Rheumatoid Arthritis: Phenomenology, Personality Profile, Stress and their Inter-Relationship.

The purpose of this study was to study the psychiatric morbidity of Rheumatoid Arthritis and to look for an association between disease parameters and personality dimensions of Rheumatoid Arthritis patients. Methods: 40 patients were selected from Rheumatoid Clinic of P.B.M.Hospital,Bikaner as per Association of Rheumatoid Arthritis (A.R.A.) revised criteria. The ICD-10 Module of International Personality Disorder Examination (IPDE),Social And Occupational Functioning Assessment Scale (SOFAS),Hamilton’s Rating Scale for depression(HAM-D),Presumptive Stressful Life Events Scale(PSLE) were administered to these patients .Bivariate statistical methods were used to find association between illness variables and psychological dimensions. Group differences were analyzed by students T-test and ANOVA. Results: Rheumatoid Arthritis patients with psychiatric morbidity showed higher R.A. severity (p<0.02), swan neck and valgus deformity (p< 0.05), more number of joints involved (p<0.01), smaller joints (metacarpo-phalangeal and inter-phalangeal) involvement (p<0.05), presence of C - reactive protein in blood samples (p<0.01). Majority of patients who had personality psychopathology also reported stress in preceding one year period. Personality level psychopathology either alone or in combination is present in 17 patients that is 42.5 % of the sample. Patients with single personality trait psychopathology were better in comparison to severe personality psychopathology in terms of number of joints involved, joint deformities, social and occupational functioning and psychiatric morbidity. Conclusion: Preliminary findings suggest that the severity of Rheumatoid Articles correlates with psychiatric morbidity.

Personality Profile, Stress and their Inter-Relationship.

The purpose of this study was to study the psychiatric morbidity of Rheumatoid Arthritis and to look for an association between disease parameters and personality dimensions of Rheumatoid Arthritis patients. Methods: 40 patients were selected from Rheumatoid Clinic of P.B.M.Hospital,Bikaner as per Association of Rheumatoid Arthritis (A.R.A.) revised criteria. The ICD-10 Module of International Personality Disorder Examination (IPDE),Social And Occupational Functioning Assessment Scale (SOFAS),Hamilton’s Rating Scale for depression(HAM-D),Presumptive Stressful Life Events Scale(PSLE) were administered to these patients .Bivariate statistical methods were used to find association between illness variables and psychological dimensions. Group differences were analyzed by students T-test and ANOVA. Results: Rheumatoid Arthritis patients with psychiatric morbidity showed higher R.A. severity (p<0.02), swan neck and valgus deformity (p< 0.05), more number of joints involved (p<0.01), smaller joints (metacarpo-phalangeal and inter-phalangeal) involvement (p<0.05), presence of C - reactive protein in blood samples (p<0.01). Majority of patients who had personality psychopathology also reported stress in preceding one year period. Personality level psychopathology either alone or in combination is present in 17 patients that is 42.5 % of the sample. Patients with single personality trait psychopathology were better in comparison to severe personality psychopathology in terms of number of joints involved, joint deformities, social and occupational functioning and psychiatric morbidity. Conclusion: Preliminary findings suggest that the severity of Rheumatoid Articles correlates with psychiatric morbidity.

Pulmonary manifestations in brucellosis: a report on seven cases from Bikaner (north-west India).

OBJECTIVES: Pulmonary manifestations of Brucellosis are rare. We came across seven patients with predominant symptomatology of pulmonary involvement amongst 98 patients of active brucellosis seen in last four years. MATERIAL AND METHODS: The study is related to patients of brucellosis whose principal presenting features were related to respiratory symptom (cough, expectoration, pain in chest and breathlessness) along with fever and other constitutional symptoms. It included seven patients amongst 98 patients of active brucellosis seen during June 1996 to Feb. 2000 at PBM Hospital Bikaner. Diagnosis was confirmed by demonstration of the raised brucella agglutination titre of 1:320 or more in the serum. All patients were treated with rifampicin 900 mg daily and doxycyclin 100 mg twice daily for six week. The treatment was extended for another four weeks in two patients because of persistence of skiagram abnormalities. RESULT: Three patients had abnormality in skiagram chest in the form of pleural effusion, multiple paranchymal opacities and pneumonia. The skiagram chest was normal in remaining four patients. The response of treatment started with 10-15 days and all the patients became symptom-free at the end of six weeks except one patient. Skiagram chest at this time was normal in patients of pleural effusion but there was persistence of haziness and few opacities in other two patients. Follow up skiagram chest at the end of six months and twelve months was normal in all patients except calcified opacity in one patient. There was no evidence of relapse in any patient at the end of one year follow up. Liver function tests remained within normal range and no drug toxicity was observed. CONCLUSION: Pulmonary manifestations of brucellosis are rare. Treatment with rifampicin and doxycylin showed marked clinical and radiological improvement. All patients were completely disease-free at the end of one year follow up.

Scorpion envenomation causing hemiparesis.

We report a case of scorpion sting who presented with right hemiparesis and deranged level of consciousness. Prolonged BT/CT, decreased platelet counts, prolongation of PT and APTT with positive fibrinogen degradation products (FDP) D-dimer and CT scan findings of multiple cerebral haemorrhagic infarct indicating the presence of disseminated intravascular coagulation (DIC) as a cause of hemiparesis. Patient was managed with fresh blood transfusion and conventional treatment with favourable outcome.

A preliminary study of glycosylation of hair in diabetes mellitus.

Glycosylation of hair was studied in 30 diabetic (15 IDDM and 15 NIDDM) patients and in 30 age and sex matched healthy non-diabetic subjects. A positive correlation occurs between glycosylation of proximal portion of hair and the simultaneously measured glycosylated haemoglobin. The hair glycosylation remains stable along the length of hair from scalp to tip in normal subjects and suggests that a sufficiently long hair sample may offer a long term record of degree of hyperglycaemia. This may be useful in the investigation of hyperglycaemia and microvascular complications of diabetes mellitus. The level of glycosylation of hair is independent of duration of the disease, age, sex and race of the patient and colour of the hair, thus providing a universal index of hyperglycaemia in the control of diabetic state. Glycosylation of hair is perhaps the most non-invasive technique readily acceptable to the patients and yet provides a fairly accurate and reliable information regarding hyperglycaemia in the preceding duration in which the hair has been grown.

Incidence of coronary artery disease in asymptomatic uncomplicated essential hypertensive patients--evaluation by treadmill exercise test.

Treadmill exercise test was performed in 100 patients, 50 were hypertensive who were not having any clinical or electrocardiographic manifestation of coronary artery disease and 50 were controls. The test was positive in 28% of hypertensive patients as compared to 6% in controls. This study therefore suggests that hypertension is frequently associated with asymptomatic coronary artery disease as compared to normotension and it is concluded that exercise electrocardiography test is a definite diagnostic tool in diagnosis of coronary artery disease not only in symptomatic but also in asymptomatic patients with one or more risk factors.

Neurological manifestations associated with bronchogenic carcinoma.

Neurological manifestations of bronchogenic carcinoma were studied in 50 cases, 42% of whom showed neurological abnormalities with 6% having more than one type. Recurrent laryngeal nerve paralysis (20%) was the commonest, phrenic nerve paralysis (2%), paraneoplastic syndrome (12%), Pancoast's syndrome (10%) and metastatic involvement of central nervous system (4%) were other neurological manifestations. No evidence of encephalitis, motor neurone disease, myelopathy, Eaton-Lambert syndrome, myositis and drug-induced peripheral neuropathy was found in this study.

An epidemiologic study of acute intermittent porphyria in Maheshwari community of Sri-Dungargarh municipal area.

Fifteen patients of acute intermittent porphyria (AIP) were detected out of 2500 persons of Maheshwari community surveyed. These 15 patients belonged to 11 families. The prevalence of AIP in Maheshwari population came out to be 1:640 which is considerably higher than the figures reported from many other areas of our country. AIP was more common in females than males, the ratio being 9:6. Maximum number of cases (6) were encountered in the age group of 11-20 years. AIP was observed to be inherited as an autosomal dominant disease in 3 families. Spontaneous mutation of gene may be considered to be the mode of inheritance in the remaining 8 families. The disease was found to be more common in Daga and Tapadia subcastes. There were 5 cases belonging to Daga subcaste and 3 belonging to Tapadia subcaste.

Prognostic significance of exercise testing three weeks after myocardial infarction.

Treadmill exercise test was performed in 50 patients aged 35-60 years, 3 weeks after myocardial infarction. Thirty-two had anterior and 18 had inferior wall transmural myocardial infarction. Cardiac events like angina, reinfarction and sudden death were more common in patients with positive stress test. Thus treadmill testing in the early postinfarction period is of great prognostic value.