Identification of factors associated with treatment refractoriness of oral lesions in pemphigus vulgaris.

BACKGROUND: The oral mucosal lesions of patients with pemphigus vulgaris are known to show more treatment refractoriness than skin lesions. OBJECTIVES: To identify which clinical and laboratory parameters may indicate treatment refractoriness of oral lesions in pemphigus vulgaris. METHODS: This was a prospective study of 50 adults with pemphigus vulgaris and oral lesions; patients were given treatment appropriate for overall disease severity. Treatment refractoriness was defined arbitrarily as less than 75% reduction in oral objective Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) after treatment for 6 months. RESULTS: Of 46 patients who completed the study, 17 (37%) were treatment refractory whereas 29 (63%) were treatment responsive. At baseline, the treatment refractory group had a significantly longer mean duration of disease (P = 0·02) and mean duration of oral lesions (P = 0·01), a higher percentage of lesions in the retromolar trigone (P = 0·05) and on the occlusion line along the buccal mucosa (P = 0·04), a higher percentage of deep/crateriform ulcers (P < 0·001) and erosions with a lichenoid hue (P < 0·001). Herpes simplex virus (HSV) DNA positivity, assessed by polymerase chain reaction in oral tissue scrapings (P = 0·02), was also significantly higher in the treatment refractory group. No other factors we tested for were statistically significant. CONCLUSIONS: Treatment refractoriness of oral lesions was significantly associated with duration of disease/oral lesions; specific morphology and location of oral lesions; and the presence of HSV DNA in the oral cavity. These factors may forewarn the treating physician about a refractory course of oral lesions that may help with counselling patients.

Evaluation of non-microbial salivary caries activity parameters and salivary biochemical indicators in predicting dental caries.

AIM: The aim of the present study was the evaluation of non-microbial salivary caries activity parameters and salivary biochemical indicators in predicting dental caries. MATERIALS AND METHODS: The present study was carried out on 60 children, aged 4-6 years, selected from the schools of Panchkula district, Haryana, on the basis of their caries status. Level of hydration, flow rate, pH, buffering capacity, relative viscosity, calcium, phosphorus and alkaline phosphatase levels in caries-free and caries-active children were evaluated. RESULTS: Results showed that 90% of subjects in the caries-free group and 30% of subjects in the caries-active group had normal level of hydration value of less than 60 s and the difference was found to be statistically very highly significant. Normal flow rate of stimulated saliva was found in 90% of the subjects in caries-free group and 33.3% subjects in the caries active group and difference was found to be statistically very highly significant. Adequate salivary pH was found in 100% subjects in caries-free group and 30% in caries-active group and the difference was statistically very highly significant. CONCLUSION: To conclude, within limitations of this study, it became clear that normal level of hydration and higher values for flow rate, pH, buffering capacity of saliva lead to good oral health and a reduced caries occurrence. Increased salivary viscosity plays a role in increasing caries incidence. Salivary biochemical indicators like calcium, phosphorus and alkaline phosphatase also play their respective role in determining caries susceptibility of an individual. These salivary parameters can be used as diagnostic tool for caries risk assessment.

Effect of aqueous extract of Tribulus terrestris on oxalate-induced oxidative stress in rats.

The present study was aimed at studying the effect of Tribulus terrestris on different parameters of oxidative stress and gene expression profiles of antioxidant enzymes in renal tissues of male wistar rats after induction of hyperoxaluria. The animals were divided into three groups. The animals in group I (control) were administered vehicle only. In group II, the animals were treated with ethylene glycol (hyperoxaluric agent) and those in group III were administered T. terrestris plant extract in addition to ethylene glycol. All treatments were continued for a period of seven weeks. Ethylene glycol feeding resulted in hyperoxaluria as well as increased excretion of calcium and phosphate. Serum creatinine, uric acid and blood urea nitrogen levels were also altered in hyperoxaluric animals. Various oxidative stress parameters viz. lipid peroxidation and activity of antioxidant enzymes were used to confirm the peroxidant state. Reverse transcription-polymerase chain reaction (RT-PCR) analysis was used to confirm whether steady-state transcription level of different antioxidant enzymes was altered. T. terrestris significantly reduced the excretion of oxalate, calcium, and phosphate along with decreased levels of blood urea nitrogen, uric acid and creatinine in serum. T. terrestris also reduced hyperoxaluria- caused oxidative stress, and restored antioxidant enzyme activity and their expression profile in kidney tissue. Histological analysis depicted that T. terrestris treatment decreased renal epithelial damage, inflammation, and restored normal glomerular morphology.

Management of open olecranon fractures using clamp-cum-compressor device.

BACKGROUND: Open fractures of olecranon are not a rare occurrence in patients with road traffic accidents particularly motor bike riders who don't use elbow guards. Definitive treatment has to be delayed in many till the wound heals. The present study was conducted to evaluate the results of open fractures of olecranon using clamp-cum-compressor device. MATERIALS AND METHODS: Seventeen patients between the ages of 20 and 45 years of open olecranon fractures reported 5-20 days after injury were treated using an indigenous clamp-cum-compressor. All fractures were Mayo type II-A, i.e., displaced, stable and noncomminuted. Four patients had Gustilo-Anderson grade I and 13 had Gustilo-Anderson grade II open fractures. The patients with transverse or short oblique fractures were included in the study. The apparatus was applied under regional anesthesia after thorough washing and debridement of wounds with few loose sutures applied wherever needed. The wounds healed within 2-4 weeks and fractures united within 8-10 weeks. The elbow was mobilized with apparatus still in place. The results were evaluated by MayoElbow performance score. RESULTS: We achieved excellent results in twelve patients, good in four and poor in one patient, who reported late, hooks of the apparatus were cut through the proximal fragment, leading to union of fracture in elongation and restricted elbow movements. CONCLUSION: The apparatus was found to be quite useful in transverse and short oblique fractures with contamination or infection, where internal fixation has to be delayed or avoided.

Thompson's quadricepsplasty for stiff knee.

BACKGROUND: Stiffness of the knee after trauma and/or surgery for femoral fractures is one of the most common complications and is difficult to treat. Stiffness in extension is more common and can be reduced by vigorous physiotherapy. If it does not improve then quadricepsplasty is indicated. The present study was undertaken to evaluate the results of Thompsons quadricepsplasty. MATERIALS AND METHODS: Twenty-two male patients (age range 20-45 years) with posttraumatic knee stiffness following distal femoral fractures underwent Thompson's quadricepsplasty where knee flexion range was less than 45°. The index injury in these patients was treated with plaster cast (n=5), plates (n=3), intramedullary nailing (n=3) and external fixator for open fractures (n=9). Thompson's quadricepsplasty was performed in all the patients using anterior approach, with incision extending from the upper thigh to the tibial tubercle. Release of rectus femoris from underlying vastus intermedius and release of intraarticular adhesions were performed. After surgery the patients needed parenteral analgesia for three days and then oral analgesics for three weeks. Active assisted knee mobilization exercises was started on the first postoperative day. Continuous passive motion machine was used from the same day. Supervised physiotherapy was continued in hospital for six weeks followed by intensive knee flexion and extension exercise including cycling at home for atleast another six months. RESULTS: Out of 22 patients, 20 had excellent to good results and two patients had poor results using criteria devised by Judet. One poor result was due to peroperative fracture of patella which was then internally fixed and hence the flexion of knee could not be started immediately. There was peroperative avulsion of tibial tuberosity in another patient who finally gained less than 50° knee flexion and hence a poor result. CONCLUSION: Thompsons quadricepsplasty followed by a strict and rigourous postoperative physiotherapy protocol successfully increases the range of knee flexion.