Clinical profile of ankylosing spondylitis at a teaching hospital.

Introduction/Background: Ankylosing spondylitis (AS), a type of spondyloarthropathy, is an autoimmune disease that mainly involves spine joints, sacroiliac joints and their adjacent soft tissues, such as tendons and ligaments. Progression of disease can lead to fibrosis and calcification, resulting in the loss of flexibility and mobility of the spine. The common clinical presentation is inflammatory back pain which is often neglected. The aim of our study was to assess the demographic and clinical proflie of patients of ankylosing spondylitis diagnosed on the basis of radiographic sacroillitis. Methods: In a cross sectional hospital based study, the patients visiting to outpatient departments with inflammatory back pain were evaluated and 200 patients who had sacroiliitis according to modified New york criteria were diagnosed to have ankylosing spondylitis.The demographic and clinical profile was studied. Disease activity was assessed by using the ASDAS and BASDAI and function by BASFI and BASMI. Results: Amongst the study participants, 72 % were males and 28 % were females. The mean age of participants was 46± 12years. The mean duration of symptoms was10± 3 years. Out of all, 92% patients were HLA B27 positive. High BASDAI score (>4) was positively correlated with elevated CRP, ESR ,neutrophil lymphocyte ratio and had negative correlation with serum vitamin D levels. Conclusion: Most of the patients in our study had advanced disease might be due to delay in the diagnosis. They had high BASDAI with elevated inflammatory markers. Awareness for early and definite diagnosis of ankylosing spondylitis is needed to prevent irreversible structural damage, and worsening of quality of life.

Résumé Introduction/Contexte: La spondylarthrite ankylosante (AS), un type de spondyloarthropathie, est une maladie auto-immune qui implique principalement Les articulations de la colonne vertébrale, les articulations sacroiliaques et leurs tissus mous adjacents, tels que les tendons et les ligaments. La progression de la maladie peut entraîner une fibrose et Calcification, entraînant la perte de flexibilité et de mobilité de la colonne vertébrale. La présentation clinique courante est les maux de dos inflammatoires qui est souvent négligé. Le but de notre étude était d'évaluer le proflie démographique et clinique des patients de la spondylarthrite ankylosante diagnostiquée sur la base de la sacroie radiographique. Méthodes: Dans une étude en section d'hôpital transversal, les patients visitant des services ambulatoires avec des maux de dos inflammatoires ont été évalués et 200 patients souffrant de sacro -iliite selon les critères modifiés de New York ont été diagnostiqués avoir une spondylite ankylosante. Le profil démographique et clinique a été étudié. L'activité de la maladie a été évaluée en utilisant les Asdas et Basdai et fonction par Basfi et Basmi. Résultats: Parmi les participants à l'étude, 72% étaient des hommes et 28% étaient des femmes. La moyenne L'âge des participants était de 46 ± 12 ans. La durée moyenne des symptômes était de 10 ± 3 ans. Sur tous, 92% des patients étaient positifs HLA B27. Le score de Basdai élevé (> 4) était positivement corrélé avec le rapport lymphocytaire CRP, ESR, ESR élevé et avait une corrélation négative avec taux sériques de vitamine D. Conclusion: La plupart des patients de notre étude avaient une maladie avancée pourraient être dus à un retard dans le diagnostic. Ils avaient Basdai élevé avec des marqueurs inflammatoires élevés. Une conscience pour un diagnostic précoce et définitif de la spondylarthrite ankylosante est nécessaire pour prévenir Dommages structurels irréversibles et aggravation de la qualité de vie. Mots-clés: spondylarthrite ankylosante, indice d'activité de la spondylarthrite ankylosante du bain, maux de dos inflammatoires, spondyloarthropathie.

Neutrophil Gelatinase-associated Lipocalin (NGAL) as a Marker of Renal Tubular Injury in Metabolic Syndrome Patients with Hyperuricemia.

BACKGROUND: Hyperuricemia has been associated with chronic kidney disease, evidence suggests that hyperuricemiamight plays a role in progression of renal damage. Whether hyperuricemia can lead to renal tubular injury remains unclear. In this study we aimed to determine serum NGAL and urinary NGAL/creatinine ratio as markers of reanal tubular injury in metabolic syndrome patientshave hyper or normouricemia. MATERIAL AND METHODS: In this hospital based cross- sectional study,180 par ticipants with metabolic syndrome were included,90 patients had hyperuricemia and 90 were with normouricemia. Clinical biochemical parameters of serum NGAL and urinary NGAL were measured using a commercially available enzyme-linked immunosorbent assay (ELISA) kit. Receiver operating characteristic(ROC) curve was analysis was employed to assess the sensitivity and specificity of serum NGAL and urine NGAL/creatinine ratio. RESULTS: Out of all, 96 were males and 84 were females. The mean age of participants was 45 ± 7 years. Serum NGAL levels and Urinary NGAL/creatinine ratio were higher in metabolic syndrome patients with hyperuricemia. High Serum NGAL was positively correlated with presence of hypertension; HbA1c and waist-hip ratio and negatively correlated with HDL. CONCLUSION: Serum NGAL levels and urinary NGAL/creatinine ratio were higher in metabolic syndrome patients with hyperuricemia that indicates presence of renal tubular injury in these patients. High Serum NGAL was positively correlated with presence of hypertension; HbA1c and waist-hip ratio.

Study of Association of Metabolic Syndrome and Risk Factors of Nephrolithiasis.

BACKGROUND AND AIM: The increasing incidence of nephrolithiasis in recent decades is coinciding with rising epidemic of obesity, metabolic syndrome, and type 2 diabetes. This temporal concordance suggests that a link might exist between these metabolic abnormalities and urinary stone disease. Therefore, the present study was aimed to investigate the association between presence of risk factors of nephrolithiasis and metabolic syndrome. METHODS: In a hospital-based, case control study, hundred patients of metabolic syndrome diagnosed according to IDF criteria and hundred age and matched controls were studied for presence of risk factors of nephrolithiasis. RESULTS: Patients with metabolic syndrome had significantly higher uricosuri a,hypercalciuria,oxaluria and hypocitraturia. The prevalence of risk factors of nephrolithiasis was also higher in patients with metabolic syndrome. The most prevalent was low urinary pH in 40% patients with mean pH of 5.8±1.6. Amongst other factors, 33% had hyperuricemia, 29% had hypercalciuria, 15% had oxaluria 13% had hypocitraturia and 10% had hyperuricosuria. Significant correlation was observed between risk factors of nephrolithiasis and components of metabolic syndrome. CONCLUSION: The present study provides an evidence of association between risk factors of nephrolithiasis and metabolic syndrome and suggests that nephrolithiasis may be a systemic disorder representing the interaction of multiple metabolic derangements. Determining common modifiable risk factors for the development of kidney stones might uncover new preventive strategies.

Study of Hepatic Osteodystrophy in Patients with Chronic Liver Disease.

INTRODUCTION: Chronic Liver Disease (CLD) is a major cause of morbidity and mortality worldwide. It involves haemodynamic and metabolic complications. Hepatic Osteodystrophy is a metabolic bone disease that may occur in individuals with chronic liver disease. It can significantly affect morbidity and quality of life of these patients. Fractures are also associated with an excess mortality. It has been an under recognized and inadequately studied complication among Indian population. An early diagnosis is essential to correct reversible risk factors which predispose to bone mass loss. AIM: To assess the prevalence of metabolic bone disease and identify the risk factors associated with hepatic osteodystrophy in patients with cirrhosis. MATERIALS AND METHODS: This was an observational, cross-sectional, hospital based study conducted at a medical college hospital. All patients more than 20-year-old, diagnosed with chronic liver disease/Cirrhosis were enrolled. They were subjected to haematological, biochemical investigations, evaluation of Vitamin D and other hormonal parameters. Bone Mineral Density (BMD) was estimated by Dual Energy X-ray Absorptiometry (DEXA). RESULTS: A total of 72 patients with mean age 50.04±11.24 years were included in the study. Amongst causes of chronic liver disease were alcoholic liver disease 22 (30.6%), CLD due to hepatitis B 24 (33.3%) and chronic hepatitis C 26 (36.1%). Twenty one (29.2%) patients had normal BMD while 51 (70.8%) had a low BMD. Out of these 51 patients, 36 (70.6%) were diagnosed of osteopenia and 15 (29.4%) others were found to have osteoporosis. Vitamin D levels and severity of liver disease had correlation with low BMD. CONCLUSION: Low BMD is highly prevalent in patients with chronic liver disease of variable aetiologies. We advocate more randomised and prospective studies to be conducted on homogeneous groups with chronic liver disease in its various stages. In view of numerous therapeutic options available both for liver disease and bone disease, it is prudent to characterize this condition in order to give these patients a better chance of survival with good quality of life.