Background: Lupus nephritis (LN) can cause significant morbidity and mortality if not diagnosed and treated in time. This study aimed to assess a non-invasive biomarker (antisingle center observational study included 50 patients with newly diagnosed LN. Serum anti-C1q antibody, anti-dsDNA antibody, C3, and C4 levels were correlated with National score, using Spearman's correlation coefficient. ROC curves were drawn for these biomarkers' serum levels for predicting NIH activity index score >10 on kidney biopsy. Results: The coefficients of correlation of anti-C1q antibody, anti-dsDNA antibody, C3, and C4 serum levels with LN histological activity were 0.5, 0.43, 0.48, and 0.3, respectively, and with SELENA SLEDAI score were 0.7, 0.45, 0.40, and 0.3, respectively. A 30 U/mL cut-off level for the anti-C1q antibody titer had a 61% sensitivity, 78% specificity, and 72% predictive accuracy in assessing histological LN severity with an activity index > 10 on kidney biopsy. Conclusion: Anti-C1q antibody serum levels correlated better with LN activity than anti-ds DNA antibody, C3, and C4 serum levels. Anti-C1q antibody serum levels > 30 U/mL can be used to predict severe proliferative LN with an activity index > 10 on kidney biopsy.
Background/Objectives: Associations between renal function, as measured by the estimated glomerular filtration rate (eGFR) or its decline (dGFR), and clinical parameters in patients with rheumatoid arthritis (RA) were evaluated using a retrospective case–control series dataset. Methods: Patients with RA who followed up for one or more consecutive years were recruited for the study. For calculating the eGFR, cystatin C (CysC) was adopted. The moment when CysC was measured was set as the baseline. The association between the eGFR and baseline clinical parameters, including disease activity in RA as measured by the simplified disease activity index (SDAI), was statistically evaluated. The association between the mean annual decline in the eGFR from the baseline and clinical parameters was also statistically assessed. Results: A total of 513 patients were enrolled; with a mean age of 70.9; a mean follow-up length of 52.5 months; a mean BMI of 22.9; a 68.7 eGFR; and a mean annual dGFR of 2.74. Significant parameters that correlated with the eGFR were age; rheumatoid factor titer; C-reactive protein; the presence of hypertension; chronic heart failure; chronic obstructive pulmonary disease; type 2 diabetes mellitus; methotrexate administration; and polypharmacy at baseline. An annual dGFR was correlated with the follow-up length, and the mean SDAI score multiplied by the yearly length of the follow-up was significantly correlated. Conclusions: Many factors confound the determination of the eGFR in RA patients. The disease activity score and length of time are the key factors for declining eGFRs.
BACKGROUND:Hepatocellular carcinoma (HCC) is considered uncommon in India. The aim of this study was to document the demographic characteristics and clinical aspects of HCC in Kerala, India. METHODS:A survey of HCC in Kerala was performed. All gastroenterologists in the region were invited. From May 2018 to April 2020, data was collected in a standardized questionnaire. RESULTS:Forty-three doctors from 15 centers contributed the data. Total 1217 patients were analyzed. This is the largest state-wide survey of HCC in India. HCC was more common in men (90%) than in women (p < 0.01). The etiology of liver disease was hepatitis B virus (7%), hepatitis C virus (4%) and alcohol (40%). Diabetes mellitus was present in 64%, hypercholesterolemia in 17% and hypertension in 38%. Obesity was present in 33% and 15% were overweight. Non-alcoholic fatty liver disease (NAFLD) with or without metabolic syndrome was present in 44%. Serum alpha-fetoprotein was > 400 ng/mL in 24%, total tumor diameter was > 5 cm in 59%, portal vein invasion was seen in 35% and distant metastasis was seen in 15%. Specific therapy was given to 52%. Treatments given included liver transplantation (n = 24), liver resection (n = 39) and transarterial chemoembolization (TACE, n = 184). Although the study was not designed to compare survival, patients who had liver transplantation had longer survival (median 69 months) compared to matched patients given only TACE (median 18 months) (p = 0.03). CONCLUSION:HCC is common in Kerala, India. NAFLD has a predominant association with HCC in Kerala. Most of the patients report late when curative treatment is not possible.
The Indian Society of Gastroenterology developed this evidence-based practice guideline for management of gastroesophageal reflux disease (GERD) in adults. A modified Delphi process was used to develop this consensus containing 58 statements, which were generated by electronic voting iteration as well as face-to-face meeting and review of the supporting literature primarily from India. These statements include 10 on epidemiology, 8 on clinical presentation, 10 on investigations, 23 on treatment (including medical, endoscopic, and surgical modalities), and 7 on complications of GERD. When the proportion of those who voted either to accept completely or with minor reservation was 80% or higher, the statement was regarded as accepted. The prevalence of GERD in India ranges from 7.6% to 30%, being < 10% in most population studies, and higher in cohort studies. The dietary factors associated with GERD include use of spices and non-vegetarian food. Helicobacter pylori is thought to have a negative relation with GERD; H. pylori negative patients have higher grade of symptoms of GERD and esophagitis. Less than 10% of GERD patients in India have erosive esophagitis. In patients with occasional or mild symptoms, antacids and histamine H2 receptor blockers (H2RAs) may be used, and proton pump inhibitors (PPI) should be used in patients with frequent or severe symptoms. Prokinetics have limited proven role in management of GERD.
