ObjectivesAreca nut is widely consumed in many parts of the world, especially in South and Southeast Asia, where cardiovascular disease (CVD) is also a huge burden. Among the forms of CVD, acute coronary syndrome (ACS) is a major cause of mortality and morbidity. Research has shown areca nut chewing to be associated with diabetes, hypertension, oropharyngeal and esophageal cancers, and CVD, but little is known about mortality and re-hospitalization secondary to ACS among areca nut users and non-users. MethodsA prospective cohort was studied to quantify the effect of areca nut chewing on patients with newly diagnosed ACS by categorizing the study population into exposed and non-exposed groups according to baseline chewing status. Cox proportional hazards models were used to examine the associations of areca nut chewing with the risk of re-hospitalization and 30-day mortality secondary to ACS. ResultsOf the 384 ACS patients, 49.5% (n=190) were areca users. During 1-month of follow-up, 20.3% (n=78) deaths and 25.1% (n=96) re-hospitalizations occurred. A higher risk of re-hospitalization was found (adjusted hazard ratio [aHR], 2.05; 95% confidence interval [CI], 1.29 to 3.27; p=0.002) in areca users than in non-users. Moreover, patients with severe disease were at a significantly higher risk of 30-day mortality (aHR, 2.77; 95% CI, 1.67 to 4.59; p<0.001) and re-hospitalization (aHR, 2.72; 95% CI, 1.73 to 4.26; p<0.001). ConclusionsThe 30-day re-hospitalization rate among ACS patients was found to be significantly higher in areca users and individuals with severe disease. These findings suggest that screening for a history of areca nut chewing may help to identify patients at a high risk for re-hospitalization due to secondary events.

Background: Rheumatoid arthritis is a common problem in elderly individuals. It is reported that lung involvement in these patients is widely present. This study was done with the purpose to assess the burden and characteristics of lung involvement in rheumatoid arthritis patients attending rheumatology clinic. Methods: This descriptive cross-sectional study, in which data was retrospectively collected, was carried out from April 2019 to December 2020 at the Rheumatology Department of Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan. All adult rheumatoid arthritis individuals, irrespective of gender or duration of disease, were consecutively enrolled. Information regarding the baseline characteristics, medication history for rheumatoid arthritis, findings of immunological tests along with the frequency of lung involvement and its pattern were observed. Results: Of 254 patients, the mean age was 37.46 ±12.39 years. Females were predominantly higher as compared to males, i.e., 232 (91.3%) vs. 22 (8.7%) respectively. Current smoking status was found positive in 7 (2.8%) patients. The mean disease duration was 4.41 ±3.96 years. Furthermore, frequency of pulmonary manifestation was observed in 45 (17.7%) patients. A significantly higher mean difference of age (p-value <0.001) and disease duration (p-value <0.001) was observed among patients with and without pulmonary manifestation. Moreover, a significant association of current smoker was also observed with pulmonary manifestation. Conclusion: A considerable number of patients with rheumatoid arthritis had pulmonary manifestation. Furthermore, a significant relationship was observed with age, duration of disease, and current smokers.

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Objective: To determine the burden of thyroid dysfunctions in Rheumatoid Arthritis (RA) patients attending tertiary care hospital of Karachi, Pakistan. Methods: A cross-sectional study was conducted at rheumatology clinic of a Jinnah Post Graduate Medical Centre in Karachi, Pakistan from April 2019 to January 2021. All diagnosed cases of RA having seronegative or seropositive RA were consecutively enrolled. Clinical records and laboratory data of these patients were collected along with outcome variables. Results: Of 136 patients, thyroid abnormality was observed in 56 (41.2%) patients. In particular, 80 (58.8%) had normal, 8 (5.9%) had hypothyroidism, 14 (10.3%) had hyperthyroidism, 32 (10.5%) had subclinical hypothyroidism, and 2 (1.5%) had subclinical hyperthyroidism. A significantly lower hemoglobin levels (p-value <0.001), mean corpuscular volume (p-value 0.011), total leucocyte count (p-value 0.004), and platelet counts (p-value 0.040) were observed in patients with thyroid abnormality than those without thyroid abnormality. Furthermore, a significantly lower urea (p-value <0.001) and creatinine levels (p-value <0.001) were also observed among patients with thyroid abnormality than those without thyroid abnormality. Conclusion:In patients with RA, thyroid dysfunction has been shown to be highly prevalent. Subclinical hypothyroidism, the most common thyroid disorder and obvious hyperthyroidism were observed.