Dry eye disease and high disease activity score (DAS-28) in rheumatoid arthritis: An underrated combination.

OBJECTIVE: To determine the association of dryness of eyes with rheumatoid arthritis severity. METHODS: The cross-sectional, observational study was conducted at the Jinnah Medical College Hospital, Karachi, from December 2020 to May 2021, and comprised adult patients of either gender with rheumatoid arthritis who were diagnosed on the basis of clinical and serological investigations. Data was collected using a structured pre-tested questionnaire. Ocular Surface Disease Index questionnaires with Tear Film Breakup Time were used to assess the severity of dry eyes. Disease Activity Score-28 with erythrocyte sedimentation rate was used to assess the severity of rheumatoid arthritis. Association between the two was explored. Data was analysed using SPSS 22. RESULTS: Of the 61 patients, 52(85.2%) were females and 9(14.8%) were males. The overall mean age was 41.7±12.8 years, with 4(6.6%) aged <20 years, 26(42.6%) aged 21-40 years, 28(45.9%) aged 41-60 years and 3(4.9%) aged >60years. Further, 46(75.4%) subjects had sero-positive rheumatoid arthritis, 25(41%) had high severity, 30(49.2%) had severe Occular Surface Density Index score and 36(59%) had decreased Tear Film Breakup Time. Logistic Regression analysis showed there were 5.45 times higher odds of having severe disease among the people with Occular Surface Density Index score >33 (p=0.003). In patients with positive Tear Film Breakup Time, there were 6.25 higher odds of having increased disease activity score (p=0.001). CONCLUSIONS: Disease activity scores of rheumatoid arthritis were found to have strong association with dryness of eyes, high Ocular Surface Disease Index score and increased erythrocyte sedimentation rate.

Adherence to antiretroviral therapy in HIV-positive, male intravenous drug users in Pakistan.

BACKGROUND: Human immunodeficiency virus (HIV) is fifth leading cause of mortality and disability among infectious diseases worldwide. HIV burden is increasing annually and compliance with antiretroviral therapy (ART) is low among intravenous drug users, especially in developing countries. AIM: To determine the adherence level to ART among HIV-positive intravenous drug users in Karachi Pakistan. METHODS: A cross-sectional study was conducted in 2015. A pretested questionnaire was administered to 375 of 3000 people who inject drugs, registered at the Civil Hospital in Karachi, Pakistan. RESULTS: The mean age was 30 years, 181 were married, 179 were illiterate and 287 had income < 5000 rupees per month. Only 63 patients were adherent to ART and 343 were alcoholics. Nonadherence was greater in patients who were single and did not have children. The most common reason for missing ART was that they simply forgot to take the tablets. CONCLUSION: We conclude that adherence to ART among intravenous drug users was low. Family cohesion and support were essential to maintain adherence to ART.

Environmental determinants of aplastic anemia in Pakistan: a case-control study.

AIM: Aplastic anemia (AA) affects the Asian population two to three fold more than people in other regions. Besides the host genetics and socioeconomic status, several other environmental exposures have been linked with an AA etiology. We aimed to examine the association of various environmental exposures with AA occurrence among Pakistani individuals. SUBJECTS AND METHODS: A case-control study was conducted in Karachi, Pakistan, where cases (diagnosed AA patients) were selected from the National Institute of Blood Disease and Bone Marrow Transplantation (NIBD), while for each case, a single control (who was free of AA and visited the outpatient department of the same hospital for the treatment of minor ailments) was selected matched by age and sex. A total of 428 participants were included in this study with equal proportions of cases and controls. Information related to disease characteristics, sociodemographics and exposure to chemicals was collected through a survey questionnaire, laboratory investigations and medical records. Descriptive results were reported as frequencies and proportions, adjusted odds ratios with 95 % confidence intervals and population attributable risk (PAR) as percentage. RESULTS: Among study participants (n = 428), AA was significantly associated with various environmental exposures. Participants residing in rural settings (OR = 2.29, 95 % CI 1.12-4.67, p-value < 0.01) and those who reported exposure to pesticides (OR = 3.58, 95 % CI 1.27-10.10, p-value 0.01; PAR = 18.16 %) were significantly more likely to report AA. Participants with a formal education were significantly less likely to have AA (OR = 0.27, 95 % CI 0.10-0.71, p-value < 0.01). CONCLUSIONS: This study observed a significant association of aplastic anemia with a lower socioeconomic profile, and certain environmental exposures among the Pakistani population. The evidence may be helpful in understanding the pathophysiology of aplastic anemia in the context of environmental exposures.