LL Patients Research Articles

Modifications of the articular eminence inclination in association with the loss of occlusal support in the molar area. A cone-beam computed tomography study.

The articular eminence (AE) is part of the temporal component of the temporomandibular joint (TMJ). The inclination of the AE (AEI) has an important role in TMJ biodynamics, influencing the path of movement of the disc-condyle complex. Although AEI values might change due to tooth loss, little is known about what effect could have the loss of occlusal support in the molar area on AE morphology. AEI was measured on cone-beam computed tomography (CBCT) images of 41 patients (82 TMJs) with or without occlusal support in the molar region. The patients included in this study were divided into four groups: (1) patients with maintained occlusal support in the molar areas on both sides (right and left side) (MM); (2) patients with loss of occlusal support in the molar areas on both sides (right and left side) (LL); (3) patients with loss of occlusal support in the molar area only on the right side, but with maintained occlusal support on the left molar area (LM); (4) patients with loss of occlusal support in the molar area only on the left side, but with maintained occlusal support in the right molar area (ML). AEI values were higher in the TMJs on the side with maintained occlusal support in the molar area (M) than the AEI values measured in TMJs from the side with loss of occlusal support in the molar area (L). AEI values on the right side were higher in the MM patients in comparison to the AEI values on the right side of LL patients. The loss of occlusal support in the molar areas changes the mandibular biodynamics, which might be reflected in the morphological changes at the AE level, where it might cause flattening of the articular slope predominantly on the right side.

Whole blood transcriptomics reveals the enrichment of neutrophil activation pathways during erythema nodosum leprosum reaction.

Patients with the multibacillary form of leprosy can develop reactional episodes of acute inflammation, known as erythema nodosum leprosum (ENL), which are characterized by the appearance of painful cutaneous nodules and systemic symptoms. Neutrophils have been recognized to play a role in the pathogenesis of ENL, and recent global transcriptomic analysis revealed neutrophil-related processes as a signature of ENL skin lesions. In this study, we expanded this analysis to the blood compartment, comparing whole blood transcriptomics of patients with non-reactional lepromatous leprosy at diagnosis (LL, n=7) and patients with ENL before administration of anti-reactional treatment (ENL, n=15). Furthermore, a follow-up study was performed with patients experiencing an ENL episode at the time of diagnosis and after 7 days of thalidomide treatment (THAL, n=10). Validation in an independent cohort (ENL=8; LL=7) was performed by RT-qPCR. An enrichment of neutrophil activation and degranulation-related genes was observed in the ENL group, with the gene for the neutrophil activation marker CD177 being the most enriched gene of ENL episode when compared to its expression in the LL group. A more pro-inflammatory transcriptome was also observed, with increased expression of genes related to innate immunity. Validation in an independent cohort indicated that S100A8 expression could discriminate ENL from LL. Supernatants of blood cells stimulated in vitro with Mycobacterium leprae sonicate showed higher levels of CD177 compared to the level of untreated cells, indicating that the leprosy bacillus can activate neutrophils expressing CD177. Of note, suggestive higher CD177 protein levels were found in the sera of patients with severe/moderate ENL episodes when compared with patients with mild episodes and LL patients, highlighting CD177 as a potential systemic marker of ENL severity that deserves future confirmation. Furthermore, a follow-up study was performed with patients at the time of ENL diagnosis and after 7 days of thalidomide treatment (THAL, n=10). Enrichment of neutrophil pathways was sustained in the transcriptomic profile of patients undergoing treatment; however, important immune targets that might be relevant to the effect of thalidomide at a systemic level, particularly NLRP6 and IL5RA, were revealed. In conclusion, our study reinforces the key role played by neutrophils in ENL pathogenesis and shed lights on potential diagnostic candidates and novel therapeutic targets that could benefit patients with leprosy.

Association of serum chemerin levels with complications and comorbidity in rheumatoid arthritis

Introduction. Rheumatoid arthritis (RA) is a systemic autoimmune disease as well as a typical inflammatory process. Chemerin is a fat tissue cytokine, which specific receptors were discovered on the surface of the innate immune cells. It is of interest to study the association of chemerin with the complications and comorbidity in RA.Aim. To study the association between serum chemerin levels with complications and comorbidity in rheumatoid arthritis.Materials and methods. 88 women with RA were enrolled in our study. ll patients undergone standard clinical and laboratory examination. Serum chemerin, high-sensitive C-reactive protein (hsCRP), anti-citrullinated protein antibodies, insulin and C-peptide levels were determined using ELISA. X-ray absorptiometry was performed. Statistical analysis was performed using conventional methods with a software package Statistica 10.0.Results. Median chemerin concentration was 463.5 [366–576.5] ng/ml. Chemerin concentration correlated with the age (ρ = 0.232; р = 0.030), weight (ρ = 0.254; р = 0.017) and body mass index (BMI) (ρ = 0.212; р = 0.047), but wasn’t associated with the RA classification criteria. Positive correlation between chemerin concentration and number of painful joints (NPJ) (ρ = 0.213; р = 0.046) and hsCRP (ρ = 0.273; р = 0.010) was observed. Patients with type 2 diabetes mellitus (DM2) had higher chemerin concentration (598.0 ng/ml vs 479.5 ng/ml, Z = -2.68; p = 0.007) and patients with cholecystectomy in anamesis had lower (359.0 ng/ml vs 479.0 ng/ml, Z = 2.02; p = 0.043). Chemerin concentration correlated with systolic and diastolic blood pressure (BP) (ρ = -0.41; р < 0.001 and ρ = -0.27; р = 0.028, respectively).Conclusions. Chemerin concentration in women with RA correlates with age, weight, BMI, NPJ and hsCRP. Chemerin concentration in patients with comorbid DM2 was higher and in patients comorbid with cholecystectomy in anamnesis was lower. Chemerin concentration correlates negatively with a systolic and diastolic BP.

A CROSS SECTIONAL ANALYTICAL STUDY ON ADHERENCE AND PERSISTENCE OF CONTINUING SECONDARY PREVENTIVE MEDICINES FOR STROKE AT THE END OF 3 MONTHS IN A TERTIARY CARE CENTRE IN SOUTH INDIA

Prevalence of stroke in India is 90-222/100000 population. It causes so much morbidity to patient and family. Several classes of drugs are effective in preventing stroke recurrence by modifying the risk factors. There is limited data on long-term use of secondary prevention medications following stroke. Persistence is dened as the continuation of all medications patient was last prescribed at the end of 3 months. Adherence is dened as taking modied medications as per needs as per doctor's advice. A Methodology: ll patients with stroke both is chaemic and haemorrhagic and age more than 18 years , sustained in the one year when study is conducted as from the records of neurology department and attending the department for follow up are taken for study. A semi structured interview is done with them or their care givers to get information on their background characteristics, aetiology of stroke, comorbidities, cost of medication and affordability, various classes of medications administered and whether they are persistent in taking drugs, are they adherent to drugs, if not adherent/persistent ,reason for the same by open ended questions. A total of 260 patients were included, mean age was 58.5 years. Result: 78.5% had 3-month persistence and 3 month adherence 35.6%. Independent predictors of 3 month medication persistence included age more than 60 years, marital status, fewer medications prescribed at discharge and patients taking anti hypertensives . Most common reason for non-persistence was because the patients did not know why medication is being taken by them. Various factors play a role in persistence and adherenc Conclusion: e of medications in stroke. A multifactorial intervention including patient and health care providers are warranted, because of morbidity and mortality associated with every episode of stroke.

Comparison of Serum Levels of Interleukin 17 and Interleukin 9 in Leprosy Patients with and without Lepra Reaction: A Cross-Sectional Analytical Study from Central India.

New pathways of host defence have emerged in leprosy, such as T helper (Th) -17, Th-9, T regulatory cells, and other factors like transforming growth factor-beta, etc. Interleukin (IL) 17 produced by Th17 cells has been found to be elevated in lepra reaction, especially type 2 lepra reaction (T2R). Role of IL-9 has not been studied widely in leprosy reactions so far. The study aimed to compare serum levels of IL-17 and IL-9 in leprosy patients with and without lepra reaction. This was a cross-sectional analytical study including untreated adult leprosy patients with and without lepra reaction. A total of 65 patients were included in the study with 30 leprosy patients without reaction and 35 with lepra reaction. Serum levels of IL-17 and IL-9 were measured in these patients using direct enzyme-linked immunosorbent assay and were compared. Borderline tuberculoid (BT) leprosy with type 1 and Lepromatous (LL) leprosy with T2R patients showed significantly higher levels of IL-17 than BT and LL leprosy patients without lepra reaction, respectively. LL patients with T2R showed significantly lower levels of IL-9 than lepromatous cases without reaction. IL-9 levels were higher in BT patients with T1R as compared to BT patients without reaction but the difference was not significant. We found evidence in support of role of IL-17 in the pathogenesis of T2R, which might serve as useful serum markers for the same. IL-17 might have a role in BT leprosy with T1R. IL-9 seems to have a protective role in T2R as opposed to IL-17, working in synergism with Th1 cytokines.

8886 Endometrial Wound Healing Duration after Hysteroscopic Treatment of Type 2 and 3 Myomas

<h3>Study Objective</h3> To assess the mean resolution time of the fovea after hysteroscopic treatment of type 2 and type 3 myoma. <h3>Design</h3> Prospective observational study. <h3>Setting</h3> University of Naples Federico II, Naples, Italy. <h3>Patients or Participants</h3> <b>W</b>omen aged 30-50 years, with at least one type 2 or type 3 myoma, history of infertility or uterine bleeding who underwent hysteroscopic myomectomy. <h3>Interventions</h3> <b>A</b>ll patients underwent hysteroscopic myomectomy, using a 15 Fr or 26 Fr resectoscope, either outpatient or in the operating room. All surgical procedures were performed by one expert hysteroscopist. Cold loop myomectomy applied to bipolar resectoscope was used for the removal of the intramural component of the myomas. All women underwent repeated follow-up office hysteroscopies every week after the surgical procedure for the first month and then every two weeks for the following months <h3>Measurements and Main Results</h3> Thirty-one patients with type 2 or 3 myoma with infertility (26/31) or uterine bleeding (15/31) were enrolled. The resectoscopic myomectomy was successful in all cases, without any significant complications. Overall, the mean diameter of resected myomas was 23 mm. The fovea was almost completely restored between three to six weeks after surgery in case of myomas < 2 cm and on average within 56 days for myomas of any size. The resolution was faster in women < 40 years old. No correlation was observed between the resolution time of the fovea and the different localization of the myomas <h3>Conclusion</h3> These preliminary data showed short time to resolution of the fovea in case of type 2 and 3 myomas hysteroscopically treated. The respect of the myometrium and the reduced thermal injury obtained thanks to the cold loop technique applied to bipolar resectoscope, may have influenced the resolution time of the fovea

COMPARISON OF LARYNGOSCOPIC VIEW &amp; HAEMODYNAMIC RESPONSE TO LARYNGOSCOPY&amp; OROTRACHEAL INTUBATION BY USING MACINTOSH/ MACCOY LARYNGOSCOPE FOR ADULT PATIENTS

Background: Direct Laryngoscopy and intubation lead to stress response and sympathetic stimulation which is disadvantage for some high risk patients of cardiac ischemia, raised intracranial tension, cerebral aneurysm, open globe injury, glaucoma etc. Hence reduction of the intense stress response is of utmost importance for a stable and safe hemodynamics in those patients. Aims and Objectives: To access hemodynamic response to laryngoscopy done by the Macintosh/ McCoy blade. Materials and Methods: In this study we had selected 60(male and female in equal number) ASA grade-I&amp;ll patients posted for elective general surgery. They were randomly divided into two groups - group I(laryngoscopy done by Macintosh blade)and group II(laryngoscopy done by McCoy blade). Systolic Blood Pressure, Diastolic Blood Pressure , Mean Blood Pressure and Heart Rate were recorded before and after anaesthesia induction, just after intubation and one, three ,five minutes after orotracheal intubation. Results: The results were compared over time between the two groups. Mean values of Systolic Blood Pressure, Diastolic Blood Pressure, Mean Blood Pressure and heart rate were significantly higher in group 2 as compared to group 1. Conclusion: The stress response was significantly higher when laryngoscopy was done with Macintosh blade as compared with McCoy blade. Intubation with McCoy laryngoscope blade provide better laryngoscopy view.we recommend usage of McCoy blade in routine Anaesthesia practice as non pharmacology means to attenuate haemodynamic response to laryngoscopy&amp; intubation.

A deep learning framework (DLF) to identify clinical predictors of disease progression and mortality in metastatic castration-resistant prostate cancer (mCRPC) patients treated with docetaxel/prednisone (DP).

e13550 Background: Treatment with DP improves survival in mCRCP but is associated with significant toxicity. The question remains as to whether the improved survival is worth the toxicity risk. In this study, we have investigated the ability of a DLF to identify those patients on which treatment with DP is likely to be beneficial. Methods: The dataset (n = 2028) included a compilation of records from 4 randomized phase 3 trials (NCT00273338, NCT00988208, NCT00617669, and NCT00519285) in which the comparator arm consisted of D (75 mg/m2 q3w) plus P (5mg PO bid) as first-line therapy for mCRPC patients. Data was obtained from www.projectdatasphere.org and contained more than 150 clinical variables at baseline. These were used to generate synthetic state representations (SSR) of every patient that were then input into the DLF to identify subgroup of patients based on their similarities. The resultant subgroups were correlated with progression-free survival (PFS) and overall survival (OS). Results: DLF identified three patient subgroups with specific clinical traits: LL (n = 438), HL (n = 386) and HH (n = 1204). These subpopulations varied in clinical outcome after DP treatment. LL patients (median PFS 19.3 months) had a lower risk of progression compared to HL (median PFS 8.2 months; HR 0.32, 95% CI 0.26-0.40, p &lt; .0001) and HH (median PFS: 9.2 months; HR 0.44, 95% CI 0.36-0.52, p &lt; .0001). No differences were observed for HL and HH. In reference to OS, patients in LL (median OS not reached) and HL (median OS 27 .2 months) did not show any difference; however, both subpopulations showed a lower risk of death compared to HH (median OS 17.7 months) (HR 0.45, 95% CI 0.38-0.54, p &lt; 0.001; HR 0.55 95% CI 0.46-0.62, p &lt; 0.001, respectively). Feature contribution analysis showed that LL signature was associated with ECOG0 and lower levels of PSA, LDH, ALP and AST. LL patients had received less cancer therapy since diagnosis and were more treated with biguanides. In contrast, HL signature had more patients with ECOG 1, and intermediate levels of PSA, LDH, ALP and AST. HL patients had received more hormonal therapy since diagnosis and were more treated with HMG-COA reductase inhibitors. Finally, HH signature was characterised with the highest levels of PSA, LDH, ALP and AST and were more treated with opioids. Other major differences were observed on anthropometrics, vital signs, testosterone, albumin and ALT levels, and non-opioid concomitant medications. Conclusions: We show a methodology that identifies distinct baseline clinical features correlated to the risk of progression and death after DP treatment. While evident for LL (PFS and OS) and HL (OS), HH patients would not receive any treatment benefit on survival. Further work is required to validate this approach as a novel predictive tool for DP treatment decision making on mCRPC patients.

Saudi Arabian real-life experience with biologic therapy in severe asthma.

BackgroundSevere asthma (SA) is a common health problem associated with increased morbidity and mortality and high medical costs. Biological therapies have emerged in recent decades as promising treatment options for patients with high type 2 (T2) SA. This retrospective observational study from Saudi Arabia aimed to investigate the effects of additional biologics therapy on reducing oral corticosteroid (OCS) consumption, frequency of asthma exacerbations, improvement in lung function, and asthma control.MethodsThis multicenter observational study enrolled a cohort of 97 patients from March 2019 to February 2021. Outcomes of anti-IgE, anti-IL5/IL5R, and anti-IL4R therapies in severe type 2 asthma were recorded and analyzed in terms of number of exacerbations (emergency visits or hospitalizations required), asthma symptoms, and use of oral corticosteroids, blood eosinophil count, asthma control according to GINA classification, and FEV1 before and during biologic therapy.ResultsNinety-seven patients were included in the analysis The mean age was 46.7±14.1 years, and 69.1% of them were female. The average duration of biological treatment was 16.4±6.8 months. At the time of data collection, the four biologic therapies reduced the exacerbation rate per year from 82/97 (84.5%) to 14/97 (14.4%) with a percent improvement of 83% from 2.9 per year in the year before biologic treatment to 1.6 per year (p<0.001). OCS was reduced from 75/97 (77.3%) to 10/97 (10.3%) for a percent improvement of 86.7%, and the average OCS dose decreased from 7.12 mg to 6.8 mg. Mean blood eosinophil count also decreased after biologic therapy from 750.5±498.5 to 188.0±122.4 cells/μl, most significant result achieved with benralizumab, and mean FEV1 improved from 59.0±12.9% to 76.0±10.2%, most significant result achieved with omalizumab. ll patients had uncontrolled asthma before biologics therapy, but asthma control improved by 91.8% after treatment.ConclusionsBiologic as add-on therapy for high T2 SA was found to reduce asthma exacerbations, systemic glucocorticoid doses, and SA symptoms.

Timing of Psychopharmacological and Nutritional Interventions in the Inpatient Treatment of Anorexia Nervosa: An Observational Study.

This study aims to investigate possible different outcomes in the inpatient treatment of anorexia nervosa (AN) related to different timings of psychopharmacological and nutritional interventions. A retrospective observational study was conducted, involving young patients hospitalized for AN, treated with naso-gastric tube feeding (NGT). Participants were divided into five groups according to early (0–7 days) or late (8+ days) introduction of atypical antipsychotics (AAP) and NGT: early AAP-early NGT (EE), early AAP-late NGT (EL), late AAP-early NGT (LE), late AAP-late NGT (LL) and a control group treated with NGT only (NGT). Concurrent clinical and treatment variables were analyzed. AN psychopathology was measured with the Eating Disorder Inventory-3 (EDI-3) EDRC score. Outcomes were assessed as admission-discharge body-mass index (BMI) improvement and length of hospital stay (LOS). Contributions of variables related to outcomes were assessed with multifactorial-analyses of variance (MANOVA). Seventy-nine patients were enrolled in the study. LOS was different among treatment groups (F (4, 75) = 5.993, p < 0.001), and EE patients showed lower LOS than LE (p < 0.001) and LL (p = 0.025) patients. BMI improvement was not significantly different among treatment groups but correlated negatively with age (F (1, 72) = 10.130, p = 0.002), and admission BMI (F (1, 72) = 14.681, p < 0.001). In conclusion, patients treated with early AAP and early NGT showed lower LOS than those treated with late AAP. Prognostic treatment variables should be investigated in wider samples.

Analgesic Efficacy of Perioperative Esmolol as an Adjunct to Morphine in Mastectomy- A Prospective Observational Study

Introduction: Multimodal analgesia with opioids as the prime component is the mainstay of postoperative analgesia for mastectomy, which can lead to many opioid related unwanted side-effects. Esmolol infusion has been found as a useful adjunct in reducing opioid requirements. Aim: To find the effect of perioperative esmolol infusion on postoperative pain and opioid requirements. Materials and Methods: This prospective observational study was done in 140 American Society of Anaesthesiologists (ASA) physical status l and ll patients, between 20-65 years of age posted for mastectomy under general anaesthesia. Esmolol group (group E) received 0.25 mg/kg of esmolol bolus ten minutes before induction followed by continuous infusion 5 μg/kg/min till end of surgery while control group (group C) received equivalent volumes of saline. Primary outcome measures were Numerical Rating Scale (NRS) for pain, total postoperative opioid consumption and time to first rescue analgesic dosage till 24 hours. Intraoperative haemodynamics and other side-effects were secondary outcomes. Descriptive statistics of numerical rating scores and analgesic requirements were analysed in terms of mean and standard deviation. Independent t-test was used to compare numerical rating scores and analgesic requirement of the two groups. A p-value of &lt;0.05 was considered statistically significant. Results: The mean numerical pain scores were significantly lower in the esmolol group for the first 24 hour. The mean time to first rescue analgesic was 17.59±5.012 hour in the esmolol group and 8.21±2.22 hour in the control group which was statistically significant (p&lt;0.001). The total tramadol consumption was also significantly lesser in the esmolol group (42.14±29.03 mg), compared to control group (102.86±22.3 mg), (p=0.0001). Mean heart rate was statistically lower in the esmolol group, but there was no incidence of bradycardia requiring treatment. Mean Arterial Pressures (MAP) were comparable. Conclusion: Perioperative esmolol infusion when used as an adjunct to morphine decreased postoperative pain and analgesic requirements for the first 24 hours without any haemodynamic disturbances.

A COMPARATIVE STUDY OF SERUM AND SALIVARY BIOCHEMICAL MARKERS IN DIABETES MELLITUS TYPE II WITH HEALTHY INDIVIDUALS

Introduction: Blood is the gold standard body fluid for diagnosis of Diabetes Mellitus (DM) but saliva can offers an alternative to serum as a biological fluid for diagnostic purposes because it contains serum constituents. People wants that medical science should promote non invasive method for diagnosis of disease.&#x0D; Aim: The study was conducted to estimate and compare serum and salivary glucose, total protein, calcium and phosphorus levels in DM type ll and healthy subjects and to evaluate whether saliva can be used as a diagnostic fluid in DM type ll patients. The target population of this study was individuals who have Type-2 DM for different period of time and resident INDORE.&#x0D; Materials &amp; Methods: Study consisted of 50 subjects from OPD/IPD Index Medical College &amp; Research Center, INDORE, MADHYA PRADESH, India. The study groups were divided into Group I-25 DM patients (TypeII) and Group II-25 healthy subjects. The saliva and serum samples were collected from each subject and levels of different biochemical parameters were estimated.&#x0D; Result: were noted. On comparing values in saliva and serum, among two groups, a significant difference (p&lt;0.005) was found between few of them.&#x0D; Conclusion: Values regarding blood and salivary biochemical parameters were distinctly different between two groups suggesting salivary parameters can be used as a diagnostic alternative to blood parameters for diabetes mellitus.&#x0D;

Ultrasonography involvement of carotid, upper and lower limb arteries in a large cohort of systemic sclerosis patients.

Data on macrovascular involvement in systemic sclerosis (SSc) are still debatable. The aim of this study was to estimate its prevalence and possible determinants in a large cohort. One hundred and fifty-five outpatients with SSc were enrolled. Data about disease characteristics and cardiovascular risk factors were collected and patients underwent ecocolor Doppler ultrasonography of arteries of the neck and lower (LL) and upper (UL) limbs. Mean age was 57.9±14.5years and most were female (88.4%) with a limited subset (63.2%). Mean disease duration was 11.4±8.1years. Twenty-three (14.8%) had hypertension, 7 (4.8%) diabetes, 64 (41.3%) hypercholesterolemia and 63 (40.6%) were active/past smokers. Seventy-nine (49%) patients had plaques at carotids, 49 (32.9%) at LL and 7 (4.9%) at UL. In multivariate analysis, patients with carotid plaques had more often a limited pattern (P=.001), patients with distal LL plaques pulmonary arterial hypertension (P=.006) and patients with proximal LL plaques lower diffusing capacity for carbon monoxide adjusted to hemoglobin and its ratio to alveolar volume (P=.004). In patients with UL plaques traditional cardiovascular risk factors were not more common, while forced vital capacity was lower (P=.023). Finally, upper limb and proximal LL plaques were as common in early disease patients as in longstanding ones, although the former were younger. This study shows that macrovascular involvement is quite common in SSc and that some disease characteristics linked to microvascular involvement are associated with atherosclerotic plaques, which can be present even in early disease. Our study suggests that a complete evaluation of macrocirculation is mandatory for rheumatologists treating SSc patients.

Nail Changes in Leprosy: An Observational Study of 125 Patients.

Introduction:Leprosy is a disease primarily affecting skin and nerve. Nail involvement, although indirect, is observed in several patients. This is a study to determine the pattern of nail changes in leprosy.Methods:It was an observational study involving 125 patients. Apart from cutaneous and neurological examination, nails were examined. Diagnosis was confirmed by previous records in already diagnosed cases, while by slit skin smear and histopathologically in new cases. Patients were grouped as per Ridley-Jopling classification and further subdivided as per age, sex, and duration and reaction status. Nail changes in these groups were summarized and compared.Results:Overall prevalence of nail changes was 80% with 66.6% in TT patients, 79.4% in BT patients 50% in BB patients, 83.7% in BL patients and 84.3% in LL patients. Longitudinal melanonychia and longitudinal ridges were frequent finger nail changes with longitudinal melanonychia being more common among tuberculoid pole and longitudinal ridges among lepromatous pole. Brachyonychia, subungual hyperkeratosis and brown black pigmentation were frequent finger nail changes, with onychorrhexis being commonest among TT patients, subungual hyperkeratosis among BT patients, while brachyonychia among BL and LL patients. Anonychia and rudimentary nails were not found in tuberculoid pole. Beau's lines, terry nails, pterygium, pincer nail, and onychorrhexis were significantly more frequent in ENL patients. Onychomadesis, which is not reported yet in leprosy, was found in one patient after severe ENL.Conclusion:Various changes in leprosy are due to multiple causes like neuropathic, traumatic, vascular, osseous, infections and drugs reflecting extensive systemic morbidity caused by Mycobacterium leprae.

Clinicopathologic correlation of different types of leprosy lesions

Background: Leprosy is one of the major public health problems of the developing countries. The principle of reducing the load of infection in society, to break the chain of infection, is the cornerstone of leprosy control work today. Aim of the Study: To study clinicopathologic correlation of different types of leprosy lesions. Materials and Methods: The present study was conducted in the Department of Dermatology of the medical institute. The ethical clearance for the study was approved from the ethical committee of the hospital. A total of 90 leprosy skin biopsies were studied over a period of 12 months. All the biopsies were received in the Department of Pathology of the hospital. Cases were selected regardless of their age, sex, socio­economic status and occupation. Biopsies were fixed in 10% formalin and processed. 5 micron sections were stained with haematoxylin and eosin; modified Fite and studied. Results: There were 65 males and 25 females between 8 and 70 years of age. We observed that borderline tuberculoid leprosy was the most common cases in clinical and histopathological types, although more number of cases were seen in histopathological types of leprosy. We observed that the while correlating the histopathological diagnosis with clinical diagnosis, maximum correlation (75%) was noted in LL patients followed by BT (59%) and BB (50%). Conclusion: Within the limitations of the present study, it can be concluded that there is some degree of overlap between different types of leprosy, both clinically and histopathologically, correlation of clinical and histopathological features along with bacteriological index appears to be more useful for accurate typing of leprosy than considering any one of the single parameters alone.

Involvement of TNF-Producing CD8+ Effector Memory T Cells with Immunopathogenesis of Erythema Nodosum Leprosum in Leprosy Patients.

Type 2 reaction (T2R) or erythema nodosum leprosum (ENL), a sudden episode of acute inflammation predominantly affecting lepromatous leprosy patients (LL), characterized by a reduced cellular immune response. This possibly indicates a close relationship between the onset of T2R and the altered frequency, and functional activity of T lymphocytes, particularly of memory subsets. This study performed ex vivo and in vitro characterizations of T cell blood subpopulations from LL patients with or without T2R. In addition, the evaluation of activity of these subpopulations was performed by analyzing the frequency of these cells producing IFN-γ, TNF, and IL-10 by flow cytometry. Furthermore, the expression of transcription factors, for the differentiation of T cells, were analyzed by quantitative real-time polymerase chain reaction. Our results showed an increased frequency of CD8+/TNF+ effector memory T cells (TEM) among T2Rs. Moreover, there was evidence of a reduced frequency of CD4 and CD8+ IFN-γ-producing cells in T2R, and a reduced expression of STAT4 and TBX21. Finally, a significant and positive correlation between bacteriological index (BI) of T2R patients and CD4+/TNF+ and CD4+/IFN-γ+ T cells was observed. Thus, negative correlation between BI and the frequency of CD4+/IL-10+ T cells was noted. These results suggest that CD8+/TNF+ TEM are primarily responsible for the transient alteration in the immune response to Mycobacterium leprae in ENL patients. Thus, our study improves our understanding of pathogenic mechanisms and might suggest new therapeutic approaches for leprosy.

Regional differences in endoscopic sinus surgery in Finland: a nationwide register-based study

ObjectivesEndoscopic sinus surgery (ESS) is a common operation typically performed due to chronic rhinosinusitis (CRS). There are limited data on the nationwide ESS rate and factors contributing to its regional...

Cytokines as biomarkers to monitoring the impact of multidrug therapy in immune response of leprosy patients

Leprosy or Hansen’s disease is a chronic infectious disease of the skin and nerves, caused by the intracellular bacilli Mycobacterium leprae. It is characterized by a spectrum of clinical forms depending on the host’s immune response to M. leprae. Patients with tuberculoid (TT) leprosy have strong cell-mediated immunity (CMI) with elimination of the bacilli, whereas patients with lepromatous (LL) leprosy exhibit defective CMI to M. leprae. Despite advances in the understanding of the pathogenesis of leprosy and the development of new therapeutic strategies, there is a need for the identification of biomarkers which be used for early diagnosis and to discrimination between different forms of the disease, as prognostic markers. Here, we analyzed the serum levels of IL-1β, IL-6, IL-8, IL-10, IL-12p70, IL-13, IL-17A, IFN-γ and TNF in order to address the contribution of these cytokines in late phase of M. leprae infection, and the impact of multidrug therapy (MDT). Our results demonstrated that patients of LL group presented higher expression of serum levels of inflammatory cytokines before MDT, while TT patients presented a balance between inflammatory and regulatory cytokines. MDT changes the profile of serum cytokines in M. leprae infected patients, as evidenced by the cytokine network, especially in TT patients. LL patients displayed a multifaceted cytokine system characterized by strong connecting axes involving inflammatory/regulatory molecules, while TT patients showed low involvement of regulatory cytokines in network overall. Cytokines can be identified as good biomarkers of the impact of MDT on the immune system and the effectiveness of treatment.

Abstract 247: The Association of the Serotonin Transporter Polymorphism LL-Genotype with Non-Syndromic Mitral Valve Prolapse Requiring Surgery at a Younger Age

Background: Non-syndromic mitral valve prolapse (MVP) is a highly prevalent heart valve disease that is treated surgically when indicated by clinical deterioration. Serotonin (5HT)-related valvulopathies have been reported; however, 5HT has not been shown to be directly associated with MVP. A polymorphism (5-HTTLPR), with a 44-base micro-insertion/deletion in the promoter of the 5HT transporter (SERT) gene, is present in all human populations studied. 5-HTTLPR, with designated long (L) or short (S) alleles, has been reported to have an impact on SERT expression in non-cardiac valve studies. We hypothesized that MVP surgical patients may have an altered distribution of 5-HTTLPR, resulting in SERT expression levels associated with an increased risk of disease progression. Methods: 201 MVP surgical patients were recruited under an IRB approved protocol; DNA extraction followed by genomic fragment analysis was performed to determine allelic frequencies. qRT-PCR of SERT and related genes was carried out on RNA extracted from available MVP tissue (N=64). A RT2 Profiler microarray study for 84 genes associated with human dopamine and 5HT signaling was also performed (N=44). Results: MVP surgical patients had an overall frequency of LL-32%, LS-50%, and SS-18%. The frequency of 5-HTTLPR-LL was significantly increased in males under 55 years of age (N=19/41, 47.6%) ( p=0.04 ) compared to the rest of the population. Interestingly, the LL patients had the lowest SERT expression levels per qRT-PCR compared to LS and SS. A similar expression pattern was also noted for another 5HT transporter, vesicular monamine transporter-2 (VMAT2), with the lowest expression in the LL specimens. Expression of 5HT receptors 2A and 2B were comparable between genotypes in the MVP samples analyzed. Similarly, microarray studies demonstrated tight regulation of 5HT-associated genes, but with LS/SS patients expressing &gt;2-fold more SERT than LL. Conclusion: 5-HTTLPR-LL is associated with MVP surgery at a younger age in men, with relatively lower expression of both SERT and VMAT2, suggesting a reduced capacity for transporter processing of 5HT. The 5-HTTLPR-LL genotype may constitute a novel risk factor useful for identifying MVP patients more likely to have rapid disease progression.

Inpatients Nutritional Requirements Indicator at Army Hospital Dr. Soepraoen Malang

Introduction: Patient acceptance to diet in fl uences patient intake during the hospitalization. Patient acceptance on meals provided by the hospital can be seen from the left over. Whilst factors which in fl uences patient motivation to finish their meals including addtional food, taste, and adaptation level to the hospital, the aim of this research was to identify factors that related to patient acceptance on meals provided by the hospital in class three ward dr. Soepraoen Hospital, Malang.Method: Descriptive analitic was used as research design with cross-sectional approach. As many as 51 samples were chosen with purposive sampling. Data was analyzed with chi square with 95%signi fi cance.Results: The results showed a signi fi cant relation between additional food and the leftover (p-Value = 0,018). There is signi fi cant relation on the taste and the leftover (p-Value = 0.032) and adaptation level and leftover (p-Value = 0.026).Discussion: It can be concluded that additional food, taste, and adaptation level to the hospital have signi fi cant relation with hospitalized patient acceptance on their diet. It is suggested that nurse pay more attention on these factors to fulfi ll patient nutrition needs during hospitalization.