Exploring the Role of Th10 Cells and IL-10 in Systemic Lupus Erythematosus.

INTRODUCTION: Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by autoantibody production and immune complex deposition in various organs. The pathogenesis of SLE is multifactorial, involving genetic, hormonal, environmental, and immune factors. Interleukin-10 (IL-10) is a pleiotropic cytokine produced by various immune cells and has conflicting roles in inflammation. MATERIALS AND METHODS: This is a cross-sectional study involving 56 SLE patients and 30 healthy controls. RESULTS AND ANALYSIS: We found a significant increase in T helper 10 (Th10) cells and IL-10 levels in SLE patients compared to controls. Disease activity, measured by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score, correlated positively with Th10 cells and IL-10 levels. Further analysis categorized patients into active and inactive SLE, showing significant differences in laboratory parameters, including C3, C4, Th10 cells, and IL-10, between the two groups. Notably, Th10 cells and IL-10 exhibited a significant positive correlation with SLEDAI scores. The study also explored SLE patients with and without nephritis, a severe manifestation of the disease. Th10 cell expression was significantly higher in nephritis patients, while IL-10 levels did not differ significantly between the two groups. CONCLUSION: In conclusion, this study provides valuable insights into the association between Th10 cells, IL-10, and disease activity in SLE. The findings suggest that Th10 cells and IL-10 could serve as potential biomarkers for disease activity in SLE, offering a basis for further research into therapeutic interventions targeting these factors. These results contribute to our understanding of the complex immunological factors at play in SLE and may pave the way for more targeted and effective treatment approaches.

Antifibrotics in the Management of Rheumatoid Arthritis-Associated Interstitial Lung Disease: Prospective Real-World Experience From an Interstitial Lung Disease Clinic in India.

BACKGROUND & OBJECTIVES: Interstitial lung disease (ILD) in rheumatoid arthritis (RA) is a serious complication with varied prevalence ranging from 4% to as high as 68%, with varied presentation. Immunosuppressants and antifibrotics are used in the management of RA ILD. The clinicodemographic profile and presentation in our country need to be further explored. We assessed the efficacy and safety profile of antifibrotic drugs in combination with immunosuppressants among RA ILD patients. METHODS: A prospective observational study was conducted in the Interstitial Lung Disease (ILD) Clinic in the Department of Pulmonary Medicine, All India Institute of Medical Sciences Raipur, India, between January 2022 to January 2023. RA patients with dyspnea and chronic cough were referred to us for evaluation of ILD. Patients underwent clinical examination, complete lung function study including spirometry, single breath diffusion capacity for carbon monoxide (DLCO), six-minute walk test, and high-resolution computed tomography of the thorax. Quality of life was assessed using the King's Brief Interstitial Lung Disease (KBILD) questionnaire. RESULTS: Two hundred eighteen RA patients were evaluated and out of these, 43 (20.8%) had features of ILD on high-resolution computed tomogram (HRCT) thorax. Twenty-six (2.18%) met the inclusion criteria for starting antifibrotics. The mean ± SD. age of the patients was 52.96 ± 14.04 and the majority (77%) were females. Fourteen (53.38%) patients had usual interstitial pneumonia (UIP)/probable UIP pattern and 12 (46.22%) had nonspecific interstitial pneumonia (NSIP) patterns on HRCT. Out of 26 patients, 24 (92.3%) were started on antifibrotics. Fourteen (53.8%) patients were on nintedanib and 10 (38.4%) were on pirfenidone. The mean ± SD forced vital capacity (FVC)% predictedwas 62.5 ± 20.04. The mean ± SD. The DLCO percentage predicted was 54.4 ± 22.8. Twenty-two (84.6%) patients did not experience any side effects. The mean ± SD. KBILD score was 59.9 ± 11.17 and was similar in both sexes. CONCLUSION: In our study, the prevalence of RA ILD was nearly 20.8% and more common in females. Twenty-four (2%) patients were included for antifibrotic treatment. There was an improvement in lung function at the end of six months, but the change was not significant. All patients tolerated antifibrotics well without any serious adverse events.

Deciphering the Neuropsychiatric Lupus Enigma: Navigating the Intersection of Acute Inflammatory Demyelinating Polyneuropathy (AIDP), Infection, and Flare.

A 17-year-old male diagnosed with systemic lupus erythematosus (SLE), showing poor compliance with medication, presented to our facility with a 20-day history of fever, polyarthritis, and cough. Additionally, he had experienced a seizure episode, followed by a one-day history of altered mentation. Subsequently, he developed pneumonia, respiratory distress, and shock, necessitating ventilator and inotropic support. Neuropsychiatric lupus (NP-lupus) was suspected, and hence high-dose steroids, hydroxychloroquine, and broad-spectrum antibiotics were initiated. Following successful extubation, he manifested ascending flaccid paralysis. The presence of albumin-cytological dissociation and axonal neuropathy confirmed the diagnosis of acute inflammatory demyelinating polyneuropathy (AIDP). He underwent further management with pulse steroids and plasmapheresis. Upon recovery, he was discharged on a regimen of steroids, cyclophosphamide, and hydroxychloroquine. During follow-up, he maintained ambulatory status with no residual neurological sequelae.

Analysis of Drugs Prescribed to Elderly Patients in a Tertiary Health Care Center in Raipur, Central India: An Observational Study.

Background Most elderly patients suffer from multiple diseases and are on multiple drugs for treatment. Polypharmacy in the elderly, physiological changes with old age, changes in the pharmacokinetics and pharmacodynamic effects of many drugs, and newer drug prescription trends for diseases like diabetes and cardiovascular disease make drug prescribing in the elderly more difficult. There are many chances of drug-drug interactions with easily available over-the-counter (OTC) medications. To prevent the irrational use of drugs in the elderly, there is a need for prescription analysis studies. Prescription analysis studies will help in finding errors in prescriptions and also change trends in the use of medication among the elderly. Methodology This cross-sectional observation study was conducted on 234 elderly patients to investigate medicine use patterns among the geriatric patients attending the Medicine Outpatient Department in a tertiary care teaching hospital. Drug data were collected from the study participants after obtaining written informed consent and analysed, including demographic details, personal history, disease history, and details of the drug, including the generic name of the drug, dose and duration of therapy, and prescription pattern. The proportions of drugs prescribed for different diseases were analysed. Also, the drugs were analysed as per their pharmacological profiles. Results and interpretation A total of 1298 drug prescriptions were analysed in this study. Of the total participants, 60.26% were male, 35% were unemployed, 53% were retired, and 27% were taking OTC herbal medications. Most of the patients included in this study were suffering from diabetes, hypertension, and other comorbidities. Telmisartan and telmisartan in combination with other drugs were the most commonly encountered prescription drugs, i.e., 24% among the cardiovascular drugs. Aspirin and statins alone or in combination were the most commonly encountered prescriptions, i.e., 27.88% of the drugs used for prophylaxis of cardiovascular diseases. Conclusion This study showed a prescription pattern for the elderly and highlighted precautions to be taken with some of the prescribed drugs. As polypharmacy is observed with elderly prescriptions, possible drug interactions must be taken into account. Regular prescription analysis of drugs prescribed to the elderly will help in the appropriate and rational use of drugs.

Brucellosis in a Sickle Cell Patient with Hyposplenia.

Sickle cell disease patients are prone to infection and overwhelming sepsis because an immunedeficient state arises from asplenia (autosplenectomy/surgical splenectomy) and functional hyposplenism. The common pathogen encountered in sepsis with asplenic/hyposplenism patients is encapsulated organism, gram-negative bacilli, but in developing countries like India, there are many possibilities of infection by an uncommon organism that make it difficult to diagnose. Here, we have described a case of sickle cell disease presented with persistent fever and later, found to have an atrophic spleen with involvement of respiratory system and osteoarticular system. After extensive workup, he was diagnosed to be brucellosis. So, unusual infectious causes be kept as a differential diagnosis in a susceptible host while dealing with persistent symptoms. Uncommon infections like Brucella need to be studied in hyposplenism patients as data are lacking.

Association of Serum IL-17 and IL-23 Cytokines With Disease Activity and Various Parameters of Rheumatoid Arthritis in Indian Patients.

Introduction Interleukin-23/T helper 17 (IL-23/Th17) axis cytokine has been thought to be a critical pathway for rheumatoid arthritis (RA) disease development and its association with disease severity, joint erosion, and functional outcome. There is a paucity of data on the role of IL-23/Th17 axis cytokines in an Indian RA subset of patients. We aimed to determine the association between serum cytokines (interleukin-17 [IL-17] and [IL-23]) and disease activity as well as with clinical and biochemical parameters of RA patients. Methods In this observational cross-sectional study, 84 consecutive RA cases were recruited after obtaining consent. Serum IL-17 and IL-23 levels were measured by the enzyme-linked immunosorbent assay (ELISA) method. Clinical and laboratory parameters, disease activity score 28-erythocyte sedimentation rate (DAS28-ESR), and Health Assessment Questionnaire-II (HAQ-II) were recorded. Correlation of cytokines with various clinical and biochemical parameters was elicited. Results Only C-reactive protein (CRP) correlated positively with IL-23 (rs = 0.26, p = 0.014) but not the ESR. Both IL-17 and IL-23 levels showed an insignificant, weak positive correlation with the disease activity DAS28 (rs = 0.18, p = 0.097; rs = 0.12, p = 0.259, respectively). Neither IL-17 nor IL-23 levels differed among the disease severity group (p = 0.13, p = 0.215). Only the IL-23 level positively correlated with functional status (HAQ-II) (rs = 0.28, p = 0.009). IL-17 level was higher in advanced RA as compared to early RA (p = 0.028). Both IL-17 and IL-23 levels did not vary within the different subgroups (age, obesity, disease-modifying drugs/steroid/biologics use, and serology status). Conclusion Females had higher IL-23 levels than males. Advanced RA had higher IL-17 levels than early RA. The cytokine levels were not influenced by factors like age, duration of disease, serology status, or drugs. Neither of the cytokines correlated significantly with disease severity. Higher IL-17 levels may have a role in the progression of early non-erosive to chronic erosive arthritis. Higher IL-23 levels may signal a bad functional outcome.

Tuberculous Skull Base Osteomyelitis With Cerebral Venous Sinus Thrombosis in an Immunocompetent Adolescent: A Case Report.

Skull-base osteomyelitis is a rare yet lethal entity. It is infrequently observed among immunocompetent children and young adults, and Mycobacterium is much less common among the various bacterial and fungal etiological causes noted. We report a rare case of a 17-year immunocompetent girl who presented with complaints of head and neck pain and restricted neck movements. The analysis of her cerebrospinal fluid revealed a lymphocytic pleocytosis with elevated protein levels. Imaging studies revealed erosion of the occipital condyle and clivus and an extradural collection extending into the prevertebral and paravertebral spaces until the second cervical vertebra level. In addition to this life-threatening complication, the potential involvement of the cerebral venous sinuses is also of particular interest-a diagnosis of tubercular meningitis with skull base osteomyelitis based on the CSF and imaging findings. The drastic improvement in the initiation of anti-tubercular therapy emphasizes the need for prompt and early initiation of anti-tubercular therapy in endemic areas. The clinical picture, diagnosis, and treatment of tubercular skull-base osteomyelitis are further discussed, and pertinent literature has been reviewed.