Clinical Profile and Diagnostic Accuracy of Patient-submitted Photographs in Teledermatology.

Background: The COVID-19 pandemic has shifted healthcare from physical in-person patient visits to teleconsultations in order to curtail the spread of this virus. Dermatology, being a visual science, lends itself amenably to teleconsultation. Objective: This study was performed to assess the basic dermatological diseases which are more easily diagnosable and managed through teleconsultation, distinguishing them from diseases for which a face-to-face consultation may be a better option and to delineate the factors affecting the image quality which is the cornerstone of a teledermatology consultation. Methods: A retrospective observational study was conducted over a three-month period during the pandemic. Store and forward, video conferencing, and hybrid consultations were included. Two dermatologists of different clinical experience independently assessed the clinical photographs of the patients and gave each photograph an objective score (Physician Quality Rating Scale) and a diagnosis. The diagnostic concordance between the two dermatologists as well as the correlation of this score with the certainty of diagnosis was calculated. Results: A total of 651 patients completed the study. Mean PQRS score of Dermatologist 1 was 6.22 while the mean score of Dermatologist 2 was 6.24. Patients in whom both the dermatologists were absolutely certain about their diagnosis had a higher PQRS score and interestingly had a higher education level than the rest. There was 97.7 percent diagnostic concordance between the two dermatologists. Infections, acne, follicular disorders, pigmentary disorders, tumors, and STDs had the largest proportion of cases wherein both the dermatologists were in total agreement with each other. Conclusion: Teledermatology might be best for the care of patients with characteristic clinical presentation or for follow-up of already diagnosed patients. It can be used in the post-COVID era to triage patients requiring emergency care and reduce patient wait times.

Clinico-pathological Spectrum of Primary Skin Malignancies in an Indian Tertiary Care Hospital.

Background: Skin malignancies are the most common form of malignant disease in the western world, predominantly affecting older age groups. The majority of skin cancers are basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma, which account for more than 95% of total skin malignancies. However, in India, these constitute only 1-2% of all cancers. There is an increase in incidence in India over 10 years of period. There is scarcity of data on the clinico-pathological profile of these tumours from this geographical region. Materials and Methods: This was a retrospective study conducted in a tertiary care teaching hospital in which archival records and histopathology sections of all patients of skin carcinomas diagnosed over a period of 5 years (January 2016 to December 2020) were analysed. The clinical parameters and histopathological features of the cases were analysed and correlated for any possible association. Results: Out of the 230 skin malignancies studied, SCC constituted the most common type (n = 148), followed by BCC (n = 70) and malignant melanoma (n = 12). The tumour commonly presented in the 6th decade of life with slightly higher male preponderance (M: F =1.6:1). Sun-exposed areas were the most common sites, and the common presentations included non-healing ulcer, fungating/cauliflower/polypoidal growth, and hyperpigmented or nodular plaque. In SCC, previous history of diabetes and burns was noted in 10% and 3.4% of the patients, respectively. Conclusion: SCC is likely the most common histological type of skin malignancies in India. The clinico-pathological profile of skin malignancies of patients depends on multiple factors, notably the skin colour and the geographical location.

Skin camouflage therapy.

Camouflage is defined as a combination of materials, colouration or illumination for concealing something. Skin camouflage therapy is the use of specially formulated products to conceal skin diseases and disfigurements, with the goal of giving a temporarily normal appearance. It gives immediate relief in various dermatological disorders, especially those affecting the visible areas, which are known to be associated with profound psychosocial impact. Despite considerable evidence for its emotional benefits, its utilisation among dermatologists in clinical practice remains low. This article is intended to familiarise dermatologists with the use of skin camouflage therapy including its availability, indications, contraindications, techniques, limitations and future trends.

Autologous intralesional platelet rich plasma improves melasma.

Platelet rich plasma (PRP) is an upcoming interventional therapy for the treatment of melasma. Its efficacy is due to the multiple growth factors present in it which decrease melanogenesis by various signal transduction pathways. The present study evaluated the efficacy of PRP as a standalone agent in treatment of melasma. This is an open labeled prospective trial. Forty patients were given intralesional PRP at once monthly interval. Three such PRP sessions were carried out and the patients were followed up for 3 months. Assessment was done by calculating the modified melasma area severity index score (mMASI) for each patient. Patients were also asked to self-evaluate their improvement based on a scale. There was an average 54.5% reduction in the mMASI score at the end of the study. There was no relapse in any patient. This reduction was irrespective of the skin type, gender, and type of melasma. Patients self-evaluation showed that more than 90% of the patients were pleased or very pleased with the results. There were no significant side effects. PRP appears to be a potential new therapy with significant efficacy in improving pigmentation of melasma, standalone as monotherapy.

Antibacterial Activity of Nitrogen-Doped Carbon Dots Enhanced by Atomic Dispersion of Copper.

Antibiotic resistance is an imminent threat to human health, requiring the development of effective alternate antibacterial agents. One such alternative includes nanoparticle (photo)catalysts that are good at producing reactive oxygen species (ROS). Herein, we report the design and preparation of nitrogen-doped carbon dots functionalized with atomically dispersed copper centers by Cu-N coordination (Cu/NCD) that exhibit apparent antibacterial activity toward Gram-negative Escherichia coli (E. coli) under photoirradiation. The growth of E. coli cells is found to be markedly inhibited by Cu/NCD under 365 nm photoirradiation, whereas no apparent inhibition is observed in the dark or with the copper-free carbon dots alone. This is ascribed to the prolonged photoluminescence lifetime of Cu/NCD that facilitates the separation of photogenerated electron-hole pairs and ROS formation. The addition of tert-butyl alcohol is found to completely diminish the antimicrobial activity, suggesting that hydroxyl radicals are responsible for microbial death. Consistent results are obtained from fluorescence microscopic studies using CellROX green as the probe. Similar bactericidal behaviors are observed with Gram-positive Staphylococcus epidermidis (S. epidermidis). The copper content within the carbon material is optimized at a low loading of 1.09 wt %, reducing the possibility of toxic copper-ion leaching. Results from this study highlight the significance of carbon-based nanocomposites with isolated metal species as potent antimicrobial reagents.

Clinical Efficacy of Topical Tranexamic Acid With Microneedling in Melasma.

BACKGROUND: Melasma is a common, recurrent, and refractory cause of facial pigmentation resulting in cosmetic disfigurement. Tranexamic acid (TA) has been used systemically and locally for clearance of pigmentation. OBJECTIVE: To assess the clinical efficacy of topical TA (10%) with microneedling in melasma. METHODS: A split face, prospective, randomized, open-label study with a sample size of 40. Left or right side of the face was chosen randomly and microneedling was done on both the sides, followed by 10% TA solution application on one side of the face (test side) and distilled water on the other side of face (control). The procedure was done at 2 weekly intervals (0, 2, 4, and 6 weeks). Clinical images were taken at each visit including modified Melasma Area and Severity Index (mMASI) scoring of each half of the face to assess the clinical response along with patient satisfaction scores and side effects. RESULTS: On the test side, there was 65.92% improvement in the mean mMASI score compared with 20.75% on the control side of the face at the end of 8 weeks. CONCLUSION: Tranexamic acid may be a promising therapeutic agent in melasma and the topical solution along with microneedling seems to be efficacious.

NonScarring Diffuse Hair Loss in Women: a Clinico-Etiological Study from tertiary care center in North-West India.

BACKGROUND: Diffuse hair loss (DHL) is a common problem in adult women and has a major impact on quality of life. Ascertaining the etiological diagnosis is a challenging task in such patients. Satisfactory treatment can only be instituted after ascertaining the cause of hair loss. OBJECTIVE: To study the clinico-epidemiological profile of nonscarring DHL in females and to ascertain its underlying etiological factors. STUDY DESIGN: Of a total of 110 females, who presented with nonscarring DHL to the outpatient dermatology department, 100 qualified for inclusion in the study. A detailed history, clinical examination, and laboratory investigations were performed in all the patients. Statistical analysis was performed on the data collected. RESULTS: Of 100 cases of DHL which were included in the study, commonest was chronic telogen effluvium (CTE) (62%), followed by female pattern hair loss (FPHL) (22%) and acute telogen effluvium (ATE) (16%). Incidence of hair loss was highest in 21-40 years age group. Psychological stress was seen to be a precipitating factor in 18 patients and found most commonly in women belong to CTE group (n-16, 25.8%). Hemoglobin levels ranged from 80 to 142 gm/L (mean: 119 ± 110). Low hemoglobin level (<120 gm/L) was observed in 57% patients. Total serum ferritin <10 ng/mL was seen in 20 patients, vitamin B12 < 211 pg/mL in 76 cases, vitamin D3 < 30 ng/mL in 81 cases. Subclinical hypothyroidism was present in 11% cases. CONCLUSIONS: Nonscarring DHL is a multifactorial condition with highest incidence in 21- to 40-year age group. Serum ferritin, serum vitamin B12, and D3 levels seem to have a contributing role in the pathogenesis of hair loss, and their supplementation may be needed for a faster regrowth of hair in all cases of hair loss irrespective of the pattern.

Effect of physical activity level on orthodontic pain perception and analgesic consumption in adolescents.

INTRODUCTION: The objective of this study was to assess the effect of baseline physical activity level on orthodontic pain perception and analgesic consumption after orthodontic separator placement in adolescents. METHODS: One hundred fifty participants (mean age, 14.5 years; SD, 1.7 years; 73 girls, 77 boys) were included in this longitudinal study. The physical activity questionnaire was used to assess their baseline physical activity levels. Once participants completed the questionnaire, orthodontic separators were placed at the mesial and distal contact points of the maxillary and mandibular first molars. A 100-mm visual analog scale was used for pain assessment. Analgesic consumption was recorded as a binary response (yes/no). Both outcomes were assessed at 1 baseline time point and 7 follow-up time points (bedtime on days 1 to 7). A multilevel mixed-effect model analysis approach was used to analyze the longitudinal data. RESULTS: Of the 150 participants in the study, data from 137 were included in the analysis (mean age, 14.4 years; SD, 1.7 years; 65 girls, 72 boys). Compared with the low-activity group (84 participants; 61.3%), the high-activity group (53 participants; 38.7%) experienced significantly less pain (mean estimate, -8.958; P = 0.0114; 95% confidence interval, -15.868 to -2.049) and consumed fewer analgesics (odds ratio, 0.443; P <0.0318; 95% confidence interval, 0.199 to 0.786) during the study period. CONCLUSIONS: Physical activity has a significant influence on orthodontic pain perception and analgesic consumption in adolescents undergoing orthodontic treatment. Further research is needed on this topic to elucidate the association between physical activity and orthodontic pain.

Reporting quality of randomized controlled trials in orthodontics--what affects it and did it improve over the last 10 years?

INTRODUCTION: Objectives were to investigate the factors affecting the overall reporting quality and the reporting quality trend of each item over the last 10 years for orthodontic randomized controlled trials (RCTs). MATERIAL AND METHODS: MEDLINE, The Cochrane Library, and EMBASE databases were searched (2003-12) to retrieve studies. Four major orthodontic journals and reference list of included articles were hand searched to identify additional RCTs. The overall reporting quality for all included RCTs (2003-12) was assessed using CONSORT, 2001 (ORQs 2001, score 0-20). In addition, CONSORT, 2010 (ORQs 2010, score 0-27), was used for RCTs published after 2010. Generalized estimated equations (GEEs) model was used for analysis (ORQs 2001 and ORQs 2010). Cochran-Armitage trend test was used to evaluate the reporting quality trend of each individual item based on the CONSORT, 2001. RESULTS: Totally 309 relevant studies were identified, out of which 86 were published after 2010. The median for total ORQs 2001 and ORQs 2010 was 9 (interquartile range 7-12) and 12 (interquartile range 9-15), respectively. Year and journal of publication were significant predictors for both ORQs 2001 and ORQs 2010. Location, sample size, and multicentre trials were significant predictors only for ORQs 2001, and not for ORQs 2010. Trend test showed that reporting quality of four items, namely identification of trial as randomized, sample size, blinding, and randomization has improved significantly with time. CONCLUSION: There is an improvement in the reporting quality. However, it is still suboptimal. To improve the reporting quality, the CONSORT guidelines should be followed strictly.

A randomized clinical trial investigating pain associated with superelastic nickel-titanium and multistranded stainless steel archwires during the initial leveling and aligning phase of orthodontic treatment.

OBJECTIVE: To investigate and compare the effects of superelastic nickel-titanium and multistranded stainless steel archwires on pain during the initial phase of orthodontic treatment. DESIGN: A double-blind two-arm parallel design stratified randomized clinical trial. SETTING: A single centre in India between December 2010 and June 2012. A total of 96 participants (48 male and 48 females; 14.1±2.1 years old) were randomized (stratified on age, sex and initial crowding) to superelastic nickel-titanium or multistranded stainless steel archwire groups using a computer-generated allocation sequence. METHODS: We compared 0.016-inch superelastic nickel-titanium and 0.0175-inch multistranded stainless steel wires in 0.022-inch slot (Roth prescription) preadjusted edgewise appliances. The follow-up period was 14 days. Outcome was assessed with a visual analogue scale at baseline and 32 pre-specified follow-up points. Data was analyzed using mixed-effects model analysis. RESULTS: One participant was lost to follow up and 10 were excluded from the analysis due to bond failure or incomplete questionnaire answers. Ultimately, 85 participants (42 males and 43 females; 14.1±2.0 years old) were analysed for the final results. No statistically significant difference was found for overall pain [F value = 2.65, degrees of freedom (df) = 92.6; P = 0.1071]. However, compared to multistranded stainless steel wires, pain in subjects with superelastic nickel-titanium archwires was significantly greater at 12 h (t = 2.34; P = 0.0193), as well as at day 1 in the morning (t = 2.21, P = 0.0273), afternoon (t = 2.11, P = 0.0346) and at bedtime (t = 2.03, P = 0.042). CONCLUSION: For overall pain, there was no statistically significant difference between the two wires. However, subjects with superelastic nickel-titanium archwires had a significantly higher pain at peak level.

Orthodontic pain: an interaction between age and sex in early and middle adolescence.

OBJECTIVE: To investigate the age and sex interaction effect on orthodontic pain in adolescence during the initial phase of fixed orthodontic treatment. MATERIALS AND METHODS: Three hundred participants (mean age 13.85 ± 1.98 years; 152 female, 148 male) met all inclusion criteria and enrolled in the study designed as 2 × 2 factorial trial with two levels each for age (11-14 years; 14-17 years) and sex (male; female). A 0.16-inch superelastic NiTi wire was used in a 0.022-inch slot (Roth's prescription) preadjusted edgewise appliance for initial leveling and alignment of mandibular anterior dentition. The follow-up period was 7 days. Pain was assessed by using 100 mm visual analog scale for one baseline and nine follow-up repeated measurements at prespecified time points. Data were analyzed by using generalized linear mixed effect model analysis. RESULTS: Three participants were lost to follow-up, and 17 participants were not considered for analysis due to incomplete or improperly completed questionnaire. Therefore, 280 participants (mean age 13.96 ± 2.01 years; 138 female, 142 male) were analyzed for results. Results showed that age and sex interaction had statistically significant effect on pain (F  =  3.56; P  =  .0151; df 3/218). In the 11-14 year age group, there was no significant difference for pain between male and female. In the 14-17 year age group, girls reported significantly greater pain compared to 14- to 17 year-old boys (t  =  2.76; P  =  .0209). Pain reported by 14- to 17-year-old girls was also significantly greater compared to 11- to 14-year-old boys (t  =  2.91; P  =  .0206). CONCLUSIONS: Age and sex interaction has significant effect on orthodontic pain during adolescence, and 14- to 17-year-old girls experienced maximum pain.

Efficiency, behavior, and clinical properties of superelastic NiTi versus multistranded stainless steel wires: a prospective clinical trial.

OBJECTIVE: To investigate efficiency, behavior, and properties of superelastic NiTi vs multistranded stainless steel wires in Begg and preadjusted edgewise appliance (PEA) under moderate to severe crowding conditions. MATERIAL AND METHODS: Ninety-six participants (48 male, 48 female), aged 12-18 years old (mean age  =  15.2 ± 1.95), with moderate (≤ 6 mm; mean  =  5.3 ± 0.48) to severe (> 6 mm; mean  =  7.9 ± 0.66) initial crowding were distributed into four groups: superelastic NiTi PEA (n  =  24), superelastic NiTi Begg (n  =  24), multistranded (coaxial) stainless steel PEA (n  =  25), and multistranded (coaxial) stainless steel Begg (n = 23). In this study, 0.16-inch superelastic (austenitic active) NiTi and 0.175-inch multistranded (six stranded, coaxial) stainless steel wires were used in a 0.022-inch slot (Roth prescription) PEA and Begg appliance with a follow-up of six weeks. RESULTS: Analysis of variance revealed no significant difference in reduction of crowding between superelastic NiTi PEA and multistranded (coaxial) stainless steel PEA groups, but reduction in crowding was significantly greater in the superelastic NiTi Begg group compared with the multistranded (coaxial) stainless steel Begg group with F (3, 44)  =  8.896, P < .001, and effect size (ω) 0.57 in moderate crowding and F (3, 44)  =  122.341, P < .001, and effect size (ω) 0.93 in severe crowding. Linear regression demonstrated significant (P < .05) positive correlation between amount of initial crowding and reduction in crowding in all groups except the multistranded (coaxial) stainless steel Begg group, wherein a negative correlation did exist. CONCLUSION: Superelastic NiTi performed significantly better than multistranded (coaxial) stainless steel wire in the Begg appliance. However, in PEA, there was no significant difference.