Oral Zinc Supplementation for Reducing Mortality in Probable Neonatal Sepsis: A Double Blind Randomized Placebo Controlled Trial.

Objective: To study the role of Zinc in the treatment of neonatal sepsis. Design: Double blind, randomized, placebo controlled trial. Setting: Tertiary Care Hospital. Participants: 614 neonates with probable neonatal sepsis. Intervention: The drug group (n=307) received 1mg/kg/day of elemental zinc, and placebo group (n=307) received the placebo, in addition to antibiotic therapy and supportive care, till the final outcome (discharge/death). Outcome Measures: Decrease in mortality rates (primary outcome), duration of hospital stay and need of higher lines of antibiotic therapy (secondary outcomes) were tested. Results: Baseline characteristics of the two groups were similar. No statistically significant differences between drug and placebo group were found in mortality rate (9.77% vs 7.81 %; P=0.393), mean duration of hospital stay (142.85±69.41 hrs, vs. 147.99±73.13 hrs; P=0.841), and requirement of higher lines of antibiotic therapy (13.35% vs 12.05%, P=0.628) after supplementation. Conclusions: This study does not report decrease in mortality rates, duration of hospital stay and requirement of higher lines of antibiotic therapy following zinc supplementation in neonatal sepsis.

In vitro high frequency regeneration of plantlets of Vigna mungo and their ex vitro growth.

Of the five explants of V. mungo var. T9 used, the excised shoot tips gave best response with regard to offshoot formation followed by the embryonal axis explants. While a treatment comprising 0.5 mgL(-1) BAP, 0.5 mgL(-1) 2iP and 0.1 mgL(-1) NAA induced differentiation of an average 10 offshoots in shoot tip explants, only 3 offshoots were formed in the explants of embryonal axis in a treatment containing 0.5 mgL(-1) BAP and 0.1 mgL(-1) NAA, found optimum for them. Multiple shoots differentiated when explants with earlier regenerated and growing offshoots were first cultured in a treatment containing 0.1 mgL(-1) BAP, 0.25 mgL(-1) IAA and 5 mgL(-1) CCC and then subcultured in the same treatment but having only 1 mgL(-1) CCC. The isolated shoots rooted in 0.5 mgL(-1) IAA resulted in the formation of complete plantlets of an average height of 15 cm in 20 days. The in vitro-regenerated plants grew normally under field conditions and came to flowering as well.

Effect of potash alum (aluminium potassium sulphate) on human semen and sperm.

25 normal and healthy human volunteers were engaged in this investigation. The different concentration of potash alum solution have different effects on sperm, motility/death and fructose level of the semen. Higher concentration have higher effects.

Effect of D-penicillamine on lymphocyte subsets: correlation with clinical response in rheumatoid arthritis.

We studied the effects of D-penicillamine (DP) on the clinical response, immunoinflammatory parameters and the lymphocyte subsets in 46 patients with rheumatoid arthritis (RA). Patients were evaluated before the start of the drug and then at 3 and 9 months during the follow up. 38 of 46 (82.6%) patients could continue DP treatment for over 9 months, while in 8 the drug was withdrawn due to adverse effects. Improvement in the various disease activity indices of more than 50% (responders) was seen in 25 of 38 (65.8%) patients. Responders showed a significant decrease in the serum IgA and IgM at 9 months, and in IgM only at 3 months. The serum levels of C3 and C4 did not show any significant change. Serum levels of C-reactive protein and rheumatoid factor (RF) showed a significant decrease at 3 and 9 months. A significant decrease in CD3+ and CD4+ lymphocytes along with a fall in CD4+/CD8+ lymphocyte ratio was also seen in responders at 3 and 9 months, compared to the baseline. Our results suggest that DP may have immunomodulatory action in RA.

Methotrexate: clinical and immunological effects in refractory rheumatoid arthritis.

Thirty five patients with refractory rheumatoid arthritis were given 7.5 mg of methotrexate (Mtx) every week. Eleven patients had to discontinue treatment either because of adverse effects or unresponsiveness. Twenty four patients showed clinical response and significant improvement in ESR and they continued Mtx for a mean of 25.24 months. Seven patients achieved clinical remission as defined by ARA criteria. Immunological parameeters including IgG, IgM, IgA, lymphocyte subsets (CD3+, CD4+, CD8+ and B), C3 and C4 however, did not show any change during this treatment in any of the groups upto 6 months. There was a significant fall in the erythrocyte sedimentation rate (ESR), c-reactive protein (CRP) and rheumatoid factor (RF) levels in responders only.

Intermittent intravenous pulse cyclophosphamide treatment in systemic lupus erythematosus.

To determine the efficacy and safety of intermittent intravenous pulse cyclophosphamide in patients of severe systemic lupus erythematosus (SLE), 50 patients having severe/refractory lupus nephritis, vasculitis or neuropsychiatric manifestations were treated with 3 weekly pulses of cyclophosphamide for 6 such pulses. This treatment was found to be associated with significant and sustained improvement during a 2 yr follow up with respect to the mean renal activity score, individual renal parameters (proteinuria, erythrocyturia, and serum creatinine levels), focal neurological manifestations, vasculitic lesions, antinuclear antibody titers, complement component C3, anti-dsDNA antibodies levels and ESR. There was a sustained decrease in the overall mean disease activity score, and the mean daily dose of prednisolone (pretreatment 32.62 mg daily to 3.75 mg daily after 24 months). There was a significant decline in the percentage and absolute B cell count after 7, 14 and 21 days of this treatment. Effect on other lymphocyte subsets (CD3+, CD4+ and CD8+) was not marked. Pulse cyclophosphamide could therefore be an effective and less toxic form of treatment in patients with SLE having severe lupus nephritis, focal neurological lesions or vasculitis.

Pathogenesis of peptic ulcer in rheumatoid arthritis.

To assess the pathogenesis of the gastro-duodenal mucosal lesions in rheumatoid arthritis, 36 patients, consisting of 23 (group I) receiving non-steroidal anti-inflammatory drugs (NSAIDs) and 13 (group II) on alternative forms of treatment, were examined by fibreoptic upper gastrointestinal endoscopy. Ten (43%) of 23 patients receiving NSAIDs showed mucosal damage in the form of erosions or a definite ulcer crater, compared to only one (8%) of 13 in group II (p less than 0.05). There was no correlation between the duration of illness and the incidence of mucosal lesions. These findings indicate that the high incidence of gastroduodenal mucosal abnormalities seen in rheumatoid arthritis is related to the use of NSAIDs and not to the underlying disease process.

Clinical significance of anti-Sm antibody in systemic lupus erythematosus & related disorders.

A retrospective analysis was undertaken of the clinical and immunological profile of 33 anti-Sm antibody positive (group I) and 243 anti-Sm antibody negative (group II) patients with systemic connective tissue diseases including systemic lupus erythematosus and related disorders (overlap, mixed and undifferentiated connective tissue diseases). The disease patterns were comparable, except for cutaneous vasculitis and hypocomplementaemia (low serum C3 levels). Vasculitis was observed in 55 per cent of group I and 35 per cent of group II subjects (P less than 0.05). Hypocomplementemia was also detected more frequently (86%) in group I as compared to group II (66%) patients (P less than 0.05). No association was found between anti-Sm antibody and renal, neuropsychiatric and cardiopulmonary features. The study thus demonstrated the association of anti-Sm antibody with immune complex mediated vasculitis.

Occurrence of systemic autoimmune disorders & autoantibodies in house-hold contacts of patients with systemic lupus erythematosus.

Household contacts of 22 randomly selected patients with systemic lupus erythematosus (SLE) were screened for autoimmune diseases and autoantibodies. Thirty nine consanguineous and 17 nonconsanguineous household contacts were studied. In the first group symptomatic SLE was seen in 5 per cent, rheumatoid arthritis in 2.5 per cent, antinuclear antibody (ANA) in 10 per cent and rheumatoid factor (RF) in 5 per cent while anti-dsDNA, anti-nRNP and anti-Sm antibodies were not detected in any individual. The second group showed total absence of any marker of autoimmunity. In normal controls only RF was detected in 3 per cent. The occurrence of markers of autoimmunity only in consanguineous household contacts of patients with SLE further confirms the recognised role of genetic factors in the etiology of SLE.

Effect of high dose intravenous pulse dexamethasone on lymphocyte phenotypes.

The lymphocyte phenotypes were enumerated in 10 patients with collagen diseases at 0 h, 4 h, 24 h and 7 days after a megadose (100 mg) iv pulse dexamethasone. A significant decrease in CD3 (from a mean of 2324.3/mm3 to 705.9/mm3) and CD4 (from a mean of 1642.6 to 317.6/mm3) cells was observed at 4 h, which recovered partially by 24 h (186.7 and 1226.3/mm3 respectively) and completely at 7 days (2496.1 and 1838.4/mm3). A transient decrease in CD8 cells at 4 h was also observed. There was no significant effect on B cells.

Clinical and laboratory profile of systemic sclerosis in northern India.

The clinical and laboratory features of 87 patients with systemic sclerosis (SSc) are described. A large majority of patients presented with diffuse disease with extensive ulcerations and digital resorption. No case of CREST syndrome was seen. The pattern of systemic involvement was generally similar to that reported in the Western literature. Renal involvement appeared to be less aggressive and chronic in its course. A possible aetiology was identified in three patients.

Pure red cell aplasia with rheumatoid arthritis. A case report and review of literature.

Pure red cell aplasia (PRCA) is an extremely uncommon treatable manifestation of rheumatoid arthritis. Here we describe a case of long standing rheumatoid arthritis with severe refractory anaemia, which was proven to be due to PRCA.

Antibodies to extractable nuclear antigens in connective tissue disorders in India: prevalence and clinical correlations.

Antibodies to Extractable Nuclear Antigens (ENAs) namely Sm, nRNP, SS-A and SS-B were studied in 397 patients with various connective tissue diseases (CTD), 146 patients with inflammatory polyarthropathies, 16 cases of systemic vasculitides, and 39 normal subjects using counterimmunoelectrophoresis and double immunodiffusion methods. Anti-ENA antibodies were positive in 40.8 percent cases of Systematic lupus erythematosus (SLE) (n = 191), 36.4 percent of overlap CTD (OCTD, n = 44), 27.8 percent of Sjogren's syndrome (n = 18), 10.6 percent of progressive systemic sclerosis (PSS, n = 66) and 2.7 percent of rheumatoid arthritis (n = 111) patients. The correlation of these antibodies with disease features was done. The significant finding was negative association of anti-nRNP antibodies (when present alone) with renal involvement. Anti-Sm antibodies did not correlate with any disease feature. The other associations included correlation of anti-nRNP with pulmonary parenchymal lesions, anti-SS-A with serositis and pulmonary hypertension, and anti-SS-B with myocarditis and recurrent diarrhoea. We conclude that Anti-ENAs may correlate with certain subsets of these diseases but the subject is controversial.

Coagulation abnormalities in systemic lupus erythematosus.

Coagulation profile was studied in 55 patients of systemic lupus erythematosus (SLE). Abnormal kaolin clotting time (KCT) was observed in fewer patients (12.9%) as compared to abnormal Russel's viper venom time (RVVT, 20.4%) or activated partial thromboplastin time (APTT, 32.7%). Prolonged prothrombin time (PT), observed in 7.3 per cent patients was not found to be a sensitive test for lupus anticoagulant (LAC). The correction of RVVT and KCT on addition of inosithin suggested a deficiency of platelet lipid factor in these patients. The initial value of uncorrected KCT in patient's plasma did not correlate with the amount of inosithin required for neutralisation. Occurrence of thromboembolic events was significantly associated with prolonged KCT. No other clinical feature showed significant association with any coagulation abnormality.

Massive lower gastrointestinal bleeding as a presenting feature of Behcet's disease.

This reports a 27 yr old female Patient with seronegative polyarthritis who presented with lower GI bleeding and subsequently developed evidence of cutaneous vasculitis (palpable purpura) and orogenital ulcers. The cause of the GI bleeding was multiple ulcerations in the terminal ileum, cecum ascending colon and transverse colon. Continued and massive bleeding necessitated surgical resection of the involved segment of gut which on histopathological examination confirmed the presence of vasculities. This patient was thus diagnosed as having Behcet's disease. Although major GI bleeding is a rare manifestation of Behcet's disease with vasculitis of the gut, one must consider this possibility if the patient has multi-system involvement with evidence of vasculitis involving the skin in the form of palpable purpura.