CASE REPORT-RECONSTRUCTION OF ORBITAL FLOOR WITH TITANIUM MESH IN A ZYGOMATICOMAXILLARY COMPLEX FRACTURE

Zygomaticomaxillary fractures are complex fractures that can involve the ?oor of the orbit. These fractures often lead to complications like diplopia, disability in rotation of the eye superiorly due to herniation of muscle and orbital fat into the maxillary sinus. These fractures if left untreated can result in malunion, visual disturbances and are not aesthetically pleasing due to effect on the symmetry of face. Various treatment modalities are available for the treatment of zygomaticomaxillary fracture and reconstruction of the ?oor of the orbit. Complications include retrobulbar hemorrhage, orbital ?ssure syndrome, and reduction in orbital volume, with minor effects like ectropion or entropion. A case report of a 21-year-old male patient with a Orbit zygomaticomaxillary complex fracture is described.

Case Report of Fibrodysplasia Ossificans Progressiva.

Fibrodysplasia ossificans progressiva is a rare genetic disease characterized by widespread soft tissue ossification and congenital stigmata of the extremities. We report a male patient who had bilateral hallux valgus since birth. Other noticed anomalies included multiple swellings over the back, stiffness of lower back area, multiple joints, restricting movement of spine, shoulders, elbows, and right hip and right knee. Patient was not able to bend forward, squat or turn head to either side. Patient also had multiple foci of ossification developed over left knee, and back region. All swellings and restrictions were painless.

A Randomized, Open Label, Prospective, Comparative, Multicentric Study to Evaluate the Efficacy and Safety of Montelukast and Fexofenadine Fixed-dose Combination vs Montelukast and Levocetirizine Fixed-dose Combination in Allergic Rhinitis.

Background: Allergic rhinitis (AR) has impact on the physical, psychological and social aspects of the patients’ life and work. Therefore, it is imperative to identify the treatment options for AR. Objective: This randomized, open label, prospective, two arm, comparative, multicentric study evaluated the efficacy and safety of montelukast 10 mg + fexofenadine 120 mg (MF) fixed dose combination (FDC) versus montelukast 10 mg + levocetirizine 5 mg (ML) FDC in subjects with AR. Materials and methods: The adult subjects were randomized to either treatment: ML (n = 62), MF (n = 56), administered once-daily for 14 days. The primary endpoint was the change in total symptom score (TSS) (the sum of total nasal symptom score [TNSS]) and total ocular symptom score (TOSS]) at the end of study as compared to baseline. The secondary endpoints were TNSS and TOSS: At the end of study as compared to baseline, physician’s and patient’s global assessment for efficacy and tolerability and adverse events. Results: Both groups were comparable with respect to demographic characters and vital parameters. In MF group, the reduction in TSS at the end of study was 93.86% as compared to 87.71% in ML. The changes in TNSS and TOSS at the end of study were 92.52% and 95.34% in MF group as compared to 85.58% and 92.23% in ML group. Global impression by investigator showed 53.23% subjects rated excellent to very good with MF as compared to 36.36% subjects with ML. Global impression by subjects showed excellent to very good rating for 50% subjects with MF and for 34.54% subjects with ML. Conclusions: Montelukast + fexofenadine showed better improvement in symptoms of AR and a better global impression by both investigators and subjects compared to montelukast + levocetirizine.

Hand eczema: An update.

Eczema, the commonest disorders afflicting the hands, is also the commonest occupational skin disease (OSD). In the dermatology outpatient departments, only the severe cases are diagnosed since patients rarely report with early hand dermatitis. Mild forms are picked up only during occupational screening. Hand eczema (HE) can evolve into a chronic condition with persistent disease even after avoiding contact with the incriminated allergen / irritant. The important risk factors for hand eczema are atopy (especially the presence of dermatitis), wet work, and contact allergy. The higher prevalence in women as compared to men in most studies is related to environmental factors and is mainly applicable to younger women in their twenties. Preventive measures play a very important role in therapy as they enable the affected individuals to retain their employment and livelihood. This article reviews established preventive and therapeutic options and newer drugs like alitretinoin in hand eczema with a mention on the etiology and morphology. Identifying the etiological factors is of paramount importance as avoiding or minimizing these factors play an important role in treatment.

Amylase production by endophytic fungi Cylindrocephalum sp. isolated from medicinal plant Alpinia calcarata (Haw.) Roscoe

Amylases are among the most important enzymes used in modern biotechnology particularly in the process involving starch hydrolysis. Fungal amylase has large applications in food and pharmaceutical industries. Considering these facts, endophytic fungi isolated from the plant Alpinia calcarata (Haw.) Roscoe were screened for amylolytic activity on glucose yeast extract peptone agar (GYP) medium. Among thirty isolates of endophytic fungi, isolate number seven identified as Cylindrocephalum sp. (Ac-7) showed highest amylolytic activity and was taken for further study. Influence of various physical and chemical factors such as pH, temperature, carbon and nitrogen sources on amylase production in liquid media were studied. The maximal amylase production was found to be at 30ºC and at pH 7.0 of the growth medium. Among the various carbon and nitrogen sources tested, maltose at 1.5% and Sodium nitrate at 0.3% respectively gave optimum amylase production.

Photodermatoses in India.

Photodermatoses are a group of disorders resulting from abnormal cutaneous reactions to solar radiation. They include idiopathic photosensitive disorders, drug or chemical induced photosensitivity reactions, DNA repair-deficiency photodermatoses and photoaggravated dermatoses. The pathophysiology differs in these disorders but photoprotection is the most integral part of their management. Photoprotection includes wearing photoprotective clothing, applying broad spectrum sunscreens and avoiding photosensitizing drugs and chemicals.

To evaluate the involvement of autonomic nervous system during pre and post menstrual phases in young women.

Background: During reproductive life, Women undergo many types of behavioural and hormonal changes, which influence various functions of body. ANS provides physiological adaptive background for these changes. The main aim of this study is to carry out autonomic function tests during various phases of menstrual cycle. Method: Different Methods were used to evaluate sympathetic and Parasympathetic activity. This study was carried out in two different phases of menstrual cycle viz. premenstrual phase (late luteal phase-LL) and post menstrual phase (early follicular phase –EF). Results: The autonomic function tests and heart rate variables were recorded and data was tabulated for Statistical evaluation with student paired “t” test. P 0.05 was considered as statistically significant. The tests for sympathetic activity were compared during pre and post menstrual phases. It was observed that pulse rate, blood pressure and cold pressor test were statistically more significant (p<0.01), while orthostatic variation in arterial blood pressure was statistically significant (p<0.05) in premenstrual phase as compared to post menstrual phase of menstrual cycle. For parasympathetic activity it was observed that heart rate response, expiratory: inspiratory ratio and valsalva ratio were statistically not significant (p>0.05) in both pre and post menstrual phases of menstrual cycle. Conclusion: In this study the responses to various sympathetic tests were significantly altered in premenstrual phase as compare to that of postmenstrual phase, reflecting the significant increase in the sympathetic activity. These changes may be due to gonadal steroids imbalance during post menstrual phase (EF) and premenstrual phase (LL) of menstrual cycle which in turn affects HPA axis and ANS significantly. Significant increased sympathetic activity responses indicate an augmented stress system.

Involvement of autonomic nervous system in isometric handgrip in healthy young subject.

Background: HRV can be considered a relatively simple, noninvasive and sensitive method for studying autonomic modulation, purpose of the present study was to determine whether readily measured blood pressure (BP) indices and responses to autonomic reflex tests could be used as surrogates of short-term heart rate variability. Different Methods were used to evaluate sympathetic and Parasympathetic activity. Results: The autonomic function tests and heart rate variables were recorded and data was tabulated for Statistical evaluation. A two tailed P value less than or equal to 0.05 (5%) were considered statistically significant. Heart Rate Variability in Male Mean R-R interval and SDNN of time domain analysis were highly significant on comparing supine to standing (P<0.001),Similarly LF, HF power, Total Power and LFnu of frequency domain analysis were highly significant on comparing supine to standing (P<0.001) and in Females also it is same. Conclusion : Considering the results our data indicate a decrease in HRV that seems to be expressions of a reduction in autonomic modulation in postural change from supine to standing erect both in male and female subjects. The findings suggestive of a shift in cardiac autonomic regulation towards sympathetic activation in response to real life stressors which also includes the decrease in parasympathetic modulation and no significant correlation between readily measured blood pressure indices to heart rate variables in both male and female groups, we suggest that mean heart rate, SBP, DBP and RPP cannot be used as surrogates of HRV. However, observations need to be made in healthy subjects belonging to various age groups and in patients with conditions known to be associated with autonomic deregulation.

Lasers for vascular lesions: Standard guidelines of care.

Introduction: Lasers are a good therapeutic tool for congenital and acquired vascular lesions. Technological advances in lasers have reduced the adverse effects and increased the efficacy. Machines: Among the various lasers used for treating vascular lesions, pulsed dye laser (PDL) has the best efficacy and safety data. The other machines that are widely available are Nd:YAG laser and intense pulse light (IPL). Rationale and scope of guideline: Much variation exists in different machines and techniques, and therefore, establishing standard guidelines has limitations. The guidelines recommended here indicate minimum standards of care for lasers on vascular lesions based on current evidence. Physician Qualification: Laser may be administered by a dermatologist, who has received adequate background training in lasers during post-graduation or later at a center that provides education and training in lasers, or in focused workshops, which provide such trainings. He/she should have adequate knowledge of the lesions being treated, machines, parameters, cooling systems, and aftercare. Facility: The procedure may be performed in the physician's minor procedure room with adequate laser safety measures. Indications: PWS, hemangioma, facial telangiectasia, rosacea, spider angioma, pyogenic granuloma, venous lakes, leg veins. Contraindications: Absolute: Active local infection, photo-aggravated skin diseases, and medical conditions. Relative: Unstable vitiligo, psoriasis, keloid and keloidal tendencies, patient on isotretinoin, patient who is not cooperative or has unrealistic expectation. Patient Selection: Patient selection should be done after detailed counseling with respect to the course of lesions, different treatment options, possible results, cost, need for multiple treatments, and possible postoperative complications. Treatment Sessions: The number of treatments per lesion varies from 2 to 12 or more at 6-8 week intervals. All lesions may not clear completely even after multiple sessions in many cases. Hence, a realistic expectation and proper counseling is very important. Laser parameters: Laser parameters vary with area, type of lesion, skin color, depth of the lesion, and machine used. A test spot may be performed to determine individual specifications. Complications: Pain, edema, purpura, bleeding, scarring, postinflammatory hyperpigmentation/hypopigmentation, and atrophy changes.

Topical corticosteroid abuse on the face: A prospective, multicenter study of dermatology outpatients .

Background: Abuse of topical corticosteroids (TC), especially over the face, is prevalent worldwide, including in India. Data about the magnitude of this problem in our country is lacking. Aims: The aims of this study were to ascertain the demographics, magnitude and clinical features of TC misuse on the face in the dermatology outpatient department (OPD) attendees in order to raise awareness about this problem and to analyze its causes. Methods: This was a prospective multicenter questionnaire-based clinical study conducted at 12 dermatology centers nationwide. Patients with relevant facial dermatoses reporting to the investigator were asked about their current use of over-the-counter topical formulations and a structured questionnaire applied in case the same was confirmed to be TC. Results: A total of 2926 patients with facial dermatoses were screened, of which 433 (14.8%) were using TC. TC was used as a fairness/general purpose cream or aftershave in 126 (29%) and in 104 (24%) for acne. Steroid combinations were used by 258 (59.6%). Potent and super-potent TC were significantly (P = 0.05) more frequently used by the rural/suburban population. The younger age groups used more potent formulations. A non-physician recommendation for TC use was obtainable in 257 (59.3%) patients. Of these, 232 (90.3%) were for potent/super-potent steroids. Among 176 physician prescriptions, 78 (44.3%) were from non-dermatologists. All non-physician prescriptions and 146 (83%) physician prescriptions for TC were inappropriately refilled. Adverse effects were seen in 392 (90.5%) TC users. Acne/exacerbation of acne was the most common adverse effect. Conclusions: TC misuse in patients with facial dermatoses is quite common, and most of this use is unwarranted. Use as a fairness cream is the most common indication in this cohort. Limitations: This was an OPD-based study and, therefore, it may or may not accurately reflect the community data.

Irritancy potential of 17 detergents used commonly by the Indian household.

Background: Detergents are used by almost every household in the developed and developing world. Soap and most detergents are anionic surfactants and attack the horny layer of the skin and increase its permeability with little or no inflammatory change and may result in hand eczema, which is very distressing and incapacitating. Aim: To evaluate the irritant potential of common household detergents (laundry and dish wash) used by the Indian population using a 24-hour patch test and to convincingly educate the patients on the detergents less likely to cause irritation in the particular individual. Methods: Seventeen commonly used detergents found in Indian market were included in the study, of which, 12 were laundry detergents (powders - seven, bar soap - five) and five were dish wash detergents (powder - one, liquid - one, bar soap - three). The irritant potential of the 17 detergents were evaluated in 30 volunteers. Thirty microliters of each of the detergent bar solutions, distilled water (negative control), and 20% SDS (positive control) were applied to Finn chambers with a micropipette and occluded for 24 hours. Erythema, scaling, and edema were graded in comparison to the reaction at the negative control site (distilled water) for each volunteer separately. The scoring of erythema / dryness and wrinkling on a 0 - 4 point scale and edema on another 0 - 4 point scale was based on the Draize scale. The pH of each of the detergent solutions was determined using litmus papers (Indikrom papers from Qualigens fine chemicals). Results: The difference between detergents (F value) was significant for erythema / dryness and wrinkling (F = 3.374; p = 0.000), but not significant for edema (F = 1.297; p = 0.194). [Table 2] lists the means for erythema / dryness and wrinkling, and edema. The F value of the totals of the means for erythema / dryness and wrinkling and edema was significant (F = 2.495; p = 0.001). The pH of all the detergents was found to be alkaline except Pril utensil cleaner which tested acidic (pH 6). The positive control, 20% SDS also tested acidic (pH 6). Conclusion : Similar to patch testing in allergic contact dermatitis, 24-hour patch testing with detergent solutions (8% w/v), will educate the patient on what detergent to avoid. This may bring down the total medication requirement and frequent hospital consultations for these patients.