Abhishek Agrawal

Carotid Intima Media Thickness as a Marker of Atherosclerosis in Ankylosing Spondylitis

Aim. Increased cardiovascular morbidity and mortality have been observed in ankylosing spondylitis because of accelerated atherosclerosis. We measured carotid intima media thickness (CIMT) as a surrogate marker of atherosclerosis in this study. Methods. In this study 37 cases of AS and the same number of matched individuals were recruited. CIMT measurements were done using B-mode ultrasound. Disease activity was assessed using Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), and Bath ankylosing spondylitis metrological index (BASMI) scores and C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels. Results. Mean age of the study groups was 29.43 ± 9.00 years. Average disease duration was 65.62 ± 54.92 months. Twenty-eight (75.68%) of cases were HLA B-27 positive. A significantly increased CIMT was observed in cases as compared to control group (0.62 ± 0.12 versus 0.54 ± 0.04; P < 0.001). CIMT in the cases group positively correlated with age (r = 0.357; P < 0.05), duration of disease (r = 0.549; P < 0.01), and BASMI (r = 0.337; P < 0.05) and negatively correlated with ESR (r = −0.295; P < 0.05). Conclusions. Patients of AS had a higher CIMT than those of the control group. CIMT correlated with disease chronicity.

A study of an influenza A (H1N1)pdm09 outbreak in pregnant women in Rajasthan, India

To describe the clinical and epidemiological factors of influenza A (H1N1)pdm09‐infected patients who were pregnant or in the puerperal period during a recent influenza outbreak in Rajasthan, India.

Ultrasonographic evaluation of joint involvement in rheumatoid arthritis: Comparison with conventional radiography and correlation with disease activity parameters

Background: Ultrasound (US) including power Doppler (PD) are increasingly being used to evaluate joint involvement in rheumatoid arthritis (RA). Aim of this study was to evaluate joint involvement in RA by US including PD and gray scale imaging and its comparison with conventional radiographic changes and correlation with disease activity parameters. Methods: Patients with RA of less than 3.5 years disease duration were subjected to detailed clinical examination and laboratory investigations. After X-ray imaging (posterior-anterior view) of both hand joints, PD and gray scale US examination of 14 joints of both hands was performed and mean cumulative flow signal score (CFS) was calculated. Disease activity score (DAS28) was also calculated for each patient. Results: Out of total 57 patients evaluated, 54 had abnormal findings on US as compared to only 17 having radiographic abnormalities. US could detect erosions in 29 patients including all of the fourteen patients who had radiographically detectable erosions. On US evaluation, radiocarpal joint was involved most frequently. The mean CFS was 1.17 ± 1.64 in patients who were in remission (DAS28 5.1). The difference in CFS among these groups was statistically significant (P < 0.01). In 5 out of 12 patients with DAS28 <2.6, i.e., in remission, CFS were high showing subclinical synovitis. Mean CFS correlated significantly with DAS28 (r = +0.42, P < 0.05); C-reactive protein (r = +0.50, P < 0.05); and erythrocyte sedimentation rate (r = +0.39, P < 0.05). Conclusions: US detected CFS which an indicator of ongoing inflammation in RA patients with clinical remission (DAS28 <2.6). US is more sensitive than conventional radiography for detection of erosions. CFS on PD had a significant correlation with markers of disease activity.

Serum C-peptide level as a predictor of atherosclerosis and cardiovascular disease in type 2 diabetes mellitus

Objective: To assess the correlation of serum C-peptide level to carotid intima media thickness (a surrogate marker of atherosclerosis) and risk of developing cardiovascular disease (CVD) in type 2 diabetes patients as determined by United Kingdom Prospective Diabetes Study (UKPDS) risk engine. Materials and Methods: About 101 cases of diabetes mellitus (DM) type 2 (diagnosed according to American Diabetes Association 2007 criteria) were subjected to detail clinical examination and laboratory investigations. The intima media thickness of both carotid arteries (CIMT) was measured for each patient with color Doppler. The risk of CVD was calculated using UKPDS risk engine. Observations: Age of subjects, glycated hemoglobin (HbA1c), body mass index (BMI), levels of systolic blood pressure (SBP), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-DL (LDL), homocysteine, CIMT, and the 10 years CVD risk according to the UKPDS were significantly different across the C-peptide quartiles (P for trend <0.05). Significant positive correlations of C-peptide levels were found with age of subjects, duration of DM, BMI, fasting plasma glucose, HbA1c, SBP, TC, TG, LDL, and homocysteine. Significant negative correlation of C-peptide levels was observed with HDL. C-peptide levels had significant positive correlation with CIMT (atherosclerosis) and 10 years CVD risk (future CVD) by UKPDS risk engine. Conclusions: Serum C-peptide level seems to be significantly related to the development of atherosclerosis and future CVD in type 2 DM. It may be used as a predictor of subclinical atherosclerosis and CVD in these patients.