Frequency and predictors of pulmonary hypertension in patients with systemic Lupus Erythematosus

Objective: To determine the frequency and predictors of pulmonary hypertension in patients with Systemic Lupus Erythematosus in a Pakistani population, presenting at a tertiary care hospital

Methods: This cross-sectional study was conducted at the Department of Rheumatology, Shiekh Zayed Hospital, Lahore from March to June 2018. A total of 97 patients, who fulfilled the Systemic Lupus Erythematosus [SLE] criteria of American College of Rheumatology [ACR] 1992 were enrolled. Pulmonary Arterial Hypertension [PAH] was measured by calculating pulmonary arterial systolic pressure through echocardiography by a single consultant cardiologist. Disease characteristics and demography was collected in a self-administered proforma. PAH was defined as mean pulmonary arterial pressure of 25mmHg or above by calculating with a formula. SPSS version 20 was used for analysis of data

Results: Out of 97 patients, 89.7% [n=87] were females and 10.3% [n=10] were males, with mean age of 31.29+/-8.824 years. The mean disease duration was 24.21+/-30.46 months. PAH was found in 23.3% [n=23] patients, including 19 females and 4 males. On further analysis of data, Raynaud phenomenon, rheumatoid factor and nephritis were assessed as predictors of PAH and all of these showed statistical significance for presence of PAH as per Chi-square test [p<0.05]

Conclusion: In this study, 23.3% SLE patients showed evidence of PAH and positive statistical significance was found between predictors like Raynaud phenomenon, rheumatoid factor, nephritis and presence of PAH. So it is imperative to detect PAH early and start prompt treatment to achieve better quality of life

Impact of Fibromyalgia on Das-28 score in Rheumatoid Arthritis

Objective: To determine the frequency of fibromyalgia American college of rheumatology [ACR] 2010/2011 criteria] in patients with rheumatoid arthritis and its impact on disease activity score [DAS-28]

Study Design: Cross-sectional study

Place and Duration of study: Department of Rheumatology and Immunology, Sheikh Zayed Hospital Lahore from Jun 2016 to Feb 2017

Patients and Methods: Total 140 diagnosed patients of rheumatoid arthritis by criteria ACR 2010 were included in this study. ACR modified 2010/2011 criterion of fibromyalgia was used to diagnose co existing fibromyalgia in these patients. Clinically disease activity status was assessed by standardized and validated DAS-28 calculator; 2ml of blood was drawn and sent to laboratory for estimation of erythrocyte sedimentation rate for all study participants

Results: The mean age, duration of disease, DAS-28 of sampled population was 49.12 +/- 8.5 years, 7.36 +/- 3.8 years, 4.08 +/- 1.1 respectively. Out of 140 patients, 127 patients [90.7percent] were females. Fibromyalgia was diagnosed in 41 patients [29.1percent]. The mean DAS-28 score in patients of rheumatoid arthritis with fibromyalgia was 5.39 +/- .58 while for patients of without fibromyalgia it was 3.54 +/- 0.69 [p-value<0.001]

Conclusion: Secondary fibromyalgia is common in patients with rheumatoid arthritis and needs to be screened out in all patients diagnosed as rheumatoid arthritis and on subsequent follow up visits, coexisting fibromyalgia affects the disease activity status and this may result into inappropriate and unnecessary changes in treatment plans

Prevalence of usual and unusual skin manifestations of systemic lupus erythematosus in a tertiary care hospital

Objective: To determine prevalence of different types of skin manifestations in SLE in our country

Methods: The study was carried out at the Rheumatology and Immunology Department, Shaikh Zayed Hospital, Lahore. 125 patients who were diagnosed with SLE on basis of American College of Rheumatology classification criteria for SLE and also having skin manifestations were included from June 2011 till June 2015 from outdoor and inpatient departments

Results: SLE specific skin manifestations were as follow: malar rash was seen in 83 [71.6%] patients, photosensitivity in 61 [49.12%] patients, oral ulcers in 39 [31.35%], maculopapular rashes in 29 [23.46%], discoid rash in 26 [20.7%], subacute cutaneous lupus erythematosus [SCLE] in 6 [5.18%] patients. The SLE non-specific skin manifestations included: vasculitic rash in 50 [40.0%], non-scarring alopecia in 39 [30.9%], palmar erythema in 26 [21.1%], vasculitic ulcers in 7 [4.9%], livedo reticularis in 5 [3.8%], digital gangrene in 3 [2.7%], and Raynaud's phenomenon in 3 [2.2%] patients. Patients having SLE specific skin manifestations like malar and discoid rash were more likely to have internal organ involvement, while with those having SLE non-specific skin manifestations were seen with acute flare of disease. ANA and anti-ds DNA antibodies were positive in 92% and 63% patients, respectively

Conclusion: Skin manifestions in SLE are important disease parameters which can give important diagnostic and disease activity information. Thorough focus on dermatological aspect is very important for diagnosis and treatment in this entity

Cardiovascular risk score in Rheumatoid Arthritis

Objective: To determine the 10-year Cardiovascular risk score with QRISK-2 and Framingham risk calculators in Rheumatoid Arthritis and Non Rheumatoid Arthritis subjects and asses the usefulness of QRISK-2 and Framingham calculators in both groups

Methods: During the study 106 RA and 106 Non RA patients age and sex matched participants were enrolled from outpatient department. Demographic data and questions regarding other study parameters were noted. After 14 hours of fasting 5 ml of venous blood was drawn for Cholesterol and HDL levels, laboratory tests were performed on COBAS c III [ROCHE]. QRISK-2 and Framingham risk calculators were used to get individual 10-year CVD risk score

Results: In this study the mean age of RA group was [45.1 +/- 9.5] for Non RA group [43.7 +/- 8.2], with female gender as common. The mean predicted 10-year score with QRISK-2 calculator in RA group [14.2 +/- 17.1%] and Non RA group was [13.2 +/- 19.0%] with [p-value 0.122]. The 10-year score with Framingham risk score in RA group was [12.9 +/- 10.4%] and Non RA group was [8.9 +/- 8.7%] with [p-value 0.001]. In RA group QRISK-2 [24.5%] and FRS [31.1%] cases with predicted score were in higher risk category. The maximum agreement scores between both calculators was observed in both groups [Kappa=0.618 RA Group; Kappa=0.671 Non RA Group]

Conclusion: QRISK-2 calculator is more appropriate as it takes RA, ethnicity, CKD, and Atrial fibrillation as factors in risk assessment score

Fetal outcome of pregnancy with hypertension

Objective: to assess relationship of neonatal morbidity and mortality with severity of hypertension. The effect of severity of hypertension on time of delivery and neonatal outcome including birth weight, APGAR score, neonatal nursery admission, intrauterine death and neonatal deaths was studied

Methods: all pregnant patients with diastolic blood pressure of at least 90 mmHg or systolic blood pressure of 140 mmHg taken at two occasions at least 6 hours apart, with singleton pregnancy at any gestational age were included in the study. They were categorized in two groups according to diastolic blood pressure at the time of presentation. Mild to moderate hypertensive patients were those with diastolic blood pressure up till 109 mmHg. Patients with diastolic blood pressure 110 mmHg or more were labeled as severely hypertensive patients. AU patients were followed throughout antenatal period till delivery. Time of delivery was decided by senior consultants according to obstetrical parameters. All babies delivered were attended by pediatricians and admission in neonatal nursery was decided by pediatricians. Babies admitted in nursery were followed till discharge or expiry

Results: out of 1661 screened patients, 119 hypertensive pregnant patients were detected [an incidence of 7 .16%]. Out of these 78.2% were mild to moderate hypertensive and 21.8% were severely hypertensive patients. The effect of severity of hypertension was significant on time of delivery. There were 74% preterm deliveries in severely hypertensive patients as compared to 13% in mild to moderate group [p; 0.0001]. The effect of severity of hypertension was significant on birth weight, APGAR score, intrauterine and neonatal deaths

Conclusion: fetal morbidity and mortality is directly related to severity of hypertension in terms of birth weight, pre-term deliveries, APGAR score and perinatal mortality rate

Extra intestinal manifestations of irritable bowel syndrome

Objectives: This study was done to assess the frequency of extra intestinal features present in patients with irritable bowel syndrome

Design and place of study: It was an observational study conducted in out-patient Department of Medicine, Shaikh Zayed Hospital, Lahore affiliated with Federal Postgraduate Medical Institute, over a period of two years from January 2005 to December 2006

Subject and methods: The patients fulfilling the Rome II criteria of IBS were included in the study. A check list of extra intestinal symptoms was administered to all the patients

Results: A total of 63 patients were included in the study. There were 41 men and 22 women [male to female ratio of 1.86: I] with the age range from 18 to 61 years [mean of 33 .09 +/- 8.5 SD]. The mean duration of disease was 2.78 years. Urinary symptoms like frequency and urgency were present in almost one third of patients. These symptoms were more frequent in men [47%] than in women [33%]. The most common non-specific pain was chronic headache [62%] followed by fibromyalgia [43%] and non-specific chest pain [37%] of all cases. All of these non-specific pain symptoms were more common in women. Dysmenorrhoea [45%] was the commonest genitourinary symptom in women while impotence and premature ejaculation each were seen in 7% of men. As a group sexual and genital symptoms were more common in women than men

Conclusion: Majority of the IBS patients along with intestinal symptoms also suffers from extra intestinal complaints. Therefore, these patients should be actively screened for the presence of these extra intestinal complaints so that a timely multidisciplinary intervention may prevent further prolongation of their misery

Frequency of posttraumatic stress disorder symptoms in earthquake survivors

Objectives: This study was done to assess the frequency of symptoms of Posttraumatic Stress Disorder in earthquake survivors

Design and place of study: It was an observational study conducted on in-patient survivors of Oct 8. 2005 earthquake, admitted in different departments of Shaikh Zayed Hospital, Lahore affiliated with Federal Postgraduate Medical Institute

Subject and methods: The patients who had received different physical injuries and their surviving attendants were administered with a check-list of symptoms of Posttraumatic Stress Disorder [PTSD] diagnostic criteria of DSM-IV

Results: A total of 124 survivors [85 patients and 39 attendants] were identified and administered with the check-list. In all 52 [41.94%] of the survivors, 38 [44.77%] of patients and 14 [35.90%] of the attendants fulfilled the entire DSM-IV symptom criteria for PTSD. Among the patients more females i.e. 27 [52.94%] as compared to males i.e. 11 [32.32%] fulfilled the symptom criteria for PTSD

Conclusion: Posttraumatic Stress Disorder symptoms are very common in the survivors of an earthquake, an evidence to sensitize health care providers to organize and implement timely psychosocial assessment and interventions

Extensive gastrointestinal involvement in Behcet's syndrome - a case report

Behcet's syndrome is a relatively rare entity, originally characterized by a diagnostic triad of oral and genital ulceration with ocular abnormalities. Since the syndrome was described in 1937 by Behcet, a Turkish dermatologist, many papers have described multisystemic involvement in the disease. Recognized clinical features include arthritis, arterial thrombosis, encephalitis, cardiomyopathy, erythema nodosum, amyloidosis, g!omerulonephritis, and pneumonitis. We report here a case of Behcet's syndrome in 29 year old male presenting with orogenital as well as colonic ulcers