Clopidogrel-Induced Recurrent Polyarthritis

Clopidogrel is an oral thienopyridine and together with aspirin is a component of dual antiplatelet therapy for the prevention of stent thrombosis after intracoronary stent placement. The common adverse effects from its use are an increased risk of bleeding, neutropenia, and rash. Arthralgia and backache are also known to occur with its use. There have been case reports linking arthritis with the use of clopidogrel. We describe the case of a 64-year-old man who reported symptoms of fever and joint pains following initiation of therapy with clopidogrel. Acute-phase reactants were elevated. Laboratory and radiologic testing were unremarkable. Incidentally, he reported experiencing a similar arthritis after he received a loading dose of clopidogrel prior to a diagnostic coronary angiography in the past. The symptoms improved dramatically on discontinuation of clopidogrel. There was no recurrence of symptoms with prasugrel. This describes possibly the second incidence of recurrent arthritis with clopidogrel therapy

OBESITY IS NOT ASSOCIATED WITH A DIFFERENTIAL OUTCOME FOLLOWING CORONARY ARTERY BYPASS SURGERY

Background: Conflicting data exists regarding the impact of obesity on mortality and morbidity following coronary artery bypass graft (CABG) surgery with some suggesting a paradoxical reduction in adverse outcomes. We aimed to compare the in-hospital outcomes of CABG in obese and non-obese subjects. Methods: The Nationwide Inpatient Sample for years 2003- 2014 was used to identify adults (age ≥18 years) who underwent isolated CABG. Results: A total of 2,297,932 patients underwent CABG of which 554,857 (28.2%) surgeries were for acute coronary syndrome (ACS) and 1,743075 (74.2%) were elective. Obese patients in either group were younger, were more likely to be female and had more co-morbidities at baseline (Table 1). There was no difference in adjusted all-cause mortality in obese versus non-obese patients with ACS (2.7%-vs-4.2%, OR=1.03, 95% CI=0.98-1.07, p=0.25) or elective (0.9%-vs-1.5%, OR=0.98, 95% CI=0.94-1.03, p=0.47) CABG. Adjusted rates of acute kidney injury requiring dialysis and of wound infection were higher among obese patients whereas those of acute stroke were lower. Rates of blood transfusion were lower in obese patients undergoing CABG for ACS but not for elective indications. Obese patients with and without ACS more often received internal mammary artery grafts (90.8%-vs-88.5%, P\u3c0.001). Conclusion: Data from this comprehensive national database did not show a significant difference in in-hospital mortality among obese and non-obese patients undergoing CABG surgery

Relation Between Obesity and Survival in Patients Hospitalized for Pulmonary Arterial Hypertension (from a Nationwide Inpatient Sample Database 2003 to 2011).

There have been numerous studies reporting lower mortality rates in obese patients with various cardiovascular disorders than in nonobese patients, a phenomenon known as the obesity paradox. Limited data exist regarding the effect of obesity on prognosis in patients with pulmonary arterial hypertension (PAH). We used the National Inpatient Sample database for years 2003 to 2011 to identify all patient hospitalizations aged ≥18 years with a primary diagnosis of PAH. Patients with a diagnosis of obesity were identified using Elixhauser co-morbidity measure provided in Nationwide Inpatient Sample database, based on International Classification of Diseases, Ninth Revision, Clinical Modification, codes and the diagnosis-related groups. Multivariable logistic regression was used to compare in-hospital mortality between obese and nonobese patients with PAH. Of the 18,450 patients with a primary diagnosis of PAH, 14.7% were obese. Obese patients with PAH were younger, more often women, and more often black compared with nonobese white patients. After risk adjustment for demographics, hospital characteristics, and baseline co-morbidities, obese patients with PAH had lower observed in-hospital mortality compared with nonobese patients with PAH (3.5% vs 8.1%; adjusted odds ratio 0.66, 95% confidence interval 0.51 to 0.85, p = 0.001). In conclusion, from a 9-year nationwide cohort of patients with PAH, we observed significantly lower risk-adjusted in-hospital mortality in obese patients compared with nonobese patients

Ischemia-Induced Brugada Phenocopy.

A 65-year-old man with history of schizoaffective disorder was admitted with a suspicion for syncope. ECG changes consistent with type-1 Brugada pattern were noted on admission. A personal history of angina was reported but a family history of sudden cardiac death or ICD implantation was denied. A fixed perfusion defect and hypokinesis of the distal infero-lateral wall were reported on a pharmacological stress test prompting a coronary angiography. A stent was deployed across a 95% stenosis of the dominant mid right coronary artery with satisfactory results. Resolution of the Brugada type pattern was noted on ECGs repeated after the stenting

The forgotten disease: Bilateral lemierre\u27s disease with mycotic aneurysm of the vertebral artery.

PATIENT: Male, 25 FINAL DIAGNOSIS: Lemierre\u27s disease Symptoms: Back pain • fever • headache • tachycardia • tachypnoe MEDICATION: - Clinical Procedure: - Specialty: Infectious Diseases. OBJECTIVE: Rare disease. BACKGROUND: Lemierre\u27s disease, also known as the forgotten disease, postanginal sepsis, or necrobacillosis, was first reported in 1890 by Courmont and Cade, but it was Dr. Andre Lemierre, a professor of microbiology, who described this disease in 1936. The typical causative agent is Fusobacterium necrophorum, although other organisms may be involved. The pathogenesis of Lemierre\u27s disease is not well understood. It is characterized by a primary oropharyngeal infection associated with septicemia, internal jugular vein thrombosis, and metastatic septic emboli. CASE REPORT: We report a case of Lemierre\u27s disease with bilateral internal jugular vein (IJV) thrombosis and metastatic septic emboli to the lungs and brain, associated with epidural abscess and mycotic aneurysm of the vertebral artery, which is quite rare in Lemierre\u27s disease. This is the first report of a case of Lemierre\u27s disease associated with mycotic aneurysm of the vertebral artery. CONCLUSIONS: Lemierre\u27s disease is a rare and perplexing medical entity. Clinical suspicion should be high in previously healthy young adults presenting with fever and neck pain following oropharyngeal infection. Dr. Lemierre stated that \u27symptoms and signs of Lemierre\u27s disease are so characteristic that it permits diagnosis before bacteriological examination\u27. The prognosis of patients with Lemierre\u27s disease is generally good, provided prompt recognition and appropriate treatment