Histopathological finding of vesiculobullous lesions of skin in relation to their clinical presentation: Prospective study from a tertiary care center

Background: Vesiculobullous disorders (VBDs) are extant with diverse clinical manifestations. Vesicles and bullae are fluid-filled cavities present within or beneath the epidermis. They are autoimmune blistering disorders in which autoantibodies are directed against target antigens present in the epidermis and dermo-epidermal junction. Objective: Evaluation of the various clinicodemographic profile of patients with a pattern of distribution (subtypes) of VBDs of the skin and assess the association between clinical aspects and histological changes in vesiculobullous lesions of the skin. Materials and Methods: The study material constituted 93 cases of VBDs out of 936 skin biopsies reported over two and a half years (January 2016 to June 2018) from the tertiary care center. A detailed history of the patients was taken, and a complete physical and dermatological examination with findings including clinical diagnosis was recorded. Histopathological examination (incisional/excisional/punch biopsy) was done in each case. The clinico-demographic evaluation was done and the results were correlated with histopathological findings. Results: Vesiculobullous lesions constituted 10.06% of all skin biopsies. The majority of cases were of pemphigus vulgaris (PV) 30 (32.25%) followed by 16 (17.2%) of bullous pemphigoid. In 83 cases (89.24%) histopathology findings were consistent with clinical diagnosis. Out of 34 cases that were diagnosed clinically as PV , the histopathological study proved 30 cases (88.23%) as PV. Conclusion: Vesiculobullous lesions of the skin are a heterogeneous group of disorders. It is essential to differentiate each pattern of subtype based on clinical examination and histopathological findings. Histopathological diagnosis with clinical correlation plays a major role in arriving at the diagnosis.

Comparative Efficacy of Hydrochlorthiazide and Chlorthalidone, used either alone or in Combination Therapy in Patients with Essential Hypertension in Tertiary Care Hospital of Uttrakhand

Aims : To study the comparative efficacy of Hydrochlorothiazide and Chlorthalidone, either used alone or in combination on Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Lipid Profile and Anthropometry. Methods : It was a Prospective, Randomised, Longitudinal study, where consecutive patients presenting to medicine Out Patient Department (OPD) and In Patient Department (IPD) were screened for essential hypertension based upon the JNC VII Guidelines. Those subjects who satisfy the inclusion and exclusion criterias were included in the study. These subjects were divided into four subgroups. Each patient was assessed for Blood Pressure (BP), Lipid profile, Anthropometry for a period of 180 days. Results : There was statistically significant reduction in both systolic blood pressure and DBP in both the groups over a period of 180 days. This trend was progressive during the observed period in both the groups till a stable state was reached. There was a greater reduction in the SBP in the chlorthalidone group as compared to the Hydrochlorothiazide group (P value 0.05). However, such trend was not observed on the DBP on the two groups. Over a six months follow up there was no change in the Lipid parameters either on the same group or while comparing the two groups. The body Anthropometry , especially waist Hip ratio and Body Mass Index also did not show any significant difference in the two groups( either used alone or in combination). Conclusion : Chlorthalidone was found to be a relatively more potent Anti-hypertensive on SBP when compared with Hydrochlorothiazide .Both these drugs failed to show any significant difference in the Lipid Profile and Anthropometry in a period of six months.

Seroprevalence of Transfusion Transmissible Infections among Blood Donors at a Tertiary Care Teaching Hospital in Central India

Introduction: Blood transfusion is both a life saving measurein many medical and surgical emergencies and a source oftransfusion transmitted infections. So a provision for strictcriteria in recruitment and deferral of blood donors mayimprove safe transfusion practice. The present study wasconducted to estimate the prevalence of transfusion transmittedinfections in voluntary and replacement donors at a tertiarycare teaching hospital in Indore, Madhya Pradesh,CentralIndia.Material and Methods: The present study was a 4 yearretrospective study from 2015 to 2018. Data was analyzedfrom blood bank records,pertaining to all donors who werescreened for HBsAg, Hepatitis C virus and HIV by usingappropriate methods.Results: A total of 45,704 Voluntary & replacement donorswere screened out of which 44,663 (97.72%) were males &1041 (2.27%) were females. The overall seroprevalence ofHBV & HCV was 1.29% & 0.072% respectively, while theprevalence of HIV was 0.076%.The prevalence rate washighest for HBV followed by HIV and HCV in decreasingorder. The overall seroprevalence of various TTI’s among thestudied donors was 1.43%.Conclusion: Blood is still one of the main sources oftransmission of infections like HIV, Hepatitis B and HepatitisC. Extensive donor selection and screening procedures willhelp in improving the blood safety.

Antihypertensive drug utilization pattern and awareness in diabetic hypertensive patients at tertiary care centre.

Background: Patients with diabetes has 2 fold higher chances of suffering from hypertension. Hypertension is risk factor for development of diabetes as well for complications like nephropathy, CAD and neuropathy etc. Hypertension control is vital to prevent and retard progression of microvascular and macrovascular complications. Therefore, we undertook this study to evaluate treatment patterns in diabetic patients with hypertension, those are being followed at our institute. Methods: Study group comprised of diabetic patients who had hypertension as well. All patients with diabetes reporting to medicine OPD from March 2014 to September 2014 at our institute were screened. Patients with follow up of at least 3 months and age more than 18 years of either sex were included. Results: There were 223 patients. Study group comprised of 121 males and 102 females. Mean age of group was 48.6 years. One hundred three patients (46.18%) were on monotherapy and remaining 120 patients were on combination antihypertensive drugs. There were total 398 antihypertensive drug exposures. Patient needed mean antihypertensive drug of 1.78. Angiotensin receptor blockers were the most commonly prescribed drugs. Angiotensin inhibitors (angiotensin receptor blockers and ACE inhibitors) were utilized in 158 (71%) patients. Hypertension control was achieved in 84 (37.66%) patients. One hundred eighty one patients (81.2%) knew about disease. Conclusion: Our study showed that majority of diabetic hypertensive patients needed multiple drug therapy to control hypertension. Most of the patients were on ARBs/ACE inhibitors. This was according to recommendation by ADA or JNC8.

Comparative evaluation of beta-blockers with or without statins in the treatment of essential hypertension at a tertiary health care setup.

Background: The effects of statins apart from their role as cholesterol lowering agents have prompted this study to evaluate their antihypertensive role. Beta-blockers (BB) are one of the most effective drugs in hypertension. The present study was designed for comparative evaluation of BB with or without statins in the treatment of essential hypertension in a tertiary health care setup. Methods: This study was conducted in 20 hypertensive patients by Pharmacology Department in Medicine outpatient department at SGRRIM and HS Dehradun for 1 year. Initially, patients were stabilized for 4 weeks by BB and then subdivided into 2 groups. Group I: BB (n=10) and Group II: BB+statins (n=10). Patients were followed up every 4 weeks for 16 weeks. Systolic blood pressure (SBP) and diastolic blood pressure (DBP), waist hip ratio (WHR), body mass index (BMI) were done every visit. Lipid profile was done at 4 and 16 weeks. Analysis was performed using t test. p≤0.05 was significant. Results: At 4 and 16 weeks, SBP in Group I was 133.6±3.7 and 127±1.61 mmHg (p>0.05) and in Group II was 141.2±2.97 and 130.6±0.71 mmHg (p<0.01). At 4 and 16 weeks DBP in Group I was 79.6±2.37 and 81±0.54 mmHg (p>0.05) and in Group II was 84.6±1.39 and 83.8±1.45 mmHg (p>0.05), respectively. At 16 weeks intergroup SBP and DBP comparison was done, which was not significant (p>0.05). At 4 and 16 weeks improvement in lipid profile in Group I (p>0.05) was not significant, but a significant improvement in Group II (p<0.05) have been observed and no significant changes in BMI and WHR in Groups I and II (p>0.05), respectively. Conclusions: Both groups showed significant improvement in BP. However, no significant difference was seen on intergroup comparison. Larger studies with more patients are needed to establish the role of statins in hypertension.

A retrospective analysis of adverse drug reactions in a tertiary care teaching hospital at Dehradun, Uttarakhand.

Background: Adverse drug reactions (ADRs) are one of the major causes of hospital admissions. The objective of this study was to ascertain the various ADRs occurring in a tertiary care teaching hospital at Dehradun, Uttarakhand. Methods: The ADRs were collected from January 2010 to June 2014 by the Department of Pharmacology in Shri Guru Ram Rai Institute of Medical & Health Sciences, Dehradun, Uttarakhand. A total of 123 ADRs were collected, analyzed and assessed on WHO causality assessment scale. Results: A total of 123 ADRs were assessed. Male:female ratio was 1.5:1. Age-wise distribution of ADRs was done: 0-15 years had 15 (12.19%), 16-30 had 50 (40.65%), 31-45 showed 25 (20.32%), 46-60 years 22 (17.88%) and >60 years had 11 (8.94%). 112 (91.05%) ADRs were serious, and 11 (8.94%) were non-serious. As per the WHO causality assessment scale, 91 (73.98%) ADRs were probable, 30 (24.39%) were possible, and 2 (1.62%) were certain. Most commonly occurring ADRs were fixed drug eruption in 42 (34.14%) patients, erythematous maculopapular rash in 20 (16.26%) patients and urticarial rash in 15 (12.19%) patients, followed by others. The drugs most frequently associated with ADRs were non-steroidal antiinflammatory drugs (NSAIDs), fluoroquinolones, penicillins, cephalosporins and phenytoin sodium, followed by others. Conclusions: Majority of ADRs were probable according to WHO causality assessment scale. Most common ADR was fixed drug eruption. Most frequent drugs associated with ADRs were NSAIDs. ADRs contribute to increased morbidity and mortality in patients; thereby pose a huge burden on the society.

Clinical profile and outcome of Hantavirus infection with renal involvement in India.

Background: Hantavirus infections are found all over world but there is paucity of information about clinical features of Hantavirus infection in India. Aim of current study was to study clinical profile and outcome of patients with Hantavirus infection and renal insufficiency who presented at our institute. Methods: All patients who were admitted in department of medicine with Hantavirus infection and renal insufficiency were included. Their basic demographic profile with relevant laboratory investigations was recorded. They were diagnosed with Hantavirus infection if they had positive IgM antibodies by ELISA test. Results: There were seven patients with mean age of 54 years. They had mean serum creatinine level of 4.37 ± 1.86 mg%. All had thrombocytopenia and hepatic dysfunction as well. Five patients had hypotension. There was need of dialysis in three patients. They also had hypoalbuminemia. No patient had features suggestive of acute respiratory distress syndrome. All patients had recovery of renal function and there was no mortality. Conclusion: Patients with Hantavirus infection presented like hemorrhagic fever with renal syndrome. Their outcome is good. We need to suspect Hantavirus infection in appropriate clinical scenario in India.

Therapeutic Applications of Vasopressin in Pediatric Patients.

Context: Reports of successful use of vasopressin in various shock states and cardiac arrest has lead to the emergence of vasopressin therapy as a potentially major advancement in the management of critically ill children. Objective: To provide an overview of physiology of vasopressin, rationale of its use and dose schedule in different disease states with special focus on recent advances in the therapeutic applications of vasopressin. Data Source: MEDLINE search (1966-September 2011) using terms “vasopressin”, “terlipressin”, “arginine-vasopressin”, “shock”, “septic shock”, “vasodilatory shock”, “cardiac arrest”, and “resuscitation” for reports on vasopressin/terlipressin use in children and manual review of article bibliographies. Search was restricted to human studies. Randomized controlled trials, cohort studies, evaluation studies, case series, and case reports on vasopressin/terlipressin use in children (preterm neonates to 21 years of age) were included. Outcome measures were analysed using following clinical questions: indication, dose and duration of vasopressin/terlipressin use, main effects especially on systemic blood pressure, catecholamine requirement, urine output, serum lactate, adverse effects, and mortality. Results: 51 reports on vasopressin (30 reports) and terlipressin (21 reports) use in pediatric population were identified. A total of 602 patients received vasopressin/terlipressin as vasopressors in various catecholamine-resistant states (septic - 176, post-cardiotomy - 136, other vasodilatory/mixed shock - 199, and cardiac arrest - 101). Commonly reported responses include rapid improvement in systemic blood pressure, decline in concurrent catecholamine requirement, and increase in urine output; despite these effects, the mortality rates remained high. Conclusion: In view of the limited clinical experience, and paucity of randomized controlled trials evaluating these drugs in pediatric population, currently no definitive recommendations on vasopressin/terlipressin use can be laid down. Nevertheless, available clinical data supports the use of vasopressin in critically ill children as a rescue therapy in refractory shock and cardiac arrest.

Diabetic Foot in Uttaranchal

The aim of the study was to evaluate the clinical and the bacteriological profile of patients with diabetic foot. The clinical and the bacteriological profile along with the antibiotic sensitivity pattern was assessed in patients with Diabetes mellitus over 3 years period (From January 2001 to December 2004). The foot ulcers were categorized as mild or non-limb threatening and severe or limb threatening. Cultures from the wounds were sent prior to the first debridement and the antibiotic sensitivity was done in each case. The possible risk factors responsible for these ulcers were also recorded. Out of 61 cases of diabetic foot ulcers, non-limb threatening infections were seen in 38 patients (62.29%) and the limb threatening was seen in 23 patients (37.7%). Of these 23 patients with limb threatening infections, 14 (60.87%) had to undergo amputation during one-year follow-up. The organisms isolated from the cultures included Staphylococcus sp in 15 patients (28.84%), Streptococcus sp in 11 (21.15%), Pseudomonas sp in 8 (15.38%), Enterococcus sp in 30 (57.69%) and anaerobes in 27 patients (51.92%). The antibiotics to which they were found to be most sensitive included Amoxy-Clav 49 (94.23%), Ceftrioxone 48(92.30%), Ceftazidime 41 (78.84%), Cefurexime 46 (88.46%), Chloremphenicol 44(84.61%), Amikacin 46(88.46%) and Polymixin- B 46 (88.46%).