An unexpected diagnosis in a dyspnoeic patient with primary Sjogren syndrome.

We describe a case of a 50-year-old lady with newly diagnosed primary Sjogren syndrome who presented with severe pulmonary artery hypertension and pericardial effusion. She was managed by immunosuppressive agents and a combination of standard therapy for pulmonary hypertension. Our patient had a clinically significant involvement of cardio-pulmonary system that is atypical of this disease. Prompt recognition and management of this condition are extremely crucial as untreated cases carry a grave prognosis. However, the ideal treatment strategy is yet to be defined for this condition.

Acute coronary syndrome registry from four large centres in United Arab Emirates (UAE-ACS Registry).

OBJECTIVE: To identify the characteristics, treatments and hospital outcomes of patients diagnosed as having acute coronary syndrome (ACS) in the United Arab Emirates (UAE). DESIGN: A 3-year prospective registry. SETTING: Four tertiary care hospitals in three major cities of UAE from December 2003 to December 2006. PATIENTS: 1842 eligible consecutive patients with suspected ACS. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Characteristics, treatments and in-hospital outcomes were recorded. RESULTS: The mean age was 50.8±10.0 years, and 93.1% were male. More than half (51%) had ST elevation myocardial infarction (STEMI). The smoking rate was 46.4%, and diabetes was present in 38.9%. Only a minority (17.3%) used the ambulance services. For patients with STEMI, the median symptom to hospital time was 127 (IQR 60-256) min, and the median diagnostic ECG to thrombolysis time was 28 (IQR 16-50) min. Reperfusion in STEMI was in 81.4% (64.8% thrombolysis and 16.6% primary percutaneous coronary intervention). During hospitalisation, only a minority of the patients did not receive antiplatelets, anticoagulants, beta-blockers, ACE inhibitors and statin therapy. In-hospital complications were not common in our registry cohort. In-hospital mortality was 1.68%. CONCLUSIONS: ACS patients in UAE are young but have higher risk factors such as smoking and diabetes. Almost half present as STEMI. Only a minority use ambulance services.

The potential of erythropoietin for conferring cardioprotection complementing reperfusion.

OBJECTIVES: Despite the well-recognized effects of erythropoietin (EPO) on augmenting red blood cell production, EPO exerts multiple additional effects in diverse tissues. Evidence indicating the potential for tissue protection is reviewed as is a description of a study now initiated, in which its potential benefit on the evolution of acute myocardial infarction in patients is being explored. METHODS: The literature demonstrating tissue-protective effects of EPO in experimental animals and patients is cited as is the protocol of the recently undertaken Vermont/Dubai study assessing the potential benefits conferred by EPO on the evolution of infarction in patients. RESULTS: Compelling arguments can be made indicating that EPO and its congeners, some of which are devoid of erythropoietic effects, can protect tissue against injurious stimuli. Accordingly, the promise of EPO for favorably altering the evolution of acute myocardial infarction merits exploration. Congeners of erythropoietin or EPO itself may be beneficial in protecting the heart against injury induced by ischemia thereby favorably modifying infarct size. Rigorous testing of this hypothesis is now in progress in a study involving patients with acute myocardial infarction admitted to hospital within 6 h after the onset of chest pain in whom infarct size is being evaluated based on serial analyses of concentrations of creatine kinase in plasma and thrombolysis is induced pharmacologically as promptly as possible. CONCLUSION: EPO is promising for myocardial protection. Its potential is being delineated in a clinical study of myocardial infarction treated with tenecteplase with or without concomitant EPO.