Clinical Profile of Rheumatoid Arthritis

INTRODUCTION: Rheumatoid arthritis (RA) is a chronic multisystem disease of unknown cause. The characteristic feature of RA is persistent inflammatory synovitis usually involving the peripheral joints in a symmetric fashion. The hallmark of the disease is cartilage damage and bone destruction1. Rheumatoid arthritis is the most common inflammatory arthritis, affecting 0.5% to 1% of general population worldwide. Because of its prevalence and ready accessibility of joint samples for laboratory investigation, rheumatoid arthritis has served as a useful model for the study of all inflammatory and immune mediated disease. Rheumatoid arthritis patients can present with variety of clinical features, various articular and extra articular involvement. They may result in various complications which can impair the physical function in these patients. Pain in affected joints, aggravated by movement, is the most common manifestation of established RA. Generalized stiffness is frequent and is usually greatest after periods of inactivity. Rheumatoid arthritis does not involve the same type of joints in all patients. In general the number and severity of articular features vary with the duration and severity of the disease. Articular manifestations (AM) can severely affect the functional quality of an individual due to various deformities ,such as “Z” deformity, Swan neck deformity boutonnière deformity and hallux valgus. The Extra articular manifestations (EAM) may be due to formation of immune complexes. EAM includes the involvement of skin, eye, serosa, lung, heart, kidney, nervous system. The extra articular manifestations also depend upon the duration of the disease. If the duration is more the severity is also more. EAM are also associated with excessive mortality, since they affect major organs. In two-third of the patients, RA begins insidiously with constitutional symptoms such as fever, loss of appetite, fatigability and generalized weakness. This also makes the patients to abstain from day-to-day routine activities. AIM: The aim of the study is: 1. To identify and analyze the common presenting complaints of rheumatoid arthritis patients like loss of appetite, fever and fatigability. 2. To assess the various joint involvement and extent of damage due to the disease process in patients with proven rheumatoid arthritis and it’s severity with the duration of the disease. 3. To document EAM in patients with proven rheumatoid arthritis and its significance with the duration and severity of the disease. 4. To establish beneficial effects of disease modifying anti rheumatic drugs. MATERIALS AND METHODS: Patients with symptoms suggestive of Rheumatoid arthritis who represented the Medical OPD and Rheumatology OPD, Government Stanley Medical College hospital during a period from July 2005 to June 2006 were included in this study. A total number of 100 patients who met the inclusion criteria below were included in this study. Inclusion Criteria: a. Patients who presented with typical clinical features based on the Modified American College of rheumatology criteria. b. Patients above 16 years of age. c. Patients already diagnosed to have RA. Exclusion Criteria: a. Patients with mono articular involvement. b. Patients below 16 years. c. Patients who did not fulfilled the ACR criteria. RESULTS: A total number of hundred patients were included in this study in the age group ranging from 18-74years. The mean age is being 41.6. 1. The Total number of cases screened – 100, 2. Gender: * No. of male RA patients screened - 18, * No. of female RA patients screened - 82. CONCLUSION: 1. Fatigability, Loss of weight and Fever were observed in 91%, 41% & 52% of patients respectively. 2. All patients showed involvement of PIP& MCP joints. The next common joint involved was wrist in 82% of patients. 3. Cervical joint involvement is seen in three patients and one of them had neurological deficit in the form of atlantoaxial subluxation resulting in quadriplegia. 4. Extra articular manifestations (EAM) were found in 41%of patients studied. Among the EAM, anemia was the predominant manifestation and seen in 22% of patients. 5. The frequency of complications was well correlated with duration of the disease. Those who were having the disease more than two years showed evidence of joint damage and extra articular manifestations. 6. Majority of the patients with EAM were seropositive. And seropositive patients presented with joint damage earlier than seronegative patients. 7. DMARD is required in 85% of patients to overcome the symptoms

Characteristics and natural history of gastric varices in portal hypertension.

INTRODUCTION : Portal hypertension can occur due to many reasons. One of the commonest causes for portal hypertension is cirrhosis. Other important causes are non cirrhotic portal fibrosis (NCPF) and extra hepatic portal vein obstruction (EHPVO). Portal pressure increases in cirrhosis initially as a result of an increased resistance to portal flow. This mostly results from fibrous tissue and regenerative nodules formation within the hepatic parenchyma which leads to distortion of the architecture of the liver. Along with this structural resistance to blood flow, there is an intra-hepatic constriction of the vessels that accounts for twenty to thirty percent of the increase in resistance within the liver. This happens because there is decreased synthesis of nitric oxide endogenously. The obstruction to the portal flow is at perisinusoidal level in NCPF but in EHPVO the obstruction is extra hepatic, which is commonly due to the formation of thrombosis in the portal vein. Porto-systemic collaterals are formed due to the development of portal hypertension. Although the collaterals are formed to relieve the portal pressure portal hypertension persists due to two causes: (1) an increase in portal venous inflow due to splanchnic arteriolar vasodilatation along with the formation of collaterals and (2) inadequate decompression of the portal venous system through the collaterals since they have a higher resistance than the normal liver. Therefore, an increased portal pressure gradient results from both an increase in portal blood inflow and increase in resistance to portal flow. Gastroesophageal varices are commonly seen in up to 50% of patients with cirrhosis.6 Gastric varices are seen in 20-25% of patients with portal hypertension. If the patient is not having varices it will develop at the rate of 8% per annum and one who have small varices will develop larger varices at 8% per year.. In few subsets of patients such as in primary biliary cirrhosis and hepatitis C with bridging fibrosis, even in the absence of overt cirrhosis they have propensity to develop varices in up to 16 % of the patients. Irrespective of the aetiology, the important and dreadful complication of varices is upper gastrointestinal bleeding. Prevalence of gastric varices is low when compared to esophageal varices. They are present in 6%-35% of patients with portal hypertension. The incidence of bleeding is about twenty-five percent in 2 years and highest bleeding rate is for fundal varices. Risk factors for gastric variceal haemorrhage include fundal varices size (large varices defined as >10 mm, medium -5-10 mm and small >5 mm), Child-Turcotte-Pugh score, particularly Child C status and endoscopic presence of variceal red spots (defined as localized reddish mucosal area or spots on the mucosal surface of a varix). The risk of bleeding with gastric varices is half that of esophageal varices. The transfusion requirement and mortality are high once the bleeding has occurred particularly for isolated gastric varices (IGV). Large gastric varices patients have a lower portal pressure compared to esophageal varices, which is due to the development of gastrorenal portosysytemic shunts, or large size of the varices resulting in increased wall tension. The type and prevalence of gastric varices varies greatly. AIM : The aim of this study is to assess 1. The prevalence of gastroesophageal varices in patients with portal hypertension in a tertiary referral centre 2. Characteristics of the gastric varices and 3. Natural history of gastric varices in portal hypertension. CONCLUSION : In conclusion, the results of our study confirm that the prevalence of gastroesophageal varices was low but within the range when compared with various studies. The type of the varices in Our study tallies with the international classification and the common type is GOV1 as denoted by many studies. GOV1 is relatively have a benign course and requires treatment only in the form of gastric variceal sclerotherapy if they bleed. For most GOV2 varices, endoscopic variceal obliteration therapy with N-Butyl 2- Cyanoacrylate is quite useful in arresting the bleeding and achieving the variceal obliteration. Although endoscopic therapy was effective in treating some patients with IGV1 varices, surgery was required in significant no. of patients to prevent re bleeding. In our study, the surgery was contemplated for such patients and also for other type of gastric varices because those patients were from far remote places where the immediate endoscopic intervention may not be feasible always. IGV2 cases were less in Our study and it might require long term follow up to identify such patients. Because the gastric varices have the potential to cause severe upper GI bleeding, its recognition is very important to manage the cases appropriately

Quality of life and visual function in Nigeria: findings from the National Survey of Blindness and Visual Impairment

Aims To assess associations of visual function (VF) and quality of life (QOL) by visual acuity (VA), causes of blindness and types of cataract procedures in Nigeria. Methods Multi-stage stratified cluster random sampling was used to identify a nationally representative sample of persons aged >= 40 years. VF/QOL questionnaires were administered to participants with VA = 6/12. Results VF/QOL questionnaires were administered to 2076 participants. Spearman's rank correlation showed a strong correlation between decreasing VA and VF/QOL scores (p< 0.0001) with greatest impact on social (p< 0.0001) and mobility-related activities (p< 0.0001). People who were blind due to glaucoma had lower VF and QOL scores than those who were blind due to cataract. Mean VF and QOL scores were lower after couching compared with conventional cataract surgery (mean VF score=51.0 vs 63.0 and mean QOL score=71.3 vs 79.3). Finally, VF and QOL scores were lower among populations with specific characteristics. Conclusions Populations with the following characteristics should be targeted to improve VF and QOL: people who are blind, older people, women, manual labourers, people living in rural areas, those living in the northern geopolitical zones, those practising Islamic and Traditionalism faith, those not currently married and those who have undergone couching

A double-edged sword: the merits and the policy implications of Google Translate in higher education

Machine translation, specifically Google Translate is freely available on a number of devices, and is improving in its ability to provide grammatically accurate translations. This development has the potential to provoke a major transformation in the internationalisation process at universities, since students may be, in the future, able to use technology to circumvent traditional language learning processes. While this is a potentially empowering move that may facilitate academic exchange and the diversification of the learner and researcher community at an international level, it is also a potentially problematic issue in two main respects. Firstly, the technology is at present unable to align to the socio-linguistic aspects of university level writing and may be misunderstood as a remedy to lack of writer language proficiency – a role it is not able to fulfil. Secondly, it introduces a new dimension to the production of academic work that may clash with Higher Education policy and, thus, requires legislation, in particular in light issues such as plagiarism and academic misconduct. This paper considers these issues against the background of English as a Global Lingua Franca, and argues two points. First of these is that HEIs need to develop an understanding and code of practice for the use of this technology. Secondly, three strands of potential future research will be presente

Changes in Scottish suicide rates during the Second World War

BACKGROUND: It is believed that total reported suicide rates tend to decrease during wartime. However, analysis of suicide rates during recent conflicts suggests a more complex picture, with increases in some age groups and changes in method choice. As few age and gender specific analyses of more distant conflicts have been conducted, it is not clear if these findings reflect a change in the epidemiology of suicide in wartime. Therefore, we examined suicide rates in Scotland before, during and after the Second World War to see if similar features were present. METHODS: Data on deaths in Scotland recorded as suicide during the period 1931 – 1952, and population estimates for each of these years, were obtained from the General Register Office for Scotland. Using computer spreadsheets, suicide rates by gender, age and method were calculated. Forward stepwise logistic regression was used to assess the effect of gender, war and year on suicide rates using SAS V8.2. RESULTS: The all-age suicide rate among both men and women declined during the period studied. However, when this long-term decline is taken into account, the likelihood of suicide during the Second World War was higher than during both the pre-War and post-War periods. Suicide rates among men aged 15–24 years rose during the Second World War, peaking at 148 per million (41 deaths) during 1942 before declining to 39 per million (10 deaths) by 1945, while the rate among men aged 25–34 years reached 199 per million (43 deaths) during 1943 before falling to 66 per million (23 deaths) by 1946. This was accompanied by an increase in male suicides attributable to firearms and explosives during the War years which decreased following its conclusion. CONCLUSION: All age male and female suicide rates decreased in Scotland during World War II. However, once the general background decrease in suicide rates over the whole period is accounted for, the likelihood of suicide among the entire Scottish population during the Second World War was elevated. The overall decrease in suicide rates concealed large increases in younger male age groups during the War years, and an increase in male suicides recorded as due to the use of firearms. We conclude that the effects of war on younger people, reported in recent conflicts in Central Europe, were also seen in Scotland during the Second World War. The results support the findings of studies of recent conflicts which have found a heterogeneous picture with respect to age specific suicide rates during wartime

Biology, Fishery, Conservation and Management of Indian Ocean Tuna Fisheries

The focus of the study is to explore the recent trend of the world tuna fishery with special reference to the Indian Ocean tuna fisheries and its conservation and sustainable management. In the Indian Ocean, tuna catches have increased rapidly from about 179959 t in 1980 to about 832246 t in 1995. They have continued to increase up to 2005; the catch that year was 1201465 t, forming about 26% of the world catch. Since 2006 onwards there has been a decline in the volume of catches and in 2008 the catch was only 913625 t. The Principal species caught in the Indian Ocean are skipjack and yellowfin. Western Indian Ocean contributed 78.2% and eastern Indian Ocean 21.8% of the total tuna production from the Indian Ocean. The Indian Ocean stock is currently overfished and IOTC has made some recommendations for management regulations aimed at sustaining the tuna stock. Fishing operations can cause ecological impacts of different types: by catches, damage of the habitat, mortalities caused by lost or discarded gear, pollution, generation of marine debris, etc. Periodic reassessment of the tuna potential is also required with adequate inputs from exploratory surveys as well as commercial landings and this may prevent any unsustainable trends in the development of the tuna fishing industry in the Indian Ocean

Breast Cancer Disparities: A Multicenter Comparison of Tumor Diagnosis, Characteristics, and Surgical Treatment in China and the U.S.

Incidence of and mortality rates for breast cancer continue to rise in the People’s Republic of China. The purpose of this study was to analyze differences in characteristics of breast malignancies between China and the U.S

Pressure Load: The Main Factor for Altered Gene Expression in Right Ventricular Hypertrophy in Chronic Hypoxic Rats

BACKGROUND: The present study investigated whether changes in gene expression in the right ventricle following pulmonary hypertension can be attributed to hypoxia or pressure loading. METHODOLOGY/PRINCIPAL FINDINGS: To distinguish hypoxia from pressure-induced alterations, a group of rats underwent banding of the pulmonary trunk (PTB), sham operation, or the rats were exposed to normoxia or chronic, hypobaric hypoxia. Pressure measurements were performed and the right ventricle was analyzed by Affymetrix GeneChip, and selected genes were confirmed by quantitative PCR and immunoblotting. Right ventricular systolic blood pressure and right ventricle to body weight ratio were elevated in the PTB and the hypoxic rats. Expression of the same 172 genes was altered in the chronic hypoxic and PTB rats. Thus, gene expression of enzymes participating in fatty acid oxidation and the glycerol channel were downregulated. mRNA expression of aquaporin 7 was downregulated, but this was not the case for the protein expression. In contrast, monoamine oxidase A and tissue transglutaminase were upregulated both at gene and protein levels. 11 genes (e.g. insulin-like growth factor binding protein) were upregulated in the PTB experiment and downregulated in the hypoxic experiment, and 3 genes (e.g. c-kit tyrosine kinase) were downregulated in the PTB and upregulated in the hypoxic experiment. CONCLUSION/SIGNIFICANCE: Pressure load of the right ventricle induces a marked shift in the gene expression, which in case of the metabolic genes appears compensated at the protein level, while both expression of genes and proteins of importance for myocardial function and remodelling are altered by the increased pressure load of the right ventricle. These findings imply that treatment of pulmonary hypertension should also aim at reducing right ventricular pressure