[Late-onset rheumatoid arthritis: clinical, biological, and therapeutic features About a retrospective study]. / Polyarthrite rhumatoïde à révélation tardive : caractéristiques cliniques, biologiques et thérapeutiques À propos d'une étude rétrospective.

Rheumatoid arthritis (RA) is the most common chronic inflammatory rheumatism in adults. The objective of our study was to analyze the clinical, biological and therapeutic characteristics in subjects over 60 years old. PATIENTS AND METHODS: We performed a retrospective, monocentric, descriptive study on medical records consultations. The data collection concerned subjects over 60 years of age who had been diagnosed with "rheumatoid arthritis" in the rheumatology and internal medicine departments of CHU Reims over a period stretching from 2010 to 2015. RESULTS: Thirty-two patients were included in our study for this period. The mean age of diagnosis was 66.6 years, for a median age of 67.5 years (min: 60 years, max: 88 years). There were 22 female (69%) and 10 male (31%) patients, with a sex ratio H/F of 2.2. The mean duration of symptom progression before diagnosis was 33.2 months. What dominates our series is the inaugural involvement of the interphalangeal proximal, wrists, shoulders and metacarpophalangeal for the vast majority of cases. Oral corticosteroids were used in 27 patients and were the only treatment in 3 patients. Methotrexate (MTX) was introduced in 27 patients. Nine patients received biotherapy: it was tocilizumab (Roactemra®) for 5 patients, adalimumab (Humira®) for 2 patients, abatacept (Orencia®) for 2 patients, etanercept (Enbrel®) for 2 patients, golimumab (Simponi®) for 1 patient and infliximab (Remicade®) for one patient. In our series, 7 patients are over 75 years old at the time of diagnosis of RA. CONCLUSION: The rheumatoid arthritis of the elderly remains a common condition and constitutes a diagnostic and therapeutic challenge. Because of the co-morbidities, the clinician's perception of the patient's overall condition and the inaccuracies in the use of certain molecules in these patients, under-treatment may, on the contrary, weaken a patient whose remission will be postponed. This was not the case in our series, with a methodical use of methotrexate as well as effective dose biotherapies.

Circadian Variation In The Onset Of Acute Myocardial Infarction In Diabetics.

BACKGROUND: It has been shown in previous studies there is circadian variation in the onset of acute myocardial infarction. The objective of this study was to evaluate the relation of circadian variation in onset of Acute Myocardial infarction in Diabetic subjects. METHODS: This study was conducted at the Services Institute of Medical Sciences Lahore and Punjab Institute of Cardiology from January 2015 to February 2016. Hundred diabetic and 100 Non-diabetic patients with Myocardial infarction were included in the study. Among diabetics those were included in the study that had diabetes for ≥5 years. The time of onset of symptoms to determine the circadian rhythm was noted. In order to determine the frequency of acute myocardial infarction associated with circadian rhythm, 24 hours of the day were divided into four equal sections of 6 hours each. We noted time of onset of acute MI. Thereafter, patients were bracketed in their respective six-hour time periods. These six-hour periods were 0-6, 6:01-12, 12:01-18, and 18:01-24 hours. RESULTS: In this study patients' mean age was 59.16±13.81. Forty-two (71.2%) non-diabetic patients had acute myocardial infarction (AMI) during 6:00-12:00 hours whereas 17 (28.8%) diabetic patients presented with AMI during this time. CONCLUSIONS: Incidence of AMI is significantly increased in the morning 6:01-12:00 hours in non-diabetics. However, diabetic subjects did not show significant increased incidence of AMI during this time rather there was increased incidence of AMI during 0-6:00 hours.

Association of metabolic factors with dengue viral infection on admission triage which predict its clinical course during Lahore dengue epidemic.

OBJECTIVE: The study was done to identify metabolic factors which were associated with an increased risk of dengue haemorrhagic fever in clinically diagnosed patients of dengue viral infection. METHODS: 563 patients with dengue viral infection that presented to 3 tertiary care hospitals of Lahore were included in this study, out of which approximately half of the patients were diagnosed as dengue haemorrhagic fever. RESULTS: A total of 563 patients with 263(46.7%) dengue fever and 300(53.3%) dengue haemorrhagic fever patients were studied. The mean age of patients was 48.48 ± 20.07 years. In patients younger than 60 (n=355), 171 patients had DF and 184 had DHF, while 116 patients above 60 years had DHF and 92 had DF (n=208). The presence of metabolic risk factors such as diabetes (OR = 2.146), hypertension (OR =1.65), diabetes and hypertension (OR =3.56), abnormal liver function tests (OR = 2.27), abnormal renal function tests (OR = 2.282) all increased the risk of DHF relative to DF. CONCLUSIONS: The study showed that metabolic factors especially diabetes with and without hypertension are important risk factors for the development of DHF.