Is syndrome of inappropriate antidiuretic hormone secretion an extra-articular manifestation of rheumatoid arthritis?

SIR, Syndrome of inappropriate antidiuretic hormone secretion(SIADH) is a disorder of fluid and electrolyte balance whichresults from the excessive release of antidiuretic hormone (ADH)that leads to hyponatraemia. Systemic diseases of many typesand various groups of drugs have been associated with SIADH.The association of SIADH with rheumatoid arthritis (RA) is notvery well established. We report a patient with recent onsetRA and SIADH whose hyponatraemia improved upon control of theinflammatory arthritis. An 84-yr-old woman with     

Noncirrhotic portal fibrosis/idiopathic portal hypertension: APASL recommendations for diagnosis and treatment

The Asian Pacific Association for the Study of the Liver (APASL) Working Party on Portal Hypertension has developed consensus guidelines on the disease profile, diagnosis, and management of noncirrhotic portal fibrosis and idiopathic portal hypertension. The consensus statements, prepared and deliberated at length by the experts in this field, were presented at the annual meeting of the APASL at Kyoto in March 2007. This article includes the statements approved by the APASL along with brief backgrounds of various aspects of the disease.     

Isolation of cDNA clones coding for human tissue factor: primary structure of the protein and cDNA.

Tissue factor is a membrane-bound procoagulant protein that activates the extrinsic pathway of blood coagulation in the presence of factor VII and calcium. lambda Phage containing the tissue factor gene were isolated from a human placental cDNA library. The amino acid sequence deduced from the nucleotide sequence of the cDNAs indicates that tissue factor is synthesized as a higher molecular weight precursor with a leader sequence of 32 amino acids, while the mature protein is a single polypeptide chain composed of 263 residues. The derived primary structure of tissue factor has been confirmed by comparison to protein and peptide sequence data. The sequence of the mature protein suggests that there are three distinct domains: extracellular, residues 1-219; hydrophobic, residues 220-242; and cytoplasmic, residues 243-263. Three potential N-linked carbohydrate attachment sites occur in the extracellular domain. The amino acid sequence of tissue factor shows no significant homology with the vitamin K-dependent serine proteases, coagulation cofactors, or any other protein in the National Biomedical Research Foundation sequence data bank (Washington, DC).     

Gastric adenocarcinoma in a patient re-infected with <Emphasis Type="Italic">H. pylori</Emphasis> after regression of MALT lymphoma with successful anti-<Emphasis Type="Italic">H. pylori</Emphasis>therapy and gastric resection: a case report

Background

Helicobacter pylori (H. pylori) has been etiologically linked with primary gastric lymphoma (PGL) and gastric carcinoma (GC). There are a few reports of occurrence of both diseases in the same patient with H. pylori infection.

Case presentation

We report a patient with PGL in whom the tumor regressed after surgical resection combined with eradication of H. pylori infection. However, he developed GC on follow up; this was temporally associated with recrudescence / re-infection of H. pylori. This is perhaps first report of such occurrence.

Conclusions

Possible cause and effect relationship between H. pylori infection and both PGL and GC is discussed. This case also documents a unique problem in management of PGL in tropical countries where re-infection with H. pylori is supposed to be high.

     

Improvement in glucose tolerance after one year of follow-up in a Hindu community in Africa

Oral glucose tolerance was studied following a 75 g glucose load in 108 (82.4%) of 131 male and 110 (79.1%) of 139 female members of a Hindu subcommunity aged 15 years and over in Dar es Salaam. One year later, the glucose tolerance tests were repeated in 93 (86.1%) and 93 (84.5%) of the 108 male, and 110 of the female subjects, respectively. In the first survey, 25 (26.9%) of the 93 male and 24 (25.8%) of the 93 female subjects had impaired glucose tolerance (IGT), 6 (6.4%) and 15 (16.1%), respectively, had diabetes mellitus; and 62 (66.7%) and 54 (58.1%), respectively, had normal glucose tolerance. In the repeat survey, of the 93 male and 93 female subjects, 8 (8.6%) and 7 (7.5%) had IGT, 4 (4.3%) and 10 (10.8%) had diabetes; and 81 (87.1%) and 76 (81.7%) were normal, respectively. Of the 21 subjects diagnosed as having diabetes in the first survey, 13 (61.9%) continued to show diabetic glucose tolerance; 4 (19%) IGT and 4 (19%) had normal glucose tolerance with no gender difference. One (1.6%) of the 62 male subjects and none of the 54 females with normal glucose tolerance in the first survey progressed to IGT, while the remainder retained normal glucose tolerance. Diabetes and IGT rates in both surveys were higher for the older than the younger persons. A significant fall in mean fasting and post-75 g blood glucose levels, and in mean systolic and diastolic pressure levels was observed between the first and second surveys in both genders. There was, however, no significant difference in body mass index (BMI), serum total cholesterol and triglyceride levels between surveys, suggesting that major dietary changes had not taken place. Male subjects who showed persistent IGT had significantly lower mean level of body mass index (kg/m²) than subjects who reverted to normal, whilst for the whole group those who had persistent IGT were older. It is tempting to speculate that these changes were due to community action. However, in view of the lack of change in weight and lipids and similar results in other communities in Tanzania when retested at 1 week, further studies are needed to establish the significance of the findings.     

Prevalence of gestational diabetes mellitus in urban and rural Tanzania

Aim

To estimate prevalence of gestational diabetes mellitus (GDM) and associated determinants in urban and rural Tanzania.

Methods

A cross-sectional study was conducted from 2011 through 2012 in selected urban and rural communities. Pregnant women (609 urban, 301 rural), who were not previously known to have diabetes, participated during usual ante-natal clinic visits. Capillary blood samples were collected at fasting and 2 h after 75 g glucose load and were measured using HemoCue. Diagnosis of GDM was made using 1999 World Health Organization (WHO) criteria.

Results

Women in rural areas were younger (26.6 years) than in urban areas (27.5 years). Mean gestational age, height, and mid-upper arm circumference (MUAC) were similar for the two areas. Overall prevalence of GDM averaged 5.9%, with 8.4% in urban area and 1.0% in rural area. Prevalence of GDM was higher for women who had a previous stillbirth (OR 2.8, 95% CI 1.5–5.4), family history of type 2 diabetes (OR 2.1, 95% CI 1.1–4.2), and MUAC above 28 cm (OR 1.9, 95% CI 1.1–3.3), and lower for women with normal hemoglobin compared with anemia (OR 0.45, 95% CI 0.22–0.93).

Conclusions

Prevalence of GDM is higher than expected in urban areas in Tanzania, indicating an increasing population who are at risk for delivery complications and type 2 diabetes in Sub-Saharan Africa.     

Redox modulatory protective effects of ω-3 fatty acids rich fish oil against experimental colitis

Ulcerative colitis (UC), a form of inflammatory bowel disease (IBD), is an immune-modulated disorder characterized by chronic and recurring inflammatory episodes. Oxidative stress and COX pathway of prostaglandin (PG) biosynthesis are indispensable to pathogenesis of UC. Any imbalance between PGs can compromise the mucosal homeostasis, leading to mucosal damage and chronic inflammation. However, blocking these PGs using classical Cox inhibitors such as non-steroidal anti-inflammatory drugs (NSAIDs) can instead aggravate signs of IBD. Therefore, realizing the need for safer and well tolerable alterative treatment approaches, currently, we evaluated the efficacy of n-3 fatty acids rich fish oil (FO) in the resolution of UC. Using a dextran sodium sulfate (DSS) model of experimental colitis, we have demonstrated that supplementation of FO containing 180?mg EPA and 120?mg DHA for 1 month relieved the signs (diarrhea, bloody stools, weight loss) of colitis-associated inflammation. To understand the biophysical changes associated with FO mediated inflammatory regulation, impedance measurement and Fourier transform infrared spectroscopy (FTIR) were done. These changes were also correlated with oxidative stress through markers such as GST, glutathione peroxidase (GPx), LPO, catalase, protein carbonyl content, GR, etc. in colonic mucosa. The modulation of COX mediated pathways in UC-associated inflammation was observed by protein expressions of various pro-inflammatory cytokines such as TNF-α and enzymes of PG synthesis such as COX-2, PGES, TXAS, and anti-inflammatory PGDS. Refuting the earlier reports that suggested the contradictory effects of FO, in the current study, we evidently demonstrated that the protective effects of FO are mediated through molecular mechanisms involving the redox-regulation of metabolism of key lipid metabolites.