Clinico-histopathological study of multidrug therapy in indeterminate leprosy

A study was undertaken in 42 patients with indeterminate leprosy to evaluate the efficacy of multidrug therapy (MDT) in Indeterminate leprosy for 12 months. The main clinical finding was a single hypopigmented macule in 31 (73.8%) of the 42 cases. Histopathologically all cases showed lymphohistiocytic infiltration around skin appendages and dermal nerves. At the end of six months of MDT all the cases were evaluated clinically and 33 (85.5%) showed marked improvement or total inactivation while the lesions were still active clinically in 21.4% cases. Histopathological examination of lesions in 30 patients showed complete histological resolution in 9 cases only. At the end of one year of treatment it was found that 28 cases (66.3%) had become inactive and only 2 (4.7%) were found to be still active.     

Evaluation of coital incontinence by electronic questionnaire: prevalence,associations and outcomes in women attending a urogynaecology clinic

Introduction and hypothesis

Coital incontinence is the involuntary leakage of urine during sexual intercourse and is divided into that occurring with penetration and that occurring with orgasm. Mechanisms of coital incontinence are poorly understood. The aim of this retrospective study was to measure the prevalence of coital incontinence and evaluate the association among various types of coital incontinence with stress urinary incontinence (SUI), overactive bladder (OAB) and impact on quality-of-life in women attending a urogynaecology clinic.

Methods

A total of 2,312 women completed the electronic Personal Assessment Questionnaire-Pelvic Floor (ePAQ-PF) in advance of their urogynaecology consultation. Logistic regression and Spearman’s rank-order correlation evaluated associations between types of coital incontinence and OAB and SUI. The Mann–Whitney test evaluated the relationship between coital incontinence and self-reported quality of sex life and self-avoidance and partner avoidance of sex. Subgroup analysis analysed outcomes in 84 women with coital incontinence undergoing treatment with tension-free vaginal tape (TVT).

Results

Prevalence of coital incontinence in the cohort was 30%. Symptoms of OAB (p < 0.005) and SUI (p < 0.005) were significantly and independently associated with both types of coital incontinence (orgasm and penetration). In women with coital incontinence compared with those without, there was significant self-avoidance of sex (p < 0.0005), partner avoidance of sex (p < 0.0005) and impaired quality of sex life due to sexual problems (p < 0.005). The impact of this was significant in each group. Subgroup analysis of 84 women undergoing TVT showed significant improvement in all coital incontinence symptoms 3 months post-operatively.

Conclusion

Using an electronic questionnaire before consultation has identified coital incontinence to be a prevalent symptom, having a significant impact on the patient’s sex life. Coital incontinence at orgasm and penetration are both significantly associated with SUI and OAB.

     

Membranous nephropathy with light chain restricted deposits

The literature on membranous nephropathy (MN) with monoclonal deposits on immunofluorescence (IF) and their outcome is very scarce. We report our experience of managing five patients with this clinical entity. The mean age of the patients was 33.2 ± 6.55 years. The mean proteinuria, serum albumin and serum creatinine was 5.73 ± 2.17 g/day, 2.86 ± 0.51 g/dL and 1.34 ± 1.19 mg/dL, respectively. None of the patients had a lymphoproliferative disorder. Only one patient had an elevated free light chain ratio. Four (80%) patients were M‐type phospholipase A2 receptor (PLA2R) negative (tissue and serum), and one (20%) was PLA2R related. Three (60%) cases had monoclonal IgG3/k, one IgG3/λ, whereas one patient with PLA2R positivity had an IgG3/IgG4k subtype. Two (67%) patients treated with cyclical cyclophosphamide and steroids (cCYC/GC) achieved complete remission and one patient (33%) with elevated baseline creatinine had a reduction in serum creatinine with persistent proteinuria at the end of the 12th month of follow‐up. One patient with PLA2R positive MN was treated with Rituximab and is in complete remission. The patient with an elevated free light chain at baseline was treated with Bortezomib/Thalidomide/Dexamethasone, had complete remission at 12 months, however, had a progressive rise in creatinine over the next 40 months of follow‐up. The current series, though limited by numbers, documents the efficacy of conventional therapies in non‐malignant associated MN with monoclonal deposits on IF.     

Is lower 30-day mortality posthospital admission among blacks unique to the Veterans Affairs health care system?

BACKGROUND: Several studies have reported lower risk-adjusted mortality for blacks than whites within the Veterans Affairs (VA) health care system, particularly for those age 65 and older. This finding may be a result of the VA's integrated health care system, which reduces barriers to care through subsidized comprehensive health care services. However, no studies have directly compared racial differences in mortality within 30 days of hospitalization between the VA and non-VA facilities in the US health care system. OBJECTIVE: To compare risk-adjusted 30-day mortality for black and white males after hospital admission to VA and non-VA hospitals, with separate comparisons for patients younger than age 65 and those age 65 and older. RESEARCH DESIGN: Retrospective observational study using hospital claims data from the national VA system and all non-VA hospitals in Pennsylvania and California. SUBJECTS: A total of 369,155 VA and 1,509,891 non-VA hospitalizations for a principal diagnosis of pneumonia, congestive heart failure, gastrointestinal bleeding, hip fracture, stroke, or acute myocardial infarction between 1996 and 2001. MEASURES: Mortality within 30 days of hospital admission. RESULTS: Among those under age 65, blacks in VA and non-VA hospitals had similar odds ratios of 30-day mortality relative to whites for gastrointestinal bleeding, hip fracture, stroke, and acute myocardial infarction. Among those age 65 and older, blacks in both VA and non-VA hospitals had significantly reduced odds of 30-day mortality compared with whites for all conditions except pneumonia in the VA. The differences in mortality by race are remarkably similar in VA and non-VA settings. CONCLUSIONS: These findings suggest that factors associated with better short-term outcomes for blacks are not unique to the VA.     

Complete bladder prolapse: a case report and literature review

Complete bladder prolapse through the urethra is very rare but needs to be recognised early as it can lead to serious complications and requires prompt treatment. Several predisposing factors have been described. A high index of suspicion is required for diagnosis, and the involvement of a multidisciplinary team approach is important in the management of such patients.     

Night-time intra-oesophageal bile and acid: a comparison between gastro-oesophageal reflux disease patients who failed and those who were treated successfully with a proton pump inhibitor

Aliment Pharmacol Ther 2011; 33: 837–844

Summary

Background Little is known about the contribution of bile and acid reflux to night‐time symptoms generation in patients who failed PPI treatment. Aim To compare the degree of night‐time oesophageal acid and bile [by the surrogate duodenogastroesophageal reflux (DGER)] exposure between gastro‐oesophageal reflux disease (GERD) patients who failed and those who fully responded to PPI once a day while on treatment. Methods Gastro‐oesophageal reflux disease patients were assigned to the PPI failure group if they continued to report symptoms ≥3/week and to the PPI success group if they were asymptomatic for the last 3 months while on PPI once a day. All patients underwent upper endoscopy and subsequently simultaneous 24‐h oesophageal Bilitec and pH testing while on PPI treatment. Results Twenty‐three patients were enrolled into the PPI failure group and 24 patients into the PPI success group. The percentage of night‐time pH < 4 and the number of night‐time acid reflux episodes were significantly higher in the PPI failure group as compared with the PPI success group. All night‐time DGER parameters were similar between the PPI failure and PPI success groups. Conclusions Night‐time oesophageal acid exposure is significantly higher in the PPI failure group vs. PPI success group. The degree of night‐time bile reflux is similar in the two groups of patients with GERD.     

Toxic effects of imidazolium ionic liquids on the green seaweed Ulva lactuca: oxidative stress and DNA damage

The green credentials of ionic liquids (ILs) are being increasingly questioned due to the growing evidence of their toxicity to aquatic ecosystems, although the mechanisms of toxicity are unknown. This study provides insights into the mechanism of toxicity and biological effects of 1-alkyl-3-methylimidazolium bromide [C(n)mim]Br (n = 4 to 16) on the marine macroalga Ulva lactuca. The cell viability of this alga during IL exposure was found to be negatively correlated to the chain length of the alkyl group. The IL ([C(12)mim]Br) exposure triggers the generation of reactive oxygen species (ROS viz. O(2)(?-), H(2)O(2), and OH(?)), damage of the membrane and DNA, and inhibition of antioxidant systems in the alga. The enhanced production of ROS and lipid peroxidation in the alga subjected to LC(50) concentration for 4 days was largely attributed to lipoxygenase (LOX) activity coupled with the induction of two LOX isoforms (~80 kDa and ~55 kDa). Pretreatment of the algal thallus with enzyme inhibitors such as diphenylene iodonium, sodium azide, cantharidin, and oxadiazoloquinoxalin-1-one, prior to [C(12)mim]Br exposure showed the regulation of ROS by the activation of membrane bound NADPH-oxidase and cytochrome oxidase. The IL exposure resulted in the accumulation of n-3 and n-6 fatty acids at 0.5 LC(50) concentration indicating the induction of desaturase enzymes. Furthermore, antioxidant enzyme activities such as superoxide dismutase (SOD), ascorbate peroxidase (APX), and glutathione reductase (GR) were enhanced by 1.3-2.0-fold, while glutathione peroxidase (GSH-Px) diminished, together with a higher regeneration rate of reduced ascorbate and glutathione. The isoforms of antioxidant enzymes, namely, Mn-SOD (~85 kDa), APX (~125 and 45 kDa), and GR (~135 kDa) regulated differentially to IL exposure. The comet assay performed for the first time for seaweeds revealed the significant induction of DNA damage (>50-70% increase in % tail DNA over control) in alga exposed to ≥ LC(50) concentration.