An Open-Label Non-Randomized Preliminary Noninferiority Study Comparing Home-Based Handheld Narrow-Band UVB Comb Device with Standard Hospital-Based Whole-Body Narrow-Band UVB Therapy in Localized Vitiligo.

Background: Narrow-band ultraviolet B (NB-UVB) is the standard therapy for vitiligo. Objective: The objective of this study is to compare the safety and clinical efficacy of a handheld NB-UVB comb device with the standard whole-body NB-UVB therapy in localized stable vitiligo. Materials and Methods: Thirty-one vitiligo patients were allocated to either daily therapy with a home-based handheld comb device (group A, n = 17) or thrice-weekly hospital-based whole-body NB-UVB therapy (group B, n = 14) for 4 months, based on their preference. The primary and secondary outcomes were assessed at each follow-up, and appropriate statistical tools were used for analysis. Results: Of the 31 patients enrolled, 26 patients (study groups A/B: 15/11) completed the study. Primary outcome: Median percentage repigmentation of the representative patch in groups A and B were 51.35% and 63.85%, respectively (P = 0.64). The median size reduction of the representative patch in both groups was statistically significant (P < 0.05). The mean difference between "per protocol analysis" and "intention to treat" showed noninferiority. Secondary outcomes: Both groups were comparable on Lund and Browder score, patient global assessment and investigator global assessment scores, adverse events, color match, and change in the quality of life. The comparison group had a significantly greater number of missed sessions (P = 0.02). The majority of patients had a "good" response in both groups. Conclusion: Handheld NB-UVB comb device daily with a fixed dose of fluence was found to be noninferior with better compliance to standard whole-body NB-UVB therapy.

Oral Propranolol Therapy for Infantile Hemangioma: Long-term Follow-up.

ß-blocker therapy is currently the treatment of choice for infantile hemangiomas (IH), albeit with limited data on long-term treatment outcomes. Herein, authors treated 67 IH lesions in 47 patients with oral propranolol at 2 mg/kg/d for a median of 9 mo and followed them up for a median of 48 mo. While no maintenance therapy was required for 18 lesions (26.9%), the rest needed maintenance therapy. Both treatment regimens had comparable efficacy (83.3±23.9% and 92.0±13.8%) but chances of IH recurrence was higher in lesions requiring maintenance therapy. Also, patients treated at ≤5 mo of age had a significantly better response and a lower recurrence rate than patients treated at >5 mo of age (95.0±7.9% vs. 87.0±17.5%, p = 0.05). Authors' experience suggests that longer durations of maintenance therapy offered no added advantage to the overall improvement of IH while treatment initiation at an earlier age showed better improvement and lower recurrence rates.

Copper(ii) and cobalt(iii) Schiff base complexes with hydroxy anchors as sensitizers in dye-sensitized solar cells (DSSCs).

Two Schiff base complexes of copper(ii) and cobalt(iii) having the formulae [CuL2] (Cu-Sal) and [CoL3] (Co-Sal) (HL = 2-(((2-hydroxyethyl)imino)methyl)phenol) have been synthesized and characterized microanalytically, spectroscopically and in the case of Cu-Sal using single crystal X-ray diffraction technique. The single crystal X-ray analysis reveals a square planar geometry around Cu(ii) satisfied by phenoxide oxygen and imine nitrogen of the L- ligand to generate a six membered chelate ring. The solid state structure of Cu-Sal is satisfied by varied intermolecular non-covalent interactions. The nature of these interactions has been addressed with the aid of Hirshfeld surface analysis. Both compounds have been used as sensitizers in TiO2 based dye sensitized solar cells (DSSCs) and the DSSC experiments revealed that Co-Sal offers better photovoltaic performance in comparison to Cu-Sal. The Co-Sal exhibited a J sc of 9.75 mA cm-2 with a V oc of -0.648 V, incident photon to current conversion efficiency (IPCE) of 57% and η of 3.84%. The relatively better photovoltaic performance of Co-Sal could be attributed to better light absorption and dye loading than that of Cu-Sal.

Transethnic analysis of psoriasis susceptibility in South Asians and Europeans enhances fine-mapping in the MHC and genomewide.

Because transethnic analysis may facilitate prioritization of causal genetic variants, we performed a genomewide association study (GWAS) of psoriasis in South Asians (SAS), consisting of 2,590 cases and 1,720 controls. Comparison with our existing European-origin (EUR) GWAS showed that effect sizes of known psoriasis signals were highly correlated in SAS and EUR (Spearman ρ = 0.78; p < 2 × 10-14). Transethnic meta-analysis identified two non-MHC psoriasis loci (1p36.22 and 1q24.2) not previously identified in EUR, which may have regulatory roles. For these two loci, the transethnic GWAS provided higher genetic resolution and reduced the number of potential causal variants compared to using the EUR sample alone. We then explored multiple strategies to develop reference panels for accurately imputing MHC genotypes in both SAS and EUR populations and conducted a fine-mapping of MHC psoriasis associations in SAS and the largest such effort for EUR. HLA-C*06 was the top-ranking MHC locus in both populations but was even more prominent in SAS based on odds ratio, disease liability, model fit and predictive power. Transethnic modeling also substantially boosted the probability that the HLA-C*06 protein variant is causal. Secondary MHC signals included coding variants of HLA-C and HLA-B, but also potential regulatory variants of these two genes as well as HLA-A and several HLA class II genes, with effects on both chromatin accessibility and gene expression. This study highlights the shared genetic basis of psoriasis in SAS and EUR populations and the value of transethnic meta-analysis for discovery and fine-mapping of susceptibility loci.

Genu valgum deformity - correction by a wedgeless implantless femoral "V" osteotomy.

Coronal malalignment of the knee joint is very common in developing countries especially because of nutritional rickets. Significant valgus deformity needs to be treated surgically to improve appearance, gait and function of the patient. The purpose of this prospective study was to evaluate the results of supracondylar "V" osteotomy as a surgical technique for correction of the valgus knee deformity. This study was conducted in a tertiary level teaching hospital and 30 cases were included in the study. For all the patients deformity was assessed using ana- tomical tibiofemoral angle, mechanical axis deviation and intermalleolar distance preoperatively and post- operatively. The average age of our patients was 13.7 years and the average follow up was3.29 years (1.39-14.22 yrs). Clinically the average value of intermalleolar distance preoperatively was 16cm and 3.2 cm postperatively. Average pre-operative tibiofemoral angle was 23° and the average postoperative angle was 6 0 which was found to be statistically significant using the Paired t test (p<0.005). The average value of preoperative mechanical axis deviation was 3.1 cm which decreased to an average value of 1.1 cm postoperatively. The results with this technique have been encouraging. The advantages of this technique are low morbidity, good stability allowing early ambulation, ability to adjust alignment postoperatively by casting and no need for internal fixation. Few studies have been conducted on osteotomies that do not require internal fixation and are inherently stable. This technique has the advantage of practically no occurrence of any infection or a second surgery to remove hardware in children and adolescents. Since no specialized instrumentation, image intensifier and implants are required, it is cost effective and can be used in any primary care or district level surgical setup in a developing country like ours.

Impact of a Psychodermatological Education Package on the Subjective Distress, Family Burden, and Quality of Life among the Primary Caregivers of Children Affected with Epidermolysis Bullosa.

BACKGROUND: Epidermolysis bullosa (EB) has profound effect on the subjective distress, family burden, and quality of life (QOL) of the primary caregivers (PCG). Knowledgeable PCG can efficiently manage children with these skin diseases and also improve their QOL. OBJECTIVES: To assess the subjective distress, family burden, and QOL, to develop and assess the short-term effectiveness of a psycho-dermatological education package (PDEP) for the PCG of children with EB. METHODS: In this interventional study, 30 PCG of EB were assessed for subjective distress, family burden, and QOL. PDEP, a structured educational tool explaining the disease and its care and stress management, was developed by the authors for the PCG and administered to them after one month of enrolment. They were reassessed after three months and compared with the baseline assessment scores. For comparison, 37 PCG of CI were also studied. RESULTS: The mean age (years) of the subjects was 28.7 ± 6.7 for EB and 30.5 ± 4.6 for CI. The mean or median (range) baseline scores for subjective distress, family burden and QOL of PCG (n = 20) of EB were 8.4 ± 7.9, 6.5 (0-30); 28.5 ± 17.5, 24 (7-77) and 12.6 ± 6.7, 11.5 (4-28) and for PCG (n = 14) of CI were 12 ± 4.3, 38.9 ± 16.2 and 17.7 ± 3.6 respectively. The PDEP improved the QOL (p = 0.01), knowledge (p < 0.01) and practices (p < 0.001) for PCG of EB and it improved subjective distress (p < 0.001), QOL (p < 0.01) and knowledge (p < 0.01) for PCG of CI. CONCLUSIONS: PDEP is an effective educational tool in improving the QOL and knowledge of PCG, which in turn provides efficient management and psychological support to children affected with EB and CI. It should, therefore, be routinely used for educating the PCG of children with EB and CI.

A split face randomized controlled trial comparing 1,064 nm Q-switched Nd-YAG laser and modified Kligman's formulation in patients with melasma in darker skin.

BACKGROUND: No randomized studies compared the efficacy and safety of modified Kligman's triple combination (TC) with 1,064 nm Q-switched Nd-YAG laser (QSNYL) in melasma in darker skin. OBJECTIVES: To compare the efficacy and safety of QSNYL and TC in the treatment of melasma in Fitzpatrick skin types IV and V. METHODS: In this split face randomized controlled trial, participants' cheeks were randomized to receive either weekly QSNYL (group A) or daily TC (group B) for 12 weeks, followed by 12 weeks of follow-up. RESULTS: Twenty-eight patients completed the intervention, and 21 of them completed follow-up. We found a significant but modest reduction in mean melanin index, modified Melasma Area Severity Index (MASI), and photographic and patient's assessment in both modalities (P < 0.01). No significant differences were detected between the groups. All patients had reappearance of pigmentation by the end of follow-up. Adverse reactions were significantly more in group B (P < 0.001). LIMITATION: The desired sample size could not be achieved. CONCLUSION AND RELEVENCE: No statistically significant differences were observed between QSNYL and TC as monotherapy in melasma. Reappearance of melasma is inevitable after stopping treatment.

Comparison of Platelet-Rich Plasma Prepared Using Two Methods: Manual Double Spin Method versus a Commercially Available Automated Device.

BACKGROUND: In the absence of a standard protocol, several methods and devices have been used for preparing platelet-rich plasma (PRP) with varying platelet concentrations. METHODS: Venous blood sample from 20 patients was used for preparing PRP using two methods: a manual double-spin method (1st spin at 160 g × 10 min, 2nd spin at 400 g × 10 min), and using a commercially available automated device (DrPRP-Kit®, REMI Laboratory Instruments). Platelet, erythrocyte, and total leukocyte counts were calculated for each PRP sample and compared. RESULTS: Platelet count in the PRP prepared with the manual double-spin method (PRPm, 12.51 ± 5.89 × 105/µL) as well as with the automated device (PRPa, 7.25 ± 4.74 × 105/µL) had significantly higher mean platelet count than whole blood (2.58 ± 0.81 × 105/µL, P < 0.001). The mean platelet count in PRPm was statistically significantly higher than PRPa (P < 0.001). The platelet capture efficiency of the manual method (mean 47.11%, median 41.75%) was statistically significantly higher than that of the automated device (mean 31.89%, 29.51%, P = 0.012). Platelet counts in both PRPs were variable, but the counts were more dispersed in PRPa(coefficient of variation 65%) as compared to PRPm(coefficient of variation 47%). CONCLUSION: The manual double-spin method had a higher platelet capture efficiency resulting in a higher platelet concentration as compared to the automated device. Though there was a significant interindividual variation in the platelet yield in the PRPs produced by both methods, results were more consistent with the manual method.

A split-face randomized controlled study comparing the efficacy and safety of intralesional radiofrequency-assisted subcision vs conventional subcision in postacne scars.

BACKGROUND: Postacne scars have significant psychosocial distress among patients. Subcision is a well-known treatment modality specially for rolling type of acne scars, but is a crude mechanical process, which carries a risk of hematoma formation. AIMS: To compare the efficacy and safety of radiofrequency-assisted subcision (rSubcision) with conventional subcision in postacne scars. METHODS: In this randomized, split-face study, adult patients with postacne scars were randomized to receive either conventional subcision or rSubcision in 2 sessions, 4 weeks apart and followed up for 2 months. Outcome was measured using Goodman and Baron score (GBS), investigator global assessment (IGA) by two blinded dermatologists, and patient global assessment (PGA). RESULTS: Seventeen out of 21 patients completed the treatment. Statistical analysis of the results was performed using SPSS 15.0 statistical software (SPSS). Patients in both the groups had significant improvement from baseline according to quantitative scoring (P = .0001), number of scars (P = .0001), IGA, and PGA. The improvement was comparable in both the groups according to GBS and IGA but better on rSubcision side in terms of PGA. Two patients developed small entry point burn during rSubcision which healed in one month and one developed persistent hematoma with conventional subcision. CONCLUSIONS: Both modalities were comparable in terms of assessment scores and investigator assessment, but patients found improvement better on rSubcision side.

Rituximab as an adjuvant therapy for pemphigus: experience in 61 patients from a single center with long-term follow-up.

BACKGROUND: Rituximab is increasingly being used as an adjuvant treatment for recalcitrant or relapsed pemphigus, but information on its use as a first-line agent is limited. We describe the long-term effectiveness and safety of rituximab in the treatment of pemphigus and compare the treatment outcomes when rituximab is used as first-line treatment vis-à-vis after treatment failure or relapse. METHODS: This was a retrospective review of 61 patients with pemphigus treated with rituximab at our center from March 2012 to October 2018. RESULTS: Of the 61 patients, 51 achieved complete remission (on or off treatment) and 10 had partial remission. Forty-nine (80.33%) patients achieved complete remission off prednisolone over a mean period of 8.08 ± 4.45 (range 3-20) months. Seventeen (27.9%) patients relapsed after a mean period of 23.94 ± 13.15 months after first rituximab cycle and 15.97 + 13.7 months after stopping prednisolone. Treatment-related serious adverse effects were noted in six (9.8%) patients. Eighteen (29.5%) patients were administered rituximab as the first-line adjuvant, while 43 (70.5%) patients received it after treatment failure or relapse. In both groups, remission rates on prednisolone (88.9%, 81.4%) and off prednisolone (88.9%, 76.7%) were comparable (P > 0.05). Relapse rates in the group which received rituximab as first-line treatment were about half of those who received rituximab after relapse or treatment failure (16.7% vs. 32.6%, P = 0.348). No statistically significant difference was seen in the times to different treatment endpoints (disease control, complete remission on and off prednisolone, and relapse) between the two groups. CONCLUSIONS: Rituximab is a safe and effective adjuvant in the treatment of pemphigus. Treatment outcomes were better for patients who received rituximab as first-line treatment, but the difference was not statistically significant.

Effect of Q-switched Nd-YAG laser on the clinical, pigmentary, and immunological markers in patients with lichen planus pigmentosus: A pilot study.

The persistent discoloration in lichen planus pigmentosus (LPP) is secondary to persistent melanophages in the superficial dermis in these patients. We evaluated the effect of Q-switched Nd-YAG laser on the clinical, pigmentary, and immunological markers in patients with LPP. Nine females with a clinical diagnosis of LPP were included in the study. After six sessions of laser with toning protocol, performed over a representative area of 5 × 5 cm2 at 2-weekly intervals, the mean clinical improvement as per the physician assessment was 25.7% (10-40%). There was no significant reduction in melanin and erythema index. On expression analysis using quantitative-polymerase chain reaction, the reduction in tyrosinase (p = 0.03) was statistically significant, though, the reduction in other pigment and immunological markers was not significant. The immunohistochemistry quantification data of corresponding proteins also did not show any significant difference. Post inflammatory hypopigmentation was noted in one patient. Q-switched Nd-YAG laser toning protocol resulted in modest clinical and histological improvement in patients of LPP.

Typing of Neisseria gonorrhoeae isolates by phenotypic and genotypic techniques in New Delhi, India.

BACKGROUND: The objective of this study is to investigate gonococcal isolates using phenotypic and genotypic methods. METHODOLOGY: Sixty gonococcal isolates obtained were examined. Strains were divided into 9 resistant phenotypes: Chromosomally mediated penicillin-resistant Neisseria gonorrhoeae (CMRNGP), penicillinase-producing NG (PPNG), chromosomally mediated tetracycline-resistant NG (CMRNGT), TRNG, PPNG and TRNG, CMRNGPT, quinolone resistant NG (QRNG), Azithro R, and decreased susceptibility (DS) to ceftriaxone. These isolates were also subjected to auxotyping and NG-multi-antigen sequence typing (MAST). RESULTS: Of 60 isolates, 32 (53.33%) PPNG and only one was CMRNGP; 16 (26.66%) were CMRNGT, while 18 (30%) were TRNG. Both PPNG and TRNG found in 13 (21.66%) and none were CMRNGPT. QRNG was seen in 93.33%, 5% Azithromycin R, and 6.66% were DS to ceftriaxone. Based on auxotyping, 24 (40%) nonrequiring, 16 (26.66%) were proline requiring, 13 (21.66%) arginine requiring while 7 (11.66%) belonged to others. The most common ST was 6058 (32.5%). The discriminatory indices of antibiogram, auxotyping and NG-MAST were 0.77, 0.72, and 0.95, respectively. CONCLUSIONS: NG-MAST is the method of choice for epidemiological studies.

A randomised controlled trial comparing the efficacy of micellised and fat-soluble vitamin D3 supplementation in healthy adults.

Nanoemulsion formulation of vitamin D3 have been shown to have better bioavailability than the coarse emulsion preparation in vitro and in vivo animal studies. In the absence of randomised trial in humans, comparing the efficacy of nanotechnology-based miscellised vitamin D3 over conventional vitamin D3, we undertook this study. A total of 180 healthy adults were randomised to receive either micellised (DePura, group A) or conventional vitamin D3 (Calcirol, group B) at a monthly dose of 60 000 IU (1500µg) for 6 months. The outcome parameters were serum 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH), Ca, phosphate, alkaline phosphatase and urinary Ca:creatinine ratio. A total of eighty-nine subjects in group A and seventy-seven in group B completed the trial. Subjects in both the groups had a significant increase in their serum 25(OH)D levels following supplementation (group A: 21·5 (sd 10·9) to 76·7 (sd 18·8) nmol/l (P<0·001); group B: 22·8 (sd 10·4) to 57·8 (sd 16·0) nmol/l (P<0·001)). Participants in micellised group had an additional increase of 20·2 (95 % CI 14·0, 26·4) nmol/l in serum 25(OH)D levels (P<0·001). The difference between the groups was 17·5 (95 % CI 11·8, 23·1) nmol/l, which remained statistically significant (P<0·001) even after adjustment for age and sex. Significant decline in mean serum PTH was observed in both the groups. No hypercalcaemia or hypercalciuria was noted. Although supplementation with both the preparations resulted in a significant rise in serum 25(OH)D levels, micellised vitamin D3 appeared to be more efficacious in achieving higher levels of serum 25(OH)D.

DRD2 methylation and regional grey matter volumes in young adult offspring from families at ultra-high risk for alcohol dependence.

Dopaminergic alteration is a prominent feature in those with AD and may influence brain development in those with a family history of AD. MRI scans (3T) from 43 HR offspring (27.4 ±â€¯3.6 years) and 45 controls (24.5 ±â€¯4.1 years) provided whole brain (WB) and region of interest (ROI) analyses. The VBM8 toolbox was used for WB analysis (threshold p < 0.005; cluster = 100 voxels); the MarsBaR ROI toolbox provided region of interest data. Pyrosequencing of CpG sites within the DRD2 gene was performed. DRD2 methylation was significantly increased in association with familial high-risk status. Significant familial risk group differences were seen with HR individuals showing reduced volume of the Left Inferior Temporal, Left Fusiform and Left Insula regions relative to LR controls. These regions have previously been linked to social cognition. DRD2 methylation was negatively related to grey matter volumes in these regions. Because these regions, have been previously linked to facial affect perception and social cognition, lesser grey matter volumes in individuals at high-risk for developing AD suggests that neural underpinnings of social cognitive impairment may be a premorbid risk factors for AD.