Behcet\u27s Syndrome: Case Report and Literature Review

Behcet\u27s syndrome is a disease commonly found in Japan and in countries around the Mediterranean Sea. In the U.S., it is relatively uncommon. This report describes a 24-year-old Lebanese-American man with Behcet\u27s syndrome who presented with symptoms four months after he developed arthritis and who had been initially diagnosed as having incomplete Reiter\u27s syndrome. A literature review is Included

Etiological Profile and Clinical Patterns of Uveitis

BACKGROUND: Uveitis is defined as inflammation of the uvea. The inflammatory process primarily affects the uvea with subsequent damage to the retina, optic nerve, sclera and vitreous. Uveitis can be classified based on the anatomical site involved [Standardization of Uveitis Nomenclature (SUN)], or clinical course (acute, chronic, or recurrent), or etiology (infectious or noninfectious), or pathology (granulomatous or nongranulomatous). AIM OF THE STUDY: To study the etiological profile and clinical patterns of uveitis. MATERIALS AND METHODS: Study Design: Cross sectional study. Sample Size: 50. Source of Data: A series of patients with uveitis attending the ophthalmology outpatient department in tirunelveli medical college for a period of 18 months from October 2017 to April 2019. Inclusion Criteria: ◈ All patients with anterior, intermediate, posterior and panuveitis. ◈ Both male and female. ◈ Any age group with uveitis. Exclusion Criteria: ◈ Uveitis with trauma as the etiology. ◈ Uveitis following intraocular surgery. 50 patients with uveitis were enrolled in the study after getting informed consent. A detailed history regarding age, occupation, residence, known systemic diseases past or present was elicited. Patients were questioned about backache/joint problems, skin diseases, respiratory diseases, neurological diseases, gastrointestinal diseases, oral and genital ulcers and sexually transmitted diseases. A thorough ocular examination included best corrected visual acuity (BCVA), slit lamp examination (SLE), indirect ophthalmoscopy (IDO), applanation tonometry (AT), gonioscopy. In addition, fundus fluorescin angiography (FFA), optical coherence tomography (OCT)B scan ultrasonograph were performed if needed. RESULTS: In my study adults (70%) were most commonly affected due to uveitis. The age of patients ranged from 30-60 years. The mean age at presentation was 39.7± 14.06 yrs. Children (1%) and elderly (14%) were less commonly affected. there was no sexual preponderance. Unilateral uveitis (70%) was more common than bilateral (30%). Anterior uveitis was the most common anatomical type of uveitis (64% n=32) followed by panuveitis (16% n=8), posterior (14%n=7) and intermediate uveitis (6% n=3). Chronic uveitis (56%) was more common than acute uveitis (28%). 42% of the uveitis was non granulomatous and 38% of the uveitis was granulomatous .32% (n=16)of the uveitis was due to non infectious etiology and 36%(n=18) of the uveitis was due to infective etiology. CONCLUSION: 1. Anterior uveitis is the most common anatomical type of uveitis. 2. Idiopathic uveitis is the most common type of anterior uveitis. 3. Pars planitis is the most common cause of intermediate uveitis. 4. TB related posterior uveitis is the most common cause of posterior uveitis. 5. Vogt Koyanagi Harada disease and TB related panuveitis are the most common causes of pan uveitis. 6. Infective uveitis is more common than non infective uveitis. 7. Infective uveitis is more common in posterior and panuveitis. 8. Tuberculosis is the most common form of infectious uveitis. 9. Spondyloarthropathy is the most common cause of non-infective cause of uveitis

A study on p00 revalance of Helicobacter pylori infection in gastroduodenal perforation

AIM OF THE STUDY: To study the prevalence of helicobacter pylori infection in Gastroduodenal perforations in Rajiv Gandhi Government General Hospital, Chennai. METHODS: Prospective observational study. The study includes the patients admitted ,evaluated and diagnosed as Gastroduodenal perforation intra operatively. Biopsy was taken from the perforated ulcer site and adjacent mucosa, which was sent for Histopathological examination for Helicobacter Pylori detection by Giemsa staining. RESULTS: 50 patients presenting intra-operatively with Gastroduodenal perforation were studied for H.Pylori by histopathological examination. Of them, 44 (88%) patients were found to have duodenal perforation and 6 (12%) were found to have Gastric perforation. In the duodenal perforation group, 21 (42%) patients were found to be H. pylori positive. In the gastric perforation group, 1 (2%) patient was found to be H. pylori positive. CONCLUSION: 1. Gastroduodenal ulcer perforation still remains one of the most common cause of acute abdominal catastrophe, with male preponderance. 2. We conclude that H. pylori is an important factor in the etiology of gastroduodenal ulcer perforation and accounts for 44 % of the cases. (Duodenal perforation – 42%, Gasstric perforation – 2%) 3. In our study, we found that gastroduodenal ulcer perforation is a multifactorial disease with alcohol (64%), smoking (48%) and NSAIDs (22%) being common causative factors. 4. Hence we conclude that , H.Pylori is one of the causative factor for the Gastroduodenal perforation

A Comparative study to Assess the Outcome and Complications of Grahams Omental Patch Closure Versus Modified Grahams Omental Patch Closure in Perforated Duodenal Ulcer among Patients admitted in General Surgery Department, Government Rajaji Hospital, Madurai

INTRODUCTION: Duodenal ulcer perforation is one of the manifestation of Peptic ulcer disease. Duodenal ulcer represent almost 2/3rd of all peptic ulcer diseases. Perforated duodenal ulcer remains a major health problem world wide. Peptic ulcer disease is primarily associated with H-pylori infection and excessive use of NSAIDs. Since the burden of peptic ulcer disease and its complications are significant worldwide, it is important to conduct a study based on peptic ulcer disease. Life prevalence of duodenal ulcer has found to be 11-14% for males and 8-10% for women. Male to female ratio of duodenal ulcer have reduced from 10:1 to 1.5:1. Duodenal ulcer have been characterized by the presence of a well demarcated break in the mucosa that may extend into muscularis propriya of the duodenum. Duodenal perforation is the second most common complication of PUD and occurs in as many as 10% of patients with PUD. My study compares the outcome and complications of two surgical procedures done for perforated duodenal ulcer namely Grahams Omental Patch Repair and Modified Grahams Omental Patch Closure. AIM OF THE STUDY: The aim of this study is to compare outcome and complications of Graham’s Omental Patch Closure Versus Modified Graham’s Omental Patch Closure for treating perforated duodenal ulcers. OBJECTIVES: To compare outcome and complications of Graham’s Omental Patch Closure Versus Modified Graham’s Omental Patch closure for treating perforated duodenal ulcers. MATERIALS AND METHODS: Study Design: Period of Study: 6 months (April 2018 – September 2018). Place of Study: Government Rajaji Hospital, Madurai. Selection of Study Subjects: All patients diagnosed with peritonitis secondary to hollow viscus perforation who are willing for definitive surgery. Sample Size: 60 patients. Data Collection: Data regarding history, clinical examination,laboratory values & postoperative analysis. METHODS: Prospective comparitative study. ELIGIBILITY CRITERIA: Inclusion Criteria: All patients with perforated duodenal ulcer size < 20 mm who are admitted in general surgery department GRH, Madurai. Exclusion Criteria: Duodenal perforation of other origin such as traumatic and neoplasia. Large duodenal perforation > 20 mm, Posterior duodenal perforation, Sealed duodenal perforation, Patient who expired before definitive surgery, Patient not willing for definitive surgery, Patient not willing for the study. MATERIALS USED: Proforma containing patient history, clinical examination, Informed consent forms. METHODOLOGY: After obtaining clearance and approval from the institutional ethical committee and patients fulfilling the inclusion / exclusion criteria were included in the study after obtaining informed consent. • Patients admitted in surgery department who are diagnosed with perforated duodenal ulcer are grouped into group 1 and group 2. • Non probability purposive sampling technique was used to allocate the subjects into group 1(Grahams omental patch closure) and group 2 (Modified Graham’s omental patch closure). • Initial preoperative work up and resuscitation with intravenous fluids, antibiotics, analgesics, nasogastric decompression was done in all the cases. DISCUSSION In our study we included 60 patients. 30 patients were under Group 1 (GRAHAMS OMENTAL PATCH REPAIR) and 30 patients under Group 2 (MODIFIED GRAHAMS OMENTAL PATCH REPAIR). Age distribution of the patients affected ranged from 13-70 years in the present study. The maximum number of cases studied were in the age group of 31 to 40 (25%). In group 1 mean age was 40.7 (SD – 15.020). In group 2 the mean age was 40.83 (SD-23.181). The two tailed P value equals 0.9795. This difference is considered to be statistically not significant. Most of the patients were males (males 51%). Male female ratio was 51:9. Comparing the two groups chi square statistics is 3.268. The p value is 0.70645. This result is not significant at p < 0.05. Majority of patients presented with symptoms of abdominal pain for 1 to 2 days. (mean days of presentation- 1.68 days). 9 out of 60 patients were diabetic, 3 out of 60 patients were hypertensive. 41 patients out of 60 patients studied had history of smoking (68.3%). 9 out of 60 patients had history of NSAID abuse (15%). The mean duration of ventilator support was 0.3667 days in group 1 and 0.43333 days in group 2. Comparing the two groups the two tailed p value is 0.9409. This result is not statistically significant at p < 0.05. Patients in group 1 have return of bowel activity in an average of 3.43 days. Patients in group 1 have return of bowel activitiy in an average of 3.966 days. Comparing the two groups the two tailed p value is 0.3788. This result is not statistically significant at p < 0.05. 8 out of 30 patients in group 1 developed surgical site infection, while 6 out of 30 patients in group 2 developed surgical site infection. Comparing the two groups chi square statistics is 0.3727 the p value is 0.541552. This result is not statistically significant at p < 0.05. 2 out of 30 patients in group 1 developed metabolic abnormalities post operatively. 2 out of 30 patients in group 2 developed metabolic abnormalities post operatively Comparing the two groups chi square statistics is 0 .the p value is 1. This result is not statistically significant at p < 0.05. Average days of hospital stay in group 1 is 9.9 days. Average days of hospital stay in group 2 is 8.46 days. Comparing the two groups. The two tailed p value is 0.7840. This result is not statistically significant at p < 0.05. 4 out of 30 patients in group 1 died during hospital stay. 4 out of 30 patients in group 2 died during hospital stay. Comparing the two groups chi square statistics is 0 .the p value is 1. This result is not statistically significant at p < 0.05. CONCLUSION: The outcome and complication of both surgeries for perforated duodenal ulcer, that is GRAHAMS OMENTAL PATCH REPAIR and MODIFIED GRAHAMS OMENTAL PATCH REPAIR are independent of the method of surgery done. Thus it is the surgeons choice to select one of the two methods. The major contributing factor for outcome and complication of surgery are the age, day of presentation, peritonitis index and comorbidities of patient rather than the type of surgery done

The significance of antibody production in human renal transplantation

Screening for HLA specific antibodies is an important part of laboratory testing for transplantation. The conventional technique for screening is complement dependent lymphocytotoxicity. The development and increasing use of the sensitive flow cytometric crossmatch technique has meant that this conventional screening method is often less sensitive than the final crossmatch. The aim of this study was the development of a flow cytometric screening technique which would be as sensitive as the flow cytometric crossmatch and the investigation of the newly developed ELISA screening method PRA-STAT. These methods were used to investigate antibody production in patients with failed transplants. Flow cytometric analysis of antibody binding to pooled cells was found to be a reliable and sensitive method for the detection of HLA class I and class II specific antibodies. PRA-STAT also detects both class I and class II specific antibodies. Both flow cytometric and PRA-STAT screening methods were shown to be more sensitive than conventional cytotoxic screening. Screening of patients with failed transplants by these sensitive methods showed that the majority of patients produce both HLA class I and class II donor specific antibodies following failure of a primary transplant. Flow cytometric and PRA-STAT screening detected antibody production earlier than cytotoxic screening in some patients. HLA matching was shown to be related to both graft survival and to the levels of antibody produced following graft failure with poorly matched grafts resulting in higher levels of sensitisation than well matched grafts. Patients with detectable post graft failure antibodies had a lower chance of receiving a second transplant and had significantly worse regraft survival than patients with no antibody. The results of the study suggest that HLA class II specific antibodies and repeat class II mismatches may be detrimental in regrafts and this requires further study

Evaluation of Anti-Ulcer and Anti-Inflammatory Activity of Ethanolic Extract of Solanum Pubescens Willd Leaves on Experimental Animals.

Herbs are staging a comeback and herbal ‘renaissance’ is happening all over the globe. The herbal products today symbolise safety in contrast to the synthetics that are regarded as unsafe to human and environment. Although herbs had been priced for their medicinal, flavoring and aromatic qualities for centuries, the synthetic products of the modern age surpassed their importance, for a while. However, the blind dependence on synthetics is over and people are returning to the naturals with hope of safety and security. Over three-quarters of the world population relies mainly on plants and plant extract for health care. More than 30% of the entire plant species, at one time or other were used for medicinal purposes the study of the ethonolic extract of Solanum pubescens willd leaves possess Anti-ulcer and Anti-inflammatory activity in animal models. Solanum pubescens willd showed a significant decrease in the ulcer development in both the animal models ( pylorus ligated model and Aspirin-induced ulcer model) used in the study

Identification of genetic risk factors for Behçet’s disease

Tese de doutoramento, Ciências Biomédicas (Genética), Universidade de Lisboa, Faculdade de Medicina, 2013Background: Behçet’s disease (BD) is a complex disorder characterized by a generalized vasculitis, whose pathophysiology remains unclear. The identification of genes involved in BD can help to elucidate the disease mechanisms and, ultimately, result in diagnostic and treatment advances.Objectives: To identify genetic risk factors implicated in BD susceptibility. Methods: We performed four independent studies: 1) Analysis of the role of the mitochondrial genome by testing the association of mitochondrial haplogroups and variants with BD risk in 615 Iranian BD cases and 434 controls; 2) Follow-up of IL10 and IL23RIL12RB2 associations, previously identified as BD risk factors, in 973 Iranian BD cases and 637 controls; 3) Gene expression profiling in 15 Portuguese BD cases and 14 controls and association testing of the differentially expressed genes in 976 Iranian BD cases and 839 controls; 4) A genome-wide association study for the Iranian population in DNA pools of 292 BD cases and 294 controls and replication of the association findings in 684 BD cases and 532 controls.Results: We identified a novel association of BD with the mitochondrial 12S rRNA gene (7.00E-03<P<3.80E-02); replicated the association of IL10 (P=2.53E-02) and IL23R-IL12RB2 loci (1.93E-06<P<1.78E-05) and identified the region upstream IL23R as the most associated one; identified EREG, AREG and NRG1 (members of the Neuregulin signalling) as downregulated in BD patients, found a novel association in the EREG-AREG locus (P=2.51E-02) and replicated three associations at NRG1 (6.61E-04<Pmeta<2.10E-03); and identified five coding variants at FUT2 associated with BD (2.97E-06<P<1.34E-04).Conclusions: During the course of this project we have uncover the mitochondrial genome,the neuregulin signaling and the FUT2 gene as novel players in BD susceptibility that may contribute to the abnormal immunological response observed in BD patients. We have further contributed to establish the IL10 and IL23R loci as worldwide risk factors for Behçet’s disease.Introdução: A doença de Behçet (DB) é uma doença complexa caracterizada por uma vasculite generalizada, cuja patofisiologia é ainda pouco conhecida. A identificação de genes envolvidos na DB pode ajudar a elucidar os mecanismos de doença levando a avanços a nível do diagnóstico e tratamento.Objetivos: Identificar factores de risco genético para a DB. Métodos: Realizou-se quatro estudos independentes: 1) Análise do papel do genoma mitocondrial, onde se testou a associação da DB com haplogrupos e variantes mitocondriais, em 615 casos e 434 controlos Iranianos; 2) Follow-up da associação dos genes IL10 e IL23RIL12RB, previamente identificados como factores de risco para a DB, em 973 casos e 637 controlos Iranianos; 3) Estudo de perfis génicos em 15 casos com DB e 14 controlos Portugueses e teste da associação dos genes diferencialmente expressos em 976 casos e 839 controlos Iranianos; 4) Estudo de associação no genoma inteiro (GWAS) para a DB na população Iraniana, em pools de ADN com 292 casos e 294 controlos, e replicação das associações identificadas em 684 casos e 532 controlos.Resultados: Identificou-se uma nova associação da DB com o gene mitocondrial 12S rRNA (7.00E-03<P<3.80E-02); Replicou-se a associação do IL10 (P=2.53E-02) e locus IL23R-IL12RB2 (1.93E-06>P<1.78E-05) e identificou-se a região regulatória do IL23R como a mais mais fortemente associada; Verificou-se a sub-expressão do EREG, AREG e NRG1 (pertencentes à via da Neuregulina) em pacientes com DB, a associação do locus EREG-AREG (P=2.51E-02) e replicou-se três associações no NRG1 (6.61E-04<Pmeta<2.10E-03); Identificou-se cinco variantes codificantes no FUT2 associadas com a DB (2.97E-06<P<1.34E-04). Conclusões: Durante o curso deste projecto, identificou-se o genoma mitocondrial, a via da Neuregulina e o FUT2 como novos intervenientes na suscetibilidade para a DB que podem contribuir para a resposta imunológica alterada observada nos pacientes com DB. Adicionalmente, contribui-se para estabelecer o IL10 e IL23R como fatores de risco mundiais para a DB

Design, Insilico Molecular Docking,Synthesis and Evaluation of Antiulcer Activity of Benzimidazole Derivatives

The present study was aimed to design some possible novel benzimidazole derivatives as H+/K+-ATPase receptor inhibitor, carry out their molecular docking study and finally to evaluate its antiulcer activity by Indomethacin induced and Pylorus ligation induced ulcer model. All the designed compounds were docked with the crystal structure of H+/K+-ATPase receptor (PDB ID:2ZBD) using Glide software version 10.1,Schrodinger,LLC,New York, NY, 2015 and a series of benzimidazole derivatives have been synthesized based on dock score and interactions. The structures of synthesized compounds were characterized by UV,FTIR,1H NMR and mass spectral analysis. The synthesized compounds were evaluated for their in vitro antioxidant activity and in vitro cell viability assay .Acute toxicity study was carried out for the compound P-28(dock score:-8.67) based on OECD 423 Guidelines and the compound was found to be safe up to the dose of 1000mg/kg. After 6 days pretreatment with the test compound at the 50mg/kg (Low dose) ,100mg/kg (High dose) and the standard drug, pantoprazole was administered at the dose of (10mg/kg) ,on the 7th day toxicant was administered and after 4hrs animals were sacrificed , ulcer index , gastric volume, gastric pH, total acidity, free acidity was measured. In vivo antioxidant activity of treated group showed a increased level of SOD,CAT,GPX, GSH, Total protein and an decreased level of LPO,MPO . Histopathological studies were carried out to further analyze the compound. Based on above results ,it was concluded that the compound P-28 posses significant in vivo antioxidant and antiulcer activity as that of the standard (pantoprazole) and can be used as a lead for the development of newer antiulcer agents

Pathological Anatomy. Lecture course

УЧЕБНО-МЕТОДИЧЕСКИЕ ПОСОБИЯАНАТОМИЯПАТОЛОГИЧЕСКАЯ АНАТОМИЯPATHOLOGICAL ANATOMYLECTURE COURSEЧАСТНАЯ ПАТОЛОГИЯПАТОЛОГИЯВ пособии представлены наиболее важные темы, охватывающие полный курс патологической анатомии