Spectrum of Neurological Illnesses in Pregnancy – An Observational Study from a Tertiary Care Centre of Eastern India

Introduction: Metabolic syndrome is a constellation of interrelated risk factors that increase the risk of cardiovascular diseases (CVD) and diabetes mellitus. The increase in prevalence of hyperuricemia was considered to be directly related to increasing incidence of obesity and Metabolic Syndrome in developing and developed countries. Hyperuricemia is defined as serum uric acid of 6.0mg/dl and 7.0mg/dl for females and males respectively. Aims and Objectives: To study correlation of hyperuricemia with metabolic syndrome or its components. Materials and Methods: An observational, cross sectional single centre study with 316 patients fulfilling inclusion and exclusion criteria was carried out. Results: Out of 316 patients, 202 (63.9%) were males and 114 (36.1%) were females. 138(43.7%) were from rural areas and 178 (56.3%) were from urban areas. 126 (39.9%) patients had an active lifestyle and 190 (60.1%) had a sedentary lifestyle. Mean waist circumference among114 females was 82.10 cm and among men was 87.07cm. 113 patients fulfilled the criteria for central obesity with the mean uric acid level of 8.14 mg/dl (p=0.001); Mean uric acid level of patients without central obesity was 7.36 mg/dl. 99 (31.33%) fulfilled the criteria for hypertriglyceridemia with mean s.uric acid level 8.24mg/dl (p=0.0440). 124 had elevated blood pressure with mean s.uric acid 8.28 mg/dl (p=0.004). Patients with normal blood pressure had a mean value of s. uric acid 7.86 mg/dl. 33.44% fulfilled the criteria for metabolic syndrome (41.23%of total females and 32.10% of total males). Odds ratio was 1.28 and 0.864 for females and males respectively. Conclusion: Prevalence of metabolic syndrome in patients with hyperuricemia was 35.4%. More common in females than males. Hyperuricemia is more prevalent in patients with a sedentary lifestyle. Hyperuricemia positively correlates with central obesity, blood pressure, hypertriglyceridemia and hyperglycemia. Hence, it is of utmost importance to screen patients of hyperuricemia for metabolic syndrome or its components to prevent mortality and morbidity associated with CVDs.

Spirometric Assessment in Juvenile Idiopathic Arthritis.

Objective : To estimate the prevalence of abnormal spirometry in Juvenile idiopathic arthritis (JIA) patients and to evaluate its relation with subtype, gender, disease activity and methotrexate therapy. Methods : A cross-sectional study was carried out involving 5-12 years old JIA patients. Forced vital capacity (FVC), Forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, Forced expiratory flow between 25-75% of vital capacity (FEF25-75%) and peak expiratory flow rate (PEFR) were measured. Result : Out of 33 patients, 18 were male. Six patients had oligoarthritis, 16 had polyarthritis and 11 had systemic JIA. Seventeen patients had clinically inactive disease and 16 received methotrexate. None had respiratory symptoms. Thirteen patients had decreased FVC with normal FEV1/FVC. One had decreased FEV1 and FEV1/FVC with normal FVC. Decreased FEF25-75% was found in 4 and decreased PEFR in 8 patients. JIA subtypes differed significantly with regard to prevalence of decreased FVC and FEV1. Conclusion : Abnormal spirometry was present in 13 patients and affected all subsets in terms of subtypes, gender, disease activity and methotrexate therapy.

Spirometric Evaluation in Juvenile Systemic Lupus Erythematosus.

Objective: Spirometric evaluation in juvenile systemic lupus erythematosus. Methods: Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/ FVC, forced expiratory flow between 25-75% of vital capacity (FEF25-75%) and peak expiratory flow rate (PEFR) of 21 patients with juvenile SLE (jSLE) were compared to controls. Result: Reduced FVC and FEF25-75% was found in 18 and 9 patients, respectively. All had normal FEV1/FVC. None had respiratory complaint. When compared to controls, patients had significantly reduced FVC [mean (SD):1.97 (0.56) vs 2.35 (0.60), P=0.002] and FEF25-75% [2.19 (0.83) vs 2.63 (0.76), P=0.028] but similar FEV1/FVC [86.87(7.03) vs 86.72 (6.35), P=0.639]. Conclusion: jSLE patients had significant restrictive pattern and small airway involvement.

Growth of Children with Juvenile Idiopathic Arthritis.

Objective: To evaluate the growth pattern in children with juvenile idiopathic arthritis and its subtypes in comparison with age, sex and temporally matched controls. Study design: Prospective study. Setting: Pediatric rheumatology clinic of a tertiary care hospital in Eastern part of India. Participants: Seventy-five children (2-12 years) diagnosed as juvenile idiopathic erthritis by International League of Associations for Rheumatology criteria and 75 age- and sex- matched controls. Intervention: Weight, height and body mass index were recorded at six monthly interval in both groups over a period of 3 years. Main outcome measures: weight, height and body mass index. Results: Subtype distribution of juvenile idiopathic arthritis was: oligoarthritis (49%, n=37), rheumatoid factor negative polyarthritis (27%, n=20), rheumatoid factor positive polyarthritis (8%, n=6), systemic onset (15%, n=11) and enthesitis related arthritis (1.3%, n=1). Anthropometric parameters in children with juvenile idiopathic arthritis were not significant different from controls. Comparison between the subtypes showed significant differences in height (P=0.011), weight (P=0.005), and growth velocity (P=0.005), but not in body mass index. Systemic onset disease led to significant restriction in height (P=0.018; 95% CI 2.13-33.77) and weight (P=0.008; 95% CI 1.47-14.43) compared to controls. Growth velocity was significantly affected in rheumatoid factor positive polyarthritis (P=0.003; 95% CIO. 46-3.14). Conclusions: Children with juvenile idiopathic arthritis do not have significantly lower values of anthropometric parameters compared to controls. Significant restriction in height and weight is seen in systemic onset disease, and growth velocity is significantly reduced in rheumatoid factor positive subjects.

Prevalence, Geographical Distribution, Social Problems and Treatment of Thalassemia Patients.

A total of 700 beta thalassemia patients were gathered at the outdoor of the Hematology department of Medical College, Kolkata, attending during the period from January 2010 to December 2010. The data is generated by the interaction between them and their family members in presence of the physicians. Actual ethnic identities, place of residence, parity and sibship together with social stigma, if any, faced by the patient or by the member of the family and details of their treatment including transfusion history were noted down and reconfirmed from past records. The prevalence of thalassemia was found 70% among Hindus of which the 62.26% was contributed by castes like Maishya, Namasudra, Barga Kshatriya and Panda Kshatriya. The relative prevalence of subtypes of b-thalassemia was found to be 65% E-b thalassemia, 30% Homozygous b-thalassemia and 5% S-b thalassemia. The aboard of the 85.28% patients were found to be localised along banks river Hooghly and Ganga delta region and we can thus consider tentatively that this belt is a thalassemia zone in West Bengal. The maximum number of cases showed parity to be 1 and there was considerable amount of reproductive wastage. Regarding social stigma, 82.71% responded with no stigma. Early diagnosis and early onset of transfusion with chelation therapy was found to provide benefit for the patient reducing the total amount of transfusion needed per year and also restoring the quality of their life.

Epidemiology of epilepsy--Indian perspective.

There are about 20 epidemiological studies on epilepsy from different parts of India. They include both rural and urban studies. The prevalence rate stands at around 5/1000 population (at this rate present estimate of total epileptics in this country is about 5 million) and incidence rate varies from 38 to 49.3 per 100,000 population per year from two community-based studies in India. Case-control studies indicate that febrile seizures, family history of epilepsy and head trauma are significant risk factors. Type of seizure pattern showed maximum number of cases belonged to generalised seizures which is different from Western countries where partial seizure is the commonest variety. Treatment gap, which is a measure of per cent of patient populations not receiving the treatment, estimated to be up to 73.7% to 78% in India. Aetiology is unknown in about two-thirds of cases. Hot water epilepsy is unique in South India and single solitary ring enhancing lesion in brain imaging is a common feature in Indian subcontinent. Evaluation of prevalence study indicates that more case-control studies to find out the aetiology, pharmaco-economic study to find out the affordable drug for general public and mass health education should be undertaken to dispel the social stigma and to bring about change in the attitude about the disease.