The prevalence and significance of monoclonal gammopathy of undetermined significance in acute medical admissions

Monoclonal gammopathy of undetermined significance (MGUS) affects 3·2% of adults aged >50 years. MGUS carries a life-long risk of progression to multiple myeloma and causes complications including infection and renal impairment; common causes of hospital admission. This study aimed to assess MGUS prevalence in emergency medical hospital admissions. Patients were recruited from unselected emergency medical admissions in a hospital in the United Kingdom. Serum protein electrophoresis was performed, with immunofixation of abnormal results. Reason for admission and routine test results were recorded. After education about MGUS and myeloma, patients chose whether they wished to be informed of new diagnoses. A total of 660 patients were tested and 35 had a paraprotein suggestive of MGUS. The overall rate of MGUS was 5·3%. MGUS prevalence in those aged >50 years was 6·94%, higher than the previously published rate of 3·2% (P < 0·0005). There were higher rates in those with chronic kidney disease (13·75% vs. 4·14%, P = 0·002), heart failure (14% vs. 4·59%, P = 0·012), anaemia (8·96% vs. 3·41%, P = 0·003) or leucocytosis (9·33% vs. 3·04%, P = 0·002). In all, 96% of patients wished to be informed of their screening results. The prevalence of MGUS in emergency hospital admissions is higher than expected based on previous population-based rates. This may suggest a selected population for screening.     

Docking Based Screening of Potent Flavonoids as CHK2 Inhibitors from Genus Miliusa

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - Annonaceae plants play significant role in ethanopharmacology due to their medicinal properties and...     

Post-Resection Surveillance in GI Cancers

Recurrence after curative resection of gastrointestinal (GI) cancers is common. Early detection of resectable recurrences may result in a curative resection. In un-resectable recurrences, early detection may improve the quality of life by palliation or with the use of newer chemotherapeutic drugs. The guidelines regarding follow-up of patients after curative resection of GI cancers are from the West which is very different from the Indian population in terms of a disease pattern and social milieu. The guidelines which are commonly used are also not strictly followed. We have proposed in this article the protocols which we follow at our centre after curative resection of GI cancer and how these are different from the guidelines proposed by the West.     

A Young Child with Eosinophilia,Rash, and Multisystem Illness: Drug Rash,Eosinophilia, and Systemic Symptoms Syndrome After Receipt of Fluoxetine

Drug rash, eosinophilia, and systemic symptoms (DRESS) syndrome is a severe systemic hypersensitivity reaction that usually occurs within 6 weeks of exposure to the offending drug. Diagnosis is usually straightforward in patients with pyrexia, skin rash, hepatitis, and eosinophilia with a preceding history of exposure to agents often associated with DRESS syndrome, such as aromatic anticonvulsants and sulfa drugs, but diagnosis of DRESS may still be a challenge. We report a 4‐year‐old child with probable DRESS syndrome complicated by multiple hematologic complications that developed 1 month after exposure to fluoxetine, a drug not known to be associated with such severe reactions.     

Urethral ratio on voiding cystourethrogram: A comparative method to assess success of posterior urethral valve ablation

ObjectiveTo develop a simple, objective and reproducible quantitative measurement to assess success of posterior urethral valve ablation.MethodIn 30 patients with posterior urethral valves the diagnosis was confirmed by voiding cystourethrogram (VCUG). Our protocol was to perform valve ablation, and repeat VCUG at 12 weeks postoperatively. Urethral ratio was calculated by dividing the posterior urethral diameter by the anterior urethral diameter. Thirty males undergoing VCUG for urinary tract infections were evaluated as normative controls.ResultsMedian age of controls was 12 months (2 days–6 years) and of study group was 13 months (1 day–11 years). Mean urethral ratio in pre-fulguration group was 4.94 (±2.97) and in post-fulguration group was 2.134 (±1.19) (P < 0.001). The mean urethral ratio in the control group of 1.73 (±0.577) was significantly different from the pre-fulguration group result (P < 0.001), but not significantly different in comparison to the post-fulguration group (P = 0.104).ConclusionCalculation of urethral ratio on VCUG as a method of assessment of outcome of fulguration is objective, reproducible, and allows preoperative and postoperative VCUG from different facilities to be compared. A post-fulguration urethral ratio of 2.5–3 represents an acceptable result postoperatively.     

A Simple and Cost Effective Template for Central Segment Reconstruction of Mandible with Free Fibula Flap

Purpose  

A variety of templates are being used for mandible reconstruction with free flaps. We describe a simple and cost effective method using a ‘K’ wire template for the central segment reconstruction of the mandible with free fibula flap.     

Efficacy and safety of rituximab treatment in Indian pemphigus patients

Background Pemphigus is a potentially fatal autoimmune epidermal bullous disorder. Various treatment modalities have been described to treat pemphigus. In cases where the disease fails to respond to conventional therapy, rituximab has been shown to be effective. Objective To study the efficacy of rituximab in the treatment of resistant or severe pemphigus in Indian patients. Methods Patients with pemphigus were treated with intravenous rituximab 1000 mg in adults or 375 mg/m² body surface area in children by two doses, 15 days apart in this open labelled pilot study. Anti‐desmoglein1 (anti‐Dsg1) antibodies and anti‐desmoglein3 (anti‐Dsg3) antibodies were measured at the start of therapy and at the end of the follow‐up period. The outcome was studied in terms of control of disease activity (CD), complete remission (CR), partial remission (PR) and time to disease control (TDC) as defined by the consensus statement from the International Pemphigus Committee. Results A total of 9 (90%) of 10 patients responded to the treatment. Three (30%) had CR of disease and were off all treatment. Four (40%) patients had CR and were on low dose oral prednisolone. Two (20%) patients had PR and were on low dose prednisolone. One patient died of sepsis. The mean TDC was 8 weeks. Response to treatment showed good correlation with index values of anti‐Dsg1 antibody. Infusion‐related angioedema and sepsis were seen as complications due to rituximab administration. Conclusion Rituximab is effective in treating resistant and severe pemphigus in Indian patients. Acute complications can occur during rituximab infusion and require close monitoring.     

Bilateral Pedicled Nasolabial Flaps for the Anterior Alveolus Mandibular Defect: a Review

With the increasingly wide spread application of microvascular free tissue transfer technique for oral cavity reconstruction, the routine need for variety of local and regional flap has decreased. However, a number of such flaps remains quite useful and should be included in modern armamentarium of reconstructive surgeon. Nasolabial flap is versatile, simple, easy to harvest local flap that can cover a variety of defect in face. We present the success and utility of bilateral pedicled flap for reconstruction of mandibular anterior alveolus after the wide excision of squamous cell carcinoma of mandibular anterior alveolus. And the restoration of esthetics and functional dental health with the artificial prosthesis. Patient had been followed for two years and six month with no signs of recurrence as yet.