Clinical Use of Super-Bioavailable Itraconazole for the Management of Dermatophytosis: Consensus Statement by Dermatologists from India via the Modified Delphi Technique.

Super-bioavailable itraconazole (SB ITZ) overcomes the limitations of conventional itraconazole (CITZ) such as interindividual variability and reduced bioavailability. It has been approved for systemic mycoses in Australia and Europe as 50 mg and the USA as 65 mg and in India as 50 mg, 65 mg, 100 mg, and 130 mg. However, data on the ideal dose and duration of SB ITZ treatment in managing dermatophytosis are insufficient. This consensus discusses the suitability, dosage, duration of treatment, and relevance of using SB ITZ in managing dermatophytosis in different clinical scenarios. Sixteen dermatologists (>15 years of experience in the field and ≥2 years clinical experience with SB ITZ), formed the expert panel. A modified Delphi technique was employed, and a consensus was reached if the concordance in response was >75%. A total of 26 consensus statements were developed. The preferred dose of SB ITZ is 130 mg once daily and if not tolerated, 65 mg twice daily. The preferred duration for treating naïve dermatophytosis is 4-6 weeks and that for recalcitrant dermatophytosis is 6-8 weeks. Moreover, cure rates for dermatophytosis are a little better with SB ITZ than with CITZ with a similar safety profile as of CITZ. Better patient compliance and efficacy are associated with SB ITZ than with CITZ, even in patients with comorbidities and special needs such as patients with diabetes, extensive lesions, corticosteroid abuse, adolescents, and those on multiple drugs. Expert clinicians reported that the overall clinical experience with SB ITZ was better than that with CITZ.

Chronic Eczema Developing Over Skin Treated for Dermatophytosis in Atopic Patients -Importance of Treating Gently and Intelligently.

A novel observation of chronic eczema developing over the skin of adequately treated lesions of tinea cruris/tinea corporis in six atopic individuals is being shared. We propose that the skin of atopic individuals affected by dermatophytosis be observed for secondary changes even after the complete resolution of the lesions. The use of bland emollients with topical antifungal agents should be encouraged in atopic patients. The extent and duration of the compromised epidermal barrier function of the skin of atopic individuals with dermatophytosis need to be studied further.

Cyclically Loaded Copper Slag Admixed Reinforced Concrete Beams with Cement Partially Replaced with Fly Ash.

Generally, the concrete with higher strength appears to produce brittle failure more easily. However, the use of mineral admixture can help in enhancing the ductility, energy dissipation, and seismic energy in the designed concrete. This paper presents energy absorption capacity, stiffness degradation, and ductility of the copper slag (CS) admixed reinforced concrete with fly ash (FA) beams subjected to forward cyclic load. The forward cyclic load was applied with the help of servo-hydraulic universal testing machines with 250 kN capacity. Twenty-four beams with a size of 100 mm × 150 mm × 1700 mm made with CS replaced for natural sand from 0% to 100% at an increment of 20%, and FA was replaced for cement from 0% to 30% with an increment of 10% were cast. Beams are designed for the grade of M30 concrete. Based on the preliminary investigation results, compressive strength of the concrete greatly increased when adding these two materials in the concrete. Normally, Grade of concrete can change the behaviour of the beam from a brittle manner to be more ductile manner. So, in this work, flexural behaviour of RC beams are studied with varying compressive strength of concrete. Experimental results showed that the RC beam made with 20% FA and 80% CS (FA20CS80) possesses higher ultimate load-carrying capacity than the control concrete beam. It withstands up to 18 cycles of loading with an ultimate deflection of 60 mm. The CS and FA admixed reinforced concrete composite beams have excellent ultimate load carrying capacity, stiffness, energy absorption capacity, and ductility indices compared to the control concrete beam.

Kaposiform hemangioendothelioma with Kasabach-Merritt phenomenon in a neonate of life- and limb-threatening nature: A case report.

Kaposiform hemangioendothelioma involving whole of a leg in a neonate with Kasabach-Merritt phenomenon causing limb and life-threatening situation has not been reported. One such case and its successful management is presented in this case report. Literature review is made.

Fine needle aspiration cytology of Kikuchi-Fujimoto's disease: a report of 2 cases with emphasis on cytologic features and differential diagnosis.

BACKGROUND: Kikuchi-Fujimoto's disease (KFD) or histiocytic necrotizing lymphadenitis is an uncommon, benign, self-limited disease of unknown etiology, primarily affecting young women. Herein, we present the cytologic features of KFD of 2 cases that presented with different clinical pictures and discuss the cytologic differential diagnosis of this condition. CASES: Case 1 was a 17-year-old girl who presented with cervical lymphadenopathy since 6 weeks and case 2 was a 32-year-old female who had cough and axillary lymphadenopathy since 8 weeks. The fine needle aspiration (FNA) smears of both cases revealed a polymorphous lymphoid population intermingled with histiocytes, many of which showed a small size, eccentric location, crescent-shaped nuclei and abundant karyorrhectic debris in the background. A diagnosis of histiocytic necrotizing lymphadenitis was made on FNA cytology, which was confirmed by subsequent histologic examination of the lymph nodes. CONCLUSION: Precise diagnosis of KFD on cytologic smears is crucial as it can be mistaken for tuberculous lymphadenitis, systemic lupus erythematosus, malignant lymphoma or even metastatic carcinoma, and to avoid unnecessary investigations and potentially harmful treatment. With adequate, well-preserved samples and appropriate clinical setting, the presence of abundant karyorrhectic debris, crescentic macrophages, a polymorphous lymphoid population and absence of epithelioid cell granulomas, giant cells and neutrophils must alert the cytopathologist to arrive at a correct diagnosis.