Is there an association between central venous pressure measurement and ultrasound assessment of the inferior vena cava?

Introduction:Early assessment of volume status is paramount in critically ill patients. Central venous pressure (CVP) measurement and ultrasound assessment of the inferior vena cava (IVC) are both used for volume assessment in the emergency centre. Recent data is conflicting over whether there is a correlation between CVP and ultrasound assessment of the IVC.Methods:This was a retrospective review of an audit previously performed in the Emergency Unit of Ngwelezane Hospital in Kwazulu-Natal. The audit involved measuring inferior vena cava collapsibility index (IVC-CI) within 5 min of CVP measurement. In this retrospective study, audit data were analysed to determine if an association exists.Results:Twenty-four patients were included. The median age of participants was 36 (IQR 42) years (95% CI 33­56). The median time to ultrasound was 18.6 (52.5) h (95% CI 7.5­36.2). The mean CVP was 13.7 ±â€¯7.7 cm H2O and mean IVC-CI was 39.4 ±â€¯17.8%. Based on a Pearson correlation test, there was a weak negative correlation between CVP and IVC-CI, which was not statistically significant (r = −0.05, n = 24, p = 0.81, 95% CI −0.5 to 0.4) for all participants. However, among females there was a moderate negative correlation between CVP and IVC-CI, which was not statistically significant (r = −0.43, n = 7, p = 0.34, 95% CI −0.9 to 0.5), while among males there was a weak positive correlation, which was not statistically significant (r = 0.16, n = 17, p = 0.53, 95% CI −0.3 to 0.6).Discussion:There is no significant correlation between CVP and IVC-CI. Further validation research is required to support our preliminary findings of no significant correlation between CVP measurement and ultrasound assessment of the IVC. CVP and IVC ultrasound should be used as clinical adjuncts, and not as stand-alone measures of volume assessment

Psoriatic Arthritis: An Assessment of Clinical; Biochemical and Radiological Features in a Single-Centre South African Cohort

BACKGROUND:Although psoriatic arthritis (PsA) is a well-documented clinical entity; epidemiological; clinical and radiological studies of South African (SA) patients are scarce.OBJECTIVES:To assess clinical; biochemical and radiological features in a single-centre SA cohort.METHODS: We conducted a prospective assessment of the clinical; biochemical and radiological features of 384 consecutive patients with PsA seen at the rheumatology clinic at Prince Mshiyeni Memorial Hospital; Durban; SA; between January 2007 and December 2013. Patients were assessed at enrolment and 6 months after enrolment. They were classified into five groups as described by Moll and Wright; being entered into the group that best described the clinical manifestations. Clinicopathological characteristics recorded at enrolment were age at the time of examination; racial background; personal and family medical history; age and symptoms at the onset of PsA; pattern of joint involvement; joint pain; and the relationship between joint pain and the onset of PsA.RESULTS:Of the patients; 59.1% had a polyarticular presentation indistinguishable from rheumatoid arthritis; 19.0% had distal interphalangeal involvement; 9.1% had spondyloarthropathy; 11.9% had oligoarthritis and 0.9% had arthritis mutilans. The epidemiological trends (male/female ratio 1.45:1; mean age at onset of arthritis 50.2 (standard deviation 11.8) years; female preponderance in the polyarticular group and male preponderance in the spondyloarthropathy and oligoarticular groups) were similar to trends published elsewhere. A notable characteristic of our cohort was the complete absence of black South Africans with PsA.CONCLUSIONS:The complete absence of black South Africans with PsA is interesting. We anticipate that our findings will prompt genetic studies to isolate both protective and susceptibility genes for further elucidating PsA