bluuebunny/crossref_metadata_2025 huggingface dataset:
Posterior Reversible Encephalopathy Syndrome in Spotted Fever Group of Rickettsial Infection with Brugada Syndrome
Authors: Palleti Siva Karthik Reddy , Kolla Viswateja , Kamath Vasantha
Published: April 2022

Rickettsioses are one of the common causes of undifferentiated febrile illness. Patients present commonly with fever, rash, and eschar. Posterior Reversible Encephalopathy Syndrome (PRES) also known as reversible posterior encephalopathy syndrome is a rare condition, in which parts of the brain are affected by swelling as a result of an underlying cause such as infection. However, PRES caused by spotted fever group of rickettsiosis is rarely reported. We are here with reporting such a case. A 55-year-old male was admitted to MVJ Medical College and Research Hospital, Bengaluru, with complaints of fever for 3 days and one episode of Generalized Tonic Clonic Seizures (GTCS) following which he was in altered sensorium. On examination, there was hepatosplenomegaly. Weil-Felix OX19 and OX2 were 1:320. Lumbar puncture was done which showed 15 cells 98% lymphocytes and 2% neutrophils, proteins-119 mg/dl, and sugar- 153 mg/dl. Magnetic resonance imaging of the brain showed bilateral symmetric hyperintensities on T2-weighted imaging in the parietal and occipital lobes. The calcarine and occipital lobes were spared suggestive of posterior reversible encephalopathy syndrome. Electrocardiogram showed ST elevation in V1 and V2 along with T-wave inversion (Brugada sign). Posterior reversible encephalopathy syndrome is usually commonly seen in hypertensive encephalopathy and in infections such as dengue and few cases of scrub typhus. This is one of the rare cases where spotted fever group of rickettsia has caused posterior reversible encephalopathy syndrome and Brugada syndrome.
Posttransplant Membranous Nephropathy - A Case Report
Authors: Sullaiman Shabna , Chauhan Prabhat , Kumar Ashwani , Nada Ritambhra , Minz Ranjana , Kumar Vinod , Sharma Ashish , Singh Sarbpreet , Kumar Vivek , Rathi Manish , Kohli Harbir Singh , Ramachandran Raja
Published: April 2022

Primary membranous nephropathy (PMN) is a common cause of adult-onset nephrotic syndrome. Anti-M-type phospholipase A2 receptor (PLA2R) antibodies are pathogenic and correlate with clinical outcomes. The role of anti-PLA2R in recurrent PMN is unclear. In the present manuscript, we report five cases of PMN who underwent kidney transplantation (KT) with varying titers of anti-PLA2R pre-kidney transplantation (KT). Two patients with anti-PLA2R in the second and third tertiles had a recurrence of PMN, whereas patients with a negative or anti-PLA2R in the first tertile had no recurrence. The report signals a heightened risk of PMN recurrence in patients with elevated anti-PLA2R antibody titer at KT.
Clinicopathologic Features of Polyomavirus Nephropathy
Authors: Veduruvada Ramya , Madireddy Nishika , Koyya Soundarya Samskruthi , Guditi Swarnalatha , Taduri Gangadhar , Raju Sree Bhushan , Uppin Megha Shantveer
Published: April 2022

Introduction:

Polyomavirus nephropathy (PVN) is now being frequently encountered in renal transplant recipients receiving highly potent immunosuppressive drugs and has emerged as an important cause of allograft loss. In this study, we tried to study the clinical and morphological features while incorporating the latest Banff 2018 classification of PVN and correlating it with graft outcomes.

Materials and Methods:

This was a retrospective study including ten patients with biopsy-proven PVN. The risk factors, clinical, histomorphological, and immunohistochemical features of all the patients were studied. We scored the intrarenal polyomavirus load and Banff interstitial fibrosis as described by Banff 2018 working group.

Results:

There were 6 male and 4 female patients and the mean age at the time of biopsy was 42.5 ± 10.8 years. All patients were on triple immunosuppression and the mean transplant duration to the time of diagnosis was 6.98 ± 4 months. The mean serum creatinine at the time of biopsy was 2.73 ± 1.12 mg/dl. A prior history of antibody-mediated rejection was present in two patients. All ten biopsies showed tubular epithelial basophilic, intranuclear inclusions suggestive of BK virus which was confirmed by positivity for SV40 antigen on immunohistochemistry (IHC). As per the Banff 2018 classification, seven biopsies were categorized as Class 2 and three were class 3. On follow-up, three patients went into graft loss, five patients had persistent graft dysfunction, and two expired.

Conclusion:

PVN is an important cause of renal dysfunction and premature allograft loss. Light microscopy for viral cytopathic changes aided by IHC with SV40 is essential for the diagnosis of PVN. The Banff scheme of classification is helpful in predicting the prognosis. It is important to diagnose PVN and differentiate it from rejection for appropriate management.
Rectal Carcinoma 27 Years' Postkidney Transplant in a Chronic Hepatitis B Patient - A Case Report
Authors: Anupama Sneha Haridas , Parthasarathy Rajeevalochana , Mathew Milly , Anupama Priya Haridas , Abraham Georgi
Published: April 2022

Here, we report a 72-year-old male with HBsAg-positive status who had a live sibling kidney transplant 27 years ago. He was on minimal maintenance immunosuppressive therapy with prednisolone and microemulsion cyclosporine. He presented with vague abdominal symptoms and was diagnosed to have moderately differentiated adenocarcinoma of the rectum, which was treated by low anterior resection with loop ileostomy and is currently undergoing radiotherapy.
Turn Around Time in Matched Unrelated Donor Search Workup National versus International Registries
Authors: Mishra Vikash Chandra , Dey Nikki , Bhardwaj Amit Kr , Chandra Dinesh , Anthwal Archana , Raina Vimarsh
Published: April 2022

Background:

Timeline is a key factor for hematopoietic stem cell transplant (HSCT) recipient. HSCT by matched unrelated donor (MUD) is a standard definitive therapeutic approach for many hematological disorders which are not amenable to chemotherapy and other conventional treatment.

Aims and Objectives:

The aim of the present study was to compare the turnaround time (TAT) involved in completion of MUD HSCT workup from an Indian registry (Genebandhu) with international registries.

Materials and Methods:

On receipt of pre-transplant matching request through a transplant physician, patient's human leukocyte antigen (HLA) type was entered in both Genebandhu and World Marrow Donor Association search tool for initiating a “search.” The software gave the descending order of the best possible matches by performing computational analysis. The search result was considered a “match” when potential 10/10 HLA match was found. The average TAT was calculated in the middle of search request and HLA confirmatory typing (CT) and infectious disease marker (IDM). Further, TAT was also determined between the infusion of harvested stem cell product and CT and IDM. At last, the total time engaged in completion of each MUD HSCT workup was determined and compared in national versus international registries.

Results:

The average TAT involved in between search request and CT and IDM was 71 days in case of global registry and 67 days in case of Genebandhu. Similarly, the average TAT involved between infusion of harvested cell product and CT and IDM testing in case of donor identified in global stem cell registry was 65 days whereas 45 days in case of Genebandhu. At last, the average time associated with the finishing of a MUD workup was 136 days in case of global registry, whereas 112 days in the case of Genebandhu at P ≤ 0.05 with a 95% confidence interval.

Conclusion:

To conclude, the average TAT obtained through this study clearly demonstrates the advantages in terms of donor availability for MUD HSCT through the national registry.
Impact of Pretransplant Malnutrition on Short-Term Clinical Outcomes of Liver Transplantation - An Exploratory Study
Authors: Bakshi Neha , Singh Kalyani , Soin Arvinder Singh
Published: April 2022

Introduction:

Malnutrition is highly prevalent among patients undergoing liver transplantation (LT) and can affect various clinical factors. The present study focuses on the impact of pretransplant malnutrition on various short-term outcomes of LT.

Methods:

Ninety LT recipients undergoing elective living donor LT were recruited in the study. Based on subjective global assessment (SGA), they were grouped as normal, moderate, and severely malnourished. Information regarding prognostic factors (Child-Turcotte-Pugh [CTP] and Model for End-Stage Liver Disease [MELD] scores), biochemical parameters (hemoglobin, TLC, platelets, bilirubin [T], serum glutamic-oxaloacetic transaminase, serum glutamic-pyruvic transaminase, albumin, creatinine, and sodium), dietary intake, % weight loss, and short-term outcomes (hospital stay, intensive care unit days, blood unit usage during surgery, and dead and alive status after 1 year) were gathered.

Results:

The recipient evaluation showed that 54.4% of the patients were moderately malnourished and 27.8% of the patients were severely malnourished. The prognostic scores, CTP, and MELD significantly had higher scores in moderately and severely malnourished patients (P < 0.001 and P = 0.003). Among the biochemical parameters, hemoglobin, albumin, and sodium showed significantly lower levels in moderately and severely malnourished patients (P < 0.001, P = 0.02, and P = 0.01). The data also showed a significantly higher degree of ascites, % weight loss, and lower calorie intake among malnourished patients. A higher degree of malnutrition was associated with poor outcomes of LT; higher hospital stay (P = 0.014), packed red blood cell unit usage during surgery (P = 0.005), and deaths after 1 year of LT (P = 0.03).

Conclusion:

Pre-LT malnutrition by SGA was associated with poor short-term outcomes of LT with higher hospital stay and deaths. Hence, the present data emphasize the need for early nutrition intervention for improved surgery results.
Role of Telemedicine in Kidney Transplant Recipient in COVID 19 Era
Authors: Kute Vivek B. , Gupta Vaibhav , Patel Himanshu V. , Banerjee Subho , Engineer Divyesh P. , Meshram Harishankar , Navadia Vijay , Patel Ansy H.
Published: April 2022

Introduction:

Telemedicine represents an innovative but untested approach to maintain patient care and reduce the risk of COVID-19 exposure to patients, health-care workers, and the public. In this study, we evaluated the applicability and efficacy of telemedicine in a kidney transplant recipient (KTR) cohort in COVID 19 era.

Materials and Methods:

An observational cohort study was conducted at a tertiary-care public-sector kidney disease institute in western India between March and September 2020. We evaluated the reasons, modes, and outcomes of patient contacts by telemedicine in the KTR cohort. We also evaluated the utility of telemedicine across three age groups.

Results:

Of 840 participants, whose mean age was 38.78 ± 12.39 years, male to female ratio was 4:1. The most common mode of communication was WhatsApp (653, 77.7%) followed by in-person surrogates (126, 15%). Acceptability of telemedicine was significantly better in younger and middle-age groups (P < 0.00001) compared to the elderly. Request for drug delivery (n = 756) was the most common reason for contact overall and managed through postal parcels. KTRs (n = 200) and donors (n = 75) were evaluated for medical illnesses. The most common medical reasons for contact were for febrile illness (n = 120) and graft dysfunction (n = 60). COVID-19-related disease was diagnosed and managed in 80 KTRs and 2 donors. COVID-19 updates were given to all contacts.

Conclusion:

Telemedicine is underutilized in the care of the KTR cohort. Telemedicine can be used across all ages although it's best suited for young and middle age groups. The impact of telemedicine on short- and long-term patient outcomes is unclear and warrants further study.
Efficacy and Safety of Bortezomib in the Treatment of Active Antibody-Mediated Rejection in Adult Kidney-Transplant Recipients
Authors: Bhadauria Dharmendra , Kumar Sai , Yachha Monika , Kaul Anupma , Patel Manas Ranjan , Kushwaha Ravi Shankar , Behera Manas R , Prasad Narayan
Published: April 2022

Introduction:

The management of active antibody-mediated rejection (ABMR) is evolving, and optimal treatment remains uncertain due to incomplete understanding of pathogenesis. Bortezomib is found to be useful in the treatment of active ABMR. We studied the efficacy and safety of bortezomib in renal-transplant recipients with active ABMR.

Materials and Methods:

We retrospectively included renal-transplant recipients with active ABMR, who received bortezomib as main management.

Results:

Eighteen live-related renal-transplant recipients of active ABMR were included. C4d was positive in 14 patients and negative in eight patients. Patients with active ABMR had a mean improvement in glomerular filtration rate (GFR) of 7, 10.5, and 15 ml/min/1.73 m2 at 3, 6, and 12 months, respectively, from baseline GFR. Improvement was significant at 3 (P = 0.009) and 6 months (P = 0.018) of follow-up.

Conclusion:

Bortezomib may be a safe and effective therapy in patients with active ABMR in patients.
Consensus Statement on Organ Donation from COVID-Positive Deceased Donors-Indian Society of Organ Transplantation, Liver Transplant Society of India and Indian Society for Heart and Lung Transplantation
Authors: Asthana Sonal , Kute Vivek , Shah Unmil , Mohanka Ravi , Sahay Manisha , Chinnadurai R , Rajagopal Swati , Patwardhan Sujata , Prasad Narayan , Guleria Sandeep , Bansal Shyam , Choudhary Arpita Roy , Ray Deepak S , Kolte Sanjay , Gulati Sanjeev , Seth Sandeep , Agarwal Sanjay K. , Ojha Jai Prakash , Varma PP , Shroff Sunil
Published: April 2022

COVID has drastically impacted organ donation across the world, leading to untold misery for thousands of patients who have been waiting for organs. Early rules on the use of organs from COVID positive or affected donors were stringent due to the fear of spread of disease or thrombotic complications in patients who received these organs. However much has changed in the past two years. Most of our adult population has either been infected with COVID, or has received two doses of vaccine, or both. The current variant, despite being more infective, is associated with mild disease, especially in those who have been vaccinated Our armamentarium against severe COVID has improved dramatically in the past year- we have effective vaccines, monoclonal antibodies for treatment of mild COVID in high risk patients and post exposure and antiviral prophylaxis and treatment which can substantially reduce the risk of severe COVID requiring ICU admission. The risk of transmission of COVID infection has to be balanced against the risk of patients dying with end organ disease. We will have to learn to live with COVID- this also means investigating whether organs from donors who are, or have been COVID positive can be used with acceptable risk –benefit in selected patients with end stage organ failure. This document is a summary of evidence and information regarding donor screening for SARS-CoV-2 and considerations for organ acceptance from donors with a history of COVID-19.
COVID-Associated Pulmonary Aspergillosis in a Post Renal Transplant Patient
Authors: Balwani Manish R. , Pasari Amit S. , Bhawane Amol , Gurjar Prasad , Tolani Priyanka R.
Published: April 2022

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) is usually mild in general population, while in renal transplant patients, it can turn fatal. Some patients suffer from post COVID-19 secondary bacterial and fungal infections due to virus-induced immunosuppression. We here report a case of immediate post renal transplant patient who contracted COVID-19 illness and later developed pneumonitis which on BAL was found to be due to Aspergillus fumigatus. Through this case report, the author aims to highlight the importance of keeping check on post COVID-19 secondary opportunistic infections in post renal transplant patients. Early diagnosis with high index of suspicion is essential to start timely and effective treatment.
Study of Noninduction Immunosuppression in Intermediate-Risk Living Donor Kidney Transplantation in Rural Population of India - A Retrospective Observational Study
Authors: Data Ankit , Gadekar Kshitija G. , Mogal Vajed R. , More Abhijeet S. , Kulkarni Sudhir Gajanan
Published: April 2022

Introduction:

Kidney transplant is a costly affair, especially in a developing country like India. The current study was carried out with the aim to analyze the clinical outcome retrospectively in terms of acute rejection (AR), graft survival, and patient survival in intermediate-risk recipients undergoing first renal transplant with Tacrolimus (TAC), Mycophenolic acid (MPA), and corticosteroid based triple maintenance immunosuppression in one of the most underprivileged population of the country who has to bear the cost of the induction agent not covered by any government scheme.

Materials and Methods:

It is a retrospective observational study. We included 101 patients, out of which 42 were in basiliximab group and 59 patients did not receive any induction agent. Apart from the induction, agent rest of the Immunosuppression protocol was same in all patients. The primary endpoint of the study was number of biopsy-proven AR within 1st year of transplantation. The secondary endpoints were patient and graft survival by 1 year.

Results:

Human leukocyte antigen mismatch and mean age of the patients in basiliximab group were significantly higher than noninduction group; otherwise, both groups were similar in all other baseline parameters. There was no significant difference between AR (21.43% v/s 18.64%), graft survival (97.30% v/s 98.15%), and patient survival (88.10% v/s 91.52%) at 1 year.

Conclusion:

Our study suggests that Induction immunosuppression may not be necessary for patients undergoing intermediate-risk living donor kidney transplant in the current scenario of TAC and MPA-based maintenance immunosuppression.
Needle Stick Injuries and Postexposure Prophylaxis for Hepatitis B Infection
Authors: Sharma Tarika , Chaudhary Ashok , Singh Jitender
Published: April 2022

Hepatitis B virus (HBV) infection is a global public health challenge as roughly a quarter of the world's population has serological evidence of past or present hepatitis B virus (HBV) infection. Healthcare personnel, who work in healthcare settings, represent a high-risk population for serious, potentially life-threatening Hepatitis B Virus infections. Needle stick injuries pose a serious risk for occupational transmission of hepatitis B virus and may occur during various procedures such as needle recapping, operative procedures, blood collection, intravenous line administration, blood sugar monitoring, and due to improper sharps/needle disposal. Infections acquired through occupational exposure are largely preventable through strict control measures such as the use of safe devices, proper waste disposal, immunization and prompt management of exposures including the use of Post Exposure Prophylaxis. The current review highlights the first aid management, reporting, baseline investigations as well as post exposure prophylaxis for Hepatitis B following needle stick injury.
Knowledge, Attitude, and Practice toward Prevention and Management of COVID-19 among Indian Nurses
Authors: Rastogi Aayushi , Syed Sabin , Bansal Akanksha , Ramalingam Archana , Sharma Tarika , Kumar Vinay , George Mini , Varshney Mohit
Published: April 2022

Background:

To plan suitable policy against COVID-19 pandemic, it is important that the nurses have updated knowledge related to prevention, diagnosis, treatment, and management of COVID-19 and have an optimistic attitude and good practices in managing the patients during the pandemic crisis. Thus, we conducted a study on the knowledge, attitude, and practices (KAP) related to COVID-19 among Indian nursing professionals.

Methodology:

A cross-sectional study was conducted from April 22 to May 22, 2020 using a pretested 37-item-self-reported e-questionnaire among nursing professionals above 18 years of age, working in health-care setting across 25 states. The questionnaire consisted of four sections: demographic details, knowledge (26 items), attitude (6 items), and practice (5-itmes). KAP questionnaire was shared through e-mail, SMS, and WhatsApp groups.

Results:

A total of 1182 participants responded to the online survey with 94% completion rate. The study analyzed the data for 1110 nurses with a mean age of 30 ± 6.7 years and 68% being females. The mean KAP score was 16.82 ± 3.3, 9.77 ± 2.03, and 18.37 ± 3.29, respectively. Knowledge was significantly correlated with attitude (r = 0.1316) and practice (r = 0.1526). Practice and attitude were also found to be positively correlated (r = 0.4398). Good knowledge related to COVID-19 was significantly affected by age, gender, location, and type of facility (<0.01).

Conclusion:

The study raised concerns regarding poor knowledge, anxiety, and fear from COVID-19 duty affects the health-care workers (HCWs) performance and provides resistance in working. A comprehensive training program for HCWs focuses more in terms of infection, prevention, control, and management and maintaining good mental health is required.
Home Management of Intestinal Stoma
Authors: Kang Harmeet Kaur , Choudhary Mamta
Published: April 2022

Shortened hospital stays for clients with an intestinal stoma have shifted the focus from institutional care in hospitals to self-care of ostomies to the home setting. Clients with intestinal ostomy experience numerous changes in physical functioning, psychosocial health, and in their sexual life after creation of stoma. This enhances the importance of a guide for home management of intestinal stoma to assist home care clinicians and stoma care nurses, who are determined to make ostomates self-reliant. This evidence-based review focused on published articles from the Medline, CINAHL, Social Sciences Citation Index, Psych INFO, a hand search through selected journals published since 2000, and from references lists, to prepare home management guide for intestinal stoma. This article provides information regarding measures to protect skin around stoma, daily care management for ostomates, and ways to prevent peristomal skin complications.
Knowledge and Practices of Blood Donors regarding COVID-19
Authors: Sharma Tarika , Raza Vaseem , Kumari Manglam , Srivastava Swati , Ponnappan Karthik
Published: April 2022

Introduction:

COVID-19 pandemic has threatened the safety of both donors and recipients thus negatively impacting the blood donation process. Home confinement limits the ability of donors to attend blood services and the staff to take part in collection teams as well. The restrictions and limitations of large gatherings also reduce the number of large blood drives and campaigns.

Aim:

The current survey was undertaken soon after the official announcement of nationwide lockdown to assess the COVID-19-related knowledge and expressed practices about precautions among blood donors visiting blood bank.

Materials and Methods:

This was a cross-sectional survey conducted on 109 blood donors visiting blood bank in the month of March–April 2020. Data were collected using structured knowledge questionnaire and expressed practice checklist. After collecting data, the donors were provided with information related to COVID-19, and its precautions as per the guidelines from the Ministry of Health and Family Welfare, India. The obtained data were analyzed using the SPSS software version 22.

Results:

In terms of knowledge, it was found that 51.3% donors had very good knowledge, 42.3% had good knowledge, whereas 6.4% donors had poor knowledge about COVID-19. With regard to practices related to COVID precautions, it was noticed that most (90.82%) of the donors followed best practices, 9.18% donors followed good practices, whereas none of the donor followed poor practices. A significant positive correlation (P ≤ 0.01) was found between knowledge and practice score of blood donors. Significant association was seen in knowledge with educational status (P = 0.003) and practice with place of residence (P = 0.010).

Conclusion:

Based on the findings, it was concluded that 51.3% donors had very good knowledge, whereas 6.4% donors had poor knowledge about COVID-19. With regard to the practices related to COVID precautions, most (90.82%) of the donors followed best practices, 9.18% donors followed good practices, whereas none of the donor followed poor practices. Hence, the health-care professionals must take active steps to disseminate correct and updated information to blood donors regarding COVID-19 and related precautions.
Correlation of Immunohistochemical Expression of p16, Ki-67, and p53 with Histopathological Diagnosis of Noninvasive Cervical Lesions
Authors: Ogbu Christian C. , Ndukwe Chinedu Onwuka , Chiemeka Michael Emeka , Madubuike Kingsley C. , Ukah Cornelius Ozobia
Published: April 2022

Background:

There is a high burden of cervical cancer in our environment. Most patients present late when the prognosis is guarded. Hence, accurate diagnosis of preinvasive lesions from cervical biopsies is important for clinical decisions and patient management. The aim of the study is to correlate the expression of p16INK4a, p53, and Ki-67 with histopathological diagnosis of noninvasive cervical lesions.

Materials and Methods:

The paraffin blocks of all cervical biopsies (excluding cases histologically diagnosed as invasive lesions) seen in two histopathology laboratories in Nnewi, Southeast Nigeria, over a 10-year period (2011–2020) were retrieved from the archives of both facilities. The cases were subjected to immunohistochemistry using p16INK4a, Ki-67, and p53 monoclonal antibodies.

Results:

There were 23 normal/reactive (45.1%), 6 low-grade squamous intraepithelial lesion (11.8%), and 22 hIL (43.1%). There is a very strong positive correlation between p16INK4a expression and the histopathological diagnosis (Spearman's correlation = 0.98). There is a strong positive correlation between Ki-67 expression and the histopathological diagnosis (Spearman's correlation = 0.70). There is a weak positive correlation between p53 expression and histopathological diagnosis (Spearman's correlation coefficient = 0.40).

Conclusion:

p16INK4a shows the best correlation with histopathological diagnosis of noninvasive cervical lesions and may be a very useful adjunct to H and E for diagnosing preinvasive cervical lesions. However, p53 correlates poorly with histopathologically diagnosed noninvasive cervical lesions and therefore may not be diagnostically useful.
Histopathological Spectrum of Skin Lesions in the Elderly
Authors: Ndukwe Chinedu Onwuka , Ndukwe Chinwe Chioma , Uzoigwe Joseph Chukwuma , Eni Anthony Onyeka , Nnamani Christian Sunday , Nwokoro Onyekachi Chibueze , Chiemeka Michael Emeka
Published: April 2022

Background:

There are only a few epidemiological studies published on skin disorders in the elderly within the Nigerian context and none from the Southeast Region of the country. In addition, none of these studies has considered the pattern and frequency of histopathologically diagnosed geriatric skin lesions. Hence, we attempted to determine the frequency as well as the age and gender distributions of histologically diagnosed dermatological diseases in geriatric population from skin biopsies submitted to the histopathology department of a tertiary care hospital in Southeast Nigeria.

Materials and Methods:

This is a cross-sectional retrospective hospital-based study involving all skin biopsies of patients 60 years and above, received at the Department of Histopathology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, from January 2004 to December 2019.

Results:

During the study period, 751 skin biopsies were received in the histopathology department. Of these, 142 were from patients who were older than 60 years. Thus, the overall share of geriatric patients was 18.9%. The mean age at presentation was 71.1 ± 8.6 years. The M: F was 1:1, and most of the patients belonged to the age group of 60–69 years (69 cases, 48.6%). The mean age of the male patients was 72.1 ± 9.5 years. In the female patients, it was 70.1 ± 7.5 years. The most common disease category was neoplasms (91, 64.1%). Most neoplasms were malignant. There were 67/142 (47.2%) malignant lesions. The most common was Squamous cell carcinoma (SCC) (30 cases) which is 21.1% of all geriatric skin biopsies and 44.8% of malignant skin biopsies. This is closely followed by melanoma (29 cases).

Conclusion:

Malignant neoplasms, benign neoplasms, and papulosquamous disorders are the three most common histologically diagnosed skin lesions in our geriatric population. The most common skin malignancies in this group of patients are SCC and malignant melanoma.
Poverty, Gambling, and Illicit Drug Use Perpetuate Each other in a Bidirectional Cycle
Authors: Bhattacharya Sudip , Singh Amarjeet
Published: April 2022

Illicit drug use and gambling are global problem, and multiple stakeholders are involved in it. This often leads to devastating physical, mental, and socioeconomic consequences for the family. In this case study, we describe our experience with an urban poor family from north India that was disintegrated by illicit drug and gambling use by one of its members. In this case, the family and school failed to recognize and act on the early warning signs of drug addiction and gambling. Health system failed to retain and follow him up. Law enforcement was also inadequate. It was a multisystem failure. For managing an illicit drug use case, we have also to address the cultural and social complexities that are part of the poverty subculture. Adequate involvement of multiple sectors and optimal follow-up can not only help the patient but also it prevents the collateral damage to a large extent in the affected families.
Quality of Life and Psychiatric Comorbidity in Vitiligo
Authors: Benny Deepthi , Makkuni Anoop , Thyvalappil Anoop , Mathew Pretty , Sridharan Rajiv , Druhin A V.
Published: April 2022

Background:

Vitiligo is a common, acquired, idiopathic, depigmenting disorder with a profound effect on the patient's quality of life (QoL).

Purpose:

The objective of the study was to measure the QoL of patients with vitiligo using the dermatology life quality index (DLQI) and to assess psychiatric comorbidity in vitiligo patients using the General Health Questionnaire-28 (GHQ-28).

Methods:

Sixty patients above 16 years of age with vitiligo were enrolled. Age, sex, occupation, marital status, duration of disease, extent of involvement, visibility of lesions, details of treatment, duration of treatment, and response to treatment were collected. Independent t-test and ANOVA were used to test for significance of continuous variables and Chi-square test for categorical variables. Correlation between DLQI and GHQ-28 was assessed using Spearman's rho correlation coefficient.

Results:

Females scored higher than males on overall GHQ-28 scores and in individual domains of anxiety/insomnia, social dysfunction, and severe depression. Unmarried participants had higher scores compared to married subjects in all dimensions of DLQI and GHQ-28, indicating worse QoL and mental health.

Conclusion:

More than half of vitiligo patients had psychiatric comorbidity. There was a strong correlation between DLQI and GHQ-28 score, indicating strong association of QoL impairment with psychological problems. Proper counseling of patients of vitiligo along with specific treatment may be prudent.
Public Knowledge and Attitude toward Vitiligo in Saudi Arabia
Authors: Algarni Malak A. M. , Alqarni Waleed A. , Alghanemi Logain G. , Alnashri Maryam M. , Alghanemi Rand G. , Mleeh Nouf T.
Published: April 2022

Background:

Knowledge and positive attitude toward vitiligo would foster support for affected individuals, improving their sense of well-being and possibly treatment outcome.

Purpose:

To evaluate the levels of public knowledge and attitude toward vitiligo among Saudis.

Methods:

A cross-sectional study among 12,181 participants. Data were collected using a self-administered questionnaire enquiring about knowledge, attitude, and perceptions in vitiligo.

Results:

The response rate was 95.4%. Most respondents had heard about vitiligo (96.9%). The median knowledge score was four out of eight and median attitude score was six out of eight. Social media/Internet was the most commonly reported source of information (34.7%), followed by family/friends/acquaintances (30%). Higher proportions of correct responses were recorded regarding the noninfectious nature of vitiligo (85.0%) and whether vitiligo was dangerous or connected to skin cancer (63.4%). However, unsatisfactory responses were found regarding the immunological basis of the condition: only 24.3% knew that vitiligo was an immune disease and 24.5% knew about the role of heredity in vitiligo. The majority of respondents did not mind employing patients with vitiligo (89.0%). Only 40.6% responded that they would marry someone with vitiligo. Positive attitude was significantly common in respondents aged 31–50 years (P < 0.01), women (P < 0.01), and those who had a university degree or higher (P < 0.05).

Conclusion:

Although overall attitude toward vitiligo patients was positive, there were gaps in the knowledge, particularly regarding the nature of the disease. More awareness and education are required to improve attitude toward vitiligo patients, with an aim to improve their overall well-being.
Factor Structure of the Bengali Version of Atopic Dermatitis Burden Scale for Adults
Authors: Agrawal Ekta , Gautam Ashish K. , Shaikh Abdur R. , Dutta Souvik , Dey Samit , Mukherjee Shyamal K. , Saha Sangita , Mandal Sanjukta , Ghosh Shubhamoy , Koley Munmun , Saha Subhranil
Published: April 2022

Background:

Atopic dermatitis (AD) is associated with increased burden and reduced health-related quality of life (HRQoL); however, there is no available Bengali questionnaire assessing the same.

Purpose:

We aimed to develop the Bengali version of the questionnaire and examine its cross-cultural adaptability considering linguistic equivalence.

Methods:

A multicentric, mixed methods, cross-sectional study was conducted through the consecutive sampling at the outpatients of three homeopathy hospitals in West Bengal. The Bengali version of the questionnaire was produced by standardized forward-backward translations. Psychometric analysis was run to examine its factor structure, validity, and reliability. Reliability was examined using internal consistency (n = 230). Construct validity was examined by the exploratory factor analysis (EFA; n = 115) using the principal component analysis (PCA; varimax rotation). Subsequently, confirmatory factor analysis (CFA; n = 115) was performed to verify the model fit.

Results:

The internal consistency (Cronbach's α =0.876 (95% confidence interval 0.851–0.898)), test-retest reliability and concurrent validity – all were within the acceptable limits. The Kaiser-Meyer-Olkin (KMO = 0.793) and Bartlett's test of sphericity (Chi-square: 1038.981 at 153° of freedom, P < 0.001) both suggested adequacy of the sample. In factor analysis using varimax, all the items loaded above the prespecified value of 0.4 and identified five components, explaining 68.3% of the variation. The goodness-of-fit of the 5-components model in CFA was also acceptable (comparative fit index = 0.858, Tucker Lewis index = 0.823, root mean square error of approximation = 0.102, and standardized root mean square residual = 0.188).

Conclusion:

The Bengali version of the questionnaire consisting of 18 items and framed within five components appeared to be a valid and reliable instrument measuring disease burden and HRQoL in adults suffering from AD.
Prevalence of Topical Corticosteroid Use without Prescription in Saudi Arabia
Authors: Al-Aojan Shaikah , Al-Marzoug Alanoud , Alaujan Abdulrahman , Abanmi Samiah , AlJasser Mohammed I.
Published: April 2022

Background:

Misuse of topical corticosteroids (TCS) is common and constitutes a serious problem in many parts of the world where they can be obtained without prescription. Limited studies have been performed in Saudi Arabia to address this issue.

Purpose:

We aim to study the prevalence, predisposing factors, and adverse consequences of TCS use without prescription in Saudi Arabia.

Methods:

A cross-sectional study was performed using an Arabic questionnaire distributed through social media applications in May 2020 in Saudi Arabia. Individuals aged 18 years and above who used TCS within the last 2 years were included. The questionnaire consisted of detailed questions about TCS use and demographic information.

Results:

A total of 720 participants completed the questionnaire. TCS were used without prescription by 43.1% of respondents. Being female was the only identified risk factor for the use of TCS without prescription. The main reason for purchasing TCS without prescription was that the problem seemed too trivial to consult a physician (36.6%). The most common conditions for which TCS were used were treatment of pruritus without skin disease (23.7%) and cosmetic reasons (19.9%). Side effects were reported in 25.6% of participants. The most common side effects were hypopigmentation, itching, redness, and skin sensitivity.

Conclusion:

The use of TCS without prescription is prevalent in Saudi Arabia. We recommend that local health authorities regulate the use of TCS.
Quality of Life and Psychological Aspects of Patients with Hidradenitis Suppurativa in Saudi Arabia
Authors: Alsharif Sahar , Khan Zakaria , Almuntashri Fahad , Alghamdi Ahmad
Published: April 2022

Background:

Hidradenitis suppurativa (HS) is a chronic recurrent painful auto-inflammatory skin disease of the terminal hair follicle, causing nodules, abscesses, sinus tracts, and scars on intertriginous areas.

Purpose:

This study aims is to determine the effect of HS on patients' psychology and quality of life in the Makkah population.

Methods:

This is a cross-sectional, multi-center study conducted on HS patients who visited the dermatology clinic during 2017−2020. A total of 165 patients participated in the study by completing a questionnaire consisting of demographic data, the dermatology life quality index, depression, anxiety, and stress score.

Results:

In total, 147 patients were included in the final analysis, and the mean age of the participants was 32.0 ± 10.6. HS had a very large effect on the quality of life of 32% of the participants. Quality of life was worse with the number of flares per year (P < 0.003) and with axillary and perianal involvement, (P < 0.018 and P < 0.024, respectively). Moreover, a higher level of depression was associated with a higher body mass index (P < 0.020).

Conclusion:

HS had a large effect on the quality of life regardless of Hurley stage and was correlated with the number of flares per year and area of disease involvement.
Pregnancy and Neonatal Outcome with Maternal Exposure to Finasteride
Authors: BinJadeed Hessah F. , Alajlan Abdulmajeed
Published: April 2022

Background:

Finasteride, a type II 5-α reductase inhibitor, is approved for the management of benign prostate hyperplasia and male pattern hair loss. Finasteride is used off-label for female pattern hair loss. In utero fetal exposure to finasteride might lead to external genital anomalies in males.

Purpose:

The aim of this study is to assess the outcomes of in utero finasteride exposure.

Methods:

We report seven pregnant women with maternal exposure to finasteride. A detailed history was obtained from patients after delivery.

Results:

In one woman who was pregnant with twin boys, one boy died at the 16th week of gestation and the other delivered at the 34th week of gestation with hypospadias. Another woman had threatened abortion and delivered a normal healthy baby girl. A third had induced elective abortion in the 9th week of gestation. The outcomes of the other four pregnancies were completely healthy, three girls and one boy.

Conclusion:

External genital anomalies may occur in male fetuses exposed in utero to finasteride depending on the timing of exposure.
Microneedling with Topical 5-Fluorouracil in the Localized Stable Vitiligo – Is This the Way Out? – Our Experience
Authors: Singrodia Ankit K. , Mehta Rajesh Datt , Sharma Divya , Choudhary Paras , Ghiya Bhikamchand Chand , Bai S Jyothi
Published: April 2022

Background:

Vitiligo is a dermatological challenge with a major socio-psychological concern. Despite the availability of numerous medical and surgical treatment options, a single universally reliable therapeutic modality is yet to emerge due to the variability of response rate in different patients.

Purpose:

The objective of this study was to assess the safety and efficacy of microneedling along with topical 5-fluorouracil (5-FU) solution application in localized stable vitiligo.

Methods:

This open, nonrandomized, single-arm study was enrolled with 100 patients with localized stable vitiligo. Microneedling with topical 5-FU solution application was performed on 204 patches. The procedure was performed fortnightly for maximum 6 months.

Results:

At the end of 3 months, good to excellent (Grade IV) repigmentation was noted in 106 patches (51.96%) and Grade I to Grade II repigmentation was seen in 56 (27.45%) patches whereas at the end of follow-up, 128 (62.74%) patches showed good to excellent response.

Conclusion:

In conclusion, the results of this study showed that needling with 5-FU is a simple, cost-effective, and well-tolerated procedure which can be used as an alternative or additive modality in the treatment of localized stable vitiligo.
Prurigo Pigmentosa
Authors: Samarkandy Sahal J. , Alharbi Bader A. , Almalki Basel B. , Alamri Samer A.
Published: April 2022

Prurigo pigmentosa (PP) was originally reported in Japan. It is an uncommon inflammatory skin disorder that usually involves the neck and trunk and characterized by a sudden eruption of pruritic indurated macules, papules, and Vescio papules that involute, leaving a reticulated pigmentation. It commonly affects young adult females. PP was initially thought to have a predilection for the Asian race, however several cases have been reported worldwide. The exact etiology of PP is yet unclear. However, it has been associated with ketosis and a ketogenic diet. Oral antibiotic is a major treatment in this disorder, while topical steroid and antihistamines are not successful.
Primary Cutaneous Gamma-Delta T-Cell Lymphoma
Authors: Hrin Matthew L. , Newsom Megan R. , Ghamrawi Rima I. , Niehaus Angela G. , Feldman Steven R. , Sigmon Justin R. , Strowd Lindsay C.
Published: April 2022

Background:

Primary cutaneous gamma delta T cell lymphoma (PCGD TCL) is a rare and rapidly progressive cutaneous malignancy that can be diagnostically challenging.

Purpose:

To improve characterization of the clinical and histologic features of PCGD-TCL.

Methods:

We present two patients with PCGD TCL and review an additional 97 PCGD TCL cases from the English literature.

Results:

A 51 year old male with biopsy proven psoriasis and a previously healthy 31 year old male with vitiligo developed PCGD-TCL. Initial biopsy specimens in both patients suggested tumor stage mycosis fungoides (MF), but subsequent histopathology confirmed PCGD TCL. Ninety-seven patients were identified in the literature, mostly males (53%) with a mean age of 55.2 years. Lesions most commonly involved the lower (60%) and upper (30%) extremities and existed a mean of 26 months before diagnosis. The most common immunohistochemical markers were EBV(-), CD3(+), CD4(-), CD5(-), CD7(-), CD8(-), CD30(-), CD56(+), granzyme-B(+), perforin(+), and βF1(-). Radiation and CHOP chemotherapy were the most common interventions and 52% of patients died.

Conclusion:

PCGD TCL is a devastating disease that can clinically and histologically mimic more common dermatologic conditions, such as psoriasis and MF, and its diagnosis may require multiple biopsies and review by a multi specialty pathology team.
The Journey of Insulin Over 100 Years
Authors: Swain Jayshree , Jena Sushree , Manglunia Ankit , Singh Jaspreet
Published: April 2022

The year 2021 marks 100 years of insulin discovery. In 1921, Banting and Best identified the pancreas as a key organ mainly responsible for carbohydrate metabolism and pathogenesis of diabetes. This work led to the purification of extract from the pancreas, which was later identified to be insulin. Since its discovery, there has been a lot of work to refine the properties of insulin and improve patient outcomes. Presently, short-acting, rapid-acting, intermediate-acting, long-acting, ultra-long-acting co-formulations, biosimilar, concentrated insulins are available and have revolutionized diabetes management and patient care. These new preparations have onset of action in a few minutes and some have their action lasting around 48 h. Also, there are a lot of advances in insulin delivery devices with the availability of ultra-fine needles and prefilled, reusable pens to hybrid closed-loop systems in which insulin is delivered as per continuous glucose monitoring recordings. Our article enfolds the milestones in insulin discovery and its evolution from the crude extract to highly designed once-weekly insulin.
Probiotic Supplementation (Vibact DS) in Patients with Type 2 Diabetes Mellitus
Authors: Gupta Sunil , Kamat Tejas , Chawla Rajeev , Abhyankar Mahesh V. , Revankar Santosh , Walia Silki
Published: April 2022

Purpose:

The aim of this study was to evaluate the effect of probiotic supplementation (Vibact DS) on anthropometric, glycemia, and lipid parameters in Indian patients with type 2 diabetes mellitus (T2DM).

Materials and Methods:

In this multicentric, retrospective, observational study, adult patients with T2DM who had received Vibact DS probiotic supplement for 3 months were identified from the patient medical records at each center. We assessed the effect of probiotic use on weight, body mass index (BMI), glycemic parameters, lipid profile, and impact on gastrointestinal (GI) side effects.

Results:

From 50 centers across India, data of 308 patients were analyzed retrospectively. In this sample, the mean age was 54.15 years, 60.69% were males, and the mean weight was 70.97 ± 10.38 kg. After 3 months of Vibact DS, there was a significant reduction in body weight, BMI, fasting plasma glucose (FPG), and postprandial plasma glucose (PPG) (P < 0.0001 for each parameter). Mean reduction in HbA1c was statistically significant (mean change at 3 months: -0.8%; P < 0.0001). There were significant improvements in lipid parameters (P < 0.0001) excepting high-density lipoprotein. Control of GI side effects was reported in 12.66% of patients. Physicians rated excellent and very good clinical efficacy in 25.9% and 40.6% of patients, whereas excellent and very good tolerability was reported in 28.2% and 42.1% of patients, respectively.

Conclusion:

This real-world evidence from India shows that regular use of probiotics such as Vibact DS may significantly improve the glycemic and metabolic profile and aids in relieving GI problems in patients with T2DM.