Proforma for registration of subject for dissertation



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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION



1.

NAME OF THE CANDIDATE AND ADDRESS





DR. ARUN.T.

POST GRADUATE STUDENT,

DEPARTMENT OF SKIN & STD.

KARNATAKA INSTITUTE OF MEDICAL SCIENCES,

HUBLI-580022.



2.

Name of the institution

KARNATAKA INSTITUTE OF MEDICAL SCIENCES, HUBLI-580022.





3.


Course of the study and subject


m.d. in DERMATOLOGY, venereology & leprology.



4.


Date of admission to the course

14-06-2008.





5.



Title of the topic

β€œTHE CLINICAL AND PATHOLOGICAL STUDY OF



VESICULOBULLOUS DISORDERS ”.


6.


Brief resume of intended work:
6.1 NEED FOR THE STUDY:

Vesiculobullous disorders represent a heterogeneous group of dermatoses with protean manifestations. They have dramatic impact on the patient and their family and have severe economic consequences associated with pain, agony and manpower loss1. Certain diseases like Pemphigus vulgaris are associated with high mortality if not diagnosed and treated promptly. Some disorders like Bullous pemphigoid can be associated with internal disorders or malignancy.

Considering the prevalent load of this disease, the proportion of study undertaken to study the aspect of vesiculobullous disorder is surprisingly low. Many studies have been done in Western World, the concern is deeper in developing countries like India. This study is undertaken to evaluate the clinical feature and histopathology of various autoimmune vesiculobullous disorders of skin for the diagnostic potential and to correlate them for greater diagnostic accuracy.
6.2 Review of Literature
Chan.P.T did local retrospective survey in Hongkong between 1985 to 1992. 234 Chinese

patient were diagnosed by skin biopsies. Bullous pemphigoid, Pemphigus vulgaris and

Pemphigus foliaceous were common accounting for 63.7%, 16.2% and 9.9% cases

respectively.2


Javedi Z et al studied 178 patients with Pemphigus at Mahad, Iran and found pemphigus vulgaris was the most common type (86.5%). F:M was 1:4. In Pemphigus vulgaris there was involvement of both skin and mucosa in 64.3%, mucosal lesion in 14%, 2% of patient had positive family history.3
Nair.P.S et al conducted a record based retrospective descriptive study of 37 dermatology cases who died during the period of 1995 to 2001. They found vesiculobullous disorder was the most commonest cause of death found in 18 cases (48.6%), followed by drug reaction in 5(13.5%), malignancy in 5(13.5%), and collagen vascular disorders in 2 cases (5.40%). Pemphigus being the most fatal vesiculobullous disorders (13 cases-35.13%).4
Kandhari.K.C et al did study on 34 cases reported to AIIMS, New Delhi over a period of 4 years, observed 26 cases were of Pemphigus vulgaris, 5 cases of Pemphigus foliaceous, and 3 cases of pemphigus erythematosus.5
Singh.R.P studied 50 cases of different types of pemphigus over a period of 5 years at Patna Medical College and Hospital, observed 72% of cases were males and maximum incidence was among the age group of 21-50 years (72%), there was preponderance of pemphigus vulgaris cases (72%). 80% cases were associated with blood group B. Trunk involvement in 90%, mucous membrane involvement in 82%.6
Handa.P et al studied 85 cases of pemphigus over a period of 12 years from 1961 to 1972 at Rajendra Prasad Medical College and Hospital, Patiala observed 49 cases were of age group of 11 to 45 years and Pemphigus vulgaris being the largest with 83 cases. Majority of cases had moderate severity and were asymptomatic.7

Shafi M et al conducted study of 109 cases (90 females and 19 males) from 1981 to 1992 in Libya. Age of onset of the disease varied from 17 to 85 years. While duration of the disease at the time of presentation varied from 3 days to 13 days. On the basis of clinical features and routine histological findings the cases were divided into various subtypes as : pemphigus foliaceus 65 cases, pemphigus vulgaris 34 patients, pemphigus erythematosus 5, herpetiform pemphigus 3 and vegetans type 2 cases.8


6.3 aims of the Study :

  1. To study the various clinical and pathological patterns of autoimmune vesiculobullous disorders.

  2. To correlate between the clinical and histopathological findings.




7.

Materials and methods :

7.1 Source of data :

This study will be conducted in the Department of Dermatology and S.T.D, KIMS, Hubli from 15th November 2008 to 15th May 2010 ( 18 months ). As it is a time bound study, all cases attending and referred from other department with an intact / ruptured, vesicle / bulla at the time of presentation will be selected.



7.2 methods of collection of data :

The clinical history like age, sex, demography, duration of the disease, site of lesion, any significant family history, any associated systemic disease, any history of drug intake, history of injury, risk factors and complications will be noted in a pre-tested and pre-designed proforma after taking informed and written consent. Diagnosis will be established by history and clinical examination. After this, biopsy will be done under aseptic condition and with consent.


INCLUSION CRITERIA :
All cases of autoimmune vesiculobullous disorder with fresh lesion, not on treatment attending the Dermatology Department irrespective of age, sex and associated diseases.


EXCLUSION CRITERIA :

Infectious diseases ( Viral, fungal and Bacterial Blisters )

Thermal, suction, chemical blisters,

Drug induced,

Metabolic disorders,

Others-like irritant contact dermatitis, eczematous dermatitis, erythema multiforme,

TEN / SJS.



SAMPLE SIZE : 50 cases

This is calculated by taking average of the yearly number of cases of autoimmune disorders over the last three years. But as it is a time bound study ( 18 months ) all cases of vesiculobullous disorders fulfilling the inclusion and exclusion criteria during the period of study from 15th November 2008 to 15th May 2010 ( 18 months ) will be taken for the study.



7.3 does the study require any investigations or interventions to be conducted on patients or other humans or animals ? if so, please describe briefly.

β€œYes”

Apart from routine investigations, the following specific investigation will be done.



  1. Tzanck smears.

  2. Skin biopsy- a small early vesicle/bulla will be chosen for the punch biopsy or

elliptical biopsy.

3. Any relevant investigation as and when required.



7.4 Has Ethical Clearance been obtained from your institution

in case of 7.3 ?

Yes.



8.


List of references:



  1. Burns T, Breahnach S, Cox N, Griffiths C, editors. Rooks text book of Dermatology, 7th edition. London:Blackwell Science:41.1-41.59.

  2. Chan.P.T. Clinical feature and diagnosis of common Autoimmune Bullous Disorder in Hongkong. Hongkong Medical Diary October 2008;13:12-15.

  3. Javedi Z. Meibodi.N.T, Nahidi Y, Epidemiology of Pemphigus in North East Iran: A 10 year retrospective study. Indian J Dermatol 2007;52:188-91.

  4. Nair.P.S, Moorthy.K.P, Yogragan.K. A study of mortality in dermatology. Indian J of Dermatol venerol leprol 2005;71:23-25.

  5. Kandhari.K.C. & Parischa.J.S. Pemphigus in Northern India-clinical studies in 34 patients. Indian J of Dermatol Venereol Leprol 1965;62-71.

  6. Singh.R.P. Pemphigus in Trophics. Indian J of Dermatol Venereol Leprol 1970;15:69-73.

  7. Handa.P, Aggrawal.R.R, Kumar R. A clinical study of 85 cases of pemphigus, Indian J of Dermatol Verereol, 1973:39:106-110.

  8. Shafi M, Khatri ML, Mashina M, Ben-Ghazeil M. Pemphigus: A clinical study of 109 cases from Tripoli, Libya. Indian J Dermatol Venereol Leprol 1994:60:140-143.




9.


SIGNATURE OF THE CANDIDATE





10.



REMARKS OF THE GUIDE

Vesiculobullous disorders are very interesting in that some of them are very easy to diagnose and few very difficult. Response to treatment is also variable.Prognosis is also extremely variable. Some of them like extensive Pemphigus Vulgaris are fatal where as few like bullous pemphigoid are benign and rarely fatal. This study would be very interesting and first of this kind in our Department.



11.


11.1 NAME AND DESIGNATION OF

THE GUIDE


Dr. RAVI. M. RATHOD md,

PROFESSOR

department OF DERMATOLOGY, VENEREOLOGY & LEPROLOGY,

kims, hubli.



11.2 SIGNATURE




11.3 CO-GUIDE (IF ANY)


DR. SUJATHA .S. GIRIYAN MD,

PROFESSOR,

DEPARTMENT OF PATHOLOGY

KIMS, HUBLI.


11.4 SIGNATURE




11.5 HEAD OF THE DEPARTMENT


Dr. RAGHAVENDRA. TOPHAKHANEMD,

PROFESSOR & HEAD,

DEPARTMENT OF DERMATOLOGY, VENEREOLOGY & LEPROLOGY,

KIMS, HUBLI



11.6 SIGNATURE





12


12.1 REMARKS OF THE CHAIRMAN AND THE PRINCIPAL







    1. SIGNATURE






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