Obstructive Sleep Apnea: A Contributing Factor in Gout.

INTRODUCTION: Obstructive sleep apnea (OSA) is a comorbidity, which has shared risk factors with gout as well as causes pathophysiological mechanisms causing hyperuricemia. The relationship remains contentious. METHODS: TrinetX, a global federated research network that provides a dataset of electronic medical records from different healthcare organizations (HCOs). We utilized this network to query patients who had a BMI greater than 30 and then two subgroups were made based on the presence or absence of OSA. Furthermore, propensity score matching (PSM) was carried out to match age, sex, race, chronic kidney disease (CKD), heart failure, and the use of diuretics. Compare outcome analytic function was utilized to map the co-relation with Gout. RESULTS: A total of 3541566 patients who had a BMI >30 were identified, out of which 817638 (23.09%) patients had OSA. 7.19% of patients with OSA had gout while 2.84% without OSA had gout (p<0.0001). The odds of having gout are 2.65 times higher in patients with OSA than patients without OSA (hazard ratio is 2.393, 95% confidence interval (CI) 2.367-2.419, p<0.0001). After PSM, both the groups of obese patients with and without International Classification of Diseases, 10th Revision (ICD-10) diagnosis of OSA included 801526 patients, within which 6.93% of patients with OSA had gout while 4.63% of patients without OSA had gout (p<0.0001). The odds ratio was 1.533 (95% CI 1.512-1.554, p<0.0001) and the hazard ratio was 1.404 (95% CI 1.386-1.423). CONCLUSION: Our study demonstrated that there is a strong correlation between gout and OSA. Chronic hypoxia-induced hyperuricemia is the most widespread explanation. OSA is a treatable condition with timely diagnosis and proper treatment. Prospective cohort studies are required to further test the strength of the relationship between OSA and gout.

Focal Alveolar Hemorrhage Secondary to Hydralazine-Associated Antineutrophilic Cytoplasmic Antibody Vasculitis.

Hydralazine is rarely associated with antineutrophilic cytoplasmic antibody (ANCA) vasculitis. In the appropriate clinical scenario, such as in a patient with pulmonary, renal, or cutaneous manifestations, finding antibodies against nuclear and cytoplasmic neutrophil antigens may suggest drug-induced vasculitis after exposure to hydralazine. We present the case of an elderly man diagnosed with focal alveolar hemorrhage with elevated concentrations of anti-myeloperoxidase antibody, anti-proteinase-3 antibody, and antinuclear antibodies in the setting of prolonged hydralazine therapy. We observed a rapid clinical improvement with hydralazine discontinuation and systemic corticosteroids. We did not observe further disease activity while on mycophenolate mofetil six months later.

Pulmonary Aspergillosis Complicated by Hemophagocytic Lymphohistiocytosis: A Case Report and Literature Review.

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome involving excessive immune activation. It can be primary (familial) or secondary (triggered by infection, malignancy, or rheumatological disease). This is a case of a previously healthy 43-year-old African American woman who presented with fever and confusion. The patient was eventually diagnosed with pulmonary aspergillosis and responded well to antifungal therapy. She met the diagnostic criteria of HLH-2004 trial for hemophagocytic lymphohistiocytosis. She also fulfilled the 2019 classification criteria for systemic lupus erythematosus (SLE) without the classical signs and symptoms of SLE. HLH management includes supportive management, treatment of underlying condition, and immunosuppressive treatment. Etoposide and dexamethasone are commonly used treatments for HLH; however, underlying active infection can limit the treatment options. In our case, the patient was treated with steroids and hydroxychloroquine. Her condition gradually improved and she recovered without complications. Based on our literature review, we encountered six cases of HLH secondary to Aspergillosis with a mean age of approximately 47 years. The diagnosis of HLH is often delayed because of nonspecific presentation. Early identification and treatment are crucial to improve the survival rate.

A Rare Presentation of Rickets Mimicking Sacroiliitis: A Case Report and Literature Review.

Hypophosphatemic rickets can cause a variety of bone and joint symptoms, one of its rare presentations is sacroiliac joint involvement, which may be mistaken for inflammatory spondylitis. Here, we report the case of a 31-year-old African American woman who presented with a two-year history of lower back pain and morning stiffness, initially suspected to be due to inflammatory spondyloarthritis. Laboratory tests revealed negative inflammatory markers, normal serum calcium, vitamin D3, and parathyroid hormone levels; however, the alkaline phosphatase levels were elevated and serum phosphorus level was low. Magnetic resonance imaging (MRI) of the lumbosacral spine revealed mild widening of the sacroiliac joint with periarticular sclerosis with no signs of osteitis or bone marrow edema. Her condition was attributed to a known diagnosis of X-linked hypophosphatemic rickets affecting her sacroiliac joints. Her symptoms gradually improved after conservative treatment with physical therapy, nonsteroidal anti-inflammatory drugs, phosphate, and vitamin D supplementations. Based on our literature review, we have come across only five rickets cases with similar presentations. Two patients had previously undiagnosed hypophosphatemic rickets at 15 and 35 years of age. One case was related to vitamin D-deficient rickets, and the final two cases were adult-onset vitamin D-resistant rickets misdiagnosed as ankylosing spondylitis. Radiological signs of sacroiliac joint involvement in these cases include narrowing of the sacroiliac joints, fusion of the sacroiliac joints, subchondral hypointense signal changes, and chondral surface irregularities. Vitamin D supplementation has significantly reduced the incidence of rickets; however, there are still cases of familial rickets that can present with a variety of symptoms, including signs and symptoms consistent with inflammatory spondylitis, which can be easily misdiagnosed or mistreated if this presentation is not recognized.

Cryptococcal Osteomyelitis in an Immunocompetent Patient.

Cryptococcal osteomyelitis is extremely rare. When cryptococcal infections occur, they are usually caused by Cryptococcus neoformans and involve the lungs or central nervous system in an immunocompromised individual. However, we report a case of osteomyelitis of the right ankle and right elbow due to C. neoformans in a 29-year-old immunocompetent male.

Pregnancy in patients with systemic lupus erythematosus after cyclophosphamide therapy.

Systemic lupus erythematosus (SLE) often affects females of reproductive age and Cyclophosphamide, an alkylating agent leading to premature ovarian insufficiency (POF) and labelled category D for pregnancy is used as induction therapy for severe manifestations of lupus. There have been multiple case series reflecting variable outcomes of pregnancies after cyclophosphamide use for cancers and autoimmune diseases. With increasing maternal age, we have an increasing population of lupus patients who may wish to conceive after having received cyclophosphamide therapy. The objective of our study was to improve our understanding of the impact of cyclophosphamide exposure on fertility and pregnancy outcomes in patients with SLE.We retrospectively reviewed the charts of all patients who had received intravenous cyclophosphamide at our academic institute in the time period from 2000-2018 and identified 440 patients which included 157 female patients of reproductive age. There were 37 documented pregnancies after the cyclophosphamide infusion, of which 23 patients had successful outcomes; 4 elective abortion and 10 miscarriages. There were 17 patients who developed POF, of which 7 also had end stage renal disease. The average cumulative dose of cyclophosphamide in the patients who had successful pregnancy was 4080.37 mg compared to 2806.25 mg in those who had a miscarriage (p 0.164) and 5526.47 mg in those who developed POF (p 0.046). Using multiple regressions to evaluate risk factors impacting pregnancy outcomes, when taken as a set, the predictors including race, serological profile, exposure to steroids and Mycophenolate mofetil, age at cyclophosphamide infusion, age at pregnancy, and cumulative cyclophosphamide dose accounted for 46.29% of the variance in outcome of pregnancy (p 0.23) and 39.58% of the variance in development of premature ovarian failure (p 0.008). We noted statistical significance in the impact of maternal age at time of pregnancy (p 0.04) and duration of time between the last infusions to subsequent pregnancy (p 0.02) to pregnancy outcome.Our findings suggest that a longer time interval between the last cyclophosphamide infusion and subsequent pregnancy was favorable for a successful outcome and higher cumulative cyclophosphamide dose is more likely to be associated with premature ovarian failure.

Intramedullary spinal cord involvement: a rare presentation of sarcoidosis.

Sarcoidosis is a systemic granulomatous disease of uncertain etiology, which predominantly affects the lungs, eyes, lymph nodes, and skin. Nervous system involvement (neurosarcoidosis) occurs in approximately 5-10% of patients, but spinal cord involvement is very rare, affecting <1% of patients. We present a rare case of intramedullary sarcoidosis.

Development of LTA zeolite membrane from clay by sonication assisted method at room temperature for H2-CO2 and CO2-CH4 separation.

In this work, sodium aluminosilicate zeolite powder and membranes were synthesized by ultrasonic irradiation at room temperature using montmorillonite clay as precursor material. For comparison, same zeolite powder and membranes were synthesized at 100 °C also. The synthesized zeolites were characterized by X-ray diffraction (XRD), infrared (IR) spectral analysis, and field-emission scanning electron microscopy (FESEM). XRD and IR results showed that phase pure mainly LTA phase was formed after 15 days of aging at room temperature. By using the zeolite powders as seeds, membranes were synthesized on clay alumina support tubes at room temperature and also at 100 °C. In both the cases membranes were formed on support surface. The membrane thickness was found to be 15 µm. The performances of the membranes were evaluated by single gas as well as mixture gas permeation measurement for H2-CO2 and CO2-CH4 respectively. The H2-CO2 and CO2-CH4 separation selectivity for the mixture gas of the membrane was found to 16.2 and 20.9 at room temperature respectively. To the best of our knowledge, there is no report of synthesis of zeolite membrane at room temperature using clay as raw materials. For the first time we have reported the synthesis of alumino-silicate zeolite membrane on clay alumina support surface using clay as starting material by sonochemical method at room temperature.

Yamaguchi syndrome presenting as atrioventricular nodal re-entrant tachycardia in an African-American patient.

Apical hypertrophic cardiomyopathy (Yamaguchi syndrome) is a rare subtype of hypertrophic cardiomyopathy. The syndrome is more common in Japan where it was first described. Outside Asia, it is a very rare cause of hypertrophic cardiomyopathy. Apical hypertrophic cardiomyopathy is usually detected incidentally and has a good long-term outcome. We present a case of apical hypertrophic cardiomyopathy in an African-American patient manifesting as atrioventricular nodal re-entrant tachycardia.

Awareness of osteoporosis in postmenopausal Indian women: An evaluation of Osteoporosis Health Belief Scale.

CONTEXT: The level of awareness about osteoporosis in postmenopausal women who are the common sufferers. AIMS: This study aims to evaluate the level of awareness in postmenopausal women using the Osteoporosis Health Belief Scale (OHBS). SETTINGS AND DESIGN: Osteoporosis has emerged as a common health problem in geriatric population. A proactive role needs to be played for preventing its consequences. Before initiating any preventive measures, an evaluation of awareness level of the target population is necessary. The questionnaire-based study design was used for this study. SUBJECTS AND METHODS: A questionnaire (OHBS)-based study in 100 postmenopausal women in Chandigarh was conducted. The bone mineral density (BMD) was measured in each case by dual energy X-ray absorptiometry. Height, weight, and body mass index (BMI) of the participants were noted. STATISTICAL ANALYSIS USED: Statistical analysis was conducted to evaluate any correlation between the various components of the OHBS and the BMD. RESULTS: No statistically significant difference was noted in the seven component parameters of OHBS among the normal, osteopenic, and osteoporotic women suggesting that the health belief regarding susceptibility is not much different between the three groups of the study population. A statistically significant difference between the mean BMI of normal and osteoporotic population was noted. CONCLUSIONS: The results show that there is a great deficit in the awareness level of postmenopausal Indian women regarding osteoporosis. Most of the women were unaware of the condition and the means to prevent it. The study emphasizes that health care professionals have lot of ground to cover to decrease the incidence of osteoporosis and its associated health problem.