Androgenetic Alopecia: update on Etiology, Pathophysiology, Diagnosis and Treatment

Alopecia means loss of hair. Androgenetic alopecia (AGA) now called as patterned hair loss (male pattern hair loss; MPHL, female pattern hair loss; FPHL) is caused by androgens in a predisposed individual. It is modulated by factors like age, sex, genes, smoking, and alcohol. If untreated this leads to psychological problems like stress, anxiety, depression and decrease self-confidence which affect quality of life. A thorough clinical examination and a certain hormonal estimation could reveal levels of androgens, hyperandrogenism, adrenal hyperplasia, (PCOS) polycystic ovarian syndrome, and ovarian/adrenal tumors. A simple Trichoscopy could show the typical picture of hair miniaturization commonly seen in this condition. Finally, a biopsy of the scalp could help in clinching conclusive diagnosis. Out of the many treatments at our disposal, the non-pharmacologic methods like temporary camouflage techniques, synthetic hair wigs, hair-thickening fibers, hair weaving, pigmented powders are useful. Semi-permanent options like scalp micro-pigmentation (thorough tattooing) are useful to enhance appearances. Presently the United States Food and Drug Administration (USFDA) approved pharmacologic treatments are Minoxidil and Finasteride. The non-USFDA approved methods of treatments like various surgical procedures {[hair transplantation]: follicular unit transplantation (FUT), follicular unit extraction (FUE), microneedling, light therapy, indigenous medicines, Platelet-Rich Plasma (PRP)}, and various loco-regional hair care practices are in vogue. The outcome of this review is to offer the latest update and insights into the newer novel therapies in patterned hair loss. Also, the patients could enhance their knowledge about the condition, the benefits and prognosis of each treatment.

Effective adsorption of drug from aqueous solution using citric acid functionalized magnetite nanoparticles and their antibacterial studies

The synthesis of magnetite nanoparticles and their applications after surface modification have drawn in the eye of researchers toward it all through the previous a few times. In the present study, the synthesis of citric acid-modified magnetic nanoparticles has been reported. Numerous technical approaches such as x-ray diffraction, field emission scanning electron microscopy, thermogravimetric analysis and fourier transform infrared spectroscopy were accustomed to characterize these synthesized magnetite nanoparticles. The main emphasis of this examination was to study the adsorption behavior of these synthesized nanoparticles for ciprofloxacin drug from aqueous solution. The influences of various experimental parameters including pH, the contact time, amount of nanoparticles and initial concentration of ciprofloxacin drug, were investigated simultaneously. Moreover, isotherm study was observed to follow Langmuir isotherm model and the value of maximum adsorption capacity was 20.65 mg/g as calculated. Furthermore, the kinetic study was found to fit well with pseudo-second-order kinetics model. The overall study suggested that these functionalized magnetite nanoparticles can be utilized as a proficient tool for the adsorption of drug from aqueous solution. The antibacterial behavior of these drug loaded nanoparticles was also scrutinized.

Protocol paper: kainic acid excitotoxicity-induced spinal cord injury paraplegia in Sprague-Dawley rats

BACKGROUND: Excitotoxicity-induced in vivo injury models are vital to reflect the pathophysiological features of acute spinal cord injury (SCI) in humans. The duration and concentration of chemical treatment controls the extent of neuronal cell damage. The extent of injury is explained in relation to locomotor and behavioural activity. Several SCI in vivo methods have been reported and studied extensively, particularly contusion, compression, and transection models. These models depict similar pathophysiology to that in humans but are extremely expensive (contusion) and require expertise (compression). Chemical excitotoxicity-induced SCI models are simple and easy while producing similar clinical manifestations. The kainic acid (KA) excitotoxicity model is a convenient, low-cost, and highly reproducible animal model of SCI in the laboratory. The basic impactor approximately cost between 10,000 and 20,000 USD, while the kainic acid only cost between 300 and 500 USD, which is quite cheap as compared to traditional SCI method. METHODS: In this study, 0.05 mM KA was administered at dose of 10 µL/100 g body weight, at a rate of 10 µL/min, to induce spinal injury by intra-spinal injection between the T12 and T13 thoracic vertebrae. In this protocol, detailed description of a dorsal laminectomy was explained to expose the spinal cord, following intra-spinal kainic acid administration at desired location. The dose, rate and technique to administer kainic acid were explained extensively to reflect a successful paraplegia and spinal cord injury in rats. The postoperative care and complication post injury of paraplegic laboratory animals were also explained, and necessary requirements to overcome these complications were also described to help researcher. RESULTS: This injury model produced impaired hind limb locomotor function with mild seizure. Hence this protocol will help researchers to induce spinal cord injury in laboratories at extremely low cost and also will help to determine the necessary supplies, methods for producing SCI in rats and treatments designed to mitigate post-injury impairment. CONCLUSIONS: Kainic acid intra-spinal injection at the concentration of 0.05 mM, and rate 10 µL/min, is an effective method create spinal injury in rats, however more potent concentrations of kainic acid need to be studied in order to create severe spinal injuries.

Evaluation of Functional Outcome of Laminectomy and Laminotomy for The Surgical Management of Lumber Spine Stenosis: An Institutional Based Study

Background: Lumbar spinal stenosis (LSS) is commonly seenin the elderly especially owing to the aging of the spine.Growing in the facet joints, ligamentum flavum hypertrophy,disc degeneration, and osteophytes cause the spinal canal toconstrict and accordingly result in spinal cord and nerve rootcompression. If conservative treatments fail, surgicalintervention will be considered as the next treatment. Surgicaldecompression for LSS is indicated in a patient with intractablepain, neurogenic claudication, and motor weakness,accompanied by compromised spinal canal. Laminectomy forLSS is considered the standard surgical option to which othertechniques are compared. Ascertaining superiority of adecompression technique necessitates establishing if anydifferences exist in the complication rates and the functionaland symptomatic outcomes.Aim of the Study: To evaluate functional outcome oflaminectomy and laminotomy for the surgical management oflumber spine stenosis.Materials and Methods: The present study was conducted inthe Department of Orthopaedics, NIIMS Medical College,Jaipur, Rajasthan, India. For the study, patients with confirmedLSS (both lateral and/or central) on MR imaging who had failedconservative management, were considered for operativemanagement. Patients with spondylolisthesis, or scoliosis andthose who had undergone fusion, discectomies or furtherrevisions were excluded from the study. Following exclusions,50 patients were enrolled; 30 underwent a laminectomy withoutfusion and 20 underwent either a bilateral or unilaterallaminotomy.Results: We observed that VAS pain score decreased 6weeks post operatively for patients who underwentlaminectomy and laminotomy, however there was slightincrease in the pain score at 1-year post operatively. Theresults on comparison were found to be statically significant.Conclusion: Within the limitations of the present study, it canbe concluded that both surgeries were equally effective inimproving pain and disability.

Dystrophic Scoliosis With Rib Head Dislocation Into Spinal Canal In Neurofibromatosis-1 And Its Surgical Management: A Case Report

Neurofibromatosis-1(NF-1) is one of the most common single-gene disorders in humans. Patients with NF-1 may present with a wide variety of clinical manifestations. Spinal deformity is the most common musculoskeletal manifestation of NF-1. Rib head dislocation into the spinal canal is not a common entity but if left untreated can lead to serious neurological complications. The present report describes thoracolumbar dystrophic scoliosis with rib head dislocation into the spinal canal in a 28-year-old male who presented with complaint of spinal deformity with gait disturbance. Cobb angles measured 92 degrees of scoliosis (T9-L2), and 110 degrees of kyphosis and also highlights the importance of preoperative planning and radiological imaging for the successful surgical outcomes and our experience of single-stage posterior deformity correction with pedicle screw construct along with rib head excision

Capillary versus Serum b-hydroxybutyrate in Pediatric Diabetic Ketoacidosis

Objective:To find the strength of agreement between point-of-care and serum β-hydroxybutyrate. Methods: 236 paired samples (capillary β-hydroxybutyrate by a point ofcare device and serum β-hydroxybutyrate by colorimetric enzymatic estimation) sampleswere collected from 26 children aged <13 years admitted with diabetic ketoacidosis. Inbornerrors of metabolism and septic shock were excluded. Results: Capillary β-hydroxybutyrateshowed excellent agreement with serum â-hydroxybutyrate with mean (SD) bias of 0.027(0.78); 95% limit of agreement -1.51, 1.56 and intraclass correlation 96.1% (95%CI 95%–97%, P<0.001). An increase in the bias noted for value above 5 mmol/L (P<0.001) (serummeasurements were higher than capillary point-of-care measure-ments). Capillary â-hydroxybutyrate correlated significantly with blood pH, anion gap,bicarbonate and carbondioxide levels on blood gas analysis (P<0.05). Conclusions: Capillary β-hydroxybutyrateestimation is a valid method for monitoring of ketonemia in pediatric diabetic ketoacidosis

Evaluation of Risk of Development of Fractures in Diabetes Patients: An Observational Study

Background: Osteoporosis is mostly common amongstpostmenopausal females, leading to an increased lifetime riskof vertebral, hip and wrist fractures, approximately around40%. The present study evaluated the risk of fracture amongstdiabetic subjects.Materials and Methods: The presence of co-morbiditiesamongst the subjects like osteomyelitis, renal disease anddepression were noted amongst the patients. They weredivided according to the age group. All the fractures weremanaged by closed reduction and immobilized according to thesite of fracture. Chi square test was used for statisticalanalysis. Probability value of less than 0.05 was regarded assignificant.Results: There were 64% males and 36% females amongstnon-diabetics and 65% females and 35% males amongstdiabetics. There were 165 diabetics with osteomyelitiscompared to only 25 diabetics with osteomyelitis. Depressionwas seen amongst 1% non-diabetics and 2% diabetics. Therewere 5 non diabetics and 20 diabetics with renal disease.There was a significant difference between the groups as the pvalue was more than 0.05.Conclusion: In our study there was a significant effect of comorbidities amongst the diabetics that lead to increasedincidence of fracture amongst them.

Falknor's needling method as a potential immunotherapy in palmo-plantar warts

Background and Aim: Treatment of palmoplantar warts is a challenge for dermatologists. We aimed to study the efficacy and safety of Falknor's needling method in palmoplantar warts. Methods: In an open, nonrandomized study, the index wart of eligible patients was punctured several times with a 26-gauge needle to produce a “beefy” red wound. Patients were followed up to 6 months. Results: Out of 82 patients, complete resolution occurred in 58 (70.7%) and partial response in 5 (6.1%) patients. Nine (10.9%) patients developed secondary infection. Limitations: Small sample size, No comparison group. Conclusion: Falknor's needling method provides a high rate of complete resolution after a single treatment session. It is easy to perform and is cost effective.

Invitro Evaluation Of Laws Of Pulp Chamber Anatomy In North Kerala Population In India

Context: This study was conducted in the department of Conservative Dentistry and Endodontics , Govt Dental College Calicut to evaluate the anatomy of the pulp chamber and the pulp chamber oor in North Kerala population in India and to see if specic, consistent landmarks or congurations exist and are quantifiable. Aims: 1. To observe the anatomy of the pulp chamber and the pulp chamber oor. 2. To study the relationships of the pulp chamber to the clinical crown and relationship of the orice on the pulp chamber oor. 3. To verify the anatomic laws of pulp chamber anatomy in North Kerala population Settings and Design: Sixty extracted permanent molars were collected from the Department of Oral & Maxillofacial Surgery, Govt. Dental College Calicut The teeth were divided into three groups (i) 20 mandibular molar teeth with three root canals (ii) 20 mandibular molar teeth with four root canals (iii) 20 maxillary molar teeth Methods and Material: All teeth were sectioned at the level of cement enamel junction (CEJ )by using micromotor with straight handpiece and diamond disk so that the outline of the pulp chamber relative to the CEJ could be observed. Each cut section was irrigated with water, dried and examined. The teeth were analyzed at National Institute of Technology, Calicut under stereomicroscope and digital photographs were taken to record observed anatomical relationship. Statistical analysis used: Observations were statistically analysed using SPSS17 software Results, Conclusions : The present study shows that laws regarding the location of orices, namely law of orice location 1,2 and 3 were also found to be valid after the teeth were viewed under stereomicroscope.

Application of HPLC and ESI-MS techniques in the analysis of phenolic acids and flavonoids from green leafy vegetables (GLVs) / 药物分析学报

Diets containing high proportions of fruits and vegetables reduce the risk of onset of chronic diseases.The role of herbal medicines in improving human health is gaining popularity over the years,which also increases the need for safety and efficiency of these products.Green leafy vegetables(GLVs)are the richest source of phenolic compounds with excellent antioxidant properties. Increased consumption of diets containing phenolic compounds may give positive and better results to human health and significantly improves the immune system.Highly selective,susceptible and versatile analytical techniques are necessary for extraction,identifica-tion, and quantification of phenolic compounds from plant extracts, which helps to utilize their important biological properties. Recent advances in the pre-treatment procedures, separation techniques and spectro-metry methods are used for qualitative and quantitative analysis of phenolic compounds.The online coupling of liquid chromatography with mass spectrometry(LC–MS)has become a useful tool in the metabolic profiling of plant samples.In this review,the separation and identification of phenolic acids and flavonoids from GLVs by LC–MS have been discussed along with the general extraction procedures and other sources of mass spectrometer used. The review is devoted to the understanding of the structural configuration, nature and accumulation pattern of phenolic acids and flavonoids in plants and to highlighting the recent developments in the chemical investigation of these compounds by chromatographic and spectroscopic techniques.It concludes with the advantages of the combination of these two methods and prospects.

Giant Condyloma Acuminatum of the Anorectum : Surgical or Topical Treatment.

Giant condyloma (Buschke-Loewenstein tumour) is a rare disease that commonly affects the urogenital area. We encountered an eighteen year old, nonhomosexual, HIV negative, male, who presented with a cauliflower like warty mass around perianal region. The mass was 8×6 cm in size, circumferential, soft and papillary in nature. Wide excision of mass was carried out with anoplasty reconstruction. Post-operatively, wound healing was uneventful. After wound healing, the topical applications of five percent imiquimod were done regularly under the care of dermatologist for three months. At six months of follow-up, patient is free from tumour, and is having neither signs of anal stenosis nor incontinence.

Induction of resistant mutants of Salmonella enterica serotype Typhi under ciprofloxacin selective pressure.

Background & objectives: Infection with Salmonella enterica serovar Typhi (hereafter S. Typhi) is an important public health problem in India. There has been an increase in the number of reported clinical failures to ciprofloxacin treatment but the data on possible mechanism of failure are limited. One mechanism that has been widely reported and found associated with ciprofloxacin resistance, is the mutations in target genes in QRDR (quinolone resistance determining region). It is hypothesized that mutations in DNA gyrase or topoisomerase IV result in therapeutic failure under selective pressure of antibiotic while the patient is on treatment. We undertook in vitro sequential selection studies to expose the clinical isolates of S. Typhi to different concentration of ciprofloxacin to study the role of antibiotic selective pressure in the development of mutations in QRDR. Methods: Total 26 clinical isolates were divided in to two parts: part I included six isolates obtained from three patients with relapse of enteric fever and part II included 20 isolates with different ciprofloxacin MIC levels. For in vitro induction of mutation experiment, five S. Typhi isolates were selected which included three NAS (nalidixic acid sensitive) and 2 NAR (nalidixic acid resistant) S. Typhi. These isolates were grown under increasing concentrations of ciprofloxacin and mutations acquired in QRDR of DNA gyrase (gyrA and gyrB) and topoisomerase IV (parC and parE) were investigated by sequencing. Results: For the isolates included in the part I of the study, it was found that the MIC to ciprofloxacin increased in the isolates obtained during the relapse of enteric fever as compare to the first isolate. All isolates had single mutation in gyrA gene at S83 without additional mutation in the second isolate. In the second part of the study, the nine isolates with varying MICs to ciprofloxacin also had single mutation in gyrA gene at S83 and another six had triple mutations, two mutations in gyrA gene (at S83 and D87) and one mutation in parC gene (at S80). In in vitro induction of mutation experiment, all mutated isolates showed triple mutation (two mutation in gyrA and one in parC gene) while no mutations were found in wild isolates. Interpretation & conclusions: Upon exposure to the step-wise increased concentration of ciprofloxacin, isolates become more tolerant to the ciprofloxacin and showed 2-4 fold higher MICs without new mutation after 8 μg/ml. So the accumulation of mutations under continuous ciprofloxacin pressure and tolerance of the mutant isolates led to the clinical failure. These results also suggested that there could be another mechanism responsible for resistance.

Cardiac surgery during pregnancy: Continuous fetal monitoring using umbilical artery Doppler flow velocity indices.

The fetal death rate associated with cardiac surgery with cardiopulmonary bypass (CPB) is as high as 9.5‑29%. We report continuous monitoring of fetal heart rate and umbilical artery flow‑velocity waveforms by transvaginal ultrasonography and their analyses in relation to events of the CPB in two cases in second trimester of pregnancy undergoing mitral valve replacement. Our findings suggest that the transition of circulation from corporeal to extracorporeal is the most important event during surgery; the associated decrease in mean arterial pressure (MAP) at this stage potentially has deleterious effects on the fetus, which get aggravated with the use of vasopressors. We suggest careful management of CPB at this stage, which include partial controlled CPB at initiation and gradual transition to full CPB; this strategy maintains high MAP and avoids the use of vasopressors. Maternal and fetal monitoring can timely recognize the potential problems and provide window for the required treatment.

Prevalence and clinical patterns of psoriatic arthritis in Indian patients with psoriasis.

Background: The prevalence and clinical patterns of psoriatic arthritis (PsA) varies in different parts of the world and there is little clinical and epidemiological data from the Indian subcontinent. Aims: Our study was designed to evaluate the prevalence and clinical patterns of PsA in Indian patients. Methods: This was a non-interventional, cross-sectional study, in which 1149 consecutive psoriasis patients seen over 1 year were screened for PsA according to classification of psoriatic arthritis (CASPAR) criteria. Demographic and disease parameters were recorded including Psoriasis Area and Severity Index (PASI), Nail Psoriasis Severity Index (NAPSI), and number of swollen and tender joints. Results: Among 1149 patients with psoriasis, 100 (8.7%) patients had PsA, of which 83% were newly diagnosed. The most common pattern was symmetrical polyarthritis (58%), followed by spondyloarthropathy 49%, asymmetric oligoarthritis (21%), isolated spondyloarthropathy (5%), predominant distal interphalangeal arthritis (3%), and arthritis mutilans (1%). Enthesitis and dactylitis were present in 67% and 26% of cases, respectively. The mean number of swollen and tender joints were 3.63 ± 3.59 (range, 0-22) and 7.76 ± 6.03 (range, 1-26), respectively. Nail changes were present in 87% of the cases. The median PASI and NAPSI of the subjects with PsA was 3.6 and 20, respectively. There was no significant correlation of number of swollen/tender joints with PASI or NAPSI. Conclusion: There is a relatively low prevalence of PsA among Indian psoriasis patients presenting to dermatologists. No correlation was found between the severity of skin and nail involvement and articular disease

Ultrasound imaging versus conventional histopathology in diagnosis of periapical lesions of endodontic origin: A comparative evaluation.

Context: Accurate assessment of periapical status is critical in diagnosis, treatment planning, and evaluation of healing. Novel imaging modalities like sonography offer promising results with reduced radiation risks. Aims: To evaluate the potential of ultrasound imaging technique together with the application of color Doppler to differentiate between periapical lesions of endodontic origin. Materials and Methods: Twenty patients with periapical lesions of endodontic origin who were already scheduled for undergoing endodontic surgery were examined further using sonography. Color Doppler was performed to assess blood flow. Information on the size of the lesion, its content, and vascular supply was gained and recorded by means of ultrasound images. The sonographic images were analyzed and discussed with an expert sonologist, and a tentative diagnosis between a periapical cyst and periapical granuloma was made. Endodontic surgery and histopathological examination was done for each case and the results were compared. Results: The sonograms revealed the lesions within the bone in three dimensions and their contents, that is, fluids or tissues or blood vessels. Measurements of the periapical lesions in three dimensions were also obtained. Of the twenty cases studied, ultrasound could detect periapical granulomas in all 9 cases and radicular cysts in all 11 cases. Conclusion: Ultrasound imaging had the potential to be used for the evaluation of periapical lesions of endodontic origin. However, further studies are required to establish a definite correlation.

Pharmacognostical study and establishment of quality parameters of aerial parts of Costus speciosus-a well known tropical folklore medicine

Objective: To evaluate the diagnostic pharmacognostical characters of Costus speciosus (aerial parts) along with their physico-chemical parameters and fluorosence analysis.Method:microscopy, powder microscopy, leaf constant, fluorescence analysis and preliminary phytochemical investigation.Results:The findings of macroscopy revealed that leaves elliptic to oblong or oblong-lancoelate, The pharmacognostical characters were determined in terms of macroscopy, thick, spirally arranged, with stem clasping sheaths up to 4 cm, flowers large, white, cone-like terminal spikes, with bright red bracts. Transverse section of leaflet showed the presence of cuticularised epidermis with polygonal cells on adaxial surface and bluntly angled cells on abaxial surface of lamina, mesophyll cells differentiated in to single layered palisade cells on each surface and 2-3 layered spongy parenchyma, unicellular and uniseriate multicellular covering trichomes, paracytic stomata and vascular bundles surrounded by sclerenchymatous multicellular sheath. Preliminary phytochemical screening exhibited the presence of various phytochemical groups like alkaloids, glycosides, steroids, phenolic constituents. Further, the leaf constants, powder microscopy and fluorescence characteristics indicated outstanding results from this investigationConclusions:Various pharmacognostical and physico-chemical parameters have pivotal roles in identification, authentication and establishment of quality parameters of the species.

Oral multiunit pellet extended release dosage form: A review.

Oral drug delivery is the most preferred route for the various drug molecules among all other routes of drug delivery, because ease of administration which lead to better patient compliance. So, oral extended release drug delivery system becomes a very promising approach for those drugs that are given orally but having the shorter half-life and high dosing frequency. Recent trends indicate that multiparticulate drug delivery systems are especially suitable for achieving extended release oral formulations with low risk of dose dumping, flexibility of blending to attain different release patterns as well as reproducible and short gastric residence time. The release of drug from pellets depends on a variety of factors including the carrier used to form pellets and the amount of drug contained in them. Consequently, pellets provide tremendous opportunities for designing new controlled and extended release oral formulations, thus extending the frontier of future pharmaceutical development.

Multiple locus sequence typing of Salmonella Typhi, isolated in north India - a preliminary study.

Background & objectives: In India enteric fever is a major public health problem and Salmonella Typhi is the most common aetiologic agent. Any control strategy for such infections depends to a large extent on the understanding of the disease and relatedness of strains across the world. Multi locus sequence typing (MLST) is one such method of genotyping of bacteria based upon housekeeping genes of known function and chromosome position. MLST data of pathogens are important to determine the molecular evolution by a stable and reproducible method. This study was undertaken to determine the sequence types of representatives S. Typhi isolates obtained from enteric fever patients in a tertiary care centre in north India, over a period of 20 years (1990-2010). Methods: A total of 30 representative isolates of S. Typhi identified by biochemical and serological tests were subjected to multi locus sequence typing (MLST). Seven housekeeping genes of known function and chromosome position were used for the typing by MLST. Sequencing was carried out by using an automated DNA sequencer and results were analyzed to generate phylogenetic tree. Results: MLST pattern grouped S. Typhi into two sequence types- ST1 and ST2. ST1 was predominantly present followed by ST2. Interpretation & conclusions: By MLST the presence of both sequence types, ST1 and ST2, was found in S. Typhi isolates in our region. Predominately ST1 was present followed by ST2. These preliminary results corroborate the global distribution of both sequence types of S. Typhi and also emphasize for the continuous screening of S. Typhi.

Oral multiunit pellet extended release dosage form: A review.

Oral drug delivery is the most preferred route for the various drug molecules among all other routes of drug delivery, because ease of administration which lead to better patient compliance. So, oral extended release drug delivery system becomes a very promising approach for those drugs that are given orally but having the shorter half-life and high dosing frequency. Recent trends indicate that multiparticulate drug delivery systems are especially suitable for achieving extended release oral formulations with low risk of dose dumping, flexibility of blending to attain different release patterns as well as reproducible and short gastric residence time. The release of drug from pellets depends on a variety of factors including the carrier used to form pellets and the amount of drug contained in them. Consequently, pellets provide tremendous opportunities for designing new controlled and extended release oral formulations, thus extending the frontier of future pharmaceutical development.