Therapeutic options for systemic sclerosis

Systemic sclerosis is a uncommon connective tissue disorder characterized by vascular damage, immune cell activation and fibrogenesis. Each of these components may respond to different therapies. Therefore, a combination strategy treating all three processes is more likely to control the disease than single agent therapy. Clinical trials have gone a long way towards defining the therapy of scleroderma and many drugs previously used for scleroderma have been critically assessed. Angiotensin blockade is effective in treating as well as preventing scleroderma renal crisis. The 9-year cumulative survival has improved from 38% to 68% after the introduction of angiotensin blockade. There is definitive evidence supporting the use of cyclophosphamide in systemic sclerosis associated alveolitis. Newer molecules aimed at various cytokines are being tried. The therapy for systemic sclerosis is far from perfect at present. But, individualization of the treatment with respect to stage and subset of disease as well as organ involvement can eventually result in rational, effective management

Leprosy & gangrene: A rare association; role of anti phospholipid antibodies

BACKGROUND: Leprosy still remains an important public health problem for many parts of the world. An association of gangrene with leprosy is a rare one & can have a number of causative mechanisms. We present a case with Leprosy & gangrene with positive anti phopholipid antibody titers. CASE PRESENTATION: A 50-year-old non-diabetic, non-hypertensive lady presented with 2 months history of progressive gangrene of bilateral toes. She was found to have madarosis & hypopigmented, hypoaesthetic macular lesions on the upper limb & thighs. Bilateral ulnar & popliteal nerves were thickened. A skin biopsy of the lesions revealed borderline tuberculoid leprosy, slit skin smears revealed a bacteriological index of 1+. She did not have any evidence of thromboembolic episode or atherosclerosis. ACLA was positive at presentation & also on another occasion 6 weeks later. ACLAs were of the IgM type on both occasions. Lupus Anticoagulant & β2 GPI antibody were negative. DOPPLER of the lower limb arteries did not reveal any abnormality. Patient was successfully treated with multi-drug antileprotics & anticoagulants. CONCLUSION: Infectious APLAs should be recognized as a cause of thrombosis in Leprosy. Appropriate anticoagulation can salvage limb function

Therapeutic options for systemic sclerosis

Systemic sclerosis is a uncommon connective tissue disorder characterized by vascular damage, immune cell activation and fibrogenesis. Each of these components may respond to different therapies. Therefore, a combination strategy treating all three processes is more likely to control the disease than single agent therapy. Clinical trials have gone a long way towards defining the therapy of scleroderma and many drugs previously used for scleroderma have been critically assessed. Angiotensin blockade is effective in treating as well as preventing scleroderma renal crisis. The 9-year cumulative survival has improved from 38% to 68% after the introduction of angiotensin blockade. There is definitive evidence supporting the use of cyclophosphamide in systemic sclerosis associated alveolitis. Newer molecules aimed at various cytokines are being tried. The therapy for systemic sclerosis is far from perfect at present. But, individualization of the treatment with respect to stage and subset of disease as well as organ involvement can eventually result in rational, effective management

Leprosy & gangrene: A rare association; role of anti phospholipid antibodies

Abstract Background Leprosy still remains an important public health problem for many parts of the world. An association of gangrene with leprosy is a rare one & can have a number of causative mechanisms. We present a case with Leprosy & gangrene with positive anti phopholipid antibody titers. Case presentation A 50-year-old non-diabetic, non-hypertensive lady presented with 2 months history of progressive gangrene of bilateral toes. She was found to have madarosis & hypopigmented, hypoaesthetic macular lesions on the upper limb & thighs. Bilateral ulnar & popliteal nerves were thickened. A skin biopsy of the lesions revealed borderline tuberculoid leprosy, slit skin smears revealed a bacteriological index of 1+. She did not have any evidence of thromboembolic episode or atherosclerosis. ACLA was positive at presentation & also on another occasion 6 weeks later. ACLAs were of the IgM type on both occasions. Lupus Anticoagulant & β2 GPI antibody were negative. DOPPLER of the lower limb arteries did not reveal any abnormality. Patient was successfully treated with multi-drug antileprotics & anticoagulants. Conclusion Infectious APLAs should be recognized as a cause of thrombosis in Leprosy. Appropriate anticoagulation can salvage limb function.</p

E-Medicine - Use of the Internet as a resource of health information by patients: A clinic-based study in the Indian population

Background: There is abundant literature documenting that the Internet is fast changing the way patients access health-related information, learn about their illnesses, and make healthcare- related decisions. However, there is hardly any data regarding Indian patients accessing health-related information available on the Internet. Aims: To determine patients\u2032 use of the Internet as a medical information resource and to determine their experience, their perceptions of the quality and reliability of the information available. Setting: The study was carried out in the outpatient clinic of an urban, tertiary care private sector hospital in November 2004. Material and Methods : Our survey instrument consisted of an anonymous single-page questionnaire. Eight hundred and eighty consecutive adults aged 18-70 years, attending the general outpatient clinic of a tertiary care private hospital completed the questionnaire. Results: Two hundred and eighty-one (32%) patients acknowledged surfing the Internet, while 75% (212/281) of them acknowledged that they accessed health-related information. Amongst those who accessed the Internet, 130 (61%) found the information on the net to be of average quality. Almost all patients (211/212) felt that the information served the purpose and 95% (201/212) also found also found it to be reliable. Only 7% (21/281) patients were aware of the presence of any quality standards pertaining to health information sites and none could name any accreditation standard. Conclusions: One in four patients attending the private set-up is using the Internet for health information. A majority of patients find the information on the net reliable and of good quality. Awareness about health information quality standards is a rarity