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Background: Patients with systemic lupus erythematosus (SLE) may require prolonged periods of corticosteroid therapy which lead to excessive weight gain and increased cardiovascular risk. Objective: To assess the utility of a low glycaemic index diet in patients with corticosteroid dependent SLE in achieving weight loss and improving glycaemic control. Design: A total of 23 women were enrolled in a 6 week study. All had mild, stable SLE, were receiving corticosteroids and had a body mass index > 25 kg/m2. Subjects were randomly assigned to a low glycaemic index (Low GI) diet or a calorie restricted (Low Cal) diet. The primary end point was weight loss. Secondary end points included tolerability of diet, bio-markers of cardiovascular risk, disease activity, fatigue and sleep quality. Results: Weight loss in both treatment groups was significant (mean ± SD: Low GI diet 3.9 ± 0.9 kg; Low Cal diet 2.4 ± 2.2 kg, p < 0.01 from baseline in each group). There were also significant improvements in waist and hip measurements. However, the difference in weight loss and waist and hip measurements between the two diet groups was not statistically significant. There was a statistically significant reduction in Fatigue Severity Scale in both diet groups, (p < 0.03). Both Low GI and Low Cal diets were well tolerated, resulting in no serious adverse effects or increase in disease activity. Conclusion: Significant weight loss is achievable over 6 weeks in a diet-specific trial in subjects with stable SLE, who are on low dose prednisolone. Both diets were equally tolerable, and did not cause flares in disease activity. Our results suggest that dietary manipulation may significantly improve fatigue in subjects with SLE.

Objective *Deceased.The objective of this paper is to report the clinical outcome of B cell depletion therapy in 18 patients with refractory lupus nephritis (LN). Methods Eighteen patients received rituximab on an open-label basis with prospective evaluations. All patients had renal disease refractory to conventional immunosuppressive therapy, including intravenous cyclophosphamide (CyC). All patients fulfilled the revised ACR classification criteria for SLE. Rituximab was given as 2 × 1 g infusions with 500 mg iv CyC and 500 mg iv methylprednisolone, two weeks apart. Complete remission (CR) of nephritis at six months was defined as normal serum creatinine and serum albumin levels, inactive urine sediment, and proteinuria < 0.5 g/day; partial remission (PR) was defined as a ≥50% improvement in all renal parameters that were abnormal at baseline. Clinical response was assessed by the British Isles Lupus Assessment Group (BILAG) score pre- and post-rituximab treatment, and efficacy was recorded by extent and duration of B lymphocyte depletion (normal range 0.100–0.500 × 109/l). Follow-up data were collected at six months, one year post-treatment and at the most recent clinic visit. Results At six months, 11/18 patients reached renal CR and two of 18 PR. The mean global BILAG scores for responders decreased from 15 (SD 10) to 5 (SD 3), and a total of ten A scores disappeared. Five patients failed to show complete or partial renal response despite peripheral B lymphocyte count depletion, and progressed to end-stage renal failure (ESRF) and dialysis. Four of these patients had severe proliferative, crescentic nephritis, of whom three had Class IV-G, one Class III and one late membranous glomerulonephritis. One patient died six years after rituximab therapy from overwhelming sepsis while on long-term haemodialysis. Conclusion Rituximab therapy achieved a response in 13/18 patients with refractory LN. However, in patients with rapidly progressive crescentic LN, when there is already evidence of significant renal impairment, rituximab therapy may not prevent progression to ESRF and dialysis. Our data also suggest that severe Class IV-G LN may be associated with a poor response to therapy.

Background: Hypertension is common in the antiphospholipid (Hughes) syndrome (APS) and its cause is poorly understood. Anecdotal evidence suggests that renal artery stenosis (RAS) may be a relevant and treatable cause of hypertension. Objective: To investigate the prevalence of RAS in patients with APS and hypertension. Patients and methods: Three groups of patients were evaluated: (1) 77 patients with positive antiphospholipid antibodies (aPL) (60 secondary APS, 11 primary APS, and 6 with aPL only) and uncontrolled hypertension who were receiving two or more antihypertensive drugs; (2) 91 patients (⩽50 years) attending hypertension clinics;(3) 92 normotensive healthy, potential renal transplant donors. Magnetic resonance renal angiography was used to image the renal arteries in all three groups. Results: Group 1: 20/77 (26%) patients had evidence of RAS (16 unilateral and 4 bilateral). Sixteen patients (80%) had smooth well defined stenoses in the proximal third of the renal artery. Three further patients had irregular arteries without distinct stenosis. Group 2: 7/91 (8%) hypertensive patients had RAS (χ2=10.3, p<0.001 v group 1). Group 3: 3/92 (3%) healthy donors had RAS (χ2=18.2, p<0.0001 v group 1). Conclusion: A significantly increased prevalence of RAS (26%) was found in patients with APS and hypertension, compared with relatively young (⩽50 years) hypertensive controls and healthy potential donors.

Table 1 Adverse effects/flares after infliximab infusions Diagnosis Number of infusions New autoantibodies Adverse events/flares Hospital admission Treatment for flares/adverse reaction Deaths Wegener's granulomatosis 5 Nil Hearing and vision deterioration No CPM+M pred No Wegener's granulomatosis 5 ANA, DNA Hearing loss and lupus-like reaction No Prednisolone+CPM No Wegener's granulomatosis 3 Nil Leucopenia and anaemia No Blood transfusion No Churg strauss disease 2 Nil Brain stem event and lupus-like reaction Yes M pred +IVIG No Behcet's disease 5 Nil Severe lupus-like syndrome and flare Yes M pred and IVIG No Behcet's disease 5 ANA, DNA Scleritis, nodular vasculitis No Prednisolone 80 mg/day No Henoch Schonlein purpura 1 Nil Severe lupus-like reaction Yes M pred+IVIG No Relapsing polychondritis 3 ANA, DNA and lupus anticoagulant Tired and progressive tracheal stenosis No Prednisolone 20 mg/day No Adult-onset Still's disease 5 ANA, DNA and smooth muscle Severe flare (serum ferritin >14 000, CRP >300 and ESR 110) Yes M pred+IVIG Yes, after 6 months ANA, antinuclear antibodies; CPM, intravenous cyclophosphamide; CRP, C reactive protein; ESR, erythrocyte sedimentation rate; IVIG, intravenous immunoglobulins; M pred, intravenous methyl prednisolone. Solid malignancies were noted in the etanercept arm, giving rise to serious safety concerns. 6 In summary, the adverse effects and lack of benefit experienced in our series raises concerns about the role of anti-TNFα in patients with systemic vasculitides.

Patients with clinical features of angina pectoris in the absence of coronary artery pathology have remained an enigma to clinicians. Previous data has suggested that almost 20% of women with symptoms suggestive of angina had abnormal stress induced ischaemia. This phenomenon is more commonly observed in women than in men.

The antiphospholipid syndrome (APS) is a prothrombotic disorder characterised by recurrent thrombotic events and pregnancy morbidity in the context of autoantibodies against phospholipid binding proteins. There is increasing evidence that these autoantibodies are associated with accelerated atherosclerosis. The presence of stenotic lesions radiologically and abnormalities of the ankle-brachial index, flow-mediated dilatation and carotid abnormalities supports this view and this clinical evidence is reviewed.

Context: The assessment of micronuclei (MN) in exfoliated oral epithelial cells is a promising tool for the study of epithelial carcinogens and can be used to detect chromosome breakage or mitotic interference, thought to be relevant to carcinogenesis. Aims: To detect MN in exfoliated oral mucosal cells in individuals using various tobacco forms and also to detect frequency of MN in premalignant lesions and conditions (potentially malignant diseases [PMD′s]) and oral squamous cell carcinoma (OSCC). To correlate frequency of MN in oral exfoliated cells in clinically diagnosed cases of OSCC followed by a histopathological grading. Materials and Methods: A total of 90 subjects (30 smokeless tobacco users, 30 smokers and 30 nontobacco users) consisted of clinically diagnosed cases of PMD′s and OSCC were selected for the study. Cytosmears from the groups were stained with rapid Papanicolaou stain. MN was identified according to the Tolbert et al. criteria. Results: MN cells were found to be significantly higher in smokeless tobacco users than in smokers. The frequency of MN was three to four times higher in patients with OSCC as compared to patients in PMD′s (P < 0.0001). The frequency of MN correlated with the histopathological grade was statistically significant. Conclusion: MN index can be used as a biomarker/screening test among the high-risk groups particularly the smokeless tobacco users and PMD′s. MN can be a candidate to serve as a biomarker for prediction of the grade of OSCC.

Estimation of the age is a procedure adopted by anthropologists, archeologists and forensic scientists. Different methods have been undertaken. However none of them meet the standards as Demirjian's method since 1973. Various researchers have applied this method, in both original and modified form (Chaillet and Demirjian in 2004) in different ethnic groups and the results obtained were not satisfactory. To determine the applicability and accuracy of modified Demirjian's method of dental age estimation (AE) in 8-18 year old Tibetan young adults to evaluate the interrelationship between dental and chronological age and the reliability between intra- and inter observer relationship. Clinical setting and computerized design. A total of 300 Tibetan young adults with an age range from 8 to 18 years were recruited in the study. Digital panoramic radiographs (DPRs) were evaluated as per the modified Demirjian's method (2004). Pearson correlation, paired t-test, linear regression analysis. Inter -and intraobserver reliability revealed a strong agreement. A positive and strong association was found between chronological age and estimated dental age (r = 0.839) with P < 0.01. Modified Demirjian method (2004) overestimated the age by 0.04 years (2.04 months)in Tibetan young adults. Results suggest that, the modified Demirjian method of AE is not suitable for Tibetan young adults. Further studies: With larger sample size and comparision with different methods of AE in a given population would be an interesting area for future research.