| Immunology |
1. The Clinical Spectrum of Sarcoidosis D Santosh Kumar, V Shobha Sarcoidosos is a chronic multi system disorder of unknown cause characterized by noncaseating granuloma that can infiltrate any oran. Sarcoidosis can affect individuals of both sexes almost all ages, races and geographic locations. Materials and Methods : Records of 40 patients seen both on OPD and Inpatient basis between 2000-2007 April were analyzed in terms of symptoms, organ systems involved, investigations including ACE, Calcium levels, treatment given, side effects of therapy and outcomes. Results : Lungs were most commonly involved (52.5%) followed by joint (47.5%) skin (45%) and eye (25%) involvement. There were also 3 cases with neurosarcoid. Though many patients had radiological evidence of lung involvement it caused clinical symptoms less commonly. Most common reason for outpatient consultation were skin and joint symptoms while most common cause for in patient admission were respiratory symptoms. Among joints knee most commonly involved. Erythema nodosum was the most common skin ailment. ACE levels were inconsistent with clinical picture with only 33% showing high levels. Most patients responded to steroids though they had recurrence or relapse on tapering the dose or stopping treatment. Hydroxychloroquine, azathioprine, methotrexate were other drugs found useful. Conclusions : Sarcoidosis is a chronic disease with remitting course, which needs awareness and high degree of suspicion among physicians. Diagnosis is mainly clinical than laboratory. If identified and treated and monitored carefully, outcome is better. 2. A Comparison of Lipid Profile in PLHA on HAART and Those without It V Rampal, SK Gupta, SS Soodan Objectives : HIV/AIDS now presenting as global pandemic is engulfing or sub-continent in enormous proportions. In west 25% to 75% of deaths (autopsy) are related to cardiovascular events, with dyslipidemia, a major constituent. No Indian data are available on this subject. Dyslipidemia being a common complication of HAART and hence a need to study its prevalence and measures for its prevention/management due to high cost of lipid lowering drugs. Methodology : Fifty PLHA on HAART and an equal number of matched PLHA not on HAART were followed for a period of 27 months. All baseline tests including a lipid profile were carried out at the beginning. The lipid profile was repeated every 3 months and other tests when needed. Complication if any were managed and the offending drug replaced if necessary. Summary : In HAART group 3 patients had a rise in total cholesterol after 9 months, 2 after 12 months and 5 after 18 months which stabilized thereafter till end. Two patients had a rise in Triglycerides after 6 months, 3 after 9 months and 3 after 15 months which stabilized thereafter. One patient developed pancreatitis which was treated and the offending drug replaced, another showed fatty infiltration of liver needing drug replacement.In non HAART group cholesterol rose in 2 patients after 6 months in 2 after 15 months and 1 after 18 months which stabilized thereafter. Two patients had rise in Triglycerides after 15 months and 1 after 18 months which stabilized thereafter. Not much differences were observed in LDL, HDL or VLDL levels. Conclusion : HAART especially thymidines are notorious for dyslipidemia leading to adverse cardiovascular events, hence a necessity to treat with costly lipid lowering drugs. In this study except for two complications (probably alcoholic, drivers) not much differences were observed in the complications in two groups. Even in the absence of lipid lowering drugs no adverse cardiovascular events occurred. Could the mortality in western population be due to other factors like genetic, dietary, environment or stress etc? A larger and longer follow-up of this continuing study may give some answer! 3. Systemic Sclerosis – A Clinical Perspective JM D’Souza, J Rajendran, J Elizabeth, V Shobha Systemic sclerosis is a multiorgan disease that is associated with considerable morbidity. There are considerable differences across studies in eligibility criteria, definitions of manifestations, pattern of systemic involvement and outcomes. In this retrospective study we evaluated 50 patients with systemic sclerosis admitted at a tertiary care hospital over the past 5 years. Results : The average age was 31.20 years. More than 90% of our patients were women. The duration of illness prior to presentation was between 3 months and 10 years. Clinical features included Raynauds phenomena (68%), skin thickening (60%), arthralgia (48%) gangrene of digit tip (18), telangiectasia (12%) and sclerodactyly (10%). Investigations revealed anaemia in 24% of these patients, varying ANA positivity patterns (14% - homogenious, 10% - nucleolar, 30% - speckeled) and varying immunoline positivity (Scl-70 in 20%, RNP in 20%, anti-centromere antibody in 10%). Clinical involvement included predominant pulmonary manifestations among 24% patients followed by gastrointestinal involvement among 18% and renal involvement among 4% patients. Discussion : In comparison to western studies pulmonary involvement was found to be common among our patients with systemic sclerosis. Conclusion : Systemic sclerosis is an uncommon disorder. This study attempts to evaluate patterns of organ involvement. |