Anti-TNF-Alpha-Induced Psoriasis – An Unusual Paradox

Anti-TNF-α agents are currently utilised for the treatment of a vast array of autoimmune conditions including inflammatory bowel disease, rheumatoid arthritis, ankylosing spondylitis and psoriasis. It is however noted that such therapeutic strategies have been linked to the specific induction of cutaneous-based reactions such as dermatitis, erythema multiforme and psoriasis. Here we present the case of a young female patient with Crohn's disease who developed psoriasis following treatment with the anti-TNF-α drug adalimumab and highlight the possible pathogenetic mechanisms involved in such an occurrence

Ethno-Medicinal Uses and Agro-Biodiversity of Barmana Region in Bilaspur District of Himachal Pradesh, Northwestern Himalaya

India is one of the richest countries in traditional knowledge, because of its ambient biodiversity, variety of habitats and rich ethnic divergence. Thus we have had well established local health tradition still relevant in indigenous healthcare system. The paper provides first hand information on the agro-biodiversity and ethno-medicinal uses of the area. In the present study 50 species belonging to 37 genera and 17 families i.e. Shrub (1 spp.), tree (1 spp.), herb (48 spp.) were recorded under the agro-biodiversity region of the area. The utilization pattern of the species indicated that leaves of 22 species, stem of 1 species and seeds of 23 species, whole part of 11 species, tubers and flowers of 4 species, fruits of 18 species, each are used. 6 species were Indian origins, while others were non-native to Indian Himalayan Region

Effectiveness and toxicity of oil spill reagents on Artemia Salina

Purpose: To determine the safety and effectiveness of three potential reagents which could be used to manage a simulated oil spill (SOS). Methods: The effectiveness of three agents used manage a simulated oil spill was evaluated: liquid soap, human hair, and Enviro-Bond 403 polymer. To evaluate safety, 1 hour-Artemia survival was evaluated; serial dilutions were employed to construct LC50 curves for a normal environment (control 1), for a SOS (control 2) and for a SOS managed with each of the 3 agents. Results: Hair and oil were effective absorbents as only 12% and 20% of the oil remained at 1 hour, repsectively; soap was ineffective with 62% of oil remaining unbound. Over a 1-hour period there was a 63% reduction in survival in Artemia exposed to an untreated SOS, when compared to natural conditions (p=0.001). Oil exposure exhibited a classic dose response curve as more Artemia died as its concentration increased; its LC50 was 17.5%. Hair and polymer were well tolerated by Artemia – neither reached their LC50 and approximately 80% of Artemia were alive at the end of one hour.  Soap, with or without oil, was toxic to Artemia and its LC50 was 7%. These results were statistically significant between the three groups (ANOVA; p-value = <0.001).  Conclusion: Hair and polymer we both effective and well tolerated by Artemia in a simulated oil spill.  Objet: Pour déterminer la sécurité et l’efficacité de trois réactifs qui pourraient se servir à nettoyer une marée noire artificielle. Méthodes: L’efficacité de trois agents en nettoyant une marée noire artificielle a été évaluée: celle du savon liquide, de cheveux humains, et du polymère Enviro-Bond 403. Pour voir si ces agents sont sûrs, la survie de l’Artemia a été observée pendant une heure, et les dilutions en série ont été faites pour construire des courbes CL50 représentant un environnement normal (1er groupe témoin), une marée noire (2e groupe témoin), et une marée noire nettoyée avec chacun des trois agents. Résultats: Les cheveux et le polymère ont été des bons absorbants car seulement 12% et 20% du pétrole y restait après une heure, respectivement. Par contre, le savon a été inefficace car encore 62% du pétrole y restait. Pendant la première heure, la survie de l’Artemia dans une marée noire non traitée a été réduite par 63%, comparé aux conditions naturelles (p=0.001). L’exposition au pétrole a produit une courbe dose-réponse conventionnelle car plus d’Artemia sont morts quand la concentration du pétrole a été augmentée; son CL50 a été 17.5%. L’Artemia a supporté les cheveux et le polymère puisqu’aucun agent a atteint son CL50, et environ 80% de l’Artemia ont survécu après une heure. Le savon, n’importe s’il y avait du pétrole, a été toxique à l’Artemia et son CL50 a été 7%. Ces résultats ont été importants statistiquement parmi ces trois groupes (ANOVA; valeur p =<0.001). Conclusion: Les cheveux et le polymère ont été tous les deux des agents efficaces que l’Artemia a supporté dans un environnement de marée noire artificielle

Evaluation of 2 mm locking plates for treating mandibular fractures

Background: The progressive development in the trauma management has now paved way to the use of miniplates for the treatment of mandibular fractures. We present a case series of twenty-five patients treated with miniplates for the mandibular fractures.Methods: The study was done on twenty-five patients diagnosed clinically and radiographically with mandibular fractures and attending the outpatient department of Oral and Maxillofacial surgery of a tertiary care hospital in Jaipur city. The selected cases were treated by open reduction and internal fixation under general anesthesia. 2.0-mm titanium locking mini plates were used as a method of internal fixation. The patients were evaluated for the location, type and number of fractures, time required for adaptation and fixation of single four hole 2.0-mm locking plate, complications during surgery, pre and post-surgical occlusal relationship, adequacy of reduction on postoperative radiograph and any post-surgical complications requiring a secondary surgical intervention.Results: Majority were in the age group of 21-30 years (72%) with a mean age of 26.6 years. Among these, there were 23(92%) male and 2(8%) female patient. Maximum (28%) patients were of symphysis and angle fracture followed by symphysis and condylar (25%), while only 2% cases were of Para symphysis and condylar. The mean time taken for single plate adaptation and fixation was 11.34 minutes for symphysis fracture, 14.12 minutes for parasymphysis fracture, and 11.56 minutes for body fracture and 18.90 minutes for angle fractures.Conclusions: The locking miniplates in mandibular fractures is efficacious enough to appreciate early recovery of normal jaw function, uneventful healing and good union at the fracture site with minimal weight loss due to early reinstatement of masticatory function

Possible Association between Expression of Chemokine Receptor-2 (CCR2) and Amyotrophic Lateral Sclerosis (ALS) Patients of North India

BACKGROUND AND OBJECTIVES: We earlier reported elevated chemokine ligand-2 (CCL2) in Indian amyotrophic lateral sclerosis (ALS) patients. We now analysed chemokine receptor-2 (CCR2), the receptor of CCL2, in these ALS patients. METHODS: Indian sporadic ALS patients (n=50) were included on the basis of El Escorial criteria. Percentage (%) of CCR2 expressing peripheral blood mononuclear cells (PBMCs) was evaluated using Flow Cytometry. Real Time Polymerase Chain Reaction (PCR) was used to quantitate CCR2 mRNA expression in PBMCs. Normal controls (n = 40) were also included for comparison. RESULTS: Flow Cytometry revealed significantly reduced CCR2 expressing PBMCs in the ALS patients. We also found a significant decline in number of CCR2 expressing PBMCs in limb onset ALS when compared to bulbar onset ALS. PBMCs from ALS patients showed substantial down-regulation of CCR2 mRNA. CCR2 mRNA expression was found to be decreased among limb ALS patients as compared to bulbar onset ALS. Further, the count of CCR2+ PBMCs and CCR2 mRNA transcript in PBMCs was significantly lower in severe and moderate ALS as compared to ALS patients with mild impairments. CONCLUSIONS: Downregulation of PBMCs CCR2 may indicate its etio-pathological relevance in ALS pathogenesis. Reduced PBMCs CCR2 may result in decreased infiltration of leukocytes at the site of degeneration as a compensatory response to ALS. CCR2 levels measurements in hematopoietic stem cells and estimation of comparative PBMCs count among ALS, disease controls and normal controls can unveil its direct neuroprotective role. However, the conclusions are restricted by the absence of neurological/non-neurological disease controls in the study

Vascular endothelial growth factor-A and chemokine ligand (CCL2) genes are upregulated in peripheral blood mononuclear cells in Indian amyotrophic lateral sclerosis patients

<p>Abstract</p> <p>Background</p> <p>We have earlier shown that protein levels of vascular endothelial growth factor-A (VEGF-A) and chemokine ligand-2 (CCL2) were elevated in Indian amyotrophic lateral sclerosis (ALS) patients. Here, we report the mRNA levels of VEGF-A and CCL2 in Indian ALS patients since they display extended survival after disease onset.</p> <p>Methods</p> <p>VEGF-A and CCL2 mRNA levels were measured in peripheral blood mononuclear cells (PBMCs) of 50 sporadic Indian ALS patients using Real Time Polymerase Chain Reaction (PCR) and compared with normal controls (n = 50). Their levels were adjusted for possible confounders like cigarette smoking, alcohol and meat consumption.</p> <p>Results</p> <p>VEGF-A and CCL2 mRNA levels were found to be significantly elevated in PBMCs in ALS patients as compared to controls. PBMCs from definite ALS revealed higher VEGF-A mRNA expression as compared to probable and possible ALS. CCL2 mRNA levels were found to be unaltered when definite, probable and possible ALS were compared. PBMCs from patients with respiratory dysfunction showed much higher VEGF-A and CCL2 elevation when compared to patients without respiratory dysfunction. No association of smoking, alcohol and meat consumption with VEGF-A and CCL2 was observed after analyzing the data with univariate and multivariate analysis.</p> <p>Conclusion</p> <p>VEGF-A and CCL2 mRNA upregulation in PBMCs may have a clinico-pathological/etiological/epidemiological association with ALS pathogenesis. The cross-cultural and cross-ethnic investigations of these molecules could determine if they have any role in enhancing the mean survival time unique to Indian ALS patients.</p

Comparative analysis of post-operative analgesic requirements in patients undergoing minor oral surgery using buprenorphine with lignocaine versus lignocaine: a clinical study

Background: We aimed to inspect the post -operative analgesic requirement in patient undergoing minor oral surgery using buprenorphine versus lignocaine and lignocaine alone. Minor oral surgeries are followed by inflammatory reaction characterized by pain, mild swelling and discomfort. Opioid analgesics have an advantage over non-steroidal anti-inflammatory drugs (NSAIDs) as they do not cause organ damage. Buprenorphine has an antinociceptive potency greater than that of morphine. Hence, in this study, buprenorphine was added to lignocaine in relieving postoperative pain after minor oral surgery.Methods: A total of 100 patients requiring minor oral surgery were included in the study. The patients were randomized by a third party and allocated to one of the two study groups. Hence a total of 50 patients in each group were selected for study, during a period of 24 months. 1 ml of buprenorphine hydrochloride injection I.P which contains an equivalent of 0.3 mg buprenorphine was withdrawn into a syringe and injected into a 30 ml vial of 2% lignocaine with adrenaline 1:200000.Results: The pain was found to be statistically significant at 2-hour, 24 hour and 36 hours postoperatively, thereafter the difference in NRS values between the solutions was not significant. Hence, the analgesic effect of solution A (buprenorphine) was effective at 2-hour, 24 hour and 36 hours postoperatively.Conclusions: Our study indicate that addition of 0.3 mg of buprenorphine to local anesthetic solution provides efficient post-operative analgesia and reduces patient's discomfort

A qualitative study exploring the role of pharmacists in medical student training for the prescribing safety assessment

Five years after the introduction of the Prescribing Safety Assessment (PSA) in the UK, the role pharmacists play to help prepare medical students for this challenge is uncertain. Our study explored pharmacists' perceptions about their role in undergraduate medical training for the Prescribing Safety Assessment (PSA). One hundred and seventy-nine prospective participants from UK hospitals and education and training boards were emailed an interview schedule aimed at ascertaining their current involvement in undergraduate medical education, particularly the preparation for PSA. Responses received via email were thematically-analysed. A total of 27 hospital pharmacists and 3 pharmacists from local education and training boards participated in the interviews. Pharmacists were positive about their involvement in medical student training, recognising the added value they could provide in prescribing practice. However, respondents expressed concerns regarding resource availability and the need for formal educational practice mentoring. Despite a low response rate (17%), this research highlights the potential value of pharmacists' input into medical education and the need for a discussion on strategies to expand this role to maximise the benefits from having a pharmacist skill mix when teaching safe prescribin

A Qualitative Study on How Health Professional Students and Their PBL Facilitators Perceive the Use of Mobile Devices During PBL

Mobile devices are increasingly being used by undergraduate students to access online information in the problem-based learning (PBL) process, initially in the self-directed phase, and more recently within face-to-face tutorials. This qualitative study across three undergraduate health professional programs used semi-structured interviews to investigate facilitators’ and students’ perceptions of mobile device usage in PBL tutorials. Transcribed interviews were analyzed thematically, drawing on the principles of grounded theory. Implications for future practice were identified. Students perceived that mobile devices are useful and convenient for instant access to various sources of information, for note taking, and for visually sharing their research and ideas. Despite some facilitator concerns that mobile devices are potentially distracting in face-to-face PBL tutorials, students prioritized collaboration through brainstorming and sharing ideas with group members in face-to-face tutorials over searching online. Facilitators and students suggested practical guidelines for mobile device usage in tutorials to enhance critical thinking in PBL