Risk of tuberculosis with anti-tumor necrosis factor-alpha therapy in patients with psoriasis and psoriatic arthritis in Indian population.

Anti-tumor necrosis factor-alpha (TNF-α) immunotherapy has revolutionized the treatment of inflammatory diseases, such as psoriasis and psoriatic arthritis. However, a major concern is that patients receiving this therapy have an increased risk of infection, particularly of reactivation of latent tuberculosis (TB). There were an estimated 10.4 million new cases of tuberculosis in 2016, worldwide, and India has one of the largest TB case burden with an estimated incidence of 2.79 million cases of TB in the same year. Anti-TNF agents like etanercept and infliximab are available in India approved for psoriasis and psoriatic arthritis. But long-term use of these agents possesses a risk of reactivation of latent TB. In this review article, we assessed the risk of TB with anti-TNF therapy especially in patients with psoriasis and psoriatic arthritis in India. At the end of the article, we have also suggested a recommendation for screening of latent tuberculosis and its management, before starting anti-TNF-α therapy.

Trinuclear heterometallic Cu(II)-Mn(II) complexes of a salen type Schiff base ligand: anion dependent variation of phenoxido bridging angles and magnetic coupling.

Five new trinuclear heterometallic Cu(II)-Mn(II) complexes [(CuL)2Mn(O2CPh)2] (1), [(CuL)2Mn(N3)2] (2), [(CuL)2Mn(NCO)2] (3), [(CuL)2Mn(NO3)2] (4) and [(CuL)2Mn(Sal)2]·CH2Cl2 (5) have been synthesized with the di-Schiff base ligand H2L (where H2L = N,N'-bis(salicylidene)-1,3-propanediamine and Sal = salicylate). These complexes with different anionic co-ligands have been synthesized to attain a large variation in phenoxido bridging angles and to investigate its consequence on magnetic properties. Single crystal X-ray diffraction analyses reveal that complexes 1, 2, 4 and 5 are linear, whereas 3 has an angular geometry. Variable temperature magnetic susceptibility measurements suggest that all five complexes possess an overall antiferromagnetic interaction between Cu(II) and Mn(II) ions, which results in a final ferrimagnetic ground state with spin 3/2 in the Cu(II)-Mn(II)-Cu(II) trinuclear structure. The weakest antiferromagnetic interaction (J(Cu-Mn) = -7.0 cm(-1)) is observed for 2 having the lowest value of the Cu-O-Mn angle (92.0°), while the strongest antiferromagnetic interaction (J(Cu-Mn) = -26.5 cm(-1)) is observed for 3 having the largest Cu-O-Mn angle (101.4°). Complexes 1, 4 and 5 show average Cu-O-Mn angles of 98.2°, 97.6° and 97.7°, respectively, that lead to intermediate antiferromagnetic interactions (J(Cu-Mn) = -9.6, -9.7, -9.3 cm(-1) respectively).

Evaluation of chronic arsenic poisoning due to consumption of contaminated ground water in West Bengal, India.

BACKGROUND: Chronic arsenic poisoning is an important public health problem and most notable in West Bengal and Bangladesh. In this study different systemic manifestations in chronic arsenic poisoning were evaluated. METHODS: A nonrandomized, controlled, cross-sectional, observational study was carried out in Arsenic Clinic, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, over a period of 1 year 4 months. Seventy-three cases diagnosed clinically, consuming water containing arsenic ≥50 µg/L and having hair and nail arsenic level >0.6 µg/L, were included. Special investigations included routine parameters and organ-specific tests. Arsenic levels in the drinking water, hair, and nail were measured in all. Twenty-five nonsmoker healthy controls were evaluated. RESULTS: Murshidabad and districts adjacent to Kolkata, West Bengal, were mostly affected. Middle-aged males were the common sufferers. Skin involvement was the commonest manifestation (100%), followed by hepatomegaly [23 (31.5%)] with or without transaminitis [7 (9.58%)]/portal hypertension [9 (12.33%)]. Restrictive abnormality in spirometry [11 (15.06%)], bronchiectasis [4 (5.47%)], interstitial fibrosis [2 (2.73%)], bronchogenic carcinoma [2 (2.73%)], oromucosal plaque [7 (9.58%)], nail hypertrophy [10 (13.69%)], alopecia [8 (10.95%)], neuropathy [5 (6.84%)], and Electrocardiography abnormalities [5 (6.84%)] were also observed. CONCLUSIONS: Mucocutaneous and nail lesions, hepatomegaly, and restrictive change in spirometry were the common and significant findings. Other manifestations were characteristic but insignificant.

Evaluation of respiratory manifestations in systemic lupus erythematosus with special reference to pulmonary interstitial involvement.

Different respiratory manifestations in systemic lupus erythematosus (SLE) are not uncommon. We lack sufficient Indian data in this regard. Forty diagnosed cases of SLE were evaluated, to find out the prevalence of respiratory manifestations in SLE, as also to correlate the findings as observed by different diagnostic methods. It was a single centre cross-sectional observational study conducted at rheumatology clinic, IPGME&R, Kolkata. Patients suffering from chronic airways obstruction, upper airway diseases, left ventricular failure and lung cancer were all excluded from the study. After clinical evaluation and routine testing of organ specific parameters, patients underwent spirometry and chest x-ray in all cases and pleural fluid study, pleural biopsy and high resolution CT scan of thorax selectively as required. Mean age at presentation was 26.8 years and female to male ratio was 39:1. Commonest respiratory symptom was dyspnoea and commonest respiratory manifestation was pleural effusion. Pleural effusion was bilateral in 80% of cases. Interstitial lung disease (ILD) was found in 10% of cases presented either subacutely or chronically. High resonance CT was found to be more sensitive to diagnose ILD, as in 50% of ILDs diagnosed by scan, chest x-rays were normal. Pleuropulmonary infections (7.5%) were next most common manifestation and tuberculosis was found to be the commonest cause. Lupus pneumonitis was found in one only (2.5%). Screening lung function test as done by spirometry, could pick up some abnormality in 50% cases and restrictive change was the major abnormality (47%). None showed evidence of bronchial hyper-responsiveness. No case was detected to have neuromuscular disease, acute respiratory distress syndrome or pulmonary thrombo-embolism. All the respiratory manifestations as noted appeared in variable period after the onset of SLE.

Prevalence of malnutrition and its correlation with various diseases in elderly patients in a tertiary care centre in eastern India.

Geriatric population is growing very fast but they do not receive due attention from the family members as well as in the society. So incidence of malnutrition is likely to be very high in them. This fact prompted us to evaluate nutritional status in this group of population. In this study persons more than 60 years were included. A total of 76 patients, both inpatients and outpatients, in a tertiary care centre were studied. Their ages ranged from 60-84 years. Their nutritional status were assessed clinically by body mass index (BMI), triceps skin fold thickness, waist-hip ratio (WHR), mid-arm muscle circumference (MAMC) and from investigational parameters like blood for total and differential counts, ESR, serum for albumin, sugar, urea, creatinine, cholesterol and routine urine examination. According to BMI, undernutrition was found approximately in a quarter of all the elderly under study while overnutrition which includes both overweight (BMI 25-29.9 kg/m2 of body surface area) and obesity (BMI > or = 30 kg/ m2 of body surface area) was found in only 14.5% of patients. Central obesity as per WHR was strikingly high in females (85%) compared to males.

Bacterial incidence and antibiotic sensitivity pattern in moderate and severe infections in hospitalised patients.

Infectious diseases are among the leading causes of death and sometimes curable. Bacteria are the most common aetiology in hospitalised patients. Objectives of this study were to evaluate the incidence of bacterial infections and their pattern of susceptibility to antibiotics in moderate and severe infections in hospitalised patients. The study was performed in the apical teaching hospital of West Bengal in the first half of 2005. Patients admitted in medical wards and medical ICU, suffering from moderate and severe infections having APACHE-II score > 5 were studied. Clinical evaluation, routine and specific investigations were done in each case. Microbiological samplings were tried on day 1, after completion of antibiotic therapy and in between as required. Aerobic BACTEC bacterial culture and sensitivity tests were done. Pending initial culture and sensitivity report empiric antibiotic therapy was started, which was modified on getting the culture and sensitivity report. Outcome was observed as no response, cured, resolved, inconclusive, died and left against medical advice. Out of 40 patients total number of samples were 54 and that of sites of infections were 48. Primary site could not be detected in 11 infections (22.9%). Commonest form was urinary tract infection and abdominal infection in community acquired infection (n=18) and pneumonia in hospital acquired infection (n = 15). Culture was positive in 33 (61.11%), Gram-negative infection was more common in general, but incidence of Gram-positive infection was also quite high and Gram-positive infection was more common in community acquired infection. In general S aureus was most common bacteria -8 (24.24%). In community acquired infection S aureus 4 (22.22%) predominated followed by E coli and in hospital acquired infection S aureus -4 (26.66%) followed by E coli and P aeruginosa. Incidence of methicillin resistant Staph aureus was low. But it constituted 50% of S aureus. No methicillin resistant Staph aureus was found in community acquired infection. Two isolates of vancomycin intermediate sensitive Staph aureus were observed. Methicillin resistant Staph aureus showed maximum sensitivity to linezolid (100%) and all methicillin resistant Staph aureus but one vancomycin intermediate sensitive Staph aureus were sensitive to vancomycin. Coagulase negative Staph aureus were all sensitive to vancomycin and linezolid. Gram-negatives were mostly resistant to aminoglycosides and P aeruginosa were all sensitive to aztreonam. Single strain of S typhi as isolated was resistant to ceftriaxone and ciprofloxacin. P miribalis, P aeruginosa and coagulase negative Staph aureus were notoriously multidrug resistant; 82.5% of cases responded to treatment of which 35% were cured microbiologically. Gram-negative infection was more common overall, but incidence of Gram-positive infection was also very high. Gram-negative infections were responsible for more severe infections and case fatality. Multidrug resistant Gram-positive infections are rising.

A study on endocrine changes in patients in intensive care unit.

Pattern of endocrine changes in moderate to severely ill patients in a medical intensive care unit, correlation with the severity of illness and whether these changes can predict outcome of the critically ill patients were evaluated and studied in 80 patients admitted with acute physiology and chronic health evaluation (APACHE) II score >10 and without any pre-existing endocrinopathies or on drugs likely to affect the endocrine axis. Adrenal insufficiency was present in 45%, and mortality was higher in those with lower (<15 microg/dl) and higher (>30 microg/dl) serum cortisol. Sick euthyroid syndrome was detected in 80%, and those with low mean T3 (<0.6 ng/ml), free T4 (<0.89 ng/dl) and total T4 (<4 microg/dl) and had increased mortality. Hypotestosteronaemia was found in 92% of men and was significantly associated with severity of illness in men. Though prolactin is the first hormone to be elevated, there was no correlation between prolactin and severity of illness or mortality.