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Background: Chemotherapy has increased survival rate in patients but is associated with systemic as well as cutaneous adverse effects. Among cutaneous adverse effects, nail changes caused by chemotherapy are often overlooked. But these changes are a major cause of cosmetic concern and negatively affect the quality of life (QoL) of patients. Aim: This study was conducted to evaluate the impact of chemotherapy-induced nail changes on QoL of patients with malignancy and to compare the severity of impact on QoL in various nail changes. Materials and Methods: This hospital-based cross-sectional observational study was conducted for a period of 12 months. Only patients on chemotherapy who developed nail changes were included in the study. A nail-specific QoL questionnaire was used. Statistical analysis was conducted to evaluate the impact of nail changes on QoL. Results: The mean QoL score of 188 patients was 32.37 ± 7.9. The mean QoL score of females was more than that of males. QoL was statistically more significant in younger age groups [<20 years: 46.71 ± 1.7] (P < 0.001). Patients with pigmentary nail changes (melanonychia and leukonychia) had more significant impact on QoL (P < 0.001). Conclusion: There is a significant impact of chemotherapy-induced nail changes on QoL of patients leading to psychological distress, reduced self-confidence and social limitation. This highlights the importance of proper counselling of patients beforehand regarding the possibility of associated nail changes during and after the chemotherapy regimens.
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BACKGROUND: The nail changes caused by chemotherapy in cancer patients are difficult to assess and often overlooked by clinician. The present study was undertaken to study nail changes caused by various chemotherapeutic agents and various drug protocols most commonly associated with them. MATERIALS AND METHOD: Five hundred patients with malignancies receiving chemotherapy in the oncology ward and skin outpatient department were screened in this cross-sectional observational study from November 2018 to October 2019. RESULTS: Nail changes due to chemotherapy were observed in 37.6% patients. The most common condition observed was melanonychia (84.04%), followed by half and half nails (6.91%), erythronychia (5.31%), longitudinal grooves (2.12%), leukonychia (2.12%), Mees' lines (1.59%), Beau's lines (0.53%), pitting (0.53%), and subungual hyperkeratosis (0.53%). The usual protocol to cause melanonychia was platinum analogues + taxanes based combinations, half and half nails by platinum analogues + taxanes + 5 fluorouracil (5FU) based polypharmacy, and erythronychia by cisplatin-based adjuvants. CONCLUSION: The knowledge of the nail changes caused by chemotherapy will help in counseling of already worried patients with malignancy. It will also improve patient compliance and enrich the clinicians' knowledge pertaining to chemotherapy-induced nail changes.
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INTRODUCTION: Cutaneous leishmaniasis is a vector borne disease caused by Leishmania major and Leishmania tropica. Bikaner is an endemic pocket for cutaneous leishmaniasis caused by Leishmania tropica. MATERIALS AND METHODS: A prospective study was done to evaluate the efficacy of different concentrations of intralesional amphotericin B as a treatment modality for cutaneous leishmaniasis in Bikaner, Rajasthan, India from January 2016 to June 2017. Fifty patients were randomized into two groups, A and B. Twenty-five patients from group A, received intralesionl amphotericin B (2.5 mg/ml) 0.5 ml/cm2, weekly for 8 weeks. Another group of 25 patients were treated by intralesional amphotericin B (5.0 mg/ml) weekly for same period. The cases were followed-up for response, side effects, and recurrence of disease. RESULTS: The results at the end of 8 weeks, showed complete response in 18 (72%) patients, partial response in 5 (20%) and 2 (8%) patients were non responders in group A. In group B, complete response was observed in 14 (56%), partial response in 7 (28%) patients and 4 (16%) patients did not show response. The difference was statistically insignificant (P > 0.05). No side effects were observed in both groups. CONCLUSION: The difference between the efficacy of 5 mg/ml and 2.5 mg/ml concentrations of Amphotericin B injections was found to be statistically insignificant. So, weekly injections of amphotericin B looks promising, however, larger sample size is required to assess the efficacy of both concentrations in the treatment of cutaneous leishmaniasis.
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BACKGROUND AND OBJECTIVE: Cutaneous Leishmaniasis (CL) is a dermal manifestation caused by various species of Leishmania. This is the most common Leishmanial syndrome seen worldwide and is emerging as and threatens to become an uncontrollable disease. The present study was planned to understand the current epidemiology of CL in the conventionally endemic area of Bikaner, Rajasthan. Species characterization was also done. MATERIAL AND METHODS: The diagnostic modalities used in the study were microscopy, histopathologic examination, antigen testing and confirmation and species characterization by PCR. Field evaluation of the new antigen detection kit approved by FDA in 2016 CL Detect™ IC-RDT was done and its results compared with other available diagnostic tests. RESULTS: A total of 14 cases with 25 skin lesions presented to the Skin OPD during the six month study period (January to June 2018). Out of these, 5 were males and 9 were females, average age being 32 yrs. Students and housewives of poor socio economic group were the most frequently affected groups. Lesions were found on the exposed areas of the body, mainly on the upper limbs and facial region. Majority of them were ulcerated plaques. Out of 14 cases under study, antigen test confirmed 7 positives; thereby yielding a positive rate of 50% against 71.4% for microscopy, 72.7% for PCR and a mere 38.5% for histopathology. Species characterization revealed Leishmania tropica as the causative organism. INTERPRETATION AND CONCLUSION: The study indicates that the number of cases have declined substantially over the past decade in Bikaner. Despite being the oldest technique used, microscopy still is a good option for diagnosis. Combined with PCR, diagnostic accuracy and hence utility is increased multifold. In its current form, IC-RDT may not be very useful.
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BACKGROUND: Radiofrequency-induced heat therapy (RFHT) has been found to be safe and effective against cutaneous leishmaniasis (CL) in the short term, but its long-term efficacy is unclear. OBJECTIVES: To compare the long-term efficacy of RFHT vs. intralesional sodium stibogluconate (SSG) injections in the treatment of CL in India. METHODS: One hundred patients with a confirmed diagnosis of CL were randomly assigned in a 1 : 1 ratio to receive topical RFHT for 30-60 s or seven intralesional injections of SSG (50 mg cm(-2) of lesion). Improvement and recurrence were monitored every 15 days after the initiation of treatment for 4 months and then at 5, 6, 9, 12 and 18 months post-treatment; the rates of complete cure were compared. RESULTS: Lesions were healed in 47 out of 50 patients (94%) in the RFHT group and in 46 out of 50 patients (92%) in the SSG group at week 12. Time to complete healing was comparable in the two groups. At 6 months post-treatment, cure rates in the RFHT and SSG groups were 98% [95% confidence interval (CI) 94-100%] and 94% (95% CI 86-100%), respectively. Age, sex and lesion size or number had no effect on cure rates. No relapse of infection was recorded in cured patients in either group up to 12-18 months after initiation of treatment. Skin biopsies of cured lesions in eight out of eight (100%) patients from the RFHT group and three of three from the SSG group at 12 months showed minimal fibrosis and were negative for Leishmania tropica by polymerase chain reaction test. CONCLUSIONS: A single application of RFHT is safe, cosmetically acceptable and effective in inducing a long-term cure of CL.
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Gluconato de Sodio Antimonio/administración & dosificación , Antiprotozoarios/administración & dosificación , Hipertermia Inducida , Leishmaniasis Cutánea/tratamiento farmacológico , Leishmaniasis Cutánea/terapia , Terapia por Radiofrecuencia , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , India , Inyecciones Intralesiones , Masculino , Persona de Mediana Edad , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Eritema Nudoso/patología , Lepra Lepromatosa/patología , Mycobacterium leprae/aislamiento & purificación , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Adulto , Terapia Antirretroviral Altamente Activa , Biopsia , Recuento de Linfocito CD4 , Eritema Nudoso/tratamiento farmacológico , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Humanos , Huésped Inmunocomprometido , Lepra Lepromatosa/tratamiento farmacológico , Masculino , Reacción en Cadena de la Polimerasa , Resultado del TratamientoRESUMEN
BACKGROUND: Cutaneous leishmaniasis (CL) is caused by Leishmania major and L. tropica in the old world. Bikaner, the 'Thar Desert', situated in the north-western corner of India, is an endemic pocket for CL caused by L. tropica. Skin lesions of CL heal slowly, causing disfiguring scars if remaining untreated. Current recommended treatment for CL comprises systemic administration of sodium stibogluconate (SSG) for 2-3 weeks. Five to seven injections of SSG intralesionally have also been found to be effective. OBJECTIVES: To determine the efficacy of a short-duration, twice-weekly intralesional SSG treatment for CL. METHODS: Two hundred and twenty patients with CL having 298 lesions were included in the present study. They were divided into groups A and B (110 patients each). Patients were treated with five to seven intralesional injections of SSG in doses of 50 mg cm(-2) of lesion either once (group A) or twice (group B) weekly. Improvement was recorded at 6, 8, 10, 12, 16, 20 and 24 weeks and the rate of complete cure was compared. RESULTS: Complete cure rate at 6, 8 and 10 weeks was higher (20%, 57% and 73%, respectively) in group B as compared with group A (12%, 36% and 62%, respectively). The differences in cure rates at these time points were statistically significant (P < 0.05). The complete cure rate at 24 weeks was similar in both groups (96% in group B and 92% in group A). The remaining 4% and 8% of patients in groups B and A were 'nonresponders', respectively. No major side-effects were observed in either group. In all cured cases, there were no relapses reported up to 2 years after treatment. CONCLUSIONS: A short-duration, twice-weekly intralesional SSG treatment for CL accelerates cure and is highly effective and well tolerated.
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Gluconato de Sodio Antimonio/administración & dosificación , Antiprotozoarios/administración & dosificación , Leishmaniasis Cutánea/tratamiento farmacológico , Adolescente , Adulto , Niño , Preescolar , Esquema de Medicación , Femenino , Humanos , India , Inyecciones Intralesiones , Leishmaniasis Cutánea/patología , Masculino , Persona de Mediana Edad , Adulto JovenAsunto(s)
Masturbación/complicaciones , Urticaria/etiología , Adulto , Humanos , Masculino , Factores de Tiempo , Urticaria/fisiopatologíaRESUMEN
Resurfacing of facial rhytides (periorbital crow-feet wrinkles) was performed in three cases by carbon dioxide laser (Sharplan((R)) 1030 machine). Good to excellent results were observed. However, erythema and postinflammatory pigmentation were important side effects.
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BACKGROUND AND AIMS: Therapy systemic lupus erythematosus (SLE) has been generally discouraging. Methyl-prednisolone pulse therapy has been used for various connective tissue disorders. We used intravenous dexamethasone cyclophosphamide pulse therapy to treat SLE. METHODS: Fourteen patients (10 females and 4 males) between the age of 15-48 years with definite or classical clinical criteria laid by American Rheumatism Association criteria were treated by Dexamethasone-Cyclophosphamide pulse (DCP) therapy at our center. RESULTS: It was possible to induce a complete clinical remission with DCP therapy in most of the patients thereby offering them life free from disease and drugs. The side effects commonly observed with conventional daily dose regimen of corticosteroids were not present or were mild. CONCLUSIONS: Almost all patients had good response after 3-4 pulses to allow them a normal life style. Fever, malar rash and oral ulceration responded early but photosensitivity, discoid rash, alopecia and joint pains took some more time.
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Ciclofosfamida/administración & dosificación , Dexametasona/administración & dosificación , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Adolescente , Adulto , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Humanos , India , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Quimioterapia por Pulso , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
The amniotic membranes were collected from the placentae of selected and screened donors. Processing was done by washing the fresh amniotic membrane successively in sterile saline, 0.05% sodium hypochlorite solution and sterile distilled water until it was completely cleared of blood particles. The membranes were sterilized by gamma irradiation at 25 kGy. The processed amniotic membranes were applied to 50 open wounds comprising of 42 full thickness defects and eight partial thickness defects. These included leprotic, diabetic, traumatic, gravitational ulcers and superficial burn in the form of scald and corrosive burn. The radiation processed amniotic membranes favoured healing of unresponsive and non-healing ulcers of different etiologies. Ulcers with duration of minimum 3 weeks to maximum 12 months were found to heal in 2-6 weeks by the application of amniotic membranes.
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Amnios , Apósitos Biológicos , Úlcera Cutánea/terapia , Amnios/efectos de la radiación , Quemaduras/patología , Quemaduras/terapia , Rayos gamma , Humanos , Úlcera Cutánea/etiología , Úlcera Cutánea/patología , Factores de Tiempo , Cicatrización de HeridasAsunto(s)
Lepra/parasitología , Ratas/genética , Ratas/microbiología , Ratas/parasitología , Ratas/virologíaRESUMEN
INTRODUCTION: Oral azithromycin has been advocated by some in the treatment of acne. However, its efficacy has not been established. MATERIAL AND METHODS: This non-randomized controlled trial was conducted on 70 outpatients with acne vulgaris to compare the efficacy and safety of azithromycin and doxycycline in the treatment of inflammatory acne. In the first group, azithromycin was administered 500 mg daily before meals for 3 consecutive days in a 10-day cycle, with the remaining seven days in each cycle being drug-free days. The second group was given doxycycline 100 mg daily after meals. Topical erythromycin was prescribed to all patients. Clinical assessment was done at 10-day intervals for both the groups up to three months. We followed the severity index described by Michaelsson for assessment of outcome measures. RESULTS: There was 77.26% improvement in azithromycin treated group in comparison to 63.74% in the doxycycline treated group. There was a statistically significant reduction in severity in the azithromycin treated group. CONCLUSION: The study showed that a combination of azithromycin with topical erythromycin was significantly better than doxycycline with topical erythromycin in the treatment of acne vulgaris. The incidence and severity of side effects were also lower with azithromycin.
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Leprosy is a chronic infectious disease caused by Mycobacterium Leprae and is characterized by well-recognized pathological changes. But there are various disagreement in clinical type and histological finding of leprosy. We observed highest parity in LL and TT group followed by histoid, BT, BL, BB, & indeterminate respectively. There was 10% minor disagreement (difference of one group) and 5% major disagreement (difference of two or more group). Non-specific histological finding was present in 20% cases.