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Background: Information on bullous pemphigoid in an Indian context is scarce. Aim: To report clinico-demographic profile, associated comorbidities and prescription pattern of bullous pemphigoid patients in India. Methods: This was a retrospective study, where past records of all bullous pemphigoid patients diagnosed and treated between November 2013 and October 2019 were accessed and analysed. Patients having a compatible clinical presentation with either histopathological and/or direct immunofluorescence evidence of bullous pemphigoid were included. Results: There were 96 bullous pemphigoid patients, with a male: female ratio of 1.6:1. The mean age at diagnosis was 62.5 ± 2.2 years, with mean duration of illness 27.5 ± 4.5 months before presentation. Comorbidities were present in 80 (83%) patients, with type 2 diabetes mellitus (38.5%), hypertension (36.4%) and neurological illness (16.7%) being the commonest ones. Clinically, blisters were the predominant presentation in 81 (84.4%) patients. The majority (87.5%) of patients showed a predominant eosinophilic infiltrate on histopathology. Direct immunofluorescence revealed immunoglobulin G deposits with complement C3 in 77 (80.2%) cases. The majority of patients (77.1%) were treated with oral prednisolone, either alone (11.5%) or in combination (65.6%) with other topical and systemic agents. Topical steroids were used in 29.1%, azathioprine in 28%, dapsone in 16.7% and omalizumab in 6.2% of patients. Limitations: The study is retrospective. Immunofluorescence on salt split skin, direct immunofluorescence serration pattern analysis, and immunoblotting were not performed. Hence, there is a possibility that a few included cases were suffering from other subepidermal autoimmune bullous diseases like epidermolysis bullosa acquisita or anti-p200 pemphigoid. Conclusion: Bullous pemphigoid patients in this study had a younger age of onset and showed male preponderance. Comorbidities like type 2 diabetes, hypertension and neurological disorders were freq
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Objective Multisystem infammatory syndrome (MIS-C) in children is a febrile illness that has overlapping presentation with other locally prevalent illnesses. Clinicolaboratory profle of children admitted with MIS-C and dengue were compared to understand their presentation at the outset. Methods This was a retrospective study of children?12 y admitted with MIS-C (WHO defnition) or laboratory-confrmed dengue between August 2020 and January 2021 at a tertiary center in North India. Results A total of 84 children (MIS-C - 40; dengue - 44) were included. The mean (SD) age [83.5 (39) vs. 91.6 (35) mo] was comparable. Rash (72.5% vs. 22.7%), conjunctival injection (60% vs. 2.3%), oral mucocutaneous changes (27.5% vs. 0) and gallop rhythm (15% vs. 0) were seen more frequently with MIS-C, while petechiae [29.5% vs. 7.5%], myalgia (38.6% vs. 10%), headache (22.7% vs. 2.5%), and hepatomegaly (68.2% vs. 27.5%) were more common with dengue. Children with MIS-C had signifcantly higher C-reactive protein (124 vs. 3.2 mg/L) and interleukin 6 (95.3 vs. 20.7 ng/mL), while those with dengue had higher hemoglobin (12 vs. 10.2 g/dL) lower mean platelet count (26 vs. 140× 109 /L), and greater elevation in aspartate (607 vs. 44 IU/L) and alanine (235.5 vs. 56 IU/L) aminotransferases. The hospital stay was longer with MIS-C; however, PICU stay and mortality were comparable. Conclusion In hospitalized children with acute febrile illness, the presence of mucocutaneous features and highly elevated CRP could distinguish MIS-C from dengue. The presence of petechiae, hepatomegaly, and hemoconcentration may favor a diagnosis of dengue.
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Purpose: To compare visual outcomes of standard occlusion therapy at home versus clinic in amblyopic children. Methods: A retrospective study of case records of children aged <15 years with diagnosis of strabismic or anisometropic amblyopia or both was conducted at a tertiary eye hospital located in rural North India between Jan 2017–Jan 2020. Those with at least 1 follow?up visit were included. Children with ocular co?morbidities were excluded. Treatment in clinic by admission or at home was based on the parents’ discretion. Children in clinic group underwent part time occlusion & near work exercises for minimum 1 month, in classroom format which we called amblyopia school. Those in home group underwent part time occlusion as per PEDIG recommendations. Primary outcome measure was improvement in number of Snellen’s lines at the end of 1 month & at final follow?up. Results: We included 219 children with mean age of 8.8±3.23 years, out of which clinic group had 122 (56%) children. At one?month, visual improvement in clinic group (2.1±1.1 lines) was significantly greater than home group (mean=1.1±0.8 lines) (P < 0.001). Both groups continued to improve vision on follow?up, however the vision in the clinic group (2.9±1.2 lines improvement at mean follow?up of 4.1±1.6 months), continued to be better than home group (2.3±1.1 lines improvement at mean follow?up 5.1±0.9 months) (P = 0.05). Conclusion: Clinic based amblyopia therapy in the form of an amblyopia school can help expedite visual rehabilitation. Thus, it may be a better option for rural settings where patients in general tend to be poorly compliant.
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Background: Psoriasis is associated with significant morbidity and impaired quality of life. Identification of the host genes that influence disease susceptibility and can potentially guide future, targeted therapy is the need of the hour. Aims: The aim of the study was to investigate the associations of macrophage migration inhibitory factor (MIF) gene polymorphisms, that is, a 5–8-CATT tetra nucleotide repeats at -794 (-794*CATT5–8) and a single-nucleotide polymorphism at -173 (-173*G/C) with the risk of chronic plaque psoriasis and to observe the correlation, if any, of disease determinants with genetic functional variants and circulating MIF levels. Methods: Five hundred and seventeen individuals (265 psoriasis patients and 252 controls) were genotyped for MIF gene polymorphisms. Data were analyzed with respect to disease susceptibility, serum MIF levels, disease severity, age at onset, disease duration and presence of comorbidities. Results: The presence of co-morbidities was more frequently noted in patients with late onset disease (P = 0.01). No statistically significant differences were observed either in genotype (P = 0.680) or allele frequency (P = 0.69) with respect to distribution of MIF-173*G/C polymorphism between patients and controls. The frequencies of genotypes -794*CATT 5/7 and 7/7 were significantly lower in patients (P = 0.027* and 0.038*, respectively). CATT*5/MIF-173*C haplotype occurred at a higher frequency in patients (odds ratio 3.03, 95% confidence intervals 1.09–8.47, P = 0.02). The mean serum MIF levels were significantly higher in patients as compared to controls (P < 0.001). The presence of either extended MIF -794*CATT repeats or C allele did not reveal any significant association with serum MIF levels or age at onset. Analysis of effect of various disease determinants revealed no significant association with genetic variants and serum MIF levels. Limitations: The lesional expression of MIF could not be studied. Conclusion: Our results showed that CATT*5/MIF-173*C haplotype is associated with increased susceptibility to psoriasis vulgaris.
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Background: Patient satisfaction is crucial for research, administration, and planning. Since it reveals the ef-fectiveness of the provider, customer happiness is of utmost importance as a gauge of the quality of service.Inpatient satisfaction is an essential tool to identify the level of patient satisfaction and it is one of the im-portant goals of any healthcare system. The objective of the study is to validate the questionnaire developed and to assess the inpatient satisfaction level among patients admitted to OBG ward in a tertiary care hospital. Methods: A cross-sectional study was done among 160 women inpatients admitted in the OBG ward in a ter-tiary care hospital, Chengalpattu. Patient satisfaction was measured by a validated questionnaire with seven domains, the data were collected by face-to-face interview method. Results: Themean age of the respondent were 28 years. 60% of respondents were highly satisfied with the effectiveness of the treatment. Only 33.8% of respondents were highly satisfied with the diet food served and 56.3% were highly satisfied with the cleanliness of wards, and restrooms. Conclusions: The results obtained from the present study can serve as a baseline to compare the future sur-vey and helps to provide healthcare services that fulfil patient desires and expectations.
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Background: Tuberculosis (TB) can have manifestations closely mimicking autoimmune diseases. The prevalence of autoantibodies in TB varies among different populations. Objectives: To study the prevalence of anti-neutrophilic cytoplasmic antibodies (ANCA) and antinuclear antibodies (ANA) in pulmonary tuberculosis (PTB). Methods: This was a cross-sectional, observational study. Subjects with microbiologically confirmed PTB, either via smear or culture positivity on sputum or bronchoalveolar lavage (BAL) fluid, or positive rapid diagnostic tests were included. ANCA against proteinase-3 (PR3), myeloperoxidase (MPO), lactoferrin, and elastase were tested using an enzyme-linked immunosorbent assay (ELISA). ANA was detected using indirect immunofluorescence (IIF). Results: Eighty-nine subjects with a median [interquartile range (IQR)] age of 28 (20–46) years, 67.4% males, were recruited. Eighty-one subjects had microbiological confirmation on sputum examination, and eight required examination of BAL fluid. Sera were drawn from 62 treatment-naïve subjects, the rest (27) were on antitubercular therapy (ATT). Eighty-six (96.6%) subjects tested positive for anti-elastase antibody, seven of which were also positive for anti-PR3. None were positive for anti-MPO and anti-lactoferrin. Six (6.7%) subjects tested positive for ANA. None of the subjects had features of underlying connective tissue disease or vasculitis. Conclusion: PTB patients showed a high prevalence of anti-elastase and a low prevalence of ANA and anti-PR3 antibodies. ANCA positivity should be interpreted with caution in TB endemic areas. The role of anti-elastase antibodies in differentiating TB from ANCA-associated vasculitis (AAV) needs further research.
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Introduction: Hereditary bleeding disorders are the diverse group of disorders that happen due to the inherent abnormalities in the blood vasculature preventing the blood clotting process and leading to delayed bleeding. Objectives: To review this heterogenous group of disorders and update the clinicians about their oral manifestations and dental management to prevent the onset of any complications in dental settings. Materials and Methods: Review papers, original studies, case reports published in PubMed/MEDLINE, Web of Science, Scopus, Science Direct, and Google Scholar, as well as numerous publications, were used to compile the data by four reviewers. Result and Conclusion: This review article explains the existing paradigm. Children with various hereditary bleeding disorders are a significant challenge for clinicians. Many authors have emphasized that patients with bleeding disorders can be managed safely in a dental setting if specific recommendations are followed.
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Scrub typhus, also called bush typhus, is a zoonotic disease a Gram-negative bacterium. Its presentation may range from nonspecific febrile illness to severe disease, with cardiovascular, renal, hepatic and neurological involvement. Myocarditis is one of the rare complications of scrub typhus. Hence, we are reporting a case of a 50-year-old male, farmer by occupation, presenting to us in multiorgan dysfunction syndrome who developed myocarditis during second week of his illness.
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Background: Dental caries is one of the most prevalent posteruptive bacterial infections worldwide, characterized by a progressive demineralization process that affects the mineralized dental tissues. Although the decline of dental caries prevalence can be attributed to the widespread use of dentifrices that contain fluoride, yet there is a need for an advanced alternative nonfluoride remineralizing dentifrice. Yet, there is a need for an advanced alternative nonfluoride remineralizing dentifrice. Aim: The aim of this study was to evaluate and compare the remineralizing effect of nonfluoride-based and herbal-based pediatric dentifrice in demineralized primary teeth with an ideal in vitro method of pH cycling and evaluating the values under Polarized Light Microscope (Olympus BX43) using image analysis software (ProgRes, Speed XT core3). Materials and Methods: A total of 30 tooth samples were collected and placed in the demineralizing solution for 96 h to produce a demineralized lesion of approximately 100 ?m, and then cut longitudinally into 60 sections that were randomly assigned to two groups with 27 samples each, Group A – nonfluoride-based dentifrice (Mee Mee®), Group B – herbal-based dentifrice (Mamaearth™), after which they were subjected to pH cycling for 7 days along with dentifrice slurry preparation. The sections were evaluated under the polarizing light microscopy for remineralizing efficacy. The lesion depth was measured and tabulated to be sent for statistical analysis. Results: The mean demineralization value for nonfluoride and herbal-based dentifrice groups were 7.8730 ?m and 28.3174 ?m, respectively. Hence, it can be inferred that since lesion depth measured was lesser in nonfluoride than herbal-based dentifrice, remineralization has occurred in the nonfluoride-based dentifrice group. Conclusion: Nonfluoride-based dentifrice showed significant results in remineralizing the demineralized lesion, while herbal-based dentifrice showed poor efficiency in remineralizing the demineralized lesion.
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Background: Anemia, the decrease of haemoglobin (Hb) concentration is a common disorder complicating pregnancy mostly due to hemodilution, increased demand of iron and poor dietary intake of iron. The aim of this study was to evaluate whether parenteral iron sucrose can be used as an alternative to daily oral iron during pregnancy.Methods: It was a prospective interventional study conducted in the Department of Obstetrics and Gynaecology, Rohilkhand Medical College and Hospital, Bareilly involving pregnant women at 16-24 weeks with Hb 7-10 g/dl. They were randomly allocated to two groups I and II. Group I (oral group) was given oral iron tablets containing 100 mg of elemental iron and 0.5 mg of folic acid as per therapeutic requirement. Group II (parenteral group) were admitted as day care patients and given a total calculated dose of iron sucrose in divided doses of 200 mg each in 100 ml of normal saline as slow intravenous infusion. Hb, packed cell volume (PCV), blood indices were measured at the start, 2 weeks and 4 weeks of treatment. Any side-effects of treatment were also studied.Results: A statistically significant increase in values of Hb, hematocrit, reticulocyte count, red blood cells (RBC's) indices: mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC) and mean corpuscular hemoglobin (MCH) coupled with no serious side effects with iron sucrose as compared with oral iron.Conclusions: Intravenous iron sucrose complex is safe, convenient and effective alternative to oral iron for treatment of iron deficiency anemia in pregnancy.
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The role of nurse changes as the health care is needed in the hospitals, society or community. Nurses are providing essential health care services throughout the health care system. In response to COVID-19 pandemic, the role of nurse changes to care or respond to the needs of the patients, their families and their caregivers. They also should take part in policies making, doing procedures and taking care of necessary supply of the material and equipment in the hospitals. All over the world nurses are demonstrating their kindness, care, courage, values and professional responsibility as nursing personnel. Prior to the COVID-19 pandemic in many institutions / organizations, there was a focus on nurses, mental health, physical health and wellbeing such as workload, anxiety, anger, irritability, burnout etc. They have to follow the rules, regulations, ethics and standard of nursing. However, while working in the isolation units or intensive care unit with COVID-19 patients, the nurse has to decide how much quality care they can provide to the patients while taking care of themselves. Hospital authorities have the responsibility to provide optimal work environments for all staff involved in the care of COVID-19 patients and health care professionals must follow the protocols that protect their ethical rights as a health care professional. In a 2018 policy brief, the American Nurses Association, said “nurse leaders are the key to preventing and containing widespread illnesses. They have the skills and education to develop coordinated global networking and properly identifying of infectious diseases”.
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Background: Non-stress test (NST) is a graphical recording of changes in fetal heart activity and uterine contraction along with fetal movement when uterus is quiescent. NST is primarily a test of fetal condition and it differs from contraction stress test which is a test of uteroplacental function. The present study aimed at evaluating the efficacy and diagnostic value of NST for antenatal surveillance in high-risk pregnancy and comparing the mode of delivery with test results.Methods: A clinical study of NST was done between November 2014 to October 2015. NST was used for their surveillance from 32 weeks of gestation and NST was recorded weekly, biweekly, on alternate days or even on daily basis depending on high risk factors and were followed up.Results: A total of 100 cases were enrolled in the study. The mean age of patients was 25.09±3.78 years. In all 14 cases (23.3%) with reactive NST underwent lower caesarean section (LSCS) whereas 36 cases (90%) with non-reactive NST underwent LSCS. The mean NST delivery interval with reactive NST was 9.8±7.1 hours and in cases with non-reactive NST it was 9.2±8.6 hours, the difference was statistically not significant (p=0.70).Conclusions: NST tells about acute fetal hypoxia and decision to delivery time can be made for those patients with fetal distress so that a major improvement in the outcome among parturient can be achieved with abnormal NST results. An abnormal NST should alert the clinician of fetal compromise and has to be followed up by other biophysical tests.
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Background: Airway management is considered as an integral part of general anesthesia. Use of Baska mask, since asupraglottic airway device, could result in the low incidence of hemodynamic alterations and post-operative pharyngolaryngealcomplications. We conducted this study to compare the hemodynamic parameters, i.e., systolic blood pressure (SBP),diastolic blood pressure, mean arterial pressure (MAP), heart rate (HR), ease of insertion, time of insertion, and post-operativepharyngolaryngeal complications during Baska mask and endotracheal tube (ETT) insertion.Materials and Methods: It was a prospective randomized study which was conducted on 80 adult patients admitted for electivesurgery under general anesthesia (GA) of 60–90 min duration. A total of 80 patients were randomly allocated into two groups,i.e., Group B and Group E of 40 each. Group B patients underwent Baska mask insertion and Group E patients underwent ETTinsertion. The statistical analysis was done by Student’s t-test and Chi-square test. P < 0.05 was considered statistically significant.Results: There was a statistically significant rise in SBP, diastolic blood pressure, MAP, and HR during ETT insertion as comparedto Baska mask insertion. The mean time of insertion of Baska mask was 12.8 ± 1.36 s and of ETT was 15.93 ± 1.51 s. Insertionof Baska mask was easy in 85% whereas insertion of ETT was easy in 65%.Conclusion: Baska mask can be used as an alternative to ETT in adult patients undergoing surgeries under GA of 60–90 minduration with minimal hemodynamic alterations and post-operative pharyngolaryngeal complications.
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Megalencephalic Leukoencephalopathy is a rare entity which was first described by Van Der Knaap et al in 1995.[1] It is a progressive neurodegenerative disorder characterized by slow progression of mental deterioration. Megalencephaly sets in early in the disease usually in first year and can be more than 4 standard deviation above the mean. Seizures are present in almost all the patients. [2] We present typical MRI findings in a case of megalencephalic leukodystrophy with sub-cortical cysts.Megalencephalic leukoencephalopathy with sub-cortical cysts is a rare entity that presents with macrocephaly and seizures. Mental deterioration is often mild with slow progression. Macrocephaly may be present at birth or develops in first year. Typical magnetic resonance imaging (MRI) findings help to clinch the diagnosis.
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The pathophysiology and clinical course of focal fat infarction of appendage of falciform ligament is similar to other acute fat infarction abdominal conditions like omental infarction and epiploic appendagitis in that it presents with acute abdominal pain and responds well to conservative treatment. Importance of radiological diagnosis is to avoid unnecessary surgery.[1] Torsion and focal fat infarction of appendage of falciform ligament is an extremely rare condition which presents with acute abdomen. It can mimic other serious abdominal conditions which require urgent surgical intervention. It is important to be aware of its computed tomography (CT) findings so as to avoid unnecessary surgical intervention. We present CT findings in case of focal fat infarction of appendage of falciform ligament in a young male who presented with acute epigastric pain.
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DNET is a low grade cortical neoplasm which closely resembles cortical dysplasia on magnetic resonance imaging (MRI). It is usually non-enhancing but can show some enhancement on about one third of case. Rarely enhancement can be ring like and when the mass is large in size, it can cause considerable diagnostic problem from higher grade gliomas. However, age of the patient and associated features like calcification, lack of mass effect and long duration of symptoms should assist in reaching the correct diagnosis. Dysembryoplastic neuroepithelial tumour (DNET) is low grade cortical glioma which is most commonly seen in temporal lobe. It is usually a non-enhancing tumour but sometimes it can show enhancement and occasionally it can be ring like, which can cause diagnostic confusion with higher grade gliomas. We report a case of DNET which showed ring like enhancement of post contrast images.
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Schwannomas are benign tumours arising from neoplastic transformation of Schwann cells around the nerve fibres. Tumours situated deeply like in retroperitoneum or pelvis are usually asymptomatic and may not be detected. Such long standing tumours may undergo extensive degenerative changes giving rise to ancient schwannomas.[1] Ancient schwannoma is an uncommon variant of schwannomas characterized by extensive degenerative changes and hypocellular areas. Presacral ancient schwannomas are rare and most of the reported cases are in females. We describe computed tomography (CT) findings in a case of presacral ancient schwannoma in a 49 year old male patient.
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Post-traumatic isolated mesenteric tear with associated small bowel gangrene is a rare event after blunt abdominal trauma and has been reported previously in literature. [1] Post-traumatic thrombosis of inferior vena cava (IVC) is a very rare event with only isolated case reported in literature. [2] We report a rare case of mesenteric tear with segmental small bowel infarction. There was also right adrenal gland haematoma with associated thrombosis of right adrenal vein, which was extending into inferior vena cava causing its partial thrombosis. Post blunt trauma focal mesenteric tear and segmental small bowel gangrene is a rare event. Posttraumatic right adrenal haematoma is well described in literature while traumatic inferior vena cava (IVC) thrombosis is exceedingly rare. We report a rare case showing association of focal mesenteric tear with segmental small bowel gangrene and associated right adrenal haematoma with adrenal vein haematoma extending into IVC causing its partial thrombosis. To the best of our knowledge, such unusual association has not been reported previously in literature.
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Lepa is considered as an important and initial Chikitsa in reference with Vranashotha chikitsa described by Acharya Sushruta and when the Lepa is applied around the outer surface of eyes it is termed as Vidalaka. Vidalaka a type of Kriyakalpa therapy which is mainly indicated in acute inflammatory conditions of eyes such as Daha (burning sensation), Updeha (discharge), Ashru (watering) Shopha (swelling) and Raga (redness). Different formulations are given in classic texts for eye diseases and one among them is Yashtayadi lepa mentioned by Acharya Sharangadhara in Sharangadhara Samhita. It is described as Sarvanetrarujahara Yoga and consists Yastimadhu, Gairika, Saindhav, Daruharidra and Rasanjana as its main ingredients. Yashtyadi lepa was prepared as per the guidelines given for Lepa in API (Ayurvedic Pharmacopoeia of India) and analyzed using various standard physico-chemical parameters given for Lepa such as Loss on drying, Ash value, Water extract value, Alcohol extract value and pH. There is no standard guidelines is given for pharmaceutical analysis for Yastyadi Lepa in API. With this background the present study was undertaken to find pharmacognostical and physicochemical qualities of Lepa as recommended in Ayurvedic Pharmacopoeia of India (API) and to use them as reference for future studies on Yashtyadi Lepa for different ocular diseases.
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The purpose of this study is to show the phytochemical composition and in vitro antidiabetic potential in the leaves of Ceriops tagal, Bruguiera cylindrica, and Salvadora persica mangrove plants. The phytochemical composition was studied by qualitative analysis. To determine in vitro antidiabetic activity leaves were subjected to solvent extraction by the Soxhlet method using methanol, ethanol, ethyl acetate, and pet ether and α-amylase, α-glucosidase inhibition assays were performed. The findings indicates that alkaloid, steroid, flavonoid, terpenoid, glycosides, tannin, saponin, phenol, quinones and coumarin principles are present in the leaves of selected mangrove species. Among the selected mangrove species C. tagal leaves recorded the highest antidiabetic activity for both the assay followed by B. cylidrica and S. persica. Overall C. tagal was found highly potent in the antidiabetic activity.