Hydroxyurea as an alternative therapy for psoriasis

Background: Methotrexate is the drug of choice in extensive psoriasis in developing countries. In patients who can not take methotrexate either due to intolerance or concomitant liver disease, there is an urgent need for an alternative affordable and accessible drug. Aims: To evaluate the therapeutic efficacy and safety of hydroxyurea as an alternative in the management of patients with extensive psoriasis. Methods: A prospective study was carried out over 16 months on 34 patients with chronic plaque psoriasis (>20% body surface area involvement), erythrodermic or generalized pustular psoriasis who were partially responsive or non-responsive to the conventional topical and systemic modalities of therapy. Besides doing a baseline hemogram, liver and renal function tests, and urine analysis, these tests were frequently repeated during the course of therapy. Hydroxyurea was started at 1 g daily and increased to 1.5 g, if required. The therapeutic response was evaluated by a global assessment made by the patient and physician and regular PASI scoring. Results: Good to excellent response was observed in 25 (73.5%) patients, less than 50% response in 7 (20.6%) patients, while 2 (5.9%) patients were lost to follow up. The mean PASI score was reduced by 76% at 10-12 weeks. Therapy was discontinued in 3 patients due to leukopenia that recovered on discontinuation of hydroxyurea. Patients were followed up to 1 year and relapse was observed in 5 patients. The duration of remission varied from 6 months to 1 year. Conclusion: Hydroxyurea is an effective and reasonably safe second line agent for psoriasis

Cardiovascular Risk Factor and Coronary Artery Disease Prevalencein Patients of Rheumatic and Nonrheumatic Valvular Heart Disease-A Study from Major Centre in North Eastern India

Abstract Introduction:Indian data about the prevalence ofCoronary artery disease(CAD) in patients with valvular heart disease are limited. Prevalence of CAD in valvular heart disease is unknown in North Easter

Study - Hydroxyurea as an alternative therapy for psoriasis

Methotrexate is the drug of choice in extensive psoriasis in developing countries. In patients who can not take methotrexate either due to intolerance or concomitant liver disease, there is an urgent need for an alternative af fordable and accessible drug. Aims: To evaluate the therapeutic efficacy and safety of hydroxyurea as an alternative in the management of patients with extensive psoriasis. Methods: A prospective study was carried out over 16 months on 34 patients with chronic plaque psoriasis (>20% body surface area involvement), erythrodermic or generalized pustular psoriasis who were partially responsive or non-responsive to the conventional topical and systemic modalities of therapy. Besides doing a baseline hemogram, liver and renal function tests, and urine analysis, these tests were frequently repeated during the course of therapy. Hydroxyurea was started at 1 g daily and increased to 1.5 g, if required. The therapeutic response was evaluated by a global assessment made by the patient and hysician and regular PASI scoring. Results: Good to excellent response was observed in 25 (73.5%) patients, less than 50% response in 7 (20.6%) patients, while 2 (5.9%) patients were lost to follow up. The mean PASI score was reduced by 76% at 10-12 weeks. Therapy was discontinued in 3 patients due to leukopenia that recovered on discontinuation of hydroxyurea. Patients were followed up to 1 year and relapse was observed in 5 patients. The duration of remission varied from 6 months to 1 year. Conclusion: Hydroxyurea is an effective and reasonably safe second line agent for psoriasis

Efficacy and Safety of Angiotensin Receptor Neprilysin Inhibitor versus Angiotensin Converting Enzyme Inhibitor in Heart Failure with Reduced Ejection Fraction- A Prospective Observational Study from a Major Tertiary Care Hospital, Assam, India

Introduction: Angiotensin Receptor Neprilysin Inhibitor (ARNI) has shown to reduce morbidity and mortality in comparison to Angiotensin Converting Enzyme Inhibitors (ACEI) inpatients of Heart Failure with Reduced Ejection Fraction (HFrEF). However, the use of ARNI in real-world practice is limited and has not been studied in North Eastern Indian population Aim: To compare the efficacy and safety of ARNI with ACEI in the management of symptomatic chronic HFrEF in North Eastern Indian population. Materials and Methods: The prospective observational study was conducted in the Department of Cardiology at Gauhati Medical College, Guwahati, Assam, India, from April 2019 to October 2020. The study included patients with diagnosis of chronic HFrEF <40%, on ACEI therapy and who had atleast one hospitalisation for Acute Decompensated Heart Failure (ADHF) in the last 6 months. A total of 63 patients were included in this study. Three patients were lost on follow-up. Out of the 60 patients who were included in the final analysis, 30 patients each were included in two groups i.e, ARNI group and ACEI group. As perdiscretion of the treating physician, the patients were started on ARNI 50 mg twice daily which consist of Sacubitril/Valsartan (24/26 mg), along with other anti-heart failure medications, and they were compared with the patients who continued on ACEI. Uptitration was considered with the aim to double the dose till the target dose was achieved at every 2-4 weeks at the treating physician’s discretion The endpoints included the rate of repeat HF hospitalisation, mortality, renal outcomes and quality of life. All statistical analyses were performed using Statistical Package for Social Sciences (SPSS, IBM) software version 20.0. Results: The demographics and clinical characteristics were comparable between the groups. The dose of ARNI was uptitrated to a maximum of 100 mg twice daily in 11 patients. ARNI significantly reduced HF hospitalisation (36.7% vs. 66.7%; p-value=0.039) and mortality (10% vs. 20%, p-value=0.038) compared to patients with ACEI. There was a significant improvement in the KCCQ score in the ARNI group as compared to the ACEI group (p-value=0.001). Treatment with ARNI was also associated with a significant improvement in the New York Heart Association (NYHA) functional class, serum creatinine, and estimated Glomerular Filtration Rate (eGFR) and a significant reduction in N-Terminal pro B-type Natriuretic Peptide (NT-proBNP) level. Conclusion: In patients with symptomatic HFrEF, shifting to ARNI from background therapy on ACE inhibitors in comparison with continuation of ACE inhibitors appeared to be safe and superior in reducing the risk of death and of hospitalisation, when initiated on outpatient basis. ARNI could not be uptitrated in two-third of patients, yet substantial benefits are evident even at low doses in comparison to ACE inhibitor ramipri

White Grain Eumycetoma due to Aspergillus flavus in Infancy: A Rare Case Report from Assam

Mycetoma is a slowly progressive, chronic granulomatous infection of skin and subcutaneous tissue caused by traumatic inoculation of either fungi (eumycotic) or bacteria (actinomycotic). The disease is characterized by triad of tumefaction, discharging sinuses and grains. Here, we report a case of eumycetoma in an infant presenting with multiple discharging sinuses in lower limb. Aspirate and biopsy tissue from the sinuses were processed. The discharge revealed presence of white grains. Potassium hydroxide (KOH) mount revealed presence of hyaline septate hyphae. Histopathological examination showed granulation tissue and fungal hyphae. Repeated culture on sabouraud’s dextrose agar (SDA) with chloramphenicol showed growth of Aspergillus flavus on each occasion. Antifungal susceptibility testing was done following Clinical Laboratory Standard Institute (CLSI) M38-A2 protocol and showed high minimum inhibitory concentration (MIC) for fluconazole, caspofungin, anidulofungin and micafungin. The patient responded to itraconazole. Hence, exact categorization of lesion is essential for effective therapy and better prognosis

Prevalence of Vibrio cholerae O1 serogroup in Assam, India: A hospital-based study

Background & objectives: Although cholera remains to be an important public health problem, studies on reliable population-based estimates of laboratory confirmed cholera in endemic areas are limited worldwide. The aim of this hospital-based study was to evaluate the prevalence of Vibrio cholerae serogroup in Assam, India, during 2003-2013. Methods: Stool samples/rectal swabs were collected from acute watery diarrhoea (AWD) cases during 2003-2013 and processed by standard microbiological procedures. Antibiotic sensitivity test was done following the Clinical and Laboratory Standards Institute guidelines. Year-wise epidemiological trend of cholera was analyzed. Results: Cholera contributed to 3.93 per cent of AWD cases. In Assam, cholera was found to be more prevalent in the rural areas (6.7%) followed by the tea gardens (5.06%), urban slum (1.9%) and urban areas (1.4%). Highest proportion of cholera (13.7%) was observed in 0-10 yr age group. Of them, 11.5 per cent belonged to 0-5 yr age group. V. cholerae O1 El Tor serotype Ogawa was the predominant isolate. Multiple drug-resistant isolates of V. cholerae O1 Ogawa were reported in the study. Interpretation & conclusions: Emergence of resistance amongst V. cholerae towards many antibiotics is a matter of concern. Hence, continuous surveillance for diarrhoeal disorders is necessary to control the future outbreaks of cholera in this region