DRESS, the maverick among SCARS: A case series-based review of literature.

DRESS is a potentially life-threatening severe cutaneous adverse reaction (SCAR). Historically, it was most frequently linked with phenytoin and was initially described as phenytoin hypersensitivity syndrome; however, it was later found to be caused by various other medications, with the commonest been aromatic anticonvulsants, allopurinol and sulfonamides. The severity of this entity is related to systemic involvement, which can result in multiorgan failure and death. The diagnosis of DRESS, especially in the early stages, remains challenging and elusive due to its heterogeneous clinical presentation and the complex course of the disease with different patterns depending on the causal drug. The most important step in the management of DRESS is early diagnosis and immediate cessation of the suspected offending drug along with oral steroids or immunosuppressants to control the disease. We describe the varying presentation and management of six adults with DRESS from a tertiary care hospital, observed over a two-year period with a brief review of the literature.

Methotrexate toxicity in psoriasis-A multicentric retrospective study.

Even today methotrexate (MTX) remains the backbone of psoriasis management in dermatological practice. The widespread usage as well as over the counter availability of drug in India has led to frequent incidents of overdosing, resulting in toxicity. However, there is a lack of large size, comprehensive study in literature emphasizing upon reasons behind drug toxicity, clinical manifestations, and various management aspects. The present study aims to evaluate risk factors, clinical features, and suggest best management protocol based upon our experience in the management of MTX toxicity. A multicentric, retrospective study was conducted including all cases of psoriasis who were treated for MTX toxicity in the last 5 years. Complete information including demographic details, drug history, detailed clinical evaluation, laboratory parameters, management protocol, and outcome were studied and analyzed. A total of 21 patients of psoriasis with MTX toxicity were included, of which 20 had mucocutaneous ulcerations and hematological abnormalities were found in 76% patients. All cases were treated with folinic acid and 85% patients recovered within 7-14 days. Three out of 21 patients succumbed to their illness despite the best possible treatment. Overdosing was found to be the most common cause (66%) of drug toxicity, either inadvertent or due to self-medication. Patients must be counseled regarding course of the disease, drug regimen, and dreaded side effects prior to initiating the drug. In case the symptoms of toxicity appear, a prompt medical advice must be sought.

Hansen's disease in the era of COVID-19: An observation on a series of six patients with co-infection.

Since the onset of the present pandemic, effect of the novel corona virus on other infectious conditions continues to be investigated. Although the immunological responses to SARS-Cov-2 infection have been elaborated extensively, they fail to explain, variations in its clinical manifestations and its interaction with other diseases. Hansen's disease is known to present as a complex immunological response to the lepra bacilli, resulting in its varied spectral manifestations. An interaction between these two infectious agents, hence, may affect Hansen's disease. We came across six cases of Hansen's disease who developed COVID19 co-infection. This series presents their clinical course and outcome, during the period of co-infection. All cases were followed up for a minimum eight-week period thereafter. In all these cases the active phase of coronavirus infection had no effect on Hansen's disease and those on prednisolone for their lepra reaction had a more favorable outcome, with two cases manifesting exacerbation of their lepra reactions in the follow period.

Magnetically recoverable silica catalysed solvent-free domino Knoevenagel-hetero-Diels-Alder reaction to access divergent chromenones.

A three-component domino Knoevenagel-hetero-Diels-Alder (DKHDA) reaction between 1,3-dicarbonyl, aldehydes/ketones, and alkenes/alkynes leading to the divergent synthesis of chromenones, dihydrochromenones, and spirocyclic chromenones is reported. The reaction was carried out under solvent-free conditions using a magnetically separable silica (Fe3O4@SiO2) catalyst. While two component DKHDA reactions are known, this is the first example of a three component DKHDA reaction involving 1,3-dicarbonyl, ketones, and alkynes producing spirocyclic pyranone derivatives. Twenty-six different highly substituted chromenones were synthesized using this methodology. A wide substrate scope due to the multicomponent nature of the reaction, high atom economy, the use of inexpensive and non-toxic recyclable silica as the catalyst, and solvent free reaction conditions make it an advantageous process. The catalyst was characterized using different analytical techniques such as XRD, IR, HRTEM, VSM, and TGA. Based on the earlier reports a mechanism has also been proposed.

Combining platelet rich plasma with ablative laser for post acne scars: A review.

Background Acne scars are one of the most common sequelae of inflammatory acne. It commonly affects adolescents and young adults and hence is associated with significant psychological morbidity. It is historically resistant to oral as well as surgical modalities. In the last two decades, ablative lasers (fractional or otherwise) have proven to be effective in management of acne scars. Some studies have proven the efficacy of platelet rich plasma in reducing the adverse effects and improving the efficacy of lasers. Objective Review of the studies combining platelet rich plasma with ablative laser for post acne scars. Methods A literature review of the MEDLINE database for studies evaluating the combination of ablative lasers with platelet rich plasma was performed. Only studies with higher levels of evidence (randomised controlled trials and comparative studies) were included in this review. Results Adding intradermal platelet rich plasma to fractional ablative lasers in the management of post acne scars increases clinical efficacy, reduces downtime as well as frequency and duration of ablative lasers related adverse effects. The efficacy of topical platelet rich plasma is less as compared to intradermal platelet rich plasma. Limitations The studies analysed are heterogeneous in nature with varied protocols and duration of follow up. Conclusions It is recommended to combine the ablative lasers with intradermal platelet rich plasma for better clinical response and reduce adverse effects as well as downtime.

Plasmonic enhancement of photovoltaic characteristics of organic solar cells by employing parabola nanostructures at the back of the solar cell.

In this paper, we demonstrate the enhanced performance of organic solar cells (OSCs) comprising low band gap photoactive layers (PMDPP3T:PC70BM) and 2-dimensional (2D) arrays of either Ag nano-spheres, nano-hemispheres, or nano-parabolas embedded at the back of the OSCs. Finite-difference time-domain (FDTD) simulations were performed to compare the performance of the OSCs containing the different plasmonic nanostructures, in terms of optical absorption, short circuit current density (JSC) and power conversion efficiency (PCE). The results demonstrate that single junction OSCs consisting of this new active layer polymer (PMDPP3T), blended with PC70BM, and plasmonic nanostructures at the back of the OSC can enhance the optical absorption in the visible and the NIR region. We demonstrate that the aspect ratio of the nanoparticles embedded at the back of OSCs is a vital parameter for light absorption enhancement. It is observed that the performance in terms of JSC and PCE enhancement of OSC having 2D arrays of Ag nano-parabola at the back of the solar cell improved by 26.41% and 26.37%, respectively, compared to a planar OSC. The enhancement in photon absorption can be attributed due to the enhancement of light scattering from metallic nanostructures near their localized plasmon resonance.

Pustular psoriasis: A distinct aetiopathogenic and clinical entity.

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.

Application of q-rung orthopair fuzzy based SWARA-COPRAS model for municipal waste treatment technology selection.

Despite several methods available for the treatment of solid wastes, the management of municipal solid waste is still a crucial and complex process. The available methods for waste treatment range from advanced to conventional techniques. The identification of a proper method for municipal solid waste management involves several techno-eco and environmental considerations. To solve the real-world problems of municipal waste management, the research proposed an integrated q-rung orthopair fuzzy number-based stepwise weight assessment ratio analysis-complex proportional assessment (SWARA-COPRAS) mathematical model to rank the waste treatment techniques. The research aimed to develop a systematic approach for a suitable selection of waste treatment methods. Ten (10) different alternatives for waste treatments were ranked against seven (07) different techno-eco and environmental criteria. The ambiguity in the decision was handled by the q-rung orthopair fuzzy numbers. The proposed integrated model has identified upcycling and recycling of waste having priority values of 100% and 99.9%, respectively, as the suitable practices for the successful management of generated solid wastes, whereas landfilling has obtained a minimum priority value of 66.782% and, therefore, is least preferable for waste management. The ranking of the alternatives followed the sequence as upcycling > recycling > pyrolysis > hydrolysis > biotechnological > core plasma pyrolysis > incineration > composting > gasification > landfilling. The comparison between the rankings of the proposed model with other techniques has revealed that the values of Spearman's rank correlation coefficient are in the range of 0.8545 to 0.9272; thereby, the robustness of the proposed model is verified. Sensitivity analysis for the criteria weight has showed that the ranking results are influenced significantly by the change in criteria weights and suggested that an accurate estimation of the criteria weight is decisive in determining the overall ranking of the alternative. The study has provided a framework for decision-making in the technology selection for solid waste management.

Synergy of waste plastics and natural fibers as sustainable composites for structural applications concerning circular economy.

The increasing demand for shelters, depleting natural resources, concern for plastic waste, and rising awareness for the environment have attracted the contemporary world towards the recycling of waste plastics for the development of an alternative and sustainable building construction material. The plastics suffer due to their poor strength which can be successfully overcome by the reinforcement of natural fibers. The work aimed to develop and investigate the properties of natural fiber-reinforced composites for structural applications such as floor tiles and pavements. The composites were developed by utilizing three different types of waste plastics, namely, low-density polyethylene, high-density polyethylene, and polypropylene with the reinforcement of coconut (cocos nucifera) and Tossa jute (corchorus olitorius) fibers. The evaluation of the density, water absorption, compressive strength, and flexural strength was performed. Moreover, three-body abrasive wear performance was investigated under the conditions of different loads and sliding speeds. The wear mechanism was explored by the morphological analyses of the fractured and worn-out surfaces. The composite HDPE80C20 showed a maximum density of 1.603 g/cm3 and minimum percentage of water absorption to 0.2022. Moreover, the composite attained a maximum compressive and flexural strength of 40.10 and 10.04 (MPa), respectively. The ranges for abrasive wear were found to be 0.002375-0.20015 (cm3) and 0.01987-0.39593 (cm3) under the considered conditions of loads and sliding speeds, respectively. The comparative analysis of the properties suggested the reinforcement of 20 wt% of jute fiber with 80 wt% of high-density polyethylene for the development of composites for structural applications. The study highlighted the potential of waste plastics and natural fibers as value-added products for building construction with relevancy from socio-eco and environmental points of view.

Synergy of silica sand and waste plastics as thermoplastic composites on abrasive wear characteristics under conditions of different loads and sliding speeds.

The diverse nature of polymers with attractive properties has replaced the conventional materials with polymeric composites. The present study was sought to evaluate the wear performance of thermoplastic-based composites under the conditions of different loads and sliding speeds. In the present study, nine different composites were developed by using low-density polyethylene (LDPE), high-density polyethylene (HDPE) and polyethylene terephthalate (PET) with partial sand replacements i.e., 0, 30, 40, and 50 wt%. The abrasive wear was evaluated as per the ASTM G65 standard test for abrasive wear through a dry-sand rubber wheel apparatus under the applied loads of 34.335, 56.898, 68.719, 79.461 and 90.742 (N) and sliding speeds of 0.5388, 0.7184, 0.8980, 1.0776 and 1.4369 (m/s). The optimum density and compressive strength were obtained to be 2.0555 g/cm3 and 46.20 N/mm2, respectively for the composites HDPE60 and HDPE50 respectively. The minimum value of abrasive wear were found to 0.02498, 0.03430, 0.03095, 0.09020 and 0.03267 (cm3) under the considered loads of 34.335, 56.898, 68.719, 79.461 and 90.742 (N), respectively. Moreover, the composites LDPE50, LDPE100, LDPE100, LDPE50PET20 and LDPE60 showed a minimum abrasive wear of 0.03267, 0.05949, 0.05949, 0.03095 and 0.10292 at the sliding speeds of 0.5388, 0.7184, 0.8980, 1.0776 and 1.4369 (m/s), respectively. The wear response varied non-linearly with the conditions of loads and sliding speeds. Micro-cutting, plastic deformations, fiber peelings, etc. were included as the possible wear mechanism. The possible correlations between wear and mechanical properties, and throughout discussions for wear behaviors through the morphological analyses of the worn-out surfaces were provided.

Acceptorless dehydrogenation of alcohols to carboxylic acids by palladium nanoparticles supported on NiO: delving into metal-support cooperation in catalysis.

In this work, we have developed a simple NiO-supported Pd nanocatalyst (Pd@NiO) for oxidant-free dehydrogenative oxidation of primary alcohols to carboxylic acids along with hydrogen gas as a byproduct. The catalyst has been characterized by techniques like XRD, HRTEM, SEM-EDX, XPS and ICP-AES. The nanostructured Pd@NiO material showed excellent dehydrogenative oxidation activity and outperformed the activity of free NiO or Pd nanoparticles supported on silica/carbon as a catalyst, which could be attributed to synergistic effect of Pd and NiO. A diverse range of aromatic and aliphatic primary alcohols could be efficiently converted to their corresponding carboxylates in high yields with a catalyst loading as low as 0.08 mol%. Notably, highly challenging biomass derived heterocyclic alcohols such as furfuryl alcohol and piperonyl alcohol can also be efficiently converted to their corresponding acids. Moreover, our catalyst can convert benzyl alcohol to benzoic acid on a gram scale with 89% yield. Interestingly, the H2 gas liberated in the reaction can also be used as a substrate for the hydrogenation of 3a to 4a in 65% yield. The nanostructured catalyst is highly reusable and no significant decrease in activity was observed after six reaction cycles. A kinetic study revealed that the reaction followed first-order kinetics with a rate constant of k = 1.47 × 10-4 s-1, under optimized conditions. The extent of reactivity of different functionalities towards dehydrogenation was also investigated using a Hammett plot showing good linearity.

Development of sand-plastic composites as floor tiles using silica sand and recycled thermoplastics: a sustainable approach for cleaner production.

Strict environmental concerns, depleting natural recourses, and rising demand for building construction materials have promoted scientific research toward alternative building materials. This research supports the idea of sustainability and a circular economy via the utilization of waste to produce value-added products. The research explored the potential of waste plastics and silica sand for developing thermoplastic composite as floor tiles. The samples were characterized by water absorption, compressive strength, flexural strength, and sliding wear. The morphological analysis of the sand-plastic interfaces was covered under the umbrella of this study. The maximum compressive and flexural strength were found to be 46.20 N/mm2 and 6.24 N/mm2, respectively, with the minimum water absorption and sliding wear rate of 0.039% and 0.143 × 10-8 kg/m, respectively. The study suggests the workability of the developed floor tiles in non-traffic areas of public places. Thus, the study provides a green building material through recycling waste plastics for sustainable development.

Ross Syndrome Presenting as Heat Exhaustion: A Report of Two Cases.

Ross syndrome is a rare clinical disorder of sweating associated with tonic pupil and areflexia. There are very few case reports of Ross syndrome in dermatology literature, most presenting with patchy hyperhidrosis. Here, we report two isolated cases who had presented to the emergency department with heat exhaustion. Multidisciplinary evaluations of the first case revealed focal anhidrosis, patchy hyperhidrosis, postural hypotension, absent deep tendon reflex, and tonic pupil while the second case had similar features except for postural hypotension, prompting the diagnosis of Ross syndrome. Presentation of these two patients highlights the importance of a high index of suspicion of dysautonomic disorder, interdisciplinary workup of a case of patchy anhidrosis, or hyperhidrosis, which may get missed in busy outpatient department (OPD) visit.

An unusual case of tenosynovitis in Hansen's disease.

Tenosynovitis is an infrequent presentation of Hansen's disease. It may occur during the natural course of disease or treatment as part of type 1 reaction or rarely may be the presenting complaint. We report a case of tenosynovitis of bilateral wrist joints who after being ineffectively treated by an orthopedician as well as rheumatologist for several months and was finally diagnosed as a case of Hansen's disease (borderline lepromatous) in type 1 reaction with excellent response to multidrug therapy and tapering doses of systemic steroids.

Synergy of RHA and silica sand on physico-mechanical and tribological properties of waste plastic-reinforced thermoplastic composites as floor tiles.

The usage of waste for the development of sustainable building materials has received an increasing attention in socio-eco-environment spheres. The rice husk ash (RHA) produced during burning of rice husk and the ever-increasing plastic wastes are useless causing detrimental effects on the environment. This research supports the idea of sustainability and circular economy via utilization of waste to produce value-added products. This research explores the potential of waste plastics, RHA, and silica sand as thermoplastic composite materials. The different composite samples were prepared through waste plastics which includes low- and high-density polyethylene and polypropylene with incorporation of RHA and silica sand in proportions. The study investigates the effect of filler/polymer in 30/70, 20/80, and 10/90 (wt. %) on the workability of the developed composite materials. The workability of the composites was found to improve with filler reinforcement. The experimental results showed the maximum density of 1.676 g/cm3 and mechanical strength of 26.39, 4.89, and 3.25 MPa as compressive, flexural, and tensile strengths, respectively. The minimum percentage of water absorption was 0.052%. The wear tests resulted in a minimum abrasive and sliding wear rate of 0.03759 (cm3) and 0.00692 × 10-6 kg/m. The correlations between wear mechanisms and responses were morphologically analyzed. The developed composites verify the feasibility of RHA and plastics waste as a cost effective and environmentally competent product. The results and discussions provided a direction for the future research on sustainable polymeric composite materials.

Short, highly effective, and inexpensive standardized treatment of multidrug-resistant tuberculosis.

RATIONALE: Based on expert opinion, the global guidelines for management of multidrug-resistant tuberculosis impose lengthy and often poorly tolerated treatments. OBJECTIVES: This observational study evaluates the effectiveness of standardized regimens for patients with proven multidrug-resistant tuberculosis previously untreated with second-line drugs in low-income countries. METHODS: Consenting patients were sequentially assigned to one of six standardized treatment regimens. Subsequent cohorts were treated with regimens adapted according to results in prior cohorts. The study was designed to minimize failure and default while reducing total treatment duration without increasing relapse frequency. MEASUREMENTS AND MAIN RESULTS: We report the treatment outcome of all patients with laboratory-confirmed, multidrug-resistant tuberculosis enrolled from May 1997 to December 2007. The most effective treatment regimen required a minimum of 9 months of treatment with gatifloxacin, clofazimine, ethambutol, and pyrazinamide throughout the treatment period supplemented by prothionamide, kanamycin, and high-dose isoniazid during an intensive phase of a minimum of 4 months, giving a relapse-free cure of 87.9% (95% confidence interval, 82.7-91.6) among 206 patients. Major adverse drug reactions were infrequent and manageable. Compared with the 221 patients treated with regimens based on ofloxacin and commonly prothionamide throughout, the hazard ratio of any adverse outcome was 0.39 (95% confidence interval, 0.26-0.59). CONCLUSIONS: Serial regimen formulation guided by overall treatment effectiveness resulted in treatment outcomes comparable to those obtained with first-line treatment. Confirmatory formal trials in populations with high levels of human immunodeficiency virus coinfection and in populations with a higher initial prevalence of resistance to second-line drugs are required.

Systematic Review and Recommendations to Combine Newer Therapies With Conventional Therapy in Psoriatic Disease.

Background: Psoriasis continues to have unmet needs in its management despite introduction of newer molecules. Monotherapy with these newer agents may not achieve therapeutic goals in all cases, hence necessitating their combinations with other molecules. Improved understanding of newer as well as conventional treatment modalities and experiences in their combinations hence necessitates therapeutic guidelines for their use in psoriasis. Objective: To review the combinations of treatments reported in literature and recommendations for their use based on best current evidence in literature. Methods: A literature review of MEDLINE database for studies evaluating combinations of newer therapies with conventional therapies in psoriasis was done. Newer therapies were identified as biologic disease modifying anti rheumatic drugs and other molecules such as apremilast while conventional therapies included methotrexate, cyclosporine, or retinoids, phototherapy and others. The therapeutic guidelines are proposed with the aim to provide evidenced based approach to combine newer and conventional agents in day-to-day psoriasis management. Findings: Combination of acitretin and narrow band ultraviolet B (NB-UVB)/Psoralen with ultraviolet A (PUVA) achieves faster clearance and allows reduction of dose of the latter. A variable outcome is reported of methotrexate with TNF-α inhibitors vs. TNF-α inhibitors alone, although addition of methotrexate appears to reduce immunogenicity of TNF-α inhibitors thereby preventing formation of anti-drug antibodies especially in case of infliximab. While combination of acitretin and PUVA is beneficial, combining TNF-α inhibitors and phototherapy too produces better and faster results but long term risks of Non Melanoma Skin Cancers (NMSCs) may preclude their use together. Combination of cyclosporine and phototherapy is not recommended due to greater chances of NMSCs. Adding phototherapy to Fumaric Acid Esters (FAEs) improves efficacy. Apremilast can be safely combined with available biologic agents in patients with plaque psoriasis or psoriatic arthritis not responding adequately to biologics alone. Hydroxyurea and acitretin may be used together increasing their efficacy and reducing doses of both and hence their adverse effects. Conclusion: Selected clinical scenarios shall benefit from combinations therapies, improving efficacy of both conventional and newer agents and at the same time helping reduce toxicity of higher dosages when used individually.

Fabrication of magnetically separable ruthenium nanoparticles decorated on channelled silica microspheres: Efficient catalysts for chemoselective hydrogenation of nitroarenes.

Fe3O4-SiO2 microspheres were synthesized by a three-step synthetic procedure involving silica coating, surface capping, and surface modification. These magnetic mesoporous microspheres were employed as sorbents for the incorporation of ultrasmall Ru nanoparticles (2-5 nm) followed by thermal aggregation of the microspheres for achieving better heterogeneity and low leaching. The Ru decorated Fe3O4-SiO2 microspheres (Ru@Fe3O4-CSM) were applied as chemoselective catalysts to convert more than 20 substituted nitroarenes to corresponding amines with good-to-excellent conversion (77-99%) and selectivity (70-100%) under mild conditions; the catalyst can be magnetically recovered within a frame of 90s (recovery time-lapse) and reused up to 5 times without significant decrease in activity or selectivity. Magnetic hysteresis studies were performed to elucidate the magnetic behavior of the ruthenium decorated materials.