Histomorphological study of vesiculobullous lesions of skin: a study of 66 cases at tertiary care center

Background: Wide variety of pathological processes can lead to development of vesiculobullous eruptions over the body. They may occur in many dermatoses which include various inflammatory, infective, autoimmune, drug induced as well as genetic conditions. Each entity of vesiculobullous lesion has similar or confusing clinical features but different histopathological morphology outcome. However, these disorders are still associated with substantial morbidity, considerable mortality and impaired quality of life. Histopathological examination is helpful in definitive diagnosis of vesiculobullous disorder which is very essential for specific treatment and an appropriate desirable outcome. Aim was to study and classify various vesiculobullous lesions of the skin. Methods: It was a hospital based prospective and retrospective study conducted for a period from January 2016 to July 2019 in the department of pathology at Government medical college, Surat, Gujarat. Total of 66 patients, aged 3-70 years with vesiculobullous lesions of both sexes attending the department of dermatology were selected and analysed clinically. The specimens were routinely processed and hematoxylin and eosin stained slides were studied. Results: In the present study, majority of patients presented between 41-50 years of age (32%) with male to female ratio of 1.08:1. Pemphigus vulgaris constituted the most common vesiculobullous disorder (30.30%) followed by pemphigus foliaceous (24.24%) followed by bullous pemphigoid (15.05%). Bullae were located intra epidermally in (36%+24.78%) and sub epidermally in 24% of the patients. Conclusions: Thorough histopathological workup and clinical correlation is essential to confirm diagnosis of vesiculobullous lesions of skin

FORMULATION, OPTIMIZATION, CHARACTERIZATION AND IN VIVO ANTI-ULCER ACTIVITY OF ESOMEPRAZOLE MAGNESIUM TRIHYDRATE GASTRORESISTANT MICROSPHERES

Objective: The objective of the present investigation was to prepare gastro-resistant microspheres of esomeprazole magnesium trihydrate (EMT) to prevent its degradation in the acidic environment of the stomach and enhance its bioavailability via intestinal absorption.Methods: EMT loaded gastro-resistant microspheres were prepared using hypromellose acetate succinate (HPMCAS) as the gastro-resistant polymer by ‘non-aqueous solvent evaporation' technique. A 3-factor 3 level factorial design was used to optimise EMT: HPMCAS ratio, the concentration of Span 80 and stirring speed with respect to percent entrapment efficiency and particle size. Further characterization was carried out using scanning electron microscopy (SEM), differential scanning calorimetry (DSC), In vitro release study and In vivo anti-ulcer activity.Results: Fourier transform infrared (FTIR) study indicated compatibility between drug and polymer. DSC study revealed that the drug was molecularly dispersed in the polymer. The optimised batch showed 49.63±1.23% drug entrapment and 170.12±3.36 μm particle size. SEM study showed that microspheres were spherical in shape. In vitro drug release study showed only 4.28±1.23% drug release in simulated gastric media in 2 hr and 93.46±1.20% release in simulated intestinal media after 1 hr from the optimised batch.Conclusion: Results of in vitro release studies indicated the gastro-resistant nature of the developed microspheres. In vivo anti-ulcer activity demonstrated that EMT loaded microspheres were able to significantly reduce ethanol-induced ulcer formation in rats' stomach as compared to the aqueous solution of EMT. So it can be concluded that the developed gastro-resistant microspheres of EMT prevented drug release in the stomach which would lead to a significant improvement in its bioavailability through enhanced intestinal absorptio

A Review of Palm Oil Biodiesel under Long-Term Storage Conditions

Palm-oil biodiesel is widely used as alternative to diesel; the influences of long-term oxidative degradation on its burning characteristics are a matter of some concern. To further our understanding of this issue, this study investigated the heat release, carbon residue, flash point, and cetane index, oxidative stability, Density, Viscosity, Total acid no. of palm-oil biodiesel in a constant-temperature water bath after long-term storage. DOI: 10.17762/ijritcc2321-8169.15016

A Review of Internal Combustion Engine Design

The most successful inventions of human includes internal combustion engine (I C Engine) as top of the list. The recent emphasis on fuel economy, pollution control and other automobile fields like low friction body profile has also stimulated theoretical searches for an automobile. Studies have found no alternative type that promises to have significant advantages in fuel economy or pollution control than conventional I C Engines. But from these studies, it appears that the conventional types of spark-ignition and Diesel engines will remain in their present predominant position in land and sea transportation and for industrial and portable power for the foreseeable future. And so, here is an approach to have combined design aspects for all basic I C Engine components in one paper. Design aspects includes components like, piston, piston rings, cylinder, cylinder head, connecting rod, crank and crank shaft, cam and cam shaft along with valve and valve gear mechanism. A paper can be the base for future detailed designing work of I C Engine along with stress analysis and simulation

Sporadic ovarian sex cord-stromal tumor with annular tubules: a rare case report

Ovarian sex cord stromal tumor with annular tubules (SCTAT) is a distinctive, rare subtype of sex cord stromal tumor of the ovary, predominant component of which has morphological features intermediate between that of granulosa cell and sertoli cell. The majority of ovarian SCTAT are benign. So far, malignant behavior in SCTAT has been reported only in sporadic cases. We have presented a case of SCTAT in a 40 year old lady with no association of Peutz-Jegher (P-J) syndrome. The patient’s chief complaints were post-menopausal bleeding for 1 year on and off along with menorrhagia. MRI abdomen was suggestive of intensely enhancing solid tissue mass lesion in the right  adnexa, features suggestive of ovarian mass. Panhysterectomy was done. Grossly uterus and left adnexa appeared to be normal. Right ovary showed mass measuring 17x11x9cm3 in size, on cut section, solid, homogenous lobulated, yellowish areas identified. Microscopic and Immunohistochemistry findings confirmed the diagnosis of sex cord stromal tumor with annular tubules of granulosa cell type. PAS stain supported the diagnosis

Carcinoma of breast with medullary features: a case report in 27 year old female

Medullary carcinoma of breast is a rare variant of invasive ductal carcinoma of breast and its incidence is less than 5% of invasive breast carcinomas. These tumours tend to occur in younger women, with the average age reported to range from 42 to 52 years. Authors are presenting this case in a 27 years old female having single, large, well circumscribed mass in right breast for 6 months. Fine needle aspiration cytology report was proliferative lesion with atypia Histopathology report was given as carcinoma with medullary features. Immunohistochemistry showed Estrogen Receptor (ER), Progesterone Receptor (PR) and Her-2 neu negative. Authors are presenting this case of Medullary carcinoma of breast for being a specific histopathological subtype

Clinical profile of patients with prosthetic heart valve thrombosis undergoing fibrinolytic therapy and NYHA class as a predictor of outcome

Background: Prosthetic heart valve thrombosis (PHVT) is a potentially fatal complication of heart valve replacement with mechanical prostheses mainly due to thrombosis.Aim: The study aimed to evaluate the clinical profile of the patients presenting with PHVT undergoing fibrinolytic therapy and analyzing patients with respect to New York Heart Association (NYHA) functional class on presentation and its association with outcome of fibrinolytic therapy.Settings & design: This was prospective, observational study conducted from June, 2016 to April, 2017. Total 133 patients with prosthetic heart valve thrombosis were included. Materials and methods: Routine blood investigations included complete hemogram, liver and renal function tests. Prothrombin time with INR was done on admission. The diagnosis of PHVT was assessed by fluoroscopy and/or echocardiography (transthoracic/transesophageal). Follow-up at 6 months was scheduled for all patients.Statistical analysis: Parametric values between two groups were performed using the independent sample t-test or chi-square test, as appropriate. Univariate and multivariate logistic regression was used to find out factors associated with outcome.Results: All patients received fibrinolytic therapy in which 108 (81.2%) were treated with streptokinase and 25 (18.8%) were treated with urokinase. On presentation, 48.9% patients were in NYHA class III, 41.4% in NYHA class IV and 9.77% in NYHA class II. Fibrinolytic therapy was successful in 105 patients (78.9%) and it failed in 28 patients (21.1%). Mortality in NYHA class II was 0%, NYHA class III was 4.6% and in NYHA class IV was 23.6%. During 6 months follow up prosthetic heart valve thrombosis recurred in 12 (11.43%) patients.Conclusion: From our single centre experience, fibrinolytic therapy is fairly effective first line therapy for prosthetic heart valve thrombosis and NYHA functional class on presentation can predict the outcome of fibrinolytic therapy

Adipose saturation reduces lipotoxic systemic inflammation and explains the obesity paradox

Obesity sometimes seems protective in disease. This obesity paradox is predominantly described in reports from the Western Hemisphere during acute illnesses. Since adipose triglyceride composition corresponds to long-term dietary patterns, we performed a meta-analysis modeling the effect of obesity on severity of acute pancreatitis, in the context of dietary patterns of the countries from which the studies originated. Increased severity was noted in leaner populations with a higher proportion of unsaturated fat intake. In mice, greater hydrolysis of unsaturated visceral triglyceride caused worse organ failure during pancreatitis, even when the mice were leaner than those having saturated triglyceride. Saturation interfered with triglyceride\u27s interaction and lipolysis by pancreatic triglyceride lipase, which mediates organ failure. Unsaturation increased fatty acid monomers in vivo and aqueous media, resulting in greater lipotoxic cellular responses and organ failure. Therefore, visceral triglyceride saturation reduces the ensuing lipotoxicity despite higher adiposity, thus explaining the obesity paradox

Study of usefulness of speckle-tracking echocardiography in detecting left ventricular dysfunction among adult cancer patients undergoing chemotherapy

Objective: Cancer treatment-related cardiac dysfunction (CTRCD) is a significant concern for patients undergoing chemotherapy. The aim of the present study was to study the accuracy and value of longitudinal strain in prediction of left ventricular dysfunction (LVD) in cancer patients undergoing cancer therapy. Methods: This was a prospective observational study conducted among 183 adult patients undergoing chemotherapy between 2018 and 2020. Patients with congenital or acquired valvular disease, prior myocardial infarction, coronary revascularization, or cardiac surgery were excluded. The patients were evaluated using a detailed history, clinical examination and echocardiography at baseline, 1 month, 3 months, and 6 months after chemotherapy. Speckle-tracking strain analysis was used to evaluate left ventricular (LV) global longitudinal strain (GLS), circumferential strain (GCS), and radial strain (GRS). LVD was defined as >15% decrease in GLS, GCS, or GRS from baseline to 6 months. Accuracy of longitudinal strain in prediction of LVD was studied using ROC analysis. Results: Of the 183 patients, 59% were male, and 54.1% were between 46-60 years of age. Breast cancer was the most common malignancy (10.9%). The most common chemotherapy regimen was doxorubicin + paclitaxel (9.9%). At baseline, the mean GLS, GCS, and GRS were -18.6 (1.03)%, -20.4 (1.11)%, and 39.9 (6.09)%, respectively. At the 6-month follow-up, 27 (14.8%) patients had LVD. The incidence of LVD was higher (51.48%) in patients who received doxorubicin-containing regimens compared to non-doxorubicin-containing regimens (P <0.0001). GLS has good accuracy in prediction of LVD at 6 months of follow-up (88.37%). Conclusions: The incidence of LV dysfunction was higher (51.48%) in patients who received doxorubicin-containing regimens. GLS is different in LVD vs non LVD and the accuracy of GLS is more in prediction of LVD development during 6-month follow-up (88.37%)

Src Dependent Pancreatic Acinar Injury Can Be Initiated Independent of an Increase in Cytosolic Calcium

Several deleterious intra-acinar phenomena are simultaneously triggered on initiating acute pancreatitis. These culminate in acinar injury or inflammatory mediator generation in vitro and parenchymal damage in vivo. Supraphysiologic caerulein is one such initiator which simultaneously activates numerous signaling pathways including non-receptor tyrosine kinases such as of the Src family. It also causes a sustained increase in cytosolic calcium- a player thought to be crucial in regulating deleterious phenomena. We have shown Src to be involved in caerulein induced actin remodeling, and caerulein induced changes in the Golgi and post-Golgi trafficking to be involved in trypsinogen activation, which initiates acinar cell injury. However, it remains unclear whether an increase in cytosolic calcium is necessary to initiate acinar injury or if injury can be initiated at basal cytosolic calcium levels by an alternate pathway. To study the interplay between tyrosine kinase signaling and calcium, we treated mouse pancreatic acinar cells with the tyrosine phosphatase inhibitor pervanadate. We studied the effect of the clinically used Src inhibitor Dasatinib (BMS-354825) on pervanadate or caerulein induced changes in Src activation, trypsinogen activation, cell injury, upstream cytosolic calcium, actin and Golgi morphology. Pervanadate, like supraphysiologic caerulein, induced Src activation, redistribution of the F-actin from its normal location in the sub-apical area to the basolateral areas, and caused antegrade fragmentation of the Golgi. These changes, like those induced by supraphysiologic caerulein, were associated with trypsinogen activation and acinar injury, all of which were prevented by Dasatinib. Interestingly, however, pervanadate did not cause an increase in cytosolic calcium, and the caerulein induced increase in cytosolic calcium was not affected by Dasatinib. These findings suggest that intra-acinar deleterious phenomena may be initiated independent of an increase in cytosolic calcium. Other players resulting in acinar injury along with the Src family of tyrosine kinases remain to be explored. © 2013 Mishra et al