relationship between serum pro-brain natriuretic peptide [Pro-BNP] levels and pulmonary arterial hypertension [PAH] in patients with limited scleroderma

Introduction: Pulmonary arterial hypertension [PAH] is a late progressive sclerodermarelated complication, which can lead to right heart failure and cor pulmonale. Given that cardiac catheterization is a diagnostic method of choice for PAH, and considering the high risks of this method, the purpose of this study was to evaluate the relationship between serum Pro-Brain natriuretic peptide [Pro-BNP] Levels and PAH in patients with limited scleroderma

Materials and Methods: In this cross sectional study, during June 2011- Dec 2013, referring patients to two major educational hospitals, Mashhad- Iran, with scleroderma, who were afflicted with the disease for at least two years [or more], were enrolled in the study if they met the inclusion and exclusion criteria. All the patients underwent echocardiography to determine the pulmonary artery pressure [PAP]. Afterwards, the subjects were referred to a lung center for performing body plethysmography, carbon monoxide diffusing capacity [DLCO], and 6-minute walk test [6MWT]. Pro-BNP Serum level was determined using flourescent immune assay method

Results: The present study included 20 patients [18 female subjects] with the mean age of 43.28 +/- 9.56 yrs, and the mean pro-BNP level of 138 pg/ml. The logarithmic correlation between PAP values, Forced Vital Capacity /DLCO ratio, and pro-BNP level, which was measured using Pearson's correlation coefficient, showed a significant association among these variables[ respectively, r=0.76, P=0.001; r=0.677, P=0.011]. Moreover, the DLCO decrease was associated with increasing pro-BNP level, though this relationship was not significant

Conclusion: This study showed that there was a significant relationship between the serum levels of pro-BNP marker and increased PAP in the echocardiography, DLCO reduction, and FVC/DLCO increase. In fact, this serum marker can be used in patients with systemic scleroderma [SSc] to evaluate the status of PAH

Vasculitic peripheral neuropathy

Primary systemic vasculitis in pre-capillary arteries is associated with peripheral neuropathy. In some types of systematic vasculitis about 60% of patients have peripheral nervous system [PNS] involvement. In vasculitic peripheral neuropathies [VPN] a necrotizing and inflammatory process leads to narrowing of vasa nervorum lumen and eventually the appearance of ischemic lesions in peripheral nerves. Some features might be suggestive of VPN, like: axonal nerve degeneration, wallerian-like degeneration, and diameter irregularity of nerve. Peripheral nervous system [PNS] destruction during systemic vasculitides should be considered, due to its frequency and early occurrence in vasculitis progression. The first line treatment of non systematic VPNs is corticosteroid agents, but these drugs might worsen the VPNs or systemic vasculitis

case report of unusual vasculitic reaction after methocarbamol injection

Descriptive case report of a 42-year old woman with coetaneous vasculitis, and severe abdominal pain, which was led to diagnostic laparotomy. These presentations are probably as a side effect of Methocarbamol injection. This is the first report according to our literature search [PubMed, google scholar, ISI web of knowledge, ProQuest, MD consult, Science Direct, SCOPUS] about Methocarbamol related vasculitis from 1966 since now. Vasculitis is not a known side effect of Methocarbamol. This case indicates, likely the potential for development of vasculitis with this medication

Correlation between serum levels of soluble fas [CD95/Apo-1] with disease activity in systemic lupus erythematosus patients in Khorasan, Iran

Soluble Fas [sFas] is a marker of apoptosis that appears to increase in the serum of systemic lupus erythematosus patients and may have a correlation with disease activity. The exact role of sFas in apoptosis is not clear. The purpose of this study is to assess the correlation between serum levels of soluble Fas [Apo/1-CD95] and the activity of systemic lupus erythematosus. Our study was performed on 114 systemic lupus erythematosus patients who were compared with 50 randomly selected sex, age and race-matched healthy controls. Disease activity was defined according to the Systemic Lupus Erythematosus Disease Activity Index [SLEDAI-2K]. All physical exams and laboratory parameters were collected to determine the SLEDAI. sFas levels were determined using a commercially available ELISA kit. There was a significant difference between serum levels of sFas in the case and control groups [P=0.001]. A significant correlation coefficient existed between the sFas and SLEDAI2K variables [P=0.001, r=0.494]. Significant statistical difference was found between serum levels of sFas in the active and inactive phases of disease according to SLEDAI< 9 or >10, [P=0.002]. The sFas levels were 270 - 300 pg/mL for SLEDAI<9 and 355-502 pg/mL for SLEDAI>10, with a confidence interval of 95%. This study shows a significant elevation of sFas levels in the sera of systemic lupus erythematosus patients with active disease; therefore it can be used as an appropriate marker for evaluation of disease activity