High-Resolution Ultrasound in Evaluation of Peripheral Neuropathy in Patients of Hansen's Disease.

Introduction: Hansen's disease (HD) is a major public health problem in developing countries. It causes peripheral neuropathy, and if left untreated, it leads to deformities. It is important to diagnose such cases early, and prompt treatment should be given to patients to preserve nerve function. Materials and Methods: A total of 40 patients with HD who were already on multi-drug therapy (MDT) or treatment-naive were included in this study. These were clinically diagnosed cases of HD as per the Ridley-Jopling classification, and these patients were subjected to high-resolution ultrasonography (HRUS). A total of 19 controls were also included. The patients were clinically evaluated, and HRUS of bilateral ulnar nerves (UNs) was performed in all cases and controls. The other peripheral nerves, if clinically thickened, were evaluated using HRUS. Results: The cross-sectional area (CSA) of the UN in cases was significantly thickened as compared to controls. There was no difference in the CSA of patients on MDT as compared to treatment naïve patients. In two patients with pure neuritic HD, the clinical examination missed the bilateral nerve enlargement, and only unilateral nerve thickening was clinically appreciated. However, bilateral thickening was detected on HRUS. Conclusion: HRUS is a non-invasive and sensitive diagnostic tool that gives significant information on nerve structure and morphology. HRUS adds a new dimension to diagnosing HD, particularly the pure neuritic type, with the assessment of early nerve damage, which can prevent disabilities. HRUS is an objective diagnostic tool that can complement the clinical examination.

Comparison of efficacy of platelet-rich plasma therapy with or without topical 5% minoxidil in male-type baldness: A randomized, double-blind placebo control trial.

BACKGROUND: Male-type baldness is a common chronic hair loss disorder among males. Male type baldness is characterized by stepwise miniaturization of the hair follicle, due to alteration in the hair cycle dynamics, leading to transformation of the terminal hair follicle into a vellus one. Platelet-rich plasma (PRP) seems to be a new technique which may improve hair regrowth. We planned a randomized, double-blinded placebo control trial to see the efficacy of PRP with and without topical minoxidil and to compare with placebo and standard treatment. MATERIALS AND METHODS: The study design was a randomized, double-blind placebo control trial. The sample size was calculated, and randomization was done. Patients with male type baldness were allocated into four groups; first group topical minoxidil only, the second group PRP with minoxidil, the third group normal saline (NS), and fourth group PRP only. Interventions were done monthly for 3 months and patients were followed up for the next 2 months. Effects of interventions were assessed by hair density, patient self-assessment, and clinical photography. RESULTS: A total of 80 patients were included. The maximum improvement was found in PRP with minoxidil group. Increase in hair density (in descending order) was PRP with minoxidil group, PRP-alone group, minoxidil-alone group, while a decrease in hair density was found in NS group, after 5 months. The maximum patient satisfaction was found in PRP with minoxidil group followed by (in descending order), PRP-alone group, minoxidil-alone group, and NS group. LIMITATION: Long-term follow up of patients was not done. Hair counts and hair thickness estimation were not estimated. CONCLUSION: In our study, we found PRP with topical minoxidil is more effective than PRP alone and topical minoxidil alone.

Epitope imprinting of Mycobacterium leprae bacteria via molecularly imprinted nanoparticles using multiple monomers approach.

Mycobacterium leprae causes endemic disease leprosy which becomes chronic if not treated timely. To expedite this 'timely diagnosis', and that also at an early stage, here an attempt is made to fabricate an epitope-imprinted sensor. A molecularly imprinted polymer nanoparticles modified electrochemical quartz crystal microbalance sensor was developed for sensing of Mycobacterium leprae bacteria through its epitope sequence. Multiple monomers, 3-sulphopropyl methacrylate potassium salt, benzyl methacrylate and 4-aminothiophenol were utilized to imprint this bacterial epitope. Imprinted nanoparticles were electropolymerized on gold coated quartz electrode. The sensor was able to show specific binding towards the blood samples of infected patients, even in the presence of 'matrix' and other plasma proteins such as albumin and globulin. Even other peptide sequences, similar to epitope sequences only with two amino acid mismatches were also unable to show any binding. Sensor withstood analytical tests viz. selectivity, specificity, matrix effect, detection limit (0.161 nM), quantification limit (and 0.536 nM), reproducibility (RSD 2.01%). Hence a diagnostic tool for bacterium causing leprosy is successfully fabricated in a facile manner which will broaden the clinical access and efficient population screening can be made feasible.

Relapse in psoriasis with two different tapering regimens of methotrexate: a randomized open-label controlled study.

UNLABELLED: Background : Systemic therapy with methotrexate is a very useful modality in psoriasis, but relapses can occur soon after stopping it. Aim : To compare the relapse rates in psoriasis with two different tapering regimens of methotrexate after control is achieved. Methods : This was a randomized open-label controlled study, and patients of chronic plaque psoriasis with psoriasis area and severity index (PASI) >10 were included. Methotrexate 0.3 mg/kg weekly was given and the PASI calculated every 2 weeks. After achieving a 75% reduction in the PASI (PASI-75), patients were assigned randomly in to one of three groups. In the half-dose group, the dose of methotrexate was reduced to half and given weekly; in the 2-weekly group, the same dose was given at 2-week intervals; in the control group, methotrexate was stopped. Patients were followed up for 12 weeks. Results : Out of 141 registered patients, 81 were included: 27 in the half-dose group, 28 in the 2-weekly group, and 26 in the control group. After further exclusions due to adverse effects and loss to follow-up, the results were analysed for 16, 17 and 19 patients respectively in the 3 groups. There was statistically a highly significant difference in relapse rates between the half-dose and control groups (P < 0.001), and a significant difference between the 2-weekly and control groups (P = 0.001). Relapse rates in the half-dose and 2-weekly groups did not show a significant difference (P = 0.680). LIMITATION: Many (35.8%) patients were excluded and only 52 (64.2%) completed the study. CONCLUSION: There appears to be no significant difference in the frequency of relapse in psoriasis whether methotrexate is tapered by halving the weekly dose or by doubling the interval between two doses, and both methods led to fewer relapses than abrupt cessation of the drug.

Type 2 lepra reaction in an immunocompromised patient precipitated by filariasis.

Though patients affected with both acquired immuno deficiency syndrome (AIDS) and leprosy commonly present with type 1 lepra reaction, there are few isolated reports of type 2 lepra reaction in retropositive patients affected with leprosy. We are presenting a case report of 35-year-old male affected with AIDS, tubercular lymphadenitis, and lepromatous leprosy with recurrent episodes of type 2 lepra reaction manifesting as erythema nodosum leprosum (ENL). Dipstick enzyme-linked immunosorbent assay (ELISA) for filarial antigen was also positive. The patient was treated with 100 mg thalidomide daily, 300 mg diethylcarbamazine, and modified multidrug therapy (MDT) for leprosy. He responded well and has not had any further reaction in the last 6 months.