Assessment of ideal serum dilution for screening of antinuclear antibodies by an indirect immunofluorescence method in diagnosis of autoimmune disorders.

BACKGROUND: Time and cost constraints lead to majority of clinical laboratories deviating away from an ideal practice of checking for antinuclear antibodies (ANAs) by indirect immunofluorescence (IIF) at multiple dilutions. Usage of screening dilution of 1:40 recommended by most manufacturers of commercial ANA kits results in numerous false positive-tests and misdiagnosis of connective tissue disorders (CTDs). We sought to study the ideal screening dilution for ANA by IIF for a diagnosis of ANA-related CTDs. METHODS: Serum samples of patients with ANA-related conditions (n = 233) and healthy controls (n = 154) were evaluated by IIF using Immuno Concepts Hep-2000 ® ANA kits at dilutions from 1:40 to 1:640. Accuracy for diagnosis of CTDs for each serum dilution was assessed by receiver operating curve (ROC) analysis. RESULTS: Antinuclear antibodies (ANA) positivity was observed in 19.5%, 10.4%, 4.55%, 0.65%, and 0% of healthy controls at dilutions of 1:40, 1:80, 1:160, 1:320, and 1:640, respectively. ANA positivity at 1:40 dilution was observed among 26.4% cases with mimics of CTDs. Prevalence of ANA positivity in ANA-related CTDs was 97.3%, 96.4%, 89.3%, 83.9%, and 71.4% at dilutions of 1:40, 1:80, 1:160, 1:320, and 1:640, respectively. ROC analysis revealed best test performance for distinction between healthy and ANA-related CTD populations at a serum dilution of 1 in 80. CONCLUSIONS: Antinuclear antibodies (ANA) positivity at low titers (1:40) is highly prevalent in healthy population (19.5%) as well as amongst mimics of CTD (26.4%). Our study suggests a higher screening dilution of 1:80 for ANA by IIF for diagnosis of CTD maybe better. Combination of 1:80 and 1:160 dilutions provides optimum sensitivity and specificity for diagnosis of ANA-related disorders.

Long-Term Study about the Incidence of Epilepsy in Male Service Personnel from India: A Retrospective, Cohort Study.

Background The data on the epidemiology of epilepsy are limited for developing countries including India. We estimated the incidence of epilepsy in a cohort of service personnel from India followed for over two decades. Materials and Methods The data for this epidemiological study were derived from the electronic medical records (EMRs) of the male service personnel. The participants (age < 18 years) were enrolled into active service between 1990 and 2015 in good health. The data pertaining to the diagnosis of epilepsy were derived from the EMR using the prevalent International Classification of Diseases codes. We calculated the incidence rate as per person-years (py) using appropriate statistical methods. Results Our data included 51,217 participants (median age: 33 years, range: 17-54) with a mean follow-up of 12.5 years, giving a cumulative follow-up duration of 613,925 py. A total of 291 patients developed epilepsy during the study, giving an incidence rate of 0.47 per 1000 py (95% confidence interval: 0.42-0.53). Undifferentiated spondyloarthropathy, central nervous system disorders, and alcohol dependence syndrome were the common comorbid ailments in patients with epilepsy. Conclusion Our cohort had a comparable incidence rate of epilepsy with other studies from India and abroad.

Cardiovascular outcomes of Nephrotic syndrome in childhood (CVONS) study: a protocol for prospective cohort study.

BACKGROUND: Nephrotic syndrome (NS) is characterized by dyslipidemia which is a well-known risk factor for atherogenesis. Atherosclerosis in childhood is mostly subclinical and endothelial dysfunction is known to precede this. Evidence for screening for endothelial dysfunction and cardiovascular risk factors and early identification of premature onset of atherosclerosis in childhood NS remains tenuous in the absence of well-designed prospective studies addressing cardiovascular comorbidity in NS. The objective of our study is to examine endothelial dysfunction and short-term cardiovascular outcomes in a carefully phenotyped cohort of patients with Nephrotic syndrome as compared to healthy controls. METHODS: In a multi-centric prospective cohort study, 70 Steroid Resistant NS (SRNS), 70 Steroid Sensitive (SSNS) patients along with 70 Healthy Controls are being recruited. After a baseline assessment of functional and structural status of heart (2D Echocardiography), arteries (Carotid Doppler and Intima Media Thickness measurements) and microcirculation [a combination of 2D Echocardiography, Laser Doppler Flowmetry (LDF) and Brachial Artery Flow mediated dilation (FMD) and Nail Fold Capillaroscopy (NFC)], the patients are being investigated for endothelial dysfunction. Venous blood sample (15 ml) is being collected for routine investigations and assay of biochemical endothelial markers through Flow Cytometry. The patients will be followed up at 12 months and 24 months after the recruitment to look for any change from baseline period. DISCUSSION: This study will able to provide a better understanding of the epidemiology of endothelial dysfunction and associated subclinical cardiovascular co-morbidity in childhood NS. Findings on characterization of prevalence of endothelial dysfunction and subclinical markers may be used to design future randomized controlled trials for evaluating the efficacy of preventive and therapeutic interventions in reducing the incidence of cardiovascular disease.

A long term follow-up study from India assessing the risk of diabetes mellitus in service population.

OBJECTIVE: The data about the incidence of diabetes is scarce from developing countries. We studied the incidence of type 1 (T1DM) and type 2 DM (T2DM) in a cohort of young military personnel followed for a long duration. METHODS: The data for this descriptive epidemiologic study was derived from the electronic medical records (EMR) of the male service personnel enrolled between 1990 and 2015. All subjects were recruited before 18 years of age in good health and the onset of DM was derived from the EMR. We calculated the incidence rates as per person years using appropriate statistical methods. RESULTS: Our study population includes 51,217 participants (median age 33 years, range 17-54) with a mean follow up of 12.5 years, giving a cumulative follow up duration of 613,925 person-years (py). A total of 251 patients developed T2DM and 15 patients developed T1DM during the study period. The incidence rate of T2DM was 0.41 per 1000 py and that of T1DM was 2.44 per 100,000 py. CONCLUSION: Our cohort had low incidence rates of diabetes when compared with other studies from India and abroad. Active military service with good life style measures may offer protection from the DM.

Incidence of essential hypertension in young adult males followed for over two decades.

BACKGROUND: The data about the incidence of hypertension in India is scarce and is lacking about hypertension in young adult patients. We studied the incidence of hypertension in a cohort of young adult male military personnel followed for a long duration. METHODS: The data for this retrospective, observational study was derived from the electronic medical records (EMR) of the male service personnel enrolled between 1990 and 2015. All subjects were recruited before 18 years of age in good health without any disease. Hypertension in young adults was defined as the onset of the disease prior to 45 years of age. We calculated the incidence rates as per person years using appropriate statistical methods. RESULTS: Our study population includes 51,217 participants (median age 33 years, range 17-54) with a mean follow up of 12.5 years, giving a total observation period of 613,925 person-years (py). During the study period, 360 patients developed hypertension, giving an incidence rate of 58.6 per 100,000 py (95% CI 52.8-64.9). The mean age at the time of diagnosis was 33.5±5.7years (range 20-45) with 5.6±3.9years (range 0.3-21yr) of follow up after the diagnosis. Only 16 patients (4.4%) had associated cardiovascular complications attributable to hypertension. CONCLUSION: Our cohort had low incidence rates of hypertension when compared with other studies from abroad. Active military service may offer protection from the hypertension and associated complications.

Incidence of Endocrine Disorders in Indian Adult Male Population.

BACKGROUND: The comprehensive epidemiology of endocrine disorders is lacking from our country. Most of the available data pertain to the prevalence of diabetes and thyroid disorders only. We studied the incidence of endocrine disorders in a cohort of service personnel followed for a long duration. MATERIALS AND METHODS: The data for this descriptive epidemiologic study were derived from the electronic medical records of the male service personnel enrolled between 1990 and 2015. They were recruited between the ages of 17 and 20 years in good health, and their morbidity data were derived from the medical records. We calculated the incidence rates as per person-years (py) using appropriate statistical methods. RESULTS: Our analysis includes 51,217 participants (median: age 33 years, range: 17-54) with a mean follow-up of 12.5 years. Yearly evaluation of the data gave a cumulative follow-up duration of 613,925 py. The incidence of diabetes, obesity, and dyslipidemia was 0.41, 0.23, and 0.12 per 1000 py, respectively. The incidence of thyroid, parathyroid, pituitary, adrenal, and metabolic bone disorders was 3.9, 8.6, 1.6, 0.81, and 0.97 per 100,000 py, respectively. CONCLUSION: Our cohort had lower incidence rates of endocrine disorders when compared with the Western population. Long-term epidemiological studies are essential to identify the demographic trends of the endocrine disorders in India.

Incidence of parathyroid disorders in Indian adult male population: A 25-year follow-up study.

CONTEXT AND OBJECTIVE: Detailed information on the epidemiology of parathyroid disorders in India is lacking. Most of the available data pertain to primary hyperparathyroidism (PHPT) rather than the overall burden of parathyroid disorders. We studied the incidence of parathyroid disorders in a cohort of service personnel followed for a long duration. DESIGN, SETTING AND PATIENTS: The data for this retrospective, descriptive epidemiological study were derived from the electronic medical records (EMR) of health care personnel enrolled between 1990 and 2015. Subjects were recruited between the ages of 17 and 20 years in good health, and the data pertaining to parathyroid disorders were derived from the EMR. MAIN OUTCOMES MEASURES: We calculated the incidence rates per person-years of parathyroid disorders using appropriate statistical methods. RESULTS: Our analysis includes 51 217 participants (median age 33, range 17-54 years) with a mean follow-up of 12.5 years. Yearly evaluation of the data gave cumulative follow-up duration of 613 925 person-years. PHPT was diagnosed in 37 patients and hypoparathyroidism in 16 patients, giving incidence rates of 6 and 2.6 per 100 000 person-years, respectively. Only one patient was diagnosed with pseudohypoparathyroidism (0.16 per 100 000 person-years). Of the 37 patients with PHPT, 16 (43%) developed postsurgical hypoparathyroidism. CONCLUSIONS: Our cohort had a low incidence of PHPT when compared to Western populations. Long-term epidemiological studies are essential to identify the demographic trends of metabolic bone disorders in India.

Amniotic band sequence--a debilitating syndrome.

A male baby was delivered by Caesarean section at term to a 35 years second gravida lady with fibroid uterus. The mother was booked and immunized and not on any medication. Antenatal and natal periods including serial ultrasounds were normal. At birth the neonate was observed to have multiple grooves over ring & middle index finger of left hand and hypoplasia of left little finger. Both great toes were amputated. In view of asymmetrical involvement, presence of amniotic bands, no other organ involvement and sporadic nature, he was diagnosed as a case of amniotic band sequence. Congenital amputations should be distinguished from congenital hypoplasia and/or aplasia. Differentiation is important for genetic counselling and evaluation of the risk of recurrence.

Meconium Aspiration Syndrome: An Insight.

Meconium aspiration syndrome (MAS) is respiratory distress in a newborn baby caused by the presence of meconium in the tracheobronchial airways. The aspiration of meconium stained amniotic fluid by the fetus can happen during antepartum or intrapartum periods and can result in airway obstruction, interference with alveolar gas exchange, chemical pneumonitis as well as surfactant dysfunction. These pulmonary effects cause gross ventilation-perfusion mismatching. To complicate matters further, many infants with MAS have primary or secondary persistent pulmonary hypertension of the newborn as a result of chronic in utero stress and thickening of the pulmonary vessels. Although meconium is sterile, its presence in the air passages can predispose the infant to pulmonary infection. MAS is essentially a clinical diagnosis and should always be suspected in a child with respiratory distress and meconium-stained amniotic fluid at delivery. Though a known entity for a long time, its management still remains contentious. Intubation and direct tracheal suction is performed when meconium is observed in the amniotic fluid and the infant is not vigorous. Subsequent management involves ventilation, surfactant instillation and lavage, inhaled nitric oxide and high frequency ventilation. The role of steroids continues to be controversial.

Unilateral palatal palsy with viral hepatitis.

Isolated unilateral palatal (velopalatopharyngeal) palsy is a clinical rarity. This usually presents in a child as acute onset rhinolalia, unilateral absent palatal reflex and pharyngeal asymmetry with a benign self-resolving course. Etiology remains controversial. We report association of this entity in a male child with viral hepatitis A.