A comparative study of the conduction velocity of motor and sensory fibres of ulnar and median nerves among leprosy patients and normal subjects

Background: Leprosy and the associated scourge have affected humanity for thousands of years. One of the most debilitating consequences of leprosy is peripheral neuropathy. Nerve Conduction Velocity study provides us with a non-invasive modality to assess peripheral nerve involvement in leprosy.Methods: With this in mind, a cross-sectional observational study was conducted including 30 leprosy patients as "Cases" and 30 age-matched healthy subjects, not suffering from any kind of neurological disorders, as "Controls". Using a digital electromyography machine, the Latency, Amplitude and Conduction Velocities of Motor and Sensory fibres of Ulnar and Median nerves were recorded. The results were compared among controls and cases using suitable statistical tests (descriptive statistics and significance testing using unpaired t-test).Results: In this study, with regard to Sensory Nerve conduction Velocity (SNCV), statistically very significant difference was noted in case of right (p 0.0011) and left (p 0.0037) ulnar nerves among controls and cases. The difference in the amplitude of Motor Action potential (MAP) with regard to right median nerve, among cases and controls, was also statistically significant (p 0.0127). Further the amplitude of Sensory Nerve Action Potential (SNAP) values were higher among cases compared to controls.Conclusions: As such, the findings of this study (and which is also corroborated by many previous studies) lead us to the conclusion that NCV studies can detect lepromatous neuropathy much before the emergence of frank clinical signs and this type of neuropathy is predominantly demyelinating in nature with occasional axonal loss.

A randomized, double-blind trial of amorolfine 0.25% cream and sertaconazole 2% cream in limited dermatophytosis

Background: Dermatophytosis is becoming increasingly unresponsive to conventional antifungals. Newer topical antifungals may be more effective in these patients. Aims: To evaluate and compare the efficacy and safety of amorolfine 0.25% cream and sertaconazole 2% cream in limited tinea cruris/corporis. Methods: A single-center, randomized (1:1), double-blind, parallel group, active-controlled trial (CTRI/2014/12/005246) was performed. Sixty-six untreated adults with acutely symptomatic tinea cruris/corporis were included in the study. All patients had limited cutaneous involvement and were KOH mount positive. Group A received amorolfine 0.25% cream, and group B received sertaconazole 2% cream twice daily application to the lesions for 4 weeks. After the baseline visit, four follow-up visits were carried out. The outcome measures for effectiveness were clinical and mycological cure. Safety parameters studied were treatment-emergent adverse events and changes in routine laboratory parameters. Results: Both sertaconazole and amorolfine significantly reduced symptoms (P < 0.001) in both groups. However, improvement in symptoms (pruritus, burning sensation, erythema, scaling and crusting) was significantly greater in the sertaconazole group at every follow-up visit. Sertaconazole cream was also more effective than amorolfine cream in reducing the number of lesions (P = 0.002 at 12 weeks) and improving the Dermatology Life Quality Index (P < 0.001) at all the follow-up visits. Adverse events were similar in the two groups (P = 0.117). Fungal cultures became negative in 92.3% of the sertaconazole group as compared to 80% in the amorolfine group (P = 0.010). Limitations: Antifungal susceptibility testing could not be done. Conclusion: Sertaconazole 2% is superior to amorolfine 0.25%, both in terms of effectiveness and tolerability. Improvement can be appreciated from second week onwards.

Safety and effectiveness of autoinoculation therapy in cutaneous warts: A double - blind, randomized, placebo - controlled study.

Background: In spite of the availability of multiple treatment options, viral warts are known for their persistence and recurrence, causing frustration to patients and treating physicians. Aims: To study the effectiveness and safety of autoinoculation as a treatment modality in cutaneous warts. Methods: A double‑blind, placebo‑controlled study was carried out. In the treatment group, full‑thickness warty tissue was excised, minced and implanted in a small dermal pocket. In the control group, warty tissue was only excised and not implanted, though a dermal pocket was made. Patients were evaluated every four weeks with lesion counts. The procedure was repeated at 4 and 8 weeks. Response was assessed at each visit and at 12 weeks. Results: Forty‑eight patients with cutaneous warts (male: female = 32:16) were randomized into autoinoculation and control groups. The number of warts at baseline was comparable in both groups (P = 0.293). Reduction in the number of warts was significantly more in the autoinoculation group (8.50 ± 13.88) than in the control group (10.04 ± 5.80) from 8 weeks onwards (P = 0.010). Complete resolution occurred only in the autoinoculation group, in 62.5% of cases. Adverse effects were seen in 11 patients, including infection of the donor site (5 cases), keloid formation (3) and hypopigmentation (3). Conclusion: Autoinoculation may be an effective therapeutic modality for cutaneous warts and two sessions may be required for optimum results.