Fractional CO2 laser with topical 1% terbinafine cream versus oral itraconazole in the management of onychomycosis: A randomized controlled trial

Background: Onychomycosis accounts for 20–40% of all nail disorders. It is difficult to cure with resistance to anti-fungal drugs, their side effects and drug interactions limiting treatment options. Itraconazole is a widely accepted oral medication used for onychomycosis while fractional CO2 laser along with a topical anti-fungal has shown promising results for nail plate clearance in onychomycosis. Aim: To compare the efficacy of fractional CO2 laser with 1% terbinafine cream versus itraconazole in the management of onychomycosis. Methods: A prospective, randomised, single-centre, two-arm, parallel-group interventional study was conducted at Command Hospital Air Force, Bangalore. Onychomycosis cases confirmed by KOH mount/culture-positive were included. Patients were randomly divided into two groups. Group A received 4 sessions of fractional CO2 laser every fourth week with twice-daily application of 1% terbinafine cream; Group B received one-week pulse therapy with capsule itraconazole once every four-week for three pulses. The response was assessed by Onychomycosis Severity Index, a validated onychomycosis assessment scale, at baseline and at six months. Results: Group A had 50 patients with a total of 98 nails. Clinical improvement was seen in 83/98 (84.7%) nails. The average reduction in Onychomycosis Severity Index was 8.65 (P < 0.05). Group B had 50 patients with a total of 136 nails. Clinical improvement was seen in 104/136 (76.5%) nails. The average reduction in Onychomycosis Severity Index was 7.37 (P < 0.05). Both groups showed statistically significant improvement measured by ‘Reduction in Onychomycosis Severity Index’ at six months; however, there was no significant difference between the two arms. Limitations: The main limitations of the study are the small sample size and lack of long-term follow-up to assess recurrence of infection. Conclusion: Fractional CO2 laser with 1% terbinafine cream is an effective and safe method for inducing nail clearance in onychomycosis and has efficacy similar to itraconazole pulse therapy.

A Study Of Retromolar Foramen/canal In North Indian Population

The Retromolar foramen/canal are one of the non-metric variants of the mandible located in the retromolarfossa of the mandible behind the 3rd molar of mandible. These are obviously of profound dental and surgicalimportance. The aim of the study was to know the prevalence of retromolar canal/foramen in north Indianpopulation. In the present study, 35 dry mandibles of unknown sex of north Indian origin were examined bynaked eyes to know the incidence of retromolar foramen/canal. The retromolar foramen/canal was found in 6mandibles (17.14%), bilaterally in 2 mandibles and unilaterally in 4 mandibles. We conclude that retromolarforamen /canal is of profound clinical importance.

Physicochemical and antioxidant properties of kiwifruit as a function of cultivar and fruit harvested month

The present study was carried out to find the effect of fruit harvesting stage (October, November and December) on the physicochemical and antioxidant properties in five kiwi cultivars (Abbot, Bruno, Allison, Hayward, Monty). Results showed that soluble solid content (SSC) and pH increased while ascorbic acid (Vit C), titrated acidity (TAD) and SSC/TAD decreased in all the cultivars with delay in harvesting. Total polyphenols (TP) were decreased while total flavonoids (TF) increased in all tested cultivars with delay in harvesting. The highest concentration of TP (2.02 mg gallic acid equivalent/g fresh weight) and TF (51.12 mg catechin equivalent/100g FW) were found in cultivar 'Allison' in the month of October and December, respectively. Antioxidant activities (AA) were genotype depended and no trend was observed with month of harvesting. Principal component analysis (PCA) showed strong correlation between Vit C, TP and antioxidant activities. Two major clusters were computed using agglomerative hierarchical clustering (AHC). All the studied important traits may be used in the breeding programmes to increase the variability for different physiochemical and antioxidative characteristics and to make suitable selections that could be acceptable to consumers.

Evaluation of Phenolic contents and Antioxidant potential of Murraya Koenigii (L) spreng roots.

The present study was to evaluate the antioxidant potential of ethanol extract from roots of Murraya koenigii. Ethanol extract of roots was used to study their total phenolic and flavonoid contents and antioxidant including radical scavenging of 1,1-Diphenyl-2-picrylhydrazyl (DPPH) and nitric oxide. The ethanol extract showed significant results, Total phenolic contents were estimated to be equivalents to 51.23 ± 2.53mg of gallic acid equivalent and total flavonoid contents were 43.58 ± 1.89mg of catechin/g equivalent. The percentage of DPPH and NO scavenging activity increased with increasing various concentration of extract.

Ion-exchange resin complexation: Masking the bitter taste of cefuroxime axetil / Complejación de la resina de intercambio de iones: enmascaramiento del sabor amargo de cefuroxime acetil

OBJECTIVE: the purpose of this research was to formulate taste masked complexes of cefuroxime axetil and to evaluate them for taste, drug loading and characterized by FTIR, XRD. Tablets were formulated of selected batches and evaluated for drug release and physical parameters. METHODS: complexation technique is used to prepare complexes of drug where ion exchange resins such as Indion® 214, Indion® 234 and Indion® 414 were used with a drug-resin ratio of 1:0.5, 1:1, 1:2. The drug resinates were characterized by Infrared Spectroscopy, DSC and X-Ray Diffraction pattern and evaluated for drug loading and taste. Direct compression method was used to formulate tablets. In vitro dissolution was carried out using USP II apparatus. RESULT: potential taste masking increased with increasing concentration of resin. Indion® 214 resin showed better taste masking effect as compared to Indion® 234 and Indion® 414. Percent of drug loading was maximum at drug : resin ratio of 1:1, after that it decreased. Prolonged (upto 5 h) and slow drug release was observed with resin 214 at higher concentration. CONCLUSIONS: out of three resins chosen, Indion® 214 at higher concentration exhibit excellent taste masking as well as sustained drug release action.

OBJETIVO: el objetivo de esta investigación fue formular los complejos con sabor amargo de cefuroxime acetil y evaluarlos por sabor, carga medicamentosa y caracterización por FTIR, XRD. Las tabletas fueron formuladas a partir de lotes seleccionados y evaluados en busca de la liberación medicamentosa y parámetros físicos. MÉTODOS: la técnica de complejación se utilizó para preparar complejos farmacológicos donde las resinas de intercambio iónico como Indion® 214, Indion® 234 y el Indion® 414 se emplearon a una proporción resina-medicamento de 1:0.5, 1:1, 1:2. Los resinados medicamentosos fueron caracterizados mediante espectroscopia infrarroja, DSC y el patrón de difracción-rayos-X, y evaluados para determinar la carga medicamentosa y el sabor. El método de compresión directa fue empleado para formular las tabletas. Se efectuó una disolución in vitro utilizando el equipo USP II. RESULTADOS: el posible enmascaramiento del sabor aumentó con la creciente concentración de resina. La resina Indion® 214 mostró el mejor enmascaramiento del gusto amargo en comparación con Indion® 234 e Indion® 414. El porcentaje de carga medicamentosa fue máximo en el fármaco: proporción de la resina 1:1, después disminuyó. Se observó una liberación medicamentosa prolongada (hasta 5 h) y lenta con la resina 214 a una mayor concentración. CONCLUSIONES: de las 3 resinas escogidas, Indion®214 a una mayor concentración muestra un excelente enmascaramiento del sabor así como una mantenida acción liberadora del fármaco.

Undiagnosed purpura: a case of autoerythrocyte sensitization syndrome associated with dermatitis artefacta and pseudo-ainhum.

A 23-year-old young woman presented with recurrent episodes of painful bruising along with linear erosions on the accessible areas of the body of nine years duration with a pseudo-ainhum of her left nipple for the past three months. Her case history included repeated visits to various physicians at different centers and an extensive investigative profile. A diagnosis of autoerythrocyte sensitization was made on the basis of the clinical history, dermatological examination complemented by a positive autoerythrocyte sensitization test, psychiatric evaluation and absence of any organic cause for her ailment. She was placed on psychiatric management and has remained symptom-free after six months follow-up. The case is reported for its rarity, as well as for the association of autoerythrocyte sensitization syndrome with frank dermatitis artefacta and pseudo-ainhum, which to the best of our knowledge has not yet been reported in the literature.

Relapsing linear acantholytic dermatosis in a four-year-old boy.

Linear acantholytic dermatoses are a spectrum of cutaneous disorders that form a subset of linear dermatoses with distinct clinical features and histopathologically show acantholysis. The lesions may be zosteriform or follow the lines of Blaschko. This report describes a four-year-old boy who, on a follow up of two years, exhibited a relapsing acantholytic dermatosis along the lines of Blaschko. Histopathology of a representative lesion revealed epidermal acantholysis with multiple acantholytic keratinocytes with in the prickle cell layer and an absence of corp ronds and grains, consistent with features of Hailey-Hailey disease. This, to our knowledge, is the third case of relapsing linear acantholytic dermatosis reported.

Reiter's disease in a six-year-old girl.

Reiter's syndrome has characteristically been described in young males and presents with a triad of urethritis, conjunctivitis and arthritis. Reiter's syndrome has been known to affect children, although they usually do not manifest with the typical triad. Only a few such cases have been reported and these have described males predominantly. A case of a six-year-old girl who presented with watery diarrhea, redness of eyes and joint pains followed by skin involvement is reported. She was managed with topical salicylic acid and hydrocortisone, and oral aspirin and showed complete resolution of her clinical features in three weeks.

Cutaneous reactions in nuclear, biological and chemical warfare.

Nuclear, biological and chemical warfare have in recent times been responsible for an increasing number of otherwise rare dermatoses. Many nations are now maintaining overt and clandestine stockpiles of such arsenal. With increasing terrorist threats, these agents of mass destruction pose a risk to the civilian population. Nuclear and chemical attacks manifest immediately while biological attacks manifest later. Chemical and biological attacks pose a significant risk to the attending medical personnel. The large scale of anticipated casualties in the event of such an occurrence would need the expertise of all physicians, including dermatologists, both military and civilian. Dermatologists are uniquely qualified in this respect. This article aims at presenting a review of the cutaneous manifestations in nuclear, chemical and biological warfare and their management.

Role of the Parasight-F test in the diagnosis of complicated Plasmodium falciparum malarial infection

An evaluation was made of the diagnostic efficacy and utility of the Parasight-F test in diagnosing Plasmodium falciparum malaria, compared with conventional microscopy, particularly in severe and complicated cases. This study was designed as a prospective, case control hospital-based study. Febrile patients suspected to be suffering from malaria were selected randomly and were subjected to peripheral smear examinations (thick and thin) and Parasight-F tests till the required number of at least 30 cases of P. falciparum infection were identified, including at least 15 complicated cases. In addition 20 cases of P. vivax malarial infection as well as 20 healthy age and sex-matched individuals were taken as two control groups. The outcome measure was the number of cases with positive Parasight-F test results compared with conventional microscopy. Thirty-two patients with P. falciparum malaria were identified, with 15 severe and complicated cases. Peripheral smears were positive in 29 (91 percent) of these, while parasight-F test was positive in 31 out of 32 (97 percent) cases. Parasites were detected only by bone marrow examination in one case. Diagnostic sensitivity and specificity of peripheral smears for detecting falciparum infection were 90.6 percent and 100 percent respectively while that of the Parasight-F test were 96.8 percent and 100 percent, respectively (P>.05). The Parasight-F test has high sensitivity and specificity in diagnosing P. falciparum malarial infection, comparable to or even higher than microscopy exams, particularly in severe and complicated cases, with additional advantages of speed, simplicity and objectivity.