ABSTRACT
Background: Treatment of acne scars with ablative fractional laser resurfacing has given good improvement. But, data on Indian skin are limited. A study comparing qualitative, quantitative, and subjective assessments is also lacking. Aim: Our aim was to assess the improvement of facial acne scars with Erbium-doped Yttrium Aluminium Garnet (Er:YAG) 2940 nm fractional laser resurfacing and its adverse effects in 25 patients at a tertiary care teaching hospital. Methods: All 25 patients received four treatment sessions with Er:YAG fractional laser at 1-month interval. The laser parameters were kept constant for each of the four sittings in all patients. Qualitative and quantitative assessments were done using Goodman and Barron grading. Subjective assessment in percentage of improvement was also documented 1 month after each session. Photographs were taken before each treatment session and 1 month after the final session. Two unbiased dermatologists performed independent clinical assessments by comparing the photographs. The kappa statistics was used to monitor the agreement between the dermatologists and patients. Results: Most patients (96%) showed atleast fair improvement. Rolling and superficial box scars showed higher significant improvement when compared with ice pick and deep box scars. Patient's satisfaction of improvement was higher when compared to physician's observations. No serious adverse effects were noted with exacerbation of acne lesions forming the majority. Conclusion: Ablative fractional photothermolysis is both effective and safe treatment for atrophic acne scars in Indian skin.Precise evaluation of acne scar treatment can be done by taking consistent digital photographs.
Subject(s)
Female , Fluorescent Antibody Technique , Humans , Middle Aged , IgA Vasculitis/pathologyABSTRACT
To study the clinical features and factors associated with Paederus dermatitis/blister beetle dermatitis [BBD] and to carry out an epidemiological survey in Manipal with regard to Paederus dermatitis. The study was conducted in two parts, viz., clinical and epidemiological. In the clinical study the patients were evaluated by means of a standard pro forma. In the epidemiological study, 55 randomly chosen houses each in 4 localities were assessed by a detailed standard questionnaire. The majority of subjects in the clinical study comprised of students with exposed areas being common sites of occurrence and a higher incidence in summer seasons. There was a previous occurrence in nearly one third of patients. The epidemiological study revealed preventive measures like closing windows and use of repellents being utilized. Presence of dense vegetation around household accounted to be a factor in occurrence of BBD. There was a higher occurrence in summer and rainy seasons. The exposed parts of the body were common sites of occurrence of BBD. The lesions Paederus dermatitis arise following crushing of the bug following bite and associated with burning or itching sensations mainly on the exposed areas. Kissing ulcers, whiplash dermatitis and Nairobi eye are some of the clinical manifestations of Paederus dermatitis. This study provides epidemiological as well as clinical data of Paederus dermatitis and recommends preventive measures in reducing future incidences of Paederus dermatitis
ABSTRACT
INTRODUCTION: Mild hypoxia has been seen in approximately one third of patients with chronic liver disease. Development of hypoxemia in patients with chronic liver disease, modifies the line of management and worsens the prognosis of the disease. Hence an early detection of hypoxemia in these patients is essential. Hypoxemia results from various causes in patients with chronic liver disease. Hepato pulmonary syndrome is an important cause in a patient with hypoxemia and chronic liver disease. Development of this complication in chronic liver disease indicates a poorer prognosis in these patients. Chronic liver disease is also known to be associated with pulmonary manifestations that affect both the pleural space and lung parenchyma. This study was undertaken to study the prevalence of hypoxemia and assess the prognosis in patients with chronic liver disease. MATERIALS AND METHODS: Fourty three patients aged 18 years and above with evidence of cirrhosis, admitted under the department of Medicine and Gastroenterology, were included in the study. A detailed history was taken and clinical examination were done in all patients. All patients underwent ultrasonography, LFT, biochemical tests and upper gastrointestinal endoscopy to confirm chronic liver disease, portal hypertension and varices, if any chest X-ray, 2-D transthoracic echocardiogram, viral studies and pulmonary function tests. The patients in whom arterial hypoxemia was detected with a positive contrast echocardiogram were considered to have hepato pulmonary syndrome. RESULTS: Six out of the 43 patients (13.9%) included in the study had hypo-xemia. Among these 6 patients with hypoxemia, 3 were found to have contrast enhanced echocardiographic evidence of intra pulmonary vascular dilatations and diagnosed hepato pulmonary syndrome. The other 3 patients had evidence of both, interstitial lung disease and pleural effusion contributing to hypoxemia. The patients with hepato pulmonary syndrome had a significant P (A-a) O2 gradient, died during the study period, indicating a poorer prognosis. CONCLUSIONS: We conclude that identification of hypoxemia and its aetiology in patients with chronic liver disease is essential. Identification of hepato pulmonary syndrome is important, as it carries a poor prognosis in patients with chronic liver disease.