Cardiac sarcoid is an infiltrative, granulomatous disease of the myocardium. It is more prevalent entity than once believed, especially subclinical disease. It affects heart mechanics causing ventricular failure, and disrupts the cardiac electrical system leading to third degree heart block, malignant ventricular arrhythmias, and sudden cardiac death. This makes early diagnosis and treatment of this devastating disease essential. Based on reviewed literature this paper proposes step‐wise diagnostic and therapeutic algorithms for patients with suspected cardiac sarcoidoisis who do or do not have prior history of systemic sarcoidosis. Clin. Cardiol. 2012 DOI: 10.1002/clc.21982The authors have no funding, financial relationships, or conflicts of interest to disclose.Special thanks to Dr. Maziar Zafari for his help with the editing process.

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PurposeThe burden of cancer is rising in low- and middle-income countries, yet cancer treatment requires resources that are often not available in these settings. Although management of chronic myeloid leukemia (CML) has been described in low- and middle-income countries, few programs involve patients treated in rural settings. We describe characteristics and early outcomes of patients treated for CML at rural district hospitals in Rwanda.MethodsWe conducted a retrospective review of patients with confirmed BCR-ABL–positive CML who were enrolled between July 1, 2009 and June 30, 2014. Types of data included patient demographics, diagnostic work up, treatment, clinical examination, laboratory testing, and death.ResultsForty-three patients were included, with a maximum follow-up of 58 months. Of 31 patients who were imatinib-naïve at enrollment, 54.8% were men and the median age at diagnosis was 36.9 years (interquartile range: 29-42 years). Approximately two-thirds of patients (67.7%) were on the national public insurance scheme. The imatinib dose was reduced for 16 patients and discontinued for five. Thirty-two of the 43 patients continued to have normal blood counts at last follow-up. Four patients have died and four are lost to follow-up.ConclusionOur experience indicates that CML can be effectively managed in a resource-constrained rural setting, despite limited availability of on-site diagnostic resources or specialty oncology personnel. The importance of model public-private partnerships as a strategy to bring high-cost, life-saving treatment to people who do not have the ability to pay is also highlighted.

Moderate alcohol intake is beneficial to the heart and cardiovascular system. A J- or U-shaped response has been shown in the majority of studies examining alcohol's effect on cardiovascular mortality and downstream cardio-metabolic effects, with heavy alcohol intake associated with worse outcomes. These effects apply to individuals with and without underlying coronary artery disease. However, care must be taken in defining "moderate" intake between the sexes. Males appear to have a wider therapeutic window and can afford 2 to 3 drinks per day whereas women should limit intake to 1 to 2 drinks per day (a "drink" being classified as 10 to 14 grams of alcohol). More than half of alcohol's cardioprotective effects can be attributed to its effect on lipoproteins, specifically an increase in high-density lipoprotein. Interestingly, the risk of cardiovascular mortality in former heavy drinkers has been shown to ultimately approach the risk seen in lifelong abstainers.

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