Causes of Raynaud's phenomenon and the predictive laboratory and capillaroscopy features for the evolution to a definite connective tissue disease.

OBJECTIVE: In patients with RP, capillaroscopy is useful for discriminating primary from secondary causes. There are certain capillaroscopy and lab values as predictive factors leading to a known CTD. We conducted the present study to evaluate the causes of RP in our area and followed the studied subjects to find prognostic factors indicating a definite CTD or remaining a UCTD. METHODS: In this retrospective cohort study we included all adult patients with RP who were referred for capillaroscopy from 2010 to 2019. All the patients with primary and secondary RP with follow-up were evaluated for demography, laboratory results and capillaroscopy to find the risk factors of their progression to a CTD. RESULTS: A total of 760 of 776 patients were included, with 679 being female (89.3%) and 81 (10.7%) male. There were 660 subjects (90.8%) with secondary RP [mostly UCTD (48.2%) and then SSc (16.4%)] and 67 (9.2%) with primary RP; 109 patients were followed up and 42 (42%) of those with secondary RP developed a definite CTD. The scleroderma pattern and some capillary changes on capillaroscopy and/or positive ANA had statistically significant differences for CTD transition. CONCLUSION: We had a small number of patients with primary RP. The most prevalent causes of secondary RP in our patients were UCTD and SSc. Some capillaroscopy and laboratory results alone or in combination could be used as a predictive marker for the transition of patients with UCTD to CTD.

The effect of kidney transplantation on speckled tracking echocardiography findings in patients on hemodialysis.

Introduction: Cardiac dysfunction is a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). Previous studies have shown that kidney transplantation can reverse some of the gross changes in the myocardial structure such as left ventricular ejection fraction (LVEF) and volumes. Whether kidney transplantation can reverse the subtle and early myocardial changes in ESRD patients who do not suffer from gross alternations in myocardial function is not yet studied. The aim of this study was to answer this question. Methods: We followed 25 patients with ESRD at baseline that all of them had a kidney transplant and were reassessed 1 month after the transplantation. Conventional and speckle tracking echocardiography (STE)was done at baseline and 1 month after kidney transplantation in patients. Results: LV hypertrophy was the most prevalent finding at baseline (58%), followed by diastolic dysfunction (53%). Kidney transplantation significantly improved the ejection fraction (EF) (treatment effect = 4.23 ± 2.06%; P = 0.046) and apical 4-chamber strain (treatment effect = -0.89 ± 0.37%; P = 0.021) in the patients. It also reduced the LV mass index (treatment effect = -73.82 ± 11.6; P < 0.001) and relative wall thickness (treatment effect = -0.056±0.023; P = 0.021). Other variables including global longitudinal strain and diastolic dysfunction were not improved significantly. Conclusion: STE may show early improvements in myocardial function 1 month after renal transplantation.

Spontaneous multi-focal coronary artery spasm: a case report.

Spontaneous coronary artery vasospasm is one of the important causes of acute chest pain syndromes. The diagnosis of diffuse multifocal spasm can be quite challenging and it could be easily mistaken for diffuse coronary artery disease. The use of intracoronary nitroglycerin can relieve spasm and reveal the real extent of coronary artery disease. Herein we present a case presenting with acute myocardial infarction due to severe coronary artery spasm that had even received fibrinolytic therapy. Multiple narrowing was shown during coronary angiography and the patient was scheduled for percutaneous coronary intervention (PCI). But after intracoronary (IC) injection of nitroglycerin, all of lesions disappeared completely and the diagnosis of coronary spasm was confirmed.

Upper third to lower third width ratio on chest x-ray may predict severity of obstruction in obstructive lung disease.

BACKGROUND: The symptoms and functional limitations due to obstructive lung disease (OLD) are the direct results of airway and lung parenchymal destruction. In these conditions, airflow obstruction leads to increased work of breathing, and gas exchange abnormalities. Hyperinflation, which is inferred from a standard chest radiograph (CXR), may imply increased total lung capacity that can be seen in patients with OLD. Based on experimental observations in OLD patients, we proposed that upper third width in posterioranterior (PA) CXR could be used as a rapid screening method for suggestion of OLD. MATERIALS AND METHODS: In this cross-sectional study, 99 patients admitted to the Respiratory Ward of Razi Medical Center, a teaching referral hospital affiliated to Guilan University of Medical Sciences (GUMS), were entered in the study. The inclusion criteria were any FEV1 with FEV1/FVC <70% or FEV1/FVC>70% with MMEF 75/25 <65%. All cases with diagnostic possibilities other than OLD were excluded. The PA and lateral CXR were performed and 13 measurements - including previous well-known measurements and our proposed new ones- were made by an ordinary ruler on the films. RESULTS: There was no significant correlation between the upper third width and superior/inferior (sup/inf) ratio with spirometric indices in patients. When considering only patients with FEV1/FVC <70%, middle third proportion width had a significant correlation with FEV1/FVC. In subgroup analysis when considering sup/inf ratio > 0.8, superior and inferior third widths were correlated with FEV1/FVC and when considering sup/inf ratio > 0.9, sup/inf ratio was significantly correlated with FEV1/FVC and FEV1. CONCLUSION: The sup/inf ratio >0.9 in PA CXR, may be a predictor of obstructive pattern in OLD patients. For better correlation determination, larger and more extensive studies are needed.