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.

American Rheumatism Association 1958 and 1987 revised criteria for rheumatoid arthritis--how useful to the clinician.

The American Rheumatism Association (ARA) criteria for rheumatoid arthritis (RA) were evaluated in 52 newly referred consecutive, clinically diagnosed cases of RA. The 1958 and 1987 criteria were highly correlated (r = 0.795). By the 1958 criteria, 48 cases (92.3%) had classical/definite RA while 40 cases (76.9%) satisfied the 1987 criteria traditional format. By the 1987 classification tree 50 cases (96.2%) belonged to the first three RA subsets while 2 cases (3.8%) belonged to the non-RA subsets. Comparing the clinicians opinion of the outcome with the statistical modelling of variables based on ARA criteria, we conclude that the clinicians opinion of the outcome is reflected by a combination of morning stiffness duration, number of swollen joints, erosion score on hand radiographs and erythrocyte sedimentation rate. We conclude that evaluation of ARA 1958 and 1987 criteria in individual cases has both diagnostic and prognostic significance. We propose a short questionnaire based on ARA criteria, for use in hospital out patient clinic for diagnosis of RA.