The Burden of Histoid Leprosy in Post Elimination Era

Histoid leprosy is a rare variant of lepromatous leprosy, may occur de novo or may occur in cases earlier treated with dapsone monotherapy. Demographic, clinico-histopathological and treatment details of biopsy proven cases of histoid leprosy, collected retrospectively from the leprosy clinic of tertiary care hospital of SMS Medical College, Jaipur. During the study period of 5 years (2011-2016), 28 (2.98 %), patients had histoid leprosy among total 937 patients of leprosy. Most were in 21 – 40 years of age group with M: F ratio 2.5: 1. Histoid lesions developed with primary diagnosis of lepromatous leprosy in (71.4%) and de novo in (28.6%). Predominant site of involvement was upper extremity (85.7%) and most common presentation was subcutaneous nodules, Nerve thickening seen in (85.7%), and ulnar nerve being most common. Neuritis and disabilities were present in 6 and 16 patients respectively. Type 2 reaction seen in17.9% (5/28) patients. Biopsy and slit skin smear of all cases were done. Most (25/28) cases responded well to standard one-year multibacillary drug therapy (MDT), it had to be extended in three cases up to 2 years. Histoid leprosy may occur de novo or may be due to inadequate therapy, resistant strains, earlier dapsone monotherapy. Although India as whole has achieved leprosy elimination in January 2006, however new cases continue to be reported. Occurrence of histoid leprosy specially with changed morphology of the lesions and poor histopathological correlation needs to be investigated as these cases may be important source of infection even in low endemic situations.

A study of risk factors and epidemiologic profile of posterior polar cataract/posterior subcapsular cataract in Northwest Rajasthan

Background: In India, cataract is the foremost cause of blindness, leading to the mild-to-severe morbidity. Objective: The objective of the study was to find out the epidemiologic profile and risk factors of posterior polar cataract/posterior subcapsular cataract. Materials and Methods: A prospective non-comparative observational study involving 50 patients having posterior polar cataracts attending our outpatient department was selected and was questioned about their locality, systemic diseases, ocular disease, and use of steroid in any form which were included in the study. Results: Of the 50 patients, 30 were male and 20 females, most patients were in the age group of 61–70 years. About 66% of the patient belongs to the rural locality. Most of the females were homemaker, 24% were farmer, 8% were shopkeeper, and 6% retired persons while 2% each of electrician, computer programmer, and bus driver. About 48% had bilateral cataracts, 42% (21) were pseudophakic in one eye, and 1% (5) unilateral cataract. About 24% of patients had hypertension, 18% of patients had of asthma/chronic obstructive pulmonary disease, 16% of patients had diabetes mellitus, 2% of patients had h/o arthritis, 8% had skin disease, 6% had h/o injudicious use of over-the-counter topical drops while 4% of patients of thyroid disease were noted and 34% of patients had h/o steroid use. The most common type of cataract seen Grade I (52%, 26 patients), followed by Grade II (36%, 18 patients), Grade III (8%, 4 patients), and Grade IV (4%, 2 patients). Conclusion: With increasing injudicious use of steroid can result in formation of posterior polar/posterior subcapsular cataract in young age and professional office class workers who are seeking medical help at early stage. An ultrasound should be done to rule out posterior capsular defect if suspected and the patient should be counseled well about the complication prior taking into surgery.

A study of tubercular lymphadenitis: A comparison of various laboratory diagnostic modalities with a special reference to tubercular polymerase chain reaction.

Objective: The purpose of our study was to compare various laboratory diagnostic methods, namely histopathological examination, Ziehl-Neelsen (ZN) stain, AFB culture by conventional Lowenstein-Jensen (LJ) method and fluorescence-based mycobacterial growth indicator tube (MGIT) technique and polymerase chain reaction (PCR) in clinically suspected cases of tubercular lymphadenitis. Materials and Methods: A total of 65 lymph nodes biopsied from patients clinically suspected of having tubercular lymph nodes were included. Specimens were processed for AFB culture after NaOH-NALC concentration and inoculation on LJ medium and using the MGIT system. PCR was performed on all specimens using a commercial nested PCR kit targeting IS6110 insertion element of Mycobacterium tuberculosis complex. All lymph node specimens were subjected to histopathological examination. Results: Of the 65 lymph nodes, 37 (56.9%) were positive on MGIT culture and 45 (69.2%) were positive by PCR. Histopathology showed maximum sensitivity (96%) but with compromised specificity (78.5%). PCR showed 90.1% sensitivity and 100% specificity. The mean turnaround time for mycobacterial growth in smear negative specimens was 30 days determined by LJ and 20 days by MGIT techniques. Conclusion: PCR is a rapid and useful method for diagnosis of TB lymphadenitis and definitely increases the positive predictive value of a positive histopathology report. MGIT is better than LJ culture as regards time to positivity and higher yield.

Hair dye poisoning.

Hair dye ingestion is an uncommon form of poisoning in the west, however, in some parts of the world such as East Africa and Indian Sub-continent it is not uncommon. The main component of hair dye causing toxicity is Paraphenylenediamine (PPD). This compound has been found to cause angioneurotic edema, rhabdomyolysis and renal failure. We present a case of hair dye poisoning who presented with respiratory distress due to laryngeal edema and later developed trismus and carpopedal spasm. This case report highlights the combined toxicities of sodium EDTA and PPD.

Positron emission tomography imaging in evaluation of cancer patients.

Positron emission tomography (PET) is a diagnostic imaging technique that has progressed rapidly from being a research technique in laboratories to a routine clinical imaging modality. The most widely used radiotracer in PET is Fluorine18-fluorodeoxyglucose (F18-FDG), which is an analogue of glucose. The FDG uptake in cells is directly proportional to glucose metabolism of cells. Since glucose metabolism is increased many fold in malignant tumors PET has a high sensitivity and a high negative predictive value. PET with FDG is now the standard of care in initial staging, monitoring the response to the therapy, and management of lung cancer, colonic cancer, lymphoma, melanoma, esophageal cancer, head and neck cancer and breast cancer. Other indications of PET like bone tumor, ovarian cancer and cancer of unknown primary (CUP) has also been discussed in brief. The aim of this review article is to review the clinical applications of PET in various malignancies and only limited number of important studies will be discussed for this effort.

Anticonvulsant hypersensitivity syndrome study of 60 cases.

Sixty patients of anticonvulsant hypersensitivity syndrome were studied. Fever and skin rash were present in all patients with peripheral blood leucocytosis and eosinophilia in 30 patients. Phenytoin was the commonest offending drug(39 patients) followed by carbamazepine (19 patients). AHS appeared after 2-12 weeks of the intake of offending drugs. Head injury was the primary illness in 43 patients (70 per cent) followed by brain tumors (9 patients). Cross reactivity between phenytoin and carbamazepine was seen in 3 patients. Most patients recovered well with withdrawal of the offending drugs and treatment with topical corticosteroids and antihistamines. There was only one fatality.

Angiokeratoma of tongue.

An 8-year-old male child who presented with lesions of angiokeratoma on tongue is described.

Isolated pemphigus vegetans of the tongue.

Pemphigus vegetans affecting only the tongue is reported in a 35-year-old woman.

Treatment seeking behaviour in sexually transmitted diseases.

The present study has been conducted to assess social and behavioural factors predisposing individuals suffering from sexually transmitted diseases to seek treatment and the role of the health provider in them. Out results showed that the demographic, socio-economic and behavioural characteristics of patients seeking treatment at alternative places and those attending the referral hospital in the first instance were comparable. Inhibition, time and distance were important considerations for selecting a health facility. Private clinics were the most preferred (72.4%) source of treatment. In 60.3% of cases written prescriptions were not given and advice regarding treatment of sexual partner was not there in any of the cases. 98.3% of the patients lacked awareness about their disease and 91.4% patients about the treatment they were receiving.

Time-resolved emission spectroscopy as a tool to follow nucleic acid-protein interaction.

Fluorescence spectroscopy is undoubtedly a useful tool to study the structural and functional aspects of nucleic acids-protein interactions as well as the catalytic functions of particular residues of multi-subunit enzyme complexes. The dynamic interaction of nucleic acids and proteins occurring at nanosecond time scale can now be monitored by making life-time measurements or by time-resolved emission spectroscopy. These measurements are made by exploiting the intrinsic fluorescent residues in proteins i.e. W or by the use of extrinsic fluorophores which are tagged on to particular residues and that are sensitive to the microenvironment changes. In this study we describe the use of time resolved emission spectroscopy to (a) analyse the transient binding between sigma 70 and DNA by monitoring the quenching of W residues and (b) monitor the various states which nucleosomes of active, inducible or inactive chromatin may adopt in vivo.