Bullous pemphigoid in India: Review of cases registered in an autoimmune bullous disease clinic

Background: Information on bullous pemphigoid in an Indian context is scarce. Aim: To report clinico-demographic profile, associated comorbidities and prescription pattern of bullous pemphigoid patients in India. Methods: This was a retrospective study, where past records of all bullous pemphigoid patients diagnosed and treated between November 2013 and October 2019 were accessed and analysed. Patients having a compatible clinical presentation with either histopathological and/or direct immunofluorescence evidence of bullous pemphigoid were included. Results: There were 96 bullous pemphigoid patients, with a male: female ratio of 1.6:1. The mean age at diagnosis was 62.5 ± 2.2 years, with mean duration of illness 27.5 ± 4.5 months before presentation. Comorbidities were present in 80 (83%) patients, with type 2 diabetes mellitus (38.5%), hypertension (36.4%) and neurological illness (16.7%) being the commonest ones. Clinically, blisters were the predominant presentation in 81 (84.4%) patients. The majority (87.5%) of patients showed a predominant eosinophilic infiltrate on histopathology. Direct immunofluorescence revealed immunoglobulin G deposits with complement C3 in 77 (80.2%) cases. The majority of patients (77.1%) were treated with oral prednisolone, either alone (11.5%) or in combination (65.6%) with other topical and systemic agents. Topical steroids were used in 29.1%, azathioprine in 28%, dapsone in 16.7% and omalizumab in 6.2% of patients. Limitations: The study is retrospective. Immunofluorescence on salt split skin, direct immunofluorescence serration pattern analysis, and immunoblotting were not performed. Hence, there is a possibility that a few included cases were suffering from other subepidermal autoimmune bullous diseases like epidermolysis bullosa acquisita or anti-p200 pemphigoid. Conclusion: Bullous pemphigoid patients in this study had a younger age of onset and showed male preponderance. Comorbidities like type 2 diabetes, hypertension and neurological disorders were freq

Clinical and metabolic characteristics of males with early-onset androgenetic alopecia

Background: Men with early-onset androgenetic alopecia (AGA) often have an abnormal hormonal milieu. Objective: To ascertain the clinico-phenotypic characteristics and the prevalence of hormonal and metabolic changes in men with early-onset AGA. Methods: Consecutive male patients less than 30 years of age with a Norwood-Hamilton grade ?3 AGA were recruited in this comparative cross-sectional study. After endocrine evaluation they were classified into two groups, that is, Group A consisting of subjects with an altered hormonal profile and Group B with normal hormonal profiles. The groups were assessed for differences in disease phenotype and severity (Norwood-Hamilton grade), insulin resistance and parameters of metabolic syndrome (ATP III guidelines). Results: Altered hormonal profiles were seen in 34 of the 100 subjects with AGA, while insulin resistance and metabolic syndrome were noted in 44 and 26 respectively. Altered hormonal profiles were significantly associated with insulin resistance and severe alopecia (grade 4 and above Hamilton-Norwood Scale). Insulin resistant Group A patients had a significantly higher prevalence of severe alopecia (>grade 4) (P = 0.0036). The prevalence of metabolic syndrome was similar in both groups. Limitation: The cross sectional study design was a drawback of this study. Further, a control arm without AGA was not included and the sample size of 100 was selected arbitrarily. Conclusion: An altered hormonal profile and insulin resistance was noted in a third of the males with early-onset AGA. Subjects with altered hormonal profiles had a higher prevalence of insulin resistance and were likely to have severe grades of AGA

Binding interaction of laccases from Bacillus Subtilis after industrial dyes exposure: Molecular docking and molecular dynamics simulation studies

Dyes are becoming more widely used around the world wide, but there is no effective bioremediation approach for removing them completely from the environment. Several dyes are mentioned to be degraded through bacteria; however, it's still unknown how the particular enzymes act throughout the dye degradation. The behavior and function of these enzymes in the biodegradation of azo dyes (Textile dyes) had been investigated experimentally by the numbers of the researchers, however, the molecular mechanisms remain unclear. Therefore, the interaction mechanisms of textile dye (methyl orange) with laccase from B. subtilis were explored through molecular docking and molecular dynamics simulations, the three selected dyes (methyl orange, malachite green, and acid blue 62) that interact positively with laccase on the basis of their maximum binding energy, molecular docking results indicate that one of the three dyes is more stable as a target for degradation through Bacillus subtilis laccase. Therefore, subsequent research focused solely on one substrate: methyl orange. Molecular Dynamics simulation study was applied after the molecular docking to determine the interaction between laccases and methyl orange dyes. The trajectory was proved with root mean square deviation and root mean square fluctuation analysis. According to the molecular dynamics simulation results, laccase-methyl orange complexes remain stable during the catalytic reaction. So, this study demonstrates how laccase is involved in methyl orange bioremediation.

Effect of dexamethasone implant on intraocular cytokines in diabetic macular edema

Purpose: Our primary aim was to evaluate intraocular cytokines (IC) before and after dexamethasone in diabetic macular edema (DME). Our secondary aim was to study the early and late effects of single dexamethasone implant in DME. Methods: This before and after comparative study was conducted at the Department of Ophthalmology and Centre for Nanosciences at a quaternary referral center in Kerala, India, from September 2016 to September 2018. Patients underwent complete ophthalmological examination and cytokine analysis before and after dexamethasone implant. Levels of cytokines at baseline and repeat sample were studied. Results: Twenty?seven eyes (21 patients) were divided into two groups depending on time from baseline to second injection. Group 1 included patients with <3 months between the two samples – 12 (44.4%). Group 2 included patients with >3 months between the two samples –15 (55.6%). Best corrected visual acuity (BCVA) and central macular thickness (CMT) improved significantly post?dexamethasone in group 1, but not in group 2. Interleukin (IL)?4, IL?6, IL?10, vascular endothelial growth factor (VEGF), IL?1?, interferon?gamma inducible protein?10 (IP?10), monocyte chemoattractant protein?1 (MCP?1), and IL?2 decreased post?injection in group 1. But cytokines increased post?dexamethasone in group 2, except IL?10. When compared to baseline, IL?6 reduced to half in group 1 (P?value 0.814) and it tripled in group 2 ( P?value 0.009). The level of VEGF in the first and second samples was not different in either group. Conclusion: Our study suggests that dexamethasone acts more on IC than VEGF in DME. This is significant in the first 3 months with a rebound effect on IL?6 after 3 months. Our study also suggests that repeat injection of DEX in DME should be done at 3 months to prevent deterioration of visual acuity (VA) and worsening of CMT.

Inkk Trial - Intraoperative ketamine for perioperative pain management following total knee endoprosthetic replacement in oncology: a double-blinded randomized trial

Abstract Background There has been a growing interest in the use of ketamine following orthopedic surgeries. We hypothesized that low dose intravenous ketamine during surgery would help in mobilization following total knee replacement (TKR) in oncology patients as assessed by the timed to up and go (TUG) test at 72 hours post-surgery. Our secondary objectives were to compare the opioid requirement at the end of 72 hours, pain scores, satisfaction with pain management, adverse effects, range of joint movement achieved in the post-operative period and the functional recovery at the end of 1 month. Methods After the ethics commitee approval, registration of the trial with the Clinical Trial Registry - India (CTRI), and informed consent, this double-blinded trial was conducted. Using computer generated randomization chart, an independent team randomized the patients into ketamine group which received at induction, a ketamine bolus dose of 0.5 mg.kg-1 before the incision followed by 10 µg.kg-1min-1 infusion which was maintained intraoperatively till skin closure and the saline group received an equivalent volume of saline. Postoperatively, patient controlled morphine pumps were attached and the pain score with morphine usage were recorded for 72 hours. The TUG tests and range of motion were assessed by the physiotherapists until 72 hours. Results Fifty-two patients were enrolled in the trial. Demographics were comparable. No significant intraoperative hemodynamic changes and post-operative adverse events were noted between the groups. A decrease in the TUG test, along with decreased opioid usage with a better range of movements was noted in the ketamine group, but this was not statistically significant. Day of discharge, patient satisfaction score, and functional recovery assessed by Oxford Knee Score (OKS) were comparable between the groups. Conclusion In conclusion, low dose intraoperative ketamine infusion does not provide clinical benefit in perioperative pain management and postoperative rehabilitation following total knee endoprosthetic replacement in oncology.

Evaluation of the heavy metals tolerant UV rays treated bacteria isolated from anthropogenic sites of Chambal region, India

Industrial waste is released into the environment and leads to various types of heavy metal, which are toxic, mutagenic and carcinogenic in nature. Heavy metals are not biodegradable but accumulated by living organisms and cause diseases at even low concentrations. In this study, we selected four anthropogenic sites from Chambal region, isolated bacteria and investigated its heavy metal removal capability. The bacteria was isolated and identified as Escherichia coli (Ag-5), on the basis of biochemical and 16S rRNA gene sequence. Among the five (cadmium, cobalt, lead, nickel and zinc) heavy metals studied, Ni2+ has been observed to be highly toxic with minimum inhibitory concentration score of 200 ppm. E. coli could tolerate Zn2+ (300 ppm), Cd2+ (400 ppm), Co2+ (400 ppm) and Pb+2 (500 ppm). Heavy metal tolerance capability was also evaluated by UV rays treated E. coli (Ag-5) isolate and compared with wild strain Ag-5. The result indicated that the tolerance capability was enhanced by UV rays treated bacterial isolate as compared to wild strain with respect to all tested heavy metals. Atomic absorption spectroscopy results revealed that wild strain removed 78.2% cadmium nitrate, while UV rays 30 and 60 s. exposed strain removed 85.9 and 83% cadmium nitrate. Wild strain removed 64.4% nickel chloride, while UV rays 30 and 60 s exposed strain removed 66.9 and 74.5% nickel chloride. The results indicate that indigenous E. coli treated with UV rays could serve as heavy metal tolerant bacteria and utilized in bioremediation processes.

Municipal solid waste landfill leachate induced cytotoxicity in root tips of Vicia faba: Environmental Risk posed by non-engineered landfill

Landfills are considered the main option for dumping of municipal solid waste (MSW) all over the world, but these landfills are mostly non-engineered. The decomposition of solid waste in the landfill and rainwater penetration into the decomposing waste produces leachate that contains dissolved organic and inorganic compounds, heavy metals, suspended particles, and hazardous substances. Leachate migration in the environment may pose serious health risks to organisms exposed. Hence, the present study explored the cytotoxic potential of landfill leachate collected in different seasons from the Okhla landfill site, Delhi, India. Cytotoxicity of leachate samples was evaluatedby cell apoptosis and ultrastructural observation based on Transmission Electron Microscopy (TEM) of the cells of root tips of vicia faba seedlings treated with the leachates collected in summer, winter and monsoon in a time and dose dependent manner. Leachate collected in all the three seasons induced apoptosis in cells of root tips of vicia faba that increased in a time and dose dependent manner when compared to control. The apoptosis was highest in the samples treated with leachate collected in the summer season, followed by winter and monsoon. It was further confirmed with TEM images that there was induction of apoptotic-like morphological changes in the root cells treated with landfill leachate when compared with the control. The present study indicates that municipal solid waste leachate is very toxic and it should be treated before disposing it to the environment.

Association Between Abo Blood Group And Obesity In Medical Students

Background — Over the past years, there seems to have been good attention paid to the connection between some diseases and the ABO blood group type. To our knowledge, nostudy has been done todetermine the association between obesity and ABO blood group. To find the prevalence of obesity in medical students and to determine theAims — association between obesity and ABO blood group. A cross sectional study was carried outMaterials and methods — among 745 medical students. Height, weight, waist circumference, hip circumference was measured. BMI and waist —hip ratio was determined. Blood group was determined by slide agglutination method The findings of theResults — present study reported that the most prevalent blood group was B+ whereas the blood group AB was least prevalent. 25.5% of the total study subjects were overweight and 7.2%were obese. Overweight and obesity were more common among students with blood group B. It was also observed that WHR statistically associated with ABO Blood group system. Conclusion — Participants with blood group B+ had higher prevalence of overweight and obesity. ABO Blood group system showed statistically significant association with WHR.

Profile of Children with Kawasaki Disease Associated with Tropical Infections

Objective To describe various infectious triggers for Kawasaki disease (KD) in India. Methods A series of 10 children with diagnosed infections who developed KD during their course of illness has been presented. They were diagnosed by the American Heart Association (AHA) 2017 guidelines. Echocardiography was done to check for coronary artery dilation. Treatment was instituted as per standard protocol. Results Kawasaki disease was diagnosed in 8 boys and 2 girls, aged 1 mo to 11 y. These children were being treated for dengue, chikungunya, SARS-CoV-2, hepatitis A, tuberculosis, brucellosis, disseminated staphylococcal sepsis, scrub typhus, and enteric fever. Conclusions Kawasaki disease has been associated with infectious triggers. It should be considered in febrile patients with mucocutaneous involvement or in nonresponsive sepsis, despite adequate therapy.

A case report of pediatric mog-antibody disease with Bilateral optic neuritis

MOG – Antibody disease is an inflammatory demyelinating condition of the CNS characterized by a monophasic or relapsing course of neurological dysfunction which does not meet the typical criteria for multiple sclerosis or other known neuro inflammatory conditions and occurs in presence of serum MOG antibodies using specific cell based assays. In pediatric patients MOG antibodies are detected in range of relapsing phenotypes including relapsing inflammatory optic neuritis (RION), acute disseminated encephalomyelitis followed by optic neuritis (ADEM – ON), brain stem demyelination and aquaporin P4 antibody negative neuromyelitis optica spectrum disorder (AQP4-Ab negative NMOSD).MOG positive optic neuritis is frequently bilateral and associated with optic nerve head swelling.It is associated with neurological diseases like Multiple Sclerosis, ADEM or Transverse Myelitis.MOG antibody IgG is detected in serum by indirect fluorescence test.IV Methylprednisolone is the treatment of choice, if it fails to improve vision or if optic neuritis is recurring, then a combination of plasma exchange and IV Methylprednisolone should be considered.Long term immunosuppressants used for Prevention include corticosteroids, azathioprine, mycophenolate mofetil and rituximab. The optimal preventive therapy has yet to be determined.Once the disease has been diagnosed, uncertainty remains over the best treatment approach and clinical trials for the pharmacological management of MOG- antibody optic neuritis are still needed

Ocular sequelae in severe COVID-19 recovered patients of second wave

Purpose: To evaluate the retinal microvascular changes in patients, recovered from severe COVID?19 during the second wave of the pandemic in North India. Methods: In this observational cross?sectional study, 70 eyes of 35 patients who recovered from severe COVID?19 during the second wave underwent detailed ophthalmic evaluation 4–6 weeks after discharge. Twelve controls were also enrolled, and the difference in the findings between the case and control groups on optical coherence tomography (OCTA) were studied. Result: The ages of study participants ranged from 27 to 60 years with the male:female ratio being 1.05:1. The fundus changes suggestive of ischemia in the form of cotton wool spots and vascular tortuosity were seen in 25 eyes (35.71%). Increased venous tortuosity was the most common finding seen in 23 eyes (32.85%), of which 10 eyes (28.57%) had concurrent hypertensive retinopathy (HTR) changes. There was a significant reduction in the mean vascular density (VD) and perfusion density (PD) for both the superficial capillary plexus (SCP) and deep capillary plexus (DCP) at inner, outer ring, and whole (P < 0.05). Foveal avascular zone was significantly enlarged in both the SCP (P = 0.01) and the DCP (P = 0.03). The mean ganglion cell?inner plexiform layer (GC?IPL) was significantly reduced in comparison to controls (P < 0.001). Conclusion: Severe COVID?19 can result in microvascular changes at the macula in the form of reduction in vascular and perfusion density, which can be evaluated using OCTA. As structural changes precede functional changes, a close watch is recommended in patients showing compromise in retinal microvasculature

Assessing contrast sensitivity change in retinal diseases with use of yellow-amber NoIR glasses

Purpose: The purpose of this study was to assess change of contrast sensitivity (CS) in subjects having retinal diseases with yellow?amber no infrared (NoIR) glasses used as low vision aid (LVA). Methods: We examined CS in 82 low vision (LV) subjects having retinal diseases with Pelli Robson Chart at 1 m distance before and after wearing yellow?amber NoIR glasses. We also found type of retinal affection and macular optical coherence tomography (OCT) features. Results: The distance and near best?corrected visual acuity (BCVA) was, respectively, 0.68 ± 0.17 (median = 0.70) and 0.72 ± 0.25 (median = 0.70) logmar units. The pre?LVA CS was 0.52 ± 0.29 (median = 0.3) and post? LVA was 0.52 ± 0.28 (median = 0.45) logunits (mean reduction = ?0.002 ± 0.24; Median reduction = 0; P = 0.909). The pre?LVA and post?LVA CS showed a negative correlation with logmar distance BCVA [r = ?0.090; P = 0.317 and r = ?0.152; P = 0.090 respectively]. The pre?LVA and post?LVA CS showed a negative correlation with logmar near BCVA [r = ?0.114; P = 0.207 and r = ?0.054; P = 0.549 respectively]. The CS did not improve in subjects having macular degeneration, pathological myopia, hereditary maculopathy, and diabetic retinopathy. The macular OCT features like fluid, exudates, scars, drusens, traction, and hole did not significantly influence CS both at pre?LVA and post?LVA stage. Conclusion: This is the first study with yellow?amber NoIR glasses which blocks “both ultraviolet and infrared light.” The subjects having macular degeneration, pathological myopia, hereditary maculopathy, and diabetic retinopathy did not improve in CS with filters. The correlation values showed that filters may improve CS in subjects having good baseline BCVA.

COVID-19 in Children with Cancer and Continuation of Cancer-Directed Therapy During the Infection

Objective To report the experience with COVID-19 in children with cancer at the largest tertiary-cancer care and referral center in India. Methods This study is a single tertiary center experience on COVID-19 in children with cancer and continuation of cancerdirected therapy in them. Children?15 y on active cancer treatment detected with COVID-19 until September 15th, 2020 were prospectively followed up in the study. Patients were managed in accordance with well-laid guidelines. Treatment was continued for children with COVID-19 who were clinically stable and on intensive treatment for various childhood cancers. Results One hundred twenty-two children (median age 8 y; range 1–15 y, male:female 1.7:1) with cancer were diagnosed with COVID-19. Of 118 children, 99 (83.9%), 60 (50.8%), 43 (36.4%), 26 (22.0%), and 6 (5.1%) had RT-PCR positivity at 14, 21, 28, 35, and 60 d from diagnosis of COVID-19, respectively. Scheduled risk-directed intravenous chemotherapy was delivered in 70 (90.9%) of 77 children on active systemic treatment with a median delay of 14 d (range 0–48 d) and no increased toxicities. All-cause mortality rate was 7.4% (n=9) and COVID-19 related mortality rate was 4.9% (n=6). One hundred-ffteen (94.2%) children with COVID-19 did not require any form of respiratory support during the course of infection. Conclusions COVID-19 was not a major deterrent for the continuation of active cancer treatment despite persistent RT-PCR positivity. The long-term assessment of treatment adaptations requires further prospective follow-up and real-time addressal.

Cytotoxic and genotoxic assessment of wastewater on HEK293 cell line

The increasing industrialisation and urbanisation have deteriorated the quality and quantity of water bodies, harming the surrounding flora and fauna. Therefore, in our studies, we have chosen the HEK293 cell line to examine further the level of wastewater toxicity to which living beings are exposed. The water samples were collected from various sites around the Agra Canal in the Faridabad region of Haryana. Furthermore, cytotoxicity and genotoxicity confirmation of wastewater samples were done by MTT and comet assay, respectively. The water quality of the Agra canal is heavily influenced by agricultural, domestic, and industrial waste, which may affect the genetic material of species exposed to contaminated water and the sustainability of the local environment. As a result, continuous environmental monitoring and proper policy formulation are required to minimise the adverse effects of pollutants in waste, which would further enrich India’s preparation to take India a step ahead, and that could be the best possible way to commemorate India’s 75th year of Independence with the Azadi Ka Amrit Mahotsav.

Laparohysterotomy for Managing Dystocia due to Uterine Inertia in a Sow: A Case Report

A nondescript sow with the history of delivering eight piglets and one remain in uterus since three days but unable to deliver was reported. The case was diagnosed as dystocia due to uterine inertia and laparohysterotomy was performed under general anesthesia, one male dead piglet was recovered successfully. The animal showed uneventful recovery.

The after-effects of COVID-19 on academia and scientific community: Researchers perspective

The commotion pandemic has caused has affected almost every aspect of the academic community. Distancing and issues related to the risk of spread have caused researchers to stop most of their most non-COVID clinical trials and experiments, causing a reduction in recruitment of research associates and a lag in data entry into clinical trial databases. Fresh graduates and research scholars who have not yet begun their doctoral research or postdoctoral fellowship are among the most who will endure the consequences. Few valuable crowdfunding options have surfaced to help fund effective scientific research that may otherwise not receive financial support. The institutes affected by the COVID-19 pandemic can seek extra financial aid to cover expenditures that arise from projects being delayed or derailed. The research community should raise awareness of the challenges faced by universities and researchers worldwide and clearly explain the need for action to prevent or limit any further unfavorable consequences.

Ayurvedic Management of Vatik Kasa in Era of Covid 19- A Case Series

Majority of the patients having cough (Kasa) is the presentation of respiratory disease. In general, air pollution; smoking and improper food habits are the triggering factors, which enhance this disease. Since the time 2nd wave of COVID 19 has gone the patients these days are coming with the major complaints of severe itching in the throat along with dry cough. Kasa is Kapha-Vata dominant disorder having 5 types, among which the pattern of cough relates to most of the symptoms of Vatik Kasa. The drugs like Vasavaleha and Chandramruta rasa helps to alleviate the vitiated Kapha Vata Dosha along with Haritaki as Anulomna and Abhyanga with Sarshapa taila mixed with Saindhava lavan, and Vashpa swedana on Uraha Pradesh. The major symptoms of Vatika Kasa subsided within 3 days and rest of the symptoms got cured in 10 days. Aim: Management of Vatik Kasa by Ayurvedic treatment modalities. Methodology: The study was conducted on three patients having symptoms of Vatik Kasa. In this case series, 3 patients were treated with local Abhayanga and Swedana, Haritiki, Vasavaleha and Chandramruta rasa and for 10 days. Conclusion: The use of Vasavaleha and Chandramruta rasa Muhurmuha along with local Abhyanga and Swedana showed significant improvement in the symptoms of the patients. Improvement was quite quick and highly significant on the symptoms of Vatika Kasa.

A Clinical Comparative Study on The Efficacy of Sahacharadi Kwath with and without Matra Basti in the Management of Janu Sandhigat Vata w.s.r. to Osteo Arthritis

Sandhigat Vata is a Vata vyadhi of degenerative nature, and Basti is preferred line of treatment for all Vata vyadhi as mentioned by Acharya Charak. Matra Basti is a type of Anuvasan Basti which is used for many degenerative diseases. So for present study Matra Basti with Sahachar Tail was selected. Acharya Charaka has mentioned Sahachar Taila in the management of the Vat Vyadhi. Acharya Yogratnakar has mentioned Sahacharadi Kwath with Til Taila under the context of Vat Vyadhi. Here Sahacharadi Kwath with Til Taila was selected for Shaman Chikitsa. Aims and objectives: To evaluate and compare the effect of Sahacharadi Kwath with and without Matra Basti in the management of Janu Sandhigat Vata w.s.r to Osteo-arthritis. Material and methods: For present study 30 patients of Janu Sandhigat Vata were selected according to the classical signs and symptoms of Sandhigat Vata according to Ayurveda as well as modern science, were randomly divided into 2. Result: In Group A, total 15 patients were treated. Out of 15 patients 20.0% patients got marked improvement, 73.33% got moderate improvement while 6.67% patients got mild improvement. No patient got complete remission. In Group B, total 15 patients were treated. Out of them 6.67% patients got marked improvement, 40.0% patients got moderate improvement and 46.67% showed mild improvement. One patient remains unimproved. No patient got complete remission. Conclusion: It is concluded that Matra Basti along with Sahacharadi Kwath provided better result as compare to only Sahacharadi Kwath in the management of Janu Sandhigata Vata.