Efficacy and safety of oral tranexamic acid as an adjuvant in Indian patients with melasma: a prospective, interventional, single-centre, triple-blind, randomized, placebo-control, parallel group study.

BACKGROUND: Melasma is a chronic recalcitrant pigmentary disorder whose treatment frustrates physician and patient alike. Tranexamic acid, a plasmin inhibitor, has demonstrated hypopigmenting properties. AIM: To compare safety and efficacy of combination of oral tranexamic acid (TXA) and topical fluocinolone-based combination cream (FbTC) with that of topical FbTC alone in melasma. METHOD: One hundred and eighty patients patients of facial melasma of either sex attending dermatology OPD were screened. Consenting 130 participants were randomized into two blinded groups with 65 patients in each group. Group A patients received oral tranexamic acid 250 mg and oral ranitidine 150 mg twice daily and applied a triple combination cream containing fluocinolone acetonide 0.01%, tretinoin 0.05% and hydroquinone 2% once daily, and Group B was asked to take placebo tablets (calcium lactate and multivitamin) and apply the cream only for 12 weeks. Response was evaluated using modified melasma area severity index (mMASI) and graded mMASI improvement at 4th, 8th and 12th weeks, and at 24th week for recurrence. Data were analysed using SPSS software. RESULTS: Results were analysed in 120 patients who completed the study with 61 and 59 patients in group A and B, respectively. Demographic profile was equally distributed in both the groups. In group A, 13.1% patients showed marked improvement (>75%) in mMASI as compared to group B (1.7%) at 4th week. By 12th week, 65.6% patients had marked improvement in group A in contrast to only 27.1% in group B. At 24th week, group A (65.6%) had sustained improvement as compared to group B (11.9%) despite stopping treatment; all of which were statistically significant. Recurrence observed was 18.03% in group A vs. 64.4% in group B at 24th week. CONCLUSION: Oral tranexamic acid is definitely a boon to the armamentarium of melasma management and should be used as an adjuvant to fluocinolone-based triple combination cream for a faster, sustained improvement and to prevent recurrence.

Gallbladder cancer incidence in Gwalior district of India: Five-year trend based on the registry of a regional cancer center.

BACKGROUND: We have reported here the 5-year incidence (2004-2008) of gallbladder cancer (GBC) in North Central India along with its descriptive epidemiology. This provides potential clues for better prevention. The present study has also evaluated the association of ABO blood groups with GBC. PATIENTS AND METHODS: The study comprised 742 GBC cases referred to the regional cancer hospital, Gwalior, during 2004-2008. The demographic statistics of Gwalior district was considered to calculate the relative risk and incidence rates. ABO blood group distribution amongst 90,000 healthy subjects registered in the local blood bank during 2002-2007 was taken as controls to study the association of blood groups with GBC. RESULTS: The age-standardized total incidence rate of GBC was calculated to be 7.16/1,00,000. The relative risk of females getting GBC was 2.693 at 95% confidence interval of 2.304-3.151 (P < 0.0001). The females formed 69.5% of total cancer cases, with age-standardized incidence rate of 10/1,00,000. The mean age of male and female GBC cases was found to be 55.4 years (SD = 13, SE = 0.77) and 51.5 years (SD = 12.3, SE = 0.50), respectively. The blood groups A (P = 0.0022) and AB (P < 0.0001) had a positive association with GBC with significant level of differences in comparison to controls. CONCLUSION: Our study provided an estimate of a 5-year incidence of GBC in North Central India for the first time. With regard to the association of risk factors like obesity, age, and urban living with GBC, the findings of the present study are contradictory to the general opinion. Blood groups A and AB were found to be associated with GBC, which would be provisional for further investigations.

The liver function test enzymes and glucose level are positively correlated in gallbladder cancer: a cancer registry data analysis from north central India.

AIM OF STUDY: To investigate the trend of expression of liver function test enzymes and other biochemical changes during gallbladder carcinogenesis. MATERIALS AND METHODS: Eight hundred and seventy-eight gallbladder disease patients were selected to study the liver function test enzymes and routine blood biochemical changes in the last five years (2004-08). Statistical analysis was performed using Graph Pad prism 5.02 software. RESULTS: The liver function test enzymes showed significant correlations among themselves, and with glucose in gallbladder cancer and gallstone disease patients (N = 878). Out of 878 gallbladder cases, 46 (5.24%) showed significantly higher glucose level of 216.66 mg/dL (P < 0.0001). All the three pathological conditions of gallbladder, gallbladder cancer with stones (GBCS), gallbladder cancer without stones (GBC) and calculus cholecystitis (CC), showed highly significant positive correlation (Pearson) between Serum Glutamic Oxaloactetic Transaminase (SGOT) and Serum Glutamic Pyruvic Transaminase (SGPT) [P < 0.0001, (GBCS); P < 0.0001, (GBC), and P < 0.0001, (CC)]. SGOT and SGPT also showed positive correlation with higher glucose level independently, in both GBCS and CC (P < 0.0001 and P < 0.0001), respectively. CONCLUSION: Simultaneous elevation of glucose and liver function test enzymes in GBC makes the diagnosis complex. Any patient of gallbladder diseases with higher level of glucose may have the possibility of developing gallbladder cancer.

Prevalence of smear-positive pulmonary tuberculosis in different ethnic groups in India: evaluation of public health.

OBJECTIVE: To estimate the prevalence of pulmonary tuberculosis (TB) in a high-risk rural area of central India. STUDY DESIGN: Retrospective analysis of primary data. METHODS: In total, 10,963 sputum smears were screened from Hindu tribes (n = 4032), Hindu non-tribal (n = 5445) and Muslim communities (n = 1486) between 2004 and 2009. Smears were recorded as positive or negative for tubercle bacilli following staining with acid-fast bacilli, in accordance with the guidelines of the World Health Organization. Age- and gender-specific prevalence rates and relative risks (RR) were calculated using Statistical Package for the Social Sciences Version 13.0. RESULTS: The prevalence of TB was found to be significantly higher in Hindu tribes compared with Hindu castes and Muslims (P < 0.005). The overall RR of developing smear-positive disease was 1.4-fold higher (95% confidence interval 1.1-1.7; P < 0.005) in males than females in all the study groups. The highest prevalence of TB was observed in subjects aged 15-34 years. CONCLUSIONS: Hindu tribes and males of working age are still at high risk of smear-positive TB.

Vitiligo and associated autoimmune disorders: a retrospective hospital-based study in Mumbai, India.

BACKGROUND: It is a hospital based study focusing on epidemiological aspects of vitiligo and association with autoimmune disorders. There are few studies elucidating the association of autoimmune disorders with vitiligo in the Indian population. Our study is a small attempt in this direction. AIM: To study epidemiological parameters of vitiligo and to study coexistence of autoimmune disorders. MATERIALS AND METHODS: Records of 33,252 new patients attending the dermatology outpatient department from June 2002 to June 2008 were analysed for the presence of vitiligo and details of important epidemiological variables, and associated autoimmune disorders of these patients were collected and analysed. RESULTS: Total number of vitiligo patients was 204. Proportion of vitiligo patients was 0.61%. Male:female proportion was almost equal. Family history of vitiligo was seen in 3.43% of cases. Associated autoimmune disorders were seen in 2.94% cases and were mainly skin associated autoimmune diseases (morphoea, alopecia areata, discoid lupus erythematosus, and pemphigus erythematosus) except for one case of Grave's disease. CONCLUSION: Association of vitiligo with other autoimmune diseases emphasizes autoimmune aetiology of vitiligo. This study also emphasizes the need to actively look for, and if necessary, investigate patients with vitiligo for other autoimmune diseases.