Health-related quality of life in patients with generalized pustular psoriasis: A systematic literature review.

Generalized pustular psoriasis (GPP) is a rare, chronic, neutrophilic inflammatory skin disease characterized by episodes of widespread eruption of sterile, macroscopic pustules that can be accompanied by systemic inflammation and symptoms. A systematic literature review and narrative synthesis were conducted to determine the impact of GPP on patients' health-related quality of life (HRQoL) and patient-reported severity of symptoms and to compare its impact to patients with plaque psoriasis (plaque PsO). Searches were undertaken in Embase, MEDLINE and the Cochrane Library from 1 January 2002 to 15 September 2022. Screening was carried out by two reviewers independently. Outcome measures included generic (e.g. EQ-5D, SF-36) and dermatology-specific (e.g. DLQI) clinical outcome assessments, and other relevant patient-reported outcome measures (PROMs) (e.g. severity of pain measured by a numerical rating scale). Overall, 20 studies were found to be eligible for inclusion, of which seven also had data for plaque PsO. The DLQI was the most frequently reported outcome measure (16 out of 20 studies). When reported, mean DLQI (SD) scores varied from 5.7 (1.2) to 15.8 (9.6) across the studies, indicating a moderate to very large effect on HRQoL; the wide range of scores and large SDs were explained by the small population sizes (n ≤ 12 for all studies except two). Similar ranges and large SDs were also observed for other measures within individual studies. However, in general, people with GPP reported a greater impact of their skin condition on HRQoL, when compared to people with plaque PsO (i.e. higher DLQI scores) and higher severity for itch, pain and fatigue. This systematic review highlighted the need for studies with a larger population size, a better understanding of the impact of cutaneous and extracutaneous symptoms and comorbidities on HRQoL during and between GPP flares, and outcome measures specifically tailored to the unique symptoms and the natural course/history of GPP.

Effects of Cold Stimulation Induced Pain on Cardiopulmonary Parameters: A Gender Based Study.

Background Cold pressor induced pain elicits sympathetic responses which can be monitored by measuring blood pressure, heart rate and respiratory rate after exposure to the cold stress. Objective This study was done to evaluate gender difference in acute pain induced by cold pressor test on blood pressure, heart rate and respiratory rate of healthy individuals. Method Our study was cross sectional study with the sample size of 40 including 20 male and 20 female undergraduates. Acute pain was induced by immersion of hand in cold water at 4o C. Changes in blood pressure, heart rate and respiratory rate were recorded by the digital sphygmomanometer and AD Instruments (Model: ML856, Serial: T26-4025) and analysis was done by Lab Chart 7 Pro v 7.3.3 respectively. Acute pain parameter like pain threshold was also recorded. Statistical analysis was done by using Paired "t" test and non-parametric test. Result The present study enrolled 40 participants, aged between 18 - 24 years, and body mass index from 15.78 - 36.06 kg/m2 . The respiratory rate was increased in both males (17.30±3.19 to 19.0±3.21, P=0.01) and females (18.60±1.98 to 19.90±2.82, P= 0.01) however significant increase in heart rate was only found in females (77.80±8.07 to 80.70±7.80, P=0.03) after cold pressor test. The systolic as well as diastolic blood pressure did not increase significantly after cold pressor test. The pain thresholds ranged from 25.2 to 105.8 seconds (61.60±23.26, male Vs. 52.69±18.49, female, p = 0.188). Conclusion Our findings point towards autonomic adjustments suggesting more of sympathetic over activity immediately after cold pressor test.

Skin Conductance and RR Interval for Regulated Discrete Physiological Stimuli: A Two Prong Strategy to Detect Sympathetic Activation.

Background Several studies have found skin conductance a good indicator for detection of sympathetic response. But, valid and reliable tool for detection of sympathetic outflow in health and disease is still a quest. Thereby, comparison of superficial and, at core sympathetic effluence induced by deliberately supplied discrete external stimuli has been attempted in this study. Objective To assess the degree of sympathetic outflow for discrete cognitive and physical stimuli through perturbations in skin conductance and variations in heart rate in healthy adults. Method Quantitative and cross-sectional study was performed in 104 healthy subjects following random sampling method. Induction of sympathetic activity was realized by providing separate time bound cognitive exercises intervened with change in posture. Recordings to detect sympathetic responses at rest and, for supplied stimuli were made by electrocardiogram and galvanic skin response. Result Cognitive performance and postural change shifts baseline effluence and increases the sympathetic outflow significantly (p=0.000). There occurs no detectable rise in sympathetic effluence at the core (p=0.362) but, eventuate significantly appreciable sympathetic outflow to sweat glands in skin (p=0.000), when compared cognitive versus physical stimuli. Conclusion Sympathetic outflow induced by cognitive challenge and physical change in posture is readily assessable through sympathetic skin response yet core sympathetic effluence for latter stimuli is steady and unwavering. Differential effluence for sympathetic response called upon by discrete stimuli is operational for maintenance of steady state in healthy subjects.

Galvanic Skin Response as a Simple Physiology Lab Teaching Tool- An Alternative Indicator of Sympathetic Arousal.

Background Sympathetic arousal response due to rewarding emotion may not be considered threat to the well-being but such arousal response evoked by fear or punishment can be stressful. When such changes are recorded in lab as biological signals, induced with appropriate stimulus, the observed response may serve as a good indicator of homeostatic alteration. In this study, skin conductance was utilized to record sympathetic response for cognitive load, by application of simple subtraction task. Objective To detect sympathetic arousal by utilization of galvanic skin response during mental arithmetic task. Method Total of eighty two subjects, forty two female and forty male participated in the study. Twenty two subjects were provided mental task to record skin conductance. In sixty subjects, galvanic skin response, pulse rate, respiratory rate and temperature were recorded by appropriate transducers to obtain baseline and task response to detect differential recordings. Subjects performed the mental exercise of arithmetic task (MAT) with transducer placed in upper limbs. Mean of averages for respective variables were statistically calculated from obtained recordings. Result For measured galvanic skin response, 57 subjects showed increased skin conductance (rise in amplitude) whereas, 25 subjects had no rise in amplitude ("A peak") while performing the mental arithmetic task, when compared to control recording. However, in 20 subjects, pulse rate and respiratory rate showed significant rise though, the change in the skin conductance was not significant. Conclusion Galvanic skin response is useful for demonstration of sympathetic activation induced by simple mental subtraction task, and can be utilized along with vital parameters mentioned in this study to discuss in vivo variation that exist as differential for core and superficial sympathetic outflow among individuals.

Systemic Sclerosis Sine Scleroderma.

Systemic sclerosis sine scleroderma is a rare form of limited systemic sclerosis. These patients are without skin involvement, but do not differ in its clinical or laboratory features and prognosis from classical systemic sclerosis. In the absence of cutaneous signs/symptoms, its diagnosis is delayed leading to significant morbidity and mortality. We report a case of sixty year old female who presented to us with dyspnoea on exertion and Raynaud's phenomenon. She was investigated and was found to have this disorder with pulmonary artery hypertension.

Kyphoplasty for the treatment of pain distant to osteoporotic thoracolumbar compressive fractures.

Vertebral fractures are one of the most common osteoporotic fractures. We sought to investigate the incidence of distant pain after osteoporotic vertebral compressive fracture (OVCF) at the thoracolumbar junction, and to explore the effect of kyphoplasty in the treatment of distant pain post-OVCF. Eighty-seven patients diagnosed OVCF between T11 and L2 were included in the study. The region of pain and its proximity to the thoracolumbar compressive fracture was recorded. For pain management, all patients received kyphoplasty. The follow-up period was every 3 months for 1-year post-surgery. The Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used pre-operatively, post-operatively, and at 3-, 6-, and 12-month follow-ups to assess patient status. All patients completed the operation, with 72 patients having focal pain over the compression fracture. Eleven cases also had pain distal to the fracture region in the following areas: lower back, near the iliac crest (n = 6), the groin (n = 3), and the trochanteric region (n = 2). Four cases had pain in distant to the fracture: lower back, near iliac crest (n = 3), and the trochanteric region (n = 1). All patients had a significant improvement in clinical symptoms. The average VAS and the ODI decreased significantly pre-operatively to post-operatively (p < 0.05). In addition to focal tenderness, many patients with thoracolumbar compression fractures may have pain distant to the fracture. This can be successfully treated using kyphoplasty. This phenomenon also indicates that patients at risk of osteoporosis who also have lower back pain should not neglect the potential for a thoracolumbar fracture.

Association of B12 deficiency and clinical neuropathy with metformin use in type 2 diabetes patients.

CONTEXT: Long-term metformin use has been hypothesized to cause B12 deficiency and neuropathy in Type 2 diabetes patients. However, there is a paucity of Indian data regarding the same. AIM: To compare the prevalence of B12 deficiency and peripheral neuropathy in patients with Type 2 diabetes mellitus treated with or without metformin. MATERIALS AND METHODS: We recruited patients with Type 2 diabetes and divided them into metformin exposed and nonmetformin exposed groups. We measured baseline demographic variables like age, sex, vegetarian status, and HbA1c levels in both groups. We compared vitamin B12 levels and severity of peripheral neuropathy (using Toronto Clinical Scoring System (TCSS)) in both groups. Definite B12 deficiency was defined as B12 <150 pg/ml and possible B12 deficiency as <220 pg/ml. The difference in vitamin B12 levels and TCSS was calculated in both groups using independent samples t-test. Spearman's rank correlation between cumulative metformin use and B12 level was calculated. Odds ratio of vitamin B12 deficiency in metformin exposed group was also estimated. RESULTS: Mean serum B12 levels was significantly lower in metformin exposed group (n=84) compared with nonmetformin exposed group (n=52) (410±230.7 versus 549.2±244.7, P=0.0011). Mean neuropathy score was significantly higher in metformin exposed group. (5.72±2.04 versus 4.62±2.12, P=0.0064). Odds ratio for possible B12 deficiency was 4.45 (95% CI 1.24-15.97). There was significant negative correlation between cumulative metformin dose and vitamin B12 level (r=-0.68, P<0.0001). CONCLUSION: Metformin use is associated with vitamin B12 deficiency and clinical neuropathy in Type 2 diabetes patients.

Assessment of assimilative capacity of Kanhan river stretch using MIKE-11 modeling tool.

In the present paper, it is attempted to carry out computer simulation studies for Kanhan river stretch using MIKE-11 modeling tool to evaluate Assimilative Capacity (AC) based on existing and projected waste load scenarios. AC of Kanhan river was estimated in relation to biochemical oxygen demand (BOD) and dissolved oxygen (DO). MIKE-11 model simulates the DO and BOD parameters in a one dimensional fashion by calibrating with field data different constant and model parameters. The modeling studies would help in deciding the appropriate waste load allocation based on stream's AC rather than simple effluent standards. The model studies will provide vital information and greater insight into the impact of point and non-point sources of pollution on quality of Kanhan river in a stretch of 120 km.

Cancer stem cells in osteosarcoma: recent progress and perspective.

BACKGROUND: To review the current progress in osteosarcoma stem cells, including isolation and identification, special cell surface markers, relationship between drug-resistance and metastasis, and the involving signal pathways. METHODS: A review of the literature encompassing osteosarcoma stem cells was performed. RESULTS: Although the cancer stem cells hypothesis was first proposed about 50 years ago, it is only in the last 10 years that advances in stem cell biology have provided increasing experimental evidence supporting this hypothesis. It has been postulated that within a tumor, a minor subpopulation of cells, termed cancer stem cells (CSC), drive the self-renewal and differentiation that account for the initiation, proliferation, metastasis, therapeutic resistance and recurrence of cancer. The CSC hypothesis opens up a novel conceptual approach for curing tumors that selectively kills CSCs, making it possible to eradicate cancer. Currently, osteosarcoma stem cells have been isolated and identified using various methods. Given the specific stem cell features, the study of CSCs has important implications in osteosarcoma prevention, detection and treatment, especially in curing early metastasis and preventing drug resistance. Focusing on their stem-like character, CSCs can be appropriately targeted by identifying links between the cells and their microenvironment. CONCLUSION: All of this research is in its infancy - many problems still exist. Further studies are needed to search for specific targeted therapies for osteosarcoma, in-depth study of mechanism of drug resistance, identifying the role that CSCs play in tumor metastasis, and demonstrate the imbalance of specific pathways in osteosarcoma stem cells.

Antinociceptive activity of chromophoric chain substituted hemicyaninocolourants.

Some of the chromophoric chain substituted hemicyaninocolourants (CCHCs) were synthesized and confirmed on the basis of nitrogen analysis. These were tested for their antinociceptive activity in albino rats against tail flick technique and sodium chloride induced writhing test. Test compounds were given in graded doses (10, 20 and 50 mg/kg, intraperitoneally) and compared with morphine and aspirin as standard controls. Two compounds CCHC-1 and CCHC-2 showed antinociceptive activity in a dose-dependent manner in both the experimental models. The compound CCHC-3 did not exhibit antinociceptive activity to any significant extent.

Computed tomography (CT) in late infantile metachromatic leucodystrophy.

Computed tomographic features of 7 cases of the late infantile form of MLD confirmed by sural nerve biopsy are presented. Diffuse symmetrical white matter, low attenuation of the cerebral parenchyma was the common feature. Hypodensity of the temporal lobes and the cerebellar hemispheres are 2 features which have not been reported earlier. Three patients had brainstem atrophy without evidence of cerebral atrophy. Awareness of the various CT features of MLD may help in more definitive radiological diagnosis of the disease and to differentiate it from other dysmyelinating diseases of the central nervous system.

'Antiandrogenic properties of neem seed oil (azadirachta indica) in male rat and rabbi'.

Azadirachta indica (Neem) seed oil brings about a significant diminution in spermatozoan motility and density. It leads to reduction of fertility rate in rats and rabbits. The body weight of the animals remain unaffected but the weights of reproductive oranges declined. Reduction of cauda epididymal protein, sialic acid, acid phosphatase and seminal vesicular fructose concentration in rats and rabbits could bedue to antiandrogenic action of the seed oil as confirmed with the help of bioassay techniques. Histopathology of testis revealed arrest of spermatogenesis and sever degenerative changes in the cauda epididymis.

Role of extra amniotic rubber catheters in midtrimester pregnancy termination.

PIP: The objective of the investigation was to test the efficacy of the simplest mechanical method of midtrimester pregnancy termination, i.e., extraamniotic rubber catheters without use of any drugs, because medical disorders complicating pregnancy were also included in the present series. The pregnancy was terminated in midtrimester in 200 patients by introducing autoclaved rubber catheter in extraamniotic space. This work was carried out in the Department of Obstetrics and Gynecology of Patna Medical College in Patna, India during the August 1978 to August 1979 period. Radiological examination of the abdomen and pelvis was done 10 minutes after introduction of catheters in 64 of the 200 cases. The abortion process was enhanced by oxytocin drip if there was delay in induction abortion interval. After completion of the abortion, the postabortal period was carefully observed for any complication. 55% of the patients aborted within 24-36 hours. 33% of the patients aborted within 24 hours. There was no definite correlation between period of gestation and induction abortion interval. The coiling of the catheter at the level of fundus resulted in abortion within 24 hours in 28 out of 32 cases. In sum, this is a safe, simple, and effective method of midtrimester pregnancy termination. This is the only method which can be used safely in medical disorders complicating pregnancy.^ieng

An improved polychrome staining method for thick epoxy sections.

Improved polychrome staining of 1-1.5 mum epoxy sections is achieved with sequential applications of a single basic fuchsin-methylene blue mixture at two different pH values. The dye solution is applied for 2-3 min at 50-52 C first at pH 7.9, then at pH 6.7. In sections of mouse mammary tissue, epithelial cells are stained deep blue, connective tissue pink, and fat cells bright olive-green. This simple technique consistently yields uniform, vivid, contrasting colors that sharply delineate the elements of the complex glandular architecture of the mammary gland. Similar polychromatic effects are obtained in applications to other tissues, such as stomach, adrenal gland, mammary tumor and artery.