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.

Stress and its risk factors in medical students: An observational study from a medical college in India.

Objectives: Stress in medical students is well established. It may affect academic performance and lead to anxiety, depression, substance abuse, and burnouts. There is limited data on stress in Indian medical students. We conducted an analytical observational study to assess the magnitude of stress and identify possible "stressors" in medical students of a teaching hospital in Kolkata. Materials And Methods: This questionnaire-based study was conducted in the Institute of Post Graduate Medical Education and Research, Kolkata with consenting undergraduate students of 3 rd , 6 th , and 9 th (final) semesters, during lecture classes in individual semesters on a particular day. The students were not informed about the session beforehand and were assured of confidentiality. The first part of the questionnaire captured personal and interpersonal details which could be sources of stress. The rest comprised three rating scales - the 28-item General Health Questionnaire to identify the existence of stress, the Warwick-Edinburgh mental well-being scale to assess the mental well-being, and the revised version of the Lubben social network scale to assess the social networking. The responses and scores were compared between the three semesters as well as between various subgroups based on baseline characteristics. Results: Data from 215 respondents were analyzed - approximately 75% were male, 45% came from rural background, 25% from low-income families, and 60% from vernacular medium. Totally, 113 (52.56%; 95% confidence interval: 43.35-61.76%) students were found to be stressed, without significant difference in stress incidence between the semesters. About 60% of the female students were stressed in contrast to 50% of the males, but this observed difference was not statistically significant. The mental well-being and social networking of stressed respondents suffered in comparison to their non-stressed counterparts. Conclusions: The stress incidence in medical students in this institution in India is high and is negatively affecting their mental well-being. Further multicentric and longitudinal studies are needed to explore the incidence, causes, and consequences of stress in our setting.

Trends of Childhood Vasculitides in Eastern India.

A prospective follow up for 7 years (2004-2010) revealed 10.2% children (n=158) had vasculitis among all rheumatological cases (n=1544). Henoch-Schonlein Purpura (HSP) (56.9%) and Kawasaki disease (KD) (24%) were major groups.

Bilateral fibular hemimelia with recto-vestibular fistula associated with amniotic bands.

Fibular Hemimelia is a rare congenital disorder of deficiency to complete absence of fibula. It has been associated with post axial skeletal anomalies like shortening of femur, absence of lateral rays of foot and syndactyle, polydactyle etc. We report this case because of associated amniotic constriction bands over both the forearm, suggesting amniotic bands may be one of the causal factors of Fibular Hemimelia due to insult to the growing limb bud.