/kg body weight/day) during the first 24 hours, starting preoperatively, whereas the other half, the control animals, were given the same amount of physiological saline. All animals underwent preoperative and postoperative walking track analysis (toe spread [TS] and intermediate toe spread [ITS]) twice weekly for 6 weeks. Results: For nonconfined space groups, there was no significant difference between the 2 groups (P=.052 for ITS and P =.315 for TS) during the first 2 weeks. Starting from the end of the second week, animals treated with betamethasone recovered more rapidly than did the controls (P <.001) and continued to do so until the end of the observation period. In the confined space groups, there was a significant difference between the 2 groups for ITS (P <.001) and for TS (P <.05) during the first 2 weeks. The difference continued at almost the same level of significance (P =.001) for ITS, whereas for TS, the difference disappeared after the second week. Conclusions: We conclude that short-term perioperative administration of betamethasone has a beneficial effect on the recovery of the injured rat sciatic nerve

Comorbidity Profile among Patients with Rheumatoid Arthritis and the Impact on Prescriptions Trend

Comorbid conditions play a pivotal role in rheumatoid arthritis management and outcomes. We estimated the percentage of comorbid illness among rheumatoid arthritis patients and explored the relationship between this comorbidity and different prescriptions. A cross-sectional study of patients with rheumatoid arthritis in three centers in Saudi Arabia was carried out. Comorbidity and antirheumatoid medication regimens prescribed were recorded on a specially designed Performa. The association between comorbidity and different drugs was analyzed. A total of 340 patients were included. The most comorbidities were hypertension 122 (35.9%), diabetes 105 (30.9%), osteoporosis 88 (25.8%), and dyslipidemia in 66 (19.4). The most common drug prescribed was prednisolone in 275 (80.8%) patients followed by methotrexate in 253 (74.4%) and biological therapy in 142 (41.5%) patients. Glucocorticoids were prescribed considerably more frequently in hypertensive and diabetic patients as well as in patients with osteoporosis and dyslipidemia. Most patients with rheumatoid arthritis suffered from comorbid diseases

Populationsbewegungen und Tuberkulose: Querschnittsstudie über eine vernachlässigte Erkrankung in Saudi-Arabien

Background: International travel, migration and human population movements facilitate the spread of tuberculosis (TB).Objective: To study the impact of poorly screened expatriates working in Saudi Arabia on the local incidence of TBs.Patients and methods: This cross sectional study was carried out in the Chest Disease Hospital, Taif. All confirmed cases of TB from June 2009 to May 2010 admitted to the hospital were enrolled. Inclusion criteria were diagnosed cases of TB (pulmonary & extra-pulmonary) in patients between the ages of 14 to 65 years. Patients with HIV and coexistent malignancies were excluded. The age, gender and ethnic group of each patient was recorded, and patients were divided into two groups. Of the two groups, Group A consisted of Taif residents and group B of patients referred from other cities in the country.Results: Of the 686 cases studied, 370 (54%) were Saudi nationals (Group A = 80 & Group B = 290) and 316 (46%) cases were from other countries. Males outnumbered females and most of the patients were aged 20 to 29 years. The number of cases from the areas close to the pilgrimage sites, i.e. Makah (233) and Jeddah (275), outnumbered those in Taif (110).Conclusions: Our study identifies an increased prevalence of TB cases in areas close to the pilgrimage (Group B). The higher proportion of non-Saudi TB patients in group B is most likely explained by the higher number of poorly screened illegal expatriates in the region.Hintergrund: Internationale Reisen, Migration und Bevölkerungsbewegungen erleichtern die Ausbreitung der Tuberkulose (TBC).Ziel: Untersuchung des Einflusses von wenig untersuchten ausländischen Arbeitern auf die lokale Inzidenz der TBC in Saudi-Arabien.Patienten und Methoden: Diese Querschnittsstudie wurde im Chest Disease Hospital, Taif, Saudi-Arabien durchgeführt. Einbezogen wurden alle bestätigten Fälle von TBC, die im Zeitraum von Juni 2009 bis Mai 2010 in die Klinik eingewiesen wurden. Einschlusskriterien waren diagnostizierte Fälle von TBC (Lungen- und allgemeiner TBC) bei Patienten im Alter zwischen 14 und 65 Jahren. HIV-Patienten und Patienten mit koexistenten Krebserkrankungen wurden ausgeschlossen. Alter, Geschlecht und die ethnische Zugehörigkeit jedes Patienten wurden erfasst. Die Patienten wurden in zwei Gruppen aufgeteilt: Gruppe A bestand aus Einwohnern von Taif und Gruppe B aus Patienten, die aus anderen Regionen des Landes überwiesen wurden.Ergebnisse: Von den 686 untersuchten Fällen waren 370 (54%) saudische Staatsangehörige (Gruppe A = 80, Gruppe B = 290) und 316 (46%) der Patienten stammten aus anderen Ländern. Die Zahl der Männer übertraf die der Frauen und die meisten Patienten waren 20-29 Jahre alt. Die Zahl der Fälle aus den Gebieten in der Nähe der Pilgerstätten, d.h. Makah (233) und Dschidda (275), übertraf die in Taif (110).Schlussfolgerung: Diese Studie zeigt eine erhöhte Prävalenz der TBC-Fälle in Gebieten in der Nähe der Pilgerstätten (Gruppe B). Der höhere Anteil von TBC-Patienten nicht-saudischer Nationalität in Gruppe B ist am ehesten durch die größere Zahl von schlecht untersuchten illegalen Einwanderern in der Region zu erklären