Risk Factors for Acute Gastroenteritis Among Patients Hospitalized in 5 Veterans Affairs Medical Centers, 2016-2019.

Background: In the United States, ∼179 million acute gastroenteritis (AGE) episodes occur annually. We aimed to identify risk factors for all-cause AGE, norovirus-associated vs non-norovirus AGE, and severe vs mild/moderate AGE among hospitalized adults. Methods: We enrolled 1029 AGE cases and 624 non-AGE controls from December 1, 2016, to November 30, 2019, at 5 Veterans Affairs Medical Centers. Patient interviews and medical chart abstractions were conducted, and participant stool samples were tested using the BioFire Gastrointestinal Panel. Severe AGE was defined as a modified Vesikari score of ≥11. Multivariate logistic regression was performed to assess associations between potential risk factors and outcomes; univariate analysis was conducted for norovirus-associated AGE due to limited sample size. Results: Among 1029 AGE cases, 551 (54%) had severe AGE and 44 (4%) were norovirus positive. Risk factors for all-cause AGE included immunosuppressive therapy (adjusted odds ratio [aOR], 5.6; 95% CI, 2.7-11.7), HIV infection (aOR, 3.9; 95% CI, 1.8-8.5), severe renal disease (aOR, 3.1; 95% CI, 1.8-5.2), and household contact with a person with AGE (aOR, 2.9; 95% CI, 1.3-6.7). Household (OR, 4.4; 95% CI, 1.6-12.0) and non-household contact (OR, 5.0; 95% CI, 2.2-11.5) with AGE was associated with norovirus-associated AGE. Norovirus positivity (aOR, 3.4; 95% CI, 1.3-8.8) was significantly associated with severe AGE. Conclusions: Patients with immunosuppressive therapy, HIV, and severe renal disease should be monitored for AGE and may benefit from targeted public health messaging regarding AGE prevention. These results may also direct future public health interventions, such as norovirus vaccines, to specific high-risk populations.

Prospective Study of Growth Factor Concentrate Therapy for Treatment of Melasma.

BACKGROUND: Melasma is a common acquired pigmentary skin disorder. Currently, there are various treatment options available but none is effective universally. OBJECTIVE: Assess the role of Yuskin®, a growth factor concentrate (GFC) therapy, a modified platelet rich plasma (PRP) technique for the treatment of melasma. MATERIALS AND METHODS: Subjects of Fitzpatrick skin type IV-V, of either gender, more than equal to 18 years of age, with a clinical diagnosis of melasma were enrolled in the study. Total three sessions of GFC monotherapy were given with one-month interval (day 0, day 30, and day 60) and follow up of subjects was done at day 90 for the final clinical assessment. RESULTS: Out of 40 subjects enrolled, 30 subjects completed three GFC sessions and 26, completed day 90 follow-up. Statistically significant decrease in the mean mMASI scores was observed at all visits compared to baseline (P < 0.005 for each visit). Totally, 66.7% of severe melasma subjects showed improvement to mild to moderate category. Significant improvement in mean mMASI score was seen in subjects who had mild to moderate melasma at baseline (P < 0.05). Overall, aesthetic improvement was reported in 88.5% of subjects. Side effects reported were mild such as injection site pain, erythema, oedema and bruising, and resolved spontaneously within a few hours to few days of onset. CONCLUSION: Significant improvement in melasma was observed with GFC monotherapy, which needs further confirmation in larger randomized controlled studies. Overall, it was well tolerated. Thus, GFC therapy can be a safe, effective, and new option in the armamentarium of melasma management.

Management of aging skin: A questionnaire-based study among Indian dermatologists.

INTRODUCTION: With increased life expectancy, the desire to look younger has increased. Hence, many patients approach dermatologists for antiaging treatment. However, data regarding management of skin aging in India are scarce. AIMS: To understand management patterns for skin aging among dermatologists in India. METHODS: Overall, 147 Indian dermatologists were administered a questionnaire-based survey about patient characteristics, signs of skin aging, treatment options, and cost. RESULTS: Among all the patients coming for dermatologists' consultation, 10%-40% were for antiaging treatment. About 70% dermatologists opined that majority of patients aged 30-40 years consulted for antiaging treatment, and the male to female ratio was 3:7. Approximately 46% of dermatologists felt that antiaging treatment should be initiated by the age of 30. Common signs of aging were wrinkles, pigmentation, dull skin or complexion, and dry skin. Based on patient's age and sex, dermatologists prescribed a combination of 2-4 products, which included antioxidants, retinoids, growth factors, and moisturizers. Improvement was assessed by photographic and clinical evaluation, and by patients' satisfaction (55%). Effect of the antiaging products was evident within 4-6 months. Earliest improvement was noted in dry skin and dull complexion. Average extent of improvement noted by 6 months was approximately 20%-30%. The average monthly expenditure on antiaging treatments was 2000-4000 INR. CONCLUSION: Both men and women seek clinical treatment for skin aging in India. Dermatologists prescribe a combination of 2-4 products, including antioxidants, retinoids, growth factors, and moisturizers. Available antiaging therapies show an average improvement of up to 30% by 6 months.

Laser Skin Rejuvenation With Fractional 1064 Q-switched Nd:YAG In 252 Patients: An Indian Experience.

OBJECTIVE: The objective of our study was to present the results and safety profile of fractional 1064 Q-switched Nd: YAG laser treatment in skin rejuvenation in Indian patients with Fitzpatrick skin type III-VI. MATERIALS AND METHODS: We studied our clinical data of 252 patients who underwent treatment for facial skin rejuvenation with the Q switched Nd:YAG laser 1064 wavelength, using the fractional mode of 5mm spot size with fluences from 1.2 J ~ 2 J/cm2 and the energy ranging from 300-500 mJ, a repetition rate of 7Hz and pulse duration of 8 ns for 6 sessions at two weekly intervals. We evaluated results with the aid of clinical photography taken before start of treatment, on 3rd and 5th sessions along with patient satisfaction and dermatologist assessment scores. Any adverse events were also recorded. RESULTS: At the end of 6 sessions, both patients and dermatologists reported visible improvement in skin texture and tone. The laser sessions resulted in an immediate improvement in skin texture and tone in the first session itself that increased over 3 sessions and then stabilized. Transient erythema was reported in a few cases. No hypo- or hyperpigmentation were noted. CONCLUSIONS: The 1064 QSNYL is popularly used for skin rejuvenation especially in the Asian countries. But there is lack of substantial clinical data to validate the clinical results. We present the first study that shows the fractional 1064 Qswitched ND:YAG laser is a safe and effective option for skin rejuvenation in skin types III-VI.

Efficacy of a Low Fluence, High Repetition Rate 810nm Diode Laser for Permanent Hair Reduction in Indian Patients with Skin Types IV-VI.

Background: The study's aim is to evaluate the novel "in motion" technique for permanent hair removal using a low level fluence/high repetition rate on patients with a dark skin type over different areas of the body. Objectives: To assess fluence, accumulative energy, and number of treatments needed to achieve a significant hair reduction and patient satisfaction with minimal side effects, low discomfort levels, and high safety profile in a skin type IV-VI Indian patients. Methods: Seventy-one Indian female patients with skin type IV-VI were enrolled in the study. All patients were treated with a low fluence, high repetition rate 810nm diode laser using a predetermined set of parameters for 5 to 6 treatments in 1- to 3-month intervals. Hair reduction was measured by patients' satisfaction and all adverse effects were documented. Results: Results obtained a high degree of patient satisfaction and a very low record of adverse events. Treatments were complication-free for dark skins and a reasonable schedule or sessions and intervals. The discomfort during the sessions was negligible.

Treatment of Postinflammatory Pigmentation Due to Acne with Q-Switched Neodymium-Doped Yttrium Aluminum Garnet In 78 Indian Cases.

BACKGROUND: Postinflammatory hyperpigmentation (PIH) is a common sequela seen in the Indian population following affliction by acne. It is psychologically extremely disturbing for the patients and can severely affect the quality of life. Very few therapeutic modalities have proved to be really efficacious in this condition. AIMS: The aim was to review our experience with 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet (QSNY) laser in the treatment of PIH. MATERIALS AND METHODS: Seventy-eight patients with postacne hyperpigmentation were included in the study. They were treated with six sessions at two weekly intervals using a 1,064-nm QSNY laser. Patient and physician scores were assessed at 1 month and 3 months after the last treatment. Clinical photographs also were reviewed to determine the efficacy. Adverse effects were noted. RESULTS: Seventy percent of the patients reported significant improvement in hyperpigmentation as compared to the baseline. The majority of the adverse events were limited to mild, brief erythema. CONCLUSION: The 1,064-nm QSNY laser is an effective modality for the treatment of PIH caused by acne.

Childhood epilepsy: Management in resource-limited setting.

OBJECTIVE: To optimize the use of phenobarbital and/or phenytoin as frontline drugs for treatment of childhood epilepsy. DESIGN: Before-and -after study. SETTING: Epilepsy clinic at paediatric OPD, Sassoon General Hospital, Pune. MATERIALS AND METHODS: Epilepsy is a condition in which seizures are triggered recurrently from within the brain. For epidemiological classification purpose epilepsy is considered to be present when two or more unprovoked seizures occur at an interval greater than twenty four hours apart. Seizures were classified as generalized and partial seizures, with underlying etiology investigated with EEG, CT scan in majority of the patients. Follow - up rate, seizure - control and antiepileptic drugs used among 151 children enrolled as on 31 March 2005 were compared with 106 children with new onset epilepsy enrolled as on February 2006. Eight children with breakthrough convulsion after a seizure free period of five to eighteen months were followed up after injection vitamin D. Nineteen children with poor control of seizures receiving polytherapy with newer antiepileptic drugs were assessed with frontline antiepileptic medication of phenobarbital and/or phenytoin. Serum calcium, phosphorus, alkaline phosphatase were done in seventy two consecutive children with seizure disorder. RESULTS: During post protocol period good seizure control was achieved in 84.8% as against 80.7% and use of phenobarbital and/or phenytoin increased to 65.11% from 22.87%. Of the 8 cases with breakthrough seizures seven remained seizure free after vitamin D administration and with no dose enhancement of AED medications of the nineteen. Children receiving polytherapy thirteen children could be successfully switched to phenobarbital and/or phenytoin. Forty four (61%) children had hypocalcemia (less than 9 mg%), fifty seven (79%) children had raised alkaline phosphatase levels (more than 270 IU). COMMENTS: Phenobarbital and/or phenytoin have been found to be effective frontline AED. Periodic administration of vitamin D plays a supportive role.