PERICARDIAL FEATURES OF IN-HOSPITAL RHEUMATOLOGY PATIENTS: AN OBSERVATIONAL STUDY

Reumatske bolesti mogu biti povezane s perikarditisom, ali su teži oblici te bolesti rijetki. Cilj ovog opservacijskog istraživanja bio je proučiti obilježja perikarda u bolesnika s različitim reumatskim bolestima. Uklju čeno je trideset i pet bolesnika hospitaliziranih u Klinici za reumatologiju Sveučilišnoga kliničkog centra Kosova od 1. do 21. listopada 2014. Prikupljeni su demografski podaci, anamnestički podaci, učinjeni su EKG i ehokardiografi ja s posebnim naglaskom na perikard. Ehokardiografi ja je bila posebno usmjerena na količinu perikardijalnog izljeva i njegovu debljinu u stražnjoj srčanoj ovojnici. Srednja dob bolesnika bila je 51,5 ± 13,8 god., a 65,7% njih bile su žene. Među analiziranim bolesnicima bilo je 88,6% s upalnim reumatskim bolestima, od čega njih 11,3% s blagim simptomima, 68,7% s umjerenim i 20% s teškim simptomima. U svih je bolesnika naglašena perikardijalna hiperehogenost sa srednjom debljinom perikarda od 4,68 ± 1,66 mm. Perikardijalni izljev manje količine bio je prisutan u 57,1% bolesnika s količinom od 3,3 ± 1,9 ml. Težina reumatske bolesti bila je značajno i pozitivno povezana s prisutnošću perikardijalnog izljeva (r = 0,29; p = 0,04) i količinom perikardijalnog izljeva (r = 0,28; p = 0,05). Bolesnici nisu znali da imaju perikardijalni izljev niti su imali kliničke simptome u tom smislu. Zaključno, u ovome kratkotrajnom malom opservacijskom istraživanju promjene perikarda bile su čest nalaz u bolesnika s reumatskim bolestima. Ipak, najčešće se radilo o perikarditisu supkliničkog oblika i s malom količinom izljeva. Aktivnost bolesti može biti povezana s perikarditisom. Potrebne su studije s većim brojem bolesnika i dužeg trajanja da bi se dalje istražilo ovo područje.Rheumatic disorders can be associated with pericarditis, but severe forms of pericarditis are rare. Th e aim of this observational study was to evaluate pericardial features in patients with diff erent rheumatic diseases. Th irty-fi ve patients hospitalized at the Clinic of Rheumatology, University Clinical Center of Kosovo, from October 1 to October 21, 2014 were included in the study. Demographic data, history, laboratory, ECG, and echocardiography data, with special emphasis on the analysis of the pericardium, were obtained from each patient. Echocardiography was especially focused on the amount of pericardial fl uid and pericardial thickness in the posterior wall of the heart. Mean patient age was 51.5 ± 13.8 years. 65.7% of the patients were women. Out of the patients that we analyzed, 88.6% had an infl ammatory rheumatologic disease. 11.3% of the patients had mild symptoms, in 68.7% the symptoms were moderate, and in 20% severe. In all patients, pericardial hyperechogenicity was marked, with a mean pericardial thickness of 4.68 ± 1.66 mm. Pericardial eff usion in a small amount was present in 57.1% of patients, with a mean pericardial fl uid amount of 3.3 ± 1.9 mm. Th e severity of rheumatic disease had a positive and signifi cant correlation with the presence of pericardial eff usion (r= 0.29, p=0.04) and its amount (r= 0.28, p=0.05). Th e patients had not been aware of the pericardial involvement and did not have any clinical symptoms. In conclusion, in this short-term small observational study pericardial changes were a frequent fi nding in the rheumatology patients. In general, the pericarditis was subclinical and with small amounts of eff usion. Th e disease activity of rheumatic disorders can be associated with pericarditis. Further studies with larger samples of patients and of longer duration are needed to further explore this issue

Poststaphylococcal coagulase negative reactive arthritis: a case report

We report a case of a 49-year-old patient who developed poststaphylococcal coagulase negative reactive arthritis. The woman presented with constitutional symptoms, arthritis, urinary infection and conjunctivitis. The blood culture was positive for the staphylococcal coagulase negative infection. Erythrocyte sedimentation rate and C-reactive protein were elevated, whereas the rheumatoid factor was negative. Radiographic findings confirmed diagnosis of pleuropneumonia, and one year later of chronic asymmetric sacroileitis. Physicians should be aware of possible reactive arthritis after staphylococcal coagulase negative bacteremia

Association of interatrial septal abnormalities with cardiac impulse conduction disorders in adult patients: experience from a tertiary center in Kosovo

Interatrial septal disorders, which include: atrial septal defect, patent foramen ovale and atrial septal aneurysm, are frequent congenital anomalies found in adult patients. Early detection of these anomalies is important to prevent their hemodynamic and/or thromboembolic consequences. The aims of this study were: to assess the association between impulse conduction disorders and anomalies of interatrial septum; to determine the prevalence of different types of interatrial septum abnormalities; to assess anatomic, hemodynamic, and clinical consequences of interatrial septal pathologies. Fifty-three adult patients with impulse conduction disorders and patients without ECG changes but with signs of interatrial septal abnormalities, who were referred to our center for echocardiography, were included in a prospective transesophageal echocardiography study. Interatrial septal anomalies were detected in around 85% of the examined patients. Patent foramen ovale was encountered in 32% of the patients, and in combination with atrial septal aneurysm in an additional 11.3% of cases. Atrial septal aneurysm and atrial septal defect were diagnosed with equal frequency in 20.7% of our study population. Impulse conduction disorders were significantly more suggestive of interatrial septal anomalies than clinical signs and symptoms observed in our patients (84.91% vs 30.19%, P=0.002). Right bundle branch block was the most frequent impulse conduction disorder, found in 41 (77.36%) cases. We conclude that interatrial septal anomalies are highly associated with impulse conduction disorders, particularly with right bundle branch block. Impulse conduction disorders are more indicative of interatrial septal abnormalities in earlier stages than can be understood from the patient’s clinical condition

Immature teratoma mimicking pulmonary stenosis: a case report

Abstract Background Immature teratoma in a mediastinal location is a rare disease that might present as a valve pathology. Germ cell tumors with mediastinal locations account for up to 6% of immature teratoma cases. We present a case of an immature teratoma located primarily in the anterior mediastinum that manifested solely through symptoms of pulmonary stenosis. Case presentation We report a case of a 20-year-old white man with an immature teratoma who presented with progressive exertional dyspnea. During a cardiac examination, an ejection systolic murmur was observed, and echocardiography findings at an Emergency Centre revealed high velocity flow at the level of the pulmonary artery, indicating pulmonary stenosis. He was hospitalized in our Cardiology Department for further investigation. A chest X-ray revealed a mediastinal mass, and repeated echocardiography indicated the presence of a large mediastinal mass compressing his main pulmonary artery. Magnetic resonance imaging confirmed the tumor in the mediastinum, and a histopathological diagnosis of immature teratoma was established following biopsy. Conclusion Immature teratoma causing cardiac-related complaints might shift the diagnosis toward cardiovascular diseases, thus requiring prompt examination by standard and sophisticated methods to clarify the diagnosis

PERICARDIAL FEATURES OF IN-HOSPITAL RHEUMATOLOGY PATIENTS: AN OBSERVATIONAL STUDY

Reumatske bolesti mogu biti povezane s perikarditisom, ali su teži oblici te bolesti rijetki. Cilj ovog opservacijskog istraživanja bio je proučiti obilježja perikarda u bolesnika s različitim reumatskim bolestima. Uklju čeno je trideset i pet bolesnika hospitaliziranih u Klinici za reumatologiju Sveučilišnoga kliničkog centra Kosova od 1. do 21. listopada 2014. Prikupljeni su demografski podaci, anamnestički podaci, učinjeni su EKG i ehokardiografi ja s posebnim naglaskom na perikard. Ehokardiografi ja je bila posebno usmjerena na količinu perikardijalnog izljeva i njegovu debljinu u stražnjoj srčanoj ovojnici. Srednja dob bolesnika bila je 51,5 ± 13,8 god., a 65,7% njih bile su žene. Među analiziranim bolesnicima bilo je 88,6% s upalnim reumatskim bolestima, od čega njih 11,3% s blagim simptomima, 68,7% s umjerenim i 20% s teškim simptomima. U svih je bolesnika naglašena perikardijalna hiperehogenost sa srednjom debljinom perikarda od 4,68 ± 1,66 mm. Perikardijalni izljev manje količine bio je prisutan u 57,1% bolesnika s količinom od 3,3 ± 1,9 ml. Težina reumatske bolesti bila je značajno i pozitivno povezana s prisutnošću perikardijalnog izljeva (r = 0,29; p = 0,04) i količinom perikardijalnog izljeva (r = 0,28; p = 0,05). Bolesnici nisu znali da imaju perikardijalni izljev niti su imali kliničke simptome u tom smislu. Zaključno, u ovome kratkotrajnom malom opservacijskom istraživanju promjene perikarda bile su čest nalaz u bolesnika s reumatskim bolestima. Ipak, najčešće se radilo o perikarditisu supkliničkog oblika i s malom količinom izljeva. Aktivnost bolesti može biti povezana s perikarditisom. Potrebne su studije s većim brojem bolesnika i dužeg trajanja da bi se dalje istražilo ovo područje.Rheumatic disorders can be associated with pericarditis, but severe forms of pericarditis are rare. Th e aim of this observational study was to evaluate pericardial features in patients with diff erent rheumatic diseases. Th irty-fi ve patients hospitalized at the Clinic of Rheumatology, University Clinical Center of Kosovo, from October 1 to October 21, 2014 were included in the study. Demographic data, history, laboratory, ECG, and echocardiography data, with special emphasis on the analysis of the pericardium, were obtained from each patient. Echocardiography was especially focused on the amount of pericardial fl uid and pericardial thickness in the posterior wall of the heart. Mean patient age was 51.5 ± 13.8 years. 65.7% of the patients were women. Out of the patients that we analyzed, 88.6% had an infl ammatory rheumatologic disease. 11.3% of the patients had mild symptoms, in 68.7% the symptoms were moderate, and in 20% severe. In all patients, pericardial hyperechogenicity was marked, with a mean pericardial thickness of 4.68 ± 1.66 mm. Pericardial eff usion in a small amount was present in 57.1% of patients, with a mean pericardial fl uid amount of 3.3 ± 1.9 mm. Th e severity of rheumatic disease had a positive and signifi cant correlation with the presence of pericardial eff usion (r= 0.29, p=0.04) and its amount (r= 0.28, p=0.05). Th e patients had not been aware of the pericardial involvement and did not have any clinical symptoms. In conclusion, in this short-term small observational study pericardial changes were a frequent fi nding in the rheumatology patients. In general, the pericarditis was subclinical and with small amounts of eff usion. Th e disease activity of rheumatic disorders can be associated with pericarditis. Further studies with larger samples of patients and of longer duration are needed to further explore this issue

Influence of apelin-12 on troponin levels and the rate of MACE in STEMI patients

Abstract Background During acute myocardial infarction, phosphorylated TnI levels, Ca2+ sensitivity and ATPase activity are decreased in the myocardium, and the subsequent elevation in Ca2+ levels activates protease I (caplain I), leading to the proteolytic degradation of troponins. Concurrently, the levels of apelin and APJ expression are increased by limiting myocardial injury. Methods In this prospective observational study, 100 consecutive patients with ST-elevation acute myocardial infarction were included. Patients meeting the following criteria were included in our study: (1) continuous chest pain lasting for >30 min, (2) observation of ST-segment elevation of more than 2 mm in two adjacent leads by electrocardiography (ECG), (3) increased cardiac troponin I levels, and (4) patients who underwent reperfusion therapy. We evaluated the levels of apelin-12 and troponin I on the first and seventh days after reperfusion therapy in all patients. Results Apelin-12 was inversely correlated with troponin I levels (Spearman’s correlation = −0.40) with a p value 2.2 for the association of apelin with MACE was determined, and the AUC was 0.71 (95% CI, 0.58–0.84). Survival analysis using the Kaplan-Meier method showed a lower rate of MACE among patients with apelin levels >2.2 (p = 0.002), and the ROC curve analysis showed a statistically significant difference in the area under the curve (p = 0.004). Conclusion The influence of apelin levels on troponin levels in the acute phase of STEMI is inversely correlated, whereas in the non-acute phase, low apelin values were associated with a high rate of MACE