Erythrodermic dermatophytosis: an alarming consequence of steroid abuse and misuse. A multicentre prospective study from India.

Erythroderma is usually attributed to some of the commoner causes such as eczematous disorders, psoriasis, malignancies, idiopathic situations and drug-induced scenarios. Rarely, erythroderma has been found to result from dermatophytic infections. Erythrodermic dermatophytosis may be a direct sequel of extensive tinea corporis (with or without a background of topical steroid misuse), paraneoplastic phenomenon, an id reaction or congenital erythrodermic disorders, with subsequent development of dermatophytosis. We present a series of patients who developed erythrodermic dermatophytosis on a background of misuse of steroids.

Pinch of salt: A modified technique to treat umbilical granuloma.

BACKGROUND: Umbilical granuloma is an overgrowth of granulation tissue following the separation of umbilical cord. Treatment options for this common entity are limited and have side effects such as chemical burns. In this study, we present a novel modification of the salt application method to treat infants with umbilical granuloma. METHODS: Seventeen infants were recruited in our study after institutional ethics committee approval and consent from the parents. The area of application was cleaned, and common table salt was carefully applied over the lesion. The granuloma was then occluded with surgical adhesive tape for 24 hours. Cases were followed up the next day to remove the occlusive tape and for assessment of improvement. RESULTS: All seventeen cases responded well to this approach with complete resolution of lesions at 24 hours. Small clotlike shrunken tissue was found at the site of granuloma, which was easily scraped off during gentle cleansing. No major complication or recurrence was noted in 3 months of follow-up. CONCLUSION: Complete resolution of umbilical granuloma can be achieved with a single, clinic-based application of salt under occlusion for 24 hours. Salt causes shrinkage of granuloma inside occluded hyperosmolar chamber by desiccant effect. The salient features of this method include ease of application, low cost of treatment, accurate one-time physician-controlled application, and complete and rapid resolution without complication.

Dietary strategies for chronic spontaneous urticaria: an evidence-based review.

Although the relationship between diet and chronic spontaneous urticaria (CSU) remains elusive, several patients seek dietary modifications as they are easy and cost-effective. Adequate patient education and counseling are crucial as modified diets may be beneficial for a subset of antihistamine refractory CSU patients, and no modality currently exists to identify these patients. Elimination of food items based exclusively on patient history may lead to unnecessary restrictions in most cases resulting in nutritional deficiencies and impaired quality of life. Several dietary strategies have been tried till date with varying rates of success and evidence. This review highlights the various dietary strategies along with their levels of evidence, which may help the treating dermatologists and physicians to counsel CSU patients and make evidence-based treatment decisions. There is grade A recommendation for the elimination of food additives (artificial pseudoallergens), personalized diets, vitamin D supplementation, Diamine oxidase supplementation and probiotics (in children), grade B recommendation for dietary elimination of red meat, fish and their products, natural pseudoallergens (fruits, vegetables, and spices), and low-histamine diet, while dietary elimination of gluten (with concomitant celiac disease) has grade C recommendation. Notably, elimination diets should be continued for at least 3 consecutive weeks to assess their effectiveness.

Interlay Type-1 Tympanoplasty with or Without Cortical Mastoidectomy in an Inactive Mucosal Chronic Otitis Media with Large Central Perforation: A Retrospective Comparative Study.

Background: Chronic otitis media (COM) is a pathology involving the middle ear cleft characterized by discharging ear and a non-healing perforation in tympanic membrane. Different techniques have been used for closing the perforation but interlay myringoplasty has become popular among surgeons since the past few decades. Objectives: To evaluate and compare the success rate of Type-1 interlay tympanoplasty in large tympanic membrane perforation with or without cortical mastoidectomy in terms of graft take-up rate and improvement in hearing outcomes. Materials and methods: A retrospective study for the period of eighteen months with total of 90 patients further subdivided into two groups. Group I of 45 patients underwent Type-1 interlay tympanoplasty alone, and 45 patients in Group II underwent type-1 interlay tympanoplasty with cortical mastoidectomy. Results: In group I the mean pre-operative, post-operative pure tone average and air bone gap was found to be 36.49 ± 4.49, 29.24 ± 4.39 and 25.11 ± 3.15, 14.76 ± 3.12 respectively. In group II the mean pre-operative, post-operative pure tone average and air bone gap was found to be 35.60 ± 5.27, 25.96 ± 5.29 and 23.96 ± 3.76 and 13.33 ± 3.38. An independent sample t-test was performed for intergroup comparison and found to be statistically significant (p < 0.005). The graft uptake was 95.5% in group II and 82.2% in group I. Conclusion: Interlay type-1 tympanoplasty coupled with cortical mastoidectomy gives excellent results in terms air bone gap closure and graft uptake in inactive mucosal COM than Interlay type-1 tympanoplasty alone. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03781-7.

Off-pump CABG surgery in left main coronary artery disease: a single-center prospective registry.

Background and objective: The treatment of left main (LM) coronary artery disease (CAD) requires complex decision-making. Patients with left main multi-vessel coronary artery disease (LM CAD) have concerns regarding incomplete revascularization and reduced survival with off-pump (OPCAB) when compared with on-pump (ONCAB) coronary bypass surgery. To evaluate outcomes among high-risk LM CAD patients undergoing OPCAB, we performed a registry-based prospective study. Methods: We performed 4868 coronary artery bypass graft (CABG) surgeries from Jan 2013 to Jun 2019 with 4662 (95.8%) OPCAB. In OPCAB cohort, we had 1323 patients (28.4%) with significant LM (> 50%) triple vessel CAD. Data regarding clinical features, extent of CAD, operative details, in-hospital outcomes, and 3-year follow-up were obtained. Descriptive statistics are reported. Results: The study cohort (n = 1323) was aged 63 ± 9 years with men 88.4%. Tobacco use was in 328 (24.8%), diabetes 598 (45.2%), previous myocardial infarction 463 (35.0%), previous coronary intervention 40 (3.0%), and congestive heart failure in 54 (4.1%). All patients had LM (100.0%) with triple vessel disease in 99.4% (LAD, left anterior descending 100.0%; LCX, left circumflex 99.4%; RCA, right coronary artery 78.7%). Vessels bypassed/patient were 2.7 ± 0.4 with 3.2 ± 0.7 total grafts and 2.1 ± 0.8 venous grafts. In total, 1278 (96.5%) patients received left internal mammary artery (LIMA), 63(4.7%) bilateral internal mammary artery (BIMA), and 74 (5.6%) radial artery grafts. There was no patient with conversion from OPCAB to ONCAB. In-hospital major adverse cardiovascular events (MACE: all-cause deaths, myocardial infarction, and stroke) were in 21 (1.6%). At 3-year follow-up (n = 1041), MACE rates were in 84 (8.1%) and cardiovascular deaths in 28 (2.7%). Conclusions: This study shows that off-pump CABG surgery is safe in patients with LM CAD. There is low in-hospital mortality and MACE and 3-year outcomes are similar to the published data of LM CAD patients who undergo on-pump CABG. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-023-01526-3.

Sisters with No Pain, No Tears: A Report of a New Variant of Hereditary Sensory and Autonomic Neuropathy (Type IX) Caused by a Novel SCN11A Mutation.

Lack of pain sensation in children involves a rare group of heritable disorders; hereditary sensory and autonomic neuropathy (HSAN). Till date, eight types of HSAN have been described depending on the clinical phenotype and the underlying gene mutation. We report a new variant of HSAN (Type IX) in two siblings (of Indian origin) with a novel mutation of SCN11A gene and a distinct clinical phenotype.

A Study to Evaluate Depression and Perceived Stress Among Frontline Indian Doctors Combating the COVID-19 Pandemic.

OBJECTIVE: Amid the ongoing coronavirus disease 2019 (COVID-19) pandemic, health care workers of multiple disciplines have been designated as frontline doctors. This unforeseen situation has led to psychological problems among these health care workers. The objective of this study was to evaluate the mental health status of pan-Indian frontline doctors combating the COVID-19 pandemic. METHODS: A cross-sectional, observational study was conducted among frontline doctors of tertiary care hospitals in India (East: Kolkata, West Bengal; North: New Delhi; West: Nagpur, Maharashtra; and South: Thiruvananthapuram, Kerala) from May 23, 2020, to June 6, 2020. Doctors involved in clinical services in outpatient departments, designated COVID-19 wards, screening blocks, fever clinics, and intensive care units completed an online questionnaire. The 9-item Patient Health Questionnaire and the Perceived Stress Scale were used to assess depression and perceived stress. RESULTS: The results of 422 responses revealed a 63.5% and 45% prevalence of symptoms of depression and stress, respectively, among frontline COVID-19 doctors. Postgraduate trainees constituted the majority (45.5%) of the respondents. Moderately severe and severe depression was noted in 14.2% and 3.8% of the doctors, respectively. Moderate and severe stress was noted in 37.4% and 7.6% of participants, respectively. Multivariate regression analysis showed working ≥ 6 hours/day (adjusted odds ratio: 3.5; 95% CI, 1.9-6.3; P < .0001) to be a significant risk factor for moderate or severe perceived stress, while single relationship status (adjusted odds ratio: 2.9; 95% CI, 1.5-5.9; P = .002) and working ≥ 6 hours/day (adjusted odds ratio: 10.3; 95% CI, 4.3-24.6; P < .0001) significantly contributed to the development of moderate, moderately severe, or severe depression. CONCLUSIONS: The pandemic has taken a serious toll on the physical and mental health of doctors, as evident from our study. Regular screening of medical personnel involved in the diagnosis and treatment of patients with COVID-19 should be conducted to evaluate for stress, anxiety, and depression.

A Study of In vitro Antifungal Susceptibility Patterns of Dermatophytic Fungi at a Tertiary Care Center in Western India.

BACKGROUND: Recent years have seen an alarming rise in the prevalence of recalcitrant and relapsing dermatophyte infections in India associated with lack of clinical response to standard antifungal regimens. AIMS AND OBJECTIVES: A study was undertaken to identify the antifungal susceptibility patterns of dermatophyte species isolated from lesions of dermatophytoses in patients examined at our center. MATERIALS AND METHODS: A total of 85 patients with clinically diagnosed dermatophytoses were subjected to skin scrapings for potassium hydroxide mount (microscopic examination) and culture using Sabouraud's agar medium containing chloramphenicol and cycloheximide (incubated at 30°C). Antifungal susceptibilities [minimum inhibitory concentration-90 (MIC-90)] of the identified dermatophytes were tested for seven systemic and topical antifungal agents (terbinafine, griseofulvin, itraconazole, fluconazole, sertaconazole, ketoconazole, and clotrimazole) using Clinical and Laboratory Standards Institute broth microdilution method (M38-A). RESULTS: Trichophyton rubrum (50%) and Trichophyton mentagrophytes complex (47.2%) were the two major species isolated. Isolates of both showed downy and granular forms (61.11%, 38.89% and 32.35%, 67.65%, respectively). The overall in-vitro susceptibility profiles (MIC-90 ranges in µg/mL) of the seven drugs for T. rubrum and T. mentagrophytes complex respectively were as follows: terbinafine (0.008-0256, 0.016-0.256), griseofulvin (0.03-1, 0.06-1), itraconazole (0.125-2, 0.25-2), fluconazole (0.125-1, 0.25-32), sertaconazole (0.03-1, 0.03-1), ketoconazole (0.06-1, 0.125-1), and clotrimazole (0.03-2, 0.06-1). CONCLUSIONS: This study indicates a rising proportion of T. mentagrophytes complex with increased proportion of granular form (T. mentagrophytes var. mentagrophytes). This study represents the current antifungal susceptibility profile of dermatophytic infections in a tertiary care medical center in western India with rising MICs to terbinafine and itraconazole.