Characterization of proinsulin-specific regulatory T cells in type 1 diabetes at different ages of onset

BACKGROUND AND OBJECTIVES

Regulatory T cells (Tregs) play an important role in maintaining tolerance to self-antigens. Defects in the frequency and function of polyclonal Tregs have been reported in type 1 diabetes (T1D). However, characteristics of proinsulin (PI)-specific Tregs in human T1D have not yet been explored. Therefore, we aimed to characterize PI-specific Tregs in two distinct pathophysiological subtypes of T1D, juvenile-onset T1D (JOT1D) and adult-onset T1D (AOT1D), distinguished by the age of onset.

METHODS

Peripheral blood mononuclear cells of the recruited subjects were stimulated in vitro with PI-derived peptides. PI-specific Tregs were characterized by flow cytometry using the combination of markers CD25, CD137, FOXP3 and CD45RA.

RESULTS

Firstly, we observed similar frequencies of polyclonal Tregs in the T1D (n = 25) and healthy control (HC) (n = 20) subjects (P = 0.96), with a positive correlation between age and frequency of polyclonal Tregs (r = +0.35, P = 0.04). While the frequency of polyclonal Tregs was higher in AOT1D group (P = 0.02), both JOT1D (n = 14) and AOT1D groups (n = 11) had a comparable frequency of PI-specific Tregs in their peripheral blood. The frequency of PI-specific memory Tregs was significantly high in both the JOT1D (P = 0.02) and AOT1D (P = 0.009) groups compared to their respective HC groups (n = 10). Finally, we observed no significant difference in the expression of FOXP3 and IL-2 receptor in PI-specific Tregs in all the groups.

CONCLUSIONS

Unlike polyclonal Tregs, both T1D subtypes harbor comparable frequencies of PI-specific Tregs. Chronic antigen presentation results in a distinct memory-like phenotype of PI-specific Tregs in these subjects irrespective of the age of disease onset.

Role of nucleic acid sensing in the pathogenesis of type 1 diabetes

During infections, nucleic acids of pathogens are also engaged in recognition via several exogenous and cytosolic pattern recognition receptors, such as the toll-like receptors, retinoic acid inducible gene-I-like receptors, and nucleotide-binding and oligomerization domain-like receptors. The binding of the pathogen-derived nucleic acids to their corresponding sensors initiates certain downstream signaling cascades culminating in the release of type-I interferons (IFNs), especially IFN-α and other cytokines to induce proinflammatory responses towards invading pathogens leading to their clearance from the host. Although these sensors are hardwired to recognize pathogen associated molecular patterns, like viral and bacterial nucleic acids, under unusual physiological conditions, such as excessive cellular stress and increased apoptosis, endogenous self-nucleic acids like DNA, RNA, and mitochondrial DNA are also released. The presence of these self-nucleic acids in extranuclear compartments or extracellular spaces or their association with certain proteins sometimes leads to the failure of discriminating mechanisms of nucleic acid sensors leading to proinflammatory responses as seen in autoimmune disorders, like systemic lupus erythematosus, psoriasis and to some extent in type 1 diabetes (T1D). This review discusses the involvement of various nucleic acid sensors in autoimmunity and discusses how aberrant recognition of self-nucleic acids by their sensors activates the innate immune responses during the pathogenesis of T1D.

Evaluating the Effect of Supplementation with Bacillus clausii on Therapeutic Outcomes in Atopic Eczema-Results of an Observer-Blinded Parallel-Group Randomized Controlled Study

BACKGROUND

Atopic dermatitis (AD) is an itchy, chronic or chronically relapsing, inflammatory skin condition.

AIMS

To study the effectiveness of probiotic supplementation (Bacillus clausii) in achieving clinical remission, preventing relapse and its effect on immunological profile in children with AD.

METHODS

In this randomized controlled study, 114 children with AD were randomized into two groups (57 each): Group A received conventional treatment, along with Bacillus clausii (Strains O/C, N/R, SIN and T) suspension available as Enterogermina® at the dose 2 billion spores/5 ml twice daily for 8 weeks and Group B receiving conventional treatment only. Baseline and follow-up SCORAD were assessed at 0, 4, 8, 12, 16, 20 and 24 weeks. Serum IL-17A levels were measured at baseline and 12 weeks.

RESULTS

There was no significant difference in mean SCORAD between the two groups at baseline, 12 weeks (p = 0.21) and 24 weeks (p = 0.26). The two groups did not differ significantly in terms of the number of patients who achieved SCORAD 90 (p = 0.19), SCORAD 75 (p = 0.59), and those who relapsed (p = 0.5). IL-17A levels were not significantly different between the two groups at baseline and 12 weeks (p = 0.7). There was no statistically significant correlation between IL-17A levels and AD severity.

LIMITATIONS

Lack of double-blinding, lack of the use of placebo and a short follow-up period were the limitations of the present study.

CONCLUSION

Administration of the probiotic Bacillus clausii in addition to conventional treatment does not offer any additional benefit in inducing remission or prevention relapse in AD.

Correlation of serum vitamin D levels with severity of pediatric atopic dermatitis and the impact of vitamin D supplementation on treatment outcomes

INTRODUCTION

There is scarcity of prospective studies assessing the correlation between vitamin D deficiency and atopic dermatitis (AD).

MATERIALS AND METHODS

We conducted a prospective study where in serum 25-hydroxy-vitamin D levels were measured in 35 AD patients and 35 age and sex-matched controls. AD patients deficient in vitamin D were supplemented with 1000 IU of vitamin D per day for three months. Serum vitamin D levels and SCORAD were again measured at the end of three months in all AD patients.

RESULTS

The baseline vitamin D levels in patients and controls did not have any statistically significant difference (p = .97). There was a statistically significant (p = .02) inverse relationship between the AD severity and serum vitamin D levels at baseline (r = -0.52). Maximum reduction in SCORAD (41.4 ± 12.7) after 3 months of vitamin D supplementation was seen in severe AD and the minimum (2.4 ± 13.2) in mild AD (p = .0003).

CONCLUSIONS

We found no difference in the mean serum vitamin D levels between AD patients and controls. An inverse correlation was seen between serum vitamin D levels at baseline and severity of AD. Beneficial effect of vitamin D supplementation was observed maximally in severe AD as observed by a reduction in SCORAD.

Association between plasma cortisol and death or vasopressor refractory hypotension in preterm neonates: a prospective, cohort study

OBJECTIVES

Temporal relation between adrenal insufficiency and hypotension is poorly understood. We examined the association between basal and post-stimulation cortisol and death or vasopressor refractory hypotension in preterm neonates.

STUDY DESIGN

Prospective cohort study in ≤30 weeks' and/or <1,250 g weight. Primary outcome-composite of death or vasopressor refractory hypotension by day 14 of life. Plasma cortisol levels were measured at 24-36 h (T1), 72-84 h (T2) and 10 days (T3), and post-stimulation cortisol at T1 and later at T2 and T3 if the adrenal response was inadequate earlier.

RESULTS

Basal cortisol (µg/dl) at 24-36 h was significantly higher in the outcome group (37.2 ± 21.1 vs. 22.04 ± 14.6; mean difference (MD) (95% confidence interval (CI)): -15.1 (-23.6, -6.6); p = 0.005). High basal cortisol at 24-36 h (odds ratio (OR) (95% CI): 1.044 (1.009, 1.079); p = 0.01) and need for ventilation (OR (95% CI): 9.7 (1.2, 81.2); p = 0.04) independently increased the risk of death or vasopressor refractory hypotension.

CONCLUSION

Preterm neonates who died or developed vasopressor refractory hypotension by day 14 had significantly elevated basal cortisol at 24-36 h of life.

Changes in plasma intact parathyroid hormone levels following 24-hour incubation at room temperature as determined by Roche electrochemiluminescence PTH immunoassay

BACKGROUND

Estimation of circulatory PTH is necessary for correct diagnosis of diseases related to the parathyroid gland, bone, and kidney.

METHODS

Roche Electrochemiluminescence PTH immunoassay was used to measure changes in plasma iPTH concentration in 100 random samples following a 24 hours incubation at room temperature.

RESULTS

Low to normal iPTH concentration individuals showed higher decrease in iPTH concentration as compared to individuals with elevated PTH and the rate of PTH degradation was significantly higher (p < 0.05) in the low to normal PTH group.

CONCLUSIONS

Blood samples from suspected hypo- or normo-parathyroid subjects should be analyzed as soon as possible as a little degradation of PTH at room temperature could influence their clinical interpretation.

Acute Hypercalcaemia and Hypervitaminosis D in an Infant with Extra Pulmonary Tuberculosis

In patients with tuberculosis, abnormal extrarenal production of 1,25-dihydroxyvitamin D3 by activated macrophages in granulomatous tissues may result in hypercalcaemia. More commonly reported in adults with active pulmonary tuberculosis, this complication may rarely occur in extrapulmonary tuberculosis, and children. The hypercalcaemia may be precipitated by usually recommended vitamin D and calcium supplementation in patients with tuberculosis. We report here an infant with tubercular meningitis who developed hypercalcaemia 12 days after starting routine vitamin D and calcium supplementation. This communication highlights the importance of close monitoring of calcium levels in patients with tuberculosis, especially if started on vitamin D and calcium replacement before anti-tubercular therapy.

Comparison of efficacy and cost-efficiency of an immunologically targeted low dose rituximab protocol with the conventional rheumatoid arthritis protocol in severe pemphigus

BACKGROUND

Various dosing protocols of rituximab have been used in pemphigus. B-cell repopulation post-rituximab can be considered a forerunner of clinical relapse. Immunologically-guided dosing may obviate the need of fixed timepoint maintenance dosing, hence proving more cost-effective and perhaps safer.

OBJECTIVE

Comparison of overall efficacy and cost-efficiency of low dose rituximab with immunologically-guided ultra-low (200mg) top-up infusions versus rheumatoid arthritis (RA) protocol with 500mg repeat infusion upon clinical relapse, in severe pemphigus over one-year period.

METHODS

23 patients of severe pemphigus were randomized into Group-A (RA protocol: 1000mg, 2 doses, 2 weeks apart) and Group-B (low-dose rituximab: 500mg, 2 doses, 2 weeks apart). Both groups also received short-term oral corticosteroids and were followed clinically and immunologically (3-monthly flowcytometric assessments of B-cell subtypes). While Group-A got a 500mg rituximab top-up upon clinical relapse; Group-B received an ultra-low top-up (200mg) on B-cell repopulation, intended to prevent clinical relapse. Outcome parameters [complete remission off treatment (CROT), relapse (clinical and immunological), total corticosteroid dose and direct cost of therapy] were compared.

RESULTS

Time to CROT (Group-A: 27±1.6 weeks; Group-B: 26±1.2 weeks, p=0.09) and cumulative prednisolone dose (p=0.28) were comparable. 10/11 (90.9%) patients in Group-B had B-cell repopulation (8.4±2.4 months) and a single 200mg top-up dose successfully prevented clinical relapse. In Group-A, 3/9 (33.3%) patients had clinical relapse (9.3±0.4 months). Overall cost of therapy was 37.4% cheaper in Group-B.

CONCLUSION

An immunologically- guided low dose rituximab regimen can be an equally effective yet affordable alternative to conventional rituximab regimens in pemphigus.

High Prevalence of Hypovitaminosis D in Indian Chronic Low Back Patients

BACKGROUND

Vitamin D has a significant role to play in bone metabolism and neuromuscular function. Several researchers have indicated that Vitamin D deficiency may be possibly related to chronic musculoskeletal pain including chronic low back pain (CLBP).

OBJECTIVES

The present study was conducted to determine the prevalence of hypovitaminosis D and its contribution to chronic lower back pain.

STUDY DESIGN

Controlled study.

SETTING

Outpatient pain clinic of tertiary care hospital.

METHODS

Data presented in this manuscript are from patients who were screened for inclusion in an open label, single arm clinical trial aimed to assess the effectiveness of vitamin D supplementation in patients with CLBP. Consecutive patients visiting the outpatient pain clinic of a tertiary care hospital with a diagnosis of CLBP with or without leg pain were recruited. A visual analogue scale (VAS) was used to measure low back pain intensity, and the Modified Oswestry disability questionnaire (MODQ) was used to measure functional ability. Plasma 25-OHD levels of all patients were measured and the prevalence of hypovitaminosis D was calculated. The multivariate logistic regression model was used to investigate the association between vitamin D deficiency and patient characteristics.

RESULTS

A total of 328 patients were included in the study. Mean age of the study population was 43.8 years. Two hundred eighty-two (86%) (men 153/172 [89%], women 129/156 [83%]) of patients had below normal plasma vitamin D levels. Among these, 217 (66%) (men 126 [73%], women 91 [58%]) were found to be deficient and 65 (20%) (men 27 [16%], women 38 [24%]) were had insufficient levels. Multivariate regression analysis found that men were significantly more prone to have deficiency as compared to women (OR = 1.78 (1.10-2.88), P = 0.02). We also found a significantly positive relationship between vitamin D deficiency and increased functional disability (OR = 1.53 (1.24-1.87), P = 0.01). However, we did not find any relationship with pain severity, presence of other co-morbidities and educational level.

LIMITATIONS

Not possible to access a good quality data on sun exposure and vitamin D dietary inake dieat in study population. No bone scans were performed.

CONCLUSION

The result of this study provides a message about the high prevalence of hypovitaminosis D in the Indian CLBP population. Clinical guidelines for managing CLBP should include assessment of vitamin D status, together with advice on appropriate vitamin D supplementation in those found to be deficient.

CLINICAL TRIAL REGISTRATION

CTRI/2014/03/004459.

Psychomotor retardation in a girl with complete growth hormone deficiency

Infants with complete growth hormone deficiency may suffer from psychomotor retardation in addition to severe growth failure. Without replacement therapy, they may have a compromised intellectual potential manifesting as learning disabilities and attention-deficit disorders in later life. In this communication, we discuss an infant who showed improvement in physical growth after growth hormone therapy but her psychomotor skills did not improve probably due to late start of treatment. There is a need to start growth hormone therapy as early as possible in infants with complete growth hormone deficiency to avoid adverse effects on psychomotor and brain development.

Comparing the Effectiveness of Propranolol versus Atenolol in Inducing Clinical Clearance in the Treatment of Infantile Haemangioma: A Randomised Controlled Trial

Background

Despite the excellent clinical efficacy of oral propranolol in the management of infantile haemangiomas (IHs), there is a need to further evaluate other beta blockers that may be equally efficacious but result in lesser adverse effects. We compared the efficacy and short-term safety of atenolol, a hydrophilic cardio-selective beta blocker, with propranolol, in the treatment of IHs.

Materials and Methods

Sixty patients with complicated and/or cosmetically significant IHs were randomised into two groups, oral propranolol group (2 mg/kg/day) and the oral atenolol (1 mg/kg/day) group, respectively, for 9 months. Patients were assessed clinically, by the use of Doppler ultrasonography (USG) and measurement of serum hypoxia-inducible factor 1 alpha (HIF-1α).

Results

Twenty-two of 30 patients achieved complete clearance in the propranolol group (0.73; 95% CI = 0.54 to 0.87) compared with 13 of 25 patients in the atenolol group (0.52; 95% CI = 0.31 to 0.72). The mean time to achieve Physician Global Assessment Score 5 (PGA5) (25.00 ± 8.87 weeks) was significantly lesser in the propranolol group versus the atenolol group (31.69 ± 7.01 weeks; log-rank = 0.04). The two groups were comparable in terms of adverse effect profile, degree of volume reduction in USG and reduction in HIF-1α levels.

Conclusions

Propranolol (2 mg/kg/day) is better than atenolol (1 mg/kg/day) in inducing complete clinical clearance of IH although the results need to be reproduced in larger studies.

The Impact of Bisphosphonates on the Osteoclast Cells of Osteogenesis Imperfecta Patients

Bisphosphonates (BPs) are widely used for treatment of osteogenesis imperfecta (OI). However, prolonged use may be associated with suppression of bone turnover, the exact molecular mechanism of which is poorly understood. The objective of this study was to evaluate the effect of zoledronic acid (ZOL) on precursor osteoclasts by studying caspase 3 activity. A total of 15 children participated in the study (n = 10 OI patients, n= 5 controls). Out of the 10 OI children, 5 had received a cumulative dose of <30 mg and 5 received > 30 mg of ZOL. Isolated mononuclear cells were studied for caspase 3 activity from all study participants. The mean age of study participants was 7 ±1.5 years. Six of them had OI type IV, two had type III and one had types I & II each. Radiographs showed “zebra stripe sign” and dense metaphyses; suggestive of acquired osteosclerosis. Bone turnover markers (PINP and CTx) were suppressed in all OI patients compared to controls. Caspase-3 activity was significantly increased in precursor osteoclasts cells at higher doses of BPs (>30 mg). Overzealous use of ZOL in OI suppresses bone turnover markers (P1NP, CTx) causes osteosclerosis and increased expression of caspase 3 activity in precursor osteoclasts which results in adynamic bone.

Hypothalamic Pituitary Adrenocortical Axis Suppression following a Single Epidural Injection of Methylprednisolone Acetate

BACKGROUND

Epidural injections (EIs) are the most commonly performed minimally invasive intervention in managing chronic low back pain (CLBP). There is inconsistency in data to accurately predict the degree of hypothalamic-piuitary-adrenal (HPA) axis suppression in patients receiving exogenous steroid therapy, especially in the form of epidural steroid injections (ESIs).

OBJECTIVE

We aim to quantify the degree and duration of HPA axis suppression after a single ESI of 80 mg methyl prednisolone acetate in patients with CLBP.

STUDY DESIGN

A single open-label prospective study.

SETTING

An operating room of a tertiary care hospital.

METHODS

Patients with CLBP and unilateral radicular pain were included in this study. An ESI of 80 mg of methylprednisolone acetate was administered in each patient. Blood samples for cortisol and adrenocorticotropic hormone (ACTH) were collected before the ESI and on days 7, 14, and 28 after the ESI. The patients' pain levels were graded on the numeric rating scale (NRS) at baseline and on days 7, 14, 28, and 60 after the ESI in the pain clinic.

RESULTS

A total of 30 patients were enrolled in this study. The median with interquartile range (IQR) serum cortisol level at baseline and on days 7, 14, and 28 after intervention were found to be 329.55 (208.49 - 399.48) nmol/L, 72.99 (52.95 - 119.82) nmol/L, 194.45 (73.88 - 292.52) nmol/L, and 302.56 (257.68 - 357.43) nmol/L, respectively. A significant discrease in the serum cortisol levels was observed on days 7 (P < 0.001) and 14 (P < 0.001). Twenty-six (87%), 13 (43%), and 2 (7%) patients had serum cortisol levels below normal (<170 nmol/L) on days 7, 14, and 28, respectively. HPA axis suppression was observed in all of the patients for a median (IQR) period of 14 days (range: 11-17 days).

LIMITATIONS

This study was an unblinded observational study. The effect of a single ESI was studied and the sample collection of day 21 serum cortisol and ACTH were passed over.

CONCLUSIONS

HPA axis function was suppressed after the ESI until day 14 and returned to the normal range by postoperative week 4.

KEY WORDS

Epidural injections, steroids, HPA, suppression, cortisol, ACTH.

Antidesmoglein 1 and 3 serum IgG and positivity by direct immunofluorescence microscopy is associated with relapse in pemphigus in a prospective bicontinental study

Background

Prospective studies identifying immunological parameters that can predict clinical relapse in pemphigus are scarce.

Objective

To periodically assess immunological parameters in patients with pemphigus vulgaris and foliaceous in remission to understand immunological events preceding clinical relapse.

Methods

A total of 105 patients were included. Baseline assessment included direct immunofluorescence (DIF), serum IgG against desmoglein (Dsg) 1, IgG, IgG1, and IgG4 against Dsg 3, IgG against the extracellular domains 1 and 2 of Dsg 3, IgG against muscarinic (M3)-AchR, and peripheral CD19+CD27+ memory B cells/plasma cells, repeated every 3 months for up to 12 months or until clinical relapse. DIF was repeated at month 12 and on relapse.

Results

About 29 of 105 patients (28%) experienced a relapse. Longer duration of clinical remission, presence of pruritus and positive anti-Dsg1 at baseline correlated with higher relapse rates. Compared with the visit immediately preceding relapse, a significantly increased number of patients with positive anti-Dsg1 (38% vs 31.1%, P = .01), anti-Dsg3 (51.7% vs 41.4%, P = .01) and IgG positivity by DIF (85.7% vs 25%, P < .001) was observed at the time of relapse.

Conclusion

Regular monitoring of anti-Dsg 1 and anti-Dsg 3 serum levels and DIF positivity during the course of the disease in remission may predict relapse.

Seasonal variation and Incidence of rupture of intracranial aneurysm : A prospective study and Literature review

OBJECTIVES

Some studies have found an association of incidence of aneurysmal Sub arachnoid hemorrhage (aSAH) seasonal variations and weather patterns but others have refuted this. With conflicting reports in the literature, we tried to find out whether climatic conditions influence the incidence of aSAH.

PATIENTS AND METHODS

This was a prospective single centre study involving patients with aSAH operated in a tertiary care hospital over one calendar year. Meteorological parameters like temperature, barometric pressure, humidity and sunshine hours were noted for 2 consecutive days prior to the ictus and on the day of ictus.

RESULTS

392 patients of aSAH who underwent clipping were enrolled. There was no significant difference in the incidence of aSAH across various seasons (p > 0.05). Pre ictus fall in temperature lead to a surge in number of cases. 241 patients (61.5%) reported were from geographical areas which had experienced a fall in temperature over preceding 2 days, with a mean fall in temperature of 1.1(SD 2.1) degree celsius (p less then 0.05). The incidence of aSAH patients in low sunshine hour seasons (1.13 patients/day) was significantly more than that in higher sunshine hour seasons (0.9 patients/day) (p less than 0.05 ).

CONCLUSIONS

Seasonal variation had no direct bearing on the incidence of aSAH. Pre ictus fall in temperature lead to a rise in number of cases. Also, higher incidence of aneurysmal subarachnoid haemorrhage was seen in lower sunshine hour seasons.

A randomised clinical trial to assess the adjuvant potential of methotrexate to corticosteroids in mucosal or limited mucocutaneous pemphigus vulgaris

Glucocorticoids are the mainstay of treatment for pemphigus vulgaris (PV). However, the requirement of high doses for long durations often leads to serious adverse events. Methotrexate as an adjuvant has shown potential in retrospective studies but randomized trials are lacking. The objective of the study was to assess the adjuvant potential of methotrexate in mucosal/limited mucocutaneous PV. In this randomised prospective study, 44 patients with mucosal/limited mucocutaneous PV were randomised (1:1) to receive either prednisolone 1 mg/kg/day (later fixed at a maximum dose of 60 mg/day) alone or with methotrexate 0.3 mg/kg/week for 9-months study period. Prednisolone dose was tapered once there was an 80% reduction in Pemphigus Disease Activity Index. Outcome measures were total cumulative dose of prednisolone, the proportion of patients achieving disease control, time taken for disease control and remission on minimal treatment, and adverse effects. No significant difference in the total cumulative dose of prednisolone among the groups was observed (p = 0.68). Disease control was achieved in 95.5% and 86.4% of patients in the prednisolone alone group, and prednisolone and methotrexate group respectively (p = 0.61). No statistically significant difference was observed among the groups with respect to the proportion of patients achieving remission, time taken for disease control and remission, and the number of adverse events. Our study showed no additional benefit of methotrexate to prednisolone in the treatment of mucosal/limited mucocutaneous PV.

Trial registration: CTRI/2018/07/015002; Registered on 23/07/2018]; Trial Registered Retrospectively. http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=24964&EncHid=&modid=&compid=%27,%2724964det%27.

Correlation of plasma levels of itraconazole with treatment response at 4 weeks in chronic dermatophytosis: Results of a randomised controlled trial

BACKGROUND

Itraconazole in varying doses and duration is being frequently used for the management of dermatophytosis. There is a scarcity of studies on the bioavailability of various itraconazole brands available in the market.

AIMS AND OBJECTIVES

The aim of this study was to determine the plasma concentration of itraconazole of various brands and its correlation with clinical efficacy in chronic dermatophytosis.

MATERIALS AND METHODS

One hundred patients with chronic dermatophytosis with age >18 years were studied at the outpatient clinic of our tertiary care hospital. Plasma itraconazole level was estimated on Week 2 and Week 4 after randomly dividing the patients into Groups A, B and C who received cap itraconazole 100 mg twice a day of innovator, multinational and local generic brands, respectively, for 4 weeks. Both efficacy (cure, partial cure or no cure), safety and recurrence were compared between the three groups.

RESULTS

At 4 weeks, number of patients classified as 'cured' were 10/26 (38.4%) in Group A, 5/22 in Group B (22.7%) and 3/21 (14.2%) in Group C (p = .002). Mycological cure rates at Week 4 in Groups A, B and C were 21 (80.8%), 17 (81.0%) and 5 (26.3%), respectively (p = .006). Plasma levels of itraconazole were comparable between the three groups at Week 2 and Week 4. No statistically significant correlation was found between itraconazole levels and treatment response in any of the groups at 4 weeks. Incidence of adverse effects and recurrence rates was also similar among the three groups.

CONCLUSION

Cure rates for chronic dermatophytosis were poor with all three itraconazole brands at 4 weeks of treatment. Higher cure rates were obtained with innovator drug as compared to multinational and local generic brands at 4 weeks. Plasma levels of the three drugs were however similar, indicating that factors other than serum bioavailability are at play in determining response of chronic dermatophyte infections to oral itraconazole.

High prevalence of cardiovascular risk factors in Asian Indians: a community survey - Chandigarh Urban Diabetes Study (CUDS)

BACKGROUND & OBJECTIVES

Studies conducted to assess the prevalence of cardiovascular (CV) risk factors among different regions of the country show variation in risk factors in different age groups and urban and rural population. We undertook this study to determine the prevalence of cardiovascular risk factors among urban adults in a north Indian city.

METHODS

In a cross-sectional survey, 2227 subjects aged ≥ 20 yr were studied from April 2008 to June 2009 in Urban Chandigarh, a north Indian city. Demographic history, anthropometry and blood pressure were assessed. Fasting, and 2 h capillary plasma glucose after 75 g glucose load, HDL-C and triglycerides were estimated.

RESULTS

The most prevalent cardiovascular risk factors in the age group of 20-29 yr was sedentary lifestyle (63%), while from fourth decade and onwards, it was overweight/obesity (59-85%). The second most common prevalent cardiovascular risk factor in the age group of 20-29 yr was overweight/obesity, in 30-49 yr sedentary lifestyle, in 50-69 yr hypertension and in subjects ≥70 yr, it was hypertriglyceridaemia. The prevalence of overweight/obesity, hypertension, dysglycaemia and smoking was almost double in subjects in the fourth decade of life, as compared to those in the third decade of life. The prevalence of CV risk factors significantly increased with age irrespective of gender and prevalence of low HDL-C was significantly more common in women as compared to men.

INTERPRETATION & CONCLUSIONS

Sedentary lifestyle, obesity and low HDL-C are the most prevalent CV risk factors in subjects in the third and fourth decade of life in this north Indian population and clustering of these cardiovascular risk factors increases with advancing age. Strategies need to be formulated to target this population to prevent the epidemic of cardiovascular disease.

IL-17 A correlates with disease progression in papillary thyroid carcinoma

BACKGROUND

Cancer progression can be promoted by chronic inflammation. Local immune response may be associated with favourable or unfavourable prognosis of Papillary Thyroid Carcinoma (PTC). Regulatory T (Treg) cells and T helper 17 (Th17) cells exert opposing function and their balance may have a vital role in promotion of tumor growth. Treg cells in tumor microenvironment (TME) may promote tumor progression and reduced survival of patients. Whereas, Th17 cells can promote or inhibit tumor progression depending on phenotypic characteristics of tumor. In this study, we aimed to analyse the kind of immune response developed and its prognostic impact in future therapeutics.

METHODS

Cytometric Bead Array (CBA) analysis of pro and anti-inflammatory cytokines (IFN-gamma, IL-2, IL-6, IL-17 A, TNF-alpha and IL-4, IL-10) was done in 15 PTC irrespective of Lymphocytic Thyroiditis (LT) and 16 Hashimoto's Thyroiditis (HT) cases. Immunohistochemical expression of FoxP3 and IL-17 A was studied in 27 cases of PTC with LT. Whereas, quantitative gene expression of both was analysed in 10 cases.

RESULTS

All the pro-inflammatory cytokines showed mild elevation in PTC with LT. On IHC, IL-17 A expression was observed in 74% PTC with LT. Whereas, FoxP3 was present in only 40% cases. Also, IL-17 A expression was significantly associated with age group (> 45 years), tumor size ≤ 1 cm and disease progression.

CONCLUSIONS

Increased expression of cytokines suggested correlation between inflammatory factors and progression of thyroid tumors. Along with this, the balance between IL-17 A and FoxP3 may play an important role in PTC development, prognosis and future management.