ABSTRACT
Introduction: Chronic activation of the immune system,as observed in the pathogenesis of rheumatoid arthritis,potentially leads to insulin resistance. Insulin resistance is amajor component of type 2 diabetes mellitus and metabolicsyndrome. The risk of myocardial infarction is more thantwice in rheumatoid arthritis cases compared to the generalpopulation. Stratifying those at risk could direct therapies forprevention of significant morbidity and mortality.Material and methods: This is a case-control study of 102cases of Rheumatoid Arthritis diagnosed by ACR/EULAR2010 and a similar number of age and sex-matched healthycontrols. Insulin resistance was calculated using HOMA-IRmodel, those having values greater than 2.5 were consideredinsulin resistant. HOMA-IR values were correlated to diseaseactivity (using the DAS28 score). Blood pressure, BMI, waisthip ratio and lipid profile were compared between the twogroups.Results: 71.6% Rheumatoid Arthritis cases were insulinresistant whereas the same in controls was 21.4%, althoughthe mean BMI was lower in the former (22.78±2.71 vs23.21±3.20). Insulin resistance was more prevalent (69.8%) inthose with high disease activity (DAS28>5.1). Blood pressurewas lower in the control group but the lipid profile was betterin the cases.Conclusion: This study showed that the majority of patientsand 1/5th of the apparently healthy population had insulinresistance. There was significant correlation betweendisease activity and insulin resistance. All those havinginsulin resistance need to be carefully monitored to preventcardiovascular morbidity and mortality
ABSTRACT
Introduction: Acute Encephalitis Syndrome is a major health problem in Assam, claiming thousands of lives every year and crippling the survivors. Japanese Encephalitis is the leading agent of this group. Much emphasis has been given to the vaccination drive but the effort has not been fruitful. This study aims to explore the common presentations of these diseases, the causative agents and the vaccination status of those affected. Material and methods: This is a single centre observational study carried out in Unit-V of the Department of Medicine of Assam Medical College and Hospital, Dibrugarh for a period of two years. Acute Encephalitis Syndrome was defined as per World Health Organisation definition. Data were collected and serum and CSF were analysed in search of the etiologic agent. Results: Of the 74 cases studied, 37 tested positive for Japanese Encephalitis. Fever, altered sensorium and seizure were the most common presentations. Herpes Simplex had 50% mortality, the highest among all the agents tested for. Only 2 out of 37 cases had been vaccinated against Japanese Encephalitis. Conclusion: Acute Encephalitis Syndrome is a major threat to public health, particularly in Assam. Adequate vaccination coverage could prevent significant morbidity and mortality.