Osama Dasa

Successful Treatment of Life-Threatening Interstitial Lung Disease Secondary to Antisynthetase Syndrome Using Rituximab: A Case Report and Review of the Literature.

We are presenting a case of antisynthetase syndrome (ASS) that manifested with severe interstitial pneumonitis in the presence of anti-Jo-1 and Ro (SSA) antibodies. Our patient developed respiratory failure with high oxygen requirements despite treatment by high-dose steroids. The patient was then treated with rituximab. This treatment led to significant improvement in the patient condition, with resolution of the ground glass opacities on high-resolution computerized tomography and near normalization of pulmonary function tests. In this communication, we performed a literature review and summarized previous reports pertinent to using of rituximab to treat interstitial lung disease (ILD) secondary to ASS by searching the PubMed database from 1980 to 2014. We were able to find 14 reports that included total of 45 patients with ILD secondary to ASS. A significant improvement in ILD was reported in the majority of reported patients who received rituximab, while there was only 1 mortality-related to Pneumocystis jirovecii pneumonia. Rituximab treatment was tolerated well in the majority of cases. It is our conclusion that rituximab can be considered a therapeutic option in ILD secondary to ASS based on our experience with this case and the currently available evidence in the literature. Nevertheless, there is a need for additional controlled studies to assess the efficacy and safety of rituximab in ILD secondary to ASS compared with other immunosuppressive regimens.

Risk of Ischemic Heart Disease in Patients With Sjögren’s Syndrome

Background: Ischemic heart disease (IHD) has emerged as a major cause of morbidity and mortality in patients with autoimmune conditions such as systemic lupus erythematosus and rheumatoid arthritis, but the risk of IHD in Sjögren’s syndrome (SjS) is unknown. To fill this knowledge gap, we estimated the prevalence and risk of IHD with SjS compared to controls from the general population using the Healthcare Cost and Utilization Project National Inpatient Sample 2011 database. Materials and Methods: The Healthcare Cost and Utilization Project administrative longitudinal database contains encounter‐level information on inpatient stays, emergency department visits and ambulatory surgery in all U.S. hospitals. We conducted a cross‐sectional study among the inpatient population diagnosed with SjS and matched 1:4 with controls for age, sex and hospital region. Odds ratio for IHD was calculated as cases compared to controls. The contribution of various risk factors to IHD was also evaluated by logistic regression. Results: Analysis demonstrated that 7,154 of 13,086 cases (54.7%) of SjS had IHD compared to 27,367 of 52,448 controls (52.2%). The adjusted odds ratio for IHD in those with SjS was 0.898 (95% CI: 0.844‐0.955). Patients with SjS were significantly more likely to have hypertension, diabetes, apnea and lipid disorders. Conclusions: To our knowledge, this is the largest population‐based study investigating the risk of IHD in patients with SjS. We found a modest, though statistically significant, decrease in the risk of IHD in SjS compared to controls.

Role of closed loop stimulation pacing (CLS) in vasovagal syncope: RUZIEH et al.

Vasovagal syncope (VVS) or neurocardiogenic syncope is defined by transient loss of consciousness with spontaneous and rapid recovery. Recently, a closed loop stimulation (CLS) pacing system has emerged as a new strategy which appears superior to conventional pacing for patients with refractory syncope. However, its efficacy remains of considerable debate and large randomized controlled clinical trials are needed. Between 2002 and 2017, 12 total studies evaluated the use of CLS pacing in patients with refractory VVS, and are summarized in this article.

Endobronchial Cartilage Rupture: A Rare Cause of Lobar Collapse.

Endobronchial cartilage rupture is a rare clinical condition, which can present in patients with severe emphysema with sudden onset shortness of breath. We present a case of a 62-year-old male who presented to our emergency department with sudden onset shortness of breath. Chest X-ray showed lung hyperinflation and a right lung field vague small density. Chest Computed Tomography confirmed the presence of right middle lobe collapse. Bronchoscopy revealed partial right middle lobe atelectasis and an endobronchial cartilage rupture. Endobronchial cartilage rupture is a rare condition that can present as sudden onset shortness of breath due to lobar collapse in patients with emphysema and can be triggered by cough. Bronchoscopic findings include finding a collapsed lung lobe and a visible ruptured endobronchial cartilage. A high index of suspicion, chest imaging, and early bronchoscopy can aid in the diagnosis and help prevent complications.

DECREASED RISK OF ISCHEMIC HEART DISEASE IN PATIENTS WITH SJGREN’S SYNDROME: AN ANALYSIS OF UNITED STATES NATIONAL DATABASE

Ischemic heart disease (IHD) has emerged as a major cause of morbidity and mortality in patients with autoimmune conditions such as systemic lupus erythematosus and rheumatoid arthritis but the risk of IHD in Sjogren’s Syndrome (SjS) is relatively unknown. To fill this knowledge gap we estimated

Clinical Efficacy of Cardiac Resynchronization Therapy in Patients with Ischemic and Non-ischemic Cardiomyopathy

We evaluated the response of cardiac resynchronization therapy (CRT) in ischemic cardiomyopathy (ICMP) and non-ischemic cardiomyopathy (NICMP). We determined if the cause of cardiomyopathy, ischemic versus non-ischemic, affects CRT outcomes in regard to New York Heart Association (NYHA) category and ejection fraction. We used a retrospective chart review for adult patients who underwent biventricular device placement between January 2005 and July 2015 at the university of Toledo medication center as part of their standard of care. NYHA category and ejection fraction were compared before and after CRT in both ICMP and NICMP patients. The NYHA category improved by 0.39±0.90 and 0.81±0.79 (p1⁄4 0.001) in ICMP and NICMP, respectively. The NYHA category worsened on follow-up in 11 (11.2%) patients in the ICMP group and five (5.2%) patients in the NICMP group (p1⁄4 0.12). A total of 50 (51%) patients in the ICMP group and 26 (26.8%) in the NICMP had no improvement in their NYHA category (po0.001). Thirty-seven (37.8%) patients in the ICMP group and 66 (68%) in the NICMP group showed improvement by one or more in their NYHA categories (po0.001). NICMP remained a significant predictor of response to CRT independent of other variables after controlling it using logistic regression analysis. The ejection fraction increased by 5.58±11.41 in ICMP compared with 12.86±14.55 in NICMP (p1⁄4 0.001). Our study shows an improvement in NYHA functional class and ejection fraction after CRT therapy in heart failure patients regardless of etiology. However, a more favorable outcome was noticed in the NICMP subgroup. A future randomized control trial with a control group that specifically addresses this question and investigates possible etiologies is warranted.