Evaluation of the Efficacy of Intralesional Measles, Mumps, and Rubella Vaccine with Intralesional Vitamin D3 as Immunotherapies in the Treatment of Recalcitrant Cutaneous Warts in Adult- A Randomized Placebo-Controlled Study.

INTRODUCTION: Currently, various destructive and ablative treatment options are conventionally used for warts, but all of them are limited in some form by their adverse effects, high recurrences, suboptimal effectiveness, and the need to treat every wart. Lately, immunotherapy has emerged as a safe treatment relying on biological substances that modulate the immune system to achieve disease control. AIMS AND OBJECTIVES: We aimed at conducting a placebo-controlled study to compare the rate of efficacy of intralesional MMR vaccine with vitamin D3 in the management of recalcitrant extragenital warts in immune-competent adults. Follow-up was done at third and sixth month. MATERIALS AND METHODS: Patients were divided into three groups, namely, group A, B, and C. Groups A, B, and C received intralesional MMR vaccine, vitamin D3 and normal saline, respectively, in the largest wart. The injections were repeated every 2 weeks, for a maximum of four injections. RESULTS: Among injected warts, in group A, complete clearance was seen in 29 (87.8%) patients, partial clearance in two (6.1%) and no response in two (6.1%) patients. In group B, 24 (77.4%) patients, five (16.1%) patients, and two (6.5%) patients showed signs of complete, partial, and no clearance, respectively, in injected warts. Complete response in distant warts was seen in 25 (75.7%) patients in group A and 20 (64.5%) patients in group B. There was no statistically significant difference between responses of the two groups. In group C, only three (12.5%) patients had complete clearance in injected warts, and none in distant warts. Recurrence was seen in two (6.4%) patients, each in group B and C. However, for management of verruca plana MMR was found to be superior to vitamin D3. LIMITATIONS: Our study was limited by a small sample size, absence of immunological analysis, and limited follow-up period. CONCLUSION: MMR vaccine and vitamin D3 are equally effective and safe treatment option for multiple, recalcitrant warts, as well as warts on difficult to treat sites with minimal recurrence.

Estimating the Impact of Extragenital Warts versus Genital Warts on Quality of Life in Immunocompetent Indian Adult Patients: A Comparative Cross-Sectional Study.

BACKGROUND: Extra-genital warts (EGWs) affect 7-10% of population. Even though a plethora of studies have been conducted to assess the impact of genital warts (GWs) showing a significant impact on the quality of life but surprisingly, barely any data has been collected on the impact of EGWs on quality of life. AIMS AND OBJECTIVE: This cross-sectional study aimed at comparing the magnitude of EGWs on health-related quality of life and various variables with that of GWs. PATIENTS AND METHODS: The study consisted of two groups of immunocompetent adults, each with 100 patients aged 18 years or above, attending the skin outpatient department at our tertiary center between April 2018 and March 2019 and consented to participate. Group A consisted of patients with EGWs and group B comprised of patients with GWs. All patients were asked to fulfill the validated Hindi hard copy of the Dermatology Life Quality Index (DLQI) questionnaire. RESULTS: The mean DLQI score of patients with EGWs was 8.73 ± 0.84 and that of patients with GWs was 5.83 ± 0.83 (P = 0.026). In group A, those affected the most were patients with warts on multiple exposed sites (mean DLQI score of 14), followed by warts on feet (mean DLQI score of 10.69), followed by warts on hands (DLQI score of 9.12), and facial warts (DLQI score of 6.80). Patients with a prior history of failed treatment and/or a longer duration of illness had a higher level of dissatisfaction. To the best of our knowledge, no such study has been conducted in the past in our country. CONCLUSIONS: EGWs inflict a severe negative impact on the quality of life. Owing to its notorious persistence and recurrence, healthcare professionals must educate patients on how to prevent the spread and recurrence, discuss details of available treatment modalities while keeping in view the psychological and sociological impact.

Characterization of event related potentials using information theoretic distance measures.

Analysis of event-related potentials (ERPs) using signal processing tools has become extremely widespread in recent years. Nonstationary signal processing tools such as wavelets and time-frequency distributions have proven to be especially effective in characterizing the transient phenomena encountered in event-related potentials. In this paper, we focus on the analysis of event-related potentials collected during a psychological experiment where two groups of subjects, spider phobics and snake phobics, are shown the same set of stimulus: A blank stimulus, a neutral stimulus and a spider stimulus. We introduce a new approach, based on time-frequency distributions, for analyzing the ERPs. The difference in brain activity before and after a stimulus is presented is quantified using distance measures as adapted to the time-frequency plane. Three different distance measures, including a new information theoretic distance measure, are applied on the time-frequency plane to discriminate between the responses of the two groups of subjects. The results illustrate the effectiveness of using distance measures combined with time-frequency distributions in differentiating between the two classes of subjects and the different regions of the brain.

Quality estimation of subdurally recorded, event-related potentials based on signal-to-noise ratio.

Our goal is to develop a direct brain interface (DBI) that will provide communication and environmental control to persons who are "locked-in" (or nearly so) as a consequence of brainstem stroke, amyotrophic lateral sclerosis (ALS), or other etiologies. Previously we demonstrated that templates constructed from trigger averaged event-related potentials (ERPs) can be cross-correlated with ongoing electrocorticograms (ECoGs) to detect ERPs associated with the performance of simple motor actions. However, it was difficult to predict a priori which of many candidate ECoG recording site(s) could provide signals that would provide adequate motor action detection. We present here a measure of ERP quality based on an estimate of the signal to noise ratio (SNR) associated with the formation of an ERP template from the performance of consecutive voluntary actions. Detection-theory-based receiver operator characteristics (ROCs) and a database of ECoGs (6000+) recorded from the cortical surface of awake human subjects were used to assess the usefulness of the SNR technique. The SNR method was found to predict the detection efficacy of ERPs when characterized over a wide parameter range, with the majority of ROC curve areas greater than 90%. This method was compared with our previously developed quality measure (the peak-to-baseline ratio) and found to provide significantly better performance (ROC area differences from 4.4% to 13.7%). Thus, the SNR estimate of the ERP is a useful tool to predict the efficacy of ERP templates for cross-correlation-based detection and assist in the selection of viable ERP templates for DBI applications.