Role of 30 kDa antigen of enteric bacterial pathogens as a possible arthritogenic factor in post-dysenteric reactive arthritis.

Background: Reactive arthritis (ReA)/Reiter’s syndrome (RS) may be caused as a sequel of infections caused by enteric bacterial pathogens, although the mechanisms through, which different pathogens cause similar disease are not clear. Aim: This study was done to look for the presence and role of any common bacterial antigen among the pathogens isolated from such patients. Materials and Methods: A total of 51 patients of ReA and 75 controls (three groups of 25 subjects each: Group 1: Patients who did not develop arthritic complications within 3 months after bacillary dysentery/diarrhea; Group 2: Patients with other arthritic diseases and Group 3: Normal healthy subjects) were included. The isolated enteric pathogens were tested to detect the immunodominant antigens. Results and Conclusions: A common 30 kDa antigen was found to be specifi cally present among seven arthritogenic enteric bacterial strains belonging to three genera, Salmonella, Shigella and Hafnia. Post-dysenteric ReA patients’ sera show higher levels of immunoglobulin G, immunoglobulin M and immunoglobulin A antibodies against this antigen as compared to the controls. Lymphocytes of ReA patients recognize this antigen, proliferate and produce interleukin-2 in response to this antigen more than the lymphocytes of controls. 30 kDa antigen may be a common arthritogenic factor associated with postdysenteric ReA/RS. The association of Hafnia alvei with post-dysenteric ReA is described for the fi rst time. Four cases of mycobacterial ReA had an association with this antigen, suggesting that the arthritogenic antigen of mycobacteria and enteric bacteria may be of a similar nature.

Cutaneous vasculitis in a patient with primary Sjogren's syndrome.

Sjogren's syndrome (SS) is an uncommonly described disorder from India. In this report we describe a patient with SS and who developed cutaneous vasculitis.

Neutrophil functions in rheumatoid arthritis.

Neutrophils play an important role in the pathogenesis of rheumatoid arthritis by accumulation and liberation of active proteolytic enzymes. Despite the active participation of the neutrophils, the patients afflicted with rheumatoid arthritis are prone to multiple infections. We studied neutrophil functions in 20 rheumatoid arthritis patients in active disease and equal number in remission and 20 healthy normal controls. No change in neutrophil function was seen in patients in remission. Phagocytic capacity of the neutrophils in active disease was found to be significantly reduced (p < 0.05). This inversly correlated with the rheumatoid factor (r = -0.128, p = 1). Random migration and chemotaxis was statistically reduced when compared with either healthy controls (p < 0.01) or when compared with patients in remission (p < 0.01). The chemotaxis inhibition was further enhanced by autologus serum (p < 0.05). The serum from patients with active disease also reduced chemotaxis of neutrophils from normal individuals (p < 0.01), indicating reduced cellular response as well as inhibitors in serum. The positive correlation (r = 0.466, p < 0.01) with rheumatoid factor, suggests the inhibitory activity may be due to the circulating rheumatoid factor in the active disease. The postulate that prior saturation of neutrophil receptors with immune complexes lower phagocytosis as well as chemotaxis is sustained. Destruction of chemotaxis receptors by release of various strong oxidative enzymes by neutrophils may also be a factor. Normal leucocytes are seen to take up immunoglobulins from diseases serum but not from normal serum. This uptake of diseased serum may be responsible for reducing the chemotactic and phagocytic function of neutrophils and hence increased incidence of infection in these patients.

Epstein-Barr virus induced non-Hodgkin's lymphoma as a presenting manifestation of acquired immune deficiency syndrome.

A 30 year old, human immunodeficiency virus (HIV) positive patient presented with fever and intra-abdominal lymphadenopathy. Cytology smears from the nodes showed a high grade Non-Hodgkin's lymphoma (NHL) which was B cell in origin. NHL was the acquired immune deficiency syndrome (AIDS) defining disease in this patient. Polymerase chain reaction (PCR) studies on tumour tissue showed presence of Epstein Barr Virus.

Elevated levels of anti-proteus antibodies in patients with active rheumatoid arthritis.

We carried out this study to determine if our patient population with rheumatoid arthritis (RA) has elevated levels of antibodies to gut bacteria. Seventy patients with RA were categorised as being either active or inactive on clinical grounds. Antibodies to the H and O antigens of Proteus mirabilis and Salmonella typhi were determined by tube agglutination method in these patients, 18 patients with osteoarthritis and 82 healthy controls. There was no significant difference in the anti-proteus antibody titres between both the control groups and patients with inactive disease. However, antibody levels among patients with active disease were significantly higher than controls (P < 0.001). There was no significant difference in anti-salmonella antibody titres among the various disease and control groups. Elevated antibody levels could suggest a role for Proteus as an etiological agent in RA.

Plasma reactive nitrogen intermediate levels in patients with clinically active rheumatoid arthritis.

We studied reactive nitrogen intermediate levels in 31 patients with active rheumatoid arthritis (RA) taking indomethacin and 20 healthy controls using nitrite and citrulline levels, measured by spectrophotometry, as markers. Twenty patients with RA were followed up after 4 and 8 wk of treatment with additional therapy in the form of methotrexate. Mean nitrite levels in 31 patients were 0.94 +/- 0.41 mumol/ml and 20 controls it was 1.18 +/- 0.99. After treatment with methotrexate for 4 and 8 wk the levels were 0.9 +/- 0.45 and 1.25 +/- 1.15 mumol/ml, respectively. Mean citrulline levels in all patients was 1.68 +/- 0.11 and controls was 1.39 +/- 0.6 mumol/ml. Following therapy with methotrexate for 4 and 8 wk the levels were 1.40 +/- 0.49 and 1.40 +/- 0.51 mumol/ml, respectively. It is possible that serum levels of these products may not reflect alterations in the synovial fluid levels. Alternatively, whatever lowering may have been achieved by the anti-inflammatory effect of the therapy may have been countered by drug derived free radicals.

Lack of expression of c-myc oncogene in peripheral blood mononuclear cells of patients with active rheumatoid arthritis.

We looked for the expression of c-myc oncogene, one of the genes that enhance apoptosis, in 11 patients with active rheumatoid arthritis (RA) along with five patients with osteoarthritis (OA) knee as disease controls and six healthy volunteers. A dot-blot assay using a probe specific for c-myc oncogene was performed on total RNA obtained from peripheral blood mononuclear cells. There was no expression in patients with active RA and healthy volunteers. One patient with OA expressed c-myc. Lack of expression of c-myc suggests that in active RA circulating lymphocytes are not in the replicative phase despite ongoing disease activity.

Wegener's granulomatosis: clinical experience with eighteen patients.

Wegener's granulomatosis is being recognised with increasing frequency in India. Our 18, histologically confirmed, patients had a clinical profile similar to that described from developed countries. Delayed diagnosis led to the death of nine patients, usually within days of hospital admission, due to extensive vasculitis and renal failure. Tuberculosis was the most frequently considered diagnosis and 12 patients had been treated for it in spite of progressive clinical deterioration. Those who could be adequately treated with low dose daily cyclophosphamide and corticosteroids did well. Six of seven such patients are alive and well 1-8 years later. We believe that if prompt lung biopsy and ANCA determination are resorted to in patients with "resistant tuberculosis", it will greatly expedite case detection, diagnosis and optimum treatment of this remediable disease.

Patients' attitude towards health care at a teaching hospital in India.

Using a questionnaire, 362 patients attending the outpatients services of Internal Medicine of Nehru Hospital attached to our institution were randomly interviewed. Seventy per cent of the patients were in the 21-50 years age range; 50% came from rural and 50% from urban areas. Forty per cent travelled more than 30 Km; 72% used a public transport to reach hospital. Most patients had an income less than Rs. 1000/-. Ninety per cent had already consulted another medical practitioner earlier. The largest number of complaints related to the gastrointestinal, cardiovascular and respiratory systems. On an average 1-2 drugs were prescribed per patient; only 13% of these were available at the hospital dispensary. Most patients were willing to purchase the prescribed drugs from the market.

Pulmonary complications of upper abdominal surgery.

Pulmonary complications encountered in 67 patients undergoing upper abdominal surgery in our unit in one year period are analysed. Pulmonary function tests and their post-operative reduction, as also the risk factors are discussed. Pathophysiology responsible for pulmonary complications is outlined.

A study of relation between physical growth and sexual maturity in girls--V.

The findings indicate that sexual maturity would be initiated only after the attainment of requisite morphological body size such as weight on an average nearly 27 kg and height of 137 cm, irrespective of age and SES. The girls from LSES were chronologically older throughout the span of pubertal growth. However, they took lesser time to reach full maturity after the attainment of mid-pubertal growth compared to USES. Menarche appeared after attaining about a minimum weight of 35 kg, height of 143 cm and bicristal breadth is 24 cm. Its appearance followed the attainment of peak height velocity and 3rd developmental stage of breast and/or pubic hair. It, however preceded the attainment of weight and bicristal breadth peak velocities.

A mixed-longitudinal study on the pattern of pubertal growth: relationship to socioeconomic status and caloric-intake--IV.

The pubertal growth pattern was observed on 791 girls belonging to upper and low SES. These girls ranged between 7-16 years. The effect of calorie intake on the pubertal growth was also ascertained. The development of breast was first to appear at the age of 8.25 years. It was followed by pubic and axillary hair development. The mean age of menarche was 12 years and 12.8 years for USES and LSES, respectively. The onset of menarche, breast and pubic hair was significantly delayed in LSES girls by 0.8 years. Menarche was found to correlate better with breast development than pubic or axillary hair. The girls on adequate calories showed early onset of breast, pubic hair and axillary hair development and of menarche. Similarly, these girls attained mature stage (adult) of these variables earlier compared to those who were on inadequate calories. However, intermittent developmental stages of pubic hair and axillary hair showed no consistency with intake of calories. The girls on inadequate calories showed approximately one year late onset of breast and pubic hair development. The present observations suggest that the onset of puberty is strongly influenced by environment but its attainment is under the genetical control.

Evaluation of anthropometric indices for the assessment of nutritional status in girls--III.

Total subjects were regrouped into three, based on the growth velocity indicating pre-adolescent, adolescent and post-adolescent stages. Three nutritional indices based on 4 body measurements (weight, height, triceps, midarm circumference) were calculated for each subject. It was found that the energy protein index was the only reliable and suitable index for evaluating the nutritional level of adolescents and post-adolescents while weight/height2 and arm circumference were more suitable for determining the nutritional status of pre-adolescent girls.

Physical growth in school girls: relationship to socio-economic status and dietary intake--II.

Growth of 955 healthy normal girls between ages 5-16 years was measured with a mixed-longitudinal design to observe variations due to socio-economic status and the dietary intake. Five hundred and thirteen girls belonged to upper socio-economic status (USES) and 442 girls to lower SES. The 24 hours diet-intake of each girl was recorded by 24 hour-recall method. The LSES girls were significantly smaller in every physical measurements compared to USES girls. Annual mean increments for the linear and circumferential measurements were also lower among LSES girls till the peak velocity was attained. The mean increments for triceps were also lower in LSES for all ages. The girls on inadequate calories were significantly smaller in their growth than who consumed adequate or more than adequate calories. The effect of protein was less evident. A higher percentage of LSES girls (91.2%) consumed inadequate calories than those of USES girls 38.2%). The present study thus established that SES and dietary intake had significant bearing on the physical growth of the pre-adolescent and adolescent girls.

A mixed longitudinal study of physical growth in girls--I.

A total of 492 apparently normal healthy Punjabi girls belonging to upper socio-economic status between 5-15 years of age were selected from the schools for the study of physical growth. Twenty one measurements were made on each girl. Girls below the age of 13 years were examined five times at interval of six months each. Beyond 13 years, only those girls who had not attained menarche, were followed-up 6 monthly. The linear and circumferential measurements followed similar pattern while skinfold thicknesses showed different pattern. Each linear and circumferential measurement and weight increased progressively from age 5 to 15 years. Annual growth gain per year was slow upto 9/10 years followed by a rapid growth with a peak velocity between 11-13 years of age. Thereafter, growth rate declined. The skin-fold thicknesses showed decrease in absolute values upto 10 years of age. Beyond 13 years of age, these increased rapidly. However, no peak velocity in either of the skinfold was detected. Thus, three periods of growth rate, viz., preadolescent (age 5-9 years); adolescent (10-13 years) and post adolescent (beyond 13 years) could be identified.