Παρασκευή 14 Δεκεμβρίου 2018
Pericardial effusion as a complication of chronic graft versus host disease
A 24-year-old man with previous matched unrelated donor allogenic bone marrow transplant for aplastic anaemia and chronic graft versus host disease on steroid taper presented with progressively worsening anasarca. CT revealed large pericardial effusion, while echocardiogram was concerning for early tamponade physiology. He underwent emergent pericardiocentesis with pericardial drain placement. Extensive rheumatological and infectious work-up was unrevealing with patient's presentation attributed to pericardial graft versus host disease. This highlights the need of physicians to be aware of pericardial serositis as a complication of graft versus host disease due to its life-threatening complications, which require immediate intervention.
https://ift.tt/2Cg19xX
Potassium chloride mixture may maintain hypokalaemia and hypertension
Hypokalaemia can be treated with potassium chloride mixture. Some mixtures contain liquorice extract (glycyrrhizin) as a supplement to improve taste. Glycyrrhizin can cause pseudohyperaldosteronism and thereby result in hypertension and hypokalaemia. We here present a case where treatment with potassium chloride mixture causes hypertension and hypokalaemia in a 50-year-old woman. After unravelling differential diagnosis, the potassium chloride mixture was stopped. After the discontinuation, the patient's blood pressure was well managed and the potassium levels normalised.
https://ift.tt/2Cg3J6Z
Catatonia due to alprazolam withdrawal
A 50-year-old man with multiple psychiatric comorbidities including major depressive disorder and general anxiety disorder presented to the emergency room (ER) with altered mental status, immobility and mutism. The patient was unresponsive to commands and unable to provide any history. In the ER he was given a provisional diagnosis of cerebrovascular accident (CVA). Vital signs on admission were stable. On physical examination, he exhibited grimacing, muscle rigidity and areflexia. Workup for CVA and infectious aetiology was unremarkable and the patient's urine toxicology screen was negative. History from the patient's family revealed that 4 days prior to presentation, the patient had discontinued his prescribed dose of alprazolam 1 mg four times per day. The patient was diagnosed with catatonia due to benzodiazepine withdrawal and had gradual return to baseline with administration of lorazepam 1 mg intravenous three times per day.
https://ift.tt/2CfGdHr
Dexmedetomidine-assisted drug interviews: an observation in psychiatric setting
Drug-assisted interviews are an effective tool in the management of various psychiatric illnesses where psychopharmacological, as well as routine psychological interventions, do not prove beneficial. These have most commonly been done by using barbiturates and benzodiazepines that have given favourable results for a long time. However, they carry the risk of respiratory depression and difficulty in maintaining the plane of sedation where the patient is amenable to interviewing. In our experience of drug-assisted interviews with two patients we used intravenous dexmedetomidine, which is being used in anaesthesia practice for conscious sedation or sedation in the intensive care unit. We found dexmedetomidine to be superior to thiopentone in achieving a level of conscious sedation where the patients were amenable for an interview, with no significant adverse events and faster post-anaesthetic recovery.
https://ift.tt/2LiDEqP
Metastatic adenocarcinoma of mandible: in search of the primary
We present here a case of a 64-year-old female patient who reported with a complaint of pain in the chin region of 3-month duration. The radiographs revealed an irregular radiolucent lesion in the anterior part of the mandible. An incisional biopsy was carried out and the microscopy showed features of adenocarcinoma. Suspecting a metastatic lesion, the patient was then sent for whole body examination which showed a mass in the lungs. A whole body scan also showed metastasis to other organs such as kidney, gallbladder and vertebrae. This case is unusual in that the patient complained only of a vague jaw pain with no other systemic symptoms even in the presence of widespread disease.
https://ift.tt/2CeZjNJ
Renal sarcoidosis: a rare case
Sarcoidosis is a multisystemic granulomatous disease with rare renal involvement. We describe a case of a 45-year-old female patient admitted to the hospital with severe acute kidney injury and uveitis. After clinical investigation, sarcoidosis with renal, hepatic and ocular involvement was diagnosed. Renal biopsy revealed acute granulomatous interstitial nephritis and treatment with systemic corticosteroids was started with marked improvement in renal function.
https://ift.tt/2CeU7cC
Late onset of dropped head syndrome following mantle radiation therapy for Hodgkin lymphoma
Dropped head syndrome (DHS) is a rare condition, characterised by weakness of the cervical paraspinal muscles with sagging of the head. It is usually seen in association with neurological disorders and rarely can follow radiotherapy. We report a case of a 54-year-old man survivor of Hodgkin lymphoma (HL), who developed DHS 28 years after radiotherapy. He was referred to our department due to progressive weakness and atrophy of cervical paraspinal and shoulder girdle musculature. Physical and neurophysiological examination, electromyography and MRI confirmed the diagnosis of DHS. In the following years, there was no progression of symptoms.
https://ift.tt/2LgZkna
Thyroid storm: a case of haemodynamic failure promptly reversed by aggressive medical therapy with antithyroid agents and steroid pulse
Hyperthyroidism is a common metabolic disorder, although its presentation as an endocrine emergency called thyroid storm is rare. Here we review a case of a thyroid storm as the initial presentation of thyrotoxicosis, with multiple organ failure and haemodynamic collapse due to low-output cardiac dysfunction. Quick intervention with aggressive antithyroid therapy, including steroid pulse, and supportive intensive care measures led to an outstanding improvement and full recovery. The present case clearly shows the beneficial impact of initial clinical suspicion resulting in an early diagnosis and intensive therapy. Moreover, it supports the additional role of steroids to aggressive antithyroid strategy in order to control associated deleterious systemic inflammatory reactions.
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Single right coronary artery with congenital absence of left coronary system
Single coronary artery (SCA) is a very rare coronary anomaly. The accurate diagnosis of the entity requires multimodality imaging of the coronary anatomy. SCA is often incidentally diagnosed when patients are investigated for symptoms of suspected coronary artery disease with invasive or non-invasive coronary angiography. There are no established diagnostic electrocardiographic or echocardiographic criteria to identify the presence of SCA, which makes the diagnosis a far-reaching fruit. We present a young male patient presenting with a non-ST elevation myocardial infarction. He was found to have SCA on invasive coronary angiography, which was subsequently confirmed by CT coronary angiography.
https://ift.tt/2LkcorL
Haemostatic radiation therapy for a bleeding intraductal papillary neoplasm of the biliary tree
Haemostatic radiation was effectively used as a novel rescue therapy in a 60-year-old man who presented with recurrent melaena refractory to all conventional medical and surgical measures. He needed multiple transfusions and was diagnosed to be bleeding from an intraductal papillary biliary neoplasm which was not amenable to surgical resection in view of the background liver disease. He received conventional radiation therapy (RT) of a dose of 3 Gy per fraction for 3 consecutive days after which he stabilised. After cessation of the RT, he did not require transfusion for the next 2 months. His quality of life improved and it gave us time to evaluate for other definitive measures.
https://ift.tt/2CdtZPs
Anaphylaxis after treatment with recombinant factor VIII: investigation and therapeutic challenge
We report a 10-year-old patient with haemophilia A developing anaphylaxis to recombinant factor VIII (octocog alfa). Allergic reactions, and especially anaphylactic events, are rare in patients with haemophilia A. The nature of these reactions is not fully understood. Here, we demonstrate a type I hypersensitivity reaction using sodium dodecyl sulfate-polyacrylamide gel electrophoresis immunoblotting assay. This test revealed itself as an essential diagnostic tool, as it allowed us to choose an alternative treatment (moroctocog alfa). Its safety was later confirmed by an uneventful challenge test.
https://ift.tt/2CeRLKM
Exogenous steroid-induced hypoadrenalism in a person living with HIV caused by a drug-drug interaction between cobicistat and intrabursal triamcinolone
We report a diagnosis of exogenous steroid-induced hypoadrenalism in a person living with HIV caused by a drug–drug interaction (DDI) between intrabursal triamcinolone and the pharmacokinetic booster cobicistat. A 53-year-old woman living with HIV, managed with dolutegravir and cobicistat-boosted darunavir, presented to the orthopaedic clinic with worsening hip pain. She was diagnosed with greater trochanteric pain syndrome (GTPS) of the hip and was treated with intrabursal injection of bupivacaine and triamcinolone. Seven days following this injection, she presented with Cushingoid features, an undetectable cortisol and was diagnosed with exogenous steroid-induced hypoadrenalism. Cobicistat is a cytochrome P450 3A inhibitor and in this case inhibited clearance of intrabursal triamcinolone, leading to exogenous glucocorticoid excess and adrenal suppression. This is the first report to describe this predictable DDI with cobicistat following intrabursal glucocorticoid injection. This case highlights the complexities in managing non-HIV-related chronic morbidities in people living with HIV.
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Giant juvenile papillomatosis of the breast in a Nigerian girl
Juvenile papillomatosis is a benign epithelial proliferative tumour of young women. It was recognised as a distinct clinicopathological entity with defining criteria by Rosen et al since 1980. However, giant juvenile papillomatosis is rare. We report a case of a 14-year-old girl who presented to our institution's breast clinic with a huge right breast mass measuring 20 cm x 15 cm. She had no personal history of previous breast disease and there was no family history of breast cancer. Our initial preoperative diagnosis was of a phylloides tumour. The patient had a total excision of her breast mass which revealed florid juvenile papillomatosis at histology. This presentation highlights the clinical presentation and imaging features of juvenile papillomatosis. The classical histopathological characteristics, unusual microscopic findings and management of a huge-sized tumour in an adolescent Nigerian patient are also presented.
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Unusual case of cellulitis due to primary cutaneous histoplasmosis
A 63-year-old white man with a history of rheumatoid arthritis on adalimumab was admitted to the hospital for left arm swelling and erythema. On physical examination, the patient was afebrile and non-toxic appearing and there was tense oedema of the left forearm. Initial laboratory work was unremarkable except for elevated inflammatory markers. MRI of the arm showed non-specific findings of inflammation. The patient was started on empiric antibiotics but did not improve. Given the patient's immunosuppression, early consideration was given to fungal or mycobacterial causes. Initial serum fungal studies were negative and the patient was taken for diagnostic local incision and biopsy of the left volar forearm. Grocott's methenamine silver and periodic acid–Schiff staining revealed fungal organisms resembling Histoplasma and intraoperative fungal cultures grew Histoplasma capsulatum confirming the diagnosis. The patient was treated with a 6-month course of itraconazole with improvement in his condition and eventual complete resolution.
https://ift.tt/2CfoYG0
Case of a missed airway stent migration
This case report describes a rare complication to stent management of airway compression. An 84- year-old man was admitted to the outpatient clinic with haemoptysis, cough and dyspnoea. A CT scan showed an intraluminal, non-occluding tumour close to the right side of the main carina. A stent was inserted in the right main bronchus. The patient was, 7 months later, admitted to the emergency room with severe cough and dyspnoea. The stent was produced during a coughing spell. Retrospective investigation of available imaging revealed that the stent had been dislodged to a nearly 'perfect' position in the left main bronchus several months earlier which, however, had not been noticed and thus not reported by the radiologist describing the CT. The possibility of a right-left confusion should always be kept in mind, especially if a patient presents with renewed symptoms that should have been managed successfully.
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The Relationship of Exhaled Nitric Oxide with Ethnicity and Gender in Rural Georgia YouthAuthors
Nitric oxide is produced by the human bronchial epithelium1 and is associated with airway eosinophilic inflammation seen in asthmatics and other airway diseases.2 Airway inflammation is a characteristic of asthma, along with airway hyper-responsiveness and airway obstruction. Inhaled corticosteroids (ICS) to treat the inflammation are a mainstay of asthma treatment. Measurement of exhaled nitric oxide (eNO) as a biomarker of eosinophilic inflammation is noninvasive, safe, reproducible, and easy to perform; however, the clinical value of measurements has been limited by imprecise reference ranges.
https://ift.tt/2zY8f8I
Associations of urban greenness with asthma and respiratory symptoms in Mexican American children
Asthma is one of the most common childhood chronic conditions with approximately 19 million adults and seven million children affected in the United States alone. 1 The etiology of asthma and other allergic conditions is not fully understood, but environmental and lifestyle factors have been implicated in the inception of these conditions. In the United States, the prevalence of asthma and asthma related symptoms is disproportionately high in urban poor neighborhoods.2-4 Although this might be due partly to sociodemographic factors, studies have suggested that urbanization and its detrimental impact on the natural environment and lifestyle might increase the risk of respiratory conditions.
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miR-487b mitigates allergic rhinitis through inhibition of the IL-33/ST2 signaling pathway
OBJECTIVE: To investigate the potential effect of miR-487b/IL-33-ST2 axis on the pathology of allergic rhinitis (AR) and the relevant mechanism.
PATIENTS AND METHODS: The expression level of interleukin-33 (IL-33), a homolog of sulfotransferase (ST2), and miR-487b were detected in patients with or without allergic rhinitis. Luciferase assay was performed to evaluate the interaction between miR-487b and IL-33, and the effects of miR-487b/IL-33-ST2 axis on allergic rhinitis mice were determined by established allergic rhinitis model in mice by ovalbumin (OVA). The levels of OVA-specific immunoglobulin E (Ig-E), proinflammatory cytokines (IL-4, IL-5, and IL-13), and pathological alterations were detected.
RESULTS: The level of IL-33 and its specific ligand ST2 were found increased in allergic rhinitis patients while miR-487b expression level was markedly repressed. To confirm whether miR-487b has a regulation effect on IL-33, we checked it in three publicly available algorithms, TargetScan, miRDB, and microRNA. We found that IL-33 is a direct target of miR-487b, and Luciferase assays confirmed our hypothesis, the subsequent experiments showed that up-regulation of miR-487b could inhibit expression of IL-33 and ST2, resulting in the decrease of the immunoglobulin E (Ig-E), proinflammatory cytokines and mitigation of pathological alterations.
CONCLUSIONS: Our research discovered the suppressor function of miR-487b in allergic rhinitis and revealed that miR-487b/IL-33-ST2 axis may be a potential therapeutic target for the treatment of allergic rhinitis.
L'articolo miR-487b mitigates allergic rhinitis through inhibition of the IL-33/ST2 signaling pathway sembra essere il primo su European Review.
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Positive influence of simvastatin used as adjuvant agent for cavity lining
Abstract
Objectives
To assess the biological, antimicrobial, and mechanical effects of the treatment of deep dentin with simvastatin (SV) before application of a glass-ionomer cement (GIC).
Materials and methods
Dentin discs were adapted to artificial pulp chambers and SV (2.5 or 1.0 mg/mL) was applied to the occlusal surface, either previously conditioned or not with EDTA (±EDTA). The extracts (culture medium + SV that diffused through dentin) was obtained and then applied to cultured odontoblast-like MDPC-23 cells. Cell viability, alkaline phosphatase (ALP) activity, and mineralization nodule (MN) deposition were evaluated. Untreated discs were used as control. The antibacterial activity of SV (2.5 or 1.0 mg/mL) against Streptococcus mutans and Lactobacillus acidophilus, as well as the bond strength of GIC to dentin in the presence of SV 2.5 mg/mL (±EDTA) were also assessed. The data were analyzed by ANOVA/Tukey tests (α = 5%).
Results
EDTA + SV 2.5 mg/mL significantly enhanced the ALP activity and MN deposition in comparison with the control, without changing in the cell viability (p < 0.05). The association EDTA + SV 2.5 mg/mL + GIC determined the highest ALP and MN values (p < 0.05). SV presented intense antimicrobial activity, and the EDTA dentin conditioning followed by SV application increased bond strength values compared with SV treatment alone (p < 0.05).
Conclusion
SV presents antimicrobial activity and diffuses across conditioned dentin to biostimulate odontoblast-like pulp cells.
Clinical significance
The use of SV as adjuvant agent for indirect pulp capping may biostimulate pulp cells thus preserving vitality and function of the pulp-dentin complex.
https://ift.tt/2S0AYAI
Making the Case for Sesame: A Major U.S. Food Allergen
Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 241-242, December 2018.
https://ift.tt/2Lgm7iV
Pediatric Spontaneous Pneumothorax: Our Experience and a Review of the Literature
Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 208-214, December 2018.
https://ift.tt/2CdaYfM
Angiopoietin-1, Angiopoietin-2, and Periostin Levels in Children with Recurrent Wheeze
Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 230-235, December 2018.
https://ift.tt/2Lijugt
Comparison of 3 Indices for Assessing the Severity of Bronchial Asthma Exacerbations in Children
Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 215-220, December 2018.
https://ift.tt/2CfC6Lj
Looking Towards the Future
Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 207-207, December 2018.
https://ift.tt/2LklhS8
Relationship Between Health Literacy in Parents and Asthma Control in Their Children: A Prospective Study in a Diverse Suburban Population
Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 221-225, December 2018.
https://ift.tt/2Cf1mkQ
Role of the Airway Microbiome in Respiratory Infections and Asthma in Children
Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 236-240, December 2018.
https://ift.tt/2Liha9p
Direct Observed Therapy of Inhaled Corticosteroids for Asthma at School or Daycare
Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 226-229, December 2018.
https://ift.tt/2Cd0MnA
Highlights from the U.S. Asthma Summit 2018
Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 243-244, December 2018.
https://ift.tt/2LjaxDU
Clear cell acanthoma (CCA)-like lesions of the nipple/areola: A clinicopathological study of 12 cases supporting a nonneoplastic eczematous disease
Clear cell acanthoma (CCA) of the nipple/areola has been reported. The CCA-like histology more likely represents a feature of eczematous dermatitis of the nipple/areola.
https://ift.tt/2A19BiX
High prevalence of clinical spondyloarthritis features in patients with hidradenitis suppurativa
To the Editor: Hidradenitis suppurativa (HS) is associated with several comorbidities, including possibly spondyloarthritis.1 Spondyloarthritis is a group of interrelated chronic autoinflammatory rheumatic conditions.2 A spondyloarthritis diagnosis is based mainly on the presence of spondyloarthritis features, which includes spinal (axial) features sacroiliitis and spondylitis, peripheral features, such as peripheral arthritis, enthesitis, and dactylitis; and the extra-articular manifestations uveitis, psoriasis, and inflammatory bowel disease.
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In vitro characterization of hepatic toxicity of Alternaria toxins
Abstract
Alternaria mycotoxins are secondary fungal metabolites which can contaminate food and feed. They are produced by Alternaria species with alternariol (AOH), alternariol monomethyl ether (AME), tenuazonic acid (TeA), and tentoxin (TEN) as the main representatives for Alternaria mycotoxins in food. Once passing the intestinal barrier, Alternaria toxins can reach the liver to exert yet uncharacterized molecular effects. Therefore, hepatic in vitro systems were used to examine selected Alternaria mycotoxins for their induction of metabolism-dependent cytotoxicity, phosphorylation of the histone H2AX as a surrogate marker for DNA double-strand breaks, and relevant marker genes for hepatotoxicity. Analysis of cell viability as well as the induction of H2AX phosphorylation in the hepatocarcinoma cell line HepG2 revealed a detoxification of 100 μmol/l AME and AOH by pre-treatment with S9 liver homogenate as shown by a decrease in cytotoxicity and H2AX histone phosphorylation to levels observed in control cells. Concentrations up to 100 μmol/l TeA and TEN did not induce H2AX phosphorylation whether metabolized or not. In the metabolically competent human hepatoma cell line HepaRG, no cytotoxicity of Alternaria toxins occurred even at high concentrations up to 100 μmol/l, which indicates a low cytotoxic potential. Induction of gene expression associated with liver toxicity was analyzed by quantitative real-time PCR using a specific hepatotoxicity PCR array in HepaRG cells: here, an evidence was found that 50 μmol/l of AOH, AME, TeA, and TEN might be associated with hepatotoxic effects, necrosis, and the development of diseases like cholestasis and phospholipidosis.
https://ift.tt/2QWDfzu
Effect of hyaluronic acid on the osseointegration of dental implants
The mechanism of osseointegration is related to many factors, including the quality of the bone, the biocompatibility and surface characteristics of the implant material, the surgical technique, and functional loading. The purpose of this study was to investigate the effects of hyaluronic acid gel on the osseointegration of implants placed in defined areas of the mandible in rabbits. Hyaluronic acid is known to have an osteoinductive effect during regeneration of bony defects, and we thought that it might also have a favourable effect on osseointegration, a specialised mechanism to heal bone.
https://ift.tt/2LjQo0m
Acquired partial lipoatrophy as graft-versus-host disease and treatment with metreleptin: two case reports
Acquired partial lipoatrophy has been reported after bone marrow transplantation during childhood; however, no adult cases have previously been reported. We herein report two adult cases of acquired partial li...
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Effectiveness of 2% Articaine as an anesthetic agent in children: randomized controlled trial
Abstract
Aim
The aim of this study was to compare the effectiveness of 2% articaine and 2% lignocaine in achieving adequate anesthesia in children between the age group of 6–13 years using inferior alveolar nerve block.
Methods
A triple blinded randomized controlled trial was conducted in 180 participants (90 patients- 2% articaine, 90 patients-2% lignocaine). Effectiveness of the anesthetic agent was determined at 3 points determined by subjective evaluation of pain using pain scales (FPS-R). Paired sample t-test and chi square test were performed for statistical significance.
Result
Anesthetic success for 2% articaine were 64.4%, 42.2% and 81.8% respectively. The anesthetic success of 2% lignocaine was 66.7%, 48.9% and 85.7% at point one, point two and point three respectively (p > 0.05).
Conclusion
This study concludes that 2% articaine in 1:2,00,000 did not demonstrate superior clinical effectiveness in comparison to 2% lignocaine.
Clinical significance
Lignocaine has always been considered the gold standard. With its unique chemical structure and increased potency, Articaine has been gaining popularity. Its efficacy in 2% concentration had not been compared to 2% lignocaine. 2% articaine did not show clinical superiority but its comparable effectiveness with lignocaine can encourage further research in using articaine in reduced concentrations to improve effectiveness.
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The Essentials-Only Emergency Tracheotomy Pan: Keeping It Simple With Open Emergent Airways.
| Related Articles |
The Essentials-Only Emergency Tracheotomy Pan: Keeping It Simple With Open Emergent Airways.
JAMA Otolaryngol Head Neck Surg. 2018 Dec 13;:
Authors: Van Mai JP, Whited C, Dailey S
PMID: 30543370 [PubMed - as supplied by publisher]
https://ift.tt/2zYm9Ya
Severe Facial-Disfiguring Xeroderma Pigmentosum With Rapidly Progressing Malignant Tumors.
| Related Articles |
Severe Facial-Disfiguring Xeroderma Pigmentosum With Rapidly Progressing Malignant Tumors.
JAMA Otolaryngol Head Neck Surg. 2018 Dec 13;:
Authors: Zan T, Huang X, Li Q
PMID: 30543363 [PubMed - as supplied by publisher]
https://ift.tt/2PG0KIF
Is It Time to Rethink the Approach to Internal Nasal Valve Stenosis?
| Related Articles |
Is It Time to Rethink the Approach to Internal Nasal Valve Stenosis?
JAMA Otolaryngol Head Neck Surg. 2018 Dec 13;:
Authors: Moss WJ
PMID: 30543362 [PubMed - as supplied by publisher]
https://ift.tt/2A0iE3I
Association Between Conventional Bicycle Helmet Use and Facial Injuries After Bicycle Crashes.
| Related Articles |
Association Between Conventional Bicycle Helmet Use and Facial Injuries After Bicycle Crashes.
JAMA Otolaryngol Head Neck Surg. 2018 Dec 13;:
Authors: Benjamin T, Hills NK, Knott PD, Murr AH, Seth R
Abstract
Importance: Bicycling is an increasingly common activity in the United States that is often associated with fall injuries to the head and face. Although helmets lessen head injury, their role in reducing facial injuries is less clear; therefore, it is important to understand the protective capacity for the face in current helmet design.
Objective: To estimate the conventional bicycle helmet's association with the rate of facial injury after bicycle crashes.
Design, Setting, and Participants: This retrospective cohort study accessed records from January 1, 2010, to December 31, 2014, from the National Trauma Databank, which collects data from emergency departments in US hospitals. Each record pertained to 1 emergency department admission for a bicycle crash. The National Trauma Databank registry data are collected and recorded by incident, which is equivalent to an injury-related hospital admission. All injuries involving patients aged 18 to 65 years for whom data on helmet use and injury were available were included. Statistical analysis was conducted from July 19 to October 17, 2016.
Exposures: Helmeted and nonhelmeted bicycle crashes.
Main Outcomes and Measures: Head and facial injuries among helmeted and nonhelmeted bicycle crashes.
Results: A total of 85 187 facial injuries met inclusion criteria (patient age 18-65 years, availability of helmet use status, and type of injury). Demographic information on bicycle riders was frequently unavailable. Among all injuries, fractures to the head (11.6% [9854]) and face (11.3% [9589]) occurred at similar rates. Helmets reduced head fractures by 52% (from 14.0% [7623] to 7.3% [2231]) and head soft-tissue injuries by 30% (from 15.0% [8151] to 10.9% [3358]), but had lower rates in protecting against facial injuries. While reducing facial injuries overall, the amount of protection with helmet use varied with facial location of the injury. Reduction in facial fractures was 35% (95% CI, 31%-39%) for upper face, 28% (95% CI, 23%-32%) for mid face, and 21% (95% CI, 15%-26%) for the lower face. Helmets were less protective against facial soft-tissue injuries, with a reduction of 33% (95% CI, 30%-36%) in the upper face, 21% (95% CI, 16%-26%) in the mid face, and 2% (95% CI, 0-6%) in the lower face.
Conclusions and Relevance: Although bicycle helmets provide some protection against facial injuries after bicycle crashes, the level of protection depends on the proximity of the injury to the helmeted head. The lower face is particularly vulnerable to injury despite helmet use.
PMID: 30543361 [PubMed - as supplied by publisher]
https://ift.tt/2PAgYms
Collagen/nano-sized β-tricalcium phosphate conduits combined with collagen filaments and nerve growth factor promote facial nerve regeneration in miniature swine: an in vivo study
Publication date: Available online 14 December 2018
Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Zhen Zhang, Xiang Li, Zheyi Li, Yuxing Bai, Guiqing Liao, Juli Pan, Chenping Zhang
Abstract
Purpose
We aimed to investigate the efficiency of a novel biomedical system that repairs facial nerve gaps in a miniature swine model.
Methods
A collagen (COL)/nano-sized β-tricalcium phosphate (nβ-TCP) conduit combined with COL filaments and nerve growth factor (NGF) was prepared and used to bridge a 35-mm-long facial nerve gap in miniature swine. The functional recovery and axonal regeneration were evaluated by electrophysiological and histological assessments among the different groups at 6 months postoperatively.
Results
Morphological analysis revealed that the COL+NGF, COL/nβ-TCP+NGF, and autograft groups exhibited a superior recovery compared to the COL and COL/nβ-TCP groups. The compound muscle action potential (CMAP) ratios were significantly greater in the COL/nβ-TCP+NGF group compared to the COL+NGF and COL/nβ-TCP groups (p < 0.01). Moreover, transmission electron microscopy (TEM) demonstrated significantly larger axon diameters and myelin sheath thicknesses in the COL/nβ-TCP+NGF group compared to the COL, COL+NGF, and COL/nβ-TCP groups (p < 0.05). The expression of S-100 was significantly greater in the COL/nβ-TCP+NGF group than in the COL+NGF and COL/nβ-TCP groups (p < 0.05).
Conclusion
The functional nerve biomedical system containing the COL/nβ-TCP conduit combined with COL filaments and NGF could promote facial nerve regeneration, thus showing promising potential for clinical applications.
https://ift.tt/2PBSKZ6
Removal of the articular fibrous layers with discectomy leads to temporomandibular joint ankylosis
Publication date: Available online 14 December 2018
Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Hua-Lun Wang, Hao Liu, Jun Shen, Pei-Pei Zhang, Su-Xia Liang, Ying-Bin Yan
Objectives
The aim of this study was to investigate whether the direct damage of the articular fibrous layers without condylar fracture, combined with discectomy, was enough to induce temporomandibular joint (TMJ) ankylosis.
Study Design
Bilateral TMJ surgery was performed in 8 growing sheep. The lateral 2/3 of disc removal (DR) was performed on the control side, whereas the lateral 2/3 of disc and articular fibrous layers removal (DFLR) were performed on the experimental side. Four and 4 animals were sacrificed respectively at 1 and 3 months postoperatively.
Results
Fibrous ankylosis was achieved on the DFLR side of the 2 of 4 sheep, and fibro-osseous ankylosis in the other 2 sheep at 1 month after surgery. Fibro-osseous ankylosis developed on the DFLR side of 4 sheep at 3 months postoperatively. On the DR side of animals, pathological characteristics of TMJ osteoarthritis could be found, however no evidence of ankylosis was observed. The scores of TMJ ankylosis for the DR side were significantly lower than that of the DFLR side at different time points (P < 0.05).
Conclusion
This study demonstrated that removal of articular fibrous layers combined with discectomy can lead to traumatic TMJ ankylosis.
https://ift.tt/2zXpbfo
The Reliability of MAML2 Gene Rearrangement in Discriminating Between Histologically Similar Glandular Odontogenic Cysts and Intraosseous Mucoepidermoid Carcinomas
Publication date: Available online 14 December 2018
Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Rekha Reddy, Mohammed N. Islam, Donald M. Cohen, Indraneel Bhattacharyya, Sarah G. Fitzpatrick, Seema Ganatra
Abstract
Objective
MAML2 expression is proven in the majority of mucoepidermoid carcinomas (MEC) arising in salivary glands. MEC can also occur intraosseously (IMEC). Glandular odontogenic cyst (GOC) is an odontogenic cyst with histologic overlap with IMEC. This study will determine the reliability of MAML2 in distinguishing cases of IMEC from GOC.
Study Design
An IRB-approved retrospective search of IMEC, GOC, and IMEC with prior history of GOC was performed within the archives of the University of Florida and University of Alberta Oral Pathology Biopsy Services. Nine cases from five patients were selected. Break apart fluorescent in situ hybridization analysis was performed on seven cases for the presence of MAML2 rearrangement.
Results
Four cases had negative MAML2 gene rearrangement while three cases had positive MAML2 gene rearrangement.
Conclusion
Although it can be concluded that the three cases with positive translocation for MAML2 are IMEC, the same conclusion could not be drawn for the four cases with negative translocation. Whether the cases that were negative for the translocation are GOCs with MEC-like islands or MAML2 negative IMEC could not be ascertained. Therefore, MAML2 rearrangement is not always reliable in differentiating IMECs and GOCs with overlapping histology.
https://ift.tt/2PF23Ya
How well do we manage the odontogenic keratocyst? A multicenter study
Publication date: Available online 14 December 2018
Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Brian Kinard, Gentry Hansen, Marshall Newman, Peter Dennis, Tyler Haeffs, Sebastian Perez, Hamao Sakamoto, Martin Steed, Pamela Hughes, Meredith August, Shelly Abramowicz
Abstract
Objective
To answer the clinical question: among patients treated for odontogenic keratocysts (OKCs), what is the overall 5-year disease-free rate and what factors are associated with disease recurrence?
Study Design
The investigators implemented a multicenter retrospective cohort study composed of patients presenting for the evaluation and management of previously untreated OKCs. The predictor variables were grouped into demographic, medical, radiographic and operative categories. The primary outcome variable was time to lesion recurrence. Data analyses were performed using bivariate analysis and univariate or multivariate Cox proportional hazards models.
Results
The study sample was composed of 231 OKCs. Fifty-seven (24.7%) were treated with decompression with residual cystectomy, 86 (37.2%) with enucleation without adjuvant therapy and 78 (33.8%) with enucleation with peripheral ostectomy. There were 44 recurrences (19%), with a median time to recurrence of 26.7 months [15.8, 49.8].
Conclusion
This multicenter study is the largest study analyzing disease recurrence after treatment of OKCs using appropriate statistical analysis for a time-to-event outcome (disease recurrence). The 5-year disease-free estimate was 29%. Mandibular lesions, multilocular lesions and lesions treated with decompression and residual cystectomy were associated with recurrence.
https://ift.tt/2CcluE2
Diagnostic utility of microsurgical carbon-dioxide laser excision of oral potentially malignant lesions (OPMLs) vs incisional biopsy: a retrospective histopathological review
Publication date: Available online 14 December 2018
Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Dr. Jacinta Vu, A/Prof. Hedley G. Coleman, A/Prof Carsten E. Palme, A/Prof. Faruque Riffat, A/Prof. Mark Schifter, Prof. Hans Zoellner
Objective
Complete excision of oral potentially malignant lesions (OPMLs) could result in improved and earlier detection of more severe grades of oral epithelial dysplasia and/or frank malignancy. Transoral micro-surgical carbon dioxide (CO2) laser techniques allow for resection of OPMLs, even those that are extensive. The advantages are improved diagnostic yield, improved viability of the specimen for pathologic evaluation reduced post-surgical morbidity and easier post-operative clinical surveillance.
Study Design
Retrospective review of the histopathology slide material and attendant clinical notes of 31 sequential patients with OPML that demonstrated the following histopathologic diagnoses on CIB: verrucous hyperplasia (2 patients); mild dysplasia (11 patients), moderate dysplasia (3 patients) or severe dysplasia (15 patients); and subsequently went on to have LEB of their OPML.
Results
Histological diagnosis was upgraded after LEB in 14 (45%) patients (p<0.001), with unexpected cancer in 9 cases (29%) and more severe dysplasia in 5 cases (16%).
Conclusions
Use of LEB to supplement CIB appears superior in the detection of severe dysplasia and frank malignancy in OPMLs when compared to reliance on the CIB alone. Prospective trials are indicated to determine if the superior diagnostic utility of LEB improves patient outcomes with regards to earlier detection of OSCC.
https://ift.tt/2zXpaYS
Individualized Follow-Up Strategy for Patients with an Indeterminate Response to Initial Therapy for Papillary Thyroid Carcinoma
Thyroid, Ahead of Print.
https://ift.tt/2QQV179
Role of “revascularization surgery” in the management of mandibular osteoradionecrotic lesions: a report of twenty‐one years of experience
Abstract
Experiment based on the conviction of a biological dimension of reconstructive surgery where the contribution of a vascularized transplant within irradiated tissue constitutes a physiological response to hypoxia, hypocellularity and hypovascularization characteristic of osteoradionecrotic injury.
Between 1992 and 2013, 119 osteoradionecrotic lesions were treated requiring 125 free flaps.
Revascularization surgery efficiency rate during the study period of 94%.
Complex surgery: 49% complications including 38% vascular complications (total or partial flap necrosis) and 37% intolerance to osteosynthesis material.
Proposal of a therapeutic algorithm retaining the indication of a revascularization surgery in case of cutaneous osteoradionecrotic damage and/or bone exposure greater than 2 centimeters and/or osteolysis of interest to the lower alveolar canal.
This article is protected by copyright. All rights reserved.
https://ift.tt/2rynSis
hand-foot syndrome due to paclitaxel: A rare case report p. 284 Pritam S Kataria, Pradip P Kendre, Apurva A Patel, Nahush Tahiliani, Vijay Bhargav, Honey Parekh DOI:10.4103/ijp.IJP_547_17 Hand-foot syndrome (HFS) is a relatively frequent adverse reaction to certain anticancer drugs. HFS is a type of dermatitis which has been most commonly described with 5-fluorouracil and capecitabine. However, HFS with paclitaxel is rare and has been reported sparingly in the literature. A 52-year-old male patient with recurrent carcinoma of the buccal mucosa was started on palliative chemotherapy regimen, injection paclitaxel (175 mg/m2) in combination with injection carboplatin. On post-chemotherapy day 13, the patient started developing pain, dysesthesia followed by bullae formation, and desquamation over palms and soles. Clinically, the patient had Grade 3 HFS characterized by symmetrical, tender skin lesions over the dorsal aspect of palms, and soles with desquamation necessitating interrupti
Safety of CDNF by Brain Infusion in Patients With Parkinson's Disease. Extension to HP-CD-CL-2002 Clinical Study
Conditions: Parkinson Disease; Movement Disorders; Neuro-Degenerative Disease; Nervous System Diseases; Brain Diseases
Interventions: Drug: Cerebral Dopamine Neurotrophic Factor; Device: Renishaw Drug Delivery System
Sponsors: Herantis Pharma Plc.; Renishaw plc.
Recruiting
https://ift.tt/2GfOkYd
Interventions: Drug: Cerebral Dopamine Neurotrophic Factor; Device: Renishaw Drug Delivery System
Sponsors: Herantis Pharma Plc.; Renishaw plc.
Recruiting
https://ift.tt/2GfOkYd
A Phase I Safety, Pharmacodynamic and Pharmacokinetic Study of GZ17-6.02 in Advanced Solid Tumors or Lymphoma
Conditions: Advanced Cancer; Gastric Cancer; Breast Cancer; Pancreatic Cancer; Prostate Cancer Metastatic; Colo-rectal Cancer; Solid Tumor; Solid Carcinoma; Solid Carcinoma of Stomach; Cancer of Stomach; Lymphoma; Sarcoma; Cutaneous T Cell Lymphoma; Head and Neck Squamous Cell Carcinoma
Intervention: Drug: GZ17-6.02
Sponsors: Genzada Pharmaceuticals USA, Inc.; Translational Drug Development
Not yet recruiting
https://ift.tt/2rD6MQG
Intervention: Drug: GZ17-6.02
Sponsors: Genzada Pharmaceuticals USA, Inc.; Translational Drug Development
Not yet recruiting
https://ift.tt/2rD6MQG
Oral Cancer With Wide Excision and Free Flap Reconstruction
Condition: Head and Neck Cancer
Intervention: Procedure: swallow fuction and swallow training
Sponsor: National Taiwan University Hospital
Recruiting
https://ift.tt/2GfOr65
Intervention: Procedure: swallow fuction and swallow training
Sponsor: National Taiwan University Hospital
Recruiting
https://ift.tt/2GfOr65
The Role of Bathing Additives in the Treatment of Pediatric Atopic Dermatitis
Conditions: Atopic Dermatitis; Eczema
Interventions: Procedure: Water; Procedure: Bleach; Procedure: Acetic acid
Sponsors: Mayo Clinic; HealthPartners Institute
Not yet recruiting
https://ift.tt/2Lo2aqJ
Interventions: Procedure: Water; Procedure: Bleach; Procedure: Acetic acid
Sponsors: Mayo Clinic; HealthPartners Institute
Not yet recruiting
https://ift.tt/2Lo2aqJ
Nivolumab, Ipilimumab and Chemoradiation in Treating Patients With Resectable Gastric Cancer
Conditions: Clinical Stage 0 Gastric Cancer AJCC v8; Clinical Stage 0 Gastroesophageal Junction Adenocarcinoma AJCC v8; Clinical Stage I Gastric Cancer AJCC v8; Clinical Stage I Gastroesophageal Junction Adenocarcinoma AJCC v8; Clinical Stage IIB Gastric Cancer AJCC v8; Clinical Stage IIB Gastroesophageal Junction Adenocarcinoma AJCC v8; Clinical Stage III Gastroesophageal Junction Adenocarcinoma AJCC v8; Clinical Stage IVA Gastric Cancer AJCC v8; Clinical Stage IVA Gastroesophageal Junction Adenocarcinoma AJCC v8; Gastric Adenocarcinoma; Localized Gastric Carcinoma; Localized Gastroesophageal Junction Adenocarcinoma; Pathologic Stage 0 Gastric Cancer AJCC v8; Pathologic Stage 0 Gastroesophageal Junction Adenocarcinoma AJCC v8; Pathologic Stage I Gastric Cancer AJCC v8; Pathologic Stage IA Gastric Cancer AJCC v8; Pathologic Stage IA Gastroesophageal Junction Adenocarcinoma AJCC v8; Pathologic Stage IB Gastric Cancer AJCC v8; Pathologic Stage IB Gastroesophageal Junction Adenocarcinoma AJCC v8; Pathologic Stage IC Gastroesophageal Junction Adenocarcinoma AJCC v8; Pathologic Stage II Gastroesophageal Junction Adenocarcinoma AJCC v8; Pathologic Stage IIA Gastric Cancer AJCC v8; Pathologic Stage IIA Gastroesophageal Junction Adenocarcinoma AJCC v8; Pathologic Stage IIB Gastric Cancer AJCC v8; Pathologic Stage IIB Gastroesophageal Junction Adenocarcinoma AJCC v8; Pathologic Stage IIIA Gastric Cancer AJCC v8; Pathologic Stage IIIB Gastroesophageal Junction Adenocarcinoma AJCC v8; Pathologic Stage IVA Gastroesophageal Junction Adenocarcinoma AJCC v8
Interventions: Drug: Fluorouracil; Radiation: Intensity-Modulated Radiation Therapy; Biological: Ipilimumab; Biological: Nivolumab; Drug: Oxaliplatin; Procedure: Therapeutic Conventional Surgery
Sponsors: M.D. Anderson Cancer Center; National Cancer Institute (NCI)
Not yet recruiting
https://ift.tt/2CdH1fI
Interventions: Drug: Fluorouracil; Radiation: Intensity-Modulated Radiation Therapy; Biological: Ipilimumab; Biological: Nivolumab; Drug: Oxaliplatin; Procedure: Therapeutic Conventional Surgery
Sponsors: M.D. Anderson Cancer Center; National Cancer Institute (NCI)
Not yet recruiting
https://ift.tt/2CdH1fI
Lichen planus pigmentosus and frontal fibrosing alopecia: The link explored Highly accessed article p. 73 Ashraf Raihan, Muthu Sendhil Kumaran DOI:10.4103/Pigmentinternational.Pigmentinternational_19_18 There has been a recent rush of data regarding the combined presentation of lichen planus pigmentosus and frontal fibrosing alopecia in premenoposal women of dark skin. This review article addresses the relationship between the two.
Sunscreens
| Sunscreens: Time to think beyond UV rays | p. 78 |
| Chitralekha Keisham, Nelson Elangbam, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_15_18 It has been known to us that solar radiation contributes to photoaging. Until recently, it was thought to be due to ultraviolet rays alone. However, a growing number of evidence confirms that visible and infrared (IR) rays also contribute to extrinsic aging. Visible and IR rays account for 50% and 45% of the solar radiation reaching the earth. Ultraviolet A induces retrograde mitochondrial signal, thus leading to induction of matrix metalloproteinase. Ultraviolet B and IRC cause heat-related generation of free radicals and destruction of collagen and elastin. Exposure to visible light induces cytokines, free-radical formation, and pigmentary changes in human skin. The end result of solar radiation is generation of free radicals and ultimately oxidative damage, photoaging, and photocarcinogenesis. The present broad spectrum sunscreen does not provide complete protection of the human skin from oxidative insult. So, a combination of a sun protection factor active component along with an antioxidant is the ideal way of photoprotection. Till date, a number of antioxidants have been tried in human and animals which have shown to be an effective photoprotective agent, though few studies have failed to prove the same. Even with conflicting reports, effect of antioxidants on human skin needs to be explored more. A good study design with a large sample size in humans must be conducted as visible light and IR rays contribute significantly to photodamage. |
Idiopathic guttate hypomelanosis: An overview p. 83 Indrashis Podder, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_17_18 Idiopathic guttate hypomelanosis is a commonly acquired, benign leukoderma characterized by multiple, discrete round or oval, porcelain-white macules on sun-exposed areas, especially the extensor aspect of forearms and shins, sparing the face, neck, and trunk. It usually affects the geriatric population (>50 years); chronic exposure to ultraviolet rays and senile degeneration being the important pathogenic factors. The diagnosis remains essentially clinical, whereas newer confirmatory investigations are emerging. Despite the benign course of progression, many patients seek medical attention owing to cosmetic concerns. Several treatment modalities have been tried over time including topical, physical, and surgical measures, although there is lack of a standard treatment regime. In this article, we have reviewed the different aspects of this
Melasma p. 91 Rupali Dharni, Bhushan Madke, Adarsh L Singh, DOI:10.4103/Pigmentinternational.Pigmentinternational_33_17 Introduction: Melasma is a commonly acquired pigmentary disorder that manifests as symmetric hyperpigmented macules and patches on the face. Aim: To correlate Wood’s lamp and dermatoscopic findings in patients having melasma. Materials and Methods: A total of 80 patients who were clinically diagnosed with melasma were examined under a Wood’s lamp and dermatoscope, and all the findings were recorded and analyzed. Result: The degree of agreement between the Wood’s lamp findings and dermatoscopic findings was found to be substantial as analyzed by kappa statistics with K = 0.813 and P = 0.0001 (significant). Conclusion: Dermatoscopy is advocated globally as a screening and diagnostic procedure for melasma and other pigmentary disorders, especially for earlier therapeutic intervention targeting different stages and mechanisms involved in pathogenesis.
PUVASOL and NBUVB in patients with vitiligo p. 96 Vaaruni Ravishankar, Santoshdev P Rathod, Siddhartha Saikia, Raju G Chaudhary, Rekha B Solanki DOI:10.4103/Pigmentinternational.Pigmentinternational_39_17 Introduction: Vitiligo is an acquired, hypomelanotic disease, characterized by circumscribed depigmented macules. Phototherapy, which is the use of ultraviolet irradiation with or without exogenous photosensitizer is a well established treatment option. Psoralens with sunlight as the source of ultraviolet A-rays is known as PUVASOL. Narrow band Ultraviolet B phototherapy (NBUVB; 311–313 nm) has been introduced over the past decade. Aims: To study the clinical effectiveness and assess the safety of NBUVB and PUVASOL therapy in Vitiligo patients. Methods: The patients were randomly allocated in to two groups containing 25 patients each. Group A patients received NBUVB with an initial dose of 250 mJ/cm2, incremented by 20% with each subsequent visit till optimum dose was achiev
Actinic keratosis in vitiligo after oral PUVAsol therapy with review p. 103 Saumya Sankhwar, Sunil K Gupta DOI:10.4103/Pigmentinternational.Pigmentinternational_2_18 Abstract Vitiligo is an acquired disorder characterised by depigmentation. The etiopathogenesis is still unclear and many theories have been proposed for the same. It is believed that due to lack of protective melanin, a vitiliginous patch is more prone to photodamage by UV radiation and development of skin cancers especially following PUVASOL therapy. But, few cutaneous malignancies have been reported and even fewer cases of actinic keratoses have been reported over a vitiliginous skin. Here, we report a case of elderly female who developed actinic keratoses over longstanding sun exposed vitiliginous skin post PUVA therapy.
Xeroderma pigmentosum complicated by keratoacanthoma in a Kashmiri girl p. 107 Yasmeen J Bhat, Peerzada Sajad, Najmu Saqib, Iffat Hassan, Roohi Wani DOI:10.4103/Pigmentinternational.Pigmentinternational_5_18 Xeroderma pigmentosum is a rare autosomal recessive genetic disorder characterized by defective DNA repair leading to clinical and cellular hypersensitivity to ultraviolet radiation. It manifests clinically as intense cutaneous photosensitivity, acute burning under minimal sun exposure, erythema, xerosis, poikiloderma, actinic keratosis, lentigines, and development of malignant lesions like basal cell carcinoma, squamous cell carcinoma, and melanoma in sun-exposed areas. We hereby report a case of xeroderma pigmentosum complicated by keratoacanthoma in a 9-year-old ethnic Kashmiri girl who had history of photosensitivity, dry skin, and pigmentary changes from the age of 2 years.
Erythema dyschromicum perstans in pregnancy p. 110 Shagufta Rather, Atiya Yaseen, Sameena Batool, Iffat Hassan DOI:10.4103/Pigmentinternational.Pigmentinternational_8_18 Erythema dyschromicum perstans is a slowly progressive acquired dermatoses characterized by macular hyperpigmentation. There is no racial, genetic, or sex predilection. It occurs in adults, with some isolated cases and small series occurring in prepubertal children. The pigmentary disorder has never been reported in patients during pregnancy. We report a singular case of the disorder in a pregnant woman.
Steroid-induced perilymphatic hypopigmentation: Response to tacrolimus p. 114 Sneha Ghunawat, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_11_18 Intralesional steroids are commonly used in dermatological practice. This route of administration has the advantage of minimal side effects. However, other adverse reactions namely local atrophy, ulceration, infections, etc. have been noted. One peculiar side effect following this route of administration “steroid-induced perilymphatic hypopigmentation and atrophy” has been described below. Although this condition repigments spontaneously, the use of tacrolimus to fasten the response has been highlighted in the case report.
Pigment International (Pigment Int) 2018 | July-December | Volume 5 | Issue 2
| EDITORIAL | ||
  | Lichen planus pigmentosus and frontal fibrosing alopecia: The link explored  | p. 73 |
| Ashraf Raihan, Muthu Sendhil Kumaran DOI:10.4103/Pigmentinternational.Pigmentinternational_19_18 There has been a recent rush of data regarding the combined presentation of lichen planus pigmentosus and frontal fibrosing alopecia in premenoposal women of dark skin. This review article addresses the relationship between the two. | ||
| [ABSTRACT] [HTML Full text] [PDF] [Mobile Full text] [EPub] [Sword Plugin for Repository]Beta | ||
| REVIEW ARTICLES |  | |
| Sunscreens: Time to think beyond UV rays | p. 78 | |
| Chitralekha Keisham, Nelson Elangbam, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_15_18 It has been known to us that solar radiation contributes to photoaging. Until recently, it was thought to be due to ultraviolet rays alone. However, a growing number of evidence confirms that visible and infrared (IR) rays also contribute to extrinsic aging. Visible and IR rays account for 50% and 45% of the solar radiation reaching the earth. Ultraviolet A induces retrograde mitochondrial signal, thus leading to induction of matrix metalloproteinase. Ultraviolet B and IRC cause heat-related generation of free radicals and destruction of collagen and elastin. Exposure to visible light induces cytokines, free-radical formation, and pigmentary changes in human skin. The end result of solar radiation is generation of free radicals and ultimately oxidative damage, photoaging, and photocarcinogenesis. The present broad spectrum sunscreen does not provide complete protection of the human skin from oxidative insult. So, a combination of a sun protection factor active component along with an antioxidant is the ideal way of photoprotection. Till date, a number of antioxidants have been tried in human and animals which have shown to be an effective photoprotective agent, though few studies have failed to prove the same. Even with conflicting reports, effect of antioxidants on human skin needs to be explored more. A good study design with a large sample size in humans must be conducted as visible light and IR rays contribute significantly to photodamage. | ||
| [ABSTRACT] [HTML Full text] [PDF] [Mobile Full text] [EPub] [Sword Plugin for Repository]Beta | ||
 | Idiopathic guttate hypomelanosis: An overview | p. 83 |
| Indrashis Podder, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_17_18 Idiopathic guttate hypomelanosis is a commonly acquired, benign leukoderma characterized by multiple, discrete round or oval, porcelain-white macules on sun-exposed areas, especially the extensor aspect of forearms and shins, sparing the face, neck, and trunk. It usually affects the geriatric population (>50 years); chronic exposure to ultraviolet rays and senile degeneration being the important pathogenic factors. The diagnosis remains essentially clinical, whereas newer confirmatory investigations are emerging. Despite the benign course of progression, many patients seek medical attention owing to cosmetic concerns. Several treatment modalities have been tried over time including topical, physical, and surgical measures, although there is lack of a standard treatment regime. In this article, we have reviewed the different aspects of this condition including treatment, along with the recent updates to create awareness about this dermatological entity. | ||
| [ABSTRACT] [HTML Full text] [PDF] [Mobile Full text] [EPub] [Sword Plugin for Repository]Beta | ||
| ORIGINAL ARTICLES | | |
 | Correlation of clinicodermatoscopic and Wood's lamp findings in patients having melasma | p. 91 |
| Rupali Dharni, Bhushan Madke, Adarsh L Singh, DOI:10.4103/Pigmentinternational.Pigmentinternational_33_17 Introduction: Melasma is a commonly acquired pigmentary disorder that manifests as symmetric hyperpigmented macules and patches on the face. Aim: To correlate Wood's lamp and dermatoscopic findings in patients having melasma. Materials and Methods: A total of 80 patients who were clinically diagnosed with melasma were examined under a Wood's lamp and dermatoscope, and all the findings were recorded and analyzed. Result: The degree of agreement between the Wood's lamp findings and dermatoscopic findings was found to be substantial as analyzed by kappa statistics with K = 0.813 and P = 0.0001 (significant). Conclusion: Dermatoscopy is advocated globally as a screening and diagnostic procedure for melasma and other pigmentary disorders, especially for earlier therapeutic intervention targeting different stages and mechanisms involved in pathogenesis. | ||
| [ABSTRACT] [HTML Full text] [PDF] [Mobile Full text] [EPub] [Sword Plugin for Repository]Beta | ||
 | A study of comparison of PUVASOL and NBUVB in patients with vitiligo | p. 96 |
| Vaaruni Ravishankar, Santoshdev P Rathod, Siddhartha Saikia, Raju G Chaudhary, Rekha B Solanki DOI:10.4103/Pigmentinternational.Pigmentinternational_39_17 Introduction: Vitiligo is an acquired, hypomelanotic disease, characterized by circumscribed depigmented macules. Phototherapy, which is the use of ultraviolet irradiation with or without exogenous photosensitizer is a well established treatment option. Psoralens with sunlight as the source of ultraviolet A-rays is known as PUVASOL. Narrow band Ultraviolet B phototherapy (NBUVB; 311–313 nm) has been introduced over the past decade. Aims: To study the clinical effectiveness and assess the safety of NBUVB and PUVASOL therapy in Vitiligo patients. Methods: The patients were randomly allocated in to two groups containing 25 patients each. Group A patients received NBUVB with an initial dose of 250 mJ/cm2, incremented by 20% with each subsequent visit till optimum dose was achieved, twice a week on non-consecutive days. Group B patients received PUVASOL-oral Trimethylpsoralen or topical 0.2% w/w Trioxsalen followed by exposure to sunlight, twice a week on non-consecutive days. The extent of repigmentation was documented at regular intervals upto 6 months. Results: Amongst patients receiving NBUVB and PUVASOL, 56% and 48% had ≥50% repigmentation respectively. Disease was unstable in 48% and 36% of patients prior to commencement of therapy which reduced to 12% and 16% after therapy, respectively. 16% and 36% of the patients experienced side effects and 76% and 48% showed excellent colour match of the repigmented patches respectively. Conclusion: While both PUVASOL and NBUVB are both good therapeutic options; NBUVB therapy is found to be more effective and more cosmetically acceptable, with better colour matching of lesions and minimal adverse effects. | ||
| [ABSTRACT] [HTML Full text] [PDF] [Mobile Full text] [EPub] [Sword Plugin for Repository]Beta | ||
| CASE REPORTS | | |
 | Actinic keratosis in vitiligo after oral PUVAsol therapy with review | p. 103 |
| Saumya Sankhwar, Sunil K Gupta DOI:10.4103/Pigmentinternational.Pigmentinternational_2_18 Abstract Vitiligo is an acquired disorder characterised by depigmentation. The etiopathogenesis is still unclear and many theories have been proposed for the same. It is believed that due to lack of protective melanin, a vitiliginous patch is more prone to photodamage by UV radiation and development of skin cancers especially following PUVASOL therapy. But, few cutaneous malignancies have been reported and even fewer cases of actinic keratoses have been reported over a vitiliginous skin. Here, we report a case of elderly female who developed actinic keratoses over longstanding sun exposed vitiliginous skin post PUVA therapy. | ||
| [ABSTRACT] [HTML Full text] [PDF] [Mobile Full text] [EPub] [Sword Plugin for Repository]Beta | ||
 | Xeroderma pigmentosum complicated by keratoacanthoma in a Kashmiri girl | p. 107 |
| Yasmeen J Bhat, Peerzada Sajad, Najmu Saqib, Iffat Hassan, Roohi Wani DOI:10.4103/Pigmentinternational.Pigmentinternational_5_18 Xeroderma pigmentosum is a rare autosomal recessive genetic disorder characterized by defective DNA repair leading to clinical and cellular hypersensitivity to ultraviolet radiation. It manifests clinically as intense cutaneous photosensitivity, acute burning under minimal sun exposure, erythema, xerosis, poikiloderma, actinic keratosis, lentigines, and development of malignant lesions like basal cell carcinoma, squamous cell carcinoma, and melanoma in sun-exposed areas. We hereby report a case of xeroderma pigmentosum complicated by keratoacanthoma in a 9-year-old ethnic Kashmiri girl who had history of photosensitivity, dry skin, and pigmentary changes from the age of 2 years. | ||
| [ABSTRACT] [HTML Full text] [PDF] [Mobile Full text] [EPub] [Sword Plugin for Repository]Beta | ||
 | Erythema dyschromicum perstans in pregnancy | p. 110 |
| Shagufta Rather, Atiya Yaseen, Sameena Batool, Iffat Hassan DOI:10.4103/Pigmentinternational.Pigmentinternational_8_18 Erythema dyschromicum perstans is a slowly progressive acquired dermatoses characterized by macular hyperpigmentation. There is no racial, genetic, or sex predilection. It occurs in adults, with some isolated cases and small series occurring in prepubertal children. The pigmentary disorder has never been reported in patients during pregnancy. We report a singular case of the disorder in a pregnant woman. | ||
| [ABSTRACT] [HTML Full text] [PDF] [Mobile Full text] [EPub] [Sword Plugin for Repository]Beta | ||
 | Steroid-induced perilymphatic hypopigmentation: Response to tacrolimus | p. 114 |
| Sneha Ghunawat, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_11_18 Intralesional steroids are commonly used in dermatological practice. This route of administration has the advantage of minimal side effects. However, other adverse reactions namely local atrophy, ulceration, infections, etc. have been noted. One peculiar side effect following this route of administration "steroid-induced perilymphatic hypopigmentation and atrophy" has been described below. Although this condition repigments spontaneously, the use of tacrolimus to fasten the response has been highlighted in the case report. | ||
| [ABSTRACT] [HTML Full text] [PDF] [Mobile Full text] [EPub] [Sword Plugin for Repository]Beta | ||
| LETTER TO EDITOR | | |
 | Dermoscopy − Master by analysis and patience, not haste and nonchalance | p. 117 |
| Sidharth Sonthalia, Abhijeet K Jha, Manal Bosseila, Enzo Errichetti DOI:10.4103/Pigmentinternational.Pigmentinternational_38_17 | ||
| [HTML Full text] [PDF] [Mobile Full text] [EPub] [Sword Plugin for Repository]Beta | ||
| THE CLINICAL PICTURE | | |
 | Bilateral nevus of Ota | p. 120 |
| M. M. Aarif Syed, Bibush Amatya, Shazia Alam DOI:10.4103/Pigmentinternational.Pigmentinternational_1_18 | ||
| [HTML Full text] [PDF] [Mobile Full text] [EPub] [Sword Plugin for Repository]Beta | ||
| THROUGH THE DERMOSCOPE | | |
 | Dermoscopy of pigmented basal cell carcinoma | p. 123 |
| Kinjal D Rambhia, Vrutika H Shah, Rajesh P Singh DOI:10.4103/Pigmentinternational.Pigmentinternational_13_18 | ||
| [HTML Full text] [PDF] [Mobile Full text] [EPub] [Sword Plugin for Repository]Beta | ||
| CURRENT BEST EVIDENCE | | |
| Current Best Evidence in Pigmentary Dermatology | p. 125 | |
| Divya Kamat, Vinay Keshavamurthy DOI:10.4103/Pigmentinternational.Pigmentinternational_22_18 | ||
| [HTML Full text] [PDF] [Mobile Full text] [EPub] [Sword Plugin for Repository]Beta | ||
| CROSSWORD | | |
 | PIGMENTCROSS 4 | p. 130 |
| Ashish Amrani, Anupam Das DOI:10.4103/Pigmentinternational.Pigmentinternational_24_18 | ||
| [HTML Full text] [PDF] [Sword Plugin for Repository]Beta | ||
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