Dibyendu De

Incidence and risk factors of immune reconstitution inflammatory syndrome in HIV-TB coinfected patients

UNLABELLED Tuberculosis is one of the leading causes of development of Immune reconstitution inflammatory syndrome (IRIS) in HIV patients receiving antiretroviral therapy (ART). OBJECTIVE To determine the incidence of IRIS in HIV-TB coinfected patients, and to find out the possible risk factors associated with IRIS. MATERIALS AND METHODS Study commenced with 96 patients adhered to standard antitubercular therapy (ATT) and ART without defaulting, and followed up for six months. RESULT The mean (± SD) CD4 count and CD4 percentage at baseline was 59.16 (± 24.63) per mm³ and 4.59% (± 1.73) respectively. Only 18.75% developed IRIS after 57.05 (± 14.12) days of initiation of ART. Extrapulmonary tuberculosis was the most significant factor associated with IRIS (83.33%) than those without IRIS (44.87%) (p = 0.0032). Specifically, tubercular lymphadenitis (38.88%, p = 0.0364) and disseminated tuberculosis (33.33%, p = 0.0217) were significantly associated with IRIS. The other risk factors associated with appearance of IRIS were higher CD4 count (p = 0.0212) at three months after initiation of ART and increment of CD4 count (p = 0.0063) and CD4 percentage (p = 0.0016) during this period. The major manifestations of IRIS were fever (40%), followed by lymphadenitis (38%). The mortality rate in IRIS was not higher than those without IRIS. CONCLUSION Patients with extrapulmonary tuberculosis, especially tubercular lymphadenitis, were more likely to develop IRIS and fever was associated in most of them. Higher increment of CD4 count may indicate development of IRIS in presence of new or worsening tuberculosis lesion.

Musculoskeletal involvement in leprosy

Abstract Introduction Leprosy classically presents with cutaneous and neurological involvement, though musculoskeletal symptoms may be the initial symptom. Methods The study was conducted on 102 patients with leprosy to determine the prevalence and spectrum of rheumatological diseases in this group. Eighty four patients were referred from leprosy clinic and 18 patients presented first in rheumatology clinic with arthritic symptoms and were later diagnosed to have leprosy. Results In the first group, symmetrical polyarthritis involving the large and small joints, similar to rheumatoid arthritis was the most common manifestation. Whereas in the second group, tenosynovitis was the commonest presentation. Rheumatoid factor was positive in 72 (70%) cases. Discussion Variety of musculoskeletal symptoms were found in patients with leprosy and many of them were associated with Lepra reaction.

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome in a tertiary care hospital: A retrospective analysis

Background Remitting seronegative symmetrical synovitis with pitting edema (RS 3 PE) affects mainly elderly males, characterized by acute onset pitting edema of hands, negative rheumatoid factor and excellent result with short course of low dose corticosteroid therapy. Objective To re-evaluate the clinical, laboratory features, management, and ultimate disease progression of RS 3 PE cases in rheumatology clinic in tertiary care hospital and compare results with previous literature. Methods We selected the patients of RS 3 PE in the Rheumatology clinic, Medical College, Kolkata, between 1 January 2002 and 1 January 2010 and followed them up. Results Among the cases reviewed 23 were female patients and 12 were male patients with mean (SD) age of 54.74 (3.03) and 58.33 (5.33) years, respectively. Oral Hydroxychloroquine was started in all, giving a satisfactory result in 21 patients; rest of the 14 patients needed additional corticosteroid, to alleviate musculoskeletal symptoms. Baseline mean (SD) C-reactive protein and erythrocyte sedimentation rate were 21.63 (2.08) mg/L and 81.34 (9.29) mm/hr, respectively, and reduced to 3.23 (0.95) mg/L and 17.43 (5.55) mm/hr, respectively, following therapy. During follow-up, musculoskeletal symptoms relapsed in 17 patients, seven (20%) of them were found to be associated with malignancy. At the time of last visit during the follow-up period, only four patients developed definite arthropathy (one seronegative rheumatoid arthritis, three undifferentiated spondyloarthropathy), rest of the 31 cases were remitted. Conclusion Regarding RS 3 PE, results of our study showed similarity with previous reports excepting the gender. Hydroxychloroquine has been proved as a good steroid-sparing agent in RS 3 PE. This study supported the association of RS 3 PE with malignancy in the previous literatures.

Assessment of the efficacy of pulse Ibandronate therapy in non-steroidal anti-inflammatory drug refractory ankylosing spondylitis: An open prospective study

Abstract Background Amino-bisphosphonates like Pamidronate, having weak anti-Tumour Necrosis factor (TNF)-alpha property is effective in ankylosing spondylitis (AS). Objective To assess the efficacy of intravenous pulse Ibandronate, another bisphosphonate, in non-steroidal anti-inflammatory drug (NSAID) refractory/intolerant AS, as it is cheaper, requires less frequent dosing and is easily available. Methods Thirty-four patients, diagnosed as AS by Modified New York Criteria, having Bath AS Disease Activity Index (BASDAI) ≥ 4 (i.e. active disease) and NSAID refractory/intolerant, received six doses of injection Ibandronate (3 mg) intravenously, three monthly, for 15 months. Patients with peripheral arthritis were given sulfasalazine along with Ibandronate. Outcome assessed comparing baseline and final BASDAI, Bath AS metrology index (BASMI), Bath AS functional index (BASFI), Bath AS global score (BAS-G), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Response defined according to assessments in ankylosing spondylitis (ASAS)-20 and BASDAI-50, and, reduction in tender and swollen joint counts in patients with peripheral arthritis. Results Twenty-eight patients received all six doses. Twenty-one (75%) and 23 (82%) patients achieved BASDAI-50 and ASAS-20 responses, respectively. Significant reductions in mean BASDAI (48.36%), BASMI (55.08%), BASFI (47.03%), BASG (47.47%), ESR (49.24%) and CRP (66.38%) were noted after 15 months. Ten patients having peripheral joint involvement had significant decrement in swollen (67.74%) and tender (57.14%) joint counts. Conclusion Intravenous Ibandronate has reasonable efficacy in the treatment of AS.