Cardiovascular events in systemic lupus erythematosus and rheumatoid arthritis : emerging concepts, early diagnosis and management.

The incidence of cardiovascular disease is significantly increased in the two common autoimmune disorders Systemic Lupus Erythematous (SLE) and Rheumatoid Arthritis (RA). Cardiovascular mortality is a major cause of death in these patients. This has been linked to acceleration of the atherosclerotic process in these disorders. Traditional cardiovascular risk factors alone cannot fully explain the accelerated atherogenesis in these disorders. In addition to the systemic inflammation, additional mechanisms have been put forward that are more specific for the pathophysiology of these autoimmune chronic inflammatory disorders. Further, longitudinal studies are required to define optimal preventive strategies for cardiovascular comorbidity in SLE and RA.

Diagnostic and prognostic utility of rapid strip (OptiMal and Paracheck) versus conventional smear microscopy in adult patients of acute, uncomplicated P. falciparum malaria in Mumbai, India.

OBJECTIVES: The present study compared the diagnostic and prognostic utility of two rapid tests the (Paracheck and OptiMal) versus conventional smear microscopy. METHODS: Using two independent microscopists we carried out the three tests in 31 adult cases of smear positive, acute, uncomplicated Plasmodium falciparum malaria. All three tests were done pretreatment, and on Days 8, 15 and 29. RESULTS: Compared to microscopy, the Paracheck had a sensitivity of 100%, while the OptiMal had a sensitivity of 83.7%. The lower sensitivity of OptiMal resulted from misidentification by both microscopists of 6/31 cases as Plasmodium vivax. As a follow up tool, the OptiMal was better than Paracheck, due to the earlier disappearance of the parasite LDH. Also in the Paracheck, between microscopists, there was a significant difference in reading the tests, on Days 8 and 15. CONCLUSION: Our study reiterates, the continued utility of conventional smear microscopy.

Seroprevalence of human immunodeficiency virus infection in an infectious disease hospital.

AIMS AND OBJECTIVES: To analyse clinicopathological features of HIV infected patients admitted in an infectious disease hospital in Mumbai. MATERIAL AND METHODS: Retrospective study of 501 patients admitted from 1st September, 1996 to 28th February, 1998 and screened for HIV status out of clinical suspicion was carried out. HIV seropositivity was established by double confirmation of spot test results with microwell Elisa test. RESULTS: HIV seropositivity was seen in 39.92%. Out of these 94% were adults with male preponderance and 96.5% had only HIV-1 infection. The significant clinical features in HIV positive patients were chronic diarrhea (51.5%), prolonged fever (41.5%) and history of exposure (34%). Pulmonary tuberculosis could be diagnosed in 19.5% of HIV positive patients. In patients with prolonged/recurrent jaundice HBsAg and HIV was noted as a coinfection within 10/42 cases tested. CONCLUSIONS: Increasing prevalence of HIV seropositivity was noted in patients admitted to an infectious disease hospital. Association of HIV infection with tuberculosis and in icteric cases with HBsAg was significant. The HIV screening should be carried out in patients with prolonged illness resistant to usual mode of treatment.

Dapsone hypersensitivity syndrome with coexisting acute hepatitis E.

A 14-year-old girl presented with fever, generalized lymphadenopathy, skin rash and hepatitis after starting dapsone. All abnormalities reversed with institution of prednisolone therapy after discontinuation of dapsone. The hepatic involvement was of hepatocellular type; it was associated with IgM anti-HEV antibodies, suggesting coexisting acute hepatitis E. We believe a causal link between the hepatotrophic viruses and dapsone hypersensitivity syndrome could exist.