bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of Frozen Section in the Rapid Diagnosis of Severe Cutaneous Adverse Drug Reactions
Authors: Nicholas Rajam , Bindra Mandeep Singh , Mathew Lydia , Sathishkumar Dharshini , Lakshmanan Jeyaseelan , George Renu 
Published: November 2021

Context:
Early diagnosis is the mainstay in the management of severe cutaneous adverse reactions (SCARs) to drugs.

Aims:
To study the role of frozen section in the rapid diagnosis of SCARs and the impact on outcome of the affected patients.

Settings and Design:
A single-blind, hospital-based study was conducted from December 2014-July 2016.

Methods and Material:
We biopsied 32 adults with SCARs diagnosed by clinical features and standard criteria. The histopathological features seen on frozen sections were compared to that of paraffin blocks. The impact of rapid diagnosis on the clinical outcome was studied in toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), drug rash with eosinophilia and systemic symptoms (DRESS) and acute generalized exanthematous pustulosis (AGEP).

Statistical Analysis:
Z test was used to compare two proportions. Kappa statistic, sensitivity, specificity, positive predictive value, and negative predictive value of the frozen section diagnosis were calculated in TEN/SJS and DRESS using MedCalc software.

Results:
Frozen and paraffin sections were done in TEN/SJS spectrum (13), DRESS (17), and AGEP (2). The sensitivity, specificity and kappa values for frozen section diagnosis in SJS/TEN and DRESS were 91.7%, 95%, 0.867 and 94.4%, 100%, 0.937 respectively. The concordance between frozen and paraffin section diagnosis was 100% in TEN, SJS, DRESS and AGEP. All the 6 patients with TEN and 2 with AGEP survived. Taking the worst-case scenario, the mortality in SJS was 28.6%. The mortality among patients with DRESS was 11.8%.

Conclusions:
Frozen section helps in the rapid diagnosis and early treatment of SCARs and differentiates it from diseases that mimic it.
Iatrogenic Cushing's Syndrome in Patients with Superficial Dermatophytosis
Authors: Thakran Priyesh , Agrawal Sonia , Singal Archana , Verma Shyam , Madhu S.V. 
Published: November 2021

Background:
The epidemic-like scenario of superficial fungal infections in India has been complicated by the prescription of systemic and topical potent steroids. As a result, alarming number of patients are presenting with exogenous Cushing's syndrome.

Methods:
This cross-sectional study involved 23 patients of superficial dermatophytosis on steroids who presented with clinical features like that of Cushing's syndrome. Their clinical details and laboratory investigations including fungal culture and serum cortisol, were recorded on a pre-designed proforma.

Results:
There were 23 patients (14 males and 9 females) with mean age of 29.47 ± 15.5 years, majority with extensive tinea cruris and corporis. All of them received oral (Betamethasone) or parenteral corticosteroids along with potent topical steroids (clobetasol propionate and betamethasone valerate) for at least two months. In majority (56.5%), treatment was prescribed by unqualified medical practitioners and in the rest by alternative medical practitioners. Striae, buffalo hump, hirsutism were observed in 16 (69.5%), 15 (65.2%), 13 (56.5%) patients, respectively. Serum cortisol estimation revealed low levels and ranged from 0.66 to 6 μg/ml with a mean of 1.53 ± 1.27 μg/ml (normal 7-25 μg/ml).

Conclusions:
Corticosteroids are life saving for many dermatological diseases; their injudicious use (topical, oral, and parenteral) for prolonged periods in the treatment of superficial dermatophytosis can lead to Cushing's syndrome.
Factors Predicting the Outcome of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis
Authors: Thakur Vishal , Vinay Keshavamurthy , Kumar Sheetanshu , Choudhary Rajat , Kumar Ashok , Parsad Davinder , Kumaran Muthu Sendhil 
Published: November 2021

Background:
Clinicodemographic and laboratory parameters predicting the outcome of Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) may vary among populations owing to genotypic and environmental variations. There is a scarcity of studies evaluating these parameters in Indian population.

Aims:
To analyze clinicodemographic and laboratory parameters predicting disease outcome in patients of SJS/TEN.

Materials and Methods:
Clinical records of patients admitted with a diagnosis of SJS/TEN from January 2014 to December 2018 were reviewed retrospectively with respect to data pertaining to clinicodemographic details, laboratory parameters, and disease outcome.

Results:
Of 51 patients included in the study, 24 (47.06%) were females. Anticonvulsants [phenytoin (19.6%), carbamazepine (13.7%), others (5.88%)] were the most commonly implicated drugs followed by NSAIDs (19.6%). The overall mortality was 21.6% [SJS (0%), SJS-TEN overlap (18.8%), and TEN (28.6%)]. The mean detached body surface area (BSA) (35.4% ± 10.4% vs. 25.7% ± 11.8%; P = 0.02) was significantly higher among patients with mortality. Blood urea nitrogen, serum HCO3
− levels, and random blood sugar were significantly associated with mortality. Presence of sepsis during the disease course was associated with higher mortality (9/12 vs. 2/39; P = 0.001). Other components of SCORTEN like age and heart rate were not significantly associated with poor outcome in our study. None of our patients had associated malignancy.

Conclusion:
A higher detached BSA, presence of sepsis, higher blood urea nitrogen and random blood sugar, and lower serum HCO3
− levels were associated with mortality. Refinement of scoring systems predicting the outcome of SJS-TEN is needed for better disease prognostication.
Clinico-Epidemiological Profile of Childhood Alopecia Areata Along with Dermoscopic Correlation
Authors: Bhardwaj Pallawi , Basu Dibyendu , Podder Indrashis , Gharami Ramesh C. 
Published: November 2021

Background:
Childhood alopecia areata (AA) is a common cause of dermatologic consultation; however, data is scarce in the present set-up.

Objectives:
To evaluate the clinico-epidemiological profile of childhood AA along with dermoscopic correlation.

Methods:
We conducted a cross-sectional study including 50 new cases of childhood AA for 1 year. Dermoscopy was performed in each child and findings recorded.

Results:
Childhood AA was more common in girls (M: F 1:1.4), mean age being 11.1 ± 3.7 years. Scalp was commonest site of involvement in 86% cases, while 32 (64%) children had mild disease (<25% involvement). Localized circumscribed patch was the commonest presentation in 37 (74%) children, while sisaipho was the least (2%). A positive family history of AA was noted in 5 (10%) children. Twenty-four children (48%) provided a history of atopic disorders, while 30% had a positive family history of atopy. Stress was the commonest precipitating factor in 13 (26%) subjects. Nail involvement was observed in 19 (38%) children (pitting >thinning), while systemic associations like vitiligo and thyroid dysfunction were present in 26% and 24% cases, respectively. Dermoscopy revealed yellow-dots to be the commonest finding in 44 (88%) cases, followed by short vellus hair and black dots in 76% and 28% children, respectively, while exclamation-mark hair was rare.

Conclusion:
Female gender, younger age, nail involvement, and presence of concomitant atopy, vitiligo, and thyroid dysfunction were associated with severe disease, but not statistically significant (p > 0.05). Regression model failed to detect any risk factors for severe AA. Dermoscopy is an important non-invasive tool for evaluating childhood AA.
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
Authors: Manomy P. A. , Yenamandra Vamsi K. , Dabas Garima , Joshi Poonam , Ambekar Atul , Sreenivas Vishnubhatla , Sharma Vinod K. , Vatsa Manju , Ravindran Surya , Sethuraman Gomathy 
Published: November 2021

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.
Clinico-Epidemiological Characteristics of Hidradenitis Suppurativa
Authors: Kamat Divya , Gaba Sunil , Kumaran Muthu S. 
Published: November 2021

Background:
Hidradenitis suppurativa (HS) is a chronic debilitating disease with a relapsing and remitting course. Due to delay in diagnosis, patients are often referred when the disease is very severe. Management strategies vary across multiple guidelines.

Aims:
The aim of this study was to analyze the demographic and clinical characteristics of patients with HS among our outpatient attendees and to study the outcomes of various treatments offered.

Methodology:
This was a retrospective cohort study analyzing case files and photographic records of all patients diagnosed with HS, presenting to our tertiary care institute over 18 months.

Results:
A total of 22 patients (10 males and 12 females) of HS were studied with majority having Hurley stage 2 and 3 diseases. The most common site affected was axilla. Overweight and obese patients were 45.4% and 18.1%, respectively. Rifampicin–clindamycin combination or doxycycline was the first line therapy offered. Adalimumab was given in only two patients but could not be continued for long term due to financial issues. Surgery was performed in six patients. Procedures included wide local excision and deroofing which is left to heal by secondary intention. Least number of remissions and most satisfactory improvement was seen with a combination of antibiotics and surgery compared to medical treatment alone.

Limitations:
Retrospective nature and a single center study were the major drawbacks.

Conclusion:
Patients undergoing procedural intervention in addition to pharmacotherapy have best overall outcomes and involvement of a multidisciplinary team plays a key role, however a larger follow-up study is required.
Prospective Study of Growth Factor Concentrate Therapy for Treatment of Melasma
Authors: Sthalekar Bindu , Agarwal Madhuri , Sharma Vijay , Patil Chetan Y. , Desai Maulek 
Published: November 2021

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.
Histopathological and immunohistochemical features of 14 peritoneal mesotheliomas with clinical outcomes and recent updates
Authors: Karmarkar Srushti , Rekhi Bharat , Deodhar Kedar K. , Menon Santosh 
Published: November 2021

Background:
Malignant peritoneal mesotheliomas (MPMs) are rare tumors with overlapping clinical and histopathological features, especially with epithelial ovarian carcinomas (EOCs). There is no substantial documentation on these rare tumors from our country.

Objective:
To study the clinicopathological features including immunohistochemical (IHC) profile and clinical outcomes of 14 MPMs, diagnosed at our institution.

Materials and Methods:
This was a retrospective study, wherein 14 cases of MPM, occurring in female patients, diagnosed at our institution, between January 2008 and May 2019 were included, after a critical review.

Results:
Median age was 54.5 years. Most patients presented with ascites, omental nodularity, and fat stranding. Microscopically, most cases (11, 78.6%) displayed epithelioid morphology, followed by biphasic pattern (2, 14.3%) and a single case of well-differentiated MPM. IHC, diagnostic sensitivity and specificity of calretinin were 100% (13/13) and 85.7%; of HBME1 were 100% (5/5) and 100%; and of podoplanin (D2–40) were 60% (2/5) and 100%. Other positively expressed immunomarkers were epithelial membrane antigen (n = 2/5, 40%), cytokeratin 5/6 (n = 4/4, 100%), and WT1 (n = 9/10, 90%). Most patients (5/12, 41.7%) were treated with chemotherapy. The 3-year disease-free and overall survival rates were 25.7% and 54%, respectively, including improved survival trend in patients with epithelioid type of MPMs.

Conclusion:
MPMs are diagnosed with a combination of clinicopathological features and optimal IHC markers. Their differentiation from EOCs and other metastatic carcinomas is imperative in view of significant treatment implications.
Hepatoprotective and immune-reconstitution potentials of carrot-ginger blend among HIV-infected patients taking antiretroviral therapy in Kaduna, Nigeria
Authors: Joshua Zamani Pius , Abarshi Muawiyam Musa , Sani Ibrahim , Olumuyiwa Owolabi Adeyemi , Mada Sanusi Bello , Dallhatu Rhoda Yakubu 
Published: November 2021

Hepatotoxicity, micronutrients insufficiency and cost of micronutrient supplements are challenges faced by HIV infected patients on antiretroviral therapy (ART). This study investigated the effect of natural plant micronutrients (vitamins A, C, and E, selenium and Zinc supplements from carrot-ginger (75:25) blend on liver enzymes: Alanine transaminase (ALT) and Aspartate transaminase (AST), CD4 + T lymphocytes and body mass index (BMI) of HIV-infected-patients taking ART. Ninety HIV-infected-patients attending Special Treatment Clinic, Kafanchan General Hospital, Kaduna State, Nigeria, were randomized into three groups of thirty patients each: Group 1 is control group and received ART alone, Group 2 is standard group and received ART with ready to use commercial micronutrient supplement (SelACER supplement) while Group 3 is supplement group and received ART + Carrot-Ginger blend for 90 days. Serum Alanine, Aspartate transaminase, CD4 + T lymphocytes and BMI were assessed using standard methods at baseline (day 0), 30 days, 60 days and 90 days. The results indicated that patients on CarrotGinger blend and SelACER micronutrients supplements show significant (p<0.05) reduction in ALT and AST level. However, there was no significant (p>0.05) difference in patients treated with ART alone when compared to their baseline values. The results indicated that patients on carrot-ginger blend and SelACE® supplements had significant (p<0.05) increase in BMI, CD4+ T-cell counts, serum vitamins A, C, E, selenium and zinc from day zero. There was no significant (p>0.05) difference in patients treated with ART alone compared to their baseline values. In addition, patients on SelACE® supplement revealed significant (p<0.05) difference in their mean BMI, CD4+ T-cell counts, serum vitamins A, C, E, Selenium and Zinc compared to patients on carrot-ginger blend after 90 days. The results also indicated a strong positive association (r=0.97) between serum ALT and AST activity and between CD4+ T cell counts and body mass index (r=0.77) after 90 days. Therefore, micronutrients supplementation of HIV patients during ART treatment with Carrot-Ginger blend could also be a beneficial adjunct to ART due to its potentials to reconstitute the immune system and protect the liver in HIV individuals on ART.
EVALUASI SISTEM MANAJEMEN SUMBER DAYA MANUSIA PADA PENEMPATAN KERJA PETUGAS DI UPT PUSKESMAS MALINGPING
Authors: Febriani Mita Melisa , Hidayat Syamsul , Saepudin Saepudin 
Published: November 2021

One of the important resources in management is human resources. The importance of human resources needs to be realized by all levels of management. However advanced technology is today, the human factor still plays an important role for the success of a Puskesmas. The study aims to evaluate the HR management system in planning, organizing, directing, and contolling the work placement of officers at Puskesmas Malingping. The type of research used in the research is qualitative fenomenology research, namely observation, in-depth interviews and documentation. The resuls showed that the Puskesmas Malingping reports the shortage to the health office by looking at the vacancies in the health center. Health workers, midwives and nurses who do not have competence in the fields of management, UKP Pharmachy and laboratory analysis are forced to fill the vacancies in these sections due to a lack of manpower.
The conclusion of this researcher shows that the human resource management system at the puskesmas Malingping four aspects, namely planning, organizing, directing and controlling and its evaluation shows that the human resource management system in work placements at the puskesmas Malingping has not been maximized due to the lack of health works resulting in placement work that is not in accordance with the disiplince of science
ANALISIS KINERJA BPSPAMS TIRTO SUMBER MULYO SEBAGAI PERTIMBANGAN MENJADI UNIT BUMDES DI DESA MIJEN KECAMATAN KEBONAGUNG KABUPATEN DEMAK
Authors: Astohar Astohar , Savitri Dhian Andanarini Minar , Ristianawati Yuyun , Nugroho Prihansantyo Siswo 
Published: November 2021

BPSPAMS Tirto Sumber Mulyo Mijen Village is one of the BPSPAMS in the District Kebonagung which has the task of managing water and sanitation at the village level. In the management of water and sanitation facilities at the village level it is necessary to assess the performance so that it can be evaluated for future follow-ups for the strategy or position of the management group that has been included in the BUMDes Maju Lancar unit. This performance appraisal standard uses the performance appraisal standard from the 2020 Technical Guidelines for SPAMS Management. The results of the performance appraisal show that in general the performance of BPSPAMS Tirto Sumber Mulyo is in the medium category. Partially, it shows the performance of planning in the low category, in the high-performance administration and finance, on the performance of drinking water and sanitation services in the medium category and for the performance of the partnership in the low category. The hope in the future for improving the performance of BPSPAMS together with BUMDes Maju Lancar needs to collaborate or increase cooperation with external parties such as academics, practitioners and government institutions that can increase benefits and benefits for the public
Modelo experimental de queratosis actínica por exposición a radiación ultravioleta A
Authors: Peñate Alvariño Liuba , Margarita Garau Grety , Valido Díaz Arianna , Ferrer Pérez Arletis , González Madariaga Yisel , Bermúdez Toledo Deodelsy 
Published: November 2021

Las queratosis actínicas son lesiones cutáneas preneoplásicas frecuentes causadas por una exposición crónica a las radiaciones solares. La obtención de modelos animales que contribuyan a comprender los mecanismos implicados en esta patología y a evaluar nuevas terapias farmacológicas resulta de gran interés para la comunidad científica. Se desarrolló un biomodelo de queratosis actínica en ratones Balb/c, empleando como inductor la radiación UVA. Se aplicaron dos esquemas de irradiación: Grupo I, expuesto a tres sesiones diarias de radiación de 2h y Grupo II, dos sesiones diarias de 4h, con igual tiempo de receso entre sesiones y durante un período de 14 días. Se evaluaron parámetros macroscópicos y microscópicos, y la frecuencia de aparición de micronúcleos en sangre periférica. Los animales correspondientes al Grupo I no mostraron lesiones mascroscópicas y microscópicamente evidenciaron una leve acantosis con ausencia de displasia; mientras que en los animales del Grupo II se observaron lesiones macroscópicas que se correlacionan histopatológicamente con la presencia de una queratosis actínica. La frecuencia de micronúcleos obtenida en el Grupo II fue significativamente superior a la formación de micronúcleos espontáneos en el Grupo Control. El biomodelo experimental de queratosis actínica obtenido reproduce el efecto de las radiaciones ultravioletas sobre la piel.