ABSTRACT
Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease and musculoskeletal ultrasonography (USG) is gaining popularity for assessing the disease activity bed side, objectively and cost effectively. There is paucity of such studies from India which establish the correlation between RA disease activity and musculoskeletal USG. Objective: The objective of this study was to compare the disease activity scores in RA patients, assessed by ‘clinical and laboratory evaluation’ with ‘musculoskeletal ultrasound scoring of the affected joints. Methodology: It was a cross sectional study conducted from December 2015to May 2017. We enrolled the diagnosed patients of RA, having at least one USG assessable joint with definite clinical synovitis. Disease activity was assessed by swollen joint count, tender joint count, Clinical Disease Activity Index (CDAI), Disease Activity Score (DAS) 28 ESR and DAS 28 CRP. Musculoskeletal USG was performed by experienced radiologist. Grayscale scores (GSUS) and Power Doppler scores (PDUS) were calculated in 22 joints as per SONAR criteria and each joint was examined as per standardized score. Results: Our study showed that DAS 28 CRP, DAS 28 ESR, CDAI, tender joint count and swollen joints count had positive correlation (p<0.001) with various musculoskeletal USG scores, whereas ESR and CRP failed to show any significant correlation. Conclusion: GSUS-PDUS can be used for diagnosing joint space narrowing, joint effusion, and synovial thickening. PD may become a cost-effective alternative to gadolinium enhanced MRI. Strong correlation exists between USG and physical examination of joint swelling as well as disease activity scores in RA patients.
ABSTRACT
Background: Assessment of awareness of common rheumatological diseases amongst final year medical undergraduate students – single centre questionnaire-based survey.Methods: A cross-sectional survey of final year students was conducted during a national undergraduate medical summit. Participants were asked to fill out a 10-question survey (online link/in print). Results were summarized using descriptive statistics.Results: A total 162 medical students completed the survey. Only 18 of 162 respondents were able to score more than 50% in all domains with only one respondent getting all the questions correct. Partial awareness about the major rheumatological diseases in adults was seen with 122 (75%), 110 (68%) and 105 (65%) students having more than 50% correct in the domains of lupus, psoriasis and rheumatoid respectively without scoring completely. By contrast even general awareness of pediatric rheumatology was low with only 34 respondents (21%) having more 50% score in this domain.Conclusions: These findings are consistent with the general consensus amongst rheumatologists that medical students are inadequately exposed to rheumatological disorders and evolving treatments. Awareness of paediatric rheumatology is the lowest and needs urgent addressing.
ABSTRACT
Background: Mild Cognitive Impairment (MCI) a transitional stage between normal aging and dementia has been observed more in people with diabetes when compared with general population. The risk factors for MCI in type 2 diabetes mellitus (T2DM) have been defined in elderly patients and aging may itself contribute to declining in cognitive functions. As the large number people with T2DM are under 60years, the prevalence of MCI and factors contributing to it are not much studied. So, this study aimed to find out the factors contributing to MCI in non-elderly T2DM patients.Methods: In this cross-sectional study, 257 patients with T2DM underwent cognitive assessment by Montreal cognitive assessment test and the cognitive levels were correlated with their glycosylated hemoglobin, lipid profile, and highly sensitive C-reactive protein (hsCRP).Results: The prevalence of mild cognitive impairment (MCI) was 64.2%. MCI significantly correlated with duration of diabetes, socioeconomic status, HbA1c, serum triglycerides, low-density lipoprotein, very low-density lipoprotein and hsCRP levels. The factors that were statistically insignificant were body mass index and high-density lipoprotein levels.Conclusions: Cognitive impairment is seen even in non-elderly T2DM patients. It should be considered along with the other complications of diabetes and individuals with T2DM should be screened for cognitive impairment to prevent progression to dementia.