Human monkeypox disease.

There has been an alarming rise in human monkeypox cases during these past few months in countries where the disease is not endemic. The recent COVID-19 pandemic and the connection of the monkeypox virus with the smallpox-causing variola virus makes it highly likely to be a candidate for another human health emergency. The transmission mode is predominantly via sexual contact, especially among men who have sex with men (MSM); anogenital lesions are the most typical presentation. Although it is a disease with a self-limiting course, some patients require admission for severe anorectal pain, pharyngitis, eye lesions, kidney injury, myocarditis, or soft tissue superinfections. Antiviral therapy has been advocated, of which tecovirimat is promising in patients with comorbidities. Vaccines will be the mainstay for the present and future control of the disease.

Association of Low body Mass Index with Respiratory Failure in Chronic Obstructive Pulmunary Disease.

BACKGROUND: Various studies have shown that low body mass index co-relates with the severity of Chronic obstructive pulmonary disease. The reduced body mass index in these patients is thought to be due to nutritional abnormality and raised circulating inflammatory markers. The study is aimed to find the association of body mass index with respiratory failure in patient with chronic obstructive pulmunory disease. METHODS: 142 patients who attended emergency /out-patient-department in Sir Sundarlal Hospital from August 2018 to July 2020 were enrolled for the study. 81 patients in one group had chronic obstructive pulmonary disease exacerbation with Type II respiratory failure. Among this group low and normal body mass index subgroup was categorized.61 patients in another group had chronic obstructive pulmonary disease. Non-invasive ventilation was applied to case group. Categorization of body mass index was done <18.5(Low BMI) and 18.5-24.9 (Normal BMI ). RESULTS: The mean age of the study group was (63.53±9.021). There was a significant difference in the body mass index between the groups ( p=<0.001,t=15.40). Severity of respiratory failure was compared using ph and pco2 in the between the groups which showed no significant difference (p=1,chi square 0.000), (p=0.40,chi square=0.72) however it did affect the outcome. CONCLUSIONS: Our study shows that overall respiratory failure was common in low body mass index cases compared to Control. Nevertheless there was no difference among severity of respiratory failure among low and normal body mass index subgroups and however it did affect the outcome.

Performance of semi-quantitative lung ultrasound in the assessment of disease severity in interstitial lung disease.

BACKGROUND: Accurate staging of disease severity and its serial monitoring thus is central to the effective management protocols of interstitial lung disease (ILD). PURPOSE: The aim is to evaluate the effectiveness of semi-quantitative parameters of lung ultrasound (LUS) in patients of ILD as a means of staging disease severity. MATERIALS AND METHODS: LUS of 47 patients of ILD and 20 age-matched controls was performed, and findings such as B-line distance, pleural thickening, subpleural changes, decreased lung sliding, and fragmented pleural lining were charted, and an LUS score was done using these parameters. Findings were compared with the Modified Medical Research Council (MMRC) dyspnea grade and spirometry parameters. RESULTS: The presence of B-lines and fragmented pleural lining were the most common findings observed in patients of ILD. Predicted forced vital capacity (FVC) and predicted forced expiratory volume in 1 s (FEV1) showed a good correlation with all the LUS parameters. B-line distance was the most significant LUS parameter to predict the variability in predicted FEVI, FVC, and MMRC dyspnea score. LUS severity score also showed good negative correlation with predicted FEV1 (r = -0.674, P < 0.001) and predicted FVC (r = -0.65, P < 0.001). LUS severity score of 4 or more predicted MMRC dyspnea score of > 3 with 82% sensitivity and 70% specificity. CONCLUSION: Semi-quantitative LUS score and B-line distance can provide a simple but effective estimate of disease severity in ILD.

Transthoracic ultrasonography in patients with interstitial lung disease.

BACKGROUND: Transthoracic ultrasonography (TUS) is suggested as a noninvasive, radiation-free method for the assessment of interstitial lung disease (ILD). This study was designed to study TUS features of ILD. Furthermore, possible correlations of these features with parameters of spirometry, arterial blood gas (ABG) analysis and 6-min walk test (6MWT) were assessed. MATERIALS AND METHODS: Fifty patients with ILD were diagnosed based on history, examination, chest X-ray/high-resolution computed tomography, and spirometry. Each patient underwent 6MWT, ABG analysis, and TUS. TUS was also performed on 20 healthy volunteering controls. RESULTS: The TUS features among patients were B pattern in 40 patients (80.0%, P < 0.001), decreased lung sliding in 22 patients (44.0%, P < 0.001), pleural line thickening in 28 patients (56.0%, P < 0.001), pleural line irregularity in 39 patients (78.0%, P < 0.001) and subpleural changes in 22 patients (44.0%, P < 0.01). Increasing pleural line thickness was inversely correlated with forced vital capacity (FVC) percent predicted (r = -0.345, P < 0.05), pO2 (r = -0.335, P < 0.01), SpO2 at rest (r = -0.444, P < 0.01), 6-min walk distance (6MWD) (r = -0.554, P < 0.001) and distance-saturation product (DSP) (r = -0.572, P < 0.001). Increasing distance between B lines also correlated inversely with FVC percent predicted (r = -0.278), pO2 (r = -0.207), SpO2 at rest (r = -0.170), 6MWD (r = -0.209), and DSP (r = -0.214); however these correlations were not statistically significant (P > 0.05). CONCLUSION: TUS seems to be a useful imaging method for the diagnosis of ILD. It can be used to estimate the severity of ILD. It is simple, bedside, cost-effective, and radiation-free. It may be especially useful in the follow up of patients in low resource settings, pregnant females, and bed-ridden or unstable patients who cannot be shifted to radiology suite.

Footwear Contact Dermatitis: A Prospective Cross-Sectional Study of 108 Outpatients from Delhi, India.

Footwear contact dermatitis is a common problem with multifactorial exogenous, as well as endogenous, etiologies. Patch testing is the gold standard for detection of the possible contactants. A cross-sectional study was conducted in 108 outpatients over a period of 18 months. Demographic data comprising age, sex, and occupation were collected. Details of clinical and laboratory investigations were used to define the incriminating ingredient(s), subsequently confirmed by patch test using Indian standard and footwear series approved by the Contact and Occupational Dermatitis Forum of India. Reading and interpretation were carried out according to the International Contact Dermatitis Research Group (ICDRG) guidelines. Of the 108 patients, 64 were girls or women and 44 boys or men. Although footwear contact dermatitis affected all age groups, most individuals were 21 to 40 years old. The morphology and distribution of the lesions were very specific. Patch testing was helpful, the primary sensitizing agent being mercapto mix, followed by mercaptobenzothiazole, potassium dichromate, and paraphenylenediamine. Footwear contact dermatitis is an extraordinary entity, requiring a high level of expertise (or knowledge) to determine its etiology through history, clinical examination, and patch testing.

Prevalence of Mycobacterium tuberculosis Beijing genotype and its association with drug resistance in North India.

The global presence and rapid dissemination of Beijing genotype of Mycobacterium tuberculosis, makes it an important issue of public health. Its presence and association with multi-drug resistance has been shown in many settings. In present study we tried to find its prevalence and association with drug resistance in North India. One hundred and twenty four M. tuberculosis isolates were analyzed with spoligotyping, further drug susceptibility testing was done by 1% proportional method. Out of these, 11 (8.9%) M. tuberculosis isolates were identified as Beijing and 113 (91.1%) as non-Beijing genotypes. While looking at their drug susceptibility patterns, 6 (54.5%) & 22 (19.5%) were found to be multi drug resistant (MDR) among Beijing and non-Beijing isolates respectively. Our study concluded that the Beijing strains were not so common in north India and these strains do not fully associate with MDR.

Footwear Dermatitis: Diagnosis and Management-Part III.

Footwear dermatitis is an entity with clear clinical features, and the confirmation of its diagnosis is vital. The authors review several tools used for its diagnosis to facilitate appropriate and timely management.

Atopic Dermatitis: Clinical Connotations, Especially a Focus on Concomitant Atopic Undertones in Immunocompromised/Susceptible Genetic and Metabolic Disorders.

Atopic dermatitis (AD) is an intriguing clinical entity. Its clinical connotations are varied, the updates of which are required to be done periodically. An attempt to bring its various facets have been made highlighting its clinical features keeping in view the major and the minor criteria to facilitate the diagnosis, differential diagnosis, complications, and associated dermatoses. The benefit of the current dissertation may percolate to the trainees in dermatology, in addition to revelations that atopic undertones in genetic susceptibility and metabolic disorder may provide substantive insight for the future in the understanding of thus far enigmatic etiopathogenesis of AD.

Atopic Dermatitis: A Cross-Sectional (Descriptive) Study of 100 Cases.

BACKGROUND: Atopic dermatitis is a distinct age-related clinical entity. Its etiopathogenesis is largely insubstantial. Nevertheless, it seems to be an outcome of interplay of maternal and inheritance, pregnancy/intrauterine and environmental factors. Besides, immune dysregulation, and nutritional supplements also play essential roles. Its diagnosis has been perpetuated by three or more major/minor criteria. OBJECTIVES: An endeavor to study its demographic and clinical pattern in contemporary prospective. MATERIALS AND METHODS: 100 fresh patients of atopic dermatitis, diagnosed on the basis of an established three or more major and minor criteria, salient presentations of which were recorded in a preset proforma, which also recorded age, duration, age of onset, and sex. Serum immunoglobulin E (IgE) levels were determined by conventional technique. The data thus obtained was analysed to study its clinical pattern and to correlate its severity to IgE levels. RESULTS: Its overall (new and old) prevalence was 0.98%, while that of new patients was 0.24%. 83 (83%) were in the age group of 2-12 years, of which 54 (83.1%) were males and 29 (82.9%) were female, of which 70 (70%) had urban, while 30 (30%) had rural background. Its duration varied from 8 to 192 weeks, with a mean of 76 weeks, and a standard deviation of 21.42 weeks [76 ± 21.42]. CONCLUSION: Atopic dermatitis is a discrete, overt, age and IgE-related entity frequently displaying varying demographic and clinical connotation.

Atopic Dermatitis; Etio-Pathogenesis, An Overview.

Atopic dermatitis is a well-recognized clinical entity, several facets of which continue to be mystified. Accordingly, its etio-pathogenesis is largely elusive. It appears to be an outcome of interplay of several undertones, namely: genetics, maternal factor and inheritance, pregnancy/intrauterine, environmental factors, immune dysregulation, immuno-globulins, role of diet, and infection. Besides, recent innovative breakthroughs consisting of nutritional supplementation, the highlights of which were considered worthwhile to take stock of to define its current status. An endeavor to enlighten the audience has been made for their benefit.

Effect of Oral Appliance for Snoring and Obstructive Sleep Apnea.

To analyze therapeutic and clinical efficacy of mandibular advancement device (MAD) on snoring and obstructive sleep apnea (OSA). Thirty patients with OSA were recruited on the basis ofpolysomnography with an Apnea and Hypopnea Index (AHI) greater than 5 but less than 30. Repeat polysomnography was performed in follow up with the appliance in place. MAD used in the study is Medical Dental Sleep Appliance (MDSA). It is a titratable appliance. With the appliance in position, the mandible was advanced to an extent that did not exceed 70% of maximum protrusion capacity; Vertical opening did not exceed on an average 3-4 mm beyond freeway space. Comparison of pre AHI scores (diagnostic PSG) with post AHI scores (PSG with OA in-situ) showed a decrease from Mean +/- SD 26.2367 +/- 6.53 to 13.7111 +/- 627. A highly significant (p < 0.001) improvement in AHI was observed. Pre and post ESS score showed a mean decrease from 14.2333 +/- 5.00 to 6.1481 +/- 2.46 MDSA is effective in reducing apnea hypopnea index scores and improving oxygen saturation level.

Illness perception in tuberculosis by implementation of the Brief Illness Perception Questionnaire - a TBNET study.

How patients relate to the experience of their illness has a direct impact over their behavior. We aimed to assess illness perception in patients with pulmonary tuberculosis (TB) by means of the Brief Illness Perception Questionnaire (BIPQ) in correlation with patients' demographic features and clinical TB score. Our observational questionnaire based study included series of consecutive TB patients enrolled in several countries from October 2008 to January 2011 with 167 valid questionnaires analyzed. Each BIPQ item assessed one dimension of illness perceptions like the consequences, timeline, personal control, treatment control, identity, coherence, emotional representation and concern. An open question referred to the main causes of TB in each patient's opinion. The over-all BIPQ score (36.25 ± 11.054) was in concordance with the clinical TB score (p ≤ 0.001). TB patients believed in the treatment (the highest item-related score for treatment control) but were unsure about the illness identity. Illness understanding and the clinical TB score were negatively correlated (p < 0.01). Only 25% of the participants stated bacteria or TB contact as the first ranked cause of the illness. For routine clinical practice implementation of the BIPQ is convenient for obtaining fast and easy assessment of illness perception with potential utility in intervention design. This time saving effective personalized approach may improve communication with TB patients and contribute to better behavioral strategies in disease control.

Footwear dermatitis: historical background, epidemiology, clinical connotation-Part II.

Footwear dermatitis is a disabling condition that is identified by blistering and/or weeping feet that may become secondarily infected and painful. Fissuring is a common feature, resulting in an inability to walk, and it may prevent the wearing of footwear, especially when shoes are the cause of the dermatosis. In the absence of adequate care and therapy, footwear dermatitis may turn into a chronic distressing disease that largely effects the daily quality of life of patients.

Hair biology and its comprehensive sequence in female pattern baldness: clinical connotation diagnosis and differential diagnosis--Part II.

Hair can become a source of concern when there is a change in its texture, number, and thinning. Although female pattern baldness is common, it has received little attention compared with male pattern baldness. Thinning that affects the vertex is insidious and progressive. Hair loss in women has accordingly been interpreted and classified differently than that in men. The Ludwig scale is the most accepted classification. The gross anatomy and the general microanatomy of the hair follicle, including that of the anagen, catagen, and telogen phase, are presented. The hair growth cycle, encompassing anagen, catagen, telogen, exogen, and kenogen, is also discussed to address pattern hair loss in women and provide therapeutic options that are currently available.