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Objectives: Patients with ST elevation myocardial infarction (STEMI) without standard modifiable cardiovascular risk factors (SMuRFs; dyslipidaemia, hypertension, diabetes mellitus and smoking) are reported to have a worse clinical outcome compared to those with SMuRFs. However, robust prospective data and low-and middle-income country perspective are lacking. We aimed to study the patients with first STEMI and assess the influence of SMuRFs on clinical outcomes by comparing the patients with and without SMuRFs. Methods:We included all consecutive STEMI patients without prior coronary artery disease enrolled in the Madras Medical College STEMI Registry from September 2018 to October 2019. We collected baseline clinical characteristics, revascularisation strategies and clinical outcome. We analysed suboptimal self-reported sleep duration as a 5 th extended SMuRF (eSMuRF). Primary outcome was in-hospital mortality. Secondary outcomes included in-hospital complications and one-year all-cause mortality.Results: Among 2,379 patients, 605 patients (25.4%) were SMuRF-less. More women were SMuRF-less than men (27.1% vs 22.1%; P = 0.012). SMuRF-less patients were older (57.44 ± 13.95 vs 55.68 ± 11.74; P < 0.001), more often former tobacco users (10.4% vs 5.0%; P < 0.001), with more anterior wall MI (62.6% vs 52.1%; P = 0.032). The primary outcome [in-hospital mortality (10.7% vs 11.3%; P = 0.72)] and secondary outcomes [in-hospital complications (29.1% vs 31.7%; P = 0.23) and one-year allcause mortality (22.3% vs 22.7%; P = 0.85)] were similar in both groups. Addition of suboptimal self-reported sleep duration as a 5 th eSMuRF yielded similar results.Conclusions: 25% of first STEMI patients were SMuRF-less. Clinical outcomes of patients without SMuRFs were similar to those with SMuRFs. Suboptimal sleep duration did not account for the risk associated with the SMuRF-less status.

Background and aims Mizoribine is an inhibitor of inosine monophosphate dehydrogenase, which is widely used for patients with lupus nephritis and also patients after renal transplants. Its anti-cytomegaloviral effect is unique as an immunosuppressant. We examined the efficacy and safety of early sequential combination of mizoribine and tacrolimus in lupus nephritis. Methods Retrospective review of electric medical record was performed for all the 63 patients who received the combination therapy of mizoribine and tacrolimus and corticosteroids for induction or maintenance of lupus nephritis at St. Luke's International Hospital, Tokyo, Japan. For efficacy analysis, we extracted a series of change in serum creatinine, serum complement level, urine protein creatinine ratio, dose of corticosteroid. We further reviewed safety profile such as adverse events occurred during the use of multi-target therapy, drug survival rate, or reasons for discontinue multi-target therapy in all patients. Complete remission of lupus nephritis was defined as a value of proteinuria <0.5 g/gCr, normal urinary sediment, serum albumin 3.5 g/dl and a normal value of serum creatinine. Results Fifty six out of the sixty three patients (female: male=59:4, average age 37.4 years old) achieved complete remission in 6 months and there were only two relapses and both of them had Class V nephritis. At four month, the average urine protein creatinine ratio was 0.36 g/gCr, and the average dose of prednisolone was 9.9 mg/day. There were only three episodes of infections which required antibiotics administrations. Conclusions Early sequential combination of mizoribine and tacrolimus seems to be effective and safe for lupus nephritis. Background and aims Interferon (IFN)-as are pivotal in systemic lupus erythematosus (SLE), and type III IFNs (IFN-ls) were recently also associated with SLE. We investigated levels of IFN-a and IFN-l1, and related cytokines in SLE patients and controls. Methods We included 261 SLE patients and 261 population controls. All were examined and assessed for current organ manifestations and disease activity/damage using SLAM, SLE-DAI and ACR/SDI scales. Levels of IFN-l1, IFN-a, IL-17A, IL-23 and IP-10 were measured by ELISA. Results IFN-l1 and IFN-a were detected in 29% and 44% of patients respectively, but their levels did not correlate. High serum levels of IFN-l1 were positively associated with antinucleosome antibodies and lymphopenia, but negatively with musculoskeletal damage. Positive correlations between levels of IFN-l1, IL-17A and IL-23 were observed. Patients with high levels of these three cytokines had more disease damage, especially renal. High levels of IFN-a were associated with mucocutaneous disease, leukopenia, low complement, Ro/SSA and La/SSB, whereas vascular events and antiphospholipid antibodies (aPL) were uncommon.We identified two subgroups with high disease activity: one double IFN-l1 and IFN-a high and another IP-10 high. The former had more neuropsychiatric manifestations, while the latter had more ar...