Comparative study of azathioprine and cyclosporin in rheumatoid arthritis – a sixteen weeks follow-up study.

Rheumatoid Arthritis (RA) is a chronic progressive deforming polyarthritic disease involving multisystems and associated with considerable morbidity. Immunosuppressive drugs have been used to reduce/arrest the progression of the disease. The present study was undertaken to compare the efficacy of Azathioprine and cyclosporin in Rheumatoid Arthritis patients. Study consisted of 100 patients of Rheumatoid Arthritis (as per criteria of American Rheumatism Association, 1987) divided into two groups : group I received Azathioprine 1 mg/kg/d and group II received cyclosporin 2.5-3.0 mg/kg/d for 16 weeks. Assessment of efficacy was based on clinical, biochemical and radiological parameters. All patients showed marked improvemen (p value < 0.001) in all clinical parameters i.e. relief in pain, reduction in morning stiffness, painful/swollen joint along with walking time for 50 feet and increase in grip strength. All patients showed reduction (p < 0.001) in ESR without any change in rheumatoid factor titres. Both drugs showed equal efficacy (p value = NS) in improvement of clinical and biochemical parameters. But cyclosporin showed more reduction in bony erosions and juxtaarticular osteoporosis. Ten patients showed nephrotoxicity with cyclosporin. Cyclosporin has an edge over azathioprine in reducing the rate of progression of joint change in Rheumatoid Arthritis but is associated with increased incidence of side effects that are generally manageable.

Life and past one year stressful events in coronary artery disease.

Personality type and role of stressful life events in the etiology of various disease has been a fertile field for research for past few decades. OBJECT STUDY: Very limited studies have been conducted especially for the estimation of stressful life events in Indian population with coronary artery disease (CAD), so a study was conducted to evaluate the same. METHODOLOGY: Ninety patients of CAD (positive for TMT or angiographic proved coronary obstruction) formed the study material. These were evaluated by Jenkin's activity survey (JAS) for personality type and on Presumptive Stressful Life Events (PSLE) scale for life events. SUMMARY OF RESULTS: The mean age of subjects was 57 +/- 8.03 years and male: female ratio was 14:1 Fifty one subjects (57%) had Type A personality while thirty nine subjects (43%) had Type B personality. Mean life time stressful life events were 3.4 +/- 1.92 which were higher (p < 0.001) when compared to respective average score of normal Indian population i.e. 10.34 +/- 5.4 and 1.90 +/- 2.62 respectively. CONCLUSION: Based on the present study it may be concluded that Type A personality is more frequently seen in CAD and also that these subjects had a statistically higher incidence of lifetime and past one year stressful events which could have made these subjects more vulnerable to CAD.

Gelatinous transformation of the bone marrow complicated by self induced starvation.

Gelatinous bone marrow transformation (GMT) is rare. It has been found to be associated with severe illnesses and malnutrition (rarely). A case report highlighting GMT as " starvation marrow" along with review of literature is being presented.

Ciprofloxacin-induced QTc prolongation.

Ciprofloxacin has been widely used for treating infections and has been found to have very low cardiovascular side effects. QTc prolongation with the use of ciprofloxacin is yet to be reported in literature. A case report highlighting QTc prolongation by use of ciprofloxacin is being presented.

Evaluating mental stress test in coronary artery disease treadmill positive patients.

Evaluation of CAD is more routinely done by treadmill test (TMT i.e. physical strain) than the more frequently occurring mental strain, so a study was planned to assess the provocability of ischaemia by various mental tasks in patient with positive TMT. Thirty educated subjects, positive on TMT were put on a 24 hour holter monitoring. During this time, subjects were assessed by Mental Stress Test (MST) by subjecting to various mental tasks - (a) Time stress test (b) Mental arithmetic test (c) Reading test (d) Zeigarnik effect test and observed for heart rate, blood pressure and ischaemic/arrhythmia responses. The results showed that the male : female ratio was 14:1 with a mean age of 57 ± 8.03 years. The mean change produced during MST in (a) heart rate was 9.16 (SD ± 1.24)/min (b) SBP was 8.86 (SD ± 1.32) mmHg (c) rate pressure product was 82x103; which were statistically low (p<0.001) when compared to haemodynamic changes with TMT. Ischaemia was inducible in only one subject by MST and no increased incidence of arrhythmias during MST was noticed. The low yield of inducible ischaemia by MST when compared to TMT could be due to poor haemodynamic responses achieved by MST when compared to responses of TMT (p<0.001). It is concluded that mental stress does produce ischaemic changes. More intense and sustained MST's which could bring about significant haemodynamic changes are required for inducing ischaemia as by TMT.

Assessment of utility of Siriraj Stroke Score (SSS) in stroke patients of Pt. BD Sharma PGIMS hospital, Rohtak, India.

India has predominantly poor rural population where brain CT scan, most often advised investigation in patients of stroke, may not always be available, hence Indian physician in such setting base his diagnosis on bed side sign evaluation for which Siriraj Stroke Score (SSS) could be helpful. Objective of study: to assess the utility of SSS in patients of stroke. Methodology: sixty subjects of stroke were evaluated on SSS and 'probable' diagnosis so made was compared with CT scan's (brain) 'certain' diagnosis. Main findings: by using SSS, the probable bedside diagnosis was cerebral infarct (score < -1) in 32 subjects and cerebral haemorrhage (score > +1) in 24 subjects while 4 subjects had indeterminant score (-1 to +1). Fifty subjects had their probable diagnosis matched with brain CT scan certain diagnosis. The above findings showed that SSS had 93.7% sensitivity, 76.6% specificity, 81.2% positive predictive value, 92% negative predictive value with an overall accuracy as 93.7% for diagnosis of cerebral infarction. For patients of cerebral haemorrhage the sensitivity was 83.3%, specificity was 92.5%, positive predictive value was 86.9%, negative predictive values was 92.5% with overall accuracy as 83.3%. Principal conclusion: physicians in the rural settings may find SSS to be quite useful in the management of stroke especially where more sophisticated radiological investigations may not be available for confirmation of diagnosis due to high cost or attended due to transportation risk.

Cardiovascular manifestations in aluminium phosphide poisoning with special reference to echocardiographic changes.

Twenty five patients of aluminium phosphide poisoning along with clinical evidence of peripheral circulatory failure were studied. Chief symptoms noted were vomiting and epigastric pain though subsequently three patients developed respiratory distress. Sensorium was normal in most of the patients. Three patients developed pulmonary edema. Raised JVP, feeble heart sounds and S3 gallop beside tachy and bradycardia were other cardiovascular manifestations observed in these patients. In 80% of the patients, various types of ECG changes were observed. ST-T changes were observed in 40% of the patients. Echo-cardiography on day 1 revealed marked LV systolic dysfunction (mean ejection fraction-43.52 +/- 10.18% and mean fractional shortening 17.35 +/- 4.97%) in them whereas repeat echocardiography on day 5 indicated normalisation of these values (mean ejection fraction 71.64 +/- 8.61% and mean fractional shortening 34.35 +/- 8.23%). This might be because of direct toxic action of phosphine on myocardium and later when phosphine gets excreted either through lungs or kidney leads to improvement in LV systolic function.

Phage-mediated conjugation in staphylococci as a means of transfer of drug-resistance.

Penicillin resistance plasmid was transferred from Staphylococcus aureus B4 (PcrKms, donor) to S. aureus ML351 (PcsKmr, recipient) by co-cultivation of the donor with the recipient in nutrient broth with or without the modifying effects of CaCl2 or sodium dodecyl sulfate. It was found that the transfer of drug-resistance occurred maximally between 6 and 18 hr postinoculation; however, addition of DNase (200 micrograms/ml) could totally prevent such a transfer up to 6 hr and significantly reduce it thereafter. Cell-free filtrate of the donor culture when mixed with the recipient was ineffective in bringing about the transfer of Pcr.

Diltiazem as adjunctive oral therapy in patients with chronic atrial fibrillation.

Digoxin frequently fails to control the heart rate in patients of chronic atrial fibrillation particularly during exertion. We have studied in 20 such patients the effect of adding diltiazem (180 mg/day) on resting and peak exercise heart rates. An attempt was also made to determine its effects on exercise tolerance by using treadmill and 6 minute walk test. Addition of diltiazem resulted in significant attenuation of heart rate both at rest and at peak exercise. The resting and exercise mean heart rates on digoxin alone were 98.9 +/- 21.5 b.p.m. and 160.2 +/- 35.68 b.p.m. respectively. After diltiazem this reduced to 78.7 +/- 12.30 b.p.m. at rest and 132.4 +/- 40.4 b.p.m. at peak exercise (p < 0.01). There was no significant effect on exercise tolerance. In conclusion, the addition of diltiazem substantially reduced the excessive heart rate response to exercise in digitalised patients of chronic atrial fibrillation.

Spectrum of psychiatric symptomatology in children in high and low socio-economic groups in Ludhiana.

A door to door survey was conducted to study the spectrum of psychiatric symptomatology in children aged 1-12 years belonging to high and low socio-economic groups. One hundred families in each group were studied. Symptom prevalence rate was comparable in the two groups, i.e., 479/1000 in the high socio-economic (HSE) group and 487/1000 in the low socio-economic (LSE) group. However, there were significant differences in the spectrum of symptomatology. Symptoms like quarrelsomeness, disobedience, abusive language, stealing, truancy, pica, school refusal, enuresis, mental subnormality and poor scholastic performance were significantly more in the LSE group. In the HSE group, symptoms like nail biting, food refusal, food fads and temper tantrums were significantly more.

Jaccoud's arthritis.

A 16 year old girl with multivalvular heart disease and recurrent episodes of polyarthritis with correctable deformities of hands and feet fitting into that of Jaccoud's arthritis is reported. The condition is rare and often difficult to differentiate from rheumatoid arthritis.

Aluminium phosphide poisoning. Two cases with rare presentation.

We report two cases of aluminium phosphide poisoning who presented with rare manifestations, one with bleeding diathesis, hepatitis and acute tubular necrosis and the other with acute respiratory failure.

Insulin response and glucose tolerance in survivors of myocardial infarction.

Insulin response and glucose tolerance was studied in 25 adult patients who had survived acute myocardial infarction 2-24 months prior to study. The results were compared with 15 age and sex matched healthy controls. Mean fasting glucose and serum insulin levels were normal in both groups. These values were significantly higher in patient group during glucose tolerance test (GTT) done after 75 g of glucose load. Eight patients (32%) had abnormal glucose tolerance and hyperinsulinaemia. Another 6 patients had hyperinsulinaemia (total 14 patients--56%). This is thought to be due to co-existent potential diabetes in these patients. The frequency of abnormal GTT or hyperinsulinaemia was not related to serum cholesterol levels but showed a positive correlation with serum triglyceride levels.