Utility of oral mucosa as a substrate for the serodiagnosis of pemphigus: A descriptive analysis

Background: The indirect immunofluorescence test is useful in the serodiagnosis of pemphigus. As indirect immunofluorescence titers correlate with disease activity in pemphigus, it is often used as a monitoring tool. The sensitivity of indirect immunofluorescence depends on the substrate used, and the preferred substrates are monkey esophagus for pemphigus vulgaris and normal human skin for pemphigus foliaceus. Aims: We evaluated oral mucosa as a substrate for indirect immunofluorescence in pemphigus. Methods: Fifty patients with pemphigus (40 with pemphigus vulgaris and ten with pemphigus foliaceus) and 50 controls were enrolled for study. Demographic and clinical details were recorded and indirect immunofluorescence using two substrates (oral mucosa and normal human skin) was carried out in serial dilution. Desmoglein (Dsg) 1 and 3 enzyme-linked immunosorbent assay was also evaluated simultaneously. Results: Indirect immunofluorescence was positive in 40 patients (80%) with oral mucosa substrate and 34 patients (68%) with normal human skin substrate. Circulating antibodies were detected with oral mucosa in 33 (82.5%) of the 40 pemphigus vulgaris patients and in 26 (65%) patients using normal human skin. Antibodies were detected in eight of the ten pemphigus foliaceus patients (80%) with normal human skin and in seven (70%) patients with oral mucosa. Dsg enzyme-linked immunosorbent assay was positive in 45 (90%) patients, and 37 of these were also indirect immunofluorescence positive with oral mucosa. In the five Dsg enzyme-linked immunosorbent assay-negative patients, indirect immunofluorescence with oral mucosa was positive in three. Limitations: A comparison of oral mucosa with monkey esophagus could not be performed. Conclusion: Oral mucosa is a suitable and sensitive substrate for indirect immunofluorescence in pemphigus. Further studies comparing the sensitivity of indirect immunofluorescence using oral mucosa with monkey esophagus are recommended.

Mesodiverticular Band Of Meckel‘S Diverticulum, A Rare Cause Of Strangulated Small Bowel Obstruction In An Adult: A Case Report

Mesodiverticular band (believed to be remnant of a vitelline artery) causing gangrene of Meckel’s diverticulum (MD) with simultaneous mechanical small bowel obstruction is the rarest complication of Meckel’s Diverticulum. We report a case of 34 year female, who presented with acute small bowel obstruction caused by Mesodiverticular band of MD. She presented with severe abdominal pain, distension and vomiting. Laparotomy revealed gangrene of Meckel’s diverticulum along with adjacent ileal segment caused by a Mesodiverticular band of MD. The mesodiverticular band was released from the ileal mesentery and the gangrenous ileal segment with MD was resected and an end to end ileoileal anastomosis was performed. The postoperative period was uneventful and the patient was discharged after 6 days. Because of the rarity of this anatomic anomaly in adults, we find this case of interest.

Pulmonary function tests in stone crushers.

A cross-sectional type of observational study was conducted at 7 various stone crusher units on 120 male stone crushers and 120 healthy male controls. Values of FEF25-75% and PEFR were recorded on computerized spirometer and were compared between workers and age matched controls group. The value of FEF25-75% and PEFR was significantly reduced in stone crushers as compared to controls. Also as the duration of exposure increases the values of flow rates goes on decreasing among workers. Stone crushers of Marathwada region of Maharashtra exposed to silica dust were prone to develop lung disorders as indicated by reduced value of FEF25-75% and PEFR.

Adenoid cystic carcinoma of the external auditory canal: Report of two cases.

Adenoid cystic carcinoma occurring in the external auditory canal is very rare. Two cases are being reported. One was diagnosed on cytology based on which surgery was planned. In the second case, fine needle aspiration procedure had to be abandoned due to severe pain and a biopsy was required for its diagnosis. Morphologically, it resembles its more common salivary gland counterpart. Though severe pain during needling may be a limiting factor, adenoid cystic carcinoma of external auditory canal can be confidently diagnosed on cytology based on which surgical management can be planned.

Vision recovery in human immunodeficiency virus-infected patients with optic neuropathy treated with highly active antiretroviral therapy: A case series.

We describe three patients with bilateral, presumed human immunodeficiency virus (HIV)-induced optic neuropathy. The above diagnosis was made by exclusion of infectious agents and neoplasms by detailed clinical and laboratory investigations. All patients had decreased visual acuity, pale optic discs and constriction of visual fields. Improvement was documented in all three patients for visual acuity and in one patient for visual fields following treatment with highly active antiretroviral therapy (HAART). Optic neuropathy in HIV-positive patients does not necessarily carry a poor prognosis even when a treatable cause is not found. This article emphasizes the effectiveness of HAART in presumed HIV-induced optic neuropathy.

Efficacy and safety of oxum in treatment of the venous ulcer.

The present study was carried out to find out the efficacy and safety of oxum in the treatment of venous ulcers. The oxum (superoxidised water) is a pH neutral, non-irritating, aqueous solution that possesses a good antiseptic, antimicrobial activity and wound healing properties. The study was conducted in 30 patients of venous ulcers with a culture examination positive for pathogenic microbial flora. All patients received a gauze dressing impregnated with oxum followed by compression bandage for 28 days. The primary endpoint was the calculation of ulcer size using ulcer tracing. Assessment of periwound oedema, periwound erythema, wound fibrin and wound granulations were considered as secondary endpoints. There was a singificant reduction in ulcer size starting from day 7 of the treatment. Significant improvements in secondary endpoints were observed. This study has demonstrated that oxum improved the clinical status, reduced the signs of inflammation in venous ulcers in addition to its well confirmed anti-infective properties.

Monoethylglycinexylidide (MEGX) as a liver function test in cirrhosis.

AIMS: To compare the performance of monoethylglycinexylidide (MEGX) test and conventional liver function tests (LFT) in differentiating between healthy volunteers and patients with different severity of liver cirrhosis, as judged using Child-Pugh (CP) classification. METHODS: One hundred and four patients with cirrhosis (CP class A, 47; B, 32; C, 25) and 25 healthy volunteers were studied between January 2005 to June 2006. In these subjects, conventional LFT were done, and serum specimens collected 15, 30 and 60 minutes after lidocaine injection were analyzed for MEGX. RESULTS: Conventional liver function tests showed minor differences between healthy volunteers and patients with Child class A, whereas these discriminated well between patients with Child class C and healthy volunteers. The changes in ALT, AST, bilirubin, albumin, AP and PT values were statistically significant in CP class B and C but not in class A when compared with healthy volunteers. MEGX concentration at 60 min was significantly higher in healthy volunteers (131.2 ng/mL) as compared to patients with cirrhosis (CP A - 51.3 ng/mL; CP B - 37.1 ng/mL; CP C - 17.3 ng/mL). There were significant differences (p <0.001) among all four groups (healthy volunteers and patients with CP classes A, B and C) for MEGX concentrations at each time point. MEGX test correlated well with CP scores (p <0.0001). CONCLUSION: MEGX test is a useful marker to stratify patients with liver cirrhosis based on liver function.

Salt wasting disorder in the newborn.

The clinical presentation of pseudohypoaldosteronism (PHA) mimics congenital adrenal hyperplasia (CAH). Poor response of the dehydration and electrolyte abnormalities to steroid therapy should make one suspect PHA. The treatment is supportive in the form of salt replacement and sodium resonium. We report a case of PHA that presented as salt wasting on the second day of life, initially appearing like CAH. The baby responded well to sodium resonium and salt replacement.

Evaluation of efficacy and safety of fixed dose combination of glimepiride 2 mg pluspioglitazone 15 mg plus metformin SR 500 mg in the management of patients with type-2 diabetes mellitus.

An estimated 25 million Indians currently have diabetes and the projections indicate Indians would be the largest group by the year 2025 AD. An open, phase III, multicentric study was conducted to determine the efficacy and tolerability of the triple drug combination glimepiride 2 mg plus pioglitazone hydrochloride 15 mg plus metformin SR 500 mg for 8 weeks in 101 Indian patients with type 2 diabetes mellitus. The study revealed that the triple drug combination could achieve the recommended goals, recommended by American Diabetic Association, for fasting blood glucose < or = 140 mg/dl and glycosylated haemoglobin (HbA1c) of < or = 8%. After 8 weeks, the mean fasting blood glucose (baseline 189.61) was reduced to 111.68 (41% reduction); the mean glycosylated haemoglobin (baseline 10.32) was significantly reduced to 7.54 (26% reduction). The triple drug combination significantly reduced the levels of triglyceride, low density lipoproteins and total cholesterol. These significant levels were achieved within 8 weeks and all patients tolerated the drug well with no reported case of serious adverse events including hypoglycaemia. There were also no reported drug interactions in the study. Since the decrease in HbA1c was continuous and throughout the study, a further decrease in the HbA1c levels would have been noted since the present trial was designed for a period of 8 weeks. Thus, the present study confirms the efficacy and safety of FDC of the triple drug combination in patients with type 2 diabetes.

History, magnitude and rationality of injection use--a compilation.

Injection is a skin piercing event performed by a syringe and needle with the purpose of introducing a curative substance or vaccine into a patient. Dated back to 1657 with the first injection in animals the device is traced till 1991. The concern for proper management of injections is for occupational risk to the health worker, newer technologies to protect health workers is discussed including risk to patients and indirect risk via the environment to the community. Injection overuse is a cause of worry as it exposes the patient the risk of acquiring infections. In healthcare settings in India, most injections are unnecessary. Moreover irrational injection prescription is harmful. There also lies the misconceptions about injectable and oral medications. All professionals, in particular the doctors and nurses should become the advocates of safe injections.

Injection safety for immunisation--Andhra Pradesh experience.

Injection safety is one component of a major immunisation project being implemented in partnership with Government of Andhra Pradesh and PATH, an international NGO. Prior to the project wrong and dangerous injection giving practices were present among the staff which needed immediate attention. It was decided to introduce auto disable syringes along with safety boxes with high quality training to staff and make all these available to all districts along with hepatitis B introduction in the routine immunisation. The State of Andhra Pradesh became the first to implement 'bundling' concept in the immunisation project. Implementation was planned to be done in a phased manner to cover all the 23 districts over a five-year period. For routine immunisation sessions, smaller locally produced boxes may be more acceptable. The Government of India made a decision on 21st July, 2004 on implementing injection safety. Injection safety and proper disposal of used needles and syringes can be successfully advocated if medical associations, paediatric associations, key governmental bodies and international agencies come together. PATH established a group and holds the secretariat for the India injection safety coalition on similar basis as the Safe Injection Global Network of WHO (SIGN). Description of AP system for safe disposal of needles and syringes using manual needle-cutters and plastics recycling has been depicted in this article.

Acute necrotizing gastritis.

A 17-year-old man presented with signs of peritonitis. Laparotomy revealed gangrene of the stomach without obvious cause. The patient underwent total gastrectomy with esophago-jejunal anastomosis with formation of jejunal pouch. Bacterial culture of the peritoneal fluid grew Strept. pyogenes and E. coli. The patient was discharged on day 21 after a stormy postoperative course.

Degloving injury of small intestine.

Self-inflicted stab wounds are seldom very grave. We report a 25-year-old man who inflicted stab wounds with a glass piece under the influence of alcohol. This led to evisceration and later degloving injury to the small bowel. He recovered following surgery.