The role of precautions: Organising a medical conference during COVID-19 pandemic-Lessons from IADVL MIDDERMACON 2021.

Background: The use of virtual platforms for clinical meetings has become the default approach during this pandemic era. Organising an offline conference during a pandemic is a challenge and is possible if the participating crowd is vaccinated and is willing to follow appropriate pandemic protocols. Objective: To determine the feasibility of conducting a conference among mostly vaccinated delegates using standard precautionary protocols. Methods: This study was conducted at IADVL MIDDERMACON 2021, held in Mangalore, India, in late October 2021, during the phase of decline of the Delta variant of SARS-CoV-2. The study population included all conference attendees, including support staff. Details were collected about their vaccination status, comorbidities, and mode of travel to the conference venue. An reverse-transcription polymerase chain reaction (RT-PCR) test was done randomly among the attendees for COVID-19 infection. A post-conference assessment and RT-PCR tests were done at the end of 2 weeks to assess the occurrence of infections among study participants. Results: A total of 1744 people were present at the venue, of which 576 (33.03%) participated in the study. The percentage of fully vaccinated was 88.88% (512/576). The majority had taken the vaccine Covishield (manufactured by AstraZeneca), that is, 85.06% (490/576). Infection post the conference was reported in 0.195% (1/576). Conclusions: Holding large gatherings like medical conferences pose a challenge during a pandemic. However, to increase the benefits of the conference, it is advisable to hold them offline with vaccinated delegates, follow the advice of the conference organising committee, and practise safe precautionary measures.

Hair and Humor - 1 - "The Only Problem".

Perhaps the best solution for hair loss is a little bit of philosophy and a lot of humor. Endless trips to trichologists, hair potions and lotions hardly prevent the reluctant march to baldness. Unless of course, the patient agrees to a hair transplant.

Safety and efficacy of low-fluence, high-repetition rate versus high-fluence, low-repetition rate 810-nm diode laser for permanent hair removal--a split-face comparison study.

BACKGROUND: This study was designed to evaluate the hypothesis that low-level fluences done repetitively on a hair follicle will produce permanent hair removal with less discomfort and fewer side effects than a single high-fluence pulse. OBJECTIVE: To compare the safety and efficacy of a low-fluence, high-repetition rate versus a high-fluence, low-repetition rate 810-nm diode laser for permanent hair reduction in patients with facial hirsutism. METHODS: Forty-two female patients with confirmed polycystic ovaries by ultrasonography with facial hirsutism were subjected to the low-fluence, high-repetition Soprano® XL laser in SHR mode and the LightSheer™ laser on each side of the face using preset parameters once a month for six sessions. Hair counts were done at the end of the sixth session using a 'Hi Quality Hair Analysis Program System' and the pain score was recorded by a visual analog scale. RESULTS: The overall median reduction of hair was 90.5% with the Soprano XL and 85% with the LightSheer, with a standard deviation of 7 and 8.5 respectively. DISCUSSION: This new technology, with low fluence and high repetition, showed a statistically insignificant increase in hair reduction compared to the LightSheer, but did show a significant reduction in hair thickness and a low pain score.

Response to narrow-band UVB--vitiligo-melasma versus vitiligo: a comparative study.

BACKGROUND: Vitiligo is the most common depigmentary disorder of the skin and hair, resulting from selective destruction of melanocytes. Melasma, a hyperpigmentary disorder, presents as irregular, brown, macular hypermelanosis. A small subset of vitiligo patients paradoxically also have melasma. OBJECTIVE: To evaluate and compare the response to narrow-band UVB in a group of patients with vitiligo, and another group of patients with vitiligo and coexisting melasma (vitiligo-melasma). METHODS: Patients in both groups were treated with narrow-band UVB and a comparison of the zonal repigmentation was made at 4, 8, and 12 weeks after the initiation of therapy. RESULTS: At the end of 12 weeks, 86% of patients in the vitiligo-melasma group attained ≥75% pigmentation on the face, whereas this was achieved in only 12.5% of patients in the vitiligo group. Over the limbs, 73% of patients in the vitiligo-melasma group attained 75% or more pigmentation at the end of 12 weeks compared with only 9% in the vitiligo group. On the trunk, only 20% of vitiligo-melasma patients showed ≥75% pigmentation at 12 weeks compared with 63% of patients in the vitiligo group. CONCLUSION: Patients having both vitiligo and melasma have a significantly better prognosis for repigmentation on the face and limbs with narrow-band UVB compared with patients with vitiligo alone; the vitiligo-melasma patients achieve repigmentation much earlier and also attain a greater level of repigmentation. Unexpectedly, for truncal lesions, patients with vitiligo alone responded better than those with both conditions. Although the vitiligo-melasma group with truncal lesions started repigmenting earlier, the final pigmentation was more extensive in the vitiligo group.

A novel treatment for plantar ulcers in leprosy: local superficial flaps.

Plantar ulceration is the most common serious disability occurring in patients of leprosy. Growth and emergence of innovative procedures in plastic surgery has greatly revolutionized the treatment of this highly frustrating problem. In the present study, a total of 40 leprosy patients were included. These ulcers were managed using different types of local superficial flaps (advancement, rotation, transposition and first toe web flap). Majority of ulcers healed within 4 weeks and patients were discharged within 6-8 weeks postoperatively. Patients were followed up for a period of 6 months to 3 years. Ulcers recurred in only 25% of all the ulcers operated upon and we observed that management of plantar ulcers by using appropriate local superficial plantar flaps is a viable option and worth trying in view of low incidence of recurrence and relatively shorter duration of hospital stay.

Methicillin-resistant Staphylococcus aureus in community-acquired pyoderma.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an important nosocomial pathogen. It can also cause community-acquired infections. Indian reports about MRSA in community-acquired infections are rare. AIM: To evaluate the rate of MRSA in community-acquired pyoderma and the nasal colonisation with S. aureus in such patients. METHODS: Two hundred and fifty patients with community-acquired pyoderma, who attended outreach camps around Mangalore, south India between January 2000 and July 2001, were studied. Swabs collected from the skin lesions and anterior nares were inoculated onto blood agar and MacConkey's agar. Antimicrobial sensitivity testing was performed using Kirby-Bauer disk diffusion, agar dilution, and agar screen. RESULTS: Of 250 pyoderma cases, S. aureus was isolated from 202 (80.8%) patients. Twenty-two (10.9%) S. aureus isolates were methicillin resistant, 179 (88.6%) were resistant to penicillin, and 114 (56.4%) were resistant to erythromycin. S. aureus colonization in the anterior nares was observed in 136 (54.4%) cases, 11.8% of which were MRSA. Antibiograms of clinical isolates of S. aureus matched with nasal isolates in 99 (49%) cases. CONCLUSION: The emergence of MRSA in the community is a warning. A high nasal carriage rate may contribute to recurrent pyoderma. A correct antimicrobial policy and the avoidance of inappropriate antimicrobial usage are mandatory to reduce the spread of MRSA in the community.

Med estimation for narrow band UV-B on type IV and type V skin in India.

With an aim to determine minimum erythema dose of narrow band UV-B, 30 subjects, 20 with type IV skin and 10 with type V skin were subjected to graded incremental doses of 311-Narrow band UV-B phototherapy cabiner by Daavlin. Barely perceptible erythema 24 hours after exposure was taken as MED. 33.3% developed erythema at 745 mj, 26.6% at 620 mj, 23.3% at 1075 mj, and 10% at 1290 mj. The average MED for narrow band UV-B exposure for type 1V skin was 600 mj, [range 5515-755 mj] and for type V skin 1100 mj {range 895-1290 mj}. Better therapeutic response can be obtained by giving approximately 360-450 mj as initial irradiation dose for type 1 V skin and 600-825 mj for type V skin.