Pulmonary hypertension in systemic sclerosis with usual interstitial pneumonia.

Retrospective study comparing pulmonary hypertension risk in systemic sclerosis (SSc) and non-SSc interstitial lung disease patients with usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP). Retrospective analysis of 144 interstitial lung disease patients, 53 SSc (32 UIP and 21 NSIP) and 91 non-SSc (47 UIP and 44 NSIP). Pulmonary hypertension was diagnosed as pulmonary systolic artery pressure (PAPs) > 25 mmHg. All SSc and non-SSc patients with pulmonary hypertension were classified WHO Group 3. Pulmonary hypertension was identified in 21/32 (65.6%), 9/21 (42.8%), 14/47 (29.7%), and 28/44 (45.4%) SSc-UIP, SSc-NSIP, control-UIP, and control-NSIP groups, respectively. PAPs mean of SSc-UIP group was higher than control-UIP group (32.6 ± 9.8 vs 28.5 ± 6.6, p-value = 0.02). PAPs mean of SSc-NSIP group was lower than control-NSIP group (27.0 ± 7.1 vs 33.9 ± 8.8, p = 0.002). Frequency of patients with PAP > 25 mmHg in SSc-UIP group was 60% higher in comparison to control-UIP (OR = 1.62, 95% CI 0.51-5.16) and SSc-NSIP (OR = 1.60, 95% CI 0.45-5.70) groups. Logistic regression analysis estimating the linear trend per ten-unit increase in PAPs levels demonstrated an increment for the SSc-UIP group compared to the control-UIP (OR = 2.64, 95% CI 1.25-5.58, p = 0.01) and the control-NSIP (OR = 6.34, 95% CI 2.82-14.3, p < 0.001) groups. The case-control study confirms that pulmonary hypertension is frequently found in SSc patients and demonstrates, for the first time, a significant increased risk of pulmonary hypertension among SSc-UIP patients.

Systemic sarcoidosis with pituitary adenoma.

Involvement of the nervous system with sarcoidosis is seen clinically in approximately 5-15% of cases. In most cases, lesions are localized to the leptomeninges and cranial nerves, and rarely to the pituitary gland, leading to endocrinologic abnormalities. We report on an original clinical case demonstrating the effectiveness of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scan in the diagnosis and monitoring of systemic sarcoidosis with probable pituitary involvement.

Serum soluble triggering receptor on myeloid cells-1 (sTREM-1) is elevated in systemic lupus erythematosus but does not distinguish between lupus alone and concurrent infection.

We sought to determine serum triggering receptor expressed on myeloid cell-1 (sTREM-1) level in a cohort of patients with systemic lupus erythematosus (SLE). Serum sTREM-1 level of 98 patients with SLE and 49 healthy controls was assayed by ELISA. Serum sTREM-1 level was significantly elevated in a cohort of 78 unselected consecutively recruited patients with SLE (mean 1.1 ± 2.8 ρg/ml, median 0.02 ρg/ml) compared to that of the controls (mean 0.11 ± 0.3 ρg/ml, median 0 ρg/ml; p < 0.0001). We also determined serum sTREM-1 level of 20 SLE patients with a concurrent infection (mean 0.6 ± 1.1 ρg/ml, median 0.12 ρg/ml) and found it not statistically significant compared with that of the patients without infection. Serum sTREM-1 level did not correlate with SLE disease activity. Our finding of elevated serum sTREM-1 level suggests an increased shedding of TREM-1 in SLE and a possible novel pathway of innate immune response in autoimmunity.

Examining the relationship between alopecia areata, androgenetic alopecia, and emotional intelligence.

BACKGROUND: Emotional stress has been associated with the development of alopecia areata (AA) and androgenetic alopecia (AGA). Emotional intelligence (EI), a component of general intelligence, is thought to govern the recognition, expression, and control of stress and other emotions. People with low EI are unable to adequately control stress in everyday life. OBJECTIVE: To investigate EI differences between AA and AGA patients and a control population. METHODS: Thirty-five AGA patients and 42 AA patients, with patchy (n  =  28), ophiasis (n  =  5), totalis (n  =  5), and universalis (n  =  4) distribution of hair loss, completed a 133-item Emotional Quotient-Inventory (EQ-I ) psychometric assessment. Scores were compared between AA, AGA, and 77 control subjects obtained from the North American normative population sample on which the psychometric instrument was normed. RESULTS: Statistically significant differences were found in EI between AA patients and controls with the EQ-I Stress Tolerance scale (p  =  .005). AGA patients also differed significantly from the controls but to a lesser degree compared toAA patients. In overall EI, there were no apparent differences between AGA and AA patients. CONCLUSIONS: AA and AGA patients exhibit a mild depressive reaction to their condition, with AA patients demonstrating a significantly stronger deficiency in coping with stress than AGA patients. The data support a psychosomatic contribution to AA. Referral of patients for EI assessment and psychosocial counseling could help reduce stress.

Break dancing: a new risk factor for scarring hair loss.

BACKGROUND: We report on a first case of lichen planopilaris (LPP) mimicking androgenetic alopecia (AGA) in an individual who has been break-dancing on his head for many years. LPP is an autoimmune inflammatory scalp condition that when left untreated can result in scarring and irreversible hair loss. The etiology of LPP is unknown. Different treatment modalities are used for LPP and AGA. OBJECTIVE: To increase the awareness of physicians to the possibility of scarring hair loss (LPP) presenting like AGA. RESULTS: Scalp examination showed scarring patches of hair loss. A scalp biopsy confirmed the diagnosis of LPP. CONCLUSION: Chronic scalp trauma due to break dancing may be a trigger for LPP. A meticulous scalp examination should be performed before making a diagnosis of nonscarring conditions of hair loss such as AGA. Early recognition of LPP and appropriate treatment are important before scarring and irreversible hair loss ensue.

Red cell membrane omega-3 fatty acids are decreased in nondepressed patients with social anxiety disorder.

The "phospholipid hypothesis" attributes a pathophysiologic role to the polyunsaturated fatty acid (PUFA) composition of phospholipids in depression. The aim of the present study was to determine whether the hypothesis is relevant to social anxiety disorder (SAD). The study sample consisted of 27 untreated, nondepressed patients with SAD (DSM-IV) and 22 controls. Severity of SAD was assessed with the Liebowitz Social Anxiety Scale (LSAS). Erythrocyte PUFA concentrations were measured by gas-liquid chromatography. Concentrations of most n-3 PUFAs were lower in the patients: 18:3n-3 by 32% (p < 0.002), 20:3n-3 by 34%, 20:5n-3 by 36% (all p < 0.001) and 22:6n-3 by 18% (p = 0.002). No significant differences were observed in other fatty acids. Significant inverse correlations were obtained between levels of n-3 PUFAs and LSAS scores. In conclusion, the phospholipid hypothesis may apply to SAD, thereby opening new therapeutic options. The robust relationship between low erythrocyte n-3 PUFA concentrations and SAD justifies exploration of relevant neuropathophysiological mechanisms.