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Joshi N.,Post Gra Institute Of Medical Education And Research | Minz R.W.,Post Gra Institute Of Medical Education And Research | Anand S.,Post Gra Institute Of Medical Education And Research | Parmar N.V.,Post Gra Institute Of Medical Education And Research | Kanwar A.J.,Post Gra Institute Of Medical Education And Research
BMC Research Notes | Year: 2014

Background: Pemphigus vulgaris (PV) is an autoimmune bullous disease caused by acantholysis of keratinocytes due to pathogenic desmoglein-3 autoantibodies. Role of vitamin D has been recently implicated in various autoimmune conditions due to its immunomodulatory effects on innate and adaptive immune responses. One of the key mechanisms of the immune regulation by vitamin D is through its anti-inflammatory effects by suppression of Th17 functions. Thus, vitamin D may be involved in pathogenesis of PV. In this study, the serum vitamin D, IL-17 and TGF-β levels in PV patients as well as healthy controls were estimated in order to understand the underlying immune mechanism involved in disease pathogenesis. Results: This retrospective study included 30 biopsy proven PV patients' sera. Ten age matched volunteers without any cutaneous or autoimmune conditions were recruited as healthy control (HC). Serum Vitamin D levels were measured using chemiluminescence, whereas IL-17 and TGF-β levels were determined using ELISA. All patients showed deficient vitamin D levels (11.1 ± 5.8 ng/ml). Moreover, all the PV patients had elevated serum IL-17 levels (210.7 ± 105.3), whereas it was not detectable in any (n = 10) of the healthy controls sera (ELISA sensitivity ≥ 8 pg/ml). The mean serum TGF-β concentration was also lower in patient sera as compared to healthy control, and the TGF-β/IL-17 ratio was drastically reduced in patients (30.30 ± 28), as compared to healthy controls (1363.34 ± 559.52). Conclusions: Hypovitaminosis is common in North India, as ascertained by deficient levels in healthy controls, and was also consistently observed in PV patient. These low levels were not related to age or gender. The increased serum IL-17 and dramatic reduction in TGF-β/IL-17 ratio in diseased patients further indicate that dysregulation of the Treg/Th-17 axis of T effector cells may be of significance in pathogenesis of PV. Thus, the study indicates that vitamin D insufficiency may be a predisposing factor in PV, contributing through its role in any of the various adaptive immune mechanisms that regulate T cell functions in vivo. Thus, there is a need to further evaluate the Treg/Th-17 axis, as it may have an important role in disease progression. © 2014Joshi et al.; licensee BioMed Central Ltd.

Yadav M.,Post Gra Institute Of Medical Education And Research | Bhatia A.,Post Gra Institute Of Medical Education And Research | Saxena A.,Post Gra Institute Of Medical Education And Research | Khandelwal N.,Post Gra Institute Of Medical Education And Research
Annals of Tropical Medicine and Public Health | Year: 2013

The problem of left behind radiological investigations is encountered round the world, which adds to the wastage of resources. Aims: This article attempts to highlights the problem of left behind conventional radiographs in an emergency setting in a tertiary care center of northern India. Settings and Design: Tertiary care center, retrospective study. Materials and Methods: The number of radiographs left behind in the emergency over a period of 14 months was retrospectively assessed. The radiographs were classified as normal, abnormal and technically poor. The technically poor radiographs included the ones with poor centering, inadequate inspiration and improper exposure factors limiting the interpretation. Statistical Analysis Used: Discrete categorical data is presented as n (%). Results: A total of 2783 radiographs were left behind. The total cost of these left out radiographs worked out to 139,150 Indian rupees. Of the 2783 radiographs, 1108 had positive findings (39.8%) and 1399 were normal (50.2%). The technically poor radiographs were 276 (10%) and no definite conclusion could be given as no clinical history was provided in the majority of these cases. Conclusions: A joint cost-effective strategy should be formulated by hospital administration, radiology and allied departments to overcome the problem of ever increasing bundles of left out radiography, especially in the developing countries having resource-poor settings.

Sharma R.R.,Post Gra Institute Of Medical Education And Research | Pollock K.,University of Minnesota | Hubel A.,University of Minnesota | McKenna D.,University of Minnesota
Transfusion | Year: 2014

Mesenchymal stem cells (MSCs) have recently generated great interest in the fields of regenerative medicine and immunotherapy due to their unique biologic properties. In this review we attempt to provide an overview of the current clinical status of MSC therapy, primarily focusing on immunomodulatory and regenerative or tissue repair applications of MSCs. In addition, current manufacturing is reviewed with attention to variation in practices (e.g., starting material, approach to culture and product testing). There is considerable variation among the 218 clinical trials assessed here; variations include proposed mechanisms of action, optimal dosing strategy, and route of administration. To ensure the greatest likelihood of success in clinical trials as the field progresses, attention must be given to the optimization of MSC culture. © 2013 American Association of Blood Banks.

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