Modifiable cardiovascular risk factors in rheumatoid arthritis

Objective: To determine the frequency of modifiable cardiovascular risk factors in Rheumatoid Arthritis patients at tertiary care hospital

Methods: During this study 246 patients of Rheumatoid Arthritis were enrolled from outpatients department of Medicine of Central Park Medical College Hospital, Lahore from July 1, 2016 to January 31, 2017. Demographic data and questions related to study were noted. After 14 hours of fasting 5ml of venous blood was drawn for Cholesterol, triglycerides, HDL and blood sugar level. Blood tests were performed on COBAS c III [ROCHE], Framingham 10 year Risk score was calculated for every individual

Results: The mean age of male population was [50.2 +/-7.5] and females [48.4+/-7.6] and female gender was common. Seventy eight [78%] of study population has one modifiable risk factor. Most frequent risk factor found in this study was BMI >30 in 48.4% [n=119], High LDL 43.5% [n=107], moderate to high FRS score 40.2% [n=99], Hypertension 37.4% [n=92], Diabetes Mellitus was present in 22.8% [n=56], while smoking was least frequent risk factors with frequency of 15.9% [n=39]. Framingham cardiovascular risk score was significantly different, males were having higher mean 10 year risk score [19.7%] and females [8.7%] with [p<0.01]. Regression analysis revealed that older patients of Rheumatoid Arthritis with disease duration of more than seven years are four times more likely to have High Framingham risk score, moderate to high LDL and diabetes mellitus with significant high Odds ratio [p-value <0.05]

Conclusion: Rheumatoid Arthritis patients are having increased chances of developing cardiovascular risk factors leading to cardiovascular events with male sex, increasing age and disease duration

Clinical presentation and CT scan findings in patients of ischemic and hemorrhagic strokes

To compare the weighted clinical score and computed tomography scan brain of patients of ischemic and hemorrhagic strokes. This descriptive non-interventional study was conducted on 100 consecutive patients of all ages and both sexes presenting with stroke within 48 hours of the onset of the symptoms due to hemorrhage or infarction but not due to transient ischemic attack, reversible ischemic neurologic deficit, sub-arachnoid hemorrhage, tumors or trauma. The patients were admitted and examined, Siriraj Stroke Score was applied to make the clinical diagnosis and this score was compared with CT scan of the brain as gold standard. Out of 100 patients, eight were excluded due to invalid Siriraj Stroke Score between+1 to-1. Among 92 patients, 58.7% [54] were male and 41.3% [38] were female with a mean age of 61.8 +/- 7.8 years. Mean diastolic blood pressure was 94.78 mm Hg with range of 50 to 160. Hypertension was the most prevalent risk factor being present in 57.1% of ischemic and 54.4% of hemorrhagic patients. Clinically 72.8% [67] patients had ischemic and 27.2% [25] patients had hemorrhagic stroke. CT scan showed 76.1% [70] patients had ischemic and 23.9% [22] patients had hemorrhagic stroke. For ischemic strokes, Siriraj Stroke Score is 87%sensitive and 73% specific having a positive predictive value of 91%. For hemorrhagic stroke, Siriraj Stroke Score is 73% sensitive and 87% specific with a positive predictive value of 63%. Yule's coefficient using Chi-square test showed a high comparability between clinical and CT scan diagnoses. Siriraj Stroke Score needs to be further modified to be more objective and it should be compared with diffusion weighted magnetic resonance imaging as gold standard and not with computed tomography of the brain

evaluate the association of anthropometric indices with metabolic syndrome and insulin resistance in patients with NAFLD

To evaluate the association of anthropometric indices [body mass index and waist circumference] resistance [IR] and metabolic syndrome [MS] in patients having non-alcoholic fatty liver disease [NAFLD]. From August 2005 to Mar 2006 a case series of 70 patients with clinical and/or histological diagnosis of NAFLD were selected at the gastroenterology and Hepatology clinic of Ghurki trust teaching hospital. Liver function tests, lipid profile, glucose and insulin were checked in all patients. Body mass index [BMI] and waist circumference [WC] were determined according to WHO criteria. IR was measured by means of the homeostasis model assessment [HOMA] and IR was present in those having HOMA >/= 3. Metabolic Syndrome [MS] was defined according to the Adult Treatment Panel III [ATP III]. Liver biopsy was performed in 20 cases. Body mass index >/= 30kg/m[2] [obesity] was found in 40% of the cases and BMI 25-29.9 kg/m[2] [overweight] in 52%. BMI correlated with IR [r = 0.39; P = 0.02] and WC with ALT [r =0.02; P = 0.03] IR [p=0.01] and MS [p=0.001]. The presence of steatohepatitis with fibrosis on liver biopsy was associated with overweight BMI [72%], increase of WC [50%] and IR [18%] [p<0.05]. Conclusions: Body mass index and WC are associated with MS, IR and histological findings in patients with NAFLD