Relapsing polychondritis: clinical presentations, disease activity and outcomes.

Background: Relapsing polychondritis is a rare disease characterised by inflammation of cartilaginous and proteoglycan rich structures. As there are only a few published single centre case series from all across the world, we describe our experience with 26 patients at a tertiary centre in north India.

Methods: A retrospective study with all patients meeting Damiani and Levine's modification of McAdam's diagnostic criteria.

Causes of mortality among inpatients with systemic lupus erythematosus in a tertiary care hospital in North India over a 10-year period.

Introduction: Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder with significant morbidity and mortality. The present study was undertaken to identify the causes of in-hospital mortality of patients with SLE.

Methods: This was a retrospective study.

Tubercular serpiginous-like choroiditis presenting as multifocal serpiginoid choroiditis.

Purpose: To describe the clinical features, course, and outcome in tubercular serpiginous-like choroiditis.

Design: Retrospective cohort study.

Participants: A total of 105 patients (141 eyes) between May 2002 and July 2010.

Causes of DMARD withdrawal following ADR within 6 months of initiation among Indian rheumatoid arthritis patients.

The present study was conducted in Indian rheumatoid arthritis (RA) patients prescribed disease-modifying anti-rheumatic drugs (DMARDs) to determine the incidence and type of adverse drug reactions (ADRs) leading to their withdrawal in the initial 6 months of therapy. This was considered important as pharmacogenetic variations in the pattern of RA in different populations and genetic differences in efficacy and safety to drugs demand separate studies to be conducted in different populations. Hospital records were used to identify 1,000 consecutive patients with RA fulfilling the American College of Rheumatology criteria and having at least 6-month follow-up.

Successful treatment of aortic root dilatation in a patient with relapsing polychondritis.

Cardiovascular involvement occurring in 20-30% patients is the second most common cause of mortality in patients with relapsing polychondritis. Aortic insufficiency occurs as a result of aortic root dilatation rather than primary valvular involvement. We are reporting a patient of relapsing polychondritis with aortic root dilatation, in whom institution of early and aggressive therapy successfully prevented the progression of aortic insufficiency.

High-dose prednisolone and bolus cyclophosphamide in interstitial lung disease associated with systemic sclerosis: a prospective open study.

Aim: Currently, therapy for interstitial lung disease in patients with systemic sclerosis is unsatisfactory. A prospective open label study was conducted in a North Indian tertiary Institute to assess the efficacy of intermittent pulse cyclophosphamide (CYC) and high-dose prednisolone in systemic sclerosis (SSc)-related interstitial lung disease (ILD).

Methods: Consecutive patients with SSc and ILD, diagnosed on spirometry, carbon monoxide diffusing capacity (DLCO) and high-resolution computed tomography (HRCT) scan were treated.

Ocular signs predictive of tubercular uveitis.

Purpose: To determine ocular signs predictive of tubercular uveitis.

Design: Retrospective, nonrandomized, comparative interventional case study.

Methods: Three hundred eighty-six patients with active uveitis were treated at a tertiary care single-center uveitis practice.

Clinical characteristics and predictors of mortality in 67 patients with primary pyomyositis: a study from North India.

Primary pyomyositis is infection of the skeletal muscles in the absence of adjacent skin, soft tissue, and bone infection. This study was undertaken to look at the spectrum of clinical presentations, therapeutic interventions, and their outcomes and also to evaluate the association of various risk factors with mortality. This was a retrospective study in which the patients admitted with the diagnosis of primary pyomyositis from January 2000 to June 2007 were included.

Cryptococcal meningitis in HIV infected: experience from a North Indian tertiary center.

Background: Cryptococcal meningitis is a common opportunistic infection in Human Immunodeficiency Virus (HIV)-infected individuals. There is little information specifically addressing cryptococcal meningitis in HIV-infected patients from North India.

Aims: To determine clinical presentation, hospital course, response to treatment, complications developed, in-hospital mortality, any recurrence of cryptococcal meningitis and reasons of recurrence during follow-up.

Angioinvasive pulmonary mucormycosis presenting as multiple bilateral pulmonary nodules in a patient without obvious predisposing factors.

Pulmonary mucormycosis is a rare, frequently fatal, fungal infection. It is usually seen in the presence of various immunocompromised states, such as diabetes mellitus, haematological malignancy or renal transplantation. In the absence of underlying predisposing conditions, presentation with infiltrates, consolidation, cavitation and mass lesion have been reported.

Role of anti-tubercular therapy in uveitis with latent/manifest tuberculosis.

Purpose: To assess the role of anti-tubercular therapy in uveitis with latent/manifest tuberculosis (TB).

Design: Retrospective, interventional case series.

Methods: A total of 360 patients from uveitis clinic with following inclusion criteria were studied: 1) complete clinical records of visual acuity, slit-lamp biomicroscopic examination, intraocular pressure, complications if any, and treatment records at the baseline and at all follow-up visits; 2) a documented positive tuberculin skin test (10 mm of induration or more) at 48 to 72 hours; 3) evidence of active uveitis, i.

Decline in beta-2 microglobulin levels after antitubercular therapy in tubercular patients with HIV infection.

Background: Infection with Mycobacterium tuberculosis results in a state of immune activation, more so, when there is concomitant HIV infection. Beta-2 microglobulin (B2M) is a useful marker to study the state of immune activation among the HIV infected. Objective.

Elevated urinary nitrite and citrulline levels in patients with rheumatoid arthritis.

The objective of this research was to determine, if NO production, as measured in the serum and urine, is increased in patients with rheumatoid arthritis. Forty-seven patients with RA were recruited in the study and subdivided into inactive and active disease (24 and 23 patients, respectively). Twenty-eight healthy individuals served as controls and nine patients with gastroenteritis were studied to validate the technique of measurement of NO production.

Serum transferrin receptor-ferritin index shows concomitant iron deficiency anemia and anemia of chronic disease is common in patients with rheumatoid arthritis in north India.

Anemia is a frequent cause of morbidity in patients with rheumatoid arthritis (RA). We studied the prevalence of anemia of chronic disorders (ACD) and ACD with coexistent iron deficiency anemia (IDA) in patients with RA using sTfR/log ferritin ratio (sTfR - F index). Complete blood counts, percent transferrin saturation, serum ferritin, sTfR, sTfR-F index measurements were carried out in 100 anemic RA patients.

Autoimmune inflammatory myopathy in pregnancy.

Autoimmune diseases such as systemic sclerosis, Wegner's granulomatosis, and polyarteritis nodosa are rarely seen in pregnancy, unlike systemic lupus erythematosus, whose association with pregnancy is well studied. Dermatomyositis is a protean disease that affects women in reproductive age. There are only a few case reports documenting the outcome of pregnancy in patients with dermatomyositis/polymyositis.

Relapsing polychondritis in North India: a report of 10 patients.

Objective: Relapsing polychondritis (RP) is a rare autoimmune disorder characterized by recurrent episodes of inflammation and destruction of cartilaginous tissues. We describe the outcome of 10 patients followed up at the Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, over the past 10 years.

Methods: All the patients fulfilling the diagnostic criteria suggested by McAdam et al (Medicine (Baltimore) 1976;55:193-215) and modified by Damiani and Levine (Laryngoscope 1979;89;929-46) were included in the study.

Successful treatment of severe gastrointestinal involvement in adult-onset Henoch-Schönlein purpura.

Henoch-Schönlein purpura is a small vessel vasculitis which is uncommon in adults. The presentations of adult-onset disease are different from those seen in childhood. The commonly-recognised serious gastrointestinal complications of childhood are less well-documented in adults.

Phrenic nerve palsy in a patient of Churg Strauss syndrome and mononeuritis multiplex.

Neurological manifestations like mononeuritis multiplex are seen commonly in patients with Churg Strauss syndrome. Cranial nerve involvement and central nervous system involvement are also reported, although infrequently. Phrenic nerve involvement has not been reported so far.

HLA typing in Vogt-Koyanagi-Harada syndrome in North Indian patients.

Purpose: To report the HLA profile of VKH patients from India.

Method: Forty-one patients and 50 controls were studied. Phenotyping using a lymphocytotoxicity assay was done for HLA-A and -B.

Prevention of opportunistic infections in HIV infection by pentoxiphylline.

Background & Objectives: Levels of tumour necrosis factor (TNF) are increased in patients with HIV infection leading to increased apoptosis and reduced CD4 cell life. Pentoxiphylline is a TNF inhibitor with properties that might make it useful for the treatment of HIV infection. These include improved cell mediated immunity and inhibition of viral replication.

Acute tubulo-interstitial nephritis leading to acute renal failure following multiple hornet stings.

Background: Hornet stings are generally associated with local and occasionally anaphylactic reactions. Rarely systemic complications like acute renal failure can occur following multiple stings. Renal failure is usually due to development of acute tubular necrosis as a result of intravascular haemolysis, rhabdomyolysis or shock.

Wegener's granulomatosis presenting as diabetes insipidus.

Pituitary gland involvement in Wegener's granulomatosis (WG) occurs most commonly in the form of central diabetes insipidus (CDI). However, CDI as a presenting manifestation of WG is very rare. We report two such cases; one of them had multi-organ involvement at presentation, while other developed it during follow-up.

Serum and urine nitrite and citrulline levels among patients with systemic lupus erythematosus: a possible addition to activity parameters?

Nitric oxide (NO) plays a significant role in the inflammatory process and has been implicated in several autoimmune disorders. This study was carried out prospectively to estimate the levels of nitrite and citrulline in the serum and urine, as surrogate markers of NO production, among patients with systemic lupus erythematosus (SLE). Forty-seven patients and 44 age- and sex-matched, healthy volunteers were studied.