ABSTRACT
BACKGROUND: Cutaneous tuberculosis (TB) is re-emerging as a significant problem in India due to increased incidence of human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS), other immunosuppressive states/factors like drugs, and emergence of multidrug resistance (MDR-TB). Proper diagnosis is warranted as there is varied clinical presentation and similarity with many other diseases. OBJECTIVE: To assess the sensitivities of DNA polymerase chain reaction (PCR), culture, and histopathology for the diagnosis of cutaneous TB in clinically suspected skin lesions. METHODS: Clinically suspected cases of cutaneous TB were enrolled in the study. Two skin punch biopsies were taken from each patient and sent for histopathology examination and DNA PCR with culture, respectively. RESULTS: Of the total 70 cases enrolled, 49 were detected as cutaneous TB by the above tests. The sensitivities of DNA PCR, culture, and histopathology were 24.5, 16.3, and 91.8%, respectively. CONCLUSION: DNA PCR and culture should be advised in cases of cutaneous TB with inconclusive histopathology. DNA PCR should be considered in preference over culture if facilities are available as it gives rapid results and has a higher sensitivity.
Subject(s)
Mycobacterium tuberculosis/isolation & purification , Tuberculosis, Cutaneous/diagnosis , Tuberculosis, Cutaneous/pathology , Adolescent , Adult , Bacteriological Techniques , Biopsy , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Mycobacterium tuberculosis/genetics , Polymerase Chain Reaction , Sensitivity and Specificity , Sequence Analysis, DNA , Skin/pathology , Tuberculosis, Cutaneous/microbiology , Young AdultABSTRACT
BACKGROUND: Oral isotretinoin is highly effective in all forms and grades of acne, even in lower dosages (<0.5 mg/kg/day). There is a paucity of comparative data on the various low-dose regimens of oral isotretinoin in the Indian literature. OBJECTIVES: To assess and compare the efficacy and tolerability of two low-dose oral isotretinoin treatment regimens (20 mg daily and 20 mg alternate days) in moderate to severe acne vulgaris. MATERIALS AND METHODS: A total of 240 patients with moderate to severe acne vulgaris were selected and randomized into two groups and treated with a fixed dose of 20 mg of isotretinoin (Group A - daily and Group B - alternate days) for 24 weeks and followed up for 12 weeks post therapy. RESULTS: A total of 234 patients completed the study. At the end of therapy, decrease in the total acne loads up to 98.99% (Group A) and 97.69% (Group B) was achieved from the baseline (P < 0.01), excellent response was observed in 98.3% (Group A) and 93.96% (Group B) patients (P = 0.166). In the severe acne, Group A performed significantly better than Group B until the end of 36 weeks. While in the moderate acne, significant difference in the response between both groups was observed only up to 12 weeks. No serious side effect was observed. CONCLUSION: Both isotretinoin regimens were well tolerated and found to be an effective treatment for moderate to severe acne vulgaris. However, in moderate acne 20 mg alternate day regimen may be preferred. A 20 mg daily regimen is a better choice for severe acne in terms of response. LIMITATION: Small sample size and short follow-up period.
Subject(s)
Breast Diseases/pathology , Breast Neoplasms/diagnosis , Diagnostic Errors , Fibroadenoma/diagnosis , Mycetoma/pathology , Adult , Antifungal Agents/therapeutic use , Breast Diseases/drug therapy , Breast Diseases/microbiology , Diagnosis, Differential , Female , Humans , Itraconazole/therapeutic use , Mycetoma/drug therapy , Mycetoma/microbiologyABSTRACT
BACKGROUND: Defects in the immune system may affect vaccine responsiveness. Because of the splenic hypofunction and abnormal opsonic activity, it was unknown whether patients with sickle cell disease (SCD) would respond appropriately to H1N1 vaccination. The objective of this study was to assess seroprotective post-vaccine H1N1 antibody response in children with SCD. PROCEDURE: Serum antibody titers were measured by hemagglutination inhibition and microneutralization (MN) assays. Correlations were established between clinical and treatment parameters and immune response. RESULTS: Twenty-nine of 38 (76.3%) subjects (mean age 11 ± 5.4 years) had durable protective antibody titers 8 ± 1.6 months (range 5-12 months) post-vaccination. Lessened immune response was not associated with time interval from vaccination, splenectomy, or hydroxyurea treatment. Lack of antibody response was associated with age less than 3 years and treatment with chronic transfusions. Of the nine non-responders, seven were on chronic transfusions (39% unresponsiveness rate in the transfused group). The difference in the number of patients with seropositivity between the non-transfused and the transfused groups was statistically significant (P = 0.039). CONCLUSIONS: Most subjects were able to mount an influenza-specific antibody response against the inactivated H1N1 vaccine. Similar to the general population, children less than 3 years were less likely to respond. In addition, patients on chronic transfusions were less likely to respond when compared to non-transfused children. Clinicians should be aware of the possibility of decreased vaccine response in patients with SCD on chronic transfusions. We postulate that transfusion-related immunomodulation (TRIM) may be related to decreased response.
