Drug-induced Stevens-Johnson syndrome: A case series

Stevens-Johnson syndrome (SJS) can be defined as a rare, serious disorder of the skin and mucous membrane characterized by widespread vesiculobullous rash with epidermal sloughing and necrosis involving mainly eyes, oral cavity, and skin. SJS can be diagnosed if there is <10% of the skin involvement. SJS occurs as an idiosyncratic reaction to various medications. Among them, the most common are antimicrobial agents (AMAs), antiepileptics, and non-steroidal anti-inflammatory drugs (NSAIDs). SJS is one of the dermatological emergencies for which initial treatment can only be supportive like fluids and nasogastric or parenteral feeding and symptomatic measures like analgesic mouth rinse for mouth ulcer. Beyond this, no treatment for SJS is approved. Cases of drug-induced SJS as diagnosed by Skin and VD department were included in the study. Interpretations were drawn out from that data and causality assessment was done according to the WHO-UMC causality assessment. Total four cases of drug-induced SJS were available. two cases of male patients and two of female patients. Out of them, three cases were by NSAIDs induced and one case was anti-epileptic (phenytoin) induced. In the present study, it was found that three of the cases of drug-induced SJS were caused NSAIDs and one case by anti-epileptic. According to the WHO-UMC Causality assessment, three cases were probable and one was unclassified.

Implant Supported Overdenture - A Review

Background:Traditional complete dentures were the most common treatment option for patients with edentulous arches. However, the initiation of implant-supported overdentures has substitutedorthodox dentures as animproved standard for restoration. Careful case selection is important criteria for improving success rate of implant supported over denture. Lower arch implant-supported overdentures have a better success percentage than upper arch implant-supported overdentures. Upper arch implant-supported overdentures are simulating a form of “salvage treatment,” rather than being the primary modality of treatment for patients with completely edentulous upper arch.

A Prospective Observational Study Of Evaluation Of Progress Of Labour With Partograph In Primigravida And Multigravida

Background:Labour progress in partograph plotting helps to early recognition and prevention of the complication of labour. This helpful in better maternal and perinatal outcome. Aim of the study is to evaluate the maternal and perinatal outcome in primigravida and multigravida by comparing their partograph in labour.Material And Methods:This prospective observational study was carried out in Smt. SCL General Hospital a teaching tertiary care hospital from May-2018 to November-2019. Total 250 cases out of which 125 cases of primigravida and 125 cases of multigravida admitted in labour room were randomly selected and monitored by using modified WHO partograph. All the cases reporting to labour room and fulfilled the inclusion criteria were included in thisstudy. Individual partograph was studied to know the various aspect of course of labour.Result:208 out of 250 cases were before alert line, 34 cases were between alert and action line and 8 cases were beyond action line. Rate of cervical dilatation in most primigravida was between 1.1-2cm/hour and in multigravida was >2.1cm/hour. In Zone A, in primigravida 90.7% had VD and 9.3% had LSCS whereas in multigravida 96.4% had VD and 3.6% had LSCS. In Zone B, in primigravida 47.8% had vaginal delivery and 52.2% had LSCS whereas in multigravida 54.4% had VD and 45.5% LSCS. In Zone C, in primigravida and multigravida there were no VD and 100% had LSCS. Protracted active phase (50%) was presents the most common abnormality of first stage of labour in both group inpresent study and in second stage, arrest of decent (82%) was more common. In both groups, NICU admission were more in Zone C (3.2%) as c ompared to Zone A (2%) and Zone B (1.6%).Conclusion:This study has shown that using the partograph can be highly effective in reducing complications from both mother and neonate. It is also helpful in monitoring of labour and early diagnosis of abnormal labour. It prevents maternal mortality and morbidity.

A systematic review of standard treatment guidelines in India

Background & objectives: Standard treatment guidelines (STGs) are the cornerstone to therapeutics. Multiple agencies in India develop STGs. This systematic review was conducted to find out STGs available in India, evaluate if these were as per World Health Organization (WHO) recommendations for STGs and compare these with National Institute for Health and Care Excellence (NICE) guidelines. Information on legal authority and responsibility for formulating STGs was also sought. Methods: PRISMA guidelines were followed. Publications from PubMed and Google Scholar were searched for STGs using terms 'Standard Treatment Guidelines AND India'. Data from STGs were compiled in excel as per the WHO and authors' criteria for STGs and compared with NICE guidelines. Results: PubMed and Google Scholar search provided 56 publications (out of 1695 search results) mentioning 27 STGs. Google search and replies from authors led us 36 STGs, totalling to 63 STGs. No STG mentioned any specific period of revision, eight STGs were not evidence-based, 55 had some Indian references, 48 STGs were for single disease and the remaining multi-disease, three STGs did not include diagnostic criteria, 16 STGs did not give prescribing information of recommended treatment and 16 STGs provide no referral criteria for patients. Fifty five STGs did not mention level of health care. While NICE is a single legal authority in England and guidelines are as per WHO recommendations for STGs, in India although Acts and rules do not vest authority, National Health Systems Resource Center is generally designated responsible for STGs. Interpretation & conclusions: In India, although there are multiple STGs developed by various authorities and professionals for the same conditions, these fulfil WHO recommendations only partially. Authority with statutory duty collaborating with professional organizations, a standard methodology for adopting international guidelines, Indian data for evidence base, attention to local needs will help in developing better STGs and their acceptance.

Evaluation of positional accuracy of the Varian's exact-arm and retractable-arm support electronic portal imaging device using intensity-modulated radiotherapy graticule phantom

Purpose: The aim of the present study was to compare the positional accuracy of varian's exact-arm (E-arm) and retractable-arm (R-arm) supporting electronic portal imaging device (EPID) systems (amorphous silicon flat-panel detector) using the intensity-modulated radiotherapy (IMRT) graticule phantom. Materials and Methods: The known shifts of 0.5, 1.0, and 1.5 cm were introduced to the given phantom in longitudinal, lateral, and vertical directions, respectively, with respect to treatment couch of medical linear accelerator. The experiment was repeated for different gantry angle and varying source to imager distances (SIDs). The images were acquired for each shift at varying SIDs and beam orientations for both EPID supporting systems. The corresponding shifts obtained from treatment planning system (TPS) were recorded and compared. Results: The known (expected) and observed (recorded from TPS) shifts obtained for different beam angles (namely, 0°, 90°, 180°, and 270° for anterior, left lateral, posterior, and right-lateral portal images, respectively) in the longitudinal, lateral, and vertical direction at varying SID were compared. The maximum shift in the observed value from the expected one was 3 and 2 mm, respectively, out of the all beam configuration for R-arm and E-arm. These shifts were randomly observed for all imager position and beam orientation. Conclusion: The IMRT graticule phantom is an effective tool to check the mechanical characteristic and consistency of different EPID supporting arms. The effect of EPID sag due to gravity (gantry and treatment couch) was not significant for detection of shift in patient's position. The E-arm support EPID has better mechanical stability and accuracy in detection of patient's position than that of R-arm

Important Herbs in Treatment of Cancer.

Cancer is a major public health burden in bath developed and developing countries. Plant derived agents are being used for the treatment of cancer. Reservoir of bioactive compounds exists in many species of plants of Earth, only a small percentage of which have been examined and continued to be an important source of anticancer agents. Worldwide effects are ongoing to identify new anticancer compounds from plants. With the current decline in the number of new molecular entities from the pharmaceutical industry, novel anticancer agents are being sought from traditional medicines. In recent years owing to the fear of side effects people prefer more and more use of natural plant products for cancer. This article reveals a detailed review of important herbs in cancer from Indian medicinal plants which will be useful to treat various types of cancer. It will be helpful to explore the medicinal value of the plants and for the new drug discovery from them for the researchers and scientists around the globe.

Spectrum and antibiotic susceptibility pattern of bacterial isolates from conjunctival swabs.

Conjunctivitis is the most common disease of conjunctiva which occurs by exogenous or endogenous source. Bacterial conjunctivitis is the most common type of this infection for which emperical treatment is started without knowing the etiological agents because prior cultures are generally not taken. We conducted this survey to study the etiological agents of conjunctivitis in a total of 6763 swabs obtained over a period of four years (2001 to 2004). The prevalence of bacterial conjunctivitis was found to be 20.4% with a predominance of Staphylococcus aureus (87.2%) followed by Streptococcus pneumoniae (4.7%) and gram negative rods (E.coli + Klebsiella spp. + Pseudomonas spp.) in 8.1% swabs. For S. aureus, amikacin showed maximum sensitivity (73.2%) while for S. pneumoniae, cefotaxime (90.6%) and cefazolin (89%) were found to be highly sensitive drugs. For gram negative rods, ceftazidime (74.1%) and cefotaxime (67%) were found to be preferred options. Thus it is concluded that bacterial conjunctivitis in our hospital is predominated by S. aureus. The bacterial isolates obtained from conjunctiva have not yet attained a high level of antibiotic resistance and hence averts the need to unnecessarily start new/latest generations of antibiotic eyedrops or antibiotic combination which may lead to acquisition of resistance by these bacteria.

Phacoemulsification after penetrating keratoplasty with autologous limbal transplant and amniotic membrane transplant in chemical burns.

We report a patient who had earlier penetrating keratoplasty with amniotic membrane transplant and autologous limbal cell transplant for chemical injury who underwent cataract surgery by phacoaspiration. A posterior limbal incision with corneal valve was made superotemporally with extreme caution to avoid damage to the limbal graft. Aspiration flow rates and vacuum were kept low to avoid any turbulence during surgery. A 6.0 mm optic diameter acrylic foldable intraocular lens was inserted in the bag. The patient achieved a best-corrected visual acuity of 6/12 at 10 months' follow-up with a clear corneal graft. We conclude that caution during wound construction and phacoaspiration can help preserve corneal and limbal graft integrity in patients undergoing cataract surgery after corneal graft and limbal transplantation.

Periodontal regeneration--fantasizing the future.

Periodontal Regenerative Surgical Procedures are, by definition, supposed to restore all three tooth-supporting tissues i.e. periodontal ligament fibres, alveolar bone and the cementum. In humans, we can now regenerate considerable amounts of alveolar bone, and periodontal ligament with the use of bone graft material and barrier membranes. The purpose of this article is to acquaint the reader with the current trends as well as some new areas along which periodontal regenerative therapy might shape up in the future. Since, some fields are still in their infancy, it can be only envisioned as to how these new fields of science might constantly evolve to redefine periodontal therapy in due time.

Intracrevicular application of 0.3% Flurbiprofen gel and 0.3% Triclosan gel as anti inflammatory agent. A comparative clinical study.

This study compared the anti-inflammatory efficacy of Triclosan and Flurbiprofen in a gel form on clinical parameters of moderate gingivitis cases. The study comprised of 100 sites from 16 volunteers and used split mouth technique. 0.3% Triclosan/0.3% Flurbiprofen gels applied intracrevicularly once daily for one week. Clinical parameters like Plaque index, Gingival index and Bleeding index scores were recorded at 0 day, 4th day and 8th day. The obtained results showed significant reductions in clinical parameters from baseline to 8th day. This indicates local delivery of 0.3% Triclosan/0.3% Flurbiprofen gel can be used as an anti-inflammatory agents either alone or as an adjunct to scaling in periodontal therapy.

Celiac disease--a worldwide problem.

Celiac disease and dermatitis herpetiformis are caused by the alcohol soluble fractions of wheat, barley, and rye. Reliable serological tests are available for both mass and risk group screening and recent epidemiological studies on celiac disease suggest that the prevalence varies between 1:100-300 in different continents. The clinical manifestations of the disease has changed in the West and the classical symptomatic cases represent only approximately 1/7th of all diagnosed cases. Symptoms such as, anemia, short stature, dental enamel defect or osteoporosis can be the only manifestations of the atypical disease. There is an increased prevalence of celiac disease in patients with autoimmune diseases. Recent data suggest that there is a correlation between the prevalence of autoimmune diseases and the number of years that an individual consumes gluten-containing foods. Genetic studies revealed a high prevalence of certain HLA antigens in celiac patients, however, there is likelihood that non-HIA genes are also important in the pathomechanism. An interesting new development is the recognition of tissue transglutaminase (tTG), an enzyme that probably forms an autoantigen with gluten. It is generally accepted that antibodies to tTG are identical to the previously described antiendomysium antibodies. Whether or not tTG is responsible for the initiation of an immunoreaction against prolamines or just exacerbates the immune response is a subject of further investigations.

Acute and chronic pancreatitis in childhood.

The incidence of acute and chronic pancreatitis in childhood is unknown. Both are associated with significant morbidity and mortality. The role of clinical suspicion is vital as these disorders can be misdiagnosed easily. Molecular basis of several disorders are being elicited and promising new diagnostic tests are being developed, including tests to assess fat malabsorption by non-invasive methods. Etiological spectrum of acute pancreatitis ranges from congenital, structural or inherited disorders to trauma, infections, drug toxicity and interventions such as endoscopic retrograde cholangiopancreatography and organ transplantation. Chronic tropical calculus pancreatitis is a progressive disorder that presents in childhood with recurrent abdominal pain, progressing to diabetes by puberty. Idiopathic recurrent pancreatitis has recently been associated with higher frequency of cystic fibrosis gene mutations. Therapeutic use of lexipafant opens the field to new powerful therapies designed to reduce the systemic inflammatory response syndrome and thus reduce the morbidity and mortality significantly.

Pediatric gastritis and peptic ulcer disease.

Inflammation of the gastric and duodenal mucosa is the end result of an imbalance between mucosal defensive and aggressive factors. The degree of inflammation and imbalance between defensive and aggressive factors can then result in varying degrees of gastritis and/or mucosal ulceration. Gastritis and ulcers of the duodenum or stomach can be classified as primary or secondary. The majority of children with chronic gastritis and ulcers in the stomach or duodenum have secondary inflammation or mucosal ulceration. These secondary ulcers generally occur due to a systemic condition like head trauma or overwhelming sepsis, or as sequelae to drug ingestion (i.e. non-steroidal anti-inflammatory agents), but secondary gastroduodenal ulcers can also occur in specific disease conditions such as Zollinger-Ellison syndrome or Crohn's disease. In almost all children with primary duodenal or gastric ulcers mucosal inflammation and, less frequently, ulceration is caused by a spiral shaped, gram-negative, microaerobic rod Helicobacter pylori. Recent epidemiological evidence has linked chronic H. pylori infection with the development of gastric carcinomas.

Seroepidemiology of ocular toxoplasmosis-profile of an urban population.

200 uveitis cases and 100 controls were serologically analysed for Toxoplasma antibodies (Ab) using indirect fluorescent antibody test (IFAT-IgG, Igm) and enzyme linked immunosorbent assay (ELISA IgG, IgM). Ophthalmologically cases were segregated into 4 groups anterior uveitis, posterior uveitis, pan uveitis and varied presentation uveitis. Toxoplasma seropositivity of 32% in cases and 4% in controls was established. IHA, IFAT, ELISA detected 20%, 18% and 32% cases as seropositive respectively, IFAT being most specific (100%) and ELISA most sensitive (41.37%). Insignificant change in Ab titre was observed in sequential samples of seropositive cases. Posterior Uveitis cases had the maximum seropositivity (41.7%). Highest seropositivity was in 16-25 years age group with no sex preponderance. Dietary habits and occupational history had no bearing on Toxoplasma infection. Results indicate that serology in mandatory for diagnosing Toxoplasma as a cause of uveitis, 2 or more tests on a single serum sample detecting IgG and Igm Ab are the best indicators of infection.

Modified food starches in baby foods.

Modified food starches were developed as a stabilizer, providing desirable consistency, texture, and storage ability. They are used primarily in strained and junior foods and, to a minor extent, in infant formulas. However, despite the fact that there is an increasing tendency to introduce solid foods to infants at a very early age, there is few long-term studies to delineate the effect of starch feeding on the growth of young infants. Modified food starches used by the food industry for infants and young children are of concern and there is an urgent need for additional data regarding their bioavailability, effect on nutrient absorption, intestinal changes, and toxic, mutagenic, and carcinogenic effects. Therefore, the inclusion of modified food starches should be used prudently and sparingly.

Diagnosis of Helicobacter pylori.

In view of its potential risk for the development of gastrointestinal disease or even gastric cancer at a later age, the study of Helicobacter pylori infection in childhood is gaining increasing importance and H. pylori infection is being considered a major issue of public health. H. pylori infection can be detected by a variety of methods. Because of its easy use, affordability, and overall availability, serology is the preferred diagnostic test, especially for large epidemiological studies. Based on our results, one might consider treating a child with recurrent abdominal pain and positive serology for H. pylori without further work-up, and only perform additional investigations when an anti-H. pylori therapy fails to resolve the complaints. According to this proposition, endoscopy of the upper gastrointestinal tract remains indicated in children if the noninvasive tests for Helicobacter pylori are negative in the absence of a diagnosis, or if symptomatology persists despite treatment.

An appraisal of periodontal bone loss surgically and by radiovisiography. A comparative study.

The objective of the present study was to conduct a comparative evaluation of periodontal bone loss surgically and by radiovisiography. This study included 26 subjects with 23 mesial and 20 distal sites. Majority of RVG measurements were marginally higher than surgical values. On drawing a comparison between surgical and RVG bone loss, the difference value was statistically significant. On mesial sites, the 't' value was 4.55 with p < .001 and on distal sites 't' value was 2.79 with p < .02. In total 60% of sites showed a difference of < 0.5 mm between RVG and surgical values, 28% of sites showed values between 0.6-1.0 mm and 12% showed a1 mm difference.