Prevalence of eczema among older persons: A population-based cross-sectional study

Background: There are very few population-based studies on the prevalence of eczema among older persons Aims: To estimate the prevalence and types of eczema in those aged 65 years or more in the community and to evaluate the effectiveness of community-based interventions for case finding. Methods: In the first stage of this cross-sectional survey, trained health workers of a non-governmental organization surveyed the eligible population and identified persons likely to have eczema. In the second stage, dermatologists examined such persons to ascertain the diagnosis. Statistical analysis was done using Epi Info software version 7. Prevalence of eczema was expressed in percentages. Chi-square test was used for comparing the difference in prevalence of eczema in various age groups and sex. Results: Health workers identified 98 persons as possible cases of eczema after interviewing 385 older persons in the community. Among them 95 persons were examined by dermatologists and 44 were confirmed to have eczema (diagnostic accuracy of health workers = 46.3%).Point prevalence of eczema was 11.4% (44/385). Prevalence was similar in males and females. It was greater (18.2 %) among persons aged 81 years or more. Asteatotic eczema, gravitational eczema and lichen simplex chronicus were the more common types of eczema. Limitations: Possible underestimation of the prevalence rates due to limited medical knowledge of health workers; limited facilities for examination and investigations at the medical camps and home visits. Conclusion: There appears to be a considerable burden of eczema among older persons in the community. A community-based approach involving non-governmental organizations has the potential to identify cases and offer care close to their homes

Comparative Study Between Follicular Unit Extraction (FUE) And Non Cultured Melanocyte Transfer (NCMT) In Stable Vitiligo Patients

Background: Vitiligo is an acquired, hypomelanotic disorder characterized by circumscribed depigmented macules in the skin resulting from the loss of functional melanocytes from the cutaneous epidermis. It also causes significant psychological and social distress. Aims and Objectives: To compare the efficacy of follicular unit extraction and non cultured melanocyte transfer in patients of stable vitiligo with respect to repigmentation, vitiligo noticeability and global treatment success. Material and Methods: A total of 15 patients with stable vitiligo (as per IADVL guidelines) were enrolled in the study. In the same patient follicular unit extraction (FUE) was done in the vitiliginous lesions and the hair was transplanted approximately 3-5 mm apart on the left side of the body, while another vitiliginous lesion in the same patient was selected for non cultured melanocyte transfer (NCMT) which was done on the dermabraded area on the right side of the body. These patients were followed-up for a period of 6 months, initially at every 2 weeks or till first signs of repigmentation, then monthly follow-ups for two times and then followed-up in every 2 months. Visual analogue scale was used for assessment of repigmentation, VNS scale was used to evaluate vitiligo noticeability and global treatment success was calculated. Results: There were 2 (13.3%) females and 13 (86.7%) males in our study, showing a male preponderance. Majority of the patients were in the age group 21-40 years (66.7%). There was statistically significant increase in the mean pigmentation at each follow-up in comparison to the earlier follow-up in both the groups (p<0.05). The mean pigmentation and mean pigmentation difference, between the two groups was also comparable (p>0.05). Excellent pigmentation was seen in 60% patients of FUE and 73.3% patients of the NCMT group. Vitiligo was ‘not noticeable’in 33.3% patients of FUE and 40.0% patients of NCMT group. Global treatment success was 80% in both the groups. Bony prominence, greying and loss of follicles in FUE group; and graft displacement and herpes zoster in NCMTgroup were the factors responsible for low pigmentation. Conclusion: From the above study, we conclude that repigmentation was seen in both the groups, with equal efficacy seen between the two methodologies. Thus, any method can be applied for repigmentation with due considerations to complications of each method used.

Methicillin-resistant Staphylococcus aureus colonization and disease severity in atopic dermatitis: A cross-sectional study from South India.

Background: Colonization by methicillin-resistant Staphylococcus aureus (MRSA) in atopic dermatitis is little studied but has therapeutic implications. It may have a role in disease severity given the additional virulence factors associated. Aims: Our aims were to record the proportion of patients with MRSA colonization in atopic dermatitis and to ascertain if any association exists between MRSA colonization and disease severity. Methods: An observational cross-sectional study involving children aged≤12 years with atopic dermatitis attending the outpatient department of Government Medical College, Kottayam was conducted. Socio-demographic data, exacerbating factors and risk factors for hospital care-associated MRSA were documented. Extent of atopic dermatitis was recorded using a standardized scale (Eczema Area Severity Index, EASI). Skin swabs were taken from anterior nares and the worst affected atopic dermatitis sites for culture and sensitivity. Results: Of the 119 subjects recruited during the study period (November 2009-April 2011), Staphylococcus aureus was isolated from 110 (92.4%) patients and MRSA from 30 (25.21%) patients. A total of 18 patients with MRSA had risk factors for healthcare associated-MRSA. The patients whose cultures grew MRSA were found to have significantly higher EASI score when compared to those patients colonized with methicillin sensitive Staphylococcus aureus (P < 0.01). Presence of Staphylococcus aureus, early age of onset, presence of food allergies, seasonal exacerbation and inadequate breastfeeding did not seem to influence disease severity. Conclusions: There is a high degree of prevalence of MRSA (25.2%) in atopic dermatitis and presence of MRSA is associated with increased disease severity. Further studies are needed to validate these findings.

Enhanced MHC I antigen expression on tumour target cells is inversely correlated to lysis by allogenic but not by xenogenic NK cells.

Relationship between the levels of MHC class 1 antigen expressed on tumour cells and their susceptibility to allogenic and xenogenic NK cells was investigated. Mouse and human natural killer-resistance inducing factor (NK-RIF) preparations were used for augmenting/inducing MHC 1 antigen expression on murine YAC and human K562 tumour cells, respectively YAC cells with augmented MHC I antigen expression became relatively resistant to lysis by murine NK cells but not to rat NK cells. Similarly, induction of MHC I antigens on K562 cells reduced their susceptibility to human NK cells but not to monkey NK cells. These results indicate that the inverse correlation of MHC I antigen expression and NK susceptibility does not hold true for xenogenic pairs of NK effector and target cells.

Effect of gamma interferon on the expression of class I MHC antigens on fresh leukemic cells and their susceptibility to lysis by lymphokine activated killer cells.

Relationship between MHC class I antigen expression on PBLs from leukemia patients and their susceptibility to lysis by LAK cells was investigated. LAK cells induced small yet significant lysis of leukemic cells. In nine out of 14 cases studied, treatment with Interferon gamma (200 U/ml for 48 hours) resulted in a decrease in the LAK susceptibility of leukemic cells. In six of these cases, there was a concomitant increase in the expression of class I MHC antigen expression. In three samples, the increase in MHC class I antigen expression was not accompanied by a decrease in LAK susceptibility. IFN treatment had no effect on the binding of leukemic cells to LAK effector cells.

Quantitative estimation of major histocompatibility complex antigens on live tumour cells.

Quantitation of major histocompatibility complex (MHC) antigens on cells can accurately be done by using a flowcytometer. Since flowcytometer is not freely accessable an alternate, simple method for relative quantitation of MHC antigens has been devised. In this procedure, YAC lymphoma cells were first treated with a monoclonal anticlass I MHC antibody and then with a rabbit anti mouse Ig-antibody coupled to peroxidase, followed by colour development using a substrate of peroxidase enzyme. Various assay parameters have been optimized. The validity of the procedure was examined by assessing the enhanced MHC expression on YAC cells treated with a soluble rat spleen derived factor, by the new procedure as well as by the flowcytometer. Comparable results were obtained by using both techniques.

Interleukin-2 induced activation of natural killer cells in rats and mice: a comparative study.

Effects of interleukin-2 (IL-2) on the natural killer (NK) activities of BALB/c mouse and Wistar rat spleen cells were compared. While mouse spleen cells cultured alone rapidly lost NK activity, co-culture with IL-2 resulted in a marked enhancement of NK activity. In contrast, the levels of NK activity of rat spleen cells cultured alone increased and remained high for 3 days and declined thereafter. Addition of human recombinant IL-2 or purified rat IL-2 did not influence the NK levels in rat spleen cell bulk cultures. Both IL-2 preparations were however biologically active as shown by their capacities to induced proliferation in rat spleen cells. Rat spleen cells suppressed the IL-2 activation of mouse spleen cells in a dose dependent manner, indicating a suppressor influence generated by rat spleen cells. Culture supernatants of rat spleen cells cultured with or without IL-2 for 3 or 5 days could also suppress the mouse spleen NK activation in response to IL-2. The suppressor activity could be concentrated on a 5K MW cut-off Amicon filter indicating that the molecular weight of the factor is more than 5000. These results indicate that a suppressor of IL-2 induced NK activation of mouse spleen cells is released by cultured rat spleen cells.