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Biomedical subjects

A N Malaviya

Publications and source records attributed to A N Malaviya.

At least 19 recordsLinked to original sources
PubMed2001

Long-term outcome of undifferentiated spondylarthropathy.

Undifferentiated spondylarthropathy is one of the common disease subsets in the group of so-called seronegative spondarthritides. It is not exactly known how often it differentiates into ankylosing spondylitis or other well-defined disease subsets over time. The present study was designed to find out the long-term outcome in this subset. Thirty-five patients diagnosed with undifferentiated spondylarthropathy between January 1987 and December 1988 were recruited. Twenty-two (63%) of them were available for detailed assessment 11 years after the original diagnosis. Their baseline characteristics did not differ from those of the original cohort of 35 patients and were as follows: male:female ratio 19:3, median age of onset 17 years (range 8-39), and median duration of disease 8 months (range 4-24). Clinical features were enthesitis (45%) and inflammatory pain in the back (100%), buttock (77%), hip (64%), shoulder (18%), knee (82%), ankle (77%), and hand and wrists (50%). There was no restriction in spinal movement. Family history was positive in two cases. Radiologically, the only finding was grade I sacroiliitis in 17 patients (77%). Human leukocyte antigen (HLA)-B27 was positive in all. Functionally, all were in class I. During follow-up, one patient developed psoriatic skin lesions after 9 years. Uveitis developed in four patients (18%). After a median follow-up of 11 years, 15 (68%) had ankylosing spondylitis, one developed psoriatic arthritis, four remained undifferentiated, and two had natural remission. Functionally, 19 patients (86%) were in class I and three (14%) were in class III. No patient had bamboo spine, but three underwent total hip replacement. Thus, a majority of patients (68%) with undifferentiated spondylarthropathy gradually developed ankylosing spondylitis of mild severity.

Adolescent↗
PubMed2001

Calcium pyrophosphatase dihydrate (CPPD) crystal deposition disease in a teaching hospital in Kuwait.

OBJECTIVE: A Medline electronic search showed a paucity of reports on calcium pyrophosphate dihydrate crystal deposition disease (CPPD-CDD) from the Gulf region. To date only a single case report has been published from this region. Therefore, this study aimed, firstly, at finding out the prevalence of chondrocalcinosis in adult Arabs in Kuwait presenting with knee arthritis and, secondly, at carrying out an observational study of CPPD-CDD among Arabs in Kuwait. METHODS: For the study of the prevalence of chondrocalcinosis 100 consecutive adult patients presenting with knee arthritis were radiologically examined. For the observational study the clinical, laboratory, and radiological findings were analysed in patients with CPPD-CDD seen over a period of five years. RESULTS: This study showed the presence of chondrocalcinosis in two (2%) of the 100 adult Kuwaiti and other Middle-Eastern Arab patients (70 men, 30 women, median age 50 (range 45-80)) who presented to the rheumatology clinic for the evaluation of knee pain. When the younger age of the group (only three patients aged >70) is taken into account the figure was comparable with that reported from Western countries. Over a period of five years a total of 2726 new patients were evaluated at the rheumatology clinic of this institution. A diagnosis of crystal arthritis was made in 85 patients (3%). Fourteen of these 85 (that is, 16.5%, but 0.5% of the total cases) were diagnosed with definite (eight patients) or probable (six patients) CPPD-CDD. Different clinical presentations, including that of acute monarthritis (that is, pseudogout), premature generalised osteoarthritis, and polyarticular rheumatoid-like presentations, were seen in different patients. Overlap with true gout, with the additional presence of monosodium urate crystals in the joint aspirate, was seen in two patients. CONCLUSION: The present report shows that CPPD-CDD may not be uncommon among Arabs in the Gulf region. A high degree of clinical awareness and routine examination of joint aspirates with careful analysis for crystals may make it a more common diagnosis in this part of the world. In this regard it is interesting to note that cases and case series including familial cases have been reported from North Africa, especially Tunisia, indicating that the disease has been well described in Arabs of other geographical regions.

Adult↗
PubMed2001

Systemic lupus erythematosus with polyglandular autoimmune syndrome type II: report of an unusual case.

A patient with systemic lupus erythematosus (SLE) is described who had associated autoimmune thyroiditis with subclinical hypothyroidism and idiopathic Addison's disease. The presence of autoimmune thyroid disease and Addison's disease could classify her as having polyglandular autoimmune syndrome (PGAS) type II, which is the commonest of the three types of this syndrome. However, the additional presence of SLE in PGAS type II has not been described earlier. This patient appears to be the first such case.

Addison Disease↗
PubMed1999

Infective arthritis in adults--experience at a teaching hospital in Kuwait.

Infective arthritis (InfectA) has a variable geographical pattern. A 'Medline' search did not yield any earlier series on epidemiological pattern of InfectA from Kuwait or the Gulf region. Therefore, an observational prospective study of sequential cases seen over a period of 4 years was carried out. Of a total of 2021 patients seen during this period, 36 (1.8%) were diagnosed to have InfectA. There were 6 (16.7%) cases of neisserial and 30 (83.3%) of non-neisserial InfectA. Predisposing factors were seen in 17 (47.2%), all with non-neisserial InfectA. Microbiological diagnosis was proven in 15 (41.7%) cases, and included Neisseria gonorrhoeae in 5, Brucella spp. in 4, Staphylococcus aureus in 3, and Neisseria meningitidis, Salmonella spp. and Mycobacterium tuberculosis in 1 each. In the remaining 21 (58.3%) cases the diagnosis was made on clinical grounds and confirmed on therapeutic response. The most common presentation of neisserial InfectA was acute polyarthritis while that of non-neisserial InfectA was acute monoarthritis. All patients recovered with little disability and no mortality.

Adolescent↗
PubMed1999

Musculoskeletal manifestations with panniculitis--a hospital based study on 62 patients in Kuwait.

The study describes 62 patients seen over a period of 4 years mainly presenting with an acute inflammatory ankle arthritis/periarthritis associated with panniculitis. Based upon the clinical characteristics of panniculitis two distinct categories could be defined. These included patients with characteristic lesions of erythema nodosum, seen in 51 (82%), the idiopathic form in 29 (57%), and secondary EN in 22 (43%). Associated conditions included Behçet's disease, oral contraceptive pills, pregnancy and penicillin treatment. Patients clinically not having typical EN was seen in 11 (18%). In this group the histopathology showed erythema induratum in 4, cutaneous-polyarteritis nodosa with minimal panniculitis in 3, Weber-Christian disease, cytophagic histiocytic panniculitis, and 'mixed' lobular and septal variety of panniculitis in 1 each. (In 1 patient the disease was not panniculitis but cutaneous variant of granuloma annulare). It is concluded that in a hospital setting EN associated with acute musculoskeletal symptoms, mainly ankle arthritis/periarthritis or an acute peripheral polyarthritis, was a common rheumatological problem in Kuwait. However, other forms of panniculitides also presented with musculoskeletal manifestations requiring accurate histopathological diagnosis for appropriate treatment.

Adolescent↗
PubMed1998

Characteristics of osteoarthritis among Kuwaitis: a hospital-based study.

Sixty-nine Kuwaiti patients with osteoarthritis (OA) were studied. Primary knee OA was seen in 65 (94.2%) patients. The mean age of this group was 53.18 years with a range of 39-97 years. The female to male ratio was 2.82:1. OA was bilateral in 84.62% and predominantly involved the medial tibiofemoral joint. According to Kellgren's grading of knee OA, grade 1 changes were present in 40.0%, grade 2 in 32.5%, grade 3 in 22.5% and grade 4 in 5.0%. Grade I obesity was seen in 13%, grade II in 64% and grade III in 23% of patients. Generalised primary nodular OA was seen in only four patients, all of whom were women. Primary OA of the hip joint and chondrocalcinosis were conspicuous by their absence.

Adolescent↗
PubMed1998

Behçet's syndrome: a report of 41 patients with emphasis on neurological manifestations.

Forty one patients with the clinical diagnosis of Behçet's syndrome from two teaching hospitals in Kuwait were studied. There were 34 male and seven female patients. Age at presentation ranged from 14 to 48 years. Neurological manifestations were present in 24 patients. Eleven patients showed evidence of increased intracranial pressure, and 10 of these had radiologically confirmed dural sinus thrombosis. Five patients presented with a meningoencephalitic or meningomyelitic picture, three with a stroke-like picture, and three with primarily brain stem signs. One patient developed trigeminal neuritis, and five patients exhibited (along with other features) variable degrees of psychological manifestations. All patients with neurological involvement were treated with steroids, and some also had courses of other immunosuppressant drugs and colchicine. The disease took a relatively benign course, except those patients with meningoencephalitic and meningomyelitic presentation, one of whom died from the disease. Those treated early had a better prognosis. The incidence of dural sinus thrombosis in this series of patients is unusually high. In most patients, the course of the disease was more favourable than reported in the literature. This may be attributed to early and aggressive treatment.

Adolescent↗
PubMed1998

Systemic lupus erythematosus in Kuwait--hospital based study.

The present study describes the clinical characteristics of patients with systemic lupus erythematosus (SLE), from the rheumatology service of the two main teaching hospitals in Kuwait. It was a retrospective-cum-prospective clinical study of 108 SLE patients. There were 98 females and 10 males, with a median age of 31.5y. Kuwaitis constituted 69%, while 31% were expatriates. The mean disease duration was 62 months. The main clinical features were: musculoskeletal involvement (87%), photosensitivity (48%), malar rash (43%), discoid lesions (10%), oral ulcers (33%), vasculitic skin lesions (10%), haematological features (53%), constitutional symptoms (51.4%), neuropsychiatric manifestations (23%), renal involvement (37%), serositis (29%), clinical manifestations of antiphospholipid syndrome (21%), cardiac involvement (10%) and pulmonary manifestations (19%). In conclusion, the clinical features of SLE in Kuwait were similar to most major studies from developed countries. Main differences included prominent haematological and mucocutaneous manifestations and possibly a low prevalence of anti-Sm antibodies. Whether these differences are due to the environment or genetic factors, remains to be studied.

Adult↗
PubMed1997

Outcome of polyarteritis nodosa in northern India.

Over the last 10 years, 17 patients (13 males and 4 females) diagnosed as having classical polyarteritis nodosa (PAN) were treated and followed up in the rheumatology clinic of our institute. The median age and duration of symptoms at presentation were 29 years (range 13-59) and 9.5 months, respectively. Patients presented with the typical clinical picture of classical PAN. The diagnosis was established with the help of an aortogram (7/10), sural nerve biopsy (7/8), muscle biopsy (5/7) and renal biopsy (3/4). For reasons not known, none of the 17 patients was HBsAg positive. Patients were treated with a combination of oral prednisolone (1 mg/kg per day) for 6 weeks, which was slowly tapered off over 6 months, and monthly intravenous cyclophosphamide pulses (15 mg/kg) for the first 6 months, followed by 3-monthly pulses for a total of 2 years. Remission was achieved in 14 patients after a median of 5 months of treatment. Remission was stable for a median of 5 years of follow-up. Three patients did not respond well and died within 6 months of diagnosis. The causes of death in these were intracerebral haemorrhage in one patient and gastrointestinal bleeding in two patients. This experience is in accord with the reported literature that classical PAN is mostly a monophasic disease with either an excellent response to the appropriate immunosuppressive therapy and a long remission or a downhill course culminating in death. A chronic course is rare.

Administration, Oral↗
PubMed1997

Serological characteristics of systemic lupus erythematosus from a hospital-based rheumatology clinic in Kuwait.

Thirty-one consecutive patients with SLE were screened for antinuclear antibody (ANA), anti-DNA antibodies, extractable nuclear antigen antibodies (anti-ENAs) including anti-Sm, anti-RNP, anti-SSA (anti-Ro), anti-SSB; (anti-La), anti-Scl-70, rheumatoid factor (RF), C-reactive protein (CRP), C3 and C4 levels, anti-cardiolipin antibodies (aCL), biologically false positive serological test for syphilis (BF-STS) using VDRL test and Coombs' test. The age of the patients ranged from 11 to 52 year with a median of 29 year; female to male ratio of 5:1. There were 21 Kuwaitis, four Egyptians, three from the Indian subcontinent, two Filipinos and one Syrian. Main clinical categories of SLE were: mild cutaneous SLE in 12 (38.7%), clinical antiphospholipid syndrome (APS) secondary to SLE in 8 (25.8%), haematological manifestations of SLE in 5 (16.1%), renal lupus in four (12.9%), neuropsychiatric in three (9.7%), others (6.4%). Clinical features overlapped in several patients. ANA was positive in 96.8% (mean value 891.61 units/ml), anti-DNA in 35.5% (mean value 56.4 units) that was lower than expected and could be due to selection bias as the patients were from a rheumatology clinic, anti-ENA in 42%, anti-Sm 13% that was lower than other non-Caucasian populations, anti-RNP 13%, anti-SS-A in 35.5%, anti-SS-B in 19.4%, Scl-70 in 13%, CRP in 71% (moderate 58%, very high 13%); C3 mean 1.52 mg/ml (3.2% low levels), C4 mean 0.35 mg/ml (32% low levels), anticardiolipin mean GPL 35.35 units (high 58%), mean MPL 10.61 units (high 26%), BF-STS in 6%, Coombs' test in 6%, RF positive in 36%. The only significant positive clinical associations observed were those of renal involvement with anti-DNA antibodies (P = 0.042), and clinical antiphospholipid antibody syndrome with aCL antibodies (P = < 0.05).

Adolescent↗
PubMed1997

Systemic lupus erythematosus in India.

The first case of systemic lupus erythematosus (SLE) was reported from India in 1995 followed by two more case reports and further, a series of eight cases, till 1969. Since the establishment of a clinical immunology laboratory at a major teaching institution in New Delhi in 1968, SLE was extensively studied and reported from that centre. From mid-1980 onwards several other centres in different regions in India including Chennai (old name Madras), Mumbai (old name Bombay), Calcutta and Hydrabad, also published their regional experience on SLE. Based on these data, the present report describes the clinical and laboratory characteristics of 1366 SLE patients seen in different regions of India. Arthritis, rash, photosensitivity, seizures and psychosis were seen in comparable proportions to other racial groups. Similarly, ANA and anti-DNA antibody positivity was also within the range seen in other racial groups. When compared with other series, however, alopecia, renal lupus, oral ulcers and neurological involvement was seen in higher proportions, reaching statistically significant figures in comparison to some racial groups. In contrast, haematological manifestations were seen in significantly less proportions in comparison to some of the racial groups. Serositis and discoid lesions were also seen in lower proportions than in most of other races. The proportion of those with anti-Sm antibodies was in between two extremes of highest among Africans and Israelis and lowest among Chinese and Europeans. Other manifestations were comparable to most other racial groups. Compared to North American and European reports, significantly low 5 and 10 year survival was observed among patients from India. This could be related to the general public health situation in the country including less than optimal management facilities in hospitals, delay in diagnosis due to lack of awareness of the disease, referral bias where only serious patients reach major city hospitals, or a truly severe disease among Indians, or a combination of these genetic, environmental and/or sociocultural factors. The Main causes of death were irreversible renal damage, infections and neurological involvement. Despite a comparable prevalence of anticardiolipin antibodies (aCL) and lupus anticoagulants (LAC), clinical antiphospholipid syndrome was significantly less common. Genetic studies showed appreciable increase of HLA DR4 (37.5%) among patients compared with controls (18%). Additionally the haplotype B8-DR3 was encountered frequently in the patient group.

Humans↗
PubMed1996

Infection-related morbidity in systemic lupus erythematosus: a clinico-epidemiological study from northern India.

The present study was undertaken to retrospectively evaluate the frequency and pattern of infections in 309 patients with systemic lupus erythematosus (SLE) attending the Rheumatology Clinic of the All India Institute of Medical Sciences Hospital between January 1989 and May 1994. Eighty-two patients (26.5%) were found to be suffering from one or more infections during this period. Tuberculosis was the commonest infection observed. Seventy-four patient (23.9%) had a single infection, while 8 (2.6%) had multiple infections. The infection rate was found to be higher among patients with SLE and major organ involvement than among those with mild superficial SLE.

Adult↗