Modifying priming techniques in cardiopulmonary bypass circuit in known case of sickle-cell trait undergoing open heart surgery.

Modifying cardiopulmonary bypass (CPB) circuit's priming technique before the onset of CPB in cardiac patients known with sickle-cell disease or sickle cell trait has been observed to be of substantial significance in dealing with such challenges without having any life-threatening consequences. We modified our routine heparinized crystalloid priming of the CPB circuit with partial exchange transfusion by adding donor blood (packed red blood cells), fresh frozen plasma (FFP), and bicarbonate. This has helped us bring down the overall sickle cell hemoglobin in the blood thereby reducing its risk of sickling.

Preparedness for establishing COVID-19 services during acute emergency of COVID-19 pandemic: Experience of a tertiary care TB and respiratory diseases hospital.

BACKGROUND: The ongoing coronavirus disease 2019 (COVID-19) calls for setting up of well-equipped and dedicated health facilities to manage sick patients while protecting healthcare workers and the environment. An ideal high-level isolation unit requires a high level of administrative commitment, availability of space, human resource and logistics. METHOD: The experience of setting up COVID-19 care facilities on a noticeably short period in a tertiary TB and respiratory diseases institute in wake of the COVID-19 pandemic is being shared here. RESULT: All the essential COVID-19 services were set up in record time of 8 days. A total of 115 COVID-19 patients were admitted. Out of these 89 patients were discharged in a satisfactory condition. There were 19 deaths, and 4 patients became critical and had to be referred to level 3 facility for ICU care. CONCLUSION: This experience will help other hospitals in planning out the strategies and solve the difficulties they may face while opening a COVID-19 care facility under limited resources on an urgent basis.

Lupus Miliaris Disseminatus Faciei: Response to Combination of Isotretinoin and Oral Minipulse.

A 32-year-old man presented with multiple reddish and skin-colored asymptomatic skin lesions over his face and ears present for a year. These lesions appeared in crops at variable intervals, healing with scarring over the next few months. He had received doxycycline and azithromycin for about 6 months without any relief. No history of flushing, worsening of lesions on sun exposure, or eating spicy food, was reported. He had no chronic illness or prolonged usage of any medication. The patient neither had abdominal pain, respiratory distress, or uveitis to suggest sarcoidosis nor accounted any personal or family history of tuberculosis. (SKINmed. 2022;20:307-310).

Generalized Linear Porokeratosis in a Bilateral Distribution: An Unusual Presentation.

An 8-year-old girl was seen for asymptomatic flat to raised hyperpigmented plaques distributed in a linear pattern over multiple segments of her body present 1 year of age. The eruption initially started as an itchy papule over the left lateral malleolus, which developed into hyperpigmented plaque and gradually extended linearly over a period of 2-3 months to involve the leg. Over the next year, similar lesions appeared on the hands and left side of the body. Most of the lesions progressed in size; however, a few lesions on the extremities resolved partially, becoming hyperpigmentation. There was no further progression of the eruption in the following 6 months. There was no history of erosions, blisters, or comedone-like lesions. There was no history of developmental delay or mental retardation. There was no relevant family history. (SKINmed. 2022;20:220-223).

Primary Localized Cutaneous Amyloidosis Secondary to Sand Rubbing in a Wrestler.

A 40-year-old male, wrestler since 15 years of age presented with asymptomatic hyperpigmentation over both his both upper extremities for 10 years. There was no history of preceding itching or redness; of using a nylon brush, scrubbers, or sponges during bathing; or of excessive towel rubbing after bathing and applying cosmetics; however, he had been rubbing sand over both arms for 15 years. He had no personal or family history of atopy, diabetes, or thyroid disease. Cutaneous examination revealed the presence of symmetrical sharply defined reticulate brownish hyperpigmentation over both arms and favoring the left (Figure 1). Dermatoscopy revealed multiple uniform small brown fine streaks radiating from the center becoming reticulated (Figure 2). Hematologic and biochemical studies, in particular thyroid studies, were normal. Histopathologic examination revealed an amorphous eosinophilic deposit in the papillary dermis suggestive of macular amyloidosis (MA) (Figure 3). Methyl violet stain revealed amyloid positive areas (Figure 4), and a diagnosis of MA was made. With the cessation of the sand rubbing and the application of tacrolimus ointment (0.1%), the lesions slowly diminished. (SKINmed. 2022;20:141-143).

A comparative study of topical tacrolimus and topical triamcinolone acetonide in nodular scabies.

The aim of this study was to compare the efficacy and safety of 0.1% triamcinolone acetonide and 0.03% tacrolimus ointment for the treatment of nodular lesions of scabies. In this double-blind randomized controlled trial, 50 Indian men with postscabeitic persistent nodular lesions (labelled to have nodular scabies (NS)/postscabies prurigo (PSP)) over the external genitalia, were enrolled. They were randomized into two groups to receive either a mid-potency topical corticosteroid (TCS); triamcinolone acetonide 0.1% ointment twice daily, or topical calcineurin inhibitor (CNI); tacrolimus ointment 0.03% twice daily over the nodular lesions for 2 weeks. All patients were followed up on three visits: 1, 2, and 6 weeks, for assessment. Efficacy was evaluated by 5-point range investigator-assessed VAS, and a 4-point severity of pruritus scale (SPS) score. The mean VAS score was higher in triamcinolone group compared to tacrolimus group at both follow-ups, although statistically significant only at 2nd week visit. The fall in mean SPS at both follow-ups was also higher in the steroid group, but the difference was not statistically significant. While, the overall tolerance to either ointment was excellent, mild hypopigmentation, and epidermal atrophy were detected on dermoscopic evaluation of the treated areas at the 2nd week visit in a small subset of patients in the triamcinolone group. The frequency of relapse of lesions and/or pruritus after four weeks of the 2-week therapy was high in both the groups (higher in tarolimus group). Conclusively, although both treatment options provided safe and satisfactory short term improvement, the results from this study suggest an overall higher efficacy of a mid-potency TCS like triamcinolone 0.1% over topical CNI like tacrolimus 0.03%, in the short-term treatment of nodular lesions of NS/PSP. Topical CNIs may be considered for maintenance of effect, if prolonged therapy is warranted.

Fabrication of Conducting Nanochannels Using Accelerator for Fuel Cell Membrane and Removal of Radionuclides: Role of Nanoparticles.

Latent tracks in pure polymer and its nanohybrid are fabricated by irradiating with swift heavy ions (SHI) (Ag+) having 140 MeV energy followed by selective chemical etching of the amorphous path, caused by the irradiation of SHI, to generate nanochannels of size ∼80 nm. Grafting is done within the nanochannels utilizing free radicals generated from the interaction of high-energy ions, followed by tagging of ionic species to make the nanochannels highly ion-conducting. The uniform dispersion of two-dimensional nanoparticles better controls the size and number density of the nanochannels and, thereby, converts them into an effective membrane. The nanoparticle and functionalization induce a piezoelectric ß-phase in the membrane. The functionalized membrane removes the radioactive nuclide like 241Am+3 (α-emitting source) efficiently (∼80% or 0.35 µg/cm2) from its solution/waste. This membrane act as a corrosion inhibitor (92% inhibition efficiency) together with its higher proton conduction (0.13 S/m) ability. The higher ion-exchange capacity, water uptake, ion conduction, and high sorption by the nanohybrid membrane are explored with respect to the extent of functionalization and control over nanochannel dimension. A membrane electrode assembly has been fabricated to construct a complete fuel cell, which exhibits superior power generation (power density of 45 mW/cm2 at a current density of 298 mA/cm2) much higher than that of the standard Nafion, measured in a similar condition. Further, a piezoelectric matrix along with its anticorrosive property, high sorption characteristics, and greater power generation makes this class of material a smart membrane that can be used for many different applications.

Concurrent Presentation of Systemic Lupus Erythematosus in Mother and Daughter.

Systemic lupus erythematosus (SLE) is a connective tissue disorder with a high prevalence in certain races like Africans. It also has a female predilection. The pathogenesis of SLE is a complex interplay of genetic and environmental factors. Familial presentation of SLE has been well documented. We herein illustrate a scenario of SLE presenting in related females (mother and daughter) concurrently with similar clinical features and fulfilling the Systemic Lupus Collaborating Clinics criteria. Stress was identified as a common possible triggering factor.

Chemical Peeling as an Innovative Treatment Alternative to Oral Antifungals for Onychomycosis in Special Circumstances.

Toe nail onychomycosis (ONM) is a common problem in elderly patients. Treatment in diabetic patients with associated comorbidities such as congestive heart failure becomes a challenge. Oral antifungals are best avoided owing to most of them being contraindicated or unsafe due to comorbidities and/or risk of drug interactions stemming from polypharmacy. Topical agents alone are not effective. Unlike isolated ONM in healthy and younger patients, ONM involving multiple nails in geriatric and diabetic patients warrants treatment as it serves as a source of recurrent tinea of the feet and other sites, and even contributes to formation of diabetic foot ulcers. Long-pulsed Nd:YAG and fractional CO>sub<2>/sub< laser (in addition to antifungals) have been reported to provide gratifying results in toe nail ONM. But high treatment cost is a major limitation. Nail peeling with glycolic acid (GA) and low-concentration croton-oil free phenol (CFP) peels have been used in different nail conditions but not specifically for ONM. We report the successful use of Black peel (a superficial-to-medium depth peel used typically for anti-acne and cosmetic indications), a combination of 50% black acetic acid, 0.5% salicylic acid, 6% tetrahydrojasmonic acid, 10% bio sulphur, and 0.1% potassium iodide, in two difficult cases with ONM of multiple nails, the rationale of use being the additional anti-fungal effects of all the peel components.

Systemic Lupus Erythematosus Presenting as Livedoid Vasculopathy over the Forearms.

38-year-old married woman presented with multiple spontaneous painful ulcers that had involved both forearms for the previous month, along with a single episode of generalized tonic-clonic seizures, with no residual palsy or paresis. She complained of photosensitivity and diffuse hair loss for the past 6 months. She also had had arthralgia for the previous 3 years, which had initially involved the small joints of the fingers (especially the proximal interphalangeal joints) and gradually progressed to involve the larger joints. There was no history of recurrent oral ulcers, psychosis, thromboembolic events, or any other skin lesions. Two years previously, she had taken antitubercular treatment for pulmonary tuberculosis.

Double-blind randomized placebo-controlled trial to evaluate the efficacy and safety of short-course low-dose oral prednisolone in pityriasis rosea.

PURPOSE: To evaluate the efficacy and safety of short-course low-dose oral prednisolone in symptomatic pityriasis rosea (PR) of onset <5 days and compare it with placebo. MATERIAL AND METHODS: Placebo-controlled randomized double-blind study design with the treatment group receiving tapering doses of oral prednisolone over 2 weeks and the control group receiving a placebo. Outcome measures evaluated were subsidence of patient-perceived pruritus, improvement in rash quantified by a specific score, adverse effects and relapse at 12 weeks. RESULTS: The improvement in the pruritus score as well as objective rash score were much better in the prednisolone-treated group. No adverse effects reported in either group. The relapse rate at 12 weeks was much higher in the prednisolone treated group. CONCLUSIONS: Oral corticosteroids, even if used in low-dose and for a short tapering course should not be the first line of therapy for PR. The only justified indication may be extensive and highly symptomatic lesions of PR.

Patch testing in patients with suspected cosmetic dermatitis: A retrospective study.

BACKGROUND: Growing use of cosmetics has led to an increase in the incidence of allergic contact dermatitis (ACD) to cosmetics. Patch testing helps to confirm allergy to cosmetics and pinpoint the exact offending allergens. AIMS AND OBJECTIVES: The study aimed to find the frequency of positive patch test reactions in cases with suspected ACD to cosmetics, and the common allergens responsible for it. METHODS: This is a retrospective record-based study of 58 patients, with suspected ACD to cosmetics, who had undergone patch testing with Indian standard series and Indian cosmetic and fragrance series from January 2013 to December 2015. RESULTS: The majority of patients (60.34%) belonged to the age group of 20-40 years. The most common site of involvement was face (94.8%) followed by neck (22.4%). The most commonly implicated cosmetics in history were soaps (53.4%), and face creams (24.1%). The most common allergens detected on patch testing were cetrimide (20.7%) and thimerosal (15.5%) followed by paraphenylenediamine (6.9%), and fragrance mix (5.2). Positive allergic reactions were obtained in 2.12% of the patches. CONCLUSION: Most common cosmetic products implicated for causing ACD were face creams, soaps, and hair dyes. The principal culprit allergens were cetrimide and thimerosal.