Evaluation of Wound Healing Activity of Ethanolic Extract of Pongamia pinnata Bark.

Present study evaluate wound healing activity of ethanolic extract of stem bark of Pongamia pinnata (PP). Evaluation of wound healing activity, 2 wound models were used I. e., incision and excision wounds were perform in this study on Albino wistar rats (150-200 g). The rats were been treated with 10% and 5% ointment base formulation at dose 15 µl/wound topically. The parameters studied were breaking strength in case of incision wounds, epithelization period and wound area in case of excision wound. The ethanolic extract treated group showed a significant (P < 0.01) reduction in the wound breaking strength in incision type of wound model and significant increase in epithelization period and reduction in percentage of wound area in excision type of wound model as compared to control group. Extract treated groups showed significant (P < 0.01) improvement in all the wound healing parameters of incision and excision wound models as compared to control. This study justify the traditional use of ethanolic extract of Pongamia pinnata stem bark shows wound healing property.

Mononucleosis-like drug rash: an interesting case presentation.

Dapsone hypersensitivity syndrome (DHS) is a rare adverse effect of the commonly prescribed drug dapsone. We present a case of a 35-year-old male who was referred to us from the gastroenterologist with complaints of rash, nausea, vomiting, and jaundice since 2 days with a provisional differential diagnosis of infectious mononucleosis or viral exanthema. On enquiry patient gave history of taking dapsone a week prior for refractory urticaria. After thorough investigations we diagnosed him with DHS. This syndrome occurs in a relatively small proportion of patients, but it is associated with considerable morbidity and mortality. The reason for presenting this case is to remind physicians of the unpredictability and potential severity of this reaction which makes it a major concern in clinical practice.

Recurrent intestinal obstruction with acquired angio-oedema, due to C1-esterase inhibitor deficiency.

A 52-year male with past history of ulcerative colitis 20 years back (now in remission), developed recurrent small intestinal obstruction at intervals of a few months. CT scan did not detect the cause initially. A repeat CT scan (USA) showed interbowel fluid with transient ascites (serum albumin normal). Angio-oedema was suspected and low C4 with C1-esterase inhibitor (C1-INH) deficiency confirmed the diagnosis. Further investigation showed he was suffering from a chronic low grade small B cell lymphoma. He was treated with Rituximab 375 mg/m2 at intervals of one week for 4 weeks. He is asymptomatic with Transexamic acid (500 mg TDS) for last 1½ years.

Organ donation: victory after death.

Despite the Transplantation of Human Organ Act passed in Indian Parliament in 1994, cadaver liver and/or kidney transplant are infrequently performed (in a few private hospitals) in our country compared to living donor liver or kidney transplant. The need for performing more cadaver liver and/or kidney transplants in private and public hospitals is obvious. Immediate measures which should be taken to facilitate more cadaver organ transplant both in private and public hospitals are suggested. Organ donation is for an individual or a family an invaluable opportunity, to register victory after death.

Does model for end-stage liver disease (MELD) require modification?

Model for End-stage Liver Disease (MELD) measures serum bilirubin (mg/dL), serum albumin (g/dL), International Normalised Ratio (INR) for prothrombin time. MELD score accurately predicts survival in 3 months for cirrhotic patients on the waiting list of liver transplantation. In about 15% of patients, it does not accurately predict survival and hence MELD-Na is recommended. MELD score is a poor predictor of survival after liver transplantation. Downgrading of MELD score for age of recipient and chance of recurrence of the disease is recommended to accurately predict survival after liver transplantation.

Cryptogenic cirrhosis: a vanishing entity.

The diagnosis of cryptogenic cirrhosis (cirrhosis of unknown etiology) has dramatically decreased, following the discovery of hepatitis B virus (1965), hepatitis D virus (1977), hepatitis C virus (1989). Improving the diagnostic criteria for Autoimmune Hepatitis, by devising the scoring system and the recognition of the fact that Nonalcoholic Steatohepatitis can progress to cirrhosis (in 8 to 10 years), further reduced the diagnosis of cryptogenic cirrhosis. Establishing the etiology of cirrhosis in the vast majority of the patients has provided numerous options for its prevention and treatment.

Factors responsible for the increasing incidence of oesophageal adenocarcinoma.

Amongst white population of developed countries, the prevalence of oesophageal adenocarcinoma has dramatically increased during the last four decades. During this period, the increased damage to the oesophageal mucosa with gastroesophageal reflux could result from increased acid output (due to absence of Helicobacter pylori in the gastric mucosa with excellent sanitation) and/or increased frequency of reflux due to an "epidemic" of overweight (65% of the population). The most important environmental factors, responsible for the fastest increasing cancer in humans, are discussed.

Investigations proposed to accurately classify chronic gastritis.

Patients of chronic gastritis should be investigated with gastric mucosal biopsy, parietal cell antibody, intrinsic factor antibody, Helicobacter pylori antibody, urea breath test or faecal antigen test for Helicobacter pylori, to accurately classify them. The results of these tests will indicate Helicobacter pylori infection (present or past), the role of hereditary factor (intrinsic factor antibody present or absent) and the success or failure of Helicobacter pylori eradication treatment.

Helicobacter pylori link to pernicious anaemia.

An immunological classification of chronic gastritis based on the detection of Helicobacter pylori (H. pylori) antibody, parietal cell antibody, intrinsic factor antibody, is reported. H. pylori chronic gastritis, slowly progresses to atrophic gastritis, in the majority of patients; in a few patients, with genetic susceptibility to form intrinsic factor antibody, it progresses to pernicious anaemia. In majority of patients of pernicious anaemia, H. pylori gradually disappears from the gastric mucosa, on development of intestinal metaplasia in them. Atrophic gastritis results from H. pylori or non H. pylori. H. pylori infection is diagnosed in the presence of H. pylori in the gastric mucosal biopsy and/or H. pylori antibody (IgG) in the serum. The presence of the genetic factor (intrinsic factor antibody) is essential for the diagnosis of pernicious aneamia. Pernicious anaemia patients without intrinsic factor antibody, should be correctly diagnosed as atrophic gastritis, in view of the absence of the genetic factor (intrinsic factor antibody) in them.

Acquired apolipoprotein B deficiency with chronic hepatitis C virus infection.

Chronic hepatitis C virus (HCV) infection is often associated with fatty liver. Apolipoprotein B (ApoB) deficiency is one of the known causes of fatty liver and acquired ApoB deficiency has recently been reported with HCV infection. We report two patients (47-year-old lady and 48-year-old man) who had asymptomatic transaminase elevation, fatty liver, anti-HCV positive with high viral load (genotype 3). Their lipid profile showed low total cholesterol, low-density lipoprotein, triglycerides and ApoB. One of the patients who received treatment for HCV infection showed improvement in lipid profile and ApoB levels.

Is the presence or absence of Helicobacter pylori in gastric mucosa a greater risk?

Helicobacter pylori is a unique organism which is pathogenic for stomach-duodenum (chronic gastritis, duodenal ulcer, gastric ulcer, gastric malignancy, mucosa-associated lymphoid tissue (MALT) lymphoma) and protective for oesophagus (Barrett's oesophagus, oesophageal adenocarcinoma) at the same time in an individual. For prevention of diseases, the necessity of presence of some bacteria throughout the gastrointestinal lumen needs to be emphasized. The concept--only good Helicobacter pylori is a dead Helicobacter pylori, is dangerous and humans should learn to live in harmony with a few bacteria throughout the gastrointestinal tract.