ABSTRACT
Background: SLE is a common connective tissue disease in Indians (mostly women) which is frequently underdiagnosed due to limited awareness and knowledge regarding the disease. Methods: This is a retrospective observational study conducted in a tertiary care hospital in Western India among patients of SLE attending outpatient Rheumatology Clinic and inpatient admissions of Topiwala Medical College and BYL Nair Charitable Hospital, Mumbai. Sixty patients were recruited based on inclusion and exclusion criteria. Results: In clinical profile, arthralgia was the most common manifestation seen in 53 patients (88.3%) followed by alopecia in 46 patients (76.7%). In systemic involvement, CNS lupus was the most common manifestation seen in 27 patients (45%) followed by renal involvement in 13 cases (21%). Pulmonary hypertension (PH) was another noticeable finding seen in 24 cases (40%) of which 18 (75%) had mild PH, 6 (25%) patients had severe PH. The mean SLEDAI score was 11.85 at baseline which reduced to 2.65 at 6 months and remained 3.65 at the end of 3 years of the study. In immunological profile, ANA was positive in all patients. Speckled pattern of ANA was the most common pattern seen in 34 patients (56.7%). A titre of above 1:100 was noted in 53 patients (88.3%). ds DNA was positive in 26 patients (43.3%). Anti Ro/La was positive in 3 patients (5%) and U1RNP in 2 patients (3.3%). Autoimmune hemolytic anemia (AIHA) was the most common autoimmune association seen in 25 patients (41.7%), antiphospholipid antibody(APLA) was seen in 15 patients (25%), 7 patients (11.6%) were anti TPO antibody positive, 3 patients (5%) were Ro/La positive while only 2 patients(3.3%) were U1RNP positive. Conclusion: Clinical profile and immunological patterns of SLE are diverse. A systematic work up is needed to identify the multisystem involvement and asking for specific antibody tests to identify common autoimmune associations is recommended.
ABSTRACT
Background: Inflammatory systemic rheumatologic disorders are responsible for significant morbidity and premature deaths. The present study was done to assess causes of mortality in these patients.Methods: In the retrospective study, the death records of patients with inflammatory rheumatologic illnesses from January 2012 to January 2017 were studied. The demographic details, disease activity, organ involvement, treatment received and evidence of infection were noted.Results: 50 records were analyzed (25 systemic lupus erythematosus (SLE), 13 rheumatoid arthritis (RA), four immune myositis, three systemic sclerosis (SS), two takayasu’s arteritis (TA), two ankylosing spondylitis (AS) and one granulomatosis with polyangiitis (GPA)). The me an age of death was 39.94 years. Sixteen patients had disease related organ damage, 17 had active disease. Infection was present in 31 patients (gram negative organisms most commonly isolated), being the major contributor of mortality. Only two patients succumbed to acute coronary syndrome.Conclusions: Infection, disease activity and organ damage due to the disease are the major contributors to of death in hospitalized patients with inflammatory rheumatological disorders.
ABSTRACT
Background: Nurses are a vital component of our healthcare system. Their health would directly affect the delivery of healthcare to our patients. We designed a study to look at the health status and stress levels of staff nurses in our hospital. Methods: After ethics committee approval, we enrolled 100 staff nurses working at Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai. A pretested semi-structured questionnaire with questions pertaining to their age, years of working experience and time taken to travel to work, and past medical history was administered. A brief clinical examination, routine investigations were performed. Cohen’s Perceived Stress Scale (PSS-14) was administered. Results: Maximum respondents were in the age group of 41 to 50 years, majority of them had an experience of 15-20 years working in this hospital. When asked about their preferred choice of contraceptive, tubectomy was the most common response (49.5%). 3% were suffering from asthma , 12% had tuberculosis at some point in time and 8% had needle-stick injury. Their past medical history gave us an insight into various medical conditions they were suffering from. As per Cohen’s Perceived Stress scale, 88% of the nurses were under stress. Though all those with diseases such as hypertension, diabetes, asthma and anaemia as well as greater proportion of those with complicated pregnancies and obesity, were under stress, we could not document statistically significant relationship between perceived stress scores and the above. Conclusion: This study gives us data about the health status of nurses working in our hospital. A high proportion of the staff nurses were stressed out. Future research should focus on effective interventions to reduce the stress levels amongst nurses.
ABSTRACT
Several studies have shown that 20 to 66.2% of patients with rheumatoid arthritis have associated psychiatric comorbidity especially depression. Dothiepin hydrochloride is a well-established and effective antidepressant in patients with depressive symptoms of varying severity and co-existing anxiety. To document the efficacy and tolerability of dothiepin hydrochloride in the management of major depressive disorder (MDD) in rheumatoid arthritis patients a phase IV, open, single arm, prospective study was initiated with dothiepin hydrochloride in the dose of 75 mg/day, duration of therapy was 6 weeks. Twenty-five rheumatoid arthritis patients suffering from co-morbid MDD completed the 6-week dothiepin hydrochoride treatment and were considered for final analysis. There was significant reduction (p < 0.05) in mean HAM-D scores at week 2 (13.92 +/- 5.45), week 4 (9.28 +/- 4.13) and week 6 (5.72 +/- 3.26) compared to baseline (21.64 +/- 5.93). There was significant reduction (p < 0.05) in mean HAM-A scores at week 2 (6.52 +/- 3.34), week 4 (4.0 +/- 2.25) and week 6 (2.76 +/- 1.59) compared to baseline (10.68 +/- 3.68). The global impression of efficacy at the end of 6 weeks of dothiepin hydrochloride treatment was rated by the clinician (psychiatrist) as marked and moderate improvement in 20 (80%) and 5 patients (20%) respectively. Only 2 patients reported dry mouth as an adverse event in the study. The overall assessment of tolerability at the end of 6 weeks of dothiepin hydrochloride treatment was rated by the clinician (psychiatrist) as good and fair in 19 (76%) and 6 patients (24%) respectively. Dothiepin hydrochloride was found to be an effective and well-tolerated drug in the management of MDD and anxiety in patients suffering from rheumatoid arthritis.