Adipokines: mediators of immunity and inflammation

White adipose tissue has emerged as a highly dynamic organ that releases a plethora of immune and inflammatory mediators that are involved in obesity, metabolic syndrome and immune mediated diseases. Adipokines have complex role in various physiological and pathological processes by exerting potent modulatory actions on target tissues In this Review, In this review, we explore the effects of different adipokines, focusing primarily on leptin, adiponectin, visfatin and resistin in causing immune-mediated and/or inflammatory diseases

An observational study on pneumococcal and influenza vaccination status of patients with type 2 diabetes mellitus

Background: India has more than sixty million subjects with diabetes. Diabetes confers an increased risk of developing and dying from infectious diseases with an enhanced susceptibility to morbidity, mortality and hospitalizations due to influenza and pneumococcal disease. The Advisory Committee on Immunization Practices (ACIP) recommends influenza and pneumococcal vaccines for all individuals with diabetes.Methods: Around 249 patients with type 2 diabetes mellitus were enrolled in the study. All patients were asked a detailed history about diabetes, its duration, type of diabetes and the vaccinations for influenza and pneumococcus, who suggested vaccination and the reasons for declining the vaccination if it had been medically advised. Any other co-morbid condition such as hypertension, diabetes mellitus, heart disease, COPD, hypothyroidism and CKD were noted.Results: Vaccination rates for influenza in patients aged 50 or more were higher (7.6% of 172 patients) as compared to those aged <50 years (0% of 77); (p=0.013) whereas pneumococcal vaccination rates were 8.1% as against 1.3% (p=0.036) respectively. In males the vaccination rates for influenza were 4.7% compared to females (5.8%); (p=0.675), whereas for pneumococcus the respective vaccination rates were 6.2% for male and 5.8% for female (p=0.903). Vaccination uptake among male and female were almost same. Patients having chronic kidney disease on dialysis were having highest vaccination rate.Conclusions: The poor vaccination uptake for influenza and pneumococcus in patients with diabetes, calls for intensive efforts aimed at increasing coverage

A study of prevalence of peripheral arterial disease in type 2 diabetes mellitus using ankle-brachial index and its correlation with coronary artery disease and its risk factors

Background: Peripheral arterial disease (PAD) is one of the macrovascular complications of type 2 diabetes mellitus (T2DM). There is significant difference in the reported prevalence of PAD and its associated risk factors between Indian and Western studies. The purpose of this study was to examine the PAD complicating T2DM, in particular the influence of PAD on the risk of CAD.Methods: Randomly selected 100 T2DM patients presented to Guru Nanak Dev hospital were included. In addition to a detailed history and physical examination, anthropometric parameters like body mass index was measured. CAD in patients was diagnosed by a history of angina, ECG changes, any past history of CAD or any treatment taken for CAD. Ankle brachial index (ABI) was measured. Data was collected systematically and analyzed according to the standard statistical methods.Results: The prevalence of PAD was 15%. CAD was present in 31%. PAD was found to be significantly correlated with age, duration of diabetes, smoking, systolic blood pressure, diastolic blood pressure, prevalence of BMI &gt;25 kg/m2, HbA1c and serum HDL ≤40 mg%. Old age, high HbA1c level, and dyslipidaemia were found to be significant independent predictors of CAD.Conclusions: Using ABI authors found evidence of PAD in 15% patients of T2DM. The prevalence of CAD was higher in patients with PAD. So, there is definite and strong correlation between PAD and CAD. Thus, the early diagnosis of PAD should alert the clinician to a high probability of underlying CAD

Systemic flare and cutaneous ulceration following cytomegalovirus infection in a patient with anti-melanoma differentiation-associated protein 5 (MDA5) associated myositis: Diagnostic challenge during the time of coronavirus disease (COVID-19) pandemic

Background: Anti-melanoma differentiation-associated protein 5 (MDA5) associated idiopathic inflammatory myopathy (IIM) often manifests with minimal muscle weakness and rapidly progressive interstitial lung disease (RP-ILD) with a poor prognosis. The clinical presentation may be varied in different ethnic groups. The ongoing coronavirus disease (COVID-19) pandemic has made management even more challenging as certain manifestations may be difficult to diagnose remotely. Aim of the work: To throw light on the rare association of CMV infection in established anti-MDA5 myositis with severe consequences. Similar cases were presented and compared. Case report: A 42-year-old lady presented with heliotrope rash, periorbital edema, ulcerated Gottron’s papules, proximal muscle weakness and intermittent fever of six-month duration. Anti-MDA5 antibodies were positive. Active disease, including myocarditis and RP-ILD, were challenging to diagnose on teleconsultation. Upon initiating tofacitinib, cytomegalovirus (CMV) polymerized chain reaction (PCR) came positive. Ganciclovir was started with the possibility of viral activation being the potential driving force for interferon pathway activation and dermatomyositis (DM) flare, but the patient succumbed to the illness. Conclusion: Viral triggers are known to induce autoimmune disease in the genetically predisposed. However, CMV infection in established anti-MDA5 myositis is uncommon and further association with myocarditis is a rare occurrence. Ulcerated Gottron’s and periorbital oedema may carry a sinister connotation in Indians with anti-MDA5 DM, with worse manifestations such as myocarditis– which albeit rare, can be fatal

Individuals with reactive arthritis suffer from poor health-related quality of life akin to individuals with ankylosing spondylitis:A multigroup study

Background: Reactive arthritis (ReA) and ankylosing spondylitis (AS), both spondyloarthropathies predominantly affecting young men seriously hamper mobility during the active phases of disease. While AS is thoroughly researched, specific studies on ReA are relatively scarce despite its pervasive nature and ever evolving epidemiology. Thus, it is imperative to understand the quality of life (QoL) of ReA patients in comparison to those with AS and healthy controls (HC) to reduce the disparity in patient care. Methods: An inception cohort of adults with ReA (Braun's criteria) was surveyed to collect the data on demographics, clinical profile, disease activity (Bath AS Disease Activity Index [BASDAI], pain Visual Analog Scale [VAS]), functional status Bath AS Functional Index (BASFI), and QoL (ASQoL instrument) between November 2019 and January 2020. HC and AS were surveyed for the same parameters using an anonymized e-survey (SurveyMonkey.com). All the data are expressed as medians and interquartile range. Results: A total of 147 participants (62 ReA, 45 AS and 40 HC) were included. Patients with ReA were younger than those with AS and HC-25, 29, and 28 years, respectively, and had a shorter disease duration (P &lt; 0.0001). Baseline clinical characteristics (peripheral arthritis and enthesitis), pain VAS (body pain and back pain) were comparable in ReA and AS groups. All the clinical characteristics of ReA and AS cohorts were significant in comparison to the HC cohort. Notably, functional and activity scores of AS and ReA patients were similar, whereas all functional scores of patients with either spondyloarthropathy were significantly worse than HC (BASDAI, BASFI, ASQoL, P &lt; 0.0001). ASQoL scores were comparable across all domains of ReA and AS except in upper limb activities where patients with ReA fared better than AS. No difference in QoL was observed between acute or chronic ReA. Conclusion: QoL in ReA and AS is comparable, thus the impact of disease on physical function must be recognized to improve patient care. Patients with ReA exhibit significantly worse QoL than HC using ASQoL instrument.</p