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2.
J Postgrad Med ; 2005 Apr-Jun; 51(2): 116-8
Article in English | IMSEAR | ID: sea-115838

ABSTRACT

BACKGROUND: There is abundant literature documenting that the Internet is fast changing the way patients access health-related information, learn about their illnesses, and make healthcare-related decisions. However, there is hardly any data regarding Indian patients accessing health-related information available on the Internet. AIMS: To determine patients' use of the Internet as a medical information resource and to determine their experience, their perceptions of the quality and reliability of the information available. SETTING: The study was carried out in the outpatient clinic of an urban, tertiary care private sector hospital in November 2004. MATERIAL AND METHODS: Our survey instrument consisted of an anonymous single-page questionnaire. Eight hundred and eighty consecutive adults aged 18-70 years, attending the general outpatient clinic of a tertiary care private hospital completed the questionnaire. RESULTS: Two hundred and eighty-one (32%) patients acknowledged surfing the Internet, while 75% (212/281) of them acknowledged that they accessed health-related information. Amongst those who accessed the Internet, 130 (61%) found the information on the net to be of average quality. Almost all patients (211/212) felt that the information served the purpose and 95% (201/212) also found also found it to be reliable. Only 7% (21/281) patients were aware of the presence of any quality standards pertaining to health information sites and none could name any accreditation standard. CONCLUSIONS: One in four patients attending the private set-up is using the Internet for health information. A majority of patients find the information on the net reliable and of good quality. Awareness about health information quality standards is a rarity.


Subject(s)
Adolescent , Adult , Aged , Female , Humans , India , Internet/standards , Male , Middle Aged , Outpatient Clinics, Hospital , Patient Education as Topic/methods , Quality of Health Care , Surveys and Questionnaires
3.
Indian J Med Sci ; 2005 Apr; 59(4): 165-70
Article in English | IMSEAR | ID: sea-68027

ABSTRACT

Bisphosphonate group of agents are known for their anti-bone resorptive properties. However, recently their anti-inflammatory and anti-arthritis properties have come to light. Clinical trials of their use in spondyloarthropathy are showing promising results, especially in patients with shorter disease duration. The adverse event profile is mainly limited to postinfusion arthralgia, myalgia and fever. The concept of pamidronate in spondyloarthropathy management should be evaluated further in light of these clinical studies and could have a major impact on our resource-restricted setting.


Subject(s)
Anti-Inflammatory Agents/adverse effects , Diphosphonates/adverse effects , Humans , Spondylitis, Ankylosing/drug therapy
4.
Article in English | IMSEAR | ID: sea-69049

ABSTRACT

Internet is the biggest medical library in the world. It has transformed the way many health seekers find health information. Seekers on net have exponentially increased from 54 million in 1998 to 110 million in 2002 (U.S. figures) and are ever increasing. Act of looking for health or medical information is the third most popular activities online. Search engines are used by almost 81% of the e-patients to look for the information they want. Internet is fast becoming an influential force as more than 70% consumers say that the information on the net has influenced their treatment decisions. However, the reliability of all the health information available on the Internet is questionable. Numerous studies have indicated deficiencies in the quality of information on the Internet. Due to technical and commercial reasons, the results provided by various search engines can be potentially biased. Only about a quarter of health seekers thoroughly check the source, timeliness of information every time they search for health information. In fact, most adults from USA, Japan, France and Germany who participated in a recent survey thought online health care information to be trustworthy, of good quality, easy to understand and easy to find. Efforts are now being taken to ensure the quality of health information on the Internet. Patients need to be educated about the worthiness of a site and also be prescribed the right sites to be consulted for information.


Subject(s)
Health Education/standards , Humans , Internet/standards , Patient Education as Topic/standards
7.
Article in English | IMSEAR | ID: sea-93146

ABSTRACT

AIMS OF THE STUDY: To evaluate the advantages and reliability of screening for antinuclear antibodies (ANA) by enzyme immunoassay (ELISA). METHODOLOGY: Sera from 96 patients comprising 51 with systemic lupus erythematosus (SLE), 11 with other systemic rheumatological diseases (SRD) and 34 with various other diseases (non-SRD) were tested using a commercial ELISA kit (ANA-Ease, Genesis Biotechnology, U.K.). These sera consisted of 53 immunofluorescence assay (IF) ANA-positive and 43 IF ANA-negative samples RESULTS: We observed that when compared to the IF for ANA the sensitivity, specificity, predictive values for positives (PPV) and negatives (NPV) of ELISA were 90.7%, 85.7%, 89.1% and 87.8% respectively. Exclusion of borderline ELISA positive by slightly raising the cut-off optical density (OD) increased the specificity and PPV to 93.1%, and 94.1% respectively. Importantly, none of the non-SRD sera were positive when this higher cut-off was used. ELISA was noted to be strongly positive in three IF ANA-negative SLE patients. However there was no correlation between the ELISA ANA semi-quantitative index and the IF ANA titers. CONCLUSIONS: ELISA appears to be suitable as a preliminary screening test for ANA. An appropriate cut-off should be identified to segregate low positive samples that could be false-positives. Nevertheless, IF will need to be performed to estimate the titers, identify patterns of ANA positive samples and confirm results of low positive "gray-zone" samples and ELISA negative sera from patients with a high index of clinical suspicion of SLE.


Subject(s)
Antibodies, Antinuclear/blood , Biomarkers/blood , Enzyme-Linked Immunosorbent Assay , False Negative Reactions , False Positive Reactions , Humans , Lupus Erythematosus, Systemic/diagnosis , Mass Screening/methods , Predictive Value of Tests , Sensitivity and Specificity
9.
Indian J Dermatol Venereol Leprol ; 2004 Mar-Apr; 70(2): 67-75
Article in English | IMSEAR | ID: sea-52910

ABSTRACT

Systemic sclerosis is a uncommon connective tissue disorder characterized by vascular damage, immune cell activation and fibrogenesis. Each of these components may respond to different therapies. Therefore, a combination strategy treating all three processes is more likely to control the disease than single agent therapy. Clinical trials have gone a long way towards defining the therapy of scleroderma and many drugs previously used for scleroderma have been critically assessed. Angiotensin blockade is effective in treating as well as preventing scleroderma renal crisis. The 9-year cumulative survival has improved from 38% to 68% after the introduction of angiotensin blockade. There is definitive evidence supporting the use of cyclophosphamide in systemic sclerosis associated alveolitis. Newer molecules aimed at various cytokines are being tried. The therapy for systemic sclerosis is far from perfect at present. But, individualization of the treatment with respect to stage and subset of disease as well as organ involvement can eventually result in rational, effective management.

10.
Article in English | IMSEAR | ID: sea-91927

ABSTRACT

We present, herein, a case of venous thrombosis who was lupus anticoagulant negative and had low levels of anticardiolipin antibodies at the time of initial presentation. A definite diagnosis of antiphospholipid syndrome (APS) could be made only when repeat testing, six months later, revealed a dramatic rise of these antibodies.


Subject(s)
Adult , Antibodies, Anticardiolipin/blood , Antiphospholipid Syndrome/diagnosis , Female , Humans , Lupus Erythematosus, Systemic/diagnosis , Time Factors , Venous Thrombosis/immunology
12.
Article in English | IMSEAR | ID: sea-86984

ABSTRACT

A young female patient was admitted with myelitis. She had oral ulcers, hair loss and redness of hand suggestive of lupus. Diagnostic work including an MRI confirmed lupus myelitis. Unusual features of this case along with relevant literature are reviewed.


Subject(s)
Adult , Female , Humans , Lupus Erythematosus, Systemic/diagnosis , Methylprednisolone/therapeutic use , Myelitis/drug therapy
13.
Article in English | IMSEAR | ID: sea-88037

ABSTRACT

OBJECTIVE: We report our experience with use of plasmapheresis (PP) as an adjunct therapy in severe progressive neuropsychiatric systemic lupus erythematosus (NPSLE). METHOD: Three patients of NPSLE (including 2 with status epilepticus) who were progressively worsening on steroids or combination of pulse cyclophosphamide (CPM) and steroids were treated with PP followed by synchronized CPM. Pre and post treatment SLE Disease Activity Index (SLEDAI) and laboratory tests were carried out. RESULTS: Significant clinical improvement with decrease in SLEDAI occurred immediately following PP. Mean SLEDAI before and after PP were 33 and 11. Mean erythrocyte sedimentation rate decreased from 121 to 31. Rebound flare of disease activity noted in two patients between 7th-10th day requiring additional immunosuppressants or steroids. CONCLUSIONS: PP used as an adjunct therapy in severe, progressive NPSLE is well tolerated and can turn the patient around. PP should be followed by synchronized pulse CPM to prevent disease flare.


Subject(s)
Adolescent , Adult , Central Nervous System Diseases/etiology , Neurocognitive Disorders/etiology , Female , Follow-Up Studies , Humans , Lupus Erythematosus, Systemic/complications , Nervous System Diseases/etiology , Plasmapheresis , Time Factors
14.
Article in English | IMSEAR | ID: sea-89091

ABSTRACT

Cryptococcal meningeal or cerebral infection has become an increasing global problem.(1) In this respect there are many anacedotal Indian case reports.(2) More than 50% of CNS infections occur in immunosuppressed patients and other debilitating conditions. Neurological form of cryptococcosis in immunocompetant patients needs to be considered in situations with intractable headache, papilloedema, hydrocephalus and prior to decisions on shunt placements.(3) We report on two such immunocompetent patients who presented with CNS involvement. Their clinical features and outcome is discussed.


Subject(s)
Adolescent , Adult , Antifungal Agents/therapeutic use , Female , Humans , Immunocompetence , Meningitis, Cryptococcal/diagnosis , Treatment Outcome
16.
Article in English | IMSEAR | ID: sea-94767

ABSTRACT

We report a case of paediatric lupus who during her admission developed near fatal central nervous system complication of status eilepticus with respiratory paralysis and was managed with intravenous immunoglobulins, extended course of methyl prednisolone with a favourable outcome.


Subject(s)
Central Nervous System Diseases/drug therapy , Child , Female , Humans , Immunoglobulins, Intravenous/therapeutic use , Lupus Erythematosus, Systemic/drug therapy , Methylprednisolone/therapeutic use , Treatment Outcome
18.
Article in English | IMSEAR | ID: sea-93985

ABSTRACT

OBJECTIVES: This study was undertaken to see if brucella spondylitis existed as a cause of backache in Mumbai and to identify the clinical setting in patients of backache where brucella serology is indicated. METHODS: In 18 months (June 1996-Dec. 1997) we performed tube agglutination test (TAT) for Brucella melitensis and abortus on 72 patients of low backache from Orthopaedics Department of a teritary health centre. All 72 patients satisfied the inclusion and exclusion criteria designed to exclude radiologically detectable congenital or degenerative cause of backache. RESULTS: Six out of 72 patients were seropositive for brucellosis. All six patients had either history of animal contact or ingestion of raw milk or milk product (cheese or paneer). The lumbosacral backache was severe, radiating to the legs and straight leg raising test was significantly positive, they had marked tenderness on spinous process of lower lumbar vertebrae. Changes of brucella spondylitis were present on plain radiogram of lumbosacral spine in three patients. Four patients had abnormalities on bone scintigraphy. CONCLUSION: Low backache of brucella spondylitis closely simulates pain of prolapsed intervertebral disc. Serologic testing for brucellosis is an important step in management of such patients, especially when history of animal contact or raw milk or milk product ingestion is present, as the disease can be eminantly treated with antibiotics.


Subject(s)
Adolescent , Adult , Agglutination Tests , Anti-Bacterial Agents/therapeutic use , Brucella abortus/isolation & purification , Brucella melitensis/isolation & purification , Brucellosis/complications , Doxycycline/therapeutic use , Female , Humans , Low Back Pain/drug therapy , Lumbar Vertebrae/pathology , Male , Rifampin/therapeutic use , Spondylitis/drug therapy
19.
Indian J Chest Dis Allied Sci ; 1998 Oct-Dec; 40(4): 243-50
Article in English | IMSEAR | ID: sea-29193

ABSTRACT

Collagen vascular diseases (CVD) are commonly associated with interstitial lung diseases. Bronchoalveolar lavage (BAL) fluid analysis has important diagnostic value when considered in conjunction with other information. The present study was undertaken in newly diagnosed patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) at presentation to characterise BAL cellular constituents and elucidate the cellular picture in patients with and without pulmonary symptoms and in those with and without radiological (high resolution computed tomography) features of interstitial lung disease. All the patients were non-smokers and had not received any form of treatment for their diseases. The means of percentages of lymphocytes, neutrophils, and macrophages were 23.3%, 6.2%, 70.5% respectively. There was a significant BAL lymphocyte predominance in patients with pulmonary symptoms, and a lymphocyte and neutrophil predominance in those having radiological evidence of interstitial lung disease.


Subject(s)
Adult , Arthritis, Rheumatoid/complications , Biopsy , Bronchi/pathology , Bronchoalveolar Lavage Fluid/cytology , Collagen Diseases/complications , Female , Humans , Lung Diseases, Interstitial/complications , Lupus Erythematosus, Systemic/complications , Lymphocyte Count , Male , Middle Aged , Prognosis , Prospective Studies , Pulmonary Fibrosis/complications , Severity of Illness Index
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