Conversion of clinically isolated syndrome to multiple sclerosis: a prospective multi-center study in Eastern India.

BACKGROUND: In White populations more than 60% of clinically isolated syndrome (CIS) convert to multiple sclerosis (MS) on a long-term follow-up; several predictors for conversion have been identified. OBJECTIVE: This study aimed to determine the conversion rate and the predictors of conversion from CIS to MS (McDonald 2010) among Indians. The other objective was to evaluate the diagnostic accuracy of the new McDonald 2017 criteria in prediction of a second clinical attack. METHODS: Clinical and demographic data of CIS cohorts were collected. Baseline investigations included cerebrospinal magnetic resonance imaging (MRI) with contrast and cerebrospinal fluid (CSF) testing for oligoclonal band (OCB). Follow-up clinical and MRI examinations were performed annually for at least 24 months. RESULTS: Of the 82 subjects (age range 15-58 years), 36 (43.9%) converted to MS; 31/82 (37.8%) converted in 24 months. The predictors for conversion were earlier age of onset, CSF-OCB, cerebral MRI T2 lesion count, and periventricular and juxtacortical location of lesions. Twenty-two (26.83%) CIS fulfilled the McDonald MS 2017 criteria at baseline. CONCLUSION: In this first prospective study of CIS in India, the risk factors for conversion are similar but the conversion rate to MS is lower than that in the western nations.

A comparative study of heart rate variability tests and lipid profile in healthy young adult males and females.

BACKGROUND: Coronary Heart Disease (CHD) is the leading cause of death in many developed countries. The relation between heart rate variability (HRV) and CHD was recently explored after the development of HRV techniques. Lower HRV was proven to be associated with a greater risk for developing hypertension among normotensive men, and hypertension is one of the major risk factors of CHD. Acute myocardial infarction is accompanied by decreased HRV, which is due to reduced vagal or increased sympathetic outflow to the heart. AIM: This study was designed to test the hypothesis of influence of gender and lipid profile difference on heart rate variability tests. MATERIALS AND METHODS: Thirty healthy adult male and thirty healthy adult female subjects in the age group of 18- 25 years without any addictions and gross systemic disease were selected. Heart rate variability tests during Valsalva maneuver, deep breathing and 30:15 R-R intervals ratio were carried and lipid profile of the subjects were analyzed. RESULTS: We found a decrease in values of HRV tests during the Valsalva maneuver, deep breathing in male individuals as compared with age- and Body Mass Index, BMI-matched females. VHeart Rate Variability tests during 30:15 R-R intervals Ratio in male individuals were significantly decreased as compared with females. Values of total cholesterol, Low Density Lipoprotein, LDL cholesterol were found to be significantly increased and High Density Lipoprotein, HDL cholesterol significantly decreased in males. CONCLUSION: Healthy adult males may be at a higher risk of developing acute myocardial infarction and CHD due to decreased HRV and atherogenic lipid profile. Lower level of serum estrogen may be the cause of this difference in HRV among males. The difference in HRV tests among males and females disappears after menopause.

Relation of microalbuminuria to glycosylated hemoglobin and duration of type 2 diabetes.

BACKGROUND: Nephropathy is one of the complications of type 2 diabetes mellitus that could lead to end-stage renal disease. Persistent microalbuminuria is the best predictor of high risk of developing diabetic nephropathy. The relation between HbA 1c and microalbuminuria with the duration of diabetes is not clear. OBJECTIVES: To determine microalbuminuria levels in type 2 diabetics and to correlate changes in microalbuminuria levels to glycosylated hemoglobin level and duration of diabetes. MATERIALS AND METHODS: Study was conducted at Medical College, Kolkata. Fifty both male and female type 2 diabetics of age groups 30-60 years, without any complications were taken as cases and 50 healthy (male and female) subjects of comparable age were taken as controls. Cases with anemia, any other diseases or person using drugs that could affect HbA 1c levels and microalbuminuria were excluded from the study. Fasting and postprandial blood glucose, HbA 1c serum urea and serum creatinine were analyzed. Urine was analyzed for microalbuminuria. The Statistical Software SPSS 15.0 were used for the analysis of the data. RESULTS: Urinary microalbumin, HbA 1c levels were significantly higher in the cases. Microalbumin levels were linearly correlated to the duration of diabetes and HbA 1c. CONCLUSIONS: Impaired glycemic control is associated with significant elevations in urinary microalbumin levels. Furthermore, there is an increased urinary microalbumin levels with increased duration of diabetes, which suggests that the detection of increased urinary microalbumin levels at the initial stage can avert, reduce the clinical and economic burden of diabetic complications in future.

Relation of iron stores to oxidative stress in type 2 diabetes.

BACKGROUND: Recent studies revealed elevated serum ferritin levels predict new-onset type 2 diabetes. Further studies proved ferritin to be an important and independent predictor of the development of diabetes. The link between hyperglycemia, enhanced free radical activity (oxidative stress) and serum iron and its stores (serum ferritin levels) levels is not clear. OBJECTIVES: The present study is an attempt to understand the relationship between serum ferritin levels and oxidative stress (measured by malondialdehyde). MATERIALS AND METHODS: The study comprised of 30 apparently healthy controls and 30 type 2 diabetic patients who attended the outpatient and inpatient departments of Medical College, Kolkata. Levels of fasting blood glucose, postprandial blood glucose, serum iron, serum ferritin, glycosylated hemoglobin (HbA1c) and malondialdehyde (MDA), serum urea and creatinine were estimated. The statistical software SPSS 11.0 and Systat 8.0 were used for the analysis of the data and Microsoft Word and Excel have been used to generate tables and graphs. RESULTS: Serum iron (82.16 ± 13.24 µg/dl), serum ferritin (224.53 ± 96.06 µg/L), HbA1c (8.62 ± 1.79%), MDA (2.66 ± 0.76 nmol/ml) levels were significantly higher in type 2 diabetics compared with apparently healthy controls. Elevations in serum iron, ferritin and HbA1c are accompanied by a parallel increase in blood glucose. Based on groups of glycemic control, i.e. HbA1c levels >8%, serum ferritin levels were highest, 258.63 ± 22.67 µg/dl. There is an inverse correlation of serum ferritin levels to MDA levels in the diabetic cases of longer duration of more than 10 years. CONCLUSION: Serum ferritin level in the present study is found to be higher in the newly diagnosed cases and lower in those patients suffering from diabetes for more than 10 years. This study probably suggests that serum ferritin can represent either as a pro-oxidant or as an antioxidant in a time-dependent manner.

Serology and immunoglobulin profile in rheumatoid arthritis.

One hundred and twenty cases of clinically diagnosed rheumatoid arthritis, 80 non-rheumatoid cases suffering from various other diseases and 40 healthy individuals were investigated for the presence of rheumatoid factor, quantitation of serum immunoglobulin, demonstration of ANA and LE cell phenomenon. Microlatex agglutination test of serum for rheumatoid factor showed 56.6% positivity in rheumatoid group and 3.7% positivity in non-rheumatoid group. All three serum immunoglobulins (IgG, IgM, IgA) were raised in serum in significant titre in cases of rheumatoid arthritis, whereas only IgA lever was elevated in the group of non-rheumatoid diseases. ANA and LE cell phenomenon were observed in 11.7% and 4.4% cases of rheumatoid arthritis who had severe underlying disease. In non-rheumatoid group, only one of 6 cases of systemic lupus erythematosus showed rheumatoid factor and that too in an insignificant titre (less than 1:20). Synovium and synovial fluid contained plenty of plasma cells and lymphocytes. It has been observed that RF appears first in synovial fluid and it may take several months to a year to attain detectable level in serum.

Transrectal fine needle aspiration cytology of granulomatous prostatitis.

Transrectal fine needle aspiration cytology by Franzen technique was carried out from January, 1985 till January, 1992 on 567 patients having prostatomegaly which were suspicious of malignancy by clinical per rectal examination. Granulomatous prostatitis was diagnosed in 56 cases. Analysis showed 34 cases were tuberculous prostatitis and 22 cases were nonspecific granulomatous prostatitis. Comparison of aspiration cytology with bacteriological study of the aspirated material and histopathology showed correct diagnosis of granulomatous prostatitis by fine needle aspiration. The findings indicate that transrectal fine needle aspiration cytology is a reliable procedure for diagnosis of granulomatous prostatitis which can clinically mimic prostatic malignancy when it presents as a diffuse or nodular enlargement with firm to hard consistency.

Neonatal candidemia.

Fifty five clinically diagnosed cases of neonatal septicaemia of the nursery ward, Medical College Hospital Calcutta were subjected to blood culture on two consecutive days in all cases. Bacterial isolates were found in 34 (61.8%) cases as pure growth and candida species from 9 (16.4%) as pure culture. Remaining 12 samples did not yield any growth. Species distribution of candida showed C. albicans 6, C. parapsilosis 2, and C. guillermondii 1. Asphyxia neonatorum was the common feature in all cases of candidaemia. All neonates with candidal infection were low-birth-weight and premature. C. albicans, the predominant species (66.6%) recovered, was responsible for a localised outbreak of infection in the nursery.

Transferable drug resistance in Salmonella senftenberg.

Six Salmonella senftenberg strains were isolated from blood samples of patients clinically diagnosed to be suffering from enteric fever during the recent outbreak of enteric fever in and around Calcutta. All of them were multidrug resistant including chloramphenicol. The minimum inhibitory concentration (MIC) of the drugs in which they were resistant, were well above the normal level. All these strains were sensitive to cephalexin, gentamicin, furazolidone and ciprofloxacin. The transferable drug resistance test suggested that the strains were carrying transferable drug resistant gene containing ACSTK resistant factor.

Fine needle aspiration cytology (FNAC) in the diagnosis of solid renal masses--a study of 92 cases.

Percutaneous fine needle aspiration cytology (FNAC) was employed as preoperative diagnosis in 92 solid renal masses from June, 1984 till December, 1990. Ultrasonography guided FNAC was employed in 26 lesions. There were 79 malignant tumours, 3 benign tumours, 6 lesions were inflammatory and only necrotic material was seen in 4 cases. Correlation with histopathology showed diagnostic accuracy of 91.3%. There were two false positive reports. No complication was encountered in this study.

Some prospective observations on recent outbreak of typhoid fever in West Bengal.

The present study was designed to study the clinical behaviour of a recent epidemic of typhoid fever in West Bengal. Of 46 cases studied, 67% (31) had chloramphenicol resistant typhoid fever. The chloramphenicol-resistant cases were comparatively severe in nature with higher complication and mortality rates. Salmonella typhi resistant to chloramphenicol were also resistant to ampicillin, cloxaxillin and cotrimoxazole. Strains of Salmonella typhi sensitive to chloramphenicol retained their sensitivity to these other antimicrobials.

The role of transrectal fine needle aspiration cytology in the diagnosis of prostatic nodules suspicious of malignancy--a study of 126 cases.

Transrectal fine needle aspiration cytology by Franzen technique was carried out in 126 patients having enlarged prostate which were suspicious of malignancy by clinical per rectal examination. Analysis showed benign adenoleiomyomatous hyperplasia in 40 cases, chronic prostatitis in 4 cases, tuberculosis of prostate in 4 cases, malignancy in 76 cases and 2 cases were reported as suspicious of malignancy. Comparison of aspiration cytology with histopathology, serial serum acid phosphatase estimation, repeat a spiration cytology after hormone therapy with or without orchiectomy and clinical follow up showed accuracy of cytologic diagnosis of 98.4 per cent. False negative was 1.6 per cent. There was no false positive diagnosis. No complication was encountered in this procedure.

ABO blood groups in relation to hepatitis-B surface antigen (Australia antigen).

The ABO blood groups and their relationship with Australia antigen (HBsAg) were studied in 500 blood donors and 76 patients. Most of the blood donors belonged to group 'B' while the Australia antigen (HBsAg) was prevalent in the blood group 'A' (9.30%). 76 patients clinically diagnosed as viral hepatitis showed a similar trend, having the highest percentage of HBsAg positivity in 'A' group (35.71%). In both, this was found statistically significant (P greater than 0.005). None of those with AB blood group showed HBsAg.

Incidence of Australia antigen in leprosy.

Ninety seven male patients attending the Leprosy clinic of the Dermatology Out-patients' Department were studied for the detection of Australia antigen. There was a 20% antigen positivity in patients suffering from Lepromatous Leprosy and 5.7% in the cases with Tuberculoid Leprosy. SGPT level was found to be significant in patients with Lepromatous Leprosy having Australia antigen as compared to other groups.