Granulomatosis with polyangiitis: clinical course and outcome of 60 patients from a single center in South India

Granulomatosis with polyangiitis (GPA) previously known as Wegener’s granulomatosis is one of the forms of idiopathic systemic vasculitis. There is very scanty data available on GPA in Asian and Indian population. We studied data of 60 patients from southern India, diagnosed with GPA to describe the physical characteristics, the treatment, and outcome. Patients who fulfilled any two of the four criteria proposed by the American College of Rheumatology, and those with clinical features of GPA with ANCA positivity and histopathological confirmation, were included in the study. Disease activity and damage were assessed by Birmingham Vasculitis Activity Score v. 3 (BVAS v. 3) and Vasculitis Damage Index (VDI), respectively. Relapses were defined as recurrence of GPA of sufficient severity to require treatment or increase in the dose of treatment on a patient who was previously stable. Out of 60 patients, initial BVAS evaluation showed that 57 (95%) patients had severe disease and 3 (5%) patients had limited disease where median BVAS was 21.5 (range 17–44). Follow-up BVAS evaluation for severe disease showed that 13 (22.8%) patients continued with severe disease of which 9 patients did not survive, 24 (42.3%) had remission, 11 (19.2%) had persistent disease, and 9 (15.7%) were lost to follow-up. The mean VDI score was 2.5 ± 2. Renal involvement was established in 42 (70%) patients. Upper and lower respiratory involvement was seen in 38 (63%) patients. Nervous system involvement was noted in the 15 (25%) patients. Articular manifestations were seen in 16 (27%) patients. Diverse clinical manifestation delay early diagnosis and treatment of this potentially treatable vasculitis. Focused approach could expedite early diagnosis and can reduce the mortality.     

The balance between stress and personal capital during pregnancy and the relationship with adverse obstetric outcomes: findings from the 2007 Los Angeles Mommy and Baby (LAMB) study

Stress during pregnancy is a salient risk factor for adverse obstetric outcomes. Personal capital during pregnancy, defined as internal and social resources that help women cope with or decrease their exposure to stress, may reduce the risk of poor obstetric outcomes. Using data from the 2007 Los Angeles Mommy and Baby study (N?=?3,353), we examined the relationships between the balance of stress and personal capital during pregnancy, or the stress-to-capital ratio (SCR), and adverse obstetric outcomes (i.e., pregnancy complications, preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA)). Women with a higher SCR (i.e., greater stress relative to personal capital during pregnancy) were significantly more likely to experience at least one pregnancy complication, PTB, and lower gestational age, but not LBW or SGA. Accounting for pregnancy complications completely mediated the association between the SCR and PTB. Our findings indicate that experiencing greater stress relative to personal capital during pregnancy is associated with an increased risk for pregnancy complications, PTB, and lower gestational age and that pregnancy complications may be a mechanism by which the SCR is related to adverse obstetric outcomes.     

Does mindfulness improve outcomes in patients with chronic pain? Systematic review and meta-analysis

Background

Chronic pain and its associated distress and disability are common reasons for seeking medical help. Patients with chronic pain use primary healthcare services five times more than the rest of the population. Mindfulness has become an increasingly popular self-management technique.

Aim

To assess the effectiveness of mindfulness-based interventions for patients with chronic pain.

Design and setting

Systematic review and meta-analysis including randomised controlled trials of mindfulness-based interventions for chronic pain. There was no restriction to study site or setting.

Method

The databases MEDLINE^®, Embase, AMED, CINAHL, PsycINFO, and Index to Theses were searched. Titles, abstracts, and full texts were screened iteratively against inclusion criteria of: randomised controlled trials of mindfulness-based intervention; patients with non-malignant chronic pain; and economic, clinical, or humanistic outcome reported. Included studies were assessed with the Yates Quality Rating Scale. Meta-analysis was conducted.

Results

Eleven studies were included. Chronic pain conditions included: fibromyalgia, rheumatoid arthritis, chronic musculoskeletal pain, failed back surgery syndrome, and mixed aetiology. Papers were of mixed methodological quality. Main outcomes reported were pain intensity, depression, physical functioning, quality of life, pain acceptance, and mindfulness. Economic outcomes were rarely reported. Meta-analysis effect sizes for clinical outcomes ranged from 0.12 (95% confidence interval [CI] = −0.05 to 0.30) (depression) to 1.32 (95% CI = −1.19 to 3.82) (sleep quality), and for humanistic outcomes 0.03 (95% CI = −0.66 to 0.72) (mindfulness) to 1.58 (95% CI = −0.57 to 3.74) (pain acceptance). Studies with active, compared with inactive, control groups showed smaller effects.

Conclusion

There is limited evidence for effectiveness of mindfulness-based interventions for patients with chronic pain. Better-quality studies are required.     

Technique of using Cionni capsular tension ring in the management of of ectopia lentis cases

Background:Ectopia lentis is a condition that compromises vision in childhood by inducing either double vision or aphakic visual axis. Correction of lens status is of prime importance to prevent amblyopia or sensory strabismus.Purpose:Placing an intraocular lens (IOL) in the bag in such cases will maintain aqueous vitreous barrier but it is a difficult task.This video demonstrates the method of placing modified Cionni capsular tension ring (CTR) and placement of IOL in children.Synopsis:This video shows the management of multiple cases of ectopia lentis with more than 180 degree subluxation. Making intact rhexis is crucial and technically difficult in such cases. The way of making a proper capsulorhexis is shown. After making capsulorhexis, all the cases were managed with single loop Cionni CTR. Cionni CTR has a loop with a anterior offset of 0.4 mm to override the anterior capsule. It has two designs – right and left design, based on the position of islet in the CTR. Since the offset of the hook is tiny, there are high chances to flip the Cionni CTR. If the Cionni CTR is placed in a flipped manner, it would not give effective pull of the bag, when fixated to sclera. And also, it could be traumatic to explant and place in correct manner. Hence it is vital to place the Cionni CTR in correct orientation, so that anterior offset will orient anteriorly. This video gives guidance to the viewers about the correct way of placing different designs of Cionni CTR in different types of subluxation.Timing of passing sutures through sclera may be done either before or after placing the Cionni CTR in the bag. Both the ways are demonstrated in different cases.Highlights:Different technique of doing Cionni CTR fixation with IOL placement are demonstrated. Surgeons who wish to try this procedure can choose the option that they feel comfortable with. We conclude that choice of Cionni CTR design and technique of placement depends on surgeon’s choice and not based on the type of subluxation.Video link: https://youtu.be/zbdpP0lhykw     

Reactive oxygen species generation by copper(II) oxide nanoparticles determined by DNA damage assays and EPR spectroscopy

Copper(II) oxide nanoparticles (^NPCuO) have many industrial applications, but are highly cytotoxic because they generate reactive oxygen species (ROS). It is unknown whether the damaging ROS are generated primarily from copper leached from the nanoparticles, or whether the nanoparticle surface plays a significant role. To address this question, we separated nanoparticles from the supernatant containing dissolved copper, and measured their ability to damage plasmid DNA with addition of hydrogen peroxide, ascorbate, or both. While DNA damage from the supernatant (measured using an electrophoresis assay) can be explained solely by dissolved copper ions, damage by the nanoparticles in the presence of ascorbate is an order of magnitude higher than can be explained by dissolved copper and must, therefore, depend primarily upon the nanoparticle surface. DNA damage is time-dependent, with shorter incubation times resulting in higher EC₅₀ values. Hydroxyl radical (^?OH) is the main ROS generated by ^NPCuO/hydrogen peroxide as determined by EPR measurements; ^NPCuO/hydrogen peroxide/ascorbate conditions generate ascorbyl, hydroxyl, and superoxide radicals. Thus, ^NPCuO generate ROS through several mechanisms, likely including Fenton-like and Haber-Weiss reactions from the surface or dissolved copper ions. The same radical species were observed when ^NPCuO suspensions were replaced with the supernatant containing leached copper, washed ^NPCuO, or dissolved copper solutions. Overall, ^NPCuO generate significantly more ROS and DNA damage in the presence of ascorbate than can be explained simply from dissolved copper, and the ^NPCuO surface must play a large role.