Aparna Agrawal

Vitiligo: Repigmentation with Dermabrasion and Thin Split-Thickness Skin Graft

BACKGROUND Vitiligo is a common benign condition of great concern. Though a large number of medical and surgical treatment methods are available, none of them is fully dependable in all the areas. OBJECTIVE Split‐thickness skin grafting (STSG) has been used for the treatment of vitiligo for over three decades, but it did not gain popularity. This presentation evaluates the degree of repigmentation achieved with this technique, its complications, and drawbacks. METHODS A case series of 21 patients with 32 localized, stable, and refractory vitiligo patches treated institutionally by dermabrasion and thin STSG has been presented. The patients have been followed up for 1–6 years. Three patients lost to follow‐up before 1 year have not been included. RESULTS The graft take was 100% in 27patches and 90–95% in the remaining five. One hundred percent repigmentation was achieved in 22patches and 90–95% in 10. Time taken for satisfactory color match was 4–9 months (average, 6.3 months). The complications encountered were all minor and did not affect the results. CONCLUSION This is a simple, outpatient procedure performed under local anesthesia resulting in an excellent color match on a long‐term follow‐up. This technique can be used over any part of the body, including the hair‐bearing areas, without compromising the end results.

Influence of CYP2C9 gene polymorphisms on response to glibenclamide in type 2 diabetes mellitus patients

PurposeThe antidiabetic drug glibenclamide is metabolized by the enzyme cytochrome P450 2C9 (CYP2C9) encoded by the polymorphic gene CYP2C9. Previous studies involving healthy volunteers have shown a significant influence of variant CYP2C9 genotypes on glibenclamide metabolism. The aim of this study was to investigate the influence of genetic polymorphisms of CYP2C9 on the response to glibenclamide and on glibenclamide plasma levels in type 2 diabetes mellitus patients.MethodsThe study cohort consisted of type 2 diabetes mellitus patients (n = 80) on regular therapy with glibenclamide either alone or with concomitant metformin. Plasma levels of glibenclamide were estimated by reverse phase high pressure liquid chromatography. The variant alleles of CYP2C9, namely CYP2C9 *2 and *3, were identified by PCR–restricted fragment length polymorphism. The plasma levels of glibenclamide and occurrences of hypoglycemic adverse effects with their severity were compared between the genotype groups.ResultsOf the 80 patients (61 males, 19 females), 78 were on concomitant treatment with two drugs, namely, glibenclamide and metformin, and two were on monotherapy with glibenclamide. There was a significant association (p < 0.001) between genotype status of CYP2C9 and the control of diabetes in patients receiving treatment with glibenclamide. There were no statistically significant differences in hypoglycemic adverse effects between the genotype groups.ConclusionThe type 2 diabetes mellitus patients participating in this study with variant genotypes of CYP2C9 were found to respond better to treatment with glibenclamide than those with the normal genotype. The variant genotype CYP2C9 *1/*3 did not significantly influence the hypoglycemic adverse effects among those patients on long-term glibenclamide treatment.

Vitiligo: surgical repigmentation of leukotrichia.

BACKGROUND Patients with vitiligo frequently have premature gray hair. Until recently the literature was silent about its management. While surgically treating vitiligo, we incidentally observed repigmentation of gray hair. OBJECTIVE Based on our observations we undertook this study to see the effect of surgical treatment of vitiligo on repigmentation of leukotrichia, as well as to evaluate the percentage of repigmentation, if any, in the different hair‐bearing areas, and the time taken for it. METHODS A case series of eight patients with nine patches of localized, stable, and refractory vitiligo with leukotrichia of 3–12 years duration is presented. The patients were followed up for 2–6 years. One patient was lost from follow‐up after 2 months. The vitiligo was treated by dermabrasion and thin split‐thickness skin grafting under local anesthesia, as outpatients. RESULTS Repigmentation of the hair occurred in all the areas but it was seen earlier (3 months) and was more complete in the eyebrows (70–95%). In the scalp and the beard areas it started later (6–9 months) and was around 50–60% only. The degree of pigmentation increased until about 3 years after surgery. No complications in the form of graft loss or alopecia were observed. CONCLUSIONS Partial to near‐total repigmentation of leukotrichia can be achieved surgically. Contrary to the present theory, we hypothesize that melanocytes also migrate from the repigmented epidermis to the hair follicle, resulting in repigmentation of the hair.

Increased glycation of hemoglobin and plasma proteins in normotensive, non-diabetic obese Indian subjects: putative role of lipid peroxides

Abstract Background: Glycation and lipid peroxidation are spontaneous reactions believed to contribute to the pathogenesis of many clinical disorders. The purpose of the present study was to evaluate the levels of lipid peroxides and glycated proteins in normotensive, non-diabetic obese Indian subjects and to assess possible associations between them. Methods: A total of 28 obese male subjects and 20 non-obese subjects were included in the present study. Whole blood glycated hemoglobin, plasma lipid peroxides and fructosamine levels were estimated in both groups. Results: Lipid peroxides, glycated hemoglobin and fructosamine levels were significantly higher in obese subjects in comparison with non-obese subjects. We also found a significant association between malondialdehyde and body mass index (r=0.424, p=0.025). Partial correlation analysis revealed that malondialdehyde was significantly correlated with glycated hemoglobin (r=0.590, p=0.01) and fructosamine (r=0.442, p=0.021) after controlling for glucose. Conclusions: Increased glycation of proteins was found in normotensive, non-diabetic obese Indian subjects. These data also support the premise that lipid peroxides per se play a role in the glycation of hemoglobin and plasma proteins. Clin Chem Lab Med 2007;45:996–9.

A clinical study of dermatoses in diabetes to establish its markers.

Background: Cutaneous manifestations of diabetes mellitus generally appear subsequent to the development of the disease, but they may be the first presenting signs and in some cases they may precede the primary disease manifestation by many years. Aims: The aim of our study was to study the spectrum of dermatoses in diabetics, to know the frequency of dermatoses specific to diabetes mellitus (DM), and to establish the mucocutaneous markers of DM. Material and Methods: The study was conducted at a diabetic clinic and our department between September 2008 and June 2010. Two hundred and twenty-four diabetic patients were included in the study group and those with gestational diabetes were excluded. Healthy age- and sex-matched individuals were taken as controls. Results: The male to female ratio was 1 : 1.21. Type 2 DM was seen in 89.7% and type 1 DM in 10.3% of the patients. Dermatoses were seen in 88.3% of the diabetics compared to 36% in non-diabetic controls (P<0.05). Cutaneous infections were the most common dermatoses followed by acanthosis nigricans and xerosis in diabetics. Type 2 DM was found to have an increased risk of complications than type 1 DM. Complications of diabetes were seen in 43.7% of the diabetic cases. Diabetic dermopathy, loss of hair over the legs, diabetic foot ulcer, and so on, were found to be the cutaneous markers of DM in our group of cases. Conclusion: Dermatoses were more common in diabetics than non-diabetics. Cutaneous infections formed the largest group of dermatoses in DM.

Possible modulation of glycated protein levels in prehypertension by lipid peroxides.

Glycation and lipid peroxidation are two important processes known to play a key role in complications of many pathophysiological processes. Malondialdehyde (MDA) has been reported to play a possible role in the genesis of glycated proteins. This study was undertaken to unravel the possible association of MDA with glycated hemoglobin and fructosamine in prehypertensive patients. A case–control study was performed on 42 prehypertensive and 30 control subjects. Plasma glucose, MDA, fructosamine, and glycated hemoglobin were analyzed in both the groups. Partial correlation analysis was performed to predict the independent association of MDA and fasting glucose on fructosamine and glycated hemoglobin. Plasma of prehypertensive subjects revealed significantly higher concentrations of lipid peroxides and fructosamine than in controls. Glycated hemoglobin concentrations were also found to be significantly increased in test group when compared with healthy controls. When the effects of fasting glucose on the concentrations of glycated hemoglobin and fructosamine were refuted by partial correlation analysis, MDA was found to be a significant determinant of glycated hemoglobin and fructosamine in subjects with prehypertension. These data also support the premise that lipid peroxides per se could play a role in the glycation of hemoglobin and plasma proteins in prehypertension.

Association Between Protein-Bound Sialic Acid and High-Sensitivity C-Reactive Protein in Essential Hypertension: A Possible Indication of Underlying Cardiovascular Risk

The aim of this study was to examine the possible alteration in the levels of C-reactive protein, protein-bound sialic acid, and other lipid risk factors in newly diagnosed essential hypertensive subjects. In all, 56 hypertensive and 33 normotensive male subjects were enrolled in the study. Lipid profile, C-reactive protein, apolipoprotein-B, and protein-bound sialic acid were estimated in both the groups. Total cholesterol, triglyceride, low-density lipoprotein—cholesterol, C-reactive protein, apolipoprotein-B, and protein-bound sialic acid were significantly increased in patients with essential hypertension. Correlation analysis revealed a significant association between the protein-bound sialic acid with mean arterial pressure, C-reactive protein, and low-density lipoprotein—cholesterol. The findings of the present study suggest that in essential hypertension there is an association between protein-bound sialic acid and C-reactive protein, which reflects the clustering of cardiovascular risk factors in these patients.