Clinicopathological characteristics of cutaneous lupus erythematosus patients in Bangladesh.

Introduction: Nearly all epidemiologic studies have involved patients with systemic lupus erythematosus (SLE). Few authors have investigated the characteristics of patients with cutaneous lupus erythematosus (CLE). Aim: To describe the clinical and pathologic characteristics of a series of patients diagnosed with CLE. Material and methods: This is a descriptive retrospective cross-sectional study carried out using the consecutive registered records of 218 patients attending the 'Lupus Clinic' in Chittagong Medical College Hospital during the period between 2010 and 2020. The activity and damage of CLE were assessed according to the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). Results: There were 187 (85.8%) females and 31 (14.2%) males, with the female:male ratio being 6 : 1. The mean age was 30.0 ±11.7 years. The chronic cutaneous lupus erythematosus (CCLE) patients numbered 154 (70.6%), followed by acute cutaneous lupus erythematosus (ACLE) n = 46 (21.1%), and subacute cutaneous lupus erythematosus (SCLE) n = 18 (8.3%). In LE-specific skin lesions, the most common manifestation was photosensitivity, 198 (90.8%), followed by discoid rash, 155 (71.1%) and maculo-papular lupus rash, 55 (25.2%). Among LE-nonspecific skin lesions, the most common manifestation was non-scarring alopecia, 123 (56.4%), followed by livedo reticularis, 18 (8.3%), Raynaud's phenomenon, 17 (7.8%), vasculitis, 15 (6.9%), periungual telangiectasia, 7 (3.2%), erythema multiforme, 6 (2.7%) and leg ulcers, 5 (2.3%). Antinuclear antibodies (ANA) were the most common type of autoantibody (n = 132, 60.5%) followed by anti-ds DNA (n = 91, 41.7%) and anti-phospholipid antibodies (n = 9, 4.1%). Conclusions: CCLE was the most common subtypes of CLE. Photosensitivity was the most common clinical manifestation, whereas ANA were the most frequent autoantibodies of the LE patients of this region. Patients with different subtypes of CLE have distinct clinical and pathological characteristics.

Efficacy of oral methotrexate (MTX) monotherapy vs oral MTX plus narrowband ultraviolet light B phototherapy in palmoplantar psoriasis.

Palmoplantar psoriasis (PPP) is a chronic, inflammatory dermatosis of the palms and/or soles with significant morbidity. It is notoriously difficult to treat and unresponsive to traditional topical agents. We aim to compare the effect of oral methotrexate (MTX) monotherapy vs MTX plus narrowband ultraviolet light B (NB-UVB) in the treatment of recalcitrant PPP. This was a comparative clinical trial involving 90 patients of PPP. Eligible patients were randomly assigned to one of the two treatment groups. We aim patients in group A received 10 mg oral MTX weekly, and patients in group B received oral MTX 10 mg weekly and NB-UVB sessions twice weekly for 12 weeks. There was a statistically significant difference in reduction of modified PPP Area Severity Index (m-PPPASI) of patients in MTX plus NB-UVB at week 12. The mean m-PPPASI at week 12 was 3.66 ± 2.11 in MTX plus NB-UVB group and 6.51 ± 2.04 in MTX only group (P < .001). Marked improvement (m-PPPASI 75) was achieved in 20 (44.44%) patients in MTX plus NB-UVB group compared with 6 (13.3%) in MTX monotherapy group (P < .001). Combination of MTX and NB-UVB phototherapy helps to attain a better clinical response (reduction in m-PPPASI score) than MTX monotherapy in the treatment of recalcitrant PPP.

Intraoperative pathology consultation: error, cause and impact.

BACKGROUND: Correlation of intraoperative frozen section diagnosis with final diagnosis can be an important component of an institution's quality assurance process. METHODS: We performed a quality assurance review of 1207 frozen section diagnoses from 812 surgical cases performed in the Hamilton Regional Laboratory Medicine Programme during a 6-month period in 2007. We reviewed the frozen section and permanent slides from all potentially discordant cases using a multiheaded microscope to arrive at a consensus pertaining to the type and reason for error. We reviewed the clinical record to determine whether there had been a potential adverse impact on immediate clinical management. RESULTS: Frozen sections were most commonly requested for head and neck, nervous system and female genital tract specimens. Twenty-eight frozen sections (3%) were deferred. We identified 24 discordant diagnoses involving 3% of cases and 2% of specimens. The organ systems showing the greatest frequency of discordance relative to the total number from that system were the nervous system, head and neck, and the lungs. Of the errors identified, most occurred owing to diagnostic misinterpretation, followed by problems related to tissue sampling. There was a potential adverse impact on immediate clinical management in 14 cases. CONCLUSION: Our results add to the Canadian data on the correlation between frozen sections and permanent sections; we note comparability to the concordance rates reported in the literature.

CONTEXTE: La corrélation entre le diagnostic fondé sur une analyse peropératoire des coupes congelées et le diagnostic final pourrait être un élément important du processus d'assurance qualité dans les établissements de santé. MÉTHODES: À des fins d'examen de l'assurance qualité, le Programme régional de médecine de laboratoire d'Hamilton a procédé à une revue de 1207 diagnostics fondés sur l'analyse de coupes congelées prélevées lors de 812 interventions chirurgicales au cours d'une période de 6 mois en 2007. Nous avons analysé les coupes congelées et les spécimens fixés pour tous les cas potentiellement discordants à l'aide d'un microscope multitête, dans la recherche d'un consensus quant au type d'erreur et à la raison de celle-ci. Nous avons passé en revue les dossiers cliniques pour mesurer, le cas échéant, un quelconque impact négatif sur la prise en charge clinique immédiate. RÉSULTANTS: Les coupes congelées ont le plus souvent été demandées pour des spécimens de tissu de la tête et du cou, du système nerveux et des voies génitales féminines. Vingt-huit coupes congelées (3 %) ont été écartées. Nous avons relevé 24 diagnostics discordants concernant 3 % des cas et 2 % des spécimens. Les systèmes et organes pour lesquels la fréquence de la discordance a été la plus élevée par rapport au nombre total de spécimens du même type, ont été le système nerveux, la tête et le cou et les poumons. Parmi les erreurs relevées, la plupart ont été attribuables à une mauvaise interprétation diagnostique, suivie de problèmes relatifs au prélèvement tissulaire. Dans 14 cas, l'erreur a pu exercer un impact négatif sur la prise en charge clinique immédiate. CONCLUSIONS: Nos résultats viennent étayer les données canadiennes sur la corrélation entre les coupes congelées et les lames adhérentes; nous notons que nos taux de concordance sont comparables à ceux qui sont cités dans la littérature.

A very active cu-catalytic system for the synthesis of aryl, heteroaryl, and vinyl sulfides.

cis-1,2-Cyclohexanediol (L3) has been shown to be an efficient and versatile bidentate O-donor ligand that provides a highly active Cu-catalytic system. It was more effective than diols such as trans-1,2-cyclohexanediol or ethylene glycol. This commercially available cis-1,2-cyclohexanediol ligand facilitated the Cu-catalyzed cross-coupling reactions of alkyl, aryl, or heterocyclic thiols with either alkyl, aryl, heterocyclic, or substituted vinyl halides. This new catalytic system promoted the mild and efficient stereo- and regiospecific synthesis of biologically important vinyl sulfides. The yields obtained using electron-rich substituted vinyl sulfides with this catalyst system are generally 75-98%. Most importantly, this singular catalyst system is extremely versatile and provides entry into a wide range of sulfides. This method is particularly noteworthy given its mild reaction conditions, simplicity, generality, and exceptional level of functional group tolerance.

White fiber dissection of brain; the internal capsule: a cadaveric study.

AIM: This study was done to study the three dimensional anatomy of internal capsule's white fibers completely by cadaveric dissection and its relation to basal ganglia and other related anatomical structures. MATERIAL AND METHODS: Eight formalin fixed cerebral hemispheres were dissected for internal capsule under operating microscope. Klingler's technique of fiber dissection was adopted. The internal capsule was dissected from superiolateral inferior and medial surface of cerebral hemisphere. During and after dissection its relation with basal ganglia and other related structures were studied. RESULTS: The internal capsule was demonstrated by dissecting fibers of all its parts. Fibers that forms the internal capsule originate from different parts of cerebral cortex and pass through corona radiata that lies in lateral periventricular area and lateral to the caudate nucleus above the upper border of lentiform nucleus. The internal capsule is situated medial to lentiform nucleus and lateral to caudate nucleus and thalamus. Caudally it continues in the midbrain as cerebral peduncle. It has an anterior limb, genu, posterior limb, retrolentiform and sublentiform part. The relation of different parts of internal capsule with surrounding structures were also shown. CONCLUSION: Knowledge of the microsurgical anatomy of the internal capsule and other white fibers tracts is essential for neurosurgeons and other neuroscientists.

Cutaneous tuberculosis--a study of 400 cases.

A prospective study was conducted on 400 cases having clinical manifestation of cutaneous tuberculosis from 1992 to 2001 in the department of Dermatology and Venereology, Dhaka Medical College Hospital (DMCH) and Bangabandhu Sheikh Mujib Medical University (BSMMU), formerly Institute of Postgraduate Medicine and Research, Dhaka, Bangladesh. The clinical diagnosis was confirmed by histopathological examination. Among 400 cases, 260 (65%) were males and 140 (35%) were females with a male to female ratio 1.86:1. Age ranged from 10 to 70 years. Majority of the cases 200 (50%) were diagnosed as Tuberculosis verucosa cuties, 160 cases (40%) and 40 cases (10%) were diagnosed as Lupus vulgaris and Scrofuloderma respectively. All patients received combined antitubercular therapy.

Leprosy profiles in post-elimination stage: a tertiary care hospital experience.

BACKGROUND: Most countries that were previously highly endemic for leprosy have achieved elimination at the national level. OBJECTIVES: To find out the pattern, prevalence, and trends of leprosy in the post-elimination stage. METHODS: A descriptive retrospective cross-sectional study was carried out using the registered records of patients attending the leprosy clinic in Chittagong Medical College Hospital between the periods 2001 and 2011. RESULTS: The new case detection rate was declining. The prevalence rate was 0.75 at the end of 2011. Of a total of 789 patients, males (74%) outnumbered the females (26%). The age of the patients in the study group ranged from 6 years to 87 years with mean age 35.58 years ± 0.05 SEM. Paucibacillary (PB) and multibacillary (MB) cases were 314 (39.80%) and 475 (60.20%), respectively. MB percentage was increasing more among new cases in the study period, and 119 (15.08%) patients presented with grade 2 deformities. Smear positive cases were 141 (17.87%). Leprosy reaction comprised of 193 (24.46%) type 1, 68 (8.62%) type 2, and 97 (12.29%) neuritis cases. LIMITATIONS: This is a retrospective study from a single tertiary health center. CONCLUSION: MB cases with grade 2 deformities are in an upward trend, and rates of children are declining. Developing reinforced new therapies to curb reactions, deformities are very important and contact tracing, especially of children, is essential. Domiciliary treatment needs to be made available to ensure early diagnosis.

Transcranial microsurgical and endoscopic endonasal cavernous sinus (CS) anatomy: a cadaveric study.

AIMS AND OBJECTIVES: Even in the era of tremendous microneurosurgical and endoscopic development, the cavernous sinus (CS) is a challenging anatomical site for a neurosurgeon. Many transcranial and a few endoscopic cadaveric studies have been done to study the CS; probably none were undertaken to study its microsurgical and endoscopic anatomy side by side. In this cadaveric study we perform a side-by-side comparison of the microsurgical and endoscopic anatomy of the CS that can help neurosurgeons deal with CS lesions more efficiently. MATERIALS AND METHOD: Sixteen fresh cadaveric heads were studied after dissection. Six heads were dissected for transcranial study and six for endoscopic study of CS. During the transcranial study, the supratentorial brain was removed in three heads and CS and related anatomical structures were dissected. In the remaining heads, the CS was studied by keeping the brains in situ. In four heads both transcranial and endoscopic study was done simultaneously. Following dissection, microsurgical and endoscopic anatomy of CS was studied. RESULT: The CS and related anatomical structures were dissected sequentially in all cases (transcranially in 10 [6 + 4] heads; endoscopically in 10 [6 + 4] heads), and their relationship was studied. CONCLUSION: Microscopic and endoscopic exposure of the CS is relatively easy in cadavers. But endoscopic or microsurgical exposure of the CS during surgery is more difficult requiring skill. With experience of the cadaveric study , the CS may be explored via transcranial microsurgery, endonasal endoscopy, or both simultaneously, according to the nature and extension of the pathology.

Endoscopic endonasal transsphenoidal exposure of circle of Willis (CW); can it be applied in vascular neurosurgery in the near future? A cadaveric study of 26 cases.

AIM: Endonasal transsphenoidal approaches are getting rapidly popular in removing many midline skullbase lesions from crista galli to foramen magnum. For safe removal of these lesions, familiarity with endoscopic endonasal anatomy of circle of Willis is very important. Furthermore, for safe development of this approach in vascular neurosurgery in the near future, endoscopic endonasal exposure of circle of Willis is a fundamental step. The goals in this study were to dissect the circle of Willis completely through the endoscopic endonasal approach and to become more familiar with the views and skills associated with the technique by using fresh cadaveric specimens. MATERIAL AND METHODS: After obtaining ethical clearance, 26 fresh cadaver heads were used without any preparation. Using a neuroendoscope, complete exposure of the circle of Willis was done endonasaly, and various observations including relation of circle of Willis was recorded. RESULTS: Complete exposure of the circle of Willis was made through an endonasal approach in all cases without injuring surrounding structures. CONCLUSION: Endoscopic endonasal extended transsphenoidal exposure of CW can make the surgeon more efficient in removing midline skullbase lesions with safe handling of different parts of circle of Willis and it may help in development of endonasal endoscopic vascular neurosurgery in the near future.

Experimental and trajectory study on the reaction of protonated methionine with electronically excited singlet molecular oxygen (a1Δg): reaction dynamics and collision energy effects.

The reaction of protonated methionine with the lowest electronically excited state of molecular oxygen O(2)(a(1)Δ(g)) was studied in a guided ion beam apparatus, including the measurement of reaction cross sections over a center-of-mass collision energy (E(col)) range of 0.1-2.0 eV. A series of electronic structure and RRKM calculations were used to examine the properties of various complexes and transition states that might be important along the reaction coordinate. Only one product channel is observed, corresponding to generation of hydrogen peroxide via transfer of two hydrogen atoms (H2T) from protonated methionine to singlet oxygen. At low collision energies, the reaction approaches the collision limit and may be mediated by intermediate complexes. The reaction shows strong inhibition by collision energy, and becomes negligible at E(col) > 1.25 eV. A large set of quasi-classical direct dynamics trajectory simulations were calculated at the B3LYP/6-21G level of theory. Trajectories reproduced experimental results and provided insight into the mechanistic origin of the H2T reaction, how the reaction probability varies with impact parameter, and the suppressing effect of collision energy. Analysis of the trajectories shows that at E(col) = 1.0 eV the reaction is mediated by a precursor and/or hydroperoxide complex, and is sharply orientation-dependent. Only 20% of collisions have favorable reactant orientations at the collision point, and of those, less than half form precursor and hydroperoxide complexes which eventually lead to reaction. The narrow range of reactive collision orientations, together with physical quenching of (1)O(2) via intersystem crossing between singlet and triplet electronic states, may account for the low reaction efficiency observed at high E(col).

An Improved Process for the Synthesis of 4H-Imidazo[1,5-a][1,4]benzodiazepines.

The construction of CNS active imidazo[1,5-a][1,4]benzodiazepines has been improved in a one-pot annulation process.