Intermediate uveitis as an initial presentation of HLA B27 associated spondyloarthropathy in an adolescent boy: A rare case report and review of literature

Juvenile ankylosing spondylitis is less prevalent in children, and usually, children are presented to the hospital with chronic inflammatory back pain, enthesitis, and often hip and shoulder joint involvement. A significant proportion of these children develop ocular complications such as anterior and intermediate uveitis. Most of these children have HLA B27 positivity. On the other hand, in cases with anterior and intermediate uveitis, a considerable proportion has positivity for HLA B27 antigen. Few of these patients, later on, develop other clinical features suggestive of ankylosing spondylitis. However, there are only a few anecdotal case reports of similar HLA B27 associated intermediate uveitis, who later on developed juvenile ankylosing spondylitis. The current case is a 12-year old boy, who initially had bilateral intermediate uveitis with HLA B27 positivity without any other systemic or musculoskeletal features. However, on follow-up he developed enthesis and sacroiliitis suggestive of ankylosing spondylitis. Both rheumatological and visual complains had an excellent clinical response to corticosteroids in this child. The current case report demonstrates the importance of evaluation for HLA B27 positivity in all children with isolated intermediate uveitis, even if systemic and musculoskeletal examinations are normal

Pharmacovigilance in cancer chemotherapy in regional cancer center of Eastern India: prospective observational study

Background: Globally cancer is the leading cause of morbidity and mortality with annual death rate of 12%. According Indian Council of Medical Research, more than 1300 Indians die every day due to cancer. Chemotherapy is one of the multimodal approaches for treatment of cancer and regimens are much complex and cancer patients are more susceptible to adverse drug reaction with little tolerance due to diminished immunity. The present study was done to evaluate the prevalence of various adverse drug reactions with different cancer chemotherapy regimens, their nature and severity as well as their causality assessment as per WHO scale.Methods: This prospective observational study was conducted from July 2015 to June 2016. Patients receiving cancer chemotherapy from regional cancer centre, Cuttack were observed during the study period for the adverse drug reactions. Those ADRs were analysed for causality assessment, severity and preventability.Results: It was observed that after the initiation of chemotherapy, ADRs were observed in 92 (88.46%) patients. Among these 329 observed ADRs, during the study period, female predominance was observed in the age group 51-60yrs. Most common ADRs observed were nausea and vomiting 57 (17.37%), alopecia 46 (13.98%) and neutropenia 38 (11.55%). ADRs were most commonly seen with the haematological systems (37.68%) followed by gastrointestinal system amounting 25.22% of the total ADRs. Platinum Compound (58.35%), followed by antibiotics, antimetabolites, were the most common group of drugs causing different adverse drug reactions. On causality assessment, as per WHO-UMC criteria 68.38% were probable and 31.62% ADRs were possible. Severity assessment showed majority of the ADRs were moderate 228 (69.31%) followed by mild 67 (20.36%) and severe 34 (10.33%). It was observed that majority 212 (64.45%) of the ADRs were not preventable, 72 (21.88%) were definitely preventable and 45 (13.67%) were probably preventable.Conclusions: Cancer chemotherapy has definitely improved the quality of life, but associated ADRs need early diagnosis, prompt management and routine reporting. Thus, pharmacovigilance will definitely reduce morbidity and mortality, so also the financial burden for the patients and society

Demography and clinical profile of patients with chronic pancreatitis in a tertiary referral hospital in eastern India

Background: Chronic pancreatitis is defined as a pathological fibro-inflammatory syndrome of the pancreas in individuals with genetic, environmental and/or other risk factors who develop persistent pathological responses to parenchymal injury or stress. Potential causes can include toxic factors (such as alcohol or smoking), metabolic abnormalities, idiopathic mechanisms, genetics, autoimmune responses and obstructive mechanisms. We studied the epidemiological patterns in relation to age, sex and socioeconomic status, the etiological factors and pattern of clinical presentations. the different modes of management of chronic pancreatitis.Methods: This prospective study on chronic pancreatitis was conducted in 55 patients admitted in Srirama Chandra Bhanja Medical College and Hospital (SCB M. C. H.), Cuttack, general surgery and surgical gastroenterology department.Results: In the study sample 37 patients (68%) were male and 18 patients (32%) were female. the etiological distribution of the study sample is shown. 29 patients (53%) showed topical etiology, 21 patients (37%) showed alcoholic and 5 patients showed idiopathic. The sign and symptoms (clinical) of the study sample, 54 patients (98%) showed abdominal pain, 26 patients (47%) had diabetes (type 2), 1 patient showed steatorrhea, 2 patients (4%) had jaundice, 2 patients (4%) had pseudocyst and 1 patient (2%) had ascites. Surgical drainage procedure performed on the patients 23 patients (42%) underwent Pvestow lateral (longitudinal) pancreatic jejunostomy, 18 patients (33%) underwent frey, 7 patients (13%) had lateral pancreatic jejunostomy,1 patient (2%) had V section, 1 patient (2%) underwent whipple, 3 patients (5%) had cystogastrostomy and cystodudenostomy and 2 patients (3%) underwent cholecystojejunostomy.Conclusions: The study revealed Puestow’s procedure was the most commonly performed surgical drainage procedure with satisfactory results

Receptor for pre-Sl(21-47) component of hepatitis B virus on the liver cell: role in virus cell interaction

Attachment of hepatitis B virus to a hepatoblastoma cell line (HepG2) was examined using a synthetic peptide corresponding to the pre-S1 (21-47) region of the envelope protein. Scatchard analysis revealed a single class binding site of Kd 104 &#177; 27 nM/I and 5.4 &#177; 1.2 &#215; 10<SUP>5</SUP> sites per cell. Competition of HBV with pre-S1 peptides was dose dependent, and demonstrated it as the dominant binding site. In view of the suggested sequence homology between the peptide and IgA, cross-competition studies were carried out. The results indicate no direct role of IgA receptor in HBV binding. The receptor for the pre-S1 pep- tide was identified as a single major peptide of molecular weight 31 kD using in-situ ligand receptor crosslinking

Significance of natural polymerized albumin and its receptor in hepatitis B infection of hepatocytes

Lack of information regarding the presence of native albumin polymer in serum and its structural similarity to the one produced by glutaraldehyde treatment casts doubt on the postulate that hepatitis B virus attachment to hepatocytes is mediated through polymerized albumin. We used a sandwich enzyme-linked immunosorbent assay with murine monoclonal antibodies raised against glutaraldehyde-polymerized albumin to detect native albumin polymer in human serum and its cross-reactivity with other albumin polymers. Presence of polymerized albumin receptor on the HepG2 cell was studied by radioreceptor assay. Purified hepatitis B virus and synthetic peptide analogous to part of pre-S2 sequence (120-145) were used to study polymerized albumin-dependent attachment of the virus to HepG2 cells. Antibodies raised against pre-S2 peptide were used to inhibit the pre-S2 and hepatitis B virus attachment to HepG2 cells. Glutaraldehyde-treated polymerized albumin was found to be immunologically cross-reactive with native albumin polymer. Its levels were found to be significantly raised in sera of patients with liver diseases. Polymerized albumin has specific saturable receptor on HepG2 cells with two classes of binding sites of different equilibrium dissociation constant (Kd1) = (16 &#177; 9.6)pmol/L and Kd2 = (1,019 &#177; 172)pmol/L. Albumin monomer was unable to compete for the polymerized albumin receptor sites on HepG2 cells. Antipre-S2 antibodies inhibit hepatitis B virus and pre-S2 binding to hepatocyte by 40% and 70%, respectively. Added extraneous polymerized albumin and the antibody against it did not interfere with virus attachment to HepG2 cells