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J S Pasricha

Publications and source records attributed to J S Pasricha.

At least 19 recordsLinked to original sources

Effect of prolonged treatment with levamisole on vitiligo with limited and slow-spreading disease.

BACKGROUND: For an effective treatment of vitiligo, it is as important to arrest the progression of the disease (if it is still active) as it is to induce repigmentation in existing lesions. In patients having limited and slow-spreading vitiligo, we evaluated the efficacy of levamisole to control the activity of the disease process and to induce repigmentation of the vitiliginous areas. METHODS: Levamisole was given to 64 patients in an oral dose of 150 mg on two consecutive days every week for periods varying from 4-48 months. In 14 patients levamisole was used alone, in 38 patients it was combined with topical 0.1% fluocinolone acetonide acetate ointment massaged on the lesions once a day, and in 12 patients it was combined with topical 0.05% clobetasol propionate used in the same way. There was no other adjuvant therapy. RESULTS: In 34 of the 36 patients (94%) having active disease, the progression of the disease could be arrested within 2-4 months. A variable degree of spontaneous repigmentation of the vitiliginous areas was seen in 9 patients (64%) treated with levamisole alone, 33 patients (87%) treated with levamisole and topical fluocinolone, and all the 12 patients treated with levamisole and topical clobetasol. The side effects with levamisole were minimal except in two cases where treatment had to be discontinued. Topical fluocinolone was fairly safe in the Indian patients, but clobetasol frequently produced atrophy and telangiectasia. CONCLUSIONS: Levamisole seems to be a simple, safe, and fairly effective remedy for controlling the activity of the disease process in vitiligo patients who have limited and slow-spreading disease. Some patients develop spontaneous repigmentation as well. To achieve a faster rate of repigmentation, levamisole can be combined with other treatment methods such as topical corticosteroids.

Administration, Oral

Pemphigus in Oxford, UK, and New Delhi, India: a comparative study of disease characteristics and HLA antigens.

A study of pemphigus in New Delhi, India, and Oxford, UK, was undertaken including 20 patients in Oxford and 50 in New Delhi. Data included clinical and histological subtypes and socio-economic data; patients were HLA typed. In New Delhi pemphigus vulgaris predominated, but in Oxford pemphigus vulgaris and pemphigus foliaceus have equal prevalence. Disease distribution with sex was the same, but age at onset was significantly lower in New Delhi (p = 0.0019). HLA typing in pemphigus vulgaris patients revealed a significant reduction in HLA-DR2 in New Delhi (p = 0.0008) and Oxford (p = 0.09). A small increase in HLA-DR1 and -DR4 was found in both groups and, in males only, a subtle increase in HLA-DR6 and reduction in HLA-DR3. No differences were found in the class I antigens. Thus there are striking differences in the types of pemphigus between the two populations, yet the genetic predisposition is the same.

Adolescent

Curative effect of dexamethasone-cyclophosphamide pulse therapy for the treatment of pemphigus vulgaris.

In 1982, five patients having pemphigus vulgaris, four men and one woman, ranging in age between 16 and 48 years, were treated with an arbitrary regimen designed by us. The regimen consisted of giving 100 mg dexamethasone in 500 mL of 5% glucose by a slow intravenous infusion on three consecutive days, along with 500 mg cyclophosphamide on one day only. Such dexamethasone-cyclophosphamide pulses (DCP) were meant to be given once a month, but most patients were not regular in this treatment. In between these pulses the patients received only 50 mg cyclophosphamide orally per day. Oral corticosteroids were given only when necessary. After having received a total of 14 to 48 DCPS, further treatment for pemphigus was withdrawn. All the patients are in continuous clinical remission for the last 4 to 9 years and without any treatment for 2 to 7 years. Further studies on more pemphigus patients have yielded similar results suggesting that it may be possible to cure pemphigus.

Administration, Oral

Intermittent high-dose dexamethasone-cyclophosphamide therapy for pemphigus.

Since 1982, we have treated 79 pemphigus patients with an arbitrarily designed regimen of 100 mg dexamethasone dissolved in 5% glucose given by an intravenous infusion over 1 h, daily on 3 consecutive days and in addition, 500 mg cyclophosphamide on day 1 only. The intermittent high doses (IHD) of dexamethasone are repeated every 2-4 weeks, and the patient continues to take 50 mg/day oral cyclophosphamide. This treatment is divided into four phases. During Phase I, the patient continues to develop relapses of pemphigus a variable number of days after IHD, but the lesions heal up quickly after IHD. These relapses become progressively milder and stop after a few months, but the IHD are continued once a month for 6-9 months (Phase II). In the next phase (Phase III), the monthly IHD are stopped, and the patient continues to take 50 mg/day cyclophosphamide orally. After approximately 1 year this maintenance treatment is withdrawn and the patient is observed for any relapses (Phase IV). Of the 79 patients treated, 10 patients have been lost to follow-up and two have died, one due to leukopaenia caused by inadvertent additional administration of methotrexate, and the other of an unknown cause. Of the remaining 67 patients, 25 are off treatment (Phase IV), 25 are taking only 50 mg cyclophosphamide daily (Phase III), ten are also in remission, but still receiving intermittent high doses of dexamethasone-cyclophosphamide (Phase II), and seven still have active disease (Phase I).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

Objective grading of the loss of pain and touch sensations in leprosy patients.

Two new instruments named Pain/Touch Sensation Testing and Grading devices, which provide standardized and graded stimuli of pain and touch, respectively, were employed to grade the sensory loss at the center of 110 lesions in 97 patients. The grades of sensory loss for pain were 0 (no sensory loss) in 8 lesions, 1 in 6 lesions, 2 in 14 lesions, 3 in 26 lesions, 4 in 19 lesions, and 5 (complete loss) in 37 lesions (total 110 lesions). Grades of sensory loss for touch were 0 in 12 lesions, 1 in 3 lesions, 2 in 5 lesions, 3 in 9 lesions, 4 in 15 lesions, and 5 in 22 lesions (total 66 lesions). Reevaluation done after 2-40 weeks in 46 of these lesions revealed that the grade for pain had decreased in 17 lesions, increased in 4, and remained the same in 25. The grade for loss of touch sensation had decreased in 10, increased in 1, and remained the same in 35. Grading of the sensory loss in most of the 1-cm-square areas of the entire lesion, done in 19 patients (26 lesions), revealed that the sensory loss was not uniform all over the lesion and it was also not maximum at the center of the lesion, though generally it was less at the margin in comparison with the central area. Follow up of 11 of these lesions revealed a decrease in the grades in 7 lesions for both pain and touch sensations, while 2 lesions showed a decrease in the grades for touch sensation only.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans

Minimum temperature felt as hot (MTH)--a new concept for grading the loss of temperature sensation in leprosy patients.

In order to grade the loss of the temperature sensation in the skin of leprosy patients, a newly designed instrument called the Temperature-Sensation-Testing-and-Grading device has been employed to determine the minimum temperature felt as hot (MTH) at the skin area. The MTH in normal subjects was observed to vary from one region of the body to another; it was generally higher on the distal parts of the extremities compared to the proximal parts; and it was also higher on the lower extremities compared to the upper ones. The abdomen and the back generally had the lowest values. There were no variations according to age (11-80 years) or sex and no differences on symmetrical sites of the body. The MTH value, however, showed a dependence on the environmental temperature, the values being lower at low environmental temperatures and higher at high environmental temperatures. But at the same site and the same environmental temperature, the MTH value was found to be almost constant. Different individuals had different MTH values at the same body site and even at the same environmental temperature. The unaffected skin of leprosy patients showed values comparable to the controls. At the leprosy lesions, however, the degree of sensory loss could easily be determined in comparison with the MTH at the contralateral/adjoining unaffected skin. Out of 54 leprosy patients, 7 patients had no sensory loss; in 27 patients the loss varied between 1 degree C and 20 degrees C; while in 20 patients the loss was complete--they could not perceive even 50 degrees C as hot.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

Demonstration of tyrosinase in the vitiligo skin of human beings by a sensitive fluorometric method as well as by 14C(U)-L-tyrosine incorporation into melanin.

Tyrosinase activity (Monophenol, dihydroxyphenylalanine: oxygen oxidoreductase EC 1.14.18.1) in vitiligo and normal epidermal homogenates of skin from human beings was measured by estimating beta 3,4-dihydroxyphenylalanine (dopa) by a highly sensitive fluorometric method described in this paper. The tyrosine activity in the vitiligo skin was about 4 to 37% of corresponding normal skin. The activity of tyrosinase in normal human skin from different individuals and from different regions of the body was in the range of 4 to 140 picomoles of beta 3,4-dihydroxyphenylalanine formed per min/mg protein of epidermal homogenate. The enzyme from vitiligo and normal skin was severely inhibited by substance(s) of low molecular weight. The enzyme exhibits a lag of about 4 hr in the absence of added beta 3,4-dihydroxyphenylalanine and 1 hr in presence of 5 microM dopa. Tyrosinase from the normal and vitiligo skin was inhibited by excess concentration of tyrosine. The homogenates from vitiligo skin could synthesize melanin from C14(U)-L-Tyrosine. The rate of tyrosine incorporation into melanin by the epidermal homogenates is increased by 3,4-dihydroxyphenylalanine (dopa) disproportionate to its effect on tyrosinase activity. Based on the data presented in this paper it is concluded that melanocytes are present in the vitiligo skin. A tentative hypothesis is put forward to explain the lack of melanin synthesis by the vitiligo skin under in vivo conditions, although melanocytes are present.

Cadaver

Drugs causing fixed eruptions.

Forty patients having fixed drug eruptions were subjected to provocation tests. Twelve patients failed to complete the provocation tests while in the remaining, the causative drugs were shown to be tetracyclines (6), analgin (metamizole) (6), oxyphenbutazone (5), phenobarbitone (4), sulphadiazine (3), sulphaphenazole (2), penicillin (1), suphadimethoxone (1), Saridon (1), sulphadimidine (1) and sulphamethoxypryridazine (1). There was evidence of cross-sensitivity between tetracycline and demethylchlortetracycline and also between exyphenbutazone and phenylbutazone, but not between different sulphonamides, In 2 cases, the minimum dose of the drug capable of reactivating the lesions was 100 mg of sulphadiazine and 50 mg of Saridon respectively.

Antipyrine