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Secondary care rheumatology services for patients with inflammatory arthritis (IA) in the West Midlands were audited using Arthritis and Musculoskeletal Alliance (ARMA) standards of care. Questionnaires were analysed from 1,715 patients in 11 rheumatology departments. ARMA standards recommend full multidisciplinary team assessment; referral rates to nurse specialists (52.3%), physiotherapists (48.7%) and occupational therapists (36.5%) were, however, lower than expected. Attendance at existing hospital-led education groups was rare (8.9%), awareness of existing helplines was moderate (59.2%) but the proportion of patients reporting satisfaction with advice about their disease was high (80.5%). Significant variations were found between departments. For patients with IA < 2 years (n = 236), 84.5% were seen by a rheumatologist within the ARMA standard of 12 weeks of referral; diagnosis of a type of IA was made at the first rheumatology appointment in 66.4%; 82.8% of rheumatoid arthritis patients had commenced disease-modifying drugs, although time to commencement varied across departments. This study raises issues regarding provision of rheumatology services, prioritisation of patient referral and patient education.

Three monocot lectins from underground tubers of plants belonging to the family Araceae were investigated for their mitogenic potential towards human peripheral blood lymphocytes. All the three lectins turned out to be potent mitogens in the [3H]-thymidine uptake assay. Gonatanthus pumilus lectin was mitogenic at an optimum concentration of 25 micrograms/ml while Alocasia indica and Sauromatum guttatum lectins were most effective at a concentration of 50 micrograms/ml. [3H]-thymidine incorporation studies further revealed that the lectins were T-cell mitogens and did not induce any appreciable DNA synthesis in B-enriched lymphocytes. The proliferation kinetic studies detected maximum incorporation on day 3 and the mitogenic response was shown to be inhibited by asialofetuin in a concentration-dependent manner.

Background: Anti-tumour necrosis factor (anti-TNF) therapy has been an important development for the treatment of rheumatoid arthritis (RA) but the impact of its delivery on hospital resources in still emerging. Aims: We audited the effect of starting anti-TNF on the use of other anti-rheumatic therapies and hospital resources in a routine secondary care setting. Methods: A retrospective study of resource use before and after anti-TNF was conducted. Hospital records of 54 RA patients were studied and data taken from the time of commencing anti-TNF to 1 October 2004 and an equal time period prior to commencing anti-TNF. Identical data were collected for 54 controls not on anti-TNF. Relevant figures were extrapolated to per annum rates. Results were analysed using two-factor ANOVAs comparing the pre- versus post-anti-TNF period. Cases on intravenous (IV) versus subcutaneous (SC) anti-TNF were also compared in separate ANOVAs. Results: Mean duration of anti-TNF therapy was 17.04 months (range 3.60–42.36). Mean pre- and 3-months post-anti-TNF Disease Activity Scores (DAS28) were 6.93 and 3.88, respectively. Cases were more likely than controls to be on oral prednisolone pre- and post-anti-TNF. Methylprednisolone requirement, number of disease-modifying anti-rheumatic drugs (DMARDs), telephone helpline contacts and duration as an inpatient reduced significantly post-anti-TNF. Day case admissions increased but outpatient appointments decreased only in cases on IV anti-TNF. Conclusions: In a pragmatic setting, anti-TNF therapy led to reduced need for steroid injections and other DMARDs, as well as reductions in use of several hospital resources. Wider replication of these findings will be important for planning delivery. Copyright: © 2006 John Wiley & Sons, Ltd.

Azo dyes, the largest portion of manufactured dyestuffs, are primarily used as colouring substances in food, textiles, and the plastic industry. It has been estimated that 128 tonnes per annum of dyes are released into the environment worldwide [Anliker, 1977]. Certain azo compounds are known to be mutagenic in bacterial tests [Yahagi et al., 1975; Venitt and Bushell, 1976; Brown et al., 1978]. Watersoluble dyes are biotransformed by intestinal micro-organisms in the gastro intestinal tract, and the toxicity, mutagenicity, and carcinogenicity of these dyes in the gut or liver may be attributed to their metabolites. Since it is desirable to have a genotoxic evaluation of a chemical being released into the environment in order to check their indiscriminate use, a project has been initiated to determine the mutagenicity of the azo dyes being used commercially. The present report deals with the results of 13 dyes tested in Salmonella typhimurium with and without metabolic activation.

Mycetoma of the knee, caused by Nocardia caviae and idangosed by culture and histopathology, occurred in a 20 year old farmer from a rural area of Varanasi District in Uttar Pradesh, India. The isolate was pathogenic to mice and it showed close agreement with the standard description of the species. It is suggested that infection due to this species has a higher prevalence than is currently recognized.

Candida viswanathii has been isolated from the cerebrospinal fluid of a 20 year old male patient suffering from meningitis which ended fatally. The fungus proved pathogenic to cortisone treated mice but was poorly so to the normal mice challenged intravenously.

We studied the effect of prostate resection on serum creatine kinase (EC 2.7.3.2) and lactate dehydrogenase (EC 1.1.1.27) isoenzymes in 22 patients. Two hours after their operations, two-thirds of these patients had increased total creatine kinase activity. The MB isoenzyme was demonstrated in sera of 66% of the patients and the BB isoenzyme in 76%. MB content varied from 1 to 7% of total creatine kinase activity, the average activity being 7.4 +/- 6 (SD) U/L. BB content varied from 1 to 29% of the total creatine kinase activity, the average activity being 8.5 +/- 5.4 U/L. No patients showed evidence of cardiac damage. In contrast to the enzyme changes associated with cardiac injury, MB isoenzyme seen after prostate resection is usually associated with the appearance of BB activity. In addition, the ratio of lactate dehydrogenase isoenzymes 1 and 2 was "inverted" in only five of the 33 patients, and appeared to corrlate with the degree of hemolysis in the postoperative sera. The prostate contains all three creatine kinase isoenzymes, BB predominating.

The induced auxotrophy for p-aminobenzoic acid (PABA) resulted in a complete loss of virulence of Aspergillus fumigatus for normal as well as cortisone-treated mice. The PABA-requiring mutant of A. fumigatus survived in vivo for 4 to 7 days without causing any infection. However, it showed conditional virulence in animals receiving PABA in very small quantities. Repeated inoculations of the viable spores of the avirulent mutant strain gave favorable results in building immunity against intravenous challenge of the virulent strain. The immunogenicity of the PABA-requiring mutant was comparable with that of a wild strain of the fungus in agar gel double-diffusion tests using clinical and hyperimmune sera and in skin tests on patients with allergic bronchopulmonary aspergillosis.

A comprehensive survey has been carried out on the occurrence ofAspergillus species in the respiratory tract of patients of bronchopulmonary diseases in Delhi. In all, 1238 clinical specimens, which included 1082 sputa, 143 bronchial aspirates and 13 throat swabs obtained from 812 patients, were examined. Of these 61.7 per cent patients were culturally positive yielding 29 different species ofAspergillus. The prevalence of aspergilli in sputa was significantly higher than in the bronchial aspirates.Aspergillus niger was the commonest species isolated showing a prevalence of 36.7 per cent. It was followed byA. flavus, A. nidulans, A. terreus, A. versicolor, A. sydowi, A. japonicus andA. oryzae. None of theAspergillus species showed a significant correlation with any of the diseases, or the type of treatment the patients had received. Of the 8 broad occupational groups investigated farmers and labourers showed higher prevalence ofA. niger andA. flavus. The prevalence ofAspergillus species in the throats of healthy persons was 16 per cent withA. versicolor being the commonest species followed byA. flavus, A. amstelodami, A. sydowi andA. terreus. A comparison of the prevalence ofAspergillus species in the patients, healthy individuals and atmosphere of Delhi appears to support the view that the aspergilli are transient residents in the human respiratory tract following their inhalation from the environment.

Available published reports on deep mycoses in India have been critically and exhaustively reviewed. So far there seem to be only 9 cases of actinomycosis reported, mostly of thoracic type and diagnosed on the basis of the presence of “sulphur granules” in the lesions. Nocardiosis and its chief causal agentNocardia asteroides have received particular attention in recent studies. To-date there are 18 authentic cases reported from India and significantly 12 of these have been diagnosed by applying the paraffin bait technique to the isolation ofN. asteroides from sputa and other clinical specimens. In most of these 12 cases timely diagnosis allowed for the successful treatment of the disease with heavy doses of sulphadiazine. Case reports on cryptococcosis which include 26 adequately documented cases, have been published from various parts of the country. Occurrence ofCryptococcus neoformans in soil and its association with old pigeon excreta have also been confirmed by studies done in some northern and western regions of this country. The status of histoplasmosis in India still remains a debatable subject although there is a suggestive evidence that the disease may be endemic in the northeastern parts. There are 9 case reports in which diagnosis has been supported by histopathologic findings and in 3 cultures have also been positive. However, attempts to isolateHistoplasma capsulatum from soil or any other extra-human source have remained futile and the limited surveys have revealed only low skin sensitivity to histoplasmin and none to blastomycin and coccidioidin. As yet there is no authentic case of blastomycosis, coccidioidomycosis or paracoccidioidomycosis reported from India. Two cases of invasive aspergillosis and 6 of bronchopulmonary aspergillomas have been published. In the latterAspergillus fumigatus, A. niger andA. flavus have been found to be the aetiologic agents. In addition, a recent report on a series of 8 patients recognises for the first time the occurrence of allergic aspergillosis in this country. Two cases of phycomycoses, involving the lungs in one and brain in the other case have been described. Diagnosis of bronchopulmonary candidiasis has been claimed in as many as 16 patients by several authors but in none the evidence is unequivocal. The isolation ofCandida viswanathii from the cerebrospinal fluid of two fatal cases is suggestive of the possible aetiologic role of this new yeast in human meningitis. Besides, there are 3 cases of brain mycoses described in Indian literature, two due toCladosporium trichoides while in the third caseUstilago maydis, the causal agent of maize smut, has been implicated.

The effect of cortisone on bronchopulmonary aspergillosis in experimental mice forced to inhale aerosols of dry and viable spores of 6 Aspergillus species was investigated. A significant enhancement in mortality and tissue invasion due to all the test species: — A. flavus, A. fumigatus, A. nidulans, A. nidulans var. dentatus, A. niger, A. tamarii and A. terreus was observed in the cortisone treated animals.

Serum specimens from 138 patients suffering from chronic respiratory disorders including 63 with allergic bronchopulmonary aspergillosis (ABPA), 20 with suspected ABPA, 25 with pulmonary tuberculosis, 14 with bronchial asthma, 10 with chronic bronchitis and 6 with miscellaneous pulmonary conditions were studied for circulating antibodies to Aspergillus. The ammonium sulfate test was employed with an iodine-125 labeled mycelial component derived from Aspergillus fumigatus. When compared to normal controls from the same area, this test indicated that sera from 82 per cent of patients with ABPA had elevated binding titers to the radiolabeled antigenic component. Immunodiffusion using a culture filtrate antigen from A. fumigatus, revealed precipitating antibody to this fungus in 89 per cent of sera from ABPA patients. The majority of patients with ABPA demonstrated marked elevations of total serum IgE, moderate elevations of serum IgA and IgD and slightly increased levels of IgG and IgM.

The efficacy of paraffin bait technique in the isolation ofNocardia asteroides from clinical specimens has been investigated. In a comparative study 1091 clinical specimens, mostly sputa and bronchial aspirates collected from 639 patients of bronchopulmonary diseases and 11 of meningitis, were examined by paraffin baiting and the conventional technique. Thirty-six clinical specimens originating from 12 of the patients yieldedN. asteroides by the paraffin bait technique but only 4 by the conventional technique. Approximately 95 % of 125 sputum samples inoculated withN. asteroides yielded the pathogen by paraffin baiting as against 49 % by the conventional technique. Paraffin baiting was more productive than the conventional technique in the isolation ofN. asteroides from mixed suspensions with a number of fungi and bacteria. It is concluded that paraffin baiting can be profitably adopted as a suitable technique for the isolation ofN. asteroides from clinical specimens, such as, sputum, gastric lavage, etc., which are often contaminated. The technique has no particular advantage with non-contaminated specimens.

Effect of cortisone administration on the pathogenicity of Nocardia asteroides, N. caviae , and N. brasiliensis for white mice has been investigated by using the intravenous route of inoculation. The observations indicated that the susceptibility of white mice to nocardiosis was enhanced by cortisone. Test strains of the three species of Nocardia caused a higher and more rapid mortality, as well as more extensive lesions, in the cortisone-treated than in the normal mice. The mean lethal dose (LD 50 ) values of N. asteroides and N. caviae for the cortisonetreated group were found to be seven and eight times lower than their respective values for the normal group. N. asteroides and N. caviae were more virulent than N. brasiliensis , the LD 50 of N. brasiliensis for cortisone-treated mice being 30 and 26 times higher than that of the former two species, respectively. N. brasiliensis also differed from the other two species in its inability to infect the brain. In the untreated animals, N. asteroides and N. caviae showed a tendency to form conglomerate growth, in contrast to formation of freely dispersed growth in the lesions of cortisone-treated animals.

Of 1,510 sputum samples examined from 1,016 patients with bronchopulmonary disorders, Nocardia asteroides was isolated from 67 samples by paraffin baiting, as compared with only 30 isolations by the conventional technique of culturing on Sabouraud dextrose agar. This higher efficacy of the paraffin bait technique was found to be statistically significant (P less than 0.001).