J.N.Suresh Kumar

Pemphigus vulgaris is a chronic autoimmune intraepithelial disease that forms flaccid blisters and erosions of skin and mucous membranes. Pemphigus vulgaris is a rare disease resulting from an autoimmune process in which IgG serum antibodies are produced against normal desmosomal adhesion molecules (desmoglein 3 and to lesser extent desmoglein 1) on the cell membrane of keratinocytes causing loss of cell adhesion, with separation of epithelial layers (acantholysis) and also appearance of blisters on skin or mucosa. Patients have ill-defined, irregularly shaped, gingival, buccal, or palatine erosions, which are painful and slow to heal. Pemphigus vulgaris shows have an approximately equal prevalence among men and women. PV Causes genetics like HLA DR4 and HLA DR14. The mucous membranes often affected are those of oral cavity other surfaces involved including conjunctiva, oesophagus labia, vagina, cervix, vulva, penis, urethra, nasal mucosa, and anus. The diagnosis is based on set of criteria: clinical features, histology and immunological tests. Laboratory examinations include: Tzanck smear to detect acantolytic cells, direct and indirect immunofluorescence, ELISA test and when diagnosis remain uncertain, immunoprecipitation and immunoblotting techniques are helpful. The main objective of therapeutic management is to control the disease, heal the bullous skin and mucous lesions and to minimize the associated functional impairment. The standard treatment for pemphigus vulgaris is use of systemic corticosteroids. Azathioprine and mycophenolate mofetil are used in case of nonsteroidal treatment. In case of recalcitrant pemphigus, Rituximab is extremely effective when other treatments fail to control the disease. The present review emphasized the etiopathogenesis, clinical characteristics, diagnosis and treatment strategies for Pemphigus vulgaris and challenges in the management of this uncommon disease. Key words: Pemphigus vulgaris (PV), Acantholysis, keratinocytes, Oral lesions, Nikolsky sign, prednisolone, immunosuppressive agent,  

Over the last decade, diabetes mellitus has emerged as an important clinical and public health problem throughout the world. The aim of the study is   perceive the Potentiality of a newer oral Antihyperglycemic combination therapy over conventional therapy in type 2 diabetes. The prospective study was conducted over a period of six months in the department of Medicine, Guntur City Hospital. The prevalence of type2 diabetes was high in male 65.79 % than female 34.21%. Majority of the patients  (23.68 %) belonged to age group of 51–55 years. Majority of patients (55.26%) having a family history of Diabetes. Majority of patients receiving Combination of Glibenclamide + Metformin (60.53%), evaluated for effect on FPG for both combinations. The mean changes in FPG were noted. In the same way effect on HbA1c also noted. Mean changes in for every month HbA1c will be noted. Our study reveals that Combination therapy with Metformin plus Glimepiride is more effective than Glibenclamide plus Metformin; in improving glycemic control in type 2 diabetes, while also allowing a reduction of the dosage of each drug.