Publication date: Available online 16 February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Gil Ben-Yakov, Devika Kapuria, Jamie Marko, Min Ho Cho, Stefania Pittaluga, David Erwin Kleiner, Christopher Koh, Steven Holland, Gulbu Uzel, Theo Heller
Παρασκευή 16 Φεβρουαρίου 2018
Liver disturbances in activated phosphoinositide 3-kinase δ syndrome
Syndromic sebaceous nevus: current findings
Abstract
Background
Sebaceous nevus is a congenital malformation of the skin that usually occurs on the scalp or face. Syndromic forms do rarely exist with associated cerebral and ocular malformations. The skin lesions are pale at birth and become irregular by puberty. In the adult patient, tumors (usually benign) develop from sebaceous nevus. Their surgical excision during childhood can give a better result in terms of the definitive scar.
Objectives
The aim of this study is to analyze our cases of syndromic sebaceous hamartoma, perform a review of the existing literature, and propose guidelines for the therapeutic plan.
Methods
This is a retrospective study reviewing the cases of syndromic sebaceous nevus treated in the Department of Orthopedic Plastic Pediatric Surgery in Montpellier, France, and the Department of Pediatric Surgery in Lausanne, Switzerland, between 1994 and 2016.
Results
The files of six patients with syndromic sebaceous nevus were analyzed. The average age at the first consultation was 4 months. The location was craniofacial in all cases. Cerebral radiological imaging was performed on all patients; two showed abnormal findings. Four patients underwent ophthalmic examination, which all revealed abnormalities. Three patients had other associated malformations. Three patients presented with epilepsy or learning difficulties in the course of follow-up.
Conclusion
All patients presenting with extensive sebaceous nevus of the craniofacial region should benefit from cerebral imagery and ophthalmic examination since there is a very high probability of associated abnormalities. The developmental problems encountered could not be definitively associated with the skin malformations.
Gendered Safety and Health Risks in the Construction Trades
Abstract
Objectives
Despite women's increased representation in the overall workforce, construction remains a male-dominated industry. Prior studies have noted that the hazardous workplace environment combined with a culture that can be discriminatory and openly hostile can threaten women workers' health and safety. However, little information exists about the current physical and psychosocial hazards at work affecting tradeswomen. Methods
We examined differences in workplace exposure between women and men, and the association of these exposures with self-reported stress and work injury, in order to highlight how gendered conditions of work negatively affect tradeswomen's health. A holistic view of health that included the influence of both home and work spheres as well as hazards related to women's social experience was considered. Almost 300 workers (198 tradeswomen and 93 tradesmen) throughout Washington State completed surveys. We used descriptive statistics to compare exposures between genders, and logistic regression to model the association between psychosocial exposures and injury and stress outcomes. Results
We found that women were significantly more likely than men to report high perceived stress (31 and 18%, respectively) and being injured at work in the past year (31 and 12%, respectively). Ten of the 12 work-related psychosocial exposures were found to be associated with either stress (job strain, gender and age discrimination, bullying, work/life balance, isolation, sexual harassment, safety climate, and social support) or injury (gender discrimination, bullying, overcompensation, and sexual harassment) for women. Conclusions
The industry continues to lag in supporting tradeswomen's health and safety needs. This study suggests that multiple exposures (including discrimination, overcompensation, and work/life balance) have an important impact on worker well-being. The findings underscore the complex interaction of gender, psychosocial exposures, and occupational risks, and indicate areas for intervention.Subungual exostosis on index finger in a child
Piyush Kumar, Ghuncha Alam
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):232-233
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):232-233
Disseminated herpes simplex virus and varicella zoster virus co-infection in an immunocompetent patient
Ziying Vanessa Lim, Hongliang Tey
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):212-214
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):212-214
Antihypertensives in dermatology Part II - Cutaneous adverse reactions to antihypertensives
P. S. S. Ranugha, Jayadev B Betkerur
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):137-147
Antihypertensive drugs are prescribed frequently and can cause cutaneous adverse reactions. The exact incidence and frequency of these reactions are unknown. Multiple antihypertensive drug consumption has contributed to a substantial increase in the number of cutaneous adverse reactions to them. Thus, there is a need for dermatologists and physicians to be aware of the wide range of available antihypertensives and the type of reactions that can be expected. This review article focuses on the various clinical presentations that have been implicated or associated with them. The diagnosis and management have been discussed in brief.
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):137-147
Antihypertensive drugs are prescribed frequently and can cause cutaneous adverse reactions. The exact incidence and frequency of these reactions are unknown. Multiple antihypertensive drug consumption has contributed to a substantial increase in the number of cutaneous adverse reactions to them. Thus, there is a need for dermatologists and physicians to be aware of the wide range of available antihypertensives and the type of reactions that can be expected. This review article focuses on the various clinical presentations that have been implicated or associated with them. The diagnosis and management have been discussed in brief.
Erratum: Extranodal natural killer/T cell lymphoma, nasal type presenting as recurrent facial cellulitis
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):249-249
Total serum immunoglobulin E level and specific allergens in adults with skin diseases
Byung Gon Choi, Yang Won Lee, Yong Beom Choe, Kyu Joong Ahn
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):148-152
Background: Immunoglobulin E (IgE) plays an important role in allergic diseases. Although several studies have shown the association of serum total IgE and allergen-specific IgE levels with allergic dermatological diseases such as atopic dermatitis, there are few studies addressing this association for skin diseases in general. Aims: We sought to evaluate IgE levels in skin diseases and investigate the differences based on the disease type and clinical factors such as gender and age. Methods: Data from 2836 patients who visited the dermatologic clinic of the Konkuk University Hospital, Seoul, Republic of Korea for 4 years were reviewed to document IgE levels and clinical information. IgE levels were collated with the type of skin disease, gender, and age. Results: Patients with atopic dermatitis had a much higher total IgE level and were more susceptible to allergens as compared to other disease groups. Patients in other disease groups showed no significant differences in IgE levels. Men showed higher total IgE levels but the gender differences decreased with increasing age. Limitations: The data were collected from patients at a referral centre and thus may not represent the general population of dermatologic patients. There was a lack of information regarding factors that could potentially influence IgE levels such as smoking history and disease severity. Conclusions: The results suggest that there are physiological or environmental differences in IgE-mediated immune responses between males and females. Also, except for atopic dermatitis, there were no clinical differences in the IgE levels among various skin diseases.
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):148-152
Background: Immunoglobulin E (IgE) plays an important role in allergic diseases. Although several studies have shown the association of serum total IgE and allergen-specific IgE levels with allergic dermatological diseases such as atopic dermatitis, there are few studies addressing this association for skin diseases in general. Aims: We sought to evaluate IgE levels in skin diseases and investigate the differences based on the disease type and clinical factors such as gender and age. Methods: Data from 2836 patients who visited the dermatologic clinic of the Konkuk University Hospital, Seoul, Republic of Korea for 4 years were reviewed to document IgE levels and clinical information. IgE levels were collated with the type of skin disease, gender, and age. Results: Patients with atopic dermatitis had a much higher total IgE level and were more susceptible to allergens as compared to other disease groups. Patients in other disease groups showed no significant differences in IgE levels. Men showed higher total IgE levels but the gender differences decreased with increasing age. Limitations: The data were collected from patients at a referral centre and thus may not represent the general population of dermatologic patients. There was a lack of information regarding factors that could potentially influence IgE levels such as smoking history and disease severity. Conclusions: The results suggest that there are physiological or environmental differences in IgE-mediated immune responses between males and females. Also, except for atopic dermatitis, there were no clinical differences in the IgE levels among various skin diseases.
Atypical generalized morphea-like scleroderma occurring in a patient exposed to organic solvents and having chronic hepatitis C virus infection
Amina Aounallah, Ines Lahouel, Sana Mokni, Mehdi Ksiaa, Marouen Hayouni, Colandane Belajouza, Feten Kotti, Wafa Saidi, Lobna Boussofara, Olfa El Maalel, Marwa Guerfala, Badreddine Sriha, Mohamed Denguezli, Nejet Ghariani, Rafiaa Nouira
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):221-224
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):221-224
Kumkum-induced allergic contact dermatitis: Are we missing the actual culprit?
Ashwini Annabathula, S Priya, CR Srinivas
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):153-156
Background: Kumkum, made with turmeric and slaked lime along with colour enhancing dyes is known to cause allergic contact dermatitis. The possible contact allergens in kumkum include turmeric, Sudan-1, 4-aminoazobenzene, brilliant lake red R and cananga oil. We report patch test results among patients with suspected contact hypersensitivity to kumkum. Objective: To identify the allergen causing kumkum induced allergic contact dermatitis by patch testing and to advise patients about organic kumkum which doesnot contain colour enhancing dyes. Methods: Eighteen patients with suspected contact hypersensitivity to kumkum were patch tested with undiluted kumkum, undiluted turmeric, Sudan-1 (95%), 4-aminoazobenzene and allergens of the Indian Standard Series. Results: Of the 18 patients, 14 patients had patch test positivity to kumkum and 4 had a negative reaction to kumkum. Patch test with other suspected contact allergens showed positive reaction to turmeric in 4 patients, Sudan-1 in 3 patients and 4-aminoazobenzene in 2 patients. Among the allergens of the Indian Standard Series, positivity to nickel and fragrance mix was seen in 5 and 2 patients respectively. Positive reaction to PPD, chlorocresol and parthenium was seen in 1 patient each. Limitation: Small sample size. Conclusion: Allergic contact dermatitis to kumkum occurs both due to the dyes (added for enhancing the colour) and turmeric. All patients with suspected allergic contact dermatitis should be patch tested with kumkum, turmeric and dyes, based on which alternative non-allergic material could be advised. Kumkum dermatitis can also occur due to various other allergens, for which too patch testing should be done.
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):153-156
Background: Kumkum, made with turmeric and slaked lime along with colour enhancing dyes is known to cause allergic contact dermatitis. The possible contact allergens in kumkum include turmeric, Sudan-1, 4-aminoazobenzene, brilliant lake red R and cananga oil. We report patch test results among patients with suspected contact hypersensitivity to kumkum. Objective: To identify the allergen causing kumkum induced allergic contact dermatitis by patch testing and to advise patients about organic kumkum which doesnot contain colour enhancing dyes. Methods: Eighteen patients with suspected contact hypersensitivity to kumkum were patch tested with undiluted kumkum, undiluted turmeric, Sudan-1 (95%), 4-aminoazobenzene and allergens of the Indian Standard Series. Results: Of the 18 patients, 14 patients had patch test positivity to kumkum and 4 had a negative reaction to kumkum. Patch test with other suspected contact allergens showed positive reaction to turmeric in 4 patients, Sudan-1 in 3 patients and 4-aminoazobenzene in 2 patients. Among the allergens of the Indian Standard Series, positivity to nickel and fragrance mix was seen in 5 and 2 patients respectively. Positive reaction to PPD, chlorocresol and parthenium was seen in 1 patient each. Limitation: Small sample size. Conclusion: Allergic contact dermatitis to kumkum occurs both due to the dyes (added for enhancing the colour) and turmeric. All patients with suspected allergic contact dermatitis should be patch tested with kumkum, turmeric and dyes, based on which alternative non-allergic material could be advised. Kumkum dermatitis can also occur due to various other allergens, for which too patch testing should be done.
Distribution of killer immunoglobulin-like receptor genes in HIV infected long-term non-progressors from Mumbai, India
Vijay R Chavan, Zakiya Ansari, Preeti Mehta, Jayanti Mania-Pramanik
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):247-247
Background: Few reports suggest the association of killer immunoglobulin-like receptors of natural killer cells with human immunodeficiency virus infection. India with world's third largest population of human immunodeficiency virus / acquired immunodeficiency syndrome, offers scope to study such association. Objective: Current study (2010-2015) was designed to evaluate if killer immunoglobulin-like receptors gene polymorphisms are associated with HIV infection outcomes specifically, with long term non progressors. Methods: Killer immunoglobulin-like receptors genotyping was done using polymerase chain reaction - sequence-specific primer method. Viral load was measured by Cobas Taqman HIV-1 test. Estimation of CD4 counts was done using BD FACS CD4 count reagent. Results: The activating gene frequencies identified were 3DS1 (53.8%), 2DS3 (69.2%), 2DS4 (76.9%), 2DS5 (69.2%), 2DS1 (76.9%) and 2DS2 (92.3%). The inhibitory gene frequencies were 2DL2 (92.3%), 2DL5 (76.9%), 2DL3 (69.5%), 3DL1 (84.6%), 3DL2 (92.3%) and 2DL1 (100%). The results highlight high frequency of 3DS1/3DL1 heterozygote and killer immunoglobulin-like receptor 2DS1, among these long term non progressors indicating their possible association with slow progression. Genotype analysis shows total 13 genotypes, of which 8 genotypes were identified for the first time from India. Two genotypes were unique/novel, which were unreported. All genotypes observed in this study were considered to be Bx genotype (100 %). Limitations: A small sample size (n=13, due to a rare cohort) and the absence of control group were the limitations of this study. Conclusions: The present study highlights the distribution of killer immunoglobulin-like receptor genes in a very rare group of human immunodeficiency virus -1 infected individuals - long term non progressors. All the long term non progressors tested show the presence of Bx haplotype and each long term non progressors has a different killer immunoglobulin-like receptor genotype.
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):247-247
Background: Few reports suggest the association of killer immunoglobulin-like receptors of natural killer cells with human immunodeficiency virus infection. India with world's third largest population of human immunodeficiency virus / acquired immunodeficiency syndrome, offers scope to study such association. Objective: Current study (2010-2015) was designed to evaluate if killer immunoglobulin-like receptors gene polymorphisms are associated with HIV infection outcomes specifically, with long term non progressors. Methods: Killer immunoglobulin-like receptors genotyping was done using polymerase chain reaction - sequence-specific primer method. Viral load was measured by Cobas Taqman HIV-1 test. Estimation of CD4 counts was done using BD FACS CD4 count reagent. Results: The activating gene frequencies identified were 3DS1 (53.8%), 2DS3 (69.2%), 2DS4 (76.9%), 2DS5 (69.2%), 2DS1 (76.9%) and 2DS2 (92.3%). The inhibitory gene frequencies were 2DL2 (92.3%), 2DL5 (76.9%), 2DL3 (69.5%), 3DL1 (84.6%), 3DL2 (92.3%) and 2DL1 (100%). The results highlight high frequency of 3DS1/3DL1 heterozygote and killer immunoglobulin-like receptor 2DS1, among these long term non progressors indicating their possible association with slow progression. Genotype analysis shows total 13 genotypes, of which 8 genotypes were identified for the first time from India. Two genotypes were unique/novel, which were unreported. All genotypes observed in this study were considered to be Bx genotype (100 %). Limitations: A small sample size (n=13, due to a rare cohort) and the absence of control group were the limitations of this study. Conclusions: The present study highlights the distribution of killer immunoglobulin-like receptor genes in a very rare group of human immunodeficiency virus -1 infected individuals - long term non progressors. All the long term non progressors tested show the presence of Bx haplotype and each long term non progressors has a different killer immunoglobulin-like receptor genotype.
Percutaneous ethanol injection as a promising and minimally invasive treatment for axillary osmidrosis: Double-blinded randomized controlled trial
Ali Asilian, Masoom Shahbazi, Bahareh Abtahi-Naeini, Nazila Poostiyan, Mohammad Ali Nilforoushzadeh
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):157-162
Background: Axillary osmidrosis is a common problem with a strong negative impact on the professional and social quality of life. Several options are available for its treatment. But there are no treatment guidelines. The objective of this study was to evaluate efficacy and safety of percutaneous ethanol injection for treatment of axillary osmidrosis. Methods: A randomized, double-blind, placebo-controlled clinical trial to assess clinical efficacy and postoperative complications of percutaneous ethanol injection was performed among 60 patients (12–35 years of age) with axillary osmidrosis. The active agent used in the experimental group (n = 30) was sterile 90% ethanol and the placebo used in the control group (n = 30) was sterile normal saline administered in an identical syringe. The results of malodor elimination were graded by the patients as excellent, good, fair, and poor. All patients were followed-up for 10 months. Results: Malodor elimination was graded as good by 15 (50%) patients treated with percutaneous ethanol injection. A significant difference in the improvement of axillary osmidrosis was found between the experimental and control groups (P < 0.001). The most common post-procedure complication was transient subjective skin stiffness in the experimental group, which regressed spontaneously. There were no serious permanent side effects. Limitations: Relatively short duration of follow-up; and lack of histopathological evidence of destruction of the apocrine glands after treatment in most patients. Conclusions: Percutaneous ethanol injection is an effective and safe treatment method for axillary osmidrosis and does not have permanent side effects.
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):157-162
Background: Axillary osmidrosis is a common problem with a strong negative impact on the professional and social quality of life. Several options are available for its treatment. But there are no treatment guidelines. The objective of this study was to evaluate efficacy and safety of percutaneous ethanol injection for treatment of axillary osmidrosis. Methods: A randomized, double-blind, placebo-controlled clinical trial to assess clinical efficacy and postoperative complications of percutaneous ethanol injection was performed among 60 patients (12–35 years of age) with axillary osmidrosis. The active agent used in the experimental group (n = 30) was sterile 90% ethanol and the placebo used in the control group (n = 30) was sterile normal saline administered in an identical syringe. The results of malodor elimination were graded by the patients as excellent, good, fair, and poor. All patients were followed-up for 10 months. Results: Malodor elimination was graded as good by 15 (50%) patients treated with percutaneous ethanol injection. A significant difference in the improvement of axillary osmidrosis was found between the experimental and control groups (P < 0.001). The most common post-procedure complication was transient subjective skin stiffness in the experimental group, which regressed spontaneously. There were no serious permanent side effects. Limitations: Relatively short duration of follow-up; and lack of histopathological evidence of destruction of the apocrine glands after treatment in most patients. Conclusions: Percutaneous ethanol injection is an effective and safe treatment method for axillary osmidrosis and does not have permanent side effects.
Clinical experience of adalimumab in the treatment of psoriasis - A 10-year journey in a tertiary dermatology centre
Wai Man Mandy Chan, Hazel Hweeboon Oon, Wei-Sheng Chong
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):205-208
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):205-208
Effectiveness of topical green tea against multidrug-resistant Staphylococcus aureus in cases of primary pyoderma: An open controlled trial
Nagaraju Umashankar, Belliappa Pemmanda, P Gopkumar, AJ Hemalatha, Priya K Sundar, HV Prashanth
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):163-168
Background: Antimicrobial activity of green tea against Staphylococcus aureus both in vitro and in vivo has been reported recently. Studies on clinical efficacy and safety of green tea as antibacterial agent against S. aureus in human cases are rare. Objectives: To evaluate the clinical effectiveness and safety of topical green tea on primary pyoderma caused by S. aureus. We also attempted to determine the minimum inhibitory concentration of green tea against S. aureus and methicillin-resistant S. aureus. Methods: Open label, prospective, placebo-controlled study included community-acquired primary pyoderma cases caused by S. aureus. Severity grading was done on a scale of 1–5. Green tea ointment 3% and placebo ointment were used. Cure was defined on the basis of negative culture and assessment of clinical improvement. Minimum inhibitory concentration was determined by agar dilution method. Data were analyzed using Statistical Package for Social Sciences (SPSS) software version 16. Results: Of the 372 patients, 250 received green tea and 122 received placebo. Multidrug-resistant S. aureus was isolated in 89.1% in green tea group and 81.1% in placebo group, respectively. Methicillin-resistant S. aureus was isolated in 24 patients. Cure was seen in 86% in green tea group and 6.6% in placebo group which was statistically very significant. The number of days for comprehensive cure in green tea group was 9.2 ± 6.4 days. All patients with methicillin-resistant S. aureus infection in the green tea group were cured. Minimum inhibitory concentration of green tea against S. aureus was 0.0265 ± 0.008 μg/ml and against methicillin-resistant S. aureus was 0.0205 ± 0.003 μg/ml. Limitations of the Study: Comparative trial was not conducted in the same patient with different lesions; children less than seven years were not considered as the school authorities did not permit for younger children to be included in the study and true randomization and blinding of investigators were not done. Conclusions: Green tea has a significant antibacterial effect against multidrug-resistant S. aureus. Minimum inhibitory concentration of green tea is established and is promising in methicillin-resistant S. aureus infections.
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):163-168
Background: Antimicrobial activity of green tea against Staphylococcus aureus both in vitro and in vivo has been reported recently. Studies on clinical efficacy and safety of green tea as antibacterial agent against S. aureus in human cases are rare. Objectives: To evaluate the clinical effectiveness and safety of topical green tea on primary pyoderma caused by S. aureus. We also attempted to determine the minimum inhibitory concentration of green tea against S. aureus and methicillin-resistant S. aureus. Methods: Open label, prospective, placebo-controlled study included community-acquired primary pyoderma cases caused by S. aureus. Severity grading was done on a scale of 1–5. Green tea ointment 3% and placebo ointment were used. Cure was defined on the basis of negative culture and assessment of clinical improvement. Minimum inhibitory concentration was determined by agar dilution method. Data were analyzed using Statistical Package for Social Sciences (SPSS) software version 16. Results: Of the 372 patients, 250 received green tea and 122 received placebo. Multidrug-resistant S. aureus was isolated in 89.1% in green tea group and 81.1% in placebo group, respectively. Methicillin-resistant S. aureus was isolated in 24 patients. Cure was seen in 86% in green tea group and 6.6% in placebo group which was statistically very significant. The number of days for comprehensive cure in green tea group was 9.2 ± 6.4 days. All patients with methicillin-resistant S. aureus infection in the green tea group were cured. Minimum inhibitory concentration of green tea against S. aureus was 0.0265 ± 0.008 μg/ml and against methicillin-resistant S. aureus was 0.0205 ± 0.003 μg/ml. Limitations of the Study: Comparative trial was not conducted in the same patient with different lesions; children less than seven years were not considered as the school authorities did not permit for younger children to be included in the study and true randomization and blinding of investigators were not done. Conclusions: Green tea has a significant antibacterial effect against multidrug-resistant S. aureus. Minimum inhibitory concentration of green tea is established and is promising in methicillin-resistant S. aureus infections.
Wolf's isotopic nonresponse in healed herpes zoster in erythroderma
Surabhi Sinha, Gunjan Verma, PK Sharma, Arvind Ahuja
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):217-220
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):217-220
Granulomatous slack skin syndrome: Report of a unique case
S Uma Maheswari, V Sampath, A Ramesh
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):169-173
Granulomatous slack skin syndrome is a rare variant of cutaneous T-cell lymphoma (mycosis fungoides). It is characterized clinically by redundant skin folds, which show a predilection towards flexural areas such as the axilla and the groin. Histologically, it shows a granulomatous T-cell infiltrate and loss of elastic tissue. It has an indolent but progressive course; and is usually refractory to treatment. We report a unique case of slack skin syndrome, sparing the classical sites with rapid and unusual involvement of non-intertriginous areas.
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):169-173
Granulomatous slack skin syndrome is a rare variant of cutaneous T-cell lymphoma (mycosis fungoides). It is characterized clinically by redundant skin folds, which show a predilection towards flexural areas such as the axilla and the groin. Histologically, it shows a granulomatous T-cell infiltrate and loss of elastic tissue. It has an indolent but progressive course; and is usually refractory to treatment. We report a unique case of slack skin syndrome, sparing the classical sites with rapid and unusual involvement of non-intertriginous areas.
Bulla formation at the tuberculin skin test site in a patient with bullous pemphigoid: Koebnerization or severe delayed-type hypersensitivity?
Anuradha Bishnoi, Dipankar De, Sanjeev Handa, Rahul Mahajan, Debajyoti Chatterjee, Uma Nahar Saikia
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):227-229
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):227-229
Effect of intravenous pulse dexamethasone versus daily oral prednisolone on bone mineral density in dermatology patients: Is it a site-specific response?
Sanjeev Handa, Gurjeet Singh, Amanjot Kaur Arora, Niranjan Khandelwal, Vivek Gupta
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):174-178
Background: The use of glucocorticoids in various forms of administration is complicated by their systemic side effects. Although intravenous pulse therapy is considered to have lesser systemic side effects, there are few studies in literature comparing the effects of intravenous pulse glucocorticoids versus oral daily glucocorticoids on bone mineral density. Aim: To compare the effects of intravenous pulse glucocorticoids and oral daily glucocorticoids on bone mineral density with the aim of finding any site-specific osteopenic side effect. Methods: The study was conducted by the department of dermatology of Postgraduate Institute of Medical Education and Research, Chandigarh, India. The study comprised of two groups of patients. Group A consisted of 28 patients with pemphigus vulgaris who received intravenous pulses of dexamethasone at 4 weekly intervals. Group B consisted of 21 patients with airborne contact dermatitis who received oral daily prednisolone therapy. All the patients had a dual X-ray absorptiometry scan at baseline, and at 3 and 6 months of follow-up. The results were analyzed as changes in bone mineral density. Results: There was loss of bone mineral density at lumbar spine and the head of radius in both the groups. At the lumbar spine, Group B showed more reduction in bone mineral density at 3 months whereas in Group A it was more at the head of radius. In patients on oral steroids, the lumbar spine was significantly more affected than the head of radius at both 3 and 6 months of follow-up. However, in patients on intravenous pulse steroids, both the sites were equally affected at 3 and 6 months. Limitations: In our study, we used different glucocorticoids in the two groups: prednisolone in the oral daily group and dexamethasone in the intravenous pulse steroids group. A similar reduction in bone mineral density in both the groups may have been due to a longer half-life or more bone-directed side effects of dexamethasone as compared to prednisolone. Conclusion: Dermatologists need to be aware of the detrimental effects of high-dose intravenous pulsed glucocorticoids on bone mineral density and assessment of this parameter should be done before the initiation of therapy and also at regular intervals thereafter. During follow up, either the lumbar spine or the head of radius can be used to assess the osteopenic effect of intravenous pulse steroids, whereas the lumbar spine is a better site for this evaluation in patients on oral steroids.
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):174-178
Background: The use of glucocorticoids in various forms of administration is complicated by their systemic side effects. Although intravenous pulse therapy is considered to have lesser systemic side effects, there are few studies in literature comparing the effects of intravenous pulse glucocorticoids versus oral daily glucocorticoids on bone mineral density. Aim: To compare the effects of intravenous pulse glucocorticoids and oral daily glucocorticoids on bone mineral density with the aim of finding any site-specific osteopenic side effect. Methods: The study was conducted by the department of dermatology of Postgraduate Institute of Medical Education and Research, Chandigarh, India. The study comprised of two groups of patients. Group A consisted of 28 patients with pemphigus vulgaris who received intravenous pulses of dexamethasone at 4 weekly intervals. Group B consisted of 21 patients with airborne contact dermatitis who received oral daily prednisolone therapy. All the patients had a dual X-ray absorptiometry scan at baseline, and at 3 and 6 months of follow-up. The results were analyzed as changes in bone mineral density. Results: There was loss of bone mineral density at lumbar spine and the head of radius in both the groups. At the lumbar spine, Group B showed more reduction in bone mineral density at 3 months whereas in Group A it was more at the head of radius. In patients on oral steroids, the lumbar spine was significantly more affected than the head of radius at both 3 and 6 months of follow-up. However, in patients on intravenous pulse steroids, both the sites were equally affected at 3 and 6 months. Limitations: In our study, we used different glucocorticoids in the two groups: prednisolone in the oral daily group and dexamethasone in the intravenous pulse steroids group. A similar reduction in bone mineral density in both the groups may have been due to a longer half-life or more bone-directed side effects of dexamethasone as compared to prednisolone. Conclusion: Dermatologists need to be aware of the detrimental effects of high-dose intravenous pulsed glucocorticoids on bone mineral density and assessment of this parameter should be done before the initiation of therapy and also at regular intervals thereafter. During follow up, either the lumbar spine or the head of radius can be used to assess the osteopenic effect of intravenous pulse steroids, whereas the lumbar spine is a better site for this evaluation in patients on oral steroids.
Silymarin: An interesting modality in dermatological therapeutics
Konchok Dorjay, Tasleem Arif, Mohammad Adil
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):238-243
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):238-243
Recurrent painful lesions on the lower lip
Paula Hasbún Acuña, Ana Castro Pardo, Mauricio Aspée Roa
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):179-181
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):179-181
Congenital hypertrichosis lanuginosa
Iffat Hassan Shah, Sumaya Zeerak, Peerzada Sajad, Safia Bashir, Yasmeen J Bhat, Syed Mubashir
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):248-248
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):248-248
Music box spine keratoderma
Tasleem Arif, Mohammad Adil, Suhailur Rehman
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):182-183
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):182-183
Elimination of leprosy in India: An analysis
Utpal Sengupta
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):131-136
India attained the elimination figure of less than 1 case of leprosy per 10,000 people during December 2005. Despite this, India still accounts for the largest number of new leprosy cases in the world, maintaining more than 50 per cent of the leprosy burden of the world, notwithstanding over three decades of use of multidrug therapy. The present review analyzes the process of execution of the elimination program, identifies any lacunae therein and presents corrective measures that could be taken up for elimination of the disease from the country.
Indian Journal of Dermatology, Venereology, and Leprology 2018 84(2):131-136
India attained the elimination figure of less than 1 case of leprosy per 10,000 people during December 2005. Despite this, India still accounts for the largest number of new leprosy cases in the world, maintaining more than 50 per cent of the leprosy burden of the world, notwithstanding over three decades of use of multidrug therapy. The present review analyzes the process of execution of the elimination program, identifies any lacunae therein and presents corrective measures that could be taken up for elimination of the disease from the country.
Distribution and removal of organochlorine pesticides in waste clay bricks from an abandoned manufacturing plant using low-temperature thermal desorption technology
Abstract
The distribution of pollutants in waste clay bricks from an organochlorine pesticide-contaminated site was investigated, and removal of the pollutants using a thermal desorption technology was studied. The results showed that the contents of HCHs in both the surface and the inner layer of the bricks were slightly higher than those of DDTs. The total pore volume of the bricks was 37.7 to 41.6% with an increase from external to internal surfaces. The removal efficiency by thermal treatment was within 62 to 83% for HCHs and DDTs in bricks when the temperature was raised from 200 to 250 °C after 1 h. HCHs were more easily removed than DDTs with a higher temperature. Either intraparticle or surface diffusion controls the desorption processes of pollutants in bricks. It was feasible to use the polluted bricks after removal of the pollutants by low-temperature thermal desorption technology.
Green synthesis of zero-valent Fe-nanoparticles: Catalytic degradation of rhodamine B, interactions with bovine serum albumin and their enhanced antimicrobial activities
Publication date: Available online 16 February 2018
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Zaheer Khan, Shaeel Ahmad Al-Thabaiti
Biomimetic method was used for the synthesis of Fe-nanoparticles (FeNPs). FeCl3 and Hibiscus sabdariffa, Roselle flower aqueous extract (HBS) were employed in the present studies. The FeNPs have been characterized by using UV–visible spectroscopy, transmission electron microscope (TEM), and energy dispersion X-ray spectroscopy (EDS). The average particles diameter was found to be 18 nm. The as prepared FeNPs were used as a catalyst to the oxidative degradation of rhodamine B (RB) in presence of NaBH4. The effects of various quencher on the degradation rates were examined by employing ammonium oxalate (AO), benzoquinone (BQ), isopropyl alcohol (IPA), and potassium iodide (KI). The interactions of FeNPs with bovine serum albumin (BSA) have been determined and discussed. Adsorption of FeNPs into the core of BSA changes the tryptophan environment from hydrophobic to hydrophilic (from folding to partially folded and/or unfolded). Tryptophan residues, indole moieties of BSA were responsible to complex formation with FeNPs in excited states via electrostatic, van der Waals, hydrogen bonding, hydrophobic and hydrophilic interactions with static quenching. The antimicrobial activities of FeNPs have been determined against human pathogens. Hibiscus sabdariffa flower extract shows mild antimicrobial activities against all target pathogenic organisms. FeNPs have potential antimicrobial activity against both bacterial strains and candida fungus even at low concentration, and retains potential application in biomedical industries.
Graphical abstract
Keratin-chitosan/n-ZnO nanocomposite hydrogel for antimicrobial treatment of burn wound healing: Characterization and biomedical application
Publication date: Available online 16 February 2018
Source:Journal of Photochemistry and Photobiology B: Biology
Author(s): Mingcui Zhai, Yichen Xu, Biao Zhou, Weibin Jing
In the Present-day medicinally applied wound bandages have many drawbacks for, instance, rigidity, non-porosity, low mechanical potency, also an affinity for bandages to stick onto the injury exterior; additionally, a greater part of the bandages did not secure bactericidal activity. Hydrogel derived injury bandages would be supportive to afford a chill feeling with a humidity atmosphere, in addition, to performing as an obstruction to bacteria. To overcome these drawbacks, we have fabricated porous keratin-chitosan/n-ZnO nanocomposite (KCBZNs) bandages via the inclusion of nano-ZnO into the keratin-chitosan hydrogel. The functional group and surface of as-fabricated bandages were characterized using Fourier transform infrared spectroscopy (FT-IR), X-ray diffractometry (XRD), and scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM-EDX) and transmission electron microscopy with selected area diffraction (TEM-SAD). Moreover, mechanical, swelling, bactericidal, bio-compatibility of nanocomposite was assessed to exhibit its efficacy for biological applications. The nanocomposite illustrated increased swelling, and bactericidal activity. Bio-compatibility of the nanocomposite has been investigated in normal human fibroblast cells. Also, the in vivo assessments in SD rats exposed that as-fabricated nanocomposite bandages increased the wound curing with assisted for quicker skin cell construction along with collagen development. Hence, the acquired information strongly supports to utilize of this nanocomposite hydrogels for burn wounds.
Graphical abstract
Using combined multiple techniques to characterize refractory organics during anammox process with mature coal chemical wastewater as influent
Abstract
This study combined spectroscopy techniques to assess the composition of refractory organics and highlighted the potential application of excitation–emission matrix (EEM) fluorescence spectroscopy within future monitoring of coal chemical wastewater treatment by the anammox process. The results showed that the anammox process could effectively degrade refractory organic substances, with fulvic-like, UV-humic acid, and Vis-humic acid component removal efficiencies of 43.61, 53.93, and 100%, respectively. In this study, EEM fluorescence spectroscopy was proven to be an effective method of assessing the removal of dissolved organic nitrogen during anammox treatment of mature coal chemical wastewater. Furthermore, remarkable accumulation (9.3–16.2%) of Ca. Kuenenia occurred in the anammox granules that underwent long-term cultivation in mature coal chemical wastewater, which provided the high nitrogen removal rate. The abundance of Anaerolineaceae and Bacteroides was vital in refractory organic degradation.
Macroelements and heavy metals content in energy crops cultivated on contaminated soil under different fertilization—case studies on autumn harvest
Abstract
Heavy metals (HMs) contamination of soils is a major problem occurring worldwide. Utility of energy crops for biofuel feedstock production systems offers a feasible solution for a commercial exploitation of an arable land contaminated with HMs. Experiments involved field testing of Miscanthus x giganteus and Spartina pectinata cultivated on HMs-contaminated soil with standard NPK fertilizers and commercially available microbial inoculum. Biomass yield, water content, macronutrients (N, P, K, Mg, Ca), and heavy metal (Cd, Pb, Zn) concentrations in plant shoots were assessed at the end of the first and the second growing season. Independently of the applied fertilizers, Miscanthus x giganteus produced higher biomass yield while contrary results were obtained for S. pectinata. Higher HMs content in plants influenced the status of the mineral macronutrients in particular N and K. Occurrence of hasted senescence induced by drought in the second growing season caused reduction in the concentrations of all elements (except Pb), due to earlier rhizomes relocation.
Fenton treatment of bio-treated fermentation-based pharmaceutical wastewater: removal and conversion of organic pollutants as well as estimation of operational costs
Abstract
The Fenton process is used as a tertiary treatment to remove organic pollutants from the effluent of bio-treated pharmaceutical wastewater (EBPW). The optimal and most appropriate Fenton conditions were determined by an orthogonal array test and single-factor experiments. The removal of chemical oxygen demand (COD) was influenced by the following factors in a descending order: H2O2/Fe(II) molar ratio > H2O2 dosage > reaction time. Under the most appropriate Fenton conditions (H2O2/Fe(II) molar ratio of 1:1, H2O2 dosage of 120 mg L−1 and reaction time of 10 min), the COD and dissolved organic carbon (DOC) were removed with efficiencies of 62 and 53%, respectively, which met the national discharge standard (GB 21903-2008) for the Lake Tai Basin, China. However, the Fenton treatment was inadequate for removal of N compounds, and the removal of organic nitrogen led to an increment in N-NH3 from 3.28 to 19.71 mg L−1. Proteins and polysaccharides were completely removed, and humic acids (HAs) were partly removed with an efficiency of 55%. Three-dimensional excitation/emission matrix spectra (3DEEMs) indicated complete removal of fulvic acid-like substances and 90% reduction in the florescence intensity of humic acid-like substances. Organic pollutants with molecular weights (MW) > 10 kDa were completely removed, MW 5–10 kDa were degraded into smaller MW ones, and some low molecular weight acids (MW 0.1–1 kDa) were mineralized during the Fenton process. Some species, including pharmaceutical intermediates and solvents were detected by gas chromatography-mass spectrometry (GC-MS). The operational costs of the Fenton's treatment were estimated to be 0.58 yuan RMB/m3 EBPW based on reagent usage and iron sludge treatment and disposal.
MicroRNA-411 promoted the osteosarcoma progression by suppressing MTSS1 expression
Abstract
MicroRNAs (miRNAs) play crucial roles in the progression of different tumors. In our study, we investigated the expression and roles of miR-411 in human osteosarcoma. In this study, we first confirmed that the miR-411 expression was higher in the serum of patients with osteosarcoma than in the serum of healthy volunteers. In addition, we found that the miR-411 expression was upregulated in the osteosarcoma tissues compared to that in the matched normal bone tissues. We also demonstrated that the miR-411 expression was upregulated in the four osteosarcoma cell lines. Elevated expression of miR-411 promoted osteosarcoma cell proliferation and migration. Moreover, we identified that metastasis suppressor protein 1 (MTSS1) was a direct target gene of miR-411 in the osteosarcoma cell. We also demonstrated that the MTSS1 expression was downregulated in the osteosarcoma tissues compared to that in the matched normal bone tissues. In addition, MTSS1 expression level was inversely correlated with miR-411 expression in the osteosarcoma tissues. Furthermore, elevated expression of miR-411 enhanced the osteosarcoma cell proliferation and migration through inhibiting the MTSS1 expression. These data suggested that miR-411 played as oncogene in the osteosarcoma partly by inhibiting the MTSS1 expression.
Cytotoxic effect of chlorpyrifos is associated with activation of Nrf-2/HO-1 system and inflammatory response in tongue of male Wistar rats
Abstract
Repeated administration of chlorpyrifos (CPF), an organophosphate pesticide, can increase the risk of oral cytotoxicity. The current study was designed to assess the mechanism by which CPF mediates its cytotoxic effect on lingual mucosa of rats. Twenty-four male Wistar rats were used in the present study and divided into three groups: group I: healthy rats (negative control), group II: rats treated with CPF 1/40 LD50 (3.375 mg/kg, orally/daily) for 28 days, group III: rats treated with CPF 1/10 LD50 (13.5 mg/kg, orally/daily) for 28 days. At the end of the experiment, all rats were sacrificed by cervical dislocation under ketamine anesthesia. Tongue samples were dissected out at their base for detection of heme oxygenase-1 (HO-1) and nuclear erythroid 2-related factor 2 (Nrf-2) by western blotting and histopathological and electron microscopic studies. Immunostaining was used to determine cleaved caspase 3 and the nuclear factor kappa B (NF-κB) localization. Structural and ultrastructural examination of treated lingual mucosa with CPF demonstrated degenerative changes that involved both the dorsal and ventral surfaces of the tongue as well as the lingual glands. CPF-treated rats demonstrated a significant increase in the levels of pro-inflammatory cytokines such as interleukin-1β (IL-1β) and tumor necrosis factor (TNF-α) in addition to a significant dose-dependent activation of NF-κB and cleaved caspase 3. Furthermore, CPF activated HO-1 and Nrf-2 pathway in a dose-dependent manner. In conclusion, this data suggests that the CPF-induced cytotoxicity may be explained by NF-κB activated inflammatory cascade. In addition, CPF triggers an adaptive activation of Nrf-2/HO-1 pathway.
The Effect of Dermatology Consultation on Outcomes of Patients With Presumed Cellulitis
This randomized clinical trial examines the association of dermatologic consultation with duration of hospital stay and intravenous antibiotic treatment in patients with suspected cellulitis.
Melanocyte Density Counts in Topical Imiquimod-Treated Skin Surrounding Lentigo Maligna
This study examines melanocyte density counts in imiquimod-treated lentigo maligna and negative control biopsy specimens to determine if there was a measurable difference in melanocyte density.
Erythema Nodosum–like Eruption in the Setting of Sorafenib Therapy
This case report describes a patient with erythema nodosum–like eruption in the setting of sorafenib therapy.
Outcomes of Early Dermatology Consultation for Inpatients Diagnosed With Cellulitis
This cohort study examines the effects of dermatology consultation on misdiagnosis of cellulitis in patients admitted to emergency departments.
Inpatient Dermatologists—Crucial for the Management of Skin Diseases in Hospitalized Patients
Inpatient dermatology is an emerging subspecialty focused on the care of skin diseases in hospitalized patients. Inpatient dermatologists provide expertise that the primary team and other consultative services lack. The cases encountered in hospital dermatology are often different from those seen in the traditional dermatology outpatient clinic and therefore require dermatologists with specific expertise.
Occurrence and assessment of the risk of ultraviolet filters and light stabilizers in Victorian estuaries
Abstract
This reconnaissance study was undertaken to examine the occurrence of common ultraviolet filters (UVF) and light stabilizers (UVLS), and preservatives in four different estuaries in Port Philip Bay, Victoria, for the first time. In total, 11 UV filters, 10 UV stabilizers, 12 preservatives and a metabolite, and one fragrance were screened in grab samples of water and sediment using a combination of solid phase extraction and gas and liquid chromatography mass spectrometry measurement techniques. In that context, 16 of the UVF and UVLS and 5 of the preservatives screened were observed in water and/or sediment samples. There are no marine water quality guideline values for any of the fragrances, preservatives and UV filters and light stabilizers in Australia's current national water quality guidelines, so potential risk was assessed using the risk quotient (RQ) and toxic unit (TU) concepts. In that context, only two chemicals (OC and EHMC) had both an RQ above 1 and a log10TU above − 3, suggesting that few of the screened chemicals would have posed an individual, short-term risk to organisms in the waters studied at the time of sampling. However, the detection of common UV filters, such as 4MBC, EHMC, OC and the common preservatives 2-PE, MP, and PB in these Victorian estuaries highlights that the existence of personal care products in the environment is not just an issue for more densley populated countries in the northern hemisphere, but also potentially of concern in Australia. And, in that context, more sampling campaigns in Port Philip Bay are of paramount importance to assess the potential risk posed by these compounds to aquatic ecosystems.
The trouble with having standards
Abstract
The uniqueness thesis states that for any body of evidence and any proposition, there is at most one rational doxastic attitude that an epistemic agent can take toward that proposition. Permissivism is the denial of uniqueness. Perhaps the most popular form of permissivism is what I call the Epistemic Standard View (ESV), since it relies on the concept of epistemic standards. Roughly speaking, epistemic standards encode particular ways of responding to any possible body of evidence. Since different epistemic standards may rationalize different doxastic states on the same body of evidence, this view gives us a form of permissivism if different agents can have different epistemic standards. Defenders of the ESV, however, have not paid sufficient attention to what it means to have a particular epistemic standard. I argue that any theory of epistemic standard possession must satisfy two criteria to adequately address the broader needs of the ESV. The first criterion is the normative criterion: a theory of standard-possession should explain why agents are rationally required to form beliefs in accordance with their own (rational) epistemic standard, rather than any other (rational) standard. The second criterion is the applicability criterion: a theory of standard-possession should rule that agents have the epistemic standards we intuitively think they have. I then argue that no extant theories of standard-possession can satisfy both these criteria. I conclude by diagnosing why these criteria are so hard to jointly satisfy. Defenders of the ESV are thus left with a serious obstacle to forming a complete and plausible version of their view.
Primary sebocytes and sebaceous gland cell lines for studying sebaceous lipogenesis and sebaceous gland diseases
Abstract
Sebocytes, the major cell type in sebaceous glands (SGs), are differentiated epithelial cells that gradually accumulate lipids and eventually disrupt, releasing their content (sebum) in a secretory process known as holocrine secretion. Via the hair canal, sebum reaches the skin surface, where it has several known or postulated functions, including pheromonal, thermoregulatory, antimicrobial and antioxidant activities. Altered sebum secretion and/or structural SG changes have also been involved in the pathogenesis of skin diseases, such as acne vulgaris and some forms of alopecia. Here we assess how recent work employing primary sebocytes and SG cell lines contributed for our understanding of sebaceous lipogenesis and its role in skin health and disease.
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Dermatology Training Across the Globe, Part II: A summary of the literature
Abstract
In the United States (U.S.), dermatology training program rankings often stem from assessments by practicing physicians or evaluations of scholarly achievements such as grants and publicatons.1 To the best of our knowledge, similar ranking systems outside of the U.S. do not exist. In fact, outside of the U.S., dermatology departments are assessed in alternative ways such as utilization of inpatient bed capacity, research funding, and metrics of patient care.
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Successful therapy of Pyoderma gangrenosum with a JAK2 inhibitor
Abstract
Pyoderma gangrenosum (PG) is a rare, solitary or multiple, chronically progressive, painful, destructive, sterile neutrophil inflammation of unexplained aetiology and pathogenesis, which often remains resistant to treatment. An autoimmunological and autoinflammatory genesis is discussed, which is the main reason why there are so many immunosupressant therapies available. PG may occur in association with inflammatory and haematological disorders, such as Crohn's disease, myeloma, leukaemia, lymphoma and polycythemia vera (PV), as it is the case in our patient presented here.
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Optimizing case reports and case series: guidance on how to improve quality
Abstract
Case reports and case series remain an important part of journals and are often first to document medical breakthroughs. This article reviews their characteristics, aims and limitations. It provides information on how to increase the validity of the bedside decision-making process that these studies report, using tools such as validated outcomes and split body or n-of-1 trials. A section describing tools to improve writing of case reports and case series provides suggestions for detailed reporting and good evaluation of novelty, validity and relevance. It includes general and British Journal of Dermatology specific guidance.
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Acute psychosocial stress downregulates N-Methyl-d-aspartate receptors (NMDAR) in healthy human skin
Abstract
Psychosocial stress impacts both healthy and diseased skin1. Whilst acute stress activates the Hypothalamic-Pituitary-Adrenal (HPA) axis, chronic stress induces suppression and impairs wound healing in humans and animals1,2. Although the underlying pathomechanisms are yet to be fully elucidated, it is clear that a better understanding of the complex relationship between neuroendocrine pathways, the immune system and the skin (the "brain-skin axis") is pivotal to the optimal management of both stress-responsive dermatoses and cutaneous wound healing.
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Isolation of marine xylene-utilizing bacteria and characterization of Halioxenophilus aromaticivorans gen. nov., sp. nov. and its xylene degradation gene cluster
Abstract
Seven xylene-utilizing bacterial strains were isolated from seawater collected off the coast of Japan. Analysis of 16S rRNA gene sequences indicated that six isolates were most closely related to the marine bacterial genera Alteromonas, Marinobacter or Aestuariibacter. The sequence of the remaining strain, KU68FT, showed low similarity to the 16S rRNA gene sequences of known bacteria with validly published names, the most similar species being Maricurvus nonylphenolicus strain KU41ET (92.6% identity). On the basis of physiological, chemotaxonomic and phylogenetic data, strain KU68FT is suggested to represent a novel species of a new genus in the family Cellvibrionaceae of the order Cellvibrionales within the Gammaproteobacteria, for which the name Halioxenophilus aromaticivorans gen. nov., sp. nov. is proposed. The type strain of Halioxenophilus aromaticivorans is KU68FT ( = JCM 19134T = KCTC 32387T). PCR and sequence analysis revealed that strain KU68FT possesses an entire set of genes encoding the enzymes for the upper xylene methyl-monooxygenase pathway, xylCMABN, resembling the gene set of the terrestrial Pseudomonas putida strain mt-2.Fixation of CO2 and CO on a diverse range of carbohydrates using anaerobic, non-photosynthetic mixotrophy
Abstract
Biological CO2 fixation is an important technology that can assist in combating climate change. Here, we show an approach called anaerobic, non-photosynthetic mixotrophy can result in net CO2 fixation when using a reduced feedstock. This approach uses microbes called acetogens that are capable of concurrent utilization of both organic and inorganic substrates. In this study, we investigated the substrate utilization of seventeen different acetogens, both mesophilic and thermophilic, on a variety of different carbohydrates and gases. Compared to most model acetogen strains, several non-model mesophilic strains displayed greater substrate flexibility, including the ability to utilize disaccharides, glycerol, and an oligosaccharide, and growth rates. Three of these non-model strains (Blautia producta, Clostridium scatologenes, and Thermoanaerobacter kivui) were chosen for further characterization, under a variety of conditions including H2- or syngas-fed sugar fermentations and a CO2-fed glycerol fermentation. In all cases, CO2 was fixed and carbon yields approached 100%. Finally, the model acetogen C. ljungdahlii was engineered to utilize glucose, a non-preferred sugar, while maintaining mixotrophic behavior. This work demonstrates the flexibility and robustness of anaerobic, non-photosynthetic mixotrophy as a technology to help reduce CO2 emissions.Secreted bacterial RNA: an unexplored avenue
Abstract
Gradually, it is becoming clear that our well-being depends significantly on the contribution and composition of microorganisms that are associated with us. The majority of human-associated microorganisms are bacteria, which maintain their niche through interactions with the human host and neighboring microorganisms. Secretory products contribute largely to maintaining their position in a complex ecosystem. The role of bacterial-released secreted RNA (seRNA) is mostly unexplored, and the study on seRNA will open a new branch in science. There are observations that have demonstrated the functional potential of seRNA, but more investigations are required to cover the entire path from their origin to function.Over-expression of the periplasmic nitrate reductase supports anaerobic growth by Ensifer meliloti
Abstract
The alfalfa endosymbiont Ensifer meliloti strain1021 is known to be an incomplete denitrifier due to its inability to grow anoxically using nitrate as respiratory substrate to produce ATP and grow under anoxic conditions. Although this bacterium contains and expresses the complete set of denitrification genes napEFDABC, nirK, norECBQD and nosRZDFYLX encoding the periplasmic nitrate reductase (Nap), Cu-containing nitrite reductase (NirK), c-type nitric oxide (cNor) and nitrous oxide reductase (Nos), respectively, the reasons of its inability to grow under anoxic conditions are still very poorly understood. In the present study, we have constructed an E. meliloti strain over-expressing napEFDABC genes (Nap+) and demonstrated that this strain is able to grow through anaerobic nitrate respiration. Furthermore, Nap+ showed increased NapC levels as well as Nap, Nir, and cNor activities and higher capacity to produce NO and N2O compared to wild-type cells. These results suggest that the inability of E. meliloti to grow under anaerobic conditions using nitrate as electron acceptor is attributable to a limitation in the expression of the periplasmic nitrate reductase.Children with Facial Morphea Managing Everyday Life: A Qualitative Study
Summary
Background
This study explores the everyday experiences of children with facial morphea by examining the psychosocial impact of living with facial morphea and how children and their families manage its impact.
Methods
We used a qualitative, social constructionist approach involving focus groups, in-depth interviews and drawing activities with 10 children with facial morphea 8-17 years of age and 13 parents. Interpretive thematic analysis was utilized to examine the data.
Results
Children and parents reported on the stress of living with facial morphea, which was related to the lack of knowledge about facial morphea and the extent to which they perceived themselves as different from others. Self-perceptions were based on the visibility of the lesion, different phases of life transitions and reactions of others, (e.g. intrusive questioning and bullying). Medication routines and side effects, such as weight gain added to participants' stress. To manage the impact of facial morphea, children and their parents used strategies to normalize the experience by hiding physical signs of the illness, constructing explanations about what 'it' is, and by connecting with their peers.
Conclusion
Understanding what it is like to live with facial morphea from the perspectives of children and parents is important for devising ways to support children with facial morphea to achieve a better quality of life. Health care providers can help families access resources to manage anxiety, deal with bullying and construct adequate explanations of facial morphea, as well as providing opportunities for peer support.
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Aquagenic Wrinkling of the Palms in Patients with Cystic Fibrosis
Abstract
Aquagenic wrinkling of the palms (AWP) is a condition characterized by oedema, confluent white papules and excessive wrinkling of the palms after few minutes exposure to water. The phenomenon may be associated with pain, numbness and pruritus1,2. It was first noticed and described in 1974 in children with cystic fibrosis (CF) by a paediatrician R.B. Elliott3.
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“It's a traumatic illness, traumatic to witness.” A qualitative study of the experiences of bereaved family caregivers of patients with cutaneous T-cell lymphoma
Abstract
Background
Cutaneous T-cell lymphomas (CTCL) are rare cancers which can be difficult to diagnose, are incurable and adversely affect quality of life, particularly in advanced disease. Families often provide care, but little is known about their experiences or needs while caring for their relative with advanced disease or in bereavement.
Objectives
To explore the experiences of bereaved family caregivers of patients with CTCL.
Methods
Single semi-structured qualitative interviews were conducted with bereaved family caregivers of patients with CTCL recruited via a supra-regional CTCL clinic. Transcribed interviews were analysed thematically, focusing on advanced disease, the approach of death and bereavement.
Results
Fifteen carers of eleven deceased patients participated. Experiences clustered under four themes
1 Complexity of care and medical intervention
2 Carer roles in advanced CTCL
3 Person vs. organisation-centred care in advanced CTCL
4 Knowing and not knowing: reflections on dying, death and bereavement
Caregivers often had vivid recollections of the challenges of caring for their relative with advanced CTCL and some took on quasi-professional roles as a result. Advanced disease made high demands on both organisational flexibility and family resources. For many caregivers, seeing disease progression was a prolonged and profoundly traumatic experience. The extent to which they were prepared for their relative's death and supported in bereavement was highly variable.
Subthemes within each theme provide more detail about caregiver experiences.
Conclusions
Family caregivers should be considered part of the wider healthcare team, acknowledging their multiple roles and the challenges they encounter in looking after their relative with CTCL as the disease progresses. Their experiences highlight the importance of organisational flexibility and of good communication between health care providers in advanced CTCL.
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The Validity of the Diagnostic Code for Pyoderma Gangrenosum in an Electronic Database
Abstract
Pyoderma gangrenosum (PG) is a rare inflammatory and ulcerative neutrophilic dermatosis with an estimated incidence of 3-10 cases per million people annually.1Given that our understanding of PG is limited by disease rarity and considerable misdiagnosis rates (~30-50%),2 establishing a method to identify cases in large databases would facilitate population-based research. This approach has been used in other dermatologic diseases,3–6 where case identification is performed by diagnosis-related queries based on the International Classification of Diseases (ICD) code.
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Effective management of severe cutaneous mastocytosis in young children with omalizumab (Xolair®)
Summary
Omalizumab (Xolair®) is an anti-IgE monoclonal antibody, which may benefit adults with systemic mastocytosis. We report effective treatment with omalizumab in two toddlers with severe diffuse cutaneous mastocytosis. Our cases offer preliminary evidence to support the safe use of omalizumab in paediatric patients with cutaneous mastocytosis.
Assessing normal values for the FACE-Q Rhinoplasty module: an observational study
Summary
Objectives
The goal of this study was to determine normal values for the FACE-Q Rhinoplasty Module.
Design
A prospective monocentric observational cohort study.
Setting
We tested FACE-Q Satisfaction with Nose and Satisfaction with Nostrils in two groups of patients, seeking or not a rhinoplasty.
Participants
One hundred and four patients were included in the study, fifty-two in each group.
Main outcome measurements
Primary outcome was to identify possible cutting scores to establish normal values for each of the FQRM questionnaires.
Results
Regarding the Satisfaction with Nose scale, there was a statistically significant difference between the two groups (p < 0.001). Area under the ROC curve was 0.964 (95%CI= 0.931-0.997). Forty-seven points was the value presenting the best Youden index (Sensitivity = 96.2%, Specificity =86.5%). Regarding the Satisfaction with Nostrils scale, there was a statistically significant difference between the two groups (p < 0.001). Area under the ROC curve was 0.820 (95%CI= 0.741-0.899). Sixty-four points was the value presenting the best Youden index (Sensitivity=94.2%, Specificity=53.8%).
Conclusion
This is the first study to generate normative data for the FACE-Q rhinoplasty module. The findings presented here have important implications for future clinical care and research. The definition of a normal score can help practitioners to better analyze their patients and to support a therapeutic indication.
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Disinfection of saline solutions and devices for nasal irrigation – why, when, and how?
Abstract
Nasal irrigation using a saline solution is one of the primary treatments for patients with sinonasal inflammatory diseases and following endonasal surgeries. Irrigation devices and the solutions used often become contaminated, and patients are advised to adopt disinfection techniques (1,2). However, there are currently no guidelines for how patients should perform this task.
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Assessment of narrative writing by Persian-speaking students with hearing impairments
Abstract
Objective
Previous studies have highlighted that narrative skill is critical to the development of the literacy skills by children. Children with cochlear implants (CI) and hearing-aids (HA) may have problems in narrative development compared to peers with healthy hearing (HH). There is no exact data about the narrative writing ability of Persian-speaking students who are hearing-impaired. The current study was undertaken to compare the microstructure and macrostructure scores for narrative writing of Persian-speaking students who are hearing-impaired and peers with HH.
Design
This was a cross-sectional descriptive-analytical study.
Setting
The subjects were recruited from elementary schools in the city of Tehran.
Participants
A total of 144 elementary school students were participated.
Outcome measures
The written narratives were elicited using a wordless pictorial storybook story. Three-way ANOVA with post hoc adjusted Bonferroni test were applied to determine the main effects and interactions of grounded variables on the microstructure and macrostructure components of narrative writing.
Results
No significant differences were observed in the macrostructure components of narrative writing between hearing-impaired and HH students. Factors analysis showed that the 4th grade HH students had significantly the highest scores, and the 3rd grade HA students had significantly the lowest scores in microstructure components of narrative writing.
Conclusion
The findings revealed that hearing-impaired students similarly to their HH peers can transmit the main idea (macrostructure) of narrative writing, but show critical difficulties when using complete grammatical elements (microstructures) to form sentences in order to convey the idea in the narrative.
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The influence of heavy metals, polyaromatic hydrocarbons, and polychlorinated biphenyls pollution on the development of antibiotic resistance in soils
Abstract
The minireview is devoted to the analysis of the influence of soil pollution with heavy metals, polyaromatic hydrocarbons (PAHs), and the polychlorinated biphenyls (PCBs) on the distribution of antibiotics resistance genes (ARGs) in soil microbiomes. It is shown that the best understanding of ARGs distribution process requires studying the influence of pollutants on this process in natural microbiocenoses. Heavy metals promote co-selection of genes determining resistance to them together with ARGs in the same mobile elements of a bacterial genome, but the majority of studies focus on agricultural soils enriched with ARGs originating from manure. Studying nonagricultural soils would clear mechanisms of ARGs transfer in natural and anthropogenically transformed environments and highlight the role of antibiotic-producing bacteria. PAHs make a considerable shift in soil microbiomes leading to an increase in the number of Actinobacteria which are the source of antibiotics formation and bear multiple ARGs. The soils polluted with PAHs can be a selective medium for bacteria resistant to antibiotics, and the level of ARGs expression is much higher. PCBs are accumulated in soils and significantly alter the specific structure of soil microbiocenoses. In such soils, representatives of the genera Acinetobacter, Pseudomonas, and Alcanivorax dominate, and the ability to degrade PCBs is connected to horizontal gene transfer (HGT) and high level of genomic plasticity. The attention is also focused on the need to study the properties of the soil having an impact on the bioavailability of pollutants and, as a result, on resistome of soil microorganisms.
A review of cutaneous manifestations within glucagonoma syndrome: necrolytic migratory erythema
Abstract
Necrolytic migratory erythema (NME) is a rare skin disorder that is a cutaneous manifestation of the glucagonoma syndrome. It presents with annular eruptions of migrating erythematous papules and plaques with superficial epidermal necrosis, central flaccid bullae, and crusted erosions located primarily in the intertriginous areas. Treatment with the long-acting somatostatin analog Octreotide is a potential therapy to help ameliorate skin symptoms. We present a case of a patient with a 1-year history of a pancreatic glucagonoma that developed an ulcerated, plaque-like, weeping rash over multiple areas of their body despite current treatment with Octreotide and stable pancreatic tumor staging. The patient had a similar rash when initially diagnosed with a glucagonoma, and it quickly improved after Octreotide treatment. Clinical examination and biopsy were consistent with necrolytic migratory erythema due to an underlying glucagonoma. This rare case adds to our understanding of the clinical presentation of NME, as well as highlights the relapsing and remitting course, even if the underlying pancreatic tumor is stable and the patient is undergoing treatment.
Evaluation of an Abutment-level SuperPower Sound Processor for Bone-Anchored Hearing
Abstract
Objectives
Performance of an abutment-level superpower sound processor for bone-anchored hearing, the Ponto 3 SuperPower from Oticon Medical (BCD2), was compared to an earlier model from Oticon Medical (BCD1).
Design
A comparative study in which each patient serves as its own control.
Setting
Tertiary clinic.
Participants
Eighteen experienced BCD1 users with profound mixed hearing loss.
Main outcome measures
speech reception thresholds in noise; APHAB and SSQ questionnaires.
Results
In a group of 18 patients with severe mixed hearing loss the performance of a recently introduced bone conduction device (BCD2) is evaluated relative to that of an earlier model (BCD1). Speech reception thresholds for the sentence-in-noise test in the speech and noise frontal condition are not significantly different (p>0.05) for BCD1 and BCD2. Speech reception thresholds for frontal speech and three identical noise sources are 1.7 dB lower for BCD2 than for BCD1 (p<0.05).
With the APHAB questionnaire the score for background noise is significantly lower (p<0.01), i.e. more favourable, for BCD2 than for BCD1 with an effect size of 0.91. The APHAB domain scores for ease-of-communication, reverberation, and aversiveness of loud sounds are not significantly different for both devices (p>0.05). Scores for the speech, spatial, and quality of hearing domains of the SSQ questionnaire are significantly higher (p<0.01), i.e. more favourable, for BCD2 than for BCD1 with effect sizes of 1.22, 0.71, and 1.05, respectively. Scores for the SSQ-factors "speech understanding", "spatial", "clarity, separation and identification", and "listening effort and concentration" were all significantly higher (p<0.05) for BCD2 than for BCD1, with effect sizes of 1.28, 0.64, 0.98, and 0.78, respectively. On a proprietary questionnaire 16 patients indicate a preference for BCD2 over BCD1 for conversations in a small group and two patients have no preference for either device. In a large group one patient prefers BCD1, six patients have no preference and eleven patients prefer BCD2. When listening to music all patients prefer BCD2 over BCD1, with a strong preference for BCD2 for seven patients. When asked for an overall preference, all patients prefer BCD2 over BCD1, with nine patients strongly preferring BCD2.
Conclusions
The lower speech reception thresholds in noise with BCD2 relative to BCD1 can be attributed to the 'speech-omni' directionality mode of BCD2. The combination of an improved directionality for primarily low-level inputs and a higher maximum force output, relevant for mid and high-level inputs, results in a clear preference for BCD2 over BCD1.
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Asthma Exacerbations Associated with Lung Function Decline in Patients with Severe Eosinophilic Asthma
Publication date: Available online 15 February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Hector Ortega, Steven W. Yancey, Oliver N. Keene, Necdet B. Gunsoy, Frank C. Albers, Peter H. Howarth
BackgroundLimited data describe the association between the frequency of asthma exacerbations and the decline in lung function in severe asthma.ObjectiveTo determine whether asthma exacerbations are associated with enhanced decline in lung function.MethodsChanges in lung function were analyzed retrospectively using data from the DREAM and MENSA studies of mepolizumab intervention in patients with severe asthma. Patients were either nonsmokers or former smokers. A linear regression model was used to analyze the relationship between the number of exacerbations and decline in FEV1 across treatment groups.ResultsIn a combined post hoc analysis, 57% (n = 572) of patients had no exacerbations and experienced an improvement in postbronchodilator FEV1 of 143 mL. In contrast, in patients who experienced 3 or more exacerbations, there was a decrease in postbronchodilator FEV1 of 77 mL in the combined analysis. The linear modeling analysis estimated that for each exacerbation seen during the observational period, there was a decrease of 50 mL in FEV1 (P < .001).ConclusionsA direct relationship between the number of exacerbations in patients with severe eosinophilic asthma and decline in lung function was observed. Repeated exacerbations may be associated with accelerated loss of lung function.
Quality of life analysis of the MITO-8, MaNGO, BGOG-Ov1, AGO-Ovar2.16, ENGOT-Ov1, GCIG study comparing platinum-based versus non-platinum-based chemotherapy in patients with partially platinum-sensitive recurrent ovarian cancer.
Abstract
Background
MITO-8 showed that prolonging platinum-free interval by introducing non-platinum-based chemotherapy (NPBC) does not improve prognosis of patients with partially platinum-sensitive recurrent ovarian cancer. Quality of life (QOL) was a secondary outcome. Patients and methods
Ovarian cancer patients recurring or progressing 6-12 months after previous platinum-based chemotherapy (PBC) were randomized to receive PBC or NPBC as first treatment. QOL was assessed at baseline, 3rd and 6th cycle, with the EORTC C-30 and OV-28 questionnaires. Mean changes and best response were analysed. Progression-free survival (PFS), response rate, and toxicity are also reported for proper interpretation of data. All analyses were based on intention-to-treat. Results
Out of 215 patients, 151 (70.2%) completed baseline questionnaire, balanced between the arms; thereafter, missing rate was higher in the NPBC arm. At mean change analysis, C30 scores were prevalently worse in the NPBC than PBC arm, statistical significance being attained for emotional functioning, global health status/QOL, fatigue and dyspnoea (effect sizes ranging from 0.30 to 0.51). Conversely, as for OV28 scale, the other chemotherapy side effects item was significantly worse with PBC at 3 and 6 cycles, with a larger effect size (0.70 and 0.54, respectively). At best response analysis, improvement of emotional functioning and pain and worsening of peripheral neuropathy and other chemotherapy side effects were significantly more frequent in the PBC arm. PFS (median 9 vs 5 months, p = 0.001) and objective response rate (51.6% vs 19.4%, p = 0.0001) were significantly better with PBC. Allergy, blood cell count, alopecia, nausea, musculoskeletal and neurologic side effects were more frequent and severe with PBC; hand-foot skin reaction, rash/desquamation, mucositis and vascular events were more frequent with NPBC. Conclusion
MITO-8 QOL analysis shows that deterioration of some functioning and symptom scales is lower with PBC, with improvement of emotional functioning and pain, despite worsening of toxicity-related items.ClinicalTrials.gov NCT00657878
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