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Introduction: Dapsone forms the backbone of multi-drug therapy (MDT) in leprosy and many other dermatological disorders. Haemolysis is its common side effect which often necessitates drug stoppage. Currently, wide variation in data of haemolysis with dapsone exists in literature ranging from 24.7% to 83% and none of the studies point towards the timing of onset of haemolysis/timing of maximal haemolysis which is important in therapeutic decision making regarding continuing or stopping the drug. This study aimed to answer such unanswered questions. Objectives: Primary: To estimate the fall in haemoglobin (Hb) levels after administering MDT for 3 months in patients with leprosy. Secondary: To determine factors associated with Hb change - age, glucose-6-phosphate dehydrogenase (G6PD) status, pole of leprosy and duration of MDT taken (if any). Materials and Methods: All freshly diagnosed cases of Hansen's disease were studied for 3 months. At baseline, demographic data (age, sex), skin biopsy, slit skin smear and G6PD were taken. Haemoglobin (Hb), serum glutamate oxaloacetate transferase (SGOT), serum glutamate pyruvate transferase (SGPT), serum bilirubin, lactate dehydrogenase (LDH), reticulocyte count, peripheral blood smear (PBS) along with clinical photography was done at baseline, 1, 2 and 3 months. Results: Out of the 48 patients who completed the study: Mean Hb (g/dL) decreased from 13.37 at baseline to a minimum of 12.08 at 2 months, and then increased to 12.34 at 3 months. Of 42 patients (87.5%) with a fall in Hb, 13 (27.1%) had severe (fall >20%), 17 (35.4%) had moderate (fall 10-20%), 12 (25%) had mild fall (fall <10%) and in 6 (12.5%), there was no haemolysis. Reticulocyte count, LDH, SGOT and SGPT were significantly associated with haemolysis. Severe haemolysis occurred more frequently in the lepromatous spectrum. Conclusion: Dapsone causes maximal fall of hemoglobin by 1.29 g/dl at two months following which it increases. The fall of hemoglobin is reversible and hemoglobin starts to increase by 3 months of therapy making cessation of the drug unnecessary in most of the patients.
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Upcycled foods are created from surplus food, edible food waste and by-products. Food and beverage brands are launching upcycled foods and promoting their product to consumers. Little is known about how consumers respond to upcycled foods, nor how these products can be most effectively promoted. To better understand marketing strategies for upcycled foods, two studies were conducted, one online (n = 300) and one in retail stores (n = 65), in New Zealand to examine differences in consumer sentiment toward upcycled beer. In both studies, environmental benefits were identified as the most important benefits of upcycled foods and information provision on pack and online were important promotional strategies. Consumers reported greater awareness and acceptance of upcycled food in-store, yet raised concerns relating to taste and price. Only 31% of participants surveyed in-store associated 'no negatives' with upcycled foods compared with 47% of consumers surveyed online. These findings help differentiate a potential promotion strategy for upcycled foods.
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Pustular psoriasis is a distinct subset of psoriasis that presents with involvement of the skin in the form of sterile pustules along with systemic manifestations. Though it has been conventionally grouped under the umbrella of psoriasis, recent research has shed light on its pathogenetic mechanisms associated with the IL-36 pathway, which is distinct from conventional psoriasis. Pustular psoriasis in itself is a heterogeneous entity consisting of various subtypes, including generalised, localised, acute, and chronic forms. There is confusion regarding its current classification as entities like deficiency of IL-36 antagonist (DITRA) which are closely related to pustular psoriasis both in their pathogenetic mechanism and its clinical manifestations, are not included under pustular psoriasis. Entities like palmoplantar pustulosis, which presents with similar clinical features but is pathogenetically distinct from other forms of pustular psoriasis, are included under this condition. Management of pustular psoriasis depends upon its severity; while some of the localised variants can be managed with topical therapy alone, the generalised variants like Von Zumbusch disease and impetigo herpetiformis may need intensive care unit admission and tailor-made treatment protocols. The advent of newer biologics and better insight into the pathogenesis of pustular psoriasis has opened the way for newer therapies, including tumour necrosis factor-alpha inhibitors, interleukin-1 inhibitors, interleukin-17 inhibitors, and granulocyte monocyte apheresis. It continues to be an enigma whether pustular psoriasis is actually a variant of psoriasis or an entirely different disease entity, though we feel that it is an entirely different disease process.
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Productos Biológicos , Psoriasis , Humanos , Psoriasis/diagnóstico , Psoriasis/etiología , Psoriasis/terapia , Piel/patología , Interleucinas , Productos Biológicos/uso terapéuticoRESUMEN
Psoriasis is a common skin disorder affecting approximately 1% of the general population. The treatment of psoriasis depends on the body surface area involvement, quality of life impairment and associated co-morbidities. Special population comprising of pregnant women, lactating mothers, elderly individuals and children, is more vulnerable. They are not included in drug trials; rendering the data for use of systemic treatment scant and is mainly based on anecdotal evidence. In this narrative review, we discuss systemic treatment options in this special population. Though couples planning a family are not considered a special population, they form a subset that require special therapeutic consideration and have also been included in this review.
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The COVID-19 epidemic, food and water insecurity, and the climate emergency have impacted the lives of billions of people worldwide. Ecosystems play a crucial role in tackling these problems. Hence, it is a prime necessity to keep the ecosystems safe and sustainably manage the resources. But this would not suffice for the protection and sustainable management of our surviving natural landscapes and oceans; we also need to restore the planet's devastated ecosystems and the enormous benefits they give. Mining exerts a lot of pressure on the land resources further depleting the fertility of the soil. The overburdened dumps are devoid of the nutrients which turns natural succession at a slow pace. The restoration of the degraded mined areas is essential to re-establish the ecological balance so that a self-sustaining ecosystem can be maintained. The plantation of selected species of plants could be a sustainable and organic tool for the restoration of the degraded mined land. In today's context, various ways regarding ecological restoration are suggested, but the native plant species plantation is the best tool for restoring the degraded land at a quicker pace. The present paper reviews the importance of the native plant species and their efficacy in restoring degraded mined land based on area and time of succession and climax.
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The COVID-19 pandemic caused by SARS-CoV-2 spread across many countries between 2020 and 2022. The similarities in clinical presentation with other endemic diseases pose a challenge to physicians in effectively diagnosing and treating the infection. Approximately 129 nations have a risk of dengue infection, and more than 100 of those are endemic to dengue. During the COVID-19 pandemic, the number of dengue cases decreased in many countries owing to the isolation measures followed. However, the common clinical presentation between them has led to misdiagnosis. Both COVID-19 and dengue fever cause a surge in pro-inflammatory cytokines and chemokines, thus sharing a common pathophysiology. False positive serological test results also posed difficulty differentiating between COVID-19 and dengue fever. This review aims to compare the clinical features, pathophysiology, and immune response between dengue and COVID-19, to benefit public health management during the pandemic.
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Background: Verruca vulgaris is a viral infection with high recurrence rates and is very difficult to treat. It occurs due to the ability of the virus to evade immune recognition. This immune evasion by the human papillomavirus (HPV) can be circumvented by injecting HPV antigens subcutaneously and inducing inflammation and a systemic immune response. Falkner technique is an approved technique for the treatment of warts. In this observational study, we analyzed the recovery rate among patients undergoing this technique as part of their routine treatment. The aim of this study is to study the clinical outcome of Falkner's needling technique that is being used for the treatment of verruca vulgaris. Methods: Under local anaesthesia, only a single wart was vertically punctured using a 26-gauge needle up till the subcutis multiple times till bleeding was observed. No treatment was done for other warts. Patients were advised not to take any anti-inflammatory medications for pain and were observed for responses after 1 week as well as 1 and 3 months. Results: Of 41 patients included in this study, the total resolution of both the punctured and distant warts occurred in 28 patients (68.29%) and partial response in 7 patients (17.1%) by the end of 3 months. Interestingly, individual warts that were subjected to needling showed complete resolution in 35 patients (85.4%). Conclusion: Falkner's needling method provides a high rate of complete resolution of multiple warts at both the needled and distant sites after a single treatment session of only a single lesion. This modality has a high cure rate, is easy to perform, requires minimal infrastructure support, is cost-effective, and can be undertaken at most peripheral settings with minimal training.
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INTRODUCTION: Acne vulgaris is one of the commonest dermatoses encountered in a dermatology clinic. Although the inflammatory processes are centered around the pilosebaceous unit, a myriad of external factors that alter the pathogenesis have been hypothesized. Newer therapies are focused on targeting these as possible scaffolds for drug development. Existing topical and oral medications have considerable overlap between pharmacotherapy and cosmeceuticals directed toward acne treatment making new drug development extremely competitive and financially burdening. Teratogenicity associated with retinoids, cutaneous adverse effects of topical anti-acne medications, and lack of long-term remission induction are a few hindrances that have to be tackled by novel therapies. AREAS COVERED: Numerous topical and systemic medications for acne vulgaris are undergoing clinical trials presently. The review has dealt with anti-acne drugs undergoing phase II and III clinical trials with emphasis on the rationale of various combinations in tandem with the complex pathogenesis of the disease. EXPERT OPINION: The current strategies in new drug development target sebocyte function, neo-inflammatory mediators, and methods combatting drug resistance while broadening the anti-microbial spectrum against Cutibacterium acnes. A holistic approach is pivotal to strengthen the management protocol for acne to achieve precision dermatological practice.
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Acné Vulgar , Antibacterianos , Humanos , Antibacterianos/efectos adversos , Acné Vulgar/tratamiento farmacológico , Acné Vulgar/etiología , Acné Vulgar/patología , Retinoides/efectos adversos , Administración Cutánea , Quimioterapia Combinada , Ensayos Clínicos Fase II como AsuntoAsunto(s)
Exantema , Vancomicina , Exantema/inducido químicamente , Humanos , Vancomicina/efectos adversosRESUMEN
Deep plantar fissures are a common, painful condition, which are often recalcitrant to multiple modalities. Autologous platelet-rich fibrin is a reservoir of supraphysiological concentration of platelets housing various growth factors shown to accelerate wound healing. This unique form factor affords a novel advantage of its ability to be applied over and within these fissures under occlusion. We report the innovative use of disposable syringes to fashion platelet-rich fibrin casts for management of these deeper fissures.
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Dermatosis Bullosa IgA Lineal/complicaciones , Psoriasis/complicaciones , Anciano , Antiinfecciosos/uso terapéutico , Dapsona/uso terapéutico , Fármacos Dermatológicos/uso terapéutico , Dermoscopía , Técnica del Anticuerpo Fluorescente Directa , Humanos , Dermatosis Bullosa IgA Lineal/tratamiento farmacológico , Dermatosis Bullosa IgA Lineal/patología , Masculino , Metotrexato/uso terapéutico , Psoriasis/tratamiento farmacológico , Psoriasis/patologíaRESUMEN
The consumer price index in the United States has increased since the COVID-19 outbreak. Little is known about how consumers perceive price increases during such a crisis. Our research focuses on how consumers' price fairness perceptions change at different time points of the COVID-19 pandemic. Results from a longitudinal study (April-May, 2020, N = 271) suggest that when the lockdown restrictions were eased, consumers experienced changes in affect and perceived price increases to be less unfair. Our analysis reveals that such an effect was driven by changes in positive affect rather than negative affect. This research advances pricing literature by showing that affect, triggered by external situations such as a crisis, influences price fairness perceptions over and above the negative affect induced by the price increase.
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Independently, psoriasis and lichen planus (LP) are common inflammatory skin conditions affecting around 2-3% and 1% of the population, respectively. However, the coexistence of both diseases is rare. Common immunological mechanisms with altered T-cell-mediated autoimmunity, cytokine milieu, and Koebner phenomenon play a role in their pathogenesis. As reviewed in the literature, psoriasis may independently be associated with other autoimmune conditions like vitiligo, alopecia areata, LP, and discoid lupus erythematosus. A rare co-occurrence of these two or three autoimmune diseases has been reported. Here, we report a case of a 10-year-old boy who presented with persistent nonpruritic multiple hyperpigmented scaly papules and plaques over the body since 6 months of age. Histopathology revealed features suggestive of both LP and psoriasis in the same section. A diagnosis of psoriasis-LP overlap was made, and the patient was managed with tab acitretin 25 mg daily and narrowband ultraviolet B (NBUVB) phototherapy with which he showed satisfactory clearance of the lesions.