Perfil clínico, teste padrão da resistência à droga e resultados do tratamento de pacientes com tuberculose abdominal da Índia ocidental / Clinical profile, drug resistance pattern and treatment outcomes of abdominal tuberculosis patients in western india

ABSTRACT BACKGROUND: Abdominal tuberculosis is an increasing problem in developing world. OBJECTIVE: The objective of the study was to describe the clinical presentations, drug resistance pattern and treatment outcomes of abdominal tuberculosis in Western India. METHODS: All the cases of abdominal tuberculosis from May 2014 to April 2017, diagnosed on the basis of clinical profile and gross morphological findings at endoscopy, imaging, followed by histology and/or GeneXpert and MGIT culture were included. All patients received antitubercular drug (AKT) therapy according to national protocol. Patients were followed from diagnoses till completion of treatment and various parameters were studied. RESULTS: Out of the 176 patients, 48% were males. Abdominal pain was most common complaint in 83.5%. On colonoscopy terminal ileum and ileocaecal valve were most commonly involved segments. Upper gastrointestinal tract was involved in four patients. Overall ulceronodular lesions were most common followed by ulcerative/nodular lesion. Strictures in bowel were seen in 28 (15.9%) patients with ileocaecal valve being most commonly involved, of which 23 had symptomatic relief with AKT and only three required dilatation. Histopathology showed granuloma in 80.8% cases. MGIT was positive in 43 (35.80%) cases and GeneXpert was positive in 35 (26.1%) cases. Eight patients had multi drug resistant tuberculosis. Only two patients required surgical management. CONCLUSION: Abdominal tuberculosis with wide spectrum of presentation, can still be managed with early diagnosis and treatment even in patients with sub acute intestinal obstruction. Weight gain or resolving symptoms were considered early markers of treatment response. Patients with stricture can become asymptomatic with medical treatment alone.

RESUMO CONTEXTO: A tuberculose abdominal é um problema crescente no mundo em desenvolvimento. OBJETIVO: O objetivo do estudo foi descrever as apresentações clínicas, o padrão de resistência a fármacos e os desfechos de tratamento da tuberculose abdominal na Índia ocidental. MÉTODOS: Foram incluídos todos os casos de tuberculose abdominal de maio de 2014 a abril de 2017, diagnosticados com base no perfil clínico e nos resultados morfológicos brutos na endoscopia, imagem latente, seguido pela histologia e/ou pela cultura de GeneXpert e de MGIT. Todos os pacientes receberam a terapia antitubercular da droga (AKT) de acordo com o protocolo nacional. Os pacientes foram acompanhados de diagnósticos até a conclusão do tratamento e vários parâmetros foram estudados. RESULTADOS: Dos 176 pacientes, 48% eram do sexo masculino. A dor abdominal foi a queixa mais comum em 83,5%. Na colonoscopia, o íleo terminal e a válvula íleo-cecal foram os segmentos mais comumente envolvidos. O trato gastrointestinal superior foi envolvido em quatro pacientes. As lesões ulceronodulares totais foram as mais comuns seguidas pela lesão ulcerosa/nodular. As estenoses foram observadas em 28 (15,9%) pacientes priciplamente com a válvula íleo-cecal envolvida, dos quais 23 tiveram alívio sintomático com AKT e somente três necessitaram de dilatação. A histopatologia mostrou o granuloma em 80,8% casos. O MGIT foi positivo em 43 (35,80%) e GeneXpert foi positivo em 35 (26,1%) casos. Oito pacientes tiveram tuberculose resistente a múltiplas drogas. Apenas dois pacientes necessitaram de manejo cirúrgico. CONCLUSÃO: A tuberculose abdominal com amplo espectro de apresentação, ainda pode ser manuseada com diagnóstico precoce e tratamento mesmo em pacientes com obstrução intestinal sub-aguda. Ganho de peso ou sintomas resolvidos foram considerados marcadores precoces de resposta ao tratamento. Pacientes com estenose podem se tornar assintomáticos com tratamento médico isoladamente.

Hereditary Sensory and Autonomic Neuropathy Type VIII.

Hereditary sensory and autonomic neuropathy type VIII (HSAN 8 or HSAN VIII) is a rare genetic disorder that usually begins in infancy and is characterized by an inability to feel pain and inability to sweat (anhidrosis). The sensory loss in individuals with HSAN VIII is due to abnormal functioning of the sensory nerves that control responses to pain and temperature. Anhidrosis can cause recurrent episodes of fever and high body temperature. An inability to feel pain can lead to unintentional self-mutilation, repeated fractures, and joint damage. Affected individuals and especially children or infants may be unaware of injury delaying treatment. HSAN VIII is caused by mutations in the PRDM12 gene which is essential for human pain perception.

A rare case of paediatric trichotillomania complicating into Rapunzel syndrome: a case report

Background: Trichotillomania is a psychological condition that involves strong urge to pull one’s hair. Trichophagia is disorder of eating of hair. Bezoar is collection of undigested material such as hair, drugs and plastic or combinations. Rapunzel syndrome is a rare type of trichobezoar, which has mass of hair lodged in stomach extending up to ileum. In majority, diagnosis is made very late, at a stage where surgery is the only option. Case description: A 9 year old girl was brought with complaints of loss of hair on scalp since 8 months, decreased appetite, and constipation, weight loss since 5 months and vomiting since 2 weeks. Patient had paediatric consultations without much benefit; patient was referred to dermatologist and paediatric surgeon. Ultrasound showed mass in abdomen. Patient was operated to find a mass extending from stomach to terminal ileum. Patient was referred to a Psychiatrist and diagnosis of Trichotillomania was made. Discussion: Trichobezoar is common in young females, often with an underlying psychiatric disorder, they present late due to the low index of suspicion. As this condition is a rarity in paediatric age group and very little progress to Rapunzel syndrome, this paper discusses about the systemic team management of the above individual. Conclusion: High index of suspicion is needed to diagnose this condition in paediatric age group.

Bilateral Dupuytren’s Contracture.

Dupuytren’s contracture (DC) is painless flexion contracture of ulnar side of palm where fingers bend towards palm and cannot be straightened. It is a fibrosing disorder that results in slowly progressive thickening and shortening of the palmar fascia, leading to the debilitating digital contractures. The prevalence of DC is found to be higher in patients with cirrhotic or noncirrhotic alcoholic liver disease. We report the case of a 56-year-old male chronic alcoholic who presented with distention of abdomen, yellow discoloration of sclera since 1 month and altered sensorium since 1 day. He had bilateral contractures on ulnar side of hands, suggestive of DC.

Solubility enhancement of oral hypoglycemic agent by solid dispersion technique.

The present study was aimed to increase the solubility of the poorly water soluble drug (Gliclazide) by using hydrophilic polymers (PVP K-30 and HPMC E4). Solid dispersions were prepared by kneading method. Phase solubility study, in-vitro dissolution of pure drug, physical mixtures and solid dispersions were carried out. PVP and HPMC were found to be effective in increasing the dissolution of Gliclazide in solid dispersions when compared to pure drug. FT-IR spectroscopy, differential scanning calorimetry and X-ray diffractometry studies were carried out in order to characterize the drug and solid dispersion.

Different methods of formulation and evaluation of mucoadhesive microsphere.

Mucoadhesion is topic of current interest in the design of drug delivery system. Mucoadhesive microsphere exhibit a prolonged residence time at the site of application and facilitate an intimate contact with the underlying absorption surface and thus contribute to improved or better therapeutic performance of drug. Mucoadhesive drug delivery systems promises several advantages that arise from localization at a given target site, prolonged residence time at the site of drug absorption and an intensified contact with the mucosa increasing the drug concentration gradient. Hence, uptake and consequently bioavailability of the drug is increased and frequency of dosing reduced with the result that patient compliance is improved. In recent years such Mucoadhesive microspheres have been developed for oral, buccal, nasal, ocular, rectal and vaginal for either systemic or local effects. The principles underlying the development of Mucoadhesive microsphere and research work carried out on these systems are reviewed here.