Pulmonary Involvement in Systemic Lupus Erythematosus Patients in a Tertiary Care Hospital.

INTRODUCTION: In half of the individuals with systemic lupus erythematosus (SLE), over the course of the disease, pulmonary involvement occurs frequently and is one of the parts in the array of presenting symptoms. But the published research and information on SLE have historically concentrated on renal, central nervous system (CNS), and dermatological manifestations, while the pulmonary effects of SLE have received very less attention. OBJECTIVE: To know the extent and pattern of pulmonary involvement in SLE patients in a tertiary care hospital. MATERIALS AND METHODS: A cross-sectional observational study was conducted among 70 diagnosed SLE [who fulfilled the revised American College of Rheumatology (ACR) criteria for the classification of SLE] patients attending a tertiary care center. Seventy diagnosed SLE patients who met the updated ACR criteria for the classification of SLE and were enrolled in a tertiary care facility in West Bengal participated in a cross-sectional observational study. After informed consent, clinical examinations, general survey, respiratory examination, cardiovascular examination, and relevant investigations [chest X-ray, pulmonary function test, echocardiography and electrocardiography, and high-resolution computed tomography (HRCT)/chest computed tomography (CT) scan] were performed. RESULTS: The majority of the study subjects belonged to the 21-30 years of age-group (45.7%) and were females. Most of the study subjects were treatment-naïve as they were newly diagnosed. Among the chief presenting complaints, the most common was cough followed by dyspnea and pleuritic chest pain. Chest X-rays showed pleural pathology in 37% of study subjects and pulmonary function tests were found to have a restrictive pattern in 4.3%. Echocardiography documented that 19.6% had pulmonary artery hypertension. HRCT revealed that 19.4% of subjects had definitive findings of interstitial lung diseases (ILD). CONCLUSION: A substantial contributor to morbidity and death, SLE is a potentially fatal, commonly debilitating autoimmune illness with pulmonary symptoms. Cough was the most common presenting complaint, and the most common radiological abnormality detected was pleural effusion. Spirometry revealed, as expected, a restrictive pattern in most of the cases. Around 29% of cases revealed features suggestive of or confirmatory evidence for intestinal lung disease. As a whole, the prevalence of lung involvement in SLE in the study was 67%. But this being a study with only 70 participants, a further longitudinal is recommended to study disease activity correlation with the incidence of early pulmonary involvement in SLE disease course.

A Randomized Controlled Trial Comparing the Efficacy of a Combination of Rifaximin and Lactulose with Lactulose only in the Treatment of Overt Hepatic Encephalopathy.

Background: Hepatic encephalopathy (HE), or portosystemic encephalopathy, represents a reversible decrease in neurologic function caused by liver disease, and treatment has traditionally been with non-absorbable disaccharides along with antibiotics and supportive measures. The present study was undertaken to evaluate if their combination therapy were superior to the established therapy in management of HE. Methods: Ninety six (96) patients of hepatic encephalopathy were randomly assigned to receive either lactulose and rifaximin in standard dosage or lactulose only and their response to therapy was monitored using standard assessment tools. The statistical analysis was done using Kaplan- Meier methods to estimate the percentage of patients maintaining survival over time. Results: The patients who were on lactulose and placebo revealed to have lower mortality than those on lactulose and rifaximin. Also, improvement in neurological status was of Grade 1 or more was more in patients on lactulose and placebo when compared to those on lactulose and rifaximin. Although survival analysis revealed no statistical difference between two groups, the mean survival in the placebo group was higher. Conclusions: The present study reveals that improvement in neurological status of the group treated with lactulose only was that of a higher percentage than that of the group being treated with lactulose and rifaximin, which reiterates the recommendation that lactulose be used as a first line therapy in overt hepatic encephalopathy (OHE). Also the outcome was better in patients who had a lower grade of encephalopathy on admission.

Perceived HIV Related Stigma among Patients Attending ART Center of a Tertiary Care Center in Rural West Bengal, India.

INTRODUCTION: Despite the advent of modern technologies, India is still grappling with the HIV/AIDS pandemic. Stigma is one of the key aspects which can interfere with HIV test-seeking behaviour, care-seeking behaviour upon diagnosis, quality of care given to HIV-positive patients and perception and treatment of People Living with HIV/AIDS (PLHA) by communities, families, and partners. AIM: To determine the perceived stigma associated with HIV/AIDS and its correlates among PLHAs attending the Anti Retroviral Therapy (ART) centre of North Bengal Medical College, Darjeeling, West Bengal, India. MATERIALS AND METHODS: An observational cross-sectional study was conducted over a period of four months among 454 patients aged ≥18years attending ART centre of North Bengal Medical College. Perceived stigma among the study subjects were assessed using a face and content validated version of Berger's HIV stigma scale. Linear regression analysis was used for statistical analysis of the predictors of perceived stigma. Data were analysed using SPSS version 16 software. RESULTS: The majority of the study population had moderate to low stigma. Regression analysis showed that being on treatment with ART had the highest contribution towards stigma followed by gender and HIV serostatus of the patients. CONCLUSION: The patients attending ART centre of North Bengal Medical College had moderate to low level of stigma. In absence of any efficacious stigma reduction programs in this region, more work needs to be done to assist PLHA in coping with stigma.