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.

Knowledge, attitude and practices regarding generic medicines and its usage: a community-based study

Background: India is the largest provider of generic medications globally. Despite this, several essential medicines remain inaccessible to majority of the general population, due to poor awareness, unavailability of drugs, distrust about the quality of the medicines, poor policy implementation and inadequate recommendation by doctors. Methods: A community-based cross-sectional study was carried out among 1151 adults in rural and urban areas attached to the community outreach area of a University Medical College. Written informed consent was taken from the participants. Data was collected using a pre-tested semi-structured online questionnaire and analysed using SPSS 15.0. Results: Knowledge regarding generic medicines was found to be low among the surveyed population (666, 57.9%), irrespective of their socio-economic status, education, occupation, place of residence or presence of chronic illnesses. As the knowledge was poor, participants were briefed about the generic medicines and their benefits. Thereafter, the attitude was assessed and found to be favourable among more than half (633, 55.0%) of the surveyed population. The usage of Generic medicines was found to be poor among the respondents. Only 53 (4.6%) of the total study population had switched from branded to generic medicines in the past six months as generic medicines were less expensive compared to their branded counterparts. Conclusions: The awareness about generic drugs and its usage was poor in the surveyed population. A favourable attitude towards generic drugs was achieved by educating the people about their similarity to branded medications. Therefore, there is a need to educate people not only about the quality, safety and efficacy of the generic medicines but also about the government initiatives like the Jan Aushadhi scheme.

Effect of different musical tempo on post-exercise recovery in young adults.

The role of music in increasing the exercise performance is well recognised. There is very little information about effect of music on time taken for post exercise recovery. We examined the effect of music and different musical tempo on post exercise recovery time, following treadmill work. 30 volunteers (15 male, 15 female) subjected to isotonic exercise (submaximal treadmill work) on three consecutive days. They were allowed to rest in silence on the first day, rest by hearing slow music on second day and rest with fast music on third day. Parameters such as Pulse rate, blood pressure, rating of perceived exertion (RPE) were measured at predetermined intervals. Repeated measures ANOVA test showed that with slow music, recovery time of systolic blood pressure (SBP) (7.9±2.5), diastolic blood pressure (DBP) (5.5±3.4) pulse rate recovery (PR) (8.0±2.3) and recovery from exertion (RPE) (7.7±2.5) were significantly faster when compared to both no music and fast music. The individual music preference made no significant difference in the relaxation time. The study concluded that music hastens post exercise recovery and slow music has greater relaxation effect than fast or no music, recovery time being independent of the gender and individual music preference.

Adequacy of two versus three sputum specimens for the diagnosis of pulmonary tuberculosis.

Background. The new guidelines issued by the Revised National Tuberculosis Control Programme for diagnosis of smear-positive tuberculosis recommend examination of only 2 sputum smears. We did a retrospective analysis of data from a designated microscopy centre to ascertain the diagnostic yield of 2 smears and the additional yield provided by the third smear. Methods. Data were obtained from the designated microscopy centre attached to our medical college. A total of 3257 patients with suspected tuberculosis had undergone sputum examination between September 2004 and March 2009. However, only 1762 of them had 3 sputum specimens examined. Data were entered and analysed using SPSS version 11.5. Results. Among the 1762 suspected patients, positivity in any 2 samples was found to be 17.7% while 19% were found to be positive in a single smear. A statistically insignificant association was found between the grading and positivity of the sputum samples using McNemar test. A positive third sample was found in 309 patients. If the first 2 samples were negative, the possibility of missing a third positive sample was 0.4%. Conclusion. Under field conditions, 2 sputum smears are as effective as 3 smears for diagnosing smear-positive tuberculosis.