Impact of baseline fluorescent antinuclear antibody positivity on the clinical outcome of patients with primary autoimmune hemolytic anemia

Abstract Introduction Autoimmune haemolytic anaemia (AIHA) is an autoimmune disorder that can present in primary or secondary forms. The literature looking at impact of baseline fluorescent antinuclear antibody (FANA) positivity on outcomes of AIHA patients is infrequent. Objective To study the impact of baseline FANA positivity in patients with primary AIHA. Method A prospective cohort study involving 29 consecutive primary AIHA patients presenting to the Haematology department from 2013 to 2015 was analysed. After recording baseline investigations including fluorescent ANA, all patients were treated as per the standard therapeutic protocols. Clinical remission, disease free survival, relapse, mortality were compared between the FANA positive and FANA Negative AIHA groups. Results Baseline FANA positivity was found in 17 patients (58.62%). Both the groups were comparable in terms of age, sex, Hemoglobin, LDH at presentation, number of lines of treatment needed and duration of follow up. Evan's syndrome was seen in six of FANA positive patients which was statistically significant (0 v/s 6, p= 0.023). FANA positive patients had significantly higher rates of relapse per patient month follow up (1.22 v/s 3.57, p= 0.023) and lower rates of complete response (83.33% v/s 35.29%, p= 0.0118) and relapse free survival at five years. Morbidity and mortality were numerically higher in FANA positive patients. Conclusion Baseline FANA positivity among AIHA patients was found to be associated with lower complete response rates and higher relapse rates with possible higher rates of morbidity. Presence of FANA will give us prognostic value and help us in deciding the treatment options.

Morphometric And Morphological Study On The Septomarginal Trabecula

Background and objectives: Moderator band is a specialized bridge present between the base of the anteriorpapillary muscle and interventricular septum. It carries the right branch of the bundle of HIS with it. The band isknown to prevent the over distension of the right ventricle during the diastolic phase. There is a need of lot ofresearch and studies on the septomarginal trabecula as it proves to be important clinically. Here we measuredthe length, breadth, height, angle with the interventricular septum, and the superficial marking of Moderatorband on the sternocostal surface of the right ventricle is done. This paper describes the morphological variationsfound in its origin and insertion.Materials and Methods: 15 formalin-soaked cadaveric hearts were taken from the Department of Anatomy ofKVG Medical College, Sullia. The foetal hearts, the hearts with gross pathology, if any are excluded from the study.Result: The morphometric parameters are tabulated and the morphological variations are noted. The results arecompared with the results of the previous studies on the moderator band.Conclusion: It is confirmed that the thickness of moderator band varies at its origin and insertion. The surfacemarking of moderator band on sternocostal surface of the heart will help in locating the moderator band throughthe echocardiography and during cardiac surgeries on right ventricle. The possibility of second moderator band,multiple origin or insertion is more than 20%.

Chronic arthritis in Juvenile Behcet’s Syndrome: a rare case

Behçet’s syndrome is a chronic multisystem vasculitis characterized by mucocutaneous, articular, neurological, gastrointestinal and ophthalmological lesions. Behcet’s syndrome is a disease of uncertain etiology. It may be due to immune dysregulation including circulating immune complex, autoimmune cytokines and heat shock proteins are major factor in the pathogenesis of Behcet’s syndrome. Patient’s positive pathergy test suggests a diagnosis of Behcet’s disease. Corticosteroids and immunosupressive drugs are the first line of treatment. This is a case report of juvenile Behcet’s syndrome in a thirteen year old girl associated with arthritis.

Significance of MRSA strains in community associated skin and soft tissue infections.

The study was conducted to determine the antibiotic susceptibility profile of community-associated methicillin resistant Staphylococcus aureus (CAMRSA) strains isolated from infections. S. aureus strains were isolated from clinical specimens using the standard procedures. CDC definition was used to classify CAMRSA. Antibiotic susceptibility test was done using Kirby-Bauer disk diffusion method. Double disk diffusion method (D-test) was used to detect inducible macrolide, lincosamide and streptogramin B resistance (inducible MLS B resistance ) . A total of 83 CAMRSA were isolated from abscesses and other skin infections in persons without known risk factors for MRSA infection. All CAMRSA were susceptible to vancomycin. Out of 83 CAMRSA, 13 (15.65%) were D-test positive (inducible MLS B positive) and 6 (7.23%) were positive for constitutive MLS B resistance. Eight strains (9.63%) were resistant to tetracycline and 26 (31.32%) strains were resistant to erythromycin. Increased rate of inducible clindamycin resistance among CAMRSA indicates the importance of identification of such strains by D test to avoid treatment failure when clindamycin is used.

Comparison of potassium hydroxide mount and mycological culture with histopathologic examination using periodic acid-Schiff staining of the nail clippings in the diagnosis of onychomycosis.

BACKGROUND: Onychomycosis is a common problem noticed in clinical practice. Currently available standard laboratory methods show inconsistent sensitivity; hence there is a need for newer methods of detection. AIMS: This study involves comparison of standard laboratory tests in the diagnosis of onychomycosis, namely, potassium hydroxide mount (KOH mount) and mycological culture, with histopathologic examination using periodic acid-Schiff (PAS) staining of the nail clippings. METHODS: A total of 101 patients with clinically suspected onychomycosis were selected. Nail scrapings and clippings were subjected to KOH mount for direct microscopic examination, culture using Sabouraud's dextrose agar (with and without antibiotics) and histopathologic examination with PAS staining (HP/PAS). Statistical analysis was done by McNemar's test. RESULTS: Direct microscopy with KOH mount, mycological culture, and HP/PAS showed positive results in 54 (53%), 35 (35%), and 76 (75%) patients respectively. Laboratory evidence of fungal infection was obtained in 84 samples by at least one of these three methods. Using this as the denominator, HP/PAS had a sensitivity of 90%, which was significantly higher compared to that of KOH mount (64%) or mycological culture (42%). CONCLUSIONS: Histopathologic diagnosis with PAS staining of nail clippings was the most sensitive among the tests. It was easy to perform, rapid, and gave significantly higher rates of detection of onychomycosis compared to the standard methods, namely KOH mount and mycological culture.

Ellis-van Creveld Syndrome (chondro-ectodermal dysplasia) in two siblings.

Two male siblings aged 12 and 15 years (Figure 1) presented with growth retardation, limb abnormalities and, defective teeth and nail since childhood. There was no history of similar defects in other family members. On examination their height was 114 cm and 130 cm (expected height; 169 cm and 150 cm) respectively. There were hypoplastic and dystrophic nails, and microdontia and hypodontia on dental examination. There were post-axial polydactyly in both the hands and left foot. Skeletal survey revealed short forearms, legs & distal phalanges (Acromesomelia). Cardiac or other organ system defects were not noticed on clinical examination or echocardiogram. Clinical picture was suggestive of a diagnosis of Chondroectodermal dysplasia (Ellis van Creveld syndrome). These cases have been reported for their rarity and for the presence of some rare features of this syndrome.

In search of endodontic pathogens.

Success of root canal therapy depends on the complete eradication of microflora from the root canal system. A great deal of research is needed to identify and define the role of the pathogens which are involved in the pathogenesis of the periradicular diseases. This will help the endodontist to plan the best treatment by irradiation of pathogens which, in turn predict the outcome of the treatment. This article reviews the endodontic microflora, routes of microbial entry, methods to identify endodontic microbes and markers that permit the clinician to know when to conclude the treatment.

Enhancement of thermal effect in virally infected mammalian cells in vitro and its modification by chlorpromazine.

NIH/3T3 cells chronically infected with Moloney murine leukemia virus (M-MuLV) were more thermosensitive than uninfected cells. Cells upregulated by a primary dose of heat formed giant colonies and had an altered response to a second dose of heat. Thermosensitivity depended upon the time elapsed between heat treatments. Heating the cells at either 42 degrees or 42.5 degrees C yielded biphasic survival curves, indicating a mixed population of productively infected and quiescent cells. Hyperthermia at 43 degrees C abolished this effect. Thermal sensitivity of infected cells was correlated with the expression of a viral reporter protein. Chlorpromazine (CPZ), a membrane active drug potentiated the heat effect in both uninfected and virally infected cells. The drug also abolished the biphasic effect of heat in infected cells, suggesting that heat sensitivity of both productively and quiescent cells is membrane mediated. The combined effect of heat at 42.5 degrees C and CPZ was equivalent to the effect of heat alone at 43.5 degrees C. These observations indicate that heat can selectively be lethal to productively infected cells and the membrane active drugs could further amplify this hyperthermic effect.

Metabolic acidosis induced by cetrimide-chlorhexidine solution in hydatid cyst surgery.

A patient with a large hydatid cyst of the left lobe of the liver developed metabolic acidosis following rather liberal use of cetrimide-chlorhexidine solution as a scolicidal agent. The progress and management of this complication are described in the patient is being reported.

Short colon variant.

A one day old neonate with a short colon, associated exomphalos minor; bifid scrotum and ileovesical fistula is reported.