Sudden Cardiac Death due to Coronary Artery Vasculitis in a Patient with Relapsing Polychondritis

Relapsing polychondritis (RP) is a systemic autoimmune disease characterized by relapsing and remitting inflammation of the cartilaginous structures of the ears, nose, tracheobronchial tree, and joints. Diagnosis is challenging due to the heterogeneity of clinical manifestations, the relapsing and remitting nature of the disease, the presence of coexistent diseases in at least one-third of patients, and the lack of a diagnostic blood test. Although RP-associated cardiac disease is the second most common cause of death behind tracheobronchial complications, coronary artery vasculitis is rare. This report describes a case of sudden cardiac death due to vasculitis affecting the coronary arteries in a patient with RP. The pathologic findings included obliterative coronary arteritis with plasma cells and storiform fibrosis, features suggesting that IgG4-related disease (IgG4-RD) may have contributed to the patient’s cardiac disease. The literature on vasculitis and cardiac disease in RP and the possible role of IgG4-RD in this setting is also reviewed. The primary take-home message from this case report is the importance of frequent screening for cardiac disease, regardless of symptoms, in patients with RP. In addition, considering the diagnosis of IgG4-RD in some cases thought to be RP may also be warranted

Unused Pharmaceutical Disposal Model

Supporting Information for research article "Life cycle comparison of environmental emissions from three disposal options for unused pharmaceutical". This spreadsheet provides the calculations and values used for this study; please refer to the manuscript and supporting information (as text) available at http://dx.doi.org/10.1021/es203987b for details about how to use this spreadsheet. We use life cycle assessment methodology to compare three disposal options for unused pharmaceuticals: (i) incineration after take-back to a pharmacy, (ii) wastewater treatment after toilet disposal, and (iii) landfilling or incineration after trash disposal. For each option, emissions of active pharmaceutical ingredients to the environment (API emissions) are estimated along with nine other types of emissions to air and water (non-API emissions). Under a scenario with 50% take-back to a pharmacy and 50% trash disposal, current API emissions are expected to be reduced by 93%. This is within 6% of a 100% trash disposal scenario, which achieves an 88% reduction. The 50% take-back scenario achieves a modest reduction in API emissions over a 100% trash scenario while increasing most non-API emissions by over 300%. If the 50% of unused pharmaceuticals not taken-back are toileted instead of trashed, all emissions increase relative to 100% trash disposal. Evidence suggests that 50% participation in take-back programs could be an upper bound. As a result, we recommend trash disposal for unused pharmaceuticals. A 100% trash disposal program would have similar API emissions to a take-back program with 50% participation, while also having significantly lower non-API emissions, lower financial costs, higher convenience, and higher compliance rates.http://deepblue.lib.umich.edu/bitstream/2027.42/91619/1/Unused_Pharmaceutical_Disposal_v-Apr-8-2012.xlsx2