Real-World Study of Definisse Threads for Facial Reshaping in Indian Patients: REDEFINE FACE Study.

INTRODUCTION: In recent years, thread lifting has gained popularity as a less invasive cosmetic surgery. It helps raise and realign sagging tissue. The newest thread type for thread lifting procedure is poly-lactic acid-polycaprolactone (PLCL) Definisse threads (RELIFE S.r.l., Florence, Italy). These are fourth-generation absorbable suspended barbed threads. Their double action involves an immediate elevating impact through mechanical action and, over time, the promotion of histological rejuvenating activity through inducing fibroblasts and the synthesis of elastin, hyaluronic acid, and collagen. OBJECTIVES: The REDEFINE FACE study assessed the effectiveness and tolerance of Definisse threads in a real-world setting for facial reshaping in patients in India. METHODS: This multicenter, retrospective observational research included patients treated with Definisse threads for face contouring. RESULTS: Three hundred seventeen patients with a mean follow-up of 4.9 months and an average age of 48.6 years participated in the study. All patients underwent thread lifts using either a single or a combination of Definisse thread reshaping techniques. The Global Aesthetic Improvement Scale for Physicians and Subjects (PGAIS and SGAIS) reported improvement instantly following the treatment (mean score- 3.23 and 3.18, respectively). Improvements continued to enhance during the follow-up visits (mean score- 4.09 and 4.03, respectively). Following the procedure, 96% of patients on the PGAIS and SGAIS exhibited enhancement. Most procedure-related side effects were minor and went away on their own in a few days without the need for proactive care. CONCLUSION: The results of this real-world analysis showed that the latest Definisse threads effectively achieve facial reshaping on patients in India and have both immediate and long-term effects. Treatment was generally well tolerated, and no patient experienced serious adverse events.

Comparing Laser-Assisted and Conventional Excision in the Management of Oral Soft Lesions: A Prospective Clinical Study.

Introduction: Oral soft lesions represent a diverse array of pathological conditions that necessitate precise and effective treatment. Laser-assisted excision has gained prominence due to its purported benefits in terms of reduced procedural time, decreased bleeding, and improved aesthetic outcomes. However, conventional excision remains a common practice. Materials and Methods: A total of 100 patients with clinically diagnosed oral soft lesions were enrolled in this prospective study. The patients were randomly divided into two groups: the laser-assisted excision group and the conventional excision group. Demographics, lesion characteristics, and medical histories were recorded for each patient. Procedural parameters such as operative time and intraoperative bleeding were meticulously documented. Results: The laser-assisted excision group exhibited a statistically significant reduction in procedural duration compared to the conventional excision group (P < 0.05), with mean operative times of 15.2 and 20.8 min, respectively. Intraoperative bleeding was significantly reduced in the laser-assisted group (P < 0.01), with an average blood loss of 15.7 ml, while the conventional excision group reported an average blood loss of 28.6 ml. Postoperative complications analysis demonstrated that the laser-assisted group had a lower incidence of wound infections (P < 0.05) compared to the conventional excision group (5% vs. 15%). Additionally, the laser-assisted group exhibited significantly reduced scarring (P < 0.01) as reported by both patients and clinicians. Patient satisfaction scores were consistently higher in the laser-assisted excision group, with 85% of patients reporting contentment with the procedure, in contrast to 65% in the conventional excision group. Conclusion: In light of the results obtained from this study, laser-assisted excision emerges as a favorable approach for the management of oral soft lesions.

Practical Aspects of Acne Scar Management: ASAP 2024.

Acne scars are one of the most common complications of acne. They can significantly affect the patient's quality of life. Often, several types of atrophic acne scars are observed simultaneously; therefore, consideration must be given to the type of scar while choosing the treatment modality. Effective treatment is not only important to prevent and improve acne scars but also crucial in preventing psychosocial effects. Treatment of acne scars requires an algorithmic approach that targets each component of the scars, and combination therapy on a patient-specific basis may offer the best chance for significant improvement. The goal of the current article is to discuss the practical aspects of management of atrophic acne scars using the vast modalities of treatment available. The panel of dermatologists and plastic surgeons, each one with at least 20 years of experience in acne scar treatment, participated in a series of 'Practical Aspects of Acne Scar Management' (ASAP) meetings: ASAP 2024. ASAP meetings were organized by "Scar Forum India" from March 2023 to July 2023 in four Indian cities (Mumbai, Delhi, Bengaluru, and Kolkata), each one for a duration of at least three hours. During these meetings and discussions, panelists reviewed and discussed the acne scar-related literature, their clinical experience in its management, available treatment options, along with recent advances. Consequently, a summary of the discussion and practical approach for the management of acne scars is developed. It was concluded that, though there is no specific guideline available to optimize acne scar management despite the multitude of treatment options, the best results can be achieved through the synergy of multiple treatment modalities and using the algorithmic approach.

Use of secukinumab in erythrodermic psoriasis: A single center experience.

Background: Erythrodermic psoriasis is an acute inflammatory condition presenting as erythema and scaling involving more than 90% of body surface area in patients with a history of psoriasis vulgaris. If not treated promptly, metabolic complications and infections due to acute skin failure can cause significant morbidity and mortality in this condition. Interleukin-17 (IL-17) is considered to be the key player in initiating the inflammatory cascade in psoriasis. IL-17 blockers have been successfully used in the management of psoriasis vulgaris. However, its use in unstable erythrodermic psoriasis is limited to isolated case reports. Methods: We hereby report an observational study of nine patients of unstable psoriatic erythroderma successfully managed with injection secukinumab and followed up over the next 24 months. Results: Nine patients were managed during the study period, and a successful outcome was noted in all the patients. The Psoriasis Area and Severity Index response rate improved by at least 75% from baseline in 33.3% (3/9) at week 4 and improved to 88.9% (8/9) at week 12. None of the patients had a recurrence of erythroderma till 24 months of followup. Conclusion: The study concluded that secukinumab is quick, safe, and efficient in psoriatic erythroderma, and there was no relapse of erythroderma in any of the patients in the 24 months of followup.

Students' preparedness and perception toward online learning in dental education - A cross-sectional study.

Background: Amid the health risk posed by coronavirus disease 2019 pandemic, all the educational institutions in India have adopted online teaching as a method of imparting education. Thus, the current study was executed to evaluate the perception and preparedness of dental students toward online learning in dental education. Materials and Methods: The present cross-sectional study was conducted on 286 dental undergraduate (UG) and postgraduate (PG) students employing a pretested questionnaire. The questionnaire focused on technological access, computer and online skills, and motivational skills to use e-learning for educational purpose. The response scale for each domain was classified into low readiness level (mean value = 1-<3), acceptable/moderate readiness level (mean value = 3-<4), and high readiness level (mean value = 4-5). Results: The results showed a high level of computer (4.02 ± 0.73) and online skills (4.05 ± 0.70) and acceptable levels of technology access (3.62 ± 0.73) and motivational level (3.61 ± 0.82). There was a significant difference in computer (P = 0.017) and online skills (P = 0.044) among UG and PG students, with PG students reporting better soft skills. Majority of the students reported participating in online workshops (68.2%) and examinations (76.6%). Around 55.2% of the students reported a positive impact and 8% reported a very positive impact of online methods on their learning. Conclusion: Students showed a high level of readiness toward e-learning methods along with some difficulties faced during e-learning.

Prospective Efficacy and Safety Study of an Innovative Kerascalp Hair Growth Serum in Mild-to-Moderate Alopecia in India: Regrowth Study.

BACKGROUND AND AIM: Male and female pattern baldness, commonly known as androgenetic alopecia is the most common type of alopecia, often predetermined genetically, which generally affects the scalp and is characterized by progressive terminal hair loss, known as miniaturization. This study aimed to assess the safety and efficacy of Kerascalp hair serum, a unique combination of esculin, ximenynic acid, and lauric acid, extracted from natural sources in subjects with mild to moderate androgenetic alopecia. METHODS: An open-label, single-arm clinical study was conducted on healthy males and females aged 18-60 years. Each subject applied the hair serum once daily for 90 days. The efficacy of hair serum was evaluated in terms of the following outcome variables: anagen and telogen ratio (A:T ratio), hair thickness, hair density, hair fall, and hair strength assessment. Subjects were assessed on day 0, day 30, day 60, day 90, and on follow-up day 120. RESULTS: Thirty subjects completed all assessment visits. After using the hair serum for 90 days, statistically significant (p<0.0001) improvement was observed in A:T ratio, hair density, hair thickness, and hair strength; a statistically significant reduction (p<0.0001) in hair fall was also observed. Moreover, improvement in general appearance of hair (in terms of hair volume and density) and scalp (in terms of itchiness, redness, roughness, and dryness) was recorded through dermatological assessment at each treatment visit and at follow-up visit compared to baseline. No adverse event was recorded during the study period, and on follow-up. CONCLUSIONS: The results of this clinical study suggest that a 90 days treatment with a phyto-ingredient-based Kerascalp hair serum is safe and effective in significantly improving A:T ratio, hair density, hair thickness, and hair strength, while reducing hair shedding. The improvement in the test parameters persists, even 30 days after stopping the usage of the serum.

Non-Surgical Lower Face Contouring in an Indian Patient: A Case Study.

A 31-year-old Indian female patient presented with a ptotic face with signs of lower face ageing. She was concerned about sagging, an older look, and blunting of the jawline. She wished to have a more oval and narrow face contour. After the evaluation of the patient, we decided to perform a sequential treatment. Initially, the lower face was debulked with high-intensity focused ultrasound (HIFU). Following that, the jawline reshaping (JR) and malar reshaping (MR) techniques were performed with Definisse double needle 12 cm poly-ε-caprolactone-co-l-lactic acid (PCLA) threads. Lower-face hyaluronic acid (HA) filler injections were given for final contouring. Global Aesthetic Improvement Scale (GAIS) and subject level of satisfaction scores showed consistent improvement with the sequential procedures and at the six-month follow-up. Overall, the treatment procedures were uneventful and without any major adverse events. The current case of an Indian patient with a ptotic face and evident signs of lower face ageing showed improvement with a combination of procedures including Definisse threads.

Retrospective real-world study of Definisse threads for jaw line reshaping in Indian patients (REDEFINE JAW study).

BACKGROUND: Thread lifting is a minimally invasive aesthetic procedure that lifts and realigns sagging tissue. Definisse double-needle threads are the latest fourth generation absorbable, monofilament, suspension barbed threads of synthetic origin with convergent bidirectional barbs. Definisse thread produces dual action; mechanical action gives a lifting effect and over a period, it promotes histological revitalizing action. OBJECTIVES: To evaluate the real-world efficacy and safety of Definisse double-needle threads for lower facial lifting for jaw line reshaping in Indian patients. METHODS: This is an observational, retrospective study involving patients who underwent treatment for lower-face reshaping using Definisse double-needle 12 cm threads. RESULTS: Fifty patients with a mean age of 47.44 years were included in the study with an average follow-up of 5.14 months. All the patients have undergone Jawline Reshaping (JR) procedure, while 70% of patients also underwent Malar Reshaping (MR) technique simultaneously. Mean of Physician and Subject Global Aesthetic Improvement Scale (PGAIS and SGAIS) showed improvement immediately after the procedure (mean scores 2.82 and 2.7, respectively) and showed further improvement at the follow-up (3.72 and 3.58, respectively). Moreover, most of the patients immediately after the procedure rated the improvement in PGAIS and SGAIS as "much improved" compared to pre-procedure appearance (78% and 66%, respectively), while, at follow-up, 76% and 66% of the patients, respectively, rated "improved very much" compared to pre-procedure appearance. CONCLUSION: Current study has demonstrated the effectiveness of the latest Definisse threads in Indian patients in performing tissue repositioning to provide a noticeable lifting effect. Procedure was also well tolerated and none of the patients developed serious complications.

Efficacy and safety of innovative acne scar serum in Indian patients (ESTEEM India study).

BACKGROUND: Scarring is a common and undesirable outcome of acne vulgaris. There are limited effective topical formulations for acne scar treatment. The investigational product, acne scar serum (HEXILAK® Acne Scar Serum) is latest topical formulation developed for treatment of acne scar with unique ingredients, Kollaren and Exo-T. OBJECTIVE: Evaluate safety and efficacy of latest acne scar serum on the reduction of acne scars in Indian population. MATERIALS AND METHODS: Subjects, diagnosed clinically with acne scars with or without hyperpigmentation, of either gender in the age group of 15 to 45 years were enrolled in the study. The investigational acne scar serum was applied twice daily for 3 months with monthly follow for outcome evaluation. RESULTS: Out of 72 subjects enrolled, 67 completed the study. Most of the subjects, 79.1% showed improvement in acne scar at Day 90. Significant reduction of mean total post-acne hyperpigmentation index (PAHI) was seen at all follow up visits compared with baseline. Significant improvement in mean acne scar depth, mean acne scar volume, and mean L value using 3D imaging were observed at all visits compared with baseline. All side effects reported were mild and overall, it was well tolerated by all subjects. CONCLUSION: We found that there was a significant reduction in acne scar and post-acne pigmentation with new acne scar serum as a monotherapy, this needs further confirmation in larger randomized controlled studies. Therefore, topical acne scar serum with unique ingredients Kollaren and Exo-T can be a safe, effective, and new option in the armamentarium of acne scar management.

A study of clinical pattern and seasonal variation of dermatoses in children: Contemplating findings for family physicians.

Introduction: Pediatric skin disorders are different from the adult type in their presentations, types, treatment and prognosis. Their presentation varies from place to place. Aim: To study the different clinical pattern and seasonal variation of dermatoses in children attending a multispecialty hospital in Uttar Pradesh. Materials and Methods: This study was conducted among 640 children who attended the OPD of multispecialty hospital over a period of one year. All children up to 10 years of age with cutaneous presentations were included in the study. Results: Study showed that there was a male preponderance among the study participants. According to the age group, school-aged children (6-10 years) constituted the highest percentage (53%) followed by toddlers or pre-school children (41%). The most common skin conditions were infections (47%) followed by eczematous group (31%) of disorders. Among the infections, the most common infections were fungal - 35.64% (107) followed by parasitic infection (31%), viral infections (20%) and then bacterial infections (12.5%). Out of total eczematous dermatoses, Atopic dermatosis was maximum in number (61; 30%). This was followed by pityriasis Alba (47; 23.15%), and acute eczemas (32; 15.76%). Third most common dermatosis was Appendageal disorder (33; 5.15%). It included 15 cases of miliaria i.e. approximately 45.45%. Seventeen (2.65%) children reported for treatment of different kind of nevi. Pigmentary disorders were seen in 16 cases (2.5%). Three nutritional disorders were also seen. Season wise, most of the cases were seen in monsoons (June to October). Conclusions: Dermatoses is very common in children in the western region of Uttar Pradesh. The largest group was formed by infections followed by eczemas. Few cases increased in number depending upon the weather like fungal and bacterial infections, acne, miliaria in summers and xerosis, scabies in winters. This variation strongly suggests that weather has a very important role. Thus various measures including health education programs to be initiated to control and prevent the sudden spread of the diseases. Thus, Primary care providers and family physicians being the first responders should always keep in mind the seasonal variations while dealing with dermatosis in children.

To Check the Reliability of Various Cephalometric Parameters used for Predicting the Type of Malocclusions and Growth Patterns.

Background: There are many different types of malocclusions that may result from the sagittal, vertical, or transverse deviations in normal craniofacial development. When it comes to orthodontic problems, malocclusions in the sagittal plane may have a considerable impact on a person's self-esteem as well as their ability to speak and eat properly. Sagittal anomalies in the skeletal, dental, and soft tissue systems may now be accurately diagnosed using a universally accepted standard lateral cephalogram (SLCE). Methods and Materials: The principal investigator manually traced the cephalograms, identified skeletal landmarks, and measured the following data. The ANB angle (normal range: 0° to 4°) is the angle framed by the point A, Nasion, and B. Estimated oppositely from point A and B on the functional occlusal plane, with Wits evaluation: AO-to-BO direct distance. AB plane angle : the angle formed by the AB and the Npog plane (normal range = -9° to 0°). Beta angle: the angle framed by the A-CB and AB lines, with a typical range of 27° to 35°. W angle: this is the angle created by the opposite line from M to the S-G line and the M-G line, with a typical range of 51 to 55 degrees. The angle of convexity: the angle between N-point A and A-Pog. (Normal range: -8.5 to 10 degree). Results: We utilised Pearson correlation to see how well the different skeletal studies correlated with one another. Wits and the ANB angle of convexity exhibited an excellent relationship with each other, with r = 0.831 and Downs angle of convexity (both r = 0.823 and P = 0.01) being statistically significant. This study used Kappa statistics to assess the degree of agreement between several cephalometric diagnostic criteria. The agreement between the ANB and final groups was strong (k = 0.802, P = 0.01). Conclusion: There was a strong link between all of the cephalometric measures. The cephalometric landmark and valid indication was determined to be the most dependable in evaluating malocclusion and development pattern.

Understanding the dynamics of IgM & IgG antibodies in COVID-19-positive patients.

Background & objectives: The pandemic caused by the SARS-CoV-2 has been a threat to humankind due to the rapid spread of infection and appearance of multiple new variants. In the present study, we report the dynamics and persistence of immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies in asymptomatic and symptomatic COVID-19 patients by chemiluminescent assay. Methods: A total of 463 serum samples from 218 SARS-CoV-2 PCR-positive patients were collected over a period of 124 days post-onset of disease (POD). Antibody levels were measured by chemiluminescence bioanalyzer. Neutralizing antibody titres were assessed by plaque reduction neutralization test (PRNT) for SARS-CoV-2. Results: Both IgM and IgG started appearing from day five post-infection in symptomatic and asymptomatic patients. IgM antibody response peaked around day 35 POD and rapidly diminished thereafter, with the last IgM-positive sample observed at 90 days POD. IgG antibody response peaked around 45 days POD and persisted till 124 days. The chemiluminescence immunoassay (CLIA) results showed a moderate correlation (R=0.5846, P<0.001) compared with PRNT. Additional analysis indicated a neutralizing titre of 250 corresponded to 12.948 AU/ml of YHLO iFlash SARS-CoV-2 IgG units. Interpretation & conclusions: Both symptomatic and asymptomatic COVID-19 patients seem to initiate production of antibody responses from day five of onset of disease. Although the CLIA gives high sensitivity and specificity and also its binding IgG antibody titres may correlate moderately with protective immunity, our results indicate that the values of binding antibody alone may not be a perfect guide to represent virus neutralization titre during donor selection for plasma therapy. However, IgM and IgG antibody detection may help in monitoring the status of disease progression and burden in the community.

In Situ Assessment of Porcine Osteochondral Repair Tissue in the Visible-Near Infrared Spectral Region.

Standard assessment of cartilage repair progression by visual arthroscopy can be subjective and may result in suboptimal evaluation. Visible-near infrared (Vis-NIR) fiber optic spectroscopy of joint tissues, including articular cartilage and subchondral bone, provides an objective approach for quantitative assessment of tissue composition. Here, we applied this technique in the 350-2,500 nm spectral region to identify spectral markers of osteochondral tissue during repair with the overarching goal of developing a new approach to monitor repair of cartilage defects in vivo. Full thickness chondral defects were created in Yucatan minipigs using a 5-mm biopsy punch, and microfracture (MFx) was performed as a standard technique to facilitate repair. Tissues were evaluated at 1 month (in adult pigs) and 3 months (in juvenile pigs) post-surgery by spectroscopy and histology. After euthanasia, Vis-NIR spectra were collected in situ from the defect region. Additional spectroscopy experiments were carried out in vitro to aid in spectral interpretation. Osteochondral tissues were dissected from the joint and evaluated using the conventional International Cartilage Repair Society (ICRS) II histological scoring system, which showed lower scores for the 1-month than the 3-month repair tissues. In the visible spectral region, hemoglobin absorbances at 540 and 570 nm were significantly higher in spectra from 1-month repair tissue than 3-month repair tissue, indicating a reduction of blood in the more mature repair tissue. In the NIR region, we observed qualitative differences between the two groups in spectra taken from the defect, but differences did not reach significance. Furthermore, spectral data also indicated that the hydrated environment of the joint tissue may interfere with evaluation of tissue water absorbances in the NIR region. Together, these data provide support for further investigation of the visible spectral region for assessment of longitudinal repair of cartilage defects, which would enable assessment during routine arthroscopy, particularly in a hydrated environment.

Model-based characterization platform of fiber optic extended-wavelength diffuse reflectance spectroscopy for identification of neurovascular bundles.

SIGNIFICANCE: Fiber-optic extended-wavelength diffuse reflectance spectroscopy (EWDRS) using both visible/near-infrared and shortwave-infrared detectors enables improved detection of spectral absorbances arising from lipids, water, and collagen and has demonstrated promise in a variety of applications, including detection of nerves and neurovascular bundles (NVB). Development of future applications of EWDRS for nerve detection could benefit from the use of model-based analyses including Monte Carlo (MC) simulations and evaluation of agreement between model systems and empirical measurements. AIM: The aim of this work is to characterize agreement between EWDRS measurements and simulations and inform future applications of model-based studies of nerve-detecting applications. APPROACH: A model-based platform consisting of an ex vivo microsurgical nerve dissection model, unique two-layer optical phantoms, and MC model simulations of fiber-optic EWDRS spectroscopic measurements were used to characterize EWDRS and compare agreement across models. In addition, MC simulations of an EWDRS measurement scenario are performed to provide a representative example of future analyses. RESULTS: EWDRS studies performed in the common chicken thigh femoral nerve microsurgical dissection model indicate similar spectral features for classification of NVB versus adjacent tissues as reported in porcine models and human subjects. A comparison of measurements from unique EWDRS issue mimicking optical phantoms and MC simulations indicates high agreement between the two in homogeneous and two-layer optical phantoms, as well as in dissected tissues. Finally, MC simulations of measurement over a simulated NVB indicate the potential of future applications for measurement of nerve plexus. CONCLUSIONS: Characterization of agreement between fiber-optic EWDRS measurements and MC simulations demonstrates strong agreement across a variety of tissues and optical phantoms, offering promise for further use to guide the continued development of EWDRS for translational applications.