Mahasampath Gowri

Weight Gain and Height Growth during Infancy, Childhood, and Adolescence as Predictors of Adult Cardiovascular Risk

Objectives To investigate independent relationships of childhood linear growth (height gain) and relative weight gain to adult cardiovascular disease (CVD) risk traits in Asian Indians. Study design Data from 2218 adults from the Vellore Birth Cohort were examined for associations of cross‐sectional height and body mass index (BMI) and longitudinal growth (independent conditional measures of height and weight gain) in infancy, childhood, adolescence, and adulthood with adult waist circumference (WC), blood pressure (BP), insulin resistance (homeostatic model assessment‐insulin resistance [HOMA‐IR]), and plasma glucose and lipid concentrations. Results Higher BMI/greater conditional relative weight gain at all ages was associated with higher adult WC, after 3 months with higher adult BP, HOMA‐IR, and lipids, and after 15 years with higher glucose concentrations. Taller adult height was associated with higher WC (men &bgr; = 2.32 cm per SD, women &bgr; = 1.63, both P < .001), BP (men &bgr; = 2.10 mm Hg per SD, women &bgr; = 1.21, both P ≤ .001), and HOMA‐IR (men &bgr; = 0.08 log units per SD, women &bgr; = 0.12, both P ≤ .05) but lower glucose concentrations (women &bgr; = −0.03 log mmol/L per SD P = .003). Greater height or height gain at all earlier ages were associated with higher adult CVD risk traits. These positive associations were attenuated when adjusted for adult BMI and height. Shorter length and lower BMI at birth were associated with higher glucose concentration in women. Conclusions Greater height or weight gain relative to height during childhood or adolescence was associated with a more adverse adult CVD risk marker profile, and this was mostly attributable to larger adult size.

Xpert MTB/Rif for the diagnosis of extrapulmonary tuberculosis – an experience from a tertiary care centre in South India

The Xpert MTB/Rif, with a detection limit of 131 CFU/ml, plays a valuable role in the diagnosis of extrapulmonary tuberculosis, both susceptible and resistant. This study aims at evaluating the Xpert MTB/Rif for the same, at a tertiary care centre in south India, assessing it against both culture and a composite gold standard (CGS).

The impact of hearing loss in the life of adults: A comparison between congenital versus late onset hearing loss

Aim of the Study: The aim of our study was to compare the impact of hearing loss in the life of adults who had congenital hearing loss with that of adults with acquired adult onset hearing loss (auditory neuropathy). Methodology: The quality of life scale questionnaire was administered on two groups. One group consisted of 10 adults with prelingual bilateral severe to profound hearing loss identified before the age of 3 years and who were using hearing aids and had received regular intervention for speech and language development by a qualified speech language pathologist. Second group consisted of 10 adults with auditory neuropathy. Results and Discussion: Wilcoxon rank sum test was used to compare the domains across the groups and the gender distributions between two groups were analyzed using Fisher′s exact test. The results revealed that differences between the adults with early-onset hearing loss and late onset hearing loss was statistically significant for most of the domains. The results indicated the fact that accepting a hearing loss during adulthood leads to more psychological trauma than adjusting and living with the hearing loss from the early years of life. Loss of hearing is quite traumatic to adults. Psychological trauma that they undergo is as important as their physiological problem and psychological referral to a clinical psychologist may be beneficial to many of them.

Study of clinical utility of antibodies to phosphatidylserine/prothrombin complex in Asian-Indian patients with suspected APS

Antiphospholipid syndrome (APS) is the most common acquired pro-thrombotic disorder, also associated with obstetric complications. Phosphatidylserine/Prothrombin complex antibody (aPSPT) though associated with various APS manifestations, is not included in the revised Sapporo Criteria. To study the prevalence of aPSPT in Asian-Indian patients with suspected APS and compare its performance with the criteria anti-phospholipid antibodies (APLs). Electronic charts of 372 individuals whose sera was tested for aPSPT in suspected APS between June 2014 and May 2016 were retrieved and analyzed. aPSPT was assayed by ELISA. aPSPT tested individuals were categorized into cases—seropositive and seronegative APS (SNAPS) and controls. aPSPT was positive in 24/58 (41.3%) cases and 17/314 (5.4%) controls (p < 0.001). aPSPT positivity was seen in 44.5%, 38.7%, and 58.4% in primary, secondary and SNAPS patients respectively. aPSPT had the best performance among all APLs, in obstetric APS with 31% sensitivity, 97.7% specificity, and an odds ratio of 18.8. It showed 41.4% sensitivity, 94.6% specificity for the classification/diagnosis of primary APS and 38.7% sensitivity, 91.5% specificity for secondary APS. Addition of aPSPT to current APS criteria to SNAPS patients led to reclassification of additional 12.1% patients as APS overall and 42.8% in obstetric APS category. In Asian-Indian patients with suspected APS, aPSPT outperformed all classical APLs in diagnosis/classification of obstetric APS and both isotypes of beta 2-glycoprotein-I antibodies in diagnosis/classification of APS. aPSPT could reclassify additional 12.1 and 42.8% patients as APS overall and obstetric APS respectively, over and above the cases satisfying revised Sapporo criteria.

62 Study of clinical utility of antibodies to phosphatidylserine/prothrombin complex in indian patients

Background and aims To explore utility of Antibodies to Phosphatidylserine/Prothrombin Complex (aPSPT), in Indian Anti phospholipid Syndrome (APS) patients. Methods Data of 372 subjects whose sera was tested for aPSPT by ELISA (AESUKU,GERMANY), was retrospectively analysed. Performance of various APLs was compared using non-parametric tests. To ascertain additional utility of aPSPT, patients with suspected APS were categorised into 2 groups i.e. i) those with any one of criteria antibodies positive ii) those with any one APL positivity including anti- PSPT positivity. Results In 46 patients of APS, 38 (82.60%) had thrombotic events (21 arterial , 26 venous) and 11 ( 23.91%) had obstetric events. Lupus anticoagulant was present in 37/46 (80.43%) ,anticardiolipin antibody in 19/46 (41.33%), aPSPT in 17/46 (36.95%), anti-β2glycoprotein1 (β2GP1) IgG and IgM in 13/46 (28.26%) and 7/46 (15.21%) patients of APS respectively. aPSPT tested positive in 9/60 (15%) patients with seronegative APS (SNAPS). aPSPT did not differ from other criteria APLs in any clinical parameter except compared to those with IgM B2GP-1 positivity. aPSPT was numerically more sensitive and specific than IgM B2GP1 for thrombotic, non-criteria events but less sensitive for detecting obstetric events (Table 2). Inclusion of aPSPT test in patients with suspected APS increased sensitivity marginally but with concomitant decrease in specificity. Table 1 Showing the categorization of Study subjects into patients and controls. Table 2 Comparision of sensitivity and specificity of aPSPT and IgM anti-β2GP1 in definite APS patients. Conclusions In our study, aPSPT was third most common antibody in APS patients, displaying higher sensitivity and specificity in comparison to IgM anti-β2 GP1 for all APS manifestations except obstetric ones. SNAPS patients may test positive for aPSPT, thus endorsing its inclusion in classification criteria of APS.

THU0322 Descriptive study of asian indian patients with rheumatoid vasculitis in retrospect: a single, tertiary care centre experience

Background Rheumatoid vasculitis (RV) is a severe extra-articular manifestation of rheumatoid arthritis (RA), with high morbidity and mortality reported in literature Objectives To describe the Asian Indian perspective on RV patients, their clinico-laboratory features and their outcome along with the factors affecting them Methods A retrospective review of electronic medical records of 8984 RA patients from January 2007 to August 2016, was done for those satisfying Scott & Bacon criteria for RV1. Probable RV was defined as patients not satisfying Scott & Bacon Criteria, but were managed like RV after exclusion of alternate diagnosis. Birmingham Vasculitis activity score (BVAS) version 32 was used for monitoring activity of RV Results 63 patients of RV were identified, with a study period prevalence of 0.7%, in our RA cohort. 33 (52.4%) patients were female. Mean age of patients was 50.7±11.5 years with median duration of RA being 6 years. Involvement of Peripheral Nervous System (PNS) was the commonest manifestation of RV in 52/63 (82.5%) patients followed by skin in 34/63 (53.9%) patients. Rheumatoid Nodule was seen in 14/ 63 (22.2%) patients. Percentage of current and ex-smokers combined,was same as rheumatoid nodule prevalence. 52 (82.5%) patients had biopsy evidence of vasculitis.26/51 (50.9%)patients were started on mycophenolate mofetil, 13/51 (25.5%)patients on cyclophosphamide, 8/51 (15.7%) patients on azathioprine, 4/51 (7.8%) patients on Methotrexate as immunosuppressive (IS) agent along with mean dose of 46.6±13.7 (0.86±0.23mg/kg/day) prednisolone. Additionally, Rituximab & IVIg were used in 2 patients each respectively. 3 months after initiation of immunosuppression 26/50 (52%) patients on follow-up were in remission and 39/47 (82.9%) patients attained remission at 6 months. Mean time to achieve remission was 151.1±86.3 days. All IS agents were equally effective in inducing remission at 3 and 6 months and showed statistically similar BVAS reduction at 3 and 6 months from baseline (t test & chi-square test). 7 (11.2%) deaths noted in the cohort at their respective last visit during 195.3 patient years cumulative follow up. Multiple regression analysis showed that at baseline, presence of PNS involvement, eosinophilia, thrombocytosis, higher BVAS score and higher steroid requirement were predictors of persistently active vasculitis and absence of eye involvement and higher hemoglobin % at baseline were predictors for remission, at 3 months (p<0.05). 4/50 (8%) patients had relapse of vasculitic symptoms. 2 and 5 year survival rates were 96.2% and 83.9% respectively Conclusions Our cohort of Asian Indian RV was comparitively younger with lesser RA duration, less percentage of ever-smokers, lesser rheumatoid nodule prevalence, higher PNS involvement with better survival/mortality rates compared to published literature. All IS agents showed equal rates of BVAS remission & BVAS reduction at 3 and 6 months of treatment References Scott DG, Bacon PA. Intravenous cyclophosphamide plus methylprednisolone in treatment of systemic rheumatoid vasculitis. Am J Med. 1984 Mar;76(3):377–84. Mukhtyar C, Lee R, Brown D, Carruthers D, Dasgupta B, Dubey S, et al. Modification and validation of the Birmingham Vasculitis Activity Score (version 3). Ann Rheum Dis. 2009 Dec;68(12):1827–32. Disclosure of Interest None declared

The diagnostic utility of line probe assays for multidrug-resistant tuberculosis

Owing to the burden of multidrug-resistant tuberculosis, molecular techniques have been approved by the WHO for the rapid diagnosis of the same. The objectives of this prospective, diagnostic study, conducted at Christian Medical College, a tertiary care center in South India, were to compare the performance of line probe assay (GenoTypeMTBDRplus) with culture, as well as the Xpert MTB/Rif assay on sputum samples. Ninety-one consecutive suspects of multidrug-resistant pulmonary tuberculosis patients from January 2013 to June 2013 were enrolled in this study and the results of line probe assay compared to culture and Xpert MTB/Rif. Compared to culture, the assay demonstrated a sensitivity and specificity of 81.5% (95%CI 67.4–91.1%) and 87.5% (95%CI 71–96.5%) for the detection of tuberculosis, with sensitivity and specificity of 100% (95%CI 85.2–100%) and 93.8% (95%CI 69.8–99.8%), respectively, for rifampicin resistance. For isoniazid resistance, sensitivity and specificity were 89.3% (95%CI 71.8–97.7%) and 100% (95%CI 71.5–100%), respectively. Compared to Xpert MTB/Rif assay, the assay showed a sensitivity of 80% (95%CI 68.2–88.9%) and specificity of 100% (95%CI 85.8–100%) for the detection of tuberculosis a sensitivity of 94.3% (95%CI 80.8–99.3%) and specificity of 94.1% (95%CI 71.3–99.9%) for rifampicin resistance was attained. This assay performed well on smear positive samples, but poorly on smear negative and scanty samples, and can serve as a rapid diagnostic tool, particularly in isoniazid monoresistant cases of tuberculosis, which are not diagnosed by Xpert MTB/Rif.