BACKGROUND Autoimmune phenomenon is described in many cases of myelodysplastic syndrome. The incidence of autoimmune phenomenon in de novo cases of myelodysplastic syndrome varies from 10 to 30 percent of cases in Western literature with arthritis, vasculitis or haemolytic anaemia. The data from India is very scanty and that from Kerala, virtually non-existent. The aim of this study is to evaluate the prevalence of autoimmune phenomenon in diagnosed cases of myelodysplastic syndrome focusing on the prevalence of the different types of autoimmune phenomenon in the cases of myelodysplastic syndrome and to examine if any subtype of myelodysplastic syndrome is more associated with autoimmune phenomenon.
BACKGROUND Myelodysplastic syndromes are clonal marrow stem cell disorders characterised by ineffective haemopoiesis leading to blood cytopenias. Various prognostic parameters have been used to assess the prognosis of the disease like age, gender, IPSS score, modified IPSS score, serum albumin, Red Cell Distribution Width (RDW), serum ferritin and Lactate Dehydrogenase (LDH). Multiple studies from the west have shown serum albumin levels at presentation to correlate well with prognosis of patients. Studies from India investigating the levels of serum albumin with prognosis of patients with myelodysplastic syndrome are scanty. The aim of this study was to investigate the relationship of serum albumin levels at presentation of patients and the consequent development of complications and death that occurred in the follow-up period of patients with myelodysplastic syndrome. METHODS For this purpose, we studied 117 consecutive confirmed cases of myelodysplastic syndrome that presented to the Department of Medicine and Haematology in Calicut Government Medical College between July 2009 and June 2013. Serum albumin levels were taken on diagnosis. All patients were followed up till December 2014 and subsequently developing complications both outpatient and inpatient) along with deaths that occurred were studied. RESULTS Although, only 40.2% of patients with myelodysplastic syndrome had low serum albumin at presentation, the undifferentiated subtype, RAEB-2 subtype and RAEB-1 had a statistically significant low serum albumin levels. Of the 47 patients who had low serum albumin, 33 patients had developed complications during the course of the illness. Of the 70 patients who had normal serum albumin, 35 had developed complications, which was statistically significant. CONCLUSIONS A low level of serum albumin (<3.5 mg%) at presentation in cases of myelodysplastic syndrome was statistically associated with poor prognostic subtypes of myelodysplastic syndrome and in turn was associated with high levels of complications and mortality during the course of illness.
BACKGROUNDCutaneous vasculitis is a condition caused by various aetiologies. They can be primary or secondary. Cutaneous lesions maybe a pointer to systemic diseases. So, it is important to identify the various aetiological factors in the occurrence of the various types of cutaneous vasculitis. The patterns and the various aetiologies of cutaneous vasculitis in Kerala is not well documented in the existing literature. MATERIALS AND METHODSThe present study is a cross-sectional descriptive study of patients with a clinical diagnosis of cutaneous small vessel vasculitis admitted in Medicine and Dermatology Wards of Calicut, Government Medical College during January 2013 to December 2013. A detailed history and clinical examination of patients along with histopathological examination of skin biopsy was done. RESULTSOut of the 70 cases of cutaneous vasculitis studied, idiopathic cutaneous small vessel vasculitis was the most common type followed by Henoch-Schonlein purpura. The most common aetiology identified was drugs followed by infections. No aetiological factor was identified in 42.8% of the cases. CONCLUSIONAn aetiological association could be found in 57.8% of cases. The causes identified include drugs, infections, malignancy, connective tissue disorder associated, chronic systemic diseases and Behcet's disease in decreasing order of frequency. HOW TO CITE THIS ARTICLE:Malayath P, Balakrishnan S. A study of aetiological factors in the occurrence of cutaneous vasculitis in a tertiary care centre in north Kerala. J. Evid. Based Med.
BACKGROUND Myelodysplastic syndromes are clonal marrow stem cell disorders characterised by ineffective haemopoiesis leading to blood cytopenias. Various prognostic parameters have been used to assess the prognosis of the disease like age, gender, IPSS score, modified IPSS score, serum albumin, Red Cell Distribution Width (RDW), serum ferritin and Lactate Dehydrogenase (LDH). MATERIALS AND METHODS The aim of this study was to investigate the relationship of serum lactate dehydrogenase at presentation of patients and the consequent development of complications and death that occurred in the followup period. RESULTS For this purpose, we studied 117 consecutive confirmed cases of myelodysplastic syndrome that presented to the Department of Medicine and Haematology in Calicut Government Medical College between July 2009 and June 2013. Serum lactate dehydrogenase levels were taken on diagnosis. All patients were followed up till December 2014. All subsequently developing complications-both outpatient and inpatient along with deaths that occurred were studied. CONCLUSION Although, a majority of patients with myelodysplastic syndrome (66.7%) had an LDH levels less than 500 IU/L, the undifferentiated subtype, RAEB-2 subtype and RAEB-1 subtype had a statistically significant high LDH levels probably due to high cell turnover rate. There was a positive correlation between LDH values and the complication rate of patients. A statistically significant correlation was seen between high LDH value and the frequency of death that occurred in the study group.
BACKGROUND Infection is a major cause of morbidity and mortality in patients receiving chemotherapy for acute leukaemias. This is an attempt to study oropharyngeal, respiratory and skin infections in patients with acute leukaemia receiving chemotherapy with reference to their aetiology, response to antimicrobial treatment and relation with neutropenia. MATERIALS AND METHODS All acute leukaemic patients on chemotherapy with any clinical or laboratory features of oropharyngeal, respiratory tract or skin infections admitted in the Haematology Unit of Calicut Government Medical College were included in the study. In the present study, a total of 70 febrile episodes were studied. These episodes were investigated for infectious aetiology by putting appropriate specimen(s) for culture/microscopy for bacterial, fungal and parasitic agents. RESULTS Maximum incidence of infections and the poorest outcome was observed when absolute neutrophil count was <500. Incidence of severe neutropenia in our study was 42.86% with high mortality in severely neutropenics (40%). Respiratory system was the commonest site of infection (54%). Pyogenic bacteria were predominating in the culture studies with 21 cultures positive. Staphylococcus aureus (47.61%) was the commonest agent in the culture samples. CONCLUSION Rate of neutropenia as well as mortality is high in AML patients when comparing with ALL. Most common symptom indicating infection is fever even if the patient is having defective immunity. Thrombophlebitis at intravenous cannula site is a common focus of infection. Majority of patients responded well to first line antibiotics, even though culture and sensitivity studies were negative.
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