Realizing avalanche criticality in neuromorphic networks on a 2D hBN platform.

Networks and systems which exhibit brain-like behavior can analyze information from intrinsically noisy and unstructured data with very low power consumption. Such characteristics arise due to the critical nature and complex interconnectivity of the brain and its neuronal network. We demonstrate a system comprising of multilayer hexagonal boron nitride (hBN) films contacted with silver (Ag), which can uniquely host two different self-assembled networks, which are self-organized at criticality (SOC). This system shows bipolar resistive switching between the high resistance state (HRS) and the low resistance state (LRS). In the HRS, Ag clusters (nodes) intercalate in the van der Waals gaps of hBN forming a network of tunnel junctions, whereas the LRS contains a network of Ag filaments. The temporal avalanche dynamics in both these states exhibit power-law scaling, long-range temporal correlation, and SOC. These networks can be tuned from one to another with voltage as a control parameter. For the first time, two different neural networks are realized in a single CMOS compatible, 2D material platform.

Evaluating diagnostic utility of PAS stained skin scrape cytology smear in clinically suspected superficial cutaneous mycoses: A simple yet unpracticed technique.

Background and Objectives: For fungal dermatitis, a wet Potassium Hydroxide (KOH) preparation of the skin scrapings forms the routine practice for diagnosis. This study was carried out to determine the diagnostic accuracy and to evaluate the value-added information of PAS-stained scrape cytology smear in evaluating the presence of fungal elements. Methods: This prospective study was carried out on the patients clinically diagnosed with superficial cutaneous mycoses. For each patient, a wet KOH preparation and one PAS-stained skin scrape cytology (SSC) smear was prepared. Results: Out of the 52 suspected cases of superficial cutaneous mycoses, 50 showed fungal elements on either or both the techniques. The presentation was Tinea cruris together with Tinea corporis in 21 cases (42%), isolated tinea cruris in 19 cases (38%), tinea corporis in 8 cases (16%), and tinea corporis with tinea manuum and onychomycosis in 2 cases (4%). KOH preparation was positive in 45 out of 50 cases (90%) and SSC was positive in 49 out of 50 cases (98%). The sensitivity, specificity, positive predictive value, and negative predictive value for PAS-stained SSC smear was 98%, 100%, 100%, and 66% and that for KOH preparation was 90%, 100%, 100%, and 28%, respectively. Fungal elements quantity was graded on SSC smear as 1+(5), 2+(19), 3+(19), 4+(6), and in one case, it was negative. Conclusion: Incorporation of the PAS-stained SSC smear for fungal dermatitis ensures more efficient and confident diagnosis and the slides are available for archivable studies.

Formulation of Trichloroacetic Acid with Help of a Syringe.

We describe a unique method for formulating trichloroacetic acid (TCA) in different strengths with the help of a syringe.

Hand Glove: A Tool Not Used to Its Potential.

A hand glove is not only used to maintain sterility of the procedure but also to protect the physician from communicable diseases. A glove can be used in a variety of procedures, which are commonly performed in clinics. These help the doctor by serving as a tool in procedures and in cutting the cost of these procedures. A hand glove could be used in various innovative ways as highlighted in this article.

Bacillus Calmette-Guerin Immunotherapy for Recurrent Multiple Warts: An Open-Label Uncontrolled Study.

BACKGROUND: Cutaneous warts present a therapeutic challenge because of recurrence and multiplicity and may become a frustrating condition for both patients and physicians. In the past few years, there has been an increase in intralesional immunotherapy for recurrent multiple warts not only because of its encouraging results in the treatment but also due to its ability to clear distant warts and preventing recurrence. OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of intralesional bacillus Calmette-Guerin (BCG) vaccine immunotherapy in the treatment of recurrent multiple warts. MATERIALS AND METHODS: This study included 40 adult patients with multiple recurrent extragenital warts of different sizes, numbers, and duration, with or without distant warts. Patients were injected intralesionally with 0.1 ml BCG vaccine into the largest wart at a 3-week interval, directly without a pre-sensitization skin test, until complete clearance or for a maximum of three sessions. Follow-up was done every month for 3 months to detect any recurrence. RESULTS: Out of the 40 patients enrolled in the study, 34 patients completed the treatment protocol of three injections and 3 months of follow-up and six patients discontinued for various reasons. Complete clearance of the lesions was achieved in 25 (73.53%) patients, partial clearance in 8 (23.53%) patients, and no response in 1 (2.94%) patient. Complete response was demonstrated in 75% of those presenting with distant warts. Therapy-related side effects were mild in the form of pain during injection, itching, erythema at the site of injection, and flu-like symptoms. None of the patients with complete response showed recurrence of lesions in a 3-month follow-up period. CONCLUSION: Intralesional BCG immunotherapy is a safe, effective, and promising treatment modality for recurrent multiple warts.

A Pocket-Friendly and Sustainable Iontophoresis Apparatus for Palmoplantar Hyperhidrosis: Advancement over a Previously Described Homemade Design.

INTRODUCTION AND OBJECTIVES: Tap water iontophoresis is a promising therapy for palmoplantar hyperhidrosis. Non-affordability and nonavailability of the marketed device restrict its usage for many patients hailing from villages or small cities. MATERIALS AND METHODS: In an article named "A simple user-made iontophoresis device for palmoplantar hyperhidrosis" published previously in this journal, a simple inexpensive homemade device that runs on 12 V direct current battery was described. We made a small modification by using a 220-12 V alternate current to direct current semiconductor diode-based transformer for the current supply. RESULTS: The added innovation made the device lightweight, cheaper, and usable with domestic electric supply at home/clinic. Sustained supply of current at same voltage without dip and non-requirement to change/replace battery are added advantages. Cost of the whole assembly is ₹310. Working and clinical efficacy of our device were comparable to the commercially available apparatus as reported by 13 patients who received thrice a week of 15min sessions with our device. Mild electric pricking sensation was felt by all patients. Four of thirteen reported that pricking sensation was a bit more with our device as compared to the marketed device. No calibration for intensity is available in our device. CONCLUSION: This simple to assemble and inexpensive device makes iontophoresis applicable in many needy patients with similar efficacy and few limitations compared to expensive marketed devices.

De Novo Histoid Leprosy.

Histoid leprosy is an uncommon entity with specific clinical, histopathological and bacteriological features. Histoid lepromas are sudden eruption of dome shaped lesions usually associated with dapsone resistance, as a variant of lepromatous leprosy or rarely arising de novo. We report a case who presented for the first time with histoid features with no history of taking dapsone/antileprosy treatment earlier in an elderly male with small to large lesions over normal skin in the post-leprosy elimination era.

Misuse of topical corticosteroids: A clinical study of adverse effects.

BACKGROUND: Misuse of topical corticosteroids is a widespread phenomenon among young people in India, especially women. The practice is associated with significant adverse effects and poor awareness of these effects among the general public. AIM: This study was conducted to examine the misuse and adverse effects of topical corticosteroids among the people in Bastar region in Chhattisgarh state of India. MATERIALS AND METHODS: Data collected from patients presenting with at least one of the adverse effects of topical corticosteroids as the chief complaint, from November 2010 to October 2011. RESULTS: Out of the 6723 new patients, 379 (5.63%) had presented with misuse and adverse effects of topical corticosteroids, of whom 78.89% were females. More than 65% of the patients were in the age group 10-29 years. The main reason for using the topical corticosteroids was to lighten skin colour and treat melasma and suntan. Acne (37.99%) and telangiectasia (18.99%) were the most common adverse effects noted. CONCLUSIONS: Misuse of topical corticosteroids has a huge impact on dermatological practice, leading to a significant proportion of visits to the dermatologist. This hydra-headed problem needs multi-dimensional interventions, involving educational, legal and managerial approaches with cooperation from different sectors of society.

Loose anagen hair syndrome in black-haired Indian children.

Loose anagen hair syndrome (LAHS) is an uncommonly reported autosomal dominant hair disorder with incomplete penetrance that primarily affects children but is occasionally seen in adults. LAHS is characterized by the ability to easily and painlessly extract unsheathed anagen hairs from the scalp with gentle traction. The hair is sparse and does not grow long. Usually the hairs are not fragile and do not have areas of breakage. Initially it was considered a rare, sporadic condition found predominantly in young white girls with blonde hair. Because autosomal dominant inheritance has been reported, it was suspected that the condition might be equally common in boys but was probably underdiagnosed.

Adverse effects of multi-drug therapy in leprosy, a two years' experience (2006-2008) in tertiary health care centre in the tribal region of Chhattisgarh State (Bastar, Jagdalpur).

OBJECTIVE: To assess the adverse effects of multi drug therapy (MDT) in leprosy patients. METHODS: A prospective and descriptive study carried out in Department of Dermatology, Government Medical College, Jagdalpur. The adverse effects were recorded on the personal record of every individual patient, filled during the course of treatment. RESULTS: 176 patient's records were analysed, looking for adverse effects. Among the 176 patients, 79 had adverse effects due to one or more components of MDT, 73 had adverse effects due to dapsone, eight due to rifampicin and 16 due to clofazimine. Mean (+/- SD) duration for the development of adverse effects from the start of therapy was 1.99 (+/- 0.69) months for dapsone, 36 (+/- 0.68) months for rifampicin and 7.13 (+/- 0.79) months for clofazimine. There was a significant (P < 0.05) correlation between adverse effects and low Body Mass Index (BMI). The suspected drug was stopped and an alternative regime started in nine patients; six had dapsone stopped, two had rifampicin stopped and one had clofazimine stopped. CONCLUSION: Adverse effects attributed to MDT are comparable to previous studies and we found that ADR due to Dapsone was very high but most of the ADR were managed by supportive treatment without replacing the suspected drug.

Dermatological manifestations in HIV-infected patients at a tertiary care hospital in a tribal (Bastar) region of Chhattisgarh, India.

BACKGROUND: Cutaneous disorders during HIV infection are numerous and skin is often the first and only organ affected during most of the course of HIV disease. Some Cutaneous disorders reflect the progression of HIV disease; though the relation is still controversial. AIMS: The objective of this study, conducted at a tertiary care centre in Bastar, Jagdalpur, is to estimate the status of cutaneous manifestation in HIV-infected patients and its relationship with CD4 cell counts. METHODS: We enrolled 137 HIV positive subjects. Demographic information such as age, gender, weight, height, socioeconomic status, and educational status were recorded. Laboratory parameter (CD4 counts) and treatment regimen were noted. Patients were examined for skin disorders by a dermatologist. Data were analyzed using chi-square test for categorical variables. RESULTS: Majority of the patients were from rural area (65.69%) and belonged to a low socioeconomic and educational status. 30.65% of the patients were housewives, 23.35% drivers, and 16.78% labourers. Predominant mode of transmission was heterosexual contact (94.16%). Most common HIV-related dermatological manifestations were seborrheic dermatitis (74.16%), xerosis (52.5%), generalized skin hyperpigmentation 56 (46.67%), onychomycosis 53 (44.16%), pruritic papular eruption 27 (22.5%), oral candidiasis 21 (17.5%), photo dermatitis 21 (17.5%), and scabies 4 (3.33%). Significant correlation with low CD4+ cell counts was found for oral candidiasis (P < 0.0001) and Kaposi's sarcoma (P = 0.03), while other disorders such as seborrheic dermatitis (P = 0.22), xerosis (P = 0.25), and onychomycosis (P = 0.08) were not statistically significant. CONCLUSION: This study showed high prevalence of dermatological manifestations in HIV-infected subjects, and they occur more frequently with progression of HIV and decline in immune functions. Therefore, early diagnosis and management of skin disorders can improve the quality of life of HIV-infected subjects.