Pediatric Dermatology, EarlyView.
Παρασκευή 6 Απριλίου 2018
Idiopathic facial aseptic granuloma—A diagnostic challenge in pediatric dermatology
Pediatric Dermatology, EarlyView.
Better kitchens and toilets: both needed for better health
Abstract
Both poor water, sanitation, hygiene (WaSH) and household air pollution (HAP) adversely affect the health of millions of people each year around the globe and specifically in developing countries. The objective of current work is to highlight the importance of HAP in parallel to WaSH for decision making to achieve better health specially in developing countries. There are examples, where developing countries are strengthening efforts to tackle the issue of poor water and sanitation such as 'Clean India Mission' was recently launched by the Government of India. However, there is lack of actions to address the issue related to HAP—to extend the coverage of clean fuel, efficient stoves and ventilated kitchens to the deprived population under the 'Clean India Mission'. Most of the rural household and urban slums in developing countries have only a single room, where people cook and sleep. This leads them to exposure to toxic HAP, which can be minimized by developing country specific indoor air quality guidelines and action framework. Hence, there should be policies to provide them not only the subsidy for clean fuel but also to build properly ventilated kitchens along with the promotion of clean toilets and water supplies. There is a need to strengthen global efforts, to jointly address the challenges associated with the risks related to WaSH and HAP in order to efficiently reduce the global burden of disease. Further, this will also help to timely attain the sustainable development goals for better health and environment.
Increased associated effects of topography and litter and soil nutrients on soil enzyme activities and microbial biomass along vegetation successions in karst ecosystem, southwestern China
Abstract
Studying the influence of topography and litter and soil nutrients on soil enzymes and microbial biomass is important to the understanding of soil nutrient transformation and cycling, but these relationships in heterogeneous soils of karst ecosystem remains poorly understood. We determined environment factors influencing the urease (URS) and alkaline phosphatase (ALP) activity and microbial biomass C and N (MBC and MBN) with advancing vegetation succession. The results showed that ALP increased but URS decreased with the advancing vegetation succession. The MBC and MBN were highest in shrubland, but both were lowest in grassland. The URS was positively correlated with the surface cover of rock outcrops (SRO) but negatively correlated with litter N, and soil available N and pH. Conversely, ALP was positively correlated with litter N, soil organic carbon (SOC), and soil available N and pH, but negatively correlated with soil total N. The MBC was positively related to litter quantities and SOC but negatively related to soil pH; the MBN was positively related to slope gradient (SLG), SOC, and soil total P and available P. Additionally, the trends of the index URS/MBN were grassland > secondary forest > shrubland > primary forest, but the index ALP/MBN increased with advancing vegetation succession. It indicated that soil microorganism mainly exudate extracellular URS and ALP to soils. We also found the interactions of topography (SLG and SRO), litter (nutrients and quantity), and soil (nutrients and pH) explained 42.00, 87.00, and 66.00% of the variations in URS, ALP, and microbial biomass, respectively. Path analysis showed that the topography had a directly positive effect on litter nutrients and quantities, but not on soil nutrients; the litter nutrients and quantities had direct positive effect on soil nutrients, which had direct effect on soil enzymes and microbial biomass; the relationships (R2) between the independent variable and enzymes activities and microbial biomass increased with advancing successions. Thus, it suggested that high SLG and SRO are good for collecting litters back to soils and then the topography, litter, and soil factors increased its controlling effect on soil enzymes activities and microbial biomass with advancing successions in karst ecosystem.
Techno-economic and environmental assessment of biogas production from banana peel ( Musa paradisiaca ) in a biorefinery concept
Abstract
Two scenarios for the biogas production using Banana Peel as raw material were evaluated. The first scenario involves the stand-alone production of biogas and the second scenario includes the biogas production together with other products under biorefinery concept. In both scenarios, the influence of the production scale on the process economy was assessed and feasibility limits were defined. For this purpose, the mass and energy balances were established using the software Aspen Plus along with kinetic models reported in the literature. The economic and environmental analysis of the process was performed considering Colombian economic conditions. As a result, it was found that different process scales showed great potential for biogas production. Thus, plants with greater capacity have a greater economic benefit than those with lower capacity. However, this benefit leads to high-energy consumption and greater environmental impact.
Assessment of toxicity of heavy metal-contaminated soils toward Collembola in the paddy fields supported by laboratory tests
Abstract
Effects on soil Collembola of Cu, Zn, Pb, and Cd pollution from Cu smelters over 40 years were investigated in paddy fields from an area of Eastern China. We compared the field effects to those observed in single-species laboratory tests employing the hemiedaphic collembolan Folsomia candida and the epedaphic Sinella curviseta obtained from laboratory cultures and exposed to field-collected polluted soil. The results indicated that different collembolan species responded differently to the pollution in the fields and could be divided into sensitive, indifferent, and tolerant types accordingly. The abundance of sensitive species decreased as the pollution increased, but this was not the same for indifferent and tolerant species. The dominant species changed from sensitive to tolerant species as the pollution increased. The reproduction of F. candida and S. curviseta was most sensitive to the contaminated soil compared to growth and survival; the sensitivity of the two species was similar. The growth was more sensitive than the survival for F. candida but not for S. curviseta. The growth and survival of F. candida were much more sensitive than those of S. curviseta. Sensitivity of field populations of F. candida (EC10 31 [15–46]) and hemiedaphic species Folsomia quadrioculata (EC10 52 [0.7–102]) were comparable with sensitivity of the reproduction of F. candida in the single-species tests (EC10 21 [14–27]), suggesting that single-species test based on laboratory cultures and field soil could be used to link laboratory and field data and then reflect the field situation. S. curviseta could be used as an epedaphic species in single-species tests and F. quadrioculata as an indicator species for assessment of field effect.
Vitamin D-Dependent rickets Type II with alopecia: A rare case report
Divya Vupperla, Snehal Balvant Lunge, Praveen Elaprolu
Indian Journal of Dermatology 2018 63(2):176-179
Vitamin D-dependent rickets type II is a rare hereditary disorder. It occurs due to mutations in the gene chr. 12q12-q14, which codes for vitamin D receptor. End-organ resistance to 1,25-(OH)2vitamin D3 and alopecia in severe cases are the characteristic features. We report a case of a 4-year-old boy with loss of hair over the scalp and body – first observed after 1 month of birth. The boy also developed difficulty in walking at the age of 2 year. On analysis, reduced serum calcium level (7.5 mg/dL) and elevated alkaline phosphatase level (625 IU/L) were reported. Initially, the treatment included intramuscularly administered single dose of 600,000 IU vitamin D, followed by 400 IU of vitamin D along with 1 g of supplemental calcium every day. Periodic follow-up was conducted for 2 months. Improvement was observed in the biochemical parameters and X-rays of the distal radial and ulnar metaphyses, although no improvement was observed in alopecia.
Indian Journal of Dermatology 2018 63(2):176-179
Vitamin D-dependent rickets type II is a rare hereditary disorder. It occurs due to mutations in the gene chr. 12q12-q14, which codes for vitamin D receptor. End-organ resistance to 1,25-(OH)2vitamin D3 and alopecia in severe cases are the characteristic features. We report a case of a 4-year-old boy with loss of hair over the scalp and body – first observed after 1 month of birth. The boy also developed difficulty in walking at the age of 2 year. On analysis, reduced serum calcium level (7.5 mg/dL) and elevated alkaline phosphatase level (625 IU/L) were reported. Initially, the treatment included intramuscularly administered single dose of 600,000 IU vitamin D, followed by 400 IU of vitamin D along with 1 g of supplemental calcium every day. Periodic follow-up was conducted for 2 months. Improvement was observed in the biochemical parameters and X-rays of the distal radial and ulnar metaphyses, although no improvement was observed in alopecia.
Common contact allergens in patients with palmoplantar and scalp psoriasis and impact of their avoidance on dermatology life quality index: A hospital-based study
Farhan Rasool, Saniya Akhtar, Iffat Hassan, Sumaya Zeerak, Syed Mubashir, Gousia Sheikh
Indian Journal of Dermatology 2018 63(2):160-164
Background: Scalp psoriasis and psoriasis limited to palms and/or soles have been referred to as difficult to control psoriasis. Contact allergy has long been suspected to aggravate existing lesions and cause resistance to therapy in these psoriasis variants. Objectives: The objective of the study was to assess common contact allergens in patients with palmoplantar and scalp psoriasis and the impact of their avoidance on dermatology life quality index (DLQI). Materials and Methods: A total of 54 patients with palmoplantar and scalp psoriasis were patch tested with Indian Standard Series. The patch test results were read on day 2 and day 4. DLQI was calculated before patch testing and at 1 month and 3 month in patch test positive patients after instructing allergen avoidance. Results: Sixteen out of fifty-four patients (29.62%) showed positive patch test reactions. Metal antigens like nickel and cobalt were the most common sensitizers identified. Statistically significant improvement in DLQI was observed at 1 month and at 3 month of allergen avoidance. Conclusion: Patch testing is a useful test to determine the triggering or aggravating antigens in patients with palmoplantar and scalp psoriasis and subsequent allergen avoidance should be stressed on.
Indian Journal of Dermatology 2018 63(2):160-164
Background: Scalp psoriasis and psoriasis limited to palms and/or soles have been referred to as difficult to control psoriasis. Contact allergy has long been suspected to aggravate existing lesions and cause resistance to therapy in these psoriasis variants. Objectives: The objective of the study was to assess common contact allergens in patients with palmoplantar and scalp psoriasis and the impact of their avoidance on dermatology life quality index (DLQI). Materials and Methods: A total of 54 patients with palmoplantar and scalp psoriasis were patch tested with Indian Standard Series. The patch test results were read on day 2 and day 4. DLQI was calculated before patch testing and at 1 month and 3 month in patch test positive patients after instructing allergen avoidance. Results: Sixteen out of fifty-four patients (29.62%) showed positive patch test reactions. Metal antigens like nickel and cobalt were the most common sensitizers identified. Statistically significant improvement in DLQI was observed at 1 month and at 3 month of allergen avoidance. Conclusion: Patch testing is a useful test to determine the triggering or aggravating antigens in patients with palmoplantar and scalp psoriasis and subsequent allergen avoidance should be stressed on.
Stamping a case of cutaneous adverse drug reaction: Proving beyond causality assessment
Sudip Das, Projna Biswas, Dayamay Pal, Abhishek De
Indian Journal of Dermatology 2018 63(2):99-106
Different types of skin testing with a suspected drug have been reported to be helpful in determining the cause of cutaneous adverse drug reactions (CADRs). It is of utmost importance for practicing dermatologists to have a first hand knowledge of different types of skin tests available in a case of CADR. In each suspected case, a detailed investigation with the suspected agent and correlation of the positive skin reaction with clinical variant of CADR is advocated. Drug skin tests are performed 6 weeks to 6 months after complete healing of the CADR. Drug patch tests are performed similar to the methods used in patch testing in studying contact dermatitis. The commercialized form of the drug used by the patient is tested at 30% dilution. The pure drug is tested at 10% dilution. In severe CADR, drug patch tests should be performed at lower concentrations. It is also of value to test on the most affected site of the initial CADR.
Indian Journal of Dermatology 2018 63(2):99-106
Different types of skin testing with a suspected drug have been reported to be helpful in determining the cause of cutaneous adverse drug reactions (CADRs). It is of utmost importance for practicing dermatologists to have a first hand knowledge of different types of skin tests available in a case of CADR. In each suspected case, a detailed investigation with the suspected agent and correlation of the positive skin reaction with clinical variant of CADR is advocated. Drug skin tests are performed 6 weeks to 6 months after complete healing of the CADR. Drug patch tests are performed similar to the methods used in patch testing in studying contact dermatitis. The commercialized form of the drug used by the patient is tested at 30% dilution. The pure drug is tested at 10% dilution. In severe CADR, drug patch tests should be performed at lower concentrations. It is also of value to test on the most affected site of the initial CADR.
Autoimmune progesterone dermatitis
Astuty Apurwa, Sharmila Patil, Parag Chaudhari, Nitin J Nadkarni
Indian Journal of Dermatology 2018 63(2):188-190
Indian Journal of Dermatology 2018 63(2):188-190
Unusual and interesting adverse cutaneous drug reactions
Vaishali Masatkar, Ashok Nagure, Lalit Kumar Gupta
Indian Journal of Dermatology 2018 63(2):107-116
Any drug can cause any rash! Cutaneous adverse drug reactions (CADRs) are great mimickers and can be included in the differential diagnosis of any inflammatory dermatoses. Several drugs can cause rash of similar morphology and the same drug can cause rash of different morphology. While some common and specific drug reaction patterns are recognized easily by the clinicians, many a times unusual and interesting patterns can be induced by drug(s), thus leading to erroneous diagnosis and mistreatment. This review aims to familiarize clinicians with some rare, yet interesting patterns of CADR.
Indian Journal of Dermatology 2018 63(2):107-116
Any drug can cause any rash! Cutaneous adverse drug reactions (CADRs) are great mimickers and can be included in the differential diagnosis of any inflammatory dermatoses. Several drugs can cause rash of similar morphology and the same drug can cause rash of different morphology. While some common and specific drug reaction patterns are recognized easily by the clinicians, many a times unusual and interesting patterns can be induced by drug(s), thus leading to erroneous diagnosis and mistreatment. This review aims to familiarize clinicians with some rare, yet interesting patterns of CADR.
Peutz-Jeghers syndrome: A circumventable emergency
Sourav Choudhury, Anupam Das, Priyankar Misra, Udipta Ray, Sujata Sarangi
Indian Journal of Dermatology 2018 63(2):168-171
Peutz-Jeghers syndrome (PJS) is characterized by multiple hamartomatous polyps in the gastrointestinal tract and mucocutaneous pigmentation. Here we present, a case of multiple gastrointestinal hamartomatous polyps in a 22-year-old male who had been operated for intestinal obstruction due to ileocolic intussusception. Resection of the affected segment was done with proximal ileostomy and distal mucous fistula formation. Clinicopathological diagnosis of PJS was made. Later, during ileostomy closure, it was found that the patient had a transverse colonic mass which was resected. Histological examination with immunohistochemistry confirmed it to be a Mucosa-Associated Lymphoid Tissue Lymphoma (MALToma). Colonic MALToma in the background of PJS is a unique case for which it has been reported.
Indian Journal of Dermatology 2018 63(2):168-171
Peutz-Jeghers syndrome (PJS) is characterized by multiple hamartomatous polyps in the gastrointestinal tract and mucocutaneous pigmentation. Here we present, a case of multiple gastrointestinal hamartomatous polyps in a 22-year-old male who had been operated for intestinal obstruction due to ileocolic intussusception. Resection of the affected segment was done with proximal ileostomy and distal mucous fistula formation. Clinicopathological diagnosis of PJS was made. Later, during ileostomy closure, it was found that the patient had a transverse colonic mass which was resected. Histological examination with immunohistochemistry confirmed it to be a Mucosa-Associated Lymphoid Tissue Lymphoma (MALToma). Colonic MALToma in the background of PJS is a unique case for which it has been reported.
Management of stevens-johnson syndrome-toxic epidermal necrolysis: Looking beyond guidelines!
Rajesh Kumar, Anupam Das, Sudip Das
Indian Journal of Dermatology 2018 63(2):117-124
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions, which are mainly caused by drugs; and these are usually associated with high degree of morbidity and mortality. Recently, two detailed guidelines were published on the management of SJS/TEN, Indian guidelines and UK guidelines. Still, there is no consensus on the management of SJS/TEN. In this article, our aim is to conceptualize the management aspect of SJS/TEN considering Indian setup. Early discontinuation of all medicines, supportive measures (hydration, electrolytes, and care of denuded skin), corticosteroids and cyclosporine has been found to be useful. Oral provocation test is reserved for patients, who undergo complete remission and this is to be done after hospitalization, under strict vigilance. As there is no consensus, the treatment should be individualized on case to case basis.
Indian Journal of Dermatology 2018 63(2):117-124
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions, which are mainly caused by drugs; and these are usually associated with high degree of morbidity and mortality. Recently, two detailed guidelines were published on the management of SJS/TEN, Indian guidelines and UK guidelines. Still, there is no consensus on the management of SJS/TEN. In this article, our aim is to conceptualize the management aspect of SJS/TEN considering Indian setup. Early discontinuation of all medicines, supportive measures (hydration, electrolytes, and care of denuded skin), corticosteroids and cyclosporine has been found to be useful. Oral provocation test is reserved for patients, who undergo complete remission and this is to be done after hospitalization, under strict vigilance. As there is no consensus, the treatment should be individualized on case to case basis.
Cutaneous metastasis leading to the diagnosis of carcinoma of the prostate: A rare case report and review of literature
Pritam Sureshchandra Kataria, Pradip Piraji Kendre, Apurva Ashok Patel, Sameer Dalsaniya
Indian Journal of Dermatology 2018 63(2):182-185
Prostate adenocarcinoma is a common urologic malignant neoplasm in man. Distant cutaneous metastases (CMs) of prostate carcinoma are extremely rare with a reported incidence of 0.36% and usually they occur late. Clinically, cutaneous metastasis of prostate carcinoma can mimic other skin conditions such as cellulitis, sebaceous cyst, zosteriform lesions, telangectasias, and more, resulting in a poor recognition. Few cases of true cutaneous metastatic prostate carcinoma exist in the literature. We present a case, where the first sign of carcinoma of the prostate was CM over the anterior abdominal wall. Radiological and histopathological confirmation pointed to a diagnosis of carcinoma of the prostate. The patient was treated with orchidectomy and was started on bicalutamide. After 1 month of bicalutamide therapy there was subjective decrease in the size of the metastasis. A high index of suspicion is required while evaluating the different differential diagnoses of this entity particularly in elderly patients.
Indian Journal of Dermatology 2018 63(2):182-185
Prostate adenocarcinoma is a common urologic malignant neoplasm in man. Distant cutaneous metastases (CMs) of prostate carcinoma are extremely rare with a reported incidence of 0.36% and usually they occur late. Clinically, cutaneous metastasis of prostate carcinoma can mimic other skin conditions such as cellulitis, sebaceous cyst, zosteriform lesions, telangectasias, and more, resulting in a poor recognition. Few cases of true cutaneous metastatic prostate carcinoma exist in the literature. We present a case, where the first sign of carcinoma of the prostate was CM over the anterior abdominal wall. Radiological and histopathological confirmation pointed to a diagnosis of carcinoma of the prostate. The patient was treated with orchidectomy and was started on bicalutamide. After 1 month of bicalutamide therapy there was subjective decrease in the size of the metastasis. A high index of suspicion is required while evaluating the different differential diagnoses of this entity particularly in elderly patients.
Controversies in the management of cutaneous adverse drug reactions
Yashpal Manchanda, Sudip Das, Aarti Sarda, Projna Biswas
Indian Journal of Dermatology 2018 63(2):125-130
Some cutaneous adverse drug reactions (CADRs) are severe life-threatening conditions due to multisystem involvements with a high morbidity and mortality rates ranging from 25 - 70% and require immediate medical care. But there are huge controversies regarding the management because large clinical trials are lacking. Most frequent discussion and division occur regarding the use of systemic corticosteroid as early intervention with corticosteroids controls inflammation. Corticosteroids are potent agents that target several intracellular processes to modify almost all components of inflammatory and immune responses but their impact on the long term disease course is not known. Controlled relapses of rash and hepatitis may occur as corticosteroids are tapered. A chronic HHV6 activation promoted by systemic steroids could explain these relapses. Second important issue is the use of antitubercular drugs (ATD) in case of CADR due to multidrug therapy of ATD. As both the tuberculosis and CADR are life threatening conditions and we can not spare treatment of tuberculosis for CADR, we should come to a conclusion which is not yet decided. In the same way the use of antileprotic MDT in CADR due to MDT raises a similar controversy. So, here we focus on those controversies and discuss the issues.
Indian Journal of Dermatology 2018 63(2):125-130
Some cutaneous adverse drug reactions (CADRs) are severe life-threatening conditions due to multisystem involvements with a high morbidity and mortality rates ranging from 25 - 70% and require immediate medical care. But there are huge controversies regarding the management because large clinical trials are lacking. Most frequent discussion and division occur regarding the use of systemic corticosteroid as early intervention with corticosteroids controls inflammation. Corticosteroids are potent agents that target several intracellular processes to modify almost all components of inflammatory and immune responses but their impact on the long term disease course is not known. Controlled relapses of rash and hepatitis may occur as corticosteroids are tapered. A chronic HHV6 activation promoted by systemic steroids could explain these relapses. Second important issue is the use of antitubercular drugs (ATD) in case of CADR due to multidrug therapy of ATD. As both the tuberculosis and CADR are life threatening conditions and we can not spare treatment of tuberculosis for CADR, we should come to a conclusion which is not yet decided. In the same way the use of antileprotic MDT in CADR due to MDT raises a similar controversy. So, here we focus on those controversies and discuss the issues.
Hidradenitis suppurativa: Inside and out
Sharmila Patil, Astuty Apurwa, Nitin Nadkarni, Shweta Agarwal, Parag Chaudhari, Manjyot Gautam
Indian Journal of Dermatology 2018 63(2):91-98
Hidradenitis suppurativa is a chronic, disabling, suppurative disease characterized by deep tender subcutaneous nodules; complicated by fibrosis and extensive sinuses affecting primarily the apocrine gland bearing areas. It affects all races in early 20s with greater prevalence seen in women (3 to 5:1). The estimated disease prevalence is 1 - 4 %. The disease is speculated to be caused by follicular structural abnormalities with associated risk factors as smoking, obesity, positive family history and shaving. Certain co-morbidities can also be seen such as inflammatory bowel disease, spondyloarthropathies, epithelial tumors, pyoderma gangrenosum etc. Treatment modalities include counseling of the patient to lose weight if obese, to wear loose clothes, stop smoking and maintain good hygiene. Topical antibiotics, like 1% clindamycin, have shown to give good results along with benzoyl peroxide wash. Orally cocktail of antibiotics can be given, though biologicals remain the best treatment option. Surgical excision can be done in later stages and in recalcitrant cases.
Indian Journal of Dermatology 2018 63(2):91-98
Hidradenitis suppurativa is a chronic, disabling, suppurative disease characterized by deep tender subcutaneous nodules; complicated by fibrosis and extensive sinuses affecting primarily the apocrine gland bearing areas. It affects all races in early 20s with greater prevalence seen in women (3 to 5:1). The estimated disease prevalence is 1 - 4 %. The disease is speculated to be caused by follicular structural abnormalities with associated risk factors as smoking, obesity, positive family history and shaving. Certain co-morbidities can also be seen such as inflammatory bowel disease, spondyloarthropathies, epithelial tumors, pyoderma gangrenosum etc. Treatment modalities include counseling of the patient to lose weight if obese, to wear loose clothes, stop smoking and maintain good hygiene. Topical antibiotics, like 1% clindamycin, have shown to give good results along with benzoyl peroxide wash. Orally cocktail of antibiotics can be given, though biologicals remain the best treatment option. Surgical excision can be done in later stages and in recalcitrant cases.
Evaluation of adolescents diagnosed with acne vulgaris for quality of life and psychosocial challenges
Murat Eyuboglu, Incilay Kalay, Damla Eyüboglu
Indian Journal of Dermatology 2018 63(2):131-135
Background: Acne vulgaris is a common skin condition which affects most adolescents. It has a major impact on quality of life and psychosocial well-being. Aims: The aims of the study were to examine the psychosocial effects of acne on adolescents and changes in quality of life, and to reveal any difference in the possible effect between genders. In addition, an investigation of the association between acne severity and quality of life as well as psychosocial stress was conducted. Materials and Methods: The present study included 164 adolescents with a mean age of 12–18 years and was diagnosed with acne vulgaris without any previous treatment. The control group consisted of 188 healthy volunteers. Acne severity was evaluated by the global acne grading system. All patients filled in a Children's Dermatology Life Quality Index, Pediatric Quality of Life Questionnaire (PedsQL), and a Strength and Difficulties Questionnaire (SDQ). Results: The scores of SDQ and PedsQL were significantly lower in the case group. There was no significant correlation found between the genders in the control group for acne severity and scale scores. No significant correlation was found between acne severity and psychosocial challenges. Conclusions: The results of the present study show that acne has a significant effect on quality of life for adolescents, and this has an impact on their psychosocial life. Another important finding of the present study is that worsening in quality of life is not affected by some factors such as duration, severity of acne and age.
Indian Journal of Dermatology 2018 63(2):131-135
Background: Acne vulgaris is a common skin condition which affects most adolescents. It has a major impact on quality of life and psychosocial well-being. Aims: The aims of the study were to examine the psychosocial effects of acne on adolescents and changes in quality of life, and to reveal any difference in the possible effect between genders. In addition, an investigation of the association between acne severity and quality of life as well as psychosocial stress was conducted. Materials and Methods: The present study included 164 adolescents with a mean age of 12–18 years and was diagnosed with acne vulgaris without any previous treatment. The control group consisted of 188 healthy volunteers. Acne severity was evaluated by the global acne grading system. All patients filled in a Children's Dermatology Life Quality Index, Pediatric Quality of Life Questionnaire (PedsQL), and a Strength and Difficulties Questionnaire (SDQ). Results: The scores of SDQ and PedsQL were significantly lower in the case group. There was no significant correlation found between the genders in the control group for acne severity and scale scores. No significant correlation was found between acne severity and psychosocial challenges. Conclusions: The results of the present study show that acne has a significant effect on quality of life for adolescents, and this has an impact on their psychosocial life. Another important finding of the present study is that worsening in quality of life is not affected by some factors such as duration, severity of acne and age.
Primary mucinous adenocarcinoma of skin: Myoepithelial cells are a clue to its diagnosis
Radha Sistla, Tameem Afroz, Jithendran Narayanswamy
Indian Journal of Dermatology 2018 63(2):165-167
Primary mucinous adenocarcinoma is a rare adnexal neoplasm of eccrine gland. Fewer than 200 cases are reported in literature. Clinically, it can be mistaken as a benign lesion. The primary challenge in these lesions is to differentiate these rare primary lesions from more frequent mucinous secondary deposits. Morphologically, they are similar to metastatic deposits of mucinous carcinoma from other viscera such as breast, lung, or gastrointestinal tract. Use of ancillary techniques and a thorough metastatic work up are mandatory to differentiate these lesions from metastases. We report a case of primary mucinous carcinoma of nasojugal region in a 51-year-old female. It was diagnosed on fine-needle aspiration cytology, and later, the lesion was excised and diagnosis confirmed on histopathological examination and immunohistochemistry.
Indian Journal of Dermatology 2018 63(2):165-167
Primary mucinous adenocarcinoma is a rare adnexal neoplasm of eccrine gland. Fewer than 200 cases are reported in literature. Clinically, it can be mistaken as a benign lesion. The primary challenge in these lesions is to differentiate these rare primary lesions from more frequent mucinous secondary deposits. Morphologically, they are similar to metastatic deposits of mucinous carcinoma from other viscera such as breast, lung, or gastrointestinal tract. Use of ancillary techniques and a thorough metastatic work up are mandatory to differentiate these lesions from metastases. We report a case of primary mucinous carcinoma of nasojugal region in a 51-year-old female. It was diagnosed on fine-needle aspiration cytology, and later, the lesion was excised and diagnosis confirmed on histopathological examination and immunohistochemistry.
Lipid accumulation product index as visceral obesity indicator in psoriasis: A Case–control Study
Satyaki Ganguly, Lopamudra Ray, Sheela Kuruvila, Sunil Kumar Nanda, Kandasamy Ravichandran
Indian Journal of Dermatology 2018 63(2):136-140
Background: Psoriasis has well-known associations with individual components of metabolic syndrome such as hypertension, dyslipidemia, insulin resistance, and obesity. Traditional anthropometric measurements of obesity such as waist circumference (WC) and body mass index (BMI) do not differentiate between subcutaneous fat and visceral fat, the latter being associated with cardiovascular risk factors. Lipid accumulation product (LAP) index is a measure of visceral fat and has been found to be a better predictor of cardiovascular risk. However, LAP index has not been well-studied in psoriasis patients. Aims and Objectives: Our objective was to find out if LAP index differs significantly between psoriasis patients and controls and whether LAP index shows a correlation with duration and severity of psoriasis. Materials and Methods: A case–control study was undertaken with 40 chronic plaque psoriasis patients and 42 controls. BMI and LAP index were calculated for all the patients and controls. Psoriasis area severity index (PASI) was calculated for all the psoriasis patients. Mann–Whitney U-test was done for comparing the age, BMI, WC, serum triglyceride, and LAP index between the cases and controls and to compare the LAP index between mild psoriasis and moderate-to-severe psoriasis groups. Spearman's correlation coefficient was used to assess the correlation of LAP index with duration of psoriasis and with PASI. Logistic regression models were done to assess the risk factors in psoriasis. Results: A statistically significant difference was observed between the LAP index of controls (23.79 ± 13.02) and that of psoriasis patients (46.42 ± 27.2). LAP index was significantly higher in the moderate-to-severe psoriasis group as compared to the mild psoriasis group. LAP index was a significant risk factor associated with psoriasis (OR = 1.07; 95% CI: 1.03 – 1.11). Conclusion: Calculation of LAP index in psoriasis patients helps in identification of more individuals at high risk of cardiovascular morbidity than traditional anthropometric measurements of obesity.
Indian Journal of Dermatology 2018 63(2):136-140
Background: Psoriasis has well-known associations with individual components of metabolic syndrome such as hypertension, dyslipidemia, insulin resistance, and obesity. Traditional anthropometric measurements of obesity such as waist circumference (WC) and body mass index (BMI) do not differentiate between subcutaneous fat and visceral fat, the latter being associated with cardiovascular risk factors. Lipid accumulation product (LAP) index is a measure of visceral fat and has been found to be a better predictor of cardiovascular risk. However, LAP index has not been well-studied in psoriasis patients. Aims and Objectives: Our objective was to find out if LAP index differs significantly between psoriasis patients and controls and whether LAP index shows a correlation with duration and severity of psoriasis. Materials and Methods: A case–control study was undertaken with 40 chronic plaque psoriasis patients and 42 controls. BMI and LAP index were calculated for all the patients and controls. Psoriasis area severity index (PASI) was calculated for all the psoriasis patients. Mann–Whitney U-test was done for comparing the age, BMI, WC, serum triglyceride, and LAP index between the cases and controls and to compare the LAP index between mild psoriasis and moderate-to-severe psoriasis groups. Spearman's correlation coefficient was used to assess the correlation of LAP index with duration of psoriasis and with PASI. Logistic regression models were done to assess the risk factors in psoriasis. Results: A statistically significant difference was observed between the LAP index of controls (23.79 ± 13.02) and that of psoriasis patients (46.42 ± 27.2). LAP index was significantly higher in the moderate-to-severe psoriasis group as compared to the mild psoriasis group. LAP index was a significant risk factor associated with psoriasis (OR = 1.07; 95% CI: 1.03 – 1.11). Conclusion: Calculation of LAP index in psoriasis patients helps in identification of more individuals at high risk of cardiovascular morbidity than traditional anthropometric measurements of obesity.
A tale of H syndrome with typical radiographic findings
Praneet Pradeep Awake, Lakshmi Chandravathi Penmetcha, Anil Fonseca, Prasad Prabhakar Jawalkar
Indian Journal of Dermatology 2018 63(2):172-175
H syndrome is a recently described autosomal recessive genodermatosis with cutaneous phenotypes of varying severity and multi-system involvement. Patients suffering from this disorder can be easily mistaken for sclerodermoid conditions. The radiological findings of H syndrome are typical but have been described only anecdotally. We present a case of a 29 year old male patient of H syndrome with typical radiological features.
Indian Journal of Dermatology 2018 63(2):172-175
H syndrome is a recently described autosomal recessive genodermatosis with cutaneous phenotypes of varying severity and multi-system involvement. Patients suffering from this disorder can be easily mistaken for sclerodermoid conditions. The radiological findings of H syndrome are typical but have been described only anecdotally. We present a case of a 29 year old male patient of H syndrome with typical radiological features.
A study of onychomycosis at a tertiary care hospital in Eastern Bihar
Anindita Sen, Deblina Bhunia, Pijush Kanti Datta, Atanu Ray, Parthajit Banerjee
Indian Journal of Dermatology 2018 63(2):141-146
Background: Onychomycosis (OM) is a major public health problem which is increasing worldwide. It is associated with high morbidity and causes physical, psychological, and occupational problems in patients. Aims: This study aims to study the pattern of etiological agents, clinical features, and severity assessment of OM in this part of India. Materials and Methods: Sixty eight clinically suspected patients with positive potassium hydroxide and fungal culture were studied. Results: Males were infected more often than females (1.61:1). The most common age group affected was 21–40 years. Finger nails were affected more frequently than toe nails. Distal and lateral subungual OM was the most common (48 cases, 70.59%) clinical pattern. For most of the patients (66.18%), nail involvement was severe. Discoloration was the most common (67 cases, 98.53%) change, followed by subungual hyperkeratosis (51 cases, 75%). Principal causative agents were dermatophytes (55 cases, 80.88%) with Trichophyton rubrum being the most common one (35 cases, 51.47%). In 9 (13.23%) cases, Candida albicans, in 6 (8.82%) Aspergillus niger and in 1 (1.47%) case Acremonium sp. (AC) have been isolated as the sole causative agent. In 2 (2.94%) cases, mixed infection with dermatophyte and Aspergillus and in 1 (1.47%) case dermatophyte and Candida were noted. Conclusion: Although dermatophytes were the most common causative agent of OM, nondermatophytic molds, and yeasts were also encountered. The genus and species identification helps in the proper diagnosis and management. Morphological changes in nail may help in presumptive diagnosis of OM.
Indian Journal of Dermatology 2018 63(2):141-146
Background: Onychomycosis (OM) is a major public health problem which is increasing worldwide. It is associated with high morbidity and causes physical, psychological, and occupational problems in patients. Aims: This study aims to study the pattern of etiological agents, clinical features, and severity assessment of OM in this part of India. Materials and Methods: Sixty eight clinically suspected patients with positive potassium hydroxide and fungal culture were studied. Results: Males were infected more often than females (1.61:1). The most common age group affected was 21–40 years. Finger nails were affected more frequently than toe nails. Distal and lateral subungual OM was the most common (48 cases, 70.59%) clinical pattern. For most of the patients (66.18%), nail involvement was severe. Discoloration was the most common (67 cases, 98.53%) change, followed by subungual hyperkeratosis (51 cases, 75%). Principal causative agents were dermatophytes (55 cases, 80.88%) with Trichophyton rubrum being the most common one (35 cases, 51.47%). In 9 (13.23%) cases, Candida albicans, in 6 (8.82%) Aspergillus niger and in 1 (1.47%) case Acremonium sp. (AC) have been isolated as the sole causative agent. In 2 (2.94%) cases, mixed infection with dermatophyte and Aspergillus and in 1 (1.47%) case dermatophyte and Candida were noted. Conclusion: Although dermatophytes were the most common causative agent of OM, nondermatophytic molds, and yeasts were also encountered. The genus and species identification helps in the proper diagnosis and management. Morphological changes in nail may help in presumptive diagnosis of OM.
Chronic cutaneous lupus erythematosus in a blaschkoid pattern over face
Manju Meena, Manisha Balai, Sharad Mehta, Garima Bharti
Indian Journal of Dermatology 2018 63(2):180-181
Linear lesions following the lines of Blaschko of chronic cutaneous lupus erythematosus is a highly unusual variant of cutaneous lupus, particularly in adult. The lesions are restricted to one anatomical site with facial predilection in most of the reported cases. We herein, report a case of chronic cutaneous lupus erythematosus due to rarity of presentation and later age of onset.
Indian Journal of Dermatology 2018 63(2):180-181
Linear lesions following the lines of Blaschko of chronic cutaneous lupus erythematosus is a highly unusual variant of cutaneous lupus, particularly in adult. The lesions are restricted to one anatomical site with facial predilection in most of the reported cases. We herein, report a case of chronic cutaneous lupus erythematosus due to rarity of presentation and later age of onset.
Conventional versus giant basal cell carcinoma, a review of 57 Cases: Histologic differences contributing to excessive growth
J Chase Purnell, Jerad M Gardner, J Ahmad Brown, Sara C Shalin
Indian Journal of Dermatology 2018 63(2):147-154
Background: Giant basal cell carcinoma (GBCC) is defined as a basal cell carcinoma (BCC) exceeding 5 cm in size. While these tumors impart significant morbidity due to local tissue destruction and have a higher rate of metastatic disease than their conventional (smaller) counterparts, reasons for their large size remain unclear. While theories relating to neglect or faster growth rate are often invoked; to date, there has not been a comprehensive evaluation of the histologic features of these large tumors that may contribute to their size. Methods: Histologic features of GBCCs (n = 29) were evaluated and compared to those of conventional BCC (n = 28). Available clinical demographic data were also reviewed. Results: GBCCs, in addition to overall larger size, more often were thicker, displayed ulceration, and showed a more infiltrative growth pattern than their conventional counterparts. These rare tumors also displayed an insignificant increased propensity for a brisk host immune response, and the infiltrate significantly more often included clusters of plasma cells. Conclusions: Most histologic features seen in GBCCs likely reflect their large size. Histologic features alone are unlikely to explain the size of these rare tumors. The possibility of an altered host immune response contributing to the growth of these tumors requires further investigation.
Indian Journal of Dermatology 2018 63(2):147-154
Background: Giant basal cell carcinoma (GBCC) is defined as a basal cell carcinoma (BCC) exceeding 5 cm in size. While these tumors impart significant morbidity due to local tissue destruction and have a higher rate of metastatic disease than their conventional (smaller) counterparts, reasons for their large size remain unclear. While theories relating to neglect or faster growth rate are often invoked; to date, there has not been a comprehensive evaluation of the histologic features of these large tumors that may contribute to their size. Methods: Histologic features of GBCCs (n = 29) were evaluated and compared to those of conventional BCC (n = 28). Available clinical demographic data were also reviewed. Results: GBCCs, in addition to overall larger size, more often were thicker, displayed ulceration, and showed a more infiltrative growth pattern than their conventional counterparts. These rare tumors also displayed an insignificant increased propensity for a brisk host immune response, and the infiltrate significantly more often included clusters of plasma cells. Conclusions: Most histologic features seen in GBCCs likely reflect their large size. Histologic features alone are unlikely to explain the size of these rare tumors. The possibility of an altered host immune response contributing to the growth of these tumors requires further investigation.
Perforating calcific elastosis: Revisiting a rare entity
Niharika Ranjan Lal, Debabrata Bandyopadhyay, Rachna Verma, Anjani Kumar Shukla
Indian Journal of Dermatology 2018 63(2):186-188
Indian Journal of Dermatology 2018 63(2):186-188
Antimicrobial susceptibility of tinea capitis in children from Egypt
Reham William Doss, Abdel-Aziz El-Rifaie, Nagla Radi, Aya Yehia El-Sherif
Indian Journal of Dermatology 2018 63(2):155-159
Background: Dermatophytic fungi of genera Trichophyton and Microsporum are the most important fungal species causing tinea capitis. Choice of treatment for tinea capitis is determined by the species of fungus. Aim: The aim of the study was to investigate the most prevalent fungal species causing tinea capitis in children from Egypt and the most useful antifungal agent for treatment. Patients and Methods: A total of 100 patients diagnosed clinically with tinea capitis were included in the study. Samples were collected and sent to the microbiology and immunology laboratory for sample processing and fungal identification by routine laboratory techniques. A study of antifungal susceptibility to chosen antifungal medications (fluconazole, ketoconazole, clotrimazole, miconazole, amphotericin, caspofungin, itraconazole, terbinafine, and griseofulvin) was done by minimum inhibitory concentration technique. Results: Our analysis revealed that Microsporum canis is the most commonly isolated strain. Amphotericin was the most effective antifungal agent followed by terbinafine. The most sensitive strain to fluconazole and griseofulvin is Microsporum gypseum, while Microsporum audouinii was mostly responsive to terbinafine. Conclusion: Identification and evaluation of the antifungal susceptibility of the pathogenic species in a certain geographic region is important to achieve a good clinical response.
Indian Journal of Dermatology 2018 63(2):155-159
Background: Dermatophytic fungi of genera Trichophyton and Microsporum are the most important fungal species causing tinea capitis. Choice of treatment for tinea capitis is determined by the species of fungus. Aim: The aim of the study was to investigate the most prevalent fungal species causing tinea capitis in children from Egypt and the most useful antifungal agent for treatment. Patients and Methods: A total of 100 patients diagnosed clinically with tinea capitis were included in the study. Samples were collected and sent to the microbiology and immunology laboratory for sample processing and fungal identification by routine laboratory techniques. A study of antifungal susceptibility to chosen antifungal medications (fluconazole, ketoconazole, clotrimazole, miconazole, amphotericin, caspofungin, itraconazole, terbinafine, and griseofulvin) was done by minimum inhibitory concentration technique. Results: Our analysis revealed that Microsporum canis is the most commonly isolated strain. Amphotericin was the most effective antifungal agent followed by terbinafine. The most sensitive strain to fluconazole and griseofulvin is Microsporum gypseum, while Microsporum audouinii was mostly responsive to terbinafine. Conclusion: Identification and evaluation of the antifungal susceptibility of the pathogenic species in a certain geographic region is important to achieve a good clinical response.
Multiple eruptive clear cell acanthoma
Sha Zhou, Jianjun Qiao, Juan Bai, Yinhua Wu, Xiaoling Jiang, Yunlei Pan, Lina Xu, Hong Fang
Indian Journal of Dermatology 2018 63(2):190-192
Indian Journal of Dermatology 2018 63(2):190-192
Treatment of nevoid hyperkeratosis of the areola and nipple with topical tacalcitol: A case report
Dermatologic Therapy, EarlyView.
Reconstruction of a buttock defect after excision of inflammatory linear verrucous epidermal nevus
Dermatologic Therapy, EarlyView.
Morphological and genetical changes of endothelial progenitor cells after in-vitro conversion into photoreceptors
Publication date: Available online 6 April 2018
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Shi Qiang, Hiba Amer Alsaeedi, Cheng Yuhong, Hao Yang, Li Tong, Suresh Kumar, Akon Higuchi, Abdullah A. Alarfaj, Rusheni Munisvaradass, Mok Pooi Ling, Pei Cheng
BackgroundRetinal degeneration is a condition ensued by various ocular disorders such as artery occlusion, diabetic retinopathy, retrolental fibroplasia and retinitis pigmentosa which cause abnormal loss of photoreceptor cells and lead to eventual vision impairment. No efficient treatment has yet been found, however, the use of stem cell therapy such as bone marrow and embryonic stem cells has opened a new treatment modality for retinal degenerative diseases. The major goal of this study is to analyze the potential of endothelial progenitor cells derived from bone marrow to differentiate into retinal neural cells for regenerative medicine purposes.MethodsIn this study, endothelial progenitor cells were induced in-vitro with photoreceptor growth factor (taurine) for 21 days. Subsequently, the morphology and gene expression of CRX and RHO of the photoreceptors-induced EPCs were examined through immunostaining assay.FindingsThe results indicated that the induced endothelial progenitor cells demonstrated positive gene expression of CRX and RHO. Our findings suggested that EPC cells may have a high advantage in cell replacement therapy for treating eye disease, in addition to other neural diseases, and may be a suitable cell source in regenerative medicine for eye disorders.
Chemically synthesized butein and butin: Optical, structure and electrochemical redox functionality at electrode interface
Publication date: Available online 6 April 2018
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Priya Darshani, Manju Bhargavi Gumpu, Prasanth Thumpati, John Bosco Balaguru Rayappan, Velayutham Ravichandiran, Gururaja Perumal Pazhani, Murugan Veerapandian
Progress in the development of phytochemistry has delivered advancement in materials functionality for range of inter/trans-disciplinary application. Here, we investigated the structural functionality of chemically synthesized phytoconstitutent, chalcone (butein) and flavanone (butin). Photoactive and electroactive behavior of butein and butin were comprehensively studied using UV–vis absorbance, photoluminescence and cyclic voltammetric techniques. Surface morphology of the butein and butin powders was characterized from scanning electron microscope at an operating voltage of 10 kV. Significant ultraviolet absorbance property are observed from butein and butin due to the distribution of π → π* and n → π* transitions. Photoluminescence emission spectra of the prepared materials are well resolved at visible region via keto-enol tautomerization and can be influenced by solvent pH. Cyclic voltammetric studies on the prepared materials enabled a direct electron-transfer reaction at gold-screen printed electrode, indicating the feasibility for analytical validation in herbal industries. Existence of multiple electroactive hydroxyl groups makes butein and butin a redox-functional species at electrode interface. Dispersion ability in aqueous and organic solvents makes butein and butin suitable for variety of photochemical applications. This phytochemical material offers new degrees of optical and redox functionality similar to inorganic nanostructures, in addition to inherent bioactivity, that may be advantageous for further biomedical function.
Graphical abstract
MiR-340/iASPP axis affects UVB-mediated retinal pigment epithelium (RPE) cell damage
Publication date: Available online 6 April 2018
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Jiazhao Yan, Yuhui Qin, Jingsheng Yu, Qinghua Peng, Xiangdong Chen
Long-term exposure to ultraviolet B (UVB) light increases the risk of UVB damage due to increased UVB absorption by the retina and may further lead to age-related eye diseases. The retinal pigment epithelium (RPE) cell is a main target of UVB reaching the retina; its degeneration is an essential event in UVB-mediated age-related macular degeneration (AMD). Herein, we first evaluated the expression and effect of iASPP, an inhibitory regulator of apoptosis, in UVB-induced RPE cell damage. Through the mechanism of RNA interference at the post-transcriptional level, miRNA affects a variety of cellular processes, including UVB-mediated cell damage. We next screened for upstream candidate miRNAs that may regulate iASPP expression. Among 8 candidate miRNAs, UVB significantly increased miR-340 levels. We also confirmed the direct binding of miR-340 to the 3′UTR of iASPP, and assessed the combined effect of miR-340 and iASPP on UVB-induced RPE cell damage. Taken together, we demonstrated the possible mechanisms involved in UVB-induced retinal damage. In RPE cells, UVB irradiation inhibits iASPP expression through inducing miR-340 expression, thereby promoting RPE cell apoptosis and suppressing cell viability via affecting p53, p21 and caspase-3 protein expression. Targeting miR-340 to rescue iASPP expression in RPE cells may help treat UVB-mediated retinal damage.
Behaviors of active sunbeds users and their knowledge on the potential health risks; results of cross‐sectional study in Poland
Journal of Cosmetic Dermatology, EarlyView.
Automated muscle segmentation from CT images of the hip and thigh using a hierarchical multi-atlas method
Abstract
Purpose
Patient-specific quantitative assessments of muscle mass and biomechanical musculoskeletal simulations require segmentation of the muscles from medical images. The objective of this work is to automate muscle segmentation from CT data of the hip and thigh.
Method
We propose a hierarchical multi-atlas method in which each hierarchy includes spatial normalization using simpler pre-segmented structures in order to reduce the inter-patient variability of more complex target structures.
Results
The proposed hierarchical method was evaluated with 19 muscles from 20 CT images of the hip and thigh using the manual segmentation by expert orthopedic surgeons as ground truth. The average symmetric surface distance was significantly reduced in the proposed method (1.53 mm) in comparison with the conventional method (2.65 mm).
Conclusion
We demonstrated that the proposed hierarchical multi-atlas method improved the accuracy of muscle segmentation from CT images, in which large inter-patient variability and insufficient contrast were involved.
Exposure of Escherichia coli to human hepcidin results in differential expression of genes associated with iron homeostasis and oxidative stress
Abstract
Hepcidin belongs to the antimicrobial peptide family but has weak activity with regards to bacterial killing. The regulatory function of hepcidin in humans serves to maintain an iron-restricted environment that limits the growth of pathogens; this study explored whether hepcidin affected bacterial iron homeostasis and oxidative stress using the model organism Escherichia coli. Using the Miller assay it was determined that under low iron availability exposure to sub-inhibitory doses of hepcidin (4 -12μM) led to 2-fold and 4-fold increases in the expression of ftnA and bfd respectively (p < 0.05), in both a wild type (WT) and Δfur (ferric uptake regulator) background. Quantitative real-time PCR analysis of oxyR and sodA, treated with 4 or 8μM of hepcidin showed that expression of these genes was significantly (p < 0.05) increased, whereas expression of lexA was unchanged, indicating that hepcidin likely mediated oxidative stress but did not induce DNA damage.Expanding Treatment Options for Injectable Agents
Abstract
Loss of facial volume and soft-tissue support are common to types of facial aging. Restoration of a youthful appearance relies upon correction of this loss, and can be achieved in various capacities through use of biostimulatory or hyaluronic acids (HA) injectable fillers. Here, the authors discuss the versatility of calcium hydroxylapatite (CaHA) in volume replacement and the applications and facial regions for which CaHA, poly-L-lactic acid (PLLA), and HA fillers are best suited.Differentiating Nonpermanent Injectable Fillers: Prevention and Treatment of Filler Complications
Abstract
Though the incidence of complications and adverse events with dermatological fillers is inherently low, practitioners should be well versed in both prevention of filler complications and the treatment algorithms for addressing "granulomas," nodules, infection, and vascular compromise. Appropriate preventative measures, coupled with timely and effective treatment, are critically important for patient safety and satisfaction. In addition to the preventive measures and treatment algorithms outlined here, the authors emphasize that the broad classification and treatment of nodules as "granulomas" is likely to lead to ineffective treatment, or worse, unnecessary exposure to incorrect treatment. In practice, nodules are classified and treated based on clinical manifestation (eg, late vs early or noninflammatory vs inflammatory) rather than on histology. Indeed, classification of a nodule as a granuloma requires a histological examination, rarely available (or necessary) in clinical practice to guide treatment. Thus, the apparent inflammatory nature of the nodule and the time of onset should drive treatment approach. The treatment algorithms presented here are based on these clinically meaningful parameters.Physiochemical Characteristics of Poly-L-Lactic Acid (PLLA)
Abstract
Poly-L-lactic acid (PLLA) is a synthetic, biocompatible, biodegradable polymer. For soft-tissue augmentation, the size and chemical attributes of the PLLA microparticles are central to this agent's ability to promote a subclinical inflammatory response that stimulates deposition of collagen in the extracellular matrix. The resultant restoration of facial volume occurs in a controlled, predictable manner and is long lasting. The unique physiochemical and biostimulatory properties of PLLA differentiate it from other available treatments and are the foundation of the unique treatment methodology required for optimal results.Calcium Hydroxyapatite (CaHA) Indication for Hand Rejuvenation
Abstract
The recent approval in 2015 of Radiesse for injection into the hand by the FDA has spurred an increase in interest among patients and clinicians in nonsurgical hand rejuvenation using fillers. Application of the same techniques used to treat the face to the dorsum of the hands does not account for the unique nature of the skin and underlying anatomy, and can lead to suboptimal outcomes and an increased risk of adverse events such as the formation of nodules. Here, the authors discuss dilution strategies and injection techniques for hand rejuvenation using Radiesse for optimal patient safety and aesthetic outcomes.Composite Facial Volumization With Calcium Hydroxylapatite (CaHA) for the Treatment of Aging
Abstract
Paradigms in the treatment of aging have evolved to address volume loss as a central and primary hallmark of the aging face. The concept of "composite volumization" was recently proposed by Dr. Z. Paul Lorenc to describe the effect of Radiesse (Merz Aesthetics, Inc., Raleigh, NC), when placed on bone in the supraperiosteal plane, on all overlying tissues (skin, superficial and deep fat compartments, and muscle). The physiochemical properties of Radiesse make it especially well suited for efficient and effective volumization of areas especially prone to volume loss; the temple, zygomatic arch, anterior cheek, pyriform aperture, and prejowl sulcus. Placement of Radiesse on bone in these areas creates a scaffold upon which additional restoration of fine lines and wrinkles may be accomplished, restoring a youthful appearance.Physiochemical Characteristics of Calcium Hydroxylapatite (CaHA)
Abstract
The clinical performance of fillers in soft tissue augmentation depends upon their physiochemical properties, anatomical areas injected, interaction with the recipient, and the skill and experience of the physician. Scientific measures of filler properties facilitate appropriate selection of treatments for optimal treatment outcomes, and inform adjustments to treatments that improve patient safety and aesthetic outcomes. The rheological properties of calcium hydroxylapatite (CaHA), elastic modulus (G') and viscosity, coupled with its capacity to offer both immediate results and continued stimulation of collagen type I deposition, support its distinction as an ideal treatment for the volume loss characteristic of aging. Furthermore, the comparatively higher G' of CaHA offers a physiochemical basis for the clinical performance observed by the authors, especially in regions such as the temple and chin, where the force exerted by CaHA against bone permits expansion of overlaying tissue, permitting it to behave as a liquid implant.BI1 is associated with microvascular protection in cardiac ischemia reperfusion injury via repressing Syk–Nox2–Drp1-mitochondrial fission pathways
Abstract
Background
Mitochondrial fission has been identified as the pathogenesis underlying the development of cardiac microvascular ischemia reperfusion (IR) injury, although the regulatory signaling upstream from fission is far from clear. Bax inhibitor is a novel anti-apoptotic factor, and, however, its role of cardiac microvascular IR injury and mitochondrial homeostasis remains unclear.
Methods
The cardiac microvascular IR injury was performed in WT mice and BI1 transgenic (BITG ) mice. The alterations of microvascular structure and function were detected via electron microscope, immunohistochemistry and immunofluorescence in vivo. Cardiac microvascular endothelial cells were isolated form WT and BITG mice and underwent hypoxia/reoxygenation injury in vitro. Cellular viability and apoptosis were analyzed via MTT assay and caspase-3 activity. Mitochondrial function, morphology and apoptosis were detected. Signaling pathways were analyzed via inhibitor, siRNA and mutant plasmid.
Results
Herein, we demonstrated that Bax inhibitor 1 (BI1) was downregulated following cardiac microvascular IR injury, and its expression correlated negatively with microvascular collapse, endothelial cell apoptosis and mitochondrial damage. However, compared to wild-type mice, BI1 transgenic mice were actually protected from the acute microvascular injury and mitochondrial dysfunction. Functional studies illustrated that reintroduced BI1 directly interacted with and inhibited the Syk pathway, leading to the inactivation of Nox2. Subsequently, less Nox2 was associated with ROS downregulation, inhibiting Drp1 phosphorylated activation. Through repression of the Syk–Nox2–Drp1 signaling axis, BI1 strongly disrupted mitochondrial fission, abolishing mitochondrial apoptosis and thus sustaining endothelial cell viability.
Conclusions
In summary, our report illustrates that BI1 functions as a novel microvascular guardian in cardiac IR injury that operates via inhibition of the Syk–Nox2–Drp1-mitochondrial fission signaling axis. Thus, novel therapeutic strategies to regulate the balance between BI1 and mitochondrial fission could provide a survival advantage to microvasculature following IR stress.
Community response to a sustainable restoration plan for a superfund site
Abstract
Large-scale copper (Cu) mining activities in Michigan's Upper Peninsula produced millions of metric tons of mining wastes also known as stamp sands. The stamp sands containing high concentrations of Cu were disposed of into several lakes connected to the Lake Superior. Eventually, as aquatic organisms in these lakes started to exhibit toxicity symptoms, the stamp sands were dredged and discarded on the lake shores. Consequently, these areas turned into degraded, marginal lands and were collectively classified as a Torch Lake Superfund site by the US EPA. Due to the lack of vegetative cover, the Cu-rich stamp sands eroded into the lakes, affecting the aquatic life. To alleviate this issue, a sustainable restoration plan (SRP) was developed and tested in a greenhouse environment prior to field implementation. Cold-tolerant oilseed crops, camelina (Camelina sativa) and field pennycress (Thlaspi arvense), were grown on compost-fertilized stamp sands, which reduced soil erosion by acting as a vegetative cap. Oilseed plants produced normal yield, demonstrating their potential utilization as biofuel feedstock. Prior to implementing the SRP in field-scale in the Torch Lake Superfund site, a public opinion survey of the local community was conducted to understand the views of residents. Door-to-door survey was performed in July–August 2015, which yielded a response rate of 68.1%. Results showed that residents were generally concerned with stamp sand erosion into the Torch Lake and were overwhelmingly supportive of the SRP, which would not only provide environmental benefits but could boost the local economy via biofuel production. To gauge the general environmental awareness of the respondents, the survey included questions on climate change. Most of the respondents acknowledged that climate change is real and anthropogenically mediated. Having college education and a relatively high annual household income showed a positive and significant correlation with climate change awareness.
Moving beyond surveys to assess patient preferences
Publication date: Available online 5 April 2018
Source:Journal of the American Academy of Dermatology
Author(s): Clifford S. Perlis
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Publication date: Available online 28 September 2017 Source: Actas Dermo-Sifiliográficas Author(s): F.J. Navarro-Triviño
