Impact of baseline fluorescent antinuclear antibody positivity on the clinical outcome of patients with primary autoimmune hemolytic anemia

Abstract Introduction Autoimmune haemolytic anaemia (AIHA) is an autoimmune disorder that can present in primary or secondary forms. The literature looking at impact of baseline fluorescent antinuclear antibody (FANA) positivity on outcomes of AIHA patients is infrequent. Objective To study the impact of baseline FANA positivity in patients with primary AIHA. Method A prospective cohort study involving 29 consecutive primary AIHA patients presenting to the Haematology department from 2013 to 2015 was analysed. After recording baseline investigations including fluorescent ANA, all patients were treated as per the standard therapeutic protocols. Clinical remission, disease free survival, relapse, mortality were compared between the FANA positive and FANA Negative AIHA groups. Results Baseline FANA positivity was found in 17 patients (58.62%). Both the groups were comparable in terms of age, sex, Hemoglobin, LDH at presentation, number of lines of treatment needed and duration of follow up. Evan's syndrome was seen in six of FANA positive patients which was statistically significant (0 v/s 6, p= 0.023). FANA positive patients had significantly higher rates of relapse per patient month follow up (1.22 v/s 3.57, p= 0.023) and lower rates of complete response (83.33% v/s 35.29%, p= 0.0118) and relapse free survival at five years. Morbidity and mortality were numerically higher in FANA positive patients. Conclusion Baseline FANA positivity among AIHA patients was found to be associated with lower complete response rates and higher relapse rates with possible higher rates of morbidity. Presence of FANA will give us prognostic value and help us in deciding the treatment options.

Effect of High Normal Thyroid Stimulating Hormone Levels on Lipid Parameters in Non-diabetic Subjects.

Aim: To investigate relationship between serum TSH and lipid parameters in subjects with different levels of TSH. Study Design: Cross-sectional study. Place and Duration of Study: Clinical Biochemistry Department of Kasturba Medical College, Hospital Mangalore, between January 2014 to June 2014. Methodology: 348 subjects were screened of which 194 were selected. Lipid parameters, TSH, T3, T4 and glycemic status were determined. Association between TSH and serum lipids were studied by categorizing subjects into three groups based on their thyroid status. Group 1 [TSH= 0.27-2.5 mIU/L], Group 2 [TSH= 2.6-4.12 mIU/L] and Group 3 [TSH= 4.13-9.9mIU/L].Statistical analysis was performed by ANOVA followed by Tukey’s multiple comparison test. The relationships between TSH and different parameters were evaluated by Pearson’s correlation analysis. Results: TSH showed a significant positive linear correlation with total cholesterol (r=0.288; P = 0.001), Triglycerides (r=0.129; P=0.016), LDL cholesterol (r=0.305; P =0.001) and negative correlation with HDL (r = - 0.129; P=0.750). Increasing TSH showed a consistent linear association with altered lipids quite evident from the uppermost part of the reference range that is considered clinically normal and there on. Conclusion: A subtle variations of TSH alone in clinically normal thyroid state can alter serum lipids and hence asserts the role of TSH in maintaining lipid homeostasis.

Factors Correlating with Severity of Coronary Artery Disease in Type 2 Diabetic Patients on Treatment for More Than 5 Years.

Aims: To evaluate the correlation between insulin resistance and other conventional risk factors with respect to severity of coronary artery disease (CAD) in patients with more than 5 years of treatment for type 2 diabetes mellitus. Study Design: Cross-sectional study. Place and Duration of Study: Department of Medicine and Department of Cardiology, Kasturba Medical College, Hospital Mangalore, between February 2013 and December 2013. Methodology: 61 people with more than 5 years of type 2 diabetes who underwent Original Research Article British Journal of Medicine & Medical Research, 4(26): 4364-4372, 2014 4365 coronary angiogram for the evaluation of CAD were recruited in this study. Insulin resistance (HOMA-IR), anthropometric and biochemical parameters were determined, and was correlated with severity of CAD which was assessed by syntax score. Results: There was significant positive linear correlation between log HOMA-IR and syntax score in people with more than 5 years of type 2 diabetes [r=0.605 (95%CI 0.417–0.744), P<0.001]. The correlation of syntax score with other known risk factors of CAD was not significant. Further multivariate analysis after adjusting for conventional risk factors showed a significant association of Log-IR with severity of CAD in people with type 2 diabetes mellitus of more than 5 years of duration (β=0.667, P<0.001) Conclusion: In type 2 diabetes mellitus with treatment more than 5 years of duration, high HOMA-IR appears to be a good indicator of severity of CAD in Type 2 diabetes mellitus and might be a marker of severity of disease, thus helping us in identifying high risk type 2 diabetes mellitus subjects.