Dermatology's role in the fight against human trafficking: A report from the AAD Ad Hoc Task Force and call to action.

While the majority of American Academy of Dermatology members have some broad awareness of human trafficking, most are not aware of it in their communities or of the skin signs that could prompt identification of those being exploited, and have requested educational resources to assist patients affected by trafficking. The American Academy of Dermatology Ad Hoc Task Force on Dermatologic Resources for the Intervention and Prevention of Human Trafficking has been working to develop relevant resources, including an online toolkit on the American Academy of Dermatology website: https://www.aad.org/member/clinical-quality/clinical-care/human-trafficking.

Platelet-Rich Plasma: Advances and Controversies in Hair Restoration and Skin Rejuvenation.

BACKGROUND: Platelet-rich plasma (PRP) and its combined therapeutic modalities have catalyzed new possibilities in dermatology; however, limitations in evidence and lack of consensus remain among clinicians regarding optimal composition, protocol, technique, and application. OBJECTIVE: To provide an update and analysis of the evidence for PRP in hair restoration and skin rejuvenation through review of recent available data, highlighting controversies and expert insights to guide future studies, and stimulate discourse and innovations benefitting patients. METHODS: A structured review and expert analysis of PubMed publications before October 2023, with a focus on recent literature from January 2020 through October 2023. RESULTS AND CONCLUSION: Growing literature supports the utility and benefits of PRP and related autologous products for applications for skin and hair, with strongest evidence for androgenetic alopecia and skin rejuvenation. However, this is limited by lack of consensus regarding best practices and protocols. Randomized, controlled trials with uniform metrics comparing outcomes of various compositions of autologous blood products, preparation methods, dosimetry, and frequency of treatments are still required. This will allow the medical discourse to grow beyond the realm of expert opinion into consensus, standardization, and more wide spread adoption of best practices that will benefit patients.

Synthesis, characterization and anticancer activity of the green-synthesized hematite nanoparticles.

The conventional synthesis of hematite nanoparticles (HNPs) is expensive and creates secondary contaminants. Therefore, to combat these issues, there is a requirement for a cheap, effective, and eco-friendly technique. Herein, HNPs were prepared using the fruit extract of Spondias pinnata - an abundant source available in Western-coastal India. The polyphenolic compounds aided the synthesis process and the entire procedure was very rapid. The obtained HNPs had needle-like morphology with agglomerations due to the magnetic interactions as seen in FESEM and HRTEM images. Fe and O elements were noticed in EDS results. The crystalline nature and crystal phase were confirmed from XRD and SAED patterns. The lattice parameters of HNPs were in tandem with the literature. Fe-O crystalline vibrations were noticed in FTIR studies. VSM results portrayed the superparamagnetic nature of HNPs with a high magnetic saturation value of 8.949 emu/g and a negligible hysteresis loop. Thermal stability was ascertained using TGA results with 32% overall weight loss. XPS studies revealed the existence of pure HNPs with signature peaks. Raman spectrum showed the bands specific for HNPs, comparable to the commercial one. In addition, the HNPs were mesoporous with a high surface area (72.04 m2/g) - higher than the commercial one. The anticancer potential of the HNPs was successfully demonstrated against two mammalian cancer cell lines. Therefore, the HNPs synthesized in this study could be applied in various biomedical fields, especially for anticancer formulations.

Study Correlating Neutrophil-Lymphocyte Ratio with Clinical Staging in Mucormycosis Patients.

Rhino-orbital mucormycosis is an aggressive fungal opportunistic infection of the immune-compromised, debilitated patients. The presence of neutrophilia and lymphocytopenia in patients affected with mucormycosis have been reported. Not much study has been done to establish the ratio of neutrophil to lymphocyte as a possible indicator for the severity of Rhino-orbital mucormycosis which is clinical staged. As such, this study aims to find out the relationship of the neutrophil-lymphocyte ratio with the clinical staging of Rhino-orbital mucormycosis in COVID19 recovered patient and if such a ratio can help to identify the severity of the opportunistic fungal infection. MATERIAL: This is a Cross-sectional study done on 100 patients who were diagnosed with Mucormycosis based on radiological findings, post-COVID19 recovery. The neutrophil-lymphocyte ratio was estimated after obtaining the complete blood count of the patient and calculating the ratio by the division of differential Neutrophil by the differential Lymphocyte count. The clinical staging of Mucormycosis was done based on radiological findings. OBSERVATION: The median value of Neutrophil Lymphocyte ratio was found to be elevated in all the clinical stages of Mucormycosis (from stage 2 to 4) at the time of admission as well as discharge considering the normal value of N/L ratio in a healthy individual to be 3. The median N/L ratio was also found to be in decreasing trend as compared from the time of admission to discharge in all the stages 2 to 4 of mucormycosis and was statistically significant (p=0.00) in stage 3 of mucormycosis. CONCLUSION: The Neutrophil-Lymphocyte ratio can be used as a viable marker of severity of mucormycosis and is a good prognostic indicator for resolution of disease especially in stage 3 of mucormycosis. This study helps to reiterate the importance of N/L ratio in the treatment protocol of mucormycosis.

Clinico-microbiological Profile and Outcomes of Asymptomatic Bacteriuria in Pregnancy.

Background: Asymptomatic bacteriuria (ASB) during pregnancy can lead to symptomatic urinary tract infection (UTI), with increased fetal and maternal morbidity and mortality. We evaluated the incidence, clinical and microbiological profile, and outcome of ASB in pregnant women attending our antenatal clinic. Materials and Methods: This prospective study was conducted on 3769 pregnant women in a routine antenatal clinic at a tertiary care center. Participants were divided into two groups, ASB and non-bacteriuria. Data were collected in a standard proforma and analyzed using the software Statistical Package for the Social Sciences (SPSS) v. 20. Results: The incidence of ASB was 3.29% (124/3769). Majority of the women were in the age group of 21-30 years (78.76%, n = 89). Escherichia coli (61.06%) was the most common organism isolated. Maternal anemia (30.08% and 2.93% in the ASB and non-bacteriuria groups, respectively), low birth weight (LBW; 42.5% and 27.98% in the ASB and non-bacteriuria groups, respectively), intrauterine death (4.4% and 1.4% in the ASB and non-bacteriuria groups, respectively), and preterm delivery (37.2% and 22.31% in the ASB and non-bacteriuria groups, respectively) were were associated with ASB (P = 0.001). Conclusion: ASB was associated with maternal anemia, preterm delivery, intrauterine death, and LBW. Early detection and treatment of ASB may result in favorable maternal outcome.

Evolving perspectives in reverse cardio-oncology: A review of current status, pathophysiological insights, and future directives.

Cardiovascular disease (CVD) and cancer are leading causes of mortality worldwide, traditionally linked through adverse effects of cancer therapies on cardiovascular health. However, reverse cardio-oncology, a burgeoning field, shifts this perspective to examine how cardiovascular diseases influence the onset and progression of cancer. This novel approach has revealed a higher likelihood of cancer development in patients with pre-existing cardiovascular conditions, attributed to shared risk factors such as obesity, a sedentary lifestyle, and smoking. Underlying mechanisms like chronic inflammation and clonal hematopoiesis further illuminate the connections between cardiovascular ailments and cancer. This comprehensive narrative review, spanning a broad spectrum of studies, outlines the syndromic classification of cardio-oncology, the intersection of cardiovascular risk factors and oncogenesis, and the bidirectional dynamics between CVD and cancer. Additionally, the review also discusses the pathophysiological mechanisms underpinning this interconnection, examining the roles of cardiokines, genetic factors, and the effects of cardiovascular therapies and biomarkers in cancer diagnostics. Lastly, it aims to underline future directives, emphasising the need for integrated healthcare strategies, interdisciplinary research, and comprehensive treatment protocols.

Post-Inflammatory Hypopigmentation: Review of the Etiology, Clinical Manifestations, and Treatment Options.

Post-inflammatory hypopigmentation is a common acquired pigmentary disorder that is more prominent in skin of color, leading to great cosmetic and psychosocial implications. Often, a diagnosis with a pigmentary disorder can negatively impact an individual's health-related quality of life and may result in stigma. Although most cases of post-inflammatory hypopigmentation resolve spontaneously over time, a systematic diagnostic approach can help with identifying the underlying etiology and informing treatment strategies. It can be due to cutaneous inflammation, sequelae of inflammatory or infectious dermatoses, or dermatologic procedures. Therefore, a thorough understanding of the epidemiology, patient history, physical exam findings, and clinical features of post-inflammatory hypopigmentation phenomenon can explain the primary cause to providers and allow for patient education. It is also important to understand the various therapeutic approaches available and the efficacy of these options, which will inform providers to choose the appropriate therapy for patients. Although algorithms exist for classifying acquired disorders of hypopigmentation, there are no established algorithms for the diagnosis and treatment of post-inflammatory hypopigmentation, which warrants further exploration and discourse.

Correlation between NT proBNP and left ventricular ejection fraction in elderly patients presenting to emergency department with dyspnoea.

OBJECTIVE: Shortness of breath is a common complaint for which the elderly seek medical attention in the emergency department (ED). Differentiating cardiac from respiratory causes of dyspnoea in this population is quite a challenge. N Terminal pro brain-natriuretic-peptide (NT proBNP) has been studied extensively as a biomarker of left ventricular (LV) failure. METHODS: The NT proBNP was measured in 100 patients above 60 years of age who presented to the ED with shortness of breath. The level was compared with echocardiographic findings to assess correlation with ejection fraction (EF). RESULTS: The NT proBNP values increased significantly as the functional severity of heart failure (HF) increased (P < 0.001). The mean NT proBNP level was 1503.33 pg/mL. Patients with respiratory causes of dyspnoea had a mean NT proBNP level of 309.28 pg/mL with normal LV function. CONCLUSION: The NT proBNP levels had a good correlation with worsening LVEF.

Study of hypothalamo pituitary adrenal axis in frail elderly subjects.

BACKGROUND: Frail elderly people are at increased risk of death and disability from minor environmental stresses such as infection because they do not have the reserves to respond and maintain adequate homeostasis Studies have shown that elderly patients had a significantly smaller response to ACTH stimulation test. Due to paucity of data regarding HPA axis functioning in frail elderly in Indian studies, we assessed the adrenocortical response to ACTH stimulation test in frail elderly subjects. OBJECTIVES: To assess the basal serum cortisol levels and serum cortisol response to 1 mcg ACTH stimulation test in frail elderly subjects. METHODOLOGY: Case control study. Elderly patients visiting OPD or admitted at M.S.Ramaiah hospital from September 2007 to August 2009 were classified into 2 groups. Those fulfilling the criteria of frailty above 65 yrs were taken as cases, non frail elderly were taken as controls. 40 cases and 20 controls were included. RESULTS: Equal number of hospitalized and out patient subjects were studied (20 in each group). Mean age was 75.35 years in hospitalized frails, 69.6 years in out patient frails, 68.3 years in controls. M: F ratio was 1:1. 45% of cases had frailty index of 4. A delta rise of > 9 mcg/dl (after 1 mcg ACTH stimulation test) was seen in 10 cases (25%) of frail elderly as compared to 16 controls(80%) indicating a possible adrenal insufficiency in remaining 30 cases (75%). The mean duration of hospital stay was 5.6 days. Frail elderly with poor ACTH response had poor quality of life as measured by activities of daily living score (p = .026). CONCLUSION: Frail elderly individuals have adrenal insufficiency (subclinical hypocortisolemia) compared to healthy elderly subjects, thereby indicating a poorer response to ACTH stimulation test may influence outcome during acute illness. Frail elderly with poor ACTH response had poor quality of life as measured by activities of daily living score (p = .026). Hyponatremia and hypotension co related well with state of adrenal insufficiency.

A study to assess the outcome in COVID-19 confirmed cases receiving Remdesivir as compared to conventional therapy: Medical records-based audit.

Introduction: COVID-19 infection caused by SARS-Corona virus-2 (SARS-CoV-2) has caused large number of infections and mortality globally. There are no proven medications to prevent and treat COVID-19, nevertheless several potential pharmacotherapeutic agents have been tried. Remdesivir was found to be effective in few studies. Aims: To assess the outcome in COVID-19 confirmed cases receiving Remdesivir as compared to conventional therapy. Methodology: This study was conducted in a tertiary hospital in South India after the approval of the Institutional ethical committee. It was a medical records-based retrospective, longitudinal study. Medical records of the inpatients with confirmed COVID-19 infection were reviewed from the period of June 15, 2020 to September 15, 2020. This study was conducted to assess the clinical and laboratory profile and outcome in the patients admitted with moderate and severe COVID-19 disease who received Remdesivir. Statistical Analysis: The analysis was done using SPSS Inc. released 2009, PASW statistics for Windows version 18.0, Chicago. Results: One hundred eleven (N = 111) patients were included in the study. 56 patients received the conventional treatment (Hydroxychloroquine HCQ) and 55 patients received Remdesivir. It was seen that among patients treated with HCQ, 24 (42.9%) required non-invasive ventilation and seven (12.7%) patients treated with Remdesivir required it (P = 0.001). It was noticed that the mean duration of hospitalization was 16.6 days in HCQ group and was 11.4 days in Remdesivir group (P = 0.021). Conclusion: The study demonstrates that Remdesivir does have benefit in reducing the mortality and duration of hospital stay. There was reduced requirement of non-invasive and invasive ventilation among patients treated with Remdesivir.

Assessment of Functions of the Autonomic Nervous System in the Elderly with Different Comorbid Factors.

Background Studies in healthy elderly patients have shown the prevalence of autonomic dysfunction (AD) in the range of 20 to 30%. However, there is paucity in data pertaining to AD in the elderly in the Indian context. Objective To assess the prevalence of AD in the elderly irrespective of their comorbidity status. Methods A total of 141 elderly patients with or without comorbidities/symptoms of AD were included. Demographic and clinical details of the patients were recorded. Autonomic function tests (AFTs) such as deep breathing test, Valsalva ratio, orthostatic heart rate (OHR), isometric handgrip test, and orthostatic blood pressure were performed based on Ewing's battery of tests. The sensitivity, specificity, positive predictive value, negative predictive value, and the accuracy of AFTs were evaluated. Results Most patients ( n = 85) were aged between 60 and 69 years, with a male predominance (58.87%). Hypertension and diabetes mellitus were the most common comorbidities. Postural hypotension was the most common symptom of AD. With advancing age, symptoms of AD manifested significantly more. Overall, 73.8% of patients had AD, of whom 45.4% had early AD. Number of AD symptoms, glycated hemoglobin (HbA1c) level, and comorbid factors (diabetes and hypertension) were significantly associated with the results of AFTs ( p < 0.05). AFTs were highly significant with respect to the results obtained ( p < 0.001). Deep breathing test, abnormal in majority of study patients, has a sensitivity of 93.3% and OHR has a specificity of 81.1% to determine AD. Conclusion The study concludes that age itself is an independent predictor of AD, which increases in severity if associated with comorbidities.

Clinical Profiles of Elderly Patients Presenting with Persistent Dizziness.

BACKGROUND: Dizziness among elderly patients is primarily treated in emergency and primary care centers. However, the causes and comorbidities responsible for dizziness in the elderly may differ in tertiary health care centers. OBJECTIVE: To determine the subtypes of persistent dizziness and to evaluate the number of contributory causes of dizziness among elderly patients. METHODS AND MATERIALS: This observational cross-sectional study comprised of 130 patients aged >60 years. A detailed history of existing comorbidities was obtained. A standardized comprehensive evaluation of all patients was done using an International Delphi procedure. Data from each patient was independently reviewed for major and contributory causes of dizziness. Chi square test was used to find the association between dizziness and various contributing factors. RESULTS: Presyncope was the most frequent dizziness subtype (71.5%). Majority of patients showed one dizziness subtype (54.6%) and three contributory causes of dizziness (40.6%). An adverse effect of drug was the most common contributory cause for dizziness (20%). The most frequent underlying cause of dizziness was noted to be cardiovascular disease (40%), followed by peripheral vestibular disease (22.3%) and neurological disease (19%). Sixty six percent of the patients were identified with more than one contributing cause for dizziness. CONCLUSION: Primary care physicians need to anticipate that many elderly dizzy patients can have more than one cause of dizziness. A systematic and planned approach can help the clinician to effectively treat dizziness in the elderly.

Arterial hypoxemia in patients with cirrhosis of liver.

INTRODUCTION: Mild hypoxia has been seen in approximately one third of patients with chronic liver disease. Development of hypoxemia in patients with chronic liver disease, modifies the line of management and worsens the prognosis of the disease. Hence an early detection of hypoxemia in these patients is essential. Hypoxemia results from various causes in patients with chronic liver disease. Hepato pulmonary syndrome is an important cause in a patient with hypoxemia and chronic liver disease. Development of this complication in chronic liver disease indicates a poorer prognosis in these patients. Chronic liver disease is also known to be associated with pulmonary manifestations that affect both the pleural space and lung parenchyma. This study was undertaken to study the prevalence of hypoxemia and assess the prognosis in patients with chronic liver disease. MATERIALS AND METHODS: Fourty three patients aged 18 years and above with evidence of cirrhosis, admitted under the department of Medicine and Gastroenterology, were included in the study. A detailed history was taken and clinical examination were done in all patients. All patients underwent ultrasonography, LFT, biochemical tests and upper gastrointestinal endoscopy to confirm chronic liver disease, portal hypertension and varices, if any chest X-ray, 2-D transthoracic echocardiogram, viral studies and pulmonary function tests. The patients in whom arterial hypoxemia was detected with a positive contrast echocardiogram were considered to have hepato pulmonary syndrome. RESULTS: Six out of the 43 patients (13.9%) included in the study had hypo-xemia. Among these 6 patients with hypoxemia, 3 were found to have contrast enhanced echocardiographic evidence of intra pulmonary vascular dilatations and diagnosed hepato pulmonary syndrome. The other 3 patients had evidence of both, interstitial lung disease and pleural effusion contributing to hypoxemia. The patients with hepato pulmonary syndrome had a significant P (A-a) O2 gradient, died during the study period, indicating a poorer prognosis. CONCLUSIONS: We conclude that identification of hypoxemia and its aetiology in patients with chronic liver disease is essential. Identification of hepato pulmonary syndrome is important, as it carries a poor prognosis in patients with chronic liver disease.

Effect of mechanical coronary reperfusion on QT dispersion in acute coronary syndrome.

BACKGROUND: The time for cardiac repolarization and homogeneity of repolarization on surface electrocardiogram is denoted by QT interval and QT dispersion, respectively. Numerous studies suggest an association between an increased dispersion of the QT interval obtained from the 12-lead electrocardiogram and increased risk for serious cardiac events. METHODS AND RESULTS: We evaluated the effect of thrombolysis and percutaneous transluminal coronary angioplasty on QT dispersion in acute coronary syndrome in 45 patients (age: 55 +/- 6 years). QT dispersion was calculated on admission and immediately after the procedure (thrombolysis and percutaneous transluminal coronary angioplasty). There was a significant decrease in QT dispersion after percutaneous transluminal coronary angioplasty (75 +/- 21 ms to 38 +/- 20 ms, p < 0.0001). In a subset of these patients with acute myocardial infarction (n = 29) who underwent thrombolysis, QT dispersion decreased only marginally (78 +/- 19 ms to 67 +/- 22 ms, p < 0.05). Even in this subgroup, there was a significant decrease in QT dispersion after percutaneous transluminal coronary angioplasty (to 37 +/- 22 ms, p < 0.0001). In patients with unstable angina (n = 16), there were similar significant changes after percutaneous transluminal coronary angioplasty (p < 0.0001). CONCLUSIONS: These results suggest a highly significant decrease in QT dispersion after percutaneous transluminal coronary angioplasty compared to a less significant decrease after thrombolysis, which may have clinical implications.