RESUMEN
Nanoemulsion formulation of vitamin D3 have been shown to have better bioavailability than the coarse emulsion preparation in vitro and in vivo animal studies. In the absence of randomised trial in humans, comparing the efficacy of nanotechnology-based miscellised vitamin D3 over conventional vitamin D3, we undertook this study. A total of 180 healthy adults were randomised to receive either micellised (DePura, group A) or conventional vitamin D3 (Calcirol, group B) at a monthly dose of 60 000 IU (1500µg) for 6 months. The outcome parameters were serum 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH), Ca, phosphate, alkaline phosphatase and urinary Ca:creatinine ratio. A total of eighty-nine subjects in group A and seventy-seven in group B completed the trial. Subjects in both the groups had a significant increase in their serum 25(OH)D levels following supplementation (group A: 21·5 (sd 10·9) to 76·7 (sd 18·8) nmol/l (P<0·001); group B: 22·8 (sd 10·4) to 57·8 (sd 16·0) nmol/l (P<0·001)). Participants in micellised group had an additional increase of 20·2 (95 % CI 14·0, 26·4) nmol/l in serum 25(OH)D levels (P<0·001). The difference between the groups was 17·5 (95 % CI 11·8, 23·1) nmol/l, which remained statistically significant (P<0·001) even after adjustment for age and sex. Significant decline in mean serum PTH was observed in both the groups. No hypercalcaemia or hypercalciuria was noted. Although supplementation with both the preparations resulted in a significant rise in serum 25(OH)D levels, micellised vitamin D3 appeared to be more efficacious in achieving higher levels of serum 25(OH)D.
Asunto(s)
Colecalciferol/administración & dosificación , Suplementos Dietéticos , Portadores de Fármacos , Micelas , Deficiencia de Vitamina D/tratamiento farmacológico , Adulto , Índice de Masa Corporal , Calcifediol/sangre , Femenino , Voluntarios Sanos , Humanos , India , Masculino , Persona de Mediana Edad , Nanomedicina , Hormona Paratiroidea/sangre , Solubilidad , Deficiencia de Vitamina D/sangre , Adulto JovenAsunto(s)
Alopecia/inducido químicamente , Dermatitis Alérgica por Contacto/etiología , Tinturas para el Cabello/efectos adversos , Fenilendiaminas/efectos adversos , Adulto , Alopecia/patología , Dermatitis Alérgica por Contacto/patología , Tinturas para el Cabello/química , Humanos , Hiperpigmentación/inducido químicamente , Hiperpigmentación/patología , MasculinoAsunto(s)
Síndromes Mielodisplásicos , Síndrome de Sweet , Antimetabolitos Antineoplásicos/uso terapéutico , Azacitidina/uso terapéutico , Humanos , Síndromes Mielodisplásicos/diagnóstico , Síndromes Mielodisplásicos/tratamiento farmacológico , Síndrome de Sweet/inducido químicamente , Síndrome de Sweet/diagnóstico , Síndrome de Sweet/tratamiento farmacológicoAsunto(s)
Antifúngicos/uso terapéutico , Dermatosis Facial/diagnóstico , Fluconazol/administración & dosificación , Griseofulvina/administración & dosificación , Tiña/diagnóstico , Administración Oral , Preescolar , Dermatosis Facial/tratamiento farmacológico , Humanos , Masculino , Pronóstico , Recurrencia , Retratamiento , Medición de Riesgo , Índice de Severidad de la Enfermedad , Tiña/tratamiento farmacológico , Resultado del TratamientoAsunto(s)
Cara , Herpes Simple , Piel , Cara/patología , Cara/virología , Femenino , Humanos , Labio/patología , Labio/virología , Persona de Mediana Edad , Piel/patología , Piel/virologíaRESUMEN
BACKGROUND: No randomized studies compared the efficacy and safety of modified Kligman's triple combination (TC) with 1,064 nm Q-switched Nd-YAG laser (QSNYL) in melasma in darker skin. OBJECTIVES: To compare the efficacy and safety of QSNYL and TC in the treatment of melasma in Fitzpatrick skin types IV and V. METHODS: In this split face randomized controlled trial, participants' cheeks were randomized to receive either weekly QSNYL (group A) or daily TC (group B) for 12 weeks, followed by 12 weeks of follow-up. RESULTS: Twenty-eight patients completed the intervention, and 21 of them completed follow-up. We found a significant but modest reduction in mean melanin index, modified Melasma Area Severity Index (MASI), and photographic and patient's assessment in both modalities (P < 0.01). No significant differences were detected between the groups. All patients had reappearance of pigmentation by the end of follow-up. Adverse reactions were significantly more in group B (P < 0.001). LIMITATION: The desired sample size could not be achieved. CONCLUSION AND RELEVENCE: No statistically significant differences were observed between QSNYL and TC as monotherapy in melasma. Reappearance of melasma is inevitable after stopping treatment.
Asunto(s)
Láseres de Estado Sólido , Melanosis , Humanos , Láseres de Estado Sólido/uso terapéutico , Melaninas , Resultado del TratamientoRESUMEN
The ridged skin of the palms and soles has several unique features: (i) presence of dermatoglyphics created by alternating ridges and grooves forming a unique pattern, (ii) presence of the highest density of eccrine sweat glands and absence of pilosebaceous units, and (iii) differential expression of keratins compared to the glabrous skin. These features explain the preferential localization of palmoplantar keratoderma (PPK) and several of its characteristic clinical features. PPK develops as a compensatory hyperproliferation of the epidermis and excessive production of stratum corneum in response to altered cornification of the palmoplantar skin due to mutations in the genes encoding several of the proteins involved in it. PPK can manifest as diffuse, focal, striate, or punctate forms per se or as a feature of several dermatological or systemic diseases. There is a wide genetic and phenotypic heterogeneity in hereditary PPK, due to which reaching an accurate diagnosis only on the basis of clinical features may be sometimes challenging for the clinicians in the absence of molecular studies. Nevertheless, recognizing the clinical patterns of keratoderma, extent of involvement, degree of mutilation, and associated appendageal and systemic involvement may help in delineating different forms. Molecular studies, despite high cost, are imperative for accurate classification, recognizing clinical patterns in resource poor settings is important for appropriate diagnosis, genetic counseling, and management. This review intends to develop a practical approach for clinical diagnosis of different types of hereditary PPK with reasonable accuracy.
RESUMEN
Acrodermatitis enteropathica (AE) is a rare inherited zinc deficiency that usually manifests in infancy within days in cases of bottlefed infants and days to weeks after weaning in breastfed infants. It is characterised by diarrhoea, dermatitis, alopecia and systemic symptoms. We report a case of acquired nutritional AE in a 6-month-old female infant who had diarrhoeal episodes and the characteristic dermatitis lesions in the acral and anogenital regions. She responded dramatically to oral zinc supplementation.
Asunto(s)
Acrodermatitis/diagnóstico , Zinc/deficiencia , Zinc/metabolismo , Zinc/uso terapéutico , Acrodermatitis/metabolismo , Administración Oral , Lactancia Materna , Diarrea/etiología , Femenino , Humanos , Lactante , Leche Humana/química , PobrezaRESUMEN
A 15-year-old boy had persistent and refractory erythroderma since early childhood. His parents noticed polycyclic skin lesions and hair fragility around the age of 5 years. He was treated by a local untrained practitioner for more than 3 years without any significant improvement, and he developed weight gain, thinning of skin, muscle weakness and growth retardation. He was evaluated in 2015 and found to have iatrogenic Cushing's disease with severe skeletal complications and pituitary-adrenal-gonadal suppression, which persisted despite gradual withdrawal of steroids.
Asunto(s)
Dermatitis Exfoliativa/patología , Cabello/patología , Ictiosis/patología , Síndrome de Netherton/diagnóstico , Inhibidor de Serinpeptidasas Tipo Kazal-5/genética , Piel/patología , Adolescente , Calcio/uso terapéutico , Síndrome de Cushing/inducido químicamente , Dermatitis Exfoliativa/etiología , Dermatitis Exfoliativa/genética , Dieta Rica en Proteínas/métodos , Humanos , Masculino , Síndrome de Netherton/tratamiento farmacológico , Síndrome de Netherton/genética , Resultado del Tratamiento , Vitamina D/uso terapéuticoRESUMEN
Systemic inflammatory rheumatic diseases have shown an increase in frequency of internal malignancies, predominantly lymphoproliferative disorders. Occurrence of solid organ tumours is exceedingly rare. It is even rarer for it to manifest as recurrent syncope. We report a 55-year-old woman with systemic lupus erythematosus, who later developed episodes of syncope and dizziness along with diaphoresis and palpitations. She also had associated abdominal pain and vomiting. Imaging revealed a gall bladder (GB) mass with hepatic extension, which was histologically consistent with adenocarcinoma of the GB. Subsequently she succumbed to death during chemotherapy.
Asunto(s)
Adenocarcinoma/diagnóstico , Neoplasias de la Vesícula Biliar/diagnóstico , Lupus Eritematoso Sistémico/diagnóstico , Síncope/etiología , Cavidad Abdominal , Adenocarcinoma/complicaciones , Adenocarcinoma/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Neoplasias de la Vesícula Biliar/complicaciones , Neoplasias de la Vesícula Biliar/diagnóstico por imagen , Humanos , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/diagnóstico por imagen , Persona de Mediana Edad , RecurrenciaRESUMEN
Facial granulomatous papules are important to recognise, as some of them are associated with significant systemic association, particularly sarcoidosis and certain infectious conditions. Lupus miliaris disseminatus faciei (LMDF) is a benign granulomatous disorder of unknown aetiology characterised by symmetrical, monomorphic, reddish-brown papules on the face. It is not associated with any underlying systemic involvement. We report a case of LMDF in a middle-aged man who presented to us with multiple asymptomatic and monomorphic reddish papules on the face for 3 months. Skin biopsy showed well-formed perifollicular epithelioid cell granulomas with focus of necrosis suggestive of LMDF. The lesions significantly responded to oral steroids.
Asunto(s)
Antiinflamatorios/uso terapéutico , Betametasona/uso terapéutico , Dermatosis Facial/diagnóstico , Granuloma/diagnóstico , Administración Oral , Adulto , Antiinflamatorios/administración & dosificación , Betametasona/administración & dosificación , Diagnóstico Diferencial , Esquema de Medicación , Dermatosis Facial/tratamiento farmacológico , Dermatosis Facial/patología , Granuloma/tratamiento farmacológico , Granuloma/patología , Humanos , MasculinoRESUMEN
A 34-year-old Indian man presented to an orthopaedician with gradually progressive hypoesthesia affecting his right lower limb and an ipsilateral common peroneal nerve swelling around the knee. The nerve swelling was diagnosed as a peripheral nerve sheath tumour based on MRI findings and was excised, only to be revealed as leprous nerve abscess on histopathology later. The patient developed right foot drop as a result of common peroneal nerve biopsy. This case presents several learning points in the diagnosis of pure neural leprosy.