Fine needle aspiration cytology in leprosy.

BACKGROUND: Laboratory diagnosis of leprosy by slit skin smear and skin biopsy is simple but both techniques have their own limitations. Slit skin smear is negative in paucibacillary cases whereas skin biopsy is an invasive technique. Fine needle aspiration cytology (FNAC) from skin lesions in leprosy with subsequent staining with May-Grunwald-Giemsa (MGG) stain has been found useful. AIM: To evaluate the possible role of cytology in classifying leprosy patients. METHODS: Seventy-five untreated cases of leprosy attending the outpatient department were evaluated. Smears were taken from their skin lesions and stained using the MGG technique. Skin biopsy was also done from the lesions, which was compared with cytology smears. RESULTS: A correlation of clinical features with FNAC was noticed in 87.5% of TT, 92.1% of BT, 81% of BL, and 66% of LL cases. Correlation of clinical with histopathological diagnoses revealed 12.5% specificity in TT leprosy, 55.3% in BT, 52.4% in BL and 50% in LL, and 100% in neuritic and histoid leprosy cases. Both correlations were found to be statistically significant by paired t test analysis. Thus, it was possible to distinguish the tuberculoid types by the presence of epithelioid cells and the lepromatous types by the presence of lymphocytes and foamy macrophages. CONCLUSION: FNAC may be used to categorize the patients into paucibacillary and multibacillary types, but is not a very sensitive tool to classify the patients across the Ridley-Jopling spectrum.

Universal acquired melanosis (Carbon baby).

We report a 3-year-old girl born with fair complexion which became darker. The color change was insidious in onset at the age of 5 months, asymptomatic and progressive involving the entire body surface. Histopathology revealed increased pigmentation of the epidermal basal layer. Universal acquired melanosis is a rare form of hypermelanosis which was synonymously referred to as "Carbon baby". This is a rare presentation with only one earlier case report.

A clinical study of psoriatic arthropathy.

BACKGROUND: The incidence of uncomplicated psoriasis is 1-3% in the general population. Arthritis is found in increased frequency in psoriatic patients and its incidence is estimated to be 5-7%. AIM: To assess the prevalence of arthritis in psoriatic patients. METHODS: Four hundred and seventy-two psoriatic patients were enrolled in the study out of which 40 patients had (psoriatic) arthropathy (PsA). Severity of psoriasis was assessed by the psoriasis area and severity index (PASI). Routine blood investigations were carried out along with radiological investigations. RESULTS: Forty percent of the 40 PsA patients were in the age group of 51-60 years. Seven patients out of the 40 (17.5%) psoriatic arthropathic (PsA) patients had a family history of psoriasis. Nail involvement was observed in 37 cases (92.5%). Rheumatoid factor was present in five out of the 40 (12.5%) PsA patients. Serum uric acid levels were above normal in eighteen out of the 40 (45%) PsA patients. Asymmetric oligoarthropathy was the most commonly observed feature in 42.5% of the 40 PsA patients. Narrowing of joint spaces and erosions were observed in 62.5% and 45% of the 40 PsA patients. CONCLUSION: There is an association between the duration of skin lesions and duration of arthropathy. Similarly the PASI score is also directly related with arthropathy.

Palăśa (Butea monosperma (Lamk.) Taub.) and its medico-historical study.

Palăśa (Butea monosperma (Lamk.) Taub.) is considered sacred both by Hindus and Buddhists. It is known to the Hindus under the Sănskrt name Palăśa as it possesses valuable medicinal properties. This sacred tree is being called the treasurer of the gods and of sacrifice. It grows throughout India except in very arid parts and is a medium sized deciduous tree. Parts used are bark, leaf, flower, seed and gum. It is mainly useful as antihelmenthic appetizer, aphrodisiac, laxative etc. Thus its medico- historical aspects are being presented in this paper.

Introduction to Garudapurăna with reference to Ayurvĕda.

The Purănas are the encyclopedic works of the ancient and medieval Hindu religion, philosophy, history, politics, ethics, sciences etc. There are 18 (Astădaśa) purănas, which are, considered as mahăpurănas, among which Garudapurăna is popular one. The Garudapurăna is divided into two parts viz., Pŭrvakhanda and Uttarakhanda. The first part, which is also called Acărakhanda consists of 240 chapters. The greater part of the Pŭrvakhanda occupies the descriptions of Vratas (religious observances), sacred places dedicated to the Sŭrya (sun), Lord Siva and Lord Visnu. It also contains treatises on various aspects like astrology, palmistry, politics, Sănkhya, Yŏga, anatomy, precious stones and extensive information on vedic medicine i.e., Ayurveda. The Uttarakhanda consists of two khandas viz. Dharmakhanda and Brahmakhanda, which are divided into 42 and 29 chapters, respectively. The Dharmakhanda is also known as the Prĕtakalpa which contains directions for the performance of obsequies rites. The Prĕtakalpa portion of the Garudapurăna is generally recited during the period of mourning and so its importance is self-evident. It is almost impossible to narrate within such a small framework, the wide range of splendid truths scattered in the pages of this noble purănam. Little information is available from internal evidence to establish its exact period. However, it is supposed to be quite ancient in its origin.

Medico-historical study of "aśvattha" (sacred fig tree).

Aśvattha (Ficus religiosa Linn.) is a tree which has got mythological, religious and medicinal importance in Indian culture since ancient times. As per Vedic Index Aśvattha means horse stand, a place or site or an object where or under which horses stand. Aśvattha is also known as Pipal and Bodhidrma. This tree is the oldest depicted tree in India. In Vedic times it was used to make fire by friction and considered sacred. Atharvavĕda associates it with the third heaven. It discusses medicinal properties of Aśvattha along with Soma and Kuştha. Aśvattha is associated with the triad of Gods-Brahma, vişņu and siva. Reference to Aśvattha is found in Rămăyaņa, Mahăbhărata, Bhagavadgĭta, Buddhistic literature, Arthaśăstra, Purănăs, Upanişads etc. non-medical literature also. According to Ayurvĕda it has several synonyms. Most of them symbolize its sacredness. Aśvattha is useful in various ailments like consumption, vomiting, ulcers in oral cavity, burns, gynaecological problems etc. Thus its medico-historical importance, regional nomenclature, morphological features in brief etc. are being presented in this article with few illustrations.

Kindler syndrome.

Kindler syndrome is a rare autosomal recessive disorder associated with skin fragility. It is characterized by blistering in infancy, photosensitivity and progressive poikiloderma. The syndrome involves the skin and mucous membrane with radiological changes. The genetic defect has been identified on the short arm of chromosome 20. This report describes an 18-year-old patient with classical features like blistering and photosensitivity in childhood and the subsequent development of poikiloderma. The differential diagnosis of Kindler syndrome includes diseases like Bloom syndrome, Cockayne syndrome, dyskeratosis congenita, epidermolysis bullosa, Rothmund-Thomson syndrome and xeroderma pigmentosum. Our patient had classical cutaneous features of Kindler syndrome with phimosis as a complication.

Biography of Kaśyapa and his contribution to Kaumărabhrtya (paediatrics).

Maharsi Kaśyapa, the author of Kaśyapa Samhită was the son of sage Marica and Kala. Kaśyapa was an eminent physician and specialist in Kaumărabhŗtya (children's diseases) during ancient times. He was contemporary with Punarvasu. Bower's manuscript referred to him as skillful in children's diseases and many formulae are ascribed to him. Two names Kaśyapa and Kăśyapa appear in the history. Hornle thinks these two are the names of the same rsi there is a confusion over his date. Vrddha Jĭvaka was his disciple. Kaśyapa Samhită or Vrddha Jĭvakĭya Samhită was composed in the form of dialogue between Kaśyapa as the teacher and Vrddha Jĭvaka as his pupil. Vatsya later redacted it during Gupta period. The present editions of the Kaśyapa Samhită are based on the manuscript acquired by Pandit Hemraj Sharma. First edition was published in 1953. This Samhită mainly deals with the children's diseases.

MDT-MB therapy in paucibacillary leprosy: a clinicopathological assessment.

BACKGROUND: The World Health Organization recommends treatment regimens for paucibacillary (PB) and multibacillary (MB) leprosy, which differ in their duration and components. Hence accurate classification of the disease is required. To overcome difficulties in classification Uniform Multi Drug Therapy (U-MDT) has been recommended. AIM : To evaluate the benefit of adding clofazimine to paucibacillary regimens in leprosy patients by measuring clinical and histological resolution. METHODS: Forty-four paucibacillary patients were included in the study. Twenty-two patients were given MDT-PB regimen and the remaining MDT-MB regimen for six months . Skin biopsies were done before the commencement and at the end of treatment. Clinical and histological resolutions were measured according to the standard criteria a laid down. The results were analyzed using Fishers' test and Crammers' V test. RESULTS: Clinical improvement was observed in 90.9% in the MB group as compared to 27.3% in the PB group. Regression in the nerve swelling was observed in 70% in the MB group and in 37.5% in the PB group while histological resolution was observed in 72.8% and 54.5% respectively. CONCLUSIONS: Addition of clofazimine helps to resolve leprosy lesions both clinically and histologically, thus justifying the concept of Uniform MDT regimen for all patients.

Medico - historical study of "Visŭcikă" (Cholera).

The Sanskrit word Visŭcikă refers to a condition in which vitiated văta dŏşa causes pain like pricking with a needle over the body. It occurs in a person suffering with ajĭrna (indigestion) and its detailed description is available in Ayurvedic literature. This disease has its existence in India since ancient times; it has also been referred in Mahăhărata and Tripitikas. Its etiology, signs, symptoms, complications, prognosis and treatment etc. as described in Ayurveda may be correlated with the disease Cholera, which is commonly known as "Haiza" in Hindi. In Greek language, the word Cholera means a flow of bile or the bilious disease. Cholera is an acute infectious diarrheal disease, caused by comma bacillus or vibrio cholerae sero groups 01 or 0139. Aretaetus, Benjamin Rush, Chadwick, John Snow, Robert Koch, etc. were some of the pioneers in Cholera research. Medico- historical importance of Cholera, its transmission, description and references from Ayurvedic texts etc., are being presented in this article.

Medicinal plants referred in Kautilya's Arthaśastra.

Kautilya's Arthaśastra which was written somewhere in 321-300 B.C. on ancient Indian Polity, holds a unique place in Indian history and culture. It was discovered at Tanjavore district of Mysore in Karnataka. The Manuscript of Arthaśastra (Devanagiri script) traced by Sri Munisri Jinavijayajee of Patna. Mr. Shyama Sastry had first published the translated text in 1909 as Volume 37 of the Bibliotheca Sanskrta of Mysore. There are 150 chapters in this work. The author of this work, Kautilya is also known as Visnugupta or Canakya. The author himself in the concluding verse of the Arthaśastra quoted his name as Visnugupta. The later writers on his works also designated his name as Cinakya. It was also translated into German and Russian languages. The plants and herbs having medicinal value were compiled the Arthaśastra to bring out the knowledge of the period and how the people honored, patronized, considered their own indigenous system as a part of their life. Same information is being presented in this article.

Scleromyxedema with subclinical myositis.

A 49-year-old farmer presented with papules on the face, arms, chest and back associated with sclerosis. Histopathology and PAS stain confirmed the clinical diagnosis of scleromyxedema. He also had elevated CPK levels due to myopathy. Screening for internal malignancy was negative.

Biography of Bhăvamiśra author of Bhăvaprakăśa (a treatise of Laghutrayee).

Bhăvamiśra, the author of Bhăvaprakăśa was a great scholar in Samsŗt and ancient medical science. He set a great example to modernize ayurvĕda by incorporating new drugs, diseases, procedures of treatment etc. and making ayurvĕda up to date. He was the son of Latakanamiśra. Bhăvamiśra was an orthodox Brahmin. He belonged to Măgada (South Bihar in North India). Date can be determined from the following points. The latest text from which Bhăvamiśra was quoted is Madanapăla Nighaņţu. This was completed in 1347 A.D. and this will be the upper limit for the date of Bhăvamiśra. Yogaratnakara and Vaidyajivana (by Lolimbaraja) both texts belonging to 17th century A.D. quoted verses from Bhăvaprakăśa. His works are Bhăvaprakăśa (most famous), Guņaratnamăla, a commentary on Mădhava Nidăna and Vaidyanighaņţu.

Medico-historical study of "Kilasa" (vitiligo/leucoderma) a common skin disorder.

The earliest known reference to Kilăsa was in 2200 B.C. in the period of Aushooryan. In 1550 B.C. information regarding Vitiligo was noted in the Ebers Papyrus. Atharvavĕda also carries the description of the disease Kilăsa along with several herbal prescriptions. Buddhist literature (Pĭtikăs) especially Vinaya Pĭtika carries the description of Kilăsa. Old Testament also carries the description of white spots i.e. in the Leviticus chapter 13. In ayurvĕda the word Kuşţa was used for all types of skin diseases. Both Kilăsa and Switra are mentioned together in ayurvĕda because of similarity in their aetiology. Kilăsa is also called as Băhya (external) Kuşţa. It is classified into three types based on three Dŏşăs. Prognosis of the disease was also described in ayurvĕda. This disease can be compared with Vitiligo/leucoderma in modern medicine. The Roman Physician Celsus first coined the term Vitiligo in the 2nd Century A.D. This article carries medico-historical references of Kilăsa from ancient to modern literature.