Immunofluorescence pattern of antinuclear antibody and its association with autoantibody profile in systemic lupus erythematosus

Background: Antinuclear antibody (ANA) is useful in the diagnosis of systemic lupus erythematosus (SLE). Association of specific autoantibodies with the immunofluorescence pattern of ANA in SLE as noted in Western literature has been taken as reference in all over the world. However, in Bangladesh such research work or data correlating the autoantibodies and their ANA patterns is inadequate. Objective: To identify an association between immunofluorescence patterns of antinuclear antibody on HEp-2 cell and more specific antinuclear reactivities (e.g. anti-dsDNA and anti-extractable nuclear antigen) in the serum samples of SLE patients.Methods: Serum samples of 37 SLE patients who were diagnosed by ARA (American Rheumatism Association) classification criteria and laboratory tests, attending at lupus clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) during the study period of six months were subjected for ANA testing by Indirect Imrnunofluorescence (IIF) on HEp-2 cell, anti-dsDNA by ELISA and anti- extractable nuclear antigen (anti-ENA) by Dot Immunoblot. Dot blot strips were tested for anti-Sm, anti-RNP, anti-SSA/Ro, and anti-SSB/La. Results: Out of 37 SLE patients 32 (86.5%) cases were ANA positive by IIF on HEp-2 cell. ANA positive sera exhibited three fluorescence patterns such as speckled (43.7%), peripheral (34.3%) and homogenous pattern (21.8%). Peripheral pattern (100%) was strongly associated with anti-dsDNA (p<0.05) and homogenous pattern (85.7%) was also predominantly associated with anti-dsDNA (p<0.05). Speckled pattern (85.6%) was significantly associated with anti-ENA (p<0.05). Anti-dsDNA was positive in 75% of SLE cases and majority (45.8%) of which showed peripheral pattern whereas anti-ENA was positive in 48.6% cases and majority (70.5%) of which showed speckled pattern. The most commonly identified antinuclear autoreactivity was directed towards anti-RNP (22.2%) then anti-Sm (16.6%), anti-SSA (16.6%) and anti-SSB (11.1 %). Multiple anti-ENA reactivities were identified in 33.3% cases. Conclusion: Peripheral and homogenous pattern is strongly associated with anti-dsDNA therefore may be predicted that patients have active SLE and speckled pattern may predict anti-ENA (specially ribonucleoprotiens). Thus, ANA-IIF method may suffice and probably reduce the expense of detailed immunological work-up with minimal loss in diagnostic accuracy

Lymphoedema Presenting with Pleural Effusion: A Case Report

Lymphatic obstruction either congenitally determined (primary) or by a consequence of acquired lymphatic failurebecause of obstruction or damaged lymphatics (secondary). Milroy disease is an example of primary lymphoedemawhere edema is present at birth or soon thereafter. A 16 year old young boy presented with bilateral leg with scrotaloedema since birth with ups and downs of his symptoms. According to the statement of the mother the boy was seen byseveral physicians and also attended several tertiary hospitals in Dhaka city and eventually was diagnosed as a case ofMilroy disease in 2003. Patient was in a reasonably stable condition till July 2008 when he developed massive pleuraleffusion on right side and chylous fluid was aspirated. After that he developed five episodes of right sided pleuraleffusion at one to three month interval. Thoracic surgeon was consulted and intra thoracic tube drainage and pleurodesiswas done on 19. 02. 2009. After couple of weeks repeat chest x-ray revealed left sided pleural effusion and again left sidedpleurodesis was performed. He is now clinically stable except mild oedema in his both feet.DOI: 10.3329/bsmmuj.v3i1.5514BSMMU J 2010; 3(1): 40-4

Lymphoedema Presenting with Pleural Effusion: A Case Report

Lymphatic obstruction either congenitally determined (primary) or by a consequence of acquired lymphatic failurebecause of obstruction or damaged lymphatics (secondary). Milroy disease is an example of primary lymphoedemawhere edema is present at birth or soon thereafter. A 16 year old young boy presented with bilateral leg with scrotaloedema since birth with ups and downs of his symptoms. According to the statement of the mother the boy was seen byseveral physicians and also attended several tertiary hospitals in Dhaka city and eventually was diagnosed as a case ofMilroy disease in 2003. Patient was in a reasonably stable condition till July 2008 when he developed massive pleuraleffusion on right side and chylous fluid was aspirated. After that he developed five episodes of right sided pleuraleffusion at one to three month interval. Thoracic surgeon was consulted and intra thoracic tube drainage and pleurodesiswas done on 19. 02. 2009. After couple of weeks repeat chest x-ray revealed left sided pleural effusion and again left sidedpleurodesis was performed. He is now clinically stable except mild oedema in his both feet.DOI: 10.3329/bsmmuj.v3i1.5514BSMMU J 2010; 3(1): 40-4

Immunofluorescence pattern of antinuclear antibody and its association with autoantibody profile in systemic lupus erythematosus

Background: Antinuclear antibody (ANA) is useful in the diagnosis of systemic lupus erythematosus (SLE). Association of specific autoantibodies with the immunofluorescence pattern of ANA in SLE as noted in Western literature has been taken as reference in all over the world. However, in Bangladesh such research work or data correlating the autoantibodies and their ANA patterns is inadequate. Objective: To identify an association between immunofluorescence patterns of antinuclear antibody on HEp-2 cell and more specific antinuclear reactivities (e.g. anti-dsDNA and anti-extractable nuclear antigen) in the serum samples of SLE patients. Methods: Serum samples of 37 SLE patients who were diagnosed by ARA (American Rheumatism Association) classification criteria and laboratory tests, attending at lupus clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) during the study period of six months were subjected for ANA testing by Indirect Imrnunofluorescence (IIF) on HEp-2 cell, anti-dsDNA by ELISA and anti- extractable nuclear antigen (anti-ENA) by Dot Immunoblot. Dot blot strips were tested for anti-Sm, anti-RNP, anti-SSA/Ro, and anti-SSB/La. Results: Out of 37 SLE patients 32 (86.5%) cases were ANA positive by IIF on HEp-2 cell. ANA positive sera exhibited three fluorescence patterns such as speckled (43.7%), peripheral (34.3%) and homogenous pattern (21.8%). Peripheral pattern (100%) was strongly associated with anti-dsDNA (p<0.05) and homogenous pattern (85.7%) was also predominantly associated with anti-dsDNA (p<0.05). Speckled pattern (85.6%) was significantly associated with anti-ENA (p<0.05). Anti-dsDNA was positive in 75% of SLE cases and majority (45.8%) of which showed peripheral pattern whereas anti-ENA was positive in 48.6% cases and majority (70.5%) of which showed speckled pattern. The most commonly identified antinuclear autoreactivity was directed towards anti-RNP (22.2%) then anti-Sm (16.6%), anti-SSA (16.6%) and anti-SSB (11.1 %). Multiple anti-ENA reactivities were identified in 33.3% cases. Conclusion: Peripheral and homogenous pattern is strongly associated with anti-dsDNA therefore may be predicted that patients have active SLE and speckled pattern may predict anti-ENA (specially ribonucleoprotiens). Thus, ANA-IIF method may suffice and probably reduce the expense of detailed immunological work-up with minimal loss in diagnostic accuracy

Advancement of chitin and chitosan as promising biomaterials

Biopolymers like cellulose, polysaccharides, chitosan, starch, chitin, and alginates have sparked an increasing curiosity in creating natural replacements for synthetic polymers during the last several decades. Chitin is a major part of fungi’s cell walls, the crustaceans’ exoskeletons, like lobsters, crabs, and shrimps, cephalopod beaks, the radulae of mollusks, and fish and lissamphibians scales. Since the late 1970 s, biopolymer chitosan has gathered interest in basic science and applied research due to its incredible macromolecular framework, physicochemical properties, and biological activities, which differ from those of synthetic polymers. Chitin and derivatives thereof have practical usages in chemistry, the agriculture sector, medicine, cosmetics, as well as textile and paper industries. Chitosan has also received a lot of recent interest in the fields of dentistry, ophthalmology, veterinary science, biomedicine, the drink industry, hygiene and personal care, catalysis, chromatography, sewage treatment, and biotechnology. Numerous fundamental investigations have been conducted on chitin and chitosan. This article presents a short compact summary of research over the last two decades in an attempt to highlight the works on chitin and chitosan applications

The knowledge level of rheumatoid arthritis patients about their disease in a developing country: A study in 168 Bangladeshi RA patients

Objectives To assess disease-related knowledge of rheumatoid arthritis (RA) patients Patients and methods Consecutive RA patients were invited from the rheumatology departments of BSMM University, Dhaka, Bangladesh. The Bangla version of the Patient Knowledge Questionnaire (B-PKQ) was used. Correlations between the B-PKQ scores and clinical-demographic data were measured using Pearson’s correlation coefficient. Impact of independent variables on the level of knowledge about RA was analyzed through multiple regression analysis. Possible explanatory variables included the following: age, disease duration, formal education level, and Bangla Health Assessment Questionnaire (B-HAQ) score. Analysis of variance (ANOVA) was used to test the difference between demographical, clinical, and socioeconomic variables. For statistical analysis, SPSS statistics version 20 was used. Results A total of 168 RA patients could be included. The mean B-PKQ score was 9.84 (range 1–20) from a possible maximum of 30. The mean time for answering the questionnaire was 24.3 min (range 15–34). Low scores were observed in all domains but the lowest were in medications and joint protection/energy conservation. Knowledge level was higher (15.5) in 6 patients who had RA education before enrollment. B-PKQ showed positive correlation with education level (r = 0.338) and negative correlation with HAQ (r = −0.169). The B-PKQ showed no correlation with age, disease duration, having first degree family member with RA, education from other sources (neighbor, RA patient, nurses), or information from mass media. Conclusions Disease-related knowledge of Bangladeshi RA patients was poor in all domains. Using these findings, improved education and knowledge will result in better disease control