Evaluation of myofibroblasts in oral submucous fibrosis: correlation with disease severity

J Oral Pathol Med (2011) 40 : 208–213 Background: Oral submucous fibrosis (OSMF) is a chronic debilitating disease and a premalignant condition of the oral cavity characterized by generalized submucosal fibrosis. Myofibroblasts are contractile cells expressing α‐smooth muscle actin (α‐SMA) and are considered primary producers of extracellular matrix after injury. Their accumulation has been established as a marker of progressive fibrosis in organs like lungs, liver, kidney and skin. This study aims to evaluate the presence of myofibroblasts in various histological stages of OSMF. Materials and Method: Seventy cases of OSMF, which were further categorized histologically into early (35 cases) and advanced (35 cases), were subjected to immunohistochemistry using α‐SMA antibody for detection of myofibroblasts. Fifteen normal oral mucosa specimens were also stained as controls. Results: The number of α‐SMA‐stained myofibroblasts in OSMF was significantly increased when compared to that of the normal controls (P < 0.001). Additionally, a statistically significant increase in the myofibroblasts population between early and advanced stages was observed (P = 0.000). Conclusions: Our results corroborate the possibility that OSMF actually represents an abnormal healing process in response to chronic mechanical and chemical irritation because of areca nut chewing as demonstrated by the increased incidence of myofibroblasts in this disease. Furthermore, the progressive increase in myofibroblasts from early to advanced stages suggests their potential use as markers for evaluating the severity of OSMF.     

Trichophyton Tonsurans Induced Recurrent Onychomadesis in a Very Young Infant

Abstract: Onychomadesis, or nail shedding, is rarely seen in children and can be due to stress, systemic illnesses, trauma, and drug therapy or may be idiopathic. Fungal infection of the nail is only rarely reported as a cause of onychomadesis. We present here a case of Trichophyton tonsurans–induced onychomycosis and resultant onychomadesis in a 9‐month‐old boy with onset of lesions at 2 weeks of life.     

Cost of Treatment of Multiple Myeloma in a Public Sector Tertiary Care Hospital of North India

Multiple myeloma (MM) is a neoplastic disorder, which accounts for 13% of all hematological malignancies globally. While, conventional chemotherapy used to be the mainstay treatment for the disease, the landscape of treatment witnessed a paradigm shift with the introduction of high-dose chemotherapy and autologous stem cell transplant (ASCT). In this paper, we present a cost analysis of various services provided to multiple myeloma patients, using either of the two modalities of treatments i.e. conventional chemotherapy or ASCT. Bottom-up costing methodology was used to collect data on all health system resources, i.e. capital or recurrent, which were used to provide various services to MM patients. Capital costs were annualized for their useful life using a discount rate of 5%. Out of pocket expenditure on treatment was also ascertained. Cost was assessed for various services, including outpatient consultation, bed day hospitalization in general ward, high dependency unit intensive care setting and bone marrow transplant unit. Unit costs were calculated from both health system and patient perspective. The overall cost per patient for ASCT (including high dose chemotherapy) and conventional chemotherapy from societal perspective was INR 395,527 (USD 6085) and INR 62,785 (USD 966) respectively. Estimates on cost from our study could be used for planning health services, and evaluating cost effectiveness of different modalities of care for multiple myeloma.     

Hirsutism

Hirsutism is a common condition affecting women of reproductive age and is associated with significant psychological morbidity. This abnormal excess growth of terminal hair is usually driven by hyperandrogenism, most commonly, polycystic ovarian syndrome. Numerous other causes exist including idiopathic, endocrine or malignant pathologies. This review outlines the aetiology of hirsutism, the clinical assessment of a patient presenting with hirsutism, and treatment options. Mechanical hair removal methods have usually been tried already before a patient seeks medical attention. Other treatment options include suppression of endogenous androgen secretion or action. At least 6 months of treatment is usually required before improvement in symptoms can be expected.