51 research outputs found
A Study of Dexamethasone - Cyclophosphamide Pulse Therapy in Pemphigus Patients
INTRODUCTION :
The term “Pulse Therapy” has been used for a system of administering drugs
in which a very high dose of the drug is given over a very short period for getting a
quick result, and then the drug is withdrawn completely till it is needed or used again.
Pulse therapy (the big shot) defined as administration of large (supra
pharmacological) dose of drugs in an intermittent manner, to enhance the therapeutic
effects and to reduce the iatrogenic side effects of drugs.
It is a relatively recent concept; this method has been observed to produce
superior therapeutic results which cannot be produced by the conventional methods of
giving daily dosages while the side effects of the drugs are reduced very
significantly.
The list of dermatological indications for pulse therapy is increasing day by
day and now it includes pemphigus and other autoimmune bullous diseases, collagen
vascular diseases like systemic lupus erythematosus, progressive systemic sclerosis,
Dermatomyositis, allergic vasculitis, Pyoderma gangrenosum, Prurigo nodularis,
generalized lichen planus, resistant alopecia universalis, sarcoidosis, psoriasis,
Darrier’s disease, fast spreading vitiligo, airborne contact dermatitis.
The auto immune vesiculo bullous diseases are a heterogenous group of
diseases. They are classified on the basis of their clinical, histopathological and
immuno pathological features. They can be broadly classified histopathologically into
epidermal and sub-epidermal blistering dermatoses.Though these disorders are rare in
general population, for a given patient the impact of the diseases on the quality of the
life can be devastating. The severity is often variable and the course is unpredictable
and may even be fatal.
Pemphigus is the commonest autoimmune vesiculobullous disorder of the
Indian subcontinent5. The main treatment for pemphigus lies in using corticosteroids
and other similar drugs which do help the patient to recover from the disease but
whenever an attempt is made to withdraw the drugs the disease tends to became active
again. Long term use of these drugs lead to some serious side effects.
The Dexamethasone cyclophosphamide pulse therapy pioneered by
Dr.Pasricha et al. consists of giving dexamethasone and cyclophosphamide in a very
large doses on three consecutive days and repeated at fixed 28 days interval. In this
method these drugs are claimed to knock out the disease process so that the patient
recovers completely while the side effects are very much reduced and almost
insignificant6. It is claimed that there is almost no risk of a relapse or recurrence
provided the treatment has been taken strictly as per the recommendations7.
With the ever increasing use of DCP pulse therapy in dermatology there is an
increasing necessity for studies to evaluate its efficacy and side effect profile, and this
study is an attempt in that direction.
AIM OF THE STUDY :
This study of Dexamethasone Cyclophosphamide Pulse therapy in Pemphigus
patients was undertaken
1. To find out the clinical efficacy of DCP therapy in Pemphigus patients.
2. To find out the various side effects of the regimen.
MATERIALS AND METHODS :
The material for this study was from the patients attending the skin OPD,
Government Rajaji Hospital, Madurai Medical College, Madurai with pemphigus,
during the period of June 2005 – June 2007.
Inclusion Criteria:
1. Above 18 years of age
2. The patients with pemphigus vulgaris, pemphigus foliaceus, pemphigus
erythematosus registered during the period from June 2005 –June 2007 and whose
diagnosis was confirmed by Histopathological examination and Direct
immunofluorescence.
Exclusion Criteria :
1. Age below 18 years.
2. Uncontrolled diabetes mellitus/ Hypertension. However diabetic and hypertensive
patients were included, if their disease was under control with appropriate therapy.
The routine antidiabetic and antihypertensive drugs were continued in the same
dose along with DCP. However six units of insulin was added to counter the effect
of 5% dextrose in diabetic patients.
3. Severe systemic diseases where high dose steroids are contra-indicated.
4. Pregnant and lactating mothers.
5. Patients on long term systemic steroids therapy.
6. Pemphigus patients in whom the diagnosis could not be confirmed by DIF.
7. Patients who had not completed their family.
After applying the criteria mentioned above, 26 cases of pemphigus enrolled
for pulse therapy and followed up from June 2005 – June 2007. After their informed
consent they were hospitalized and thorough general, systemic and dermatological
examinations were done. Relevant Baseline investigations like complete haemogram,
routine blood biochemistry, urine examination, electro-cardiography, chest X-ray,
semen analysis, baseline Fitzpatrick skin typing were done.
Dexamethasone Cyclophospamide pulse therapy was administered to each
patient, strictly adhering to the prescribed guidelines. Due importance was given to
patient education regarding the disease process and the treatment regimen.
During every pulse, complete blood count, urine analysis especially for red
blood cells, electrocardiogram, blood sugar, blood urea, serum electrolytes, liver
function tests, stool examination for occult blood, ophthalmic examination for
cataract, blood pressure recording and weight charting were done.
RESULTS :
In this study, 26 cases of Pemphigus patients from the outpatient Department
of Dermatology, Government Rajaji Hospital, Madurai were treated with
Dexamethasone Cyclophosphamide pulse therapy and observed during the period of
June 2005 – June 2007; The following observations were made.
Of the 26 pemphigus patients 18 (70%) patients had pemphigus vulgaris,
7 (26%) patients had pemphigus foliaceus, and 1 (4%) patient had pemphigus
erythematosus. Thus pemphigus vulgaris is by far the most predominant type of
pemphigus requiring DCP therapy.
CONCLUSION :
1. Pemphigus vulgaris is by far the commonest epidermal autoimmune
vesiculobullous disorder that requires Dexamethasone cyclophosphamide
pulse therapy.
2. An overwhelming majority of patients requiring DCP for Pemphigus are in
the reproductive age group.
3. DCP significantly improves patient compliance by reducing the duration of
hospital stay.
4. The average number of pulses required to achieve clinical remission is
significantly higher than the figures mentioned in the available literature.
5. Septicaemia is the commonest cause of death in patients receiving DCP.
6. Metabolic side effects attributable to long term steroid therapy are
significantly lower in patients treated with DCP.
7. An universally acceptable clinical grading of Pemphigus is needed to
objectively assess the baseline severity and subsequent improvement. It would
also allow for a fair comparison of the results reported by different centres.
8. Potentially irreversible gonadal suppression appears to be the most important
side effect against which the benefits of DCP have to be weighed.
9. Ways and means to reduce the gonadal toxicity of DCP need to be explored,
as DCP therapy is likely to stay as the treatment of choice in autoimmune
vesiculobullous diseases
Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study
Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research
Reproductive biology and biochemical changes associated with flowering of Dendrocalamus stocksii and Ochlandra travancorica
EFFECT OF CRUDE SULPHATED POLYSACCHARIDE FROM MARINE BROWN ALGAE IN TPA INDUCED INFLAMMATION ON POLY MORPHONUCLEAR LEUKOCYTES
Objective: The present study aims to evaluate the anti-inflammatory activity of crude sulphated polysaccharide from marine brown algae sargassum ilicifoliumMethods: The present study involves the investigation of crude sulphated polysaccharide from marine brown algae sargassum ilicifolium for anti-inflammatory activity by TPA [12- O- Techanoyl 13 – Myristate] induced inflammation in Polymorphonuclear leukocytes [PMNL]. T.h.e cell viability by Trypan blue dye exclusion assay, MTT assay, release of Cathepsin D, Nitrite, TNF-α levels was assessed. Diclofenac was used as the standard drug for comparison.Results: Crude sulphated polysaccharide were isolated from brown seaweed sargassum ilicifolium. Crude sulphated polysaccharide showed the significant increase in the number of viable PMNL cells. It has further reduced the release of Cathepsin D, Nitrite and TNF-α. The levels of which are increased during inflammatory conditions.Conclusion: Therefore our studies support the isolation and the use of sulphated polysaccharide in treating inflammation and rheumatism.Â
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