Reverse cardio-oncology: A budding concept.

Having established the significance of cardiovascular side-effects of anti-neoplastic drugs, present day cardio-oncology has forayed into newer territories buoyed by research into the multiple connections that exist between cardiovascular disease and cancer. An emerging concept of reverse cardio-oncology focuses on the heightened risk of cancer in patients with cardiovascular disease. Common mechanistics of cancer and heart failure (HF) like chronic inflammation and clonal haematopoesis as well as common predisposing factors like obesity and diabetes underline the relation between both cardiovascular disease and various cancers.This review discusses the potential magnitude of the problem, the underlying pathophysiological mechanisms and classification of this novel subject.

Rheumatoid Arthritis Co-relation with Anti-CCP Antibodies with special reference to its Prevalence in Asymptomatic First-Degree Relatives.

Objectives: Rheumatoid Arthritis (RA) is a chronic inflammatory autoimmune disease. First-degree relatives (FDR) of patients with RA sharing genetic and environmental risk factors for RA may represent a pre-RA state. This study showed the clinical co-relation of RA with Anti-Cyclic citrullinated peptide (anti-CCP) antibody and prevalence of sero-positive anti-CCP antibody in asymptomatic first-degree relatives (AFDR) of rheumatoid arthritis patients. Methods: Total 85 RA patients, 105 AFDR, and 105 healthy controls who belonged to the same geographical area having no family history of autoimmune diseases were enrolled in this cross-sectional study. RA patients were clinically examined, and DAS-28 was calculated. Anti-CCP was sent for RA patients, AFDR, and control group. Appropriate statistical tools were applied to find if any significant co-relation exists. Results: DAS 28 co-related significantly with anti-CCP positivity (p≤0.01) but not with Rheumatoid Factor (RF). No significant co-relation was observed between anti-CCP and extra-articular manifestation (EAM) (p≥0.05). Seropositivity for anti-CCP antibody was detected in 22/105 (20.9%) AFDR and in 13/105 (12.3%) control group respectively. Anti-CCP antibody seropositivity was more prevalent in AFDR than in control group but the difference was not statistically significant (p = 0.1378). Conclusions: Anti-CCP should be preferred over RF as it correlated well with disease activity, but it does not guide well for the EAM. The higher sero-prevalence of Anti-CCP in AFDR may lead to higher risk of development of RA in near future. Thus, all AFDR should be screened so that we may follow up the positive cases for early detection and treatment of RA.

Quality of life among HIV-tuberculosis co-infected patients.

BACKGROUND: India is the world's third leading country in terms of people living with human deficiency virus (HIV) (2.1 million) with 0.4 million deaths due to HIV-associated tuberculosis (TB). Physical and mental stress degrades the quality of life (QOL) in these patients. Studies have been done in HIV patients but very few on HIV-TB co-infected patients. Our study aims at assessing and comparing the QOL in HIV patients with and without TB. MATERIALS AND METHODS: It was a cross-sectional study done at Antiretroviral Treatment Center of KMC, Mangalore and District Wenlock Hospital, Mangalore, over 6 months. A sample size was 104. Semi-structured questionnaire to collect clinico-demographic data, World Health Organization QOL (WHOQOL)-HIV BREF to assess the QoL, and Beck's Depression Inventory Scale (Physical health, psychological well-being, social relationship, environmental health, level of independence, and spiritual health) to identify depression were used. The Cronbach's alpha was used to measure the internal consistency for each domain of the WHOQOL-HIV instrument. RESULTS: HIV-TB co-infected patients had a lower mean score in all domains as compare to only HIV patients, suggesting that HIV-TB co-infected patients had a poor QOL (P < 0.05). Internal consistency of each domain was good (α >0.7). CONCLUSION: To improve the QOL in HIV patients, it is important to identify the determinants of QOL and work toward its improvement.

An atypical initial presentation of AIDS as cryptococcal lymphadenitis.

A patient complained of fever on and off, difficulty in swallowing and cough (with scanty expectoration) since one and a half months and weight loss over 2 months. On examination, pallor was found to be present. Then ultrasonography of abdomen was done and it showed mesenteric and retroperitoneal lymphadenopathy. Sputum for acid-fast Bacilli was examined and found to be negative but despite this, based on the epidemiological data, antitubercular therapy (ATT) was started but after 2 weeks no clinical improvement was found. Then, fine-needle aspiration cytology of lymph node was done and it resulted in the presence of cryptococcal lymphadenitis as the final report. Antifungal therapy was initiated with amphotericin B followed by fluconazole and there was clinical improvement. Ultrasonographical findings also supported it. Though it is a rare case (but not impossible) that cryptococcus is the cause of lymphadenopathy. Thus, in initial presentation of acquired immuno deficiency syndrome it should always be kept in mind that such cases may happen. In India, presuming Mycobacterium tuberculosis as the leading cause exposes the patient to unwanted hepatic and renal toxicity of ATT.

Is There a Preventive Role for Vernix Caseosa?: An Invitro Study.

BACKGROUND: Vernix caseosa is a naturally occurring substance covering the skin of the newborn babies. Chemical composition of Vernix caseosa has been studied. But the antibacterial properties have not been explored phenotypically. There has been only a few studies related to the properties of Vernix caseosa (VC) and most of them focused on deciphering the chemical nature of VC. These studies found that VC has enzymes such as lysozyme, cathelicidin, lactoferrin, defencins, etc, but no study has proved their presence phenotypically. AIM: To know the anti-bacterial and mechanical barrier properties of VC. MATERIALS AND METHODS: A cross-sectional study done at Government Lady Goshen Hospital, Mangalore, India. Subjects- 63 healthy infants born by LSCS (Lower Segment Caesaren Section) (Confidence interval- 95%, Power- 90%). In lab, sterility of Vernix caseosa was determined. Lawn culture of S.aureus and E.coli on nutrient agar was done and wells were made in it. Vernix broth was prepared using Tween 80 and was put into the well. It was incubated overnight at 37°C and observed for area of Decreased Bacterial Growth (DBG) around the well. Filter papers impregnated with VC were used for testing for mechanical barrier properties. STATISTICAL ANALYSIS: Data was entered in SPSS 12.0 version and analysed. The zone of inhibition (in mm) in case of bacterial growth was expressed as mean with standard deviation. Student's independent t-test was used to compare the means across the groups (males and females). RESULTS: There was no significant difference in the anti-bacterial property based on gender. DBG {mean (SD)} for E.coli and S.aureus was 18.06 mm (1.56) and 13.34 mm (1.94) respectively (p-value <0.000). Result for mechanical barrier was inconclusive due to limitations explained in the article. CONCLUSION: Vernix caseosa has antibacterial properties. But further studies are needed to explore the mechanical barrier properties against bacteria.

Evaluation of adverse drug reactions in HIV positive patients in a tertiary care hospital.

CONTEXT: The advancement and development of new drugs and treatment strategies increase the risk of unusual Adverse Events (AEs) in HIV patients. AIMS: The objective of our study was to assess the incidence, types and nature of AEs in HIV positive subjects. SETTINGS AND DESIGN: Patients with WHO stage IV disease irrespective of the CD4 cell count, or WHO stage III disease with a CD4 cell count <350 cell/cu. Mm, or, WHO stage I or II disease with a CD4 cell count of <200 cells/cu. mm, and on prior anti-retroviral therapy for not more than six months preceding the observation date, were included in the study. After initiation of therapy, the patients were examined for the occurrence any adverse events including the type and severity, or any other abnormal laboratory findings. Causality assessment of the adverse events was done using the Naranjo's scale. RESULTS: Out of 327 patients studied prospectively, 43 patients developed AEs. Out of these, 23 (53.5%) were males and 20 (46.5%) were females. A total of 53 (16.21%) AEs were reported. Antitubercular drugs caused the maximum AEs (28.3%) followed by zidovudine (20.7%), nevirapine (15.0%) and efavirenz (5.6%). Stavudine, ethambutol, sulfamethoxazole and trimethoprim, and atazanavir were also responsible for 3.7% of AEs individually. Causality assessment done according to the Naranjo's scale revealed that 66.04% AEs were 'probable' and 33.96% were 'possible'. CONCLUSIONS: Anemia, hepatitis and dermatological adverse effects are the most common AEs. Antitubercular drugs contributed significantly for the incidence of AEs in these patients. Frequency of AEs was slightly more in males compared to females.