Pedro Gemal Lanzieri

Smoking and Its Association With Morbidity in Systemic Lupus Erythematosus Evaluated by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index: Preliminary Data and Systematic Review

Due to the increased availability of effective treatments, patients with systemic lupus erythematosus (SLE) now have longer survival times, and factors involved in cumulative chronic damage in SLE need to be better understood. This study was undertaken to evaluate the relationship between smoking and cumulative chronic damage in SLE patients.

Smoking and its association with morbidity in systemic lupus erythematosus evaluated by the SLICC/ACR‐DI: Preliminary data and systematic review

Due to the increased availability of effective treatments, patients with systemic lupus erythematosus (SLE) now have longer survival times, and factors involved in cumulative chronic damage in SLE need to be better understood. This study was undertaken to evaluate the relationship between smoking and cumulative chronic damage in SLE patients.

Cirrhotic Cardiomyopathy: Another Case of a Successful Approach to Treatment of Hepatorenal Syndrome

Hepatorenal syndrome (HRS) is defined as a failure of renal function, potentially reversible, in patients with liver cirrhosis and ascites. Recently, a component of cardiomyopathy associated with HRS was described, but the use of positive inotropic medicine as part of the treatment of the acute phase has not been extensively evaluated. We report a second case in our hospital of a patient with HRS type I without previous heart disease, with secondary hemodynamic decompensation due to liver disease, in which the abnormalities in systolic function by speckle-tracking echocardiography were observed and could be reversed by the use of inotropes. After partial response to current therapies, the patient presented a clinical and laboratorial response with improvement of renal function after infusion of dobutamine. Clinical studies are needed for the therapy approach to HRS taking into account myocardial dysfunction as a major contributing factor for renal dysfunction.

Orbital Pseudotumor: Uncommon Initial Presentation of IgG4-Related Disease

IgG4-related disease (IgG4-RD) encompasses a group of fibroinflammatory conditions recognized in recent times. The main clinical features include variable degrees of tissue fibrosis, tumorlike expansions, perivascular lymphocytic infiltration rich in IgG4-positive plasma cells, and elevated serum IgG4. A case has been reported of an elderly patient with an unexplained unilateral exophthalmia; biopsy was performed and revealed lymphocytic infiltration, suggesting IgG4-RD. High serum levels of IgG4, in association with a good response to steroid therapy and to the exclusion of other diagnoses, confirmed the hypothesis of orbital pseudotumor by IgG4-RD.

Nobel prizes: contributions to cardiology.

The Nobel Prize was created by Alfred Nobel. The first prize was awarded in 1901 and Emil Adolf von Behring was the first laureate in medicine due to his research in diphtheria serum. Regarding cardiology, Nobel Prize’s history permits a global comprehension of progress in pathophysiology, diagnosis and therapeutics of various cardiac diseases in last 120 years. The objective of this study was to review the major scientific discoveries contemplated by Nobel Prizes that contributed to cardiology. In addition, we also hypothesized why Carlos Chagas, one of our most important scientists, did not win the prize in two occasions. We carried out a non-systematic review of Nobel Prize winners, selecting the main studies relevant to heart diseaseamong the laureates. In the period between 1901 and 2013, 204 researches and 104 prizes were awarded in Nobel Prize, of which 16 (15%) studies were important for cardiovascular area. There were 33 (16%) laureates, and two (6%) were women. Fourteen (42%) were American, 15 (45%) Europeans and four (13%) were from other countries. There was only one winner born in Brazil, Peter Medawar, whose career was all in England. Reviewing the history of the Nobel Prize in physiology or medicine area made possible to identify which researchers and studies had contributed to advances in the diagnosis, prevention and treatment of cardiovascular diseases. Most winners were North Americans and Europeans, and male.

Cirrhotic Cardiomyopathy: A New Clinical Phenotype

Hepatic cirrhosis is the final spectrum of several aggressions to the liver, with great relevance to public healthcare. National data estimate a prevalence of 0.14% to 0.35%, mortality of 3 to 35 per 100,000 individuals and an annual average of 30,000 hospital admissions in Brazil.1,2 With the ageing population, the prevalence of chronic liver diseases, in particular steatohepatitis associated to obesity and metabolic syndrome, results in an increase in the number of hepatic cirrhosis cases.3

Systemic lupus erythematosus: review of cardiovascular aspects

Systemic lupus erythematosus (SLE) is an autoimmune condition with a complex pathophysiological process in which its inflammatory activity is an enhancer of coronary disease by systemic inflammation, endothelial dysfunction and predisposition to thrombosis. The cardiovascular involvement in SLE is not a diagnostic criterion and is considered only as damage established in the long-term of the disease. The objective of this study is to highlight the importance of clinical vision for the early identification of cardiovascular involvement in SLE. A critical analysis of the cardiac approach in SLE, with emphasis on clinical aspects, cardiovascular biomarkers and genetics and rational request of additional tests. The particularity of patients with lupus nephritis and antiphospholipid antibody syndrome is also highlighted. The perception of subclinical cardiac damage is critical for interrupting the cycle of myocardial injury and to avoid progression of heart disease.

Cirrhotic Patients with Child-Pugh C Have Longer QT Intervals

Fundamento e objetivos: A cardiomiopatia cirrotica tem sido usada para descrever a disfuncao cardiaca cronica em pacientes cirroticos sem doenca cardiaca estrutural previa. Alem disso, o prolongamento do intervalo QT e uma das alteracoes cardiacas mais importantes relacionadas a cirrose. Estudos previos sugerem que o prolongamento QT esta associado com uma taxa de mortalidade mais alta em pacientes cirroticos. O objetivo deste estudo foi analisar intervalos QTs segundo a gravidade da cirrose, medida pela classificacao Child-Plugh. Materiais e metodos: Em um estudo transversal, um total de 67 pacientes com cirrose nao alcoolica submeteu-se a avaliacao clinica e eletrocardiografica. A gravidade da cirrose foi classificada de acordo com o escore Child-Pugh. O intervalo QT foi medido por um eletrocardiograma de 12 derivacoes. Resultados: Os intervalos QTs foram mais longos em pacientes no grupo Child-Plugh C que nos grupos Child-Pugh A e B (459 ± 33 vs 436 ± 25 e 428 ± 34 ms, respectivamente, p = 0,004). Houve uma correlacao positiva entre o intervalo QT e o escore Child-Pugh em individuos com escore Child-Pugh ≥ 7 (r = 0,50; p < 0,05) e intervalos QT ≥ 440 ms (r = 0,46, p < 0,05). Conclusao: O presente estudo mostrou que pacientes com cirrose Child-Plugh C apresentam intervalos QTs mais longos, o que reforcou a relacao entre a gravidade da cirrose e achados eletrocardiograficos da cardiomiopatia cirrotica. Alem disso, esse resultado foi encontrado em pacientes sem sintomas cardiacos, o que destacou a importância de um metodo simples e nao invasivo, como o eletrocardiograma, para identificar pacientes cirroticos com cardiomiopatia. (Int J Cardiovasc Sci. 2017; [online].ahead print, PP.0-0)

Cirrhotic cardiomyopathy: we already know. What comes next?

Cirrhotic Cardiomyopathy is a recently recognized condition consisting of myocardial dysfunction manifested in cirrhotic patients in the absence of previous cardiac disease. The underlying pathogenetic mechanisms includes a “miocardiotoxic” environment that leads to a blunted heart response to stress, whether physical or pharmacological. This condition is now better understood and can be diagnosed supported clinical, by laboratory electrocardiography and echocardiography criteria. Clinically, systolic incompetence is most evident when cirrhotic patients are placed under stress, whether physical or pharmacological. Despite of being well understood, there is a lack of knowledge to a proper practical application. Recent case reports have suggested that CCM must be treated early because it may be an triggering factor for cirrhosis complications. Studies are needed to identify potential treatments that alter the natural history of heart disease in cirrhotic patients, especially in the phases in which the patients are asymptomatic. Correspondence to: Pedro Gemal Lanzieri, Department of Clinical Medicine, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil, Tel: +55-21-26299210; Email: pedrogemal@id.uff.br

Posterior Cord Syndrome and Trace Elements Deficiency as an Uncommon Presentation of Common Variable Immunodeficiency

Diarrhea is one of the most common symptoms in common variable immunodeficiency, but neurologic manifestations are rare. We presented a 50-year-old woman with recurrent diarrhea and severe weight loss that developed a posterior cord syndrome. Endoscopy found a duodenal villous blunting, intraepithelial lymphocytosis, and lack of plasma cells and magnetic resonance imaging of the spine was normal. Laboratory assays confirmed common variable immunodeficiency syndrome and showed low levels of trace elements (copper and zinc). Treatment was initiated with parenteral replacement of trace elements and intravenous human immunoglobulin and the patient improved clinically. In conclusion, physicians must be aware that gastrointestinal and neurologic disorders may be related to each other and remember to request trace elements laboratory assessment.