ABSTRACT
Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory disorder, involving joints and extra-articular manifestations. About 50% mortality in RA is due to cardiovascular disease. Cardiovascular events occur approximately a decade earlier in RA like that in diabetes mellitus. Aim: The aim of the study was to correlate and compare the association between disease severity and various clinical and cardiovascular manifestations in RA patients. Materials and Methods: This prospective cross-sectional study is carried out in known RA patients fulfilling the American College of Rheumatology criteria 2010 attending General Medicine and Rheumatology outpatient clinic of Tirunelveli Medical College Hospital between April 2017 and April 2018. They have been subjected to detail clinical and laboratory investigations and their cardiovascular manifestations are compared with their clinical profile and disease activity score. Results: In this study, 50 patients were included, with a mean age of 47.76 years and 72% of female patients. The mean clinical disease activity index (CDAI) score among them is 25.16 ± 10.4. The disease severity was high among our study group with 60% of cases occupying high CDAI score with no patients under remission. The most common electrocardiogram abnormality found in the study group was left axis deviation (30%) followed by nonspecific ST-T changes (24%). Mean carotid intima-media thickness (CIMT) was found to be increased in 68% of patients. Asymptomatic carotid plaque was present in 8% of patients. The most common echocardiographic abnormality is left ventricular (LV) diastolic dysfunction, which contributes 44% in our study group. Conclusion: Cardiovascular abnormalities such as LV diastolic and systolic dysfunction, premature atherosclerosis occur commonly in RA patients and positively correlate with CDAI score, disease duration, and treatment duration. All RA patients should be screened for chorionic villus sampling abnormalities through echocardiography and CIMT periodically
ABSTRACT
Introduction: The increasing prevalence of ureteric stone is a matter of concern in this era and it may be linked to improvedquality of life. Medical expulsive therapy, including alpha-blockers, steroids, and calcium channel blockers, has been extensivelystudied for improving the rate of stone passage in patients who do not require immediate urologic intervention.Aim: The aim of this study is to compare the efficacy of tamsulosin and tadalafil in expulsive treatment for distal ureteralstones.Materials and Methods: This was a prospective comparative study included 120 adult patients (>18 years of age) presentingwith distal ureteric stones were randomized into 60 patients with tamsulosin 0.4 mg once daily (Group A) or 60 patients withtadalafil 10 mg once daily (Group B) treatment. Therapy was given for a maximum of 4 weeks.Results: About 85% of study patients had a size between 5 mm and 7 mm and 18 patients had size between 8 mm and 10 mm.There was no statistical difference noted in the pain duration and analgesic usage of both groups. In Group A, 67% of patientshad expulsion of stones; in Group B, 63% of patients had expulsion of stones. About 90% of patients in 40 cases of expelledstones are in <5 days in Group A and 89% of patients 38 cases of expelled stones are in <5 days in Group B. There was nostatistical difference noted between both groups.Conclusion: Tamsulosin and tadalafil have shown similar expulsion rate. Both of them simultaneously provides better paincontrol and significantly lower the needs for analgesia.