Role of neutrophil-to-lymphocyte, neutrophil-to-eosinophil and platelet-to-lymphocyte ratios in the diagnosis of bullous pemphigoid and Pemphigus disease

Context: Bullous pemphigoid (BP) and “Pemphigus diseases” (PD) can have overlapping clinical manifestations and accurate distinction is crucial for appropriate management. Aims: The study aimed at analyzing the utility of simple hematological markers of systemic inflammation like neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-eosinophil ratio (NER), and platelet-to-lymphocyte ratio (PLR) in clinical decision making in the setting of clinical differentials of BP and PD in a particular case. Methods: This single-centre based retrospective observational analytical study included adult subjects newly diagnosed to have BP (n=66) or PD (n=53), confirmed with direct immune-fluorescence testing, over a period of six years. Blood counts performed using Coulter™ hematology analyser, at the time of their initial presentation, were retrieved from the hospital medical records, and the leucocyte ratios were calculated.Statistical Analysis: The data were compared between the two groups, using Mann–Whitney U test and chi-square test /Fisher's exact test. ROC curve analysis was performed to estimate cut-off values. Results: The BP group had a significantly higher NLR, total leukocyte counts (TLC), absolute eosinophil counts (AEC), and absolute lymphocyte counts (ALC), and lower NER values compared to the PD group (P < 0.05). Areas under ROC for NLR, NER, TLC, AEC, and ALC were between 0.5 and 0.7. NLR ? 7, AEC ? 2055/cumm, and TLC ? 15,000/cumm had a specificity of 90.6, 100, and 100% respectively for identifying BP patients out of the two groups, but with a low sensitivity of 22.7, 21, and 22.7%, respectively. Conclusions: NLR can be a valuable diagnostic adjunct in subtyping autoimmune bullous disorders, albeit in a small proportion of cases.

Coping strategy in persons with low vision or blindness – an exploratory study

Purpose: Coping strategies employed by people with visual disability can influence their quality of life (QoL). We aimed to assess coping in patients with low vision or blindness. Methods: In this descriptive cross sectional study, 60 patients (25–65 years) with <6/18 best-corrected vision (BCVA) in the better eye and vision loss since ?6 months were recruited after the institutional ethics clearance and written informed consent. Age, gender, presence of other chronic illness, BCVA, coping strategies (Proactive Coping Inventory, Hindi version), and vision-related quality of life (VRQoL; Hindi version of IND-VFQ33) were recorded. Range, mean (standard deviation) for continuous and proportion for categorical variables. Pearson correlation looked at how coping varied with age and with VRQoL. The analysis of variance (ANOVA) and t-test compared coping scores across categorical variables. Statistical significance was taken at P < 0.05. Results: Sixty patients fulfilled inclusion criteria. There were 33 (55%) women; 25 (41.7%) had low vision, 5 (8.3%) had economic blindness, and 30 (50.0%) had social blindness; 27 (45.0%) had a co-morbid chronic illness. Total coping score was 142 ± 26.43 (maximum 217). VRQoL score (maximum 100) was 41.9 ± 15.98 for general functioning; 32.1 ± 12.15 for psychosocial impact, and 41.1 ± 17.30 for visual symptoms. Proactive coping, reflective coping, strategic planning, and preventive coping scores correlated positively with VRQoL in general functioning and psychosocial impact. Conclusion: Positive coping strategies are associated with a better QoL. Ophthalmologists who evaluate visual disability should consider coping mechanisms that their patients employ and should refer them for counseling and training in more positive ways of coping.

Audit of repeat fine needle aspiration in cytopathology laboratory.

Background: FNAC is cost-effective, high diagnostic accuracy, reliable, rapid and inexpensive procedure in diagnosis of various clinically palpable as well as deep seated swellings. This study was intended to discover factors associated with repeat aspiration with the help of audit of cytology laboratory. Material and methods: Retrospective study of 248 cases which came to Cytology Laboratory of Dhiraj Hospital during the period of 1st January 2013 to 30th December 2013 had included. All patients who attended the Cytology laboratory for the FNAC procedure and USG guided FNAC were included in the study. Data for the audit was collected from the cytology records. The following information was documented for this audit: Age and sex, site of FNAC, documented reasons for repeat and patient IPD/OPD numbers. We had also noted the documented reasons for repeats and the duration between the repeats. Results: Out of 248 aspirations, 61 from breast swellings, 75 from the lymph nodes, 58 from the thyroid lesions, and 54 were from the miscellaneous lesions. 31 patients (12.5%) were advised repeat aspiration and 22 (8.87%) were actually repeated. In our study the most common cause for the repeat aspiration was inadequate cellularity (51.61%). Outcome of the repeat aspirations included 16 (72.73%) diagnostic and 6 (27.27%) non diagnostic aspirations. Conclusion: In our study, there were so many reasons for the repeat aspirates. In order of occurrence these are: Inadequate aspirates, non-diagnostic descriptive reports and hemorrhagic aspiration.

Glycaemic evaluation of Psidium guajava in rats.

BACKGROUND & OBJECTIVE: Many plant polysaccharides exhibit hypoglycaemic effect. Though the fruit of Psidium guajava is known to contain free sugars, the fruit extract showed hypoglycaemic effect in alloxan treated mice and human subjects. The present study was aimed to determine the glycaemic potential of P. guajava fruit peel extract on blood glucose level (BGL) of normal and streptozotocininduced sub-diabetic rats during fasting blood glucose (FBG) and glucose tolerance test (GTT). METHODS: Female albino Wistar rats (n=42) were divided into seven equal groups, and were given different doses of fruit peel extract. Diabetes was induced by streptozotocin injection (ip) at a dose of 45 mg/kg body weight. Blood glucose levels were measured after collecting the blood from tail veins. RESULTS: The diabetic and sub-diabetic models showed hyperglycaemic effect from a single oral administration of variable doses of P. guajava fruit peel extract. The maximum rise of 26.51 per cent was observed in BGL from a dose of 400 mg/kg bw exactly after 8 h of administration in normal rats whereas the maximum rise of 90.7 per cent was observed with the same dose of 400 mg/kg bw after 2 h of glucose administration in sub-diabetic rats. INTERPRETATION & CONCLUSION: The hyperglycaemic effect of P. guajava fruit peel suggests that the diabetic patients should peel off the guava fruits before consuming. However, it can also be useful in controlling hypoglycaemia occasionally caused due to excess of insulin and other hypoglycaemic drugs.

Fly-ash induced synthesis of phytochelatins in chickpea (Cicer arietinum L.) plants.

Phytochelatins and related metabolites (cysteine and GSH) were found to be induced in the shoots of two varieties of Cicer arietinum viz., CSG-8962 and C-235 grown under different amendments of fly-ash with garden soil and press mud. Cysteine, GSH, PCs and its speciation were found in higher concentrations in amended fly-ash than in the control 100% soil. Two species of metal binding peptides i.e., PC2 and PC4 were found in both varieties and in amendments, however, their concentration varied depending upon the fly-ash concentrations in both amendments. Further, var. CSG-8962 was found more tolerant than var. C-235 because of higher concentrations of PCs and related metabolites.

Biological aspects of tooth fragment reattachment in immature incisors.

Tooth fragment reattachment is a relatively new technique and there are many aspects which still need to be explored. Reported here is a case of enamel and dentin fracture of 11 and 21. There was a very thin layer of dentin clinically over the pulp chamber and the root apices were immature. The reattachment procedure was modified slightly. The initial joint was made with protective calcium hydroxide and glass ionomer cement on the approximating surfaces. The further reattachment was accomplished using composites and acid etch technique. This was done for pulpal protection. After six months, reattachment was intact and successful with no staining, sensitivity or pain. The radiographs revealed root completion of the immature incisors. The reattachment procedure proved to be biologically superior in addition to its esthetic value and psychological advantage.

Gastric acid study in patients operated on for perforated duodenal ulcer.

OBJECTIVES: To determine the acid secretory status of patients operated on for perforated duodenal ulcer, with or without prior history suggestive of acid-peptic disease. METHOD: Basal and peak acid output were measured in 48 patients with perforated duodenal ulcer who were treated by simple closure alone, 10 patients with uncomplicated chronic duodenal ulcer and 30 normal controls. Patients operated on for perforated duodenal ulcer were analyzed according to presence (or absence) and duration of prior history of acid-peptic disease. RESULTS: Peak acid output was similar in controls and patients with perforated duodenal ulcer with no prior symptoms. However, patients with prior symptoms had significantly higher peak acid output, similar to those with uncomplicated duodenal ulcer. CONCLUSION: Patients with perforated duodenal ulcer with no antecedent history of acid-peptic disease have normal gastric acid output. These patients may therefore have other etiological factors for their ulcers.

Pattern of acute renal failure at a referral hospital.

Fifty two children (upto 12 years age) with acute renal failure (ARF) admitted to the Nephrology services between January, 1989 to August, 1992 were studied to determine the cause and outcome. Of these, 39 were boys and 13 girls; 27 (51.9%) patients were below 4 years of age. Hemolytic uremic syndrome (HUS) was the commonest cause of ARF (30.8%) followed by acute tubular necrosis (ATN) in 28.84% and acute glomerulonephritis in 19.23%. All patients had severe renal involvement with anuria in 53.6% and oliguria in 46.4% at presentation. HUS was the leading cause of anuria (53.6%), followed by obstructive uropathy (21.4%). Thirty five patients required dialytic support for a median duration of 18 days (2-90 days). The mortality was 34.6%. Seven patients of HUS, 4 patients of ARF following surgery, 3 patients each of ATN and glomerulonephritis and one patient of obstructive uropathy died. Anuria at onset, central nervous system or respiratory complications and delay in institution of dialytic support were bad prognostic factors. We conclude that early referral and prompt institution of dialytic support may be helpful in decreasing the mortality.

Insulin oedema: an uncommon complication of insulin therapy.

A 45 year old markedly underweight man presented with polydipsia, polyuria and tingling sensation in both lower limbs of one month duration. Following insulin treatment, he developed gross fluid retention (peripheral oedema and puffiness of face) and a weight gain of 1.8 kg. The oedema occurred on the 3rd day after starting treatment and disappeared on the 7th day without the use of diuretics. Insulin oedema is an uncommon complication of insulin which may occur on introduction of insulin therapy or on increasing the dose, and may be due to the effect of insulin on vascular permeability and renal tubules.