A Delphi consensus on the nomenclature and diagnosis of lichen planus pigmentosus and related entities

Background: Although well known in clinical practice, research in lichen planus pigmentosus and related dermal pigmentary diseases is restricted due to lack of consensus on nomenclature and disease definition. Aims and Objectives: Delphi exercise to define and categorise acquired dermal pigmentary diseases. Methods: Core areas were identified including disease definition, etiopathogenesis, risk factors, clinical features, diagnostic methods, treatment modalities and outcome measures. The Delphi exercise was conducted in three rounds. Results: Sixteen researchers representing 12 different universities across India and Australia agreed to be part of this Delphi exercise. At the end of three rounds, a consensus of >80% was reached on usage of the umbrella term ‘acquired dermal macular hyperpigmentation’. It was agreed that there were minimal differences, if any, among the disorders previously defined as ashy dermatosis, erythema dyschromicum perstans, Riehl’s melanosis and pigmented contact dermatitis. It was also agreed that lichen planus pigmentosus, erythema dyschromicum perstans and ashy dermatosis did not differ significantly apart from the sites of involvement, as historically described in the literature. Exposure to hair colours, sunlight and cosmetics was associated with these disorders in a significant proportion of patients. Participants agreed that both histopathology and dermatoscopy could diagnose dermal pigmentation characteristic of acquired dermal macular hyperpigmentation but could not differentiate the individual entities of ashy dermatosis, erythema dyschromicum perstans, Riehl’s melanosis, lichen planus pigmentosus and pigmented contact dermatitis. Limitations: A wider consensus involving representatives from East Asian, European and Latin American countries is required. Conclusion: Acquired dermal macular hyperpigmentation could be an appropriate conglomerate terminology for acquired dermatoses characterised by idiopathic or multifactorial non-inflammatory macular dermal hyperpigmentation

Clinical Usefulness of Cancer Markers in Cancer

Background: Objectives: Cancer is the uncontrolled growth of abnormal cells anywhere in a body these cells can infiltrate normal body tissues of body. The definitive diagnosis of cancer being histo - pathological examination of tissue. The measurement of tumor markers is currently one of the most rapidly growing areas in laboratory medicine and is helpful in differential diagnosis of tumor type in metastatic deposits and also during follow - up evaluations. Methods: Advanced Cancer Institute is a tertiary care cancer institute in Mal wa region of Punjab, old cases with proven history and in the advanced stage of disease, measurement of tumor markers in them is a very important tool for their evaluation of treatment outcome and in staging, emphasis of our study is to highlight and to encourage tumor marker assays for early diagnosis of cancer by checking baseline levels in healthy and in high risk population for screening for the presence of cancer. Results: The Study was carried out Department of Microbiology, Total of 300 Blood Samples were checked in Automated Immune Analyzer (Biomeriux) with different panels of Tumor markers (PSA,AFP,CEA19.9,CA - 125,CA15.3)Kits available in our Lab. of commonly diagnosed cancer. Conclusion: Focus has to be directed towards identification a nd proper use of suitable tumor markers which may prove to be an invaluable tool to early detect the deadly disease in mankind and not to use markers only as a prognostic indicator in proven cases.

Study of Cholesterol Levels in Ascitic Fluid to Differentiate Malignant from Non-Malignant Effusion.

Collection of more than normal quantity fluid in a serous cavity is called effusion. Itis classified as per location i.e. pericardial, pleural and peritoneal. Fluid collection inabdominal cavity is called ascites. Effusions are of two types - (1) Transudate (2)Exudate. Transudate develops as a result of physiological disturbances of circulationusually a rise in venous pressure or decrease in oncotic pressure, while exudateforms as a result of increased capillary permeability which is usually due toinflammation. Transudates usually have low specific gravity due to low proteincontent whereas exudates have high specific gravity due to high protein content.Transudates are usually associated with cardiac-, hepatic- or renal-disease. Whileexudates are caused by inflammatory conditions like tuberculosis and malignanciesof pelvic and abdominal organs. Recently fibronectin and cholesterol levels ofperitoneal fluid have been found to differentiate between ascites of differentaetiologies. The estimation of fibronectin levels in fluid is sensitive but complicated.So, in this study we have taken the value of cholesterol for the aetiologic diagnosisof ascites as a simple procedure.METHODSThe present descriptive study of 100 cases of ascites was conducted over a period of12 months i.e. January. 2019 to January 2020. Various fluids were collected fromOPD and IPD of Medical and Surgery units.RESULTSIn the present study, 84% of the cases were transudates while exudates accountedfor 16% of cases. Cirrhosis (65%) was the commonest cause among transudates.Other causes included congestive cardiac failure (09%), nephrotic syndrome (06%),& anaemias (04%). Exudative ascites was caused by tuberculosis in 10% cases &malignancy in 06% cases. Cholesterol level of >70 mg/dL was found in 82% ofmalignant ascites. So, it was concluded that ascitic fluid cholesterol levels weresignificantly greater in malignant cases in comparison to ascites caused by non -malignant aetiologies. Inference - Cholesterol concentration in ascitic fluid helps todifferentiate ascites in malignancy, from non - malignant ascites.CONCLUSIONSCholesterol estimation in ascitic fluid is a better parameter to differentiatemalignant ascites from non - malignant ascites.

Analysis of biological factors for determination of air pollution tolerance index of selected plants in Yamuna Nagar, India.

Air pollution tolerance index (APTI) calculated for various plant species growing in vicinity of three different industrial areas (Paper mill, Sugar mill, Thermal Power Plant) and Yamuna River belt of Yamuna Nagar. Studies were carried out to determine the physiological response of ten plant species. The leaf samples collected from these plant species were used to determine their plant APTI by calculating the ascorbic acid, total chlorophyll, pH, and relative water content for all selected sites. Highest pH, relative water content, ascorbic acid and total chlorophyll was observed in Castor (9.86), Parthenium (96.99%), Ficus benghalensis (14.90 mg g-1) and Amaranthus (7.08 mg g-1) at Yamuna river, Thermal power plant, Yamuna river and paper mill respectively. It was concluded that out of ten species studied only one species (Ficus benghalensis) showed moderately tolerant response in all selected sites, while other species showed sensitive response. According to observed APTI values, Ficus benghalensis showed the highest value (21.65) at sugar mill followed by thermal power plant (19.38), Paper mill (17.65) and Yamuna River (17.61). The lowest APTI values were reported in Oxalis corniculata (6.42) at Yamuna River belt followed by Malvestrum at sugar mill (7.71).

Orodispersible tablets: A comprehensive review.

Oral route is presently the gold standard in the pharmaceutical industry where it is regarded as the safest, most economical and most convenient method of drug delivery resulting in highest patient compliance. Oral delivery of active ingredients include a number of technologies, many of which may be classified as Orodispersible tablets (ODTs). Usually, elderly people experience difficulty in swallowing the conventional dosage forms like tablets, capsules, solutions and suspensions because of tremors of extremities and dysphagia. In some cases such as motion sickness, sudden episodes of allergic attack or coughing, and an unavailability of water, swallowing conventional tablets may be difficult. ODTs systems may offer a solution for these problems. Advancements in the technology arena for manufacturing these systems includes the use of freeze drying, cotton candy, melt extrusion, sublimation, direct compression besides the classical wet granulation processes. This has encnouraged both academia and industry to generate new orally disintegrating formulations and technological approaches in this field. This article attempts at discussing the ideal characteristics, advantages and disadvantages, formulation aspects, formulation technologies and future potential of ODTs.

Tinea capitis in the pediatric population: A study from North India.

Background: Tinea capitis (TC) is a common superficial fungal infection seen predominantly in children. The etiological factors vary from one region to the other. The clinical and microbiological characteristics of the same were studied in patients up to the age of 12 years seen at a pediatric superspeciality hospital in New Delhi, India. Aims: To delineate the various patterns of TC observed in North India and to assess for any correlation between the clinical, microscopic and microbiologic findings in the patients seen. Also, to identify the common fungal species responsible for producing TC in North India. Methods: Clinical morphology and KOH findings were studied in 214 patients with the suspected diagnosis of TC. Fungal culture were also performed for all the cases. An attempt was made to evaluate any correlation among the clinical, microscopic and etiological findings. The epidemiological factors associated with the disease were also assessed. Results: TC was found to be most common in the 8-10-year age group, with noninflmmatory TC being the more common type (56.5%). A mixed morphological pattern was recorded in 10% of the cases. Microscopic examination revealed an endothrix pattern of hair invasion to be more common (41.5% cases). Again, 8.8% of the cases showed foci of both endothrix and ectothrix pattern of invasion simultaneously. Trichophyton violaceum was the most common fungal species isolated. Conclusions: In the present study, clinical morphology or KOH findings were not found to be clearly or exclusively predictive of the species involved. There was a fair degree of overlap in the clinical or microscopic patterns produced by the fungal species. Mixed patterns were observed both on clinical examination as well as on KOH examination. However, none of the specimens grew more than one fungal species.